Ticks in the metropolitan area of Berlin, Germany

A high-resolution city map showing the geographic distribution of 12 tick species (Acari: Argasidae, Ixodidae) that have been recorded from the metropolitan area of Berlin, Germany is presented. A total of 237 tick locations was mapped. These include ten ixodid tick species: Dermacentor reticulatus, Haemaphysalis concinna, Hyalomma rufipes, Ixodes ricinus, Ixodes canisuga, Ixodes hexagonus, Ixodes arboricola, Ixodes frontalis, Ixodes trianguliceps and Rhipicephalus sanguineus sensu lato. The two tick species Hy. rufipes and R. sanguineus s.l. are not endemic to Berlin. Hyalomma rufipes ticks are introduced in Europe with migratory birds from Africa every spring. Rhipicephalus sanguineus s.l. are introduced to Central Europe with dogs that had travelled to or were imported from countries where this tick is endemic. In Germany, they are able to develop and reproduce inside heated buildings. Occurrences of two soft tick species, the pigeon tick Argas reflexus and the short-legged bat tick Carios vespertilionis were also mapped. Other tick species that are likely to be endemic to Berlin and its environs, but for which documented findings or geographical coordinates are lacking, are mentioned. These include the long-legged bat tick I. vespertilionis and the marten tick I. rugicollis documented in Brandenburg, the federal state surrounding Berlin. It can be assumed that if appropriate field studies are carried out, these tick species will also be found in the metropolitan area of Berlin. The high-resolution mapping of all tick species found in a city (like Berlin) forms the basis for further investigations into the impact of climate change and changing land use on ticks and tick-borne diseases, precisely in those habitats where most people will live in the future

Molecular Epidemiology of Mycobacterium abscessus Isolates Recovered from German Cystic Fibrosis Patients

Infections due to Mycobacterium abscessus are a major cause of mortality and morbidity in cystic fibrosis (CF) patients. Furthermore, M. abscessus has been suspected to be involved in person-to-person transmissions. In 2016, dominant global clonal complexes (DCCs) that occur worldwide among CF patients have been described. To elucidate the epidemiological situation of M. abscessus among CF patients in Germany and to put these data into a global context, we performed whole-genome sequencing of a set of 154 M. abscessus isolates from 123 German patients treated in 14 CF centers. We used MTBseq pipeline to identify clusters of closely related isolates and correlate those with global findings. Genotypic drug susceptibility for macrolides and aminoglycosides was assessed by characterization of the erm(41), rrl, and rrs genes. By this approach, we could identify representatives of all major DCCs (Absc 1, Absc 2, and Mass 1) in our cohort. Intrapersonal isolates showed higher genetic relatedness than interpersonal isolates (median 3 SNPs versus 16 SNPs; P < 0.001). We further identified four clusters with German patients from same centers clustering with less than 25 SNPs distance (range 3 to 18 SNPs) but did not find any hint for in-hospital person-to-person transmission. This is the largest study investigating phylogenetic relations of M. abscessus isolates in Germany. We identified representatives of all reported DCCs but evidence for nosocomial transmission remained inconclusive. Thus, the occurrence of genetically closely related isolates of M. abscessus has to be interpreted with care, as a direct interhuman transmission cannot be directly deduced.Peer Reviewe

Symptom Burden and Palliative Care Needs of Patients with Incurable Cancer at Diagnosis and During the Disease Course

Background Although current guidelines advocate early integration of palliative care, symptom burden and palliative care needs of patients at diagnosis of incurable cancer and along the disease trajectory are understudied. Material and Methods We assessed distress, symptom burden, quality of life, and supportive care needs in patients with newly diagnosed incurable cancer in a prospective longitudinal observational multicenter study. Patients were evaluated using validated self-report measures (National Comprehensive Cancer Network Distress Thermometer [DT], Functional Assessment of Cancer Therapy [FACT], Schedule for the Evaluation of Individual Quality of Life [SEIQoL-Q], Patients Health Questionnaire-4 [PHQ-4], modified Supportive Care Needs Survey [SCNS-SF-34]) at baseline (T0) and at 3 (T1), 6 (T2), and 12 months (T3) follow-up. Results From October 2014 to October 2016, 500 patients (219 women, 281 men; mean age 64.2 years) were recruited at 20 study sites in Germany following diagnosis of incurable metastatic, locally advanced, or recurrent lung (217), gastrointestinal (156), head and neck (55), gynecological (57), and skin (15) cancer. Patients reported significant distress (DT score >= 5) after diagnosis, which significantly decreased over time (T0: 67.2%, T1: 51.7%, T2: 47.9%, T3: 48.7%). The spectrum of reported symptoms was broad, with considerable variety between and within the cancer groups. Anxiety and depressiveness were most prevalent early in the disease course (T0: 30.8%, T1: 20.1%, T2: 14.7%, T3: 16.9%). The number of patients reporting unmet supportive care needs decreased over time (T0: 71.8 %, T1: 61.6%, T2: 58.1%, T3: 55.3%). Conclusion Our study confirms a variable and mostly high symptom burden at the time of diagnosis of incurable cancer, suggesting early screening by using standardized tools and underlining the usefulness of early palliative care. Implications for Practice A better understanding of symptom burden and palliative care needs of patients with newly diagnosed incurable cancer may guide clinical practice and help to improve the quality of palliative care services. The results of this study provide important information for establishing palliative care programs and related guidelines. Distress, symptom burden, and the need for support vary and are often high at the time of diagnosis. These findings underscore the need for implementation of symptom screening as well as early palliative care services, starting at the time of diagnosis of incurable cancer and tailored according to patients' needs

There is inadequate evidence to support the division of the genus Borrelia

There are surely scientific, genetic or ecological 60 arguments which show that differences exist between the relapsing fever (RF) spirochaetes and the Lyme borreliosis (LB) group of spirochaetes, both of which belong to the genus Borrelia. In a recent publication, Adeolu and Gupta (Adeolu & 63 Gupta, 2014) proposed dividing the genus Borrelia into two genera on the basis of genetic differences revealed by comparative genomics. The new genus name for the LB group of spirochaetes, Borreliella, has subsequently been entered in GenBank for some species of the group and in a validation list (List of new names and new combinations previously effectively, but not validly, published) (Oren & Garrity, 2015). However, rapidly expanding scientific knowledge and considerable conflicting evidence combined with the adverse consequences of splitting the genus Borrelia make such a drastic step somewhat premature. In our opinion, the basis of this division rests on preliminary evidence and should be rescinded

What do we still need to know about Ixodes ricinus?

In spite of many decades of intensive research on Ixodes ricinus, the castor bean tick of Europe, several important aspects of its basic biology remain elusive, such as the factors determining seasonal development, tick abundance and host specificity, and the importance of water management. Additionally, there are more recent questions about the geographical diversity of tick genotypes and phenotypes, the role of migratory birds in the ecoepidemiology of I. ricinus, the importance of protective immune responses against I. ricinus, particularly in the context of vaccination, and the role of the microbiome in pathogen transmission. Without more detailed knowledge of these issues, it is difficult to assess the likely effects of changes in climate and biodiversity on tick distribution and activity, to predict potential risks arising from new and established tick populations and I. ricinus-borne pathogens, and to improve prevention and control measures. This review aims to discuss the most important outstanding questions against the backdrop of the current state of knowledge of this important tick species

Microsatellite variation among diverging populations of Dermacentor Reticulatus

Dermacentor reticulatus is the second most reported tick species after Ixodes ricinus in Europe. Geographic distribution of these ticks is fragmented. Five microsatellite loci were assayed for 23 populations (Latvia, Lithuania, Eastern and Western Poland, Germany, Czech Republic, Slovakia, Croatia, Spain and Ukraine) from three regions (Western-, Central- and Nors-Eastern Europe) spanning the range of distribution, and the levels and distribution of genetic variation were estimated. A total 232 ticks were investigated. Results of analysis showed that most of the molecular variability is contained within populations, and that populations cluster together similarly to known geographic distribution. Genetic drift and limited gene flow was considered to be important in determining the genetic structure within regions. Genetic differentiation FST values ranging from 0.014 to 0.256. Neighbour-joining dendrograms, Bayesian-clustering and PCoA analyses showed two genetic groups of D. reticulatus ticks: Western Europe and Eastern Europe. Eastern Europe group showed no evidence of clusterization according to geographical distribution patterns with low molecular variability between populations. Low genetic differences between Lithuanian, Latvian, Eastern Poland and Slovak populations of D. reticulatus show close relatedness among these populationsBiologijos katedraGamtos mokslų fakultetasVytauto Didžiojo universiteta

Determinants of severe QTc prolongation in a real-world gerontopsychiatric setting.

INTRODUCTION QTc prolongation carries the risk of ventricular tachyarrhythmia (Torsades de Pointes) and sudden cardiac death. Psychotropic drugs can affect ventricular repolarization and thus prolong the QTc interval. The present study sought to investigate the risk factors (pharmacological and non-pharmacological) of severe QTc prolongation in gerontopsychiatric patients. METHODS Electrocardiograms of patients on a gerontopsychiatric ward were screened for QTc prolongation. Medication lists were examined utilizing the AzCERT classification. Potential drug interactions were identified with the electronic drug interaction program mediQ. RESULTS The overall prevalence of QTc prolongation was 13.6%, with 1.9% displaying severe QTc prolongation (≥ 500 ms). No statistically significant differences between patients with moderate and severe QTc prolongation were identified; however, patients with severe QTc prolongation tended to take more drugs (p = 0.063). 92.7% of patients with QTc prolongation took at least one AzCERT-listed drug, most frequently risperidone and pantoprazole. Risperidone and pantoprazole, along with pipamperone, were also most frequently involved in potential drug interactions. All patients displayed additional risk factors for QTc prolongation, particularly cardiac diseases. CONCLUSION In addition to the use of potentially QTc-prolonging drugs, other risk factors, especially cardiac diseases, appear to be relevant for the development of QTc prolongation in gerontopsychiatric patients. Pantoprazole was frequently involved in potential drug interactions and should generally not be used for more than 8 weeks in geriatric populations. As clinical consequences of QTc prolongation were rare, potentially QTc-prolonging drugs should not be used overcautiously; their therapeutic benefit should be considered as well. It is paramount to perform diligent benefit-risk analyses prior to the initiation of potentially QTc-prolonging drugs and to closely monitor their clinical (side) effects