Measles and its Complications

Measles is a highly contagious viral illness caused by an RNA paramyxovirus. Patients usually experience non-specific cold-like symptoms such as cough, fever, coryza, and conjunctivitis for a week before the appearance of a rash. Koplik spots, grey/white spots in the oral mucous membranes, are a telltale sign of the disease. Treatment is supportive, and symptoms usually resolve within one to two weeks in mild cases.

However, measles can lead to various complications, including diarrhea, vomiting, conjunctivitis, and laryngitis. Less common complications include meningitis, pneumonia, encephalitis, hepatitis, bronchitis, thrombocytopenia, and croup. Rare complications such as optic neuritis and subacute sclerosing panencephalitis (SSPE) can also occur. SSPE is a fatal condition that can develop several years after the measles infection and is characterized by gradual psycho-neurological deterioration, seizures, ataxia, and coma. Fortunately, SSPE is rare, occurring in only 1 in 100,000 cases of measles.

Common Causes of Gastrointestinal Infections

Gastrointestinal infections can be caused by a variety of bacteria and viruses. Among the most common are Clostridium difficile, Salmonella spp., Norovirus, Escherichia coli, and Campylobacter spp.

Clostridium difficile is a spore-forming bacterium that causes pseudomembranous colitis, a form of colitis associated with antibiotic treatment. It produces toxins that damage the mucosal lining of the bowel, leading to diarrhea. Risk factors for developing C. difficile-associated diarrhea include age, antibiotic treatment, exposure to infected persons, and hospitalization.

Salmonella spp. are associated with infections of the gastrointestinal tract and diarrhea. Infection is mostly associated with eating undercooked meat, poultry, eggs, or egg products.

Norovirus is the most common viral gastroenteritis in the UK and spreads quickly within a contaminated environment. It is often seen in hospital wards and care homes.

Escherichia coli is associated with infections of the gastrointestinal tract and can cause severe diarrhea. It is most commonly associated with ingestion of contaminated water, unpasteurized milk or cheese, and undercooked beef.

Campylobacter spp. are a common cause of gastroenteritis, mostly associated with ingestion of contaminated food in the form of raw poultry and unpasteurized milk products.

It is important to identify the causative organism early and treat it according to local treatment guidelines to prevent complications such as toxic megacolon, bowel perforation, septicemia, and death. All confirmed cases of gastrointestinal infections must be reported to Public Health.

• Ciprofloxacin is a well-tolerated antibiotic with broad action, but it can reduce intestinal flora and increase the risk of tendon rupture.
• Azithromycin is a macrolide antibiotic used for respiratory conditions, with potential drug interactions.
• Alendronic acid is a bisphosphonate used for bone protection, but can cause gastrointestinal side effects and musculoskeletal symptoms.
• Calcium supplements are not directly linked to tendon damage, but may contribute to calcific tendonitis.
• Creon is a pancreatic enzyme preparation used for cystic fibrosis patients, without known musculoskeletal side effects.

Differentiating gonorrhoeae from Other Infections

gonorrhoeae is a common sexually transmitted infection that can cause urethritis and arthritis. When someone returns from an area with a high prevalence of gonorrhoeae, they may experience symptoms such as a purulent discharge, fever, and joint pain. This is not a reactive arthritis because the patient has both urethritis and arthritis at the same time, and is pyrexial during the current illness.

The acute monoarthritis is a manifestation of disseminated gonococcal infection, which can be confirmed through a Gram stain that shows intracellular Gram negative diplococci. While reactive arthritis can occur after gonorrhoeae, it typically presents as a polyarthritis and has a lag of one to three weeks from the time of the initial disease.

Chlamydial infection, on the other hand, does not usually cause a purulent discharge and symptoms usually occur slightly longer after exposure than with gonorrhoeae. Pyelonephritis presents with fever and pain in the renal angles, while trichomoniasis is much less common than gonorrhoeae and does not usually present with arthritis. By the differences between these infections, healthcare providers can accurately diagnose and treat patients.

Management of Suspected Bacterial Urinary Tract Infection in Patients with Long Term Catheters

Chronic colonisation of catheters can make it difficult to completely eliminate infections in patients with long term catheters. Therefore, it is recommended to change the catheter before starting antibiotic therapy. Dipstick testing and microscopy are not reliable in such cases, so the management of suspected bacterial urinary tract infection in adults should be based on symptoms of acute bacterial sepsis, according to SIGN guidelines. Local policies determine the choice of antibiotics, but co-amoxiclav is often the first line empirical option in this situation.

It is important to note that patients with long term catheters require special attention and care to prevent infections. The management of suspected bacterial urinary tract infection in such patients should be based on careful observation of symptoms and adherence to local policies for antibiotic therapy. By following these guidelines, healthcare professionals can help prevent complications and improve patient outcomes.

Understanding Hepatitis B Serology Results

Hepatitis B is a viral infection that can cause liver damage and even liver cancer. Vaccination is the best way to prevent infection, but it’s important to understand the results of hepatitis B serology tests to determine if someone is immune, currently infected, or susceptible to infection.

Vaccinated against infection: This result indicates that the patient has previously been vaccinated with hepatitis B and is now immune to infection.

Current chronic infection: A positive HBsAg, anti-HBc, and positive IgG anti-HBc result would indicate a current chronic infection. However, the picture shown represents a vaccinated individual.

Current acute infection: A positive HBsAg, anti-HBc, and IgM anti-HBc result would indicate a current acute infection. However, the picture shown represents a vaccinated individual.

Resolved infection: A positive anti-HBs and anti-HBc result, in addition to a negative HBsAg result, would indicate a resolved infection.

Susceptible to infection: A completely negative serology result would indicate that the patient is susceptible to infection and should consider vaccination.

Distinguishing Between Measles and Other Viral Infections

Measles, a highly contagious viral infection, is often mistaken for other viral illnesses such as rubella, Kawasaki disease, mumps, and parvovirus B19. However, there are distinct differences in their clinical presentations. Measles is characterized by cough, coryza, and conjunctivitis, along with the presence of Koplik spots on the buccal mucosa. Rubella, on the other hand, presents with low-grade fever, conjunctivitis, and an erythematosus rash, but without Koplik spots. Kawasaki disease is an idiopathic vasculitis that affects young children and is associated with fever, inflammation of the mouth and lips, and cervical lymphadenopathy. Mumps, caused by a paramyxovirus, typically affects the salivary glands and is not associated with a rash. Parvovirus B19, also known as fifth disease, causes an erythematosus rash on the cheeks and can also cause a morbilliform rash, but without Koplik spots. Therefore, recognizing the presence of Koplik spots is crucial in distinguishing measles from other viral infections.

Common Viral Infections and Their Oral Manifestations

Herpes simplex virus, Parvovirus B19, Coxsackie A16, Molluscum contagiosum, and Varicella-zoster are all common viral infections that can cause various oral manifestations. Herpes simplex virus can cause gingivostomatitis, which can lead to dehydration and require treatment with acyclovir. Parvovirus B19 can result in ‘slapped cheek syndrome’ with a maculopapular rash and non-specific viral symptoms. Coxsackie A16 can cause hand, foot and mouth disease with vesicular and ulcerative oral lesions and macular lesions on the hands and feet. Molluscum contagiosum can cause papular lesions with a central dimple, but rarely in the oral cavity. Varicella-zoster can cause chickenpox with itchy, papular lesions progressing to vesicles, but blisters in the mouth are less common. Understanding these viral infections and their oral manifestations can aid in diagnosis and treatment.

Drug Reaction with Atazanavir and Indinavir

The use of protease inhibitors such as atazanavir and indinavir can lead to unconjugated hyperbilirubinemia, which is characterized by elevated levels of bilirubin in the blood. This condition was observed in a patient who had normal renal function and mildly raised liver enzymes. The reaction is usually benign and reversible upon discontinuation of the drug. The mechanism of this drug reaction is competitive inhibition of the UGT1A1 enzyme. Individuals with Gilbert’s syndrome are more susceptible to this reaction.

Other drugs used in the treatment of HIV/AIDS have different side effect profiles. Nevirapine can cause hepatitis, which is characterized by elevated liver enzymes. Stavudine can cause peripheral neuropathy and pancreatitis, but it is being phased out of treatment regimens. Tenofovir can lead to renal dysfunction, which was not observed in this patient. Zidovudine can cause anemia, hepatitis, and myopathy, among other side effects.

In conclusion, the patient’s presentation of unconjugated hyperbilirubinemia is most likely due to the use of atazanavir or indinavir. Discontinuation of the drug is usually sufficient to reverse the condition. Other drugs used in the treatment of HIV/AIDS have different side effect profiles and should be considered when evaluating patients for drug reactions.

Dengue Fever

Dengue fever is a viral infection that is transmitted through the bite of an infected Aedes mosquito. It is prevalent in tropical countries, with an estimated 100 million people being infected annually. The symptoms of dengue fever include fever, headache, muscle pain, nausea, vomiting, skin rash, and mild bleeding. However, it cannot be spread from person to person.

The high-risk areas for dengue fever include the Indian subcontinent, Southeast Asia, Southern China, Taiwan, Pacific Islands, Caribbean, Mexico, Africa, and Central and South America. Diagnosis is made through a blood test to identify the virus, and treatment is supportive with symptom control. Unfortunately, there are currently no vaccines available to prevent dengue fever.

The best way to prevent infection is to avoid mosquito bites. This can be done by wearing protective clothing, using mosquito repellent, and staying in air-conditioned or screened areas. the symptoms and risk factors of dengue fever can help individuals take necessary precautions to protect themselves from this potentially serious illness.

Differential Diagnosis of a Morbilliform Rash: Parvovirus B19

A patient presents with a generalised, macular rash with a lacy appearance on the trunk and extremities, along with arthralgia and arthritis. The differential diagnosis for a morbilliform rash includes infections such as measles virus, rubella, parvovirus B19, human herpesvirus 6, enterovirus, and other non-specific viruses. However, the lacy appearance of the rash and the presence of arthralgia and arthritis suggest a parvovirus B19 infection. In children, this infection presents with slapped cheek erythema, while in adults, it presents with a lacy erythematous rash and rheumatoid arthritis-like arthropathy. Diagnosis is made through positive anti-B19 IgM serology or positive serum B19 DNA polymerase chain reaction. Other infections, such as rubella, may also cause a morbilliform rash with arthropathy, but they do not typically have a lacy appearance. Human herpesvirus 6 does not cause arthropathy or a lacy rash, while staphylococcal toxins cause a sunburn-like or exfoliative rash. Measles is associated with a prodrome of conjunctivitis, coryza, and cough, but not arthritis, and the rash is not reticular in appearance. Therefore, parvovirus B19 should be considered in the differential diagnosis of a morbilliform rash with arthralgia and arthritis.

Protease Inhibitors: A Breakthrough in HIV and Hepatitis C Treatment

Protease inhibitors are a class of drugs that block the activity of the viral enzyme called protease, which is essential for the maturation of the virus. Initially used for the treatment of HIV, protease inhibitors are now also used for the treatment of hepatitis C infections. Telaprevir is a protease inhibitor specifically designed for hepatitis C virus.

Abacavir and rilpivirine are two other drugs used for HIV treatment. Abacavir is a nucleoside reverse transcriptase inhibitor (NRTI), while rilpivirine is a non-nucleoside reverse transcriptase inhibitor (NNRTI). Protease inhibitors are often used as second-line therapy for HIV treatment, with ritonavir commonly used as a booster with other protease inhibitors.

For hepatitis C treatment, protease inhibitors such as telaprevir, boceprevir, simeprevir, and danoprevir are used in combination with interferon and ribavirin. These drugs inhibit NS3/4A protease, which is a promising development in hepatitis C management. They are said to decrease the treatment duration, but their high cost is a major limiting factor for their use.

In conclusion, protease inhibitors have revolutionized the treatment of HIV and hepatitis C infections. While they are not without limitations, they offer hope for patients with these chronic viral diseases.

When you see the CD symbol on a prescription, it means that the medication is a controlled drug. This indicates that the substance must be requested by a qualified practitioner and signed and dated. The prescription must also include the prescriber’s address. Additionally, the prescriber must write the patient’s name and address, the preparation, and the dose in both figures and words. If the prescription is written by a dentist, it should state for dental use only. Controlled drugs include opiates and other substances that require careful monitoring and regulation. By the CD symbol and the requirements for prescribing controlled drugs, patients can ensure that they receive safe and effective treatment.

Bacterial Causes of Gastroenteritis: Yersinia, Vibrio, E. coli, Campylobacter, and Salmonella

Gastroenteritis is a common condition caused by various bacterial pathogens. Yersinia enterocolitica is one such pathogen that can cause invasive gastroenteritis, leading to mesenteric lymphadenitis and erythema nodosum. Vibrio vulnificus is another Gram-negative bacterium that causes gastroenteritis and skin blisters after consuming contaminated oysters, with chronic liver disease patients at higher risk. Escherichia coli has several pathogenic strains, including enterotoxigenic, enteropathogenic, enteroinvasive, and enterohaemorrhagic, each causing different types of gastroenteritis. Campylobacter is the most common cause of bacterial gastroenteritis worldwide, with invasive symptoms and often bloody stool. Salmonella, a non-lactose fermenter, can also cause gastroenteritis and diarrhea, usually non-bloody. Understanding the different bacterial causes of gastroenteritis is crucial for proper diagnosis and treatment.

Tetanus Toxoid Immunisation Schedule

Active immunisation with tetanus toxoid is a routine vaccination given to infants at 2, 3, and 4 months of age as part of the DPT vaccine. A fourth dose is administered after three years, and a fifth dose is given before leaving school. Once a patient has received all five injections at the appropriate intervals, further toxoid is generally not required due to the risk of side effects and decreased immunity caused by overstimulation. Therefore, this man is considered fully immunised against tetanus.

Adult Onset Still’s Disease

Adult onset Still’s disease is a type of inflammatory disorder that affects young adults. Its exact cause and development are still unknown, but it is characterized by various symptoms such as fever, rash, joint pain, and organ enlargement. The disease can have systemic exacerbations and chronic arthritis, with periods of remission in between. To diagnose adult onset Still’s disease, a person must have at least five criteria, including two major criteria such as high fever lasting for a week or longer, joint pain lasting for two weeks or longer, rash, and abnormal white blood cell count. Minor criteria include sore throat, lymph node or spleen swelling, liver problems, and the absence of rheumatoid arthritis.

It is important to note that mildly raised ASO titres may be present in inflammatory or infective conditions, but an ASO titre of at least 500-1000 is expected in active acute rheumatic fever. Additionally, an ejection systolic murmur may be caused by the hyperdynamic circulation in adult onset Still’s disease, unlike acute rheumatic fever or acute bacterial endocarditis, which cause acute valvular regurgitation and result in pan-systolic or early-diastolic murmurs. Lastly, bacterial endocarditis does not cause the pink rash associated with adult onset Still’s disease.

Management of Varicella in Pregnancy

Explanation:
When a pregnant woman presents with a vesicular pruritic rash, it is important to consider the possibility of varicella zoster virus infection. Varicella is a teratogenic virus that can harm the fetus, so prompt management is necessary. The first step is to check the woman’s immune status by testing for varicella antibodies. If the results are not available within two working days, referral to secondary services for prophylaxis should be considered. Watching and waiting is not appropriate in this situation. Administering a varicella zoster vaccine is not recommended due to the theoretical risk to the fetus. Immunoglobulins for rubella are not indicated. acyclovir may be used for symptomatic patients, but informed consent is required as the evidence for its safety in pregnancy is not strong. Overall, prompt and appropriate management is crucial in protecting the health of both the mother and the fetus.

Common Organisms in Osteomyelitis and Related Conditions

Acute osteomyelitis in children over the age of 4 years is most commonly caused by Staphylococcus aureus. Fortunately, immunisation has greatly reduced the incidence of haematogenous osteomyelitis caused by Haemophilus influenzae. In sickle cell anaemia, Salmonella is the typical organism responsible for infection. Meanwhile, Pseudomonas infection is frequently seen in haemodialysis patients and intravenous drug users. These organisms can cause serious infections that require prompt medical attention. It is important to be aware of the common organisms associated with osteomyelitis and related conditions in order to facilitate early diagnosis and treatment.

Distinguishing Neurodegenerative Diseases: A Case Study

A patient presents with rapidly progressive dementia, imbalance leading to falls, and myoclonus. The most likely diagnosis is Creutzfeldt–Jakob disease (CJD), a devastating prion disease without cure. Magnetic resonance imaging (MRI) is preferred for diagnosis, as CT head is ineffective.

Vascular dementia, another common cause of cognitive impairment, typically has a slower and stepwise onset in patients with a significant vascular history. A CT head would likely identify existing small vessel disease in the brain of a patient with vascular dementia.

Huntington’s disease, characterized by abnormal movements and cognitive impairment, is not the most likely diagnosis due to the rapid progression and lack of family history.

Lewy body dementia, which features visual hallucinations and Parkinsonian symptoms, usually presents over a longer period of time.

Motor neuron disease, which includes weakness and fasciculations, is unlikely due to the absence of weakness in this presentation. Frontotemporal dementia may rarely develop in motor neuron disease, but it is a slowly progressive phenomenon, unlike the rapid deterioration in this case.

Managing Chickenpox in Pregnancy: Testing and Treatment Options

Chickenpox, caused by the varicella zoster virus, can pose a risk to pregnant women and their unborn babies. If a patient is unsure whether they have had chickenpox in the past, it is important to test for immunity before deciding on a course of action. This is done by checking varicella zoster IgG levels. If a patient has confirmed lack of immunity and is exposed to chickenpox, they may be offered varicella zoster immunoglobulin as prophylaxis. High-risk patients with confirmed chickenpox may require IV acyclovir treatment, while oral acyclovir is reserved for certain patients. Reassurance alone is not appropriate in this situation. It is important to take steps to manage chickenpox in pregnancy to ensure the health and safety of both the mother and the baby.

Anthrax: Types, Symptoms, and Treatment

Anthrax is a bacterial infection caused by Bacillus anthracis, a spore-forming bacterium. It is a rare but serious disease that can be acquired through contact with infected animals or contaminated animal products. There are three main types of anthrax: cutaneous, inhalation, and intestinal.

Cutaneous anthrax is the most common type, accounting for 95% of cases. It is caused by direct contact with the skin or tissue of infected animals. The symptoms start with an itchy pimple that enlarges and eventually forms a black eschar. Inhalation anthrax, on the other hand, is caused by inhaling anthrax spores from infected animal products such as wool. The initial symptoms are similar to a cold, but respiratory failure may develop two to four days later. Intestinal anthrax is the rarest form and is caused by swallowing spores in contaminated meats. Symptoms include severe abdominal pain, nausea, and bloody diarrhea.

Antibiotics are used to treat all three types of anthrax. It is important to start treatment as soon as possible after exposure to ensure maximum efficacy. The anthrax vaccine can also be given in combination with antibiotics. the types, symptoms, and treatment of anthrax is crucial in preventing and managing this serious disease.

Bacterial Causes of Pneumonia

Pneumonia is a respiratory infection that can be caused by various bacteria. The most common organism associated with pneumonia is Streptococcus pneumoniae, which can be identified by its Gram-positive spherical shape and chain formation. It is also known for causing rust-coloured sputum. Staphylococcus aureus, another Gram-positive bacterium, grows in clusters rather than chains. Klebsiella pneumoniae, a Gram-negative rod-shaped bacterium, is commonly associated with aspiration pneumonia. Haemophilus influenzae, a small Gram-negative rod-shaped bacterium, is often linked to exacerbation of COPD. Streptococcus pyogenes, a Gram-positive spherical bacterium that aligns in clusters, does not typically cause pneumonia and is associated with complete haemolysis on a blood agar plate. Knowing the characteristics of these bacteria can aid in the diagnosis and treatment of pneumonia.

Koplik’s Spots: A Diagnostic Sign of Measles

Koplik’s spots are a distinctive sign of measles, characterized by small, irregular, bright red spots with blue-white centers. These spots are typically found on the inside of the cheek next to the premolars and are only seen in cases of measles, making them a diagnostic indicator of the disease.

Koplik’s spots usually appear briefly after the onset of fever and a few days before the generalized rash associated with measles appears. In some cases, the spots may disappear as the rash develops. These spots typically start to appear around two days after initial infection.

Overall, the presence of Koplik’s spots is an important diagnostic sign of measles and can help healthcare professionals identify and treat the disease more effectively.

Syndromic Management for Vaginal Discharge

When laboratory support is not available, the World Health Organisation recommends syndromic management based on signs and symptoms alone. This means that all possible conditions should be treated, as vaginal discharge is not a reliable indicator of the presence of a sexually transmitted infection (STI).

Trichomoniasis is the most common non-viral STI worldwide and is more prevalent in less advantaged women in affluent countries. However, the possibility of Chlamydia trachomatis and gonorrhoeae depends on a risk assessment based on local factors.

In summary, when laboratory support is not available, syndromic management should be used for vaginal discharge.

HIV Seroconversion Illness: Diagnosis and Differential Diagnosis

HIV-related seroconversion illness is a non-specific illness that occurs between one to six weeks following infection. It often mimics infectious mononucleosis but may have additional signs such as oral candidiasis or CNS symptoms. The best way to diagnose acute infection is by the presence of p24 antigen or HIV RNA by PCR. Malaria is less likely in this case than HIV, and stool culture would be useful in the diagnosis of gastroenteritis but is unlikely to be the cause of symptoms in this case. A CT chest, abdomen, and pelvis is non-specific and would not yield the diagnosis. A genital swab would be of benefit if there were suspicions of other sexually transmitted infections, but the symptoms and timing of onset in this case clearly point towards HIV seroconversion. It is important to consider HIV testing and prevention in patients with risk factors for infection.

Infectious Diseases and Their Modes of Transmission

Children who have chicken pox and measles should be kept away from others as there is a high chance of spreading the infection to others. This is because these diseases are highly contagious and can easily spread from one person to another. It is important to isolate these children to prevent the spread of the disease.

Post streptococcal GN and rheumatic fever are caused by immune complexes that develop after an initial infection. These diseases are not contagious and cannot be spread from one person to another. However, it is important to treat the initial infection to prevent the development of these diseases.

Herpetic gingivostomatitis is a disease that is spread through direct contact with infected secretions. This means that the disease can be transmitted when infected secretions come into contact with the skin of an uninfected person. There is no risk of aerosol spread, which means that the disease cannot be spread through the air.

HSP is a disease that is not infectious and cannot be spread from one person to another. This disease is caused by an abnormal immune response and is not contagious.

Isoniazid Monotherapy for TB Prevention

Isoniazid monotherapy is a treatment used to prevent active tuberculosis in individuals who have been exposed to M. tuberculosis. However, it is important to note that isoniazid-induced hepatitis can occur in approximately 1% of patients, with a higher risk in those over the age of 35. The risk of hepatitis is less than 0.3% in patients under 20 years old, but increases to 2-3% in individuals over 50 years old.

Aside from hepatitis, other side effects of isoniazid therapy include peripheral neuritis, which can be prevented by taking pyridoxine prophylactically. Additionally, a systemic lupus erythematosus (SLE)-like syndrome may also occur. It is important for healthcare providers to monitor patients closely for any adverse reactions while on isoniazid therapy.

PrePex Device Offers Painless Male Circumcision for HIV Prevention

The PrePex device is a new method of male circumcision that is painless, sutureless, and does not require anaesthesia. It has been approved in countries such as Rwanda and is currently only available in sub-Saharan Africa. The World Health Organization (WHO) has found scientific evidence that male circumcision can significantly reduce the risk of HIV transmission. As a result, WHO is promoting this strategy in sub-Saharan Africa, where there has been a significant increase in the number of circumcision operations. However, it is important to note that circumcision should be used in conjunction with other measures, such as condom use, to reduce the incidence of HIV infection. The PrePex device is not designed for any other purposes.

Skin Conditions and Their Characteristics

Scabies is a skin infestation caused by the mite Sarcoptes scabiei. The mite burrows into the skin, resulting in a rash that is itchy and typically affects the skin folds and interdigital webs of the arms and legs. The itch may persist for a few weeks even after successful treatment. The condition is spread through skin contact and sharing of clothes and bedding. Treatment involves the use of permethrin-containing lotions.

Henoch-Schönlein purpura is a type of vasculitis that affects the blood vessels in the skin. Psoriasis is characterized by plaques on the extensor surfaces of the body, which are topped with thick, silvery scales. Pemphigus vulgaris may present as crusted, weeping, diffuse lesions in elderly patients. If the blisters are intact, bullous pemphigoid or cicatricial pemphigoid may be considered. Look for involvement in other sites, as erosions in the mouth are typically involved in pemphigus vulgaris. Bullous pemphigoid is associated with new medication and involves the flexural areas of the body.

Mycoplasma pneumonia commonly affects individuals aged 15-30 years and presents with systemic upset, dry cough, fever, myalgia, and arthralgia. It can also cause extrapulmonary manifestations such as haemolytic anaemia, renal failure, hepatitis, myocarditis, meningism, transverse myelitis, cerebellar ataxia, and erythema multiforme. Haemolysis is associated with the presence of cold agglutinins. Diagnosis is based on the demonstration of anti-mycoplasma antibodies in paired sera.