The Laboratory Diagnosis of Syphilis.

Syphilis is a multisystem infection caused by the spirochete Treponema pallidum. Currently, cases of possible syphilis are commonly investigated using the treponemal serological tests T. pallidum IgG chemiluminescence immunoassay (CLIA) and the T. pallidum particle agglutination (TPPA). The nontreponemal rapid plasma reagin (RPR) flocculation test is used to assess disease activity. There has been a resurgence of syphilis diagnoses in Australia. Large foci of infection have been identified in isolated communities. The remoteness of these locations, in conjunction with the particular sociocultural characteristics of the population, pose unique challenges to the traditional diagnostic and treatment paradigms for syphilis. As a consequence of this increased incidence of syphilis, there has been interest in the utility of point-of-care tests (POCTs), nucleic acid amplification tests (NAATs), the role of IgM testing in suspected congenital syphilis, and the laboratory investigation of possible neurosyphilis. This review looks at the current status of traditional serological assays and provides an update on more recent methods. It assesses the published literature in this area and makes recommendations for the rational use of pathology testing to aid in the diagnosis of the many facets of syphilis.

Antimicrobial stewardship in diabetic ketoacidosis: a single-centre experience.

BACKGROUND: Diabetic ketoacidosis (DKA) is a common and serious complication arising predominantly in patients with type 1 diabetes mellitus. International data demonstrate that infection is one of the most common precipitating causes of DKA. Currently there are limited data regarding the role of antimicrobial stewardship (AMS) in this setting. AIM: To provide epidemiologic data regarding infections precipitating DKA, microbiological aetiology and antimicrobial prescribing practices in order to inform AMS interventions. METHODS: Retrospective chart review of all type 1 diabetes mellitus DKA presentations from May 2015 to June 2018. RESULTS: In total, 249 DKA presentations occurred in 111 patients. Suspected infection accounted for 100/249 (40%) presentations, and only 36/249 (14.5%) were proven or probable infections. Skin and soft tissue infection was the most common (9/36, 25%), followed by urinary tract infection (8/36, 22%) and respiratory tract infection (7/36, 19%). A pathogen was identified in 24/100 presumed infections and included Staphylococcus aureus (24, 46%), Klebsiella pneumoniae (4/24, 17%) and Escherichia coli (3/24, 13%). No viral pathogens were identified. Of 80 empirical antimicrobial prescriptions, 75% were inappropriate based on guideline management of the documented suspected infection. Single agent ceftriaxone was appropriately prescribed in 7/23 (30%) cases, and was most frequently prescribed overall 23/80 (29%). CONCLUSION: This study demonstrates a lower incidence of infection compared to most previous publications, and suggests that infection-precipitated DKA may be over reported. Furthermore, our findings provide support for the role of AMS in the management of DKA.

Successful outpatient management of Campylobacter fetus bacteremia in an immunocompetent patient with endovascular involvement.

We describe a case of Campylobacter fetus bacteremia with endovascular involvement in an immunocompetent female patient. The patient was treated with high dose ciprofloxacin as an outpatient and recovered well.

Bacterial culture and antibiotic susceptibility testing.

Complicated bacterial infections should prompt clinicians to pursue a definitive diagnosis. Two methods of bacterial culture and antibiotic susceptibility testing are commonly used in veterinary medicine: (1) the disk diffusion technique and (2) the broth dilution technique. Both methods identify the infecting pathogen and the antibiotics that are likely to inhibit its growth. The broth dilution test also provides the minimal inhibitory concentration, which can help in making the best antibiotic choice.