[Home visits of vacationers returning from foreign travel].
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Diagnosis, Differential↗
Biomedical subjects
T Löscher
Publications and source records attributed to T Löscher.
Influence of rheumatoid factor on the specificity of a rapid immunochromatographic test for diagnosing dengue infection.
In order to determine the influence of rheumatoid factor in serum specimens on the specificity of an immunochromatographic test for the detection of antibodies against dengue virus, 50 clinical specimens containing rheumatoid factor were evaluated for cross reactivity with a commercially available assay. While specificity for the detection of immunoglobulin (Ig) G antibodies was 100%, the IgM component of the test showed false-positive results in 26% of cases. Thus, it is important to consider interference by rheumatoid factor when using immunochromatographic assays for the detection of specific IgM produced during dengue infection.
Antibodies, Viral↗
[Psychosocial, economic and physical status of former leprosy patients in Uganda].
This study investigates the general living condition, the psychosocial, economical and physical situation of 161 leprosy patients previously treated at the St. Francis Leprosy Hospital at Buluba/Uganda, basing on interviews and clinical examinations. The results point to a negative correlation between general education and specific knowledge of leprosy and highlight a serious psychosocial situation of previously treated leprosy patients. The most important conclusion is that besides leprosy-specific chemotherapy, lifelong extensive general and leprosy-specific health education and posttreatment care can prevent disabilities in leprosy patients.
Adult↗
Close genotypic relationship between Enterocytozoon bieneusi from humans and pigs and first detection in cattle.
The reservoirs and the routes of transmission of Enterocytozoon bieneusi are still unknown. In humans, it is the most commonly found microsporidial species. It has also been found repeatedly in pigs, too. The first detection of E. bieneusi in cattle is reported herein. Two distinct genotypes were characterized and compared with 4 other genotypes from humans, 6 from pigs, and 1 from a cat. From these 13 E. bieneusi genotypes known to date, 25 polymorphic sites could be identified in the internal transcribed spacer of the rRNA gene. The spectrum of polymorphisms within and between each of the 4 host species indicates a close relationship between E. bieneusi strains from humans and pigs, whereas those from cattle are more distantly related. The data suggest the absence of a transmission barrier between pigs and humans for this pathogen.
Animals↗
[Persistent arthralgias in Ross-River-Virus disease after travel to the South Pacific].
HISTORY AND CLINICAL FINDINGS: A 57-year-old patient presented with malaise and severe persistent arthralgia of the left shoulder. He reported an acute illness with fever, generalized myalgia and arthralgias of the large joints which had started one month earlier during his flight back to Germany after a two weeks trip to the South Pacific. Physical examination showed extensive pain on palpation of the glenohumeral and acromioclavicular joints with impairment of active and passive mobility. Investigation of the cervical spine was normal. INVESTIGATIONS: Apart from elevated C-reactive protein and erythrocyte sedimentation rate levels, routine laboratory investigations were normal including negative immunodiagnostic tests for autoantibodies and various global infections that may be associated with arthritis. Immunofluorescence tests showed significant levels of specific IgM- and IgG-antibodies against Ross River virus (RRV) but not against other arboviruses endemic in the South Pacific and Australia (Dengue, West Nile, Chikungunya, Sindbis, Barmah Forest). This was confirmed by a positive RRV neutralisation test. Attempts at virus isolation and detection of viral RNA by PCR were not successful. TREATMENT AND COURSE: Symptomatic treatment with high doses of diclofenac quickly led to pain relief, and arthralgias receded within 10 days after begin of treatment. However, several bouts of arthralgia of the left shoulder and left knee occurred during a period of 4 months. CONCLUSIONS: Because of the current epidemiological situation in the South Pacific and Australia, infections by arboviruses like RRV should be considered in travellers returning from these areas with severe and persistent arthralgia of unknown origin, even in the absence of fever and other symptoms of acute infection.
Alphavirus Infections↗
[Malaria. Risks and prevention for travellers].
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Antimalarials↗
Sensitivity and specificity of a rapid immunochromatographic test for diagnosis of visceral leishmaniasis.
A rapid immunochromatographic dipstick test has become available for the qualitative detection of total anti-Leishmania immunoglobulins using the recombinant K39 antigen. To evaluate the test, 96 serum specimens from patients with a variety of tropical infections were tested. Fourteen of the specimens derived from patients with parasitologically confirmed kala-azar, and all were strongly positive for antibodies to Leishmania donovani complex using the immunofluorescence test. Although all 82 samples negative by the immunofluorescence test were confirmed as negative by the dipstick assay, only 10 (71.4%) of the 14 positive samples were reactive. These results indicate that the test in its current form lacks sufficient sensitivity to be recommended as a screening tool, but it might be useful for indicating further diagnostic procedures in a clinical setting.
Animals↗
Culture-independent prediction of isoniazid resistance in Mycobacterium tuberculosis by katG gene analysis directly from sputum samples.
BACKGROUND: The molecular prediction of isoniazid (INH) resistance in Mycobacterium tuberculosis is hampered by the need for specialized equipment, expertise, high costs, a limited range of detectable mutations, or several of these factors. The rationale for the study was to find a practical alternative and to demonstrate generally valid problems. METHODS AND RESULTS: DNA extracted from decontaminated sputum pellets was used to amplify a 0.26 kb target sequence within the katG gene. Mutations of codon 315, frequently found in isoniazid-resistant isolates, could be discriminated in a simple agarose minigel format following an AciI digest of the nested polymerase chain reaction (PCR) product. Within a panel of 22 sputum samples, INH resistance could be predicted in 5 of 10 samples containing isoniazid-resistant M. tuberculosis. The protocol is robust, requires little expertise and no specialized equipment, and provides the test results within 2 days. CONCLUSION: The results show the feasibility to rapidly and easily detect mutations highly predictive of isoniazid resistance. Nevertheless, this, like any other molecular resistance prediction test, is affected by often neglected factors, including mutation prevalences, the phenomenon of heteroresistance, and a possible bias toward one's own method.
Antitubercular Agents↗
Population structure of recrudescent Plasmodium falciparum isolates from western Uganda.
It has been proposed that polymorphisms of the Merozoite Surface Protein 1 and 2 (MSP1 and MSP2) and the Glutamate Rich Protein (GLURP) genes can be considered as genetic markers for the genotyping of field populations of Plasmodium falciparum. During a field study on in vivo drug resistance against chloroquine, sulphadoxine/pyrimethamine (S/P) and cotrimoxazole in West Uganda, sensitive and resistant isolates were collected from patients by fingerprick for genotyping. 59 (72.8%) of the 81 P. falciparum samples isolated at day 0 showed multiclonal infection with 2-7 clones. Among the isolates we investigated, presence of the allelic family MAD20 of MSP1 at day 0 was significantly (P = 0.0041) associated with decreased resistance to antimalarials. Use of this method in a field study on in vivo drug resistance demonstrates another potential application of genotyping as a tool for epidemiological investigations.
Adolescent↗
[Pulmonary trichomoniasis: diagnosis based on identification of irritation in bronchoalveolar lavage].
Bronchopulmonary infections caused by trichomonads have been reported mainly in patients with pre-existing pulmonary or debilitating disease (e.g. bronchial carcinoma, lung abscess, bronchiectasis). Pulmonary trichomoniasis is most often due to infection with Trichomonas tenax, usually regarded as a harmless commensal of the human mouth, and may rarely be caused by other trichomonas species. A 45 year old female presented with a dry cough, exertional dyspnoea and malaise. These symptoms persisted for 6 months regardless of anti-inflammatory and anti-obstructive inhalative therapy. Sarcoidosis of the lungs, diagnosed 20 years prior, had been asymptomatic since and there was no coexistent disease. Laboratory data revealed increased ACE-levels (90 IE/ml) and lung function showed bronchial hyperreactivity on histamine challenge. No other abnormalities were found (chest x-ray, bronchoscopy, lung function test, blood count and serum calcium). The diagnosis was based on the cytological identification of numerous trophozoites of T. tenax in the bronchoalveolar lavage. Therapy with oral metronidazol for 40 days led to complete recovery from symptoms and normalisation of ACE serum levels. The patient has remained well for 12 months since. The pathogenicity of oral trichomonads in the non-immunocompromised host remains uncertain. Our patient had no known medical risk factors by comparison with published cases. The case illustrates the clinical relevance of pulmonary trichomoniasis in an otherwise healthy person.
Animals↗
Seroconversion to circumsporozoite antigen of Plasmodium falciparum demonstrates a high risk of malaria transmission in travelers to East Africa.
Circumsporozoite (CS) antibodies have been shown to be reliable indicators of malaria transmission in endemic areas. Their prevalence in travelers can indicate the degree of exposure to plasmodial infection. Two hundred sixty-two short-term travelers to Kenya were recruited to a prospective study to determine the incidence of CS antibody conversion. All travelers were receiving malaria chemoprophylaxis. Serum samples were drawn before departure and 4-6 weeks after their return to Germany. Sera from 310 volunteers who did not leave Germany served as controls. Serum specimens from 13 (4.96%) of the 262 travelers were found to be positive after return. None of the travelers developed symptoms of clinical malaria or antibodies against the blood stages of Plasmodium falciparum. All 310 control samples tested negative. These data demonstrate a considerable risk of malaria transmission for short-term travelers to East Africa.
Adolescent↗
Vaccination of travelers against hepatitis A and B.
Despite the fact that effective preventive measures have become available, there has been no decline in the incidences of both hepatitis A and hepatitis B in most industrialized countries to date. This is, in part, due to the rapid increase in the number of travelers to areas of medium and high endemicity for both diseases, primarily developing countries. Targeting of travelers at risk of contracting these diseases for vaccination offers a chance of significantly reducing their incidence. Hepatitis A, an acute disease associated with poor food hygiene, is the most common vaccine-preventable infection in travelers. Hepatitis A immunity should, therefore, be considered essential for anyone visiting an area of high endemicity. In contrast, hepatitis B is a blood-borne virus which was thought, until recently, to pose a relatively low risk to the majority of travelers. However, the 1990s has seen international tourism and business travel grow faster in Europe than anywhere else in the world, with travel to areas of high endemicity for hepatitis B (Africa, Asia and South America) being commonplace. Thus the number of reported hepatitis B cases is increasing in many countries. Furthermore, there is considerable overlap of high-endemicity areas of hepatitis A and hepatitis B so that travelers are often considered to be at risk from both viruses. As well as separate hepatitis A and B vaccine preparations, a combined hepatitis A and B vaccine is now available which may offer improvements in vaccination schedule, enhanced patient compliance, and reduced cost.
Developing Countries↗
Sensitivity and specificity of dipstick tests for rapid diagnosis of malaria in nonimmune travelers.
Swift diagnosis of Plasmodium falciparum malaria in areas where the disease is not endemic is frequently complicated by the lack of experience on the side of involved laboratory personal. Diagnostic tools based on the dipstick principle for the detection of plasmodial histidine-rich protein 2 (HRP-2) and parasite-specific lactate dehydrogenase (pLDH), respectively, have become available for the qualitative detection of P. falciparum malaria. In order to evaluate two of the currently available assays, specimens from 231 patients were screened during a prospective multicenter study. Among the screened specimens, samples from 53 patients (22.9%) were positive for P. falciparum malaria by microscopy and/or PCR. While the test kit based on the detection of HRP-2 performed with a sensitivity of 92.5% and a specificity of 98.3%, the kit for the detection of pLDH showed a sensitivity of 88.5% and a specificity of 99.4%. Dipstick tests have the potential of enhancing speed and accuracy of the diagnosis of P. falciparum malaria, especially if nonspecialized laboratories are involved.
Biomarkers↗
Significance of ahpC promoter mutations for the prediction of isoniazid resistance in Mycobacterium tuberculosis.
To determine the value of ahpC promoter mutations for the rapid prediction of isoniazid resistance, this genomic region was characterized in 50 isoniazid-resistant and 12 isoniazid-sensitive Mycobacterium tuberculosis isolates. Of the resistant isolates, 12 had ahpC promoter mutations, but only one possessed both an ahpC promoter mutation and a katG codon 315 substitution, although the latter was found in the majority (54%) of the isoniazid-resistant isolates investigated. This investigation presents empirical evidence that the central portion of the ahpC promoter is the most valuable genetic locus to complement katG codon 315 characterizations in order to increase the sensitivity of molecular tests for the prediction of isoniazid resistance.
Antitubercular Agents↗
Sensitive ELISA dipstick test for the detection of chloroquine in urine under field conditions.
OBJECTIVE: To evaluate a new enzyme-linked immunosorbent assay (ELISA) dipstick test for detecting chloroquine (CQ) in urine in a malaria-endemic region of north-western Namibia. METHOD: Urine samples from 92 patients attending the outpatient department of Kamhaku Hospital with suspected malaria infection were tested for CQ with both the Dill-Glazko test and the ELISA dipstick test. Results were compared to the history of CQ intake as documented in the patients' health passes. RESULTS: The dipstick test proved an easy-to-handle and very sensitive tool for the detection of CQ with a lower limit of detection at 120 nmol/l. It showed high agreement with the history of CQ intake within the last 6 months. The specificity in a negative control group was 100%. The Dill-Glazko test was far less sensitive and specific with a lower detection limit of 150 micromol/l. CONCLUSION: The dipstick test can be used in pharmacological studies to evaluate the use of CQ, and as an inclusion criterion for in vivo and in vitro sensitivity tests, whereas the Dill-Glazko test is appropriate to test compliance during and a few days after CQ intake.
Adolescent↗
Blinded, externally controlled multicenter evaluation of light microscopy and PCR for detection of microsporidia in stool specimens. The Diagnostic Multicenter Study Group on Microsporidia.
The quality parameters for the detection of microsporidia in identical sets of 50 stool samples were determined for six laboratories where technicians used light microscopy and for six laboratories where technicians used PCR. The average overall sensitivities were 67% (89% for patient samples only) for the PCR laboratories and 54% (80% for patient samples only) for the light microscopy laboratories. Specificities were 98 and 95%, respectively. Differences in results were most apparent between the individual laboratories rather than between the two major methods used.
Animals↗
Assessing the incidence of infection with Plasmodium falciparum among international travelers.
Circumsporozoite (CS) antibodies, indicating plasmodial infection but not necessarily development of disease, have been shown to be reliable indicators of transmission in endemic areas. To estimate the actual rate of plasmodial infection, the prevalence of CS antibodies was investigated by an ELISA test system in a selected population of 2,131 travelers returning from areas endemic for malaria who presented to an outpatient clinic without any apparent symptom or clinical sign of malaria. Serum specimens from 104 of the investigated 2,131 patients (4.9%) were found to be positive (titer > or = 6.25 international ELISA units [IEU]). The geometric mean titer of antibody concentrations (IEU) in seropositive patients was 18.64 IEU (95% confidence interval [CI] = 13.15-24.13), while it was 2.1 IEU (95% CI = 1.8-2.4) in seronegative patients. A significantly above average risk for plasmodial infection could be found among travelers to East Africa (risk ratio [RR] = 4.5, P < 0.001), West Africa (RR = 4.5, P < 0.001), and Southern Africa (RR = 3.2, P = 0.015), while areas with a comparatively low risk included Central America (RR = 0.86, P < 0.001), the Indian subcontinent (RR = 0.45, P = 0.015), South America (RR = 0.49, P = 0.091), East Asia (RR = 0.68, P = 0.441), West Asia (RR = 0.24, P = 0.099), and Southeast Asia (RR = 0.69, P = 0.094). The results of this study emphasize the importance of adequate malaria chemoprophylaxis in nonimmune travelers to endemic areas. By use of the described method, estimates of the true infection rate of malaria in travelers can be derived for certain areas and the value of prophylactic measures can be demonstrated.
Adolescent↗
Strain differentiation in microsporidia.
Microsporidia are obligate intracellular, spore-forming protozoa and are regarded as newly emerging pathogens . Enterocytozoon spp. as well as Encephalitozoon spp. are recognized as major aetiological agents in chronic diarrhoea of immnunocompromised patients. The detection and differentiation of strains within microsporidial species is a prerequisite for the elucidation of their hitherto unknown reservoirs and their mode of transmission . In Enterocytozoon bieneusi, the most prevalent human-pathogenic microsporidium, 6 different genotypes of the internal transcribed spacer (ITS) of the rRNA gene are known so far, with 12 polymorphic sites . This pathogen has infrequently been detected in 2 animal hosts only, pigs and rhesus macaques, and only the genotype of the latter has also been found in a human patient, too. Encephalitozoon cuniculi has a wider confirmed spectrum of animal hosts, but only one polymorphic site is known in the ITS, differing in 3 different numbers of a tetranucleotide repeat. Therefore, further genomic targets may have to be characterized, too. Few data are available on strain differentiation in Encephalitozoon intestinalis and E. hellem.
Animals↗