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Background: Relapsing fever is an infectious disease caused by Spirochaetes. The presentation is characterised by recurrent episodes of fever., Case Description: At the end of her trip through South Africa and Botswana, a 54-year-old woman had symptoms of fever and dry cough. Back in the Netherlands, physical examination at the emergency department did not reveal any abnormalities besides fever. Laboratory investigation found thrombocytopenia and elevated infection markers. Thick blood smear revealed the presence of Spirochaetes. Following a working diagnosis of 'relapsing fever', the patient was treated with doxycycline. There was no Jarisch-Herxheimer reaction. At a follow-up outpatient appointment two weeks later, the patient had fully recovered., Conclusion: Relapsing fever is a rare disease without specific symptoms. The diagnosis is therefore easily overlooked. Untreated, mortality is high. During episodes of fever, the diagnosis can be established with a thick blood smear.

Revision of the rabies policy in the Netherlands The WHO aims to eliminate dog-transmitted rabies deaths in humans by 2030 ('zero by 30'). The Dutch rabies policy advisory board has revised its national rabies guidelines on the basis of the WHO guidelines revised in 2018. In the revised Dutch guidelines, there is increased focus on the importance of instant wound care after potential exposure to the rabies virus. Pre-exposure prophylaxis (PrEP) is limited to two vaccines given on days 0 and 7, rather than the previous regime of three vaccines. Post-exposure prophylaxis (PEP) no longer consists of five vaccines for unvaccinated individuals; instead it is four vaccines on days 0, 3, 7, and 14-28. For type III wounds, when indicated, rabies immunoglobulin (RIG) is only injected into and around the wound bed; residual volumes are no longer administered intramuscularly. RIG no longer needs to be administered in cases of potential mucosal contact exposure to the rabies virus where there is no injury. The vaccination scheme for PrEP (3) and PEP (5) does not change for immunocompromised patients, and RIG is administered regardless of the vaccination status of the affected individual.

Prosthetic joint infection (PJI) is a major complication after total joint arthroplasty. The most common source of these PJIs is a wound infection immediately after implantation of the artificial joint; however, haematogenous infection is also a common source of PJIs. We describe 3 patients, all suffering from (rheumatoid) arthritis, who presented at the emergency department with a wound on the foot or ankle and a swollen and painful prosthetic knee joint, which was functioning well for a long period of time (6 months to 5 years). All patients had several debridements of their infected total knee arthroplasty with local and systemic antibiotics. Patient outcome was widely diverse: from death to successful treatment. These case descriptions are good examples of the different outcomes from a major complication after a small wound. Care should be taken particularly for wounds around the foot and ankle in patients with a total joint arthroplasty, especially those who also have diabetes, rheumatoid arthritis or are immunocompromised.

A 23-year-old woman was working in a factory unpacking jars of Spanish olives when a spider bit her finger. She presented to the emergency outpatient department carrying the spider in a box. She was worried and wanted to know whether the spider, which may have originated from Spain, was poisonous. After a ten minute Internet search the spider was identified as Segestria florentina. It can inject neurotoxins causing temporary local numbness and pain. The patient was reassured and discharged without further treatment. Later, experts confirmed the species. Internet-based search engines can draw attention to unusual diagnoses which otherwise may easily be overlooked. A general search engine can also provide access to subjects that fall outside the scope of the more usual medical sources.