{"id":1141,"date":"2016-12-05T22:52:23","date_gmt":"2016-12-05T21:52:23","guid":{"rendered":"http:\/\/www.newslab.sk\/2016\/12\/05\/moznosti-laboratornej-diagnostiky-neisseria-gonorrhoeae-a-jej-aktualna-rezistencia-na-antibiotika\/"},"modified":"2017-10-04T08:30:29","modified_gmt":"2017-10-04T06:30:29","slug":"the-possibilities-for-laboratory-diagnosis-of-neisseria-gonorrhoeae-and-the-current-situation-in-antimicrobial-resistance","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/the-possibilities-for-laboratory-diagnosis-of-neisseria-gonorrhoeae-and-the-current-situation-in-antimicrobial-resistance\/","title":{"rendered":"The possibilities for laboratory diagnosis of Neisseria gonorrhoeae and the current situation in antimicrobial resistance"},"content":{"rendered":"<pre><strong><span style=\"color: #ff0000;\">\u00a0*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf <\/span><\/strong>\r\n <strong><span style=\"color: #ff0000;\">attachment at the end of the paper.<\/span> <\/strong><\/pre>\n<p>&nbsp;<\/p>\n<h5><strong>Klinick\u00e9 pr\u00edznaky<\/strong><\/h5>\n<p>K prenosu kvapavky doch\u00e1dza takmer v\u00fdlu\u010dne prostredn\u00edctvom sexu\u00e1lneho styku, preto naj\u010dastej\u0161ie postihuje mo\u010dovo-pohlavn\u00e9 org\u00e1ny. U\u00a0mu\u017eov sa gonorea prejavuje typick\u00fdm hnisav\u00fdm v\u00fdtokom z\u00a0mo\u010dovej r\u00fary, bielej a\u017e \u017eltej farby a rezan\u00edm alebo p\u00e1len\u00edm pri mo\u010den\u00ed. U\u00a0\u017eien hlienovit\u00fdm a\u017e hnisav\u00fdm v\u00fdtokom z\u00a0po\u0161vy, boles\u0165ou v\u00a0podbru\u0161\u00ed a pri pohlavnom styku. Bezpr\u00edznakov\u00fd priebeh infekcie sa ud\u00e1va u\u00a010% mu\u017eov a\u00a050% \u017eien. Nelie\u010den\u00e9 alebo nespr\u00e1vne lie\u010den\u00e9 ochorenie m\u00f4\u017ee prejs\u0165\u00a0 do chronick\u00e9ho \u0161t\u00e1dia. U\u00a0\u017eien\u00a0 m\u00f4\u017ee postupuj\u00faca infekcia zasiahnu\u0165 bartoliniho \u017e\u013eazu a org\u00e1ny malej panvy (PID). U\u00a0mu\u017eov sa chronick\u00e1 infekcia prejav\u00ed naj\u010dastej\u0161ie z\u00e1palom nadsemenn\u00edkov (epididimitis). U\u00a0oboch pohlav\u00ed v\u00a0pr\u00edpade zanedbanej lie\u010dby m\u00f4\u017ee pr\u00eds\u0165 a\u017e k\u00a0syst\u00e9movej infekcii, ktor\u00e1 sa prejavuje polyartralgiou, tenosynovit\u00eddou a\u00a0dermatit\u00eddou. Zriedkavo sa syst\u00e9mov\u00e1 infekcia m\u00f4\u017ee prejavi\u0165 sepsou, endokardit\u00eddou alebo meningit\u00eddou. K\u00a0prenosu infekcie z\u00a0chorej matky do oka novorodenca m\u00f4\u017ee pr\u00eds\u0165 pri p\u00f4rode. O\u010dn\u00e1 forma sa vyskytuje i u\u00a0dospel\u00e9ho \u010dloveka pri nedostato\u010dnej osobnej hygiene autoinfekciou z\u00a0genit\u00e1lnej oblasti. Zriedkav\u00e9 neb\u00fdvaj\u00fa ani farynge\u00e1lne a\u00a0rekt\u00e1lne infekcie v\u00a0z\u00e1vislosti od sexu\u00e1lnych prakt\u00edk pou\u017e\u00edvan\u00fdch postihnutou osobou. Maj\u00fa ne\u0161pecifick\u00e9 pr\u00edznaky ktor\u00fdmi s\u00fa: podr\u00e1\u017eden\u00e1 sliznica, boles\u0165 hrdla, svrbenie alebo boles\u0165 v\u00a0kone\u010dn\u00edku. Vo v\u00e4\u010d\u0161ine pr\u00edpadov extragenit\u00e1lnych infekci\u00ed sa na ne nemysl\u00ed a\u00a0ost\u00e1vaj\u00fa nediagnostikovan\u00e9. Tak\u00edto pacienti s\u00fa rezervo\u00e1rom pre \u010fal\u0161ie \u0161\u00edrenie infekcie.<\/p>\n<h4>Diagnostika<\/h4>\n<h5><strong>Mikroskopick\u00e9 a\u00a0kultiva\u010dn\u00e9 vy\u0161etrenie<\/strong><\/h5>\n<p>Kultiva\u010dn\u00e9 vy\u0161etrenie zost\u00e1va \u0161tandardn\u00fdm postupom v\u00a0diagnostike kvapavky. Vhodn\u00e9 je hlavne v\u00a0ak\u00fatnom \u0161t\u00e1diu infekcie. Dokazuje pr\u00edtomnos\u0165 \u017eivotaschopn\u00fdch bakt\u00e9rii. Falo\u0161ne negat\u00edvne m\u00f4\u017ee by\u0165 toto vy\u0161etrenie v\u00a0pr\u00edpade predo\u0161lej antibiotickej terapie. Vzorky sa kultivuj\u00fa na selekt\u00edvnej p\u00f4de v\u00a0atmosf\u00e9re so zv\u00fd\u0161enou koncentr\u00e1ciou CO<sub>2<\/sub>. Izolovan\u00e9 kmene, s\u00fa \u010falej identifikovan\u00e9 diagnostick\u00fdmi testami. V\u00fdhodou tejto met\u00f3dy je mo\u017enos\u0165 stanovenia citlivosti na antibiotik\u00e1, \u010do m\u00e1 v\u00fdznam pre spr\u00e1vnu vo\u013ebu lie\u010dby, vzh\u013eadom na zvy\u0161uj\u00facu sa rezistenciu. S\u00fa\u010das\u0165ou kultiva\u010dn\u00e9ho vy\u0161etrenia je aj mikroskopick\u00e9 vy\u0161etrenie, ktor\u00e9 je r\u00fdchle a\u00a0v\u00a0pr\u00edpade pozit\u00edvneho n\u00e1lezu u\u017e v\u00a0de\u0148 prijatia vzorky umo\u017e\u0148uje predbe\u017ene diagnostikova\u0165 gonokokov\u00fa infekciu na z\u00e1klade pr\u00edtomnosti leukocytov a\u00a0gramnegat\u00edvnych diplokokov v\u00a0typickom mikroskopickom obraze.<\/p>\n<h5><strong>D\u00f4kaz DNA <em>Neisseria gonorrhoeae<\/em> met\u00f3dou PCR<\/strong><\/h5>\n<p>Najmodernej\u0161ie s\u00fa molekul\u00e1rno-biologick\u00e9 diagnostick\u00e9 met\u00f3dy, ktor\u00e9 dokazuj\u00fa pr\u00edtomnos\u0165 DNA gonokokov vo vzorke. V\u00fdhodou PCR vy\u0161etrenia je jeho vysok\u00e1 senzitivita. Deteguje aj m\u0155tve alebo m\u00e1lo vit\u00e1lne bakt\u00e9rie, ktor\u00e9 by kultiva\u010dn\u00e9 vy\u0161etrenie nedok\u00e1zalo. V\u00a0pr\u00edpade pozit\u00edvneho n\u00e1lezu je vhodn\u00e9 doplni\u0165 kultiva\u010dn\u00e9 vy\u0161etrenie a\u00a0stanovi\u0165 citlivos\u0165 na antibiotik\u00e1. V\u00fdhodou tejto met\u00f3dy je aj mo\u017enos\u0165 s\u00fa\u010dasne vy\u0161etri\u0165 pr\u00edtomnos\u0165 DNA <em>Chlamydia trachomatis <\/em>spolu s\u00a0DNA<em> Neisseria gonorrhoeae <\/em>z\u00a0jednej vzorky. Limituj\u00facim faktorom m\u00f4\u017ee by\u0165 v\u00a0pr\u00edpade vzoriek z\u00a0faryngu alebo rekta falo\u0161n\u00e1 pozitivita, nako\u013eko nie je vyl\u00fa\u010den\u00e1 skr\u00ed\u017een\u00e1 reakcia s\u00a0DNA komenz\u00e1lnych neis\u00e9ri\u00ed pr\u00edtomn\u00fdch v\u00a0hrdle. V\u00a0tomto pr\u00edpade je preto potrebn\u00e9 potvrdi\u0165 pozit\u00edvny n\u00e1lez kultiva\u010dn\u00fdm vy\u0161etren\u00edm, pr\u00edpadne inou molekul\u00e1rno-biologickou met\u00f3dou.<\/p>\n<h5><strong>Odber materi\u00e1lu<\/strong><\/h5>\n<p>Na kultiva\u010dn\u00e9 vy\u0161etrenie je vhodn\u00fdm materi\u00e1lom u\u00a0mu\u017eov v\u00fdter z\u00a0uretry a\u00a0ejakul\u00e1t. U\u00a0\u017eien v\u00fdter z\u00a0cervixu alebo po\u0161vy. Pri podozren\u00ed na kvapavku je vhodn\u00e9 odobra\u0165 aj v\u00fdter z\u00a0tonz\u00edl alebo z rekta, pod\u013ea sexu\u00e1lnych prakt\u00edk pacienta. V\u00a0pr\u00edpade o\u010dnej infekcie sa odober\u00e1 ster z\u00a0o\u010dnej spojovky. Tamp\u00f3ny musia by\u0165 vlo\u017een\u00e9 do transportnej p\u00f4dy a\u00a0v\u00a0dobe transportu uchov\u00e1van\u00e9 pri izbovej teplote, nako\u013eko gonokoky s\u00fa citliv\u00e9 na vonkaj\u0161ie prostredie a\u00a0zmenu teploty. Na \u017eiadanke je potrebn\u00e9 vyzna\u010di\u0165 po\u017eadovan\u00e9 kultiva\u010dn\u00e9 vy\u0161etrenie na <em>Neisseria gonoorhoeae<\/em>. V\u00a0pr\u00edpade potreby je mo\u017en\u00e9 odobra\u0165 tekut\u00e9 materi\u00e1ly ako hnis, punkt\u00e1t, krv na hemokult\u00faru alebo likvor.<\/p>\n<p>Na vy\u0161etrenie pr\u00edtomnosti gonokokovej DNA sa na odber pou\u017e\u00edva \u0161peci\u00e1lna odberov\u00e1 s\u00faprava dod\u00e1van\u00e1 laborat\u00f3riom, ktor\u00e1 pozost\u00e1va z\u00a0dvojice tamp\u00f3nov a\u00a0sk\u00famavky s\u00a0tekut\u00fdm transportn\u00fdm m\u00e9diom. Je mo\u017en\u00e9 pou\u017ei\u0165 aj in\u00fd vhodn\u00fd tamp\u00f3n pre v\u00fdter z\u00a0urogenit\u00e1lneho traktu, tamp\u00f3n sa v\u0161ak mus\u00ed vlo\u017ei\u0165 do sk\u00famavky bez transportn\u00e9ho m\u00e9dia. Vhodn\u00fdm materi\u00e1lom z\u00a0h\u013eadiska komfortu pacienta je prv\u00fd pr\u00fad rann\u00e9ho mo\u010du, ktor\u00fd obsahuje dostatok epitelov\u00fdch buniek a\u00a0bakt\u00e9ri\u00ed zo sliznice mo\u010dovej r\u00fary. Mo\u017en\u00e9 je vy\u0161etri\u0165 aj vzorky LBC odobrat\u00e9 na cytologick\u00e9 vy\u0161etrenie v\u00a0r\u00e1mci skr\u00edningu karcin\u00f3mu kr\u010dka maternice.<\/p>\n<p>V pr\u00edpade ne\u00faspe\u0161nej antibiotickej terapie je vhodn\u00e9 opakova\u0165 kultiva\u010dn\u00fa anal\u00fdzu o 3 a\u017e 7 dn\u00ed po ukon\u010den\u00ed lie\u010dby. V pr\u00edpade, \u017ee je v\u00fdsledok negat\u00edvny, po t\u00fd\u017edni od ukon\u010denia terapie je potrebn\u00e9 zopakova\u0165 anal\u00fdzu met\u00f3dou PCR. U pacientov po \u00faspe\u0161nej lie\u010dbe je odpor\u00fa\u010dan\u00e9 zopakova\u0165 anal\u00fdzu met\u00f3dou PCR 2 t\u00fd\u017edne po ukon\u010den\u00ed terapie.<\/p>\n<p>&nbsp;<\/p>\n<h5><strong>Preh\u013ead rezistencie vo\u010di antibiotik\u00e1m<\/strong><\/h5>\n<p>Gonokoky si postupne vytvorili rezistenciu vo\u010di antibiotik\u00e1m, ktor\u00e9 sa pou\u017e\u00edvaj\u00fa v\u00a0lie\u010dbe. Zo v\u0161etk\u00fdch skup\u00edn antibiot\u00edk ostali cefalospor\u00edny tretej gener\u00e1cie jedinou vo\u013ebou pre empirick\u00fa terapiu. V\u00a0\u00c1zii boli dokonca izolovan\u00e9 kmene, ktor\u00e9 boli rezistentn\u00e9 vo\u010di v\u0161etk\u00fdm dostupn\u00fdm antibiotik\u00e1m. D\u00f4le\u017eit\u00fd je neust\u00e1ly monitoring v\u00fdvoja rezistencie a\u00a0aktualiz\u00e1cia smern\u00edc pre antibiotick\u00fa terapiu. V\u00a0Eur\u00f3pe t\u00fato funkciu vykon\u00e1va Eur\u00f3pske centrum pre kontrolu a\u00a0prevenciu chor\u00f4b (ECDC) prostredn\u00edctvom programu EuroGASP (European Gonococcal Antimicrobial Surveillance Programme). V\u00a0r\u00e1mci tohto programu sa vykon\u00e1va testovanie citlivosti na antibiotik\u00e1 u\u00a0zaslan\u00fdch izol\u00e1tov zo v\u0161etk\u00fdch z\u00fa\u010dastnen\u00fdch kraj\u00edn. Preh\u013eady a\u00a0trendy v\u00fdvoja rezistencie s\u00fa vyhodnocovan\u00e9 spolu s\u00a0epidemiologick\u00fdmi d\u00e1tami z\u00edskan\u00fdmi pomocou dotazn\u00edkov. Tieto \u00fadaje s\u00fa ve\u013emi cenn\u00e9 pre tvorbu strat\u00e9gie na spomalenie \u0161\u00edrenia rezistencie najm\u00e4 prostredn\u00edctvom aktualiz\u00e1cie smern\u00edc pre terapiu a\u00a0diagnostiku ochorenia a\u00a0\u0161\u00edren\u00edm osvety medzi odbornou verejnos\u0165ou. S\u00fa\u010das\u0165ou surveillance je aj zavedenie hl\u00e1senia a\u00a0\u0161etrenia pr\u00edpadov zlyhania terapie cefalospor\u00ednmi tretej gener\u00e1cie do epidemiologick\u00e9ho informa\u010dn\u00e9ho syst\u00e9mu (EPIS). Slovensk\u00fa republiku v\u00a0tejto surveillance zastupuje laborat\u00f3rium HPL spol. s\u00a0r. o. v\u00a0spolupr\u00e1ci s\u00a0niektor\u00fdmi \u010fal\u0161\u00edmi mikrobiologick\u00fdmi laborat\u00f3riami.<\/p>\n<p>Najv\u00e4\u010d\u0161ia pozornos\u0165 sa moment\u00e1lne venuje rezistencii cefalospor\u00ednov 3. gener\u00e1cie, ktor\u00e9 ostali jedinou skupinou antibiot\u00edk vhodn\u00fdch pre empirick\u00fa terapiu gonokokov\u00fdch infekci\u00ed. Sledovanie rezistencie cefalospor\u00ednov bolo zaraden\u00e9 do eur\u00f3pskej surveillance v\u00a0roku 2009, kedy rezistencia vo\u010di cefix\u00edmu dosahovala 5,1%, najvy\u0161\u0161ia bola v\u00a0roku 2010 8,7%, v\u00a0roku 2011 7,6% a\u00a0v\u00a0prvom polroku 2012 bol zaznamenan\u00fd pokles rezistencie na 3,6%. Rezistencia vo\u010di ceftriax\u00f3nu bola zaznamenan\u00e1 ve\u013emi sporadicky. Penicilin\u00e1zu produkuj\u00facich kme\u0148ov bolo pribli\u017ene 10%. Najvy\u0161\u0161iu rezistenciu dosahuje ciprofloxac\u00edn, v\u00a0roku 2009 63%. V\u00a0prvom polroku 2012 to bolo 50%. Rezistencia vo\u010di azitromyc\u00ednu bola okrem roku 2009 menej ako 10%.<\/p>\n<p>V\u00a0roku 2013 sme v\u00a0laborat\u00f3ri\u00e1ch HPL spol. s\u00a0r. o. kultiva\u010dn\u00fdm vy\u0161etren\u00edm dok\u00e1zali 218 pr\u00edpadov gonokokovej infekcie. Rezistencia vo\u010di cefix\u00edmu dosiahla 4,2%, \u010do je pod 5% hranicou, kedy je e\u0161te mo\u017en\u00e9 antibiotikum pou\u017ei\u0165 ako liek prvej vo\u013eby. Citlivos\u0165 na ceftriax\u00f3n bola testovan\u00e1 iba u\u00a0kme\u0148ov, ktor\u00e9 mali hrani\u010dn\u00fa MIC alebo boli rezistentn\u00e9 na cefix\u00edm. U \u00a0t\u00fdchto kme\u0148ov nebola zaznamenan\u00e1 rezistencia vo\u010di ceftriax\u00f3nu. Na penicil\u00edn bolo citliv\u00fdch len 22,8% kme\u0148ov. Rezistencia vo\u010di ciprofloxac\u00ednu dosiahla 52,6% a\u00a0na tetracykl\u00edn bolo citliv\u00fdch 54,9% kme\u0148ov (obr. 1).<\/p>\n<p>Obr. 1: preh\u013ead rezistencie kme\u0148ov <em>N. gonorrhoeae<\/em> izolovan\u00fdch v\u00a0roku 2013<\/p>\n<p>V\u00a0r\u00e1mci z\u00edskavania epidemiologick\u00fdch \u00fadajov pomocou dotazn\u00edkov bolo zis\u0165ovan\u00e9, ak\u00e9 antibiotik\u00e1 boli pou\u017eit\u00e9 v\u00a0empirickej terapii. Pod\u013ea eur\u00f3pskej smernice s\u00fa vo\u013ebou pre lie\u010dbu v\u00a0prvej l\u00ednii cefalospor\u00edny 3. gener\u00e1cie, ktor\u00e9 boli podan\u00e9 v\u00a030% pr\u00edpadov. V\u00a0ostatn\u00fdch pr\u00edpadoch boli podan\u00e9 antibiotik\u00e1 chinol\u00f3nov\u00e9 (23%), tetracykl\u00ednov\u00e9 (22%), penicil\u00ednov\u00e9 (19%) a\u00a0makrolidov\u00e9 &#8211; azitromyc\u00edn (6%) (obr. 2). Pou\u017e\u00edvanie antibiot\u00edk, vo\u010di ktor\u00fdm, je vy\u0161\u0161ia ako 50% rezistencia, v\u00a0empirickej terapii je neefekt\u00edvne, predl\u017euje sa tak diskomfort pacienta a\u00a0zvy\u0161uje riziko \u010fal\u0161ieho \u0161\u00edrenia infekcie. Azitromyc\u00edn nie je vhodn\u00e9 pou\u017ei\u0165 v\u00a0monoterapii gonokokovej infekcie, ale iba v\u00a0kombin\u00e1cii s\u00a0in\u00fdmi antibiotikami.<\/p>\n<p>Obr. 2: pou\u017eit\u00e9 antibiotik\u00e1 v\u00a0empirickej terapii.<\/p>\n<p>&nbsp;<\/p>\n<h5><strong>Terapia gonokokov\u00fdch infekci\u00ed<\/strong><\/h5>\n<p>Ak\u00fatna gonokokov\u00e1 infekcia je v\u00a0pr\u00edpade pou\u017eitia adekv\u00e1tnej terapie pomerne \u013eahko lie\u010dite\u013en\u00e1. D\u00f4le\u017eit\u00fd je v\u00fdber antibiotika pre lie\u010dbu v\u00a0prvej l\u00ednii. Vzh\u013eadom na vysok\u00fa rezistenciu zo v\u0161etk\u00fdch skup\u00edn antibiot\u00edk ostali vhodn\u00e9 pre pou\u017eitie v\u00a0empirickej terapii len cefalospor\u00edny 3. gener\u00e1cie. V\u00a0pr\u00edpade nekomplikovanej ak\u00fatnej infekcie je mo\u017en\u00e9 poda\u0165 peror\u00e1lne cefix\u00edm, 400 mg v\u00a0jednorazovej d\u00e1vke alebo intramuskul\u00e1rne ceftriax\u00f3n 500 mg v\u00a0jednorazovej d\u00e1vke.<\/p>\n<p>Pod\u013ea eur\u00f3pskych guidelines sa v\u00a0empirickej terapii odpor\u00fa\u010da pod\u00e1va\u0165 len ceftriax\u00f3n intramuskul\u00e1rne. Vzh\u013eadom na preskrip\u010dn\u00e9 obmedzenie ceftriax\u00f3nu a\u00a0ni\u017e\u0161iu rezistenciu ako 5% u cefix\u00edmu v Slovenskej Republike, je alternat\u00edvnou mo\u017enos\u0165ou podanie cefix\u00edmu Cefalospor\u00edny m\u00f4\u017eu ma\u0165 zn\u00ed\u017een\u00fd \u00fa\u010dinok na <em>Neisseria gonorrhoeae<\/em> v\u00a0hrdle, v pr\u00edpade farynge\u00e1lnej infekcie, preto by mal by\u0165 s\u00fa\u010dasne podan\u00fd aj azitromyc\u00edn peror\u00e1lne 2 g v\u00a0jednorazovej d\u00e1vke. Azitromyc\u00edn m\u00e1 s\u00a0cefalospor\u00ednmi synergick\u00fd \u00fa\u010dinok a\u00a0je \u00fa\u010dinn\u00fd aj v\u00a0pr\u00edpade s\u00fa\u010dasnej chlam\u00fddiovej infekcie. Ostatn\u00e9 antibiotik\u00e1 by mali by\u0165 pou\u017eit\u00e9 len na z\u00e1klade v\u00fdsledkov testovania citlivosti v\u00a0pr\u00edpade, \u017ee je kme\u0148 na dan\u00e9 antibiotikum citliv\u00fd. Je mo\u017en\u00e9 poda\u0165 ciprofloxac\u00edn peror\u00e1lne 500 mg v\u00a0jednorazovej d\u00e1vke alebo doxycykl\u00edn peror\u00e1lne 100 mg dva razy denne po dobu 7 a\u017e 10 dn\u00ed.<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<h5><strong>Pou\u017eit\u00e1 literat\u00fara<\/strong><\/h5>\n<p>Bignell C and Unemo M. On behalf of the European STI Guidelines Editorial Board. European guideline on the diagnosis and treatment of gonorrhoea in adults. Int J STD AIDS. Forthcoming 2012. Available from:<\/p>\n<p>&lt;http:\/\/www.iusti.org\/regions\/Europe\/pdf\/2012\/Gonorrhoea_2012.pdf&gt;<\/p>\n<p>ECDC Surveillance Report. 2013 Gonococcal antimicrobial susceptibility surveillance in Europe 2011. Available from:<\/p>\n<p>&lt;http:\/\/www.ecdc.europa.eu\/en\/publications\/Publications\/Forms\/ECDC_DispForm.aspx?ID=1082)&gt;<\/p>\n<p>Dost\u00e1l V\u00a0a\u00a0kol. Infektologie, Karolinum, Praha 2005, ISBN 80-246-0749-2<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u00a0*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf attachment at the end of the paper. &nbsp; Klinick\u00e9 pr\u00edznaky K prenosu kvapavky doch\u00e1dza takmer v\u00fdlu\u010dne prostredn\u00edctvom sexu\u00e1lneho styku, preto naj\u010dastej\u0161ie postihuje mo\u010dovo-pohlavn\u00e9 org\u00e1ny. U\u00a0mu\u017eov sa gonorea prejavuje typick\u00fdm hnisav\u00fdm v\u00fdtokom z\u00a0mo\u010dovej r\u00fary, bielej a\u017e \u017eltej farby<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[292],"tags":[744,743,742],"class_list":["post-1141","post","type-post","status-publish","format-standard","hentry","category-microbiology","tag-antimicrobial-resistance","tag-gonorrhoea","tag-neisseria-gonorrhoeae","typ_clanku-review-article"],"acf":{"abstrakt":"<p>Gonorrhoea is the second most common bacterial sexually transmitted disease following the chlamydia infections. Its is caused by the gram-negative diplococcus Neisseria gonorrhoeae that adheres to and gets into the mucous membranes where it leads to inflammation. This infection is usually easy to treat and in case of successful therapy it does not leave any permanent consequences. However, treatment has become problematic after resistance to used antibiotics occurred and increased. Therefore, attention must be paid to thorough laboratory diagnosis and correctly selected treatment.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Key words<\/strong>: Neisseria gonorrhoeae, gonorrhoea, antimicrobial resistance<\/p>\n","casopis":[{"ID":1000,"post_author":"7","post_date":"2015-11-21 14:33:24","post_date_gmt":"2015-11-21 13:33:24","post_content":"<h4><strong>GENETICS<\/strong><\/h4>\r\n<ul>\r\n \t<li>The laboratory age<\/li>\r\n \t<li>The Odyssey of DNA reading<\/li>\r\n \t<li>Comparative genomic hybridisation: a methodological introduction<\/li>\r\n \t<li>Next generation sequencing and its application in clinical genetics<\/li>\r\n<\/ul>\r\n<h4><\/h4>\r\n<h4><strong>BIOCHEMISTRY<\/strong><\/h4>\r\n<ul>\r\n \t<li>Determining of the trace elements in blood serum<\/li>\r\n \t<li>Determining of \u03b1-tocopherol (vitamin E) in serum by way of liquid chromatography with tandem mass spectrometry (LC\/MS\/MS)<\/li>\r\n \t<li>Analysis of urinary calculi and its path to Europe<\/li>\r\n<\/ul>\r\n&nbsp;\r\n<h4><strong>IMMUNOLOGY <\/strong><\/h4>\r\n<ul>\r\n \t<li>New autoantibodies in diagnosis of autoimmunity myopathies<\/li>\r\n \t<li>Taking advantage of flow-based cytometry in determining prognostic markers<\/li>\r\n<\/ul>\r\nCD38 and ZAP-70 in patients with B-CLL\r\n\r\n&nbsp;\r\n<h4><strong>CYTOLOGY AND PATHOLOGY <\/strong><\/h4>\r\n<ul>\r\n \t<li>Mucinous ovarian carcinoma \u2013 news in diagnosis from the pathologist\u2019s perspective<\/li>\r\n<\/ul>","post_title":"newsLab","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"newslab-12015","to_ping":"","pinged":"","post_modified":"2017-08-16 21:43:10","post_modified_gmt":"2017-08-16 19:43:10","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.newslab.sk\/casopis\/newslab-12015\/","menu_order":0,"post_type":"casopis","post_mime_type":"","comment_count":"0","filter":"raw"}],"strana":"42","upload_clanok":{"ID":1142,"id":1142,"title":"medirex_1_2015-pavlik","filename":"MEDIREX_1_2015-\u2013-Pavlik.pdf","filesize":197315,"url":"https:\/\/www.newslab.sk\/wp-content\/uploads\/2016\/12\/MEDIREX_1_2015-\u2013-Pavlik.pdf","link":"https:\/\/www.newslab.sk\/en\/the-possibilities-for-laboratory-diagnosis-of-neisseria-gonorrhoeae-and-the-current-situation-in-antimicrobial-resistance\/medirex_1_2015-pavlik\/","alt":"","author":"7","description":"","caption":"","name":"medirex_1_2015-pavlik","status":"inherit","uploaded_to":1141,"date":"2016-12-05 21:42:21","modified":"2016-12-05 21:42:21","menu_order":0,"mime_type":"application\/pdf","type":"application","subtype":"pdf","icon":"https:\/\/www.newslab.sk\/wp-includes\/images\/media\/document.png"}},"_links":{"self":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1141","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/comments?post=1141"}],"version-history":[{"count":0,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1141\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/media?parent=1141"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/categories?post=1141"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/tags?post=1141"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}