Abhijit M. Bal

The echinocandins: three useful choices or three too many?

Echinocandins act by inhibiting 1,3-beta-D-glucan synthesis in the fungal cell wall. The three licensed agents in this class, namely anidulafungin, caspofungin and micafungin, have a favourable pharmacological profile. These agents are narrow spectrum with clinically relevant activity against Candida and Aspergillus spp. Several trials have established the non-inferiority of these agents over existing agents in the treatment of invasive fungal infections. Caspofungin is also licensed for empirical antifungal therapy of presumed fungal infections in patients with febrile neutropenia. This paper reviews the literature on echinocandins.

Fatal Morganella morganii bacteraemia in a diabetic patient with gas gangrene.

We report a case of a 60-year-old lady with a history of a heel ulcer that had not responded to antibiotic therapy. This progressed to involve the right leg, which was swollen and erythematous. Radiological imaging revealed the presence of gas within the fascial planes. Blood cultures on admission yielded Morganella morganii. Due to the extent of the gas gangrene and her co-morbidities the patient was not suitable for surgical intervention and was treated conservatively with antibiotics. She deteriorated and died within 72 h of presentation. Non-clostridial gas gangrene is relatively rare, and diagnosis is frequently delayed and often missed. Early aggressive surgical intervention combined with appropriate antibiotic therapy is essential. Bacterial species other than Clostridium should be considered in all cases of gas gangrene.

Gemella haemolysans Bacteraemia in a Patient with Solitary Liver Abscess

We present a case of a 42-year-old man with a solitary liver abscess and Gemella haemolysans bacteraemia. No other focus of infection was identified. The patient did not have any predisposing factors. He was treated with antibiotics for 6 weeks and the abscess was drained. He made a complete recovery.

Policy needs to be revisited

Consent should be obtained before publishing case reports.1 Signed consent forms include patient’s name and the manuscript title, which often states the illness. Several UK journals insist that consent forms are sent to their editorial offices. In the UK, processing of personal data is governed by the Data Protection Act …

English as she is spoke

I was a specialist registrar (SpR) in medical microbiology. My consultant and I were discussing a complicated case of an elderly man admitted to the surgery ward. I had earlier asked the surgery SpR to hold off antibiotics and instead monitor the patient. My consultant …