Fever in the returning traveller

Fever in the returning traveller is always a diagnostic challenge in terms of what samples to send. For those that have travelled to high prevalance areas, always consider dengue as 40% of the worlds population live in areas where there is a risk of transmission. An excellent review can be found here.

AMH.

Eggerthella lenta - what is that?

Eggerthella lenta bacteremia
 
Until today, I had not come across this organism, although it has been described in the literature. This is an anaerobic, nonspore-forming Gram-positive rod that is a common gut commensal. It is capable of invasive disease, particularly in patients whose gut mucosal integrity is compromised. In this case report, this Crohn's patient improved on meropenem.
 
AMH.

Carbapenems and penicillin allergy

Q: Are carbapenems safe in patients who have an allergy to penicillin?

A: The simple answer is that depends on the nature of the penicillin allergy, the agent being prescribed and the confidence of the prescriber. The short answer is that if in doubt do not prescribe this class of drug to patients with a documented anaphylaxis to penicillin. As we will see the evidence is somewhat unclear.

  1. Where is the evidence?

There are quite a few reviews on this subject on PubMed.  Carbapenems contain the basic beta-lactam ring that is common to all penicillins and their derivatives. Skin test cross-reactivity can be as high as 25% between imipenem and patients with a history of penicillin allergy. It is worth mentioning that skin reactions do not translate into clinical cross-reactivity.

Multi-drug resistance in Candida spp.

Candida spp. - what species?

The old idea that the majority of Candida spp. isolated from significant infections as C. albicans and these are all fluconazole sensitive has been fully dispelled. Guidlines for good practice, based upon the IDSA and ESCMID, suggest that all Candida spp. isolated from sterile sites should go for identification and susceptibility testing.  

Method of identification:

Invasive trichosporonosis

Background:

Trichosporon spp. are basidiomycetous yeast-like anamorphic organisms that are widely distributed in nature and found predominantly in tropical and temperate areas. These organisms can be found in substrates such as soil, decomposing wood, air, rivers, lakes, seawater, cheese, scarab beetles, bird droppings, bats, pigeons, and cattle. In humans, these oraganismsfungal species occasionally are part of the gastrointestinal and oral cavity nicrobiota and can transiently colonize the respiratory tract and skin.

Morphological Characteristics:

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