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Fighting an unknown killer with knowledge

In Germany, community acquired pneumonia is the most important infectious disease. Every year, 800,000 people contract the disease; and 50,000 die of it, making it the sixth most common cause of death. The number of people who are hospitalised due to pneumonia is still rising. It thus seems surprising that medical personnel and researchers know relatively little about this widespread disease, the pathogens that cause the disease, their resistance to antibiotics and the progression of the disease. A new foundation based in Ulm is hoping to contribute to a better understanding of this unpleasant disease and to improve the therapy to combat it.

Our understanding of the disease has been improving since 2002 when the German government paid twelve million euros to fund the cooperation of all CAPNETZ professionals. CAP is short for community acquired pneumonia. Funds have gone into clinical research projects, microbiological and virological studies and disease-oriented basic research. The network has collected 6,500 cases from ten regions in an Ulm-based database and is currently evaluating these data in the largest study worldwide on this subject.

Pneumococcae are the most important pathogens in Germany

It was only recently determined that in Germany 50 per cent of all CAP cases are caused by the pathogen Streptococcus pneumoniae (shown in the picture). (Photo: University Hospital Ulm)
It was only determined recently that in Germany 50 per cent of all CAP cases are caused by the pathogen Streptococcus pneumoniae (shown in the picture). (Photo: University Hospital Ulm)
The CAPNETZ experts are satisfied with the initial results: Simpler, more affordable antibiotics are able to treat community acquired pneumonia well and many errors in therapy have been stopped by the insights gained by the network. The researchers also found that only one in five pneumonia patients in Germany is treated according to the international and/or national guidelines. These guidelines were developed with significant input from CAPNETZ and are based partially on the insights gained in the study.

The researchers also identified the pathogens that cause community acquired pneumonia in Germany: 50% of all cases are caused by the pathogen Streptococcus pneumoniae. “It was interesting to note that in the USA or Spain, other pneumococcal strains occur compared to those in Germany,” says Reinhard Marre, head medical director of Ulm University Hospital. This explains the necessity of German clinical studies.

Four questions enable the clear prognosis of the progression of the disease

Pneumonia as determined by x-ray (Photograph: University Hospital Ulm)
Pneumonia as determined by x-ray (Photograph: University Hospital Ulm)
An additional insight: In one in five cases, the researchers found that it was the bacterium Haemophilus influenzae which caused the disease, predominantly in smokers. Viruses, however, mostly of the influenza type, caused the disease in one in ten pneumonia patients. The disease often progresses more aggressively in patients over the age of 65. Researchers also discovered a new marker in the blood (procalcitonin 3) of pneumonia patients, which facilitates a more specific prognosis together with breathing rate, blood pressure and alertness. “These tests will make sure that the right patients enter the clinic,” Tobias Welte (Hanover Medical School) concludes.

Still free from resistance

“Unlike in neighbouring countries with high antibiotic resistance, doctors in Germany are not confronted with resistant strains. Studies have shown which antibiotic works best for which manifestation of pneumonia for certain patient groups,” says Norbert Suttorp of the Berlin Charité.
“Another new finding from the study is that a large number of patients infected with legionella recover on their own,” says Reinhard Marre of the University of Ulm hospital.

But the experts would like to see much greater awareness in both professional circles and by the public. Infectiology still has a low profile at universities despite its medical importance. Suttorp compared infectious diseases such as community acquired pneumonia to a “fire in the cellar”. Every missed hour increases mortality by five percent. Though public awareness has increased in the last few years, many patients still see their doctor too late because they do not take their infection seriously as its symptoms are difficult to discern.

Now third-party funds can be applied for

Happy to have the foundation certificate in their hands: Foundation councillor Norbert Suttorp (Charité), Guido Adler, Vice President of the University of Ulm, Foundation councillors Reinhard Marre (University Hospital Ulm) and Tobias Welte (Hanover Medic
Happy to have the foundation certificate in their hands: Foundation councillor Norbert Suttorp (Charité), Guido Adler, Vice President of the University of Ulm, Foundation councillors Reinhard Marre (University Hospital Ulm) and Tobias Welte (Hanover Medical School). (Photograph: University Hospital Ulm)
The nationwide network receives funding from the BMBF, though this funding will steadily decrease until it ends in 2010. After that, the network will have to stand on its own feet. Back in May 2007, the University Hospital of the Berlin Charité, the Hanover Medical School and Ulm University Hospital turned the publicly-funded competence network CAPNETZ into an independent foundation. The infrastructure remains the same though the new foundation will be able to raise third-party and other funds.

The members of the foundation board made no specifications as to the level of the foundation’s capital. Klaus Richter (Ulm) was elected chairman of the foundation. Norbert Suttorp (Charité), Tobias Welter (Hannover) and Reinhard Marre (Ulm) were elected as members of the foundation board.

Foundation is to strengthen network

In addition to research, the collaboration with GP’s and clinics is an important element of the work of CAPNETZ. Over 500 medical practitioners nationwide work together and remain in close contact with the researchers in the field. For Richter, preserving and strengthening this infrastructure is the most important task of the new foundation.

wp - 13.12.2007
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