The Journal of Hospital Infection - Supplement 1 - November 2016

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ID: 4871
Group B streptococcal meningitis in a previously healthy adult
male
Lucy Li, Sanjay Cheema, Nupur Goel. West Middlesex University Hospital
Background: Group B streptococcus (GBS) is an infrequent cause of
meningitis in adults that usually affects elderly patients and thosewith
serious underlying disease.[1] It is recognised as one of the leading
aetiological agents of neonatal meningitis.
Case Presentation: We report a case of a previously healthy 26 year old
male builder who initially presented with a 4 hour history of
worsening severe headache, photophobia and confusion. Lumbar
puncture results were consistent with bacterial meningitis and blood
cultures grew GBS. The patient was initially treated with intravenous
aciclovir, ceftriaxone and dexamethasone and completed a two week
course of ceftriaxone making a rapid improvement within 48 hours.
To our knowledge, our patient represents one of the few reported cases
of GBS meningitis in a previously healthy young male. We discuss
genetic factors that may predispose certain people to develop
meningitis with normally harmless microorganisms such as GBS.
Key messages
1. GBS is an infrequent cause of adult meningitis, but carries a high
case fatality
2. GBS meningitis must not be considered exclusive to the
peripartum infectious period or to patients with co-morbid
illnesses
3. Further research is required to characterise any genetic predis-
position to both bacterial and viral CNS infections.
Reference
[1] Jackson LA, Hilsdon R, Farley MM, Harrison LH, Reingold AL,
Plikaytis BD, Wenger JD, Schuchat A. Risk factors for group B
streptococcal disease in adults. Ann Intern Med. 1995;123(6):
415–20.
ID: 4874
A curious case of chorio-amnionitis
Jessica Johnson, Jane Democratis. Wexham Park Hospital
Background: Case: 29 year old Pakistani lady who presented at 26
weeks gestation with 1 week history of acute fever of unknown origin
and PV bleeding. She was initially diagnosed with chorio-amnionitis
and delivered prematurely at 27 weeks via caesarian section for foetal
distress. Two days later she deteriorated with hypoxia, respiratory
distress, ground glass changes on CT Chest, confusion and high protein,
low glucose and lymphocytes on CSF analysis. She was transferred to
ITU and the baby to the neonatal unit.
Discussion: Empirical treatment was started for listeria, TB, bacterial
and viral CNS infection. TB was later identified on CSF PCR and
eventually cultured from sputum, urine and CSF, consistent with
miliary TB (defined as progressive, widely disseminated haematogen-
ous TB). TB is one of the great chameleons of the ID world, and can be
notoriously difficult to diagnose with unique diagnostic challenges
present in pregnancy and in the neonate. Diagnosis during pregnancy
affords opportunity for specific testing at birth to determine risk
of vertical transmission. Congenital TB most commonly presents
approximately 24 days after delivery. We suggest the following:
prophylaxis should be initiated at birth with full investigation to
exclude neonatal TB. All available samples should be cultured,
including gastric lavage, mother’s placenta and endometrial samples.
If TB is confirmed then the baby should be fully treated for TB.
ID: 4882
Deadly zoonoses from cats and dogs: two case reports describing
occult transmission of common pet commensals in a vulnerable
elderly population
James Wilson 1,2, Shermayne Ng3, Douglas Fink4. 1Imperial College
Healthcare NHS Trust, 2Hammersmith Hospital, 3Charing Cross Hospital,
4Hospital for Tropical Diseases
Background: Bacteraemia secondary to C. canimorsus and P. multocida
disproportionately affects the elderly and are associatedwith a 20–30%
mortality rate.
Aim(s)/Objective(s): We present two elderly patients treated for
sepsis from organisms typically associated with cat and dog bites. The
cases highlight occult modes of transmission and the relative
vulnerability of elderly patients to potentially deadly zoonoses.
Method(s): Retrospective review of case notes. Literature review of
important zoonoses and age-related immune dysfunction.
Results: The first case describes a 70 year-old lady who has a
background of epilepsy and lives with her Italian greyhound.
The patient reports frequent dog licking, although denies bites or
broken skin. She initially presents with a seizure secondary to
hyponatraemia and on day 3 of admission becomes acutely unwell
with fulminant sepsis and multi-organ dysfunction. Capnocytophaga
canimorsus septicaemia is isolated from PCR of blood culture colonies.
She makes a full recovery with IV piperacillin and tazobactam. C.
canimorsus remains a rare cause of fulminant sepsis, with 13 cases
previously described in the UK.
The second case describes an 84 year-old lady who presents with rapid
onset cellulitis and sepsis associated with a shin laceration after falling
against scaffolding. Pasteurella multocida is isolated in the blood
culture. She is treated with IV ceftriaxone for severe sepsis andmakes a
full recovery. P. multocida is the most common isolate from dog and cat
bite wounds however is seldom a cause of bacteraemia.
Discussion and/or Conclusion(s): We conclude with a brief review of
the important pet zoonoses and explore the link between ageing and
immune dysfunction.
ID: 4885
The case of the unexpected diabetic foot ulcer…ans
Gayti Islam1, Laura Prtak1, Joanne White 2, Norman Fry2,
Charlotte Featherstone3, Rajiv Gandhi 1, Fionuala Creagh1,
Nachi Arunachalam4. 1Sheffield Teaching Hospitals Foundation Trust,
2National Infection Service, Public Health England, London, UK, 3Animal
and Plant Health Agency (APHA), 4South Yorkshire Health Protection
Team, Public Health England
Background: Corynebacterium ulcerans is a rare, but leading cause of
toxigenic diphtheria in the UK; there is an increasing incidence of
reported cutaneous diphtheria infections. We are the first to describe a
case of toxigenic C. ulcerans associated with animal contact in a patient
with diabetic foot infection.
Aim(s)/Objective(s):
• Present an indigenous case of toxigenic cutaneous C. ulcerans
infection.
• Highlight the importance of laboratory advances in the identifi-
cation of corynebacterium species.
• Discuss issues regarding management in the context of recently
revised Public Health England guidance.
Method(s): Case description: a 58 year old woman presented to
outpatients with evidence of an infected hallux ulcer with discussion
including summary of existing literature.
Results: A swab isolated corynebacterium species, further identified
as C. ulcerans by MALDI-TOF MS. Subsequently reference laboratory
testing by PCR and Elek test confirmed the presence of the tox gene
and toxin production. The patient was systemically well and managed
with oral antibiotics in the community. The likely source was a
domestic pet (dog/cat), despite both testing negative for C. ulcerans . No
further cases or carriers were identified.
Discussion and/or Conclusion(s): We present an unusual case of
cutaneous toxigenic C. ulcerans associated with diabetic foot infection.
The use of MALDI-TOF MS enabled rapid and accurate identification of
C. ulcerans. This technology has become more available in clinical
laboratories and is likely to increase case ascertainment. Difficulties
and delays in testing the suspected source animals were encountered
due to issues surrounding costs. This is likely to remain problematic as
C. ulcerans is not a notifiable disease in animals.
Abstracts of FIS/HIS 2016 – Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24–S134 S53