It’s that time of year… no, not Christmas! In our house it’s Dentist time! While training I was told by a wise veterinary friend that “Doctors shouldn’t treat pets or teeth; they’re not vets or dentists…” and after a course of “stored-up” Metronidazole hadn’t helped my “sensitive tooth” my routine check-up visit has turned into “a repair appointment”. I should have taken my friend’s excellent advice…my issue was not an infection and my abilities in dental diagnosis are clearly lacking! However as Microbiologists we are allowed to consider the causes of dental infections and how they might lead to patients needing antibiotic treatment or even being admitted to hospital.
 
“What time did you go to the Dentist?”
 
“Two thirty” (Ha ha Tooth hurty, tee hee!)

The Microbiologists were out having their Christmas curry together when the oncall phone twitched into action. Looking around the table, under pulled crackers and wrapping paper, the oncall Microbiologist (the only one not drinking!) took the call while the others ordered some more drinks and food… It was a noisy gathering as Microbiologists don’t get out much…
 
The waiter looked expectantly to take more drinks orders….
 
“I’m sure she said a mango lassie, I’ll get her one …yes… one mango lassie please and five cobra beers and another taka dahl, thanks”. The waiter scuttled off.
 
“I ordered you the mango lassie” said the (tipsy off duty) Microbiologist
 
“Why did you get me a lassie?” asked the oncall Microbiologist.
 
“You said mango lassie while on the phone… when we were ordering more drinks… didn’t you!?!”
 
“No… that was the Med Reg from the Royal Free, saying they thought one of contacts of the Dutch Lassa fever cases might be transferred to us for follow up and thought we’d like to be aware, as it was in the news and may cause us a call or two if the local media get to know!”… continuing… [and huffing]  “Really… its 10:30 on Friday night, I do not need to know this oncall, but everyone wants their minute of fluster and fame!!” … “Mango lassie…?! You lot need a hearing test or less Cobra beer!” said the oncall Microbiologist.
 
“5 Cobras and a mango lassie…” said the waiter with impeccable timing!
 
The Microbiologists crumpled in laughter and thanked the waiter who just looked puzzled and said he’d bring over the dahl.

The Critical Care ward round was moving slowly. It was a Monday and so most of the patients were new to everyone, including the Microbiologist.
 
The next patient was a middle aged woman who had been intubated and ventilated but who looked otherwise pretty well. [You get a feel for how unwell a patient is just by standing at the end of their bed and observing; equipment, medications, drains and tubes, as well as the colour and appearance of the patient are all clues.]
 
“This lady has Guillain-Barre Syndrome, so no infection issues” said the Critical Care Registrar moving past the end of the bed.
 
Guillain-Barre Syndrome is a rare neurological syndrome of progressive weakness that usually recovers with supportive care. It is thought to be autoimmune in nature.
 
“How did she present?” asked the Microbiologist doing his normal “I’m looking for trouble” kind of thing.
 
Humouring the Microbiologist the Registrar explained that the patient had presented with progressive difficulty swallowing and speaking following an episode of diarrhoea and vomiting. She had become so weak they had needed to ventilate her.
 
“This sounds like sausage poisoning” said the Microbiologist

"Why do we give broad spectrum antibiotics like Benzylpeniciilin, Gentamicin and Metronidazole to babies with necrotising enterocolitis [NEC] when their gut is sterile?" asked the Neonatal Unit [NNU] Registrar.
 
It was the middle of the NNU multidisciplinary ward round.
 
"Pardon?" said the Microbiologist, caught red-handed reaching for a second chocolate biscuit and suddenly feeling self-conscious as everyone turned to stare at him.
 
"Babies are born with a sterile gut so when they develop NEC why do they need antibiotics; surely there are no bacteria to cause a problem". The Registrar restated his question again but with more clarity.
 
The Microbiologist recognised the question was being rephrased; he obviously looked like he did not understand what was being asked! It was actually a very good observation of the Microbiologist! But it was an even better question thought the Microbiologist…so it needed a good answer…
 
Fortunately the Microbiologist was on the ball, and in fact was armed with the latest research provided by the NNU Pharmacist only a few weeks earlier.
 
Hopefully everyone knows where babies come from... but do you know where babies gut bacteria come from? Read on...

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…