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Objectives: To characterise and describe the diagnostic utility of Endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) in intrathoracic tuberculosis in a cohort of patients with mediastinal lymphadenopathy of unknown aetiology., Methods: Consecutive patients with intrathoracic lymphadenopathy undergoing EBUS-TBNA between 2012 and 2016 were identified. Demographic data, biopsy cytopathology and mycobacteriology results, HIV and vitamin D status, susceptibility results and final diagnoses were recorded. Pre- and post-procedure probability scores were assigned to each case to reflect the probability of tuberculosis., Results: 315 cases were identified; 54 (17.1%) had tuberculosis and 261 (82.9%) had a non-tuberculosis diagnosis. amongst TB cases, the sensitivity of EBUS-TBNA was 59.3% (95% CI 45.06-72.14), specificity 100% (95% CI 98.19-100) and the negative predictive value (NPV) was 92.23% (95% CI 88.31-94.95). 19/54 (35%) TB cases were confirmed by EBUS mycobacterial culture and 13/54 (24.1%) by cytopathology.  33 (61.1%) of the TB cases, had a low to medium pre-test probability score assigned prior to EBUS-TBNA. Amongst EBUS culture-confirmed cases, we found a resistance rate of 10.5% to one or more first line TB drugs, with one case of multi-drug resistant TB., Conclusions: We confirmed the utility of EBUS-TBNA in the diagnosis of intrathoracic tuberculosis in an undifferentiated cohort of patients with mediastinal lymphadenopathy of unknown aetiology and advocate sending samples for mycobacterial culture in all cases in high tuberculosis incidence areas., (Copyright © 2021 The British Infection Association. Published by Elsevier Ltd. All rights reserved.)

UK guidance recommends that all patients with falciparum malaria be admitted to hospital, although a number of cohort studies in the developed world demonstrate that outpatient treatment of falciparum malaria is feasible and safe in selected patients. We review the literature on outpatient treatment in developed countries and present local data from East London where a selected immigrant population were successfully treated as outpatients. Although it is premature to claim that outpatient treatment of falciparum malaria is safe in all selected patients, we conclude it is time for a large UK-based safety study or randomised trial to dispel the belief that all patients with uncomplicated Plasmodium falciparum must be admitted to hospital.

Objectives: To assess the proportion and clinical significance of bacteraemia caused by viridans streptococci (VS) in immunocompetent adults and children., Methods: Over a 25-month period, we collected data on all patients with VS bacteraemia at a UK district general hospital., Results: VS caused 50/723 (6.9%) adult and 13/106 (12.3%) paediatric community-acquired bacteraemias. Of the 43 adult and 12 paediatric patient notes reviewed, 26 (47.3%) cultures were of 'definite' or 'probable' clinical significance. No patients were neutropenic and overall penicillin resistance was 11/55 (20.0%). Amongst adults, there were five (11.6%) confirmed or suspected cases of infective endocarditis compared to none in the paediatric cohort. Similar proportions of adults (16.3%) and children (16.7%) had lower respiratory tract infections. Among non-significant cultures, a history of seizures was observed in one (1.3%) adult and four (33.3%) children (p=0.008). Thirty-day mortality was 7.3%. No children and four adults died, one directly attributable to infection. Median adult inpatient stay was 11 days compared to 2 days in the paediatric population (p=0.003)., Conclusion: Despite cases of infective endocarditis and an incidence of penicillin resistance of 20%, mortality directly attributable to VS infection in immunocompetent adults and children was rare.

Objectives: To determine the differences in mortality and length of hospital stay in patients with bacteraemic infection caused by ESBL and non-ESBL producing Escherichia coli. Main outcome measures were mortality, time from bacteraemia to death and length of inpatient stay., Methods: From June 2003 to November 2005, we prospectively collected clinical and microbiological data on all adult patients with E. coli bacteraemia., Results: ESBL producing E. coli caused 16/242 (6.6%) community-acquired and 30/112 (26.8%) hospital-acquired bacteraemic infections. The most common sites of infection were urine 239/354 (67.5%) and bile 41/354 (11.6%). All ESBL producers were resistant to cephalosporins. Resistance to ciprofloxacin, trimethoprim, gentamicin and amikacin were 42/46 (91.3%), 39/46 (84.8%), 14/46 (30.4%) and 2/46 (4.3%), respectively. A significantly higher proportion of patients died following a bacteraemic infection caused by ESBL producing E. coli, 28/46 (60.8%), compared to non-ESBL producing E. coli, 73/308 (23.7%). The adjusted odds ratio for death was 3.57 (95% CI 1.48-8.60, p<0.005). Delay in initiating an appropriate antibiotic was significantly associated with death and ESBL production. There was no significant difference between time from bacteraemia to death (median time 7 days (ESBL +ve group) vs 5 days (ESBL -ve group); p=0.69) and, in those who survived, length of inpatient stay (median time 9 days (ESBL +ve group) vs 12 days (ESBL -ve group); p=0.111)., Conclusions: Mortality following bacteraemic infection caused by ESBL producing E. coli was significantly higher than non-ESBL producing E. coli. These findings have serious implications for antibiotic prescription, as cephalosporins are ineffective treatment for many E. coli infections.