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ID: 4774

Post malaria neurological syndrome: Are steroids useful?

Farnaz Dave, Ashley Horsely, Andrew Ustianowski, Javier Vilar.


West Infectious Diseases Unit @ North Manchester General Hospital


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.



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



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).


It is more

common in severe malaria than uncomplicated malaria and has been

associated with the use of mefloquine in malaria treatment.


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



1. World Health Organisation. World malaria report 2015. Accessed


http:/ / report-2015/en/

2. Cathcart

et al.

Estimating unreported malaria cases in England: a

capture-recapture study.

Epidemiol Infect


3. Nguyen

et al.

Post-malaria neurological syndrome.

The Lancet




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


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.


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 Waldron


, Helen Creigton


, Isabelle Delaney


, Mary Herzig



Ivan Keogh


, Martin Cormican




University College Hospital Galway,


National University of Ireland, Galway


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


M. genevase

. It is

possible that it may not have been consistently differentiated from



We report a case of

Mycobacterium lentiflavum


a three year old immune-competent child with chronic unilateral

cervical lymphadenopathy that failed to respond to beta lactam



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.


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


Keith Yuen, Melis Altunel, Adeel Anwar, Sulman Hasnie, Philip Stanley.

Bradford Royal Infirmary


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