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Innerhalb der Reihe "GrenzBereiche des Lesens" gehaltener Vortrag. "GrenzBereiche des Lesens" ist eine kulturwissenschaftliche Vortragsreihe, die 2003 und 2004 an der Universität Frankfurt stattfand. Thomas Küpper nimmt in seinem Beitrag das Kriterium der Wiederholungslektüre, das als Qualitäts- und Differenzmerkmal ästhetisch anspruchsvoller Literatur gilt, zum Anlass, die Grenzziehung zwischen Kitsch und Kunst genauer zu überdenken. Nicht die Wiederholungslektüre an sich macht bereits den Unterschied, vielmehr muss eine Unterscheidung zwischen verschiedenen Formen der Wiederholungslektüre getroffen werden. In systemtheoretischer Perspektive lässt sich eine solche typologische Differenzierung anhand des je spezifischen Verhältnisses von Medium, d.h. hier: der Gattungen, und der Form, d.h. der Texte, präzise vornehmen. Trivialliteratur unterscheidet sich dann von der Kunst, insofern ihre Medien der eigentlichen Formrealisierung nur wenig Spielraum lassen: Nicht die Abweichung, sondern die Bestätigung der gegebenen Schemata wird honoriert. Auch der Kitsch bietet Variationen des Bekannten, doch – und hier nähert er sich der Kunst an – die vertrauten und wiederholten Muster werden als einmalige und besondere Formen von bleibendem Wert inszeniert. Am Beispiel des Kultfilms "Pretty Woman" spielt Thomas Küpper diese unterschiedlichen Lektüren durch und zeigt an diesem vermeintlich eindeutig trivialen Fall, dass sich die Faszination des Films den vielen Wiederholungen verdankt.
Introduction Disseminated infection due to non-tuberculous mycobacteria has been a major factor of mortality and comorbidity in HIV patients. Until 2018, U.S. American guidelines have recommended antimycobacterial prophylaxis in patients with low CD4 cell counts, a practice that has not been adopted in Europe. This study aimed at examining the impact of disseminated NTM disease on clinical outcome in German HIV patients with a severe immunodeficiency. Materials and methods In this retrospective case control study, HIV patients with disseminated NTM disease were identified by retrospective chart review and matched by their CD4 cell counts to HIV patients without NTM infection in a 1:1 alocation. Primary endpoints were mortality and time to first rehospitalisation. In addition, other opportunistic diseases, as well as antimycobacterial and antiretroviral treatments were examined. Results Between 2006 and 2016, we identified 37 HIV patients with disseminated NTM disease. Most of them were suffering from infections due to M. avium complex (n = 31, 77.5%). Time to event analysis showed a non-significant trend to higher mortality in patients with disseminated NTM disease (p = 0.24). Rehospitalisation took place significantly earlier in patients with disseminated NTM infections (median 40.5 days vs. 109 days, p<0.0001). Conclusion In this retrospective case control study, we could demonstrate that mortality is not significantly higher in HIV patients with disseminated NTM disease in the ART era, but that they require specialised medical attention in the first months following discharge.
Highlights
• Open pulmonary tuberculosis patient discharge policy was not reviewed for decades.
• After smear-negativity conversion, substantial cultural positivity may remain.
• It remains unclear, whether smear-negative patients still may be infective.
• The clinical relevance of this finding warrants further investigation.
Abstract
Objectives: Patients with open pulmonary tuberculosis (opTB) are subject to strict isolation rules. Sputum smear microscopy is used to determine infectivity, but sensitivity is lower than for culture. This study aimed to investigate the clinical relevance of this mismatch in contemporary settings.
Methods: Differential results between microscopy and culture were determined at the time of microscopic sputum conversion, from all patients with opTB between 01/2013 and 12/2017. In addition, data on HIV, multi/extensive drug-resistant TB status, time to smear- and cultural-negativity conversion were analyzed; and a Kaplan-Meier curve was developed.
Results: Of 118 patients with opTB, 58 had demographic data available for microbiological and clinical follow-up analysis; among these, 26 (44.8%) had still at least one positive culture result. Median time from opTB-treatment initiation to full microscopic sputum- or culture conversion, was 16.5 days (range 2-105), and 20 days (1-105), respectively (median difference: +3.5 days). Sixteen days after de-isolation, >90% had converted culturally. HIV- or multi/extensive drug-resistant TB status did not impact conversion time.
Conclusion: When patients with opTB were de-isolated after 3 negative sputum smear microscopy tests, a substantial part still revealed cultural growth of Mycobacterium tuberculosis complex, but it remains unclear, whether smear-negative and culturally-positive individuals on therapy are really infective. Thus, the clinical relevance of this finding warrants further investigation.