Biomedical subjects

U Heininger

Publications and source records attributed to U Heininger.

At least 73 records · Page 4Linked to original sources

PubMed1994

Comparative study of Lederle/Takeda acellular and Lederle whole-cell pertussis-component diphtheria-tetanus-pertussis vaccines in infants in Germany.

In preparation for a large efficacy trial in Germany, a pilot study was initiated in December 1990. In this study 149 infants were enrolled; with double-blind randomization 75 received Lederle/Takeda acellular pertussis component diphtheria-tetanus-pertussis vaccine (APDT) and 74 received Lederle whole-cell pertussis component diphtheria-tetanus-pertussis vaccine (DTP). The mean age at first dose was 3.5 months, and the second and third doses followed at 6-week intervals. Reactions were relatively mild with both vaccines; in general they were less frequent following APDT. The IgG antibody responses to lymphocytosis promoting factor (LPF) and fimbriae-2 were similar in both groups whereas the responses to pertactin and filamentous haemagglutinin (FHA) were greater in APDT recipients. DTP recipients had greater responses to tetanus and diphtheria toxoids. When age of first dose was examined (8-12 weeks versus 16-20 weeks), it was found that young age had a suppressive effect on antibody responses in DTP but not APDT recipients to LPF toxoid, pertactin, fimbriae-2, and tetanus and diphtheria toxoids. High values of transplacentally acquired antibody lessened the response to LPF toxoid and tetanus toxoid in DTP recipients and to tetanus toxoid in APDT vaccinees. The IgG immune response to LPF toxoid, FHA and fimbriae-2 was found to be more uniform in APDT recipients than in DTP vaccinees. An IgA antibody response to fimbriae-2 was noted in 13% of DTP recipients but in no APDT vaccinees. The broad immunogenicity and mild reactogenicity of this APDT vaccine justifies its use in the German efficacy trial.

Antibodies, Bacterial↗

PubMed1994

Clinical characteristics of illness caused by Bordetella parapertussis compared with illness caused by Bordetella pertussis.

In conjunction with a pertussis vaccine efficacy trial in Germany, nasopharyngeal specimens were collected from May, 1992, to March, 1993, from patients with cough illnesses. Clinical data were obtained by initial and follow-up questionnaires. Bordetella parapertussis was isolated from 38 patients (mean age, 3.5 years; 68% girls). Clinical characteristics in these cases were compared with those of 76 patients (matched by age and sex) with illness caused by Bordetella pertussis during the same period. Findings were: (B. pertussis/B. parapertussis): cough > 4 weeks 57%/37% (P = 0.06); whoop 80%/59% (P = 0.07); whoop > 2 weeks 26%/18% (P = 0.05); paroxysms 90%/83% (P = 0.5); body temperature > or = 38 degrees C 9%/0% (P = 0.17); vomiting 47%/42% (P = 0.69); and mean leukocyte and lymphocyte counts 12,500/mm3 and 7600/mm3 (P < 0.0001) and 7800/mm3 and 3500/mm3 (P < 0.0001), respectively. Illness caused by B. parapertussis was typical of pertussis but less severe than that caused by B. pertussis. In contrast with B. pertussis infection, lymphocytosis is not a characteristic of B. parapertussis infection. This is most likely a result of the lack of production of lymphocytosis-promoting factor toxin by B. parapertussis.

Bordetella↗

PubMed1994

[Current aspects in diagnosis and therapy of pediatric facial paralysis].

Between 1986 and 1992, 60 children with facial nerve palsy (FNP) were examined at the ORL hospital at Erlangen-Nuremberg University. By using blood and cerebrospinal fluid (CSF)-serological tests acute infection with Borrelia burgdorferi (B.b.) could be proved in 16 of 40 children (40%) whose pareses could not be clarified etiologically at first examination. Whereas all idiopathic FNP patients (22) had normal CSF-results, more than half of the B.b.-infected children showed pathological findings, with pleocytosis indicating meningitis. These findings demonstrated that lumbar puncture should be performed in children with FNP of unclear etiology, particularly in cases with positive borreliosis blood serology. The children with borreliosis received penicillin G or ceftriaxone intravenously for at least 14 days and patients with idiopathic FNP were treated with cortisone either orally alone or intravenously in combination with pentoxifylline and hydroxyethylstarch. The outcome in 95% of the patients showed that complete recovery was similar in borreliosis and idiopathic FNP irrespective of treatment with cortisone. Overall, 88% of the FNP recovered completely, indicating a favorable prognosis of FNP in children.

Adolescent↗

PubMed1993

Brain abscesses in neonates--report of three cases.

We report three newborns with brain abscesses. Two infants suffered from Serratia marcescens meningitis and one infant had enterococcal sepsis and meningitis. Brain abscesses were detected by cerebral sonography. Outcome in one infant with S. marcescens infection was poor. This patient developed multicystic encephalo-malacia and severe developmental retardation. In the other patient with S. marcescens infection surgical drainage of the abscess was performed. The outcome was good both in this infant and in the patient with enterococcal brain abscess.

Brain Abscess↗

PubMed1993

Clinical and laboratory diagnosis of pertussis in the regions of a large vaccine efficacy trial in Germany.

As a support service for a pertussis vaccine efficacy trial, a central diagnostic laboratory was established. Physicians in the geographic areas of the planned study were encouraged to send nasopharyngeal specimens from children and household contacts with cough illnesses whether or not the illnesses were typical of pertussis. From April, 1991, to February, 1992, 3629 specimens were received and in 601 instances (16.6%) Bordetella pertussis was isolated. Only 3.3% of patients with positive cultures had received pertussis vaccine whereas 16.1% of culture-negative patients had received vaccine (P < 0.0001). Fever was more common (12.2%) in patients with negative cultures compared with those with positive cultures (5.4%) (P < 0.0001). B. pertussis isolation rates fell markedly after 21 days of cough. Significantly more patients with negative cultures compared with those with positive cultures had been treated with erythromycin (8.5 vs. 2.9%; P < 0.0001). Patients with cough for greater than 4 weeks and specimen collection within 2 weeks of cough onset had a B. pertussis isolation rate of 59%. Similarly if whoop occurred under the same circumstances the isolation rate was 80%. In this study 25.5% of patients with culture confirmed pertussis had illnesses with cough of less than 21 days duration. This finding suggests to us that a pertussis case definition in efficacy trials that requires cough of 21 days is excessively restrictive.

Adolescent↗

PubMed1993

[Tick bite and Lyme borreliosis. An epidemiologic study in the Erlangen area].

BACKGROUND: Lyme borreliosis is transmitted by tick bites. Approximately every fifth local tick (Ixodes ricinus) is infected. Transmission, therefore does not occur with every bite, and disease doesn't always follow infection. The goal of the study was to investigate the risks of infection and disease after tick bites in the area of Erlangen/Germany. METHODS: Between April 1989 and October 1991 seventy-one of our out-patients (30 females, 41 males) aged 6 months to 29 years had a tick bite and were enrolled into the study. After the ticks had been removed, a blood specimen for a specific Borrelia burgdorferi antibody assay (IFT) was collected. An interview by phone was performed 4 weeks later and an appointment for a second blood collection was arranged. RESULTS: In 69 patients the initial titer was negative, in two patients it was 1:32. Sixty patients could be reached by phone, and in 43 a second blood sample was available. There was seroconversion detectable in 4 instances, two of whom were asymptomatic, one had unspecific symptoms and one developed lymphocytoma. There were no manifestations of late stage disease in the study population. CONCLUSION: These results confirm the current recommendation of the Bundesgesundheitsamt (German Federal Health Institute) that generally antibiotic treatment after a tick bite is not necessary.

Adolescent↗

PubMed1992

Serious pertussis overlooked in infants.

Two infants with life-threatening pertussis are presented in whom the diagnosis was delayed. A review of pertinent literature suggests that the diagnosis of pertussis in infants is frequently missed and therefore the morbidity and mortality from this disease is underestimated.

Diagnostic Errors↗

PubMed1992

[Pertussis--an illness with typical clinical symptoms?].

There has been a noticeable increase in the incidence of pertussis in West Germany over the last decade. Since the availability of adequate bacteriological diagnosis a much broader clinical spectrum can be attributed to infections with B. pertussis. Three patients with an unusual clinical presentation of pertussis are presented. A three month old infant presented with severe apneic spells without cough as the sole clinical symptoms of the infection. B. pertussis was isolated in the nasopharyngeal swab. A nine month old premature infant with bronchopulmonary dysplasia after long time intubation and artificial ventilation presented with apneic spells, pulmonary and cardiac decompensation and required ventilatory support. The diagnosis was suggested by a massive leucocytosis with lymphocytosis. The diagnosis on the patient was established by serologic methods. Adult contacts of this patient developed longstanding cough and clinical signs of pertussis. The diagnosis of pertussis in these persons was established by nasopharyngeal culture. The third patient with trisomy 21 and a corrected AV canal suffered from nonspecific cough and gradually developed signs of congestive heart failure with pneumonia. B. pertussis was isolated from the nasopharynx. This patient showed neither the typical paroxysmal coughing spells nor disclosed the typical lymphocytosis in his white blood count. Microbiological investigations of patients with symptoms of respiratory tract infections should include the isolation of B. pertussis. Thus, additional cases of pertussis not suspected on the basis of their initial clinical presentation will be detected.

Administration, Oral↗

PubMed1990

Simultaneous palsy of facial and vestibular nerve in a child with Lyme borreliosis.

We describe a boy with borreliosis characterized by lymphocytic meningitis and simultaneous palsy of facial and vestibular nerves on the left side. A mild sensoneural affection was also confirmed by brainstem evoked response audiometry. While symptoms of vestibular dysfunction quickly decreased during antibiotic treatment, facial palsy improved only slowly.

Child↗

PubMed1990

Demonstration of perivascular echogenicities in congenital cytomegalovirus infection by colour Doppler imaging.

Two children with congenital cytomegalovirus infection and intracerebral echogenicities were investigated by computer sonography and colour Doppler imaging (CDI). By simultaneous imaging of brain tissue and CDI, blood flow within the stripe-like echogenicities of the basal ganglia was demonstrated. Using CDI the echogenicities were identified as the walls of thalamostriate vessels.

Basal Ganglia↗

PubMed1989

[An unusual late manifestation of hemorrhage caused by vitamin K deficiency].

After an uneventful pregnancy and birth at home without vitamin K-prophylaxis, a 13-day-old breast-fed newborn showed an unexplained swelling of his right elbow and avoided movement of his right arm. One week later a swelling of his left thigh and hip with extensive hematoma led to the diagnosis of vitamin K-deficiency. The initial symptoms can be interpreted as an unusual primary manifestation of late hemorrhagic disease caused by vitamin K-deficiency.

Blood Coagulation Tests↗

PubMedDate not supplied

Facial palsy with elevated protein in otherwise normal CSF in a child with Lyme disease.

This is a report on an eight-year-old girl who presented with facial palsy, headache, fatigue, arthralgias and myalgias six weeks after two tick bites. Physical examination was unremarkable with the exception of a left-sided facial palsy. Laboratory investigation revealed normal complete blood count, ESR and CRP. The spinal tap showed a protein of 63 mg/dl, glucose 45 mg/dl and no cells. IFT titres to Borrelia burgdorferi in serum and CSF were significantly elevated. The diagnosis was supported by Western blot analysis. Treatment was started with ceftriaxone i.v. for a total of 14 days. Under this therapeutic regimen the patient improved substantially within five days. Investigation of CSF in patients with facial palsy may help to establish the diagnosis of Lyme disease by simultaneously measuring IFT to B. burgdorferi in serum and spinal fluid, even in cases where CSF shows little or no signs of inflammation.

Cerebrospinal Fluid Proteins↗

PubMedDate not supplied

Human but not ovine isolates of Bordetella parapertussis are highly clonal as determined by PCR-based RAPD fingerprinting.

The DNA fingerprints of 170 human isolates and ten ovine isolates of Bordetella parapertussis were examined by arbitrarily-primed PCR/RAPD with 29 primers. Based on this technique, all the human isolates appear highly genetically homogeneous. The ovine isolates could be distinguished from human isolates and they showed diversity among themselves. Therefore, human isolates of B. parapertussis are a highly clonal group adapted to infect humans and they are distinct from polymorphic ovine isolates.

Animals↗

PubMedDate not supplied

Scarlet fever associated with hepatitis--a report of two cases.

Infection with group A beta-hemolytic streptococci (GABHS) is the most common bacterial cause of acute pharyngitis and tonsillitis beyond infancy. We report on two patients with scarlet fever associated with hepatitis. The patients (boys aged 6 and 7 years) both presented with a scarlatiniform rash, dark urine and light-colored stools. Laboratory studies revealed elevated liver transaminases and negative antibody tests against hepatitis viruses A, B and C, cytomegalovirus and Epstein-Barr virus. Both patients were treated with antibiotics and recovered completely within a few days. Although the association between scarlet fever and hepatitis has been known for many decades, the pathogenesis is still unknown. Physicians treating patients with group A beta-hemolytic streptococcal infections should be aware of possible hepatic involvement.

Anti-Bacterial Agents↗

PubMedDate not supplied

[Papilledema and acute bilateral amaurosis accompanying acute sinusitis].

BACKGROUND: Acute sinusitis can lead to severe complications. This includes involvement of the optical nerve with visual loss and brain abscess as a life-threatening complication. PATIENTS: Empyema of the chiasma opticum region with neuritis nervi optici and bilateral acute amaurosis was observed in a 13 year old boy with sinusitis sphenoidalis and ethmoidalis. In a 11 year old girl, pronounced papilledema was found to be closely associated with sinusitis sphenoidalis. While she recovered completely on appropriate antibiotic therapy, visual loss in the boy was irreversible despite surgical intervention. CONCLUSIONS: Sinusitis should always be considered in patients with impaired vision, neuritis nervi optici or unexplained papilledema, especially if occurring in association with an upper respiratory infection. In addition to physical examination, cranial computer tomography or magnetic resonance imaging of the brain including sinuses and chiasma opticum should be applied early. If empyema is found, immediate surgical intervention is of prognostic importance.

Acute Disease↗

PubMedDate not supplied

[Aminoglycosides in patients with mucoviscidosis and pulmonary exacerbation. Comparison of once or three times daily administration].

Twenty-six patients with cystic fibrosis and pulmonary exacerbations were enrolled in a prospective randomized study to compare the efficacy of aminoglycosides (tobramycin or netilmicin) administered once daily (21 episodes, 5 with netilmicin, 16 with tobramycin) and thrice daily (23 episodes, 2 with netilmicin, 21 with tobramycin), respectively. In addition, the patients received an anti-pseudomonal beta-lactam antibiotic. In the single-dose group the total daily dosage was 4.97 +/- 1.12 mg/kg (total dosage per exacerbation: 74.55 mg/kg), compared to 9.60 +/- 2.70 mg/kg in the triple-dose group (total dosage per exacerbation: 165.12 mg/kg). The mean peak and trough serum levels of the aminoglycoside were 8.31 +/- 1.76 mg/l and 0.18 +/- 0.10 mg/l, respectively in the single dose group compared to 6.12 +/- 1.30 mg/l and 0.58 +/- 0.31 mg/l in the triple dose group. Success of treatment, defined as decrease in leucocyte counts, normalization of elevated CRP-values, number of days in hospital and interval until next admission to hospital, was not different between both groups. We conclude that single daily dose of aminoglycosides was as efficacious as triple dose in our patients.

Adolescent↗

PubMedDate not supplied

[Tumor necrosis factor in the serum--a useful supplemental parameter in the diagnosis of infection in cystic fibrosis?].

In 15 patients with cystic fibrosis 18 blood samples were investigated for signs of infection including full white blood count, c-reactive protein (CRP) and tumour-necrosis-factor alpha (TNF). Ten patients were hospitalized for pulmonary exacerbation, one for orthostatic collapse and one for equivalent of meconium ileus. The latter two as well as three out-patients with cystic fibrosis on routine-visits served as controls. Blood was taken on admission and at the time of the visit in our out-patient department, respectively. In three cases, blood was taken repeatedly during their stays in hospital. While leucocytosis (17.700 +/- 3.500) and elevated CRP-levels (6.4 +/- 7.3 mg/dl) pointed to an infectious cause of deterioration in the exacerbation-group, TNF-levels without exception were undetectable (less than 15 pg/ml). In the control group, leucocyte counts (10.700 +/- 3.600) and CRP-levels (1.2 +/- 1.1 mg/dl) showed minor pathologic results. TNF-levels were undetectable, too. While elevated TNF-levels measured quantitatively in patients with invasive bacterial infections, e.g. septicaemia due to Neisseria meningitidis, correlate well with prognosis of disease, in patients with cystic fibrosis such a relationship can't be found.

Adolescent↗

PubMedDate not supplied

[Congenital Langerhans-cell histiocytosis presenting as a varicella infection].

UNLABELLED: We report on a preterm infant (33rd gestational week) with a varicella-like congenital rash, which initially appeared to respond to therapy with acyclovir. At the age of 3 weeks, lesions were in different stages of evolution and still resembled a varicella zoster virus (VZV) infection. However, since proof of VZV infection was lacking and new lesions erupted at the age of 4 weeks, a skin biopsy was performed which revealed a diagnosis of Langerhans cells histiocytosis. Therapy with prednisone resulted in prompt healing of the lesions. DISCUSSION: Congenital Langerhans cell histiocytosis is rare and symptoms may vary substantially from case to case. Like in our observation it may be confused with congenital varicella. In case of congenital skin lesions of uncertain etiology a skin biopsy should be performed.

Anti-Inflammatory Agents↗