ObjectiveThe increasing number of refugees seeking asylum in Europe in recent years poses new challenges for the healthcare systems in the destination countries. The goal of the study was to describe the evolution of medical problems of asylum seekers at a tertiary care centre in Switzerland.MethodsAt the University Hospital Basel, we compared all asylum seekers during two 1-year time periods in 2004/05 and 2014/15 concerning demographic characteristics and reasons for referrals and hospitalizations.ResultsHundred ninety five of 2’544 and 516 of 6’243 asylum seekers registered at the national asylum reception and procedure centre Basel were referred to the University Hospital Basel in 2004/05 and 2014/15, and originated mainly from Europe (62.3%, mainly Turkey) and Africa (49.1%, mainly Eritrea), respectively. Median age was similar in both study periods (26.9 and 26.2 years). Infectious diseases in asylum seekers increased from 22.6% to 36.6% (p<0.001) and were the main reasons for hospitalizations (33.3% of 45 and 55.6% of 81 hospitalized patients, p = 0.017) in 2004/05 compared to 2014/15. The leading infectious diseases in hospitalized patients were tuberculosis (n = 4) and bacterial skin infections (n = 2) in 2004/05; Malaria (n = 9), pneumonia (n = 6), Chickenpox (n = 5), other viral infections (n = 5) and bacterial skin infections (n = 5) in 2014/15. Infectious diseases like malaria, cutaneous diphtheria, louseborne-relapsing fever or scabies were only found in the second study period. Almost one third of the admitted asylum seekers required isolation precautions with median duration of 6–9.5 days in both study periods.ConclusionsThe changing demography of asylum seekers arriving in Switzerland in the current refugee crisis has led to a shift in disease patterns with an increase of infectious diseases and the re-emergence of migration-associated neglected infections. Physicians should be aware of these new challenges.

We report an imported case of louse-borne relapsing fever in a young adult Eritrean refugee who presented with fever shortly after arriving in Switzerland. Analysis of blood smears revealed spirochetes identified as Borrelia recurrentis by 16S rRNA gene sequencing. We believe that louse-borne relapsing fever may be seen more frequently in Europe as a consequence of a recent increase in refugees from East Africa travelling to Europe under poor hygienic conditions in confined spaces.

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Background: Management of post-traumatic open fractures resulting from severe injuries of the lower extremity continues to challenge orthopedic and reconstructive surgeons. Moreover, post-traumatic osteoarticular infections due to Clostridium species are rare, with few reports in the literature. We describe possible pathomechanisms and propose treatment options for cases of delayed diagnosis of osteoarticular infections with Clostridium spp. Case Reports: Two patients sustained severe osteoarticular infection due to Clostridium spp. after open epi-and metaphyseal fractures of the lower extremity. In combination with radical debridement, ankle arthrodesis and long-term antibiotic treatment, satisfactory results were achieved after a followup of 18 months and 24 years. Conclusion: Clostridium species are difficult to identify, treatment is usually delayed and most patients have unfavourable outcomes. Although Clostridium species can be found regularly in posttraumatic wounds, post-traumatic osteoarticular infection due to Clostridium is rare. Approximately 20 cases have been reported in patients with open fractures, located mainly in the diaphyseal area (1-4). Clostridium species are found most often in fractures with severe environmental contamination of the wound during trauma (5). Clostridium species are anaerobic or occasionally aerotolerant gram-positive rods, found in soil, feces, sewage and marine sediments (6). They have the ability to form endospores, mainly under anaerobic conditions. These spores display high resistance to physical and chemical influences and are not sensitive to antibiotics. In addition, several Clostridium species have the ability to produce numerous protein toxins, causing necrotizing tissue destruction (7). Thus, bone marrow necrosis or necrotic bone fragments may occur (1, 8). The laboratory diagnosis of clostridial diseases depends on proper collection and handling of tissue samples (6). However, diagnosis is complicated by the fact that bone and joint infections due to Clostridium species are often polymicrobial (2). Although identification can be time-consuming, complete identification and testing of antimicrobial sensitivities have to be pursued. Species other than C. perfringens display a high variability in sensitivity testing, including to penicillin, cephalosporins, carbapenems and clindamycin (9). Once the strain has been identified, aggressive surgical treatment is mandatory (10). When in doubt, temporary or definitive external fixation should be preferred over internal fixation to allow repeated lavage if necessary (2). Wound excision and lavage without extensive bone tissue resection nearly always fails (2), probably due to persistence of spores in surrounding tissue. All the infected tissue must be excised and any internal fixation hardware removed (2). As a rule of thumb, Clostridium spp. complicating diaphyseal fractures cause extended bone loss due to necrosis. Reconstruction requires time-consuming segmental bone reconstruction, frequently combined with soft tissue ...

Fallbeschreibung Ein 57-jähriger Patient stellt sich mit einem seit 8 Monaten bestehenden Hautbefund an der linken Hand (▶ Abb. 1a) in der infektiologischen Sprechstunde vor. Im Bereich des distalen Metacarpale III wird ein kleiner Tumor chirurgisch entfernt. Die Inspektion des Handrückens und die Histopathologie des exstirpierten Materials (▶ Abb. 1b, c) ergeben 3 pathologische Befunde. > Welche Befunde sind es? > Legen diese Befunde eine Verdachtsdiagnose nahe? > Wenn ja, welche? > Sind Differenzialdiagnosen möglich? > Wenn ja, welche?