Leptospirosis presenting as a haemorrhagic fever in a traveller from Africa

Leptospirosis is usually a mild illness, although the severity of clinical manifestations may vary between the serovars of leptospires. In May 1993, a 48-year-old man from Ghana presented with severe icteric leptospirosis, initially managed as viral haemorrhagic fever. The causative serovar, bataviae, had not been previously diagnosed in human infection in Australia.

Haemophilus paraphrophilus vertebral osteomyelitis

OBJECTIVE

To report the first case of Haemophilus paraphrophilus vertebral osteomyelitis--the second reported case of osteomyelitis of any site caused by this organism.

CLINICAL FEATURES

A 41-year-old male bus driver with no significant previous medical history presented with severe abdominal and back pain, which was eventually localised to the eleventh thoracic vertebra (T11). H. paraphrophilus was isolated from pus aspirated from the vertebral body.

INTERVENTIONS AND OUTCOME

The patient was treated with penicillin given intravenously for four weeks, then with antibiotics given orally for a further three weeks, with good clinical response.

CONCLUSION

H. paraphrophilus is an infrequent pathogen which may be difficult to identify and test for antibiotic susceptibility, but can cause serious infection, including primary haematogenous osteomyelitis.

Pasteurella multocida meningitis in a two-day old neonate

A normal full-term baby boy, born by vaginal delivery, became ill on day 2 with fever and failure to feed. CSF examination revealed 260 x 10(6)/l leucocytes, mainly mononuclears, protein 2 g/l and glucose zero. Pasteurella multocida was isolated in pure culture from the baby's CSF, blood and umbilicus and from the mother's vagina. The baby was treated with i.v. penicillin for 7 weeks. Progress was complicated by mild hydrocephalus, which resolved, and prolonged low grade fever. Recovery was complete, without neurological sequelae. This case illustrates that P. multocida can infect the vagina where it presents a hazard to a newborn infant delivered vaginally. Early diagnosis is critical, intravenous high dose penicillin being the treatment of choice.

Listeria monocytogenes peritonitis associated with CAPD

Listeria monocytogenes peritonitis developed in a 67-year-old man on continuous ambulatory peritoneal dialysis following a catered luncheon. Alcoholic liver disease was a predisposing factor. L. monocytogenes multiplies at 4 degrees C. It is often present in imported soft cheese, less often in chicken and other refrigerated food. Listeria peritonitis has not been previously reported in Australia.

Shigella dysenteriae type 1 enterocolitis

Shigella dysenteriae type 1 is much more virulent than Shigella flexneri and sonnei which are endemic in Australia. This report describes a 22 year old woman who acquired Shigella dysenteriae type 1 whilst travelling in India. During the course of her illness, she developed severe enterocolitis for which a subtotal colectomy was performed. The illness resembled fulminant ulcerative colitis and its infectious nature was difficult to establish because several fecal cultures failed to grow the pathogen. Her infection was complicated by shigella bacteremia, disseminated intravascular coagulation, and renal cortical necrosis which requires continued hemodialysis.