What three infections should be prioritised for vaccine development and why? This is the question that the World Health Organisation has had to answer in the last few weeks. It may seem simple and you may have your top three but I wonder if you agree with the WHO.
 
So what did the WHO decide were their priorities?
The WHO has a published list of Top 5 diseases likely to cause an epidemic in the near future. These were agreed by a panel of experts in 2015 and include:

• Crimean Congo haemorrhagic fever, Ebola virus disease and Marburg
• Lassa fever
• Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome coronavirus diseases
• Nipah
• Rift Valley fever

​The Microbiologist recently received a letter from a colleague asking for advice about how to manage a patient with Helicopter pylon. After a little pondering, it was decided that in fact advice was really required for a patient with Helicobacter pylori who had had failed two courses of treatment and was still symptomatic for peptic ulcer disease. It was clear that the automatic spell checker had made its own diagnosis! Spell checkers are a nightmare in medicine but often lead to some interesting questions. The colleague was asking whether the microbiology laboratory could perform culture and sensitivity on a biopsy sample and if so how the sample should be sent. There was also a question about what antibiotics to use next to treat the patient.

​A patient was admitted with a temperature of 38.5oC with a normal heart rate and blood pressure. There was no obvious focus of infection. The patient was started on IV Piptazobactam because he was febrile and blood cultures were sent to the lab. Three days later the doctors rang the Microbiologist for advice on their patient with pyrexia of unknown origin (PUO). The Microbiologist tried to explain this was not a patient with PUO; this was just a patient with a fever… “a PUO is not just a patient with a fever for whom you do not yet have a diagnosis…” they also explained that their management of IVs and blood cultures was a little over the top and not really helpful in aiding a diagnosis!  
 
So what is a PUO? How should it be managed? Why does the management of PUO often go wrong?

​What is pyrexia of unknown origin?