There have been infrequent reports of isolated central nervous system blastomycosis. We report a case of intracranial epidural abscess secondary to Blastomyces dermatitidis in a patient residing in Rhode Island with a history of remote travel to an endemic area. The clinical, radiographic, and pathologic features of this unique case are reviewed.

PURPOSE OF REVIEW:The review details recent literature reports regarding Hepatitis B Virus (HBV) and, in particular, Hepatitis B prevalence/incidence in incarcerated populations around the world. Furthermore, the review will summarize the national/international guidelines regarding HBV and look at diagnosis, vaccination, treatment, and linkage to care after release.RECENT FINDINGS:HBV affects prisoners at a much higher rate than the general populations. Many who are at increased risk for HBV infection are also at increased risk for incarceration. Incarcerated settings also have higher rates of HBV transmission.SUMMARY:Incarcerated individuals should be immunized if they are not already immune to HBV. Increased access to safe injecting and tattoo paraphernalia, condoms, and personal hygiene equipment could reduce the spread of HBV and other blood-borne and sexually transmitted infections. Future research should focus on ways to prevent the spread of HBV and similar viruses in incarcerated settings in order to protect incarcerated individuals and the general public. Research on effective linkage to community HBV care following release is needed.

SESSION TITLE: Chest Infections Posters ISESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PMPURPOSE: Influenza-like illness is common but not always due to influenza virus. Diagnostic testing to identify true influenza cases has important clinical implications. Molecular testing methods are now commonly used for this purpose, including multiplex RT-PCR to test for multiple respiratory viruses (RVP) and single analyte realtime PCR (rPCR) for influenza specifically. In our institutions, the specific assays used are the xTAG® Respiratory Viral Panel (RVP) and Cepheid Xpert® Flu (rPCR). Published literature on the Xpert Flu test suggests that it is highly sensitive, however several cases in which an initial negative rPCR test was followed by an RVP test that was positive for influenza suggested that this may not be the case. This investigation assesses the performance of the Xpert Flu test in patients with RVP-confirmed influenza and identifies subsequent clinical ramifications.METHODS: A retrospective chart review was performed of all patients who had an rPCR performed within 7 days before or after a positive RVP for influenza. The performance of the rPCR was then assessed. Clinical information obtained included demographics, patient comorbidities, patient vaccination status, testing characteristics, and selected outcome measures.RESULTS: In the 2013-2014 influenza season, there were 176 patients who tested positive for influenza by RVP and had an rPCR test done within a 7 day period. This included 130 patients with influenza A and 46 patients with influenza B. The rPCR test was positive for influenza in only 56% of these cases (58% of influenza A, 52% of influenza B). The rPCR was less likely to be positive when testing was not performed on the same date (p<0.01). No other patient or test factors were identified that increased the likelihood of a false negative result. Patients with false negative rPCR tests were less likely to be treated with oseltamivir (p<0.01).CONCLUSIONS: In patients with RVP-proven influenza who had concomitant testing with the Xpert Flu PCR test during the 2013-2014 influenza season, the Xpert Flu test failed to detect a significant number of cases of influenza. The patients who had a false negative Xpert Flu test were less likely to receive treatment with oseltamivir.CLINICAL IMPLICATIONS: Caution should be advised for clinicians treating patients with suspected influenza. Confirmatory testing with a respiratory viral panel may be appropriate in admitted or severely ill patients when a primary flu test is negative.DISCLOSURE: The following authors have nothing to disclose: Nicholas Csikesz, Sonja Chen, Jacob Smith, Roberta Dickenson, Kimberle Chapin, Gerardo CarinoNo Product/Research Disclosure Information SESSION TITLE: Chest Infections Posters I SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: Influenza-like illness is common but not always due to influenza virus. Diagnostic testing to identify true influenza cases has important clinical implications. Molecular testing methods are now commonly used for this purpose, including multiplex RT-PCR to test for multiple respiratory viruses (RVP) and single analyte realtime PCR (rPCR) for influenza specifically. In our institutions, the specific assays used are the xTAG® Respiratory Viral Panel (RVP) and Cepheid Xpert® Flu (rPCR). Published literature on the Xpert Flu test suggests that it is highly sensitive, however several cases in which an initial negative rPCR test was followed by an RVP test that was positive for influenza suggested that this may not be the case. This investigation assesses the performance of the Xpert Flu test in patients with RVP-confirmed influenza and identifies subsequent clinical ramifications. METHODS: A retrospective chart review was performed of all patients who had an rPCR performed within 7 days before or after a positive RVP for influenza. The performance of the rPCR was then assessed. Clinical information obtained included demographics, patient comorbidities, patient vaccination status, testing characteristics, and selected outcome measures. RESULTS: In the 2013-2014 influenza season, there were 176 patients who tested positive for influenza by RVP and had an rPCR test done within a 7 day period. This included 130 patients with influenza A and 46 patients with influenza B. The rPCR test was positive for influenza in only 56% of these cases (58% of influenza A, 52% of influenza B). The rPCR was less likely to be positive when testing was not performed on the same date (p<0.01). No other patient or test factors were identified that increased the likelihood of a false negative result. Patients with false negative rPCR tests were less likely to be treated with oseltamivir (p<0.01). CONCLUSIONS: In patients with RVP-proven influenza who had concomitant testing with the Xpert Flu PCR test during the 2013-2014 influenza season, the Xpert Flu test failed to detect a significant number of cases of influenza. The patients who had a false negative Xpert Flu test were less likely to receive treatment with oseltamivir. CLINICAL IMPLICATIONS: Caution should be advised for clinicians treating patients with suspected influenza. Confirmatory testing with a respiratory viral panel may be appropriate in admitted or severely ill patients when a primary flu test is negative. DISCLOSURE: The following authors have nothing to disclose: Nicholas Csikesz, Sonja Chen, Jacob Smith, Roberta Dickenson, Kimberle Chapin, Gerardo Carino No Product/Research Disclosure Information

A case is reported with multiple fistulization of the esophagus resulting in an esophagopleural communication, a mycotic empyema, and esophago-aortic perforation. Trauma with superimposed infection was probably the predominant factor in the etiology of this condition.