The Clinical Department has 68 beds for in-patients, including three intensive care beds for surveillance of seriously ill patients. In addition there are two isolator bed systems for contagious diseases and those infectious diseases with high mortality for which vaccinations are not available. These are Lassa fever, Marburg virus infection, Ebola fever etc. Besides the in-patients, the Department is taking care of approximately six thousand out-patients a year.

The technical facilities include endoscopy, ECG and ergometry, pulmonary function test, X-ray, ultrasound, routine laboratory and research laboratory. In 1998, the X-ray installation was replaced by a modern version for X-ray technology. The endoscopy was improved by installing video-endoscopy (coloscopy, rectosigmoidoscopy and gastroduodenoscopy). With computer-sonogramme and the modern surveillance system, the diagnostic facilities in the Department meets the standards of modern diagnostics.

The Clinical Department is functioning as a hospital for internal diseases which includes general medicine but is specialized, of course, in infectious diseases and tropical diseases including HIV and AIDS. The Clinical Department is serving as a reference centre throughout Germany and beyond.

Besides the routine patient work and routine diagnostics, members of the medical team participate in several scientific activities, either in collaboration with other departments of the Bernhard Nocht Institute for Tropical Medicine or in collaboration with other institutions in Hamburg, in Germany and beyond.

In the line of the previous years of successful research in pathophysiology of human malaria, recent installations of research positions financed by the Institute after more than twenty years fighting for it, facilitate the execution of scientific research in the Department. The hospital is treating human malaria cases up to 200 per year, which enables us to follow these patients very closely. On the other hand we have established endothelial cell cultures in order to simulate the patient‘s situation under a heavy malaria attack. This led to new knowledge about the cascade of events in the human malaria attack, especially by P. falciparum. Studies involve cytokines and other mediators, endothelial reaction and interaction of different origin and the haemostaseological system as a fine indicator for the row of advents occurring during a malaria attack. With the institutional support this type of research can now be intensified.

Since 1983, the Clinical Department has been involved in the research of pathology of HIV infection. Already then it has been postulated that possibly an animal reservoir in the deep forest of Africa may be existing. In the last years and even more recently it has been established that this is the case. HIV-1 has links to chimpanzees in three African regions, HIV-2 has close links to macaques. It is now proven by epidemiology and phylogenetics that HIV infection is a tropical disease of African origin which has spread all over the world in analogy to other tropical diseases which have been spread all over the world by travelling as e. g. cholera, smallpox and leprosy.

It is mandatory that institutes for tropical medicine and those institutions dealing with research of human parasitology engage in HIV research for the following reasons:

• first of all it is a tropical disease which has been spread all over
• second the HIV-induced immune defect shows us, which events lead to development of disease or symptomless parasitism of protozoa. The analysis of precise defects and the human parasite interaction will clarify aspects of pathology of human parasitic diseases more easily
• It is a humanitarian must to help people in tropical areas to fight against HIV, either by assisting in finding ways of medical treatment or prevention of opportunistic diseases. Therefore we have - in collaboration with the Department of Virology and the Department of Pathology - been acting in this field since 1983, here in Hamburg as well as in other places, e. g. Gabon and Uganda. Studies have been performed together with the Joint Clinical Research Centre in Kampala/Uganda, which has obtained the highest credit by expert visitors of that place. One of the studies on Tuberculosis and HIV has received an international award.

Figure A: Histologic section of aspirated bone marrow. The klarge cells are megakyryocytes.  Giemsa staining. x20

Figure B: Immunohistochemical reaction showing CD4+ T lymphocytes. Bone marrow aspirate. x 40