A case of a giant right atrial diverticulum associated with neonatal supraventricular tachycardia is reported. The electrocardiogram in sinus rhythm showed pre-excitation that may have been caused by the right atrial diverticulum adhering to the right ventricle.Congenital diverticulum or aneurysm of the right atrium is a very rare anomaly. Morrow et al reported the case of a 23 year old woman with a large congenital aneurysm of the right atrium that caused repeated attacks of supraventricular tachycardia and was successfully treated by surgical resection of the diverticulum.' A case of atrial tachycardia in a five month old infant caused by multiple congenital saccular aneurysms of the right and left atrium that was successfully treated surgically has also been reported.2 Aneurysms of the left atrium have also been reported to be associated with atrial arrhythmias.3 Our case was noticed prenatally, was subsequently diagnosed with cross sectional echocardiography, and was successfully treated with antiarrhythmic drugs.

Introduction:Zika virus (ZIKV) and Chikungunya virus (CHIKV) can share the same mosquito vector, and co-infections by these viruses can occur in humans. While infections with these viruses share commonalities, CHIKV is unique in causing arthritis and arthralgias that may persist for a year or more. These infections are commonly diagnosed by RT–PCR-based methods during the acute phase of infection. Even with the high specificity and sensitivity characteristic of PCR, false negatives can occur, highlighting the need for additional diagnostic methods for confirmation.Case presentation:On her return to the USA, a traveller to Colombia, South America developed an illness consistent with Zika, Chikungunya and/or Dengue. RT-PCR of her samples was positive only for ZIKV. However, arthralgias persisted for months, raising concerns about co-infection with CHIKV or Mayaro viruses. Cell cultures inoculated with her original clinical samples demonstrated two types of cytopathic effects, and both ZIKV and CHIKV were identified in the supernatants. On phylogenetic analyses, both viruses were found to be related to strains found in Colombia.Conclusion:These findings highlight the need to consider CHIKV co-infection in patients with prolonged rheumatological symptoms after diagnosis with ZIKV, and the usefulness of cell culture as an amplification step for low-viremia blood and other samples.

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A 37-year-old woman with a history of type II diabetes and Crohn's disease, status postcholecystectomy, presented with a >2-week history of cramping abdominal pain, nausea, non-bloody/non-bilious emesis and, later, diarrhoea. A flexible sigmoidoscopy was performed, revealing that 'a segmental pseudomembrane was found from rectum to sigmoid colon'. Clostridium difficile PCR on the stool was repeated twice and resulted negative both times. A food history prior to onset of symptoms was consistent with Staphylococcal food poisoning and a stool culture was positive for heavy growth of methicillin-resistant Staphylococcus aureus and the absence of enteric flora. The patient was successfully treated with oral vancomycin.