Comparison of the performance of selenite cystine and mannitol selenite enrichment broths in the isolation of Salmonella spp. from faeces.

Over a four-month period, 4,658 routine faecal samples were examined in four laboratories and the isolation rates of Salmonella spp. from mannitol selenite (MS) and selenite cystine (SC) broths plated to xylose lysine desoxycholate agar (XLD) compared. The isolation rate by MS was 1.55% and by SC was 1.48%, a small difference which is not statistically significant. Significantly fewer colonies were selected for supplementary testing from SC than MS (p = 0.029), thus reducing confirmatory work. In laboratories where SC is already used for food and environmental work, an opportunity exists to limit stocked salmonella enrichment broths to SC alone.

Fungal infections: a survey of laboratory services for diagnosis and treatment.

A questionnaire on the services provided and the methods used for the diagnosis of fungal infections and for the support of antifungal chemotherapy was sent to members of the British Society for Medical Mycology (BSMM) and the British Society for Antimicrobial Chemotherapy (BSAC). Ninety-five responses from general microbiology laboratories in the United Kingdom were analysed, and we compared services provided by laboratories that serve a transplant unit with those offered by other laboratories. We estimate that about 150 cases of cryptococcosis, 500 to 600 of candidaemia, and 300 to 400 of invasive aspergillosis are identified by laboratories in the United Kingdom (UK) each year. The clinical laboratories are aware of the importance of fungal infection, but rely heavily on reference services. In some laboratories, however, the degree of investigation of specimens and the procedures in use are inadequate for diagnosing systemic mycoses and determining the susceptibility of isolates to antifungal agents. The balance between reference and local services requires attention and external quality assurance needs to be applied effectively. In addition, effective methods for the diagnosis of systemic mycoses, and reliable and practicable methods for determining the susceptibility of isolates to antifungal agents, are needed urgently.

Gastrocolic fistula secondary to primary gastric lymphoma.

Gastrocolic fistula in primary non-Hodgkin's lymphoma (NHL) of the stomach is rare; in a review of the literature we found only four cases, all in association with disseminated (stage IV) disease. We describe the first case of a gastrocolic fistula in a patient with stage IE lymphoma. The diagnosis was suggested by feculent vomiting, and the fistula was located using barium enema and CT scan. Therapy consisted of local resection followed by combination chemotherapy.

Venous intravasation of barium: CT findings.

Portal venous barium and air intravasation occurred during an air contrast enema in a man with ulcerative colitis. Abdominal plain radiography and CT subsequently showed increased hepatic density. Computed tomography also showed colonic intramural and pericolic nodal or venous barium, increased splenic density, and pulmonary arterial barium. The patient's course was benign because little barium embolized beyond the liver into the systemic circulation.

Prevention of infection by ciprofloxacin in neutropenia.

Ciprofloxacin with erythromycin, each at a dose of 250 mg 12-hourly, is effective prophylaxis against Gram-negative bacteraemia in neutropenic patients. The erythromycin component may contribute little to prophylaxis and does select for erythromycin-resistant viridans streptococci which then cause bacteraemia. Ciprofloxacin prophylaxis does not prevent coagulase-negative staphylococcal bacteraemia and resistant strains are selected. Initial use of vancomycin with a ureidopenicillin in pyrexial patients is currently justified by the exclusively Gram-positive nature of breakthrough bacteraemia. In patients failing to respond to this regimen, treatment modification to include full-dose amphotericin is frequently effective. Surveillance and containment isolation of patients carrying resistant Gram-negative species is prudent to prevent the spread of such resistant bacteria in oncology/haematology units.