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Singh S, Bolz M, Cornelius A, Desvignes L. Intravenous BCG driven antigen recognition in a murine tuberculosis model. Comp Immunol Microbiol Infect Dis 2022; 87:101838. [PMID: 35700556 DOI: 10.1016/j.cimid.2022.101838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/02/2022] [Accepted: 06/04/2022] [Indexed: 10/18/2022]
Abstract
Bacille Calmette-Guerin (BCG) is the only approved vaccine against tuberculosis but the subcutaneous route does not provide for the elimination of Mycobacterium tuberculosis (Mtb), thus highlighting the need for investigating other routes of administration. We used a unique set of 60 peptide pools with unprecedented coverage of the bacterium that had previously been used to study T cell responses in subjects latently infected with Mtb. We showed that intravenous BCG vaccination of C57BL/6 mice elicited a more robust IFN-γ response from splenocytes than the subcutaneous route, with the highest responses driven by the Ag85A/B and PE/PPE family epitopes, followed by TB10.4 and Esx-1. We then compared the spectrum of antigen recognition in BCG-naïve H37Rv-challenged and BCG-vaccinated H37Rv-challenged mice. Peptides belonging to TB10.4, ESAT-6, CFP-10, Ag85A/Ag85B, PE/PPE and Esx families up-regulated IFN-γ production in the lungs of BCG-naïve H37Rv-challenged mice but the response was much lower in the BCG-vaccinated group. Historically, a limited number of Mtb antigens have been used to study T cell responses in TB. The goal of using this 60-peptide assay was to define T cell responses in TB down to the epitope level. We envision that the use of broad antigen panels such as ours in conjunction with studies of bacterial load reduction will help delineate the protective efficacy of 'groups' of antigens.
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Affiliation(s)
- Shivani Singh
- Division of Pulmonary and Critical Care Medicine, USA.
| | - Miriam Bolz
- Division of Infectious Diseases and Immunology, Department of Medicine, USA
| | - Amber Cornelius
- Division of Infectious Diseases and Immunology, Department of Medicine, USA
| | - Ludovic Desvignes
- Division of Infectious Diseases and Immunology, Department of Medicine, USA; Office of Science & Research, New York University Grossman School of Medicine, New York, USA
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Saric J, Bolz M, Waser M, Käser M. The consequences of compromising the EU's free movement of persons principle on Swiss research: how to survive constrained access to regional funding. Health Res Policy Syst 2021; 19:30. [PMID: 33676534 PMCID: PMC7936228 DOI: 10.1186/s12961-021-00684-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/24/2021] [Indexed: 11/25/2022] Open
Abstract
Between 2014 and 2016, Switzerland’s access to some of the EU funding was limited after a referendum against mass immigration was accepted and the country refused to sign the free movement accord to the EU’s newest member, Croatia. It is well documented that Switzerland has suffered from a drop in participation, funding and a decrease in consortium lead positions. However, there is no account of the consequences on institutional level. We therefore aimed at describing the immediate- and longer-term impact of the partial association status to the Swiss Tropical and Public Health Institute (Swiss TPH) and to identify key strategies for minimizing institutional damage during a limited access period to a key regional funding source. A quantitative analysis of the institute’s grants database, from 2007 to 2019, did not show any clear trends related to the partial association status of Switzerland for funding and projects awarded. The qualitative outcomes changed along the timeline assessed; whereas in 2014 a range of negative effects were stated by Swiss TPH researchers, a survey conducted in 2019 with Swiss TPH applicants and project partners to Horizon 2020, revealed that most project leaders felt that the partial association did neither affect their external partners’ willingness to collaborate nor Swiss TPH’s role in the proposal or consortium. On the other hand, the institutional strategic goal of taking on consortia leads was delayed by several years as a direct consequence of the partial association. Also, the exclusion from European research networks and the lack of consultation of expertise by the European partner institutions was widely seen as damaging. A policy of favouring long-term partnerships over ad-hoc collaborations, along with constant and trustful communication, as immediate mitigation measure, helped averting some of the reputational and access damage. Moreover, the Swiss TPH business model based on a three-way strategy of research, education and services has proven highly viable allowing to build a large pool of potential funding sources internationally, resulting in relative resilience in terms of income lost.
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Affiliation(s)
- Jasmina Saric
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4003, Basel, Switzerland.,University of Basel, P.O. Box, CH-4003, Basel, Switzerland
| | - Miriam Bolz
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4003, Basel, Switzerland.,University of Basel, P.O. Box, CH-4003, Basel, Switzerland
| | - Marco Waser
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4003, Basel, Switzerland.,University of Basel, P.O. Box, CH-4003, Basel, Switzerland
| | - Michael Käser
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4003, Basel, Switzerland. .,University of Basel, P.O. Box, CH-4003, Basel, Switzerland.
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Vandelannoote K, Pluschke G, Bolz M, Bratschi MW, Kerber S, Stinear TP, de Jong BC. Introduction of Mycobacterium ulcerans disease in the Bankim Health District of Cameroon follows damming of the Mapé River. PLoS Negl Trop Dis 2020; 14:e0008501. [PMID: 32886658 PMCID: PMC7473558 DOI: 10.1371/journal.pntd.0008501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 01/13/2020] [Accepted: 06/19/2020] [Indexed: 11/18/2022] Open
Abstract
Buruli ulcer (BU) is an emerging ulcerative skin disease caused by infection with Mycobacterium ulcerans. Efforts to control its spread have been hampered by our limited understanding of M. ulcerans reservoirs and transmission, and the factors leading to the emergence of BU disease in a particular region. In this report we investigate an anecdotal link between damming the Mapé River in Cameroon and the emergence of BU in the Health Districts bordering Lake Bankim, the impoundment created by the Mapé dam. We used bacterial population genomics and molecular dating to find compelling support for a 2000 M. ulcerans introduction event that followed about 10 years after the filling of the newly created impoundment in 1988. We compared the genomic reconstructions with high-resolution satellite imagery to investigate what major environmental alterations might have driven the emergence of the new focus.
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Affiliation(s)
- Koen Vandelannoote
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology and Immunology, The University of Melbourne at the Doherty Institute for Infection & Immunity, Melbourne, Australia
| | - Gerd Pluschke
- Molecular Immunology, Swiss Tropical Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Miriam Bolz
- Molecular Immunology, Swiss Tropical Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Martin W. Bratschi
- Molecular Immunology, Swiss Tropical Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sarah Kerber
- Molecular Immunology, Swiss Tropical Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Timothy P. Stinear
- Department of Microbiology and Immunology, The University of Melbourne at the Doherty Institute for Infection & Immunity, Melbourne, Australia
| | - Bouke C. de Jong
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
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Mursch-Edlmayr A, Pickl L, Calzetti G, Waser K, Wendelstein J, Beka S, Aranha dos Santos V, Luft N, Schmetterer L, Bolz M. Comparison of Neurovascular Coupling between Normal Tension Glaucoma Patients and Healthy Individuals with Laser Speckle Flowgraphy. Curr Eye Res 2020; 45:1438-1442. [DOI: 10.1080/02713683.2020.1752390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A.S. Mursch-Edlmayr
- Department for Ophthalmology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - L. Pickl
- Johannes Kepler University, Linz, Austria
| | - G. Calzetti
- Ophthalmology Unit, University Hospital of Parma, Parma, Italy
| | - K. Waser
- Department for Ophthalmology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - J. Wendelstein
- Department for Ophthalmology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - S. Beka
- Department for Ophthalmology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - V. Aranha dos Santos
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - N. Luft
- Department for Ophthalmology, University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - L. Schmetterer
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
| | - M. Bolz
- Department for Ophthalmology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
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Abstract
Approximately 5% of the patients in the ophthalmological practice suffer from non-organic vision loss. In children non-organic vision loss has been observed from the age of 6 years. In order to be able to make a rapid diagnosis knowledge of the relevant clinical tests is decisive. If a patient shows signs of non-organic visual loss, diagnostic externalization of the visual function is crucial. Depending on the symptoms there are various tests, which can be used to differentiate between organic and non-organic disorders. For therapeutic and economic reasons an early diagnosis of a non-organic visual loss is crucial. Ophthalmologists need to differentiate between malingering and augmentation, where the patient is aware of the fraud and tries to gain personal benefit from it, and somatoform disorders. In the latter, a more sensitive approach is recommended.
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Affiliation(s)
| | - D Mojon
- Airport Medical Center Eye Clinic, Zürich, Schweiz
| | - M Bolz
- Kepler Universitätsklinikum Linz, Krankenhausstr. 9, 4020, Linz, Österreich
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Ruf MT, Steffen C, Bolz M, Schmid P, Pluschke G. Infiltrating leukocytes surround early Buruli ulcer lesions, but are unable to reach the mycolactone producing mycobacteria. Virulence 2017; 8:1918-1926. [PMID: 28873327 PMCID: PMC5810495 DOI: 10.1080/21505594.2017.1370530] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Marie-Thérèse Ruf
- a Swiss Tropical and Public Health Institute , Basel , Switzerland.,b University of Basel , Basel , Switzerland
| | - Christina Steffen
- c Department of Surgery , Cairns Hospital , Cairns , QLD , Australia
| | - Miriam Bolz
- a Swiss Tropical and Public Health Institute , Basel , Switzerland.,b University of Basel , Basel , Switzerland
| | - Peter Schmid
- a Swiss Tropical and Public Health Institute , Basel , Switzerland.,b University of Basel , Basel , Switzerland
| | - Gerd Pluschke
- a Swiss Tropical and Public Health Institute , Basel , Switzerland.,b University of Basel , Basel , Switzerland
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Schmidl D, Witkowska K, Luft N, Bolz M, Fondi K, Bata A, Wozniak P, Werkmeister R, Garhofer G, Schmetterer L. Assessment of retinal blood flow using Laser Speckle Flowgraphy. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.01145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- D. Schmidl
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | - K. Witkowska
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | - N. Luft
- Department of Ophthalmology; Kepler University Hospital; Linz Austria
| | - M. Bolz
- Department of Ophthalmology; Kepler University Hospital; Linz Austria
| | - K. Fondi
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | - A. Bata
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | - P. Wozniak
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | - R. Werkmeister
- Center for Medical Physics and Biomedical Engineering; Medical University of Vienna; Vienna Austria
| | - G. Garhofer
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | - L. Schmetterer
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
- Center for Medical Physics and Biomedical Engineering; Medical University of Vienna; Vienna Austria
- Singapore Eye Research Institute; Ocular Imaging; Singapore Singapore
- Nanyang Technological University; Lee Kong Chian School of Medicine; Singapore Singapore
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Schulz S, Legorburu Cladera B, Giraldo B, Bolz M, Bar KJ, Voss A. Neuronal desynchronization as marker of an impaired brain network. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2017:2251-2254. [PMID: 29060345 DOI: 10.1109/embc.2017.8037303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Synchronization is a central key feature of neural information processing and communication between different brain areas. Disturbance of oscillatory brain rhythms and decreased synchronization have been associated with different disorders including schizophrenia. The aim of this study was to investigate whether synchronization (in relaxed conditions with no stimuli) between different brain areas within the delta, theta, alpha (alpha1, alpha2), beta (beta1, beta2), and gamma bands is altered in patients with a neurological disorder in order to generate significant cortical enhancements. To achieve this, we investigated schizophrenic patients (SZO; N=17, 37.5±10.4 years, 15 males) and compared them to healthy subjects (CON; N=21, 36.7±13.4 years, 15 males) applying the phase locking value (PLV). We found significant differences between SZO and CON in different brain areas of the theta, alpha1, beta2 and gamma bands. These areas are related to the central and parietal lobes for the theta band, the parietal lobe for the alpha1, the parietal and frontal for the beta2 and the frontal-central for the gamma band. The gamma band revealed the most significant differences between CON and SZO. PLV were 61.7% higher on average in SZO in most of the clusters when compared to CON. The related brain areas are directly related to cognition skills which are proved to be impaired in SZO. The results of this study suggest that synchronization in SZO is also altered when the patients were not asked to perform a task that requires their cognitive skills (i.e., no stimuli are applied - in contrast to other findings).
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9
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Wozniak P, Luft N, Aschinger G, Fondi K, Bata A, Witkowska K, Schmidl D, Werkmeister R, Bolz M, Garhöfer G, Schmetterer L. The assessment of ocular blood flow with laser speckle flowgraphy in healthy caucasian. Acta Ophthalmol 2016. [DOI: 10.1111/j.1755-3768.2016.0391] [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: 11/27/2022]
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Ruf MT, Bolz M, Vogel M, Bayi PF, Bratschi MW, Sopho GE, Yeboah-Manu D, Um Boock A, Junghanss T, Pluschke G. Spatial Distribution of Mycobacterium ulcerans in Buruli Ulcer Lesions: Implications for Laboratory Diagnosis. PLoS Negl Trop Dis 2016; 10:e0004767. [PMID: 27253422 PMCID: PMC4890796 DOI: 10.1371/journal.pntd.0004767] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/18/2016] [Indexed: 11/16/2022] Open
Abstract
Background Current laboratory diagnosis of Buruli ulcer (BU) is based on microscopic detection of acid fast bacilli, quantitative real-time PCR (qPCR), histopathology or cultivation. Insertion sequence (IS) 2404 qPCR, the most sensitive method, is usually only available at reference laboratories. The only currently available point-of-care test, microscopic detection of acid fast bacilli (AFB), has limited sensitivity and specificity. Methodology/ Principal Findings Here we analyzed AFB positive tissue samples (n = 83) for the presence, distribution and amount of AFB. AFB were nearly exclusively present in the subcutis with large extracellular clusters being most frequently (67%) found in plaque lesions. In ulcerative lesions small clusters and dispersed AFB were more common. Beside this, 151 swab samples from 37 BU patients were analyzed by IS2404 qPCR and ZN staining in parallel. The amount of M. ulcerans DNA in extracts from swabs correlated well with the probability of finding AFB in direct smear microscopy, with 56.1% of the samples being positive in both methods and 43.9% being positive only in qPCR. By analyzing three swabs per patient instead of one, the probability to have at least one positive swab increased from 80.2% to 97.1% for qPCR and from 45% to 66.1% for AFB smear examination. Conclusion / Significance Our data show that M. ulcerans bacteria are primarily located in the subcutis of BU lesions, making the retrieval of the deep subcutis mandatory for examination of tissue samples for AFB. When laboratory diagnosis is based on the recommended less invasive collection of swab samples, analysis of three swabs from different areas of ulcerative lesions instead of one increases the sensitivity of both qPCR and of smear microscopy substantially. Currently, four laboratory methods are available to diagnose Buruli ulcer, a neglected tropical skin disease caused by Mycobacterium ulcerans affecting mainly children in remote rural areas of West Africa. Only one of the four methods, direct microscopic examination of wound exudate for acid fast bacilli, is suitable as point-of-care test. The others, histopathology, culture and IS2404 quantitative PCR, require sophisticated laboratory infrastructure. However, in comparison to the current gold standard, IS2404 quantitative PCR, microscopic smear examination has limited sensitivity. Our results on the distribution of M. ulcerans in Buruli ulcer lesions emphasize that the sensitivity of Buruli ulcer laboratory diagnosis is dependent on optimal sampling procedures. Accurate histopathology crucially depends on tissue samples containing all three skin layers, including the subcutis in which the majority of the bacteria are found. For IS2404 quantitative PCR, culture and direct smear detection, the margin of ulcerative lesions should be sampled at several positions, since bacteria and bacterial DNA are unevenly distributed. With optimized sampling, well-trained laboratory personnel and good microscopy infrastructure, direct smear examination reached a sensitivity of 73%, as compared to IS2404 quantitative PCR.
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Affiliation(s)
- Marie-Thérèse Ruf
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Miriam Bolz
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Moritz Vogel
- Section Clinical Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Pierre F. Bayi
- Fairmed, Bureau Régional pour l’Afrique, B.P. 5807, Yaoundé, Cameroon
| | - Martin W. Bratschi
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Dorothy Yeboah-Manu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Alphonse Um Boock
- Fairmed, Bureau Régional pour l’Afrique, B.P. 5807, Yaoundé, Cameroon
| | - Thomas Junghanss
- Section Clinical Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Gerd Pluschke
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
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Bolz M, Ruggli N, Borel N, Pluschke G, Ruf MT. Local Cellular Immune Responses and Pathogenesis of Buruli Ulcer Lesions in the Experimental Mycobacterium Ulcerans Pig Infection Model. PLoS Negl Trop Dis 2016; 10:e0004678. [PMID: 27128097 PMCID: PMC4851394 DOI: 10.1371/journal.pntd.0004678] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/09/2016] [Indexed: 11/19/2022] Open
Abstract
Background Buruli ulcer is a neglected tropical disease of the skin that is caused by infection with Mycobacterium ulcerans. We recently established an experimental pig (Sus scrofa) infection model for Buruli ulcer to investigate host-pathogen interactions, the efficacy of candidate vaccines and of new treatment options. Methodology/Principal Findings Here we have used the model to study pathogenesis and early host-pathogen interactions in the affected porcine skin upon infection with mycolactone-producing and non-producing M. ulcerans strains. Histopathological analyses of nodular lesions in the porcine skin revealed that six weeks after infection with wild-type M. ulcerans bacteria extracellular acid fast bacilli were surrounded by distinct layers of neutrophils, macrophages and lymphocytes. Upon ulceration, the necrotic tissue containing the major bacterial burden was sloughing off, leading to the loss of most of the mycobacteria. Compared to wild-type M. ulcerans bacteria, toxin-deficient mutants caused an increased granulomatous cellular infiltration without massive tissue necrosis, and only smaller clusters of acid fast bacilli. Conclusions/Significance In summary, the present study shows that the pathogenesis and early immune response to M. ulcerans infection in the pig is very well reflecting BU disease in humans, making the pig infection model an excellent tool for the profiling of new therapeutic and prophylactic interventions. Buruli ulcer is a necrotizing ulcerative disease of the skin and underlying tissue caused by infection with Mycobacterium ulcerans. Because patients often present late to health facilities, early stages of Buruli ulcer are only insufficiently described by histopathology. To study early host-pathogen interactions, we recently established an experimental pig infection model for Buruli ulcer. Here we used the model to study the pathogenesis and the local cellular immune responses upon infection with mycolactone-producing and non-producing M. ulcerans strains. Infection with toxin-producing bacteria led to the development of nodular lesions six weeks after infection, in which extracellular clumps of acid fast bacilli were surrounded by distinct layers of leukocytes. Ulceration of the nodular lesions subsequently led to the loss of most of the bacterial burden. In contrast, after infection with toxin-deficient M. ulcerans bacteria increased granulomatous cellular infiltration was observed, and massive tissue necrosis was absent. Pathogenesis as well as early immune responses to M. ulcerans infection in the pig is very well reflecting the human disease, making it a good model for the evaluation of the efficacy of new treatment options and candidate vaccines.
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Affiliation(s)
- Miriam Bolz
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicolas Ruggli
- Institute of Virology and Immunology (IVI), Mittelhäusern, Switzerland
| | - Nicole Borel
- Institute of Veterinary Pathology, University of Zurich, Vetsuisse Faculty, Zurich, Switzerland
| | - Gerd Pluschke
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
| | - Marie-Thérèse Ruf
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Bieri R, Bolz M, Ruf MT, Pluschke G. Interferon-γ Is a Crucial Activator of Early Host Immune Defense against Mycobacterium ulcerans Infection in Mice. PLoS Negl Trop Dis 2016; 10:e0004450. [PMID: 26863011 PMCID: PMC4749296 DOI: 10.1371/journal.pntd.0004450] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 10/22/2015] [Accepted: 01/21/2016] [Indexed: 12/13/2022] Open
Abstract
Buruli ulcer (BU), caused by infection with Mycobacterium ulcerans, is a chronic necrotizing human skin disease associated with the production of the cytotoxic macrolide exotoxin mycolactone. Despite extensive research, the type of immune responses elicited against this pathogen and the effector functions conferring protection against BU are not yet fully understood. While histopathological analyses of advanced BU lesions have demonstrated a mainly extracellular localization of the toxin producing acid fast bacilli, there is growing evidence for an early intra-macrophage growth phase of M. ulcerans. This has led us to investigate whether interferon-γ might play an important role in containing M. ulcerans infections. In an experimental Buruli ulcer mouse model we found that interferon-γ is indeed a critical regulator of early host immune defense against M. ulcerans infections. Interferon-γ knockout mice displayed a faster progression of the infection compared to wild-type mice. This accelerated progression was reflected in faster and more extensive tissue necrosis and oedema formation, as well as in a significantly higher bacterial burden after five weeks of infection, indicating that mice lacking interferon-γ have a reduced capacity to kill intracellular bacilli during the early intra-macrophage growth phase of M. ulcerans. This data demonstrates a prominent role of interferon-γ in early defense against M. ulcerans infection and supports the view that concepts for vaccine development against tuberculosis may also be valid for BU. Mycobacterium ulcerans is the causative agent of Buruli ulcer (BU), a slow progressing ulcerative skin disease. The mode of transmission of M. ulcerans remains unknown and only little is known about the early stages of the disease and the nature of protective immune responses against this pathogen. Given the increasing evidence for an early intracellular growth phase of M. ulcerans, we aimed at evaluating the impact of cell-mediated immunity for immunological defense against M. ulcerans infections. By comparing wild-type and interferon-γ-deficient mice in a BU mouse model, we could demonstrate that interferon-γ is a critical regulator of early host immune defense against M. ulcerans infections, indicative for an important role of early intracellular multiplication of the pathogen. In mice lacking interferon-γ the bacterial burden increased faster, resulting in accelerated pathogenesis. The observed differences between the two mouse strains were most likely due to differences in the capacity of macrophages to kill intracellular bacilli during the early stages of infection.
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Affiliation(s)
- Raphael Bieri
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Miriam Bolz
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Marie-Thérèse Ruf
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Gerd Pluschke
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
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Bolz M, Bénard A, Dreyer AM, Kerber S, Vettiger A, Oehlmann W, Singh M, Duthie MS, Pluschke G. Vaccination with the Surface Proteins MUL_2232 and MUL_3720 of Mycobacterium ulcerans Induces Antibodies but Fails to Provide Protection against Buruli Ulcer. PLoS Negl Trop Dis 2016; 10:e0004431. [PMID: 26849213 PMCID: PMC4746116 DOI: 10.1371/journal.pntd.0004431] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/13/2016] [Indexed: 12/29/2022] Open
Abstract
Background Buruli ulcer, caused by infection with Mycobacterium ulcerans, is a chronic ulcerative neglected tropical disease of the skin and subcutaneous tissue that is most prevalent in West African countries. M. ulcerans produces a cytotoxic macrolide exotoxin called mycolactone, which causes extensive necrosis of infected subcutaneous tissue and the development of characteristic ulcerative lesions with undermined edges. While cellular immune responses are expected to play a key role against early intracellular stages of M. ulcerans in macrophages, antibody mediated protection might be of major relevance against advanced stages, where bacilli are predominantly found as extracellular clusters. Methodology/Principal Findings To assess whether vaccine induced antibodies against surface antigens of M. ulcerans can protect against Buruli ulcer we formulated two surface vaccine candidate antigens, MUL_2232 and MUL_3720, as recombinant proteins with the synthetic Toll-like receptor 4 agonist glucopyranosyl lipid adjuvant-stable emulsion. The candidate vaccines elicited strong antibody responses without a strong bias towards a TH1 type cellular response, as indicated by the IgG2a to IgG1 ratio. Despite the cross-reactivity of the induced antibodies with the native antigens, no significant protection was observed against progression of an experimental M. ulcerans infection in a mouse footpad challenge model. Conclusions Even though vaccine-induced antibodies have the potential to opsonise the extracellular bacilli they do not have a protective effect since infiltrating phagocytes might be killed by mycolactone before reaching the bacteria, as indicated by lack of viable infiltrates in the necrotic infection foci. Buruli ulcer is a slow progressing ulcerative disease of the skin and subcutaneous tissue that is most prevalent in West African rural communities. Mycobacterium ulcerans, the causative agent of the disease, produces a toxin called mycolactone, which is held responsible for the extensive tissue damage seen in advanced Buruli ulcer lesions. To date, no effective vaccine against the disease exists and it is unclear to what extent antibodies against cell surface antigens of M. ulcerans play a role in protection. To assess whether vaccine induced antibodies against cell surface proteins can protect against Buruli ulcer, we formulated two surface vaccine candidate antigens, MUL_2232 and MUL_3720, as adjuvanted recombinant proteins and investigated their protective potential in a mouse model of M. ulcerans infection. Despite the induction of strong antibody responses against the surface molecules and cross-reactivity of the induced antibodies with the antigens in their native context, we did not observe protection against the disease. While the vaccine-induced antibodies could opsonize the extracellular bacilli, infiltrating phagocytes might be killed early by mycolactone.
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Affiliation(s)
- Miriam Bolz
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Angèle Bénard
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Anita M. Dreyer
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sarah Kerber
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Andrea Vettiger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | | | - Gerd Pluschke
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
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Stubert J, Kleber T, Bolz M, Külz T, Richter DU, Reimer T. Solubles Endoglin, Serum Amyloid A, Progranulin, Transthyretin, CRP und Interleukin 6 in der Prädiktion von Präeklampsie und IUGR bei Patientinnen mit pathologischem Dopplerfluss der uterinen Arterien: eine prospektive Kohortenanalyse. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566680] [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: 10/22/2022]
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15
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Bolz M, Junghanß C, Gerber B. Paroxysmale nächtliche Hämoglobinurie (PNH) und Schwangerschaft – Kasuistik und Literaturübersicht. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566604] [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: 10/22/2022]
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16
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Schöpa FL, Bolz M, Krammer-Steiner B, Gerber B. Non-Hodgkin-Lymphom und Schwangerschaft. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566620] [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: 10/22/2022]
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Vogel M, Bayi PF, Ruf MT, Bratschi MW, Bolz M, Um Boock A, Zwahlen M, Pluschke G, Junghanss T. Local Heat Application for the Treatment of Buruli Ulcer: Results of a Phase II Open Label Single Center Non Comparative Clinical Trial. Clin Infect Dis 2015; 62:342-350. [PMID: 26486698 PMCID: PMC4706634 DOI: 10.1093/cid/civ883] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 06/23/2015] [Accepted: 10/03/2015] [Indexed: 12/02/2022] Open
Abstract
Buruli ulcer (BU) is a necrotizing skin disease. Local thermotherapy is a highly effective, simple, cheap and safe treatment. It has in particular potential as home-based remedy for BU suspicious lesions at community level where laboratory confirmation is not available. Background. Buruli ulcer (BU) is a necrotizing skin disease most prevalent among West African children. The causative organism, Mycobacterium ulcerans, is sensitive to temperatures above 37°C. We investigated the safety and efficacy of a local heat application device based on phase change material. Methods. In a phase II open label single center noncomparative clinical trial (ISRCTN 72102977) under GCP standards in Cameroon, laboratory confirmed BU patients received up to 8 weeks of heat treatment. We assessed efficacy based on the endpoints ‘absence of clinical BU specific features’ or ‘wound closure’ within 6 months (“primary cure”), and ‘absence of clinical recurrence within 24 month’ (“definite cure”). Results. Of 53 patients 51 (96%) had ulcerative disease. 62% were classified as World Health Organization category II, 19% each as category I and III. The average lesion size was 45 cm2. Within 6 months after completion of heat treatment 92.4% (49 of 53, 95% confidence interval [CI], 81.8% to 98.0%) achieved cure of their primary lesion. At 24 months follow-up 83.7% (41 of 49, 95% CI, 70.3% to 92.7%) of patients with primary cure remained free of recurrence. Heat treatment was well tolerated; adverse effects were occasional mild local skin reactions. Conclusions. Local thermotherapy is a highly effective, simple, cheap and safe treatment for M. ulcerans disease. It has in particular potential as home-based remedy for BU suspicious lesions at community level where laboratory confirmation is not available. Clinical Trials Registration. ISRCT 72102977.
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Affiliation(s)
- Moritz Vogel
- Section Clinical Tropical Medicine, Department of Infectious Diseases, Heidelberg University Hospital, Germany
| | - Pierre F Bayi
- FAIRMED, Bureau Régional pour l'Afrique, Yaoundé, Cameroon
| | - Marie-Thérèse Ruf
- Swiss Tropical and Public Health Institute
- University of Basel, Basel
| | - Martin W Bratschi
- Swiss Tropical and Public Health Institute
- University of Basel, Basel
| | - Miriam Bolz
- Swiss Tropical and Public Health Institute
- University of Basel, Basel
| | | | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Gerd Pluschke
- Swiss Tropical and Public Health Institute
- University of Basel, Basel
| | - Thomas Junghanss
- Section Clinical Tropical Medicine, Department of Infectious Diseases, Heidelberg University Hospital, Germany
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Bolz M, Bratschi MW, Kerber S, Minyem JC, Um Boock A, Vogel M, Bayi PF, Junghanss T, Brites D, Harris SR, Parkhill J, Pluschke G, Lamelas Cabello A. Locally Confined Clonal Complexes of Mycobacterium ulcerans in Two Buruli Ulcer Endemic Regions of Cameroon. PLoS Negl Trop Dis 2015; 9:e0003802. [PMID: 26046531 PMCID: PMC4457821 DOI: 10.1371/journal.pntd.0003802] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/29/2015] [Indexed: 12/02/2022] Open
Abstract
Background Mycobacterium ulcerans is the causative agent of the necrotizing skin disease Buruli ulcer (BU), which has been reported from over 30 countries worldwide. The majority of notified patients come from West African countries, such as Côte d’Ivoire, Ghana, Benin and Cameroon. All clinical isolates of M. ulcerans from these countries are closely related and their genomes differ only in a limited number of single nucleotide polymorphisms (SNPs). Methodology/Principal Findings We performed a molecular epidemiological study with clinical isolates from patients from two distinct BU endemic regions of Cameroon, the Nyong and the Mapé river basins. Whole genome sequencing of the M. ulcerans strains from these two BU endemic areas revealed the presence of two phylogenetically distinct clonal complexes. The strains from the Nyong river basin were genetically more diverse and less closely related to the M. ulcerans strain circulating in Ghana and Benin than the strains causing BU in the Mapé river basin. Conclusions Our comparative genomic analysis revealed that M. ulcerans clones diversify locally by the accumulation of SNPs. Case isolates coming from more recently emerging BU endemic areas, such as the Mapé river basin, may be less diverse than populations from longer standing disease foci, such as the Nyong river basin. Exchange of strains between distinct endemic areas seems to be rare and local clonal complexes can be easily distinguished by whole genome sequencing. Buruli ulcer (BU) is a progressively necrotizing disease of the skin, caused by infection with Mycobacterium ulcerans. BU occurs very focally with highest incidence in West Africa. The mode of transmission and the nature and role of potential environmental reservoirs are currently not entirely understood. In this study we sequenced whole genomes of sets of M. ulcerans case isolates from two BU endemic regions in Cameroon. We identified two distinct phylogenetic lineages, which directly correlated with the two endemic regions. Furthermore, we showed that the genetic diversity of M. ulcerans is higher in the older endemic region of Cameroon (Nyong river basin) compared to the more recently emerged infection focus in the same country (Mapé river basin). Together, our results demonstrate that M. ulcerans is developing local clonal complexes by the accumulation of single nucleotide polymorphisms (SNPs) and that these complexes often remain confined to individual endemic foci. The gene encoding for rpoB, which is known to harbour drug resistance mutations against rifampicin in M. tuberculosis, was not affected by SNPs in any of the analysed M. ulcerans strains.
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Affiliation(s)
- Miriam Bolz
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Martin W. Bratschi
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sarah Kerber
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jacques C. Minyem
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- FAIRMED, Yaoundé, Cameroon
| | | | - Moritz Vogel
- Section Clinical Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Thomas Junghanss
- Section Clinical Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Daniela Brites
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Simon R. Harris
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Julian Parkhill
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Gerd Pluschke
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
| | - Araceli Lamelas Cabello
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Stubert J, Kleber T, Richter DU, Bolz M, Külz T, Reimer T. Stellenwert neuer Serummarker für die Prädiktion von Präeklampsie und fetaler Wachstumsrestriktion an einem Hochrisikokollektiv – eine prospektive Kohortenstudie. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1548676] [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: 10/23/2022] Open
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20
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Kleber T, Richter DU, Bolz M, Külz T, Reimer T, Stubert J. Solubles Endoglin in der Prädiktion schwangerschaftsassoziierter Erkrankungen bei Risikopatientinnen im zweiten Trimenon – eine prospektive Kohortenstudie. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1548697] [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: 10/23/2022] Open
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21
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Dreyer A, Röltgen K, Dangy JP, Ruf MT, Scherr N, Bolz M, Tobias NJ, Moes C, Vettiger A, Stinear TP, Pluschke G. Identification of the Mycobacterium ulcerans protein MUL_3720 as a promising target for the development of a diagnostic test for Buruli ulcer. PLoS Negl Trop Dis 2015; 9:e0003477. [PMID: 25668636 PMCID: PMC4344477 DOI: 10.1371/journal.pntd.0003477] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 12/13/2014] [Indexed: 11/29/2022] Open
Abstract
Buruli ulcer (BU) caused by Mycobacterium ulcerans is a devastating skin disease, occurring mainly in remote West African communities with poor access to health care. Early case detection and subsequent antibiotic treatment are essential to counteract the progression of the characteristic chronic ulcerative lesions. Since the accuracy of clinical BU diagnosis is limited, laboratory reconfirmation is crucial. However, currently available diagnostic techniques with sufficient sensitivity and specificity require infrastructure and resources only accessible at a few reference centres in the African endemic countries. Hence, the development of a simple, rapid, sensitive and specific point-of-care diagnostic tool is one of the major research priorities for BU. In this study, we have identified a previously unknown M. ulcerans protein, MUL_3720, as a promising target for antigen capture-based detection assays. We show that MUL_3720 is highly expressed by M. ulcerans and has no orthologs in other prevalent pathogenic mycobacteria. We generated a panel of anti-MUL_3720 antibodies and used them to confirm a cell wall location for MUL_3720. These antibodies could also specifically detect M. ulcerans in infected human tissue samples as well as in lysates of infected mouse footpads. A bacterial 2-hybrid screen suggested a potential role for MUL_3720 in cell wall biosynthesis pathways. Finally, we demonstrate that a combination of MUL_3720 specific antibody reagents in a sandwich-ELISA format has sufficient sensitivity to make them suitable for the development of antigen capture-based diagnostic tests for BU. According to the recommendations of the World Health Organization, the clinical diagnosis of BU should be reconfirmed by at least two laboratory techniques. However, out of the four currently available tests, three (PCR, histopathology and cultivation of M. ulcerans) can only be performed at centralized reference laboratories; the fourth (microscopic detection of acid fast bacilli) lacks the required sensitivity and specificity. Therefore, a simple tool for early diagnosis of the disease, which can be implemented in rural health care facilities of the endemic countries, is of urgent need. In this study we aimed at the identification of M. ulcerans proteins as potential targets for the development of a simple and rapid diagnostic antigen detection assay. Among 36 proteins, MUL_3720 best met the predefined criteria of being highly expressed by M. ulcerans and not having orthologs in other pathogenic mycobacterial species prevalent in the endemic regions. Here we generated monoclonal and polyclonal antibodies against this protein and carried out pilot studies for the development of an antigen capture-based diagnostic test.
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Affiliation(s)
- Anita Dreyer
- Swiss Tropical and Public Health Institute, Molecular Immunology, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Katharina Röltgen
- Swiss Tropical and Public Health Institute, Molecular Immunology, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jean Pierre Dangy
- Swiss Tropical and Public Health Institute, Molecular Immunology, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Marie Thérèse Ruf
- Swiss Tropical and Public Health Institute, Molecular Immunology, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Scherr
- Swiss Tropical and Public Health Institute, Molecular Immunology, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Miriam Bolz
- Swiss Tropical and Public Health Institute, Molecular Immunology, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicholas Jay Tobias
- Department of Microbiology and Immunology, University of Melbourne, Parkville, Australia
| | - Charles Moes
- Swiss Tropical and Public Health Institute, Molecular Immunology, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Andrea Vettiger
- Swiss Tropical and Public Health Institute, Molecular Immunology, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Timothy Paul Stinear
- Department of Microbiology and Immunology, University of Melbourne, Parkville, Australia
| | - Gerd Pluschke
- Swiss Tropical and Public Health Institute, Molecular Immunology, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
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Schneider D, Radloff S, Müller S, Möller D, Bolz M, Briese V. Analysis of Infants Based on Data from the German Perinatal Survey of the Years 1994-2011 in Mecklenburg-Pomerania, Germany. Classification of Infants with regard to their Gestation Duration and Birth Weight. Z Geburtshilfe Neonatol 2014; 219:93-8. [PMID: 25525815 DOI: 10.1055/s-0034-1383584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The demographic change in -Germany describes an ongoing process of population development of which the eastern German states tend to be more affected. These ongoing changes have an influence on the reproductive behavior of the population. After twenty-three years of German reunification, the present study has investigated the question to what extent the somatic classification of newborns in Mecklenburg-Pomerania (M-P), Germany, is affected. MATERIAL AND METHODS Newborn singleton births (n=174,084) were classified from the existing data of the German Perinatal Survey between 1994 and 2011. The rate of premature birth, SGA, and LGA rate as well as the rate of low birth weight ≤2,499 g were determined both gender-dependently and independently. In addition, a combined analysis of the rates has been taken into account. The obtained data material from M-P made it possible for the first time to compare by values. National and international reference studies were considered in this comparison. RESULTS In M-P, the premature birth rate is 5.2%; the rate of newborns with low birth weight ≤ 2,499 g is 4.4%. Among newborns of ≤2,499 g and SGA newborns, girls compose a higher percentage (4.7%, 12.5%) compared to boys (4.0%, 7.4%). The premature birth rate and LGA newborns appear conversely. For these, the percentage of boys (5.6%, 12.6%) is higher than that of girls (4.8%, 7.0%). 60.6% of the gender non-specific newborns ≤2,499 g are simultaneously premature newborn infants. Only a very small percentage of 0.5% of SGA newborns is at the same time premature infants and newborns with low birth weight. CONCLUSIONS By getting nationwide country-specific figures, a detailed analysis of the newborns in M-P can be performed. The analysis supports the existing national values and is a helpful addition for practice-oriented advice.
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Affiliation(s)
- D Schneider
- Department of Oral and Maxillofacial Surgery, HELIOS Hospital Schwerin, Schwerin, Germany
| | - S Radloff
- Department of Obstetrics and Gynaecology, University of Rostock, Rostock, Germany
| | - S Müller
- Department of Obstetrics and Gynaecology, University of Rostock, Rostock, Germany
| | - D Möller
- Department of Obstetrics and Gynaecology, University of Rostock, Rostock, Germany
| | - M Bolz
- Department of Obstetrics and Gynaecology, University of Rostock, Rostock, Germany
| | - V Briese
- Department of Obstetrics and Gynaecology, University of Rostock, Rostock, Germany
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Bratschi MW, Bolz M, Grize L, Kerber S, Minyem JC, Um Boock A, Yeboah-Manu D, Ruf MT, Pluschke G. Primary cultivation: factors affecting contamination and Mycobacterium ulcerans growth after long turnover time of clinical specimens. BMC Infect Dis 2014; 14:636. [PMID: 25433390 PMCID: PMC4264541 DOI: 10.1186/s12879-014-0636-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 11/18/2014] [Indexed: 12/03/2022] Open
Abstract
Background While cultivation of pathogens represents a foundational diagnostic approach in the study of infectious diseases, its value for the confirmation of clinical diagnosis of Buruli ulcer is limited by the fact that colonies of Mycobacterium ulcerans appear only after about eight weeks of incubation at 30°C. However, for molecular epidemiological and drug sensitivity studies, primary isolation of M. ulcerans remains an essential tool. Since for most of the remote Buruli ulcer endemic regions of Africa cultivation laboratories are not easily accessible, samples from lesions often have to be stored for extended periods of time prior to processing. The objective of the current study therefore was to determine which transport medium, decontamination method or other factors decrease the contamination rate and increase the chance of primary isolation of M. ulcerans bacilli after long turnover time. Methods Swab and fine needle aspirate (FNA) samples for the primary cultivation were collected from clinically confirmed Buruli ulcer patients in the Mapé Basin of Cameroon. The samples were either stored in the semi-solid transport media 7H9 or Amies or dry for extended period of time prior to processing. In the laboratory, four decontamination methods and two inoculation media were evaluated and statistical methods applied to identify factors that decrease culture contamination and factors that increase the probability of M. ulcerans recovery. Results The analysis showed: i) that the use of moist transport media significantly increased the recovery rate of M. ulcerans compared to samples kept dry; ii) that the choice of the decontamination method had no significant effect on the chance of M. ulcerans isolation; and iii) that Löwenstein-Jensen supplemented with antibiotics as inoculation medium yielded the best results. We further found that, ten extra days between sampling and inoculation lead to a relative decrease in the isolation rate of M. ulcerans by nearly 20%. Finally, collection and processing of multiple samples per patient was found to significantly increase the M. ulcerans isolation rate. Conclusions Based on our analysis we suggest a procedure suitable for the primary isolation of M. ulcerans strains from patients following long delay between sample collection and processing to establish a M. ulcerans strain collection for research purposes. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0636-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Martin W Bratschi
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Miriam Bolz
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Leticia Grize
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Sarah Kerber
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Jacques C Minyem
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,FAIRMED Africa Regional Office, Yaoundé, Cameroon.
| | | | - Dorothy Yeboah-Manu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana.
| | - Marie-Thérèse Ruf
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Gerd Pluschke
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
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Bolz M, Ruggli N, Ruf MT, Ricklin ME, Zimmer G, Pluschke G. Experimental infection of the pig with Mycobacterium ulcerans: a novel model for studying the pathogenesis of Buruli ulcer disease. PLoS Negl Trop Dis 2014; 8:e2968. [PMID: 25010421 PMCID: PMC4091941 DOI: 10.1371/journal.pntd.0002968] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 05/31/2014] [Indexed: 12/04/2022] Open
Abstract
Background Buruli ulcer (BU) is a slowly progressing, necrotising disease of the skin caused by infection with Mycobacterium ulcerans. Non-ulcerative manifestations are nodules, plaques and oedema, which may progress to ulceration of large parts of the skin. Histopathologically, BU is characterized by coagulative necrosis, fat cell ghosts, epidermal hyperplasia, clusters of extracellular acid fast bacilli (AFB) in the subcutaneous tissue and lack of major inflammatory infiltration. The mode of transmission of BU is not clear and there is only limited information on the early pathogenesis of the disease available. Methodology/Principal Findings For evaluating the potential of the pig as experimental infection model for BU, we infected pigs subcutaneously with different doses of M. ulcerans. The infected skin sites were excised 2.5 or 6.5 weeks after infection and processed for histopathological analysis. With doses of 2×107 and 2×106 colony forming units (CFU) we observed the development of nodular lesions that subsequently progressed to ulcerative or plaque-like lesions. At lower inoculation doses signs of infection found after 2.5 weeks had spontaneously resolved at 6.5 weeks. The observed macroscopic and histopathological changes closely resembled those found in M. ulcerans disease in humans. Conclusion/Significance Our results demonstrate that the pig can be infected with M. ulcerans. Productive infection leads to the development of lesions that closely resemble human BU lesions. The pig infection model therefore has great potential for studying the early pathogenesis of BU and for the development of new therapeutic and prophylactic interventions. Buruli ulcer caused by Mycobacterium ulcerans infection is a necrotizing disease of the skin and the underlying subcutaneous tissue. Since the skin of pigs (Sus scrofa) has striking structural and physiological similarities with human skin, we investigated whether it is possible to develop an experimental M. ulcerans infection model by subcutaneous injection of the mycobacteria into pig skin. Injection of 2×106 or 2×107 colony forming units of M. ulcerans led to the development of lesions that were both macroscopically and microscopically very similar to human Buruli ulcer lesions. In particular for the characterization of the pathogenesis of Buruli ulcer and of immune defence mechanisms against M. ulcerans, the pig model appears to be superior to the mouse foot pad model commonly used for the evaluation of the efficacy of chemotherapeutic regimens.
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Affiliation(s)
- Miriam Bolz
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicolas Ruggli
- Institute of Virology and Immunology (IVI), Mittelhäusern, Switzerland
| | - Marie-Thérèse Ruf
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Meret E. Ricklin
- Institute of Virology and Immunology (IVI), Mittelhäusern, Switzerland
| | - Gert Zimmer
- Institute of Virology and Immunology (IVI), Mittelhäusern, Switzerland
| | - Gerd Pluschke
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
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Röltgen K, Bratschi MW, Ross A, Aboagye SY, Ampah KA, Bolz M, Andreoli A, Pritchard J, Minyem JC, Noumen D, Koka E, Um Boock A, Yeboah-Manu D, Pluschke G. Late onset of the serological response against the 18 kDa small heat shock protein of Mycobacterium ulcerans in children. PLoS Negl Trop Dis 2014; 8:e2904. [PMID: 24853088 PMCID: PMC4031220 DOI: 10.1371/journal.pntd.0002904] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 04/14/2014] [Indexed: 11/18/2022] Open
Abstract
A previous survey for clinical cases of Buruli ulcer (BU) in the Mapé Basin of Cameroon suggested that, compared to older age groups, very young children may be less exposed to Mycobacterium ulcerans. Here we determined serum IgG titres against the 18 kDa small heat shock protein (shsp) of M. ulcerans in 875 individuals living in the BU endemic river basins of the Mapé in Cameroon and the Densu in Ghana. While none of the sera collected from children below the age of four contained significant amounts of 18 kDa shsp specific antibodies, the majority of sera had high IgG titres against the Plasmodium falciparum merozoite surface protein 1 (MSP-1). These data suggest that exposure to M. ulcerans increases at an age which coincides with the children moving further away from their homes and having more intense environmental contact, including exposure to water bodies at the periphery of their villages. Although M. ulcerans, the causative agent of Buruli ulcer (BU), was identified in 1948, its transmission pathways and environmental reservoirs remain poorly understood. The occurrence of M. ulcerans infections in endemic countries in West and Central Africa is highly focal and associated with stagnant and slow flowing water bodies. BU is often described as a disease mainly affecting children <15 years of age. However, taking the population age distribution into account, our recent longitudinal survey for BU in the Mapé Dam Region of Cameroon revealed that clinical cases of BU among children <5 years are relatively rare. In accordance with these findings, data of the present sero-epidemiological study indicate that children <4 years old are less exposed to M. ulcerans than older children. Sero-conversion is associated with age, which may be due to age-related changes in behavioural factors, such as a wider movement radius of older children, including more frequent contact with water bodies at the periphery of their villages.
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Affiliation(s)
- Katharina Röltgen
- Swiss Tropical and Public Health Institute, Molecular Immunology, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Martin W. Bratschi
- Swiss Tropical and Public Health Institute, Molecular Immunology, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Amanda Ross
- Swiss Tropical and Public Health Institute, Molecular Immunology, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Samuel Y. Aboagye
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Kobina A. Ampah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Miriam Bolz
- Swiss Tropical and Public Health Institute, Molecular Immunology, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Arianna Andreoli
- Swiss Tropical and Public Health Institute, Molecular Immunology, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - James Pritchard
- Swiss Tropical and Public Health Institute, Molecular Immunology, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jacques C. Minyem
- Swiss Tropical and Public Health Institute, Molecular Immunology, Basel, Switzerland
- FAIRMED, Yaoundé, Cameron
| | | | - Eric Koka
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | | | - Dorothy Yeboah-Manu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Gerd Pluschke
- Swiss Tropical and Public Health Institute, Molecular Immunology, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
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Schneider D, Radloff S, Bolz M, Briese V. Analysis of infants based on data from the German Perinatal Survey of the years 1994-2011 in Mecklenburg-Pomerania, Germany: new percentile values for anthropometric measures of infants. Z Geburtshilfe Neonatol 2014; 218:74-9. [PMID: 24788836 DOI: 10.1055/s-0034-1368697] [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: 10/25/2022]
Abstract
BACKGROUND This communication presents precise percentile values for birth weight, birth length and cranial circumference of infants in Mecklenburg-Pomerania, Germany. MATERIAL AND METHODS Based on data from the German Perinatal Survey of the years 1994-2011 in Mecklenburg-Pomerania, the 3rd, 10th, 25th, 50th, 75th, 90th and 97th percentile values for birth weight, birth length and head circumference are specified. The measurements of a total of 174,084 infants from non-multiple births are shown. RESULTS The statistically calculated percentile values are presented in tabular and graph forms. The mean birth weight of the infants was 3,437.8 g. The average age of the mothers was 27.9 years. The average duration of pregnancy was 39.4 complete weeks. CONCLUSIONS The insights gained from many years of data collection are presented as standardised, regional percentile values and curves for Mecklenburg-Pomerania for the first time. The differentiated presentation for the federal state opens the possibility for individually tailored consultations in clinical practice and may provide support for recognised national curves for these values.
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Affiliation(s)
- D Schneider
- HELIOS Hospital Schwerin, Oral and Maxillofacial Surgery, Schwerin, Germany
| | - S Radloff
- Maxillo-facial surgery, Partnership Dr. Tödtmann & Dr. Herzog, Rostock, Germany
| | - M Bolz
- Obstetrics and Gynaecology, University Rostock, Rostock, Germany
| | - V Briese
- Obstetrics and Gynaecology, University Rostock, Rostock, Germany
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Ullmann S, Stubert J, Bolz M, Külz T, Grabow D, Richter DU, Briese V, Gerber B, Reimer T. Prädiktion schwangerschaftsassoziierter Erkrankungen durch sFlt-1 und PlGF in einem Risikokollektiv. Geburtshilfe Frauenheilkd 2013. [DOI: 10.1055/s-0033-1347705] [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: 10/26/2022] Open
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Bolz M, Körber S, Schober HC. TSH-sezernierendes Hypophysenadenom (TSHom) - seltene Ursache einer Hyperthyreose in der Schwangerschaft. Dtsch Med Wochenschr 2013; 138:362-6. [DOI: 10.1055/s-0032-1332921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M. Bolz
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock
| | - S. Körber
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock
| | - H.-C. Schober
- Klinik für Innere Medizin I am Klinikum Südstadt Rostock
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Führer A, Bolz M, Hofmann J. [Hantavirus infection due to Dobrava-Belgrade virus in a third trimester pregnant woman]. Dtsch Med Wochenschr 2012; 137:2369-72. [PMID: 23132155 DOI: 10.1055/s-0032-1327261] [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: 10/27/2022]
Abstract
HISTORY AND ADMISSION FINDINGS A 20-year-old woman was admitted to our hospital because of acute renal failure. She was pregnant in the third trimester. She reported on nausea, feeling of sickness, vomiting, abdominal pain and consecutively gross hematuria and sinustachycardia. Under suspicion of premature labour the patient was admitted to an external hospital. An antibiotic therapy with intravenous ampicillin/sulbactam was initiated. Because of acute kidney injury the patient was transferred firstly to the university women's hospital and finally to the department of nephrology. Obesity, the clinical signs of pregnancy, dehydration and small edema of the lower legs were the main medical findings on examination. INVESTIGATIONS Laboratory tests revealed hyperuricemia, virological tests detected an acute infection with Dobrava-Belgrade virus. The ultrasonography demonstrated a pregnancy in good condition and a dilated (physiological) renal pelvis but otherwise normal renal morphology. DIAGNOSIS, TREATMENT AND COURSE A Hantavirus associated acute kidney failure due to infection with the Dobrava-Belgrade virus was diagnosed. The course of the acute renal failure was characterised by remission of all symptoms. Intermittent evaluation by an obstetrician and a nephrologist were done to diagnose maternal and/or fetal complications. A renal replacement therapy was not necessary. At the 41st week of gestation a healthy male infant was born. The development of the newborn was age-appropriate. CONCLUSION Hantavirus infections should be considered in cases of pregnancy-associated acute kidney injury.
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Affiliation(s)
- A Führer
- Zentrum für Innere Medizin, Universitätsmedizin Rostock, Medizinische Klinik II, Sektion für Nephrologie.
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Bratschi MW, Njih Tabah E, Bolz M, Stucki D, Borrell S, Gagneux S, Noumen-Djeunga B, Junghanss T, Um Boock A, Pluschke G. A case of cutaneous tuberculosis in a Buruli ulcer-endemic area. PLoS Negl Trop Dis 2012; 6:e1751. [PMID: 22953005 PMCID: PMC3429378 DOI: 10.1371/journal.pntd.0001751] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Martin W. Bratschi
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Earnest Njih Tabah
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- National Committee for Leprosy, Buruli Ulcer, Yaws and Leishmaniasis Control, Department of Disease Control, Ministry of Public Health, Yaoundé, Cameroon
| | - Miriam Bolz
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - David Stucki
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sonia Borrell
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sebastien Gagneux
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | | | - Gerd Pluschke
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
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Abstract
This paper provides an overview of premenstrual dysphoric disorder (PMDD) and its clinical relevance in differentiation to premenstrual syndrome (PMS). Regarding recent research on epidemiology, aetiology, symptoms and therapy, PMDD is a discrete disorder and has a good prognosis in cases of appropriate diagnosis and therapy. The information provided in this review will help to better integrate PMDD into the psychiatric diagnostic process; options for diagnosis and treatment are also presented.
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Affiliation(s)
- D Passow
- Forensisch Psychiatrischer Dienst, Klinik für Affektive Erkrankungen und Allgemeinpsychiatrie ZH Ost, Psychiatrische Universitätsklinik Zürich, Zürich, Schweiz.
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Wang L, Chopp M, Szalad A, Liu Z, Bolz M, Alvarez FM, Lu M, Zhang L, Cui Y, Zhang RL, Zhang ZG. Phosphodiesterase-5 is a therapeutic target for peripheral neuropathy in diabetic mice. Neuroscience 2011; 193:399-410. [PMID: 21820491 DOI: 10.1016/j.neuroscience.2011.07.039] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 06/17/2011] [Accepted: 07/19/2011] [Indexed: 12/16/2022]
Abstract
Peripheral neuropathy is a common and major complication of diabetes, the underlying mechanisms of which are not fully understood. Using a mouse model of type II diabetes, the present study investigated the role of phosphodiesterase-5 (PDE5) in peripheral neuropathy. BKS.Cg-m+/+Leprdb/J (db/db) mice were treated with sildenafil, a specific inhibitor of PDE5, at doses of 2 and 10 mg/kg or saline. Levels of PDE5 and morphometric parameters in sciatic nerve tissue as well as the motor and sensory function were measured in these mice. In diabetic mice, PDE5 expression in sciatic nerve tissue was significantly upregulated, whereas the myelin sheath thickness, myelin basic protein (MBP), and subcutaneous nerve fibers were significantly reduced. Treatment with sildenafil significantly improved neurological function, assayed by motor and sensory conducting velocities and thermal and mechanical noxious stimuli, concomitantly with increases in myelin sheath thickness, MBP levels, and subcutaneous nerve fibers. In vitro, hyperglycemia upregulated PDE5 in Schwann cells and reduced Schwann cell proliferation, migration, and expression of brain-derived neurotrophic factor (BDNF). Blockage of PDE5 with sildenafil increased cyclic guanosine monophosphate (cGMP) and completely abolished the effect of hyperglycemia on Schwann cells. Sildenafil upregulated cGMP-dependent protein kinase G I (PKGI), whereas inhibition of PKGI with a PKG inhibitor, KT5823, suppressed the inhibitory effect of sildenafil on Schwann cells. These data indicate that hyperglycemia substantially upregulates PDE5 expression and that the cGMP/PKG signaling pathway activated by sildenafil mediates the beneficial effects of sildenafil on diabetic peripheral neuropathy.
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Affiliation(s)
- L Wang
- Department of Neurology, Henry Ford Health Sciences Center, 2799 W. Grand Boulevard, Detroit, MI 48202, USA
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Bolz M, Streppel M, Guntinas-Lichius O. Stellenwert der Notfallambulanz einer Universitäts-HNO-Klinik für die ambulante Patienten-Versorgung. Laryngorhinootologie 2010; 90:17-22. [DOI: 10.1055/s-0030-1267224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ritter M, Bolz M, Haidinger M, Deák G, Sacu S, Säemann M, Schmidt-Erfurth U. Functional and morphological macular abnormalities in membranoproliferative glomerulonephritis type II. Br J Ophthalmol 2010; 94:1112-4. [PMID: 20679091 DOI: 10.1136/bjo.2009.159475] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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35
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Dieterich M, Bolz M, Reimer T, Costagliola S, Gerber B. Two different entities of spontaneous ovarian hyperstimulation in a woman with FSH receptor mutation. Reprod Biomed Online 2010; 20:751-8. [PMID: 20378412 DOI: 10.1016/j.rbmo.2010.02.017] [Citation(s) in RCA: 19] [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] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Revised: 11/05/2009] [Accepted: 01/18/2010] [Indexed: 11/16/2022]
Abstract
Spontaneous ovarian hyperstimulation syndrome (OHSS) is an extremely rare event. Normally OHSS is seen in the context of IVF. In 2003 a mutation of the FSH receptor (FSHR D567N) was identified for the first time as a cause of spontaneous OHSS. In most FSHR mutations, a hypersensitivity to human chorionic gonadotrophin (HCG) or thyroid-stimulating hormone (TSH) is described. This clinical case presents for the first time two occurrences of spontaneous OHSS in a single woman with a FSHR mutation and two different entities. Pathophysiology of both pregnancies was completely different. During the first pregnancy, elevated HCG and androgen concentrations led to spontaneous OHSS and finally to miscarriage. The second pregnancy with spontaneous OHSS was dominated by a latent hypothyroidism and normal HCG concentrations and ended in a delivery of a healthy female newborn. Due to the unusual courses of the pregnancies, the study looked for a mutation in the FSHR and surprisingly identified the same mutation previously described. This report confirms for the first time the in-vitro findings in a single clinical case that TSH as well as HCG leads to spontaneous OHSS in patients with FSHR D567N mutation. Hypothyroidism has to be treated or ruled out.
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Affiliation(s)
- M Dieterich
- Department of Obstetrics and Gynecology, University of Rostock, Suedring 81, 18055 Rostock, Germany.
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36
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Reuss R, Rommer PS, Bruck W, Paul F, Bolz M, Jarius S, Boettcher T, Grossmann A, Bock A, Zipp F, Benecke R, Zettl UK. A woman with acute myelopathy in pregnancy: case progression. West J Med 2009. [DOI: 10.1136/bmj.b4025] [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: 11/04/2022]
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Reuss R, Rommer PS, Bruck W, Paul F, Bolz M, Jarius S, Boettcher T, Grossmann A, Bock A, Zipp F, Benecke R, Zettl UK. A woman with acute myelopathy in pregnancy: case presentation. West J Med 2009. [DOI: 10.1136/bmj.b3862] [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: 11/04/2022]
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38
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Fritzsche C, Loebermann M, Aepinus C, Bolz M, Barten M, Reisinger EC. Vaginal ulceration and local lymphadenopathy in an African immigrant. Clin Infect Dis 2009; 48:441-2, 493-4. [PMID: 19586377 DOI: 10.1086/596473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- C Fritzsche
- Division of Tropical Medicine and Infectious Diseases, Department of Medicine, University of Rostock Medical School, Rostock, Germany
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39
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Bolz M, Simader C, Ritter M, Ahlers C, Benesch T, Prünte C, Schmidt-Erfurth U. Morphological and functional analysis of the loading regimen with intravitreal ranibizumab in neovascular age-related macular degeneration. Br J Ophthalmol 2009; 94:185-9. [PMID: 19692384 DOI: 10.1136/bjo.2008.143974] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To quantify and correlate the morphological and functional effects of the recommended loading regimen with intravitreal ranibizumab in neovascular age-related macular degeneration (AMD). METHODS In a prospective, interventional clinical trial, 29 consecutive patients (29 eyes) with choroidal neovascularisation secondary to AMD received three initial monthly intravitreal injections of ranibizumab. During this loading regimen, best corrected visual acuity (BCVA) and microperimetry (MP) testing, as well as optical coherence tomography and fluorescein angiography (FA), were performed using a standardised protocol and the results correlated. RESULTS Significant morphological and functional therapeutic effects were observed as early as 1 week following the first treatment. Throughout the loading-dose period, central retinal thickness, including intraretinal cysts and subretinal fluid, decreased fast and significantly (p<0.01); pigment epithelial detachment resolved less rapidly. The mean leakage area by FA decreased (p<0.01) and retinal function (BCVA and MP) increased significantly (both p<0.01). However, the change in morphology and function was only significant between baseline and week 1. There was no significant additional morphological or functional benefit following the second and third injection. CONCLUSION The initial administration of intravitreal ranibizumab in neovascular AMD induced a significant effect on intra- and subretinal fluid and visual function; subsequent injections had a less pronounced effect. It remains to be determined whether this loading regimen should be mandatory in all patients or if a single dose regimen would lead to a comparable functional and morphological retinal improvement.
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Affiliation(s)
- M Bolz
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
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40
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Fritzsche C, Loebermann M, Aepinus C, Bolz M, Barten M, Reisinger E. Vaginal Ulceration and Local Lymphadenopathy in an African Immigrant. Clin Infect Dis 2009. [DOI: 10.1086/596474] [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: 11/03/2022] Open
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41
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Bolz M. [Individual and interdisciplinary treatment of rheumatic diseases in pregnancy]. Dtsch Med Wochenschr 2008; 133:2415. [PMID: 18988135 DOI: 10.1055/s-0028-1100934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- M Bolz
- Universitätsfrauenklinik und Poliklinik, Klinikum Südstadt der Hansestadt Rostock, Südring 81, 18059 Rostock.
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Jordan K, Bolz M, Rudolph S, Gerber B. Postoperative Schmerztherapie nach Sectio caesarea: Vergleich von zwei Therapieregimen – Eine 2-armige kontrollierte randomisierte Studie der Universitätsfrauenklinik Rostock. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1088939] [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: 10/19/2022] Open
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43
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Dieterich M, Bolz M, Costagliola S, Gerber B. FSH-Rezeptor Mutation als Ursache für spontanes Überstimmulationssyndrom mit Abortinduktion und erfolgreicher 2. Schwangerschaft – Fallbericht einer erfolgreichen Schwangerschaft nach vorausgegangener Abortinduktion bei spontanem OHSS III in der 15 SSW. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089332] [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: 10/19/2022] Open
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44
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Bolz M, Ritter M, Polak K, Ahlers C, Hirn C, Prünte C, Golbaz I, Benesch T, Schmidt-Erfurth U. Die Rolle des Stratus-OCT bei der Anti-VEGF-Therapie. Ophthalmologe 2008; 105:650-5. [DOI: 10.1007/s00347-007-1639-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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45
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Dieterich M, Bolz M, Gerber B. Spontanes ovarielles Überstimulationssyndrom (OHSS) bei einer 26-jährigen Nullipara in der 12. Schwangerschaftswoche – Kasuistik und Literaturübersicht. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-988675] [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: 10/21/2022] Open
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46
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Uhlemann M, Evert S, Bolz M, Briese V, Külz T, Plath C, Haffner D. Outcome bei Kindern mit fetofetalem Transfusionssyndrom –2 Fallberichte. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-983252] [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: 10/21/2022]
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47
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Jordan K, Kringel U, Bolz M, Gerber B. Extrauteringravidität im Omentum majus- ein Fallbericht. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952616] [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: 10/20/2022] Open
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48
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Körber S, Bolz M, Briese V, Hampel R, Gerber B. Untersuchungen zur Jodidversorgung in der Einlings- und Mehrlingsschwangerschaft. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952428] [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: 10/20/2022] Open
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49
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Gerber B, Bolz M, Kringel U, Janni W. [Gynecological and obstetric aspects of general practice]. MMW Fortschr Med 2006; 148:23-7. [PMID: 16526335 DOI: 10.1007/bf03364550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The general practitioner called upon to provide medical care to the older woman for diseases other than gynecological or obstetric illness, should not neglect to recommend gynecological cancer screening, which is of particular importance in this group. In many differential diagnoses, the general practitioner must also give consideration to gynecological-obstetric aspects. Thus, for example, when a patient presents with lower abdominal pain, gynecological pathology must always be taken into account. Numerous preparations with differing actions and applications used in contraception or hormone therapy in the post-menopausal woman, require individual counseling by the gynecologist.
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Affiliation(s)
- B Gerber
- Director Klinik und Poliklinik für Frauenheilkunde der Universität Rostock.
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50
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Prinz A, Bolz M, Findl O. Advantage of three dimensional animated teaching over traditional surgical videos for teaching ophthalmic surgery: a randomised study. Br J Ophthalmol 2005; 89:1495-9. [PMID: 16234460 PMCID: PMC1772942 DOI: 10.1136/bjo.2005.075077] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [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: 11/04/2022]
Abstract
BACKGROUND/AIM Owing to the complex topographical aspects of ophthalmic surgery, teaching with conventional surgical videos has led to a poor understanding among medical students. A novel multimedia three dimensional (3D) computer animated program, called "Ophthalmic Operation Vienna" has been developed, where surgical videos are accompanied by 3D animated sequences of all surgical steps for five operations. The aim of the study was to assess the effect of 3D animations on the understanding of cataract and glaucoma surgery among medical students. METHOD Set in the Medical University of Vienna, Department of Ophthalmology, 172 students were randomised into two groups: a 3D group (n=90), that saw the 3D animations and video sequences, and a control group (n=82), that saw only the surgical videos. The narrated text was identical for both groups. After the presentation, students were questioned and tested using multiple choice questions. RESULTS Students in the 3D group found the interactive multimedia teaching methods to be a valuable supplement to the conventional surgical videos. The 3D group outperformed the control group not only in topographical understanding by 16% (p<0.0001), but also in theoretical understanding by 7% (p<0.003). Women in the 3D group gained most by 19% over the control group (p<0.0001). CONCLUSIONS The use of 3D animations lead to a better understanding of difficult surgical topics among medical students, especially for female users. Gender related benefits of using multimedia should be further explored.
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Affiliation(s)
- A Prinz
- Department of Ophthalmology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Wien, Austria.
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