Table of Contents Table of Contents
Previous Page  85 / 150 Next Page
Show Menu
Previous Page 85 / 150 Next Page
Page Background

wanted to determine the potential impact on diagnostic yield of

extending this policy to testing for other organisms.


The primary aimwas to determine the diagnostic

yield of non-diarrhoeal versus diarrheal stools. A secondary aim, was

to assess the clinical/public health significance of positive results from

non-diarrhoeal stools.


A database search retrieved stool sample results from 1st

August 2015 to 20th October 2015. Our laboratory records note

whether samples are non-diarrhoeal or diarrhoeal. Hospital electronic

discharges and laboratory clinical notes for all patients with positive

stool culture results were analysed.


2747 samples were received: 146 were not processed. Forty-

four percent were non-diarrhoeal. 119 samples were positive for


sp. (36 non-diarrhoeal). 25 samples were positive for


sp. (12 non-diarrhoeal). 11 were positive for

Salmonella sp (2 were non-diarrhoeal). 4 were positive for


sp. (2 were non-diarrhoeal). Only two samples (both diarrhoeal) were

positive for

E. coli


Discussion and/or Conclusion(s):

In this study, almost a third of

positive stool samples were non-diarrhoeal. Unfortunately, due to

limitations of the available clinical data, we could not ascertain the full

clinical/public health significance of these positives. However, the

organisms isolated are generally regarded as significant human


In conclusion, we would advise against extending the policy of only

testing unformed stools to encompass enteric pathogens other than




ID: 5130

Tuberculous meningitis

diagnostics audit

Michael Riste, James Scriven.

Heart of England NHS Foundation Trust


CNS infections result in significant morbidity and

mortality and their management can be complex and difficult.

Anecdotal evidence suggests that some areas of this are suboptimal

at our trust but objective evidence is lacking. As part of this wider CNS

audit we looked specifically at TB meningitis diagnosis and manage-

ment to compare this with national guidelines.


To determine whether patients with presumed

tuberculous meningitis are investigated appropriately.

Specific audit targets followed the BIA guidelines for TB of the central

nervous system 2009).


Patients were identified using the Birmingham TB

database (proposal was to look at all lymphocytic CSFs, but this data

was not available at the time of audit). Electronic and paper records

were then assessed and an audit proforma completed with details of

demographics, clinical presentation, investigations and management.


Headache and fever were the most common presenting


There were significant delays in performing lumbar puncture in these


CSF volume was poorly documented and not assessable from current

laboratory reporting methods.

Only 1 patient had a positive CSF TB culture. 2 grew TB from sputum or

BAL and the remainder were treated as probable TBM.

14/15 patients had some form of imaging to look for extrapulmonary


Discussion and/or Conclusion(s):

Appropriate CSF sampling is

difficult to audit presently; this requires better documentation and

amendments to laboratory reporting.

Despite CSF culture and PCR being frequently negative, few patients

had further microbiological samples obtained. Clinicians should

pursue such investigations more aggressively to aid diagnosis.

ID: 5133

Evaluation of the Enigma MiniLab (RSV, influenza A, B) during the


2016 influenza season

Julian Wei-Tze Tang


, Marie-Jo Medina


, Catherine Noon



Kelly Statham-Gill


, Teena Eddison


, Mouna Bouridane


, Harsha Varia



Christopher W. Holmes


, Alexander M. Martin


, Ann Hunter




University Hospitals of Leicester NHS Trust,


University of Leicester,

Leicester, UK


Rapid point-of-care tests (POCTs) are now available in

many formats, particularly for respiratory viruses. However, users

need to consider a balance between the turnaround time (TAT),

sensitivity/specificity, ease of use and cost of the test.


To evaluate the new Enigma MiniLab PCR-based

POCT that tests for RSV, influenza A and B (without any subtyping),

against our in-house respiratory PCR assay, in an adult bone marrow

transplant/oncology unit, during the 2015

2016 influenza season.


Symptomatic, consenting patients requiring treatment

and isolation for influenza-like illness were tested by taking two

swabs, one each for the Enigma POCT (TAT = 90 minutes) and in-house

assay (TAT = 6 hours).


In total, 86 samples were tested. For RSV, influenza A and B,

respectively: 80, 81, 81 samples were NEG on both assays; 2, 3, 3

samples were POS on both assays; 1, 2, 0 samples were POS on the in-

house assay and NEG on the POCT; whereas, 3, 0, 2 samples were found

POS on the POCTand NEG on the in-house assay. The POS% on the POCT

and in-house assay, respectively were: RSV: 5.8%, 3.5% (Kappa

coeff = 0.477, McNemar

s test p = 0.625); influenza A: 3.5%, 5.8%

(Kappa coeff = 0.739, McNemar

s test p = 0.500); influenza B: 5.8%,

3.5% (Kappa coeff = 0.739, McNemar

s test p = 0.500), showing no

statistical difference between the performance of the two assays.

Discussion and/or Conclusion(s):

All the ward staff commented on

how easy the POCT was to use. However, given the small number of

positive samples for each virus, further evaluation of this Enigma

MiniLab assay will continue through this coming influenza season.

ID: 5142

Something old, something new. The utility of old and new

diagnostics in tricky clinical cases

Daniel Burns


, Danai Papakonstantinou


, Tom Troth


, Jamie Scriven




Army Medical Directorate Birmingham Heartlands Hospital,


Birmingham Heartlands Hospital,


Birmingham Heartlands Hospital/

Army Medical Directorate


An 18 year old asylumseeker travelled fromEritrea to the

UK overland through Libya, the Mediterranean, and Europe. He

presented with a month

s history of fever, weight loss, malaise and

abdominal pain.

Initial investigations including a chest X-ray, routine bloods, abdom-

inal ultrasound, malaria films, HIV test, and blood and urine cultures

were all unremarkable apart from raised inflammatory markers.

Sputum cultures grew

Haemophilius influenzae

but despite a course of

amoxicillin the fevers continued. Awide differential was considered in

view of the ongoing fevers, travel history and lack of organ focus.

Extensive investigation was performed including a CT of the chest,

abdomen and pelvis, brucella, leishmania and coxiella serology, a bone

marrow biopsy, stool cultures and microscopy, and a vasculitis screen

but no cause was found.

A PET scan was performed to localize the presumed infective or

malignant lesion and allow targeted biopsy. Multiple metabolically

active abdominal and thoracic lymph nodes not apparent on CT were

seen. EBUS collected insufficient sample for definitive histology. Given

his country of origin, clinical picture and a positive T-spot test a

diagnosis of occult tuberculous lymphadenitis was made and anti-

tuberculous therapy was started. The patient defevresced and put on

weight. Subsequently a stool culture and the lymph node biopsy

sample grew

Mycobacterium bovis.

Abstracts of FIS/HIS 2016

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