[Emergencies in infectious diseases]. / Infektiologische Notfälle.

This article aims to provide an overview of common and high-impact medical emergencies that require prompt and effective infectious diseases management. In the described clinical scenarios of malaria, sepsis, necrotizing fasciitis, and meningitis the authors have emphasized the crucial importance of rapid and accurate diagnosis, as well as appropriate treatment from the perspective of infectious diseases. All of these emergencies demand a high degree of clinical suspicion for accurate diagnosis. Some of them also necessitate the involvement of other medical disciplines, such as neurology in the case of meningitis or surgery for necrotizing fasciitis. Additionally, implementing the right empiric antibiotic regimen or, in the case of malaria, antiparasitic treatment is crucial for improving patient outcomes. As patients with these diagnoses may present at any outpatient department, and efficient and quick management is essential, a deep understanding of diagnostic algorithms and potential pitfalls is of the utmost importance.

[Emergencies in infectious diseases]. / Infektiologische Notfälle.

This article aims to provide an overview of common and high-impact medical emergencies that require prompt and effective infectious diseases management. In the described clinical scenarios of malaria, sepsis, necrotizing fasciitis, and meningitis the authors have emphasized the crucial importance of rapid and accurate diagnosis, as well as appropriate treatment from the perspective of infectious diseases. All of these emergencies demand a high degree of clinical suspicion for accurate diagnosis. Some of them also necessitate the involvement of other medical disciplines, such as neurology in the case of meningitis or surgery for necrotizing fasciitis. Additionally, implementing the right empiric antibiotic regimen or, in the case of malaria, antiparasitic treatment is crucial for improving patient outcomes. As patients with these diagnoses may present at any outpatient department, and efficient and quick management is essential, a deep understanding of diagnostic algorithms and potential pitfalls is of the utmost importance.

[Sexually transmitted diseases, STD]. / Sexuell übertragbare Erkrankungen.

Early detection and competent treatment of sexually transmitted diseases (STDs) is essential to maintain or restore the sexual health of those affected and to prevent further transmission. In this context, counselling on Sexually transmitted infections (STI) is of particular importance, both in terms of prevention and rapid diagnosis and treatment. STI are not rare in Germany: syphilis, gonococcal and chlamydial infections even occur with increasing frequency, especially among MSM. At-risk populations (MSM, sex workers, people from high-prevalence regions, partners of STI sufferers) should be offered STI screening. If an STI is present, those affected should also be actively screened for other STIs, and furthermore partners should also be examined for STIs and treated if necessary. Syphilis and other STIs also occur with completely unspecific symptoms. Even asymptomatic infections by gonococci, chlamydia, mycoplasma, HPV, HBV, HCV and HPV can lead to serious complications and late consequences. For STI (HIV, HBV, syphilis), highly effective post-exposure prophylaxis (PEP) is available in some cases.

Comparison of four diagnostic criteria for invasive pulmonary aspergillosis-A diagnostic accuracy study in critically ill patients.

BACKGROUND: In the absence of lung biopsy, there are various algorithms for the diagnosis of invasive pulmonary aspergillosis (IPA) in critically ill patients that rely on clinical signs, underlying conditions, radiological features and mycology. The aim of the present study was to compare four diagnostic algorithms in their ability to differentiate between probable IPA (i.e., requiring treatment) and colonisation. METHODS: For this diagnostic accuracy study, we included a mixed ICU population with a positive Aspergillus culture from respiratory secretions and applied four different diagnostic algorithms to them. We compared agreement among the four algorithms. In a subgroup of patients with lung tissue histopathology available, we determined the sensitivity and specificity of the single algorithms. RESULTS: A total number of 684 critically ill patients (69% medical/31% surgical) were included between 2005 and 2020. Overall, 79% (n = 543) of patients fulfilled the criteria for probable IPA according to at least one diagnostic algorithm. Only 4% of patients (n = 29) fulfilled the criteria for probable IPA according to all four algorithms. Agreement among the four diagnostic criteria was low (Cohen's kappa 0.07-0.29). From 85 patients with histopathological examination of lung tissue, 40% (n = 34) had confirmed IPA. The new EORTC/MSGERC ICU working group criteria had high specificity (0.59 [0.41-0.75]) and sensitivity (0.73 [0.59-0.85]). CONCLUSIONS: In a cohort of mixed ICU patients, the agreement among four algorithms for the diagnosis of IPA was low. Although improved by the latest diagnostic criteria, the discrimination of invasive fungal infection from Aspergillus colonisation in critically ill patients remains challenging and requires further optimization.

[Invasive Pulmonary Aspergillosis]. / Invasive pulmonale Aspergillose.

Invasive pulmonary aspergillosis is a life-threatening disease occurring in patients with severe immunosuppression. It is classically associated with severe neutropenia following hematopoietic stem cell transplantation, but other risk factors include COPD, corticosteroid therapy, solid organ transplant, liver failure and preceding severe influenza infection. Due to the high mortality of the disease, rapid diagnosis and treatment are crucial. Diagnosis is based on CT scan and bronchoscopy including microscopy, culture and galactomannan detection in BAL. Histopathology remains the gold standard diagnosis but is not feasible in many cases. First line treatment is voriconazole, new recommendations also support the triazole isavuconazole.