Acquired arteriovenous communication: complication of cannulation of internal jugular vein.

Pneumococcal cross infection in hospitalThe mortality associated with pneumococcal infection has been reduced with chemotherapy and modern supportive care, though pneumococcal bacteraemia in elderly patients still carries a poor prognosis.The ready availability of penicillin and other antibiotics that are effective against pneumococci may have distracted attention from cross infection among patients. Case reportsFour women admitted to the same postnatal ward after delivery were infected with the same serotype of Streptococcus pneumoniae.The first woman to be infected was feverish when first seen, complaining of shortness of breath and generalised muscular pain.Cultures of blood taken on admission showed S pneumoniae capsular type 9.She received parenteral ampicillin within 48 hours after admission.Two days after the first patient was delivered a second patient, who had previously been well, developed a temperature of 39 C and signs of lobar pneumonia.S pneumoniae capsular type 9 was grown from her sputum.Two days later two more patients who had both undergone caesarean section one day before and were being nursed in adjacent rooms on the same ward, developed similar signs.Results of microscopic examination of sputum in both were consistent with pneumococcal infection, but culture of sputum yielded negative results as parenteral ampicillin had been started before the sputum was obtained.Countercurrent immunoelectrophoresis on sputum showed the presence of type 9 pneumococcal antigen in both cases.The table shows the results of laboratory investigations in all four patients. Results of laboratory investigationsSputum Case Blood culture No Culture Antigen titre 1 No pathogens isolated Not done S pneumoniae type 9 2 S pneumoniae type 9 .Positive; 1/100 Negative t Spneumoniae type 9 3 No pathogens isolated* fPositive; neat Negative Spneumoniae type 9 4 No pathogens isolated* Positive; 1/1000 Negative t S pneumoniae type 9 *Antibiotics administered before specimen collected.Three patients (cases 2, 3, and 4) were probably infected by the strain of S pneumoniae introduced by the first patient.The last two patients to be infected were nursed in single side rooms, and no further cases were detected.'Sinigar H.The variability in virulence of the pneumococcus.