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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.


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


Peter Johnson, Adrian Kennedy, Phil Stanley, Paul McWhinney,

Sulman Hasnie, Riccardo Guintini, Ben Jeffs.

Bradford Royal Infirmary


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.


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


, Karen Macsween


, Guy Vernham



Panos Asimakopoulos


, Diane Lindsay




NHS Lothian,



Haemophilus, Legionella, Meningococcus and Pneumococcus Reference

Laboratory, Glasgow


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


, Shiu Soo




Nottingham University Hospitals/Health

Education East Midlands,


Nottingham University Hospitals


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.


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.


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





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


ID: 4703

A case report of Whipple

s disease with neurological and ocular


Katherine Watson, Julie Samuel, Peh Sun Loo, William Innes,

Bridget Griffiths, Shahzad Shikoh.

Newcastle upon Tyne Hospitals NHS

Foundation Trust


A 47 year old man presented with progressive weight

loss, lymphadenopathy, back pain, visual disturbance, myoclonus and

poor memory.


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