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Zusammenfassung Nicht-Cholera-Vibrionen können beim Menschen Ohrinfektionen, Magen-Darm-Entzündungen sowie Wundinfektionen in unterschiedlicher klinischer Ausprägung verursachen. Im Jahr 2021 wurden dem Robert Koch-Institut insgesamt 29 solcher Infektionen gemeldet. Es ist davon auszugehen, dass die fortschreitende globale Erwärmung in Zukunft weltweit zu einem starken Anstieg der Infektionszahlen durch diese Erreger führen wird. Daher sollten medizinisches Personal, Gesundheitsämter und vulnerable Bevölkerungsgruppen über die Möglichkeit von Infektionen mit Nicht-Cholera-Vibrionen informiert sein.

Was ist neu? Epidemiologie und Klinik Die im Rahmen der COVID-19-Pandemie ergriffenen Infektionsschutzmaßnahmen und Reisebeschränkungen haben auch die Übertragung saisonaler Influenzaviren stark eingeschränkt. Es muss jedoch davon ausgegangen werden, dass das Infektionsgeschehen in der kommenden Influenzasaison nach dem Wegfall dieser Maßnahmen wieder zunehmen wird. Koinfektionen von saisonalen Influenzaviren und SARS-CoV-2 sind möglich und gehen gegebenenfalls mit einem erhöhten Risiko für schwere Krankheitsverläufe einher. Influenza-Impfung Die STIKO empfiehlt seit 2021 ab einem Alter von 60 Jahren den Einsatz tetravalenter Hochdosis-Impfstoffe. Diese enthalten im Vergleich zu standarddosierten Impfstoffen die 4-fache Antigenmenge. Impfstoffe, die auf der mRNA-Technologie beruhen, sowie universelle Influenza-Impfstoffe befinden sich in klinischer Prüfung. Es besteht nun auch für Apotheker*innen die Möglichkeit, Grippeimpfungen unter bestimmten Auflagen durchzuführen. Therapie Für Patient*innen mit erhöhtem Risiko für einen schweren Verlauf wird weiterhin eine frühzeitige antivirale Therapie mit dem Neuraminidase-Inhibitor Oseltamivir empfohlen. Der Gemeinsame Bundesausschuss (G-BA) sieht für Baloxavir marboxil dagegen keinen Zusatznutzen hinsichtlich der Therapie der Influenzavirus-Infektion. Die aktuelle S3-Leitlinie „Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie“ gibt eine moderate Empfehlung zur antibakteriellen Behandlung hospitalisierter Patient*innen mit Influenza-Nachweis und nachgewiesenen pulmonalen Infiltraten. Der Grund dafür ist, dass eine bakterielle Superinfektion auch bei fehlendem mikrobiologischem Nachweis nicht ausgeschlossen werden kann und diese mit erhöhter Letalität einher geht.

ZusammenfassungKrankenhauspersonal, das eine Grippe- oder COVID-19-Schutzimpfung erhalten oder eine COVID-19-Schutzimpfung abgelehnt hatte, wurde bezüglich Einstellungen zur jeweiligen Schutzimpfung, Inanspruchnahme der Grippeschutzimpfung und Ablehnungsgründen der COVID-19-Schutzimpfung befragt. COVID-19-Schutzimpfungsablehnende schätzten verglichen mit den anderen beiden Gruppen das Risiko einer Infektion für sich selbst und generell sowie die Wirksamkeit der Schutzimpfung am niedrigsten und das Risiko der Schutzimpfung am höchsten ein. Auch berichteten sie die niedrigste frühere Inanspruchnahme der Grippeschutzimpfung. Der wahrgenommene Druck zur Impfung erwies sich als relevante Barriere. Zukünftige Impfkampagnen sollten eine Balance zwischen Informationen zu Impfstoffen, der Notwendigkeit der Schutzimpfung und Freiwilligkeit der Inanspruchnahme erhalten.

Hintergrund: Nicht-Cholera-Vibrionen nehmen im Rahmen des Klimawandels eine zunehmende Bedeutung als humane Pathogene ein, da die Prävalenz dieser Erreger im Meereswasser entscheidend von der Wassertemperatur abhängt. In den letzten Jahren konnten während der Sommermonate wiederholt größere Infektionsausbrüche in gemäßigten Klimazonen beobachtet werden. Ziel der Arbeit: Information einer breiten ärztlichen Leserschaft über potenziell lebensbedrohliche Krankheitsbilder, die durch Infektionen mit Nicht-Cholera-Vibrionen ausgelöst werden. Material und Methoden: Übersicht über aktuelle Literatur zu Infektionen mit Nicht-Cholera-Vibrionen im Allgemeinen und zur epidemiologischen Situation in Deutschland im Speziellen. Ergebnisse: Nicht-Cholera-Vibrionen verursachen vorwiegend Wund- und Ohrinfektionen nach Kontakt mit kontaminiertem Meereswasser sowie Gastroenteritiden nach dem Konsum nicht ausreichend gegarter Meerestiere. Da bis März 2020 keine Meldepflicht für diese Erreger in Deutschland bestand, muss von einer hohen Dunkelziffer ausgegangen werden. Immunsupprimierte sowie chronisch erkrankte Menschen haben ein deutlich erhöhtes Risiko für schwere Krankheitsverläufe. Schon bei klinischem Verdacht sollte eine kalkulierte antiinfektive Therapie erfolgen und bei Wundinfektionen eine chirurgische Sanierung erwogen werden. Diskussion: Aufgrund des fortschreitenden Klimawandels muss in den kommenden Jahren mit dem vermehrten Auftreten von Infektionen mit Nicht-Cholera-Vibrionen gerechnet werden. Ärzte sollten über diese potenziell lebensbedrohlichen Erkrankungen informiert sein, um Patienten einer entsprechenden Diagnostik und Behandlung zuzuführen. Background: The abundance of non-cholera Vibrio spp. in the aquatic environment shows a positive correlation with water temperatures. Therefore, climate change has an important impact on the epidemiology of human infections with these pathogens. In recent years large outbreaks have been repeatedly observed during the summer months in temperate climate zones. Objective: To inform medical professionals about the potentially life-threatening diseases caused by non-cholera Vibrio spp. Material and methods: Review of the current literature on infections with non-cholera Vibrio spp. in general and on the epidemiological situation in Germany in particular. Results: Non-cholera Vibrio spp. predominantly cause wound and ear infections after contact with contaminated seawater and gastroenteritis after consumption of undercooked seafood. As there have not been mandatory notification systems for these pathogens in Germany up to March 2020, a high number of unreported cases must be assumed. Immunosuppressed and chronically ill patients have a much higher risk for severe courses of diseases. If an infection with non-cholera Vibrio spp. is suspected anti-infective treatment should be promptly initiated and surgical cleansing is often necessary for wound and soft tissue infections. Conclusion: Due to the ongoing global warming an increased incidence of human infections with non-cholera Vibrio spp. must be expected in the future. Medical professionals should be aware of these bacterial pathogens and the potentially life-threatening infections in order to enable timely diagnostics and treatment.

Background Frequent outbreaks around the globe and endemic appearance in different parts of the world emphasize the substantial risk of hantavirus diseases. Increasing incidence rates, trends of changing distribution of hantavirus species and new insights into clinical courses of hantavirus diseases call for multinational surveillance. Furthermore, evidence-based guidelines for the management of hantavirus diseases and scoring systems, which allow stratification of patients into risk categories, are lacking. Methods Hantavirus registry (HantaReg) is a novel registry platform facilitating multinational research of hantavirus-caused diseases, such as haemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS). HantaReg provides an electronic case report form and uses the General Data Protection Regulation compliant platform clinicalsurveys.net, which can be accessed from any internet browser in the world. Having a modular structure, the registry platform is designed to display or hide questions and items according to the documented case (e.g. patient with HFRS versus HCPS) to facilitate fast, but standardized, data entry. Information categories documented in HantaReg are demographics, pre-existing diseases, clinical presentation, diagnostic and therapeutic approaches, as well as outcome. Conclusions HantaReg is a novel, ready-to-use platform for clinical and epidemiological studies on hantavirus diseases and facilitates the documentation of the disease course associated with hantavirus infections. HantaReg is expected to promote international collaboration and contributes to improving patient care through the analysis of diagnostic and treatment pathways for hantavirus diseases, providing evidence for robust treatment recommendations. Moreover, HantaReg enables the development of prognosis-indicating scoring systems for patients with hantavirus disease.

While several studies have described the clinical course of patients with coronavirus disease 2019 (COVID-19), direct comparisons with patients with seasonal influenza are scarce. We compared 166 patients with COVID-19 diagnosed between February 27 and June 14, 2020, and 255 patients with seasonal influenza diagnosed during the 2017–18 season at the same hospital to describe common features and differences in clinical characteristics and course of disease. Patients with COVID-19 were younger (median age [IQR], 59 [45–71] vs 66 [52–77]; P

The ongoing monkeypox virus outbreak includes at least 7553 confirmed cases in previously non-endemic countries worldwide as of July 2022. Clinical presentation has been reported as highly variable, sometimes lacking classically described systemic symptoms, and only small numbers of cutaneous lesions in most patients. The aim of this study was to compare clinical data with longitudinal qPCR results from lesion swabs, oropharyngeal swabs and blood in a well characterized patient cohort.16 male patients (5 hospitalized, 11 outpatients) were included in the study cohort and serial testing for monkeypox virus-DNA carried out in various materials throughout the course of disease. Laboratory analysis included quantitative PCR, next-generation sequencing, immunofluorescence tests and virus isolation in cell culture.All patients were male, between age 20 and 60, and self-identified as men having sex with men. Two had a known HIV infection, coinciding with an increased number of lesions and viral DNA detectable in blood. In initial- and serial testing, lesion swabs yielded viral DNA-loads at, or above 10The data presented underscore the reliability of lesion swabs for monkeypox virus-detection, even in later stages of the disease. Oropharyngeal swabs and blood samples alone carry the risk of false negative results, but may hold value in pre-/asymptomatic cases or viral load monitoring, respectively.

We aimed to provide in vitro data on the neutralization capacity of different monoclonal antibody (mAb) preparations against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) delta and omicron variant, respectively, and describe the in vivo RNA kinetics of coronavirus disease 2019 (COVID-19) patients treated with the respective mAbs. Virus neutralization assays were performed to assess the neutralizing effect of the mAb formulations casirivimab/imdevimab and sotrovimab on the SARS-CoV-2 delta and omicron variant. Additionally, respiratory tract SARS-CoV-2 RNA kinetics are provided for 25 COVID-19 patients infected with either delta variant (n = 18) or omicron variant (n = 7) treated with the respective mAb formulations during their hospital stay. In the virus neutralization assay, sotrovimab exhibits neutralizing capacity at therapeutically achievable concentrations against the SARS-CoV-2 delta and omicron variant. In contrast, casivirimab/imdevimab had neutralizing capacity against the delta variant but failed neutralization against the omicron variant except for a very high concentration above the currently recommended therapeutic dosage. In patients with delta variant infections treated with casivirimab/imdevimab, we observed a rapid decrease of respiratory viral RNA at day 3 after mAb therapy. In contrast, no such prompt decline was observed in patients with delta variant or omicron variant infections receiving sotrovimab.

We report a Leishmania infantum reactivation in an immunocompetent patient manifesting as visceral leishmaniasis with secondary IgA nephropathy nine years after an initial episode of mucosal leishmaniasis, which had been treated with liposomal amphotericin B.

The risk of SARS-CoV-2 infection is particularly high for healthcare workers during the pandemic. Home care workers visit many different households per shift. Encounters with mostly elderly patients and their relatives increase the potential for the undetected spread of SARS-CoV-2. In order to gain insight into the seroprevalence of SARS-CoV-2 antibodies and possible transmission risks in outpatient care, this follow-up study was conducted with nursing services in Hamburg. The aim was to estimate the dynamics of seroprevalence in this occupational group over a 12-month period, to identify occupation-specific risk factors, and to collect information on the vaccination status of the surveyed nursing staff. Antibody testing for SARS-CoV-2 IgG against the S1 domain (EUROIMUN Analyser I® Lübeck, Germany) was performed on participating healthcare workers with patient contact at a total of four time points within one year from July 2020 to October 2021 (baseline, follow-up after three, six and twelve months). The data were mostly analysed descriptively. Differences in IgG titres were analysed using variance analysis methods, particularly Tukey’s range test. The seroprevalence was 1.2% (8/678) at baseline and 1.5% (9/581) at the three-month follow-up (T1). At the second follow-up (T2) after six months, vaccination against SARS-CoV-2 was available from January 2021 onwards. The prevalence rate of positive IgG antibodies relative to the S1 domain of the spike protein test among unvaccinated individuals was 6.5%. At (T3) after twelve months (July to October 2021), 482 participants were enrolled, and 85.7% of the workers were considered fully vaccinated at this time point, while 51 individuals were unvaccinated. The prevalence was 13.7% (7/51). In our study, a low seroprevalence was found among home care workers, which was lower than in our studies conducted in the clinical setting. Therefore, it can be assumed that the occupational risk of infection is rather low for both the nursing staff and the patients/clients cared for in the outpatient setting. The good provision of protective equipment and the high vaccination rate of the staff probably had a positive influence.

Background Previous studies have documented a spectrum of brain magnetic resonance imaging (MRI) abnormalities in patients with cerebral malaria, but little is known about the prevalence of such abnormalities in patients with non-cerebral malaria. The aim of this study was to assess the frequency of brain MRI findings in returning travellers with non-cerebral malaria. Methods A total of 17 inpatients with microscopically confirmed Plasmodium falciparum non-cerebral malaria underwent structural brain MRI at 3.0 Tesla, including susceptibility-weighted imaging (SWI). Presence of imaging findings was recorded and correlated with clinical findings and parasitaemia. Results Structural brain abnormalities included a hyperintense lesion of the splenium on T2-weighted imaging (n = 3) accompanied by visible diffusion restriction (n = 2). Isolated brain microhaemorrhage was detected in 3 patients. T2-hyperintense signal abnormalities of the white matter ranged from absent to diffuse (n = 10 had 0–5 lesions, n = 5 had 5–20 lesions and 2 patients had more than 50 lesions). Imaging findings were not associated with parasitaemia or HRP2 levels. Conclusion Brain MRI reveals a considerable frequency of T2-hyperintense splenial lesions in returning travellers with non-cerebral malaria, which appears to be independent of parasitaemia.

Highlights • Clinical performance of five different commercially available automated SARS-CoV-2 antibody tests. • No overlap of “false” positive samples between different serology assays was observed. • The ability to rule out acute SARS-CoV-2 infection at hospital admission with serology is limited., Background The global market for SARS-CoV-2-immunoassays is becoming ever more crowded with antibody-tests of various formats, targets and technologies, careful evaluation is crucial for understanding the implications of individual test results. Here, we evaluate the clinical performance of five automated immunoassays on a set of clinical samples. Methods Serum/plasma samples of 75 confirmed COVID-19 patients and 320 pre-pandemic serum samples of healthy blood donors were subjected to two IgG and three total antibody SARS-CoV-2-immunoassays. All test setups were automated workflows. Results Positivity of assays (onset of symptoms > 10 days) ranged between 68.4% and 81.6% (Diasorin 68.4%, Euroimmun 70.3%, Siemens 73.7%, Roche 79.0% and Wantai 81.6%). All examined assays demonstrated high specificity of >99% (Euroimmun, Diasorin: 99.1%, Wantai: 99.4%) but only two reached levels above 99.5% (Roche: 99.7%, Siemens 100%). Interestingly, there was no overlap in false positive results between the assays. The strongest correlation of quantitative results was observed between the Diasorin and Euroimmun IgG tests (r2 = 0.76). Overall, we observed no difference in the distribution of test results between female and male patients (p-values: 0.18-0.87). A significant difference between severely versus critically ill patients was demonstrated for the Euroimmun, Diasorin, Wantai and Siemens assays (p-values < 0.041). Conclusion All assays showed good clinical performance. Our data confirm that orthogonal test strategies as recommended by the CDC can enhance clinical specificity. However, the suboptimal rates of test positivity found at time of hospitalization in this cohort underline the importance of molecular diagnostics to rule out/confirm active infection with SARS-CoV-2.

To determine epidemiological, clinical and laboratory characteristics of leptospirosis, 24 consecutive patients diagnosed with the infection between 2011 and 2017 at the University Medical Center Hamburg-Eppendorf were retrospectively analyzed. The majority of patients were male travelers who returned from Southeast Asia and had a history of freshwater-associated activities. Considering the lack of discriminatory clinical or clinical chemistry parameters, leptospirosis should be regarded as differential diagnosis in any patient with acute febrile illness, especially with a history of travel to tropical and subtropical regions or freshwater exposure.

Detailed information on the immune response after second vaccination of cirrhotic patients and liver transplant (LT) recipients against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is largely missing. We aimed at comparing the vaccine-induced humoral and T-cell responses of these vulnerable patient groups.In this prospective cohort study, anti-SARS-CoV-2 spike-protein titers were determined using the DiaSorin LIAISON (anti-S trimer) and Roche Elecsys (anti-S RBD) immunoassays in 194 patients (141 LT, 53 cirrhosis Child-Pugh A-C) and 56 healthy controls before and 10 to 84 days after second vaccination. The spike-specific T-cell response was assessed using an interferon-gamma release assay (EUROIMMUN). A logistic regression analysis was performed to identify predictors of low response.After the second vaccination, seroconversion was achieved in 63% of LT recipients and 100% of cirrhotic patients and controls using the anti-S trimer assay. Median anti-SARS-CoV-2 titers of responding LT recipients were lower compared with cirrhotic patients and controls (P.001). Spike-specific T-cell response rates were 36.6%, 65.4%, and 100% in LT, cirrhosis, and controls, respectively. Altogether, 28% of LT recipients did neither develop a humoral nor a T-cell response after second vaccination. In LT recipients, significant predictors of absent or low humoral response were age65 years (odds ratio [OR], 4.57; 95% confidence interval [CI], 1.48-14.05) and arterial hypertension (OR, 2.50; 95% CI, 1.10-5.68), whereas vaccination failure was less likely with calcineurin inhibitor monotherapy than with other immunosuppressive regimens (OR, 0.36; 95% CI, 0.13-0.99).Routine serological testing of the vaccination response and a third vaccination in patients with low or absent response seem advisable. These vulnerable cohorts need further research on the effects of heterologous vaccination and intermittent reduction of immunosuppression before booster vaccinations.

ZusammenfassungHIV und Malaria sind weltweit 2 der wichtigsten Infektionskrankheiten und gemeinsam für über 2 Mio. Todesfälle pro Jahr verantwortlich. Koinfektionen treten insbesondere in Subsahara-Afrika häufig auf. Die Infektionen scheinen sich gegenseitig zu begünstigen und den jeweiligen Krankheitsverlauf auf vielfältige Weise negativ zu beeinflussen. HIV-positive Reisende in Malariaendemiegebiete sind keinem allgemein erhöhten Malariarisiko ausgesetzt, jedoch müssen bei Chemoprophylaxe oder notfallmäßigen Selbstbehandlung vielfältige Wechselwirkungen zwischen Antimalariamedikamenten und antiretroviraler Therapie beachtet werden.

ZusammenfassungLeitlinien in mehreren europäischen Ländern empfehlen die notfallmäßige Selbstbehandlung einer Malaria (SBET) für Reisende in Malariagebiete mit geringem Transmissionsrisiko. Dabei sollen die mitgeführten Medikamente eingenommen werden, falls eine Malaria möglich und sofortige medizinische Hilfe nicht verfügbar ist. Über die Praktikabilität der SBET wurde innerhalb der Reisemedizin in der Vergangenheit vermehrt spekuliert. Neuere Daten stellen das Konzept der SBET für alle in Regionen mit niedrigem oder mittlerem Transmissionsrisiko Reisende infrage.

In order to be able to understand how body supply was maintained at the Dr. Senckenbergische Anatomie from 1933 to 1945 – with special emphasis on victims of the National Socialist regime – we have collected information from various and often fragmentary sources. The documents reveal that during this period at least 474 bodies were brought to the anatomical institute. Among them were the bodies of at least 71 prisoners, 51 of whom had been executed, and the bodies of 8 inmates of (labor-) camps. 356 unclaimed bodies were received, some of them may stem from victims of “euthanasia” programs. The sources of 39, as of yet, unnamed bodies could not be verified. The current collections and the catalogs were screened for remains of victims of the National Socialist regime, but none were found. The vast majority of the bodies were used for teaching purposes. Hans Schreiber, one of the directors of the institute, whose biography is provided here, used at least 9 additional executed individuals for his research. Wherever possible, we have identified the victims of the National Socialist regime, executed persons and the inmates of (labor-) camps, whose bodies were used by the anatomists in Frankfurt, by name. Among the victims was Georg Froba, a communist philanthropist, whose biography is provided.

Until recently, it was believed that all internal documentation regarding student affairs and body procurement of the Dr. Senckenbergische Anatomie concerning the time before March 1944 - when the building was destroyed during an Allied air raid - was lost. A few years ago, however, we discovered stacks of old documents in the current anatomy building. These documents permitted a reconstruction (1) of the history of body procurement, student numbers and course management from 1914 to 1944, as well as (2) some aspects of the building's history in the time immediately after its destruction that have hitherto not been documented. In this paper (Part I), we will deal with the organizational history of the Dr. Senckenbergische Anatomie from 1914 to 2013, placing special emphasis on the development of the student population and body procurement, as well as on the major changes that occurred in the gross anatomy labs of the last century. More than 30,000 students were trained in the Dr. Senckenbergische Anatomie over the last 100 years, and more than 3000 bodies have been received. The number of incoming bodies has remained quite stable in all these years and is, on average, approximately 32 per year. The number of students entering the gross anatomy lab during that period, however, rose from less than 100 to more than 600. A companion paper (Part II) deals with the years of the Third Reich (1933-1945) in more detail.