​The patient was a 12 year old girl who was originally from Eastern Europe having moved to the UK 5 years earlier. She presented to the paediatricians having become blind in one eye. The paediatricians and ophthalmologists could see a white lesion on fundoscopy and a provisional diagnosis of retinoblastoma was made. Blood tests were performed and the astute Paediatric Registrar who looked at the results noted that the patient’s eosinophil count was raised, and in fact this was the only abnormal result. The Paediatrician called the Microbiologist to ask if this might actually be infection instead of cancer.
 
There are a number of infections that can result in unilateral blindness including the more common infections like uveitis, keratitis and endophthalmitis as well as those that are less common e.g. Cytomegalovirus, toxoplasmosis and toxocariasis. Only one of these presents with a white lesion in the eye combined with a raised eosinophil count (eosinophilia), toxocariasis. On further questioning it was noted that whilst growing up in Eastern Europe the patient used to play outside where numerous stray dogs were present. Urgent blood samples were arranged for Toxocara spp. antibodies (both cat and dog!).

​As a result of my earlier blog about topical antibiotics, there were a number of questions and stories of personal experience with topical antiseptics and I was asked for my opinion on their use. We don’t tend to use them in the acute setting so I thought I’d look for the evidence and write a blog about these this week. Topical treatments for infections have been around for thousands of years (AD1210 the use of pig manure to cure nose bleeds, AD1530 the use of mercury to treat syphilis, scabies and leprosy and the ancient Egyptians used mashed up mouse for skin wounds!!) OK, OK, I am not advocating these for modern medical practice; however the supporting evidence for these old treatments is possibly equal to the topical treatments we currently have!! So what do we really know about modern topical antiseptics, is their use anecdotal and akin to “old wives tales” or is there actual evidence for their clinical use and effectiveness?

One of the trickiest things for a Microbiologist is to determine when the classical symptoms and signs of infection are NOT in fact infection at all! Consider the 3 patients below:

• Patient 1 was a 65 year old man who presented with severe pain, redness and swelling of his left thigh. He had a temperature of 37.5oC, a raised CRP and a creatine kinase (CK) of 2117 IU/L (normal range 40-320). He was diagnosed with cellulitis and started on Flucloxacillin. Because his CK was raised the orthopaedic surgeons were asked to review him for the possibility of necrotising fasciitis but they felt it wasn’t. He was continued on Flucloxacillin but showed little improvement...
• Patient 2 was a 57 year old man who had a temperature of 38oC, a raised CRP and was being treated for an intra-abdominal abscess following a bowel perforation. He had grown mixed bowel flora including Candida albicans from the pus sample taken during the operation. After a period of intravenous antibiotics the surgeons wanted to change him to oral antibiotics to finish his treatment...
• Patient 3 a 52 year old man presented with a temperature of 39oC, high CRP, hypotension and tachycardia. He had a severe headache and a rapidly spreading blanching rash that started on his chest and spread down his arms. He was very unwell and required inotropic support on the critical care unit. He was started on broad spectrum IV antibiotics and had extensive investigations including a lumbar puncture but all was normal...