Hepatitis E virus antibody prevalence in hunters from a district in Central Germany, 2013: a cross-sectional study providing evidence for the benefit of protective gloves during disembowelling of wild boars.

BACKGROUND: In Germany, 17% of the general human population have antibodies to hepatitis E virus (HEV) (recomLine HEV-IgG/IgM immunoassay [Mikrogen GmbH]). Wild boars represent an animal reservoir for HEV genotype 3, which is the common genotype in Germany. We estimated the seroprevalence among hunters with contact to wild boars to identify factors that may be associated with past or present HEV infection. METHODS: In 2013, the local veterinarian authority in a district in Central Germany attended meetings of hunters who provided blood specimens and completed a questionnaire collecting information on age, sex, hunting-related activities and consumption of wild boar meat. Specimens of wild boars were taken during drive hunts in this district during the season 2012/2013. All specimens were tested for HEV RNA and anti-HEV IgM and IgG antibodies. Log-binomial regression was used to estimate prevalence ratios (PR) for the hunters. RESULTS: Of 126 hunters (median age 55; 94% male) 21% tested positive for anti-HEV IgG antibodies (95% confidence interval [CI] 13-28%) (recomWell HEV IgG assay [Mikrogen GmbH]). Anti-HEV prevalence was highest in the age group of the 70-79-year-olds (67%; 95% CI 39-95%). Wild boars showed an average anti-HEV prevalence of 41%. HEV RNA was detected in 4/22 (18%) liver specimens and in 1/22 (4.5%) muscle specimens. Most wild boars were tested positive for HEV RNA (3/10; 30%) and HEV-specific antibodies (7/15; 47%) in the southwestern part of the district. Hunters preferring this hunting ground had a lower anti-HEV prevalence when gloves were frequently used during disembowelling of wild boars compared to hunters using gloves never or infrequently (age-adjusted PR 0.12; 95% CI 0.02-0.86). CONCLUSIONS: Hunters may benefit from wearing gloves when in contact with blood or body fluids of HEV animal reservoirs. Anti-HEV prevalence among the hunters of this study did not significantly differ from that of the general population suggesting that other factors play a major role in the epidemiology of HEV in Germany.

[Long central apnea as the chief symptom of aseptic meningoencephalitis in a 6-week-old infant]. / Lange zentrale Apnoen als Hauptsymptom einer aseptischen Meningoenzephalitis bei einem 6 Wochen alten Säugling.

Viral infections can cause apnoea, bradycardia, and desaturation events in preterm and new born infants. These symptoms do not always occur in older infants. A link between virus infection, apnoea, apparent life threatening events (ALTE) and sudden infant death (SID) is speculated. We report a 6-week-old infant with long central apnoea as the first and main symptom of meningoencephalitis caused by enterovirus.

Resolution of obstructive sleep apnea syndrome after adenoidectomy in congenital central hypoventilation syndrome.

We report on a 2 1/2-year-old boy who is currently ventilated at home by positive pressure ventilation through a nasal mask during the night because of congenital central hypoventilation syndrome (CCHS). Up to age 2 he had developed normally. A reevaluation was performed because of symptoms suggestive of obstructive sleep apnea syndrome (OSAS), including snoring, nocturnal sweating, frequent nighttime awakenings, speech impairment, daytime fatigue, and failure to thrive. A sleep study indicated obstructive apnea episodes lasting up to 40 s and arterial desaturations below 50% during spontaneous sleep. During mechanical ventilation snoring persisted, and capillary PCO2 rose to 60 mm Hg. Partial upper airway obstruction, leaking around the mask, and arousal movements developed on passive flexion of the neck to 20 degrees. After adenoidectomy, symptoms of OSAS resolved. There were no more obstructive apneas during spontaneous sleep, but obstructive apneas could be provoked by neck flexion to 20 degrees. During ventilation, neck flexion of 20 degrees was tolerated, but a 40 degrees flexion led to partial obstruction. In CCHS patients, the problem of upper airway obstruction is rarely noted because most patients are ventilated through a permanent tracheostomy. Today, noninvasive ventilation strategies are becoming more common. Reduced activity of upper airway muscles and impaired reflex mechanisms could lead to upper airway obstruction during face mask positive pressure ventilation in children with CCHS. Enlarged adenoids worsened this problem in our patient, leading to insufficient ventilation and OSAS. Adenoidectomy resolved symptoms of OSAS and enabled successful nasal mask ventilation. Close follow-up of the patient avoided hypoxia and sequelae from OSAS such as pulmonary hypertension.

Renal pyelectasis in fetuses and neonates: diagnostic value of renal pelvis diameter in pre- and postnatal sonographic screening.

OBJECTIVE: Pre- and postnatal pyelectasis detected by sonographic screening is of questionable pathologic importance. Therefore, we defined the natural course and diagnostic value of renal pelvis diameter (RPD) during fetal life and the neonatal period as such dilatation was revealed on routine sonography. MATERIALS AND METHODS: Routine sonography in pregnant women was obtained between gestational weeks 22 and 30. Sonograms were obtained for 1021 fetuses, of which 15 could not be followed up as neonates. The remaining 1006 fetuses also underwent neonatal sonography. All neonates with an RPD larger than 5 mm were followed up sonographically. Neonates with an RPD larger than 9 mm or persistent widening (> 5-9 mm) were examined by voiding cystourethrogram, radionuclide renogram, or both. RESULTS: Thirty fetuses (3%) had an RPD larger than 5 mm. Nine of these fetuses also had an RPD larger than 5 mm as neonates. Of these nine neonates, one had bilateral grade II vesicoureteric reflux (VUR) and two had urinary tract obstructions (one posterior urethral valve and one ureteropelvic junction obstruction). Forty-nine neonates whose results on fetal sonograms had been normal showed an RPD larger than 5 mm on neonatal sonograms. Grade III VUR was found in one boy, and ureteropelvic junction obstruction was found in two boys. The kidneys of 54 neonates who showed an RPD larger than 5 mm without urinary tract obstruction were followed up until an RPD of 0-5 mm was evident. RPD normalized within 1 year of birth, whether VUR was present or not. Symptomatic urinary tract infection was diagnosed in 17 infants who had no renal pelvis dilatation seen on pre-or postnatal screening during the observation period. Seven of the 17 neonates had VUR. Conversely, none of the infants with pre- postnatal dilatation presented with symptomatic urinary tract infection. However, in one neonate an asymptomatic urinary tract infection without VUR was diagnosed by routine urinalysis. CONCLUSION: In our study, we linked renal pelvis dilatation on pre- and postnatal sonograms to obstructive uropathies rather than to vesicoureteric reflux. Prenatal sonography proved less sensitive than postnatal sonography in revealing obstructive uropathies. An RPD smaller than 10 mm on neonatal sonography was of no pathologic significance because renal collecting systems normalized spontaneously in all infants within 1 year of birth. These neonates and infants had no significant risk for urinary tract infection and did not need further evaluation.

[Life-threatening hemorrhage caused by vitamin K deficiency in breast-fed infants]. / Lebensbedrohliche Blutungen durch Vitamin-K-Mangel bei gestillten Säuglingen.

4 infants (2 males, 2 females) with acute bleedings due to vitamin K-deficiency beyond the neonatal period are reported. Two infants had intracranial haemorrhage and died. All infants were born appropriate for date and became no vitamin K-prophylaxis. All were breast-fed. This report is a further prove for the existence of the late onset haemorrhagic disease of the newborn. The importance of general vitamin K-prophylaxis is outlined.

Kidney dimensions in ultrasound compared to somatometric parameters in normal children.

In 196 children aged between 4 weeks and 16 2/12 years a sonographic investigation of kidneys was performed and put into relation to somatometric data including bodyweight (BW) bodylength (BL), length of the trunk and the upper and the lower limb, breadth of thorax and pelvic, head circumference, maximum cranial length and maximum cranial breadth. None of the children had signs of renal disorder. Morphometric data, as kidney length, width, depth, parenchymal areas in longitudinal and transverse sections and the prolate ellipsoid volume (PEV) were documented. The children were divided into five groups (group 1: 2-6 months, group 2: 6-31 months, group 3: 31-99 months, group 4: 99-131 months, group 5: 131-194 months). Mean values of all parameters were calculated. For each group a multiple regression analysis was performed and a regression equation of kidney length, parenchymal areas and volume was established. This method allows an individual determination of renal size and parenchymal mass.

Fructose-1,6-diphosphatase deficiency: glycerol excretion during fasting test.

A Turkish boy had suffered since the age of 10 months from recurrent attacks of severe metabolic acidosis and hypoglycaemia precipitated by moderate respiratory tract infections. A liver biopsy showed lack of fructose 1,6-diphosphatase and absence of phosphorylase. The patient died in shock following fructose ingestion. Upon fasting, acidosis with increased lactate and glycerol excretion was found. Findings indicate that, in this inherited disorder of gluconeogenesis, lactic acidosis combined with increased glycerol excretion upon fasting are of diagnostic importance.

[Combined propyphenazone and codeine poisoning in childhood (analysis of 6 patients with Spasmoplus poisoning)]. / Kombinierte Prophyphenazon- und Codeinvergiftung im Kindesalter (Analyse von 6 Patienten mit Spasmoplus-Vergiftung).

The case histories are presented of 6 patients with accidental poisoning by Spasmoplus suppositories. The main toxic constituents are codeine and the pyrazolone derivative, propyphenazone. All patients had symptoms of codeine intoxication with somnolence, miosis and oedema, 2 patients had also symptoms of prophyphenazone intoxication with hypotension, coma and convulsions. 1 patient died during the acute stage in a state of shock, with arrhythmia, and asystole.

Recurrent pyoderma in a family with a defect in leucocyte locomotion.

Granulocyte functions including leucocyte locomotion and chemoluminescence were studied in three generations of a family in which all male members had presented with recurrent pyoderma. While parameters of humoral immunity including serum concentrations of IgG, IgA, IgM, and IgE and of complement components C3 and C4 as well as the response of mononuclear leucocytes to mitogens proved to be within the normal range, leucocyte locomotion was found to be severely impaired in all affected subjects. Moreover, granulocyte dysfunction in male members was associated with the occurrence of a single haplotype (HLA-A2, B13, DR7). These findings suggest that the defect in leucocyte locomotion and the pyoderma might not only have been inherited in an X linked manner but might also have been linked to a gene within the inherited HLA haplotype.