Maggots are fly larvae. Their life cycle goes like this: flies are attracted to food and other rubbish on which they lay their eggs; later the eggs hatch into maggots, which turn into flies. You may be wondering if you have eaten that picnic sandwich which a fly had just landed on (and possibly laid its eggs), whether the eggs and maggots can survive!? Answer: larvae that might be accidentally ingested with food cannot usually survive in the gastrointestinal environment.
Hospital acquired infections are never a good thing, usually there is simply lapse in care, resources or common sense behind most occurrence. The normal kinds of infection you “expect” to see being acquired in hospitals are MRSA, Norovirus or Clostridium difficile. However sometimes outbreaks can be a real mystery to solve. I have had to deal with an unusual outbreak of hospital acquired fungal infection myself, so I was intrigued to “read on” when I saw this week’s headlines that “a strange outbreak had occurred in a Scottish hospital”.
This outbreak occurred at the Queen Elizabeth University Hospital in Glasgow and sadly patients have died as a result. An outbreak is defined when there are two or more cases linked in time, place or person. A single infection can constitute an outbreak if the infection is significantly rare or unlikely in the particular situation. The Glasgow outbreak is unusual in that it is not the normal kind of infection you expect to see being acquired in hospitals, this was cryptococcosis.
Cryptococcosis is a fungal infection caused by yeast like organisms of the family Cryptococcus spp. There are three main subspecies which infect humans:
Cryptococcus spp. are found worldwide and throughout the environment; C. gatii is mainly found in the tropics whereas C. neoformans is more common and widespread. C. neoformans is principally found in pigeon droppings and pigeon nests as well as soil whereas C. gatii tends to be found in the bark of trees as well as soil. Other animals have been known to carry Cryptococcus spp. including cats, dogs, horses and even camels, llamas and alpacas!
Okay, so the Bug Blog is usually about the clinical and scientific aspects of microbiology but this week I’m going to do something a bit different. Now I’m not someone who watches much TV; there was very little on that interested me over the Christmas period. However, I did watch a short TV hospital dramatization called Charité on Netflix which I thought was brilliant and something that anyone interested in microbiology would also enjoy. OK so it’s in German with English subtitles, but it is the best show I have watched in a long time! Let me explain.
As some of you will be aware from reading previous New Year blogs (see Pandemic Legacy blog) I love board games and of course microbiology. This year Santa has brought me another brilliant bug board game combo… Plague Inc.
This is the opposite to the Pandemic games in which humans battle to eradicate bugs; here you are the bug and the aim is to infect cities of the world and kill off entire countries and continents! Now I feel this game lacks the shear panic that Pandemic Legacy gave me but it has meant I have slept over the two weeks of Christmas, which I did not when playing Pandemic Legacy (the ultimate, epic, scary and brilliant game for Microbiologists and all those interested in infection).
But back to Plague Inc, you start as a bacterium (all bacilli of various colours) with one country that you already infect and 5 Trait Cards. You gain DNA points (1 bonus point each round plus 1 for each country where your infection cubes are in control) that allow you to evolve by buying a trait from the Trait Cards you hold in your hand… At the start your bacterium has little potency (2 DNA points) so the game feels a bit slow, but it will grow on you!
The Microbiologist was sat at his desk Boxing Day morning authorising out results and waiting for some further work on the blood cultures before ringing them out when his oncall mobile phone went off.
“Hi, it’s the ED Registrar here; can I discuss a patient with you?”
“Of course, what have you got” answered the Microbiologist.
“We’ve got a chap who has recently been abroad and has presented with a fever and feeling unwell. The basic story is that he returned home from work in the early hours of this morning looking flushed and tired. His wife was worried about him, as his belly was rather distended, so persuaded him to come to the hospital. He insists this is how he normally feels at this time of year but his wife isn’t convinced.”
The phone started to vibrate at midnight and the Microbiologist groaned. Who would be ringing at the witching hour on Halloween? Then he started to worry… would it be safe to answer? Would there be some crazy person on the other end? Was it a vicious axe murderer? Then he remembered this was just the scary film he had watched before going to bed and he was actually on call for the hospital.
The person on the other end turned out to be the Emergency Department Registrar (certainly crazy for working Halloween in the ED…!)
“I’ve got a patient who has been bitten on their hand by a bat and I wondered what antibiotics we should start. We have guidelines for dog, cat and even human bites but nothing for bats.”
I have been to a number of meetings and had numerous discussions with colleagues, who lament the loss of the practical component of the Fellowship of the Royal College of Pathologists (FRCPath) exam. With a tear in their eye they talk about the “good old days”, that the exam was “character building” and how “trainees today have it so easy”… but is this really true? Was the practical exam such an essential element of the examination, were we made better for completing it; were those days really all rosy and wonderful as they say? And if so why has it been changed?
Back in the dim distant past when I took my FRCPath exam it was very different to what it is now. In 2003 the FRCPath consisted of two parts, and was sat after 1-3 years in a Registrar post. You needed to “lose some sense of reality” my wife says in order to submerge yourself enough to pass!
The patient was admitted 3 days after arriving in the UK from Nigeria. He had felt unwell with a fever and generalise aches and pains the day before he travelled. On the morning of admission he had noticed a rash on his left leg as well as tender enlarged lymph nodes in his groin.
The admitting Consultant Physician spoke to infection control before the patient arrived and it was decided to admit the patient directly to a negative pressure side-room in the infectious diseases unit without bringing the patient into the main hospital in case this might be a viral haemorrhagic fever. The patient met a diagnosis of low possibility of viral haemorrhagic fever; temperature ≥ 37.5 oC PLUS been in endemic area within 21 days of onset of illness.
Any story involving the unnecessary death of a child and the removal of a doctor from the medical register is going to hit the headlines, but why do the medical profession as a whole feel so affected? Two weeks ago, Dr Bawa-Garba’s name was reintroduced to the medical register and she was allowed to continue to practice medicine. I watched the BBC Panorama program “Doctors on Trial” and I was even more shocked at what has happened. I have also been asked for my opinion of the situation by a number of Medical Student and Junior Doctor colleagues and since one of the main areas of criticism of Dr Bawa-Garba was her apparent failure to recognise sepsis I felt I needed to blog about the issues raised.
***WARNING – SPOILERS***
Previously …on Poldark’s “Brain Fever”…
Last week I looked at the curious case of Lieutenant Hugh Armitage who acquired a “Brain Fever” in a French prison before escaping with the help of Ross Poldark. Lt. Armitage then went on to seduce Poldark’s wife (that’s gratitude for you!) before eventually succumbing to “Brain Fever”, despite the excellent efforts of Dr Enys.