Implementation of influenza immunisation policy in general practice: 1997 to 1998.

Influenza immunisation policy and practice in primary care in central southern England was surveyed in early 1998, when national guidelines advised immunisation only for people with specified 'higher risk' medical conditions or who lived in long stay facilities such as nursing or residential homes. Three hundred and one questionnaires were returned from 441 general practices (68%). Between 71% and 82% of all respondents stated that they 'always' offered influenza immunisation to adults with the specified 'higher risk' medical conditions. For children the corresponding range was 33% to 43%. We estimated that 11.5% of the combined practice population of two million had received influenza immunisation late in 1997. The age data supplied suggested that 64% of those aged over 75 years had been immunised. Seventy-four per cent of respondents said they would be willing to follow an age based policy. The total coverage figures mask suboptimal uptake in target groups, coupled with immunisation of those outside the target groups. This could be partly addressed by rewarding high coverage of target groups such as elderly people aged over 75 years and by clarifying the guidelines for immunisation of children with 'higher risk' medical conditions.

An atypical case of Corynebacterium diphtheriae endocarditis and subsequent outbreak control measures.

An atypical case of Corynebacterium diphtheriae endocarditis with severe rhabdomyolysis and cerebral emboli is presented. The patient underwent successful mitral and aortic valve replacements and is only the third reported case with a successful outcome following surgery. Outbreak control measures were complicated by an equivocal result from guinea pig toxin tests.

Citrobacter diversus ventriculitis and brain abscesses in an adult.

A case of Citrobacter diversus brain abscesses following urinary infection in an adult is described. The patient was treated with surgical drainage, netilmicin and cefotaxime. Citrobacter species CNS infection is discussed.

Septic arthritis caused by Corynebacterium xerosis following vascular surgery.

A case of septic arthritis due to Corynebacterium xerosis occurred after vascular surgery and was successfully treated with intravenous cefotaxime followed by oral erythromycin. The only previously reported case of C. xerosis arthritis developed in a patient with a history of similar recent surgery. The possible association of this infection with such a postsurgical setting is discussed.

Splenic and renal abscesses following Salmonella virchow septicaemia--conservative management with ciprofloxacin.

Splenic abscess formation is a serious condition which usually requires prompt surgical intervention. We report on a patient with Salmonella virchow septicaemia, complicated by peritonitis and multiple splenic and renal abscesses. This is an uncommon manifestation of non-typhoid salmonella infection, which was managed conservatively with oral ciprofloxacin, leading to satisfactory resolution and cure.

Listeria monocytogenes infection in a prosthetic knee joint in rheumatoid arthritis.

The prosthetic knee joint of a 64 year old woman with severe rheumatoid arthritis was found to be infected with Listeria monocytogenes. After treatment with intravenous antibiotics, symptoms gradually resolved. She subsequently received prolonged treatment with oral co-trimoxazole and 18 months later remained well.

Isolation of Vibrio cholerae non-01 from a Somerset farmworker and his tropical fish tank.

Vibrio cholerae non-01 is occasionally isolated from wounds. To our knowledge, this is the first such case to be reported from the U.K. It was associated with isolation of a similar organism from a tropical fish tank.

Skin rash associated with Candida guilliermondii.

We report a case in which the development of a skin rash in a neutropenic patient was associated with multiple blood culture isolates of Candida guilliermondii--an unusual isolate not previously documented to cause rashes.