A leg ulcer with pulsating varicose veins - from the legs to the heart.

We present the case of a 58-year-old man who presented to our wound care centre with a 7 -month history of a progressive unilateral leg ulcer. He reported intermittent, heavy bleeding at the ulcer. The duplex sonography showed a bilateral incompetence of the saphenofemoral junctions and the entire course of the great saphenous veins and, surprisingly, also a bilateral reversed arterial-like pulsating flow in the great and small saphenous veins as well as in the deep veins of the lower extremities. During cardiac examination by auscultation and echocardiography, we detected a previously undescribed severe tricuspid insufficiency with strongly reduced systolic ejection of both the left and the right ventricle and repercussions on the peripheral venous system as a cause for the pulsating veins. This case report highlights that, although infrequent, the presence of pulsating varicose veins points to the presence of cardiac abnormalities, especially severe tricuspid insufficiency, and should direct clinicians to initiate a thorough cardiological examination. Our case highlights that consequent compression therapy can be sufficient for wound healing in such cases and should be initially considered. These patients are at risk of severe bleeding, and therefore, interventions should be carefully planned.

Genetic differences between invasive and noninvasive neonatal group B streptococcal isolates.

BACKGROUND: Streptococcus agalactiae, also known as group B streptococcus (GBS), is the most common cause of neonatal sepsis and meningitis. To improve our understanding of the pathogenesis of neonatal GBS sepsis, better knowledge of clonal relatedness and diversity among invasive and noninvasive GBS isolates is critical. METHODS: In a Germany-based study, invasive neonatal GBS isolates were compared with noninvasive isolates from neonates in whom sepsis was suspected, but whose blood cultures were sterile. The comparison was conducted by means of pulsed-field gel electrophoresis and surface protein gene profiling. In addition, multilocus sequence typing was performed on invasive and noninvasive isolates of the most frequent invasive serotype III. RESULTS: Pulsed-field gel electrophoresis analysis of noninvasive GBS showed a remarkably more diverse fingerprinting pattern than that of invasive isolates. In contrast to invasive strains, noninvasive isolates did not show any clustering. Surface protein gene profiling also showed significantly different distribution patterns between the 2 panels of isolates. Multilocus sequence typing of invasive and noninvasive serotype III isolates revealed the same clonal complexes, but displayed different sequence types (ST); ST-17 was most common (68.6%) among invasive strains, whereas ST-389 (clonal complex-19) was predominant among noninvasive strains (47.8%). CONCLUSIONS: Our results illustrate a large molecular diversity among neonatal noninvasive GBS strains. Invasive strains, however, represent only a small proportion of the noninvasive GBS population. These findings suggest a selection process that prefers more virulent strains during invasion.