V. Schäfer

Prophylaxis with povidone-iodine against induction of oral mucositis by radiochemotherapy.

Oral mucositis is a frequent complication of radiochemotherapy. The origin of radiation-induced mucosal lesions is iatrogenic in nature, although further development of mucositis is essentially influenced by infection. It can be assumed that disinfection measures should decrease the severity of mucositis induced by radiochemotherapy. Therefore, in a prospective randomised study the efficacy of prophylactic oral rinsing with a disinfection agent was investigated. A randomised, prospective comparative trial was conducted with 40 patients undergoing radiochemotherapy of the head and neck region because of malignant disease. The treatment scheme consisted of irradiation to the tumour region and adjacent lymph nodes, with a total dose of 71.3 Gy, and simultaneous chemotherapy with carboplatin (60 mg/m2) on days 1–5 and 29–34. In all patients mucositis prophylaxis with nystatin, rutosides, panthenol and immunoglobulin was undertaken. In addition, 20 patients rinsed the oral cavity 4 times daily with povidone-iodine solution, while the group for comparison rinsed with sterile water. Clinical examination of the oral mucosa was performed weekly. Onset, grading and duration of mucositis were used as the main variables. Clinically manifest oral mucositis was observed in 14 patients in the iodine group (mean grading: 1.0) and in all 20 patients in the control group (mean grading: 3.0). The total duration (mean) of clinically observed mucositis was 2.75 weeks in treatment patients and 9.25 weeks in control patients. Median AUC (area under curve for grade vs duration) was 2.5 in the iodine rinsing patients and 15.75 in control patients. All differences found between the two groups were statistically significant. Increased iodine incorporation was not observed. A pathologic rise in thyroid hormone levels was not found in the iodine group. The results obtained indicate that incidence, severity and duration of radiochemotherapy-induced mucositis can be significantly reduced by oral rinsing with povidone-iodine in addition to the standard prophylaxis scheme. It can be concluded that rinsing with povidone-iodine is an easy, cheap and safe prophylactic method and can be recommended as a supportive treatment during antineoplastic treatment of the head and neck region.

Prospective Multicenter Study Evaluating Fecal Calprotectin in Adult Acute Bacterial Diarrhea

BACKGROUND Every year, about 2.2 million deaths occur worldwide due to diarrhea. Reliable diagnosis of patients with acute infectious diarrhea remains a formidable challenge to the clinicians. This is the first study reporting use of fecal calprotectin in diagnosing acute diarrhea. The aim was to compare the diagnostic accuracy of fecal calprotectin, fecal lactoferrin, and guaiac-based fecal occult blood test in a diverse group of consecutive patients with acute diarrhea in which routine bacterial stool cultures and cytotoxins for Clostridium difficile were performed. METHODS This was a prospective case-control multicenter study from January 2004 until October 2007 in 2383 consecutive patients with acute diarrhea. They provided stool samples for performing cultures. Patients with positive cultures and an equal number of matched controls with negative cultures underwent fecal occult blood test and calprotectin and lactoferrin assays. RESULTS Calprotectin, lactoferrin, and fecal occult blood tests demonstrated sensitivity and specificity of 83% and 87%, 78% and 54%, and 38% and 85%, respectively, for diagnosing acute bacterial diarrhea. CONCLUSIONS Calprotectin showed high correlation with bacteriologically positive infectious diarrhea compared with lactoferrin and fecal occult blood test. It may potentially revolutionize management algorithm for patients with acute diarrhea. As a screening test, calprotectin can generate results within hours to support presumptive diagnosis of infectious diarrhea, which can decide suitability of stool samples for culture.

Cryptococcus neoformans peritonitis in a patient with alcoholic cirrhosis : Case report and review of the literature

AbstractIn the absence of coexisting HIV infection Cryptococcus neoformans is rarely considered in the differential diagnosis of peritonitis that occurs in patients with cirrhosis and ascites. Here, we report on a 39–year–old male, HIV–negative patient with decompensated alcohol toxic liver cirrhosis who developed a lethal intraperitoneal infection with C. neoformans. We reviewed the literature and found an additional 19 cases with culture confirmed cryptococcal peritonitis in combination with liver disease or AIDS. We suggest that awareness of this unusual but lethal entity may lead to earlier diagnosis and proper treatment.

Medical and veterinary use of antimicrobial agents: implications for public health. A clinician's view on antimicrobial resistance

It is often proposed that the indiscriminate use of antimicrobial agents in the veterinary field leads to increased resistance in bacteria pathogenic to humans. Although for human medicine there is some potential danger behind the use of antimicrobial agents in animals, very few species (such as Staphylococci, Salmonella, Escherichia coli, Yersinia and Campylobacter) isolated in animals, which are also pathogenic to man, have been mentioned in the literature. The present paper analyzes the areas and bacteria where the clinician faces problems in the treatment of infection in man.

Prophylaxe der radiochemotherapeutisch bedingten Mukositis

BACKGROUND Oral mucositis is a frequent complication of radiochemotherapy. The origin of radiation-induced mucosa lesions is of iatrogenic nature although further development of mucositis is essentially influenced by infection. It can be assumed that disinfection measures should decrease the severity of mucositis induced by radiochemotherapy. Therefore, in a prospective randomised study the efficacy of prophylactic oral rinsing with a disinfection agent was investigated. PATIENTS AND METHOD An open, randomised, prospective comparative trial was conducted with 40 patients undergoing radiochemotherapy of head and neck region due to malignant disease. The treatment scheme consisted of irradiation to tumor region and adjacent lymph nodes with a total dose of 71.3 Gy and simultaneous chemotherapy with carboplatin (60 mg/m2) on days 1 to 5 and 29 to 34. In all patients, a prophylaxis of mucositis with nystatine, rutosides, panthenol and immunoglobulin was undertaken. In addition, 20 patients rinsed oral cavity 4 times daily with povidone-iodine-solution, the comparative group rinsed with sterile water. Clinical examination of the oral mucosa was performed weekly. Onset, grading and duration of mucositis were used as main variables. RESULTS Clinically manifested oral mucositis was observed in 14 patients of the iodine group (mean grading: 1.0) and all 20 patients of the control group (mean grading: 3.0). Total duration (mean) of clinically observed mucositis was 2.75 weeks in treatment patients and 9.25 in control patients. Median AUC (area under curve for grade vs duration) was 2.5 in iodine rinsing patients and 15.75 in control patients. All differences found between the 2 groups were statistically significant. Increased iodine incorporation was not observed. A pathological increase of thyroid hormone levels in the iodine group was not found. CONCLUSIONS The gained results indicate that incidence, severity and duration of radiochemotherapy-induced mucositis can be significantly reduced by oral rinsing with povidone-iodine performed additionally to the standard prophylaxis scheme.ZusammenfassungHintergrundMukositis ist eine häufige Komplikation der Radiochemotherapie von Kopf-Hals-Tumoren. Obwohl der Ursprung von Mukosaläsionen iatrogener Natur ist, wird die weitere Entwicklung im wesentlichen durch die Infektion beeinflußt. Es ist deshalb anzunehmen, daß antiseptische Maßnahmen die Häufigkeit der radiochemotherapeutisch induzierten Mukositis herabsetzen. Aus diesem Grunde wurde in einer prospektiven, randomisierten Studie die Wirksamkeit der prophylaktischen Mundspülungen mit Polyvidon-Iod zur Vorbeugung der radiogenen Mukositis untersucht.Patienten und MethodeDie Untersuchung erfolgte in einer offenen, randomisierten, prospektiven Vergleichsstudie an 40 Patienten, die wegen maligner Erkrankung einer Radiochemotherapie im Kopf-Hals-Bereich unterzogen wurden. Das Therapieschema bestand aus Bestrahlung der Tumorregion und der Lymphabflußwege mit einer Gesamtdosis von 71,3 Gy sowie einer simultanen Chemotherapie mit Carboplatin (60 mg/m2 der Körperoberfläche) an den Tagen 1 bis 5 und 29 bis 34. Bei sämtlichen Patienten wurde eine Mukositisprophylaxe mit Nystatin, Rutosiden, Panthenol und Immunglobulin vorgenommen. Bei 20 Patienten erfolgte zusätzlich viermal täglich eine Mundspülung mit PVP-Iodlösung, 20 Patienten (Kontrollgruppe) spülten mit sterilem Wasser. Eine klinische Untersuchung der Mundschleimhaut erfolgte einmal wöchentlich. Als Zielvariablen dienten: Zeitpunkt des Mukositisbeginns, die Ausprägung und Dauer der Mukositis.ErgebnisseIn der PVP-Iod-Gruppe trat bei 14 Patienten eine klinisch manifeste Mukositis auf (mittlere Ausprägung: Grad 1,0) bei der Kontrollgruppe bei allen 20 Patienten (Grad 3,0). Die Gesamtdauer der klinisch feststellbaren Mukositis (Größe=WHO I) betrug in der PVP-Iod-Gruppe 2,75 und in der Kontrollgruppe 9,25 Wochen. Die medianen AUC-Werte (Ausprägung über Dauer) betrugen 2,5 für die PVP-Iod-Gruppe und 15,75 für die Kontrollgruppe. Alle Prüfgrößen zeigten statistisch signifikante Unterschiede zwischen den beiden Gruppen. Eine pathologische Erhöhung der Schilddrüsenwerte konnte in der mit Iod behandelten Gruppe nicht festgestellt werden.SchlußfolgerungDie erhobenen Ergebnisse deuten darauf hin, daß eine zusätzlich zu einem üblichen Prophylaxeschema durchgeführte Mundspülung mit einer PVP-Iodlösung sowohl Inzidenz, Schweregrad als auch Dauer einer radiochemotherapeutisch bedingten Mukositis der Mundhöhle signifikant vermindern kann.AbstractBackgroundOral mucositis is a frequent complication of radiochemotherapy. The origin of radiation-induced mucosa lesions is of iatrogenic nature although further development of mucositis is essentially influenced by infection. It can be assumed that disinfection measures should decrease the severity of mucositis induced by radiochemotherapy. Therefore, in a prospective randomised study the efficacy of prophylactic oral rinsing with a disinfection agent was investigated.Patients and MethodAn open, randomised, prospective comparative trial was conducted with 40 patients undergoing radiochemotherapy of head and neck region due to malignant disease. The treatment scheme consisted of irradiation to tumor region and adjacent lymph, nodes with a total dose of 71.3 Gy and simultaneous chemotherapy with carboplatin (60 mg/m2) on days 1 to 5 and 29 to 34. In all patients, a prophylaxis of mucositis with nystatine, rutosides, panthenol and immunoglobulin was undertaken. In addition, 20 patients rinsed oral cavity 4 times daily with povidone-iodine-solution, the comparative group rinsed with sterile water. Clinical examination of the oral mucosa was performed weekly. Onset, grading and duration of mucositis were used as main variables.ResultsClinically manifested oral mucositis was observed in 14 patients of the iodine group (mean grading: 1.0) and all 20 patients of the control group (mean grading: 3.0). Total duration (mean) of clinically observed mucositis was 2.75 weeks in treatment patients and 9.25 in control patients. Median AUC (area under curve for grade vs duration) was 2.5 in iodine rinsing patients and 15.75 in control patients. All differences found between the 2 groups were statistically significant. Increased iodine incorporation was not observed. A pathological increase of thyroid hormone levels in the iodine group was not found.ConclusionsThe gained results indicate that incidence, severity and duration of radiochemotherapy-induced mucositis can be significantly reduced by oral rinsing with povidone-iodine performed additionally to the standard prophylaxis scheme.

Six enteropathogens isolated from a case of acute gastroenteritis

SummaryIsolation of six different gastrointestinal pathogens (Entamoeba histolytica, Plesiomonas shigelloides, Campylobacter jejuni and three differentSalmonella species [Salmonella typhimurium, Salmonella blockley andSalmonella hadar]) in the feces of a German female tourist suffering from acute diarrhoea after a trip to Bali.ZusammenfassungBei einer deutschen Touristin wurden bei einer akuten Gastroenteritis nach Bali-Aufenthalt insgesamt sechs verschiedene darmpathogene Erreger isoliert, darunterEntamoeba histolytica, Plesiomonas shigelloides, Campylobacter jejuni, sowie drei verschiedene Salmonellenarten (Salmonella typhi-murium, Salmonella blockley, undSalmonella hadar).

INFLUENCE OF FOSFOMYCIN ON THE INTESTINAL AND PHARYNGEAL FLORA OF MAN

SummaryThe influence of 5 g fosfomycin i. v. every 12 hours on the intestinal and pharyngeal flora was studied in eight healthy, male volunteers. TheEscherichia coli counts were markedly reduced during application and returned to normal in all subjects within a maximum period of 12 days. The total count of Enterococci was reduced by one to two decimal potencies under medication. There was no change in the counts ofBacteroides and anaerobic lactobacteria. No selection ofClostridium difficile was observed. Throughout the study period the pharyngeal flora of all subjects was consistent, and no changes were seen. No selection ofCandida spp. was observed.ZusammenfassungAcht gesunde männliche Probanden erhielten 5 g Fosfomycin i. v. alle 12 Stunden. Untersucht wurde die Zusammensetzung der Darm- und Rachenflora vor, während und nach der Gabe von Fosfomycin. Unter der Gabe kam es zu einer starken Reduktion vonEscherichia coli im Stuhl, mit Normalisierung innerhalb von 12 Tagen. Die Zahl der Enterokokken wurde um ein bis zwei Zehnerpotenzen reduziert. Kein Einfluß wurde auf die Zahl der Bacteriodes oder anaeroben Laktobakterien gesehen. Eine Selektion vonClostridium difficile wurde nicht beobachtet. Während der gesamten Studiendauer wurde keine Veränderung in der Rachenflora festgestellt. Eine Selektion von Hefen wurde ebenfalls nicht beobachtet.

Zur Bewertung der Cand‐Tec‐Latex‐Agglutination Ramco bei disseminierter Candidose

Zusammenfassung:  109 Seren von gesun‐den Probanden, 36 Seren von 32 Patien‐ten mit kulturell nachgewiesenen Candida‐Infektionen, 36 Seren von Patienten mit neoplastischen Erkrankungen und 37 Seren von 34 Personen mit HIV‐Infektion wurden mittels Ramco‐Test auf das Vor‐handensein von Candida‐Antigen unter‐sucht. Lediglich eine Serumprobe von ge‐sunden Probanden war mit einem Titer von 1:4 positiv, diese Probe war auch auf Rheumafaktor positiv. Von den 32 Patienten mit kulturell nachgewiesenen Candida‐Infektionen waren 25 Seren negativ. Bei zwei dieser Patienten mit negativem Antigennachweis lag eine disseminierte Candidose vor. Obwohl klinisch ausge‐prägter Mundsoor vorlag, war bei keinem der Patienten mit HIV‐Infektion der Ag‐glutinationstest positiv. Bevor der Einsatz des Testes routinemäßig empfohlen wer‐den kann, sind weitere Studien erforder‐lich, da ein negativer Ausfall eine invasive Candidose nicht ausschließt.