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Nenoff P, Reinel D, Mayser P, Abeck D, Bezold G, Bosshard PP, Brasch J, Daeschlein G, Effendy I, Ginter-Hanselmayer G, Gräser Y, Hamm G, Hengge U, Hipler UC, Höger P, Kargl A, Kolb-Mäurer A, Krüger C, Malisiewicz B, Mayer J, Ott H, Paasch U, Schaller M, Uhrlaß S, Zidane M. S1-Leitlinie Onychomykose. J Dtsch Dermatol Ges 2023; 21:678-694. [PMID: 37338845 DOI: 10.1111/ddg.14988_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/04/2022] [Indexed: 06/21/2023]
Affiliation(s)
- Pietro Nenoff
- Labopart - Medizinische Laboratorien, Labor Leipzig-Mölbis, Rötha OT Mölbis, Deutschland
| | | | | | - Dietrich Abeck
- Hautzentrum Nymphenburg [Nymphenburg Skin Center], München, Munich, Germany
| | | | - Philipp P Bosshard
- Dermatologische Klinik, Universitätsspital Zürich, Universität Zürich, Zürich, Schweiz
| | - Jochen Brasch
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Deutschland
| | | | - Isaak Effendy
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum OWL, Campus Klinikum Bielefeld, Universität Bielefeld, Bielefeld, Germany
| | | | - Yvonne Gräser
- Charité - Universitätsmedizin Berlin, Institut für Mikrobiologie und Infektionsimmunologie, Nationales Konsiliarlabor für Dermatophyten, Berlin, Germany
| | - Gudrun Hamm
- Hautarztpraxis Dr. med. Gudrun Hamm, Halle (Saale), Deutschland
| | | | | | - Peter Höger
- Abteilung Pädiatrische Dermatologie und Allergologie, Kath. Kinderkrankenhaus Wilhelmstift, Hamburg, Germany
| | | | - Annette Kolb-Mäurer
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Constanze Krüger
- Labopart - Medizinische Laboratorien, Labor Leipzig-Mölbis, Rötha OT Mölbis, Deutschland
| | - Bartosz Malisiewicz
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | | | - Hagen Ott
- Abteilung für pädiatrische Dermatologie und Allergologie, Kinder- und Jugendkrankenhaus auf der Bult, Hannover, Deutschland
| | - Uwe Paasch
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Martin Schaller
- Universitäts-Hautklinik Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - Silke Uhrlaß
- Labopart - Medizinische Laboratorien, Labor Leipzig-Mölbis, Rötha OT Mölbis, Deutschland
| | - Miriam Zidane
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-Based Medicine (dEBM), Berlin, Deutschland
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Nenoff P, Reinel D, Mayser P, Abeck D, Bezold G, Bosshard PP, Brasch J, Daeschlein G, Effendy I, Ginter-Hanselmayer G, Gräser Y, Hamm G, Hengge U, Hipler UC, Höger P, Kargl A, Kolb-Mäurer A, Krüger C, Malisiewicz B, Mayer J, Ott H, Paasch U, Schaller M, Uhrlaß S, Zidane M. S1 Guideline onychomycosis. J Dtsch Dermatol Ges 2023. [PMID: 37212291 DOI: 10.1111/ddg.14988] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/04/2022] [Indexed: 05/23/2023]
Abstract
Onychomycosis is a fungal infection of the fingernails and toenails. In Europe, tinea unguium is mainly caused by dermatophytes. The diagnostic workup comprises microscopic examination, culture and/or molecular testing (nail scrapings). Local treatment with antifungal nail polish is recommended for mild or moderate nail infections. In case of moderate to severe onychomycosis, oral treatment is recommended (in the absence of contraindications). Treatment should consist of topical and systemic agents. The aim of this update of the German S1 guideline is to simplify the selection and implementation of appropriate diagnostics and treatment. The guideline was based on current international guidelines and the results of a literature review conducted by the experts of the guideline committee. This multidisciplinary committee consisted of representatives from the German Society of Dermatology (DDG), the German-Speaking Mycological Society (DMykG), the Association of German Dermatologists (BVDD), the German Society for Hygiene and Microbiology (DGHM), the German Society of Pediatric and Adolescent Medicine (DGKJ), the Working Group for Pediatric Dermatology (APD) and the German Society for Pediatric Infectious Diseases (DGPI). The Division of Evidence-based Medicine (dEBM) provided methodological assistance. The guideline was approved by the participating medical societies following a comprehensive internal and external review.
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Affiliation(s)
- Pietro Nenoff
- Labopart - Medizinische Laboratorien, Labor Leipzig-Mölbis [Labopart - Medical Laboratories, Laboratory Leipzig-Mölbis], Rötha OT Mölbis, Germany
| | - Dieter Reinel
- Praxis für Dermatologie [Dermatology practice], Hamburg, Germany
| | | | - Dietrich Abeck
- Hautzentrum Nymphenburg [Nymphenburg Skin Center], München, Munich, Germany
| | - Guntram Bezold
- Hautarztpraxis Neu-Ulm [Neu-Ulm dermatology practice], Neu-Ulm, Germany
| | - Philipp P Bosshard
- Dermatologische Klinik, Universitätsspital Zürich, Universität Zürich [Department of Dermatology, University Hospital Zurich, University of Zurich], Zürich, Switzerland
| | - Jochen Brasch
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein Campus Kiel [Department of dermatology, venereology and allergology, Schleswig-Holstein University hospital, Kiel campus], Kiel, Germany
| | - Georg Daeschlein
- Hautklinik, Städtisches Klinikum Dessau [Skin clinic, Dessau City Hospital], Dessau, Germany
| | - Isaak Effendy
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum OWL, Campus Klinikum Bielefeld, Universität Bielefeld [Department of Dermatology, Venereology and Allergology, University Hospital OWL, Campus Bielefeld, University of Bielefeld], Bielefeld, Germany
| | - Gabriele Ginter-Hanselmayer
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz [University department of dermatology and venereology, Graz Medical University], Graz, Austria
| | - Yvonne Gräser
- Charité - Universitätsmedizin Berlin, Institut für Mikrobiologie und Infektionsimmunologie, Nationales Konsiliarlabor für Dermatophyten [Charité - University Medicine Berlin, Institute of Microbiology and Infection Immunology, National consultant lab for dermatophytes], Berlin, Germany
| | - Gudrun Hamm
- Hautarztpraxis Dr. med. Gudrun Hamm [Gudrun Hamm MD dermatology practice], Halle (Saale), Germany
| | - Ulrich Hengge
- Hautzentrum [Skin Center] Prof. Hengge, Düsseldorf, Germany
| | - Uta-Christina Hipler
- Klinik für Hautkrankheiten, Universitätsklinikum Jena [Skin disease clinic, Jena University Hospital], Jena, Germany
| | - Peter Höger
- Abteilung Pädiatrische Dermatologie und Allergologie, Kath. Kinderkrankenhaus Wilhelmstift [Department of Pediatric Dermatology and Allergology, Catholic Children's Hospital Wilhelmstift], Hamburg, Germany
| | - Alexandra Kargl
- Hautärzte am Gasteig, München [Dermatologists am Gasteig, Munich], Germany
| | - Annette Kolb-Mäurer
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg [Department of dermatology, venereology and allergology, Würzburg University Hospital], Würzburg, Germany
| | - Constanze Krüger
- Labopart - Medizinische Laboratorien, Labor Leipzig-Mölbis [Labopart - Medical Laboratories, Laboratory Leipzig-Mölbis], Rötha OT Mölbis, Germany
| | - Bartosz Malisiewicz
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt [Department of dermatology, venereology and allergology, Frankfurt University Hospital], Frankfurt am Main, Germany
| | | | - Hagen Ott
- Abteilung für pädiatrische Dermatologie und Allergologie, Kinder- und Jugendkrankenhaus auf der Bult [Department of dermatology and allergology, Children's and adolescents' hospital auf der Bult], Hannover, Germany
| | - Uwe Paasch
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig [Department of dermatology, venereology and allergology, Leipzig University Hospital], Leipzig, Germany
| | - Martin Schaller
- Universitäts-Hautklinik Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Silke Uhrlaß
- Labopart - Medizinische Laboratorien, Labor Leipzig-Mölbis [Labopart - Medical Laboratories, Laboratory Leipzig-Mölbis], Rötha OT Mölbis, Germany
| | - Miriam Zidane
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Dermatologie, Venerologie und Allergologie [Department of dermatology, venereology and allergology], Division of Evidence-Based Medicine (dEBM), Berlin, Germany
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König A, Kreft H, Hengge U, Braun R, Roelcke D. Coexisting Anti-I and Anti-Fl/Gd Cold Agglutinins in
Infections by Mycoplasma pneumoniae. Vox Sang 2017. [DOI: 10.1159/000461866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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4
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Kourí V, Correa C, Martínez PA, Sanchez L, Alvarez A, González G, Silverio CE, Hondal N, Florin J, Pérez L, Duran DP, Perez Y, Cazorla N, Gonzalez D, Jaime JC, Arencibia A, Sarduy S, Pérez L, Soto Y, González M, Alvarez I, Dorticós E, Marchena JJ, Solar L, Acosta B, Savón C, Hengge U. Prospective, comprehensive, and effective viral monitoring in Cuban children undergoing solid organ transplantation. Springerplus 2014; 3:247. [PMID: 24877035 PMCID: PMC4035497 DOI: 10.1186/2193-1801-3-247] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 05/07/2014] [Indexed: 12/30/2022]
Abstract
PURPOSE In Cuba, viral monitoring in the post-transplant period was not routinely performed. The aim of this research is to identify the most frequent viruses that affect transplanted Cuban children, by implementing a viral follow-up during the post-transplant period. METHODS The study population included all Cuban pediatric patients who underwent solid organ transplantation (SOT) between November 2009 and December 2012. A total of 34 transplanted pediatric patients of kidney (n = 11) and liver (n = 23) were prospectively monitored during a 34-week period for viral DNAemia and DNAuria by simultaneous detection of cytomegalovirus (CMV), Epstein-Barr virus, herpes simplex virus type 1 and 2, varicella zoster virus, human herpesvirus 6, human adenovirus, and polyomaviruses (BKV and JCV) using quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS Viral genome of at least one virus was detected in 21 of 34 recipients, 18 patients excreted virus in urine while 12 presented DNAemia. CMV (41.2%) and BKV (35.3%) were the most frequent viruses detected during the follow-up. CMV was the virus mainly associated with clinical symptoms and DNAemia. Its excretion in urine (with cut off value of 219 copies/mL) was associated with detection in plasma (p < 0.001); furthermore, CMV viruria was predictive of CMV viremia (OR:8.4, CI:2.4-29.1, p = 0.001). There was no association between high viral load and clinical complications, due to the prompt initiation of preemptive ganciclovir. CONCLUSION This comprehensive viral monitoring program effectively prevents the development of critical viral disease, thus urge the implementation of qRT-PCR as routine for viral monitoring of transplanted Cuban organ recipients.
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Affiliation(s)
- Vivian Kourí
- Sexually Transmitted Diseases Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba ; Virology Department, Institute of Tropical Medicine ¨Pedro Kourí¨, Autopista Novia del Mediodia Km 6., La Lisa, Havana City, Cuba
| | - Consuelo Correa
- Sexually Transmitted Diseases Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Pedro A Martínez
- Sexually Transmitted Diseases Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Lizet Sanchez
- Epidemiology and Statistic Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Alina Alvarez
- Sexually Transmitted Diseases Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Grehete González
- Respiratory Viruses Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - César E Silverio
- University Pediatric Hospital "William Soler", Havana City, Cuba
| | - Norma Hondal
- University Pediatric Hospital "William Soler", Havana City, Cuba
| | - Jose Florin
- University Pediatric Hospital of "Centro Habana", Havana City, Cuba
| | - Lourdes Pérez
- University Pediatric Hospital of "Centro Habana", Havana City, Cuba
| | - Diana P Duran
- University Pediatric Hospital of "Centro Habana", Havana City, Cuba
| | - Yardelis Perez
- University Pediatric Hospital of "Centro Habana", Havana City, Cuba
| | - Nancy Cazorla
- University Pediatric Hospital of "Centro Habana", Havana City, Cuba
| | | | - Juan C Jaime
- National Institute of Haematology and Immunology, Havana City, Cuba
| | | | - Sandra Sarduy
- National Institute of Haematology and Immunology, Havana City, Cuba
| | - Lissette Pérez
- Sexually Transmitted Diseases Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Yudira Soto
- Sexually Transmitted Diseases Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Mabel González
- University Pediatric Hospital "William Soler", Havana City, Cuba
| | - Iliana Alvarez
- University Pediatric Hospital "William Soler", Havana City, Cuba
| | - Elvira Dorticós
- National Institute of Haematology and Immunology, Havana City, Cuba
| | - Juan J Marchena
- University Pediatric Hospital of "Centro Habana", Havana City, Cuba
| | - Luis Solar
- University Pediatric Hospital of "Centro Habana", Havana City, Cuba
| | - Belsy Acosta
- Respiratory Viruses Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Clara Savón
- Respiratory Viruses Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
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Ariel MP, Vivian K, Orestes B, Virginia C, Yoandra A, Yoan A, Denis V, Narciso J, Iraida C, Gilberto F, Yaumara U, Odalys C, Alina Á, Hengge U. The Role of Human Herpesvirus 8 Molecular Characterization in the Management of HIV Infected Patients Diagnosed with Malignancies Associated with Its Infection. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/wja.2013.33030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kourí V, Martínez PA, Capó V, Blanco O, Rodríguez ME, Jiménez N, Fleites G, Caballero I, Dovigny MC, Alemán Y, Correa C, Pérez L, Soto Y, Cardellá L, Álvarez A, Nambiar S, Hengge U. Kaposi’s Sarcoma and Human Herpesvirus 8 in Cuba: Evidence of subtype B expansion. Virology 2012; 432:361-9. [DOI: 10.1016/j.virol.2012.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 06/14/2012] [Accepted: 06/16/2012] [Indexed: 11/16/2022]
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Worth C, Heukelbach J, Fengler G, Walter B, Liesenfeld O, Hengge U, Feldmeier H. Acute morbidity associated with scabies and other ectoparasitoses rapidly improves after treatment with ivermectin. Pediatr Dermatol 2012; 29:430-6. [PMID: 22211573 DOI: 10.1111/j.1525-1470.2011.01680.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [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] [Indexed: 11/28/2022]
Abstract
In resource-poor settings, scabies is associated with considerable morbidity. Which factors determine morbidity and how rapidly it recedes after specific treatment is not known. Patients with scabies were recruited in three urban slums in Fortaleza, Northeast Brazil. Diagnosis was established according to dermatoscopy, skin scraping, or adhesive film test. Severity of scabies-associated morbidity was assessed semiquantitatively. Patients and close contacts were treated with oral ivermectin (200 μg/kg, repeated after 7 days) and followed up for 2 weeks. Ninety-five patients were included in the study. Papules were the most common lesion type (98.9%). Excoriations due to scratching were observed in 43.2% and bacterial superinfection in 24.2%. Predilection sites were the arms (82.1%) and the abdomen (81.1%). At baseline, 36.3% of patients complained about intense or severe itching. Intense or severe itch decreased to 6.3% 2 weeks after treatment (p=0.02). Whereas 37.5% of the patients complained about intense or severe itch-related sleep disturbances at baseline, only 8.8% reported the symptom 2 weeks after treatment (p=0.35). At baseline, the degree of itching was correlated with the degree of sleep disturbance (ρ=0.64; p<0.001). One week after the first dose of ivermectin, the intensity of itching and of sleep disturbance decreased significantly (p<0.001). In patients living in resource-poor setting, scabies was associated with considerable morbidity. Treatment with ivermectin rapidly reconstituted health in almost all cases.
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Affiliation(s)
- Christine Worth
- Institute of Microbiology and Hygiene, Charité University Medicine, Berlin, Germany
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8
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Mrowietz U, Adamczyk A, Augustin M, Boehncke W, Bonnekoh B, Gambichler T, Hengge U, Lippert U, Ludwig RJ, Luger T, Merk H, Norgauer J, Philipp S, Reich K, Röcken M, Rostami-Yazdi M, Schön MP, Scola N, Sticherling M, Thaci D, Viehweg A, Wallbrecht K, Wozel G, Zouboulis C, Neureither M. Neue Erkenntnisse zu Fumarsäureestern (Fumaderm®): Ergebnisse eines Experten-Workshops. J Dtsch Dermatol Ges 2011; 9 Suppl 4:1-13. [DOI: 10.1111/j.1610-0379.2011.07765.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Walter B, Heukelbach J, Fengler G, Worth C, Hengge U, Feldmeier H. Comparison of dermoscopy, skin scraping, and the adhesive tape test for the diagnosis of scabies in a resource-poor setting. ACTA ACUST UNITED AC 2011; 147:468-73. [PMID: 21482897 DOI: 10.1001/archdermatol.2011.51] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Scabies is a parasitic skin disease endemic in resource-poor communities in low-income countries. The best ways to diagnose scabies in this setting have not been investigated. OBJECTIVE To compare the diagnostic properties of dermoscopy, the microscopic examination of a skin scraping, and the adhesive tape test in 125 patients with a presumptive diagnosis of scabies. DESIGN A prospective evaluator-blinded study. RESULTS The sensitivity of dermoscopy was 0.83 (95% confidence interval [CI], 0.70-0.94) and significantly higher than the sensitivity of the adhesive tape test (0.68; 95% CI, 0.52-0.81; P < .001). The sensitivity of skin scraping was low (0.46; 95% CI, 0.31-0.62). The specificity of dermoscopy was 0.46 (95% CI, 0.34-0.58); by definition, it was 1.00 for skin scraping and the adhesive tape test. The negative predictive value was identical for dermoscopy and the adhesive tape test (0.85; 95% CI, 0.69-0.94 and 0.75-0.91, respectively) but significantly lower for skin scraping (0.77; 95% CI, 0.67-0.84; P < .001). The sensitivity of dermoscopy increased with the severity of the disease, whereas the sensitivity of the adhesive tape test did not depend on this characteristic. Limitations Because of active case finding, the duration of the infestation was short and the severity of disease was rather low in most patients. The rather short duration of the infestation might have affected the diagnostic properties of each test in different ways. CONCLUSIONS When trained personnel are available, dermoscopy is a valid tool for diagnosing scabies in a resource-poor setting. The adhesive tape test is easy to perform and, because it has high positive and negative predictive values, the test is ideal for screening purposes. Skin scraping cannot be recommended as a diagnostic tool in this setting.
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Affiliation(s)
- Birke Walter
- Institute of Microbiology and Hygiene, Charité Universität Berlin, Campus Benjamin Franklin, Campus Benjamin Franklin, Berlin, Germany
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Kourí V, Martínez PA, Blanco O, Capó V, Rodríguez ME, Dovigny MDC, Cardellá L, Gala A, Jiménez NA, Correa C, Alemán Y, Pérez L, Álvarez A, Hengge U. Simultaneous quantification of human herpesvirus 8 DNA by real time PCR in different tissues of HIV infected cuban patients with Kaposi's sarcoma. Herpesviridae 2010; 1:3. [PMID: 21429238 PMCID: PMC3050434 DOI: 10.1186/2042-4280-1-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 12/07/2010] [Indexed: 11/10/2022]
Abstract
In Cuba, previous reports have shown an increase of epidemic KS, reaching a total of 120 cases by the end of 2007, despite the use of HAART. To evaluate and compare the role of human herpes virus 8 (HHV-8) viral loads in different compartments of AIDS-related Kaposi's sarcoma (AIDS-KS) patients real-time polymerase chain reaction (RT-PCR) was used to determine the genome copy number of HHV-8 in plasma, saliva, tissue and peripheral blood mononuclear cells (PBMC) of 49 AIDS-KS patients. Overall, 98% of AIDS-KS patients harbored detectable HHV-8. HHV-8 could be detected in 91.6% of KS tissue lesions showing the highest viral load (median log = 3.14 copies/100 ng DNA) followed by saliva and PBMC which were positive in 78%, and 69.2%; respectively. In contrast, HHV-8 was detected in only 37% of plasma samples, which also showed lower viral loads. Men who had sex with men (MSM) were more likely to have three-times higher HHV-8 genome copies in KS lesions when compared with tissues from heterosexuals individuals (OR 3; 95% CI 1.1 to 12.5). These results emphasize the systemic nature of HHV-8-infection and demonstrate the possible role of saliva in HHV-8 transmission among MSM.
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Affiliation(s)
- Vivian Kourí
- Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | | | - Orestes Blanco
- Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Virginia Capó
- Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | | | | | | | - Angela Gala
- Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | | | - Consuelo Correa
- Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Yoan Alemán
- Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Lissette Pérez
- Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Alina Álvarez
- Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
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Kourí V, Martínez PA, Blanco O, Capó V, Rodríguez ME, Dovigny MDC, Cardellá L, Gala A, Jiménez NA, Luzardo C, Correa C, Alemán Y, Pérez L, Álvarez A, Hengge U. Kaposi’s sarcoma-associated herpesvirus load in asymptomatic contacts of Cuban epidemic KS patients. Arch Virol 2010; 155:1971-6. [DOI: 10.1007/s00705-010-0788-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Accepted: 08/23/2010] [Indexed: 10/19/2022]
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13
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Hoff NP, Degrandi D, Hengge U, Pfeffer K, Wurthner JU. Carboxypeptidase D: A Novel TGF-β Target Gene Dysregulated in Patients with Lupus Erythematosus. J Clin Immunol 2007; 27:568-79. [PMID: 17641957 DOI: 10.1007/s10875-007-9118-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2007] [Accepted: 06/25/2007] [Indexed: 10/23/2022]
Abstract
Transforming growth factor-beta (TGF-beta) is a multifunctional cytokine that mainly acts as an inhibitor of immune functions. A lack of functional TGF-beta leads to autoimmune disease in animal models and dysregulated TGF-beta signaling is implicated in human autoimmune diseases. To define target genes that play a part in the inhibitory role of TGF-beta in the immune system, we have identified genes stimulated by TGF-beta in macrophages by gene-chip analysis. One of the TGF-beta regulated genes is carboxypeptidase D (CpD), a 180-kDa type I membrane protein. We have demonstrated that CpD is regulated by TGF-beta in various cell types of both, murine and human origin and, interestingly, is significantly downregulated in CD14 positive cells isolated from patients with lupus erythematosus (LE). Moreover, we show that downregulation of CpD leads to downmodulation of TGF-beta itself, suggesting a role for CpD in a positive feedback loop, providing further evidence for a role of this enzyme in LE. To our knowledge, this is the first report that demonstrates carboxypeptidase D as a TGF-beta target gene that is implicated in the pathogenesis of LE.
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Affiliation(s)
- Norman-Philipp Hoff
- Institute for Medical Microbiology, University of Duesseldorf, 40225, Duesseldorf, Germany.
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Affiliation(s)
- J Rieker
- Hautklinik der Heinrich-Heine-Universität, Düsseldorf
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Affiliation(s)
- S Meller
- Hautklinik der Heinrich-Heine-Universität, Moorenstrasse 5, 40225 Düsseldorf, Germany
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Kouri V, González E, Martínez P, Capó V, González R, Pérez L, Cardellá L, Hengge U. R2195 Distinct genotypic distribution of cytomegalovirus (CMV) envelope glycoprotein B in a Cuban cohort of patients with different CMV diseases. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)72034-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kortüm AK, Meller S, Hengge U, Kruse R, Reifenberger J, Bruch-Gerharz D. Pityrosporumfollikulitis (Malasseziafollikulitis). Hautarzt 2006; 57:908-9. [PMID: 16960729 DOI: 10.1007/s00105-006-1212-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A-K Kortüm
- Hautklinik der Heinrich-Heine-Universität, Moorenstrasse 5, 40225 , Düsseldorf, Deutschland
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Schuster-Grussler A, Gerber PA, Hengge U, Neumann NJ, Bruch-Gerharz D. [Juvenile pityriasis rubra pilaris]. Hautarzt 2006; 57:907-8. [PMID: 16960730 DOI: 10.1007/s00105-006-1211-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A Schuster-Grussler
- Hautklinik der Heinrich-Heine-Universität, Moorenstrasse 5, 40225 , Düsseldorf, Deutschland
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19
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Affiliation(s)
- H Dräger
- Hautklinik der Heinrich-Heine-Universität, Düsseldorf
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20
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Affiliation(s)
- E Roller
- Hautklinik der Heinrich-Heine-Universität, Düsseldorf
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21
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22
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Abstract
A 41-year old male patient presented with yellowish papules on the elbows, upper arms, back and the buttocks, as well as yellow streaks in the palmar creases. Laboratory examination revealed Fredrickson type IIb hyperlipidemia. Histologic changes were consistent with eruptive xanthomas. Treatment was started with HMG-CoA reductase inhibitors and dietary measures were taken to lower serum levels of cholesterol and triglycerides. Hyperlipidemia is the cause of eruptive xanthomas and strongly increases the risk of cardiovascular diseases.
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Affiliation(s)
- E Roller
- Hautklinik der Heinrich-Heine-Universität, Düsseldorf
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Abstract
Confluent and reticulated papillomatosis is an uncommon dermatosis of unknown etiology which is often difficult to diagnose. Lesions appear on the mid-trunk and affect mostly young females. We report a 15-year-old girl with typical clinical and histologic features of this rare disorder in whom the lesions rapidly improved after minocycline therapy. Topical treatment with isotretinoin and erythromycin was ineffective.
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Affiliation(s)
- A Wiesenborn
- Hautklinik der Heinrich-Heine-Universität, Düsseldorf
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24
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Abstract
A 36-year-old man presented with a giant congenital melanocytic nevus and multiple disseminated melanocytic nevi. After he had developed neurological symptoms (grand mal seizures), a cerebral metastasis of a malignant melanoma without a primary melanoma was found. The patient was diagnosed as having a neurocutaneous melanosis with a cerebral metastasis. In spite of a variety of therapeutic attempts (surgery, radiation therapy and chemotherapy) he followed a rapidly progressive, lethal course with increased intracranial pressure, hydrocephalus and spinal metastases.
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Affiliation(s)
- U Tartler
- Hautklinik der Heinrich Heine-Universität, Düsseldorf
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25
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26
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Wolf R, Mirmohammadsadegh A, Walz M, Lysa B, Tartler U, Remus R, Hengge U, Michel G, Ruzicka T. Molecular cloning and characterization of alternatively spliced mRNA isoforms from psoriatic skin encoding a novel member of the S100 family. FASEB J 2003; 17:1969-71. [PMID: 12923069 DOI: 10.1096/fj.03-0148fje] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In an effort to identify psoriasis-associated genes, we compared gene expression in normal and psoriatic skin, using differential display RT-PCR technique. Sequence analysis of a 650-bp cDNA fragment (clone 110) that was highly up-regulated in lesional skin revealed homology to a noncoding cDNA (NICE-2). By subsequent cDNA cloning, using RNA from psoriatic skin, we have identified two alternatively spliced mRNA-isoforms (0.5 and 4.4 kb), which differ in composition of their untranslated regions. By sequence comparison, we have mapped the novel gene, named S100A15, to the S100 gene cluster within the epidermal differentiation complex (chromosome 1q21). Analysis of the deduced amino acid sequence revealed a protein of 101 amino acids containing two potential EF-hand motifs with high homology to the S100A7. Northern blot hybridization and semiquantitative RT-PCR analysis confirmed the S100A15 overexpression in psoriasis, showing different levels of expression of the S100A15 mRNA isoforms. In situ hybridization of the S100A15 revealed a markedly increased staining of basal and suprabasal epidermal layers of psoriatic skin compared with healthy tissue. Our data suggest an involvement of the novel S100A15 in epidermal differentiation and inflammation and might therefore be important for the pathogenesis of psoriasis and other diseases.
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Affiliation(s)
- Ronald Wolf
- Department of Dermatology, Heinrich-Heine University Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.
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Pföhler C, Cree IA, Ugurel S, Kuwert C, Haass N, Neuber K, Hengge U, Corrie PG, Zutt M, Tilgen W, Reinhold U. Treosulfan and gemcitabine in metastatic uveal melanoma patients: results of a multicenter feasibility study. Anticancer Drugs 2003; 14:337-40. [PMID: 12782938 DOI: 10.1097/00001813-200306000-00002] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
No effective treatment currently exists for metastatic uveal melanoma. However, recent results obtained by an ATP-based tumor chemosensitivity assay have shown consistent activity of treosulfan+gemcitabine in up to 80% of tumor specimens tested. In this study we describe the first clinical results observed with this drug combination at different European centers in patients with metastatic uveal melanoma. Clinical case series of patients with metastatic uveal melanoma were treated with treosulfan+gemcitabine at seven different centers. Fourteen patients, 13 previously untreated and one pretreated with chemoimmunotherapy, were included in the study. Patients received treosulfan+gemcitabine in four different dose regimens. The response rates, progression-free and overall survival, and toxicity were evaluated. The analysis of 14 patients revealed one complete response, three partial responses and a stable disease in eight cases. The objective response rate was 28.6%, the median overall survival was 61 weeks [95% confidence interval (CI) 54-133 weeks], the progression-free survival was 28.5 weeks (95% CI 13-62 weeks) and the 1-year survival rate was 80%. The drugs were well tolerated. The most common side-effects were leuko- and thrombocytopenia. These preliminary results suggest potential therapeutic benefit of treosulfan+gemcitabine treatment in metastatic uveal melanoma and warrant further controlled studies.
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Affiliation(s)
- Claudia Pföhler
- Saarland University Hospital, Department of Dermatology, Homburg/Saar, Germany.
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Affiliation(s)
- Ulrich Hengge
- Department of Dermatology, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany.
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Affiliation(s)
- Brian Berman
- Dept. of Dermatology and Cutaneous Surgery, School of Medicine, University of Miami, 1600 NW 10th Avenue, Room 2023 A, Miami, FL 33101, USA.
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Geraminejad P, Memar O, Aronson I, Rady PL, Hengge U, Tyring SK. Kaposi's sarcoma and other manifestations of human herpesvirus 8. J Am Acad Dermatol 2002; 47:641-55; quiz 656-8. [PMID: 12399755 DOI: 10.1067/mjd.2002.128383] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
UNLABELLED Kaposi's sarcoma (KS) was described by Moritz Kaposi in 1872 and was known for an entire century as a rare disorder of older men usually of Eastern European, Mediterranean, and/or Jewish origin. In the early 1980s, the prevalence of KS began to increase dramatically and soon became the most common malignancy in patients with AIDS, especially those who were male homosexuals. In 1994, a new human herpesvirus (HHV) was found to be present in almost 100% of KS lesions. This virus was found to be a gammaherpesvirus, closely related to Epstein-Barr virus, and was designated HHV-8. Subsequently, HHV-8 DNA was found in almost all specimens of classic KS, endemic KS, and iatrogenic KS, as well as epidemic KS (ie, AIDS KS). It is now believed that HHV-8 is necessary, but not sufficient, to cause KS and that other factors such as immunosuppression play a major role. The use of highly active antiretroviral therapy (HAART) since 1996 has markedly reduced the prevalence of AIDS KS in western countries, but because 99% of the 40 million patients with AIDS in the world cannot afford HAART, KS is still a very common problem. Primary effusion lymphoma and multicentric Castleman's disease are also thought to be due to HHV-8. Although HHV-8 DNA has been described in a number of other cutaneous disorders, there is little evidence that HHV-8 is of etiologic significance in these diseases. The mechanism by which HHV-8 causes KS, primary effusion lymphoma, and multicentric Castleman's disease is not well understood but is thought to involve a number of molecular events, the study of which should further our understanding of viral oncology. (J Am Acad Dermatol 2002;47:641-55.) LEARNING OBJECTIVE At the completion of this learning activity, participants should be familiar with Kaposi's sarcoma and other manifestations of human herpesvirus 8.
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Hengge U. [The skin as protein factory. Healthy and beautiful with gene cream? (interview by Waltraud Paukstadt)]. MMW Fortschr Med 2001; 143:13. [PMID: 11556181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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32
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Hengge U. [Initial success with topical immunomodulators. A creme for skin cancer? (interview by Renate Jackle)]. MMW Fortschr Med 2001; 143:11. [PMID: 11420824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
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Maschke M, Kastrup O, Esser S, Ross B, Hengge U, Hufnagel A. Incidence and prevalence of neurological disorders associated with HIV since the introduction of highly active antiretroviral therapy (HAART). J Neurol Neurosurg Psychiatry 2000; 69:376-80. [PMID: 10945813 PMCID: PMC1737101 DOI: 10.1136/jnnp.69.3.376] [Citation(s) in RCA: 234] [Impact Index Per Article: 9.8] [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: 11/04/2022]
Abstract
OBJECTIVE To determine the change of incidence and prevalence of neurological disorders caused by the human immunodeficiency virus (HIV) and opportunistic infections in HIV positive patients under treatment since the introduction of highly active antiretroviral therapy (HAART). METHODS The data of all HIV infected patients were retrospectively analysed, who were examined in the HIV outpatients clinic of the neurological department of the University Clinic Essen between 1995 and 1998 (n=563, total number of visits=735). Data from identified patients were divided into two groups according to the time of examination from 1995 to 1996 (334 visits) and from 1997 to 1998 (401 visits). The incidence and prevalence of neurological disorders were statistically compared between both time intervals. RESULTS Significantly more patients received HAART in 1997-8 (p<0. 001) and mean CD4+ cell count was significantly higher in 1997-8 (p<0.001). The prevalence of HIV associated dementia and HIV associated polyneuropathy were significantly lower in 1997-8 (both: p=0.02) and the incidence of toxoplasma encephalitis decreased from 5.7% in 1995-6 to 2.2% in 1997-8 (p=0.015). Based on the small number of patients significant changes in HIV associated myopathy, progressive multifocal leukoencephalopathy, cryptoccocal meningitis, and cytomegalovirus-encephalitis could not be detected. CONCLUSION The prevalence of the most frequent HIV associated neurological disorders and incidence of toxoplasma encephalitis decreased since the introduction of HAART. This may be due to the improvement of immunostatus by HAART as demonstrated by the higher CD4+ cell count in the later time interval. Direct antiretroviral effects within the nervous system may be considered causative as well. The prevalence and incidence of HIV associated neurological disorders and opportunistic CNS infections decreased after introduction of HAART.
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Affiliation(s)
- M Maschke
- Department of Neurology, University Clinic Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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Abstract
In recent years, cutaneous epithelial stem cells have attained a genuine celebrity status. They are considered the key resource for epidermal and skin appendage regeneration, and are proposed as a preferential target of cutaneous gene therapy. Follicular epithelial stem cells may also give rise to a large variety of epithelial tumors, and cutaneous epithelial stem cells likely are crucial targets for physical or chemical agents (including carcinogens) that damage the skin and its appendages. However, as this Controversies feature illustrates, few experts can agree on how exactly to define and identify these elusive cells, or on where precisely in the skin they are localized. Given their potential importance in skin biology, pathology and future dermatological therapy, it is, therefore, timely to carefully reconsider the basic questions: What exactly is a stem cell, and how can we reliably identify epithelial stem cells? How many different kinds are there, and how do they differ functionally? Where exactly in the skin epithelium is each of the putative stem cell subpopulations located, and can we selectively manipulate any of them?
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Affiliation(s)
- G Cotsarelis
- M8 Stellar-Chance Laboratories, Philadelphia, PA 19104, USA.
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Walker PS, Scharton-Kersten T, Rowton ED, Hengge U, Bouloc A, Udey MC, Vogel JC. Genetic immunization with glycoprotein 63 cDNA results in a helper T cell type 1 immune response and protection in a murine model of leishmaniasis. Hum Gene Ther 1998; 9:1899-907. [PMID: 9741428 DOI: 10.1089/hum.1998.9.13-1899] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Genetic immunization is a promising gene therapy approach for the prevention and treatment of infectious disease. Plasmid DNA expressing genes of pathogens is directly introduced into host cells and specific cell-mediated and/or humoral immune responses are elicited against the encoded protein. Leishmaniasis is a significant world-wide health problem for which no vaccine exists. In susceptible animals, such as BALB/c mice, protection from leishmaniasis requires induction of a Thl immune response. In this study, cell-mediated immunity to Leishmania major (L. major) was induced by injecting BALB/c mice intradermally with plasmid DNA expressing the conserved L. major cell surface glycoprotein gp63 (gp63-pcDNA-3). CD4 T lymphocytes from gp63-pcDNA-3-immunized mice proliferated and produced IFN-gamma (but not IL-4) when stimulated in vitro with freeze-thawed parasites, consistent with a Th1 immune response. In contrast, lymphocyte proliferation in animals immunized with freeze-thawed parasites was associated with IL-4 (but not IFN-gamma) production, suggesting a nonprotective Th2 response. Challenge studies revealed that gp63-pcDNA-3 vaccination protected 30% of susceptible mice (21 of 70) from Leishmania infection while neither gp63 protein (0 of 20) nor freeze-thawed parasite vaccines (0 of 50) were efficacious. Dendritic cells derived from skin of gp63-pcDNA-3-injected mice also immunized naive recipients and protected them from leishmaniasis. We conclude that gp63-pcDNA-3 genetic vaccination results in a CD4-dependent Th1 immune response that correlates with protection from disease, and suggest that skin-derived dendritic cells are involved in priming this response.
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MESH Headings
- Adoptive Transfer
- Animals
- Antigens, Protozoan/genetics
- DNA, Complementary/administration & dosage
- Dendritic Cells
- Immunity, Cellular
- Interferon-gamma/blood
- Interleukin-4/blood
- Leishmania major/immunology
- Leishmaniasis, Cutaneous/immunology
- Leishmaniasis, Cutaneous/prevention & control
- Lymphocyte Activation
- Metalloendopeptidases/genetics
- Metalloendopeptidases/immunology
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Protozoan Vaccines/administration & dosage
- Protozoan Vaccines/genetics
- Protozoan Vaccines/immunology
- Skin/immunology
- Th1 Cells/immunology
- Vaccination
- Vaccines, DNA/administration & dosage
- Vaccines, DNA/genetics
- Vaccines, DNA/immunology
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Affiliation(s)
- P S Walker
- Dermatology Branch, NCI, National Institutes of Health, Bethesda, MD 20892, USA
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Pfutzner W, Hengge U, Ye J, Foster RA, Vogel JC. A model to study topical selection of keratinocytes containing the multi-drug resistance gene. J Dermatol Sci 1998. [DOI: 10.1016/s0923-1811(98)83842-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Malessa R, Agelink MW, Hengge U, Mertins L, Gastpar M, Brockmeyer NH. Oligosymptomatic neurosyphilis with false negative CSF-VDRL in HIV-infected individuals? Eur J Med Res 1996; 1:299-302. [PMID: 9367943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The true prevalence of neurosyphilis in HIV-infection is unknown, since a sufficiently sensitive and specific test is lacking. In a prospective study we found reactive serum TPHA and FTA-ABS IgG tests in 95 (31%) of 307 HIV-infected patients. Three of 11 patients with latent syphilis revealed reactive CSF-VDRL tests, six others only demonstrated CSF abnormalities. Resolution of CSF abnormalities during a six month follow up after high dose antibiotic therapy led to the diagnosis of oligosymptomatic or asymptomatic neurosyphilis in all nine patients. Thus, the specificity of the CSF-VDRL was 100%, but the sensitivity was only 33%. The overall prevalence of neurosyphilis was 2.9%, increasing to 9.5% in patients with a reactive serum TPHA. Our study emphasizes the importance of antibiotic therapy for presumptive neurosyphilis in HIV-infected patients with latent syphilis and CSF abnormalities but nonreactive CSF-VDRL tests, even if they are neurologically asymptomatic or present with complaints inconclusive of neurosyphilis.
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Affiliation(s)
- R Malessa
- Department of Neurology, University of Essen, Hufelandstr. 55, Essen D-45147, Germany
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Malessa R, Heimbach M, Brockmeyer NH, Hengge U, Rascher W, Michel MC. Increased neuropeptide Y-like immunoreactivity in cerebrospinal fluid and plasma of human immunodeficiency virus-infected patients: relationship to HIV encephalopathy. J Neurol Sci 1996; 136:154-8. [PMID: 8815163 DOI: 10.1016/0022-510x(95)00305-l] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Neuropeptide Y (NPY) is one of the most abundant and phylogenetically best conserved peptides in the mammalian central and peripheral nervous system where it plays an important role in the regulation of cardiovascular, metabolic, endocrine, immunological and cognitive functions. In a prospective study we determined neuropeptide Y-like immunoreactivity (NPY-LI) in cerebrospinal fluid (CSF) and plasma of 95 HIV-seropositive (n = 49) or seronegative (n = 46) patients who underwent diagnostic CSF examination. CSF and plasma NPY-LI but not noradrenaline concentrations were higher in seropositive than in seronegative patients indicating that raised levels of NPY-LI did not result from a non-specific activation of the sympathetic nervous system. Increased CSF NPY-LI was positively correlated with the degree of HIV encephalopathy (P < 0.01, Kruskal-Wallis test). Inflammatory disorders of the central nervous system and dementia due to other causes in HIV-seronegative patients were not associated with increased CSF NPY-LI. Our data suggest that increased CSF NPY-LI is a relatively specific phenomenon of HIV encephalopathy and may be involved in the pathogenesis of HIV-related neurological dysfunction. The links between retroviral infection and increased expression of neuropeptide Y and their pathophysiological implications remain to be determined.
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Affiliation(s)
- R Malessa
- Department of Neurology, University of Essen, Germany
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Malessa R, Krams M, Hengge U, Weiller C, Reinhardt V, Volbracht L, Rauhut F, Brockmeyer NH. Elevation of intracranial pressure in acute AIDS-related cryptococcal meningitis. Clin Investig 1994; 72:1020-6. [PMID: 7711408 DOI: 10.1007/bf00577748] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Prior to the AIDS-era, elevation of intracranial pressure was known to be a typical complication of cryptococcal meningitis associated with an increased risk of early death. In AIDS-patients, however, the prevalence and clinical significance of this complication are as yet unclear. We analysed clinical features and courses, CSF findings, serological results and neuroimaging scans in acute cryptococcal meningitis in eight patients with AIDS. Five showed symptoms and signs compatible with raised intracranial pressure, which was life-threatening in one and the most probable cause of death in another. Serial monitoring of intracranial pressure together with repeated CSF analysis revealed that severe intracranial pressure elevation in AIDS related cryptococcal meningitis can occur in spite of effective antimycotic treatment, does not depend on an increased CSF/serum osmolality ratio or CSF overproduction and can be associated with normal cranial computed tomography and magnetic resonance imaging findings. Our data support the hypothesis that CSF reabsorption failure plays the crucial role in the pathophysiological mechanism. External lumbar drainage may be of benefit in selected cases of acute AIDS related cryptococcal meningitis with persisting life threatening elevation in intracranial pressure and normal computed tomogram.
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Affiliation(s)
- R Malessa
- Neurologische Klinik, Universitätsklinikum Essen, Germany
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Abstract
The antigens Fl and Vo, recognized by cold agglutinins, are protease-resistant differentiation antigens like I and i antigens. In contrast to Ii, Fl and Vo are sialidase-susceptible antigens like the protease-resistant Gd antigens. Because I/i antigens are branched/linear type-2 (poly-N-acetyllactosamine or neolacto series) chains which are cleaved from red cells by endo-beta-galactosidase, the effect of the enzyme on Fl, Vo and Gd antigens was studied. Fl and Gd antigens, previously shown to be sialylated branched (Fl), and linear and branched (Gd) type-2 sequences, were not inactivated on red cells by the enzyme, whereas Vo antigenicity was completely abolished. The data suggest that Vo antigen is expressed on sialylated linear poly-N-acetyllactosamine sequence.
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Affiliation(s)
- D Roelcke
- Institute of Immunology, University of Heidelberg, FRG
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42
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Roelcke D, Hengge U, Kirschfink M. Neolacto (Type-2 Chain)-Sialoautoantigens Recognized by Human Cold Agglutinins. Vox Sang 1990. [DOI: 10.1159/000461216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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43
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Abstract
192 sera containing cold agglutinins of apparent anti-I specificity were reinvestigated for concomitant cold agglutinins (CA) against sialic acid-dependent antigens. 35 cases of additional anti-F1 and 3 cases of additional anti-Gd were detected. 53% of cases with coexisting anti-I and anti-F1/Gd CA had a clinical diagnosis of pneumonia, in 39% IgM antibodies against Mycoplasma pneumoniae could be demonstrated. Since F1 and Gd antigens are identical with the structures identified as receptors for M. pneumoniae, the findings support the hypothesis that postinfectious CA are directed against the receptor of the infectious agent.
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Affiliation(s)
- A L König
- Institute for Immunology and Serology, University of Heidelberg, FRG
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