PubMed Health⌕ Search

Biomedical subjects

T Riordan

Publications and source records attributed to T Riordan.

At least 19 recordsLinked to original sources
PubMed2004

Lemierre's syndrome: more than a historical curiosa.

Lemierre's syndrome is a severe illness caused by the anaerobic bacterium, Fusobacterium necrophorum which typically occurs in healthy teenagers and young adults. The infection originates in the throat and spreads via a septic thrombophlebitis of the tonsillar vein and internal jugular vein. The ensuing bacteraemia is complicated by septic emboli to a range of sites such as lung, joints, and bones. Although rare, there is evidence of a resurgence in the condition in recent years, possibly associated with reduced use of antibiotic therapy for sore throats. The typical clinical picture is characteristic but many clinicians are unaware of the condition and diagnosis is often delayed with potentially fatal consequences.

Adolescent↗
PubMed2002

Neuroinvasion during delayed primary HHV-7 infection in an immunocompetent adult with encephalitis and flaccid paralysis.

Antibody avidity tests have been used to detect primary human herpesvirus-7 (HHV-7) infection in an immunocompetent 19-year-old man with encephalitis and flaccid paralysis for which all other suspected causes had been excluded. The finding of the viral DNA in the cerebrospinal fluid (CSF) but not in serum samples suggests that primary HHV-7 infection with invasion of the central nervous system and consequential disease had occurred. As almost all adults are infected with HHV-7 in early childhood, the present case of delayed primary infection with serious symptoms must be exceptionally rare and no cases of such late acquisition of the virus have been documented in the literature. This report of HHV-7 DNA in the CSF of an immunocompetent adult is also unique.

Adult↗
PubMed2002

How do microbiology consultants undertake their jobs? A survey of consultant time and tasks in South West England.

AIMS: To measure the total consultant medical microbiologist (CMM) weekly workload, to identify time spent on different activities, and to differentiate those tasks that were viewed by a consensus of consultants as core activities from those that could be accorded a lower priority. METHODS: A self administered questionnaire completed by consultant medical microbiologists in the Public Health Laboratory Service South West Group. RESULTS: Reported hours worked by respondents ranged from 41 to 65 hours each week, excluding on call activities. Eleven of 20 respondents reported working in excess of 48 hours each week. There was no correlation between hours worked and laboratory workload as measured by numbers of specimens. Clinical liaison, result authorisation, infection control, and management activities took up most time. Working practices varied widely between individuals, partly reflecting their differing roles in the laboratory. A consensus was reached regarding the relative importance and priority of many regular CMM activities. CONCLUSIONS: Consultant microbiologists can identify, with consensus, both high and lower priority activities in their daily practice. If such clinical priorities can be more widely agreed across the profession, this would provide a rational approach to workload control.

Attitude of Health Personnel↗
PubMed2001

Streptococcus pneumoniae: a rare skin pathogen?

Streptococcus pneumoniae is a rare cause of skin infections in adults. We present three cases and a review of the literature on this infection. Nine of the 42 (21%) cases occurred in previously healthy individuals without predisposing conditions. The majority of cases (88%) had bacteraemia. More than half the cases (22/42, 52%) required surgical intervention in addition to antimicrobial therapy.

Adult↗
PubMed2001

Investigation of postanginal sepsis and Lemierre's syndrome in the South West Peninsula.

We describe a retrospective case series of postanginal sepsis and Lemierre's syndrome (LS) identified from laboratory records of Fusobacterium necrophorum isolates and from clinical case note review. Some patients presented with sore throat, tonsillitis, quinsy or a septicaemic illness, whereas others presented with symptoms related to metastatic septic lesions with later recognition of the significance of the preceding sore throat. Patients with otitis media and mastoiditis are included in the study. The incidence of postanginal sepsis and LS appears to have increased over the study period (1994-99). The population of patients who had received antibiotics pre-admission has decreased in recent years. Attention is drawn to features which may assist in differentiating this condition from simple viral sore throats not requiring antibiotic therapy. A prospective study of the incidence of this rare but life-threatening condition mainly affecting young people is required in view of the more restricted use of antibiotic treatment for sore throat now recommended.

Adolescent↗
PubMed2000

Zygomycosis in relapsed acute leukaemia.

We would like to report the use of liposomal amphotericin in eradicating mucormycosis in two patients who had relapsed acute leukaemia. The first patient with relapsed acute myeloid leukaemia developed a rapidly expanding solitary necrotic neck lesion associated with opacity of maxilliary sinus at a time when he was profoundly pancytopenic following high dose chemotherapy. The second patient was a 3-year-old boy with pre-B acute lymphoblastic leukaemia who developed a central nervous system relapse whilst on his first line treatment and was treated with more aggressive chemotherapy on the Medical Research Council Relapse Protocol. During a period of profound pancytopenia following re-induction therapy, including high dose steroids and prolonged course of antibiotics for proven septicaemia, he developed periorbital swelling and proptosis and a clinical diagnosis of rhinocerebral mucormycosis was made. Both patients were treated with high doses of liposomal amphotericin (Ambisome Nexstar). The doses were escalated to 10 and 15 mg/kg/day, resulting in successful eradication of the mucormycosis.

Absidia↗
PubMed1999

Epidemiology of Streptococcus pneumoniae infections at the Edinburgh City Hospital: 1980-95.

We present data on pneumococcal isolates collected from deep and superficial sites over a 16-year period at the Edinburgh City Hospital. The 10 most frequent serotypes overall were 6, 19, 11, 9, 3, 14, 1, 15 and 18 in children and 19, 23, 6, 6, 9, 11 3, 15, 14, 22 and 4 in adults. Over 88% (2588/2932, 88.3%) of these pneumococci were of serotypes represented in the 23-valent polysaccharide pneumococcal vaccine. Within the 20-45 years age group, 228/434 (52.5%) of specimens were from HIV-infected individuals. The isolations showed a seasonal distribution with peaks in February and troughs in September. The annual numbers of blood culture isolates showed an upward trend. Recurrent isolations were more frequent in HIV-infected individuals (49/132, 37%) than in non-HIV-infected individuals (218/2421, 9.9%) (relative risk = 5.05, 95% confidence interval, 3.46-7.03). The prevalence of resistance to penicillin and erythromycin was lower than that reported in other parts of the UK.

Adolescent↗
PubMed1998

A possible secondary case of pneumococcal meningitis.

Although institutional outbreaks of pneumococcal infection have been reported, secondary cases of pneumococcal meningitis do not seem to have been described. We report two cases of pneumococcal meningitis involving the same serotype occurring in individuals with direct contact.

Humans↗
PubMed1998

Acquisition and carriage of meningococci in marine commando recruits.

Meningococcal acquisition is a prerequisite for invasive disease. Three hundred and eleven male marine commando recruits were studied throughout 29 weeks of basic training to identify factors influencing meningococcal carriage and acquisition including troop number, season, smoking, respiratory infection, antibiotic usage and nasopharyngeal bacterial interference flora. A high carriage rate on entry to training (118/311, 37.9%) and subsequent sustained high rates of meningococcal acquisition were found. Of the potential factors examined, only active and passive smoking were found to be associated significantly with meningococcal carriage on entry. The association between active smoking and meningococcal carriage was dose-dependent, with odds ratios (OR) of 2.2 (95% CIs 1.0-4.8) and 7.2 (95% CIs 2.3-22.9) for light and heavy smokers respectively. Passive smoking predisposed independently to carriage (OR 1.8, 95% CIs 1.1-3.0). Active and passive smoking combined to give an attributable risk for meningococcal carriage of 33%. In contrast, despite a high and sustained rate of meningococcal acquisition in the study population, none of the risk factors investigated, including active smoking, was associated significantly with meningococcal acquisition. No cases of meningococcal disease occurred during the 16-month study period. Therefore smoking may increase the duration of meningococcal carriage rather than the rate of acquisition, consistent with the increased risk of meningococcal disease from passive as opposed to active smoking. Public health measures that reduce the prevalence of smoking should reduce the risk of meningococcal disease.

Adult↗
PubMed1998

The effect of intracameral, per-operative antibiotics on microbial contamination of anterior chamber aspirates during phacoemulsification.

PURPOSE: To assess the effect of per-operative antibiotics on contamination of anterior chamber (AC) aspirates during phacoemulsification. METHODS: Two hundred and twenty patients undergoing phacoemulsification of cataract were randomly allocated to receive an irrigation infusion fluid containing either balanced salt solution (BSS) alone or BSS with vancomycin (20 mg/l) and gentamicin (8 mg/l) during surgery. Conjunctival swabs were obtained from all patients immediately before pre-operative preparation. At the end of surgery 20 ml of the AC aspirate was sent for direct and enrichment cultures. Qualitative and quantitative microbiological studies were undertaken. The chi-squared test was used to compare differences between the two groups. RESULTS: There was no significant difference between the positive culture rates of the conjunctival swabs (28 vs 27; p > 0.8). In the group that received BSS alone there were 22 (20%) positive AC aspirate cultures, 18 of which were from enrichment cultures. There were 3 positive (2.7%) cultures from the group that received antibiotics added to the BSS (p < 0.0001). CONCLUSION: The addition of gentamicin and vancomycin to the irrigation fluid during phacoemulsification results in a highly significant reduction in the microbial contamination of AC aspirates.

Anterior Chamber↗
PubMed1998

A five year survey of inoculation injuries in Exeter.

A new policy was introduced in Exeter as part of the process of improving the management of inoculation injuries. Completion of detailed questionnaires by injured health care workers has enabled us to monitor their occurrence. This has helped in the management of individual incidents, provided valuable data for staff education, prevented injuries, and identified deficiencies in compliance with procedures.

England↗
PubMed1997

A college outbreak of group C meningococcal infection: how widely should investigation and prophylaxis extend?

Neisseria meningitidis group C type 2b, P1.2, P1.5 caused an outbreak of four cases, two of whom were members of an agricultural college in Devon, and two outside contacts of students who were documented carriers of the outbreak strain. The identification of the outbreak was made more difficult by the fact that none of the three cases first linked with the college was culture positive and indeed only one of these was actually a member of the college. Carriage of the outbreak strain was significantly associated with residence in college and enrollment on one particular course. The question was raised of whether in outbreaks of this type control measures should be extended beyond the confines of the affected institution.

Adolescent↗
PubMed1997

Peroperative microbial contamination of anterior chamber aspirates during extracapsular cataract extraction and phacoemulsification.

BACKGROUND: The normal conjunctival flora is one of the main sources of intraocular contamination during cataract surgery. The theory that the positive anterior chamber (AC) pressure during phacoemulsification (phaco), and the smaller wound utilised, might reduce the rate of contamination was studied. METHODS: The peroperative AC aspirates of 210 consecutive patients undergoing cataract surgery were assessed. In group 1, 100 patients underwent a standard extracapsular cataract extraction (ECCE). In group 2, 110 patients underwent phacoemulsification of the crystal-line lens through a scleral tunnel. AC aspirates from the Simcoe irrigation/aspiration cannula (group 1) and phaco probe (group 2) were collected and microbiological studies performed after direct and enrichment cultures. RESULTS: There were 29 (29%) positives in the ECCE group compared with 22 (20%) positive cultures from AC aspirates in the phaco group. Coagulase negative staphylococcus (CNS) was the commonest contaminant in both groups. CONCLUSION: Although there was a higher rate of AC contamination during ECCE, the difference was not statistically significant (p > 0.10, chi 2 = 2.31).

Anterior Chamber↗
PubMed1996

A prolonged outbreak of streptococcal infection among workers at a meat plant.

We describe an outbreak of skin sepsis due to an erythromycin-resistant strain of Streptococcus pyogenes in workers at a meat plant. The outbreak began among butchers in the boning room but subsequently spread to other groups of workers in the plant. Despite the introduction of additional control measures, the outbreak persisted for 7 months and affected 46/194 staff with 'hands on' occupations. Spread of infection from the plant to a retail butcher was documented.

Disease Outbreaks↗
PubMed1995

Non-tuberculous mycobacterial infections presenting as salivary gland masses in children: investigation and conservative management.

Non-tuberculous mycobacterial (NTM) infections in children commonly present as cervicofacial masses. The importance of early diagnosis is in the exclusion of infection requiring treatment, particularly tuberculosis and the rare case of malignancy. Five children with NTM presenting with salivary gland masses illustrate the value of skin testing with new tuberculins and the place of fine-needle aspiration cytology in the investigation of these infections. Four children who were skin tested reacted specifically to one of the new tuberculins, two indicating infection with Mycobacterium malmoense, confirmed by culture, the others responding to tuberculins from M. scrofulaceum and M. avium-intracellulare, neither having a positive culture. The one case not skin tested produced M. avium-intracellulare on culture. All five patients were managed conservatively. The place for conservative management when the facial nerve is at risk and extensive skin excision is indicated are discussed.

Biopsy, Needle↗
PubMed1993

A point source outbreak of campylobacter infection related to bird-pecked milk.

A point source outbreak of Campylobacter jejuni affected 11 children in a day nursery. Milk consumed by the children was known to have been pecked by magpies on occasions. Illness was significantly associated with consumption of milk on a single morning. Examination of milk from a bottle pecked after the outbreak yielded campylobacters. The level of contamination was approximately six cells of C. jejuni per 500 ml of milk.

Animals↗