Pneumonia and meningitis are the 2 most frequent manifestations of Streptococcus neumoniae infection. Pneumococcal septic arthritis is considered to be relatively uncommon. Between 1985 and 1998, 32 (8. 2%) of 389 cases of septic arthritis seen in the 2 hospitals in Nottingham, United Kingdom, were due to S. pneumoniae. Six of 7 children with pneumococcal septic arthritis were aged <2 years. Of the 25 adults, 20 (80%) were aged >60 years, 11 (44%) had concomitant pneumococcal infection elsewhere, and 23 (92%) had articular or nonarticular diseases and/or other risk factors. In the elderly, a lack of febrile response was striking. S. pneumoniae was isolated from blood and joint cultures in >70% of cases, and gram-positive diplococci were seen in the joint fluids of 90% of patients. The mean duration of antimicrobial therapy for adults was twice as long as that for children. Eight (32%) of the adults died.

The clinical spectrum of extraintestinal salmonellosis comprises enteric fever (typhoid and paratyphoid) and invasive infections due to nontyphoidal salmonellae. This study describes the clinical spectrum, management and outcome of all confirmed cases of extraintestinal salmonellosis in patients admitted to University Hospital, Nottingham, UK, between 1980 and 1997. There were 142 cases (children, 42; adults, 100) of extraintestinal salmonellosis, of which 38 (children, 20; adults, 18) were enteric fever, consisting of 21 cases of typhoid, 12 of paratyphoid A and five of paratyphoid B. All patients with typhoid and paratyphoid A fever were from Indian or Pakistani families and, except for two adults, all were considered to be previously fit. The outcome in patients with enteric fever was excellent, and there were no complications. Of the 104 patients (children, 22; adults, 82) with nontyphoidal salmonellosis, 69 were bacteraemic secondary to gastroenteritis, 10 were bacteraemic without an obvious focus of infection and 25 had focal infections. The three major sites of focal infections were meningitis in five infants, osteomyelitis in two children and three adults, and arterial infections in ten adults. The three most frequently isolated organisms were Salmonella enteritidis (40%), Salmonella typhimurium (25%) and Salmonella virchow (14%). Sixty-seven percent of these patients had underlying disease(s)/risk factors. In contrast to the outcome of enteric fever, there were 19 deaths (children, 2; adults, 17) in patients with nontyphoidal salmonellosis. Sixteen of the 17 adults who died were over the age of 60 years. Eight (25%) of 32 males over the age of 60 years with nontyphoidal Salmonella bacteraemia had arterial infections. In some patients, the diagnosis of Salmonella arterial infection is likely to be delayed or missed altogether if blood cultures are not obtained. Mortality in patients over the age of 60 years with nontyphoidal Salmonella infections was 28%.

Aims: To evaluate the incidence, spectrum of clinical manifestations, and outcome of invasive pneumococcal disease (IPD) in children. To determine the major serogroups of Streptococcus pneumoniae responsible for invasive disease and the potential coverage by the new pneumococcal conjugate vaccines. Methods: Analysis of prospectively recorded information of all children admitted to two teaching hospitals in Nottingham with IPD between January 1980 and December 1999. Results: A total of 266 episodes of IPD in children were identified; 103 (39%) were aged ,1 year and 160 (60%) ,2 years. Major clinical presentations were meningitis in 86 (32%), pneumonia in 82 (31%), and bacteraemia without an obvious focus in 80 (30%). The age specific mean annual incidence rates of IPD overall among children aged ,1, ,2, and ,5 years were 47.1, 37.8, and 20 per 100 000 population, respectively. Mortality rates for children with meningitis and non-meningitic infection were 20% and 7%, respectively. Neurological sequelae following meningitis were documented in 16 (26%) of the 61 survivors assessed. The potential coverage rates in children between the ages of 6 months and 5 years are 84% by the 7-valent, 91% by the 9-valent, and 95% by the 11-valent conjugate vaccines. Conclusion: This study indicates that inclusion of a pneumococcal conjugate vaccine in the primary immunisation programme in the UK would have a considerable effect on the mortality and morbidity associated with IPD.

Pneumonia and meningitis are the most frequent manifestations of Streptococcus pneumoniae infection. Spinal infection is considered to be a rarity. Between 1985 and 1997, 8 patients with spinal infection (vertebral osteomyelitis, 3; spinal epidural abscess, 1; both, 4) due to S. pneumoniae were seen at University Hospital (Nottingham, U.K.). Predisposing factors for pneumococcal infection were documented for five patients and included diabetes mellitus, alcoholism, and corticosteroid therapy. One patient presented with concomitant meningitis and endocarditis. Clinical features of note were prolonged symptoms and a lack of febrile response. S. pneumoniae was isolated from the blood of five patients. Magnetic resonance imaging was used to localize the spinal infection in five patients. Two cases were managed medically. Three patients died after a protracted illness. A literature search revealed 20 other cases of spinal infections due to S. pneumoniae. The salient features of the cases are summarized.

Twenty seven patients with cystic fibrosis under the age of 12 years and 27 matched patients with asthma were followed up in a prospective study for one year. The isolation rate of non-capsulated strains ofHaemophilus influenzae from cough swabs and sputum specimens taken at routine clinic visits every two months was significantly greater in cystic fibrosis than in asthma. Haemophilus parainfluenzae was equally common in both groups. During exacerbations the isolation rate of H influenzae in cystic fibrosis was significantly greater than at other times, whereas in asthma there was no significant difference.The distribution of biotypes ofH influenzae and H parainfluenzae was similar in the two groups. In cystic fibrosis, biotype I was associated with exacerbations. Biotype V was more common than in previous studies, but was not associated with exacerbations.