Infections associated with unpasteurised milk

Infections associated with unpasteurised milk include:

• Bovine TB
• Salmonella
• Campylobacter
• Staphylococcal food poisoning
• Q fever
• Brucellosis
• Listeria
• E coli 0157

Botulism

Botulism is associated with poor home-preserved and bottled food, due to bacterial contamination and toxin production. Wound-associated botulism is a well-recognised problem in intravenous drug abusers.

Side Effects of HIV and AIDS Drugs

Anti-HIV drugs are associated with numerous side effects but are not linked to hypocalcaemia.

Some data, however, do suggest a link with premature osteoporosis.

Facial thinning is caused by fat redistribution (lipodystrophy) associated with insulin resistance, and disturbed fat and glucose metabolism.

Zidovudine induces a grey discolouration of the nails in persons with pigmented skins. Indinavir crystallises in the renal tract leading to renal impairment and stones.

One of the most serious side effects is lactic acidosis and liver failure associated with nucleoside reverse transcriptase inhibitors.

Lyme Disease

The rash is erythema chronicum migrans, which is a feature of early Lyme disease (Stage 1) in 70% of cases. Regional lymphadenopathy may also be a feature. The diagnosis is confirmed by serology. The treatment for early disease is 2-3 weeks of doxycycline or amoxicillin.

Hospital Infection Control

Acquisition of C. difficile may occur by person-to-person spread in outbreak situations in institutions, such as nursing homes and hospitals and thus a history of antibiotic use is not an essential prerequisite. Mortality in the elderly may be high and isolation is essential. Pneumonia due to M. bovis is TB (though most is due to M. tuberculosis). Vancomycin resistant enterococcal infections are more important than drug-sensitive infections, particularly as enterococcus is generally a pathogen of low virulence. Outbreaks of multidrug resistant Klebsiella can sweep through ITUs very quickly and to devastating effect. MRSA, which is resistant to glycopeptides such as vancomycin, is a potentially untreatable organism and intermediate-resistant isolates have already been recognized in the UK.