NTS bacteraemia has a high mortality (47%) and recurrence (43%) rate in HIV-infected African adults. Recurrence is caused by recrudescence rather than re-infection. As focal infections were rarely found, recrudescence may often be a consequence of intracellular tissue sequestration. There is an urgent need for improved primary treatment and secondary prophylaxis in Africa.

We determined the molecular characteristics of methicillin-resistant staphylococci from animals and staff at a small animal and equine hospital. Methicillin-resistant Staphylococcus aureus (MRSA) identical to human EMRSA-15 was found in dogs and hospital staff. In contrast, 5 distinct MRSA strains were isolated from horses but not from hospital staff.

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Infection with Burkholderia cepacia due to social contact is well described in patients with cystic fibrosis. However, social transmission to non-cystic fibrosis individuals or chronic colonisation in non-cystic fibrosis individuals has not been described. A report of B cepacia bronchiectasis is presented where a previously healthy mother of two cystic fibrosis children colonised with B cepacia became infected by the same epidemic strain. The implications of this for parents, siblings, and partners of individuals with cystic fibrosis are discussed. (Thorax 1998;53:430-432) Keywords: Burkholderia cepacia; cross infection Burkholderia cepacia is a well recognised pathogen in patients with cystic fibrosis, immunocompromised patients, and those undergoing mechanical ventilation.1 Rare cases of acute non-pulmonary B cepacia infection have also been described in immunocompetent patients. 2 Transmission is either nosocomial 3 or, in the case of cystic fibrosis, by social contact. 4 5 However, social transmission to or chronic colonisation in non-cystic fibrosis individuals has not been described. We present a case of chronic B cepacia bronchiectasis in the mother of two children with cystic fibrosis already colonised with B cepacia. Case reportA 47 year old non-smoking woman with an unremarkable previous medical history presented to her GP with persistent right pleuritic chest pain in September 1995. A chest radiograph showed vague shadowing in the right upper zone and she was treated with analgesia and oral co-amoxiclav. A repeat chest radiograph showed little change and, although her symptoms remained, no immediate further action was taken. Three months later she was referred to her local district general hospital complaining of increasing malaise and more chest pain. A further chest radiograph showed progression of the right upper zone shadowing and a diagnosis of tuberculosis was considered.She was not producing sputum and fibreoptic bronchoscopy was carried out in order to obtain microbiological samples. This revealed an inflamed right upper lobe orifice, washings from which grew a fully sensitive strain of Haemophilus influenzae. She had a two week course of co-amoxiclav with no benefit. Direct smear examination of the washings showed no evidence of tuberculosis.One month later she presented to the local accident and emergency department complaining of progressive malaise, weight loss, and pyrexia and a further chest radiograph showed marked worsening of the right lung shadowing (fig 1). She was transferred to our unit because of the possibility that she was suffering from tuberculosis. On admission she was pyrexial (38.5°C), tachypnoeic, and mildly hypoxaemic (PaO 2 9.6 kPa). She had lost 6 kg in weight over the preceding two months. There were crackles over the right upper lobe. Her white cell count was 15 400 (82% neutrophils, rest of diVerential count normal). A Mantoux test was negative and she was unable to produce sputum. An HIV test was negative, serum immunoglobulins showed a non-specific p...

In this selected group of ciprofloxacin- and cefotaxime-resistant bacteria, carriage of the qnrA gene was high (32%). This compares with <2.0% as demonstrated in worldwide studies of laboratory collections of ciprofloxacin-resistant bacteria. The majority of qnrA-positive isolates in our study originated from high-dependency care units within our hospital, but were shown not to be clonal by PFGE. This is the first report of qnrA-positive Enterobacteriaceae in the United Kingdom.