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Tick-borne encephalitis (TBE) virus is a major cause of central nervous system infections in endemic countries. Here, we present clinical and laboratory characteristics of a large international cohort of patients with confirmed TBE using a uniform clinical protocol. Patients were recruited in eight centers from six European countries between 2010 and 2017. A detailed description of clinical signs and symptoms was recorded. The obtained information enabled a reliable classification in 553 of 555 patients: 207 (37.3%) had meningitis, 273 (49.2%) meningoencephalitis, 15 (2.7%) meningomyelitis, and 58 (10.5%) meningoencephalomyelitis; 41 (7.4%) patients had a peripheral paresis of extremities, 13 (2.3%) a central paresis of extremities, and 25 (4.5%) had single or multiple cranial nerve palsies. Five (0.9%) patients died during acute illness. Outcome at discharge was recorded in 298 patients. Of 176 (59.1%) patients with incomplete recovery, 80 (27%) displayed persisting symptoms or signs without recovery expectation. This study provides further evidence that TBE is a severe disease with a large proportion of patients with incomplete recovery. We suggest monitoring TBE in endemic European countries using a uniform protocol to record the full clinical spectrum of the disease. [ABSTRACT FROM AUTHOR]

Comparative analysis of ospC genes from 127 Borrelia burgdorferi sensu stricto strains collected in European and North American regions where Lyme disease is endemic and where it is not endemic revealed a close relatedness of geographically distinct populations. ospC alleles A, B, and L were detected on both continents in vectors and hosts, including humans. Six ospC alleles, A, B, L, Q, R, and V, were prevalent in Europe; 4 of them were detected in samples of human origin. Ten ospC alleles, A, B, D, E3, F, G, H, H3, I3, and M, were identified in the far-western United States. Four ospC alleles, B, G, H, and L, were abundant in the southeastern United States. Here we present the first expanded analysis ofospC alleles of B. burgdorferi strains from the southeastern United States with respect to their relatedness to strains from other North American and European localities. We demonstrate that ospC genotypes commonly associated with human Lyme disease in European and North American regions where the disease is endemic were detected in B. burgdorferi strains isolated from the non-human-biting tick Ixodes affinis and rodent hosts in the southeastern United States. We discovered that some ospC alleles previously known only from Europe are widely distributed in the southeastern United States, a finding that confirms the hypothesis of transoceanic migration of Borrelia species. [ABSTRACT FROM AUTHOR]

The national guideline aims to highlight the latest knowledge about clinical manifestations of the infection, to summarize the diagnostic algorithm and to recommend the appropriate antibiotic therapy with respect to evidence-based medicine. The recommendations are consistent with most European guidelines as well as those published by the IDSA. The guideline provides the most recent information on the epidemiology, etiology and pathogenesis of Lyme borreliosis, dermatological, neurological and musculoskeletal involvement, the appropriate diagnostic procedure and prevention. Some information is also provided about post-treatment Lyme disease syndrome. Recommended oral and intravenous antimicrobials are listed in a table showing the doses and duration of therapy. The guideline also mentions diagnostic methods to be avoided or whose results should be interpreted with caution. Although the guideline cannot account for all individual variations among patients, it may provide instructions to physicians in typical and frequent clinical situations.

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.

Salmonella spp. are a common cause of bacterial gastroenteritis. In infants, Salmonella infection is uncommon, posing a higher risk for a severe course. The authors present a case of a 3-month-old infant with suspected Salmonella sepsis. Also discussed are the correct approach to therapy and potential errors in the treatment of the youngest age groups.

Objectives: Enteroviruses (EVs) are the most common cause of aseptic viral meningitis. In some cases, they can cause severe meningoencephalitis and acute flaccid paralysis - an association with some virulent serotypes. The objectives were to describe the epidemiological situation of EV meningitis in children in South Moravia, to elucidate the etiology including the incidence of virulent serotypes and to evaluate the clinical presentation., Material and Methods: A total of 88 children with EV meningitis were prospectively evaluated. In case of aseptic inflammation in the cerebrospinal fluid, EV was detected using real-time PCR. Genotyping was performed in 56 samples using repeated one-step PCR and partial sequencing on a genetic analyzer in the National Reference Laboratory for Enteroviruses in Prague., Results: The patients' age range was 3-17 years; there were more boys than girls. Two epidemics occurred, one involving 17 Roma children and the other involving 8 swimming pool visitors. The most common symptoms were headache, fever and stiff neck. The most frequently (59%) detected agent was Echovirus 30 identified as the cause of the epidemics. In one boy, EV 71 (virulent serotype) was found. The clinical course did not vary from that in other serotypes. All 88 children recovered without complications., Conclusions: EVs are an important part of the differential diagnosis of neuroinfections, although most infections are benign aseptic meningitis. The clinical presentation did not vary between infections with various serotypes. Higher incidence rates of virulent serotypes were not reported. Echovirus 30 was detected most frequently and was repeatedly identified as the cause of epidemics throughout the Czech Republic.

We present a case report of a small boy with cystic fibrosis complicated by pertussis and pneumothorax. The child had not been vaccinated against Bordetella pertussis due to the failure to thrive and was infected with the bacterium at the age of 4 months. The course of the disease was severe, with respiratory distress and spontaneous pneumothorax. The diagnosis of pertussis was serologically confirmed. A suspicion for cystic fibrosis increased after an unusually prolonged course of the disease and a history of the failure to thrive. A comprehensive diagnostic procedure revealed Pseudomonas aeruginosa respiratory infection, anemia, pancreatic insufficiency, a positive sweat test and the presence of two CFTR gene mutations. The patient, treated with comprehensive cystic fibrosis therapy, recovered from acute respiratory illness and started to thrive soon.

The article summarizes the latest knowledge about the etiology, epidemiology, pathogenesis, clinical signs, diagnostic procedures and therapy of erythema migrans (EM), a cutaneous form of Borrelia infection. The sole focus on this clinical entity is intentional since EM is the most common clinical involvement in Lyme borreliosis (LB) in the Czech Republic (CR). New genospecies from the Borrelia burgdorferi sensu lato complex, B. lusitaniae and B. spielmanii, as etiologic agents are reported. Although there are no commercial tests available yet for their detection, ticks are demonstrably infected with them in Europe and probably even in the CR. Six pathogenic genospecies circulate among vertebrates and Ixodes ricinus ticks in Europe. The transmission cycle in nature, hosts identified as reservoirs and distribution of borreliae in Europe are presented. Clinical forms of EM are described in detail including accompanying features. Types of erythema in the USA and Europe are compared. In the part on differential diagnosis, allergies, skin and infectious diseases with similar appearance on the skin as EM are mentioned. Although the diagnosis of EM is exclusively clinical and serology is not indicated, methods of direct detection and two-tier testing of antibodies are discussed. There are therapeutic recommendations concerning the choice of antibiotics available in the CR.

The diagnosis of visceral leishmaniasis (VL) is not an easy task. The clinical presentation of VL is similar to lymphomas which have significantly higher incidence in our country. This fact is one of the complications in the diagnosis of VL. Moreover, diagnostic methods have low sensitivity and bone marrow aspiration is necessary. We present a case report of a patient who fell ill in the first year of life and due to atypical lifestyle of his parents was seriously examined after 11 months from the first symptoms of the disease. Many problems with the diagnostic algorithm leading to the definitive diagnosis of VL were encountered. Thereafter, the patient underwent treatment with amphotericin B lipid complex. The course was complicated by febrile neutropenia and anemia, with the necessity for blood transfusion.

We present a case of eye involvement -- intermediate uveitis -- during tick-borne borreliosis in a 10-year-old boy. Ophthalmologic examination revealed impaired vision, apparent thick floating whitish opacity in the vitreous humour of the left eye and fine fibres in the vitreous humour of the right eye. Sonographic examination confirmed hyperechogenic opacity in the vitreous humour. An autoimmune process was suspected but not confirmed. Serological examination showed IgG antibodies against three pathogenic borreliae and borderline values of IgM antibodies against Borrelia garinii were found by immunoblot. The boy was treated with intravenous ceftriaxone for 21 days. The subsequent sonographic examination showed only minute sporadic echogenicity. Biomicroscopically, only residual opacity in the vitreous humour was found. Isolated eye involvement of borrelia aetiology is rare. The discussion provides a review of similar cases of uveitis including diagnosis of the eye form as published in literature.

In 2005, six children were treated in our department who had been in contact with a bat infected with European bat lyssavirus 1 (EBL1). In the Czech Republic, this was the first confirmed case of rabies since 2002, but the fourth case of bat rabies since 1994. All the cases were related to Southern Moravia and bat species which almost do not migrate. This suggests only endemic prevalence of EBL1 in this country. Bat rabies is different from rabies in terrestic mammals. Based on genetic analyses, the lyssavirus genus may be divided into 6 genotypes of which genotypes 1 (rabies virus), 5 (EBL1) and 6 (EBL2) are found in Europe. The infectious cycles of bat lyssaviruses are limited solely to bat populations, in particular the Eptesicus serotinus species and the Myotis genus. Transmission to other mammals is rare. In Europe, four cases of human infection and death due to rabies caused by any of bat lyssaviruses have been reported. Immunologically, bat lyssaviruses are very similar to the common rabies virus. Therefore, the standard prophylactic methods are sufficient. Because of a different natural reservoir, the Czech Republic may be still considered a rabies-free country. However, contacts with bats always pose a risk of rabies.

Objectives: Evaluation of a new kit of the 3rd generation, EIA Borrelia recombinant IgM in the serodiagnosis of Lyme borreliosis (LB) and comparison with the EIA test based on the whole cell antigen in the detection of IgM antibodies., Material and Methods: In total 123 children (147 sera) were examined, 71 children (93 sera) of whom showed clinically defined stage of LB. The other 54 sera of 52 children were tested for suspicion for LB which was later excluded, and for cross-reacting antibodies. They represented the control group of children with other infectious or autoimmune diseases. The EIA B. recombinant IgM kit (Test-Line, CR) is based on the selected antigen fragments: outer surface protein C (OspC) and internal flagellin (p41i). The fragments were selected according to the most frequent Borrelia spp. in the Czech Republic., Results: Samples compared 101/147 (69 %) with both tests showed correspondent reactions. 46 samples reacted inconsistently, 26 from children with LB and 20 from the control group. The total specificity and sensitivity of the recombinant kit in IgM antibody class was 88,9 % and 26,9 %, respectively. In the case of early disseminated LB infection the sensitivity was 35,6 % and it is comparable with the sensitivity of immunoblot. Statistically, there is no difference in the sensitivity (p = 0,101) and specificity (p = 0,383) of EIA B. recombinant IgM and immunoblot., Conclusions: The EIA B. recombinant IgM kit shows comparable diagnostic sensitivity in children with acute LB together with significantly higher specificity in children with non-specific response in kits based on the whole cell antigen and at the same time high conformity with results of IgM class immunoblot. This kit of the 3rd generation is reliable for screening of IgM antibodies.