Carriage of Neisseria meningitidis in newly enlisted young military professionals during the COVID-19 pandemic

Aim: Invasive meningococcal disease (IMD) is still a major threat not only to the youngest age group of children but also to adolescents and young adults. Higher rates of meningococcal disease have also been reported in specific at-risk groups, such as secondary and tertiary students and members of the military. Infection occurs after close contact with a clinically ill individual, but most often with an asymptomatic carrier. The aim of our study was to determine the prevalence of carriage of N. meningitidis in young persons newly enlisted in the Army of the Czech Republic (ACR). Material and methods: During August 2021, persons entering the service in the ACR were asked to participate in the presented study approved by the Ethics Committee. Nasopharyngeal and oropharyngeal swabs were collected from the study participants in August. A questionnaire survey was administered to each of them after signing an informed consent form. The biological samples were cultured on the day of collection and analysed for N. meningitidis. In case of meningococcal detection, the serogroup of N. meningitidis was determined. For most of the study participants, swabs were repeated after 2-3 months, in October and November. Swabs were also collected from additional participants, namely students entering the first year of bachelor and master studies at a military college. Results: A total of 252 newly recruited young military professionals, 201 males and 51 females, were included in the study. Carriage of N. meningitidis was found in 13 study participants, i.e., 5.2 % of all tested subjects, with a predominance of positive findings in the summer period. All carriers were males while in females, meningococcal carriage was not detected. In carriers, serogroup B was predominant over non-groupable isolates (NG). There was no evidence of carriage of meningococcal groups A, C, W, X, or Y. Meningococcal isolation was significantly more successful from oropharyngeal compared to nasopharyngeal swabs. Only in five of 17 positive findings, meningococci were detected from both the oropharynx and nasopharynx. No isolation was made from the nasopharynx alone. Conclusion: The lower percentage of meningococcal carriage in young military professionals in the Czech Republic in the study period 2021 as compared to similar reports on military collectives from other countries can be attributed to the current epidemic situation, where the measures taken in connection with the efforts to prevent the spread of COVID-19 resulted in the loss of seasonality of respiratory diseases and also their significantly lower incidence. This correlates with a reduction in carriage in the monitored age category.

[Experience with laboratory diagnosis of Clostridium difficile]. / Zkusenosti s laboratorní diagnostikou Clostridium difficile.

BACKGROUND: Clostridium difficile is currently a significant cause of nosocomial diarrhea. For several years, the number of infectious cases in the community has also been increasing. Since the beginning of 2010, quite a large increase in the number of Clostridium difficile infections (CDIs) has been noted in Pardubice Regional Hospital (PRH). The objectives of this study were to describe and evaluate the methods used in the laboratory diagnosis of CDIs in PRH, and to describe the laboratory diagnostic algorithm used here. MATERIAL AND METHODS: Samples of stools were taken from symptomatic patients hospitalized or examined in the outpatient departments of PRH from 1 July 2010 to 31 December 2012. For the detection of glutamate dehydrogenase (GDH) and toxin A/B, the dual test based upon the principle enzyme immunoassays C. Diff Quik Chek Complete, Techlabo (D-EIA) was used. The system GeneXpert PCR Cepheid (PCR) was used for confirmation of laboratory findings. Since the beginning of 2011, all the GDH-positive samples were cultured. RESULTS: A total of 2,040 samples were examined. The D-EIA test was used for examination of 2,014 samples. Of those, 1,373 (68.2 %) samples were GDH- and toxin A/B-negative. In 359 (17.8 %) samples, both GDH and toxin A/B were detected. The D-EIA sensitivity and specificity for detecting toxigenic strains in stool samples were 21.8% and 97.2%, respectively. The PPV and NPV rates calculated for the populations with prevalence rates of disorders of 5%, 10%, 20% and 50 % were 0.29, 0.46, 0.66, 0.88 and 0.96, 0.92, 0.83, 0.55, respectively. The sensitivity and specificity of GDH for the detection of Clostridium difficile in stools were 100.0% and 96.2%, respectively. PCR examination was carried out in 140 samples. Of those, 82 samples were PCR-positive. The gene for the production of toxin B was detected in 47%, the finding suspected for ribotype 027 (gene for toxin B, binary toxin and deletion of tcdC) in 48%. In 5% of the samples, the gene for toxin B and the gene for the binary toxin were detected. CONCLUSION: Considering the low sensitivity of the D-EIA test for detecting the toxigenic strain of Clostridium difficile, if used as the only one, a two-step algorithm was introduced for routine laboratory examination of infections with Clostridium difficile in the Clinical Microbiology Department of PRH. In the first step, the D-EIA test diagnosed 86 % of examined samples in 30 minutes as positive (GDH +; toxin A/B +) or negative (GDH -; toxin A/B -). The examination with PCR in the second step increased the number of patients diagnosed with CDI. The test results are available within two hours. This enables quick introduction of isolation measures in the departments of PRH and appropriate antibiotic treatment of the patients.

[Herpes zoster in the Czech Republic--epidemiology and clinical manifestations]. / Herpes zoster v Ceské republice--epidemiologie a klinické projevy.

Herpes zoster (shingles) is a viral infection of the skin that manifests itself as painful, unilateral vesicular rash. The causative agent is varicella-zoster virus (VZV). Primary infection with VZV causes chickenpox, a common childhood infection, and then the virus lies dormant in the sensory neural ganglia, reactivating to cause shingles. The most important complications are neurological disorders (in particular postherpetic neuralgia) and eye disorders. First-line therapy are antiviral agents. A single vaccine has been registered to date. Herpes zoster occurs sporadically in the Czech Republic and its incidence is long-term stable. In 1990-2008 the average annual incidence was 6306 cases (61.3 cases/100,000 population), with the lowest number of 5511 cases (53.5/100,000) reported in 1991 and the highest number of 6,894 cases (67.6/100,000) reported in 2002. The incidence rate in females (69.9/100,000) was 1.4 times as high as in males (49.5/100,000). From the age perspective, the elderly are at a considerably higher risk of developing shingles. In 2008, the incidence rate was the highest in the age group 70 years (155.0/100,000). Nevertheless, the beginning of the upward trend is seen in the age group 45-49 years. Herpes zoster does not show any seasonal trend.

[Penetration of ceftriaxone into the cerebrospinal fluid and its relationship to inflammatory markers during bacterial meningitis]. / Prunik ceftriaxonu do likvoru a jeho v vztah k markerum zánetu v prubehu invazivní bakteriální infekce.

AIM: To evaluate the penetration of ceftriaxone into the cerebrospinal fluid (CSF) in patients with invasive bacterial infection and to define correlation between the penetration and laboratory markers of inflammation. MATERIAL AND METHODS: Levels of ceftriaxone in the serum and CSF of 17 patients with purulent meningitis were examined. Serum concentrations of ceftriaxone before and after its administration were measured in 9 patients (18 samples, 52.9 %) by microbiological assay based on the agar diffusion test. In all patients, the CSF/serum quotient for ceftriaxone was calculated and correlated with laboratory markers of inflammation (C-reactive protein, fibrinogen and neutrophils). The CSF from nine patients with positive culture for bacteria was used for a modified bactericidal test. RESULTS: Ceftriaxone levels in the serum before and after administration (31.2 mg/l -/+ SD 12.29 and 300.0 mg/l -/+ SD 125.9, respectively) were different (p = 0.000156). The decrease of ceftriaxone levels in the CSF was gradual. There was also a significant difference between the levels of inflammatory markers and CSF/serum quotient of ceftriaxone. Patients with the values higher than 0.1 had higher CRP serum levels (p = 0.00192), fibrinogen serum levels (p = 0.0178) as well as neutrophil count in the CSF (p = 0.0112). However, no inflammatory markers (or their combinations) predicted the extent of penetration of ceftriaxone into the CSF. CONCLUSION: High serum concentration of ceftriaxone causes higher penetration through the inflamed blood-brain barrier. Higher antibiotic penetration correlated with the extent of systemic inflammatory response. However, no inflammatory marker predicted the rate of ceftriaxone crossing the blood-brain barrier. Ceftriaxone penetration, with a 24-hour regimen of administration, remains reliable and efficient therapy of purulent meningitis.

Long-term monitoring of the immune reactivity of stainless steel welders.

The immune reactivity of stainless steel welders (n = 22-53) was evaluated in a three year's study. The results (phagocytic activity, cellular and humoral immunity) were statistically compared with those in control group of non-exposed persons from the same plant (n = 14-23) and with long-term laboratory reference values (LRV) (n = 14-311). In welders several changes were found when compared to the LRV: in humoral response there were higher prealbumin, lysozyme, circulating immune complexes and lower IgG. In phagocytic tests there were lower ingestion, bactericidal activity and higher metabolic activity of peripheral mononuclear leucocytes. In cellular immunity the marked lymphocytosis, higher counts of T-lymphocytes, CD4+ and CD8+ lymphocytes were noticed. After lowering the concentrations of metals in the working area there were trends to normal values in some parameters [relative numbers of T-lymphocytes, relative number of CD4+ lymphocytes, phagocytic activity, metabolic activity of leucocytes (INT index), IgA, complement C3, transferrin]. The extent and the length of the exposure to welding fumes, smoking and changed conditions at working place were followed as well.

[Dynamics of antibiotic release from glass ceramic material.]. / Dynamika uvolnování antibiotik ze sklokeramických materiálu

Using the agar pit method, the authors assessed elution curves of the antibiotics lincomycin, gentamicin and neomycin previously used to saturate bioactive glass ceramic materials BAS-0 and BAS-HA with different porosities. The release into buffered saline at a temperature of 37 C was investigated for a 60-day period. Coagulated human blood on the surface of the granules and blocks used retarded and prolonged the release of antibiotics from glass ceramics. Elution took place in two stages: during the first 12 hours, the maximum of each antibiotic was released and this rapid rise was followed by flattening of the curve and release of a small amount of antibiotic only, which however was detectable still after 60 days. From BAS-0 lincomycin was released most readily, from BAS-HA gentamicin. The poorest release was recorded in all instances from neomycin, al-though the amount of this antibiotic was sufficient for bactericide activity. Further research should lead to prolongation of the first stage of maximum antibiotic release. Key words: bioactive, porous glass ceramics, release of antibiotics from carrier.

[Dynamika uvolnování neomycinu a linkomycinu in vitro ze sklokeramických materiálu]. / Dynamics of Releasing of Neomycin and Lincomycin in Vitro from Glass-ceramic Materials.

The dynamics of release of neomycin and lincomycin from glass-ceramic materials BAS-0, BAS-HA and BAS-R in the form of cullet was monitored in vitro. After the saturation by individual antibiotics the glass-ceramic samples were overlaid with fibrin glue and after it became solid they were covered with buffered physiological solution. In the samples taken at planned intervals in the course of 2 months eluted ATB quantity was determined by agar well method. Release of ATB from glass-ceramics proceeded in two phases, elution slowed down in most cases after 6 hours. With the use of composites there occurred another slowing down of the speed of elution after another 48 hours. Of the total eluted quantity of ATB 50 % was released in neomycine in 2-4 hours, in lincomycin in 6 hours. After 48 hours only small quantities of ATB were eluted, however, they were still detected at the end of the monitored period. The total released quantity of ATB was influenced by the type of the material used, or to a lesser extent, also by size of its particules and in case of composites by the proportion of their components. Key words: bioactive, porous glass-ceramics, separation of antibiotics from the carrier, Beriplast fibrin glue.

Immunological monitoring of dry-cleaning shop workers--exposure to tetrachloroethylene.

A panel of immunological parameters has been examined in a group of dry-cleaning workers (n = 21) and in a control group of administrators (n = 16) from the same plant. The results were also compared to long-term laboratory reference values (LRV) (n = 14-311). External exposure to tetrachloroethylene (PER) was represented by TWA (8 h) values in the range 11-752 mg PER/m3. Biological monitoring showed an amount from 9 to 344 mg PER/m3 in exhaled air by the end of workshift. 1. The exposed dry-cleaning workers compared to the controls from the plant had statistically significant changes in metabolic activity of phagocytes, alpha 2-macroglobulin, C3 and C4 complement component, salivary secretory IgA, and blastic transformation test. Most of the values were within the range of normal values. 2. The exposed dry-cleaning workers had several abnormal immune parameters compared to the long-term laboratory values (LRV) especially in the alpha 2-macroglobulin, C3 and percentage of T-lymphocytes. Most of the changes, even those that were statistically significant, were still within the range of normal values, but they might be classified as trends or shifts away from normal (spontaneous blastic transformation, absolute number of phagocyting cells, coeruloplasmin, circulating immunocomplexes, serum lysozyme). 3. The non-exposed controls from the same plant showed both quantitative and qualitative differences when compared to the LRV. Changes were seen in IgG, C4, CSI and in increased spontaneous metabolic activity of leucocytes, total leucocyte count, absolute number of phagocyting cells, alpha 2-macroglobulin, prealbumin, C4, circulating immunocomplexes and serum lysozyme. 4. The distribution analysis of all results detected a large number of abnormal values in both groups, more in the at-risk group. 5. As inhalation was the main route of PER exposure it was concluded that the changes might represent aspects of the response of the respiratory immune system, mainly of the alveolar macrophages. Additional postinfection effects could not be excluded in both studied groups. Individual differences in immune reactivity as well as individual range of exposure should be taken into consideration.

[Basic indicators of cellular immunity in patients with chronic staphylococcal osteomyelitis]. / Základní ukazatele buneené imunity u pacientu s chronickou stafylokokovou osteomyelitidou.

The objective of the presented work is to compare the state of the immune system in patients with chronic osteomyelitis with a group of the healthy population. The authors followed up on a long-term basis a group of 24 patients with chronic osteomyelitis of staphylococcal origin; they completed immunological examinations comprising cellular and humoral immunity (in particular assessment of T-lymphocytes and their sub-populations by means of monoclonal antibodies, examination of phagocytic capacities of blood elements, assessment of selected plasma protein and immunoglobulin levels). Comparison of results of these examinations in patients with chronic osteomyelitis and the healthy population proved statistically very significant differences in particular in the number of T-lymphocytes (reduction of T-lymphocytes CD 4+, i.e. helpers, immunity stimulating cells and reduction of the ratio of immunity promoting lymphocytes and immunity inhibiting lymphocytes). The authors found also significant differences in the levels of plasma proteins and immunoglobulins.

[Health status in stainless steel welders]. / Sledování zdravotního stavu svárecu nerezových ocelí.

Health state, as well as hematological, biochemical and cytogenetical changes of 53 stainless steel welders were checked-up. Results were compared to those of non exposed persons (control), and to a group of firemen. Urine metals concentrations correlated with the welding fumes density. In the majority of welders typical complaints appeared: aqueous nasal secretion of a clogged nose feeling. Only some of workers suffered from a metal vapours fever. No changes witnessing the above mentioned risk factors influence on the hematological and biochemical findings were ever proved. Cytogenetical analysis confirmed an increased genetic risk.