Trends in incidence of extrapulmonary tuberculosis in children in the Czech Republic in the past 35 years.

OBJECTIVE: Extrapulmonary tuberculosis (EPTB) in children globally represents a proportion of all cases of tuberculosis, reaching 20% according to published reports. Children are at a higher risk for disseminated TB and extrapulmonary forms. The most prevalent clinical presentations of EPTB in children worldwide are peripheral lymphadenitis and osteoarticular TB. Peritoneal, urogenital, or meningeal tuberculosis is less frequent, and their diagnosis is often difficult. The aim of the study was the determination of EPTB incidence in children in a low-prevalence region over 35 years. METHODS: Descriptive retrospective study of the incidence of EPTB in children and adolescents (aged 0-18 years) in the Czech Republic in the years 1987-2021 as reported in the tuberculosis register. RESULTS: Total amount of EPTB cases was 95. The most prevalent form was extrathoracic lymph node TB. The median age was 10 years. Most patients (84%) were Czechs. None of them died. The ratio of pulmonary and extrapulmonary TB was 79.8% to 20.2%. CONCLUSION: The low incidence of EPTB in Czech children is congruent with a low incidence of TB in the Czech Republic. Our study confirms that the most frequent form of EPTB is peripheral lymph node TB. Our study did not prove a significant change in the trend of EPTB after the cessation of the mandatory Bacillus Calmette-Guerin (BCG) vaccination programme.

Ten Years' Experience with the Discontinuation of the Bacillus Calmette-Guérin Vaccination in the Czech Republic.

Background: Bacillus Calmette-Guérin (BCG) vaccination programs were introduced in Czechoslovakia more than 60 years ago under a quite different epidemiological situation than that of today. Compulsory mass BCG vaccination was abolished in November 2010 and changed to a selective vaccination program for infants at high risk of contracting tuberculosis (TB). Methods: This work sets out to ascertain the risk of TB and nontuberculous mycobacterial (NTM) infection in the 10-year period following the change to the vaccination program and to compare this with the same period of time when mass BCG vaccination was compulsory. Descriptive study. Statistical analysis of the incidence of tuberculosis and non-tuberculous mycobacteriosis as reported in the TB register in years 2001-2020. Conclusions: The incidence trend of TB in children in both monitored time periods is identical and statistically significantly decreasing (P < 0.001). In the first monitored period, the incidence trend of NTM cervical lymphadenitis in children is degressive and is not statistically significant (P = 0.561). However, in the second monitored period, the trend increases and is statistically significant (P < 0.001); in every compared 2-consecutive year period, there is an increase of 8%. These findings indicate that the change from mass BCG vaccination to selective vaccination of high-risk newborns and the abolishment of BCG revaccination can be recommended, so long as a keen eye is kept on NTM caused lymphadenitis.

Nontuberculous mycobacterial infections in children in the Czech Republic in the period 2003-2018.

AIM: Comparision of the incidence of cervical lymphadenitis caused by nontuberculous mycobacteria in two equal time periods before and after the ending of widespread calmetization (tuberculosis vaccination). Backgroung. From 2011 to 2018, 89 children were registered in the Tuberculosis Register with cervical lymphadenitis caused by nontuberculous mycobacteria, as confirmed by cultivation. In the majority of cases, the infection was caused by a mycobacterium belonging to the Mycobacterium avium complex. Only 7 cases of cervical lymphadenitis of the same etiology were registered during the same time interval between 2003 and 2010. The authors consider the ending of widespread calmetization (tuberculosis vaccination) in 2010 to be the main cause of the growing incidence. METHOD: A comparison of data for the period 2003-2018 about cases of the illness caused by atypical mycobacteria as reported in the Tuberculosis Register. RESULTS: The average incidence per year in the first interval was 0.04/100 000 children and in the second interval 0.53/100 000 children. During the second time interval, there was an increase from 0.14/100 000 children in 2011 to 1.40/100 000 children in 2018. While the incidence during the first time interval did not show any time trend (P=0.885), the year 2010 marks a significant turning point, with growth during the second interval being highly statistically significant (P<0.001).

Cardiovascular Comorbidities in Patients with Psoriasis: Risk Profile Including Carotide Ultrasonography Assessed in Hospital-based Case Control Study.

Psoriasis is a chronic inflammatory disease, and its comorbidities have attracted serious interest in recent years. The evidence that psoriasis is associated with systemic inflammation and significantly higher incidence of cardiovascular risk factors has already been described. The results of published studies are highly variable, the conclusions are ambiguous, and further epidemiological studies are needed for validation of published data. Therefore, we initiated a project aimed at identifying the association with cardiovascular risk factors, including early stages of atherosclerosis, that represent important comorbidities in patients with psoriasis. We carried out a hospital-based case-control study on 189 patients with chronic plaque psoriasis enrolled as cases. The control group consisted of 378 patients with other skin diseases complying with the same exclusion criteria who were recruited to the study as the controls. All participants underwent physical examination, blood tests, and measuring of blood pressure and waist circumference. Furthermore, we evaluated carotid intima-media thickness (CIMT) in a subset of 117 cases and controls (matched 1:2) with no history of cardiovascular disease. The results showed higher prevalence of hypertension, hyperlipidemia, waist circumference, weight, body-mass index (BMI), and C-reactive protein (CRP) level in patients with psoriasis than in controls. These parameters have been clearly demonstrated to be risk factors for the development of cardiovascular diseases. The associations between psoriasis and diastolic blood pressure, BMI value, and low-density lipoprotein (LDL) cholesterol were statistically significant in the binary data logistic model as well. CIMT was not significantly higher in patients compared with controls.

Immunosuppressive therapy in the posttransplant period and skin cancer.

AIMS: To determine the incidence of malignancies in renal transplant recipients (RTRs) and to analyze the association between the risk of skin cancer and immunosuppressive regiments used in the posttransplant period. MATERIALS AND METHODS: A cohort study was performed on 797 RTRs. Standardized morbidity ratio (SMR) was calculated for the most common types of cancer developed in the posttransplant period and different types of immunosuppressive therapy used in the cohort. RESULTS: 192 cases of malignancies were diagnosed in 86 RTRs (10.8%). Nonmelanoma skin cancer (NMSC) was the most frequent type of cancer (SMR = 6.42, p = 0.000), followed by renal cancer (SMR = 5.9, p = 0.000), malignant melanoma (SMR = 2.59, p = 0.080), and prostate cancer (SMR = 1.21, p = 0.593). The risk to develop NMSC was significantly higher in the group where cyclosporine has been used besides tacrolimus, mycophenolatemophetil and steroids as well as in the group treated with the combination without cyclosporine (SMR = 9.62, p = 0.001 and SMR = 5.18, p = 0.000). Furthermore, the risk was significantly higher in RTRs receiving anti-thymocyte globulin within induction therapy (SMR = 4.14, p = 0.000). CONCLUSION: The preliminary results indicate that the risk of NMSC in RTRs is significantly higher than in the general population and thus emphasize the need to improve preventive strategies in the Czech transplant population.

Relative Importance of Traditional Risk Factors for Malignant Melanoma in the Czech Population.

AIM: The Czech Republic is one of the leading European countries in incident cases of malignant melanoma (MM), which is on the rise. The study objective was to assess the strength of associations between MM and the known generally accepted risk factors for MM in the population of the Czech Republic. METHODS: The study was designed as a case-control study where cases were incident cases of MM detected at the Department of Dermatology and Venereology of the Bulovka Hospital. Controls were selected from cancer-free patients admitted to departments other than Dermatology and Venereology. Validated questionnaires were used to collect demographic, epidemiological, and clinical data. RESULTS: The binary logistic model shows the main risk factors for MM: male, female (OR=0.292, 95% CI=0.175-0.486), a changed mole (OR=6.371, 95% CI=3.774-10.756), a history of skin cancer (OR=95.704, 95% CI=37.241-10.756), and sunbeds use (OR=3.594, 95% CI=1.288-10.028). Using sunscreen products was considered as a protective factor against MM (OR=0.253, 95% CI=0.137-0.466). CONCLUSION: The primary and secondary prevention increasingly emerges as a public health priority in the effort to reverse the negative trend in cases of MM and mortality from this disease in the Czech Republic. A prerequisite for an effective secondary prevention through screening is, among others, the identification of the population groups at highest risk for MM.

Malignant melanoma in organ transplant recipients: incidence, outcomes, and management strategies: a review of literature.

Malignant melanoma is considered to be an immunogenic tumor, which is expected to change its behaviour in the field of immunosuppression. Although the incidence of melanoma in organ transplant recipients is increased to a smaller degree than in non-melanoma skin cancer, its potential morbidity and mortality has to be considered in the posttransplant care. The aim of this review is to investigate the relationship between melanoma and immunosuppression and to discuss management strategies for different melanoma scenarios in pre-transplant as well as posttransplant period.

Gastrointestinal comorbidities in patients with psoriasis in the Czech Republic: The results of 189 patients with psoriasis and 378 controls.

AIMS: The aim of the study was to investigate gastrointestinal comorbidities, identify risk factors and detect the early stages of autoimmune gastrointestinal diseases, such as Crohn's disease, ulcerative colitis and coeliac disease in patients with psoriasis. METHODS: This was a hospital-based case-control study. Patients with chronic plaque psoriasis were included as cases. The control group consisted of patients with other skin diseases and who complied with the same selection criteria as cases. Two controls were selected per one case. We analysed the following antibodies (ASCA, AEP, p-ANCA, AGC, EMA, ARA, tTG, AGA) and non-specific signs of gastrointestinal diseases. RESULTS: There were significant differences between cases and controls in several parameters. Leucocyte count, CRP, total protein, transglutaminase IgA antibodies and p-ANCA were statistically significant between groups (P < 0.05). In the binary logistic model, leucocyte count and p-ANCA (for all parameters included in the logistic model P ≤ 0.001) were associated with psoriasis. CONCLUSION: Patients with psoriasis should be regularly screened for coeliac and inflammatory bowel disease. Early diagnosis of gastrointestinal diseases and risk factors may prevent complications and greatly improve the patient's quality of life.

Significantly higher incidence of skin cancer than other malignancies in patients after heart transplantation. A retrospective cohort study in the Czech Republic.

AIMS: To perform the first study in Czech Republic on heart transplant recipients (HTRs), compare the risks for different types of cancer and provide comprehensive analysis of skin cancer and other types of cancer morbidity from which we would be able to derive an evidence-based skin cancer surveillance program. MATERIALS AND METHODS: A retrospective cohort study was performed to determine and compare standardized morbidity ratio (SMR) of different types of cancer developed after heart transplantation. We analysed data obtained from medical documentation of 603 HTRs transplanted between 1993 and 2010. RESULTS: 191 incident cases of malignancy occurred in123 HTRs (20.4%). According to expectations, nonmelanoma skin cancer was the most frequent type of malignancy (119 cases) with SMR 7.6 (P < 0.001), followed by lung cancer with SMR 2.7 (P < 0.001). SMR for melanoma was 2.5, P = 0.129. Other types of cancer in HTRs (prostate and kidney cancer) were less frequent (SMR 2.06, P = 0.038 and SMR 2.03, P = 0.122). CONCLUSION: The risk of malignancy development is significantly higher for HTRs compared to the general population. Squamous cell carcinoma of the skin is the most frequent type of cancer followed by basal cell carcinoma. These findings emphasise the importance of regular skin cancer screening in HTRs.

First case of pachyonychia congenita in the Czech Republic.

Pachyonychia congenita (PC) is a rare autosomal dominant skin disorder characterized predominantly by hypertrophic nail dystrophy, oral leukokeratosis, and painful palmoplantar keratoderma. It is associated with a mutation in one of five keratin genes, KRT6A, KRT6B, KRT6C, KRT16, or KRT17. The International PC Research Registry (IPCRR) confirms that as of January 2014 there have been 547 cases of PC genetically confirmed. It is estimated that there are between 2000 and 10,000 cases of PC in the world. However, the exact prevalence of PC is not yet established. We report a case of PC-K6a, p.Arg164Pro, in a 40-year-old man. Initially he was diagnosed with onychomycosis and was treated with systemic antifungals. This is the first genetically confirmed case of PC in the Czech Republic.

Risk factors for comorbidities in Czech psoriatic patients: results of a hospital-based case-control study.

BACKGROUND: Psoriasis is now known to be associated with multiple other diseases/comorbidities - including the metabolic syndrome, atherosclerosis and gastrointestinal diseases which are all significantly higher in psoriasis patients. Research results however are highly variable and the conclusions are ambiguous. As no similar study has been performed to date in Czech psoriatic patients, this study aimed at identifying risk factors and early stages of selected diseases/comorbidities in the patients. METHODS AND RESULTS: The study was designed as a hospital-based case-control study. 131 patients with chronic plaque psoriasis formed the cases and 267 patients with other skin disorders formed the controls. A comparison was made of basic demographic and anthropometric indicators, metabolic parameters, the presence of specific antibodies (ASCA, AEP, p-ANCA, AGC, EMA, ARA, t-TG, AGA) and non-specific signs of gastrointestinal diseases. The chi squared, MWU tests and binary logistical model were used to evaluate the data. The results showed significant differences (P<0.05) for the following parameters: blood pressure, waist circumference, weight, BMI values, leucocytes values, HDL cholesterol level, glycemia and gliadine antibody IgA level. All differences were to the detriment of psoriasis patients. In the binary logistical model the following parameters were associated with psoriasis: diastolic blood pressure, leucocyte value and glycemia. For all variables included in the logistical model P≤0.001. CONCLUSIONS: The results were coherent and consistent with existing data. They indicate that psoriasis is interconnected with hypertension, higher BMI and a decreased level of HDL cholesterol. These parameters have been clearly demonstrated as risk factors for the development of cardiovascular diseases. Higher levels of gliadine IgA antibodies are one of the diagnostic markers of celiac disease. Higher values of leukocytes may be interpreted as a nonspecific indicator of gastrointestinal inflammatory diseases. The associations between psoriasis and diastolic blood pressure, BMI value and glycemia are statistically significant in the binary logistic regression model. Care for psoriatic patients should focus especially on secondary prevention of predisposing diseases.

A comparative study of the impairment of quality of life in Czech children with atopic dermatitis of different age groups and their families.

BACKGROUND: Atopic dermatitis (AD) still remains one of the most common childhood inflammatory skin diseases. As a chronic disease, it can have a physical and psychological effect on social functioning of the affected child as well as their family. The objective of this study was to evaluate the quality of life of children with AD of different age groups and their families. METHODS: A total of 203 children with a diagnosis of AD from newborn to 18 years of age and 202 of their parents took part in our study (as one parent did not return the questionnaire). All participants, according to their age, completed the following questionnaires: Infants' Dermatitis Quality of Life Index (IDQOL); Children's Dermatology Life Quality Index (CDLQI) - text and cartoon version; and Dermatitis Family Impact questionnaire (DFI). RESULTS: The mean total IDQOL score in our study was 8.18 (SD = 5.84, n = 120). The mean total CDLQI scores in the groups of children from 7 to 13 and from 14 to 18 years were 8.58 (SD = 4.98, n = 48) and 9.89 (SD = 5.26, n = 35). There was also a proven influence of the child's AD on the quality of life of his parents with the mean score: 7.98 (SD = 6.41, n = 202). CONCLUSIONS: The study demonstrated and confirmed that AD significantly impairs the children's quality of life in all age groups and also quality of life of their families. Such data give us patient-oriented information that is of great importance for understanding the situation of individuals with AD and its influence on members of their family.

Rates of contraindications and use of alternative vaccines in routine immunisation of children: a population based study in the Czech Republic.

Contraindications and requests for alternative vaccines can have important implications on vaccination coverage but population rates of contraindications and alternative vaccination occurring in routine immunisation programmes have not been reported. We investigated the rates of contraindications, the proportion of children who fail to complete regular vaccination, and the use of alternative vaccines within the compulsory immunisation of children in the Czech Republic. We conducted a retrospective review of medical records of all 5038 children born between 1 January 2000 and 31 December 2004 and registered in 24 primary paediatric practices. Contraindications against at least one vaccine were found in 291 (5.8%) children. Contraindications were most commonly reported for the DTP-Hib vaccine (263 children, 5.2%), and the most frequent type were central nervous system disorders (171 cases). Contraindications resulted in 181 (3.6%) of incomplete immunisations by at least 1 vaccine, with 80 children (1.6%) remaining unprotected. Alternative vaccines were administered to 935 (18.6%) children; of these, 271 were due to contraindication and 664 on parental request. The rates of contraindications, incomplete immunisations and alternative vaccine use more than tripled over the study period. This study suggests that within the routine immunisation programme, contraindications occur in approximately 6% of children, and many of these children remain incompletely vaccinated.