Kawasaki disease in a 13 month old diagnosed at post mortem

Posted on May 11, 2016 by mdjkf

Guest posting: Dr Leah Clifton, NEWCASTLE DEPARTMENT OF FORENSIC MEDICINE,  Forensic Pathology Registrar

Kawasaki disease is characterized with acute systemic vasculitis, occurs predominantly in children between 6 months to 5 years of age. Patients with this disease recover well and the disease is self-limited in most cases .  Here is an excellent recent case: KAWASAKI DX Clifton May 2016.

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Reference

Posted in Cautionary tales, Pathology | Tagged , | 1 Comment

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

Posted on April 2, 2016 by mdjkf

Guest posting: Dr Melanie-Anne John, Microbiology Registrar, Pathology North, formerly Infectious Disease Department, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, RSA

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

Cytomegalovirus – congenital disease prevention & treatment

Posted on February 20, 2016 by mdjkf

Excellent series of expert reviews in Microbiology Australia recently including:

And several more – see the Microbiology Australia site. This  Microbiology Australia journal is a good place to go when you wish to see current reviews on key topics (along with Clinical Microbiology Reviews from ASM (USA).

[CMV is a must know virus for post-grads! ]

Posted in Med Micro topics-advanced, Viruses | Tagged | Leave a comment

How well is your lab performing antimicrobial susceptibility testing?

Posted on January 3, 2016 by mdjkf

Production of reliable AST results is critical for clinicians and their patients. AST results enable correct antibiotic therapy to be directed against the specific pathogen(s).

Please review this brief presentations from our bacteriology scientist Fiona Oehme. 

Please see this  previous posting for discussion of key AST concepts.

Posted in Antimicrobial susceptibility testing, Module-basic microbiology and AMR, Quality management | Tagged , | Leave a comment

Relative mortality risk from antibiotic use compared

Posted on December 23, 2015 by mdjkf

The relative safety of antibiotics is a critical issue to consider- it is apparent that chloramphenicol which most of the world has stopped using systemically owing to the risk of idiosyncratic and fatal aplastic anaemia may in fact be safer than some agents that are used very widely for relatively minor indications! Food for thought!

koh10's avatarAIMED - Let's talk about antibiotics

Much time is spent discussing the development of antimicrobial resistance and changes to the microbiome but perhaps should we should also focus on the potential for patient mortality.  Based on best current estimates, trimethoprim, macrolides and quinolones may be less safe than chloramphenicol in certain patient populations.

A future posting will provide a practical approach to the prolonged QT issue that may arise with macrolides and quinolones.

View original post 80 more words

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Must know Gram negative pathogens for medicine and pathology registrars/residents

Posted on November 18, 2015 by mdjkf

By focusing your study on these organisms first, you will gain knowledge that is generalisable across most less common pathogens and diseases. Be systematic in your study – see proforma.

  • Enterobacteriaceae : E. coli, Klebsiella sp, Proteus sp, Enterobacter sp,  Salmonella sp, Shigella sp.
  • Vibrio sp.
  • Neisseriaceae : Neisseria gonorrhoeae and N. meningitidis 
  • Haemophilus influenzae including type B
  • Pseudomonas aeruginosa
  • Acinetobacter baumannii
  • Campylobacter sp. and Helicobacter sp.
  • Bordetella pertussis

See also ORGANISM knowledge proforma.

Posted in Bacteria (GNEG) | Leave a comment

Dientamoeba fragilis morphological diagnosis and clinical relevance

Posted on November 16, 2015 by mdjkf

Dientamoeba fragilis measures 9-12 uM and have 1-2 nuclei (nearly half have only 1 nucleus).

Important notice from RCPA 2015 concerning the (overall lack of) significance of Dientamoeba and Blastocystis detected in stool.  [Multiplex faecal PCR assays often include these species in the panel].

Continue reading →

Posted in Module - Parasitology, Protozoa | Tagged , , | Leave a comment

Must know Gram positive bacterial pathogens for medical and pathology registrars/residents

Posted on November 12, 2015 by mdjkf

By focusing your study on these organisms first, you will gain knowledge that is generalisable across most less common pathogens and diseases. Be systematic in your study – see proforma.  Future postings will provide background on key emerging issues with each species

  • Staphylococcus aureus  (methicillin – susceptible and methicillin-resistant, vancomycin-resistant)
  • Streptococcus pneumoniae 
  • Streptococcus pyogenes and other betahaemolytic streptococci (groups B, C and G)
  • Streptococcus ‘Viridans’ species including Strep. Milleri group
  • Enterococcus species (vancomycin-susceptible and resistant)
  • Corynebacterium diphtheriae
  • Mycobacterium tuberculosis
  • Mycobacterium leprae

See also ORGANISM knowledge proforma.

Posted in Bacteria (GPOS), Microbiology | Leave a comment

ISBAR – an essential process for improving clinical handover and liaison by pathology services

Posted on November 11, 2015 by mdjkf

Structured conversations between clinicians or between pathologists and clinicians are a good idea – poor communication risks patient safety and contributes to adverse outcomes.  The ISBAR framework enables clear, focused and information relevant clinical communications.   Continue reading →

Posted in Module - Blood cultures, Quality management | Tagged , | Leave a comment

Maximising the value of blood cultures

Posted on October 20, 2015 by mdjkf

mdjkf's avatarAIMED - Let's talk about antibiotics

Blood cultures give a critically important window on bacterial and fungal sepsis, providing direct patient treatment guidance and reliable antimicrobial susceptibility data that are used to construct cumulative antibiograms and empirical treatment guidelines.  They also help to rule out serious bacterial infection, provided that collection occurs prior to antibiotic treatment and an adequate patient sample is taken.

Here are some golden rules:

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