ABSTRACT
Q fever is a worldwide distributed zoonotic disease with a mostly benign course, which regularly reoccurs in Germany. This report is about a patient with sporadic serologically proven Q fever, which also showed typical histopathological findings with nonspecific granulomatous hepatitis, usually seen in acute disease. The bone marrow biopsy revealed so-called doughnut granulomas, which are not pathognomonic but a typical finding in Q fever. This case report impressively underlines that the histomorphological findings can make a decisive contribution to the clarification by extended differential diagnostics, even though it plays a subordinate role in the routine diagnostics of disseminated Q fever.
Subject(s)
Granulomatous Disease, Chronic/diagnosis , Granulomatous Disease, Chronic/pathology , Hepatitis A/diagnosis , Hepatitis A/pathology , Q Fever/diagnosis , Q Fever/pathology , Rare Diseases , Adult , Anti-Bacterial Agents/therapeutic use , Aortic Valve/pathology , Biopsy, Needle , Bone Marrow/pathology , Diagnosis, Differential , Drug Therapy, Combination , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/pathology , Granulomatous Disease, Chronic/drug therapy , Hepatitis A/drug therapy , Humans , Liver/pathology , Male , Q Fever/drug therapy , RecurrenceABSTRACT
While hands are acknowledged to be the most important source of pathogens from the skin of the surgical team, the transmission of pathogens from the forearms may also be relevant. Preoperative hand disinfection is recommended, but evidence-based standards for the forearms are lacking. As neither the European standard EN 12791 nor the American guidelines ASTM 1115 are applicable to the forearms, a new test method based on the European standard EN 12791 and the German Society for Hygiene and Microbiology (DGHM) method for testing for the efficacy of skin antiseptics was developed to address the forearms. The antiseptic efficacy of a commercially available alcohol-based hand rub [76.7% (w/w) ethanol] was assessed on the upper arm after 15s, 2.5 min, and 30 min, and on the lower arm after 2.5 min, 30 min, and 3 h. On the upper arm, application of the product followed the DGHM standard procedure. On the forearm, the product was applied by the participants themselves with the right hand over the left forearm and vice versa as performed during preoperative hand disinfection. Sampling and culture were performed according to the DGHM method for skin antisepsis on the upper arm. Twenty-two volunteers were investigated. The efficacy of the antiseptic treatment on the forearm was not significantly lower than on the upper arm for any of the areas tested (P > 0.05). Reduction factors for all tested areas and times were quite similar, with confidence intervals ranging between 1.43 and 2.31 log10. We suggest that an application time of 10s may be sufficient for the treatment of the forearm as part of preoperative hand disinfection, provided that an appropriate product is used.
