Skin infection caused by a novel strain of Staphylococcus pseudintermedius in a Siberian husky dog owner.

Introduction.Staphylococcus pseudintermedius, an opportunistic pathogen of dogs and cats, is rarely reported to cause infection in humans. Here, we describe a case of severe skin infection caused by S. pseudintermedius, in a 47-year-old male, a dog owner; to the best of our knowledge, this is the first such case reported from Scotland. Case presentation. The patient presented with a short history of a severe ecthyma-like lesion on his forehead, with smaller lesions on his abdomen and legs. Bacterial culture revealed Clostridium perfringens, thought to be colonizing the wound, and a Staphylococcus species, identified as S. pseudintermedius by matrix-assisted laser desorption/ionization-time of flight MS and confirmed by molecular methods using a PCR-RFLP approach. The patient was treated with flucloxacillin, penicillin V and Fucibet cream, and recovered fully. Zoonotic infection was considered likely; however, screening swabs from his dogs grew S. pseudintermedius of a different clonal type. Both patient and dog strains carried Staphylococcus intermedius exfoliative toxin and leucocidin I, closely related to Panton-Valentine leucocidin, possibly contributing to the severity of the infection. S pseudintermedius, although coagulase positive, is normally negative by rapid slide clumping and latex agglutination tests routinely used to identify Staphylococcus aureus. Hence, S. pseudintermedius may easily be misidentified as a coagulase-negative staphylococcus and considered insignificant. Conclusion. This is, to the best of our knowledge, the first reported case of a human S. pseudintermedius infection in Scotland. Zoonotic transmission of S. pseudintermedius between pets and owners has been shown. However, in this case zoonosis could not be confirmed.

Reducing inappropriate testing in the diagnosis of the menopause and peri-menopause.

The menopause should be diagnosed based on age, menstrual history and clinical symptoms, and as such, follicle stimulating hormone testing may be considered inappropriate when diagnosing the menopause or peri-menopause in women aged 45 and over. As part of a demand optimisation programme, the number of follicle stimulating hormone tests requested to diagnose the menopause in this age group was quantified and educational interventions were implemented to reduce inappropriate testing. The number of follicle stimulating hormone tests requested to diagnose the menopause in women aged 45 and over was successfully and sustainably reduced.

Cobas 4800 HPV detection in the cervical, vaginal and urine samples of women with high-grade CIN before and after treatment.

AIMS: To assess the performance of a clinically validated human papillomavirus (HPV) test (the Cobas 4800 HPV test) in urine and self-taken vaginal specimens within a colposcopy population and to assess HPV prevalence before and after treatment across the different biospecimens. METHODS: A total of 100 women attending a colposcopy clinic provided three biospecimens (a clinician-taken liquid-based cytology sample (LBC), a self-taken vaginal sample and a urine sample) for HPV testing. HPV prevalence and concordance was compared across the biospecimens and clinical performance relative to the detection of cervical intraepithelial neoplasia (CIN)2+ and CIN3+ was assessed. A total of 39 women retuned at 6 months for a post-treatment follow-up appointment, and HPV concordance in all biospecimens was measured relative to their original HPV status. RESULTS: 65 cases of CIN2+ were detected in the baseline population; sensitivity for CIN2+ was 92% (82 to 97) for the vaginal and the LBC sample and 80.0 (68% to 88%) for the urine sample. In the follow-up (post treatment) population, women were twice as likely to be HPV positive in their urine or vaginal sample compared with the equivalent LBC sample. CONCLUSIONS: Vaginal and LBC samples showed very similar performance for the detection of CIN2+ in this population using the Cobas HPV test; further validation of these findings in screening contexts will be of value. Self-taken samples may have less utility in a 'test of cure' setting-given the higher prevalence of HPV relative to LBC.

Spontaneous bacterial peritonitis due to Listeria monocytogenes: importance of enrichment culture.

A case of Listeria monocytogenes induced spontaneous bacterial peritonitis (SBP) is reported in a patient with primary biliary cirrhosis. It is an indolent illness and may not show a neutrophil reaction in peritoneal fluid. Enrichment broth was required to isolate L monocytogenes in the patient. This is not routinely used in the UK and therefore isolates may be missed. L monocytogenes remains sensitive to ampicillin, penicillin and gentamicin, but is resistant to cephalosporin antibiotics. The rising incidence of listeriosis in the population suggests that the incidence of SBP from L monocytogenes is likely to increase.