Is Slovakia Almost a Hepatitis D Free Country?

BACKGROUND: It is assumed that the prevalence of hepatitis D in HBsAg-positive individuals reaches 4.5-13% in the world and on average about 3% in Europe. Data from several European countries, including Slovakia, are missing or are from an older period. METHODS: We analyzed all available data on hepatitis D from Slovakia, including reports from the Slovak Public Health Authority and the results of one prospective study, and three smaller surveys. The determination of anti-HDV IgG and IgM antibodies and/or HDV RNA was used to detect hepatitis D. RESULTS: In the years 2005-2022, no confirmed case of acute or chronic HDV infection was reported in Slovakia. The presented survey includes a total of 343 patients, of which 126 were asymptomatic HBsAg carriers, 33 acute hepatitis B, and 184 chronic hepatitis B cases. In a recent prospective study of 206 HBsAg-positive patients who were completely serologically and virologically examined for hepatitis B and D, only 1 anti-HDV IgG-positive and no anti-HDV IgM or HDV RNA-positive cases were detected. In other smaller surveys, two anti-HDV IgG-positive patients were found without the possibility of HDV RNA confirmation. In total, only 3 of 329 HBsAg-positive patients (0.91%) tested positive for anti-HDV IgG antibodies, and none of 220 tested positive for HDV RNA. CONCLUSION: The available data show that Slovakia is one of the countries with a very low prevalence of HDV infection, reaching less than 1% in HBsAg-positive patients. Routine testing for hepatitis D is lacking in Slovakia, and therefore it is necessary to implement testing of all HBsAg-positive individuals according to international recommendations.

Outbreak of Alimentary Tick-Borne Encephalitis in Eastern Slovakia: An Analysis of Affected Patients and Long-Term Outcomes.

OBJECTIVE: Tick-borne encephalitis (TBE) is an endemic zoonotic viral disease in many European countries and in the central and eastern parts of Asia. Slovakia reports the highest occurrence of alimentary tick-borne encephalitis in Europe, after the consumption of unpasteurized milk and cheese from domestic ruminants. In May 2016, an outbreak of tick-borne encephalitis that emerged after the consumption of sheep cheese occurred in eastern Slovakia. In total, 44 people were ill and 36 were hospitalized. METHODS: Data from the 36 hospitalized patients at the Department of Infectology and Travel Medicine in Kosice with TBE were retrospectively analysed from the medical documentation. The patients were contacted 3 years after discharge. RESULTS: Twenty of the hospitalized patients had meningoencephalitis and 16 had meningitis. The main symptoms that occurred in all patients were fever and headache. Nuchal rigidity was seen in 50% of the patients. Three patients developed late systemic complications and another six patients had psychiatric complications. None of the patients died. Three years after the disease onset, 52% of contacted patients reported persistent discomfort. CONCLUSIONS: TBE is an infection with a wide range of clinical courses. Our findings suggest that alimentary-acquired TBE lead to severe disease and persistent discomfort.

Comparison of Two Diagnostic Methods for the Detection of Hepatitis B Virus Genotypes in the Slovak Republic.

The hepatitis B virus (HBV), belonging to the Hepadnaviridae family, is responsible for a global health concern still in the 21st century. The virus is divided into 10 genotypes, which differ in geographical distribution and in their effect on disease progression and transmission, susceptibility to mutations, and response to treatment. There are many methods for diagnostics of HBV and differentiating its genotypes. Various commercial kits based on real-time polymerase chain reaction (RT PCR) and hybridization available, as well as whole genome sequencing or the sequencing of only individual parts of the genomes. We compared a commercial kit AmpliSens HBV-genotype-FRT, based on RT PCR, with an adapted method of amplification of the surface genomic region combined with Sanger sequencing. In the examined samples we identified the A, B, C, D, and E genotypes. By PCR with Sanger sequencing, the genotypes were determined in all 103 samples, while by using the commercial kit we successfully genotyped only 95 samples, including combined genotypes, which we could not detect by sequencing.

[Tick-borne encephalitis in a pregnant patient].

There is a lack of information in the literature about the course and risk of vertical transmission of tick-borne encephalitis (TBE) during pregnancy. Presented is a case report of a female patient in the 37th week of pregnancy infected by foodborne transmission. She developed meningitis with no neurological damage. Three weeks after the first symptoms, she gave birth to a healthy child who, at the age of 30 months, had a negative result of anti-TBE antibodies in both IgM and IgG classes. In the child, no signs of neurological injury or impaired psychomotor development were observed throughout the follow-up period.

Noninvasive Assessment of Liver Fibrosis in Patients with Chronic Hepatitis B or C by Contrast-Enhanced Magnetic Resonance Imaging.

Background and Aim. To develop a noninvasive magnetic resonance imaging (MRI) method for evaluation of liver fibrosis. We evaluate the utility of hepatocyte-phase Gadoxetate disodium-enhanced magnetic resonance (MR) imaging in staging hepatic fibrosis and compare it with histological analysis as the reference standard (liver biopsy). Methods. Prospective cohort of 78 patients, who received Gadoxetate disodium dynamic contrast-enhanced MRI (DCE-MRI), were divided into three groups. The first group (n=19) was a control group of healthy individuals without liver injury and remaining 59 subjects were chronic hepatitis B and C patients who underwent liver biopsy. These patients were divided into the mild fibrosis F1-F2 (n=32) and advanced fibrosis F3-F4 (n=27) groups. Patients were examined by generated DCE-MRI in 20th minute. Variables such as liver surface changes, homogeneities, and quantitative contrast liver/spleen ratio-Q-LSCR were evaluated and these results were consequently compared between the three groups. Results. Gd-EOB-DTPA contrast-enhanced dynamic liver MRI examination (DCE-MRI) can in the 20th minute differentiate mild stage of liver fibrosis (F1-F2) from severe stage of liver fibrosis (F3-F4) on the basis of liver surface changes, homogeneities, and quantitative contrast liver/spleen ratio-Q-LSCR. Diagnostic MRI criteria were created and named MRI Triple test. This test correctly identified 96% of patients with F3-F4 fibrosis and 91% of patients with the F1-F2 fibrosis in the liver biopsy. This test correctly identified 42,1% of patients in the control group (presumed F0 fibrosis without liver disease). Spearman's rank correlation coefficient (r = 0,86, P < .001) confirmed high agreement of biopsy and MR Triple test. MR Triple test's sensitivity was 96.30% (95%CI 81.03% to 99.91%), specificity 90.62% (95%CI 74.98% to 98.02%), positive predictive value 89.66% (95%CI 74.64% to 96.23%), and negative predictive value 96.67% (95%CI 80.86% to 99.50%) for discrimination between F3-4 and F1-2 fibrosis on liver biopsy. Conclusions. Gd-EOB-DTPA contrast-enhanced MRI liver examination in 20th minute is able to reliably differentiate mild stage of liver fibrosis (F1-F2) from severe stage fibrosis (F3-F4) on the basis of Triple test (liver surface changes, homogeneities, and quantitative contrast liver/spleen ratio-Q-LSCR).

Single centre clinical experience with fidaxomicin in the treatment of Clostridium difficile infection in Slovakia.

OBJECTIVE: Clostridium difficile infection (CDI) has become one of the most common causes of hospital-acquired infections. Fidaxomicin is one of the latest antibiotics used in the treatment of CDI, however, treatment cost affects recommendations for its use in several countries. We have analysed the treatment of our patients with CDI, treated by fidaxomicin since it was introduced to the market in 2018 and became available in the second biggest Slovak hospital, University Hospital of L. Pasteur. Our aim was to determine efficacy and safety of fidaxomicin in the treatment of CDI in Slovak patients. METHODS: We reviewed all courses of fidaxomicin use in our hospital (n = 60). Fidaxomicin was used for first recurrence (12 times), second recurrence (4 times), third recurrence (2 times), and fifth recurrence (1 patient). 41 patients received fidaxomicin first-line. RESULTS: Success of fidaxomicin treatment was recorded at 86.7% within the whole cohort. In the recurrent Clostridium difficile infection (rCDI) subgroup, fidaxomicin was 63% effective with three patients dying (15.7%) and two patients developing subsequent rCDI. During the duration of the study, 6 patients in total died. Only one of three patients, with three or more recurrences of CDI, had no further presentations after eight weeks of completion of treatment. CONCLUSIONS: The biggest benefit from fidaxomicin treatment was shown in a cohort of patients with primary CDI infection demonstrating a low recurrence rate and significant reduction of fidaxomicin effectiveness in preventing a recurrence when treating patients with multiple rCDI.

Lower Viral Response to Pegylated Interferon Alpha 2a Treatment of Chronic Hepatitis B in Roma People in Eastern Slovakia.

Aim. To evaluate the compliance and virological response to pegylated interferon alpha 2a treatment of chronic hepatitis B in Roma population compared to majority Caucasian population in Slovakia. Methods. Retrospective evaluation of a cohort of all Roma patients treated with pegylated interferon alpha 2a from 2007 to 2013 in 3 centers for treatment of chronic viral hepatitis B. The Study included 43 Roma patients with chronic viral hepatitis B and randomly selected control group. Treatment duration was 48 weeks. Viral response was evaluated after 24 weeks, at the end of treatment, and 24 weeks after the end of treatment. Results. Complete treatment course was finished by 79.1% of Roma patients compared to all patients from the control group (p = 0.0009). There was a tendency toward lower viral response rate in Roma at all time points; however significant difference was only at end of treatment viral response (51.2% Roma versus 81.4% majority, p = 0.003). We also did not find significant difference at the rate of HBsAg loss. Conclusion. Roma patients with chronic hepatitis B have significantly worse compliance to treatment with pegylated interferon and they have significantly lower rate of end of treatment viral response.