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ID: 4886

A rare case of primary cervical spondylodiscitis due to

Streptococcus pneumoniae

in an immunocompetent patient

Harry Theron


, Alice Bradley


, Daniel Chan


, Marina Morgan




University of Exeter Medical School & Exeter Spine Unit,



Medical School,


Royal Devon and Exeter NHS Foundation Trust & Exeter

Spine Unit,


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


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


ID: 4898

A case of pneumococcal endocarditis

Jo Quinn


, Adrian Kennedy


, Phil Stanley


, Paul McWhinney



Sulman Hasnie


, Riccardo Guintini


, Ben Jeffs




Bradford Royal



Bradford Teaching Hospitals


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



Trans-oesophageal echocardiogram showed evidence of

aortic valve endocarditis. Five sets of blood cultures grew

Streptococcus pneumoniae

. Vitreous humour cultures showed no


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



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.


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


ID: 4911

A rare case of infective endocarditis caused by Erysepelothrix


Wijitha Weerakoon, Milind Khare, Ann-Marie O

Meara, David Pickard.

Derby Teaching Hospitals NHS Trust


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.


Clinical case review


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.


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