A cross-sectional survey of snake oral bacterial flora from Hong Kong, SAR, China.

OBJECTIVE: To determine the pattern of oral bacterial flora and their sensitivity to antibiotics in freshly captured native snakes in Hong Kong SAR, People's Republic of China. METHODS: Healthy native snakes were captured and kept in a designated centre. Snake species were identified by experienced herpetologists. Mouth swabs were taken by the veterinarian using strict aseptic techniques. The snakes were released back to the wild immediately after the above procedure. Swabs were sent for microbiological studies of bacterial culture and antibiotic sensitivity. RESULTS: 47 venomous snakes of the families Colubridae, Elapidae and Viperidae and 53 non-medically important snakes were captured. 406 bacterial isolates of 72 different species were cultured: these included gram negative and positive bacterial species and also anaerobic bacterial species. With the exception of the white-lipped pit viper (Cryptelytrops albolabris), venomous snakes harboured more pathogenic bacteria and total bacteria species compared to the non-medically important species. Of the venomous snakes, the Chinese cobra (Naja atra) harboured the largest number of bacterial species. In the present study, all gram negative bacteria associated with wound infection were sensitive to levofloxacin, netilmicin and piperacillin/tazobactam. Many gram negative bacteria in the study were not sensitive to cefuroxime axetil. Amoxicillin/clavulanic acid was an appropriate choice to cover Enterococcus faecalis and anaerobes. CONCLUSION: In the presence of wound infection from snakebite injury in Hong Kong, first line empirical antibiotics include amoxicillin/clavulanic acid plus levofloxacin. Prophylactic antibiotics may be considered in selected cases of Chinese cobra (N. atra) bite, otherwise prophylactic antibiotics are not recommended in snakebite unless tissue necrosis is present.

Resequencing microarray for detection of human adenoviruses in patients with conjunctivitis.

BACKGROUND: Although high-density resequencing microarray is useful for detection and tracking the evolution of viruses associated with respiratory tract infections, no report on using this technology for the detection of viruses in patients with conjunctivitis is available. OBJECTIVES: To test if high-density resequencing microarray can be applied to detection of viruses in conjunctival swabs for patients with conjunctivitis. STUDY DESIGN: In this prospective proof-of-concept study, every 4 or 5 bacterial culture-negative conjunctival swab samples were pooled and subject to viral detection using TessArray Resequencing Pathogen Microarrays-Flu 3.1 (RPM-Flu-3.1). Results were compared with human adenovirus (HAdV) hexon gene PCR sequencing and viral culture. RESULTS: Thirty-two of the 38 conjunctival swab samples were bacterial culture-negative. Four of the 7 pooled samples were positive for HAdV using RPM-Flu-3.1. Hexon gene PCR sequencing on the 38 original individual samples showed that 3 and 4 samples contained HAdVs species D and B respectively. All the 6 samples that were positive for hexon gene PCR but negative for bacterial culture were also positive by the resequencing microarray. Viral culture was positive for HAdV type 3 in 1 sample, which was also positive by PCR and resequencing microarray. CONCLUSIONS: Resequencing microarray is as sensitive as PCR for detection of HAdV in conjunctival swabs. Unlike viral culture and hexon gene PCR sequencing, resequencing microarray was not able to differentiate the type and species of HAdV. Development of microarrays for conjunctivitis can be performed for rapid diagnosis of the viral cause of conjunctivitis.

Community-associated methicillin-resistant and methicillin-sensitive Staphylococcus aureus: skin and soft tissue infections in Hong Kong.

This prospective study assessed the epidemiology of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) among patients with purulent skin and soft tissue infections (SSTIs) in Hong Kong. Among 298 patients with SSTIs, 10.4% (13/125) of all S. aureus isolates and 5% (12/241) of all abscesses were attributed to pvl-positive CA-MRSA. Overall, 77% and 69.9% of CA-MRSA and methicillin-sensitive S. aureus (MSSA) were susceptible to erythromycin, 77% and 74.8% to clindamycin, 100% and 97.1% to minocycline, and 100% and 98.1% to rifampin, respectively. Filipino ethnicity was the only clinical and epidemiologic factor significantly associated with CA-MRSA infection (odds ratio, 14.8; 95% confidence interval, 3.3-70.0; P < 0.001). Pulsed-field gel electrophoresis analysis showed that 6 CA-MRSA isolates belonged to the ST30-HKU100 clone, 5 belonged to the ST59-HKU200 clone, and 1 was singleton. Features of HKU100 isolates include SCCmec type IV, agr3, spa t019, and pan-susceptibility to non-beta-lactam antibiotics. In contrast, HKU200 isolates are characterized by having SCCmec type IV or V, agr4, spa t437, and variable non-beta-lactam susceptibility profiles. The major CA-MRSA spa types were shared by a minority of the MSSA.

Acute retrobulbar haemorrhage: an ophthalmic emergency.

Acute retrobulbar haemorrhage is a rare complication of blunt eye trauma. It can be sight-threatening but is reversible when recognized and treated promptly. We presented a case of acute retrobulbar haemorrhage with profound reduction of vision. Emergency surgical decompression was performed to preserve the vision. Clinical features and management are discussed.