Infectious diseases pose a major challenge in the elderly for two reasons: on the one hand the susceptibility to infection increases with age and when infections occur they often present atypically-on the other hand diagnostic uncertainty is much more pronounced in the geriatric population. Reconciling the opposing aspects of optimizing patient outcomes while avoiding antibiotic overuse requires significant expertise that can be provided by an infectious diseases consultant. In addition, geriatric facilities are reservoirs for multidrug-resistant organisms and other nosocomial pathogens, and infectious diseases consultants also play a vital role in assuring appropriate infection control measures. In this review we outline the challenges of diagnosis and management of infectious diseases in the elderly, and discuss the importance of appropriate antibiotic use in the elderly in order to demonstrate the value of the infectious diseases consultant in this special setting.

Wild poliovirus–associated paralytic poliomyelitis has not been reported in Australia since 1977. We report type 1 wild poliovirus infection in a man who had traveled from Pakistan to Australia in 2007. Poliomyelitis should be considered for patients with acute flaccid paralysis or unexplained fever who have been to poliomyelitis-endemic countries.

Schistosomiasis antibody titers varied after adequate treatment. Therefore an increase in titer in the first 6 to 12 months or a failure to reduce after 3 years should not automatically justify re-treatment.

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Aim: To evaluate clinical usefulness of metagenomics sequencing alongside conventional testing in two adult cases of CNS infection. Methods: For both cases, bacterial microscopy and culture, herpes multiplex PCR, enterovirus PCR, parasitology multiplex PCR, Acanthamoeba culture, fungal culture, cryptococcal antigen and M. tuberculosis culture and PCR were done on the cerebrospinal fluid (CSF) with 4 mL required for each patient. Metagenomics sequencing required only 0.4 mL of CSF for each patient. CSF was subjected to particle enrichment (virus and ribosomes), random amplification of extracted RNA and DNA, library preparation and Ion Torrent next generation sequencing (NGS). Although clearly an experimental method, this method has been successful in detecting viruses and other microbes in a range of samples. Result: All conventional testing as mentioned above was negative. NGS of sample 1 generated 3.7 million reads, mean read length 156 nucleotides; sample 2 generated 4 million reads, mean read length 185 nucleotides. Analysis of NGS reads focusing on finding an infectious aetiology, did not reveal any significant findings. Clinicians were reassured to prescribe immune-suppressive therapy with good response for Case 1 and have antibiotics ceased in Case 2. Conclusion: Metagenomics sequencing alongside conventional testing may be useful for ruling out active infection in patients with possible CNS infection.