Parvimonas micra (P. micra) infections causing spinal cord compression are extremely rare. We report an occult oesophageal pleural fistula presenting with spinal epidural and brain abscesses resulting in severe neurological deficits caused by P. micra. Molecular detection proved to be instrumental in identifying the causative pathogen. Essential management with decompression, drainage, antibiotics and fistula repair lead to a good outcome.

Aim: To evaluate the In vitro antimicrobial activity of Melaleuca alternifolia oil (tea tree oil), (TTO) on selected clinical isolates of fungi and bacteria, including some multidrug resistant strains commonly associated with nosocomial infection.Study Design: Laboratory experimental study. Place and Duration of Study: Public Health England (PHE), Microbiology laboratory, Southampton University Hospital, England, May 2014.Methodology: Three different concentrations (1%, 5% and 10%) of commercially available TTO were prepared (% v/v). Using an improvised disc diffusion antibiotic susceptibility testing method, the activity of TTO was tested against pure reference strains of Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922, clinical isolates of Candida albicans, Pseudomonas aeruginosa, Streptococcus pyogenes, Bacteroides fragilis, methicillin-resistant Staphylococcus aureus (MRSA), extended spectrum beta lactamase Escherichia coli (ESBL) vancomycin-resistant Enterococcus faecium (VRE), and Carbapenemase-producing Klebsiella pneumoniae (CRKP). The zones of inhibition were measure for each organism at the various concentrations of TTO.Results: All the organisms tested showed susceptibility to TTO at concentration range of 5% 10%, except Pseudomonas aeruginosa. Staphylococcus aureus ATCC 25923, MRSA, and VRE did not show any susceptibility at TTO concentration of 1%. The zones of inhibition for the susceptible organisms ranged between 10mm-19mm at 5% concentration and 15 mm-36 mm at 10% concentration of TTO.Conclusion: TTO has a broad spectrum of In vitro activity against clinical pathogens. The essential oil or its active ingredient could be of potential benefit in the treatment of fungal, common bacterial and multidrug-resistant bacteria usually associated with hospital-acquired infections as well as mixed bacterial infections involving anaerobic bacteria.

An increasing number of reports suggest that Propionibacterium acnes can cause serious invasive infections. Currently, only limited data exist regarding the spectrum of invasive P. acnes infections. We conducted a non-selective cohort study at a tertiary hospital in the UK over a 9-year-period (2003-2012) investigating clinical manifestations, risk factors, management, and outcome of invasive P. acnes infections. Forty-nine cases were identified; the majority were neurosurgical infections and orthopaedic infections (n = 28 and n = 15 respectively). Only 2 cases had no predisposing factors; all neurosurgical and 93.3 % of orthopaedic cases had a history of previous surgery and/or trauma. Foreign material was in situ at the infection site in 59.3 % and 80.0 % of neurosurgical and orthopaedic cases respectively. All neurosurgical and orthopaedic cases required one or more surgical interventions to treat P. acnes infection, with or without concomitant antibiotic therapy; the duration of antibiotic therapy was significantly longer in the group of orthopaedic cases (median 53 vs 19 days; p = 0.0025). All tested P. acnes isolates were susceptible to penicillin, ampicillin and chloramphenicol; only 1 was clindamycin-resistant. Neurosurgical and orthopaedic infections account for the majority of invasive P. acnes infections. Most cases have predisposing factors, including previous surgery and/or trauma; spontaneous infections are rare. Foreign material is commonly present at the site of infection, indicating that the pathogenesis of invasive P. acnes infections likely involves biofilm formation. Since invasive P. acnes infections are associated with considerable morbidity, further studies are needed to establish effective prevention and optimal treatment strategies.

External ventricular drainage (EVD) is one of the commonest neurosurgical procedures with more than 2500 EVDs inserted in England from April 2012 to March 2013.1 Though invariably life-saving, each...

ABSTRACT Results from 3,263 QuantiFERON-TB Gold in-tube (QFT-GIT) assays were analyzed to determine the impact of age on test performance. The proportion of indeterminate results was significantly higher in pediatric and elderly (9.1% and 7.4%, respectively) than in adult (2.6%; chi-square test, P < 0.0001) patients. A detailed analysis of indeterminate QFT-GIT assay results is presented.

The detection of a novel coronavirus in patients from the Arabian Peninsula in late 2012 raised serious concerns of a possible international outbreak. Ministries of health of the three affected countries invited missions from the World Health Organization to participate in a review of data and capacity to detect and respond to further cases. Recommendations were made for investigations to answer critical questions about human-to-human transmission and the geographic extent of the virus. Additional recommendations were made to improve surveillance capacity by acquiring the capacity to test for the virus and enhance syndromic surveillance. Available evidence continues to suggest an unknown animal reservoir for the virus with sporadic zoonotic transmission the primary epidemiological pattern of transmission. Human-to-human transmission, while it can occur, does not appear to be sustained in the community.

We present a case of a previously healthy 19-year-old man who was admitted to our intensive care unit (ICU) with meningitis and signs of cerebral coning. Investigation confirmed raised intracranial pressure (ICP) with cerebellar tonsillar herniation and cerebral venous thrombosis. Blood polymerase chain reaction (PCR) demonstrated evidence of Neisseria meningitides, serogroup Y. Besides antibiotics and steroids, treatment included intubation and ventilation to maintain a PaO2 >11 kPa, PaCO2 approximately 4.5 kPa, maintenance of a mean arterial pressure >80 mm Hg, regular IV mannitol, therapeutic anticoagulation and an external ventricular drain. Three weeks following admission, he was fully alert and orientated with no focal neurological deficits. Although elevated ICP is expected in cases of meningitis, we have demonstrated that aggressive measures to reduce ICP are worthwhile, even in the presence of clinical signs of coning, which in this case resulted in a good outcome.

We describe an unusual case of visceral Leishmaniasis affecting the gastrointestinal tract in a young immunocompetent patient whose only recent foreign travel was a trip to Mexico 9 months previously. She presented insidiously with diarrhoea, weight loss and developed subacute intestinal failure. Interestingly, she lacked most of the typical features of acute infection, including visceromegaly, fevers and hypergammaglobulinaemia. Atypical visceral involvement involving the gastrointestinal tract is well recognized in HIV coinfection, but very rare in immunocompetent patients. Repeated microscopy and culture of endoscopic biopsies failed to identify Leishmania parasites. Serological tests - direct agglutination test and anti-K39 antibody tests - were negative. This case highlights a very rare presentation of the condition with the absence of other visceral involvement and diagnosis being eventually made solely on polymerase chain reaction of rectal tissue, with a subsequent excellent response to therapy with intravenous liposomal amphotericin.

Severe sepsis is increasingly a cause of death. Rapid and correct initial antimicrobial treatment reduces mortality. The aetiological agent(s) cannot always be found in blood cultures (BCs). A novel multiplex PCR test (SeptiFast (alpha version)) that allows identification of 20 bacterial and fungal species directly from blood was used, comparatively with BC, in a multicentre trial of patients with suspected bacterial or fungal sepsis. Five hundred and fifty-eight paired samples from 359 patients were evaluated. The rate of positivity was 17% for BC and 26% for SeptiFast. Ninety-six microorganisms were isolated with BC, and 186 microorganisms were identified with SeptiFast; 231 microrganisms were found by combining the two tests. Of the 96 isolates identified with BC, 22 isolates were considered to be contaminants. Of the remaining 74 non-contaminant BC isolates available for comparison with SeptiFast, 50 were identified as a species identical to the species identified with SeptiFast in the paired sample. Of the remaining 24 BC isolates for which the species, identified in the BC, could not be detected in the paired SeptiFast sample, 18 BC isolates were identified as a species included in the SeptiFast master list, and six BC isolates were identified as a species not included in the SeptiFast master list. With SeptiFast, 186 microorganisms were identified, 12 of which were considered to be contaminants. Of the 174 clinically relevant microorganisms identified with SeptiFast, 50 (29%) were detected by BC. More than half of the remaining microorganisms identified with SeptiFast (but not isolated after BC) were also found in routine cultures of other relevant samples taken from the patients. Future clinical studies should assess whether the use of SeptiFast is of significant advantage in the detection of bloodstream pathogens.

A high prevalence of Dientamoeba fragilis is reported in faecal samples collected from patients attending complementary medicine practitioners in the British Isles. Specimens were collected directly after passing into sodium acetate-acetic acid-formalin (SAF). During two observation periods in 2002-04 and 2005-07, a D fragilis prevalence of 14.6% (n = 543) and 16.9% (n = 421), respectively, was recorded. These results confirm a surprisingly high prevalence of D fragilis among a selected population. Clinical information was only available for half of the patients with D fragilis; 50% of requests with clinical information reported gastrointestinal symptoms. For further work on its pathogenic role and prevalence among patients with gastrointestinal symptoms, immediate collection in SAF should be considered the optimal sampling modality for UK based laboratories.

BACKGROUND AND METHODS:The exact aetiology of pouchitis is unknown, but an association with dysbiosis has been suggested. This is a retrospective review of 17 studies published between 1985 and 2005, identified by a search of the Medline, Pubmed and Embase databases.RESULTS:The methodology of the studies varied widely. Many were performed at a time when the distinction between a healthy and an inflamed pouch was vague; misclassification of patients makes the analysis of data difficult and conclusions uncertain.CONCLUSION:The evidence that dysbiosis is a cause of pouchitis is poor. Nevertheless, available data allow the construction of an algorithm to aid management and suggest a structured approach for future research.

A 29 year-old Nigerian studying in the UK presented with a neck lump and otitis media. Paragonimus-like trematode eggs were found in the neck lump aspirate. Morphologically these eggs resembled Paragonimus uterobilateralis or Achillurbainia congolensis. We favoured the diagnosis of achillurbainiasis over extrapulmonary paragonimiasis on the basis of clinical features and because we could not amplify DNA sequences using PCR primers specific for Paragonimus species. We discuss current diagnostic challenges for this rare parasitic infection.

Mycobacterium szulgai is a nontuberculous, acid-fast bacillus or atypical mycobacteria, which prior to 1972 was not thought of as a pathogen. Since then most cases reported in the literature have been of pulmonary disease with only a few case reports of cutaneous disease. Our patient, who had an underlying, uncategorized, immunosuppressive condition, presented with multiple severe ulcers spreading proximally up the arms in a sporotrichoid pattern with more scatttered lesions on his legs. He made a full recovery with appropriate antimicrobial treatment.