In this large, prospective, multinational cohort, more than one half of all cases of non-HACEK gram-negative bacillus endocarditis were associated with health care contact. Non-HACEK gram-negative bacillus endocarditis is not primarily a disease of injection drug users.

Epidemiologic evidence shows that mosquitoes play a role in transmission to humans.

Objective To assess vitamin D intake and casual exposure to sunshine in relation to serum 25‐hydroxyvitamin D (250HD) levels. Design Cross‐sectional study of a population‐based, random sample of women aged 20–92 years, assessed between 1994 and 1997. Setting and participants 861 women from the Barwon Statistical Division (population, 218000), which includes the city of Geelong (latitude 38° south) in Victoria. Main outcome measures Vitamin D intake; serum 250HD level; season of assessment; exposure to sunshine. Results Median intake of vitamin D was 1.2 μg/day (range, 0.0–11.4 μg/day). Vitamin D supplements, taken by 7.9% of participants, increased intake by 8.1% to 1.3 μg/day (range, 0.0–101.2 μg/day) (P< 0.001). A dose–response relationship in serum 250HD levels was observed for sunbathing frequency before and after adjusting for age (P<0.05). During winter (May–October), serum 250HD levels were dependent on vitamin D intake (partial r2=0.01; P<0.05) and were lower than during summer (November–April) (age‐adjusted mean, 59nmol/L [95% CI, 57–62] v 81 nmol/L [95% CI, 78–84]; P<0.05). No association was detected between serum 250HD and vitamin D intake during summer. The prevalences of low concentrations of serum 250HD were, for <28 nmol/L, 7.2% and 11.3% overall and in winter, respectively; and, for < 50 nmol/L, 30.0% and 43.2% overall and in winter, respectively. Conclusions At latitude 38° south, the contribution of vitamin D from dietary sources appears to be insignificant during summer. However, during winter vitamin D status is influenced by dietary intake. Australia has no recommended dietary intake (RDI) for vitamin D, in the belief that adequate vitamin D can be obtained from solar irradiation alone. Our results suggest that an RDI may be needed.

Objective: To describe the effect of antibiotics on outcomes of treatment for Buruli or Bairnsdale ulcer (BU) in patients on the Bellarine Peninsula in south‐eastern Australia. Design: Observational, non‐randomised study with data collected prospectively or through medical record review. Patients and setting: All 40 patients with BU managed by staff of Barwon Health's Geelong Hospital (a public, secondary‐level hospital) between 1 January 1998 and 31 December 2004. Main outcome measures: Epidemiology, clinical presentation, diagnosis, treatment and clinical outcomes. Results: There were 59 treatment episodes; 29 involved surgery alone, 26 surgery plus antibiotics, and four antibiotics alone. Of 55 episodes where surgery was performed, minor surgery was required in 22, and major surgery in 33. Failure rates were 28% for surgery alone, and 19% for surgery plus antibiotics. Adjunctive antibiotic therapy was associated with increased treatment success for lesions with positive histological margins (P < 0.01), and lesions requiring major surgery for treatment of a first episode (P < 0.01). The combination of rifampicin and ciprofloxacin resulted in treatment success in eight of eight episodes, and no patients ceased therapy because of side effects with this regimen. Conclusions: Adjunctive antibiotic therapy may increase the effectiveness of BU surgical treatment, and this should be further assessed by larger randomised controlled trials. The combination of rifampicin and ciprofloxacin appears the most promising.