Benjamin T. Schleenvoigt

HIV post exposure prophylaxis induced bicytopenia: a case report

Long and short term side effects of antiretroviral drugs are not fully understood yet. Here a case of reversible blood count changes following post exposure prophylaxis with tenofovir/emtricitabin and lopinavir/ritonavir is reported. We propose that antiretroviral drugs used in post exposure prophylaxis may have a significant impact on hematopoiesis.

[African tick bite fever--rickettsiosis after holiday in South Africa].

HISTORY AND CLINICAL FINDINGS A 61-year-old female patient presented with multiple tick bites. Some of them turned into skin ulcera. The patient acquired the tick bites during a stay in South Africa for several weeks. EXAMINATIONS AND DIAGNOSIS: According to the history and typical skin manifestations, a tick borne infection (rickettsiosis) was diagnosed and serologically confirmed. TREATMENT AND CLINICAL COURSE The empiric treatment with doxycycline resulted in a fast regression of the skin ulcera. CONCLUSION Rickettsial infections can be diagnosed in the presence of typical skin manifestations (eschar andor centripedal exanthema) and after an appropriate history of travel. In such cases, empiric treatment with tetracyclines can be performed.

Norovirus outbreaks in german refugee camps in 2015

Purpose Refugees often live in confined housing conditions with shared kitchen and sanitary facilities, rendering susceptible to communicable diseases. We here describe the outbreak, spread and self-limiting nature of a norovirus outbreak in a German refugee camp in the winter of 2015. Methods During a norovirus outbreak, data on clinical symptoms, nationality and living conditions was obtained in a refugee camp in northern Germany in the winter of 2015. Furthermore secondary data on norovirus outbreaks in 2015 was assessed. Results Amongst n = 982 refugees, n = 36 patients (3.7 %) presented with acute norovirus gastroenteritis. The vast majority of cases were children, only the first patient was admitted to the hospital. Intensified hygiene measures were implemented on day 2 of the outbreak, but new cases peaked on day 21 and occurred until one month after the first case. Different cultural backgrounds, eating habits and hygiene standards amongst the refugees made it particularly challenging to implement stringent isolation and hygiene measures. Despite these predisposing factors, only minor norovirus outbreaks were reported in refugee camps in 2015. Conclusion Adults refugees had a low attack rate of symptomatic norovirus infection, while small children are at high risk. Infection spreads despite hygiene measures and camp sites and staff should be prepared for the particular challenges of such situations with a particular focus on cultural-background specific implementation of hygiene measures.

Acute Q fever infection in Thuringia, Germany, after burial of roe deer fawn cadavers (Capreolus capreolus): a case report

We report on a case of a 48-year-old man who presented with acute Q fever infection after burying two fawn cadavers (Capreolus capreolus). Recent outbreaks of Q fever in Europe have been traced back to intensive goat breeding units, sheep flocks in the proximity of highly populated urban areas or to farmed deer. To our knowledge, this is the first case report describing Q fever infection in a human linked to roe deer as a source of infection.

56-jähriger Patient mit unklaren Durchfällen nach Thailandreise

Institute 1 Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena 2 Institut für Tropenmedizin und Internationale Gesundheit, Charité – Universitätsmedizin Berlin 3 Bernard-Nocht-Institut für Tropenmedizin, Hamburg 4 Institut für Medizinische Mikrobiologie, Universitätsklinikum Jena Bibliografie DOI https://doi.org/10.1055/a-0579-5908 Dtsch Med Wochenschr 2018; 143: 861–862

Improvement of a tissue maceration technique for the determination of placental involvement in schistosomiasis

Schistosomiasis in pregnancy may cause low birth weight, prematurity and stillbirth of the offspring. The placenta of pregnant women might be involved when schistosome ova are trapped in placental tissue. Standard histopathological methods only allow the examination of a limited amount of placental tissue and are therefore not sufficiently sensitive. Thus, placental schistosomiasis remains underdiagnosed and its role in contributing to schistosomiasis-associated pregnancy outcomes remains unclear. Here we investigated an advanced maceration method in order to recover a maximum number of schistosome ova from the placenta. We examined the effect of different potassium hydroxide (KOH) concentrations and different tissue fixatives with respect to maceration success and egg morphology. Placental tissue was kept either in 0.9% saline, 5% formalin or 70% ethanol and was macerated together with Schistosoma mansoni infested mouse livers and KOH 4% or 10%, respectively. We found that placenta maceration using 4% KOH at 37°C for 24 h was the most effective method: placental tissue was completely digested, egg morphology was well preserved and alkaline concentration was the lowest. Ethanol proved to be the best fixative for this method. Here we propose an improved maceration technique in terms of sensitivity, safety and required skills, which may enable its wider use also in endemic areas. This technique may contribute to clarifying the role of placental involvement in pregnant women with schistosomiasis.

Development of visceral leishmaniasis in an HIV + patient upon immune reconstitution following the initiation of antiretroviral therapy

Case presentationHere, we report on a case of VL in an HIV-infected patient from the Republic of Georgia who had moved to Germany 14 years before and who had travelled several times to southern Europe in between. After presenting with typical Pneumocystis jiroveci pneumonia, which was treated appropriately, the patient was started on antiretroviral therapy. Shortly thereafter, however, he developed fever of unknown origin. All laboratory assays for the diagnosis of various infectious agents including serological assays and polymerase chain reaction testing of bone marrow aspirate to diagnose VL did not yield positive results at first. Only upon repetition of these tests, diagnosis of VL could be made and the patient treated accordingly.Case discussionVisceral leishmaniasis (VL) is a common opportunistic infection in HIV-positive patients from endemic countries but occurs rarely following antiretroviral treatment. This case demonstrates that patients who develop VL upon immune reconstitution may not be diagnosed initially by standard laboratory assays for the diagnosis of VL and underlines the necessity to repeat serologic and molecular biologic testing for VL in cases of fever of unknown origin in patients from or with travel history to endemic countries.

Kutane Tuberkulosemanifestation als Ursache einer Wundheilungsstörung nach Bagatelltrauma

HISTORY AND CLINICAL FINDINGS After a trivial injury, a male patient from India presented with a non-healing minor injury. A necrotic lesion at the right medial ankle was evident. EXAMINATIONS Mycobacterium tuberculosis complex was detected from tissue material both in cultures and by molecular markers. Sonography of the abdomen indicated a retroperitoneal abcess formation. DIAGNOSIS, TREATMENT AND COURSE Cutaneous tuberculosis with involvement of the spine and an abscess of the psoas muscle was diagnosed. After initiation of antituberculotic treatment elevation of liver enzymes was noted. The initially observed skin lesion in the area of the right ankle healed quickly; however, the abscess of the psoas muscle did not. The abscess was drained by puncture. During follow up no fistula formation was observed. CONCLUSION Tuberculosis should be considered as differential diagnosis in cases of poorly healing skin lesions caused by trauma, especially in patients from tuberculosis high incidence regions.

Health problems and behavioural risks in travellers to the tropics – A commentary

With great interest we have read the paper “Does the use of alcohol-based hand gel sanitizer reduce travellers’ diarrhoea and gastrointestinal upset? A preliminary survey” by D. Henriey [1], published recently in this Journal. In our own study we have evaluated risk-factors for travellers’ diarrhoea in east german travellers revealing other preventive measures and behaviours in travellers comparing the differences and similarities between our results and this study. Our study included 546 participants and was performed in the outpatient department for infectious diseases at the Friedrich-Schiller-University of Jena from 2004 to 2007. All travellers asking for medical advice before travelling to tropical and subtropical countries at the outpatient department or at a general practitioner in the city of Jena, received a questionnaire they were asked to complete after their return. The questionnaire comprised questions concerning demographic aspects, travel details, risk behaviour, compliance with antimalarials and the presence of symptoms and diagnosed diseases during and after the journey. In comparison to the study performed in travellers arriving at international airports [1], travellers in our study were younger (mean age 40 years vs. 50 years) and had longer travel duration (33 vs. 21 days). The female to male ratio in our cohort is approximately equal (52.2%e47.8% vs. 70.5%e29.5%).

61-jährige Frau mit unklarem neurologischen Befund

Eine 61-jahrige Frau stellt sich wegen Gangstorungen, die seit mehr als 6 Monaten zunehmen und Kribbelparasthesie in beiden Handen arztlich vor. Deshalb wird ambulant ein MRT der Halswirbelsaule (HWS) veranlasst. Die Untersuchung inklusive der Kontrastmittel-Sequenzen ergibt 3 pathologische Befunde.