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Cancer patients are at high risk of severe COVID-19 with high morbidity and mortality. Further, impaired humoral response renders SARS-CoV-2 vaccines less effective and treatment options are scarce. Randomized trials using convalescent plasma are missing for high-risk patients. Here, we performed a multicenter trial (https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-001632-10/DE) in hospitalized patients with severe COVID-19 within four risk groups (1, cancer; 2, immunosuppression; 3, lab-based risk factors; 4, advanced age) randomized to standard of care (CONTROL) or standard of care plus convalescent/vaccinated anti-SARS-CoV-2 plasma (PLASMA). For the four groups combined, PLASMA did not improve clinically compared to CONTROL (HR 1.29;p=0.205). However, cancer patients experienced shortened median time to improvement (HR 2.50,p=0.003) and superior survival in PLASMA vs. CONTROL (HR 0.28;p=0.042). Neutralizing antibody activity increased in PLASMA but not in CONTROL cancer patients (p=0.001). Taken together, convalescent/vaccinated plasma may improve COVID-19 outcome in cancer patients unable to intrinsically generate an adequate immune response.

A patient with rheumatoid arthritis and immunosuppression developed symptoms of wasting, neuropathy and lung cavitations eventually leading to central nervous system symptoms and fatal multi-organ failure. Disseminated infection with Histoplasma capsulatum proved to be the underlying cause. The primary infection had apparently been acquired 4 years earlier on a holiday to the Caribbean. Rare infectious diseases should be considered in patients under immunosuppression and travel activities to specific endemic areas.Ein Patient mit rheumatoider Arthritis sowie B‑Symptomatik, Polyneuropathie und einschmelzenden Lungenveränderungen unter Immunsuppression entwickelte nach zunächst subakutem Verlauf rasch progrediente zentrale neurologische Symptome und ein letales Multiorganversagen. Als ursächlich erwies sich eine disseminierte Infektion mit Histoplasma capsulatum unter Beteiligung des zentralen Nervensystems. Die Erstinfektion hatte sich fünf Jahre zuvor bei einem Karibikurlaub ereignet. Die Kombination aus Reiseaktivität und Immunsuppression erfordert die Berücksichtigung sonst in Deutschland sehr seltener infektiologischer Diagnosen.

Chronische Hautveranderungen, die bei Patienten auftreten, die sich zuvor in tropischen Landern aufgehalten haben, stellen fur uns Arzte vielfach eine diagnostische Herausforderung dar. Insbesondere wenn sich histologisch eine granulomatose Entzundungsreaktion darstellt, sollten wir auch infektiologische Erkrankungen in unser diagnostisches Kalkul mit einbeziehen. Hierzu gehort insbesondere bei Patienten aus Hochrisikoregionen wie Vietnam die kutane Tuberkulose, die eine grundliche Durchuntersuchung des Patienten und eine umfassende Therapie nach sich zieht. Dieses Fallbeispiel stellt dar, welche Schritte bei Verdacht auf eine kutane Tuberkulose in Erwagung gezogen werden sollten.

Wir berichten uber den Fall einer 73-jahrigen Patientin bosnischer Herkunft, die mit einem akuten Nierenversagen aufgenommen wurde. Die Nierenbiopsie erbrachte die Diagnose einer infektassoziierten nekrotisierenden sowie extrakapillar proliferativen Glomerulonephritis. Die Patientin berichtete, etwa zwei Wochen zuvor einen fieberhaften Infekt gehabt zu haben. Unsere Diagnostik ergab keinen Hinweis auf einen aktuellen floriden Infekt. Es erfolgte eine systemische Steroidtherapie mit gutem Ansprechen. Sechs Wochen spater erfolgte die erneute stationare Aufnahme der Patientin in einem schwer kranken Zustand. Wir konnten bioptisch in der Magenschleimhaut eine Strongyloides-stercoralis-Infestation nachweisen. Unter der Steroidtherapie hatte sich ein sogenanntes Hyperinfektionssyndrom entwickelt, an dem die Patientin trotz intensivmedizinischer Bemuhungen verstarb. Dieser Fall illustriert, dass insbesondere bei Patienten aus Endemiegebieten auch hierzulande an diese Parasitose gedacht werden muss. Wir diskutieren eine wahrscheinliche kausale Verknupfung mit der Glomerulonephritis und geben eine Ubersicht uber die Diagnostik, den Krankheitsverlauf und die Therapie dieser Parasitose.

Bei einem 52-jahrigen Patienten trat eine unklare Panzytopenie 1,5 Jahre nach Fremdspenderstammzelltransplantation auf. Durch eine Knochenmarkuntersuchung wurde eine viszerale Leishmaniose (VL) gesichert. Obwohl die VL weltweit verbreitet ist, handelt es sich um einen auserst seltenen Befund bei stammzelltransplantierten Patienten.

Outbreaks of infectious diseases pose particular challenges for hospitals and intensive care units.Typical infectiological scenarios and their significance for modern intensive care medicine are presented.Selected pathogens/infectious diseases that have significantly strained the resources of intensive care units are described.Intensive medical care is necessary in severe cases of many infectious diseases. In the context of epidemics/pandemics, many critically ill patients have to be admitted within a short time. Examples are the 2009 H1N1 influenza pandemic, the 2011 enterohemorrhagic Escherichia coli (EHEC) outbreak in northern Germany, the 2014/2015 Ebola fever outbreak and the 2020 coronavirus disease 19 (COVID-19) pandemic. Multidisciplinary teams, protocol development, adequate staffing, and training are required to achieve optimal treatment outcomes, including prevention of healthcare worker infections.Pandemics and epidemics are unique challenges for intensive care unit preparedness planning.HINTERGRUND: Ausbrüche von Infektionskrankheiten stellen Krankenhäuser und Intensivstationen vor besondere Herausforderungen.Es werden grundlegende infektiologische Szenarien und ihre Bedeutung für die moderne Intensivmedizin dargestellt.Ausgewählte Erreger/Infektionskrankheiten, die das Potenzial haben, die Ressourcen der Intensivstationen deutlich zu belasten, werden beschrieben.Eine Intensivmedizinische Betreuung ist bei schweren Verläufen vieler Infektionserkrankungen notwendig. Im Rahmen von Epidemien/Pandemien kann es innerhalb kurzer Zeit zu einer Aufnahme von vielen kritisch kranken Patienten kommen. Beispiele dafür sind die Pandemie im Jahr 2009 durch das Influenzavirus H1N1, der Ausbruch einer Infektion mit enterohämorrhagischen Escherichia coli (EHEC) in Norddeutschland, der Ebola-Fieber-Ausbruch in den Jahren 2014/2015 und die Pandemie durch die Coronaviruserkrankung 2019 (COVID-19) im Jahr 2020. Multidisziplinäre Teams, die Entwicklung von Protokollen, eine adäquate Personalbesetzung und Schulungen sind erforderlich, um ein optimales Behandlungsergebnis zu erzielen. Dies beinhaltet insbesondere auch die Prävention von Infektionen des Gesundheitspersonals.Pandemien und Epidemien sind einzigartige Herausforderungen für die Bereitschaftsplanung der Intensivstation.

Chronic skin lesions that occur in patients who have previously stayed in tropical countries pose a diagnostic challenge for physicians. In particular, if there is a granulomatous inflammatory reaction histologically, infectious diseases should also be included in the differential diagnosis. Particularly in persons returning from high-risk regions such as Vietnam, this includes cutaneous tuberculosis, which entails a thorough examination of the patient and comprehensive therapy. This case study shows which steps should be considered if cutaneous tuberculosis is suspected.

This article reports about a 73-year-old woman of Bosnian descent who presented with acute renal failure. A renal biopsy was diagnostic for a postinfect necrotizing and extracapillary proliferative glomerulonephritis. The patient reported a febrile infection fever 2 weeks previously. The diagnostics did not reveal any indications of an ongoing infection. The glomerulonephritis responded to treatment with systemic steroids. The patient was readmitted to hospital 6 weeeks later in a severely ill condition. A gastric biopsy revealed a Strongyloides stercoralis infestation. Due to the systemic steroid therapy the patient had developed a so-called hyperinfection syndrome and died despite treatment on the intensive care unit. This case illustrates the need for awareness of this rare parasitosis, particularly in patients from endemic areas. A likely causal relationship with the glomerulonephritis is discussed and an overview of the diagnostics, course of the disease and treatment of this parasitosis is given.

A 52-year-old patient developed pancytopenia of unknown origin 1.5 years after allogeneic stem cell transplantation. The bone marrow aspirate showed visceral leishmaniasis (VL). Although VL is distributed world-wide, the incidence in patients after allogeneic stem cell transplantation is rare.

Die zunehmende Migration nach Europa konfrontiert Arzte mit hierzulande kaum noch bekannten Erkrankungen. Wir berichten uber einen Fall von Lauseruckfallfieber bei einem somalischen Fluchtling. Die Diagnose des Ruckfallfiebers wurde auf der Basis eines Blutausstrichs gestellt. Molekularbiologisch zeigte sich Borrelia recurrentis als Ursache. Die Erkrankung sollte bei Patienten mit unklarem Fieber und passender Reiseanamnese bzw. Migrationshintergrund in Betracht gezogen und mit Blutausstrichen abgeklart werden. Die Therapie birgt die Gefahr einer Jarisch-Herxheimer-Reaktion, die eine intensivmedizinische Versorgung erforderlich machen kann.

In this case report, we describe the clinical course of a patient with Ebola virus disease who was transferred to the Highly Contagious Pathogens Treatment Unit at the Hamburg University Medical Center. High volume turnover, electrolyte imbalances, paralytic ileus, sepsis with multiresistant gram-negative pathogen, and respiratory failure due to blood aspiration were major clinical challenges.

We report a case of an extracutaneous involvement of pyoderma gangrenosum. The patient initially presented with multiple sterile abscesses of the skin, heart, prostate, and kidney. Extracutaneous involvement in pyoderma gangrenosum is very rare. Confirmation of the diagnosis was only possible after exclusion of other relevant differential diagnoses. Continuous search for microbes proved negative and after an empiric therapeutic attempt with prednisolone, the patient improved quickly. However, each time we reduced the steroids even in combination with methotrexate or with azathioprine the patient relapsed. Only after therapy with the tumor necrosis factor-α-inhibitor infliximab was permanent remission achieved.

The increasing migration into Europe may confront clinicians with diseases barely known any more in this part of the world. We present a case of louse-borne relapsing fever in a Somali refugee. Blood smears led to the diagnosis of relapsing fever and DNA sequencing was positive for Borrelia recurrentis. This disease should be considered in all patients with unclear fever and a compatible travel or migration history. Blood smears are employed as the primary diagnostic method. Therapy harbors the danger of a Jarisch-Herxheimer reaction, a complication that may require intensive medical care.

Einleitung: Der pyogene Leberabszess (PLA) ist eine Erkrankung, die sich in den letzten Jahrzehnten hinsichtlich ihrer Genese sowie der diagnostischen und therapeutischen Moglichkeiten verandert hat. Material und Methodik: In dieser Studie wurden die letzten 20 Patienten, die mit der Hauptdiagnose eines PLA in einer gastroenterologischen Abteilung eines Universitatsklinikums behandelt wurden, retrospektiv analysiert. Dabei wurden die epidemiologischen, klinischen, mikrobiologischen und therapeutischen Aspekte ausgewertet. Ergebnisse: 75 % der Patienten waren mannlich. Das mittlere Erkrankungsalter lag bei 51,7 ± 16,6 Jahren. Die Genese des PLA war mit 70 % am haufigsten hepatobiliar; Hauptrisikofaktoren waren der Diabetes mellitus (25 %) und das Cholangiokarzinom (20 %). Bei mindestens einem Patienten kam ursachlich ein Morbus Crohn infrage. Die haufigsten Symptome waren Fieber (70 %) und Tachykardie (50 %), alle Patienten zeigten eine Erhohung des C-reaktiven Proteins. In Abszesskulturen waren Enterokokken (> 40 %) und Anaerobier (> 20 %), in Blutkulturen Escherichia coli (25 %) die haufigsten Erreger. Diskussion: Der PLA prasentiert sich klinisch oft unspezifisch, sodass die Erkrankung gerade bei Patienten mit typischen Risikofaktoren in die differenzialdiagnostischen Uberlegungen eingeschlossen werden sollte. Insbesondere bei Patienten ohne Vorerkrankungen sollte der Diagnose eines PLA eine Suche zur Klarung der Genese folgen.

Prolonged fever of unknown origin together with night sweats in the elderly requires a systematic search for malignant and infectious foci. Here we present a case of fever of unknown origin which ultimately led us to the diagnosis of everolimus-induced fever. After changing the immunosuppressive regime it resolved rapidly.

Differentiation between lymphadenopathy in potentially life-threatening systemic lupus erythematosus (SLE) and self-limiting necrotizing lymphadenitis, also called Kikuchi— Fujimoto disease (KFD), is difficult. In the past, co-occurrence of SLE and KFD has been described repeatedly in case reports. Here, we report a case of necrotizing lymphadenitis, describe the clinical and histopathologic features in detail and discuss the current literature. KFD may in fact be a histopathologic characteristic of SLE supporting the hypothesis that KFD is a rare manifestation of SLE. To clarify whether KFD is the same entity as lupus lymphadenitis, more cases with SLE and lymphadenopathy should be examined in detail. Lupus (2010) 19, 89—92.

Die Differenzialdiagnose granulomatoser Darmerkrankungen fuhrt wiederholt zu Fehldiagnosen. Unser Patient, der sich mit gastrointestinalen Beschwerden vorstellte, wurde aufgrund des zunachst diagnostizierten M. Crohn immunsuppressiv behandelt. Unter der Therapie exazerbierten jedoch die Symptome. Der Nachweis von saurefesten Stabchen in verschiedenen Korpersekreten und die Prasenz nekrotisierender Granulome in Darmbiopsien fuhrten zur Diagnose einer Abdominaltuberkulose. Unter einer adaquaten tuberkulostatischen Therapie verbesserte sich der Zustand des Patienten.

We report a case of an extracutaneous involvement of pyoderma gangrenosum. The patient initially presented with multiple sterile abscesses of the skin, heart, prostate, and kidney. Extracutaneous involvement in pyoderma gangrenosum is very rare. Confirmation of the diagnosis was only possible after exclusion of other relevant differential diagnoses. Continuous search for microbes proved negative and after an empiric therapeutic attempt with prednisolone, the patient improved quickly. However, each time we reduced the steroids even in combination with methotrexate or with azathioprine the patient relapsed. Only after therapy with the tumor necrosis factor-α-inhibitor infliximab was permanent remission achieved.

Gastroenteritiden und Enterokolitiden sind Erkrankungen der Schleimhaute des Magen-Darm-Trakts, die durch Mikroorganismen oder deren Toxine verursacht werden. Sie fuhren klinisch zu Ubelkeit, Erbrechen, Durchfall und Leibschmerzen, teils auch zu Fieber. Pathogenetisch stehen der Wasser- und Elektrolytverlust im Vordergrund. Entzundungen innerhalb der Peritonealhohle (Peritonitis) konnen diffus oder lokalisiert ablaufen. Die diffuse Form zeigt fliesende Ubergange zur Sepsis. Lokalisierte Erkrankungen betreffen intraperitoneale Abszesse in den verschiedenen Rezessus (z. B. Douglas-Abszess, subphrenischer Abszess) oder abgegrenzte Entzundungen in der Umgebung erkrankter Hohlorgane, z. B. Pericholezystitis, perityphlitische (= periappendizitische) oder perikolische Infiltrate.

The practical year (PY) during the final year of medical education is intended to deepen and broaden knowledge, skills, and abilities that were acquired during previous years of their studies. Against this background, this study pursues the question of how the knowledge of future physicians and their confidence in terms of cancer pain therapy and other palliative care issues develops during the PY.At the end of the PY, students from two university hospitals completed a 3-part online questionnaire (self-assessment of the confidence, questions about palliative care knowledge, and assessment of palliative care training during the PY). These results are compared with previously published data from the same collective that had been collected at the beginning of the PY.Overall, 92 of 318 students participated (28.9 %). Less than 10 % of students said that they were more confident regarding palliative care topics at the end of their medical studies. Improvements in the self-assessment could only be observed in the recognition of and screening for cancer pain (increase from 36 % to 65%). With regard to the palliative care knowledge, only the knowledge of how to treat symptoms other than pain improved significantly; however, knowledge in this regard prior to the PY was particularly low (an increase from 25 % to 35 %, p 0.05). In the only multiple-choice question about ethics, the correct answer rose slightly from 51 % (before) to 55 % (after the PY). Of participating students, 21% (prior to the PY 27 %) stated that not providing fluids to dying patients is a form of euthanasia. In terms of palliative care training, between 36 and 83 % of participants stated having insufficient opportunities to gain knowledge and experience on various topics in the treatment of patients with advanced and incurable diseases during their PY.In the present study, considerable deficits in confidence and knowledge regarding palliative care issues were also observed at the end of PY. Integration of palliative care into the medical school curriculums should be given special attention in terms of a longitudinal training of the PY.

In this case report, we describe the clinical course of a patient with Ebola virus disease who was transferred to the Highly Contagious Pathogens Treatment Unit at the Hamburg University Medical Center. High volume turnover, electrolyte imbalances, paralytic ileus, sepsis with multiresistant gram-negative pathogen, and respiratory failure due to blood aspiration were major clinical challenges.

Viral blips are thought to represent random biological variations around a steady state of residual HIV viraemia and to lack clinical significance. We aimed to assess the association of immune activation and the occurrence of blips.HIV-infected patients from our out-patient cohort who developed a blip after having been on fully suppressive highly active antiretroviral therapy (HAART) for at least 180 days were matched with patients without blips according to duration of complete viral suppression (CVS), age, sex and Centers for Disease Control and Prevention (CDC) stage. Frequencies of CD3(+), CD3(+) CD4(+), CD3(+) CD8(+), CD3(+) HLA-DR(+), CD4(+) CD45RA(+), CD16(+) CD56(+) CD3(-) and CD19(+) cells, as well as C-reactive protein (CRP) levels and clinical parameters, were included in conditional logistic regression models. Adherence to HAART was assessed by measuring prescribed nonnucleoside reverse transcriptase inhibitor (NNRTI) or protease inhibitor (PI) plasma levels in a sample of 57 patients.Eighty-two patients with viral blip were matched with 82 controls from the same cohort. The mean age was 47.2 years [standard deviation (SD) 12.1 years], 80.5% of patients were male and 42.7% had CDC stage C disease. Viral blips occurred after a median of 14 months [interquartile range (IQR) 8-34 months] of CVS. In the logistic regression, activated CD3(+) HLA-DR(+) lymphocytes [odds ratio (OR) 1.25 per 100 cells/μL; 95% confidence interval (CI) 1.02-1.54; P = 0.03] were significantly associated with blips and there was a trend for an association of longer time on HAART with blips (OR 1.31 per year; 95% CI 0.96-1.78; P = 0.09). No between-group difference regarding subtherapeutic drug levels was found (P = 0.46).The occurrence of viral blips after suppressive HAART was associated with elevated markers of T-cell activation. Blips may identify a subset of patients with higher immune activation and increased risk for HIV disease progression.

To the best of our knowledge, the German Association for the Control of Viral Diseases (DVV) e.V. and the Society for Virology (GfV) e.V. are the first in Europe to provide precise recommendations for the management of health care workers (HCWs) who are infected with human immunodeficiency virus (HIV). Requirements for HIV-infected HCWs need to be clearly defined. With a permanent viral burden of less than or equal to 50 copies/mL, HIV-positive HCWs are allowed to perform any surgery and any invasive procedure, as long as the infected HCW uses double-gloving, undergoes follow-up routinely by occupational medicine professionals, undergoes a quarterly examination of viral burden, and has a regular medical examination by a physician who has expertise in the management of HIV. Unrestricted professional activity is only possible with a strict compliance to take antiretroviral therapy and if the HIV-infected HCW strictly adheres to the recommended infection control procedures. Complete compliance with the recommendation almost certainly leads to no HIV transmission risk in patient care.

Pyogenic liver abscess (PLA) is a disease with changing origins as well as diagnostic and therapeutic options in the last decades.A retrospective study of the last 20 patients treated at a gastroenterological department of a university clinic for the major diagnosis of PLA was conducted. Epidemiological, clinical, microbiological and therapeutic aspects were recorded.75 % of the patients were male. The mean age was 51.7 ± 16.6 years. Most of PLA (70 %) had a hepatobiliary origin. Diabetes mellitus (25 %) and cholangiocarcinoma (20 %) were the major risk factors for PLA. Crohn's disease was a possible cause in at least one patient. Fever (70 %) and tachycardia (50 %) were the most common symptoms. The C-reactive protein was elevated in all patients. Enterococci (40 %) and anaerobes (20 %) were the most frequent organisms in abscess cultures, Escherichia coli (25 %) was the most frequent organism in blood cultures.The clinical presentation of PLA is usually non-specific. Therefore especially with patients having typical risk factors the differential diagnosis of PLA should be considered. Particularly patients suffering from PLA without any pre-existing illness should be examined for an underlying disease.

A 38-year old patient with previously untreated HIV infection presented with progressive cephalgia, photophobia, polydpsia and nausea/vomiting.Clinical findings revealed a reduced general state of health and focal neurological deficits. Laboratory findings demonstrated a lymphocytopenia. In addition to positive crytococcus culture and antigen titer in cerebrospinal fluid/serum, Cryptococcus neoformans was detected by light microscopy (India ink stain) in cerebrospinal fluid.A cryptococcal meningitis was diagnosed. After initiating antifungal and antiretroviral treatment the clinical course worsened after months 2, 3, and 5, respectively. Apart from unspecific inflammation in the lab work, no signs of disease relapse or therapy refractory course were found in additional diagnostics. After critical evaluation of the clinical course and diagnostic results, immune reconstitution inflammatory syndrome (IRIS) was diagnosed. Clinical improvement was achieved during adjuvant treatment with steroids within six months.In the presence of neurological symptoms, cryptococcal meningitis is a rare but possible differential diagnosis in daily routine. Diagnosis can be easily achieved by India ink stain in combination with culture of cerebrospinal fluid as well as antigen detection in most cases. Tests of antifungal resistance should be reserved for patients who do not respond to initial treatment, patients with atypical course of disease or failing longterm antifungal therapy. The IRIS is no rare complication after initiation of antiretroviral treatment in HIV associated cryptococcal infections. It is an important differential diagnosis in an atypical course of disease, and sufficient treatment is usually achieved by steroids.

Background: Previous pooled analyses have reported an association between magnetic fields and childhood leukaemia. We present a pooled analysis based on primary data from studies on residential magnetic fields and childhood leukaemia published after 2000. Methods: Seven studies with a total of 10 865 cases and 12 853 controls were included. The main analysis focused on 24-h magnetic field measurements or calculated fields in residences. Results: In the combined results, risk increased with increase in exposure, but the estimates were imprecise. The odds ratios for exposure categories of 0.1–0.2 μT, 0.2–0.3 μT and ⩾0.3 μT, compared with

A woman in her fifties was treated for falciparum malaria at the University Medical Centre in Hamburg, Germany in April 2008.

The differential diagnosis of granulomatous intestinal diseases leads to recurrent false diagnoses. Our patient who was presenting with gastrointestinal complaints was first diagnosed as having Crohn's disease. Put on an immunosuppressive treatment, the symptoms deteriorated. Examination of sputum revealed acid-fast bacilli, later confirmed as M. tuberculosis in culture, and colonoscopy showed necrotizing granulomas, which lead us to the final diagnosis of abdominal tuberculosis. Our patient improved under an adequate tuberculostatic regime.

Rabies is a fatal viral encephalitis characterized by a clinically acute and progressive course. With rare exceptions, there is a discrepancy between clinical outcome and frank histological alterations in rabies. Investigators have postulated that rabies virus may modify neurotransmission through occupancy of cellular receptors or alteration of ion channels. We took advantage of these observations to improvise a successful therapy for rabies. The Milwaukee protocol ( www.mcw.edu/rabies ) was further modified to treat two German patients. We measured pterins and monoamine neurotransmitter metabolites in the CSF of patients with rabies by HPLC with electrochemical or fluorescent detection. We report loss of tetrahydrobiopterin (BH(4)) and associated pathological decrease of dopaminergic and serotoninergic neurotransmission in three successive patients with rabies. CSF levels of BH(4) and neurotransmitter metabolites increased in two patients who were supplemented. Our findings support the long-standing speculation of modified neurotransmission in the pathogenesis of rabies, but by another mechanism. Brain turnover of dopamine and serotonin is reduced following rabies-acquired BH(4) deficiency. Neuronal nitric oxide synthase is BH(4)-dependent and may also be involved, possibly causing cerebrovascular insufficiency in one patient. This work must be carefully replicated in animal models and future patients. We are cautiously optimistic at the prospect of readily available, metabolically specific, enteral therapy for rabies.

In this article we describe the clinical presentation of a trichinellosis epidemic in a German family.

This article provides an overview of possible causes of fever after traveling in tropical and subtropical areas and emphasizes the necessity of a conclusive diagnosis.