Between February 1991 and January 1992, elevated alanine aminotransferase (ALT) levels were observed in several hemodialysis patients in a dialysis center in Dendermonde, Belgium. By the end of 1992, 25 out of 68 patients had seroconverted for HCV antibodies. The HCV strains from 23 of these seroconverters were genotyped and classified as genotype 1b. Sequence analysis of the HCV Core region was carried out in 12 patients, 9 of whom were infected with a strain bearing a unique sequence motif as compared with the currently known HCV 1b strains. A new 5' UR/Core line probe assay was designed to screen for such variations. Twenty patients tested positively for this special sequence motif, while the other 3 showed the regular subtype 1b sequence. Phylogenetic analysis of the Core sequences further revealed that the latter three were neither related to the main special strain of the infection, nor to each other. These three strains could be traced to two patients already infected at the time of residence in other dialysis units and to one patient who already showed ALT elevations in 1989. Epidemiological studies revealed no traceable source for this outbreak. In conclusion, molecular analysis demonstrates nosocomial transmissions by a peculiar genotype 1b strain in a dialysis center. Three other genotype 1b strains were also present in the unit, but were not responsible for the outbreak.

Streptococcus zooepidemicus is an animal commensal with the potential of zoonotic transmission through ingestion of contaminated dairy products, leading to outbreaks of Post-Streptococcal Glomerulonephritis (PSGN). We report for the first time acute renal failure with need for renal replacement therapy, as a complication of S. zooepidemicus bacteremia resulting from direct horse to human transmission in a young adult. Both clinical disease course and immunohistochemical staining patterns on renal biopsy had some atypical features of PSGN suggesting persistent activation of the alternative complement pathway but no known complement factor dysregulations could be identified.

Introduction. At emergency departments, history taking is often very brief. We present a case of an Aeromonas wound infection, that illustrates the importance of careful history taking. We also report the first successful use of polarized light as additional therapy for healing of this infectious wound. Case presentation. A healthy boy was diagnosed with a wound infection, after a fall onto rocks. At first, it remained unmentioned that there had been contact with ditchwater, so he was treated with amoxicillin-clavulanic acid. Only after the finding of an Aeromonas strain in the wound culture, and treatment with a fluoroquinolone, did he recover. Wound healing was aided with the use of polarized light, and with good effect. To our knowledge, this is the first report on the effect of polarized light on the healing of infectious wounds. Conclusion. Careful history taking is essential for adequate empiric therapy when faced with wounds and wound infections. Aeromonas infections are associated with water exposure, and should be treated with fluoroquinolones. Polarized light seems to have a good result on healing of infectious wounds.