Klinik fur Padiatrische Pneumologie

Hannover, Germany

Klinik fur Padiatrische Pneumologie

Hannover, Germany
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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.

Ballarini A.,University of Trento | Scalet G.,University of Trento | Scalet G.,University of Verona | Kos M.,University of Trento | And 3 more authors.
BMC Microbiology | Year: 2012

Background: Pseudomonas aeruginosa is an opportunistic pathogen which has the potential to become extremely harmful in the nosocomial environment, especially for cystic fibrosis (CF) patients, who are easily affected by chronic lung infections. For epidemiological purposes, discriminating P.aeruginosa isolates is a critical step, to define distribution of clones among hospital departments, to predict occurring microevolution events and to correlate clones to their source. A collection of 182 P. aeruginosa clinical strains isolated within Italian hospitals from patients with chronic infections, i.e. cystic fibrosis (CF) patients, and with acute infections were genotyped. Molecular typing was performed with the ArrayTube (AT) multimarker microarray (Alere Technologies GmbH, Jena, Germany), a costeffective, time-saving and standardized method, which addresses genes from both the core and accessory P. aeruginosa genome. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were employed as reference genotyping techniques to estimate the ArrayTube resolution power. Results: 41 AT-genotypes were identified within our collection, among which 14 were novel and 27 had been previously described in publicly available AT-databases. Almost 30% of the genotypes belonged to a main cluster of clones. 4B9A, EC2A, 3C2A were mostly associated to CF-patients whereas F469, 2C1A, 6C22 to non CF. An investigation on co-infections events revealed that almost 40% of CF patients were colonized by more than one genotype, whereas less than 4% were observed in non CF patients. The presence of the exoU gene correlated with non-CF patients within the intensive care unit (ICU) whereas the pKLC102-like island appeared to be prevalent in the CF centre. The congruence between the ArrayTube typing and PFGE or MLST was 0.077 and 0.559 (Adjusted Rand coefficient), respectively. AT typing of this Italian collection could be easily integrated with the global P. aeruginosa AT-typed population, uncovering that most AT-genotypes identified (> 80%) belonged to two large clonal clusters, and included 12 among the most abundant clones of the global population. Conclusions: The ArrayTube (AT) multimarker array represented a robust and portable alternative to reference techniques for performing P. aeruginosa molecular typing, and allowed us to draw conclusions especially suitable for epidemiologists on an Italian clinical collection from chronic and acute infections. © 2012 Ballarini et al.; licensee BioMed Central Ltd.

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.

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.

Background: B-cells play an important role in the pathogenesis of systemic lupus erythematosus (SLE); however, many other cell types are also involved in disease development. In a murine lupus model it was demonstrated that basophils are indispensable for the development of lupus symptoms. Aim: This study investigated whether there is evidence for a relevant interaction between B-cells and basophils under physiological and pathological conditions. Material and methods: A selective review of the literature was performed and some preliminary data about the interaction of basophils and B-cells are reported in this article. For the experiments, isolated B-cells were cultured in vitro in the presence or absence of basophils and B-cell survival, proliferation, plasma cell development and antibody production were determined. Results: Data from the literature show that there is evidence for an interaction between basophils and B-cells in a murine model. Our investigations confirmed that human basophils also support the survival and proliferation of B-cells. Furthermore, plasma cell differentiation and antibody production, most importantly IgG secretion, are enhanced. First experimental ex vivo analyses of basophils from SLE patients demonstrate that these cells exhibit a higher activation level compared to basophils from healthy controls. Discussion: In summary, previously published data and our own data demonstrate that there is an interaction between human basophils and B-cells. A better understanding of the role of basophils in the pathogenesis of SLE could lead to the development of new therapeutic strategies. © 2015, Springer-Verlag Berlin Heidelberg.

Wetzke M.,Klinik fur padiatrische Pneumologie | Hansen G.,Klinik fur padiatrische Pneumologie
Monatsschrift fur Kinderheilkunde | Year: 2016

Stenosing laryngitis in childhood leads via an infection-related swelling of the laryngeal mucous membrane and subglottic region to narrowing of the upper airways. The main symptom is a variably pitched respiratory stridor caused by abnormal air passage. This sound is usually heard during inspiration and is a common symptom leading to referral to a pediatrician. The most common cause of acute stridor in children is a viral infection leading to croup syndrome with the hallmark symptoms of hoarseness, stridor and barking cough. Viral croup is usually easy to diagnose and is treated with systemic steroids and inhalation of adrenalin; however, it needs to be differentiated from severe causes of laryngeal obstruction, such as diphtheria and epiglottitis due to Haemophilus influenzae infections, foreign body aspiration or anatomical abnormalities and tumors. This article gives an updated overview on the causes, diagnostics and management of laryngeal obstructions in childhood. © 2016, Springer-Verlag Berlin Heidelberg.

Werfel T.,Klinik fur Dermatologie | Schwerk N.,Klinik fur Padiatrische Pneumologie | Hansen G.,Klinik fur Padiatrische Pneumologie | Kapp A.,Klinik fur Dermatologie
Deutsches Arzteblatt International | Year: 2014

Background: Atopic dermatitis is the most common skin disease in children, with a prevalence of 10% to 15%, and is common in adults as well. Close coordination between primary care physicians and specialists is essential for the adequate treatment of chronically and severely affected patients. Methods: This article is a review of pertinent publications that were retrieved by a selective search in Pubmed, with additional consideration of the guidelines of the Association of Medical Scientific Societies in Germany (AWMF) and the European Dermatology Forum. Results: Trigger factors such as skin irritants, allergens, microbial pathogens, and psychological factors can affect the condition of the skin differently in individual patients and should be individually assessed. The use of skin moisturising creams or emollients along with avoidance of specific and unspecific irritants is of great importancel, as these patients have an impaired cutaneous barrier. Topical anti-inflammatory treatment with glucocorticoids or calcineurin inhibitors is a central part of the management of atopic dermatitis; in exceptional cases, severely affected patients are treated with systemic anti-inflammatory drugs. Interdisciplinary patient education has been found to be an effective tool in the complex management of this disease. Chronically and severely affected patients present special challenges for diagnosis and treatment. Conclusion: Recent advances in the understanding of the molecular basis of cutaneous barrier disorders and of congenital and acquired immune disorders have led to new approaches to the treatment of atopic dermatitis.

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.

Klockgether J.,Klinik fur Padiatrische Pneumologie | Cramer N.,Klinik fur Padiatrische Pneumologie | Wiehlmann L.,Klinik fur Padiatrische Pneumologie | Davenport C.F.,Klinik fur Padiatrische Pneumologie | Tummler B.,Klinik fur Padiatrische Pneumologie
Frontiers in Microbiology | Year: 2011

The Pseudomonas aeruginosa genome (G + C content 65-67%, size 5.5-7 Mbp) is made up of a single circular chromosome and a variable number of plasmids. Sequencing of complete genomes or blocks of the accessory genome has revealed that the genome encodes a large repertoire of transporters, transcriptional regulators, and two-component regulatory systems which reflects its metabolic diversity to utilize a broad range of nutrients.The conserved core component of the genome is largely collinear among P. aeruginosa strains and exhibits an interclonal sequence diversity of 0.5-0.7%. Only a few loci of the core genome are subject to diversifying selection. Genome diversity is mainly caused by accessory DNA elements located in 79 regions of genome plasticity that are scattered around the genome and show an anomalous usage of monoto tetradecanucleotides. Genomic islands of the pKLC102/PAGI-2 family that integrate into tRNALys or tRNAGly genes represent hotspots of interand intraclonal genomic diversity.The individual islands differ in their repertoire of metabolic genes that make a large contribution to the pangenome. In order to unravel intraclonal diversity of P. aeruginosa, the genomes of two members of the PA14 clonal complex from diverse habitats and geographic origin were compared. The genome sequences differed by less than 0.01% from each other. One hundred ninety-eight of the 231 single nucleotide substitutions (SNPs) were non-randomly distributed in the genome. Non-synonymous SNPs were mainly found in an integrated Pf1-like phage and in genes involved in transcriptional regulation, membrane and extracellular constituents, transport, and secretion. In summary, P. aeruginosa is endowed with a highly conserved core genome of low sequence diversity and a highly variable accessory genome that communicates with other pseudomonads and genera via horizontal gene transfer.© 2011 Klockgether, Cramer, Wiehlmann, Davenport and Tümmler.

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