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Olomouc, Czech Republic

Liba-Vrabelova Z.,Klinika Detske Neurologie | Kayserova J.,Ustav imunologie | Komarek V.,Klinika Detske Neurologie
Ceska a Slovenska Neurologie a Neurochirurgie | Year: 2013

Introduction: Europe is an important endemic area for infection with the Borrelia burgdorferi sensu lato complex that includes several genospecies. Incidence and symptoms vary between areas. B. garinii has high affinity to the central nervous system and is the main genospecies in the Czech Republic. Correct diagnosis of Lyme neuroborreliosis (LNB) is crucial for its therapy. Diagnosis may be difficult and the infection may become chronic. The aim of this study was to determine the incidence of LNB and to establish clinical and laboratory findings in our pediatric patients. Methods: Retrospective evaluation of clinical and laboratory data obtained over a two-year period on 286 children with neurological symptoms (unconsciousness, focal deficit, headache, meningeal syndrome etc.) who underwent a lumbar puncture to exclude neuroinflammation. Antibodies against borrelia (and neurotrophic viruses) in the cerebrospinal fluid (CSF) and serum were determined. Cytological, immunological and biochemical analysis of CSF were performed as well as the PCR for the presence of borrelial DNA. Results: An association between neurological symptoms and borrelial infection was confirmed in 58 children (median age 7.44 years; range 0.5-17.5 years). Tick-bite was reported in 53% of children only and skin erythema in none of them. LNB was confirmed with laboratory tests in 53 children. The other 5 children had no laboratory signs of inflammation in the CNS. The main presentations of LNB were peripheral facial nerve palsy (PFNP) in 69% and meningitis in 15%. PFNP of borrelial etiology formed 53% of all PFNP in the period analyzed. Conclusion: LNB in children in the Czech Republic is very common. Comprehensive diagnostic approach, including lumbar puncture, is crucial. Correct therapy at the right time may prevent the chronic course of the disease.

Szturz P.,Interni Hematoonkologicka Klinika | Adam Z.,Interni Hematoonkologicka Klinika | Sediva A.,Ustav imunologie | Fojtik Z.,Interni Hematoonkologicka Klinika | And 5 more authors.
Klinicka Onkologie | Year: 2011

Backgrounds: The most important diagnostic criteria for Schnitzler syndrome include chronic urticaria, the presence of monoclonal IgM immunoglobulin, marked inflammation (leukocytosis, elevated CRP and erythrocyte sedimentation rate), subfebrile temperatures or fevers and bone and joint pains. It is a rare idiopathic disease that may lead to potentially life-threatening complications such as development of secondary amyloidosis or transformation into malignant lymphoproliferation. Schnitzler syndrome should be included in differential diagnostics of chronic urticaria and fevers of unknown origin. The diagnostic algorithm is based on clinical presentation and serum and urine electrophoreses to detect monoclonal components. Blockade of interleukin-1 (IL-1), key cytokine in the pathogenesis of the disease, dominates current therapeutic protocols. Anakinra (Kineret™), recombinant human IL-1 receptor antagonist, is the most widely used treatment option. According to literature, disease remission was obtained in all treated patients. Therefore, anakinra represents a significant diagnostic possibility to differentiate Schnitz-ler syndrome from e. g. monoclonal gammopathy of unknown significance (MGUS) associated with urticaria of different aetiology. Biological therapy with rilonacept (Arcalyst™) and canakinumab (Ilaris™) represents a new treatment alternative for patients, allowing prolonged dosing intervals of 1 and 8 weeks, respectively (compared to 24 hours with anakinra). The review article also presents findings of various imaging methods (conventional radiography, computed tomography, traditional bone scintigraphy) and photographs of patients with Schnitzler syndrome before and after anakinra therapy. Design: The aim of the review is to draw attention to the existence of this rare autoinflammatory and potentially pre-malignant condition, present a simple diagnostic algorithm and provide an overview of therapeutic options for the patients. Conclusions: Malign potential of Schnitzler syndrome, possible development into systemic amyloidosis and the fact that patients are frequently referred to oncology clinics for differential diagnostics of monoclonal gammopathy, are the main reasons why clinical oncologists should be aware of Schnitzler syndrome.

Paukert J.,Detske oddeleni | Kopelentova E.,Ustav imunologie | Dvorakova L.,Detske oddeleni
Pediatrie pro Praxi | Year: 2015

Penicillin and other beta-lactams are among the most commonly prescribed antibiotic groups. It is also a group with most frequently reported allergic reacions. The majority od patients are classified as penicillin allergic based on clinical evaluation only without further additional testing. False diagnosis of a penicillin allergy then leads to overuse of alternative, usually broad spectrum antibiotics with a high rate of associated side effects, thus increasing microbial resistence and treatment cost. Thorough evalution of a suspected beta- -lactam allergy involves detailed patient history and examination, skin tests, laboratory tests and drug provocation tests. Suspected drug hypersensitivity can be safely excluded with detailed evaluation in a large number od cases. Where suspected beta-lactam allergy is confirmed, alternative antibiotic could be recommended.

Vernerova E.,Ustav imunologie
Interni Medicina pro Praxi | Year: 2012

A dramatic increase in the prevalence of allergy and asthma has occurrred during the past few decades. Although the symptoms of many allergic disorders can be suppressed quite effectively by pharmacological interventions, these do not provide a curative solution and therefore involve lifelong use of medication. The pivotal role in the regulation and maintaining of allergen tolerance represent T cell subsets, particullary T regulatory cells (T reg). These cells represent targets in the treatment of allergic disorders.

Appropriate and efficient recognition of pathogens by the immune system represents the key step in the initiation of the immune response. Recognition of pathogen associated molecular patterns is mediated by the set of germ line encoded pattern recognition receptors. Toll-like receptors (TLRs) represent the most important member of pattern recognition receptors. It has been shown that defects in TLRs signalling pathways cause increased susceptibility to bacterial or viral infections. Defects in signaling molecules downstream of TLRs recognizing bacteria have been described in patients with severe invasive pneumococcal infections. Defects in TLRs responsible for the induction of an anti-viral immune response have been detected in children with necrotizing herpetic encephalitis.

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