Lymphogranuloma venereum verläuft häufig asymptomatisch bei Männern, die Sex mit Männern haben, in Österreich

Hintergrund und Ziele

Lymphogranuloma venereum (LGV) ist eine sexuell übertragene Erkrankung verursacht durch Chlamydia trachomatis (CT), Serovar L1–L3. Eine Zunahme von LGV ist vorwiegend bei Männern, die Sex mit Männern haben (MSM), beobachtet worden. Die Unterscheidung zwischen LGV und Nicht‐LGV‐Serovaren hat therapeutische Konsequenzen, daher wurden Prävalenz und Charakteristika von LGV innerhalb aller CT‐Infektionen untersucht.

Patienten und Methodik

Alle CT‐positiven Befunde, erhoben an den vier größten österreichischen HIV‐ und STI‐Kliniken von 04/2014–12/2021, wurden hinsichtlich Charakteristika der Erkrankung und Demographie der Patienten ausgewertet.

Ergebnisse

Insgesamt wurden n = 2083 CT‐Infektionen bei n = 1479 Personen dokumentiert. Das mediane Alter betrug 31,4 Jahre, 81% waren männlich, 59% MSM, 44% HIV‐positiv, 13% nutzten HIV‐Prä‐Expositionsprophylaxe. Serovaranalysen waren bei 61% (1258/2083) verfügbar, wobei L1–L3 in 15% (192/1258) aller Fälle nachgewiesen wurde. Bei MSM mit rektaler CT‐Infektion waren 23% (101/439) LGV. LGV‐Fälle verglichen mit CT‐Infektionen traten vermehrt bei MSM (92% [177/192] vs. 62% [1179/1891], p < 0,001), HIV‐Positivität (64% [116/180] vs. 46% [631/1376]; p < 0,001) und konkomitanter Syphilisinfektion (18% [32/180] vs. 7% [52/749]; p < 0,001) auf. LGV‐Infektionen verliefen zumeist asymptomatisch (45% [87/192]), gefolgt von Proktitis (38% [72/192]).

Schlussfolgerungen

Lymphogranuloma venereum machte 23% der rektalen CT‐Infektionen bei MSM aus und 45% aller LGV‐Fälle waren asymptomatisch. Bei fehlender CT‐Serovar‐Analyse sollte in Risikopopulationen eine erhöhte LGV‐Prävalenz in Betracht gezogen und bei der empirischen Therapiedauer berücksichtigt werden.

Pyogenic spondylodiscitis in HIV-positive patients under antiretroviral therapy: A case series

Background: The incidence of pyogenic spondylodiscitis has been increasing in countries of Europe and North America, probably due to an increasing number of persons with risk factors for this infection. It is unclear whether HIV infection in the era of antiretroviral therapy (ART) increases the risk for spondylodiscitis. Method: We present 7 cases of pyogenic spondylodiscitis of the cervical, thoracic, and lumbar spine in six individuals living with HIV under ART with suppressed viral load. Results: All patients presented with severe non-radicular pain and elevated inflammatory markers. Diagnosis was confirmed by magnetic resonance imaging (MRI) scan and isolation of the pathogen. Staphylococcus aureus was the causative pathogen in five patients. One patient suffered from an infection with Klebsiella pneumoniae followed by a mixed infection with Cutibacterium acnes and Bacillus circulans 18 months later. All patients needed surgical intervention, and the mean duration of antibiotic treatment was 17 weeks (range 12-26). Five patients recovered fully, including two persons who also suffered from endocarditis. One patient died from multi-organ failure. Conclusion: Spondylodiscitis may be seen more frequently in persons living with HIV as they grow older and suffer from comorbidities which put them at risk for this infection. HIV physicians should be aware of the infection and its risk factors.

Asymptomatic lymphogranuloma venereum is commonly found among men who have sex with men in Austria

BACKGROUND AND OBJECTIVES

Serovar L1-L3 of Chlamydia trachomatis (CT) causes lymphogranuloma venereum (LGV). A surge in LGV-cases has been observed among HIV-positive men who have sex with men (MSM). Discrimination between LGV and non-LGV is pivotal since it has major treatment implications. Here, we aimed to determine the prevalence and characteristics of LGV among CT-infections.

PATIENTS AND METHODS

All CT-positive results from 04/2014-12/2021 at the four largest Austrian HIV and STI clinics were evaluated. Disease characteristics and patient demographics were analyzed.

RESULTS

Overall, n  =  2,083 infections of CT were documented in n  =  1,479 individual patients: median age was 31.4 years, 81% were male, 59% MSM, 44% HIV-positive, 13% on HIV pre-exposure-prophylaxis. Available serovar analyses (61% [1,258/2,083]) showed L1-L3 in 15% (192/1,258). Considering only MSM with rectal CT-infection, LGV accounted for 23% (101/439). Cases of LGV vs. other CT-infections were primarily MSM (92% [177/192] vs. 62% [1,179/1,891], p < 0.001), more often HIV-positive (64% [116/180] vs. 46% [631/1,376]; p < 0.001) and had frequently concomitant syphilis infection (18% [32/180] vs. 7% [52/749]; p < 0.001). LGV commonly manifested as proctitis (38% [72/192]) whereas 45% (87/192) were asymptomatic.

CONCLUSIONS

Lymphogranuloma venereum accounted for 23% of rectal CT-infections in MSM. Furthermore, 45% of all LGV-cases were asymptomatic. In the absence of CT-serovar analysis, a high LGV prevalence should be considered in risk-populations and guide empiric treatment selection.

[Postoperative wound care with custom-made wound dressings for hidradenitis suppurativa : Wound care after radical excision with secondary wound closure]

Hidradenitis suppurativa is a chronic, recurrent, autoinflammatory skin disease of the hair follicle and sebaceous glands in intertriginous skin areas. Treatment is based on clinical severity (typically classified according to Hurley stage). In advanced stages, radical excision of affected skin areas with secondary wound closure remains first-line treatment. Postoperative care in this setting should comprise nonadhesive wound dressings. The purpose of this article is to illustrate postoperative wound care after radical excision with secondary wound closure using nonadhesive, absorbent dressings for economical and effective care.

Spectrum of ichthyoses in an Austrian ichthyosis cohort from 2004 to 2017

BACKGROUND

Ichthyoses are a heterogeneous disease group, which makes clinical classification challenging. An ichthyosis cohort at a center for genodermatoses is presented in detail.

PATIENTS AND METHODS

Patients with clinically and/or genetically confirmed ichthyosis seen from 2004 to 2017 and listed in a database were included. Disease onset, phenotype, histology, comorbidities and family history were described in detail. In genetically tested patients, the prevalence of various ARCI genes, ARCI phenotypes and syndromic ichthyoses, as well as genotype-phenotype correlation and year/method of genetic testing was assessed.

RESULTS

Of all 198 patients who were included in the cohort, 151 were genetically tested. 81 had ichthyosis vulgaris, 43 X-linked ichthyosis, 38 autosomal recessive congenital ichthyosis (ARCI), 9 keratinopathic ichthyosis (KPI) and one exfoliative ichthyosis. 26 individuals suffered from syndromic ichthyoses. A good genotype-phenotype correlation was observed for common ichthyoses and KPI; the correlation was less good in syndromic ichthyoses. In 91 % of ARCI patients an accurate diagnosis was obtained by genetic testing. In only 33 % of syndromic ichthyoses was the definitive diagnosis suspected before genetic testing, which revealed a causative mutation in 86 % of cases.

CONCLUSION

This study describes the spectrum of ichthyoses in a center of expertise and shows that genetic testing should become a diagnostic standard for this disease group.