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Infektiologie Engl 1
Infektiologie Engl 1
Infectious Diseases
Combatting viruses and bacteria
Dear Reader,
our immune system is put to the test prac- for Infectious Diseases (WZI). Clinical
tically every day each time the human hygiene is also an effective help in prevent-
body is confronted with new infectious ing infections from occurring.
micro-organisms (pathogens). These viruses
or bacteria particularly affect patients Founded in 2013, WZI brings together the
with weakened immune systems: When relevant infectious disease management
patients require new organs or suffer from disciplines at the University Hospital of
tumours, to achieve the best possible Essen and promotes close interaction
medical outcome they have to undergo between doctors and scientists. Our
treatment which involves suppressing the clinical experts in the infectious disease
immune system. This can often result in outpatient unit and an interdisciplinary
an immune deficiency which makes the infections ward diagnose and treat all
patient more susceptible to infection. relevant infectious ailments. In large col-
laborative research projects funded by the
Treating and – preferably – preventing German Research Foundation (GRF), scien-
infections requires a great deal of expertise. tific experts investigate the causes and
Infections involving resistant pathogens origins of the diseases, thereby laying the
are especially difficult to treat and call for foundation for better treatment prospects.
new strategies in the management of
treatment, for example special isolation By founding WZI and pooling our skills and
measures. For this reason, an interdiscipli- capabilities, we serve patients by offering
nary team of internal medicine specialists, the very highest level of medical care, put-
clinical infectious disease specialists, ting them at the centre of what we do
paediatricians, dermatologists, microbiol- every single day.
ogists, virologists and immunologists of
the highest medical calibre work in close
collaboration at the West German Centre
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Preventing
infection together
We humans are constantly surrounded
by viruses and bacteria. The fact that we
are not constantly getting infections is
primarily thanks to our immune system.
Medical progress and social change
have also contributed to the significant
decline in the risk of many infectious
diseases in recent decades.
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In his view, there is set to be an increase in Other specialists in other disciplines can
the number of immune deficiency patients be brought in quickly as required to advise
in future years. “Medical progress is actu- on treatment. The UH Essen Clinical
ally one of the reasons for this because it’s Hygiene Unit, all intensive care units and
a major contributor to ever-growing life the Antibiotics Consultancy Service are
expectancy of people in industrialised also involved in the centre’s work.
nations like Europe and North America.
In advanced age, though, there’s also an This pooling of expertise is a real advan-
increased risk of things like cancer and tage because, particularly with infectious
major organ diseases that often require diseases, doctors and scientists involved
immunosuppressive therapy. At the same in diagnosis and treatment should work
time, the functioning of the immune together in an interdisciplinary manner as
system is significantly reduced in old age the diseases do not usually fall under any
even without organic diseases. These single discipline alone. Accordingly, the
factors weaken the immune system in a staff of participating clinics and institutes
lasting way and encourage infectious meet for regular case conferences and to
diseases”, concludes Prof Dittmer. Greater discuss the best treatment or therapy for
research into infections and, as a result, each patient from different specialist
better treatment of infectious disease medical perspectives.
patients, is therefore of growing social
and medical relevance. One main focal point of the work at WZI is
the treatment of immune deficiency
Doctors, scientists and nurses at UH Essen patients. An immune deficiency can arise
recognised this trend early on and res from an immunosuppressive therapy after
ponded to the growing medical importance an organ transplant, after chemotherapy
of infections by establishing the West for the treatment of tumour diseases or in
German Centre for Infectious Diseases the case of chronic infection. In addition to
(WZI) in 2013. caring for affected patients, research and
teaching in the field of infectious diseases
The management of infectious disease is take high priority. Doctors at our centre in
an interdisciplinary science – reflected in Essen are also engaged in developing new
the fact that WZI pulls together the UH diagnostic procedures and treatment rec-
Essen clinics and institutes dealing with ommendations to ensure lasting improve-
the study, prevention, diagnosis and treat- ments in the quality of care nationwide.
ment of infectious diseases. WZI has
teams of internal medicine and infectious
disease specialists, paediatricians, derma-
tologists, microbiologists, virologists and
immunologists working closely together
for the benefit of patients.
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Excellent outpatient care
For outpatient care as well as pre-stay and post-op aftercare issues. This availability is
post-stay inpatients we have a General especially important from a treatment
Infection Outpatient Unit, several special- success point of view, as infectious-disease
ised outpatient clinics and an infectious- and immunological problems can occur
disease surgery available at WZI. In the before and after transplantation.
outpatient clinics, doctors treat patients
with immune deficiencies, unexplained People with liver transplants receive excel-
syndromes and suspected infectious dis- lent care in the Liver Transplant Outpatient
eases. For diagnostic evaluation they gen- Aftercare Unit. Lifelong immunosuppres-
erally involve specialists from the Institutes sive medication following a transplant
of Medical Microbiology and Virology. requires a very precise, customised pro-
Together, the doctors and scientists then gramme of aftercare aimed at protecting
determine diagnostic measures and treat- patients from infectious disease.
ment plans.
The Bone Marrow Transplantation (BMT)
In addition to the General Infection Out Outpatient Unit looks after oncology
patient Unit, people with HIV/AIDS and patients recovering from allogeneic periph-
other sexually transmitted and proctologic eral blood stem cell or bone marrow trans-
diseases are looked after in HPSTD Out plantation with the aim of prevention,
patient Unit. Staff can provide not only early detection and suitable treatment of
highly specialised medical care but also infectious-disease complications, thereby
psycho-social support and assistance. Our ensuring long-term treatment success.
Hepatitis Outpatient Unit provides screen-
ing for and early diagnosis of hepatitis and Staff at the outpatient units are also points
other liver diseases. These disorders can of contact for inpatient and outpatient
be caused by viruses and often manifest physicians throughout the Ruhr conurbation
themselves in uncharacteristic symptoms, on serious issues associated with infectious
thus requiring careful diagnosis. diseases.
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New Clinic for Infectiology for inpatients
Inpatients are generally treated in those conjunction with the UH Essen’s Clinical
clinics under the WZI umbrella or on the Hygiene Unit”, continues Prof Witzke,
“M-INF” interdisciplinary infections ward emphasising the special importance of
of the Radiotherapy Clinic. Patients who interdisciplinary collaboration. Infectious
are not accommodated on the new infec- disease specialists on hand right at the
tions ward, but on other wards, are looked bedside work closely with colleagues from
after by the Infectiological Consultation the diagnostic virology and microbiology
Service (second opinions, etc.) and the departments, making it possible to diag-
Antibiotics Consultancy Service, both of nose infection disorders more quickly and,
which are located on-site. thereby, home in and get started on the
optimum treatment plan. In order to avoid
The M-INF ward under the medical leader- subjecting critically ill patients to strenuous
ship of Prof Dr Oliver Witzke (M. D.) from and stressful bed moves, the M-INF inter-
the Clinic for Infectiology has a total of disciplinary infections ward offers one
nine single rooms, four doubles and one further advantage: thanks to the technical
patient reception room. Seven single equipment on hand in the ward, diagnosis
rooms and one double are fitted out as is performed in the immediate vicinity of
isolation rooms: “The ward has isolation the patient.
beds where patients with particularly
severe infectious diseases, poor immune However, WZI staff do not just deal with
response or mandatory isolation require- the acute phase of an infectious disorder,
ments can be given the best possible care”, but also handle the aftercare period which
Prof Dr Witzke explains. Vacuum-operated is of great importance to the patient. “Close
air-lock entrances ensure that pathogens psychosocial care is particularly important
are unable to spread throughout the entire to patients. They allow the impending
ward. In addition, the spread of dangerous release and subsequent convalescence
germs is also prevented by an adapted activities to be planned and initiated in a
ventilation system and separate entrances more patient-oriented manner”, explains
to the isolation rooms. “We developed Prof Witzke, referring to the package of
the underlying safety blueprint, which therapies and interventions offered by
includes regular training of ward staff, in WZI.
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The Institute of Virology is led by Prof Dr
Ulf Dittmer (D.Sc.). It offers an extensive
range of services for the diagnosis of viral
infections. One special area of focus is the
detection of chronic viral infections. These
include infections in patients with immune
deficiencies following an organ or bone
marrow transplant. But the Institute of
Virology has its part to play in everyday
matters too: at the vaccination and travel
health advisory surgery anyone can register
to receive guidance on recommended
vaccinations when travelling far afield.
It offers a full range of advice on travel
Institutes at the WZI vaccinations, putting together a medicine
and first aid kit, how to avoid traveller’s
diarrhoea and much more besides – all
tailored to the country of visit and the
In addition to the outpatient units, the type of travel involved.
institutes also play a key part in successful
treatment of patients at WZI, because As the official yellow fever vaccination point
there can be no optimum treatment for the province of North-Rhine West-
without detailed and rapid diagnosis. phalia, the travel vaccination surgery also
offers inoculation against yellow fever as
The Institute of Medical Microbiology well as all other important vaccines.
headed by Prof Dr Jan Buer (M. D.) detects
infectious agents (bacteria, fungi and par- Small children are in the stage of life which
asites) using conventional and the very brings the most infections. Added to this
latest molecular biological methods and is the fact that, per head of population,
tests their sensitivity to antibiotics. One young children in German outpatient units
area of focus is the microbiological moni- are prescribed the most antibiotics. This
toring of patients with particular risk of can lead to fear and uncertainty on the
infection, for example after chemotherapy part of parents. The Paediatric Infections
and transplants. Within the interdisciplinary & Advice Surgery is aimed at parents with
team, the Antibiotics Consultancy Service children who suffer unusually often from
(ACS) conducts consultations on the diag- infections or who show signs of rare or
nosis and treatment of serious infections. especially serious infections.
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Applied research
for the benefit of patients
Improving the treatment of infections in Antiviral treatment for infective hepatitis
patients with immune deficiencies requires Untreated, hepatitis B and C virus infections
a fundamental understanding of the cause- can result in chronic inflammation of the
and-effect interaction of these d isorders. liver and eventually lead to liver failure or
For this reason, research into infectious liver cancer. In order to develop effective
disorders at UH Essen is of great impor- drug-based therapies for the treatment of
tance, extremely practice-led and linked chronic hepatitis, doctors and scientists
into international networks. Our number need an intimate understanding of the
one objective is to allow basic research basic mechanisms of the human immune
findings to be adopted in clinical care response to these viruses. To this end,
settings as soon as possible. Researchers at research is undertaken at WZI as part of an
WZI conduct studies on the following top- international research network (Transregio
ics: SFB) and a German Research Foundation
Postgraduate Group as well as in special
Antiretroviral treatment of HIV i nfections clinical study protocols. Of particular note
Nowadays, HIV infections can be treated is the very close interaction between foun-
by using so-called antiretroviral drugs. dational researchers and clinic-based hep-
However, the drugs must be taken long- atitis specialists who are able to fast-track
term and can cause long-term side effects. research results into c linical care settings.
In our national HPSTD Outpatient Unit,
virologists and HIV specialists develop
strategies to optimise HIV treatment with
a view to minimising the emergence of
resistance and side effects in patients over
the long term.
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Infection prevention following solid
organ transplants
Following an organ transplant, patients
have a significantly increased risk of both
mortality and the development of severe
infections. Often these are infections
involve “atypical” pathogens, also known
as “opportunistic” pathogens, which are
usually harmless when found in healthy
people. For years, doctors and scientists
at WZI have been investigating and opti-
mising preventive treatments and
vaccines aimed at avoiding, or treating
more effectively, such infections in organ
recipients, with a focus on infections
involving the cytomegalovirus.
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Scientific exchanges with China
When people develop chronic viral infec- 80+ project staff in Germany and China
tions such as hepatitis B, hepatitis C or with an extra 7.5 million euros to develop
HIV, there are still only limited treatment new strategies for immune treatments
options available that can be used to elimi- and vaccines combatting chronic viral
nate viruses and avoid protracted conse- infections. The common goal now is to
quences from these chronic infections. develop drugs and vaccines to overcome
For this reason, in 2009, German and the “slowdown mechanisms” of the
Chinese scientists joined forces to create immune system and thereby be able to
what became known as the Transregio 60 bring an end to chronic viral infections. “If
Collaborative Research Centre (TRR 60). we’re successful we could combat a very
Researchers at the University Hospitals of major global health problem long-term”,
Duisburg-Essen and Bochum Universities explains Prof Dr Ulf Dittmer (M. D.), Direc-
are collaborating with universities and tor of the Institute of Virology and Chair-
institutions in Wuhan and Shanghai (China) man of the Research Syndicate.
to investigate the interaction of viruses with
cells of the immune system to develop Another side effect of international collab-
foundations for new immunotherapies oration which is good news for patients
and vaccines. is: thanks to the close interaction with for-
eign colleagues, the German researchers
They analyse the mechanisms underlying now have fast access to new viruses and
the transition from acute to chronic infec- other pathogens – such as avian influenza
tion in order to develop an understanding viruses (bird ‘flu) – that are first detected
of how viruses are able to escape the in Asia, and are able to develop effective
defence mechanisms of the human immune detection methods and medicines for
system. All scientists involved meet regu- Europe.
larly in Germany and China at annual
workshops to discuss the latest findings
from their research.
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Supporting young professionals
The BIOME Postgraduate Group has been There are good reasons for choosing this
supporting doctoral candidates in medicine subject area: Despite intensive research,
and the natural sciences in their sophisti- vaccines and treatment options are
cated scientific training since 2010. Founded nowhere near available for all pathogens.
by the Faculty of Medicine and Faculty of As a result, the immune response of any-
Biology at the University of Duisburg-Essen, one affected is of great importance as it
it provides a platform for regular scientific largely determines how an infection will
exchange and discussion. progress. For this reason, the postgraduate
group’s name also carries the subtitle
Launched in April 2014, the new 1949 “Immune response in infectious diseases –
Postgraduate Group also offers young regulation of innate and acquired immu-
researchers the opportunity to obtain their nity”. The interaction between the early
doctorates at a high professional level in immune response and the subsequently
the field of infection research. The post- acquired pathogen-specific immunity is
graduate group is receiving total funding set to be analysed in detail. “This type of
of 4.5 million euros from the German collaboration setting, such as joint semi-
Research Foundation for the first four and nars and courses conducted in an alter-
a half years. This enables up to 30 scientists nating form at the three universities in
at the three participating universities Bochum, Düsseldorf and Duisburg/Essen,
(Ruhr-University Bochum, Heinrich-Heine- are helpful in achieving a doctorate at a
University Düsseldorf and Duisburg-Essen very high professional level”, says Prof
University) to be supported financially and Westendorf who is certain that multi-uni-
academically. When asked about the versity research and training of doctoral
material the group will be addressing, students offers the best opportunities
Prof Dr Astrid Westendorf (D.Sc.), Institute young scientists can get.
of Medical Microbiology, and Prof Dr
Mirko Trilling (D.Sc.), Institute of Virology,
say “The researchers will in future be
concerning themselves with the way the
immune system responds to infectious
diseases”. They direct and coordinate the
group of researchers together.
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Using research to prevent
post-transplant complications
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Vaccinations are not only used in trans- The second key challenge in transplant
plant recipients, but also for live donors of medicine are rejections. The aim of the
organs or blood stem cells. The background work of Prof Lindemann and her team is
is that in the context of transplants, immune to improve donor selection and medical
cells – and with them immune responses treatment. To this end, the doctors esti-
to infections – are transferred from donors mate the risk of rejection in both donors
to recipients. This immune transfer through and recipients in the laboratory before
blood stem cell transplantation has already transplantation. The focus here is on live
been used in treatments: “The immune kidney transplants: Transplants can be
protection of donors has been transferred planned and, as a result, the immunologi-
to infected patients by means of transplan- cal risks can be analysed accurately before
tation”, says Prof Lindemann, explaining the transplant is made. The lab results can
her approach. “By vaccinating the donor be used to help scientists and case doctors
before the transplant we’ve already man- determine further treatment measures.
aged to heal cases of hepatitis B in two
blood stem cell recipients”, she continues.
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Junior researcher wants
to decrypt herpes viruses
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system to respond to the viruses, but medicines more appropriately”, says Prof
never fully defeat them. The pathogens Trilling as he looks to the future. By block-
remain latent in the body until the equilib- ing the viruses’ “sheep’s clothing”, patients’
rium between the immune system and immune systems could be helped to defeat
viral countermeasures is so corrupt that the them entirely.
virus can no longer be kept in check. This is
the case, for example, when patients are What Prof Trilling especially values about
immunosuppressed due to disease or organ Essen as a research location are the out-
transplants. standing scientific environment and the
clear link to clinical research and, thus, to the
“Once we’ve found the genes responsible patient. This is made possible, among other
and once we understand the basic mecha- things, by an interdisciplinary approach:
nisms of viruses, we should be able to “Collaboration between scientists and
remove specific genes from the genome of medical doctors in different hospitals and
the viruses to produce attenuated viruses institutes here in Essen is exceptionally
for vaccine purposes. It would also be good, with the result that we’ve got the
possible to use the knowledge gained for very best environment for developing the
specific development of pharmacological right medicines and effective agents“.
substances, or – put more simply – apply
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Outlook
Our medical and nursing activities are However, new drugs are sometimes asso-
characterised throughout by focussing ciated not just with favourable, but also
on patients and their specific needs. For adverse long-term consequences: some
this reason, we are particularly pleased viruses develop resistance, as they are
that, by founding the WZI, we are now often genetically highly variable. That said,
also able to pool knowledge and infor- modern diagnostics is well armed against
mation more effectively in the field of this complication as the latest methods
infectious disease management – bene- make it possible to pinpoint the genetic
fitting from the very latest research both information of viruses accurately. In this
medically/scientifically and in terms of way, a “genetic fingerprint” can be created
patient care. for each individual patient’s infection virus.
Using this information, the case doctor can
Protective vaccines and drugs are not yet select effective drugs to which the type of
available for all dangerous pathogens: virus in question has no resistance.
That is reason enough to move ahead
strongly and continue to support our Personalised, individually tailored medical
highly motivated researchers in this field. service for each patient is a new treatment
strategy that has already become reality at
In recent years, great strides have been WZI within the UH Essen.
made in pathogen-specific treatments,
primarily in the field of virology: Here, the
number of effective drugs has multiplied
over a very short space of time. An example
of this is the treatment of the hepatitis C
viral infection which, until 2013, did not have
a great success rate and caused severe side
effects. Since 2014, however, several clini-
cal care medications have been approved
which are able to cure chronic infection
completely in most patients.
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Your contacts at WZI
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Directions and Map
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For further information on how to get here,
and for the UH Essen site map, please go to
www.uk-essen.de/anfahrt450/
Editorial Details
Publisher
University Hospital of Essen
Hufelandstraße 55
45147 Essen
Design
designlevel 2
Photography
Prof Dr Monika Lindemann (M. D.)
University of Duisburg-Essen – Press Office
University Hospital of Essen
zelck – fotografie, Essen
Printing
Print office of UH Essen
Date
November 2015
University Hospital of Essen
Hufelandstraße 55
45147 Essen