Explore the vast range of titles available.

In September 2018, monkeypox virus was transmitted from a patient to a healthcare worker in the United Kingdom. Transmission was probably through contact with contaminated bedding. Infection control precautions for contacts (vaccination, daily monitoring, staying home from work) were implemented. Of 134 potential contacts, 4 became ill; all patients survived.

Viral meningitis is increasingly recognised, but little is known about the frequency with which it occurs, or the causes and outcomes in the UK. We aimed to determine the incidence, causes, and sequelae in UK adults to improve the management of patients and assist in health service planning. We did a multicentre prospective observational cohort study of adults with suspected meningitis at 42 hospitals across England. Nested within this study, in the National Health Service (NHS) northwest region (now part of NHS England North), was an epidemiological study. Patients were eligible if they were aged 16 years or older, had clinically suspected meningitis, and either underwent a lumbar puncture or, if lumbar puncture was contraindicated, had clinically suspected meningitis and an appropriate pathogen identified either in blood culture or on blood PCR. Individuals with ventricular devices were excluded. We calculated the incidence of viral meningitis using data from patients from the northwest region only and used these data to estimate the population-standardised number of cases in the UK. Patients self-reported quality-of-life and neuropsychological outcomes, using the EuroQol EQ-5D-3L, the 36-Item Short Form Health Survey (SF-36), and the Aldenkamp and Baker neuropsychological assessment schedule, for 1 year after admission. 1126 patients were enrolled between Sept 30, 2011, and Sept 30, 2014. 638 (57%) patients had meningitis: 231 (36%) cases were viral, 99 (16%) were bacterial, and 267 (42%) had an unknown cause. 41 (6%) cases had other causes. The estimated annual incidence of viral meningitis was 2·73 per 100 000 and that of bacterial meningitis was 1·24 per 100 000. The median length of hospital stay for patients with viral meningitis was 4 days (IQR 3–7), increasing to 9 days (6–12) in those treated with antivirals. Earlier lumbar puncture resulted in more patients having a specific cause identified than did those who had a delayed lumbar puncture. Compared with the age-matched UK population, patients with viral meningitis had a mean loss of 0·2 quality-adjusted life-years (SD 0·04) in that first year. Viruses are the most commonly identified cause of meningitis in UK adults, and lead to substantial long-term morbidity. Delays in getting a lumbar puncture and unnecessary treatment with antivirals were associated with longer hospital stays. Rapid diagnostics and rationalising treatments might reduce the burden of meningitis on health services. Meningitis Research Foundation and UK National Institute for Health Research.

The Human Papilloma Virus (HPV) vaccine provides protection against the main cause of cervical cancer, and was licensed in both the US and the EU in 2006.1 As of October 2014, 64 countries and 12 overseas territories have implemented this vaccine into national immunisation schedules, with the vast majority of the coverage being in women in high-income settings.2 A 2016 review of 10 years of global HPV prevalence data has demonstrated reductions up to ~90% in HPV infections and genital warts, typically within four years after introduction of the vaccination programs, and across numerous countries on different continents.3 The impact of this vaccine is likely to be immense, with an estimated 345,000 cases of cervical cancer and 156,000 deaths predicted to be averted in 47 million women vaccinated by 2014 (ref. 2). The observed safety profile of the HPV vaccine has been excellent, with large well-conducted interventional and observational studies concluding there are no side-effects of significant prevalence that might counteract recommendations to implement the vaccine.4–6

[...]cerebral perfusion pressure takes a \"double whammy,\" and the end result may be clinically significant cerebral ischaemia from profoundly inadequate cerebral perfusion, which is likely to worsen neurological outcomes.

CaseA 67 year old man presented with a febrile illness after returning from Goa, India. On the day of admission he developed severe shooting pain which radiated up his left arm, to his neck. The following day he was unable to dorsiflex his wrist or extend his fingers. He developed intermittent paraesthesia of his left forearm and wasting over the extensor aspect of the forearm. He was positive for hepatitis E IgM. On examination there was wasting in the left upper arm and forearm/hand. There was weakness of shoulder external rotation, mild weakness of elbow extension but severe weakness of wrist dorsiflexion, finger extension, abductor pollicis brevis and reduced sensation left C5.Electrophysiological testing supported a diagnosis of left brachial plexopathy.DiscussionBrachial plexopathy is one of the many neurological manifestations of hepatitis E infection reported in the literature. A previous study has shown that acute hepatitis E infection was identified in 10% of patients with acute brachial plexopathy at the start of the illness.ConclusionAcute hepatitis E infection is often subclinical and only associated with mild transient transaminitis. We suggest screening for hepatitis E infection in patients with acute neurology and concurrent liver enzyme derangement.

Background Disproportionately high gonococcal incidence rates amongst men have altered the clinical picture of disseminated gonococcal infection (DGI). The ‘classical’ female patient experiencing a triad of arthritis, tenosynovitis and cutaneous lesions no longer predominates. We present two cases emphasising the need for thorough investigation with evident clinical signs of DGI. Cases A 48 year old Nigerian heterosexual male presented with a 6 cm inguinal mass and oral hairy leukoplakia. Impression was of lymph node abscess; HIV testing was positive. Urine Nucleic Acid Amplification Testing (NAAT) for chlamydia and gonorrhoea (CT/GC) was negative. Subsequently he developed a swollen tender left wrist. Inguinal abscess aspiration for NAAT testing returned a positive gonococcal result. Treatment was instigated with intravenous ceftriaxone for 4 days, subsequently switching to cefixime for a further week. 3 weeks later his wrist swelling resolved. A 50 year old HIV-positive British heterosexual male presented after returning from Thailand. He had developed a tender swollen left wrist. Urine NAAT for CT/GC was negative. He reported condomless oral and vaginal sex with multiple Thai females. Gonococcal tenosynovitis was suspected and extragenital NAATs and cultures for CT/GC were taken; NAAT for pharyngeal gonorrhoea was positive. Single dose ceftriaxone and azithromycin was prescribed, followed by cefixime for 1 week. Two weeks later his symptoms cleared. Conclusion Reflecting on these cases a DGI diagnosis was attained following careful consideration of possible differentials and persistence in identifying Neisseria gonorrhoeae. Both diagnoses would have been missed if following current testing guidance which recommends penile-only sampling of heterosexual men.