Non-tuberculous mycobacteria (NTM) include more than 160 ubiquitous, environmental, acid-fast-staining bacterial species, some of which may cause disease in humans. Chronic pulmonary infection is the most common clinical manifestation. Although patients suffering from chronic lung diseases are particularly susceptible to NTM pulmonary disease, many affected patients have no apparent risk factors. Host and pathogen factors leading to NTM pulmonary disease are not well understood and preventive therapies are lacking. NTM isolation and pulmonary disease are reported to rise in frequency in Europe as well as in other parts of the world. Differentiation between contamination, infection, and disease remains challenging. Treatment of NTM pulmonary disease is arduous, lengthy, and costly. Correlations between results of in vitro antibiotic susceptibility testing and clinical treatment outcomes are only evident for the Mycobacterium avium complex, M. kansasii, and some rapidly growing mycobacteria. We describe the epidemiology of NTM pulmonary disease as well as emerging NTM pathogens and their geographical distribution in non-cystic fibrosis patients in Europe. We also review recent innovations for the diagnosis of NTM pulmonary disease, summarize treatment recommendations, and identify future research priorities to improve the management of patients affected by NTM pulmonary disease.

/pdf/pulmonary-disease-caused-by-non-tuberculous-mycobacteria-3tl7f27492.pdf

Pulmonary Disease Caused by Non-Tuberculous Mycobacteria

This archive-based study investigates tuberculosis policy in the German Democratic Republic (GDR) from the 1940s to the 1960s. The focus is on the sanatorium as the major site of treatment and on BCG vaccination as the major preventive tool. The article tests and accepts the thesis that the GDR’s guiding health paradigm is best described by the term “medicalized social hygiene.” The article finds that methods of both treatment and prevention were characterized less by radical change and innovation than by tradition and pragmatism at least until the mid-1950s. Thus, “forced institutionalization” of “asocial” patients continued after 1945. Yet the health ministry long hesitated to make BCG vaccination obligatory. The German past, the Cold War context of German–German rivalry, and medical and popular attitudes toward vaccination, TB, and TB patients are considered as possible explanations for the mix of continuity and change in TB policy.

Medicalized Social Hygiene?: Tuberculosis Policy in the German Democratic Republic

Recently in this journal, Salfinger and Migliori [1] discussed the accessibility of bedaquiline drug susceptibility testing and the analysis of minimum inhibitory concentrations (MICs) for strains of Mycobacterium tuberculosis . As the recommended treatments for diseases caused by M. avium , and especially M. intracellulare , have high failure rates [2, 3], we measured the MIC of bedaquiline in 20 clinical isolates of these species.

Bedaquiline is a potential agent to treat severe or relapsing M. avium-intracellulare complex infections

https://erj.ersjournals.com/content/erj/49/3/1601969.full.pdf

Bedaquiline as a potential agent in the treatment of M. intracellulare and M. avium infections.

Der Lebensweg des judischen Urologen Paul Rosenstein (1875–1964) charakterisiert exemplarisch das Schicksals eines Wissenschaftlers zu Beginn des 20. Jahrhundert im Spannungsfeld zwischen beginnender Fachetablierung der Urologie an grosstadtischen Krankenhausern, beruflichem Erfolg sowie massiven Einschnitten wahrend der NS Zeit und Flucht aus Nazi Deutschland uber ein von wirtschaftlicher Depression gepragtes und wenig aufnahmewilliges New York nach Brasilien, wo er seinen Lebensabend verbrachte.

Urologie und Nationalsozialismus

BACKGROUND: The care of lung cancer patients in Germany has not been systematically evaluated yet. The aim of this article is to give an overview on the current state of lung cancer care on the basis of existing data. METHODS: In April and May 2010, a literature search was performed in order to collect relevant information concerning epidemiology as well as diagnostic, therapeutic (systemic therapy, radiotherapy, surgery, palliative therapy), and interdisciplinary structures in lung cancer treatment. RESULTS: The published database on lung cancer care in Germany is overall deficient. Treatment of lung cancer patients is mainly located in hospitals, particularly in chest clinics or specialised departments. The access of hospitals for an outpatient treatment as provided per § 116 b SGB V has not yet been realised in all German states. CONCLUSIONS: A systematic and prospective evaluation of lung cancer care is necessary in order to better allocate resources in the future.

/pdf/lungenkrebs-in-deutschland-zur-versorgungslage-der-nation-h2axisozq2.pdf

Lungenkrebs in Deutschland – zur Versorgungslage der Nation

Von der Phthisiologie zur Pneumologie und Thoraxchirurgie 60 Jahre Lungenklinik Heckeshorn

Nontuberculous mycobacterioses comprise a group of diseases caused by mycobacteria which do not belong to the Mycobacterium (M.) tuber- culosis complex and are not ascribed to M. leprae. These mycobacteria are characterized by a broad variety as to environmental distribution and adaptation. Some of the species may cause specif- ic diseases, especially in patients with underlying immunosuppressive diseases, chronic pulmonary diseases or genetic predisposition, respectively. Worldwide a rising prevalence and significance of nontuberculous mycobacterioses can be recog- nized. The present recommendations summarise actual aspects of epidemiology, pathogenesis, cli- nical aspects, diagnostics - especially microbiolo- gical methods including susceptibility testing -, and specific treatment for the most relevant spe- cies. Diagnosis and treatment of nontuberculous mycobacterioses during childhood and in HIV-in- fected individuals are described in separate chap- ters.

/pdf/empfehlungen-zur-diagnostik-und-therapie-nichttuberkuloser-1akb3c3hc1.pdf

Empfehlungen zur Diagnostik und Therapie nichttuberkulöser Mykobakteriosen des Deutschen Zentralkomitees zur Bekämpfung der Tuberkulose (DZK) und der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP) Recommendations for Diagnosis and Treatment of Nontuberculous Mycobacterioses of the German Central Committee against Tuberculosis and the German Respiratory Society

The "International Standards for Tuberculosis Care" (ISTC) were developed by the World Health Organisation (WHO) and others to provide inter- nationally agreed and, if possible, evidence-based standards for tuberculosis care including the care by private providers who are not part of national tuberculosis programmes or health-care systems. Hence, the ISTC primarily address resource-re- strained countries with high tuberculosis preva- lence. In this article, the German translation of the 21 standards from 2009 is presented � addressing diagnostic and therapeutic standards, co-infection (especially with HIV) and public- health issues. The accompanying comments show how these standards have to be modified for Germany due to the medical resources available here and country-specific characteristics respec- tively.

International Standards of Tuberculosis Care (ISTC) - Kommentierung aus deutscher Sicht International Standards of Tuberculosis Care (ISTC) - Comments from the German Point of View

„Am 1. April 1947 wurde das »Städtische Tuberkulosekrankenhaus Heckeshorn« auf dem Gelände der ehemaligen Reichsluftschutzschule in Wannsee gegründet. Anlaß war die verheerende Tuberkuloseepidemie nach dem 2.Weltkrieg mit 65000 Tuberkulose-Erkrankten allein in Berlin. Die Ausstattung in den dafür nicht vorgesehenen Gebäuden und Baracken war zunächst äußerst behelfsmäßig mit amerikanischen Feldbetten, einem überalterten Röntgengerät und einem einzigen PneumothoraxApparat. Unter der Leitung von Karl Auersbach (1947–1963) und später Karl Ludwig Radenbach (1964–1983) entwickelte sich aber das ursprüngliche Hilfskrankenhaus mit der Einführung antibiotischer und operativer Behandlungsmethoden zunächst zu einem effektiven Tuberkulosekrankenhaus und dann weiter zu einer Spezialklinik für alle Lungenkrankheiten. Dies spiegelt sich auch in den Diagnosen der aufgenommenen Patienten wider: Kamen anfänglich nur Tuberkulosekranke zur stationären Behandlung, so waren es 1967 nur mehr die Hälfte der Patienten, 1986 sogar weniger als 10%. Folgerichtig wurde daher die Klinik 1959 in »Städtische Klinik für Lungenkranke« bzw. 1970 in »Lungenklinik Heckeshorn« umbenannt. Die gesamte Palette diagnostischer und therapeutischer Verfahren, die für die Thoraxkrankheiten von Erwachsenen und Kindern inzwischen zur Verfügung steht, hat die Klinik heute zum Berliner Zentrum für Pneumologie und Thoraxchirurgie gemacht.“

/pdf/about-traditions-the-65th-anniversary-of-the-respiratory-4eba3zfy69.pdf

[About traditions ...the 65th Anniversary of the Respiratory Diseases Clinic "Heckeshorn" (Chest-Hospital)].

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Von der Phthisiologie zur Pneumologie und Thoraxchirurgie 60 Jahre Lungenklinik Heckeshorn

International Standards of Tuberculosis Care (ISTC) - Kommentierung aus deutscher Sicht International Standards of Tuberculosis Care (ISTC) - Comments from the German Point of View

[About traditions ...the 65th Anniversary of the Respiratory Diseases Clinic "Heckeshorn" (Chest-Hospital)].