Diagnosis of Parasitic Zoonoses by Immunoenzymatic Assays—Analysis of Cross‐Reactivity Among the Excretory/Secretory Antigens of Fasciola hepatica,Toxocara canis,and Ascaris suum

Several parasitic infections such fasciolosis, toxocariosis or ascariosis are important zoonoses. During the infection with Fasciola hepatica, Toxocara canis and Ascaris suum, an important intraorganic phase in their hosts takes place, releasing antigens responsible for a humoral immune response, which enables the diagnosis of that parasitosis. A study to identify the existence of cross‐reactivity among the excretory/secretory antigens of F. hepatica, T. canis and A. suum was developed. One group of Sprague–Dawley rats was infected with 20 metacercariae of F. hepatica and another group remained uninfected as control. By means of an Indirect‐ELISA, the rat humoral immune response (IgG and IgM) against the excretory/secretory antigens of F. hepatica was analysed and measured for cross reactivity with T. canis and A. suum. IgM cross‐reaction was mainly observed in the first 10 weeks post‐infection. IgG cross‐reaction was observed throughout the study, and was maximal at the 2–3 weeks and 3–6 weeks post‐infection, which corresponds to the intraorganic migratory phase of these parasites. The western‐blot showed that the rat IgG recognised three proteins of 190, 160 and 33 kDa in the antigens from F. hepatica, T. canis and A. suum. The existence of cross‐reactivity among these antigens seems to demonstrate also the presence of structural similarities, such as tegumental proteins. These results should be consider when immunoassay probes are used in the diagnosis of parasitic infections.     

Efficacy of emodepside plus toltrazuril (Procox(®) oral suspension for dogs) against Toxocara canis, Uncinaria stenocephala and Ancylostoma caninum in dogs

The efficacy of emodepside plus toltrazuril (Procox? oral suspension for dogs) against different species of gastrointestinal nematodes (Toxocara canis, Ancylostoma caninum, Uncinaria stenocephala) was evaluated in nine randomised,blinded and placebo-controlled laboratory studies in naturally or experimentally infected dogs. The product was used at the proposed minimum dose of 0.45 mg emodepside and 9 mg toltrazuril per kg body weight. Efficacy was calculated based on worm counts after necropsy. Worm burdens in the control dogs ranged between 0 and 409 worms of the respective stage for T. canis and between 4 and 655 worms for hookworms. The studies demonstrated 100 % efficacy of emodepside/toltrazuril suspension against mature adult, ≥ 94.7 %efficacy against immature adult and 99.3 % efficacy against the L4 larval stage of T. canis. The efficacy against mature adult A. caninum was ≥ 99.5 % and the efficacy against mature adult U. stenocephala was 100 %. All differences between treatment and control groups were statistically significant and no gender effect was found. It can be concluded that the emodepside/toltrazuril suspension represents a safe and highly effective product in dogs with nematode (T. canis, hookworms) infection.     

Möglichkeiten und Grenzen einer Artdifferenzierung der Larven von Ascaris lumbricoides suis,Parascaris equorum,Toxocara canis,Toxocara cati und Toxascaris leonina in histologischen Schnitten beim nicht adäquaten Wirt (Maus) II. Teil

Ohne ZusammenfassungMit 13 TextabbildungenDie Arbeit wurde im Rahmen eines Stipendiums des Deutschen Akademischen Austauschdienstes ermöglicht, dem an dieser Stelle herzlich gedankt sei.     

Beiträge zu dem Problem der Wanderwege der Askaridenlarven (Ascaris Lumbricoides Linné 1758 und Toxocara canis Werner 1782) im experimentellen und natürlichen Wirt

Summary The larvae of Ascarids hatch in the last one-third of the ileal tract and also in Coecum only.The natural invasion of the larvae occurs only in these parts of the tracts and even when they are brought in other parts of the tract, freed from their eggshells artificially.The larvae appear regularly in the body cavity during their invasion, which is the starting point of organ migration.The liver could be achieved by two avenues — one of them is direct and the other indirect. In the same manner they can arrive the thorax, either through diaphragm or via blood. The mechanism of appearance of the larvae in lungtissue has been explained. The discripancy between the appearance of the larvae in lacrymal glands and eye ball has also been clarified.The larvae of the T. canis is much more in virulency in its behavior than that of A, lumbricoides. T. canis behave, in its migration, the same in experimental and as well as in natural host.

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An dieser Stelle möchte ich meinem hoch verehrten Lehrer, Herrn Prof. Dr. Dr. R. Lehmensick, für die Anregung zu dieser Arbeit sowie für die freundliche Unterstützung bei der Durchführung meinen herzlichsten und wärmsten Dank aussprechen.Auch Herrn Prof. Dr. R. Danneel bin ich für die Überlassung des Arbeitsplatzes zu Dank verpflichtet.Herrn Dr. G. Madel, der mir bei der Übersetzung dieser Arbeit behilflich war, danke ich ebenfalls.Die Arbeit wurde ermöglicht durch die finanzielle Unterstützung des Auslandsamtes der Universität Bonn und des Deutschen Akademischen Austausch-Dienstes.     

Bacteriological investigation—significance of time lapse after death

In cases of sudden unexpected death in infants and children (SUDI), microbiological investigation has been an important part of the autopsy protocol at the University of Oslo for the last 15 years. The purpose of this study was to compare the microbiological findings in samples taken at hospital admittance shortly after death and at autopsy. Blood cultures and cerebrospinal fluid (CSF) were collected both at the hospital and at autopsy; organ samples were additionally collected at autopsy. Hospital samples were collected at a median of 4.5 h (95% confidence interval [CI] 3.25–5) and autopsy samples at a median of 24.25 h (95% CI 22–25.5) after death. The proportion of positive cultures was stable over time; the post mortal time had no influence on bacterial growth. As long as the autopsy is performed within 48 h after death, prior microbiological examination is unnecessary. Blood culture, CSF and lung specimens are the best predictors in our study.     

Biology of Alaria spp. and human exposition risk to Alaria mesocercariae—a review

Recent incidental background findings of Alaria alata mesocercariae [“Distomum muscularis suis,” Duncker, 1896] in meat of wild boars during official Trichinella inspection initiated a re-assessment of the potential human health risk as posed by this parasite. The present review of the literature on Alaria biology shows that the human exposition risk should no longer be accepted to be negligible, as it demonstrates a general lack of knowledge in relevant areas of Alaria biology confounding any risk analysis. Sound risk assessment needs future studies which should concentrate on the most pressing questions of (1) the optimization and/or development of methods for reliable Alaria mesocercariae detection, (2) the distribution of the mesocercariae within their paratenic hosts, i.e., identification of potential predilection sites, particularly in wild boars, and (3) their prevalence in sylvatic populations of animals with respect to their introduction into the human food chain. Further, the degree and possibly also the species specificity of Alaria mesocercariae tenacity within the paratenic hosts and respective meat as pertaining to food technological treatments need to be elucidated. While these questions remain unanswered, it is an incontrovertible fact that Alaria mesocercariae have a potentially high human pathogenicity by both occupational and alimentary exposition.     

Income change after cruciate ligament injury — A population-based study

ObjectivesTo investigate the association between choice of treatment and patients' income after cruciate ligament (CL) injury and assess the effect of different covariates such as sex, age, comorbidities and type of work.MethodsThis entire-population cohort study in Sweden included working patients with a diagnosed CL injury between 2002 and 2005, identified in The National Swedish Patient Register (n = 13,662). The exposure was the treatment choice (operative or non-operative treatment). The main outcome measure was average yearly income five years after CL diagnosis, adjusted for the following covariates: sex, age, comorbidities, type of work, region, calendar year, education and income.ResultsRelative to non-operative treatment, operative treatment was associated with greater average yearly incomes (nine to 15%) after injury among patients between 20 and 50 years, patients with partial university education, patients living in large cities and patients with one comorbidity, despite no overall significant association in the national cohort. Delayed operative treatment (> 1 year) had no significant association with income change, whereas early operative treatment (< 1 year) was associated with higher average yearly incomes (11 to 16%) among females, patients between 20 and 50 years, patients living in large cities and patients with one comorbidity.ConclusionsIn a broad sense, treatment choice was not associated with changes in income five years after CL injuries among patients in the workforce, however earlier operative treatment was associated with higher average incomes among patients with ages between 20 and 50, females, living in large cities, with one comorbidity and with a high level of education.     

High-level JCPyV viruria after kidney transplantation—Clinical and histopathological findings

BackgroundThe significance of JC polyomavirus (JCPyV) after kidney transplantation ranges from irrelevant to full-blown nephropathy or PML.ObjectivesTo investigate the clinical significance of high-level JCPyV viruria and JCPyV primary infections after kidney transplantation.Study designJCPyV viruria was detected in routine screening by quantitative real-time PCR in 40/238 kidney transplant recipients and was high-level (>10⁷ copies/ml) in 17 patients. A protocol biopsy at the time of JCPyV viruria was available from 10 patients.ResultsPeak urine viral loads were 1.0 × 10⁷ − 2.5 × 10⁹ copies/ml in the 17 high-level viruria patients. 6/15 (40%) patients with high-level JCPyV viruria with pretransplant sera available were JCPyV IgG negative suggesting that JCPyV viruria resulted from the donor graft in most cases. No acute graft dysfunction was associated with JCPyV viruria. No positive SV40 staining was detected in protocol biopsies, and no specific histopathology was associated with high-level viruria; JCPyV nephropathy was not found. No differences were seen in histopathology or graft function at 3 years in patients with high-level viruria compared to non-JCPyV viruric patients transplanted during the same time period, and outcome was similar in patients with presumably primary and reactivated JCPyV. The mean estimated GFR at last follow-up was 44 ml/min (range 12–60 ml/min). One graft with high-level viruria was lost 9 years posttransplant due to recurrent IgA nephropathyConclusionsHigh-level JCPyV viruria seems to be associated with primary JCPyV infection reflecting the average seroprevalence of 60%, but is not stringently associated with inferior graft function or survival, or histopathological changes.     

Female voice changes around and after the menopause — an initial investigation

The views of 48 female and 24 male professional singers aged 40–74 years were sought regarding the occurrence of possible voice changes in around the fifth decade of life. The changes actually experienced were investigated to determine whether women's and men's voice changes were different, which might indicate that the menopause had an impact on the female voice. Respondents were approached via personal contacts and completed anonymous questionnaires that were returned by mail. Given the dilicate nature of the study topic, no information was obtained on non-responders. Seventy-seven percent of the female singers and 71% of the men were of the opinion that the voice generally underwent changes at around the age of 50. The female singers placed greater emphasis on problems affecting the high registers and voice control than the men. Overall, 29% of the women had actually experienced negative voice changes at around age 50, as compared with 38% of the men. Both sexes reported huskiness, but the women seemed to have more frequent problems with voice emission, voice control and reaching their highest registers. In addition, 27 women reported that they had experienced voice changes during menstruation and five women stated that these had occurred during use of the oral contraceptive pill, which may have reflected the impact of other hormone-related factors. Despite the limitations of this initial investigation (the sample was small and selective), the broad findings indicated that the female voice undergoes specific changes at around the time of the menopause.     

Prediction of atrial fibrillation recurrence after cardioversion—Interaction analysis of cardiac autonomic regulation

Today atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice accounting for approximately one third of hospitalizations and accompanied with a 5 fold increased risk for ischemic stroke and a 1.5 fold increased mortality risk. The role of the cardiac regulation system in AF recurrence after electrical cardioversion (CV) is still unclear.The aim of this study was to investigate the autonomic regulation by analyzing the interaction between heart rate and blood pressure using novel methods of nonlinear interaction dynamics, namely joint symbolic dynamics (JSD) and segmented Poincaré plot analysis (SPPA). For the first time, we applied SPPA to analyze the interaction between two time series. Introducing a parameter set of two indices, one derived from JSD and one from SPPA, the linear discriminant function analysis revealed an overall accuracy of 89% (sensitivity 91.7%, specificity 86.7%) for the classification between patients with stable sinus rhythm (group SR, n = 15) and with AF recurrence (group REZ, n = 12). This study proves that the assessment of the autonomic regulation by analyzing the coupling of heart rate and systolic blood pressure provides a potential tool for the prediction of AF recurrence after CV and could aid in the adjustment of therapeutic options for patients with AF.     

Immune reconstitution after HSCT in SCID—a cohort of conditioned and unconditioned patients

Immunologic Research - Allogeneic hematopoietic stem cell transplantation (HSCT) is the effective mean of immune restoration in severe combined immunodefiency (SCID). Usually, HSCT without...     

Delayed peroneal nerve palsy after total knee arthroplasty—A rare complication of tibial osteolysis

We present a case of peroneal nerve palsy which occurred 12 years after primary total knee arthroplasty as a result of extensive tibial osteolysis. The tibial osteolytic cyst extended through a cortical defect in the proximal tibia into the anterolateral compartment of the leg causing compressive neuropathy of the peroneal nerve. Imaging included radiographs, CT scan and MRI. At revision surgery, the tibial component was found loose with significant proximal tibial osteolysis. The cyst in the leg was decompressed through the cortical defect in the proximal tibia and analysis of cystic fluid revealed polyethylene debris. At 7-year follow-up after revision, the osteolytic cyst had resolved but the peroneal palsy did not recover.     

Varicella-Zoster Reactivation after Allogeneic Stem Cell Transplantation without Routine Prophylaxis—The Incidence Remains High

One-year prophylaxis with acyclovir has been shown to effectively prevent varicella-zoster virus (VZV) reactivation after allogeneic hematopoietic stem cell transplantation (HSCT) in a cohort that underwent transplantation in the beginning of the 2000s. Transplantation procedures have since changed considerably and reduced-intensity conditioning (RIC) is nowadays common. We investigated VZV reactivation without routine prophylaxis in a cohort of HSCT patients, 50% of whom had received RIC. The cumulative 2-year incidence of VZV reactivation was 20.7%. Risk factors in a multivariate analysis were treatment with mesenchymal stromal cells (relative hazard [RH], 1.65; confidence interval [CI], 1.07 to 2.54; P = .02), total body irradiation ≥6 Gy (RH, 1.55; CI, 1.14 to 2.13; P = .006), engraftment later than day 16 (RH, 1.46; CI, 1.07 to 2.00; P = .02), and age 0 to 19 years (RH, 1.68; CI, 1.21 to 2.35; P = .002). There was no difference in VZV reactivation between patients receiving myeloablative conditioning or RIC. VZV-related complications occurred in 29% of the patients with reactivation; most common were disseminated disease and postherpetic neuralgia. No single low-risk group for VZV reactivation could be identified. We conclude that VZV reactivation remains common after HSCT and carries a high complication rate, warranting prophylaxis.     

Kidney Pathology after Hematologic Cell Transplantation—A Single-Center Observation Study of Indication Biopsies and Autopsies

Hematopoietic cell transplantation (HCT) is an increasingly used treatment for hematologic malignancies as well as for nonmalignant diseases. Kidney impairment remains an important early and late post-transplantation complication. Although numerous histopathological changes have been reported, the pathophysiology remains incompletely understood. Furthermore, correlations between clinical findings and morphological changes have not been well studied. Between 2000 and 2016, 17 recipients of allogeneic (n?=?12) or autologous (n?=?5) HCT underwent kidney biopsy for either proteinuria or deterioration of kidney function at our center. The most common biopsy findings were therapy-related changes with thrombotic microangiopathy (n?=?5), calcineurin inhibitor toxicity (n?=?4), and membranous glomerulonephritis (n?=?3), representing the majority of cases in this category. In addition, kidney findings from 137 autopsies performed between 1995 and March 2017 were analyzed. The most common changes were acute kidney injury (n?=?55), most likely due to the patients' premortal deteriorated state, and thrombotic microangiopathy (n?=?14). Several cases demonstrated involvement by either infectious agents (n?=?6) or tumors (n?=?9). Distinct kidney diseases, such as glomerulonephritis, were rare (3% of cases). Uncommon and yet rarely described diagnoses for this patient cohort were IgG4-related tubulointerstitial nephritis and fibrillary nephritis. This study provides a comprehensive overview of the histomorphological findings in kidney biopsy specimens from HCT recipients. Along with treatment-related complications, one putative correlate of chronic GVHD of the kidney could be documented: membranous glomerulonephritis. In contrast, no morphological correlate of acute GVHD of the kidney was identified. Findings at the time of autopsy varied greatly, spanning a wider range than those of indication biopsies.