Fingerprints of the Local Moment Formation and its Kondo Screening in the Generalized Susceptibilities of Many-Electron Problems.

We identify the precise hallmarks of the local magnetic moment formation and its Kondo screening in the frequency structure of the generalized charge susceptibility. The sharpness of our identification even pinpoints an alternative criterion to determine the Kondo temperature of strongly correlated systems on the two-particle level, which only requires calculations at the lowest Matsubara frequency. We showcase its strength by applying it to the single impurity and the periodic Anderson model as well as to the Hubbard model. Our results represent a significant progress for the general understanding of quantum field theory at the two-particle level and allow for tracing the limits of the physics captured by perturbative approaches for correlated systems.

Attractive Effect of a Strong Electronic Repulsion: The Physics of Vertex Divergences.

While the breakdown of the perturbation expansion for the many-electron problem has several formal consequences, here we unveil its physical effect: flipping the sign of the effective electronic interaction in specific scattering channels. By decomposing local and uniform susceptibilities of the Hubbard model via their spectral representations, we prove how entering the nonperturbative regime causes an enhancement of the charge response, ultimately responsible for the phase-separation instabilities close to the Mott metal-insulator transition. Our analysis opens a new route for understanding phase transitions in the nonperturbative regime and clarifies why attractive effects emerging from a strong repulsion can induce phase separations but not s-wave pairing or charge-density wave instabilities.

[Hepatitidis E virus]. / Virus hepatitidy E.

UNLABELLED: The number of detected cases of hepatitis E (HE) shows an increasing trend in the Czech Republic, probably due the introduction of new diagnostic methods and greater awareness of HE. In most cases, the source of infection has remained unconfirmed or entirely unclear. The causative agent, the hepatitis E virus (HEV), belongs to the Hepeviridae family. Recently, many isolates from mammals, birds, and fish have been identified. HEV is widespread among farm pigs and wild boar populations all over the word. Both species serve as HEV reservoirs. Consumption of undercooked meat or offal from the reservoir animals is considered to be unsafe due to zoonotic transmission of HEV. The aim of the present article is to summarize recent findings regarding HEV. KEY WORDS: hepatitis E - zoonosis - food-borne infection.

[Human hantavirus diseases - still neglected zoonoses?]. / Onemocnení cloveka zpusobená hantaviry - stále opomíjené zoonózy?

Hantavirus disease is the most common rodent-borne viral infection in the Czech Republic, with a mean annual incidence of 0.02 cases per 100 000 population and specific antibodies detected in 1% of the human population. Four hantaviruses (Puumala, Dobrava-Belgrade, Tula, and Seewis) circulate in this country, of which Puumala virus (responsible for a mild form of hemorrhagic fever with renal syndrome called nephropathia epidemica) and Dobrava-Belgrade virus (causing haemorrhagic fever with renal syndrome) have been proven to cause human disease. The aim of this study is to provide a comprehensive review of the hantaviruses occurring in the Czech Republic, based on the literature published during the past three decades, including their geographical distribution and clinical symptoms. The recent detection of Tula virus in an immunocompromised person as well as reports of Seoul virus infections in Europe highlight the possible emergence of neglected hantavirus infections in the foreseeable future.

[Immune response in the pathogenesis of hepatitis C virus infection]. / Imunitní odpoved v patogenezi infekce virem hepatitidy C.

The pathogenesis of hepatitis C virus (HCV) infection is regulated by the host immunity and several metabolic factors affecting liver metabolism, including oxidative stress, insulin resistance, and hepatic steatosis. Both innate and adaptive immunity play an important role in HCV infection. Cytotoxic lymphocytes have a crucial role in viral eradication or viral persistence. Major cause of viral persistence during HCV infection could be the development of a weak antiviral immune response to the viral antigens, with corresponding inability to eradicate infected cells.

Evaluation of potential biomarkers for the discrimination of bacterial and viral infections.

PURPOSE: Timely knowledge of the bacterial etiology and localization of infection are important for empirical antibiotic therapy. Thus, the goal of this study was to evaluate routinely used biomarkers together with novel laboratory parameters in the diagnosis of infection. METHODS: In this prospective study, 54 adult patients with bacterial infections admitted to the Department of Infectious Diseases were included. For comparison, 27 patients with viral infections were enrolled. In these patients, white blood cell (WBC) counts, differential blood counts, serum levels of procalcitonin (PCT), IL-1ß, IL-6, IL-8, IL-10, IL-12, TNF-α, IFN-γ, soluble CD14 (sCD14), heparin-binding protein (HBP), cortisol (Cort), and monocyte surface expression of TLR2, TLR4, HLA-DR, and CD14 were analyzed. Also, these biomarkers were evaluated in 21 patients with acute community-acquired bacterial pneumonia (CABP), as well as in 21 patients with pyelonephritis and urosepsis. RESULTS: The highest sensitivity and specificity (expressed as the area under the curve [AUC]) for bacterial infection were observed in serum concentration of PCT (0.952), neutrophil and lymphocyte counts (0.852 and 0.841, respectively), and serum levels of HBP (0.837), IL-6 (0.830), and Cort (0.817). In addition, the serum levels of IFN-γ and Cort were significantly higher and IL-8 levels were lower in CABP when compared to pyelonephritis or urosepsis. CONCLUSIONS: From the novel potential biomarkers, only PCT demonstrated superiority over the routine parameters in the differentiation of bacterial from viral infections. However, some of the novel parameters should be further evaluated in larger and better characterized cohorts of patients in order to find their clinical applications.

[Infectious complications of biological therapy]. / Infekcní komplikare biologické lécby.

Biological treatment represents a significant progress in the therapy of many serious diseases. Together with the growing knowledge of pathophysiology and subsequent development of new therapeutic agents, this progress will definitely lead to further expansion of biologics. Since biologics interfere with many mechanisms of host defence, which may sometimes be compromised by them, increased risk of infectious complications must be taken into account. Patients treated with biologics are prone to classical virulent infections (e.g. listeriosis, legionellosis and tuberculosis) and opportunistic infections such as progressive multifocal leukoencephalopathy. Furthermore, suppression of the immune response that is caused by biologics may lead to reactivation of latent infections such as tuberculosis or viral hepatitis B. Therefore, the knowledge of basic mechanisms by which biologics modify the immune response is important for a rapid clinical diagnosis of possible aetiology of infectious complications.

[Viral hepatitis B in a patient with follicular lymphoma treated with biological therapy]. / Virová hepatitida B u pacientky s folikulárním lymfomem lécené biologickou terapií.

Reactivation, recurrence or acute infection with hepatitis B virus (HBV) represent severe complications of biological therapy. Reported is a case of a 58-year-old female treated in the past with cytostatics and rituximab for follicular lymphoma, in whom HBV infection was detected during a follow-up of the contacts of her partner diagnosed with acute viral hepatitis B. At the beginning, the patient had a very high serum level of HBV DNA (4.3 × 108 IU/mL) and therefore she was treated with combined antiviral therapy (lamivudine and tenofovir). After 10 months, the serum level of HBV DNA decreased significantly (3,100 IU/mL) and the combined antiviral therapy was switched to monotherapy with tenofovir. Another 5 months later, the serum level of HBV DNA was only 950 IU/mL. This case demonstrates important clinical problems connected with HBV infection in immunocompromised persons.

[A case of acute hepatitis E acquired in the Czech Republic]. / Prípad akutní virové hepatitidy E získané v Ceské republice.

We report a case of 54-year-old female, who was diagnosed with acute viral hepatitis E with uncomplicated anicteric course of the infection. The patient did not have a specific travel history to endemic areas and the infection has been acquired in the Czech Republic. The epidemiologic history was remarkable only because she consumed undercooked pork meat. A differential diagnostic process of acute viral hepatitis in our conditions as well as problems of acute viral hepatitis E as an autochtonous infection in Western and Central Europe are discussed.

Antithrombin as a marker of severe acute hepatitis B.

BACKGROUND: Acute hepatitis B (AHB) can run a severe course, which sometimes leads to a fulminant disease with acute liver failure (ALF). Pro-coagulation factors are well-established markers of AHB severity, but less is known about the levels of anti-coagulation parameters in AHB. METHODS: In this study, we demonstrate that antithrombin (AT) plasma levels were associated with AHB severity in 161 patients. RESULTS: Nine (6%) patients had severe AHB (i.e. international normalized ratio [INR] ≥ 1.6 and total bilirubin ≥ 10 mg/dL). Coagulopathy (i.e. INR > 1.2 and/or AT < 80%) was observed in 65 (40%) AHB patients on admission. Low initial plasma AT levels (i.e. < 80%) were observed in 56 (35%) patients. In all, plasma AT levels decreased in 91 (57%) patients during their hospital stay. Both baseline and nadir AT levels were significantly lower in severe than in mild and moderate AHB. Moreover, the concentration of AT negatively correlated with INR, aspartate aminotransferase, and total and conjugated bilirubin levels. Interestingly, nadir AT levels positively correlated with the duration of hospitalization. CONCLUSIONS: These results indicate that plasma AT levels can be used as an additional marker of AHB severity.

[Liver diseases of infectious aetiology]. / Onemocnení jater infekcní etiologie.

Review article is dealing with the problems of infectious diseases of the liver. Attention is paid to the basic infectious agents, jaundice accompanying infectious diseases and focal infections of the liver. Specific infections of the liver are supplemented by brief pathological and anatomical characteristics.

Infectious arthritis: clinical features, laboratory findings and treatment.

An infection of native joints leads generally to suppurative arthritis, which may be of one joint (monarticular) or several joints (oligoarticular). Bacteria that produce symptoms in multiple joints during bacteraemia, such as Neisseria gonorrhoeae, may also induce inflammation in the neighbouring tendon sheaths. Viral infections frequently involve multiple joints and produce inflammation without suppuration. Chronic granulomatous monarticular arthritis may occur because of infection with either mycobacteria or fungi, which must be differentiated from other causes of chronic monarticular arthritis. A sterile arthritis may occur early in infection (as with hepatitis B), or later (as with a post-infectious arthritis). Any patient presenting with an inflamed joint should have infection as a diagnostic possibility and appropriate cultures must be performed.

Interferon-gamma and cortisol levels in cerebrospinal fluid and its relationship to the etiology of aseptic meningoencephalitis.

The aim of the study was to analyze the concentrations of Th1/Th2 cytokines and cortisol in the cerebrospinal fluid (CSF) from patients with aseptic meningoencephalitis (AM). The study enrolled 37 patients with AM and 11 control subjects. CSF concentrations of IL-2, IL-4, IL-5, IL-10, IFN-gamma, and TNF-alpha were analyzed using cytokine bead array and flow cytometry; CSF cortisol concentrations were measured by a RIA method. Cortisol was detected in 37 CSF samples (100%) from patients with AM, and it was significantly elevated in comparison to control subjects. IFN-gamma was detected in 32 CSF samples (86.5%) and IL-10 was detectable in 9 CSF samples (24.3%). The CSF cortisol levels correlated negatively with the duration of AM. The intrathecal concentration of IFN-gamma correlated positively with CSF numbers of leukocytes and lymphocytes, and negatively with the duration of AM. The etiology of AM influenced the CSF cortisol concentration, which was significantly higher in patients with tick-borne encephalitis when compared to persons with AM of unknown origin and control subjects. The results indicate that the prevailing intrathecal immune reaction during AM is shifted to a Th1-like response, whereas anti-inflammatory response in the brain is executed by the effect of cortisol.

Epidemiology and clinical features of imported dengue fever in Europe: sentinel surveillance data from TropNetEurop.

Travelers have the potential both to acquire and to spread dengue virus infection. The incidence of dengue fever (DF) among European travelers certainly is underestimated, because few centers use standardized diagnostic procedures for febrile patients. In addition, DF is currently not reported in most European public health systems. Surveillance has commenced within the framework of a European Network on Imported Infectious Disease Surveillance (TropNetEurop) to gain information on the quantity and severity of cases of dengue imported into Europe. Descriptions of 294 patients with DF were analyzed for epidemiological information and clinical features. By far the most infections were imported from Asia, which suggests a high risk of DF for travelers to that region. Dengue hemorrhagic fever occurred in 7 patients (2.4%) all of whom recovered. Data reported by member sites of the TropNetEurop can contribute to understanding the epidemiology and clinical characteristics of imported DF.

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.

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.

Administration of antibiotics before admission in patients with meningococcal disease.

PURPOSE: To determine whether parenteral or oral antibiotics given before admission to a regional hospital with a special intensive care unit (ICU) reduce the case fatality rate in patients with meningococcal disease. DESIGN: Prospective analysis of 164 consecutive patients with meningococcal disease admitted to 5 regional hospitals in the Czech Republic between August 1996 and October 2001. Main outcome measure was number of deaths from meningococcal disease. Fisher's exact test was used for statistical analysis. MAIN FINDINGS: Nine out of 116 patients (8%) given antibiotics before admission died, compared with five deaths in 48 patients (10%) admitted without such a treatment (p = 0.55). None of 19 patients given oral or combined oral and parenteral pre-admission antibiotics died. CONCLUSION: Parenteral and probably also oral antibiotics given before admission to a regional hospital and an adequate treatment of shock can reduce the case fatality rate from meningococcal disease.

Dengue fever in the Czech Republic.

BACKGROUND: Dengue fever has become, in Western Europe, the second most frequently imported disease after viral hepatitis A. OBJECTIVES: Dengue fever was diagnosed at the Department of Infectious Disease, University Hospital in Brno, so the authors decided to make local physicians aware of the possibility of the disease being contracted by Czech travelers. METHODS: The first two cases of dengue fever, with the patients hospitalized at the Department of Infectious Disease, University Hospital in Brno, Czech Republic, are described. RESULTS: A young couple contracted this infection in a region usually visited by tourists in Thailand. The disease broke out 12 hours after their return home. The clinical and laboratory pictures of the disease and the kinetics of serological responses are described in detail. CONCLUSION: The chief diagnostic clue with this disease, beside a visit to a high-risk area, can be considered a sudden onset of fever accompanied by marked fatigue, myalgia, and arthralgia. Laboratory tests showed characteristic thrombocytopenia, leukopenia, and pathological values of AST and ALT. The clinical picture is characterized by symptoms of persisting fatigue and exhaustion, even after the fever has subsided.

The review of imported visceral leishmaniosis in the Czech Republic.

BACKGROUND: From the late 1950s through 2000, a total of 8 cases of imported visceral leishmaniosis (VL) were registered in the Czech republic. OBJECTIVES: The authors were made to point to the issue of imported VL by the fact 3 cases of this disease (imported from East Africa, Croatia, and southern Italy) were reported in 1999, plus another one (again imported from Croatia) in 2000. METHODS: The case reports of 4 cases of imported VL are presented. They are cases 5-8 ever reported in the Czech Republic. RESULTS: The infection manifested itself by fever, marked splenomegaly, leukopenia, thrombocytopenia, and rapid weight loss. The diagnosis was confirmed by the microscopic finding of amastigotes in punctate obtained from bone marrow, liver, spleen and, also, by serology. All the patients were successfully treated with amphotericin B. CONCLUSION: Infection by VL should be considered when establishing the diagnosis not only in patient returning from endemic regions and show hepatosplenomegaly, fever, leukopenia, and thrombocytopenia. Given the long incubation time, VL may be encountered also in foreigners who had lived in the above regions. Besides, the diagnosis of VL should also be considered in immunocompromised individuals. (Ref. 27.).

[Basic factors affecting the development of chronic hepatitis B virus infection]. / Základní faktory ovlivnující vývoj chronické infekce virem hepatitidy B.

The authors followed up for a period of five years 276 convalescents after viral hepatitis B where all remained carriers of HBsAg. The group comprised 108 cases of chronic persisting hepatitis, 134 cases of chronic active hepatitis, 13 cirrhoses of the liver and 21 symptom-free carriers of HBsAg. In the group of chronic active hepatitis at the onset of the investigation 128 were HBeAg positive. In the course of five years in 43 patients seroconversion to HBeAg negativity occurred. Thus an annual index of seroconversion from HBeAg of 6.7% was recorded. In the course of five years in 38 patients of 128 HBeAg positive ones an acute relapse was observed. The causes of the relapse were explained by detailed serological examination. Superinfection with the hepatitis A virus participated three times (7.9%), probable superinfection with the hepatitis non-A non-B virus six times (15.8%), superinfection with the EB virus three times (7.9%), superinfection with cytomegalovirus twice (5.3%), seroconversion HBeAg to anti-HBe 14 times (36.8%), discontinuation of corticotherapy six times (15.8%), superinfection with the delta virus in none of the patients and relapses due to other causes four times (10.5%). Seroconversion of HBeAg to anti-HBe was in cca one third of the patients associated with acute exacerbation of the hepatic process. These relapses were, however, transient and their regression was followed by a further improvement of the chronic inflammation. Also relapses after discontinuation of corticotherapy usually improved spontaneously after a certain time interval. When the cause of the relapse was superinfection with the EB virus or cytomegalovirusas as a rule acceleration and further progress of the inflammatory process occurred.