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Background: In a HCV genotype 3a-infected patient, viremia with a different genotype (1b) was detected after 16 weeks of ineffective therapy. Serological typing revealed that this genotype had already been present prior to therapy., Objectives: To investigate the epidemiology of multiple HCV infections and the therapeutical consequences for patients superinfected with a new HCV strain., Methods: Sera of 600 patients were screened for infection with multiple genotypes by using sequencing and a serological assay in parallel., Results: Infection with two different HCV types was detected in 13 patients. The prevailing strain was genotyped by sequencing. From two of these patients additional sera were available which had been drawn up to 24 and 28 months prior to the current sample, respectively. Those early samples showed viremia with a HCV subtype that could not be detected by PCR afterwards. Only antibodies to the initial strain were detectable in the later samples., Conclusion: In patients serially infected by different HCV strains, one strain will prevail as the viremic virus. Under antiviral therapy, the displaced strain may become viremic again and may influence the outcome of therapy. Detection of inferior strains by serological assays before antiviral therapy may be important for choosing the adequate regimen.

The prevalence of a newly described DNA virus (SENV-H) was examined in a population of 599 individuals by polymerase chain reaction (PCR). All individuals were assigned to a nonrisk or a risk group depending on the presence of historical or serological factors indicating an increased risk for parenterally transmitted diseases. In a group of 226 healthy blood donors, 38 (16.8%) were found to be SENV-H viraemic. The highest prevalence of SENV-H viraemia was observed among patients infected by HIV (28 of 63; 44.4%). Contrarily, of 78 individuals on maintenance haemodialysis, only 10 (12.8%) were found positive in the SENV-H PCR. Our results demonstrate that SENV-H viraemia is widespread in the general population. Therefore, it seems to be questionable if parenteral transmission is the main route for spreading SENV-H. The hepatitis-inducing capacity of SENV-H is unclear. However, taking our clinical and epidemiological data into account it seems unlikely that this virus is responsible for hepatitis.

Nosocomial Infections caused by vancomycin-resistant enterococci (VRE) are an emerging threat to critically ill patients. At the University Hospital Eppendorf, VRE were isolated from 38 patients between August 1993 and April 1997, of whom 32 were hospitalized at the Department of Pediatrics. Pulsed-field gel electrophoresis revealed that 26 Enterococcus faecium isolates from patients of the Department of Pediatrics were identical or closely related, and that isolates from three additional patients of the same department were possibly related. All of these isolates were of vanA genotype. They were resistant to glycopeptides, ampicillin, ciprofloxacin, clindamycin, and erythromycin. Most isolates displayed high-level resistance to gentamicin, but all remained susceptible to quinupristin/dalfopristin. Implementation of stringent hand disinfection and environmental disinfection policies, as well as measures for patient isolation contained this first outbreak of VRE at a German Children's hospital, which emphasizes the importance of hygienic measures for the control of nosocomial spread of these organisms.

The prevalence of intestinal microsporidiosis among human immunodefiency virus (HIV)-infected persons with chronic diarrhea varies from 7% to 50%; thus, microsporidia are a significant source of morbidity and, occasionally, mortality among these patients. Anecdotal reports suggest that intestinal microsporidiosis is also an important infection in patients with AIDS in Germany. To determine the prevalence of microsporidiosis among HIV-infected patients in Germany, we performed a prospective coprodiagnostic study of 97 consecutive HIV-infected patients. Microsporidia were the most common enteropathogen identified in 18 (36.0%) of 50 patients with diarrhea and 2 (4.3%) of 47 patients without diarrhea (P < .001; chi2 test). Microsporidia were present in 60% of patients with chronic diarrhea and 5.9% of patients with acute diarrhea. The etiologic agent was Enterocytozoon bieneusi in 18 patients and Encephalitozoon intestinalis in two patients. The prevalence of intestinal microsporidiosis in this cohort of German patients with AIDS and diarrhea is one of the highest to be reported anywhere in the world. Microsporidiosis seems to represent one of the most important causes of diarrhea in HIV-infected patients in Germany and thus must be considered in the differential diagnosis for all AIDS patients presenting with diarrhea.

The distribution of hepatitis C virus (HCV) genotypes was determined in isolates of 447 chronically HCV-infected German patients by nucleotide sequencing. Of these, 206 (46.1%) were infected with the subtype 1a, 215 (48.1%) with subtype 1b, 2 (0.4%) with subtype 1c, 9 (2.0%) with subtype 3a, and 15 (3.4%) with subtype 4a. Subtype 1a was predominant in those < 40 years old (62.6%) and was associated with the risk factor of intravenous drug addiction and with shorter duration of disease. Conversely, subtype 1b was more frequent in patients > 50 years old (84.7%; P < .001) and was associated with the risk factor of blood transfusions and with longer duration of disease. These data suggest that a shift from subtype 1b to subtype 1a occurred in the population studied. An increase in HCV infection with subtype 1a and a diminution of subtype 1b in the future can be expected.

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.

The HIV-status of 3999 fatalities (aged 1-60 years) examined at the Institute of Forensic Medicine in Hamburg from 1989-1992 was tested. Former predictions of an enormous increase of HIV-infections, especially in the risk group of IVDA (intravenous drug addicts), did not come true. HIV-screening of fatalities is an instructive additional method of gaining information about the epidemiological development of HIV-infections.

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.

Needle sharing among drug addicts leads to the transmission of infectious diseases such as hepatitis B and AIDS. After development of a test system based on gene technology against the hepatitis C virus (HCV), drug addicts have been regarded as an important reservoir for hepatitis C. In our study 113 (40.1%) out of 282 addicts who died from drug abuse in Hamburg between 1988 and 1990 had antibodies against HCV (anti-HCV). The prevalence of anti-HCV differed in various age groups; the highest prevalence was found in addicts aged 30-34 years. Co-infections with hepatitis B and hepatitis C virus were found in 57 drug addicts (59.4%) out of 96 deceased with antibodies to hepatitis B (anti-HBc), whereas only 8 out of 23 HIV-infected were anti-HCV positive (34.8%).

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.