Okay, so I’m not one to watch much TV but I happened to have it on the other night and saw the program “Watchdog”. For our friends outside of the UK who may not know this program it’s a consumer rights program where companies are held to account by the media for their poor customer service or down-right dodgy dealing. Even a threat of writing to Watchdog has been known to solve many consumer issues.

The thing that caught my attention this week was an item called the “Swab Mob”. In this section members of the public are encouraged to write in suggesting places where the show could look for bacteria in order to see if there was a risk to public health. This week the area people wanted to swab was supermarket shopping trolleys and baskets.
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Off went the presenters to different supermarkets and there were lots of shots of people rubbing bacteriology swabs on different types of shopping baskets and trolleys; many of the baskets were propped up on the floor. The swabs were sent to a laboratory which cultured bacteria; armed with the results the show then tried to get an authoritative representative to agree that bacteria on shopping baskets was a national scandal.

The biomedical scientist came to find the duty Microbiologist. The Microbiologist could tell they were frustrated.
 
“Look at this“, the BMS exclaimed thrusting a request form at the Microbiologist. “How the heck do they expect us to do all of these tests on such a small sample, not to mention that most can’t even be done on an EDTA sample?”
 
Sure enough the request form was covered in a tiny scrawl of hand writing requesting about 20 different tests for the small blood sample that had been sent with the request.
 
The clinical details just said “cardiomyopathy”.
 
“Don’t worry, I’ll sort it out. It’s just that someone has probably done their exams and now knows a list of all the possible causes of cardiomyopathy and has therefore written them down” said the Microbiologist.
 
The BMS made a “harrumphing” noise and stomped off back to the lab. They were of course right, this was a ridiculous request, but cardiomyopathy is a condition where looking for the cause can be very difficult so it requires considered thought.

So having been thinking about a case of fusarium keratitis last week I started to wonder whether the new antifungal Isavuconazole might have a role to play. I then got to thinking that it would be good to write a summary of Isavuconazole for a blog… so here it is…. :-)

Whilst authorising the results the Microbiologist saw a corneal scrape sample appear on the list, shuddering and saying “oooh” out loud, as he really doesn’t like ophthalmology it makes him squeamish! The culture result said “Fusarium species isolated” and the clinical details said “keratitis, contact lens wearer”. This was a bit out of the ordinary compared to the hundreds of urine results that he normally authorises so he picked up the phone to call the Ophthalmologist.
 
It turned out that the patient was in her mid-thirties and a contact lens wearer who had presented to the eye casualty unit with a painful red eye which had been diagnosed clinically as keratitis. The Ophthalmologist had taken a sample and started treatment for bacterial keratitis, the most common cause, as an outpatient with topical Levofloxacin 0.5% eye drops. The Ophthalmologist admitted that they weren’t confident that the patient was that careful with the sterility of their contact lens solutions.
 
The Microbiologist told the Ophthalmologist that a Fusarium species had been isolated confirming the diagnosis of fusarium keratitis so the patient was recalled for alternative treatment targeted at the fungal cause rather than the previously suspected bacterial one.
 
What is keratitis?
Keratitis is inflammation of the cornea of the eye. It can be caused by bacteria, viruses, fungi and parasites. It typically presents with a painful red eye, increased sensitivity to light, and excessive production of tears. As the infection progresses a hypopyon may develop (pus in the anterior chamber of the eye; gravity causes the pus to form a level line). Eventually the cornea may perforate, become scarred and cloudy, and the patient may become blind in that eye.