First report of invasive liver abscess syndrome with endophthalmitis caused by a K2 serotype ST2398 hypervirulent Klebsiella pneumoniae in Germany, 2016.

We report a case of severe infection with liver abscess and endophthalmitis caused by a hypervirulent Klebsiella pneumoniae strain in an immunocompetent German male patient without travel history to Asia. Phenotypic and molecular characterization showed high similarity to the reference genome NTUH-K2044 isolated in Asia. The isolate was assigned as ST2398 (clonal complex 66). The findings underline global spread of hypervirulent Klebsiella pneumoniae strains to Europe.

[House dust mite allergy]. / Hausstaubmilbenallergie.

House dust mites can be found all over the world where human beings live independent from the climate. Proteins from the gastrointestinal tract- almost all known as enzymes - are the allergens which induce chronic allergic diseases. The inhalation of small amounts of allergens on a regular base all night leads to a slow beginning of the disease with chronically stuffed nose and an exercise induced asthma which later on persists. House dust mites grow well in a humid climate - this can be in well isolated dwellings or in the tropical climate - and nourish from human skin dander. Scales are found in mattresses, upholstered furniture and carpets. The clinical picture with slowly aggravating complaints leads quite often to a delayed diagnosis, which is accidently done on the occasion of a wider spectrum of allergy skin testing. The beginning of a medical therapy with topical steroids as nasal spray or inhalation leads to a fast relief of the complaints. Although discussed in extensive controversies in the literature - at least in Switzerland with the cold winter and dry climate - the recommendation of house dust mite avoidance measures is given to patients with good clinical results. The frequent ventilation of the dwelling with cold air in winter time cause a lower indoor humidity. Covering encasings on mattresses, pillow, and duvets reduces the possibility of chronic contact with mite allergens as well as the weekly changing the bed linen. Another option of therapy is the specific immunotherapy with extracts of house dust mites showing good results in children and adults. Using recombinant allergens will show a better quality in diagnostic as well as in therapeutic specific immunotherapy.

Classical and new proving methodology: provings of Plumbum metallicum and Piper methysticum and comparison with a classical proving of Plumbum metallicum.

OBJECTIVE: To study the reliability of a proving methodology and the reproducibility of proving symptoms. METHODS: Two homeopathic medicines and placebo were given, in a double-blind randomized design, to 31 healthy volunteers (13 Piper methysticum 30C, 11 placebo and 7 Plumbum metallicum 30C), 5 drops 4 times daily, until the onset of unbearable symptoms, or at most for 1 week. The primary outcome measure was the number of phrases containing unusual or new symptoms selected by supervisors (SEL) from unstructured diaries and the number of these symptoms (SYM) present in SELs. The secondary outcome measures were the number of symptoms with modalities of both verum groups concordant with symptoms reported in a previous proving of Plumbum 12C. Other parameters evaluated were repeated and crossed symptoms in SELs. RESULTS: Both medicines showed qualitative and quantitative differences from placebo. Piper: 146 SELs (median: 5), Plumbum: 118 SELs (16), placebo: 48 SELs (2), containing 260 (8), 199 (29) and 58 (2) SYMs, respectively. There was a significant difference from placebo in Plumbum but not in Piper SELs and SYMs (P < 0.05). 31, 24 and 4 'repeated' and 18, 22 and 2 'crossed' symptoms were found in Piper, Plumbum and placebo. 8 and 30 symptoms concordant with the classical proving of Plumbum were found for Piper and Plumbum, corresponding to about 10% and 45% of their total SELs. CONCLUSIONS: Open diaries, supervision and double-blind placebo are useful methods in homeopathic pathogenetic trials. Estimates of concordance should be introduced in proving methodology.

[Allergy to house dust mites: allergy independent symptoms dominate]. / Hausstaubmilbenallergie: Allergenunabhängige Symptome überwiegen.

A sensitisation to allergens has not always a clinical relevance. Therefore, the history has an uppermost importance for defining the relevance of a sensitisation. In contrast to the history in seasonal rhino-conjunctivitis, which causes typical complains in a restricted time period patients with house dust mite allergy seem to have less defined complaints. To define the most relevant symptoms of this frequent allergy, we evaluated 35 patients with clearly defined house dust mite allergy by a questionnaire and evaluated the same questionnaire also in a control group of 18 patients without sensitisation or asthma. The symptoms described in the patient group confirm that symptoms of house dust mite allergy are frequently not related to a direct allergen exposure. Some patients complained about itchy red eyes in the morning, but the majority of symptoms occurred independent from allergen exposure. These are blocked nose as well as exercise induced asthma. These symptoms are present all year around and are not only restricted to mite exposed areas. They are probably related to the underling eosinophilic inflammation. Thus exercise induced asthma and blocked nose are symptoms, which may indicate a mite allergy, particular in younger patients.

Zafirlukast has no beneficial effects in the treatment of chronic urticaria.

BACKGROUND: Leukotriene receptor antagonists have shown some efficacy in t he treatment of asthma. Injection of LTC4, LTD4 and LTE4 into the skin leads to a weal-and-flare reaction, suggesting an involvement of leukotrienes in the pathogenesis of urticaria. Indeed, various reports have indicated a beneficial effect for leukotriene receptor antagonists in patients with chronic urticaria. OBJECTIVE: To determine the therapeutic effect of the leukotriene receptor antagonist zafirlukast in patients with chronic urticaria. METHODS: The study was a double-blind, placebo-controlled, cross-over study lasting for 12 weeks. Fifty-two patients with chronic urticaria were investigated at a university hospital. The patients were randomized to receive 20 mg zafirlukast b.i.d. or placebo and cross-over was scheduled after 6 weeks. The efficacy of the treatment was evaluated by a daily symptom score, six physical examinations, the requirement of rescue antihistamines (acrivastine) and an overall assessment by the patient andthe investigating physician. RESULTS: Forty-six patients completed the study: zafirlukast was well tolerated without alteration of the investigated laboratory parameters. In comparison with placebo, treatment with zafirlukast resulted in no significant positive effect for any of the efficacy measures. Moreover, we were unable to identify any subgroup of patients with chronic urticaria responding with a therapeutic benefit. CONCLUSIONS: The leukotriene receptor antagonist zafirlukast does not provide a significant therapeutic benefit at a dose of 20 mg b.i.d. in patients with chronic urticaria.

[House dust mites and storage compartment mites as allergy inducers]. / Hausstaubmilben und Vorratsmilben als Allergieausläoser.

Perennial respiratory diseases like chronic rhinopathy or bronchial asthma can often be related to an allergy to indoor allergens. Of these, the most relevant allergens are derived from house dust mites. Epidemiologic data show that 8.9% of the general population exhibit a sensitization to house dust mites. Based on a better knowledge of the biology and the living habits of house dust mites effective allergen avoidance measures can be performed which are, however, quite cumbersome and go beyond just encasing mattresses. Of particular relevance is the reduction of the relative humidity below 50%. Relatives of house dust mites are storage mites which are increasingly realized as an important cause of respiratory allergies. The most important is Lepidoglyphus destructor which is dominant in dust probes from Europe and shows crossreactivity with other storage mites. They are found in barns and grain stores and are thus important causes for occupational respiratory diseases in farmers. The existence of storage mites in house dust is connected with damp housing conditions.

Three years of specific immunotherapy with house-dust-mite extracts in patients with rhinitis and asthma: significant improvement of allergen-specific parameters and of nonspecific bronchial hyperreactivity.

Twenty-seven patients with allergy to house-dust mite and the clinical symptoms of perennial rhinitis and/or mild asthma were treated with specific immunotherapy (SIT) with standardized extracts of house-dust mite for 3 years. The success of therapy was evaluated in yearly intervals by 1) subjective rhinitis and asthma scores. 2) allergen-specific skin and conjunctival tests. 3) nonspecific bronchial hyperreactivity to methacholine. 4) medication scores of rhinitis and asthma. SIT induced a significant improvement of all parameters already after 1 year, with further improvement in the follow-up measurements at 2 and 3 years. We found a constant improvement of the rhinitis and asthma symptom scores, a reduced reactivity in the skin prick and conjunctival provocation tests, and a constantly increasing reduction of bronchial hyperreactivity to methacholine. Concomitantly, the use of medication (topical corticosteroids, beta2-mimetics, and antihistamines) was reduced. Our data support the concept that SIT with standardized extracts of house-dust mite results in an improvement of allergen-specific parameters in patients with perennial rhinitis and intermittent asthma. This beneficial effect of SIT on allergen-specific immune parameters seems to induce also a diminution of nonspecific bronchial hyperreactivity and enables reduction of symptomatic treatment.

[Allergy to house dust mites]. / Hausstaubmilbenallergie.

The prevalence of atopic disease in Switzerland is 15-20%. About 30% of these patients have perennial symptoms and a substantial proportion are allergic to house-dust mite proteins. If absolute air humidity is lower than 7.0 g water per kg air, house-dust mites will not proliferate. This is why the occurrence of house-dust mites varies between different regions. About half of the patients with allergy to house-dust mites complain of rhinitis, a quarter of asthma and a quarter of asthma and rhinitis. The diagnosis is usually by history, skin prick tests and if necessary provocation. Therapy includes allergen avoidance (reduction of air humidity in dwellings by ventilation, encasing of mattresses and bedding), medication (mainly topical corticosteroids) and specific immunotherapy.

[Corticosteroid allergy: a paradox?]. / Kortikosteroidallergie: Ein Paradoxon?

Although corticosteroids have both antiinflammatory and immunosuppressive effects, they can occasionally induce allergic reactions when given topically or systemically. Since cross-reactions exist within the corticosteroid groups A-D, the corticosteroid should be changed to another group whenever suspicion arises. It makes sense to render an allergy-related diagnosis early so that a suitable corticosteroid is ready for an emergency.

T cell involvement in persulfate triggered occupational contact dermatitis and asthma.

BACKGROUND: Ammonium and potassium persulfates may induce a variety of cutaneous and respiratory diseases. The precise underlying mechanisms, however, are unclear. OBJECTIVE: To describe a hairdresser, who developed contact dermatitis, rhinoconjuntivitis, and bronchial asthma of delayed onset after occupational exposure to hair bleaches containing persulfate salts and to provide evidence for a common T-cell mediated mechanism responsible for the clinical manifestations. METHODS: We performed skin testing, routine histologic and immunohistochemical examination of the skin reaction after prick testing, lymphocyte proliferation analysis, nasal challenge test, and pulmonary function testing. RESULTS: The causative role of bleaching powder and ammonium persulfate was demonstrated by case history, skin tests, and a nasal challenge test. Patch tests produced a delayed cutaneous reaction to ammonium persulfate confirming contact sensitization. Prick tests with bleaching powder and ammonium persulfate were negative at 15 minutes but revealed a late skin reaction with a papule at the prick sites after 24 hours. Histologic examination of this late reaction demonstrated a perivascular infiltration comprising predominantly T lymphocytes. Further, a significant proliferation of T cells to bleaching powder was reproducibly found by a lymphocyte proliferation analysis. Nasal challenge test with bleaching powder showed a significant reduction of air flow after 24 hours. CONCLUSION: Our findings suggest that immunologic mechanism with direct involvement of T cells may not only play an important role in the pathogenesis of the cutaneous but also in the respiratory and rhinoconjunctival reactions.

Specific immunotherapy with Dermatophagoides pteronyssinus and D. farinae results in decreased bronchial hyperreactivity.

To evaluate the tolerability and efficacy of specific immunotherapy with mite extracts, we performed a double-blind, placebo-controlled immunotherapy study in 30 patients with proven allergy to mite allergens. The specific immunotherapy with standardized extracts of Dermatophagoides pteronyssinus and D. farinae by a clustered rush protocol was well tolerated. After 1 year of treatment, the actively treated group showed a significant improvement compared to their starting value as well as to the placebo-treated patients with regard to skin prick test, conjunctival provocation test, and subjective rhinitis score. The subjective asthma score and bronchial hyperreactivity, measured by the methacholine provocation test, was improved in comparison to the starting value, but not to the placebo group, after 12 months. However, a further, open comparison of the placebo- and verum-treated groups at 18 months revealed a significant reduction. The drug intake was not increased in the verum-treated group. Exposure to mite levels was constant throughout this time period, as revealed by antigen measurement. We conclude that specific immunotherapy in perennial, mite-allergen-induced asthma may reduce not only immediate, IgE-mediated symptoms but, after a rather long time period of 12-18 months, also the inflammatory component of bronchial asthma, thus leading to a reduction of unspecific hyperreactivity.

IgE cross-reactivity between birch pollen, mugwort pollen and celery is due to at least three distinct cross-reacting allergens: immunoblot investigation of the birch-mugwort-celery syndrome.

BACKGROUND: Allergy to celery is often associated with sensitization to birch and/or mugwort pollen. OBJECTIVE AND METHODS: In a multi-centre study, sera from 23 patients suffering from type 1 allergy to celery and 15 patients with positive celery RAST but no clinical sensitization were compared. To examine whether cross-reactivity between celery and mugwort pollen includes cross-sensitization to birch pollen allergens, we determined cross-reacting structures in birch pollen, mugwort pollen and celery by means of immunoblotting. Inhibition studies were performed by preincubation of sera with extracts of birch pollen, mugwort pollen, and celery. RESULTS: We identified three groups of proteins--homologues of Bet v 1 and birch profilin (Bet v 2) as well as a group of proteins with a molecular range of 46 to 60 kD--displaying IgE-cross-reactivity, which were shared by birch pollen and celery. Two of these groups of allergens (profilin and the 46 to 60 kD proteins) were also present in mugwort pollen. In this paper we demonstrate that most cross-reacting allergens present in mugwort pollen and celery can also be detected in birch pollen extract. CONCLUSION: Therefore we propose, from a serological point of view, to extend the mugwort-celery syndrome to the birch-mugwort-celery syndrome.

[Determining the effectiveness of percutaneous cava filters: experimental studies]. / Bestimmung der Effektivität perkutaner Kavafilter: Experimentelle Untersuchungen.

PURPOSE: In vitro clot-trapping capacity of 16 different caval filters should be evaluated under varying experimental conditions. MATERIAL AND METHODS: In a flow model simulating in vivo conditions (soft latex tube, dextran solution at 37 degrees C, pulsatile flow at a mean rate of 3 1/min) the efficiency of 16 caval filters was evaluated in horizontal and vertical position by using 640 or 1280 clots/filter (8 sizes). Non-self centering filters were tested in centric and in tilted position. RESULTS: Efficiency of optimally centered caval filters varied between 97.8 and 69.4%. The largest thrombi were captured by all optimal centered filters. A change from vertical to horizontal position of the flow model resulted in a variation of filter efficiency by about 4.8%. Efficiency of non-self centering filters decreased significantly when placed in a tilted position (mean decrease 15.5%; range 2.7%-37.7%) resulting in a deterioration of the capture rate by as much as 43.2%. CONCLUSION: Under optimal study conditions efficiency of all evaluated caval filters was high. Tilting of caval filters resulted in a significant efficiency decrease.

The influence of LCD shutter glasses on spatial perception in stereoscopic visualization.

For a general establishment of stereoscopic visualisation systems in clinical routine a fundamental analysis of the influence of technical, optical and physiological parameters onto visual spatial perception seems to be necessary to achieve an optimisation of the existing devices. As one important component of these systems we perform studies on the influence of LCD Shutter glasses on the individual binocular perception. The developed shutter system, the initial experiments and their results are presented.

Three-dimensional versus two-dimensional video endoscopy. A clinical field study in laparoscopic application.

Stereoscopic visualisation systems are available for the medical application in clinical routine, especially in the field of endoscopic or minimal invasive surgery. As we have shown in laboratory studies in 1991 the use of stereoscopic visualisation systems leads to a significant improvement of endoscopic manipulation. A broader diffusion of these systems in clinical routine will be based on quantitative evaluation of the influence of stereoscopic visualisation systems on the intervention. As a first approach we performed a clinical field study to compare 2D and 3D video endoscopy in laparoscopic interventions in urological surgery.

Selective stimulation of CD4+ versus CD8+ T-cell subsets in symptomatic and asymptomatic HIV-1-infected individuals.

To analyze the proliferative capacity of CD4+ or CD8+ T-cell subsets of individuals infected with human immunodeficiency virus type 1 (HIV-1) and to optimize the in vitro conditions for virus replication, CD4+ or CD8+ cells of HIV-1-infected patients were selectively activated inside the whole peripheral blood mononuclear cell (PMNC) population by dual antibody stimulation. To do so PMNC of HIV-1-infected individuals were stimulated with the per se nonmitogenic anti-CD3 antibody fragment BMA030 F(ab)2 crosslinked through goat antimouse antibodies with an anti-CD4 or an anti-CD8 antibody, which lead to selective proliferation of either the CD4+ or the CD8+ T-cell subset. In the presence of monocyte supernatant and recombinant interleukin-2 (rIL2) CD4+ cells of HIV-1 patients responded normally upon such stimulation as their proliferation correlated (r = 0.9) to the percentage CD4+ cells present in the PMNC population. Selective stimulation and proliferation of CD8+ cells could, however, only partially be elicited by dual antibody stimulation, even in the presence of rIL-2 and monocyte supernatant. Their proliferative response did not correspond (r = 0.1) to the percentage CD8+ cells present in the PMNC culture. A positive correlation (r = 0.7) was detected only between percentage CD8+ HLA-DR- cells and proliferation. This confirmed previous studies showing that the defective in vitro proliferative response of peripheral blood lymphocytes of HIV-infected individuals to mitogens, which is usually interpreted being due to a CD4 cell defect, is actually due to a failure of CD8+DR+ cells to proliferate.(ABSTRACT TRUNCATED AT 250 WORDS)

[Exertion-induced anaphylaxis]. / Anstrengungsinduzierte Anaphylaxie.

The syndrome of exercise induced anaphylaxis represents a distinct form of physical allergy. This syndrome and the features which distinguish it from other forms of physical allergy are discussed in the context of 10 case reports. The symptoms usually start after 5-30 minutes' exercise with cutaneous pruritus, warmth and progress to urticaria and angioedema. In 3 cases signs of laryngeal edema were present; additional manifestations included upper respiratory distress, gastrointestinal tract symptoms and collapse. The syndrome is distinct from exercise induced asthma or cholinergic urticaria. One patient had both cholinergic urticaria induced by stress, heat and exercise, and anaphylactoid symptoms induced by exercise alone. While the symptoms of cholinergic urticaria subsided after 2-4 hours, the anaphylactoid symptoms lasted up to 48 hours. The symptoms are elicited irregularly, which suggests a multifactorial trigger mechanism. The intake of particular foods or acetylsalicylic acid, and certain weather conditions, are possible cofactors. In 8 of 10 patients an atopic diathesis was found but no exposition to a specific allergen, which could explain the symptoms, was observed. Therapy consists of avoidance of cofactors, change of training habits and cessation of exercise as soon as prodromal symptoms develop. If attacks are frequent, antihistamines or ketotifen can be tried. The acute attack should, like other anaphylactoid reactions, be treated by antihistamines, injection of epinephrine (s.c.) and infusions (colloidal solutions).