Akutní zánět středouší (otitis media acuta, OMA) patří stále k nejobvyklejším onemocněním u dětí. Článek se zaměřuje na jednotlivé bakteriální původce OMA u dětí, jejich charakteristiku, změny v čase, stav rezistence a doporučené postupy léčby OMA na základě aktuálních dat.

Acute otitis media (AOM) is still one of the most common diseases in children. The article focuses on the individual bacterial agents of AOM in children, their characteristics, changes over time, the state of resistance and recommended management for the treatment of AOM based on current data.

• MeSH
• antibakteriální látky farmakologie   klasifikace   terapeutické užití   MeSH
• dítě MeSH
• Haemophilus influenzae patogenita   účinky léků   MeSH
• lidé MeSH
• Moraxella catarrhalis patogenita   účinky léků   MeSH
• otitis media * etiologie   farmakoterapie   mikrobiologie   MeSH
• penicilin V farmakologie   terapeutické užití   MeSH
• peniciliny farmakologie   terapeutické užití   MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• Streptococcus pneumoniae patogenita   účinky léků   MeSH
• Streptococcus pyogenes patogenita   účinky léků   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• přehledy MeSH

BACKGROUND: The Invasive Respiratory Infection Surveillance (IRIS) Consortium was established to assess the impact of the COVID-19 pandemic on invasive diseases caused by Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, and Streptococcus agalactiae. We aimed to analyse the incidence and distribution of these diseases during the first 2 years of the COVID-19 pandemic compared to the 2 years preceding the pandemic. METHODS: For this prospective analysis, laboratories in 30 countries and territories representing five continents submitted surveillance data from Jan 1, 2018, to Jan 2, 2022, to private projects within databases in PubMLST. The impact of COVID-19 containment measures on the overall number of cases was analysed, and changes in disease distributions by patient age and serotype or group were examined. Interrupted time-series analyses were done to quantify the impact of pandemic response measures and their relaxation on disease rates, and autoregressive integrated moving average models were used to estimate effect sizes and forecast counterfactual trends by hemisphere. FINDINGS: Overall, 116 841 cases were analysed: 76 481 in 2018-19, before the pandemic, and 40 360 in 2020-21, during the pandemic. During the pandemic there was a significant reduction in the risk of disease caused by S pneumoniae (risk ratio 0·47; 95% CI 0·40-0·55), H influenzae (0·51; 0·40-0·66) and N meningitidis (0·26; 0·21-0·31), while no significant changes were observed for S agalactiae (1·02; 0·75-1·40), which is not transmitted via the respiratory route. No major changes in the distribution of cases were observed when stratified by patient age or serotype or group. An estimated 36 289 (95% prediction interval 17 145-55 434) cases of invasive bacterial disease were averted during the first 2 years of the pandemic among IRIS-participating countries and territories. INTERPRETATION: COVID-19 containment measures were associated with a sustained decrease in the incidence of invasive disease caused by S pneumoniae, H influenzae, and N meningitidis during the first 2 years of the pandemic, but cases began to increase in some countries towards the end of 2021 as pandemic restrictions were lifted. These IRIS data provide a better understanding of microbial transmission, will inform vaccine development and implementation, and can contribute to health-care service planning and provision of policies. FUNDING: Wellcome Trust, NIHR Oxford Biomedical Research Centre, Spanish Ministry of Science and Innovation, Korea Disease Control and Prevention Agency, Torsten Söderberg Foundation, Stockholm County Council, Swedish Research Council, German Federal Ministry of Health, Robert Koch Institute, Pfizer, Merck, and the Greek National Public Health Organization.

• MeSH
• bakteriální infekce * MeSH
• COVID-19 * epidemiologie   MeSH
• Haemophilus influenzae MeSH
• lidé MeSH
• Neisseria meningitidis * MeSH
• pandemie MeSH
• Streptococcus pneumoniae MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

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• MeSH
• Haemophilus influenzae * patogenita   MeSH
• hemofilové infekce * epidemiologie   mortalita   prevence a kontrola   MeSH
• hemofilové vakcíny MeSH
• hlášení nemocí normy   MeSH
• lidé MeSH
• surveillance populace MeSH
• Check Tag
• lidé MeSH
• Geografické názvy
• Česká republika MeSH

• MeSH
• antibiotická rezistence MeSH
• antigeny farmakologie   MeSH
• biofilmy * MeSH
• Haemophilus influenzae metabolismus   MeSH
• lidé MeSH
• Staphylococcus aureus metabolismus   MeSH
• vakcinologie MeSH
• vývoj vakcíny * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

Cíl práce: Zhodnocení stavu a změny trendů ve výskytu invazivních onemocnění způsobených Haemophilus influenzae v České republice (ČR) v letech 1999–2020 s ohledem na zavedení očkování dětí proti H. influenzae sérotypu b (Hib) v roce 2001. Charakterizace kmenů multilokusovou sekvenční typizací (MLST) a hledání korelací mezi sérotypy, sekvenčními typy a skupinami pacientů či klinickými projevy onemocnění. Materiál a metody: Analyzováno bylo 623 invazivních kmenů H. influenzae zachycených v rámci surveillance invazivního hemofilového onemocnění v ČR. Pro všechny kmeny byly určeny biotypy na základě fenotypového projevu a sérotypy pomocí sklíčkové aglutinace se specifickými antiséry a-f. U 383 kmenů ze sbírky Národní referenční laboratoře pro hemofilové nákazy (NRL HEM) získaných v rámci surveillance v ČR byla provedena MLST s určením sekvenčních typů (ST). Pro analýzy byl dataset doplněn z databáze PubMLST 5 kmeny sérotypů vyskytujících se v ČR výjimečně nebo vůbec. Kalkulace podobnosti kmenů na základě MLST a dat o kmenu (sérotyp, biotyp, ST) a pacientovi (diagnóza, pohlaví, věk) byla provedena v programu BioNumerics 7.6. Výsledky: Po zavedení očkování proti Hib v roce 2001 došlo v následujících letech k dramatickému poklesu invazivních Hib onemocnění o více než 90 %. V letech 1999-2020 bylo v ČR zaznamenáno celkem 623 invazivních onemocnění způsobených H. influenzae, v posledních letech se jednalo o cca 20 invazivních onemocnění ročně. V současnosti jsou v ČR dominantní skupinou kmenů způsobující hemofilové invazivní onemocnění neopouzdřené kmeny (HiNT) následované kmeny sérotypů Hif a Hie. Nejběžnější manifestací hemofilového invazivního onemocnění byla před zavedením očkování meningitida, nyní je to sepse. Analyzovány byly sekvenční typy 383 kmenů ze sbírky NRL HEM získaných v rámci surveillance v ČR. Výsledky ukázaly vysokou klonálnost opouzdřených kmenů a diverzitu HiNT, což odpovídá i výsledkům jiných studií. Analýza podobnosti kmenů neukázala žádné prokazatelné vztahy mezi věkem pacientů či klinickou manifestací a sérotypy a konkrétními ST. Závěr: Z hlediska invazivních hemofilových onemocnění došlo k dramatické změně v důsledku očkování proti Hib po roce 2001, kdy došlo ke snížení onemocnění způsobených Hib z desítek na jednotky případů ročně. V posledních 10 letech je situace v ČR stabilní bez výrazných změn v počtech případů či v zastoupení sérotypů a odpovídá situaci v ostatních zemích Evropské unie. Pro sledování dalšího vývoje je žádoucí pokračovat v NRL HEM v surveillance invazivních onemocnění způsobených H. influenzae včetně molekulárně-biologické charakterizace kmenů. MLST je metoda umožňující charakterizaci kmenů na základě alelických variant vybraných housekeeping genů, avšak neumožňuje spojit konkrétní sekvenční typy H. influenzae se skupinami pacientů na základě věku, pohlaví či klinických projevů. V budoucnu by mohlo být možné identifikovat závislost onemocnění na konkrétních skupinách kmenů pomocí celogenomové sekvenace.

Aim: To assess the trends and changes in the incidence of invasive disease caused by Haemophilus influenzae in the Czech Republic (CR) between 1999 and 2020 with regard to the introduction of childhood vaccination against H. influenzae serotype b (Hib) in 2001. Characterization of strains by multilocus sequence typing (MLST) and search for correlations between serotypes, sequence types, and patient groups or clinical manifestations of the disease. Material and methods: A total of 623 invasive H. influenzae strains from surveillance of invasive Haemophilus disease in the Czech Republic were analysed. All strains were biotyped based on phenotypic characteristics and serotyped using slide agglutination with specific a-f antisera. Three hundred and eighty-three strains from the collection of the National Reference Laboratory for Haemophilus Infections (NRL HEM) originating from surveillance in the CR were analysed by MLST and assigned to sequence types (ST). For analyses, the dataset was supplemented with five strains from the PubMLST database of serotypes rarely or not at all found in the CR. Similarity calculations based on MLST and strain (serotype, biotype, ST) and patient (diagnosis, sex, age) data were performed in BioNumerics 7.6. Results: After the introduction of Hib vaccination in 2001, a dramatic decline of more than 90% was observed in invasive Hib disease over the following years. Between 1999 and 2020, a total of 623 cases of invasive disease caused by H. influenzae were recorded in the CR, with about 20 cases reported annually in recent years. At present, the dominant agents causing Haemophilus invasive disease in the CR are non-enveloped strains (HiNT) followed by strains of Hif and Hie serotypes. The most common manifestation of Haemophilus invasive disease in the pre-vaccination era was meningitis, while now it is sepsis. Sequence types of 383 strains from the NRL HEM collection originating from surveillance in the CR were analysed. The results showed high clonality of the encapsulated strains and diversity of HiNT strains, which is consistent with the results of others. Strain similarity analysis showed no demonstrable relationships between patient age or clinical manifestation and serotype and ST. Conclusion: In invasive Haemophilus disease, there has been a dramatic change as a result of Hib vaccination after 2001, with a reduction of cases caused by Hib from tens to units annually. In the last decade, the situation in the CR has been stable with no significant changes in the number of cases or in the representation of causative serotypes and is in line with the reports from other EU countries. In order to monitor further developments, it is desirable that the NRL HEM should continue the surveillance of invasive disease caused by H. influenzae, including molecular biological characteristics of strains. MLST allows the characterisation of strains based on allelic variants of selected housekeeping genes, but it does not allow the association of specific H. influenzae sequence types with patient age, sex or clinical manifestations. In the future, whole genome sequencing could be a useful tool for determining the correlation between the disease and specific strains.

• MeSH
• epidemiologické studie MeSH
• Haemophilus influenzae * izolace a purifikace   MeSH
• hemofilové infekce * epidemiologie   prevence a kontrola   MeSH
• lidé MeSH
• sérotypizace MeSH
• surveillance populace MeSH
• techniky typizace bakterií MeSH
• Check Tag
• lidé MeSH

V programu surveillance České republiky bylo v roce 2021 nahlášeno 15 invazivních onemocnění způsobených Haemophilus influenzae. Do Národní referenční laboratoře pro hemofilové nákazy bylo odesláno k ověření 12 kmenů H. influenzae. Celková nemocnost byla 0,14/100 000 obyvatel, nejvyšší ve věkové skupině 65 let a více (0,41/100000 obyv.). V souvislosti s invazivním onemocněním vyvolaným H. influenzae zemřeli čtyři pacienti, celková smrtnost byla 26,7 %. Nejčastější klinickou formou byla sepse (12 onemocnění). V roce 2021 nebylo zjištěno žádné selhání Hib vakcinace. Z klinického materiálu bylo izolováno 6 neopouzdřených a 5 opouzdřených kmenů H. influenzae. V letech 2009–2021 bylo celkem zaznamenáno 273 invazivních hemofilových onemocnění. Nejvyšší věkově specifická nemocnost byla opakovaně zjištěna u dětí do jednoho roku věku a starších osob (65 let a více). Invazivní onemocnění způsobené H. influenzae bylo spojeno se smrtností v průměru 16,1 %. Ve sledovaném období byla nejvíce hlášena sepse (133 případů). Nejčastějším původcem byl neopouzdřený HiNT, který vyvolal 158 chorob (58 %). Identifikace 60 původců invazivních onemocnění (22 %) probíhala jen na úroveň H. influenzae bez další typizace.

In 2021, 15 invasive diseases caused by Haemophilus influenzae were reported in the program of surveillance of the Czech Republic. The National Reference Laboratory for Haemophilus Infections received twelve strains of H. influenzae for verification. The overall morbidity was 0.14/100,000 population, the highest in the age group of 65 years and over (0.41/100,000 population). Four patients died of invasive H. influenzae disease, the overall fatality rate thus being 26.7%. The most common clinical form was sepsis (12 cases). No Hib vaccine failures were identified in 2021. From the clinical material, 6 non-encapsulated and 5encapsulated strains of H. influenzae were isolated. In the years 2009–2021, a total of 273 invasive Haemophilus influenzae diseases were recorded. The highest age-specific morbidity was repeatedly found in children under one year of age and the elderly (65 years and older). Invasive disease caused by H. influenzae was associated with an average fatality rate of 16.1%. In the monitored period, the most frequently reported clinical form was sepsis (133 cases). The most common agent was unencapsulated HiNT, causing 158 diseases (58 %). The identification of 60 causative agents of invasive diseases (22%) took place only at the level of H. influenzae without further typing.

• MeSH
• epidemiologické monitorování MeSH
• Haemophilus influenzae * patogenita   MeSH
• hemofilové infekce diagnóza   epidemiologie   klasifikace   MeSH
• hemofilové vakcíny farmakologie   klasifikace   MeSH
• lidé MeSH
• morbidita MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Epidemiologie invazivních pneumokokových i meningokokových infekcí u dětí závisí kromě neovlivnitelných rizikových faktorů na šíření bakterií v komunitě. Protiepidemická opatření zdánlivě snižují výskyt některých infekcí, ale jejich závažný potenciál se nemění. Je nezbytné navzdory obtížným a změněným podmínkám udržet a zvýšit proočkovanost celé dětské populace, ale především rizikových jedinců.

The epidemiology of invasive pneumococcal and meningococcal infections in children is, in addition to uncontrollable risk factors, dependent on the spread of bacteria in the community. Anti-epidemic measures seem to reduce the incidence of some infections; however, their serious potential remains unchanged. Despite the challenging and altered conditions, it is necessary to maintain and increase the vaccination coverage of in the entire pediatric population, especially in at-risk individuals.

• MeSH
• dítě MeSH
• Haemophilus influenzae typu B MeSH
• lidé MeSH
• meningokokové infekce * epidemiologie   prevence a kontrola   MeSH
• meningokokové vakcíny MeSH
• pneumokokové infekce * epidemiologie   prevence a kontrola   MeSH
• pneumokokové vakcíny MeSH
• vakcinace MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• přehledy MeSH

BACKGROUND: Treponema pallidum subspecies pertenue causes yaws. Strategies to better control, eliminate, and eradicate yaws are needed. METHODS: In an open-label, cluster-randomized, community-based trial conducted in a yaws-endemic area of Papua New Guinea, we randomly assigned 38 wards (i.e., clusters) to receive one round of mass administration of azithromycin followed by two rounds of target treatment of active cases (control group) or three rounds of mass administration of azithromycin (experimental group); round 1 was administered at baseline, round 2 at 6 months, and round 3 at 12 months. The coprimary end points were the prevalence of active cases of yaws, confirmed by polymerase-chain-reaction assay, in the entire trial population and the prevalence of latent yaws, confirmed by serologic testing, in a subgroup of asymptomatic children 1 to 15 years of age; prevalences were measured at 18 months, and the between-group differences were calculated. RESULTS: Of the 38 wards, 19 were randomly assigned to the control group (30,438 persons) and 19 to the experimental group (26,238 persons). A total of 24,848 doses of azithromycin were administered in the control group (22,033 were given to the participants at round 1 and 207 and 2608 were given to the participants with yaws-like lesions and their contacts, respectively, at rounds 2 and 3 [combined]), and 59,852 doses were administered in the experimental group. At 18 months, the prevalence of active yaws had decreased from 0.46% (102 of 22,033 persons) at baseline to 0.16% (47 of 29,954 persons) in the control group and from 0.43% (87 of 20,331 persons) at baseline to 0.04% (10 of 25,987 persons) in the experimental group (relative risk adjusted for clustering, 4.08; 95% confidence interval [CI], 1.90 to 8.76). The prevalence of other infectious ulcers decreased to a similar extent in the two treatment groups. The prevalence of latent yaws at 18 months was 6.54% (95% CI, 5.00 to 8.08) among 994 children in the control group and 3.28% (95% CI, 2.14 to 4.42) among 945 children in the experimental group (relative risk adjusted for clustering and age, 2.03; 95% CI, 1.12 to 3.70). Three cases of yaws with resistance to macrolides were found in the experimental group. CONCLUSIONS: The reduction in the community prevalence of yaws was greater with three rounds of mass administration of azithromycin at 6-month intervals than with one round of mass administration of azithromycin followed by two rounds of targeted treatment. Monitoring for the emergence and spread of antimicrobial resistance is needed. (Funded by Fundació "la Caixa" and others; ClinicalTrials.gov number, NCT03490123.).

• MeSH
• antibakteriální látky aplikace a dávkování   MeSH
• azithromycin aplikace a dávkování   MeSH
• bakteriální léková rezistence MeSH
• dítě MeSH
• frambézie farmakoterapie   epidemiologie   MeSH
• Haemophilus ducreyi izolace a purifikace   MeSH
• kojenec MeSH
• kožní vředy mikrobiologie   MeSH
• lidé MeSH
• masová profylaxe * MeSH
• mladiství MeSH
• polymerázová řetězová reakce MeSH
• předškolní dítě MeSH
• prevalence MeSH
• Treponema izolace a purifikace   MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze III MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Geografické názvy
• Papua Nová Guinea MeSH

BACKGROUND: Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, which are typically transmitted via respiratory droplets, are leading causes of invasive diseases, including bacteraemic pneumonia and meningitis, and of secondary infections subsequent to post-viral respiratory disease. The aim of this study was to investigate the incidence of invasive disease due to these pathogens during the early months of the COVID-19 pandemic. METHODS: In this prospective analysis of surveillance data, laboratories in 26 countries and territories across six continents submitted data on cases of invasive disease due to S pneumoniae, H influenzae, and N meningitidis from Jan 1, 2018, to May, 31, 2020, as part of the Invasive Respiratory Infection Surveillance (IRIS) Initiative. Numbers of weekly cases in 2020 were compared with corresponding data for 2018 and 2019. Data for invasive disease due to Streptococcus agalactiae, a non-respiratory pathogen, were collected from nine laboratories for comparison. The stringency of COVID-19 containment measures was quantified using the Oxford COVID-19 Government Response Tracker. Changes in population movements were assessed using Google COVID-19 Community Mobility Reports. Interrupted time-series modelling quantified changes in the incidence of invasive disease due to S pneumoniae, H influenzae, and N meningitidis in 2020 relative to when containment measures were imposed. FINDINGS: 27 laboratories from 26 countries and territories submitted data to the IRIS Initiative for S pneumoniae (62 837 total cases), 24 laboratories from 24 countries submitted data for H influenzae (7796 total cases), and 21 laboratories from 21 countries submitted data for N meningitidis (5877 total cases). All countries and territories had experienced a significant and sustained reduction in invasive diseases due to S pneumoniae, H influenzae, and N meningitidis in early 2020 (Jan 1 to May 31, 2020), coinciding with the introduction of COVID-19 containment measures in each country. By contrast, no significant changes in the incidence of invasive S agalactiae infections were observed. Similar trends were observed across most countries and territories despite differing stringency in COVID-19 control policies. The incidence of reported S pneumoniae infections decreased by 68% at 4 weeks (incidence rate ratio 0·32 [95% CI 0·27-0·37]) and 82% at 8 weeks (0·18 [0·14-0·23]) following the week in which significant changes in population movements were recorded. INTERPRETATION: The introduction of COVID-19 containment policies and public information campaigns likely reduced transmission of S pneumoniae, H influenzae, and N meningitidis, leading to a significant reduction in life-threatening invasive diseases in many countries worldwide. FUNDING: Wellcome Trust (UK), Robert Koch Institute (Germany), Federal Ministry of Health (Germany), Pfizer, Merck, Health Protection Surveillance Centre (Ireland), SpID-Net project (Ireland), European Centre for Disease Prevention and Control (European Union), Horizon 2020 (European Commission), Ministry of Health (Poland), National Programme of Antibiotic Protection (Poland), Ministry of Science and Higher Education (Poland), Agencia de Salut Pública de Catalunya (Spain), Sant Joan de Deu Foundation (Spain), Knut and Alice Wallenberg Foundation (Sweden), Swedish Research Council (Sweden), Region Stockholm (Sweden), Federal Office of Public Health of Switzerland (Switzerland), and French Public Health Agency (France).

• MeSH
• analýza přerušované časové série MeSH
• bakteriální infekce epidemiologie   přenos   MeSH
• COVID-19 * prevence a kontrola   MeSH
• Haemophilus influenzae MeSH
• incidence MeSH
• infekce dýchací soustavy epidemiologie   MeSH
• lidé MeSH
• Neisseria meningitidis MeSH
• prospektivní studie MeSH
• Streptococcus agalactiae MeSH
• Streptococcus pneumoniae MeSH
• surveillance populace MeSH
• veřejné zdravotnictví - praxe MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

In Glässer's disease outbreaks, Glaesserella (Haemophilus) parasuis has to overcome the non-specific immune system in the lower respiratory tract, the alveolar macrophages. Here we showed that porcine alveolar macrophages (PAMs) were able to recognize and phagocyte G. parasuis with strain-to-strain variability despite the presence of the capsule in virulent (serovar 1, 5, 12) as well in avirulent strains (serovar 6 and 9). The capsule, outer membrane proteins, virulence-associated autotransporters, cytolethal distending toxins and many other proteins have been identified as virulence factors of this bacterium. Therefore, we immunized pigs with the crude capsular extract (cCE) from the virulent G. parasuis CAPM 6475 strain (serovar 5) and evaluated the role of the anti-cCE/post-vaccinal IgG in the immune response of PAMs to in vitro infection with various G. parasuis strains. We demonstrated the specific binding of the antibodies to the cCE by Western-blotting assay and immunoprecipitation as well as the specific binding to the strain CAPM 6475 in transmission electron microscopy. In the cCE, we identified several virulence-associated proteins that were immunoreactive with IgG isolated from sera of immunized pigs. Opsonization of G. parasuis strains by post-vaccinal IgG led to enhanced phagocytosis of G. parasuis by PAMs at the first two hours of infection. Moreover, opsonization increased the oxidative burst and expression/production of both pro- and anti-inflammatory cytokines. The neutralizing effects of these antibodies on the antioxidant mechanisms of G. parasuis may lead to attenuation of its virulence and pathogenicity in vivo. Together with opsonization of bacteria by these antibodies, the host may eliminate G. parasuis in the infection site more efficiently. Based on these results, the crude capsular extract is a vaccine candidate with immunogenic properties.

• MeSH
• alveolární makrofágy imunologie   metabolismus   mikrobiologie   MeSH
• antigeny bakteriální imunologie   MeSH
• bakteriální pouzdra imunologie   MeSH
• fagocytóza MeSH
• Haemophilus parasuis imunologie   patogenita   MeSH
• hemofilové infekce imunologie   metabolismus   mikrobiologie   MeSH
• kinetika MeSH
• kultivované buňky MeSH
• neutralizující protilátky imunologie   metabolismus   MeSH
• protilátky bakteriální imunologie   metabolismus   MeSH
• reaktivní formy kyslíku metabolismus   MeSH
• séroskupina MeSH
• specificita protilátek MeSH
• Sus scrofa MeSH
• virulence MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH