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C. difficile is transmitted in a faecal-oral mode and is widespread in hospital environment. Symptoms of Clostridial infection range from asymptomatic carriage to life-threatening toxic colitis. The treatment of a Clostridial infection is dependent on the seriousness of the symptoms. The diagnosis of the pathogen as well as the introduction of an efficient antibiotic therapy is crucial. Oral metronidazole is the gold standard in treatment of mild infection. Vancomycin should be introduced only in refractory cases or in particular situations. While there is a desire to avoid colectomy, inappropriate delay in a very ill patient can be fatal. Judgement on when to intervene is difficult and requires analysis of the factors which predict outcome with and without surgery. A total abdominal colectomy sparing the rectum with end ileostomy is the procedure of choice.

Rapid-growing mycobacteria (e.g. M. abscessus and M. chelonae) are emerging pathogens with various clinical manifestations. Among immunocompetent individuals, rapid-growing mycobacteria may be responsible of pulmonary, cutaneous, osteoarticular and postoperative infections, as well as lymphadenitis and catheter-associated infections. Among immunocompromised patients, disseminated infections are also observed. Diagnosis relies on specific microbiological investigations to confirm etiology and guide antibiotic treatment. The treatment requires a multi-disciplinary approach that includes specific long-term antibiotic treatment, surgical debridement and reduction of immunosuppression whenever possible.

The recommendations for the treatment of gonorrhea have been changed: ceftriaxone 500 mg IM plus azithromycin 1 g PO is recommended. Prophylaxis of recurrent cellulitis with penicillin 250 mg 2 x/d PO may be considered. E. coli ESBL does not require contact isolation anymore. Fecal transplantation seems so far to be the most effective treatment of recurrent C. dificile. Two new respiratory viruses, Middle East Coronavirus (MERS-CoV) and avian-origin Influenza A (H7N9) have been reported. Oral valganciclovir treatment reduces the risk of hearing loss in congenital CMV infection. An outbreak of mould infections of the central nervous system has been described in the United States following injection of contaminated steroids.

Spirochetal infections present with a variety of clinical syndromes and epidemiologic features. Diagnosis remains challenging for the clinician because of the often protean clinical presentation and poor performance of stan-dard microbiological tests. We present 3 clinical cases, illustrating interesting or unusual features of these infections. First, we present a case of leptospirosis acquired in Switzerland after a rat bite. We then present a case of early disseminated Lyme disease with multiple erythema migrans, lymphopenia, thrombocytopenia and liver enzyme elevation. Finally, we present a case of secondary syphilis in an HIV-positive man, complicated by sensorineural deafness. For each case we highlight and discuss the specific epidemiological, clinical and therapeutic features.