Clostridioides difficile is an important opportunistic pathogen mainly linked to healthcare-associated infections, which arise when the intestinal microbiota is disrupted - most often due to antibiotic treatment. In recent years, however, its presence in the community has been reported more frequently. The incidence of C. difficile infection reflects both the quality of antibiotic policies and the rigor of infection control, while mortality remains substantial, especially among the elderly and patients with multiple comorbidities. The pathogenesis of the disease is based on the production of toxins A and B, which damage the intestinal epithelium and lead to the development of manifestations ranging from mild diarrhea to fulminant colitis. Diagnosis requires correlation of the clinical presentation with evidence of a toxigenic strain or its toxins while colonization alone, without clinical symptoms, is not an indication for treatment. The high rate of recurrence remains a significant problem. A rational antibiotic policy and strict hygiene measures play a crucial role in prevention. The treatment of C. difficile infection has undergone a significant shift in recent years. Current recommendations favor fidaxomicin as the first-line treatment for the initial episode due to a lower risk of recurrence; oral vancomycin is an alternative. For recurrent forms, an individualized approach is necessary, including the possibility of using fecal microbiota transplant or monoclonal antibodies. In the Czech Republic, oral vancomycin is still widely used; it is now also available in a standardized capsule form, which improves pharmaceutical safety and facilitates dosing. Keywords: Clostridioides difficile, fidaxomicin, oral vancomycin, antimicrobial stewardship.
OBJECTIVE:To characterize the demographic and exposure characteristics and management of rabies post-exposure prophylaxis (rPEP) among international travelers, and to identify deficiencies in pre-travel prevention, initial wound management, and subsequent post-exposure care. MATERIAL AND METHODS:A retrospective observational study was conducted at the Department of Infectious Diseases and Travel Medicine, Motol and Homolka University Hospital. The study included patients evaluated between December 2022 and December 2024 following animal-related exposures. Demographic data, exposure characteristics, wound management, and details of rPEP, including rabies vaccination and rabies immunoglobulin (RIG) administration, were anayzed. Exposures were classified according to the World Health Organization (WHO) categories. Data were analyzed using descriptive statistical methods. RESULTS:A total of 134 patients were included, with a median age of 31 years. Exposures predominantly occurred in Southeast Asia (35.1%) and Western Asia (25.4%), particularly in Türkiye, Thailand, and Indonesia. Dogs were the most frequently implicated animals (46.3%), followed by cats (23.9%) and monkeys (20.9%). Bites accounted for 66.4% of exposures, while 65.7% of cases were classified as WHO category III exposures. Initial wound management was frequently suboptimal; only 54.9% of patients reported immediate wound washing, and 76.1% applied a disinfectant. Preexposure rabies vaccination had been received by only 6.7% of travelers. rPEP was initiated abroad in 62.7% of cases. However, among patients indicated for RIG administration, 77.8% did not receive it. Deviations from recommended rabies vaccination schedules were documented in 38.2% of patients. Wound infections developed in 4.5% of cases. CONCLUSION:This study highlights significant gaps in rabies prevention and post-exposure management among international travelers. Low uptake of pre-exposure vaccination, frequent deviations from recommended rPEP protocols, and limited access to RIG in rabies-endemic settings represent major barriers to optimal prevention. These findings underscore the importance of comprehensive pre-travel counseling and broader implementation of pre-exposure rabies vaccination among travelers at increased risk of animal exposure.
Brucellosis, one of the most important zoonoses worldwide, has been eliminated in many countries including the Czech Republic through veterinary control measures. It now occurs only as an imported disease. Owing to its non-specific clinical presentation, brucellosis is classified among the so-called "great imitators" and may overlap in the differential diagnosis with lymphoma, tuberculosis, or systemic inflammatory diseases. We present the case of a 44-year-old woman with imported chronic brucellosis who presented with prolonged fever of unknown origin, arthralgias, hepatosplenomegaly, and bulky retroperitoneal and supraclavicular lymphadenopathy. FDG-PET/CT findings were initially suspicious for a lymphoproliferative disorder and prompted diagnostic lymph node excision. Histopathology revealed granulomatous necrotizing lymphadenitis, and Brucella spp. serology was concurrently positive, with a subsequent fourfold rise in antibody titer. Combination antibiotic therapy according to the Ioannina regimen (doxycycline and gentamicin) was initiated; due to persistently high antibody titers and the chronic nature of the disease, doxycycline therapy was extended to a total of six months. The patient achieved complete clinical cure and was discharged from follow-up after 12 months of monitoring. The discussion section addresses the clinical forms of brucellosis including neurobrucellosis, the role of imaging modalities (particularly FDG-PET/CT) in diagnosis and treatment monitoring, characteristic findings of non-specific laboratory diagnostic tests, and current principles of antibiotic therapy. This case illustrates the value of taking a targeted travel and exposure history in patients with prolonged febrile illness of unclear etiology and underscores the importance of including brucellosis in the differential diagnosis of fever of unknown origin even in non-endemic countries. Keywords: brucellosis, zoonosis, Brucella melitensis, fever of unknown origin, retroperitoneal lymphadenopathy, FDGPET/CT, doxycycline, travel medicine.
A case of a 31-year-old female with the oroglandular form of tularemia, most likely acquired by consuming vegetables from her own garden, is presented. Initial treatment of a condition presenting as acute tonsillitis did not lead to regression of cervical lymphadenopathy, prompting serological testing and subsequent diagnosis of tularemia. The patient was then treated with a combination of ciprofloxacin and gentamicin; however, due to progression of cervical lymph node involvement with central colliquation, surgical extirpation of the affected lymph node package was indicated. Following the procedure, the patient's clinical condition evolved without further complications, although wound healing was prolonged. During hospitalization, flow cytometry was used for the first time to determine the relative proportion of CD3+/CD4-/CD8- T-lymphocytes, which was initially 56.9%. This proportion remained elevated at 11.8% even three years after the acute illness. These findings illustrate the potential diagnostic value of the elevation of this T-cell subpopulation in the early phase of tularemia, even before seroconversion, and point to a long-term alteration of the immune system induced by Francisella tularensis. Keywords: tularemia, case report, cellular immunity, T-lymphocytes.
This brief report outlines the history of rabies incidence and its control in animals within the Czech Republic. Furthermore, it provides information on laboratory diagnostic options for post-mortem examination of brain tissue to detect the rabies virus, which are available in the Czech Republic. It also summarizes the recommended procedures to be followed when a laboratory investigation of the central nervous system for rabies is indicated in an animal. Keywords: bat rabies, immunofluorescence test, RT-PCR, transport of samples to the laboratory, State Veterinary Institute.
Brucellosis is a bacterial zoonosis characterized by a variable clinical presentation. The disease is endemic in many popular tourist destinations visited by Czech citizens. Approximately 300 cases of brucellosis are reported annually in Europe; in the Czech Republic, only a few cases are recorded each year, all of which are imported. The Czech Republic is free of brucellosis in livestock. However, Brucella suis still occurs in the country's wildlife, particularly in the European hare. Laboratory diagnosis of the disease relies primarily on serological tests, as direct identification of the pathogen from clinical material is less frequently successful. Serology offers a range of tests that differ in their diagnostic value for various stages of the disease and specific pathogen species. Today, the genus Brucella includes numerous species, but four representatives are of significance to human health: B. melitensis, B. abortus, B. suis, and B. canis. Keywords: zoonosis, imported infections, Brucella melitensis, Brucella abortus, Brucella suis Brucella canis.
Sepsis is a critical condition characterized by life-threatening organ dysfunction caused by a dysregulated host response to infection, where each hour of delay in initiating adequate therapy increases mortality by 7-10%. This paper summarizes current trends in microbiological diagnostics, moving from the gold standard of blood culture toward advanced molecular identification. The traditional culture-based process is limited by a time lag of 12-48 hours. Modern approaches include accelerating identification from positive blood cultures using MALDI-TOF MS and RAST methods, which reduce the time to targeted treatment. Significant innovation is represented by culture-independent technologies such as T2MR, SepsiTest-UMD, Cube Dx, and InfectID-BSI, enabling pathogen detection directly from whole blood within a few hours. The future of sepsis diagnosis is further enhanced by digital PCR for absolute quantification of bacterial load, metagenomic sequencing (mNGS) for identifying unexpected pathogens, and transcriptomics for assessing the host immune response. Integrating these technologies with artificial intelligence (AI) predictive models paves the way for precision medicine and personalized care for septic patients. Keywords: sepsis, blood culture, molecular diagnostics, PCR, mNGS, MALDI-TOF MS, artificial intelligence.
Sepsis and septic shock are complex pathological conditions that significantly influence patient prognoses and are among the leading causes of in-hospital mortality. This review focuses on current understanding of the pathophysiology, diagnosis, and treatment of sepsis and septic shock, with an emphasis on recent advances and innovations that have emerged in the past few years, as well as their practical impact on clinical care. A comprehensive view of sepsis is presented, with particular attention given to the dysregulation of inflammatory and immune processes, as well as vascular endothelial damage leading to multiorgan dysfunction. These pathological changes contribute not only to the high mortality of sepsis, but also to long-term morbidity and late mortality among survivors. This review aims to highlight the complexity and interconnectedness of these mechanisms. Based on current knowledge, potential directions for improving care for septic patients are outlined, focusing on timely intervention and high-quality follow-up care. Keywords: sepsis, septic shock, diagnosis, therapy, mortality, morbidity.
Blood cultures remain the cornerstone of diagnosing bloodstream infections, and their appropriate use directly impacts timely diagnosis, targeted antimicrobial therapy, and patient safety. However, their diagnostic yield and clinical interpretability are determined not only by laboratory processing itself, but also by the entire sequence of interconnected pre-analytical, analytical, and post-analytical steps. This review article summarizes the principles of blood culture testing, focusing on appropriate indications and timing of blood collection, recommended number of culture sets and blood volume, aseptic collection techniques, specimen labeling, transport, and laboratory receipt. It also addresses the analytical phase, including the selection of culture systems and media, the role of additives, incubation conditions, monitoring for positivity, and subsequent processing of positive blood cultures. Separate attention is devoted to the post-analytical phase, particularly result interpretation, reporting critical findings, blood culture contamination, surveillance of catheter-associated infections, and isolate storage. The final section focuses on quality indicators and the importance of systematic quality management throughout the entire process. The article emphasizes that blood cultures should be regarded as a complex diagnostic process, whose quality depends on the coordination of clinical and laboratory procedures, workflow standardization, and ongoing evaluation of measurable performance indicators. Keywords: blood cultures, bacteremia, fungemia, pre-analytical phase, analytical phase, post-analytical phase, blood culture contamination, quality management.
OBJECTIVES:To detect the presence of SARS-CoV-2 ribonucleic acid (RNA) in blood (viremia) in hospitalized patients with COVID-19 at hospital admission, analyze the frequency of viremia, and assess its implications for the timing of convalescent plasma therapy. METHODS:In a prospective, observational, multicenter study, plasma samples were evaluated for detection of SARS-CoV-2 RNA by reverse transcription quantitative polymerase chain reaction in hospitalized patients with confirmed COVID-19 and symptom duration of seven days or less who either received or did not receive convalescent plasma. RESULTS:Fifty-one patients were included in the analysis, with viremia detected in three patients (5.9%). In the group receiving convalescent plasma (n = 28), viremia was detected in three patients (10.7%), while it was not detected in any patient in the group not receiving convalescent plasma (n = 23). All patients with documented viremia had critical disease. Viremia was detected exclusively between the third and fourth days from symptom onset. CONCLUSION:The results of the study suggest that the occurrence of viremia in COVID-19 is relatively low. This fact may represent one of the factors that could limit the full therapeutic potential of convalescent plasma or monoclonal antibodies.
Sepsis constitutes a major global health challenge associated with high mortality and a substantial economic burden. From a clinical microbiology perspective, bacterial sepsis is defined as life-threatening organ dysfunction resulting froma dysregulated host response to bacterial infection. The pathogens include both Gram-negative and Gram-positive bacteria, with the etiological spectrum often reflecting the site of the primary infection. Timely identification of the causative agent and initiation of appropriate antibiotic therapy, preferably within the first hour after diagnosis, are critical for improving outcomes. Diagnostic workflows traditionally rely on blood cultures, as well as phenotypic and, when necessary, genotypic susceptibility testing. Advanced methods, such as MALDI-TOF MS, PCR-based detection of antimicrobial resistance (AMR) genes, and rapid antimicrobial susceptibility testing (RAST) significantly shorten turnaround times and facilitate targeted therapy. However, AMR remains a major therapeutic limitation and is associated with increased mortality. A comprehensive strategy encompassing optimal clinical sample collection, rapid and accurate diagnosis, careful interpretation of results, and close collaboration between microbiologists and clinicians is essential to reduce sepsis-related morbidity and mortality. Keywords: bacteria, infections, sepsis, diagnosis.
Antiretroviral therapy (ART) is the most important part of treatment for HIV-positive individuals. Antiretroviral drugs are divided into groups according to their mechanism of action and chemical structure. Most of them block the function of three viral enzymes, others prevent the virus from entering the cell through three different mechanisms, and one drug disrupts the function of the capsid. In most patients, viral replication is suppressed, which is a prerequisite for the restoration or maintenance of adequate immune system function. Treatment is also important for restricting the transmission of infection to other people. Although treatment prevents the typical health complications of HIV infection associated with immunodeficiency, it does not completely suppress the activation of the immune system and thus the risk of non-AIDS complications. Antiretrovirals are administered in combinations, typically in a triple combination, but thanks to the resilience of new integrase inhibitors to the development of resistance, dual combinations are also sufficiently effective. A novel treatment for virologically suppressed patients is a long-acting dual regimen administered parenterally with a pair of intramuscular injections once every two months. Patients who have failed multiple ART regimens have the option of rescue therapy, which includes the latest antiretroviral drugs fostemsavir and lenacapavir. The elimination of viral reservoirs in cells and the cure of HIV infection remain unattainable goals. Therefore, treatment remains long-term and indefinite. Keywords: human immunodeficiency virus infection, HIV, antiretroviral therapy (ART).
The article focuses on the role of nutrition as a risk factor for the development of lifestyle diseases in people living with HIV. Among these individuals, an increase in obesity and the progression of metabolic syndrome, cardiovascular diseases, hypertension, and type 2 diabetes occur faster and appear earlier than in the HIV-negative population. A combination of an unhealthy lifestyle, chronic HIV-related inflammation, and long-term antiretroviral therapy increases the risk of these comorbidities. Regularly takings patients' medical history, including substance abuse, is important for monitoring their nutritional status. It is also crucial to regularly monitor body weight and fat distribution (e.g., using the waist-hip ratio). Patients' social and work conditions are key to establishing effective nutritional interventions as they can affect their ability to adhere to regular diets and physical activity. Laboratory tests are also used to assess nutritional status by monitoring parameters such as lipid profiles, blood glucose levels, and immune function. In a general practitioner's office, the emphasis is placed on preventing and diagnosing the aforementioned comorbidities early and initiating long-term, sustainable nutritional interventions. Overall, infectious disease doctors and general practitioners také a comprehensive approach to monitoring and adjusting the lifestyle of HIV-positive individuals, thereby significantly contributing to prolonging and improving their quality of life. Keywords: human immunodeficiency virus (HIV) infection, nutritional status, lifestyle diseases.
Human immunodeficiency virus (HIV) progressively impairs immune function. If the infection is detected late or left untreated, it leads to the development of AIDS. Therefore, from a public health perspective, it is necessary to monitor the occurrence of infection in the population, as well as trends overall and in specific subgroups. This is achieved through a national HIV surveillance system, whose outputs can be used not only to describe the epidemiological situation but also to guide preventive activities. The text outlines the organizational components of the surveillance system developed since 1986 and presents the key epidemiological data describing the HIV epidemic in the Czech Republic. Between 1985 and 2024, a total of 4888 cases of HIV infection were detected among Czech citizens and foreigners with long-term or permanent residence. Of those, 926 were diagnosed with AIDS, and 654 died. The basic characteristics of the HIV epidemic in the Czech Republic are the predominance of sexual transmission, especially among men who have sex with men, but with increasing numbers of heterosexually transmitted infections, a low proportion of women (approximately 15%), and an increasing proportion of foreigners (48% in the last five years). The annual number of new cases initially hovered around a few dozen, then steadily increased from 2003 until reaching 286 in 2016. After a slight decline, the numbers peaked at 292 in 2022. Recent trends have been affected by the COVID-19 pandemic and the war in Ukraine. In addition to the above figures, 856 HIV-positive refugees from Ukraine were registered in 2022-2024. Despite these facts, the Czech Republic continues to be classified as a low-prevalence country in both the European and global contexts. However, the trend in recent years has not been favorable, with the number of new cases showing a slight increase. Keywords: HIV, AIDS, surveillance, HIV transmission, foreigners.
In the Czech Republic, laboratory diagnostics of HIV is designed as a multi-level system that integrates clearly defined legislative requirements, modern diagnostic technologies, and close interdisciplinary collaboration among specialists. Reliable and early detection of HIV infection is a key factor for the timely initiation of treatment, which not only benefits the patient, but also serves as the most effective tool for preventing further spread of the infection. The diagnostic algorithm includes highly sensitive screening tests followed by mandatory confirmatory testing at the National Reference Laboratory for HIV/AIDS at the National Institute of Public Health. Molecular biological methods are primarily applied in monitoring therapy for HIV-positive patients. However, they also serve as a tool for molecular epidemiology, enabling the tracking of infection dynamics in the population and, based on these insights, the optimization of preventive interventions and evaluation of their effectiveness. Keywords: HIV, NRL for HIV/AIDS, laboratory diagnostics, screening test, confirmatory test, viral load, drug resistance monitoring.
OBJECTIVE:Lung transplant recipients represent a high-risk population for COVID-19, primarily due to long-term immunosuppressive therapy. The study aimed to describe the impact of COVID-19 in a cohort of lung transplant recipients during the pandemic and to identify selected risk factors associated with an unfavorable disease course. MATERIAL AND METHODS:This retrospective analysis included patients followed at a specialized post-transplant outpatient clinic of the Department of Respiratory Medicine, University Hospital Olomouc. All patients had undergone lung transplantation at the 3rd Department of Surgery, Motol University Hospital, and were followed within an inter-institutional collaborative care program. Data were obtained from the national infectious diseases information system (ISIN), outpatient and inpatient medical records, and were statistically analyzed with a focus on clinical and genetic risk factors. RESULTS:A total of 87 patients (29 women, 58 men) were included in the study and followed from the beginning of the pandemic in 2020 through December 2023. COVID-19 was diagnosed in 65 patients (74.7%), while 22 patients (25.3%) remained uninfected. The overall mortality was 15.4% (10 patients), with the highest fatality rates observed during the early pandemic waves dominated by the original SARS-CoV-2 variants. Over time, the prognosis improved in association with the availability of vaccination, antiviral prophylaxis, and the emergence of the less pathogenic Omicron variant. Older age was identified as a significant risk factor for severe disease and mortality. Time since transplantation and the presence of a single native lung did not have a significant impact on disease severity. Genetic risk factors associated with severe COVID-19 included the polymorphisms rs16944G (IL1B), rs2069763A (IL2), and rs2076295*G (DSP). CONCLUSIONS:COVID-19 had substantial clinical consequences in the evaluated cohort of lung transplant recipients, with an overall mortality of approximately 15%. Independent risk factors for an unfavorable course included older age and insufficient prophylaxis. Selected genetic polymorphisms may represent additional risk factors. These findings may contribute to improved risk stratification for viral infections and to a better understanding of immune status in lung transplant recipients.
Capnocytophaga spp. are typical members of the commensal microflora of the oral cavity. However, C. canimorsus can also be a dangerous pathogen, often causing fatal systemic infections, usually from contact with the saliva of dogs or cats. The article discusses the clinical significance of zoonotic infections with this bacterium as well as its natural occurrence, pathogenic adaptation, and the current problem of antimicrobial resistance. Keywords: Capnocytophaga spp., zoonosis, bite wound infection, oral microflora.
Acute bacterial skin and soft tissue infections represent a common clinical problem, and accurate diagnosis is crucial for initiating appropriate therapy. However, conditions such as cellulitis and erysipelas can be clinically mimicked by a variety of non-infectious conditions, including eczematous, venous, lymphatic, and autoimmune diseases. This review summarizes the key differences in clinical presentation, patient history, and laboratory findings that help distinguish true infections from their non-infectious mimickers. Special attention is given to conditions such as microbial eczema, herpes zoster, stasis dermatitis, lymphedema, vasculitis, and other less common causes. Accurate differential diagnosis is essential for preventing unnecessary antibiotic use, minimizing complications, and initiating targeted therapy. Keywords: bacterial skin diseases, soft tissue infections, cellulitis, phlegmon, erysipelas, differential diagnosis.
Myiasis is a parasitic infestation caused by the larvae of dipteran flies, affecting living or necrotic tissues in humans and animals. It is classified into obligatory and facultative forms, depending on the relationship between the parasite and the host. Clinically, myiasis may present as cutaneous, wound, cavity, intestinal, urogenital, or blood-feeding larval infestations. Diagnosis is based on the characteristic clinical presentation, with definitive identification provided by a parasitological examination of the larvae. Treatment involves the mechanical removal of the larvae and appropriate wound care. Myiasis should be considered in the differential diagnosis of furuncular and non-healing wounds in travelers returning from tropical or subtropical regions. This article presents a case of scrotal myiasis caused by Dermatobia hominis in a traveler coming back from Ecuador. Keywords: myiasis, larvae, travel-related infection.
OBJECTIVE:To evaluate the quality of care provided to patients with febrile neutropenia (FN) hospitalized at the Depart-ment of Infectious Diseases, Military University Hospital Prague, as a foundation for improving the management of this condition. MATERIAL AND METHODS:A retrospective observational analysis of patients diagnosed with the ICD-10 code D70 from 1 January 2015 to 1 June 2023. All evaluated parameters were selected primarily to facilitate the assessment of care quality and compliance with recommended practices. RESULTS:Of 32 evaluated patients, 19 met the criteria for FN. A history of conditions or treatments predisposing to neutropenia was noted in 74 % of patients. Seventy-four percent were admitted following evaluation or referral from an emergency department or another specialist. Blood cultures (at least two sets) were initially obtained in 80 % of cases. Antibiotics were initially administered correctly to all patients. However, considering antibiotic combinations would have been appropriate in 40 % of cases. No patients received antibiotics within one hour of initial contact with a healthcare facility. Antifungals were therapeutically administered to 58% of patients, though 37 % of these had no clear indication. A hematologist was consulted in 75 % of cases, and a stimulating factor (filgrastim) was administered in 88 % of cases. All patients were treated in isolation. An infection source was identified in 74 % of cases. CONCLUSION:The analysis highlighted areas for improving the quality of care for patients with FN. Based on this study, an internal procedure is now being developed that will focus on coordination with emergency and other departments, emphasize obtaining blood cultures, and ensure the timely and correct administration of antibiotics, including their possible combinations, as well as antifungals.
