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ID: 4886
A rare case of primary cervical spondylodiscitis due to
Streptococcus pneumoniae
in an immunocompetent patient
Harry Theron
1
, Alice Bradley
2
, Daniel Chan
3
, Marina Morgan
4
.
1
University of Exeter Medical School & Exeter Spine Unit,
2
Peninsula
Medical School,
3
Royal Devon and Exeter NHS Foundation Trust & Exeter
Spine Unit,
4
Royal Devon and Exeter NHS Foundation Trust
Discussion and/or Conclusion(s):
Presented is a very rare case of a
primary spondylodiscitis due to
Streptococcus pneumoniae
affecting
not only the cervical spine in a female patient with no immunosup-
pression or predisposing risk factors. She presented to spinal-clinic
complaining of mid-cervical spinal pain with a flexion deformity,
ataxia and bilateral arm pain suggestive of a C6 nerve root irritation.
Apart from reporting a severe anaphylactic allergy to penicillin, her
past medical history was unremarkable. MRI showed destruction
of C5 and C6 as well as a partially liquefied pre-vertebral soft
tissue mass compressing the cord for which she had emergency
anterior cervical decompression and reconstruction surgery. Due to
her penicillin allergy, and need to penetrate biofilm, an empirical
combination of intravenous vancomycin, clindamycin and oral
rifampicin was commenced, later changed to clindamycin and
rifampicin when
S. pneumoniae
was isolated from tissues removed at
operation. The isolates were sensitive to penicillin clindamycin,
rifampicin and daptomycin. Shortly afterwards, development of a
maculopapular rash attributed to clindamycin necessitated changing
to oral rifampicin and intravenous daptomycin, both continued for 3
months as an outpatient from which she recovered well. The
pneumococcus was serotyped as serotype 6C and is not currently
covered by any of the available conjugate vaccines. The recognition of
this emerging serotype raises the question as to whether or not the
current pneumococcal vaccines need to be developed to include
emerging strains such as this. This would appear to be the first
reported case of pneumococcal osteomyelitis being treated with
daptomycin.
ID: 4898
A case of pneumococcal endocarditis
Jo Quinn
1
, Adrian Kennedy
2
, Phil Stanley
2
, Paul McWhinney
2
,
Sulman Hasnie
2
, Riccardo Guintini
2
, Ben Jeffs
2
.
1
Bradford Royal
Infirmary,
2
Bradford Teaching Hospitals
Background:
Streptococcus pneumoniae
is a rare cause of infective
endocarditis, with a high morbidity and mortality. A 53 year-old
previously fit and well gentleman was admitted generally unwell
and pyrexial with an aortic murmur and visual loss secondary to
panuveitis.
Results:
Trans-oesophageal echocardiogram showed evidence of
aortic valve endocarditis. Five sets of blood cultures grew
Streptococcus pneumoniae
. Vitreous humour cultures showed no
growth.
Discussion and/or Conclusion(s):
He was treated with intravenous
vancomycin and gentamicin, changed to intravenous benzylpenicillin
after 2 days with sensitivities. He required a valve replacement on day
12 of admission. His endophthalmitis was empirically treated with
intravitreal ceftazidime and benzylpenicillin plus oral steroids.
Teicoplanin (10 mg/kg) once daily was started on day 25 to facilitate
out-patient administration. The patient was treated with a total of four
weeks of intravenous antibiotics, and made a good clinical recovery.
Infective endocarditis due to
Streptococcus pneumoniae
mainly affects
individuals without a previous cardiac history. It predominantly affects
the aortic valve as in this case. Pneumococcal endocarditis is often
associated with endophthalmitis and meningitis (Austrian syndrome).
Our patient did develop endophthalmitis but there were no signs
or symptoms of meningitis, and thus a lumbar puncture was not
performed. There is often a high rate of valve destruction and need for
valve replacement surgery as in this case. There is a relatively high
mortality rate for pneumococcal endocarditis, particularly when
associated with meningitis.
ID: 4903
Double vision
Chloe Walsh, Kavita Sethi, Jane Minton.
Leeds Teaching Hospitals NHS
Trust
Background:
A 35 year old man who injected drugs presented to A&E
with a painful thigh and double vision. Hewas admitted under surgery
and had incision and drainage of a thigh abscess and received
flucloxacillin. He underwent CT head to assess the double vision;
this was normal. Over the next 48 hours, he continued to complain of
double vision. He was haemodynamically stable and apyrexial. He
went on to develop dysphonia, dysphagia and stridor. He was referred
to Infectious Diseases and on review, he had bilateral ptosis,
ophthalmoparesis, non-reactive pupils, dysarthria and flaccid paraly-
sis of the neck, facial muscles and tongue.
Results:
A clinical diagnosis of wound botulism was made and
the patient was transferred to intensive care, where he received
anti-toxin and was intubated. He had further debridement and
received penicillin and metronidazole. He made good neurological
recovery, with mild diplopia at discharge after 18 days. Culture of pus
and tissue from the debridement confirmed
Clostridium botulinum
(type B).
Discussion and/or Conclusion(s):
Wound botulism is a rare
diagnosis, but well recognised in people who inject drugs (PWID).
There were 227 cases in the UK between 2000 and 2015 and this
case was one of a cluster of three recently reported to Public Health
England. This patient presented with a classical afebrile, descending,
flaccid paralysis; anti-toxin and debridement are the key to
management. It is essential to maintain a high index of suspicion
of wound botulism in PWID due to potentially fatal consequences
when not recognised and to facilitate co-ordinated public health
response.
ID: 4911
A rare case of infective endocarditis caused by Erysepelothrix
rhusiopathiae
Wijitha Weerakoon, Milind Khare, Ann-Marie O
’
Meara, David Pickard.
Derby Teaching Hospitals NHS Trust
Background:
Erysepelothrix rhusiopathiae is a ubiquitous organism
found in decaying nitrogenous waste. Infection in human is occupa-
tional related occuring as a result of contact with animals and their
products and waste.
Human infection can be a mild cutaneous infection known as
erysepeloid. Diffuse cutaneous form and a serious although rare
complications with septicaemia and endocarditis have been reported.
Aim(s)/Objective(s):
Clinical case review
Method(s):
We report a 74 year old female patient whowas diagnosed
with infective endocarditis caused by Erysepelothrix rhusiopathiae.
She presented with a history of being unwell on and off, febrile and
lethargic for 6 weeks. Shewas anaemic and had temperature and a pan
systolic mumur on examination.
Results:
Echocardiography showed abnormal mitral valve leaflets
with vegetation and possible perforation of the anterior leaflet and
vegetation on the aortic valve. She was empirically started on
intravenous amoxicillin & gentamicin after taking the blood cultures.
Blood cultures isolated a gram positive bacilli which was resistant to
vancomycin. The organism was identified as Erysepelothrix rhusio-
pathiae by VITEK and confirmed by the Reference Laboratory.
She was treated with high dose intravenous Benzyl penicillin for 4
weeks with a good outcome with no valve replacement.
No epidemiological risk factors found on this patient. She had no
history of penicillin allergy.
Discussion and/or Conclusion(s):
Rapid identification of
Erysepelothrix rhusiopathiae from other gram positive organisms is
critical in the appropriate management of infective endocarditis
especially if the patient has a history of penicillin allergy.
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S54