[Current Aspects of Epididymo-Orchitis]. / Aktuelle Aspekte der Epididymo-Orchitis.

BACKGROUND: Acute epididymitis is an inflammation of the epididymis. It mostly occurs unilaterally and may spread to the testis ('epididymo-orchitis') if untreated. Increasing technological advances allow for an even more detailed examination of concurrent symptoms such as ejaculate changes and the whole spectrum of pathogenic agents, which ranges from sexually transmitted pathogens such as Chlamydia and gonococci to enterobacteria and, rarely, viruses. This review summarises major aspects of the disease including the latest scientific findings. METHODS: A selective literature search including the last 40 years was performed via Medline. RESULTS: With about 400 cases a year in 100 000 men, acute epididymitis is the most common urogenital infection in men. It occurs across all age groups including children. Despite the fact that bacterial ascension is aetiologically of utmost relevance, only one out of three men reports signs of dysuria or urethritis. In young, sexually active men, sexually transmitted pathogens are regularly found in addition to the characteristic enterobacteriae, even if these men have an unremarkable sexual history. 88% of epididymal abscess formations can be successfully treated without surgery. Patients with indwelling urethral catheters are at a high risk of multiple drug resistance and should be treated empirically with both a fluoroquinolone and a third-generation cephalosporin until antimicrobial susceptibility testing has been completed. About 40 out of 100 patients develop post-inflammatory sub-fertility. Here, virulence factors like haemolysin A produced by uropathogenic E. coli have a negative impact on semen parameters compared to those patients suffering from epididymitis induced by haemolysin A negative strains. With adequate antibiotic treatment there is no evidence for testicular atrophy. Only one out of 10 men relapses. These cases should be examined thoroughly for subvesical obstruction. Some of them may benefit from prophylactic vasectomy. CONCLUSIONS: This review presents key aspects of acute epididymitis, which are increasingly adopted in updated guidelines.

Late-onset posttraumatic skin and soft-tissue infections caused by rapid-growing mycobacteria in tsunami survivors.

BACKGROUND: In the tsunami catastrophe in Thailand in 2004, several thousand Swedish tourists were injured, with contaminated crush trauma of the legs being the main cause of injury among the survivors. METHODS: Patient and laboratory data for those who received hospital care in Stockholm and Gothenburg and contracted late-onset infections due to rapid-growing mycobacteria were reviewed retrospectively. Also, concomitant infections were recorded. RESULTS: Fifteen patients with late-onset skin and soft-tissue infections due to rapid-growing mycobacteria are described here. Mycobacterium abscessus was isolated in 7 cases, Mycobacterium fortuitum was isolated in 6 cases, and Mycobacterium peregrinum and Mycobacterium mageritense were isolated in 1 case each. The infections appeared after a delay of 20-105 days (median, 60 days) after the trauma, targeting undamaged skin located near primary sutured wounds or skin grafts. Antimycobacterial drugs were given to 9 (60%) of the patients. The course of infection was protracted, but all infections due to rapid-growing mycobacteria healed within 12 months. Concomitant subcutaneous infections due to other microorganisms, such as Burkholderia pseudomallei or Cladophialophora bantiana, appeared early or late after the trauma. CONCLUSIONS: Repeated cultures of abscess and wound specimens for Mycobacterium species may be needed to find the etiologic agents causing contaminated skin and soft-tissue infections, such as those that developed after traumas that occurred during the tsunami. These cultures are especially necessary when symptoms appear late and when conventional bacterial culture results are negative. A biopsy is recommended for the best yield and for complementary histopathological examination.

The retrospective prevalence of community-acquired methicillin-resistant Staphylococcus aureus in soft tissue abscesses at two military level I trauma centers.

STUDY OBJECTIVE: Many studies have shown that community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) is a very prevalent organism. However, no data have been published to date with regard to CAMRSA prevalence in patients presenting to the emergency department (ED) of a military medical facility. Our objective is to estimate the period prevalence of CAMRSA in cases of soft tissue abscesses seen in the emergency departments of two major military hospitals. METHODS: A retrospective review of electronic records was performed from January 1, 2004 to August 10, 2005. This database was used to identify patients with the diagnosis of abscess, the procedure code for incision and drainage, and culture of wound. After data were accumulated, standard prevalence calculations were applied to determine prevalence of CAMRSA in abscesses at our emergency departments. Antibiotic susceptibilities were then evaluated with regard to the CAMRSA bacteria. RESULTS: The prevalence at our two emergency departments was 68% (751 abscesses, 220 cultured, 155 methicillin-resistant S. aureus (MRSA)-positive cultures). The prevalence at Brooke Army Medical Center and Wilford Hall Medical Center emergency departments was 70% (520 abscesses, 145 cultured, and 101 MRSA positive) and 65% (231 abscesses, 75 cultured, and 49 MRSA positive), respectively. CONCLUSION: The occurrence of CAMRSA is not isolated to the civilian population. The prevalence of CAMRSA in this population is significant, and may pose serious operational and deployment-related ramifications requiring the attention of military medical planners as well as forward medical care providers. The probability of CAMRSA infection should be considered when treating soft tissue abscesses in the military emergency department.

Epidemiological and molecular evidence of a monophyletic infection with Staphylococcus aureus causing a purulent dermatitis in a dairy farmer and multiple cases of mastitis in his cows.

An epidemiological and molecular investigation of a cutaneous suppurative infection with Staphylococcus aureus in a dairy farmer, occurring concurrently with an outbreak of clinical mastitis in his herd, was carried out. A common aetiology for the diseases in the farmer and his cows was established by combining clinical evidence with a molecular genomic analysis of the bacterial isolates using pulsed field gel electrophoresis of DNA macro-restriction fragments. This case indicates the possibility of the emergence and circulation of anthropozoonotic clones of S. aureus in dairy herds. It also provides further evidence of the severe impact of infection with highly virulent clones on dairy lactating cattle.

[Mechanism of development of septic metastases]. / Mekhanizm razvitiia septicheskikh metastazov.

On the basis of personal investigations and literature data the author considers metastatic abscesses in sepsis to be formed in necrosis foci resulting from the action of proteolytic enzymes, prostaglandins, cationic proteins and leukocytes with pathogenic microbes included.