{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T19:56:00Z","timestamp":1781639760812,"version":"3.54.5"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T00:00:00Z","timestamp":1772841600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:00:00Z","timestamp":1776384000000},"content-version":"vor","delay-in-days":41,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Frankfurt"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Microbiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Extrapulmonary tuberculosis (TB) and non-tuberculous mycobacterial (NTM) disease remain a diagnostic challenge and conventional methods such as mycobacterial culture or molecular methods (e.g. GeneXpert) performed on formalin-fixed paraffin embedded (FFPE) specimens are often unsuccessful. In this study, we assessed the diagnostic accuracy of chip hybridization from FFPE specimens in a cohort with predominantly extrapulmonary mycobacterial disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>FFPE specimens from patients with presumed mycobacterial disease underwent chip hybridization with two different assays (MYCO Direct 1.7 and MYCO Chip Vision Array 2.0) in addition to conventional diagnostic methods for TB and NTM disease including mycobacterial culture, molecular methods and conventional histology. The different techniques were assessed with regards to sensitivity, specificity and species identification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, 184 samples were assessed by one of the two chip hybridization techniques (MYCO Direct 1.7 n=65 and MYCO Chip Vision Array n=119). Samples were mainly extrapulmonary (160\/184, 87.0%). Of all samples, 32 (17.4%) turned positive in chip hybridization and 74\/184 patients (40.2%) were diagnosed with clinically relevant mycobacterial disease (59 with TB and 15 with NTM disease). For the detection of\n                      <jats:italic>Mycobacterium tuberculosis<\/jats:italic>\n                      complex (MTBC), sensitivity was 38.9% when compared to mycobacterial culture from the same specimen. For the detection of NTM, sensitivity was 50% against NTM culture. Species identification was overall consistent with conventional methods but did not allow for species differentiation of members of the MTBC or\n                      <jats:italic>Mycobacterium avium<\/jats:italic>\n                      complex, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>As extrapulmonary TB and NTM disease remain a diagnostic challenge, the investigated chip hybridization techniques might present a complementation of the diagnostic portfolio. However, with a low sensitivity to detect MTB from extrapulmonary FFPE specimens, they should not supplant conventional diagnostic methods but could be used to rule in TB when native specimens are not available.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12866-026-04875-2","type":"journal-article","created":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T03:45:22Z","timestamp":1772855122000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic accuracy of chip hybridization from formalin-fixed paraffin embedded bioptic specimens in a cohort with predominantly extrapulmonary mycobacterial disease"],"prefix":"10.1186","volume":"26","author":[{"given":"Ria","family":"Winkelmann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Belana","family":"Blasczok","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Winter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Wild","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria J.G.T.","family":"Vehreschild","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volkhard A.J.","family":"Kempf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas A.","family":"Wichelhaus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raja","family":"Idris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils","family":"Wetzstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,7]]},"reference":[{"key":"4875_CR1","unstructured":"Genus. Mycobacterium. Available: https:\/\/lpsn.dsmz.de\/genus\/mycobacterium.\u00a0Cited 3 Mar 2022."},{"key":"4875_CR2","unstructured":"Global tuberculosis report 2025. https:\/\/www.who.int\/teams\/global-programme-on-tuberculosis-and-lung-health\/tb-reports\/global-tuberculosis-report-2025."},{"key":"4875_CR3","doi-asserted-by":"publisher","unstructured":"Rachwal N, Idris R, Dreyer V, Richter E, Wichelhaus TA, Niemann S, et al. Pathogen and host determinants of extrapulmonary tuberculosis among 1035 patients in Frankfurt am Main, Germany, 2008\u20132023. Clin Microbiol Infect. 2024;0. https:\/\/doi.org\/10.1016\/j.cmi.2024.11.009.","DOI":"10.1016\/j.cmi.2024.11.009"},{"key":"4875_CR4","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-022-01921-9","author":"N Wetzstein","year":"2022","unstructured":"Wetzstein N, Drummer A-P, Bockey A, Herrmann E, K\u00fcpper-Tetzel CP, Graf C, et al. Occurrence of extrapulmonary tuberculosis is associated with geographical origin: spatial characteristics of the Frankfurt TB cohort 2013\u20132018. Infection. 2022. https:\/\/doi.org\/10.1007\/s15010-022-01921-9.","journal-title":"Infection"},{"key":"4875_CR5","doi-asserted-by":"publisher","unstructured":"Daley CL, Iaccarino JM, Lange C, Cambau E, Wallace RJ, Andrejak C et al. Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS\/ERS\/ESCMID\/IDSA clinical practice guideline. https:\/\/doi.org\/10.1183\/13993003.00535-2020.","DOI":"10.1183\/13993003.00535-2020"},{"key":"4875_CR6","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1111\/lam.12243","volume":"59","author":"A Lahiri","year":"2014","unstructured":"Lahiri A, Kneisel J, Kloster I, Kamal E, Lewin A. Abundance of Mycobacterium avium ssp. hominissuis in soil and dust in Germany - implications for the infection route. Lett Appl Microbiol. 2014;59:65\u201370. https:\/\/doi.org\/10.1111\/lam.12243.","journal-title":"Lett Appl Microbiol"},{"key":"4875_CR7","doi-asserted-by":"publisher","unstructured":"Honda J, Virdi R, Chan ED. Global environmental nontuberculous mycobacteria and their contemporaneous man-made and natural niches. Front Microbiol. 2018;9:2029. https:\/\/doi.org\/10.3389\/fmicb.2018.02029.","DOI":"10.3389\/fmicb.2018.02029"},{"key":"4875_CR8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2021.10.027","author":"N Wetzstein","year":"2021","unstructured":"Wetzstein N, Kessel J, Bingold TM, Carney J, Graf C, Koch BF, et al. High overall mortality of Mycobacterium genavense infections and impact of antimycobacterial therapy: Systematic review and individual patient data meta-analysis. J Infect. 2021. https:\/\/doi.org\/10.1016\/j.jinf.2021.10.027. [cited 25 Nov 2021].","journal-title":"J Infect"},{"key":"4875_CR9","doi-asserted-by":"publisher","unstructured":"Dahl VN, M\u00f8lhave M, Fl\u00f8e A, van Ingen J, Sch\u00f6n T, Lillebaek T, et al. Global trends of pulmonary infections with nontuberculous mycobacteria: a systematic review. Int J Infect Dis Elsevier B V. 2022;120\u201331. https:\/\/doi.org\/10.1016\/j.ijid.2022.10.013.","DOI":"10.1016\/j.ijid.2022.10.013"},{"key":"4875_CR10","volume-title":"others. Qualit\u00e4tsstandards in der mikrobiologisch-infektiologischen Diagnostik: MIQ\u20135 Tuberkulose Mybakteriose","author":"E Richter","year":"2010","unstructured":"Richter E, Beer J, Diel R. others. Qualit\u00e4tsstandards in der mikrobiologisch-infektiologischen Diagnostik: MIQ\u20135 Tuberkulose Mybakteriose. M\u00fcnchen: Elsevier, Urban und Fischer; 2010."},{"key":"4875_CR11","unstructured":"WHO. Module 3: diagnosis WHO operational handbook on tuberculosis. https:\/\/www.who.int\/publications\/i\/item\/9789240110991."},{"key":"4875_CR12","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1055\/a-1934-8303","volume":"76","author":"T Schaberg","year":"2022","unstructured":"Schaberg T, Brinkmann F, Feiterna-Sperling C, Geerdes-Fenge H, Hartmann P, H\u00e4cker B, et al. Tuberculosis in adulthood: The Sk2-Guideline of the German Central Committee against Tuberculosis (DZK) and the German Respiratory Society (DGP) for the diagnosis and treatment of adult tuberculosis patients. Pneumologie. 2022;76:727\u2013819. https:\/\/doi.org\/10.1055\/a-1934-8303.","journal-title":"Pneumologie"},{"key":"4875_CR13","doi-asserted-by":"publisher","unstructured":"Aisenberg GM, Jacobson K, Chemaly RF, Rolston KV, Raad II, Safdar A. Extrapulmonary tuberculosis active infection misdiagnosed as cancer: Mycobacterium tuberculosis disease in patients at a Comprehensive Cancer Center (2001\u20132005). Cancer. Cancer; 2005. pp. 2882\u20137. https:\/\/doi.org\/10.1002\/cncr.21541.","DOI":"10.1002\/cncr.21541"},{"key":"4875_CR14","doi-asserted-by":"publisher","unstructured":"Stellmacher F, Perner S. Histopathology of pulmonary tuberculosis. Pathologe. Springer Medizin. 2021:71\u20137. https:\/\/doi.org\/10.1007\/s00292-021-00910-3.","DOI":"10.1007\/s00292-021-00910-3"},{"key":"4875_CR15","doi-asserted-by":"publisher","unstructured":"Rammeh S, Romdhane E. Pathology of tuberculosis. Medical Radiology. Springer Science and Business Media Deutschland GmbH. 2022:29\u201358. https:\/\/doi.org\/10.1007\/978-3-031-07040-2_3.","DOI":"10.1007\/978-3-031-07040-2_3"},{"key":"4875_CR16","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1016\/j.humpath.2016.09.015","volume":"59","author":"LD Racsa","year":"2017","unstructured":"Racsa LD, DeLeon-Carnes M, Hiskey M, Guarner J. Identification of bacterial pathogens from formalin-fixed, paraffin-embedded tissues by using 16S sequencing: retrospective correlation of results to clinicians\u2019 responses. Hum Pathol. 2017;59:132\u20138. https:\/\/doi.org\/10.1016\/j.humpath.2016.09.015.","journal-title":"Hum Pathol"},{"key":"4875_CR17","doi-asserted-by":"publisher","first-page":"87","DOI":"10.4103\/2212-5531.201892","volume":"6","author":"P Polepole","year":"2017","unstructured":"Polepole P, Kabwe M, Kasonde M, Tembo J, Shibemba A, O\u2019Grady J, et al. Performance of the Xpert MTB\/RIF assay in the diagnosis of tuberculosis in formalin-fixed, paraffin-embedded tissues. Int J Mycobacteriology. 2017;6:87\u201393. https:\/\/doi.org\/10.4103\/2212-5531.201892.","journal-title":"Int J Mycobacteriology"},{"key":"4875_CR18","doi-asserted-by":"publisher","unstructured":"Huang S, Qin M, Shang Y, Fu Y, Liu Z, Dong Y, et al. Performance of Xpert MTB\/RIF in diagnosis of lymphatic tuberculosis from fresh and formaldehyde-fixed and paraffin embedded lymph nodes. Tuberculosis. 2020;124. https:\/\/doi.org\/10.1016\/j.tube.2020.101967.","DOI":"10.1016\/j.tube.2020.101967"},{"key":"4875_CR19","doi-asserted-by":"publisher","unstructured":"Lo CKF, Purych D, Sekirov I, Khattra J, Hird TJ, Masud S. Evaluation of GeneXpert MTB\/Rif Ultra assay performance on formalin-fixed paraffin-embedded tissues for Mycobacterium tuberculosis detection. J Med Microbiol. 2024;73. https:\/\/doi.org\/10.1099\/jmm.0.001918.","DOI":"10.1099\/jmm.0.001918"},{"key":"4875_CR20","doi-asserted-by":"publisher","first-page":"7143","DOI":"10.1093\/nar\/gkad519","volume":"51","author":"TA Steiert","year":"2023","unstructured":"Steiert TA, Parra G, Gut M, Arnold N, Trotta JR, Tonda R, et al. A critical spotlight on the paradigms of FFPE-DNA sequencing. Nucleic Acids Res. 2023;51:7143\u201362. https:\/\/doi.org\/10.1093\/nar\/gkad519.","journal-title":"Nucleic Acids Res"},{"key":"4875_CR21","doi-asserted-by":"publisher","unstructured":"Dietrich D, Uhl B, Sailer V, Holmes EE, Jung M, Meller S, et al. Improved PCR performance using template DNA from formalin-fixed and paraffin-embedded tissues by overcoming PCR inhibition. PLoS ONE. 2013;8. https:\/\/doi.org\/10.1371\/journal.pone.0077771.","DOI":"10.1371\/journal.pone.0077771"},{"key":"4875_CR22","doi-asserted-by":"publisher","unstructured":"Bass BP, Engel KB, Greytak SR, Moore HM. A review of preanalytical factors affecting molecular, protein, and morphological analysis of formalin-fixed. Paraffin-Embedded (FFPE) tissue: how well do you know your FFPE specimen? Archives of Pathology and Laboratory Medicine. College of American Pathologists. 2014:1520\u201330. https:\/\/doi.org\/10.5858\/arpa.2013-0691-RA.","DOI":"10.5858\/arpa.2013-0691-RA"},{"key":"4875_CR23","doi-asserted-by":"publisher","first-page":"426","DOI":"10.15616\/bsl.2019.25.4.426","volume":"25","author":"S-B Park","year":"2019","unstructured":"Park S-B, Park H, Bae J, Lee J, Kim J-H, Kang MR, et al. Comparison of One-Tube Nested-PCR and PCR-Reverse Blot Hybridization Assays for Discrimination of Mycobacterium tuberculosis and Nontuberculous Mycobacterial Infection in FFPE tissues. Biomed Sci Lett. 2019;25:426\u201330. https:\/\/doi.org\/10.15616\/bsl.2019.25.4.426.","journal-title":"Biomed Sci Lett"},{"key":"4875_CR24","doi-asserted-by":"publisher","first-page":"898","DOI":"10.5588\/ijtld.12.0818","volume":"17","author":"J Munkhdelger","year":"2013","unstructured":"Munkhdelger J, Wang HY, Choi Y, Wairagu PM, Lee D, Park S, et al. Identification of Mycobacterium species in FFPE granulomatous lymphadenitis tissue using REBA Myco-ID\u00ae. Int J Tuberc Lung Dis. 2013;17:898\u2013902. https:\/\/doi.org\/10.5588\/ijtld.12.0818.","journal-title":"Int J Tuberc Lung Dis"},{"key":"4875_CR25","unstructured":"Countries | World Health Organization. Available: https:\/\/www.who.int\/countries.\u00a0Cited 21 Aug 2025."},{"key":"4875_CR26","unstructured":"Definitions - WHO consolidated guidelines on tuberculosis. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK581326\/. Cited 21 Aug 2025."},{"key":"4875_CR27","unstructured":"R Core Team. RA language and environment for statistical computing. Vienna, Austria. 2018. Available: https:\/\/www.r-project.org\/."},{"key":"4875_CR28","doi-asserted-by":"publisher","first-page":"1686","DOI":"10.21105\/joss.01686","volume":"4","author":"H Wickham","year":"2019","unstructured":"Wickham H, Averick M, Bryan J, Chang W, McGowan LD, Fran\u00e7ois R, et al. Welcome to the {tidyverse}. J Open Source Softw. 2019;4:1686. https:\/\/doi.org\/10.21105\/joss.01686.","journal-title":"J Open Source Softw"},{"key":"4875_CR29","unstructured":"Harrison E, Drake T, Ots R, finalfit. Quickly create elegant regression results tables and plots when modelling. 2022. Available: https:\/\/github.com\/ewenharrison\/finalfit."},{"key":"4875_CR30","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1186\/s12866-021-02210-5","volume":"21","author":"AM Elbrolosy","year":"2021","unstructured":"Elbrolosy AM, El Helbawy RH, Mansour OM, Latif RA. Diagnostic utility of GeneXpert MTB\/RIF assay versus conventional methods for diagnosis of pulmonary and extra-pulmonary tuberculosis. BMC Microbiol. 2021;21:144. https:\/\/doi.org\/10.1186\/s12866-021-02210-5.","journal-title":"BMC Microbiol"},{"key":"4875_CR31","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/s12879-019-4749-x","volume":"20","author":"K Antel","year":"2020","unstructured":"Antel K, Oosthuizen J, Malherbe F, Louw VJ, Nicol MP, Maartens G, et al. Diagnostic accuracy of the Xpert MTB\/Rif Ultra for tuberculosis adenitis. BMC Infect Dis. 2020;20:33. https:\/\/doi.org\/10.1186\/s12879-019-4749-x.","journal-title":"BMC Infect Dis"},{"key":"4875_CR32","doi-asserted-by":"publisher","unstructured":"Njau AN, Gakinya SM, Sayed S, Moloo Z. Xpert\u00ae MTB\/RIF assay on formalin-fixed paraffin-embedded tissues in the diagnosis of extrapulmonary tuberculosis. Afr J Lab Med. 2019;8. https:\/\/doi.org\/10.4102\/ajlm.v8i1.748.","DOI":"10.4102\/ajlm.v8i1.748"},{"key":"4875_CR33","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1007\/s00428-017-2213-0","volume":"471","author":"A Guyard","year":"2017","unstructured":"Guyard A, Boyez A, Pujals A, Robe C, Van Tran J, Allory Y, et al. DNA degrades during storage in formalin-fixed and paraffin-embedded tissue blocks. Virchows Arch. 2017;471:491\u2013500. https:\/\/doi.org\/10.1007\/s00428-017-2213-0.","journal-title":"Virchows Arch"},{"key":"4875_CR34","doi-asserted-by":"publisher","first-page":"18275","DOI":"10.1038\/s41598-024-69285-8","volume":"14","author":"D Salgkamis","year":"2024","unstructured":"Salgkamis D, Sifakis EG, Agartz S, Wirta V, Hartman J, Bergh J, et al. Systematic review and feasibility study on pre-analytical factors and genomic analyses on archival formalin-fixed paraffin-embedded breast cancer tissue. Sci Rep. 2024;14:18275. https:\/\/doi.org\/10.1038\/s41598-024-69285-8.","journal-title":"Sci Rep"},{"key":"4875_CR35","doi-asserted-by":"publisher","unstructured":"Antonello M, Scutari R, Lauricella C, Renica S, Motta V, Torri S, et al. Rapid detection and quantification of mycobacterium tuberculosis DNA in paraffinized samples by droplet digital PCR: a preliminary study. Front Microbiol. 2021;12. https:\/\/doi.org\/10.3389\/fmicb.2021.727774.","DOI":"10.3389\/fmicb.2021.727774"}],"container-title":["BMC Microbiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12866-026-04875-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12866-026-04875-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12866-026-04875-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T19:31:42Z","timestamp":1781638302000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12866-026-04875-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,7]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4875"],"URL":"https:\/\/doi.org\/10.1186\/s12866-026-04875-2","relation":{},"ISSN":["1471-2180"],"issn-type":[{"value":"1471-2180","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,7]]},"assertion":[{"value":"20 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was performed in accordance with the Declaration of Helsinki. As all samples were acquired during clinical routine and this was a retrospective study, no informed consent was needed. Informed consent was therefore waived and the study approved by the Institutional Review Board (ethics committee) of the University Hospital Frankfurt under file numbers 2022\u2009\u2212\u2009672_3 and 2023\u2009\u2212\u2009570_3.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Ria Winkelmann, Belana Blasczok, Volkhard A.J. Kempf and Nils Wetzstein have nothing to declare.Melanie Winter received honoraria from talks and advisory board roles from Amgen, AstraZeneca, Bayer, Biocartis, Diaceutics, Roche, and Sophia Genetics. Peter Wild received consulting fees and honoraria (private\/institutional) for lectures by Bayer, Janssen-Cilag, Novartis, Roche, MSD, Astellas Pharma, Bristol-Myers Squibb, Thermo Fisher Scientific, Molecular Health, Sophia Genetics, Qiagen, and Astra Zeneca. Thomas A. Wichelhaus reports research grants from BMBF, JPIAMR, Deutsche Krebshilfe, MSD as well as speaker fees and consulting honoraria from Landes\u00e4rztekammer Hessen, Insmed, Osartis, all outside the submitted work. Maria J.G.T. Vehreschild received grants or contracts from MSD, Heel, Roche, Tillotts; consulting fees from GILEAD, Tillotts, Pfizer, Bioaster, GSK, Ecraid, Eumedica, Bactolife, PAION; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Akademie f\u00fcr Infektionsmedizin, Astra Zeneca, bioMerieux, Biotest, COCS GmbH, DGI, European Society of Neurogastroenterology, Falk Foundation, FomF GmbH, GILEAD, GSK, Helios Kliniken, Hessisches Landessozialgericht, Infektio Forum, Janssen Cilag GmbH, Klinikum Kassel, Landes\u00e4rztekammer Hessen, LMU Kliniken, MSD, Pfizer, Streamed up, St. Vincent Hospital, Tillotts; all outside the submitted work. Raja Idris received speaker fees from Tillotts Pharma and Gilead Sciences outside the submitted work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"372"}}