[Show abstract][Hide abstract] ABSTRACT: For surveillance purposes real-time PCR assays for influenza viruses had to be adapted to the pandemic influenza A(H1N1)2009 strain. We combined published primers and probes for influenza A, influenza B and an internal amplification control with a detection system for influenza A(H1N1)2009 to set up a rapid, reliable, simple and cost-effective high-throughput multiplex one-step real-time RT-PCR. The workflow also includes automated sample preparation for high-throughput screening. The lower limit of detection of the multiplex assay was 3.5x10(2) RNA copies per PCR reaction. The diagnostic sensitivity of the multiplex assay was 87.7%, but increased to 99.4% for influenza-positive samples yielding C(t) values of less than 34 cycles in the respective diagnostic assay. High specificity was confirmed by sequencing and correct detection of 15 reference samples from two quality assurance studies. The multiplex PCR was introduced for surveillance of samples from a network of general practitioners and paediatricians in Bavaria, Germany during the influenza pandemic of 2009. Comparison with surveillance data from reported cases proved the reliability of the multiplex assay for influenza surveillance programmes.
Euro surveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin 01/2011; 16(7). · 5.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Here we report the case of a 54-year old, immunocompetent German patient with primary varicella whose Varicella-Zoster Virus (VZV)-specific T-cell responses could be detected early in infection and before the onset of seroconversion. This case demonstrates that the detection of VZV-specific T-cells may under certain circumstances support the diagnosis of a primary varicella infection, as for example in cases of atypical or subclinical varicella or in the absence of detectable VZV DNA in plasma.
[Show abstract][Hide abstract] ABSTRACT: There is a high incidence of diarrhea in traveling populations. Norovirus (NV) infection is a common cause of diarrhea and is associated with 7% of all diarrhea related deaths in the US. However, data on the overall prevalence of NV infection in traveling populations is limited. Furthermore, the prevalence of NV amongst travelers returning to Europe has not been reported. This study determined the prevalence of NV among international travelers returning to Germany from over 50 destinations in and outside Europe.
Stool samples of a total of 104 patients with a recent (< 14 days) history of international travel (55 male, mean age 37 yrs.) were tested for the presence of NV genogroup (GG) I and II infection using a sensitive and well established quantitative RT PCR method. 57 patients experienced diarrhea at the time of presentation at the Department of Infectious Diseases & Tropical Medicine. The remaining 47 patients had no experience of diarrhea or other gastrointestinal symptoms for at least 14 days prior to their date of presentation at our institute.
In our cohort, NV infection was detected in 15.7% of returning travelers with diarrhea. The closer to the date of return symptoms appeared, the higher the incidence of NV, ranging as high as 21.2% within the first four days after return.
In our cohort, NV infection was shown to be frequent among returning travelers especially in those with diarrhea, with over 1/5 of diarrhea patients tested positive for NV within the first four days after their return to Germany. Due to this prevalence, routine testing for NV infection and hygienic precautions may be warranted in this group. This is especially applicable to patients at an increased risk of spreading the disease, such as healthcare workers, teachers or food-handlers.
[Show abstract][Hide abstract] ABSTRACT: We describe a cluster of cowpox virus (CPXV) infections in humans that occurred near Munich, Germany, around the beginning of 2009. Previously, only sporadic reports of CPXV infections in humans after direct contact with various animals had been published. This outbreak involved pet rats from the same litter.
[Show abstract][Hide abstract] ABSTRACT: Human Bocavirus (HBoV) is considered to be responsible for lower respiratory tract infections in small children. Recent publications also reported the detection of HBoV in stool samples of gastroenteritis patients. Therefore HBoV might be associated with gastroenteritis cases.
To investigate the prevalence and the causative role of HBoV in gastroenteritis outbreaks in day care facilities for children.
We examined 307 stool samples using a real time PCR protocol for HBoV load. Samples were collected from 48 independent outbreaks of gastroenteritis in day care facilities.
HBoV was detected in 14/307 stool samples (4.6%). HBoV load in the samples was low and the 14 HBoV positive samples were distributed among 13 different outbreaks. Coinfections with Norovirus in single samples were frequent (57.1%), but no gastroenteritis outbreak could be associated with HBoV infection or coinfection.
This study indicates that HBoV is not a causative agent for gastroenteritis outbreaks.
Journal of Clinical Virology 11/2008; 43(3):340-2. · 3.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The SARS-epidemic of 2002/2003 with worldwide 8.096 cases and 774 fatalities was the first pandemia of the 21st century. SARS, the severe acute respiratory syndrome, arose in southern China and spread from Southeast-Asia finally over
all five continents. It caused heavy pneumonia with pulmonal failure and enteric involvement in man. The causative agent was
a novel coronavirus (SARS-CoV), which was transmitted from bats to small carnivores and from them to man. The mutations of
the viral receptor gene thus allowed the infection of man and the transmission from man to man. The SARS-pandemia can therefore
be regarded as a model of an emerging disease.
Der SARS-Seuchenzug in den Jahren 2002 und 2003 mit weltweit 8.096 Erkrankten und 774 Toten war die erste Pandemie des 21.
Jahrhunderts. SARS, das severe acute respiratory syndrome, nahm in Südchina seinen Ausgang und verbreitete sich über Südostasien
schließlich auf alle 5 Kontinente. Es verursachte beim Menschen schwere Pneumonien mit Lungenversagen und enterischer Beteiligung.
Auslöser war ein neuartiges Coronavirus (SARS-CoV), das von Fledermäusen auf fleischfressende Kleinsäuger und von diesen auf
den Menschen übertragen wurde. Die dabei stattgehabten Mutationen des viralen Rezeptorgens führten nicht nur zur Infektion
des Menschen, sondern vermittelten auch die Übertragbarkeit von Mensch zu Mensch. Die SARS-Pandemie kann daher als Modell
für eine emerging disease angesehen werden.
Journal für Verbraucherschutz und Lebensmittelsicherheit 10/2008; 3(4):417-420. · 0.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cytomegalovirus (CMV) positive recipients of CMV negative bone marrow bear a significantly higher risk of developing CMV disease compared to all other constellations. Here, we report a case of severe CMV induced esophagitis after allogeneic bone marrow transplantation for paroxysmal nocturnal hemoglobinuria. The patient developed the first symptoms between day 10 and 20 after dose reduced conditioning and HLA-matched unrelated stem cell transplantation. Esophageal tissue biopsies as well as peripheral blood proved positive for CMV DNA by PCR. Treatment with acyclovir, ganciclovir, foscarnet, cidofovir, and immunoglobulines resulted in elimination of CMV in peripheral blood but not in clinical improvement. Only tapering of cyclosporine at day +120 eventually led to the development of CMV-specific T-cells and resolution of esophagitis.
Journal of Clinical Virology 12/2005; 34(3):219-23. · 3.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Patients with CLL responding to initial chemotherapy with fludarabine alone (F) or in combination with cyclophosphamide (FC) were randomized for treatment with alemtuzumab (30 mg i.v. TIW, 12 weeks) or observation. Of 21 evaluable patients, 11 were randomized to alemtuzumab before the study was stopped due to severe infections in seven of 11 patients. These infections (one life-threatening pulmonary aspergillosis IV; four CMV reactivations III requiring i.v. ganciclovir; one pulmonary tuberculosis III; one herpes zoster III) were successfully treated and not associated with cumulative dose of alemtuzumab. In the observation arm, one herpes zoster infection II and one sinusitis I were documented. At 6 months after randomization, two patients in the alemtuzumab arm converted to CR, while three patients in the observation arm progressed. After alemtuzumab treatment, five of six patients achieved a molecular remission in peripheral blood while all patients in the observation arm remained MRD-positive (P=0.048). At 21.4 months median follow-up, patients receiving alemtuzumab showed a significant longer progression-free survival (no progression vs mean 24.7 months; P=0.036). In conclusion, a consolidation therapy with alemtuzumab is able to achieve molecular remissions and longer survival in CLL, but a safe treatment regimen needs to be determined.
[Show abstract][Hide abstract] ABSTRACT: We tested blood samples of 25 pediatric renal transplant recipients for Epstein-Barr virus (EBV) DNA load by quantitative polymerase chain reaction (PCR). Eleven of these transplant recipients showed clinical persistent mononucleosis-like symptoms years after transplantation (Tx). A quantitation of EBV DNA by PCR in peripheral blood lymphocyte (PBL) and serum samples revealed variable EBV DNA titers. The majority of EBV PCR results in samples of the 14 asymptomatic transplant recipients was repeatedly below detection limit. In contrast, patients with mononucleosis-like symptoms showed persistent EBV genome titers over a period of 6 months, ranging from 75 to 18 750 copies/10 000 PBL and from 680 to 335 000 copies/mL serum, respectively. One child suffering from this mononucleosis-like condition developed an EBV-associated Burkitt-like lymphoma 29 months after Tx. Whereas clinical and histological investigations did not indicate a post-transplant lymphoproliferative disorder (PTLD) until tumor detection, EBV titers in PBL and serum had been high for at least 8 months. We propose that pediatric transplant recipients who show both, recurrent mononucleosis-like symptoms and a sustained high EBV genome load, are at increased risk for severe EBV-related post-transplant complications.
[Show abstract][Hide abstract] ABSTRACT: A 45-year-old man was admitted with generalized itchy papules. He was originally from the Carribean island of Grenada. The disease had started two years before and was diagnosed as lupus erythematosus, polymorphic light eruption and atopic eczema. Physical examination showed skin-colored papules all over the integument, sebostasis and enlarged supraclavicular and inguinal lymph nodes.
Lymphocyte count was elevated with 58% as well as LDH (322 U/l) and gamma GT (133 U/l). In a blood smear characteristic pleomorphic lymphoid cells (flower cells) could be obtained. Histopathologic evaluation demonstrated a subepidermally located infiltrate of pleomorphic lymphocytes with epidermal involvement. HTLV-I/II serology (ELISA-screening test) was positive. Polymerase chain reaction analysis revealed HTLV-specific sequences.
Diagnosis of adult T-cell lymphoma/leukemia was obtained. Treatment consisted of interferon alpha 2b and zidovudine which resulted in a rapid response. However, as a result of an increased loss of weight (12 kg) this therapy was stopped. Two weeks later generalized lymphadenopathy and disseminated skin lesions were observed. Chemotherapy (CHOP-scheme) was initiated. The patient deceased with signs of an acute leukemia after a short period.
Adult T-cell lymphoma/leukemia is a rare disease in Europe. However, in patients with skin rashes, and lymphadenopathy, which are originally from HTLV-I endemic areas, adult T-cell lymphoma/leukemia should be considered.
[Show abstract][Hide abstract] ABSTRACT: A voluntary recall of VAQTA in prefilled syringes was implemented in Europe in late 2001 after the manufacturer noted a slight decrease in the antigen content of a small percentage of the syringes manufactured over a particular time frame. In Germany, a large-scale serologic testing program was implemented. The assay results were conveyed to the subject's physician, and free vaccine was provided for anyone requesting revaccination. An analysis was performed on a subset of 58,546 vaccine recipients with hepatitis A antibody results. Of the 28,681 persons who received either two 25 units (25 U) or two 50 units (50 U) doses of VAQTA, the seropositivity rate (SPR) was 99.5% after receipt of 2 doses, similar to the results in prelicensure clinical trials. The SPR was similar among recipients of lots that had been manufactured over the time frame associated with the recalled lots versus those receiving lots not associated with the recalled lots (25U: 99.7% versus 99,7%; 50U: 98.6% versus 99.6%, respectively). There were less recipients of 25U doses of the affected lots, who had high hepatitis A antibody titers (> or =100 mIU/mL), compared to recipients of unaffected lots.