Pub Date : 2026-02-01DOI: 10.1016/j.mpmed.2025.11.012
Benjamin Barker, Theodore Gouliouris
Skin and soft tissue infections are commonly encountered in community and hospital settings. They can affect patients of all ages and can result in significant morbidity and, in some cases, mortality. This article gives an overview of the likely pathogens, important risk factors, key clinical syndromes and treatment recommendations, providing a concise summary to support clinicians to effectively diagnose and manage these conditions.
{"title":"Skin and soft tissue infections","authors":"Benjamin Barker, Theodore Gouliouris","doi":"10.1016/j.mpmed.2025.11.012","DOIUrl":"10.1016/j.mpmed.2025.11.012","url":null,"abstract":"<div><div>Skin and soft tissue infections are commonly encountered in community and hospital settings. They can affect patients of all ages and can result in significant morbidity and, in some cases, mortality. This article gives an overview of the likely pathogens, important risk factors, key clinical syndromes and treatment recommendations, providing a concise summary to support clinicians to effectively diagnose and manage these conditions.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 2","pages":"Pages 111-119"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.mpmed.2025.11.002
Lucy Brodie, Anne Melhuish, Fiona McGill
Viruses are a major cause of central nervous system (CNS) infection worldwide. Meningitis and encephalitis commonly present with headache and fever. Encephalitis also causes neurological deficits, reflecting the involvement of the brain parenchyma. Meningitis affects the meninges alone. Enteroviruses are the most common cause of meningitis in the UK, and herpes simplex virus (HSV)-1 is the most common cause of encephalitis. However, the epidemiology of viral meningitis and encephalitis varies widely across the world, with many arboviruses responsible for CNS infection. Cerebrospinal fluid (CSF) sampling is the key investigation if viral CNS infection is suspected, and the most common viral pathogens can be detected in CSF by a polymerase chain reaction (PCR). Additional supporting diagnostic tests can include PCR of faeces, whole blood or throat swabs, alongside magnetic resonance imaging of the brain. Next-generation sequencing may become a future diagnostic option and has helped identify emerging CNS pathogens. Viral meningitis is managed supportively. HSV encephalitis is treated with intravenous aciclovir, but despite therapy many individuals are left with severe neurological sequelae and mortality is high.
{"title":"Viral meningitis and encephalitis","authors":"Lucy Brodie, Anne Melhuish, Fiona McGill","doi":"10.1016/j.mpmed.2025.11.002","DOIUrl":"10.1016/j.mpmed.2025.11.002","url":null,"abstract":"<div><div>Viruses are a major cause of central nervous system (CNS) infection worldwide. Meningitis and encephalitis commonly present with headache and fever. Encephalitis also causes neurological deficits, reflecting the involvement of the brain parenchyma. Meningitis affects the meninges alone. Enteroviruses are the most common cause of meningitis in the UK, and herpes simplex virus (HSV)-1 is the most common cause of encephalitis. However, the epidemiology of viral meningitis and encephalitis varies widely across the world, with many arboviruses responsible for CNS infection. Cerebrospinal fluid (CSF) sampling is the key investigation if viral CNS infection is suspected, and the most common viral pathogens can be detected in CSF by a polymerase chain reaction (PCR). Additional supporting diagnostic tests can include PCR of faeces, whole blood or throat swabs, alongside magnetic resonance imaging of the brain. Next-generation sequencing may become a future diagnostic option and has helped identify emerging CNS pathogens. Viral meningitis is managed supportively. HSV encephalitis is treated with intravenous aciclovir, but despite therapy many individuals are left with severe neurological sequelae and mortality is high.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 2","pages":"Pages 81-86"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.mpmed.2025.11.010
Charles Coughlan, Ravikar Ralph
Botulism and tetanus are toxin-mediated neurological diseases that carry alarming morbidity and mortality and require a high index of suspicion for diagnosis. They present with distinct clinical syndromes reflecting the activity of structurally related neurotoxins at different nervous system sites. There is a significant overlap in their pathophysiology and management. Both diseases are caused by gas-forming anaerobic bacteria belonging to the genus Clostridium; common principles of management include prompt antitoxin administration and provision of supportive care, notably airway management. While botulism is a global rarity, tetanus remains a major avoidable cause of death and disability in resource-constrained settings despite a highly effective vaccine. Early consideration and timely provision of treatment is likely to be key in reducing mortality from both botulism and tetanus across all settings.
{"title":"Botulism and tetanus","authors":"Charles Coughlan, Ravikar Ralph","doi":"10.1016/j.mpmed.2025.11.010","DOIUrl":"10.1016/j.mpmed.2025.11.010","url":null,"abstract":"<div><div>Botulism and tetanus are toxin-mediated neurological diseases that carry alarming morbidity and mortality and require a high index of suspicion for diagnosis. They present with distinct clinical syndromes reflecting the activity of structurally related neurotoxins at different nervous system sites. There is a significant overlap in their pathophysiology and management. Both diseases are caused by gas-forming anaerobic bacteria belonging to the genus <em>Clostridium</em>; common principles of management include prompt antitoxin administration and provision of supportive care, notably airway management. While botulism is a global rarity, tetanus remains a major avoidable cause of death and disability in resource-constrained settings despite a highly effective vaccine. Early consideration and timely provision of treatment is likely to be key in reducing mortality from both botulism and tetanus across all settings.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 2","pages":"Pages 91-95"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.mpmed.2025.11.013
{"title":"Self-assessment/CPD answers","authors":"","doi":"10.1016/j.mpmed.2025.11.013","DOIUrl":"10.1016/j.mpmed.2025.11.013","url":null,"abstract":"","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 2","pages":"Pages 149-152"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.mpmed.2025.11.005
Andrew D McCallum, Andrew J Brent
Sepsis occurs when a dysregulated host response to infection causes potentially life-threatening organ dysfunction. It is usually caused by bacterial infection and carries a 30% mortality, causing millions of deaths worldwide each year. Effective management requires prompt recognition, antimicrobial therapy, source control and supportive treatment. Early, appropriate antimicrobial therapy is associated with improved survival from sepsis. Rapid identification and control of the source of infection (e.g. drainage of pus) is equally important in many cases. These and other elements of the initial management of sepsis are incorporated into the ‘Sepsis Six’ bundle of care.
{"title":"Sepsis","authors":"Andrew D McCallum, Andrew J Brent","doi":"10.1016/j.mpmed.2025.11.005","DOIUrl":"10.1016/j.mpmed.2025.11.005","url":null,"abstract":"<div><div>Sepsis occurs when a dysregulated host response to infection causes potentially life-threatening organ dysfunction. It is usually caused by bacterial infection and carries a 30% mortality, causing millions of deaths worldwide each year. Effective management requires prompt recognition, antimicrobial therapy, source control and supportive treatment. Early, appropriate antimicrobial therapy is associated with improved survival from sepsis. Rapid identification and control of the source of infection (e.g. drainage of pus) is equally important in many cases. These and other elements of the initial management of sepsis are incorporated into the ‘Sepsis Six’ bundle of care.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 2","pages":"Pages 124-129"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.mpmed.2025.11.001
Philip Bejon, Esther Robinson
Bone and joint infections are serious. They can be life-threatening or, more commonly, associated with long-term disability and reduced quality of life. The spectrum of disease has changed over time, with infected prosthetic joints and diabetic foot infections now more common than haematogenous osteomyelitis. Osteomyelitis results when bacteria colonize bone, usually a sterile tissue, via direct inoculation from trauma or surgery, haematogenous seeding from bloodstream infection or contiguous spread from another infected site. The pathophysiology of biofilm formation leads to a chronic infection that is resistant to host immunity and antibiotics. Presentation is with pain, swelling, lack of mobility and systemic symptoms. Diagnosis requires clinical symptoms, appropriate radiological imaging and microbiological sampling. Early or very limited osteomyelitis may be managed with antibiotics alone, but surgical debridement is key for many infections. Therapy should be undertaken by multidisciplinary teams including infection specialists, surgeons, radiologists and other clinical professionals.
{"title":"Bone and joint infection","authors":"Philip Bejon, Esther Robinson","doi":"10.1016/j.mpmed.2025.11.001","DOIUrl":"10.1016/j.mpmed.2025.11.001","url":null,"abstract":"<div><div>Bone and joint infections are serious. They can be life-threatening or, more commonly, associated with long-term disability and reduced quality of life. The spectrum of disease has changed over time, with infected prosthetic joints and diabetic foot infections now more common than haematogenous osteomyelitis. Osteomyelitis results when bacteria colonize bone, usually a sterile tissue, via direct inoculation from trauma or surgery, haematogenous seeding from bloodstream infection or contiguous spread from another infected site. The pathophysiology of biofilm formation leads to a chronic infection that is resistant to host immunity and antibiotics. Presentation is with pain, swelling, lack of mobility and systemic symptoms. Diagnosis requires clinical symptoms, appropriate radiological imaging and microbiological sampling. Early or very limited osteomyelitis may be managed with antibiotics alone, but surgical debridement is key for many infections. Therapy should be undertaken by multidisciplinary teams including infection specialists, surgeons, radiologists and other clinical professionals.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 2","pages":"Pages 120-123"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.mpmed.2025.11.006
Germain Yueling Lam, Rhianna Sheridan, Temi Lampejo, Caoimhe Nic Fhogartaigh
Infective gastroenteritis remains a globally prevalent condition with a wide range of viral, bacterial and parasitic causes. Viral gastroenteritis accounts for most cases, with norovirus increasingly becoming the most common cause since the introduction of the rotavirus vaccine. Norovirus, astrovirus, adenovirus and rotavirus are key viral agents, each with distinct transmission patterns, seasonal peaks and clinical features. Bacterial causes include Campylobacter, various diarrhoeagenic Escherichia coli strains, Salmonella, Shigella, Vibrio and Clostridioides (Clostridium) difficile, with presentations ranging from mild diarrhoea to severe systemic illness. Accurate management relies on a detailed clinical history, assessment of hydration status and further investigations if indicated. Treatment is primarily supportive, focusing on fluid and electrolyte replacement, with antibiotics reserved for specific indications. Special attention is warranted for high-risk groups, such as immunocompromised individuals, travellers and children, as well as in outbreak or healthcare-associated settings.
{"title":"Infective gastroenteritis","authors":"Germain Yueling Lam, Rhianna Sheridan, Temi Lampejo, Caoimhe Nic Fhogartaigh","doi":"10.1016/j.mpmed.2025.11.006","DOIUrl":"10.1016/j.mpmed.2025.11.006","url":null,"abstract":"<div><div>Infective gastroenteritis remains a globally prevalent condition with a wide range of viral, bacterial and parasitic causes. Viral gastroenteritis accounts for most cases, with norovirus increasingly becoming the most common cause since the introduction of the rotavirus vaccine. Norovirus, astrovirus, adenovirus and rotavirus are key viral agents, each with distinct transmission patterns, seasonal peaks and clinical features. Bacterial causes include <em>Campylobacter</em>, various diarrhoeagenic <em>Escherichia coli</em> strains, <em>Salmonella</em>, <em>Shigella</em>, <em>Vibrio</em> and <em>Clostridioides (Clostridium) difficile</em>, with presentations ranging from mild diarrhoea to severe systemic illness. Accurate management relies on a detailed clinical history, assessment of hydration status and further investigations if indicated. Treatment is primarily supportive, focusing on fluid and electrolyte replacement, with antibiotics reserved for specific indications. Special attention is warranted for high-risk groups, such as immunocompromised individuals, travellers and children, as well as in outbreak or healthcare-associated settings.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 2","pages":"Pages 102-110"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.mpmed.2025.11.011
Simon Stoneham, Joanna Peters, James Price
Staphylococci and streptococci are leading causes of healthcare- and community-acquired bacterial infections worldwide. Within each genus, virulent species such as Staphylococcus aureus, Streptococcus pyogenes and Streptococcus pneumoniae are associated with diverse syndromes of superficial infection, invasive infection and exotoxin production. Within each genus, less virulent species such as coagulase-negative staphylococci and viridans streptococci are common harmless human commensals but are frequently cultured from clinical samples. For these organisms, differentiating opportunistic infection from contamination is a major diagnostic challenge. Infections caused by these species are typically associated with prosthetic material, and increasing use of implanted medical devices has led to their rising importance as pathogens. Medically important staphylococcal species such as S. aureus and Staphylococcus epidermidis are frequently resistant to commonly used antibiotics. Clinicians should have a sound understanding of how staphylococci and streptococci cause the clinical syndromes they do and how they are treated.
{"title":"Staphylococcal and streptococcal infections","authors":"Simon Stoneham, Joanna Peters, James Price","doi":"10.1016/j.mpmed.2025.11.011","DOIUrl":"10.1016/j.mpmed.2025.11.011","url":null,"abstract":"<div><div>Staphylococci and streptococci are leading causes of healthcare- and community-acquired bacterial infections worldwide. Within each genus, virulent species such as <em>Staphylococcus aureus, Streptococcus pyogenes</em> and <em>Streptococcus pneumoniae</em> are associated with diverse syndromes of superficial infection, invasive infection and exotoxin production. Within each genus, less virulent species such as coagulase-negative staphylococci and viridans streptococci are common harmless human commensals but are frequently cultured from clinical samples. For these organisms, differentiating opportunistic infection from contamination is a major diagnostic challenge. Infections caused by these species are typically associated with prosthetic material, and increasing use of implanted medical devices has led to their rising importance as pathogens. Medically important staphylococcal species such as <em>S. aureus</em> and <em>Staphylococcus epidermidis</em> are frequently resistant to commonly used antibiotics. Clinicians should have a sound understanding of how staphylococci and streptococci cause the clinical syndromes they do and how they are treated.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 2","pages":"Pages 135-142"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.mpmed.2025.11.007
Katharine A Relph, Charles OC Langoya, Rebecca K Sutherland
Nocardia and Actinomyces are Gram-positive bacteria of the order Actinomycetales. These ubiquitous organisms exhibit filamentous branching structures, sometimes coalescing and developing into bundles known as mycelia. They are the cause of rare but clinically important infections and have been termed ‘the great masqueraders’. Affected individuals tend to present with chronic debilitating suppurative infections, and there can be a significant delay before a definitive diagnosis is made; this calls for a high level of clinical vigilance. Microbiological diagnosis is challenging, but advances in molecular techniques are improving the identification of these organisms. Outcomes for patients are more favourable if these infections are diagnosed quickly and effective treatment is started in good time.
{"title":"Nocardia and Actinomyces","authors":"Katharine A Relph, Charles OC Langoya, Rebecca K Sutherland","doi":"10.1016/j.mpmed.2025.11.007","DOIUrl":"10.1016/j.mpmed.2025.11.007","url":null,"abstract":"<div><div><em>Nocardia</em> and <em>Actinomyces</em> are Gram-positive bacteria of the order Actinomycetales. These ubiquitous organisms exhibit filamentous branching structures, sometimes coalescing and developing into bundles known as mycelia. They are the cause of rare but clinically important infections and have been termed ‘the great masqueraders’. Affected individuals tend to present with chronic debilitating suppurative infections, and there can be a significant delay before a definitive diagnosis is made; this calls for a high level of clinical vigilance. Microbiological diagnosis is challenging, but advances in molecular techniques are improving the identification of these organisms. Outcomes for patients are more favourable if these infections are diagnosed quickly and effective treatment is started in good time.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 2","pages":"Pages 87-90"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.mpmed.2025.11.004
LZ Heng, Robin D Hamilton
Ophthalmology is often viewed as minor in relation to other specialties, despite being the largest surgical and outpatient specialty. It is important to note, however, that there are numerous ophthalmic manifestations of neurological, rheumatological and general medical conditions. Some of these are considered emergencies but often signs are found within the eye that lead to systemic diagnoses requiring further intervention.
{"title":"Medicine in ophthalmology","authors":"LZ Heng, Robin D Hamilton","doi":"10.1016/j.mpmed.2025.11.004","DOIUrl":"10.1016/j.mpmed.2025.11.004","url":null,"abstract":"<div><div>Ophthalmology is often viewed as minor in relation to other specialties, despite being the largest surgical and outpatient specialty. It is important to note, however, that there are numerous ophthalmic manifestations of neurological, rheumatological and general medical conditions. Some of these are considered emergencies but often signs are found within the eye that lead to systemic diagnoses requiring further intervention.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 2","pages":"Pages 143-148"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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