Parasitäre Infektionen während der Schwangerschaft in Lambaréné, Gabun: Epidemiologie, Risikofaktoren und Wandel

Definition der Fragestellung: Die Feststellung konkreter Einflussfaktoren für Helmintheninfektionen spielt eine wichtige Rolle für das Ergreifen geeigneter Schutzmaßnahmen gegen die Infektion. Das erste Ziel der vorliegenden Arbeit war es, vermutete Einflussfaktoren auf Helmintheninfektionen während der Schwangerschaft in Lambaréné und Umgebung zu untersuchen. Die letzten Studien zur Häufigkeit von P. falciparum während der Schwangerschaft in Lambaréné und Umgebung stammen aus der Zeit direkt nach der nationalen Einführung des IPTps in Gabun. Das zweite Ziel der vorliegenden Arbeit war es, das aktuelle Vorkommen von Infektionen mit P. falciparum in Lambaréné und Umgebung in der Schwangerschaft festzustellen. Genotypische Untersuchungen zu den Merozoiten-Oberflächen-Proteinen 1 und 2 (MSP-I und MSP-II) von P. falciparum sind Bestandteil der Entwicklung und Überprüfung von Malaria-Eindämmungsstrategien. Das dritte Ziel der vorliegenden Arbeit war es, mittels Genotypisierung von MSP-I und MSP-II eine Charakterisierung der aktuellen Parasitenpopulation von P. falciparum für Infektionen während der Schwangerschaft in Lambaréné und Umgebung vorzunehmen. Methodik: Zur Feststellung von durch Lebensumstände bedingten Einflussfaktoren auf Helmintheninfektionen während der Schwangerschaft wurde ein standardisiertes Interview mit schwangeren Frauen in Lambaréné und Umgebung durchgeführt. Die Fragebogenergebnisse infizierter Probandinnen wurden den Fragebogenergebnissen nicht infizierter Probandinnen gegenüber gestellt. Das Vorkommen von P. falciparum in der Schwangerschaft wurde durch nested-PCR mit den Primern rPLU 5&6 und rFAL 1&2 untersucht. Zur Genotypisierung von MSP-I und MSP-II wurden die mit P. falciparum infizierten Proben mit zwei weiteren nested-PCRs untersucht. Ergebnisse: Die Befragung mit standardisiertem Fragebogen erfolgte in 123 Fällen. Die Überprüfung der Einflussfaktoren ergab einen statistisch auffälligen Zusammenhang (p = 0,016) zwischen einer Infektion mit T. trichiura und dem Wohnen in dörflicher Umgebung. Für 152 schwangere Frauen lagen Blutproben zu Malariaanalysen durch PCR vor. Im peripheren Mutterblut wurde eine Infektion mit P. falciparum in 17,4% der Fälle festgestellt, im Plazentablut in 17,1% der Fälle und im Nabelschnurblut in 0% der Fälle. Im mit P. falciparum infizierten peripheren Mutterblut war für MSP-I die Verteilung der Allele folgendermaßen: 47,6% MAD20, 42,9% K1, 9,5% Ro33. Für MSP-II: 60% 3D7, 40% FC27. Im mit P. falciparum infizierten Plazentablut war für MSP-I die Verteilung der Allele folgendermaßen: 70% MAD20, 30% K1. Für MSP-II: 87,5% 3D7, 12,5% FC27. Diskussion: Das Wohnen in dörflicher Umgebung um Labaréné wurde für Infektionen mit T. trichiura als Risikofaktor festgestellt. Weitere die häuslichen Umstände betreffenden untersuchten Faktoren spielten gegenüber der dörflichen Umgebung als Risikofaktor eine untergeordnete Rolle. Das Vorkommen von P. falciparum bei 17,4% der schwangeren Frauen trotz IPTp erscheint hoch. Der Vergleich der Forschungsergebnisse der vorliegenden Arbeit mit früheren Arbeiten aus den Jahren 2000 und 2001 zur Genotypisierung von MSP-I und MSP-II in Lambaréné zeigte sowohl für MSP-I als auch für MSP-II eine Veränderung des genotypischen Profils von P. falciparum

Magnetic resonance imaging of diverticular disease and its association with adipose tissue compartments and constitutional risk factors in subjects from a western general population

Purpose To determine the association of asymptomatic diverticular disease as assessed by magnetic resonance imaging (MRI) with adipose tissue compartments, hepatic steatosis and constitutional risk factors within a cohort drawn from a Western general population. Materials and Methods Asymptomatic subjects enrolled in a prospective case-control study underwent a 3 Tesla MRI scan, including an isotropic VIBE-Dixon sequence of the entire trunk. The presence and extent of diverticular disease were categorized according to the number of diverticula in each colonic segment in a blinded fashion. The amount of visceral, subcutaneous, and total adipose tissue (VAT, SAT, and TAT) was quantified by MRI. Additionally, the degree of hepatic steatosis, indicated as hepatic proton density fat fraction (hepatic PDFF) was determined using a multi-echo T1w sequence. Constitutional cardiometabolic risk factors were obtained and univariate and multivariate associations were calculated. Results A total of 371 subjects were included in the analysis (58.2% male, 56.2±9.2 years). Based on MRI, 154 participants (41.5%) had diverticular disease with 62 cases (17%) being advanced diverticular disease. Subjects with advanced diverticular disease had a significantly higher body mass index (BMI) (BMI: 29.9±5.1 vs. 27.5±4.6, p<0.001; respectively). Furthermore, all adipose tissue compartments were increased in subjects with advanced diverticular disease (e.g. VAT: 6.0±2.8 vs. 4.2±2.6 and SAT: 9.2±3.6 vs. 7.8±3.6, all p<0.001, respectively). Similarly, subjects with advanced diverticular disease had significantly higher hepatic PDFF (4.9 [2.7, 11.4] vs. 6.1 [5.5, 14.6], p=0.002). Conclusion Advanced diverticular disease is associated with an increased volume of adipose tissue compartments and BMI, which may suggest a metabolic role in disease development. Key Points: Diverticular disease is associated with constitutional risk factors such as BMI. Excess of adipose tissue compartments and hepatic steatosis are associated with the prevalence of diverticular disease. Our results suggest a shared pathological pathway of cardiometabolic alterations and the prevalence of diverticular disease. MRI is feasible for the assessment of adipose tissue compartments, hepatic steatosis, and diverticular disease and allows identification of patients who are at risk but in an asymptomatic disease state. Citation Format Storz C, Rospleszcz S, Askani E etal. Magnetic Resonance Imaging of Diverticular Disease and its Association with Adipose Tissue Compartments and Constitutional Risk Factors in Subjects from a Western General Population. Fortschr Röntgenstr 2020; DOI: 10.1055/a-1212-5669

Computed Tomographic Imaging Features of COVID-19 Pneumonia Caused by the Delta (B.1.617.2) and Omicron (B.1.1.529) Variant in a German Nested Cohort Pilot Study Group

Background: The aim of this study was to evaluate CT (computed tomography) imaging differences for the Delta and the Omicron variant in COVID-19 infection. Methods: The study population was derived from a retrospective study cohort investigating chest CT imaging patterns in vaccinated and nonvaccinated COVID-19 patients. CT imaging patterns of COVID-19 infection were evaluated by qualitative and semiquantitative scoring systems, as well as imaging pattern analysis. Results: A total of 60 patients (70.00% male, 62.53 ± 17.3 years, Delta: 43 patients, Omicron: 17 patients) were included. Qualitative scoring systems showed a significant correlation with virus variants; “typical appearance” and “very high” degrees of suspicion were detected more often in patients with Delta (RSNA: p = 0.003; CO-RADS: p = 0.002; COV-RADS: p = 0.001). Semiquantitative assessment of lung changes revealed a significant association with virus variants in univariate (Delta: 6.3 ± 3.5; Omicron: 3.12 ± 3.2; p = 0.002) and multivariate analysis. The vacuolar sign was significantly associated with the Delta variant (OR: 14.74, 95% CI: [2.32; 2094.7], p = 0.017). Conclusion: The Delta variant had significantly more extensive lung involvement and showed changes classified as “typical” more often than the Omicron variant, while the Omicron variant was more likely associated with CT findings such as “absence of pulmonary changes”. A significant correlation between the Delta variant and the vacuolar sign was observed

Dietary habits and the presence and degree of asymptomatic diverticular disease by magnetic resonance imaging in a Western population: a population-based cohort study

BACKGROUND: Despite the worldwide burden of diverticular disease, the connections between diverticular disease and dietary habits remain poorly understood, particularly in an asymptomatic representative sample. We investigated the association between asymptomatic diverticular disease as assessed by magnetic resonance imaging (MRI) and dietary habits in a Western study cohort. METHODS: Participants from a cross-sectional sample of a population-based cohort study underwent whole-body 3T-MRI including an isotropic VIBE-Dixon sequence. The presence and extent of diverticular disease was assessed in blinded fashion. Habitual dietary intake was recorded using a blended approach, applying 24-h food lists and a food-frequency questionnaire. Traditional cardiometabolic risk factors were obtained by interviews and medical examination. Univariate and multivariate associations were calculated. RESULTS: A total of 308 subjects were included in this analysis (56% male, 56.4 ± 9.1 years). 39.9% had any form of diverticular disease and 15.3% had advanced asymptomatic diverticular disease. After adjustment for age, sex and total energy intake a higher intake of fiber and vegetables was associated with a lower odds for asymptomatic diverticular disease (fiber: OR 0.68 95% CI [0.48, 0.95]; vegetables: OR 0.72 95% CI [0.53, 0.97]) and an increased intake of meat was associated with an approximately two-fold higher odds for advanced asymptomatic diverticular disease (OR 1.84 95% CI [1.13, 2.99]). However, after additional adjustment for body-mass-index (BMI), alcohol consumption, smoking behavior and physical activity only a high fiber and vegetables intake remained significantly associated with lower odds of asymptomatic diverticular disease. CONCLUSION: Our results indicate that a high-fiber diet and increased intake of vegetables is associated with lower odds of having asymptomatic diverticular disease, independent of age, sex, total energy intake, BMI and other life-style factors. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12986-021-00599-4

Impact of Helminth Infections during Pregnancy on Vaccine Immunogenicity in Gabonese Infants

Helminth infections are common in sub-Saharan Africa. Besides direct clinical effects, a bias towards a T helper type 2 (Th2) cell immune response is observed. The consequences of parasite infection during pregnancy for the mother and particularly for the fetus and the newborn can be severe and may include impaired immune response during acute infection and vaccination. Here, we present data of immune responses to vaccines given within the expanded program on immunization (EPI) of infants born to helminth infected or non-infected mothers. The study was conducted in Lambaréné and surroundings, Gabon. Maternal helminth infection was diagnosed microscopically using the Kato-Katz method for soil-transmitted helminths (STH), urine filtration for Schistosoma haematobium infections and the saponin-based method for filarial infections. Plasma antibody levels to different vaccine antigens were measured in mothers and their offspring by enzyme-linked immunosorbent assay (ELISA) at different timepoints. We found 42.3% of the mothers to be infected with at least one helminth species. Significantly lower anti-tetanus toxoid immunoglobulin (Ig) G was detected in the cord blood of infants born to helminth infected mothers. Following vaccination, immune responses of the infants to EPI vaccines were similar between the two groups at nine and 12 months. Even though infection with helminths is still common in pregnant women in Gabon, in our setting, there was no evidence seen for a substantial effect on infants’ immune responses to vaccines given as part of the EPI