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Ms R, Riffelmann M, Kunze-Szikszay N, Lier M, Schmid O, Haus H, Schneider S, Jf H. Vacuum mattress or long spine board: which method of spinal stabilisation in trauma patients is more time consuming? A simulation study. Scand J Trauma Resusc Emerg Med 2021; 29:46. [PMID: 33706791 PMCID: PMC7953765 DOI: 10.1186/s13049-021-00854-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spinal stabilisation is recommended for prehospital trauma treatment. In Germany, vacuum mattresses are traditionally used for spinal stabilisation, whereas in anglo-american countries, long spine boards are preferred. While it is recommended that the on-scene time is as short as possible, even less than 10 minutes for unstable patients, spinal stabilisation is a time-consuming procedure. For this reason, the time needed for spinal stabilisation may prevent the on-scene time from being brief. The aim of this simulation study was to compare the time required for spinal stabilisation between a scoop stretcher in conjunction with a vacuum mattress and a long spine board. METHODS Medical personnel of different professions were asked to perform spinal immobilizations with both methods. A total of 172 volunteers were immobilized under ideal conditions as well as under realistic conditions. A vacuum mattress was used for 78 spinal stabilisations, and a long spinal board was used for 94. The duration of the procedures were measured by video analysis. RESULTS Under ideal conditions, spinal stabilisation on a vacuum mattress and a spine board required 254.4 s (95 % CI 235.6-273.2 s) and 83.4 s (95 % CI 77.5-89.3 s), respectively (p < 0.01). Under realistic conditions, the vacuum mattress and spine board required 358.3 s (95 % CI 316.0-400.6 s) and 112.6 s (95 % CI 102.6-122.6 s), respectively (p < 0.01). CONCLUSIONS Spinal stabilisation for trauma patients is significantly more time consuming on a vacuum mattress than on a long spine board. Considering that the prehospital time of EMS should not exceed 60 minutes and the on-scene time should not exceed 30 minutes or even 10 minutes if the patient is in extremis, based on our results, spinal stabilisation on a vacuum mattress may consume more than 20 % of the recommended on-scene time. In contrast, stabilisation on a spine board requires only one third of the time required for that on a vacuum mattress. We conclude that a long spine board may be feasible for spinal stabilisation for critical trauma patients with timesensitive life threatening ABCDE-problems to ensure the shortest possible on-scene time for prehospital trauma treatment, not least if a patient has to be rescued from an open or inaccessible terrain, especially that with uneven overgrown land.
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Affiliation(s)
- Roessler Ms
- Department for Anaesthesiology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.
| | - M Riffelmann
- Praxis Schmallenberg, Obringhauser Strasse 4, 57392, Schmallenberg, Germany
| | - N Kunze-Szikszay
- Department for Anaesthesiology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | - M Lier
- Department for Anaesthesiology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | - O Schmid
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Eichsfeld Clinic, Windische Gasse 112, 37308, Heilbad Heiligenstadt, Germany
| | - H Haus
- Department for Anaesthesiology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | - S Schneider
- Department of Medical Statistics, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | - Heuer Jf
- Department of Anaesthesiology, Intensive-Care-, Emergency- and Pain-Medicine, Augusta Krankenanstalt Bochum, Bergstrasse 26, 44791, Bochum, Germany
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Kolnsberg L, Riffelmann M, Friedrich M. Comparison of Serum 25-Hydroxyvitamin D Levels in Patients With Malignant and Benign Gynaecological Disease. Anticancer Res 2020; 40:545-550. [PMID: 31892610 DOI: 10.21873/anticanres.13983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 10/02/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Many studies have shown an antiproliferative, anti-inflammatory, anti-angiogenetic, and apoptosis-inducing effect of Vitamin D. A vitamin D deficiency has been associated with an increased risk for different types of cancer. This study examined vitamin D 25(OH)D levels in gynaecological cancers in comparison with benign gynaecological diseases. PATIENTS AND METHODS Serum 25(OH)D levels in 688 gynaecological patients (488 with malignant, 200 with a benign gynaecological disease) were assayed between 2009 and 2015 using an electrochemiluminescence immunoassay. RESULTS In total, the 25(OH)D levels in cancer patients were lower, but not significantly lower than those in cancer-free patients. Significant results were shown regarding seasonal effects for patients with breast-, endometrial and ovarian cancer. No significant effects occurred with regard to menopause status, nicotine, or grade in relation to 25(OH)D levels. CONCLUSION 25(OH)D levels seem to influence gynaecological cancers.
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Affiliation(s)
- Laura Kolnsberg
- Department of Gynaecology and Obstetrics, Helios Hospital Krefeld, Krefeld, Germany
| | - Marion Riffelmann
- Institute of Laboratory Medicine, Helios Hospital Krefeld, Krefeld, Germany
| | - Michael Friedrich
- Department of Gynaecology and Obstetrics, Helios Hospital Krefeld, Krefeld, Germany
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Weinberger R, Riffelmann M, Kennerknecht N, Hülße C, Littmann M, O'Brien J, von Kries R, von König CHW. Long-lasting cough in an adult German population: incidence, symptoms, and related pathogens. Eur J Clin Microbiol Infect Dis 2018; 37:665-672. [PMID: 29302815 PMCID: PMC7088169 DOI: 10.1007/s10096-017-3158-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 09/22/2017] [Accepted: 11/30/2017] [Indexed: 12/26/2022]
Abstract
Studies of the incidence of pertussis in adults have shown that it accounts for only 5–15% cases of prolonged coughing. We assessed the burden of suffering related to prolonged coughing and tried to identify further causative agents. Based on a sentinel study with 35 general practitioners in two German cities (Krefeld, Rostock), with 3,946 patients fulfilling the inclusion criteria, we estimated the incidence of prolonged coughing in adults. In 975 of these outpatients, PCR and/or serology for adenovirus, Bordetella pertussis and B. parapertussis, human metapneumovirus, influenza virus A and rhinovirus, parainfluenza virus, Mycoplasma pneumonia, and respiratory syncytial virus (RSV) were performed. Treatment data were extracted for a subgroup of 138 patients. Descriptive statistics, including Kaplan–Maier curves were generated. Yearly incidence ranged between 1.4 and 2.1% per population in the two cities. Adult patients sought medical attention only after a median of 3 weeks of coughing. Irrespective of smoking and unrelated to the identified pathogens, the median duration of coughing was 6 weeks, with an interquartile range of 4–11 weeks. In 48.3% of patients, possible pathogens were identified, among which adenovirus (15.1%), RSV (7.5%), B. pertussis (5.6%), and influenza viruses (4.0%) were most often found. Symptoms were not indicative of a specific agent and a total of 64% of patients received antibiotics. Prolonged adult coughing requiring medical attention prompts substantial healthcare use. Apart from B. pertussis, a broad range of pathogens was associated with the symptoms. However, patients sought medical attention too late to guide efficacious therapeutic interventions using the diagnostic tests.
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Affiliation(s)
- Raphael Weinberger
- Institut für Soziale Pädiatrie, Ludwig-Maximilians-Universität, Munich, Germany
| | - Marion Riffelmann
- Labor: Medizin Krefeld MVZ GmbH, Krefeld, Germany.,Institut für Hygiene und Labormedizin, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Nicole Kennerknecht
- Institut für Hygiene und Labormedizin, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Christel Hülße
- Landesamt für Gesundheit und Soziales des Landes Mecklenburg Vorpommern, Rostock, Germany
| | - Martina Littmann
- Landesamt für Gesundheit und Soziales des Landes Mecklenburg Vorpommern, Rostock, Germany
| | - Judith O'Brien
- Institut für Soziale Pädiatrie, Ludwig-Maximilians-Universität, Munich, Germany.,Labor: Medizin Krefeld MVZ GmbH, Krefeld, Germany.,Institut für Hygiene und Labormedizin, HELIOS Klinikum Krefeld, Krefeld, Germany.,Landesamt für Gesundheit und Soziales des Landes Mecklenburg Vorpommern, Rostock, Germany
| | - Rüdiger von Kries
- Institut für Soziale Pädiatrie, Ludwig-Maximilians-Universität, Munich, Germany
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Sobotzki C, Riffelmann M, Kennerknecht N, Hülsse C, Littmann M, White A, Von Kries R, Wirsing VON König CH. Latent class analysis of diagnostic tests for adenovirus, Bordetella pertussis and influenza virus infections in German adults with longer lasting coughs. Epidemiol Infect 2016; 144:840-6. [PMID: 26380914 DOI: 10.1017/s0950268815002149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/07/2022] Open
Abstract
Laboratory tests in adult outpatients with longer lasting coughs to identify a potential causal pathogen are rarely performed, and there is no gold standard for these diagnostic tests. While the diagnostic validity of serological tests for pertussis is well established their potential contribution for diagnosing adenovirus and influenza virus A and B infections is unclear. A sentinel study into the population-based incidence of longer lasting coughs in adults was done in Rostock (former East Germany) and Krefeld (former West Germany). A total of 971 outpatients who consulted general practitioners or internists were included. Inclusion criteria were coughing for ⩾1 week and no chronic respiratory diseases. We evaluated the performance of polymerase chain reaction (PCR) as well as IgG and IgA serology, applying a latent class model for diagnosing infections with adenovirus, B. pertussis, and influenza virus A and B. The adult outpatients first sought medical attention when they had been coughing for a median of 3 weeks. In this situation, direct detection of infectious agents by PCR had a low sensitivity. Modelling showed that additional serological tests equally improved sensitivity and specificity for diagnosis for adenovirus, B. pertussis and influenza virus A and B infections. The combination of serology and PCR may improve the overall performance of diagnostic tests for B. pertussis and also for adenovirus, and influenza virus A and B infections.
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Affiliation(s)
- C Sobotzki
- Institut für Soziale Pädiatrie und Jugendmedizin,Ludwig-Maximilians-Universität,München,Germany
| | | | - N Kennerknecht
- Institut für Hygiene und Labormedizin,HELIOS Klinikum Krefeld,Germany
| | - C Hülsse
- Landesamt für Gesundheit und Soziales des Landes Mecklenburg Vorpommern,Rostock,Germany
| | - M Littmann
- Landesamt für Gesundheit und Soziales des Landes Mecklenburg Vorpommern,Rostock,Germany
| | - A White
- Trinity College Dublin,School of Computer Science and Statistics,Dublin,Ireland
| | - R Von Kries
- Institut für Soziale Pädiatrie und Jugendmedizin,Ludwig-Maximilians-Universität,München,Germany
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Riffelmann M, Mohr J, Hellenbrand W, Wirsing von Koenig CH. Time since last vaccine dose in PCR-positive and PCR-negative children with suspected pertussis to monitor pertussis vaccine effectiveness. Eur J Clin Microbiol Infect Dis 2013; 33:805-8. [DOI: 10.1007/s10096-013-2016-4] [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] [Received: 09/02/2013] [Accepted: 11/06/2013] [Indexed: 10/26/2022]
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Riffelmann M, Thiel K, Schmetz J, Wirsing von Koenig CH. Performance of commercial enzyme-linked immunosorbent assays for detection of antibodies to Bordetella pertussis. J Clin Microbiol 2010; 48:4459-63. [PMID: 20943873 PMCID: PMC3008456 DOI: 10.1128/jcm.01371-10] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 08/02/2010] [Accepted: 10/03/2010] [Indexed: 11/20/2022] Open
Abstract
Measuring antibodies to Bordetella pertussis antigens is mostly done by enzyme-linked immunosorbent assays (ELISAs). We compared the performance of ELISA kits that were commercially available in Germany. Eleven measured IgG antibodies, and nine measured IgA antibodies. An in-house ELISA with purified antigens served as a reference method. Samples included two WHO reference preparations, the former Food and Drug Administration (FDA)/Center for Biologics Evaluation and Research (CBER) reference preparations, serum samples from patients with clinically suspected pertussis, and serum samples from patients having received a combined tetanus, diphtheria, and pertussis (Tdap) vaccination. Kits using pertussis toxin (PT) as an antigen showed linearity compared to the WHO Reference preparation (r2 between 0.82 and 0.99), and these kits could quantify antibodies according to the reference preparation. ELISA kits using mixed antigens showed no linear correlation to the reference preparations. Patient results were compared to results of in-house ELISAs using a dual cutoff of either ≥100 IU/ml anti-PT IgG or ≥40 IU/ml anti-PT IgG together with ≥12 IU/ml anti-PT IgA. The sensitivities of kits measuring IgG antibodies ranged between 0.84 and 1.00. The specificities of kits using PT as an antigen were between 0.81 and 0.93. The specificities of kits using mixed antigens were between 0.51 and 0.59 and were thus not acceptable. The sensitivities of kits measuring IgA antibodies ranged between 0.53 and 0.73, and the specificities were between 0.67 and 0.94, indicating that IgA antibodies may be of limited diagnostic value. Our data suggest that ELISAs should use purified PT as an antigen and be standardized to the 1st International Reference preparation.
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Affiliation(s)
- M. Riffelmann
- Institut für Hygiene und Labormedizin, Zentrum für Kinder-und Jugendmedizin, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - K. Thiel
- Institut für Hygiene und Labormedizin, Zentrum für Kinder-und Jugendmedizin, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - J. Schmetz
- Institut für Hygiene und Labormedizin, Zentrum für Kinder-und Jugendmedizin, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - C. H. Wirsing von Koenig
- Institut für Hygiene und Labormedizin, Zentrum für Kinder-und Jugendmedizin, HELIOS Klinikum Krefeld, Krefeld, Germany
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Guiso N, Berbers G, Fry NK, He Q, Riffelmann M, Wirsing von König CH. What to do and what not to do in serological diagnosis of pertussis: recommendations from EU reference laboratories. Eur J Clin Microbiol Infect Dis 2010; 30:307-12. [PMID: 21069406 PMCID: PMC3034915 DOI: 10.1007/s10096-010-1104-y] [Citation(s) in RCA: 174] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 10/18/2010] [Indexed: 11/29/2022]
Abstract
Bordetella pertussis-specific antibodies can be detected by enzyme-linked immunosorbent assays (ELISAs) or multiplex immunoassays. Assays use purified or mixed antigens, and only pertussis toxin (PT) is specific for B. pertussis. The interpretation of results can be based on dual-sample or single-sample serology using one or two cut-offs. The EU Pertstrain group recommends that: (i) ELISAs and multiplex immunoassays should use purified non-detoxified PT as an antigen, that they should have a broad linear range and that they should express results quantitatively in International Units per millilitre (IU/ml); (ii) a single or dual diagnostic cut-off for single-serum serology using IgG-anti-PT between 50 and 120 IU/ml should be used, and diagnostic serology cannot be validly interpreted for one year after vaccination with acellular pertussis (aP) vaccines; (iii) IgA-anti-PT should only be used with indeterminate IgG-anti-PT levels or when a second sample cannot be obtained. This group discourages using: (i) other antigens in routine diagnostics, as they are not specific; (ii) micro-agglutination, due to its lack of sensitivity; (iii) immunoblots for pertussis serodiagnosis, as results cannot be quantified; (iv) other methods, such as complement fixation or indirect immunofluorescence, due to their low sensitivity and/or specificity.
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Affiliation(s)
- N Guiso
- Institut Pasteur, Paris, France
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Rieber N, Graf A, Belohradsky BH, Hartl D, Urschel S, Riffelmann M, Wirsing von König CH, Liese J. Differences of humoral and cellular immune response to an acellular pertussis booster in adolescents with a whole cell or acellular primary vaccination. Vaccine 2008; 26:6929-35. [DOI: 10.1016/j.vaccine.2008.09.064] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 09/22/2008] [Accepted: 09/24/2008] [Indexed: 10/21/2022]
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Riffelmann M, Littmann M, Hellenbrand W, Hülße C, Wirsing von König CH. Pertussis: not only a disease of childhood. Dtsch Arztebl Int 2008; 105:623-8. [PMID: 19471626 PMCID: PMC2680566 DOI: 10.3238/arztebl.2008.0623] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Accepted: 06/17/2008] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Pertussis is not just a childhood disease, but a respiratory infection that causes persistent cough in all age groups, from newborns to the elderly. METHODS The authors performed a selective literature search and reviewed national and international recommendations for treatment and vaccination. RESULTS Pertussis is found principally in young unvaccinated infants, but school-age children, adolescents, and adults are also affected. Up to 1% of infants contract pertussis, and their respiratory symptoms are often accompanied by apnea. School-age children occasionally display the coughing spasms typical of the disease. Annually, 0.2% to 0.5% of all adolescents and adults are infected and suffer from prolonged, frequently non-paroxysmal coughing. Severe and fatal cases of pertussis occur mainly in newborns and infants, and 25% of affected adults experience complications. Bordetella DNA may be detected by polymerase chain reaction (PCR) for four weeks after symptom onset; except in infants, the sensitivity of this diagnostic technique is low. Although the diagnosis can be confirmed by serological tests, the methods are not well standardized. Treatment with a macrolide prevents the spread of infection, but generally does not alleviate the symptoms. Combination vaccines are the most effective means of prophylaxis. DISCUSSION Pertussis is usually not included in the differential diagnosis of persistent respiratory symptoms. The considerable burden of disease could be reduced in adults and young infants by vaccinating adults with acellular combination vaccines.
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Littmann M, Hülße C, Riffelmann M, Wirsing von König CH. Long-term immunogenicity of a single dose of acellular pertussis vaccine in paediatric health-care workers. Vaccine 2008; 26:2344-9. [DOI: 10.1016/j.vaccine.2008.02.065] [Citation(s) in RCA: 9] [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] [Received: 10/28/2007] [Revised: 02/21/2008] [Accepted: 02/28/2008] [Indexed: 12/01/2022]
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Reder S, Riffelmann M, Becker C, Wirsing von König CH. Measuring immunoglobulin g antibodies to tetanus toxin, diphtheria toxin, and pertussis toxin with single-antigen enzyme-linked immunosorbent assays and a bead-based multiplex assay. Clin Vaccine Immunol 2008; 15:744-9. [PMID: 18321880 PMCID: PMC2394830 DOI: 10.1128/cvi.00225-07] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Revised: 10/01/2007] [Accepted: 02/22/2008] [Indexed: 11/20/2022]
Abstract
Bead-based assay systems offer the possibility of measuring several specific antibodies in one sample simultaneously. This study evaluated a vaccine panel of a multianalyte system that measures antibodies to tetanus toxin, diphtheria toxin, and pertussis toxin (PT) from Bordetella pertussis. The antibody concentrations of human immunoglobulin G (IgG) to PT, tetanus toxin, and diphtheria toxin were measured in 123 serum pairs (total of 246 sera) from a vaccine study. The multianalyte bead assay was compared to a standardized in-house IgG- anti-PT enzyme-linked immunosorbent assay (ELISA) of the German reference laboratory for bordetellae, as well as to various commercially available ELISAs for anti-PT IgG, anti-tetanus IgG, and anti-diphtheria IgG. The results of the multiplex assay regarding the antibodies against diphtheria toxin compared favorably with a regression coefficient of 0.938 for values obtained with an ELISA from the same manufacturer used as a reference. Similarly, antibodies to tetanus toxin showed a correlation of 0.910 between the reference ELISA and the multianalyte assay. A correlation coefficient of 0.905 was found when an "in-house" IgG anti-PT and the multiplex assay were compared. Compared to single ELISA systems from two other manufacturers, the multiplex assay performed similarly well or better. The multianalyte assay system was a robust system with fast and accurate results, analyzing three parameters simultaneously in one sample. The system was well suited to quantitatively determine relevant vaccine induced antibodies compared to in-house and commercially available single-antigen ELISA systems.
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Hallander H, Advani A, Riffelmann M, von König CHW, Caro V, Guiso N, Mooi FR, Gzyl A, Kaltoft MS, Fry NK, Mertsola J, He Q. Bordetella pertussis strains circulating in Europe in 1999 to 2004 as determined by pulsed-field gel electrophoresis. J Clin Microbiol 2007; 45:3257-62. [PMID: 17699646 PMCID: PMC2045341 DOI: 10.1128/jcm.00864-07] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Revised: 06/11/2007] [Accepted: 08/03/2007] [Indexed: 11/20/2022] Open
Abstract
Clinical isolates of Bordetella pertussis collected during the year 2004 (n = 153) in eight European countries, Denmark, Finland, France, Germany, The Netherlands, Poland, Sweden, and United Kingdom, were analyzed by pulsed-field gel electrophoresis (PFGE), and their PFGE profiles were compared with those of isolates collected in 1999 (n = 102). The 255 isolates produced 59 distinct PFGE profiles. Among the 153 isolates from 2004, 36 profiles were found, while within the 102 isolates from 1999, 33 profiles were detected. One PFGE profile, BpSR11, was dominant (30% to 50%) in all countries except Denmark (10%) and Poland (0%). In comparison with 1999, there was an increase in BpSR11 prevalence in Finland in 2004 from 5% to 40%, coinciding with a major incidence peak. Some other PFGE profiles seemed to be associated with limited dissemination. Poland was the only country in which the most common actual European PFGE profiles were not found. In a dendrogram analysis, all common PFGE profiles were identified within PFGE group IV, and BpSR11 clustered together with PFGE subgroup IVbeta. Compared to the 1999 isolates, PFGE group V representative for pertactin variant prn3 strains had disappeared, and a new cluster was seen. In conclusion, some PFGE profiles, such as BpSR11, evidently have a higher capacity to spread, suggesting increased fitness to the present immunological environment. It is therefore of major interest to continue with surveillance programs of B. pertussis isolates, as both waning vaccine-derived immunity and strain variation may play a role in the persistence of pertussis.
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Affiliation(s)
- Hans Hallander
- Department of Immunology Vaccinology, Swedish Institute for Infectious Disease Control, Solna, Sweden
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Abstract
BACKGROUND AND OBJECTIVE A prospective sentinel study into the population-based incidence of pertussis in adults was done between 2001 and 2004 in Rostock (former East Germany) and Krefeld (former West Germany). PATIENTS AND METHODS 971 outpatients, who consulted general practitioners or internists, were included. Clinical inclusion criteria were coughing for one week or more and no chronic respiratory diseases. Bordetella infection was diagnosed by PCR on nasopharyngeal swabs and ELISA for serology (IgG-anti-PT, IgA-anti-PT, IgG-anti-FHA, IgA-anti-FHA). RESULTS We found a total of 97 cases of pertussis in this cohort. The main symptom was coughing for a median of 7-8 weeks. Population-based incidence was estimated in Krefeld at 169 cases/100000 population per year, and in Rostock at 160/100000 per year. Resource use was 120 EUR of direct medical cost and 434 euro of indirect medical cost, not including hospitalization in this study. CONCLUSIONS Pertussis is a frequent cause of longer lasting cough in German adults, and it causes significant morbidity and costs.
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Affiliation(s)
- M Riffelmann
- Institut für Infektiologie Krefeld GmbH, Krefeld.
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Hille S, Rein DT, Riffelmann M, Neumann R, Sartorius J, Pfützner A, Kurbacher CM, Schöndorf T, Breidenbach M. Anticancer drugs induce mdr1 gene expression in recurrent ovarian cancer. Anticancer Drugs 2006; 17:1041-4. [PMID: 17001177 DOI: 10.1097/01.cad.0000231480.07654.b5] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Ovarian cancer is currently the most lethal gynecologic malignancy in Europe and the US. Platin analogues and paclitaxel demonstrate high remission rates, but unfortunately the efficacy of cytostatic agents is limited by the development of multidrug resistance (mdr). Clinical paclitaxel resistance is often associated with mdr1 overexpression. In a recent study, we introduced a highly specific quantitative real-time reverse transcriptase polymerase chain reaction for the quantification of mdr1 transcripts. In the present study, we demonstrate that primary tumor cells from patients with recurrent ovarian cancer overexpress mdr1. To evaluate mdr1 expression, we collected tumor cells from 77 ovarian cancer patients (13 chemotherapy-naive ovarian cancer, 64 recurrent ovarian cancer). Cancer cells were aspirated from 49 solid specimens (63%) and 28 ascitic fluids (37%). Subsequently, cancer cells were exposed in 221 short-term cultures either to blank medium (control) or to a single anticancer drug, cisplatin, doxorubicin or paclitaxel. The drug concentrations applied referred to clinical relevant doses. mdr1 mRNA expression was significantly higher in specimens from recurrent ovarian cancer incubated in paclitaxel than in specimens from chemotherapy-naive ovarian cancer. No significant differences were detectable between the mean value of mdr1 mRNA expression in tumor specimens from recurrent ovarian cancer incubated in cisplatin or doxorubicin. Differences within the untreated patients group were also not statistically significant. The result of this study confirms clinical observations, as well as in-vitro studies based on tumor cell lines, that paclitaxel resistance is correlated with mdr1 overexpression.
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Affiliation(s)
- Stephanie Hille
- Department of Gynecology and Obstetrics, University of Düsseldorf, Düsseldorf bKlinikum Krefeld, Krefeld, Germany.
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Knuf M, Zepp F, Meyer C, Grzegowski E, Wolter J, Riffelmann M, Wirsing von König CH. Immunogenicity of a single dose of reduced-antigen acellular pertussis vaccine in a non-vaccinated adolescent population. Vaccine 2006; 24:2043-8. [PMID: 16356597 DOI: 10.1016/j.vaccine.2005.11.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Revised: 09/18/2005] [Accepted: 11/14/2005] [Indexed: 10/25/2022]
Abstract
German adolescents (n=123) without previous pertussis vaccination, no history of pertussis and low IgG-anti-pertussis-toxin (PT) levels received one dose of the Tdap vaccine Boostrix. Blood samples were taken before, and 5-12 days and 29-49 days after vaccination. IgG- and IgA-anti-PT, IgG- and IgA-anti filamentous hemagglutinin, IgG-anti-pertactin, IgG-anti-tetanus-toxin, and IgG-anti-diphtheria-toxin were measured by ELISA. 88.6% of subjects had an immune response to PT, and all vaccinees had an immune response to at least one pertussis antigen 29-49 days after vaccination. IgA-anti-PT and IgA-anti-FHA responses were found in 43 and 81% of subjects, respectively. This study shows that in unvaccinated German adolescents pertussis immunity can be achieved by a single dose of Tdap.
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Affiliation(s)
- Markus Knuf
- Department of Pediatrics, Johannes Gutenberg University of Mainz, Germany
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17
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Affiliation(s)
- M Riffelmann
- Institut fuer Infektiologie Krefeld GmbH, Lutherplatz 40, D-47805 Krefeld, Germany
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18
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van Amersfoorth SCM, Schouls LM, van der Heide HGJ, Advani A, Hallander HO, Bondeson K, von König CHW, Riffelmann M, Vahrenholz C, Guiso N, Caro V, Njamkepo E, He Q, Mertsola J, Mooi FR. Analysis of Bordetella pertussis populations in European countries with different vaccination policies. J Clin Microbiol 2005; 43:2837-43. [PMID: 15956406 PMCID: PMC1151907 DOI: 10.1128/jcm.43.6.2837-2843.2005] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Despite the widespread use of pertussis vaccines during the last decades, pertussis has remained an endemic disease with frequent epidemic outbreaks. Currently two types of vaccines are used: whole-cell vaccines (WCVs) and recently developed acellular vaccines (ACVs). The long-term aim of our studies is to assess the effect of different vaccination policies on the population structure of Bordetella pertussis and ultimately on the disease burden in Europe. In the present study, a total of 102 B. pertussis isolates from the period 1998 to 2001 from five European countries (Finland, Sweden, Germany, The Netherlands, and France) were characterized. The isolates were analyzed by typing based on variable number of tandem repeats (VNTR); by sequencing of polymorphic genes encoding the surface proteins pertussis toxin S1 and S3 subunits (ptxA and ptxC), pertactin (prn), and tracheal colonization factor (tcfA); and by fimbrial serotyping. The results reveal a relationship between geographic location and VNTR types, the frequency of the ptxC alleles, and serotypes. We have not observed a relationship between the strain characteristics we studied and vaccination programs. Our results provide a baseline which can be used to reveal changes in the B. pertussis population in Europe in the coming years.
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Affiliation(s)
- S C M van Amersfoorth
- Laboratory for Vaccine Preventable Diseases. National Institute of Public Health and the Environment, Anthonie van Leeuwenhoeklaan 9, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
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19
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Caro V, Njamkepo E, Van Amersfoorth SCM, Mooi FR, Advani A, Hallander HO, He Q, Mertsola J, Riffelmann M, Vahrenholz C, Von König CHW, Guiso N. Pulsed-field gel electrophoresis analysis of Bordetella pertussis populations in various European countries with different vaccine policies. Microbes Infect 2005; 7:976-82. [PMID: 15994109 DOI: 10.1016/j.micinf.2005.04.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Revised: 04/04/2005] [Accepted: 04/12/2005] [Indexed: 11/29/2022]
Abstract
The increasing incidence of pertussis in a number of countries, despite good vaccination coverage, is a cause for concern. We used pulsed-field gel electrophoresis (PFGE) typing to examine the genetic diversity of 101 clinical isolates of Bordetella pertussis, recovered during 1999-2001, and circulating in five different European countries to evaluate temporal and geographical distribution. This DNA fingerprinting approach seems to be a more discriminative epidemiological tool than sequencing of individual genes. Despite differences in vaccination policies in the five countries, these European isolates were found to be very similar and fell into the same major PFGE profile groups, with a predominance of one profile group. There was no evidence of geographic clustering, except that one new profile subgroup was predominantly found in one country. This study provides a baseline for continued surveillance of the B. pertussis population in Europe.
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Affiliation(s)
- Valérie Caro
- Institut Pasteur, Molecular Prevention and Therapy for Human Diseases Unit, Institut Pasteur, Paris, France
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20
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Bonhoeffer J, Bär G, Riffelmann M, Solèr M, Heininger U. The role of Bordetella infections in patients with acute exacerbation of chronic bronchitis. Infection 2005; 33:13-7. [PMID: 15750754 DOI: 10.1007/s15010-005-4004-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2004] [Accepted: 05/01/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Acute exacerbations of chronic bronchitis (AECB) are associated with a variety of viral and bacterial infectious agents, some of which are potentially preventable by immunization. Bordetella pertussis, which causes whooping cough, has not been studied in this context. We aimed to assess the role of Bordetella infections in patients with AECB. PATIENTS AND METHODS Patients with AECB, who presented to participating private practices in Basel, Switzerland, between October 2000 and June 2002, were evaluated by a standardized questionnaire, nasopharyngeal swabs for culture (Bordetella spp.), and PCR (Bordetella spp. and selected other respiratory pathogens) and paired blood samples for serologic diagnosis of Bordetella infection. RESULTS A total of 26 patients (34-86 years of age) were recruited. All culture and PCR samples were negative. Serology revealed Bordetella infection in eight (31%) patients. Duration of cough was shorter in patients with Bordetella infection compared to those without Bordetella infection (mean 15 days vs 41 days, p = 0.04). Cough > or = 21 days duration was present in three (43%) of seven patients with evidence of Bordetella infection compared to 17 (94%) of 18 controls (p = 0.012). Progression to convalescence from initial to follow-up visit after 4-6 weeks was comparable between both groups. CONCLUSION Bordetella infections appear to play a significant role in AECB and preventive measurements such as immunization with acellular pertussis vaccines should be considered. Extended investigations are necessary to confirm our preliminary and provocative findings.
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Affiliation(s)
- J Bonhoeffer
- University Children's Hospital Basel, P.O. Box, CH-4005 Basel, Switzerland.
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21
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Muyldermans G, Soetens O, Antoine M, Bruisten S, Vincart B, Doucet-Populaire F, Fry NK, Olcén P, Scheftel JM, Senterre JM, van der Zee A, Riffelmann M, Piérard D, Lauwers S. External quality assessment for molecular detection of Bordetella pertussis in European laboratories. J Clin Microbiol 2005; 43:30-5. [PMID: 15634947 PMCID: PMC540137 DOI: 10.1128/jcm.43.1.30-35.2005] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although the PCR for the detection of Bordetella pertussis is routinely performed in diagnostic laboratories, no quality assessment program has so far been described. We report on the results obtained with two external quality assessment proficiency panels sent to European laboratories. The first proficiency panel contained a series of dilutions of three previously characterized B. pertussis clinical isolates and two negative controls. No false-positive results were reported by six laboratories providing seven data sets. The reported limits of detection of the three B. pertussis strains varied between 4 and 4,000, 9 and 9,000, and 3 and 30,000 CFU/ml, respectively. The second proficiency panel, composed of a series of dilutions of reference strains of B. pertussis, B. holmesii, B. hinzii, and B. bronchiseptica, as well as negative controls, was sent to nine laboratories. One laboratory reported a negative result for a sample and reported a B. parapertussis-positive sample to be positive for B. pertussis. By using the B. pertussis-specific target gene pertactin, one laboratory detected B. pertussis with 100% specificity. All other laboratories, which used IS481-based assays, reported positive results for the samples containing B. holmesii and B. bronchiseptica, species that have occasionally been recovered from human respiratory samples. These data show that the choice of the target gene is particularly critical for the species specificity of B. pertussis PCR assays.
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Affiliation(s)
- G Muyldermans
- Department of Microbiology, Academisch Ziekenhuis Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
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22
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Schöndorf T, Neumann R, Benz C, Becker M, Riffelmann M, Göhring UJ, Sartorius J, von König CHW, Breidenbach M, Valter MM, Hoopmann M, Di Nicolantonio F, Kurbacher CM. Cisplatin, doxorubicin and paclitaxel induce mdr1 gene transcription in ovarian cancer cell lines. Recent Results Cancer Res 2003; 161:111-6. [PMID: 12528803 DOI: 10.1007/978-3-642-19022-3_10] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The clinical observation of the multidrug resistance (MDR) phenotype is often associated with overexpression of the mdrl gene, in particular with respect to ovarian cancer. However, until now the mdrl-inducing potential of commonly used antineoplastics has been only incompletely explored. We performed short-term cultures of six ovarian cancer cell lines (MZOV4, EF027, SKOV3, OAW42, OTN14, MZOV20) exposed to either blank medium or cisplatin, doxorubicin or paclitaxel at concentrations related to the clinically achievable plasma peak concentration. A highly specific quantitative real-time RT-PCR was used to detect the Mdr1 transcripts. Mdrl mRNA contents were calibrated in relation to coamplified GAPDH mRNA. Mdrl mRNA was detectable in each cell line. In 13 out of 18 assays (72%) the specific anticancer drug being tested induced mdr1 transcription. No decrease in mdr1 mRNA concentration was observed. Our data suggest that mdr1 induction by antineoplastics is one of the reasons for failure of ovarian cancer therapy but may vary individually.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B, Member 1/genetics
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents, Phytogenic/pharmacology
- Cisplatin/pharmacology
- DNA Primers/chemistry
- Doxorubicin/pharmacology
- Drug Resistance, Multiple/genetics
- Drug Resistance, Neoplasm/genetics
- Drug Screening Assays, Antitumor
- Female
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Ovarian Neoplasms/genetics
- Ovarian Neoplasms/metabolism
- Paclitaxel/pharmacology
- RNA, Messenger/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Transcription, Genetic/drug effects
- Tumor Cells, Cultured/drug effects
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Affiliation(s)
- Thomas Schöndorf
- Department of Gynecology and Obstetrics, University of Cologne, Kerpener Strasse 34, 50931 Köln, Germany.
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23
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Thomas P, Riffelmann M, Schweiger B, Dominik S, von König CHW. Fatal influenza A virus infection in a child vaccinated against influenza. Pediatr Infect Dis J 2003; 22:201-2. [PMID: 12613460] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
We report a fatal infection with influenza A virus in a 13-year-old child who had been vaccinated against influenza. Influenza A virus RNA was detected by PCR in lungs, bronchi and myocardium. A penicillin-sensitive strain of Staphylococcus aureus was also isolated from her bronchi. This case indicates that a primary viral pneumonia with influenza A virus complicated by a bacterial superinfection with S. aureus can run a fatal course even in a vaccinated child.
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Affiliation(s)
- Peter Thomas
- Kinderklinik, Klinikum Krefeld, Robert-Koch-Institut, Germany
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24
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Abstract
Bordetella pertussis continues to circulate even in populations where a high vaccine coverage of infants and children is achieved. Cases in adolescents and adults are reported with increasing frequency in many countries. Adults are a reservoir for infections in very young infants, in whom pertussis may be severe and life-threatening. The salient clinical feature of pertussis in adolescents and adults is prolonged coughing, and recognising that pertussis does occur in these age groups is the most important step in its diagnosis. A laboratory diagnosis can be made by bordetella-PCR from nasopharyngeal swabs or secretions and by detection of antibodies, mainly to pertussis toxin; laboratory diagnosis is, however, not well standardised. Vaccination of adolescents and adults is now possible with acellular pertussis vaccines, which are well tolerated, immunogenic, and effective. Adolescent boosters and the vaccination of health-care workers are already included in vaccination calendars in some countries. Vaccine-recommending bodies and national health-care organisations must have locally relevant information on the transmission of pertussis from adults to infants to be able to make decisions on the advisability, feasibility, and priority for booster immunisation against pertussis.
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25
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Kösters K, Reischl U, Schmetz J, Riffelmann M, Wirsing von König CH. Real-time LightCycler PCR for detection and discrimination of Bordetella pertussis and Bordetella parapertussis. J Clin Microbiol 2002; 40:1719-22. [PMID: 11980949 PMCID: PMC130942 DOI: 10.1128/jcm.40.5.1719-1722.2002] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Real-time PCR assays based on the LightCycler technology were developed for individual (simplex PCR) and simultaneous (duplex PCR) detection and discrimination of Bordetella pertussis and Bordetella parapertussis in clinical samples. The assays were evaluated with 113 specimens from patients with and without symptoms of pertussis. Results were compared to those from conventional culture and TaqMan real-time PCR. The analytical sensitivity ranged from 0.1 to 10 CFU for B. pertussis and B. parapertussis, and intra- and interassay variations were less than 7%. Results were available within 2 h. With the simplex format, 21 of 100 samples from patients with clinical symptoms of pertussis were positive for B. pertussis and/or B. parapertussis. With the duplex format, 18 of 100 samples were positive. LightCycler PCR increased the diagnostic sensitivity over that of culture by 2.0-fold (duplex PCR) (P = 0.08) to 2.3-fold (simplex PCR) (P = 0.02). Our data suggest that duplex PCR in this format showed good analytical sensitivity but lost some sensitivity on clinical samples compared with the simplex format.
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Affiliation(s)
- Katrin Kösters
- Institut für Hygiene und Laboratoriumsmedizin, Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld, Germany
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26
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Abstract
BACKGROUND To compare the antibody concentrations against Bordetella antigens in health care workers in a pediatric hospital with those of two different populations without professional contact with children. METHODS In a pediatric hospital 155 health care workers (135 female, 20 male), 292 male navy recruits after 3 months at sea and 146 regular blood donors (41 female, 105 male) were screened for antibodies of isotypes IgG and IgA to pertussis toxin (PT) and filamentous hemagglutinin (FHA) by enzyme-linked immunosorbent assay. RESULTS Pediatric health care workers were positive for IgG anti-PT in 88%, for IgA anti-PT in 52%, for IgG anti-FHA in 99% and for IgA anti-FRA in 84%. Relative numbers for blood donors and recruits were 86 and 80% for IgG anti-PT, 56 and 55% for IgA anti-PT, 100 and 98% for IgG anti-FHA and 92 and 82% for IgA anti-FHA, respectively. Reverse cumulative distribution of all antibodies except for IgA anti-FHA showed no differences among the three groups; 2% of pediatric personnel, 3% of blood donors and 3% of navy recruits, respectively, had IgG anti-PT > or = 100 enzyme-linked immunosorbent assay units/ml, indicating a recent contact to Bordetella pertussis. CONCLUSION Antibodies to B. pertussis antigens, such as IgG/IgA anti-PT and IgG/IgA anti-FHA, were similarly distributed in all three groups. Our results suggest that exposures leading to measurable immune responses to pertussis antigens in German pediatric health care workers are not significantly more frequent than in other populations without professional contacts with children.
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Affiliation(s)
- Marion Riffelmann
- Institute for Hygiene and Laboratory Medicine, Klinikum Krefeld, Germany
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27
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Maiwald-Schirra C, Riffelmann M, Wirsing von König CH. [Anthrax. Basic principles and preventive measures]. Kinderkrankenschwester 2001; 20:511-4. [PMID: 14584137] [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] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- C Maiwald-Schirra
- Kinderklinik, Institut für Hygiene und Labormedizin Klinikum Krefeld Lutherplatz 40, 47805 Krefeld
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28
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Saemann-Ischenko G, Tillmanns B, Kösters K, Riffelmann M, Wirsing von König CH. Stability of antibodies to Bordetella antigens in German adults. Eur J Clin Microbiol Infect Dis 2001; 20:850-3. [PMID: 11837635 DOI: 10.1007/s10096-001-0639-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To estimate the rate of asymptomatic exposure to Bordetella pertussis antigens in the German adult population and to evaluate the stability of antibodies to these antigens, antibody levels against Bordetella antigens and their variability over time were measured in German adult blood donors. One hundred forty-six regular blood donors (41 females, 105 males) were tested repeatedly for antibodies of isotypes IgG and IgA to pertussis toxin, filamentous hemagglutinin (FHA) and pertactin over a period of 2-5 years. Overall, 86% and 56% had IgG or IgA antibodies to pertussis toxin, respectively, 100% and 92% had IgG or IgA antibodies to FHA, respectively, and 83% and 93% had IgG or IgA antibodies to pertactin, respectively. One significant titer increase of both IgG anti-FHA and IgG anti-pertactin, one of IgG anti-FHA, and two of IgA anti-FHA as well as one significant decrease of IgG anti-pertussis toxin were observed during an observation period of 480.5 person-years. Antibody concentrations in men and women were not different. The data show that the level of antibodies to pertussis toxin, FHA, and pertactin remains stable over several years. Furthermore, depending on the definition of serological evidence, the rate of significant increases or decreases suggesting unrecognized exposure to Bordetella antigens was estimated to be between <0.2 and 1.0 per 100 person-years in the population studied.
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29
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Kösters K, Riffelmann M, VON König CHW. Evaluation of a real-time PCR assay for detection of Bordetella pertussis and B. parapertussis in clinical samples. J Med Microbiol 2001; 50:436-440. [PMID: 11339251 DOI: 10.1099/0022-1317-50-5-436] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A real-time PCR assay based on the TaqMan technology was developed for the detection of Bordetella pertussis and B. parapertussis in clinical samples. The assay was evaluated with 182 specimens from 153 patients with and without symptoms of pertussis. The analytical sensitivity ranged from 0.1 to 10 cfu for B. pertussis and B. parapertussis, respectively, and diagnostic sensitivity was 94.1% when culture was used as a reference. No sample from a patient without symptoms of pertussis was positive in PCR. Twenty-four of 28 patients who were negative by culture and positive by PCR assay met the CDC clinical case definition for pertussis; the remaining four patients had paroxysms of shorter duration. Intra- and inter-assay variation were <5% and results were available within 4 h.
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Affiliation(s)
- Katrin Kösters
- Institut für Hygiene und Laboratoriumsmedizin, Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld, Germany
| | - Marion Riffelmann
- Institut für Hygiene und Laboratoriumsmedizin, Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld, Germany
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30
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Kösters K, Riffelmann M, Dohrn B, von König CH. Comparison of five commercial enzyme-linked immunosorbent assays for detection of antibodies to Bordetella pertussis. Clin Diagn Lab Immunol 2000; 7:422-6. [PMID: 10799456 PMCID: PMC95889 DOI: 10.1128/cdli.7.3.422-426.2000] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Measuring antibodies to Bordetella pertussis antigens is mostly done by enzyme-linked immunosorbent assays (ELISAs). We compared the performance of five commercially available ELISA kits with the help of 65 serum specimens which were repetitively tested for evaluation of the kits. The specimens contained 20 paired serum samples from patients with clinical pertussis, 15 samples were from children vaccinated with a diphtheria-tetanus-acellular pertussis vaccine, seven specimens were taken from an interlaboratory comparison of ELISAs, and there were three reference preparations from the Food and Drug Administration's (FDA's) Laboratory of Pertussis and from our laboratory. Reference values were obtained from the FDA or from results obtained with an in-house ELISA. Commercial ELISAs were compared with respect to their reproducibility and variability, their ability to detect significant titer rises in paired serum samples, their ability to detect an immune response after vaccination, and the comparability of semiquantitative and quantitative results. Reproducibility was generally good (>89%), intra-assay variation ranged from 2.4 to 28.7%, and indeterminate results were recorded in up to 18.5% of all specimens. Most kits correctly identified the antibody response to an acellular pertussis vaccine. None of the commercial kits identified all cases of pertussis correctly, and the sensitivity ranged between 60 and 95%. All five commercial ELISAs showed great discrepancies when comparing semiquantitative results and contained obviously different antigen preparations. Our data suggest that the five commercial ELISAs tested here need further improvement and standardization.
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Affiliation(s)
- K Kösters
- Institut für Hygiene und Laboratoriumsmedizin, Klinikum Krefeld, Krefeld, Germany.
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31
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Wirsing von König CH, Riffelmann M. [Travel vaccinations for children]. Kinderkrankenschwester 1999; 18:322-6. [PMID: 10531945] [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] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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32
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Abstract
BACKGROUND/AIMS In 1995, a new flavivirus, GBV-C/HGV was identified. Little information is available on the clinical manifestations and epidemiology of GBV-C/HGV infection. We investigated the risk of mother-to-infant transmission in a group of GBV-C/HGV RNA positive women and followed up the GBV-C/HGV infected babies. METHODS Twenty-eight anti-HCV positive women, of whom 25 have been intravenous drug users, and their children were included in the study. RNA was extracted from serum, reverse transcribed and amplified with primers from the NS5 region of GBV-C/HGV and 5'-UTR of HCV in a nested polymerase chain reaction. Amplified DNA fragments were gel purified and sequenced; the sequences obtained were subjected to a phylogenetic analysis. RESULTS Transmission of GBV-C/HGV occurred in 10 (56%) of 18 infants born to GBV-C/HGV positive mothers; all these women were drug abusers. Only one (5%) of 19 babies whose mothers were HCV RNA positive by polymerase chain reaction, was infected with HCV during the follow up. High sequence homology in the NS5 region of GBV-C/HGV isolates in 10 mother-child pairs suggested mother-to-infant transmission. All 10 babies remained GBV-C/HGV RNA positive during follow up (2-12 months). None of the GBV-C/HGV infected infants became icteric or demonstrated any clinical or biochemical signs of liver disease. CONCLUSIONS Mother-to-infant transmission of GBV-C/HGV may be high, at least in HCV-infected, drug-addicted women. In GBV-C/HGV RNA positive infants the rate of GBV-C/HGV persistent infection is high, but the infection is not accompanied by any symptoms of liver disease.
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Affiliation(s)
- S Viazov
- Institute of Virology, Universityklinikum Essen, Germany.
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33
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Viazov S, Riffelmann M, Khoudyakov Y, Fields H, Varenholz C, Roggendorf M. Genetic heterogeneity of hepatitis G virus isolates from different parts of the world. J Gen Virol 1997; 78 ( Pt 3):577-81. [PMID: 9049408 DOI: 10.1099/0022-1317-78-3-577] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Comparative sequence analysis of a 354 nt fragment of the NS5 region of hepatitis G virus (HGV) isolates was performed to assess two levels of HGV genomic variability: (1) heterogeneity of HGV within an infected individual, and (2) heterogeneity of different HGV isolates. Comparison of nucleotide sequences of DNA clones from two virus isolates demonstrated that in each infected individual HGV is represented by a population of virions with closely related but heterogeneous genomes (quasi-species). Phylogenetic analysis of nucleotide sequences of 42 isolates collected from 14 countries revealed less significant genome variability of HGV as compared to hepatitis C virus. Sequences of all HGV isolates fell into one group of distribution of evolutionary distances. On a phylogenetic tree all HGV sequences segregated into numerous branches. All sequences of isolates from Africa, South and South-East Asia, however, were clustered together and were separated from those of other isolates collected in Europe, North America and Central Asia.
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Affiliation(s)
- S Viazov
- Ivanovsky Institute of Virology, Moscow, Russia
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Riffelmann M, Müller G, Schmieding W, Popp W, Norpoth K. Biomonitoring of urinary aromatic amines and arylamine hemoglobin adducts in exposed workers and nonexposed control persons. Int Arch Occup Environ Health 1996; 68:36-43. [PMID: 8847111 DOI: 10.1007/bf01831631] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The renal excretion of arylamines in occupationally exposed and nonexposed subjects was measured by a gas chromatography-electron capture detector method. Additionally, in the occupationally exposed persons hemoglobin adduct levels of arylamines were determined by a liquid chromatography-electrochemical detector method, together with the individual acetylator status. The aromatic amines aniline, p-toluidine, 2-naphthylamine, and 4-chloro-o-toluidine were detected in the urine of nonsmoking subjects who were not occupationally exposed to arylamines. Significantly higher concentrations of aniline, o-toluidine, m-toluidine, 2-naphthylamine, and 4-methyl-1,3-phenylenediamine could be observed in the urine of smoking control persons in comparison to nonsmokers. Comparison of smokers and nonsmokers in a group of workers primarily exposed to aniline and 4-chloroaniline revealed significant differences (P < 0.05) in the formation of 4-aminodiphenyl hemoglobin adducts and in the renal excretion of 2-naphthylamine. The slow acetylators in this group produced significantly more hemoglobin adducts of aniline and 4-chloroaniline than did the fast acetylators. In slow acetylators among the smoking workers there was a significant increase in the formation of 4-aminodiphenyl hemoglobin adducts and in the renal excretion of 4-chloroaniline and m-toluidine. The results indicate that there are influences of smoking habits and acetylator status on the levels of arylamine hemoglobin adducts as well as urinary arylamine concentrations. Hemoglobin adducts seem to be good parameters for monitoring aniline and 4-chloroaniline exposure at the workplace, especially if the acetylator polymorphism can be taken into account. 4-Aminodiphenyl hemoglobin adducts might be good parameters for monitoring individual smoking habits. The determination of urinary arylamine concentrations provides additional information concerning acute exposures to aromatic amines.
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Affiliation(s)
- M Riffelmann
- Institut für Hygiene und Arbeitsmedizin, Universitätsklinik (GHS) Essen, Germany
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35
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Roggendorf M, Lu M, Meisel H, Riffelmann M, Schreier E, Viazov S. Rational use of diagnostic tools in hepatitis C. J Hepatol 1996; 24:26-34. [PMID: 8836886] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Six years after the introduction of serological tests for the detection of antibodies to HCV these diagnostic procedures have been improved significantly. The ELISA's of the third generation contain 4-5 fragments of structural and nonstructural proteins which have increased the sensitivity and specificity for antibody detection. Several confirmatory assays have been established to detect non-specific reactions. Viremia in acute and chronic HCV infection can be detected by RT-PCR. However, studies on the quality of PCR results with serum panels in a large number of diagnostic labs indicate the urgent need to standardize the RT-PCR techniques. Quantification of viral genomes during acute and chronic HCV infection seem to be of major importance to predict the response rat to IFN. Quantitative RT-PCR techniques using internal standards and the branched DNA technology have been established. Techniques for genotyping HCV isolates have been introduced which also seemed to be important for prediction of IFN response. Recently serotyping of HCV isolates has been evaluated and seems to correlate well with genotyping by RT-PCI and specific probes. The detection of quasispecies in the 5'NCR may, in the future, be an additional prospective test for the prognosis of IFN treatment.
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Affiliation(s)
- M Roggendorf
- Institute for Virology, University of Essen, Germany
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36
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Riffelmann M. [Perinatal infection by hepatitis C viruses]. Dtsch Med Wochenschr 1994; 119:825. [PMID: 8205948] [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: 01/29/2023]
Affiliation(s)
- M Riffelmann
- Institut für Virologie, Universität, Robert-Koch-Haus, Essen
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