[Enterovirus sequencing as a new approach to the laboratory diagnosis for clinical and epidemiological purposes]. / Sekvenace enteroviru jako nový prístup k laboratorní diagnostice pro klinické i epidemiologické úcely.

OBJECTIVE: Introducing enterovirus sequencing as an advanced approach to classify the viruses isolated according to the novel nomenclature and to characterize isolates in detail. MATERIAL AND METHODS: Seventy-five specimens collected from 64 patients in two hospitals, Liberec Regional Hospital, and Plzen University Hospital, were analyzed. The study patients' age ranged from four to 54 years, with a median of 15 years in males and 16 years in females. In most patients, the reasons for admission were intense headache, fever, vomiting, tiredness, meningeal symptoms, intestinal symptoms (in two patients), and skin symptoms (in one patient). The specimens collected were rectal and throat swabs, cerebrospinal fluid (CSF) and stool specimens. Molecular detection and typing were performed using the RT-PCR method. A segment of the 5´non-coding RNA was selected for typing. Specimens were amplified using single-step PCR with external primers and with the same primers extended to include M13 sequences (Generi-Biotech). The LASERGENE software (DIASTAR) was used in sequence editing, alignment, and quality check. The sequences obtained were checked against the central GenBank sequence database using the BLAST algorithm. RESULTS: The identification of the study isolates resulted in 61 ECHO viruses 30, three coxsackie viruses B1, one coxsackie virus B3, one coxsackie virus A9, one enterovirus 86, one enterovirus 71, Two ECHO viruses 13/coxsackie virus B5, one ECHO virus 7/30/coxsackie virus B4, one coxsackie virus B4/enterovirus B, one enterovirus 87/ECHO virus 30/enterovirus B, and one ECHO virus 3. All viruses isolated, except enterovirus 71 classified into group A, were of group B. CONCLUSION: The enteroviruses were identified unambigously, although the sequencing only targeted a short, conserved segment that showed considerable variability. The sequencing was an effective alternative to enterovirus identification by the neutralisation test and allowed for detailed characterization of the isolates. The predominance of ECHO 30 as the cause of aseptic meningitis is in accordance with the literature data.

[Changes in clinical and epidemiologic characteristics in Western Bohemia of invasive meningococcal disease associated with the occurrence of an invasive clone of Neisseria meningitidis]. / Zmeny klinických a epidemiologických charakteristik invazivního meningokokového onemocnení v západních Cechách v souvislosti s výskytem invazivního klonu Neisseria meningitidis.

The authors analyzed the incidence of meningococcal diseases in the West Bohemian region in 1982-1996. The draw attention to changes of clinical and epidemiological characteristics of the disease which appeared in 1994 in conjunction with a new invasive clonus of Neisseria meningitidis C:2a:P1.2, P1.5, ET-15/37. While in 1982-1993 invasive meningococcal diseases had in 75% the course of meningitis with a relatively low fatality (4%), during the subsequent period a marked change occurred. Since 1994 the disease took in the West Bohemian region in 58% the course of sepsis with a fatality of 16%. 25% cases of meningococcal meningitis were diagnosed combined sepsis and meningitis in 17%. The disease lost its seasonal character and the authors confirmed the highest incidence of the disease in the age group from 15-19 years and 0-4 years. Neisseria meningitidis group C was detected in 1994-1996 in 73% and the invasive clone C:2a:P1.2, P1.5, ET-15/37 in 62%.

[Incidence of tick-borne encephalitis in the West Bohemia Region 1960-1999--evaluation of vaccination]. / Výskyt klíst'ové encefalitidy v Západoceském kraji v letech 1960-1999--zhodnocení vakcinace.

In 1960-1999 in the West Bohemian region 1216 cases of tick-borne encephalitis were recorded, four were fatal. Since 1992 there was a marked increase in the number of these infections--in 1992-1999 the relative morbidity was 6.7 per 100,000 population per year, the highest specific morbidity shifted to the age group of 55-64 years. In the whole region changes occurred as to the probable transmission of infection. By the end of 1999 in western Bohemia the hygiene service immunized, by at least three doses against tick-borne encephalitis 23,225 subjects, i.e. 2.7% of the population. The negligible vaccination rate did not have so far an impact on the epidemiological characteristics of the infection. In view of the more frequent and clinically more severe affection in elderly subjects it is important to raise the vaccination rate in particular in more advanced age groups.

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.

[Tick-borne encephalitis in the West Bohemian Region 1960-1991]. / Klístová encefalitida v Západoceském kraji v letech 1960-1991.

In 1960-1991 in the West Bohemian region 746 cases of tick-borne encephalitis were confirmed by serological examination. The highest morbidity was recorded in the population of Plzen--5.9 per 100,000 per year. During 1986-1991 the mean hospitalization period of patients with tick-borne encephalitis was 13.5 days. Analysis by age groups revealed the highest specific morbidity in subjects aged 15-34 years. In the limital age groups the disease was recorded only exceptionally. From data on the specific morbidity and clinical severity ensues that mass vaccination against this infection in areas with a lower risk could start in subjects older than 10 years.

[Lyme borreliosis in the West Bohemian Region. 2 years' experience]. / Lymeská borrelióza v Západoceském kraji. Dvouleté zkusenosti.

During the period between 1988-1989 529 cases of Lyme borreliosis were reported to the hygiene service of the West Bohemian region. Of these 164 (31.0%) were confirmed by indirect immunofluorescence. 342 (64.6%) patients reported contact with a tick, another 108 patients reported contact with other arthropods. Among the affected systems the skin and nervous system predominated. From the total number of 443 cases of erythema chronicum migrans the aetiology was confirmed serologically in 84 (19.0%). Comparison of skin diseases confirmed and not confirmed by laboratory tests, classified by age, sex, monthly incidence and contact with arthropods revealed that the clinical diagnosis of skin symptoms of Lyme borreliosis in the West Bohemian region is of a high standard.

[Treatment of meningococcal sepsis]. / Lécba meningokokové sepse.

BACKGROUND: Incidence of meningococcal diseases and sepsis caused by a new invasive strain of Neisseria meningitidis group C: 2a: P 1,2 has been observed in the Czech republic within the last 3 years. In 1994 the highest incidence of this disease was in the West region. Ten of the most critically ill patients were treated at the Department of Anaesthesiology and Intensive Care. The aim of this work was to present principles of the treatment of this disease. METHODS AND RESULTS: In 1994 we treated 10 patients, 8 male and 2 female with average age of 11 years (range from 5 months to 20 years). Causing strain identification was done in 9 patients, in one patient causing strain was not identified. All patients had typical clinical symptoms of the disease. All of them were treated according to the same protocol of the invasive complex treatment including artificial ventilation, circulation support, Ceftriaxon combined with potassium salt of benzylpenicillin, i.v. immunoglobulins, fresh frozen plasma, heparin, fibrinogen and antitrombin III. Average length of the stay in the Intensive Care Unit was 5 days (range from 1.5 hour to 10 days). Survival in our group was 70%. CONCLUSIONS: Early started complex therapy is a decisive factor of its success. A uniform protocol of treatment and its wide publication even to the first contact level can increase a chance for survival.

Cluster of three cases of invasive meningococcal disease in a preschool facility in West Bohemia, the Czech Republic.

From 1993 to 2009, there was only one cluster of invasive meningococcal disease (IMD) reported in a community of children in the Czech Republic. This exceptional cluster that occurred in a preschool facility is the focus of this report. In response to the announcement of the disease, anti-epidemic precautions were put in place. Neisseria meningitidis isolates were delivered from local laboratories to the National Reference Laboratory for Meningococcal Infections in Prague. Phenotyping was performed there along with multilocus sequence typing. Related factors and microbiological results were analyzed retrospectively. In October 2009, three girls contracted IMD within a period of 1 week in a 42-member group in a preschool facility attached to the elementary school in Starý Plzenec-Sedlec. In relation to three cases of the disease, another 66 people were registered of which 58 underwent a microbiological examination. N. meningitidis was detected in a total of five (8.6 %) people. The National Reference Laboratory for Meningococcal Infections defined the type of the strain to be C: P1.18-1,34-2,38: F1-7: ST-467 (cc269) and penA27. Tests showed the precise identity of all strains obtained from the three sick children and of two strains contracted through contact with the preschool facility. Despite the complete recovery of all patients with no permanent damage, the need for rapid cooperation between clinical sites, diagnostic laboratories, and epidemiologists was confirmed.

[An unusual course of neuroborreliosis with ocular involvement in a child]. / Neobvyklý prubeh neuroboreliózy s ocním postizením u dítete.

The authors present an account on a complicated case of neuroborreliosis in a child. They draw attention to the possible development of paresis of the oculomotor muscles in borreliosis. They emphasize that this diagnosis should not be omitted in differential diagnostic considerations.

[Anterior uveitis in Lyme borreliosis]. / Prední uveitida pri lymské borelióze.

The authors present an account of two patients with anterior uveitis in the second stage of Lyme borreliosis. The draw attention to diagnostic problems of the disease from the ophthalmological aspect.

[Occurrence of zoonoses in a natural reservoir in the West Bohemian Region. I. Tick-borne encephalitis--basic epidemiologic characteristics]. / K výskytu nekterých zoonóz s prírodní ohniskovostí v Západoceském kraji. I. Klíst'ová encefalitis--základní epidemiologické charakteristiky.

In 1960-1987 in the population of the West Bohemian region by means of various serological methods 621 cases of tick-borne encephalitis were diagnose. The disease was not present in the northern districts (Cheb, Sokolov, Karlovy Vary) and in the mountainous zone along the western frontier of the country. In other areas it is ubiquitary with the highest mean morbidity for the entire period - 5.1 cases per 100,000/year in the district Plzen-South. The morbidity of the population of the regional town was only slightly lower. The patients were most frequently from the age group of 20-29 years. In younger age groups there were twice as many men than women, in children and older age groups the differences were not significant. The incidence was highest in July and August. Only 5.5% cases had the character of an occupational infection. Tick-borne encephalitis is a leisure time disease in the West Bohemian region.

[The contribution of the virology laboratory to the diagnosis of neuroinfections]. / Príspevek virologické laboratore k diagnostice neuroinfekcí.

The authors summarizes the results of a virological examination in 1231 patients with neuroinfections hospitalized in 1973-1984 at the Infectious Diseases Clinic in Plzen. The virological diagnosis contributed towards the elucidation of the aetiology in 62.4% of the patients. In the aetiology participated the virus of tick-borne encephalitis in 28.2%, the virus of epidemic parotidis in 15.8% and a group of enteroviruses in 14.9%. The participation of other viral agents was small.