57 / 150
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.
NHS
Background:
Panton-Valentine Leucocidin (PVL) toxin produced by
Staphylococcus
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.
Aim(s)/Objective(s):
Here we report two patient cases at a specialist
orthopaedic hospital with invasive PVL positive methicillin-sensitive
S. aureus
strains.
Method(s):
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
boils.
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
abscesses.
Results:
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
chlorhexidine.
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
S.
aureus
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
in
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.
University
Hospitals Coventry and Warwickshire NHS Trust
Background:
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).
Aim(s)/Objective(s):
To review the adverse effects of treatment of
choice for DMCI and alternative therapeutic options.
Method(s):
We present a patient with DMCI and severe AEs to
rifabutin, ethambutol, and amikacin.
Results:
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
–
An
interesting case
Stephen Woolley
1
, Sarah Wright
2
, Kaveh Manavi
2
.
1
Royal Navy
University Hospitals Birmingham NHS Trust,
2
University Hospitals
Birmingham NHS Trust
Background:
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
3
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
’
s
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%.
1
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
1,2
, Mohamed Majeed
2
.
1
Addenbrookes
Hospital Cambridge,
2
Cambridge University Hospitals NHS Trust
Background:
We report a case of life threatening gram negative septic
shock with multi organ failure following a dog bite in an asplenic
patient.
Aim(s)/Objective(s):
A 42 year old gentleman was admitted with
septic shock of uncertain source.
Method(s):
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.
Results:
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
illness.
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
(25%).
Capnocytophaga canimorsus
is a commensal gram negative
bacterium present in the saliva of dogs and this case informs us to
consider
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
–
S134
S52