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Of the various forms of chronic viral hepatitis, in Germany 60-70% are caused by the hepatitis C virus (HCV). The virus arrives inconspicuously, i.e. an acute infection only leads to an increase in transaminases in 40% of cases and to an increase in bilirubin in only 20%. However, approximately 90% of infections take a chronic course and in 20% this leads to cirrhosis after only 20 years. The infection rate of medical personnel is not significantly higher than in the general population. The transmission of HCV from patients to medical personnel, e.g. by needle stick injuries, is very rare and the risk of infection is less than 1%. Even less frequently transmission of HCV in the reverse direction from medical personnel to patients occurs. An active or passive prophylactic immunization is not possible and protective immunization is not yet foreseeable. Recently, progress has been made with chemotherapeutical treatment of HCV. The present state-of-the-art is pegylated interferon-a in combination with ribavirin. The success rate in HCV genotypes 2 and 3 is clearly higher with 70-80% than in genotypes 1 and 4 with approximately 40%. Both drugs have significant side-effects but better forms of medication are not yet available.

Compared with other nosocomial infections, transfusion-associated infectious risks are of minor relevance in the Federal Republic of Germany today. The actual spectrum of measures for an optimal degree of safety of blood components comprises a careful donor selection, highly sensitive and specific screening assays for viral parameters, inactivation and quarantine procedures for plasmatic preparations. Further possible improvements, both in the blood bank and clinical setting are discussed with regard to the inevitable residual risks of hemotherapy.

There is a distinct spectrum of infectious diseases in prisons, known as desmoteric infections. We investigated the incidence of HIV, hepatitis A, B, and C in a group of 539 prisoners and compared them with the incidences of these infections in the normal population. The incidence of HIV was 928 out of 100,000. This figure is similar to that of the normal population. Hence, HIV infection does not seem to be a desmoteric disease. In contrast to AIDS the incidences of hepatitis A, B, and C among prisoners were 2968, 1670, and 20,000, respectively. Of course, hepatitis A, B, and C occur 100-200 times more often among prisoners and thus seem to be desmoteric infections. Moreover, especially hepatitis C is correlated strongly with intravenous drug abuse. About 80% of drug abusers were HCV positive and 50% of the total of HC infections are due to drug abusers.

Three days after the end of a bout of diarrhoea of 3 days' duration, a 19-year-old patient developed severe nocturnal thoracic pain unresponsive to isosorbitol dinitrate. There were no abnormal findings on physical examination, except a sweaty skin. SGOT (38 U/l), creatinine kinase (291 U/l, CK-MB 29 U/l) and lactate dehydrogenase (246 U/l) were all elevated. The ECG showed ST segment elevations in leads I, II, III, aVF and V1-V6 as well as negative terminal T waves in I, II, aVL, AVF and V3-V6, changes suggesting peri- and myocarditis. The Widal test gave a raised antibody titre (1:800) against Yersinia enterocolitica serotype O:3. Seven days later the immunoblot test demonstrated antibodies against the same organism, which was finally isolated from stool after 11 days. Treatment consisted of ciprofloxacin (500 mg twice daily for 14 days). All symptoms, as well as the biochemical and ECG abnormalities, quickly improved. The patient was discharged free of symptoms after 34 days.

One thousand regular blood donors of the Department of Transfusion Medicine at the University Hospital in Hamburg were screened for antibodies against the Lyme disease spirochete, B. burgdorferi. 7.2% were initially reactive in the enzyme immunoassay, 37.5% of which were confirmed by immunoblot. The seroprevalence of anti-B. burgdorferi antibodies thus is 2.7% in Hamburg blood donors. 25 of 27 positive donors received a physical exam, which did not reveal any symptoms of acute or chronic Lyme disease. 24 of these 25 donors were tested for B. burgdorferi-specific DNA in urine by polymerase chain reaction, which came out negative in all cases. Introduction of B. burgdorferi antibody screening is not regarded an effective means to prevent transfusion-transmitted Lyme disease.

A number of in vivo and in vitro results suggest that interferons have an antiretroviral effect on HIV. To check this, 15 HIV-positive patients who had no full-blown AIDS, were treated with recombinant interferon alpha 2b (5 mill. IU s. c. three times a week) over a period of six months. Twelve to 16 weeks after the initiation of treatment, an increase in CD 4 lymphocytes (+16%), NK cells (+16%), lymphocytes stimulation by con A (+ 176%), neopterin (+66%), and beta-2-microglobulin (+19%) was observed. By the end of the study, all these parameters had slightly decreased again. In all patients with CD4 lymphocytes greater than 0.2 c/nl, we observed a decrease in p24 antigen levels, but in patients with CD4 lymphocytes less than 0.2 c/nl, an increase. It would thus seem that any antiretroviral effect of IFN (as shown by the p24 antigen parameter) is more pronounced in patients with superior immune parameters.

The diagnostic value of toxoplasma serology in ocular toxoplasmosis is a controversial issue. Some authors feel that a positive titer indicates nothing more than that the patient had been exposed to Toxoplasma gondii at some stage. Even if in most cases the diagnosis is based on the morphological findings on the fundus, it might sometimes be useful to have an additional serologic evaluation. In a retrospective study we compared the level of antitoxoplasmosis antibodies (measured in a complement fixation test and an immunofluorescence test) in 75 patients with clinically proven ocular toxoplasmosis and 146 patients with uveitis of other origin. In our results we showed that the incidence of positive titers and antibody levels are significantly higher in patient with ocular toxoplasmosis than in other uveitis patient (chi 2-test, Mann-Whitney Willcoxon test, p = 0.05). There was no significant difference between antibody levels in patients with anterior uveitis, posterior uveitis or panuveitis of nontoxoplasmotic origin. No correlation between the antibody levels and amount of retinochorioidal fundus lesions could be found. Based on our results, we conclude that in cases where fundus findings are compatible with ocular toxoplasmosis and a complement fixation or immunefluorescence test is positive, specific antitoxoplasmotic therapy should be started.

Serological screening investigations for hepatitis B were carried out on 1000 sudden and unexpected fatalities from natural causes and non-natural deaths at the Institute for Forensic Medicine in Hamburg. The results were compared with the serological tests of the drug deaths from 1983-1989 and the HIV-infected bodies from 1984-1989. It was found that anti-HBc was positive in 19.2% of the unselected cases as compared with 46.1% in drug related deaths and 73% in the HIV-infected group. HBsAg as a marker that expresses infectiosity was present in 15 cases (1.5%) of 1000 unselected cases, 4.4% of the drug related deaths and 15.8% of the HIV-infected group.

In a multi-center study sera from NANB-hepatitis (NANBH) patients and members of so-called HIV-risk groups (homosexuals, i.v.-drug abusers, hemophiliacs) were investigated by the recombinant-based HCV-antibody EIA, 74.4% of chronic NANBH-patients and 20% of acute NANBH patients were anti-HCV reactive, 33.3% of HIV-1-positive homosexuals, 43.5% of i.v.-drug abusers and 73.5% of hemophiliacs. The true prevalence of infection remains to be determined by a second, independent (confirmatory) test.

Patients undergoing chronic hemodialysis are frequently affected by nosocomial viral infections, as indicated by the high prevalence of HBV antibodies. The question, to what extent HCV is transmitted by blood transfusions (NANB-PTH), or acquired in a nosocomial manner, is still unanswered. We therefore evaluated the HCV antibody rate of 387 sera of dialysis patients on the "Eurotransplant" waiting list. The HCV antibody reactivity ranged from 5.4 to 12.0% between different dialysis centers. In highly immunized (HLA antibody positive) long-term dialysis patients 31.3% (vs. 8.3% in non-immunized patients) were HCV antibody positive.

Two strains of Vibrio parahaemolyticus were isolated from stool specimens of a patient who came down with gastroenteritis 20 hours after eating imported mussels which had not been cooked sufficiently. This is the first documented case of V. parahaemolyticus enteritis acquired in the Federal Republic of Germany.

Human rotavirus infection which heals spontaneously causes gastroenteritis in newborns and infants. 150 pediatric patients infected with rotavirus as diagnosed by ELISA suffered from diarrhoea for an average of 3 days, from vomiting for 1 day, and/or fever for 1-2 days. Nowadays this disease is known as "human rotavirus syndrome". Human rotaviruses can be divided into at least 4 serotype antigens and some 3 further subgroup antigens. The serotype antigens are only detectable biologically (e.g. by neutralization test), whereas the subgroup antigens can be demonstrated as specific proteins by a solid-phase test (ELISA). This study investigated whether an infection with human rotavirus of subgroup 1 (21%) or 2 (77%), which occur most frequently causes different degrees of severity of the rotavirus syndrome. The clinical comparison of 27 (subgroup 1) and 98 (subgroup 2) infected patients shows that the disease is not significantly different. This means that the detection of subgroup antigens 1 and 2 does not result in a different prognosis for the disease. The diagnosis of subgroup antigens after human rotavirus infection is therefore clinically important only for the detection of nosocomial infections, especially due to the rarely occurring subgroups 1 and 3.

Clinical symptoms and course in a 28 year old woman who suffered from rabies are reported. Neurophysiological and neuropathological findings in this patient, who died 21 days after developing initial symptoms, are presented in more detail. This disease appears to be rare in Central Europe. It can be treated effectively only by means of early detection and a special vaccination programme. Late recognition of lyssa specific symptoms in non-vaccinated patients is invariably associated with a fatal outcome. A review of current knowledge concerning rabies research is presented.

It was possible to isolate a strain of Serratia marcescens from fresh clinical bacterial isolates which was 4-6 times more resistant against formaldehyde than other strains. It was shown that the strain harbours two plasmids with molecular sizes of 58- and 90 Mdal. It was demonstrated by conjugation-, transformation- and plasmid-curing experiments that the formaldehyderesistance is plasmid mediated and transferable to E. coli. It was shown by labelling with 14C-formaldehyde that the resistant strains bind much more formaldehyde than the sensible strains.

The isolation and characterization of the hepatitis A virus (HAV) and the hepatitis B virus (HBV) resulted in great advances in the serological diagnosis and the prophylaxis. About 20% of the viral hepatitis cases are caused by the HAV. The hepatitis A never becomes chronic and can be diagnosed by the detection of HAV antibodies of the IgM type. The HBV is the etiologic agent in 60% of the hepatitis cases and 10% of these become chronic. It is possible to immunize against the HBV and to reduce the number of neonatal infections.

The acquired immunodeficiency syndrome (AIDS) is caused by a retrovirus. LAV/HTLV-III is mainly transmitted by blood and sperm. More than 90% of the newly infected persons belong to four risk groups: male homosexuals, drug addicts, persons with multiple changing sex partners, and bisexuals. Infected individuals carry the virus and antiviral antibodies simultaneously in their blood. The antibodies can be demonstrated by the ELISA and immunofluorescence tests, but positive and questionable test results must be confirmed by the immunoblot. Not all of the persons carrying the virus will develop clinical symptoms, but the percentage of those suffering from severe illnesses rises with time and reaches 40% after 8 years. At present, there is no effective therapy and no vaccine will be ready in the near future. Therefore, it is necessary to take all precautions possible to prevent new infections.

Screening the contacts of a 33-year-old father with acute hepatitis B virus (HBV) infection revealed that this four-year-old adopted son was a persistent HBV carrier with massive viremia. The infection did not occur until they had been in contact for three and a half years. Serological findings from the wife, daughter and one of the children's playmates indicated previous hepatitis B infections which had been healed with a positive immune response. It is highly probable that the son induced these infections. The history of the child with persistent HBV infection as well as the clinical course indicate a perinatally acquired HBV infection. To prevent this infection from spreading further, seven playmates with an average age of five years were actively vaccinated against hepatitis B. The success of this vaccination was compared to a control group of adults. After applying the vaccine three times at four-week intervals, the seroconversion to anti-HBs occurred earlier and the antibody titres were higher in the children. 71% of the children had produced anti-HBs after the first vaccination compared to only 13% of the adults (mean age: 33 years). The rate of seroconversion was 100% for the children after the second vaccination, compared to only 93% for the adults four to six weeks after the third vaccination.

In the period between 1983 and 1987 autopsies were carried out on 120 drug victims at the Institute for Forensic Medicine in Hamburg, and 93 cases were serologically tested for hepatitis B. It was found that 50 cases (54%) were positive for anti-HBc, 39 (42%) for anti-HBs, and 5 cases (5%) for HBsAg. The prevalence of hepatitis-B-virus markers was dependent upon the age of the victims. In 81% inflammatory alterations of the liver (including unspecific reactive hepatitis) were diagnosed histologically. The pathogenesis of these serological and pathomorphological findings is discussed. Drug addicts are a group at risk for hepatitis B, and it can spread on account of the epidemiological connection with other risk groups, e.g., prostitutes and homosexuals. Postmortem serological investigations for hepatitis markers proved to be a well-established and reproducible means of differentiating histopathological liver alterations.

Methicillin resistance is usually not detected by routine laboratory methods. With the aid of a method that facilitates in vitro detection of methicillin resistance 8.6% of our Staph. aureus strains and 42% of the coagulase-negative staphylococci proved to be resistant towards this antibiotic.

53 persons at high risk for hepatitis B infection have been vaccinated with a hepatitis B vaccine produced in the Hygiene Institute of the University of Göttingen. The vaccine proved to be without side effects in all vaccinees. Only minor complaints at the site of inoculation were registered. Three vaccinations are necessary. Protective antibodies were present in 96% of the vaccinees after the third inoculation. The female vaccinees developed anti HBs earlier than the males, moreover they showed significantly higher antibody titers. A simultaneous active and passive immunization is possible. To minimize the risk of contracting a hepatitis B or a non A- non B hepatitis as a result of the vaccination only such vaccines should be used which have been prepared from sera containing anti-HBe and which have been inactivated with a high dose of formaldehyde.

Ampicillin-resistant Haemophilus influenzae does occur now in the FRG. In one isolate a plasmid with resistance genes (R-factor) could be demonstrated as cause of the ampicillin resistance. This R-factor influences production of a beta-lactamase of the TEM type which destroys ampicillin. The infectious nature of the ampicillin resistance was proven by the fact that it was transferable to other bacterial species through cocultivation. Parallel to ampicillin resistance tetracycline resistant Haemophilus influenzae has occurred in the FRG. Here the resistance was equally bound to plasmids. These R-factors are infectious as well. Molecular analysis of the 3 isolated resistance factors in Haemophilus influenzae showed that they carry the same resistance genes which are known from R-factors of Enterobacteriaceae. In the therapy of purulent infections due to Haemophilus influenzae such as childhood meningitis one can no longer rely on general ampicillin sensitivity of the offender. Apart from ampicillin and tetracycline resistant Haemophilus influenzae chloramphenicol resistance has been observed in a few cases.

Perinatal transmission of hepatitis B virus does not occur before the beginning of labor. Therefore, neither an embryopathy nor a fetopathy appears to be caused by an acute or chronic HBV infection during pregnancy. There is no necessity to interrupt pregnancy for the reason of a HBV infection. Transmission of HBV infection, however, may take place during delivery. By simultaneous administration of hepatitis B immunoglobulin and the HBV vaccine to the newborn infant directly after birth, perinatal infection with HBV can be prevented. This immunization procedure leads to a rapid and efficient anti-HBs response in the newborn comparable to that of adults. Protection against HBV infection by passive immunization is sufficient until active anti-HBs antibody formation is starting. The hepatitis B vaccine consists of the purified non-infectious surface of the HB virus. Due to the physical purification and chemical inactivation of the hepatitis B surface antigen (HBsAg) from human sera, the vaccine is considered to be safe. It is not harmful and exhibits an excellent compatibility in newborn infants.

A recombinant vaccine against hepatitis B derived from yeast cells (Gen-HB-Vax, Co. MSD/Behring) has been evaluated in 59 healthy young volunteers (37 men, 22 women) with an average age of 24.4 years. The seroconversion rate was 100%, and no major side effects were observed. During a follow-up period of 24 months concentrations of antibodies against HBsAg were shown to decline to one tenth within 16 to 17 months. Triple vaccination led to protective antibody titres for about 27 months on average. Based on these findings we suggest the following recommendations concerning revaccination: an anti-HBs titre of more than 10,000 mIU/ml four weeks after third vaccination should be reassessed 3-5 years later, and titres between 1000 and 10,000 mIU/ml after 2-3 years. A control of the antibody titre should be performed after 1-2 years if the titre is 200-1000 mIU/ml after the third vaccination, and after 6-12 months if it is 100-200 mIU/ml. Antibody titres between 10 and 100 mIU/ml should already be reassessed about 3-6 months later. We recommend an immediate revaccination for persons with anti-HBs titres below 10 mIU/ml. This corresponds to the course of antibody concentrations which could be seen in former studies with the conventional serum-derived vaccine. Maximum anti-HBs titres are slightly below those observed with the serum-derived vaccine.