Management of patients with epidemic methicillin-resistant Staphylococcus aureus: experience at an infectious diseases unit.

Between January 1983 and April 1984 60 patients completed their admission to an infectious diseases unit for management of methicillin-resistant Staphylococcus aureus. All had been shown to be colonized with a particular epidemic strain (EMRSA), and most isolates were from the nose or from broken skin sites. Eight patients were thought to have systemic EMRSA infection, of whom three had bacteraemia. Ten of the 60 patients died of severe underlying disease, eight were discharged home well but still colonized with EMRSA, four never had positive isolates after admission, and the remaining 38 cleared their EMRSA colonization in an average of 2 months. Five patients had further isolates of EMRSA after three negative, weekly screening tests and one after four negative screenings. No patients had further isolates after five or more negative screening tests.

Surveillance of methicillin-resistant Staphylococcus aureus in England and Wales, 1986-1990.

The incidence of methicillin-resistant Staphylococcus aureus in England and Wales was monitored by a weekly reporting scheme from early 1986 to March 1990. Potential coverage was approximately two-thirds of hospital beds. Reporting centres fell from a peak of 210 in 1986 to a low of 101 centres early in 1989 with later recovery. There were 2367 positive reports in 1986, 2174 in 1987, 1700 in 1988, 1701 in 1989 and 632 in the first quarter of 1990. Colonizations outnumbered infections by 2:1. There were marked regional differences: North-East Thames was dominant in 1986 and 1987, and then declined; South-East Thames showed a dramatic increase in 1988 which continued. Other regions showed less significant changes but there were continuing problems in the South-Western Region and in the West Midlands. Some of these changes were related to the decline of EMRSA-1, possibly due to the introduction of effective control measures, and to the emergence of EMRSA-3 in South-East Thames and its spread to Wessex.

Listeria monocytogenes meningitis associated with eating soft cheese.

A 36-year-old woman became ill with meningitis caused by Listeria monocytogenes. She had eaten soft cheese from which a similar organism was isolated.

Comparison of fitness of two isolates of Mycobacterium tuberculosis, one of which had developed multi-drug resistance during the course of treatment.

OBJECTIVES: We report the cases of two patients, brother and sister, both with pulmonary tuberculosis. Both patients complied poorly with treatment. One developed multi-drug resistant disease, whilst the other did not. We aimed to show that the two infecting strains were the same, and then to compare the fitness of the resistant strain to that of the sensitive strain. METHODS: The isolates were typed by RFLP. The fitness of the multi-drug resistant tuberculosis strain was determined by calculating the ratio of generation produced by the drug-resistant and a drug-susceptible strain in a mixed culture. The number of bacteria present in this broth culture was estimated using the Miles and Misra technique. The number of drug-resistant bacteria present was determined by inoculating aliquots of broth onto Middlebrook 7H10 agar with 5mg/l rifampicin. RESULTS: The infecting strain of Mycobacterium tuberculosis was shown to be the same on RFLP typing in both cases. It was found that the multi-drug resistant organism had decreased fitness compared to the sensitive organism. CONCLUSION: The decreased relative fitness of the resistant strain implies a physiologic cal cost for the development of drug resistance.

Post-infectious disease syndrome.

Many post-infectious syndromes have been recognized in the last 50 years, some following viral infections and others closely related to bacterial disease. The occurrence of prolonged fatigue following an apparent viral illness of varying severity is also well documented. The lack of a recognizable precipitating cause and the tendency for epidemic fatigue to occur among hospital staff led many to believe that the illness may be psychogenic in origin. However, there is serological evidence that some cases may follow enterovirus infections or occasionally delayed convalescence from infectious mononucleosis. Much interesting work is currently in progress relating fatigue to persisting immunological abnormalities, and the development of molecular immunology makes this a most exciting field of research. This paper reviews the evidence for and against a definitive post-viral fatigue syndrome and examines the results of research carried out in the last 50 years.

Childhood tuberculosis: clinical aspects.

The clinical presentation of tuberculosis in children can take many forms. This paper describes six cases seen within a 12-month period at a regional department of infectious and tropical diseases. Three of the cases had meningeal disease, two had pulmonary infection and one had miliary disease. They illustrate the difficulties of accurate diagnosis and its importance in choosing the most effective treatment. Guidelines are provided on the management of childhood tuberculosis.

Scarlet fever can mimic toxic shock syndrome.

We describe a patient who presented with a widespread erythematous rash, diarrhoea, confusion, pre-renal uraemia and hyponatraemia. The diagnosis of staphylococcal toxic shock syndrome seemed likely as she was menstruating and there was no evidence of pharyngitis. A rising ASO titre confirmed a streptococcal aetiology and thus 'toxic' scarlet fever. Toxic shock syndrome and toxic scarlet fever are compared.

Diarrhoea-causing Escherichia coli.

Current knowledge of Escherichia coli strains responsible for bowel infections, including the more recently defined entero- hemorrhagic and entero-adherent types, is reviewed.

Staphylococcal enterotoxins in scarlet fever complicating chickenpox.

Two cases of scarlet fever are described, both following super-infection of chickenpox. Enterotoxin B and C producing staphylococci were the only pathogens identified. The role of staphylococcal and streptococcal toxins in the pathogenesis of scarlet fever and toxic shock syndrome is discussed.

The clinical features of imported malaria.

Fifty-one patients with malaria were admitted to the Coppetts Wood Unit of the Royal Free Hospital in 1991. The majority had taken either no prophylaxis or a suboptimal regimen. This was especially evident among patients from ethnic minorities. The most common clinical feature of malaria is fever, which may present months and occasionally years after exposure which can lead to failure or delay in the diagnosis. Doctors should stress the need for travellers to endemic areas to take prophylaxis as well as mosquito avoidance measures. All patients for whom a diagnosis of malaria is considered should be referred for a same-day diagnostic test, preferably to a centre with appropriate expertise in tropical medicine.

Aetiology of Kawasaki disease.

Thirteen serum samples from nine children with Kawasaki disease and 23 control samples gave negative results on screening for antibodies to hog cholera virus, border disease of sheep, bovine diarrhoea virus, and equine arteritis virus. The sera from two children with Kawasaki disease were cytotoxic; a possible link with cytotoxin from Propionibacterium acnes is considered.