Nicht-Cholera-Vibrionen – derzeit noch seltene, aber wachsende Infektionsgefahr in Nord- und Ostsee

Hintergrund: Nicht-Cholera-Vibrionen nehmen im Rahmen des Klimawandels eine zunehmende Bedeutung als humane Pathogene ein, da die Prävalenz dieser Erreger im Meereswasser entscheidend von der Wassertemperatur abhängt. In den letzten Jahren konnten während der Sommermonate wiederholt größere Infektionsausbrüche in gemäßigten Klimazonen beobachtet werden. Ziel der Arbeit: Information einer breiten ärztlichen Leserschaft über potenziell lebensbedrohliche Krankheitsbilder, die durch Infektionen mit Nicht-Cholera-Vibrionen ausgelöst werden. Material und Methoden: Übersicht über aktuelle Literatur zu Infektionen mit Nicht-Cholera-Vibrionen im Allgemeinen und zur epidemiologischen Situation in Deutschland im Speziellen. Ergebnisse: Nicht-Cholera-Vibrionen verursachen vorwiegend Wund- und Ohrinfektionen nach Kontakt mit kontaminiertem Meereswasser sowie Gastroenteritiden nach dem Konsum nicht ausreichend gegarter Meerestiere. Da bis März 2020 keine Meldepflicht für diese Erreger in Deutschland bestand, muss von einer hohen Dunkelziffer ausgegangen werden. Immunsupprimierte sowie chronisch erkrankte Menschen haben ein deutlich erhöhtes Risiko für schwere Krankheitsverläufe. Schon bei klinischem Verdacht sollte eine kalkulierte antiinfektive Therapie erfolgen und bei Wundinfektionen eine chirurgische Sanierung erwogen werden. Diskussion: Aufgrund des fortschreitenden Klimawandels muss in den kommenden Jahren mit dem vermehrten Auftreten von Infektionen mit Nicht-Cholera-Vibrionen gerechnet werden. Ärzte sollten über diese potenziell lebensbedrohlichen Erkrankungen informiert sein, um Patienten einer entsprechenden Diagnostik und Behandlung zuzuführen.Background: The abundance of non-cholera Vibrio spp. in the aquatic environment shows a positive correlation with water temperatures. Therefore, climate change has an important impact on the epidemiology of human infections with these pathogens. In recent years large outbreaks have been repeatedly observed during the summer months in temperate climate zones. Objective: To inform medical professionals about the potentially life-threatening diseases caused by non-cholera Vibrio spp. Material and methods: Review of the current literature on infections with non-cholera Vibrio spp. in general and on the epidemiological situation in Germany in particular. Results: Non-cholera Vibrio spp. predominantly cause wound and ear infections after contact with contaminated seawater and gastroenteritis after consumption of undercooked seafood. As there have not been mandatory notification systems for these pathogens in Germany up to March 2020, a high number of unreported cases must be assumed. Immunosuppressed and chronically ill patients have a much higher risk for severe courses of diseases. If an infection with non-cholera Vibrio spp. is suspected anti-infective treatment should be promptly initiated and surgical cleansing is often necessary for wound and soft tissue infections. Conclusion: Due to the ongoing global warming an increased incidence of human infections with non-cholera Vibrio spp. must be expected in the future. Medical professionals should be aware of these bacterial pathogens and the potentially life-threatening infections in order to enable timely diagnostics and treatment.Peer Reviewe

Heatwave-associated Vibrio infections in Germany, 2018 and 2019

Background: Vibrio spp. are aquatic bacteria that prefer warm seawater with moderate salinity. In humans, they can cause gastroenteritis, wound infections, and ear infections. During the summers of 2018 and 2019, unprecedented high sea surface temperatures were recorded in the German Baltic Sea. Aim: We aimed to describe the clinical course and microbiological characteristics of Vibrio infections in Germany in 2018 and 2019. Methods: We performed an observational retrospective multi-centre cohort study of patients diagnosed with domestically-acquired Vibrio infections in Germany in 2018 and 2019. Demographic, clinical, and microbiological data were assessed, and isolates were subjected to whole genome sequencing and antimicrobial susceptibility testing. Results: Of the 63 patients with Vibrio infections, most contracted the virus between June and September, primarily in the Baltic Sea: 44 (70%) were male and the median age was 65 years (range: 2–93 years). Thirty-eight patients presented with wound infections, 16 with ear infections, six with gastroenteritis, two with pneumonia (after seawater aspiration) and one with primary septicaemia. The majority of infections were attributed to V. cholerae (non–O1/non-O139) (n = 30; 48%) or V. vulnificus (n = 22; 38%). Phylogenetic analyses of 12 available isolates showed clusters of three identical strains of V. vulnificus, which caused wound infections, suggesting that some clonal lines can spread across the Baltic Sea. Conclusions: During the summers of 2018 and 2019, severe heatwaves facilitated increased numbers of Vibrio infections in Germany. Since climate change is likely to favour the proliferation of these bacteria, a further increase in Vibrio-associated diseases is expected.Peer Reviewe

Lower Levels of Transaminases but Higher Levels of Serum Creatinine in Patients with Acute Hepatitis E in Comparison to Patients with Hepatitis A

In patients with hepatitis E virus (HEV) infections, extrahepatic, particularly renal and hematological manifestations, are increasingly reported in the medical literature but have never been studied compared to a control cohort. We retrospectively analyzed medical records of consecutive patients that were diagnosed with acute hepatitis E (AHE) (n = 69) or acute hepatitis A (AHA) (n = 46) at the University Medical Center Hamburg Eppendorf from January 2009 to August 2019 for demographical, clinical, and laboratory information. Patients with AHE had significantly lower median levels of ALAT (798 U/L) and total bilirubin (1.8 mg/dL) compared to patients with AHA (2326 U/L; p < 0.001 and 5.2 mg/dL; p < 0.001), suggesting a generally less severe hepatitis. In contrast, patients with AHE had significantly higher median serum creatinine levels (0.9 mg/dL vs. 0.8 mg/dL; p = 0.002) and lower median estimated glomerular filtration rate (eGFR) (91 mL/min/1.73 m2 vs. 109 mL/min/1.73 m2; p < 0.001) than patients with AHA. Leucocyte, neutrophil and lymphocyte count, hemoglobin, platelets, red cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR), and RDW to lymphocyte ratio (RLR) did not differ between patients with AHE and those with AHA. Our observations indicate that renal but not hematological interference presents an underrecognized extrahepatic feature of AHE, while inflammation of the liver seems to be more severe in AHA

SARS-CoV-2 Reinfection in a Healthcare Worker Despite the Presence of Detectable Neutralizing Antibodies

So far, only a few reports about reinfections with SARS-CoV-2 have been published, and they often lack detailed immunological and virological data. We report about a SARS-CoV-2 reinfection with a genetically distinct SARS-CoV-2 variant in an immunocompetent female healthcare worker that has led to a mild disease course. No obvious viral escape mutations were observed in the second virus variant. The infectious virus was shed from the patient during the second infection episode despite the presence of neutralizing antibodies in her blood. Our data indicate that a moderate immune response after the first infection, but not a viral escape, did allow for reinfection and live virus shedding

Milde COVID-19-Verläufe bei Mitarbeitenden einer Universitätsklinik

Background!#!Healthcare workers are among the most exposed and potentially most threatened populations of the ongoing COVID-19 pandemic. Despite some reports on numbers of infections with SARS-CoV‑2 in German healthcare workers, the courses of their clinical presentation when affected by COVID-19 are not well described.!##!Objective!#!In this contribution, characteristics and progressions of infected cases among healthcare workers at the University Medical Center Hamburg-Eppendorf during the first wave of the COVID-19 pandemic will be presented.!##!Methods!#!Between 1 July and 28 July 2020, 67 healthcare workers, who previously tested positive for SARS-CoV‑2 via PCR, were invited via E‑mail to participate in an anonymous online questionnaire; 39 persons participated.!##!Results!#!Participants (58%) were mostly ≤ 39 years old (64%) and female (70%). Most healthcare workers were involved in direct patient management (85%), including contact with SARS-CoV‑2 positive patients (62%). All participants reported acute symptoms with a median duration of 19 days. The most frequent symptoms were fatigue (85%), anosmia (67%), cough (64%), headache (62%), and shortness of breath (51%). The disease course was mostly mild with low admission rates (5%). Ongoing symptoms lasting more than four weeks post-symptom-onset, particularly anosmia, fatigue, and shortness of breath, were reported by 38%. This group more frequently had pre-existing conditions (53% vs. 12%, p = 0.010), specifically hypertension (27% vs. 4%, p = 0.062).!##!Discussion!#!Healthcare workers reported mostly mild courses of COVID-19 despite increased contact with SARS-CoV-2 patients. However, some reported persistent symptoms months after infection

Longitudinal SARS-CoV-2 Seroprevalence among Employees in Outpatient Care Services in Hamburg

The risk of SARS-CoV-2 infection is particularly high for healthcare workers during the pandemic. Home care workers visit many different households per shift. Encounters with mostly elderly patients and their relatives increase the potential for the undetected spread of SARS-CoV-2. In order to gain insight into the seroprevalence of SARS-CoV-2 antibodies and possible transmission risks in outpatient care, this follow-up study was conducted with nursing services in Hamburg. The aim was to estimate the dynamics of seroprevalence in this occupational group over a 12-month period, to identify occupation-specific risk factors, and to collect information on the vaccination status of the surveyed nursing staff. Antibody testing for SARS-CoV-2 IgG against the S1 domain (EUROIMUN Analyser I® Lübeck, Germany) was performed on participating healthcare workers with patient contact at a total of four time points within one year from July 2020 to October 2021 (baseline, follow-up after three, six and twelve months). The data were mostly analysed descriptively. Differences in IgG titres were analysed using variance analysis methods, particularly Tukey’s range test. The seroprevalence was 1.2% (8/678) at baseline and 1.5% (9/581) at the three-month follow-up (T1). At the second follow-up (T2) after six months, vaccination against SARS-CoV-2 was available from January 2021 onwards. The prevalence rate of positive IgG antibodies relative to the S1 domain of the spike protein test among unvaccinated individuals was 6.5%. At (T3) after twelve months (July to October 2021), 482 participants were enrolled, and 85.7% of the workers were considered fully vaccinated at this time point, while 51 individuals were unvaccinated. The prevalence was 13.7% (7/51). In our study, a low seroprevalence was found among home care workers, which was lower than in our studies conducted in the clinical setting. Therefore, it can be assumed that the occupational risk of infection is rather low for both the nursing staff and the patients/clients cared for in the outpatient setting. The good provision of protective equipment and the high vaccination rate of the staff probably had a positive influence

Lymphocytopenia and Anti-CD38 Directed Treatment Impact the Serological SARS-CoV-2 Response after Prime Boost Vaccination in Patients with Multiple Myeloma

Even though several SARS-CoV-2 vaccines have shown high effectiveness in the prevention of COVID-19 in healthy subjects, vaccination response in patients with plasma-cell-related disorders (PCD) remains widely unknown. Here, we report on an analysis describing the serological response after prime-boost SARS-CoV-2 vaccination in PCD patients, as compared to a healthy control group, and on possible influencing factors of serological responses. Blood samples were analyzed for the presence of quantitative anti-SARS-CoV-2 spike RBD Ig. A total of 82 patients were included; 67 received mRNA-, eight vector-based and four heterologous vaccinations. SARS-CoV-2 antibody titers (SP-AbT) were assessed in a mean of 23 days (SD ± 11 days) after the first and in a mean 21 days (SD ± 9) after prime-boost vaccination. A positive SP-AbT was detected in 31.9% of PCD patients after the first vaccination, and in 88.9% (44/49) after prime-boost vaccination, which was significantly less likely than that in the control group (100%, 78/78) (p = 0.008). Furthermore, we have been able to validate our previously suggested threshold of 30 CD19+ B lymphocytes/µL as being predictive for SP-AbT development. Despite anti-CD38 directed therapy, quadruplet treatment, higher age and missing deep remission, which correlated negatively with SP-AbT appearance, SP-AbT formation is possible in a majority of myeloma patients after prime-boost vaccination

Three Separate Spike Antigen Exposures by COVID-19 Vaccination or SARS-CoV-2 Infection Elicit Strong Humoral Immune Responses in Healthcare Workers

Background: The immunogenicity of different COVID-19 vaccine regimens and combinations in naïve and convalescent individuals has not been formally tested in controlled studies, and real-life observational studies are scarce. Methods: We assessed the SARS-CoV-2 infection and COVID-19 vaccination-induced immunity of 697 hospital workers at the University Medical Center Hamburg-Eppendorf between 17 and 31 January 2022. Results: The overall prevalence of anti-NC-SARS-CoV-2 antibodies indicating prior infection was 9.8% (n = 68) and thus lower than the seroprevalence in the general population. All vaccinated individuals had detectable anti-S1-RBD-SARS-CoV-2 antibodies (median AU/mL [IQR]: 13,891 [8505–23,543]), indicating strong protection against severe COVID-19. Individuals who received three COVID-19 vaccine doses (median AU/mL [IQR]: 13,856 [8635–22,705]) and those who resolved a prior SARS-CoV-2 infection and had received two COVID-19 vaccine doses (median AU/mL [IQR] 13,409 [6934–25,000]) exhibited the strongest humoral immune responses. Conclusions: The current study indicates that three exposures to the viral spike protein by either SARS-CoV-2 infection or COVID-19 vaccination are necessary to elicit particularly strong humoral immune responses, which supports current vaccination recommendations

Development and design of the Hantavirus registry - HantaReg - for epidemiological studies, outbreaks and clinical studies on hantavirus disease

Background. Frequent outbreaks around the globe and endemic appearance in different parts of the world emphasize the substantial risk of hantavirus diseases. Increasing incidence rates, trends of changing distribution of hantavirus species and new insights into clinical courses of hantavirus diseases call for multinational surveillance. Furthermore, evidence-based guidelines for the management of hantavirus diseases and scoring systems, which allow stratification of patients into risk categories, are lacking. Methods. Hantavirus registry (HantaReg) is a novel registry platform facilitating multinational research of hantavirus-caused diseases, such as haemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS). HantaReg provides an electronic case report form and uses the General Data Protection Regulation compliant platform clinicalsurveys.net, which can be accessed from any internet browser in the world. Having a modular structure, the registry platform is designed to display or hide questions and items according to the documented case (e.g. patient with HFRS versus HCPS) to facilitate fast, but standardized, data entry. Information categories documented in HantaReg are demographics, pre-existing diseases, clinical presentation, diagnostic and therapeutic approaches, as well as outcome. Conclusions. HantaReg is a novel, ready-to-use platform for clinical and epidemiological studies on hantavirus diseases and facilitates the documentation of the disease course associated with hantavirus infections. HantaReg is expected to promote international collaboration and contributes to improving patient care through the analysis of diagnostic and treatment pathways for hantavirus diseases, providing evidence for robust treatment recommendations. Moreover, HantaReg enables the development of prognosis-indicating scoring systems for patients with hantavirus disease