Christopher D. Sheldon

Zinc therapy for night blindness in cystic fibrosis

This is the first report of a supplemented CF patient presenting with clinical vitamin A deficiency to be successfully treated with zinc therapy alone. Therefore in addition to retinol supplementation, normalizing serum zinc levels may be important in maintaining the vitamin A status of CF patients. The interactions and synergistic effects between the two micronutrients are discussed.

Cat scratch disease

Unilateral lymphadenopathy of the groin is commonly seen in general practice. We report on a patient with initial features suggestive of sarcoidosis, but who, after careful history taking and further investigation, had cat scratch disease.nnA 29 year old woman visited her general practitioner with a painless swelling in the right groin. She was referred to a surgeon, who aspirated the node. The aspirate contained blood and a range of lymphoid cells, suggesting a reactive lymph node. Ultrasonography confirmed numerous large lymph nodes in the right groin. Lymphadenopathy was not present elsewhere. The pelvis appeared normal on ultrasonography. Two hypoechoic lesions were found in the right lobe of the liver posteriorly, and multiple similar lesions were found in the spleen, but no para-aortic lymphadenopathy was seen.nnThe surgeon took a biopsy specimen of the lymph node. This showed a reactive lymph node with prominent geminal centres and focal areas in keeping with necrotising granulomata. Cultures were Gram negative. Stains for acid fast bacilli and fungi gave negative results, and there was no evidence of caseating necrosis. Sarcoidosis was suspected, and the patient was referred to a chest physician.nnShe had no symptoms of systemic disease and had a good appetite, steady weight, and no night sweats. She had never smoked but did have several allergies, including eczema and perennial rhinitis. At initial presentation a full blood count gave normal …

Molecular epidemiology of Pseudomonas aeruginosa in an unsegregated bronchiectasis cohort sharing hospital facilities with a cystic fibrosis cohort

While Pseudomonas aeruginosa (PA) cross-infection is well documented among patients with cystic fibrosis (CF), the equivalent risk among patients with non-CF bronchiectasis (NCFB) is unclear, particularly those managed alongside patients with CF. We performed analysis of PA within a single centre that manages an unsegregated NCFB cohort alongside a segregated CF cohort. We found no evidence of cross-infection between the two cohorts or within the segregated CF cohort. However, within the unsegregated NCFB cohort, evidence of cross-infection was found between three (of 46) patients. While we do not presently advocate any change in the management of our NCFB cohort, longitudinal surveillance is clearly warranted.

S113 An Epidemiological Review of Strains of Pseudomonas aeruginosa in a Non-Cystic Fibrosis Bronchiectasis Cohort

Introduction and objectives Pseudomonas aeruginosa (Pa) is a significant respiratory pathogen. Research in Cystic Fibrosis cohorts has revealed transmissible strains, leading to heightened infection control protocols due to concerns of cross-infection. In patients with Non-Cystic Fibrosis Bronchiectasis (NCFB), the research is more limited. Our objectives were to investigate the strains found in our local NCFB population, and assess the occurrence of shared strains. Methods Patients with NCFB and previous Pa in sputum culture consented to providing sputum for the study and review of their medical notes. Sputum samples from patients were processed in the usual manner and if Pa was isolated, 10 representative colonies per patient were stored for strain typing. Isolates were subjected to Random Amplification of Polymorphic DNA (RAPD). Distinct RAPD types were verified by electrophoresis on an Agilent Bioanalyzer and subsequent cluster analysis using GelCompar II software, and further investigated by Multi-Locus Sequence Typing (MLST). Results Pa was obtained from 46 patients over 12 months providing 459 isolates. Co-existence of multiple strains was observed in two patients. Twenty patients (43%) had unique strains by RAPD and the remaining patients were clustered into 7 subgroups, defined as ≥90% homology by RAPD, using Pearson’s correlation analysis. The largest cluster showed a predominance of one MLST strain type identified as ST-17 (also known as “Clone C”) on the MLST database. In our cohort, 8 patients (17%) harboured Clone C, which is a higher prevalence than observed in previous UK studies of various patient cohorts (typically 2–6% prevalence). MLST analysis of smaller RAPD clusters identified other MLST strain types shared by 2 or 3 patients. As with Clone C, all the observed shared MLST strain types are globally distributed. MLST did not reveal any novel shared strains. Conclusions Our cohort of patients with NCFB shows evidence of shared strains of Pa including a high prevalence of Clone C compared to previous national reports. Whilst the occurrence of shared strains may reflect their global distribution, we cannot rule out cross-infection between patients.

P105 Outpatient survey of patient experience of hypertonic saline use in non-cystic fibrosis bronchiectasis

Introduction and Objectives Hypertonic Saline (HTS) is known to accelerate tracheobronchial clearance and is felt to provide a useful adjunct to physiotherapy for airway clearance in bronchiectasis1. Previous studies have demonstrated improvement in lung function, quality of life and healthcare utilisation with the use of HTS in non-CF bronchiectasis2. We have surveyed use and patient experience of HTS in our non-CF bronchiectasis clinic. Method All patients seen in our non-CF Bronchiectasis clinic over a four month period were invited to answer a questionnaire. Questionnaires were filled in anonymously and either returned to a box in clinic or by post. Results A total of 96 patients returned a questionnaire. Overall 114 patients were invited to respond, resulting in a response rate was 84%. 55 respondents (57%) were current or past users of HTS, with 36 (65%) of these still using HTS. 49 (89%) of those who had used HTS had done so for at least a month. The percentage of patients using HTS who indicated an improvement in Airway Clearance, Breathlessness and Quality of Life, were 80%, 60% and 67% respectively. Of the 19 patients who had stopped treatment, only 6 (32%) did so due to side effects. The total number of patients who had experienced side effects was 10 (18%). Conclusion Our survey demonstrates that a significant proportion of attendees to our non-CF Bronchiectasis clinic are taking, or have taken HTS treatment. Continued treatment is supported by positive feedback by patients on impact on symptoms and quality of life, as well as reasonable tolerability and side effect profile. References Kellett F, Redfern J, Niven RM. Evaluation of nebulised hypertonic saline (7%) as an adjunct to physiotherapy in patients with stable bronchiectasis. Respir Med 2005;99:27e31. Kellett F, Robert NM. Nebulised 7% hypertonic saline improves lung function and quality of life in bronchiectasis. Respir Med. 2011 Dec;105(12):1831–5