Legionella longbeachae is a predominant cause of Legionnaires' disease in some parts of the world, particularly in Australasia. Clinical reports of L. longbeachae infection are limited to case ...reports or small case series, and culture-confirmed cases.
We reviewed the clinical characteristics and outcomes of L. longbeachae pneumonia in a large case series from Christchurch, New Zealand during a 4-year period when both PCR and cultures were used as routine diagnostic tools for Legionnaires' disease. Cases of Legionella pneumophila pneumonia were reviewed for comparison.
A total of 107 cases of L. longbeachae infection were identified by PCR and/or culture. The median age was 65 years (range 25-90 years), 63% were male, and most became unwell during spring or summer. Presenting clinical features were similar to those reported for community-acquired pneumonia, with headache, myalgia and diarrhoea being common. Elevated C-reactive protein, hyponatraemia and abnormal liver function tests were also common. History of productive cough, involvement of both lungs, and high bacterial load were independently associated with culture of Legionella from lower respiratory samples. One quarter required intensive care unit admission, and 5% died. Among patients given antimicrobial therapy before admission, those given agents without anti-Legionella activity were more likely to be admitted to the intensive care unit. Limited comparisons were made with the 19 L. pneumophila cases over the same time period.
Characteristics of L. longbeachae pneumonia are broadly similar to those reported for community-acquired pneumonia from a variety of other populations, except for the spring/summer seasonality.
Catheter-related sepsis (CRS) is a common complication of long-term parenteral nutrition. Conventional antibiotic therapy is often effective in the short-term but, because of poor activity against ...intraluminal microbial biofilms, may not prevent relapse. Ethanol is an effective antiseptic. We describe a case of a patient with recurrent CRS successfully treated with 70% ethanol locks.
Summary Objectives To describe the use and outcomes of outpatient antimicrobial therapy (OPAT) for infective endocarditis (IE) within the Canterbury region of New Zealand over an 8 year period. ...Methods All cases of IE admitted to Christchurch Hospital were reviewed. Prospectively collected data from our OPAT service's database and retrospective data from case notes were analysed. Results There were 213 episodes of IE meeting modified Duke Criteria over this time. Patients received OPAT in 100 episodes. Viridans streptococci were the infecting organism in 34, Staphylococcus aureus in 27, and enterococci in 10. Adverse events were encountered in 27 episodes. Of these, 24 were related to intravenous lines, infusion devices or adverse drug reactions which resolved with change of treatment. There were 3 serious adverse events which were likely to have occurred in hospital. During 12-month follow-up there were 5 further episodes of IE and 2 deaths unlikely to be directly related to the episode of IE. Conclusions Despite significant co-morbidities and complications, nearly half of all patients with IE, including those with disease due to S. aureus and enterococci, successfully completed their treatment as outpatients. Continuous infusion devices were successfully used in 32 patients, including 22 with disease due to S. aureus.
Corynebacterium accolens is a rare human pathogen. We encountered a case of C. accolens isolated from a thigh collection in a man with osteomyelitis of the adjacent pubic symphysis.
HIV-associated tuberculosis is increasingly seen in Zimbabwe and other developing countries. The clinical and radiological features are often atypical, and diagnostic confusion may arise when sputum ...smears are negative. Patients with suspected intrathoracic tuberculosis frequently have palpable extrathoracic lymph nodes. In this study, Ziehl-Neelsen staining of aspirates from extrathoracic lymph nodes revealed acid-fast bacilli in 20 (71 %) of 28 patients with suspected tuberculosis, and 20 (87%) of 23 patients in whom a final diagnosis of tuberculosis was made Aspiration is simple, rapid, and cheap and may be of value in the diagnosis of tuberculosis, especially in developing countries with limited diagnostic and therapeutic resources.
HIV-associated tuberculosis is increasingly seen in Zimbabwe and other developing countries. The clinical and radiological features are often atypical, and diagnostic confusion may arise when sputum ...smears are negative. Patients with suspected intrathoracic tuberculosis frequently have palpable extrathoracic lymph nodes. In this study, Ziehl-Neelsen staining of aspirates from extrathoracic lymph nodes revealed acid-fast bacilli in 20 (71%) of 28 patients with suspected tuberculosis, and 20 (87%) of 23 patients in whom a final diagnosis of tuberculosis was made Aspiration is simple, rapid, and cheap and may be of value in the diagnosis of tuberculosis, especially in developing countries with limited diagnostic and therapeutic resources.
Abstract Objectives To compare the efficacy, safety, and acceptability of treatment with intravenous antibiotics for cellulitis at home and in hospital. Design Prospective randomised controlled ...trial. Setting Christchurch, New Zealand. Participants 200 patients presenting or referred to the only emergency department in Christchurch who were thought to require intravenous antibiotic treatment for cellulitis and who did not have any contraindications to home care were randomly assigned to receive treatment either at home or in hospital. Main outcome measures Days to no advancement of cellulitis was the primary outcome measure. Days on intravenous and oral antibiotics, days in hospital or in the home care programme, complications, degree of functioning and pain, and satisfaction with site of care were also recorded. Results The two treatment groups did not differ significantly for the primary outcome of days to no advancement of cellulitis, with a mean of 1.50 days (SD 0.11) for the group receiving treatment at home and 1.49 days (SD 0.10) for the group receiving treatment in hospital (mean difference 0.01 days, 95% confidence interval -0.3 to 0.28). None of the other outcome measures differed significantly except for patients' satisfaction, which was greater in patients treated at home. Conclusions Treatment of cellulitis requiring intravenous antibiotics can be safely delivered at home. Patients prefer home treatment, but in this study only about one third of patients presenting at hospital for intravenous treatment of cellulitis were considered suitable for home treatment.
The practice of an infectious diseases (ID) physician is evolving. A contemporary understanding of the frequency and variety of patients and syndromes seen by ID services has implications for ...training, service development and setting research priorities. We performed a 2-week prospective survey of formal ID physician activities related to direct inpatient care, encompassing 53 hospitals throughout Australia, New Zealand and Singapore, and documented 1722 inpatient interactions. Infections involving the skin and soft tissue, respiratory tract and bone/joints together accounted for 49% of all consultations. Suspected/confirmed pathogens were primarily bacterial (60%), rather than viral (6%), fungal (4%), mycobacterial (2%) or parasitic (1%). Staphylococcus aureus was implicated in 409 (24%) episodes, approximately four times more frequently than the next most common pathogen. The frequency of healthcare-related infections (35%), immunosuppression (21%), diabetes mellitus (19%), prosthesis-related infections (13%), multiresistant pathogens (13%) and non-infectious diagnoses (9%) was high, although consultation characteristics varied between geographical settings and hospital types. Our study highlights the diversity of inpatient-related ID activities and should direct future teaching and research. ID physicians’ ability to offer beneficial consultative advice requires broad understanding of, and ability to interact with, a wide range of referring specialities.
Mycobacterium bovis‐BCG infected macrophages were exposed in vitro to PPD‐stimulated T lymphocytes from tuberculin responsive donors or to a panel of mycobacterial‐antigen specific CD4+ T cell ...clones. Both polyclonal and clonal T cells caused considerable antigen‐specific lysis of autologous or MHC class II matched macrophages. However, lysis of infected macrophages did not significantly affect the number of viable mycobacteria which were released into the culture media from lysed macrophages. In tuberculosis, CD4+ cytolytic T cells may be primarily involved in tissue destruction and lack a significant role in acquired cellular immunity.
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