Paretic complications of tick-borne encephalitis and Lyme neuroborreliosis in the Czech Republic: Characteristics and clinical outcome.

Tick-borne encephalitis (TBE) and Lyme neuroborreliosis (LNB), the most common tick-borne diseases of the central nervous system in Central Europe, are frequently associated with pareses. The aim of this study was to characterise paretic complications in patients with TBE and LNB, including their severity, persistence and impact on the patients' quality of life. Our retrospective observational study included patients with aseptic CNS infection due to TBE virus or Borrelia burgdorferi sensu lato. Paretic complications were evaluated in the acute phase and the patients were followed up until complete regression or long-term stabilisation of any neurological deficit. The severity of the neurological deficit was graded according to the modified Rankin Scale (mRS). A total of 823 patients (582 with TBE, 241 with LNB) was included. Paretic complications were diagnosed in 63 TBE patients (10.8 %) and in 147 LNB patients (61.0 %). In TBE, the most common neurological deficit was brachial plexus paresis in 21 patients (33 %) and bulbar symptoms in 18 patients (29 %). In LNB patients, facial nerve palsy was the most frequent neurological deficit (117patients; 79.6 %), followed by lower limb paresis in 23 patients (15.6 %). Forty-nine TBE patients and 134 LNB paretic patients completed follow-up. Paresis resolved within 3 weeks in 16 TBE patients (33 %) and 53 LNB patients (39.5 %), but the proportion of patients with paresis persisting for more than 12 months was significantly higher in TBE (34.7 vs. 3.7 %, p < 0.001). The mean mRS was significantly higher in TBE paretic patients compared to LNB (p < 0.001). Paretic complications are significantly more common in LNB than in TBE but pareses associated with TBE last longer than in LNB and considerably reduce the quality of life of patients. Prevention remains the only way to influence the long-term motor deficits of TBE.

[Microbiological methods for identification of the etiological agents of bloodstream infections with focus on the T2Bacteria Panel].

Blood culture is the gold standard method for identifying the etiological agents of bloodstream infections. A relatively low sensitivity and a long time to detection are its main disadvantages, resulting in delayed administration of pathogen-specific antibiotic therapy and the need to initiate empiric treatment with broad-spectrum antibiotics. Such an approach negatively affects overall treatment outcomes and contributes to the spread of antibiotic resistance. Research in recent years has allowed the introduction of methods for rapid identification of pathogenic microbes from positive blood cultures, as well as methods for direct detection of bacteria and fungi from whole blood without the need for prior culture. Direct detection tests from whole blood have dramatically reduced the time to identify the causative pathogen of a bloodstream infection, but they also have their limitations. Methods that combine PCR and T2-weighted magnetic resonance imaging appear promising. This article provides an overview of diagnostic tests and a detailed description of the T2Bacteria Panel, its advantages and disadvantages based on prospective observational studies and review articles. Future implementation of these methods in the diagnosis of bloodstream infections and potentially localized infections could have a positive impact on the early administration of pathogen-specific antimicrobial therapy and subsequently on overall treatment outcomes, as well as on reducing the spread of antibiotic resistance.

Cerebrospinal fluid CXCL13 in non-borrelial central nervous system infections: contribution of CXCL13 to the differential diagnosis.

BACKGROUND: The chemokine CXCL13 in cerebrospinal fluid (CSF) is used as a diagnostic marker of Lyme neuroborreliosis (LNB). However, the elevated levels in other non-borrelial CNS infections and the lack of a clearly defined cut-off value are limitations of the test. METHODS: In our prospective study, we evaluated CSF CXCL13 levels in patients with LNB (47 patients), tick-borne encephalitis (TBE; 46 patients), enteroviral CNS infections (EV; 45 patients), herpetic CNS infections (HV; 23 patients), neurosyphilis (NS; 11 patients) and controls (46 patients). The correlation of CXCL13 with CSF mononuclears was determined in all groups. RESULTS: Median CXCL13 was significantly higher in LNB group; however, the cut-off value of 162 pg/mL was also exceeded in 22% of TBE patients, 2% EV patients, 44% HV patients and in 55% patients with NS. Sensitivity and specificity were 0.83 and 0.78, respectively, with a Youden index of 0.62. CXCL13 was significantly correlated with CSF mononuclears (p = .0024), but the type of infectious agent had a greater influence on CXCL13 levels. CONCLUSIONS: Increased CXCL13 levels are useful for LNB diagnostics, but other non-purulent CNS infections causes should be considered if intrathecal synthesis of borrelia specific antibodies is not confirmed or clinical manifestations are atypical.

Longer than 2 hours to antibiotics is associated with doubling of mortality in a multinational community-acquired bacterial meningitis cohort.

To optimally define the association between time to effective antibiotic therapy and clinical outcomes in adult community-acquired bacterial meningitis. A systematic review of the literature describing the association between time to antibiotics and death or neurological impairment due to adult community-acquired bacterial meningitis was performed. A retrospective cohort, multivariable and propensity-score based analyses were performed using individual patient clinical data from Australian, Danish and United Kingdom studies. Heterogeneity of published observational study designs precluded meta-analysis of aggregate data (I2 = 90.1%, 95% CI 71.9-98.3%). Individual patient data on 659 subjects were made available for analysis. Multivariable analysis was performed on 180-362 propensity-score matched data. The risk of death (adjusted odds ratio, aOR) associated with treatment after two hours was 2.29 (95% CI 1.28-4.09) and increased substantially thereafter. Similarly, time to antibiotics of greater than three hours was associated with an increase in the occurrence of neurological impairment (aOR 1.79, 95% CI 1.03-3.14). Among patients with community-acquired bacterial meningitis, odds of mortality increase markedly when antibiotics are given later than two hours after presentation to the hospital.

[Role of chloramphenicol in current clinical practice].

INTRODUCTION: Chloramphenicol is an antibiotic with a broad spectrum of action and excellent tissue penetration. It had been widely used in clinical practice until the 1970s, but due to its potential myelotoxicity, it was gradually replaced by newly introduced antibiotics in the following years. The aim of the study was to find out to what extent and with what experience it is currently used in the Czech Republic. METHODS: A questionnaire survey was conducted in July and August 2022. The heads of all inpatient infectious diseases departments, hospital infectious diseases specialists and consulting microbiologists from antibiotic centers in large teaching hospitals without an infectious diseases department were asked to fill out the questionnaire. RESULTS: Thirty-five out of 39 hospitals contacted took part in the study, a response rate of 90 %. Chloramphenicol is used in 37 % of participating hospitals, with a frequency of up to 10 patients treated per year. The most common indications are brain abscesses, purulent meningitis, intra-abdominal, pelvic and lung abscesses, and polymicrobial infections with anaerobes. Chloramphenicol is almost always administered as an alternative antibiotic because of polyvalent allergy, bacterial resistance, and failure of previous treatment. Sixty-six percent of respondents described the effect as reliable or partially reliable, 34 % did not rate the effect. Fifty-two percent of respondents considered a dose of 8-9 g to be the maximum dose for an adult patient. In practice, 60 % of respondents did not encounter or could not assess the myelotoxic effects of chloramphenicol, 37 % observed reversible bone marrow suppression at least once, and only one respondent encountered aplastic anemia once. CONCLUSION: Unfortunately, chloramphenicol is currently used in less than half of hospitals in the Czech Republic. Because of its unique properties, it still has a place in today's anti-infective treatment. When properly indicated and after weighing the benefits and risks, it can be a suitable and sometimes life-saving alternative.

COVID-19 severe pneumonia: Prospective multicentre study on demands on intensive care capacities.

OBJECTIVES: The aim of the study was to obtain data on demands on the intensive care capacities to treat COVID-19 patients, and to identify predictors for in-hospital mortality. METHODS: The prospective observational multicentre study carried out from 1 March till 30 June 2020 included adult patients with confirmed SARS-CoV-2 infection with respiratory failure requiring ventilatory support or high-flow nasal oxygen therapy (HFNO). RESULTS: Seventy-four patients, 46 males and 28 females, median age 67.5 (Q1-Q3: 56-75) years, were included. Sixty-four patients (86.5%) had comorbidity. Sixty-six patients (89.2%) were mechanically ventilated, four of them received extracorporeal membrane oxygenation therapy. Eight patients (10.8%) were treated with non-invasive ventilation and HFNO only. The median of intensive care unit (ICU) stay was 22.5 days. Eighteen patients (24.3%) needed continuous renal replacement therapy. Thirty patients (40.5%) died. Age and acute kidney injury were identified as independent predictors of in-hospital death, and chronic kidney disease showed trend towards statistical significance for poor outcome. CONCLUSIONS: Sufficient number of intensive care beds, organ support equipment and well-trained staff is a decisive factor in managing the COVID-19 epidemic. The study focused on the needs of intensive care in the COVID-19 patients. Advanced age and acute kidney injury were identified as independent predictors for in-hospital mortality. When compared to clinical course and ICU management of patients with severe community-acquired pneumonia caused by other pathogens, we observed prolonged need for ventilatory support, high rate of progression to acute respiratory distress syndrome and significant mortality in studied population.

Disseminated Pelvic Actinomycosis Caused by Actinomyces Naeslundii.

Actinomycosis is a chronic bacterial infection characterized by continuous local spread, irrespective of anatomical barriers, and granulomatous suppurative inflammation. Due to its expansive local growth, it can simulate a malignant tumour. Subsequent hematogenous dissemination to distant organs can mimic metastases and further increase suspicion for malignancy. A case of severe disseminated pelvic actinomycosis associated with intrauterine device is described here. The patient presented with a pelvic mass mimicking a tumour, bilateral ureteral obstruction, ascites, multinodular involvement of the liver, lungs and spleen, inferior vena cava thrombosis and extreme cachexia. Actinomycosis was diagnosed by liver biopsy and confirmed by culture of Actinomyces naeslundii from extracted intrauterine contraceptive device (IUD). Prolonged treatment with aminopenicillin and surgery resulted in recovery with moderate sequelae.

Selected Biomarkers Correlate with the Origin and Severity of Sepsis.

The microbial etiology and source of sepsis influence the inflammatory response. Therefore, the plasma levels of cytokines (IL-6, IL-8, and IL-10), chemokines (CCL2/MCP-1, MIP-1ß), heparin-binding protein (HBP), soluble CD14 (sCD14), and cortisol were analyzed in blood from septic patients obtained during the first 96 hours of intensive care unit hospitalization. The etiology was established in 56 out of a total of 62 patients enrolled in the study. Plasma concentrations of MCP-1, sCD14, IL-6, and IL-10 were significantly higher in patients with community-acquired pneumonia (CAP; n = 10) and infective endocarditis (IE; n = 11) compared to those with bacterial meningitis (BM; n = 18). Next, cortisol levels were higher in IE patients than in those with BM and CAP, and at one time point, cortisol was also higher in patients with gram-negative sepsis when compared to those with gram-positive infections. Furthermore, cortisol and MCP-1 levels correlated positively with the daily measured SOFA score. In addition, HBP levels were significantly higher in patients with IE than in those with BM. Our findings suggest that MCP-1, sCD14, IL-6, IL-10, cortisol, and HBP are modulated by the source of sepsis and that elevated MCP-1 and cortisol plasma levels are associated with sepsis-induced organ dysfunction.

[Guideline for the diagnosis and treatment of acute bacterial meningitis].

Acute bacterial meningitis is a severe infectious disease of the central nervous system. Its incidence decreases but lethality and sequelae remain high. The early initiation of appropriate treatment is a factor strongly determining the patient´s prognosis. The authors submit the Czech national guideline for diagnosis and treatment of community-acquired acute bacterial meningitis which has to provide clear and simple recommendations for clinicans involved in the care of meningitis in adults and children. The national guideline was based on the European guideline published in 2016 and adapted for the situation in the Czech Republic. It was acknowledged (approved? ratified?) by the Society for Epidemiology and Microbiology and the Society for Medical Microbiology of the Czech Medical Association.

[Lactic acidosis due to metformin accumulation complicating acute gastroenteritis].

Lactic acidosis is the most severe adverse effect associated with metformin therapy of type 2 diabetes mellitus. The risk increases in patients with impaired renal function, most commonly due to diabetic nephropathy, and may be augmented when concurrent medication with a negative impact on renal function is used. The authors present a series of three patients who were admitted to a department of infectious diseases for acute gastroenteritis and within a few hours developed shock syndrome caused by severe lactic acidosis due to accumulation of metformin.

[Invasive Pasteurella multocida infections: Two clinical cases and literature review]. / Invazivní infekce vyvolané Pasteurella multocida: popis dvou prípadu a prehled literatury.

Pasteurella multocida is a common commensal of the gastrointestinal and respiratory tracts of animals, especially cats and dogs. It is transmitted to humans through contact with animals. Bite wound infection is the most common clinical manifestation. Systemic infections are unusual and mainly affect immunocompromised individuals. The article presents two cases of Pasteurella infection. Wound infection in a 75-year-old female following a bite from her pet cat was associated with bacteremia. The disease course was favorable with the initial clindamycin treatment despite in vitro resistance. The other patient was a 62-year-old female diagnosed with acute bacterial meningitis with multiple brain abscesses and transient expressive aphasia. She reported frequent contacts with pets and domestic animals without a recent bite. Hematogenous dissemination of the infection was suspected. Because of poor therapeutic response, cefotaxime was switched to chloramphenicol which was later switched to a combination of cefotaxime with ciprofloxacin due to anemia. Following 6 weeks of intravenous antibiotic therapy and another 10 weeks of oral ciprofloxacin therapy, magnetic resonance imaging showed normal results and the neurological defect resolved. Epidemiological, clinical and therapeutic aspects of Pasteurella infection are discussed and literature is reviewed.

[Familial occurrence of botulism - a case report]. / Familiarni vyskyt botulismu - kazuistika.

Botulism, a life-threatening condition, is very rare in the Czech Republic. Since 1960, a total of 155 cases have been reported; between 2010 and 2012, not a single case was identified. This is a case report of familiar occurrence of botulism following consumption of home-made pork and liver pâté in three family members admitted to the Department of Infectious, Tropical and Parasitic Diseases, Na Bulovce Hospital in Prague in May 2013. The neurological symptoms were dominated by diplopia and dysarthria. After administration of an antitoxin, all patients recovered. Given the poor availability of the antitoxin, a decision was made following this small family epidemic to have an emergency reserve of life-saving anti-infective drugs for the Czech Republic in the Toxicological Information Center in Prague.

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.

[Bacteria cleaving small-colony variants as causative agents of infective endocarditis and other severe diseases]. / Bakterie tvorici drobne kolonie (small-colony variants) jako puvodci infekcni endokarditidy a dalsich zavaznych infekci.

Small-colony variants (SCV) associated with specific biochemical features were described in many bacterial species. Bacteria with SCV phenotype have knocked out metabolic pathways for aerobic respiration, thus they behave like strict anaerobes. They are handicapped in competition for nutrients with other microbes but on the other hand they are able to resist some antibiotics and survive inside eucaryotic cells. Therefore they use to cause chronic and/or recurrent infections. Recovery of these infections is not possible without surgery. SCV phenotype seems to be a common life strategy for many bacteria. Its occurrence and clinical importance is similar to that of biofilm formation.

Relapsing endocarditis caused by Enterococcus faecalis forming small colony variants.

Small colony variants (SCVs) are subpopulations of a bacterial strain that differ in morphology, growth rate, metabolism, and antibiotic sensitivity from the parent line. They are associated with chronic and difficult-to-treat infections. SCV endocarditis is very rare and usually associated with intracardiac devices. Herein, we report a case of endocarditis caused by SCV-forming Enterococcus faecalis that affected the native heart without any known predisposition.

[Phylogenetic analysis and genotyping of A/H3N2 Influenza viruses isolated from patients hospitalised with influenza-like illness symptoms in the na bulovce hospital in the season 2011/2012]. / Fylogenetická analýza a genotypizace viru chripky A/H3N2 izolovaných od pacientu hospitalizovaných s príznaky ILI (Influenza-Like Illnesses) v Nemocnici Na Bulovce v sezone 2011/2012.

Influenza A virus is an important cause of acute respiratory infections (ARI). Clinical manifestations of ARI vary from mild or moderate to life-threatening conditions requiring intensive care. Given the segmented genome, a large natural reservoir of other influenza virus subtypes, and antibody selection pressure in the population, the virus is variable and genetically unstable. The phylogenetic analysis and genotyping of A/H3N2 influenza viruses isolated from patients hospitalised with influenza-like illness symptoms in the Na Bulovce Hospital in the season 2011/2012 support the assumption that the pathogenicity is a polygenic trait modifiable by the host health status and seems not to be unambiguously associated with any specific mutations.

[Leptospirosis contracted from pet rats]. / Leptospiroza ziskana od domacich potkanu.

Leptospirosis is a worldwide zoonosis with the highest incidence in tropical regions. The reservoir animals, mainly mice and rats, excrete leptospira organisms in their urine asymptomatically. It is transmitted to human hosts either by contact with the infected urine or via contaminated water or soil during the work and recreational activities. The aim of the case reports is to point out to another potential source of leptospiral infection - domestic rats which have become favorite home pets in the last twenty years. Three patients with various severities of the disease and treated in 2005-2010 are reported. The patients most likely acquired the leptospiral infection from their pet rats.

[Microneutralization assay in the diagnosis of influenza infection]. / Mikroneutralizace v diagnostice chripkové infekce.

Serology plays an important role in the diagnosis of influenza, particularly in the detection of post-vaccination and post-infection antibodies. When considering the range of diagnostic options, the serological method should be selected depending on the circumstances - whether single or paired serum samples are tested, whether adequate patient medical history data are available, whether epidemiological links are suspected, and, in particular, to what purpose the result will be used (differential diagnosis, post-infection follow-up, post-vaccination monitoring, etc.). The virus neutralization assay is one of the most sensitive and most objective serological tests, but it is highly dependent on the reaction balance and quality of the virus used. Determining the protective titer is crucial for the routine practice. Based on our experiments, we concluded that the virus neutralizing antibody titers are up to eight times as high in comparison with the hemaglutination inhibition test (HIT) or complement fixation reaction (CFR), but the correlation varies and is significantly influenced by interindividual variation in anti-neuraminidase antibodies and those against some internal proteins of influenza virus. We assume that the protective titer in the virus neutralization assay will be not less than 1:80. The predictive value of the titers below 1:40 is questionable.