Serological responses to Cryptosporidium in human populations living in areas reporting high and low incidences of symptomatic cryptosporidiosis.

One approach to investigating differences in the reported incidence of disease is to measure the extent of exposure to the organism in question by testing for a specific antibody response. IgG responses to Cryptosporidium sporozoite antigens of low molecular size in adults have been shown to be consistent and of sufficient intensity to act as reliable markers of exposure. This study used a western blot procedure to investigate the relative intensity of IgG antibody responses to the 15/17-kDa Cryptosporidium sporozoite antigen complex and the 27-kDa antigen in sera from two cities in north-west England: Liverpool (low numbers of clinical cases reported) and Preston (high numbers reported). The intensity of antibody response to the 15/17-kDa antigen complex was significantly greater in the Liverpool sera, but there was no significant difference in intensity of response to the 27-kDa antigen. The relationship between diagnosed and reported cryptosporidiosis infections and infections identified by serological testing is complex, but could indicate a protective effect resulting from either exposure to non-pathogenic strains or from repeated low-level exposure to pathogenic strains.

Phlebotomy in inoculation risk patients: a questionnaire survey of knowledge and practices of hospital doctors in Liverpool.

To assess the knowledge of hospital doctors about patients at increased risk of infection with human immunodeficiency virus (HIV) or hepatitis B virus, and the precautions they took during phlebotomy in such patients, an anonymous postal questionnaire was sent to all 307 hospital doctors working at two District General Hospitals in Liverpool, UK. Two hundred and thirty-eight (77.5%) of the questionnaires were returned. More than 90% of respondents considered a history of male homosexuality, intravenous drug abuse, prostitution or a child of a prostitute to indicate an inoculation risk. There was uncertainty about a previous prison sentence in the 1980s, residence in a home for the mentally handicapped, previous residence in the tropics and hospital treatment in the tropics. Thirty-eight percent of doctors would never enquire about sexual preference, 54.1% about a previous prison sentence and 15.7% about intravenous drug abuse in their clinical history. Although 97.4% of doctors would sometimes or always wear gloves during phlebotomy of an inoculation risk patient, 25.5% always resheathed the needle after phlebotomy and 20.8% would never take the sharps box to the patient. More effort is required to identify accurately inoculation risk patients and greater care is needed in phlebotomy techniques.

Septicaemia with probable endocarditis caused by Kingella denitrificans.

A 59-year-old man developed septicaemia caused by Kingella denitrificans. Treatment was with ampicillin and an aminoglycoside. The illness was complicated by a cerebral embolus. An obvious source of infection was not found.

Cutaneous mucormycosis: a rare cause of leg ulceration.

Cutaneous mucormycosis followed trivial injury to the leg of a 72-year-old man. The lesion progressed rapidly requiring above-knee amputation.

Tuberculous otitis media -- a diagnostic dilemma.

Tuberculous otitis media can provide a diagnostic challenge even to the most astute and experienced clinician. The rarity of the condition and its propensity to masquerade as commoner otological conditions further delays diagnosis and treatment. We present the case of a 22-year-old female who presented with chronic aural discharge, unilateral hearing loss and recurrent hemifacial paralysis. The paper highlights the difficulty in diagnosis and stresses the need for a high index of suspicion in cases resistant to the common methods of treatment.

Reduction of drain-associated cerebrospinal fluid infections in neurosurgical inpatients: a prospective study.

BACKGROUND: External cerebrospinal fluid (CSF) diversion via a drain is associated with a variable risk of associated infections which cause significant morbidity. AIM: To establish whether simple interventions can reduce the incidence of such infections at a single centre. METHODS: A retrospective review of all patients undergoing an external CSF diversion procedure was carried out to determine the historical rate of infection. Following an institutional protocol which included standards on drain insertion, care, sampling and antibiotic prescribing a prospective study was carried out to observe whether infection rates had changed and which factors continued to predict drain-related infections. FINDINGS: Retrospective analysis identified 234 procedures in 159 patients over a two-year period. There were 54 drain-related infections, a rate of 21.5 per 1000 drainage days. Duration of CSF drainage [odds ratio (OR) = 1.15, P < 0.05] and the number of CSF samples taken per drain (OR = 5.98, P < 0.05) were independently associated with infection. In the prospectively gathered phase, 132 procedures were recorded in 107 patients over a one-year period. There were 18 infections, a rate of 13.7 per 1000 drainage days. The only independent prognostic factor was duration of CSF drainage (OR = 1.20, P < 0.05). Coagulase-negative staphylococci were the most commonly isolated type of organism in both series. CONCLUSION: Ensuring drains are removed promptly as soon as CSF diversion is no longer required may reduce the rate of nosocomial infections in this population despite multiple confounding factors. Institutional guidelines may promote best practice in this regard.

Finding cases of Trichomonas vaginalis infection in England.

We describe the use of a new molecular assay for Trichomonas vaginalis (TV), the Gen-Probe Aptima TV (ATV) in female attendees at community clinics, a genitourinary (GU) medicine clinic and a prison GU medicine service. Positivity rates at community clinics and GU medicine were 0/382 (0%) and 3/358 (0.8%, 95% confidence interval [CI] 0-1.7%), respectively. Positivity was significantly higher, 29/269 (10.8%, 95% CI 7.1-14.5%), odds ratio (OR) 14.3 (4.11 < OR < 59.55), in those tested at the prison. A questionnaire survey of English GU medicine clinics and data from the UK Health Protection Agency (HPA) for England both demonstrated the large variation in case rates by region and testing methods employed. Higher rates were seen in women, in prison GU medicine services and in London GU medicine clinics. The ATV assay is now CE-marked (Conformité Européenne) and so a larger prospective study of its potential application is warranted.

Vitamin status in treated patients with cystic fibrosis.

The water-soluble (B1, B2, B6, C, folic acid) and fat-soluble vitamin (A, carotene, E, and D) status of 36 patients with cystic fibrosis was assessed and compared with a control group of 21 age-matched normal children. Twenty-seven of the patients were receiving vitamin supplements (except folic acid and vitamin E) at the time of investigation. Vitamin B1, B2, and B6 status was adequate in all patients, and there was little evidence of folic acid deficiency. Vitamin C stores might not have been adequate in some of these patients, despite daily supplements with 50 mg of the vitamin. Steatorrhoea, often severe, was present in most of them. Serum carotene and vitamin E concentrations were low in over 90% of patients and were related to the severity of steatorrhoea. Vitamin A was low in over 40% of the patients despite daily vitamin supplements of 4000 IU and correlated with the serum retinol-binding protein level. Serum 25-OH cholecalciferol was low in some patients whether or not they were receiving a daily supplement of 400 IU vitamin D. In a short-term supplementation trial with water-miscible preparations of vitamin A and E in 14 patients, the serum levels of both vitamins responded well to 2 weeks of treatment with 50 mg vitamin E and 4000 IU vitamin A. Except for serum vitamin A, which was lowest in patients with the poorest clinical grading, the other vitamins were not influenced by the clinical grade of the patients.