Showing papers in "Immunität und Infektion in 1995"

Infections in diabetes mellitus

Abstract: Diabetes mellitus is one of the most frequent metabolic distortions predisposing for infectious diseases. Characteristic features of patients with diabetes mellitus are dysfunctions of professional phagocytes, in particular of polymorphonuclear leucocytes. Infections of skin and soft tissue in particular of the lower extremities, rhinocerebral mucormycosis, invasive external otitis and urinary tract infections are typically associated with diabetes mellitus. Frequently, a rapidly progressive infection requires urgent surgical intervention and parenteral antimicrobial therapy. Short-interval metabolic controls, improvement of metabolic functions, extended vaccination and strict hygiene measures are supportive to prevent infections or to reduce a complicated outcome of infections.

[Antioxidants in nutrition and their importance in the anti-/oxidative balance in the immune system].

Abstract: Free radicals and reactive oxygen species can damage cells and tissues of biological organisms. Due to the fact that these compounds are generated continuously in living cells defense mechanisms must exist. This so-called antioxidative system ensures that the formation of free radicals during different physiological processes does not result in cellular damage. Free radicals (oxidants) are produced form the immune system. The purpose of this immune cell products is to destroy invading organisms and damaged tissue. Oxidants enhance IL-1, IL-8 and TNF production in response to inflammatory stimuli. Sophisticated antioxidant defense systems like enzymes or vitamins protect directly and indirectly the host against the damaging influence of oxidants. While endogenous systems can hardly be influenced, exogenous antioxidants, delivered by the diet, can be upregulated in the body. By this way the pro-/antioxidative capacity can be balanced or even unbalanced.

[Coagulase gene polymorphism in Staphylococcus aureus--a new epidemiologic marker].

Abstract: Nosocomial infections with Staphylococcus aureus necessitate the prompt recognition of the infectious chain as well as a rapid investigation and exclusion of infectious sources. Conventional typification procedures (e.g. phage typing) and genotyping methods with pulsed-field gel electrophoresis (PFGE) are labor-intensive and time-consuming and can be performed only in a few laboratories. A new attractive typing technique for S. aureus utilizes the polymorphism of the coagulase (coa) gene as an epidemiological marker. This typing method is performed with primers, homologous to a conserved region within the coa gene, in order to amplify the sequences encoding the C-terminal region of this molecule. Since the number of repetitive sequences varies within the coa gene, the resulting PCR products of individual strains can be of different lengths. We have assessed the coa gene length polymorphism in 150 strains of S. aureus. By the sizes of the PCR products these strains could be categorized into 10 subgroups. AluI restriction analysis of the PCR products resulted in a significantly higher degree of discrimination. Since the repeated sequences, consisting of 81 base pairs, possess a high variability of the nucleotides, a characteristic restriction fragment length polymorphism (coa-RFLP) pattern is yielded. Overall, we could distinguish 64% of the clinical isolates by RFLP analysis; in strains sharing identical antibiograms, 56% could be distinguished. 46% oxacillin-resistant strains, some of which originated from epidemic outbreaks, could be discriminated by their RFLP pattern. Comparing these results with those obtained from the PFGE method, isolates which differed by their coagulase gene RFLP also differed by their PFGE patterns.(ABSTRACT TRUNCATED AT 250 WORDS)

[Susceptibility to infections in diabetes--effects on metabolism].

Abstract: Diabetic patients suffer from recurrent episodes of infections. The cellular and the humoral elements of the defense system against germ invasion are disturbed by the diabetic metabolism. Neuropathy and vascular damage promote the development of wounds and inhibit their healing. Altered motility of the gastrointestinal and the urinary tract lead to increased penetration of bacteria even there. Rare bacteria, atypical courses and frequent complications of infections result in delayed diagnosis and therapy. Dehydration, electrolyte disturbances, malnutrition, and reduced general conditions even increase susceptibility to an infection. On the other hand, an infection deteriorates the metabolic situation in diabetes, resulting in the need for higher insulin doses, or insulin injections in patients normally on oral medication. Altered every-day-life with modified food intake and reduced physical activity complicate diabetes therapy. Neuropathy, angiopathy, retinopathy, nephropathy and other diabetic complications can be triggered and aggravated during the course of an infection. To disrupt this vitious circle of hyperglycemia enforcing infections, which then raise blood glucose, it is necessary to know about the characteristic features of the interactions of diabetes and infection.

[Actinomycetes canaliculitis--case reports].

Abstract: Canaliculitis is a relatively rare dacryocanal infection which occurs most unilateral. It can easily be misinterpreted and not sufficiently treated. Typical agents of the canaliculitis are actinomyces, that can cause infections of the hollow spaces with formation of concrements. The clinical courses of two patients are shown. One of them was treated for a dacryocystitis for 3 years and the other one had been referred to the eye hospital for chalazion removal. Only a microbiologic examination including cultivation of the surgically obtained dacryolithes and secretion enabled us to a reliable proof of the actinomyces and to an appropriate therapy for canaliculitis.

Immunologic therapy for glomerulonephritis with combined immunoadsorption and IVIG therapy

Abstract: Immunoadsorption is an improvement of extracorporeal therapy which differs from plasmapheresis. After plasma perfusion on a special adsorption filter the patient's plasma is reinfused. Meanwhile more than 270 immunoadsorptions have been performed. 7 patients with SLE and glomerulonephritis as well as 3 patients suffering from Wegener's vasculitis and glomerulonephritis had been treated with combined immunoadsorption and IVIG therapy. After three sessions of immunoadsorption (2-3 1 plasma filtrate) the patients received 10 g 7S-immunoglobulin infusions on three consecutive days. Patients with SLE and end-stage kidney involvement (2 patients) did not show any benefit by the above mentioned treatment regimen. Patients with Wegener's vasculitis and glomerulonephritis showed no significant improvement, except in one of three patients who showed a remarkable decrease in proteinuria. On the other hand, patients with SLE and "moderate" kidney involvement (short course of disease, no fixed structural changes) showed improvement on combined immunoadsorption and IVIG therapy.

[Pentoxifylline inhibits secretion of O2- and TNF-alpha by alveolar macrophages in patients with sarcoidosis].

Abstract: Reactive oxygen species (ROS) and cytokines like tumor necrosis factor-alpha (TNF-alpha) play a crucial role as inflammatory mediators in pulmonary sarcoidosis We examined the antiinflammatory effect of pentoxifylline (POF) on alveolar macrophages (AM) of patients with sarcoidosis in vitro We could demonstrate that POF (above 410(-4) M) inhibited the secretion of superoxide anion and TNF-alpha by AM in a dose-dependent manner via a prostaglandin synthesis-dependent mechanism that was independent of the glucocorticoid receptor POF is an interesting immunomodulating substance that should be further evaluated in clinical trials

Cat scratch disease caused by Bartonella henselae

Abstract: Bartonella henselae is an etiologic agent of cat-scratch disease and, in immunocompromised patients, of bacillary angiomatosis and other severe syndromes. Cat-scratch disease usually presents as lymphadenopathy, which resolves spontaneously within 2-4 months. The utility of antibiotic therapy remains controversial. In Tyrol four cases of human cat-scratch disease were diagnosed in children in 1994, yielding a prevalence of 0.7/100,000 per year. A 3-year-old boy had lymphadenitis coli since one year despite antituberculosis therapy which was initiated because of the histopathological picture and a positive tuberculin reaction (despite negative mycobacteria-cultures and -PCR). Two girls, age 9 and 13 years, had lymphadenitis at upper or lower extremities after cat-scratches from kittens. A 13-year-old boy presented with febrile illness and right hip pain, computer tomography revealed an osteolytic lesion; symptoms subsided within 3 weeks. Diagnosis of cat-scratch disease is based on cat contact, negative studies for other similar diseases, characteristic histopathologic features (if available), and results of an indirect immunofluorescence test (antigen: Houston-1 isolate, ATCC 49882). We believe that the availability of this serological test will increase the number of diagnosed cases of human Bartonella henselae infections.

[Intestinal vasculitis and glomerulonephritis in hepatitis C- associated cryoglobulinemia].

Abstract: In a 53-year-old female patient with recurrent, sometimes bloody diarrhea, the long standing diagnosis of an ANA-negative lupus erythematosus with membranoproliferative glomerulonephritis, leucocytoclastic vasculitis and chronic hepatitis was ruled out and the diagnosis of a hepatitis C associated cryoglobulinaemia was established. The origin of the diarrhea was due to intestinal vasculitis as a result of cold food or beverages.

Defects in the immunoglobulin producing cells in bone marrow of patients with variable immunodeficiency syndrome

Abstract: The number of plasma cells, IgG+, IgA1+, IgA2+ and IgM+ cells were determined in bone marrow (BM) biopsies of 12 patients with common variable immunodeficiency syndrome (CVID) and 12 controls without signs of immunodeficiency. Controls had a median of 11 plasma cells/mm2, 76 IgG+, 76 IgA+ and 18 IgM+ cells/mm2 BM, respectively. Compared with the control group, the CVD patients showed a significant reduction of each cell type (p < 0.001). They also demonstrated a close correlation between low numbers of IgG+ and IgA+ cells in the BM and low IgG and IgA serum levels. In general, there was also a good correlation of the IgM+ cells and the respective IgM levels in the serum, except 2 CVID patients with normal IgM serum levels and subnormal numbers of IgM+ cells in the BM. Our results showed that there was an almost complete coincidence between the reduced numbers of Ig-producing cells in the BM and low serum levels of the respective Ig isotype. Thus, immunohistological analysis may be of additional help for the diagnosis of immunodeficiency.

The effect of the complement system on the acute reversible rejection of kidney transplants

Abstract: Although the involvement of complement in hyperacute renal allograft rejection is well established, its possible implication in acute reversible and chronic graft rejection remains uncertain. In recent clinical studies with a total of 83 patients undergoing renal transplantation, plasma levels of complement activation products were elevated 4-7 days before clinical diagnosis of graft rejection. Immunohistochemical analysis of biopsies revealed local complement activation with glomerular deposition of the terminal C5b-9 complex within 1 h after organ reperfusion. Increasing levels of complement activation products, preceding the clinical manifestation of renal graft rejections may be of diagnostic value in recognizing patients at risk.

[T-cell rich B-cell lymphoma: diagnosis, differential diagnosis, and classification of two representative cases].

Abstract: Two post mortem examinations from the Institute of Pathology, Albert-Ludwigs-University of Freiburg, will be presented. In both cases diagnosis of a T-cell-rich B-cell-lymphoma was first established after necropsy and evaluation of the immunohistochemical results. In the first case a peripheral T-cell-lymphoma was diagnosed after a peripheral T-cell-marker test. A liver biopsy showed suspicion of a Hodgkin-lymphoma. In the second case a biopsy of an extended retroperitoneal tumor showed a centroblastic non-Hodgkin-lymphoma 3 weeks before death. By autopsy we found in both cases a wide infiltration with small monomorphic lymphocytes. Less than 20% of the infiltrate consisted of polymorphous blasts with a wide morphologic range and prominent nucleoli. Immunohistochemistry showed the blasts to be CD20-positive, while the small monomorphic lymphocytes expressed the CD3 marker. In the first case kappa-light-chain-restriction was shown in the blasts by immunohistochemistry. Differential diagnosis difficulties, diagnostic criteria, prognosis and classification of these cases in the common non-Hodgkin-lymphoma classification will be discussed in view of the current literature.

Theory and practice of macrorestriction analysis for the clonal analysis of pathogens

Abstract: The macrorestriction analysis of bacterial genomes is a method that is generally applicable to the typing of bacteria. The chromosome is cleaved with a restriction endonuclease that cuts infrequently and subsequently separated by pulsed-field gel electrophoresis. The fragment pattern defines the genotype of the strain. The relatedness of strains is evaluated from the similarity of the fragment patterns. The quantitative comparison of fragment patterns allows the definition of the infrasubspecific rank of a clone. Macrorestriction analysis is a sensitive and specific method to trace the origin and spread of infections and to analyse the clonal structure of bacterial populations.

Schutzimpfung gegen Tuberkulose: Neue Vakzinierungsstrategien oder gibt es eine Alternative zu BCG?

Abstract: Consistently high tuberculosis rates in many developing nations, the surprising increase in tuberculosis cases in numerous industrialized countries, together with the emergence of multi-drug-resistant strains of Mycobacterium tuberculosis have sharpened public interest in this ancient scourge Improved tuberculosis control could best be achieved by an efficacious vaccine The available attenuated vaccine strain, Mycobacterium bovis BCG, has only limited efficiency This vaccine is capable of protecting against disseminated miliary tuberculosis in the newborn, but it is unable to prevent stable infection and to cause sterile pathogen eradication Hence, adult tuberculosis, representing the majority of all tuberculosis cases, is not preventable by BCG vaccination Due to the extraordinarily high rate of asymptomatic M tuberculosis infection (1/3 of the total world population) any novel vaccination strategy has to fulfil two major tasks: first, prevention of stable infection, second, eradication of already established infection T lymphocytes represent the major target for any vaccine strategy, because they serve as central mediators of acquired immunity They segregate into distinct populations, characterized by different activation conditions and biological functions These T cell populations do not act independently from, but rather interact with, each other mostly through cytokines Although CD4 T lymphocytes of T helper 1 type are essential for protection, CD8 T cells expressing cytolytic functions are required, in addition Perhaps other T cell populations, such as gamma/delta T cells and double negative alpha/beta T cells, also participate An effective vaccine has to stimulate the precise combination of T cells and cytokines required for the different tasks It remains to be clarified in how far this can be achieved by a single vaccine

Pathogenesis of idiopathic pulmonary fibrosis

Abstract: Idiopathic pulmonary fibrosis or lone cryptogenic fibrosing alveolitis is an interstitial lung disease of unknown origin carrying an unfavorable prognosis. A yet unidentified hazard triggers a chronic inflammatory infiltration of the lung parenchyma characterized by an accumulation of alveolar macrophages, neutrophil and eosinophil granulocytes, and lymphocytes. Cytokines released by the activated cells modulate the inflammatory events. Oxidants and proteases, mainly released by alveolar macrophages and neutrophil granulocytes, mediate the injury to the lung parenchyma, leading to loss of alveolar-capillary units. The ensuing repair process, mesenchymal cell proliferation and up-regulation of synthesis of collagen fibers and other components of connective tissue matrix, replaces lung parenchyma by fibrotic tissue, leading to irreversible pulmonary dysfunction.

B-Streptokokken-Screening mittels GBS-Medium in der Gebrutshilfe

Abstract: Pregnant women and newborn infants were screened for group B streptococcal (GBS) colonization by obtaining paired swabs from the cervix and urethra for the former group and from the ear, nose, umbilical cord, gastric juice and membranes for the latter. One swab was cultured on blood agar; the other was inoculated into serum-starch broth (GBS medium), which allows identification of GBS by production of a characteristic orange-colored pigment. From the 2105 paired swabs obtained, a total of 158 were GBS positive by either method; of these, 154 (97.5%) were recovered by the GBS medium and 89 (56.3%) by blood agar plate. No false positive color reactions were observed with GBS medium. 75% of the positive GBS media could be read within 24 h of incubation. The use of GBS medium proved to be an easy and reliable method for screening of maternal and neonatal GBS colonization.

Efficacy of acellular pertussis vaccines

Abstract: Acellular vaccines against pertussis could be developed because various virulence factors of B. pertussis have been characterized. Acellular pertussis vaccines should retain the efficacy but have lower side effects, as compared to the conventional whole-cell vaccine. Lacking any correlate of antibacterial resistance, the efficacy of the vaccines had to be tested in large field trials. Such trials have been conducted and are being conducted in various European and in one African country. These trials used different designs, and various different vaccines were tested. All available efficacy data show that acellular pertussis vaccine can effectively protect against typical pertussis. It also seems probable that the efficacy of vaccines, which contain more than two pertussis components may be better than a vaccine containing pertussis toxoid or pertussis toxoid with filamentous hemagglutinin. A three-component acellular pertussis vaccine has been licensed for use in primary vaccination in infants in Germany in early 1995.

Reactive oxygen species and arachidonic acid metabolites of polymorphonuclear leukocytes

Abstract: The activation of polymorphonuclear leukocytes by stimulants from host or parasites leads to various metabolic processes and to enhanced oxygen uptake. Oxygen is enzymatically processed to from reactive oxygen compounds and metabolites of arachidonic acid which are involved in killing of microbial pathogens and influence many processes in inflammation. Their activities are regulated intracellularly by antioxidants. A lack or exhaustion of these systems may lead to cell and organ damage in which DNA, proteins, lipids and sugars may be involved. Antioxidants and inhibitors of the arachidonic acid metabolism are applied to reduce these pathological changes. An essential aspect of microbial pathogenicity is the multifold modification of the formation of reactive oxygen compounds and arachidonic acid metabolites.

[Panarteritis nodosa with kidney and spleen rupture: diagnostic and therapeutic possibilities].

Abstract: Classic polyarteritis nodosa is a necrotizing vasculitis affecting medium- and small-sized arteries. Renal involvement from aneurysm formation is common and can result in perirenal or intrarenal bleeding. The gold standard of diagnostic procedures is the arteriography. Treatment of choice is a combination of steroids and cyclophosphamide, but in the case of severe hemorrhage surgery is mandatory. Patients with PAN need at least 2 years of long-term therapy; repeated arteriography will establish the efficacy of therapy.

[Dermatomyositis as a complication of a metastatic melanoma-- case report and review of the literature].

Abstract: In nearly 60% of men over 50 years of age, dermato-/polymyositis is induced by malignancies. Till now, 9 patients with melanoma-induced dermatomyositis have been reported in the literature. Here we report on a patient suffering from classic pelvic and pectoral girdle proximal weakness, typical heliotrope rash, increased serum CPK values, and biopsy-proven myositis, who died from metastasizing melanoma one year later.

Normal synoviocytes and synoviocytes from osteoarthritis and rheumatoid arthritis bind extracellular matrix proteins differently

Abstract: Extracellular matrix proteins are increased in inflammatory synovitis. We showed previously that the in situ expression of the corresponding extracellular matrix receptors (beta 1-integrins) is enhanced in synoviocytes (SC) of synovitis of different etiology (16). To investigate the adhesion of SC to extracellular matrix proteins, we examined the attachment of SC from normal and inflamed synovia to fibronectin, tenascin, laminin and collagen type IV. Compared to normal SC and SC of osteoarthritis, SC of rheumatoid arthritis showed an increased binding to tenascin, laminin, fibronectin and collagen type IV, suggesting a distinctive interaction of SC and extracellular matrix proteins in rheumatoid arthritis. Furthermore, the increased binding of SC of rheumatoid arthritis to extracellular matrix proteins may play a role in tissue remodelling associated with rheumatoid arthritis.

[Activation-dependent expression of Fc gamma-receptors on glomerular mesangial cells].

Abstract: Resting, non-cycling mesangial cells (MCs) can be induced by IFN gamma to express the Fc gamma-RIIIa and Fc epsilon RI-gamma subunits of the CD16TM receptor complex After cell surface expression of CD16TM by IFN gamma induction the binding of immune complexes to MCs induces IL-6 secretion A Fc epsilon RI-gamma gene knockout has recently been described It is now possible to study the function of Fc gamma RIIIa and other gamma chain associated Fc receptors in the initiation and progression of chronic glomerular inflammation in the context of the intact immune system in vivo

Lung function and prevalence of irritation of eyes and respiratory airways on days with elevated ozone concentrations

Abstract: In order to evaluate potential health effects on days with elevated ozone concentrations, lung function parameters and subjective votes on irritations of eyes and airways were taken repeatedly from subjects belonging to four assumed ozone risk groups and one control group (at least 40 subjects each) - senior citizens, juvenile asthmatics, forestry workers, athletes and clerks - in comparison of days with elevated (at least 100 micrograms/m3) and low ozone concentrations (at most 80 micrograms/m3). The results show no relevant ozone effects for the groups, "senior citizens" and "athletes", only minor pulmonary effects for "juvenile asthmatics", but significantly higher airway resistances on "ozone days" for "forestry workers" (by 21%) and "clerks" (by 16%). On days with moderately elevated levels of ozone in the environment it is assumed that ozone itself has minor influence on pulmonary responses compared to that of other constituents of the air in certain location like forest or indoors.

[Pathogenesis of interstitial pulmonary changes with collagen diseases--therapeutic implications].

Abstract: Autoantibodies, immune complexes and autoreactive lymphocytes represent the initial steps in the pathogenic events leading to interstitial pulmonary manifestations of collagen vascular diseases Vascular damage caused by deposition of immune complexes in the vascular wall and chemotactic factors result in an influx of neutrophils and mononuclear cells leading to inflammatory phenomena like vasculitis and alveolitis Finally, persistent activation of lung fibroblasts may result in interstitial pulmonary fibrosis characterized by nearly identical histopathological findings independent of the underlying disease Several inflammatory mediators, eg cytokines, are markedly involved in the regulation of different pathogenic mechanisms Furthermore, different pathogenic mechanisms exert variable roles depending on the specificity of the underlying disease Therefore, disease-specific effective pharmacotherapy, which in most cases will be a combination therapy, has to take into consideration not only the predominant pathogenic mechanisms but also drug-specific efficacy

Immunopathogenesis of extrinsic allergic alveolitis

Abstract: Inhalation of a variety of organic dusts may cause the onset of hypersensitivity pneumonitis (HP) finally leading to irreversible pulmonary fibrosis in some individuals. So far, the pathogenesis of HP remains partially unclear. Besides patient-related factors this is probably attributable to the complex composition of the causative dusts: in addition to specific antigens that may induce type III and type IV reactions they contain a variety of additional components like particles and toxins with the ability to promote several antigen-independent reactions. During an acute episode of HP a marked alveolitis dominated by polymorphonuclear cells develops. As we showed these polymorphonuclear cells are in an activated state and may therefore cause pronounced damage in the lung interstitium. Based on these and other findings we believe that polymorphonuclear cells are of predominant importance for the pathogenesis of HP.

[Antimicrobial oligopeptides--an important factor in non-specific defense against infection].

Abstract: For survival of plants, animals as well as main in a nature full of aggressive microbes, endogenous antibiotics play an essential role, which is not yet fully appreciated in medicine and science. For example in the granules of polymorphonuclear granulocytes and macrophages or even of specialized epithelial cells such as Paneth cells in the crypts of the intestinal mucosa, oligopeptides are produced with a wide range of antimicrobial activity. According to their chemical structures and modes of action they can be grouped into various different families. The physiological role of these agents on the surface of skin and mucosa or within host tissue is only incompletely understood.

Experimental therapy of hypoplastic paroxysmal nocturnal hemoglobinuria

Abstract: Paroxysmal nocturnal hemoglobinuria (PNH) and aplastic anemia are associated either as a PNH-aplasia syndrome or the emergence of glycosylphosphatidylinositol-(GPI)deficient blood cells in patients with severe aplastic anemia (SAA). It could be demonstrated that SAA patients with GPI-deficient cells in comparison to those without have a worse response to classical immunosuppressive therapy. Therefore, we treated a female PNH patient with severe thrombocytopenia, anemia and granulopenia with G-CSF and cyclosporine. Within 8 weeks, a trilineage response of hematopoiesis was observed. In addition, the proportion of normal to GPI-deficient granulocytes and monocytes increased significantly.

Rational use of antimycotics against yeast infections

Abstract: In clinical medicine mere colonization with yeasts is often hardly to be discriminated from true infection. Thus, a clear-cut separation of preventive from therapeutic use of antimycotics is not possible in practical medicine. The problem is that on the one hand one has no exact diagnosis of yeast infection, but on the other hand best therapeutic results are obtained when the drugs are given as early as possible. In comparison to the huge number of antibacterial compounds, the members of antimicrobials are limited. For prophylaxis, one can use the polyenes, such as amphotericin B and nystatin, or the azoles, such as fluconazole or itraconazole. Thereby the azoles act not only locally at the site of application but are absorbed and thus are distributed to remote sites, where the non-resorbable polyenes never arrive. Among the azoles, fluconazole has the advantage that resorption is independent from an acid pH in the stomach, whereas itraconazole resorption is variable in severely ill persons with neutralized gastric fluid. For therapeutic use systemically applied amphotericin B has certain disadvantages. Because of toxic reactions an optimal dose cannot be given; furthermore in some sites insufficient concentrations are achieved, particularly in the kidney and also in the CSF. In contrast, the azoles possess better pharmacologic and toxicologic properties. Resistance to antimycotics is principally possible but still rare, so that in practice a routine testing is not necessary. Candida glabrata as well as Candida krusei are primarily resistant to fluconazole.