A woman in her fifties with a post-operative infection, generalised rash and organ failure. / En kvinne i 50-årene med postoperativ infeksjon, generalisert utslett og organsvikt.

Background: Toxic shock syndrome (TSS) is a rare but potentially life-threatening disease caused by superantigen-producing Gram-positive bacteria such as Staphylococcus aureus and Streptococcus pyogenes. Staphylococcal TSS received special attention from 1978 to 1981, when an epidemic was observed associated with the use of hyper-absorbent tampons. Today the disease is rare and generally not related to menstruation, but can occur postpartum or in post-surgical wounds, intrauterine devices (IUDs), burns or other soft tissue injuries, mastitis or other focal infections. The annual incidence of staphylococcal TSS is around 0.5/100 000 and around 0.4/100 000 for streptococcal TSS. The mortality in menstrual-related cases is < 5 % and up to 22 % in non-menstrual related cases. Case presentation: This article presents a case of a middle-aged woman who developed symptoms of toxic shock syndrome five days after elective breast cancer surgery, with high fever, multiorgan failure and a characteristic desquamation of the palms. Interpretation: Toxic shock syndrome is a potentially lethal, toxin-mediated disease. Symptoms develop quickly, within hours. Early recognition and appropriate surgical management, intensive care and antibiotics are therefore important to reduce mortality and sequelae.

Infective endocarditis in right ventricular outflow tract conduits: a register-based comparison of homografts, Contegra grafts and Melody transcatheter valves.

OBJECTIVES: The aim was to investigate the incidence of infective endocarditis (IE) in right ventricle-to-pulmonary artery conduits implanted at a Danish tertiary centre. METHODS: Cases of IE in patients with homografts, Contegra grafts and Melody transcatheter valves were evaluated retrospectively with regard to the likeliness of the diagnosis using the modified Duke criteria and the likeliness of conduit involvement. Incidence rates for IE were calculated 1 and 5 years after valve implantation for all 3 conduits, and separately for Melody subgroups depending on which conduit served as landing zone. Cox regression with time-dependent covariates was used to model the impact of the conduit type on the incidence of IE. RESULTS: Annualized incidence rates of IE in homografts, Contegra grafts and Melody valves were 0.40% (0.40 cases per 100 patient-years), 0.97% and 6.96% 1 year and 0.27%, 1.12% and 2.89% 5 years after valve implantation. Hazard ratios (HRs) were 3.20 [95% confidence interval (CI) 0.91-11.17, P = 0.069] for Contegra grafts and 11.89 (95% CI 2.91-48.48, P < 0.001) for Melody valves compared to homografts. CONCLUSIONS: Bovine pulmonary conduits were more prone to endocarditis, with Melody valves being the most frequently infected. HRs for the risk of suffering from endocarditis were substantially higher for Melody valves and Contegra grafts compared to homografts, although this finding was only statistically significant for Melody valves and not for Contegra grafts.