Nocardia cyriacigeorgica: a case of endocarditis with disseminated soft-tissue infection.

Nocardia cyriacigeorgica is a common environmental organism. It has been isolated from clinical samples in Europe, Asia and North America, predominantly from respiratory samples but also from samples from several other sites. We present a case report of an 85-year-old female patient in the UK who was found to have a multi-focal soft-tissue infection from which N.

Incidence and outcome of pneumococcal meningitis in northern England.

Since pneumococcal meningitis continues to have high mortality and morbidity, and may be under-reported to national surveillance systems, the present study was conducted to assess the incidence, features, and outcomes of microbiologically confirmed cases of pneumococcal meningitis in North Yorkshire, England, between 1997 and 2002. The review revealed 50 cases, which accounted for an incidence of 1.1.

Streptococcus milleri group bacteraemia in North Yorkshire, England (1989-2000).

Background & Objectives: Though carriage and local infection with organisms of the Streptococcus milleri group (SMG) are regular in clinical practice, bacteraemia is infrequent in man. The objective of the present study was to give an account of our experience with the SMG bacteraemia over a period of 12 yr in North Yorkshire.

Methods: The laboratory and clinical records of all clinically significant cases of SMG bacteraemia in our district general hospital catchment (combined population 260,000) were reviewed for the 12 yr period from 1989 to 2000.

Changing incidence of detected streptococcal bacteraemia in North Yorkshire, England.

Background & Objectives: Streptococcal bacteraemia remains a major and challenging clinical problem throughout the world. The epidemiology of these infections appears to be changing. In the present study we analysed the data collected over a period of 20 yr (1978-1999) to throw light on this.

Report of unusual clinical appearance in bacteraemia with nonhaemolytic M-type 58 Streptococcus pyogenes.

Background & Objectives: The occurrence of haemolytic colonies on blood agar often provides the starting point for the laboratory diagnosis of pyogenic streptococci, while non-haemolytic variants could pass unrecognised, leading to a failure of diagnosis. We report the details of two epidemiologically unrelated patients with bacteraemia featuring M-type 58 Streptococcus pyogenes, a seemingly rare cause of human infection in the UK, and briefly review previous reports of infection with non-haemolytic strains of this species.

Methods: Case notes of the two patients were reviewed.

Problems with the decontamination of dental handpieces and other intra-oral dental equipment in hospitals.

Dental departments within district general hospitals contain items of equipment that require decontamination between patients. Some of these items are complex and expensive, and in busy clinics, may be required in large numbers if a sterile services department (SSD) were to be used. This may result in local manual cleaning of these instruments and sterilization in non-vacuum downward displacement autoclaves within dental departments, despite some items having narrow lumens, deep recesses and cavities, which will not adequately sterilize these instruments.

Missed opportunities in vaccination of patients with subsequent pneumococcal bacteraemia.

A 10-year survey was undertaken to determine whether patients who developed pneumococcal bacteraemia had previously been given pneumococcal vaccine, and whether they had previously had the opportunity of being vaccinated. Fifty-two per cent of the patients were candidates for vaccine. Of these, only 14% had been vaccinated.

Streptococcal toxic shock syndrome: a description of 14 cases from North Yorkshire, UK.

Objective: To analyze the clinical and laboratory features of patients diagnosed with streptococcal toxic shock syndrome (TSS) in North Yorkshire from 1986 to 1999.

Methods: Records of patients with features satisfying the published criteria for streptococcal TSS were reviewed from laboratory and clinical records made at the time and from the hospital case notes. Isolates of streptococci were analyzed for serotype and genes encoding for the production of streptococcal pyrogenic exotoxins.

Bacteraemic Streptococcus pyogenes infection in the peri-partum period: now a rare disease and prior carriage by the patient may be important.

Objectives: To describe the features of invasive peri-partum Streptococcus pyogenes infection as it occurs in current day practice in North Yorkshire.

Methods: The case and laboratory records of all mothers and/or babies with detected S. pyogenes bacteraemia in the Harrogate and Northallerton districts of North Yorkshire (combined catchment population 260 000) were reviewed for the 20 years 1980-99.

False penicillin resistance in Neisseria meningitidis following direct susceptibility tests from blood cultures.

Blood cultures drawn from a patient with clinically diagnosed invasive meningococcal disease, who had been previously administered benzylpenicillin, had beta-lactamases added to increase the probability of recovery of the causative organism. The blood cultures subsequently yielded Neisseria meningitidis but direct susceptibility tests by the comparative disk diffusion method demonstrated greatly reduced zones of inhibition to penicillin (1 unit disk). Repeat testing from subcultures showed full penicillin sensitivity.

Nosocomial Escherichia coli O157 infection.

Nosocomial transmission of Shiga toxin-producing Escherichia coli O157 to two patients and three nurses is described. The index case presented with rectal bleeding rather than diarrhoea, and additional infection control measures were therefore only instituted after detection of the organism. Of the nurses, two were asymptomatic and detected on a screening programme of all staff in contact with the affected patients.

Review of 17 cases of pneumonia caused by Streptococcus pyogenes.

Streptococcus pyogenes is an uncommon cause of community-acquired pneumonia and there have been few recent specific accounts of the condition. To describe the current nature of this disease in the UK, data was gathered on patients with clinical pneumonia from whom Streptococcus pyogenes was cultured principally from blood or other relevant normally sterile sites. In the Harrogate and Northallerton districts of North Yorkshire, pneumonia accounted for nine (20%) cases and a quarter of all deaths in a complete sequence of 45 patients with Streptococcus pyogenes bacteraemia detected during the 16-year-period 1981-1996.

Clostridium septicum infection and hemolytic uremic syndrome.

Five cases of Clostridium septicum infection secondary to Escherichia coli O157-induced hemolytic uremic syndrome have been reported. We report on three cases (one of which is included in the above five) of dual Cl. septicum and E.