Serum and mucosal antibodies fail as prognostic markers during critical influenza A infection.

BACKGROUND: Previous studies have indicated that the absence of serum antibodies to influenza A H1N1 virus on day 4 after onset of symptoms predicted a fatal outcome in patients critically ill with influenza. The underlying mechanism was suggested to be the trapping of anti-influenza antibodies in pulmonary immune complexes. OBJECTIVES: To study serum and mucosal antibodies as prognostic markers in patients with severe influenza A H1N1 infection. STUDY DESIGN: Blood and respiratory samples (n=324) from 12 patients with severe influenza were analysed for anti-H1N1 antibodies with and without immune complex dissociation from symptom onset until convalescence or death (follow up 14-169 days). Eleven healthy subjects were analysed for comparison. RESULTS: One of the 12 patients died from influenza pneumonia and had no detectable anti-H1N1 serum antibodies. However, also 2 of the 11 surviving patients remained negative for anti-H1N1 serum antibodies during follow-up (20 and 41 days, respectively). In six of the 11 survivors serum antibodies on day 4 were negative, but turned positive between day 7 and 23. In the remaining 3 patients antibodies were detected in the first 4 days of illness. Mucosal IgG or IgA was detected in all of the patients regardless of their clinical outcome and in 4 of 11 healthy subjects. No mucosal immune complexes were found in the patient who died but were detected in 3 of the 11 survivors. CONCLUSIONS: This study suggests that no prognostic conclusions can be drawn from anti-H1N1 serum and mucosal antibodies in patients with severe influenza.

What We Have Learned from the Influenza A pH1N1 2009/10 Pandemic: High Clinical Impact of Human Metapneumovirus and Respiratory Syncytial Virus in Hospitalized Pediatric Patients.

The influenza pandemic in 2009/2010 shifted public awareness to respiratory tract infections caused by the influenza virus. A prospective study was conducted during the influenza pandemic from November 2009 through April 2010 to determine the causative pathogens and clinical symptoms present in all children and adolescents admitted to the University Children's Hospital, Duesseldorf, Germany, with signs and symptoms of respiratory tract infection. A total of 272 children and adolescents were admitted with symptoms of acute respiratory tract infection (ARI) or influenza-like illness. Viral pathogens were detected in 80% (218/272). However, influenza A pH1N1 infection was only detected in 11% (30/272) of children. Human metapneumovirus (HMPV) and respiratory syncytial virus (RSV) were the predominant identified pathogens that led to the admission of young tachypneic children with pneumonia in the post pandemic phase and the requirement for more intense treatment. During the pandemic and early post-pandemic phase the clinical impact of other respiratory viruses, such as HMPV and RSV, led to a higher clinical disease burden than pH1N1. Consequently, HMPV testing should be performed as routinely as RSV testing in patients hospitalized for ARI. Even while preparing for pandemics, the awareness of other respiratory viruses must be maintained.

Primarily oseltamivir-resistant influenza A (H1N1pdm09) virus evolving into a multidrug-resistant virus carrying H275Y and I223R neuraminidase substitutions.

Antiviral susceptibility testing and reporting of viruses carrying amino acid substitutions conferring antiviral drug resistance is essential to assess the spread and clinical impact of these viruses. Here, we report on a patient who was infected with a primarily oseltamivir-resistant influenza A (H1N1pdm09) virus following allogeneic stem cell transplantation and rituximab treatment. Under prolonged virus replication and zanamivir therapy the neuraminidase amino acid substitutions H275Y and I223R were detected conferring high-level resistance to oseltamivir and cross-resistance to zanamivir. The emergence of these amino acid changes has been reported rarely worldwide and has been associated with fatal clinical outcomes. The patient survived the influenza infection after 170 days of follow-up.

Spontaneous reactivation of hepatitis B virus replication in an HIV coinfected patient with isolated anti-Hepatitis B core antibodies.

Co-infections with HBV (hepatitis B virus) occur in HIV (human immunodeficiency virus) patients frequently. It has been reported that an effective treatment of HIV can also lead to a suppression of HBV and to anti-HBs seroconversion in HBV-infected patients. Here, we report a spontaneous reactivation of HBV replication in an HIV-infected patient with anti-HBc as the only marker of chronic HBV infection. The patient was known to be coinfected with HIV and HBV for years and the HBV DNA was measured repeatedly at low levels. A significant increase of HBV DNA up to 1.7 x 107 IU/ml was found accompanied with clinical symptoms of hepatitis. Multiple mutations occurred in the S gene during the flare-up of HBV as shown by sequencing, including I103T, K122R, M133I, F134V, D144E, V164E and L175S. Anti-HIV/HBV treatment led to a resolution of symptoms and to a decrease in the HIV RNA and HBV DNA viral load. It is possible that the accumulated mutations during HBV replication were selected and responsible for the reactivation.

Early detection of oral cancer: dentists' opinions and practices before and after educational interventions in Northern-Germany.

INTRODUCTION: The question whether educational programmes improve dentists' knowledge of oral cancer is still an unexplored subject. The aim of this study was to assess dentists' opinions and practices concerning oral cancer using a standardised survey after educational intervention over one year. MATERIAL AND METHODS: Following a baseline survey which was mailed to every dentist in Schleswig-Holstein, Germany (n = 2280), the results were analysed to produce a multifaceted educational programme. After educational intervention, the same survey was redistributed and the results before and after intervention were compared. RESULTS: The results are based on 394 surveys. Following intervention, 62% of responders, compared to 49% at baseline, described their overall knowledge as current. The percentage of dentists routinely investigating older patients at the recall appointment increased from 28% at baseline to 37% if the responders had attended a continuing education course during the period of intervention. Similar improvements were observed at initial appointment for older patients, with results improving from 33% to 38% for responders who attended a further educational course. CONCLUSIONS: Our results showed that a 1-year educational intervention with a multifaceted approach was successful. They underline that continuing education programmes improve the competence of dentists performing examination of the oral cavity. Therefore, regular participation in continuing educational courses is recommended.

The oral cancer knowledge of dentists in Northern Germany after educational intervention.

The objective of this study was to assess the knowledge about oral cancer, in particular about diagnostic items and risk factors, after educational intervention by means of a standardized survey. On the basis of the evaluation at baseline, an educational programme consisting of different approaches (for instance, oral presentations, poster, DVD and a brochure) was designed. In May 2009, the questionnaire 'Practices and opinions about oral cancer' focusing on the knowledge about diagnostic factors and risk factors for oral cancer was mailed to every dentist in Schleswig-Holstein, Germany (n = 2280). The results were based on 394 of 2280 questionnaires. After a 1-year educational intervention, the dentists' overall knowledge about diagnostic procedures and risk factors for oral cancer had improved. The low baseline results for diagnostic procedures and risk factors showed the highest improvement rate immediately after the intervention. Within the reevaluation subgroups, responders who had attended a continuing education course during the intervention period showed better results compared with the whole sample of the reevaluation. The results showed that a structured educational programme with different approaches increases dentists' knowledge about diagnostic procedures and risk factors. This intervention may not only give useful recommendations for further educational courses, but emphasizes the necessity of attending continuous further educational courses.