[Laboratory diagnosis of Pneumocystis pneumonia--new developments].
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Bronchoalveolar Lavage Fluid↗
Biomedical subjects
M Lademann
Publications and source records attributed to M Lademann.
[Antibiotic-associated diarrhea].
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Anti-Bacterial Agents↗
[Tick-borne encephalitis (FSME)--how great is the danger really?].
Tick-borne encephalitis is a neurotropic viral disease transmitted by ticks, and occasionally by the drinking of milk. Its incidence in Central and Eastern Europe has increased sharply, supposedly due--among other things--to climate warming and changes in leisure activities. The probability of contracting the disease following viral infection is about 30%. Some 70% of victims manifest a biphasic course with two fever peaks. Some 10% will have lasting, sometimes severe, neurological deficits, and 1 to 2% will die. The diagnosis is based on confirmed exposure to ticks in a high-risk area, a tick bite within the previous three weeks, clinical symptomatology, infected CSF, and FSME-specific IgM and IgG antibodies in the serum. Causal treatment is not possible, but the disease can be effectively avoided by prophylactic (anti-exposure) measures and vaccination. The vaccines currently available in Germany are highly effective and well tolerated, and a vaccine for children became available in 2002. Medical counselling of travellers should give consideration to vaccination against the condition--in particular for destinations in the south east or east of Europe.
Child↗
[Histoplasmosis group disease in bat researchers returning from Cuba].
CASE HISTORY: Four males (age 25 to 40 years) and one female (age 25) were admitted to our hospital almost simultaneously with symptoms of fever up to 38 degrees C, dry cough, thoracodynia, dyspnoea, myalgia and arthralgia. All patients belonged to a team of eight German bat researchers who had returned from Cuba 10 days before, where they had investigated bats in caves. Another member of the team had only mild histoplasmosis and was followed in our outpatient clinic. Two scientists who wore their breathing masks continuously during their work in the caves did not fall ill. EXAMINATIONS: Chest X-rays of all in-patients showed pulmonary infiltrates correlating with the severity of their illness. In all patients specific IgG antibodies against Histoplasma capsulatum-antigen were found in the Western Blot assay, confirming the diagnosis of histoplasmosis. TREATMENT: Treatment with oral itraconazole 200 mg b.d was given to four inpatients for 6 weeks, in the fifth patient itraconazole was discontinued because of an increase of liver transaminases. CONCLUSION: Antimycotic treatment of advancing histoplasmosis seems appropriate also in immunocompetent patients. The high number of patients within this group suggests high numbers of Histoplasma capsulatum in the caves. Wearing breathing masks throughout the work in the caves may prevent histoplasmosis even in case of high infectious doses. Pre-travel recommendations for cave researchers have to emphasize the continuous use of breathing masks and vaccination against tetanus and rabies.
Adult↗
Schistosomiasis and travel medicine.
The rise in off-track tourism and the spread of schistosomiasis in previously non-endemic areas results in an increasing number of imported schistosomiasis cases. - Detection of eggs in stool or urine and specific serology supports the diagnosis, however eosinophilia in early infection is low. In travel groups with a single index case all members of the group with similar risk behaviour should be examined since more than 50% of group members with similar risk behaviour are likely to be infected. Asymptomatic, atypical and late presentation of the disease might delay diagnosis. Praziquantel is not effective against immature worms, therefore treatment of returning travellers with single dose praziquantel is effective when started not earlier than 2 months after infection. A combination of praziquantel plus artemether is thought to be effective also in early stages of infection. Vaccination trials in endemic areas are in progress but a single vaccine for travellers covering all schistosoma species will not be available in the near future. Advising the traveller to avoid risk behaviour like wading, bathing and swimming in endemic fresh waters and about the risk of acquiring schistosomiasis through surface or spray water during boat tours will help to reduce imported schistosomiasis.
Humans↗
Assessment of IgG antibodies against yellow fever virus after vaccination with 17D by different assays: neutralization test, haemagglutination inhibition test, immunofluorescence assay and ELISA.
We analysed serum samples of 209 subjects immunized with yellow fever vaccine 17D by different assays: neutralization test, immunofluorescence assay, haemagglutination inhibition test and ELISA, for presence of 17D-specific antibodies. Serum samples were taken from a few weeks up to 35 years after vaccination. The neutralization test had the highest sensitivity. There was no correlation of results between the serological assays. Considering NT titres > 1:10 as indicating protection, we found that about 75% of subjects remained immune even 10 years after vaccination, with a median NT titre of 1:40 in reactive sera.
Adolescent↗
[Complicated malaria tropica--therapy with artemether].
By means of 5 case reports the successful use of an new blood schizontocide against plasmodium falciparum infections is demonstrated. The local patients with severe malaria were treated in the German UN-hospital in Cambodia. Cerebral, pulmonary and haemolytic complications dominated. Intramuscularly artemether, a synthetic Qinghaosu-derivative, was combined with already used antimalarials. All patients survived, regained consciousness and were without fever after administering artemether within 48 to 72 hours. The complications were controlled by mandatory ventilation, blood transfusions, fluid balance and blood sugar monitoring. With artemether we will get a well tolerated and quickly effective schizontocide. In order to avoid recrudenscence and fast drug resistance it should be combined with a tetracycline and in consequence supplemented through a second schizontocide.
Adult↗