{"id":1295,"date":"2017-09-28T12:05:08","date_gmt":"2017-09-28T10:05:08","guid":{"rendered":"http:\/\/www.newslab.sk\/2017\/09\/28\/anaerobne-infekcie-makkych-tkaniv\/"},"modified":"2017-09-28T12:15:55","modified_gmt":"2017-09-28T10:15:55","slug":"anaerobic-infections-of-soft-tissues","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/anaerobic-infections-of-soft-tissues\/","title":{"rendered":"Anaerobic infections of soft tissues"},"content":{"rendered":"
*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf \r\nattachment at the end of the paper.<\/span> <\/strong><\/pre>\n
P\u00f4vodcovia ochorenia<\/strong><\/p>\n
Anaer\u00f3bne bakt\u00e9rie s\u00fa roz\u0161\u00edren\u00e9 v pr\u00edrode. V\u00e4\u010d\u0161ina ich ro\u00addov tvor\u00ed s\u00fa\u010das\u0165 mikrofl\u00f3ry \u013eudsk\u00e9ho tela(1)<\/sup>. Niektor\u00e9 z nich hraj\u00fa d\u00f4le\u017eit\u00fa \u00falohu aj vo fyziol\u00f3gii hostite\u013ea(2)<\/sup>.<\/p>\n
Maj\u00fa tieto spolo\u010dn\u00e9 vlastnosti:<\/p>\n
    \n
  1. nemaj\u00fa enz\u00fdmy oxidat\u00edvneho metabolizmu (katal\u00e1zy, peroxid\u00e1zy a superoxid – dismut\u00e1zy), preto nie s\u00fa schopn\u00e9 vpravi\u0165 molekul\u00e1rny kysl\u00edk do svojich biosynt\u00e9z. Bunky nie s\u00fa po\u0161kodzovan\u00e9 molekulami kysl\u00edka priamo, let\u00e1lny \u00fa\u010di\u00adnok na bakteri\u00e1lnu bunku maj\u00fa vysokoreakt\u00edvne l\u00e1tky, kto\u00adr\u00e9 vznikaj\u00fa v priebehu respir\u00e1cie, napr. peroxid vod\u00edka, superoxidy(3)<\/sup>.<\/li>\n
  2. na rozmno\u017eovanie vy\u017eaduj\u00fa n\u00edzke hodnoty oxida\u010dno-reduk\u010dn\u00e9ho potenci\u00e1lu (ch\u00fdbaj\u00fa im enz\u00fdmy schopn\u00e9 za\u00advies\u0165 do oxida\u010dno-reduk\u010dn\u00fdch dejov l\u00e1tkovej premeny kys\u00adl\u00edk). Na oxida\u010dno-reduk\u010dn\u00e9 pochody vyu\u017e\u00edvaj\u00fa prote\u00edny, ktor\u00e9 pren\u00e1\u0161aj\u00fa elektr\u00f3ny(4)<\/sup>.<\/li>\n
  3. l\u00e1tkov\u00e1 premena pri anaer\u00f3boch neprebieha tak v\u00fddatne a prijat\u00e9 l\u00e1tky nevyu\u017e\u00edvaj\u00fa tak hospod\u00e1rne ako aer\u00f3bne mikroorganizmy. Anaer\u00f3bne bakt\u00e9rie nemaj\u00fa schopnos\u0165 syntetizova\u0165 aminokyseliny, preto ich mno\u017eenie je pomal\u00ad\u0161ie ako pri aer\u00f3bnych bakt\u00e9ri\u00e1ch(1)<\/sup>.<\/li>\n
  4. kone\u010dn\u00e9 splodiny ich l\u00e1tkovej premeny nie s\u00fa rozlo\u017een\u00e9. Do prostredia sa uvo\u013e\u0148uj\u00fa zap\u00e1chaj\u00face produkty (kyselina mlie\u010dna, maslov\u00e1, s\u00edrovod\u00edk, etanol, at\u010f.).<\/li>\n<\/ol>\n
    Z taxonomick\u00e9ho h\u013eadiska tvoria anaer\u00f3by r\u00f4znorod\u00fa skupinu mikroorganizmov, ktor\u00e1 zahr\u0148uje grampozit\u00edvne i gramnegat\u00edvne bakt\u00e9rie r\u00f4zneho tvaru. Anaer\u00f3bne mikroor\u00adganizmy del\u00edme na nesporuluj\u00face a sporuluj\u00face(1A5)<\/sup>. Gram\u00adnegat\u00edvne nesporuluj\u00face bakt\u00e9rie zahr\u0148uj\u00face rody Bacteroides, Prevotella, Porphyromonas a Fusobacterium sp\u00f4sobuj\u00fa a\u017e 43 % v\u0161etk\u00fdch anaer\u00f3bnych infekci\u00ed. Bakt\u00e9rie zo skupiny Bacteroides fragilis group (B. fragilis, B. thetaiotaomicron, B. distasonis, B. vulgatus, B. ovatus at\u010f.) s\u00fa prim\u00e1rnymi vyvol\u00e1\u00advate\u013emi intraabdomin\u00e1lnych abscesov a spolu s in\u00fdmi druh\u00admi aer\u00f3bnych patog\u00e9nnych bakt\u00e9ri\u00ed sa podie\u013eaj\u00fa na vzniku a progresii infekci\u00ed doln\u00fdch kon\u010dat\u00edn u dlhodobo hospitali\u00adzovan\u00fdch pacientov. Do druhej skupiny sp\u00f4sobuj\u00facej polymikrobi\u00e1lne infekcie patria grampozit\u00edvne anaer\u00f3bne koky, ktor\u00e9 s\u00fa s\u00fa\u010das\u0165ou be\u017enej slizni\u010dnej a ko\u017enej fl\u00f3ry. S\u00fa izolo\u00advan\u00e9 pri zmie\u0161an\u00fdch anaer\u00f3bnych infekci\u00e1ch. Patog\u00e9nna ak\u00adtivita grampozit\u00edvnych nesporuluj\u00facich anaer\u00f3bnych pali\u010diek sa prejavuje pri zmie\u0161an\u00fdch endog\u00e9nnych anaer\u00f3bnych in\u00adfekci\u00e1ch. Aktinomyc\u00e9ty s\u00fa p\u00f4vodcami ochorenia, ktor\u00e9 sa podstatne l\u00ed\u0161i od ochoren\u00ed sp\u00f4soben\u00fdch in\u00fdmi nesporuluj\u00facimi anaer\u00f3bmi. Organizmus na ich pr\u00edtomnos\u0165 v tkaniv\u00e1ch reaguje leukocyt\u00e1rnou infiltr\u00e1ciou a hyperprodukciou v\u00e4zi\u00adva136<\/sup>\/ Sporuluj\u00face anaer\u00f3bne bakt\u00e9rie tvoria ve\u013emi odol\u00adn\u00e9 sp\u00f3ry. Tvorba rezistentn\u00fdch sp\u00f3r je mechanizmom, kto\u00adr\u00fd bakt\u00e9rie z\u00edskali v evol\u00facii, aby mohli pre\u017ei\u0165. Vo vhodnom prostred\u00ed r\u00fdchlo vykl\u00ed\u010dia a d\u00e1vaj\u00fa vznik nov\u00fdm vegetat\u00edvnym bunk\u00e1m. Hlavn\u00fdm prostred\u00edm, odkia\u013e poch\u00e1dzaj\u00fa, je p\u00f4da, prach a \u010drevn\u00fd trakt. Infekcie, ktor\u00e9 sp\u00f4sobuj\u00fa, s\u00fa \u010dast\u00e9 po \u00farazoch pri dopravnej nehode alebo v po\u013enohospod\u00e1rstve. Vyskytuj\u00fa sa aj ako endog\u00e9nna infekcia pri oper\u00e1ci\u00e1ch na tr\u00e1\u00adviacom trakte, perfor\u00e1cii alebo ulcer\u00e1cii \u010dreva.<\/p>\n
    Patogen\u00e9za<\/strong><\/p>\n
    Faktory virulencie anaer\u00f3bnych bakt\u00e9ri\u00ed s\u00fa rozmanit\u00e9. Okrem puzdra, ktor\u00e9 ich chr\u00e1ni pred opsoniz\u00e1ciou a fagocyt\u00f3zou, maj\u00fa \u010fal\u0161ie d\u00f4le\u017eit\u00e9 faktory virulencie a patogeni\u00adty\u00ae. Exotoxfny enzymatickej a neenzymatickej povahy rozkla\u00addaj\u00fa organick\u00e9 l\u00e1tky vo svojom okol\u00ed, ktor\u00fdmi si zabezpe\u010duj\u00fa \u017eiviny a stavebn\u00e9 l\u00e1tky pre rast(1)<\/sup>. Bakt\u00e9rie tvoria proteolytick\u00e9 enz\u00fdmy a faktory podporuj\u00face koagul\u00e1ciu a prienik do tkan\u00edv: prote\u00e1za, hyaluronid\u00e1za, heparin\u00e1za, kolagen\u00e1za, lecitin\u00e1za, neuraminid\u00e1za, fibrinolyz\u00edn a faktory adherencie. Pri\u013enutie na epitelov\u00e9 bunky je prvou podmienkou na uplatne\u00adnie ich patog\u00e9nneho \u00fa\u010dinku(7)<\/sup>. Niektor\u00e9 exotox\u00edny s\u00fa schopn\u00e9 vyvola\u0165 imunitn\u00fa odpove\u010f tvorbou antitox\u00ednov. Produktmi metabolizmu (ako je s\u00e9roton\u00edn, histam\u00edn, ed\u00e9mov\u00fd faktor) nap\u00e1daj\u00fa bielkoviny v lo\u017eisku. Prchav\u00e9 mastn\u00e9 kyseliny, bio\u00adlogicky \u00fa\u010dinn\u00e9 am\u00edny a r\u00f4zne plyny svoj\u00edm tlakom zhor\u0161u\u00adj\u00fa krvn\u00e9 z\u00e1sobenie lo\u017eiska. Produkovan\u00fd s\u00edrovod\u00edk a \u010dpavok dr\u00e1\u017edia tkanivo(3)<\/sup>. Endotoxin – toxick\u00fd lipopolysacharidov\u00fd komplex v stene gramnegat\u00edvnych pali\u010diek vyvol\u00e1va endotox\u00ednov\u00fd \u0161ok\u00ae7)<\/sup>. Tieto infekcie s\u00fa \u010dasto zmie\u0161an\u00e9, sp\u00f4sobe\u00adn\u00e9 anaer\u00f3bnymi, mikroaerofiln\u00fdmi, fakultat\u00edvne anaer\u00f3bnymi a aer\u00f3bnymi bakt\u00e9riami. Ich vz\u00e1jomn\u00e1 kooper\u00e1cia je oxido- reduk\u010dnej a metabolickej povahy a je zalo\u017een\u00e1 na princ\u00edpe, \u017ee aer\u00f3bne bakt\u00e9rie spotrebuj\u00fa v uzavretom priestore vo\u013en\u00fd kysl\u00edk(1)<\/sup>. Anaer\u00f3bne infekcie s\u00fa obvykle sp\u00f4soben\u00e9 endog\u00e9n\u00adnymi anaer\u00f3bnymi bakt\u00e9riami – nastupuj\u00fa sekund\u00e1rne, pri poru\u0161en\u00ed ekologickej rovnov\u00e1hy fyziologickej fl\u00f3ry alebo pri preniku do miest, kde sa prirodzene nevyskytuj\u00fa. Tieto infek\u00adcie vyvol\u00e1vaj\u00fa aj exog\u00e9nne anaer\u00f3bne bakt\u00e9rie – kontami\u00adn\u00e1ciou r\u00e1n pri rozsiahlych poraneniach zne\u010disten\u00fdch p\u00f4dou obsahuj\u00facou napr. sp\u00f3ry klostr\u00eddi\u00ed(4)<\/sup>. V rane je devitalizovan\u00e9 tkanivo ide\u00e1lnym prostred\u00edm na rozvoj bakteri\u00e1lnej infek\u00adcie a je aj prek\u00e1\u017ekou procesu hojenia. Zn\u00ed\u017eenie dostupnosti kysl\u00edka m\u00e1 vplyv na tvorbu kolag\u00e9nu, angiogen\u00e9zu a epiteliz\u00e1ciu(7)<\/sup>.Okrem kontamin\u00e1cie rany je pre manifest\u00e1ciu ocho\u00adrenia potrebn\u00fd v\u00fdskyt lok\u00e1lnych predispozi\u010dn\u00fdch faktorov. Prirodzen\u00e1 ochrana proti anaer\u00f3bom je nedostato\u010dn\u00e1. Bun\u00adkov\u00e1 imunita i prirodzen\u00e9 ochrann\u00e9 mechanizmy s\u00fa bloko\u00advan\u00e9 nedostato\u010dn\u00fdm cievnym z\u00e1soben\u00edm. Polymorfonukle\u00e1rne leukocyty nemaj\u00fa dos\u0165 kysl\u00edka pre oxidat\u00edvne vzplanutie, ktor\u00fd je ich z\u00e1kladn\u00fdm mechanizmom zab\u00edjania. Zlo\u017eky humor\u00e1lnej imunity (komplement, protil\u00e1tky) prenikaj\u00fa do m\u00e1lo prekrven\u00fdch tkan\u00edv len obmedzene\u00ae.<\/p>\n
    Faktory vzniku anaer\u00f3bnych infekcii<\/strong><\/p>\n
    Invazivita anaer\u00f3bov je v\u0161eobecne mal\u00e1. Anaer\u00f3bne in\u00adfekcie neprebiehaj\u00fa epidemicky. Hodnot\u00edme ich u ka\u017ed\u00e9\u00adho jedinca zvl\u00e1\u0161\u0165. Pr\u00edtomnos\u0165 virulentnej anaer\u00f3bnej bakt\u00e9\u00adrie e\u0161te neznamen\u00e1, \u017ee ide o infekciu(8)<\/sup>. Pri rozvoji klinick\u00fdch pr\u00edznakov ochorenia nehr\u00e1 \u00falohu len mno\u017estvo, ale i druh mikroorganizmu17<\/sup>\u00ae. Pre striktn\u00e9 anaer\u00f3by sa m\u00f4\u017eu vytvori\u0165 vhodn\u00e9 podmienky v po\u0161koden\u00fdch tkaniv\u00e1ch s nedostato\u010d\u00adn\u00fdm krvn\u00fdm z\u00e1soben\u00edm alebo za spolu\u00fa\u010dasti fakultat\u00edvnych anaer\u00f3bov a aer\u00f3bov, ktor\u00e9 od\u010derp\u00e1vaj\u00fa kysl\u00edk\u00ae. Z\u00e1kladn\u00fdm faktorom, ktor\u00fd vedie k anaer\u00f3bnej infekcii, je nedostato\u010d\u00adne prekrven\u00e9 tkanivo, ke\u010f tenzia kysl\u00edka v tkaniv\u00e1ch kles\u00e1 pod fyziologick\u00fa hranicu. Sp\u00f4sobuj\u00fa to procesy v organizme, ktor\u00e9 ved\u00fa k naru\u0161eniu krvn\u00e9ho z\u00e1sobovania tkan\u00edv (pora\u00adnenie tepien, ateroskler\u00f3za, diabetick\u00e9 angiopatie, Buergerova choroba, emb\u00f3lie, hlbok\u00e1 \u017eilov\u00e1 tromb\u00f3za a \u010fal\u0161ie)\u00ae\u00ae.<\/p>\n
    K anaer\u00f3bnej infekcii najviac inklinuje rana s po\u0161kodenou ve\u013ekou cievou. Krv z anastom\u00f3z nesta\u010d\u00ed saturova\u0165 sval kysl\u00ed\u00adkom. N\u00e1sledn\u00e1 isch\u00e9mia zvy\u0161uje reflektorick\u00fd lok\u00e1lny spazmus a prestupom prote\u00ednov z kapil\u00e1r do okolit\u00e9ho tkaniva sa zvy\u0161uje tenzia v po\u0161kodenom svale. Cievy sa na\u010falej stl\u00e1\u00ad\u010daj\u00fa a hypoxia sa zvy\u0161uje\u00ae\u00ae. \u010eal\u0161\u00edm faktorom je zn\u00ed\u017een\u00e1 odolnos\u0165 organizmu napr. po opera\u010dn\u00fdch z\u00e1krokoch, cukrov\u00adka, pod\u00e1vanie cytostat\u00edk, imunosupres\u00edv, chemoterapia, vy\u0161\u00ad\u0161\u00ed vek, porucha krvnej cirkul\u00e1cie, podv\u00fd\u017eiva a zn\u00ed\u017een\u00fd po\u010det neutrofilov. Riziko predstavuj\u00fa invaz\u00edvne lek\u00e1rske z\u00e1kroky, pr\u00edtomnos\u0165 cudzieho telesa a \u00farazy, ktor\u00e9 poru\u0161uj\u00fa integri\u00adtu ko\u017ee a umo\u017e\u0148uj\u00fa prienik bakt\u00e9ri\u00ed do vn\u00fatorn\u00e9ho prostre\u00addia hostite\u013ea.<\/p>\n
    Klinick\u00fd obraz<\/strong><\/p>\n
    Anaer\u00f3bne bakt\u00e9rie vyvol\u00e1vaj\u00fa r\u00f4zne ve\u013emi z\u00e1va\u017en\u00e9 ocho\u00adrenia a maj\u00fa zvy\u010dajne tri f\u00e1zy:<\/p>\n
      \n
    1. lok\u00e1lnu – m\u00f4\u017ee sa manifestova\u0165 ako infiltr\u00e1t, absces, flegm\u00f3na alebo nekrotick\u00fd rozpad tkaniva<\/li>\n<\/ol>\n
        \n
      1. roz\u0161\u00edren\u00fa do krvn\u00e9ho obehu,<\/li>\n
      2. metastatick\u00fd proces – prebieha r\u00fdchlo(10)<\/sup>.<\/li>\n<\/ol>\n
        Nesporuluj\u00face anaer\u00f3by vyvol\u00e1vaj\u00fa typicky oport\u00fanne in\u00adfekcie, s\u00fa spravidla endog\u00e9nne, pyog\u00e9nneho charakteru, s v\u00fd\u00adraznou nekrotizuj\u00facou zlo\u017ekou, \u010dasto ohrani\u010den\u00e9 na ur\u010dit\u00e9 lo\u017eisko. Infekciou trombov doch\u00e1dza k tromboflebit\u00edde, septikopy\u00e9mii a hematog\u00e9nnym metast\u00e1zam do org\u00e1nov. Z\u00e1k\u00adladom patog\u00e9nneho p\u00f4sobenia nesporuluj\u00facich anaer\u00f3bov je metabolick\u00fd rozvrat tkan\u00edv vyvolan\u00fd ich kysl\u00fdmi metabo\u00adlick\u00fdmi produktmi\u00ae. Tieto infekcie s protrahovan\u00fdm priebe\u00adhom nemaj\u00fa pre svoj endog\u00e9nny p\u00f4vod charakter infek\u010dn\u00e9ho ochorenia. Ich vznik podporuj\u00fa rozli\u010dn\u00e9 diagnostick\u00e9 a tera\u00adpeutick\u00e9 v\u00fdkony\u00ae. Anaer\u00f3bne nesporuluj\u00face bakt\u00e9rie maj\u00fa prvorad\u00fd v\u00fdznam pri infekci\u00e1ch v abdomin\u00e1lnej oblasti, naj\u00adm\u00e4 poopera\u010dn\u00fdch peritonit\u00eddach, pri tvorbe abscesov. Typy ochorenia nesporuluj\u00facimi anaer\u00f3bnymi bakt\u00e9riami: \u0161peci\u00adfick\u00fd z\u00e1palov\u00fd proces, napr. aktinomyk\u00f3za – granulomat\u00f3zny z\u00e1palov\u00fd proces s tvorbou po\u010detn\u00fdch hnisav\u00fdch abscesov, navz\u00e1jom komunikuj\u00facich s tvorbou p\u00ed\u0161\u0165al a typick\u00fdch dr\u00faz a ne\u0161pecifick\u00fd z\u00e1palov\u00fd proces: hnisav\u00e9 infekcie bru\u0161\u00adnej dutiny, hnisav\u00e9 infekcie \u017eensk\u00e9ho genit\u00e1lu, hrudn\u00e9 empy\u00e9my, s\u00ednusit\u00eddy, aspira\u010dn\u00e9 pneum\u00f3nie, sepsy – asi 3 %\u00ae.<\/p>\n
        Sporuluj\u00face anaer\u00f3by:<\/strong> najz\u00e1va\u017enej\u0161ie infekcie sp\u00f4sobuj\u00fa mikroorganizmy zaraden\u00e9 do rodu Clostridium. Klostr\u00eddie s\u00fa sporuluj\u00face, ubikvitn\u00e9, v\u0161ade sa vyskytuj\u00face mikroorganiz\u00admy. Nach\u00e1dzaj\u00fa sa v p\u00f4de, vo vode, v prachu, v potravin\u00e1ch, ale aj v \u010dreve \u010dloveka a zviera\u0165a\u00ae. S\u00fa to bakt\u00e9rie metabolicky ve\u013emi akt\u00edvne, ktor\u00e9 sa v pr\u00edrode z\u00fa\u010dast\u0148uj\u00fa na kolobehu dus\u00edka a uhl\u00edka. Medic\u00ednsky v\u00fdznamn\u00e9 klostr\u00eddiov\u00e9 infekcie del\u00edme na: toxoinfekcie – otravy z potrav\u00edn, ich diagnostika je klinick\u00e1 a \u010dist\u00e9 intoxik\u00e1cie sp\u00f4soben\u00e9 sporuluj\u00facimi mik\u00adroorganizmami\u00ae. Nemaj\u00fa invaz\u00edvny charakter, ale ak nasta\u00adn\u00fa vhodn\u00e9 podmienky pre germin\u00e1ciu sp\u00f3r a rozmno\u017eenie bakt\u00e9ri\u00ed, st\u00e1vaj\u00fa sa patog\u00e9nnymi vzh\u013eadom na tvorbu vysokoakt\u00edvnych exotox\u00ednov. C. perfringens produkuje 14 exotox\u00ednov: 4 let\u00e1lne tox\u00edny – alfa, beta, epsilon, iota, \u010fal\u0161\u00edch 9 tox\u00ednov a enterotox\u00edn\u00ae 5)<\/sup>. Tox\u00edny sa l\u00ed\u0161ia \u0161trukt\u00farou, biologic\u00adk\u00fdmi vlastnos\u0165ami a rozdielne s\u00fa aj ich mechanizmy toxic\u00adk\u00e9ho \u00fa\u010dinku\u00ae. Alfa tox\u00edn – lecitin\u00e1za je hlavn\u00fdm faktorom zodpovedn\u00fdm za patologick\u00e9 po\u0161kodenie tkaniva a vznik plynovej gangr\u00e9ny12 11)<\/sup>. Lecitin\u00e1za svoj\u00edm dermonekrotick\u00fdm a hemolytick\u00fdm \u00fa\u010dinkom \u0161tiepi lecit\u00edn na diglycerid a fosforylchol\u00edn. \u0160tiepenie lecit\u00ednu v tkaniv\u00e1ch sa prejavuje zv\u00fd\u0161e\u00adnou permeabilitou kapil\u00e1r, v d\u00f4sledku \u010doho vznik\u00e1 ed\u00e9m, hemor\u00e1gie, zv\u00fd\u0161en\u00fd tlak vo svale a \u0161ok. De\u0161trukcia buniek vedie k nekr\u00f3ze(7<\/sup>‘12)<\/sup>.<\/p>\n
        Pod\u013ea typu ochorenia ich del\u00edme na neurotoxick\u00e9 – vyvo\u00adl\u00e1vate\u013emi s\u00fa C. tetani, C. botulinum a histotoxick\u00e9 – vyvol\u00e1\u00advate\u013emi s\u00fa C. perfringens, C. septicum, C. novyi, C. difficile, C. histolyticum, C. sordellii a \u010fal\u0161ie(4)<\/sup>. Histotoxick\u00e9 klostr\u00eddi\u00e1 produkuj\u00fa tox\u00edny a enz\u00fdmy degraduj\u00face tkaniv\u00e1 s v\u00fdraz\u00adne nekrotizuj\u00facim \u00fa\u010dinkom. Leukocyty, ktor\u00e9 s\u00fa z\u00e1palov\u00fdmi medi\u00e1tormi smerovan\u00e9 do miesta infekcie, s\u00fa klostr\u00eddiov\u00fdmi tox\u00ednmi lyzovan\u00e9, preto t\u00fdmto infekci\u00e1m ch\u00fdba purulentn\u00fd charakter. Typy ochorenia histotoxick\u00fdch klostr\u00eddi\u00ed del\u00edme na toxoinfekcie m\u00e4kk\u00fdch tkan\u00edv, toxoinfekce viscer\u00e1lnych or\u00adg\u00e1nov a toxoinfekcie v \u010dreve.<\/p>\n
        Infekcie m\u00e4kk\u00fdch tkan\u00edv prebiehaj\u00fa perak\u00fatne a bez v\u010das\u00adnej a spr\u00e1vnej terapie je 100 % \u00famrtnos\u0165. Klostr\u00eddiov\u00e9 infek\u00adcie sa vyskytuj\u00fa v dvoch hlavn\u00fdch patologick\u00fdch form\u00e1ch: celulit\u00eddy a myonekr\u00f3za. Po\u010das nieko\u013ek\u00fdch hod\u00edn a\u017e dn\u00ed sa infekcia klostr\u00eddiami prejav\u00ed ako anaer\u00f3bna celulit\u00edda. Ocho\u00adrenie sa za\u010d\u00edna pozvo\u013ena, boles\u0165ou, opuchom postihnut\u00e9ho tkaniva. Pri tlaku na ko\u017eu po\u010du\u0165 praskanie. Klostr\u00eddie v tkani\u00adve menia glykog\u00e9n na met\u00e1n, ktor\u00fd vytv\u00e1ra bubliny plynu. Nekrotizuj\u00faca fascit\u00edda postihuje fascie, prejavuje sa krepit\u00e1ciou, ktor\u00e1 je sp\u00f4soben\u00e1 mal\u00fdmi bublinkami plynu v hubovito zmenenom tkanive, ed\u00e9mom, farebn\u00fdmi zmenami na ko\u017ei, boles\u0165ou v okol\u00ed rany a sekr\u00e9ciou(9)<\/sup>.Charakteristick\u00fdm rysom klostr\u00eddiov\u00fdch infekci\u00ed je prenikanie bakt\u00e9ri\u00ed hlb\u0161ie do svalu, kde sp\u00f4sobuj\u00fa gangr\u00e9nu(7)<\/sup>.<\/p>\n
        Klostr\u00eddiov\u00e1 myonekr\u00f3za (gangraena emphysematosa) je<\/strong><\/p>\n
        fulminantn\u00e1 infekcia s charakteristick\u00fdmi lok\u00e1lnymi a syst\u00e9\u00admov\u00fdmi prejavmi. Klostr\u00eddiov\u00fa myonekr\u00f3zu sp\u00f4sobuje naj\u00ad\u010dastej\u0161ie Clostridium perfringens, C. novyi, C. septicum a C. bifermentans. Inkuba\u010dn\u00e1 lehota je 6 hod\u00edn a\u017e 4 dni(1)<\/sup>. Plynov\u00e1 gangr\u00e9na m\u00f4\u017ee by\u0165 klasifikovan\u00e1 ako posttraumatick\u00e1, poo\u00adpera\u010dn\u00e1 alebo spont\u00e1nna. Posttraumatick\u00e1 plynov\u00e1 gangr\u00e9\u00adna predstavuje 60 % celkovej incidencie(13)<\/sup>. Vznik\u00e1 naj\u010das\u00adtej\u0161ie v hlbok\u00fdch rozdrven\u00fdch ran\u00e1ch, ktor\u00e9 postihuj\u00fa v\u00e4\u010d\u0161ie svalov\u00e9 skupiny s poruchou cievneho z\u00e1sobenia(4)<\/sup>. Rana je edemat\u00f3zna a ve\u013emi bolestiv\u00e1. Intenzita prenikavej bolesti sa v\u00fdrazne stup\u0148uje. Na ko\u017ei sa vytv\u00e1raj\u00fa p\u013euzgieriky naplnen\u00e9 hemoragickou tekutinou a lo\u017eisk\u00e1 nekr\u00f3zy. Krepit\u00e1cia nie je tak\u00e1 v\u00fdrazn\u00e1 ako pri klostr\u00eddiovej celulit\u00edde. Z rany sa \u0161\u00edri pre\u00adnikav\u00fd sladkast\u00fd z\u00e1pach, ktor\u00fd je sp\u00f4soben\u00fd mastn\u00fdmi kyse\u00adlinami. Ed\u00e9m sa r\u00fdchlo \u0161\u00edri, celkov\u00fd stav pacienta sa drama\u00adticky zhor\u0161uje. Ak tox\u00edny prenikn\u00fa do krvn\u00e9ho obehu, nast\u00e1va intraven\u00f3zna hemol\u00fdza, diseminovan\u00e1 porucha hemokoagul\u00e1cie a tox\u00e9mia. Pacient je subfebriln\u00fd, bled\u00fd, spoten\u00fd, m\u00e1 tachykardiu a hypotenziu. M\u00f4\u017ee by\u0165 nepokojn\u00fd alebo apatick\u00fd, vedomie b\u00fdva zachovan\u00e9. Po tox\u00e9mii sa m\u00f4\u017ee rozvin\u00fa\u0165 toxic\u00adk\u00fd \u0161ok. Pacient str\u00e1ca vedomie. Progn\u00f3za je v\u00e1\u017ena a v prie\u00adbehu kr\u00e1tkeho obdobia m\u00f4\u017ee vies\u0165 k smrti. Pacient zomiera pod obrazom sepsy a multiorg\u00e1nov\u00e9ho zlyhania alebo sep\u00adtick\u00e9ho \u0161oku(1)<\/sup>. Ku komplik\u00e1ci\u00e1m anaer\u00f3bnych infekci\u00ed patr\u00ed gangr\u00e9na okolit\u00e9ho svalstva, ktor\u00e1 m\u00f4\u017ee vies\u0165 k amput\u00e1cii, k zlyhaniu krvn\u00e9ho obehu a k po\u0161kodeniu obli\u010diek a pe\u010dene.<\/p>\n
        Diagnostika anaer\u00f3bnych infekci\u00ed sa odv\u00edja od anamn\u00e9zy, klinick\u00fdch pr\u00edznakov,v\u00fdsledkovlaborat\u00f3rnychanal\u00fdzan\u00e1lezov zobrazovac\u00edch met\u00f3d. Pri ur\u010dovan\u00ed diagn\u00f3zy je potrebn\u00e9 v\u017edy p\u00e1tra\u0165 po etiologickom agense(9)<\/sup>. Na mo\u017enos\u0165 pr\u00edtom\u00adnosti anaer\u00f3bnych bakt\u00e9ri\u00ed je nutn\u00e9 myslie\u0165 pri prim\u00e1rnych odberoch biologick\u00e9ho materi\u00e1lu na kultiv\u00e1ciu pri hnisav\u00fdch procesoch, ke\u010f hnis odporne a prenikavo p\u00e1chne, pri endokardit\u00eddach a septick\u00fdch stavoch s negat\u00edvnymi hemokult\u00farami a ak je aer\u00f3bna kultiv\u00e1cia hnisu negat\u00edvna.<\/p>\n
        Odber materi\u00e1lu a transport<\/strong><\/p>\n
        Pri podozren\u00ed na anaer\u00f3bnu infekciu je potrebn\u00e9 dodr\u017ea\u0165 spr\u00e1vny postup odberu a transportu vzoriek.<\/p>\n
        Z\u00e1sady odberu na anaer\u00f3bnu kultiv\u00e1ciu: v\u010dasn\u00fd – v ak\u00fat\u00adnej f\u00e1ze ochorenia, z\u00e1sadne pred nasaden\u00edm antibiotickej te\u00adrapie, cielen\u00fd – zameran\u00fd na materi\u00e1l, kde mo\u017eno o\u010dak\u00e1va\u0165 najviac akt\u00edvne sa mno\u017eiacich bakt\u00e9ri\u00ed, aseptick\u00fd – do ste\u00adriln\u00fdch odberov\u00fdch n\u00e1dob. Na kultiva\u010dn\u00fa anal\u00fdzu pri podo\u00adzren\u00ed na anaer\u00f3bnu infekciu sa odoberaj\u00fa: \u010dasti nekrotick\u00fdch tkan\u00edv, exsud\u00e1t, hnis – z h\u013abky lo\u017eiska, preto\u017ee povrch lo\u017eiska m\u00f4\u017ee by\u0165 kontaminovan\u00fd bakt\u00e9riami nes\u00favisiacimi s etiol\u00f3giou z\u00e1palu, ktor\u00e9 s\u0165a\u017euj\u00fa izol\u00e1ciu patog\u00e9nov a interpret\u00e1ciu v\u00fdsledku. Ster je vhodn\u00e9 zobra\u0165 najlep\u0161ie z rozhrania zdra\u00adv\u00e9ho a patologicky zmenen\u00e9ho tkaniva, kde je najviac \u017eivo\u00adtaschopn\u00fdch mikroorganizmov. Pri rozsiahlej\u0161\u00edch ran\u00e1ch je vhodn\u00e9 vykona\u0165 nieko\u013eko sterov s\u00fa\u010dasne z r\u00f4znych miest, k\u00fasky excidovan\u00e9ho tkaniva – pri myonekr\u00f3ze z miest, kde proces postupuje do \u0161\u00edrky, alebo z nieko\u013ek\u00fdch drobn\u00fdch exc\u00edzi\u00ed. Je potrebn\u00e9 odobra\u0165 dostato\u010dn\u00e9 mno\u017estvo materi\u00e1lu17 12)<\/sup>.<\/p>\n
        Transport – r\u00fdchly transport materi\u00e1lu do laborat\u00f3ria za anaer\u00f3bnych podmienok. Citliv\u00e9 mikroorganizmy zahyn\u00fa alebo sa rozmno\u017eia mikroorganizmy, ktor\u00e9 rast skuto\u010dn\u00e9ho p\u00f4vodcu ochorenia potla\u010dia 17 14)<\/sup>. Prioritne je potrebn\u00e9 odo\u00adbera\u0165 tekut\u00fd materi\u00e1l v strieka\u010dke na jedno pou\u017eitie a po vy\u00adpuden\u00ed vzduchu pre bezpe\u010dnos\u0165 pri transporte je vhodn\u00e9 ko\u00adniec strieka\u010dky zatavi\u0165, pr\u00edpadne ihlu zabodn\u00fa\u0165 do gumovej z\u00e1tky, v hemokultiva\u010dn\u00fdch n\u00e1dob\u00e1ch na anaer\u00f3bnu kultiv\u00e1\u00adciu alebo v \u0161peci\u00e1lnych anaer\u00f3bnych transportn\u00fdch n\u00e1do\u00adb\u00e1ch. Transportn\u00e9 m\u00e9dium mo\u017eno pou\u017ei\u0165 pri odbere mate\u00adri\u00e1lu tamp\u00f3nom, ktor\u00fd sa zasunie do transportn\u00e9ho m\u00e9dia. Pri predpokladan\u00ed mal\u00e9ho mno\u017estva biologick\u00e9ho materi\u00e1lu je vhodnej\u0161\u00ed a vyu\u017e\u00edvan\u00fd odber materi\u00e1lu pri l\u00f4\u017eku pacienta s okam\u017eit\u00fdm nao\u010dkovan\u00edm kultiva\u010dn\u00fdch m\u00e9di\u00ed.<\/p>\n
        Laborat\u00f3rna diagnostika anaer\u00f3bnych infekci\u00ed sa opiera hlavne o tieto bakteriologick\u00e9 anal\u00fdzy:<\/strong> mikroskopick\u00e9 vy\u0161et\u00adrenie vzorky, kultiv\u00e1cia, izol\u00e1cia a n\u00e1sledn\u00e1 identifik\u00e1cia mik\u00adroorganizmov1171215<\/sup>‘ 16)<\/sup>. Mikroskopick\u00e9 vy\u0161etrenie poskytuje prvotn\u00fa inform\u00e1ciu o pr\u00edtomnosti z\u00e1palovej reakcie a po\u010d\u00adte bakt\u00e9ri\u00ed vo vzorke. Vy\u0161etrenie n\u00e1terov farben\u00fdch pod\u013ea Grama umo\u017en\u00ed rozl\u00ed\u0161i\u0165 morfologick\u00e9 typy gramnegat\u00edvnych a grampozit\u00edvnych bakt\u00e9ri\u00ed11 9)<\/sup>. Pri podozren\u00ed na klostr\u00eddiov\u00fa infekciu mikroskopick\u00fd n\u00e1lez grampozit\u00edvnych hrub\u00fdch pa\u00adli\u010diek v materi\u00e1li z rany diagn\u00f3zu potvrd\u00ed. V\u00fdsledok anal\u00fdzy m\u00f4\u017ee by\u0165 ozn\u00e1men\u00fd do nieko\u013ek\u00fdch min\u00fat a\u017e do hodiny. Z kli\u00adnick\u00e9ho h\u013eadiska je inform\u00e1cia o etiol\u00f3gii anaer\u00f3bnej infek\u00adcie ve\u013emi d\u00f4le\u017eit\u00e1 a posl\u00fa\u017ei pri rozhodovan\u00ed o za\u010dat\u00ed empi\u00adrickej lie\u010dby.<\/p>\n
        Kultiv\u00e1cia spojen\u00e1 s identifik\u00e1ciou z\u00edskan\u00fdch kult\u00far je pomerne n\u00e1ro\u010dn\u00e1. Podmienkou \u00faspe\u0161nej kultiv\u00e1cie je spr\u00e1v\u00adny odber a transport materi\u00e1lu, ktor\u00e9 umo\u017enia anaer\u00f3bnym bakt\u00e9ri\u00e1m pre\u017ei\u0165. Podmienkou je z\u00e1brana pr\u00edstupu vzdu\u00adchu k materi\u00e1lu a odstr\u00e1nenie kysl\u00edka z kultiva\u010dn\u00fdch p\u00f4d i z prostredia(8)<\/sup>. Anaer\u00f3bne bakt\u00e9rie potrebuj\u00fa p\u00f4dy, ktor\u00e9 ob\u00adsahuj\u00fa redukuj\u00face l\u00e1tky zni\u017euj\u00face redoxn\u00fd potenci\u00e1l. D\u00f4le\u017ei\u00adt\u00e1 je atmosf\u00e9ra, v ktorej sa anaer\u00f3bne mikroorganizmy kul\u00adtivuj\u00fa (dus\u00edk 90 %, CO2 5 %, vod\u00edk 5 %).T\u00e1to atmosf\u00e9ra sa d\u00e1 dosiahnu\u0165 fyzik\u00e1lnou, biologickou, chemickou absorp\u010dnou alebo katalytickou met\u00f3dou, ktor\u00e1 sa naj\u010dastej\u0161ie pou\u00ad\u017e\u00edva v rutinnej mikrobiologickej diagnostike (9)<\/sup>. Na vytvorenie vhodnej atmosf\u00e9ry sa vyu\u017e\u00edvaj\u00fa anaerostaty alebo anaer\u00f3b\u00adne boxy s mikroprocesorovou regul\u00e1ciou (LAS – Latalov anaer\u00f3bny syst\u00e9m). Z\u00e1kladn\u00e1 kultiv\u00e1cia je 48 hod. pri teplo\u00adte 36 \u00b1 1 stupe\u0148 Celzia. Pou\u017eitie jednoduch\u00fdch testov spolu s makroskopick\u00fdm vzh\u013eadom kol\u00f3ni\u00ed, mikroskopickou mor\u00adfol\u00f3giou izol\u00e1tov m\u00f4\u017ee by\u0165 v niektor\u00fdch pr\u00edpadoch posta\u010du\u00adj\u00faca na rodov\u00fa alebo i druhov\u00fa identifik\u00e1ciu. Identifik\u00e1cia anaer\u00f3bnych bakt\u00e9ri\u00ed sa vykon\u00e1va komer\u010dn\u00fdmi biochemic\u00adk\u00fdmi testami, r\u00fdchlymi enzymatick\u00fdmi testami, PCR met\u00f3\u00addou a met\u00f3dou hmotnostnej spektrografie MALDI-TOF, ktorej v\u00fdhodou je vysok\u00e1 citlivos\u0165 a r\u00fdchlos\u0165 v porovnan\u00ed s tradi\u010d\u00adn\u00fdmi met\u00f3dami. D\u00f4kaz \u0161pecifick\u00fdch tox\u00ednov: testy in vivo (let\u00e1lny \u00fa\u010dinok, nekr\u00f3za ko\u017ee, eryt\u00e9m) a testy na ne\u017eiv\u00fdch syst\u00e9moch – cytopatick\u00fd efekt, hemol\u00fdza, lecitin\u00e1zov\u00e1 reakcia\u00a0<\/span>(1,14, 15, 16).<\/p>\n
         <\/p>\n
        Terapia<\/strong>
        \nAnaer\u00f3bne infekcie si vy\u017eaduj\u00fa urgentn\u00e9 rie\u0161enie, radik\u00e1l\u00adne inc\u00edzie a n\u00e1ro\u010dn\u00fa poopera\u010dn\u00fa starostlivos\u0165. Pri anaer\u00f3b\u00adnych infekci\u00e1ch ide \u010dasto o polymikrobi\u00e1lnu a r\u00fdchlo progreduj\u00facu infekciu ohrozuj\u00facu pacienta na \u017eivote. Nevy\u00adhnutn\u00e1 je aj proti\u0161okov\u00e1 lie\u010dba. Pri lie\u010dbe anaer\u00f3bnych infek\u00adci\u00ed chirurgick\u00e1 a antibiotick\u00e1 lie\u010dba s\u00fa rovnocenn\u00e9, nezastupite\u013en\u00e9(131718)<\/sup>. Pri chirurgickej intervencii treba otvori\u0165 v\u0161etky priestory, resekova\u0165 nekrotick\u00e9 tkaniv\u00e1, zaisti\u0165 dren\u00e1\u017e. \u010casto je nutn\u00e1 i amput\u00e1cia postihnutej kon\u010datiny(719)<\/sup>. Antimikrobi\u00e1lna lie\u010dba mus\u00ed by\u0165 r\u00fdchla, adekv\u00e1tna a komplexn\u00e1. Pre dl\u00adh\u00fd \u010das rastu anaer\u00f3bnych bakt\u00e9ri\u00ed sa za\u010d\u00edna empirick\u00e1 lie\u010d\u00adba. Antibiotik\u00e1 s\u00fa pod\u00e1van\u00e9 intraven\u00f3zne s bakteric\u00eddnym \u00fa\u010dinkom, vo vy\u0161\u0161\u00edch d\u00e1vkach ne\u017e pri infekci\u00e1ch postihu\u00adcich dobre prekrven\u00e9 tkaniv\u00e1. Pri ATB terapii je nutn\u00e9 zva\u00ad\u017eova\u0165 aj prienik antibakteri\u00e1lnej l\u00e1tky do miesta infekcie(113)<\/sup>. S\u00e9roterapia – ak sa v patogen\u00e9ze uplat\u0148uje tox\u00edn – ovplyv\u00ad\u0148uje celkov\u00e9 toxick\u00e9 pr\u00edznaky. Celkov\u00e1 intenz\u00edvna lie\u010dba pozost\u00e1va z rehydrat\u00e1cie, monitorovania pacienta, oxyge- noterapie, pod\u013ea potreby pod\u00e1vania transf\u00fazi\u00ed, diuret\u00edk, anal\u00adget\u00edk a pod. S\u00fa\u010das\u0165ou komplexnej lie\u010dby je hyperbarick\u00e1 te\u00adrapia, ktor\u00e1 zvy\u0161uje \u00fa\u010dinnos\u0165 leukocytov, toxicky p\u00f4sob\u00ed na anaer\u00f3bne bakt\u00e9rie a prebytok kysl\u00edka podporuje cel\u00fd imunit\u00adn\u00fd syst\u00e9m(13)<\/sup>. Progn\u00f3za choroby: ide o \u0165a\u017ek\u00e9, \u017eivotohrozuj\u00fa- ce ochorenie, ktor\u00e9ho priebeh je spravidla r\u00fdchly.<\/p>\n
        O progn\u00f3ze pacienta rozhoduj\u00fa hodiny.<\/strong><\/p>\n
        Prevencia:<\/strong> Ne\u0161pecifick\u00e9 prevent\u00edvne opatrenia maj\u00fa od\u00adstr\u00e1ni\u0165 pr\u00ed\u010diny a stavy, ktor\u00e9 vytv\u00e1raj\u00fa podmienky na rozvoj anaer\u00f3bnej infekcie. Endog\u00e9nnym infekci\u00e1m mo\u017eno \u010diasto\u010d\u00adne predch\u00e1dza\u0165 \u0161etrn\u00fdmi opera\u010dn\u00fdmi technikami a profylak\u00adtick\u00fdm pod\u00e1van\u00edm antibakteri\u00e1lnych l\u00e1tok tak, aby v \u010dase oper\u00e1cie bola vytvoren\u00e1 dostato\u010dn\u00e1 koncentr\u00e1cia antibioti\u00adka v mieste chirurgick\u00e9ho v\u00fdkonu a v krvi na eradik\u00e1ciu o\u010da\u00adk\u00e1van\u00fdch patog\u00e9nov. Epidemiologick\u00e1 po\u017eiadavka – pacient s plynovou gangr\u00e9nou m\u00e1 by\u0165 o\u0161etrovan\u00fd v izola\u010dnom re\u017ei\u00adme s dodr\u017eiavan\u00edm \u0161tandardn\u00fdch bari\u00e9rov\u00fdch opatren\u00ed(1)<\/sup>. Ri\u00adziko prenosu infekci\u00ed sp\u00f4soben\u00fdch anaer\u00f3bnymi bakt\u00e9riami je pre zdrav\u00e9 osoby zanedbate\u013en\u00e9.<\/p>\n
         <\/p>\n
        LITERAT\u00daRA<\/p>\n
          \n
        1. Bene\u0161 J. Infek\u010dn\u00ed l\u00e9karstv\u00ed. Praha, \u010cesk\u00e1 republika: Galen; 2009: 264-270.<\/li>\n
        2. Howard JB, Keiser JF, Smith TF, et al. Clinical and pathogenic micro\u00adbiology. 2nd ed. Louis, MO: Mosby-Year Book, Inc.; 1994: 417-418.<\/li>\n
        3. Bedn\u00e1r M, Fra\u0148kov\u00e1 V, Schindler J, a kol. L\u00e9karsk\u00e1 mikrobiologie. Pra\u00adha, \u010cesk\u00e1 republika: Marvil; 1996: 230-233, 238-240, 288-297.<\/li>\n
        4. Pato\u010dka F. L\u00e9karsk\u00e1 mikrobiologie.Praha, \u010cesk\u00e1 republika Avicenum; 1972: 68, 507-557.<\/li>\n
        5. Votava, M. L\u00e9karsk\u00e1 mikrobiologie vy\u0161etrovac\u00ed metody: Brno, Neptun, 2010, 495 str\u00e1n.<\/li>\n
        6. John C, Korych B, Schindler J a kol. L\u00e9karsk\u00e1 mikrobiologie. Praha, \u010cesk\u00e1 republika: St\u00e1tn\u00ed pedagogick\u00e9 nakladatelstv\u00ed; 1982: 132-135, 146.<\/li>\n
        7. Goering R, Dockkrell H, Zuckerman M, a kol. Mimsov\u00e1 l\u00e9karsk\u00e1 mikro\u00adbiologie, Praha, Triton, 2016: 353-354, 434-440.<\/li>\n
        8. Chmel\u00e1r, D. L\u00e9karsk\u00e1 mikrobiologie v kostce: (pro zdravotnick\u00e9 obo\u00adry a mediky).1. vyd. Ostrava: Ostravsk\u00e1 univerzita v Ostrave, 2013. 163 s.<\/li>\n
        9. Nov\u00e1kov\u00e1 E, Porubsk\u00e1 A, Kopan\u00edkov\u00e1 J, a kol. Lek\u00e1rska mikrobiol\u00f3\u00adgia. Martin, Slovensk\u00e1 republika: Lek\u00e1rska fakulta Univerzity Komensk\u00e9- ho; 2010: 33-36, 62-64.<\/li>\n
        10. Kato N, Kato H, Watanebe K, et al. Association of Enterotoxigenic Bac- teroides fragilis with Bacteremia. Clin. Infect. Dis. 1996; 23(1):83-86.<\/li>\n
        11. Murray P, Baron EJ, Pfaller MA, et al. Manual of Clinical Microbiolo\u00adgy. 6th ed. Washington, D.C. American Society for Microbiology; 1995: 125-127, 574-584.<\/li>\n
        12. Jur\u00e1nkov\u00e1 J. a kol. Klinick\u00e1 mikrobiologie v laboratorn\u00ed praxi. Brno, \u010cesk\u00e1 republika: Masarykova univerzita; 2011:<\/li>\n
        13. Nier H, Kremer K: Plynov\u00e1 gangr\u00e9na – st\u00e1le diagnostick\u00fd a terapeutic\u00adk\u00fd probl\u00e9m. Zentralbl Chir 1984.<\/li>\n
        14. Scharfen J. ml. Diferenci\u00e1ln\u00ed diagnostika v klinick\u00e9 mikrobiologii, Nucleus HK 2013:70-85-9.<\/li>\n
        15. Z\u00e1vadov\u00e1 M. Anaerobn\u00ed bakt\u00e9rie a anaerobn\u00ed infekce. Praha, \u010cesk\u00e1 republika: Avicenum; 1986:<\/li>\n
        16. Czirfuszov\u00e1 M, Hanzen J, Hu\u010dkov\u00e1 D, a kol. Aktu\u00e1lne mo\u017enosti labo\u00adrat\u00f3rnej diagnostiky klinickej mikrobiol\u00f3gie. Bratislava, Slovensk\u00e1 repub\u00adlika: A+M print, r. o.; 2013: 20-25.<\/li>\n
        17. Summanen P, Baron EJ, Ciron DM, a kol. Anaer\u00f3bne bakteriol\u00f3gie ma\u00adnual. 6th Wadsworth, Belmont, CA: Hviezda Publishing; 2002.<\/li>\n
        18. H\u00e1jek M. Chirurgie praktick\u00e9ho l\u00e9kare. Praha, \u010cesk\u00e1 republika: Grada Publishing; 1995: 323.<\/li>\n
        19. Way LW. Sou\u010dasn\u00e1 chirurgick\u00e1 diagnostika a l\u00e9\u010dba. Praha, \u010cesk\u00e1 re\u00adpublika: Grada Publishing; 1998: 1659.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"
          *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. P\u00f4vodcovia ochorenia Anaer\u00f3bne bakt\u00e9rie s\u00fa roz\u0161\u00edren\u00e9 v pr\u00edrode. V\u00e4\u010d\u0161ina ich ro\u00addov tvor\u00ed s\u00fa\u010das\u0165 mikrofl\u00f3ry \u013eudsk\u00e9ho tela(1). Niektor\u00e9 z nich hraj\u00fa d\u00f4le\u017eit\u00fa \u00falohu aj vo fyziol\u00f3gii hostite\u013ea(2). Maj\u00fa tieto spolo\u010dn\u00e9 vlastnosti:<\/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":[560,561,563,562,559,564],"class_list":["post-1295","post","type-post","status-publish","format-standard","hentry","category-microbiology","tag-anaerobic-bacteria","tag-infections-of-soft-tissues","tag-laboratory-diagnostics","tag-risk-factors","tag-terapia-en","tag-therapy","typ_clanku-review-article"],"acf":{"abstrakt":"
          Anaerobic infections are caused by bacteria that are not able to proliferate in the presence of oxygen. The differ\u00adent rate of tolerance till intolerance to oxygen is the limiting factor of growth and survival in biological samples taken for laboratory analyses. Anaerobic infections affect both genders. They occur at any age. Some are typi\u00adcal for early age (neonatal infections), others for the elderly population with more frequent predisposing factors. The incidence of diseases caused by them is also related to the level of provided health care, accidents and war injuries. Anaerobic bacteria are involved in the development of various inflammatory diseases, either as isolat\u00aded bacterial agents or more frequently as part of a mixed bacterial flora.<\/p>\n
          Keywords<\/strong>: anaerobic bacteria, infections of soft tissues, risk factors, laboratory diagnostics, therapy<\/p>\n","casopis":[{"ID":1223,"post_author":"7","post_date":"2017-09-26 14:15:30","post_date_gmt":"2017-09-26 12:15:30","post_content":"
            \r\n \t
          • Fertility disorders: immunological causes and possible curative impact<\/li>\r\n \t
          • The first results of galactose-deficient IgA1 measurement in diagnosis and monitoring of patients with IgA nephropathy<\/li>\r\n \t
          • Application of autovaccines in the treatment of chronic and recurrent colpitises<\/li>\r\n \t
          • Infections of the hip endoprostheses<\/li>\r\n \t
          • Non-invasive markers of liver fibrosis<\/li>\r\n<\/ul>","post_title":"Newslab","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"newslab-2017-2","to_ping":"","pinged":"","post_modified":"2017-09-26 14:19:35","post_modified_gmt":"2017-09-26 12:19:35","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.newslab.sk\/casopis\/newslab-2017-2\/","menu_order":0,"post_type":"casopis","post_mime_type":"","comment_count":"0","filter":"raw"}],"strana":"105","upload_clanok":{"ID":1289,"id":1289,"title":"NEWSLAB 2-2017_Cs\u00f6lleyov\u00e1","filename":"NEWSLAB-2-2017_Cs\u00f6lleyov\u00e1.pdf","filesize":594678,"url":"https:\/\/www.newslab.sk\/wp-content\/uploads\/2017\/09\/NEWSLAB-2-2017_Cs\u00f6lleyov\u00e1.pdf","link":"https:\/\/www.newslab.sk\/en\/anaerobic-infections-of-soft-tissues\/newslab-2-2017_csolleyova-2\/","alt":"","author":"7","description":"","caption":"","name":"newslab-2-2017_csolleyova-2","status":"inherit","uploaded_to":1295,"date":"2017-09-28 09:52:52","modified":"2017-09-28 09:52:52","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\/1295","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=1295"}],"version-history":[{"count":0,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1295\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/media?parent=1295"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/categories?post=1295"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/tags?post=1295"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}