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Page Background

to diagnose uncommon manifestations of bacteraemia in order to

avoid delay in treatment and to improve prognosis. It would also be

reasonable to monitor the patients if symptoms are unusual and

lingering. In the era of aging population needing more urological

interventions alongside increasing antibiotic resistancewe are likely to

see a greater incidences of Gram negative sepsis following urological

intervention and clinicians need to be vigilant in the diagnosis and

treatment of complications.

ID: 4806

PVL toxin positive

Staphylococcus aureus

: Two cases of invasive

bone infection at a Specialist Orthopaedic Hospital

Leanne Cleaver, Simon Warren, Damien Mack, Shara Palanivel.



Panton-Valentine Leucocidin (PVL) toxin produced by


aureus has long been reported as a virulence factor that

contributes to non-invasive infections such as recurrent boils and

furuncles. There have also been case reports of invasive infections such

as osteomyelitis and necrotising pneumonia.


Here we report two patient cases at a specialist

orthopaedic hospital with invasive PVL positive methicillin-sensitive

S. aureus



Patient 1 was a 6 year old female with a 4 week history of

right lateral thigh pain and subsequent diagnosis of osteomyelitis by

computed tomography scan. There was a family history of recurrent


Patient 2 was a 42 year old female with a history of continuing left

triceps pain and a subsequent diagnosis of humeral osteomyelitis on

magnetic resonance imaging. There was a family history of recurrent



Patient 1 was managed with surgical debridement, six

weeks of intravenous ceftriaxone and oral rifampicin, and decolon-

isation of patient and household contacts with naseptin and


Patient 2 was managed initially with ultrasound guided drainage of a

triceps abscess and six weeks of oral flucloxacillin. The patient is still

undergoing care for a second abscess in the femur; therefore

decolonisation has not yet been initiated.

Discussion and/or Conclusion(s):

Here we highlight that while PVL



can cause non-invasive infection, it can also cause deep seated

infection. We reinforce the importance of obtaining a full personal and

family history in order to identify patients at risk of PVL

S. aureus


bone and joint infections and the public health implications this has

for further prevention.

ID: 4814

Adverse effects of disseminated Mycobacterium chimaera

infection treatment

a case of intolerance to two antimicrobial

agents of choice

Vjeran Cajic, Goarana Kovacevic, Pritwish Banerjee.


Hospitals Coventry and Warwickshire NHS Trust


Post-cardiac surgery disseminated Mycobacterium

chimaera infections (DMCI) are associated with high mortality even

when treated with antimicrobial agents of choice. Treatment is

challenging due to limited effectiveness of few available agents, the

need for lengthy administration of antimicrobials, and their numerous

adverse effects (AE).


To review the adverse effects of treatment of

choice for DMCI and alternative therapeutic options.


We present a patient with DMCI and severe AEs to

rifabutin, ethambutol, and amikacin.


In our experience the alternative agents for treatment of DMCI

were significantly inferior to standard regimen.

Discussion and/or Conclusion(s):

AEs can render standard treatment

of DMCI inappropriate. The remaining antimicrobial options are not

supported by clinical experience and may need to include novel

treatment strategies.

ID: 4849

Diagnosing pulmonary Kaposi

s sarcoma in HIV patients


interesting case

Stephen Woolley


, Sarah Wright


, Kaveh Manavi




Royal Navy

University Hospitals Birmingham NHS Trust,


University Hospitals

Birmingham NHS Trust


A 33 yo transgender femalewith a six year history of HIV

presented to her regular HIV Clinic with four months history of

increasing shortness of breath and increasing haemoptysis. Her CD4

Count was 459 cells/mm


and she had an undetectable HIV viral load

(<40 copies/mL). Her Anti-retroviral regime was Triumeq. She had

completed four cycles of liposomal Doxorubicin for cutaneous Kaposi


sarcoma (KS) which was diagnosed in September 2014. She was

treated for a right upper lobe lung infection in November 2015,

however a repeat chest x-ray showed a right hilar mass which was

confirmed by a CT-Thorax. An Endobronchial Ultrasound was

performed however it was abandoned. A repeat Bronchoscopy

was only able to obtain two small tissue samples before the procedure

was abandoned. Immunocytochemistry for HHV-8 showed clear

strong staining in some of the spindle cell foci found in the biopsy.

In conjunctionwith the BAL (bronchoalveolar lavage) HHV-8 DNA PCR

result of 150 copies/mL, she was referred for management of

pulmonary KS. BAL HHV-8 DNA PCR is not routinely sent.

Discussion and/or Conclusion(s):

KS is an angioproliferative tumour

associated with HHV-8. It has been reported that detection of HHV-8

PCR in patients with pulmonary KS was highly specific (95%) and a

positive predictive value of 78%.


The incidence of KS has reduced

significantly with combination ARV therapy. This case is interesting as

the patient is not immunosuppressed, has a fully suppressed HIV viral

load and had a course of chemotherapy for cutaneous KS before the

pulmonary presentation of KS.

ID: 4869

An unusual case of dog bite in the asplenic patient

Priyanka Yadhunanthanan


, Mohamed Majeed





Hospital Cambridge,


Cambridge University Hospitals NHS Trust


We report a case of life threatening gram negative septic

shock with multi organ failure following a dog bite in an asplenic



A 42 year old gentleman was admitted with

septic shock of uncertain source.


He had a four week history of back pain, frontal headache,

loose stools and few days history of worsening petechial rash over the

left leg and right forearm. He had splenectomy following sports injury

when he was young and confirmed missing his last set of vaccinations.


His lactate was 6.6 mmol/L on admission and the blood

culture grew gram negative bacilli. CT scan and Ultra sound scan did

not suggest any suspicious lesions. He went on to develop multi organ

failure with disseminated intra vascular coagulation, acute liver

failure and atrial fibrillation. It was noted in the Intensive Care unit

that he had a right index finger abrasion with black margins and was

confirmed by the patient as a dog bite injury before the onset of his


Discussion and/or Conclusion(s):

An overwhelming post splenec-

tomy infection (OPSI) is rare and associated with a high mortality

rate (40

70%). The most common organisms are encapsulated

organisms such as Streptococcus pneumoniae (50

90%), Nisseria

meningitides, Hemophilius influenzae and Streptococcus pyogens


Capnocytophaga canimorsus

is a commensal gram negative

bacterium present in the saliva of dogs and this case informs us to


Capnocytophaga canimorsus

as an infective organism in

association with dog bite injury.

The diagnosis was made as septic shock from possible Capnocyto-

phaga canimoris organism.

Abstracts of FIS/HIS 2016

Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24