Víta Žampachová

Dirofilaria repens : emergence of autochthonous human infections in the Czech Republic (case reports)

BackgroundHuman dirofilariasis is a zoonotic infection that continues to spread to previously unaffected areas of Europe. In the South Moravian Region of the Czech Republic (CR), imported as well as autochthonous canine infections were recorded in the last decade, and parasite DNA was detected in mosquitoes of Aedes vexans. In the present paper, human Dirofilaria infections are reported from the country for the first time.Case presentationThe samples from five patients with suspected tissue helminthiases were investigated. In particular cases, nematodes were isolated from various tissues including skin of lower leg, soft tissues of finger, subcutaneous tissue of hypogastrium, lymph node and peritoneum. The diagnosis was based on light microscopic morphology and/or DNA analysis of the worms. In addition, ELISA examination of patients’ sera for anti-filaria IgG antibodies was performed.ConclusionsIn the CR, five cases of human dirofilariasis caused by Dirofilaria repens were recorded during 2010–2014 (species determination for three of them was confirmed besides morphological also by DNA analysis). At least, three of the cases were of autochthonous origin (the patients are Czech citizens residing in South Moravian Region who have never travelled abroad). The findings confirm the natural setting of D. repens in South Moravian Region of the CR. Dirofilariasis should be therefore considered as endemic in this area where it may represent a significant risk factor for public health.

Human Alveolar Echinococcosis, Czech Republic, 2007–2014

To the Editor: Human alveolar echinococcosis (AE) is a zoonotic parasitic disease caused by larvae of Echinococcus multilocularis tapeworms that manifests most often in the host’s liver, although it can infect the lungs, brain, and other organs. Clinical symptoms usually develop after a long incubation period (5–15 years), causing considerable diagnostic difficulties and delay in treatment. The disease is reported in all countries neighboring the Czech Republic: Slovakia, Poland, Austria, and Germany (1,2). To complete data from central Europe, we present results on the occurrence of AE in the Czech Republic collected by the National Reference Laboratory for Tissue Helminthoses during 2007–2014.

The variable clinical course of peripartum cardiomyopathy

BACKGROUNDnIn Europe, peripartum cardiomyopathy (PPCM) is a rare disorder, often difficult to diagnose and it has a variable clinical course. The aim of this report was to describe and discuss the individual variability of this disorder and its management.nnnPATIENTS AND METHODSnThree cases of PPCM manifesting as severe heart failure are compared. Common was the presence of myocardial inflammation detected by endomyocardial biopsy. Different were treatment methods and clinical course. Modern therapeutic concepts such as immunosuppressive therapy and bromocriptin administration are discussed, as well as non-pharmacological approaches.nnnCONCLUSIONnIn the differential diagnostics of dyspnea associated with pregnancy and childbirth, PPCM should be considered. The potentially severe course of the disease requires hospitalization with the possibility of comprehensive heart failure treatment, including non-pharmacological approaches such as device therapy and heart transplantation.

Improvement of left ventricular systolic function in inflammatory cardiomyopathy: What plays a role?

AIMSnTo compare the differences between patients with inflammatory cardiomyopathy (ICM) with and without improvement in left ventricular (LV) systolic function and to identify the relevant predictors of LV improvement.nnnPATIENTS AND METHODSnThe study included 63 patients with biopsy-proven ICM and heart failure symptoms of at least NYHA II, symptom duration ≤ 6 months, LV ejection fraction (LVEF) ≤ 40% assessed by echocardiography and presence of >14 mononuclear leukocytes (LCA+ cells)/mm2 in biopsy samples. Patients were evaluated at baseline and after 6 months.nnnRESULTSnIn the group with LVEF improvement of ≥ 10% (I+ group, n = 41), LVEF increased from 24 ± 7% to 47 ± 8% (P < 0.001). In 22 patients (group I-), there was no or minimal LVEF increase (< 10%). In the I+ group, there were more LCA+ cells/mm2 at baseline (25.1 ± 16.5 vs. 18.5 ± 4.4 cells/mm2; P = 0.032) and a more significant decrease in LCA+ cells in the follow-up (reduction of 13.6 ± 14.3 cells/mm2 vs. 5.0 ± 7.7 cells/mm2 in the I- group; P = 0.009). The univariate logistic regression showed a possible association of number of LCA+ cells, LV end-diastolic diameter and N-terminal fragment of pro-brain natriuretic peptide (NTproBNP) value with LVEF improvement. In the multivariate analysis, only NTproBNP at diagnosis was confirmed as an independent predictor of LVEF improvement (OR=1.2; 1.003 to 1.394; P = 0.046).nnnCONCLUSIONnThe LV systolic function improvement was observed in 65% of the patients. In these patients, the number of inflammatory cells at baseline was higher and decreased more but the higher baseline NTproBNP value was the only independent predictor of LVEF improvement.

Biopsy Based Diagnosis of Inflammatory Cardiomyopathy in a Patient with Negative Magnetic Resonance Image Finding

This article describes a case of the patient hospitalized for a sudden heart failure with severe left ventricular dysfunction. This case report presents a history of biopsy-proven inflammatory cardiomyopathy with negative MRI findings. Inflammatory Cardiomyopathy (ICM) is a potentially reversible disease, in which targeted treatment may be considered.