Pulmonary infection by Nocardia is an uncommon opportunistic infection in humans. Thirty-five patients with pulmonary nocardiosis were identified in two tertiary referral hospitals. A retrospective review of the patient characteristics, clinical and laboratory features including antimicrobial susceptibility at diagnosis was carried out. Radiological features derived from chest radiographs and CT scans were also documented. In our population, the predominant risk factors were immuno-compromised state, corticosteroid therapy, and underlying pulmonary pathology. The presenting features were similar to those previously described but disseminated infection was not common. The radiological changes were diverse and non-specific. Nocardia asteroides was the commonest species. Most Nocardia isolates were susceptible to imipenem, ceftriaxone, amikacin, and cotrimoxazole. Co-existing microbial agents are common and reflect the underlying complex disorders.

Two cases of rotavirus gastroenteritis associated with neurological involvement, one with encephalitis (defined by abnormal neurological signs, cerebrospinal fluid (CSF) pleocytosis and detection of rotavirus genomic nucleic acid in the CSF) and one with a non-inflammatory encephalopathy (defined by abnormal neurological signs, an entirely normal CSF and detection of rotavirus genomic nucleic acid in the CSF), are presented and used as a basis to review and explore potential pathogenetic mechanisms, including direct viral replication within neurons and indirect effects of the newly described rotavirus 'enterotoxin'.

Summary:Immunocompromised haematological patients are at high risk for severe, often fatal, respiratory syncytial virus (RSV) pneumonia. In the 2001 winter season, 16 of 195 (8.2%) adult haematological in-patients were diagnosed with RSV infection. Eight patients had undergone stem cell transplantation. The median age was 53 years (range 20-67). A total of 11 patients had nosocomial RSV infection while the rest (five) had community-acquired infection. All patients were febrile and had upper respiratory tract infection (URTI). Eight patients (50%) developed lower RTI. Two of the 16 patients (12.5%) died of respiratory failure, due to the RSV pneumonia, despite ICU admission and supportive ventilation. None of the studied patients received ribavirin therapy or specific RSV immunoglobulin. Two patients autografted for multiple myeloma (MM) showed delayed neutrophil and platelet engraftment despite receiving an adequate dose of stem cells. A third patient undergoing a CD34+ selected HLAmatched sibling mini-allograft for relapsed MM showed graft failure shortly after RSV infection. In our series, RSV infection was concurrent with an outbreak in the community. Unlike other published series, no specific antiviral treatment for RSV pneumonia was used and yet the overall outcome in our patients was favourable. Furthermore, RSV infection in the pre-engraftment period after autologous transplantation was associated with delayed engraftment. Bone Marrow Transplantation (2003Transplantation ( ) 32, 195-203. doi:10.1038 Keywords: respiratory syncytial virus; stem cell transplantation; engraftment; immunocompromised; RSV pneumonia Respiratory syncytial virus (RSV) is the most common viral agent causing both upper and lower respiratory tract infections in children and adults. 1 The yearly incidence of RSV infection in hospitalised patients ranges between 2 and 12% and depends upon the severity of outbreaks in the community at the time. 2 RSV is a common cause of lower respiratory tract illness in immunocompromised patients. [3][4][5] Up to 70% of stem cell or bone marrow transplant (BMT) recipients who experience RSV infection in the pre-engraftment period will develop pneumonia. 6,7 Once pneumonia develops, the overall mortality has been reported to be as high as 60-80%. 3,6,[8][9] Those patients with RSV pneumonia who develop respiratory failure requiring mechanical ventilation almost invariably die from the infection. Treatment options for established RSV pneumonia are limited and treatment is often unsuccessful. 4,10,11 RSV infection in hospitalised patients usually occurs in the setting of community outbreaks and may be community-or nosocomially acquired. Transmission of RSV takes place by droplet infection or via direct contact with infected persons. The virus can survive on nonporous surfaces, skin and gloves for many hours. RSV is not stable in fine particle aerosols, and hence small-particle air transmission is not considered to be a major route of spread. 1,2 In this report, we describe the outcome of 16 adult haemat...

These results demonstrate that Inverta-PEG is a safe and effective tube that can be removed nonendoscopically with ease in 95% of the cases.