54 / 150
hepatic encephalopathy. She had a history of cirrhosis secondary to
autoimmune hepatitis and it was initially thought that her illness was
secondary to decompensation that would necessitate liver transplant-
ation. She was born in Pakistan and had lived in the UK since 2007 last
visiting Pakistan from May to July 2015.
Results:
Routine laboratory results demonstrated worsening liver
function, pancytopenia and hyponatremia. Blood cultures were
positive for what was finally proved to be Brucella abortus. Serology
was positive for Brucella IgM/IgG. A sample from August 2015 was
retrospectively tested and was negative.
Discussion and/or Conclusion(s):
Following confirmation of brucel-
losis she was treated with 6 weeks of ciprofloxacin and 2 weeks of
gentamicin. She has had a good response and 6 months later remains
well with only mild encephalopathy at times. Human brucellosis
remains rare in the UK. This case highlights the need to consider it in
those patients who present with pyrexia of unknown origin and have
travelled to an endemic area. Due to her liver condition her treatment
regimen was chosen to avoid rifampicin. The initial concern she might
require a liver transplant has abated.
ID: 4560
A case of visceral leishmaniasis and the avoidance of a planned
splenectomy
Peter Johnson, Adrian Kennedy, Phil Stanley, Paul McWhinney,
Sulman Hasnie, Riccardo Guintini, Ben Jeffs.
Bradford Royal Infirmary
Background:
Visceral leishmaniasis is a rare illness to present in the
UK although it should be considered in the differential when there
is an appropriate travel history. A 76 year old male retired civil
engineer had been under the haematologists for investigation of
pancytopenia since November 2015. He presented with symptoms of
weight loss, night sweats, loss of appetite and lethargy. He had a
background of Psoriatic Arthritis for which he took Methotrexate.
His travel history included holidays to North America, Morocco and
more recently Spain. Lymphoma was considered a likely diagnosis
with evidence of splenomegaly on imaging. He was listed for a
splenectomy after repeated splenic biopsies came back showing only
reactive changes.
Results:
His Leishmania serology came back strongly positive
(Leishmania DAT Positive at a titre of 409,600 and Leishmania K39
test: Antibody to Leishmania K39 antigen: positive) a few days prior to
his planned splenectomy.
Discussion and/or Conclusion(s):
Visceral Leismaniasis was consid-
ered the most likely diagnosis. Hewas treated with standard liposomal
amphotericin B 3 mg/Kg (5 days). At latest follow up he has made a
good recovery. His platelet count is now normal and haemoglobin and
white cell count are improving. Leishmania was not considered in the
initial differentials and it was a few months before his serology was
performed. Although the majority of cases occur in countries such
as Bangladesh, Brazil, India and Sudan it is also endemic in the
Mediterranean area. Consideration should be given for this diagnosis if
there is an appropriate travel history especially in an immunosup-
pressed individual.
ID: 4575
A rare cause of epiglottitis
Elan Tsarfati
1
, Karen Macsween
1
, Guy Vernham
1
,
Panos Asimakopoulos
1
, Diane Lindsay
2
.
1
NHS Lothian,
2
Scottish
Haemophilus, Legionella, Meningococcus and Pneumococcus Reference
Laboratory, Glasgow
Background:
A 72 year old Australasian holidaymaker was brought by
ambulance to A + E complaining of severe, abrupt onset abdominal
pain, present for 6 hours, and a sore throat for 4 days. On examination
she was febrile 39.1°C, and was holding her neck. Her throat appeared
normal with no cervical lymphadenopathy, but her anterior neck
was tender. She was tachyopneic 40/min, saturation 95% on air, with
HR 87 and BP 140/76. There was central and right upper quadrant
abdominal tenderness. CXR showed a small right pleural effusion,
also seen on CT abdomen which also demonstrated consolidation, but
no other cause for her pain. Over three hours she became hoarse;
complaining of
“
a frog in my throat
”
. Nebulised adrenaline, intraven-
ous ceftriaxone and dexamethasone were administered. A CT neck
revealed significant soft tissue swelling and thickening of the
epiglottis. Her airway was immediately secured and she was
transferred to intensive care. Blood cultures were positive the
following day with Gram-negative diplococci, later identified as
Neisseria meningitidis
. She was extubated within 24 hours, and
completed 7 days of IV ceftriaxone before discharge. The Scottish
Reference Laboratory confirmed the
N. meningitidis
serogroup Y with a
rare MLST type for Scotland. Since 2014 Scottish figures show
serogroup Y accounts for 15% of
N. meningitidis
isolates, is invasive in
79% of cases (CSF, eye or blood culture), and affects older adults mean
66 years of age (range 1
–
89) and female > male (16F:8M). Serogroup Y
is only rarely implicated in epiglottitis, with only a handful of cases
previously reported.
ID: 4677
Unusual pneumonia after a road traffic accident
Amelia Joseph
1
, Shiu Soo
2
.
1
Nottingham University Hospitals/Health
Education East Midlands,
2
Nottingham University Hospitals
Background:
A 19 year old male was admitted after being trapped in a
car that crashed into a rural ditch. Whilst emergency services worked
to free him, he became submerged underwater.
Aim(s)/Objective(s):
On arrival to hospital he had severe respiratory
compromise requiring endotracheal intubation. Computer tomog-
raphy revealed bilateral alveolar opacities with air bronchograms
suggestive of aspiration. Bronchial washings were obtained and
piperacillin-tazobactam was commenced empirically. A beta-haemo-
lytic oxidase-positive Gram-negative organism grew on blood agar
after 24 hours. Biochemical identification confirmed the organismwas
Aeromonas hydrophilia; the isolate tested resistant to piperacillin-
tazobactam and sensitive to ciprofloxacin and meropenem.
Method(s):
After review on Intensive Care by the Microbiologist,
piperacillin-tazobactam was switched to intravenous ciprofloxacin.
The patient deteriorated with respiratory failure, sepsis and diarrhoea.
Meropenemwas added after repeat bronchial washings. Amould grew
on blood and Sabouraud agar, identified by microscopy as
Aspergillus
fumigatus
.
Results:
Voriconazole was commenced and within 72 hours he had
significantly improved. However profuse watery diarrhoea continued.
Auramine staining of a stool sample revealed Cryptosporidium cysts,
later identified as
Cryptosporidium hominis
. Following continued
improvement, he completed fourteen day courses of meropenem,
ciprofloxacin and voriconazole. His diarrhoea slowly settled and he
was discharged home a week later.
Discussion and/or Conclusion(s):
The mechanism of the trauma in
this case led to several water-borne infections. In reported literature on
near-drowning, Aeromonas species is the commonest cause of early-
onset pneumonia.
Pseudoallescheria boydii
is the commonest fungal
infection, usually with a delayed presentation. Aspergillus infection
has been reported in a small number of cases and usually has a poor
prognosis.
ID: 4703
A case report of Whipple
’
s disease with neurological and ocular
features
Katherine Watson, Julie Samuel, Peh Sun Loo, William Innes,
Bridget Griffiths, Shahzad Shikoh.
Newcastle upon Tyne Hospitals NHS
Foundation Trust
Background:
A 47 year old man presented with progressive weight
loss, lymphadenopathy, back pain, visual disturbance, myoclonus and
poor memory.
Aim(s)/Objective(s):
Due to progressive physical deterioration the
patient was admitted for investigation. A number of differentials were
considered including malignancy, lymphoma and sarcoidosis. On
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S49