The Journal of Hospital Infection - Supplement 1

ID: 4931

Invasive group B meningococcal disease: an unusual case of

diarrhoea

Laura Cottom

, Huma Changez

, Andrew Smith

Department of

Medical Microbiology, Queen Elizabeth University Hospital,

Department

of Microbiology, Glasgow Royal Infirmary, Glasgow

Background:

Neisseria meningitidis

is a rare but important cause of

meningitis and septicaemia. Invasive meningococcal disease is

associated with significant morbidity and mortality, with the highest

incidence of infection being seen in children (aged <5 years) and

younger adults (aged 16

–

25 years).

Nausea, vomiting and diarrhoea are well-documented symptoms of

meningococcal infection however presentation with predominantly

gastrointestinal symptoms is rare, being recently described in the

2015 UK outbreak. The unusual presentation with diarrhoea was

associated with Group W

N. meningitidis

in teenagers, which

progressed to severe disease. To date only one case of fulminant

meningococcemia associated with the primary presentation of

gastroenteritis has been reported in an elderly patient.

Aim(s)/Objective(s):

We report two cases of group B invasive

meningococcal disease in elderly patients who presented with

primarily gastrointestinal symptoms.

Results:

In both cases, the patient had presented with an acute history

of vomiting, diarrhoea and fever. One patient remained haemodynam-

ically stable requiring minimal support, the other who had multiple

comorbidities presented in septic shock requiring ITU support. Neither

patient exhibited any other focus of infection and had no evidence of

CNS infection.

Both patients had blood cultures taken on admission that were posi-

tive for

N. meningitidis

, later being identified as group B by molecular

testing. Both patients were treated with IV Ceftriaxone 2 g BD for 7

days and made a good recovery being discharged home.

Discussion and/or Conclusion(s):

Clinical manifestations of invasive

meningococcal disease can vary. It is important as clinicians to be

aware of atypical presentations to ensure prompt diagnosis and

effective treatment.

ID: 4975

A diagnostic conundrum: the role of rapid molecular testing for

Mycobacterium tuberculosis

in detecting mixed infection with

non-tuberculous Mycobacteria

Rosalind Saunders, Hemu Patel, Nelun Perera.

University Hospitals of

Leicester NHS Trust

Background:

Co-infection with Mycobacterium tuberculosis (MTB)

and non-tuberculous Mycobacteria (NTM) is rare, and is most

frequently encountered among patients with human immunodefi-

ciency virus infection (HIV). Detection of mixed MTB and NTM in

clinical specimens by culture can be challenging and may pose

difficulty.

Results:

We present a rare case of mixed MTB and NTM infection

where the rapid Cepheid GeneXpert

MTB/RIF polymerase chain

reaction (PCR) on a primary sputum sample helped confirm a clinical

diagnosis of pulmonary tuberculosis infection and directed the

laboratory to carefully examine the culture isolates which ultimately

confirmed the presence of both MTB and NTM.

Discussion and/or Conclusion(s):

This case illustrates the utility of

rapid molecular testing for MTB on a primary clinical sample that

benefitted both the clinician and laboratory in resolving a diagnostic

conundrum.

ID: 4987

Paediatric traumatic anaerobic wound infections

Elan Tsarfati, Olga Lucia Moncayo, Donald Inverarity,

Christopher Jones, Hilal Bahia.

NHS Lothian

A 12-year old male was referred plastics by a neighbouring Trust

’

emergency room after sustaining an avulsion injury of his left lateral

thigh while zip-lining in the forest. The wound had both skin and fat

necrosis with underlying infected haematoma. Immediate washout

and debridement was undertaken with samples of tissue, swabs and

fluid sent to microbiology lab for microscopy, culture and sensitivity

and vacuum pump applied. The samples isolated

Staphylococcus

aureus

as well as two Clostridia

–

one identified as a

C. sordellii

and the

other as

C. botulinum

using API32

–

both sensitive to metronidazole

and co-amoxiclav. Public Health England Reference laboratory did not

detect

Clostridium botulinum

neurotoxin A,B,E or F and both Maldi-TOF

and 16s PCR confirmed the isolate as a

C. sporogenes

, a non-toxin

forming

Clostridium

species which can be identified as

C. botulinum

using API32. The patient improved, had a skin graft and was sent home

within 12 days. Clostridial wound infections after penetrating trauma

are potentially deadly if not immediately debrided and appropriate

antibiotics given. Initial management must include surgical debride-

ment and antibiotic therapy. If neurological symptoms had developed

it is crucial to have a supply of antitoxin and intensive care facilities

available. It is also vital to engage reference laboratories in the

identification of clinically significant isolates.

ID: 4989

A case of fulminant sepsis due to

Capnocytophaga canimorsus

in an

immunocompetent patient

Amy Bond, Katrina Blackmore.

York Teaching Hospital

Background:

Capnocytophaga canimorsus

is a slow growing, Gram

negative bacillus that is a normal commensal of the dog oral cavity.

Human infection is uncommon but may be severe, even in immuno-

competent individuals, and is strongly associatedwith dog exposure or

bite.

Aim(s)/Objective(s):

We report a case of fulminant sepsis due to

canimorsus

in an immunocompetent patient and aim to increase

awareness of this potentially fatal pathogen.

Method(s):

A previously well 44-year-old male arrived in A&E by

ambulance with an 18-hour history of diarrhoea, vomiting and sweat-

ing. On arrival he was tachypnoeic, tachycardic and hypotensive, with

a petechial/pupuric rash on his upper body and lactate 13.5 mmol/L.

He received cefotaxime for potential meningococcal sepsis within 15

minutes of arrival and subsequent doses of piperacillin-tazobactam,

linezolid, gentamicin and human normal immunoglobulin. Despite

intensive supportive treatment, he died 8 hours after arrival at

hospital.

Results:

The anaerobic bottle of admission blood cultures signalled

positive after 28 hours incubationwith Gram negative bacilli seen. The

organism failed to grow, but

C. canimorsus

DNA was detected by 16S

PCR. Reviewof hospital records revealed an A&E attendance in 2013 for

a bite from his own dog.

Discussion and/or Conclusion(s):

Infection with

C. canimorsus

most

commonly manifests as systemic sepsis and can be indistinguishable

from meningococcal disease. It is usually susceptible to first-line

antimicrobials for severe sepsis, including third-generation cephalos-

porins and piperacillin-tazobactam, but may produce extended

spectrum beta-lactamases. It is likely that empiric antimicrobial

therapy was adequate in this case, but the patient succumbed to

irreversible multi-organ failure and disseminated intravascular

coagulation.

ID: 5003

n-MEN broke my patient

’

s heart

Vivek Nayak

, Kavita Sethi

Leeds Teaching Hospitals NHS Trust Leeds

General Infirmary,

Leeds Teaching Hospitals NHS Trust

Background:

A 66-year-old female with no past Medical/Surgical

history presented with pleuritic chest pain and progressively

worsening dyspnoea for the last 72 hrs. She denied fever or any

other symptoms. No h/o recent travel or contact.

On examination, she was afebrile with stable haemodynamics and

normal JVP. There were no audible murmurs or pericardial rub. Blood

tests revealed raised inflammatory markers with evidence of AKI

Abstracts of FIS/HIS 2016

–

Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24

–

S134

S55