Innere Medizin (Heidelberg, Germany)最新文献

Urinary tract infections (UTI) rank among the most common bacterial infections worldwide. Clinical challenges include acute severe manifestations and frequently relapsing disease, both favored by urinary tract abnormalities and systemic immune defects. To judge morbidity during clinical infection, the ORENUC criteria assess clinical risk, likelihood of relapsing disease, extragenital manifestations, nephropathy, urologic and catheter-related factors. Additional diagnostic measures of severe and unusual manifestations include an extended history and specific clinical examination together with nephro-urological imaging, namely ultrasound, laboratory assessment of systemic disease, and removal or exchange of catheters and other foreign materials in the urinary tract. The current primary antibiotics recommended for uncomplicated pyelonephritis in Germany are gyrase inhibitors and cephalosporins. Microbiological diagnosis and resistance testing is central to improve efficacy and reduce side effects, especially in complex clinical situations. New antibiotic developments offer new options, especially in presence of proven antimicrobial resistance. Management of relapsing infections needs to aim at improvement of local urogenital and systemic immunological factors, which is however frequently challenging to impossible to achieve. Patient contributions including behavioral modifications and longterm or intermittent antibiotic and other drug therapy. Overall, therapeutic options are limited and new pathophysiological and antimicrobial strategies are urgently needed.

A 59-year-old female patient presented with acute polyarthritis after a holiday in the Caribbean. In addition, constitutional symptoms as well as myalgia and arthralgia were reported. Imaging demonstrated synovitis of the wrist and fingers without erosive changes. Immunoserological findings were normal with no evidence of autoimmune disease or vasculitis. Further evaluation revealed serological evidence of chikungunya virus infection.

The case of a 72-year-old female patient with arrhythmogenic syncope associated with a combination therapy of flecainide and lacosamide is presented. The authors believe in an additive effect of both drugs on myocardial voltage-gated sodium channels with extraordinary QRS widening, exit block with temporary pacing and complete reversibility through infusion of sodium bicarbonate as bail-out therapy.

Digital health applications (apps) have been available on prescription since 2019 and offer a multitude of functions in health monitoring, symptom recognition, follow-up monitoring and patient care. The Digital Care Act from 2023 strives for a comprehensive integration of apps into medical care. The utilization of artificial intelligence (AI) in health apps promises an earlier diagnosis, sensitive symptom monitoring, optimization of courses of treatment, more effective doctor-patient communication and saving of resources. The integration of health apps and AI can enable a stronger personalized high-value care.

The following case describes the relapsing and ultimately fatal outcome of DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome as an often misdiagnosed drug-induced hypersensitivity reaction. The disease was complicated by progressive worsening with involvement of multiple organs and profound agranulocytosis. The main goal of this article is to raise awareness of the syndrome and its potential severity. Moreover, it outlines a number of pitfalls that may face the clinician.

Arterial hypertension (aHT) currently affects nearly 1 in every 3 persons in Germany and the number of those affected is steadily increasing. Only half of the patients treated show a controlled blood pressure in the follow-up. A suboptimal treatment involves the danger of cardiovascular and renal events that under certain circumstances can have a fatal course. The publication of the first national treatment guidelines (NVL) on hypertension and the new guidelines of the European Society of Hypertension (ESH) 2023 simultaneously represent two updates. Both emphasize the necessity to avoid hypertension-mediated organ damage (HMOD) and the identification of high blood pressure. The focussing on preventive measures and lifestyle recommendations as well as the simplification of target blood pressure values play important roles in the routine practice. This article provides a practical summary of the current recommendations of both guidelines on the diagnostics and treatment of aNT, discusses relevant differences and provides routinely applicable advice.

Life-threatening side effects of mistletoe therapy are mostly negated by physicians working in complementary medicine. This article reports on a case of life-threatening anaphylactic shock after carrying out mistletoe therapy. In patients with a carcinoid syndrome (flushes, diarrhea, bronchoconstriction) the diagnosis of anaphylactic shock can be masked by the findings of a neuroendocrine neoplasm. Before a planned complementary medicine mistletoe therapy patients should also be well-informed on rare life-threatening side effects.

Herpes zoster (HZ) is a sequela of the reactivation of a latent varicella zoster virus (VZV) infection of the sensory dorsal root ganglia and cranial nerves due to a decrease in specific T cell-mediated immunity as a result of immunosenescence, immunodeficiency diseases, e.g., human immunodeficiency virus (HIV) infection or immunosuppressive therapy. The disease burden of HZ greatly increases with age; however, younger patients with, e.g., inflammatory rheumatic diseases, also have an increased risk of HZ, which is higher under certain immunosuppressive drugs, e.g., Janus kinase (JAK) inhibitors or glucocorticoids. The risk of complications, e.g., postherpetic neuralgia (PHN) is also increased in this patient group. Of the two vaccines licensed in Germany, the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute recommends the recombinant adjuvanted HZ subunit vaccine for the standard vaccination of all persons ≥ 60 years and for persons ≥ 50 years with an increased HZ risk for prevention of HZ and PNH due to its better efficacy and longer duration of effectiveness. Clinical trials have demonstrated a 90-97% efficacy in preventing HZ in immune healthy adults aged ≥ 50 years, with a much higher reactogenicity in the vaccine group compared to placebo. Adequate efficacy, immunogenicity and safety have also been demonstrated in clinical trials in immunocompromised and immunosuppressed patients. An extension of the STIKO vaccination recommendation to all adults with an increased HZ risk in line with the approval would be welcome.