Nick Beeching

Liverpool School of Tropical Medicine · Department of Clinical Sciences

Intestinal helminth infections - public health aspects

Introduction Travel to resource-limited settings is a known risk for acquisition of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) and carbapenem-resistant Enterobacterales (CRE), which are both associated with increased morbidity and mortality. We investigated the ESBL-PE and CRE baseline prevalence in British service personnel...

Background: Crimean-Congo hemorrhagic fever (CCHF) is a major emerging infectious disease threat, and children are reported to have a milder disease course compared with adults, in contrast to other viral hemorrhagic fevers. The aim of this study was to compare adult and pediatric patients with CCHF to improve understanding of pathogenesis and the...

Background Gastrointestinal parasite (GIP) infections are a major cause of global morbidity, infecting hundreds of millions of people each year and potentially leading to lifelong infection and serious complications. Few data exist on screening for GIP infections in migrants entering the UK or on the current performance of different traditional dia...

Background We report clinical, epidemiological, and laboratory features of a large diarrhea outbreak caused by a novel Cryptosporidium hominis subtype during British military training in Kenya between February and April 2022. Methods Data were collated from diarrhea cases, and fecal samples were analyzed on site using the multiplex polymerase chai...

Objectives Encephalitis, brain inflammation and swelling, most often caused by an infection or the body’s immune defences, can have devastating consequences, especially if diagnosed late. We looked for clinical predictors of different types of encephalitis to help clinicians consider earlier treatment. Methods We conducted a multicentre prospectiv...

Background Cases of human monkeypox are rarely seen outside of west and central Africa. There are few data regarding viral kinetics or the duration of viral shedding and no licensed treatments. Two oral drugs, brincidofovir and tecovirimat, have been approved for treatment of smallpox and have demonstrated efficacy against monkeypox in animals. Our...

Objectives: Many patients with meningitis have no aetiology identified leading to unnecessary antimicrobials and prolonged hospitalisation. We used viral capture sequencing to identify possible pathogenic viruses in adults with community-acquired meningitis. Methods: Cerebrospinal fluid (CSF) from 73 patients was tested by VirCapSeq-VERT, a prob...

Objectives: To define the status of Infectious Diseases (ID) as an approved specialty in Europe; to enumerate the number of specialists (in general and in relation to the overall population) and specialist trainees and describe the content, delivery, and evaluation of postgraduate training in ID in different countries. Methods: Structured web-ba...

Background: There is wide variation in the availability and training of specialists in the diagnosis and management of infections across Europe. Objectives: To describe and reflect on the current objectives, structure and content of European curricula and examinations for the training and assessment of medical specialists in Clinical (Medical) M...

Although coronaviruses have lower mutation rates than other respiratory RNA viruses, the scale of the pandemic has brought the importance of viral evolution for coronaviruses to centre stage. Three recently detected SARS-CoV-2 lineages (B.1.1.7, B.1.351, and P.1), have been scrutinized because they are unusually divergent and each possesses a uniqu...

Background - Crimean-Congo Haemorrhagic Fever (CCHF) is a viral haemorrhagic fever characterized by a febrile illness and haemorrhagic manifestations that develop in late-stage disease. The mortality ranges from 4% to 30% with higher case fatality rates (CFR) in nosocomial settings. CCHF is endemic in Pakistan where it was found in 1976, with con...

Objectives: Many secondary care departments receive external advice calls. However, systematic advice-call documentation is uncommon and evidence on call nature and burden infrequent. The Liverpool tropical and infectious disease unit (TIDU) provides specialist advice locally, regionally and nationally. We created and evaluated a recording system...

Background: Primary care is likely to see the highest number of Lyme disease patients. Despite this, there is limited published data regarding Lyme disease patients accessing primary care in the UK. We aim to describe trends in the incidence of a new diagnosis, and demographics of patients identified in a primary care electronic health database....

Background: Protease inhibitors (PI) have relatively low penetration into the genital tract, raising concerns about the potential for genital HIV-RNA shedding in patients taking PI-based regimens, particularly PI monotherapy (PImono). Methods: We measured HIV-RNA and PI drug concentrations in samples of semen; cervico-vaginal and rectal mucosa s...

Background: Cutaneous leishmaniasis (CL) may be emerging among international travellers and migrants. Limited data exist on mucocutaneous leishmaniasis (MCL) in travellers. We describe the epidemiology of travel-associated CL and MCL among international travellers and immigrants over a 20-year period through descriptive analysis of GeoSentinel data...

Objectives To estimate the incidence of gastroenteritis in individuals in care homes. Design Prospective cohort study. Setting Five participating care homes in North West England, UK. Participants Residents and staff present at the five study care homes between 15 August 2017 and 30 May 2019 (n=268). Outcome measures We calculated incidence rat...

Background: Travelers to international mass gatherings may be exposed to conditions which increase their risk of acquiring infectious diseases. Most existing data come from single clinical sites seeing returning travelers, or relate to single events. Methods: Investigators evaluated ill travelers returning from a mass gathering, and presenting t...

We retrospectively assessed the utility of a flow cytometry-based test quantifying the percentage of CD3+ T cells with the CD4-/CD8- phenotype for predicting tularemia diagnoses in 64 probable and confirmed tularemia patients treated during 2003-2015 and 342 controls with tularemia-like illnesses treated during 2012-2015 in the Czech Republic. The...

The liver is frequently involved in infections that are prevalent in different regions of the tropics, and chronic liver disease, sometimes with multiple aetiological explanations, is an important cause of early morbidity and mortality. This article describes some hepatic and biliary problems that are seen in the tropics or can be imported from res...

Background Undifferentiated febrile illness (UFI) is one of the most common reasons for people seeking healthcare in low-income countries. While illness and death due to specific infections such as malaria are often well-quantified, others are frequently uncounted and their impact underappreciated. A number of high consequence infectious diseases,...

Brucellosis in pregnant women is reported to be associated with obstetric complications (OCs), and adequate data for human brucellosis during pregnancy are largely lacking. We performed this multicenter retrospective cross-sectional study to evaluate the epidemiology, clinical course, treatment responses, and outcomes of brucellosis among pregnant...

Background: Data describing the coagulopathy of Crimean-Congo haemorrhagic fever are scarce. We did rotational thromboelastometry (ROTEM) and conventional coagulation testing in patients with Crimean-Congo haemorrhagic fever to increase our understanding of the coagulopathy of this infectious disease. Methods: We did a prospective observational...

Background Crimean-Congo hemorrhagic fever (CCHF) is a serious disease with a high fatality rate reported in many countries. The first case of CCHF in Oman was detected in 1995 and serosurveys have suggested widespread infection of humans and livestock throughout the country. Methodology Cases of CCHF reported to the Ministry of Health (MoH) of Om...

Case Studies in Neurological Infections of Adults and Children - edited by Tom Solomon March 2019

Case Studies in Neurological Infections of Adults and Children - edited by Tom Solomon March 2019

Cambridge Core - Infectious Disease - Case Studies in Neurological Infections of Adults and Children - edited by Tom Solomon

Background Crimean-Congo hemorrhagic fever (CCHF) is a serious disease with a high fatality rate reported in many countries. The first case of CCHF in Oman was detected in 1995 and serosurveys have suggested widespread infection of humans and livestock throughout the country. Methodology Cases of CCHF reported to the Ministry of Health (MoH) of Oma...

Soil-transmitted helminths and Mycobacterium tuberculosis frequently coincide geographically and it is hypothesized that gastrointestinal helminth infection may exacerbate tuberculosis (TB) disease by suppression of Th1 and Th17 responses. However, few studies have focused on latent TB infection (LTBI), which predominates globally. We performed a l...

Background: Migrants may be underimmunised and at higher risk of vaccine-preventable diseases, yet there has been no comprehensive examination of what policies are currently implemented across Europe targeting child and adult migrants. We analysed vaccination policies for migrants in 32 EU/EEA countries and Switzerland. Methods: Using framework ana...

Background Migrants within the European Union and European Economic Area (EU/EEA) may be underimmunised and lack documentation on previous vaccinations. We investigated approaches to vaccination in recently arrived adult and child migrants, and guideline availability and implementation. Methods: Between March and May 2017, a national vaccination ex...

Background Migrants may be underimmunised and at higher risk of vaccine-preventable diseases, yet there has been no comprehensive examination of what policies are currently implemented across Europe targeting child and adult migrants. We analysed vaccination policies for migrants in 32 EU/EEA countries and Switzerland. Methods Using framework anal...

Background: Viral meningitis is increasingly recognised, but little is known about the frequency with which it occurs, or the causes and outcomes in the UK. We aimed to determine the incidence, causes, and sequelae in UK adults to improve the management of patients and assist in health service planning. Methods: We did a multicentre prospective...

The syndrome of pyrexia of unknown origin (PUO) was first defined in 1961 but remains a clinical challenge for many physicians. Different subgroups with PUO have been suggested, each requiring different investigative strategies: classical, nosocomial, neutropenic and HIV-related. This could be expanded to include the elderly as a fifth group. The c...

The Recommendations for Management of Endemic Diseases and Travel Medicine in Solid-Organ Transplant Recipients and Donors: Latin America clinical practice guideline is intended to guide clinicians caring for solid-organ transplant (SOT) donors, candidates and recipients regarding infectious diseases (ID) issues related to this geographical region,...

Background: Arboviruses are an emerging group of viruses that are causing increasing health concerns globally, including in Europe. Clinical presentation usually consists of a non-specific febrile illness that may be accompanied by rash, arthralgia and arthritis and/or with neurological or haemorrhagic syndromes. The range of differential diagnose...

Objectives New point of care diagnostics are urgently needed to reduce the over-prescription of antimicrobials for bacterial respiratory tract infection (RTI). We performed a pilot cross sectional study to assess the feasibility of gas-capillary column ion mobility spectrometer (GC-IMS), for the analysis of volatile organic compounds (VOC) in exhal...

Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, a...

Background As bacterial meningitis decreases in incidence, viral meningitis becomes relatively more important. The incidence and costs of viral meningitis in adults are unknown. Methods An epidemiological study of adults with suspected meningitis in England, was carried out between 2011 and 2014. We estimated incidence and healthcare costs using p...

Background Survivors of bacterial meningitis are known to suffer neuropsychological deficits after their acute illness. Previous studies have suggested that viral meningitis may also cause cognitive problems. Primary and Objective We aimed to determine what the neuropsychological problems encountered by adults with viral meningitis were compared t...

Background: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and bl...

Introduction Noroviruses are the leading cause of acute gastroenteritis in all age groups, but illness is more severe and causes excess mortality in the elderly, particularly those in long-term care. The total burden of norovirus disease in the elderly in the UK is poorly defined; no current surveillance programmes systematically or accurately quan...

Objectives: This paper review trends in emerging infections and the need for increased clinical and laboratory surveillance. Methods: Factors that contributed to the emergence of recent outbreaks have been reviewed. Known, major outbreaks over the past two decades were reviewed. Results: We identified at least four major drivers of emergent in...

Background Crimean Congo Hemorrhagic Fever (CCHF) is a life threatening acute viral infection that presents significant risk of nosocomial transmission to healthcare workers. Aim Evaluation of CCHF infection prevention and control (IP&C) practices in healthcare facilities that routinely manage CCHF cases in Eurasia. Methods A cross-sectional CCHF...

CCHF IP&C questionnaire. (DOCX)

Background: A strategy of protease inhibitor (PI) monotherapy with re-introduction of triple therapy in those who rebound has been shown to be a safe and effective treatment simplification approach for long-term management. We sought evidence for cerebrospinal fluid (CSF) virological escape in patients on long-term PI monotherapy. Methods: We pe...

BACKGROUND: : Travelers' diarrhea causes significant morbidity including some sequelae, lost travel time and opportunity cost to both travelers and countries receiving travelers. Effective prevention and treatment are needed to reduce these negative impacts. METHODS: : This critical appraisal of the literature and expert consensus guideline develop...

Fever is an elevation of body temperature mediated by the hypothalamus in response to exogenous pyrogens and pyrogenic cytokines. Patients with acute fever should be assessed promptly for signs of sepsis. Pyrexia of unknown origin (PUO) is defined as a fever ≥38.3 °C on several occasions over a period of at least 3 weeks, with uncertain diagnosis a...

Giardia is a leading but treatable cause of infectious gastroenteritis worldwide, with a reported prevalence of 2-7% in high income countries and 2-30% in low income countries. Giardiasis is included in the World Health Organization Neglected Diseases Initiative owing to its burden and association with poverty. Its incidence in the United Kingdom i...

Background: Brucella spp. prosthetic joint infections are infrequently reported in the literature, particularly in returning travellers, and optimal treatment is unknown. Method: We describe a prosthetic joint infection (PJI) caused by Brucella melitensis in a traveller returning to the UK from Thailand, which we believe to be the first detailed...

Public Health England conducts enhanced national surveillance of tetanus, a potentially life-threatening vaccine-preventable disease. A standardized questionnaire was used to ascertain clinical and demographic details of individuals reported with clinically suspected tetanus. The 96 cases identified between 2001 and 2014 were analysed. The average...

Purpose of review: The review examines the changing causes and the investigation of infectious and noninfectious diarrhoea in individuals with HIV. Recent findings: Despite the excellent prognosis conferred by combination antiretroviral therapy, diarrhoea is still common in HIV-positive individuals and is associated with reduced quality of life...

In a prospective study, 498 single faecal samples from children aged under 16 years attending an outpatient clinic in the Angkor Hospital for Children, northwest Cambodia, were examined for Cryptosporidium oocysts and Giardia cysts using microscopy and molecular assays.Cryptosporidium oocysts were detected in 2.2% (11/498) of samples using microsco...

Objective: The PIVOT trial found that protease inhibitor (PI) monotherapy as a simplification strategy is safe in terms of drug resistance but less effective than combination therapy in suppressing HIV viral load (VL).We sought to identifyfactors associated with the risk of VL rebound in this trial. Methods: PIVOT was a randomized controlled tri...

Background: Clostridium difficile infection (CDI) causes a high burden of disease in high-resource healthcare systems, with significant morbidity, mortality, and financial implications. CDI is a healthcare-associated infection for which the primary risk factor is antibiotic usage, and it is the leading cause of bacterial diarrhoea in HIV-infected...

Background: Tularemia seroconversion can take several weeks and an early diagnostic test would help with directed therapy early in the course of disease. Vgamma9Vdelta2 T-cells play a significant role in the host response to tularemia. They belong to a subgroup of double negative T-lymphocytes (DNT, CD3+/CD4-/CD8-), which express neither CD4+ nor C...

Background: The recent Ebola epidemic has increased public awareness of the risk of travel associated VHF and international preparedness to manage imported cases was inadequate, highlighted by cases of nosocomial transmission. Crimean-Congo haemorrhagic fever (CCHF) is a re-emerging tick-borne VHF centred in the Eurasian region, affecting a large...

Bacterial meningitis and meningococcal sepsis are rare conditions with high case fatality rates. Early recognition and prompt treatment saves lives. In 1999 the British Infection Society produced a consensus statement for the management of immunocompetent adults with meningitis and meningococcal sepsis. Since 1999 there have been many changes. We t...