Recurrent febrile urinary tract infections (fUTIs) in children can lead to serious complications such as renal scarring and progressive chronic kidney disease (CKD), with growing evidence indicating that gut microbiome dysbiosis may play a key role in their development. Fecal microbial transplantation (FMT) is an established therapeutic approach for restoring gut microbial balance; however, its use in patients with recurrent fUTIs remains limited and underexplored. This case study describes a 10-year-old boy with recurrent fUTIs and CKD secondary to a posterior urethral valve (PUV) anomaly. The patient was administered a total of seven doses of FMT. FMT reduced pathogenic Enterobacteriaceae, increased beneficial short-chain fatty acid (SCFA)-producing genera, and correspondingly raised SCFA levels, indicating restoration of gut microbiota balance. FMT presents an innovative therapeutic option for pediatric patients with recurrent fUTIs, demonstrating outstanding clinical outcomes.

• Klíčová slova
• Chronic kidney disease, Fecal microbial transplantation, Gut microbiome, Metabolome, Recurrent pyelonephritis,
• MeSH
• chronická renální insuficience * etiologie   terapie   MeSH
• dítě MeSH
• dysbióza terapie   mikrobiologie   MeSH
• fekální transplantace * metody   MeSH
• horečka * terapie   etiologie   MeSH
• infekce močového ústrojí * terapie   mikrobiologie   komplikace   MeSH
• lidé MeSH
• recidiva MeSH
• střevní mikroflóra MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Urinary tract infection (UTI) is a common bacterial infection in the pediatric population. Febrile urinary tract infection (fUTI) can lead to severe complications such as urosepsis as well as kidney scarring, chronic kidney disease, and systemic hypertension. Recent research supports the hypothesis that dysbiosis of the microbiome may play a role in the pathogenesis and development of fUTI in infants. Our main aim was to compare the shift in gut microbiota composition between children with the first fUTI and controls. METHODS: We conducted an observational study with 17 children with the first fUTI compared to 18 healthy controls. We performed analysis of the gastrointestinal microbiome and measurements of metabolites in stool and urine. RESULTS: In the gut microbiome, we found significant differences with lower α-diversity the Shannon index) and significantly lower relative abundance of probiogenic bacteria (short-chain fatty acids (SCFA)) in children with the first episode of fUTI before the start of antibiotic therapy. Furthermore, our findings confirm that the length of breastfeeding has significant influence on gut microbiota composition, reducing pathogenic bacteria and enhancing beneficial taxa. Shannon diversity, duration of breastfeeding, and specific taxa, particularly Faecalibacterium and Escherichia, emerged as strong predictors linked to the development of fUTI. CONCLUSIONS: This study demonstrates that gut microbiome changes are associated with the onset of fUTI in children. Machine learning models identified Shannon index, specific bacterial taxa, and breastfeeding as strong predictors of fUTI. The study highlighted the potential role of the gut microbiome in preventing fUTI.

• Klíčová slova
• Gut microbiota, Kidney, Pediatric, Pyelonephritis, SCFA,
• MeSH
• antibakteriální látky terapeutické užití   MeSH
• dítě MeSH
• dysbióza * mikrobiologie   MeSH
• feces mikrobiologie   chemie   MeSH
• horečka * mikrobiologie   etiologie   MeSH
• infekce močového ústrojí * mikrobiologie   moč   farmakoterapie   komplikace   MeSH
• kojenec MeSH
• kojení MeSH
• lidé MeSH
• metabolom * MeSH
• pilotní projekty MeSH
• předškolní dítě MeSH
• střevní mikroflóra * fyziologie   MeSH
• studie případů a kontrol MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Názvy látek
• antibakteriální látky MeSH

BACKGROUND: We report a 1-month-old infant admitted with fever, dyspnea, and desaturation after an unmonitored pregnancy in a migrant family. The patient rapidly required mechanical ventilation. Laboratory parameters were markedly elevated, suggesting an infectious etiology. METHODS: The clinical course is described with emphasis on diagnostic challenges, including imaging, laboratory findings, and the stepwise process of differential diagnosis. RESULTS: After common etiologies were excluded, rarer causes were considered. The final diagnosis was established through integration of clinical assessment, radiological imaging, laboratory data, and microbiological testing. CONCLUSION: In neonates with fever and respiratory distress, RSV bronchiolitis is usually the first consideration. If excluded, clinicians must remain alert to less frequent etiologies. This case underscores the importance of a broad differential diagnosis in infants with acute respiratory compromise.

• Klíčová slova
• acid fast rods, acute respiratory failure, dyspnea, infant, tuberculosis,
• MeSH
• diferenciální diagnóza MeSH
• dyspnoe etiologie   MeSH
• horečka * etiologie   MeSH
• infekce respiračními syncytiálními viry * diagnóza   komplikace   MeSH
• lidé MeSH
• novorozenec MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Fever is associated with brain injury after cardiac arrest. It is unknown whether fever management with a feedback-controlled device impacts patient-centered outcomes in cardiac arrest patients. This trial aims to investigate fever management with or without a temperature control device after out-of-hospital cardiac arrest. METHODS: The TEMP-CARE trial is part of the 2 × 2 × 2 factorial Sedation, TEmperature and Pressure after Cardiac Arrest and REsuscitation (STEPCARE) trial, a randomized, international, multicenter, parallel-group, investigator-initiated, superiority trial that will evaluate sedation strategies, temperature management, and blood pressure targets simultaneously in nontraumatic/nonhemorrhagic out-of-hospital cardiac arrest patients following hospital admission. For the temperature management component of the trial described in this protocol, patients will be randomly allocated to fever management with or without a feedback-controlled temperature control device. For those managed with a device, if temperature ≥37.8°C occurs within 72 h post-randomization the device will be started targeting a temperature of ≤37.5°C. Standard fever treatment, as recommended by local guidelines, including pharmacological agents, will be provided to participants in both groups. The two other components of the STEPCARE trial evaluate sedation and blood pressure strategies. Apart from the STEPCARE trial interventions, all other aspects of general intensive care will be according to the local practices of the participating site. A physician blinded to the intervention will determine the neurological prognosis following European Resuscitation Council and European Society of Intensive Care Medicine guidelines. The primary outcome is all-cause mortality at six months post-randomization. To detect a 5.6% absolute risk reduction (90% power, alpha .05), 3500 participants will be enrolled. Secondary outcomes include poor functional outcome at six months, intensive care-related serious adverse events, and overall health status at six months. CONCLUSION: The TEMP-CARE trial will investigate if post-cardiac arrest management of fever with or without a temperature control device affects patient-important outcomes after cardiac arrest.

• Klíčová slova
• cardiac arrest, feedback‐controlled device, fever, randomized controlled trial, temperature management,
• MeSH
• horečka * terapie   MeSH
• kardiopulmonální resuscitace * MeSH
• lidé MeSH
• multicentrické studie jako téma MeSH
• randomizované kontrolované studie jako téma MeSH
• tělesná teplota MeSH
• terapeutická hypotermie * přístrojové vybavení   MeSH
• zástava srdce mimo nemocnici * terapie   komplikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• protokol klinické studie MeSH

Brucellosis is a zoonosis with non-specific clinical symptoms involving multiple systems and organs. Its prevalence is low in most of EU countries, which can lead to the difficulties in laboratory and clinical diagnostic. Due to its relationship to the Ochrobactrum spp., it may be misclassified in rapid identification systems. We present a case of a 13-year-old immunocompetent girl who was examined several times for fever, fatigue, night sweats and weight loss; laboratory results showed mildly elevated C-reactive protein, anaemia and leukopenia. Four weeks before the onset of symptoms, she had been on a family holiday in Egypt. Given her symptoms, a haemato-oncological or autoimmune disease was considered more likely. The diagnosis of Brucella spondylitis was made after 4 months. The main reasons for this delay were as follows: low specificity of clinical symptoms, delay in completing the travel history, inconclusive initial serological results and misidentification of the blood culture isolate as Ochrobactrum sp. Even in countries with a low incidence of brucellosis, it is essential to educate healthcare professionals about the disease. Low specificity of symptoms and limited experience of laboratory staff may lead to late diagnosis with risk of complications and poor outcome. If Ochrobactrum spp. is detected in clinical specimens by rapid identification, careful re-evaluation must follow and all measures to prevent laboratory-acquired infections must be taken until Brucella spp. is unequivocally excluded.

• Klíčová slova
• Ochrobactrum spp, Brucellosis, Spondylitis,
• MeSH
• bakteriemie * diagnóza   mikrobiologie   MeSH
• Brucella izolace a purifikace   MeSH
• brucelóza * diagnóza   mikrobiologie   MeSH
• chybná diagnóza * MeSH
• horečka * diagnóza   etiologie   mikrobiologie   MeSH
• lidé MeSH
• mladiství MeSH
• Ochrobactrum * izolace a purifikace   MeSH
• spondylitida * diagnóza   mikrobiologie   MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Geografické názvy
• Egypt MeSH

BACKGROUND: An in-depth study of neurological symptoms and complications of influenza in elderly patients. This population group is more susceptible to complications of the disease and these complications are more likely to end in death. METHODS: A retrospective analysis of patient data was performed. All patients aged 65 years and older were included in the study. The study period was from the 1st of January , 2018 to 31st of December, 2021. All symptoms and complications of influenza were analyzed. Especially neurological and general symptoms were analyzed. Data were extracted from the complete medical records of the patients. RESULTS: The most common symptoms of influenza in the elderly were fever in 218 cases (83.52%), cough in 189 patients (72.41%), general weakness in 182 (69.73%) and fatigue in 166 patients (63.6%). Myalgias were experienced by 106 patients (40.61%) and arthralgias by 101 patients (38.7%). Headache occurred in only 21 patients (8.06%). Encephalopathy was observed in 7 elderly patients (2.68%) during hospitalization. Influenza encephalitis was noted in 2 cases. CONCLUSION: The most common neurological symptoms of influenza in more than half of the elderly are general weakness and increased fatigue. Myalgias are common, headache less often. Nausea is not uncommon. Of the complications, encephalopathy is the most common. Cases of influenza encephalitis have also been reported. We have not encountered a stroke. Concerning other complications, bacterial pneumonia was the most common.

• MeSH
• bolesti hlavy etiologie   epidemiologie   MeSH
• chřipka lidská * komplikace   epidemiologie   MeSH
• horečka etiologie   MeSH
• kašel etiologie   MeSH
• lidé MeSH
• myalgie etiologie   epidemiologie   MeSH
• nemoci nervového systému epidemiologie   etiologie   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• svalová slabost etiologie   epidemiologie   MeSH
• únava etiologie   epidemiologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Protracted febrile myalgia syndrome (PFMS) is a rare manifestation of familial Mediterranean fever (FMF), characterized by myalgia, fever and elevated inflammatory markers lasting several weeks. As the hallmark of FMF are short episodes of disease symptoms, the long duration of PFMS may lead to a delayed diagnosis and treatment. OBJECTIVES: 1. To perform a review of literature and rheumatology textbooks focused on clinical features and treatment of PFMS in children. 2. To present our own case. METHODS: All articles in Pub Med generated using the keywords "protracted febrile myalgia" and information on PFMS in seven rheumatology textbooks were collected. The systematic review was supplemented with our own case presentation. RESULTS: In total, 18 articles with 78 pediatric patients (including our own) were retrieved. More than half of the patients presented with PFMS as the first manifestation of FMF. All complained of myalgia, 65% of abdominal pain and 26% had a rash. Corticosteroids (CS) were effective in 77%. In all CS-refractory cases, anakinra was shown efficient. MRI was used in 5 patients and showed myositis in all of them. The scrutiny of seven rheumatology textbooks showed that PFMS presenting with myalgia was mentioned in six. Possible accompanying symptoms were described only once, the long duration of symptoms twice, the efficacy of corticosteroids three times and anakinra only once. The presented 6 year old patient manifested with fever, myalgia, abdominal pain and petechial rash lasting 6 weeks. She had undergone multiple diagnostic procedures before her parents mentioned a positive family history for FMF. The subsequent genetic testing confirmed a homozygosity for M694V pathogenic variant in the MEFV gene. CONCLUSION: The long duration of PFMS may be misleading to clinicians especially if PFMS occurs at manifestation of FMF. The fact that more than half of the reported patients experienced PFMS as the presenting symptom of FMF is one of the key findings of our study. Our case presentation demonstrates the importance of genetic testing early in suspected autoinflammatory diseases. Furthermore, MRI may be an important diagnostic tool showing myositis in PFMS.

• Klíčová slova
• Clinical features, Diagnostic role of MRI, Protracted febrile myalgia syndrome, Treatment,
• MeSH
• dítě MeSH
• familiární středomořská horečka * komplikace   diagnóza   MeSH
• horečka * diagnóza   etiologie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• myalgie * diagnóza   etiologie   MeSH
• syndrom MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• systematický přehled MeSH

BACKGROUND: Systemic autoinflammatory disorders (SAIDs) represent a growing spectrum of diseases characterized by dysregulation of the innate immune system. The most common pediatric autoinflammatory fever syndrome, Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis (PFAPA), has well defined clinical diagnostic criteria, but there is a subset of patients who do not meet these criteria and are classified as undefined autoinflammatory diseases (uAID). This project, endorsed by PRES, supported by the EMERGE fellowship program, aimed to analyze the evolution of symptoms in recurrent fevers without molecular diagnosis in the context of undifferentiated AIDs, focusing on PFAPA and syndrome of undifferentiated recurrent fever (SURF), using data from European AID registries. METHODS: Data of patients with PFAPA, SURF and uSAID were collected from 3 registries including detailed epidemiological, demographic and clinical data, results of the genetic testing and additional laboratory investigations with retrospective application of the modified Marshall and PRINTO/Eurofever classification criteria on the cohort of PFAPA patients and preliminary SURF criteria on uSAID/SURF patients. RESULTS: Clinical presentation of PFAPA is variable and some patients did not fit the conventional PFAPA criteria and exhibit different symptoms. Some patients did not meet the criteria for either PFAPA or SURF, highlighting the heterogeneity within these groups. The study also explored potential overlaps between PFAPA and SURF/uAID, revealing that some patients exhibited symptoms characteristic of both conditions, emphasizing the need for more precise classification criteria. CONCLUSIONS: Patients with recurrent fevers without molecular diagnoses represent a clinically heterogeneous group. Improved classification criteria are needed for both PFAPA and SURF/uAID to accurately identify and manage these patients, ultimately improving clinical outcomes.

• Klíčová slova
• AID-Net, Autoinflammatory diseases, Eurofever, JIR-cohort, PFAPA, SURF,
• MeSH
• aftózní stomatitida * diagnóza   epidemiologie   MeSH
• dědičné zánětlivé autoimunitní nemoci * diagnóza   MeSH
• dítě MeSH
• faryngitida * diagnóza   MeSH
• horečka etiologie   diagnóza   MeSH
• kojenec MeSH
• lidé MeSH
• lymfadenitida * diagnóza   epidemiologie   MeSH
• mladiství MeSH
• předškolní dítě MeSH
• recidiva MeSH
• registrace * MeSH
• retrospektivní studie 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
• Geografické názvy
• Evropa epidemiologie   MeSH

PURPOSE: To evaluate the contribution of F-18 FDG-PET/MRI in the search for the etiology of the inflammation of unknown origin (IUO) and fever of unknown origin (FUO). MATERIAL AND METHODS: The study included 104 patients who underwent F-18 FDG-PET/MRI for IUO or FUO. The sensitivity, specificity, predictive values of the PET/MRI findings in relation to the final diagnosis of IUO/FUO were evaluated. A five-point Likert scale was used to semiquantitatively assess the probability of the cause of IUO/FUO based on PET/MRI finding. Furthermore, clinical (fever, arthralgia, weight loss, night sweats, age) and laboratory (C-reactive protein, leukocytes) parameters were monitored and compared with the true positivity rate of PET/MRI. RESULTS: In patients with definitively identified etiology of FUO and IUO, FDG-PET/MRI achieved a sensitivity of 96 %, specificity of 82 %, and positive and negative predictive values of 92 and 90 %. The cause of the IUO was determined in 71 patients (68.3 %). In 33 (31.7 %) patients, the etiology of IUO/FUO remained unknown, while in 25 (75.8 %) of them the symptoms resolved spontaneously and in 8 (24.2 %) patients they persisted without explanation even after 12 months of the follow-up. The most significant parameter in relation to subsequent PET/MRI finding was increased level of CRP, which was present in 96 % of true positive PET/MRI and normal CRP level was present in 56 % of true negative PET/MRI. CONCLUSION: Based on this study, FDG-PET/MRI is a suitable alternative for the investigation of IUO/FUO, this imaging technique has a very high sensitivity and negative predictive value.

• Klíčová slova
• Fever of unknown origin, Fluorodeoxyglucose F18, Magnetic Resonance Imaging, Multimodal Imaging, Positron-Emission Tomography,
• MeSH
• C-reaktivní protein metabolismus   MeSH
• fluorodeoxyglukosa F18 * MeSH
• horečka neznámého původu * etiologie   komplikace   MeSH
• lidé MeSH
• pozitronová emisní tomografie metody   MeSH
• radiofarmaka MeSH
• zánět komplikace   diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• C-reaktivní protein MeSH
• fluorodeoxyglukosa F18 * MeSH
• radiofarmaka MeSH

RATIONALE: The manuscript aimed to show that an unmeasurable capillary C-reactive protein (CRP) should be a red flag that can indicate a possible severe hematological pathology. PATIENTS CONCERNS AND DIAGNOSES: The authors present 3 case reports of children with fever examined at the pediatric emergency department. Fever is among the most frequently exhibited symptoms of acute pediatric infectious diseases. However, sometimes fever can be the manifestation of other serious noninfectious diseases. CRP is a marker widely used in clinical pediatric practice to help us evaluate inflammation and possible bacterial infection. All mentioned patients had unmeasurable CRP from capillary blood, even though venous CRP ranged from 14 to 21 mg/L. All of the patients were consequently diagnosed with severe hemato-oncological disease. Possible explanations are that a change in blood viscosity or an elevation of circulating immune complexes in the blood of patients with leukemia leads to malfunctioning immunoturbidimetry measurement. LESSON: Although these findings are very interesting and could lead to faster recognition of acute leukemia in pediatric clinical practice, further prospective study is needed for their confirmation.

• MeSH
• bakteriální infekce * diagnóza   MeSH
• C-reaktivní protein analýza   MeSH
• dítě MeSH
• horečka etiologie   MeSH
• leukemie * komplikace   MeSH
• lidé MeSH
• prospektivní studie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• C-reaktivní protein MeSH