Cellulitis and bacteraemia caused by Streptococcus dysgalactiae post radical vulvectomy and bilateral inguinal lymph node dissection for FIGO IB squamous cell carcinoma of the vulva, a case report.

BACKGROUND: Streptococcus dysgalactiae, also known as Group C/G Streptococci, causes infection to humans and animals. Infectious syndromes range from mild pharyngitis and cellulitis, to bacteraemia and life-threatening sepsis. This report uniquely presents a case of Streptococcus dysgalactiae subspecies dysgalactiae causing fulminant sepsis post-radical vulvectomy. CASE: Four months post modified radical vulvectomy with bilateral lymph node dissection, a 78-year-old woman presented with pyrexia and associated intercrural, upper thigh and suprapubic erythema. Aside from being a smoker, there was no documented history of immunosuppression. Blood cultures yielded growth of S. dysgalactiae, and she improved with intravenous antibiotics, fluid resusitation and electrolyte replacement. CONCLUSION: Streptococcus dysgalactiae is an important pathogen associated with bacteraemia, cellulitis, meningitis and pneumonia. Prompt and appropriate antibiotic therapy in addition to further investigations with potential surgical intervention are essential.

Exercise oncology: an emerging discipline in the cancer care continuum.

Exercise is an essential component of healthy living and well-being. While there is a global acceptance of the benefits of exercise for the general population, there exists hesitancy and confusion among health-care professionals, particularly oncologists, as to whether these benefits translate to cancer patients. Patient referrals to accessible, structured exercise programs in this setting are often overlooked by physicians when formulating a cancer management plan. There is however increasing awareness and acceptance of cancer survivorship as a part of the cancer care continuum, identifying multiple factors that contribute to well-being beyond just cancer outcomes. Efforts to optimize cancer survivorship have stimulated further academic interest in the benefits of healthy living and particularly exercise oncology. There is now compelling evidence that exercise, which includes daily activities such as walking, as well as structured programs, improves multiple-cancer outcomes such as fatigue, quality of life and likely survival, and warrants consideration in the multidisciplinary care of cancer patients. International guidelines have been established that recommend counseling cancer patients with regard to healthy lifestyle changes including exercise. However, there still remains a reluctance from oncology physicians to prescribe exercise for these patients, largely due to uncertainty with regard to their patients' ability to tolerate such an intervention, coupled with insufficient understanding of the potential benefits of these programs. There also exist patient barriers and attitudes that must be overcome. Exercise strategies and bespoke programs that are tailored to the unique abilities and goals of the patients will enhance participation. To move the field forward and integrate exercise oncology into standard practice, it is imperative to raise awareness of the benefits of exercise to cancer patients and their health-care providers. This will facilitate the prescription of exercise as part of the multimodal treatment plan with the ultimate aim of promoting an active lifestyle to optimize patient care and well-being.

Increase in Community Acquired S. aureus Bloodstream Infection Associated with the Sars-Cov-2 Public Health Emergency.

Aim In March 2020, a public health emergency related to COVID-19 was declared in Ireland, resulting in certain healthcare restrictions. We hypothesised, in the microbiology laboratory in Galway University Hospital (GUH), that the national lockdown would impact results from our blood culture service. Methods A surveillance review of all blood cultures received in the microbiology laboratory in GUH for the six-month period March-August 2020 was performed and compared to the same time-period for the preceding four years. Patient demographics and blood culture isolates were collected and reviewed. Results From March to August 2020, 5,753 blood culture sets were tested, of which 6.1% (n=351) were positive; a lower positivity rate than in previous years. In 2020, 46 S. aureus isolates were detected in blood cultures (representing 13.1% of all 351 positive blood cultures), which was significantly higher than 2016-2019. Conclusion The higher number of reported S. aureus bloodstream infections in the SARS-CoV-2-era was unexpected.

Spontaneous Escherichia coli Meningitis and Pyogenic Ventriculitis in an Adult Receiving Anti-Tumour Necrosis Factor Alpha Therapy.

Presentation A 60-year-old male taking etanercept for ankylosing spondylitis was admitted to hospital with confusion and reduced level of consciousness over the preceding 24 hours. Diagnosis Magnetic Resonance Imaging (MRI) of his brain revealed pyogenic ventriculitis, and Escherichia coli was cultured from CSF. Treatment He required placement of an external ventricular drain and was treated with a prolonged course of intravenous ceftriaxone. Conclusion To our knowledge, this is the first reported case of spontaneous Gram-negative bacillary meningitis in a patient on anti-tumour necrosis factor (TNF)-alpha therapy, highlighting the risk of rare but serious infections associated with this class of medication.

Prevention of unexplained recurrent spontaneous abortion using intravenous immunoglobulin: a prospective, randomized, double-blinded, placebo-controlled trial.

PROBLEM: The efficacy of intravenous immunoglobulin (IVIG) for treatment of unexplained recurrent spontaneous abortion was assessed in a prospective, randomized, double-blinded, and placebo-controlled study. METHOD OF STUDY: The study took place in a provincial recurrent pregnancy loss clinic, located in a tertiary/quaternary care academic center. The study subjects were women with a history of two or more documented consecutive spontaneous pregnancy losses under 20 weeks of gestation, excluding any associated with aneuploidy by karyotype analysis, and with no evidence of genetic, endocrine, infectious, anatomic, or autoimmune factors associated with a history of recurrent spontaneous abortion. The subjects were randomized to receive either intravenous immunoglobulin (Gamimune N) as treatment or normal saline as placebo. Randomization was stratified for primary, secondary, and unclassified unexplained recurrent spontaneous abortion. Success was defined as an ongoing pregnancy beyond 20 weeks of gestation. RESULTS: Sixty-two subjects enrolled in the trial. There were 37 index pregnancies and 6 cross-over pregnancies. There was no clinically significant difference between the treatment arm and the placebo arm in terms of subsequent pregnancy success. There seemed to be a higher success rate with the stratified analysis of couples with secondary unexplained recurrent spontaneous abortion, but the trial did not have sufficient power to confirm this. CONCLUSIONS: Based on this trial and three similar trials in the literature, a multicentered trial is needed to determine conclusively whether IVIG is effective in the treatment of unexplained recurrent spontaneous abortion.