Patrick Lillie

Healthcare associated discitis in the era of antimicrobial resistance.

Discitis is a recognized and serious complication of healthcare. We describe the cases of 4 patients, who presented to our unit over a 1 year period. All had exposure to healthcare before the onset of discitis and developed complex infections. There were no additional risk factors for discitis in any of the cases. The risk factors for discitis were peripheral intravenous cannulation in 1 case, intraabdominal surgery in 2 cases and multiple risks including intensive care admission and urethral catheterization in another case. The described cases demonstrate the importance of ascertaining a definitive microbiological diagnosis in healthcare associated discitis and the complex and expensive antibiotic regimens that may be required for the management of such cases. Clinicians should be aware when seeing patients with back pain and recent health care exposure that discitis can be present and complicated and that resistant organisms can be the cause.

Screening African HIV positive patients for imported parasitic infections

OBJECTIVES To assess the results of screening for tropical parasitic infections in HIV patients from Africa, presenting to an infectious diseases unit in the UK. METHODS A retrospective case note review of patients from Sub-Saharan Africa, newly diagnosed with HIV infection, between March 2001 and November 2007. Data on patient demographics, clinical presentation and laboratory results, including tropical screening tests, were collected. RESULTS 146 patients had notes available for review. 22 different countries were represented. 84 patients were screened, by serology, for schistosomiasis, strongyloidiasis, filariasis and leishmaniasis. 13/122 (10.7%) patients tested had positive schistosomiasis serology and 2/107 (1.9%) had positive strongyloidiasis serology. No patients had positive Leishmania (n = 108) or filaria (n = 97) serology. 3 of 38 (7.9%) had stool samples that were positive for pathogens. Positive schistosomiasis serology was associated with male sex (61.5% vs 28.4% p < 0.05) and a higher mean eosinophil count (0.46 vs 0.12 cells/microL p < 0.0001). CONCLUSION Screening HIV patients from Sub-Saharan Africa for schistosomiasis in this population, was positive in over 1 in 10 patients. We would recommend screening for schistosomiasis in these patients. Our results do not support serological screening for leishmaniasis or filarial infection in these patients.

Empiric albendazole therapy and new onset seizures – A cautionary note

Rapid human immunodeficiency virus testing is acceptable and feasible for sooner than conventional testing. In the obstetric outpatient settings, such point-of-care testing was even faster than laboratory-based testing. Similar sensitive and specific tests are needed for point-of-care screen for influenza H1N1 virus. Fiscal support to research, academic and biotechnology industry would be essential to build up 1-2 step assays that could be carried out in physicians’ surgery and in the field. Ultimately, a field worker should be able to carry out such tests using nasopharyngeal secretions. Fiscal input would be cost effective to address H1N1 morbidity in areas where viral culture, shell vial culture, direct immunofluorescence or real time PCR are not available. Such a scenario is prevalent in remote and underserved locations in otherwise affluent countries.

Severe myositis on commencement of efavirenz, abacavir and lamivudine, in the absence of lactic acidosis or classical abacavir hypersensitivity.

Myositis in HIV may be due to HIV itself, or to opportunistic infection, malignancy or drug treatment. Severe myositis or rhabdomyolysis have never been reported with the commonly used nucleoside reverse transcriptase inhibitor abacavir, although creatine phosphokinase may rise modestly, particularly if abacavir hypersensitivity occurs. We report an unusual case of abacavir use associated with a thousand-fold rise in creatine phosphokinase in the absence of features of hypersensitivity. The case was also notable firstly in that there was an absence of the HLA-B5701 allele, the most common human leucocyte antigen (HLA) allele associated with hypersensitivity, and, secondly, as the case occurred in an African patient, African people not being prone to abacavir hypersensitivity.

Bacteraemia service model of infection care

In June 2005 we implemented a similar service to Minton et al’s,1 which provides unsolicited bedside reviews and a typewritten report for all patients with bacteraemia. We reviewed 151 adults from June 2005 to November 2006. The most common isolate was Staphylococcus aureus (45%), of which 40% were methicillin resistant; the most common source was central venous lines (27% of patients). For hospital …