Chronic multifocal osteomyelitis: is infectious causation a moot point?

Chronic multifocal osteomyelitis [CMO] is an uncommon disease entity with descriptions possibly emanating from the medical literature over one century ago, and there are numerous disease entities which have been historically detailed and which are probably synonymous. The illness is one of chronicity with exacerbating and remitting focal bony lesions. The differential diagnosis for a bony lesion which ultimately proves to be CMO is initially quite broad. There is no absolute pathognomonic clinical finding, and the diagnosis is highly dependent on clinical course, histopathology, and an absence of microbial infection. Recent studies have focused on immune dysfunction or dysregulation, and there are now many other diseases which are inflammatory in nature and which have been diagnosed among patients with CMO. Despite the aforementioned, the potential for direct infectious causation or indirect causation by infectious stimulation of immunity cannot be entirely excluded. Infection as a mechanism for pathogenesis must continue to be entertained. Multi-centre studies are key to future research

Infections in the natural environment of British Columbia, Canada

The Canadian province of British Columbia has a luxurious environment, complete with the multitude of wildlife and insects, and would at first glance appear to be suitable for the transmission of diseases in nature communicable to humans. Despite this potential, such diseases are relatively uncommon, although several have the potential for serious consequences. Attention has been recently focused on hantavirus infection, water-borne toxoplasmosis and parasitic diarrheal diseases, cryptococcosis on Vancouver Island, and rabies. West Nile virus has not yet caused endemic human infection in this province as of 2008. We review the cumulative science in this area

role of healthcare personnel in the maintenance and spread of methicillin-resistant Staphylococcus aureus

Healthcare workers may acquire methicillin-resistant Staphylococcus aureus [MRSA] from patients, both hospital and home environments, other healthcare workers, family and public acquaintances, and pets. There is a consensus of case reports and series which now strongly support the role for MRSA-carrying healthcare personnel to serve as a reservoir and as a vehicle of spread within healthcare settings. Carriage may occur at a number of body sites and for short, intermediate, and long terms. A number of approaches have been taken to interrupt the linkage of staff-patient spread, but most emphasis has been placed on handwashing and the treatment of staff MRSA carriers. The importance of healthcare workers in transmission has been viewed with varying degrees of interest, and several logistical problems have arisen when healthcare worker screening is brought to the forefront. There is now considerable support for the screening and treatment of healthcare workers, but it is suggested that the intensity of any such approach must consider available resources, the nature of the outbreak, and the strength of epidemiological associations. The task of assessing healthcare personnel carriage in any context should be shaped with due regard to national and international guidelines, should be honed and practiced according to local needs and experience, and must be patient-oriented