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• Consensus recommendations for managing chronic suppurative lung disease (CSLD) and bronchiectasis, based on systematic reviews, were developed for Australian and New Zealand children and adults during a multidisciplinary workshop. • The diagnosis of bronchiectasis requires a high-resolution computed tomography scan ofthe chest. People with symptoms of bronchiectasis, but non-diagnostic scans, have CSLD, which may progress to radiological bronchiectasis. • CSLD/bronchiectasis is suspected when chronic wet cough persists beyond 8 weeks. Initial assessment requires specialist expertise. Specialist referral is also required for children who have either two or more episodes of chronic (> 4 weeks) wet cough per year that respond to antibiotics, or chest radiographic abnormalities persisting for at least 6 weeks after appropriate therapy. • Intensive treatment seeks to improve symptom control, reduce frequency of acute pulmonary exacerbations, preserve lung function, and maintain a good quality of life. • Antibiotic selection for acute infective episodes is based on results of lower airway culture, local antibiotic susceptibility patterns, clinical severity and patient tolerance. Patients whose condition does not respond promptly or adequately to oral antibiotics are hospitalised for more intensive treatments, including intravenous antibiotics. • Ongoing treatment requires regular and coordinated primary health care and specialist review, including monitoring for complications and comorbidities. • Chest physiotherapy and regular exercise should be encouraged, nutrition optimised, environmental pollutants (including tobacco smoke) avoided, and vaccines administered according to national immunisation schedules. • Individualised long-term use of oral or nebulised antibiotics, corticosteroids, bronchodilators and mucoactive agents may provide a benefit, but are not recommended routinely.

Meningococcal septicaemia has high mortality, especially when the diagnosis is delayed or missed. Early recognition is not always straightforward, as classic clinical features may be absent or overlooked at initial presentation. Septicaemia without focal infection accounts for 15%-20% of cases of meningococcal disease and is the most worrisome manifestation in terms of diagnosis and outcome; in contrast, meningococcal meningitis is usually straightforward to diagnose, with a relatively good prognosis. Useful early clinical clues to meningococcaemia include: - a haemorrhagic (petechial or purpuric) rash; - blanching macular or maculopapular rash that appears in first 24 hours of illness; - true rigors; - severe pain in extremities, neck or back; vomiting, especially in association with headache or abdominal pain; rapid evolution of the illness; - concern of parents, relatives or friends; - patient age (highest incidence at age 3-12 months, followed by 1-4 and then 15-19 years); and - contact with a patient with meningococcal disease. In addition to specific clues, clinicians should look at the whole pattern of the illness. Timely clinical review is essential if there is doubt about the diagnosis. In any acutely febrile patient, it is prudent to ask "Why is this patient seeking help now?", then "Could this patient have meningococcaemia?".

Before embarking on an epidemiological study of acute rheumatic fever in remote Aboriginal communities, researchers engaged in the processes of community consultation, consent and household enrolment. Community expectations and time constraints are not necessarily those of the funding bodies, and a considerable investment of time and local engagement was required before the project proceeded with local support. The remoteness of the communities, harsh climate and limited infrastructure made working conditions difficult. Nevertheless, the study was completed and the results are being returned to the local councils and households. The research team continues to maintain its relationship with each study community.

Twenty-eight (53%) of 53 hospital-acquired staphylococcal bacteraemias which occurred at The Royal Melbourne Hospital over a two-year period were due to methicillin-resistant Staphylococcus aureus (MRSA). Every patient with MRSA bacteraemia had a significant underlying condition predisposing to nosocomial sepsis, and each had an intravascular foreign body in situ at the time. Most were being nursed in special care areas of the hospital and had been exposed to multiple or broad-spectrum antibiotics during the month before development of bacteraemia. Patients acquiring MRSA infection should be isolated and, when the diagnosis of bacteraemia is considered, any potential primary focus should be removed. Vancomycin is the drug of choice in life-threatening MRSA infections.

Methicillin-resistant Staphylococcus aureus was thought to be the cause of 10 cases of antibiotic-associated diarrhoea observed over a 12-month period at The Royal Melbourne Hospital. Each patient had significant underlying disease, and all had been treated with multiple, broad-spectrum antibiotic agents. The diagnosis was made on the distinctive Gram-stain appearance of faecal smears, the heavy predominant growth of methicillin-resistant Staph. aureus from stool cultures, and the absence of other bowel pathogens, including toxigenic Clostridium difficile. Diarrhoea usually responded to treatment with vancomycin or bacitracin, and, in patients whose condition improved, the stools cleared of staphylococci. Patients with staphylococcal diarrhoea present a significant crossinfection risk, and early diagnosis, treatment, and isolation are essential.

Kunjin virus encephalomyelitis is described in a 49-year-old man who presented with an episode of acute encephalitis. He developed profound bulbar, truncal and proximal muscle weakness suggestive of damage to cranial motor nuclei and anterior horn cells. This resolved very slowly. A marked rise in antibody titres to Kunjin virus was shown by haemagglutination inhibition tests. Specific IgM antibodies were detected only against Kunjin virus.