BACKGROUND:The burden of dengue disease in Germany is a growing public health concern. While travellers to dengue-endemic countries are at increased risk of contracting a dengue infection, data describing dengue-related healthcare utilization and outcomes in Germany are limited. This study investigated the healthcare burden of dengue disease in travellers returning to Germany. METHODS:A retrospective analysis (InGef research database) was used to estimate dengue incidence using anonymized representative data from the German Statutory Health Insurance from approximately 7 million insured persons/year during 2015-23. Outpatient and inpatient healthcare use and dengue associated costs were investigated. RESULTS:From 2015 to 2023, among 10 151 240 insured persons, 887 dengue episodes were recorded. Patients had a median age of 33 years (interquartile range 26-46) and 52% were male. Each year, 103-182 episodes were reported (COVID-19 pandemic period [2020-22]: 10-62). Excluding the pandemic years, incidence was 1.4-2.5/100 000 persons, with an estimated total of 1453-2639 cases/year in Germany. Of the 37% hospitalized persons, 4% required intensive care. Mean hospital stay was 3.3 days; most patients were discharged after 1 overnight stay and no dengue related deaths were reported. Overall, 41% of patients took sick leave during their episode (mean sick leave for hospitalized patients: 8.8 working days); 38% of those not hospitalized took sick leave lasting 6.9 working days on average. Patients with dengue had 2-fold increased healthcare visits, resulting in a 162% increase in costs (mean costs/episode/quarter: 930€) compared with the pre-index period, with these costs mainly driven by outpatient care (23%) and hospitalization (64%). Hospitalized patients had a 4-fold rise in costs (quarterly costs/episode: 1700€; inpatient care accounting for 80%) compared with the pre-index period. CONCLUSIONS:Dengue virus infection in travellers returning to Germany impacted the healthcare system in Germany, leading to high costs, hospitalizations and physician visits and considerable sick leave.

To analyze the associations between adherence to quality indicators (QIs) in the treatment of bloodstream infections caused by methicillin-susceptible Staphylococcus (S.) aureus (MSSA) and in-hospital mortality. A retrospective observational study was conducted in patients admitted between 2019 and 2023 to Hospital St. Georg in Leipzig, Germany, with at least one positive blood culture for S. aureus. Ten QIs were categorized into four groups based on blood culture results, echocardiography, antibiotic treatment, and other parameters such as infectious disease (ID) specialist consultation. Propensity score (PS) matching was used to compare in-hospital mortality between MSSA patients treated with flucloxacillin and those treated with cefazolin. Multivariate Cox regression analysis was performed to determine risk factors associated with in-hospital mortality. Of the 637 patients with S. aureus bloodstream infections, 495 patients with MSSA infection (77.8

An 18-year-old male patient from Ukraine, living in Germany for 2 years, presented with a painless subcutaneous swelling on the left cheek that had been present for several months. Finally, the diagnosis of subcutaneous dirofilariasis caused by Dirofilaria repens was confirmed by 12S rRNA gene PCR and sequencing from tissue by nematode-specific PCRs followed by sequencing after surgical resection of the lesion. Microfilaremia was ruled out and no further treatment was required. Subcutaneous filariasis continues to spread in Central Europe due to climate change, the expansion of vector mosquitoes and the mobility of humans and dogs.

The increasing impact of the climate crisis and further global environmental changes have important consequences for the infection risk posed by vector-borne diseases. This has a particular impact on the temperature-dependent activity and occurrence of ticks in Europe. Changes in the distribution patterns of vectors, coupled with an increased transmission risk due to behavioural factors, result in a rise in tick-borne diseases, including Lyme disease, tick-borne encephalitis (TBE), tularemia, and others. Specifically, rising temperatures and increased humidity favor the proliferation of ticks. The implementation of preventive and surveillance measures regarding tick-borne infectious diseases increasingly becomes a priority of public health.

Metagenomic next-generation sequencing (mNGS) of circulating cell-free DNA from plasma is a hypothesis-independent broadband diagnostic method for identification of potential pathogens. So far, it has only been investigated in special risk populations (e.g. patients with neutropenic fever). To investigate the extent to which mNGS (DISQVER® platform) can be used in routine clinical practice. We collected whole blood specimens for mNGS testing, blood cultures (BC), and pathogen-specific PCR diagnostics. Clinical data and pathogen diagnostics were retrospectively reviewed by an infectious disease expert panel regarding the adjustment of anti-infective therapy. In 55 selected patients (median age 53 years, 67

Reduced lymphocyte counts in peripheral blood are one of the most common observations in acute phases of viral infections. Although many studies have already examined the impact of immune (dys)regulation during SARS-CoV-2 infection, there are still uncertainties about the long-term consequences for lymphocyte homeostasis. Furthermore, as persistent cellular aberrations have been described following other viral infections, patients with “Post-COVID-19 Condition” (PCC) may present similarly. In order to investigate cellular changes in the adaptive immune system, we performed a retrospective analysis of flow cytometric data from lymphocyte subpopulations in 106 patients with confirmed SARS-CoV-2 infection who received medical care at our institution. The patients were divided into three groups according to the follow-up date; laboratory analyses of COVID-19 patients were compared with 28 unexposed healthy controls. Regarding B lymphocyte subsets, levels of IgA + CD27+, IgG + CD27+, IgM + CD27− and switched B cells were significantly reduced at the last follow-up compared to unexposed healthy controls (UHC). Of the 106 COVID-19 patients, 56 were clinically classified as featuring PCC. Significant differences between PCC and COVID-19 convalescents compared to UHC were observed in T helper cells and class-switched B cells. However, we did not detect specific or long-lasting immune cellular changes in PCC compared to the non-post-COVID-19 condition.

BackgroundPost malaria neurologic syndrome (PMNS) is a rare complication of malaria, usually caused by Plasmodium falciparum. The clinical picture is highly variable and ranges from qualitative disturbances of consciousness and psychosis to damage to the peripheral nerves, usually occurring three to eight weeks after treated malaria.Case presentationWe report the case of a 54-year-old male who presented with recurrent clinical symptoms three and a half weeks after severe falciparum malaria. After ruling out recurrent malaria, autoimmune encephalitis was suspected. Corticosteroid therapy led to a rapid improvement of the clinical symptoms. The extended examinations (including cranial MRI and FDG-PET/CT) revealed no pathological findings. Routine serologic autoimmune diagnostics remained negative. However, anti-septin complex antibodies were detected in the serum in a cell-based and a tissue-based immunofluorescence assay. Twelve months after discontinuation of corticosteroid therapy, the patient was free of immunosuppressants and completely asymptomatic.ConclusionTo our knowledge, this is the first case of septin complex autoimmunity with encephalitis associated with PMNS. All physicians treating malaria patients should therefore be aware of this rare condition and consider extended autoimmune diagnostics if routine panels remain unremarkable.

Herpes zoster (HZ) is a sequela of the reactivation of a latent varicella zoster virus (VZV) infection of the sensory dorsal root ganglia and cranial nerves due to a decrease in specific T cell-mediated immunity as a result of immunosenescence, immunodeficiency diseases, e.g., human immunodeficiency virus (HIV) infection or immunosuppressive therapy. The disease burden of HZ greatly increases with age; however, younger patients with, e.g., inflammatory rheumatic diseases, also have an increased risk of HZ, which is higher under certain immunosuppressive drugs, e.g., Janus kinase (JAK) inhibitors or glucocorticoids. The risk of complications, e.g., postherpetic neuralgia (PHN) is also increased in this patient group. Of the two vaccines licensed in Germany, the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute recommends the recombinant adjuvanted HZ subunit vaccine for the standard vaccination of all persons >= 60 years and for persons >= 50 years with an increased HZ risk for prevention of HZ and PNH due to its better efficacy and longer duration of effectiveness. Clinical trials have demonstrated a 90-97% efficacy in preventing HZ in immune healthy adults aged >= 50 years, with a much higher reactogenicity in the vaccine group compared to placebo. Adequate efficacy, immunogenicity and safety have also been demonstrated in clinical trials in immunocompromised and immunosuppressed patients. An extension of the STIKO vaccination recommendation to all adults with an increased HZ risk in line with the approval would be welcome.

Periprosthetic joint infections (PJI) are serious complications after arthroplasty, associated with high morbidity, mortality, and complex treatment processes. The outcomes of different PJI entities are largely unknown. The aim of this study was to access the early outcomes of different PJI entities. A retrospective, single-center study was conducted. The characteristics and outcomes of patients with PJI treated between 2018 and 2019 were evaluated 12 months after the completion of treatment. Primary endpoints were mortality, relapse free survival (RFS) and postoperative complications (kidney failure, sepsis, admission to ICU). A total of 115 cases were included [19.1% early (EI), 33.0% acute late (ALI), and 47.8% chronic infections (CI)]. Patients with ALI were older (p = 0.023), had higher ASA scores (p = 0.031), preoperative CRP concentrations (p = 0.011), incidence of kidney failure (p = 0.002) and sepsis (p = 0.026). They also tended towards higher in-house mortality (ALI 21.1%, 13.6% EI, 5.5% CI) and admission to ICU (ALI 50.0%, 22.7% EI, 30.9% CI). At 12 months, 15.4% of patients with EI had a relapse, compared to 38.1% in ALI and 36.4% in CI. There are differences in patient characteristics and early outcomes between PJI entities. Patients with EI have better early clinical outcomes. Patients with ALI require special attention during follow-up because they have higher occurrences of relapses and postoperative complications than patients with EI and CI.

Following an interseasonal rise in mainly pediatric respiratory syncytial virus (RSV) cases in Germany in 2021, an exceptionally high number of adult cases was observed in the subsequent respiratory season of 2022/2023. The aim of this study was to compare the clinical presentation of RSV infections in the pre- and post-SARS-CoV-2 pandemic periods. Additionally, the local epidemiology of the RSV fusion protein was analyzed at a molecular genetic and amino acid level. RSV detections in adults peaked in calendar week 1 of 2023, 8 weeks earlier than the earliest peak observed in the three pre-pandemic seasons. Although the median age of the adult patients was not different (66.5 vs. 65 years), subtle differences between both periods regarding comorbidities and the clinical presentation of RSV cases were noted. High rates of comorbidities prevailed; however, significantly lower numbers of patients with a history of lung transplantation (p = 0.009), chronic kidney disease (p = 0.013), and immunosuppression (p = 0.038) were observed in the 2022/2023 season. In contrast, significantly more lower respiratory tract infections (p < 0.001), in particular in the form of pneumonia (p = 0.015) and exacerbations of obstructive lung diseases (p = 0.008), were detected. An ICU admission was noted for 23.7% of all patients throughout the study period. Sequence analysis of the fusion protein gene revealed a close phylogenetic relatedness, regardless of the season of origin. However, especially for RSV-B, an accumulation of amino acid point substitutions was noted, including in antigenic site Ø. The SARS-CoV-2 pandemic had a tremendous impact on the seasonality of RSV, and the introduction of new vaccination and immunization strategies against RSV warrants further epidemiologic studies of this important pathogen.

ZusammenfassungDie Medizin in Deutschland steht derzeit vor großen strukturellen und wirtschaftlichen Herausforderungen. Die Infektiologie mit der kürzlich eingeführten Facharztkompetenz in der Inneren Medizin und der für fast alle Facharztgebiete möglichen Zusatzweiterbildung wird einen wichtigen Beitrag zur Bewältigung der Aufgaben leisten. Das fachliche Spektrum der Infektiologie ist sehr breit und grundsätzlich interdisziplinär, was ihren hohen Reiz und hohen Anspruch ausmacht. Die komplexen Inhalte des Faches müssen in kurzer Zeit einer möglichst großen Zahl von Ärztinnen und Ärzten als Facharztkompetenz oder als Zusatzweiterbildung Infektiologie vermittelt werden. Bis dies erreicht ist, werden für eine längere Zeit Übergangslösungen erforderlich sein. Von größter Bedeutung für die weitere Entwicklung des Faches ist die Anpassung der derzeitigen Abrechnungs- und Erlössystematik für infektiologische Leistungen in allen betroffenen Fächern sowie eine verbesserte intersektorale Zusammenarbeit.

BACKGROUND:Timely diagnosis is crucial for sepsis treatment. Current machine learning (ML) models suffer from high complexity and limited applicability. We therefore created an ML model using only complete blood count (CBC) diagnostics.METHODS:We collected non-intensive care unit (non-ICU) data from a German tertiary care centre (January 2014 to December 2021). Using patient age, sex, and CBC parameters (haemoglobin, platelets, mean corpuscular volume, white and red blood cells), we trained a boosted random forest, which predicts sepsis with ICU admission. Two external validations were conducted using data from another German tertiary care centre and the Medical Information Mart for Intensive Care IV database (MIMIC-IV). Using the subset of laboratory orders also including procalcitonin (PCT), an analogous model was trained with PCT as an additional feature.RESULTS:After exclusion, 1 381 358 laboratory requests (2016 from sepsis cases) were available. The CBC model shows an area under the receiver operating characteristic (AUROC) of 0.872 (95% CI, 0.857-0.887). External validations show AUROCs of 0.805 (95% CI, 0.787-0.824) for University Medicine Greifswald and 0.845 (95% CI, 0.837-0.852) for MIMIC-IV. The model including PCT revealed a significantly higher AUROC (0.857; 95% CI, 0.836-0.877) than PCT alone (0.790; 95% CI, 0.759-0.821; P < 0.001).CONCLUSIONS:Our results demonstrate that routine CBC results could significantly improve diagnosis of sepsis when combined with ML. The CBC model can facilitate early sepsis prediction in non-ICU patients with high robustness in external validations. Its implementation in clinical decision support systems has strong potential to provide an essential time advantage and increase patient safety.

Dengue fever is a mostly self-limiting, mosquito-borne viral infection whose distribution area has expanded massively in recent decades. It is one of the most common diagnoses for fever after returning from travel in the (sub)tropics. Since 2023, a new vaccine with good effectiveness has been available, especially for people with previous dengue disease.

ZUSAMMENFASSUNGDie zunehmenden Auswirkungen des Klimawandels und globaler Umweltveränderungen haben erhebliche Konsequenzen für das Infektionsrisiko von vektorübertragenen Erkrankungen. Dies wirkt sich insbesondere auch auf die temperaturabhängige Aktivität und das Vorkommen von Zecken in Europa aus. Veränderungen in den Verbreitungsgebieten der Vektoren, verbunden mit einem gesteigerten Übertragungsrisiko durch verhaltensbedingte Faktoren, führen zu einem Anstieg der durch Zecken übertragenen Erkrankungen, darunter Borreliose, Frühsommer-Meningoenzephalitis (FSME) und Tularämie. Insbesondere steigende Temperaturen und eine Zunahme der Luftfeuchtigkeit begünstigen die Vermehrung von Zecken. Vor diesem Hintergrund ist eine verstärkte Implementierung von Präventions- und Überwachungsmaßnahmen im Kontext zeckenübertragener Infektionskrankheiten von entscheidender Bedeutung.