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Vampires Guide to Infection & Blood Sciences Results

29/10/2014

As I dust off my vampire outfit for our Halloween party it seems fitting that I talk about the blood sciences for this spooky edition of the blog.

I have been asked on many occasions “why do microbiology laboratories not highlight on their reports what of this result is normal and what is abnormal?” Essentially microbiology laboratories report the presence or absence of microorganisms or the immune response to those microorganisms. In order to decide if the result is normal or abnormal requires an understanding of what is going on in that specific patient. Most of the time microbiology laboratories don’t have that information available, partly because request forms are not completed and partly the forms don’t actually allow for a detailed clinical history.

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Are you treating normal flora?

22/10/2014

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I am often asked “why should I bother learning about normal flora, what I need to know is what bacteria cause infections”. This is an understandable approach however it doesn't allow for the fact that the presence of bacteria can be entirely normal and even healthy. The Microbiologist’s secret is that they know where these normal bacteria should be and recognise when they are in the wrong place. Treating normal flora is a very common mistake in medicine. Some doctors think that if bacteria are identified in a laboratory report these bacteria must be causing an infection and therefore prescribe an antibiotic. But this is not always the case. Microbiology laboratories report the presence or absence of bacteria. Depending on the clinical scenario the presence could be highly significant or alternatively just normal flora. As a student said last week “so what you’re saying is that a lot of antibiotics are given to try and treat normal flora not infection”. Yes, the presence of bacteria does not necessarily mean the presence of infection.

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PCP - “Pregnancy Causes Problems”

16/10/2014

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A fretful junior doctor called for advice because their pregnant patient was extremely short of breath and they didn’t know why. They thought the patient might have PCP but couldn’t understand how that could have happened. It sounded like a difficult problem sure enough but more details were required. Shortness of breath in pregnancy is not uncommon... pregnancy can impact the diaphragm... but junior doctors don’t normally jump to the diagnosis of PCP when expectant mothers become short of breath.

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A case too difficile for Primary Care?

8/10/2014

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Clostridium difficile associated disease (CDAD) is an acute bacterial gastrointestinal infection. In this way it is no different to other types of infectious gastroenteritis such as Campylobacter spp., Salmonella spp. or even the viruses such as rotavirus or norovirus. Gastroenteritis can be severe or non-severe, need hospitalisation or care at home; any type of gastroenteritis has the potential to kill vulnerable patients. However we seem to be slipping in to the habit of admitting all patients with a positive C. difficile result irrespective of their clinical status.

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Does a bear poo in the woods?

1/10/2014

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I recently had the opportunity to discuss a case of chronic gastrointestinal parasite infection whilst on holiday in Canada and I thought I would share this with you. The case was a new mother with triplets who had recently passed a large (up to 1 metre) tapeworm. She had a degree of malnutrition as a result of this chronic infection which was being made worse due to the fact that she was currently nursing.

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Vampires Guide to Infection & Blood Sciences Results

Are you treating normal flora?

PCP - “Pregnancy Causes Problems”

A case too difficile for Primary Care?

Does a bear poo in the woods?

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