Within an 8-year period, 10 cases of fungal nosocomial meningitis in children 0-13 y old were prospectively identified, 3 caused by yeasts other than Candida spp. (Rhodotorula rubra, Aureobasidium mansoni, Clavispora lusitaniae) and 7 by Candida albicans. Seven patients survived. whereas 3 neonates with fungal meningitis (all due to C. albicans) died. Risk factors for fungal nosocomial meningitis included cancer (2 children), previous neurosurgery (2 children), cranial trauma (1 case) and prematurity with low birthweight (5 cases). All patients except 1 had received broad-spectrum antibiotics before onset of meningitis. In addition to yeasts, bacteria were isolated from CSF of 4 children. One child had additional fungaemia. Univariate analysis was used to compare 10 cases of fungal to 91 cases of bacterial nosocomial meningitis. Except for concurrent bacteraemia, (60 vs 25.3%, P < 0.03), which was more frequently observed among fungal meningitis, there were no significant differences in risk factors, sequelae or outcome (mortality) between patients with fungal vs bacterial meningitis. A review of fungal meningitis reported within the last 20 y is included.
Fees for completing attendance allowance reports SIR,-Dr Christopher Law asks how many reports are requested of doctors and why arrangements exist for such reports to be paid for outside NHS remuneration.' The answer to the first question is, "All to many!" General practitioners in particular receive a myriad of requests for reports, some of doubtful necessity. In regard to the second question, there is no doubt that the requirement to pay for these reports on an item of service basis is responsible for preventing even more requests for reports. Moreover, in these days of cross charging between all government departments it would be invidious for general practitioners, who are independent contractors, or indeed hospital doctors, who are salaried to the NHS, to be asked to subsidise a department outside the NHS. With regard to completion of the report for patients claiming attendance allowance under the new "special rules," the fee agreed with the Department of Social Security takes into account those patients whose records take much longer to examine before the form can be completed.
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