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Results of investigations on typical specimens were circulated to Australian microbiologists, who were asked to draft reports on the basis of the data provided. Many laboratories were found simply to report the results of their activities without explanations. This was true whether the finding was that of a Gram-negative rod in a postoperative sputum or an anaerobic diphtheroid in a blood culture. There was diversity of views as to what constituted probable contamination in a urine specimen. Often no clearcut verdict was given, nor did the report indicate when no conclusion was possible. Remedial measures are discussed. [ABSTRACT FROM PUBLISHER]

Eumycotic mycetoma due to Madurella grisea was diagnosed in an 81-year-old female Australian Aborigine. This is the first reported isolation of this fungus from Australia. [ABSTRACT FROM AUTHOR]

Sporothrix schenckii is a fungus which occurs in soil and on plant material. It has not often been reported in Australia from clinical sources. Most reports have been from Queensland, and it has rarely been reported from the Sydney and Newcastle metropolitan areas. Twelve isolations from the Sydney area are reported. [ABSTRACT FROM AUTHOR]

The blood-culture methods of participants in the Microbiology Quality Assurance Programme were surveyed in late 1983; 183 participants from Australasia and S.E. Asia completed a questionnaire, the results of which are discussed. The choice of skin disinfectants varied widely. Conventional broth media were used by 85 participants; one or more diphasic bottles by 56; Roche Septi-Chek was used by 25; and BACTEC by 17. Only 80% of respondents reported the use of sodium polyanethol sulfonate. Contamination rates ranged from 0 to greater than 10%. Cultures were kept for as little as five days or as long as three weeks and were examined by inspection and/or Gram stain and/or subculture at widely varying intervals. While a great diversity of methods was used, in most cases these were adequate. The workload involved in some of the more laborious routines was considerable. It would be desirable to evaluate the cost-effectiveness of many blood culture practices.

Two hundred and eight isolates of Trichosporon beigelii were identified over the period January 1973 to July 1983. 45.7% of these were from skin, 25.0% from nail, 22.6% from tissues and fluids, 3.4% from hair and 3.4% from sputum. Tr. beigelii was isolated in association with a recognized pathogen in 23 cases, 9 with a yeast, 14 with a dermatophyte. In 38 cases, Tr. beigelii was the only organism isolated when direct microscopic examination of clinical material showed the presence of hyphae and/or yeast cells. Although Tr. beigelii could only be assigned a definite pathogenic role in 6 cases of genital white piedra, and in one case of peritonitis associated with chronic ambulatory peritoneal dialysis, we believe that this organism was pathogenic in many cases of skin infection. In most of the cases where it was isolated from tissue or fluids at Royal North Shore Hospital, Tr. beigelii was not considered to be significantly contributing to the disease process.

The fungus Histoplasma capsulatum, although commonly found in bat-frequented caves in many countries, has not previously been isolated from that environment in Australia. This report describes the isolation of H. capsulatum from several sources, including cave soil, the organs of mice exposed to the cave environment, and the sputum of a patient clinically diagnosed as having acute pulmonary histoplasmosis after exposure to the cave environment.

Five hundred and fifty six dematiaceous hyphomycetes, the great majority referred from other laboratories, were identified by us over a five year period. Of these, thirty five were regarded as being of probable pathogenetic significance. These included seven isolates associated with chromoblastomycosis, and seven isolates thought to be causing phaeohyphomycosis. There were six strains of Phaeoannellomyces werneckii and five strains of Sporothrix schenckii. Seven isolates, all strains of Aureobasidium pullulans, were associated with fungal peritonitis in patients on chronic ambulatory peritoneal dialysis. Two Bipolaris isolates were associated with paranasal sinus fungus ball, a condition in which no evidence of tissue invasion by fungi could be found, even though pressure necrosis of bone could lead to very serious consequences. A further seven dematiaceous hyphomycetes, isolated from cases of paranasal fungus ball, keratitis and otitis externa, were thought to be of possible pathogenetic significance. Of the remaining 514 isolates thought to be of no pathogenetic significance, two thirds were made up of strains of Aureobasidium pullulans, Alternaria alternata, Cladosporium cladosporioides, Epicoccum purpurascens and Phoma species. In many cases it was thought that the referring laboratories had allowed insufficient time for development of conidiogenesis in these strains, before sending them to our laboratory for identification.

During an outbreak of Salmonella typhimurium food poisoning in September 1983, in Sydney, 10 affected subjects were admitted to the same hospital. On admission to hospital, all patients were severely dehydrated; two patients developed acute tubular necrosis, while a third patient had myopericarditis. Bacteraemia was confirmed in two patients, in one of whom no organisms were isolated from stool cultures. Antibiotic agents were administered to all patients, because of the unusually severe nature of the infection. This outbreak illustrates that salmonella gastroenteritis, although usually fairly mild and self-limiting, can be a virulent disease resulting in serious complications. Appropriate management should include careful initial assessment of suspected cases, vigorous correction of fluid and electrolyte disturbances, and judicious use of antibiotic agents when bacteraemia or severe toxaemic features are present.

5 typical microbiology reports were circulated to the medical staff of a 900-bed teaching hospital and they were asked for their interpretations. Approximately 160 completed replies were received and it was clear that the reports were often misinterpreted; one report (isolation of a gram-negative rod from sputum) was misinterpreted by four doctors out of five. The reasons for this failure of communication seem to be the use of jargon and unfamiliar names of bacterial species, and use of ill-defined reporting conventions. The omission of a clear-cut conclusion from many reports also contributed to misunderstanding. These deficiencies in reporting practices result in unnecessary antibiotic therapy and unnecessary work for the laboratory, since clinicians are more likely to ask for a repeat of a test with a doubtful interpretation. Communications with clinicians would be more effective if microbiologists ensured that each report is free of jargon, states what conclusion can be drawn from the test, and makes recommendations, where appropriate, for antibiotic therapy.

Routine sputum culture in microbiology laboratories is frequently a source of dissatisfaction to microbiologists and clinicians alike. Care should be taken to ensure that the investigations requested are appropriate and that an adequate specimen is collected. Co-operation between the microbiologist and the clinician is required if the laboratory's facilities are to be properly exploited for the etiological diagnosis of respiratory tract infection. In clinical conditions such as lung abscess and atypical pneumonia sputum is not an appropriate specimen for the laboratory to work on and early consideration should be given to obtaining lower respiratory tract secretions free of oropharyngeal contamination.

A case of localized, subcutaneous infection in the cheek of a three-month-old girl that was caused by the zygomycete Saksenaea vasiformis is reported. This is the fourth report of infection in Australia that was due to this fungus and, in contrast to all but one of the few previous reports in the literature, a cure was effected by surgical debridement alone.