Background. Giardiasis failing nitroimidazole first-line treatment is an emerging problem in returning European travelers. We present data on the efficacy and tolerability of 2 second-line treatment regimens. Methods. This prospective, open-label, multicenter study assessed the efficacy and tolerability of quinacrine monotherapy (100 mg 3 times per day for 5 days) and albendazole plus chloroquine combination therapy (400 mg twice daily plus 155 mg twice daily for 5 days) in nitroimidazole-refractory giardiasis. The defined end points were the clinical outcome, assessed at week 5 after treatment and the parasitological outcome, assessed using microscopy of 2 stool samples, >= 2 to <= 5 weeks after treatment. Results. A total of 106 patients were included in the study. Quinacrine achieved clinical and parasitological cure in 81% (59/73) and 100% (56/56), respectively. Albendazole plus chloroquine achieved clinical and parasitological cure in 36% (12/33) and 48% (12/25), respectively. All patients (9/9) who clinically and parasitologically failed albendazole plus chloroquine treatment and opted for retreatment with quinacrine achieved clinical cure. Mild to moderate treatment-related adverse events were reported by 45% and 30% of patients treated with quinacrine and albendazole plus chloroquine, respectively. One patient treated with quinacrine developed severe neuropsychiatric side effects. The majority of nitroimidazole-refractory Giardia infections (57%) were acquired in India. Conclusions. Quinacrine was a highly effective treatment in nitroimidazole-refractory giardiasis, but patients should be cautioned on the low risk of severe neuropsychiatric adverse event. Albendazole plus chloroquine had a low cure rate in nitroimidazole-refractory giardiasis. Nitroimidazole-refractory giardiasis was primarily seen in travelers returning from India.

2019-nCoV Transmission from Asymptomatic Patient In this report, investigators in Germany detected the spread of the novel coronavirus (2019-nCoV) from a person who had recently traveled from China...

2019-nCoV Transmission from Asymptomatic Patient In this report, investigators in Germany detected the spread of the novel coronavirus (2019-nCoV) from a person who had recently traveled from China...

Fever is the leading cause of paediatric outpatient consultations in Sub-Saharan Africa. Although most are suspected to be of viral origin, a putative causative pathogen is not identified in over a quarter of these febrile episodes. Using a de novo assembly sequencing approach, we report the detection (15.4%) of dicistroviruses (DicV) RNA in sera collected from 692 febrile Tanzanian children. In contrast, DicV RNA was only detected in 1/77 (1.3%) plasma samples from febrile Tanzanian adults, suggesting that children could represent the primary susceptible population. Estimated viral load by specific quantitative real-time RT-PCR assay ranged from < 1.32E3 to 1.44E7 viral RNA copies/mL serum. Three DicV full-length genomes were obtained, and a phylogenetic analyse on the capsid region showed the presence of two clusters representing tentative novel genus. Although DicV-positive cases were detected throughout the year, a significantly higher positivity rate was observed during the rainy season. This study reveals that novel DicV RNA is frequently detected in the blood of Tanzanian children, paving the way for further investigations to determine if DicV possibly represent a new agent in humans.

The intracellular pathogen Rickettsia felis causes flea-borne spotted fever and is increasingly recognized as an emerging cause of febrile illness in Africa, where co-infection with Plasmodium falciparum is common. Rickettsiae invade endothelial cells. Little is known, however, about the early immune responses to infection. In this study, we characterize for the first time the cytokine profile in the acute phase of illness caused by R. felis infection, as well as in plasmodial co-infection, using serum from 23 febrile children < 15 years of age and 20 age-matched healthy controls from Ghana. Levels of IL-8 (interleukin-8), IP-10 (interferon-γ-induced protein-10), MCP-1 (monocyte chemotactic protein-1), MIP-1α (macrophage inflammatory protein-1α) and VEGF (vascular endothelial growth factor) were significantly elevated in R. felis mono-infection; however, IL-8 and VEGF elevation was not observed in plasmodial co-infections. These results have important implications in understanding the early immune responses to R. felis and suggest a complex interplay in co-infections.

ZusammenfassungDie stark gestiegenen Zahlen von Menschen auf der Flucht stellen insbesondere deutsche Großstädte vor Herausforderungen. Im Jahr 2015 meldeten sich in Hamburg 40 868 Schutzsuchende, von denen 22 315 aufgenommen wurden. Ziel der medizinischen Grundversorgung ist es, auf die besonderen gesundheitlichen Risiken und Bedürfnisse der Asylsuchenden einzugehen und gleichzeitig einen möglichst raschen Übergang in das Regelsystem zu ermöglichen. Öffentliche Stellen, Hilfsorganisationen und die Zivilgesellschaft arbeiten dazu Hand in Hand. In allen Hamburger Erstaufnahmeeinrichtungen werden von Übersetzern begleitete medizinische Sprechstunden in voll ausgestatteten Arztpraxiscontainern angeboten. Pro 1 000 Asylsuchenden stehen ein Arzt und eine medizinische Assistenzkraft vollzeitig zur Verfügung. Neben Honorarkräften beteiligen sich auch Mitarbeiter vertraglich eingebundener Krankenhäuser an der Versorgung. Die systematische Erhebung von Daten über den Gesundheitszustand der Asylsuchenden sowie die Stärkung des Öffentlichen Gesundheitsdienstes sind Schlüsselfaktoren, um die Versorgung zukünftig zu planen und zu verbessern. Die Schaffung eines gesünderen Lebensumfeldes und der Zugang zum medizinischen Regelsystem bieten die Chance, eine erfolgreiche Integration der Asylsuchenden in die Gesellschaft zu unterstützen.

Rickettsial infections are an underrecognized cause of febrile illness in sub-Saharan Africa. To evaluate the epidemiology and clinical features of rickettsial disease in pediatric patients in Ghana, we screened blood samples from febrile children aged less than 15 years presenting to an outpatient department in Ghana's Ashanti Region for the presence of rickettsial DNA. We detected Rickettsia felis in 7/470 (1.5%) blood samples, using two independent real-time polymerase chain reactions. No other Rickettsia species were found. R. felis was detected repeatedly in one patient, and coinfection with Plasmodium falciparum was found in 3/7 samples. Symptoms apart from fever included cough (6/7) and vomiting (4/7). None of the R. felis-positive patients reported a rash. This study is the first report on R. felis in Ghana and adds to the growing evidence for its widespread occurrence with and without malaria coinfection in sub-Saharan Africa.

The massive increase in the number of refugees represents a great challenge to German cities. In Hamburg, 40 868 asylum seekers were registered in 2015, of which 22 315 remained in the city. The goal of the health administration is to provide primary medical care in response to specific health risks and needs of refugees while allowing them to be swiftly integrated into the standard health care system. Public authorities, charities and civil society are working hand in hand. In all reception centres in Hamburg, medical consultations with translation services are offered in fully equipped medical container practices. For every 1 000 refugees, a full-time doctor and a medical assistant are available. In addition to contractual staff, employees of contractually integrated hospitals are participating in the provision of medical care. Systematic collection of data on the health condition of the refugees as well as strengthening public health services are key factors in the planning and improvement of services in the future. Healthier living conditions and access to the standard health care system provide an opportunity to facilitate successful integration of refugees into society.

Background: Malaria incidence has declined considerably over the last decade. This is partly due to a scale-up of control measures but is also attributed to increasing urbanization. This study aimed to analyse the association between malaria and urbanization and the effect of urbanicity on the acquisition of semi-immunity.Methods: In 2012, children with fever presenting to St Michael's Hospital Pramso/Ghana were recruited. The malaria-positive-fraction (MPF) of fever cases was calculated on community-level to approximate the malaria risk. The mean age of malaria cases was calculated for each community to estimate the acquisition of semi-immunity. The level of urbanicity for the communities was calculated and associations between MPF, urbanicity and immunity were modelled using linear regression.Results: Twenty-six villages were included into the study with a mean MPF of 35 %. A linear decrease of 5 % (95 % CI: 4-6 %) in MPF with every ten-point increase in urbanicity was identified. The mean age of malaria patients increased by 2.9 months (95 % CI: 1.0-4.8) with every ten-point increase in urbanicity.Discussion: The results confirm an association between an increase in urbanicity and declining malaria risk and demonstrate that the acquisition of semi-immunity is heterogeneous on a micro-epidemiological scale and is associated with urbanicity.

Die medizinische Versorgung von Flüchtlingen, Asylbewerbern und Menschen mit ungeregeltem Aufenthaltsstatus stellt in Anbetracht der aktuellen Flüchtlingszahlen eine vordringliche Aufgabe unseres Gesundheitssystems dar. Während Gesundheitsleistungen für die genannten Personengruppen in vielen Bundesländern staatlichen Einschränkungen unterliegen, bekommen Flüchtlinge in Hamburg eine Versichertenkarte und damit Zugang zur Regelversorgung. In der Praxis ist eine adäquate medizinische Betreuung dennoch nicht immer einfach zu realisieren. Anhand einer Fallserie zeigen wir, dass Zugangsbarrieren weiterhin auf vielen Ebenen existieren. Neben der systematischen Darstellung dieser Barrieren stellen wir Lösungsansätze vor, die dazu beitragen können, den Zugang zum Gesundheitssystem zu verbessern und eine adäquate medizinische Versorgung sicherzustellen.

As the number of refugees rises, medical care for refugees, asylum seekers and people with unclear residence status becomes a priority task for our health system. While access to health care is restricted for these groups of people in many German states, Hamburg provides unrestricted access to healthcare for refugees by handing out health insurance cards on arrival. Daily practice shows, however, that adequate medical care is still not always easy to achieve. In this case series we demonstrate that barriers to health care still exist on many levels. We discuss these barriers and further propose strategies to improve and to secure access to adequate health care.

Systemische bakterielle Infektionen tragen substantiell zur kindlichen Morbiditat und Mortalitat in Subsahara-Afrika bei. Ziel dieser Studie ist es, den Einfluss soziogeographischer und soziookonomischer Faktoren auf das Risiko und Erregerspektrum systemischer bakterieller Infektionen bei Kindern in Ghana zu untersuchen. Kinder unter 15 Jahren, die sich mit Fieber ≥ 38°C in einem Krankenhaus in der peri-urbanen Zone der ghanaischen Grosstadt Kumasi vorstellten, wurden in die Studie eingeschlossen. Es erfolgte eine Blutentnahme zur Malariadiagnostik und Bakterienkultur. Der soziookomimischen Status der Patienten wurde mittels Hauptkomponentenanalyse berechnet. Zur Messung des Urbanitatsgrades des Wohnortes wurde eine numerischen Skala verwendet, die Schlussel-Charakteristika des stadtischen/landlichen Siedlungsraumes quantifiziert. In der anschliesenden Fall-Kontroll-Analyse wurden Patienten mit Bakteriamie als Falle und Patienten ohne Bakteriamie entsprechend als Kontrollen definiert. Es wurden 2.306 Krankenhauskonsultationen in die Analyse eingeschlossen. Bei 72 (3,1%) Probanden wurde eine Bakteriamie festgestellt. Nicht-typhoide Salmonellen (NTS; n = 24; 33.3%) und Salmonella Typhi (n = 18; 25.0%) waren die haufigsten Isolate. In der logistischen Regression war Bakteriamie negativ mit Urbanitat (Odds ratio [OR] = 0.8; 95% Konfidenzintervall [KI]: 0.7–1.0) und soziookonomischem Status (OR = 0.8; 95% KI: 0.6–0.9) assoziiert. Beide Assoziationen waren starker, wenn nur Falle mit NTS-Bakteriamie in die Analyse eingingen (OR = 0.5; 95% KI: 0.3–0.8 und OR = 0.6; 95% KI: 0.4–1.0). Die Ergebnisse der Studie verdeutlichen die wichtigen Einfluss individueller und gesellschaftlicher Faktoren auf das Risiko systemischer bakterieller Infektionen – und besonders systemischer NTS-Infektionen – bei Kindern in Ghana.

Zusammenfassung Die medizinische Versorgung von Flüchtlingen, Asylbewerbern und Menschen mit ungeregeltem Aufenthaltsstatus stellt in Anbetracht der aktuellen Flüchtlingszahlen eine vordringliche Aufgabe unseres Gesundheitssystems dar. Während Gesundheitsleistungen für die genannten Personengruppen in vielen Bundesländern staatlichen Einschränkungen unterliegen, bekommen Flüchtlinge in Hamburg eine Versichertenkarte und damit Zugang zur Regelversorgung. In der Praxis ist eine adäquate medizinische Betreuung dennoch nicht immer einfach zu realisieren. Anhand einer Fallserie zeigen wir, dass Zugangsbarrieren weiterhin auf vielen Ebenen existieren. Neben der systematischen Darstellung dieser Barrieren stellen wir Lösungsansätze vor, die dazu beitragen können, den Zugang zum Gesundheitssystem zu verbessern und eine adäquate medizinische Versorgung sicherzustellen.

BackgroundSystemic bacterial infections are a major cause of paediatric febrile illness in sub-Saharan Africa. Aim of this study was to assess the effects of social and geographical determinants on the risk of bacteraemia in a rural-urban transition zone in Ghana.MethodsChildren below 15 years of age with fever were recruited at an outpatient department in the suburban belt of Kumasi, Ghana's second largest city. Blood was taken for bacterial culture and malaria diagnostics. The socio-economic status of participants was calculated using Principle Component Analysis. A scale, based on key urban characteristics, was established to quantify urbanicity for all communities in the hospital catchment area. A case-control analysis was conducted, where children with and without bacteraemia were cases and controls, respectively.ResultsBacteraemia was detected in 72 (3.1%) of 2,306 hospital visits. Non-typhoidal Salmonella (NTS; n = 24; 33.3%) and Salmonella typhi (n = 18; 25.0%) were the most common isolates. Logistic regression analysis showed that bacteraemia was negatively associated with urbanicity (odds ratio [OR] = 0.8; 95% confidence interval [CI]: 0.7-1.0) and socio-economic status (OR = 0.8; 95% CI: 0.6-0.9). Both associations were stronger if only NTS infections were used as cases (OR = 0.5; 95% CI: 0.3-0.8 and OR = 0.6; 95% CI: 0.4-1.0, respectively).ConclusionsThe results of this study highlight the importance of individual as well as community factors as independent risk factors for invasive bacterial infection (IBI) and especially NTS. Epidemiological data support physicians, public health experts and policy makers to identify disease prevention and treatment needs in order to secure public health in the transitional societies of developing countries.