A10 FIS 99 Abstracts

3.2SKIN AND SOFT TISSUE INFECTIONSmShiranee Hammersmith Hospital, LondonGram positive bacteria account for the vast majority of skin and softtissue infections; a combined medical and surgical approach is oftenwarranted in the most serious cases. Empiric management regimensare largely based upon accumulated clinical experience. As withmany ‘old fashioned’ infections, there are in fact no controlled trialson which to base therapy. Even as new therapies become available,there are few trials which directly compare efficacy of newertherapies with standard treatment.This presentation will focus on those bacterial skin and soft tissueinfections which require hospitalisation; the evidence whichunderlies our approach to cellulitis, recurrent cellulitis, fasciitis, andgangrene will be discussed. It is apparent that, at present, there areno clear data to support use of widely recommended options such asintravenous immunoglobin for invasive streptococcal infection orhyperbaric oxygen for gangrene. In the future, management is likelyto be complicated by antimicrobial resistance.

Workshop laOUTBREAK DETECTION: EVIDENCE FOR ACTIONM CatchDole, H Heine, C Wroath, Communicable DiseaseSurveillance Centre, London‘Surveillance should provide evidence for action’ has become theaxiom for those that are concerned with the collection, analysis anddissemination of communicable disease data. One of the mostimportant actions in respect of communicable disease control andprevention is outbreak detection and the ensuing intervention. Modernsurveillance must provide all those that need to take action that isrequired to prevent, detect and control outbreaks with evidence that issuitable in terms of its content, presentation and timeliness. Recentdevelopments in information technology provide great opportunitiesfor more effective and more efficient outbreak management.The PHLS Communicable Disease Surveillance Centre (CDSC) hasdeveloped systems to facilitate the identification of outbreaks andexceptional events, using Poisson regression techniques and newgroupware application software. It is also involved in ongoingdevelopment work that will provide a wide constituency ofprofessionals concerned in the management of outbreaks withaccess to up to the minute surveillance data using web browsertechnologies over Extranet links.

Workshop 1 bGEOGRAPHY AND ANTIBIOTIC RESISTANCEDr Anthony Howard, University Hospital of Wales, Card@Bacteria exist in a vast and infinitely complex ecosystem. Millionof years of evolution has led to adaptations that have allowed theseorganisms to exploit all niches available to them on the globe. Thishas required a capacity to accommodate exposure to a wide varietyof physical, biological and chemical conditions. The nature of theseadaptations provides insight into the biology of these organisms andtheir immediate environment. This presentation will examinevariations in antibiotic resistance that are encountered inpopulations in different geographical locations and will examinesome of the factors that such differences highlight. It will focus onrecent data that has explored antibiotic resistance in population atregional and community level in Wales and will discuss thepotential influence of antibiotic prescribing on these results.

Workshop 2EMERGING THREATS TO DRINKING WATER SUPPLIESD r P a u l R Hunter, Countess of Chester Health Park, ChesterThe provision of a safe clean water supply is the prerequisite ofurban civilisation. It can be argued that modem Public Health

Medicine owes its inception to the impact of waterborne disease.Nevertheless, despite the importance of waterborne disease, it is acommodity which western civilisation is at risk of becoming toocomplacent about the safety and reliability of its water sources.Whilst some diseases such as cholera and typhoid have long beenknown to be waterborne, many pathogens described in the last 30years are associated with water. Examples include cryptosporidium,cyclospora, campylobacter and enterohaemorrhagic E. coli. Thispresentation considers some of the emerging threats to watersupplies.Undoubtedly the greatest emergent threat to drinking water suppliesis the increasing demand for water from a rapidly world growingpopulation, exacerbated by climatic change. Even in Europe, aregion with an apparently plentiful supply of freshwater, thecondition of some of our water sources is degrading due to overabstraction or pollution. In certain circumstances the effect ofpollution on water quality is indirect through promotion ofpotentially toxic algae. This is seen in the case of cyanobacterial anddianoflagelate blooms. Both of these groups of microorganisms canlead to potentially serious effects on human health.Given the great importance of water to human civilisation there is thepotential that water may be involved in conflicts. Water may becomeboth a reason for war and a strategic weapon deliberatelycontaminated with agents injurious to health. As with other weaponswater may also be the vehicle for terrorist action. The threat ofterrorism against drinking water supplies was raised earlier this yearwhen a threat was made to poison drinking water supplies in the UK.Other emergent threats to our water supply come from a variety ofdirections. In the developed world there is concern overMycobacteria in water supplies posing a threat to human health. Inparticular, M. avium complex infections have been linked withdrinking water in AIDS patients. Another potentially emergingthreat relates to toxoplasmosis, outbreaks of which have beenassociated with drinking water on a couple of occasions. Nooutbreaks have been detected in the UK, though given that there isno systematic screening for this pathogen, this is not surprising.

Workshop 5MALARIAL DISEASE AND IMMUNITY IN MALARIAProfessor Dominic Kwiatkowski, John Radcliffe Hospital, OxfordAlthough over a million African children die each year of malaria,this represents only a minority of the total number of infections. Westill have a very incomplete understanding of why some infectionsare fatal while others resolve uneventfully. At least part of theexplanation lies in host genetic diversity. Erythrocytepolymorphisms such as haemoglobin S and Duffy antigennegativity provide classical examples of how the evolutionarypressure of infectious disease may select for specific host genotypes.Over ten putative malaria susceptibility determinants have alreadybeen defined, including several in immunological mediators, and itis likely that very many more have yet to be discovered. The humangenome contains a vast number of DNA polymorphisms which maylead to phenotypic variation in many immunological andbiochemical pathways.Ongoing advances in DNA technology will ultimately allow us toscreen thousands of candidate genes for association withsusceptibility to severe malaria in large multi-centre studies. usingboth case-control and family-based statistical techniques. TOunderstand the functional basis of the genetic associations that such‘an exercise will generate, it will be necessary to carry out saturationmapping of candidate gene regions, and to combine this with detailedmolecular analysis of disease associated polymorphisms at thecellular level. Although this will be a large undertaking, it may bethe most direct route to gain a molecular understanding of immuneand pathogenic processes that influence clinical outcome in differentepidemiological settings, and may ultimately lead to fundamentallynew approaches to the treatment and prevention of severe malaria.