Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae co-infections among patients with newly diagnosed syphilis: a single-centre, cross-sectional study.

OBJECTIVES: The aim of the study was to determine the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae co-infections among patients with newly diagnosed syphilis. METHODS: In patients with any stage of newly diagnosed syphilis swabs were performed from urethra, rectum, pharynx and cervix according to the gender and type of sexual intercourse. From these smears standard validated nucleic acid amplification tests (NAATs) for Chlamydia trachomatis and Neisseria gonorrhoeae infections were done. RESULTS: From 548 (488 men, 60 women) screened patients co-infection was detected in 15.9% of the cases. The majority of the co-infections (86.2%) were asymptomatic. The overall prevalence of chlamydial infection was 11.1% and 8.8% for gonococcal infections. In men who have sex with men (MSM) the prevalence of co-infections was significantly higher (20.0%) than in heterosexual men and women (4.2%) (p < 0.001). In MSM patients the presence of co-infection was significantly associated with HIV infection (p < 0.001). Among MSM 9.6% of the tests detected infection in anorectal site, while prevalence in urethral (2.8%) and pharyngeal (2.4%) localization was significantly lower. In heterosexual patients prevalence was less than 2.0% in all anatomic sites. CONCLUSIONS: The implementation of screening tests in case of sexually transmitted infections in patients with newly diagnosed syphilis is an important part in the management of this disease. These results suggest that screening of asymptomatic heterosexual patients leads to detection of minimum co-infections, but in MSM (especially HIV positive) should always be performed at least in anorectal site, where asymptomatic co-infections are common.

[Guidelines for treating HIV-infected adults and post-exposure prophylaxis for HIV infection].

Antiretroviral therapy represents an essential element in the approach to treatment and prevention of human immunodeficiency virus (HIV). It has changed the fatal disease to a manageable chronic condition and is the most effective prevention of its human-to-human transmission. Knowledge regarding biological characteristics of the virus, its behavior in a human host and our understanding of these phenomena have been extended by clinical experience, new clinical data and recent scientific progress. The development of new drugs becomes a modifier for the existing therapeutic strategy and preference. Certain points are more specific than in the previous guidelines. Definitions of certain clinical and laboratory conditions have been specified more accurately. The indications of specific antiretroviral agents and pitfalls of their use in lifelong antiretroviral treatment are also described more in detail. The document is a result of a general consensus among infectious disease specialists working with HIV patients in the Czech Republic. It should serve as a basic instrument for clinicians recommending treatment of HIV infection as well as a foundation for the society when dealing with both state authorities and health care payers.

[Guidelines for caring for HIV-infected adults and post-exposure prophylaxis of HIV infection].

Presented are general principles of care for HIV-infected persons following their admission to an AIDS care center, initiation of antiretroviral therapy and follow-up. Scientific research, drug development and new clinical data in recent years have led to a change in certain therapeutic perspectives and preferences for the treatment of HIV infection. Certain conditions are better specified, which affect the choice of antiretroviral regimens. Procedures and criteria for monitoring the effect of treatment and indication of post-exposure prophylaxis are specified. The development of this document was based on the latest updates of the most prominent international and European recommendations. It also reflects some of the new scientific information published in recent months. However, general recommendations cannot fully cover all the possible alternatives. They only state basic principles based on current clinical studies, clinical observation and practice. The present document should be the basic source of information for physicians involved in the treatment of patients with HIV infection and should provide a quick reference when selecting treatment regimens in terms of modern pharmacotherapy as well as information on the pitfalls of this treatment. Finally, it should be a support for negotiations between the professional society, state authorities and health care payers.This updated version of the guidelines follows the 2012 edition; once again, they are supplemented by a modified tabular overview.

Artemether-lumefantrine, mefloquine and atovaquone-proguanil in the treatment of uncomplicated Plasmodium falciparum malaria in travellers: A retrospective comparative study of efficacy and treatment failures.

BACKGROUND: The aim of this study was to evaluate the rates of parasitaemia clearance and the prevalence of treatment failure in patients with uncomplicated Plasmodium falciparum malaria treated with artemether-lumefantrine (AL), mefloquine (MQ), and atovaquone-proguanil (AP). METHOD: The retrospective descriptive study included adult patients with uncomplicated P. falciparum malaria treated at the University Hospital Bulovka in Prague from 2006 to 2019. Parasitaemia clearance was estimated using a linear regression model. RESULTS: The study included 72 patients with a median age of 33 years (IQR 27-45) and a male to female ratio of 3.2:1. Thirty-six patients (50.0%) were treated with AL, 27 (37.5%) with MQ and 9 (12.5%) with AP. The proportion of VFR and migrants was 22.2% with no significant differences among the three groups. The median time to the parasitaemia clearance was two days (IQR 2-3) in patients treated with AL versus four days in the MQ (IQR 3-4) and AP (IQR 3-4) groups, p < 0.001. The clearance rate constant was 3.3/hour (IQR 2.5-4.0) for AL, 1.6/hour (IQR 1.3-1.9) for MQ, and 1.9/hour (IQR 1.3-2.4) for AP, p < 0.001. Malaria recrudescence occurred in 5/36 (13.9%) patients treated with AL and in no patients treated with MQ or AP. CONCLUSIONS: The findings demonstrate the superior efficacy of AL compared to other oral antimalarials in early malaria treatment. However, we observed a higher rate of late treatment failure in patients treated with AL than previously reported. This issue warrants further investigation of possible dose adjustments, extended regimens, or alternative artemisinin-based combinations.

Prevalence of human leukocyte antigen HLA-B*57:01 in HIV-infected subjects in the Czech Republic.

The HLA-B*57:01 allele is associated with a hypersensitivity reaction to abacavir, and its prevalence varies in different populations. The aim of the study was to investigate HLA-B*57:01 prevalence in the Czech HIV-infected population. HLA-B*57:01 prevalence in our cohort was 5.33%, which is similar to the situation in other Central European countries.

[Exogenous Cushing's syndrome as a serious side-effect of therapy with ritonavir an inhaled fluticasone]. / Exogenni Gushinguv syndrom jako zavazny nezadouci ucinek lecby ritonavirem a inhalacnim flutikazonem.

Inhalation of fluticasone is usually devoid of systemic side-effects. The authors describe a case of a young HIV positive woman treated concomitantly with fluticasone and inhibitors of HIV protease ritonavir and lopinavir in which developed a serious endocrine side-effect - an iatrogenic Cushing's syndrome. Plasma concentration of cortisol < 5.5 nmol/l was very low (norm 250-650 nmol/l) and plasmatic ACTH was even not detectable. The administration of fluticasone and both inhibitors of HIV protease was stopped and substitution therapy with decreasing dose of hydrocortisone was initiated. Twenty weeks later resolved both clinical and laboratory symptoms of Cushing's syndrome, and the substitution therapy with hydrocortisone was terminated. Two years later became the patient pregnant and gave birth to a healthy child.

Bilateral Holmes-Adie syndrome as an early manifestation of the HIV neuropathy.

A 38-year-old HIV-1 infected woman affected with bilateral tonic pupils. Ophthalmologic examination confirmed Holmes-Adie syndrome (HAS), and peripheral distal polyneuropathy, orthostatic hypotension and leg hyperhidrosis were detected on further workup. The HAS can be either idiopathic or associated with neuropathy of various etiology (autoimmune, paraneoplastic and infectious). In our patient, the pupillotonia was the first and early symptom of hitherto unrecognized HIV neuropathy. HAS has been previously observed in association with syphilis, Lyme borreliosis, herpes simplex and parvovirus B19 infection. Our case is the first report of HAS in a case of HIV infection.

[Two types of CMV ocular complications in patients with HIV infection]. / Dva typy cytomegalovirového postizení oka u pacientu s HIV infekcí.

CMV retinitis is the most serious ocular complication of AIDS. Introduction of the combination antiretroviral therapy markedly reduced the occurrence of CMV retinitis, on the other hand it brought a new ocular complication - CMV uveitis. CMV uveitis is an immunopathological inflammatory reaction associated with the immune reconstitution inflammatory syndrome, which is a side effect of successfully initiated cART. These two forms of CMV ocular complications differ in pathogenesis, symptomatology and therapy. The CMV retinitis is treated with anti-CMV virostatics whereas the therapy of CMV uveitis is based on attenuation of the inflammatory reaction by administration of corticosteroids. The optimal prevention of both complications is an early initiation of cART before the CD4+ T lymphocytes drop below 200/microl.

[HIV retinopathy]. / HIV retinopatie.

HIV retinopathy is an ocular affection occurring especially in HIV positive patients with deep immunodeficiency. Because of benign character the HIV retinopathy does not require any specific therapy, but it must be carefully distinguished from other ocular diseases, which can seriously damage sight, e.g. CMV retinitis. The presence of HIV retinopathy can also be a symptom of progression of HIV infection and should be perceived as a signal for considering the initiation of antiretroviral therapy in treatment naive patients.

[Procalcitonin: a reliable marker for the diagnosis and monitoring of the course of bacterial infection]. / Prokalcitonin: spolehlivý ukazatel pro diagnostiku a monitorování prubehu bakteriální infekce.

The review is aimed at the importance of determining procalcitonin serum levels (S-PCT) in numerous infectious and non-infectious diseases. Detecting increased S-PCT is particularly important for differential diagnosis of systemic bacterial as well as fungal infections. High S-PCT concentrations are also of predictive value in severe sepsis and septic shock. S-PCT kinetics may be used for monitoring the effect of antibiotic therapy. When compared to the other routinely used markers of bacterial infection (i.e. C-reactive protein, white blood cell count and neutrophil percentage), S-PCT has higher sensitivity and specificity in predicting bacterial infection.

[Proposals for guidelines for vaccination of adults infected with HIV-1 in the Czech Republic]. / Návrh doporuceného postupu ockování u dospelých osob infikovaných virem HIV-1.

HIV positive patients are in a higher risk of many infections, including the preventable ones. The vaccination is thus a very important part of health-care offered to those patients. Effectiveness of vaccination correlates strongly with the actual immunological status. Vaccination is safe, including some live vaccines, in persons with CD4+ T cells > 500/ml. In patients with CD4+ T cells > 200/ml the efficacy of vaccination is uncertain and live vaccines are strictly contraindicated. A good knowledge of all aspects of vaccination and HIV-infection is necessary, hence we recommend that vaccination of all HIV-positive persons should be realized exclusively by experts in specialized AIDS centers. In the following text we present the proposals for guidelines for vaccination of adult patients infected with HIV-1.

[Guidelines for antiretroviral therapy of human immunodeficiency virus (HIV)-infected subjects in the Czech Republic]. / Komplexní postup antiretrovirové lécby osob infikovaných virem lidské imunodeficience (HIV) v Ceské republice.

HIV infection remains an incurable disease because of the impossibility to eradicate the HIV from the organism. However, the combination antiretroviral therapy (cART) is able to efficiently limit HIV replication and slow down progression of immunodeficiency and thus prolong and improve the quality of HIV+ patients? lives. In HIV(+) pregnant women, the antiretroviral therapy substantially reduces the risk of vertical transmission of the infection. According to present knowledge, the cART is indicated mainly in symptomatic patients with stage B or C diseases and for vertical transmission and postexposure prophylaxis; less clear is the indication of cART for treating acute HIV infection and in asymptomatic patients. Various guidelines for the use of antiretroviral agents issued worldwide, e.g. in the USA, Europe or by the WHO, are not completely identical. The authors present a draft of recommendations for the use of antiretroviral agents in the Czech Republic based on the above-mentioned guidelines as well as on their own experience with taking care of HIV/AIDS patients.

[Mother-to-child HIV transmission]. / Prenos viru lidské imunodeficience z matky na díte.

Vertical HIV transmission is the main route of infection in children. The vast majority of infected children are born in the developing world. In the developed countries, including the Czech Republic, the situation is relatively favourable thanks to preventive activities and effective prophylactic measures in HIV-positive pregnant women. The risk of vertical transmission depends on a number of maternal (including immunological), virological, obstetric, feto-placental and neonatal factors. The basic prophylactic steps are: administration of antiretroviral agents, delivery by Caesarean section and avoidance of breast-feeding. Diagnosis of HIV infection in children relies on direct virological diagnosis -- the demonstration of the absence of viral genome in blood samples taken at the age of 2-3 and 4-6 months is crucial for excluding vertical infection. In the first 6 weeks of life, children receive the zidovudine prophylaxis. From the age of 6-8 weeks until approx. 6 months, children in whom HIV infection has not been excluded are on the primary co-trimoxazole prophylaxis of Pneumocystis infection.

[Prophylaxis of the vertical transmission of the human immunodeficiency virus (HIV) in the Czech Republic]. / Profylaxe vertikálního prenosu viru lidské imunodeficience (HIV) v Ceské republice.

GOAL: To assess the efficacy of prophylactic measures intended to reduce vertical transmission of HIV infection and to evaluate the predictive value of demographic, immunological and virological factors for determination of the risk of HIV transmission to fetus and neonate. METHODS: 56 pregnancies of 53 HIV-positive women were included in this retrospective study. The women have been in the care of the AIDS Centre of the Dpt. of Infectious Diseases, University Hospital Na Bulovce over the past 15 years. Cellular immunity tests and HIV RNA viral load in all subjects were regularly determined. In line with our present knowledge and the patients compliance, we introduced prophylactic measures, which included the administration of antiretroviral agents, delivery by Caesarean section and breast-feeding avoidance. 58 children were born from these pregnancies and repeated blood tests were performed to detect the presence or absence of HIV RNA. RESULTS: 58 infants were born from 56 pregnancies-and 3 of them (5.17%) were infected with HIV. In two mothers, we diagnosed HIV positivity few hours before delivery; another woman was diagnosed early, however, the failure of treatment was due to her insufficient compliance. In addition, premature amniorrhoea was present in two women. Moreover, one of them presented with untreated syphilis. The other 55 children stayed uninfected. In six of them, however, prophylactic measures were not fully followed, mainly because the patients disregarded them. CONCLUSIONS: The study fully confirms the high efficacy of prophylactic measures, which substantially reduce the risk of vertical transmission of HIV infection. Routine blood tests are necessary in all pregnant women by law. The failure of prophylaxis is in most cases due to inadequate compliance with the treatment. However, we cannot rule out the possible resistance to antiretroviral agents.

[Prevalence of GBV-C/HGV (HGV) in HIV-infected patients and potential influence of co-infection on the course of the disease.].

AIM OF THE STUDY: Assessment of prevalence of GBV-C/HGV infection in HIV-infected patients and evaluating of a possible influence of GBV-C/HGV on the course of HIV infection by assessment of immunological and virological markers of progression of HIV infection. MATERIALS AND METHODS: We have investigated serum samples of 273 HIV- infected patients from AIDS Center of the University Hospital Na Bulovce Prague during 2002-2003. Our target was to assess the presence of markers of GBV-C/HGV infection by semiquantitative HGV RNA evaluation and anti-E2 antibodies by ELISA testing. 271 of serum samples were tested for HGV RNA and 269 samples were tested for anti-E2 antibodies. HIV viral load and CD4 count were tested concurrently. We used Spearmans test to rule out the dependency of CD4 count and HIV viral load on HGV infection. RESULTS: 89 (33,3 %) of patients were positive in HGV RNA test and 101 (38,5 %) of patients were positive in anti E2-ELISA. No statistically significant effect of GBV-C/HGV infection was observed on CD4 count and HIV viral load in our cohort of patients. CONCLUSIONS: The effect of GBV-C/HGV infection on predictive laboratory markers of HIV infection was not confirmed in our study. Further investigations regarding this subject seem to be necessary.

The Effect of Latent Toxoplasma gondii Infection on the Immune Response in HIV-Infected Patients.

A relationship between latent toxoplasmosis and the immune system during HIV disease is poorly understood. Therefore, the aim of this follow-up study was to characterize immunological parameters in HIV-infected patients with latent toxoplasmosis and noninfected individuals. A total of 101 HIV-infected patients were enrolled in the study. The patients were classified into two groups based on anti-Toxoplasma gondii antibodies: a group of 55 toxoplasma-positive persons (TP) and a group of 46 toxoplasma-negative persons (TN). Absolute counts of several lymphocyte subsets decreased in the TP group, namely, T cells (p = 0.007), B cells (p = 0.002), NK cells (p = 0.009), CD4 T cells (p = 0.028), and CD8 T cells (p = 0.004). On the other hand, the percentage of CD8 T cells expressing CD38 and HLA-DR significantly increased during the follow-up in the TP group (p = 0.003, p = 0.042, resp.) as well as the intensity of CD38 and HLA-DR expression (MFI) on CD8 T cells (p = 0.001, p = 0.057, resp.). In the TN group, analysis of the kinetics of immunological parameters revealed no significant changes over time. In conclusion, the results suggest that latent T. gondii infection modulates the immune response during HIV infection.

[Manifestations of HIV infection in the oral cavity]. / Projevy infekce virem lidské immunodeficience (HIV) v dutine ústní.

Affections in the oral cavity are important clinical markers of HIV infection and may, in fact, be the first clinical manifestation of undiagnosed HIV positivity. These affections include infections, tumours, conditions caused by direct HIV activity, as well as adverse side-affects of antiretroviral and other antimicrobial drugs. The paper lists disorders of the mouth that can complicate HIV infection and manifestations of HIV infection in the oral cavity. Accompanied by photographs of the oral cavity of patients treated at the Dept of infectious diseases.

[CD38 antigen as a marker for immunological follow-up in HIV-positive patients]. / Antigen CD38 jako ukazatel pro imunologické sledování HIV-pozitivních osob.

BACKGROUND: HIV infection causes chronic activation of cytotoxic CD8+ T-lymphocytes, which is partly responsible for the hallmark of the disease--progressive loss of CD4+ T-lymphocytes. The aim of this study was to evaluate an influence of HIV infection and long-term antiretroviral therapy (HAART) on expression of the activation molecules CD38 on CD8+ T-lymphocytes. METHODS: A group of 16 HIV-positive patients treated with HAART was followed for 12 months. Also, we examined 10 persons with a newly diagnosed HIV infection that were not treated with HAART. Expression of CD38 molecules on CD8+ T-lymphocytes was determined with five-parameter cytometric analysis using monoclonal antibodies as well as their mean fluorescence intensity (MFI). RESULTS: The percentage of CD8+/CD38+ T-lymphocytes in HIV-positive patients treated with HAART significantly decreased during the follow-up period from 46.1 I 3.7 to 35.2 I 3.8 (p = 0,01). Furthermore, the percentage of these cells correlated negatively with the number of CD4+T-lymphocytes at the beginning and the end of the study (r = -0,679, p < 0.01; r = -0,51, p = 0,05, respectively). There was no correlation between these parameters in persons with newly diagnosed HIV infection. However, the percentage of CD8+/CD38+ T-lymphocytes in these patients was significantly higher than in persons treated with HAART (68.5 I 5.3 vs. 35.2 I 3.8, p < 0,01). CONCLUSIONS: Our findings support the importance of expression of CD38 antigen on CD8+ T-lymphocytes as a biological and clinical marker of HIV infection and indicate its usefulness for monitoring of the efficacy of HAART therapy.

Listeria monocytogenes meningitis in adults: the Czech Republic experience.

BACKGROUND: Listeria monocytogenes (LM) is currently the third most frequent pathogen of bacterial meningitis in adults. METHODS: A prospective study of patients with LM meningitis in a Czech tertiary care hospital, carried out from 1997 to 2012. RESULTS: Thirty-one patients were diagnosed with LM meningitis, which was 7% of a total of 440 adult patients with acute bacterial meningitis (ABM) over a 16-year period. Their median age was 63 years, range 26-80 years. Nineteen patients (61%) had underlying immunocompromising comorbidity; 15 patients (48%) were older than 65 years. Fourteen patients (45%) had arterial hypertension. The typical triad of fever, neck stiffness, and altered mental status was present in 21 patients (68%). The median count of cerebrospinal fluid (CSF) leukocytes was 680/µL, protein level 2.6 g/L, and glucose ratio 0.28. Four patients (13%) died, and nine (29%) survived with moderate to severe sequelae. CONCLUSION: LM meningitis is known to affect immunosuppressed and elderly patients. Arterial hypertension seems to be another important predisposing factor. Clinical symptoms, CSF findings, and disease outcomes, did not significantly differ from other community-acquired ABM in our study, although the CSF leukocyte count was lower. Ampicillin showed good clinical and bacteriological efficacy in the majority of patients.