Ampath Laboratories DxINSIGHTS - Issue 9 - November 2024

Introduction

INFECTIONS THAT SCARE A MICROBIOLOGIST

The thought of some infections keeps a microbiologist awake at night. The increasing numbers of pandrug-resistant Gram negatives such as carbapenemase-producing Klebsiella pneumoniae and the relentless spread of Candida auris are some of these. This article, however, refers to those infections that are so virulent that there is a very small window of opportunity to institute appropriate treatment measures and save a patient’s life. These are infections that can affect otherwise healthy young patients. It is therefore essential for emergency care doctors to familiarise themselves with these clinical entities. Two such infections are necrotising pneumonia due to Panton Valentine leukocidin (PVL)-producing Staphylococcus aureus and necrotising fasciitis, which will be the focus of this article.

ONCE BITTEN, TWICE SHY – THE MANAGEMENT OF BITE WOUNDS AND PREVENTION OF RABIES

Our relationship with domesticated animals dates back millennia. Companion animals may improve our long-term physical and mental health outcomes, but they may also increase the likelihood of zoonotic infections, allergies, injuries (due to falls) and bite wounds. Bites are more likely to be sustained from domestic animals than wildlife interactions. Dogs (Canis lupus familiaris) and cats (Felis catus) are most frequently responsible for animal bite wounds in humans. Human bite wounds are the third most common. Global estimates on the incidence of animal bites are not reliable. It is not mandatory to report cases, and patients may not seek treatment. In the United States and the United Kingdom, animal bites contribute to 1% of emergency room visits annually (2.4 to 4.7 million cases). 

THE ACUTE PORPHYRIA ATTACK

Porphyrias are inheritable diseases characterised by the build-up of precursors secondary to enzyme deficiencies within the haem biosynthes; is pathway (see Figure 1). The clinical presentation differs based on precursor accumulation secondary to the specific enzyme deficiency.