We describe a cluster of cowpox virus (CPXV) infections in humans that occurred near Munich, Germany, around the beginning of 2009. Previously, only sporadic reports of CPXV infections in humans after direct contact with various animals had been published. This outbreak involved pet rats from the same litter.

Information on parasite viability in alveolar echinococcosis (AE) cannot be obtained by conventional imaging techniques. We evaluated the glucose metabolism of AE lesions by use of [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) in 12 inoperable patients. Eight patients showed either perilesional or focal enhancement ("hot spots"), whereas 4 patients had nonenhancing (metabolically inactive) lesions. With PET, necrotic parasitic lesions and areas of enhanced metabolic activity could be clearly discriminated. Most notably, 3 of 8 patients with metabolically active lesions who were reexamined after chemotherapy treatment clearly showed improvement: the initial surrounding hot spots had disappeared in 2 of them, and had significantly decreased in 1. PET may prove valuable in assessing the efficacy of chemotherapy by showing the disappearance of metabolic activity and may also be useful for timely detection of relapses and metastases. Although costly and not readily available, FDG-PET is a promising tool toward improved management of AE and may thus help lower costs of long-term chemotherapy.

BackgroundThe overall incidence of tuberculosis (TB) in Western Europe has been declining since the 19th Century. However, immigrant sub-groups from high-prevalence countries are slowing down this trend. The aim of this study was to describe how immigration influences TB transmission in Germany. For that we prospectively investigated the dynamics of TB transmission between TB high-prevalence immigrant and TB low-prevalence local populations with molecular epidemiological methods and conventional contact investigations. Besides, we assessed transmission in relation to social mixing using an innovative tool that measures the integration of immigrants into the local social environment.MethodsA prospective study of confirmed culture positive cases of pulmonary TB and their contacts was carried out in a German federal state from 2003 to 2005. Data for the study included: 1) case data routinely collected by the local public health staff and transmitted to the state health office and the national surveillance centre, 2) a study questionnaire designed to capture social interactions of relevance for TB transmission and 3) molecular genotyping data (IS6110 DNA fingerprint and spoligotyping). The proportion of German cases caused by foreign-born cases, and vice versa, was estimated and an integration index was computed using a selected set of questions from the study questionnaire.ResultsA total of 749 cases of culture-positive pulmonary tuberculosis voluntarily enrolled in the study, representing 57.8% of all registered cases diagnosed over the study period. Data that included study questionnaire and DNA fingerprinting were available for 41% (n = 308) of the study participants. Forty-seven clusters, defined as a least two cases infected by the same TB strains, were identified by molecular methods and included 132 (17%) of the study participants. Epidemiological links were identified for 28% of the clusters by conventional epidemiological data. In mixed clusters, defined as clusters including German and foreign-born individuals, the probability of cases to be caused by foreign-born cases was estimated at 18.3%. We observed a trend to mixed clusters with increasing time spent by immigrants in the host country. This group also presented comparatively higher integration indexes than immigrants in immigrant-only clusters.ConclusionOur results confirm the findings of other studies that there is no significant TB transmission from TB high-prevalence immigrant to TB low-prevalence autochthonous population. This may be explained by the good performance of tuberculosis screening programmes for certain groups arriving in Germany from high- prevalence countries, by a low degree of mixing of immigrants with the local population or by a combination of both.

This study examined the development and persistence of immunity in humans presenting defined states of Onchocerca volvulus infection, i.e. in exposed endemic control individuals without microfilaridermia and clinical disease, in patients with patent or post‐patent onchocerciasis, and in patients concurrently infected with Mansonella perstans. Onchocerca volvulus antigen (OvAg)‐specific cellular reactivity was significantly diminished in microfilariae (mf)‐positive patients, while the highest reactivity was measured in exposed but mf‐negative endemic controls, those being free of any clinical signs of onchocercal disease. In patients who became post‐patent, responses to OvAg were significantly augmented, but did not approach entirely the magnitude observed in endemic controls. In onchocerciasis patients with concurrent mansonelliasis, cellular unresponsiveness to OvAg persisted, even when mf of O. volvulus were eliminated permanently by repeated ivermectin therapy. Cells from mf‐positive onchocerciasis patients produced significantly less interferon‐γ (IFN‐γ) (P<0·01) and interleukin‐5 (IL‐5) (P<0·05) in response to OvAg than those taken from endemic controls or post‐patent individuals in whom IFN‐γ and IL‐5 production was similarly high. In contrast, both OvAg‐driven as well as spontaneous IL‐10 secretion was higher in mf‐positive patients than in endemic controls or post‐patent cases. In all individuals examined, serological recognition of OvAg by immunoglobulins was dominated by IgG4; in mf‐positive patients OvAg of 205 000–12 000 molecular weight (MW) were strongly bound. In post‐patent individuals, and similarly in endemic controls, OvAg recognition by IgG4 varied from intense (with numerous antigens being recognized) to weak or absent antigen binding. Significantly elevated OvAg‐specific IgG isotypes were measured in mf‐positive onchocerciasis patients in comparison with endemic controls or post‐patent individuals (with the exception of IgG3). IgG1, IgG2 and IgE were higher, but IgG4 was lower in endemic controls compared with post‐patent onchocerciasis patients. The ratios of IgG4/IgG1 differed (P<0·001) between endemic controls and mf‐positive or post‐patent onchocerciasis patients, with IgG4/IgG1 ratios of R<3·0 being characteristic for endemic controls and post‐patent O. volvulus infection. In conclusion, this cross‐sectional immunoepidemiological investigation showed that distinct states of O. volvulus infection correlate with a particular cellular and humoral immune response. The mf‐free condition appeared to be associated with a vigorous parasite‐specific cellular reactivity and a particular cytokine production profile, while concurrent M. perstans infection depressed OvAg‐specific cellular responsiveness. Antibody responses, in all likelihood, reflected the intensity and state of infection, and not the degree of acquired immunity protective against parasite aggregation.

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