infection

Antimicrobial neurotoxicity: an under-recognised cause of delirium

Case Reports, Volume 21, Issue 2, Pages 65-120 (2022)

Antimicrobial associated encephalopathy (AAE) is a well-documented, though under recognised, adverse event associated with antimicrobial use.1 Clinical manifestations of AAE are varied, ranging from myoclonus and seizure to an encephalopathy with cerebellar signs.1 The phenotypic presentation of the encephalopathy syndrome is, in general, governed by the antimicrobial in question. Given its apparent rarity in everyday clinical practice, awareness of AAE is crucial for physicians. We describe a reversible encephalopathy characterised by confusion, myoclonus and stupor in a 76 year old gentleman on antimicrobial therapy for a peri-rectal abscess.

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A prospective, observational study of the performance of MEWS, NEWS, SIRS and qSOFA for early risk stratification for adverse outcomes in patients with suspected infections at the emergency department

Original Articles, Volume 20, Issue 2, Pages 89-156 (2021)

Background: Many patients with suspected infection are presented to the emergency Department. Several scoring systems have been proposed to identify patients at high risk of adverse outcomes.

Methods: We compared generic early warning scores (MEWS and NEWS) to the (SIRS) criteria and quick Sequential Organ Failure Assessement (qSOFA), for early risk stratification in 1400 patients with suspected infection in the ED. The primary study end point was 30-day mortality.

Results: The AUROC of the NEWS score for predicting 30-day mortality was 0.740 (95% Confidence Interval 0.682-0.798), higher than qSOFA (AUROC of 0.689, 95% CI 0.615- 0.763), MEWS (AUROC 0.643 (95% CI 0.583-0.702) and SIRS (AUROC 0.586, 95%CI 0.521 - 0.651). The sensitivity was also highest for NEWS≥ 5 (sensitivity 75,8% specificity of 67,4%).

Conclusion: Among patients presenting to the ED with suspected infection, early risk stratification with NEWS (cut-off of ≥5) is more sensitive for prediction of mortality than qSOFA, MEWS or SIRS, with adequate specificity.

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A prospective, observational study of the performance of MEWS, NEWS, SIRS and qSOFA for early risk stratification for adverse outcomes in patients with suspected infections at the emergency department Read More

Ambulatory drainage and management of a pleural empyema

Case Reports, Volume 19, Issue 1, Pages 1 - 60 (2020)

A 61 year old male presented to chest clinic with a lung abscess. This ruptured and resulted in an empyema that required a small bore chest drain. Pus started bypassing the drain, spilling out subcutaneously. This was probably due to the impending formation of an empyema necessitans. To stem the flow, a large bore drain was inserted. An ambulatory bag was connected to the end of that drain which enabled outpatient management through the ambulatory care unit over a ten week period. The chest drain stayed in for nine weeks. Risk stratification using the RAPID score was applied. This is a routine medical presentation with well-known and accepted investigations with routine organisms (mixed aerobic and anaerobic microbiota) and treatment with classical broad spectrum antibiotics. The striking feature of the case is that with strict supervision, patient education and motivation, ambulatory management is perfectly feasible and safe.

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Acute abdominal pain: An unusual medical cause

Clinical Reviews, Volume 8, Issue 1, Pages 1 - 52 (2009)

Abstract

Lyme disease is an infectious illness that arises from the spirochete, Borrelia burgdorferi transmitted via a bite by Ixodid ticks. There were 768 cases in the United Kingdom (incidence 1.46/100,000) identified by the Health Protection Agency in 2006. Clinical manifestations of Lyme disease can be multi-systemic. It is important for the acute physician to be aware of this condition. Its relative infrequency and unusual presentation can result in delayed diagnosis with potential for suboptimal outcome. Here, we present a case of Lyme disease presenting with abdominal pain and intestinal dysmotility.

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Fever in the returning traveller

Papers, Volume 5, Issue 2, Pages 41 - 80 (2006)

Abstract

Travel-related infections are becoming more common as travel abroad becomes easier. Whilst most imported infections will have recognisable features some of the more obscure will be less familiar to the clinician. A detailed travel history including all stopovers is vital as is a thorough examination. Falciparum malaria is a medical emergency and prompt treatment is essential. Emerging infections such as SARS and avian influenza provide new challenges in diagnosis for the admitting team.

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Medical Emergencies in Human Immunodeficiency Virus (HIV) Infection

Clinical Reviews, Volume 3, Issue 2, Pages 45 - 84 (2004)

Abstract

With increasing awareness, earlier diagnosis, and aggressive use of anti-retroviral therapy, more people with HIV are living longer so that the average survival time from diagnosis is now significantly better than what it was 10 years ago. As a consequence of this, more patients with HIV are now presenting to hospitals and emergency departments as acute medical emergencies either directly related to their HIV infection, or their treatment.1 An awareness of the potential problems with which these patients can present to hospital, plus guidance on their management is essential to all acute care physicians. In this article we outline the general management of patients with HIV presenting as emergencies to hospital, and then systematically focus on some of the more common clinical problems which may arise.

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Principles and Practice of Antibiotic Therapy for Cellulitis

Original Articles, Volume 1, Issue 2, Pages 33 - 76 (2002)

Abstract

Cellulitis is a common medical emergency. Investigations often fail to establish the specific microbial aetiology and there are few data to support common choices of antibiotic therapy used to treat cellulitis. Potentially unusual pathogens can be predicted from the epidemiological circumstances at presentation, while empirical treatment choices must be based on an understanding of the underlying pharmacokinetic and pharmacodynamic principles that govern antibiotic-microbe interactions. Animal models have established conditions that predict treatment success, taking into account confounding factors such as bacterial inoculum size. Synergistic combinations of antibiotics can improve outcome in difficult cases.

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