​Yep, it’s coming up to that time of year. All of Microbiology is excited as there is about to be a holiday and eggs are likely to feature in a big way… no not Easter!!! Its holiday time and people will be going to exotic countries and bringing back souvenir parasites and their eggs will be involved in working out what is wrong with them. Yep us Microbiologists’ love eggs, not just the chocolate variety. I don’t know, you lot all have chocolate on the brain :-)

The patient is a young female who presented with a very high fever of 40.5oC, lethargy and not eating. The past medical history included dislocated knees due to a congenital problem requiring surgery to relocate and reconstruct the patella groove. She is not taking any regular medication, has not been in contact with anyone else who is unwell and has not travelled out of the UK.
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Essentially this is a case of pyrexia of unknown origin or PUO. What is PUO and what should you do about it?

“I think my patient has syphilis” said the GP.
 
“Why do you think that?” asked the Microbiologist.
 
“Well, they have a funny skin lump and I had read recently that syphilis can mimic any other type of infection and that it’s making a comeback and so I did the test and it’s positive!”
 
The Microbiologist groaned to himself.
 
“Let me have a look at the results as well” he said.
 
To the Microbiologists surprise the patient did have positive syphilis serology.

“Where is the patient from?” the Microbiologist asked.
 
“What do you mean? They live locally” answered the GP.
 
“I mean where were they born? Have they lived abroad?”
 
“Oh, I don’t know. Why does it matter?”
 
“Can you give them a call and find out then call me back. This could be Yaws, Pinta or Bejel” replied the Microbiologist.
 
“Sorry my what? …Your's a pint of what…and a bagel? What did you say? This line is really bad” said the GP getting increasingly confused.
 
“Find out where they have been and call me back and then I’ll explain further” answered the Microbiologist.

The Bug Blog has been on holiday; okay you know this because there have been no blogs for 4 weeks or so. Having finally finished the 3rd Edition of “Nuts & Bolts” we went on holiday to Costa Rica to see what wildlife we could see; although Costa Rica only represents 0.03% of the World’s land mass it contains 6% of its biodiversity!

​We were really lucky. We saw all sorts of creatures from coatis and kinkajous (possibly the cutest animal ever!) to red-eyed tree frogs, massive cane toads, scarlet macaws and even the resplendent quetzal.

The mother was frantic.
 
“I don’t know what happened” she cried to the Paediatrician, “he was just a bit irritable when I put him to sleep last night and had a bit of redness around his mouth, but this morning his skin is falling off!” She then dissolved into floods of tears.
 
The Paediatrician took one look at the blisters and broken skin around the baby’s umbilicus and nappy area and asked “could he have been scalded with hot water at all? He looks burnt!

“Can I discuss an unwell baby?” asked the Neonatal Registrar.
 
“Of course, what’s the story?” replied the Microbiologist.
 
“We have a baby who is just over 24 hours old. They were born at term in good condition but started to grunt and looked mottled by 4 hours. We brought them to the Neonatal Unit, did blood cultures and started IV Benzylpenicillin and Gentamicin as per guidelines but they’re not really improving. Do you think we need to change the antibiotics? Has anything grown in the blood culture?”
 
The Microbiologist chose to ignore the last question as blood cultures are incubated in an automated incubator which scans the bottles every 10 minutes. If the blood culture where positive then it would have been phoned already.
 
“Is the baby’s mother okay? Have there been any problems during the pregnancy. Was the mother fully vaccinated? Was the labour normal? Is there anything else you’ve noticed about the baby, any odd lumps, bumps or spots?” asked the Microbiologist.

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 neoformans var. neoformans
• Cryptococcus neoformans var. grubii
• Cryptococcus gatii

 
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.
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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!