With an estimated 100 million victims, pandemically and epidemically occurring plague has been looked upon as a classical scourge of mankind during the last two millenia. Without treatment at least 50% of the affected individuals die from infection with Yersinia pestis, a bacterium belonging to the family of Enterobacteriaceae. The disease takes a fulminant course. After an incubation period of 2-6 days, bubonic plague primarily attacks one group of lymph nodes. The onset of pulmonic plague, transmitted by droplet infection, takes place within several hours and causes bronchopneumonia. Early recognition facilitates a promising antibiotic therapy with tetracycline, streptomycin or chloramphenicol. Human beings acquire the bacteria through bites of fleas from domestic rats in densely populated cities of countries with low hygienic standards, or sporadically in the open country from infected wild rodents. Laboratory procedure includes microscopy supplemented by immunofluorescence and cultivation of the bacterium from clinical material. Direct serology and PCR result in a fast detection of specific antigens or nucleotide sequences. Determination of serum antibodies is principally used for epidemiological investigation. Today, physicians in the civilized western world lack experience for the recognition of plague, and analytical techniques for diagnosis are only available in some specialized laboratories. Yersiniosis becomes primarily manifest as gastroenteritis caused by Yersinia enterocolitica or as pseudoappendicitis caused by Yersinia pseudotuberculosis and requires antibiotics only in severe septic cases. Different extraintestinal symptoms may be observed in dependence on the patient's HLA type and gender. The ubiquitous germ is mainly transmitted by the fecal-oral route via infected domestic or farm animals and contaminated food. The relevant virulence factors are encoded on a 70 kB plasmid common to all Yersinia species and strains that are human pathogens. The most important tools for laboratory diagnosis are culture from suitable body fluids and serological detection of specific antibodies. The infection rate among healthy individuals in Europe in terms of percentage of elevated IgA or IgG titers has been quoted to be 3-40% in different investigations but does not significantly correlate to direct bacteriological detection.

The potential of the cluster fly, Pollenia rudis sensu stricto, to transmit bacterial pathogens was investigated during a mass infestation that took place in a German hospital. Cluster flies were individually examined for mesophilic bacteria carried on the exoskeleton. Bacterial growth could only be detected by using the enrichment culture technique to increase sensitivity, but not by direct inoculation of fly samples to agar plates. All 50 cluster fly samples that were tested carried opportunistic aerobic mesophilic Bacillus spp., whereas 41 fly samples were positive for Erwinia spp., 16 samples for Erwinia amylovara, 24 samples for Stenotrophomonas maltophilia, and 4 samples for Flavobacterium odoratum. Staphylococcus lugdunensis and Pseudomonas aeruginosa were found in 5 samples. No bacteriologically sterile cluster fly samples were obtained. The whole bacterial pattern found on P. rudis s.s. is known for its potential to cause opportunistic and /or noso-comial infections in humans. The results obtained led to the assumption that mass infestations of cluster flies occurring in sensitive areas, especially in hospitals, may cause a low, but not neglect-able health threat due to mechanical transmission of bacterial pathogens.

Introduction Pathogenesis and clinical outcome of haemorrhagic fever with renal syndrome and nephropathia epidemica Hantaviruses, the causative agents for haemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS), are serologically related The pathophysiological outcome of human infection viruses of the family Bunyaviridae, and have a with Old World hantaviruses is generally characterized worldwide distribution. Unlike other Bunyaviruses, by vascular dysfunction directly associated with genesis hantaviruses are not known to be transmitted by an of more or less severe haemorrhagic fever with renal arthropod vector. The natural hosts of these viruses syndrome. Hantavirus antigen is detectable in the are small mammals. Hantavirus virions are excreted capillary endothelial cells of various organs, and is from infected rodents via saliva, urine, and faeces. involved in immunopathological processes [6 ]. Humans may become infected through inhalation of The course of hantaviral disease is usually very aerosols of dried excreta, inoculation through the short, and, if the patient survives, complete recovery conjunctiva, or entry through broken skin or rodent occurs in most cases. The incubation time is estimated bites [1]. to be 2–3 weeks (4–42 days) showing as broad specHuman hantaviral infections are not new. During trum of relatively unspecific clinical symptoms, espethe 1950s, hantavirus carried by the striped field mouse, cially when a mild or moderate course of disease Apodemus agrarius, caused approximately 3000 cases occurs, thus complicating the diagnosis. Unlike the of Korean haemorrhagic fever among United Nations American hantaviruses responsible for HPS, the troops participating in the Korean conflict. The aetioEuropean viruses target mainly the kidneys, rather logic agent, defined as Hantaan virus, was first isolated than the lungs. In rare instances, Puumala virus has in 1977 from the rodent reservoir [2]. Since then, over been found to induce pleural complications, demon20 other hantaviruses from rodent species in Asia, strating that even in European hantavirus cases, acute Europe, and the Americas have been serologically or respiratory distress syndrome may be involved in the genetically characterized. Currently, the worldwide course of the disease [7]. infection rate of hantaviral disease is estimated to Severe cases of HFRS, usually associated with the exceed 200 000 cases annually. The majority of these Asian Hantaan virus and the European Dobrava virus, show a case fatality rate which may exceed 10%. The cases are HFRS which occurs in Eastern Europe and clinical manifestation can be differentiated into five Central and East Asia. chronological phases. During the last decade, it became clear that hantaviruses are widely endemic in Europe, where at least (i) The febrile phase: duration 3–7 days, associated two different human-pathogenic strain types, Puumala, with head, abdominal and back pain, ending up and Dobrava, have been reported [3–5]. In Germany, with appearance of severe proteinuria. hantaviral infection is now reported as the most (ii) The hypotonic phase: duration several hours to 2 common endemic rodent-borne human illness, when days, with first appearance of haemorrhages assocompared with tularaemia, lymphocytic choriomeninciated with lethal shock syndrome in most severe gitis, and leptospirosis. Furthermore, hantavirus is cases. suspected to be the prevailing cause of renal failure (iii) The oliguric phase: duration 3–7 days, associated associated with infectious diseases in Central Europe. with nausea, vomiting, and acute renal failure, This report aims to provide basic information on often combined with hypertension due to simultanhantavirus infection associated with renal syndrome eous hypervolaemia; approximately 50% of the with special respect to European conditions. lethal HFRS cases appear during this phase. (iv) The diuretic phase: duration days to weeks, indiCorrespondence and offprint requests to: M. Faulde, Zentrales Institut cating a good case prognosis; further clinical probdes Sanitätsdienstes der Bundeswehr Koblenz, Laborabteilung Ilems may be dehydration electrolyte shifts, and Medizin, Labrp Med. Zoologie, BW442, Postfach 7340, D-56065 Koblenz, Germany. secondary infections.

Zusammenfassung: Das Frühsommer-Meningoenzcphalitis-Virus (FSME) wird in Europa überwiegend durch den Stich der Schildzecke Ixodes ricinus übertragen.Die Durchseuchung der Zecken weist regional große Unterschiede auf.In Deutschland gelten besonders das Bodensee-/Oberrheingebiet sowie der Raum Passau (Bayern) als endemisch.Das neurotrope FSME-Virus verursacht ein zweigipfliges Krankheitsbild: einem eher unspezifischen Prodromalstadium folgen nach mehreren beschwerdefreien Tagen Organmanifestationen als Meningitis,

A transferable solid phase enzyme immunoassay (TSP-EIA) and an immunoblot technique were evaluated for the detection of IgG antibodies against Helicobacter pylori. Using the biopsy urease test as reference method, the sensitivity and specificity of the EIA were 96% and 100%, respectively. Immunoblot analysis was carried out by testing sera from patients with a positive urease test who suffered from type B gastritis, gastric and duodenal ulcers, and a negative control group. The immunoblotted Helicobacter pylori proteins showed reproducible immunoreactive bands at molecular weights of 130, 93, 75 and 67 kDa. The molecular weight protein fractions of Helicobacter pylori of 180 kDa and higher were found to be of minor immunological significance. Proteins of less than 60 kDa exhibited wide serum-specific variations in reactivity after immunostaining. No correlation between specific immunoblot patterns and clinical signs induced by Helicobacter pylori infection was observed.

An immunofluorescence assay (IFA) for the detection of immunoglobulin G antibodies directed against Helicobacter pylori was evaluated by comparing 20 serum specimens from patients with a positive urease test on biopsy material and 20 serum specimens from patients with a negative test and with defined clinical symptoms. The resulting anti-H. pylori titers were classified as follows: negative, less than or equal to 64; borderline, 128; and positive, greater than or equal to 256. By using these criteria, the IFA was subsequently tested, using 100 serum specimens from patients with gastric complaints. Overall, the titers were 71% positive, 10% borderline, and 19% negative. Depending on the patients' biopsy urease test results, the sensitivity and specificity of the assay were calculated to be 96%. Furthermore, these sera were classified into three subgroups on the basis of clinical manifestations: gastritis with 74% positive and 10% borderline titers, duodenal ulcer with 84% positive and 4% borderline titers, and gastric ulcer with 52% positive and 16% borderline titers. A serologic follow-up study was carried out with three patients with gastric ulcers who had been treated with colloidal bismuth subcitrate for 4 weeks and erythromycin for the final 2 weeks. The results indicate that a significant decrease in titer could be expected within 9 to 12 months after successful therapy, as determined by repeated negative CLO tests. Absorption experiments demonstrated that possible cross-reactivity between H. pylori and C. jejuni did not influence serodiagnosis.

Article Problematik der serologischen Diagnostik zur Erfassung einer Primärinfektion mit Toxoplasmagondii unter besonderer Berücksichtigung der Schwangerschaftsüberwachung was published on January 1, 1991 in the journal Journal of Laboratory Medicine (volume 15, issue 4).

Zusammenfassung:Aus dem Jahr 1989 wurden 384 Serumproben, die sich in einem selbst entwickelten und evaluierten seml• quantiativen ELISA als positiv für das Vorliegen von Antikörpern der IgG-Klasse gegen Borrelia burgdorferi erwiesen hatten, bezüglich Kreuzreaktionen mit anderen Erregern bzw.Doppelinfektionen untersucht Die Ergebnisse der eingesetzten Testverfahren waren nicht immer eindeutig und wurden deshalb in positive und fragliche Befunde eingeteilt die in der Gesamtheit als auffällig bezeichnet wurden.Luesserologisch waren 0,78% der Proben positiv; genauere Recherchen ergaben in diesen Fällen das klinische Bild einer Syphilis.Positive Leptospiroseseren wurden nicht gefunden.Kreuzreaktionen innerhalb der Spirochaetales spielen demzufolge nur-bei bestimmten Testverfahren eine Rolle bei der Serodiagnostik der Lyme-Borreliose.In 0,52% der Proben wurden zweifelsfrei IgM-Antikörper gegen das Viruscapsidantigen von EBV aufgezeigt.Ob es sich hierbei um

In einem Zeitraum von vier Monaten (November 1988-Februar 1989) wurden 130 Stuhlproben von Säuglingen und Kindern sowie 320 Proben von männlichen Erwachsenen mit Gastroenteritis auf Anwesenheit von Rotaviren untersucht.Dafür standen vier kommerziell erhältliche Enzymimmunoassays zur Verfügung: zwei mit monoklonalen (Pathfinder-Rotavirus, Kallestad; Rotavirus EIA, Rohm Pharma) und zwei mit polyklonalen Antikörpern (Rotavirus-Enzygnost (Ag), Behring; Rotazyme II, Abbott).Die 130 Stuhlproben der Kinder wurden zusätzlich mittels RNA Gel-Elektrophorese analysiert.Die diagnostische Spezifität der zwei ELISA mit monoklonalen Antikörpern (je 98,9%) war höher als die der zwei mit polyklonalen Antikörpern (Enzygnost 88,6 %, Rotazyme II 96,6 %).Die diagnostische Sensitivität des Rotavirus EIA und des Enzygnost (je 95,2 %) war etwas höher als die des Pathfinder-Rotavirus (92,9 %) und deutlich höher als die des Rotazyme II (85,7 %).Von den 130 Stuhlproben der Kinder erwiesen sich 42 (= 32 %), von den 320 Proben der Erwachsenen 9 (= 2,8 %) als positiv.Rotaviren stellen bei kindlicher Gastroenteritis das wichtigste ätiologische Agens dar, wohingegen die geringere Infektionshäufigkeit von Rotaviren bei Erwachsenen annähernd mit der von Salmonellen bzw.Campylobacter vergleichbar ist.

Zusammenfassung: Die Oberflächenproteine einschließlich der immunogen wirkenden dreier europäischer Isolate von Borrelia burgdorferi, dem ätiologischen Agens der Lyme-Borreliose, wurden durch eine Natriumdodecylsulfat-Behandlung extrahiert.Nach Auftrennung der Proteine mit Hilfe einer Gradientengel-Elektrophorese und densitometrischer Auswertung der Bandenmuster konnten beträchtliche qualitative und quantitative Differenzen festgestellt werden.Vierzehn kommerziell erhältliche ELISA-Testkits zum Nachweis von Antikörpern gegen Borrelia burgdorferi im Patientenserum (6 auf IgG, 5 auf IgM und 3 kombinierte Tests) wurden an einem 98 Proben umfassenden Serumkollektiv verglichen und den IgG-Antikörpertitern eines selbst entwickelten und evaluierten ELISA gegenübergestellt, bei dem der Proteinextrakt eines definierten Borrelia-burgdorferi-Stammes als Antigenquelle verwendet wurde.Es ergaben sich dabei erhebliche Differenzen sowohl zwischen den Testkits der Anbieter als auch (bzgl.IgG) zu dem eigenen ELISA.Infolge der festgestellten starken Stammdifferenzen war ein Qualitätsurteil über die unterschiedlichen Testverfahren nicht zu treffen,