Association of extra-pulmonary tuberculosis with age, sex and season differs depending on the affected organ

SETTING

Data from tuberculosis (TB) cases in Germany who are continuously monitored for the purposes of epidemiological surveillance and disease control.

OBJECTIVE

To examine the distribution of age, sex, place of birth, seasonality and recurrence of TB disease in different types of TB organ manifestations, with particular focus on lymph nodes and pleura.

DESIGN

All TB cases reported to the Berlin State Office for Health and Social Affairs (LAGeSo) in Berlin, Germany, between 2001 and 2012 were analysed.

RESULTS

Significant differences with regard to seasonal variation as well as age and sex distribution were seen when comparing pleural TB and TB of the extrathoracic lymph nodes, the predominant types of extra-pulmonary TB. EPTB was generally more prevalent in patients born outside Europe. In contrast to a previous study, an increase in recurrent TB was not observed in EPTB when compared to pulmonary TB cases.

CONCLUSION

Significant differences in TB organ manifestation in association with season, sex and age suggest different pathophysiological mechanisms of disease development. Future studies might provide further insight into the mechanism of TB development and may therefore be of help in the prevention and treatment of EPTB.

Tularaemia in Berlin - two independent cases in travellers returning from central Anatolia, Turkey, February 2011

Tularaemia, though rare, has recently been increasingly reported in Germany. Most cases are indigenous infections. This report describes two epidemiologically independent infections with Francisella tularensis subspecies holarctica detected in Berlin in February 2011 that were acquired in central Anatolia, Turkey. In Turkey, there have been repeated tularaemia outbreaks since 2000 and the disease should therefore be considered as a differential diagnosis in travellers returning from that country.

Tularaemia in Berlin – two independent cases in travellers returning from central Anatolia, Turkey, February 2011

Tularaemia, though rare, has recently been increasingly reported in Germany. Most cases are indigenous infections. This report describes two epidemiologically independent infections with Francisella tularensis subspecies holarctica detected in Berlin in February 2011 that were acquired in central Anatolia, Turkey. In Turkey, there have been repeated tularaemia outbreaks since 2000 and the disease should therefore be considered as a differential diagnosis in travellers returning from that country.

Cohort profile: the German ClinSurv HIV project--a multicentre open clinical cohort study supplementing national HIV surveillance

BACKGROUND

New forms of HIV/AIDS therapy require new surveillance instruments to meet shifting public health demands. The Clinical Surveillance of HIV Disease (ClinSurv HIV) project was established in 1999 as a collaboration between major HIV treatment centres in Germany and the Robert Koch Institute (RKI). The project contributes to national HIV surveillance and focuses on the changing epidemiology of HIV/AIDS after the introduction of new therapies in 1995.

METHODS

ClinSurv HIV is designed as an open multicentre observational cohort study of HIV-infected patients. Anonymized data on diagnoses, treatment and laboratory parameters are collected in a standardized format. Data are currently sampled biannually via 11 centres specializing in HIV diagnosis and care within the legal framework of the German Protection against Infection Act [Infektionsschutzgesetz (IfSG)].

RESULTS

A total of 14874 patients were enrolled in the study by 30 June 2009. Of these, 10221 patients (68.7%) were enrolled after 1 January 1999 and 6006 patients (40.4%) were known to have been diagnosed as positive for HIV before 1999. Evaluation indicators, such as the number of newly enrolled patients per half-year period, loss to follow-up, completeness of data per case, availability of data per possible clinical contact, and internal quality control parameters, show a very stable evolution in the cohort, which although open, can be observed. Comparison with the national HIV surveillance data suggests a high degree of representativeness according to major demographic variables.

CONCLUSION

Bearing in mind the obvious strengths and weaknesses discussed, the German ClinSurv HIV cohort provides a broad range of research opportunities in the field of HIV/AIDS both within Germany and in international collaborative research.

Spotlight on measles 2010: preliminary report of an ongoing measles outbreak in a subpopulation with low vaccination coverage in Berlin, Germany, January-March 2010

Since early January 2010, Berlin has been experiencing a measles outbreak with 62 cases as of 31 March. The index case acquired the infection in India. In recent years, measles incidence in Berlin has been lower than the German average and vaccination coverage in school children has increased since 2001. However, this outbreak involves schools and kindergartens with low vaccination coverage and parents with critical attitudes towards vaccination, which makes the implementation of public health interventions challenging.

Spotlight on measles 2010: Preliminary report of an ongoing measles outbreak in a subpopulation with low vaccination coverage in Berlin, Germany, January-March 2010

Since early January 2010, Berlin has been experiencing a measles outbreak with 62 cases as of 31 March. The index case acquired the infection in India. In recent years, measles incidence in Berlin has been lower than the German average and vaccination coverage in school children has increased since 2001. However, this outbreak involves schools and kindergartens with low vaccination coverage and parents with critical attitudes towards vaccination, which makes the implementation of public health interventions challenging.

Implications of and perspectives on HIV surveillance using a serological method to measure recent HIV infections in newly diagnosed individuals: results from a pilot study in Berlin, Germany, in 2005-2007

OBJECTIVES

This cross-sectional study was designed to pilot the analysis of clinical data, knowledge about and attitudes towards HIV/AIDS, and prevention and risk behaviour in persons recently infected with HIV.

METHODS

Blood samples and demographic, laboratory, clinical and behavioural data were collected from patients with newly diagnosed HIV infections. The BED IgG-capture ELISA (BED-CEIA) was used to determine the recency of infection.

RESULTS

Recent HIV infections contributed 54% [95% confidence interval (CI) 45; 64%] of infections in men who have sex with men (MSM) and 16% (95% CI 0; 39%) of infections in patients with other transmission risks (P=0.041). Recently infected MSM were characterized by younger age and higher viral load as compared with MSM who had longstanding infections (P=0.011 and 0.005, respectively). Symptoms during primary infection and patients' assumptions with regard to time of infection were significantly correlated with test results indicating whether or not the HIV infection was recently acquired (P<0.001).

CONCLUSIONS

Cross-sectional surveillance of recent HIV infections proved to be relevant to the identification of current risks for acquiring HIV infection. The high proportion of recent HIV infections in MSM and the even higher proportion in MSM younger than 30 years indicate ongoing HIV transmission in this group. The method will be used in future national HIV surveillance in Germany.

Country-wide HIV incidence study complementing HIV surveillance in Germany

Serological methods exist that allow differentiating between recent and long-standing infections in persons infected with HIV. During a pilot study in Berlin between 2005 and 2007 methodologies have been evaluated. In a cross-sectional study blood samples, demographic, laboratory, clinical and behavioural data based on a KABP survey were collected from patients with newly diagnosed HIV infections. The BED-CEIA was used to determine recency of infection. Recent HIV infections contributed 54% (CI [95%]: 45; 64) in MSM and 16% (CI [95%]: 0; 39) in patients with other transmission risks (p=0.041). Proportions of recent infections were significantly higher in MSM ≤30 years (p=0.019). The mean age was 33.9 (median 34 years) in recent compared with 38.6 years (median: 38 years) in long-standing infections (p=0.011). High-risk behaviour indicated through very low condom use in recently HIV infected MSM could be identified. The results of the pilot study support expectations that the modified application of the method may contribute to improving HIV prevention efforts in Germany. On this basis the Robert Koch Institute implemented a countrywide HIV incidence study to complement HIV surveillance in early 2008. The study is funded by the German Ministry of Health. Data on recent HIV infections and current HIV transmission risks are collected. Design, methods and impact are described in detail.

Country-wide HIV incidence study complementing HIV surveillance in Germany

Serological methods exist that allow differentiating between recent and long-standing infections in persons infected with HIV. During a pilot study in Berlin between 2005 and 2007 methodologies have been evaluated. In a cross-sectional study blood samples, demographic, laboratory, clinical and behavioural data based on a KABP survey were collected from patients with newly diagnosed HIV infections. The BED-CEIA was used to determine recency of infection. Recent HIV infections contributed 54% (CI [95%]: 45; 64) in MSM and 16% (CI [95%]: 0; 39) in patients with other transmission risks (p=0.041). Proportions of recent infections were significantly higher in MSM <or=30 years (p=0.019). The mean age was 33.9 (median 34 years) in recent compared with 38.6 years (median: 38 years) in long-standing infections (p=0.011). High-risk behaviour indicated through very low condom use in recently HIV infected MSM could be identified. The results of the pilot study support expectations that the modified application of the method may contribute to improving HIV prevention efforts in Germany. On this basis the Robert Koch Institute implemented a countrywide HIV incidence study to complement HIV surveillance in early 2008. The study is funded by the German Ministry of Health. Data on recent HIV infections and current HIV transmission risks are collected. Design, methods and impact are described in detail. .

[Human granulocytic ehrlichiosis. New tick bite disease lies in wait also in German forests]

HGE is an uncommon zoonosis, transmitted to humans by ticks (Ixodes ricinus). Heavily exposed persons, such as foresters and forestry workers, are most at risk of infection. HGE usually runs an asymptomatic and self-limiting course. Symptoms include acute pyrexial illness, frequently accompanied by muscle pain, headache, nausea and vomiting. Treatment is with doxycycline/tetracycline or rifampicin. In a study in Hesse of 128 heavily exposed subjects, 19.5% had serum antibodies (IFA test) against HGE versus 4.4% in a control group. This difference is statistically significant. The prevalence of both symptoms and the seropositivity differ significantly between locations. HGE should be considered in the differential diagnosis of fever of unknown origin following tick bite exposure, at least in the North Hesse region.

Determination of the T3-3A1 antigen in PHA-induced human T-cells by standardized cell-ELISA

The treatment of mononuclear leukocytes (MNL) with lectins induces marked changes in the cell's morphology, physiology and the composition of the cell surface. We used an immunoassay to monitor the PHA-induced expression of the T-lymphocyte-specific antigen T3-3A1 in fixed MNL with a monoclonal antibody (MoAb) specific for this antigen. This assay permits the detection and quantitation of the T3-3A1 antigen in a few thousand cells without the use of a FACS. The test was calibrated with isolated plasma membranes and, combined with a total protein determination, the relative content of T3-3A1 antigen in each sample could be calculated. Maximal T3-3A1 synthesis required a 10-fold lower concentration of PHA than was necessary for optimal DNA synthesis. The test may be used to screen for PHA stimulation.