[A case report of ocular complications of leptospirosis]. / Kazuistika ocní komplikace leptospirózy.

Ocular complications are very frequent in leptospirosis and may develop in both the acute (bacteriemic) and the second (immunologic) phases of the disease. A delayed onset of these complications, even after months or years, is also possible. Keratoconjunctivitis and panuveitis belong to the most frequent signs. Targeted search for patients suspected of having leptospirosis and regular ophthalmological examinations even after cure of the acute illness may lead to early detection of ocular complications and to their specific treatment. Presented are a case report of complicated uveitis due to infection with Leptospira grippotyphosa and a literature overview.

[The effect of patient's body weight, gender and baseline viral load on the efficacy of hepatitis C therapy]. / Ovlivnení uspesnosti lécby chronické hepatitidy C hmotností a pohlavím pacienta a výsí vstupní viremie.

UNLABELLED: Today, the standard therapy of patients with chronic HCV (hepatitis C virus) infection is based on combination of pegylated interferon alpha (PEG-IFN) and ribavirin. THE STUDY OBJECTIVE: The aim of the study is to find correlations between patient's body weight, gender and baseline viral load and the efficacy of antiviral therapy in terms of achieving end-of-treatment viral response (ETVR) and sustained viral response (SVR). METHODS AND PATIENT SAMPLE: We enrolled 133 patients with chronic HCV infection. All of them were treated by combination of PEG-IFN alpha-2a (180 microg once a week) and ribavirin. Ribavirin doses were the following: For body weight < or = 74 kg - 800 mg daily in patients infected by genotype 2 (G2 - 3 patients) or G3 (18 patients), 1000 mg in patients infected by G1 (106 patients), G4 (1 patient) or G6 (1 patient); for body weight > or = 75 kg - 1200 mg daily in case of infection by G1. RESULTS: To date, 122 patients completed the therapy; 107 of them completed their therapy at least 24 weeks ago, so they can be assessed for SVR. ETVR was achieved in 76% and SVR in 60% patients. Statistically higher proportion of SVR was observed in women (p = 0.039), patients with relatively lower body weight (p = 0.034), patients in lower baseline viral load (p = 0.010) and patients with genotypes 2 and 3 (p = 0,008). Correlation analysis of individual predictive factors showed the statistically significant correlation between body weight and gender (p < 0.001), gender and baseline viral load (p = 0.027) and body weight and virus genotype (p = 0.003). Therefore, the only independent predictive factor of ETVR (p = 0.020) and SVR (p = 0.010) was the level of baseline viral load. CONCLUSION: Efficacy of PEG-IFN therapy is significantly influenced by the level of baseline viral load. According to the results of this study, patient's body weight and gender are not independent predictive factors that affect the therapy efficacy.

[Antibodies against the chlamydial heat shock protein in women with periadnexal adhesions]. / Protilátky proti proteinu tepelného soku chlamydiového puvodu u zen s periadnexálními adhezemi.

OBJECTIVE: To compare and analyze IgG antibodies against chlamydial heat shock protein (cHSP60) in the blood serum of women with or without periadnexal adhesions in small pelvis. DESIGN: Retrospective study. SETTING: Department of Gynaecology and Obstetrics, Masaryk University, Brno, Veterinary Research Institute, Brno, Department of Clinical Microbiology, Faculty Hospital Brno. METHODS: IgG antibodies against cHSP60 in the blood serum were detected by means of recombinant enzyme immunoanalysis ("cHSP60 - IgG - rELISA medac"). The presence of antibodies was expressed as +, ++ or +++ pozitive. Laparoscopy according to a standard procedure was performed in 76 women (age 28 +/- 43 years) from couples with fertility disorders treated in the Centre of Reproductive Medicine, Department of Gynaecology and Obstetrics. Chí-square test (programme Statcalc - EpiInfo 6) and calculation of OR value were used for statistical analysis. RESULTS: Twenty-four women (31.6%) had normal finding in small pelvis. Periadnexal adhesions were detected in 43 (56.6%) patients, hydrosalpinx in 13 cases (17.1%), endometriosis in 27 (35.5%) patients and uterine myomas in 11 (145%) women. In the group of 33 women without periadnexal adhesions cHSP-60 antibodies were pozitive in 3 women (9.1%), in 43 women with periadnexal adhesions were pozitive in 17 cases (39.5%). In 13 patients with hydrosalpinx cHSP-60 antibodies were pozitive in 61.5%. In patients with periadnexal adhesions semiquantitative pozitivity +++ was detected in 8 cases (18.6%), 4 of them with hydrosalpinx (30.8%). Statistical analysis found significantly higher presence of cHSP-60 antibodies in women with periadnexal adhesions (OR = 654, CI interval = 1.59 - 37.81, chi-square: p = 0.0028) CONCLUSION: Women with periadnexal adhesions have more frequent and stronger pozitivity of IgG antibodies against chlamydial heat shock protein cHSP60.

[The meaning of viral kinetics in the beginning of the pegylated interferon-alpha and ribavirin therapy for chronic hepatitis C]. / Význam virové kinetiky v pocátcích lécby chronické hepatitidy C pegylovaným interferonem alpha a ribavirinem.

UNLABELLED: Pegylated interferon alpha (PEG-IFN) and ribavirin combination therapy is the contemporary standard therapy of the patients chronically infected with hepatitis C virus (HCV). OBJECTIVE OF THE STUDY: The study is monitoring the changes in viremy through the changes of HCV RNA in serum before and during antiviral therapy and it attempts to find a relationship between the viral kinetics in the beginning of the therapy and the sustained virologic response. SET OF THE PATIENTS AND THE METHODICS: The study involved 133 patients with chronic infection with HCV, of the average age of 38 years (ranged 18-68 years). 86 of them were men. There were 88 patients who had not been treated before (naive patients), 19 of them were relabing and 26 were non-responders to the previous therapy with conventional IFNalpha and ribavirin. 106 patients (80%) were infected with genotype (G) 1, 3 (2%) with G2, 18 (14%) with G3, 1 patient with G4 and 1 with G6 (under 1%), in 4 (3%) the genotype could not be determined. All of them were treated with the combination of PEG-IFNalpha-2a (180 microg once a week) and ribavirin (800 mg per day in the infection with G2 or G3, 1000 mg at the infection with G1 and the weight up to 74 kg, 1200 mg per day at the infection with G1 and the weight 75 kg and higher). RESULTS: Up to now, 122 patients completed the therapy and 93 of them (76%) had negative HCV RNA in serum at the time of completion of the therapy. Negative HCV RNA after 24 weeks (sustained virologic response SVR) after the completion of the therapy had 64/107 (60%) of the treated patients. In the course of 12 weeks of the therapy the viremy decreased by at least 2 decadic logarithms (early virologic response - EVR) in 87 patients (82%) and in 63 of them (72%) also SVR was noted. Only 19 patients had not EVR and just 1 one of them, nevertheless, achieved SVR (5%). CONCLUSION: The achievement of EVR is a prerequisite to the successful therapy for chronic infection with HCV with the combination of PEG-IFNalpha and ribavirin. Quantitative determination of HCV RNA in serum before and during antiviral therapy is a prerequisite to the modern antiviral therapy for chronic infection with HCV.

[Infection with Chlamydophila pneumoniae as a cause of female infertility of tubal origin?]. / Infekce Chlamydophila pneumoniae jako prícina neplodnosti zen tubárního puvodu?

OBJECTIVE: A contribution to the role of Chlamydophila pneumoniae in women from the IVF program. DESIGN: A serological study proving the antibodies against the antigens of Chlamydophila pneumoniae (C. pneumoniae) and Chlamydia trachomatis (C. trachomatis) in women from the IVF program suffering from different factor of infertility. SETTING: Veterinary Research Institute, Brno. METHODS: The complement fixation test with chlamydial antigen and ELISA tests proving IgA and IgG antibodies against genus-specific antigen (cLPS) and species-specific chlamydial major outer membrane protein (cMOMP) of C. trachomatis and C. pneumoniae in the blood serum of 32 females being in the fertilization program due the tubal factor infertility have been estimated and the results compared with those obtained in 26 females being in the fertilization program due the ovarian factor and in 42 female with andrological factor, respectively. RESULTS: The frequency of positive complement fixation test proved in the group of women with tubal factor infertility was significantly higher than in the groups with ovarial and andrological factor, respectively. The number of the strongly positive reactions (with high titres) in the group with tubal factor infertility was higher than in two remaining groups. The occurrence of species-specific IgG antibodies (anti-C. trachomatis) and chlamydia genus-specific IgA antibodies proved by means of ELISA in the group with tubal factor was statistically more frequent. The difference of the species-specific anti-C. pneumoniae antibodies in all three groups examined was not significant. The simultaneous occurrence of species-specific antibodies against anti-C. pneumoniae and C. trachomatis in the group with tubal factor was higher than in other groups (in comparing with the group with andrological factor statistically significant). CONCLUSION: The opinion of the authors being in agreement with the view of most specialists is that the most important agent in the pathogenesis of tubal factor fertility is C. trachomatis. C. pneumoniae is above all a respiratory pathogen with a high prevalence and its impact for fertility disorders may be in the synergismus with C. trachomatis. The serological examination of both chlamydial infections should be a standard part of diagnostic algorithm.

[Evidence of antibodies against the chlamydial heat shock protein (cHSP60) in women from "in vitro" fertilization program]. / Prukaz protilátek proti proteinu tepelného soku chlamydií (cHSP60) u zen zarazených do in vitro fertilizacního programu.

OBJECTIVE: A contribution to the role of chlamydial heat shock protein in women from the IVF program. DESIGN: A serological study proving the antibodies against the chlamydial heat shock protein. SETTING: Veterinary Research Institute, Brno, Department of Clinical Microbiology, and Centrum of Reproductive Medicine, Faculty Hospital Brno. METHODS: The IgG antibodies against the chlamydial heat shock protein (cHSP60) and the IgA and IgG antibodies against species specific chlamydial major outer membrane protein (cMOMP) of Chlamydia trachomatis (C. trachomatis) and Chlamydophila pneumoniae (C. pneumoniae) in the blood serum of 70 females being in the fertilization program due to fertility disorders (Group 1) have been estimated and the results compared with those obtained in 50 females suffering from pelvic inflammation disease (PID) (Group 2) and in 51 female blood donors (Group 3) respectively. RESULTS: The anti-cHSP60 antibodies have been ascertained as follows: in 26 women from the first group (37.1%), in 16 of the second group (32.0%) and in 12 (23.5%) of female blood donors. The anti cHSP60-antibody-occurrence and mean index of positivity as well, found in the groups examined, was statistically insignificant. Similarly no difference has been found in the occurrence of the species specific anti-cMOMP antibodies C. trachomatis and C. pneumoniae in the groups examined. The anti-cMOMP antibodies against C. trachomatis and simultaneously against C. pneumoniae have been detected in 21 from 171 women of all groups (12.3%), only against C. trachomatis in 9 (5.3%) and against C. pneumoniae in 73 of them (42.7%). There was considerably higher occurrence of the specific antibodies against C. trachomatis in women with a positive finding of antibodies against the cHSP60, especially in women suffering from gynecological disorders, than in women without such antibodies. CONCLUSION: C. trachomatis has a significant impact on the production of antibodies against the cHSP60. This fact can be documented by considerably higher occurrence of the specific antibodies against C. trachomatis in women with a positive finding of antibodies against the cHSP60, than in women without such antibodies. Preceding infection C. trachomatis and following sensitization with chlamydial heat shock protein indicate an unfavourable prognosis of the reproductive outcome and impairs the perspective of a successful in vitro fertilization. The proof of antibodies against the chlamydial HSP60 can be recommended as a further auxiliary criterion in women suffering from fertility disorders.

[Heat shock protein antibodies and other chlamydial antigens in various diseases and their occurrence in blood donors]. / Protilátky proti proteinu tepelného soku a dalsím antigenum chlamydií u nekterých chorob ve srovnání s jejich výskytem u dárcu krve.

BACKGROUND: The chlamydial infections are very frequently considered in the causal connection with some diseases e.g. atherosclerosis or chronic joint infections. The evidence of the antibodies against the heat shock protein of chlamydial origin is not the usual part of practical serological diagnostics. The aim of this study is an attempt to identify antibodies against the heat shock protein and other antigens of chlamydiae in the sera of two groups of patients and in the sera of blood donors. METHODS AND RESULTS: The sera of patients suffering from unstable angina pectoris (NAP = 69), sera of patients waiting for the application of endoprothesis due to coxarthrosis (EKK = 49), and sera of 100 blood donors have been examined for antibodies against the heat shock protein, against the major outer membrane protein (MOMP) of C. pneumoniae, and against the chlamydial genus specific lipolysaccharides. The antibodies against the cHSP60 in the sera of patients suffering from NAP have been identified in 41 cases (59.4%), in orthopaedic patients in 21 cases (42.9%) and in 23 of the blood donors (23%). The difference of the antibody-occurrence in the sera of patients is significantly higher than in case of blood donors. The antibodies against the MOMP of C. pneumoniae prevailed in all sera of the persons examined. Their occurrence in the IgG class had a high statistical frequency. The genus specific positive reaction occurred more frequently also in the sera of the probands that reacted positively against the cHSP60 than in those negatively reacting. According to our results, the significance of C. pneumoniae in the genesis of the antibodies against of cHSP60 can be concluded. CONCLUSIONS: The proof of the anti-cHSP60 antibody and of the species-specific chlamydial antibodies may be a useful contribution to the exact diagnosis of the disease with possible chlamydial participation. The C. pneumoniae infection was probably of the main importance for the origin of the anti-cHSP60 antibody in examined persons.

[Serologic study of atherosclerosis and its vascular complications]. / Sérologické vysetrení u aterosklerózy a jejich cévních komplikací.

Chlamydia pneumoniae (C. p.) is very frequently cited as an important factor of the origin of atherosclerosis. To confirm the diagnostic value of the serological examination the following reactions have been used: microimmunofluorescence reaction (MIF) for estimating of antibodies against major outer membrane proteins C. p. (anti-MOMP) and ELISA for detecting antibodies against the lipopolysacharides of C. p. (anti-LPS), both in IgA and IgG immunoglobulin classes of the serum. The ELISA for the detection of the IgG antibodies against chlamydial heat shock protein (cHSP60) has been used. The sera of 155 patients suffering from acute myocardial infarction (AMI) and 69 patients with unstable angina pectoris (UAP) have been examined. The heart disease has been confirmed by anamnesis, electrocardiography and coronarography. As a control group the sera from 112 persons without sings of a heart disease were examined. The antibodies against the cHSP60 have been determined only in the sera 69 patients with UAP and 49 control sera. Statistically higher occurrence of the antibodies anti-MOMP C. p. in the IgA class sera of patients suffering from UAP has been noted compared with those found in the sera of the control group (chi 2 = 18.56; p < 0.01). In the globulin IgG class of the both groups no difference has been found. The anti-LPS C. p. antibodies in the IgA as well in IgG anti-LPS classes of the patients sera with UAP were present significantly more frequently than in the control group (chi 2 = 11.49; p < 0.01, chi 2 = 4.16; p < 0.05). Similarly the incidence of the anti-LPS C. p. antibodies in the IgA class sera of 155 patients suffering from AMI was significantly higher than in the control group (chi 2 = 8.55; p < 0.01). The anti-cHSP60 antibodies have been found in 41 out of 69 patients suffering from UAP (59.4%) and in 21 of 49 control individuals (42.9%). The results seem to confirm an important role of C. p. in atherogenesis. The monitoring of the antibodies against the C. p. may supplement the diagnostics in patients suffering from UAP and AMI and the efficacy of its therapy and prevention as well.

[Importance of regular screening for genital chlamydiosis in adolescents]. / Význam pravidelne opakovaného screeningu genitální chlamydiózy u dospívající mládeze.

OBJECTIVE: Determination of prevalence of genital chlamydiosis in similar group of adolescents as in that examined two years ago. Comparison of the results with the previous ones to confirm positive impact of a repeated screening on drop of prevalence of the infection. Another objective is to make the epidemiological data on genital chlamydiosis in the countries of the "Eastern Block" more accurate, and at the same time to assess the most suitable screening method. DESIGN: Prospective epidemiological study aimed at finding whether the repeated screening examinations of genital chlamydiosis in adolescents will result in decreased incidence of the infection. SETTING: Veterinary Research Institute, Department of Clinical Microbiology of the Faculty Hospital, Regional Hygienic Station, Department of Gynecology and Obstetrics, Medical Faculty, Masaryk University, Brno. METHODS: The groups under testing comprised male and female students of two secondary medical schools and one private grammar school older than 18 (n = 232, of which 33 were boys and 199 girls). Direct detection of C. trachomatis was carried out from the urinary sediment of the sample of morning urine using ligase reaction, polymerase chain reaction, ELISA and direct immunofluorescence. RESULTS: Identical positive result of C. trachomatis detection by four methods was obtained 4 times, i.e. 1.7%. The result of LCR and PCR were positive identically (4 times), ELISA and IF were, besides the above results, positive in other 1 resp. 5 cases. CONCLUSION: Screening examinations of genital chlamydiosis were performed in adolescents in the town of Brno. Morning samples of urine from 232 students of secondary schools were examined on C. trachomatis using the following methods: LCR, PCR, ELISA, and IF. The LCR and PCR were positive 4 times, ELISA 5 times, IF 9 times. Positive results by LCR and PCR were identical. ELISA and IF were positive in other cases. Noninvasive methods are suitable for screening of latent genital chlamydiosis and for estimation of its prevalence. The authors of the study recommend the ligase chain reaction (LCR) as a most suitable screening method.

Autoantibodies to asialoglycoprotein receptor in chronic hepatitis C patients.

The aim of this study was to determine the incidence of autoantibodies to asialoglycoprotein receptor (ASGPR, anti-ASGPR) in chronic hepatitis C patients and to characterize the anti-ASGPR-positive and anti-ASGPR-negative patients in more detail. A total of 79 chronic hepatitis C patients were screened for the presence anti-ASGPR by ELISA. Anti-ASGPR were detected in 11 (13.9%) patients. No significant differences were found between the anti-ASGPR-positive and anti-ASGPR-negative patients in age, alanine transaminase (ALT) activity, histological findings and response and tolerance to alpha-interferon (alpha-IFN) therapy. The male predominance in the anti-ASGPR positive group was statistically significant. It was surprising that other tested autoantibodies (antinuclear autoantibodies [ANA], smooth muscle autoantibodies [SMA], type 1 liver-kidney microsome autoantibodies [LKM-1], anti-thyroglobulin and thyroid microsome autoantibodies) and increased levels of immunoglobulins A, G and/or M were observed significantly more frequently in the anti-ASGPR-negative group.

[Importance of assessment of Helicobacter pylori antigen in faeces]. / Prínos stanovení antigenu Helicobacter pylori ve stolici.

Diagnostic methods for the detection of Helicobacter pylori (H.P.) can be divided into invasive and non-invasive ones. Among non-invasive methods we can include now also detection of H.P. antigen in faeces. The objective of our study was to evaluate the sensitivity ans specificity of the test when monitoring the eradication therapy, as compared with another non-invasive test and to test the method in common clincal practice. H.P. positivity was based on the result of the histological examination and CLO test. Repeatedly samples of faeces were collected to detect H.P. antigen in faeces before the onset of and after eradication treatment. For detection of H.P antigen the commercial Premier Platinum HpSa set was used which was developed on the principle of enzyme immunoanalysis. From the assembled data the sensitivity value (87.1%) and specificity values (88.5%) was calculated. The test correlates well with the results of the CLO test, histological examination and the breath test and is thus a suitable method for the detection of H.P. positive subjects as well as for checking the success of eradication treatment of H.P.

Efficacy of alpha-interferon therapy of chronic hepatitis patients infected with wild type hepatitis B virus and HBEAG-minus mutant.

The aim of this study was to evaluate the efficacy of alpha-interferon (alpha-IFN) treatment of 56 chronic hepatitis B (HB) patients positive for HB e antigen (HBeAg), which were previously not treated with alpha-IFN (group A). Seven of them, which did not respond to initial alpha-IFN treatment, were subjected to additional treatment with alpha-IFN (group B). Another 7 patients with chronic HB caused apparently by an HBeAg-minus HB virus (HBV) mutant represented group C. In the alpha-IFN treatment, 5 megaunits (MU) of alpha-IFN were administered subcutaneously three times a week for six months. A trend of improvement of important markers of the disease in the treated patients could be seen with increasing time after completion of the treatment even though it was not statistically significant. In group A, the absence of serum HBV DNA was found in 43% of the patients at the end of the treatment, in 41% 6 months later, and in 46% 12 months later. At the same time intervals group A showed negative HBeAg in 36%, 39% and 46%, positive anti-HBeAg in 36%, 38%, and 46%, negative HBsAg in 9%, 11%, and 14%, and normal level of alanine transaminase (ALT) in 23%, 39%, and 44%, respectively. A trend toward better results of alpha-interferon therapy for the group A patients displaying lower baseline viremia and higher ALT activity could be seen; however, this relationship was not statistically significant. Groups B and C were too small for statistical analysis. Nevertheless, 4 of 7 patients of group B were negative for HBV DNA 12 months after the treatment and HBV DNA was eliminated during the treatment in all patients of group C; however, 3 patients relapsed after the treatment.

[Prevalence of Helicobacter pylori infection in the Czech Republic--the South Moravia Region]. / Prevalence infekce Helicobacter pylori v CR--region jizní Morava.

The prevalence of Helicobacter pylori is influenced in a significant way by geographical conditions and depends to a certain extent also on the economic standard of different countries. Some published work provides evidence that Helicobacter pylori infections in eastern European countries are in general more frequent than in western European countries. It cannot be ruled out, however, that in different countries there are regional differences as far as Helicobacter pylori is concerned. In a group of 309 subjects, none of those treated previously to eradicate H.pylori, at least three weeks before blood sampling no preparations of the type of H2 blockers, proton pump blockers or drugs containing bismuth were administered. In these patients serological examinations of H.pylori antibodies were made, using kits of TEST-LINE Brno. The examined subjects were divided into six age groups by decades, starting at the age of 20 years. The general prevalence of H.pylori in the examined group was 58.8%, in the group of 20-year-old ones less than 46%. The highest prevalence was recorded in subjects aged 50-59 years and amounted to 67.3%. The authors compare their own results with findings assembled in the Czech Republic and abroad and draw attention to the necessity of an extensive epidemiological survey of H.pylori prevalence in the Czech Republic. The survey should be done by regions, using the same diagnostic method.