[Skin and Soft Tissue Infections Due to Corynebacterium ulcerans - Case Reports]. / Haut- und Weichteilinfektionen durch Corynebacterium ulcerans ­ Fallberichte.

History and clinical findings We report on three patients suffering from skin and soft tissue infections of the legs due to toxigenic Corynebacterium ulcerans strains. In all three patients, there was a predisposition due to chronic diseases. Three patients had domestic animals (cat, dog) in their households. Investigations and diagnosis A mixed bacterial flora including Corynebacterium ulcerans was found in wound swab samples. Diphtheric toxin was produced by the Corynebacterium ulcerans strains in all three cases. Treatment and course In all three patients, successful handling of the skin and soft tissue infections was possible by combining local treatment with antibiotics. Diphtheria antitoxin was not administered in any case. Conclusion Based on a review of the recent literature pathogenesis, clinical symptoms and signs, diagnostics and therapy of skin and soft tissue infections due to Corynebacterium ulcerans are discussed. Corynebacterium ulcerans should be considered as a potential cause of severe skin and soft tissue infections. Occupational or domestic animal contacts should be evaluated.

[Fatal sepsis due to capnocytophaga canimorsus after dog bite]. / Letal verlaufende Capnocytophaga-canimorsus-Sepsis nach Hundebiss.

A 56-year-old man was bitten by a dog. 8 days later he was admitted to a hospital because of severe deterioration of his clinical situation. He developed the clinical picture of fulminant sepsis. In spite of aggressive intensive care therapy the patient died 24 hours later. Capnocytophaga canimorsus was identified from initial blood cultures. This gram-negative rod is part of the normal oral flora of dogs and cats. It can be spread to humans by bites, licking or scratches and causes severe infections, especially in persons with special risk factors (splenectomy, alcoholism). The mortality rate in the published cases is 25-30%.

Mycobacterium microti--pulmonary tuberculosis in an immunocompetent patient.

Human tuberculosis is caused by members of the Mycobacterium tuberculosis complex, which includes M. tuberculosis, M. bovis, M. africanum and M. bovis BCG. However there are increasing reports of rarely occurring genetic variants such as M. canettii, M. microti and M. pinipedii. The natural reservoir, mode of transmission and potential modification of host interaction of these species is not yet fully elucidated. We report a rare case of extensive cavitary smear-positive tuberculosis of the left lung caused by M. microti in an immunocompetent tuberculin-negative 68-year-old man. Transmission by a raccoon dog or raccoon as a novel M. microti reservoir was suspected. Spoligotyping of the isolate revealed the llama subtype. The strain exhibited no detectable drug resistance. Response to standard tuberculosis treatment, initially comprising isoniacid, rifampicin, pyrazinamide and ethambutol, was excellent. Delayed growth on solid media, specific phenotypic features and contact with animals should raise suspicion for this rare mycobacterial infection.

[Endocarditis due to Cardiobacterium hominis after Ross operation. Case report and review of the literature]. / Endokarditis durch Cardiobacterium hominis nach Ross-Operation: Fallbericht und Literaturübersicht.

CASE REPORT: A case of endocarditis due to Cardiobacterium (C.) hominis in a 41-year-old female patient 1 year after aortic valve replacement with a pulmonary autograft (Ross operation) is described. Diagnosis was established by blood culture and echocardiographic detection of a vegetation on the noncoronary cusp of the autograft. Despite clinical improvement by treatment with ceftriaxone and gentamicin, a cerebral hemorrhage occurred on the 7th day of treatment and neurosurgery was necessary. Progressive insufficiency of the aortic valve and persistent large vegetation required repeated aortic valve replacement 3 weeks after cerebral hemorrhage. REVIEW OF THE LITERATURE: C. hominis is a Gram-negative, slow-growing and fastidious bacterium, rarely causing endocarditis. Subacute and chronic courses are common. That is why diagnosis often is difficult and delayed. Reviewing the literature, clinical presentation, diagnostics and therapy of endocarditis due to C. hominis are discussed.

[Endocarditis due to Granulicatella adiacens]. / Endokarditis durch Granulicatella adiacens.

CASE REPORT: A prosthetic aortic valve was implanted in a 41-year-old patient with connatal aortic stenosis. 14 months later a bacterial endocarditis was diagnosed and treated with ceftriaxone. 6 weeks later he had a relapse. Satellite streptococci could be cultivated from three blood cultures, later identified as Granulicatella adiacens. The patient was treated with penicillin and gentamicin. REVIEW OF THE LITERATURE: In a short review of the literature the most important aspects of pathogenesis, diagnostics and therapy of endocarditis due to satellite streptococci are presented.