Norovirus-Gastroenteritis

Zusammenfassung: Die meisten akuten Gastroenteritiden sind viral. Bei Kindern sind virale Gastroenteritiden häufig durch Rotaviren verursacht. Bei Erwachsenen sind Noroviren sowohl in sporadischen Fällen als auch bei Ausbrüchen führend. Noroviren sind regelmäßig für Epidemien in Krankenhäusern und Pflegeeinrichtungen verantwortlich. Die Klinik ist typisch mit akuten Brechdurchfällen als Hauptsymptom. Immunsupprimierte Patienten präsentieren sich oft mit atypischen Symptomen wie chronischer Diarrhö, Gewichtsverlust oder Mangelernährung. Goldstandard zur Diagnostik sind PCR-basierte Methoden, aufgrund der typischen Klinik ist eine Diagnostik jedoch oft nicht indiziert. Noroviren werden durch Stuhl und Erbrochenes ausgeschieden und sind hochkontagiös. Bereits 10-100 Viruspartikel können zur Ansteckung führen. Die Viruskonzentration im Stuhl ist mit > 106 Viruspartikel/ml extrem hoch. Verdachtsfälle sollten direkt isoliert werden. Die krankenhaushygienischen Maßnahmen beinhalten eine konsequente Händehygiene mit virusaktiven Desinfektionsmitteln, die Kontaktisolation und bei Erbrechen die Tröpfchenisolation. Die Therapie ist symptomatisch; für immunsupprimierte Patienten sollte bei schweren Verläufen eine Reduktion der immunsuppressiven Therapie erwogen werden

Microbial Diversity of a Brazilian Coastal Region Influenced by an Upwelling System and Anthropogenic Activity

BACKGROUND: Upwelling systems are characterised by an intense primary biomass production in the surface (warmest) water after the outcrop of the bottom (coldest) water, which is rich in nutrients. Although it is known that the microbial assemblage plays an important role in the food chain of marine systems and that the upwelling systems that occur in southwest Brazil drive the complex dynamics of the food chain, little is known about the microbial composition present in this region. METHODOLOGY/PRINCIPAL FINDINGS: We carried out a molecular survey based on SSU rRNA gene from the three domains of the phylogenetic tree of life present in a tropical upwelling region (Arraial do Cabo, Rio de Janeiro, Brazil). The aim was to analyse the horizontal and vertical variations of the microbial composition in two geographically close areas influenced by anthropogenic activity (sewage disposal/port activity) and upwelling phenomena, respectively. A lower estimated diversity of microorganisms of the three domains of the phylogenetic tree of life was found in the water of the area influenced by anthropogenic activity compared to the area influenced by upwelling phenomena. We observed a heterogenic distribution of the relative abundance of taxonomic groups, especially in the Archaea and Eukarya domains. The bacterial community was dominated by Proteobacteria, Cyanobacteria and Bacteroidetes phyla, whereas the microeukaryotic community was dominated by Metazoa, Fungi, Alveolata and Stramenopile. The estimated archaeal diversity was the lowest of the three domains and was dominated by uncharacterised marine Crenarchaeota that were most closely related to Marine Group I. CONCLUSIONS/SIGNIFICANCE: The variety of conditions and the presence of different microbial assemblages indicated that the area of Arraial do Cabo can be used as a model for detailed studies that contemplate the correlation between pollution-indicating parameters and the depletion of microbial diversity in areas close to anthropogenic activity; functional roles and geochemical processes; phylogeny of the uncharacterised diversity; and seasonal variations of the microbial assemblages

Norovirus-Gastroenteritis

Die meisten akuten Gastroenteritiden sind viral. Bei Kindern sind virale Gastroenteritiden häufig durch Rotaviren verursacht. Bei Erwachsenen sind Noroviren sowohl in sporadischen Fällen als auch bei Ausbrüchen führend. Noroviren sind regelmäßig für Epidemien in Krankenhäusern und Pflegeeinrichtungen verantwortlich. Die Klinik ist typisch mit akuten Brechdurchfällen als Hauptsymptom. Immunsupprimierte Patienten präsentieren sich oft mit atypischen Symptomen wie chronischer Diarrhö, Gewichtsverlust oder Mangelernährung. Goldstandard zur Diagnostik sind PCR-basierte Methoden, aufgrund der typischen Klinik ist eine Diagnostik jedoch oft nicht indiziert. Noroviren werden durch Stuhl und Erbrochenes ausgeschieden und sind hochkontagiös. Bereits 10–100 Viruspartikel können zur Ansteckung führen. Die Viruskonzentration im Stuhl ist mit > 106 Viruspartikel/ml extrem hoch. Verdachtsfälle sollten direkt isoliert werden. Die krankenhaushygienischen Maßnahmen beinhalten eine konsequente Händehygiene mit virusaktiven Desinfektionsmitteln, die Kontaktisolation und bei Erbrechen die Tröpfchenisolation. Die Therapie ist symptomatisch; für immunsupprimierte Patienten sollte bei schweren Verläufen eine Reduktion der immunsuppressiven Therapie erwogen werden

Morphological, hydrological, biogeochemical and ecological changes and challenges in river restoration: the Thur River case study

River restoration can enhance river dynamics, environmental heterogeneity and biodiversity, but the underlying processes governing the dynamic changes need to be understood to ensure that restoration projects meet their goals, and adverse effects are prevented. In particular, we need to comprehend how hydromorphological variability quantitatively relates to ecosystem functioning and services, biodiversity as well as ground- and surface water quality in restored river corridors. This involves (i) physical processes and structural properties, determining erosion and sedimentation, as well as solute and heat transport behavior in surface water and within the subsurface; (ii) biogeochemical processes and characteristics, including the turnover of nutrients and natural water constituents; and (iii) ecological processes and indicators related to biodiversity and ecological functioning. All these aspects are interlinked, requiring an interdisciplinary investigation approach. Here, we present an overview of the recently completed RECORD (REstored CORridor Dynamics) project in which we combined physical, chemical, and biological observations with modeling at a restored river corridor of the perialpine Thur River in Switzerland. Our results show that river restoration, beyond inducing morphologic changes that reshape the river bed and banks, triggered complex spatial patterns of bank infiltration, and affected habitat type, biotic communities and biogeochemical processes. We adopted an interdisciplinary approach of monitoring the continuing changes due to restoration measures to address the following questions: How stable is the morphological variability established by restoration? Does morphological variability guarantee an improvement in biodiversity? How does morphological variability affect biogeochemical transformations in the river corridor? What are some potential adverse effects of river restoration? How is river restoration influenced by catchment-scale hydraulics and which feedbacks exist on the large scale? Beyond summarizing the major results of individual studies within the project, we show that these overarching questions could only be addressed in an interdisciplinary framework

Efficacy of lead-in silibinin and subsequent triple therapy in difficult-to-treat HIV/hepatitis C virus-coinfected patients

Objectives: The efficacy of current hepatitis C virus (HCV) triple therapy, including a protease inhibitor, is limited in HIV/HCV-coinfected patients with advanced liver fibrosis and nonresponse to previous peginterferon-ribavirin. These patients have a low chance (only 30%) of achieving a sustained virological response (SVR) during triple therapy and cannot wait for next-generation anti-HCV drugs. In a pilot study, we investigated the efficacy of a lead-in therapy with silibinin before triple therapy in difficult-to-treat patients. Methods: Inclusion criteria were HIV/HCV coinfection with advanced liver fibrosis and documented failure of previous peginterferon-ribavirin treatment. Intervention was lead-in therapy with intravenous silibinin 20 mg/kg/day for 14 days. Subsequently, peginterferon-ribavirin combined with telaprevir was initiated for 12 weeks, followed by peginterferon-ribavirin dual therapy until week 48 after initiation of triple therapy. The outcome measurements were HCV RNA after silibinin lead-in, at weeks 2, 4 and 12 of triple therapy, and SVR at week 24 after the end of treatment. Results We examined six HIV/HCV-coinfected patients (four infected with genotype 1a). All had fibrosis grade METAVIR ≥F3 and were on fully suppressive antiretroviral therapy. Mean HCV RNA decline after silibinin therapy was 2.6 log10 IU/mL (range 2–3 log10 IU/mL). Five of the six patients were virologically suppressed at weeks 2 and 4, and all six at week 12 of triple therapy. One experienced a viral breakthrough thereafter. Four of five patients (80%) showed an SVR 24.One patient had an SVR 12 but has not yet reached week 24. Conclusions: A lead-in with silibinin before triple therapy is highly effective and increases the probability of HCV treatment success in difficult-to-treat HIV/HCV-coinfected patients with advanced liver fibrosis and previous failure of peginterferon-ribavirin