The Journal of Hospital Infection - Supplement 1 - November 2016

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Discussion and/or Conclusion(s): C. cayetanensis is a coccidian
protozoan parasite. The diarrhoea is usually self-limiting, but can be
prolonged (lasting weeks to months if untreated), copious, and
explosive. Transmission occurs by ingestion of contaminated
food and water. It is endemic in many countries including Mexico.
Outbreaks occur because the oocysts are resistant to standard water
chlorination treatments.
Standard laboratory procedures for OCPs do not detect Cyclospora. The
laboratory should be notified that Cyclospora is considered. Special
techniques to identify Cyclospora include acid-fast stains, safranin
stains, and lactophenol cotton blue stains.
Public Health England3 recommends that returning travelers from
Mexico with diarrhoea are tested for Cyclospora. Positive cases should
be reported to PHE and samples referred to the Cryptosporidium
Reference Unit in Swansea for confirmation and typing.
ID: 5144
Novel porcine model of cutaneous myiasis for training of removal
Daniel Burns1, Mark Bailey2, Major Kieran Campbell3. 1Army Medical
Directorate Birmingham Heartlands Hospital, 2Birmingham Heartlands
Hospital and the Royal Centre for Defence Medicine, 3British Army
Background: Cutaneous myiasis caused by the tumbu fly Cordylobia
anthropophagia in the African tropics and the bot fly Dermatobia
hominis in Latin America is a common well reported skin complaint
both of travellers and residents of endemic areas. The British Army
frequently exercises overseas, and in particular soldiers exercising
in the Belize jungle are at risk of developing bot fly infestation. While
the larvae can be easy to remove in the early stages, late instars,
particularly of Dermatobia hominis often require surgical removal.
We developed a novel porcine model of botfly removal to aid in the
training of medical staff deploying on exercises in areas with endemic
cutaneous myiasis. Commercially obtained maggots were inserted
under the skin of a pig’s trotter which had been prepared to replicate
a typical lesion. Students received a lecture on cutaneous myiasis,
including a video and photos of removal, before having multiple
attempts at the practical, safe removal of larvae from the botfly
model using a cruciform incision and simple surgical tools under
supervision. They received feedback on their performance. Students
reported an increase in confidence in their ability to safely remove
larvae after their training. Usefully, training materials are easily
obtained from a butcher ’s and tackle shop making this model cheap
and easy to replicate.
ID: 5173
Beyond the pail: two cases of brucellosis in travellers returning
from India
Kathryn French, Helen Jones. The Royal Wolverhampton NHS Trust
Background: A 70-year-old woman, Mrs X, presented with fever and
loin pain. Imaging revealed a psoas abscess at the level of L4. In the
meantime, the patient’s husband, Mr X, was admitted to the hospital
with fever and loss of appetite. On review of the clinical history, it was
revealed that both patients had recently travelled to the Punjab area of
India and to Spain. After four days of incubation, an organism was
isolated fromMrs X’ s blood culture. Although not identified on routine
MALDI-ToF mass spectrometry, the organism was confirmed as
Brucella melitensis. A few days later the same organism was isolated
from her husband’ s blood culture.
Discussion: Mr and Mrs X had non-focal and focal brucellosis
respectively. The couple had mostly likely acquired the disease
during their recent trip to the Punjab where they reported drinking
unpasteurised milk supplied by a local farmer. The incidence of
brucellosis in many parts of the world, particularly Asia, remains
largely unknown. The WHO recognises the disease may be endemic in
India and is likely to be under diagnosed and under reported.
Learning Points
• Brucella melitensis is not reliably identified by MALDI-ToF mass
spectrometry in a clinical laboratory. This has the potential to
complicate the diagnostic process and delay appropriate patient
management.
• Despite understanding the need to boil milk prior to consumption,
Mr and Mrs X did not always adhere to this advice. This highlights
the significant role of human behaviour in the acquisition and
transmission of infectious diseases.
Topic: Viral infections
ID: 4768
“Hear hooves, think zebras, not horses” – Case series: Atypical
presentations of Hepatitis E
Charlotte Brookfield, Dimitrios Mermerelis, Joel Paul. Pennine Acute
Hospitals Trust
Background: Hepatitis E (HEV) is generally a mild infection but can be
associated with severe disease and atypical manifestations. G3, the
commonest genotype seen indigenously in the UK, is spread mainly by
consumption of pork products and is increasing in incidence. HEV is
not commonly considered in the initial differential diagnosis or
investigations for patients with abnormal liver function tests.
Aim(s)/Objective(s): Here we present four recent cases of confirmed
HEV infection where this was not considered likely from the initial
clinical presentations.
Method(s): Patient case records were reviewed.
Results: Case one was a twenty-three year old man with a background
of diabetes and substance abuse. Initial management was based on a
presumed paracetamol overdose. Case two was a middle aged woman
who presented with weakness, dry cough, and back pain. This
patient required intensive care support for Guillian-Barré Syndrome.
The third case was a seventy-seven year old gentleman who
presented with bronchopneumonia requiring ITU support where he
was noted to be jaundiced. The fourth case was an eighty year old man
who enjoyed good health until presenting with weight loss and
jaundice. He was investigated for pancreatic malignancy and gall
bladder pathology.
Discussion and/or Conclusion(s): In common, all these patients had
deranged ALT and bilirubin but a normal INR. None of these patients
had HEV considered early in their presentation although they were
screened for the other hepatitis viruses. We present these cases to
remind people to consider HEV as an increasing cause of typical and
atypical presentations of hepatitis.
ID: 4785
The prevalence of human herpesvirus-6 central nervous system
infection in the paediatric population in Lothian
Fiona Hamilton1, Fraser Barbour2, Kate Templeton3. 1Specialist Virology
Centre, 2University of Edinburgh, 3Royal Infirmary of Edinburgh
Background: Encephalitis is a severe neurological disease associated
with multiple sequelae, high healthcare costs and mortality. Causes of
encephalitis include a range of infectious and non-infectious disease
processes. The majority of cases result from viral infection. The
aetiology of encephalitis remains unknown in up to 58% of cases in the
UK (Granerod et al., 2010).
Aim(s)/Objective(s): Real-time polymerase chain reaction (PCR) is
central to the diagnosis of viral encephalitis and identification of the
causative pathogen. However Human Herpesvirus-6 (HHV-6), which
is known to be a cause of encephalitis, is not routinely screened for in
the UK. This study aims to determine the prevalence of neurological
infection of HHV-6 in the paediatric population in Lothian throughout
2015.
Results: Using real-time PCR, 427 cerebrospinal fluid (CSF) samples
were tested for HHV-6. HHV-6 was identified in 25 samples. As HHV-6
DNA can be congenitally integrated into the host genome correspond-
ing blood samples were also tested. 10 of the patients had
corresponding blood samples tested. 2 of these samples were negative
Abstracts of FIS/HIS 2016 – Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24–S134 S132