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Gaubitz M.,Interdisziplinare Diagnostik und Therapie in der Akademie fur Manuelle Medizin An der WWU Munster | Dressler F.,Klinik fur Padiatrische Pneumologie | Huppertz H.I.,Professor Hess Kinderklinik und Neonatologie und Padiatrische Intensivmedizin | Krause A.,Immanuel Krankenhaus Berlin
Zeitschrift fur Rheumatologie | Year: 2014

These guidelines summarize the current evidence for diagnosis and treatment of Lyme arthritis and the most frequent skin manifestations of Borrelia burgdorferi infections. Lyme arthritis is a monoarticular or oligoarticular form of arthritis that typically involves the knee. A positive enzyme-linked immunosorbent assay (ELISA) for IgG antibodies should be followed by an IgG immunoblot. A positive PCR test from synovial fluid adds increased diagnostic certainty. Serum positivity for antibodies to Borrelia burgdorferi without typical symptoms does not justify antibiotic treatment. Oral antibiotic treatment for erythema migrans is recommended using doxycycline, 200 mg once per day for 10-21 days, alternative choices are amoxicillin, cefuroxime and azithromycin. For children below 8 years of age, amoxicillin is recommended. Lyme arthritis can usually be successfully treated with orally administered antimicrobial agents. Doxycycline, 1x200 or 2x100 mg for 30 days is the antibiotic agent of choice. Amoxicillin (3x500-1000 mg) can be alternatively chosen. Patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy should be treated intravenously. In this situation, ceftriaxone at 2 g per day for 14-21 days is recommended. There is no evidence to recommend long-term and combined treatments. © 2014 Springer-Verlag.


Tummler B.,Klinik fur Padiatrische Pneumologie
Pneumologie | Year: 2016

Personalized medicine promises that medical decisions, practices and products are tailored to the individual patient. Cystic fibrosis, an inherited disorder of chloride and bicarbonate transport in exocrine glands, is the first successful example of customized drug development for mutation-specific therapy. There are two classes of CFTR modulators: potentiators that increase the activity of CFTR at the cell surface, and correctors that either promote the read-through of nonsense mutations or facilitate the translation, folding, maturation and trafficking of mutant CFTR to the cell surface. The potentiator ivacaftor and the corrector lumacaftor are approved in Germany for the treatment of people with cystic fibrosis who carry a gating mutation such as p.Gly551Asp or who are homozygous for the most common mutation p.Phe508del, respectively. This report provides an overview of the basic defect in cystic fibrosis, the population genetics of CFTR mutations in Germany and the bioassays to assess CFTR function in humans together with the major achievements of preclinical research and clinical trials to bring CFTR modulators to the clinic. Some practical information on the use of ivacaftor and lumacaftor in daily practice and an update on pitfalls, challenges and novel strategies of bench-to-bedside development of CFTR modulators are also provided. © Georg Thieme Verlag KG Stuttgart · New York.


Tummler B.,Klinik fur Padiatrische Pneumologie
Monatsschrift fur Kinderheilkunde | Year: 2013

Characteristics: Cystic fibrosis (CF) is an autosomal recessive hereditary systemic disease with a chronic progressive course affecting all exocrine glands. It is caused by a mutation in the cystic fibrosis transmembrane conductance regulator gene (CFTR gene) which results in precipitation and retention of mucous secretions in the ducts of exocrine glands and a disposition to respiratory infections. Diagnosis: The diagnosis of CF is based on a pathologically increased chloride concentration or two mandatory disease-triggering CFTR gene mutations. If the genetic tests and/or chloride concentrations in intermediate ranges are uninformative but CF is clinically suspected, extended CFTR functional diagnostics should be carried out. The course of gastrointestinal and pulmonary manifestations must be monitored by regular standardized control investigations. Therapy: The standard therapy of gastrointestinal symptoms includes substitution of gastric acid-resistant pancreatic enzymes, a high calorie fat-rich diet and substitution of fat soluble vitamins. The essential pillars of the current therapy of pulmonary symptoms are liberal and early antimicrobial chemotherapy, inhalation, anti-inflammatory treatment, sport and physiotherapy. In cases of advanced pulmonary disease processes, long-term oxygen therapy, non-invasive mask ventilation and ultimately lung transplantation are further options. Conclusions: The pulmonary manifestations are critical factors which currently determine the course and prognosis of cystic fibrosis in nearly 90 % of patients. The earliest possible diagnosis and nursing in a CF center have advantageous effects. © 2013 Springer-Verlag Berlin Heidelberg.


Hansen G.,Klinik fur Padiatrische Pneumologie | Schwerk N.,Klinik fur Padiatrische Pneumologie
Monatsschrift fur Kinderheilkunde | Year: 2013

Asthma is the most common chronic disease of children living in industrialized countries and has a prevalence of 10 % among children in Germany. The report focuses on the basics of and recent advances in clinical diagnosis and therapy of asthma with special emphasis on the special challenges in the evaluation and treatment of preschool children with recurrent wheeze. © 2013 Springer-Verlag Berlin Heidelberg.


Schwerk N.,Klinik fur Padiatrische Pneumologie | Hansen G.,Klinik fur Padiatrische Pneumologie
Monatsschrift fur Kinderheilkunde | Year: 2014

Background. During recent decades, the incidence of allergic diseases has continuously increased especially in industrialized countries and now belong to the most frequent chronic diseases of childhood. Prevention. As causative treatment regimes are lacking in most cases, allergy prevention is of great interest. Whereas allergen avoidance was a central dogma of allergy prevention for many years, further research revealed that this is not the case but that delayed introduction of solid food might even be a risk factor for food allergy and atopic eczema. The future. There are many interesting new aspects which may not currently be relevant for clinical practice but which may allow for effective prevention strategies in the future. © 2014 Springer-Verlag.

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