Hepatitis B and C in travellers
THE risk of hepatitis B and C to travellers may be miscalculated.
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Pathology latest news
Antibiotics: Is there hope for the future?
ANTIBIOTIC resistance is a real threat.
CMV DNA testing
CYTOMEGALOVIRUS (CMV) is a human viral pathogen belonging to the herpes virus family.
Update on MALDI-TOF
MALDI-TOF has revolutionised microbe identification.
Emerging pathogen in kids
Kingella kingae exposure in day care centres may lead to invasive disease.
Fresh water exposure: skin and soft tissue infections
The spectrum of waterborne skin and soft tissue infections ranges from the self-limiting to the life-threatening.
Blood cultures and diagnosis
Deciding to collect a blood culture can be a key step in patient management.
Testing times in diagnosis of unusual infections
Diagnosing unusual or exotic infections can be difficult and it pays to ask some questions before testing.
Schistosomiasis
Overseas travel involving water contact can be extremely risky.
Strongyloidiasis
Some parasitic infections can remain dormant and asymptomatic for years after infection, only to cause serious illness decades later.
Testing times for C. difficile
C. difficile is increasingly common, requiring improved detection and testing.
Scoring pneumonia severity
There are several scoring systems available to help define pneumonia severity.
New approaches to molecular STI testing
The diagnosis of the most common bacterial sexually transmitted infections has changed dramatically in the past 10 years
Diagnosis of fungal nail infections
ABNORMAL or dysmorphic nails are common and, although infections caused by dermatophytes are the most common cause of abnormal nail architecture, numerous other pathologies, such as micro-trauma and psoriasis, can cause nail abnormalities. Clinical signs can often be non-specific, so the following diagnostic steps can be useful. The simplest way to confirm a fungal nail infection is to take nail clippings or nail scrapings and submit them to the laboratory for microscopy and culture. The larger the sample, and the further back towards the nail bed the sample is taken, the better the diagnostic yield. The ...
Diagnosing coeliac disease
Q: A young man with recurrent gastrointestinal symptoms is concerned about coeliac disease. What initial tests would be appropriate? A: The appropriate first test for suspected coeliac disease (CD) is IgA tissue transglutaminase (tTG) antibody. This has the best overall sensitivity and specificity (>90%), although it may miss patients with IgA deficiency. For this reason, a serum IgA can be performed at initial testing, and one approach is to use a dual IgA and IgG tTG antibody test. The incidence of IgA deficiency varies with racial background: in Middle Eastern populations it ...
Arthralgia, dry mouth and gritty eyes
Q: A 48-year-old woman presents with arthralgia, dry mouth and gritty eyes. Her rheumatoid factor (RF) is positive and antinuclear antibody (ANA) titre is 1:640, speckled pattern. What further tests might assist with diagnosis? A: This case suggests primary Sjögren’s syndrome (SS), an autoimmune disorder characterised by lymphocytic infiltration and destruction of salivary and lacrimal glands. The positive RF and arthralgias can cause diagnostic confusion with rheumatoid arthritis. Keratoconjunctivitis sicca can be confirmed by a Schirmer’s test of tear production or corneal rose-bengal staining. A blood count may show mild lymphopenia and ...
Interpreting tryptase levels after anaphylaxis
Q: A 43-year-old roof tiler disturbed a nest of yellow jackets (common wasps) and was stung several times. He developed anaphylaxis and required emergency treatment. A tryptase level performed after the event was elevated. What is the significance of this result? A: Tryptase is a neutral serine protease and the most abundant protein in mast cells. It is synthesised as protryptase and subsequently converted to mature ß tryptase and stored in mast cell granules. It is possible to measure this mature fraction, which is released during anaphylaxis. Mast cell degranulation occurs, tryptase ...
Malaria – traditional and innovative methods of diagnosis
If malaria is suspected in a returned traveller, blood must be collected urgently for same-day malaria parasite examination. LIGHT MICROSCOPY A BLOOD film should be performed on every occasion where infection is suspected. Capillary samples (ear lobe or finger prick) improve parasite density but are less commonly used for film preparation. A concentrated (thick) film with lysed red cells provides sensitivity when parasite numbers are low but does not allow accurate speciation. A routine (thin) film assists quantification of parasite number in addition to morphological differentiation. Both require experienced staff and adequate ...
Stool tests in gastroenteritis
Q: Mrs Smith, 70 years old, presents complaining of acute diarrhoea and vomiting for the past 24 hours, and feeling weak and feverish. Her husband, who has been caring for her, has had two episodes of vomiting in the past four hours. Being winter, the couple had stayed indoors but had visited a friend with gastroenteritis. What investigations would you pursue? A: Given Mrs Smith’s age, symptoms and the season, the most likely diagnosis is norovirus (NoV) gastroenteritis. The potential of norovirus to cause outbreaks and ...
What is XDRTB?
Understanding the aetiology of drug-resistant tuberculosis. XDRTB stands for extensively drug-resistant tuberculosis. Most Mycobacterium tuberculosis isolates are susceptible to four first-line anti-tuberculous drugs: isoniazid (INH), rifampicin (RIF), ethambutol and pyrazinamide. If an isolate becomes resistant to RIF and INH and/or any other first-line drug, the disease is referred to as multi-drug resistant TB or MDRTB. This is much more difficult and expensive to treat than fully sensitive TB and requires the use of fluoroquinolones (FQs) (e.g. ciprofloxacin or moxifloxacin), injectable agents (e.g. capreomycin or the aminoglycosides kanamycin or amikacin) and other less active ...