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Gloor S, Jiang W, Maurer MH, Gottstein B, Oberli A, Hagemann JB, Hotz JF, Candinas D, Lachenmayer A, Grüner B, Beldi G. The trajectory of anti-recEm18 antibody levels determines follow-up after curative resection of hepatic alveolar echinococcosis. HPB (Oxford) 2024; 26:224-233. [PMID: 37867084 DOI: 10.1016/j.hpb.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/15/2023] [Accepted: 10/03/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Recurrence after curative resection of hepatic alveolar echinococcosis remains a clinical challenge. The current study tested if assessment of anti-recEm18 allows for postsurgical patient surveillance. METHODS A retrospective study with patients undergoing liver resection for alveolar echinococcosis (n = 88) at the University Hospital Bern from 2002 to 2020 and at the University Hospital and Medical Center Ulm from 2011 to 2017 was performed. Analysis was directed to determine a potential association of pre- and postoperative values of anti-recEm18 with clinical outcomes. RESULTS Anti-recEm18 had a linear correlation to the maximum lesion diameter (R2 = 0.558). Three trajectories of anti-recEm18 were identified based on a threshold of 10 AU/ml: "Em18-low" (n = 31), "responders" (n = 53) and "residual disease" (n = 4). The decline of anti-recEm18 in "responders" reached a plateau after 10.9 months at which levels decreased by 90%. The only patient with recurrence in the entire population was also the only patient with a secondary increase of anti-recEm18. CONCLUSION In patients with preoperative elevated values, anti-recEm18 confirms curative surgery at 12 months follow-up and allows for long-term surveillance.
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Affiliation(s)
- Severin Gloor
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Wanjie Jiang
- Department of Internal Medicine III, Division of Infectious Diseases, University Hospital of Ulm, Ulm, Germany
| | - Martin H Maurer
- Department for Diagnostic, Interventional, and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute for Diagnostic and Interventional Radiology, University Oldenburg, Oldenburg, Germany
| | - Bruno Gottstein
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland; Institute for Infectious Diseases, Medical Faculty, University of Bern, Bern, Switzerland
| | - Alexander Oberli
- Institute for Infectious Diseases, Medical Faculty, University of Bern, Bern, Switzerland
| | - Jürgen B Hagemann
- Institute of Medical Microbiology and Hygiene, University Hospital of Ulm, Ulm, Germany
| | - Julian F Hotz
- Department of Internal Medicine III, Division of Infectious Diseases, University Hospital of Ulm, Ulm, Germany; Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anja Lachenmayer
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Beate Grüner
- Department of Internal Medicine III, Division of Infectious Diseases, University Hospital of Ulm, Ulm, Germany
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Furaijat G, Bettac L, Kächele M, Grüner B, Skrabal C, Barth TFE, Parlak M, Hagemann JB, Peters L, Walther G, Kersten J. An unusual presentation of invasive Fusarium aortitis in a patient who is immunocompromised: A case report. Int J Infect Dis 2023; 134:102-105. [PMID: 37279826 DOI: 10.1016/j.ijid.2023.05.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
Fusarium (F.) species are ubiquitous filamentous fungi that may cause various opportunistic infections, especially in patients who are immunocompromised. A rare manifestation of disseminated fusariosis affects the aortic valve and results in invasive aortitis, which poses a significant challenge for clinicians in diagnosis and treatment. Here, we report a case of a patient, aged 54 years, who is immunocompromised, presenting initially with Fusarium keratitis and chorioretinitis in both eyes and a new endovascular aortic mass. Positron emission tomography/computed tomography was performed, suggesting aortitis. Transoesophageal echocardiography and electrocardiogram-guided computed tomography-angiography confirmed a large intraluminal mass in the ascending aorta. The aortic mass and a part of the ascending aorta were resected surgically, and a filamentous fungus with the microscopic features of the genus Fusarium was isolated and later identified molecularly as F. petroliphilum. The course of the treatment was complicated by perioperative cerebral embolization and mesenteric ischemia. These complications could be attributed to a preoperatively existing occlusion of the superior and inferior mesenteric artery and a subtotal stenosis of the celiac trunk. This case report describes a rare manifestation of disseminated fusariosis, frequently characterized by protracted clinical courses with poor prognosis. Fusariosis may manifest at different sites at different times or persist as a long-lasting disease with reactivation. This case highlights the importance of the interdisciplinary approach for effectively treating invasive mycoses.
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Affiliation(s)
- Ghefar Furaijat
- University of Ulm, Department of Internal Medicine I, Ulm, Germany
| | - Lucas Bettac
- University of Ulm, Department of Internal Medicine I, Ulm, Germany
| | - Martin Kächele
- University of Ulm, Department of Internal Medicine I, Ulm, Germany
| | - Beate Grüner
- University of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Ulm, Germany
| | - Christian Skrabal
- University of Ulm, Department of Cardiac, Thoracic and Vascular Surgery, Ulm, Germany
| | | | - Melih Parlak
- University of Ulm, Department of Ophthalmology, Ulm, Germany
| | | | - Lynn Peters
- University of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Ulm, Germany
| | - Grit Walther
- German National Reference Center for Invasive Fungal Infections, Leibniz Institute for Natural Product Research, and Infection Biology - Hans Knöll Institute, Jena, Germany
| | - Johannes Kersten
- University of Ulm, Division of Sports and Rehabilitation Medicine, Ulm, Germany.
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Peters L, Jiang W, Eberhardt N, Hagemann JB, Grüner B, Tappe D. 18FDG-PET/CT-Scans and Biomarker Levels Predicting Clinical Outcome in Patients with Alveolar Echinococcosis-A Single-Center Cohort Study with 179 Patients. Pathogens 2023; 12:1041. [PMID: 37624001 PMCID: PMC10457873 DOI: 10.3390/pathogens12081041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/24/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
Background: Alveolar echinococcosis (AE) is a severe larval tapeworm infection with a variable clinical course of the disease. Reliable imaging techniques and biomarkers are needed to predict the course of the disease. Methods: 179 AE patients that received PET/CT scans between 2008 and 2012 were retrospectively included. From stored blood samples taken on the day of the scan, levels of IgE, parasite-specific serology, amyloid A, C-reactive protein, soluble interleukin 2 receptor, cytokeratin fragments, eosinophilic cell count, and eosinophil cationic protein were measured. Additionally, the current clinical outcome (cured, stable, or progressive disease) after a median duration of 8 years after baseline examination was assessed. Ultimately, an ordinal logistic regression was conducted to evaluate which imaging parameters and biomarkers independently influence the clinical outcome. Results: In general, patients in need of medical treatment or with progressive disease, advanced PNM stages, and positive PET/CT scans exhibited higher levels of the respective biomarkers. However, only the parasite-specific serological markers and total IgE levels differed significantly between clinical groups, WHO PNM stages, and the results of the PET/CT scan. In the multivariate analysis, PET/CT results were a strong predictor of the clinical outcome (OR 8.908, 95%CI 3.019-26.285; p < 0.001), and age at baseline was a moderate predictor (OR 1.031, 95%CI 1.003-1.060; p = 0.029). Conclusions: The PET/CT scan is, preferably in combination with parasite-specific serology and IgE levels, a valuable tool in the clinical management of AE and is able to predict the course of the disease.
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Affiliation(s)
- Lynn Peters
- Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, 89081 Ulm, Germany; (L.P.); (W.J.)
| | - Wanjie Jiang
- Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, 89081 Ulm, Germany; (L.P.); (W.J.)
| | - Nina Eberhardt
- Department of Nuclear Medicine, Ulm University Hospital, 89081 Ulm, Germany;
| | | | - Beate Grüner
- Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, 89081 Ulm, Germany; (L.P.); (W.J.)
| | - Dennis Tappe
- Bernhard Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany
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Ebong U, Büttner SM, Schmidt SA, Flack F, Korf P, Peters L, Grüner B, Stenger S, Stamminger T, Kestler H, Beer M, Kloth C. Quantitative Evaluation of COVID-19 Pneumonia CT Using AI Analysis-Feasibility and Differentiation from Other Common Pneumonia Forms. Diagnostics (Basel) 2023; 13:2129. [PMID: 37371024 DOI: 10.3390/diagnostics13122129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/14/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE: To implement the technical feasibility of an AI-based software prototype optimized for the detection of COVID-19 pneumonia in CT datasets of the lung and the differentiation between other etiologies of pneumonia. METHODS: This single-center retrospective case-control-study consecutively yielded 144 patients (58 female, mean age 57.72 ± 18.25 y) with CT datasets of the lung. Subgroups including confirmed bacterial (n = 24, 16.6%), viral (n = 52, 36.1%), or fungal (n = 25, 16.6%) pneumonia and (n = 43, 30.7%) patients without detected pneumonia (comparison group) were evaluated using the AI-based Pneumonia Analysis prototype. Scoring (extent, etiology) was compared to reader assessment. RESULTS: The software achieved an optimal sensitivity of 80.8% with a specificity of 50% for the detection of COVID-19; however, the human radiologist achieved optimal sensitivity of 80.8% and a specificity of 97.2%. The mean postprocessing time was 7.61 ± 4.22 min. The use of a contrast agent did not influence the results of the software (p = 0.81). The mean evaluated COVID-19 probability is 0.80 ± 0.36 significantly higher in COVID-19 patients than in patients with fungal pneumonia (p < 0.05) and bacterial pneumonia (p < 0.001). The mean percentage of opacity (PO) and percentage of high opacity (PHO ≥ -200 HU) were significantly higher in COVID-19 patients than in healthy patients. However, the total mean HU in COVID-19 patients was -679.57 ± 112.72, which is significantly higher than in the healthy control group (p < 0.001). CONCLUSION: The detection and quantification of pneumonia beyond the primarily trained COVID-19 datasets is possible and shows comparable results for COVID-19 pneumonia to an experienced reader. The advantages are the fast, automated segmentation and quantification of the pneumonia foci.
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Affiliation(s)
- Una Ebong
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Susanne Martina Büttner
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Stefan A Schmidt
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Franziska Flack
- Scientific Collaborations Siemens Healthcare GmbH Erlangen, 91052 Erlangen, Germany
| | - Patrick Korf
- Scientific Collaborations Siemens Healthcare GmbH Erlangen, 91052 Erlangen, Germany
| | - Lynn Peters
- Division of Infectious Diseases, University Hospital and Medical Centre of Ulm, 89081 Ulm, Germany
| | - Beate Grüner
- Division of Infectious Diseases, University Hospital and Medical Centre of Ulm, 89081 Ulm, Germany
| | - Steffen Stenger
- Institute of Medical Microbiology and Hygiene, Ulm University Medical Center, 89081 Ulm, Germany
| | - Thomas Stamminger
- Institute of Virology, Ulm University Medical Center, 89081 Ulm, Germany
| | - Hans Kestler
- Institute for Medical Systems Biology, Ulm University, 89081 Ulm, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Christopher Kloth
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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Körper S, Grüner B, Zickler D, Wiesmann T, Wuchter P, Blasczyk R, Zacharowski K, Spieth P, Tonn T, Rosenberger P, Paul G, Pilch J, Schwäble J, Bakchoul T, Thiele T, Knörlein J, Dollinger MM, Krebs J, Bentz M, Corman VM, Kilalic D, Schmidtke-Schrezenmeier G, Lepper PM, Ernst L, Wulf H, Ulrich A, Weiss M, Kruse JM, Burkhardt T, Müller R, Klüter H, Schmidt M, Jahrsdörfer B, Lotfi R, Rojewski M, Appl T, Mayer B, Schnecko P, Seifried E, Schrezenmeier H. One-year follow-up of the CAPSID randomized trial for high-dose convalescent plasma in severe COVID-19 patients. J Clin Invest 2022; 132:163657. [PMID: 36326824 PMCID: PMC9753994 DOI: 10.1172/jci163657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUNDResults of many randomized trials on COVID-19 convalescent plasma (CCP) have been reported, but information on long-term outcome after CCP treatment is limited. The objectives of this extended observation of the randomized CAPSID trial are to assess long-term outcome and disease burden in patients initially treated with or without CCP.METHODSOf 105 randomized patients, 50 participated in the extended observation. Quality of life (QoL) was assessed by questionnaires and a structured interview. CCP donors (n = 113) with asymptomatic to moderate COVID-19 were included as a reference group.RESULTSThe median follow-up of patients was 396 days, and the estimated 1-year survival was 78.7% in the CCP group and 60.2% in the control (P = 0.08). The subgroup treated with a higher cumulative amount of neutralizing antibodies showed a better 1-year survival compared with the control group (91.5% versus 60.2%, P = 0.01). Medical events and QoL assessments showed a consistent trend for better results in the CCP group without reaching statistical significance. There was no difference in the increase in neutralizing antibodies after vaccination between the CCP and control groups.CONCLUSIONThe trial demonstrated a trend toward better outcome in the CCP group without reaching statistical significance. A predefined subgroup analysis showed a significantly better outcome (long-term survival, time to discharge from ICU, and time to hospital discharge) among those who received a higher amount of neutralizing antibodies compared with the control group. A substantial long-term disease burden remains after severe COVID-19.Trial registrationEudraCT 2020-001310-38 and ClinicalTrials.gov NCT04433910.FundingBundesministerium für Gesundheit (German Federal Ministry of Health).
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Affiliation(s)
- Sixten Körper
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Beate Grüner
- Division of Infectious Diseases, University Hospital and Medical Center Ulm, Ulm, Germany
| | - Daniel Zickler
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thomas Wiesmann
- Department of Anesthesiology and Intensive Care Medicine, Phillips-University Marburg, Marburg, Germany
| | - Patrick Wuchter
- Institute of Transfusion Medicine and Immunology, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Rainer Blasczyk
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University, Germany
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Torsten Tonn
- Transfusion Medicine, Medical Faculty Carl Gustav Carus, Technische Universität Dresden and German Red Cross Blood Donation Service North-East gGmbH, Dresden, Germany
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Gregor Paul
- Department of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Klinikum Stuttgart, Stuttgart, Germany
| | - Jan Pilch
- Institute of Clinical Hemostaseology and Transfusion Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Joachim Schwäble
- Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Transfusion Service Baden-Württemberg – Hessen, Frankfurt, Germany
| | - Tamam Bakchoul
- Institute of Clinical and Experimental Transfusion Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Thomas Thiele
- Institute of Transfusion Medicine, University Hospital Greifswald, Greifswald, Germany
| | - Julian Knörlein
- Clinic of Anesthesiology and Intensive Care Medicine, University Medical Center of Freiburg, Freiburg, Germany
| | | | - Jörg Krebs
- Clinic for Anesthesiology and Surgical Intensive Care Medicine, University of Mannheim, Mannheim, Germany
| | - Martin Bentz
- Department of Internal Medicine III, Hospital of Karlsruhe, Karlsruhe, Germany
| | - Victor M. Corman
- Institute of Virology, Charité - University Medicine Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and German Centre for Infection Research, Berlin, Germany
| | - Dzenan Kilalic
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | | | - Philipp M. Lepper
- Department of Internal Medicine V – Pneumology, Allergology, Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Lucas Ernst
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Hinnerk Wulf
- Department of Anesthesiology and Intensive Care Medicine, Phillips-University Marburg, Marburg, Germany
| | - Alexandra Ulrich
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Manfred Weiss
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm University, Ulm, Germany
| | - Jan Matthias Kruse
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thomas Burkhardt
- Transfusion Medicine, Medical Faculty Carl Gustav Carus, Technische Universität Dresden and German Red Cross Blood Donation Service North-East gGmbH, Dresden, Germany
| | - Rebecca Müller
- Institute of Transfusion Medicine and Immunology, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Harald Klüter
- Institute of Transfusion Medicine and Immunology, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Michael Schmidt
- Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Transfusion Service Baden-Württemberg – Hessen, Frankfurt, Germany
| | - Bernd Jahrsdörfer
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Ramin Lotfi
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Markus Rojewski
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Thomas Appl
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Erhard Seifried
- Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Transfusion Service Baden-Württemberg – Hessen, Frankfurt, Germany
| | - Hubert Schrezenmeier
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
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Tamarozzi F, Manciulli T, Grüner B, Brunetti E. Inaccurate Sonographic Diagnosis of Hepatic CE Can Be Dangerous - Remarks on "Echinococcosis: A Challenge for Liver Sonography" by W. Kratzer et al Ultraschall in Med. 24 February 2022. Ultraschall Med 2022; 43:e135-e136. [PMID: 35944579 DOI: 10.1055/a-1921-1990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Francesca Tamarozzi
- Infectious-Tropical Diseases and Microbiology, WHO Collaborating Centre on Strongyloidiasis and other NTDs, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Tommaso Manciulli
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
- WHO Collaborating Centre on Clinical Management of Cystic Echinococosis, Foundation IRCCS Polyclinic San Matteo, Pavia, Italy
| | - Beate Grüner
- Department of Internal Medicine III, University Hospital Ulm, 89081 Ulm, Germany
| | - Enrico Brunetti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Unit of Infectious and Tropical Diseases, WHO Collaborating Centre on Clinical Management of Cystic Echinococosis, Foundation IRCCS Polyclinic San Matteo, Pavia, Italy
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Körper S, Schrezenmeier EV, Rincon-Arevalo H, Grüner B, Zickler D, Weiss M, Wiesmann T, Zacharowski K, Kalbhenn J, Bentz M, Dollinger MM, Paul G, Lepper PM, Ernst L, Wulf H, Zinn S, Appl T, Jahrsdörfer B, Rojewski M, Lotfi R, Dörner T, Jungwirth B, Seifried E, Fürst D, Schrezenmeier H. Cytokine levels associated with favorable clinical outcome in the CAPSID randomized trial of convalescent plasma in patients with severe COVID-19. Front Immunol 2022; 13:1008438. [PMID: 36275695 PMCID: PMC9582990 DOI: 10.3389/fimmu.2022.1008438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/12/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives To determine the profile of cytokines in patients with severe COVID-19 who were enrolled in a trial of COVID-19 convalescent plasma (CCP). Methods Patients were randomized to receive standard treatment and 3 CCP units or standard treatment alone (CAPSID trial, ClinicalTrials.gov NCT04433910). The primary outcome was a dichotomous composite outcome (survival and no longer severe COVID-19 on day 21). Time to clinical improvement was a key secondary endpoint. The concentrations of 27 cytokines were measured (baseline, day 7). We analyzed the change and the correlation between serum cytokine levels over time in different subgroups and the prediction of outcome in receiver operating characteristics (ROC) analyses and in multivariate models. Results The majority of cytokines showed significant changes from baseline to day 7. Some were strongly correlated amongst each other (at baseline the cluster IL-1ß, IL-2, IL-6, IL-8, G-CSF, MIP-1α, the cluster PDGF-BB, RANTES or the cluster IL-4, IL-17, Eotaxin, bFGF, TNF-α). The correlation matrix substantially changed from baseline to day 7. The heatmaps of the absolute values of the correlation matrix indicated an association of CCP treatment and clinical outcome with the cytokine pattern. Low levels of IP-10, IFN-γ, MCP-1 and IL-1ß on day 0 were predictive of treatment success in a ROC analysis. In multivariate models, low levels of IL-1ß, IFN-γ and MCP-1 on day 0 were significantly associated with both treatment success and shorter time to clinical improvement. Low levels of IP-10, IL-1RA, IL-6, MCP-1 and IFN-γ on day 7 and high levels of IL-9, PDGF and RANTES on day 7 were predictive of treatment success in ROC analyses. Low levels of IP-10, MCP-1 and high levels of RANTES, on day 7 were associated with both treatment success and shorter time to clinical improvement in multivariate models. Conclusion This analysis demonstrates a considerable dynamic of cytokines over time, which is influenced by both treatment and clinical course of COVID-19. Levels of IL-1ß and MCP-1 at baseline and MCP-1, IP-10 and RANTES on day 7 were associated with a favorable outcome across several endpoints. These cytokines should be included in future trials for further evaluation as predictive factors.
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Affiliation(s)
- Sixten Körper
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Eva Vanessa Schrezenmeier
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health Charité Universitätsmedizin Berlin, Berlin Institute of Health (BIH) Academy, Berlin, Germany
| | - Hector Rincon-Arevalo
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Grupo de Inmunología Celular e Inmunogenética, Facultad de Medicina, Instituto de Investigaciones Médicas, Universidad de Antioquia UdeA, Medellín, Colombia
| | - Beate Grüner
- Division of Infectious Diseases, University Hospital and Medical Center Ulm, Ulm, Germany
| | - Daniel Zickler
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Manfred Weiss
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm University, Ulm, Germany
| | - Thomas Wiesmann
- Department of Anaesthesiology and Intensive Care Medicine, Phillips-University Marburg, Marburg, Germany
| | - Kai Zacharowski
- Clinic of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Johannes Kalbhenn
- Clinic of Anesthesiology and Intensive Care Medicine University Medical Center of Freiburg, Freiburg, Germany
| | - Martin Bentz
- Department of Internal Medicine III, Hospital of Karlsruhe, Karlsruhe, Germany
| | | | - Gregor Paul
- Department of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Klinikum Stuttgart, Stuttgart, Germany
| | - Philipp M. Lepper
- Department of Internal Medicine V – Pneumology, Allergology, Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Lucas Ernst
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Hinnerk Wulf
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm University, Ulm, Germany
| | - Sebastian Zinn
- Department of Anaesthesiology and Intensive Care Medicine, Phillips-University Marburg, Marburg, Germany
| | - Thomas Appl
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Bernd Jahrsdörfer
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Markus Rojewski
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Ramin Lotfi
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Thomas Dörner
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Deutsches Rheumaforschungszentrum (DRFZ), Berlin, Germany
| | - Bettina Jungwirth
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm University, Ulm, Germany
| | - Erhard Seifried
- Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Transfusion Service Baden-Württemberg – Hessen, Frankfurt, Germany
| | - Daniel Fürst
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Hubert Schrezenmeier
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
- *Correspondence: Hubert Schrezenmeier,
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Balint EM, Grüner B, Haase S, Kaw-Geppert M, Thayer JF, Gündel H, Jarczok MN. A randomized clinical trial to stimulate the cholinergic anti-inflammatory pathway in patients with moderate COVID-19-pneumonia using a slow-paced breathing technique. Front Immunol 2022; 13:928979. [PMID: 36263035 PMCID: PMC9574246 DOI: 10.3389/fimmu.2022.928979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/26/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose A characteristic problem occurring in COVID-19 is excessive elevations of pro-inflammatory cytokines (e.g. IL-6 and CRP) which are associated with worse clinical outcomes. Stimulation of the vagally-mediated cholinergic anti-inflammatory reflex by slow paced breathing with prolonged exhalation may present a clinically relevant way to reduce circulating IL-6. Method Single-center randomized controlled clinical trial with enrolment of 46 patients hospitalized with confirmed severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection and moderate COVID-19 pneumonia (primary diagnosis). Differences between intervention (4sec inhalation, 6sec exhalation for 20 minutes 3x daily) and control group in IL-6 calculated using multilevel mixed-effect linear regression models with random slope including the covariates relevant comorbidities, COVID-19 medication, and age. Both groups received standard care. Results Mean age was 57 years ± 13 years, N= 28 (60%) male, N=30 (65%) with relevant comorbidities. The model including group-by-time interaction revealed a significantly lower trajectory of IL-6 in the intervention group (effect size Cohens f2 = 0.11, LR-test p=.040) in the intention-to-treat sample, confirmed by per-protocol analysis (f2 = 0.15, LR-test p=.022). Exploratory analysis using the median split of practice time to predict IL-6 of the next morning indicated a dose-response relationship with beneficial effects of practice time above 45 minutes per day. Oxygen saturation remained unchanged during slow-paced breathing (95.1% ± 2.1% to 95.4% ± 1.6%). Conclusion Patients practicing slow-paced breathing had significantly lower IL-6 values than controls with a small to medium effect size and without relevant side effects. Further trials should evaluate clinical outcomes and an earlier start of the intervention. Slow-paced breathing could be an easy to implement, low-cost, safe and feasible adjuvant therapeutic approach to reduce circulating IL-6 in moderate COVID-19 pneumonia. Clinical Trial Registration https://www.drks.de, identifier DRKS00023971, Universal Trial Number (UTN) U1111-1263-8658.
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Affiliation(s)
- Elisabeth Maria Balint
- Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Ulm, Germany
- Center for mental health, Privatklinik Meiringen, Meiringen, Switzerland
| | - Beate Grüner
- Clinic for Internal Medicine III, Division of Infectious Diseases, University Hospital Ulm, Ulm, Germany
| | - Sophia Haase
- Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Mandakini Kaw-Geppert
- Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Julian F. Thayer
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Harald Gündel
- Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Marc N. Jarczok
- Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Ulm, Germany
- *Correspondence: Marc N. Jarczok,
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Peters L, Burkert S, Brenner C, Grüner B. Experienced stigma and applied coping strategies during the COVID-19 pandemic in Germany: a mixed-methods study. BMJ Open 2022; 12:e059472. [PMID: 36002206 PMCID: PMC9412038 DOI: 10.1136/bmjopen-2021-059472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Health-related stigma is considered a social determinant of health equity and a hidden burden of disease. This study aimed to assess the level and dimensions of stigma and respective coping mechanisms in COVID-19 survivors. METHODS A mixed-methods study with sequential explanatory design was conducted at the University Hospital of Ulm, Germany. Stigma was assessed using the Social Impact Scale (SIS) including adult COVID-19 survivors with mild-to-severe disease. Subsequently, 14 participants were sampled with regard to gender, age and severity of disease for in-depth interviews to understand how stigma was experienced and coping strategies were applied. The questionnaire was analysed using descriptive statistics, t-test and analysis of variance. Content analysis was used for qualitative data. RESULTS From 61 participants, 58% were men and mean age was 51 years. The quantitative analysis of the SIS indicated an intermediate level of experienced stigma. Participants experienced stigma mainly as 'social rejection' (M=14.22, SD=4.91), followed by 'social isolation' (M=10.17, SD=4.16) and 'internalised shame' (M=8.39, SD=3.32). There was no significant difference in experienced stigma regarding gender, education, occupational status or residual symptoms. However, participants between 30 and 39 years of age experienced higher levels of stigma than other age groups (p=0.034). The qualitative analysis revealed how stigma seemed to arise from misconceptions creating irrational fear of infection, leading to stereotyping, vilification, discrimination and social exclusion of COVID-19 survivors, leaving them feeling vulnerable. Stigma cut through all social levels, from the individual level at the bottom to the institutional and societal level at the top. Social networks protected from experiencing stigma. CONCLUSION COVID-19-related stigma is a relevant burden in the ongoing pandemic. Providing accurate information and exposing misinformation on disease prevention and treatment seems key to end COVID-19-related stigma.
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Affiliation(s)
- Lynn Peters
- Department of Internal Medicine III, Division of Infectious Diseases, University Hospital Ulm, Ulm, Germany
| | - Sanne Burkert
- Department of Internal Medicine III, Division of Infectious Diseases, University Hospital Ulm, Ulm, Germany
| | - Cecilia Brenner
- Regional Office of Communicable Diseases, The Public Health Agency of Sweden, Uppsala, Sweden
| | - Beate Grüner
- Department of Internal Medicine III, Division of Infectious Diseases, University Hospital Ulm, Ulm, Germany
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Ebong U, Büttner M, Kloth C, Grüner B, Stamminger T, Stenger S, Rauch F, Panknin C, Beer M. Quantitative Erfassung und Differenzierung unterschiedlicher Pneumonien inklusive COVID-19 mittels eines KI-basierten Prototypen – Genauigkeit, Schweregradeinschätzung und Korrelation zur Klinik. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- U Ebong
- Universitätsklinikum Ulm, Klinik für diagnostische und interventio, Ulm
| | - M Büttner
- Klinik für diagnostische und interventionelle Radiologie, Universitätsklinikum Ulm, Ulm
| | - C Kloth
- Klinik für diagnostische und interventionelle Radiologie, Universitätsklinikum Ulm, Ulm
| | - B Grüner
- Klinische Infektiologie, Universitätsklinikum Ulm, Ulm
| | - T Stamminger
- Institut für Virologie, Universitätsklinikum Ulm, Ulm
| | - S Stenger
- Institut für medizinische Mikrobiologie und Hygiene, Universitätsklinikum Ulm, Ulm
| | - F Rauch
- Siemens Healthineers, Erlangen
| | | | - M Beer
- Klinik für diagnostische und interventionelle Radiologie, Universitätsklinikum Ulm, Ulm
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11
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Peters L, Burkert S, Hagemann JB, Albes R, Klemptner J, Birkle J, Schwaibold E, Siefermann S, Grüner B. Initial Risk Assessment in Patients with Alveolar Echinococcosis—Results from a Retrospective Cohort Study. Pathogens 2022; 11:pathogens11050557. [PMID: 35631078 PMCID: PMC9144025 DOI: 10.3390/pathogens11050557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/15/2022] [Accepted: 04/22/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Alveolar echinococcosis (AE) is a potentially lethal parasitosis with a broad spectrum of disease dynamics in affected patients. To guide clinical management, we assessed initial prognostic factors for both progressive and controlled AE based on initial staging. Methods: A retrospective cohort study was conducted, examining 279 patients assigned to different clinical groups: cured, stable with and without the need for benzimidazole treatment, and progressive disease. Univariate analysis compared demographic and clinical variables. Significant variables were subsequently entered into two separate logistic regression models for progressive and controlled disease. Results: Based on the multivariate analysis, a large AE lesion (OR = 1.02 per millimetre in size; 95%CI 1.004–1.029), PNM staging (OR = 2.86; 95%CI 1.384–5.911) and especially the involvement of neighbouring organs (OR = 3.70; 95%CI 1.173–11.653) remained significant risk factors for progressive disease. A negative Em2+ IgG (OR = 0.25; 95%CI 0.072–0.835) and a small AE lesion (OR = 0.97; 95%CI 0.949–0.996) were significant protective factors. Conclusions: Patients with large lesions and advanced stages should be monitored closely and most likely require long-term treatment with benzimidazoles if curative resection is not feasible. Patients with small lesions and negative Em2+ IgG seem able to control the disease to a certain extent and a less strict treatment regimen might suffice.
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Affiliation(s)
- Lynn Peters
- Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, 89081 Ulm, Germany; (S.B.); (R.A.); (J.K.); (J.B.); (E.S.); (S.S.); (B.G.)
- Correspondence:
| | - Sanne Burkert
- Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, 89081 Ulm, Germany; (S.B.); (R.A.); (J.K.); (J.B.); (E.S.); (S.S.); (B.G.)
| | | | - Rasmus Albes
- Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, 89081 Ulm, Germany; (S.B.); (R.A.); (J.K.); (J.B.); (E.S.); (S.S.); (B.G.)
| | - Jonas Klemptner
- Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, 89081 Ulm, Germany; (S.B.); (R.A.); (J.K.); (J.B.); (E.S.); (S.S.); (B.G.)
| | - Jessica Birkle
- Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, 89081 Ulm, Germany; (S.B.); (R.A.); (J.K.); (J.B.); (E.S.); (S.S.); (B.G.)
| | - Elias Schwaibold
- Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, 89081 Ulm, Germany; (S.B.); (R.A.); (J.K.); (J.B.); (E.S.); (S.S.); (B.G.)
| | - Sofia Siefermann
- Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, 89081 Ulm, Germany; (S.B.); (R.A.); (J.K.); (J.B.); (E.S.); (S.S.); (B.G.)
| | - Beate Grüner
- Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, 89081 Ulm, Germany; (S.B.); (R.A.); (J.K.); (J.B.); (E.S.); (S.S.); (B.G.)
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12
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Kern P, Grüner B. Rescue treatment of advanced alveolar echinococcosis: The case for a multidisciplinary team. Journal of Liver Transplantation 2022. [DOI: 10.1016/j.liver.2021.100068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Linschoten M, Uijl A, Schut A, Jakob CEM, Romão LR, Bell RM, McFarlane E, Stecher M, Zondag AGM, van Iperen EPA, Hermans-van Ast W, Lea NC, Schaap J, Jewbali LS, Smits PC, Patel RS, Aujayeb A, van der Harst P, Siebelink HJ, van Smeden M, Williams S, Pilgram L, van Gilst WH, Tieleman RG, Williams B, Asselbergs FW, Al-Ali AK, Al-Muhanna FA, Al-Rubaish AM, Al-Windy NYY, Alkhalil M, Almubarak YA, Alnafie AN, Alshahrani M, Alshehri AM, Anning C, Anthonio RL, Badings EA, Ball C, van Beek EA, ten Berg JM, von Bergwelt-Baildon M, Bianco M, Blagova OV, Bleijendaal H, Bor WL, Borgmann S, van Boxem AJM, van den Brink FS, Bucciarelli-Ducci C, van Bussel BCT, Byrom-Goulthorp R, Captur G, Caputo M, Charlotte N, vom Dahl J, Dark P, De Sutter J, Degenhardt C, Delsing CE, Dolff S, Dorman HGR, Drost JT, Eberwein L, Emans ME, Er AG, Ferreira JB, Forner MJ, Friedrichs A, Gabriel L, Groenemeijer BE, Groenendijk AL, Grüner B, Guggemos W, Haerkens-Arends HE, Hanses F, Hedayat B, Heigener D, van der Heijden DJ, Hellou E, Hellwig K, Henkens MTHM, Hermanides RS, Hermans WRM, van Hessen MWJ, Heymans SRB, Hilt AD, van der Horst ICC, Hower M, van Ierssel SH, Isberner N, Jensen B, Kearney MT, van Kesteren HAM, Kielstein JT, Kietselaer BLJH, Kochanek M, Kolk MZH, Koning AMH, Kopylov PY, Kuijper AFM, Kwakkel-van Erp JM, Lanznaster J, van der Linden MMJM, van der Lingen ACJ, Linssen GCM, Lomas D, Maarse M, Macías Ruiz R, Magdelijns FJH, Magro M, Markart P, Martens FMAC, Mazzilli SG, McCann GP, van der Meer P, Meijs MFL, Merle U, Messiaen P, Milovanovic M, Monraats PS, Montagna L, Moriarty A, Moss AJ, Mosterd A, Nadalin S, Nattermann J, Neufang M, Nierop PR, Offerhaus JA, van Ofwegen-Hanekamp CEE, Parker E, Persoon AM, Piepel C, Pinto YM, Poorhosseini H, Prasad S, Raafs AG, Raichle C, Rauschning D, Redón J, Reidinga AC, Ribeiro MIA, Riedel C, Rieg S, Ripley DP, Römmele C, Rothfuss K, Rüddel J, Rüthrich MM, Salah R, Saneei E, Saxena M, Schellings DAAM, Scholte NTB, Schubert J, Seelig J, Shafiee A, Shore AC, Spinner C, Stieglitz S, Strauss R, Sturkenboom NH, Tessitore E, Thomson RJ, Timmermans P, Tio RA, Tjong FVY, Tometten L, Trauth J, den Uil CA, Van Craenenbroeck EM, van Veen HPAA, Vehreschild MJGT, Veldhuis LI, Veneman T, Verschure DO, Voigt I, de Vries JK, van de Wal RMA, Walter L, van de Watering DJ, Westendorp ICD, Westendorp PHM, Westhoff T, Weytjens C, Wierda E, Wille K, de With K, Worm M, Woudstra P, Wu KW, Zaal R, Zaman AG, van der Zee PM, Zijlstra LE, Alling TE, Ahmed R, van Aken K, Bayraktar-Verver ECE, Bermúdez Jiménes FJ, Biolé CA, den Boer-Penning P, Bontje M, Bos M, Bosch L, Broekman M, Broeyer FJF, de Bruijn EAW, Bruinsma S, Cardoso NM, Cosyns B, van Dalen DH, Dekimpe E, Domange J, van Doorn JL, van Doorn P, Dormal F, Drost IMJ, Dunnink A, van Eck JWM, Elshinawy K, Gevers RMM, Gognieva DG, van der Graaf M, Grangeon S, Guclu A, Habib A, Haenen NA, Hamilton K, Handgraaf S, Heidbuchel H, Hendriks-van Woerden M, Hessels-Linnemeijer BM, Hosseini K, Huisman J, Jacobs TC, Jansen SE, Janssen A, Jourdan K, ten Kate GL, van Kempen MJ, Kievit CM, Kleikers P, Knufman N, van der Kooi SE, Koole BAS, Koole MAC, Kui KK, Kuipers-Elferink L, Lemoine I, Lensink E, van Marrewijk V, van Meerbeeck JP, Meijer EJ, Melein AJ, Mesitskaya DF, van Nes CPM, Paris FMA, Perrelli MG, Pieterse-Rots A, Pisters R, Pölkerman BC, van Poppel A, Reinders S, Reitsma MJ, Ruiter AH, Selder JL, van der Sluis A, Sousa AIC, Tajdini M, Tercedor Sánchez L, Van De Heyning CM, Vial H, Vlieghe E, Vonkeman HE, Vreugdenhil P, de Vries TAC, Willems AM, Wils AM, Zoet-Nugteren SK. Clinical presentation, disease course, and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease: a cohort study across 18 countries. Eur Heart J 2022; 43:1104-1120. [PMID: 34734634 DOI: 10.1093/eurheartj/ehab656] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/22/2021] [Accepted: 09/01/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS Patients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality. METHODS AND RESULTS We used data from the CAPACITY-COVID registry and LEOSS study. Multivariable Poisson regression models were fitted to assess the association between different types of pre-existing heart disease and in-hospital mortality. A total of 16 511 patients with COVID-19 were included (21.1% aged 66-75 years; 40.2% female) and 31.5% had a history of heart disease. Patients with heart disease were older, predominantly male, and often had other comorbid conditions when compared with those without. Mortality was higher in patients with cardiac disease (29.7%; n = 1545 vs. 15.9%; n = 1797). However, following multivariable adjustment, this difference was not significant [adjusted risk ratio (aRR) 1.08, 95% confidence interval (CI) 1.02-1.15; P = 0.12 (corrected for multiple testing)]. Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for heart failure (aRR 1.19, 95% CI 1.10-1.30; P < 0.018) particularly for severe (New York Heart Association class III/IV) heart failure (aRR 1.41, 95% CI 1.20-1.64; P < 0.018). None of the other heart disease subtypes, including ischaemic heart disease, remained significant after multivariable adjustment. Serious cardiac complications were diagnosed in <1% of patients. CONCLUSION Considerable heterogeneity exists in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with heart failure are at greatest risk of death when hospitalized with COVID-19. Serious cardiac complications are rare during hospitalization.
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Hotz JF, Peters L, Kapp-Schwörer S, Theis F, Eberhardt N, Essig A, Grüner B, Hagemann JB. Evaluation of Serological Markers in Alveolar Echinococcosis Emphasizing the Correlation of PET-CTI Tracer Uptake with RecEm18 and Echinococcus-Specific IgG. Pathogens 2022; 11:pathogens11020239. [PMID: 35215182 PMCID: PMC8880252 DOI: 10.3390/pathogens11020239] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 02/05/2023] Open
Abstract
Human alveolar echinococcosis (AE), which is caused by the cestode Echinococcus (E.) multilocularis, is an epidemiologically relevant issue in modern medicine and still poses a diagnostic and therapeutic challenge. Since diagnosis mainly relies on imaging procedures and serological testing, we retrospectively and comparatively analyzed the performance of an Echinococcus IgG screening ELISA, whole serum IgE, and two specific confirmatory ELISA platforms using the defined E. multilocularis antigens Em2-Em18 (Em2+) and recombinant Em18 (recEm18). With special emphasis on the clinical usefulness of recEm18, we correlated the laboratory results with clinical characteristics and imaging findings in a large and well-characterized cohort of N = 124 AE patients, who were followed over several years after either surgical plus subsequent pharmacological treatment or pharmacotherapy alone. All patients had routinely received PET-CTI every two years. Our data reveal strong correlations for both Echinococcus IgG and recEm18 with tracer uptake in PET-CTI and parasitic lesion size and number, suggesting additional clinical usefulness of recEm18 for certain constellations only, while IgG and Em2+ still appear reasonable and sensitive screening methods for initial diagnosis of AE. With this study, we aim to contribute to further optimizing medical care of AE patients. For instance, it might be reasonable to consider the replacement of some PET-CTI follow-ups by imaging procedures with less radiation exposure or serological means alone. Further studies that clarify the correlation of serological markers with ultrasound criteria might be particularly useful, and further retrospective as well as prospective investigations are justified in this context.
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Affiliation(s)
- Julian Frederic Hotz
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, A-1090 Vienna, Austria
- Division of Infectious Diseases, Department of Internal Medicine III, Ulm University Hospital, D-89081 Ulm, Germany; (L.P.); (S.K.-S.); (F.T.)
- Correspondence: (J.F.H.); (B.G.); (J.B.H.)
| | - Lynn Peters
- Division of Infectious Diseases, Department of Internal Medicine III, Ulm University Hospital, D-89081 Ulm, Germany; (L.P.); (S.K.-S.); (F.T.)
| | - Silke Kapp-Schwörer
- Division of Infectious Diseases, Department of Internal Medicine III, Ulm University Hospital, D-89081 Ulm, Germany; (L.P.); (S.K.-S.); (F.T.)
| | - Frauke Theis
- Division of Infectious Diseases, Department of Internal Medicine III, Ulm University Hospital, D-89081 Ulm, Germany; (L.P.); (S.K.-S.); (F.T.)
| | - Nina Eberhardt
- Department of Nuclear Medicine, Ulm University Hospital, D-89081 Ulm, Germany;
| | - Andreas Essig
- Institute of Medical Microbiology and Hygiene, Ulm University Hospital, D-89081 Ulm, Germany;
| | - Beate Grüner
- Division of Infectious Diseases, Department of Internal Medicine III, Ulm University Hospital, D-89081 Ulm, Germany; (L.P.); (S.K.-S.); (F.T.)
- Correspondence: (J.F.H.); (B.G.); (J.B.H.)
| | - Jürgen Benjamin Hagemann
- Institute of Medical Microbiology and Hygiene, Ulm University Hospital, D-89081 Ulm, Germany;
- Correspondence: (J.F.H.); (B.G.); (J.B.H.)
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Grüner B, Peters L, Hillenbrand A, Voßberg P, Schweiker J, Rollmann EG, Rodriguez LH, Blumhardt J, Burkert S, Kern P, Köhler C, Soboslay PT. Echinococcus multilocularis specific antibody, systemic cytokine, and chemokine levels, as well as antigen-specific cellular responses in patients with progressive, stable, and cured alveolar echinococcosis: A 10-year follow-up. PLoS Negl Trop Dis 2022; 16:e0010099. [PMID: 35108275 PMCID: PMC8809567 DOI: 10.1371/journal.pntd.0010099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 12/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background The infestation with Echinococcus multilocularis larvae may persist in humans for up to decades without evident clinical symptoms. Longitudinal investigations are needed to understand the dynamic immunological processes in alveolar echinococcosis (AE) patients associated with an active and progressive, a stable or a regressive course of disease. Methodology/Principal findings This study evaluated the E. multilocularis specific antibody responses, systemic cytokine, and chemokine serum levels over a 10-year follow-up period, as well as cellular responsiveness in AE patients. Our results demonstrate a rapid decrease in antibodies against E. multilocularis specific antigen Em2+. Especially in cured patients, these antibodies remained negative, making them a significant predictor for cured AE. E. multilocularis specific IgG4, and indirect hemagglutination IHA decreased later in time, after around 5 years. While total IgE did not show significant dynamics over the course of disease, E. multilocularis specific IgE decreased after one to two years, and increasing levels were a significant predictor of progressive disease. There was no significant change in systemic IL-8, IL-9, CCL18 or CCL20 serum levels over time. Univariate analysis across groups indicated lower IL-8 levels in cured patients; however, this result could not be confirmed by multivariate analysis. Levels of CCL17 decreased during treatment, especially in cured patients, and thus might serve as a predictive or risk factor for progressive disease. Levels of IL-10 and CCL13 decreased during disease, especially after five and ten years of intervention. The E. multilocularis antigen (EmAg) inducible cellular productions of MCP1(CCL13), TARC(CCL17) and PARC(CCL18) were lowest in patients with cured AE and infection-free controls, while the EmAg inducible cellular production of IFN-γ increased after cure. Significant positive cytokine and chemokine correlations were observed in AE patients for IL-9, IL-10, CCL13(MCP-4), CCL17(TARC) and CCL20(LARC)(for all p<0.001). E. multilocularis specific IgG4 response correlated positively with TARC (p<0.001). Both markers enhanced over time in progressive disease and decreased after cure. The levels of IL-8, IL-10, MCP4 and LARC enhanced with AE regression. Conclusions/Significance Repeated biomarker surveys are advisable to evaluate progression or regression of disease during longitudinal follow-up and such analyses can support imaging techniques and improve staging of AE patients. Alveolar echinococcosis (AE) is a severe disease caused by Echinococcus multilocularis, the fox tapeworm. Humans exposed to E. multilocularis may develop severe AE with progressive tissue and organ infiltrating growth of the larval stage. The E. multilocularis larvae appear to have developed effective immune evasion mechanisms which facilitate an asymptomatic incubation and an extended host and parasite coexistence for decades. Over a 10-year follow-up, this investigation aimed to gain a better understanding of the immunological process associated with an active and progressive, a stable or a regressive course of AE. In summary, the rapid decrease of antibodies against the E. multilocularis specific antigen Em2+, especially in cured patients, makes them a significant predictor for cured AE. The positive relation of E. multilocularis specific IgG4 responses and chemokine levels of TARC can indicate AE progression when both enhance over time. Enhanced levels of cytokines IL-8, IL-10, and chemokines MCP4 and LARC may predict AE regression. Repeated biomarker surveys are advisable to evaluate progression or regression of AE during longitudinal follow up, and such analyses can support imaging techniques and improve staging of AE patients.
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Affiliation(s)
- Beate Grüner
- University Hospital of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Ulm, Germany
| | - Lynn Peters
- University Hospital of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Ulm, Germany
| | - Andreas Hillenbrand
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
| | - Patrick Voßberg
- University Clinics Tübingen, Institute for Tropical Medicine, Eberhard-Karls University, Tübingen, Germany
| | - Jonas Schweiker
- University Clinics Tübingen, Institute for Tropical Medicine, Eberhard-Karls University, Tübingen, Germany
| | - Elisabeth G. Rollmann
- University Clinics Tübingen, Institute for Tropical Medicine, Eberhard-Karls University, Tübingen, Germany
| | - Laura H. Rodriguez
- University Clinics Tübingen, Institute for Tropical Medicine, Eberhard-Karls University, Tübingen, Germany
| | - Jasmin Blumhardt
- University Clinics Tübingen, Institute for Tropical Medicine, Eberhard-Karls University, Tübingen, Germany
| | - Sanne Burkert
- University Hospital of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Ulm, Germany
| | - Peter Kern
- University Hospital of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Ulm, Germany
| | - Carsten Köhler
- University Clinics Tübingen, Institute for Tropical Medicine, Eberhard-Karls University, Tübingen, Germany
| | - Peter T. Soboslay
- University Clinics Tübingen, Institute for Tropical Medicine, Eberhard-Karls University, Tübingen, Germany
- * E-mail:
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Körper S, Weiss M, Zickler D, Wiesmann T, Zacharowski K, Corman VM, Grüner B, Ernst L, Spieth P, Lepper PM, Bentz M, Zinn S, Paul G, Kalbhenn J, Dollinger MM, Rosenberger P, Kirschning T, Thiele T, Appl T, Mayer B, Schmidt M, Drosten C, Wulf H, Kruse JM, Jungwirth B, Seifried E, Schrezenmeier H. Results of the CAPSID randomized trial for high-dose convalescent plasma in patients with severe COVID-19. J Clin Invest 2021; 131:e152264. [PMID: 34464358 DOI: 10.1172/jci152264] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/26/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUNDCOVID-19 convalescent plasma (CCP) has been considered a treatment option for COVID-19. This trial assessed the efficacy of a neutralizing antibody containing high-dose CCP in hospitalized adults with COVID-19 requiring respiratory support or intensive care treatment.METHODSPatients (n = 105) were randomized 1:1 to either receive standard treatment and 3 units of CCP or standard treatment alone. Control group patients with progress on day 14 could cross over to the CCP group. The primary outcome was a dichotomous composite outcome of survival and no longer fulfilling criteria for severe COVID-19 on day 21.ResultsThe primary outcome occurred in 43.4% of patients in the CCP group and 32.7% in the control group (P = 0.32). The median time to clinical improvement was 26 days in the CCP group and 66 days in the control group (P = 0.27). The median time to discharge from the hospital was 31 days in the CCP group and 51 days in the control group (P = 0.24). In the subgroup that received a higher cumulative amount of neutralizing antibodies, the primary outcome occurred in 56.0% of the patients (vs. 32.1%), with significantly shorter intervals to clinical improvement (20 vs. 66 days, P < 0.05) and to hospital discharge (21 vs. 51 days, P = 0.03) and better survival (day-60 probability of survival 91.6% vs. 68.1%, P = 0.02) in comparison with the control group.ConclusionCCP added to standard treatment was not associated with a significant improvement in the primary and secondary outcomes. A predefined subgroup analysis showed a significant benefit of CCP among patients who received a larger amount of neutralizing antibodies.Trial registrationClinicalTrials.gov NCT04433910.FundingBundesministerium für Gesundheit (German Federal Ministry of Health): ZMVI1-2520COR802.
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Affiliation(s)
- Sixten Körper
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm, and Institute of Transfusion Medicine, and
| | - Manfred Weiss
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm University, Ulm, Germany
| | - Daniel Zickler
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thomas Wiesmann
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University Marburg, Marburg, Germany
| | - Kai Zacharowski
- Clinic of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Victor M Corman
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and German Centre for Infection Research, Berlin, Germany
| | - Beate Grüner
- Division of Infectious Diseases, University Hospital and Medical Center Ulm, Ulm, Germany
| | - Lucas Ernst
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Philipp M Lepper
- Department of Internal Medicine V - Pneumology, Allergology, Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Martin Bentz
- Department of Internal Medicine III, Hospital of Karlsruhe, Karlsruhe, Germany
| | - Sebastian Zinn
- Clinic of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Gregor Paul
- Department of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Klinikum Stuttgart, Stuttgart, Germany
| | - Johannes Kalbhenn
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Thomas Kirschning
- Department of Anaesthesiology and Surgical Intensive Care Medicine, University of Heidelberg, University Medical Centre Mannheim, Mannheim, Germany
| | - Thomas Thiele
- Institute of Immunology and Transfusion Medicine, University Hospital Greifswald, Greifswald, Germany
| | - Thomas Appl
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm, and Institute of Transfusion Medicine, and
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Michael Schmidt
- Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, Frankfurt, Germany
| | - Christian Drosten
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and German Centre for Infection Research, Berlin, Germany
| | - Hinnerk Wulf
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University Marburg, Marburg, Germany
| | - Jan Matthias Kruse
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Bettina Jungwirth
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm University, Ulm, Germany
| | - Erhard Seifried
- Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, Frankfurt, Germany
| | - Hubert Schrezenmeier
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm, and Institute of Transfusion Medicine, and
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17
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Körper S, Weiss M, Zickler D, Wiesmann T, Zacharowski K, Corman VM, Grüner B, Ernst L, Spieth P, Lepper PM, Bentz M, Zinn S, Paul G, Kalbhenn J, Dollinger MM, Rosenberger P, Kirschning T, Thiele T, Appl T, Mayer B, Schmidt M, Drosten C, Wulf H, Kruse JM, Jungwirth B, Seifried E, Schrezenmeier H. Results of the CAPSID randomized trial for high-dose convalescent plasma in patients with severe COVID-19. J Clin Invest 2021. [PMID: 34464358 DOI: 10.1101/2021.05.10.21256192] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
BACKGROUNDCOVID-19 convalescent plasma (CCP) has been considered a treatment option for COVID-19. This trial assessed the efficacy of a neutralizing antibody containing high-dose CCP in hospitalized adults with COVID-19 requiring respiratory support or intensive care treatment.METHODSPatients (n = 105) were randomized 1:1 to either receive standard treatment and 3 units of CCP or standard treatment alone. Control group patients with progress on day 14 could cross over to the CCP group. The primary outcome was a dichotomous composite outcome of survival and no longer fulfilling criteria for severe COVID-19 on day 21.ResultsThe primary outcome occurred in 43.4% of patients in the CCP group and 32.7% in the control group (P = 0.32). The median time to clinical improvement was 26 days in the CCP group and 66 days in the control group (P = 0.27). The median time to discharge from the hospital was 31 days in the CCP group and 51 days in the control group (P = 0.24). In the subgroup that received a higher cumulative amount of neutralizing antibodies, the primary outcome occurred in 56.0% of the patients (vs. 32.1%), with significantly shorter intervals to clinical improvement (20 vs. 66 days, P < 0.05) and to hospital discharge (21 vs. 51 days, P = 0.03) and better survival (day-60 probability of survival 91.6% vs. 68.1%, P = 0.02) in comparison with the control group.ConclusionCCP added to standard treatment was not associated with a significant improvement in the primary and secondary outcomes. A predefined subgroup analysis showed a significant benefit of CCP among patients who received a larger amount of neutralizing antibodies.Trial registrationClinicalTrials.gov NCT04433910.FundingBundesministerium für Gesundheit (German Federal Ministry of Health): ZMVI1-2520COR802.
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Affiliation(s)
- Sixten Körper
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm, and Institute of Transfusion Medicine, and
| | - Manfred Weiss
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm University, Ulm, Germany
| | - Daniel Zickler
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thomas Wiesmann
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University Marburg, Marburg, Germany
| | - Kai Zacharowski
- Clinic of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Victor M Corman
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and German Centre for Infection Research, Berlin, Germany
| | - Beate Grüner
- Division of Infectious Diseases, University Hospital and Medical Center Ulm, Ulm, Germany
| | - Lucas Ernst
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Philipp M Lepper
- Department of Internal Medicine V - Pneumology, Allergology, Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Martin Bentz
- Department of Internal Medicine III, Hospital of Karlsruhe, Karlsruhe, Germany
| | - Sebastian Zinn
- Clinic of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Gregor Paul
- Department of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Klinikum Stuttgart, Stuttgart, Germany
| | - Johannes Kalbhenn
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Thomas Kirschning
- Department of Anaesthesiology and Surgical Intensive Care Medicine, University of Heidelberg, University Medical Centre Mannheim, Mannheim, Germany
| | - Thomas Thiele
- Institute of Immunology and Transfusion Medicine, University Hospital Greifswald, Greifswald, Germany
| | - Thomas Appl
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm, and Institute of Transfusion Medicine, and
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Michael Schmidt
- Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, Frankfurt, Germany
| | - Christian Drosten
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and German Centre for Infection Research, Berlin, Germany
| | - Hinnerk Wulf
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University Marburg, Marburg, Germany
| | - Jan Matthias Kruse
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Bettina Jungwirth
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm University, Ulm, Germany
| | - Erhard Seifried
- Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, Frankfurt, Germany
| | - Hubert Schrezenmeier
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm, and Institute of Transfusion Medicine, and
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18
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Peters L, Burkert S, Grüner B. Parasites of the liver - epidemiology, diagnosis and clinical management in the European context. J Hepatol 2021; 75:202-218. [PMID: 33636243 DOI: 10.1016/j.jhep.2021.02.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 12/13/2022]
Abstract
Parasites in the liver cause significant global morbidity and mortality, as they can lead to recurrent cholangitis, cirrhosis, liver failure and cancer. Due to climate change and globalisation, their incidence is increasing, especially in Europe. The correct diagnosis of a hepatic parasite is often delayed because clinicians are unfamiliar with respective entities. Therefore, in this review, we aim to provide clinicians with a comprehensive clinical picture of hepatic parasites and to bring these neglected parasitic liver diseases to the wider attention of hepatology stakeholders in Europe and around the world.
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Affiliation(s)
- Lynn Peters
- University Hospital of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Sanne Burkert
- University Hospital of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Beate Grüner
- University Hospital of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
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Müller JA, Groß R, Conzelmann C, Krüger J, Merle U, Steinhart J, Weil T, Koepke L, Bozzo CP, Read C, Fois G, Eiseler T, Gehrmann J, van Vuuren J, Wessbecher IM, Frick M, Costa IG, Breunig M, Grüner B, Peters L, Schuster M, Liebau S, Seufferlein T, Stenger S, Stenzinger A, MacDonald PE, Kirchhoff F, Sparrer KMJ, Walther P, Lickert H, Barth TFE, Wagner M, Münch J, Heller S, Kleger A. SARS-CoV-2 infects and replicates in cells of the human endocrine and exocrine pancreas. Nat Metab 2021; 3:149-165. [PMID: 33536639 DOI: 10.1038/s42255-021-00347-1] [Citation(s) in RCA: 318] [Impact Index Per Article: 106.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/14/2021] [Indexed: 02/07/2023]
Abstract
Infection-related diabetes can arise as a result of virus-associated β-cell destruction. Clinical data suggest that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing the coronavirus disease 2019 (COVID-19), impairs glucose homoeostasis, but experimental evidence that SARS-CoV-2 can infect pancreatic tissue has been lacking. In the present study, we show that SARS-CoV-2 infects cells of the human exocrine and endocrine pancreas ex vivo and in vivo. We demonstrate that human β-cells express viral entry proteins, and SARS-CoV-2 infects and replicates in cultured human islets. Infection is associated with morphological, transcriptional and functional changes, including reduced numbers of insulin-secretory granules in β-cells and impaired glucose-stimulated insulin secretion. In COVID-19 full-body postmortem examinations, we detected SARS-CoV-2 nucleocapsid protein in pancreatic exocrine cells, and in cells that stain positive for the β-cell marker NKX6.1 and are in close proximity to the islets of Langerhans in all four patients investigated. Our data identify the human pancreas as a target of SARS-CoV-2 infection and suggest that β-cell infection could contribute to the metabolic dysregulation observed in patients with COVID-19.
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Affiliation(s)
- Janis A Müller
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany
| | - Rüdiger Groß
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany
| | - Carina Conzelmann
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany
| | - Jana Krüger
- Department of Internal Medicine 1, Ulm University Hospital, Ulm, Germany
| | - Uta Merle
- Department of Internal Medicine 4, University of Heidelberg, Heidelberg, Germany
| | | | - Tatjana Weil
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany
| | - Lennart Koepke
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany
| | | | - Clarissa Read
- Central Facility for Electron Microscopy, Ulm University, Ulm, Germany
- Institute of Virology, Ulm University Medical Center, Ulm, Germany
| | - Giorgio Fois
- Institute of General Physiology, Ulm University, Ulm, Germany
| | - Tim Eiseler
- Department of Internal Medicine 1, Ulm University Hospital, Ulm, Germany
| | - Julia Gehrmann
- Institute for Computational Genomics, RWTH Aachen University, Aachen, Germany
| | - Joanne van Vuuren
- Institute of Diabetes and Regeneration Research, Helmholtz Zentrum München, Neuherberg, Germany
- Institute of Stem Cell Research, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- School of Medicine, Technical University of Munich, Munich, Germany
| | - Isabel M Wessbecher
- Tissue Bank of the German Center for Infection Research, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Manfred Frick
- Institute of General Physiology, Ulm University, Ulm, Germany
| | - Ivan G Costa
- Institute for Computational Genomics, RWTH Aachen University, Aachen, Germany
| | - Markus Breunig
- Department of Internal Medicine 1, Ulm University Hospital, Ulm, Germany
| | - Beate Grüner
- Department of Internal Medicine 3, Ulm University Hospital, Ulm, Germany
| | - Lynn Peters
- Department of Internal Medicine 3, Ulm University Hospital, Ulm, Germany
| | - Michael Schuster
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Stefan Liebau
- Institute of Neuroanatomy & Developmental Biology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Thomas Seufferlein
- Department of Internal Medicine 1, Ulm University Hospital, Ulm, Germany
| | - Steffen Stenger
- Institute for Microbiology and Hygiene, Ulm University Medical Center, Ulm, Germany
| | | | - Patrick E MacDonald
- Alberta Diabetes Institute and Department of Pharmacology, University of Alberta, Edmonton, Canada
| | - Frank Kirchhoff
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany
| | | | - Paul Walther
- Central Facility for Electron Microscopy, Ulm University, Ulm, Germany
| | - Heiko Lickert
- Institute of Diabetes and Regeneration Research, Helmholtz Zentrum München, Neuherberg, Germany
- Institute of Stem Cell Research, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Martin Wagner
- Department of Internal Medicine 1, Ulm University Hospital, Ulm, Germany.
| | - Jan Münch
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany.
| | - Sandra Heller
- Department of Internal Medicine 1, Ulm University Hospital, Ulm, Germany.
| | - Alexander Kleger
- Department of Internal Medicine 1, Ulm University Hospital, Ulm, Germany.
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Grimm J, Krickl J, Beck A, Nell J, Bergmann M, Tappe D, Grüner B, Barth TFE, Brehm K. Establishing and evaluation of a polymerase chain reaction for the detection of Echinococcus multilocularis in human tissue. PLoS Negl Trop Dis 2021; 15:e0009155. [PMID: 33630840 PMCID: PMC7906421 DOI: 10.1371/journal.pntd.0009155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/19/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Alveolar echinococcosis (AE) is caused by metacestode larva of the tapeworm Echinococcus multilocularis. AE diagnostics currently rely on imaging techniques supported by serology, but unequivocal detection of AE is difficult. Although polymerase chain reaction (PCR)-based methods to detect tapeworm DNA in biopsies have been suggested for several species, no validated protocol adhering to accepted guidelines has so far been presented for AE diagnostics. We herein established a PCR protocol for metacestode biopsies and technically evaluated the method using isolated parasite DNA and cells, biopsies of clinically relevant material, and formalin fixed paraffin-embedded (FFPE) human tissue blocks. We compared the results with an immunochemical (IHC) approach using the monoclonal antibody Em2G11 specific for the antigen Em2 of E. mulitlocularis. METHODOLOGY/PRINCIPAL FINDINGS Based on tapeworm 12S rDNA sequences we established and validated a PCR protocol for robust detection of as little as 50 parasite cells per specimen and report 127 cases of positive identification of Echinococcus species in samples from humans and animals. For further validation, we analyzed 45 liver, heart, brain, and soft tissue samples as well as cytological probes of aspirates of FFPE-material from 18 patients with clinically confirmed AE. Of each patient we analyzed (i) fully viable lesions with laminated layer; (ii) tissue with mAbEm2G11-positive small particles of E. multilocularis (spems); (iii) mAbEm2G11-negative tissue adjacent to the main lesion; and (iv) lymph node tissue with mAbEm2G11-positive spems. To identify the areas for the PCR-based approach, we performed IHC-staining with the monoclonal antibody Em2G11. Micro-dissected tissue of these areas was then used for PCR-analysis. 9 of 15 analyzed samples with viable E. multilocularis lesions with laminated layer were positive by PCR. Of this group, all samples preserved for less than 6 years (6/6) were tested positive. 11 of 15 samples of spems and 7 of 9 samples of the control group mAbEm2G11-negative tissue were negative by PCR. We further show that all probes from lymph nodes with spems are PCR negative. CONCLUSIONS/SIGNIFICANCE We present a sensitive PCR method for the detection of E. multilocularis in human tissue, particularly in fresh biopsy material and tissue blocks stored for less than 5 years. While the diagnostic sensitivity of material containing only spems was higher using IHC, PCR detection was possible in IHC negative liver tissue and in patients with negative serology. Our results support the view that spems do not contain parasitic DNA or viable cells of the parasite. spems thus most probably do not directly contribute to metastasis formation during AE.
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Affiliation(s)
| | - Julian Krickl
- Consultant Laboratory for Echinococcosis, Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Annika Beck
- Institute of Pathology, University of Ulm, Ulm, Germany
| | - Juliane Nell
- Institute of Pathology, University of Ulm, Ulm, Germany
| | - Monika Bergmann
- Consultant Laboratory for Echinococcosis, Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Dennis Tappe
- Consultant Laboratory for Echinococcosis, Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Beate Grüner
- Division of Infectious Diseases, University Hospital and Medical Center, Ulm, Germany
| | | | - Klaus Brehm
- Consultant Laboratory for Echinococcosis, Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
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21
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Rüthrich MM, Giessen-Jung C, Borgmann S, Classen AY, Dolff S, Grüner B, Hanses F, Isberner N, Köhler P, Lanznaster J, Merle U, Nadalin S, Piepel C, Schneider J, Schons M, Strauss R, Tometten L, Vehreschild JJ, von Lilienfeld-Toal M, Beutel G, Wille K. COVID-19 in cancer patients: clinical characteristics and outcome-an analysis of the LEOSS registry. Ann Hematol 2020; 100:383-393. [PMID: 33159569 PMCID: PMC7648543 DOI: 10.1007/s00277-020-04328-4] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023]
Abstract
Introduction Since the early SARS-CoV-2 pandemic, cancer patients have been assumed to be at higher risk for severe COVID-19. Here, we present an analysis of cancer patients from the LEOSS (Lean European Open Survey on SARS-CoV-2 Infected Patients) registry to determine whether cancer patients are at higher risk. Patients and methods We retrospectively analyzed a cohort of 435 cancer patients and 2636 non-cancer patients with confirmed SARS-CoV-2 infection, enrolled between March 16 and August 31, 2020. Data on socio-demographics, comorbidities, cancer-related features and infection course were collected. Age-, sex- and comorbidity-adjusted analysis was performed. Primary endpoint was COVID-19-related mortality. Results In total, 435 cancer patients were included in our analysis. Commonest age category was 76–85 years (36.5%), and 40.5% were female. Solid tumors were seen in 59% and lymphoma and leukemia in 17.5% and 11% of patients. Of these, 54% had an active malignancy, and 22% had recently received anti-cancer treatments. At detection of SARS-CoV-2, the majority (62.5%) presented with mild symptoms. Progression to severe COVID-19 was seen in 55% and ICU admission in 27.5%. COVID-19-related mortality rate was 22.5%. Male sex, advanced age, and active malignancy were associated with higher death rates. Comparing cancer and non-cancer patients, age distribution and comorbidity differed significantly, as did mortality (14% vs 22.5%, p value < 0.001). After adjustments for other risk factors, mortality was comparable. Conclusion Comparing cancer and non-cancer patients, outcome of COVID-19 was comparable after adjusting for age, sex, and comorbidity. However, our results emphasize that cancer patients as a group are at higher risk due to advanced age and pre-existing conditions. Supplementary Information The online version contains supplementary material available at 10.1007/s00277-020-04328-4.
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Affiliation(s)
- Maria Madeleine Rüthrich
- Department of Internal Medicine II, Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany. .,Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knöll Institute, Jena, Germany.
| | - C Giessen-Jung
- Department of Internal Medicine III, Ludwig Maximilian University, Munich, Germany
| | - S Borgmann
- Department of Infectious Diseases and Infection Control, Ingolstadt Hospital, Ingolstadt, Germany
| | - A Y Classen
- Department I for Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - S Dolff
- Department of Infectious Diseases, University Hospital Essen, University Duisburg Essen, Essen, Germany
| | - B Grüner
- Section Clinical Infectiology, University Hospital Ulm, Ulm, Germany
| | - F Hanses
- Emergency Department, University Hospital Regensburg, Regensburg, Germany
| | - N Isberner
- Department of Internal Medicine II, Division of Infectious Diseases, University Hospital Würzburg, Würzburg, Germany
| | - P Köhler
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - J Lanznaster
- Department of Internal Medicine II, Passau Hospital, Passau, Germany
| | - U Merle
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - S Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - C Piepel
- Hospital Bremen-Center, Bremen, Germany
| | - J Schneider
- Department of Internal Medicine II, Technical University of Munich, School of Medicine, University hospital rechts der Isar, Munich, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - M Schons
- Department I for Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - R Strauss
- Medical Clinic I, University Hospital Erlangen, Erlangen, Germany
| | - L Tometten
- Department of Gastroenterology and Infectiology, Hospital Ernst-von-Bergmann, Potsdam, Germany
| | - J J Vehreschild
- Department I for Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany.,Department of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - M von Lilienfeld-Toal
- Department of Internal Medicine II, Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.,Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knöll Institute, Jena, Germany
| | - G Beutel
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - K Wille
- University of Bochum, University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Minden, Germany
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22
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Schmidberger J, Steinbach J, Schlingeloff P, Kratzer W, Grüner B. Surgery versus conservative drug therapy in alveolar echinococcosis patients in Germany - A health-related quality of life comparison. Food Waterborne Parasitol 2019; 16:e00057. [PMID: 32095627 PMCID: PMC7034038 DOI: 10.1016/j.fawpar.2019.e00057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/29/2019] [Accepted: 05/10/2019] [Indexed: 02/07/2023] Open
Abstract
Alveolar echinococcosis (AE) is a rare zoonosis caused by the parasite Echinococcus multilocularis. Nothing is known about the health-related quality of life (HRQoL) in patients with AE receiving different types of therapy. Therefore, the aim of the study was to compare HRQoL in patients with AE in Germany depending on their therapeutic regimen namely conservative drug treatment with long-term benzimidazoles versus surgical therapy by resection of the parasitic liver lesions. The 36-Item Short Form Health Survey (SF-36) questionnaire, including other echinococcosis-related questions, was used to measure HRQoL. The SF-36 scales were evaluated according to the algorithms provided by the authors. The statistical analysis was performed with SAS version 9.2. The significance level was set at α = 0.05, p < 0.05 corresponds to statistical significance. The investigated group consisted of conservatively drug treated (n = 30) and patients with curative surgery (n = 25) with confirmed AE. The study was performed at an infectious disease outpatient department from April 2018 to October 2018. The conservatively drug treated patient group consisted of 15 men (50.0%) and 15 women (50.0%) with an average age of 55.7 ± 16.7 years (Median: 59). The surgery group consisted of nine men (36.0%) and 16 women (64.3%) with an average age of 53.3 ± 31.9 years (Median: 54). The physical quality of life of the conservatively drug treated patients did not show any significant differences to the surgical treated group (45.2 ± 11.4 vs. 47.6 ± 9.9; p = 0.4079). There was also no significant difference regarding the mental quality of life between the conservatively drug treated patients, and those treated with curative surgery (45.5 ± 10.6 vs. 47.3 ± 10.8; 0.5206). Nevertheless, there was a slight advantage in the physical and mental scores of the patients treated with surgery. Furthermore, for 13 of the 25 surgically treated patients, some aspects of the HRQoL improved significantly after surgery. The evaluation showed no statistically significant differences in HRQoL in patients with AE dependent on the applied treatment strategy (conservative drug versus curative surgical therapy).
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23
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Heimann SM, Vehreschild MJGT, Cornely OA, Heinz WJ, Grüner B, Silling G, Kessel J, Seidel D, Vehreschild JJ. Healthcare burden of probable and proven invasive mucormycosis: a multi-centre cost-of-illness analysis of patients treated in tertiary care hospitals between 2003 and 2016. J Hosp Infect 2018; 101:339-346. [PMID: 30423409 DOI: 10.1016/j.jhin.2018.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Invasive mucormycosis (IM) is a rare invasive fungal infection with a high mortality rate. However, data concerning the clinical and economic burden of IM are scarce. AIM To evaluate the direct treatment costs and additional expenditures of patients with IM. METHODS A retrospective cost-of-illness analysis of cases with IM extracted from FungiScope - Global Registry for Emerging Fungal Infections, accessible through the epidemiological research platform www.ClinicalSurveys.net, was undertaken. Results of patients with IM were compared with those of matched patients with similar underlying conditions based on the German Diagnosis Related Group (G-DRG) coding. FINDINGS Out of 46 patients with probable/proven IM, 31 (67%) patients were male and the median age was 53 years (range 11-88 years). Forty-two patients (92%) had haematological diseases as the most common risk factor. Analysis of cost factors identified antifungal treatment due to IM as the primary cost driver [€22,816, 95% confidence interval (CI) €15,036-32,346], with mean overall direct treatment costs of €53,261 (95% CI €39,660-68,825). Compared with matched patients, patients with IM were treated in hospital for 26.5 additional days (standard deviation 31.8 days; P < 0.001), resulting in mean additional costs of €32,991 (95% CI €21,558-46,613; P < 0.001). Probable IM, as well as absence of chemotherapy, surgical measures due to IM, and antifungal prophylaxis were associated with lower overall costs. Nineteen patients (41.3%) died during hospitalization. CONCLUSION This study demonstrates the considerable healthcare burden of IM. The choice of antifungal agent for treatment of IM had no impact on overall cost.
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Affiliation(s)
- S M Heimann
- University Hospital of Cologne, Department I of Internal Medicine, Cologne, Germany.
| | - M J G T Vehreschild
- University Hospital of Cologne, Department I of Internal Medicine, Cologne, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - O A Cornely
- University Hospital of Cologne, Department I of Internal Medicine, Cologne, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany; Clinical Trials Centre Cologne, ZKS Köln, and Cluster of Excellence, Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
| | - W J Heinz
- University of Würzburg Medical Centre, Med. Clinic II, Würzburg, Germany
| | - B Grüner
- University Medical Centre Ulm, Comprehensive Infectious Disease Centre, Ulm, Germany
| | - G Silling
- Department of Haematology, Oncology, Haemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - J Kessel
- University Hospital of Frankfurt, Department II of Internal Medicine, Infectiology, Frankfurt/Main, Germany
| | - D Seidel
- University Hospital of Cologne, Department I of Internal Medicine, Cologne, Germany
| | - J J Vehreschild
- University Hospital of Cologne, Department I of Internal Medicine, Cologne, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
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24
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Schmidberger J, Weimer H, Schlingeloff P, Kratzer W, Grüner B. Health-related quality of life in patients with alveolar echinococcosis: a cross-sectional study. Infection 2018; 47:67-75. [PMID: 30225656 DOI: 10.1007/s15010-018-1219-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 09/11/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE The Alveolar echinococcosis (AE) is a rare zoonosis caused by the parasite Echinococcus multilocularis. To date, nothing is known about the health-related quality of life (HRQoL) in patients with AE. The aim of the study was to evaluate the HRQoL in patients with AE in comparison of the healthy population. METHODS We used the 36-Item Short Form Health Survey (SF-36) questionnaire to evaluate the HRQoL. The SF-36 scales have a range of 0-100 (0 represents the worst and 100 the most favourable state of health). SAS Version 9.2 was used for the statistical analysis of AE-cases (n = 30) and the healthy control group (n = 35). RESULTS The analysis showed that the HRQoL in people with AE is reduced in comparison with the control population. The study group consisted of 15 (50.0%) men and 15 (50.0%) women; the control group of 16 (45.7%) men and 19 (54.3%) women. The mean age was 55.73 ± 16.65 years, while that of the control group was 54.57 ± 15.34 years. The physical quality of life in patients with AE (45.21 ± 11.42) was not significantly less than that of the control group (50.54 ± 10.52); p = 0.0568. Nevertheless, AE-patients show lower SF-36 scores for the physical quality of life. For the mental quality of life, patients with AE had a significantly lower score (45.46 ± 10.57) than the control group (51.57 ± 9.04); p = 0.0154. CONCLUSIONS The HRQoL in people with AE is reduced in comparison with a control population. Assessment of the physical and mental quality of life in patients with AE may help to evaluate the patient outcome.
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Affiliation(s)
- Julian Schmidberger
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Henriette Weimer
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Patrycja Schlingeloff
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Beate Grüner
- Department of Internal Medicine III, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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25
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Hagemann JB, Haverkamp S, Grüner B, Kuchenbauer F, Essig A. Pulmonary Campylobacter concisus infection in an immunocompromised patient with underlying mucormycosis. Int J Infect Dis 2018; 76:45-47. [PMID: 30201509 DOI: 10.1016/j.ijid.2018.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/24/2018] [Accepted: 08/30/2018] [Indexed: 12/18/2022] Open
Abstract
Campylobacter concisus is a rarely encountered agent of human infection. The first isolation of C. concisus from a pulmonary abscess in an immunocompromised patient who underwent allogeneic stem cell transplantation is reported here. This unusual case demonstrates the pathogenic potential of this bacterium and outlines species-immanent difficulties in gaining a reliable diagnosis. Molecular methods were a cornerstone for definite identification of the organism grown on anaerobic culture from surgically excised tissue. Antimicrobial susceptibility testing revealed unusual quinolone and macrolide resistance, and therefore antimicrobial therapy was based on β-lactam antibiotics.
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Affiliation(s)
- Jürgen Benjamin Hagemann
- Institute of Medical Microbiology and Hygiene, University Hospital of Ulm, Albert-Einstein-Allee 23, D-89081 Ulm, Germany.
| | - Stephanie Haverkamp
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Beate Grüner
- Department of Internal Medicine III, Comprehensive Infectious Diseases Centre, University Hospital of Ulm, Ulm, Germany
| | - Florian Kuchenbauer
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Andreas Essig
- Institute of Medical Microbiology and Hygiene, University Hospital of Ulm, Albert-Einstein-Allee 23, D-89081 Ulm, Germany
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26
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Huang X, Wiehr S, Wild AM, Voßberg P, Hoffmann W, Grüner B, Köhler C, Soboslay PT. The effects of taxanes, vorinostat and doxorubicin on growth and proliferation of Echinococcus multilocularis metacestodes assessed with magnetic resonance imaging and simultaneous positron emission tomography. Oncotarget 2018; 9:9073-9087. [PMID: 29507675 PMCID: PMC5823665 DOI: 10.18632/oncotarget.24142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 01/02/2018] [Indexed: 01/08/2023] Open
Abstract
Cytostatic drugs used in cancer therapy were evaluated for their capacity to inhibit Echinococcus multilocularis metacestode growth and proliferation. Metacestode tissues were exposed in vitro to docetaxel, doxorubicin, navelbine, paclitaxel, and vorinostat for 1 week, then incubated in drug-free culture, and thereafter metacestodes were injected into the peritoneum of Meriones unguiculatus. Magnetic resonance imaging (MRI) and simultaneous positron emission tomography (PET) were applied to monitor in vivo growth of drug-exposed E. multilocularis in Meriones. At 3 month p.i., docetaxel (at 10 μM, 5 μM and 2 μM) inhibited in vivo growth and proliferation of E. multilocularis, and at 5 months p.i., only in the 2 μM docetaxel exposure group 0.3 cm 3 of parasite tissue was found. With paclitaxel and navelbine the in vivo growth of metacestodes was suppressed until 3 months p.i., thereafter, parasite tissues enlarged up to 3 cm 3 in both groups. E. multilocularis tissues of more than 10 g developed in Meriones injected with metacestodes which were previously exposed in vitro to doxorubicin, navelbine, paclitaxel or vorinostat. In Meriones infected with metacestodes previously exposed to docetaxel, the in vivo grown parasite tissues weighted 0.2 g. In vitro cultured E. multilocularis metacestodes exposed to docetaxel did not produce vesicles until 7 weeks post drug exposure, while metacestodes exposed to doxorubicin, navelbine and vorinostat proliferated continuously. In summary, docetaxel, and less efficaciously paclitaxel, inhibited in vivo and in vitro parasite growth and proliferation, and these observations suggest further experimental studies with selected drug combinations which may translate into new treatment options against alveolar echinococcosis.
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Affiliation(s)
- Xiangsheng Huang
- Institute for Tropical Medicine, Eberhard Karls University, Tübingen, Germany
| | - Stefan Wiehr
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University, Tübingen, Germany
| | - Anna-Maria Wild
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University, Tübingen, Germany
| | - Patrick Voßberg
- Institute for Tropical Medicine, Eberhard Karls University, Tübingen, Germany
| | - Wolfgang Hoffmann
- Institute for Tropical Medicine, Eberhard Karls University, Tübingen, Germany
| | - Beate Grüner
- Section of Clinical Immunology and Infectiology, University Clinics Ulm, Ulm, Germany
| | - Carsten Köhler
- Institute for Tropical Medicine, Eberhard Karls University, Tübingen, Germany
| | - Peter T Soboslay
- Institute for Tropical Medicine, Eberhard Karls University, Tübingen, Germany
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Heizelmann A, Tasdemir S, Schmidberger J, Gräter T, Kratzer W, Grüner B. Measurements of the trapezius and erector spinae muscles using virtual touch imaging quantification ultrasound-Elastography: a cross section study. BMC Musculoskelet Disord 2017; 18:370. [PMID: 28841869 PMCID: PMC5574109 DOI: 10.1186/s12891-017-1733-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/16/2017] [Indexed: 01/12/2023] Open
Abstract
Background This study uses virtual touch imaging quantification (VTIQ) technology for the first time to conduct measurements of the trapezius and erector spinae muscles in a large study population. The significance of various influencing factors, such as age and sex, are also examined. Method The study population comprised 278 subjects. The Siemens Acuson S3000 and VTIQ technology were used for measurements of the trapezius and erector spinae muscles (Siemens Healthcare, Erlangen, Germany). Results The following mean values ± standard deviation were calculated: left trapezius: males 2.89 ± 0.38 m/s, females 2.71 ± 0.37 m/s; right trapezius: males 2.84 ± 0.41 m/s, females 2.70 ± 0.38 m/s; left erector spinae: males 2.97 ± 0.50 m/s, females 2.81 ± 0.57 m/s; right erector spinae: males 3.00 ± 0.52 m/s, females 2.77 ± 0.59 m/s. A significant difference between male and female subjects was demonstrated both for the shear wave velocities of the trapezius and erector spinae as well as for the thickness of the trapezius muscle (p < 0.05). There was also a significant difference in muscle elasticity between subjects over 60 years of age and those under 60 (p < 0.05). Furthermore, the results indicate that regular physical activity has an effect on muscle elasticity. Conclusions Our results demonstrate significantly different results between male and female subjects and between under- and over-sixty-year-old subjects. This means that sex-related and age-adapted considerations are obviously needed for further studies.
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Affiliation(s)
- Anne Heizelmann
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee, 23 89081, Ulm, Germany
| | - Sümeyra Tasdemir
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee, 23 89081, Ulm, Germany
| | - Julian Schmidberger
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee, 23 89081, Ulm, Germany
| | - Tilmann Gräter
- Department of Diagnostic and Interventional Radiology, Ulm University Hospital, Albert-Einstein-Allee 23, Ulm, 89081, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee, 23 89081, Ulm, Germany.
| | - Beate Grüner
- Department of Internal Medicine III, Ulm University Hospital, Albert-Einstein-Allee 23, Ulm, 89081, Germany
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Grüner B, Schmidberger J, Drews O, Kratzer W, Gräter T. Imaging in alveolar echinococcosis (AE): Comparison of Echinococcus multilocularis classification for computed-tomography (EMUC-CT) and ultrasonography (EMUC-US). ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.jrid.2017.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ricken FJ, Nell J, Grüner B, Schmidberger J, Kaltenbach T, Kratzer W, Hillenbrand A, Henne-Bruns D, Deplazes P, Moller P, Kern P, Barth TFE. Albendazole increases the inflammatory response and the amount of Em2-positive small particles of Echinococcus multilocularis (spems) in human hepatic alveolar echinococcosis lesions. PLoS Negl Trop Dis 2017; 11:e0005636. [PMID: 28542546 PMCID: PMC5462468 DOI: 10.1371/journal.pntd.0005636] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 06/07/2017] [Accepted: 05/10/2017] [Indexed: 12/17/2022] Open
Abstract
Background Alveolar echinococcosis (AE) is caused by the metacestode stage of Echinococcus multilocularis. The inflammatory response to this infection is influenced by the interaction of the parasite with the host. We aimed to analyze human liver lesions infected with Echinococcus multilocularis and the changes of the cellular infiltrates during albendazole (ABZ) treatment. Methodology/Principal findings We analyzed liver tissue samples from 8 untreated patients, 5 patients treated with two daily doses of 400 mg ABZ for up to two months and 7 patients treated for more than two months with the same ABZ therapy. A broad panel of monoclonal antibodies was used to characterize the lesion by immunohistochemistry. A change in the cellular infiltrate was observed between the different chemotherapy times. During the initial phases of treatment an increase in CD15+ granulocytes and CD68+ histocytes as well as in small particles of Echinococcus multilocularis (spems) was observed in the tissue surrounding the metacestode. Furthermore, we observed an increase in CD4+ T cells, CD20+ B cells and CD38+ plasma cells during a longer duration of treatment. Conclusions/Significance ABZ treatment of AE leads to morphological changes characterized by an initial, predominantly acute, inflammatory response which is gradually replaced by a response of the adaptive immune system. Alveolar echinococcosis (AE) is a life-threatening disease in humans caused by the larval stages of E. multilocularis. It has been shown that the infection in humans is associated with a modulated immune response. Depending on multiple factors, such as the stage of disease, total or partial surgical resection and albendazole (ABZ) therapy are treatments of choice. ABZ is known as a parasitostatic drug that has to be administered for years to suppress metacestode development. Here we compared human liver lesions before and after short and long term treatment with ABZ by immunohistochemistry using a broad panel of antibodies. We found a change in the cellular infiltrate, characterized by a shift to an infiltrate rich in T cells, B cells and plasma cells during long-term treatment with ABZ, including a pronounced detection of small particles of E. multilocularis (spems). We argue that ABZ treatment is likely to change the cellular infiltrate, leading to an enhancement of the host immune response during treatment.
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Affiliation(s)
| | - Juliane Nell
- Institute of Pathology, Ulm University, Ulm, Germany
| | - Beate Grüner
- Division of Infectious Diseases, University Hospital and Medical Center, Ulm, Germany
| | | | - Tanja Kaltenbach
- Department of Medicine I, University Hospital of Ulm, Ulm, Germany
| | - Wolfgang Kratzer
- Department of Medicine I, University Hospital of Ulm, Ulm, Germany
| | - Andreas Hillenbrand
- Department of General and Visceral Surgery, University Hospital of Ulm, Ulm, Germany
| | - Doris Henne-Bruns
- Department of General and Visceral Surgery, University Hospital of Ulm, Ulm, Germany
| | - Peter Deplazes
- Institute of Parasitology, University of Zürich, Zürich, Switzerland
| | - Peter Moller
- Institute of Pathology, Ulm University, Ulm, Germany
| | - Peter Kern
- Division of Infectious Diseases, University Hospital and Medical Center, Ulm, Germany
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30
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Gräter T, Kratzer W, Seufferlein T, Schmiedberger J, Leitner E, Grüner B. Auswertung bildmorphologischer Kriterien bei alveolärer Echinokokkose der Leber anhand der EMUC-CT Klassifikation. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- T Gräter
- Universitätsklinikum Ulm, Klinik für Diagnostische und Interventionelle Radiologie, Ulm
| | - W Kratzer
- Universitätsklinikum Ulm, Klinik für Innere Medizin I, Ulm
| | - T Seufferlein
- Universitätsklinikum Ulm, Klinik für Innere Medizin I, Ulm
| | | | - E Leitner
- Universitätsklinikum Ulm, Klinik für Innere Medizin I, Ulm
| | - B Grüner
- Universitätsklinikum Ulm, Klinik für Innere Medizin III, Ulm
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Grüner B, Kern P, Mayer B, Gräter T, Hillenbrand A, Barth TEF, Muche R, Henne-Bruns D, Kratzer W, Kern P. Comprehensive diagnosis and treatment of alveolar echinococcosis: A single-center, long-term observational study of 312 patients in Germany. GMS Infect Dis 2017; 5:Doc01. [PMID: 30671323 PMCID: PMC6301735 DOI: 10.3205/id000027] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Alveolar echinococcosis (AE) is the most Iethal human helminthic infection. The malignancy-like disease is rare, but morbidity and treatment costs are high. Objective of the study was to identify factors at baseline and during specific AE therapy influencing the long-term outcome of the disease. All patients with AE seen at the specialized treatment unit in Ulm between January 1992 and December 2011 were included in the analysis. The data of 312 patients were analyzed; 108 were diagnosed before 2000 (series A), 204 since 2000 (series B); 290 received specific AE treatment. Patients of series B were more often symptom-free at diagnosis (44.1% vs. 21.3%), had lower disease stages (50.0% vs. 34.2%) and more complete resections (57.7% vs. 20.0%), but higher rates of side effects and drug toxicity (54.1% vs. 40.8%). In series B, more patients remained relapse- or progression-free after 5 years (90.5% vs. 82.8%); after 10 years, the ratio of relapses converged (70.3% vs. 66.9%, p=0.0507). Relapses or progression occurred more often after incomplete surgery or long treatment pauses. The 5-year and 10-year survival rates were 96.9% and 90.6%, respectively, and 17% of the patients were cured. We observed a shift towards early diagnosis, earlier initiation of specific therapy and more complete resections after 2000. Although diagnosis and treatment of AE pose a challenge, with an individual interdisciplinary management 88.8% of the patients have a favorable outcome.
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Affiliation(s)
- Beate Grüner
- Department of Internal Medicine III, University Hospital Ulm, Germany
| | - Petra Kern
- Institute of Epidemiology and Medical Biometry, University of Ulm, Germany
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, University of Ulm, Germany
| | - Tilmann Gräter
- Department of Interventional and Diagnostic Radiology, University Hospital Ulm, Germany
| | | | | | - Rainer Muche
- Institute of Epidemiology and Medical Biometry, University of Ulm, Germany
| | | | - Wolfgang Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Germany
| | - Peter Kern
- Department of Internal Medicine III, University Hospital Ulm, Germany
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Ambregna S, Koch S, Sulz MC, Grüner B, Öztürk S, Chevaux JB, Sulima M, de Gottardi A, Napoléon B, Abergel A, Bichard P, Boytchev I, Deprez P, Dumortier J, Frossard JL, Kull E, Meny B, Moradpour D, Prat F, Vanbiervliet G, Thevenot T, Vuitton DA, Bresson-Hadni S, Vuitton L. A European survey of perendoscopic treatment of biliary complications in patients with alveolar echinococcosis. Expert Rev Anti Infect Ther 2016; 15:79-88. [PMID: 27788612 DOI: 10.1080/14787210.2017.1252260] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Biliary complications represent a turning point in the course of Alveolar Echinococcosis (AE). We conducted a European survey to collect data on the current usage and results of perendoscopic interventions (PEIs) for their treatment. METHODS Patient's characteristics and follow-up until January 31st, 2015 were recorded using an online questionnaire. RESULTS From 18 centers 129 PEIs were analyzed in 38 patients; 139 plastic stents were inserted during 85 PEIs; median time between stent placements was significantly longer when 3 stents or more were placed. Initial symptoms disappeared in 95% and long-term bile duct patency was obtained in 73% of cases. Cholangitis was a more frequent complication of the PEIs (10%) than in other indications; intensive lavage of the bile ducts may prevent this complication. CONCLUSION European centers use perendoscopic biliary drainage as an efficient and safe alternative to surgery to treat AE biliary complications. Insertion of multiple plastic stents delays stent occlusion and leads to effective and prolonged bile duct patency.
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Affiliation(s)
- Sylvain Ambregna
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
| | - Stéphane Koch
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
| | - Michael C Sulz
- b Division of Gastroenterology and Hepatology , Kantonsspital , St. Gall , Switzerland
| | | | | | | | - Małgorzata Sulima
- e Institute of Maritime and Tropical Medicine in Gdynia , Medical University of Gdynia , Poland
| | | | - Bertrand Napoléon
- g Gastroenterology department, Mermoz Private Hospital , Générale de Santé , Lyon , France
| | - Armand Abergel
- h Gastroenterology and Hepatology department , University Hospital , Clermont-Ferrand , France
| | - Philippe Bichard
- i Gastroenterology and Hepatology department , University Hospital , Grenoble , France
| | - Isabelle Boytchev
- j Gastroenterology department , Kremlin-Bicêtre University Hospital , Paris , France
| | - Pierre Deprez
- k Gastroenterology department , Saint-Luc University Hospital , Brussels , Belgium
| | - Jerome Dumortier
- l Department of digestive diseases , Edouard Herriot University Hospital , Lyon , France
| | - Jean-Louis Frossard
- m Hepato-Pancreato-Biliary Centre , University Hospital , Geneva , Switzerland
| | - Eric Kull
- n Gastroenterology and Hepatology department , Regional Hospital , Metz , France
| | - Bernard Meny
- o Gastroenterology unit , Clinique Drevon , Dijon , France
| | - Darius Moradpour
- p Gastroenterology and Hepatology department , University Hospital , Lausanne , Switzerland
| | - Fréderic Prat
- q Gastroenterology department , Cochin University Hospital , Paris , France
| | | | - Thierry Thevenot
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
| | - Dominique Angèle Vuitton
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
| | - Solange Bresson-Hadni
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
| | - Lucine Vuitton
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
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Affiliation(s)
- Pisa Joachim Richter
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Unversität, Moorenstr. 5, D-40225, Düsseldorf, Deutschland,
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Kaltenmeier C, Gawanbacht A, Beyer T, Lindner S, Trzaska T, van der Merwe JA, Härter G, Grüner B, Fabricius D, Lotfi R, Schwarz K, Schütz C, Hönig M, Schulz A, Kern P, Bommer M, Schrezenmeier H, Kirchhoff F, Jahrsdörfer B. CD4+ T cell-derived IL-21 and deprivation of CD40 signaling favor the in vivo development of granzyme B-expressing regulatory B cells in HIV patients. J Immunol 2015; 194:3768-77. [PMID: 25780036 DOI: 10.4049/jimmunol.1402568] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 02/17/2015] [Indexed: 12/14/2022]
Abstract
IL-21 can induce both plasma cells and regulatory B cells. In this article, we demonstrate that untreated HIV patients display CD4(+) T cells with enhanced IL-21 expression and high in vivo frequencies of regulatory B cells overexpressing the serine protease granzyme B. Granzyme B-expressing regulatory B cells (GraB cells) cells from HIV patients exhibit increased expression of CD5, CD43, CD86, and CD147 but do not produce IL-10. The main functional characteristic of their regulatory activity is direct granzyme B-dependent degradation of the TCR-ζ-chain, resulting in significantly decreased proliferative T cell responses. Although Th cells from HIV patients secrete IL-21 in a Nef-dependent manner, they barely express CD40L. When culturing such IL-21(+)CD40L(-) Th cells with B cells, the former directly induce B cell differentiation into GraB cells. In contrast, the addition of soluble CD40L multimers to T cell/B cell cultures redirects B cell differentiation toward plasma cells, indicating that CD40L determines the direction of IL-21-dependent B cell differentiation. As proof of principle, we confirmed this mechanism in a patient lacking intact CD40 signaling due to a NEMO mutation. The majority of peripheral B cells from this patient were GraB cells and strongly suppressed T cell proliferation. In conclusion, GraB cells represent potent regulatory B cells in humans that are phenotypically and functionally distinct from B10 cells and occur in early HIV infection. GraB cells may contribute significantly to immune dysfunction in HIV patients, and may also explain ineffective Ab responses after vaccination. The use of soluble CD40L multimers may help to improve vaccination responses in HIV patients.
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Affiliation(s)
- Christof Kaltenmeier
- Institute of Transfusion Medicine, Ulm University, 89081 Ulm, Germany; Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213
| | - Ali Gawanbacht
- Institute of Molecular Virology, Ulm University, 89081 Ulm, Germany
| | - Thamara Beyer
- Institute of Transfusion Medicine, Ulm University, 89081 Ulm, Germany
| | - Stefanie Lindner
- Institute of Transfusion Medicine, Ulm University, 89081 Ulm, Germany
| | - Timo Trzaska
- Institute of Transfusion Medicine, Ulm University, 89081 Ulm, Germany
| | | | - Georg Härter
- Comprehensive Infectious Diseases Center, Ulm University, 89081 Ulm, Germany
| | - Beate Grüner
- Comprehensive Infectious Diseases Center, Ulm University, 89081 Ulm, Germany
| | - Dorit Fabricius
- Department of Pediatrics, Ulm University, 89075 Ulm, Germany; and
| | - Ramin Lotfi
- Institute of Transfusion Medicine, Ulm University, 89081 Ulm, Germany; Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, Red Cross Blood Service Baden-Württemberg - Hessen, 89081 Ulm, Germany
| | - Klaus Schwarz
- Institute of Transfusion Medicine, Ulm University, 89081 Ulm, Germany; Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, Red Cross Blood Service Baden-Württemberg - Hessen, 89081 Ulm, Germany
| | - Catharina Schütz
- Department of Pediatrics, Ulm University, 89075 Ulm, Germany; and
| | - Manfred Hönig
- Department of Pediatrics, Ulm University, 89075 Ulm, Germany; and
| | - Ansgar Schulz
- Department of Pediatrics, Ulm University, 89075 Ulm, Germany; and
| | - Peter Kern
- Comprehensive Infectious Diseases Center, Ulm University, 89081 Ulm, Germany
| | - Martin Bommer
- Comprehensive Infectious Diseases Center, Ulm University, 89081 Ulm, Germany
| | - Hubert Schrezenmeier
- Institute of Transfusion Medicine, Ulm University, 89081 Ulm, Germany; Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, Red Cross Blood Service Baden-Württemberg - Hessen, 89081 Ulm, Germany
| | - Frank Kirchhoff
- Institute of Molecular Virology, Ulm University, 89081 Ulm, Germany
| | - Bernd Jahrsdörfer
- Institute of Transfusion Medicine, Ulm University, 89081 Ulm, Germany; Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, Red Cross Blood Service Baden-Württemberg - Hessen, 89081 Ulm, Germany
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35
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Kaltenmeier C, Gawanbacht A, Lindner S, Beyer T, Härter G, Grüner B, Bommer M, Kirchhoff F, Schrezenmeier H, Jahrsdörfer B. The fate of B cells in HIV infection - shifting the balance from plasma cell towards regulatory B cell (Breg) differentiation (LYM6P.776). The Journal of Immunology 2014. [DOI: 10.4049/jimmunol.192.supp.131.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Certain regulatory lymphocyte populations suppress T cell expansion in a granzyme B (GrB)-dependent manner. Recently, we found that human B cells also contribute to immune regulation by interleukin (IL-)21-dependent expression of GrB. GrB-expressing Bregs are induced by incompletely activated CD4+ T cells, which express high levels of IL-21, but only low CD40 ligand. In contrast, fully activated CD4+ T cells strongly induce plasma cell differentiation. Here we demonstrate that up to 60% of B cells from HIV-infected patients with high viremia exhibit a regulatory (Breg) phenotype with expression of GrB and potent suppression of T cell proliferation by GrB-dependent degradation of the T cell receptor zeta-chain (TCR-zeta). These results are supported by additional findings showing that T cells in HIV-infected individuals produce high levels of IL-21, while expressing only low levels of CD40L and TCR-zeta. Importantly, soluble CD40L multimers can restore the differentiation of Bregs derived from HIV-infected individuals into plasma cells. Our results suggest that incompletely activated CD4+ T cells in HIV patients lead to a misrouting of B cell differentiation into Bregs at the cost of fully functional plasma cells. Apart from a disturbed humoral immune response these B cells may further aggravate the immune status of HIV patients. The use of CD40L multimers may disrupt the defective B cell-T cell interactions and may prove beneficial for future HIV vaccination approaches.
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Affiliation(s)
| | - Ali Gawanbacht
- 2Institute of Molecular Virology, University of Ulm, Ulm, Germany
| | - Stefanie Lindner
- 1Institute of Clinical Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Thamara Beyer
- 1Institute of Clinical Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Georg Härter
- 3Comprehensive Infectious Diseases Center, University of Ulm, Ulm, Germany
| | - Beate Grüner
- 3Comprehensive Infectious Diseases Center, University of Ulm, Ulm, Germany
| | - Martin Bommer
- 3Comprehensive Infectious Diseases Center, University of Ulm, Ulm, Germany
| | - Frank Kirchhoff
- 2Institute of Molecular Virology, University of Ulm, Ulm, Germany
| | | | - Bernd Jahrsdörfer
- 1Institute of Clinical Transfusion Medicine, University of Ulm, Ulm, Germany
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Just B, Kern P, Luthardt R, Rudolph H, Grüner B, Wahlers K. Echinococcus cysts affecting oromaxillofacial structures--a systematic review. Oral Dis 2014; 20:756-61. [PMID: 24495132 DOI: 10.1111/odi.12225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/15/2014] [Accepted: 01/22/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Cystic echinococcosis is a worldwide spread zoonosis and humans become accidental intermediate hosts. Any tissue can be affected. However, oromaxillofacial cystic echinococcosis is very uncommon and has never been studied systematically and no evidence-based treatment recommendations are available. Aim of this paper is to summarize the current knowledge and clinical experience with oromaxillofacial manifestations of cystic echinococcosis. MATERIALS AND METHODS PubMed database was accessed with a comprehensive, complex search strategy. Medical Subject Headings terms, wildcard search, truncated search terms and Boolean operators were used. No filters to restrict the results were set. Two evaluators jointly assessed the results in terms of defined criteria. RESULTS The search strategy retrieved 538 results in total. After evaluation 83 publications presenting 108 cases on oromaxillofacial cystic echinococcosis were included. Parotid gland, mandibular region and maxillary region were most commonly affected. Median patient age was 22 years (range 2.5 months to 81 years). Surgical treatment was performed in 97 cases. CONCLUSIONS In cases of oromaxillofacial cystic echinococcosis a thorough evaluation of the patients for further cysts is essential. Therapeutic treatment options are surgical or minimally invasive intervention and drug treatment with benzimidazoles. The diagnosis can be difficult and often require a multidisciplinary approach.
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Affiliation(s)
- Ba Just
- Department of Prosthetic Dentistry, Center of Dentistry, Ulm University Hospital, Ulm, Germany
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37
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Härter G, Grüner B. [Better prognosis: when and which screening methods and immunizations in HIV-infected people]. MMW Fortschr Med 2013; 155 Suppl 1:32-35. [PMID: 23961652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Georg Härter
- Comprehensive Infectious Diseases Center Ulm, Universitätsklinikum Ulm.
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Giese C, Mullins T, Grüner B, Weidemüller M, Stienkemeier F, Mudrich M. Formation and relaxation of RbHe exciplexes on He nanodroplets studied by femtosecond pump and picosecond probe spectroscopy. J Chem Phys 2012; 137:244307. [PMID: 23277936 DOI: 10.1063/1.4772749] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Giese
- Physikalisches Institut, Universität Freiburg, 79104 Freiburg, Germany
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Selucký P, Bubeníková M, Rais J, Grüner B, Brusko VV. Synergistic extraction of Eu(III) with N-phosphorylated bis-ureas and chlorinated cobalt bis(dicarbollide) ion. RADIOCHIM ACTA 2012. [DOI: 10.1524/ract.2013.1995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Extraction of Eu(III) with a synergistic mixture of polydentate N-phosphorylated bis-ureas with the general formula (i-PrO)2P(O)NHC(O)NHXNHC(O)NHP(O)(Oi-Pr)2 (X = (CH2)7, (CH2)2O(CH2)2 and (CH2)2O(CH2)2O(CH2)2) and chlorinated cobalt bis(dicarbollide) ion (CCD−) with formula closo-[(1,2-C2B9H8Cl3)2-3-Co]− was studied using nitrobenzene as the solvent. Extraction of Eu(III) was very effective up to high concentrations of nitric acid. Eu(III) is most likely extracted into the organic phase as the [EuL2]3+ species whereas the positive charge of extracted complex is compensated by CCD and/or nitrate anions.
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Barth TFE, Herrmann TS, Tappe D, Stark L, Grüner B, Buttenschoen K, Hillenbrand A, Juchems M, Henne-Bruns D, Kern P, Seitz HM, Möller P, Rausch RL, Kern P, Deplazes P. Sensitive and specific immunohistochemical diagnosis of human alveolar echinococcosis with the monoclonal antibody Em2G11. PLoS Negl Trop Dis 2012; 6:e1877. [PMID: 23145198 PMCID: PMC3493387 DOI: 10.1371/journal.pntd.0001877] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 09/10/2012] [Indexed: 12/26/2022] Open
Abstract
Background Alveolar echinococcosis (AE) is caused by the metacestode stage of Echinococcus multilocularis. Differential diagnosis with cystic echinococcosis (CE) caused by E. granulosus and AE is challenging. We aimed at improving diagnosis of AE on paraffin sections of infected human tissue by immunohistochemical testing of a specific antibody. Methodology/Principal Findings We have analysed 96 paraffin archived specimens, including 6 cutting needle biopsies and 3 fine needle aspirates, from patients with suspected AE or CE with the monoclonal antibody (mAb) Em2G11 specific for the Em2 antigen of E. multilocularis metacestodes. In human tissue, staining with mAb Em2G11 is highly specific for E. multilocularis metacestodes while no staining is detected in CE lesions. In addition, the antibody detects small particles of E. multilocularis (spems) of less than 1 µm outside the main lesion in necrotic tissue, liver sinusoids and lymphatic tissue most probably caused by shedding of parasitic material. The conventional histological diagnosis based on haematoxylin and eosin and PAS stainings were in accordance with the immunohistological diagnosis using mAb Em2G11 in 90 of 96 samples. In 6 samples conventional subtype diagnosis of echinococcosis had to be adjusted when revised by immunohistology with mAb Em2G11. Conclusions/Significance Immunohistochemistry with the mAb Em2G11 is a new, highly specific and sensitive diagnostic tool for AE. The staining of small particles of E. multilocularis (spems) outside the main lesion including immunocompetent tissue, such as lymph nodes, suggests a systemic effect on the host. Echinococcosis is a life-threatening disease in humans that is caused by the larval stages of the tapeworms Echinococcus multilocularis and Echinococcus granulosus. The eggs of the parasites are released with faeces of canids, and humans are aberrantly infected. In humans, the larval stages of the parasites cause tumour-like lesions mainly in the liver and the lungs. Precise diagnosis of the parasite responsible for human disease is of utmost importance since therapy regimens largely differ between cystic and alveolar echinococcosis. Diagnosis is based on serology, imaging and histology, the latter being the gold standard. However, conventional histology cannot always clearly identify the causative parasite because both parasites can cause human tissue to present similar features. Therefore, we have developed the monoclonal antibody Em2G11 and an immunohistological technique that allows a cheap and fast clear-cut diagnosis of E. multilocularis even on aspirates and small archived bioptic tissue samples. Furthermore, this technique disclosed an unknown feature of human alveolar echinococosis we called "small particles of E. multilocularis" (spems). We argue that these small particles represent micro-fragments of E. multilocularis and thus point to a new form of host-parasite interaction.
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Schirmbeck R, von Kampen J, Metzger K, Wild J, Grüner B, Schleef M, Kröger A, Hauser H, Reimann J. DNA-Based Vaccination with Polycistronic Expression Plasmids. Methods Mol Med 2012; 29:313-22. [PMID: 21374331 DOI: 10.1385/1-59259-688-6:313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
DNA-based vaccination is a potent technique to prime cellular (T-cell mediated) immune responses (reviewed in 1). Many details of the priming of T-cell precursors by antigen translated from injected expression plasmid DNA are unknown. The relevant cell that is transfected in situ after DNA vaccination and that can process and present the protein in an immunogenic form has not yet been identified. Alternatively, the transfected cell may initiate 'cross-priming' in vivo by transferring processed antigen to a professional antigen-presenting cell (APC).
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Affiliation(s)
- R Schirmbeck
- Institute of Medical Microbiology and Immunology, Universität Ulm, Ulm (Donau), Germany
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Bubeníková M, Selucký P, Rais J, Grüner B, Švec P. Studies on Am(III) separation from simulated high-level waste using cobalt bis(dicarbollide) (1− ) ion derivative covalently bound to N,N′-di-n-octyl diglycol diamide as extractant and DTPA as stripping agent. J Radioanal Nucl Chem 2012. [DOI: 10.1007/s10967-012-1679-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Fechner L, Grüner B, Sieg A, Callegari C, Ancilotto F, Stienkemeier F, Mudrich M. Photoionization and imaging spectroscopy of rubidium atoms attached to helium nanodroplets. Phys Chem Chem Phys 2012; 14:3843-51. [PMID: 22327348 DOI: 10.1039/c2cp22749e] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- L Fechner
- Physikalisches Institut, Universität Freiburg, Freiburg, Germany
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Selucký P, Lučaníková M, Grüner B. Separation of trivalent actinides and lanthanides from simulated high-level waste using cobalt bis(dicarbollide) ion derivate substituted with diphenyl-N-tert.octyl-carbamoylmethylphosphine oxide. RADIOCHIM ACTA 2011. [DOI: 10.1524/ract.2012.1903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
A derivative with cobalt bis(dicarbollide)(1−) ion covalently bonded with diphenyl-N-tert.octyl-carbamoylmethylphosphine oxide with a formula [(8-Ph2P(O)-CH2C(O)N-t-C8H17-(CH2-CH2O)2-(1,2-C2B9H10)(1´,2´-C2B9H11)-3,3´-Co]− (CMPO-COSAN) has been evaluated for actinides(III)/lanthanides(III) separation from high level liquid waste (HLLW) from PUREX reprocessing. The procedures for HLLW treatment by CMPO-COSAN dissolved in low polar mixture of hexylmethylketone and hydrogenated tetrapropylene (HMK/TPH, 1:1) or polar mixture of nitrobenzene/bromoform (NB/BF, 9:1) were proposed. The good separation of Am(III)/Ln(III) from bulk of fission products was achieved. The trivalent radionuclides were effectively stripped from the loaded organic phase by using ammonium citrate or solution of ammonium citrate and ammonium diethylenetriamine pentaacetate (DTPA). The co-extraction of some undesirable elements as Zr, Mo, Pd was suppressed using oxalic acid and HEDTA in extraction and a scrub steps. However, co-extraction of Ag has to be solved, yet.
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Affiliation(s)
| | - M. Lučaníková
- Nuclear Research Institute plc., Rez near Prague, Tschechische Republik
| | - B. Grüner
- Academy of Sciences of the Czech Republic v.v.i, Institute for Inorganic Chemistry, Rez, Tschechische Republik
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Grüner B, Schlesinger M, Heister P, Strunz WT, Stienkemeier F, Mudrich M. Vibrational relaxation and dephasing of Rb2 attached to helium nanodroplets. Phys Chem Chem Phys 2011; 13:6816-26. [PMID: 21394372 DOI: 10.1039/c0cp02355h] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The vibrational wave-packet dynamics of diatomic rubidium molecules (Rb(2)) in triplet states formed on the surface of superfluid helium nanodroplets is investigated both experimentally and theoretically. Detailed comparison of experimental femtosecond pump-probe spectra with dissipative quantum dynamics simulations reveals that vibrational relaxation is the main source of dephasing. The rate constant for vibrational relaxation in the first excited triplet state 1(3)Σ(g)+ is found to be constant γ ≈ 0.5 ns(-1) for the lowest vibrational levels v ≲ 15 and to increase sharply when exciting to higher energies.
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Affiliation(s)
- B Grüner
- Physikalisches Institut, Universität Freiburg, 79104 Freiburg, Germany
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Grüner B, Kvíčalová M, Selucký P, Lučaníková M. Anionic alkyl diglycoldiamides with covalently bonded cobalt bis(dicarbollide)(1−) ions for lanthanide and actinide extractions. J Organomet Chem 2010. [DOI: 10.1016/j.jorganchem.2010.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Objective A commercial cysticercosis Western blot was evaluated for serological cross-reactivity of sera from patients with alveolar (AE) and cystic echinococcosis (CE). Methods A total of 161 sera were examined, including 31 sera from AE-patients, 11 sera from CE-patients, 9 sera from patients with other parasitic diseases and 109 sera from patients with unrelated medical conditions. All AE-and CE-sera were also examined by the echinococcosis Western blot. Results More sera from patients with AE than with CE showed cross-reactivity in the form of ladder-like patterns ("Mikado aspect") and untypical bands at 6-8 kDa (71% and 77.4% versus 27.3% and 45.5%, respectively). In contrast, triplets of bands in the area above 50 kDa and between 24 and 39-42 kDa were more frequent in CE than in AE sera. The fuzzy band at 50-55 kDa typical for cysticercosis was absent in all AE and CE sera. Conclusions Atypical banding patterns in the cysticercosis Western blot should raise the suspicion of a metacestode infection different from Taenia solium, i.e. Echinococcus multilocularis or E. granulosus, especially when the Mikado aspect and an altered 6-8 kDa band is visible in the absence of a fuzzy 50-55 kDa band.
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Affiliation(s)
- Dennis Tappe
- Institute of Hygiene and Microbiology, University of Würzburg, Würzburg, Germany.
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Selucký P, Rais J, Lučaníková M, Grüner B, Kvíčalová M, Fejfarová K, Císařová I. Lanthanide and actinide extractions with anionic ligands based on cobalt bis(dicarbollide) ions with covalently bonded CMPO functions. RADIOCHIM ACTA 2009. [DOI: 10.1524/ract.2008.1488] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Compounds were synthesized with the aim to develop efficient extraction agents for liquid-liquid extraction of polyvalent cations, i.e. lanthanides and actinides from high-level activity nuclear waste. Compounds of general formulation [(8-CMPO-(CH2-CH2O)2-1,2-C2B9H10)(1′,2′-C2B9H11)-3,3′-Co(III)]- with different phosphorus and nitrogen substitution (CMPO=2R,3R P(O)-(CH2)
n
C(O)N1R, 1R=t-octyl, H, Ph, 2R=Ph, n-octyl, 3R=Ph, n=1,2)-(4a to 4e), were prepared and characterized by combination of 11B NMR, 1H high field NMR, ESI-M.S., HPLC and other techniques. Molecular structure of the sodium complex of ligand 4a (1R=t-octyl, 2R=3R=Ph, n=1) was determined by single crystal X-ray diffraction analysis. Effect of several modifications in the structure of 4a–4e on the extraction properties was outlined. The study resulted in the definition of ionic ligand with enhanced extraction efficiency for 4a,b (t-octyl and H on the amidic nitrogen atom) and a better solubility of 4a and 4d (1R=t-octyl, 2R=n-Oct, 3R=Ph, n=1) in less polar solvents. Low polar mixtures of hydrogenated tetrapropylene (TPH) hexyl methyl ketone (HMK) can be applied as an auxiliary solvent for 4a, selected for detailed studies, replacing thus the polar and less environmentally friendly nitro-, fluoro- and chloro- solvents used in the current dicarbollide liquid-liquid extraction process. Results of the fission products separation from the simulated PUREX feed using 4a are presented inclusive procedures for Eu3+ stripping.
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Richter J, Orhun A, Grüner B, Müller-Stöver I, Reuter S, Romig T, Häussinger D, Kern P. Autochthonous cystic echinococcosis in patients who grew up in Germany. Euro Surveill 2009; 14. [DOI: 10.2807/ese.14.22.19229-en] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Human cystic echinococcosis (CE) is a widespread zoonosis. Cases occurring in Germany are considered to result from imported infection and it is unclear if Echinococcus granulosus (sensu lato) is still transmitted in Germany. Therefore, exposure was investigated in 15 patients with cystic echinococcosis (7 female, 8 male; age-range 16-68, with a median of 48 years) who grew up in Germany. Fourteen patients had most likely acquired their infection in rural Germany, 11 from local dogs, one from an imported dog, two without obvious dog contacts. Taking into account multiple conceivable confounding factors might also account for some of infections: contacts with imported dogs or contact with dogs during travel in highly endemic regions, and ingestion of food contaminated by worm ova, whether in Germany or abroad. However, in at least two cases autochthonous transmission is beyond doubt, because these patients had never left Germany. The long pre-symptomatic development of cystic echinococcosis does not allow for a precise evaluation of the actual epidemiological situation. Compulsory notification of human cystic echinococcosis is an important instrument in the surveillance of the disease in humans. Regular inquiries at laboratories carrying out work in the field of veterinary medicine and at slaughterhouses, supervision of dogs at risk as well as genetic investigations on the strain or species of the causal agent of cystic echinococcosis are needed.
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Affiliation(s)
- J Richter
- Tropical Medicine Unit, University Hospital for Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine-University, Düsseldorf, Germany
| | - A Orhun
- Tropical Medicine Unit, University Hospital for Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine-University, Düsseldorf, Germany
| | - B Grüner
- Comprehensive Infectious Diseases Center (CIDC), Division of Infectious Diseases and Clinical Immunology, University Hospital of Ulm, Germany
| | - I Müller-Stöver
- Tropical Medicine Unit, University Hospital for Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine-University, Düsseldorf, Germany
| | - S Reuter
- Tropical Medicine Unit, University Hospital for Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine-University, Düsseldorf, Germany
| | - T Romig
- Department of Parasitology, University Hohenheim, Stuttgart, Germany
| | - D Häussinger
- Tropical Medicine Unit, University Hospital for Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine-University, Düsseldorf, Germany
| | - P Kern
- Comprehensive Infectious Diseases Center (CIDC), Division of Infectious Diseases and Clinical Immunology, University Hospital of Ulm, Germany
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