Journal of Infection (2011) 63, 489e509

www.elsevierhealth.com/journals/jinf

Federation of Infection Societies 2010 Meeting,Edinburgh - Free Papers

SCIENTIFIC FREE PAPERS e 17THNOVEMBER

OFFERING HIV TESTING IN AN ACUTE ADMISSIONUNIT IN NEWCASTLE UPON TYNE e APILOT STUDY

Simon Ellis 1, Lisa Graham 2, Ashley Price 1,2,Edmund Ong 1,2

1Royal Victoria Infirmary, Newcastle upon Tyne,United Kingdom2Newcastle University, Newcastle upon Tyne,United Kingdom

Introduction

There are an estimated 22,000 people living in the UK withHIV who are unaware of their diagnosis. Late diagnosis inNewcastle remains a problem and in 2008, 60% of newdiagnoses had a CD4 count CD4 <350 compared to 55%nationally. In 2008, the UK National Guidelines for HIVTesting were published in an attempt to increase testingnationally. They state that HIV testing should be offered toall general medical admissions where the reported preva-lence of HIV is > 2/1000. Newcastle Primary Care Trust hasan HIV prevalence of 3-4/1000. We undertook a prospectiveaudit offering HIV testing to all general medical admissionsattending the Emergency Assessment Unit (EAU) to assessfeasibility, acceptability and point prevalence.

All patients attending EAU with capacity to verbalconsent were offered HIV testing during two block periodsof 6 and 11 weeks in 2009 (14/09 e 26/10) and in 2010 (04/01-19/03). The first period was physician led, the secondphysician-assistant led (band 4 practitioners appointed toprovide physician support with phlebotomy). Training wasundertaken and led by the Infectious Diseases Team. Aninformation leaflet regarding HIV testing and highlightingthe reasons for this audit was given to patients who hadmental capacity to consent on admission. Patients who

gave their consent were tested with a fourth generationantigen/antibody blood test with the aim of providing theresult within 36 hours. A standardised one page proformadocumenting data including patients’ demographic, reasonsfor non-consent and its acceptability was undertaken bythe staff offering the test.

Scientific findings

586 patients were considered for an HIV test (16% of totaladmissions). 396 tests were performed (42% >age 65) with 2new HIV diagnoses. Both were from high risk groups andpresented with an AIDS defining illness. Tests were notperformed on 190 (75% >age 65). 57% (n¼108) of theselacked capacity to consent. 43% (n¼82) refused testing with59% believing they were not at risk and only 5% believingEAU was an inappropriate place to test. Point prevalence ofHIV in EAU was w5 per 1000. 95% of results were availablewithin 36 hours (100% within 48 hours).

Discussion

This pilot study demonstrates that HIV testing in an EAUsetting is acceptable to themajority of patients and providingresults within 36 hours of admission is feasible. Many of thepatients offered testing were over age 65 and from low riskgroups. It is likely to be most cost effective to offer testing inan EAU setting to those in high risk groups or presenting withindicator diseases. Factors limiting testing include stigma(patients/staff), restrictions on time and misperceptionsaboutwhatanHIV test entails andmoreeducation is required.

Conclusions

� HIV testing is acceptable to the majority of pa-tients attending EAU.

� The addition of an ‘HIV test indicated?’ prompt onan admissions proformawould be a usefulway of re-minding physicians to consider offering HIV testing

490 Abstracts

to their patients andmayhelp tomakeHIV testing ina general medical setting more acceptable.

CROSS-TALK BETWEEN MONOCYTES ANDTeLYMPHOCYTES MODIFIES CELL DEATHPROCESSES FOLLOWING STREPTOCOCCUSPNEUMONIAE INFECTION

Marc Daigneault, Julie Preston, Paul Collini,David DockrellUniversity of Sheffield, South Yorkshire, United Kingdom

Introduction

Streptococcus pneumoniae is one of the four leadingcauses of infection related death world wide and themost common cause of community acquired pneumonia.Telymphocytes have been shown to be critical in the colo-nisation of S. pneumoniae. Depletion of IL-17A or CD4 pos-itive Telymphocytes impairs the recruitment ofmacrophages and therefore the efficient clearance of thebacterium.Bacterial infection has been shown to induce ap-optosis in Telymphocytes from patients with sepsis but theeffects of S. pneumoniae on human Telymphocytes arepoorly characterised. Excessive Telymphocyte apoptosismay compromise critical effector functions in the lungwhile impaired Telymphocyte apoptosis may contribute to-wards excessive inflammation and lead to poor outcomesduring sepsis.The purpose of this study was to determine the fate ofhuman Telymphocytes following S. pneumoniae infectionand identify host and microbial factors involved.

Scientific findings

In vitro infection of human Telymphocytes with Strepto-coccus pneumoniae (D39) resulted in cell death that wasdose and time dependent. Death was confirmed as apopto-sis by PI stain, TUNEL and DNA laddering; and was also ap-parent in an in vivo mouse model of S. pneumoniae inducedsepsis.Pneumolysin was the major bacterial factor responsi-ble for the Telymphocyte death. Monocytes enhancedTelymphocyte activation and preferentially induced apo-ptosis as compared to bacterial induced necrosis. Prelimi-nary findings suggest the pathway responsible involvescell contact.Elevated Telymphocyte activation during HIVinfection resulted in significantly higher levels of apoptosisfollowing infection.

Discussion

Naive Telymphocytes are naturally resistant to apoptosiswith previous reports describing low levels of caspase 3which increase following activation. Following S. pneumo-niae infection we report CD3 positive Telymphocyte deathby apoptosis regulated by monocytes and closely related toactivation state.

Conclusions

Monocyte mediated Telymphocyte apoptosis ensuresremoval of activated cells during S. pneumoniae infectionby a death mechanism with less inflammatory cost to thehost.

IMPROVING THE DIAGNOSIS OF BACTERIALRESPIRATORY TRACT INFECTIONS

Clare Ling 1, Aoife Malloy 2, Susan Hopkins 2,Holly Ciesielczuk 2, Julianne Lockwood 2,Tim McHugh 3, Stephen Gillespie 3

1Health Protection Agency, London, United Kingdom2Royal Free Hospital NHS Trust, London, United Kingdom3University College, London, United Kingdom

Introduction

The diagnosis of bacterial respiratory tract infections (RTIs)based on current microbiology techniques such as micros-copy, serology and culture are insensitive and time con-suming. Crucially these methods of diagnosis do not provideanswers in a clinically relevant timeframe. Consequently,an aetiological diagnosis is rarely sought and antibiotics areprescribed on an empirical basis. A comprehensive rapidrespiratory bacteriological diagnostic test could improvepatient care and reduce the selective pressure of inappro-priate antibiotic therapy. We report the development andevaluation of such an approach.

A multiplex PCR targeting Chlamydophila pneumoniae,Mycoplasma pneumoniae and Legionella pneumophila hadbeen developed previously. To compliment this and to pro-vide a complementary assay that could be used to rapidly de-tect secondary bacterial infections during an influenzaoutbreak, we developed a multiplex PCR assay targetingStreptococcus pneumoniae, Moraxella catarrhalis, Haemo-philus influenzae and Staphylococcus aureus; together withan amplification control. The assay was constructed to bequantitative to enable colonsation and infection to be distin-guished. The analytical sensitivity and specificity were estab-lished using a panel of DNA from 85 bacterial species. Toassess its clinical utility, a retrospective studyon sputumsam-ples collected from patients with community acquired lowerRTIswas performed. Positives from this studywere confirmedby alternative PCRs and/or sequencing of the PCR product.The PCR results were compared with culture results andwhere possible clinical data including CRP levels, total whitecell counts (WCC), neutrophil counts and chest radiology.

Scientific findings

The assay was found to be sensitive (approx. 104 genomeequivalents/ml) and specific. During the retrospectivestudy 88 samples were tested. Partial inhibition was de-tected in 1 sample. A higher yield was obtained with thePCR compared to culture [H. influenzae (33% vs 13%), S.pneumoniae (10% vs 6%), M. catarrhalis (7% vs 0%) and S.aureus (1% for both)]. All culture positive samples were