[Terbinafine-resistant dermatophytoses and onychomycosis due to Trichophyton rubrum]

BACKGROUND

In recent years, therapy-refractory courses of dermatophytoses have increasingly become the focus of attention. The most frequent pathogens are Trichophyton (T.) rubrum and T. mentagrophytes. In addition to local therapy, first-line treatment includes terbinafine, an allylamine antifungal agent that acts by inhibiting squalene epoxidase and thus interfering with ergosterol synthesis. In refractory cases, terbinafine resistance due to point mutation in the squalene epoxidase gene has been frequently detected.

OBJECTIVES

The aim is to present specific aspects in the epidemiology of dermatophytoses with terbinafine resistance and to illustrate them on the basis of four patient cases including diagnostic procedures.

MATERIALS AND METHODS

A review of handbook knowledge, a selective literature search, and a review of four patient cases were performed.

RESULTS

Detection of the terbinafine resistance was performed by in vitro testing using the breakpoint method as well as sequencing of the Trichophyton isolate and detection of the point mutation with amino acid substitution at position L393F or F397L of squalene epoxidase.

CONCLUSION

In refractory and recurrent dermatophytoses, terbinafine resistance should be considered, especially in T. mentagrophytes and T. rubrum, and in vitro resistance testing of the dermatophyte and point mutation analysis of squalene epoxidase (SQLE) should be performed. Therapeutically, intermittent administration of itraconazole in combination with antifungal local therapy is recommended. Nevertheless, a recurrent course is to be expected and long-term therapy with itraconazole is usually necessary.

Life cycle environmental impacts of chemical recycling via pyrolysis of mixed plastic waste in comparison with mechanical recycling and energy recovery

A large portion of plastic produced each year is used to make single-use packaging and other short-lived consumer products that are discarded quickly, creating significant amounts of waste. It is important that such waste be managed appropriately in line with circular-economy principles. One option for managing plastic waste is chemical recycling via pyrolysis, which can convert it back into chemical feedstock that can then be used to manufacture virgin-quality polymers. However, given that this is an emerging technology not yet used widely in practice, it is not clear if pyrolysis of waste plastics is sustainable on a life cycle basis and how it compares to other plastics waste management options as well as to the production of virgin plastics. Therefore, this study uses life cycle assessment (LCA) to compare the environmental impacts of chemical recycling of mixed plastic waste (MPW) via pyrolysis with the established waste management alternatives: mechanical recycling and energy recovery. Three LCA studies have been carried out under three perspectives: waste, product and a combination of the two. To ensure robust comparisons, the impacts have been estimated using two impact assessment methods: Environmental footprint and ReCiPe. The results suggest that chemical recycling via pyrolysis has a 50% lower climate change impact and life cycle energy use than the energy recovery option. The climate change impact and energy use of pyrolysis and mechanical recycling of MPW are similar if the quality of the recyclate is taken into account. Furthermore, MPW recycled by pyrolysis has a significantly lower climate change impact (-0.45 vs 1.89 t CO₂ eq./t plastic) than the equivalent made from virgin fossil resources. However, pyrolysis has significantly higher other impacts than mechanical recycling, energy recovery and production of virgin plastics. Sensitivity analyses show that some assumptions have notable effects on the results, including the assumed geographical region and its energy mix, carbon conversion efficiency of pyrolysis and recyclate quality. These results will be of interest to the chemical, plastics and waste industries, as well as to policy makers.

Rapid detection of SARS-CoV-2 by pulse-controlled amplification (PCA)

In the current pandemic of SARS-CoV-2, rapid identification of infected individuals is crucial for management and control of the outbreak. However, transport of samples, sample processing and RT-qPCR analysis in laboratories are time-consuming. Here we present a prototype of a novel nucleic acid-based test format - pulse controlled amplification - that allows detection of SARS-CoV-2 directly from up to eight swab samples simultaneously without the need for RNA extraction within 25 min with a sensitivity of 100 % for samples with a viral load of ≥ 1.6 × 10e3 copies/μl This new principle might pave the way to rapid and sensitive point of care testing.

[Toxic shock syndrome due to Staphylococcus aureus in a small child, a (clinical or laboratory chemical) visual diagnosis?]

It is reported about the case of a 3-year-old girl who was admitted to hospital with high fever, vomiting, skin rash, dehydration, suspected staphyloderma and for exclusion of a severe acute respiratory syndrome coronavirus type 2-infection (SARS-CoV‑2 infection). The suspicion of a toxic shock syndrome, among other inflammatory diseases as differential diagnoses, was based on profound erythroderma and arterial hypotension. The diagnostic pathway, treatment and clinical course of this rare disease are described.

What is the outcome of re-recurrent vs recurrent inguinal hernia repairs? An analysis of 16,206 patients from the Herniamed Registry

INTRODUCTION

The proportion of recurrent repairs in the total collective of inguinal hernia repairs among men is 11.3-14.3% and among women 7.0-7.4%. The rate of re-recurrences is reported to be 2.9-9.2%. To date, no case series has been published on second and ≥ third recurrences and their treatment outcomes. Only case reports are available.

MATERIALS AND METHODS

In an analysis of data from the Herniamed Registry the perioperative and 1-year follow-up outcomes of 16,206 distinct patients who had undergone first recurrent (n = 14,172; 87.4%), second recurrent (n = 1,583; 9.8%) or ≥ third recurrent (n = 451; 2.8%) inguinal hernia repair between September 1, 2009 and July 1, 2017 were compared.

RESULTS

The intraoperative complication rate for all recurrent repairs was between 1-2%. In the postoperative complications a continuous increase was observed (first recurrence: 3.97% vs second recurrence: 5.75% vs ≥ third recurrence 8.65%; p < 0.001). That applied equally to the complication-related reoperation rates (first recurrence: 1.50% vs second recurrence: 2.21% vs ≥ third recurrence 2.66; p = 0.020). Likewise, the re-recurrence rate rose significantly (first recurrence: 1.95% vs second recurrence: 2.72% vs ≥ third recurrence 3.77; p = 0.005). Similarly, the rate of pain requiring treatment rose highly significantly with an increasing number of recurrences (first recurrence: 5.21% vs second recurrence: 6.70% vs ≥ third recurrence 10.86; p = < 0.001).

CONCLUSION

The repair of re-recurrences in inguinal hernia is associated with increasingly more unfavorable outcomes. For the first recurrence the guidelines should definitely be noted. For a second and ≥ third recurrence diagnostic laparoscopy may help to select the best possible surgical technique.

[Macular pucker surgery with and without delamination of the internal limiting membrane-a prospective randomized study]

BACKGROUND

There is evidence that additional internal limiting membrane (ILM) removal reduces the recurrence rate after pucker surgery with a similar functional outcome. On the other hand, morphological changes of the inner retinal layers after ILM peeling have been described. The aim of this study was to compare the long-term data after vitrectomy with and without ILM delamination in order to uncover possible differences in morphological and functional results.

METHODS

In a prospective study of 32 patients with idiopathic epiretinal membrane, 16 patients were randomized into each of 2 groups. Both groups underwent pars plana vitrectomy (ppV) with peeling of the epiretinal membrane. In group 1 no forced additional peeling of the ILM was performed and in group 2 the ILM or ILM residues were additionally removed after staining. The investigated parameters were visual acuity, central retinal thickness (CRT) in optical coherence tomography (OCT), metamorphopsia and surgical complications. The time points of the examinations were directly preoperative, after 1, 3 and 6 months and partly 8.4 years postoperatively.

RESULTS

In group 1 (n = 15) the preoperative mean visual acuity improved from 0.54 logMAR to 0.38 logMAR after 6 months postoperatively (n = 13). Of this group 6 patients could be examined in the long-term course and the visual acuity improved further to 0.32 logMAR after 8 years. The CRT decreased from 473 µm preoperatively to 235 µm in the long-term interval. In group 2 (n = 15) the mean visual acuity preoperatively was 0.47 logMAR and improved 6 months postoperatively (n = 13) to 0.38 logMAR and in the long-term examination (n = 5) to 0.1 logMAR. The CRT in this group decreased from 417 µm preoperatively to 278 µm in the long-term interval. In group 1 one recurrence occurred in the follow-up period, in group 2 none.

CONCLUSION

The study showed that there was no significant difference in visual acuity and CRT between the two groups neither after 6 months nor after 8 years of follow-up. The observed recurrence in the group without ILM delamination underlines the assumption that additional ILM peeling could reduce the recurrence rate.

A methodology for integrating the biomass balance approach into life cycle assessment with an application in the chemicals sector

Driven by the need to reduce greenhouse gas emissions and dependence on fossil resources, the chemical and other industries are gradually starting to develop bio-based products. For the introduction of bio-feedstocks in existing production pathways in a cost-effective way, a simplified approach based on mass balance has been proposed. This concept is known as the biomass balance (BMB) approach and the resulting products are called BMB products. They do not necessarily contain biomass material but can contribute to sustainable sourcing and production of bio-based products in the supply chain without any performance loss in comparison to the same products derived from fossil resources. The aim of the study is to show how the BMB approach can be used in life cycle assessment (LCA) while following the requirements set out in the ISO 14040 and 14044 standards. To demonstrate that, the proposed BMB approach has been used to estimate life cycle environmental impacts of a polymer product, which can be produced using fossil or bio-feedstocks. For the polymer derived from bio-feedstocks, bio-naphtha and biogas are considered as replacement to naphtha and its impacts are compared with the fossil-based alternative. The paper demonstrates that the BMB approach provides a quick and pragmatic method for establishing the biomass content in chemical and related products while incentivising the industry to continue increasing the proportion of bio-based products in their product portfolio. It also shows that the environmental performance of BMB products is highly dependent on the particular bio-feedstock used, the way it is sourced and on key modelling assumptions, including the assumptions on biogenic carbon uptake in the bio-feedstocks.

[Tinea barbae profunda due to Trichophyton mentagrophytes after journey to Thailand : Case report and review]

Tinea barbae represents a very rare dermatophytosis. We report on a tinea barbae profunda following a journey to Southeast Asia. After travel to Thailand, a businessman was affected by a foudroyant proceeding abscessing infection of the upper lip and beard area. The initial therapy with oral acyclovir and oral ciprofloxacin, which later was changed to ampicillin plus sulbactam, intravenously, was unsuccessful. In a biopsy sample, histologically, with Grocott-Gomori's methenamine silver stain, fungal mycelium was apparent in the tissue. Thereupon, terbinafine 250 mg was given for 4 weeks, topically, a 1% ciclopiroxolamine-containing cream. In fungal culture, T. mentagrophytes were found to grow. Meanwhile, the patient's German wife suffered from a tinea faciei. From skin scrapings from the cheek, T. mentagrophytes was also cultivated. This zoophilic dermatophyte was identical with other zoophilic strains of T. mentagrophytes currently found in Germany, which were also acquired in Thailand. The patient had contact with Thai female sex workers who must be considered as a source of infection of the dermatophytosis. There was no animal contact, neither in Thailand, nor in Germany. The infection chain of the dermatophytosis from Thailand probably reached from a female sex worker via the here described patient to his wife in Germany. This pathway of infection has been known for 1 or 2 years, but until now, in Germany, Switzerland, and Austria exclusively via pubogenital infections (tinea genitalis profunda) due to T. mentagrophytes after journeys to Southeast Asia. For treatment, oral antifungal agents should be used, first of all terbinafine, alternatively fluconazole or itraconazole.

A magnetically focused molecular beam source for deposition of spin-polarised molecular surface layers

Separating molecular spin isomers is a challenging task, with potential applications in various fields ranging from astrochemistry to magnetic resonance imaging. A new promising method for spin-isomer separation is magnetic focusing, a method which was shown to be capable of producing a molecular beam of ortho-water. Here, we present results from a modified magnetic focusing apparatus and show that it can be used to separate the spin isomers of acetylene and methane. From the measured focused profiles of the molecular beams and a numerical simulation analysis, we provide estimations for the spin purity and the significantly improved molecular flux obtained with the new setup. Finally, we discuss the spin-relaxation conditions which will be needed to apply this new source for measuring nuclear magnetic resonance signals of a single surface layer.

[Trichophyton mentagrophytes-from snow leopard to man : A molecular approach for uncovering the chain of infection]

Sources of infection for Trichophyton (T.) mentagrophytes-a zoophilic dermatophyte-comprise pet rodents (guinea pigs, mice, rabbits) and sometimes cats. Human infections due to dermatophytes after contact with zoo animals, however, are extreme rare. Four zoo keepers from Basel Zoo were diagnosed to suffer from tinea manus and tinea corporis due to T. mentagrophytes. The 22-year-old daughter of one zoo keeper was also infected with tinea corporis after having worked in the snow leopard section for one day. The strain of the index patient was confirmed by a direct uniplex-PCR-EIA and sequence analysis of the ribosomal internal transcribed spacer (ITS) region (18S rRNA, ITS1, 5.8S rRNA, ITS2, 28S rRNA) as T. mentagrophytes. Three young snow leopards from Basel Zoo were identified as the origin of the fungal skin infection. The transmission occurred due to direct contact of the zoo keepers with the young snow leopards when removing hedgehog ticks (Ixodes hexagonus). Two adult snow leopards had developed focal alopecia of the facial region which was diagnosed as dermatomycoses due to T. mentagrophytes by the zoo veterinarians. By sequence analysis, both the strains from the animals and a single strain of the index patient showed 100% accordance proving transmission of T. mentagrophytes from animals to the zoo keepers. Molecular biological identification revealed a strong relationship to a strain of T. mentagrophytes from European mink (Mustela lutreola) from Finland. Treatment of patients was started using topical ointment with azole antifungals, and oral terbinafine 250 mg once daily for 4 weeks. Both adult snow leopards and the asymptomatic young animals were treated with oral itraconazole.

Dermatophyten-Infektionen der Haut, Haare und Nägel bei Kindern – ein Update

Das klinische Spektrum und die Erreger der Dermatophytosen unterscheiden sich deutlich zwischen Kindern und Erwachsenen. Im Gegensatz zu Erwachsenen, bei denen die Tinea pedis die häufigste Pilzinfektion der Haut darstellt, werden bei Kindern vor allem die Tinea corporis und Tinea capitis diagnostiziert. Eine neue und beunruhigende Entwicklung ist die Zunahme der Onychomykose – meist durch Trichophyton rubrum – im Kindesalter. Die Tinea capitis stellt eine diagnostische und vor allem therapeutische Herausforderung für Kinderärzte und auch Dermatologen dar. Erreger der Tinea capitis sind in Deutschland vorzugsweise zoophile Dermatophyten. An erster Stelle steht Microsporum canis, das Verhältnis verschiebt sich jedoch mehr und mehr zu den zoophilen Trichophyton-Arten, z. B. Trichophyton interdigitale (früher Trichophyton mentagrophytes). Trichophyton species von Arthroderma benhamiae ist ein neuer Erreger, der im Kindesalter wahrscheinlich mittlerweile alle anderen zoophilen Dermatophyten in Bezug auf die Häufigkeit überflügelt hat. Seltener werden Trichophyton verrucosum – Erreger der „Kälberflechte“ – und Trichophyton erinacei („Igelpilz“) isoliert. Anthropophile Erreger, wie Microsporum audouinii und Trichophyton tonsurans, müssen Anlass sein, nach der Infektionsquelle zu fahnden. Das kann ein familiärer Immigrationshintergrund sein oder auch die Infektion in einem Kampfsportverein (Tinea gladiatorum capitis et corporis).

Dermatophyten-Infektionen der Haut, Haare und Nägel bei Kindern – ein Update

Dermatophyten verursachen oberflächliche Infektionen von Haut, Nägeln und Kopfhaut (Haarfollikeln), nicht jedoch der Schleimhaut bzw. des Körperinneren. Erreger sind meist zoophile Dermatophyten, z. B. Microsporum (M.) canis, zoophile Stämme von Trichophyton (T.) interdigale und T. verrucosum (Erreger der „Kälberflechte“). Bei Kindern und Jugendlichen ist mit einer Tinea corporis und Tinea capitis zu rechnen. Ursache einer Fuß-pilzinfektion oder Tinea pedis ist fast immer die anthropophile Dermatophyten-Art T. rubrum. Neuerdings erkranken zunehmend auch Kinder an einer Nagelmykose, fast immer hervorgerufen durch T. rubrum.

Die meist zentrifugalen erythrosquamösen Läsionen einer Tinea corporis sind überwiegend trocken und hyperkeratotisch, zum mikrobiologischen Nachweis der Erreger werden Hautschuppen aus dem Randbereich der Dermatomykose entnommen (tangentiales Abschaben der Hautschuppen mittels Skalpell oder scharfem Löffel). Bei Tinea capitis sollten neben Kopfschuppen auch Haarwurzeln epiliert und untersucht werden. Die Diagnosesicherung einer Onychomykose erfordert die Entnahme von Nagelspänen mittels Skalpell oder Fräse.

Die mykologische Untersuchung im Labor umfasst das sehr empfindliche fluoreszenzoptische Nativpräparat mittels Calcofluor- oder Blancophor-Lösung sowie den kulturellen Nachweis der Dermatophyten auf Spezialnährmedien. Das Ergebnis der Pilzkultur liegt erst nach 3–4 (–6) Wochen Inkubationszeit vor. Neue molekularbiologische Methoden zum Direktnachweis der Dermatophyten aus Hautschuppen, Haarwurzeln und Nagelmaterial erlauben eine schnelle und gleichzeitig sehr empfindliche und spezifische Diagnosestel-lung. In einzelnen Laboren wurde dafür eine Polymerasekettenreaktion (PCR) zum Nachweis von Dermatophyten-DNS etabliert.

Die Tinea der freien Haut wird zunächst topisch antimykotisch behandelt, u. a. mit Azolen, z. B. Clotrimazol, alternativ mit Ciclopirox. Die Tinea capitis, aber auch die Tinea faciei, werden fast immer systemisch behandelt, die Auswahl des Antimykotikums hängt vom nachgewiesenen Erreger ab. Bei Tinea capitis durch Microsporum spp. ist Griseofulvin das Mittel der Wahl, Terbinafin hingegen ist bei Infektionen durch Trichophyton spp. überlegen. Daraus folgt das Konzept der sog. Spezies-spezifischen antimykotischen Behandlung der Tinea capitis.

Für die systemische antimykotische Therapie der Nagelpilzinfektion im Kindesalter liegen bisher keine verbindlichen Empfehlungen vor. Die meisten Erfahrungen bei Kindern und Jugendlichen mit Onychomykose existieren bisher zum Einsatz von Terbinafin bzw. Itraconazol.

Measurement of the ν μ energy spectrum with IceCube-79: IceCube Collaboration

IceCube is a neutrino observatory deployed in the glacial ice at the geographic South Pole. The ν μ energy unfolding described in this paper is based on data taken with IceCube in its 79-string configuration. A sample of muon neutrino charged-current interactions with a purity of 99.5% was selected by means of a multivariate classification process based on machine learning. The subsequent unfolding was performed using the software Truee. The resulting spectrum covers an E ν -range of more than four orders of magnitude from 125 GeV to 3.2 PeV. Compared to the Honda atmospheric neutrino flux model, the energy spectrum shows an excess of more than 1.9 σ in four adjacent bins for neutrino energies E ν ≥ 177.8 TeV . The obtained spectrum is fully compatible with previous measurements of the atmospheric neutrino flux and recent IceCube measurements of a flux of high-energy astrophysical neutrinos.

Trichophyton rubrum-Syndrom und Tinea incognita unter immunsuppressiver Behandlung mit Leflunomid und Fumarsäureestern bei Patienten mit rheumatoider Arthritis und Psoriasis vulgaris

Ein 70-jähriger Patient mit rheumatoider Arthritis (Anti-CCP-Antikörper positiv), Nikotinabusus und Arteriosklerose wurde immunsuppressiv mit Leflunomid 20 mg und Prednisolon 50 mg täglich behandelt. Am Körperstamm traten großflächige, ekzematisierte, randbetonte, zentrifugal wachsende erythrosquamöse Läsionen auf. Die Haut der rechten Hand und beider Füße war trocken, schuppend und atrophisch. Außerdem bestanden gelbbraune Onychodystrophien aller Fingernägel der rechten Hand sowie aller Zehennägel. Das Blankophor®-Präparat aus Hautschuppen war positiv, kulturell und mit PCR ließ sich Trichophyton (T.) rubrum nachweisen. Die ausgeprägte Tinea corporis wurde mit einer Antimykotika- und Glukokortikoid-haltigen Creme behandelt, wegen der Tinea unguium kam Terbinafin zur Anwendung.

Ein 68-jähriger Psoriatiker erhielt bereits seit 1979 Fumarsäureester zur systemischen antipsoriatischen Therapie. Seit einigen Monaten entwickelten sich an Flanken, Rücken, gluteal, an den Waden, prätibial und an den Oberschenkeln blass-rote erythrosquamöse Plaques im Sinne einer Tinea corporis incognita. Das Nativpräparat war positiv, kulturell und mit PCR gelang aus insgesamt 6 Lokalisationen der Nachweis von T. rubrum. Da eine systemische antimykotische Behandlung abgelehnt wurde, kam Terbinafin-Creme im Wechsel mit Clotrimazol- + Betamethason-Creme zur Anwendung.

Die großflächige und generalisierte Tinea corporis mit Onychomykose erfüllte bei beiden Patienten die Kriterien eines sog. T. rubrum-Syndroms. Dieses, aber auch die Tinea incognita, entwickeln sich in der Regel infolge einer Autoinokulation von einer vorbestehenden Tinea pedis et unguium. Disponierender Faktor für das T. rubrum-Syndrom, aber auch für die Tinea incognita, ist nicht selten eine immunsupprimierende Therapie, hier durch Glukokortikoide, Leflunomid sowie Fumarsäureester.

[Non-viral sexually transmitted infections - Epidemiology, clinical manifestations, diagnostics and therapy : Part 1: Gonococci]

Approximately 1 million people are infected per day worldwide by one or more sexually transmitted infections (STI) as estimated by the World Health Organization (WHO). Gonorrhoea represents an almost exclusively sexually transmitted infection, which predominantly affects mucous membranes of the genitourinary tract. Extragenital localization of infections is also possible, e. g. in the anorectal region. Currently, only syphilis and human immunodeficiency virus (HIV) are notifiable diseases according to the Infection Protection Act in Germany. In Saxony, an extended registration ordinance according to the German Infection Protection Act is in force, which means that besides syphilis the laboratory detection of Neisseria gonorrhoeae, Chlamydia trachomatis and genital mycoplasms are also notifiable infections. In particular, beginning in 2009 in Saxony a spectacular increase of registered infections due to N. gonorrhoeae was observed and in 2015 altogether 824 infections due to N. gonorrhoeae were reported. Alarming is the increase in resistance of N. gonorrhoeae against penicillin, doxycycline, ciprofloxacin and recently also against azithromycin and third generation cephalosporins. The so-called superbug of N. gonorrhoeae, which originated in Japan with multidrug resistance against most of the currently available oral antibiotics, has now arrived in Europe. Intramuscular or intravenous injection of ceftriaxone plus oral azithromycin, each given as single dose is the standard therapy for gonorrhoea.

Aβ seeding potency peaks in the early stages of cerebral β-amyloidosis

Little is known about the extent to which pathogenic factors drive the development of Alzheimer's disease (AD) at different stages of the long preclinical and clinical phases. Given that the aggregation of the β-amyloid peptide (Aβ) is an important factor in AD pathogenesis, we asked whether Aβ seeds from brain extracts of mice at different stages of amyloid deposition differ in their biological activity. Specifically, we assessed the effect of age on Aβ seeding activity in two mouse models of cerebral Aβ amyloidosis (APPPS1 and APP23) with different ages of onset and rates of progression of Aβ deposition. Brain extracts from these mice were serially diluted and inoculated into host mice. Strikingly, the seeding activity (seeding dose SD₅₀) in extracts from donor mice of both models reached a plateau relatively early in the amyloidogenic process. When normalized to total brain Aβ, the resulting specific seeding activity sharply peaked at the initial phase of Aβ deposition, which in turn is characterized by a temporary several-fold increase in the Aβ42/Aβ40 ratio. At all stages, the specific seeding activity of the APPPS1 extract was higher compared to that of APP23 brain extract, consistent with a more important contribution of Aβ42 than Aβ40 to seed activity. Our findings indicate that the Aβ seeding potency is greatest early in the pathogenic cascade and diminishes as Aβ increasingly accumulates in brain. The present results provide experimental support for directing anti-Aβ therapeutics to the earliest stage of the pathogenic cascade, preferably before the onset of amyloid deposition.

[Onychocola canadensis Sigler in onychomycosis : A new dermatophyte-like mould in Germany]

Moulds or non-dermatophyte moulds (NDM) are being increasingly isolated as causative agent of onychomycoses. Known causes of a NDM-OM are Scopulariopsis brevicaulis, Fusarium, Aspergillus, Acremonium, Neoscytalidium dimidiatum, Arthrographis kalrae, and Chaetomium. In this article, 5 patients with suspected nail infection due to Onychocola canadensis are reported for the first time in Germany. Systemic antifungal agents are not considered to be effective in NDM onychomycosis. In individual cases, however, terbinafine seems to be effective in Onychocola canadensis infection of the nails. Treatment of choice represents, however, nontraumatic nail avulsion using 40 % urea ointment followed by antifungal nail lacquer with ciclopirox olamine or amorolfine.

New insights on the antibacterial efficacy of miconazole in vitro

Miconazole is a broad-spectrum antifungal used in topical preparations. In the present investigation the minimal inhibitory concentration (MIC) of miconazole for eighty wild type strains of gram-positive and gram-negative bacteria isolated from infected skin lesions was assessed using a modified agar dilution test (adapted to CLSI, Clinical Laboratory Standards Institute). 14 ATCC reference strains served as controls. Miconazole was found efficacious against gram-positive aerobic bacteria (n=62 species), the MICs against Staphylococcus (S.) aureus, S. spp., Streptococcus spp. und Enterococcus spp. ranged between 0.78 and 6.25 μg/mL. Interestingly, there were no differences in susceptibility between methicillin-susceptible (MSSA, 3) methicillin-resistant (MRSA, 6) and fusidic acid-resistant (FRSA, 2) S. aureus isolates. Strains of Streptococcus pyogenes (A-streptococci) (8) were found to be slightly more sensitive (0.78-1.563 μg/mL), while for gram-negative bacteria, no efficacy was found within the concentrations tested (MIC >200 μg/mL). In conclusion, for the gram-positive aerobic bacteria the MICs of miconazole were found within a range which is much lower than the concentration of miconazole used in topical preparations (2%). Thus topically applied miconazole might be a therapeutic option in skin infections especially caused by gram-positive bacteria even by those strains which are resistant to antibiotics.

Constraints on Ultrahigh-Energy Cosmic-Ray Sources from a Search for Neutrinos above 10 PeV with IceCube

We report constraints on the sources of ultrahigh-energy cosmic rays (UHECRs) above 10^{9}  GeV, based on an analysis of seven years of IceCube data. This analysis efficiently selects very high- energy neutrino-induced events which have deposited energies from 5×10^{5}  GeV to above 10^{11}  GeV. Two neutrino-induced events with an estimated deposited energy of (2.6±0.3)×10^{6}  GeV, the highest neutrino energy observed so far, and (7.7±2.0)×10^{5}  GeV were detected. The atmospheric background-only hypothesis of detecting these events is rejected at 3.6σ. The hypothesis that the observed events are of cosmogenic origin is also rejected at >99% CL because of the limited deposited energy and the nonobservation of events at higher energy, while their observation is consistent with an astrophysical origin. Our limits on cosmogenic neutrino fluxes disfavor the UHECR sources having a cosmological evolution stronger than the star formation rate, e.g., active galactic nuclei and γ-ray bursts, assuming proton-dominated UHECRs. Constraints on UHECR sources including mixed and heavy UHECR compositions are obtained for models of neutrino production within UHECR sources. Our limit disfavors a significant part of parameter space for active galactic nuclei and new-born pulsar models. These limits on the ultrahigh-energy neutrino flux models are the most stringent to date.

[Microsporum canis: Current data on the prevalence of the zoophilic dermatophyte in central Germany]

BACKGROUND

Microsporum (M.) canis, whose source of infection is mostly cats, is still considered as the most frequently occurring zoophilic dermatophyte in Germany and Europe. In distinct areas of Germany, the zoophilic dermatophyte Trichophyton (T.) anamorph of Arthroderma (A.) benhamiae also presents a frequent and emerging causative agent of dermatophytoses.

MATERIALS AND METHODS

Over a period of 3 years, from March 2010 to March 2013, skin samples from scalp, face, trunk, and limbs were investigated using mycological cultivation and by polymerase chain reaction (PCR) for dermatophytes. Materials originated in particular from the German Free States Saxony and Thuringia, and from the Federal State Saxony-Anhalt, but also included samples submitted from around Germany. The cultural detection of dermatophytes was performed on Sabouraud's 4% glucose agar with and without cycloheximide. For dermatophyte DNA detection, a uniplex PCR-ELISA was used.

RESULTS

In all, 8464 samples from a total of 7680 patients were investigated. In 114 (1.5%) of 7680 patients, M. canis could be detected both by culture and/or PCR. M. canis was detected culturally in 100 samples, in 107 samples by PCR, in 91 samples both culturally and by PCR. For 12 patients, only cultural detection was done (without PCR). Also detected was tinea corporis due to M. canis in 59 patients, tinea capitis 8, tinea faciei 5, and tinea manus 2 patients. Of the patients, 45% were younger than 20 years, 42% were 20-49 years old, and 13% were 50 years or older. In comparison, T. anamorph of A. benhamiae was detectable by culture and/or PCR in 231 of 7680 patients (2.9%). M. canis was the second most common zoophilic dermatophyte.

CONCLUSIONS

M. canis is still a frequent zoophilic dermatophyte in Germany. Since a few years ago, a rise of infections due to T. anamorph of A. benhamiae has been observed in Germany and other European countries. At least in distinct regions of Germany, this zoophilic dermatophyte, which is transferred from guinea pigs to human beings, currently seems to be more frequent when compared to M. canis.

Searches for Sterile Neutrinos with the IceCube Detector

The IceCube neutrino telescope at the South Pole has measured the atmospheric muon neutrino spectrum as a function of zenith angle and energy in the approximate 320 GeV to 20 TeV range, to search for the oscillation signatures of light sterile neutrinos. No evidence for anomalous ν_{μ} or ν[over ¯]_{μ} disappearance is observed in either of two independently developed analyses, each using one year of atmospheric neutrino data. New exclusion limits are placed on the parameter space of the 3+1 model, in which muon antineutrinos experience a strong Mikheyev-Smirnov-Wolfenstein-resonant oscillation. The exclusion limits extend to sin^{2}2θ_{24}≤0.02 at Δm^{2}∼0.3  eV^{2} at the 90% confidence level. The allowed region from global analysis of appearance experiments, including LSND and MiniBooNE, is excluded at approximately the 99% confidence level for the global best-fit value of |U_{e4}|^{2}.

Daytime sleep has no effect on the time course of motor sequence and visuomotor adaptation learning

Sleep has previously been claimed to be essential for the continued learning processes of declarative information as well as procedural learning. This study was conducted to examine the importance of sleep, especially the effects of midday naps, on motor sequence and visuomotor adaptation learning. Thirty-five (27 females) healthy, young adults aged between 18 and 30years of age participated in the current study. Addressing potential differences in explicit sequence and motor adaptation learning participants were asked to learn both, a nine-element explicit sequence and a motor adaptation task, in a crossover fashion on two consecutive days. Both tasks were performed with their non-dominant left hand. Prior to learning, each participant was randomized to one of three interventions; (1) power nap: 10-20min sleep, (2) long nap: 50-80min sleep or (3) a 45-min wake-condition. Performance of the motor learning task took place prior to and after a midday rest period, as well as after a night of sleep. Both sleep conditions were dominated by Stage N2 sleep with embedded sleep spindles, which have been described to be associated with enhancement of motor performance. Significant performance changes were observed in both tasks across all interventions (sleep and wake) confirming that learning took place. In the present setup, the magnitude of motor learning was not sleep-dependent in young adults - no differences between the intervention groups (short nap, long nap, no nap) could be found. The effect of the following night of sleep was not influenced by the previous midday rest or sleep period. This finding may be related to the selectiveness of the human brain enhancing especially memory being thought of as important in the future. Previous findings on motor learning enhancing effects of sleep, especially of daytime sleep, are challenged.

Stigmatisation, Avoidance Behaviour and Difficulties in Coping are Common Among Adult Patients with Vitiligo

Vitiligo is a non-contagious skin disorder with loss of pigmentation, often impairing patients' well-being. This study used Dermatology Life Quality Index (DLQI), Adjustment to Chronic Skin Disorders Questionnaire (ACS), Beck Depression Inventory (BDI) and additional questions to explore quality of life (QoL), coping, depression and stigmatisation and included 96 patients with vitiligo and 23 controls. Stigmatisation was common: 87/96 patients (90%) reported questions/approaches, 23/96 (24%) experienced nasty comments. Sixty-four out of 96 (66.7%) had avoided situations because of vitiligo or concealed their white spots. Sixty patients (62.5%) implied psychological stress as influential on disease's course. Patients scored higher in all questionnaires than controls (DLQI = 4.9/1.6, ACS-social anxiety/avoidance = 36.9/22.1, ACS-helplessness = 27.3/16.0, ACS-anxious-depressive mood = 19.4/15.6), except BDI (6.8/7.3). QoL of 65 patients (67.7%) was hardly impaired, 70 (72.9%) were not depressed. Treatment with pro-pseudocatalase PC-KUS reduced social anxiety/avoidance, anxious-depressive mood and depression. Patients without low-key stigmatisation scored highest in DLQI and social anxiety/avoidance. Avoidance and concealing behavior correlated with all questionnaires' scores.

Cellular composition of granulomatous lesions in gut-associated lymphoid tissues of goats during the first year after experimental infection with Mycobacterium avium subsp. paratuberculosis

Mycobacterium avium subsp. paratuberculosis (MAP) causes lesions in naturally and experimentally infected ruminants which greatly differ in severity, cellular composition and number of mycobacteria. Morphologically distinct lesions are already found during the clinically inapparent phase of infection. The complex local host response and number of MAP were characterized at the initial sites of lesions, organized gut-associated lymphoid tissue, in experimentally infected goats. Tissues were collected at 3, 6, 9 and 12 month post-inoculation (mpi) from goat kids that had orally received 10 times 10mg of bacterial wet mass of MAP (JII-1961). The cellular composition of lesions in Peyer's patches in the jejunum and next to the ileocecal valve was evaluated in 21 MAP-inoculated goats, where lesions were compared with unaltered tissue of six control goats. CD68+, CD4+, CD8+, γδ T lymphocytes, B lymphocytes and plasma cells, MHC class II+ and CD25+ cells were demonstrated by immunohistochemistry in serial cryostat sections. At 3 mpi, extensive granulomatous infiltrates predominated, consisting of numerous epitheloid cells admixed with many CD4 and γδ T lymphocytes. Only single MAP were detected. This indicates a strong cellular immune reaction able to control MAP infection. γδ T lymphocytes were markedly increased in this type of lesion which may reflect their important role early in the pathogenesis of paratuberculosis. At 9 and 12 mpi, divergent lesions were observed which may reflect different outcomes of host-pathogen interactions. In five goats, minimal granulomatous lesions were surrounded by extensive lymphoplasmacytic infiltrates and no MAP were detected by immunohistochemistry. This was interpreted as effective host response that was able to eliminate MAP locally. In three goats, decreased numbers of lymphocytes, but extensive granulomatous infiltrates with numerous epitheloid cells containing increased numbers of mycobacteria were seen. This shift of the immune response resulted in uncontrolled mycobacterial multiplication. Focal and multifocal circumscribed granulomatous infiltrates of mainly epitheloid cells may represent sites of new infection, since they were observed in goats at all times after inoculation. Their presence in goats with minimal granulomatous lesions surrounded by extensive lymphoplasmacytic infiltrates may indicate that despite the local clearance, the infection may be perpetuated. The complex cellular immune reactions postulated for the pathogenesis of paratuberculosis were demonstrated at the local sites of infection. These early host-pathogen interactions are most likely essential for the eventual outcome of the MAP infection.

Die experimentelle Bestimmung der Elektronendichteverteilung in einem Chrom-Carben- sowie einem Chrom-Carbin-Komplex / The Experimental Determination of the Electronic Deformation Densities in a Chromium Carbene and a Chromium Carbyne Complex

The electronic deformation densities for pentacarbonylmethylethoxycarbenechromium I and chlorotetracarbonylethylidynechromium II have been experimentally determined using Neutron (for I) and X-ray diffracted intensities measured from single crystals at 100 K. A build up of electron density in all bonds and around each chromium atom is observed. Deformation density maxima are directed along the 3-fold axes of the approx-imately octahedrally coordinated metal atoms and presumably represent occupation of the t2g d-orbital set. The observed electron density distributions indicate that intermole-cular bonding has an important influence on the distribution of electron density in the molecules.

Photochemische Synthese von Pinocarvon-, Pulegon- und Benzalacetophenon-tricarbonyleisen. Ein Beitrag zur Frage der Bindung α, β-ungesättigter Ketone in Eisen-Komplexen / Photochemical Synthesis of Pinocarvone-, Pulegone-, and Benzalacetophenone-tricarbonyliron. A Contribution to the Nature of Bonding in Iron-Complexes of α,β-unsaturated Ketones

The photochemical synthesis of the title compounds is described. It has been established by spectroscopic evidence and by the x-ray structure of pinocarvone tricarbonyliron that in all these cases bonding to the iron involves only the π-system of the α,β-unsaturated ketones and not the nonbonding electrons of the keto group. The preferential site of monodentate coordination of α,β-unsaturated carbonyl compounds to transition metals is discussed on the basis of MO-considerations which are extended to 1,2-dicarbonyl compounds.

Zur Reaktion von Natriumtetracarbonylcobaltat mit Aluminiumtrichlorid. Molekiilstruktur von Co4(CO)13Al(THF)3Co3(CO)10 / On the Reaction of Sodium Tetracarbonylcobaltate with Aluminiumtrichlorid. Molecular Structure of Co4(CO)13Al(THF)3Co3(CO)10

The reaction of NaCo(CO)4 with AlCl3 in benzene has been studied. Main product of the reaction is Co4(CO)12. However, fractional crystallization of the crude reaction mixture gives small amounts of black crystals of the cobalt cluster Co4(CO)13Al(THF)3Co3(CO)10

A single crystal structure determination has revealed a quasi-octahedrally coordinated Al atom which is bridging a Co3(CO)9-oxymethylidin-tricobalt-nonacarbonyl cluster unit and a Co4-carbonyl cluster unit. Three THF ligands are completing the octahedral environment of the group-III metal. The aluminium atom is bonded to the oxygen atoms of three μ3-bridging CO groups of the Co3- and Co4-cluster fragments.

The Reaction of Dienes with [Fe(Pri 2P(CH2)nPPri 2)] Species

The structure of the compounds formed upon reacting Fe(Pri 2P(CH2)nPPri 2)Cl2 (n = 1-3) and active-Mg with acyclic and cyclic 1,3-, 1,4- and 1,5-dienes depends upon the nature of the diene and upon the length of the methylene-chain bridging the two P-atoms of the bidentate ligand. For example, isoprene reacts to give either (η4-isoprene)2FePPri 2C2H4PPri 2 or (η4-isoprene)Fe(Pri 2PC3H6PPri 2) while the products of the reaction with 1,5-hexadiene are (η5-1-methylpentadienyl)Fe(Pri 2PC2H4PPri 2)H or (η2,η2-1,5-hexadiene)Fe(Pri 2PC3H6PPri 2). The crystal structures of the last two compounds have been established by X-ray diffraction. The penultimate species catalyses the linear dimerization of 1,5-hexadiene.

Reduktive Enthalogenierung von (Cl, Br)RP–CH2–PR(Cl, Br) mit Fe2(CO)9– Bildung von Komplexen mit gespannten Diphosphirangerüsten und bifunktionellen Phosphidobrücken (µ2-PR)2CH2 / Reductive Dehalogenation of (Cl, Br)RP–CH2—PR(Cl, Br) with Fe2(CO)9– Formation of Complexes with Strained Diphosphirane Skeletons and Bifunctional Phosphido Bridges (μ2-PR)2CH2

Reductive dehalogenation of the bifunctional methylene bridged halogenphosphines XRP-CH2—PRX (X = Cl, Br; R = iPr, tBu, 2,4,6-R′3C6H2 (R′ = Me, iPr, tBu), N(SiMe3)2 and 2,6,4-tBu2MeC6H2—O) with diironenneacarbonyl affords phosphido complexes with strained RP—CH2—PR backbones, Fe2(CO)6[(μ2-PR)2CH2] (8a-8g). X-Ray structural analyses of the 2,4,6-iPr3C6H2 (8d) and 2,6,4-tBu2MeC6H2—O derivatives (8g) reveal that the Fe2P2C skeletons have remarkably small P—C—P angles (83,7(4)° (8d), 78,6(1)° (8g)).

The dehalogenation of XRP—CH2—PRX with Fe,(CO)9 is preceded by the formation of iron carbonyl complexes (RXP—CH2—PRX)[Fe(CO)4]n (n = 1, 2). For derivatives with bulky substituents R complex formation proceeds diastereoselectively. In case of 3 b the diastereoisomers could be separated and a crystallographic examination of the racemic form showed that the P—C—P backbone possesses C2 symmetry with an approximately trans conformation of the P—C—P fragment. The P-atoms occupy the equatorial position within the Fe(CO)4P units.

The chloro-phosphido bridged complex Fe2(CO)6(μ2-Cl)(µ2-PR—CH2—PRCl—Fe(CO)4) (4a), formed by oxidative addition of a P—Cl bond to Fe(0), or diphosphiranes and their complexes [(RP)2CH2][Fe(CO)4]n (n = 0-2; 5-7) have been isolated as intermediates of the XRP-CH2—PRX dehalogenation. The diphosphiranes 5 were synthesized independently by reduction of the halogenphosphines XRP—CH2—PRX with lithium or magnesium. An X-ray examination of 4a showed that it contains a μ2-PR—CH2—PRCl backbone which bridges Fe2(CO)6(μ2-Cl) and Fe(CO)4 units, the P—C—P angle being remarkably large, 127,3(1)°.

Synthese und Struktur von C5Me5Pd(PR3)X: Palladiumkomplexe mit einem unsymmetrisch gebundenen Pentamethylcyclopentadienylring [1] / Synthesis and Structure of C5Me5Pd(PR3)X: Palladium Complexes with an Unsymmetrically Bonded Pentamethylcyclopentadienyl Ring [1]

The complexes C5Me5Pd(PR3)X (1-4) are prepared from [Cl(PR3)Pd]2(μ-OCOCH3)2 and TIC5Me5. Attempts to replace the halide ligand by a second C5Me5 or a C5H5 unit remained unsuccessful. The X-ray structure analysis of C5Me5Pd[P(i-Pr)3]Cl (3) indicates that the five-membered ring shows a tendency of η1-bonding towards the metal.

Intermediates in the Palladium-Catalyzed Reaction of 1,3-Dienes, Part 6 [1]

The structure of the (1,3-butadiene)M(R2PC2H4PR2) compounds (M = Ni, Pd, Pt; R = Pri, Bu′, Cy) in the solid-state have been investigated by 13C and 31P CP/MAS NMR spectroscopy. The bonding mode adopted by the diene is dependent upon the nature of the metal: the palladium compounds contain an η2-diene molecule, the nickel compound where R is cyclohexyl contains an η4-diene molecule whereas the Pr2 iPC2H4PPr2 i-stabilized platinum compound con- tains a platinacyclopentene ring. The crystal structures of (η2-1,3-C4H6)Pd(Cy2PC2H4PCy2) and (η4-1,3-C4H6)Ni(Cy2PC2H4PCy2) have been confirmed by X-ray diffraction.

Transition Metal Complexes of Diazenes, XVII [1]. Reactions of 1,2-Diazetines and 1,2-Diazetine-N-oxides with Iron Carbonyls

Enneacarbonyldiiron reacts with 3,3,4,4-tetramethyl-1,2-diazetine (L) or its mono-N-oxide (L′) to form complexes (L)Fe(CO)4 (3), (L)Fe2(CO)7 (4), (L)Fe2(CO)6 (5), or (L′)Fe(CO)4 (6), and small amounts of deoxygenated 4 and 5, respectively. Formation and stability of the complexes is compared with those of ligands with smaller and larger ring sizes and discussed in terms of the electronic properties of the ligand lone-pair Orbitals. The molecular structure of 4 is established by X-ray analysis.

Übergangsmetallkomplexe von Diazenen, XXIII [1]. Struktur und Mößbauer-Daten bi- und tricyclischer Ferracyclen / Transition Metal Complexes of Diazenes, XXIII [1] Structure and Mößbauer Data of Bi- and Tricyclic Ferracycles

Mößbauer spectra of mono and dinuclear iron carbonyl complexes of three cyclic diazenes and the crystal structures of two products formed from (cis-diazene)Fe2(CO)6 and alkynes are reported. The ring size of the diazene ligand influences the stereochemistry of the cycloadducts obtained in the latter reaction; the bicyclic diazaferracycloalkene skeleton of these compounds leads to an exo- and endo-arrangement of one iron carbonyl group relative to the five- and six- membered diazene, rcspectively.

Übergangsmetallkomplexe von Diazenen, XV [1] Darstellung und Eigenschaften von Heterodimetallkomplexen des Typs LnM-(cis-RN=NR)-MʹLm Transition Metal Complexes of Diazenes, XV [1] Synthesis and Properties of Heterodimetal Complexes LnM-(cis-RN=NR)-MʹLm

Complexes of type LnM(η2 - pentamethylenediazirine)MʹLm, LnM/MʹLm = (CO)5Cr/Mo(CO)5, (CO)5Cr/Fe(CO)4, (CO)5W/Fe(CO)4 and (CO)5Cr/Mn(CO)2 5η(-MeC5H4) were prepared from [MʹLm(THF)] or Fe2(CO)9 and (η1 -pentamethylenediazirine)MLn. The structure of the Cr/Mo complex was determined by X-ray analysis. The IR and UV-VIS data resemble those of the corresponding homodi-metal complexes.

Übergangsmetallkomplexe von Diazenen, XVI [1] Struktur und Mößbauerdaten von (2.3-Diazanorbornen)Fe3(CO)9 / Transition Metal Complexes of Diazenes, XVI [1] Structure and Mössbauer Data of (2,3-Diazanorbornene)Fe3(CO)9

The molecular structure of (2,3-diazanorbornene)Fe3(CO)9 consists of a triangular Fe3(CO)9 group bound to the diazene unit. The seven-coordinated Fe(CO)3 group forms two Fe-N bonds with lengths of 1.974 and 1.965 Å, each of the two six-coordinated Fe(CO)3 groups has slightly shorter Fe-N-bonds of 1.898 and 1.903 Å. One Fe-Fe distance, 2.612Å, is longer than the two other ones, 2.572 and 2.582 Å, which are in the range of typical single bonds. The presence of seven-and six-coordinated iron carbonyl groups is also demonstrated by the Mössbauer spectrum showing signals with quadrupole splittings of 1.23 and 0.78, 0.62 ± 0.01 mm/s, respectively.

Sequential development of lesions 3, 6, 9, and 12 months after experimental infection of goat kids with Mycobacterium avium subsp paratuberculosis

The development of lesions after infection with Mycobacterium avium subsp paratuberculosis (MAP) was examined in an experimental infection model. Goat kids were orally inoculated 10 times with 10 mg bacterial wet mass of MAP (total dose 2.6 × 10(8) colony-forming units). Six to 7 inoculated goats and 3 controls were autopsied 3, 6, 9, and 12 months postinoculation (mpi), lesions were documented, and samples were collected for histology, immunohistochemistry (IHC), and bacterial culture. Twenty-five of the 26 inoculated goats did not develop clinical signs. Macroscopic lesions were detected in 3 of the 7 inoculated goats as soon as 3 mpi. Jejunal Peyer's patches (JPPs) were thickened and had ulcerated surfaces and circumscribed serositis. Characteristic granulomatous infiltrates were seen in all goats in gut-associated lymphoid tissues (GALTs), especially JPPs and lymphoid tissue at the ileocecal valve and in intestinal lymph nodes. Granulomatous intestinal infiltrates not associated with GALT were seen beginning at 6 mpi and with increasing frequency thereafter. Interindividual differences in lesions were most pronounced at 12 mpi, varying from mild focal paucibacillary to severe diffuse multibacillary patterns. Bacterial culture of MAP confirmed the IHC findings but was more sensitive and revealed widespread dissemination at 3 and 12 mpi. Granulomatous arteritis was found in intestinal submucosa of several goats. This may contribute to the spreading of MAP to the intestinal wall and possibly systemically. The different lesions observed during the clinically inapparent period of paratuberculosis are most likely indicators for the later progression of infection and development of clinical disease.