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This artistic investigation is based on personally experienced symptoms caused by nervous disorders and is to be seen as a graphic phenomenology. Drawing physical sensations raises fundamental questions as to the very possibility of visual representation and of conveying to others what cannot be seen. Efforts to come to grips with bodily perception that has been altered as a result of a chronic illness lead, by dint of introspection and externalization, to a new understanding of one’s own body. In addition, the graphic catalogue of physical sensations can provide a stimulus for a response on the part of other persons affected by the disease while, at the same time, contributing in a general way to conveying what is simply difficult to formulate in words.

Candida auris a frequently multidrug-resistant yeast species that poses a global health threat due to its high potential for hospital outbreaks. While C. auris has become endemic in parts of Asia and Africa, transmissions have so far rarely been reported in Western Europe except for Great Britain and Spain. We describe the first documented patient-to-patient transmission of C. auris in Germany in a COVID-19 intensive care unit (ICU) and infection control measures implemented to prevent further spread of the pathogen.Identification of C. auris was performed by MALDI-TOF and confirmed by internal transcribed spacer (ITS) sequencing. Antifungal susceptibility testing was carried out. We conducted repeated cross-sectional examinations for the presence of C. auris in the patients of the affected ICU and investigated possible routes of transmission.The index patient had been transferred to Germany from a hospital in Northern Africa and was found to be colonised with C. auris. The contact patient developed C. auris sepsis. Infection prevention and control (IPC) measures included strict isolation of the two C. auris patients and regular screening of non-affected patients. No further case occurred during the subsequent weeks. Reusable blades used in video laryngoscope-guided intubation were considered as the most likely vehicle of transmission.In view of its high risk of transmission, vigilance regarding C. auris colonisation in patients referred from endemic countries is crucial. Strict and immediate IPC measures may have the potential to prevent C. auris outbreaks.

ZusammenfassungSomatosensible Symptome und Schmerz zählen zu jenen Beschwerden chronischer Erkrankungen, die sich – aus ärztlicher Sicht – oft einer objektivierbaren Beurteilung entziehen. Persönlichen Externalisierungsprozessen kann hierbei eine besondere Bedeutung zukommen.

Objectives Emerging invasive fungal infections (IFI) have become a notable challenge. Apart from the more frequently described fusariosis, lomentosporiosis, mucormycosis, scedosporiosis, and certain dematiaceae or yeasts, little is known about extremely rare IFI. Methods Extremely rare IFI collected in the FungiScopeⓇ registry were grouped as Dematiaceae, Hypocreales, Saccharomycetales, Eurotiales, Dermatomycetes, Agaricales, and Mucorales. Results Between 2003 and June 2019, 186 extremely rare IFI were documented in FungiScopeⓇ. Dematiaceae (35.5%), Hypocreales (23.1%), Mucorales (11.8%), and Saccharomycetales (11.3%) caused most IFI. Most patients had an underlying malignancy (38.7%) with acute leukemia accounting for 50% of cancers. Dissemination was observed in 26.9% of the patients. Complete or partial clinical response rate was 68.3%, being highest in Eurotiales (82.4%) and in Agaricales (80.0%). Overall mortality rate was 29.3%, ranging from 11.8% in Eurotiales to 50.0% in Mucorales. Conclusions Physicians are confronted with a complex variety of fungal pathogens, for which treatment recommendations are lacking and successful outcome might be incidental. Through an international consortium of physicians and scientists, these cases of extremely rare IFI can be collected to further investigate their epidemiology and eventually identify effective treatment regimens.

Eine angemessene Diagnose scheint zentral fur erfolgreichen Unterricht zu sein. Wie aber lasst sich charakterisieren, dass eine Lernstandeinschatzung und die Weiterarbeit aufeinander bezogen sind? Fur unsere explorative Studie setzten sich Personen mit und ohne mathematikdidaktische Expertise mit Text-Bild-Vignetten von Grundschulkindern auseinander: Sie schatzten in ausgewahlten arithmetischen Bereichen die Lernstande der Kinder ein und machten darauf basierend Vorschlage fur die Weiterarbeit. Wie die inhaltsanalytische Auswertung dieser Dokumente zeigt, sind fur die Expertinnen und Experten so genannte „mathematikdidaktische Konzepte“ handlungsleitend. Diese ermoglichen ihnen, ihre Einschatzungen der Lernstande fur die Planung der unterrichtlichen Weiterarbeit oder der Einzelforderung fruchtbar zu machen. Dagegen sind die mathematikdidaktischen Konzepte der Novizinnen und Novizen kaum belastbar, ihre Konzepte ubernehmen keine Vermittlungsfunktion zwischen Diagnose und Weiterarbeit.

Military working dogs have an increased risk of acquiring an infection with vector-borne pathogens due to kennel housing and regular exposure to wildlife and vectors. To evaluate the level of infections in clinically healthy dogs of the Austrian Armed Forces, 94 individuals of the Military Working Dog Training Centre (MWDTC) Kaisersteinbruch/eastern Austria were examined in August 2016, February 2019 and August 2019. A modified Knott test was used to determine the presence of microfilariae, PCR for DNA detection of filarioid nematodes (incl. Dirofilaria), Leishmania spp., piroplasms, Borrelia spp., Bartonella spp. and Anaplasmataceae, and serological examination for antibodies against Borrelia burgdoferi s. l. and Leishmania infantum in all dogs. Two dogs were positive for Dirofilaria repens in the Knott test, and one of them also by PCR. Six clinically healthy dogs (4.2%) were positive for Babesia canis (PCR). In serology, 10 (10.6%) of the dogs were positive for specific antibodies against Borrelia burgdoferi s. l. The results suggest that the current measures against arthropod vector exposure and the pathogens they can transmit are not fully sufficient for these dogs. Further investigations of the tick and mosquito fauna in this area will shed more light on the risk of exposure for both the dogs and the staff of the MWDTC.

Background Pulmonary invasive aspergillosis (IA) is a major clinical problem in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Acquisition of IA during allo-HSCT by inhalation of spores is the rationale for the widespread use of air filtration systems. Recent data suggest that activation of fungal growth in already colonized patients is a relevant factor, and a recent study found a positive correlation of serum immunoglobulin responses against purified recombinant Aspergillus fumigatus proteins before allo-HSCT with the incidence of IA after allo-HSCT. Methods To investigate the clinical utility of this approach, we performed a prospective study. We used a commercially available and standardized assay for detection of anti-Aspergillus immunoglobulin-G (aA-IgG) in serum (Platelia(™) Aspergillus IgG) that has previously demonstrated high sensitivity and specificity. Results In a cohort of 104 allo-HSCT recipients, we measured aA-IgG and Aspergillus antigen serum levels before allo-HSCT, and weekly during hospital stay. Overall prevalence of possible, probable, and proven IA during hospital stay was 10%, 6%, and 0%. We found no correlation between aA-IgG levels before allo-HSCT, or after allo-HSCT, and the prevalence of IA during hospital stay. Furthermore, median aA-IgG levels did not differ between patients with history of probable or proven IA, as compared to patients without history of IA. Conclusions Taken together, our data argue against the clinical utility of measuring aA-IgG levels for diagnosis or prediction of IA in patients undergoing allo-HSCT.

Cryptococcosis is a fungal infection of the central nervous system predominantly caused by Cryptococcus neoformans in immunocompromised patients. In several countries worldwide, up to 50% of isolates show in vitro resistance to clinically used antifungals including fluconazole. No prospective data on susceptibility to antifungal drugs are available for Germany. In this study, we characterised all C. neoformans isolates collected from individual patients’ samples at the German reference laboratory for cryptococcosis 2011 and 2017 (n = 133) by multi-locus sequence typing and phenotypic drug susceptibility testing. We identified serotype A/genotype VNI isolates belonging to clonal complexes previously described from Europe, Africa, Asia and South America as the most prevalent agents of cryptococcosis in Germany. Overall, we observed minimal inhibitory concentrations (MICs) above the epidemiological cut-offs (ECVs) in 1.6% of isolates regarding fluconazole and 2.3% of isolates regarding 5-flucytosine. Here, two C. neoformans var. grubii isolates displayed decreased drug susceptibility to fluconazole, one of them additionally to 5-flucytosine. We also found 5-flucytosine MICs above the ECV for two C. neoformans var. neoformans isolates. We identified a novel mutation in the ERG11 gene which might be associated with the elevated fluconazole MIC in one of the isolates. The clinical importance of the detected in vitro resistance is documented by patient histories showing relapsed infection or primary fatal disease. Of note, sertraline demonstrated antifungal activity comparable to previous reports. Systematic collection of susceptibility data in combination with molecular typing of C. neoformans is important to comprehensively assess the spread of isolates and to understand their drug resistance patterns.

High-temperature Fischer–Tropsch synthesis for the production of short-chain olefins over iron catalysts supported on multiwalled carbon nanotubes (CNTs) was investigated under industrially relevant conditions (3408C, 25 bar, H2/CO = 1) to elucidate the influence of nitrogen and oxygen functionalization of the CNTs on the activity, selectivity, and long-term stability. Surface functionalization of the CNTs was achieved by means of a gas-phase treatment using nitric acid vapor at 2008C for oxygen functionalization (O-CNTs) and ammonia at 4008C for the subsequent nitrogen doping (N-CNTs). Ammonium iron citrate impregnation followed by calcination was applied for the deposition of iron nanoparticles with particle sizes below 9 nm. Subsequent to reduction in pure H2 at 3808C, the Fe/N-CNT and Fe/O-CNT catalysts were applied in Fischer– Tropsch synthesis, in which they showed comparable initial conversion values with an excellent olefin selectivity [S(C3–C6) > 85 %] and low chain growth probability (a � 0.5). TEM analysis of the used catalysts detected particle sizes of 23 and 26 nm on O-CNTs and N-CNTs, respectively, and Fe5C2 was identified as the major phase by using XRD, with only traces of Fe3O4. After 50 h time on stream under steady-state conditions, an almost twofold higher activity compared to the Fe/O-CNT catalysts had been maintained by the Fe/N-CNT catalysts, which are considered excellent Fischer–Tropsch catalysts for the production of short-chain olefins owing to their high activity, high selectivity to olefins, low chain growth probability, and superior long-term stability.

The adsorption of carbon monoxide on an either unpromoted or potassium-promoted bulk iron catalyst was investigated at 303 K and 613 K by means of pulse chemisorption, adsorption calorimetry, temperature-programmed desorption and temperature-programmed surface reaction in hydrogen. CO was found to adsorb mainly molecularly in the absence of H(2) at 303 K, whereas the presence of H(2) induced CO dissociation at higher temperatures leading to the formation of CH(4) and H(2)O. The hydrogenation of atomic oxygen chemisorbed on metallic iron was found to occur faster than the hydrogenation of atomically adsorbed carbon. At 613 K CO adsorption occurred only dissociatively followed by recombinative CO(2) formation according to C(ads) + 2O(ads)→ CO(2(g)). The presence of the potassium promoter on the catalyst surface led to an increasing strength of the Fe-C bond both at 303 K and 613 K: the initial differential heat of molecular CO adsorption on the pure iron catalyst at 303 K amounted to 102 kJ mol(-1), whereas it increased to 110 kJ mol(-1) on the potassium-promoted sample, and the initial differential heat of dissociative CO adsorption on the unpromoted iron catalyst at 613 K amounted to 165 kJ mol(-1), which increased to 225 kJ mol(-1) in the presence of potassium. The calorimetric CO adsorption experiments also reveal a change of the energetic distribution of the CO adsorption sites present on the catalyst surface induced by the potassium promoter, which was found to block a fraction of the CO adsorption sites.

The formation of methane over unpromoted and potassium-promoted bulk iron catalysts applied in Fischer–Tropsch synthesis (FTS) was studied by dosing carbon monoxide pulses in hydrogen. A bulk metallic iron catalyst was obtained by H 2 reduction, and cementite (Fe 3 C)-containing but oxygen-free iron was prepared by exposure to methane. The pulse experiments yielded mainly CH 4 as well as small amounts of ethane and propane. The potassium-promoted samples reached higher degrees of CO conversion and lower CH 4 selectivities. The Fe 3 C-containing catalysts were found to be more selective towards ethane and propane than reduced ones indicating that Fe 3 C is more active in FTS than metallic iron. The pulse experiments resulted in different signal shapes of the CH 4 response curves reflecting the influence of the potassium promoter. The presence of potassium influenced the formation of CH 4 by blocking the fast formation channel and by establishing a new and slower reaction pathway, whereas the addition of potassium did not change the reaction pathway towards higher hydrocarbons. Therefore, the decreasing CH 4 formation rate contributes to the decreasing CH 4 selectivity with increasing potassium content found under high-pressure steady-state conditions. Pressure variation experiments at steady state revealed that the kinetic results obtained during the pulse experiments were reproduced at 1 bar. Gradual continuous changes in the product distribution were observed with increasing pressure allowing extrapolating the concepts obtained from experiments at atmospheric pressure to industrial high-pressure FTS conditions.

We carried out a prospective study on galactomannan enzyme immuno assay (GEI) (Platelia Aspergillus EIA, Bio-Rad) testing for diagnosis of invasive aspergillosis (IA) in serum and broncho-alveolar lavage (BAL) in 200 patients with hematological malignancies and profound neutropenia. The incidence of proven and probable IA was 6% and 5.5%, respectively. In patients with fever or pneumonia, a single-positive GEI test result (galactomannan index >or= 0.5) had excellent specificity (100%). Sensitivity was relatively low (40%) at onset of fever, but increased to 94.7% after 6 days of fever. In patients with infiltrates in chest X-ray or computed tomography scan (n = 48), GEI testing in BAL had a favorable diagnostic accuracy as compared with GEI testing in serum (sensitivity 100% versus 71%). Our findings indicate that antifungal therapy should be started immediately at onset of fever in neutropenic patients with positive GEI tests. In patients with fever refractory to broad-spectrum antibiotics (>or=6 days of fever), the high diagnostic accuracy makes GEI testing a valuable diagnostic tool and questions the common strategy to carry out antifungal treatment irrespective of diagnostic testing in this situation. Our data also show that GEI testing in BAL can be useful for early diagnosis of IA in patients with hematological malignancies and pulmonary infiltrates.

The back-titration of atomic oxygen chemisorbed on metallic copper using carbon monoxide is investigated by microcalorimetry. Results from simulations based on a microkinetic model of the back-titration are used for processing of microcalorimetric data. In addition, surface oxidation of copper by nitrous oxide is investigated by microcalorimetry. The results are compared with results obtained by nitrous oxide reactive frontal chromatography and by static oxygen adsorption studied by microcalorimetry. The heat of adsorption of nitrous oxide on copper amounts to 304 kJ mol−1, and the heat of adsorption of carbon monoxide on surfaceoxidized copper is in the range from 120 to 70 kJ mol−1.

Reactive arthritis can occur after numerous bacterial infections, including bacillary dysentery caused by Escherichia coli Shigella. A major risk factor for the disease is the HLA B27 phenotype in the human host. By comparison between plasmid profiles of arthritogenic vs. nonarthritogenic Shigella strains, the pHS-2 plasmid has been previously associated with the arthritogenic capacity of Shigella isolates. However, the prevalence of this plasmid in the various Shigella biotypes and serotypes is largely unknown. On this background, 188 clinical isolates from intestinal disease representing all 46 Shigella serogroups were studied for the presence of the pHS-2 plasmid, using PCR, dot blot and Southern blot techniques and by analysis of restriction fragment length polymorphisms. The pHS-2 plasmid was found in nine of 14 E. coli Flexneri serogroups, in E. coli Dysenteriae 1 and in E. coli Boydii 16. In addition, we show marked variability of this plasmid in E. coli Flexneri 3A and 4A strains. Major biological diversity of the pHS-2 plasmid was found to be strictly related to Shigella serogroups. The prevalence pattern of the pHS-2 plasmid matches published data on arthritogenic Shigella isolates, providing additional indirect evidence for the potential validity of this plasmid as a marker for arthritogenicity.

Eriophora fuliginea (Araneae, Araneidae), a tropical orb-weaving spider from Panama, undergoes a dramatic color change in the course of its ontogenesis. The first free instar has an amber opisthosoma, which soon becomes bright yellow, later green. Subadults change to olive, adults are dark brown with a white median stripe. Parallel to this color modification the spider's behavior changes as well. The main activity phase shifts from day to night and web architecture changes from symmetrical horizontal orb-webs on the upper side of leaves with the spider on the hub, to asymmetrical horizontal orb-webs between shrubs with spiders in a rolled leaf nearby.

Efficient control of Shigella-induced, rho-dependent cytoskeletal rearrangements seems to be required to shape the delicate cellular structures associated with bacterial invasion of epithelial cells. We therefore studied a class IX myosin and rho antagonist, the GTPase-activating protein (GAP) myr5, for a potential role in the bacterial entry process. We show that myr5 is recruited into bacterial entry spots. The recruitment pattern resembled that of rhoC or ezrin, but not rhoA, rac or CDC42, while in vitro GAP activity of myr5 was similar for rhoA, B or C. Analysis of myr5 mutants suggested that GTPase- or ATP-binding activites are not required for Shigella-induced recruitment of this atypical myosin to the bacterial entry site. Functional studies revealed a potential dual role of the myosin functions and the GAP module of myr5 for bacterial internalization.

Leptospirosis is one of the most relevant zoonosis worldwide and a potentially life-threatening infectious disease. While it is frequent in tropic regions, it is uncommon in European industrialized countries. Angiopoietin-2 (Angpt-2) and asymmetric and symmetric dimethylarginine (ADMA and SDMA) are markers of endothelial activation and systemic inflammation. These parameters have been studied recently in the context of sepsis and MODS showing potential to determine disease severity and outcome specific parameters like acute kidney injury (AKI) and survival. These biomarkers were measured in 13 patients with leptospirosis. High levels of Angpt-2 were statistically significant associated with a complicated clinical course with occurrence of AKI, Sepsis and intensive care unit treatment. ADMA was significantly associated with occurrence of AKI and ICU treatment whereas SDMA was associated with AKI. Therefore these endothelial markers may serve as additional tools for risk stratification in these patients.

Differentiation of Candida dubliniensis from C. albicans using biochemical methods is time consuming and may be difficult to achieve because of ambiguous results. Here, we describe a simple, rapid and inexpensive method for unequivocal differentiation of C. dubliniensis from C. albicans using polymerase chain reaction (PCR)/RFLP.

Fusarium infections are associated with high mortality after allogeneic stem cell transplantation. We report on successful treatment of a disseminated cutaneous Fusarium proliferatum infection using liposomal amphotericin B and terbinafine. In vitro susceptibility tests of antifungal drugs suggest that terbinafine is a potent additional antifungal drug for disseminated cutaneous fusariosis.

We evaluated the impact of piperacillin/tazobactam (PT) therapy on galactomannan enzyme immunoassay (GEI) testing (Platelia; Bio-Rad, Marnes La Coquette, France). Galactomannan contents of PT batches were highly variable. We found that false-positive GEI results can be avoided by performance of blood sampling before PT administration and by using separate sites for blood sampling and for administration of antibiotics.

A novel denaturing high-performance liquid chromatography (DHPLC)-based technique allows rapid high-resolution analysis of PCR products. We used this technique for unequivocal molecular identification of seven Candida species. We show the application of this PCR/DHPLC approach for direct detection and identification of yeast species from blood cultures and for detection of Candida colonization in the gastrointestinal tract of allogeneic transplant patients.

For molecular diagnosis of fungal disease using DNA amplification procedures in the routine laboratory, choice of appropriate target structures and rapid and inexpensive identification of amplification products are important prerequisites. Most diagnostic procedures described thus far are characterized by limited applicability, considerable cost for laboratory equipment or low power of discrimination between species. This study aimed at identification of a PCR target appropriate for diagnosis of clinically relevant yeasts and an affordable procedure for characterization of the PCR products to the species level. Here, we describe a PCR-based system using amplification of intergenic spacers ITS1 and ITS2 and restriction length polymorphism of PCR products after sequence-specific enzymatic cleavage. We show the evaluation of the system for clinically relevant Candida species. The simple and inexpensive procedure should be instrumental for rapid identification of medically important yeasts.

The new VITEK 2 system is a fully automated system dedicated to the identification and susceptibility testing of microorganisms. In conjunction with the VITEK ID-YST card the VITEK 2 system allows the identification of clinically important yeasts and yeast-like organisms in 15 h due to a sensitive fluorescence-based technology. The ID-YST card consists of 47 biochemical reactions. The database comprises 51 taxa, including newly described species. In this study we evaluated the reliability of the VITEK ID-YST card for the identification of yeasts and yeast-like organisms encountered in a clinical microbiology laboratory. A total of 241 strains representing 21 species were studied. The strains were isolated from clinical samples within a period of 60 days prior to the identification. The tests were performed using 24-h to 55-h subcultures on Sabouraud-gentamicin-chloramphenicol agar. Each strain was tested in parallel using the ID 32C strip as a comparison method combined with microscopic morphology and an agglutination test for C. krusei . Overall, 222 strains (92.1%) were unequivocally identified including 11 isolates (4.6%) identified with low discrimination resolved by simple additional tests. Ten strains (4.1%) for which results were given with low discrimination could not be unequivocally identified with supplemental tests, 4 strains (1.7%) were misidentified and 5 strains (2.1%) could not be identified. In conclusion, we found that the VITEK 2 system is a rapid and accurate method for the identification of medically important yeasts and yeast-like organisms.