The Journal of Hospital Infection - Supplement 1 - November 2016

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ID: 4774
Post malaria neurological syndrome: Are steroids useful?
Farnaz Dave, Ashley Horsely, Andrew Ustianowski, Javier Vilar. North
West Infectious Diseases Unit @ North Manchester General Hospital
Background: In 2015 the World Health Organisation estimated there
were 214 million cases of malaria globally and 438,000 deaths
attributable to this potentially life-threatening condition. 1 Between
1300 and 1800 malaria cases are reported each year in the UK,
although it is estimated this only represents 65% of the total number of
cases.2 Post malaria neurological syndrome (PMNS) is a rare
complication of severe malaria with a prevalence of 1.2 per 1000 in
those treated for Plasmodium falciparum Malaria (PFM). 3 It is more
common in severe malaria than uncomplicated malaria and has been
associated with the use of mefloquine in malaria treatment. 3
Discussion and/or Conclusion(s): We present a 67 year old Caucasian
male returning from The Gambia with severe PFM, having not taken
antimalarial chemoprophylaxis. He was treated with intravenous
artesunate at a tertiary referral centre but required intubation,
ventilation and haemofiltration. Following primary treatment and
improvement he subsequently deteriorated, developing generalised
weakness and increasingly confusion with a reduced Glasgow Coma
Score (GCS). After extensive investigation and exclusion of alternative
causes PMNS was diagnosed. He was treated with IV hydrocortisone
due to his depressed GCS and absence of any contra-indications. He
made a rapid clinical improvement and was discharged without
neurological impairment. We explore the decisions leading to the use
of corticosteroids in this case and similar presentations reported in the
literature.
References
1. World Health Organisation. World malaria report 2015. Accessed
22/6/16
2. Cathcart et al. Estimating unreported malaria cases in England: a
capture-recapture study. Epidemiol Infect 2010;138(7):1052e8.
3. Nguyen et al. Post-malaria neurological syndrome. The Lancet.
1996;348(9032):917–921.
ID: 4788
Case of an HIV positive gentleman with a drug resistant HSV-2
hypertrophic penile ulcer
Sarah Wright, Stephen Woolley, Meg Boothby. Department of HIV and
GU Medicine, University Hospitals Birmingham NHS Foundation Trust
Background: Herpes simplex virus (HSV) is the most common
sexually transmitted disease in HIV positive heterosexuals in the UK.
The virus has two main strains: HSV-1 and HSV-2, the latter being
the most common strain to cause recurrent genital ulceration. Viral
re-activation is closely related to the degree of immunosuppression
that HIV confers to the patient: severely immunocompromised
patients can develop atypical lesions and recurrences with resistant
HSV strains.
Aim(s)/Objective(s): We present the case of a 47 year old, HIV positive
gentleman with recurrent HSV-2 penile ulceration which is only
responsive to foscarnet.
Discussion and/or Conclusion(s): The patient was diagnosed with
HIV in 2003 with a baseline nadir CD4 count of 0 cells/mm³.
Antiretroviral therapy was commenced upon diagnosis, although
with variable patient compliance thereafter. The patient has experi-
enced multiple, valaciclovir responsive episodes of genital ulceration
since his HIV diagnosis. A severe episode of penile ulceration in
2011 required addition of thalidomide therapy for six weeks to
produce complete ulcer resolution. The patient subsequently received
high dose valaciclovir prophylaxis for the following two years but
required two further eight week courses of thalidomide for severe
ulcer recurrences. Unfortunately, there was only partial response to
thalidomide in 2014 and no response in 2016. After treatment failure
in 2014, the ulcer was biopsied which confirmed HSV-2 infection with
no malignant cell transformation. On both occasions of thalidomide
failure the patient received intravenous foscarnet therapy (35 and
42 day courses respectively) which successfully produced complete
re-epithelialisation of the ulcer.
ID: 4794
Mycobacterium lentiflavum causing unilateral cervical
lymphadenitis in a previously healthy child: a case report
Ruth Waldron1, Helen Creigton1, Isabelle Delaney1, Mary Herzig1,
Ivan Keogh1, Martin Cormican2. 1University College Hospital Galway,
2National University of Ireland, Galway
Background: Mycobacterium lentiflavum is ubiquitous in the environ-
ment including drinking water in some settings. It is increasingly
recognised as a species associated with non-tuberculous mycobacter-
ial (NTM) lymphadenitis in previously healthy children. The species is
similar in many respects to M. avium , M. simiae and M. genevase . It is
possible that it may not have been consistently differentiated from
these.
Aim(s)/Objective(s): We report a case of Mycobacterium lentiflavum in
a three year old immune-competent child with chronic unilateral
cervical lymphadenopathy that failed to respond to beta lactam
therapy.
Method(s): She had two sequential ultrasounds of her left neck mass,
which showed a centrally necrotic mass with a slight increase in size
over four weeks.
Results: Routine blood investigations were unremarkable. An MRI
neck showed enlarged matted and centrally necrotic left upper
cervical lymphadenopathy. She had surgical incision and drainage of
her cervical lymph node. Histology reported necrotic tissue mixed
with inflammation, suggestive of infection. Acid fast bacilli were not
seen on initial microscopy using Ziehl-Neelsen stain. Culture was
positive for mycobacteria other than tuberculosis (MOTT) identified as
Mycobacterium lentiflavum in a reference laboratory. It tested resistant
to rifampicin and susceptible to clarithromycin. She was further
treated with clarithromycin post-surgical excision of her lymph node
with complete resolution of her symptoms.
Discussion and/or Conclusion(s): NTM including M. lentiflavum
should be considered in otherwise healthy children with chronic
unilateral cervical lymphadenopathy. It is uncertain towhat extent the
epidemiology, clinical course, management and outcome is related to
the specific infecting species of NTM.
ID: 4799
Discitis: A rare complication of urosepsis following urological
intervention
Keith Yuen, Melis Altunel, Adeel Anwar, Sulman Hasnie, Philip Stanley.
Bradford Royal Infirmary
Background: A 71-year-old man developed symptoms of systemic
infection and generalised body aches five weeks following a trans-
urethral resection of prostate (TURP) for previous retention of
urine. Blood and urine cultured Morganella species. He was treated
accordingly with piperacillin/tazobactam for one week. Good clinical
response was observed but ongoing symptoms, now predominantly
lower back pain, necessitated a second admission. Although there was
no systemic sepsis and inflammatory markers remained normal, a
magnetic resonance imaging of the spine confirmed a discitis at
the level of his L2 vertebra. Biopsy/aspiration of the spine was not
pursued to avoid delay in the initiation of antimicrobial treatment and
our patient made a full recovery of symptoms with ertapenem for 6
weeks, and a repeat MRI nine months following the onset confirmed
complete resolution of discitis.
Discussion and/or Conclusion(s): Bacteraemia following urological
intervention is not unusual, especially for those who had previous
instrumentation and indwelling catheters, which predispose colon-
isation of bacteria in the lower urothelial tract. Patients presenting
with urosepsis associated with non-specific symptoms following
urological procedures need prompt symptom specific investigations
Abstracts of FIS/HIS 2016 – Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24–S134 S51