Well that’s what the Telegraph newspaper says so it must be true!
 
Okay, let’s try and bring this down a peg and look at what is really the story behind the sensationalist headline. Whilst it is sometimes amusing to read these stories, the lack of balance with resulting scare-mongering is frustrating.
 
A study has been performed by Public Health England in association with the National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, looking at the presence of Flaviviruses in deer and deer ticks in the UK. Gosh! What a mouthful, even abbreviated that’s NIHRHPRUEZI, yeah! So we’ll just call them “Liverpool” from now on!!!
 
Anyhow back to the Flaviviruses! Some Flaviviruses cause tick-borne encephalitis (TBE), a condition transmitted by ticks of the Ixodes spp. which usually feed on deer. There are three main types of TBE based upon geographical area:

• European (Scandinavia down to the Adriatic)
• Far-Eastern (Russia, China, Japan)
• Siberian (Siberia and the Baltic)

The Microbiologist picked up the phone to call out a result.
 
“This one looks interesting” he said to himself even though he knew he had been told never to use the word interesting in relation to microbiology…. Ever…!
 
“You have a baby boy on the ward with salmonellosis, what’s the story?” he asked when the Paediatric SHO answered the phone.
 
“He’s a six week old who developed bloody diarrhoea a couple of days ago and started vomiting. He was febrile and looked septic so we started him on empirical IV Ceftriaxone.”
 
“Any pets?” asked the Microbiologist.
 
“He’s only 6 weeks old, why would he have any pets?” answered the tired junior.
 
“Not him, the family; specifically reptiles. Any snakes or lizards?”
 
“I have no idea.”
 
“Well carry on with the IV Ceftriaxone as he has a Salmonella species in his blood culture and call me back about the reptiles… no wait, I’ll come up and ask myself.”
 
The junior doctor hung up. Muttering to himself about mad Microbiologists he wandered off to get on with some other work.
 
So why did the Microbiologist want to know about reptiles? Was he just mad or was there method to his madness?

“I think my patient has TB but they have had BCG in the past so I was wondering what might mimic TB?” asked the junior doctor.
 
“They could have TB” replied the Microbiologist.
 
“But they’ve had their BCG” replied the junior doctor, gosh he’s not listening, he’s probably playing spider solitaire, thought the junior doctor, as he could hear clicking in the background.
 
“Yes, but they could still have TB” repeated the Microbiologist.
 
Deep inhale… “Yes, but they have a BCG scar on their arm, they have been immunised in the past, so they can’t have TB” stated the junior doctor firmly.
 
You’d think the junior’s right, wouldn’t you? But I’m blogging on it so, who is right? Can you get TB having been immunised with BCG? Let’s talk about BCG first…

Warning: this blog mite make you itch!
 
The Oncology Registrar sat in the Multidisciplinary Team meeting looking thoroughly miserable. They looked like they hadn’t slept for ages, and whilst this can often be the case for junior doctors, the Microbiologist knew the registrar had only just returned from annual leave.
 
Whilst trying to pay attention to the patient discussions the Microbiologist watched as the poor Registrar kept scratching at his hands and arms.
 
As the meeting drew to a close, the Microbiologist wandered over…they can’t help but meddle!!!
 
“You look like your suffering” he said sympathetically, when in fact he was “itching” to make a shrewd diagnosis!!!
 
“Yeah. My hands and arms are really itchy, and it was worse in that room as it was so hot. I think I’m allergic to something”.
 
The Microbiologist wasn’t so sure.
 
“Show me your hands” he said.
 
The Registrar helpfully held out his hands which looked red and inflamed.
 
Looking closely whilst not touching (oooh, all those germs!!! He’d seen the Infection Control hand plates in the past!!!) the Microbiologist soon realised the likely cause of the problem.

At the weekly Neonatal Unit Multidisciplinary Team Meeting the Microbiologist was asked about a baby with Cytomegalovirus infection. The baby had been born at term but was very small, below the 3rd centile. Other than the size of the baby there were no other concerns during the pregnancy. The baby had looked otherwise well and was behaving normally. A number of tests had been done to look for a reason why the baby might be small and a urine sample had tested positive for Cytomegalovirus DNA by PCR.
 
The Neonatologists wanted to know what they should do next and the MDT members looked at the Microbiologist expectantly, who started to feel somewhat uncomfortable under all those stares…

The Biomedical Scientist walked hesitantly into the duty Microbiologists office.
 
“We have a mould growing in a blood culture” they said.
 
“You mean a yeast?” asked the Microbiologist.
 
“Nope, definitely a mould” replied the BMS.
 
“A contaminant maybe?” asked the Microbiologist again, now starting to hope this was the case.
 
“Nope, definitely not a contaminant” replied the BMS.
 
“Please tell me this was handled in Cat 3?” asked the Microbiologist again, starting to sound worried and thinking he should maybe put the Health and Safety Executive (HSE) telephone number into his phone!
 
“Nope, not in Cat 3” replied the BMS looking crest fallen, “but it should have been… I think it’s Talaromyces marneffei”
 
The Microbiologist just stared at them lost for words… why did it always happen when he was on duty?!
 
What is Talaromyces marneffei?
T. marneffei is a dimorphic fungus; it has two types of growth depending on the temperature (a bit like cheese! Cheese is a solid block when in the fridge but when sliced and put on toast under a grill it’s all gooey!!!) It used to be called Penicillium marneffei, but like many other microorganisms it has undergone a recent name change just to keep us on our toes.

On his way to review a ward patient the Microbiologist was stopped by one of the Consultant Physicians and asked about a different patient. These “corridor consultations” are fairly frequent in medicine and often lead to significant decisions about patient care, it’s important to document them though; remember, “if it isn’t written down then you didn’t do it”.
 
“I have a patient who I have been seeing in clinic who I think might have tuberculosis, but the sputum and bronchoalveolar lavage cultures are negative. Is there anything else that can present in the same way that I might be missing?” the Physician asked.
 
“Why do you think they have TB?” asked the Microbiologist, thinking is this related to those pesky Tabby Cats!?