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Rachow A, Ivanova O, Bakuli A, Khosa C, Nhassengo P, Owolabi O, Jayasooriya S, Ntinginya NE, Sabi I, Rassool M, Bennet J, Niemann S, Mekota AM, Allwood BW, Wallis RS, Charalambous S, Hoelscher M, Churchyard G. Performance of spirometry assessment at TB diagnosis. Int J Tuberc Lung Dis 2023; 27:850-857. [PMID: 37880896 PMCID: PMC10599411 DOI: 10.5588/ijtld.23.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/08/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND: Spirometry is considered relevant for the diagnosis and monitoring of post-TB lung disease. However, spirometry is rarely done in newly diagnosed TB patients.METHODS: Newly diagnosed, microbiologically confirmed TB patients were recruited for the study. Spirometry was performed within 21 days of TB treatment initiation according to American Thoracic Society/European Respiratory Society guidelines. Spirometry analysis was done using Global Lung Initiative equations for standardisation.RESULTS: Of 1,430 eligible study participants, 24.7% (353/1,430) had no spirometry performed mainly due to contraindications and 23.0% (329/1,430) had invalid results; 52.3% (748/1,430) of participants had a valid result, 82.8% (619/748) of whom had abnormal spirometry. Of participants with abnormal spirometry, 70% (436/619) had low forced vital capacity (FVC), 6.1% (38/619) had a low ratio of forced expiratory volume in 1 sec (FEV1) to FVC, and 19.1% (118/619) had low FVC, as well as low FEV1/FVC ratio. Among those with abnormal spirometry, 26.3% (163/619) had severe lung impairment.CONCLUSIONS: In this population, a high proportion of not performed and invalid spirometry assessments was observed; this was addressed by removing tachycardia as a (relative) contraindication from the study guidance and retraining. The high proportion of patients with severe pulmonary impairment at the time of TB diagnosis suggests a huge morbidity burden and calls for further longitudinal studies on the relevance of spirometry in predicting chronic lung impairment after TB.
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Affiliation(s)
- A Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - O Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich
| | - A Bakuli
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich
| | - C Khosa
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - P Nhassengo
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - O Owolabi
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - S Jayasooriya
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - N E Ntinginya
- Mbeya Medical Research Centre, National Institute for Medical Research, Mbeya, Tanzania
| | - I Sabi
- Mbeya Medical Research Centre, National Institute for Medical Research, Mbeya, Tanzania
| | - M Rassool
- Clinical HIV Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - J Bennet
- Clinical HIV Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - S Niemann
- Leibniz Lung Center, Research Center Borstel, Borstel, Germany
| | - A-M Mekota
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich
| | - B W Allwood
- Division of Pulmonology, Department of Medicine Stellenbosch University and Tygerberg Hospital, Cape Town
| | | | - S Charalambous
- The Aurum Institute, Johannesburg, Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - M Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - G Churchyard
- The Aurum Institute, Johannesburg, Department of Medicine, Vanderbilt University, Nashville, TN, USA
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Dierig A, Hoelscher M, Schultz S, Hoffmann L, Jarchow-MacDonald A, Svensson EM, Te Brake L, Aarnoutse R, Boeree M, McHugh TD, Wildner LM, Gong X, Phillips P, Minja LT, Ntinginya N, Mpagama S, Liyoyo A, Wallis RS, Sebe M, Mhimbira FA, Mbeya B, Rassool M, Geiter L, Cho YL, Heinrich N. A phase IIb, open-label, randomized controlled dose ranging multi-centre trial to evaluate the safety, tolerability, pharmacokinetics and exposure-response relationship of different doses of delpazolid in combination with bedaquiline delamanid moxifloxacin in adult subjects with newly diagnosed, uncomplicated, smear-positive, drug-sensitive pulmonary tuberculosis. Trials 2023; 24:382. [PMID: 37280643 DOI: 10.1186/s13063-023-07354-5] [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: 09/01/2022] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Linezolid is an effective, but toxic anti-tuberculosis drug that is currently recommended for the treatment of drug-resistant tuberculosis. Improved oxazolidinones should have a better safety profile, while preserving efficacy. Delpazolid is a novel oxazolidinone developed by LegoChem Biosciences Inc. that has been evaluated up to phase 2a clinical trials. Since oxazolidinone toxicity can occur late in treatment, LegoChem Biosciences Inc. and the PanACEA Consortium designed DECODE to be an innovative dose-ranging study with long-term follow-up for determining the exposure-response and exposure-toxicity relationship of delpazolid to support dose selection for later studies. Delpazolid is administered in combination with bedaquiline, delamanid and moxifloxacin. METHODS Seventy-five participants with drug-sensitive, pulmonary tuberculosis will receive bedaquiline, delamanid and moxifloxacin, and will be randomized to delpazolid dosages of 0 mg, 400 mg, 800 mg, 1200 mg once daily, or 800 mg twice daily, for 16 weeks. The primary efficacy endpoint will be the rate of decline of bacterial load on treatment, measured by MGIT liquid culture time to detection from weekly sputum cultures. The primary safety endpoint will be the proportion of oxazolidinone class toxicities; neuropathy, myelosuppression, or tyramine pressor response. Participants who convert to negative liquid media culture by week 8 will stop treatment after the end of their 16-week course and will be observed for relapse until week 52. Participants who do not convert to negative culture will receive continuation phase treatment with rifampicin and isoniazid to complete a six-month treatment course. DISCUSSION DECODE is an innovative dose-finding trial, designed to support exposure-response modelling for safe and effective dose selection. The trial design allows assessment of occurrence of late toxicities as observed with linezolid, which is necessary in clinical evaluation of novel oxazolidinones. The primary efficacy endpoint is the change in bacterial load, an endpoint conventionally used in shorter dose-finding trials. Long-term follow-up after shortened treatment is possible through a safety rule excluding slow-and non-responders from potentially poorly performing dosages. TRIAL REGISTRATION DECODE was registered in ClinicalTrials.gov before recruitment start on 22 October 2021 (NCT04550832).
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Affiliation(s)
- A Dierig
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Munich, Germany
- German Center for Infection Research (DZIF), Munich partner site, Munich, Germany
| | - M Hoelscher
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Munich, Germany
- German Center for Infection Research (DZIF), Munich partner site, Munich, Germany
| | - S Schultz
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Munich, Germany
- German Center for Infection Research (DZIF), Munich partner site, Munich, Germany
| | - L Hoffmann
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Munich, Germany
- German Center for Infection Research (DZIF), Munich partner site, Munich, Germany
| | - A Jarchow-MacDonald
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Munich, Germany
- German Center for Infection Research (DZIF), Munich partner site, Munich, Germany
- Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK
| | - E M Svensson
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | - L Te Brake
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R Aarnoutse
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M Boeree
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - T D McHugh
- Division of Infection & Immunity, UCL Centre for Clinical Microbiology, University College of London, London, UK
| | - L M Wildner
- Division of Infection & Immunity, UCL Centre for Clinical Microbiology, University College of London, London, UK
| | - X Gong
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of California San Francisco, San Francisco, USA
| | - Ppj Phillips
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of California San Francisco, San Francisco, USA
| | - L T Minja
- National Institute for Medical Research, Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - N Ntinginya
- National Institute for Medical Research, Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - S Mpagama
- Kilimanjaro Clinical Research Institute, Kilimanjaro, Tanzania
| | - A Liyoyo
- Kilimanjaro Clinical Research Institute, Kilimanjaro, Tanzania
| | - R S Wallis
- The Aurum Institute, Tembisa, South Africa
| | - M Sebe
- The Aurum Institute, Tembisa, South Africa
| | - F A Mhimbira
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - B Mbeya
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - M Rassool
- Clinical HIV Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - L Geiter
- LegoChem Biosciences, Daejeon, South Korea
| | - Y L Cho
- LegoChem Biosciences, Daejeon, South Korea
| | - N Heinrich
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Munich, Germany.
- German Center for Infection Research (DZIF), Munich partner site, Munich, Germany.
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3
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Sabi I, Olomi W, Nkereuwem E, Togun T, Gomez MP, Sylla M, Diarra B, Sanogo M, Sichone E, Mahiga H, Njeleka F, Ebonyi AO, Egere U, Ntinginya NE, Hoelscher M, Heinrich N, Kampmann B. Diagnosis of paediatric TB using Xpert ® MTB/RIF Ultra on fresh respiratory samples. Int J Tuberc Lung Dis 2022; 26:862-868. [PMID: 35996291 PMCID: PMC9423021 DOI: 10.5588/ijtld.22.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE: To evaluate the diagnostic accuracy of Xpert® MTB/RIF Ultra (Ultra) on fresh respiratory samples for the diagnosis of pulmonary TB (PTB) in children.METHODS: Between July 2017 and December 2019, children with presumed TB were prospectively enrolled at clinical sites in three African countries. Children were assessed using history, physical examination and chest X-ray. Sputum or gastric aspirate samples were analysed using Ultra and culture. The diagnostic accuracy of Ultra was calculated against culture as the reference standard.RESULTS: In total, 547children were included. The median age was 4.7 years, 77 (14.1%) were HIV infected and 77 (14.1%) had bacteriologically confirmed TB. Ultra detected an additional 20 cases in the group of children with negative culture results. The sensitivity of Ultra was 66.3% (95% CI 47-82), and the specificity was 95.4% (95% CI 89-99) when assessed against culture as the reference standard.CONCLUSION: Despite the improved performance of Ultra as compared to Xpert as was previously reported, its sensitivity remains sub-optimal for the detection of TB in children. Ultra detected additional 20 cases which otherwise could not have been detected by culture alone, suggesting that the latter is an imperfect reference standard.
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Affiliation(s)
- I Sabi
- National Institute for Medical Research, Mbeya Medical Research Center, Mbeya, Tanzania, Center for International Health, University Hospital, Ludwig Maximilian University (LMU) Munich, Germany
| | - W Olomi
- National Institute for Medical Research, Mbeya Medical Research Center, Mbeya, Tanzania
| | - E Nkereuwem
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - T Togun
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - M P Gomez
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - M Sylla
- Paediatrics Department, University Teaching Hospital Gabriel Toure, Bamako, Mali
| | - B Diarra
- University Clinical Research Centre, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - M Sanogo
- University Clinical Research Centre, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - E Sichone
- National Institute for Medical Research, Mbeya Medical Research Center, Mbeya, Tanzania
| | - H Mahiga
- National Institute for Medical Research, Mbeya Medical Research Center, Mbeya, Tanzania
| | - F Njeleka
- National Institute for Medical Research, Mbeya Medical Research Center, Mbeya, Tanzania
| | - A O Ebonyi
- Department of Paediatrics, Jos University Teaching Hospital, Jos, Nigeria
| | - U Egere
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - N E Ntinginya
- National Institute for Medical Research, Mbeya Medical Research Center, Mbeya, Tanzania
| | - M Hoelscher
- Center for International Health, University Hospital, Ludwig Maximilian University (LMU) Munich, Germany, German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany, Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Germany
| | - N Heinrich
- Center for International Health, University Hospital, Ludwig Maximilian University (LMU) Munich, Germany, German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany, Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Germany
| | - B Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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4
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Boeree MJ, Lange C, Thwaites G, Paton N, de Vrueh R, Barros D, Hoelscher M. UNITE4TB: a new consortium for clinical drug and regimen development for TB. Int J Tuberc Lung Dis 2021; 25:886-889. [PMID: 34686229 PMCID: PMC8544922 DOI: 10.5588/ijtld.21.0515] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- M J Boeree
- Lung Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - C Lange
- Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
| | - G Thwaites
- Clinical Research Unit, Hospital for Tropical Diseases, Oxford University, Oxford, UK
| | | | | | - D Barros
- Global Health, GSK, Brentford, UK
| | - M Hoelscher
- Department of Infectious Diseases and Tropical Medicine, Munich, Germany
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Pfeifer P, Hoelscher M, Werner N, Nickenig G, Jansen F. TAC induced cardiac hypertrophy leads to increased levels of circulating microvesicles. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Cardiac hypertrophy and heart failure are wide spread diseases of elderly patients in the industrialised world and drive a majority of healthcare costs in these countries. Therefore, there is a high urgency to understand the development and progress of heart failure to find new therapeutic strategies especially in early stages. Microvesicles are involved in the development and propagation of almost all cardiac diseases and increased levels of circulating microvesicles can be found in blood of patients with chronic heart failure. To point out the underlying mechanisms and to provide a new animal model based approach, we investigated microvesicle (MV)-release in mice that underwent Transverse Aortic Constriction (TAC). TAC is a common method to induce cardiac hypertrophy and heart failure in mice by inducing pressure overload. We hypothesized that TAC leads to upregulation of total MV and MV of specific origin.
Methods and results
Wildtype C57BL/6 mice underwent TAC to induce cardiac hypertrophy and heart failure. After TAC, mice developed cardiac hypertrophy as determined by altered heart weight/ bodyweight ratio, end-diastolic and end-systolic diameter and decreased fractional shortening. Total numbers of circulating microvesicles were detected 1, 4 and 12 weeks after TAC. We found that total numbers of circulating macrovesicles raised in a time dependent manner. Similar observations could be done with samples stained for annexin V, although results were not significant. Moreover, microvesicles were stained with specific surface markers for lymphocyte (CD3), monocyte (CD14), endothelial cells (CD31), thrombocytes (CD41), B-cells (CD45) and neutrophils (Lys6). One week after TAC increased numbers of specific microvesicles could be detected which in the course declined rapidly. Only microvesicles subgroup of lymphocyte origin showed significant increase one week after TAC-OP.
Conclusion
In this study, we show that total number of circulating microvesicles raise after TAC over an observation period of 12 weeks. Furthermore, we found that increased numbers of circulating microvesicles of specific origin like lymphocytes, monocytes, endothelial cells, thrombocytes, B-cells and neutrophils showed a trend towards increased levels one week after TAC with a rapid decline in subsequent detection. To our knowledge this is the first time that the impact of TAC on number of circulating microvesicles in mice was investigated. Future studies should characterize the content and effects of these MV on recipient cells to elucidate possible contributions to heart failure progression or protective effects. Detecting new harmful or protective effects of heart failure triggered by circulating microvesicles could offer new highly needed approaches to suppress heart failure development or deliver the possibility to develop new drugs for heart failure treatment.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Else Kröner-Fresenius
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Affiliation(s)
- P Pfeifer
- University Hospital Bonn, Department of Internal Medicine II Cardiology, Pneumology, and Angiology, Bonn, Germany
| | - M Hoelscher
- University Hospital Bonn, Department of Internal Medicine II Cardiology, Pneumology, and Angiology, Bonn, Germany
| | - N Werner
- University Hospital Bonn, Department of Internal Medicine II Cardiology, Pneumology, and Angiology, Bonn, Germany
| | - G Nickenig
- University Hospital Bonn, Department of Internal Medicine II Cardiology, Pneumology, and Angiology, Bonn, Germany
| | - F Jansen
- University Hospital Bonn, Department of Internal Medicine II Cardiology, Pneumology, and Angiology, Bonn, Germany
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Koentges C, Khan E, Birkle S, Hoelscher M, Pfeil K, Gollmer J, Hoffmann M, Bode C, Zirlik A, Bugger H. Sirtuin 4 contributes to heart failure development by increasing mitochondrial oxidative stress. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Sirtuin 4 (SIRT4) is a mitochondrial NAD+-dependent deacylase which inhibits the oxidation of glucose and fatty acids, and has been implicated in the regulation of oxidative stress. Given the importance of cardiac energy depletion and ROS during heart failure development, we aimed to define the role of SIRT4 in the development of heart failure. Mice with deletion (SIRT4−/−) or overexpression (SIRT4 TG) of SIRT4 were subjected to transverse aortic constriction (TAC) for 12 weeks or underwent sham procedures. Using echocardiography, ejection fraction (EF) was not different between SIRT4 TG and WT mice subjected to sham operations. In contrast, TAC induced a more pronounced decrease in EF (35% vs. 51%; p<0.05), and a more pronounced increase in LV endsystolic diameter (4.5mm vs. 3.6mm; p<0.05) and myocardial fibrosis (2.2-fold; p<0.05) in SIRT4 TG mice compared to WT mice. Myocardial levels of the lipid peroxidation product 4-hydroxynonenal were increased in WT mice following TAC and were synergistically increased in SIRT4 TG mice following TAC (+66% vs. WT TAC; p<0.05). Administration of the mitochondria-targeted antioxidant MitoQ normalized 4-hydroxynonenal levels, markedly attenuated the decline in EF and almost normalized endsystolic LV diameter in SIRT4 TG mice following TAC. Cardiac function and morphology were unaffected in SIRT4−/− mice during normal or increased workload conditions. Thus, while SIRT4 is not required to maintain cardiac function even in response to increased energy demands, increased expression of SIRT4 accelerates the development of heart failure following TAC, at least in part due to increased mitochondrial oxidative stress.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): German Research Foundation
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Affiliation(s)
- C Koentges
- Heart Center Freiburg University, Cardiology and Angiology I, Freiburg, Germany
| | - E Khan
- Heart Center Freiburg University, Cardiology and Angiology I, Freiburg, Germany
| | - S Birkle
- Heart Center Freiburg University, Cardiology and Angiology I, Freiburg, Germany
| | - M Hoelscher
- Heart Center Freiburg University, Cardiology and Angiology I, Freiburg, Germany
| | - K Pfeil
- Medical University of Graz, Department of Cardiology, Graz, Austria
| | - J Gollmer
- Medical University of Graz, Department of Cardiology, Graz, Austria
| | - M.M Hoffmann
- University Hospital of Freiburg, Institute for Clinical Chemistry and Laboratory Medicine, Freiburg, Germany
| | - C Bode
- Heart Center Freiburg University, Cardiology and Angiology I, Freiburg, Germany
| | - A Zirlik
- Medical University of Graz, Department of Cardiology, Graz, Austria
| | - H Bugger
- Medical University of Graz, Department of Cardiology, Graz, Austria
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Abstract
BACKGROUND This is a report on the high incidence of olfactory dysfunction in COVID-19 patients in the first cohort of COVID-19 patients in Germany (Webasto cluster). METHODS Loss of sense of smell and/or taste was reported by 26 of 63 COVID-19 patients (41%), whereas only 31% of the patients experiencing hyposmia had simultaneous symptoms of rhinitis. Smell tests were performed in 14 of these patients and taste tests in 10. The measurements were conducted in a patient care setting in an early COVID-19 cohort. RESULTS An olfactory disorder was present in 10/14 patients, before as well as after nasal decongestion. In 2 of these patients, hyposmia was the leading or only symptom of SARS-CoV‑2 infection. All tested patients reported recovery of smell and/or taste within 8 to 23 days. CONCLUSION The data imply that a) COVID-19 can lead to hyposmia in a relevant number of patients, the incidence was approximately 30% in this cohort; b) in most cases, the olfactory disturbance was not associated with nasal obstruction, thus indicating a possible neurogenic origin; and c) the olfactory disorder largely resolved within 1-3 weeks after the onset of COVID-19 symptoms. There were no indications of an increased incidence of dysgeusia. These early data may help in the interpretation of COVID-19-associated hyposmia as well as in the counseling of patients, given the temporary nature of hyposmia observed in this study. Furthermore, according to the current experience, hyposmia without rhinitic obstruction can be the leading or even the only symptom of a SARS-CoV‑2 infection.
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Affiliation(s)
- S Bocksberger
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, München Klinik Schwabing, Akademisches Lehrkrankenhaus der Ludwig-Maximilians-Universität, Kölner Platz 1, 80804, München, Deutschland
| | - W Wagner
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, München Klinik Schwabing, Akademisches Lehrkrankenhaus der Ludwig-Maximilians-Universität, Kölner Platz 1, 80804, München, Deutschland.
- Universitätsklinikum der Eberhard Karls Universität, Tübingen, Deutschland.
| | - T Hummel
- Interdisziplinäres Zentrum für Riechen und Schmecken, Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - W Guggemos
- Infektiologie und Tropenmedizin, München Klinik Schwabing, Akademisches Lehrkrankenhaus der Ludwig-Maximilians-Universität, Kölner Platz 1, 80804, München, Deutschland
| | - M Seilmaier
- Infektiologie und Tropenmedizin, München Klinik Schwabing, Akademisches Lehrkrankenhaus der Ludwig-Maximilians-Universität, Kölner Platz 1, 80804, München, Deutschland
| | - M Hoelscher
- Abteilung für Infektions- und Tropenmedizin, Klinikum der Ludwig-Maximilians-Universität, Leopoldstraße 5, 80802, München, Deutschland
| | - C-M Wendtner
- Infektiologie und Tropenmedizin, München Klinik Schwabing, Akademisches Lehrkrankenhaus der Ludwig-Maximilians-Universität, Kölner Platz 1, 80804, München, Deutschland
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Neumann AC, Bauer D, Hoelscher M, Haisch C, Wieser A. Identifying Dormant Growth State of Mycobacteria by Orthogonal Analytical Approaches on a Single Cell and Ensemble Basis. Anal Chem 2018; 91:881-887. [DOI: 10.1021/acs.analchem.8b03646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- A.-C. Neumann
- German Center for Infection Research (DZIF), Partner Site Munich, 80802 Munich, Germany
| | - D. Bauer
- Chair of Analytical Chemistry and Water Chemistry, Technical University of Munich, Munich, Germany
| | - M. Hoelscher
- German Center for Infection Research (DZIF), Partner Site Munich, 80802 Munich, Germany
| | - C. Haisch
- Chair of Analytical Chemistry and Water Chemistry, Technical University of Munich, Munich, Germany
| | - A. Wieser
- German Center for Infection Research (DZIF), Partner Site Munich, 80802 Munich, Germany
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9
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Wayant C, Moore G, Hoelscher M, Cook C, Vassar M. Adherence to reporting guidelines and clinical trial registration policies in oncology journals: a cross-sectional review. BMJ Evid Based Med 2018; 23:104-110. [PMID: 29653939 DOI: 10.1136/bmjebm-2017-110855] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 03/08/2018] [Indexed: 01/10/2023]
Abstract
Reporting guidelines (RG) aim to improve research transparency and ensure high-quality study reporting. Similarly, clinical trial registration policies aim to reduce bias in results reporting by ensuring prospective registration of all trial outcomes. Failure to adhere to quality standards documented in RGs may result in low-quality and irreproducible research. Herein, we investigate the adherence to common RGs and trial registration policies in 21 oncology journals. We surveyed the Instructions for Authors page for each of the included oncology journals for adherence to common reporting guidelines and trial registration policies. We corresponded with editors to determine accepted study types and cross-referenced this information with a journal's RGs and trial registration policies to calculate the per cent of journals that adhere to a specific guideline or policy. 76.2% (16/21) of oncology journals surveyed adhere to Consolidated Standards of Reporting Trials guidelines for clinical trials while only 33.3% (7/21) adhere to Strengthening the Reporting of Observational Studies in Epidemiology for observational studies. Similarly, 76.2% (16/21) of oncology journals adhere to clinical trial registration policies. We further demonstrate that journal adherence to RGs positively affects author reporting, despite adherence to trial registration policies showing no such benefit. Our results show that oncology journals adhere to RGs and trial registration policies at a higher rate than other specialties, but nonetheless show room for improvement. We conclude that oncology journal adherence to RGs and trial registration policies is encouraging, but nonetheless suboptimal. We recommend the adoption of RGs and trial registration policies by all oncology journals.
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Affiliation(s)
- Cole Wayant
- Department of Psychiatry, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Gretchan Moore
- Department of Psychiatry, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Mark Hoelscher
- Department of Psychiatry, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Courtney Cook
- Department of Psychiatry, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Matt Vassar
- Department of Psychiatry, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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10
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Egere U, Togun T, Sillah A, Mendy F, Otu J, Hoelscher M, Heinrich N, Hill PC, Kampmann B. Identifying children with tuberculosis among household contacts in The Gambia. Int J Tuberc Lung Dis 2018; 21:46-52. [PMID: 28157464 DOI: 10.5588/ijtld.16.0289] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Greater Banjul Area of the Gambia. OBJECTIVES To identify co-prevalent tuberculosis (TB) among child contacts of adults with smear-positive TB. DESIGN Child contacts aged <15 years in the immediate household and compound were prospectively enrolled and evaluated for TB disease using screening questionnaires and the tuberculin skin test (TST). Symptomatic and/or TST-positive (10 mm) contacts were further investigated. RESULTS Of 4042 child contacts who underwent symptom screening and TST, 3339 (82.6%) were diagnosed as TB-exposed but not infected, 639 (15.8%) were latently infected and 64 (1.6%) had co-prevalent TB. Of the 64 TB cases, 50 (78.1%) were from within the immediate household of the index case, and 14 (21.9%) from within the same compound. Of the 27 asymptomatic but TST-positive children diagnosed with TB, 7 were microbiologically confirmed. The median age of the TB cases was 4.4 years (interquartile range 1.9-6.9); 53.1% were aged <5 years. Of the 4042 child contacts, 206 (5%) slept in the same bed as the index case; 28.1% of all TB cases occurred in this group. Symptom screening alone would have detected only 57.8% of the co-prevalent cases. CONCLUSION In our community setting, if contact tracing is restricted to symptom screening and immediate households only, nearly half of all co-prevalent TB disease in child contacts would be missed.
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Affiliation(s)
- U Egere
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit-The Gambia, Banjul, The Gambia; Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - T Togun
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit-The Gambia, Banjul, The Gambia; Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - A Sillah
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit-The Gambia, Banjul, The Gambia
| | - F Mendy
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit-The Gambia, Banjul, The Gambia
| | - J Otu
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit-The Gambia, Banjul, The Gambia
| | - M Hoelscher
- Center for International Health, Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, German Center for Infection Research, Munich Partner Site, Munich, Germany
| | - N Heinrich
- Center for International Health, Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, German Center for Infection Research, Munich Partner Site, Munich, Germany
| | - P C Hill
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - B Kampmann
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit-The Gambia, Banjul, The Gambia; Centre for International Child Health, Academic Department of Paediatrics, St Mary's Campus, Imperial College London, London, UK
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11
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Sabiiti W, Mtafya B, Kuchaka D, Azam K, Viegas S, Mdolo A, Farmer ECW, Khonga M, Evangelopoulos D, Honeyborne I, Rachow A, Heinrich N, Ntinginya NE, Bhatt N, Davies GR, Jani IV, McHugh TD, Kibiki G, Hoelscher M, Gillespie SH. Optimising molecular diagnostic capacity for effective control of tuberculosis in high-burden settings. Int J Tuberc Lung Dis 2018; 20:1004-9. [PMID: 27393531 DOI: 10.5588/ijtld.15.0951] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The World Health Organization's 2035 vision is to reduce tuberculosis (TB) associated mortality by 95%. While low-burden, well-equipped industrialised economies can expect to see this goal achieved, it is challenging in the low- and middle-income countries that bear the highest burden of TB. Inadequate diagnosis leads to inappropriate treatment and poor clinical outcomes. The roll-out of the Xpert(®) MTB/RIF assay has demonstrated that molecular diagnostics can produce rapid diagnosis and treatment initiation. Strong molecular services are still limited to regional or national centres. The delay in implementation is due partly to resources, and partly to the suggestion that such techniques are too challenging for widespread implementation. We have successfully implemented a molecular tool for rapid monitoring of patient treatment response to anti-tuberculosis treatment in three high TB burden countries in Africa. We discuss here the challenges facing TB diagnosis and treatment monitoring, and draw from our experience in establishing molecular treatment monitoring platforms to provide practical insights into successful optimisation of molecular diagnostic capacity in resource-constrained, high TB burden settings. We recommend a holistic health system-wide approach for molecular diagnostic capacity development, addressing human resource training, institutional capacity development, streamlined procurement systems, and engagement with the public, policy makers and implementers of TB control programmes.
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Affiliation(s)
- W Sabiiti
- School of Medicine, University of St Andrews, St Andrews, UK
| | - B Mtafya
- Mbeya Medical Research Centre, National Institute of Medical Research, Mbeya, Tanzania
| | - D Kuchaka
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - K Azam
- Instituto Nacional de Saude, Ministerio da Saude, Maputo, Mozambique
| | - S Viegas
- Instituto Nacional de Saude, Ministerio da Saude, Maputo, Mozambique
| | - A Mdolo
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - E C W Farmer
- School of Medicine, University of St Andrews, St Andrews, UK
| | - M Khonga
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - D Evangelopoulos
- Centre for Clinical Microbiology, University College London, London, UK
| | - I Honeyborne
- Centre for Clinical Microbiology, University College London, London, UK
| | - A Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany; German Center for Infection Research, Munich, Germany
| | - N Heinrich
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany; German Center for Infection Research, Munich, Germany
| | - N E Ntinginya
- Mbeya Medical Research Centre, National Institute of Medical Research, Mbeya, Tanzania
| | - N Bhatt
- Instituto Nacional de Saude, Ministerio da Saude, Maputo, Mozambique
| | - G R Davies
- College of Medicine, University of Malawi, Blantyre, Malawi; Institutes of Global Health & Translational Medicine, University of Liverpool, Liverpool, UK
| | - I V Jani
- Instituto Nacional de Saude, Ministerio da Saude, Maputo, Mozambique
| | - T D McHugh
- Centre for Clinical Microbiology, University College London, London, UK
| | - G Kibiki
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - M Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany; German Center for Infection Research, Munich, Germany
| | - S H Gillespie
- School of Medicine, University of St Andrews, St Andrews, UK
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Koentges C, Doerfer E, Pfeil K, Birkle S, Hoelscher M, Hoffmann M, Bode C, Bugger H. P453Overexpression of SIRT4 accelerates the development of heart failure. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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13
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Egere U, Sillah A, Togun T, Kandeh S, Cole F, Jallow A, Able-Thomas A, Hoelscher M, Heinrich N, Hill PC, Kampmann B. Isoniazid preventive treatment among child contacts of adults with smear-positive tuberculosis in The Gambia. Public Health Action 2016; 6:226-231. [PMID: 28123958 DOI: 10.5588/pha.16.0073] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
Setting: Greater Banjul area of The Gambia. Objectives: To evaluate uptake, adherence and completion of treatment among tuberculosis (TB) exposed children in The Gambia when isoniazid preventive treatment (IPT) is delivered at home Design: Child (age <5 years) contacts of adults with smear-positive TB were prospectively enrolled. Following symptom screening, tuberculin skin testing and clinical evaluation where indicated, those without disease were placed on daily isoniazid, provided monthly at home. Adherence was assessed by pill counts and IsoScreen™ urine test. Results: Of 404 contacts aged <5 years, 368 (91.1%) were offered IPT. Of the 328 (89.4%) for whom consent was received and who commenced IPT, 18 (5.5%) dropped out and 310 (94.5%) remained on IPT to the end of the 6-month regimen. Altogether, 255/328 children (77.7%, 95%CI 73.2-82.2) completed all 6 months, with good adherence. The IsoScreen test was positive in 85.3% (435/510) of all tests among those defined as having good adherence by pill count and in 16% (8/50) of those defined as having poor adherence (P < 0.001). A cascade of care analysis showed an overall completion rate with good adherence of 61% for all child contacts. Conclusion: Home-delivered IPT among child contacts of adults with smear-positive TB in The Gambia achieved verifiable high uptake and adherence rates. System rather than patient factors are likely to determine the success of IPT at national level.
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Affiliation(s)
- U Egere
- Vaccines and Immunity Theme, Medical Research Council Unit-The Gambia, Banjul, The Gambia
| | - A Sillah
- Vaccines and Immunity Theme, Medical Research Council Unit-The Gambia, Banjul, The Gambia
| | - T Togun
- Vaccines and Immunity Theme, Medical Research Council Unit-The Gambia, Banjul, The Gambia ; Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - S Kandeh
- Vaccines and Immunity Theme, Medical Research Council Unit-The Gambia, Banjul, The Gambia
| | - F Cole
- Vaccines and Immunity Theme, Medical Research Council Unit-The Gambia, Banjul, The Gambia
| | - A Jallow
- National Leprosy and Tuberculosis Control Programme, Kanifing, The Gambia
| | - A Able-Thomas
- National Leprosy and Tuberculosis Control Programme, Kanifing, The Gambia
| | - M Hoelscher
- Centre for International Health, Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | - N Heinrich
- Centre for International Health, Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | - P C Hill
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - B Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit-The Gambia, Banjul, The Gambia ; Centre for International Child Health, Academic Department of Paediatrics, Imperial College London, London, UK
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14
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Steiner A, Mangu C, van den Hombergh J, van Deutekom H, van Ginneken B, Clowes P, Mhimbira F, Mfinanga S, Rachow A, Reither K, Hoelscher M. Screening for pulmonary tuberculosis in a Tanzanian prison and computer-aided interpretation of chest X-rays. Public Health Action 2016; 5:249-54. [PMID: 26767179 DOI: 10.5588/pha.15.0037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/02/2015] [Indexed: 11/10/2022] Open
Abstract
SETTING Tanzania is a high-burden country for tuberculosis (TB), and prisoners are a high-risk group that should be screened actively, as recommended by the World Health Organization. Screening algorithms, starting with chest X-rays (CXRs), can detect asymptomatic cases, but depend on experienced readers, who are scarce in the penitentiary setting. Recent studies with patients seeking health care for TB-related symptoms showed good diagnostic performance of the computer software CAD4TB. OBJECTIVE To assess the potential of computer-assisted screening using CAD4TB in a predominantly asymptomatic prison population. DESIGN Cross-sectional study. RESULTS CAD4TB and seven health care professionals reading CXRs in local tuberculosis wards evaluated a set of 511 CXRs from the Ukonga prison in Dar es Salaam. Performance was compared using a radiological reference. Two readers performed significantly better than CAD4TB, three were comparable, and two performed significantly worse (area under the curve 0.75 in receiver operating characteristics analysis). On a superset of 1321 CXRs, CAD4TB successfully interpreted >99%, with a predictably short time to detection, while 160 (12.2%) reports were delayed by over 24 h with conventional CXR reading. CONCLUSION CAD4TB reliably evaluates CXRs from a mostly asymptomatic prison population, with a diagnostic performance inferior to that of expert readers but comparable to local readers.
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Affiliation(s)
- A Steiner
- Swiss Tropical and Public Health Institute, Basel, Switzerland ; University of Basel, Basel, Switzerland
| | - C Mangu
- National Institute of Medical Research, Mbeya Medical Research Center, Mbeya, Tanzania
| | | | - H van Deutekom
- Department of Tuberculosis Control, Municipal Health Service, Amsterdam, The Netherlands
| | - B van Ginneken
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - P Clowes
- National Institute of Medical Research, Mbeya Medical Research Center, Mbeya, Tanzania ; Division of Infectious Disease and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
| | - F Mhimbira
- Swiss Tropical and Public Health Institute, Basel, Switzerland ; University of Basel, Basel, Switzerland
| | - S Mfinanga
- Muhimbili Medical Research Centre, Dar es Salaam, Tanzania
| | - A Rachow
- Division of Infectious Disease and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany ; German Centre for Infection Research, Munich, Germany
| | - K Reither
- Swiss Tropical and Public Health Institute, Basel, Switzerland ; University of Basel, Basel, Switzerland
| | - M Hoelscher
- National Institute of Medical Research, Mbeya Medical Research Center, Mbeya, Tanzania ; Division of Infectious Disease and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany ; German Centre for Infection Research, Munich, Germany
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15
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Olaru ID, Rachow A, Lange C, Ntinginya NE, Reither K, Hoelscher M, Vollrath O, Niemann S. Ascertaining in vivo virulence of Mycobacterium tuberculosis lineages in patients in Mbeya, Tanzania. Int J Tuberc Lung Dis 2015; 19:70-3. [PMID: 25519793 DOI: 10.5588/ijtld.14.0403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We evaluated the relationship between the degree of immunodeficiency indicated by the number of circulating CD4+ T-cells and Mycobacterium tuberculosis lineages identified by spoligotyping and mycobacterial interspersed repetitive units-variable number of tandem repeats genotyping in human immunodeficiency virus (HIV) infected individuals with pulmonary tuberculosis from Mbeya, Tanzania. Of M. tuberculosis strains from 129 patients, respectively 55 (42.6%) and 37 (28.7%) belonged to Latin American Mediterranean and Delhi/Central-Asian lineages, while 37 (28.7%) patients were infected with other strains. There was no difference in the distribution of M. tuberculosis lineages among patients with early or advanced stages of HIV infection (P = 0.785), indicating that the virulence of strains from these lineages may not be substantially different in vivo.
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Affiliation(s)
- I D Olaru
- *Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; German Center for Infection Research, Borstel Site, Borstel, Germany
| | - A Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany; German Center for Infection Research Tuberculosis Unit, Munich, Germany
| | - C Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; German Center for Infection Research, Borstel Site, Borstel, Germany; International Health/Infectious Diseases University of Lübeck, Lübeck, Germany; Department of Internal Medicine, University of Namibia School of Medicine, Windhoek, Namibia
| | - N E Ntinginya
- National Institute of Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - K Reither
- Swiss Tropical and Public Health Institute, Basel, switzerland; University of Basel, Basel, Switzerland
| | - M Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany; German Center for Infection Research Tuberculosis Unit, Munich, Germany
| | - O Vollrath
- Institute of Medical Informatics and Statistics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - S Niemann
- German Center for Infection Research, Borstel Site, Borstel, Germany; Molecular Mycobacteriology, Research Center Borstel, Borstel, Germany
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16
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Rojas-Ponce G, Rachow A, Guerra H, Mapamba D, Joseph J, Mlundi R, Marimoto S, Ntinginya NE, Mangu C, Framhein A, Butler A, Kohlenberg A, Ngatemelela D, Froeschl G, Maboko L, Hoelscher M, Heinrich N. A continuously monitored colorimetric method for detection of Mycobacterium tuberculosis complex in sputum. Int J Tuberc Lung Dis 2013; 17:1607-12. [DOI: 10.5588/ijtld.13.0317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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17
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Jansen F, Yang X, Hoelscher M, Nickenig G, Werner N. High glucose condition increases NADPH oxidase activity in endothelial microparticles that promote vascular inflammation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3261] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Phillips PPJ, Bratton DJ, Nunn AJ, Hoelscher M. Reply to Dodd and Proschan. J Infect Dis 2013; 207:544-5. [DOI: 10.1093/infdis/jis705] [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: 11/14/2022] Open
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19
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Ntinginya EN, Squire SB, Millington KA, Mtafya B, Saathoff E, Heinrich N, Rojas-Ponce G, Kowuor D, Maboko L, Reither K, Clowes P, Hoelscher M, Rachow A. Performance of the Xpert® MTB/RIF assay in an active case-finding strategy: a pilot study from Tanzania. Int J Tuberc Lung Dis 2012; 16:1468-70. [PMID: 22964006 DOI: 10.5588/ijtld.12.0127] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In this pilot study, we evaluated the Xpert® MTB/RIF assay in an active case-finding strategy, using two spot sputum samples collected within a 1-hour interval from household contacts of smear-positive TB index cases. Tuberculosis (TB) confirmed by culture served as the reference standard. Among 219 enrolled contacts, the yield of active TB was 2.3%. While the sensitivity of smear microscopy was 60% (95%CI 14.7-94.7), Xpert MTB/RIF achieved a sensitivity of 100% (95%CI 47.81-100.0). All culture-confirmed cases tested positive by Xpert MTB/RIF on the first submitted sample, suggesting that the evaluation of only one sample could be sufficient for TB diagnosis in this context.
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Affiliation(s)
- E N Ntinginya
- National Institute for Medical Research, Mbeya Medical Research Programme, Mbeya, Tanzania.
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Bauer A, Podola L, Haule A, Sudi L, Nilsson C, Mann P, Missanga M, Kaluwa B, Maboko L, Lueer C, Mwakatima M, Aboud S, Bakari M, Currier J, Robb M, Joseph S, McCormack S, Lyamuya E, Wahren B, Sandström E, Biberfeld G, Hoelscher M, Kroidl A, Geldmacher C. Preferential targeting of conserved Gag regions after vaccination with a heterologous DNA prime Modified Vaccinia Ankara boost HIV vaccine regime. Retrovirology 2012. [PMCID: PMC3441414 DOI: 10.1186/1742-4690-9-s2-p330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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21
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Mann PJ, Munseri P, Kaluwa B, Missanga M, Lwakatare J, Hoelscher M, Bakari M, Janabi M, Maboko L, Sandström E, Kroidl A. High prevalence of ECG variations and abnormalities in young and healthy TaMoVac 01 HIV vaccine trial volunteers from Tanzania. Retrovirology 2012. [PMCID: PMC3441374 DOI: 10.1186/1742-4690-9-s2-p114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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22
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Nofemela A, Bandawe G, Thebus R, Marais J, Maboko L, Hoelscher M, Williamson C, Woodman Z. Characterization of envelope function of transmitted viruses circulating in Mbeya, Tanzania, and its impact on disease progression. Retrovirology 2012. [PMCID: PMC3441964 DOI: 10.1186/1742-4690-9-s2-p144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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23
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Podola L, Bauer A, Haule A, Sudi L, Nilsson C, Godoy-Ramirez K, Mann P, Missanga M, Kaluwa B, Maboko L, Lueer C, Mwakatima M, Aboud S, Bakari M, Currier J, Robb M, McCormack S, Joseph S, Lyamuya E, Hoelscher M, Wahren B, Sandström E, Biberfeld G, Geldmacher C, Kroidl A. Breadth, phenotype and functionality of Gag-specific T cell responses induced by a heterologous DNA/MVA prime-boost HIV-1 vaccine regimen. Retrovirology 2012. [PMCID: PMC3441674 DOI: 10.1186/1742-4690-9-s2-p273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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24
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Munseri P, Kroidl A, Nilsson C, Moshiro C, Aboud S, Joachim A, Geldmacher C, Aris E, Buma D, Lyamuya E, Gotch F, Godoy-Ramirez K, Pallangyo K, Maboko L, Marovich M, Robb M, Hoelscher M, Janabi M, Mann P, Joseph S, Mfinanga S, Stoehr W, Mhalu F, Wahren B, Biberfeld G, McCormack S, Sandstrom E, Bakari M. Priming with a “simplified regimen” of HIV-1 DNA vaccine is as good as a “standard regimen” when boosted with heterologous HIV-1 MVA vaccine. Retrovirology 2012. [PMCID: PMC3441944 DOI: 10.1186/1742-4690-9-s2-p108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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25
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Mudenda V, Lucas S, Shibemba A, O'Grady J, Bates M, Kapata N, Schwank S, Mwaba P, Atun R, Hoelscher M, Maeurer M, Zumla A. Tuberculosis and Tuberculosis/HIV/AIDS-Associated Mortality in Africa: The Urgent Need to Expand and Invest in Routine and Research Autopsies. J Infect Dis 2012; 205 Suppl 2:S340-6. [DOI: 10.1093/infdis/jir859] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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O'Grady J, Maeurer M, Atun R, Abubakar I, Mwaba P, Bates M, Kapata N, Ferrara G, Hoelscher M, Zumla A. Tuberculosis in prisons: anatomy of global neglect. Eur Respir J 2011; 38:752-4. [DOI: 10.1183/09031936.00041211] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Jernigan DB, Lindstrom SL, Johnson JR, Miller JD, Hoelscher M, Humes R, Shively R, Brammer L, Burke SA, Villanueva JM, Balish A, Uyeki T, Mustaquim D, Bishop A, Handsfield JH, Astles R, Xu X, Klimov AI, Cox NJ, Shaw MW. Detecting 2009 pandemic influenza A (H1N1) virus infection: availability of diagnostic testing led to rapid pandemic response. Clin Infect Dis 2011; 52 Suppl 1:S36-43. [PMID: 21342897 DOI: 10.1093/cid/ciq020] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Diagnostic tests for detecting emerging influenza virus strains with pandemic potential are critical for directing global influenza prevention and control activities. In 2008, the Centers for Disease Control and Prevention received US Food and Drug Administration approval for a highly sensitive influenza polymerase chain reaction (PCR) assay. Devices were deployed to public health laboratories in the United States and globally. Within 2 weeks of the first recognition of 2009 pandemic influenza H1N1, the Centers for Disease Control and Prevention developed and began distributing a new approved pandemic influenza H1N1 PCR assay, which used the previously deployed device platform to meet a >8-fold increase in specimen submissions. Rapid antigen tests were widely used by clinicians at the point of care; however, test sensitivity was low (40%-69%). Many clinical laboratories developed their own pandemic influenza H1N1 PCR assays to meet clinician demand. Future planning efforts should identify ways to improve availability of reliable testing to manage patient care and approaches for optimal use of molecular testing for detecting and controlling emerging influenza virus strains.
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Affiliation(s)
- D B Jernigan
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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28
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Reither K, Saathoff E, Jung J, Minja LT, Machibya H, Maboko L, Perkins MD, Hoelscher M, Boehme CC. Evaluation of Diagnos TB AG, a flow-through immunoassay for rapid detection of pulmonary tuberculosis. Int J Tuberc Lung Dis 2010; 14:238-240. [PMID: 20074417] [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: 05/28/2023] Open
Abstract
We evaluated the diagnostic performance of the Diagnos TB AG immunoassay in 171 Tanzanians with suspected pulmonary tuberculosis (TB). The sensitivity and specificity, and positive and negative predictive values of the rapid test for the detection of pulmonary TB in this population were respectively 60.0%, 33.3%, 40.3% and 52.6%. In its current configuration, this test will not help overcome difficulties in the rapid diagnosis of TB.
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Affiliation(s)
- K Reither
- Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany.
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29
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Koehler RN, Walsh AM, Saathoff E, Currier JR, Bautista CT, Moqueet N, Ratto-Kim S, Maboko L, Hoelscher M, Robb ML, Michael NL, McCutchan FE, Kim JH, Kijak GH. S011-05 OA. HLA-A*7401 is associated with protection from HIV-1 acquisition and disease progression in Mbeya, Tanzania. Retrovirology 2009. [PMCID: PMC2767540 DOI: 10.1186/1742-4690-6-s3-o2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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30
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McCutchan FE, Hoelscher M, Tovanabutra S, Piyasirisilp S, Sanders-Buell E, Ramos G, Jagodzinski L, Polonis V, Maboko L, Mmbando D, Hoffmann O, Riedner G, von Sonnenburg F, Robb M, Birx DL. In-depth analysis of a heterosexually acquired human immunodeficiency virus type 1 superinfection: evolution, temporal fluctuation, and intercompartment dynamics from the seronegative window period through 30 months postinfection. J Virol 2005; 79:11693-704. [PMID: 16140747 PMCID: PMC1212589 DOI: 10.1128/jvi.79.18.11693-11704.2005] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [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: 12/17/2022] Open
Abstract
Human immunodeficiency virus type 1 (HIV-1) superinfection refers to the acquisition of another strain by an already infected individual. Here we report a comprehensive genetic analysis of an HIV-1 superinfection acquired heterosexually. The infected individual was in a high-risk cohort in Tanzania, was exposed to multiple subtypes, and was systematically evaluated every 3 months with a fluorescent multi-region genotyping assay. The subject was identified in the window period and was first infected with a complex ACD recombinant strain, became superinfected 6 to 9 months later with an AC recombinant, and was monitored for >2.5 years. The plasma viral load exceeded 400,000 copies/ml during the first 9 months of infection but resolved to the set point of 67,000 copies/ml by 3 months after superinfection; the CD4 cell count was 377 cells/mul at 30 months. Viral diversity was evaluated with techniques designed to fully sample the quasi-species, permitting direct observation of the evolution, temporal fluctuation, and intercompartment dynamics of the initial and superinfecting strains and recombinants derived from them. Within 3 months of superinfection, seven different molecular forms were detected in gag and six were detected in env. The proportions of forms fluctuated widely over time in plasma and peripheral blood mononuclear cells, illustrating how challenging the detection of dually infected individuals can be. Strain-specific nested PCR confirmed that the superinfecting strain was not present until the 9 month follow-up. This study further defines the parameters and dynamics of superinfection and will foster appropriate studies and approaches to gain a more complete understanding of risk factors for superinfection and its impact on clinical progression, epidemiology, and vaccine design.
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Affiliation(s)
- F E McCutchan
- US Military HIV Research Program, 1600 E. Gude Drive, Rockville, MD 20850, USA.
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31
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Boehme C, Molokova E, Minja F, Geis S, Loscher T, Maboko L, Koulchin V, Hoelscher M. Detection of mycobacterial lipoarabinomannan with an antigen-capture ELISA in unprocessed urine of Tanzanian patients with suspected tuberculosis. Trans R Soc Trop Med Hyg 2005; 99:893-900. [PMID: 16139316 DOI: 10.1016/j.trstmh.2005.04.014] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2004] [Revised: 04/08/2005] [Accepted: 04/12/2005] [Indexed: 10/25/2022] Open
Abstract
A direct antigen-capture ELISA based on the detection of mycobacterial lipoarabinomannan (LAM) in unprocessed urine was evaluated for its usefulness in clinical practice. In Tanzania, 231 patients with suspected pulmonary tuberculosis (TB) and 103 healthy volunteers were screened with standard TB tests and with the new LAM-ELISA. Of 132 patients with confirmed pulmonary mycobacterial disease (positive sputum culture), 106 were positive using the LAM-ELISA (sensitivity 80.3%). In comparison, the sensitivity of acid-fast bacilli (AFB) sputum microscopy was 62.1% (82 of 132 confirmed cases). Of the 231 patients, 17 were both culture- and AFB-negative, but had typical radiographic signs of pulmonary mycobacterial infection and did not respond to antibiotic treatment. Of these 17 patients, 13 (76.5%) had positive LAM-ELISA test results. To define the specificity of the assay, urine samples from 103 healthy volunteers were also screened using LAM-ELISA. All but one had an optical density below the cut-off (specificity 99%). Of interest was a significant correlation between level of microscopic density of mycobacteria in sputum and LAM antigen concentration in urine (chi2=8.44). The LAM-ELISA is a field-adapted tool that can improve screening standards in countries with a high incidence of TB.
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Affiliation(s)
- C Boehme
- Department of Infectious Diseases and Tropical Medicine, LMU, University of Munich, Leopoldstr. 5, 80802 Munich, Germany.
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32
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Gerhardt M, Mloka D, Tovanabutra S, Sanders-Buell E, Hoffmann O, Maboko L, Mmbando D, Birx DL, McCutchan FE, Hoelscher M. In-depth, longitudinal analysis of viral quasispecies from an individual triply infected with late-stage human immunodeficiency virus type 1, using a multiple PCR primer approach. J Virol 2005; 79:8249-61. [PMID: 15956571 PMCID: PMC1143736 DOI: 10.1128/jvi.79.13.8249-8261.2005] [Citation(s) in RCA: 46] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2004] [Accepted: 02/15/2005] [Indexed: 11/20/2022] Open
Abstract
Co-infections with more than one human immunodeficiency virus type 1 (HIV-1) subtype appear to be the source of new recombinant strains and may be commonplace in high-risk cohorts exposed to multiple subtypes. Many potential dual infections have been identified during the HIV Superinfection Study in Mbeya, Tanzania, where 600 female bar workers who are highly exposed to subtypes A, C, and D have been evaluated every 3 months for over 3 years by use of the MHAacd HIV-1 genotyping assay. Here we describe an in-depth, longitudinal analysis of the viral quasispecies in a woman who was triply infected with HIV-1 and who developed AIDS and passed away 15 months after enrollment. The MHA results obtained at 0, 3, 6, 9, and 12 months revealed dual-probe reactivities and shifts in subtype over time, indicating a potential dual infection and prompting further investigation. The multiple infection was confirmed by PCR amplification of three genome regions by a multiple primer approach, followed by molecular cloning and sequencing. A highly complex viral quasispecies was found, including several recombinant forms, with vpu/gp120 being the most diverse region. A significant fluctuation in molecular forms over time was observed, showing that the serial sample format is highly desirable, if not essential, for the identification of multiple infections. In a separate experiment, we confirmed that the detection of co-infections is more efficient with the use of multiple amplification primers to overcome the primer bias that results from the enormous diversity in the HIV-1 genome.
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Affiliation(s)
- M Gerhardt
- Department of Infectious Diseases and Tropical Medicine, University of Munich, Munich, Germany.
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33
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Hoffmann O, Zaba B, Wolff B, Sanga E, Maboko L, Mmbando D, von Sonnenburg F, Hoelscher M. Methodological lessons from a cohort study of high risk women in Tanzania. Sex Transm Infect 2005; 80 Suppl 2:ii69-73. [PMID: 15572643 PMCID: PMC1765847 DOI: 10.1136/sti.2004.011908] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [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: 11/04/2022] Open
Abstract
OBJECTIVES To describe the development, characteristics, and follow up of a high risk cohort of women in Tanzania. Differences in social background and sexual behaviour of women working in traditional and modern alcohol selling workplaces are shown. METHODS Data from questionnaires four months before the enrollment of the cohort, at enrollment, and at 32 months were compared. Key informant interviews, social mapping exercises, and focus group discussions were held before the start of the cohort. RESULTS In the absence of organised prostitution, two different groups of women with high risk exposure were identified during the baseline survey: female workers in modern alcohol selling places such as bars, guesthouses, and restaurants (barmaids) and in traditional places (local brew sellers). Overall, the population had a mean age of 27.7 years with barmaids tending to be younger (24.3 years) than local brew sellers (34.2 years). The main duration of stay in the current workplace was 2.1 years (barmaids 0.9 years; local brew sellers 4.1 years). Barmaids were more likely to have paying casual sex partners than local brew sellers and used condoms more regularly. Local brew sellers tend to be more stable with only 10% lost to follow up after 32 months compared with 24.4% of the bar workers. CONCLUSIONS Preliminary work revealed major differences in characteristics and behaviour between women working in modern and traditional alcohol selling outlets. Thorough preparation of the study, close monitoring of the cohort, and provision of selected benefits resulted in high retention rates over a 32 month project in a highly mobile population.
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Affiliation(s)
- O Hoffmann
- Department of Infectious Diseases and Tropical Medicine, University of Munich, Germany.
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34
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Riedner G, Rusizoka M, Hoffmann O, Nichombe F, Lyamuya E, Mmbando D, Maboko L, Hay P, Todd J, Hayes R, Hoelscher M, Grosskurth H. Baseline survey of sexually transmitted infections in a cohort of female bar workers in Mbeya Region, Tanzania. Sex Transm Infect 2003; 79:382-7. [PMID: 14573833 PMCID: PMC1744739 DOI: 10.1136/sti.79.5.382] [Citation(s) in RCA: 55] [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: 11/04/2022] Open
Abstract
OBJECTIVES To determine baseline prevalence of sexually transmitted infections (STI) and other reproductive tract infections (RTI) and their association with HIV as well as sociodemographic and behavioural characteristics in a newly recruited cohort of female bar workers in Mbeya Region, Tanzania. METHODS 600 female bar workers were recruited from 17 different communities during September to November 2000 and underwent gynaecological examination, laboratory testing for HIV/STI, and interviews using structured questionnaires. RESULTS HIV-1 seroprevalence was 68%. Prevalences of STI/RTI were high titre syphilis (TPPA/RPR >/=1/8), 9%; herpes simplex virus 2 antibodies, 87%; chlamydia, 12%; gonorrhoea, 22%; trichomoniasis, 24%; and bacterial vaginosis, 40%. HIV infection was associated with TPPA and HSV-2 seropositivity, bacterial vaginosis and clinically diagnosed genital ulcers, blisters, and warts. Reported high risk sexual behaviour during the past year (having multiple casual partners) was associated with prevalent STI. CONCLUSION Female bar workers in Mbeya are at high risk of STI and HIV infection. Targeted STI/HIV prevention interventions for these women and their sexual partners need to be reinforced. Methods should be sought to improve healthcare seeking and to provide easily accessible and affordable STI care services.
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Affiliation(s)
- G Riedner
- London School of Hygiene and Tropical Medicine, London, UK.
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35
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Affiliation(s)
- T Löscher
- Abteilung für Infektions- und Tropenmedizin, Medizinische Klinik Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, Munich.
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36
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Hoelscher M, Löscher T. [Malaria--case report]. Dtsch Med Wochenschr 2003; 128:1289. [PMID: 12789638 DOI: 10.1055/s-2003-39792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M Hoelscher
- Abteilung für Infektions- und Tropenmedizin, Medizinische Klinik Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, Munich
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37
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Affiliation(s)
- T Löscher
- Abteilung für Infektions- und Tropenmedizin, Medizinische Klinik Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, Munich.
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38
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Glas J, Török HP, Vilsmaier F, Herbinger KH, Hoelscher M, Folwaczny C. Anti-saccharomyces cerevisiae antibodies in patients with inflammatory bowel disease and their first-degree relatives: potential clinical value. Digestion 2003; 66:173-7. [PMID: 12481163 DOI: 10.1159/000066760] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Anti-Saccharomyces cerevisiae antibodies (ASCA) have been described as specific markers in Crohn's disease and their healthy first-degree relatives. 171 patients with Crohn's disease, their 105 first-degree relatives, 145 patients with ulcerative colitis and 101 first-degree relatives of patients with ulcerative colitis, 50 patients with infectious enterocolitis and 100 healthy controls were tested for ASCA employing the ELISA technique. When compared with the healthy controls (p < 0.0001) and patients with infectious enterocolitis (p < 0.0001) the prevalence of ASCA was significantly increased in patients with Crohn's disease and their first-degree relatives (p < 0.01). Further significant differences concerning the frequency of ASCA within the different groups of our study population were not observed. In particular, ASCA were not found in increased prevalence in infectious enterocolitis. These observations are compatible with a role of ASCA as a marker of genetic predisposition to Crohn's disease.
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Affiliation(s)
- J Glas
- Medizinische Klinik, Standort Innenstadt der Ludwig-Maximilians-Universität München, Deutschland
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39
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Gekeler F, Eichenlaub S, Mendoza EG, Sotelo J, Hoelscher M, Löscher T. Sensitivity and specificity of ELISA and immunoblot for diagnosing neurocysticercosis. Eur J Clin Microbiol Infect Dis 2002; 21:227-9. [PMID: 11957028 DOI: 10.1007/s10096-002-0695-3] [Citation(s) in RCA: 36] [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: 10/27/2022]
Abstract
In patients with neurocysticercosis (NCC), clinical manifestations and the results of neuroimaging procedures vary widely and often do not facilitate a definite diagnosis. In order to determine the value of immunodiagnosis for NCC, 222 serum and cerebrospinal fluid samples from patients with NCC and healthy subjects were examined. The samples represented patients from various endemic regions, those with other neurological disorders from an endemic area (Mexico), persons with various helminth infections other than NCC, and a group of healthy volunteers. All specimens were tested by enzyme-linked immunosorbent assay and immunoblot for the presence of Taenia solium-specific antibodies. The sensitivities of the enzyme-linked immunosorbent assay and the immunoblot test in NCC patients were almost identical (80% and 81.7%, respectively). For both tests, the sensitivity was higher when cerebrospinal fluid (86%) was tested compared with serum (75%). The overall specificity of enzyme-linked immunosorbent assay was only 75.3% because of frequent false-positive results in patients with other helminth infections, especially in those with echinococcosis. The specificity (99.4%) of the immunoblot test was clearly superior. It is concluded that enzyme-linked immunosorbent assay as a screening method and immunoblot as a confirmatory test contribute considerably to the diagnosis of NCC.
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Affiliation(s)
- F Gekeler
- Neurologische Klinik Grosshadern, Klinikum der Ludwig-Maximilians-Universität München, Germany
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40
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Hoelscher M, Kim B, Maboko L, Mhalu F, von Sonnenburg F, Birx DL, McCutchan FE. High proportion of unrelated HIV-1 intersubtype recombinants in the Mbeya region of southwest Tanzania. AIDS 2001; 15:1461-70. [PMID: 11504977 DOI: 10.1097/00002030-200108170-00002] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [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: 11/25/2022]
Abstract
BACKGROUND In Mbeya, a rural region of southwest Tanzania, HIV-1 subtypes A, C and D have been co-circulating since the early 1990s. OBJECTIVE To define to what extent the co-existence of subtypes has led to recombinant HIV-1 strains and whether there is evidence for epidemic spread of any circulating recombinant form. METHODS Nine HIV-1-seropositive young adults from Mbeya Town with no evident high-risk behaviour contributed peripheral blood mononuclear cells for this study. Nine virtually full-length-genome-sequences were amplified from this DNA and phylogenetically analysed. RESULTS Out of the nine samples, two were subtype A (22%), two were subtype C (22%) and five were recombinants (56%): four A/C recombinants and one C/D recombinant. None of the recombinants were related to each other; all of them had different mosaic structures. Most of the genome in the recombinants was subtype C. CONCLUSION A high proportion of unrelated intersubtype recombinants, none of them apparently spreading in the population, may be present in southwest Tanzania.
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Affiliation(s)
- M Hoelscher
- Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-University, Munich, Germany
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41
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Siegmund B, Folwaczny C, Bader L, Otto B, Hoelscher M, Leinsinger G, Herzer P, Loeschke K. [Multiple muscle abscesses in a Tibetan woman]. Internist (Berl) 2000; 41:903-7. [PMID: 11006877 DOI: 10.1007/s001080050642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- B Siegmund
- Abteilung für Gastroenterologie, Klinikum der Universität München.
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42
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Folwaczny C, Loeschke K, Schnettler D, Jäger G, Wiebecke B, Hoelscher M, Sauer T, König A, Endres SP, Fricke H. Endothelial cell autoantibodies are a marker of disease susceptibility in inflammatory bowel disease but apparently not linked to persistent measles virus infection. Clin Immunol 2000; 95:197-202. [PMID: 10866126 DOI: 10.1006/clim.2000.4867] [Citation(s) in RCA: 13] [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: 01/23/2023]
Abstract
Intestinal vasculitis caused by persistent measles virus infection of intestinal endothelial cells was described in Crohn's disease. Furthermore, endothelial cell autoantibodies have been demonstrated in inflammatory bowel disease (IBD). Autoantibodies against intestinal endothelial cells were visualized by indirect immunofluorescence in patients with IBD, in their healthy first-degree relatives, in patients with infectious enterocolitis, and in healthy, unrelated controls. In intestinal tissue specimens of 22 antibody-positive IBD patients a search for the measles virus genome was performed. Endothelial cell autoantibodies were significantly more frequent in patients with IBD, in both groups of first-degree relatives, and in patients with infectious enterocolitis than in the healthy controls (P = 0.0002 or less). The measles virus genome was found in none of the intestinal biopsies. Endothelial cell autoantibodies are not a genetic but rather an epigenetic (infectious) marker of disease susceptibility. The expression of these autoantibodies is unlikely to be triggered by a persistent measles virus infection.
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Affiliation(s)
- C Folwaczny
- Medizinische Klinik, Klinikum Innenstadt, Ludwig-Maximilians Universität, Munich, Germany
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43
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Hoelscher M, Hanker S, Barin F, Cheingsong-Popov R, Dietrich U, Jordan-Harder B, Olaleye D, Nägele E, Markuzzi A, Mwakagile D, Minja F, Weber J, Gürtler L, Von Sonnenburg F. HIV type 1 V3 serotyping of Tanzanian samples: probable reasons for mismatching with genetic subtyping. AIDS Res Hum Retroviruses 1998; 14:139-49. [PMID: 9462924 DOI: 10.1089/aid.1998.14.139] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
HIV-1 V3 serotyping is used to classify immunodeficiency viruses on the basis of antibody binding to V3 peptides derived from env genetic subtypes. Although it shows a reasonable overlap, it has been reported to be distinct from viral genetic subtypes. The aim of this study is to determine the feasibility of HIV-1 serotyping to predict genetic subtypes in an East African setting, where multiple HIV-1 subtypes have coexisted for many years. HIV-1 genetic subtypes of 86 AIDS patients in Mbeya Town, southwest Tanzania, were determined, using env nucleic acid sequencing as the basis for comparison. Those data were compared with V3 serotyping results obtained by four different methodologies. Four HIV-1 genetic subtypes were identified, including A (25, 29%), C (47, 55%), D (13, 15%), and G (1, 1%). The sensitivity and specificity of those serotyping assays varied considerably: sensitivity for genetic subtype A (40-48%), C (52-96%), and D (9-31%); and specificity for genetic subtype A (77-95%), C (46-63%), and D (97-100%). We further tried to identify reasons for the discrepancies between serotyping results and genetic subtypes. By means of logistic regression analysis three amino acid residues within the V3 loop (positions 12, 13, and 19; V, H, and A for serotype A, I, R, and T for serotype C) were found to be most important for antibody binding; a deviation from the subtype-specific amino acids was highly related to mismatched results. In addition, we have shown that phenetic analysis of V3 amino acid sequence data could be used to predict the majority of V3 serotypes (93-94%). Our data demonstrated that for the majority of specimens HIV-1 V3 serotyping results closely match the subtype of the analyzed sample as revealed by the V3 loop amino acid sequence. However, our data demonstrate that HIV-1 serotyping is not sufficiently accurate to predict genetic subtypes in Tanzania, where subtypes A, C, D, and G are circulating. This was due to highly similar amino acid sequences throughout the prevalent genetic subtypes, which caused the inability of HIV-1 V3 serotyping to differentiate subtype A from C as well as D from C. Instead, the serotyping results reflect the frequency distribution of V3 serotypes. To investigate HIV-1 genetic subtypes in population-based studies in this African setting additional or modified algorithms are needed.
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Affiliation(s)
- M Hoelscher
- Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-Universität-München, Munich, Germany.
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44
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Hoelscher M, Riedner G, Hemed Y, Wagner HU, Korte R, von Sonnenburg F. Estimating the number of HIV transmissions through reused syringes and needles in the Mbeya Region, Tanzania. AIDS 1994; 8:1609-15. [PMID: 7848599 DOI: 10.1097/00002030-199411000-00014] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE HIV infection attributable to medical injections is suspected to be low, although case-control studies have not provided definite results. This study aims to determine the number of HIV infections caused by the reuse of syringes and needles in the Mbeya Region, Tanzania. METHODS The direct identification or detection of HIV in syringes and needles under field conditions was not appropriate, therefore a surrogate marker consisting of two components for possible HIV transmission was used: insufficient sterilization, and blood remaining from a previous patient. The assumption was that HIV infection can only occur if both markers are positive. Samples were collected in nine health-care facilities. All syringes and needles prepared for use in these facilities were collected without prior notification. The samples were rinsed and the resulting fluid was cultured for bacteria. Traces of blood were detected by urine stick test for haemoglobin volumes > 0.0015 microliters. RESULTS Bacterial contamination was found in 32.8% of the total 1219 syringes and needles; 67% was caused by improper handling of the equipment after sterilization. Blood was detected in 12.5% of the samples. In the following three sampling strata, both contamination criteria were positive either on the syringe or the needle: wards/outpatient departments (OPD), 1.39%; laboratories, 7.45%; expanded programme on immunization (EPI), < 0.1%. We calculated that from 1.1 million patients injected in wards/OPD in any 1 year, fewer than 13 become infected, in laboratories fewer than 12 (160,000 blood-taking procedures), and less than one child in the EPI (850,000 vaccinations). CONCLUSION With an established AIDS intervention programme supporting the health system, less than 0.4% of the total annual incidence of 4500-8500 is attributable to medical injections in the Mbeya Region.
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Affiliation(s)
- M Hoelscher
- Department of Infectious Diseases and Tropical Medicine, University of Munich, Germany
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Groenewoud AF, Isemer FE, Stadler J, Heideche CD, Florack G, Hoelscher M. A comparison of early function between kidney grafts protected with HTK solution versus Euro-Collins solution. Transplant Proc 1989; 21:1243-4. [PMID: 2496492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- A F Groenewoud
- Klinikum Rechts Der Isar Technical University, Munich, West Germany
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Heidecke CD, Nicolaus C, Stadler J, Adolf J, Florack G, Bollschweiler E, Hoelscher M. Biologic assessment of cyclosporine in serum of kidney transplant patients. Transplant Proc 1988; 20:494-8. [PMID: 3284096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- C D Heidecke
- Department of Surgery, Technical University of Munich, Klinikum Rechts der Isar, FRG
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Abstract
The problem of fungus infections after liver transplantation was studied. In 100 consecutive recipients of orthotopic liver homografts there were 10 and 8 examples, respectively, of localized and disseminated infections caused by Candida species. Candidemia was demonstrated in 8 of these 18 patients. One patient who had a localized Candida infection also had disseminated cryptococcosis. An additional 31 patients were infested in that Candida could be cultured from sites where it is not normally found, such as the blood (8 examples), urine (8), ascitic fluid (8), and wounds (22). This exorbitant incidence of monilial infections and infestations was associated with a high frequency of complications involving the homograft as well as the hosts' gastrointestinal tract during the post-transplantation period. The yeasts found in blood, urine, ascitic fluid and elsewhere were thought to have originated from the gut. Ten of the 100 patients had aspergillosis which was localized in 7 instances and disseminated in 3. The lung was the most frequently affected organ. The fungus infections played a contributory role in the downhill course of our patients but in the event of death more fundamental and more frequent causes of failure were technical complications involving the homografts, difficulties in controlling rejection with reasonable immunosuppressive doses and bacterial sepsis. Suggestions have been made for the better control of fungal infections in liver recipients.
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Schröter GP, Hoelscher M, Putnam CW, Porter KA, Hansbrough JF, Starzl TE. Infections complicating orthotopic liver transplantation: a study emphasizing graft-related septicemia. Arch Surg 1976; 111:1337-47. [PMID: 793568 PMCID: PMC3262237 DOI: 10.1001/archsurg.1976.01360300027004] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In 93 recipients of 102 orthotopic liver homografts, the incidence of bacteremia or fungemia exceeded 70%. The graft itself was usually an entry site for systemic infection after both immunologic and nonimmunologic parenchymal injury, especially if there was defective biliary drainage. The role of the homograft itself as the special infectious risk factor has prompted increased use of defunctionalized jejunal Roux limbs to reduce graft contamination. It has also stimulated very aggressive postoperative diagnostic efforts to rule out remedial mechanical complications of the transplant.
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Starzl TE, Porter KA, Putnam CW, Schroter GP, Halgrimson CG, Weil R, Hoelscher M, Reid HA. Orthotopic liver transplantation in ninety-three patients. Surg Gynecol Obstet 1976; 142:487-505. [PMID: 176741 PMCID: PMC2605292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
During the 11 1/2 year period ending 13 months ago, 93 consecutive patients were treated with orthotopic liver transplantation. Fifty-six of the recipients were 18 years old or younger, and the other 37 were adults. The most common indications for operation were biliary atresia, primary hepatic malignant tumor, chronic aggressive hepatitis and alcoholic cirrhosis. There has been a gradual improvement in results throughout the period of study, although to a satisfactory level. Twenty-seven of the 93 patients survived for at least one year after liver replacement with a maximum of six years, and 16 are still alive after 13 to 71 months. The 11 late deaths after one to six years were caused by chronic rejection, biliary obstruction, recurrence of hepatoma, systemic infection or hepatitis of the homograft. Rejection of the liver as judged by classical histopathologic criteria played a surprisingly small role in the heavy over-all mortality, accounting for less than 10 per cent of the deaths. Technical or mechanical problems, especially those of biliary duct reconstruction, were a far greater cause of failure, as were systemic infections. Six of the 37 adult recipients had lethal cerebrovascular accidents during, or just after, operation. When abnormalities of liver function developed in the postoperative period, the nearly automatic diagnosis of homograft rejection, in retrospect, proved to have been wrong in most instances. Further development of liver transplantation depends upon two kinds of progress. There must be reduction of operative and early postoperative accidents and complications by more discriminating patient selection, purely technical improvement and better standardization of biliary duct reconstruction. The second area will be in sharpening the criteria for the differnetial diagnosis of postoperative hepatic malfunction, including the liberal use of transhepatic cholangiography and needle biopsy. Only then can better decisions be made about changes in medication or about the need for secondary corrective surgical procedures.
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