TY - JOUR A1 - Elias, Johannes A1 - Findlow, Jamie A1 - Borrow, Ray A1 - Tremmel, Angelika A1 - Frosch, Matthias A1 - Vogel, Ulrich T1 - Persistence of antibodies in laboratory staff immunized with quadrivalent meningococcal polysaccharide vaccine JF - Journal of Occupational Medicine and Toxicology N2 - Background Occupational exposure to live meningococci can potentially cause invasive meningococcal disease in laboratory staff. While, until recently, immunization with quadrivalent polysaccharide vaccine represented one cornerstone of protection, data on long-term persistence of antibodies in adults remain scarce. Methods We analyzed the relationship of antibody levels and time following quadrivalent polysaccharide vaccination (Mencevax® ACWY, GlaxoSmithKline) in a cross-sectional sample of 20 laboratory workers vaccinated at ages between 16.4 to 40.7 years from Germany. Sera were obtained 0.4 to 158.5 (median 35.3) months after vaccination. At the time of sampling, laboratory workers had been regularly exposed to meningococci for periods between 3.2 to 163.8 (median 41.2) months. Serum bactericidal assay (SBA) with rabbit complement and a microsphere-based flow analysis method were used to determine bactericidal titers and concentrations of IgG, respectively, against serogroups A, C, W135, and Y. Decay of antibodies was modeled using linear regression. Protective levels were defined as SBA titers ≥ 8. Results Half-lives of SBA titers against serogroups A, C, W135, and Y were estimated at 27.4, 21.9, 18.8, and 28.0 months, respectively. Average durations of protection were estimated at 183.9, 182.0, 114.6, and 216.4 months, respectively. Inter-individual variation was high; using lower margins of 95% prediction intervals, minimal durations of protection against serogroups A, C, W135 and Y were estimated at 33.5, 24.6, 0.0, and 55.1 months, respectively. The proportion of staff with protective SBA titers against W135 (65.0%) was significantly lower than proportions protected against A (95.0%), C (94.7%), and Y (95.0%). Consistently, geometric mean titer (97.0) and geometric mean concentration of IgG (2.1 μg/ml) was lowest against serogroup W135. SBA titers in a subset of individuals with incomplete protection rose to ≥ 128 (≥ 8 fold) after reimmunization with a quadrivalent glycoconjugate vaccine. Conclusions The average duration of protection following immunization with a quadrivalent polysaccharide vaccine in adults was ≥ 115 months regardless of serogroup. A substantial proportion (approximately 23% according to our decay model) of adult vaccinees may not retain protection against serogroup W135 for five years, the time suggested for reimmunization. KW - Vaccination KW - Meningococcal infection KW - Biohazard KW - Meningococcal polysaccharide caccine Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-95953 UR - http://www.occup-med.com/content/8/1/4 ER - TY - THES A1 - Münstermann, Marcel T1 - The roles of the anaphylatoxin receptors during invasive disease as well as mucosal colonization caused by \(Neisseria\) \(meningitidis\) T1 - Die Rolle der Anaphylatoxinrezeptoren während invasiver Infektion sowie mukosaler Kolonisation verursacht durch \(Neisseria\) \(meningitidis\) N2 - The human specific gram-negative bacterium Neisseria meningitidis (Nme, meningococci) is a common colonizer of the upper respiratory tract. Upon becoming invasive, Nme can cause meningitis and life-threatening sepsis. The most important immune defense mechanism in invasive meningococcal disease (IMD) is the complement mediated killing of bacteria. The complement cascade is activated through different pathogen associated patterns and finally leads to the lysis of the bacteria by the membrane attack complex. In addition to the direct bacterial killing, the complement system is also an important player in different inflammatory processes. A hallmark of IMD is an overreaction of the immune system and the release of the potent anaphylatoxins C3a and C5a by the complement system is an important factor hereby. There are three anaphylatoxin receptors (ATRs), the C3aR, the C5aR1 and the C5aR2, capable of detecting these anaphylatoxins. It has already been shown that blocking the ATR C5aR1 strongly benefitted the outcome of IMD in a murine sepsis model. However, the roles of ATRs C3aR and C5aR2 in IMD are still unclear. This work aims to analyze the role of these ATRs in meningococcal sepsis and to identify possible underlying mechanisms. Furthermore, a possible involvement of the complement system, the ATRs and the type II CRISPR/Cas system on nasopharyngeal colonization is analyzed. In vivo depletion experiments showed that without neutrophils or monocytes/macrophages the complement system alone was not able to clear a low dose Nme infection, which highlights the importance of cellular components in IMD. Analyzing the role of the ATRs in knock-out mice with high dose Nme infections, revealed that the lack of C5aR2, like the lack of C5aR1, was beneficial for the outcome of meningococcal induced sepsis. In contrast, the lack of C3aR in knock-out mice was detrimental. The positive outcome associated with the C5aRs could be reproduced by using an antagonist against both C5aRs or an antagonist specifically against C5aR1 in WT mice. These findings are giving hope to future therapeutic applications. Next, a possible contribution of neutrophils to this positive outcome was analyzed. Absence of C5aR1 led to a decrease of degranulation by neutrophils in a murine whole blood model, while the other ATRs showed no effect. Neutrophil analysis in human whole blood, on the other hand, revealed a reduced oxidative burst and IL-8 secretion upon inhibition of all three ATRs. A functional difference between the C5aRs and the C3aR in neutrophils was observed in phagocytosis, which was reduced upon C3aR inhibition, but was unaltered with C5aR1 or C5aR2 inhibition. Possible underlying mechanisms in the phosphorylation of ERK1/2 were analyzed in bone marrow derived macrophages isolated from ATR knock-out mice. The later phosphorylation of ERK1/2 in macrophages without C5aR1 or C5aR2 expression might explain, why blocking the C5aRs is beneficial for the outcome of IMD in mice. In contrast to these findings, the colonization of the nasopharynx in huCEACAM 1 expressing mice by Nme did not seem to depend on the Complement system factors C3 and C5 nor the ATRs. Additionally, no difference in the colonization could be observed in this model using Nme mutants lacking different parts of the type 2 CRISPR/Cas system. Conclusively, this work highlights the importance of the complement system, the ATRs and the cellular components in IMD. Contrariwise, these factors did not play a role in the analyzed nasopharyngeal infection model. The beneficial effects of C5aR1 and C5aR2 lack/inhibition in IMD might have medicinal applications, which could support the standard therapies of IMD in the future. N2 - Das human spezifische pathogene Gram-negative Bakterium Neisseria meningitidis (Nme, Meningokokken) ist ein Kommensale angesiedelt im Nasopharynx. Bei invasiver Erkrankung können Nme Meningitis oder eine lebensbedrohliche Sepsis verursachen. Die wichtigste Verteidigung des Immunsystems in invasiver Meningokokken-Erkrankung (IMD) ist die Abtötung von Bakterien durch das Komplementsystem. Die Komplementkaskade wird durch verschiedene pathogenassoziierte Muster in Gang gesetzt und resultiert in dem Aufbau des Membranangriffskomplex, welcher die Bakterien schließlich lysiert. Darüber hinaus spielt das Komplementsystem auch eine wichtige Rolle in verschiedenen inflammatorischen Prozessen im Körper. Ein charakteristisches Merkmal von IMD ist eine übermäßige Reaktion des Immunsystems und dabei ist die Freisetzung der Anaphylatoxine C3a und C5a, durch das Komplementsystem, ein wichtiger Faktor. Es gibt drei Anaphylatoxin Rezeptoren (ATR), den C3aR, den C5aR1 und den C5aR2, welche die jeweiligen Anaphylatoxine erkennen. In murinen Modellen wurde bereits gezeigt, dass die Inhibition des C5aR1 einen positiven Einfluss auf den Verlauf von IMD hat. Im Kontrast dazu sind die Rollen der ATRs C3aR und C5aR2 in IMD weiter unklar. Diese Arbeit hat als Ziel, die Rolle der ATRs in Meningokokken induzierter Sepsis zu untersuchen und mögliche zugrundeliegende Mechanismen zu finden. Des Weiteren soll ein möglicher Einfluss des Komplementsystems, der ATRs und des Typ II CRISPR/Cas Systems auf die Kolonisation durch Nme im Nasopharynx untersuchen werden. In vivo Depletions-Versuche zeigten, dass ohne Neutrophile oder Monozyten/Makrophagen das Komplementsystem allein nicht in der Lage war eine Nme-Infektion mit einer niedrigen Infektionsdosis zu beseitigen. Dies zeigt die Wichtigkeit von Immunzellen neben dem Komplementsystem in IMD. Experimente mit hohen Nme-Dosen in ATR knock-out Mäusen zeigten, dass die fehlende Expression von C5aR2, wie die von C5aR1, sich positiv auf den Ausgang von IMD auswirkte. Im Gegensatz dazu, verschlimmerte das Fehlen des C3aR Rezeptors den Ausgang der IMD. Die positive Wirkung in den C5aR knock-out Mäusen, konnte auch mit der Gabe von einem gegen beide C5aRs oder einem spezifisch gegen C5aR1 gerichteten Antagonisten in WT Mäusen beobachtet werden. Diese Ergebnisse geben Hoffnung auf eine mögliche zukünftige therapeutische Applikation. Als nächstes wurde eine mögliche Beteiligung von Neutrophilen an dem positiven Ausgang von IMD in Abhängigkeit von den ATRs untersucht. Eine fehlende C5aR1 Expression führte zu einer verminderten Degranulation durch Neutrophile in dem verwendeten murinen Vollblutmodel, wohingegen die fehlende Expression der anderen ATRs keinen Effekt zeigte. Im Gegensatz dazu, zeigten Versuche mit humanem Vollblut einen verminderten Oxidativen Burst sowie eine verminderte Ausschüttung von IL-8 bei der Blockade von allen drei ATRs. Ein Unterschied zwischen den C5aRs und dem C3aR zeigte sich hingegen in der Phagozytose, welche mit C3aR Inhibierung reduziert war, aber unverändert nach der Inhibierung von C5aR1 oder C5aR2 blieb. Mögliche zugrundeliegende Mechanismen in der Phosphorylation von ERK1/2 wurden anschließend in Knochenmark-gereiften Makrophagen von ATR knock-out Mäusen untersucht. Ohne C5aR1 oder C5aR2 Expression wurde eine verzögerte Phosphorylierung von ERK1/2 in den Makrophagen beobachtet, was erklären könnte warum die Blockade von C5aRs den Ausgang von Meningokokken induzierter Sepsis in Mäusen positiv beeinflusst. Im Gegensatz zu diesen Ergebnissen wurde die Kolonisation des Nasopharynx durch Nme in huCEACAM-1 exprimierenden Mäusen, weder durch die Komplementfaktoren C3 und C5 noch durch die ATRs beeinflusst. Zusätzlich konnte auch kein Unterschied in der Besiedelung des Nasopharynx durch Nme-Mutanten, die verschiedene Mutationen des Typ 2 CRISPR/Cas Systems besaßen, beobachtet werden. Diese Arbeit zeigt die Wichtigkeit des Komplementsystems, der ATRs und der Immunzellen in IMD. Zusätzlich zeigt diese Arbeit, dass das Komplementsystem und die ATRs jedoch keine Auswirkungen auf die Kolonisation des Nasopharynx in Mäusen haben. Die äußerst positive Auswirkung auf IMD, wenn C5aR1 und C5aR2 nicht gebildet oder blockiert werden, könnte medizinisch von Bedeutung sein und eventuell in der Zukunft die Standarttherapie bei IMD unterstützen. KW - Anaphylatoxine KW - Komplement C3a KW - Komplement C5a KW - Neisseria meningitidis KW - Komplement KW - anaphylatoxin receptors KW - invasive meningococcal diseases KW - Anaphylatoxinrezeptoren Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-269759 ER - TY - THES A1 - Mordhorst, Ines Louise T1 - Phylogenetische und funktionelle Analysen zur Kapsel O-Acetyltransferase NeuO von Escherichia coli K1 T1 - Phylogenetic and functional analysis on the capsule O-acetyltransferase NeuO of Escherichia coli K1 N2 - Escherichia coli ist ein Kommensale des menschlichen und tierischen Gastrointestinaltraktes. Einige E. coli-Stämme sind in der Lage, extraintestinale Erkrankungen beim Menschen wie Harnwegsinfekte, Neugeborenen-Meningitis und Sepsis, sowie beim Tier aviäre Coliseptikämien, hervorzurufen. Ein wichtiger Virulenzfaktor des Bakteriums ist dabei die aus α-2,8-verknüpften Sialinsäuremonomeren aufgebaute K1-Kapsel, die phasenvariabel mit einer hohen Frequenz O-acetyliert werden kann. Im Jahr 2005 konnte gezeigt werden, dass es sich bei dem für die O-Acetylierung verantwortlichen Enzym um die O-Acetyltransferase NeuO handelt, die von dem K1-spezifischen Prophagen CUS-3 codiert wird. Die Verteilung von neuO in der E. coli K1-Population sowie die funktionelle Relevanz der K1-Kapsel O-Acetylierung für das Bakterium waren zu Beginn der vorliegenden Arbeit weitestgehend unklar. Eine E. coli K1-Stammsammlung mit 183 Isolaten wurde aufgebaut. Die E. coli K1-Isolate stammten sowohl aus Stuhlproben gesunder Freiwilliger, humanen Harnwegsinfekten, humanen invasiven Erkrankungen (Neugeborenen-Meningitis und Bakteriämie) und aus an Coliseptikämie erkrankten Vögeln. Die Isolate der E. coli K1-Stammsammlung wurden mit der Multilokus-Sequenztypisierung (MLST) typisiert. Es konnten 39 Sequenztypen (ST) sowie fünf Sequenztyp-Komplexe (STC) identifiziert werden. Bei dem mit Abstand häufigsten STC handelte es sich um den STC95, dem 80 Stämme (44%) angehörten. Insgesamt 103 der 183 E. coli K1-Stämme waren neuO-positiv (56%). Das Gen wurde in 78 (98%) der STC95-Isolate, aber nur in 25 (24%) der 103 nicht-STC95-Stämme gefunden. NeuO war also mit dem STC95 assoziiert. Über Sequenzanalysen des CUS-3-Prophagen konnten CUS-3-Genotypen bestimmt werden. Die Gruppierung der CUS-3-Genotypen und der E. coli K1-ST sowie der anschließende Vergleich beider Gruppierungen miteinander offenbarte eine Segregation der Prophagen-Genotypen entsprechend der ST. Daher legen die in dieser Arbeit ermittelten Ergebnisse eine Koevolution des Phagen mit seinem Wirt nahe. Einige humane und aviäre E. coli K1-Isolate waren weder auf Basis der MLST bzw. der CUS-3-Genotypisierung noch anhand des Vorhandenseins verschiedener, mit extraintestinal-pathogenen E. coli-assoziierter Gene voneinander unterscheidbar, was die Hypothese einer zoonotischen Transmission dieser Stämme unterstützt. In den in dieser Arbeit durchgeführten funktionellen Analysen konnte weder ein Effekt der NeuO-vermittelten E. coli K1-Kapsel O-Acetylierung auf die Fähigkeit der Bakterien an humane mikrovaskuläre Gehirnendothelzellen zu adhärieren oder in diese zu invadieren, noch auf die in vivo-Virulenz der Bakterien im Hühnermodell beobachtet werden. Die K1-Kapsel O-Acetylierung verringerte die in vivo-Kolonisierung des Hühner-Gastrointestinaltraktes und die in vitro-Biofilmbildung durch das Bakterium, wohingegen sie die Austrocknungsresistenz von E. coli K1 erhöhte. Möglicherweise dient die phasenvariable neuO-Expression und damit die E. coli K1-Kapsel O-Acetylierung der Anpassung des Bakteriums an wechselnde Umweltbedingungen. N2 - Escherichia coli is a commensal of the human and animal intestinal tract. Some strains have the ability to cause extraintestinal disease in humans such as urinary tract infections, neonatal meningitis and septicemia, but also animal infection such as avian colisepticemia. A major virulence factor of the bacterium is the K1 capsule composed of α-2,8-linked sialic acid monomers, which can be phase variably O-acetylated at a high frequency. In 2005, it was shown that the enzyme responsible for O-acetylation is the O-acetyltransferase NeuO, which is encoded by the K1-specific prophage CUS-3. The distribution of neuO as well as the functional relevance of the K1 capsule O-acetylation for the bacterium were largely unknown at the start of the thesis. A strain collection comprising 183 E. coli K1 strains was established. The E. coli K1 isolates derived from stool samples of healthy donors, human urinary tract infections, human invasive diseases like newborn meningitis and bacteremia, and from avian colisepticemia. All isolates were typed by multilocus sequence typing (MLST). Thirty-nine sequence types (ST) and five sequence type complexes (STC) were identified. The major share of the strains belonged to the STC95 (80 strains, 44%). 103 of 183 E. coli K1 strains were neuO-positive (56%). The gene was found in 78 (98%) STC95 isolates, but only in 25 (24%) of 103 non-STC95 isolates. Therefore, there was an association of neuO with the STC95. With the help of DNA sequencing of internal fragments of CUS-3, distinct CUS-3 genotypes were assigned. There was a segregation of CUS-3 genotypes according to STs, suggesting coevolution of the prophage CUS-3 and its host. Some human and avian isolates were indistinguishable with respect to MLST, CUS-3 genotyping and the presence of genetic markers associated with extraintestinal pathogenic E. coli, which was compatible with the hypothesis of zoonotic transmission of these strains. Functional analyses performed in this study neither revealed an impact of NeuO-mediated K1 capsule O-acetylation on the ability of the bacteria to adhere to or invade into human brain microvascular endothelial cells, nor on the in vivo virulence of the bacteria in a chicken infection model. K1 capsule O-acetylation decreased in vivo chicken gut colonization and in vitro biofilm formation, while increasing E. coli K1 desiccation resistance. This study provides evidence that phase variable neuO expression and the subsequent O-acetylation of the E. coli K1 capsule serves as an efficient tool for the adaptation to changing environments. KW - Escherichia coli KW - Kapsel KW - Biofilm KW - Phylogenie KW - Virulenzfaktor KW - Acetylierung KW - Genexpression KW - O-Acetylierung KW - Multilokus-Sequenztypisierung KW - O-acetylation KW - multilocus sequence typing Y1 - 2009 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-47880 ER - TY - JOUR A1 - Aldejohann, Alexander Maximilian A1 - Wiese-Posselt, Miriam A1 - Gastmeier, Petra A1 - Kurzai, Oliver T1 - Expert recommendations for prevention and management of Candida auris transmission JF - Mycoses N2 - Candida auris was first described as a yeast pathogen in 2009. Since then, the species has emerged worldwide. In contrast to most other Candida spp., C. auris frequently exhibits multi-drug resistance and is readily transmitted in hospital settings. While most detections so far are from colonised patients, C. auris does cause superficial and life-threatening invasive infections. During management of the first documented C. auris transmission in a German hospital, experts from the National Reference Centers for Invasive Fungal Infections (NRZMyk) and the National Reference Center for Surveillance of Nosocomial Infections screened available literature and integrated available knowledge on infection prevention and C. auris epidemiology and biology to enable optimal containment. Relevant recommendations developed during this process are summarised in this guidance document, intended to assist in management of C. auris transmission and potential outbreak situations. Rapid and effective measures to contain C. auris spread require a multi-disciplinary approach that includes clinical specialists of the affected unit, nursing staff, hospital hygiene, diagnostic microbiology, cleaning staff, hospital management and experts in diagnostic mycology / fungal infections. Action should be initiated in a step-wise process and relevant interventions differ between management of singular C. auris colonised / infected patients and detection of potential C. auris transmission or nosocomial outbreaks. KW - Candida auris KW - nosocomial transmission KW - infection prevention KW - expert recommendation Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318570 VL - 65 IS - 6 SP - 590 EP - 598 ER - TY - JOUR A1 - Surat, Güzin A1 - Vogel, Ulrich A1 - Wiegering, Armin A1 - Germer, Christoph-Thomas A1 - Lock, Johan Friso T1 - Defining the scope of antimicrobial stewardship interventions on the prescription quality of antibiotics for surgical intra-abdominal infections JF - Antibiotics N2 - Background: The aim of this study was to assess the impact of antimicrobial stewardship interventions on surgical antibiotic prescription behavior in the management of non-elective surgical intra-abdominal infections, focusing on postoperative antibiotic use, including the appropriateness of indications. Methods: A single-center quality improvement study with retrospective evaluation of the impact of antimicrobial stewardship measures on optimizing antibacterial use in intra-abdominal infections requiring emergency surgery was performed. The study was conducted in a tertiary hospital in Germany from January 1, 2016, to January 30, 2020, three years after putting a set of antimicrobial stewardship standards into effect. Results: 767 patients were analyzed (n = 495 in 2016 and 2017, the baseline period; n = 272 in 2018, the antimicrobial stewardship period). The total days of therapy per 100 patient days declined from 47.0 to 42.2 days (p = 0.035). The rate of patients receiving postoperative therapy decreased from 56.8% to 45.2% (p = 0.002), comparing both periods. There was a significant decline in the rate of inappropriate indications (17.4% to 8.1 %, p = 0.015) as well as a significant change from broad-spectrum to narrow-spectrum antibiotic use (28.8% to 6.5%, p ≤ 0.001) for postoperative therapy. The significant decline in antibiotic use did not affect either clinical outcomes or the rate of postoperative wound complications. Conclusions: Postoperative antibiotic use for intra-abdominal infections could be significantly reduced by antimicrobial stewardship interventions. The identification of inappropriate indications remains a key target for antimicrobial stewardship programs. KW - antimicrobial stewardship KW - antibiotic prescription behavior KW - surgical intra-abdominal infections KW - post-operative antibiotic treatment Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-223034 SN - 2079-6382 VL - 10 IS - 1 ER - TY - THES A1 - Drayß, Maria T1 - Asymptomatisches Trägertum von Staphylococcus aureus und Haemophilus influenzae bei Senioren T1 - Asymptomatic carriage of Staphylococcus aureus and Haemophilus influenzae in elderly people N2 - Ältere Menschen sind gegenüber invasiven Infektionen und Sepsis besonders vulnerabel mit ungünstiger Prognose. Staphylococcus aureus und Haemophilus influenzae können beide invasive Infektionen verursachen. Oft geht eine asymptomatische Besiedelung einer Infektion voraus und ist ein Risikofaktor für eine invasive Infektion. Daher wurde eine bizentrische Querschnittstudie in den Regionen Aachen und Würzburg durchgeführt, um die Prävalenz von H. influenzae, S. aureus und MRSA (Methicillin resistenter S. aureus) bei asymptomatischen Senioren zu bestimmen, wie auch Risikofaktoren für eine Besiedelung. Von Oktober 2012 bis Mai 2013 wurden 677 Erwachsenen im Alter von 65 Jahren oder älter eingeschlossen, die zu Hause oder in Seniorenheimen lebten. Die Prävalenz von H. influenzae bei älteren Menschen war mit einer Trägerrate von nur 1,9% ([95% CI: 1,0 - 3,3%]; 13/677) sehr niedrig. Trägerisolate waren überwiegend nicht typisierbare H. influenzae, zeigten eine hohe clonale Diversität und waren alle Ampicillin-sensibel. Die Prävalenz von S. aureus war mit 28,5% ([95% CI: 25,1 - 32,1%]; 193/677) hoch, wie für die deutsche Allgemeinbevölkerung bekannt, während MRSA bei weniger als 1% der Teilnehmer gefunden wurde (0,7% [95% CI: 0,2 - 1,7%]; 5/677). Die Prävalenz von H. influenzae, S. aureus und MRSA unterschied sich nicht signifikant zwischen selbständig zu Hause lebenden Senioren und Pflegeheimbewohnern. Ältere, selbständig lebende Menschen mit höherem Bildungsniveau hatten signifikant höhere Kolonisierungsraten mit S. aureus (adjusted OR: 1,905 [95% CI: 1,248 - 2,908]; p = 0,003). Bei Pflegeheimbewohnern war eine Kolonisierung signifikant mit Verheiratet sein assoziiert (adjusted OR: 3,367 [95% CI: 1,502 - 7,546]; p = 0,003). Diese Ergebnisse unterstreichen die Bedeutung von sozio-demographischen Faktoren für eine Kolonisierung mit S. aureus und schließen eine Lücke bei epidemiologischen Daten zu H. influenzae. N2 - Elderly people are especially vulnerable to invasive infections and sepsis with often poor outcome. Staphyloccus aureus and Haemophilus influenzae both can cause invasive infections. Asymptomatic colonization often precedes infection and poses a risk for invasive infection. Therefore, a bi-centric cross-sectional carrier study was conducted in the regions of Aachen and Wuerzburg, Germany, to determine the prevalence of H. influenzae, S. aureus and MRSA (methicillin resistant S. aureus) in asymptomatic elderly people and to identify risk factors for colonization. From October 2012 to May 2013 677 adults aged 65 years and older were included, living at home or in nursing homes. In contrast to children and younger adults the prevalence of H. influenzae was very low among elderly people with a carriage rate of only 1.9% ([95% CI: 1.0 - 3.3%]; 13/677). Carrier isolates were predominantly non typeable H. influenzae, showed a high clonal diversity and were all susceptible to ampicillin. The prevalence of S. aureus was expectedly high as known for the German general population (28.5% [95% CI: 25.1 - 32.1%]; 193/677), while MRSA was found in less than 1% of the individuals (0.7% [95% CI: 0.2 - 1.7%]; 5/677). The prevalence of H. influenzae, S. aureus und MRSA did not differ significantly between community dwellers and nursing home residents. Elderly community-dwellers with higher education level had significantly higher colonization rates with S. aureus (adjusted OR: 1.905 [95% CI: 1.248 - 2.908]; p = 0.003). Among nursing home residents, colonization was significantly associated with being married (adjusted OR: 3.367 [1.502 - 7.546]; p = 0.003). These results underline the importance of socio-demographic factors for colonization with S. aureus and close a gap in epidemiological data on H. influenzae. KW - Staphylococcus aureus KW - Haemophilus influenzae KW - MRSA KW - Senioren KW - Besiedelung KW - Multilocus-Sequenz-Typisierung Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-272276 ER - TY - JOUR A1 - Rohde, Jörn A1 - Himmel, Wolfgang A1 - Hofinger, Clemens A1 - Lâm, Thiên-Trí A1 - Schrader, Hanna A1 - Wallstabe, Julia A1 - Kurzai, Oliver A1 - Gágyor, Ildikó T1 - Diagnostic accuracy and feasibility of a rapid SARS-CoV-2 antigen test in general practice - a prospective multicenter validation and implementation study JF - BMC Primary Care N2 - Background PCR testing is considered the gold standard for SARS-CoV-2 diagnosis but its results are earliest available hours to days after testing. Rapid antigen tests represent a diagnostic tool enabling testing at the point of care. Rapid antigen tests have mostly been validated by the manufacturer or in controlled laboratory settings only. External validation at the point of care, particularly in general practice where the test is frequently used, is needed. Furthermore, it is unclear how well point of care tests are accepted by the practice staff. Methods In this prospective multicenter validation study in primary care, general practitioners included adult individuals presenting with symptoms suggesting COVID-19. Each patient was tested by the general practitioner, first with a nasopharyngeal swab for the point of care test (Roche SARS-CoV-2 Rapid Antigen Test) and then with a second swab for PCR testing. Using the RT-PCR result as a reference, we calculated specificity, sensitivity, positive predictive value and negative predictive value, with their 95% confidence intervals. General practitioners and medical assistants completed a survey to assess feasibility and usefulness of the point of care tests. Results In 40 practices in Würzburg, Germany, 1518 patients were recruited between 12/2020 and 06/2021. The point of care test achieved a sensitivity of 78.3% and a specificity of 99.5% compared to RT-PCR. With a prevalence of 9.5%, the positive predictive value was 93.9% and the negative predictive value was 97.8%. General practitioners rated the point of care test as a helpful tool to support diagnostics in patients with signs and symptoms suggestive for infection, particularly in situations where decision on further care is needed at short notice. Conclusion The point of care test used in this study showed a sensitivity below the manufacturer’s specification (Sensitivity 96.25%) in the practice but high values for specificity and high positive predictive value and negative predictive value. Although widely accepted in the practice, measures for further patient management require a sensitive interpretation of the point of care test results. KW - COVID-19 testing KW - feasibility study KW - attitude of health personnel KW - sensitivity and specificity KW - general practice Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-299659 VL - 23 IS - 1 ER - TY - THES A1 - Stieber, Hanna T1 - Auswirkungen des Sphingolipidsynthese-Inhibitors Myriocin auf Vitalität und Antimykotikaresistenz von \(Candida\) \(auris\) T1 - Impact of the sphingolipid synthesis inhibitor myriocin on viability and antifungal susceptibility of \(Candida\) \(auris\) N2 - Candida Spezies gehören als kommensale Organismen zur normalen menschlichen Mikroflora, können allerdings unter bestimmten Bedingungen Krankheitswert erlangen. Limitationen in der Behandlung durch immer mehr resistente Candida Spezies und die wachsende Zahl immunsupprimierter Patienten gelten als Hauptursachen für die steigende Häufigkeit invasiver Candidosen und systemischer Candidämien. Die 2009 entdeckte Spezies C. auris stellt durch ihre zahlreichen Resistenzen, das Potential zur Auslösung nosokomialer Ausbrüche in Krankenhäusern und die schnelle Verbreitung über mehrere Kontinente eine neue Herausforderung dar. Der Bedarf an neuen Antimykotika mit anderen Wirkmechanismen und neuen Zielstrukturen ist größer denn je. Die fungale Sphingolipid-Biosynthese wurde bereits mehrfach als potenzielles Ziel antimykotischer Therapie diskutiert, allerdings bezieht sich die meiste Forschung hierzu auf C. albicans]. In vorliegender Arbeit wurden die Auswirkungen der Inhibition der Sphingolipid Biosynthese durch Myriocin auf C. auris und sein Resistenzverhalten untersucht und mit denen auf andere Candida Spezies verglichen. Sowohl die Mikrodilution als auch die Plattentropftests zeigten, dass C. auris verglichen mit anderen Candida Spezies besonders sensitiv auf die Anwesenheit von Myriocin reagierte und stärker im Wachstum gehemmt wurde. Der Survival Assay ergab für alle drei Spezies ein Absenken der CFU durch Myriocin, die Abweichungen zwischen den Stämmen waren jedoch unwesentlich. Unterschiede konnten in Vitalität und Vermehrung der verschiedenen Spezies unter Myriocineinfluss festgestellt werden. Aus der Lebend/Tot-Färbung ging hervor, dass Myriocin bei allen Stämmen zum Absterben von Candida Zellen führte, C. albicans und C. glabrata allerdings signifikant niedrigere Überlebensraten im Vergleich zu den C. auris Isolaten aufwiesen. Im Gegensatz dazu konnte mithilfe der FITC-Mikroskopie gezeigt werden, dass Candida Zellen unter Zugabe von Myriocin weniger Tochterzellen ausbildeten, was auf eine erschwerte oder zumindest verlangsamte Zellvermehrung hindeutet. Dabei schien das Wachstum der C. auris Stämme durch Myriocin deutlich eingeschränkter zu sein als das von C. albicans und C. glabrata. Durch weitere Mikroskopie und die Kombination aus Lebend/Tot Färbung mittels PI und FITC Färbung, sollte die Verteilung der toten Zellen auf Mutter- und Tochterzellen evaluiert werden. Hier konnte ein Trend zu einem vermehrten Zellsterben der Tochterzellen, vor allem für C. auris, festgestellt werden. Abschließende E-Tests für Amphotericin B, Anidulafungin und Fluconazol ergaben eine signifikante Herabsetzung der MHK für alle C. auris Isolate durch Myriocin. Die hier vorgestellten Ergebnisse und die durch mehrere Studien festgestellten Differenzen in der Sphingolipidkomposition von C. auris verglichen mit anderen Candida Spezies geben Hinweis darauf, dass Sphingolipide für Vitalität, Zellteilung und vor allem für die Wirkung einiger Antimykotika auf C. auris eine besondere, wenn nicht übergestellte Bedeutung haben könnten. Zwar wurde die Sphingolipidsynthese bereits mehrfach als potenzieller Angriffspunkt für die antifungale Therapie diskutiert, allerdings lediglich am Beispiel anderer Candida Spezies. Der Sphingolipidstoffwechsel könnte somit ein vielversprechender Ansatz für die Behandlung des sonst so therapieresistenten und lebensbedrohlichen Pilzes C. auris sein. N2 - Candida species are commensal organisms belonging to the normal human microflora, but can become pathogenic under certain conditions. Limitations in treatment due to an increasing number of resistant Candida species and the growing number of immunosuppressed patients are considered to be the main reasons for the increasing frequency of invasive candidiasis and systemic candidemia. C. auris, a species discovered in 2009, shows potential to cause nosocomial outbreaks in hospitals, limited susceptibility to numerous antifungals and a rapid spread across several continents. This leads to a need for new antifungal agents with different mechanisms of action and new targets. Fungal sphingolipid biosynthesis has been discussed several times as a potential target of antifungal therapy, however most research on this relates to C. albicans. In the present work, the effects of inhibition of sphingolipid biosynthesis by myriocin on C. auris and its impact on fungal susceptibility were investigated and compared with those on other Candida species. Both microdilution and plate droplet assays showed that C. auris was more sensitive to myriocin compared with other Candida species and showed severe growth defects. The survival assay showed a lowering of CFU by myriocin for all three species, but the differences between the strains were insignificant. Live/dead staining showed that myriocin led to the death of Candida cells in all strains, but C. albicans and C. glabrata had significantly lower survival rates compared to the C. auris isolates. In contrast, FITC microscopy showed that Candida cells produced fewer daughter cells when myriocin was added, indicating that cell proliferation was impeded or at least slowed. In this regard, the growth of C. auris strains appeared to be significantly more restricted by myriocin than that of C. albicans and C. glabrata. Further microscopy and the combination of live/dead staining using PI and FITC staining, was performed to evaluate the distribution of dead cells between mother and daughter cells. Here, a trend towards increased cell death of daughter cells, especially for C. auris, was observed. Final E-tests for amphotericin B, anidulafungin, and fluconazole revealed a significant reduction in MIC for all C. auris isolates by myriocin. These results and the differences in sphingolipid composition of C. auris compared with other Candida species established by several studies provide evidence that sphingolipids may have a special, if not superimposed, importance for viability, cell division, and especially for the suscteptibility of C. auris to some antifungals. It is true that sphingolipid synthesis has been discussed several times as a potential target for antifungal therapy, but only using other Candida species as examples. Sphingolipid metabolism could thus be a promising approach for the treatment of the therapy-resistant and life-threatening fungus C. auris. KW - Candida KW - Sphingolipide KW - Sphingolipidstoffwechsel KW - Multiresistenz KW - pathogene Pilze KW - Candida auris KW - Antimykotikaresistenz KW - antifungal susceptibility KW - myriocin Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-289121 ER - TY - JOUR A1 - Schlegel, Jan A1 - Peters, Simon A1 - Doose, Sören A1 - Schubert-Unkmeir, Alexandra A1 - Sauer, Markus T1 - Super-resolution microscopy reveals local accumulation of plasma membrane gangliosides at Neisseria meningitidis Invasion Sites JF - Frontiers in Cell and Developmental Biology N2 - Neisseria meningitidis (meningococcus) is a Gram-negative bacterium responsible for epidemic meningitis and sepsis worldwide. A critical step in the development of meningitis is the interaction of bacteria with cells forming the blood-cerebrospinal fluid barrier, which requires tight adhesion of the pathogen to highly specialized brain endothelial cells. Two endothelial receptors, CD147 and the β2-adrenergic receptor, have been found to be sequentially recruited by meningococci involving the interaction with type IV pilus. Despite the identification of cellular key players in bacterial adhesion the detailed mechanism of invasion is still poorly understood. Here, we investigated cellular dynamics and mobility of the type IV pilus receptor CD147 upon treatment with pili enriched fractions and specific antibodies directed against two extracellular Ig-like domains in living human brain microvascular endothelial cells. Modulation of CD147 mobility after ligand binding revealed by single-molecule tracking experiments demonstrates receptor activation and indicates plasma membrane rearrangements. Exploiting the binding of Shiga (STxB) and Cholera toxin B (CTxB) subunits to the two native plasma membrane sphingolipids globotriaosylceramide (Gb3) and raft-associated monosialotetrahexosylganglioside GM1, respectively, we investigated their involvement in bacterial invasion by super-resolution microscopy. Structured illumination microscopy (SIM) and direct stochastic optical reconstruction microscopy (dSTORM) unraveled accumulation and coating of meningococci with GM1 upon cellular uptake. Blocking of CTxB binding sites did not impair bacterial adhesion but dramatically reduced bacterial invasion efficiency. In addition, cell cycle arrest in G1 phase induced by serum starvation led to an overall increase of GM1 molecules in the plasma membrane and consequently also in bacterial invasion efficiency. Our results will help to understand downstream signaling events after initial type IV pilus-host cell interactions and thus have general impact on the development of new therapeutics targeting key molecules involved in infection. KW - Neisseria meningitidis KW - sphingolipids KW - gangliosides and lipid rafts KW - super-resolution microscopy KW - single-molecule tracking Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-201639 VL - 7 IS - 194 ER - TY - JOUR A1 - Marincola, Gabriella A1 - Liong, Olivia A1 - Schoen, Christoph A1 - Abouelfetouh, Alaa A1 - Hamdy, Aisha A1 - Wencker, Freya D. R. A1 - Marciniak, Tessa A1 - Becker, Karsten A1 - Köck, Robin A1 - Ziebuhr, Wilma T1 - Antimicrobial Resistance Profiles of Coagulase-Negative Staphylococci in Community-Based Healthy Individuals in Germany JF - Frontiers in Public Health N2 - Coagulase-negative staphylococci (CoNS) are common opportunistic pathogens, but also ubiquitous human and animal commensals. Infection-associated CoNS from healthcare environments are typically characterized by pronounced antimicrobial resistance (AMR) including both methicillin- and multidrug-resistant isolates. Less is known about AMR patterns of CoNS colonizing the general population. Here we report on AMR in commensal CoNS recovered from 117 non-hospitalized volunteers in a region of Germany with a high livestock density. Among the 69 individuals colonized with CoNS, 29 had reported contacts to either companion or farm animals. CoNS were selectively cultivated from nasal swabs, followed by species definition by 16S rDNA sequencing and routine antibiotic susceptibility testing. Isolates displaying phenotypic AMR were further tested by PCR for presence of selected AMR genes. A total of 127 CoNS were isolated and Staphylococcus epidermidis (75%) was the most common CoNS species identified. Nine isolates (7%) were methicillin-resistant (MR) and carried the mecA gene, with seven individuals (10%) being colonized with at least one MR-CoNS isolate. While resistance against gentamicin, phenicols and spectinomycin was rare, high resistance rates were found against tetracycline (39%), erythromycin (33%) and fusidic acid (24%). In the majority of isolates, phenotypic resistance could be associated with corresponding AMR gene detection. Multidrug-resistance (MDR) was observed in 23% (29/127) of the isolates, with 33% (23/69) of the individuals being colonized with MDR-CoNS. The combined data suggest that MR- and MDR-CoNS are present in the community, with previous animal contact not significantly influencing the risk of becoming colonized with such isolates. KW - coagulase-negative staphylococci KW - antimicrobial resistance KW - One Health KW - community settings KW - Germany Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-240881 SN - 2296-2565 VL - 9 ER - TY - JOUR A1 - Walther, Grit A1 - Zimmermann, Anna A1 - Theuersbacher, Johanna A1 - Kaerger, Kerstin A1 - Lilienfeld-Toal, Marie von A1 - Roth, Mathias A1 - Kampik, Daniel A1 - Geerling, Gerd A1 - Kurzai, Oliver T1 - Eye infections caused by filamentous fungi: spectrum and antifungal susceptibility of the prevailing agents in Germany JF - Journal of Fungi N2 - Fungal eye infections can lead to loss of vision and blindness. The disease is most prevalent in the tropics, although case numbers in moderate climates are increasing as well. This study aimed to determine the dominating filamentous fungi causing eye infections in Germany and their antifungal susceptibility profiles in order to improve treatment, including cases with unidentified pathogenic fungi. As such, we studied all filamentous fungi isolated from the eye or associated materials that were sent to the NRZMyk between 2014 and 2020. All strains were molecularly identified and antifungal susceptibility testing according to the EUCAST protocol was performed for common species. In total, 242 strains of 66 species were received. Fusarium was the dominating genus, followed by Aspergillus, Purpureocillium, Alternaria, and Scedosporium. The most prevalent species in eye samples were Fusarium petroliphilum, F. keratoplasticum, and F. solani of the Fusarium solani species complex. The spectrum of species comprises less susceptible taxa for amphotericin B, natamycin, and azoles, including voriconazole. Natamycin is effective for most species but not for Aspergillus flavus or Purpureocillium spp. Some strains of F. solani show MICs higher than 16 mg/L. Our data underline the importance of species identification for correct treatment. KW - eye infection KW - fungal infection KW - keratitis KW - antifungal susceptibility KW - natamycin KW - Fusarium KW - Purpureocillium KW - Aspergillus KW - Alternaria KW - Scedosporium Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-241810 SN - 2309-608X VL - 7 IS - 7 ER - TY - JOUR A1 - Kurotschka, Peter Konstantin A1 - Tiedemann, Elena A1 - Wolf, Dominik A1 - Thier, Nicola A1 - Forster, Johannes A1 - Liese, Johannes G. A1 - Gagyor, Ildiko T1 - Management of common infections in German primary care: a cross-sectional survey of knowledge and confidence among General Practitioners and outpatient pediatricians JF - Antibiotics N2 - Outpatient antibiotic use is closely related to antimicrobial resistance and in Germany, almost 70% of antibiotic prescriptions in human health are issued by primary care physicians (PCPs). The aim of this study was to explore PCPs, namely General Practitioners' (GPs) and outpatient pediatricians' (PDs) knowledge of guideline recommendations on rational antimicrobial treatment, the determinants of confidence in treatment decisions and the perceived need for training in this topic in a large sample of PCPs from southern Germany. Out of 3753 reachable PCPs, 1311 completed the survey (overall response rate = 34.9%). Knowledge of guideline recommendations and perceived confidence in making treatment decisions were high in both GPs and PDs. The two highest rated influencing factors on prescribing decisions were reported to be guideline recommendations and own clinical experiences, hence patients' demands and expectations were judged as not influencing treatment decisions. The majority of physicians declared to have attended at least one specific training course on antibiotic use, yet almost all the participating PCPs declared to need more training on this topic. More studies are needed to explore how consultation-related and context-specific factors could influence antibiotic prescriptions in general and pediatric primary care in Germany beyond knowledge. Moreover, efforts should be undertaken to explore the training needs of PCPs in Germany, as this would serve the development of evidence-based educational interventions targeted to the improvement of antibiotic prescribing decisions rather than being focused solely on knowledge of guidelines. KW - infectious diseases management KW - general practitioner KW - pediatrician KW - primary care KW - outpatient KW - antibiotic use KW - antimicrobial resistance KW - antimicrobial stewardship KW - survey KW - knowledge Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-246272 SN - 2079-6382 VL - 10 IS - 9 ER - TY - THES A1 - Nürnberg, Sebastian T1 - Invasive \(Haemophilus\) \(influenzae\)-Isolate in Deutschland: Methodenvalidierung des VITEK MS IVD MALDI-TOF-MS und Untersuchung von Resistenzen gegen Imipenem und Cefotaxim T1 - Invasive \(Haemophilus\) \(influenzae\) Isolates in Germany: Method Validation of the VITEK MS IVD MALDI-TOF-MS and Investigation of Imipenem and Cefotaxime Resistance N2 - Die Inzidenz invasiver H. influenzae-Infektionen in Deutschland steigt seit Jahren an. Die akkurate Identifizierung und Resistenztestung dieses Erregers sind von großer klinischer und epidemiologischer Bedeutung. Daher wurden im Rahmen der vorliegenden Promotionsarbeit umfangreiche Untersuchungen zur Diagnostik und zur Epidemiologie von Antibiotikaresistenzen bei H. influenzae durchgeführt. Es konnte gezeigt werden, dass die in der Routinediagnostik mittlerweile weit verbreitete MALDI-TOF-MS-Diagnostik durch das VITEK MS IVD nur eingeschränkt zur sicheren Unterscheidung von H. influenzae und H. haemolyticus einsetzbar ist. H. influenzae-Isolate erkannte das System mit einer Genauigkeit von 100 %. Bei H. haemolyticus-Isolaten wurden dagegen 42 % der untersuchten Stämme fälschlicherweise als H. influenzae erkannt. Dieser Fragestellung wurde mit der bisher umfangreichsten molekularbiologisch charakterisierten Studienpopulation beider Bakterienspezies nachgegangen. Die kalkulierte antibiotische Therapie einer Sepsis oder Meningitis erfolgt häufig mit Carbapenemen, die leitliniengerechte Therapie invasiver H. influenzae-Infektionen mit Drittgenerations-Cephalosporinen. Imipenem und Cefotaxim gehören zu den Hauptvertretern dieser Gruppen. Bezüglich der Antibiotikaresistenztestung wurde erstmalig für H. influenzae herausgefunden, dass die routinemäßig verwendete Gradientenagardiffusion (GAD) bei der Testung von Cefotaxim im Vergleich zum Goldstandard Bouillon-Mikrodilution gleichwertig und bei Imipenem sogar sensitiver in der Detektion von Heteroresistenzen ist. Die Epidemiologie dieser Resistenzen wurde in dieser Arbeit erstmalig für Deutschland systematisch erfasst, indem alle verfügbaren invasiven Isolate gemeldeter H. influenzae-Infektionen der Jahre 2016 (Imipenem) beziehungsweise 2016-2019 (Cefotaxim) untersucht wurden. Es wurde eine hohe Prävalenz einer Imipenem-Resistenz von 13,5 % festgestellt. Die Prävalenz einer Cefotaxim-Resistenz lag bei 0,9 %. Zur molekularen Typisierung wurde bei den Imipenem-resistenten Isolaten eine Multilocus-Sequenztypisierung, bei den Cefotaxim-resistenten Stämmen eine Sequenzierung des vollständigen Genoms durchgeführt. Hierbei wurde eine hohe genetische Diversität der Stämme festgestellt, was die Schlussfolgerung zulässt, dass resistente Mutanten sporadisch entstehen. Die Untersuchung möglicher spatio-temporaler Cluster führte zum Nachweis einer sehr selten vorkommenden Übertragung eines Imipenem-resistenten Stamms. Durch die Sequenzierung von Resistenzgenen wurde die Epidemiologie und Relevanz bekannter Aminosäuresubstitutionen beleuchtet. Unter anderem wurde für die PBP3-Substitutionen L389F und Y557H eine hochsignifikante Korrelation mit dem Auftreten von Cefotaxim-Resistenzen nachgewiesen. Die gewonnenen Genomdaten bieten die Grundlage für die Forschung an weiteren Antibiotikaresistenzdeterminanten von H. influenzae. N2 - Haemophilus influenzae is a fastidious, facultative anaerobic, Gram-negative bacillus that colonizes the respiratory tract and can cause respiratory and invasive infection such as meningitis and sepsis. Invasive H. influenzae infections are potentially life-threatening and incidence rates have been increasing for years. Therefore, fast and accurate diagnostics, reliable testing of antibiotic resistance and a successful antibiotic treatment is of great importance. Therefore, the objective of the first part of this thesis was to evaluate the diagnostic and discriminative potential of the MALDI-TOF-MS system VITEK® MS regarding H. influenzae and H. haemolyticus. H. influenzae can cause invasive infections, whereas H. haemolyticus is mostly apathogenic. The system showed excellent accuracy for the identification of H. influenzae isolates, as 100 % of the 236 isolates were correctly identified. When testing 50 H. haemolyticus strains, however, the system showed significant limitations, since 42 % of these strains were misidentified as H. influenzae. According to the current German guidelines for the treatment of sepsis and meningitis, treatment of invasive H. influenzae infections is carried out using carbapenems, such as imipenem, or third-generation cephalosporins, such as cefotaxime. Therefore, the prevalence of antibiotic resistances to these substances was investigated and possible resistance mechanisms were examined. The two antibiotic susceptibility testing methods Gradient agar diffusion (GAD) and broth microdilution (BMD) were compared. As a result, for the determination of the cefotaxime MIC, the two methods showed an excellent correlation, whereas for imipenem there were significant differences in the measured MIC values. Since strains tested by GAD often showed double or fuzzy inhibition zones, heteroresistances may be more apparent using this method and GAD may be more sensitive at detecting imipenem resistance. The prevalence of imipenem resistance was determined for the year 2016. The analysis of 474 different invasive isolates showed a high prevalence of 5.5 %. If including all resistant isolates according to GAD, the prevalence would be even as high as 13.5 %. MLST was performed on all isolates to investigate the genetic relationship. As a result, however, some sequence types were observed more frequently, it revealed a significant diversity. Both the analysis of ftsI and acrR showed previously described amino acid substitutions. Cefotaxime resistance was investigated for all 2432 invasive H. influenzae for the years 2016-2019. The low prevalence of 0.9 % shows that cefotaxime is still well suited for the treatment of invasive H. influenzae infections. For the investigation of the genetic relationship and possible causes of cefotaxime resistance whole genome sequencing (WGS) was performed on all resistant isolates. The strains showed high genetic diversity and the geographic analysis also showed that the resistant strains were evenly spread throughout the population in Germany. This led to the conclusion that cefotaxime resistance is more likely caused by sporadic mutation events rather than by specific clones spreading in certain areas. The analysis of the ftsI gene showed that the amino acid substitutions L389F and Y557H are significantly associated with elevated cefotaxime MICs. This dissertation provides comprehensive data regarding diagnostics, antimicrobial susceptibility testing and the epidemiology of antibiotic resistances of invasive H. influenzae. It could be shown that the VITEK MS IVD, although established in the routine diagnostics, can only be used to a limited extent for reliably differentiating H. influenzae and H. haemolyticus isolates. Regarding antibiotic susceptibility testing, it was found that GAD showed similar results compared to the gold standard BMD when testing cefotaxime. When testing imipenem, this method was even more sensitive in detecting heteroresistances compared to the gold standard. For the first time, the epidemiology of antibiotic resistance against cefotaxime and imipenem was carried out using a large set of precisely defined invasive H. influenzae isolates to obtain representative data for the prevalence of imipenem and cefotaxime resistance in Germany. By investigating amino acid substitutions in the ftsI and acrR gene the epidemiology and relevance of these substitutions could be shown. A well-founded statement on the relationship of the resistant strains could be made using the state-of-the-art typing methods MLST and whole genome sequencing. The genome data also offers the possibility of examining other genes of these strains in more detail. KW - Haemophilus influenzae KW - MALDI-MS KW - Antibiotikum KW - Cefotaxim KW - Imipenem KW - Haemophilus haemolyticus KW - MALDI-TOF-MS KW - Antibiotikaresistenzen Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-345067 ER - TY - THES A1 - Koike, Akito T1 - Molekular und zellbiologischer Ansatz hin zu neuartigen Medikamenten gegen \(Echinococcus\) \(multilocularis\) T1 - Molecular and cell biological approach towards novel drugs against \(Echinococcus\) \(multilocularis\) N2 - Echinococcosis is an important zoonosis. The causative agent of Alveolar Echinococcosis (AE) is Echinococcus multilocularis. The treatment of human AE is limited to surgery and chemotherapy with albendazole (ABZ). However, ABZ works only parasitostatically and it needs to be taken for long periods, although it causes adverse side effects. Thus, development of new, parasiticidal drug with selective toxicity is required. Because undifferentiated stem cells of E. multilocularis play key role in its longevity and regenerative capacity, targeting stem cells is especially important. In vitro screening of protein kinases inhibitors demonstrated that human PIM kinases inhibitors have detrimental effects on E. multilocularis. Through yeast two hybrid assay, the interaction of parasite PIM kinase (EmPIM) and its CDC25 (EmCDC25) was indicated. Through in situ hybridization, expression of EmPIM in the stem cells was observed. Therefore, EmPim is likely to be a positive regulator of cell cycle progression, the same as human Pim1. In addition, 20 compounds against EmPIM were selected through in silico screening and synthesized. One of them has a detrimental effect on E.multilocularis comparable to human pan-PIM inhibitors, but has much weaker toxicity on human cell lines. Furthermore, triclabendazole (TCBZ) and its metabolite TCBZSX, which are approved for another flatworm disease, Fascioliasis were tried on E. multilocularis. With two stem cell markers, damage to stem cells by TCBZSX was shown. In addition, primary cells from treated vesicles never regenerated and the damage to stem cells proved to be irreversible. Our in silico screening method used in EmPIM research has potential to identify compounds which overcome the side effect problem in ABZ-based chemotherapy. On the other hand, it is expected that my research of TCBZ can lead to development of a practical parasiticidal chemotherapy by combining TCBZ, which damages stem cells, and ABZ, which damages differentiated cells. N2 - Die Echinokokkose ist eine der wichtigsten Zoonosen sowohl für die Human- als auch für die Veterinärmedizin. Der Erreger der alveolären Echinokokkose (AE) ist Echinococcus multilocularis. Metazestode Bläschen, das Larvenstadium dieses parasitären Helminthen, können in die Leber eindringen und ungeschlechtlich wie bösartige Tumore wachsen. Dies kann ohne geeignete Behandlung tödlich sein. Die Behandlung von AE beim Menschen beschränkt sich auf Chirurgie und Chemotherapie, aber die Chirurgie ist nur bei einem kleinen Prozentsatz der Patienten anwendbar, die im Frühstadium diagnostiziert werden. Die meisten Patienten können sich nur auf eine Chemotherapie mit Albendazol (ABZ) verlassen. ABZ wirkt jedoch nur parasitostatisch und kann die Krankheit nicht heilen. Daher muss ABZ über einen längeren Zeitraum eingenommen werden, obwohl es mit Nebenwirkungen einhergeht. Daher ist die Entwicklung eines neuen, parasitentötenden und selektiven Medikaments gegen AE erforderlich. Da die undifferenzierte Stammzellpopulation von E. multilocularis eine Schlüsselrolle für seine Langlebigkeit und Regenerationsfähigkeit spielt, ist eine auf Stammzellen abzielende Chemotherapie wichtig. In dieser Arbeit wurde ein In-vitro-Screening verschiedener Hemmstoffe gegen Kinasen und Tubuline durchgeführt. Das Ergebnis des Screenings zeigte, dass Inhibitoren gegen humane pim-Kinasen starke schädliche Auswirkungen auf E. multilocularis haben. Durch ein Hefe-Zwei- Hybrid-System wurde die Interaktion der Parasiten-Pim-Kinase (EmPIM) mit der Zellteilungszyklus 25 (EmCDC25) nachgewiesen, und durch In-situ-Hybridisierung wurde die teilweise Lokalisierung von EmPIM in den Stammzellen beobachtet. Daher ist es wahrscheinlich, dass EmPim ein positiver Regulator der Zellzyklusprogression ist, genau wie menschliches Pim1. ... KW - Bandwürmer KW - Zellzyklus KW - Benzimidazolderivate KW - tapeworm KW - kinase KW - benzimidazole Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-288649 ER - TY - JOUR A1 - Straub, Anton A1 - Vollmer, Andreas A1 - Lâm, Thiên-Trí A1 - Brands, Roman C. A1 - Stapf, Maximilian A1 - Scherf-Clavel, Oliver A1 - Bittrich, Max A1 - Fuchs, Andreas A1 - Kübler, Alexander C. A1 - Hartmann, Stefan T1 - Evaluation of advanced platelet-rich fibrin (PRF) as a bio-carrier for ampicillin/sulbactam JF - Clinical Oral Investigations N2 - Objectives Mechanisms of wound healing are often impaired in patients with osteonecrosis of the jaw (ONJ). According to the guidelines for the treatment of this disease, early surgical intervention is indicated. However, surgery often faces complications such as wound healing disorders. The application of platelet-rich fibrin (PRF) after necrosectomy between bone and mucosa may constitute a promising approach to improve surgical results. An aspect that was not investigated until now is that PRF acts as a “bio-carrier” for antibiotics previously applied intravenously. Materials and methods We investigated the antimicrobial properties of PRF in 24 patients presenting ONJ undergoing systemic antibiosis with ampicillin/sulbactam. We measured the concentration of ampicillin/sulbactam in plasma and PRF and performed agar diffusion tests. Ampicillin/sulbactam was applied intravenously to the patient 10 minutes for blood sampling for PRF. No further incorporation of patients’ blood or PRF product with antibiotic drugs was obtained. Four healthy patients served as controls. Results Our results revealed that PRF is highly enriched with ampicillin/sulbactam that is released to the environment. The antibiotic concentration in PRF was comparable to the plasma concentration of ampicillin/sulbactam. The inhibition zone (IZ) of PRF was comparable to the standard ampicillin/sulbactam discs used in sensitivity testing. Conclusions The results of our study demonstrated that PRF is a reliable bio-carrier for systemic applied antibiotics and exhibits a large antimicrobial effect. Clinical relevance We describe a clinically useful feature of PRF as a bio-carrier for antibiotics. Especially when applied to poorly perfused tissues and bone such as in ONJ, the local release of antibiotics can reduce wound healing disorders like infections. KW - osteonecrosis of the jaw KW - osteoradionecrosis KW - antiresorptive drug-related osteonecrosis of the jaw KW - ARONJ KW - oral microbiome KW - agar diffusion test Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324515 VL - 26 IS - 12 ER - TY - THES A1 - Wilhelm, Hannah T1 - Multiresistenzen in klinischen \(C.glabrata\) Isolaten T1 - Multidrug Resistance in clinical \(C.glabarata\) Isolates N2 - Die Zahl invasiver Pilzinfektionen ausgelöst durch C. glabrata steigt zunehmend und auch die Ausbildung multipler Resistenzen wird immer häufiger registriert. In dieser Arbeit wurden zwei klinische MDR-C. glabrata-Stämme systematisch analysiert, um den Ursprung der Mehrfachresistenz zu finden. Aufgefallen waren jene Isolate in vorhergehenden Untersuchungen von Aldejohann et. al., die 176 Stämme, die dem Referenzzentrum NRZ-Myk zugesandt wurden, auf ihr Resistenzverhalten gegen Echinocandine analysierten und auf FKS-Mutationen untersuchten. Die Isolate CG22 und CG56 zeigten ein Resistenzverhalten gegen Anidulafungin ohne eine FKS-Mutation aufzuweisen. In Mehrfachtestungen wurde das einheitliche Verhalten von CG56 in zehn Einzelkolonien verifiziert, um Mischkulturen oder heterogenes Verhalten innerhalb des Isolates ausschließen zu können. Nach Analyse der gesamten Genomsequenz von CG56 zeigte sich eine Mutation kurz vor der HS-Region von FKS2, die eine Erklärung für das Resistenzverhalten zu liefern scheint. Neben der Mutation in FKS2 wurde ebenfalls eine Mutation in FKS1 und in ERG3 bestätigt. Die Mutation in ERG3 führt zu einer Verschiebung im Sterolsynthesepathway und zu einer Neuverteilung der Zellmembranbestandteile. Das klinische Isolat CG22 fällt mit Resistenzen gegen Azole, Echinocandine und Amphotericin B auf und zeigte ebenfalls eine Mutationen in ERG3. Zusätzlich dazu ergab sich eine Loss-of- Function-Mutation in ERG4 und damit verbunden einen massiv reduzierten Ergosterolgehalt der Zellmembran. Die seltene Kombination aus ERG3 und ERG4 Mutation scheint die Erklärung für die außergewöhnliche Amphotericin B-Resistenz von CG22 zu liefern und wird hier als erstmals bei einem C. glabrata Isolat beschrieben. Dieser besondere Stamm, der sogar als panresistent bezeichnet werden kann, sollte Bestandteil weiterer Forschung werden. Der Sterolsynthesepathway dient als Angriffspunkt vieler Antimykotika und kann durch seine vielen Intermediate und abweichenden Abläufen zu unterschiedlichen Stoffwechselendprodukten führen. Der Ergosterolgehalt der Zellmembran eines C. glabrata-Stammes kann weitere Rückschlüsse auf die Empfindlichkeit des Isolates geben und somit die Chancen des Therapieerfolges der Antimykotikagabe besser vorhersagen und könnte somit einen vielversprechenden Beitrag zur Behandlung lebensbedrohlicher Candidosen leisten. N2 - The number of invasive fungal infections caused by C. glabrata is increasing and the development of resistance to multiple drug classes is also being recorded more frequently. In this study, two clinical MDR C. glabrata strains were systematically analyzed to find the origin of their Multidrug Resistance. These isolates had attracted attention in previous studies by Aldejohann et. al. who studied 176 strains that have been sent to the NRZ-Myk reference center. The strains have been analyzed for their resistance to echinocandins and have been examined for mutations in FKS1 and FKS2 hotspots. The isolates CG22 and CG56 showed resistance to anidulafungin without showing mutation in the FKS hotspots. In multiple testing, the uniform behavior of CG56 was verified in ten individual colonies in order to exclude mixed cultures or heterogeneous behavior within the isolate. Analysis of the entire genome sequence of CG56 revealed a mutation just upstream of the HS region of FKS2, which appears to provide an explanation for the resistance behavior. In addition to the mutation in FKS2, a mutation in FKS1 and ERG3 was also confirmed. The mutation in ERG3 leads to a shift in the sterol synthesis pathway and to a redistribution of the cell membrane components. The clinical isolate CG22 was found to be resistant to azoles, echinocandins and amphotericin B. CG22 showed a mutation in ERG3 and additionally a loss-of-function mutation in ERG4. This leads to a massively reduced ergosterol content of the cell membrane. The rare combination of ERG3 and ERG4 mutation seems to explain the extraordinary amphotericin B resistance of CG22 and is described for the first time in a C. glabrata isolate. This particular strain, which can even be described as panresistant, should become part of further research. The sterol synthesis pathway serves as a target for many antimycotics and can lead to different metabolic products due to its many intermediates and divergent processes. The ergosterol content of the cell membrane of a C. glabrata strain can provide further information on the susceptibility of the isolate. This could possibly predict the chances of therapeutic success of antimycotic treatment better and could therefore make a promising contribution to the treatment of life-threatening candidiasis. KW - Torulopsis glabrata KW - Antimykotikum KW - Anidulafungin KW - Amphotericin B KW - FKS Gene KW - Ergosterolsyntheseweg KW - ERG Gene KW - Multiresistenzen Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-347186 ER - TY - JOUR A1 - Abimannan, Nagarajan A1 - Sumathi, G. A1 - Krishnarajasekhar, O. R. A1 - Sinha, Bhanu A1 - Krishnan, Padma T1 - Clonal Clusters and Virulence Factors of Methicillin-Resistant \(Staphylococcus\) \(Aureus\): Evidence for Community-Acquired Methicillin-Resistant \(Staphylococcus\) \(Aureus\) Infiltration into Hospital Settings in Chennai, South India JF - Indian Journal of Medical Microbiology N2 - Background and Objective: Staphylococcus aureus is one of the major pathogens of nosocomial infections as wells as community-acquired (CA) infections worldwide. So far, large-scale comprehensive molecular and epidemiological characterisation of S. aureus from very diverse settings has not been carried out in India. The objective of this study is to evaluate the molecular, epidemiological and virulence characteristics of S. aureus in both community and hospital settings in Chennai, southern India. Methods: S. aureus isolates were obtained from four different groups (a) healthy individuals from closed community settings, (b) inpatients from hospitals, (c) outpatients from hospitals, representing isolates of hospital-community interface and (d) HIV-infected patients to define isolates associated with the immunocompromised. Antibiotic susceptibility testing, multiplex polymerase chain reactions for detection of virulence and resistance determinants, molecular typing including Staphylococcal cassette chromosome mec (SCCmec) and agr typing, were carried out. Sequencing-based typing was done using spa and multilocus sequence typing (MLST) methods. Clonal complexes (CC) of hospital and CA methicillin-resistant S. aureus (MRSA) were identified and compared for virulence and resistance. Results and Conclusion: A total of 769 isolates of S. aureus isolates were studied. The prevalence of MRSA was found to be 7.17%, 81.67%, 58.33% and 22.85% for groups a, b, c and d, respectively. Of the four SCCmec types (I, III, IV and V) detected, SCCmec V was found to be predominant. Panton-Valentine leucocidin toxin genes were detected among MRSA isolates harbouring SCCmec IV and V. A total of 78 spa types were detected, t657 being the most prevalent. 13 MLST types belonging to 9 CC were detected. CC1 (ST-772, ST-1) and CC8 (ST238, ST368 and ST1208) were found to be predominant among MRSA. CA-MRSA isolates with SCCmec IV and V were isolated from all study groups including hospitalised patients and were found to be similar by molecular tools. This shows that CA MRSA has probably infiltrated into the hospital settings. KW - Community-acquired methicillin-resistant Staphylococcus aureus KW - HIV KW - hospital-acquired methicillin-resistant Staphylococcus aureus KW - innate immune evasions KW - MLST KW - microbial surface component recognising adhesive matrix molecules KW - spa typing KW - ST 772 KW - Inducible Clindamycin Resistance KW - Valentine Leukocidin Genes KW - Multiplex PCR KW - Nasal Carriage KW - Colonization KW - Prevalence KW - Emergence KW - Skin Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-226963 VL - 37 IS - 3 ER - TY - THES A1 - Koch, Thorsten Manfred T1 - Wirt – Pathogen Interaktion bei Hornhautinfektionen durch \(Fusarium\) spp. T1 - Host – Pathogen Interaction in Keratitis caused by \(Fusarium\) spp. N2 - Fusarium (F.)-Infektionen des Auges zeigen oft einen schwerwiegenden Verlauf und sind am häufigsten mit Spezies des Fusarium solani species complex assoziiert. Dabei sind das Tragen von weichen Kontaktlinsen sowie Traumata die wichtigsten prädisponierenden Faktoren. Vorangegangene Untersuchungen des Nationalen Referenzzentrums für invasive Pilzinfektionen hatten ergeben, dass Infektionen durch F. petroliphilum mit der Nutzung von Kontaktlinsen, Infektionen durch F. falciforme jedoch überwiegend traumaassoziiert uns vor allem aus tropischen und subtropischen Ländern bekannt sind. Das Ziel dieser Arbeit war es daher zu untersuchen, ob F. falcifomre und F. petroliphilum physiologische Merkmale aufweisen, die für die Unterschiede in den Risikofaktoren für Keratitiden durch die beiden Arten verantwortlich sein könnten. N2 - Fusarium (F.) - infections of the eye often show a severe course and are most frequentlyassociated with species (spp.) of the Fusarium solani species complex (van Diepeningen et al., 2014, Walther et al., 2017, Walther et al., 2018). Wearing soft contact lenses (CL) and trauma are the most important predisposing factors (Gaujoux et al., 2008, Thomas and Kaliamurthy, 2013, Ong et al., 2016, Bourcier et al., 2017). In previous studies of the National Reference Center for Invasive Fungal Infections it could be shown that infections caused by F. petroliphilum are associated with the use of CL, infections caused by F. falciforme, however, are predominantly trauma-associated and are mainly known from tropical and subtropical countries (Walther et al, 2018). This opposite behaviour of the spp. could be caused by differences in habitat and geographical distribution or by physiological differences such as germination rate, growth rate, tolerance to disinfectants, biofilm formation or cytotoxicity (Walther et al., 2018). Therefore, the aim of this study was to investigate whether F. falciforme and F. petroliphilum have physiological characteristics that could be responsible for the differences in the risk factors for keratitis between the two spp. For this purpose, the germination rate of the conidia and the length of the germ tubes of both Fusarium spp. was shown after staining of the conidia with fluorescein isothiocyanate and incubation at different incubation times in CL cleaning solutions at room temperature. A standardized approval test for CL cleaning solutions was carried out to investigate the behaviour of the conidia towards three different CL cleaning solutions that were available in Germany at the time of the investigations. Furthermore, the tolerance of the fungi to various CL cleaning solutions was examined in realistic conditions by incubating the conidia in CL cleaning solutions with CL overnight. The ability of biofilm formation was assessed by applying the conidia to CL from various manufacturers in Sabouraud-dextrose-broth and various CL cleaning solutions. The in vitro cytotoxicity of the conidia towards human corneal epithelial cells (HCE) was measured indirectly with the aid of a corneal epithelial cell model in aerobic and microaerophilic conditions via the lactate dehydrogenase release of HCE. Establishing a statement about the immune induction was possible due to the measurement of Interleukin-8 in the supernatants of the infection models. After the nightly incubation of the conidia in CL cleaning solutions, a lower germination rate was found for all F. petroliphilum isolates than for the F. falciforme isolates in one of the three cleaning solutions. It was remarkable that F. falciforme isolate 2015-96 was insensitive to this CL cleaning solution in this test setup. By contrast, the isolates did not show a different behaviour in the two other used CL cleaning solutions. It could be also shown that F. petroliphilum isolate 2014-79 germinates more frequently in one of the three tested cleaning solutions than F. falciforme, but at the same time the mycelium formation is effectively inhibited. All other isolates of both spp. behave similarly. After incubation the CL in CL cleaning solutions, no biofilm formation on the CL could be found in any of the two species in any of the test constellations, which could be due to the short incubation time or the inability of biofilm formation of the tested Fusarium spp. In the cytotoxicity and IL-8 experiments, no difference between the two spp. could be found. More realistic conditions in the test setup, such as e. g. a more realistic imitating of the effects of CL on corneal epithelial cells, could possibly reveal any differences. The natural pathogen reservoir could play the crucial role, why F. petroliphilum is more frequently associated of with corneal infections in CL users in moderate latitudes. A possible explanation could be that F. falciforme predominantly occurs in tropical areas and more often in the soil, whereas F. petroliphilum is more common in indoor areas. Another important result of my studies was that one of the tested CL cleaning solutions was proven to be ineffective against both Fusarium spp. Consequently, Fusarium would be able to get into the eyes of the CL wearer in large numbers through contamination of the CL in the cleaning vessel and trigger an infection. A further screening of CL cleaning solutions and the documentation of the cleaning solutions used by infected patients could show whether there is a connection between the occurrence of contact lens-associated eye infections and certain CL cleaning solutions. KW - Fusarium KW - Hornhautinfektionen Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-347774 ER - TY - JOUR A1 - Moremi, Nyambura A1 - Claus, Heike A1 - Vogel, Ulrich A1 - Mshana, Stephen E. T1 - The role of patients and healthcare workers Staphylococcus aureus nasal colonization in occurrence of surgical site infection among patients admitted in two centers in Tanzania JF - Antimicrobial Resistance & Infection Control N2 - Background Colonization with Staphylococcus aureus has been identified as a risk for subsequent occurrence of infection. This study investigated the relationship between S. aureus colonization of patients and healthcare workers (HCWs), and subsequent surgical site infections (SSI). Methods Between December 2014 and September 2015, a total of 930 patients and 143 HCWs were enrolled from the Bugando Medical Centre and Sekou Toure hospital in Mwanza, Tanzania. On admission and discharge nasal swabs, with an additional of wound swab for those who developed SSI were collected from patients whereas HCWs were swabbed once. Identification and antimicrobial susceptibility testing were done by VITEK-MS and VITEK-2, respectively. Detection of Panton Valentine leukocidin (PVL) and mecA genes was done by PCR. S. aureus isolates were further characterized by spa typing and Multi-Locus Sequence Typing (MLST). Results Among 930 patients screened for S. aureus on admission, 129 (13.9%) were positive of which 5.4% (7/129) were methicillin-resistant S. aureus (MRSA). Amongst 363 patients rescreened on discharge, 301 patients had been tested negative on admission of whom 29 (9.6%) turned positive after their hospital stay. Three (10.3%) of the 29 acquired S. aureus were MRSA. Inducible Clindamycin resistance occurred more often among acquired S. aureus isolates than among isolates from admission [34.5% (10/29) vs. 17.1% (22/129), P = 0.018]. S. aureus contributed to 21.1% (n = 12) of the 57 cases of investigated SSIs among 536 patients followed. Seven out of eight S. aureus carriage/infection pairs had the same spa and sequence types. The previously reported dominant PVL-positive ST88 MRSA strain with spa type t690 was detected in patients and HCW. Conclusion A significant proportion of patients acquired S. aureus during hospitalization. The finding of more than 90% of S. aureus SSI to be of endogenous source underscores the need of improving infection prevention and control measures including screening and decolonization of high risk patients. KW - S. aureus KW - colonization KW - surgical site infection KW - Tanzania Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-224185 VL - 8 ER - TY - JOUR A1 - Ruf, Dominik A1 - Brantl, Victor A1 - Wagener, Johannes T1 - Mitochondrial Fragmentation in \(Aspergillus\) \(fumigatus\) as Early Marker of Granulocyte Killing Activity JF - Frontiers in Cellular and Infection Microbiology N2 - The host's defense against invasive mold infections relies on diverse antimicrobial activities of innate immune cells. However, studying these mechanisms in vitro is complicated by the filamentous nature of such pathogens that typically form long, branched, multinucleated and compartmentalized hyphae. Here we describe a novel method that allows for the visualization and quantification of the antifungal killing activity exerted by human granulocytes against hyphae of the opportunistic pathogen Aspergillus fumigatus. The approach relies on the distinct impact of fungal cell death on the morphology of mitochondria that were visualized with green fluorescent protein (GFP). We show that oxidative stress induces complete fragmentation of the tubular mitochondrial network which correlates with cell death of affected hyphae. Live cell microscopy revealed a similar and non-reversible disruption of the mitochondrial morphology followed by fading of fluorescence in Aspergillus hyphae that were killed by human granulocytes. Quantitative microscopic analysis of fixed samples was subsequently used to estimate the antifungal activity. By utilizing this assay, we demonstrate that lipopolysaccharides as well as human serum significantly increase the killing efficacy of the granulocytes. Our results demonstrate that evaluation of the mitochondrial morphology can be utilized to assess the fungicidal activity of granulocytes against A. fumigatus hyphae. KW - Aspergillus fumigatus KW - killing KW - assay KW - PMNs KW - granulocytes KW - mitochondria KW - mitochondrial morphology KW - fungicidal activity Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-227133 VL - 8 IS - 128 ER - TY - JOUR A1 - Drayß, Maria A1 - Claus, Heike A1 - Hubert, Kerstin A1 - Thiel, Katrin A1 - Berger, Anja A1 - Sing, Andreas A1 - van der Linden, Mark A1 - Vogel, Ulrich A1 - Lâm, Thiên-Trí T1 - Asymptomatic carriage of Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, Group A Streptococcus and Staphylococcus aureus among adults aged 65 years and older JF - PLoS ONE N2 - Objective The aim of this study was to determine the prevalence of Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, group A Streptococcus (GAS), and Staphylococcus aureus in asymptomatic elderly people and to unravel risk factors leading to colonization. Methods A multi-centre cross-sectional study was conducted including 677 asymptomatic adults aged 65 years or more, living at home or in nursing homes. Study areas were Greater Aachen (North-Rhine-Westphalia) and Wuerzburg (Bavaria), both regions with medium to high population density. Nasal and oropharyngeal swabs as well as questionnaires were collected from October 2012 to May 2013. Statistical analysis included multiple logistic regression models. Results The carriage rate was 1.9% ([95%CI: 1.0–3.3%]; 13/677) for H. influenzae, 0.3% ([95%CI: 0–1.1%]; 2/677) for N. meningitidis and 0% ([95% CI: 0–0.5%]; 0/677) for S. pneumoniae and GAS. Staphylococcus aureus was harboured by 28.5% of the individuals ([95% CI: 25.1–32.1%]; 193/677) and 0.7% ([95% CI: 0.2–1.7%]; 5/677) were positive for methicillin-resistant S. aureus. Among elderly community-dwellers colonization with S. aureus was significantly associated with higher educational level (adjusted OR: 1.905 [95% CI: 1.248–2.908]; p = 0.003). Among nursing home residents colonization was associated with being married (adjusted OR: 3.367 [1.502–7.546]; p = 0.003). Conclusion The prevalence of N. meningitidis, H. influenzae, S. pneumoniae and GAS was low among older people in Germany. The S. aureus rate was expectedly high, while MRSA was found in less than 1% of the individuals. KW - Geriatric care KW - Geriatrics KW - Elderly KW - Staphylococcus aureus KW - Nursing homes KW - Haemophilus influenzae KW - Neisseria meningitidis KW - Methicillin-resistant Staphylococcus aureus Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-201042 VL - 14 IS - 2 ER - TY - JOUR A1 - Luber, Verena A1 - Lutz, Mathias A1 - Abele-Horn, Marianne A1 - Einsele, Hermann A1 - Grigoleit, Götz Ulrich A1 - Mielke, Stephan T1 - Excretion of Ascaris lumbricoides following reduced‐intensity allogeneic hematopoietic stem cell transplantation and consecutive treatment with mebendazole JF - Transplant Infectious Disease N2 - Here, we present the unique case of a 51‐year‐old German patient with multiple myeloma excreting Ascaris lumbricoides in his stool five weeks after allogeneic hematopoietic stem cell transplantation. Stool analysis remained negative for the presence of eggs, and there was no eosinophilia in the peripheral blood at any time around stem cell transplantation. The patient was commenced on a three‐day treatment with mebendazole, which was well tolerated. No serious interactions with the concomitant post‐transplant medication or negative effects on the hematopoiesis were observed, and the myeloma still is in complete remission. To our knowledge, this is the first report on excretion of A lumbricoides in the context of allogeneic stem cell transplantation. The case is remarkable with view to the fact that the parasite has supposedly survived all courses of myeloma treatment including autologous and allogeneic conditioning. Parasitosis with A lumbricoides has a worldwide prevalence of about a billion and is extremely rare in northern Europe. Possibly the patient got infected during a trip to Egypt years before multiple myeloma was diagnosed. KW - sirolimus KW - mycophenolic acid KW - multiple myeloma KW - mebendazole KW - hematopoietic stem cell transplantation KW - Ascaris lumbricoides Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-219608 SN - 1399-3062 VL - 22 IS - 1 ER - TY - JOUR A1 - Prauße, Maria T. E. A1 - Lehnert, Teresa A1 - Timme, Sandra A1 - Hünniger, Kerstin A1 - Leonhardt, Ines A1 - Kurzai, Oliver A1 - Figge, Marc Thilo T1 - Predictive Virtual Infection Modeling of Fungal Immune Evasion in Human Whole Blood JF - Frontiers in Immunology N2 - Bloodstream infections by the human-pathogenic fungi Candida albicans and Candida glabrata increasingly occur in hospitalized patients and are associated with high mortality rates. The early immune response against these fungi in human blood comprises a concerted action of humoral and cellular components of the innate immune system. Upon entering the blood, the majority of fungal cells will be eliminated by innate immune cells, i.e., neutrophils and monocytes. However, recent studies identified a population of fungal cells that can evade the immune response and thereby may disseminate and cause organ dissemination, which is frequently observed during candidemia. In this study, we investigate the so far unresolved mechanism of fungal immune evasion in human whole blood by testing hypotheses with the help of mathematical modeling. We use a previously established state-based virtual infection model for whole-blood infection with C. albicans to quantify the immune response and identified the fungal immune-evasion mechanism. While this process was assumed to be spontaneous in the previous model, we now hypothesize that the immune-evasion process is mediated by host factors and incorporate such a mechanism in the model. In particular, we propose, based on previous studies that the fungal immune-evasion mechanism could possibly arise through modification of the fungal surface by as of yet unknown proteins that are assumed to be secreted by activated neutrophils. To validate or reject any of the immune-evasion mechanisms, we compared the simulation of both immune-evasion models for different infection scenarios, i.e., infection of whole blood with either C. albicans or C. glabrata under non-neutropenic and neutropenic conditions. We found that under non-neutropenic conditions, both immune-evasion models fit the experimental data from whole-blood infection with C. albicans and C. glabrata. However, differences between the immune-evasion models could be observed for the infection outcome under neutropenic conditions with respect to the distribution of fungal cells across the immune cells. Based on these predictions, we suggested specific experimental studies that might allow for the validation or rejection of the proposed immune-evasion mechanism. KW - immune evasion KW - state-based model KW - innate immune response KW - polymorphonuclear neutrophils KW - whole-blood infection assay Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-197493 SN - 1664-3224 VL - 9 IS - 560 ER - TY - JOUR A1 - Becam, Jérôme A1 - Walter, Tim A1 - Burgert, Anne A1 - Schlegel, Jan A1 - Sauer, Markus A1 - Seibel, Jürgen A1 - Schubert-Unkmeir, Alexandra T1 - Antibacterial activity of ceramide and ceramide analogs against pathogenic Neisseria JF - Scientific Reports N2 - Certain fatty acids and sphingoid bases found at mucosal surfaces are known to have antibacterial activity and are thought to play a more direct role in innate immunity against bacterial infections. Herein, we analysed the antibacterial activity of sphingolipids, including the sphingoid base sphingosine as well as short-chain C\(_{6}\) and long-chain C\(_{16}\)-ceramides and azido-functionalized ceramide analogs against pathogenic Neisseriae. Determination of the minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) demonstrated that short-chain ceramides and a ω-azido-functionalized C\(_{6}\)-ceramide were active against Neisseria meningitidis and N. gonorrhoeae, whereas they were inactive against Escherichia coli and Staphylococcus aureus. Kinetic assays showed that killing of N. meningitidis occurred within 2 h with ω–azido-C\(_{6}\)-ceramide at 1 X the MIC. Of note, at a bactericidal concentration, ω–azido-C\(_{6}\)-ceramide had no significant toxic effect on host cells. Moreover, lipid uptake and localization was studied by flow cytometry and confocal laser scanning microscopy (CLSM) and revealed a rapid uptake by bacteria within 5 min. CLSM and super-resolution fluorescence imaging by direct stochastic optical reconstruction microscopy demonstrated homogeneous distribution of ceramide analogs in the bacterial membrane. Taken together, these data demonstrate the potent bactericidal activity of sphingosine and synthetic short-chain ceramide analogs against pathogenic Neisseriae. KW - ceramide analogs KW - Neisseria KW - ceramide Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-159367 VL - 7 ER - TY - JOUR A1 - Wagener, Johannes A1 - Loiko, Veronika T1 - Recent insights into the paradoxical effect of echinocandins JF - Journal of Fungi N2 - Echinocandin antifungals represent one of the most important drug classes for the treatment of invasive fungal infections. The mode of action of the echinocandins relies on inhibition of the β-1,3-glucan synthase, an enzyme essentially required for the synthesis of the major fungal cell wall carbohydrate β-1,3-glucan. Depending on the species, echinocandins may exert fungicidal or fungistatic activity. Apparently independent of this differential activity, a surprising in vitro phenomenon called the “paradoxical effect” can be observed. The paradoxical effect is characterized by the ability of certain fungal isolates to reconstitute growth in the presence of higher echinocandin concentrations, while being fully susceptible at lower concentrations. The nature of the paradoxical effect is not fully understood and has been the focus of multiple studies in the last two decades. Here we concisely review the current literature and propose an updated model for the paradoxical effect, taking into account recent advances in the field. KW - echinocandin KW - caspofungin KW - micafungin KW - anidulafungin KW - paradoxical effect KW - paradoxical growth KW - glucan synthase KW - Fks1 KW - antifungals KW - echinocandins Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-197960 SN - 2309-608X VL - 4 IS - 1 ER - TY - JOUR A1 - Sturm, Laura A1 - Geißel, Bernadette A1 - Martin, Ronny A1 - Wagener, Johannes T1 - Differentially Regulated Transcription Factors and ABC Transporters in a Mitochondrial Dynamics Mutant Can Alter Azole Susceptibility of Aspergillus fumigatus JF - Frontiers in Microbiology N2 - Azole resistance of the fungal pathogen Aspergillus fumigatus is an emerging problem. To identify novel mechanisms that could mediate azole resistance in A. fumigatus, we analyzed the transcriptome of a mitochondrial fission/fusion mutant that exhibits increased azole tolerance. Approximately 12% of the annotated genes are differentially regulated in this strain. This comprises upregulation of Cyp51A, the azole target structure, upregulation of ATP-binding cassette (ABC) superfamily and major facilitator superfamily (MFS) transporters and differential regulation of transcription factors. To study their impact on azole tolerance, conditional mutants were constructed of seven ABC transporters and 17 transcription factors. Under repressed conditions, growth rates and azole susceptibility of the mutants were similar to wild type. Under induced conditions, several transcription factor mutants showed growth phenotypes. In addition, four ABC transporter mutants and seven transcription factor mutants exhibited altered azole susceptibility. However, deletion of individual identified ABC transporters and transcription factors did not affect the increased azole tolerance of the fission/fusion mutant. Our results revealed the ability of multiple ABC transporters and transcription factors to modulate the azole susceptibility of A. fumigatus and support a model where mitochondrial dysfunctions trigger a drug resistance network that mediates azole tolerance of this mold. KW - mitochondrial dynamics KW - azole resistance KW - efflux pumps KW - transcription factors Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-204874 SN - 1664-302X VL - 11 ER - TY - JOUR A1 - Moremi, Nyambura A1 - Claus, Heike A1 - Mshana, Stephen E. T1 - Antimicrobial resistance pattern: a report of microbiological cultures at a tertiary hospital in Tanzania JF - BMC Infectious Diseases N2 - Background Antimicrobial resistance has been declared by the World Health Organization as a threat to the public health. The aim of this study was to analyze antimicrobial resistance patterns of the common pathogens occurring at the Bugando Medical Centre (BMC), Mwanza, Tanzania to provide data for antimicrobial stewardship programmes. Methods A total of 3330 microbiological culture results scripts representing non-repetitive specimens reported between June 2013 and May 2015 were retrieved and analyzed for pathogens and their susceptibility patterns using STATA-11 software. Results Out of 3330 specimens, 439 (13.2%) had positive culture. Staphylococcus aureus (n = 100; 22.8%), Klebsiella pneumoniae (n = 65; 14.8%) and Escherichia coli (n = 41; 9.3%) were the most frequently isolated bacteria. Of 78 Staphylococcus aureus tested, 27 (34.6%) were found to be methicillin resistant Staphylococcus aureus (MRSA). Rates of resistance of Klebsiella pneumoniae and Escherichia coli isolates to third generation cephalosporins were 38.5% (25/65) and 29.3% (12/41) respectively. Staphylococcus aureus and Klesbiella pneumoniae were commonly isolated from bloodstream infections while Escherichia coli and Pseudomonas aeruginosa were the predominant isolates from urinary tract and wounds infections respectively. Of 23 Salmonella species isolated, 22 (95%) were recovered from the blood. Nine of the 23 Salmonella species isolates (39%) were found to be resistant to third generation cephalosporins. The resistance rate of gram-negative bacteria to third generation cephalosporins increased from 26.5% in 2014 to 57.9% in 2015 (p = 0.004) while the rate of MRSA decreased from 41.2% in 2013 to 9.5% in 2015 (p = 0.016). Multidrug-resistant gram-negative isolates were commonly isolated from Intensive Care Units and it was noted that, the majority of invasive infections were due to gram-negative bacteria. Conclusion There is an increase in proportion of gram-negative isolates resistant to third generation cephalosporins. The diversity of potential pathogens resistant to commonly prescribed antibiotics underscores the importance of sustained and standardized antimicrobial resistance surveillance and antibiotic stewardship programmes in developing countries. KW - Tanzania KW - antimicrobial resistance KW - cephalosporin-resistant gram-negative bacteria KW - MRSA Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-161185 VL - 16 IS - 756 ER - TY - JOUR A1 - Glaser, Kirsten A1 - Silwedel, Christine A1 - Fehrholz, Markus A1 - Waaga-Gasser, Ana M. A1 - Henrich, Birgit A1 - Claus, Heike A1 - Speer, Christian P. T1 - Ureaplasma Species Differentially Modulate Pro- and Anti-Inflammatory Cytokine Responses in Newborn and Adult Human Monocytes Pushing the State Toward Pro-Inflammation JF - Frontiers in Cellular and Infection Microbiology N2 - Background: Ureaplasma species have been associated with chorioamnionitis and preterm birth and have been implicated in the pathogenesis of neonatal short and long-term morbidity. However, being mostly commensal bacteria, controversy remains on the pro-inflammatory capacity of Ureaplasma. Discussions are ongoing on the incidence and impact of prenatal, perinatal, and postnatal infection. The present study addressed the impact of Ureaplasma isolates on monocyte-driven inflammation. Methods: Cord blood monocytes of term neonates and adult monocytes, either native or LPS-primed, were cultured with Ureaplasma urealyticum (U. urealyticum) serovar 8 (Uu8) and Ureaplasma parvum serovar 3 (Up3). Using qRT-PCR, cytokine flow cytometry, and multi-analyte immunoassay, we assessed mRNA and protein expression of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-8, IL-12p40, IL-10, and IL-1 receptor antagonist (IL-1ra) as well as Toll-like receptor (TLR) 2 and TLR4. Results: Uu8 and Up3 induced mRNA expression and protein release of TNF-α, IL-1β and IL-8 in term neonatal and adult monocytes (p < 0.01 and p < 0.05). Intracellular protein expression of TNF-α, IL-1β and IL-8 in Ureaplasma-stimulated cells paralleled those results. Ureaplasma-induced cytokine levels did not significantly differ from LPS-mediated levels except for lower intracellular IL-1β in adult monocytes (Uu8: p < 0.05). Remarkably, ureaplasmas did not induce IL-12p40 response and promoted lower amounts of anti-inflammatory IL-10 and IL-1ra than LPS, provoking a cytokine imbalance more in favor of pro-inflammation (IL-1β/IL-10, IL-8/IL-10 and IL-8/IL-1ra: p < 0.01, vs. LPS). In contrast to LPS, both isolates induced TLR2 mRNA in neonatal and adult cells (p < 0.001 and p < 0.05) and suppressed TLR4 mRNA in adult monocytes (p < 0.05). Upon co-stimulation, Uu8 and Up3 inhibited LPS-induced intracellular IL-1β (p < 0.001 and p < 0.05) and IL-8 in adult monocytes (p < 0.01), while LPS-induced neonatal cytokines were maintained or aggravated (p < 0.05). Conclusion: Our data demonstrate a considerable pro-inflammatory capacity of Ureaplasma isolates in human monocytes. Stimulating pro-inflammatory cytokine responses while hardly inducing immunomodulatory and anti-inflammatory cytokines, ureaplasmas might push monocyte immune responses toward pro-inflammation. Inhibition of LPS-induced cytokines in adult monocytes in contrast to sustained inflammation in term neonatal monocytes indicates a differential modulation of host immune responses to a second stimulus. Modification of TLR2 and TLR4 expression may shape host susceptibility to inflammation. KW - Ureaplasma KW - infection KW - inflammation KW - immunomodulation KW - chorioamnionitis KW - neonatal morbidity KW - monocytes KW - cord blood Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-169958 VL - 7 IS - 484 ER - TY - JOUR A1 - Heidrich, Nadja A1 - Bauriedl, Saskia A1 - Barquist, Lars A1 - Li, Lei A1 - Schoen, Christoph A1 - Vogel, Jörg T1 - The primary transcriptome of Neisseria meningitidis and its interaction with the RNA chaperone Hfq JF - Nucleic Acids Research N2 - Neisseria meningitidis is a human commensal that can also cause life-threatening meningitis and septicemia. Despite growing evidence for RNA-based regulation in meningococci, their transcriptome structure and output of regulatory small RNAs (sRNAs) are incompletely understood. Using dRNA-seq, we have mapped at single-nucleotide resolution the primary transcriptome of N. meningitidis strain 8013. Annotation of 1625 transcriptional start sites defines transcription units for most protein-coding genes but also reveals a paucity of classical σ70-type promoters, suggesting the existence of activators that compensate for the lack of −35 consensus sequences in N. meningitidis. The transcriptome maps also reveal 65 candidate sRNAs, a third of which were validated by northern blot analysis. Immunoprecipitation with the RNA chaperone Hfq drafts an unexpectedly large post-transcriptional regulatory network in this organism, comprising 23 sRNAs and hundreds of potential mRNA targets. Based on this data, using a newly developed gfp reporter system we validate an Hfq-dependent mRNA repression of the putative colonization factor PrpB by the two trans-acting sRNAs RcoF1/2. Our genome-wide RNA compendium will allow for a better understanding of meningococcal transcriptome organization and riboregulation with implications for colonization of the human nasopharynx. KW - RNA KW - Neisseria meningitidis KW - dRNA-seq KW - transcriptome KW - RNA chaperone Hfq Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-170828 VL - 45 IS - 10 ER - TY - JOUR A1 - Hellenbrand, Wiebke A1 - Claus, Heike A1 - Schink, Susanne A1 - Marcus, Ulrich A1 - Wichmann, Ole A1 - Vogel, Ulrich T1 - Risk of Invasive Meningococcal Disease in Men Who Have Sex with Men: Lessons Learned from an Outbreak in Germany, 2012-2013 JF - PLoS ONE N2 - Background We undertook investigations in response to an invasive meningococcal disease (IMD) outbreak in men who have sex with men (MSM) in Berlin 2012–2013 to better understand meningococcal transmission and IMD risk in MSM. Methods We retrospectively searched for further IMD cases in MSM in Germany through local health departments and undertook exploratory interviews. We performed antigen sequence typing, characterized fHbp and aniA genes of strains with the outbreak finetype and reviewed epidemiologically or spatiotemporally linked cases from 2002–2014. Results Among the 148 IMD-cases notified from 01.01.2012–30.09.2013 in 18–59 year-old men we identified 13 MSM in 6 federal states: 11 serogroup C (MenC, all finetype C:P1.5–1,10–8:F3-6), 2 MenB. Interviews with 7 MSM revealed frequent meeting of multiple partners online or via mobile apps and illicit drug use as potential risk factors. MenC incidence was 13-fold higher in MSM than non-MSM. MenC isolates from 9/11 MSM had a novel fHbp allele 766. All C:P1.5–1,10–8:F3-6 strains from MSM versus 16/23 from non-MSM had intact aniA genes (p = 0.04). Although definitive evidence for transmission among MSM in epidemiological or spatiotemporal clusters in 2002–2014 was lacking, clusters were more frequent in men aged 20–49 years. Molecular analysis of C:P1.5–1,10–8:F3-6 strains revealed cases with intact aniA since 2007, mainly associated with fHbp361, fHbp766 and fHbp813, all involving one or more MSM. Conclusions MenC incidence was elevated in MSM during the study period. Multiple casual sexual contacts and illicit drug use were common in affected MSM. In all strains from MSM we detected an intact aniA gene coding for a nitrite reductase, which permits survival in microanaerobic environments and could play a role in meningococcal transmission in MSM through urogenital colonization. Furthermore, meningococcal transmission among MSM may be sustained over large areas and thus require modified spatiotemporal scanning algorithms for timely detection and control. KW - invasive meningococcal disease KW - men who have sex with men KW - Germany Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-166842 VL - 11 IS - 8 ER - TY - JOUR A1 - Machata, Silke A1 - Sreekantapuram, Sravya A1 - Hünniger, Kerstin A1 - Kurzai, Oliver A1 - Dunker, Christine A1 - Schubert, Katja A1 - Krüger, Wibke A1 - Schulze-Richter, Bianca A1 - Speth, Cornelia A1 - Rambach, Günter A1 - Jacobsen, Ilse D. T1 - Significant Differences in Host-Pathogen Interactions Between Murine and Human Whole Blood JF - Frontiers in Immunology N2 - Murine infection models are widely used to study systemic candidiasis caused by C. albicans. Whole-blood models can help to elucidate host-pathogens interactions and have been used for several Candida species in human blood. We adapted the human whole-blood model to murine blood. Unlike human blood, murine blood was unable to reduce fungal burden and more substantial filamentation of C. albicans was observed. This coincided with less fungal association with leukocytes, especially neutrophils. The lower neutrophil number in murine blood only partially explains insufficient infection and filamentation control, as spiking with murine neutrophils had only limited effects on fungal killing. Furthermore, increased fungal survival is not mediated by enhanced filamentation, as a filament-deficient mutant was likewise not eliminated. We also observed host-dependent differences for interaction of platelets with C. albicans, showing enhanced platelet aggregation, adhesion and activation in murine blood. For human blood, opsonization was shown to decrease platelet interaction suggesting that complement factors interfere with fungus-to-platelet binding. Our results reveal substantial differences between murine and human whole-blood models infected with C. albicans and thereby demonstrate limitations in the translatability of this ex vivo model between hosts. KW - whole blood ex vivo model KW - host-pathogen interaction KW - neutrophils KW - mice Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-222575 SN - 1664-3224 VL - 11 ER - TY - JOUR A1 - Duske, Helene A1 - Claus, Heike A1 - Krone, Manuel A1 - Lâm, Thiên-Trí T1 - Prevalence of piperacillin/tazobactam resistance in invasive \(Haemophilus\) \(influenzae\) in Germany JF - JAC-Antimicrobial Resistance N2 - Background Haemophilus influenzae (Hi) is a Gram-negative bacterium that may cause sepsis or meningitis, treatment of which mainly includes β-lactam antibiotics. Since 2019 EUCAST breakpoints for piperacillin/tazobactam have been available. Little is known about the prevalence and mechanisms of piperacillin/tazobactam resistance in Hi. Objectives To provide reliable prevalence data for piperacillin/tazobactam resistance in Hi in Germany, to evaluate different antibiotic susceptibility testing methods and to examine possible resistance mechanisms. Methods According to EUCAST breakpoints, the MIC for piperacillin/tazobactam resistance is >0.25 mg/L. All invasive Hi in Germany from 2019 were examined by gradient agar diffusion (GAD) for piperacillin/tazobactam susceptibility. Piperacillin/tazobactam broth microdilution (BMD), piperacillin GAD on tazobactam-containing agar [piperacillin GAD on Mueller–Hinton agar with horse blood (MH-F)/tazobactam) and piperacillin/tazobactam agar dilution (AD) were used for confirmation. Phenotypic testing was complemented by ftsI sequencing. Results Piperacillin/tazobactam GAD resulted in 2.9% (21/726) resistant Hi. BMD did not confirm piperacillin/tazobactam resistance. Two strains were found resistant by AD, of which one was also resistant using piperacillin GAD on MH-F/tazobactam. Overall, we found two strains with a piperacillin/tazobactam MIC >0.25 mg/L in at least two different tests (0.3%). Both were β-lactamase-producing amoxicillin/clavulanate-resistant with PBP3 mutations characterized as group III-like+. Relevant PBP3 mutations occurred in six strains without phenotypic piperacillin/tazobactam resistance. These mutations suggest a reduced efficacy of β-lactam antibiotics in these isolates. Conclusions Piperacillin/tazobactam resistance prevalence in invasive Hi is low in Germany. Reduced susceptibility was correlated with PBP3 mutations, in particular with group III mutations. KW - microbiology KW - immunology KW - generalized anxiety disorder KW - haemophilus influenzae KW - agar KW - Germany KW - piperacillin KW - piperacillin/tazobactam KW - tazobactam KW - Haemophilus influenzae Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-350424 SN - 2632-1823 VL - 6 IS - 1 ER - TY - THES A1 - Endres, Leo Maximilian T1 - Development of multicellular \(in\) \(vitro\) models of the meningeal blood-CSF barrier to study \(Neisseria\) \(meningitidis\) infection T1 - Entwicklung multizellulärer \(in\) \(vitro\) Modelle der meningealen Blut-Liquor Schranke zur Untersuchung der \(Neisseria\) \(meningitidis\) Infektion N2 - Neisseria meningitidis (the meningococcus) is one of the major causes of bacterial meningitis, a life-threatening inflammation of the meninges. Traversal of the meningeal blood-cerebrospinal fluid barrier (mBCSFB), which is composed of highly specialized brain endothelial cells (BECs), and subsequent interaction with leptomeningeal cells (LMCs) are critical for disease progression. Due to the human-exclusive tropism of N. meningitidis, research on this complex host-pathogen interaction is mostly limited to in vitro studies. Previous studies have primarily used peripheral or immortalized BECs alone, which do not retain relevant barrier phenotypes in culture. To study meningococcal interaction with the mBCSFB in a physiologically more accurate context, BEC-LMC co-culture models were developed in this project using BEC-like cells derived from induced pluripotent stem cells (iBECs) or hCMEC/D3 cells in combination with LMCs derived from tumor biopsies. Distinct BEC and LMC layers as well as characteristic expression of cellular markers were observed using transmission electron microscopy (TEM) and immunofluorescence staining. Clear junctional expression of brain endothelial tight and adherens junction proteins was detected in the iBEC layer. LMC co-culture increased iBEC barrier tightness and stability over a period of seven days, as determined by sodium fluorescein (NaF) permeability and transendothelial electrical resistance (TEER). Infection experiments demonstrated comparable meningococcal adhesion and invasion of the BEC layer in all models tested, consistent with previously published data. While only few bacteria crossed the iBEC-LMC barrier initially, transmigration rates increased substantially over 24 hours, despite constant high TEER. After 24 hours of infection, deterioration of the barrier properties was observed including loss of TEER and altered expression of tight and adherens junction components. Reduced mRNA levels of ZO-1, claudin-5, and VE-cadherin were detected in BECs from all models. qPCR and siRNA knockdown data suggested that transcriptional downregulation of these genes was potentially but not solely mediated by Snail1. Immunofluorescence staining showed reduced junctional coverage of occludin, indicating N. meningitidis-induced post-transcriptional modulation of this protein, as previous studies have suggested. Together, these results suggest a potential combination of transcellular and paracellular meningococcal traversal of the mBCSFB, with the more accessible paracellular route becoming available upon barrier disruption after prolonged N. meningitidis infection. Finally, N. meningitidis induced cellular expression of pro-inflammatory cytokines and chemokines such as IL-8 in all mBCSFB models. Overall, the work described in this thesis highlights the usefulness of advanced in vitro models of the mBCSFB that mimic native physiology and exhibit relevant barrier properties to study infection with meningeal pathogens such as N. meningitidis. N2 - Neisseria meningitidis (der Meningokokkus) ist einer der Hauptursachen bakterieller Meningitis, einer lebensbedrohlichen Entzündung der Hirnhäute. Entscheidend für das für das Voranschreiten der Krankheit ist die Fähigkeit des Erregers, die meningeale Blut-Liquor-Schranke (mBCSFB), bestehend aus spezialisierten Hirnendothelzellen (BECs) und leptomeningealen Zellen (LMCs), zu überwinden und in den submeningealen Raum einzudringen. Da es sich bei N. meningitidis um ein rein humanes Pathogen handelt, beschränkt sich die Erforschung dieser speziellen Interaktion primär auf die Verwendung von in vitro Modellen. Bisher wurden hierfür hauptsächlich periphere oder immortalisierte BECs verwendet, welchen jedoch wichtige Barriere-Eigenschaften fehlen. Um die Interaktion von N. meningitidis mit der mBCSFB in einem physiologisch relevanteren Umfeld zu untersuchen, wurden in dieser Arbeit neuartige BEC-LMC Kokulturmodelle entwickelt. Dabei wurden sowohl BEC-ähnliche Zellen, die aus induzierten pluripotenten Stammzellen generiert wurden (iBECs), als auch hCMEC/D3 Zellen verwendet und zusammen mit LMCs aus Tumorbiopsien kultiviert. Mittels Transmissions-Elektronenmikroskopie und Immunfluoreszenzfärbung konnten die unterschiedlichen Zellschichten und deren Expression charakteristischer zellulärer Marker dargestellt werden. Durchgängige Expression von wichtigen Bestandteilen Barriere-formender Zellverbindungen, sogenannter Tight und Adherens Junctions, wurde in der iBEC-Schicht beobachtet. Die Integrität der zellulären Barriere wurde mittels transendothelialer elektrischer Resistenz (TEER) und Permeabilität gegenüber Natrium-Fluorescein (NaF) bestimmt. Erhöhte TEER-Werte und verringerte NaF-Permeabilität, gemessen über einen Zeitraum von sieben Tagen, zeigten eine durch die Kokultur mit LMCs ausgelöste Steigerung der Dichtigkeit und Stabilität der iBEC-Barriere. Infektionsexperimente mit N. meningitidis zeigten in allen Modellen vergleichbare bakterielle Adhäsion und Invasion der BEC-Schicht. Bakterielle Transmigration durch die gesamten Zellbarriere war im iBEC-LMC Modell kurz nach Infektion nur in geringem Maße detektierbar, nahm jedoch innerhalb von 24 Stunden deutlich zu. Interessanterweise wurde bis zu 24 Stunden nach Infektion noch eine hohe Integrität der Barriere gemessen, welche allerdings im weiteren Verlauf verloren ging. Neben signifikantem TEER-Verlust wurde eine verringerte Expression der Tight und Adherens Junction Proteine ZO-1, claudin-5, und VE-cadherin mittels qPCR festgestellt. qPCR und siRNA Knockdown Experimente deuteten darauf hin, dass dies möglicherweise, aber nicht ausschließlich, auf den Transkriptionsfaktor Snail1 zurückzuführen war. Zusätzlich zu den beobachteten Effekten auf die zelluläre Transkription von Tight Junction Genen, zeigten Immunfluoreszenzfärbungen eine verringerte Expression von Occludin an den Zell-Zell-Verbindungen, was auf eine post-translationale Modulation schließen lässt. Zusammen deuten die Ergebnisse dieser Infektionsstudien auf eine mögliche Kombination aus trans- und parazellulärer bakterieller Transmigration der mBCSFB hin. Zuletzt wurden in dieser Arbeit noch die Immunaktivierung von BECs nach N. meningitidis Infektion in den neuen BEC-LMC Kokulturmodellen untersucht. Hierbei wurde eine erhöhte Expression von Zytokinen, insbesondere Interleukin-8, beobachtet. Insgesamt konnten in dieser Arbeit neue, fortschrittlicher in vitro Modelle der mBCSFB entwickelt werden, welche die humane Physiologie besser widerspiegeln und daher für Infektionsstudien mit Meningitis-verursachenden Erregern wie N. meningitidis von besonderem Nutzen sind. KW - Bakterielle Hirnhautentzündung KW - Blut-Liquor-Schranke KW - Induzierte pluripotente Stammzelle KW - Neisseria meningitidis KW - In-vitro-Kultur KW - Brain endothelial cells KW - Leptomeningeal cells KW - Hirnendothelzellen KW - Leptomeningealzellen Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-346216 ER - TY - JOUR A1 - Dichtl, Karl A1 - Koc, Özlem A1 - Forster, Johannes A1 - Scharf, Christina A1 - Suerbaum, Sebastian A1 - Andrassy, Joachim A1 - Wagener, Johannes A1 - Schroeder, Ines T1 - An invasive infection caused by the thermophilic mold Talaromyces thermophilus JF - Infection N2 - Background Increasing incidence of invasive infections caused by rare fungi was observed over the recent years. Case Here, we describe the first reported case of an infection caused by the thermophilic mold Talaromyces thermophilus. Cultivation and, hence, identification of this fastidious organism is challenging since standard incubation conditions are not sufficient. Retrospective analysis of patient samples and in vitro experiments demonstrated that testing for fungal antigens, i.e., the cell wall components galactomannan and β-1,3-D-glucan, is a promising tool. KW - Talaromyces KW - invasive fungal infection KW - thermophile KW - antigen testing KW - serology Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-308970 SN - 0300-8126 SN - 1439-0973 VL - 49 IS - 6 ER - TY - THES A1 - Ulrich, Johannes T1 - Molekulare Charaktierisierung einer DyP-Typ Peroxidase des Humanparasiten \(Echinococcus\) \(multilocularis\) T1 - Molecular characterisation of a DyP-type peroxidase of the human parasite \(Echinococcus\) \(multilocularis\) N2 - Die Alveoläre Echinokokkose (AE) ist eine tödliche Infektionserkrankung, die durch den parasitären Plattwurm Echinococcus multilocularis verursacht wird. Genomanalysen von E. multilocularis ergaben ein Gen, das laut Vorhersage für eine DyP-Typ Peroxidase codiere. Ziel dieser Arbeit ist die biologische Funktion des codierten Enzyms besser zu verstehen und Hinweise auf eine mögliche Rolle in der Abwehr von Reaktiven Sauerstoffspezies (ROS) zu erlangen. Das Gen wurde heterolog in E. Coli exprimiert und molekulare Charakteristika des Gens mit bioinformatischen und molekularbiologischen Methoden untersucht. Quantitative RT-PCR Untersuchungen gaben Aufschluss über das Transkriptprofil von emipox in unterschiedlichen Entwicklungsstadien von E. mulitlocularis. Mittels Whole-Mount In Situ-Hybridisierung (WMISH) wurden die Transkripte zudem lokalisiert und ihre Beziehung zum Stammzellsystem von E. multilocularis näher untersucht. Die Zugehörigkeit von EmIPOX zur Gruppe der DyP-Typ Peroxidasen wurde bestätigt. Homologe beim Menschen kommen nicht vor. Es konnte nachgewiesen werden, dass Transkripte von emipox auch, aber keinesfalls ausschließlich, in Stammzellen vorliegen. Überdurchschnittlich viele Transkripte liegen im aktivierten Protoscolex und im Metacestoden ex vivo aus einer infizierten Wirtsleber vor. Untersuchungen zur Enzymaktivität von EmIPOX zeigten neben einer Peroxidase- auch eine Katalaseaktivität. Die vorliegende Arbeit ist die erste Charakterisierung einer DyP-Typ Peroxidase bei Tieren. Sie legt nahe, dass EmIPOX eine Rolle in der Entgiftung von ROS in E. multilocularis spielt und stellt den Charakter von EmIPOX als potenzieller pharmakologischer Zielstruktur heraus. N2 - Alveolar echinococcosis (AE) is a fatal infectious disease caused by the parasitic flatworm Echinococcus multilocularis. Genome analyses of E. multilocularis revealed a gene predicted to encode a DyP-type peroxidase. The aim of this work is to better understand the biological function of the encoded enzyme and to obtain information on a possible role in the defence against reactive oxygen species (ROS). The gene was heterologously expressed in E. Coli and molecular characteristics of the gene were investigated using bioinformatic and molecular biological methods. Quantitative RT-PCR analyses provided information on the transcript profile of emipox in different developmental stages of E. mulitlocularis. Whole-mount in situ hybridisation (WMISH) was also used to localise the transcripts and investigate their relationship to the stem cell system of E. multilocularis. The affiliation of EmIPOX to the group of DyP-type peroxidases was confirmed. There are no homologues in humans. It has been shown that transcripts of emipox are also, but by no means exclusively, present in stem cells. An above-average number of transcripts are present in the activated protoscolex and in the metacestode ex vivo from an infected host liver. Investigations into the enzyme activity of EmIPOX revealed both peroxidase and catalase activity. The present work is the first characterisation of a DyP-type peroxidase in animals. It suggests that EmIPOX plays a role in the detoxification of ROS in E. multilocularis and highlights the character of EmIPOX as a potential pharmacological target. KW - Fuchsbandwurm KW - Oxidativer Stress KW - Peroxidase KW - Parasitäre Krankheit KW - Alveoläre Echinokokkose KW - alveolar echinococcosis KW - oxidative stress KW - DyP-type peroxidase KW - DyP-Typ Peroxidase KW - cestode KW - Bandwurm KW - Plathelminthes KW - flat worms KW - neglected tropical disease KW - katalase KW - Bandwürmer KW - Plattwürmer Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357143 ER - TY - JOUR A1 - Schlesinger, Tobias A1 - Weißbrich, Benedikt A1 - Wedekink, Florian A1 - Notz, Quirin A1 - Herrmann, Johannes A1 - Krone, Manuel A1 - Sitter, Magdalena A1 - Schmid, Benedikt A1 - Kredel, Markus A1 - Stumpner, Jan A1 - Dölken, Lars A1 - Wischhusen, Jörg A1 - Kranke, Peter A1 - Meybohm, Patrick A1 - Lotz, Christpher T1 - Biodistribution and serologic response in SARS-CoV-2 induced ARDS: A cohort study JF - PLoS One N2 - Background The viral load and tissue distribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remain important questions. The current study investigated SARS-CoV-2 viral load, biodistribution and anti-SARS-CoV-2 antibody formation in patients suffering from severe corona virus disease 2019 (COVID-19) induced acute respiratory distress syndrome (ARDS). Methods This is a retrospective single-center study in 23 patients with COVID-19-induced ARDS. Data were collected within routine intensive care. SARS-CoV-2 viral load was assessed via reverse transcription quantitative polymerase chain reaction (RT-qPCR). Overall, 478 virology samples were taken. Anti-SARS-CoV-2-Spike-receptor binding domain (RBD) antibody detection of blood samples was performed with an enzyme-linked immunosorbent assay. Results Most patients (91%) suffered from severe ARDS during ICU treatment with a 30-day mortality of 30%. None of the patients received antiviral treatment. Tracheal aspirates tested positive for SARS-CoV-2 in 100% of the cases, oropharyngeal swabs only in 77%. Blood samples were positive in 26% of the patients. No difference of viral load was found in tracheal or blood samples with regard to 30-day survival or disease severity. SARS-CoV-2 was never found in dialysate. Serologic testing revealed significantly lower concentrations of SARS-CoV-2 neutralizing IgM and IgA antibodies in survivors compared to non-survivors (p = 0.009). Conclusions COVID-19 induced ARDS is accompanied by a high viral load of SARS-CoV-2 in tracheal aspirates, which remained detectable in the majority throughout intensive care treatment. Remarkably, SARS-CoV-2 RNA was never detected in dialysate even in patients with RNAemia. Viral load or the buildup of neutralizing antibodies was not associated with 30-day survival or disease severity. KW - viral load Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-231348 VL - 15, 2020 IS - 11 ER - TY - JOUR A1 - Flemming, S. A1 - Hankir, M. A1 - Ernestus, R.-I. A1 - Seyfried, F. A1 - Germer, C.-T. A1 - Meybohm, P. A1 - Wurmb, T. A1 - Vogel, U. A1 - Wiegering, A. T1 - Surgery in times of COVID-19 — recommendations for hospital and patient management JF - Langenbeck's Archives of Surgery N2 - Background The novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2), has escalated rapidly to a global pandemic stretching healthcare systems worldwide to their limits. Surgeonshave had to immediately react to this unprecedented clinical challenge by systematically repurposing surgical wards. Purpose To provide a detailed set of guidelines developed in a surgical ward at University Hospital Wuerzburg to safelyaccommodate the exponentially rising cases of SARS-CoV-2 infected patients without compromising the care of emergencysurgery and oncological patients or jeopardizing the well-being of hospital staff. Conclusions The dynamic prioritization of SARS-CoV-2 infected and surgical patient groups is key to preserving life whilemaintaining high surgical standards. Strictly segregating patient groups in emergency rooms, non-intensive care wards andoperating areas prevents viral spread while adequately training and carefully selecting hospital staff allow them to confidentlyand successfully undertake their respective clinical duties. KW - SARS-CoV-2 KW - COVID-19 KW - Surgery Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-231766 SN - 1435-2443 VL - 405 ER - TY - JOUR A1 - Beierle, Felix A1 - Schobel, Johannes A1 - Vogel, Carsten A1 - Allgaier, Johannes A1 - Mulansky, Lena A1 - Haug, Fabian A1 - Haug, Julian A1 - Schlee, Winfried A1 - Holfelder, Marc A1 - Stach, Michael A1 - Schickler, Marc A1 - Baumeister, Harald A1 - Cohrdes, Caroline A1 - Deckert, Jürgen A1 - Deserno, Lorenz A1 - Edler, Johanna-Sophie A1 - Eichner, Felizitas A. A1 - Greger, Helmut A1 - Hein, Grit A1 - Heuschmann, Peter A1 - John, Dennis A1 - Kestler, Hans A. A1 - Krefting, Dagmar A1 - Langguth, Berthold A1 - Meybohm, Patrick A1 - Probst, Thomas A1 - Reichert, Manfred A1 - Romanos, Marcel A1 - Störk, Stefan A1 - Terhorst, Yannik A1 - Weiß, Martin A1 - Pryss, Rüdiger T1 - Corona Health — A Study- and Sensor-Based Mobile App Platform Exploring Aspects of the COVID-19 Pandemic JF - International Journal of Environmental Research and Public Health N2 - Physical and mental well-being during the COVID-19 pandemic is typically assessed via surveys, which might make it difficult to conduct longitudinal studies and might lead to data suffering from recall bias. Ecological momentary assessment (EMA) driven smartphone apps can help alleviate such issues, allowing for in situ recordings. Implementing such an app is not trivial, necessitates strict regulatory and legal requirements, and requires short development cycles to appropriately react to abrupt changes in the pandemic. Based on an existing app framework, we developed Corona Health, an app that serves as a platform for deploying questionnaire-based studies in combination with recordings of mobile sensors. In this paper, we present the technical details of Corona Health and provide first insights into the collected data. Through collaborative efforts from experts from public health, medicine, psychology, and computer science, we released Corona Health publicly on Google Play and the Apple App Store (in July 2020) in eight languages and attracted 7290 installations so far. Currently, five studies related to physical and mental well-being are deployed and 17,241 questionnaires have been filled out. Corona Health proves to be a viable tool for conducting research related to the COVID-19 pandemic and can serve as a blueprint for future EMA-based studies. The data we collected will substantially improve our knowledge on mental and physical health states, traits and trajectories as well as its risk and protective factors over the course of the COVID-19 pandemic and its diverse prevention measures. KW - mobile health KW - ecological momentary assessment KW - digital phenotyping KW - longitudinal studies KW - mobile crowdsensing Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-242658 SN - 1660-4601 VL - 18 IS - 14 ER - TY - JOUR A1 - Cucher, Marcela A. A1 - Mariconti, Mara A1 - Manciulli, Tommaso A1 - Vola, Ambra A1 - Rosenzvit, Mara C. A1 - Brehm, Klaus A1 - Kamenetzky, Laura A1 - Brunetti, Enrico T1 - Circulating small RNA profiling of patients with alveolar and cystic echinococcosis JF - Biology N2 - Alveolar (AE) and cystic (CE) echinococcosis are two parasitic diseases caused by the tapeworms Echinococcus multilocularis and E. granulosus sensu lato (s. l.), respectively. Currently, AE and CE are mainly diagnosed by means of imaging techniques, serology, and clinical and epidemiological data. However, no viability markers that indicate parasite state during infection are available. Extracellular small RNAs (sRNAs) are short non-coding RNAs that can be secreted by cells through association with extracellular vesicles, proteins, or lipoproteins. Circulating sRNAs can show altered expression in pathological states; hence, they are intensively studied as biomarkers for several diseases. Here, we profiled the sRNA transcriptomes of AE and CE patients to identify novel biomarkers to aid in medical decisions when current diagnostic procedures are inconclusive. For this, endogenous and parasitic sRNAs were analyzed by sRNA sequencing in serum from disease negative, positive, and treated patients and patients harboring a non-parasitic lesion. Consequently, 20 differentially expressed sRNAs associated with AE, CE, and/or non-parasitic lesion were identified. Our results represent an in-depth characterization of the effect E. multilocularis and E. granulosus s. l. exert on the extracellular sRNA landscape in human infections and provide a set of novel candidate biomarkers for both AE and CE detection. KW - echinococcosis KW - small RNA KW - extracellular KW - circulating KW - microRNA KW - serum KW - tapeworm KW - diagnosis KW - marker KW - Echinococcus Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-319270 SN - 2079-7737 VL - 12 IS - 5 ER - TY - JOUR A1 - Weiß, Martin A1 - Gründahl, Marthe A1 - Deckert, Jürgen A1 - Eichner, Felizitas A. A1 - Kohls, Mirjam A1 - Störk, Stefan A1 - Heuschmann, Peter U. A1 - Hein, Grit T1 - Differential network interactions between psychosocial factors, mental health, and health-related quality of life in women and men JF - Scientific Reports N2 - Psychosocial factors affect mental health and health-related quality of life (HRQL) in a complex manner, yet gender differences in these interactions remain poorly understood. We investigated whether psychosocial factors such as social support and personal and work-related concerns impact mental health and HRQL differentially in women and men during the first year of the COVID-19 pandemic. Between June and October 2020, the first part of a COVID-19-specific program was conducted within the “Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB)” cohort study, a representative age- and gender-stratified sample of the general population of Würzburg, Germany. Using psychometric networks, we first established the complex relations between personal social support, personal and work-related concerns, and their interactions with anxiety, depression, and HRQL. Second, we tested for gender differences by comparing expected influence, edge weight differences, and stability of the networks. The network comparison revealed a significant difference in the overall network structure. The male (N = 1370) but not the female network (N = 1520) showed a positive link between work-related concern and anxiety. In both networks, anxiety was the most central variable. These findings provide further evidence that the complex interplay of psychosocial factors with mental health and HRQL decisively depends on gender. Our results are relevant for the development of gender-specific interventions to increase resilience in times of pandemic crisis. KW - anxiety KW - depression KW - human behaviour KW - quality of life Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357858 VL - 13 ER - TY - JOUR A1 - Häder, Antje A1 - Schäuble, Sascha A1 - Gehlen, Jan A1 - Thielemann, Nadja A1 - Buerfent, Benedikt C. A1 - Schüller, Vitalia A1 - Hess, Timo A1 - Wolf, Thomas A1 - Schröder, Julia A1 - Weber, Michael A1 - Hünniger, Kerstin A1 - Löffler, Jürgen A1 - Vylkova, Slavena A1 - Panagiotou, Gianni A1 - Schumacher, Johannes A1 - Kurzai, Oliver T1 - Pathogen-specific innate immune response patterns are distinctly affected by genetic diversity JF - Nature Communications N2 - Innate immune responses vary by pathogen and host genetics. We analyze quantitative trait loci (eQTLs) and transcriptomes of monocytes from 215 individuals stimulated by fungal, Gram-negative or Gram-positive bacterial pathogens. We identify conserved monocyte responses to bacterial pathogens and a distinct antifungal response. These include 745 response eQTLs (reQTLs) and corresponding genes with pathogen-specific effects, which we find first in samples of male donors and subsequently confirm for selected reQTLs in females. reQTLs affect predominantly upregulated genes that regulate immune response via e.g., NOD-like, C-type lectin, Toll-like and complement receptor-signaling pathways. Hence, reQTLs provide a functional explanation for individual differences in innate response patterns. Our identified reQTLs are also associated with cancer, autoimmunity, inflammatory and infectious diseases as shown by external genome-wide association studies. Thus, reQTLs help to explain interindividual variation in immune response to infection and provide candidate genes for variants associated with a range of diseases. KW - antimicrobial responses KW - immunogenetics Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357441 VL - 14 ER - TY - JOUR A1 - Schreiber, Laura M. A1 - Lohr, David A1 - Baltes, Steffen A1 - Vogel, Ulrich A1 - Elabyad, Ibrahim A. A1 - Bille, Maya A1 - Reiter, Theresa A1 - Kosmala, Aleksander A1 - Gassenmaier, Tobias A1 - Stefanescu, Maria R. A1 - Kollmann, Alena A1 - Aures, Julia A1 - Schnitter, Florian A1 - Pali, Mihaela A1 - Ueda, Yuichiro A1 - Williams, Tatiana A1 - Christa, Martin A1 - Hofmann, Ulrich A1 - Bauer, Wolfgang A1 - Gerull, Brenda A1 - Zernecke, Alma A1 - Ergün, Süleyman A1 - Terekhov, Maxim T1 - Ultra-high field cardiac MRI in large animals and humans for translational cardiovascular research JF - Frontiers in Cardiovascular Medicine N2 - A key step in translational cardiovascular research is the use of large animal models to better understand normal and abnormal physiology, to test drugs or interventions, or to perform studies which would be considered unethical in human subjects. Ultrahigh field magnetic resonance imaging (UHF-MRI) at 7 T field strength is becoming increasingly available for imaging of the heart and, when compared to clinically established field strengths, promises better image quality and image information content, more precise functional analysis, potentially new image contrasts, and as all in-vivo imaging techniques, a reduction of the number of animals per study because of the possibility to scan every animal repeatedly. We present here a solution to the dual use problem of whole-body UHF-MRI systems, which are typically installed in clinical environments, to both UHF-MRI in large animals and humans. Moreover, we provide evidence that in such a research infrastructure UHF-MRI, and ideally combined with a standard small-bore UHF-MRI system, can contribute to a variety of spatial scales in translational cardiovascular research: from cardiac organoids, Zebra fish and rodent hearts to large animal models such as pigs and humans. We present pilot data from serial CINE, late gadolinium enhancement, and susceptibility weighted UHF-MRI in a myocardial infarction model over eight weeks. In 14 pigs which were delivered from a breeding facility in a national SARS-CoV-2 hotspot, we found no infection in the incoming pigs. Human scanning using CINE and phase contrast flow measurements provided good image quality of the left and right ventricle. Agreement of functional analysis between CINE and phase contrast MRI was excellent. MRI in arrested hearts or excised vascular tissue for MRI-based histologic imaging, structural imaging of myofiber and vascular smooth muscle cell architecture using high-resolution diffusion tensor imaging, and UHF-MRI for monitoring free radicals as a surrogate for MRI of reactive oxygen species in studies of oxidative stress are demonstrated. We conclude that UHF-MRI has the potential to become an important precision imaging modality in translational cardiovascular research. KW - ultrahigh-field MRI KW - large animal models KW - translational research KW - research infrastructure KW - heart KW - organoid KW - pig KW - cardiovascular MRI Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-317398 SN - 2297-055X VL - 10 ER - TY - JOUR A1 - Silwedel, Christine A1 - Speer, Christian P. A1 - Haarmann, Axel A1 - Fehrholz, Markus A1 - Claus, Heike A1 - Schlegel, Nicolas A1 - Glaser, Kirsten T1 - Ureaplasma species modulate cytokine and chemokine responses in human brain microvascular endothelial cells JF - International Journal of Molecular Science N2 - Ureaplasma species are common colonizers of the adult genitourinary tract and often considered as low-virulence commensals. Intraamniotic Ureaplasma infections, however, facilitate chorioamnionitis and preterm birth, and cases of Ureaplasma-induced neonatal sepsis, pneumonia, and meningitis raise a growing awareness of their clinical relevance. In vitro studies are scarce but demonstrate distinct Ureaplasma-driven impacts on immune mechanisms. The current study addressed cytokine and chemokine responses upon exposure of native or lipopolysaccharide (LPS) co-stimulated human brain microvascular endothelial cells (HBMEC) to Ureaplasma urealyticum or U. parvum, using qRT-PCR, RNA sequencing, multi-analyte immunoassay, and flow cytometry. Ureaplasma exposure in native HBMEC reduced monocyte chemoattractant protein (MCP)-3 mRNA expression (p < 0.01, vs. broth). In co-stimulated HBMEC, Ureaplasma spp. attenuated LPS-evoked mRNA responses for C-X-C chemokine ligand 5, MCP-1, and MCP-3 (p < 0.05, vs. LPS) and mitigated LPS-driven interleukin (IL)-1α protein secretion, as well as IL-8 mRNA and protein responses (p < 0.05). Furthermore, Ureaplasma isolates increased C-X-C chemokine receptor 4 mRNA levels in native and LPS co-stimulated HBMEC (p < 0.05). The presented results may imply immunomodulatory capacities of Ureaplasma spp. which may ultimately promote chronic colonization and long-term neuroinflammation. KW - Ureaplasma urealyticum KW - Ureaplasma parvum KW - neuroinflammation KW - meningitis KW - blood–brain barrier KW - HBMEC Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-201848 SN - 1422-0067 VL - 20 IS - 14 ER - TY - JOUR A1 - Krüger, Sören A1 - Leskien, Miriam A1 - Schuller, Patricia A1 - Prifert, Christiane A1 - Weißbrich, Benedikt A1 - Vogel, Ulrich A1 - Krone, Manuel T1 - Performance and feasibility of universal PCR admission screening for SARS‐CoV‐2 in a German tertiary care hospital JF - Journal of Medical Virology N2 - Anamnestic screening of symptoms and contact history is applied to identify coronavirus disease 2019 (COVID‐19) patients on admission. However, asymptomatic and presymptomatic patients remain undetected although the viral load may be high. In this retrospective cohort study, all hospitalized patients who received polymerase chain reaction (PCR) admission testing from March 26th until May 24th, 2020 were included. Data on COVID‐19‐specific symptoms and contact history to COVID‐19 cases were retrospectively extracted from patient files and from contact tracing notes. The compliance to the universal testing protocol was high with 90%. Out of 6940 tested patients, 27 new severe acute respiratory syndrome coronavirus‐2 infections (0.4%) were detected. Seven of those COVID‐19 cases (26% of all new cases) were asymptomatic and had no positive contact history, but were identified through a positive PCR test. The number needed to identify an asymptomatic patient was 425 in the first wave of the epidemic, 1218 in the low incidence phase. The specificity of the method was above 99.9%. Universal PCR testing was highly accepted by staff as demonstrated by high compliance. The costs to detect one asymptomatic case in future studies need to be traded off against the costs and damage caused by potential outbreaks of COVID‐19. KW - admission screening KW - COVID‐19 KW - infection control KW - SARS‐CoV‐2 KW - testing strategy Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-238971 VL - 93 IS - 5 SP - 2890 EP - 2898 ER - TY - JOUR A1 - Springer, Jan A1 - Held, Jürgen A1 - Mengoli, Carlo A1 - Schlegel, Paul Gerhardt A1 - Gamon, Florian A1 - Träger, Johannes A1 - Kurzai, Oliver A1 - Einsele, Hermann A1 - Loeffler, Juergen A1 - Eyrich, Matthias T1 - Diagnostic performance of (1→3)-β-D-glucan alone and in combination with aspergillus PCR and galactomannan in serum of pediatric patients after allogeneic hematopoietic stem cell transplantation JF - Journal of Fungi N2 - Data on biomarker-assisted diagnosis of invasive aspergillosis (IA) in pediatric patients is scarce. Therefore, we conducted a cohort study over two years including 404 serum specimens of 26 pediatric patients after allogeneic hematopoietic stem cell transplantation (alloSCT). Sera were tested prospectively twice weekly for Aspergillus-specific DNA, galactomannan (GM), and retrospectively for (1→3)-β-D-glucan (BDG). Three probable IA and two possible invasive fungal disease (IFD) cases were identified using the European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC/MSGERC) 2019 consensus definitions. Sensitivity and specificity for diagnosis of probable IA and possible IFD was 80% (95% confidential interval (CI): 28–99%) and 55% (95% CI: 32–77%) for BDG, 40% (95% CI: 5–85%) and 100% (95% CI: 83–100%) for GM, and 60% (95% CI: 15–95%) and 95% (95% CI: 75–100%) for Aspergillus-specific real-time PCR. However, sensitivities have to be interpreted with great caution due to the limited number of IA cases. Interestingly, the low specificity of BDG was largely caused by false-positive BDG results that clustered around the date of alloSCT. The following strategies were able to increase BDG specificity: two consecutive positive BDG tests for diagnosis (specificity 80% (95% CI: 56–94%)); using an optimized cutoff value of 306 pg/mL (specificity 90% (95% CI: 68–99%)) and testing BDG only after the acute posttransplant phase. In summary, BDG can help to diagnose IA in pediatric alloSCT recipients. However, due to the poor specificity either an increased cutoff value should be utilized or BDG results should be confirmed by an alternative Aspergillus assay. KW - beta-D-glucan KW - galactomannan KW - real-time PCR KW - Aspergillus KW - pediatric Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-234179 SN - 2309-608X VL - 7 IS - 3 ER - TY - JOUR A1 - Mottola, Austin A1 - Ramírez-Zavala, Bernardo A1 - Hünninger, Kerstin A1 - Kurzai, Oliver A1 - Morschhäuser, Joachim T1 - The zinc cluster transcription factor Czf1 regulates cell wall architecture and integrity in Candida albicans JF - Molecular Microbiology N2 - The fungal cell wall is essential for the maintenance of cellular integrity and mediates interactions of the cells with the environment. It is a highly flexible organelle whose composition and organization is modulated in response to changing growth conditions. In the pathogenic yeast Candida albicans, a network of signaling pathways regulates the structure of the cell wall, and mutants with defects in these pathways are hypersensitive to cell wall stress. By harnessing a library of genetically activated forms of all C. albicans zinc cluster transcription factors, we found that a hyperactive Czf1 rescued the hypersensitivity to cell wall stress of different protein kinase deletion mutants. The hyperactive Czf1 induced the expression of many genes with cell wall-related functions and caused visible changes in the cell wall structure. C. albicans czf1Δ mutants were hypersensitive to the antifungal drug caspofungin, which inhibits cell wall biosynthesis. The changes in cell wall architecture caused by hyperactivity or absence of Czf1 resulted in an increased recognition of C. albicans by human neutrophils. Our results show that Czf1, which is known as a regulator of filamentous growth and white-opaque switching, controls the expression of cell wall genes and modulates the architecture of the cell wall. KW - cell wall KW - zinc cluster transcription factor KW - Candida albicans KW - protein kinases Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-259583 VL - 116 IS - 2 ER - TY - JOUR A1 - Dick, Julia A1 - Krauß, Patrizia A1 - Hillenkamp, Jost A1 - Kohlmorgen, Britta A1 - Schoen, Christoph T1 - Postoperative Tropheryma whipplei endophthalmitis – a case report highlighting the additive value of molecular testing JF - JMM Case Reports N2 - Introduction. Tropheryma whipplei is the causative agent of Whipple’s disease. Gastrointestinal and lymphatic tissues are affected in the majority of cases, resulting in diarrhoea, malabsorption and fever. Here, we report a rare case of ocular manifestation in a patient lacking the typical Whipple symptoms. Case presentation. A 74-year-old Caucasian female presented with blurred vision in the right eye over a period of 1–2 months, accompanied by stinging pain and conjunctival hyperaemia for the last 2 days. Upon admission, visual acuity was hand motion in the affected eye. Ophthalmological examination showed typical signs of intraocular inflammation. Diagnostic and therapeutic pars plana vitrectomy including vitreous biopsy and intravitreal instillation of vancomycin and amikacin was performed within hours of initial presentation. Both microscopic analysis and microbial cultures of the vitreous biopsy remained negative for bacteria and fungi. The postoperative antibiotic regime included intravenous administration of ceftriaxone in combination with topical tobramycin and ofloxacin. Due to the empirical therapy the inflammation ceased and the patient was discharged after 5 days with cefpodoxime orally and local antibiotic and steroidal therapy. Meanwhile, the vitreous body had undergone testing by PCR for the eubacterial 16S rRNA gene, which was found to be positive. Analysis of the PCR product revealed a specific sequence of T. whipplei. Conclusion. In our patient, endophthalmitis was the first and only symptom of Morbus Whipple, while most patients with Whipple’s disease suffer from severe gastrointestinal symptoms. 16S rDNA PCR should be considered for any intraocular infection when microscopy and standard culture methods remain negative. KW - intravitreal vancomycin and amikacin KW - intravenous ceftriaxone KW - topic ofloxacin KW - Whipple's disease KW - endophthalmitis KW - Tropheryma whipplei KW - ocular infection KW - vitrectomy KW - oral cefpodoxime KW - oral doxycycline Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-158823 VL - 4 ER - TY - JOUR A1 - Tappe, Beeke A1 - Lauruschkat, Chris D. A1 - Strobel, Lea A1 - Pantaleón García, Jezreel A1 - Kurzai, Oliver A1 - Rebhan, Silke A1 - Kraus, Sabrina A1 - Pfeuffer-Jovic, Elena A1 - Bussemer, Lydia A1 - Possler, Lotte A1 - Held, Matthias A1 - Hünniger, Kerstin A1 - Kniemeyer, Olaf A1 - Schäuble, Sascha A1 - Brakhage, Axel A. A1 - Panagiotou, Gianni A1 - White, P. Lewis A1 - Einsele, Hermann A1 - Löffler, Jürgen A1 - Wurster, Sebastian T1 - COVID-19 patients share common, corticosteroid-independent features of impaired host immunity to pathogenic molds JF - Frontiers in Immunology N2 - Patients suffering from coronavirus disease-2019 (COVID-19) are susceptible to deadly secondary fungal infections such as COVID-19-associated pulmonary aspergillosis and COVID-19-associated mucormycosis. Despite this clinical observation, direct experimental evidence for severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2)-driven alterations of antifungal immunity is scarce. Using an ex-vivo whole blood stimulation assay, we challenged blood from twelve COVID-19 patients with Aspergillus fumigatus and Rhizopus arrhizus antigens and studied the expression of activation, maturation, and exhaustion markers, as well as cytokine secretion. Compared to healthy controls, T-helper cells from COVID-19 patients displayed increased expression levels of the exhaustion marker PD-1 and weakened A. fumigatus- and R. arrhizus-induced activation. While baseline secretion of proinflammatory cytokines was massively elevated, whole blood from COVID-19 patients elicited diminished release of T-cellular (e.g., IFN-γ, IL-2) and innate immune cell-derived (e.g., CXCL9, CXCL10) cytokines in response to A. fumigatus and R. arrhizus antigens. Additionally, samples from COVID-19 patients showed deficient granulocyte activation by mold antigens and reduced fungal killing capacity of neutrophils. These features of weakened anti-mold immune responses were largely decoupled from COVID-19 severity, the time elapsed since diagnosis of COVID-19, and recent corticosteroid uptake, suggesting that impaired anti-mold defense is a common denominator of the underlying SARS-CoV-2 infection. Taken together, these results expand our understanding of the immune predisposition to post-viral mold infections and could inform future studies of immunotherapeutic strategies to prevent and treat fungal superinfections in COVID-19 patients. KW - COVID-19 KW - immune impairment KW - T cells KW - granulocytes KW - Aspergillus KW - Rhizopus Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-283558 SN - 1664-3224 VL - 13 ER - TY - JOUR A1 - Springer, Jan A1 - Walther, Grit A1 - Rickerts, Volker A1 - Hamprecht, Axel A1 - Willinger, Birgit A1 - Teschner, Daniel A1 - Einsele, Hermann A1 - Kurzai, Oliver A1 - Loeffler, Juergen T1 - Detection of Fusarium Species in Clinical Specimens by Probe-Based Real-Time PCR JF - Journal of Fungi N2 - The mold Fusarium is a ubiquitous fungus causing plant, animal and human infections. In humans, Fusarium spp. are the major cause of eye infections in patients wearing contact lenses or after local trauma. Systemic infections by Fusarium spp. mainly occur in immunosuppressed patients and can disseminate throughout the human body. Due to high levels of resistance to antifungals a fast identification of the causative agent is an urgent need. By using a probe-based real-time PCR assay specific for the genus Fusarium we analysed several different clinical specimens detecting Fusarium spp. commonly found in clinical samples in Germany. Also, a large collection of lung fluid samples of haematological patients was analysed (n = 243). In these, two samples (0.8%) were reproducibly positive, but only one could be confirmed by sequencing. For this case of probable invasive fungal disease (IFD) culture was positive for Fusarium species. Here we describe a rapid, probe-based real-time PCR assay to specifically detect DNA from a broad range of Fusarium species and its application to clinically relevant specimens. KW - probe-based real-time PCR KW - Fusarium KW - bronchoalveolar lavage fluid KW - fungal molecular diagnostics Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-193111 SN - 2309-608X VL - 5 IS - 4 ER - TY - JOUR A1 - Moremi, Nyambura A1 - Claus, Heike A1 - Vogel, Ulrich A1 - Mshana, Stephen E. T1 - Faecal carriage of CTX-M extended-spectrum beta-lactamase-producing Enterobacteriaceae among street children dwelling in Mwanza city, Tanzania JF - PLoS ONE N2 - Background Data on ESBL carriage of healthy people including children are scarce especially in developing countries. We analyzed the prevalence and genotypes of ESBL-producing Enterobacteriaceae (EPE) in Tanzanian street children with rare contact to healthcare facilities but significant interactions with the environment, animals and other people. Methodology/ Principle findings Between April and July 2015, stool samples of 107 street children, who live in urban Mwanza were analyzed for EPE. Intestinal carriage of EPE was found in 34 (31.8%, 95% CI; 22.7–40.3) children. Of the 36 isolates from 34 children, 30 (83.3%) were Escherichia coli (E. coli) and six Klebsiella pneumoniae (K. pneumoniae). Out of 36 isolates, 36 (100%), 35 (97%), 25 (69%) and 16 (44%) were resistant to tetracycline, trimethoprim-sulfamethoxazole, ciprofloxacin and gentamicin, respectively. Beta-lactamase genes and the multilocus sequence types of E. coli and K. pneumoniae were characterized. ESBL gene bla\(_{CTX-M-15}\) was detected in 75% (27/36) of ESBL isolates. Sequence types (STs) 131, 10, 448 and 617 were the most prevalent in E. coli. Use of local herbs (OR: 3.5, 95% CI: 1.51–8.08, P = 0.003) and spending day and night on streets (OR: 3.6, 95% CI: 1.44–8.97, P = 0.005) were independent predictors of ESBL carriage. Conclusions/ Significance We observed a high prevalence of bla\(_{CTX-M-15}\) in EPE collected from street children in Tanzania. Detection of E. coli STs 131, 10, 38 and 648, which have been observed worldwide in animals and people, highlights the need for multidisciplinary approaches to understand the epidemiology and drivers of antimicrobial resistance in low-income countries. KW - Tanzania KW - children KW - Enterobacteriaceae KW - ESBL Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-170331 VL - 12 IS - 9 ER -