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Pfeffer T, Krug SM, Kracke T, Schürfeld R, Colbatzky F, Kirschner P, Medert R, Freichel M, Schumacher D, Bartosova M, Zarogiannis SG, Muckenthaler MU, Altamura S, Pezer S, Volk N, Schwab C, Duensing S, Fleming T, Heidenreich E, Zschocke J, Hell R, Poschet G, Schmitt CP, Peters V. Knock-out of dipeptidase CN2 in human proximal tubular cells disrupts dipeptide and amino acid homeostasis and para- and transcellular solute transport. Acta Physiol (Oxf) 2024; 240:e14126. [PMID: 38517248 DOI: 10.1111/apha.14126] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/23/2024]
Abstract
AIM Although of potential biomedical relevance, dipeptide metabolism has hardly been studied. We found the dipeptidase carnosinase-2 (CN2) to be abundant in human proximal tubules, which regulate water and solute homeostasis. We therefore hypothesized, that CN2 has a key metabolic role, impacting proximal tubular transport function. METHODS A knockout of the CN2 gene (CNDP2-KO) was generated in human proximal tubule cells and characterized by metabolomics, RNA-seq analysis, paracellular permeability analysis and ion transport. RESULTS CNDP2-KO in human proximal tubule cells resulted in the accumulation of cellular dipeptides, reduction of amino acids and imbalance of related metabolic pathways, and of energy supply. RNA-seq analyses indicated altered protein metabolism and ion transport. Detailed functional studies demonstrated lower CNDP2-KO cell viability and proliferation, and altered ion and macromolecule transport via trans- and paracellular pathways. Regulatory and transport protein abundance was disturbed, either as a consequence of the metabolic imbalance or the resulting functional disequilibrium. CONCLUSION CN2 function has a major impact on intracellular amino acid and dipeptide metabolism and is essential for key metabolic and regulatory functions of proximal tubular cells. These findings deserve in vivo analysis of the relevance of CN2 for nephron function and regulation of body homeostasis.
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Affiliation(s)
- Tilman Pfeffer
- Medical Faculty Heidelberg, Center for Pediatric and Adolescent Medicine, Department I, Division of Pediatric Neurology and Metabolic Medicine, Heidelberg University, Heidelberg, Germany
- Tissue Bank of the German Center for Infection Research (DZIF), Partner Site Heidelberg, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Susanne M Krug
- Clinical Physiology/Nutritional Medicine, Charité-Universitätsmedizin Berlin, CBF, Berlin, Germany
| | - Tamara Kracke
- Medical Faculty Heidelberg, Center for Pediatric and Adolescent Medicine, Department I, Division of Pediatric Neurology and Metabolic Medicine, Heidelberg University, Heidelberg, Germany
| | - Robin Schürfeld
- Medical Faculty Heidelberg, Center for Pediatric and Adolescent Medicine, Department I, Division of Pediatric Neurology and Metabolic Medicine, Heidelberg University, Heidelberg, Germany
| | - Florian Colbatzky
- Medical Faculty Heidelberg, Center for Pediatric and Adolescent Medicine, Department I, Division of Pediatric Neurology and Metabolic Medicine, Heidelberg University, Heidelberg, Germany
| | - Philip Kirschner
- Medical Faculty Heidelberg, Center for Pediatric and Adolescent Medicine, Department I, Division of Pediatric Neurology and Metabolic Medicine, Heidelberg University, Heidelberg, Germany
| | - Rebekka Medert
- Institute of Pharmacology, Heidelberg University, Heidelberg, Germany
| | - Marc Freichel
- Institute of Pharmacology, Heidelberg University, Heidelberg, Germany
| | - Dagmar Schumacher
- Institute of Pharmacology, Heidelberg University, Heidelberg, Germany
| | - Maria Bartosova
- Medical Faculty Heidelberg, Center for Pediatric and Adolescent Medicine, Department I, Division of Pediatric Neurology and Metabolic Medicine, Heidelberg University, Heidelberg, Germany
| | - Sotiris G Zarogiannis
- Medical Faculty Heidelberg, Center for Pediatric and Adolescent Medicine, Department I, Division of Pediatric Neurology and Metabolic Medicine, Heidelberg University, Heidelberg, Germany
| | - Martina U Muckenthaler
- Department of Pediatric Oncology, Hematology and Immunology and Hopp Children Cancer Center (KiTZ), University Hospital Heidelberg, Heidelberg, Germany
- Molecular Medicine Partnership Unit (MMPU), EMBL and University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Sandro Altamura
- Department of Pediatric Oncology, Hematology and Immunology and Hopp Children Cancer Center (KiTZ), University Hospital Heidelberg, Heidelberg, Germany
- Molecular Medicine Partnership Unit (MMPU), EMBL and University of Heidelberg, Heidelberg, Germany
| | - Silvia Pezer
- Medical Faculty Heidelberg, Center for Pediatric and Adolescent Medicine, Department I, Division of Pediatric Neurology and Metabolic Medicine, Heidelberg University, Heidelberg, Germany
| | - Nadine Volk
- Tissue Bank of the National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Constantin Schwab
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Duensing
- Department of Urology, University Hospital Heidelberg and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Thomas Fleming
- Internal Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
| | - Elena Heidenreich
- Centre for Organismal Studies (COS), University of Heidelberg, Heidelberg, Germany
| | - Johannes Zschocke
- Institute of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria
| | - Rüdiger Hell
- Centre for Organismal Studies (COS), University of Heidelberg, Heidelberg, Germany
| | - Gernot Poschet
- Centre for Organismal Studies (COS), University of Heidelberg, Heidelberg, Germany
| | - Claus P Schmitt
- Medical Faculty Heidelberg, Center for Pediatric and Adolescent Medicine, Department I, Division of Pediatric Neurology and Metabolic Medicine, Heidelberg University, Heidelberg, Germany
| | - Verena Peters
- Medical Faculty Heidelberg, Center for Pediatric and Adolescent Medicine, Department I, Division of Pediatric Neurology and Metabolic Medicine, Heidelberg University, Heidelberg, Germany
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Große-Segerath L, Follert P, Behnke K, Ettich J, Buschmann T, Kirschner P, Hartwig S, Lehr S, Korf-Klingebiel M, Eberhard D, Lehwald-Tywuschik N, Al-Hasani H, Knoefel WT, Heinrich S, Levkau B, Wollert KC, Scheller J, Lammert E. Identification of myeloid-derived growth factor as a mechanically-induced, growth-promoting angiocrine signal for human hepatocytes. Nat Commun 2024; 15:1076. [PMID: 38316785 PMCID: PMC10844291 DOI: 10.1038/s41467-024-44760-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 01/02/2024] [Indexed: 02/07/2024] Open
Abstract
Recently, we have shown that after partial hepatectomy (PHx), an increased hepatic blood flow initiates liver growth in mice by vasodilation and mechanically-triggered release of angiocrine signals. Here, we use mass spectrometry to identify a mechanically-induced angiocrine signal in human hepatic endothelial cells, that is, myeloid-derived growth factor (MYDGF). We show that it induces proliferation and promotes survival of primary human hepatocytes derived from different donors in two-dimensional cell culture, via activation of mitogen-activated protein kinase (MAPK) and signal transducer and activator of transcription 3 (STAT3). MYDGF also enhances proliferation of human hepatocytes in three-dimensional organoids. In vivo, genetic deletion of MYDGF decreases hepatocyte proliferation in the regenerating mouse liver after PHx; conversely, adeno-associated viral delivery of MYDGF increases hepatocyte proliferation and MAPK signaling after PHx. We conclude that MYDGF represents a mechanically-induced angiocrine signal and that it triggers growth of, and provides protection to, primary mouse and human hepatocytes.
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Affiliation(s)
- Linda Große-Segerath
- Heinrich Heine University Düsseldorf, Faculty of Mathematics and Natural Sciences, Institute of Metabolic Physiology, 40225, Düsseldorf, Germany
- Institute for Vascular and Islet Cell Biology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, 40225, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), Helmholtz Zentrum München, 85764, Neuherberg, Germany
| | - Paula Follert
- Heinrich Heine University Düsseldorf, Faculty of Mathematics and Natural Sciences, Institute of Metabolic Physiology, 40225, Düsseldorf, Germany
| | - Kristina Behnke
- Institute of Biochemistry and Molecular Biology II, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225, Düsseldorf, Germany
| | - Julia Ettich
- Institute of Biochemistry and Molecular Biology II, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225, Düsseldorf, Germany
| | - Tobias Buschmann
- Institute for Molecular Medicine III, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225, Düsseldorf, Germany
| | - Philip Kirschner
- Heinrich Heine University Düsseldorf, Faculty of Mathematics and Natural Sciences, Institute of Metabolic Physiology, 40225, Düsseldorf, Germany
| | - Sonja Hartwig
- German Center for Diabetes Research (DZD e.V.), Helmholtz Zentrum München, 85764, Neuherberg, Germany
- Institute for Clinical Biochemistry and Pathobiochemistry, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, Medical Faculty, 40225, Düsseldorf, Germany
| | - Stefan Lehr
- German Center for Diabetes Research (DZD e.V.), Helmholtz Zentrum München, 85764, Neuherberg, Germany
- Institute for Clinical Biochemistry and Pathobiochemistry, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, Medical Faculty, 40225, Düsseldorf, Germany
| | - Mortimer Korf-Klingebiel
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, 30625, Hannover, Germany
| | - Daniel Eberhard
- Heinrich Heine University Düsseldorf, Faculty of Mathematics and Natural Sciences, Institute of Metabolic Physiology, 40225, Düsseldorf, Germany
| | - Nadja Lehwald-Tywuschik
- Department of General, Visceral, Thorax and Pediatric Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225, Düsseldorf, Germany
| | - Hadi Al-Hasani
- German Center for Diabetes Research (DZD e.V.), Helmholtz Zentrum München, 85764, Neuherberg, Germany
- Institute for Clinical Biochemistry and Pathobiochemistry, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, Medical Faculty, 40225, Düsseldorf, Germany
| | - Wolfram Trudo Knoefel
- Department of General, Visceral, Thorax and Pediatric Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225, Düsseldorf, Germany
| | - Stefan Heinrich
- Department of General, Visceral and Transplantation Surgery, University Hospital Center Mainz, 55131, Mainz, Germany
| | - Bodo Levkau
- Institute for Molecular Medicine III, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225, Düsseldorf, Germany
| | - Kai C Wollert
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, 30625, Hannover, Germany
| | - Jürgen Scheller
- Institute of Biochemistry and Molecular Biology II, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225, Düsseldorf, Germany
| | - Eckhard Lammert
- Heinrich Heine University Düsseldorf, Faculty of Mathematics and Natural Sciences, Institute of Metabolic Physiology, 40225, Düsseldorf, Germany.
- Institute for Vascular and Islet Cell Biology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, 40225, Düsseldorf, Germany.
- German Center for Diabetes Research (DZD e.V.), Helmholtz Zentrum München, 85764, Neuherberg, Germany.
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3
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Pelligra A, Mrugala J, Griess K, Kirschner P, Nortmann O, Bartosinska B, Köster A, Krupenko NI, Gebel D, Westhoff P, Steckel B, Eberhard D, Herebian D, Belgardt BF, Schrader J, Weber AP, Krupenko SA, Lammert E. Pancreatic islet protection at the expense of secretory function involves serine-linked mitochondrial one-carbon metabolism. Cell Rep 2023; 42:112703. [PMID: 37352100 PMCID: PMC10614219 DOI: 10.1016/j.celrep.2023.112703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
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4
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Pelligra A, Mrugala J, Griess K, Kirschner P, Nortmann O, Bartosinska B, Köster A, Krupenko NI, Gebel D, Westhoff P, Steckel B, Eberhard D, Herebian D, Belgardt BF, Schrader J, Weber APM, Krupenko SA, Lammert E. Pancreatic islet protection at the expense of secretory function involves serine-linked mitochondrial one-carbon metabolism. Cell Rep 2023; 42:112615. [PMID: 37294632 PMCID: PMC10592470 DOI: 10.1016/j.celrep.2023.112615] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 03/30/2023] [Accepted: 05/23/2023] [Indexed: 06/11/2023] Open
Abstract
Type 2 diabetes is characterized by insulin hypersecretion followed by reduced glucose-stimulated insulin secretion (GSIS). Here we show that acute stimulation of pancreatic islets with the insulin secretagogue dextrorphan (DXO) or glibenclamide enhances GSIS, whereas chronic treatment with high concentrations of these drugs reduce GSIS but protect islets from cell death. Bulk RNA sequencing of islets shows increased expression of genes for serine-linked mitochondrial one-carbon metabolism (OCM) after chronic, but not acute, stimulation. In chronically stimulated islets, more glucose is metabolized to serine than to citrate, and the mitochondrial ATP/ADP ratio decreases, whereas the NADPH/NADP+ ratio increases. Activating transcription factor-4 (Atf4) is required and sufficient to activate serine-linked mitochondrial OCM genes in islets, with gain- and loss-of-function experiments showing that Atf4 reduces GSIS and is required, but not sufficient, for full DXO-mediated islet protection. In sum, we identify a reversible metabolic pathway that provides islet protection at the expense of secretory function.
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Affiliation(s)
- Angela Pelligra
- Institute of Metabolic Physiology, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Jessica Mrugala
- Institute of Metabolic Physiology, Heinrich Heine University, 40225 Düsseldorf, Germany; Institute for Vascular and Islet Cell Biology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, 40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD e.V.), Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Kerstin Griess
- Institute of Metabolic Physiology, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Philip Kirschner
- Institute of Metabolic Physiology, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Oliver Nortmann
- Institute of Metabolic Physiology, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Barbara Bartosinska
- Institute of Metabolic Physiology, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Andrea Köster
- Institute of Metabolic Physiology, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Natalia I Krupenko
- University of North Carolina (UNC) Nutrition Research Institute, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Dominik Gebel
- Institute of Metabolic Physiology, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Philipp Westhoff
- Institute of Plant Biochemistry, Cluster of Excellence on Plant Science (CEPLAS), Heinrich Heine University, 40225 Düsseldorf, Germany; Cluster of Excellence on Plant Science (CEPLAS), Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Bodo Steckel
- Department of Molecular Cardiology, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Daniel Eberhard
- Institute of Metabolic Physiology, Heinrich Heine University, 40225 Düsseldorf, Germany; Institute for Vascular and Islet Cell Biology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Diran Herebian
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Bengt-Frederik Belgardt
- Institute for Vascular and Islet Cell Biology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, 40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD e.V.), Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Jürgen Schrader
- Department of Molecular Cardiology, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Andreas P M Weber
- Institute of Plant Biochemistry, Cluster of Excellence on Plant Science (CEPLAS), Heinrich Heine University, 40225 Düsseldorf, Germany; Cluster of Excellence on Plant Science (CEPLAS), Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Sergey A Krupenko
- University of North Carolina (UNC) Nutrition Research Institute, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Eckhard Lammert
- Institute of Metabolic Physiology, Heinrich Heine University, 40225 Düsseldorf, Germany; Institute for Vascular and Islet Cell Biology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, 40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD e.V.), Helmholtz Zentrum München, 85764 Neuherberg, Germany.
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5
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Pfeffer T, Wetzel C, Kirschner P, Bartosova M, Poth T, Schwab C, Poschet G, Zemva J, Bulkescher R, Damgov I, Thiel C, Garbade SF, Klingbeil K, Peters V, Schmitt CP. Carnosinase-1 Knock-Out Reduces Kidney Fibrosis in Type-1 Diabetic Mice on High Fat Diet. Antioxidants (Basel) 2023; 12:1270. [PMID: 37372000 DOI: 10.3390/antiox12061270] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/09/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
Carnosine and anserine supplementation markedLy reduce diabetic nephropathy in rodents. The mode of nephroprotective action of both dipeptides in diabetes, via local protection or improved systemic glucose homeostasis, is uncertain. Global carnosinase-1 knockout mice (Cndp1-KO) and wild-type littermates (WT) on a normal diet (ND) and high fat diet (HFD) (n = 10/group), with streptozocin (STZ)-induced type-1 diabetes (n = 21-23/group), were studied for 32 weeks. Independent of diet, Cndp1-KO mice had 2- to 10-fold higher kidney anserine and carnosine concentrations than WT mice, but otherwise a similar kidney metabolome; heart, liver, muscle and serum anserine and carnosine concentrations were not different. Diabetic Cndp1-KO mice did not differ from diabetic WT mice in energy intake, body weight gain, blood glucose, HbA1c, insulin and glucose tolerance with both diets, whereas the diabetes-related increase in kidney advanced glycation end-product and 4-hydroxynonenal concentrations was prevented in the KO mice. Tubular protein accumulation was lower in diabetic ND and HFD Cndp1-KO mice, interstitial inflammation and fibrosis were lower in diabetic HFD Cndp1-KO mice compared to diabetic WT mice. Fatalities occurred later in diabetic ND Cndp1-KO mice versus WT littermates. Independent of systemic glucose homeostasis, increased kidney anserine and carnosine concentrations reduce local glycation and oxidative stress in type-1 diabetic mice, and mitigate interstitial nephropathy in type-1 diabetic mice on HFD.
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Affiliation(s)
- Tilman Pfeffer
- Centre for Paediatric and Adolescent Medicine, University of Heidelberg, 69120 Heidelberg, Germany
- Tissue Bank of the German Center for Infection Research (DZIF), Partner Site Heidelberg, Institute of Pathology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Charlotte Wetzel
- Centre for Paediatric and Adolescent Medicine, University of Heidelberg, 69120 Heidelberg, Germany
| | - Philip Kirschner
- Centre for Paediatric and Adolescent Medicine, University of Heidelberg, 69120 Heidelberg, Germany
| | - Maria Bartosova
- Centre for Paediatric and Adolescent Medicine, University of Heidelberg, 69120 Heidelberg, Germany
| | - Tanja Poth
- Center for Model System and Comparative Pathology (CMCP), Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Constantin Schwab
- Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Gernot Poschet
- Centre for Organismal Studies (COS), Metabolomics Core Technology Platform, University of Heidelberg, 69120 Heidelberg, Germany
| | - Johanna Zemva
- Internal Medicine I and Clinical Chemistry, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Ruben Bulkescher
- Internal Medicine I and Clinical Chemistry, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Ivan Damgov
- Institute of Medical Biometry and Informatics, University of Heidelberg, 69120 Heidelberg, Germany
| | - Christian Thiel
- Centre for Paediatric and Adolescent Medicine, University of Heidelberg, 69120 Heidelberg, Germany
| | - Sven F Garbade
- Centre for Paediatric and Adolescent Medicine, University of Heidelberg, 69120 Heidelberg, Germany
| | - Kristina Klingbeil
- Centre for Paediatric and Adolescent Medicine, University of Heidelberg, 69120 Heidelberg, Germany
| | - Verena Peters
- Centre for Paediatric and Adolescent Medicine, University of Heidelberg, 69120 Heidelberg, Germany
| | - Claus Peter Schmitt
- Centre for Paediatric and Adolescent Medicine, University of Heidelberg, 69120 Heidelberg, Germany
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6
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Levitsky Y, Pegouske DJ, Hammer SS, Frantz NL, Fisher KP, Muchnik AB, Saripalli AR, Kirschner P, Bazil JN, Busik JV, Proshlyakov DA. Micro-respirometry of whole cells and isolated mitochondria. RSC Adv 2019; 9:33257-33267. [PMID: 32123561 PMCID: PMC7051014 DOI: 10.1039/c9ra05289e] [Citation(s) in RCA: 9] [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] [Indexed: 11/21/2022] Open
Abstract
Oxygen consumption is a key metric of metabolism in aerobic organisms. Current respirometric methods led to seminal discoveries despite limitations such as high sample demand, exchange with atmospheric O2, and cumulative titration protocols leading to limited choice of useable tissue, complex data interpretation, and restricted experimental design. We developed a sensitive and customizable method of measuring O2 consumption rates by a variety of biological samples in microliter volumes without interference from the aerobic environment. We demonstrate that O2 permeability of the photopolymer, VeroClear, is comparable to that of polyetheretherketone (0.125 vs. 0.143 barrer, respectively) providing an efficient barrier to oxygen ingress. Optical transparency of VeroClear, combined with high resolution 3D printing, allows for optode-based oxygen detection in enclosed samples. These properties yield a microrespirometer with over 100× dynamic range for O2 consumption rates. Importantly, the enclosed respirometer configuration and very low oxygen permeability of materials makes it suitable, with resin pre-conditioning, for quantitative assessment of O2 consumption rates at any desired [O2], including hyperbaric, physiological or hypoxic conditions as necessary for each cell type. We characterized two configurations to study soluble enzymes, isolated mitochondria, cells in suspension, and adherent cells cultured on-chip. Improved sensitivity allows for routine quantitative detection of respiration by as few as several hundred cells. Specific activity of cell suspensions in the microrespirometer was in close agreement with that obtained by high-resolution polarographic respirometry. Adherent cell protocols allowed for physiologically relevant assessment of respiration in retinal pigment epithelial cells, ARPE-19, which displayed lower metabolic rates compared with those in suspension. By exchanging medium composition, we demonstrate that cells can be transiently inhibited by cyanide and that 99.6% of basal O2 uptake is recovered upon its removal. This approach is amenable to new experimental designs and precision measurements on limited sample quantities across basic research and applied fields. 3D printed microfluidic respirometer allows for quantitative investigation of biological energy transduction in adherent and suspension samples.![]()
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Affiliation(s)
- Yan Levitsky
- Department of Chemistry, Michigan State University, 578 S Shaw Lane, East Lansing, MI 48824, USA.,Department of Physiology, Michigan State University, East Lansing, MI, USA
| | - David J Pegouske
- Department of Chemistry, Michigan State University, 578 S Shaw Lane, East Lansing, MI 48824, USA
| | - Sandra S Hammer
- Department of Physiology, Michigan State University, East Lansing, MI, USA
| | - Nathan L Frantz
- Department of Chemistry, Michigan State University, 578 S Shaw Lane, East Lansing, MI 48824, USA
| | - Kiera P Fisher
- Department of Physiology, Michigan State University, East Lansing, MI, USA
| | - Artem B Muchnik
- Department of Chemistry, Michigan State University, 578 S Shaw Lane, East Lansing, MI 48824, USA
| | | | - Philip Kirschner
- Department of Physiology, Michigan State University, East Lansing, MI, USA
| | - Jason N Bazil
- Department of Physiology, Michigan State University, East Lansing, MI, USA
| | - Julia V Busik
- Department of Physiology, Michigan State University, East Lansing, MI, USA
| | - Denis A Proshlyakov
- Department of Chemistry, Michigan State University, 578 S Shaw Lane, East Lansing, MI 48824, USA
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7
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Schwenkenbecher P, Neyazi A, Donnerstag F, Ringshausen FC, Jacobs R, Stoll M, Kirschner P, Länger FP, Valizada E, Gingele S, Wegner F, Sühs KW, Stangel M, Skripuletz T. Chronic Granulomatous Disease First Diagnosed in Adulthood Presenting With Spinal Cord Infection. Front Immunol 2018; 9:1258. [PMID: 29915596 PMCID: PMC5994559 DOI: 10.3389/fimmu.2018.01258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 03/03/2018] [Accepted: 05/18/2018] [Indexed: 01/19/2023] Open
Abstract
Chronic granulomatous disease (CGD) is a rare genetic immunodeficiency, which is characterized by recurrent severe bacterial and fungal infections caused by a defect in phagocytic cells due to loss of superoxide production. The disease usually manifests within the first years of life. Early diagnosis allows therapeutic intervention to improve the limited life expectancy. Nevertheless, only half of the patients exceed the age of 25. Here, we present the case of a 41-year old female patient who presented with an extensive spinal cord infection and atypical pneumonia mimicking tuberculosis. The medical history with recurrent granulomatous infections and microbiological findings with multiple unusual opportunistic pathogens was the key to the diagnosis of CGD, which is exceptionally rare first diagnosed in patients in the fifth decade of life. The late diagnosis in this case was likely due to the lack of knowledge of the disease by the treating teams before but not because the patient did not have typical CGD infections along her life. The extensive progressive developing granulomas in our patient with fatal outcome raise the question of early immunosuppressive therapy in addition to anti-infectious treatment. We recommend appropriate CGD diagnostics in adult patients with unclear granulomatous diseases of the nervous system.
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Affiliation(s)
| | - Alexandra Neyazi
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Frank Donnerstag
- Institute for Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Felix C Ringshausen
- Department of Respiratory Medicine, Hannover Medical School, German Center for Lung Research (DZL), Hannover, Germany
| | - Roland Jacobs
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, Hannover, Germany
| | - Matthias Stoll
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, Hannover, Germany
| | - Philip Kirschner
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | | | - Emil Valizada
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Stefan Gingele
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Florian Wegner
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Martin Stangel
- Department of Neurology, Hannover Medical School, Hannover, Germany
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8
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Schwahn-Schreiber C, Hiss U, Gaber Y, Kirschner P, Schmeller W. Vergleich zwischen Shave-Therapie und kruraler Fasziektomie bei der Behandlung »therapieresistenter« venöser Ulzera. Phlebologie 2017. [DOI: 10.1055/s-0037-1617320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Zusammenfassung
Ziel und Methoden: Von Januar bis Dezember 1997 wurden im Rahmen einer Vergleichsstudie 13 Patienten mit insgesamt 18 nichtheilenden (sogenannten therapieresistenten) venösen Ulzera in der Klinik für Dermatologie und Venerologie der Medizinischen Universität zu Lübeck mittels Shave-Therapie behandelt; im selben Zeitraum wurden 10 Patienten einer vergleichbaren Altersgruppe mit 14 Ulzera gleichen Schweregrades mittels kruraler Fasziektomie in der Klinik für Gefäßkrankheiten der William-Harvey-Klinik, Bad Nauheim, behandelt. Alle Ulzera waren Folge einer primären bzw. sekundären Leitveneninsuffizienz oder eines postthrombotischen Syndroms; zusätzlich bestand ein arthrogenes Stauungssyndrom. Ergebnis: 3 und 12 Monate postoperativ bestanden bezüglich der Zahl der persistierten bzw. rezidivierten Ulzera bei beiden Kollektiven keine signifikanten Unterschiede; nach einem Jahr fand sich eine komplette Abheilung bei 11 von 18 Ulzera (61,1%) der Shave-Gruppe und bei 9 von 14 Ulzera (64,3%) der Fasziektomie-Gruppe. Die durchschnittliche Abnahme der Ulkusfläche nach 12 Monaten war bei den Fasziektomie-Patienten größer; die stationäre Behandlungszeit (49,8 Tage) war doppelt so lang wie bei den Shave-Patienten (24,1 Tage). Schlußfolgerung: Die Untersuchung zeigt, daß bezüglich der klinischen Ergebnisse im ersten Jahr postoperativ beide Verfahren bei venösen »Problemulzera« gleichwertig sind. Eine Entfernung der Unterschenkelfaszie mit Eröffnung der dorsalen Kompartimente bietet während dieses Zeitraums keinen eindeutigen Vorteil.
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Kümpers P, Tiede A, Kirschner P, Girke J, Ganser A, Peest D. Legionnaires' disease in immunocompromised patients: a case report of Legionella longbeachae pneumonia and review of the literature. J Med Microbiol 2008; 57:384-387. [PMID: 18287305 DOI: 10.1099/jmm.0.47556-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
In addition to Legionella pneumophila, about 20 Legionella species have been documented as human pathogens. The majority of infections by non-pneumophila Legionella species occur in immunocompromised and splenectomized patients. Here, we report a case of 'classical' lobar pneumonia caused by Legionella longbeachae in a splenectomized patient receiving corticosteroids for chronic immune thrombocytopenia. Tests for Legionella antigen were negative. L. longbeachae was immediately detected in bronchoalveolar fluid by PCR and subsequently confirmed by culture on legionella-selective media. The features of Legionnaires' disease in immunocompromised patients with special emphasis on significance and detection of non-pneumophila species are reviewed.
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Affiliation(s)
- Philipp Kümpers
- Department of Internal Medicine, Hannover Medical School, Hannover, Germany
| | - Andreas Tiede
- Department of Internal Medicine, Hannover Medical School, Hannover, Germany
| | - Philip Kirschner
- Department of Medical Microbiology, Hannover Medical School, Hannover, Germany
| | - Jutta Girke
- Department of Internal Medicine, Hannover Medical School, Hannover, Germany
| | - Arnold Ganser
- Department of Internal Medicine, Hannover Medical School, Hannover, Germany
| | - Dietrich Peest
- Department of Internal Medicine, Hannover Medical School, Hannover, Germany
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10
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Kola A, Kirschner P, Gohrbandt B, Chaberny IF, Mattner F, Strüber M, Gastmeier P, Suerbaum S. An infection with linezolid-resistant S. aureus in a patient with left ventricular assist system. ACTA ACUST UNITED AC 2007; 39:463-5. [PMID: 17464873 DOI: 10.1080/00365540601071875] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We report an infection with a linezolid-resistant S. aureus in a patient with a left ventricular assist system. Linezolid should be used with caution when invasive devices or foreign materials are in place or therapeutic courses last longer than 14 d. Previous cases of linezolid-resistant S. aureus are summarized.
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Affiliation(s)
- Axel Kola
- Institute of Medical Microbiology and Hospital Epidemiology, Hannover, Germany.
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11
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Hoffmann H, Bodmer T, Kirschner P. P2003 Recommendations for the use of interferon–gamma assays for the diagnosis of tuberculous infection. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71842-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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12
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Grigull L, Beilken A, Schmid H, Kirschner P, Sykora KW, Linderkamp C, Donnerstag F, Goudeva L, Heuft HG, Welte K. Secondary prophylaxis of invasive fungal infections with combination antifungal therapy and G-CSF-mobilized granulocyte transfusions in three children with hematological malignancies. Support Care Cancer 2006; 14:783-6. [PMID: 16482446 DOI: 10.1007/s00520-005-0910-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Accepted: 10/26/2005] [Indexed: 10/25/2022]
Abstract
Fungal infections represent a life-threatening complication for patients receiving chemotherapy or undergoing hematopoietic stem cell transplantation. Historically, antifungal monotherapy is associated with a poor outcome. We treated three children with hematological malignancies and proven fungal infections (one cerebral mold infection, one disseminated Candida infection, one naso-pharyngeal mucor infection) with combination antifungal therapy plus granulocyte-colony-stimulation-factor-mobilized granulocyte transfusions as secondary prophylaxis during subsequent neutropenic episodes. With this approach, the fungal infection was effectively treated, and the anticancer therapy was completed without major delay. All children survived the fungal infection and the underlying malignancy. These experiences illustrate the feasibility of this approach using more than one antifungal agent together with immune-therapy in high-risk patients.
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Affiliation(s)
- Lorenz Grigull
- Department of Paediatric Haematology and Oncology, Medizinische Hochschule Hannover, OE 6780, Carl-Neuberg Str. 1, D-30625 Hannover, Germany.
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13
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Abstract
The replacement of a hip joint after osteoarthritis or fracture is today a standard surgical procedure and performed worldwide in about 750,000 cases. Since it is possible to achieve durable anchorage of implants in bone and to effectively treat loss of function and pain of the hip joint, this operation belongs to the most successful in our times.Therefore, a differentiated technology has developed that encompasses modern implant materials, biomechanical knowledge, and surgical techniques. Current standards in this procedure are demonstrated.
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Affiliation(s)
- P Kirschner
- Unfall- und Wiederherstellungschirurgie, Katholisches Klinikum Mainz.
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14
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Abstract
There is still a controversial discussion in literature about the use of motor driven splints in knee surgery--as the principle of continuous passive motion, CPM. For this reason it seemed useful for an evaluation to look through the papers which were published since 1990. It was obvious, that negative results were published often before this year, but this papers are still quoted standard works. In medical data bases subito-doc.de, medscape.com, medica.de and zbmed.de 230 papers were found by search CPM, continuous passive motion and arthromot. Coincidentally there was a search for authors who were already quoted in other papers. 36 papers concerning CPM after knee surgery were utilized. The role of CPM regarding the range of motion, swelling, duration of hospital stay, use of analgesics, costs, postoperative manipulations, wound healing and thrombo embolic complications was evaluated. Although the results of this partial retrospective, partial prospective, sometimes randomized or double blinded studies are in contradiction, there can only be found a trend to better results. New clinical studies for evidence based guidelines in the handling of continuous passive motion after knee surgery are necessary.
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Affiliation(s)
- P Kirschner
- Unfall- und Wiederherstellungschirurgie, St. Vincenz- und Elisabeth-Hospital, Katholisches Klinikum Mainz.
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15
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Grigull L, Beier R, Schrauder A, Kirschner P, Loening L, Jack T, Welte K, Sykora KW, Schrappe M. Invasive fungal infections are responsible for one-fifth of the infectious deaths in children with ALL. Mycoses 2003; 46:441-6. [PMID: 14641615 DOI: 10.1046/j.0933-7407.2003.00931.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The following report will discuss in detail all lethal invasive fungal infections (IFI) that occurred in a group of 2021 children with acute lymphoblasic leukaemia (ALL). The German ALL-Berlin-Frankfurt-Muenster (BFM) study group is one of the largest cooperation for the treatment of childhood ALL. Between 1995 and 2000, 2021 children with ALL received chemotherapy according to the German BFM 95 protocols (ALL-BFM 95). This population was retrospectively screened, whether a lethal fungal infection occurred: totally, in this group, 43 of 2021 (2.1%) children died because of infections. Nine of 43 (21%) patients died in the context of an IFI: six fatal Aspergillus infections and three fatal yeast infections were reported. The following report will focus on the nine children with ALL who died from IFI. The underlying risk factors (RF) included neutropenia (seven of nine patients) and steroid medication (nine of nine patients). Seven of nine children had additional medical complications (e.g. liver failure, haemolytic uraemic syndrome and acute renal failure). In six of nine children the fungal infection was progressive despite intravenous antimycotic therapy, three patients received no antifungal therapy, as IFI was not considered. The progression of IFI despite antimycotic therapy illustrates the inherent problems of diagnosis and the need for innovative therapeutic modalities. The high percentage (21%) of death from IFI among lethal infections in paediatric ALL patients illustrates the relevance of fungi in this group of patients. On the contrary, the total number of IFI in paediatric ALL patients remains to be determined, as only lethal infections were included in this report.
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Affiliation(s)
- L Grigull
- Departments of Paediatric Haematology and Oncology, Medical School Hannover, Germany.
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16
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Cech O, Fassbender M, Kirschner P, Rozkydal Z. [Preoperative planning and surgical technic in achieving stability and leg length equality in total hip joint arthroplasty]. Acta Chir Orthop Traumatol Cech 2003; 69:362-8. [PMID: 12587498] [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] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
One of the prerequisites for a good outcome of total hip arthroplasty is preoperative planning. Using a roentgenogram, the size of an implant, incision level on the femoral neck, depth required for fitting the cup, restoration of the center of hip rotation and, if necessary, correction of length descrepancy between the legs are determined. The preoperative planning based on an X-ray image was introduced by M. E. Müller and, in 1976, was modified by R. Schneider who used a transparent sheet for a template on which all relevant points guiding the surgical procedure are marked, i.e., the right position for implantation of the cup and stem, and incision lines. In uncomplicated cases, however, this approach is not necessary and the "planning principle of parallel lines" developed by L. Spotorno in 1988 can be used instead. The determination of length discrepancy between the legs is derived from a drawing of three reference lines on the roentgenogram. The lines parallel to each other indicace the same length for both legs. If the legs differ in length, the lines will diverge from each other in a way typical for this condition.
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Affiliation(s)
- O Cech
- Ortopedicko-traumatologická klinika 3. LF a FNKV, Praha
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17
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Rosenthal O, Woywodt A, Kirschner P, Haller H. Vertebral osteomyelitis and endocarditis of a pacemaker lead due to Granulicatella (Abiotrophia) adiacens. Infection 2002; 30:317-9. [PMID: 12382095 DOI: 10.1007/s15010-002-2104-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Systemic infection due to Granulicatella (formerly Abiotrophia), a species of nutrition-deficient gram-positive cocci, is rare. We present the case of a 68-year-old diabetic male who presented with back pain and a history of fever and chills. Imaging studies revealed vertebral osteomyelitis of the Th 10/11 region. Transesophageal echocardiography disclosed a vegetation adjacent to the pacemaker lead and blood cultures grew Granulicatella adiacens. A diagnosis of vertebral osteomyelitis and endocarditis due to G. adiacens was made and the patient improved with bed rest and medical treatment alone. Granulicatella ssp. should always be part of the differential diagnosis of fastidious bacteria in vertebral osteomyelitis and endocarditis.
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Affiliation(s)
- O Rosenthal
- Division of Nephrology, University of Hannover School of Medicine, Hannover, Germany
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18
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Hambach L, Eder M, Dammann E, Schrauder A, Sykora KW, Dieterich C, Kirschner P, Novotny J, Ganser A, Hertenstein B. Diagnostic value of procalcitonin serum levels in comparison with C-reactive protein in allogeneic stem cell transplantation. Haematologica 2002; 87:643-51. [PMID: 12031922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Infections represent the major complications following allogeneic stem cell transplantation (SCT). A promising marker for a more specific and early detection of bacterial or fungal infections is procalcitonin (PCT). DESIGN AND METHODS Maximum values (m) and increase (Delta) of PCT and C-reactive protein (CRP) were prospectively analyzed during 214 clinical events in a cohort of 61 patients undergoing allogeneic SCT. Systemic reactions during bacterial or fungal infections were classified according to the ACCP/SCCM criteria. RESULTS mPCT and mCRP (normal <0.5 microg/L and <5 mg/L, respectively) levels were high during bacterial and fungal infections (median 2.3 microg/L and 188 mg/L), moderately elevated during fever of unknown origin (median 1.5 microg/L and 82 mg/L) and low during clinical events for which there was no evidence of bacterial or fungal infections (median 0.4 microg/L and 55 mg/L). The area under the receiver operator characteristic (ROC) curve was 0.70 for mPCT, 0.76 for mCRP, 0.76 for DeltaPCT and 0.83 for DeltaCRP. Cut-off concentrations for optimum prediction of bacterial or fungal infection were: mPCT > 1 microg/L, mCRP > 100 mg/L, DeltaPCT > 1 microg/L and DeltaCRP > 50 mg/L. An increase of PCT during a bacterial or fungal infection was usually detected 1 day after the onset of fever, while the rise of CRP occurred 1 day before. mPCT was strongly correlated with the severity of systemic reaction during infection (sepsis vs severe sepsis/septic shock: p=0.0002). INTERPRETATION AND CONCLUSIONS The diagnostic value of PCT was not superior to that of CRP in the detection of bacterial or fungal infections after allogeneic SCT. However, PCT assays may be useful in studies which compare the severity of infectious complications.
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Affiliation(s)
- Lothar Hambach
- Department of Hematology and Oncology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
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19
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Kirschner P, Kreutz A. [Results of cement-free St. Nabor hip prosthesis implantation and clinical and radiological results after 8 to 10 years]. Z Orthop Ihre Grenzgeb 2000; 138:306-10. [PMID: 11033897 DOI: 10.1055/s-2000-10153] [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] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE OF THE STUDY The aim of the retrospective study was to analyse the medium-term results of the cementless hip prosthesis St. Nabor. METHOD 46 patients with complete postoperative and radiographic documentation were available for clinical review. The average follow-up was eight years and five months (range from eight years, one month to ten years). The average age at the last follow-up was 60 years. Ten patients showed severe coxarthritis and 32 patients a dysplasia of the acetabulum before surgery. Two patients suffered from a severe osteonecrosis of the femoral head and two patients had fractures of the acetabulum or femoral neck, respectively. RESULTS The medium-term follow-up for the acetabular component showed a survival rate of 97.8%. The radiographic data visualized one loosening as a result of a low grade infection, 18 months after surgery. There was no migration of the acetabular component according to Sutherland et al. and no protrusion was found. None of the acetabular components showed radiolucent lines or was loose according to radiographic criteria. In comparison to the first post-operative radiograph, 26 of the hips were found with a significant reduction of lacunae, twelve of them showed a complete absence at last follow-up. The overall Harris hip score averaged 92 points (range 58 to 100 points) for the entire group. 41 (92%) of all hips were rated as excellent or good. Two hips (4%) of all hips were rated as fair and two hips (4%) were rated as poor. CONCLUSION The high rate of good and satisfying results in medium-term follow-up proves this St. Nabor acetabular component system to be an excellent implant in total hip arthroplasty for younger patients with or without dysplasia.
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20
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Abstract
Despite decontamination, overgrowth by pseudomonads renders cultural isolation of mycobacteria from respiratory specimens of patients with cystic fibrosis (CF) difficult or impossible. We performed a prospective study by comparing levels of reduction of overgrowth and recovery of mycobacteria using either pretreatment with N-acetyl-L-cysteine (NALC)-NaOH alone or pretreatment with NALC-NaOH and then with oxalic acid. From 406 specimens of 148 CF patients, 11 specimens were positive for mycobacteria, 5 of which grew mycobacteria after decontamination by either procedure. Three specimens grew mycobacteria only after decontamination with NALC-NaOH, whereas three specimens grew mycobacteria only after treatment with NALC-NaOH followed by oxalic acid but were overgrown after decontamination with NALC-NaOH. Thus, inactivation of mycobacteria by the more aggressive oxalic acid treatment offsets its beneficial effect of reducing the proportion of cultures overgrown with microorganisms other than mycobacteria.
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Affiliation(s)
- F C Bange
- Institute of Medical Microbiology, Medical School Hannover, 30625 Hannover, Germany.
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21
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Affiliation(s)
- P Kirschner
- Abteilung für Unfall- und Wiederherstellungs-chirurgie, St.-Vincenz- und Elisabeth-Hospital, D-55131, Mainz
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22
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Affiliation(s)
- P Kirschner
- Institut für Medizinische Mikrobiologie, Medizinische Hochschule Hannover, Germany
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23
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Haas WH, Butler WR, Kirschner P, Plikaytis BB, Coyle MB, Amthor B, Steigerwalt AG, Brenner DJ, Salfinger M, Crawford JT, Böttger EC, Bremer HJ. A new agent of mycobacterial lymphadenitis in children: Mycobacterium heidelbergense sp. nov. J Clin Microbiol 1997; 35:3203-9. [PMID: 9399520 PMCID: PMC230148 DOI: 10.1128/jcm.35.12.3203-3209.1997] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.7] [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: 02/05/2023] Open
Abstract
Nontuberculous mycobacterial lymphadenitis presents an increasing clinical problem in immunocompetent young children. A slowly growing, nonphotochromogenic mycobacterium was recovered twice (isolates 2553/91 and 2554/91) from the lymphatic tissue of a child with recurrent cervical lymphadenitis. It could be differentiated biochemically from described Mycobacterium species, although it most closely resembled Mycobacterium malmoense by thin-layer chromatography and high-performance liquid chromatography of mycolic acids. A striking characteristic of the isolate was its high degree of susceptibility to antituberculous drugs in vitro, including isoniazid. Direct determination of the 16S rRNA gene sequence revealed a unique sequence and positioned the strain phylogenetically on a branch separate from M. malmoense within a group of slowly growing mycobacteria that show a high degree of similarity to M. simiae at the 16S rRNA gene level. Despite 99.6% sequence identity with M. simiae at the 16S rRNA gene level, DNA-DNA hybridization studies (hydroxyapatite method) demonstrated DNA relatedness of less than 40%. We conclude that this organism is a new species for which we propose the name M. heidelbergense. A culture of the type strain, strain 2554/91, has been deposited in the American Type Culture Collection as strain ATCC 51253.
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Affiliation(s)
- W H Haas
- Department of General Pediatrics, Children's Hospital, Heidelberg University, Germany.
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24
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Tortoli E, Kirschner P, Springer B, Bartoloni A, Burrini C, Mantella A, Scagnelli M, Scarparo C, Simonetti MT, Böttger EC. Cervical lymphadenitis due to an unusual mycobacterium. Eur J Clin Microbiol Infect Dis 1997; 16:308-11. [PMID: 9177965 DOI: 10.1007/bf01695636] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A scotochromogenic acid-fast bacillus was isolated from a lymph node of a 2-year-old female. On the basis of conventional testing, the mycobacterium appeared to be Mycobacterium scrofulaceum. Its mycolic acid profile, however, was not identical to that of Mycobacterium scrofulaceum but was similar to that of Mycobacterium interjectum. Direct sequencing of the 16S rRNA gene revealed a unique nucleic acid sequence, suggesting that the isolate represents a previously undescribed pathogenic species.
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Affiliation(s)
- E Tortoli
- Laboratorio di Microbiologia e Virologia, Ospedale di Careggi, Firenze, Italy
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25
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Tortoli E, Piersimoni C, Kirschner P, Bartoloni A, Burrini C, Lacchini C, Mantella A, Muzzi G, Tosi CP, Penati V, Scarparo C, Simonetti MT, Böttger EC. Characterization of mycobacterial isolates phylogenetically related to, but different from Mycobacterium simiae. J Clin Microbiol 1997; 35:697-702. [PMID: 9041415 PMCID: PMC229653 DOI: 10.1128/jcm.35.3.697-702.1997] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The use of high-performance liquid chromatography (HPLC) revealed four previously unreported profiles within a group of mycobacteria consisting of 14 clinical isolates. These mycobacteria, whose identification by conventional tests appeared problematic, mostly resembled Mycobacterium avium complex or Mycobacterium simiae. Genetic analysis revealed, within this group, six different nucleic acid sequences in a hypervariable 16S rRNA segment, but all the isolates appeared to be phylogenetically related to M. simiae. Six isolates representing the largest of groups defined by means of genetic sequencing turned out to belong to the newly described species Mycobacterium lentiflavum. Furthermore, three such clusters precisely coincided with three of those defined by HPLC, while the three remaining clusters shared almost identical HPLC profiles. All but one strain (which, although clearly not belonging to the M. avium complex, hybridized with specific commercial DNA probes) showed high-grade resistance to the majority of antimycobacterial drugs. Three of the isolates were clinically significant according to stringent criteria. Sophisticated techniques, like genetic sequencing or HPLC, by now seem indispensable for differentiating unusual and new mycobacteria from well-established ones.
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Affiliation(s)
- E Tortoli
- Laboratory of Microbiology and Virology, Careggi Hospital, Firenze, Italy.
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26
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Sutor GC, Ockenga J, Kirschner P, Schätzle C, Mendila M, Jendro M, Stoll M, Böttger E, Schmidt RE. Tuberculosis cutis colliquativa during long-term immunosuppressive therapy for rheumatoid arthritis. Arthritis Rheum 1997; 40:188-90. [PMID: 9008616 DOI: 10.1002/art.1780400126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- G C Sutor
- Department of Medicine, Medical School of Hannover, Germany
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27
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Tortoli E, Kirschner P, Bartoloni A, Burrini C, Manfrin V, Mantella A, Scagnelli M, Scarparo C, Simonetti MT, Böttger EC. Isolation of an unusual mycobacterium from an AIDS patient. J Clin Microbiol 1996; 34:2316-9. [PMID: 8862610 PMCID: PMC229243 DOI: 10.1128/jcm.34.9.2316-2319.1996] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A mycobacterium isolated from a clinical sample of an AIDS patient was identified as Mycobacterium interjectum by direct 16S rRNA sequence determination. High-performance liquid chromatography, however, revealed a mycolic acid pattern which was different from the one shared by the previously analyzed strains of this species.
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Affiliation(s)
- E Tortoli
- Laboratorio di Microbiologia e Virologia, Ospedale di Careggi, Florence, Italy.
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28
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Jenkins BG, Brouillet E, Chen YC, Storey E, Schulz JB, Kirschner P, Beal MF, Rosen BR. Non-invasive neurochemical analysis of focal excitotoxic lesions in models of neurodegenerative illness using spectroscopic imaging. J Cereb Blood Flow Metab 1996; 16:450-61. [PMID: 8621749 DOI: 10.1097/00004647-199605000-00011] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Water-suppressed chemical shift magnetic resonance imaging was used to detect neurochemical alterations in vivo in neurotoxin-induced rat models of Huntington's and Parkinson's disease. The toxins were: N-methyl-4-phenylpyridinium (MPP+), aminooxyacetic acid (AOAA), 3-nitropropionic acid (3-NP), malonate, and azide. Local or systemic injection of these compounds caused secondary excitotoxic lesions by selective inhibition of mitochondrial respiration that gave rise to elevated lactate concentrations in the striatum. In addition, decreased N-acetylaspartate (NAA) concentrations were noted at the lesion site over time. Measurements of lactate washout kinetics demonstrated that t1/2 followed the order: 3-NP approximately MPP+ >> AOAA approximately malonate, which parallels the expected lifetimes of the neurotoxins based on their mechanisms of action. Further increases in lactate were also caused by intravenous infusion of glucose. At least part of the excitotoxicity is mediated through indirect glutamate pathways because lactate production and lesion size were diminished using unilateral decortectomies (blockade of glutamatergic input) or glutamate antagonists (MK-801). Lesion size and lactate were also diminished by energy repletion with ubiquinone and nicotinamide. Lactate measurements determined by magnetic resonance agreed with biochemical measurements made using freeze clamp techniques. Lesion size as measured with MR, although larger by 30%, agreed well with lesion size determined histologically. These experiments provide evidence for impairment of intracellular energy metabolism leading to indirect excitotoxicity for all the compounds mentioned before and demonstrate the feasibility of small-volume metabolite imaging for in vivo neurochemical analysis.
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Affiliation(s)
- B G Jenkins
- MGH-NMR Center, Department of Radiology, Massachusetts General Hospital, Charlestown, USA
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29
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Springer B, Wu WK, Bodmer T, Haase G, Pfyffer GE, Kroppenstedt RM, Schröder KH, Emler S, Kilburn JO, Kirschner P, Telenti A, Coyle MB, Böttger EC. Isolation and characterization of a unique group of slowly growing mycobacteria: description of Mycobacterium lentiflavum sp. nov. J Clin Microbiol 1996; 34:1100-7. [PMID: 8727884 PMCID: PMC228963 DOI: 10.1128/jcm.34.5.1100-1107.1996] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.0] [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: 02/01/2023] Open
Abstract
A distinct group of slowly growing mycobacteria was identified on the basis of growth characteristics, biochemical and lipid profiles, and nucleic acid analyses. The isolates showed growth at 22 to 37 degrees C, yellow pigmentation, and negative tests for Tween 80 hydrolysis, nicotinic acid, nitrate reductase, and urease; tests for arylsulfatase, pyrazinamidase, and heat-stable catalase were variable. Analysis of cellular fatty acids by gas-liquid chromatography and mycolic acids by thin-layer chromatography and high-performance liquid chromatography indicated a distinctive pattern which was unlike those of other species. Determination of the 16S rRNA gene sequence showed a unique sequence closely related to Mycobacterium simiae and M. genavense. On the basis of DNA homology studies, we suggest that these organisms are representatives of a novel species, for which the name M. lentiflavum sp. nov. is proposed.
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Affiliation(s)
- B Springer
- Institut für Medizinische Mikrobiologie, Medizinische Hochschule Hannover, Germany
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30
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Kirschner P, Rosenau J, Springer B, Teschner K, Feldmann K, Böttger EC. Diagnosis of mycobacterial infections by nucleic acid amplification: 18-month prospective study. J Clin Microbiol 1996; 34:304-12. [PMID: 8789005 PMCID: PMC228787 DOI: 10.1128/jcm.34.2.304-312.1996] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We have investigated the use of DNA amplification by PCR for the detection of mycobacteria in clinical specimens, with the gene encoding the 16S rRNA as a target. Following generic amplification of mycobacterial nucleic acids, screening was done with genus-specific probe; this was followed by species differentiation by use of highly discriminating probes or nucleic acid sequencing. In a prospective 18-month evaluation, criteria to select specimens for PCR analysis were defined. Of a total of 8,272 specimens received, 729 samples satisfied the criteria and were subjected to DNA amplification. Clinical specimens included material from the respiratory tract (sputa and bronchial washings), aspirates, biopsies, and various body fluids (cerebrospinal, pleural, peritoneal, and gastric fluids). After resolution of discrepant results, the sensitivity of the PCR assay was 84.5%, the specificity was 99.5%, the positive predictive value was 97.6%, and the negative predictive value was 96.4%. The sensitivity and negative predictive value of culture (with a combination of broth and solid media) were 77.5 and 94.8%, respectively. In conclusion, this PCR assay provides an efficient strategy to detect and identify multiple mycobacterial species and performs well in comparison with culture.
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Affiliation(s)
- P Kirschner
- Institut für Medizinische Mikrobiologie, Medizinische Hochschule Hannover, Germany
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31
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Wayne LG, Good RC, Böttger EC, Butler R, Dorsch M, Ezaki T, Gross W, Jonas V, Kilburn J, Kirschner P, Krichevsky MI, Ridell M, Shinnick TM, Springer B, Stackebrandt E, Tarnok I, Tarnok Z, Tasaka H, Vincent V, Warren NG, Knott CA, Johnson R. Semantide- and chemotaxonomy-based analyses of some problematic phenotypic clusters of slowly growing mycobacteria, a cooperative study of the International Working Group on Mycobacterial Taxonomy. Int J Syst Bacteriol 1996; 46:280-97. [PMID: 8573508 DOI: 10.1099/00207713-46-1-280] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
During previous cooperative numerical taxonomic studies of slowly growing mycobacteria, the International Working Group on Mycobacterial Taxonomy described a number of strains whose taxonomic status was ambiguous. A new study of DNA, RNA, and proteins from 66 of these organisms was performed to correlate their properties with phenotypic clustering behavior; the results of this study permitted 51 of the strains studied to be assigned to known species. The methods used to characterize the semantides included nucleotide sequencing and assessment of levels of semantide relatedness by affinity binding techniques, including whole DNA-DNA hybridization, probe hybridization, and antibody binding. There was good overall agreement between the phenotypic and chemotaxonomic clusters and the groups of organisms identified by semantide analyses. Our results supported the conclusion that we should continue to rely on polyphasic taxonomy to provide satisfactory systematic resolution of members of the genus Mycobacterium. We identified no single 16S rRNA interstrain nucleotide sequence difference value that unequivocally defined species boundaries. DNA-DNA hybridization remains the gold standard, but common resources are needed to permit DNA-DNA hybridization analyses to be made available to laboratories that are not prepared to use this technology. One of the large novel clusters which we studied corresponds to the recently described species Mycobacterium interjectum, a pathogen that resembles the nonpathogen Mycobacterium gordonae phenotypically. We also identified strains that appear to represent ribovars of Mycobacterium intracellulare which do not react with the commercial diagnostic probes that are currently used for identification of this species. Other branches or clusters consisted of too few strains to permit a decision about their taxonomic status to be made.
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Affiliation(s)
- L G Wayne
- Department of Veterans Affairs Medical Center, Long Beach, California 90822, USA
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32
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Kreuzpaintner G, Kirschner P, Wallner A, Kölble R, Hesterberg R, Thomas L, Borchard F. Mycobacteria of Runyon groups I, II and IV do not play an aetiological role in Crohn's disease. Eur J Gastroenterol Hepatol 1995; 7:1177-82. [PMID: 8789308 DOI: 10.1097/00042737-199512000-00009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In addition to Mycobacterium paratuberculosis, other slow-growing as well as rapid-growing mycobacteria were isolated from mucosa or full thickness samples of intestine from patients with Crohn's disease. The meaning of these data remained unclear. To investigate the possible aetiological role of these rapid- and slow-growing mycobacteria, serosa and mesenteric lymph nodes were also cultivated in the present study. DESIGN AND METHODS Mucosa, lymph nodes and serosa of 23 patients with Crohn's disease and 23 patients with other intestinal afflictions were incubated at 37 degrees C on Löwenstein-Jensen medium and Herrold egg yolk medium. These methods allow the cultivation of most atypical mycobacteria, including Mycobacterium paratuberculosis. In addition, full thickness samples of some of these patients were analysed for mycobacterial DNA using polymerase chain reaction. RESULTS Despite lack of decontamination of 60% of lymph nodes and serosa, no mycobacterial growth was observed over a long incubation period (an average of 718 days in Crohn's disease and 552 days in controls) on Löwenstein-Jensen medium. Polymerase chain reaction was based on the amplification of 16S ribosomal DNA sequences specific for mycobacteria of tissues derived from four patients with Crohn's disease and one control was negative. CONCLUSIONS These findings suggest that mycobacteria, such as M. fortuitum and M. chelonei, which are widespread in the environment, are not involved in the aetiology of Crohn's disease but, rather, should be considered as environmental opportunists.
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Affiliation(s)
- G Kreuzpaintner
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
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33
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Heissing R, Kirschner P, Römer H. [Wound drainage with a continuous high vacuum drainage system and a drainage system with variable vacuum]. Unfallchirurg 1995; 98:522-5. [PMID: 7502086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A study of 120 total hip replacements showed the advantages of the variable vacuum drainage system over the continuous high vacuum drainage system. Better wound healing, less severe hematomas and less occlusion of drains confirmed the higher effectiveness of secretion draining. With regard to hygienic aspects, and especially to wound infection, the continuous closed drainage system is an improvement of the intermittent closed drainage system.
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Affiliation(s)
- R Heissing
- Abteilung für Unfall- und Wiederherstellungschirurgie, St. Vincenz- und Elisabeth-Hospital Mainz
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34
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Springer B, Böttger EC, Kirschner P, Wallace RJ. Phylogeny of the Mycobacterium chelonae-like organism based on partial sequencing of the 16S rRNA gene and proposal of Mycobacterium mucogenicum sp. nov. Int J Syst Bacteriol 1995; 45:262-7. [PMID: 7537060 DOI: 10.1099/00207713-45-2-262] [Citation(s) in RCA: 104] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The Mycobacterium chelonae-like organism (MCLO) is a recently described member of the Mycobacterium fortuitum complex which causes posttraumatic skin infections and catheter sepsis. This taxon is a distinct group biochemically and has a unique mycolic acid profile as determined by high-performance liquid chromatography. Its phylogenetic relationships to other mycobacteria, however, have not been studied previously. We sequenced 1,062 bp of the 16S rRNA genes from three MCLO strains obtained from the American Type Culture Collection and compared our results with the sequences of previously described taxa of rapidly growing and slowly growing mycobacteria. Two biochemically typical strains (ATCC 49650T [T = type strain] and ATCC 49651) had identical sequences, while the sequence of a biochemically atypical strain (ATCC 49649) differed by 4 bp from the sequence of the two typical strains. The Hamming distances between these MCLO strains and related rapidly growing mycobacteria are comparable to the Hamming distances among taxa of rapidly growing mycobacteria established as species by DNA-DNA hybridization. We propose the name Mycobacterium mucogenicum sp. nov. for this new taxon because of the highly mucoid nature of most isolates on solid media.
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Affiliation(s)
- B Springer
- Institut für Medizinische Mikrobiologie, Medizinische Hochschule Hannover, Germany
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35
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Rudert M, Gross W, Kirschner P. [Gorham-Stout massive ostelysis. A case report]. Unfallchirurg 1995; 98:102-4. [PMID: 7709224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
One case of massive osteolysis Gorham-Stout is presented. Idiopathic osteolysis is a rare disease. The coincidental radiological diagnosis following minor trauma or a few months' history of mild pain involving joints is characteristic. The disease process has a sudden onset. Bones undergo partial or complete resorption, which may spread across joints to contiguous bones. The osteolytic process eventually ceases spontaneously, but generally not before severe deformation and destruction of bone has occurred. Usually radiotherapy is not successful and is followed by local resection of the osteolytic process. Based on our presented case, we suggest early operative treatment to prevent severe damage.
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Affiliation(s)
- M Rudert
- Abteilung Unfallchirurgie, St. Vincenz- und Elisabeth-Hospital, Mainz
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36
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Kirschner P, Vogel U, Hein R, Böttger EC. Bias of culture techniques for diagnosing mixed Mycobacterium genavense and Mycobacterium avium infection in AIDS. J Clin Microbiol 1994; 32:828-31. [PMID: 8195400 PMCID: PMC263133 DOI: 10.1128/jcm.32.3.828-831.1994] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Disseminated Mycobacterium avium infection is a common complication in late-stage AIDS. We describe a patient seropositive for human immunodeficiency virus with a disseminated infection caused by mycobacteria. Acid-fast rods were visible by microscopy in stool and bone marrow and in specimens from skin, liver, spleen, lung, and lymph nodes. Using molecular biology techniques and standard culture techniques, we found evidence of a mixed mycobacterial infection with M. genavense and M. avium. We suggest that the prevalence of M. genavense infection in patients with AIDS is underestimated because of the bias toward M. avium when using standard techniques for the detection and identification of mycobacteria.
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Affiliation(s)
- P Kirschner
- Institut für Medizinische Mikrobiologie, Medizinische Hochschule Hannover, Germany
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37
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Meier A, Kirschner P, Bange FC, Vogel U, Böttger EC. Genetic alterations in streptomycin-resistant Mycobacterium tuberculosis: mapping of mutations conferring resistance. Antimicrob Agents Chemother 1994; 38:228-33. [PMID: 8192448 PMCID: PMC284431 DOI: 10.1128/aac.38.2.228] [Citation(s) in RCA: 108] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
We report on the identification of mutations associated with streptomycin resistance in Mycobacterium tuberculosis. Two isolates (3656 and 3976) showed a wild-type ribosomal protein, S12, but exhibited a single point mutation at 16S rRNA position 491 (C-->T) or 512 (C-->T), respectively. Sequence analysis of a third isolate (2438) revealed a single base change at 16S rRNA position 904 (A-->G). This position is equivalent to invariant position 913 of the Escherichia coli 16S rRNA gene, an A-->G transition of which has been shown previously to impair streptomycin binding and streptomycin-induced misreading in vivo. Surprisingly, strain 2438 harbors an additional mutation in the ribosomal protein S12 (Lys-88-->Gln).
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Affiliation(s)
- A Meier
- Institut für Medizinische Mikrobiologie, Medizinische Hochschule Hannover, Germany
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38
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Meier A, Kirschner P, Springer B, Steingrube VA, Brown BA, Wallace RJ, Böttger EC. Identification of mutations in 23S rRNA gene of clarithromycin-resistant Mycobacterium intracellulare. Antimicrob Agents Chemother 1994; 38:381-4. [PMID: 8192472 PMCID: PMC284463 DOI: 10.1128/aac.38.2.381] [Citation(s) in RCA: 138] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Clarithromycin is a potent macrolide that has been used for treating infections with nontuberculous mycobacteria. Pairs of susceptible and resistant Mycobacterium intracellulare strains were obtained from patients with chronic pulmonary M. intracellulare infections undergoing monotherapy with clarithromycin. Nucleotide sequence comparisons of the peptidyltransferase region in 23S rRNAs from parental and resistant strains revealed that in three of six resistant strains, for which the MIC was > 32 micrograms/ml, a single base was mutated (Escherichia coli equivalent, A-2058-->G, C, or U). As the modification of adenine 2058 by dimethylation is a frequent cause of macrolide resistance in a variety of different bacteria, we suggest that mutation of A-2058 confers acquired resistance to clarithromycin in M. intracellulare.
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Affiliation(s)
- A Meier
- Institut für Medizinische Mikrobiologie, Medizinische Hochschule Hannover, Germany
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39
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Kreitner KF, Grebe P, Kersjes W, Runkel M, Kirschner P, Schild HH. [Application possibilities of MR arthrography in diseases of the shoulder joint]. ROFO-FORTSCHR RONTG 1994; 160:137-42. [PMID: 8312510 DOI: 10.1055/s-2008-1032391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In a prospective study possible indications for MR arthrography of the shoulder were evaluated. 37 patients were examined before and after intraarticular administration of a 2-mmolar solution of Gd-DTPA. MR arthrography was performed if there was no joint effusion and/or an uncertain finding concerning the rotator cuff or the capsulolabral complex on plain MR images. MR arthrography leads to a better demonstration of labrum pathology in 11/22 patients and to a superior delineation of the capsuloligamentous apparatus in 20/22 cases. In 9/15 patients with impingement lesions MR arthrography allowed a differentiation of severe tendinitis from partial and small full-thickness tears of the rotator cuff. MR arthrography of the shoulder joint enhances the accuracy of MR in case of an uncertain finding on plain MR images.
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Affiliation(s)
- K F Kreitner
- Klinik mit Poliklinik für Radiologie, Johannes-Gutenberg-Universität, Mainz
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40
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Abstract
The authors report on the pathologic findings in three cases of disseminated infection with Mycobacterium genavense, a recently described nontuberculous mycobacterium, in human immunodeficiency virus (HIV)-I-positive patients. The mycobacterium was identified by amplification of a 16S rDNA gene fragment and subsequent sequence determination. The organs mainly involved were the small intestine, spleen, liver, and lymph nodes. In contrast, lungs, myocardium, and kidneys were not involved, or only minimally involved, in this generalizing disease. Histopathologically, infection with Mycobacterium genavense in HIV-positive patients was mostly characterized by masses of foamy histiocytes and, depending on the immunologic reactivity of the host, by ill-formed granulomas, rarely with small foci of necrosis. The pathologic findings and clinical features were similar to those presented by patients who had generalized infection with Mycobacterium avium-intracellulare complex. To obtain more precise information about the specific course of infection with Mycobacterium genavense, scrupulous microbiologic investigations, including molecular biologic techniques, are necessary in cases with mycobacterial infections.
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Affiliation(s)
- H Maschek
- Pathologisches Institut, Medizinische Hochschule Hannover, Deutschland
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41
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Springer B, Kirschner P, Rost-Meyer G, Schröder KH, Kroppenstedt RM, Böttger EC. Mycobacterium interjectum, a new species isolated from a patient with chronic lymphadenitis. J Clin Microbiol 1993; 31:3083-9. [PMID: 7508452 PMCID: PMC266352 DOI: 10.1128/jcm.31.12.3083-3089.1993] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Mycobacterium-like organisms, isolates 2081/92 and 4185/92, were recovered from a lymph node of a child with chronic lymphadenitis. The growth characteristics, acid-fastness, and mycolic acids of the isolate were consistent with those for Mycobacterium species. The isolates were biochemically distinct from described Mycobacterium species, although they most closely resembled M. scrofulaceum. Comparative 16S rDNA sequencing showed that these isolates represent a new slow-growing Mycobacterium species which is named M. interjectum. Our results demonstrate the importance of 16S rDNA sequencing for recognizing the diversity of species within the genus Mycobacterium.
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Affiliation(s)
- B Springer
- Institut für Medizinische Mikrobiologie, Medizinische Hochschule Hannover, Germany
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42
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Kirschner P, Springer B, Vogel U, Meier A, Wrede A, Kiekenbeck M, Bange FC, Böttger EC. Genotypic identification of mycobacteria by nucleic acid sequence determination: report of a 2-year experience in a clinical laboratory. J Clin Microbiol 1993; 31:2882-9. [PMID: 7505291 PMCID: PMC266149 DOI: 10.1128/jcm.31.11.2882-2889.1993] [Citation(s) in RCA: 348] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Clinical isolates of Mycobacterium spp. were identified by direct sequence determination of 16S rRNA gene fragments amplified by polymerase chain reaction. Identification was based on a hypervariable region within the 16S rRNA gene in which mycobacterial species are characterized by species-specific nucleotide sequences. A manually aligned data base including the signature sequences of 52 species of mycobacteria easily allowed rapid and correct identification. The results of this study demonstrate that polymerase chain reaction-mediated direct sequence determination can be used as a rapid and reliable method for the identification of mycobacteria in the clinical laboratory. In addition, the prompt recognition of previously undescribed species is now feasible.
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Affiliation(s)
- P Kirschner
- Institut für Medizinische Mikrobiologie, Medizinische Hochschule Hannover, Germany
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43
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Finken M, Kirschner P, Meier A, Wrede A, Böttger EC. Molecular basis of streptomycin resistance in Mycobacterium tuberculosis: alterations of the ribosomal protein S12 gene and point mutations within a functional 16S ribosomal RNA pseudoknot. Mol Microbiol 1993; 9:1239-46. [PMID: 7934937 DOI: 10.1111/j.1365-2958.1993.tb01253.x] [Citation(s) in RCA: 265] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Multidrug-resistant strains of Mycobacterium tuberculosis have resulted in several recent outbreaks. Recognition of drug resistance is important both for treatment and to prevent further transmission. Here we use molecular biology techniques to study the basis of streptomycin resistance in single and multidrug-resistant M. tuberculosis. We demonstrate that streptomycin resistance is associated with mutations implicated in ribosomal resistance. The mutations found either lead to amino acid changes in ribosomal protein S12 or alter the primary structure of the 16S rRNA. The 16S rRNA region mutated perturbs a pseudoknot structure in a region which has been linked to ribosomal S12 protein.
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MESH Headings
- Base Sequence
- Blotting, Southern
- DNA Primers
- DNA, Bacterial/analysis
- DNA, Bacterial/genetics
- Drug Resistance, Microbial/genetics
- Drug Resistance, Multiple/genetics
- Genes, Bacterial
- Molecular Sequence Data
- Mutagenesis, Site-Directed
- Mycobacterium tuberculosis/drug effects
- Mycobacterium tuberculosis/genetics
- Mycobacterium tuberculosis/metabolism
- Nucleic Acid Conformation
- Point Mutation
- Polymerase Chain Reaction
- RNA, Ribosomal, 16S/chemistry
- RNA, Ribosomal, 16S/genetics
- Ribosomal Proteins/genetics
- Ribosomes/drug effects
- Ribosomes/metabolism
- Streptomycin/toxicity
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Affiliation(s)
- M Finken
- Institut für Medizinische Mikrobiologie, Medizinische Hochschule Hannover, Germany
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44
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Neustein SM, Cohen E, Reich D, Kirschner P. Transoesophageal echocardiography and the intraoperative diagnosis of left atrial invasion by carcinoid tumour. Can J Anaesth 1993; 40:664-6. [PMID: 8403140 DOI: 10.1007/bf03009703] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A 41-yr-old woman with pulmonary carcinoid tumour presented for thoracotomy and lung resection. However, intraoperative transoesophageal echocardiography (TEE) revealed that the tumour had invaded the left atrium, and the planned resection was aborted to allow resection under cardiopulmonary bypass at a later date. Although the incidence of cardiac involvement by lung cancer at the time of pulmonary resection is unknown, transoesophageal echocardiography can be useful in identifying the extension of hilar lung tumours. This should preferentially be done preoperatively, but can be done intraoperatively as described in this case report.
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Affiliation(s)
- S M Neustein
- Department of Anesthesiology, Mount Sinai Medical Center, New York, NY 10029
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45
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Abstract
The excretion of the urinary enzymes alanine aminopeptidase, alkaline phosphatase, gamma-glutamyl-transferase and N-acetyl-beta-D-glucosaminidase, and the 99mtechnetium-diethylenetriaminepentaacetic acid isotope clearance were studied in 35 patients treated with extracorporeal shock wave lithotripsy (ESWL*). Enzyme measurements were made before and consecutively on days 1, 2 and 5, and at 3 months after treatment. A control group investigated at the same intervals was included. Posttreatment enzyme values were not significantly different from those before treatment except for alkaline phosphatase on day 1 after ESWL. Some individuals had short-term increases of enzymuria that were greater than biological variations in the control group. The transient changes of enzymuria after ESWL had no predictive value for kidney function, since no decreased renal function was observed in individual patients with high enzyme excretions after ESWL.
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Affiliation(s)
- K Jung
- Department of Urology, University Hospital Charité, Humboldt University Berlin, Germany
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46
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Hofer M, Hirschel B, Kirschner P, Beghetti M, Kaelin A, Siegrist CA, Suter S, Teske A, Böttger EC. Brief report: disseminated osteomyelitis from Mycobacterium ulcerans after a snakebite. N Engl J Med 1993; 328:1007-9. [PMID: 8450852 DOI: 10.1056/nejm199304083281405] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- M Hofer
- Département de Pédiatrie, Hôpital Cantonal Universitaire, Geneva, Switzerland
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47
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Abstract
Strains of a new type of slowly growing mycobacterium were repeatedly isolated from sputum from a patient with pulmonary disease. This photochromogenic organism grew at 22, 31, 37, and 41 degrees C, possessed catalase, acid phosphatase, esterase, beta-galactosidase, and arylsulfatase activities, and hydrolyzed Tween. It did not produce nicotinic acid or have nitrate reductase, acetamidase, benzamidase, isonicotinamidase, nicotinamidase, pyrazinamidase, succinidamidase, and acid phosphatase activities. Urease activity was variable. The organism is susceptible to ethambutol and resistant to isoniazid and streptomycin. A mycolic acid analysis revealed the presence of alpha-mycolates, alpha'-mycolates, and keto-mycolates. The results of comparative 16S rRNA sequencing placed this organism at an intermediate position between the rapidly and slowly growing mycobacteria. On the basis of the pattern of enzymatic activities and metabolic properties, the results of fatty acid analyses, and the unique 16S rRNA sequence, we propose that this organism represents a new species, for which we propose the name Mycobacterium intermedium. The type strain is strain 1669/91; a culture of this strain has been deposited in the Deutsche Sammlung von Mikroorganismen und Zellkulturen as strain DSM 44049.
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Affiliation(s)
- A Meier
- Institut für Medizinische Mikrobiologie, Medizinische Hochschule Hannover, Germany
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48
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Abstract
Fever, loss of weight, anaemia, hepatosplenomegaly and lymphadenopathy developed in two HIV-infected patients. At first malignant lymphoma with septicaemia was thought to be the cause. In both patients Salmonella enteritidis was isolated by blood culture and found to be sensitive against the antibiotics that were given (5 g azlocillin and 2 g cefotaxime, three times daily each; additionally in case 2, metronidazole, 500 mg three times daily). Because bone-marrow biopsy demonstrated acid-fast rods, antimycobacterial treatment was started (isoniazid 300 mg/d, rifampicin 600 mg/d, ethambutol 1,200 mg/d and pyrazinamide 2 g/d). Despite this the patients died of septic shock. Histological examination revealed massive amounts of acid-fast rods in spleen, liver, gut and bone marrow. Polymerase chain reaction and sequencing identified the structure as that of the recently discovered M. genavense.
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Affiliation(s)
- H Heiken
- Abteilung Immunologie und Transfusionsmedizin, Medizinische Hochschule Hannover
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49
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Nadal D, Caduff R, Kraft R, Salfinger M, Bodmer T, Kirschner P, Böttger EC, Schaad UB. Invasive infection with Mycobacterium genavense in three children with the acquired immunodeficiency syndrome. Eur J Clin Microbiol Infect Dis 1993; 12:37-43. [PMID: 8462560 DOI: 10.1007/bf01997055] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Three children with human immunodeficiency virus infection and invasive infection with Mycobacterium genavense are reported. Fever spikes, abdominal cramps and distension, diarrhea or ileus, and anemia were the predominant symptoms in the severely immunodeficient patients (CD4 lymphocytes < 0.04 x 10(9)/l). Numerous acid-fast bacilli were readily detectable by microscopy in stool samples and in lymph node biopsies, but cultures for mycobacteria remained negative. Mycobacterium genavense should be sought when invasive non-tuberculous mycobacteriosis is suspected and mycobacterial cultures from blood or other sites show limited growth. Multiple-drug regimens including amikacin, ethambutol, rifampin, and clarithromycin may be of benefit in controlling the infection, as observed in two patients.
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Affiliation(s)
- D Nadal
- Department of Pediatrics, University of Zurich, Switzerland
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50
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Abstract
Acid-fast bacilli were isolated from lymph nodes of an immunocompetent child presenting with unilateral cervical lymphadenitis. The slowly growing mycobacterium could not be identified by traditional methods. Direct sequencing of the enzymatically amplified 16S rRNA gene revealed a unique sequence belonging to a previously unrecognized mycobacterium. Direct 16S rDNA sequencing enables definitive identification of mycobacterial isolates. The method is useful for rapid recognition of previously unrecognized pathogens.
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Affiliation(s)
- W H Haas
- Department of General Pediatrics, University Children's Hospital, University of Heidelberg, Germany
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