Saving lives by routine cryptococcal antigen screening and pre-emptive fluconazole in patients with advanced HIV

Posted on July 2, 2026 by mdjkf

Update July 2026 :  Guidelines for diagnosing, preventing and managing cryptococcal disease among adults, adolescents and children living with HIV (WHO 2022) 

  • Screening for cryptococcal antigen followed by pre-emptive antifungal therapy among cryptococcal antigen–positive people is recommended before ART (re)initiation for adults and adolescents living with HIV who have a CD4 cell count <100 cells/mm3
  • Screening for cryptococcal antigen can be considered at CD4 cell count <200 cells/mm3

LMIC laboratories in regions of the world where cryptococcal infection is documented should provide access to a Cryptococcus neoformans lateral flow assay for blood testing of HIV patients as above. 

Guest posting: Dr Melanie-Anne John, Microbiology Registrar, Pathology North, NSW, Australia (2026 posting)

Cryptococcal meningitis (CCM) has a high mortality (20-50%) in patients with AIDS. CCM is  preventable with fluconazole and is a recommended intervention in patients with a CD4 < 100 cells/ul. Early HAART programmes  record high mortality (8-26%) and 20% of these deaths are due to CCM where IRIS may be implicated. Patients entering health services with severe immunocompromise may be tested before HAART is commenced. Continue reading →

Posted in Fungi, Module-CNS infections, Module-Mycology | Tagged , , , | 1 Comment

Clarity Initiative for Infectious Diseases – a great one stop site for research and other updates

Posted on June 12, 2026 by mdjkf

The CLARITY initiative has great up-to-date infectious diseases content.

For instance:

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Blood culture liaison process – advice by organism type- 3. Gram negatives

Posted on May 6, 2025 by mdjkf

Incomplete

SECOND CLINICIAN CALL: Confirmed culture identification with susceptibility available

  • Prior to calling, check the isolate antibiogram to see that species and susceptibility are consistent with each other – see EUCAST Expert rules which provide intrinsic resistance characters by species, including unusual phenotypes.
  • If possible speak to the same clinician who you initially contacted about the Gram stain result (look at your diary record !). Make sure your interaction has an proper formality about it – this is essential for building clinician respect for the laboratory service. See previous posting concerning ISBAR process.
  • Document additional clinical data required for completion of an Bloodstream infection event record after your contact (refer to this example template for these records with definitions of key data items).

Specific advice by organism:

Enteric Gram negative – an Enterobacterales species – e.g. E. coli, Klebsiella species, Enterobacter species Continue reading →

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Blood culture liaison process – 2. Advice by organism type- Gram positives

Posted on May 6, 2025 by mdjkf

SECOND CLINICIAN CALL: Confirmed culture identification with susceptibility available

  • Prior to calling, check the isolate antibiogram to see that species and susceptibility are consistent – see EUCAST Expert rules which provide expected antibiotic phenotypes for specific bacterial species
  • If possible speak to the same clinician who you initially contacted about the Gram stain result (look at your diary record !). Make sure your interaction has a proper formality about it – this is essential for building clinician respect for the laboratory service. See previous posting concerning ISBAR process.
  • Document additional clinical data as required.  Records of significant BSI events are gold when it comes to analysis of local epidemiology of sepsis (e.g. community versus hospital acquired/associated events).

Specific advice by organism:

Continue reading →

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Positive blood culture laboratory liaison approach – 1. Initial Gram stain

Posted on May 6, 2025 by mdjkf

BACKGROUND

Important guide: G_90_Info_10_A Common Blood culture Gram stains and implications 1Sep22 amended 1May25

Documentation!

  • Always record your clinician discussion about a case in a large personal diary or preferably on the electronic pathology record for the patient’s sample if this exists.
  • Categorise and record the clinical relevance of the positive culture – a standard template to be shared soon.

Improve blood culture collection practice

  • Ensure that your clinicians know how to collect blood cultures correctly – pathology registrars/ residents can get involved with training . See this collection instruction as a guide.
  • Check out this guide before you start a collection training program – Blood culture collection tutorial notes 25 Aug 2019
  • Calculate your blood culture contamination rates regularly and identify locations that require follow-up training (if rate of contamination > 5%)

Continue reading →

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Hepatitis B and D – treatment is highly effective, safe and affordable

Posted on January 10, 2023 by mdjkf

Chronic hepatitis B is a major public health burden in most LMICscontributing to unnecessary suffering from liver failure and liver cancer leading to loss of life. Treatment is highly effective, safe, and affordable.   Simplified treatment algorithms along with access to cheaper diagnostics and antiviral therapy has provided a pathway for the expansion of treatment.

Professor Alice Lee, based at Concord Hospital, Sydney, Australia,  is international authority on viral hepatitis and the implementation of effective treatment programs across LMICs.  Her organisation’s website, hepatitisBfree has a wealth of extensive guidelines including the algorithm below that derives from WHO treatment and care guidelines and  the Asian consensus recommendations.

She has recently published this review which is important reading :  Hepatitis D Review: Challenges for the Resource-Poor Setting .  Hepatitis Delta is also an incredibly important issue for you to address / understand in your setting as its incidence will influence the impact of Hepatitis B treatment approaches.  Here are the take home messages from Prof. Lee et al.:

 

 

Posted in Module-virology | Tagged , | 1 Comment

PNG Antibiotic Guidelines 2024

Posted on September 18, 2022 by mdjkf

STOP PRESS: PNG GUIDELINES LAUNCH WILL BE SOON (July 2024) following an initial implementation workshop in June.

After quite some planning and with the support of WHO and Burnet Institute,  last week saw the convening of a Guideline Writing Committee in Port Moresby. The committee membership includes many senior PNG clinicians, co-chaired by Dr Goa Tau (NDOH) and Professor Robert Moulds (Therapeutic Guidelines, Australia.  It was a great 2 day meeting with fantastic engagement. The various topic subgroups have now been set their homework and we meet again in November.

The guidelines will have primacy over antibiotic regimens in existing standard treatment guidelines that are pending updates. Alignment with the recently updated Paediatric Guidelines will be sought before their release. The current work is based on two recent Pacific Nations antibiotic guidelines – Fiji (2019) and Timor-Leste (2022).

Posted in Pacific Island nations, PNG | 1 Comment

Respiratory specimens – approach to analysis and interpretation

Posted on July 4, 2022 by mdjkf

Guest posting: Ms Tessa Oakley, Senior Bacteriology Scientist with the Timor-Leste Fleming Fund Country Grant and PRIDA member. 

This excellent lecture is from a March 2022 session during the PRIDA Scientific Officer Microbiology Diploma course.

A useful adjunct to this talk is the practical 20 minute video masterclass provided by Dr Ashhurst-Smith here.

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Urinalysis, crystals and casts – annotated photographic guides

Posted on November 23, 2021 by mdjkf

Produced by Dr Henry Butt, Senior Hospital Scientist, Newcastle, Australia in 1998. 

See also:

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Yeast 101 – species of medical importance – Dr N Townell

Posted on May 17, 2021 by mdjkf

Yeast summary April 2021 Townell

  • Candida species
  • Cryptococcus species
  • Trichosporon species
  • Talaromyces marneffei (previously Penicillium marneffei)
  • Rhodotorula species
  • Malassezia furfur
  • Pneumocysitis jiroveci

Dimorphic fungi not included.

Posted in Fungi, Module-Mycology | Leave a comment