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In the German guidelines for prophylaxis of group B streptococcal (GBS) early onset sepsis in neonates (EOS), GBS screening of all pregnant women has been recommended, but is not yet included in the Maternity Directives. Aim of the study was to identify temporal trends in incidence of EOS and their association to GBS Screening.The analysis based on health insurance data of the statutory health insurance provider Barmer from 2005 to 2017 of 313,385 mother-child pairs. Annual frequency of GBS infections in newborns was determined by ICD-10 P36.0. The frequency of maternal GBS colonization was indicated by ICD-10 B95.1, which was used as surrogate for GBS screening. Temporal trends of the risk of EOS in neonates were assessed in logistic regression models. Pearson's correlation coefficient of EOS incidence and the surrogate marker for maternal GBS colonization was calculated.The risk of EOS in neonates caused by GBS has decreased annually by 9.3%, resulting in an overall decrease in the observation period of 72.0%. There was no statistical significant change in the risk for LOS (Late Onset Sepsis). The decrease of EOS could not be explained by temporal changes in Caesarian section, risk factors or preterm delivery. The 3.5 fold increase in the proportion of mothers with documented positive GBS colonization in the same period correlated inversely with the incidence of EOS (r=- 0.75; p=0.002).The decrease of EOS in neonates caused by GBS in Germany and the unchanged risk of LOS in neonates may be explained by the increasing application of the GBS Screening in pregnant women.In der Leitlinie zur Prophylaxe der frühen Form (Early Onset Sepsis, EOS) der Neugeborenensepsis durch Streptokokken der Gruppe B (GBS) wird ein GBS Screening aller Schwangeren empfohlen. Dieses ist jedoch nicht Bestandteil der Mutterschaftsrichtlinien. Studienziel war die Überprüfung des zeitlichen Verlaufs der Infektionsrate im Zusammenhang mit dem GBS Screening.Krankenversicherungsdaten der Jahre 2005 bis 2017 von 313 385 BARMER versicherten Mutter-Kind Paaren wurden analysiert. Über die ICD-10 P36.0 wurde die jährliche Häufigkeit von GBS Infektionen bei Neugeborenen ermittelt. Als Surrogat für das GBS Screening wurde die ICD-10 B95.1 verwendet, welche bekannte positive mütterliche GBS Besiedelung beschreibt. Durch logistische Regressionsmodelle wurden die zeitliche Veränderungen des Erkrankungsrisikos von EOS bei Neugeborenen untersucht. Pearson-Korrelationskoeffizient wurde zur Bewertung des Zusammenhangs zwischen der zeitlichen Veränderung der Häufigkeit an EOS und dem Surrogatmarker für GBS Besiedelung verwendet.Das Erkrankungsrisiko der EOS bei Neugeborenen hat jährlich um 9,3% abgenommen, gesamt über die Beobachtungsjahre um 72,0%, während für die Spätform LOS (Late Onset Sepsis) keine statistisch signifikante Veränderung beobachtet wurde. Diese Abnahme konnte nicht durch zeitliche Veränderungen bei Kaiserschnitten, Risikofaktoren oder Frühgeburten erklärt werden. Eine gleichzeitige Erhöhung des Anteils der Mütter mit bekanntem positivem GBS Status um den Faktor 3,5 korrelierte invers (r=− 0,75; p=0,002) mit der Inzidenz von EOS.Die starke Abnahme der EOS in Deutschland bei unveränderter Inzidenz von LOS könnte durch eine zunehmende Umsetzung des Schwangerenscreenings erklärt werden.

The case of an 82-year-old woman with bilateral necrotizing fasciitis and unilateral orbital involvement is presented. A mixed infection consisting of Streptococcus pyogenes, Staphylococcus aureus, and Aspergillus fumigatus could be verified. The latter was detected by molecular pathological investigations. Treatment consisted of repeated surgical debridement in combination with systemic broad-spectrum antibiotic and antimycotic treatment. Furthermore, the patient received low-dose systemic corticosteroids. After remission of acute inflammation, the healing process by secondary intention was uneventful.

Glomerulonephritis, secondary to bacterial, or, more rarely, viral or parasitic infections, is called infection-associated. The epidemiology of infection-associated glomerulonephritis has changed in recent decades. For a long time, the classic form has been acute poststreptococcal glomerulonephritis (APGN), but in developed countries its incidence has declined sharply. However, there is an increase in staphylococcal associated glomerulonephritis (SAGN). The clinical manifestations of APGN and SAGN are different: APGN typically presents with a glomerulonephritis after an infectious latency period (post-infectious), while SAGN typically shows an immune complex glomerulonephritis concomitant with infection (para-infectious). SAGN often presents with an occult infections in older patients with multiple comorbidities.

Invasive soft tissue infections byPhotographic documentation, radiological imaging, laboratory and smear diagnostics and intravenous antibiotic therapy were performed on all patients according to the recommendations of the German Robert Koch Institute and the local infectiology board.In all patients,Invasive streptococcal infections represent a challenge in the daily routine of an ophthalmologist. Interdisciplinary management and immediate onset of high-dose intravenous antibiotic therapy are crucial for successful treatment.Invasive Weichteilinfektionen durch Streptokokken sind schnell fortschreitende und potenziell lebensbedrohliche Infektionserkrankungen. Diese können auch das Augenlid betreffen. Aufgrund aggressiver Virulenzfaktoren und der Synthese von Exotoxinen kann es zu Komplikationen wie der periorbitalen nekrotisierenden Fasziitis (PONF) und dem Streptokokken-Toxic-Shock-Syndrom (STSS) kommen. Anhand von 4 Patienten mit invasiven Lidinfektionen wird das Krankheitsbild charakterisiert.Bei allen Patienten erfolgte eine Fotodokumentation, Bildgebung, Labor- und Abstrichdiagnostik sowie eine intravenöse antibiotische Therapie gemäß den Empfehlungen des Robert Koch-Instituts sowie des lokalen Infektiologieboards.Bei allen Patienten wurdeInvasive Streptokokkeninfektionen stellen eine Herausforderung im klinischen Alltag eines Ophthalmologen dar. Ein interdisziplinäres Management sowie ein sofortiger Beginn einer hochdosierten intravenösen antibiotischen Therapie sind für den Therapieerfolg entscheidend.

Streptococcus agalactiae (Gruppe B Streptokokken, GBS) gilt als der häufigste Erreger von Neugeboreneninfektionen in industrialisierten Ländern und wird auch bei Erwachsenen immer häufiger als Erreger invasiver Infektionen isoliert. Als Kommensale kommen Gruppe B Streptokokken im Urogenitaltrakt bei etwa jedem dritten Erwachsenen vor; um eine schwerwiegende Infektion zu verursachen, muss S. agalactiae demnach der Immunantwort des Wirts entgehen. Die so genannten Neutrophil Extracellular Traps (NETs), ein Abwehrmechanismus des Immunsystems, können durch extrazelluläre DNasen von Streptokokken abgebaut werden. Bislang wurden bei S. agalactiae drei extrazelluläre Nukleasen beschrieben, zu deren genetischer Grundlage es bislang nur wenige Arbeiten in der Literatur gibt. Mithilfe einer Insertionsmutantenbank wurde nach GBS-Mutanten gescreent, die eine verminderte DNase-Aktivität auf Methylgrünagar zeigten. Bei 22 Isolaten mit phänotypisch eingeschränkter DNase-Aktivität wurden die Insertionsstellen untersucht. Dies führte zur Identifizierung von drei mutmaßlich DNase-kodierenden Genen, die bezüglich des Molekulargewichtes zu den 18,6 kDa, 33 kDa und 26,5 kDa großen Nukleasen I, II und III von S. agalactiae passen. Um den enzymatischen DNA-Abbau durch die mutmaßlichen Nukleasen nachzuweisen, wurden die Gene in den Vektor pET21a kloniert und als rekombinante His-Tag-Proteine in Escherichia coli exprimiert. Die nativen Proteine zeigten in vitro einen zeit- und konzentrationsabhängigen Abbau von DNA, wobei das rekombinant exprimierte SAK_0814 den stärksten DNA-Abbau zeigte. In Genexpressionsanalysen wurde die Transkription von der Nuklease III durch Zugabe von DNA unterdrückt. Die rekombinanten Proteine wurden mittels SDS-Polyacrylamidgelelektrophorese und Western Blot auf ihre tatsächliche Größe untersucht. Dadurch ergeben sich folgende Zuordnungen zwischen Gen und der jeweiligen bekannten Nuklease: SAK_0271 (SAK_RS01335) – Nuklease I SAK_0220 (SAK_RS01090) – Nuklease II SAK_0814 (SAK_RS04075) – Nuklease III Mithilfe des oben gewählten Ansatzes konnte ein Zusammenhang zwischen SAK_0814 und Nuklease III-Produktion bestätigt werden, der bereits von anderen Arbeitsgruppen postuliert worden war. Zudem gelang es mit SAK_0271 und SAK_0220 zwei weitere Kandidatengene zu identifizieren, die direkt mit der DNase-Aktivität von Gruppe B Streptokokken zusammenhängen. Da Nukleasen wichtige Pathogenitätsfaktoren bei der Entstehung und Etablierung einer GBS-Infektion darstellen, liefert die Kenntnis der genetischen Basis und der pathophysiologischen Zusammenhänge einen wichtigen Beitrag, um zukünftig gezielt Maßnahmen gegen GBS-Infektionen bei Erwachsenen und Neugeborenen zu entwickeln.

Skin and soft tissue infections include the skin as well as fascia, muscles, ligaments, tendons, synovial membranes, fat, blood vessels, nerves, and fibrous tissues. They range from superficial infections to deep infections with a necrotizing clinical course. These infections can promptly progress with severe systemic complications, requiring rapid management, and proper surgical and medical treatment. This manuscript provides recommendations based on current practice guidelines for diagnosis and treatment of surgically relevant skin and soft tissue infections in adults. Furthermore, it deals with a clinical guide of immediate identification of life threatening necrotizing clinical courses, detection of pathogens and the use of appropriate surgical, antimicrobial, and adjuvant treatment options.Haut- und Weichteilinfektionen reichen von leichten oberflächlichen Entzündungen bis hin zu tiefen nekrotisierenden Entzündungen mit schweren systemischen Komplikationen. Ziel dieser Arbeit ist, diese im klinischen Alltag rasch zu diagnostizieren und drohende fatale Krankheitsverläufe zu erkennen, die ursächlichen Krankheitserreger zu identifizieren und rechtzeitig eine adäquate antimikrobielle und ggf. chirurgische Therapie einzuleiten.

Intracranial infectious aneurysms are rare but hazardous complications of an infective endocarditis. To date, there are no evidence-based recommendations for the treatment of patients with this condition. Therefore, it remains an interdisciplinary challenge to decide which treatment steps are required and in which order they should be carried out. To illustrate the interdisciplinary dilemma in the treatment of these patients, we here present a case of a 23-year-old, drug-addicted woman with infectious endocarditis. While antibiotic treatment of the streptococcus-mitis-induced endocarditis stabilized the overall status of the patient, rupture of a basilar artery aneurysm caused her sudden death. We discuss the decision-making processes of the treatment, potential difficulties and dilemmas when dealing with patients suffering from infectious endocarditis and infectious intracranial aneurysm. Based upon case reports, studies and reviews, we present the options and risks of conservative, neurosurgical, endovascular, and cardiosurgical treatment of intracranial infectious aneurysms, and propose a patient-centered, interdisciplinary treatment concept.

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is a disease attributed to children with obsessive compulsive or tic disorders associated with streptococcal infections. Because otolaryngologists evaluate a large number of pediatric patients with recurrent streptococcal infections, tonsillectomy (TE) is a common option of therapy. This study was undertaken to evaluate the efficacy of tonsillectomy in patients presenting with a verified PANDAS.A PubMed research was performed using search terms "tonsillectomy" and "PANDAS", "OCD", "compulsive", "pediatric autoimmune", "Chorea" and "Tic" limited by publication date January 1, 1995 to July 31, 2015. Reviews without patients were not included in the review.Nine papers matched our search terms, including 6 case reports with 8 patients and 3 case series. Most case reports were in favor for TE, but this was by far not supported by the findings in the case series. The follow-up ranged form 2-36 months (case reports) and 24-36 months (case series).establishing the diagnosis of PANDAS is complicated by underlying co-morbidities in the field of neurology-psychiatry and the lack of a reliable biomarker. The positive outcome after TE as reported in case studies may be influenced by the postoperative medication and is not supported by the results of large-scale studies. In the light of the considerable postoperative morbidity and unavoidable mortality rate it appears wise to indicate TE only in clinical studies with standardized inclusion criteria.

Postinfectious glomerulonephritis is an immune-mediated disease occurring as a result of the host response to an extrarenal infection. The classical form of poststreptococcal disease is decreasing worldwide but remains a significant health care problem in developing countries, especially in children. In industrialised countries postinfectious glomerulonephritis is now primarily due to non-streptococcal disease. In elderly patients with risk factors such as diabetes mellitus, alcohol-dependency or neoplasia and in intravenous drug users postinfectious glomerulonephritis is most often associated with staphylococcal infections of various locations. Compared to the good outcome of classical poststreptococcal glomerulonephritis the severity of the nephritic syndrom is increased and the prognosis is worse, especially if pre-existing renal disease such as diabetic or vascular nephropathy is present. The recognition and adequate therapy, often including surgical measures, of the primary focus of infection is of utmost importance to improve the outcome of this condition. Especially in patients with diabetic foot syndrome and in intravenous drug users with signs of infection and renal insufficiency or abnormal urinalysis, there should be a high index of suspicion for postinfectious glomerulonephritis.Das klassische Bild der akuten poststreptokokken Glomerulonephritis nach einer Pharyngitis oder einer Impetigo wird heutzutage seltener beobachtet als früher. Diese Krankheit bleibt eine häufige Ursache vom akuten nephritischen Syndrom bei Kindern in Entwicklungsländern. In industrialisierten Ländern werden postinfektiöse Glomerulonephritiden zunehmend bei älteren Erwachsenen mit Risikofaktoren wie Diabetes mellitus, chronischem Alkoholismus, maligner Neoplasie oder intravenösem Drogenkonsum diagnostiziert. Der Infekt ist zum Zeitpunkt der Diagnose in der Regel noch aktiv, betrifft häufiger die Haut oder innere Organe als die oberen Luftwege. Der Erreger ist am häufigsten Staphylokokkus aureus. Die Prognose der postinfektiösen Glomerulonephritis bei älteren Patienten ist deutlich schlechter als bei Kindern und jungen Erwachsenen. Trotz adäquater Behandlung des Infektes wird bei bis zu einem Drittel der geriatrischen Patienten eine terminale Niereninsuffizienz beobachtet. Besonders bei Diabetikern mit nicht heilenden Wunden und Patienten mit intravenösem Drogenkonsum muss im Fall eines Kreatininanstiegs oder eines aktiven Urinsediments an die Möglichkeit einer postinfektiösen Glomerulonephritis gedacht werden.

Surgical site infections after thyroid surgery are mostly superficial and can be well treated. Streptococcal mediastinitis in contrast is a rare but life-threatening complication.A 57-year-old female patient experienced septic fever, increase of inflammation parameters and erythema 2 days after thyroid surgery for Graves' disease. This process was triggered by a three-compartment infection by group A Streptococcus (GAS) with involvement of the mediastinum. Therapy over 6 weeks including seven wound revisions with the patient under general anesthesia, pathogen-adapted antibiotic treatment and cervical negative pressure treatment managed to control the infection. A total of 21 cases have been published on this phenomenon, 11 of which had a fatal outcome.High fever and surgical site erythema in the early postoperative period after thyroid surgery can be signs of a GAS infection, which might lead to necrotizing, descending, life-threatening mediastinitis. Early diagnosis with support of computed tomography (CT) scans, immediate therapy including wound opening, lavage, intravenous antibiotic treatment with penicillin and clindamycin are vital. If treatment resistance occurs, cervical negative pressure treatment should be considered.

We present the case of a 63 year old man who died of severe septic shock in the setting of agranulocytosis induced by dipyrone (metamizole). The patient had previously developed agranulocytosis after dipyrone exposure 18 months prior to this. The case illustrates the seriousness of dipyrone-induced agranulocytosis, highlights the risks associated with re-exposure and underlines the need for excellent communication between treating physicians and their patients. The possible underlying mechanisms, epidemiology and management of dipyrone-induced agranulocytosis are discussed.Wir stellen den Fall eines 63-jährigen Mannes vor, der einen schweren septischen Schock mit letalem Ausgang auf Basis einer Agranulozytose entwickelte. Aufgrund des zeitlichen Zusammenhangs, der Verbesserung nach Dechallenge in der Vorgeschichte und aktuellem Rechallenge ist der Kausalzusammenhang für eine erneute Metamizol-induzierte Agranulozytose sicher. Wir diskutieren die Wichtigkeit, Patienten mit einer verdächtigten Metamizol-induzierten Agranulozytose nicht erneut zu exponieren und Patienten sowie behandelnde Ärzte lückenlos zu informieren.

In an Austrian piglet producing farm with 1500 sows a high incidence of meningitis, arthritis and sudden death was recorded in five to eight week old piglets. Overall losses were 1.8%. Streptococcus (S.) suis serotype 7 was detected with an intermediate to high specific bacterial load in all samples taken from brains and joints of 17 untreated piglets with typical clinical signs. All isolates showed an identical spectrum of virulence-associated genes (mrp+, epf-, ofs-, sly-) and expressed a relatively small variant of MRP (Muramidase-Released Protein) called MRPs. A bacterin was produced using four of the S. suis serotype 7 isolates. An untreated and non-vaccinated control group A with 957 piglets, a non-vaccinated but amoxicillin-treated group B with 1012 piglets and an untreated group C with 998 piglets, which was vaccinated twice in the first and third week of life, were compared. Later, an additional group D with 290 piglets was vaccinated twice in the fourth and sixth week of life. Amoxicillin treatment in group B resulted in the lowest mortality and morbidity rate. Furthermore, the incidence of lameness and losses were significantly lower in vaccinated pigs compared to the control group. In an ex vivo blood survival assay, a strong bactericidal effect of the post immune sera of group D animals was found. This is likely due to the presence of specific opsonizing antibodies against S. suis elicited through vaccination and associated with the protective efficacy of the vaccine.

We report the case of an 81-year-old woman who fell at home on her left hand and suffered a laceration of her forehead. Within days a fulminant necrotizing fasciitis of the hand from group A β-haemolytic streptococcus developed. Lacking an apparent local germ entry point at the hand, the infection was initially misinterpreted as compartment syndrome. The patient's life was saved by amputation of the hand.

The V. A. C. INSTILL® therapy is an innovative process for treating chronic wounds that are not optimally accessible to a systemic antibiotic therapy or infected with multi-resistant pathogens. We report on our first experience and applications of V. A. C. INSTILL® therapy in the field of septic thoracic surgery.V. A. C. INSTILL therapy was used in 11 cases between 11/2009 and 01/2012. Three patients had sternum osteomyelitis (2 MRSA, 1 Finegoldia magna). In 3 patients chronic pleural empyema after lobectomy (1 Streptococcus viridans, 1 mixed infection with MRSA among others) and after pneumectomy (1 MRSA) were detected. In 2 cases there was an acute pleural empyema with extensive phlegmona in the region of the thoracic soft tissues (2 streptococci). In 1 patient a chronic pleural empyema with MRSA infection was treated. Septic arthritis of the sternoclavicular joint with joint destruction and extensive phlegmona in the region of the cervical soft tissues (1 Streptococcus pneumoniae, 1 Staphylococcus aureus) was treated in 2 patients. In all cases instillation of the wound was performed with Lavasept 0.2 %. Swabs of the wound were taken before starting and after ending V. A. C. INSTILL® therapy as well as before wound closure.Mean patient age was 48.8 ± 18.9 years. V. A. C. INSTILL® therapy was performed for 6.5 ± 1.7 days. Instillation time amounted to 21.7 ± 5.7 s. The duration of action was standardised at 18 min in all cases. In 2 cases (1 MESA, 1 finegoldia) the V. A. C. INSTILL® therapy was repeated. In 10 patients a sterile wound status was achieved before secondary wound closure. All wounds underwent secondary closure without recurrence.Chronic osteomyelitis with MRSA infections as well as chronically infected residual cavities after empyema surgery and extensive phlegmona are possible indications for V. A. C. INSTILL® therapy in order to help eradicating the infection as quickly and as completely as possible.

As immunization coverage of varicella vaccination is low, the disease is still very frequent in Austria. Albeit the prognosis in general is good, the incidence of varicella-related hospitalization is about 6 per 100,000 in all children between 0-15 years of age, affecting mainly previously healthy children. Especially young children under the age of 5 are at risk with highest rates among children younger than one year. The most common complications are secondary bacterial infections, neurological and respiratory complications. Two cases of life threatening secondary bacterial infection are presented. One child suffered from a Toxic Shock Syndrome caused by group A streptococcus along with large necrotizing skin lesions. The second child nearly lost her left eye due to a deep orbital abscess. Both children survived without severe sequelae but had to undergo several procedures of plastic surgery. Implementation of the varicella vaccination program in the USA has shown a near elimination of deaths due to severe varicella complications. The initiation of the varicella vaccination program for children until the age of 2 in Austria should be considered to prevent complications and deaths caused by varicella.

No articles on orthopedic complications of pneumonia due to influenza A H1N1 virus have yet been published. A 44-year-old male patient was hospitalized due to the suspicion of an infected knee. During arthroscopy beta-hemolytic Streptococcus group A and Acinetobacter were found and the histopathological diagnosis of an infectious bacterial synovialitis was made. Despite resistance-oriented antibiotic treatment the patient's general condition worsened. Influenza A H1N1 virus was detected in a nasal sample and was successfully treated with Tamiflu®. If fever and elevated infection markers persist a search for the focus has to be performed including unlikely diseases such as influenza A H1N1 virus.

This study is reporting an outbreak of subclinical mastitis due to beta-hemolytic group L streptococci in an Austrian dairy herd with a history of high somatic cell count. At the first survey 16 of 33 lactating cows (28 quarters of 132) were cultured positive for beta-hemolytic, CAMP and esculin negative cocci that grew on Columbia blood agar with small grey catalase negative colonies. With the commercial API 20 Strep system (bioMerieux, F) isolates were classified as members of streptococci group L. All tested strains (eight of 28) produced acid from ribose, lactose, trehalose, amidon and glycogen; they hydrolysed hippurate and showed beta-glucuronidase, beta-galactosidase, alkaline phosphatase, leucinaminopeptidase and arginindehydrolase activity. Isolates were sensitive to bacitracin but resistant to tetracycline. Using phenotypic characterisation as well as sequence analysis of the 16S-23S intergenic spacer region of a representative strain, recovered isolates were identified as Streptococcus (S.) dysgalactiae ssp. equisimilis. Mastitis was characterized by normal milk secretions and absence of clinical abnormalities but high elevations of somatic cell count. Based on the characteristics of the strains and on the observations during the first herd survey, contagious transmission during milking as a result of poor milking hygiene was assumed. The mastitis was controlled through implementation of a strict hygiene protocol including use of single-use udder towels, post milking teat desinfection and cluster disinfection between milking cows in combination with antibiotic treatment of infected udders.

The weak point of the countrywide perinatal/neonatal quality surveillance is the ignorance of interhospital differences in the case mix of patients. As a result, this approach does not produce reliable benchmarking. The objective of this study was to adjust the result of the late-onset infection incidence of different hospitals according to their risk profile of patients by multivariate analysis.The perinatal/neonatal database of 41,055 newborns of the Saxonian quality surveillance from 1998 to 2004 was analysed. Based on 18 possible risk factors, a logistic regression model was used to develop a specific risk predictor for the quality indicator "late-onset infection".The developed risk predictor for the incidence of late-onset infection could be described by 4 of the 18 analysed risk factors, namely gestational age, admission from home, hypoxic ischemic encephalopathy and B-streptococcal infection. The AUC(ROC) value of this quality indicator was 83.3%, which demonstrates its reliability. The hospital ranking based on the adjusted risk assessment was very different from hospital rankings before this adjustment. The average correction of ranking position was 4.96 for 35 clinics.The application of the risk adjustment method proposed here allows for a more objective comparison of the incidence of the quality indicator "late onset infection" among different hospitals.

Septic arthritis and osteitis at the hand are associated with a high morbidity. Trauma is the major cause for these infections. In the majority of cases the fingers are involved. Causative microorganisms are predominantly Staphylococcus aureus and Streptococcus pyogenes. In addition, an increasing number of Gram-negative bacteria have been found in hand infections. As differential diagnosis, tumours and non-septic arthritis must be considered. Treatment includes surgical debridement, immobilisation and functional rehabilitation. Crucial for the surgical strategy are the virulence of the pathogens, the resistance of the patient and the location of the infection. If functional recovery cannot be expected, salvage procedures like arthrodeses and resection arthroplasties are sometimes required. Surgical treatment is sufficient in septic arthritis and osteomyelitis of the hand. However, to avoid permanent disability, rapid diagnosis and therapy are essential. This review describes our treatment concepts in septic arthritis and osteomyelitis at the hand.

A 54-year-old patient presented with acute abdominal pain that had started after having a bowel movement.Ultrasound examination revealed free intraabdominal fluid with no signs of organ rupture. CT-scan showed a peripherally located ruptured aneurysm of a branch of the superior mesenteric artery.Intraoperatively the aneurysm was then ligated. A vascular reconstruction or bowel resection was not necessary. After an uneventful postoperative course, the patient could be discharged from the hospital on postoperative day four. Two weeks later the patient was readmitted, with fever and dyspnea. Transesophageal echocardiogram suggested the presence of bacterial growth on the aortic and mitral valves. Blood cultures and valvular vegetations grew Streptococcus viridans. The diagnosed infective endocarditis was caused by a tooth-infection, that had been recurrent for one year. After treatment of the tooth infection, the mitral and aortic valves were replaced without any complications.Because of the high mortality associated with rupture, it is important that visceral aneurysms are taken into consideration in the differential diagnosis of unexplained abdominal pain. It should also be kept in mind that the aneurysm could be due to an infective endocarditis. Therefore, echography should be carried out in each case, to avoid further complications and to give optimal treatment.

Perianal streptococcal dermatitis is generally considered a childhood disorder caused by β-hemolytic group A streptococci. It should also be considered in cases of therapy-refractory gluteal erythema in adults. We report two cases of perianal streptococcal dermatitis in adults. In both, the microbiological examination of the skin swabs showed β-hemolytic group G streptococci. Therapy of choice is penicillin.

We report the case of a 24-years old diabetic women hospitalised because of right-sided lower abdominal pain and diarrhea. She fulminantly developed shock before appendectomy could be performed and was transferred to intensive care unit. Hypotension remained and laparoscopy revealed primary peritonitis and toxic shock syndrome by Group A Streptococcus which was cultivated in blood and ascites. Therapy with penicilline and clindamycine resolved symptoms. During hospitalisation Clostridium difficile colitis occurred. This complication leaded to prolonged hospitalisation.