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Pdf, 16.47 Mb https://www.mdc-berlin.de/de/veroeffentlichungstypen/clinical- journal-club Als gemeinsame Einrichtung von MDC und Charité fördert das Experimental and Clinical Research Center die Zusammenarbeit zwischen Grundlagenwissenschaftlern und klinischen Forschern. Hier werden neue Ansätze für Diagnose, Prävention und Therapie von Herz-Kreislauf- und Stoffwechselerkrankungen, Krebs sowie neurologischen Erkrankungen entwickelt und zeitnah am Patienten eingesetzt. Sie sind eingelanden, um uns beizutreten. Bewerben Sie sich! An otherwise healthy 10-year-old girl presented to the primary care clinic with a 10-day history of multiple itchy papules on the soles of her feet and on her toes. The lesions had black dots in the center and were painful. Two weeks earlier, the family had traveled to rural Brazil. During that time, the patient had played in a pigsty without wearing shoes. Sand fleas were removed from multiple lesions. What is the most likely diagnosis? Coxsackievirus infection Furuncular myiasis Foreign body granulomas Tungiasis Scabies infestation Correct! The correct answer is tungiasis. Tungiasis is a skin infestation caused by the sand flea Tunga penetrans, an ectoparasite that is found throughout tropical and subtropical parts of the world. Treatment included flea removal and local wound care. Die Myiasis (nach griechisch μυῖα myia = „Fliege“) oder auch Fliegenmadenkrankheit ist der Befall von Lebewesen mit den Larven (Maden) von Fliegen, welche von dem Gewebe, den Körperflüssigkeiten oder dem Darminhalt des Wirtes leben. Sie ist bei Menschen in Mittel- und Südamerika sowie in Regionen mit tropischen oder subtropischem Klima verbreitet. In der Tiermedizin kommt ein Fliegenmadenbefall auch in Europa häufiger vor. Betroffen sind vor allem stark geschwächte oder anderweitig erkrankte Tiere, die nicht mehr in der Lage sind, sich selbst zu putzen. Die Larven können sich sowohl in der Haut (insbesondere in kleinen Verletzungen) als auch in den Körperöffnungen sowie in offenen Wundenansiedeln. Unzureichende hygienische Bedingungen begünstigen eine Infestation. Parasitäre Fliegenlarven gelangen auf verschiedene Weise unter die Haut: Etwa über schlammige, evtl. mit Exkrementen versetzte Tümpel können die Eier einer Tumba Fly Larva solchen Fliegenart auf die menschliche Haut gelangen. Die schlüpfende Larve gräbt sich dann in das Fleischareal, mit dem sie Kontakt bekommt, ein. Auch über verschmutzte, zum Trocknen aufgehängte Kleidung, auf die die Fliegen ihre Eier gelegt haben, können Letztere mit der Haut in Kontakt kommen. Ein dritter Weg der Kontaktaufnahme ist die Nutzung einer blutsaugenden Fliege als Transportmittel für die Eier. Die eingenistete Larve bleibt für gewöhnlich in der Nähe der Haut und gräbt sich nicht tief ein, da sie atmen muss. Sie nutzt dafür das Loch in der Haut, durch das sie eingedrungen ist. Insecta Tungiasis (also known as nigua, pio and bicho de pie, or pique or sand flea disease) is an inflammatory skin disease caused by infection with the female ectoparasitic Tunga penetrans (also known as chigoe flea, jigger, nigua or sand flea), found in the tropical parts of Africa, the Caribbean, Central and South America, and India. Tunga penetrans is the smallest known flea, measuring 1 mm across. It is also known in Latin America as the nigua and bicho de pie (Spanish) or bicho de pé (Portuguese), literally "foot bug". Tunga penetrans is a member of the genus Tunga, which comprises 13 species. At the third week after penetration and substage 4a, the eggs’ release will have stopped and the lesion will become smaller and more wrinkled. As the flea is near death, fecal and water secretion will stop altogether. Pain, tenderness, and skin inflammation will still be present. Around the 25th day after penetration, the lesion looks like a black crust and the flea’s carcass is removed by host repair mechanisms and the skin begins to heal. With the flea gone, inflammation may still persist for a while. If the patient is not vaccinated, tetanus is often a complication due to secondary infection. Gangrene is another common complication of severe infestation and superinfection. Staphylococcus aureus and Wolbachia endobacteria can be transmitted by the chigoe flea, as well as nearly 150 other different pathogens. For these reasons, the chigoe flea should be removed as soon as possible. Insecta Krätze,fachsprachlich Skabies, Scabies (von lateinisch sca bere ‚kratzen‘) oder Acarodermatitis, ist eine weitverbreitete, durch die Grab- bzw. Krätzemilbe (vor allem Sarcoptes scabiei) verursachte parasitäre Hautkrankheit des Menschen. Die halbkugelförmigen, 0,3–0,5 Millimeter großen Weibchen der Krätzmilbe bohren sich in die Oberhaut (Epidermis) und legen dort in den Kanälen (caniculi, Milbengänge) Kotballen (Skybala) und ihre Eier ab. Ihre Absonderungen führen zur erheblichen Schädigung der Haut. Die Inkubationszeit beträgt etwa einige Tage bis sechs Wochen. Für befallene Patienten gilt in Deutschland nach § 34 Infektionsschutzgesetz bereits bei Verdacht ein Verbot des Aufenthalts und Arbeitens in Gemeinschaftseinrichtungen. Andere Milbenerkrankungen Arachnida des Menschen werden als Acariasis bezeichnet. Als Entdecker des Zusammenhangs zwischen Milbenbefall und der schon zuvor bekannten Krätze gilt der italienische Arzt Giovanni Cosimo Bonomo im 17. Jahrhundert. Krätze bei Tieren wird umgangssprachlich Räude genannt, wobei hier auch andere Milben vorkommen. Außer den Haarbalgmilben können die meisten dieser Parasiten auch den Menschen als Fehlwirt befallen und eine Pseudokrätze oder Trugräude, medizinisch Pseudoscabies, hervorrufen. Eine multiresistente Tuberkulose, kurz MDR-Tb, ist eine Tuberkulose, die durch Erreger ausgelöst wird, die gegen zwei oder mehr Erstlinien-Tuberkulostatika resistent sind. Das häufig gebrauchte englische Kürzel MDR steht hierbei für "multidrug- resistant“. Zu einer MDR-Tb kommt es durch Tuberkulosebakterien, die zum Beispiel gegen Isoniazid und Rifampicin resistent sind. Sind die Tuberkuloseerreger zusätzlich auch gegen Zweitlinien-Tuberkulostatika resistent, spricht man von einer XDR-Tb. Eine Tuberkulosekranker entwickelt eine MDR-Tb, wenn während der Behandlung die Erstrang- Antituberkulotika falsch dosiert bzw. eingenommen und dadurch unwirksam werden (fehlende Kombinationstherapie). Menschen mit MDR-Tb können infektiös sein und die resistenten Erreger an andere Personen weitergeben. One mechanism is a mutation in the rpoB gene, which encodes the beta subunit of the bacteria's RNA polymerase. In non- resistant TB, rifampin binds the beta subunit of RNA polymerase and disrupt transcription elongation. Mutation in the rpoB gene changes the sequence of amino acids and eventual conformation of the beta subunit. In this case rifampin can no longer bind or prevent transcription, and the bacteria is resistant. Other mutations make the bacterium resistant to other drugs. For example, there are many mutations that confer resistance to isoniazid (INH), including in the genes katG, inhA, ahpC and others. Amino acid replacements in the NADH binding site of InhA apparently result in INH resistance by preventing the inhibition of mycolic acid biosynthesis, which the bacterium uses in its cell wall. Mutations in the katG gene make the enzyme catalase peroxidase unable to convert INH to its biologically active form. Hence, INH is ineffective and the bacteria is resistant. The discovery of new molecular targets is essential to overcome drug resistant problems. A Trial of a Shorter Regimen for Rifampin-Resistant Tuberculosis Cohort studies in Bangladesh showed promising cure rates among patients with multidrug-resistant tuberculosis who received existing drugs in regimens shorter than that recommended by the World Health Organization (WHO) in 2011. We conducted a phase 3 noninferiority trial in participants with rifampin-resistant tuberculosis that was susceptible to fluoroquinolones and aminoglycosides. Participants were randomly assigned, in a 2:1 ratio, to receive a short regimen (9 to 11 months) that included high-dose moxifloxacin or a long regimen (20 months) that followed the 2011 WHO guidelines. The primary efficacy outcome was a favorable status at 132 weeks, defined by cultures negative for Mycobacterium tuberculosis at 132 weeks and at a previous occasion, with no intervening positive culture or previous unfavorable outcome. An upper 95% confidence limit for the between-group difference in favorable status that was 10 percentage points or less was used to determine noninferiority. Participants were eligible for inclusion in the trial if they were 18 years of age or older and had pulmonary tuberculosis (as confirmed by a positive sputum smear or, if coinfected with HIV, a nucleic acid amplification test [GeneXpert, Cepheid]) with evidence of resistance to rifampin. In practice, the management of rifampin- monoresistant tuberculosis and the management of multidrug-resistant tuberculosis are similar. Kaplan–Meier Estimates of the Time to an Unfavorable Outcome and the Time to Death. Panel A shows the Kaplan– Meier estimates of the time to an unfavorable outcome, which was defined by the initiation of two or more drug therapies that were not included in the assigned regimen, treatment extension beyond the permitted duration, death from any cause, a positive culture for Mycobacterium tuberculosis from one of the two most recent specimens, or no visit at 76 weeks or later. In contrast, favorable status at 132 weeks (the primary outcome) was defined by cultures that were negative for M. tuberculosis at 132 weeks
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