James Knox

Murray Valley encephalitis: a review of clinical features, diagnosis and treatment

Murray Valley encephalitis virus (MVEV) is a mosquito‐borne virus that is found across Australia, Papua New Guinea and Irian Jaya.

Phenotypic Detection of Carbapenemase-Producing Enterobacteriaceae by Use of Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry and the Carba NP Test

ABSTRACT We compared the diagnostic accuracy of the Carba NP test with that of a straightforward matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) method for detecting carbapenemase-producing Enterobacteriaceae (CPE). Using PCR as the reference method, both tests demonstrated a sensitivity of 87% and a specificity of 100%. MALDI-TOF MS offers a potential alternative for the rapid detection of CPE in the clinical laboratory setting.

Acute encephalomyelitis syndromes associated with H1N1 09 influenza vaccination

### Case reports. #### Case 1. A previously healthy 38-year-old man presented with acute urinary retention and constipation after 4 days of progressive weakness affecting all 4 limbs and patchy sensory disturbance over the trunk and upper arms. Ten days prior to the onset of symptoms, he had received H1N1 09 influenza (Panvax H1N1, CSL Biotherapies, Parkville, Australia) vaccination and had experienced a spontaneously resolving febrile reaction 24–48 hours following administration. MRI of the brain, cervical, thoracic, and lumbar spine was performed (figure,A). Several areas of central cord T2 signal hyperintensity were demonstrated, extending from C3 to C6 and from T7 to L1, and a diagnosis of longitudinally extensive transverse myelitis was made. Serologic investigations for infective and autoimmune etiologies were unremarkable. CSF demonstrated an inflammatory pattern, with 80 × 106/L lymphocytes and 0.78 g/L total protein. Figure MRI from clinical cases (A) MRI thoracic spine, demonstrating extensive longitudinal intramedullary T2 hyperintensity. (B) MRI cervical spine, demonstrating multilevel cord edema and hyperintensity of proximal thoracic segments. The patient received IV methylprednisolone (1 g/d for 3 days), with resolution in power and sphincter function over the following 10 days. #### Case 2. A previously healthy 19-year-old …

Beyond injecting drug use: investigation of a Victorian cluster of hepatitis C among HIV-infected men who have sex with men

Objectives: To examine increased notifications of hepatitis C virus (HCV) in men who have sex with men (MSM) infected with HIV in Victoria, and evaluate HCV transmission risk factors other than injecting drug use.

Diagnosis of tuberculous lymphadenitis using fine needle aspiration biopsy.

Background:  Tuberculous lymphadenitis is the commonest form of extrapulmonary tuberculosis. However, the optimal approach to diagnosis, employing biopsy by either fine needle aspiration (FNA) or surgical excision, remains uncertain.

Laboratory detection of intestinal carriage of carbapenemase-producing Enterobacteriaceae – A comparison of algorithms using the Carba NP test

Stool specimens spiked with a panel of 46 carbapenemase-producing Enterobacteriaceae (CPE) and 59 non-carbapenemase producers were used to compare the diagnostic accuracy of 4 testing algorithms for the detection of intestinal carriage of CPE: (1) culture on Brilliance ESBL agar followed by the Carba NP test; (2) Brilliance ESBL followed by the Carba NP test, plus chromID OXA-48 agar with no Carba NP test; (3) chromID CARBA agar followed by the Carba NP test; (4) chromID CARBA followed by the Carba NP test, plus chromID OXA-48 with no Carba NP test. All algorithms were 100% specific. When comparing algorithms (1) and (3), Brilliance ESBL agar followed by the Carba NP test was significantly more sensitive than the equivalent chromID CARBA algorithm at the lower of 2 inoculum strengths tested (84.8% versus 63.0%, respectively [P<0.02]). With the addition of chromID OXA-48 agar, the sensitivity of these algorithms was marginally increased.

Sternoclavicular septic arthritis caused by Neisseria elongata subspecies nitroreducens

respiratory tract pathogens, influenza A and Staphylococcus aureus and Streptococcus pneumoniae. We have previously described an outbreak of P. jirovecii pneumonia in renal transplant recipients caused by two closely related genotypes of P. jirovecii, which subsequently spread to other institutions. Thus, we attempted MLST typing in this study to determine whether similar genotypes were present in infants. Unfortunately, we were unable to amplify all loci for all PCR positive specimens due to the assumed low fungal burden as also described by others. This indicates the need for larger volume sampling in future prospective studies examining for P. jirovecii prevalence in children. In conclusion, although limited by a small sample size and the retrospective nature of the study, the results suggest that Pneumocystis colonisation does occur in infants, and provides a basis for further investigation into the prevalence andmolecular epidemiology of P. jirovecii in the paediatric population, including longitudinal studies to determine the natural history and consequence, if any, of colonisation.

Chromoblastomycosis in a Solomon Islander.

A 71-year-old farmer from the Solomon Islands presented in Melbourne with fungating skin lesions on his left lower leg. The process began 20 years earlier, leaving areas of scarring between the active sites (Figure, A and B). He was otherwise well. A skin biopsy showed granulomatous inflammation with sclerotic bodies characteristic of chromoblastomycosis (Figure, C), and Fonsecaea pedrosoi was subsequently cultured and confirmed by ribosomal DNA internal transcribed spacer sequencing. Treatment combining surgical debridement, terbinafine and itraconazole is planned. Although chromoblastomycosis occurs in the tropics worldwide, it is seldom reported in Pacific Island nations.1 Advanced presentations such as this are not uncommon in endemic areas.2