[Clinical progression of the first wave of novel coronavirus infection in Ostrava].

OBJECTIVES: The first case of coronavirus infection in the Moravian-Silesian Region was diagnosed on March 12, 2020. The study aimed to describe the first wave and clinical manifestation of the coronavirus epidemic at the Department of Infectious Diseases in Ostrava. MATERIAL AND METHODS: The sample comprised a total of 195 patients requiring hospitalization at the Department of Infectious Diseases in Ostrava between March 1 and August 31, 2020. The virus was diagnosed using polymerase chain reaction from nasopharyngeal swabs in 192 patients and from the bronchoalveolar lavage in one patient. In the other two patients, serological tests were applied using virus neutralization assays and ELISA specific antibodies. RESULTS: The sample included 100 men and 95 women. The mean age was 69.5 years. The most common diagnosis was pneumonia, observed in 123 patients (63 %). Respiratory symptoms without pneumonia were seen in 37 patients (19 %); loss of smell and taste in 14 patients (7 %); cardiovascular complications in 9 patients (5 %); acute psychosis in 2 patients (1 %); and diarrhea and vomiting in 25 patients (13 %). The remaining 23 patients (12 %) did not present any symptoms. The mean length of hospital stay was 11 days. The most frequent comorbidity was cardiovascular disease (70 %). A total of 39 patients died (20 %); their mean age was 77 years. Mechanical ventilation was started in 16 patients, of whom 7 died (43 %). The treatment was mostly symptomatic. Hydroxychloroquine was administered to 21 patients (11 %), favipiravir to 26 patients (13 %) and remdesivir to 13 patients (6 %). CONCLUSION: Respiratory complications predominated in the majority of patients with coronavirus infection. In most cases, the treatment was symptomatic. One-fifth of the patients, mostly elderly ones, died.

[Two case reports of chronic hepatitis C retreatment].

In a group of 211 patients with chronic hepatitis C treated with direct-acting antivirals, four experienced therapy failure. Two patients, one originally treated with dasabuvir/ombitasvir/paritaprevir/ritonavir and the other with glecaprevir/pibrentasvir, received a triple combination of sofosbuvir, velpatasvir and voxilaprevir for 12 weeks. Following the retreatment, both patients were permanently virus-free.

[Vertical hepatitis C transmission - authors' experiences].

BACKGROUND: Vertical hepatitis C virus (HCV) transmission and persistence of anti-HCV antibodies were retrospectively investigated since 1999 in a group of 244 children whose mothers had a history of hepatitis C. MATERIAL AND METHODS: Initial examinations performed in most children at 6 months of age included the determination of anti-HCV antibodies, HCV nucleic acid (HCV RNA), and anti-HIV antibodies, with all children being negative for HIV. Further examinations with investigation of anti-HCV and HCV RNA were performed at half-year intervals until the disappearance of anti-HCV antibodies. Vertical HCV transmission was defined by HCV RNA positivity in at least 2 venous blood samples or at least two positive anti-HCV results in a child over 3 years of age. RESULTS: Vertical HCV transmission was detected in 11 out of 244 children (4.5%). Only 2 children spontaneously cleared HCV; positive anti-HCV antibodies were last detected when they were 8 years old. Chronic hepatitis C developed in 9 children, four of whom were infected with genotype 1b, 3 children with genotype 3a, one with genotype 1a, and the last one with genotypes 1a and 4. Antiviral treatment including conventional or pegylated interferon, or ribavirin, was administered to 3 children, with sustained elimination of the virus in 2 children. Although the proportion of children with positive anti-HCV antibodies declined gradually, anti-HCV positivity was reported in 6 uninfected children at 18 months of age but in none of them at the age of 2 years. CONCLUSIONS: Vertical transmission of HCV was found in 11 out of 244 children; chronic hepatitis C was detected in 9 children; uninfected children cleared anti-HCV antibodies by 2 years of age.

[Investigation of autoimmunity markers during interferon alpha therapy of chronic hepatitis B and C - twenty years of experience]. / Sledování autoimunitnich fenoménu pri lécbe chronické hepatitidy B a C interferonem alfa - dvacetileté zkusenosti.

OBJECTIVE: To determine the prevalence of autoimmune parameters in patients with chronic hepatitis B and C (HBV, HCV) treated with conventional or pegylated interferon alpha (IFN) and monitor the development of autoimmune diseases in connection with this treatment. PATIENTS AND METHODS: In the years 1992-2014, autoimmune parameters were evaluated in 324 patients (271 with HCV, 53 with HBV) treated with IFN at the Department of Infectious Diseases in Ostrava. Prior to, during and after completion of IFN treatment, antinuclear antibodies (ANA), antimitochondrial antibodies (AMA), smooth muscle antibodies (SMA), anti-liver/kidney microsomal antibodies (anti-LKM-1), anti-double-stranded DNA antibodies (anti-ds-DNA), antibodies against granulocytes (ANCA), anti-deoxyribonucleoprotein antibodies (anti-DNP), anti-nucleosomes antibodies, rheumatoid factor (RF) and circulating immune complexes (CIC) were determined and clinical manifestations of autoimmune diseases were evaluated. RESULTS: At least one abnormal parameter was present in 267 of 324 patients: ANA in 140, AMA in 13, SMA in 100, RF in 118, ANCA in 11, anti-ds-DNA in 2 and anti-LKM-1 in 1 patient. Increases in CIC were observed in 150 of 227 patients, anti-DNP positivity in 39 of 239 and anti-nucleosomes were positive in none of 43 patients. At least one abnormal parameter was detected in 85 % of patients with HCV and in 89 % of patients with hepatitis B, in 81 % of patients under 40 years of age and in 84 % of older indivi-duals, 90 % of patients with cirrhosis and 80 % without cirrhosis, in 74 % of patients with treatment shorter than 30 weeks and in 87 % of patients with treatment lasting over 50 weeks. Autoimmune diseases - autoimmune hepatitis, autoimmune myositis, myopathy and diabetes - developed in 4 patients while only 3 individuals had ANA, SMA or anti-DNP positivity. CONCLUSIONS: Positivity of ANA and SMA or increased RF and CIC are often found in patients with HBV and HCV treated with IFN, but their presence does not correlate with the development of autoimmune diseases.

[Thyroid dysfunction during interferon alpha therapy for chronic hepatitis B and C - twenty years of experience].

OBJECTIVE: To determine the incidence of thyroid dysfunction in patients with chronic hepatitis B and C (HBV, HCV) who were treated with interferon (IFN) alpha. PATIENTS AND METHODS: In the years 1992-2013, parameters of the thyroid gland were evaluated in 304 patients (256 with HCV, 48 with HBV) who were treated with conventional or pegylated IFN at the Department of Infectious Diseases in Ostrava. Prior to, during and after completion of antiviral treatment, levels of thyroid stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), including their free fractions fT4 and fT3, and anti-thyroid antibodies (anti-thyroglobulin, anti-microsomal fraction) were determined and clinical manifestations of thyroid dysfunction were evaluated. RESULTS: TSH changes were detected in 75 patients (25 %), of whom 68 had HCV and 7 HBV. Hypothyroidism was detected in 39 patients (34 with HCV), of whom 25 required substitute therapy which was subsequently terminated in 5 patients. Hyperthyroidism with transient suppressive therapy with carbimazole developed in 4 HCV patients. In 32 patients, TSH changes were assessed as subclinical hypothyroidism. Abnormal T3 values were found in 188 (62 %) and T4 in 49 (16 %) patients; these changes practically did not correlate with TSH changes. Autoantibodies were detected in 54 (18 %) patients of whom 30 were also found to have changes in TSH. CONCLUSIONS: In a group of 304 patients treated with IFN alpha for chronic hepatitis, thyroid disease with changes in TSH were observed in a quarter of patients; hypothyroidism clearly prevailed. Thyroid diseases developed in half of the patients with the presence of antithyroid antantibodies.

[Low response rate to a vaccination against hepatitis B in patients with end-stage liver disease]. / Malá úcinnost vakcinace proti virové hepatitide B u pacientu s pokrocilým jaterním onemocnením.

Hepatitis B vaccination was started in 41 patients with end-stage liver disease who were liver transplant candidates. Patients received three 20 microg or, starting from 1999, 40 microg doses of recombinant vaccine at 0, 2 and 4 weeks. Blood samples were obtained 4 weeks after vaccination or each revaccination; patients without protective hepatitis B surface antibodies (anti-HBs) were once or repeatedly revaccinated. Thirty-eight patients received at least 3 doses of vaccine. Protective anti-HBs level (≥ 10 IU/l) was detected in 17 of 34 patients (50 %) after the third up to eight dose. No case of chronic HBsAg carrier status was detected. Immunisation against hepatitis B in persons with liver cirrhosis is associated with a poor response and new vaccines should be considered for these patients.