Background: Tetanus disease is caused by Clostridium tetani and is one of the most common infectious diseases worldwide. Despite international recommendations for patients with a chronic leg ulcer, there has been a distinctive lack of protection provided by vaccination for these patients in the past decades. Methods: Within the context of our prospective clinical investigation we consecutively determined the concentrations of immunoglobulin G antibodies against C. tetani in 100 patients with a chronic leg ulcer between January 2005 and November 2006. Results: A total of 38 patients were male, and 62 were female. Their mean age was 71 years (25–94). In a total of 47% (n = 47; 13 male, 34 female, mean age: 76 years) of the patients, insufficient immunoglobulin G antibody concentrations were detected. Particularly the subanalysis indicated an insufficient tetanus protection provided by vaccination in 70% of the people aged ≧80 years. Conclusion: A chronic wound, e.g. in the form of a leg ulcer, is known as a potential entrance for C. tetani. Unlike acute wounds, however, it is hardly ever considered to be a reason for assessment of the tetanus immune status. The results of our investigation clarify that particularly elderly people suffering from a leg ulcer have to be tested for tetanus protection provided by vaccination more strictly than ever, and if necessary, vaccinations have to be renewed.

Dissemination is a rare complication of herpes zoster, aided by immunosuppression. In the presented case there was no evidence of malignancy or other cause of immunosuppression, but the patient also had type 2 diabetes with very high blood glucose levels. The diabetes was thought to be causally related to the ineffective immune response to varicella zoster virus. There has been no previous published report of this relationship.

Chronic wounds occur in 1-2% of the population. After the age of 80 the incidence raises up to 4-5%. Leg ulcers are the most frequent diagnosed chronic wound. In this most often affected age group malnutrition develops more frequently compared to the total population. The combined presence of chronic wounds and malnutrition suggests a potential causative connection. In this clinical investigation, data evaluating the nutritional status in patients with chronic leg ulcers, derived from clinical examination, medical history and laboratory tests was analyzed for the first time for a German patient collective. Over a time period of one year we evaluated 41 patients for body mass index, diabetes mellitus, restricted mobility, diet, nicotine and alcohol use, and blood levels of vitamins, trace elements, lipids and HbA1c. We further employed the MNA-questionnaire for malnutrition. We rarely found deficiencies but often improper nutritional practices. Thus we consider that it important to evaluate nutritional status even in obese patients with leg ulcers and poorly healing wounds.

Eine 81-jährige Patientin klagte über generalisierte Ekzeme mit therapierefraktären palmoplantaren Hyperkeratosen und akut exazerbierter Intertrigo. Seit der Jugend traten die Hautveränderungen rezidivierend auf. Im letzten Jahr kam es wiederholt zu Superinfektionen dieser Läsi-onen. > Seit der Jugend traten die Hautveränderungen rezidivierend aufIn der Verwandtschaft der Patientin sind keine vergleichbaren Erkrankungen bekannt. Die Patientin hat jedoch keine Geschwister oder Kinder. HautbefundBei der körperlichen Untersuchung zeigte sich ein generalisiertes, teilweise impetiginisiertes Ekzem mit zahlreichen Exkoriationen (. Abb. 1). Inguinal und gluteal beidseits fanden sich zudem exsudative Erosionen. Palmar und plantar imponierten ausgeprägte verruciforme Hyperkeratosen (. Abb. 2).

No abstract