Special Topic Issue: The Role of the Environment in Infection Prevention

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Streptococcus Bovis Bacteraemia in Infants in a Regional Hospital in Hong Kong

Abstract Objectives: To identify the features of infants infected by Streptococcus bovis in a regional hospital in Hong Kong. Design and setting: Case series. Main measurements: Clinical features of all patients infected by Streptococcus bovis were retrieved from the database of the Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, from 1999 to 2009. A literature review was also performed concerning this infection in infants. Results: Eight infants were identified from the medical record. All of the patients had Streptococcus bovis bacteraemia. Only 2 of our patients had the bacteria isolated from cerebrospinal fluid. Four of the patients presented with fever. Six of the patients were born at full term while the other 2 were premature babies. Six of the patients presented within the first 7 days of life, while the other 2 presented on Day 23 and Day 46 of life. At least 7 days of intravenous antibiotics were given. All of the patients recovered and none of our patients died. To date, all of our patients had normal growth and development. Conclusions: In our case series, fever was the most common manifestation. Respiratory distress was common but gastrointestinal disturbance was uncommon, which is different from previous reports. Further research has to be performed for better understanding of this bacterial infection in the paediatric population

Splenic Syndrome in a Young Man at High Altitude with Undetected Sickle Cell Trait

Introduction: Splenic syndrome is a rare presentation of sickle cell disease. It is important to rule out this possibility when an ethnically vulnerable patient presents with an acute abdominal symptoms in a background of precipitating events. Case Report: A 26-year-old man who developed a severe abdominal pain at high altitude, found to have a tender splenomegaly. However, further inquiry revealed he is from an area where sickle cell disease is prevalent. Screening for sickle cell disease was positive. Radiological investigations confirmed a massive splenic infarction keeping with a diagnosis of splenic syndrome. Patient was managed conservatively. Conclusion: Sickle cell trait is considered a benign carrier state. However, rarely they can present with life-threatening conditions. Therefore, a high degree of clinical suspicion is required for early diagnosis of these specific entities to avoid increased morbidity and mortality of these patients

European Perspective - It Could Be MS

New international consensus criteria provide guidance on making a diagnosis of optic neuritis. Once a diagnosis is made, they provide further guidance on the classification of optic neuritis subgroups such as MS-ON. These guidelines have been developed in a three year long Delphi process. A consensus of more than 80% agreement was accepted and the CREDES guidelines for designing and reporting this process were followed. Prior to the guidelines the rate of misdiagnosis of of optic neuritis was reported to be around 60%. The clinical signs and symptoms which should alert clinicians to consider an alternative diagnosis other than MS-ON will be summarised

Intrapancreatic accessory spleen: an important differential to consider before surgery

Solid tumours in the tail of the pancreas may present a diagnostic dilemma if the clinical history, imaging features or cytology is not conclusive. The common differential diagnoses for a pancreatic tail mass are a primary malignancy, neuroendocrine tumour or a retroperitoneal tumour. However a comparison to the adjacent spleen on imaging may help identify aberrant splenic tissue. We present the case of an incidental finding of a solid tumour in the tail of the pancreas, which was resected and a histological diagnosis of an intrapancreatic spleen (IPAS) was made. A suspicion of IPAS when reviewing the imaging may have prevented the resection of a benign tumour