Table of Contents Table of Contents
Previous Page  137 / 150 Next Page
Show Menu
Previous Page 137 / 150 Next Page
Page Background

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 England


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 Burns


, Mark Bailey


, Major Kieran Campbell




Army Medical

Directorate Birmingham Heartlands Hospital,


Birmingham Heartlands

Hospital and the Royal Centre for Defence Medicine,


British Army


Cutaneous myiasis caused by the tumbu fly Cordylobia

anthropophagia in the African tropics and the bot fly



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


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.


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


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


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.


Here we present four recent cases of confirmed

HEV infection where this was not considered likely from the initial

clinical presentations.


Patient case records were reviewed.


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 Hamilton


, Fraser Barbour


, Kate Templeton




Specialist Virology



University of Edinburgh,


Royal Infirmary of Edinburgh


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).


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



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