[Non-viral sexually transmitted infections - Epidemiology, clinical manifestations, diagnostics and therapy : Part 1: Gonococci]. / Nichtvirale sexuell übertragene Infektionen ­ Epidemiologie, Klinik, Labordiagnostik und Therapie : Teil 1: Gonokokken.

Approximately 1 million people are infected per day worldwide by one or more sexually transmitted infections (STI) as estimated by the World Health Organization (WHO). Gonorrhoea represents an almost exclusively sexually transmitted infection, which predominantly affects mucous membranes of the genitourinary tract. Extragenital localization of infections is also possible, e. g. in the anorectal region. Currently, only syphilis and human immunodeficiency virus (HIV) are notifiable diseases according to the Infection Protection Act in Germany. In Saxony, an extended registration ordinance according to the German Infection Protection Act is in force, which means that besides syphilis the laboratory detection of Neisseria gonorrhoeae, Chlamydia trachomatis and genital mycoplasms are also notifiable infections. In particular, beginning in 2009 in Saxony a spectacular increase of registered infections due to N. gonorrhoeae was observed and in 2015 altogether 824 infections due to N. gonorrhoeae were reported. Alarming is the increase in resistance of N. gonorrhoeae against penicillin, doxycycline, ciprofloxacin and recently also against azithromycin and third generation cephalosporins. The so-called superbug of N. gonorrhoeae, which originated in Japan with multidrug resistance against most of the currently available oral antibiotics, has now arrived in Europe. Intramuscular or intravenous injection of ceftriaxone plus oral azithromycin, each given as single dose is the standard therapy for gonorrhoea.

[Non-viral sexually transmitted infections - Epidemiology, clinical manifestations, diagnostics and therapy : Part 2: Chlamydia and mycoplasma]. / Nichtvirale sexuell übertragene Infektionen ­ Epidemiologie, Klinik, Labordiagnostik und Therapie : Teil 2: Chlamydien und Mykoplasmen.

Chlamydia trachomatis is the most common pathogen of sexually transmitted bacterial infections worldwide. Every year in Germany approximately 300,000 new infections are to be expected. Chlamydia infections occur nearly exclusively in the postpubertal period. The peak age group is 15-25 years. The infection usually runs an asymptomatic course and the diagnosis is made by nucleic acid amplification techniques (NAAT) often after chlamydial screening or if complications occur. For treatment of chlamydial infections oral doxycycline 100 mg twice daily over 7 days is initially used or alternatively oral azithromycin 1.5 g as a single dose is recommended. The sexual partner should also be investigated and treated. Genital Mycoplasma infections are caused by Ureaplasma urealyticum (pathogen of urethritis and vaginitis), Ureaplasma parvum (mostly saprophytic and rarely a cause of urethritis) and Mycoplasma hominis (facultative pathogenic). Mycoplasma genitalium represents a relatively new sexually transmitted Mycoplasma species. Doxycycline is effective in Ureaplasma infections or alternatively clarithromycin and azithromycin. Doxycycline can be ineffective in Mycoplasma hominis infections and an alternative is clindamycin. Non-gonococcal and non-chlamydial urethritis due to Mycoplasma genitalium can now be diagnosed by molecular biological techniques using PCR and should be treated by azithromycin.

[Nonviral sexually transmitted infections-epidemiology, clinical manifestations, diagnostic workup, therapy : Part 3: Treponemes, Gardnerella and trichomonads]. / Nichtvirale sexuell übertragene Infektionen ­ Epidemiologie, Klinik, Labordiagnostik und Therapie : Teil 3: Treponemen, Gardnerella und Trichomonaden.

In Germany, the reported syphilis prevalence has increased continuously since 2010, with a total of 6834 syphilis cases being reported in 2015. The largest increase of reported syphilis occurred in men who have sex with men (MSM). The antibiotic agent of choice for treatment of syphilis is still penicillin. There are no penicillin-resistant Treponema pallidum strains. Alternatives are ceftriaxone and doxycycline. In Germany, azithromycin is not approved for treatment of syphilis; however, therapy failures are increasingly reported. Bacterial vaginosis is accompanied by vaginal discharge. The vaginal secretion exhibits an increased pH value higher than 4.5. Clinical symptoms are pruritus, burning, and the characteristic amine odor. The probability for bacterial vaginosis is highest in women with higher numbers of sexual partners, unmarried women, early first sexual intercourse, in commercial female sex workers, and those women who regularly apply vaginal douches. The main pathogen of bacterial vaginosis is Gardnerella vaginalis. For oral therapy metronidazole is given, alternatively clindamycin; the latter should be applied additionally as topical agent. Trichomoniasis is considered as the nonviral sexually transmitted infection with the highest prevalence worldwide. Other than direct microscopic detection of the protozoa (trophozoites) in vaginal secretion or urine, PCR has been approved as the diagnostic method with the highest sensitivity. Oral metronidazole represents the therapy of choice in trichomoniasis.

[Sports-associated dermatophytoses : An overview]. / Sportassoziierte Dermatophytosen : Ein Überblick.

Because of high exposure (e. g. swimmers and athletes competing on mats) and disposition (e. g. microtraumata of the skin in runners) athletes are prone to a higher risk for mycotic infections by dermatophytes. In disciplines with close contact during competition-especially wrestlers and judoists-infections by the anthropophilic Trichophyton (T.) tonsurans are most important (tinea gladiatorum). These infections are highly contagious and often cause small epidemics especially if the primary source of infection is not promptly recognized. The environment of the athletes (e. g. mats) and asymptomatic carriers may be sources of further spread. Tinea pedis with its clinical manifestations seems to be often underdiagnosed and insufficiently treated. Environmental contamination by fungal spores may be responsible for the significantly higher level of mycotic infections of the feet in children and adolescents active in sports. There is a higher risk for spread of the infection to the toe nails (onychomycosis) and for consecutive infections by bacteria (e. g. erysipelas). More rarely infections by zoophilic or geophilic dermatophytes are seen in athletes (e.g. equestrians). Education and more intensive measures of prevention and environmental decontamination are essential for all dermatophytoses associated with sports.

[Infections of finger and toe nails due to fungi and bacteria]. / Infektionen an Finger- und Zehennägeln durch Pilze und Bakterien.

Infections of the finger and the toe nails are most frequently caused by fungi, primarily dermatophytes. Causative agents of tinea unguium are mostly anthropophilic dermatophytes. Both in Germany, and worldwide, Trichophyton rubrum represents the main important causative agent of onychomycoses. Yeasts are isolated from fungal nail infections, both paronychia and onychomycosis far more often than generally expected. This can represent either saprophytic colonization as well as acute or chronic infection of the nail organ. The main yeasts causing nail infections are Candida parapsilosis, and Candida guilliermondii; Candida albicans is only in third place. Onychomycosis due to molds, or so called non-dermatophyte molds (NDM), are being increasingly detected. Molds as cause of an onychomycosis are considered as emerging pathogens. Fusarium species are the most common cause of NDM onychomycosis; however, rare molds like Onychocola canadensis may be found. Bacterial infections of the nails are caused by gram negative bacteria, usually Pseudomonas aeruginosa (recognizable because of green or black coloration of the nails) but also Klebsiella spp. and gram positive bacteria like Staphylococcus aureus. Treatment of onychomycosis includes application of topical antifungal agents (amorolfine, ciclopirox). If more than 50 % of the nail plate is affected or if more than three out of ten nails are affected by the fungal infection, oral treatment using terbinafine (in case of dermatophyte infection), fluconazole (for yeast infections), or alternatively itraconazole are recommended. Bacterial infections are treated topically with antiseptic agents (octenidine), and in some cases with topical antibiotics (nadifloxacin, gentamicin). Pseudomonas infections of the nail organ are treated by ciprofloxacin; other bacteria are treated according to the results of culture and sensitivity testing.

[Dermatomycoses due to pets and farm animals : neglected infections?]. / Dermatomykosen durch Haus- und Nutztiere : Vernachlässigte Infektionen?

Dermatomycoses due to contact with pets and livestock frequently affect children and young adults. Zoophilic dermatophytes are the main important causative agents. It has long been known that the often high inflammatory dermatophytoses of the skin and the scalp are caused mostly by Microsporum canis. Due to an absence of an obligation for reporting fungal infections of the skin to the Public Health Office in Germany, an unnoticed but significant change in responsible pathogens has occurred. Today an increasing number of infections due to zoophilic strains of Trichophyton interdigitale (formerly Trichophyton mentagrophytes) and Trichophyton species of Arthroderma benhamiae are found. The latter mentioned dermatophyte is the anamorph species of the teleomorph Arthroderma benhamiae, which originally was isolated in the Far East (Japan). Source of infection of these dermatophytes are small rodents, in particular guinea pigs. These animals are bought in pet shops by the parents of those children who later are affected by the fungal infection. The coincidental purchase of the relevant fungal pathogen is not obvious to the parents. As a consequence, highly contagious dermatophytoses occur, often tinea capitis sometimes with kerion formation. Further dermatophytes should be considered as cause of a zoophilic dermatomycosis. Both Trichophyton verrucosum, the cause of the ringworm in cattle, and Trichophyton erinacei following contact to hedgehogs are worthy of note. Yeasts cannot be ignored as cause of dermatomycosis, especially Malassezia pachydermatis, the only non-lipophilic species within the genus Malassezia, which can be transferred from dog to men. Cryptococcus neoformans also comes from animal sources. The mucous yeast occurs in bird's dropping, and it causes both pulmonary and central nervous system infections, but also primary and secondary cutaneous cryptococcosis in immunocompromised patients (HIV/AIDS) as possible consequence after contact to these animals.

[Infections due to Mycobacterium marinum: a review]. / Kutane Infektionen durch Mycobacterium marinum : Eine Übersicht.

Mycobacterium marinum belongs to the non-tuberculous or "atypical" mycobacteria. The reservoirs for these ubiquitous and slowly growing bacteria are both fresh water and salt water. In particular, aquaria should be considered as important source of hobby-related infections especially of fingers, hands and forearms. Affected are both immunosuppressed patients and persons with an intact immune system. Distinctive are erythematous plaques and nodules with tendency for hyperkeratosis, crusting, and superficial ulcerations, sometimes as sporotrichoid lymphocutaneous infection. The histology shows non-caseation granulomas containing epithelioid cells and Langhans giant cells. Using the Ziehl Neelsen staining, typical acid-fast rods are not always detectable. The molecular biological detection of mycobacterial DNA using polymerase chain reaction represents the standard method of diagnosis. Cryotherapy is frequently used as first treatment. For the often long-term tuberculostatic therapy, rifampicin, ethambutol, and clarithromycin are the most used agents.

[Necrotizing fasciitis caused by Acinetobacter baumannii : A case report]. / Nekrotisierende Fasziitis durch Acinetobacter baumannii : Ein Fallbericht.

A 42-year-old man developed necrotizing fasciitis on the right leg. A multidrug-resistant Acinetobacter baumannii was cultivated from the deep wound. Following therapy with imipenem and tobramycin as well as extensive debridement, the lesions improved slowly. A. baumannii is today an important cause of nosocomial infections, especially in intensive care units.

[Ectoparasites. Part 2: Bed bugs, Demodex, sand fleas and cutaneous larva migrans]. / Ektoparasitosen. Teil 2: Bettwanzen, Haarbalgmilben, Sandfloh und Larva migrans cutanea.

Ectoparasites or epidermal parasites include a very heterogenous group of infections of the outer layers of the skin. Worldwide the most common are scabies, lice, tungiasis, and hookworm-induced cutaneous larva migrans. In recent years, bed bug infestations in hotels or vacation homes seem to have become more frequent. Demodex folliculorum and Demodex brevis are found in the facial and scalp hair follicles in 95% of individuals. Classic Demodex folliculitis is often overlooked in differential diagnostic considerations. This inflammatory sebaceous gland disease as well as Demodex blepharitis both provide a diagnostic and therapeutic challenge. Permethrin can be used topically against demodicosis. Vacationers who go barefoot on beaches in tropical Africa, South America and subtropical Asia risk infestations from female sand fleas. The lesions can be curetted or removed with a punch biopsy, then treated with antiseptics or even systemic antibiotics if a secondary infection develops. Cutaneous larva migrans is one of the most common imported ectoparasite infections from the tropics. Topical treatment measures include thiabendazole or cryotherapy. If the infestation is severe, systemic antihelminthics or ivermectin can be employed.

[Ectoparasites. Part 1: lice and fleas]. / Ektoparasitosen. Teil 1: Läuse und Flöhe.

Ectoparasites and epidermal parasitic skin diseases are a heterogeneous group of infections of the external layer of the skin. The most common forms world-wide are scabies, lice (Pediculosis capitis, corporis, vestimentorum and pubis), tungiasis and the hookworm-associated Larva migrans cutanea. The head louse is the most widespread parasite in children in Germany. The symptoms, apart from pruritus, eczematous skin eruptions and ictus reactions of the skin, are often unspecific and many differential diagnoses must be considered. Treatment of ectoparasites includes manual procedures, such as repeated cleansing and combing out of lice-infected hair and also local antiparasitic treatment with permethrin, pyrethrum extract, allethrin and dimeticon. Lindan which has been used for decades can no longer be used in medications after 2008 after a decision of the EU Commission. Failure of treatment of head lice can be a result of errors in the treatment which favor survival of the eggs, larvae or adults. This can be a result of too short reaction times and too economical use or unequal distribution of medications, excessive dilution due to wet hair or omitting repeated treatment stages. Additionally resistance of head lice to pyrethrum is a known phenomenon and has been reported in several countries.

Effects of two antibiotics on hepatic function in low birth weight infants: ampicillin vs. cefotaxime.

In 21 low birth weight infants with two regimens of antibiotic therapy during the first 3 days of life possible hepatotoxic side effects were studied 8 days after the last administration of the tested drugs. Fourteen of the infants were treated with ampicillin/gentamicin and 7 received cefotaxime/gentamicin. The serum concentrations of total bile acids, the activities of transaminases in serum and the cumulative 15N excretion in urine after administration of 3 mg of 15N-labeled methacetin/kg of body weight were used as markers of hepatotoxic side effects. Neither the concentrations of total bile acids (22.6 +/- 12.1 and 19.4 +/- 10.8 mM, respectively) nor the activities of transaminases (alanine aminotransferase, 0.27 +/- 0.06 vs. 0.30 +/- 0.09 mumol/second/liter; aspartate aminotransferase, 0.46 +/- 0.11 vs. 0.49 +/- 0.10 mumol/second/liter) were different between the two groups. In contrast the cumulative 15N excretion in urine was significantly lower in the group treated with cefotaxime/gentamicin than in the group treated with ampicillin/gentamicin (17.2 +/- 6.4 vs. 33.0 +/- 5.1% of intake; P less than 0.01) and also lower than the reported age-related reference values. On the 28th day of life no differences could be found between the cumulative 15N excretion in the urine of the infants treated with cefotaxime/gentamicin and the reported age-related reference values of this test. The results indicate a limited capacity of the monooxygenase system of the liver of low birth weight infants during the first weeks of life and a specific reversible influence of cefotaxime on this hepatocellular system. Further investigations are required to evaluate the clinical relevance of this drug-specific inhibition of the hepatic monooxygenase pathway.

Persistent vegetative state: evaluation of brain metabolism and brain perfusion with PET and SPECT.

Patients in persistent vegetative state (PVS) after severe head trauma were investigated with 99mTc-ECD SPECT and 18F-FDG PET to further characterize the degree of brain damage and to obtain insight into changes of brain perfusion and glucose metabolism. 18F-FDG PET and 99mTc-ECD SPECT were performed in 16 patients in PVS. Quantitative PET data were compared with that obtained from seven normal controls. After spatial normalization into Talairach space, global grey matter values and regional data using predefined ROI sets were derived. For comparison of PET and SPECT, regional data were normalized to their individual mean grey matter values. Patients in PVS showed significantly lower values of cerebral glucose metabolism than did the controls. The mean reduction of grey matter values in cortical and subcortical structures was 58%, except in the vermis cerebelli, where only a reduction of 16% was found compared to the controls. Comparing the glucose metabolism and perfusion within the patient group, the pattern of both modalities was similar in the neocortex and internal ganglia. In the cerebellar hemispheres a relatively higher perfusion than glucose metabolism was found. The overall reduction of 58% of glucose metabolism in grey matter structures is in accordance with other PET studies investigating PVS patients with different disease histories. The relative preserved activity of vermis cerebelli seems to be an uncommon finding not described by other authors up to now.

Soft tissue infection caused by Kingella kingae in a child.

During the last years an increasing number of reports concerning Kingella kingae infections in children has been published. Most cases were osteoarticular infections. The authors report the clinical and laboratory findings from a 3-year-old child with a presternal soft tissue infection due to K kingae. After surgical excochleation and antibiotic treatment there was an uneventful recovery. J Pediatr Surg 36:946-947.

Septic cavernous sinus thrombosis following infection of ethmoidal and maxillary sinuses: a case report.

A 10-year-old boy with a unilateral septic cavernous sinus thrombosis complicating infection of the ethmoidal and maxillary sinuses is described. The causative agents identified were Eikenella corrodens and Staphylococcus aureus. The disease was cured without any sequelae.

[Haematuria, lymphadenopathy and splenomegaly: case report in a 22-year-old man and review of the literature]. / Hämaturie, Lymphknotenschwellung und Splenomegalie : Kasuistik eines 22-jährigen Mannes und Literaturübersicht.

A 22-year-old patient attended the urological office with unclear bladder symptoms, haemorrhoids and haematuria. Splenomegaly was detected by ultrasound together with the suspicion of a bladder cyst. Computed tomography revealed mesenteric, retroperitoneal and inguinal lymph node swelling. The laboratory diagnostics produced the diagnosis of syphilis. The patient was successfully treated with ceftriaxone and benzylpenicillin benzathine.