Publications by authors named "Thomas T Brehm"

Objectives: We report prolonged mpox (>14 weeks) in a patient with HIV complicated by deep tissue MPXV infection despite two courses of tecovirimat treatment.

Methods: MPXV-DNA levels in lesional swabs, blood and tissue were quantified by qPCR. Anti-MPXV antibodies were analyzed by IF and VNT.

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Background: Influenza is the most common vaccine-preventable infection among travelers, affecting approximately one percent of those travelling to subtropical and tropical destinations.

Methods: We analysed demographic, travel-related and clinical information from travelers diagnosed with influenza at our travel clinic between January 2015 and March 2020 and influenza-negative controls.

Results: We included 68 travelers diagnosed with influenza and 207 controls.

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Purpose: Listeria monocytogenes causes severe bacterial infections with the highest mortality rate among foodborne pathogens in Europe. Combination treatment with ampicillin and gentamicin is recommended for invasive manifestations. However, evidence to support this treatment approach remains limited due to a lack of randomised controlled trials.

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Article Synopsis
  • Tuberculosis (TB) is a concern for patients being treated with tumour necrosis factor (TNF) antagonists and Janus kinase (JAK) inhibitors, leading to questions about the risk of TB relapse.
  • A systematic review analyzed various studies to evaluate the likelihood of TB relapse in patients who had previously experienced TB and were reintroduced to TNF antagonists or JAK inhibitors.
  • Out of 5018 articles reviewed, 67 studies involving 368 TB patients showed that 3.8% experienced TB relapse after restarting treatment, with an average relapse time of about 8.5 months after the initiation of therapy.
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This article aims to provide an overview of common and high-impact medical emergencies that require prompt and effective infectious diseases management. In the described clinical scenarios of malaria, sepsis, necrotizing fasciitis, and meningitis the authors have emphasized the crucial importance of rapid and accurate diagnosis, as well as appropriate treatment from the perspective of infectious diseases. All of these emergencies demand a high degree of clinical suspicion for accurate diagnosis.

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This article aims to provide an overview of common and high-impact medical emergencies that require prompt and effective infectious diseases management. In the described clinical scenarios of malaria, sepsis, necrotizing fasciitis, and meningitis the authors have emphasized the crucial importance of rapid and accurate diagnosis, as well as appropriate treatment from the perspective of infectious diseases. All of these emergencies demand a high degree of clinical suspicion for accurate diagnosis.

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The treatment of drug-resistant relies on complex antibiotic therapy. Inadequate antibiotic exposure can lead to treatment failure, acquired drug resistance, and an increased risk of adverse events. Therapeutic drug monitoring (TDM) can be used to optimize the antibiotic exposure.

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Extrapulmonary tuberculosis (TB) presents unique diagnostic and therapeutic challenges. The site of involvement can vary widely, with common sites including the lymph nodes, pleura, skin, ear, nose and throat, genitourinary system, pericardium, gastrointestinal tract, bones and joints, and central nervous system. Clinical manifestations of extrapulmonary TB are diverse and often non-specific.

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Background: Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, the roll-out of vaccines and therapeutic agents, as well as the emergence of novel SARS-CoV-2 variants, have shown significant effects on disease severity.

Methods: Patients hospitalized at our center between January 2020 and April 2022 were attributed to subgroups depending on which SARS-CoV-2 variant was predominantly circulating in Germany: (i) Wild-type: January 1, 2020, to March 7, 2021, (ii) Alpha variant: August 3, 2021, to June 27, 2021, (iii) Delta variant: June 28, 2021, to December 26, 2021, and (iv) Omicron variant: December 27, 2021, to April 30, 2022.

Results: Between January 2020 and April 2022, 1500 patients with SARS-CoV-2 infections were admitted to the University Medical Center Hamburg-Eppendorf.

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Dysautonomia has substantially impacted acute COVID-19 severity as well as symptom burden after recovery from COVID-19 (long COVID), yet the underlying causes remain unknown. Here, we hypothesized that vagus nerves are affected in COVID-19 which might contribute to autonomic dysfunction. We performed a histopathological characterization of postmortem vagus nerves from COVID-19 patients and controls, and detected SARS-CoV-2 RNA together with inflammatory cell infiltration composed primarily of monocytes.

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Never before have so many people around the world been simultaneously affected by tuberculosis. Tuberculosis is the leading cause of death from a bacterial infectious disease worldwide. The World Health Organization's ambitious goal from 2014 of achieving global elimination of tuberculosis does not seem realistic, but on current trends, tuberculosis could be eliminated in the European Union by 2040.

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Background: In May 2022, a multi-national mpox outbreak was reported in several non-endemic countries. The only licensed treatment for mpox in the European Union is the orally available small molecule tecovirimat, which in Orthopox viruses inhibits the function of a major envelope protein required for the production of extracellular virus.

Methods: We identified presumably all patients with mpox that were treated with tecovirimat in Germany between the onset of the outbreak in May 2022 and March 2023 and obtained demographic and clinical characteristics by standardized case report forms.

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Article Synopsis
  • The study investigated the impact of pre-existing neurological conditions like dementia and cerebrovascular disease on severe outcomes in COVID-19 patients hospitalized in 2022.
  • A total of 1,249 patients were analyzed, revealing low in-hospital mortality (3.8%) and ICU admission rates (9.9%), with no significant increase in risk due to dementia or cerebrovascular disease.
  • However, patients with chronic cerebrovascular disease and a history of myocardial infarction showed a higher likelihood of developing vascular complications after SARS-CoV-2 infection.
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The risk of SARS-CoV-2 infection is particularly high for healthcare workers during the pandemic. Home care workers visit many different households per shift. Encounters with mostly elderly patients and their relatives increase the potential for the undetected spread of SARS-CoV-2.

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Persistent somatic and neuropsychiatric symptoms have been frequently described in patients after infection with severe acute respiratory syndrome coronavirus 2 even after a benign clinical course of the acute infection during the early phases of the coronavirus severe acute respiratory syndrome coronavirus 2 pandemic and are part of Long COVID. The Omicron variant emerged in November 2021 and has rapidly become predominant due to its high infectivity and suboptimal vaccine cross-protection. The frequency of neuropsychiatric post-acute sequelae after infection with the severe acute respiratory syndrome coronavirus 2 Omicron and adequate vaccination status is not known.

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The SARS-CoV-2 infection leads to enhanced inflammation driven by innate immune responses. Upon TLR7 stimulation, dendritic cells (DC) mediate the production of inflammatory cytokines, and in particular of type I interferons (IFN). Especially in DCs, IRF5 is a key transcription factor that regulates pathogen-induced immune responses via activation of the MyD88-dependent TLR signaling pathway.

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Article Synopsis
  • A study analyzed the effectiveness of the monoclonal antibody sotrovimab against the Omicron variant of SARS-CoV-2 in hospitalized patients at the University Medical Center Hamburg-Eppendorf from December 2021 to June 2022.
  • Out of 1,254 patients, 185 received sotrovimab, either alone or with remdesivir, but no differences in in-hospital mortality were found between those treated with sotrovimab and those who weren't, even after adjusting for various factors.
  • These results, along with previous findings that sotrovimab has reduced effectiveness against the Omicron variant, indicate that sotrovimab is not a beneficial treatment for hospitalized patients with this infection
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Introduction: Little is known about risk factors for both Long COVID and somatic symptoms that develop in individuals without a history of COVID-19 in response to the pandemic. There is reason to assume an interplay between pathophysiological mechanisms and psychosocial factors in the etiology of symptom persistence.

Objective: Therefore, this study investigates specific risk factors for somatic symptom deterioration in a cohort of German adults with and without prior SARS-CoV-2 infection.

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Infection control measures and travel restrictions implemented during the COVID-19 pandemic have limited the transmission of seasonal influenza viruses as well. It must be assumed that after these public health measures have largely been lifted, influenza activity will sharply increase in the coming influenza season. Anticipating the potentially high number of cases, the co-circulation of influenza viruses and SARS-CoV-2, efforts to increase vaccination rates against both infectious diseases must be given more attention.

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Objectives: Abdominal tuberculosis (TB) is a "great mimic," and diagnosis remains challenging even for experienced clinicians. While mini-laparoscopy has already been demonstrated to be an efficient diagnostic tool for a variety of diseases, we aimed to demonstrate the feasibility of this technique in diagnosing abdominal TB.

Methods: We retrospectively included patients who underwent mini-laparoscopy at the University Medical Center Hamburg-Eppendorf between April 2010 and January 2022 for suspected abdominal TB.

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Objectives: The optimal treatment duration for vancomycin-resistant enterococcal (VRE) bacteraemia is still a matter of debate. The aim of the present study was to compare short-course (≤9 days) and long-course (≥10 days) antibiotic treatments in hospitalized adult patients with uncomplicated VRE bacteraemia.

Methods: This retrospective study was conducted in four university hospitals in Germany.

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