Community-associated meticillin-resistant Staphylococcus aureus: epidemiology, microbiology and clinical impact in East Yorkshire, UK.

The prevalence of community-associated meticillin-resistant Staphylococcus aureus (CA-MRSA) is increasing worldwide. Whilst CA-MRSA has been reported in the UK, there is little information concerning its clinical impact. Here we report three epidemic lineages of CA-MRSA occurring in East Yorkshire and describe their epidemiology, microbiology and clinical impact. Although CA-MRSA was most often associated with uncomplicated skin and soft tissue infections or asymptomatic colonisation, serious infection and fatalities were documented. Community-based transmission was noted in two separate households. We highlight limitations to existing definitions and propose debate to further define CA-MRSA and allow further study of its epidemiology and clinical impact in the UK.

Successful use of oral linezolid as a single active agent in endocarditis unresponsive to conventional antibiotic therapy.

Treatment of resistant gram-positive endocarditis is difficult. We report a case of resistant Staphylococcus epidermidis endocarditis that failed to respond to conventional antibiotic therapy but was treated successfully with an oral regimen of a new antibiotic, linezolid as a single active agent. This case report demonstrates the use of linezolid as an effective alternative to conventional antibiotics in such cases.

An unusual case of infective endocarditis.

A rare case of Corynebacterium striatum endocarditis on a bioprosthetic aortic valve replacement, treated medically, is reported. The presentation was subacute, and initially endocarditis screening was negative. Because of the failure of symptoms to settle further screening was performed which confirmed the organism in several sets of blood cultures. This emphasises the importance of persistent screening for endocarditis if the history raises any suspicion of this potentially serious infection, especially in the presence of prosthetic valves.

Inhaled micronised gentamicin powder: a new delivery system.

Forty patients undergoing routine bronchoscopy were randomised to receive inhaled micronised gentamicin powder (180 mg) or nebulised gentamicin solution (160 mg) one hour before the procedure. Similar levels of gentamicin were detected in bronchoalveolar lavage fluid in the two groups (micronised powder (n = 20) 9.3 (SD 9.3) mg/l, nebulised solution (n = 20) 8.0 (7.8) mg/l). The micronised gentamicin powder preparation caused cough in half the patients but this did not stop their receiving a full dose. Dry powder gentamicin may be a convenient formulation for long term inhaled treatment if the problem of cough can be overcome.

Varicella in an immunocompromised patient an electron microscopic study.

We report the electron-microscopic appearances of tissues from an immunocompromised patient who died of chickenpox. We observed structures consistent with some of the reported appearances of Varicella-Zoster virus in cultured cells, and tubular structures that have not to our knowledge been previously described.

Legionella pneumophila serogroup 12 pneumonia in a renal transplant recipient: case report and environmental observations.

We describe the first reported case of pneumonia due to Legionella pneumophila serogroup 12 in the UK. This hospital-associated infection occurred in an immuno-incompetent patient and coincided with a change in character of the local environmental strains of legionellas. The patient produced a serological response both to her own isolate and to L. pneumophila serogroups 1-6. Thus serodiagnosis was attainable using the usual screening antigens.

Mycoplasma hominis as a respiratory pathogen in X-linked hypogammaglobulinaemia.

We report a case of lower respiratory tract infection with Mycoplasma hominis in a patient with X-linked hypogammaglobulinaemia.

Parvovirus infection associated with aplastic crisis in a patient with HEMPAS.

An aplastic crisis associated with parvovirus infection occurred in a patient suffering from hereditary erythrocytic multinuclearity associated with a positive acidified (Hams) test (HEMPAS). This case emphasises that any patient who has a shortened red cell survival is susceptible to an aplastic crisis induced by parvovirus.

Cytomegalovirus antibody status in couples.

Sera from fifty couples were assayed for the presence of antibody to Cytomegalovirus. In twenty of the couples only one partner was seropositive. If serological status accurately distinguishes between infected and uninfected individuals, these data indicate that conjugal transmission of Cytomegalovirus is inefficient.