Rapid evolution of protein kinase PKR alters sensitivity to viral inhibitors.

Protein kinase PKR (also known as EIF2AK2) is activated during viral infection and phosphorylates the alpha subunit of eukaryotic translation initiation factor 2 (eIF2), leading to inhibition of translation and viral replication. We report fast evolution of the PKR kinase domain in vertebrates, coupled with positive selection of specific sites. Substitution of positively selected residues in human PKR with residues found in related species altered sensitivity to PKR inhibitors from different poxviruses. Species-specific differences in sensitivity to poxviral pseudosubstrate inhibitors were identified between human and mouse PKR, and these differences were traced to positively selected residues near the eIF2alpha binding site. Our findings indicate how an antiviral protein evolved to evade viral inhibition while maintaining its primary function. Moreover, the identified species-specific differences in the susceptibility to viral inhibitors have important implications for studying human infections in nonhuman model systems

How Long Does Evolution of the Troglomorphic Form Take? Estimating Divergence Times in Astyanax Mexicanus

Features including colonization routes (stream capture) and the existence of both epigean and cave-adapted hypogean populations make Astyanax mexicanus an attractive system for investigating the subterranean evolutionary time necessary for acquisition of the troglomorphic form. Using published sequences, we have estimated divergence times for A. mexicanus using: 1) two different population-level mitochondrial datasets (cytochrome b and NADH dehydrogenase 2) with both strict and relaxed molecular clock methods, and 2) broad phylogenetic approaches combining fossil calibrations and with four nuclear (recombination activating gene, seven in absentia, forkhead, and α-tropomyosin) and two mitochondrial (16S rDNA and cytochrome b) genes. Using these datasets, we have estimated divergence times for three events in the evolutionary history of troglomorphic A. mexicanus populations. First, divergence among cave haplotypes occurred in the Pleistocene, possibly correlating with fluctuating water levels allowing the colonization and subsequent isolation of new subterranean habitats. Second, in one lineage, A. mexicanus cave populations experienced introgressive hybridization events with recent surface populations (0.26-2.0 Ma), possibly also correlated with Pleistocene events. Finally, using divergence times from surface populations in the lineage without evidence of introgression as an estimate, the acquisition of the troglomorphic form in A. mexicanus is younger than 2.2 (fossil calibration estimates) – 5.2 (cytb estimate) Ma (Pliocene)

Evolutionary maintenance of filovirus-like genes in bat genomes

<p>Abstract</p> <p>Background</p> <p>Little is known of the biological significance and evolutionary maintenance of integrated non-retroviral RNA virus genes in eukaryotic host genomes. Here, we isolated novel filovirus-like genes from bat genomes and tested for evolutionary maintenance. We also estimated the age of filovirus VP35-like gene integrations and tested the phylogenetic hypotheses that there is a eutherian mammal clade and a marsupial/ebolavirus/Marburgvirus dichotomy for filoviruses.</p> <p>Results</p> <p>We detected homologous copies of VP35-like and NP-like gene integrations in both Old World and New World species of <it>Myotis </it>(bats). We also detected previously unknown VP35-like genes in rodents that are positionally homologous. Comprehensive phylogenetic estimates for filovirus NP-like and VP35-like loci support two main clades with a marsupial and a rodent grouping within the ebolavirus/Lloviu virus/Marburgvirus clade. The concordance of VP35-like, NP-like and mitochondrial gene trees with the expected species tree supports the notion that the copies we examined are orthologs that predate the global spread and radiation of the genus <it>Myotis</it>. Parametric simulations were consistent with selective maintenance for the open reading frame (ORF) of VP35-like genes in <it>Myotis</it>. The ORF of the filovirus-like VP35 gene has been maintained in bat genomes for an estimated 13. 4 MY. ORFs were disrupted for the NP-like genes in <it>Myotis</it>. Likelihood ratio tests revealed that a model that accommodates positive selection is a significantly better fit to the data than a model that does not allow for positive selection for VP35-like sequences. Moreover, site-by-site analysis of selection using two methods indicated at least 25 sites in the VP35-like alignment are under positive selection in <it>Myotis</it>.</p> <p>Conclusions</p> <p>Our results indicate that filovirus-like elements have significance beyond genomic imprints of prior infection. That is, there appears to be, or have been, functionally maintained copies of such genes in mammals. "Living fossils" of filoviruses appear to be selectively maintained in a diverse mammalian genus (<it>Myotis</it>).</p

Untersuchungen zum Vorkommen von Ektoparasiten bei domestizierten und wildlebenden Meerschweinchen (Cavia spp.)sowie an präinkaischen Meerschweinchenmumien in Peru, Südamerika: Faunistische und paläoparasitologische Untersuchungen

7. Zusammenfassung Untersuchungen zu Vorkommen von Ektoparasiten bei domestizierten und wildlebenden Meerschweinchen (Cavia spp.) sowie an präinkaischen Meerschweinchenmumien in Peru, Südamerika Dittmar de la Cruz, Katharina Institut für Parasitologie, Veterinärmedizinische Fakultät, Universität Leipzig (120 Seiten, 29 Tabellen, 67 Abbildungen, 187 Literaturangaben, 3 Anhänge) In den Zeiträumen von Dezember 1996 bis Februar 1997 und Februar bis Oktober 1998 sowie im Mai 1999 wurden Untersuchungen zum Vorkommen von Ektoparasiten bei Cavia spp. in Peru durchgeführt. In die Auswertungen waren insgesamt 17 421 domestizierte Meerschweinchen (Cavia porcellus) aus 14 Departments in allen Bioregionen und Höhenlagen des Landes, 143 wildlebende Meerschweinchen (Cavia aperea) aus 3 Gebieten (El Paramo, Junin, La Raya) in den Anden und Kordilleren sowie 180 etwa 1000 Jahre alte präinkaische Mumien domestizierter Meerschweinchen, Opfertiere aus der küstennahen Chiribaya-Kultur (Fundstätten Chiribaya Baja und El Yaral) im Süden Perus, einbezogen. Die rezenten domestizierten Meerschweinchen sind in intensiver Haltung in aus Beton errichteten Stallungen, in intensiver Haltung in Stallungen regional typischer Bauweise (z. B. Schilfrohr- und Flechtzäune) sowie in extensiver Haltung im unmittelbaren Umfeld des Menschen (Küche, Wohnräume) zur Fleischversorgung der Bevölkerung gezüchtet und gehalten worden. Aufarbeitung und Bestimmung der nachgewiesenen Ektoparasiten erfolgten nach parasitologischen Standardmethoden. Für die Aufbereitung der fragilen Ektoparasiten der Meerschweinchenmumien wurde eine spezielle Methode unter Verwendung von Essigsäure und 1 %iger wässriger Kalilauge selbst erarbeitet. - Insgesamt sind 24 Ektoparasiten-Spezies, d. h. Vertreter der Siphonaptera (Flöhe), Mallophaga (Haarlinge), Anoplura (Läuse), Milben und Raubwanzen in Mono- oder Polyinfestationen bei den rezenten und präinkaischen Meerschweinchen festgestellt worden, bei den Meerschweinchenmumien wurden außerdem freilebende Arthropoden, Vertreter der Pyroglyphidae (Hausstaubmilben) und Pseudoskorpione, gefunden. Von den festgestellten Ektoparasiten sind 2 Arten Erstnachweise für Cavia porcellus, 5 Arten für Cavia aperea; 8 Spezies sind erstmals bei Meerschweinchen in Peru bzw. in bestimmten Bioregionen in Peru festgestellt worden. Von den untersuchten domestizierten Meerschweinchen waren 96,6 % mit Ektoparasiten befallen, dabei konnten in Mono- und Polyinfestationen (27 verschiedene Kombinationen mit bis zu 7 Arten) nachgewiesen werden: Flöhe: Pulex sp. (Artenzuordnung noch unklar), Tiamastus cavicola, Ctenocephalides felis felis, Xenopsylla cheopis, Echidnophaga gallinacea; Haarlinge: Gliricola porcelli, Trimenopon hispidum, Gyropus ovalis; Milben: Ornithonyssus bacoti, Ornithonyssus wernecki, Eutrombicula batatas, Dermanyssus gallinae, Chirodiscoides caviae, Myocoptes musculinus, Myobia musculi, Notoedres muris; Raubwanzen: Triatoma infestans. Die Prävalenz von Ornithonyssus bacoti, der am häufigsten vertretenen Milbenart, lag bei 51,7 %. Diese Spezies konnte in der Bioregion Chala nicht nachgewiesen werden; das Vorkommen in der Küstenregion (Costa) geht auf Zukäufe von Tieren aus den anderen Bioregionen zurück. Bei mittel- bis hochgradiger Befallsstärke mit der Tropischen Rattenmilbe wiesen die Meerschweinchen starke Hautveränderungen auf, bei 38 % der Tiere trat eine Anämie durch blasse Schleimhäute und blau gefärbte Ohren klinisch in Erscheinung. Es war ein Zusammenhang zwischen einem O.-bacoti-Befall der Meerschweinchen und dem Kontakt mit wildlebenden Nagetieren (Mäuse, Ratten) sowie auch mit gleichzeitig bestehenden Microsporum-caninum- und Trichophyton-mentagrophytes-Infektionen nachzuweisen. Innerhalb einer untersuchten O.-bacoti-Population im Gebiet Huancayo zeigten sich deutliche saisonale Schwankungen im Anteil an Protonymphen, welche schwach signifikant negativ mit den Niederschlagsmengen in dieser Region korrelierten. Die Befallshäufigkeit mit Siphonaptera lag bei 76,8 %, dominierend war ein Vertreter der Gattung Pulex, während Tiamastus cavicola zu 42,4 %, Xenopsylla cheopis zu 15,1 % und Ctenocephalides felis felis zu 3,5 % vorkamen. Flöhe waren in 4 der 5 Bioregionen Perus nachzuweisen, in der Selva konnten auf keinem der untersuchten Meerschweinchen Flöhe gefunden werden. Männliche und weibliche Meerschweinchen waren gleichermaßen mit den verschiedenen Siphonaptera-Spezies befallen, auf weiblichen Meerschweinchen kamen hochsignifikant mehr weibliche Pulex sp. vor als auf männlichen. Es bestand ein hochsignifikanter Zusammenhang zwischen einem Befall mit Siphonaptera und dem Kontakt der Meerschweinchen mit anderen Tierarten (Hunde, Hühnervögel, peridomestische Nagetiere). Mallophagen wurden bei 27,8 % der untersuchten domestizierten Meerschweinchen aus allen Bioregionen nachgewiesen; die am häufigsten festgestellte Spezies war Trimenopon hispidum (60,5 %), gefolgt von Gliricola porcelli (42,7 %) und Gyropus ovalis (7,5 %). Die Befallsintensität mit Mallophagen war bei den Meerschweinchen überwiegend geringgradig. - Auf den wildlebenden Meerschweinchen konnten in Mono- und Polyinfestationen (10 verschiedene Kombinationen mit maximal 5 Arten) folgende Ektoparasiten festgestellt werden: Flöhe: Leptopsylla segnis, Ctenophthalmus hispanicus; Läuse: Polyplax spinulosa, Pterophtirus alata; Haarlinge: Gliricola porcelli; Milben: Eutrombicula bruyanti, Myocoptes musculinus, Myobia musculi. Die Siphonaptera-Spezies Ctenophthalmus hispanicus wurden erstmalig in der Neotropischen Region nachgewiesen. Nur Myobia musculi und Myocoptes musculinus waren bei Tieren aus allen 3 Untersuchungsgebieten anzutreffen. Bei den Meerschweinchen überwogen Infestationen mit Gliricola porcelli, Eutrombicula bruyanti und Myocoptes musculinus, die Befallsintensität mit Myocoptes musculinus korrelierte positiv mit dem Alter der Meerschweinchen. - Bei 67 der 180 untersuchten Meerschweinchenmumien von beiden Fundorten konnten Ektoparasiten nachgewiesen werden. Diese befanden sich, wie auch die Mumien der ehemaligen Wirtstiere, bedingt durch die geologischen und klimatischen Bedingungen in den Fundgebieten in einem ausgezeichneten Erhaltungszustand. Flöhe aus der Gattung Pulex waren die insgesamt am häufigsten festgestellten Ektoparasiten, auf den Mumien von Chiribaya Baja wurden sie ausschließlich gefunden. Meerschweinchenmumien aus El Yaral wiesen Infestationen mit Trimenopon hispidum, Gliricola porcelli, Ornithonyssus sp. und Rhipicephalus sanguineus (Erstnachweis von einem domestizierten Meerschweinchen in natürlicher Infestation) auf. Der erfolgreiche Nachweis der Ektoparasiten auf präinkaischen Meerschweinchenmumien in Peru eröffnet Möglichkeiten für die paläoparasitologische Bearbeitung auch der Mumien von Menschen und weiteren Opfertieren (Hunde, Lamas, Alpakas) aus diesem Kulturkreis.7. 1. Summary Investigation about the occurrence of ectoparasites on domesticated and wild guinea pigs (Cavia spp.) and preincaic guinea pig mummies in Peru, South America Dittmar de la Cruz, Katharina Institute of Parasitology. Veterinary Faculty, University of Leipzig (120 pages, 29 tables, 67 figures, 187 references, 3 adnex. ) Between December 1996 and February 1997, February and October 1998 and in May 1999 investigations about the occurrence of ectoparasites on the genus Cavia in Peru were carried out. The survey included 17 421 domesticated guinea pigs (Cavia porcellus) from 14 departments in all bioregions and altitude levels, 143 wild guinea pigs (Cavia aperea) from three areas (El Paramo, Junin and La Raya) in the Andes and the Cordillera and 180 about 1000 year old guinea pig mummies of C. porcellus, ritual offers from the coastal Chiribaya-Culture (archeological sites of Chiribaya Baja and El Yaral) in the South of Peru. The recent domesticated guinea pigs are bred in intensive utilization systems, with concrete stables, in intensive utilization systems with regional-traditional architecture (big reed hutches or adobe stables) or in extensive utilization systems (kitchen or outdoor dips). The identification and mounting of the specimen was done by parasitological standard techniques. In the course of the study a special technique for the preservation and mounting of the fragile ectoparasites from the guinea pig mummies was developed, using acetic acid and a 1 % potassium hydroxide solution. In total 24 ectoparasite species of the siphonaptera, mallophaga, anoplura, mites and reduviids were found in mono- and polyinfestations, the guinea pig mummies also hosted free living arthropods, such as pseudoscorpions and specimen of the Pyroglyphidae (house dust mites). In two cases C. porcellus was reported as first host record, in five cases C. aperea was mentioned for the first time as a host for some ectoparasites, 8 times for several ectoparasites new locality records for Peru or bioregions of Peru could be made 96,6 % of all domesticated guinea pigs (C. porcellus) showed an infestation with ectoparasites in mono- and polyinfestations, revealing 27 different combinations with up to 7 species of ectoparasites: siphonaptera: Pulex sp. (taxonomical status still unclear), Tiamastus cavicola, Ctenocephalides f. felis, Xenopsylla cheopis, Echidnophaga gallinacea; mallophaga: Gliricola porcelli, Trimenopon hispidum, Gyropus ovalis; mites: Ornithonyssus bacoti , Ornithonyssus wernecki, Eutrombicula batatas, Dermanyssus gallinae, Chirodiscoides caviae, Myocoptes musculinus, Notoedres muris; reduviids: Triatoma infestans. The prevalence of O. bacoti, the most frequent species, was 51,7 %. This mite had never been recorded in the bioregion Chala; the presence of the species in the Costa could be explained by a recent purchase out of the other bioregions. A medium to high infestation rate with the tropical rat mite always resulted in obvious skin alterations, of whom 38 % also showed signs of clinical anemia, with pale mucosa and blue ear tips. There was a relation between an infestation with O. bacoti and the contact with rodents as well as an simultaneus infection with dermatophytes (Microsporum caninum and Trichophyton mentagrophytes). In an O.-bacoti-population in the Huancayo region the rate of protonymphs showed a low significant monthly variation, which correlated negative with the monthly rainfall. The prevalence of siphonaptera was 76,8 %, the species most frequently detected was Pulex sp. (89,2 %), followed by T. cavicola (42,4 %), X. cheopis (15,1 %) and C. f. felis (3,5 %). The species of fleas were distributed in 4 of the 5 bioregions; in the Selva no fleas could be found. There was no difference in the infestation rate of male and female hosts, female guinea pigs were infested with a higher rate of female Pulex sp. than male guinea pigs. A highly significant relation between the contact with other mammals (dogs, fowl and peridomestic rodents) and an infestation with siphonaptera could be detected. The prevalence of mallophaga, coming from all bioregions, was 27,8 %; the most frequently detected species was T. hispidum (60,5 %), followed by G. porcelli (42,7 %) and G. ovalis (7,5 %). The infestation levels were generally low.- On the wild guinea pigs (C. aperea) prevailed mono- and polyinfestations, represented by 10 combinations with up to 5 species, with the following species of ectoparasites: siphonaptera: Leptopsylla segnis, Ctenophthalmus hispanicus; anoplura: Polyplax spinulosa, Pterophtirus alata; mallophaga: Gliricola porcelli; mites: Eutrombicula bruyanti, Myocoptes musculinus and Myobia musculi. Ctenophthalmus hispanicus was mentioned for the first time from the Neotropical region. M. musculinus and Myobia musculi were the only species to be found in all three sampling areas. Infestations with G. porcelli, E. bruyanti and M. musculinus were the most common, the infestation rate with Myocoptes musculinus correlated positive with the age of the hosts.- On 67 of 180 guinea pig mummies of both excavation areas (Chiribaya Baja and El Yaral) ectoparasites could be found. The conservation of the ectoparasites, as well as their former hosts was extraordinarily good due to geological and climatical conditions . Fleas of the genus Pulex were the most frequently detected specimen; on the guinea pig mummies of Chiribaya Baja only this species could be found. The mummies from El Yaral revealed the presence of T. hispidum, G. porcelli, Ornithonyssus sp. and Rhipicephalus sanguineus (first record for a natural infestation). The successful detection of ectoparasites on preincaic guinea pig mummies in Peru opens new possibilities for a paleoparasitological survey including also human mummies and other animal offerings (dogs, lamas, alpakas) from this cultural background

Pathoecology of Chiribaya Parasitism

The excavations of Chiribaya culture sites in the Osmore drainage of southern Peru focused on the recovery of information about prehistoric disease, including parasitism. The archaeologists excavated human, dog, guinea pig, and llama mummies. These mummies were analyzed for internal and external parasites. The results of the analysis and reconstruction of prehistoric life from the excavations allows us to interpret the pathoecology of the Chiribaya culture

In silico characterization of the family of PARP-like poly(ADP-ribosyl)transferases (pARTs)

BACKGROUND: ADP-ribosylation is an enzyme-catalyzed posttranslational protein modification in which mono(ADP-ribosyl)transferases (mARTs) and poly(ADP-ribosyl)transferases (pARTs) transfer the ADP-ribose moiety from NAD onto specific amino acid side chains and/or ADP-ribose units on target proteins. RESULTS: Using a combination of database search tools we identified the genes encoding recognizable pART domains in the public genome databases. In humans, the pART family encompasses 17 members. For 16 of these genes, an orthologue exists also in the mouse, rat, and pufferfish. Based on the degree of amino acid sequence similarity in the catalytic domain, conserved intron positions, and fused protein domains, pARTs can be divided into five major subgroups. All six members of groups 1 and 2 contain the H-Y-E trias of amino acid residues found also in the active sites of Diphtheria toxin and Pseudomonas exotoxin A, while the eleven members of groups 3 – 5 carry variations of this motif. The pART catalytic domain is found associated in Lego-like fashion with a variety of domains, including nucleic acid-binding, protein-protein interaction, and ubiquitylation domains. Some of these domain associations appear to be very ancient since they are observed also in insects, fungi, amoebae, and plants. The recently completed genome of the pufferfish T. nigroviridis contains recognizable orthologues for all pARTs except for pART7. The nearly completed albeit still fragmentary chicken genome contains recognizable orthologues for twelve pARTs. Simpler eucaryotes generally contain fewer pARTs: two in the fly D. melanogaster, three each in the mosquito A. gambiae, the nematode C. elegans, and the ascomycete microfungus G. zeae, six in the amoeba E. histolytica, nine in the slime mold D. discoideum, and ten in the cress plant A. thaliana. GenBank contains two pART homologues from the large double stranded DNA viruses Chilo iridescent virus and Bacteriophage Aeh1 and only a single entry (from V. cholerae) showing recognizable homology to the pART-like catalytic domains of Diphtheria toxin and Pseudomonas exotoxin A. CONCLUSION: The pART family, which encompasses 17 members in the human and 16 members in the mouse, can be divided into five subgroups on the basis of sequence similarity, phylogeny, conserved intron positions, and patterns of genetically fused protein domains

Rare earth element behaviour in seawater under the influence of organic matter cycling during a phytoplankton spring bloom – A mesocosm study

Rare earth elements (REEs) are used as powerful proxies for a variety of oceanic processes. The understanding of their biogeochemical behaviour in the marine environment is therefore essential. While the influence of OM-cycling on REE patterns in seawater is considered as insignificant, it has been shown that algae and bacteria provide good sorption surfaces for REEs and that components of the dissolved OM pool are able to complex REEs, thus potentially altering their behaviour. To investigate the impact of bio-associated processes on REEs in the bio-productive marine environment, we conducted an indoor mesocosm experiment that mimicked a phytoplankton spring bloom in the neritic coastal North Sea. The incubation period of 38 days covered two distinct phytoplankton bloom phases (diatoms followed by Phaeocystis sp.) and an interjacent bacterioplankton maximum. All dissolved REEs (dREEs) except samarium showed similar temporal concentration patterns, which were closely connected to the bloom succession. The concentration patterns were shaped by the ‘phytoplankton-shuttle’, which summarizes adsorption processes on phytoplankton-derived particulate OM (POM) and resulted in decreasing dREE concentrations alongside chlorophyll-a and POM maxima. The ‘heterotrophic-shuttle’ resulted in increasing dREE concentrations likely linked to heterotrophically mediated regeneration of POM and associated desorption processes. The effect of these processes on dREEs resulted in enhanced fractionation of light REEs (LREEs) relative to heavy REEs (HREEs) during adsorption processes and decreased fractionation as a result of desorption. At times of high dissolved organic carbon (DOC) concentrations, we observed a stabilization of especially dHREEs likely in organic complexes. To test the potential influence of DOC on dREEs, we used a PHREEQC model approach that revealed dREE complexation with components of the DOC pool and an increase in complexation with atomic mass of the REEs. That is, at high DOC concentrations OM-dREE complexation leads to an effective and preferential buffering of dHREE against adsorption. Our findings reveal that OM-cycling influences concentration patterns of dREEs via ad- and desorption processes as well as organic complexation with parts of the OM pool, suggesting these processes can have a significant impact on dREE concentrations in the natural marine environment under high OM conditions

Lack of population genetic structure and host specificity in the bat fly, Cyclopodia horsfieldi, across species of Pteropus bats in Southeast Asia

Background: Population-level studies of parasites have the potential to elucidate patterns of host movement and cross-species interactions that are not evident from host genealogy alone. Bat flies are obligate and generally host-specific blood-feeding parasites of bats. Old-World flies in the family Nycteribiidae are entirely wingless and depend on their hosts for long-distance dispersal; their population genetics has been unstudied to date. Methods: We collected a total of 125 bat flies from three Pteropus species (Pteropus vampyrus, P. hypomelanus, and P. lylei) from eight localities in Malaysia, Cambodia, and Vietnam. We identified specimens morphologically and then sequenced three mitochondrial DNA gene fragments (CoI, CoII, cytB; 1744 basepairs total) from a subset of 45 bat flies. We measured genetic diversity, molecular variance, and population genetic subdivision (FST), and used phylogenetic and haplotype network analyses to quantify parasite genetic structure across host species and localities. Results: All flies were identified as Cyclopodia horsfieldi with the exception of two individuals of Eucampsipoda sundaica. Low levels of population genetic structure were detected between populations of Cyclopodia horsfieldi from across a wide geographic range (~1000 km), and tests for isolation by distance were rejected. AMOVA results support a lack of geographic and host-specific population structure, with molecular variance primarily partitioned within populations. Pairwise FST values from flies collected from island populations of Pteropus hypomelanus in East and West Peninsular Malaysia supported predictions based on previous studies of host genetic structure. Conclusions: The lack of population genetic structure and morphological variation observed in Cyclopodia horsfieldi is most likely due to frequent contact between flying fox species and subsequent high levels of parasite gene flow. Specifically, we suggest that Pteropus vampyrus may facilitate movement of bat flies between the three Pteropus species in the region. We demonstrate the utility of parasite genetics as an additional layer of information to measure host movement and interspecific host contact. These approaches may have wide implications for understanding zoonotic, epizootic, and enzootic disease dynamics. Bat flies may play a role as vectors of disease in bats, and their competence as vectors of bacterial and/or viral pathogens is in need of further investigation

Eigenständige Analgesie mit Piritramid durch Notfallsanitäter – retrospektive Auswertung der elektronischen Einsatzdokumentation

Hintergrund Schmerzen sind ein häufiger Behandlungsgrund in der prähospitalen Notfallmedizin. In Bayern delegieren die Ärztlichen Leiter Rettungsdienst (ÄLRD) bei subjektiv nichttolerablen Schmerzen nach isoliertem Extremitätentrauma an Notfallsanitäter (NotSan) landesweit einheitlich die Kurzinfusion von 7,5 mg des Opioidanalgetikums Piritramid. Methode Die Routineeinsatzdokumentation aller Einsätze im bayerischen Rettungsdienst mit Heranziehungen des Delegationsalgorithmus „Isolierte Extremitätenverletzung“ der ÄLRD nach § 4 Abs. 2 Nr. 2c Notfallsanitätergesetz wurde über einen 2‑Jahres-Zeitraum ausgewertet. Evaluiert wurden der Effekt auf die Schmerzintensität nach der numerischen Rating-Skala (NRS) und dem Vorliegen nichttolerabler Schmerzen, Auswirkungen auf die Vitalfunktionen sowie die Notwendigkeit von bestimmten weitergehenden Interventionen. Ergebnisse Bei 7151 identifizierten Einsätzen erfolgte in 6097 Fällen eine eigenständige Analgesie durch NotSan entlang der Delegation der ÄLRD. Die Schmerzintensität nach der NRS konnte von im Median 7 (Interquartilsabstand [IQR] 2) auf 3 (IQR 2, p < 0,001) gesenkt und in 96,9 % ein aus Patientensicht tolerables Niveau erreicht werden. In 9,4 % der Fälle wurde ein Notarzt nachgefordert und in 5,0 % eine ergänzende Analgesie verabreicht. Etwa jeder zehnte Patient erhielt Sauerstoff. Atemwegsinterventionen waren in wenigen Einzelfällen notwendig, eine Antagonisierung nur nach höheren als den delegierten Opiatdosen. Schlussfolgerung Eine vom ÄLRD delegierte und von NotSan eigenständig durchgeführte Opiatgabe senkt das Schmerzniveau relevant. Wesentliche Hinweise auf eine Patientengefährdung fanden sich nicht. Durch dieses Verfahren konnten in Bayern jährlich geschätzt ca. 2500 Notarzteinsätze vermieden werden