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We present a case of a 17-year-old female with anti-NMDAR encephalitis probably associated with vaccination against yellow fever. Her symptoms occurred 27 days after vaccination against yellow fever. Anti-NMDAR encephalitis manifested as acute psychosis, memory loss and catatonia following fever with complex partial epileptic seizures. Interictal electroencephalogram showed slow-wave delta background activity with "delta brushes". The diagnosis was confirmed by NMDAR antibody positivity in serum and cerebrospinal fluid. Since ovarian teratoma, as the most common cause of anti-NMDAR encephalitis, did not develop within five years from its onset, the association with vaccination against yellow fever seems to be highly probable.

Intestinal infections caused by the Clostridium difficile (CDI) bacterium currently represent a serious medical problem. They belong to the most frequent nosocomial infections and, in some countries, a community-acquired disease with a significantly increased incidence of community associated CDI is reported. The infection can manifest as mind diarrhea, but also as a life-threatening illness accompanied by paralytic ileus and painful distension of the colon, developing into secondary sepsis. Recurrent forms difficult to manage are a relatively common complication of the disease. Severity of infection may be influenced by the virulence of the causative strain. Severe course of the disease is associated with ribotypes 027, 078, 001. In the Czech Republic, ribotypes 001 and 176 have predominated over the last years. Laboratory diagnosis is based on the detection of C. difficile glutamate dehydrogenase and free clostridium toxins (A,B) in a diarrheal stool sample or culture of C. difficile in anaerobic conditions. Metronidazole, vancomycin and fidaxomicin are the drugs of choice in the treatment of aC. difficile with administration according to the actual treatment guidelines. Fecal bacteriotherapy is recommended in treatment and prevention of recurrent CDI. Surgery is indicated in progressive complicated forms when no response to medication is achieved and the patient is in a critical condition.Key words: Clostridium difficile intestinal infection epidemic ribotypes clostridium colitis treatment.

Objective: To provide basic clinical, laboratory, and microbiological characteristics of adult patients with campylobacteriosis admitted to the Department of Infectious Diseases University Hospital Brno (UHB), in 2011-2013., Materials and Methods: A retrospective analysis of clinical and laboratory parameters of 160 patients hospitalized with campylobacteriosis at the Department of Infectious Diseases, UHB from 1 January 2011 to 31 December 2013., Results: There was no lethality or bacteremia reported in the study group of 160 adult patients (n=160) with campylobacteriosis. A more severe form of the disease with signs of systemic inflammatory response syndrome (SIRS) occurred in 24 patients, i.e. 15% of the study population. Transient mild to moderate leukocytopenia and thrombocytopenia were seen in 16 (10.0%) and 24 patients (15.0%), respectively, and seven patients (4.4%) had bicytopenia. The following factors correlated statistically significantly with the intestinal form of the disease and SIRS: age under 70 years (p=0.037), absence of arterial hypertension (p=0.044), immunosuppressive treatment (p=0.008), leukocyte count in the peripheral blood over 12.0×10(9)/l (p=0.023), and body temperature over 38.0 °C (p<0.001). Antibiotic treatment was used in 96.3% of patients with the intestinal form and in 100.0% of patients with SIRS. The average duration of antibiotic treatment was 8.8 and 9.3 days, respectively. Postantibiotic colitis due to Clostridium difficile occurred in seven patients (4.4%). There were no organ or autoimmune complications observed., Conclusions: Campylobacteriosis with SIRS occurs preferentially in persons under 70 years of age. Empirical antibiotic treatment is used too frequently without being adequately deescalated.

Objective: To assess the availability of the laboratory diagnosis of infections caused by C. difficile in the Czech Republic (CR), including the range of tests used, possible combinations, and adequate interpretation of model results., Material and Methods: Data were collected through a web questionnaire survey with the participation of representatives of 61 public and private microbiological laboratories. The questionnaire addressed the use of diagnostic test kits and culture media in the diagnosis of C. difficile infection (CDI). In addition, the respondents were asked to interpret a glutamate dehydrogenase (GDH) positive and, at the same time, toxin A/B negative result, without or with laboratory confirmation if available., Results: In the CR, the most commonly used test in the diagnosis of CDI is the C. DIFF Quik Chek Complete® test (Alere) for the detection of GDH and A/B toxins, as reported by 50 (82%) laboratories. Anaerobic culture is performed by 43 (70.5%) laboratories, 21 (48.8%) of which use selective agar (Oxoid). Direct detection of DNA of toxigenic C. difficile is feasible in 17 (27.9%) laboratories, with most of them (15 laboratories) using the closed system Xpert® C. difficile (Cepheid). The diagnosis based only on the detection of GDH and A/B toxins is used by 13 (21.3%) laboratories. Two (3.3%) laboratories detect A/B toxins alone and three (4.9%) laboratories carry out the detection of A/B toxins followed by anaerobic culture. A three step scheme: detection of GDH and A/B toxins with subsequent anaerobic culture is used by 26 (42.6%) laboratories. The detection of GDH and A/B toxins along with a PCR assay are provided by three (4.9%) laboratories. A complete diagnostic scheme for CDI (detection of GDH and A/B toxins, direct detection of DNA, and aerobic culture) is feasible in 14 (23%) laboratories., Conclusion: This questionnaire survey study identified 24 different testing algorithms to be in use within the study period (April to July 2014) in the CR. Five (8.2%) laboratories have no highly sensitive screening test such as the detection of GDH or nucleic acid amplification test (NAAT) included in their testing algorithm. Thirteen (21.3%) laboratories perform the detection of GDH and A/B toxins but have no confirmation method to be used if only one test turns out positive. In the case of GDH positivity and A/B toxin negativity, the result should be provided with a supplementary comment on further possibilities for the laboratory detection of CDI and the claimed sensitivity of the test used. If no confirmation test is available, the result should be considered as epidemiologically and clinically significant, once other possible causes of diarrhoea are ruled out.

Clostridium difficile infection (CDI) is a disease of varying severity. Its manifestations range from mild diarrhea to life-threatening paralytic ileus, painful distension of the large bowel, and sepsis. Another possible manifestation of the disease is recurring colitis that can exhaust the patient. For establishing the diagnosis, the patient's stool should be examined with two or three different microbiological methods (testing for clostridial toxins A and B; testing for clostridial glutamate dehydrogenase, anaerobic culture with specific media, or PCR detection of genes for production of clostridial toxins). An alternative way of assessing the etiology is colonoscopic examination; the disease is confirmed if characteristic patchy pseudomembranes are present in the bowel mucosa. Optimal treatment depends on severity of the disease and on the risk of recurrence. Metronidazole, vancomycin and fidaxomicin are used as basic drugs. Fecal transplantation is effective in recurrent disease. In the hospital setting, patients suffering from CDI should be isolated for the entire duration of diarrhea. Surveillance rules also should be applied, together with early treatment of symptomatic patients and prevention of the spread of the infection. Higher incidence of CDI in a ward implies that the local antibiotic prescription habits should be revised.

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.

The bacterium Clostridium difficile is pathogenic for both humans and animals. This feared nosocomial infectious agent is increasingly more important in the community as well. Like in humans, the gastrointestinal tract is infected in animals. The bacterium may be transmitted from animals to humans via the food chain (e.g. pork meat) or by direct contact. Identical human and animal isolates of C. difficile have been reported in several studies. The article presents results from a small local study aimed at detecting C. difficile and its toxins in the District of Olomouc, Czech Republic, by 3 different methods.

Aim of the Study: Description of basic epidemiological and clinical data of patients suffering from Clostridium difficile infection (CDI). Recognizing important predisposing factors and detecting complications of the disease., Materials and Methods: A retrospective study of clinical and laboratory parameters in patients with confirmed CDI who were admitted in our department between 1 January, 2008 and 30 June 2010. Etiology of the disease was identified using the enzyme-linked flourescent assay (ELFA)., Results: Clostridial etiology of post-antibiotic diarrhea was found in 82 patients. Those were 44 women and 38 men, aged 5-88 years (median of 66 years). Fifty-two patients (76 %) were older than 60 years. Seventy-seven patients (92 %) were given antibiotics before the onset of the disease, three patients received cytostatic therapy. In most cases, the disease began after treatment with aminopenicillins, third-generation cephalosporins or fluoroquinolones. Fifty-three patients (65 %) reported previous hospitalization. In 17 patients (21 %), the disease recurred; two patients developed ileus. Eleven patients died; with the death being caused by CDI in four of them., Conclusions: CDI is a live-threatening disease mainly affecting elderly hospitalized patients with comorbidities. The most important predisposing factor is the administration of broadspectrum antibiotics. Early diagnosis and treatment may improve the prognosis of serious cases.

In recent years, Clostridium difficile has been among the most important nosocomial pathogens. It causes intestinal infectious diseases detectable by numerous laboratory methods. Given the severity of the diseases, some tests have proved inadequately sensitive. The article summarizes the first experience with the latest kits for early and sensitive detection of toxic strains of Clostridium difficile.

Clostridium difficile is an important pathogen causing nosocomial diarrhoea and colitis which, in severe cases, may result in pseudomembranous colitis and eventually death. The main pathogenicity factors for C. difficile are toxins referred to as A and B. The diagnosis of diseases caused by C. difficile is based on detection of the toxins, together with culture and determination of susceptibility of C. difficile strains to antibiotics. The article reports results of tests of kits for detecting C. difficile toxins VIDAS(c) C. difficile Toxin A & B (bioMérieux) and Toxin A Test (Oxoid) in 170 stool samples. Also reported are results of the determination of MICs of vancomycin and metronidazole in 302 strains of C. difficile cultured in the bacteriology laboratory of the Institute of Public Health in Ostrava in 2008-2009.

Objective: To detect the presence of Clostridium difficile toxins A and B in the stools of patients hospitalized in the University Hospital Olomouc who developed diarrhoea or other abdominal symptoms (abdominal pain, tympanites, indigestion, partial intestinal obstruction) related to antibiotic therapy. Given occasional dyspepsia and necrotizing enterocolitis in preterm neonates, to consider the potential role of these toxins, in addition to that of the immature intestine, in the development of the condition. To confirm the hypothesis by stool tests to detect the toxins also in normal neonates or those with no gastrointestinal symptoms. In selected stool samples, to compare detection of the toxins with C. difficile strains confirmed by culture.