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This guideline provides a rational and cost-effective approach to patients with acute meningitis, which causes considerable morbidity and mortality, predominantly in children.There are many aetiologies, but a small number of bacteria and viruses account for the majority of cases. There should be a low threshold for suspecting acute meningitis, which is a medical emergency and antibiotics should not be delayed. Blood culture and cerebrospinal fluid (CSF) analysis are the most important diagnostic tests and should be performed whenever it is safe and practical. Contraindications to lumbar puncture are discussed and an algorithm is given regarding administering empiric antibiotics and antivirals, performing blood cultures, computer tomography brain scanning and cerebrospinal fluid analysis, depending on the clinical features and availability of resources. Administration of steroids is not recommended. Guidelines are provided for definitive therapy whenever a causative organism is identified. When no organism is identified, treatment and further investigation should be guided by laboratory results and clinical response. An approach to this process is outlined in a second algorithm. The epidemiology of resistance to common pathogens is described and advice given regarding special groups, including those with recurrent meningitis or base-of-skull fractures. Advice regarding infection control, post-exposure prophylaxis and vaccination is provided.

Healthcare professionals working in high HIV prevalence settings are at continuous risk of nosocomial acquisition of HIV. Risk factors for percutaneous injuries include recapping or manipulation of needles following venesection and improper disposal of sharps. Prompt risk assessment and access to antiretroviral post-exposure prophylaxis (PEP) is essential to reduce the risk of HIV seroconversion. This study audits the practice of doctors involved in high risk procedures for acquisition of blood-borne viruses. Forty-two doctors working at GF Jooste Hospital, Cape Town, were polled by anonymous questionnaire as to their venesection practice, sharps disposal, history of at-risk exposures and access to PEP. An observational study of sharps bin use was undertaken concurrently. Thirty-six doctors responded, 92% of whom were misusing blood-taking equipment. Five times the number of sharps bins were available in medical wards compared to surgical. Twenty-four doctors sustained a total of 67 blood risk exposures since qualification. Less than half of exposures were reported and only 35% of those who reported their incident received post-exposure counselling and appropriate management. Twenty-five exposures led to a course of PEP. Median delay to PEP was two hours and median duration of PEP was 21 days. Incorrect venesection practice, improper sharps disposal and inadequate post-exposure management are directly increasing the risk of nosocomial transmission of HIV. We believe that these practices are widespread within the South African health service and need to be addressed to adequately protect our doctors and nurses.

Pseudallescheria boydii is a very rare cause of sinusitis but an increasingly recognised infection among HIV-infected patients. Its correct identifcation is vital as voriconazole, which has good in vitro activity against the fungus, has important interactions with antiretroviral drugs. We report the successful treatment of Scedosporium apiospermum pansinusitis, in an HIV-infected woman, which required alteration of antiretroviral therapy.

On June 11th 2010, the FIFA World Cup kicks off at Soccer City Stadium, Johannesburg, in a country gripped by World Cup Fever; the good kind that is. Over 350,000 international visitors are expected to enter South Africa to attend the month-long competition, which constitutes the largest mass gathering for a single sporting event. One of the many challenges in hosting the World Cup, is to ensure that visitors stay well during their visit and do not succumb to World Cup Fever of a very different kind. Practical health advice targeted at key risk exposures have been posted on a number of sites1-3 and a summary of advice for travellers attending the World Cup is given in table 1.

A 28-year-old HIV-seropositive man presented to clinic with a four-month history of a rash on his right lower limb. The rash began as painless macules which formed nodules and coalesced (Figure a). Over the last month, new skin lesions had formed on his torso (Figure b) and a painful lesion of his tongue (Figure c) had increased in size, making speech difficult. His chest x-ray was unremarkable and there was no clinical or radiological evidence of organomegaly. A recent CD4 count was 15 cells/μL and he was antiretroviral naive.

Chronic meningitis, often caused by Mycobacterium tuberculosis or Cryptococcus neoformans , has received a great deal of attention in South Africa as its incidence has increased along with that of HIV. By comparison acute meningitis caused by a different range of pathogens, has received relatively little attention while continuing to exact a large burden of morbidity and mortality. There are a number of guidelines for acute meningitis from high resource countries 1,2 but these may be less applicable to resource-limited countries like South Africa, a large proportion of whose population live in deeply rural areas with limited access to healthcare. There are also guidelines for acute meningitis in resource-poor settings 3 but such settings are heterogenous, particularly throughout Africa.

The biennial FIDSSA congress is always an eagerly anticipated event, which delivers more than the sum of its parts. By bringing together doctors, nurses, laboratory staff, scientists and students with diverse interests in adult and paediatric infectious diseases, clinical microbiology, infection control, travel medicine and sexually transmitted infections, the FIDSSA congress provides an unparalleled learning opportunity in our field. It is a time for continuing professional development, networking, advocacy, and, dare one say, enjoyment.