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A caprine conundrum
e46
Abstracts
CONFUSARIUM
Lessons: -
Schaffer K, FitzGerald SF, Commane M, Macguinness A, Fenelon LE
1. Unusual presentation of brucellosis e eight cases of Brucella breast infection described in literature. 2. Infection control implications for laboratory staff, and necessity to use appropriate precautions when handling suspected Brucella cultures.
Dept of Medical Microbiology, St Vincent’s University Hospital, Dublin, Ireland Over a twelve-day period, Fusarium solani was isolated from three broncho-alveolar lavage (BAL) specimens of two intensive care unit (ICU) patients. The patients were not in close physical proximity, and in neither patient was the isolate deemed to be clinically significant. Since this was an unusual isolate, an investigation was undertaken by the Infection Control Team (ICT). A retrospective analysis of all BAL specimens processed in the microbiology laboratory revealed that an additional two patients had grown Fusarium solani. Both of these patients had been in the ICU within the preceding two months. The same bronchoscope had been used to obtain the BAL specimens from all four patients. This direct vision bronchoscope was reserved solely for use in ICU patients, and was processed in the central endoscope decontamination unit after each use. The bronchoscope was immediately removed from clinical use for further investigation. Extensive repairs had been carried out on the bronchoscope earlier in the year by the manufacturing company. In the period since the return of the scope, eight bronchoscopies had been performed on six ICU patients. Fusarium solani was isolated from the BAL specimens from five of those procedures. Decontamination records from the endoscopy unit were in order. Routine culture of rinse water had been negative over the period in question. Rinse water and brushings from the bronchoscope under investigation was cultured on five separate occasions; no organisms were isolated. Despite being unable to isolate Fusarium from the suspect bronchoscope, it was felt to be the most likely source and has been permanently removed from use.
A CAPRINE CONUNDRUM FitzGerald SF, Schaffer K, O’Malley N, O’Rourke K, Hall WW, Crowe M St Vincent’s University Hospital, Dublin 4, Ireland A 59-year-old woman presented with recurrent bilateral breast abscess and recent onset low back pain, complicated by acute renal failure and hepatitis. Previous investigation of the breast abscesses at another hospital had been inconclusive, and mastectomy had been advised. The patient decided to get a second opinion. MRI of spine showed disciitis at L5. Repeated blood cultures and spinal disc tissue cultures yielded a Gramnegative bacillus, subsequently identified as Brucella melitensis biovar 3. Serology was consistent with brucellosis. Acquisition of infection was presumed to be secondary to the ingestion of goat’s cheese in France. Several laboratory staff required prophylaxis, due to failure to take appropriate precautions with cultures.
British Paediatric Allergy, Immunology & Infection Group Meeting THE B CELL RESPONSE TO A BOOSTER DOSE OF MENCV AT 1 YEAR OF AGE AFTER THREE DOSE PRIMING IN INFANCY Blanchard G 1, Snape MD 1, Kelly DF 1, Waterhouse T 1, Ceddia F 2, Schultze V 3, Nau C 3, Galgani I 2, Siegrist CA 4, Pollard AJ 1 1
Oxford Vaccine Group, Center for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford 2 Novartis Vaccines and Diagnostics Srl, Sienna Italy 3 Novartis Vaccines and Diagnostics Srl, Marburg, Germany 4 W.H.O. Collaborating Center for Vaccinology and Neonatal Immunology, University of Geneva, CMU, Geneva, Switzerland Introduction: In the UK infant immunisation with meningococcal serogroup C (MenC) glycoconjugate vaccine induces a rise in MenC antibody and primes for a subsequent anamnestic response. However antibody levels are not sustained and effectiveness wanes after a year. In order to describe the phenotype and kinetics of the MenC-specific B cell compartments involved in the immune response in infants, we assessed the persistence of MenC specific memory B cells in children at one year of age, after priming with three doses of MenC-CRM197 glycoconjugate vaccine (MenCV) at 2, 3 and 4 months of age. Furthermore, we evaluated the kinetics of the MenC-specific memory B cell and plasma cell response to a booster dose of MenCV at a year of age. Materials and methods 33 healthy children primed with MenCV at 2, 3 and 4 months of age received a booster dose of MenCV at one year of age. Blood samples were obtained before and 30 days after the booster dose and participants were allocated to have one additional blood samples at day 2, 4, 6, 8, or 9 after the booster dose. The number of plasma cells specific for MenC and CRM197 were estimated using an Enzyme Linked Immuno-Spot (ELISpot) assay. Memory B cell frequency was estimated using cell culture and polyclonal B cell stimulation for 5 days followed by ELISpot or for 10 days followed by limiting dilution assay (LDA). Results: At one year of age antigen-specific memory B cells for MenC and CRM197 were infrequently detected by ELISpot/LDA in peripheral blood of infants previously primed with MenCV. However a rapid rise in both plasma cells and memory B cells was detected following the booster dose of MenCV with a peak plasma cell response in the first week after immunisation. Conclusion: This study has described the kinetics of memory B cells and plasma cells after a booster dose of MenCV in
Abstracts
CONFUSARIUM
Lessons: -
Schaffer K, FitzGerald SF, Commane M, Macguinness A, Fenelon LE
1. Unusual presentation of brucellosis e eight cases of Brucella breast infection described in literature. 2. Infection control implications for laboratory staff, and necessity to use appropriate precautions when handling suspected Brucella cultures.
Dept of Medical Microbiology, St Vincent’s University Hospital, Dublin, Ireland Over a twelve-day period, Fusarium solani was isolated from three broncho-alveolar lavage (BAL) specimens of two intensive care unit (ICU) patients. The patients were not in close physical proximity, and in neither patient was the isolate deemed to be clinically significant. Since this was an unusual isolate, an investigation was undertaken by the Infection Control Team (ICT). A retrospective analysis of all BAL specimens processed in the microbiology laboratory revealed that an additional two patients had grown Fusarium solani. Both of these patients had been in the ICU within the preceding two months. The same bronchoscope had been used to obtain the BAL specimens from all four patients. This direct vision bronchoscope was reserved solely for use in ICU patients, and was processed in the central endoscope decontamination unit after each use. The bronchoscope was immediately removed from clinical use for further investigation. Extensive repairs had been carried out on the bronchoscope earlier in the year by the manufacturing company. In the period since the return of the scope, eight bronchoscopies had been performed on six ICU patients. Fusarium solani was isolated from the BAL specimens from five of those procedures. Decontamination records from the endoscopy unit were in order. Routine culture of rinse water had been negative over the period in question. Rinse water and brushings from the bronchoscope under investigation was cultured on five separate occasions; no organisms were isolated. Despite being unable to isolate Fusarium from the suspect bronchoscope, it was felt to be the most likely source and has been permanently removed from use.
A CAPRINE CONUNDRUM FitzGerald SF, Schaffer K, O’Malley N, O’Rourke K, Hall WW, Crowe M St Vincent’s University Hospital, Dublin 4, Ireland A 59-year-old woman presented with recurrent bilateral breast abscess and recent onset low back pain, complicated by acute renal failure and hepatitis. Previous investigation of the breast abscesses at another hospital had been inconclusive, and mastectomy had been advised. The patient decided to get a second opinion. MRI of spine showed disciitis at L5. Repeated blood cultures and spinal disc tissue cultures yielded a Gramnegative bacillus, subsequently identified as Brucella melitensis biovar 3. Serology was consistent with brucellosis. Acquisition of infection was presumed to be secondary to the ingestion of goat’s cheese in France. Several laboratory staff required prophylaxis, due to failure to take appropriate precautions with cultures.
British Paediatric Allergy, Immunology & Infection Group Meeting THE B CELL RESPONSE TO A BOOSTER DOSE OF MENCV AT 1 YEAR OF AGE AFTER THREE DOSE PRIMING IN INFANCY Blanchard G 1, Snape MD 1, Kelly DF 1, Waterhouse T 1, Ceddia F 2, Schultze V 3, Nau C 3, Galgani I 2, Siegrist CA 4, Pollard AJ 1 1
Oxford Vaccine Group, Center for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford 2 Novartis Vaccines and Diagnostics Srl, Sienna Italy 3 Novartis Vaccines and Diagnostics Srl, Marburg, Germany 4 W.H.O. Collaborating Center for Vaccinology and Neonatal Immunology, University of Geneva, CMU, Geneva, Switzerland Introduction: In the UK infant immunisation with meningococcal serogroup C (MenC) glycoconjugate vaccine induces a rise in MenC antibody and primes for a subsequent anamnestic response. However antibody levels are not sustained and effectiveness wanes after a year. In order to describe the phenotype and kinetics of the MenC-specific B cell compartments involved in the immune response in infants, we assessed the persistence of MenC specific memory B cells in children at one year of age, after priming with three doses of MenC-CRM197 glycoconjugate vaccine (MenCV) at 2, 3 and 4 months of age. Furthermore, we evaluated the kinetics of the MenC-specific memory B cell and plasma cell response to a booster dose of MenCV at a year of age. Materials and methods 33 healthy children primed with MenCV at 2, 3 and 4 months of age received a booster dose of MenCV at one year of age. Blood samples were obtained before and 30 days after the booster dose and participants were allocated to have one additional blood samples at day 2, 4, 6, 8, or 9 after the booster dose. The number of plasma cells specific for MenC and CRM197 were estimated using an Enzyme Linked Immuno-Spot (ELISpot) assay. Memory B cell frequency was estimated using cell culture and polyclonal B cell stimulation for 5 days followed by ELISpot or for 10 days followed by limiting dilution assay (LDA). Results: At one year of age antigen-specific memory B cells for MenC and CRM197 were infrequently detected by ELISpot/LDA in peripheral blood of infants previously primed with MenCV. However a rapid rise in both plasma cells and memory B cells was detected following the booster dose of MenCV with a peak plasma cell response in the first week after immunisation. Conclusion: This study has described the kinetics of memory B cells and plasma cells after a booster dose of MenCV in