Gastrointestinale Infektionen werden überwiegend fäkal-oral über kontaminierte Nahrungsmittel, in Ländern mit geringem Hygienestandard häufiger über unsauberes Trinkwasser übertragen. Eine geringe erforderliche Infektionsdosis und eine Umweltresistenz des Erregers ermöglichen auch Übertragungen durch Aerosole oder kontaminierte Gegenstände (z. B. Rotaund Noroviren) sowie direkte Übertragungen von Mensch zu Mensch (z. B. Lamblien). Bei Parasitosen werden nicht immer infektiöse Stadien ausgeschieden, so dass die fäkal-orale oder fäkal-transkutane Übertragung erst nach „Reifung“ außerhalb des Wirtes möglich wird. Mit Ausnahme der Virusinfektionen setzen einige bakterielle Infektionen, die Amöbiasis und die Mehrzahl der Helmintheninfektionen den Aufenthalt in Endemiegebieten, meist Länder mit geringem Hygienestandard, voraus. Der Lebenszyklus von Trematoden und Zestoden beinhaltet meist einen bis mehrere Zwischenwirte wie Fische, Schnecken oder Flöhe, so dass für den Menschen infektiöse Stadien nur bei Verzehr dieser Tiere bzw. bei sonstigem Kontakt mit ihnen aufgenommen werden. Die Infizierten und Erkrankten sind daher nicht als unmittelbar infektiös anzusehen.

ABSTRACT We genetically characterized pinworms obtained from 37 children from different regions of Germany and established new species-specific molecular diagnostic tools. No ribosomal DNA diversity was found; the phylogenetic position of Enterobius vermicularis within the Oxyurida order and its close relationship to the Ascaridida and Spirurida orders was confirmed.

CASE HISTORY:In a 27-year-old female German patient severe headache and wandering paresthesias appeared one week after returning from a holiday in the Dominican Republic. After 3 weeks of ongoing symptoms she was admitted to our hospital with the suspicion of an inflammatory or infectious disease of the central nervous system. Upon admission slight stiffness of the neck, fever (38.2 C) and paresthesias of the right elbow and the right thigh were noticed.LABORATORY FINDINGS:Cerebrospinal fluid (CSF) revealed an eosinophilic pleocytosis. In the acute phase of the disease, antibodies against nematodes were found in CSF, without corresponding antibody-reactivity in serum. In the course levels of nematode antibodies in CSF increased and antibody-reactivity in serum was observed. Thorough investigation for other infectious or inflammatory causes of eosinophilic meningitis revealed no abnormalities.DIAGNOSIS, TREATMENT AND COURSE:Symptoms, onset within the typical incubation period and the eosinophilic meningitis lead to the diagnosis of a suspected Angiostrongyliasis. Successful treatment was achieved with a combination of oral albendazole and corticosteroids given for 4 weeks.CONCLUSION:Infection with larvae of Angiostrongylus cantonensis is one of the main causes of eosinophilic meningitis worldwide. Human infection can occur after ingestion of intermediate hosts or contaminated vegetables. Angiostrongyliasis has been endemic to Southeast Asia and the Pacific Basin and only recently cases from the Caribbean have been described. Headache, paresthesias and the finding of an eosinophilic meningitis in patients returning from tropical or subtropical regions should lead to the suspicion and eventually the treatment of an Angiostrongyliasis.

According to the WHO, the ABC of malaria prevention consists of awareness of the risk, avoiding being bitten by mosquitoes, chemoprophylaxis, and search for diagnosis and treatment. It can be extended by emergency self treatment in areas of low risk where no diagnosis is available within 24 h after the start of symptoms. Therapy depends on the type of malaria, the area of transmission, and the severity of the disease. The treatment of choice for complicated falciparum malaria is still quinine, whereas in many countries nowadays artemisinin derivatives are successfully used, especially in infected children.

Case history: In a 27-year-old female German patient severe headache and wandering paresthesias appeared one week after returning from a holiday in the Dominican Republic. After 3 weeks of ongoing symptoms she was admitted to our hospital with the suspicion of an inflammamatory or infectious disease of the central nervous system. Upon admission slight stiffness of the neck, fever (38,2 degrees C) and paresthesias of the right elbow and the right thigh were noticed.Laboratory findings: Cerebrospinal fluid (CSF) revealed an eosinophilic pleocytosis. In the acute phase of the disease, antibodies against nematodes were found in CSF, without corresponding antibody-reactivity in serum. In the course levels of nematode antibodies in CSF increased and antibody-reactivity in serum was observed. Thourough investigation for other infectious or inflammatory causes of eosinophilic meningitis revealed no abnormalities.Diagnosis, treatment and course: Symptoms, onset within the typical incubation period and the eosinophilic meningitis lead to the diagnosis of a suspected Angiostrongyliasis. Successful treatment was achieved with a combination of oral albendazole and corticosteroids given for 4 weeks.Conclusion: Infection with larvae of Angiostrongylus cantonensis is one of the main causes of eosinophilic meningitis worldwide. Human infection can occur after ingestion of intermediate hosts or contaminated vegetables. Angiostrongyliasis has been endemic to Southeast Asia and the Pacific Basin and only recently cases from the Caribbean have been described. Headache, paresthesias and the finding of an eosinophilic meningitis in patients returning from tropical or subtropical regions should lead to the suspicion and eventually the treatment of an Angiostrongyliasis.

Der Schutz vor einer Malaria bei Reisen in Endemiegebiete besteht aus Aufklärung über das Risiko, Expositions- und Chemoprophylaxe. Neben der kontinuierlichen Einnahme von Medikamenten während der Reise kommt in Gebieten mit geringem Infektionsrisiko für Reisende die Mitnahme von Medikamenten zur notfallmäßigen Selbsttherapie in Betracht. Die Behandlung der Malaria richtet sich nach Erregerart, Infektionsgebiet und Schwere der Erkrankung. Mittel der Wahl bei komplizierter Malaria tropica ist unverändert Chinin, inzwischen werden aber auch weltweit Artemisinine, insbesondere bei erkrankten Kindern, erfolgreich eingesetzt.

Einleitung: Die eosinophile Meningitis wird bei uns vorwiegend bei opportunistischen Infektionen mit Pilzen oder Parasiten beobachtet. Weltweit jedoch ist die häufigste Ursache einer eosinophilen Meningitis eine Infektion mit Larven von Helminthen, wie zum Beispiel Angiostrongylus cantonensis. Dieser bei Ratten auftretende Lungenwurm verwendet unterschiedliche Schneckenarten und Süßwasser-Krustentiere als Zwischenwirte. Nach Kontakt oder Verzehr von Zwischenwirten oder kontaminiertem Gemüse können infektiöse Larven in das humane Zentralnervensystem (ZNS) gelangen. Dort rufen sie nach einer Inkubationszeit von 2 bis 35 Tagen eine entzündliche Reaktion mit typischen klinischen Symptomen hervor. Bislang kam die Angiostrongyloidiasis im südostasiatischen und pazifischen Raum vor. Erst vor kurzem wurden erstmals Infektionsfälle bei Einwohnern und Reisenden auch in der Karibik beschrieben.

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Toxocariasis is a worldwide-occurring parasitic infection leading to tissue damage in various organs due to wandering Toxocara larvae (visceral larva migrans). More than 40 cases of CNS involvement in children and immunocompetent adults have been documented in detail to date. Here, we present evidence of eosinophilic meningomyelitis in an adult without known risk factors and with positive Toxocara antibody response in CSF, but not in blood. Toxocariasis has to remain among the differential diagnosis in patients with eosinophilic CNS infection even if serological tests in blood are negative. Adult cases seem to be more frequent than previously thought (about 60%).

Parasites from swine faeces were examined for autofluorescence. Oocysts of Eimeria polita, E. scabra and Isospora suis, cysts of Balantidium coli and eggs of Oesophagostomum dentatum, Strongyloides ransomi and Trichuris suis (but not those of Ascaris suum) emitted light after excitation with UV light. I. suis oocyst counts in McMaster chambers utilising autofluorescence were compared to those from conventional bright field microscopy. Similarly, faecal smears containing I. suis were examined using the same techniques. Autofluorescence was superior to bright field microscopy in detecting oocysts after flotation and was highly significantly more sensitive when direct smears were examined.

Aim-To determine the frequency of GB virus C (GBV-C)/hepatitis G virus (HGV) infection before and after switch to the use of virus inactivated concentrates in haemophiliac patients infected with human immunodeficiency virus (HIV).Patients and methods-Initial and follow up sera from 49 children with haemophilia were analysed for the presence of GBV-C/ HGV RNA and antibodies to HGV (anti-HGV). All patients had been infected with HIV while receiving concentrates without virus inactivation before 1984 and were subsequently treated with virus inactivated concentrates.Results-In the first available serum sample (1987 or later), two of 49 patients were GBV-C/HGV RNA positive and two further patients were anti-HGV positive. During follow up (mean, 6 years), 14 patients developed markers of GBV-C/ HGV infection. Eleven of these had received no blood products except clotting factor concentrates that had been prepared with virus inactivation.Conclusions-Despite being treated with virus inactivated clotting factor concentrates, HIV positive patients with haemophilia are at an increased risk of manifesting GBV-C/HGV infection. We hypothesise that GBV-C/HGV is transmitted by these clotting factor concentrates. However, we cannot rule out the emergence of markers of GBV-C/HGV infection as a result of the progression of immune impairment in the course of HIV infection.

There is much hope that HIV-infected patients and AIDS patients can reckon with a prolonged survival in future. The increased survival of AIDS patients with positiveToxoplasma serology is not necessarily associated with an increased risk of developingToxoplasma encephalitis. For HIV-infected patients with negativeToxoplasma serology, the probability of acquiring a primaryToxoplasma infection in highly endemic areas such as Germany had not been studied to date. One hundred eighty-three HIV-infected patients were followed up between 1987 and 1995 in a retrospective study. Within the cohort, 95% of the patients were male and 83% haemophiliacs. The initial (1987) and final (1995) prevalence rate ofToxoplasma antibodies was 33.3% and 36.6%, respectively. The annual rise of the primary infection rate was calculated as 0.41%. The dye test was used for the detection ofToxoplasma-specific antibodies. This assay proved to be reliable and stable during long-term observation. The rate of primary toxoplasmosis found in this long-term study was not higher than that of pregnant women in Germany. Chemoprophylactic measurements for seronegative HIV-infected patients are therefore not recommended, but regular serological screening to detect seroconverters is.

Question: Respiratory syncytial virus (RSV) has been accepted to be the major cause of respiratory tract diseases in infants and young children. Especially premature infants, children with congenital heart or lung diseases and immunocompromised patients are at high risk for life-threatening infection. Rapid diagnosis of RSV infections is needed because of the availability of antiviral therapy, and for the prevention of nosocomial infections. Method: We processed a total of 343 specimens, mostly (98%) nasopharyngeal washings collected from 330 pediatric patients with clinical signs of respiratory infection, with an enzyme immunoassay for detection of RSV antigen and virus culture. Results: Results from both assays could be compared for 297 specimens, and were identical in 275 out of 297 (93%) specimens. Of 108 samples found to be positive by the enzyme immunoassay, 92 were culture positive for RSV. Out of 189 specimens negative by immunoassay, six were positive by culture. Due to the high lability of viral infectivity, the failure to detect RSV by culture in 16 samples does not necessarily mean that there are false-positive reactions by the enzyme immunoassay. In 46 samples, culturing of RSV was hampered by nasopharyngeal specimens contaminated with bacteria or fungi, or by the presence of a fast growing non-RSV virus; 50% of them were positive by immunoassay. Conclusion: Since virus isolation is time-consuming and only successful when specimens are transported to the laboratory without delay, and other assays for detection of RSV need enormous methodical and technical efforts, an immunoassay will be a simple and reliable method for the rapid detection of RSV.

Inzwischen sind etwa 10 Jahre vergangen, seit die an der Universitäts-Kinderklinik Bonn betreuten hämophilen Kinder und Jugendlichen mit HIV über Gerinnungsfaktor-Konzentrate infiziert wurden. Hämophile Patienten haben bekanntermaßen ähnlich wie homosexuelle Männer im Vergleich zu anderen Risikogruppen eine bessere Prognose [3, 6–8, 11]. Aufgrund des begrenzten Zeitraumes der Serokonversion und der vergleichsweise guten Compliance, eignen sich jedoch besonders bei hämophilen HIV-Infizierten Untersuchungen hinsichtlich der Bedeutung von prognostischen Markern und Kofaktoren für den Verlauf der HIV-Infektion.