Routine examination of the water system in an establishment where showers were used by staff after work or leisure activities revealed the presence of Legionella pneumophila. Descaling and steaming cleared the system but six months later recolonization was found to have occurred. L. pneumophila was isolated from air samples collected in the shower room whilst the shower was in operation. No clinical cases have occurred. Serological examination of those using the showers throughout the six month period together with a control group showed no evidence of infection.

No abstract

No abstract

A virulent strain of Legionella pneumophila was inoculated into an enclosed system supplied with unsterilized water from a domestic hot water supply. Growth of bacteria was monitored over 10 weeks. An increase in the number of organisms other than legionellas occurred but few amoebae were observed and none could be cultured. Viable counts of L. pneumophila in the circulation fluid decreased slightly. However, particles of debris which accumulated in the apparatus and which were stained by the indirect fluorescent antibody technique were found to be almost totally composed of L. pneumophila. On dismantling the apparatus Legionella was isolated in moderately high numbers from several different types of surfaces, particularly natural rubber and silicone.

No abstract

No abstract

No abstract

Injuries of the tarsometatarsal, or Lisfranc, joint are rarely seen. Lisfranc fractures and fracture dislocations are among the most frequently misdiagnosed foot injuries in the emergency department. A misdiagnosed injury may have severe consequences including chronic pain and loss of foot biomechanics. Evaluation of a foot injury should include a high level of suspicion of a Lisfranc injury, and a thorough work-up is needed for correct diagnosis.