of thesis Diagnostics of neuroinfection caused by human herpesviruses using nucleic acid amplification methods author: MUDr. Klára Labská supervisor: doc. MUDr. Vilma Marešová, CSc. In recent years, the diagnosis of neuroinfections has undergone a shift towards molecular biology methods. Our research focused on the predictive value of the capture of herpesvirus (HV) DNA in cerebrospinal fluid. In the first study, we examined the presence of DNA neurotropic herpes viruses (HSV1, HSV2, VZV and HHV6) in cerebrospinal fluid in immunocompetent patients with laboratory-confirmed tick-borne meningoencephalitis and enterovirus meningitis and meningoencephalitis. The control group consisted of patients with proven absence of an inflammation in the cerebrospinal fluid. Patients were followed for 6 months. The course of the disease and its consequences, including laboratory tests, were compared between groups of patients with and without the presence of HV DNA. In the second study, we tried to demonstrate the presence of HSV1 DNA in cerebrospinal fluid during its symptomatic reactivation in patients with purulent meningitis. In our group of immunocompetent patients with non-purulent inflammation in the cerebrospinal fluid, the proportion of HV DNA positive patients reached 7.5% (13 out of 173), we also...

La transplantation de sang de cordon ombilical (TSCO) constitue un traitement de choix pour une multitude de pathologies hématologiques malignes et non malignes chez l’enfant et dans certains cas l’adulte. La TSCO est associée à certaines complications, dont une reconstitution immunitaire plus lente et une incidence élevée d’infections opportunistes, notamment celles reliées au cytomégalovirus (CMV) et au virus varicella-zoster (VZV). Dans le cadre de ce travail, nous nous sommes intéressés dans un premier temps à la caractérisation de la reconstitution immunitaire spécifique au CMV et au VZV. Nos résultats ont démontré que la reconstitution de l’immunité cellulaire ne requiert ni un statut séropositif pré-transplantation ni le développement de la maladie. De plus, des reconstitutions spontanées ont été détectées chez certains patients séronégatifs vis-à-vis du CMV ou du VZV. Outre le fait qu’elle se manifeste surtout à partir de 6 mois post-transplantation, ladite reconstitution mérite le qualificatif de « protectrice » en termes de réactivations virales et du développement de signes cliniques lorsqu’une fréquence de 150 cellules produisant l’IFN-γ/million est dépassée. Toutefois, moins de 5% des patients développent une réponse T anti-VZV et anti-CMV au cours 100 premiers jours suivant la TSCO. Il est donc possible que les lymphocytes CD8+ T provenant du SCO, comparativement à leurs homologues provenant de la moelle osseuse (MO), présentent un défaut de fonctionnalité, communément appelé « épuisement clonal ». La caractérisation du répertoire de récepteurs inhibiteurs exprimés par les cellules T CD8+ suivant la TSCO ou la transplantation de moelle osseuse (TMO) a révélé une augmentation significative de la fréquence des cellules exprimant PD-1 tôt suivant la transplantation. Cette population, caractérisée majoritairement par un phénotype effecteur-mémoire (EM), démontre une perte significative de la capacité proliférative et exprime moins d'IFN-γ, d'IL-2, de TNF-α et de CD107a. Une meilleure caractérisation de la reconstitution immunitaire après TSCO permettrait, d'une part de sélectionner des biomarqueurs en vue d’une meilleure gestion des patients à risques de développer des infections virales et/ou de rechuter, et d'autre part d'améliorer leur pronostic. / Umbilical cord blood transplantation (UCBT) is a treatment of choice for a variety of hematological malignancies and non-malignant diseases in children and, in some cases, in adults. UCBT is associated with a slower immune reconstitution and a high incidence of viral infections, especially related to cytomegalovirus (CMV) and the varicella-zoster virus (VZV). As part of this work, we aimed to assess the reconstitution of CMV and VZV-specific T cell responses. Neither pre-transplant serostatus nor disease development is required for development of T cell mediated immunity. Moreover, spontaneous reconstitution detected in some patients who were seronegative for CMV or VZV. Detected especially after 6 months post-transplant, antiviral responses are protective in terms of viral reactivation and development of clinical signs, when a frequency of 150 cells producing d'IFN-γ / million is achieved. However, less than 5% of patients develop an antiviral response during the first 100 following UCBT. Compared to their bone marrow (BM) counterparts, UCB CD8+ T lymphocytes may be functionally impaired, a state commonly called « clonal exhaustion ». Characterization of the inhibitory receptors repertoire expressed by CD8+ T cells following UCBT and BMT showed a significant increase in the frequency of cells expressing PD-1 early after transplantation. This population, mainly characterized by effector phenotype, showed a significant loss of proliferative capacity and produced less IFN-γ, IL-2, TNF-α and CD107a. An improved understanding of the CD8+ T cell compartment following UCBT, as well as biomarkers related to T cell exhaustion will decrease infection, transplant related mortality and correlate with better prognosis

This thesis is concerned with the level of parents´ awareness and attitudes to above-standard vaccination of children from 0-3 years in Příbram. Among the optional vaccination of children from 0-3 years belong vaccination against pneumococcal disease, rotavirus infections, meningococcal invasive disease (caused by meningococcal of group C, A+C, or A, C, W 135 and Y, now also of group B), tick-borne encephalitis, varicella smallpox, influenza and hepatitis A (or a combination of type A + B). The first part deals with the issue in a theoretical perspective. It foreshadows the basic characteristics of the diseases against which the premium vaccination of children from 0-3 years is offered. Further it is focused on vaccines against these diseases, which can occur in the Czech Republic. The survey is summarized in the research. There were parents of children attending one of the 12 kindergartens in Příbram in the sample of the research. tely 40% of the parents (or mothers) of these children in each kindergarten.The results were summarized in schedules of absolute and relative frequencies, or graphs. It was set three basic goals that were met with five hypotheses. The first of these was to monitor the attitudes of parents to above-standard vaccination of children from 0-3 years in Příbram. To this target relate hypothesis H1: Parents are interested in above-standard vaccination of children from 0-3 years in Příbram, H2: Parents with higher educational level have significantly higher interest in above-standard vaccination of children from 0-3 years and H3: Parents are statistically significantly more interested in vaccination against tick-borne encephalitis than other extra vaccination of children from 0-3 years, due to an endemic area of tick-borne encephalitis in Příbram. These hypotheses were not confirmed statistically. The second aim investigated the main reason for the possible lack of interest in extra vaccination of children from 0-3 years in Příbram. The target was filled with hypothesis H4: The main reason for the possible lack of parents´ interest in extra vaccination of children from 0-3 years is high price of vaccines, which was statistically refuted. The third goal was to explore parents' knowledge about diseases against which the extra vaccination of children from 0-3 years is offered. To this goal was set the hypothesis H5: Parents have sufficient information about the diseases against which the extra vaccination of children from 0-3 years is offered. This hypothesis was confirmed. The hypotheses were verified by ?chi-square? test at a significance level of 5%, which is an instrument of verification or falsification of hypotheses. This work may be used in practice as a preview to the parents´ awareness and interest in extra vaccination of children from 0-3 years. As well as cumulative information materials for professionals and the public about the above-standard vaccination of children from 0-3 years.

Das human pathogene Varicella-Zoster Virus (VZV) gehört zur Familie der Herpesviren und ist weltweit verbreitet. Die Primärinfektion verursacht Varicellen, welche durch einen bläschenartigen Hautausschlag charakterisiert ist. Im Anschluss daran etabliert VZV eine lebenslange Latenz und verursacht nach Reaktivierung Herpes Zoster. Seit 2004 ist der Lebendimpfstoff aus attenuierten Virionen des VZV-Stammes V-Oka in Deutschland empfohlen. Im Gegensatz zur Infektion mit zirkulierenden virulenten VZV Stämmen tritt nach Verimpfung des Vakzin-Stammes V-Oka kein Exanthem auf. Die Haut ist der Hauptreplikationsort von VZV und immunologische Unterschiede zwischen virulentem VZV und dem Vakzin-Stamm treten hier am deutlichsten auf. In der vorliegenden Arbeit konnte eine neue Immunevasionsstrategie virulenter VZV Stämme aufgedeckt werden, welche erklären könnte, wie virulente VZV Stämme frühe antivirale Immunantworten umgehen. In Hautläsionen von Herpes Zoster Patienten konnte eine massive Infiltration von myeloiden inflammatorischen Dendritischen Zellen beobachtet werden. In vitro Studien mit Monozyten abgeleiteten Dendritischen Zellen (DC), welche inflammatorische DC repräsentieren, zeigten, eine signifikant erhöhte Expression von CD1c Molekülen nach Infektion mit dem Vakzin-Stamm, sowie virulentem VZV. Funktionelle Untersuchungen mit intraepithelialen CD1c-restringierten gamma delta T Zellen zeigten, dass DC nach Infektion mit dem Vakzin-Stamm phänotypisch und funktionell reiften und somit die T Zellen zur IFN-gamma Sekretion stimulierten. Im Gegensatz dazu wurde die funktionelle Reifung von DC, die mit virulentem VZV infiziert waren, geblockt. Folglich wurde kein bioaktives IL-12 sezerniert, welches als entscheidendes Cytokin zum Aufbau einer antiviralen T-Helfer 1 Immunantwort beiträgt. Darüber hinaus konnte gezeigt werden, dass virulentes VZV die Signalkaskade des Toll-like Rezeptors 2 (TLR2) in DC inhibiert und somit die IL-12 Produktion verhindert. / Varicella-zoster virus (VZV) which belongs to the family of herpesviruses is restricted to humans and distributed worldwide. Primary infection of VZV causes chickenpox characterized by a disseminated rash. Thereafter, VZV establishes a lifelong latency and can be reactivated to cause herpes zoster. Since 2004 the attenuated strain V-Oka of VZV was licensed for Germany to immunize children against VZV infection. In contrast to infection by circulating virulent VZV strains, vaccination with V-Oka remains asymptomatic. The skin is the major replication site of VZV and immunological differences between virulent VZV and the vaccine should become most apparent within this immune organ. In summary, this study discovered a new immune evasion strategy of virulent VZV strains which might explain how virulent VZV strains overcome innate antiviral responses. A strong infiltration of myeloid-derived inflammatory DCs has been detected in skin lesions of herpes zoster patients. In vitro studies with monocyte-derived dendritic cells (DCs), reflecting inflammatory DCs, showed that they were efficiently infected by both, the vaccine and a virulent VZV strain. Intriguingly, a significant upregulation of CD1c molecules on VZV-infected DCs was observed. Functional investigations using intraepithelial CD1c-restricted gamma delta T cells revealed that DCs infected with the vaccine virus were fully instructed to mature, thereby promoting IFN-gamma secretion of gamma-delta T cells. In striking contrast, DCs infected with virulent VZV strains were efficiently blocked to mature functionally. In detail, they did not secrete bioactive IL-12 which is an instrumental cytokine for generation of antiviral T helper 1 responses. Moreover, virulent VZV blocked Toll-like receptor 2 (TLR2) signaling in DCs thereby preventing production of bioactive IL-12 which in turn inhibited IFN-gamma secretion by gamma-delta T cells.

Les infections virales en particulier celles dues aux virus de la famille des Herpesviridae pendant la période d’aplasie et de lymphopénie à la suite d’une greffe de cellules souches hématopoïétiques (GCSH) peuvent occasionner des complications très graves, souvent associées à une morbidité et mortalité élevées. Les recommandations cliniques actuelles préconisent l’utilisation des antiviraux pour la prévention de certaines de ces infections. L’efficacité du famciclovir et de l’acyclovir contre les virus de l’herpès simplex (HSV), le virus varicella-zoster (VZV) et l’herpésvirus humain de type 6 (HHV-6) est bien reconnue, cependant il nous manque des données quant à leur effet contre le virus Epstein-Barr (EBV) et le cytomégalovirus (CMV) dans la population pédiatrique. L’objectif principal de ce projet de maitrise a été de mesurer l’incidence de l’infection aux virus HSV, VZV, EBV, CMV et HHV-6 et de mesurer l’association entre l’utilisation de la prophylaxie antivirale (acyclovir et famciclovir) et l’infection (virémie asymptomatique et maladie) avec le CMV et l’EBV dans une cohorte pédiatrique de GCSH allogéniques. Les données d'une cohorte de sujets ayant subis pour la première fois une GCSH enrôlés dans quatre centres de greffes pédiatriques au Canada entre juillet 2013 et mars 2017 (Étude TREASuRE) ont été utilisées. Le recrutement a été effectué au : CHU Sainte-Justine (Montréal) (n=86), British Columbia Children’s Hospital (Vancouver) (n=31), Winnipeg Children's Hospital and CancerCare Manitoba (n=28) et Alberta Children’s Hospital (n=11). Le suivi des patients avait débuté 1 mois avant la greffe et avait duré 13 mois. L’âge médian des patients au recrutement était de 6,3 ans. Les courbes de Kaplan-Meier ont permis d’estimer l'incidence cumulée des infections CMV et EBV avec intervalle de confiance (IC) à 95% à 100 jours post-greffe en fonction de la prophylaxie antivirale (acyclovir ou famciclovir). Les modèles multivariés de régression de Cox à risques proportionnels ont permis de mesurer l'association entre la prise d’antiviraux (acyclovir ou famciclovir) et le développement de ces infections. L’étude a inclus 156 sujets âgés de 0 à 21 ans. Les incidences cumulées de la virémie des virus de HSV, VZV, EBV, CMV et HHV-6 à 100 jours de suivi ont été respectivement de 2.5% (IC 95% : 0.8–7.6), 0.8% (IC 95% : 0.1–6.1), 34.5% (IC 95% : 27.6–42.6), 19.9% (IC 95% : 14.5-27.1) et 3.4% (IC 95% : 1.2–9.1). Les incidences cumulées pour CMV et EBV n’ont pas montré de différence statistiquement significative entre les groupes ayant reçu la prophylaxie antivirale (acyclovir ou famciclovir) et ceux qui ne l’ont pas reçu. Les analyses de Cox n’ont montré aucun effet significatif des antiviraux sur le CMV avec un HR ajusté de 0.55 (IC 95% : 0.24–1.26) pour l’acyclovir et de 0.82 (IC 95% : 0.30–2.29) pour le famciclovir. Il en était de même pour l’EBV avec un HR ajusté de 1.41 (IC 95% : 0.63–3.14) pour l’acyclovir et de 0.79 (IC 95% : 0.36–1.72) pour le famciclovir. Notre étude n’a montré aucune preuve d’effet de la prophylaxie antivirale avec le famciclovir et l’acyclovir contre l’EBV et le CMV. Très peu de cas de HSV et de VZV ont été diagnostiqués dans cette cohorte ce qui est conforme avec l’idée selon laquelle l’acyclovir et le famciclovir sont efficaces pour ces virus. / Viral infections, especially those involving members of the Herpesviridae during the period of aplasia and lymphopenia following allogeneic hematopoietic stem cell transplantation (HSCT), cause very serious complications, often associated with high morbidity and mortality. Current clinical guidelines recommend prophylactic use of antivirals, which has proven to be effective against certain viruses. The efficacy of famciclovir and acyclovir against herpes simplex viruses (HSV), varicella zoster virus (VZV) and human herpesvirus type 6 (HHV-6) is well-recognized, however, we lack data on their effects against Epstein-Barr virus (EBV) and cytomegalovirus (CMV) in the pediatric population. The main objective of this master's project was to measure the incidence of herpes virus infection, specifically by HSV, VZV, EBV, CMV and HHV-6, and to measure the association between the use of antiviral prophylaxis (acyclovir and famciclovir) and infection (including both asymptomatic viremia and disease) by CMV and EBV in a pediatric cohort of allogeneic HSCT. We used data from the TREASuRE cohort, which includes patients enrolled for a first allogeneic HSCT in four pediatric centers in Canada between July 2013 and March 2017. Recruitment was carried out at: CHU Sainte-Justine (Montreal) (n = 86), British Columbia Children's Hospital (Vancouver) (n = 31), Winnipeg Children's Hospital and CancerCare Manitoba (n = 28) and Alberta Children's Hospital (n = 11). Patient follow-up began 1 month before transplant and lasted 13 months. Median patient age at recruitment was 6.3 years. Kaplan-Meier curves were used to estimate the cumulative incidence of CMV and EBV infections with 95% confidence interval (CI) at 100 days post-transplant according to antiviral prophylaxis (acyclovir or famciclovir). Multivariate proportional hazards Cox regression models were used to measure the association between antiviral use (acyclovir or famciclovir) and the detection of these infections. The study included 156 subjects aged 0 to 21 years. The cumulative incidences of viremia due to HSV, VZV, EBV, CMV and HHV-6 at day 100 of follow-up were respectively 2.5% (CI 95%: 0.8–7.6), 0.8% (CI 95%: 0.1-6.1), 34.5% (CI 95%: 27.6-42.6), 19.9% (CI 95%: 14.5-27.1) and 3.4% (95% CI: 1.2-9.1). The cumulative incidences for CMV and EBV did not show a statistically significant difference between the groups who received antiviral prophylaxis (acyclovir or famciclovir) and those who did not. Cox analyses showed no significant effect of antivirals on CMV with an adjusted HR of 0.55 (95% CI: 0.24–1.26) for acyclovir and 0.82 (95% CI: 0.30–2.29) for famciclovir. The same was true for EBV with an adjusted HR of 1.41 (95% CI: 0.63–3.14) for acyclovir and 0.79 (95% CI: 0.36–1.72) for famciclovir. Our study showed no evidence of an effect with use of famciclovir or acyclovir prophylaxis on EBV and CMV infections. Very few cases of HSV and VZV infections were diagnosed in this cohort, which is consistent with the idea that acyclovir and famciclovir are effective against the latter viruses.