Katharina Boden

Borrelia miyamotoi-Associated Neuroborreliosis in Immunocompromised Person.

Borrelia miyamotoi is a newly recognized human pathogen in the relapsing fever group of spirochetes. We investigated a case of B. miyamotoi infection of the central nervous system resembling B. burgdorferi–induced Lyme neuroborreliosis and determined that this emergent agent of central nervous system infection can be diagnosed with existing methods.

Diagnosis of acute Q fever with emphasis on enzyme-linked immunosorbent assay and nested polymerase chain reaction regarding the time of serum collection.

A commercially available enzyme-linked immunosorbent assay (ELISA) (Virion/Serion [Wuerzburg, Germany]), an indirect fluorescent antibody test (IFAT) (BIOS/Focus [Cypress, CA]), and a nested polymerase chain reaction (PCR) were explored for diagnosis of acute Q fever in reference to time of serum collection. Serum samples of 22 patients with acute Q fever collected around the fifth day of illness were included. A sensitivity of 30% by ELISA and 80% by IFAT (P = 0.1) was found for the first 5 days of illness and 92% by ELISA and 83% by IFAT during the sixth and eleventh day. PCR revealed a positive result in 8 cases (36%) with 6 cases deriving from the first 5 days of illness. We conclude that ELISA aids especially in the diagnosis of Q fever after 5 days of illness. The benefit of PCR as an additional tool to ELISA was especially evident in the early days of serum sampling.

Maternofetal consequences of Coxiella burnetii infection in pregnancy: a case series of two outbreaks

BackgroundA high complication rate of Q fever in pregnancy is described on the basis of a limited number of cases. All pregnant women with proven Q fever regardless of clinical symptoms should therefore receive long-term cotrimoxazole therapy. But cotrimoxazole as a folic acid antagonist may cause harm to the fetus. We therefore investigated the Q fever outbreaks, Soest in 2003 and Jena in 2005, to determine the maternofetal consequences of Coxiella burnetii infection contracted during pregnancy.MethodsDifferent outbreak investigation strategies were employed at the two sides. Antibody screening was performed with an indirect immunofluorescence test. Medical history and clinical data were obtained and serological follow up performed at delivery. Available placental tissue, amniotic fluid and colostrum/milk were further investigated by polymerase chain reaction and by culture.Results11 pregnant women from Soest (screening rate: 49%) and 82 pregnant women from Jena (screening rate: 27%) participated in the outbreak investigation. 11 pregnant women with an acute C. burnetii infection were diagnosed. Three women had symptomatic disease.Three women, who were infected in the first trimester, were put on long-term therapy. The remaining women received cotrimoxazole to a lesser extent (n=3), were treated with macrolides for three weeks (n=1) or after delivery (n=1), were given no treatment at all (n=2) or received antibiotics ineffective for Q fever (n=1). One woman and her foetus died of an underlying disease not related to Q fever. One woman delivered prematurely (35th week) and one child was born with syndactyly. We found no obvious association between C. burnetii infection and negative pregnancy outcome.ConclusionsOur data do not support the general recommendation of long-term cotrimoxazole treatment for Q fever infection in pregnancy. Pregnant women with symptomatic C. burnetii infections and with chronic Q fever should be treated. The risk-benefit ratio of treatment in these patients, however, remains uncertain. If cotrimoxazole is administered, folinic acid has to be added.

Specific risk factors for contracting Q fever: lessons from the outbreak Jena.

A Q fever outbreak with 331 reported cases in seven weeks occurred in a densely populated residential district in Jena (Germany) in 2005. Prompt identification of a stable infection source follow by an intense information policy, well defined and stable meteorological conditions and a large number of reported cases within one small community all allowed us to study promoting and protecting factors of Q fever. We conducted a cross-sectional study and investigated a part of the affected area for 100% sampling (in-home interviews). Out of 608 residents at home 460 (75.7%) participated in the study and 101 fulfilled our definition of an acute Q fever case. Our data revealed a critical zone for residency within 500 m of herds of gestating ewes in a typical urban dwelling area. We found an association between shift work and contracting Q fever. An association between outdoor activity and Q fever was only found after prolonged outdoor stays, on average more than 4h/day. Only open windows facing the putative source were associated with increased risk of Q fever. Therefore fully open windows of more than 6h/day is a significant parameter.

16S rDNA-PCR and Sequencing Improves Diagnosis of Bacterial Infection of the Central Nervous System

Rapid initiation of antibiotic treatment and fast diagnosis are essential in bacterial infection of the central nervous system (CNS). Culture as common method for detecting bacteria is time consuming and unreliable once antibiotic treatment has been initiated. Eubacterial 16S rDNA-PCR with species differentiation by sequencing appears to be a promising tool. Our experiences with this method performed on specimens from patients with neurological disorders between 2004 and 2006 are presented. The follow-up of 26 patients revealed bacterial infection in 12 cases (ten on effective antibiotics). The pathogen was identified in seven cases (one by culture and PCR, six by PCR alone). Additionally, two positive PCR-results failed to be sequenced, yet suggest bacterial infection. Contamination was revealed in two cases without infection, one by PCR and one by PCR and culture. In conclusion, 16S rDNA-PCR may be useful for diagnosis bacterial infection of CNS, especially after onset of antibiotic therapy.

[Multiple intracerebral lesions. Identification of the causative agent by 16S rDNA-PCR].

ZusammenfassungDurch die Nutzung molekularbiologischer Methoden stehen der modernen Mikrobiologie neue Untersuchungstechniken zur Verfügung. Gerade im Hinblick auf akute lebensbedrohliche Erkrankungen mit der Notwendigkeit einer raschen Antibiotikagabe und der damit verbundenen verminderten Nachweismöglichkeit mittels Bakterienkultur gewinnen diese Techniken stärker an Bedeutung. Anhand der Kasuistik eines 39-jährigen Mannes mit zerebralen Abszessen wird die 16S-rDNA-PCR zum Nachweis bakterieller DNA vorgestellt.SummaryMolecular biological methods such as polymerase chain reaction (PCR) enable microbiologists to detect bacteria even if antibiotic treatment has already been started. Based on this case report of a 39-year-old man with multiple intracerebral lesions, we describe a PCR method called 16S rDNA-PCR which can be used to identify panbacterial DNA by focussing on the universal gene sequences for the bacterial 16S part of the ribosome.

Neuroborreliosis and acute encephalopathy: The use of CXCL13 as a biomarker in CNS manifestations of Lyme borreliosis

We report the case of an 80-year-old patient with acute onset confusion initially suspected to reflect delirium in incipient Alzheimers disease. Cerebrospinal fluid tests revealed an unusually severe form of neuroborreliosis, which resolved following antibiotic treatment. This was mirrored in the measurement of CXCL13, which is suggested as a complementary biomarker. Clinical implications for screening, differential diagnosis and treatment are discussed.

Multiple bakterielle Hirnabszesse

ZusammenfassungDurch die Nutzung molekularbiologischer Methoden stehen der modernen Mikrobiologie neue Untersuchungstechniken zur Verfügung. Gerade im Hinblick auf akute lebensbedrohliche Erkrankungen mit der Notwendigkeit einer raschen Antibiotikagabe und der damit verbundenen verminderten Nachweismöglichkeit mittels Bakterienkultur gewinnen diese Techniken stärker an Bedeutung. Anhand der Kasuistik eines 39-jährigen Mannes mit zerebralen Abszessen wird die 16S-rDNA-PCR zum Nachweis bakterieller DNA vorgestellt.SummaryMolecular biological methods such as polymerase chain reaction (PCR) enable microbiologists to detect bacteria even if antibiotic treatment has already been started. Based on this case report of a 39-year-old man with multiple intracerebral lesions, we describe a PCR method called 16S rDNA-PCR which can be used to identify panbacterial DNA by focussing on the universal gene sequences for the bacterial 16S part of the ribosome.

Multiple bakterielle Hirnabszesse@@@Multiple intracerebral lesions: Erregernachweis mittels 16S-rDNA-PCR@@@Identification of the causative agent by 16S rDNA-PCR

ZusammenfassungDurch die Nutzung molekularbiologischer Methoden stehen der modernen Mikrobiologie neue Untersuchungstechniken zur Verfügung. Gerade im Hinblick auf akute lebensbedrohliche Erkrankungen mit der Notwendigkeit einer raschen Antibiotikagabe und der damit verbundenen verminderten Nachweismöglichkeit mittels Bakterienkultur gewinnen diese Techniken stärker an Bedeutung. Anhand der Kasuistik eines 39-jährigen Mannes mit zerebralen Abszessen wird die 16S-rDNA-PCR zum Nachweis bakterieller DNA vorgestellt.SummaryMolecular biological methods such as polymerase chain reaction (PCR) enable microbiologists to detect bacteria even if antibiotic treatment has already been started. Based on this case report of a 39-year-old man with multiple intracerebral lesions, we describe a PCR method called 16S rDNA-PCR which can be used to identify panbacterial DNA by focussing on the universal gene sequences for the bacterial 16S part of the ribosome.