More mischievous medical morsels are being served up in this week’s FFFF.
We have a flu-like illness after gardening, meningococcal disease on a plane, the inventor of the term ‘epilepsy’, something called pituri and a worrying case of facial swelling and respiratory distress following a kiss.
Time to get stuck in!
A 28 year-old Australian doctor presents to the emergency department with cough, shortness of breath, myalgias, headache and fever. He recently moved house and has been doing a lot of gardening and potting plants. What infectious cause should you consider?
- Legionella longbeachae
- This species accounts for most cases of Legionellosis in Australia, and may closely mimic the flu.
- In a soil survey in Australia published in 1990, 33 (73%) of 45 potting soil samples tested positive for Legionella; 26 (79%) of the 33 contained L. longbeachae.
- Although particularly common in Australia, the bug was first isolated in Long Beach, California and is found around the world. It is typically contracted by inhalation while working with potting mix, mulch and soil.
- Suggested safety measures include:
— Wetting down the potting mix to reduce the dust.
— Wearing gloves and a P2 mask when using potting mix.
— Washing hands after handling potting mix or soil, and before eating, drinking or smoking.
Li JS, O’Brien ED, Guest C. A review of national legionellosis surveillance in Australia, 1991 to 2000. Commun Dis Intell. 2002;26(3):461-8. PMID: 12416715.
Lim I, Sangster N, Reid DP, Lanser JA. Legionella longbeachae pneumonia: report of two cases. Med J Aust. 1989 May 15;150(10):599-601. PMID: 2654579.
A patient on a flight from Los Angeles to Sydney is found to have meningococcal disease. Who from the plane should receive chemoprophylaxis?
- Passengers that were seated either side of the affected individual.
(This assumes that no household contacts of the affected individual were also on the plane, and that the stricken person didn’t join the ‘mile high’ club with anyone en route to Sydney…)
- This advice applies to flights of 8 or more hours duration. Shorter duration flights generally don’t need chemoprophylaxis. Furthermore, passengers sitting in the row ahead or behind, or more than one seat away to the side, do not need chemoprophylaxis.
Centers for Disease Control and Prevention (CDC). Exposure to patients with meningococcal disease on aircrafts–United States, 1999-2001. MMWR Morb Mortal Wkly Rep. 2001 Jun 15;50(23):485-9. PMID: 11428727. [Free fulltext]
Who coined the term epilepsy?
- John Hughlings Jackson (1835-1911)
- Jackson is known as the ‘Father of British Neurology’ and coined the term epilepsy in 1866.
- Jackson, a Yorkshireman, is widely credited with the first electrical theory of epilepsy, but was actually preceded by Irish physician Robert Bentley Todd who lectured on the subject in 1849.
Reynolds E. Todd, Hughlings Jackson, and the electrical basis of epilepsy. Lancet. 2001 Aug 18;358(9281):575-7. PMID: 11520547.
What is pituri?
- Pituri is derived from plants of the Duboisia genus and is chewed by Indigenous Australians for its stimulant, euphoric, antispasmodic and analgesic effects.
- Duboisia hopwoodi has one of the highest nicotine contents of any native Australian plant. It also contains the anticholinergic alkaloids scopolamine and hyoscine.
- Pituri was, and is, used in traditional rituals in Central Australia. It’s use at the time of European contact has been compared to the role of tobacco in indigenous American societies prior to European discovery. Probable traditional uses include analgesia during ritual circumcision, ameliorating hunger during travel, and as a stimulant before a fight.
- Don’t mistake a wad of pituri for a fungating oral tumour! (See this photo from the National Library of Australia)
Ratsch A, Steadman KJ, Bogossian F. The pituri story: a review of the historical literature surrounding traditional Australian Aboriginal use of nicotine in Central Australia. J Ethnobiol Ethnomed. 2010 Sep 12;6:26. PubMed PMID: 20831827; PubMed Central PMCID: PMC2944156.
A young woman presents with swelling of the lips and eyes, has a hoarse voice and shortness of breath. This came on after passionately kissing her boyfriend. Her past medical history is significant for penicillin allergy. What is the likely diagnosis?
- Her boyfriend may be taking a penicillin-based antibiotic.
- Liccardi et al (2002) reported such a case, that was confirmed by challenge tests, which involved giving the partner a placebo or varying doses of antibiotic prior to kissing the patient.
- So, you can add this to the list of different forms of Dangerous Love out there…
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