Travel and migration associated infectious diseases morbidity in Europe, 2008.

BACKGROUND: Europeans represent the majority of international travellers and clinicians encountering returned patients have an essential role in recognizing, and communicating travel-associated public health risks. METHODS: To investigate the morbidity of travel associated infectious diseases in European travellers, we analysed diagnoses with demographic, clinical and travel-related predictors of disease, in 6957 ill returned travellers who presented in 2008 to EuroTravNet centres with a presumed travel associated condition. RESULTS: Gastro-intestinal (GI) diseases accounted for 33% of illnesses, followed by febrile systemic illnesses (20%), dermatological conditions (12%) and respiratory illnesses (8%). There were 3 deaths recorded; a sepsis caused by Escherichia coli pyelonephritis, a dengue shock syndrome and a Plasmodium falciparum malaria.GI conditions included bacterial acute diarrhea (6.9%), as well as giardiasis and amebasis (2.3%). Among febrile systemic illnesses with identified pathogens, malaria (5.4%) accounted for most cases followed by dengue (1.9%) and others including chikungunya, rickettsial diseases, leptospirosis, brucellosis, Epstein Barr virus infections, tick-borne encephalitis (TBE) and viral hepatitis. Dermatological conditions were dominated by bacterial infections, arthropod bites, cutaneous larva migrans and animal bites requiring rabies post-exposure prophylaxis and also leishmaniasis, myasis, tungiasis and one case of leprosy. Respiratory illness included 112 cases of tuberculosis including cases of multi-drug resistant or extensively drug resistant tuberculosis, 104 cases of influenza like illness, and 5 cases of Legionnaires disease. Sexually transmitted infections (STI) accounted for 0.6% of total diagnoses and included HIV infection and syphilis. A total of 165 cases of potentially vaccine preventable diseases were reported. Purpose of travel and destination specific risk factors was identified for several diagnoses such as Chagas disease in immigrant travellers from South America and P. falciparum malaria in immigrants from sub-Saharan Africa. Travel within Europe was also associated with health risks with distinctive profiles for Eastern and Western Europe. CONCLUSIONS: In 2008, a broad spectrum of travel associated diseases were diagnosed at EuroTravNet core sites. Diagnoses varied according to regions visited by ill travellers. The spectrum of travel associated morbidity also shows that there is a need to dispel the misconception that travel, close to home, in Europe, is without significant health risk.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Diagnosing Schistosomiasis by Detection of Cell-Free Parasite DNA in Human Plasma

Bilharzia (schistosomiasis) occurs in the tropics and subtropics and is one of the most important parasite diseases of humans. It is caused by flukes residing in the vessels of the gut or bladder, causing fever, pain, and bleeding. Bladder cancer or esophageal varices may follow. Diagnosis is difficult, requiring detection of parasite eggs in stool, urine, or gut/bladder biopsies. In this paper, we introduce a fundamentally new way of diagnosing bilharzia from the blood. It has been known for almost 20 years that patients with cancer have tumor-derived DNA circulating in their blood, which can be used for diagnostic purposes. During pregnancy, free DNA from the fetus can be detected in motherly blood, which can be used for diagnosing a range of fetal diseases and pregnancy-associated complications. We found that parasite DNA can be detected in the same way in the blood of patients with bilharzia. In patients with early disease, diagnosis was possible earlier than with any other test. DNA could be detected in all patients with active disease in our study. Patients after treatment had significantly lower parasite DNA concentrations and turned negative 1–2 years after treatment. Future studies should implement the method in large cohorts of patients and should define criteria for the confirmation of the success of treatment by comparing the concentration of fluke DNA before and after therapy

Infektionen mit HTLV-I und HTLV-II

Krämer A, Wörmann T. Infektionen mit HTLV-I und HTLV-II. In: Löscher T, Burchard G-D, eds. Tropenmedizin in Klinik und Praxis. Mit Reise- und Migrationsmedizin. 4th ed. Stuttgart: Thieme; 2010: 363-372

STIKO-Empfehlung zur COVID-19-Impfung bei Personen mit Immundefizienz (ID)

Die STIKO empfiehlt bisher ungeimpften Personen mit einer Immundefizienz zunächst 2 Impfstoffdosen eines mRNA-Impfstoffs im Abstand von 3 – 6 (Comirnaty) bzw. 4 – 6 Wochen (Spikevax). Allen Personen mit einer Immundefizienz soll etwa 6 Monate nach der Grundimmunisierung eine zusätzliche Impf¬stoffdosis eines mRNA-Impfstoffs angeboten wer¬den, bei schwer immundefizienten Personen auch schon bereits 4 Wochen nach der 2. Impfstoffdosis als Optimie¬rung der primären Impfserie. Eine serologische Antikörpertestung wird außer bei schwer immundefizienten Personen mit einer erwartbar stark verminderten Impfant¬wort nicht grundsätzlich empfohlen. Wie das Epidemiologische Bulletin 39/2021 ausführt, ist für Personen ohne ausreichenden Immunschutz weiterhin die Einhaltung von Abstands- und Hygieneregeln besonders wichtig und ihre Kontaktpersonen sollten unbe¬dingt vollständig geimpft sein und im Um-gang mit schwer immundefizienten Personen nicht auf einen medizinischen Mund-Nasen-Schutz ver¬zichten

Effect of chronic Giardia lamblia infection on epithelial transport and barrier function in human duodenum

BACKGROUND: Giardia lamblia causes infection of the small intestine, which leads to malabsorption and chronic diarrhoea. AIM: To characterise the inherent pathomechanisms of G lamblia infection. METHODS: Duodenal biopsy specimens from 13 patients with chronic giardiasis and from controls were obtained endoscopically. Short‐circuit current (I(SC)) and mannitol fluxes were measured in miniaturised Ussing chambers. Epithelial and subepithelial resistances were determined by impedance spectroscopy. Mucosal morphometry was performed and tight junction proteins were characterised by immunoblotting. Apoptotic ratio was determined by terminal deoxynucleotidyl transferase‐mediated deoxyuridine triphosphate nick‐end labelling staining. RESULTS: In giardiasis, mucosal surface area per unit serosa area was decreased to 75% (3%) of control, as a result of which epithelial resistance should increase. Instead, epithelial resistance of giardiasis biopsy specimens was decreased (19 (2) vs 25 (2) Ω cm(2); p<0.05) whereas mannitol flux was not significantly altered (140 (27) vs 105 (16) nmol/h/cm(2)). As structural correlate, reduced claudin 1 expression and increased epithelial apoptosis were detected. Furthermore, basal I(SC) increased from 191 (20) in control to 261 (12) µA/h/cm(2) in giardiasis. The bumetanide‐sensitive portion of I(SC) in giardiasis was also increased (51 (5) vs 20 (9) µA/h/cm(2) in control; p<0.05). Finally, phlorizin‐sensitive Na(+)–glucose symport was reduced in patients with giardiasis (121 (9) vs 83 (14) µA/h/cm(2)). CONCLUSIONS: G lamblia infection causes epithelial barrier dysfunction owing to down regulation of the tight junction protein claudin 1 and increased epithelial apoptoses. Na(+)‐dependent d‐glucose absorption is impaired and active electrogenic anion secretion is activated. Thus, the mechanisms of diarrhoea in human chronic giardiasis comprise leak flux, malabsorptive and secretory components

Patients with chronic disease.

a<p>Note that 10 mL of plasma were processed. 1 copy per mL = 1.67 copies per PCR vial.</p

DNA copies per mL of pooled mouse plasma (y-axis, four mice per datum point) in mice infected intraperitoneally with 100 cercariae of <i>S. mansoni</i>.

<p>After completion of parasite maturation on day 42, mice were treated orally with praziquantel on day 45 (120 mg per kg). At the indicated times (x-axis), four mice were sacrificed, their blood pooled, and 1 mL of pooled plasma was tested as described in the <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000422#s2" target="_blank">Materials and Methods</a> section for cell-free <i>Schistosoma</i> DNA. The untreated group is marked with an asterisk (*).</p

Patients with Katayama syndrome.

a<p>Days post exposure with fresh water (most likely event).</p>b<p>Days post onset of symptoms.</p>c<p>Days post treatment for second visits.</p>d<p>Leukocyte count (n per nL). Average leukocyte count in patients 1 to 5: first visit, 9.48 cells/nl; second visit, 5.92 cells/nl (p<0.0017).</p>e<p>Percent eosinophiles in total leukocytes. Average eosinophile fraction in patients 1 to 5: first visit, 18.88%; second visit: 3.2% (p<0.033).</p>f<p>Enzyme immunoassay.</p>g<p>Note that 10 mL of plasma were processed. 1 copy per mL = 1.67 copies per PCR vial.</p