Clostridial wound infection following reconstruction of the anterior cruciate ligament using bone- patella- bone autograft

A 27-year-old rugby player underwent anterior cruciate ligament [ACL] reconstruction, using autograft. Postoperatively, septic arthritis was missed due to atypical presentation but diagnosed 2 days later and underwent open arthrotomy and lavage, He received antibiotics for 5 weeks. Aspirate showed clostridium perfringens. Later, extension lag was developed, which improved by arthroscopic excision of fibrous tissue and adhesions. The source of clostridial contamination remained a mystery. Skin preparation can be ineffective in eradicating clostridium perfringens prior to procedures. Routine prophylactic use of metronidazole would be controversial. In patients with postoperative infections, we suggest that samples should be routinely sent for anaerobic cultures

Congenital Rubella Syndrome-revisited

Although rubella vaccines were developed in 1969, the incidence of congenital rubella syndrome [CRS] is still high in developing countries. The natural history of rubella and congenital rubella has been extensively studied both epidemiologically and virologically over the last 20 years. Fetal infection during organogenesis can lead to miscarriage, stillbirth, or severe malformations, especially when the exposure happens during the first 8 weeks of gestation. Fetal infection after 17 weeks' gestation is rarely associated with structural malformations, but behavioural problems and mental retardation can occur. Congenital rubella is rare in countries which have aggressive vaccination programmes. It is still a problem in developing countries