1
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Peo LC, Wiehler K, Paulick J, Gerrer K, Leone A, Viereck A, Haegele M, Stojanov S, Warlitz C, Augustin S, Alberer M, Hattesohl DBR, Froehlich L, Scheibenbogen C, Jason LA, Mihatsch LL, Pricoco R, Behrends U. Pediatric and adult patients with ME/CFS following COVID-19: A structured approach to diagnosis using the Munich Berlin Symptom Questionnaire (MBSQ). Eur J Pediatr 2024; 183:1265-1276. [PMID: 38095713 PMCID: PMC10951047 DOI: 10.1007/s00431-023-05351-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/07/2023] [Accepted: 11/23/2023] [Indexed: 03/20/2024]
Abstract
A subset of patients with post-COVID-19 condition (PCC) fulfill the clinical criteria of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). To establish the diagnosis of ME/CFS for clinical and research purposes, comprehensive scores have to be evaluated. We developed the Munich Berlin Symptom Questionnaires (MBSQs) and supplementary scoring sheets (SSSs) to allow for a rapid evaluation of common ME/CFS case definitions. The MBSQs were applied to young patients with chronic fatigue and post-exertional malaise (PEM) who presented to the MRI Chronic Fatigue Center for Young People (MCFC). Trials were retrospectively registered (NCT05778006, NCT05638724). Using the MBSQs and SSSs, we report on ten patients aged 11 to 25 years diagnosed with ME/CFS after asymptomatic SARS-CoV-2 infection or mild to moderate COVID-19. Results from their MBSQs and from well-established patient-reported outcome measures indicated severe impairments of daily activities and health-related quality of life. Conclusions: ME/CFS can follow SARS-CoV-2 infection in patients younger than 18 years, rendering structured diagnostic approaches most relevant for pediatric PCC clinics. The MBSQs and SSSs represent novel diagnostic tools that can facilitate the diagnosis of ME/CFS in children, adolescents, and adults with PCC and other post-infection or post-vaccination syndromes. What is Known: • ME/CFS is a debilitating disease with increasing prevalence due to COVID-19. For diagnosis, a differential diagnostic workup is required, including the evaluation of clinical ME/CFS criteria. • ME/CFS after COVID-19 has been reported in adults but not in pediatric patients younger than 19 years. What is New: • We present the novel Munich Berlin Symptom Questionnaires (MBSQs) as diagnostic tools to assess common ME/CFS case definitions in pediatric and adult patients with post-COVID-19 condition and beyond. • Using the MBSQs, we diagnosed ten patients aged 11 to 25 years with ME/CFS after asymptomatic SARS-CoV-2 infection or mild to moderate COVID-19.
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Affiliation(s)
- Laura-Carlotta Peo
- MRI Chronic Fatigue Center for Young People (MCFC), Pediatrics, Children's Hospital, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Katharina Wiehler
- MRI Chronic Fatigue Center for Young People (MCFC), Pediatrics, Children's Hospital, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Johannes Paulick
- MRI Chronic Fatigue Center for Young People (MCFC), Pediatrics, Children's Hospital, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Katrin Gerrer
- MRI Chronic Fatigue Center for Young People (MCFC), Pediatrics, Children's Hospital, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Ariane Leone
- MRI Chronic Fatigue Center for Young People (MCFC), Pediatrics, Children's Hospital, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Anja Viereck
- MRI Chronic Fatigue Center for Young People (MCFC), Pediatrics, Children's Hospital, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias Haegele
- MRI Chronic Fatigue Center for Young People (MCFC), Pediatrics, Children's Hospital, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Silvia Stojanov
- MRI Chronic Fatigue Center for Young People (MCFC), Child and Adolescent Psychsomatics, Children's Hospital, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Cordula Warlitz
- MRI Chronic Fatigue Center for Young People (MCFC), Pediatrics, Children's Hospital, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Silvia Augustin
- MRI Chronic Fatigue Center for Young People (MCFC), Pediatrics, Children's Hospital, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Martin Alberer
- MRI Chronic Fatigue Center for Young People (MCFC), Pediatrics, Children's Hospital, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Laura Froehlich
- Research Center CATALPA, FernUniversität in Hagen, Hagen, Germany
| | - Carmen Scheibenbogen
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin and Berlin Institute of Health (BIH), Berlin, Germany
| | - Leonard A Jason
- Center for Community Research, DePaul University, Chicago, IL, 60614, USA
| | - Lorenz L Mihatsch
- MRI Chronic Fatigue Center for Young People (MCFC), Pediatrics, Children's Hospital, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Rafael Pricoco
- MRI Chronic Fatigue Center for Young People (MCFC), Pediatrics, Children's Hospital, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin and Berlin Institute of Health (BIH), Berlin, Germany
| | - Uta Behrends
- MRI Chronic Fatigue Center for Young People (MCFC), Pediatrics, Children's Hospital, TUM School of Medicine, Technical University of Munich, Munich, Germany.
- German Center for Infection Research (DZIF), Munich, Germany.
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2
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Zwicklbauer K, Krentz D, Bergmann M, Felten S, Dorsch R, Fischer A, Hofmann-Lehmann R, Meli ML, Spiri AM, Alberer M, Kolberg L, Matiasek K, Zablotski Y, von Both U, Hartmann K. Long-term follow-up of cats in complete remission after treatment of feline infectious peritonitis with oral GS-441524. J Feline Med Surg 2023; 25:1098612X231183250. [PMID: 37548535 DOI: 10.1177/1098612x231183250] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
OBJECTIVES Feline infectious peritonitis (FIP), a common disease in cats caused by feline coronavirus (FCoV), is usually fatal once clinical signs appear. Successful treatment of FIP with oral GS-441524 for 84 days was demonstrated recently by this research group. The aim of this study was to evaluate the long-term outcome in these cats. METHODS A total of 18 successfully treated cats were followed for up to 1 year after treatment initiation (9 months after completion of the antiviral treatment). Follow-up examinations were performed at 12-week intervals, including physical examination, haematology, serum biochemistry, abdominal and thoracic ultrasound, FCoV ribonucleic acid (RNA) loads in blood and faeces by reverse transciptase-quantitative PCR and anti-FCoV antibody titres by indirect immunofluorescence assay. RESULTS Follow-up data were available from 18 cats in week 24, from 15 cats in week 36 and from 14 cats in week 48 (after the start of treatment), respectively. Laboratory parameters remained stable after the end of the treatment, with undetectable blood viral loads (in all but one cat on one occasion). Recurrence of faecal FCoV shedding was detected in five cats. In four cats, an intermediate short-term rise in anti-FCoV antibody titres was detected. In total, 12 cats showed abdominal lymphadenomegaly during the follow-up period; four of them continuously during the treatment and follow-up period. Two cats developed mild neurological signs, compatible with feline hyperaesthesia syndrome, in weeks 36 and 48, respectively; however, FCoV RNA remained undetectable in blood and faeces, and no increase in anti-FCoV antibody titres was observed in these two cats, and the signs resolved. CONCLUSIONS AND RELEVANCE Treatment with GS-441524 proved to be effective against FIP in both the short term as well as the long term, with no confirmed relapse during the 1-year follow-up period. Whether delayed neurological signs could be a long-term adverse effect of the treatment or associated with a 'long FIP syndrome' needs to be further evaluated.
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Affiliation(s)
- Katharina Zwicklbauer
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - Daniela Krentz
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - Michèle Bergmann
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - Sandra Felten
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - Roswitha Dorsch
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - Andrea Fischer
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - Regina Hofmann-Lehmann
- Clinical Laboratory, Department of Clinical Diagnostics and Services, Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Marina L Meli
- Clinical Laboratory, Department of Clinical Diagnostics and Services, Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Andrea M Spiri
- Clinical Laboratory, Department of Clinical Diagnostics and Services, Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Martin Alberer
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Laura Kolberg
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Kaspar Matiasek
- Section of Clinical and Comparative Neuropathology, Institute of Veterinary Pathology, Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - Yury Zablotski
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - Ulrich von Both
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Katrin Hartmann
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
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3
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Rathgeb C, Pawellek M, Behrends U, Alberer M, Kabesch M, Gerling S, Brandstetter S, Apfelbacher C. Correction: The Evaluation of Health Care Services for Children and Adolescents With Post-COVID-19 Condition: Protocol for a Prospective Longitudinal Study. JMIR Res Protoc 2023; 12:e48338. [PMID: 37098264 PMCID: PMC10170362 DOI: 10.2196/48338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 04/27/2023] Open
Abstract
[This corrects the article DOI: 10.2196/41010.].
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Affiliation(s)
- Chiara Rathgeb
- University Children's Hospital Regensburg, Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
- Member of the Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Maja Pawellek
- University Children's Hospital Regensburg, Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
- Member of the Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Uta Behrends
- Children's Hospital, Technical University Munich, Munich, Germany
| | - Martin Alberer
- Children's Hospital, Technical University Munich, Munich, Germany
| | - Michael Kabesch
- University Children's Hospital Regensburg, Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
- Member of the Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Stephan Gerling
- University Children's Hospital Regensburg, Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
- Member of the Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Susanne Brandstetter
- University Children's Hospital Regensburg, Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
- Member of the Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Christian Apfelbacher
- Member of the Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
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4
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Alberer M, Moe CL, Hatz C, Kling K, Kirby AE, Lindsay L, Nothdurft HD, Riera-Montes M, Steffen R, Verstraeten T, Wu HM, DuPont HL. Norovirus acute gastroenteritis among US and European travellers to areas of moderate to high risk of travellers' diarrhoea: a prospective cohort study. J Travel Med 2023:7130281. [PMID: 37074164 DOI: 10.1093/jtm/taad051] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/21/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Acute gastroenteritis (AGE) is a major medical condition for travellers worldwide, particularly travellers to low- and middle-income countries. Norovirus (NoV) is the most common cause of viral AGE in older children and adults, but data on prevalence and impact among travellers is limited. METHODS Prospective, multi-site, observational cohort study conducted 2015-2017, among adult international travellers from the US and Europe to areas of moderate to high risk of travel-acquired AGE. Participants provided self-collected pre-travel stool samples and self-reported AGE symptoms while travelling. Post-travel stool samples were requested from symptomatic subjects and a sample of asymptomatic travellers within 14days of return. Samples were tested for NoV by RT-qPCR, genotyped if positive, and tested for other common enteric pathogens by Luminex xTAG GPP. RESULTS Of the 1109 participants included, 437 (39.4%) developed AGE symptoms resulting in an overall AGE incidence of 24.7 per 100 person-weeks (95% CI: 22.4; 27.1). Twenty NoV-positive AGE cases (5.2% of those tested) were identified at an incidence of 1.1 per 100 person-weeks (95% CI: 0.7; 1.7). NoV-positive samples belonged mostly to genogroup GII (18, 85.7%); None of the 13 samples sequenced belonged to genotype GII.4. Clinical severity of AGE was higher for NoV-positive than for NoV-negative cases (mean modified Vesikari Score 6.8 vs 4.9) with more cases classified as severe or moderate (25% vs 6.8%). Eighty percent of NoV-positive participants (vs. 38.9% in NoV-negative) reported at least moderate impact on travel plans. CONCLUSIONS AGE is a prevalent disease among travellers with a small proportion associated with NoV. Post-travel stool sample collection timing might have influenced the low number of NoV cases detected; however, NoV infections resulted in high clinical severity and impact on travel plans. These results may contribute to targeted vaccine development and the design of future studies on NoV epidemiology.
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Affiliation(s)
- Martin Alberer
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Christine L Moe
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Christoph Hatz
- Epidemiology, Biostatistics and Prevention Institute, WHO Collaborating Center for Travellers' Health, University of Zurich, Zurich, Switzerland
| | - Kerstin Kling
- Immunization Unit, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Amy E Kirby
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lisa Lindsay
- P95 Pharmacovigilance and Epidemiology Services, Leuven, Belgium
| | - Hans Dieter Nothdurft
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | | | - Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, WHO Collaborating Center for Travellers' Health, University of Zurich, Zurich, Switzerland
- Division of Epidemiology, Human Genetics & Environmental Sciences, University of Texas School of Public Health, Houston, TX, USA
| | | | - Henry M Wu
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Herbert L DuPont
- Kelsey Research Foundation, Houston, TX, USA
- University of Texas-Houston Health Science Center, School of Public Health, Center for Infectious Diseases, and McGovern Medical School, Department of Internal Medicine, Houston, TX, USA
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5
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Rathgeb C, Pawellek M, Behrends U, Alberer M, Kabesch M, Gerling S, Brandstetter S, Apfelbacher C. Prospective evaluation of health care services for children and adolescents with post-COVID-19 condition in Bavaria, Germany: study protocol. JMIR Res Protoc 2023; 12:e41010. [PMID: 36867709 PMCID: PMC10132031 DOI: 10.2196/41010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/01/2022] [Accepted: 01/19/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Some children and adolescents suffer from late effects of a SARS-CoV-2 infection despite frequently mild courses of the disease. Nevertheless, extensive care for Post-COVID in children and young people is not available yet. A comprehensive care network ("PoCo") for children and adolescents with Post-COVID has been setup as a model project in Bavaria, Germany. OBJECTIVE The aim of this study is to evaluate the health care services provided within these network structures of care for children and adolescents with Post-COVID in a pre-post study design. METHODS It is envisaged to recruit 160 children and adolescents up to 17 years with Post-COVID who are diagnosed and treated in 16 participating outpatient clinics. Health care utilization, treatment satisfaction, PROs (Patient Reported Outcomes) related to health-related quality of life (primary endpoint), fatigue, post-exertional malaise and mental health will be assessed at different time points (at baseline, after four weeks, three months and six months) using routine data, interviews and self-report questionnaires. RESULTS The study is currently in the recruitment process. This will run from April 2022 until December 2022. Interim analyses will be carried out. A full analysis of the data will be conducted after recruitment is complete. The results will be published. CONCLUSIONS The results will contribute to the evaluation of therapeutic services provided for Post-COVID in children and adolescents and avenues for optimizing care may be identified. CLINICALTRIAL INTERNATIONAL REGISTERED REPORT DERR1-10.2196/41010.
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Affiliation(s)
- Chiara Rathgeb
- University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Steinmetzstraße 1-3, Regensburg, DE.,Member of the Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, DE
| | - Maja Pawellek
- University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Steinmetzstraße 1-3, Regensburg, DE.,Member of the Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, DE
| | - Uta Behrends
- Technical University Munich, Children's Hospital, Munich, DE
| | - Martin Alberer
- Technical University Munich, Children's Hospital, Munich, DE
| | - Michael Kabesch
- University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Steinmetzstraße 1-3, Regensburg, DE.,Member of the Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, DE
| | - Stephan Gerling
- University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Steinmetzstraße 1-3, Regensburg, DE.,Member of the Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, DE
| | - Susanne Brandstetter
- University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Steinmetzstraße 1-3, Regensburg, DE.,Member of the Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, DE
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, DE.,Member of the Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, DE
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6
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Alberer M. [International travels with children]. Monatsschr Kinderheilkd 2023; 171:271-281. [PMID: 36816715 PMCID: PMC9926454 DOI: 10.1007/s00112-023-01699-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 02/16/2023]
Abstract
International travels with children need special planning and preparation. Besides considering general aspects, such as the age of the child, physical fitness, pre-existing illnesses, type and extent of the journey, climatic conditions at the destination and previous travel experiences, it is important to discuss relevant travel-associated risks in the context of travel consulting. This includes extensive advice concerning mosquito protection and malaria prophylaxis and counselling and implementation of travel vaccinations. Depending on the situation of the family, an individualized travel concept can be prepared, creating the foundation for a possible problem-free international travel.
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Affiliation(s)
- Martin Alberer
- Praxis Dr. Frühwein & Partner, Briennerstr. 11, 80333 München, Deutschland
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7
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Krentz D, Zwicklbauer K, Felten S, Bergmann M, Dorsch R, Hofmann-Lehmann R, Meli ML, Spiri AM, von Both U, Alberer M, Hönl A, Matiasek K, Hartmann K. Clinical Follow-Up and Postmortem Findings in a Cat That Was Cured of Feline Infectious Peritonitis with an Oral Antiviral Drug Containing GS-441524. Viruses 2022; 14:v14092040. [PMID: 36146845 PMCID: PMC9506130 DOI: 10.3390/v14092040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/31/2022] [Accepted: 09/03/2022] [Indexed: 11/16/2022] Open
Abstract
This is the first report on a clinical follow-up and postmortem examination of a cat that had been cured of feline infectious peritonitis (FIP) with ocular manifestation by successful treatment with an oral multicomponent drug containing GS-441524. The cat was 6 months old when clinical signs (recurrent fever, lethargy, lack of appetite, and fulminant anterior uveitis) appeared. FIP was diagnosed by ocular tissue immunohistochemistry after enucleation of the affected eye. The cat was a participant in a FIP treatment study, which was published recently. However, 240 days after leaving the clinic healthy, and 164 days after the end of the 84 days of treatment, the cured cat died in a road traffic accident. Upon full postmortem examination, including histopathology and immunohistochemistry, there were no residual FIP lesions observed apart from a generalized lymphadenopathy due to massive lymphoid hyperplasia. Neither feline coronavirus (FCoV) RNA nor FCoV antigen were identified by quantitative reverse transcription polymerase chain reaction (RT-qPCR) and immunohistochemistry, respectively, in any tissues or body fluids, including feces. These results prove that oral treatment with GS-441524 leads to the cure of FIP-associated changes and the elimination of FCoV from all tissues.
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Affiliation(s)
- Daniela Krentz
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, D-80539 Munich, Germany
- Correspondence:
| | - Katharina Zwicklbauer
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, D-80539 Munich, Germany
| | - Sandra Felten
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, D-80539 Munich, Germany
| | - Michèle Bergmann
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, D-80539 Munich, Germany
| | - Roswitha Dorsch
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, D-80539 Munich, Germany
| | - Regina Hofmann-Lehmann
- Clinical Laboratory, Department of Clinical Diagnostics and Services, Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland
| | - Marina L. Meli
- Clinical Laboratory, Department of Clinical Diagnostics and Services, Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland
| | - Andrea M. Spiri
- Clinical Laboratory, Department of Clinical Diagnostics and Services, Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland
| | - Ulrich von Both
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, D-80337 Munich, Germany
| | - Martin Alberer
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, D-80337 Munich, Germany
| | - Anne Hönl
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, D-80539 Munich, Germany
- Section of Clinical and Comparative Neuropathology, Institute of Veterinary Pathology, Centre for Clinical Veterinary Medicine, LMU Munich, D-80539 Munich, Germany
| | - Kaspar Matiasek
- Section of Clinical and Comparative Neuropathology, Institute of Veterinary Pathology, Centre for Clinical Veterinary Medicine, LMU Munich, D-80539 Munich, Germany
| | - Katrin Hartmann
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, D-80539 Munich, Germany
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8
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Töpfner N, Alberer M, Ankermann T, Bender S, Berner R, de Laffolie J, Dingemann J, Heinicke D, Haas JP, Hufnagel M, Hummel T, Huppertz HI, Knuf M, Kobbe R, Lücke T, Riedel J, Rosenecker J, Wölfle J, Schneider B, Schneider D, Schriever V, Schroeder A, Stojanov S, Tenenbaum T, Trapp S, Vilser D, Brinkmann F, Behrends U. [Recommendation for standardized medical care for children and adolescents with long COVID]. Monatsschr Kinderheilkd 2022; 170:539-547. [PMID: 35637934 PMCID: PMC9131710 DOI: 10.1007/s00112-021-01408-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 12/03/2022]
Abstract
This current consensus paper for long COVID complements the existing AWMF S1 guidelines for long COVID with a detailed overview on the various clinical aspects of long COVID in children and adolescents. Members of 19 different pediatric societies of the DGKJ convent and collaborating societies together provide expert-based recommendations for the clinical management of long COVID based on the currently available but limited academic evidence for long COVID in children and adolescents. It contains screening questions for long COVID and suggestions for a structured, standardized pediatric medical history and diagnostic evaluation for patients with suspected long COVID. A time and resource-saving questionnaire, which takes the clinical complexity of long COVID into account, is offered via the DGKJ and DGPI websites as well as additional questionnaires suggested for an advanced screening of specific neurocognitive and/or psychiatric symptoms including post-exertional malaise (PEM) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). According to the individual medical history as well as clinical signs and symptoms a step by step diagnostic procedure and a multidisciplinary therapeutic approach are recommended.
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Affiliation(s)
| | - Deutsche Gesellschaft für Pädiatrische Infektiologie e. V. (DGPI)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | - Martin Alberer
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
| | | | - Gesellschaft für Pädiatrische Pneumologie e. V. (GPP)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | | | | | | | - Gesellschaft für Pädiatrische Gastroenterologie und Ernährung e. V. (GPGE)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | - Deutsche Gesellschaft für Kinderchirurgie e. V. (DGKCH)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | - Bündnis Kinder- und Jugendreha e. V. (BKJR)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | - Gesellschaft für Kinder- und Jugendrheumatologie (GKJR)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | | | | | | | - Deutsche Akademie für Kinder- und Jugendmedizin (DAKJ)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | | | | | - Gesellschaft für Neuropädiatrie e. V. (GNP)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | - Deutsche Gesellschaft für Sozialpädiatrie und Jugendmedizin (DGSPJ)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | | | | | - Deutsche Gesellschaft für Kinderendokrinologie und -diabetologie e. V. (DGKED)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | - Deutsche Gesellschaft für Schlafforschung und Schlafmedizin e. V. (DGSM)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | - Deutsche Gesellschaft für Kinder- und Jugendmedizin e. V. (DGKJ)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | | | | | - Gesellschaft für Neuropsychologie (GNP)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | | | | | - Berufsverband der Kinder- und Jugendärzte e. V. (BVKJ)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | | | - Folke Brinkmann
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
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9
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Meli ML, Spiri AM, Zwicklbauer K, Krentz D, Felten S, Bergmann M, Dorsch R, Matiasek K, Alberer M, Kolberg L, von Both U, Hartmann K, Hofmann-Lehmann R. Fecal Feline Coronavirus RNA Shedding and Spike Gene Mutations in Cats with Feline Infectious Peritonitis Treated with GS-441524. Viruses 2022; 14:v14051069. [PMID: 35632813 PMCID: PMC9147249 DOI: 10.3390/v14051069] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/08/2022] [Accepted: 05/13/2022] [Indexed: 02/04/2023] Open
Abstract
As previously demonstrated by our research group, the oral multicomponent drug Xraphconn® containing GS-441524 was effective at curing otherwise fatal feline infectious peritonitis (FIP) in 18 feline coronavirus (FCoV)-infected cats. The aims of the current study were to investigate, using samples from the same animals as in the previous study, (1) the effect of treatment on fecal viral RNA shedding; (2) the presence of spike gene mutations in different body compartments of these cats; and (3) viral RNA shedding, presence of spike gene mutations, and anti-FCoV antibody titers in samples of 12 companion cats cohabitating with the treated cats. Eleven of the eighteen treated FIP cats (61%) were shedding FCoV RNA in feces within the first three days after treatment initiation, but all of them tested negative by day 6. In one of these cats, fecal shedding reoccurred on day 83. Two cats initially negative in feces were transiently positive 1–4 weeks into the study. The remaining five cats never shed FCoV. Viral RNA loads in feces decreased with time comparable with those in blood and effusion. Specific spike gene mutations linked to systemic FCoV spread were consistently found in blood and effusion from treated FIP cats, but not in feces from treated or companion cats. A new mutation that led to a not yet described amino acid change was identified, indicating that further mutations may be involved in the development of FIP. Eight of the twelve companion cats shed FCoV in feces. All but one of the twelve companion cats had anti-FCoV antibodies. Oral treatment with GS-441524 effectively decreased viral RNA loads in feces, blood, and effusion in cats with FIP. Nonetheless, re-shedding can most likely occur if cats are re-exposed to FCoV by their companion cats.
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Affiliation(s)
- Marina L. Meli
- Clinical Laboratory, Department of Clinical Diagnostics and Services, Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland; (A.M.S.); (R.H.-L.)
- Correspondence:
| | - Andrea M. Spiri
- Clinical Laboratory, Department of Clinical Diagnostics and Services, Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland; (A.M.S.); (R.H.-L.)
| | - Katharina Zwicklbauer
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, D-80539 Munich, Germany; (K.Z.); (D.K.); (S.F.); (M.B.); (R.D.); (K.H.)
| | - Daniela Krentz
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, D-80539 Munich, Germany; (K.Z.); (D.K.); (S.F.); (M.B.); (R.D.); (K.H.)
| | - Sandra Felten
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, D-80539 Munich, Germany; (K.Z.); (D.K.); (S.F.); (M.B.); (R.D.); (K.H.)
| | - Michèle Bergmann
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, D-80539 Munich, Germany; (K.Z.); (D.K.); (S.F.); (M.B.); (R.D.); (K.H.)
| | - Roswitha Dorsch
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, D-80539 Munich, Germany; (K.Z.); (D.K.); (S.F.); (M.B.); (R.D.); (K.H.)
| | - Kaspar Matiasek
- Section of Clinical & Comparative Neuropathology, Institute of Veterinary Pathology, Centre for Clinical Veterinary Medicine, LMU Munich, D-80539 Munich, Germany;
| | - Martin Alberer
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children’s Hospital, University Hospital, LMU-Munich, D-80337 Munich, Germany; (M.A.); (L.K.); (U.v.B.)
| | - Laura Kolberg
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children’s Hospital, University Hospital, LMU-Munich, D-80337 Munich, Germany; (M.A.); (L.K.); (U.v.B.)
| | - Ulrich von Both
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children’s Hospital, University Hospital, LMU-Munich, D-80337 Munich, Germany; (M.A.); (L.K.); (U.v.B.)
- German Center for Infection Research (DZIF), Partner Site Munich, D-80337 Munich, Germany
| | - Katrin Hartmann
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, D-80539 Munich, Germany; (K.Z.); (D.K.); (S.F.); (M.B.); (R.D.); (K.H.)
| | - Regina Hofmann-Lehmann
- Clinical Laboratory, Department of Clinical Diagnostics and Services, Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland; (A.M.S.); (R.H.-L.)
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10
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Krentz D, Zenger K, Alberer M, Felten S, Bergmann M, Dorsch R, Matiasek K, Kolberg L, Hofmann-Lehmann R, Meli ML, Spiri AM, Horak J, Weber S, Holicki CM, Groschup MH, Zablotski Y, Lescrinier E, Koletzko B, von Both U, Hartmann K. Curing Cats with Feline Infectious Peritonitis with an Oral Multi-Component Drug Containing GS-441524. Viruses 2021; 13:v13112228. [PMID: 34835034 PMCID: PMC8621566 DOI: 10.3390/v13112228] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 12/26/2022] Open
Abstract
Feline infectious peritonitis (FIP) caused by feline coronavirus (FCoV) is a common dis-ease in cats, fatal if untreated, and no effective treatment is currently legally available. The aim of this study was to evaluate efficacy and toxicity of the multi-component drug Xraphconn® in vitro and as oral treatment in cats with spontaneous FIP by examining survival rate, development of clinical and laboratory parameters, viral loads, anti-FCoV antibodies, and adverse effects. Mass spectrometry and nuclear magnetic resonance identified GS-441524 as an active component of Xraphconn®. Eighteen cats with FIP were prospectively followed up while being treated orally for 84 days. Values of key parameters on each examination day were compared to values before treatment initiation using linear mixed-effect models. Xraphconn® displayed high virucidal activity in cell culture. All cats recovered with dramatic improvement of clinical and laboratory parameters and massive reduction in viral loads within the first few days of treatment without serious adverse effects. Oral treatment with Xraphconn® containing GS-441524 was highly effective for FIP without causing serious adverse effects. This drug is an excellent option for the oral treatment of FIP and should be trialed as potential effective treatment option for other severe coronavirus-associated diseases across species.
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Affiliation(s)
- Daniela Krentz
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, 80539 Munich, Germany; (K.Z.); (S.F.); (M.B.); (R.D.); (Y.Z.); (K.H.)
- Correspondence:
| | - Katharina Zenger
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, 80539 Munich, Germany; (K.Z.); (S.F.); (M.B.); (R.D.); (Y.Z.); (K.H.)
| | - Martin Alberer
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, 80337 Munich, Germany; (M.A.); (L.K.); (U.v.B.)
| | - Sandra Felten
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, 80539 Munich, Germany; (K.Z.); (S.F.); (M.B.); (R.D.); (Y.Z.); (K.H.)
| | - Michèle Bergmann
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, 80539 Munich, Germany; (K.Z.); (S.F.); (M.B.); (R.D.); (Y.Z.); (K.H.)
| | - Roswitha Dorsch
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, 80539 Munich, Germany; (K.Z.); (S.F.); (M.B.); (R.D.); (Y.Z.); (K.H.)
| | - Kaspar Matiasek
- Section of Clinical and Comparative Neuropathology, Institute of Veterinary Pathology, Centre for Clinical Veterinary Medicine, LMU Munich, 80539 Munich, Germany;
| | - Laura Kolberg
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, 80337 Munich, Germany; (M.A.); (L.K.); (U.v.B.)
| | - Regina Hofmann-Lehmann
- Clinical Laboratory, Department of Clinical Diagnostics and Services, and Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland; (R.H.-L.); (M.L.M.); (A.M.S.)
| | - Marina L. Meli
- Clinical Laboratory, Department of Clinical Diagnostics and Services, and Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland; (R.H.-L.); (M.L.M.); (A.M.S.)
| | - Andrea M. Spiri
- Clinical Laboratory, Department of Clinical Diagnostics and Services, and Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland; (R.H.-L.); (M.L.M.); (A.M.S.)
| | - Jeannie Horak
- Department Paediatrics, Division Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, 80337 Munich, Germany; (J.H.); (B.K.)
| | - Saskia Weber
- Institute of Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, 17493 Greifswald, Germany; (S.W.); (C.M.H.); (M.H.G.)
| | - Cora M. Holicki
- Institute of Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, 17493 Greifswald, Germany; (S.W.); (C.M.H.); (M.H.G.)
| | - Martin H. Groschup
- Institute of Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, 17493 Greifswald, Germany; (S.W.); (C.M.H.); (M.H.G.)
- German Center for Infection Research (DZIF), Partner Site Hamburg-Luebeck-Borstel-Riems, Greifswald-Insel Riems, 17493 Greifswald, Germany
| | - Yury Zablotski
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, 80539 Munich, Germany; (K.Z.); (S.F.); (M.B.); (R.D.); (Y.Z.); (K.H.)
| | - Eveline Lescrinier
- Medicinal Chemistry, KU Leuven, Rega Institute for Medical Research, 3000 Leuven, Belgium;
| | - Berthold Koletzko
- Department Paediatrics, Division Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, 80337 Munich, Germany; (J.H.); (B.K.)
| | - Ulrich von Both
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, 80337 Munich, Germany; (M.A.); (L.K.); (U.v.B.)
- German Center for Infection Research (DZIF), Partner Site Munich, 80337 Munich, Germany
| | - Katrin Hartmann
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, 80539 Munich, Germany; (K.Z.); (S.F.); (M.B.); (R.D.); (Y.Z.); (K.H.)
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11
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Rothe C, Rosenbusch D, Alberer M, Bühler S, Burchard G, Erkens K, Feldt T, Grobusch MP, Köhler C, Kapaun A, Löbermann M, Meischner K, Metzger W, Müller A, Nothdurft HD, Ramharter M, Rieke B, Schlaich C, Schönfeld C, Schulze MH, Siedenburg J, Steiner F, Veit O, Weitzel T, Boecken G. Empfehlungen zur Malariaprophylaxe. Flugmedizin · Tropenmedizin · Reisemedizin - FTR 2021. [DOI: 10.1055/a-1520-3764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Camilla Rothe
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Abt. für Infektions- und Tropenmedizin, Klinikum der LMU München
| | - Deike Rosenbusch
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Auswärtiges Amt – Gesundheitsdienst, Berlin
| | - Martin Alberer
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Praxis Dr. Frühwein und Partner, München
| | - Silja Bühler
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Infektionsepidemiologisches Landeszentrum und Impfzentrum, Institut für Hygiene und Umwelt der Freien und Hansestadt Hamburg
| | - Gerd Burchard
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg
| | - Kai Erkens
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Kommando Sanitätsdienst der Bundeswehr, Dez. VI 2.2, München
| | - Torsten Feldt
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Tropenmedizinische Ambulanz, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf
| | - Martin P Grobusch
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine Division of Internal Medicine, Amsterdam University Medical Centers, location AMC, University of Amsterdam
- Innere Medizin VII, Institut für Tropenmedizin, Reisemedizin, Humanparasitologie, Universitätsklinikum Tübingen
| | - Carsten Köhler
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Innere Medizin VII, Institut für Tropenmedizin, Reisemedizin, Humanparasitologie, Universitätsklinikum Tübingen
| | - Annette Kapaun
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Universitätsklinikum Heidelberg, Zentrum für Infektiologie, Sektion klinische Tropenmedizin
| | - Micha Löbermann
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Universitätsklinikum Heidelberg, Zentrum für Infektiologie, Sektion klinische Tropenmedizin
| | - Karin Meischner
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Environmental Protection, Health Management and Safety, Health Management, Siemens AG
| | - Wolfram Metzger
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Impfzentrum, Landratsamt Tübingen
| | - Andreas Müller
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Tropenmedizin Missioklinik, Klinikum Würzburg Mitte gGmbH
| | - Hans Dieter Nothdurft
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
| | - Michael Ramharter
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg
- Sektion Tropenmedizin, I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf
| | - Burkhard Rieke
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Deutsche Fachgesellschaft für Reisemedizin (DFR)
- Tropen- und Reisemedizinische Praxis, Düsseldorf
| | - Clara Schlaich
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Deutsche Gesellschaft für Maritime Medizin (DGMM)
- Hafenpraxis Hamburg Dr. Schlaich & Dr. Beyer
| | - Christian Schönfeld
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Charité – Universitätsmedizin Berlin, Institut für Tropenmedizin und Internationale Gesundheit
| | - Marco H Schulze
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Institut für Krankenhaushygiene und Infektiologie, Universitätsmedizin Göttingen
| | - Jörg Siedenburg
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Auswärtiges Amt – Gesundheitsdienst, Regionalarztdienststelle Nairobi, Kenia
| | - Florian Steiner
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Praxis für Innere Medizin und Tropenmedizin, Hausärztliche Versorgung, Tarmstedt
| | - Olivia Veit
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Schweizerisches Tropen- und Public Health-Institut, Basel, Schweiz
- Institut für Epidemiologie, Biostatistik und Prävention, Zürich, Schweiz
| | - Thomas Weitzel
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Travel Medicine Program, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Gerhard Boecken
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Auswärtiges Amt – Gesundheitsdienst, Regionalarztdienststelle Buenos Aires, Argentinien
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Rothe C, Rosenbusch D, Alberer M, Bühler S, Burchard G, Erkens K, Feldt T, Grobusch MP, Köhler C, Kapaun A, Löbermann M, Meischner K, Metzger W, Müller A, Nothdurft HD, Rieke B, Schlaich C, Schönfeld C, Schulze MH, Siedenburg J, Steiner F, Veit O, Weitzel T, Boecken G. Empfehlungen zur Malariaprophylaxe. Flugmedizin · Tropenmedizin · Reisemedizin - FTR 2020. [DOI: 10.1055/a-1204-1496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Camilla Rothe
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Abt. für Infektions- und Tropenmedizin, Klinikum der LMU München
| | - Deike Rosenbusch
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Auswärtiges Amt – Gesundheitsdienst, Berlin
| | - Martin Alberer
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Abt. für Infektions- und Tropenmedizin, Klinikum der LMU München
| | - Silja Bühler
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg
- Institut für Hygiene und Umwelt, Freie und Hansestadt Hamburg
| | - Gerd Burchard
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg
- Institut für Hygiene und Umwelt, Freie und Hansestadt Hamburg
- Ständige Impfkommission am Robert Koch-Institut (STIKO)
| | - Kai Erkens
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Kommando Sanitätsdienst der Bundeswehr, Dez. VI 2.2, München
| | - Torsten Feldt
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Tropenmedizinische Ambulanz, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinik Düsseldorf
| | - Martin P. Grobusch
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Department of Infectious Diseases, Division of Internal Medicine, Amsterdam University Medical Centers, location AMC, University of Amsterdam
| | - Carsten Köhler
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Innere Medizin VII, Institut für Tropenmedizin, Reisemedizin, Humanparasitologie, Universitätsklinikum Tübingen
| | - Anette Kapaun
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Universitätsklinkum Heidelberg, Sektion klinische Tropenmedizin
| | - Micha Löbermann
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Abt. für Tropenmedizin und Infektionskrankheiten, Zentrum für Innere Medizin, Universitätsmedizin Rostock
| | - Karin Meischner
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Environmental Protection, Health Management and Safety, Health Management, Siemens AG
| | - Wolfram Metzger
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Innere Medizin VII, Institut für Tropenmedizin, Reisemedizin, Humanparasitologie, Universitätsklinikum Tübingen
| | - Andreas Müller
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Tropenmedizin Missioklinik, Klinikum Würzburg Mitte gGmbH
| | - Hans Dieter Nothdurft
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Abt. für Infektions- und Tropenmedizin, Klinikum der LMU München
| | - Burkhard Rieke
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Deutsche Fachgesellschaft für Reisemedizin (DFR)
- Tropen- und Reisemedizinische Praxis, Düsseldorf
| | - Clara Schlaich
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Deutsche Gesellschaft für Maritime Medizin (DGMM)
- Praxis HafenCity Hamburg Dr. Schlaich & Partner
| | - Christian Schönfeld
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Charité – Universitätsmedizin Berlin, Institut für Tropenmedizin und Internationale Gesundheit
| | - Marco H. Schulze
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Institut für Krankenhaushygiene und Infektiologie, Universitätsmedizin Göttingen
| | - Jörg Siedenburg
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Auswärtiges Amt – Gesundheitsdienst, Berlin
| | - Florian Steiner
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Praxis für Innere Medizin und Tropenmedizin, Tarmstedt
| | - Olivia Veit
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Schweizerisches Tropen- und Public Health-Institut, Basel, Schweiz
- Institut für Epidemiologie, Biostatistik und Prävention, Zürich, Schweiz
| | - Thomas Weitzel
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Travel Medicine Program, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Gerhard Boecken
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Auswärtiges Amt – Gesundheitsdienst, Berlin
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Rothe C, Rosenbusch D, Alberer M, Bühler S, Burchard G, Erkens K, Feldt T, Grobusch MP, Köhler C, Kapaun A, Löbermann M, Meischner K, Metzger W, Müller A, Nothdurft HD, Rieke B, Schlaich C, Schönfeld C, Schulze MH, Siedenburg J, Steiner F, Veit O, Weitzel T, Boecken G. Reiseimpfungen – Hinweise und Empfehlungen. Flug u Reisemed 2020. [DOI: 10.1055/a-1111-8105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Camilla Rothe
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Abt. für Infektions- und Tropenmedizin, Klinikum der LMU München
| | - Deike Rosenbusch
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Auswärtiges Amt – Gesundheitsdienst, Berlin
| | - Martin Alberer
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Abt. für Infektions- und Tropenmedizin, Klinikum der LMU München
| | - Silja Bühler
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg
- Sektion Tropenmedizin, I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf
| | - Gerd Burchard
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg
- Sektion Tropenmedizin, I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf
- Ständige Impfkommission (STIKO)
| | - Kai Erkens
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Kommando Sanitätsdienst der Bundeswehr, Dez. VI 2.2, München
| | - Torsten Feldt
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Tropenmedizinische Ambulanz, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinik Düsseldorf
| | - Martin P. Grobusch
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Department of Infectious Diseases, Division of Internal Medicine, Amsterdam, University Medical Centers, location AMC, University of Amsterdam
| | - Carsten Köhler
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Innere Medizin VII, Institut für Tropenmedizin, Reisemedizin, Humanparasitologie, Universitätsklinikum Tübingen
| | - Anette Kapaun
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Universitätsklinikum Heidelberg, Sektion klinische Tropenmedizin
| | - Micha Löbermann
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Abt. für Tropenmedizin und Infektionskrankheiten, Zentrum für Innere Medizin, Universitätsmedizin Rostock
| | - Karin Meischner
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Environmental Protection, Health Management and Safety, Health Management, Siemens AG
| | - Wolfram Metzger
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Innere Medizin VII, Institut für Tropenmedizin, Reisemedizin, Humanparasitologie, Universitätsklinikum Tübingen
| | - Andreas Müller
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Tropenmedizin Missioklinik, Klinikum Würzburg Mitte gGmbH
| | - Hans Dieter Nothdurft
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Abt. für Infektions- und Tropenmedizin, Klinikum der LMU München
| | - Burkhard Rieke
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Deutsche Fachgesellschaft für Reisemedizin (DFR)
- Tropen- und Reisemedizinische Praxis, Düsseldorf
| | - Clara Schlaich
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Deutsche Gesellschaft für Maritime Medizin (DGMM)
- Praxis HafenCity Hamburg Dr. Schlaich & Partner
| | - Christian Schönfeld
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Charité – Universitätsmedizin Berlin, Institut für Tropenmedizin und Internationale Gesundheit
| | - Marco H. Schulze
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Institut für Krankenhaushygiene und Infektiologie, Universitätsmedizin Göttingen
| | - Jörg Siedenburg
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Auswärtiges Amt – Gesundheitsdienst, Berlin
| | - Florian Steiner
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Praxis für Innere Medizin und Tropenmedizin, Tarmstedt
| | - Olivia Veit
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Schweizerisches Tropen- und Public Health-Institut, Basel, Schweiz
- Institut für Epidemiologie, Biostatistik und Prävention, Zürich, Schweiz
| | - Thomas Weitzel
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Travel Medicine Program, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Gerhard Boecken
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Auswärtiges Amt – Gesundheitsdienst, Berlin
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Lindsay L, DuPont HL, Moe CL, Alberer M, Hatz C, Kirby AE, Wu HM, Verstraeten T, Steffen R. Estimating the incidence of norovirus acute gastroenteritis among US and European international travelers to areas of moderate to high risk of traveler's diarrhea: a prospective cohort study protocol. BMC Infect Dis 2018; 18:605. [PMID: 30509202 PMCID: PMC6276235 DOI: 10.1186/s12879-018-3461-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 10/31/2018] [Indexed: 12/31/2022] Open
Abstract
Background Acute gastroenteritis (AGE) is the leading cause of illness among returning travelers seeking medical care. Multiple types of enteric pathogens can cause travel-acquired AGE and, while bacterial pathogens have a predominant role, the importance of viruses, such as norovirus, is increasingly recognized. There is a lack of information on travel-acquired norovirus incidence among symptomatic and asymptomatic individuals irrespective of healthcare-seeking behavior. Our aim is to estimate the incidence of travel-acquired AGE due to norovirus and to characterize the burden of disease among international travelers from the United States and Europe. Methods We describe a prospective cohort study implemented in five US and European sites to estimate the role of AGE due to norovirus among adult international travelers. We enrolled individuals aged 18 years and older who are traveling to regions of moderate-high risk of AGE, or via cruise ship with an international port stop, with a trip duration of 3–15 days. The study will generate a wide range of health and travel-related data for pre-, during, and up to 6-months post-travel. We will identify laboratory-confirmed travel-acquired norovirus infections among both symptomatic and asymptomatic individuals from self-collected whole stool samples tested via quantitative RT-PCR. Coinfections will be identified in a subset of travelers with AGE using a multiplex molecular-based assay. Discussion This study is unique in design and breadth of data collected. The prospective collection of health and behavioral data, as well as biologic samples from travelers irrespective of symptoms, will provide useful data to better understand the importance of norovirus AGE among international travelers. This study will provide data to estimate the incidence of norovirus infections and AGE and the risk of post-infectious sequelae in the 6-month post-travel period serving as a baseline for future norovirus AGE vaccination studies. This study will contribute valuable information to better understand the role of norovirus in travel-acquired AGE risk and the impact of these infections on a broad set of outcomes.
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Affiliation(s)
- Lisa Lindsay
- P95 Pharmacovigilance and Epidemiology Services, Koning Leopold III Laan 1, 3001, Leuven, Belgium.
| | - Herbert L DuPont
- University of Texas McGovern Medical School and School of Public Health, 1200 Pressler Street, Houston, TX, 77030, USA
| | - Christine L Moe
- Emory University, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Martin Alberer
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Leopoldstrasse 5, 80802, Munich, Germany
| | - Christoph Hatz
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4056, Basel, Switzerland.,University of Basel, Petersplatz 1, 4001, Basel, Switzerland.,University of Zurich; Epidemiology, Biostatistics and Prevention Institute, WHO Collaborating Centre for Travellers' Health, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Amy E Kirby
- Emory University, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Henry M Wu
- Emory University, Division of Infectious Diseases, Department of Medicine, 550 Peachtree Street NE MOT 7, Atlanta, GA, 30308, USA
| | - Thomas Verstraeten
- P95 Pharmacovigilance and Epidemiology Services, Koning Leopold III Laan 1, 3001, Leuven, Belgium
| | - Robert Steffen
- University of Texas McGovern Medical School and School of Public Health, 1200 Pressler Street, Houston, TX, 77030, USA.,University of Zurich; Epidemiology, Biostatistics and Prevention Institute, WHO Collaborating Centre for Travellers' Health, Hirschengraben 84, 8001, Zurich, Switzerland
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Löscher T, Alberer M, Herbinger KH. Fieber nach Tropenaufenthalt. MMW Fortschr Med 2018; 160:44-54. [PMID: 30350043 PMCID: PMC7100522 DOI: 10.1007/s15006-018-0026-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bei Fieber nach Tropenaufenthalt kommen eine Vielzahl möglicher Erkrankungen in Frage. Anhand der Anamnese und einfacher Basisuntersuchungen können Sie rasch die Schwere und Bedeutung (lebensbedrohlich? ansteckend?) der Erkrankung feststellen.
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16
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Kloning T, Nowotny T, Alberer M, Hoelscher M, Hoffmann A, Froeschl G. Morbidity profile and sociodemographic characteristics of unaccompanied refugee minors seen by paediatric practices between October 2014 and February 2016 in Bavaria, Germany. BMC Public Health 2018; 18:983. [PMID: 30086731 PMCID: PMC6081864 DOI: 10.1186/s12889-018-5878-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 04/19/2018] [Accepted: 07/24/2018] [Indexed: 01/11/2023] Open
Abstract
Background This study aimed to investigate the morbidity profile and the sociodemographic characteristics of unaccompanied refugee minors (URM) arriving in the region of Bavaria, Germany, between October 2014 and February 2016. Methods The retrospective cross sectional study included 154 unaccompanied refugee minors between 10 and 18 years of age. The data was derived from medical data records of their routine first medical examination in two paediatric practices and one collective housing for refugees in the region of Bavaria, Germany. Results Only 12.3% of all participants had no clinical finding at arrival. Main health findings were skin diseases (31.8%) and mental disorders (25%). In this cohort the hepatitis A immunity was 92.8%, but only 34.5% showed a constellation of immunity against hepatitis B. Suspect cases for tuberculosis were found in 5.8% of the URM. There were no HIV positive individuals in the cohort. Notably, 2 females were found to have undergone genital mutilations. Conclusions The majority of arriving URM appear to have immediate health care needs, whereas the pathologies involved are mostly common entities that are generally known to the primary health care system in Germany. Outbreaks due to hepatitis A virus are unlikely since herd immunity can be assumed, while this population would benefit from hepatitis B vaccination due to low immunity and high risk of infection in crowded housing conditions. One key finding is the absence of common algorithms and guidelines in health care provision to URM.
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Affiliation(s)
- Teresa Kloning
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Thomas Nowotny
- Privatärztliche Kinder- und Jugendarztpraxis, Stephanskirchen, Germany
| | - Martin Alberer
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
| | - Axel Hoffmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Guenter Froeschl
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
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17
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Alberer M, Malinowski S, Sanftenberg L, Schelling J. Notifiable infectious diseases in refugees and asylum seekers: experience from a major reception center in Munich, Germany. Infection 2018; 46:375-383. [PMID: 29616458 DOI: 10.1007/s15010-018-1134-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/16/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE In 2016, the number of refugees worldwide reached 65.6 million. So far, only limited data are available on the health status of refugees and asylum seekers (RAs). Especially, notifiable infectious diseases (NIDs) carry the risk of outbreaks in communal accommodations hosting RAs. METHODS We conducted a monocentric retrolective cross-sectional study including 15,137 RAs treated in a special health care unit for RAs located in the major reception center in Munich from November 2014 to October 2016. Altogether 811 RAs with NIDs according to sections 6 and 7 of the German Infection Protection Act or with other infections relevant in the setting of a communal accommodation (RIDs) could be identified. RESULTS The gender and age distribution was generally comparable to that of refugees in Germany. However, patients from East Africa and Nigeria were significantly overrepresented. NIDs/RIDs were dominated by cases of tuberculosis, hepatitis B, and vaccine-preventable and parasitic diseases. Significant risk factors included country of origin (COI) and age for hepatitis B, age for hepatitis C, gender and age for HIV, and COI, gender and age for tuberculosis and ectoparasitosis. Calculated prevalences of hepatitis B, hepatitis C, and HIV were mostly below those of the COI. Incidences of tuberculosis were mostly strongly elevated. CONCLUSIONS COI, gender, and age have an impact on the occurrence of NIDs/RIDs. Early vaccinations and improved hygiene could be effective in preventing NIDs/RIDs in communal accommodations. Screening, prompt therapy, and infection protection measures are necessary to prevent the transmission of diseases.
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Affiliation(s)
- Martin Alberer
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the Ludwig-Maximilians-University (LMU), Munich, Germany.
| | - Svea Malinowski
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Linda Sanftenberg
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Jörg Schelling
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany
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18
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Alberer M, Gnad-Vogt U, Hong HS, Mehr KT, Backert L, Finak G, Gottardo R, Bica MA, Garofano A, Koch SD, Fotin-Mleczek M, Hoerr I, Clemens R, von Sonnenburg F. Safety and immunogenicity of a mRNA rabies vaccine in healthy adults: an open-label, non-randomised, prospective, first-in-human phase 1 clinical trial. Lancet 2017; 390:1511-1520. [PMID: 28754494 DOI: 10.1016/s0140-6736(17)31665-3] [Citation(s) in RCA: 291] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/31/2017] [Accepted: 06/01/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Vaccines based on mRNA coding for antigens have been shown to be safe and immunogenic in preclinical models. We aimed to report results of the first-in-human proof-of-concept clinical trial in healthy adults of a prophylactic mRNA-based vaccine encoding rabies virus glycoprotein (CV7201). METHODS We did an open-label, uncontrolled, prospective, phase 1 clinical trial at one centre in Munich, Germany. Healthy male and female volunteers (aged 18-40 years) with no history of rabies vaccination were sequentially enrolled. They received three doses of CV7201 intradermally or intramuscularly by needle-syringe or one of three needle-free devices. Escalating doses were given to subsequent cohorts, and one cohort received a booster dose after 1 year. The primary endpoint was safety and tolerability. The secondary endpoint was to determine the lowest dose of CV7201 to elicit rabies virus neutralising titres equal to or greater than the WHO-specified protective antibody titre of 0·5 IU/mL. The study is continuing for long-term safety and immunogenicity follow-up. This trial is registered with ClinicalTrials.gov, number NCT02241135. FINDINGS Between Oct 21, 2013, and Jan 11, 2016, we enrolled and vaccinated 101 participants with 306 doses of mRNA (80-640 μg) by needle-syringe (18 intradermally and 24 intramuscularly) or needle-free devices (46 intradermally and 13 intramuscularly). In the 7 days post vaccination, 60 (94%) of 64 intradermally vaccinated participants and 36 (97%) of 37 intramuscularly vaccinated participants reported solicited injection site reactions, and 50 (78%) of 64 intradermally vaccinated participants and 29 (78%) of 37 intramuscularly vaccinated participants reported solicited systemic adverse events, including ten grade 3 events. One unexpected, possibly related, serious adverse reaction that occurred 7 days after a 640 μg intramuscular dose resolved without sequelae. mRNA vaccination by needle-free intradermal or intramuscular device injection induced virus neutralising antibody titres of 0·5 IU/mL or more across dose levels and schedules in 32 (71%) of 45 participants given 80 μg or 160 μg CV7201 doses intradermally and six (46%) of 13 participants given 200 μg or 400 μg CV7201 doses intramuscularly. 1 year later, eight (57%) of 14 participants boosted with an 80 μg needle-free intradermal dose of CV7201 achieved titres of 0·5 IU/mL or more. Conversely, intradermal or intramuscular needle-syringe injection was ineffective, with only one participant (who received 320 μg intradermally) showing a detectable immune response. INTERPRETATION This first-ever demonstration in human beings shows that a prophylactic mRNA-based candidate vaccine can induce boostable functional antibodies against a viral antigen when administered with a needle-free device, although not when injected by a needle-syringe. The vaccine was generally safe with a reasonable tolerability profile. FUNDING CureVac AG.
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Affiliation(s)
- Martin Alberer
- Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | | | | | | | - Linus Backert
- Quantitative Biology Centre, and Applied Bioinformatics, Department of Computer Science, University of Tübingen, Tübingen, Germany
| | - Greg Finak
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Raphael Gottardo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | | | | | | | | | - Frank von Sonnenburg
- Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany.
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Alberer M, Hoefele J, Benz MR, Bökenkamp A, Weber LT. No Impact of the Analytical Method Used for Determining Cystatin C on Estimating Glomerular Filtration Rate in Children. Front Pediatr 2017; 5:66. [PMID: 28443267 PMCID: PMC5387066 DOI: 10.3389/fped.2017.00066] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/17/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Measurement of inulin clearance is considered to be the gold standard for determining kidney function in children, but this method is time consuming and expensive. The glomerular filtration rate (GFR) is on the other hand easier to calculate by using various creatinine- and/or cystatin C (Cys C)-based formulas. However, for the determination of serum creatinine (Scr) and Cys C, different and non-interchangeable analytical methods exist. Given the fact that different analytical methods for the determination of creatinine and Cys C were used in order to validate existing GFR formulas, clinicians should be aware of the type used in their local laboratory. In this study, we compared GFR results calculated on the basis of different GFR formulas and either used Scr and Cys C values as determined by the analytical method originally employed for validation or values obtained by an alternative analytical method to evaluate any possible effects on the performance. METHODS Cys C values determined by means of an immunoturbidimetric assay were used for calculating the GFR using equations in which this analytical method had originally been used for validation. Additionally, these same values were then used in other GFR formulas that had originally been validated using a nephelometric immunoassay for determining Cys C. The effect of using either the compatible or the possibly incompatible analytical method for determining Cys C in the calculation of GFR was assessed in comparison with the GFR measured by creatinine clearance (CrCl). RESULTS Unexpectedly, using GFR equations that employed Cys C values derived from a possibly incompatible analytical method did not result in a significant difference concerning the classification of patients as having normal or reduced GFR compared to the classification obtained on the basis of CrCl. Sensitivity and specificity were adequate. On the other hand, formulas using Cys C values derived from a compatible analytical method partly showed insufficient performance when compared to CrCl. CONCLUSION Although clinicians should be aware of applying a GFR formula that is compatible with the locally used analytical method for determining Cys C and creatinine, other factors might be more crucial for the calculation of correct GFR values.
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Affiliation(s)
- Martin Alberer
- Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians University, Munich, Germany
| | - Julia Hoefele
- Institute of Human Genetics, Technical University Munich, Munich, Germany
| | - Marcus R Benz
- Pediatric Nephrology, Children's and Adolescent's Hospital, University Hospital of Cologne, Cologne, Germany
| | - Arend Bökenkamp
- Department of Pediatric Nephrology, VU University Medical Center, Amsterdam, Netherlands
| | - Lutz T Weber
- Pediatric Nephrology, Children's and Adolescent's Hospital, University Hospital of Cologne, Cologne, Germany
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Hoefele J, Mayer K, Marschall C, Alberer M, Klein HG, Kirschstein M. Rare co-occurrence of osteogenesis imperfecta type I and autosomal dominant polycystic kidney disease. World J Pediatr 2016; 12:501-503. [PMID: 27059743 DOI: 10.1007/s12519-016-0014-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 12/05/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND There are several clinical reports about the co-occurrence of autosomal dominant polycystic kidney disease (ADPKD) and connective tissue disorders. A simultaneous occurrence of osteogenesis imperfecta (OI) type I and ADPKD has not been observed so far. METHODS This report presents the first patient with OI type I and ADPKD. RESULTS Mutational analysis of PKD1 and COL1A1 in the index patient revealed a heterozygous mutation in each of the two genes. Mutational analysis of the parents indicated the mother as a carrier of the PKD1 mutation and the father as a carrier of the COL1A1 mutation. The simultaneous occurrence of both disorders has an estimated frequency of 3.5:100 000 000. CONCLUSION In singular cases, ADPKD can occur in combination with other rare disorders, e.g. connective tissue disorders.
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Affiliation(s)
- Julia Hoefele
- Center for Human Genetics and Laboratory Diagnostics Dr. Klein, Dr. Rost and Colleagues, Martinsried, Germany.
| | - Karin Mayer
- Center for Human Genetics and Laboratory Diagnostics Dr. Klein, Dr. Rost and Colleagues, Martinsried, Germany
| | - Christoph Marschall
- Center for Human Genetics and Laboratory Diagnostics Dr. Klein, Dr. Rost and Colleagues, Martinsried, Germany
| | - Martin Alberer
- Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians University, Munich, Germany
| | - Hanns-Georg Klein
- Center for Human Genetics and Laboratory Diagnostics Dr. Klein, Dr. Rost and Colleagues, Martinsried, Germany
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Weber S, Strasser K, Rath S, Kittke A, Beicht S, Alberer M, Lange-Sperandio B, Hoyer PF, Benz MR, Ponsel S, Weber LT, Klein HG, Hoefele J. Identification of 47 novel mutations in patients with Alport syndrome and thin basement membrane nephropathy. Pediatr Nephrol 2016; 31:941-55. [PMID: 26809805 DOI: 10.1007/s00467-015-3302-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 12/08/2015] [Accepted: 12/10/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND Alport syndrome (ATS) is a progressive hereditary nephropathy characterized by hematuria and proteinuria. It can be associated with extrarenal manifestations. In contrast, thin basement membrane nephropathy (TBMN) is characterized by microscopic hematuria, is largely asymptomatic, and is rarely associated with proteinuria and end-stage renal disease. Mutations have been identified in the COL4A5 gene in ATS and in the COL4A3 and COL4A4 genes in ATS and TBMN. To date, more than 1000 different mutations in COL4A5, COL4A3, and COL4A4 are known. METHODS In this study mutational analysis by exon sequencing and multiplex ligation-dependent probe amplification was performed in a large European cohort of families with ATS and TBMN. RESULTS Molecular diagnostic testing of 216 individuals led to the detection of 47 novel mutations, thereby expanding the spectrum of known mutations causing ATS and TBMN by up to 10 and 6%, respectively, depending on the database. Remarkably, a high number of ATS patients with only single mutations in COL4A3 and COL4A4 were identified. Additionally, three ATS patients presented with synonymous sequence variants that possible affect correct mRNA splicing, as suggested by in silico analysis. CONCLUSIONS The results of this study clearly broaden the genotypic spectrum of known mutations for ATS and TBMN, which will in turn now facilitate future studies into genotype-phenotype correlations. Further studies should also examine the significance of single heterozygous mutations in COL4A3 and COL4A4 and of synonymous sequence variants associated with ATS.
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Affiliation(s)
- Stefanie Weber
- Pediatric Nephrology, Pediatrics II, University of Duisburg-Essen, Essen, Germany
| | - Katja Strasser
- Pediatric Nephrology, Pediatrics II, University of Duisburg-Essen, Essen, Germany
| | - Sabine Rath
- Center for Human Genetics and Laboratory Diagnostics Dr. Klein, Dr. Rost and Colleagues, Martinsried, Germany
| | - Achim Kittke
- Center for Human Genetics and Laboratory Diagnostics Dr. Klein, Dr. Rost and Colleagues, Martinsried, Germany
| | - Sonja Beicht
- Center for Human Genetics and Laboratory Diagnostics Dr. Klein, Dr. Rost and Colleagues, Martinsried, Germany
| | - Martin Alberer
- Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians University, Munich, Germany
| | - Bärbel Lange-Sperandio
- Pediatric Nephrology, University Children's Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Peter F Hoyer
- Pediatric Nephrology, Pediatrics II, University of Duisburg-Essen, Essen, Germany
| | - Marcus R Benz
- Pediatric Nephrology, University Children's Hospital, Cologne, Germany
| | - Sabine Ponsel
- Pediatric Nephrology, University Children's Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Lutz T Weber
- Pediatric Nephrology, University Children's Hospital, Cologne, Germany
| | - Hanns-Georg Klein
- Center for Human Genetics and Laboratory Diagnostics Dr. Klein, Dr. Rost and Colleagues, Martinsried, Germany
| | - Julia Hoefele
- Center for Human Genetics and Laboratory Diagnostics Dr. Klein, Dr. Rost and Colleagues, Martinsried, Germany. .,Institute of Human Genetics, Technische Universität München, Munich, Germany.
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Herbinger KH, Hanus I, Felbinger TW, Weber C, Beissner M, von Sonnenburg F, Löscher T, Bretzel G, Nothdurft HD, Hoelscher M, Alberer M. Elevated Values of Clinically Relevant Transferases Induced by Imported Infectious Diseases: A Controlled Cross-Sectional Study of 14,559 Diseased German Travelers Returning from the Tropics and Subtropics. Am J Trop Med Hyg 2016; 95:481-7. [PMID: 27215300 DOI: 10.4269/ajtmh.16-0224] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 04/16/2016] [Indexed: 11/07/2022] Open
Abstract
The aim of this controlled cross-sectional study was to assess the clinical validity of elevated values of three clinically relevant transferase enzymes (aspartate transaminase [AST], alanine transaminase [ALT], and gamma-glutamyl transferase [GGT]) induced by imported infectious diseases (IDs) seen among patients consulting the Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (from 1999 to 2014) after being in the sub-/tropics. Data sets of 14,559 diseased German travelers returning from Latin America (2,715), Africa (4,574), or Asia (7,270) and of 1,536 healthy controls of German origin without recent travels were analyzed. Among the cases, the proportions of those with elevated values of AST (7.8%) and of ALT (13.4%) were significantly larger than among controls (4.0% and 10.6%, respectively), whereas for GGT, no significant difference was found (cases: 10.0%; controls: 11.4%). The study identified IDs with significantly larger proportions of both AST and ALT (hepatitis A [100%/100%], cytomegalovirus [CMV] infection [77%/81%], chronic hepatitis C [67%/67%], infectious mononucleosis [65%/77%], typhoid fever [50%/50%], cyclosporiasis [45%/66%], dengue fever [43%/35%], malaria [20%/27%], and rickettsiosis [20%/24%]), of AST alone (paratyphoid fever [42%]), of ALT alone (giardiasis [20%]), and of GGT (hepatitis A [100%], infectious mononucleosis [71%], CMV infection [58%], rickettsiosis (20%], and dengue fever [19%]). The study demonstrates that the determination of AST and ALT among travelers returning from the sub-/tropics has a high clinical validity, as their elevated values are typically caused by several imported viral, bacterial, and protozoan IDs, whereas no additional clinical validity was found by the determination of GGT.
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Affiliation(s)
- Karl-Heinz Herbinger
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany.
| | - Ingrid Hanus
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
| | - Thomas W Felbinger
- Department of Anesthesiology, Critical Care and Pain Medicine, Neuperlach Medical Center, Munich, Germany
| | - Christine Weber
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
| | - Marcus Beissner
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
| | - Frank von Sonnenburg
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
| | - Thomas Löscher
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
| | - Gisela Bretzel
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
| | - Hans Dieter Nothdurft
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany. German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Martin Alberer
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
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Cramer JP, Jelinek T, Paulke-Korinek M, Reisinger EC, Dieckmann S, Alberer M, Bühler S, Bosse D, Meyer S, Fragapane E, Costantini M, Pellegrini M, Lattanzi M, Dovali C. One-year immunogenicity kinetics and safety of a purified chick embryo cell rabies vaccine and an inactivated Vero cell-derived Japanese encephalitis vaccine administered concomitantly according to a new, 1-week, accelerated primary series. J Travel Med 2016; 23:taw011. [PMID: 26994987 DOI: 10.1093/jtm/taw011] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2016] [Indexed: 11/14/2022]
Abstract
BACKGROUND Conventional rabies pre-exposure prophylaxis (PrEP) and Japanese encephalitis (JE) primary series vaccination regimens each require up to 4 weeks to complete and, thus, may not be feasible for individuals who need these immunizations on short notice. This Phase 3b, randomized, controlled, observer-blind study evaluated the immunogenicity and safety of concomitant administration of a purified chick embryo cell culture rabies vaccine and an inactivated, adsorbed JE vaccine according to an accelerated (1 week) regimen when compared with the conventional regimens (4 weeks). This report describes the kinetics of immune responses up to 1 year after vaccination. METHODS A total of 661 healthy adults (18 to ≤65 years) were randomized into the following accelerated or conventional vaccine regimens: Rabies + JE-Conventional, Rabies + JE-Accelerated, Rabies-Conventional and JE-Conventional. Immunogenicity was assessed by virus neutralization tests. Safety and tolerability were also evaluated. RESULTS Irrespective of rabies vaccination regimen, ≥97% of subjects had adequate levels of rabies virus neutralizing antibody (RVNA) concentrations (≥0.5 IU/ml) up to Day 57, with percentages of subjects with RVNA concentrations ≥0.5 IU/ml at Day 366 ranging between 68% in the Rabies + JE-Accelerated group and 80% of subjects in the Rabies-Conventional group. The Rabies + JE-Accelerated group revealed high JE neutralizing antibody titers at all-time points. At Day 366, the percentage of subjects with antibody titers indicative of seroprotection (PRNT50 titers ≥1:10) remained high across JE vaccine groups (86-94%). CONCLUSIONS The accelerated PrEP rabies and JE vaccination regimens, once licensed, could represent a valid alternative in the short-term to currently recommended conventional regimens. The concomitant administration of these two vaccines does not compromise immune responses to any of the vaccine antigens particularly when aiming for short-term protection. Further evidence will clarify the need for and timing to administration of rabies vaccine booster doses in subjects primed with an accelerated PrEP regimen. (NCT01662440).
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Affiliation(s)
- Jakob P Cramer
- Bernhard Nocht Institute for Tropical Medicine, Section Clinical Research and Epidemiology/University Medical Center Hamburg-Eppendorf, Bernhard Nocht Centre for Clinical Trials (BNCCT), Hamburg, Germany
| | - Tomas Jelinek
- Berlin Center for Travel and Tropical Medicine, Berlin, Germany
| | - Maria Paulke-Korinek
- Institute of Specific Prophylaxis and Tropical Medicine, Medical University Vienna, Austria, Federal Ministry of Health, Vienna, Austria
| | - Emil C Reisinger
- Department of Tropical Medicine and Infectious Diseases, University of Rostock Medical School, Rostock, Germany
| | - Sebastian Dieckmann
- Institute of Tropical Medicine and International Health, Charité-Universitaetsmedizin Berlin, Germany
| | - Martin Alberer
- Department of Infectious Diseases and Tropical Medicine, University of Munich, Munich, Germany
| | - Silja Bühler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Dietrich Bosse
- Novartis Vaccines and Diagnostics, GmbH, Marburg, Germany (a GSK company) and
| | - Seetha Meyer
- Novartis Vaccines and Diagnostics, GmbH, Marburg, Germany (a GSK company) and
| | - Elena Fragapane
- Novartis Vaccines and Diagnostics, Srl (a GSK company), Siena, Italy
| | - Marco Costantini
- Novartis Vaccines and Diagnostics, Srl (a GSK company), Siena, Italy
| | | | - Maria Lattanzi
- Novartis Vaccines and Diagnostics, Srl (a GSK company), Siena, Italy
| | - Claudia Dovali
- Novartis Vaccines and Diagnostics, Srl (a GSK company), Siena, Italy
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Herbinger KH, Alberer M, Berens-Riha N, Schunk M, Bretzel G, von Sonnenburg F, Nothdurft HD, Löscher T, Beissner M. Spectrum of Imported Infectious Diseases: A Comparative Prevalence Study of 16,817 German Travelers and 977 Immigrants from the Tropics and Subtropics. Am J Trop Med Hyg 2016; 94:757-66. [PMID: 26903611 DOI: 10.4269/ajtmh.15-0731] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/01/2016] [Indexed: 12/16/2022] Open
Abstract
The aim of this study was to assess the spectrum of imported infectious diseases (IDs) among patients consulting the University of Munich, Germany, between 1999 and 2014 after being in the sub-/tropics. The analysis investigated complete data sets of 16,817 diseased German travelers (2,318 business travelers, 4,029 all-inclusive travelers, and 10,470 backpackers) returning from Latin America (3,225), Africa (4,865), or Asia (8,727), and 977 diseased immigrants, originating from the same regions (112, 654 and 211 respectively). The most frequent symptoms assessed were diarrhea (38%), fever (29%), and skin disorder (22%). The most frequent IDs detected were intestinal infections with species of Blastocystis(900),Giardia(730),Campylobacter(556),Shigella(209), and Salmonella(183). Also frequently observed were cutaneous larva migrans (379), dengue (257), and malaria (160). The number of IDs with significantly elevated proportions was higher among backpackers (18) and immigrants (17), especially among those from Africa (18) and Asia (17), whereas it was lower for business travelers (5), all-inclusive travelers (1), and those from Latin America (5). This study demonstrates a large spectrum of imported IDs among returning German travelers and immigrants, which varies greatly based not only on travel destination and origin of immigrants, but also on type of travel.
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Affiliation(s)
- Karl-Heinz Herbinger
- Department of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
| | - Martin Alberer
- Department of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
| | - Nicole Berens-Riha
- Department of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
| | - Mirjam Schunk
- Department of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
| | - Gisela Bretzel
- Department of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
| | - Frank von Sonnenburg
- Department of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
| | - Hans Dieter Nothdurft
- Department of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
| | - Thomas Löscher
- Department of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
| | - Marcus Beissner
- Department of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
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Weber S, Büscher AK, Hagmann H, Liebau MC, Heberle C, Ludwig M, Rath S, Alberer M, Beissert A, Zenker M, Hoyer PF, Konrad M, Klein HG, Hoefele J. Dealing with the incidental finding of secondary variants by the example of SRNS patients undergoing targeted next-generation sequencing. Pediatr Nephrol 2016; 31:73-81. [PMID: 26248470 DOI: 10.1007/s00467-015-3167-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 06/29/2015] [Accepted: 06/30/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Steroid-resistant nephrotic syndrome (SRNS) is a severe cause of progressive renal disease. Genetic forms of SRNS can present with autosomal recessive or autosomal dominant inheritance. Recent studies have identified mutations in multiple podocyte genes responsible for SRNS. Improved sequencing methods (next-generation sequencing, NGS) now promise rapid mutational testing of SRNS genes. METHODS In the present study, a simultaneous screening of ten SRNS genes in 37 SRNS patients was performed by NGS. RESULTS In 38 % of the patients, causative mutations in one SRNS gene were found. In 22 % of the patients, in addition to these mutations, a secondary variant in a different gene was identified. CONCLUSIONS This high incidence of accumulating sequence variants was unexpected but, although they might have modifier effects, the pathogenic potential of these additional sequence variants seems unclear so far. The example of molecular diagnostics by NGS in SRNS patients shows that these new sequencing technologies might provide further insight into molecular pathogenicity in genetic disorders but will also generate results, which will be difficult to interpret and complicate genetic counseling. Although NGS promises more frequent identification of disease-causing mutations, the identification of causative mutations, the interpretation of incidental findings and possible pitfalls might pose problems, which hopefully will decrease by further experience and elucidation of molecular interactions.
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Affiliation(s)
- Stefanie Weber
- Pediatric Nephrology, Pediatrics II, University of Duisburg-Essen, Essen, Germany
| | - Anja K Büscher
- Pediatric Nephrology, Pediatrics II, University of Duisburg-Essen, Essen, Germany
| | - Henning Hagmann
- Renal Division, Department II of Internal Medicine and Center for Molecular Medicine, University of Cologne, Cologne, Germany
| | - Max C Liebau
- Renal Division, Department II of Internal Medicine and Center for Molecular Medicine, University of Cologne, Cologne, Germany
- Department of Pediatrics, University Hospital of Cologne, Cologne, Germany
| | - Christian Heberle
- Center for Human Genetics and Laboratory Diagnostics Dr. Klein, Dr. Rost and Colleagues, Martinsried, Germany
| | - Michael Ludwig
- Department of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
| | - Sabine Rath
- Center for Human Genetics and Laboratory Diagnostics Dr. Klein, Dr. Rost and Colleagues, Martinsried, Germany
| | - Martin Alberer
- Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians University, Munich, Germany
| | - Antje Beissert
- Pediatric Nephrology, University Children's Hospital, Würzburg, Germany
| | - Martin Zenker
- Institute of Human Genetics, University Hospital, Magdeburg, Germany
| | - Peter F Hoyer
- Pediatric Nephrology, Pediatrics II, University of Duisburg-Essen, Essen, Germany
| | | | - Hanns-Georg Klein
- Center for Human Genetics and Laboratory Diagnostics Dr. Klein, Dr. Rost and Colleagues, Martinsried, Germany
| | - Julia Hoefele
- Center for Human Genetics and Laboratory Diagnostics Dr. Klein, Dr. Rost and Colleagues, Martinsried, Germany.
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Alberer M, Wendeborn M, Löscher T, Seilmaier M. [Spectrum of diseases occurring in refugees and asylum seekers: data from three different medical institutions in the Munich area from 2014 and 2015]. Dtsch Med Wochenschr 2015; 141:e8-15. [PMID: 26710209 DOI: 10.1055/s-0041-106907] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND In 2014 the number of refugees and asylum seekers in Germany rose steeply. Therefore, the provision of sufficient medical care for this special group of people became a major topic. Up to now, data on the spectrum of illnesses in this group in Germany is scarce. PATIENTS AND METHODS Anonymized data of 548 ill refugees and asylum seekers were retrospectively evaluated. Cases from three different institutions and time periods were collected and summarized: 329 outpatients from the general medical clinic of REFUDOCS (RD, January to beginning of March 2015), 175 inpatients from the 1. medical department of the municipal hospital Schwabing (KS, June 2014 to February 2015) and 44 outpatients from the department of infectious diseases and tropical medicine of the Ludwig-Maximilians-University, Munich (AITM, 2014). RESULTS Health problems seen at the RD general medical clinic mostly matched the usual spectrum seen by general practitioners. Respiratory illnesses especially by unspecific viral infections (152 visits), followed by neuropsychiatric (68), and gastrointestinal illnesses (56), as well as musculoskeletal (52) and skin problems (45), were common. Infectious diseases or diseases typical or specific for the tropics were mostly treated in the specialized centers. Cases of pulmonary and extrapulmonary tuberculosis (53), malaria (53), scabies, pneumonia, and schistosomiasis were prevalent. CONCLUSION The results of this exemplary study mostly show the occurrence of illnesses in refugees and asylum seekers that are well known to German general practitioners and pediatricians. However, depending on the country of origin infectious / tropical diseases like tuberculosis, malaria, or relapsing fever have to be considered. Rapid diagnosis of these illnesses is warranted to prevent severe cases or further spreading of contagious diseases.
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Affiliation(s)
- M Alberer
- Abteilung für Infektions- und Tropenmedizin, Klinikum der Ludwig-Maximilians-Universität München
| | - M Wendeborn
- REFUDOCS, Verein zur medizinischen Versorgung von Flüchtlingen, Asylsuchenden und deren Kindern e. V., München
| | - T Löscher
- Abteilung für Infektions- und Tropenmedizin, Klinikum der Ludwig-Maximilians-Universität München
| | - M Seilmaier
- Klinik für Hämatologie, Onkologie, Immunologie, Palliativmedizin, Infektiologie und Tropenmedizin, Klinikum Schwabing, Akademisches Lehrkrankenhaus der Ludwig-Maximilians-Universität München
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Alberer M, Löscher T. [Vaccinations and malaria prophylaxis for international travelers]. Dtsch Med Wochenschr 2015; 140:805-14. [PMID: 26080719 DOI: 10.1055/s-0041-102193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The prevention of infectious diseases by vaccination and by counselling about malaria prophylaxis is a central aspect of travel medicine. Besides mandatory vaccinations required for entry to certain countries various vaccinations may be indicated depending on destination and type of travel as well as on individual risks of the traveler. In addition, pre-travel counselling should always include a check-up of standard vaccinations. Protection against mosquito bites is the basis of malaria prophylaxis. The addition of chemoprophylaxis is warranted in high risk areas. When regular chemoprophylaxis is not applied it is recommended to carry an appropriate antimalarial drug which can be used for emergency stand-by treatment in case of unexplained fever and when medical attention is not available within 24 hours. Travelers should realize that self-treatment is a first-aid measure and that they should still seek medical advice as soon as possible.
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Affiliation(s)
- Martin Alberer
- Abteilung für Infektions- und Tropenmedizin, Klinikum der LMU München
| | - Thomas Löscher
- Abteilung für Infektions- und Tropenmedizin, Klinikum der LMU München
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Jelinek T, Cramer JP, Dieckmann S, Hatz C, Paulke-Korinek M, Alberer M, Reisinger EC, Costantini M, Gniel D, Bosse D, Lattanzi M. Evaluation of rabies immunogenicity and tolerability following a purified chick embryo cell rabies vaccine administered concomitantly with a Japanese encephalitis vaccine. Travel Med Infect Dis 2015; 13:241-50. [PMID: 26005163 DOI: 10.1016/j.tmaid.2015.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 04/30/2015] [Accepted: 05/03/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND For individuals traveling at short notice to rabies and Japanese encephalitis (JE) endemic countries, concomitant administration of travel vaccines within a short period is often required. METHODS The aim of this study was to determine whether an accelerated (one-week: Days 1-8) pre-exposure rabies (Rabipur(®), Novartis Vaccines) vaccination regimen administered concomitantly with a Japanese encephalitis (JE) vaccination (Ixiaro(®), Valneva) regimen, is non-inferior to the standard (four-week: Days 1, 8, 29) rabies regimen administered alone or concomitantly with the JE vaccine. Healthy adults (18 to ≤ 65 years) were randomized into Rabies + JE-Standard, Rabies + JE-Accelerated, Rabies-Standard and JE-Standard groups. Relative immunogenicity for rabies in each regimen was assessed using the rapid fluorescent focus inhibition test. Safety was evaluated up to and including Day 57. RESULTS Non-inferior immunogenicity for rabies was established between the Rabies + JE-Accelerated group compared to both the Rabies-Standard and Rabies + JE-Standard groups; as well as between the Rabies + JE-Standard regimen and the Rabies-Standard regimen. By Day 57, adequate neutralizing levels were achieved by 97-100% of subjects across all groups. Adverse events (AEs) were comparable for all groups. CONCLUSIONS An accelerated pre-exposure rabies and JE vaccination regimen is non-inferior to the standard four-week rabies regimen and may thus provide a more convenient regimen for individuals traveling to endemic countries at short notice. NCT01662440.
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Affiliation(s)
- Tomas Jelinek
- Berlin Center for Travel and Tropical Medicine, Berlin, Germany
| | - Jakob P Cramer
- Bernhard Nocht Institute for Tropical Medicine, Department of Clinical Research/University Medical Center Hamburg-Eppendorf, Department of Internal Medicine, Section Tropical Medicine, Hamburg, Germany
| | - Sebastian Dieckmann
- Institute of Tropical Medicine and International Health, Charité-Universitaetsmedizin Berlin, Germany
| | - Christoph Hatz
- Institute of Social and Preventive Medicine, University of Zürich, Switzerland
| | - Maria Paulke-Korinek
- Institute of Specific Prophylaxis and Tropical Medicine, Medical University Vienna, Austria
| | - Martin Alberer
- Department of Infectious Diseases and Tropical Medicine, University of Munich, Munich, Germany
| | - Emil C Reisinger
- Department of Tropical Medicine and Infectious Diseases, University of Rostock Medical School, Rostock, Germany
| | - Marco Costantini
- Novartis Vaccines and Diagnostics Srl - a GSK company, Siena, Italy
| | - Dieter Gniel
- Novartis Vaccines and Diagnostics Srl - a GSK company, Marburg, Germany
| | - Dietrich Bosse
- Novartis Vaccines and Diagnostics Srl - a GSK company, Marburg, Germany
| | - Maria Lattanzi
- Novartis Vaccines and Diagnostics Srl - a GSK company, Siena, Italy.
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Alberer M, Burchard G, Jelinek T, Reisinger EC, Meyer S, Forleo-Neto E, Dagnew AF, Arora AK. Immunogenicity and safety of concomitant administration of a combined hepatitis A/B vaccine and a quadrivalent meningococcal conjugate vaccine in healthy adults. J Travel Med 2015; 22:105-14. [PMID: 25483566 DOI: 10.1111/jtm.12180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 10/02/2014] [Accepted: 10/03/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND This phase 3b randomized, open-label study evaluated the immunogenicity and safety of coadministration of a hepatitis A and/or B vaccine with a quadrivalent oligosaccharide meningococcal CRM197 -conjugate vaccine (MenACWY-CRM), in the context of an accelerated hepatitis A and/or B immunization schedule. METHODS A total of 252 healthy adult subjects were randomized to three groups to receive hepatitis A/B only (HepA/B), hepatitis A/B coadministered with MenACWY-CRM (HepA/B+MenACWY-CRM), or MenACWY-CRM only (MenACWY-CRM). Hepatitis A and/or B vaccination was administered in the form of a single booster dose or a primary three-dose series, depending on the hepatitis A and/or B vaccination history of subjects. Antibody responses to hepatitis A/B vaccination were assessed 1 month following the last hepatitis A and/or B dose. Serum bactericidal activity with human complement (hSBA) against meningococcal serogroups A, C, W-135, and Y was assessed 1 month post-MenACWY-CRM vaccination. Safety was monitored throughout the study. RESULTS At 1 month following the final hepatitis A and/or B vaccination, concomitant administration of hepatitis A/B and MenACWY-CRM was non-inferior to administration of hepatitis A/B alone in terms of geometric mean concentrations of antibodies against the hepatitis A and B antigens. One month post-MenACWY-CRM vaccination, the percentages of subjects achieving hSBA titers ≥8 for serogroups A, C, W-135, and Y in the HepA/B+MenACWY-CRM group (76, 87, 99, and 94%, respectively) were comparable to those in the MenACWY-CRM group (67, 82, 96, and 88%, respectively). The percentages of subjects reporting adverse events (AEs) were similar across study groups and a majority of the reported AEs were mild to moderate in nature. There were no study vaccine-related serious AEs. CONCLUSIONS MenACWY-CRM can be administered concomitantly with a hepatitis A and/or B vaccine in the context of an accelerated hepatitis A and/or B immunization schedule without increasing safety concerns or compromising the immune responses to any of the vaccine antigens. [NCT01453348].
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Affiliation(s)
- Martin Alberer
- Department of Infectious Diseases and Tropical Medicine, University of Munich, Munich, Germany
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Alberer M, Burchard G, Jelinek T, Reisinger E, Beran J, Hlavata LC, Forleo-Neto E, Dagnew AF, Arora AK. Safety and immunogenicity of typhoid fever and yellow fever vaccines when administered concomitantly with quadrivalent meningococcal ACWY glycoconjugate vaccine in healthy adults. J Travel Med 2015; 22:48-56. [PMID: 25308927 DOI: 10.1111/jtm.12164] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 06/26/2014] [Accepted: 07/21/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Compact and short pre-travel immunization schedules, which include several vaccinations in a single visit, are desirable for many travelers. However, concomitant vaccination could potentially compromise immunogenicity and/or safety of the individual vaccines and, therefore, possible vaccine interferences should be carefully assessed. This article discusses the immunogenicity and safety of travel vaccines for typhoid fever (TF) and yellow fever (YF), when administered with or without a quadrivalent meningococcal glycoconjugate ACWY-CRM vaccine (MenACWY-CRM). METHODS Healthy adults (18-≤60 years) were randomized to one of three vaccine regimens: TF + YF + MenACWY-CRM (group I; n = 100), TF + YF (group II; n = 101), or MenACWY-CRM (group III; n = 100). Immunogenicity at baseline and 4 weeks post-vaccination (day 29) was assessed by serum bactericidal assay using human complement (hSBA), enzyme-linked immunosorbent assay (ELISA), or a neutralization test. Adverse events (AEs) and serious adverse events (SAEs) were collected throughout the study period. RESULTS Non-inferiority of post-vaccination geometric mean concentrations (GMCs) and geometric mean titers (GMTs) was established for TF and YF vaccines, respectively, when given concomitantly with MenACWY-CRM vaccine versus when given alone. The percentages of subjects with seroprotective neutralizing titers against YF on day 29 were similar in groups I and II. The antibody responses to meningococcal serogroups A, C, W-135, and Y were within the same range when MenACWY-CRM was given separately or together with TF and YF vaccines. The percentage of subjects reporting AEs was the same for TF and YF vaccines with or without MenACWY-CRM vaccine. There were no reports of SAEs or AEs leading to study withdrawals. CONCLUSIONS These data provide evidence that MenACWY-CRM can be administered with typhoid Vi polysaccharide vaccine and live attenuated YF vaccine without compromising antibody responses stimulated by the individual vaccines. MenACWY-CRM can, therefore, be incorporated into travelers' vaccination programs without necessitating an additional clinic visit (NCT01466387).
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Affiliation(s)
- Martin Alberer
- Department of Infectious Diseases and Tropical Medicine, University of Munich, Munich, Germany
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Alberer M, Burchard G, Jelinek T, Reisinger E, Beran J, Meyer S, Forleo-Neto E, Gniel D, Dagnew AF, Arora AK. Co-administration of a meningococcal glycoconjugate ACWY vaccine with travel vaccines: a randomized, open-label, multi-center study. Travel Med Infect Dis 2014; 12:485-93. [PMID: 24873986 DOI: 10.1016/j.tmaid.2014.04.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/23/2014] [Accepted: 04/28/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Potential interactions between vaccines may compromise the immunogenicity and/or safety of individual vaccines so must be assessed before concomitant administration is recommended. In this study, the immunogenicity and safety of travel vaccines against Japanese encephalitis (JEV) and rabies (PCECV) administered together with or without a quadrivalent meningococcal glycoconjugate ACWY-CRM vaccine were evaluated (NCT01466387). METHOD Healthy adults aged 18 to ≤60 years were randomized to one of four vaccine regimens: JEV + PCECV + MenACWY-CRM, JEV + PCECV, PCECV or MenACWY-CRM. Immunogenicity at baseline and 28 days post-complete vaccination was assessed by serum bactericidal assay using human complement or neutralization tests. Adverse events (AEs) were collected throughout the study period. RESULTS JEV + PCECV + MenACWY-CRM was non-inferior to JEV + PCECV. Post-vaccination seroprotective neutralizing titers or concentrations were achieved in 98-99% (JE) and 100% (rabies) of subjects across the vaccine groups. Antibody responses to vaccine meningococcal serogroups were in the same range for MenACWY-CRM and JEV + PCECV + MenACWY-CRM. Rates of reporting of AEs were similar for JEV + PCECV and JEV + PCECV + MenACWY-CRM. CONCLUSIONS MenACWY-CRM was administered with an inactivated adjuvanted JE and a purified chick embryo cell-culture rabies vaccine without compromising immunogenicity or safety of the individual vaccines. These data provide evidence that MenACWY-CRM could be effectively incorporated into travel vaccination programs. TRIAL NUMBER NCT01466387.
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Affiliation(s)
- Martin Alberer
- Department of Infectious Diseases and Tropical Medicine, University of Munich, Munich, Germany
| | - Gerd Burchard
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tomas Jelinek
- Berlin Center for Travel and Tropical Medicine, Berlin, Germany
| | - Emil Reisinger
- Department of Tropical Medicine and Infectious Diseases, University of Rostock Medical School, Rostock, Germany
| | - Jiri Beran
- Vaccination and Travel Medicine Centre, Hradec Kralove, Czech Republic
| | - Seetha Meyer
- Novartis Vaccines and Diagnostics, Inc., Cambridge, MA, USA
| | | | - Dieter Gniel
- Novartis Vaccines and Diagnostics, Inc., Cambridge, MA, USA
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Berens-Riha N, Kroidl I, Schunk M, Alberer M, Beissner M, Pritsch M, Kroidl A, Fröschl G, Hanus I, Bretzel G, von Sonnenburg F, Nothdurft HD, Löscher T, Herbinger KH. Evidence for significant influence of host immunity on changes in differential blood count during malaria. Malar J 2014; 13:155. [PMID: 24758172 PMCID: PMC4021259 DOI: 10.1186/1475-2875-13-155] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 02/13/2014] [Accepted: 04/17/2014] [Indexed: 12/16/2022] Open
Abstract
Background Malaria has been shown to change blood counts. Recently, a few studies have investigated the alteration of the peripheral blood monocyte-to-lymphocyte count ratio (MLCR) and the neutrophil-to-lymphocyte count ratio (NLCR) during infection with Plasmodium falciparum. Based on these findings this study investigates the predictive values of blood count alterations during malaria across different sub-populations. Methods Cases and controls admitted to the Department of Infectious Diseases and Tropical Medicine from January 2000 through December 2010 were included in this comparative analysis. Blood count values and other variables at admission controlled for age, gender and immune status were statistically investigated. Results The study population comprised 210 malaria patients, infected with P. falciparum (68%), Plasmodium vivax (21%), Plasmodium ovale (7%) and Plasmodium malariae (4%), and 210 controls. A positive correlation of parasite density with NLCR and neutrophil counts, and a negative correlation of parasite density with thrombocyte, leucocyte and lymphocyte counts were found. An interaction with semi-immunity was observed; ratios were significantly different in semi-immune compared to non-immune patients (P <0.001). The MLCR discriminated best between malaria cases and controls (AUC = 0.691; AUC = 0.741 in non-immune travellers), whereas the NLCR better predicted severe malaria, especially in semi-immune patients (AUC = 0.788). Conclusion Malaria causes typical but non-specific alterations of the differential blood count. The predictive value of the ratios was fair but limited. However, these changes were less pronounced in patients with semi-immunity. The ratios might constitute easily applicable surrogate biomarkers for immunity.
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Affiliation(s)
- Nicole Berens-Riha
- Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Ludwig-Maximilians-Universität (LMU), Leopoldstraße 5, 80802 Munich, Germany.
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Werkstetter KJ, Schatz SB, Alberer M, Filipiak-Pittroff B, Koletzko S. Influence of exclusive enteral nutrition therapy on bone density and geometry in newly diagnosed pediatric Crohn's disease patients. Ann Nutr Metab 2013; 63:10-6. [PMID: 23867548 DOI: 10.1159/000350369] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 03/02/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Exclusive enteral nutrition (EEN) induces remission in patients with Crohn's disease (CD). We investigated the short-term impact of EEN on bone quality and muscle mass in children with CD. METHODS Ten newly diagnosed CD patients (7 male, 10.6-17.7 years of age) were assessed by peripheral quantitative computed tomography (pQCT) at the forearm before starting an 8-weeks treatment with EEN, and after 12 and 52 weeks. No steroids or biologicals were applied. Trabecular and cortical bone mineral density, total bone, and muscle cross-sectional area (CSA) were measured by pQCT and expressed as age- and sex-specific z-scores; size-dependent CSAs were corrected for low height for age. Wilcoxon rank sum test was applied. RESULTS Remission at week 12 was achieved in 8 patients; 2 still had mild disease. Initially low trabecular density z-scores improved (+0.3; p = 0.006) at week 12; simultaneously, the increased cortical density z-scores normalized (-0.4; p = 0.027). The low z-score for muscle CSA corrected for height (median -2.5, range -3.49 to -0.97) increased within 12 weeks (+1.0; p = 0.002) with no further improvement thereafter. CONCLUSIONS The results indicate disturbed bone remodeling and severely impaired muscle mass in newly diagnosed CD children. Bone metabolism and muscle mass improved within 3 months after starting EEN with no further normalization thereafter.
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Affiliation(s)
- Katharina Julia Werkstetter
- Division of Pediatric Gastroenterology and Hepatology, Dr. von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
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Beicht S, Strobl-Wildemann G, Rath S, Wachter O, Alberer M, Kaminsky E, Weber LT, Hinrichsen T, Klein HG, Hoefele J. Next generation sequencing as a useful tool in the diagnostics of mosaicism in Alport syndrome. Gene 2013; 526:474-7. [PMID: 23732293 DOI: 10.1016/j.gene.2013.05.045] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 05/01/2013] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
Abstract
Alport syndrome (ATS) is a progressive hereditary nephropathy characterized by hematuria and/or proteinuria with structural defects of the glomerular basement membrane. It can be associated with extrarenal manifestations (high-tone sensorineural hearing loss and ocular abnormalities). Somatic mutations in COL4A5 (X-linked), COL4A3 and COL4A4 genes (both autosomal recessive and autosomal dominant) cause Alport syndrome. Somatic mosaicism in Alport patients is very rare. The reason for this may be due to the difficulty of detection. We report the case of a boy and his mother who presented with Alport syndrome. Mutational analysis showed the novel hemizygote pathogenic mutation c.2396-1G>A (IVS29-1G>A) at the splice acceptor site of the intron 29 exon 30 boundary of the COL4A5 gene in the boy. The mutation in the mother would not have been detected by Sanger sequencing without the knowledge of the mutational analysis result of her son. Further investigation of the mother using next generation sequencing showed somatic mosaicism and implied potential germ cell mosaicism. The mutation in the mother has most likely occurred during early embryogenesis. Analysis of tissue of different embryonic origin in the mother confirmed mosaicism in both mesoderm and ectoderm. Low grade mosaicism is very difficult to detect by Sanger sequencing. Next generation sequencing is increasingly used in the diagnostics and might improve the detection of mosaicism. In the case of definite clinical symptoms of ATS and missing detection of a mutation by Sanger sequencing, mutational analysis should be performed by next generation sequencing.
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Affiliation(s)
- Sonja Beicht
- Center for Human Genetics and Laboratory Medicine Dr. Klein, Dr. Rost and Colleagues, Martinsried, Germany
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Herbinger KH, Drerup L, Alberer M, Nothdurft HD, Sonnenburg FV, Löscher T. Spectrum of imported infectious diseases among children and adolescents returning from the tropics and subtropics. J Travel Med 2012; 19:150-7. [PMID: 22530821 DOI: 10.1111/j.1708-8305.2011.00589.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND About 50 million people travel each year from industrialized countries to destinations in the tropics and subtropics. Among them, there are more than 2 million minors traveling. Although their number is increasing constantly, data on health risks during travel are limited. METHODS This study analyzed demographic, travel, and clinical data of 890 travelers of age <20 years presenting at the outpatient travel clinic of the University of Munich between 1999 and 2009 after returning from the tropics and subtropics. RESULTS Most (87%) of these young travelers were born in Germany. Among them, the main travel destination was Africa (46%), followed by Asia (35%) and Latin America (19%). The most frequent syndrome groups were acute diarrhea (25%, especially in age 0-4 y), dermatologic disorders (21%, especially in age 0-9 y), febrile/systemic diseases (20%), respiratory disorders (8%), chronic diarrhea (5%), and genitourinary disorders (3%). The 10 most frequent diagnosed infectious diseases were giardiasis (8%), schistosomiasis (4%), superinfected insect bites (4%), Campylobacter enteritis (4%), Salmonella enteritis (4%), cutaneous larva migrans (3%), amebiasis (3%), dengue fever (2%), mononucleosis (2%), and malaria (2%). The relative risk (RR) for acquiring any infectious disease during travel was highest in Central, West, and East Africa, followed by South America, South Asia, and Southeast Asia. CONCLUSIONS Age of young travelers and destination of travel were the most important variables being strongly correlated with the risk for acquiring infectious diseases in the tropics and subtropics. The highest risk was carried by very young travelers and those staying in sub-Saharan Africa (except Southern Africa).
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Affiliation(s)
- Karl-Heinz Herbinger
- Department of Infectious Diseases and Tropical Medicine-DITM, University Hospital, Ludwig-Maximilians University of Munich, Munich, Germany.
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Bechtold S, Alberer M, Arenz T, Putzker S, Filipiak-Pittroff B, Schwarz HP, Koletzko S. Reduced muscle mass and bone size in pediatric patients with inflammatory bowel disease. Inflamm Bowel Dis 2010; 16:216-25. [PMID: 19637389 DOI: 10.1002/ibd.21021] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Decreased bone mineral density has been reported in children with inflammatory bowel disease (IBD). We used peripheral quantitative computed tomography (pQCT) to assess bone mineralization, geometry, and muscle cross-sectional area (CSA) in pediatric IBD. METHODS In a cross-sectional study, pQCT of the forearm was applied in 143 IBD patients (mean age 13.9 +/- 3.5 years); 29% were newly diagnosed, 98 had Crohn's disease, and 45 had ulcerative colitis. Auxological data, cumulative glucocorticoid dose, disease activity indices, laboratory markers for inflammation, and bone metabolism were related to the results of pQCT. RESULTS Patients were compromised in height (-0.82 +/- 1.1 SD), weight (-0.77 +/- 1.0 SD), muscle mass (-1.12 +/- 1.0 SD), and total bone cross-sectional area (-0.79 +/- 1.0 SD) compared to age- and sex-matched healthy controls (z-scores). In newly diagnosed patients, the ratio of bone mineral mass per muscle CSA was higher than in those with longer disease duration (1.00 versus 0.30, P = 0.007). Serum albumin level and disease activity correlated with muscle mass, accounting for 41.0% of variability in muscle mass (P < 0.01). The trabecular bone mineral density z-score was on average at the lower normal level (-0.40 +/- 1.3 SD, P < 0.05). CONCLUSIONS Reduced bone geometry was explained only in part by reduced height. Bone disease in children with IBD seems to be secondary to muscle wasting, which is already present at diagnosis. With longer disease duration, bone adapts to the lower muscle CSA. Serum albumin concentration is a good marker for muscle wasting and abnormal bone development.
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Affiliation(s)
- Susanne Bechtold
- Division of Pediatric Endocrinology, Dr. v. Haunersches Kinderspital, University, Munich, Germany
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Arenz T, Antos D, Rüssmann H, Alberer M, Buderus S, Kappler M, Koletzko S. Esomeprazole-based 1-week triple therapy directed by susceptibility testing for eradication of Helicobacter pylori infection in children. J Pediatr Gastroenterol Nutr 2006; 43:180-4. [PMID: 16877981 DOI: 10.1097/01.mpg.0000228103.89454.a2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Poor compliance to therapy and antibiotic resistance are the main causes for failure of anti-Helicobacter pylori therapy. OBJECTIVE To evaluate the effectiveness of esomeprazole-based triple therapy directed by susceptibility testing. METHODS Symptomatic children with H. pylori infection, who underwent successful susceptibility testing and were colonized by no double-resistant strain, received 1-week triple therapy with esomeprazole, amoxicillin and either clarithromycin or metronidazole. Success of eradication was investigated by C-urea breath test. RESULTS Fifty-eight children (median age, 11.4 years; range, 2.2-17.7 years; 81% immigrants) were included. Helicobacter pylori was resistant to clarithromycin in 5 (9%) and to metronidazole in 9 children (16%). Eradication was successful in 49 (92%) of 53 children receiving esomeprazole, amoxicillin and clarithromycin and in all 5 children treated with metronidazole instead of clarithromycin, resulting in an eradication rate of 93% (95% confidence interval, 83%-98%, intention-to-treat analysis). All 4 treatment failures occurred in immigrants with language problems; 2 of them were obviously noncompliant. CONCLUSION Esomeprazole-based 1-week triple therapy directed by susceptibility testing is highly effective for eradication of H. pylori infection in children.
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Affiliation(s)
- Tina Arenz
- Dr von Haunersches Kinderspital of the Ludwig-Maximilians University of Munich, Germany
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Dilger K, Alberer M, Busch A, Enninger A, Behrens R, Koletzko S, Stern M, Beckmann C, Gleiter CH. Pharmacokinetics and pharmacodynamic action of budesonide in children with Crohn's disease. Aliment Pharmacol Ther 2006; 23:387-96. [PMID: 16422998 DOI: 10.1111/j.1365-2036.2006.02771.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Budesonide is effective as initial therapy of mild to moderate Crohn's disease in adults. Superior tolerability to conventional corticosteroids might be attributed to extensive first-pass metabolism of budesonide by cytochrome P450 3A. AIM To evaluate biotransformation and pharmacodynamic action of budesonide in children. METHODS Drug disposition and effects on endogenous cortisol were evaluated in 12 children with Crohn's disease (5-15 years) after first intake of 3 mg budesonide (single dose), and again after 1 week of thrice daily dosing (steady-state). The parent drug and cytochrome P450 3A-dependent metabolites were analysed in blood and urine. RESULTS Pharmacokinetic parameters of budesonide following single-dose administration (e.g. AUC(0-infinity) 7.7+/-5.1 h ng/mL, C(max) 1.8+/-1.2 ng/mL) did not change upon multiple dosing. Overall systemic elimination of budesonide reflected by clearance and half-life was not different between children and adults. After 1 week of treatment reversible adrenal suppression was observed - most pronounced in children aged below 12 years. CONCLUSIONS Disposition of oral budesonide appears to be similar between children and adults, but the doctor has to be aware of an increased risk for adrenal suppression in paediatric patients.
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Affiliation(s)
- K Dilger
- Dr Falk Pharma GmbH, Freiburg, Germany
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