Life-threatening cardiac failure in a healthy young female with Irukandji syndrome.

We present a case of a previously well 24-year-old female patient who developed severe and life-threatening Irukandji syndrome that required ventilation and inotropic support. This case provides further evidence that there are jellyfish other than the Irukandji jellyfish that can cause cardiac decompensation, and there is a suggestion that application of a pressure immobilization bandage may worsen the envenomation. We include our recommended treatment for the Irukandji syndrome.

Three fatal pneumococcal polysaccharide vaccine failures.

Three Indigenous Australian adults died of invasive pneumococcal disease, despite vaccination with the pneumococcal polysaccharide vaccine an average of 18 months previously. Pneumococcal isolates from the patients had serotypes that are included in the vaccine. Two of the adults were alcoholics and the other had heavy recent alcohol intake. The public health implications, and possible optimal vaccination schedules to minimise vaccine failures, are discussed.

The therapeutic dilemma of an ectopic pregnancy in the setting of the severe ovarian hyperstimulation syndrome.

Severe ovarian hyperstimulation syndrome as a result of assisted reproductive therapy occurs rarely. However, this iatrogenic condition can result in a life threatening illness with difficult management dilemmas for the attending physicians. A patient with severe adult respiratory distress syndrome and septicaemia after in vitro fertilization required prolonged intensive care treatment and subsequently had a probable ectopic pregnancy treated with systemic methotrexate as an alternative to surgical management. A satisfactory outcome was obtained, followed by a spontaneous successful pregnancy some months after these events.

An outbreak of hepatitis A in an intensive care unit.

We describe an outbreak of hepatitis A that occurred in an Intensive Care Unit (ICU) in a regional hospital in North Queensland. Seven people were infected including two patients, two close contacts of the index patient and three ICU nursing staff. The index case was admitted with an overdose and multiple trauma; he was not suspected to be incubating hepatitis A. The outbreak was initiated as a result of inadequate precautions taken whilst handling the index patient's bile. Problems identified upon reviewing the outbreak were inadequate terminal cleaning of equipment, food consumption in the ICU and inadequate handwashing practices. Implementation and maintenance of standard infection control practices is vital if further outbreaks of hospital-acquired hepatitis A and other enteric infections are to be avoided. We also suggest that the inactivated hepatitis A vaccine be considered for ICU staff.

Paraquat and diquat interference in the analysis of creatinine by the Jaffé reaction.

Paraquat and diquat were shown to interfere significantly in the measurement of plasma creatinine by the alkaline picrate (Jaffé) reaction in a young man who ingested a massive dose of a mixture of the 2 herbicides. It is likely that these bipyridylium compounds react in a manner similar but at different rates compared with creatinine in the Jaffé reaction.