- Email: [email protected]
P-311: Ramsay Hunt Syndrome - a case report
S114
Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
Ecology: Escherichia coli (E. coli) was the most common bacteria (75%) 32% of E. coli were sensitive to most ATB 40% of E. coli were resistant to ampicillin and sensitive to amoxicillin–clavulanic acid 28% of E. coli were resistant to quinolone 28% of E. coli were resistant to sulfa drug 0% of E. coli were resistant to nitrofurantoin. A standard operating procedure (SOP) was performed according to this ecology Conclusion: Information gathered from this study was helpful in establishing SOP on a nursing home for GP to know when and which antibiotics should be used. P-310 Human lymphadenitis due to Corynebacterium pseudotuberculosis: a case report N. Denewet1 , R. Demeester2 , D. Famere2 , J. Kengni Tameze2 , S. Higuet2 1 CHU Charleroi, ULB, Uccle, Belgium; 2 CHU Charleroi, ULB, Lodelinsart, Belgium Objectives: We report the case of a 82-year-old man who presented a 15-day history of a single painful axillary adenitis, without fever, weight loss or sweats. Methods: Physical examination of our patient was normal, without hepatosplenomegaly or other adenitis. We noted a dry cough. Initial laboratory evaluation was normal, serology was negative for Brucella or Bartonella, imaging by computed tomography (CT) showed patterns of pulmonary fibrosis, micronodular anthracosilicosis, and a large (34 mm) left axillary lymphadenopathy. Results: The lymph node was excised and bacterial cultures allowed to identify C. pseudotuberculosis. Histopathology examination showed an adenitis (dimension 2.5×1.5×1.5 cm) containing necrotic, granulomatous and abscess material. PCR was negative for Bartonella, Mycobacterium tuberculosis or atypical Mycobacteria. The patient was treated with amoxicillin antibiotherapy. Medical history review of the patient confirmed he had been skinning a sheep four months ago. Conclusions: C. pseudotuberculosis is a nonmotile, gram-positive small bacillus that grows both aerobically and anaerobically. Most of the cases of human lymphadenitis due to C. pseudotuberculosis have been reported in Australia, usually in those who have been occupationally exposed to sheep. Axillary lymphadenitis predominates, presumably because the hands and arms are frequently the site of primary infection. Histopathology features of human lymph nodes infected by C. pseudotuberculosis are variable and are characterized by necrotizing and suppurative granulomatous lympadenitis. Cases of suppurative lymphadenitis might be treated by incision and drainage, along with antibiotherapy. C. pseudotuberculosis is susceptible to penicillin and other antibiotics that are active against gram-positive bacteria or have broad-spectrum activity. P-311 Ramsay Hunt Syndrome – a case report J.P. Figueiredo Gomes1 , H. Temido2 , D. Donaire3 , M. Petrova1 , B. Barbosa1 , M. Teixeira Ver´ıssimo1 , A. Carvalho1 1 CHUC, Coimbra, Portugal; 2 Centro Hospitalar e Universit´ ario de Coimbra, Coimbra, Portugal; 3 CHUC, Coimbra Introduction: Ramsay Hunt Syndrome is a rare condition caused by the Varicela-Zoster Virus (VZV), which is characterized by facial palsy with associated erythematovesicular rash of the pinna or mouth. This syndrome is the second most common aetiology for non-traumatic peripheral facial palsy, and is diagnosed based on the patient’s clinical history and physical examination.
Case report: The case we describe refers to a 70 years old white man that presents at the hospital with oral pain, left unilateral otalgia and facial asymmetry; all of which had started 3 days prior to presenting to hospital. He had essential hypertension, dyslipidemia and was overweight (BMI = 28.125 kg/m2 ). He was medicated with a combination of lisinopril 20 mg and amlodipine 5 mg, once a day. The physical examination revealed left palsy with palpebral ptosis and Bell’s sign, and vesicular rash on soft and hard left palates. There was no sign of disease in the ear. It was presumed that was Ramsay Hunt Syndrome and the patient was medicated with deflazacorte 60 mg and acyclovir 500 mg once a day, for 7 days. One month later, he was reassessed in consultation and he still presented with facial palsy, having recovered from the remaining symptomatology. The serologic evaluation shown elevated titles of VZV antibodies [IgG 3308 (positive >165); IgM >2.3 (positive >1.1)]. Conclusion: Ramsay Hunt Syndrome is a benign aetiology of facial palsy, but it has a poor prognosis in the elderly, especially if the treatment is delayed or the patient has elevated arterial blood pressure. P-312 Antimicrobial therapy assessment in four health centers from 2010 to 2014 M. Hernandez1 , L. Puerta1 , A. Augusti2 , B. Llagostera1 , C. Plana3 , C. Mestres1 1 Grup Mutuam, Barcelona, Spain; 2 Grup Mutuam, Girona, Spain; 3 Grup Mutuam, Tarragona, Spain Objectives: Assess antimicrobials use in subacute-longterm care during the last five years, depending on the different types of patients. Identify differences in: • Group of antimicrobials used • Length of treatment • Administration route Material and Methods: • Evaluation period: 2010–2014. • Beds of the centers included: Guell ¨ 165, Girona 97, Vilaseca 25 and Diagonal 17. • Data obtained from the management program and prescription application. • DDD/100 stays were calculated according to antimicrobial group ATC-classification, antimicrobial, typology of patient and length of treatment. Results: Mean age 80.4 years (62.4% women). The percentage of patients/year with antimicrobial treatment has ranged between 33% and 40%; 47% and 54%; 10% and 28%; 54% and 69% per center. The DDD/100 stays have remained constant in Girona (12.81), and Diagonal (18.02) but have increased in Guell, ¨ from 26 in 2010 to 52.1 in 2014, and Vilaseca, from 3.8 to 8.4. Mean length of treatment 10.5 days. Parenteral route in Girona and Guell ¨ is stepping out. Antimicrobial most used was penicillin/beta-lactamase inhibitors (amoxicillin/clavulanic) in all centers. Also stand out quinolones and fosfomycin. In recent years the use of fourth generation cephalosporins, metronidazole and monobactam has increased. Conclusions: Incidence of antimicrobial treatments remains high. Antimicrobial use follows the Antimicrobial Treatments Guideline of Group Mutuam im relation to the most prevalent infections (urinary and respiratory). Decrease of treatment days related to fosfomycin high use. Complexity of patients referred to geriatric hospitals is increasing, shown by the increasing use of intravenous route and antimicrobials for multiresistant bacteria.
Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
Ecology: Escherichia coli (E. coli) was the most common bacteria (75%) 32% of E. coli were sensitive to most ATB 40% of E. coli were resistant to ampicillin and sensitive to amoxicillin–clavulanic acid 28% of E. coli were resistant to quinolone 28% of E. coli were resistant to sulfa drug 0% of E. coli were resistant to nitrofurantoin. A standard operating procedure (SOP) was performed according to this ecology Conclusion: Information gathered from this study was helpful in establishing SOP on a nursing home for GP to know when and which antibiotics should be used. P-310 Human lymphadenitis due to Corynebacterium pseudotuberculosis: a case report N. Denewet1 , R. Demeester2 , D. Famere2 , J. Kengni Tameze2 , S. Higuet2 1 CHU Charleroi, ULB, Uccle, Belgium; 2 CHU Charleroi, ULB, Lodelinsart, Belgium Objectives: We report the case of a 82-year-old man who presented a 15-day history of a single painful axillary adenitis, without fever, weight loss or sweats. Methods: Physical examination of our patient was normal, without hepatosplenomegaly or other adenitis. We noted a dry cough. Initial laboratory evaluation was normal, serology was negative for Brucella or Bartonella, imaging by computed tomography (CT) showed patterns of pulmonary fibrosis, micronodular anthracosilicosis, and a large (34 mm) left axillary lymphadenopathy. Results: The lymph node was excised and bacterial cultures allowed to identify C. pseudotuberculosis. Histopathology examination showed an adenitis (dimension 2.5×1.5×1.5 cm) containing necrotic, granulomatous and abscess material. PCR was negative for Bartonella, Mycobacterium tuberculosis or atypical Mycobacteria. The patient was treated with amoxicillin antibiotherapy. Medical history review of the patient confirmed he had been skinning a sheep four months ago. Conclusions: C. pseudotuberculosis is a nonmotile, gram-positive small bacillus that grows both aerobically and anaerobically. Most of the cases of human lymphadenitis due to C. pseudotuberculosis have been reported in Australia, usually in those who have been occupationally exposed to sheep. Axillary lymphadenitis predominates, presumably because the hands and arms are frequently the site of primary infection. Histopathology features of human lymph nodes infected by C. pseudotuberculosis are variable and are characterized by necrotizing and suppurative granulomatous lympadenitis. Cases of suppurative lymphadenitis might be treated by incision and drainage, along with antibiotherapy. C. pseudotuberculosis is susceptible to penicillin and other antibiotics that are active against gram-positive bacteria or have broad-spectrum activity. P-311 Ramsay Hunt Syndrome – a case report J.P. Figueiredo Gomes1 , H. Temido2 , D. Donaire3 , M. Petrova1 , B. Barbosa1 , M. Teixeira Ver´ıssimo1 , A. Carvalho1 1 CHUC, Coimbra, Portugal; 2 Centro Hospitalar e Universit´ ario de Coimbra, Coimbra, Portugal; 3 CHUC, Coimbra Introduction: Ramsay Hunt Syndrome is a rare condition caused by the Varicela-Zoster Virus (VZV), which is characterized by facial palsy with associated erythematovesicular rash of the pinna or mouth. This syndrome is the second most common aetiology for non-traumatic peripheral facial palsy, and is diagnosed based on the patient’s clinical history and physical examination.
Case report: The case we describe refers to a 70 years old white man that presents at the hospital with oral pain, left unilateral otalgia and facial asymmetry; all of which had started 3 days prior to presenting to hospital. He had essential hypertension, dyslipidemia and was overweight (BMI = 28.125 kg/m2 ). He was medicated with a combination of lisinopril 20 mg and amlodipine 5 mg, once a day. The physical examination revealed left palsy with palpebral ptosis and Bell’s sign, and vesicular rash on soft and hard left palates. There was no sign of disease in the ear. It was presumed that was Ramsay Hunt Syndrome and the patient was medicated with deflazacorte 60 mg and acyclovir 500 mg once a day, for 7 days. One month later, he was reassessed in consultation and he still presented with facial palsy, having recovered from the remaining symptomatology. The serologic evaluation shown elevated titles of VZV antibodies [IgG 3308 (positive >165); IgM >2.3 (positive >1.1)]. Conclusion: Ramsay Hunt Syndrome is a benign aetiology of facial palsy, but it has a poor prognosis in the elderly, especially if the treatment is delayed or the patient has elevated arterial blood pressure. P-312 Antimicrobial therapy assessment in four health centers from 2010 to 2014 M. Hernandez1 , L. Puerta1 , A. Augusti2 , B. Llagostera1 , C. Plana3 , C. Mestres1 1 Grup Mutuam, Barcelona, Spain; 2 Grup Mutuam, Girona, Spain; 3 Grup Mutuam, Tarragona, Spain Objectives: Assess antimicrobials use in subacute-longterm care during the last five years, depending on the different types of patients. Identify differences in: • Group of antimicrobials used • Length of treatment • Administration route Material and Methods: • Evaluation period: 2010–2014. • Beds of the centers included: Guell ¨ 165, Girona 97, Vilaseca 25 and Diagonal 17. • Data obtained from the management program and prescription application. • DDD/100 stays were calculated according to antimicrobial group ATC-classification, antimicrobial, typology of patient and length of treatment. Results: Mean age 80.4 years (62.4% women). The percentage of patients/year with antimicrobial treatment has ranged between 33% and 40%; 47% and 54%; 10% and 28%; 54% and 69% per center. The DDD/100 stays have remained constant in Girona (12.81), and Diagonal (18.02) but have increased in Guell, ¨ from 26 in 2010 to 52.1 in 2014, and Vilaseca, from 3.8 to 8.4. Mean length of treatment 10.5 days. Parenteral route in Girona and Guell ¨ is stepping out. Antimicrobial most used was penicillin/beta-lactamase inhibitors (amoxicillin/clavulanic) in all centers. Also stand out quinolones and fosfomycin. In recent years the use of fourth generation cephalosporins, metronidazole and monobactam has increased. Conclusions: Incidence of antimicrobial treatments remains high. Antimicrobial use follows the Antimicrobial Treatments Guideline of Group Mutuam im relation to the most prevalent infections (urinary and respiratory). Decrease of treatment days related to fosfomycin high use. Complexity of patients referred to geriatric hospitals is increasing, shown by the increasing use of intravenous route and antimicrobials for multiresistant bacteria.