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
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
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
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.
Evaluation of the Enigma MiniLab (RSV, influenza A, B) during the
2016 influenza season
Julian Wei-Tze Tang
, Marie-Jo Medina
, Catherine Noon
, Teena Eddison
, Mouna Bouridane
, Harsha Varia
Christopher W. Holmes
, Alexander M. Martin
, Ann Hunter
University Hospitals of Leicester NHS Trust,
University of Leicester,
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.
Something old, something new. The utility of old and new
diagnostics in tricky clinical cases
, 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
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
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
Abstracts of FIS/HIS 2016
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24