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ID: 4871

Group B streptococcal meningitis in a previously healthy adult


Lucy Li, Sanjay Cheema, Nupur Goel.

West Middlesex University Hospital


Group B streptococcus (GBS) is an infrequent cause of

meningitis in adults that usually affects elderly patients and thosewith

serious underlying disease.


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


GBS is an infrequent cause of adult meningitis, but carries a high

case fatality


GBS meningitis must not be considered exclusive to the

peripartum infectious period or to patients with co-morbid



Further research is required to characterise any genetic predis-

position to both bacterial and viral CNS infections.


[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):



ID: 4874

A curious case of chorio-amnionitis

Jessica Johnson, Jane Democratis.

Wexham Park Hospital


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.


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


, Shermayne Ng


, Douglas Fink




Imperial College

Healthcare NHS Trust,


Hammersmith Hospital,


Charing Cross Hospital,


Hospital for Tropical Diseases


Bacteraemia secondary to

C. canimorsus


P. multocida

disproportionately affects the elderly and are associatedwith a 20


mortality rate.


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.


Retrospective review of case notes. Literature review of

important zoonoses and age-related immune dysfunction.


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.



septicaemia is isolated from PCR of blood culture colonies.

She makes a full recovery with IV piperacillin and tazobactam.



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


Gayti Islam


, Laura Prtak


, Joanne White


, Norman Fry



Charlotte Featherstone


, Rajiv Gandhi


, Fionuala Creagh



Nachi Arunachalam




Sheffield Teaching Hospitals Foundation Trust,


National Infection Service, Public Health England, London, UK,



and Plant Health Agency (APHA),


South Yorkshire Health Protection

Team, Public Health England


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.


Present an indigenous case of toxigenic cutaneous

C. ulcerans


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.


Case description: a 58 year old woman presented to

outpatients with evidence of an infected hallux ulcer with discussion

including summary of existing literature.


A swab isolated corynebacterium species, further identified


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