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Objectives: To classify non-typhoidal salmonella bacteraemia according to clinical presentation, and to study how this correlates with the presence of underlying immunosuppression., Methods: We analysed data collected prospectively for all 82 cases of non-typhoidal salmonella bacteraemia presenting to St. Thomas' Hospital between 1970 and 1999., Results: Patients presented with one of three syndromes: diarrhoea, an extra-intestinal focus of infection, or isolated fever with no focus. Only 18% of those with diarrhoea had underlying immunosuppression, compared with 80% of those with extra-intestinal focal infections (P= 0.001) and 80% of those with no focus (P= 0.0001). There was no significant association between salmonella serotype and underlying immunosuppression. Salmonella enteritidis isolates, especially phage type 4, increased significantly during the last decade (P= 0.001). The presentation of non-typhoidal salmonella bacteraemia in the absence of diarrhoea prompted the diagnosis of HIV in two patients., Conclusion: Underlying immunosuppression should be excluded in patients presenting with non-typhoidal salmonella bacteraemia in the absence of gastroenteritis. This may lead to an earlier diagnosis of HIV., (Copyright 2000 The British Infection Society.)

We report the first case of a pseudolymphomatous skin reaction precipitated by flucloxacillin. Skin histology was suggestive of a cutaneous lymphoma, and DNA analysis by single stranded conformational polymorphism (SSCP) demonstrated T-cell receptor gamma gene monoclonality. Withdrawal of flucloxacillin led to immediate clinical improvement and gradual resolution of skin rash and lymph nodes.

Six patients with pre-existing rheumatic joint disease presented with overwhelming septicaemia but without overt signs of joint inflammation. Joint aspirates demonstrated multifocal staphylococcal infective arthritis. Despite intensive care all six died from the infection or its immediate sequelae. The contrast between this clinical entity and classical infective arthritis, presenting with one or more swollen, tender joints, is discussed.

Four patients with candida endophthalmitis are discussed; three had received prolonged intravenous therapy as well as multiple and varied courses of antibiotics for underlying gastro-intestinal disease; one was an intravenous drug abuser. The visual acuity improved dramatically in two of the five affected eyes but in the remaining three eyes remained at 6/60 or less. Visual prognosis is directly related to early diagnosis and treatment, which should include pars plana vitrectomy and systemic antifungal therapy.

An elderly woman with rheumatoid arthritis of 8 years duration and for which she was receiving indomethacin, developed multifocal cellulitis with subsequent necrosis. Streptococcus pneumoniae type 1 was isolated from her blood and from blister fluid. Previous reported cases are summarised.