[Infections as a Cause of Unexplained Fever]. / Infektionen als Ursache für Fieber unklarer Genese.

Fever of unexplained (or unknown) origin (FUO) remains a relevant clinical problem even with modern diagnostic methods. In addition to the classical definition, new categories of FUO describe different clinical situations: nosocomial FUO, FUO in neutropenic/immundeficient patients and FUO in patients with HIV-infection. The new categories are defined by much shorter duration of fever, i. e. mostly three days. Each category of FUO shows a different spectrum of infectious diseases. Often, subacute bacterial endocarditis is very difficult to verify. In many cases, patients in intensive care suffer from FUO caused by reactivation of CMV. In patients with HIV the most important diagnostic indicator concerning the origin of infection is the degree of immundeficiency. Biological and nuclear medical (PET-CT) verification procedures have been established in diagnostics. A national or international register should be created with the purpose of data transfer and validation of strategies concerning the treatment of FUO.

Injection anthrax--a new outbreak in heroin users.

BACKGROUND: Injection anthrax is a rare disease that affects heroin users and is caused by Bacillus anthracis. In 2012, there were four cases in Germany, one of which was fatal, as well as a small number of cases in other European countries, including Denmark, France, and the United Kingdom. Three cases among drug users occurred in Germany in 2009/2010, in the setting of a larger outbreak centered on Scotland, where there were 119 cases. CASE PRESENTATION AND CLINICAL COURSE: We present three cases of injection anthrax, two of which were treated in Regensburg and one in Berlin. One patient died of multi-organ-system failure on the day of admission to the hospital. The others were treated with antibiotics, one of them also with surgical wound debridement. The laboratory diagnosis of injection anthrax is based on the demonstration of the pathogen, generally by culture and/or by polymerase chain reaction, in material removed directly from the patient's wound. The diagnosis is additionally supported by the detection of specific antibodies. CONCLUSION: Injection anthrax may be viewed either as an independent disease entity or as a special type of cutaneous anthrax with massive edema, necrotizing fasciitis in many cases, and about 30% mortality. It has appeared in recent years among heroin users in various European countries. In patients with suggestive clinical presentation and a history of heroin use, anthrax infection must be suspected early, so that the appropriate diagnostic tests can be performed without delay. Timely treatment can be life-saving. It is therefore important that physicians--and the individuals at risk--should be well-informed about this disease.

[A 37-year-old patient with fever, dyspnea and elevated transaminases after a stay in Mexico]. / 37-jähriger Patient mit Fieber, Dyspnoe und erhöhten Transaminasen nach Mexikoaufenthalt.

CASE REPORT: A 37-year-old patient with cephalgia and fever after his return from Mexico is reported. Due to persistently elevated transaminases, a liver biopsy was performed. Histological examination revealed hepatic involvement of a granulomatous disease. Serologic analyses detected anti-Brucella IgM. The suspected diagnosis was thus brucellosis taking the typical anamnesis into account. Treatment with rifampicin and doxycycline led to a complete convalescence of the patient. CONCLUSION: Brucellosis is an anthropozoonosis that exists worldwide. Potential sources of infection are uncooked or unpasteurized milk and milk products of infected animals. Complete cure of most brucellosis-infected patients can be achieved by an early and adequate antibiotic treatment.