Invasive paediatric Elizabethkingia meningoseptica infections are best treated with a combination of piperacillin/tazobactam and trimethoprim/sulfamethoxazole or fluoroquinolone.

OBJECTIVES: Elizabethkingia meningoseptica is a multi-drug-resistant organism that is associated with high mortality and morbidity in newborn and immunocompromised patients. This study aimed to identify the best antimicrobial therapy for treating this infection. METHODS: A retrospective descriptive study was conducted from 2010 to 2017 in a tertiary paediatric hospital in Singapore. Paediatric patients aged 0 to 18 years old with a positive culture for E. meningoseptica from any sterile site were identified from the hospital laboratory database. The data collected included clinical characteristics, antimicrobial susceptibility and treatment, and clinical outcomes. RESULTS: Thirteen cases were identified in this study. Combination therapy with piperacillin/tazobactam and trimethoprim/sulfamethoxazole or a fluoroquinolone resulted in a cure rate of 81.8  %. The mortality rate was 15.4  % and neurological morbidity in patients with bacteraemia and meningitis remained high (75 %). CONCLUSIONS: Treatment with combination therapy of piperacillin/tazobactam and trimethoprim/sulfamethoxazole or a fluroquinolone was effective in this study, with low mortality rates being observed.

Correlations between clinical illness, respiratory virus infections and climate factors in a tropical paediatric population.

Weekly (August 2003-December 2008) numbers of five common paediatric diseases and the incidence of respiratory viruses were obtained from a children's hospital in Singapore and correlated with climate data using multivariate time-series techniques. Upper respiratory tract infections were positively correlated with the incidences of influenza A, B, respiratory syncytial virus (RSV) and parainfluenza viruses (types 1-3 combined). Lower respiratory tract infections were positively correlated with only the incidence of RSV. Both upper and lower respiratory tract infections were negatively correlated with relative humidity. Asthma admissions were negatively correlated with maximum temperature and positively correlated with the incidence of influenza B and increasing hours of sunshine. Although sporadic cases of adenovirus infection were identified, not enough cases were available for a more detailed analysis. Gastroenteritis and urinary tract infections, included as control diseases, were not correlated significantly with any climate parameters. These correlations are compatible with current understanding of respiratory virus survival under certain climate conditions and may assist the prediction of disease burdens and hospital resource planning in such tropical environments.

Visceral abscesses due to Brucella suis infection in a retired pig farmer.

A 78-year-old retired pig farmer developed brucellosis and died of liver failure >20 years after her last exposure to infected livestock. This is an exceptionally long incubation period for this infection, which usually presents within weeks of exposure.

Nocardiosis in patients with systemic lupus erythematosus. The Singapore Lupus Study Group.

Nocardia, a gram positive variably acid-fast aerobic bacterium is an opportunistic pathogen in immunocompromised hosts. We present 5 cases of nocardiosis in patients with systemic lupus erythematosus. We emphasize the clinical features, radiologic findings, and antibiotic sensitivity. Lung involvement was the predominant manifestation; others include brain abscess, retinitis, thyroiditis, and diaphragmatic infiltration. We describe the first cases of pulmonary nocardiosis presenting as pneumothorax and the use of fine needle aspiration cytology in diagnosing nocardial thyroiditis.

Serotypes and antimicrobial resistance in Haemophilus influenzae in a hospital practice.

We studied the clinical spectrum, serotypes and antimicrobial resistance of Haemophilus influenzae received by our laboratory. The majority of cases involved the elderly (more than 60 years old) and children under the age of 5 years. Most infections involved the respiratory tract and were caused by non-serotypable strains. Invasive infections (meningitis, septic arthritis and bacteraemia) were infrequent and were caused by both type b and non-serotypable strains. The estimated incidence of invasive Haemophilus influenzae type b disease in children under the age of 5 years is at most 5 per 100 000 a year. Resistance to ampicillin (40.5%) and trimethoprim-sulfa (37.7%) was high and would affect the choice of antimicrobials used for treating Haemophilus influenzae infections.