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ZUSAMMENFASSUNG2019 wurden 1,4 Milliarden internationale Reisen gezählt, wobei Deutschland zu den reisefreudigsten Nationen zählt. Kinder stellen in der Reisemedizin eine vulnerable Gruppe mit speziellem Beratungsbedarf dar. Eine qualifizierte reisemedizinische Beratung mindestens 4–6 Wochen vor einer Reise kann Gesundheitsrisiken bei Kindern und Eltern minimieren. Neben der Empfehlung einer adäquaten Auslandskrankenversicherung muss der aktuelle Impfstatus erhoben und komplettiert und ggf. um spezifische Reiseimpfungen ergänzt werden. Weitere Beratungsinhalte zielen auf Verhaltensmaßnahmen (z. B. Nahrungsmittelhygiene, Sonnenschutz), auf den Insektenschutz (Expositionsprophylaxe) sowie auf die Malariaprophylaxe in Risikogebieten. Der betreuende Kinderarzt sollte die wichtigsten Reise- und Tropenerkrankungen in Grundzügen kennen. Viele reiseassoziierte Infektionskrankheiten wie Durchfälle oder Hauterkrankungen können kompetent vom Kinderarzt behandelt werden. Im Zweifelsfall ist frühzeitig Kontakt mit einem reise- oder tropenmedizinischen Zentrum aufzunehmen. Eine potenziell fatale Malaria-Erkrankung muss bei passender Reiseanamnese sowie Fieber oder sonstigen unklaren Symptomen als Differenzialdiagnose immer in Betracht gezogen werden.

Background The possibility of repeat infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) raises questions regarding quality and longevity of the virus-induced immune response. Methods The antibody course and memory B-cell (MBC) response against SARS-CoV-2 proteins, influenza virus nucleoprotein (NP), and tetanus toxin were examined in adults with mild to moderate SARS-CoV-2 infection in the first year after infection. Results The concentration of SARS-CoV-2 receptor binding domain (RBD)-specific antibodies was low compared with the concentration of influenza virus NP-specific antibodies. The SARS-CoV-2 RBD antibody half-life increased from 95 days in the first 6 months to 781 days after 9–12 months. The SARS-CoV-2 NP antibody half-life increased from 88 to 248 days. Two thirds of the subjects had SARS-CoV-2-specific MBC responses 12 months after infection. The SARS-CoV-2 antibody levels correlated with the MBC frequency at 12 months. Conclusions The low concentration of SARS-CoV-2 spike protein antibodies indicates that re-exposure to the virus or vaccination are required to use the B-cell immunity to full capacity. The existence of a robust SARS-CoV-2 MBC response at 12 months in most subjects and the substantially increasing antibody half-life provide evidence that the immune response is developing into long-term immunity. The early antibody reaction and the ensuing MBC response are interdependent.

Vaccination is considered one of the most important achievements of modern medicine and has saved millions of lives. As a result, the age-old fear of severe or fatal infectious diseases has largely been forgotten in society; however, the pandemic triggered by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shows how quickly this fear can return. Also, many people have reservations about medical measures, especially if they are directed against vague dangers. Paradoxically, the success of vaccinations jeopardizes the acceptance. To counteract this development, this article provides information on basic vaccination principles, legal frameworks and components of vaccines. It explains the most important categories, goals, core elements of vaccination programs and the most important recommendations of the Standing Committee on Vaccination at the Robert Koch Institute (STIKO). It explains the current state of knowledge with respect to required resources, assessment of vaccine reactions, complication management and possible vaccine damage.

Introduction: Cryptosporidiosis has emerged as a major cause of diarrheal disease worldwide. It has especially serious health consequences for young, malnourished children living in endemic areas and for individuals with highly impaired T-cell function, such as HIV-positive individuals with low CD4 counts or immunosuppressed solid-organ transplant recipients.Areas covered: A selective literature search using PubMed was performed to review the available therapeutics to treat cryptosporidiosis, as well as related advances in drug development.Expert opinion: The only FDA-approved antiparasitic treatment in immunocompetent patients is nitazoxanide; however, it has failed to demonstrate convincing effectiveness among HIV-positive patients, immunosuppressed individuals and malnourished children. Thus, restoring HIV-positive patients' cellular immune response through effective antiretroviral therapy (ART), or reducing or changing immunosuppressive drugs, is important. Several new targets have been identified for chemotherapy, and the development of drugs for these targets has progressed, including parasite kinases, nucleic acid synthesis and processing, proteases and lipid metabolism. Candidate drugs that have been shown to be effective and safe in a neonatal calf model will most likely constitute the next advance for clinical trials in humans. However, developing an effective and inexpensive vaccination, as well as complementing structural preventive measures, would most decisively reduce the global cryptosporidiosis burden.

SARS CoV-2 antibody assays measure antibodies against the viral nucleoprotein (NP) or spike protein. The study examined if testing of antibodies against both antigens increases the diagnostic sensitivity. Sera (N=98) from infected individuals were tested with ELISAs based on the NP, receptor-binding domain (RBD), or both proteins. The AUROCs were 0.958 (NP), 0.991 (RBD), and 0.992 (NP/RBD). The RBD- and NP/RBD-based ELISAs showed better performance than the NP-based assay. Simultaneous testing for antibodies against NP and RBD increased the number of true and false positives. If maximum diagnostic sensitivity is required, the NP/RBD-based ELISA is preferable. Otherwise, the RBD-based ELISA is sufficient. Supplementary Information The online version contains supplementary material available at 10.1007/s10096-021-04284-5.

BACKGROUND: It is predicted that approximately two billion tourist trips to foreign countries will be taken worldwide each year by 2030. Germany has long been among the most active countries in tourism. The frequency of illness among persons returning from developing and newly industrialized countries is 43–79%. The appropriate diagnosis of fever in returning travelers is a clinically important matter, as it can be a sign of a life-threatening illness. METHODS: This review is based on publications (2001–2022) retrieved by a selective search in PubMed for studies on the epidemiology, diagnosis, and treatment of febrile illnesses in returning travelers, or on specific tropical diseases. RESULTS: Diarrhea, fever, and skin changes are the most common manifestations of disease after travel to tropical and subtropical areas. The diagnostic evaluation should be performed in a series of steps, beginning with a precise travel history and the identification of specific risk factors. Among travelers returning from sub-Saharan Africa, Plasmodium falciparum malaria is the most common cause of fever on presentation to centers for infectious diseases and tropical medicine, affecting approximately 50 per 1000 travelers. Among persons returning from travel to Southeast Asia, dengue fever is the most common infectious disease, affecting 50–160 per 1000 travelers. Further potentially dangerous diseases include chikungunya and zika fever, typhoid and paratyphoid fever, amoebic liver abscess, visceral leishmaniasis (kala-azar), leptospirosis, and, very rarely, imported cases of viral hemorrhagic fever. COVID-19 and influenza are important differential diagnoses. CONCLUSION: The differential diagnosis can be narrowed by thorough history-taking with particular attention to the patient’s travel route, combined with a good knowledge of the geographic spread and incubation times of the main tropical diseases. Algorithms help clinicians to focus the diagnostic work-up and select the appropriate further laboratory tests and diagnostic procedures.

Mucken sind Ubertrager einer Vielzahl humanpathogener Erreger. Stechmucken ubertragen neben Viren aus der Gruppe der Flavi-, Alpha- und Bunyaviren auch Protozoen, parasitische Fadenwurmer (Filarien) sowie seltener Bakterien. Viele der durch Stechmucken ubertragenen Viruserkrankungen verlaufen oligo- oder asymptomatisch. Teilweise sind aber auch ernste Erkrankungsformen moglich. Kausale Therapieansatze sind fur die meisten Viruserkrankungen - im Gegensatz zu Malaria, Leishmaniose und Filariose - nicht verfugbar. In den meisten Fallen konnen schon einfache Prophylaxemasnahmen (Expositionsprophylaxe, Impfungen z.B. gegen Gelbfieber und Japanische Enzephalitis), bei der Malaria auch eine adaquate Chemoprophylaxe, das Erkrankungsrisiko erheblich senken.

ZusammenfassungTyphus (besser: Typhus abdominalis) und Paratyphus sind global bedeutsame systemische Infektionskrankheiten, die durch Salmonella enterica Subspezies enterica Serovar Typhi (Kurzbezeichnung: Salmonella Typhi) bzw. Serovar Paratyphi (Kurzbezeichnung: Salmonella Paratyphi) hervorgerufen werden. Der Verlauf der fäkal-oral übertragenen Erkrankung ist vor allem durch hohes Fieber gekennzeichnet. Unbehandelt kann Typhus schwer verlaufen und zum Tode führen. Die Erkrankung wird zu nahezu 100 % im außereuropäischen Ausland (v. a. in Indien) erworben und ist in Deutschland, Österreich und in der Schweiz meldepflichtig. Als Paratyphus bezeichnet man ein abgeschwächtes Krankheitsbild des Typhus, dessen Erreger Salmonella Paratyphi ist. Verfügbare Impfstoffe schützen nur gegen Salmonella Typhi. Die Resistenz gegen Antibiotika spiegelt die Situation in endemischen Ländern wider und zeigt sich in einem besorgniserregenden Zuwachs von Isolaten mit Multiresistenz. Gegenwärtig werden Cephalosporine der 3. Generation wie Ceftriaxon als Erstlinientherapie empfohlen; sofern es sich um Isolate mit Chinolonempfindlichkeit handelt, können auch weiterhin Fluorchinolone wie Ciprofloxacin verabreicht werden. Entscheidende vorbeugende Maßnahmen für Reisende sind konsequente Wasser- und Nahrungsmittelhygiene sowie Impfprävention, wobei sich mit den bislang verfügbaren Impfstoffen nur Protektionsraten von 50–70 % erreichen lassen. Mit der Zunahme von multiresistenten Erregerstämmen wird ein besser wirksamer Konjugatimpfstoff gegen Salmonella Typhi mit Kreuzreaktivität gegen Salmonella Paratyphi dringender denn je benötigt.

Zu den haufigsten Gesundheitsstorungen auf Fernreisen gehort die akute Reisediarrho, die je nach geographischer Region mit einer Pravalenz von >50 % auftreten kann. Dieses uberwiegend bakteriell (v. a. durch enteropathogene Escherichia coli, Campylobacter spp., Shigella, Salmonella) bzw. manchmal viral (durch Noro- oder Rotaviren) oder seltener parasitar (durch Giardien/Lamblien, Entamoben) verursachte Krankheitsbild verlauft in den meisten Fallen unkompliziert und selbstlimitierend. Eine persistierende Diarrho ist jedoch der haufigste Grund fur eine arztliche Vorstellung nach Fernreisen in der Praxis. Fur bestimmte Personengruppen, wie Immunsupprimierte oder Schwangere, ist auch eine scheinbar banale Reisediarrho immer abklarungsbedurftig. Dann ist eine gezielte Stuhldiagnostik gerechtfertigt, ebenso bei Fieber und blutigem Stuhl. Die Therapie ist meistens symptomatisch (Flussigkeits- und Elektrolytersatz); selten sind Antibiotika indiziert. Im Rahmen einer qualifizierten Reiseberatung sollten Praventionsmasnahmen (Destinationswahl, Hygieneverhalten, Impfungen) im Vorfeld besprochen werden.

Vaccination is considered one of the most important achievements of modern medicine and has saved millions of lives. As a result, the age-old fear of severe or fatal infectious diseases has largely been forgotten in society; however, the pandemic triggered by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shows how quickly this fear can return. Also, many people have reservations about medical measures, especially if they are directed against vague dangers. Paradoxically, the success of vaccinations jeopardizes the acceptance. To counteract this development, this article provides information on basic vaccination principles, legal frameworks and components of vaccines. It explains the most important categories, goals, core elements of vaccination programs and the most important recommendations of the Standing Committee on Vaccination at the Robert Koch Institute (STIKO). It explains the current state of knowledge with respect to required resources, assessment of vaccine reactions, complication management and possible vaccine damage.Impfungen gelten als eine der wichtigsten Errungenschaften der modernen Medizin und haben Millionen Menschenleben gerettet. Im Zuge dessen ist die Angst vor schweren Infektionskrankheiten in unserer Gesellschaft weitgehend in Vergessenheit geraten. Die SARS-CoV-2-Pandemie zeigt jedoch, wie schnell dieses Angstgefühl zurückkehren kann. Gleichzeitig hegen viele Menschen Vorbehalte gegenüber medizinischen Maßnahmen, insbesondere wenn sich diese gegen mehr oder weniger abstrakte Gefahren richten. Paradoxerweise gefährdet der Erfolg von Impfungen somit deren Akzeptanz. Um dem entgegenzuwirken, informiert dieser Beitrag über Impfprinzipien, rechtliche Rahmenbedingungen und Impfkomponenten. Er erklärt die wichtigsten Impfstoffkategorien, Ziele und Kernelemente von Impfprogrammen sowie die grundlegenden Empfehlungen der Ständigen Impfkommission und erläutert den Wissensstand zu erforderlichen Ressourcen, Einschätzung von Impfreaktionen, Komplikationsmanagement und möglichen Impfschäden.

SARS-CoV-2-specific IgM antibodies wane during the first three months after infection and IgG antibody levels decline. This may limit the ability of antibody tests to identify previous SARS CoV-2 infection at later time points. To examine if the sensitivity of antibody tests falls off, we compared the sensitivity of two nucleoprotein-based antibody tests, the Roche Elecsis II Anti-SARS-CoV-2 and the Abbott SARS-CoV-2 IgG assay and three glycoprotein-based tests, the Abbott SARS-CoV-2 IgG II Quant, Siemens Atellica IM COV2T and Euroimmun SARS-CoV-2 assay with 56 sera obtained 6-8 months after SARS-CoV-2 infection. The sensitivity of the Roche, Abbott SARS-CoV-2 IgG II Quant and Siemens antibody assays was 94.6 % (95% confidence interval (CI) 85.1-98.9 %), 98.2 % (95% CI: 90.4-99.9 %) and 100 % (95% CI: 93.6-100 %). The sensitivity of the N-based Abbott SARS-CoV-2 IgG and the glycoprotein-based Euroimmun ELISA was 48.2 % (95% CI: 34.7-62.0 %) and 83.9 % (95% CI: 71.7-92.4 %). The nucleoprotein-based Roche and the glycoprotein-based Abbott RBD and Siemens tests were more sensitive than the N-based Abbott and the Euroimmun antibody tests (p=0.0001 to p=0.039). The N-based Abbott antibody test was less sensitive 6-8 months than 4-10 weeks after SARS-CoV-2 infection (p = 0.0002). The findings show that most SARS CoV-2 antibody assays correctly identified previous infection 6-8 months after infection. The sensitivity of pan-Ig antibody tests was not reduced at 6-8 months when IgM antibodies have usually disappeared. However, one of the nucleoprotein-based antibody tests significantly lost sensitivity over time.HighlightsMost antibody tests correctly identified SARS CoV-2 infection 6-8 months after infectionThe sensitivity of the antibody tests was 48.2-100 %The three tests with the highest sensitivity (94.6-100 %) were the N-based Roche and the RBD-based Abbott and Siemens assaysThe N-based Abbott IgG CMIA was significantly less sensitive 6-8 months than 4-10 weeks after infection (p = 0.0002)

Zecken sind Ubertrager einer Vielzahl humanpathogener Krankheitserreger mit einer grosen Bandbreite klinischer Symptome. Das Verbreitungsgebiet der einzelnen Erreger ist vom Vorkommen der Vektoren und Wirte abhangig. Aufgrund verschiedener Faktoren ist es in den letzten Jahren zum Teil zu einer Ausdehnung der Endemiegebiete gekommen. Am weitesten verbreitet sind Zecken-ubertragene Rickettsiosen, welche v.a. in der Reisemedizin eine Rolle spielen. Die haufigsten Zecken-ubertragbaren Erkrankungen in Deutschland und Europa sind Lyme-Borreliose und Fruhsommer-Meningoenzephalitis (FSME). Meist verlaufen die Infektionen mild oder sind — im Falle bakterieller Infektionen — gut behandelbar. Die wichtigsten praventiven Masnahmen bei Aufenthalten in einem Risikogebiet sind der Schutz vor Zeckenstichen und im Falle der FSME die sehr gut wirksame Impfung.

Background In 2019, 1.5 billion international tourist trips were counted worldwide. Germany, with 70.8 million vacations lasting ≥ 5 days, was one of the populations most willing to travel. These days, even elderly and multimorbid persons regularly travel long-distance, which can be associated with significant health risks. By advising travelers and implementing preventive measures, the risk of illness can be reduced significantly. Methods A selective survey of PubMed was performed to identify publications on medical advice for travelers between 2000 and 2020. We included guidelines, studies, and recommendations that mainly deal with the preventive aspects of travel medicine and have a high level of practical relevance and the highest possible level of evidence. Previously published guidelines (based on the GRADE criteria) were adopted, and recommendations not based on the results of scientific studies were characterized as Good Clinical Practice (GCP). Results Many medical recommendations for travelers still rely on individualized, experience-based, or consensus-based assessments. Apart from a review of medical history and vaccination status, a risk analysis is performed, travel fitness is evaluated individually, and a prevention plan is designed. Particular attention is devoted to malaria prophylaxis, vector protection, and traveler's diarrhea. Medical advice before travel is especially important for the elderly, children, pregnant women, the chronically ill, long-term and adventure travelers as well as migrants from malaria-endemic areas who are returning home. Conclusion The health risks associated with travel can be minimized by specialist medical advice. Many recommendations are empirical in nature and require further research.

Following a distinct summer heat wave, nine autochthonous cases of West Nile fever and West Nile neuroinvasive disease, including one fatality, were observed in Leipzig, Germany, in August and September 2020. Phylogenetic analysis demonstrated close relationships in viruses from humans, animals and mosquitos in eastern Germany, obtained during the preceding 2 years. The described large cluster of autochthonous West Nile virus infections in Germany indicates endemic seasonal circulation of lineage 2 viruses in the area.

Typhoid fever and paratyphoid fever are systemic infectious diseases of global significance caused by Salmonella enterica subspecies enterica Serovar Typhi (short name: Salmonella Typhi) or Serovar Paratyphi (short name: Salmonella Paratyphi). The course of these fecal-orally transmitted diseases is mainly characterized by a high fever. Left untreated, the course of typhoid fever can be severe and lethal. The infection is almost always acquired outside of Europe (mainly in India) and is notifiable in Germany, Austria and Switzerland. Paratyphoid is an attenuated disease of typhoid fever caused by Salmonella Paratyphi. Available vaccines only protect against Salmonella Typhi. Antibiotic resistance reflects the situation in endemic countries and shows a worrying increase of multi-drug resistant isolates. Currently, third-generation cephalosporins such as ceftriaxone are recommended as first-line therapy; if sensitive to quinolones, fluoroquinolones such as ciprofloxacin may continue to be administered. Crucial preventive measures for travelers to endemic regions include consistent water and food hygiene as well as vaccination, whereby only protection rates of 50-70 % are achieved by currently available vaccines. In the light of increasing multi-drug resistance, a more effective conjugate vaccine against Salmonella Typhi with cross-reactivity against Salmonella Paratyphi is needed more than ever.Typhus (besser: Typhus abdominalis) und Paratyphus sind global bedeutsame systemische Infektionskrankheiten, die durch Salmonella enterica Subspezies enterica Serovar Typhi (Kurzbezeichnung: Salmonella Typhi) bzw. Serovar Paratyphi (Kurzbezeichnung: Salmonella Paratyphi) hervorgerufen werden. Der Verlauf der fäkal-oral übertragenen Erkrankung ist vor allem durch hohes Fieber gekennzeichnet. Unbehandelt kann Typhus schwer verlaufen und zum Tode führen. Die Erkrankung wird zu nahezu 100 % im außereuropäischen Ausland (v. a. in Indien) erworben und ist in Deutschland, Österreich und in der Schweiz meldepflichtig. Als Paratyphus bezeichnet man ein abgeschwächtes Krankheitsbild des Typhus, dessen Erreger Salmonella Paratyphi ist. Verfügbare Impfstoffe schützen nur gegen Salmonella Typhi. Die Resistenz gegen Antibiotika spiegelt die Situation in endemischen Ländern wider und zeigt sich in einem besorgniserregenden Zuwachs von Isolaten mit Multiresistenz. Gegenwärtig werden Cephalosporine der 3. Generation wie Ceftriaxon als Erstlinientherapie empfohlen; sofern es sich um Isolate mit Chinolonempfindlichkeit handelt, können auch weiterhin Fluorchinolone wie Ciprofloxacin verabreicht werden. Entscheidende vorbeugende Maßnahmen für Reisende sind konsequente Wasser- und Nahrungsmittelhygiene sowie Impfprävention, wobei sich mit den bislang verfügbaren Impfstoffen nur Protektionsraten von 50–70 % erreichen lassen. Mit der Zunahme von multiresistenten Erregerstämmen wird ein besser wirksamer Konjugatimpfstoff gegen Salmonella Typhi mit Kreuzreaktivität gegen Salmonella Paratyphi dringender denn je benötigt.

IntroductionStaphylococci are the most commonly identified pathogens in bloodstream infections. Identification of Staphylococcus aureus in blood culture (SAB) requires a prompt and adequate clinical management. The detection of coagulase-negative staphylococci (CoNS), however, corresponds to contamination in about 75% of the cases. Nevertheless, antibiotic therapy is often initiated, which contributes to the risk of drug-related side effects. We developed a computerised clinical decision support system (HELP-CDSS) that assists physicians with an appropriate management of patients with Staphylococcus bacteraemia. The CDSS is evaluated using data of the Data Integration Centers (DIC) established at each clinic. DICs transform heterogeneous primary clinical data into an interoperable format, and the HELP-CDSS displays information according to current best evidence in bacteraemia treatment. The overall aim of the HELP-CDSS is a safe but more efficient allocation of infectious diseases specialists and an improved adherence to established guidelines in the treatment of SAB.Methods and analysisThe study is conducted at five German university hospitals and is designed as a stepped-wedge cluster randomised trial. Over the duration of 18 months, 135 wards will change from a control period to the intervention period in a randomised stepwise sequence. The coprimary outcomes are hospital mortality for all patients to establish safety, the 90-day disease reoccurrence-free survival for patients with SAB and the cumulative vancomycin use for patients with CoNS bacteraemia. We will use a closed, hierarchical testing procedure and generalised linear mixed modelling to test for non-inferiority of the CDSS regarding hospital mortality and 90-day disease reoccurrence-free survival and for superiority of the HELP-CDSS regarding cumulative vancomycin use.Ethics and disseminationThe study is approved by the ethics committee of Jena University Hospital and will start at each centre after local approval. Results will be published in a peer-reviewed journal and presented at scientific conferences.Trial registration numberDRKS00014320.

We report on a 40-year-old patient who presented with fever, right upper abdominal pain, right-sided chest pain and acute dyspnea. Imaging revealed several liver abscesses, as well as extensive right pleural empyema. Sixteen weeks previously, the patient underwent tooth extraction of the third molars (18, 28, 38, 48) and a first molar (46), and systematic closed periodontitis treatment. Four different species of the physiological microbiota of the oral cavity were detected in the pleura or liver abscess punctate (Streptococcus anginosus, Streptococcus constellatus, Actinomyces odontolyticus, Prevotella denticola). An underlying immune defect was ruled out. Ultrasound-guided drainage of liver abscesses and surgical treatment of pleural empyema by video-assisted thoracoscopy (VATS) and insertion of thoracic suction drains was performed, accompanied by targeted antibiotic therapy. Over a course of 6 weeks, the patient recovered completely. The case report illustrates severe infectious side effects of major dental interventions, and it critically summarizes current dental guideline recommendations on peri-interventional antimicrobial therapy. Therefore, a good clinical follow up after major tooth extractions is imperative.Wir berichten über einen 40-jährigen Patienten, der sich mit Fieber, Druckschmerz im rechten Oberbauch, atemabhängigen rechtsseitigen Thoraxschmerzen und akuter Dyspnoe vorstellte. Bildgebend wurden größere Leberabszesse sowie ein ausgedehntes rechtsseitiges Pleuraempyem nachgewiesen. 16 Wochen zuvor hatte sich der Patient einer Zahnextraktion aller 3. Molaren (18, 28, 38, 48) und eines 1. Molaren (46) sowie einer systematischen geschlossenen Parodontitis-Behandlung unterzogen. Im Pleura- bzw. Leberabszesspunktat wurden vier verschiedene Spezies der physiologischen Mikrobiota der Mundhöhle nachgewiesen (Streptococcus anginosus, Streptococcus constellatus, Actinomyces odontolyticus, Prevotella denticola). Ein zugrundeliegender Immundefekt war nicht nachweisbar. Unter sonografisch gesteuerter Leberabszessdrainage, operativer Versorgung des Pleuraempyems mittels Video-assistierter Thorakoskopie (VATS) und Einlage von Thorax-Saug-Drainagen sowie gezielter antibiotischer Therapie kam es innerhalb von 6 Wochen zur vollständigen Ausheilung. Der Fallbericht veranschaulicht relevante Infektionsrisiken größerer zahnärztlicher Interventionen und diskutiert die derzeitigen Empfehlungen zur Durchführung einer periinterventionellen antimikrobiellen Therapie in den zahnärztlichen Leitlinien. Wichtig erscheint vor allem eine gute klinische Nachbeobachtung betroffener Patienten.

For many years, researchers have postulated that helminthic infections may increase susceptibility to HIV, and that immune activation may have contributed to the extensive spread of HIV in sub-Saharan Africa. In the meantime, immunological studies have provided some evidence in support of this hypothesis, while cross-sectional clinical studies were able to further support the assumed association between HIV infection and selected helminthic co-infections. However, as many of the helminthic infections relevant to HIV-infected patients belong to the group of “neglected tropical diseases”, as defined by the World Health Organization, a certain lack of attention has inhibited progress in fully scaling up treatment and prevention efforts. In addition, despite the fact that the challenges of co-infections have preoccupied clinicians for over two decades, relevant research questions remain unanswered. The following review aims to provide a concise overview of associations between HIV and selected helminthic co-infections concerning aspects of HIV acquisition and transmission, clinical and immunological findings in co-infected individuals, as well as treatment and prevention efforts.

BACKGROUND: Symptomatic infection with pinworm (Enterobius vermicularis), a human pathogen, is clinically relevant in Germany, with an estimated prevalence in childhood of 2–20%. Enterobiasis can cause major mental distress. There is little systematically verified knowledge on the treatment of this condition, and there is no corresponding German guideline. This review is, therefore, intended as a summary of the current state of knowledge. METHODS: This review is based on pertinent publications retrieved by a selective search in PubMed for literature appearing from 1 January 1990 to 5 February 2019 and containing the search terms “enterobiasis,” “oxyuriasis,” “Enterobius vermicularis,” “pinworm,” and “threadworm.” RESULTS: More than one billion people worldwide are thought to be infected with pinworm. Estimates of its prevalence among kindergarten and primary-school pupils in Europe are generally near 20%. Infants (14 years of age), and adults are only sporadically affected. The main risk factors are age 4–11 years, uncontrolled anus-finger-mouth contact, nail-biting (onychophagia/perionychophagia), unsupervised body hygiene, and poor compliance with basic hand hygiene. No large-scale, randomized, controlled trials of treatment are available. The approved antihelminthic agents are mebendazole, pyrantel embonate, and pyrvinium embonate (success rates up to >90%). For recurrent infections, prolonged treatment for up to 16 weeks (a “pulse scheme”) is recommended. CONCLUSION: In nearly all cases, antihelminthic treatment along with attention to hygienic measures can successfully eradicate pinworm infection and prevent recurrence and autoinfection. The involvement of all persons living in the patient’s household, including sexual partners, is a prerequisite to the lasting success of treatment.

Anamnese und klinischer Befund | Ein 42-jahriger Patient mit Migrationshintergrund (Brasilien) stellte sich mit seit ca. 4 Jahren bestehenden Sensibilitatsstorungen, Hautveranderungen und lokalem Haarausfall an den oberen Extremitaten in unserer tropenmedizinischen Ambulanz vor. Ausschlaggebend fur die Prasentation bei uns waren neu aufgetretene starke Schmerzen und eine Rotung und Schwellung im Bereich der Hautveranderungen. Untersuchungen und Diagnosestellung | In der histologischen Aufarbeitung einer Biopsie der Hautveranderungen fanden sich oberflachliche und tiefe, perivaskulare, periadnexielle sowie perineurale Entzundungsinfiltrate aus Lymphozyten, Plasmazellen sowie epitheloiden Makrophagen mit Detektion einzelner saurefester Stabchen im mikrobiologischen Direktpraparat (Ziehl-Neelsen-Farbung). Die neurophysiologische Untersuchung zeigte elektroneurographisch eine rein sensible peripher-neurogene Schadigung mit Betonung des N. medianus rechts und des N. ulnaris links sowie des N. radialis links. Die Thermographie belegte eine erhohte Warme- bzw. Kalteschwelle. Die Untersuchung mittels ELISA auf IgM-Antikorper gegen das phenolische Glykolipid (PGL-1) war positiv (Titer 1 : 1200). Zusammenfassend stellten wir die Diagnose einer Borderline-Lepra (Infektion durch Mycobacterium leprae) mit Ubergang in eine multibazillare Lepra (nach WHO) und Lepra-Reaktion Typ 1. Therapie und Verlauf | Wir initiierten eine orale antimykobakterielle Therapie uber 12 Monate nach dem WHO-Schema fur die multibazillare Lepra (multidrug therapy, MDT) mit Rifampicin, Clofazimin und Dapson. Die Lepra-Reaktion Typ 1 wurde mittels Prednisolon sowie im Verlauf durch Erhohung der Clofazimin-Dosis behandelt. Unter zusatzlicher analgetischer Therapie mit Ibuprofen kam es im Verlauf zu einer raschen Besserung des Beschwerdebildes. Folgerungen | Die Lepra ist in Deutschland eine mit einer durchschnittlichen Inzidenz von 1–2 Fallen pro Jahr sehr selten auftretende Infektionskrankheit, die fast ausschlieslich bei Migranten diagnostiziert wird. Leitsymptome sind nicht-juckende, rotliche, beruhrungsunempfindliche Hautveranderungen oder Nervenausfalle. Die Diagnosestellung beruht in erster Linie auf der klinischen Prasentation unter Berucksichtigung von Erregernachweis, Histologie, neurophysiologischen Befunden und ggf. der Serologie. Standardtherapie ist eine Kombination aus Rifampicin, Clofazimin und Dapson (WHO-Schema) uber mindestens 6 Monate.

Anamnese und klinischer Befund: Eine 20-jahrige jordanische Austauschstudentin stellt sich mit undulierendem Fieber, Nachtschweis, Husten und einer Schwellung und Rotung im Knochelbereich in unserer Klinik vor. Die korperliche Untersuchung erbringt Zeichen einer beidseitigen Sprunggelenksarthritis und eine schmerzhafte zervikale Lymphadenopathie. Untersuchungen und Diagnosestellung: Laborchemisch finden sich Zeichen einer autoimmunhamolytischen Anamie, Leberwerterhohung und eine moderate Entzundungskonstellation. In allen Blutkulturen ist ein Wachstum gramnegativer kokkoider Stabchen nachweisbar, welche massenspektrometrisch zunachst als Moraxella lacunata und Ochrobactrum anthropi identifiziert werden. Die antibiogrammgerechte Therapie mit Imipenem / Cilastatin erbringt jedoch kein hinreichendes klinisches Ansprechen. Die aufgrund der Reiseanamnese mit Genuss von Joghurt aus nicht pasteurisierter Schafsmilch erganzend durchgefuhrte Brucellose-Serologie ist positiv. Die weitere Untersuchung der Blutkulturisolate fuhrt zur definitiven Diagnose einer Brucellose (Malta-Fieber, Infektion durch Brucella melitensis). Therapie und Verlauf: Nach Initiierung einer leitliniengerechten antimikrobiellen Therapie mit Doxycyclin und Rifampicin entfiebert die Patientin. Arthritis, autoimmunhamolytische Anamie sowie Begleithepatitis bessern sich im Verlauf. Folgerungen: Die Brucellose ist eine in Deutschland heute seltene, importierte meldepflichtige Infektionskrankheit, die es insbesondere bei Migranten zu bedenken gilt. Es handelt es sich um die weltweit haufigste Anthropozoonose. Leitsymptom ist ein chronisches undulierendes Fieber. Die Diagnosestellung beruht auf der Serologie und dem kulturellen Erregernachweis, wobei eine sorgfaltige Validierung von Blutkulturisolaten zu beachten ist. Standardtherapie ist eine Kombination aus Doxycyclin mit Rifampicin uber mindestens 6 Wochen.

Highlights • The sensitivity of commercial SARS CoV-2 IgG antibody tests was 64.4–93.2 %. • Positivity rate was higher with sera obtained 4 weeks than 2−3 weeks after RNA testing. • Antibody tests based on nucleoprotein and glycoprotein showed similar sensitivity. • Nucleoprotein- and glycoprotein-based antibody tests reacted with different sera., The emergence of the severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) has been followed by the rapid development of antibody tests. To assess the utility of the tests for clinical use and seroepidemiologic studies, we examined the sensitivity of commercial antibody tests from Roche, Abbott, Novatec, Virotech Siemens, Euroimmun, and Mediagnost in a prospective diagnostic study. The tests were evaluated with 73 sera from SARS CoV-2 RNA positive individuals with mild to moderate disease or asymptomatic infection. Sera were obtained at 2−3 weeks (N = 25) or > 4 weeks (N = 48) after symptom onset and viral RNA test. The overall sensitivity of the tests ranged from 64.4–93.2%. The most sensitive assays recognized 95.8–100 % of the sera obtained after 4 weeks or later. Sera drawn at 2−3 weeks were recognized with lower sensitivity indicating that the optimal time point for serologic testing is later than 3 weeks after onset of the disease. Nucleoprotein- and glycoproteinbased assays had similar sensitivity indicating that tests with both antigens are suitable for serological diagnostics. Breakdown of the test results showed that nucleoprotein- and glycoprotein-based tests of comparable sensitivity reacted with different sets of sera. The observation indicates that a combination of nucleoprotein- and glycoprotein-based tests would increase the percentage of positive results.

Background Intercontinental travel contributes to the spread of extended-spectrum beta-lactamase producing Enterobacterales (ESBL-PE). We assessed risk factors for intestinal ESBL-PE colonization in people travelling to low and middle income countries in the tropics and subtropics to better understand how travel affects ESBL-PE spread. Method This prospective cohort study in travellers attending a travel clinic in Leipzig, Germany was conducted in 2016–2017. Information on risk factors related to travel, symptoms, antibiotic use, health care usage, accommodation, destination, diet and hygiene was collected by questionnaire after travel. Stools were phenotypically tested for ESBL-PE before and after travel. Risk factors for ESBL-PE colonization were identified using logistic regression. Results Of the 230 travellers that were ESBL-PE negative before travelling, 23% (n = 53) travellers returned positive. Multivariable analyses showed that age, type of accommodation and travelling to Asia were associated with ESBL-PE colonization. Conclusions Given that a considerable amount of travellers returned with ESBL-PE, we recommend raising awareness in returning high-risk travellers, e.g. those returning from high-risk areas. They should be aware that they may carry antimicrobial-resistant bacteria after travel, and how they can prevent its spread. The role of the type of accommodation as a factor favouring intestinal colonization with ESBL-PE requires further investigation.

This is the first report of West Nile virus (WNV) infection imported by a traveller returning from a neighbouring country to Germany (Austria). Physicians should be aware of the expansion of WNV endemic areas in Europe.

History and clinical findings | A 42-year-old migrant from Brazil presented with persistent sensory disturbances, skin discolorations and local alopecia in the upper limbs. Decisive for the presentation in our Tropical Medicine Clinic were new occurrences of severe pain and redness and swelling in the area of the lesions that had already been assessed by a number of medical specialists without a clear diagnosis could be made. Investigations and diagnosis | The histological analysis of skin biopsies showed perivascular, perineural, periadnexial lymphocytic and granulomatous dermatitis. In a direct microbiological preparation individual acid fast bacilli could be detected (Ziehl-Neelsen stain). The electroneurographical examination demonstrated a sensitive peripheral-neurogenic damage with emphasis on the right median nerve and the left ulnar and radial nerves. Thermography revealed an increased heating or cooling threshold. The serological investigation by ELISA for IgM antibodies against the phenolic glycolipid (PGL-1) was positive (titer 1 : 1200). In summary, the diagnosis of borderline leprosy (infection with Mycobacterium leprae) with transition to multibacillary leprosy (according to WHO) and leprosy reaction type 1 was made. Treatment and course | We initiated an oral antimycobacterial therapy (multidrug therapy, MDT) with rifampin, clofazimine and dapsone for 12 months (WHO regimen for multibacillary leprosy). Leprosy reaction type 1 was treated with prednisolone and by increasing the dose of clofazimine. Analgesic therapy on demand was carried out with nonsteroidal anti-inflammatory drugs (ibuprofen). MDT and successful management of leprosy reaction lead to a rapid improvement of symptoms. Conclusions | Leprosy is an infectious disease occurring only rarely in Germany (average incidence of 1-2 cases per year) that is diagnosed almost exclusively among migrants. Main symptoms comprise non-itchy, reddish, touch insensitive skin lesions or nerve deficits. The diagnosis is based primarily on the clinical presentation, supplemented by pathogen detection, histology, neurophysiological findings and serology. Standard therapy is a combination of rifampin, clofazimine and dapsone (WHO scheme) for at least 6 months.

A 20-year-old Jordanian exchange student presents with recurrent fever, night sweats, cough, and swelling and redness around the ankle. Physical examination further reveals bilateral ankle arthritis and painful cervical lymphadenopathy.Laboratory tests show signs of autoimmune hemolytic anemia, elevated liver function tests, and moderate laboratory signs of inflammation. All blood cultures reveal growth of gram-negative coccoid rods which are initially identified by mass spectrometry as Moraxella lacunata and Ochrobactrum anthropi. However, antimicrobial therapy with imipenem / cilastatin does not improve the patient's clinical condition. Based on the travel history including consumption of yogurt from unpasteurized sheep's milk, we perform serological tests with a strongly positive result for Brucella species, and additional work-up of blood culture isolates confirm the definitive diagnosis of brucellosis (Malta fever, infection by Brucella melitensis).After initiation of antimicrobial therapy with doxycycline and rifampin the patient shows complete resolution of fever. Arthritis, autoimmune hemolytic anemia and accompanying hepatitis improve in the course.Thus, since brucellosis is endemic to countries like Jordan, it should be considered as a possible agent of fever of unknown origin especially in migrants unresponsive to empiric therapy and appropriate diagnostic tests including meticulous validation of blood cultures should be performed. Standard therapy is a combination of doxycycline with rifampin for at least 6 weeks.

The therapeutic effects of intravenous immunoglobulins (IVIGs) on different chronic inflammatory and autoimmune diseases is well appreciated, though clinical studies with high-evidence levels are largely missing. Similar to the broad spectrum of diseases and their underlying etiopathogenic background, the mechanisms of action seem heterogenous and multifold. Several studies addressing in vitro and in vivo effects of IVIG on various immunological parameters have been described with partly contradictory results. In this study immunoglobulins and stabilizers present in commercial IVIG preparations were studied in regard to the in vitro proliferation and cytokine production of peripheral blood mononuclear cells when stimulated with phytohemagglutinin (PHA), interleukin 2, and tetanus toxoid. Whereas the immunoglobulins stimulate the proliferation of PBMCs and decrease IFNgamma secretion, stabilizers of IVIG seem to inhibit the proliferation of PBMCs while increasing the secretion of IFN gamma. These effects have to be taken into account when balancing the impact of IVIG dosage and infusion intervals and relating them to clinical side effects and therapeutic efficacy.