SARS-CoV-2 seroprevalence and determinants of infection in young adults: a population-based seroepidemiological study.

OBJECTIVES: Most SARS-CoV-2 seroprevalence studies have focussed on adults and high-risk populations, and little is known about young adults. The objective of the present study was to provide evidence on the SARS-CoV-2 seroprevalence among young adults in Germany and to explore determinants associated with seropositivity in general and, specifically, with previously undetected infections. STUDY DESIGN: This was a population-based SARS-CoV-2 seroprevalence study. METHODS: In November 2020, a population-based study on SARS-CoV-2 seroprevalence in young adults (aged 18-30 years) was conducted in a large German city. Serum samples were obtained to analyse the SARS-CoV-2 antibody status using the Elecsys Anti-SARS-CoV-2 immunoassay. Descriptive statistics and odds ratios (ORs) of seropositivity and of previously undetected infections in relation to different determinants were calculated. RESULTS: Among 2186 participants, SARS-CoV-2 antibodies were detected in 72 individuals, equalling a test performance-adjusted seroprevalence of 3.1% (95% confidence interval [CI]: 2.4-4.0). Based on reported COVID-19 cases to the public health authority, a moderate underascertainment rate of 1.7 was calculated. Seropositivity was higher among individuals who sought COVID-19-related information from social media (OR: 1.83, 95% CI: 1.2-3.1), and undetected COVID-19 infections were more prevalent among men and those not adhering to social distancing. CONCLUSIONS: The results show a substantial underascertainment of SARS-CoV-2 infections among young adults and indicate that seroprevalence is likely to be much higher than the reported COVID-19 prevalence based on confirmed COVID-19 cases in Germany. Preventive efforts should consider the heterogeneity of risk profiles among the young adult population.

Underascertainment of COVID-19 cases among first responders: a seroepidemiological study.

BACKGROUND: Providing frontline support places first responders at a high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. AIMS: This study was aimed to determine the anti-SARS-CoV-2 seroprevalence in a cohort of first responders (i.e. firefighters/paramedics), to detect the underascertainment rate and to assess risk factors associated with seropositivity. METHODS: We conducted a serological survey among 745 first responders in Germany during 27 November and 4 December 2020 to determine the anti-SARS-CoV-2 seroprevalence using Elecsys® Anti-SARS-CoV-2 immunoassay (Roche Diagnostics, Mannheim, Germany). As part of the examination, participants were asked to provide information on coronavirus disease 2019 (COVID-19)-like-symptoms, information on sociodemographic characteristics and workplace risk factors for a SARS-CoV-2 infection and any prior COVID-19 infection. Descriptive statistics and logistic regression analysis were performed and seroprevalence estimates were adjusted for test sensitivity and specificity. RESULTS: The test-adjusted seroprevalence was 4% (95% CI 3.1-6.2) and the underascertainment rate was 2.3. Of those tested SARS-CoV-2 antibody positive, 41% were aware that they had been infected in the past. Seropositivity was elevated among paramedics who worked in the emergency rescue team providing first level of pre-hospital emergency care (6% [95% CI 3.4-8.6]) and those directly exposed to a COVID-19 case (5% [95% CI 3.5-8.1]). Overall, the seroprevalence and the underascertainment rate were higher among first responders than among the general population. CONCLUSIONS: The high seroprevalence and underascertainment rate highlight the need to mitigate potential transmission within and between first responders and patients. Workplace control measures such as increased and regular COVID-19-testing and the prompt vaccination of all personnel are necessary.

[Application of HIV drug resistance testing according to guidelines]. / Empfehlungen zum leitliniengerechten Einsatz der HIV-Resistenztestung.

Guidelines for application of HIV drug resistance testing have recently been develeped in Europe and the USA. This article discusses these recommendations. Since the widespread use of highly active antiretroviral therapy (HAART), quality of life has been improved for the majority of HIV-infected patients and the mortality rate has declined significantly. However, an incomplete suppression of viral replication results in selection of resistant viral strains resulting in a loss of HAART efficacy and worsening in the quality of life. Resistance testing is likely to improve virological monitoring of untreated but especially in pre-treated patients. Genotypical and phenotypical assays present similar results, but genotypical testing is the method of choice initially. Translation of resistance testing into clinical decisions-making requires consideration of a patient's history, interpretation of results by a validated algorithm, and expert advice. Problems of adherence should be avoided by counselling and therapeutic drug monitoring. Resistance testing or storage of a patient's plasma sample should be undertaken as early as possible in the disease history. If this is not possible, treatment with HAART, including a boosted protease inhibitor, is warranted. European and USA guidelines present similar recommendations. HIV drug resistance is preventable by rational choice of drug combinations in HAART. After development of resistance-associated mutations, drug resistance testing can preserve future treatment options and preventing further clinical deterioration. The method has been incorporated into national and international guidelines on the basis of good scientific evidence.

Wireless capsule endoscopy for the detection of small bowel diseases in HIV-1-infected patients.

BACKGROUND AND AIMS: In HIV-infected patients, manifestations of the disease are common in the gastrointestinal tract. The objective of our study was to evaluate the diagnostic yield of the Given(R) Video Capsule System (Given Imaging, Yoqneam, Israel) in these patients. METHODS: After the exclusion of GI-tract stenosis by anamnestic exploration, 49 patients were included into the study. Stratification: Group A (n = 19): HIV-positive, CD4 cell count < 200/microl, gastrointestinal symptoms present. Group B: HIV-positive, CD subset4 < 200/microl, without gastrointestinal symptoms (n = 19 Group) C: healthy volunteers (n = 11). RESULTS: In group A there was a total of 30 pathological findings, 15 of which had therapeutic implications. In group B, there was a total of 22 pathological findings, 5 relevant for therapy. In group C there was a total of 13 pathological findings, 3 with therapeutic relevance. In 89% (group A) vs. 26% (group B), pathological findings were detected distal to the ligament of Treitz (p = 0.001). All capsules were recovered without any complication after 12 to 96 h from the stool. CONCLUSION: Wireless capsule endoscopy of the small intestine should be considered for HIV-infected patients with marked immunosuppression and gastrointestinal symptoms.

Evaluation of the use of RT-PCR for the early diagnosis of dengue fever.

RT-PCR was used to diagnose dengue virus infections confirmed serologically in 26 returning travellers. RT-PCR was positive for three (75%) of four samples taken on or before day 3 of the illness, for 15 (78.9%) of 19 samples taken between days 4 and 7, and for none of three samples tested on or after day 8 (p 0.0337). When applied early, RT-PCR seems to be a useful tool for the diagnosis of dengue fever.

Atazanavir for treatment of HIV infection in clinical routine: efficacy, pharmacokinetics and safety.

INTRODUCTION: Atazanavir (ATV) is a novel protease inhibitor that has been recently introduced into therapy of HIV infection. Currently there is little data on ATV therapy from daily practice. METHODS: In this retrospective study, we report on ATV efficacy and safety in clinical routine. Drug monitoring was performed consisting of unscheduled single measurements and a 4-hour-profile. Trough concentration of >80 ng/ml and peak concentration of 2000-6000 ng/ml were regarded as sufficient. RESULTS: Between May 2003 and April 2004, ATV treatment was started in 42 patients, mean observation time was 32 weeks (6-53). Mean age was 45.6 years, 38% had prior AIDS, viral load was undetectable in 73%. Important side effects were minor or moderate diarrhea (27%) and fatigue (15%). ATV was discontinued in 10% due to side effects or malignant diseases. No significant influence on mean values of cholesterol, triglycerides, liver enzymes, CD4-cell-count, and HI-viral load was seen. Virologic failure occurred in 13% of patients, all of them were PI-experienced. Pharmacokinetic data are available for 32 patients, all patients had sufficient trough levels. 30% with unboosted ATV and 21% with boosted ATV had peak plasma concentrations below the level defined as sufficient. Mean trough levels, plasma profile and AUC did not differ significantly between groups with non-boosted versus boosted ATV regimes but showed a wide inter-patient variability. CONCLUSIONS: ATV treatment of HIV-infected patients with or without a RTV booster was safe and effective in clinical routine. Drug levels were sufficient in the majority of cases. The variability of pharmacokinetic results in our sample supports therapeutic drug monitoring in patients treated with ATV.

Primary drug-resistance in HIV-positive patients on initiation of first-line antiretroviral therapy in Germany.

BACKGROUND: Resistance against antiretroviral drugs in previously untreated HIV-infected persons is of growing relevance. The aim of the study is to determine the prevalence of resistance-associated mutations in this patient group. METHODS: In a prospective multicenter-study in Nordrhein-Westfalen, Germany, genotypic resistance testing was performed in untreated HIV-positive patients before administration of first-line highly active antiretroviral therapy (HAART). RESULTS: Between January 2001 and August 2002 resistance testing was performed in 184 therapy-naive individuals. HAART was initiated in 143 patients, who were included into the study. 70.6 % were males, mean age was 39 years, mean duration of diagnosis of HIV-infection was 1.5 years. The proportion of cases at CDC stage C was 45.4%, mean CD4-cell count was 199 /ml, mean viral load was 206,855 copies/ml. Resistance-associated mutations were detected in 20 patients (14.0%). 10.5% showed mutations indicating nucleoside reverse transcriptase inhibitor- (NRTI) resistance (M41L, E44D, D67N, T69D/N, L74V, V118I, M184V, L210W, K219Q), 2.8% showed non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance (K103N, V108I, Y181C), and 2.1% showed protease-inhibitor- (PI) associated resistance (V82A, L90M), respectively. Multi-class-resistance was found in 2.1%, mutations indicating revertant variants of resistant strains were found in 4.2% (T215C/E/L/S). 86.7% of the isolates showed secondary mutations in the protease gene. No significant difference in the distribution of the parameters age, sex, duration of HIV diagnosis, CDC stage, CD4-cell count, and viral load, between groups with and without resistance was identified. CONCLUSION: The prevalence of primary resistant virus strains can be estimated at 14% in chronically infected HAART-naive HIV-patients in Germany. The majority of these cases show NRTI-associated resistance. Resistance against NNRTI or PI as well as multi-class-resistance is of low prevalence. No risk factor of predictive value can be identified for the diagnosis of resistance mutations in the individual. In conclusion, routine genotypic resistance testing in untreated HIV-positive patients should be performed before administration of first-line HAART in this region.

Virus isolation for diagnosing dengue virus infections in returning travelers.

Dengue fever is recognized as one of the most frequent imported acute febrile illnesses affecting European tourists returning from the tropics. In order to assess the value of virus isolation for the diagnosis of dengue fever, 70 cases of dengue fever confirmed in German travelers during the period 1993-2001 were analyzed retrospectively. In 26 patients who had developed acute febrile illness within 2 weeks following their return from a trip to a dengue-endemic area, 9 of 13 attempts to isolate the virus were successful in sera drawn 1-5 days and 2 of 13 sera drawn 6-10 days after the onset of illness. DEN-1 was the most frequent serotype isolated. If performed early, virus isolation is a reliable tool for detecting dengue virus in returning travelers.

[SARS--the facts. Transmission, diagnosis and managing suspected cases]. / SARS--die Fakten. Ubertragungswege, Diagnostik und Umgang mit Verdachtsfällen.

Severe Acute Respiratory Syndrome (SARS) is a new infectious disease that, in the short period between 1 February and 24 April 2003, has been diagnosed in more than 4000 patients. Its origin was traced to Guandong, a province in southeast China. The culprit organism was identified as a new coronavirus. The clinical presentation is unspecific and includes fever, respiratory symptoms, lymphopenia and pulmonary infiltrates on X-ray. Essential steps to prevent further dissemination of the virus are rapid identification, and treatment in an isolation unit. Despite all the international efforts and the rapid progress in the investigation of SARS coordinated by the World Health Organization (WHO), the epidemic has not yet been brought under control.

Acute fascioliasis with multiple liver abscesses.

Human fascioliasis is distributed worldwide with several foci of high endemicity. Being a rare disease in Europe, we describe here a case in the initial hepatic phase of the disease. Therapeutic and, with reference to the 2 distinct stages of disease, diagnostic standards are discussed.