Legionnaires' Disease in Pediatric Patients, Control Measures and 5-Year Follow-up.

BACKGROUND: Legionnaires' disease (LD) occurs predominantly in adults and elderly people. Its incidence in Europe has been increasing in recent years. It is rare in younger age groups and prone to be reported as healthcare-associated infection with a higher risk of fatal outcome. Hospital-acquired LD is mostly associated with a colonized hospital water system. We describe 5 LD cases in a children's hospital in Slovakia, subsequent environmental investigation, control measures, and 5-year monitoring of Legionella colonization in hospital's water system. METHODS: In 2014-2019, we tested clinical specimens from 75 hospitalized patients. Respiratory samples were cultured for Legionella, patient's urine was tested for Legionella urinary antigens, and the microagglutination test was used for serologic testing. Samples of water were collected in 2015-2019 and processed according ISO11731. RESULTS: We identified 5 Legionella infections in 2014-2015. Median age of patients was 15 years. All were high-risk patients hospitalized for their underlying diseases. All patients required admission to intensive care unit, and artificial ventilation due to general deterioration and respiratory failure. Legionella pneumophila was isolated from 72% of water samples. Chlorine dioxide dosing into water system above 0.3 ppm caused significant decrease of Legionella concentration in water samples. Samples taken from outlets with antimicrobial filter installed were legionellae-negative. CONCLUSIONS: Control measures led to decreased risk of infection, but not to eradication of Legionellae. It is necessary to extend the diagnostics for Legionella infection in hospitalized children with pneumonia, especially in hospitals with colonized water system.

Epidemiology of Myasthenia Gravis in Slovakia in the Years 1977-2015.

PURPOSE: The objective of the study was to evaluate changes of epidemiological parameters in patients with myasthenia gravis (MG) in Slovakia during the period 1977-2015. METHODS: Data from medical records of MG patients registered in Slovakia were analyzed. Epidemiological rates (incidence, prevalence, mortality) were assessed for several periods to identify changes and drifts over the period of study. RESULTS: Out of 2,074 patients, 892 were males (43.0%) and 1,193 were females (57.0%). The thymoma associated MG (TAMG) was diagnosed in 123 patients (5.9%). The mean age at onset shifted from 35.8 years in 1977-1989 to 60.0 years in -2010-2015. The crude incidence increased from 0.36/100,000 in 1977-1989 to 1.74/100,000 in 2010-2015. The average annual incidence of TAMG was 0.05/100,000. Maximum increase of MG incidence was registered among the elderly (≥50 years), particularly in the group of patients in the age range 70-79 years (0.34/100,000 in 1977-1989→7.10/100,000 in 2010-2015) and 80-89 years (0.00/100,000 in 1977-1989→5.31/100,000 in 2010-2015). The crude MG prevalence on December 31, 2015 was 24.75/100,000. The average MG mortality was 0.27/100,000. CONCLUSION: The age at onset and incidence increased significantly over the study period due to marked increase of MG incidence in elderly, particularly over 70 years. Possible reasons for this trend are discussed.

MALDI-TOF MS analysis as a useful tool for an identification of Legionella pneumophila, a facultatively pathogenic bacterium interacting with free-living amoebae: A case study from water supply system of hospitals in Bratislava (Slovakia).

Legionellae, i.e. Legionella pneumophila, are human bacterial hydrophilic facultative pathogens causing pneumonia (Legionnaires' disease). Free-living amoebae (FLA) can serve as natural hosts and thus as reservoirs of many amoebae-resistant bacteria. An encysted amoeba can contribute to the resistance of intracellular L. pneumophila to various chemical and physical treatments. Humans can be infected by droplets containing bacteria from an environmental source or human-made devices such as shower heads, bathtubs, air-conditioning units or whirlpools. In this study, we were investigating the presence of FLA and L. pneumophila in plumbing systems of healthcare facilities in Bratislava (Slovakia) by standard diagnostic methods, while the presence of L. pneumophila was verified also by MALDI-TOF MS (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry) analysis. The results showed the occurrence of L. pneumophila and FLA in 62.26% and 66.4% of samples taken from four paediatric clinics, respectively. Both standard methods and MALDI-TOF MS showed comparable results and they can be successfully applied for the identification of L. pneumophila strains in environmental samples. Our approach could be useful for further monitoring, prevention and decreasing risk of Legionella infection also in other hospitals.

Incidence of orofacial clefts in the Slovak Republic.

Orofacial clefts (OC) are quite common congenital defects. Retrospective active survey collecting clinical data of children with OC examined and operated on in the three main specialized departments of plastic surgery in the Slovak Republic over 16 years (1985-2000) revealed total incidence of 1.61/10(3) live births (LB). 1,849 children suffering from OC were recognised out of 1,147,236 live births. Total incidence (TI) of OC per 1,000 live births was determined by types, gender, regions, districts and seasonal variation. The highest rate, 40.5% of clefts, affected the primary and secondary palate (CLP), more than 32% were of cleft palate type (CP), about 26% cleft lip (CL) and about 1% of associated malformations (AM). Clefts in males (1.71/10(3) LB) were significantly more common than in females (1.50/10(3) LB), sex ratio 1.14:1. Morbidity rates (TI) varies from 1.29/10(3) LB in the east Slovakia to the highest incidence of 1.93/10(3) LB in the middle Slovakia with wide range by district. Comparing data from the study and from the national register, 17% of children with OC were missed. Presented survey assessed risk of OC in Slovakia at the rate 1 newborn with OC per 620 LB compared with notified frequency of 1 OC per 745 LB.