Diagnosis of Lemierre syndrome is not always straightforward as clinical features are variable and blood cultures are often negative. Awareness of the syndrome and a high degree of suspicion are needed.

Investment in SARS-CoV-2 sequencing in Africa over the past year has led to a major increase in the number of sequences generated, now exceeding 100,000 genomes, used to track the pandemic on the continent. Our results show an increase in the number of African countries able to sequence domestically, and highlight that local sequencing enables faster turnaround time and more regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and shed light on the distinct dispersal dynamics of Variants of Concern, particularly Alpha, Beta, Delta, and Omicron, on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve, while the continent faces many emerging and re-emerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century.

The prevalence of MS in the defined region was twice as high as that reported from an adjacent area, the Waikato, 20 years previous. Our data will help to update NZ prevalence statistics and are of direct relevance to current funding issues for modern treatments which, in NZ, are presently limited to a proportion of patients with relapsing- remitting disease.

bWe present an interesting case of a patient who developed an epidural abscess caused by Streptobacillus moniliformis. This is the first report in the medical literature of a spinal epidural abscess associated with this organism. Diagnosis of S. moniliformis infection requires a high degree of suspicion, and a delay may be inevitable when a relevant clinical history is lacking. CASE REPORT We present an interesting case from New Zealand of a patient who developed an epidural abscess caused by Streptobacillus moniliformis on a background of previous spinal surgery.The patient, a 58-year-old male, presented with a 2-week history of right-sided flank pain, fevers, and lower limb weakness to the extent that he was unable to walk. He had a decreased sensation of bladder filling.He had undergone spinal laminectomy for an L4/L5 radiculopathy 6 months prior to presentation. Other past medical history included hypertension, hypercholesterolemia, and gout. A month before his admission, the patient recalled sustaining a minor abrasion on the back of his hand, which was licked on several occasions by his dog. No history of contact with rats was elicited from the admission history. On examination, he was febrile. There was marked weakness of muscles innervated by L5 and S1 on both sides. Anal tone was absent.Urgent magnetic resonance image (MRI) scanning demonstrated the presence of a large epidural abscess anterior to the L4, L5, and S1 vertebrae, compressing the thecal sac. There was also evidence of osteomyelitic involvement of these vertebrae along with septic arthritis of the facet joints between L2 and S1 ( Fig. 1).The patient was placed on empirical intravenous (i.v.) flucloxacillin, and urgent surgical drainage of the epidural abscess was performed. The abscess fluid was culture negative for bacteria after 10 days of incubation on sheep blood agar, chocolate agar (CO 2 incubation at 37°C), and fastidious anaerobic agar (anaerobic incubation at 37°C). An aliquot of the fluid was added to an aerobic blood culture bottle (BD Bactec FX) and was negative after 10 days of incubation. The aerobic bottle from a blood culture set (BD Bactec FX, paired aerobic and anaerobic bottles) taken on admission was positive after 2 days, with slender, Gram-negative bacilli seen on the Gram stain. The blood culture was subcultured onto sheep blood agar, chocolate agar (CO 2 incubation at 37°C), and fastidious anaerobic agar (anaerobic incubation at 37°C). Pinpoint, cream-colored colonies grew on the blood agar and fastidious anaerobic agar after a further 3 days of incubation, and the possibility of a Capnocytophaga species was suggested, which was also consistent with the close contact with dogs in the patient history. At that stage, there were no characteristic features in the Gram stain suggestive of S. moniliformis, such as pleomorphism or a bulbous center. The organism was oxidase negative and catalase negative. Further biochemical identification was not possible, largely because of its fastidious growth requirements.The patient was...