Towards the end of June this year there was a higher than normal number of notifications of E. coli O157 to Public Health England (PHE) which on further investigation were shown to be predominantly a single strain of bacterium. Within a week PHE had declared a national outbreak. Genetic sequencing showed this strain of E. coli O157 was not related to the UK’s normal O157 strains but was similar to those found around the Mediterranean and therefore the conclusion was drawn that the outbreak strain had been imported into the UK.
 
As of last week there have been 160 cases in this outbreak, predominantly in three clusters in the South West, North West and South East of England. Sixty two cases have been admitted to hospital, 7 have developed haemolytic uraemic syndrome and 2 have died. There is an ongoing investigation to find the source of this bacterium which is thought to be mixed salad leaves supplied to the wholesale catering industry; the source has not yet been identified but the focus is on rocket (posh greens).

​The patient was in her early 20s and came to see her GP complaining of a sore throat, fever and pains in her neck. The GP examined the patient and found tender cervical lymphadenopathy and pustular tonsils. A diagnosis of tonsillitis was made and the patient was reassured that it was nothing serious whilst being given a course of Amoxicillin. Would you have given antibiotics and if so why?
 
The next day the patient rang the practice in a panic as she had a rapidly progressive rash. The GP was concerned about the significance of the rash and immediately arranged for the patient to be seen in the Emergency Department.
 
On arrival in hospital the patient did indeed have a wide spread erythematous rash and fever. Bloods were sent to the laboratory and she was started on IV Ceftriaxone as a precaution in case this was meningococcal sepsis. The blood results showed a high lymphocyte count, abnormal mononuclear cells and raised liver enzymes. 

​A very proud moment for Microbiology Nuts and Bolts, yesterday St George’s Medical School and the University of London recognised David Garner’s contribution to delivering medical student teaching during their Graduation Ceremony at the Barbican, London. It was made all the more special knowing that it was the students themselves who voted for him to receive the award. Thank you to the Year of 2016 and we welcome you and all other new doctors to your first roles on the wards next month. 

A 19 year old woman was admitted with a high fever, low blood pressure and confusion. Her parents reported that she had been complaining about diarrhoea earlier in the day. She was started on IV Cefotaxime for possible meningitis whilst awaiting a lumbar puncture. Fluids were started and she was transferred to the Critical Care department for ongoing supportive treatment. Blood tests showed her to be in renal failure with a low white blood cell count. A lumbar puncture was done and her CSF was completely normal.
 
The patient appeared to be septic but there was no obvious focus of infection. She continued to deteriorate and so she was discussed with the Duty Microbiologist and a provisional diagnosis of toxic shock syndrome was made and IV Clindamycin was added to her treatment. The Critical Care team were advised to check for the presence of any skin or soft tissue focus of infection as well as ensure there was no retained tampon.

​Although no soft tissue focus was found a tampon was present and it was removed. At the time there was noted to be a purulent vaginal discharge and vulvovaginitis.