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12th International Congress
on Infectious Diseases
Lisbon, Portugal
June 15 ~ 18, 2006
Abstracts
19 8 6 – 2 0 0 6
International Scientific Exchange
20th
A N N I V E R S A R Y
12th International Congress
on Infectious Diseases
Lisbon, Portugal
June 15 ~ 18, 2006
Organized by the
International Society for Infectious Diseases
TABLE
OF
CONTENTS
12 t h I n t e r n a t i o n a l C o n g r e s s o n I n f e c t i o u s D i s e a s e s
Antimicrobials and Antivirals: New Agents, Pharmacokinetics, Mechanisms of Action . . . . . . . . . . . . . . 1
Antimicrobials and Antivirals: Resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Bacterial Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Clinical Trials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Emerging Infectious Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Epidemiology and Public Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Experimental Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Molecular Biology/Diagnosis of Viral, Mycotic, and Parasitic Infections . . . . . . . . . . . . . . . . . . . . . . . . . 66
Mycobacterial Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Mycoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Nosocomial Infections and Infection Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Parasitic Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Pediatric Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Surgical, Obstetric and Gynecologic Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Index of Authors and Co-Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Antimicrobials and Antivirals: New Agents,
Pharmacokinetics, Mechanisms of Action
ISE.001
Histopathological Changes in Hepatic Tissues During Severe
Malaria Due to Plasmodium falciparum in Venezuela
S. Dickson1, A.J. Rodriguez-Morales2, R. Barbella1, S. Diaz1, A.
Hernandez1. 1Instituto Anatomopatológico José A. O'Daly, UCV, Caracas,
Venezuela; 2Instituto Experimental JWT, ULA, Trujillo, Venezuela
Background: Malaria, particularly due to Plasmodium falciparum, still
continues producing an important morbidity and mortality, especially in
most undeveloped countries, where could be included Venezuela. During
complicated and severe malaria different organs could be involved, one
of them is the liver. For these reasons, we described the histopathological changes observed at hepatic tissues in cases of severe malaria due
to Plasmodium falciparum, corresponding to southern endemic zone of
Bolivar.
Methods: A complete histopathological evaluation with different staining
techniques (haematoxylin-eosine, among others) and evaluations with
optical and digital microscopy were done. Parafine blocks were evaluated with sections of 3 µm.
Results: In these cases we observed conserved lobulillary architecture,
but in one case the trabecular architecture was distortioned. Abundant
lipid droplets were evidenced at the hepatocytes cytoplasm. Portal
spaces exhibited an inflammatory mononuclear infiltrated, with border
trabeculae not impaired; Küpffer's cells hyperplasy, with parasitized red
blood cells and parasite debris were found inside degenerated hepatocytes (figure).
this bacteria by this medicinal plant, and in case the effects of bacteriocidal or bacteriostatic are determined, it is possible to use its extract or
powder as a traditional or synthetic drug.
Method: Adiantum capilus-veneris collected from Condolus medicinal
plants farm and herbarium sample was prepared out of that, then each
barium sample was identified and properly got a scientific name in each
barium of pharmaceutics faculty, then after fully wiping out of the sample
in heat of the dry laboratory it was turned into powder by electrical
grinder. Next the powder sample was extracted with using methanol solvent and using methanol the dilutions of 1/10, 1/20 and 1/40 were prepared out of the extract. Then the blank disks were placed in various dilutions to study Helicobacter pylori. To prepare the given microorganism
the science faculty of Tehran University was asked to help.
The sample was separated from the biopsy of a patient suffering from
gastric ulcer and it was cultivated in Brucella Agar media with blood and
was kept in Co2 incubator for 72 hours in order to let the bacteria grow.
To do antibiogram we immerse a sterile swap in 10 cfu/ml suspension
and then cultivate it on a plate containing Brucella agar along with other
facilities in a compact way. Then by a sterile pans put amoxicillin as a
positive control in a certain distance from the plate edge at least 10 mm
with a 24mm distance between to nearby disks fifteen minutes after putting the disks an plates we keep them upsidedown in a jar containing
pack gas in 37C temperature for 5 days. After 5 days the microbe sensitivity to antimicrobial substance is determined by a light zone around the
disk. This light zone indicates non growth of microbe.
Result: The studies showed that Adiantum capillus-veneris extract has
some great prohibitive effects on Helicobacter pylori in dilutions of 1/20
and 1/10.
Conclusion: The enormous researches on herbal medicine systems in
recent years indicate that some medicinal plants or herbs have some
effects even more than chemical drugs. For instance the research done
by some professors of Orumieh University indicates that garden thyme
essence and purple hyacinth, have antimicrobial effect as much as ceftazidim antibiotic on Klebsiella pneumonia. Likewise Sumac extract is
effectively, stronger than amoxicillin on this bacteria but despite the traditional use of such a plant for respiration disorders. No clinical research
has been done to prove such an idea. In this research some dilutions of
1/10, 1/20 and 1/40 was prepared out of this plant and using disk propagation, its effect on H.pylori was studied.
To compare the effect of some plants extract on bacteria, positive control
disks were used. The result shows that Adiantum capillus-veneris extract
has a significant effect on H.pylori.
ISE.003
Screening of Chinese Herbs for Anti-helicobacter Pylori Activity
M. Li, Z. Liu. Shanghai Research Institute of Stomatology, Shanghai,
China
Conclusion: Our results demonstrate that hepatocyte damage is an
important finding associated with the advanced stages of P. falciparum
malarial infection, which may lead to liver dysfunction in this disease.
These changes should be avoided doing an early diagnosis and proper
treatment, which is now based in Venezuela in mefloquine plus artesunate. These findings should be related with other clinical alterations
seen in the severe malaria, according to the WHO criteria.
ISE.002
Survey of Anti-bacterial (Bacteriocidal and Bacteriostatic) Effects of
Pterideae adiantum Capillus-veneris Extract on Helicobacter pylori
M. Saleh, F. Bagheri Bejestani, B. Akhoundi-Lavassani. Pasteur Institute
of Iran, Tehran, Iran
Introduction: Due to people's interest and increasing use of herbal
drugs, as well as the economic and remedial significance that this part of
Iranian natural sources possesses, the necessity of research on the
remedial effects of medicinal herbs becomes outstanding.
Adiantum capillus-veneris plant is found in most shadowy and humid
regions, and ruined wells, in particular. It has a long record in Iranian traditional medicine and is used as expectorant and emollient for curing
coughs. The abovementioned advantages make it possible to have a
wide research on this plant and generally this study aims to assess the
possibility of stopping the growth (bacteriocidal) or stopping the growth of
Background: Helicobacter pylori (H. pylori) is a bacterium implicated in
the etiology of stomach cancer and ulcers. Epidemiology of the antibiotic resistance of Helicobacter pylori appears to be higher. In search of efficiency substance of Chinese herbs, which could be used in preventing
and treating Helicobacter pylori diseases.
Methods: Extracted efficiency substance from Chinese herbs and
Identified by antimicrobial sensitivity tests performed on 96 microwell
plate. Results Its showed that all except 15 extract from 40 plants showed
bactericidal activity against the microorganism, but the most active
extracts were those from Gallnut (cocoon) of Chinese Sumac (MIC:
<1:512), Clover Flower Bud (MIC: 1:256), Houtuynia (MIC: 1:512),
Agrimony(MIC: 1:256) Coptis Rhizome (MIC: <1:512).
Conclusion: Amongst the active plants the inhibitory properties of
Helicobacter pylori were found prominent. Gallnut (cocoon) of Chinese
Sumac, Clover Flower Bud, Houtuynia, Agrimony and Coptis Rhizome
are efficient for inhibition Helicobacter pylori.
ISE.004
Insomnia Associated with the Use of Amoxicillin/clavulanic Acid for
the Treatment of Acute Otitis Media
P.M. Rifakis1, G. Cabaniel1, A.J. Rodriguez-Morales2. 1Perez de Leon
Hospital, Caracas, Venezuela; 2Instituto Experimental JWT, ULA, Trujillo,
Venezuela
Background: it has been recently reported the existence of a growing
body of evidence that amoxicillin-clavulanic acid (AM/CL) may induce
severe adverse effects in patients, especially younger, particularly producing hepatic side effects, among others. CNS side effects are rarely
associated with the its use (and in those cases these are fundamentally
headache and seizures). For these reasons we report a case of a patient
with an acute otitis media who was treated with AM/CL and developed
temporal insomnia during the antimicrobial drug therapy.
International Scientific Exchange • 1
Case: An 18 year-old boy presented for an outpatient consultation with a
2-day history of fever and mild left otalgia. Patient presented moderated
inflammation of the left tympanic membrane. CBC counts were normal
and no other significant alteration was observed. His medical history was
not relevant. This case was diagnosed as an AOM. Patient was ambulatory treated with AM/CL 875/125 mg tablets bid po x 3 days. NSAID was
also indicated. At 4th-day patient was reevaluated with a successfully
outcome of the AOM, but he referred never taken the NSAID and he suffered insomnia during all days of treatment. Previously to the treatment
with AM/CL his sleep pattern was normal, with a nocturnal sleep mean
duration of 8 hours. He was under no other concomitant medication,
except for the AM/CL combination. During treatment days he referred
sleep loss to 2-3 hours per night during the 3 days of therapy. His physical activities were the same (as a last year high school alumnus) and no
psychological problems or mental stress was referred. He referred that
the AOM associated symptoms disappeared during the first 24 hrs of
antimicrobial therapy. In this consultation, no medications were additionally prescribed, just an indication for a further reevaluation in 3 days. The
following subsequent days his sleep pattern became completely normal
again. Two months later he referred never suffered again neither from
AOM or any sleep disorder.
Conclusion: Antimicrobial drug therapy has been rarely associated with
sleep disorders in healthy people. This has been demonstrated for tetracyclines such as minocycline and doxycicline, but not for beta-lactams.
Apparently this side effect is related to prevention of protein synthesis by
some antibiotics, which has been demonstrated in animal models where
many kinds of protein synthesis inhibitors have been proven to suppress
mainly REM sleep. To our knowledge this is the first report in which the
treatment with amoxicillin/clavulanic acid is associated with a transient
and reversible sleep disorder. We consider that this could be explained in
part due to a higher dose of amoxicillin in the BID combination (875 mg
vs 500 mg) which was not used in the far previous years.
ISE.005
Effects of Lavandula stoechas Extracts on Staphylococcus aureus
and Other Gram Negative Bacteria
A.D. Khosravi, M.A. Malekan. Ahwaz Jundi Shapur University of Medical
Sciences, Ahwaz, Iran
Background: By increasing resistance of pathogenic bacteria to antibiotics in last few decades, many attempts have been made to find new
compounds as substitutes for non-effective antibiotics. Since the compounds and extracts of the plants could be part of these substitutes, so
the present study was undertaken for In vitro investigation of antibacterial effects of aques- and alcoholic extracts of Lavandula stoechas on clinical and standard strains of Staphylococcus aureus, Salmonella typhi,
Pseudomonas aeruginosa and Escherichia coli.
Methods: The compounds of the plant were extracted by distillation
method. The antibacterial property of the extracts were investigated by
tube dilution method in broth media. By using different concentrations of
the extracts, MIC and MBC were determined. In disc diffusion method,
the mean diameter of growth inhibition zones on agar media were determined by preparing discs from defined concentrations.
Results: Certain concentrations of the extracts showed significant antibacterial effect on the strains. Extracts with 20 mg concentration showed
defined growth inhibitory effect and 30 mg concentrations showed both
inhibitory and bactericidal effects on all of the given bacteria.
Conclusion: Since some of concentrations of the extracts showed significant antibacterial activity on given bacteria, more details on the plant
in future, provides more information regarding probable substitution of
that for current antibiotics.
ISE.006
The Effect of Galbanum Against Mycobacterium bovis
F. Fallah1, G. Eslami1, F. Emadi2, H. Goudarzi3, A. Ayatollahi3, S. Taheri3.
1
Pediatric Infectious Research Center, Tehran, Iran; 2Tehran University,
Tehran, Iran; 3Medical Faculty of Shaheed Beheshti University, Tehran,
Iran
Objective: Over the last decades, great advances in treatment and prevention of infectious disease have fostered complacency about infection
in a society which has access to antibiotics. However infections and also
adverse reaction of such drug remain. Also due to increasing demand for
less toxic and more potent antibiotics, it’s necessary to find new sources.
Method: In this research, anti-mycobacterial activity of the exact of
Ferula gummosa was investigated effects of the extract of the root and
fruit was tested against Mycobacterium bovis.
Result: Extract of fruit was achieved using maceration method the effect
of different concentrations of extract on the growth of mycobacterium compare to the 1 MC Farland standard and quantity of colonies, was investigat2 • International Scientific Exchange
ed by microscopic method.Streptomycin used for the control of antimycobacterial test systems. The result showed the Galbanum of 0.03 and
0.04 g/ml have protection effect and the other concentrations of extract
have decreasing effect on the growth of mycobacterium bovis. (BCG)
Conclusion: In spite of side effect of Antimycobacterial drugs we have
to search about some natural plants for treatment of mycobacterial disease. In this invitro study we could show the effect of Galbanum against
mycobacterium bovis.
ISE.007
Antibacterial Action of Honey On Bacterial Pathogens from Upper
Respiratory Tract Infections
T. Teibo. SMLS Uch, Ibadan, Nigeria
The anti bacterial activity of honey was tested using isolates from upper
respiratory tract infections. The isolates include Staphylococcus aureus,
Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli,
Pseudomonas aeruginosa and Proteus mirabilis. The antibacterial effect
of honey on the isolates was noticed at high honey concentrations. E.coli
was the most sensitive with 42mm zone of inhibition at 100% honey concentration, while P. mirabilis, P.aeruginosa and S. pneumoniae showed
the least sensitivity of 15mm each at the same concentrations of honey.
Normal antibiogram of the isolates were routinely carried out and the
results compared with the honey sensitivity test. The honey may not be
suitable for use against infections caused by P. mirabilis S. pneumoniae
and Pseudomonas aeruginosa which had the lowest inhibitory effects of
10mm each. But if subjected to exploitative studies, better activity could
be achieved against these isolates.
ISE.008
Antibacterial Effect of Coriander Oil on E. coli and Salmonella
Isolated from Patients with Gastroenteritis
G. Eslami, F. Fallah, S. Taheri, M. Pezeshki, H. Goudarzi. Medical Faculty
of Shaheed Beheshti University, Tehran, Iran
Background: Increasing of antibiotic resistance bacteria and lack of a
suitable outline of treatment of infections caused this research.
Method: The current descriptive study in 2005 has been performed in
academic treatment centers. After the diagnosis of disease by physician,
as sampling is performed of 65 infected patients who had not taken
antibiotics for at least for 3 days. Then samples were transported to transport media culture (Triptikase soy broth) in order to be sent to the labratory for bacteriologic investigation specially of Ecoli and salmonella, bacterial culture media such as blood agar and EMB agar M.c agar SS. For
identified of antimicrobial susceptibility used from Kirby Bauer method
according recommendations of National Committee of Clinical
Laboratory standards samples in blood agar
Then gram negative bacillus and coco bacillus were cultured in specific
cultures. After determining the bacteri kind, antibiogram test for specification of the sensitivity or resistance of bacteria against ciprofloxacin,
coloramphenicol and Gentamaicin has been done and blank disk
absoloutely mixed with purified coriander oil, placed apart from the other
disks by the method of diffusion. The coriander oil was extracted of
coriander seeds by distillation method. The coriander oil was be extruded by Etherdo petrol solvent and then the water freezed during 1 days in
freezer and coriander oil separated by this way. The watery phase separated of coriander oil.
Results: In this study from 65 positive samples of Ecoli and salmonella,
50 samples were Ecoli positive and 15 were salmonella Positive. The
best antibiotic answer about Ecoli relates to ciprofloxacin (96%) and
about salmonella relates to coloramphenicol (90%). The sensitivity of
Ecoli to coriander oil is 75% and sensitivity of salmonella to coriander oil
is 60%.
Conclusion: The result of this study shows that coriander oil could be
used as and antibacterial material in alimentary infections. With regard to
antibacterial properties of coriander oil it is suggested to do some more
studies on other bacteries.
ISE.009
A Study of Enteropathogenic Campylobacter in the Diarrhoeal
Patients AT Alzahra Hospital in Isfahan, Iran
S.A. Havaei1, M. Bokaeian2, R. Salehi1, A. Fazeli1. 1Isfahan University Of
Medical Sciences, Isfahan, Iran; 2Zahedan University Of Medical
Sciences, Zahedan, Iran
Background: Enteritis due to Campylobacter is the most common cause
of acute bacterial diarrhoea throughout the world. Due to the mutation of
bacteria and their resistance to antibiotics, therefore sensitivity test is
needed.
Methods: In this study we isolated C. jejuni and C. coil from the diarrhoeal
patients and then the antibiotic sensitivity of the isolates were done. In this
study 196 fecal specimens from the patients with symptoms of enteritis
were tested for the presence of Campylobacter using PCR and culture
methods. Sensitivity test were carried out using disc diffusion method.
Results: All of the isolated bacteria showed considerable sensitivity to
nalidixic acid, but were resistant to cephalotin and penicillin. The rate of
sensitivity of all strains to erythromycin was 93%, nitrofurantoin was 73%,
and tetracyclin, streptomycin as well as cholramphenicol was 60%.
Conclusion: The results showed that erythromycin was the most effective on the Campylobacter species.
ISE.010
Antimicrobial and Antioxidant Activities of Mexican Medicinal Plant
Extracts
R.E. Robles-Zepeda1, C.A. Velázquez-Contreras1, E. Ruiz-Bustos1, Z.
García-Ortega1, A. Angulo-Molina1, J. Hernández-Martínez2.
1
Departamento de Ciencias Químico Biológicas, Universidad de Sonora,
Hermosillo, Sonora, Mexico; 2Centro de Investigación en Alimentación y
Desarrollo, Hermosillo, Sonora, Mexico
The medicinal plants have been used since ancient times. Mexico
possesses a high variety and abundance of medicinal plants. Six native
plant species (Amphypteringium adstrigens, Castella tortuosa, Coutarea
latiflora, Ibervillea sonorae, Jatropha cuneata and Selaginella lepidophylla)
with different medicinal properties were screened for antimicrobial and
antioxidant activities. The plants were dried and extracted thoroughly with
methanol. These plant extracts were tested for antimicrobial and antioxidant activities by using the bacterial growth inhibition 96-well microplate
assay and the 1,1-Diphenyl-2-picrylhydrazyl (DPPH) scavenging test,
respectively. The test organisms were: Escherichia coli (ATCC 25922),
Staphylococcus aureus (ATCC 25923), Shigella flexneri (ATCC 12022)
and Salmonella cholerasuis. Plant extracts were evaluated at different
concentrations (500, 100, 10 and 0 µg ml-1). All tested plant extracts
showed antimicrobial and antioxidant activities. Amphypteringium adstrigens was the most potent plant extract against all bacteria strains tested. Complete inhibition of S. aureus growth was observed at 500 µg ml-1.
Additionally, A. adstrigens extract had the highest antioxidant activity: A.
adstrigens (90.7%), J. cuneata (84.5%), C. tortuosa (27.6%), I. sonorae
(12.1%), C. latiflora (10.7%) and S. lepidophylla (8.7%). Our data suggest
that the Mexican plants tested have important antimicrobial and antioxidant properties.
ISE.011
Susceptibility of Fosfomycin in Most Common Urinary Pathogens
and Comparison with Other Antibiotics
N. Efe Iris, P. Kepekci, T. Yildirmak, H. Sayiner. Okmeydani Teaching
Hospital, Istanbul, Turkey
Background: Urinary tract infections are usually treated empirically
before results of urine cultures are available. Periodic evaluation of
antimicrobial susceptibility of the causative microorganisms is warranted
due to the emerging bacterial resistance. Purpose of this study was to
determine the susceptibility of Fosfomycin in most common urinary
pathogens and comparison with other commonly used antibiotics.
Methods: Between August 2004 and December 2004 we examined 368
E.coli and 66 Klebsiella spp. strains which were isolated from urines of
4095 patients with a suspicion of UTI's. Identification of the strains were
determined with conventional methods and by using API 20 E (biomerieux). Antibiotic susceptibilities were determined with Kirby-Bauer
disk diffusion method according to CLSI criteria. Isolates were screened
for ESBL production by double-disk synergy test.
Results: Isolated UTI's agents were as follows; 368 E.coli (51%), 66
Klebsiella spp. (9%) and 277 (40%) other Gram negative and Gram positive bacteria. The most effective antibiotics which can be used by orally
in UTI's for E.coli were as follows; Fosfomycin (98.6%), Ciprofloxacin
(75.3%) and Nitrofurantoin (73.6%); for Klebsiella spp. Fosfomycin
(81.8%), Norfloxacin (77.3%) and Ciprofloxacin (75.7%). ESBL rates of
E.coli were found to be 14% in hospitalized patients and 6% in outpatient
group; in Klebsiella strains 55.6% in hospitalized patients and 21% in outpatient group.
Conclusion: Fosfomycin is the most effective antibiotic in E.coli and
Klebsiella strains. ESBL production rates were higher in Klebsiella strains
when compared to E.coli strains and it was higher in hospitalized patients
than outpatient group significantly.
ISE.012
Antibiotic Resistance and Genotypic Resistance Patterns of
Vancomycin-resistant Enterococci Strains Isolated with Surveillance
N. Efe Iris1, H. Sayiner1, T. Yildirmak1, Z. Aktas2, B. Gurler2, F. Simsek1, B.
Yontem1. 1Okmeydani Teaching Hospital, Istanbul, Turkey; 2IU Istanbul
Medical Faculty, Istanbul, Turkey
Background: With the aim of the determination the patients who were
colonized with VRE, we planned an active surveillance program in
our hospital. Identification, antibiotic susceptibilities high level
Aminoglycoside resistance, Beta-lactamase production and genotypically resistance patterns of these VRE strains were investigated.
Methods: Rectal cultures were collected from intensive care units, once
in every 3 months during 18 months period. Between December 2004January 2006 57 VRE strains were isolated. Fecal specimens were cultured in VRE agar base (oxoid) with 6µg/ml Vancomycin and 2µg/ml
Meropenem. Identification was performed by conventional methods and
by using Rapid Id 32Strep (biomerieux). Antibiotic susceptibilities and
determination of the HLAR were performed by agar-dilution method (biomerieux) according to NCCLS criteria. Antibiotic susceptibility patterns of
strains for Fosfomycin was detected by disk-diffusion method, for
Linezolid by disk diffusion method and E test. Vancomycin resistance
was detected by E test and Van gene characterisation was performed by
a multiplex PCR, which also confirmed the identification. Beta-lactamase
activity was detected by Nitrocefin disk.
Results: Isolated VRE strains were as follows: E.faecium 40 (70.2%),
E.casseliflavus 8 (14%), E.gallinarum 6 (10.4%), E.durans 2 (3.6%),
E.faecalis 1 (1.8%). All of the isolates were resistant to Vancomycin,
Teicoplanin, Ampicillin, Erythromycin,and Rifampicin. Resistance rates to
other antibiotics were as follows; Nitrofurantoin 70%, Chloramphenicol
70%, Ciprofloxacin 54%, Levofloxacin 47%, Tetracycline 23%,
Fosfomycin 14%, Dalfopristin-Quinupristin 7%, Linezolid 0%. High level
Gentamicin resistance was detected as 94%, HLSR was 95%. Van gene
characterisation was performed in 24 strains and all of them were Van A
type. Beta-lactamase activity was not detected.
Conclusion: VRE strains were highly resistant to Penicillin, Ampicillin,
Erythromycin, Rifampicin, Chloramphenicol, Nitrofurantoin, high level
Gentamicin and Streptomycin. It was observed moderate resistance to
Quinolones. The most effective antibiotics and their resistance rates were
as follows; Tetracycline (23%), Fosfomycin (14%), DalfopristinQuinopristin (7%) and Linezolid (0%).
ISE.013
Susceptibility of Salmonella enteritidis to Propolis Produced in
R. of Macedonia
E. Trajkovska-Dokic, A. Kaftandzieva, M. Petrovska. Institute of
Microbiology and Parasitology, Skopje, Former Yugoslav Republic of
Macedonia
Background: Propolis, a natural product collected by Apis mellifera from
plant exudates, shows a complex chemical composition. Its biological
properties-such as antibacterial, antiviral, antifungal, among other activities-have attracted the researchers interest. Reports have pointed out
propolis efficient activity against Gram positive bacteria and limited
action against Gram negative bacteria. The aim of this study was to
investigate the antibacterial activity of ethanol extract of propolis produced in R. of Macedonia to Salmonella enteritidis.
Methods: Ten human infection strains of Salmonella enteritidis in concentration of approximately 106 Colony Forming Unites (CFU) were inoculated separately in brain heart infusion plus 10% ethanol solvent of
propolis. The same strains were inoculated in 70% ethanol used as a
control of the solvent effect. After 3, 6, 9, 12, 15 and 24 hours incubation
at 37˚C, aliquots of each culture were removed and plated on blood agar
by pour plate method. Plate counts were carried out after 24 hours incubation and the survival percentage was calculated.
Results: We verified that propolis showed a bactericidal activity against
Salmonella enteritidis, showing a remarkable inhibitory effect after 15
hours and bactericidal effect after 24 hours incubation. We also observed
that 70% ethanol showed only bacteriostatic activity on all strains during
the 24 hours incubation.
Conclusion: These results suggested that propolis action was only due
to its components. This effect of ethanol extract of propolis reflects its
antibiotic action on Salmonella, suggesting its possible use as an alternative control of Salmonella infection.
ISE.014
Pathogenic Indices, Antibiograms and Activities of Medicinal Plants
Against Plesiomonas shigelloides from Stool Samples of Patients
in the Venda Region of South Africa
C.L. Obi, J. Ramalivhana, A. Samie, E.O. Igumbor. University of Venda,
Thohoyandou 0950, South Africa
Background: During the past decade, Plesiomonas shigelloides have
been frequently recognized as responsible for several diseases in both
developed and developing countries. Previous studies in the Venda
region have incriminated Plesiomonas shigelloides in diarrhoeal cases.
However, the antibiograms, activity of local medicinal plants against
P. shigelloides and pathogenicity of isolates have not been determined.
This study determined the presence of some pathogenic factors, antibiotic profiles and in-vitro activity of local medicinal plants against
Plesiomonas shigelloides isolated in the Venda region of South Africa.
Methods: A total of 686 diarrhoic stool samples were obtained from
patients attending various health centres and hospitals in the Venda
region from December 2004 to October 2005. They were screened for
Plesiomonas species using Xylose Deoxycholate Citrate Agar (XDCA).
Antibiotic susceptibility profiles of the isolates to 28 antibiotics were
determined using the disc diffusion method and analyzed according to
NCCLS guidelines. The beta lactamase production as well as the
hemolytic and hemagglutination activities of the isolates on Human,
Sheep, Pig and Chicken red blood cells were determined using the plate
and slide methods.
Results: A total of 34(5%) of Plesiomonas shigelloides were isolated
and identified using the API 20E system. 18(53%) of isolates produced
beta lactamase, 34(100%) produced haemolysis on sheep and human
red blood cells and 18(53%) were haemolytic on chicken red blood cells
whereas none (0%) was haemolytic on pig red blood cells. There was a
high level of resistance to the penicilllins with 100% resistance to
Penicillin G, amoxicillin and ampicillin followed by cefuroxime, chloramphenicol, and erythromycin. The carbapenums were the most active
amongst all the tested antibiotics. Plant extracts showed different activities depending on the extractant used, with acetone extracts demonstrating the best activities.
Conclusion: This study has demonstrated multiple antibiotic resistance
to different antibiotics as well as the potential of medicinal plants in the
management of P. shigelloides infections. Some of the isolates were beta
lactamase producers and also demonstrated other pathogenic characteristics such as haemolytic and haemagglutinating activities.
ISE.015
Testing for Induction of Clindamycin Resistance in ErythromycinResistant Isolates of Coagulase Negative Staphylococci and
Stapylococcus aureus
T. Haznedaroglu, M. Kural, N. Ardic, M. Ozyurt. GATA Haydarpasa
Training Hospital Department of Microbiology, Istanbul, Turkey
Background: The aim of the study was to determine the incidence and
the phenotypes of inducible clindamycin resistance among staphylococci in a 1000-bed tertiary hospital in Turkey.
Methods: Coagulase-negative staphylococci (CNS) and Staphyloccus
aureus isolates obtained from consecutive clinical specimens were
included in the study, comprising 106 CNS isolates, 44 of which were
methicillin-resistant and 69 S. aureus isolates, 23 of which were methicillin resistant. Disk diffusion testing were performed placing clindamycin
(2 µg) and erythromycin (15 µg) disks approximately 12 mm apart on a
Mueller-Hinton agar plate that had been inoculated with S. aureus and
CNS isolates. Two induction phenotypes (D+ and D-) and four noninduction phenotypes were detected in disk diffusion results.
Results: A clear D-shaped zone (D phenotype) was found in 4 (2,3%)
isolates. A D-shaped zone containing iner colonies (D+ phenotype) growing up to clindamycin disk was found in 20 (11,4%) isolates. Erythromycin
resistance and clindamycin susceptible phenoype was found in 9 (5,1%)
isolates and they were not inducible. Isolates susceptible by disk diffusion
testing to both clindamycin and erythromycin were found in 67 (38,3%)
strains and contrarry both clindamycin and erythromycin resistance was
found in 85 (48,6%) isolates.
Conclusion: Our clindamycin induction results for disk diffusion testing
showed two phenotypes. The D-zone phenotype (both D and D+),
observed for 24 (13,7%) isolates and considered positive for clindamycin
induction (inducible macrolide-lincosamide-streptogramin B-MLSB
resistance) which had a clear inhibition zone (D phenotype) and the other
had small colonies around the zone (D+ phenotype). Although clindamycin is an agent for the treatment of staphylococcal infections,
inducible MLSB resistance are being reported as a common problem
world wide. Routine testing of staphylococcal isolates for inducible clindamycin resistance is recommended in the 2004 NCCLS quidelines and
help to chose treatment failures especially for patients infected with
inducible MLSB isolates as in our hospital.
ISE.016
Antiviral Activity of Isoabienol and New Strategy for Antiflu
Application
G. Kuznecova1, M. Daugavietis2, S. Kuznecovs1, G. Ryazantseva2.
1
Preventive Medicine Research Institute, Riga, Latvia; 2Biolat Research
Group, Salaspils, Latvia
Background: The search and development of new substances of
natural origin with antiviral properties remain thus far one of the actual
4 • International Scientific Exchange
problems for it has been recorded the decrease in sensitivity of A-influenza vital strain to antiinfluenzal preparations. Isoabienol was found to be
the principal extractive constituents of Scots Pine needles coming from
Latvia area of growth. The content, in terms of dry needle weight of
Isoabienol is over 1%.
Methods: The investigations in vitro and in vivo were carried out.
Isoabienol action was investigated in mice on experimental influenzal
infection, caused by A-influenza virus Aichi/2/68 (H3N2).
Results: The obtained results suggest that Isoabienol exerts an inactivating effect on different antigenic versions of A-influenza virus (H2N2,
H3N2) and B and on Rhinovirus in immediate contact thus preventing the
development of viral infection. In the concentrations above 100 mg/kg
Isoabienol exerts virucide action. In immediate contact with A-influenza
virus its infection titer drop is 3.0 and over lg EID50. Isoabienol in the concentration of 100 mg/kg when intranazally administered half an our
before and after 4 hours following contamination the inhibition of 13 type
Rhinovirus reproduction in upper respiratory tracts in SwR strain mice is
1.5 lg TCID50. Isoabienol is used to add some antiviral properties to
fabric. It was established that the surgical masks treated with Isoabienol
give a 10-15-fold decrease in amount of viruses as opposed to the
control. Isoabienol application during epidemic periods in 1997–1998,
2001–2002 and 2003–2005 reduced the risks of respiratory virus infections by 2–3 times.
Conclusion: These results suggest that Isoabienol may be a good
candidate for a further antiviral research and for antiepidemic masks
treatment.
ISE.017
Efficacy of Interferon Alpha2A Therapy in the Treatment of Acute
Viral Hepatitis C
M.I. Turdean1, D.F. Tatulescu1, V. Zanc1, G. Molnar2. 1Iuliu Hatieganu
UMPh, Cluj-Napoca, Romania; 2Institute of Hygiene, Cluj-Napoca,
Romania
Given the reserved prognosis of VHC, antiviral medication (Ribavirin +
Interferon-IFN) is recommended, without any consensus being reached
on the optimal therapeutic scheme: monotherapy or association of antiviral drugs; time of initiation of therapy; doses and duration of therapy.
Objectives: To evaluate the efficacy of treatment with IFN-Alpha2A in
VHC (clinical group studied: 7 adults, admitted to the Clinic of Infectious
Diseases Cluj-Napoca between 2002-2005); therapeutic scheme: induction dose 4.5 MU/day - 4 weeks, maintenance dose: 4.5 MUx3/week - 20
weeks.
Inclusion Criteria: epidemiological: conclusive inquiry for acute HCV
infection; biochemical: ALAT levels>10xVN; immunological: IgM-VHC
positive (4 cases), total AcVHC positive (7 cases); virological: HCV-RNA
detectable (7 cases); VHB, VHD, HIV coinfections were excluded.
Patients were monitored 14 days after the initiation of IFN-Alpha2A treatment, then after 30 days.
Results: i) clinical: <1 month: pseudoinfluenza manifestations in all
patients; 2 months: dyspeptic syndrome (3 patients); ii) biochemical: normalized ALAT levels: <1 month (6 patients); 2 months (1 patient);
iii) quantitative HCV-RNA determined at: the time of the initiation of treatment, 3 months (6 of 7 patients, undetectable viremia for early virological
response); 6 months (6 of 7 patients, undetectable viremia for complete
virological response); 3 patients had undetectable viremia 6 months after
the end of treatment, the sustained virological response obtained confirming the efficacy of therapy. Only one patient was considered a nonresponder, having constantly detectable viremia. No patient presented
significant adverse effects.
Conclusions: The early administration of IFNalpha2A in acute hepatitis
C (4–6 weeks after onset, depending on the evolution of hepatocytolysis)
definitely reduces the percentage of evolution towards chronicity of VHC
by the eradication of infection in 6 of 7 cases.
ISE.018
Antibacterial and Antifungal Activity of 2-polyfluoroalkyl
Substituted 4,5,6,7-halogenobenzimidazoles
A.E. Laudy1, E. Grabowska1, M. Kozlowska2, Z. Kazimierczuk2, B.J.
Starosciak1. 1Medical University of Warsaw, Warsaw, Poland; 2Agriculture
University, Warsaw, Poland
One of the main reasons for therapeutic failures in treating bacterial and
fungal infections is the resistance of these organisms, especially hospital strains, to a broad range of antibiotics. Therefore it is necessary to
search new compounds active against microorganisms.
In this study, we determined in vitro the antimicrobial activity of newly
synthesised 2-polyfluoroalkyl substituted 4,5,6,7-halogenobenzimidazoles. The antibacterial and antifungal activity was examined by the discdiffusion test, the MIC and the MBC determination methods according to
guidelines established by the NCCLS. In the disc-diffusion test the paper
content 400 µg of a new benzimidazoles derivetives. The reference
strains of Gram-positive bacteria, non-fermentative Gram-negative rods
as well as bacteria from Enterobacteriaceae family and also strains of
yeast Candida sp. from ATCC and NCTC collections were used.
The results of our study confirm the difference in susceptibility to the new
substituted benzimidazoles between Gram-positive and Gram-negative
bacteria. In general, Gram-positive bacteria were more sensitive to all
examined agents (diameter of growth inhibition area from 11 to 56 mm;
MIC <0.781-400 mg/L). Three agents 2-nonafluorobutyl-4,5,6,7-tetrabromobenzimidazole, 2-tridecafluoroheksyl-4,5,6,7-tetrabromobenzimidazole and 2-pentadecafluoroheptyl-4,5,6,7-tetrabromobenzimidazole
showed the highest activity of studied antibiotics to E. faecalis (MIC 6.2550 mg/L), S. aureus and Bacillus strains (MIC <0.781 mg/L). The highest
bactericidal activity to cocci showed 2-tridecafluoroheksyl-4,5,6,7-tetrabromobenzimidazole (MBC 0.781 mg/L for S. aureus; MBC 12.5 mg/L for
E. faecalis). Moreover, 2-nonafluorobutyl-4,5,6,7-tetrabromobenzimidazole was also very active to Gram-negative rods, especially to S. maltophilia (MIC=MBC 6.25 mg/L) and A. baumannii (MIC 25 gm/L, MBC 50
mg/L). Additionally, the used Candida strains were sensitive to some
of studied agents. The highest activity to fungi showed 2, 4, 5, 6,
7-pentabromobenzimidazole (MIC 6.25-50 mg/L, MBC 25-50 mg/L).
These data indicated the structure-activity relationships among this class
of agents. Obtained results give the reasons for the purpose of searching
for active substances to microorganisms among new benzimidazoles.
ISE.019
Antimicrobial Activity of Lactobacillus Casei Paracasei Stains
Isolated from Traditional Dairy Products
D. Bassos1, Y. Allamanos1, C. Voidaru2, E. Bezirtzoglou3, V. Maipa1.
1
University of Ioannina, Medical School, Hygiene Lab, Ioannina, Greece;
2
T.E.I. of Epirus, Laboratory of Animal Health and Infections Diseases,
Department of Animal Production, Arta, Greece; 3Democritus University
of Thrace, School of Agricultural Development, Microbiology Lab,
Orestiada, Greece
Objectives: Fermented foods have a reputation to be beneficial to
human health, especially when lactic acid bacteria are associated with
fermented milks. Live cultures of Lactobacillus and Bifidobacterium in
foods are termed Probiotics. The beneficial effects of the probiotics
includes nutritional improvement of foods, inhibition of enteric pathogens,
hypochlolestaemic action, anticancer activity and stimulation of the
immune system by increasing IgA levels.
Methods: In order to investigate the microbial logical quality of traditional dairy products samples were collected from the following food preparations: 40 samples of unpasteurized ewins, goat or cow milk, 20 samples of 'feta' cheese, 20 samples of goat cheese and 40 samples of 'pitia'
which is a traditional Greece dairy product prepared in a dried stomach's
skin coming from a small ruminant. Selective media were tested and
incubated both aerobically and anaerobically. The identification was carried at according to Bergey's manual. Microscopic examination of Gram
stained cells, catalase, oxidase and biochemical tests were performed
when necessary to identify.
Identification of the lactic acid bacteria was performed by gallery API
method.
Results: All isolated wild strains of Lactobacillus casei paracasei, as well
a reference stains, for their antimicrobial activity against classic food
pathogens of the genus E.coli, S.aureus, Salmonella spp. : S.typhi,
S.typhimurium, S.ancona, S.enteridis. The iminnodiffusion agar method
including incubation of the microbial cultures and of the supernatant after
centrifugation of the culture liquid was used. Incubation was performed at
both 37˚C and 45˚C for 3,6,18 and 48 hours.
Conclusions: All wild strains of actobacillus casei paracasei presented
higher antimicrobial activity against the pathogens compared to the reference strains of Lactobacillus casei paracasei.
ISE.020
Antimicrobial Potentials of Mitracarpus Villosus, Parkia Biglobosa,
and Euphorbia Hirta Plants
F.E. Emele1, M.I. Izomoh2, C.A. Oyeka3. 1Department of Medical
Microbiology, College of Health Sciences, Nnamdi Azikiwe University,
Nnewi, Nigeria; 2Department of Microbiology, Faculty of Natural
Sciences, Ambrose Alli University, Ekpoma, Nigeria; 3Department of
Applied Microbiology and Brewing, Faculty of Natural Sciences, Nnamdi
Azikiwe University, Awka, Nigeria
Background: Infectious diseases remain a major problem, especially in
the developing countries, despite ever-improving therapeutic measures.
The escalating cost of antimicrobial drugs, coupled with increasing
poverty, compels many in the developing countries to the use of locally
available medicinal plants. Parkia biglobosa, Euphorbia hirta and
Mitracarpus villosus are among the plants employed in folk medicine,
and hence the need to investigate their medicinal values.
Methods: Ethanolic and water (hot) extracts of the following plant parts:
leaves of Mitracarpus villosus, Euphorbia hirta and Parkia biglobosa, as
well as the bark of P. biglobosa, were tested for activity against different
microorganisms, by agar and broth dilution techniques, using appropriate
media. Survival of test bacteria in 100mg/ml of the extracts, at different
time intervals, was also investigated.
Results: Crude Ethanolic extracts of Parkia were more antimicrobial
than the hot water extracts. The ethanolic extract of Parkia leaves had the
lowest MIC value of 0.098mg/ml for Staph. aureus, Aeromonas hydrophila and Pseudomonas aeruginosa, and disinfectant contact time of
10mins. for P. aeruginosa. Extracts of E. hirta and M. villosus had consistently higher MIC values than Parkia extracts, although Mitracarpus
(ethanolic) was essentially bactericidal and had a minimal disinfectant
contact time of 20mins [for Aeromonas]. Mitracarpus (ethanolic) also
suppressed fungi [MIC ranging from 3.125mg/ml (Microsporum
audouinii) to 50mg/ml (Trichophyton mentagrophytes)]. Prior exposure of
test bacteria to sub-lethal doses of the extracts significantly increased the
MIC values (P<0.05).
Conclusion: The high efficacy of the crude extracts tends to suggest
antimicrobial potentials, and provides scientific basis for their application
in folk medicine. Results tend to suggest that microorganisms can develop resistance (even cross-resistance) to antimicrobial principles in
medicinal plants, which seems to have therapeutic implications. It could
also be seen that tropical plants hold great promise as potential source
of anti-pseudomonas drugs.
ISE.021
Tigecycline Activity Against Staphylococcus aureus, Including
Vancomycin-intermediate and -resistant Isolates
T.R. Fritsche, H.S. Sader, H. Becker, R.N. Jones. JMI Laboratories,
North Liberty, IA, USA
Background: Antimicrobial activity of tigecycline tested against S.
aureus strains with decreased susceptibility to vancomycin, including
vancomycin-intermediate S. aureus (VISA), hetero-resistant VISA
(hVISA) and vancomycin-resistant S. aureus (VRSA) was studied.
Tigecycline, a first-in-class glycylcycline, was recently approved by the
US-FDA for use in complicated skin and skin structure and intra-abdominal infections.
Methods: 105 well-characterized strains with decreased susceptibility to
vancomycin (81 hVISA, 19 VISA, and 5 VRSA, as well as a large surveillance collection (2000–2004) of wild-type (WT) S. aureus, were susceptibility tested by the CLSI broth microdilution method against vancomycin, tigecycline (with fresh media) and comparators. Breakpoint criteria were those of the US-FDA (tigecycline) or CLSI.
Results: MIC results for the subsets of S. aureus are summarized in the
Table. While MRSA was common in surveillance studies (37.1%), vancomycin non-susceptibility was not. Among 6 isolates with vancomycin
MICs of 4 mg/L, five had tigecycline values of <= 0.5 and one at 1
mg/L. Tigecycline provides near-complete coverage of this species
(MIC90, 0.25 mg/L; 99.5% susceptible); only linezolid, vancomycin and
Synercid had marginally higher susceptibility rates (100, 100 and 99.8%,
respectively). Among VISA, hVISA and VRSA isolates, tigecycline was
uniformly active, with MIC50 and MIC90 values of 0.06 to 0.25, and 0.25
to 1 mg/L (98.1% susceptible),respectively. Against 5 VRSA (NARSA),
tigecycline MICs were consistent with WT-S. aureus (MIC∆50, 0.12 mg/L),
indicating lack of cross-resistance.
Conclusions: Tigecycline was found to be highly active against all
WT S. aureus tested, including a large MRSA subset. Among strains
with decreased susceptibility to vancomycin, no cross-resistance with
tigecycline was observed. All VISA, hVISA and VRSA strains remained
susceptible to tigecycline. The broad-spectrum of activity and potency
exhibited by tigecycline against clinically-significant Gram-positive and
-negative pathogens, supports its continued application for indicated
infections, including those caused by recently emerging, highly resistant,
staphylococci.
ISE.022
Neutralizing Activity of SAMBUCOL® Against NIBRG-14 (H5N1)
Avian Influenza Virus
S. Balasingam1, R. Lambkin1, D. Safirman2, M. Mumcuoglu2, J.S. Oxford1.
1
Retroscreen Virology Ltd, London, United Kingdom; 2Razei Bar
Industries, Jerusalem, Israel
The spread of avian influenza (H5N1) into eastern European countries
raises concerns of a possible flu pandemic and emphasizes the need to
search for prevention and cure. Two double-blind, placebo controlled clinical trials have confirmed the safety and efficacy of Sambucol,® a standardized Black Elder berry extract, in the treatment of influenza A and B
and its symptoms. The aim of the present study was to determine the
virucidal activity of Sambucol® against avian influenza NIBRG-14 (H5N1)
virus. Virucidal assays were performed in MDCK cells using two
Sambucol® dilutions. Cultures were titrated for different incubation time
points. Results show at least 99.00% significant reduction in the titre of
avian influenza NIBRG-14 (H5N1), namely 2.0 -log10 TCID50/ml, after
incubation of the virus with Sambucol.® Sambucol® reduced the titer of
NIBRG-14 (H5N1) virus to the same extent as the citrate buffer positive
control. Therapeutic index calculations indicate direct influence of
Sambucol® on titre reduction. Further animal studies should be undertaken to assess the effectiveness of Sambucol® against avian influenza
(H5N1) in humans. Contact email address: mifal@razeibar.com.
Antimicrobials and Antivirals: Resistance
ISE.023
Resistance of Catheter-associated Urinary Tract Infections to
Antibacterials in Caracas, Venezuela
C. Rodriguez1, A.J. Rodriguez-Morales2, A. Garcia1, B. Pastran1, P.
Meijomil1, N. Goncalves3, P. Rifakis3, O. Hernandez3, F. Meo3, E. Cardoso3,
F. Hernandez3, C. Alurralde3, I. Jimenez1. 1West General Hospital,
Caracas, Venezuela; 2Instituto Experimental JWT, ULA, Trujillo,
Venezuela; 3Perez de Leon Hospital, Caracas, Venezuela
Background: Catheter-associated urinary tract infections (CAUTI) are
one the most common nosocomial infections. The worldwide data show
the increasing resistance to conventional antibiotics among urinary tract
pathogens. The objective was to evaluate the antimicrobial resistance of
pathogens responsible for CAUTI in Caracas, Venezuela.
Methods: A study on CAUTI antibiotic resistance was conducted at our
institution in Caracas, Venezuela, from 1999 to 2003. Antimicrobial susceptibility was evaluated with disk diffusion technique according to
NCCLS.
Results: The results showed that 105 patients had developed CAUTI.
The seven most commonly isolated microorganisms were, in descending
order: Escherichia coli (37.4%), Klebsiella pneumoniae (9.3%), Candida
albicans (8.4%), Enterococcus faecalis (7.5%), Pseudomonas aeruginosa (7.5%), Proteus mirabilis (4.7%), Acinetobacter baumannii (2.8%),
Citrobacter freundii (2.8%), Enterobacter cloacae (2.8%) and
Staphylococcus coagulase-negative (2.8%). E. coli was highly resistant
to trimethoprim-sulfamethoxazole (81.6%), ampicillin (76.5%) and norfloxacin (57.5%) with 7.5% producer of ESβL; while some bacterias, like
K. pneumoniae showed rates of ampicillin resistance as high as 100.0%,
50% for trimethoprim-sulfamethoxazole, 44.4% for ampicillin/sulbactam
and 42.9% for ciprofloxacin. Ten percent of K. pneumoniae strains were
ESβL producers.
Conclusion: The results of this study emphasized an urgency of the prevention and introduction of clinical protocols for better management of
CAUTI. Treatment principles should better correspond to the antibiotic
sensitivity of uropathogens.
ISE.024
Surveillance of Escherichia coli Cephalosporins Resistance in
Western Caracas, Venezuela, 1997-2004
C. Rodriguez1, A. Garcia1, B. Pastran1, P. Meijomil1, I. Jimenez1, A.J.
Rodriguez-Morales2. 1West General Hospital, Caracas, Venezuela;
2
Instituto Experimental JWT, ULA, Trujillo, Venezuela
Background: Escherichia coli strains that produce enzymes capable of
degrading extended-spectrum cephalosporins have emerged as important nosocomial pathogens in Venezuela, for this reason antimicrobial
resistance surveillance is necessary to monitoring and guide treatment
of infections caused by these strains.
Methods: We evaluated in an 8-year period cephalosporins resistance
among E. coli clinical isolates in western Caracas. Antimicrobial susceptibility was evaluated by disk diffusion technique (NCCLS), using 11
cephalosporins. ESβL phenotype was determined by double disc
method. In studied period 33633 E. coli strains were evaluated.
Results: Significant interannual variation in cephalosporins resistance
was observed (p<.01). Mean period resistance against cephalosporins
was (range): cefepime 2.7% (1.2-11.4%), ceftazidime 7.4% (5.8-15%),
cefoperazone 8.3% (7.1-14%), cefotaxime 4.9% (3-9.3%), among others.
ESβL were observed in 2.75% (3.7-22.8%). A significant strong positive
correlation was observed between prevalence of cefepime/cefotaximeresistant strains (r=.83, p<.05), cefotaxime/cefoperazone-resistant
strains (r=.85, p<.05) and ceftazidime/cefoperazone-resistant strains
(r=.96, p.05).
Conclusion: Increasing cephalosporins resistance among clinical
strains isolated in Caracas, demonstrated here, represents a public
health problem in the setting of a developing country, where new drugs
are inaccessible due to economic reasons. In vitro cephalosporins activity surveillance could guide appropriate antimicrobial therapy with the
most suitable drugs for each case. Probably, we could suggest selective
restriction of some third-generation cephalosporin to improve the antibiotic susceptibility as has been demonstrated previously.
ISE.025
Microbiology of Biliary Tract Infections in a General Hospital of
Caracas, Venezuela, 1999-2003
Meijomil1, I. Jimenez1. 1West General Hospital, Caracas, Venezuela;
2
Background: Biliary tract infections (BTI) are a worldwide problem, with
a large financial burden on health care. Biliary infections can result from
multiple causes, but the most common culprit is cholelithiasis. In this
study we evaluated the microbiology and the antimicrobial susceptibility
of pathogens responsible for BTI in a general hospital Caracas,
Venezuela, during 1999–2003.
Methods: A study on BTI microbiology and antibiotic susceptibility was
conducted at our institution in Caracas, Venezuela, from 1999 to 2003.
Antimicrobial susceptibility was evaluated with disk diffusion technique
according to NCCLS.
Results: In the study period, we evaluated 79 patients. Mean age
50.1±17.4 y-old, 77.2% female and 22.8% male. From them, 129 strains
were isolated: 31.0% Escherichia coli, 20.2% Pseudomonas aeruginosa,
15.5% Klebsiella pneumoniae, 7.0% Enterobacter cloacae, 3.9%
Enterobacter aerogenes, 3.1% Acinetobacter baumannii, among others.
Escherichia coli susceptibility patterns showed: 59% resistant strains
against ampicillin, 37.8% cephalotin, 33.3% ofloxacin, 29.7%
ampicillin/sulbactam, 25% TMP-SMX, 24.2% ciprofloxacin, 14.3% cefoperazone, 10.3% cefepime. Better overall susceptibility was observed with
ceftriaxone (85%), cefoperazone/sulbactam (97.1%) and for carbapenems, imipenem (100%) and meropenem (100%). Thirteen percent of E.
coli strains were ESβL producers.
Conclusion: In the past decade, our knowledge of the mechanism of
disease, microbiology of infections, and management options has grown
enormously. Although at times perplexing, it is important to understand
this information to allow for efficient, quality, and cost-effective health
care of biliary tract infections.
ISE.026
Comparative in vitro Activity of Ertapenem Against Selected Gramnegative Bacilli in Western Caracas, Venezuela, 2004-2005
2
Background: Emergence of gram-negative bacilli antimicrobial drug
resistance is a public health threat which require to the research and
development of new effective drugs. In this group, carbapenems are an
important therapeutic choice in resistant pathogens, but meropenem and
imipenem resistance has been reported. For these reasons we compared the in vitro activity of ampicillin, ceftriaxone, cefepime,
ciprofloxacin, imipenem, meropenem and ertapenem (which is a new
carbapenem recently available in Venezuela).
Methods: A comparative in vitro study on antimicrobial resistance of
Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis clinically
isolated was conducted at our institution in Caracas, Venezuela, from
January 2004 to August 2005. Antimicrobial susceptibility for selected
drugs was evaluated with disk diffusion technique according to NCCLS.
Results: For the study period, 2126 strains were isolated, corresponding
67.1% to E. coli, 21.9% to K. pneumoniae and 11.0% to Proteus mirabilis.
Resistance for ampicillin in these pathogens ranged between 39.5% to
99.6%, followed by ciprofloxacin with 11.4% to 35.5%, cefepime 9.5% to
30.2%
and
ceftriaxone
7.9%
to
28.8%
(see
figure).
All strains tested in this study were 100% susceptible to all carbapenems
(see figure). In the E. coli strains group, 2.7% were ESβL producers, this
figure was 2.4% for K. pneumoniae and 0.4% for P. mirabilis.
ceptibility was evaluated with disk diffusion technique according to
NCCLS.
Results: A total of 106 strains of K. pneumoniae were isolated in 101
patients with BSI. Klebsiella pneumoniae represented the most common
gram-negative bacterial isolate from BSI (20%). Klebsiella pneumoniae
was highly resistant to ampicillin (100%), piperacillin (82.8%),
ampicillin/sulbactam (52.7%), ceftriaxone (46.4%), amoxicillin/clavulanate (44.1%) with 26.42% producer of ESβL; better antimicrobial activity was observed with ciprofloxacin (2.3% resistance, 2.3% intermediate
susceptibility and 95.4% of susceptibility), imipenem (1.2% resistance,
and 98.8% of susceptibility) and meropenem (100% of susceptibility).
Conclusion: In conclusion, imipenem and meropenem seems to be better choice of antibiotic, should be used for ESβL positive life-threatening
infections, because of remaining highest activity.
ISE.029
Antibiotic Susceptibility of Bacteria Most Commonly Isolated from
Bone Related Infections
2
Conclusion: These results indicate that ertapenem appears to be a
promising broad-spectrum carbapenem with a possible role against
some emerging resistant species, with an in vitro activity comparable
with that of imipenem and meropenem.
ISE.027
Achromobacter xylosoxidans: Microbiological Characteristics of
Isolates from A General Hospital in Western Caracas, Venezuela,
1998-2004
2
Background: Achromobacter xylosoxidans (formerly Alcaligenes
xylosoxidans) is a rare but important cause of bacteremia in immunocompromised patients, and strains are usually multiply resistant to
antimicrobial therapy. For these reasons we described the investigation
of documented cases of infection due to Achromobacter xylosoxidans
focusing on the antimicrobial susceptibility of isolates.
Methods: An in vitro study on antimicrobial resistance of Achromobacter
xylosoxidans clinically isolated was conducted at our institution in
Caracas, Venezuela, from January 1998 to December 2004.
Antimicrobial susceptibility for selected drugs was evaluated with disk diffusion technique according to NCCLS.
Results: For the study period, 18 cases of Achromobacter xylosoxidans
infection were diagnosed. Patient's mean age was 39.4±16.8 y-old (10
male and 8 female). Five patient had some critically illnesses and three
were surgical patients. All these infections were nosocomially acquired.
Clinical samples taken were: 6, secretions; 4, tracheal aspirates; 2,
abdominal fluid and the rest (with one per each one) were bile, abscess,
ear, external ulcer, surgical wound and pleural fluid. Antimicrobial resistance was 92.9% for amikacin, 88.9% for gentamicin, 88.2% for netilmicin
and 81.5% for aztreonam. Better antimicrobial activity was seen with
imipenem (94.1% of susceptibility) and with piperacillin (92.9% of susceptibility).
Conclusion: A. xylosoxidans isolates could be multi-resistant, for these
reasons strict infection control is needed to prevent infections due to this
organism.
ISE.028
Bloodstream Infections Due to Klebsiella pneumoniae Isolated in a
General Hospital, Caracas, Venezuela, 1997-2004
C. Rodriguez1, A. Goncalves1, B. Pastran1, P. Meijomil1, I. Jimenez1, A.J.
2
Background: Bloodstream infections (BSI) are associated with significant patient morbidity and mortality worldwide. Resistant pathogens are
increasingly isolated. Klebsiella pneumoniae resistant strains have
emerged as an important public health problem especially in BSI. The
objective of this report is to evaluate the antimicrobial resistance of K.
pneumoniae in patients with BSI in a general hospital of Caracas,
Venezuela.
Methods: We studied the prevalence of K. pneumoniae in BSI and the
occurrence of ESβL producer strains among clinical isolates. We analyzed patterns of susceptibilities to different antimicrobial agents in a
general hospital in Venezuela over an 8-year period. Antimicrobial sus-
Background: Bone infections, which can be acute or chronic, often
require aggressive antibiotic therapy, whether treated at home or in the
community. Surveillance is essential in the monitoring of antimicrobial
resistance and can act as a resource to maintain effective prescribing.
For this reason we evaluated the antibiotic susceptibility of bacteria most
commonly isolated from bone related infections.
Methods: Antimicrobial susceptibility was evaluated with the disk diffusion technique according the NCCLS, in our institution during years
1998–2004.
Results: During study period, 105 strains were isolated from bone infections in 101 patients. Mean age was 24.8±12.6 y-old, corresponding
70.3% males and 29.7% females. Isolates corresponded: 54.3% gram
positive bacteria and 45.7% gram negative bacteria. Most common
species were: Staphylococcus aureus (27.6%), Escherichia coli (17.1%),
Staphylococcus coagulase-negative (14.3%), Pseudomonas aeruginosa
(8.6%), Acinetobacter baumannii (3.8%), Enterobacter aerogenes (3.8%),
and Enterococcus faecalis (3.8%), among others. Isolated strains of S.
aureus were highly resistant to penicillin (93.1%), tetracycline (22.7%),
erythromycin (10.7%), ciprofloxacin (5.3%), gentamicin (4.8%), clindamycin (3.6% of intermediate resistant strains). No resistant strains were
observed for vancomycin, neither for teicoplanin, chloramphenicol and
even trimethoprim/Sulfamethoxazole. MRSA was isolated in 3.4%.
Isolated strains of E. coli were highly resistant to ampicillin (81.2%),
ciprofloxacin (60.0%), ampicillin/sulbactam (52.9%), gentamicin (21.4%),
cefotaxime (14.3%), cefoxitin (11.1%) and ceftriaxone (6.2%), among others. No resistant strains were observed for cefepime, imipenem and
meropenem. E. coli strains producers of ESβL were isolated in 16.7%.
Conclusion: Based on current in vitro activity, the third- and fourth- generation cephalosporins, as well carbapenems, provide broad-spectrum
coverage useful for the empirical therapy of suspected bone infections,
especially for patients treated in the community or hospitalized with community-acquired infections.
ISE.030
Antimicrobial Susceptibility of Isolates from Ophthalmological
Infections to Selected Antimicrobial Drugs
2
Background: Ophthalmological infections are a common and in some
cases vision-threatening problem. Emerging bacterial resistance to commonly used topical antibiotics has been demonstrated. Surveillance is
essential in the monitoring of antimicrobial resistance and can act as a
resource to maintain effective prescribing. For this reason we evaluated
the antibiotic susceptibility of bacteria most commonly isolated from ophthalmological infections.
Methods: Antimicrobial susceptibility was evaluated with the disk diffusion technique according the NCCLS, in our institution during years
1998–2004.
Results: During study period, 227 strains were isolated from ophthalmological infections in 227 patients. Mean age was 13.2±23.5 y-old (75.8%
occurred in <10 y-old), corresponding 55.9% males and 44.1% females.
Most common isolated species were: Staphylococcus coagulase-negative (30.8%), Staphylococcus aureus (19.8%), Escherichia coli (13.2%),
Pseudomonas aeruginosa (6.2%), Haemophilus influenzae (4.0%),
Enterobacter cloacae (3.5%), Streptococcus pneumoniae (3.5%), and
Klebsiella pneumoniae (2.6%), among others. Isolated strains of
Staphylococcus coagulase-negative were highly resistant to penicillin
(94.2%), oxacillin (70.0%), erythromycin (51.5%), gentamicin (40.8%),
tetracycline (30.4%), trimethoprim/sulfamethoxazole (23.7%), clindamycin (16.7%), ciprofloxacin (6.7%),. No resistant strains were
observed for vancomycin, neither for teicoplanin. Isolated strains of S.
aureus were highly resistant to penicillin (94.1%), erythromycin (28.3%),
tetracycline (22.7%), gentamicin (14.3%), clindamycin (7.7%),
ciprofloxacin (5.9%), trimethoprim/sulfamethoxazole (5.1%). No resistant
strains were observed for vancomycin, neither for teicoplanin. MRSA was
isolated in 34.6%. Isolated strains of E. coli were highly resistant to ampicillin (62.1%); ampicillin/sulbactam (3.4%), amoxicillin/clavulanate
(5.0%), cefoxitin (5.0%), ceftazidime (4.5%). We found high susceptibility
of E.coli for ceftriaxone (95.8%), netilmicin (96.0%) and gentamicin
(96.2%). No resistant strains were observed for amikacin, cefotaxime,
ciprofloxacin, cefepime, imipenem and meropenem. E. coli strains producers of ESβL were isolated in 3.3%.
Conclusion: This study emphasizes the importance and need of the
continued surveillance of the agents and their antimicrobial susceptibility
for the prevention and management of ophthalmological infections and
their complications.
ISE.031
Microbiological Features of Aeromonas spp. Isolates from a
General Hospital in Western Caracas, Venezuela, 1998-2004
2
Background: The genus Aeromonas comprises 14 species, although its
taxonomy has not yet been resolved. The main species considered to be
pathogenic in humans are Aeromonas hydrophila, Aeromonas caviae
and Aeromonas veronii biotype sobria. These species can cause both
gastrointestinal and extraintestinal infectious diseases. Aeromonas gastroenteritis is generally self-limiting and, except in immunocompromised
patients, antibiotic treatment is unnecessary. However, for extraintestinal
infections the susceptibility patterns should be known in order to impliment appropriate therapy. For these reasons we described the investigation of documented cases of infection due to Aeromonas spp. focusing
on the antimicrobial susceptibility of isolates.
Methods: An in vitro study on antimicrobial resistance of Aeromonas spp.
clinically isolated was conducted at our institution in Caracas, Venezuela,
from January 1998 to December 2004. Antimicrobial susceptibility for
selected drugs was evaluated with disk diffusion technique according to
NCCLS. Results: For the study period, 17 cases of Aeromonas spp. infection were diagnosed. Patient's mean age was 29.58±19.06 y-old (10 male
and 7 female). One patient was in ICU, 3 were surgical patients, 3 pediatric patients, 3 in medical wards and 8 were otupatients. All these infections were community acquired. Clinical samples taken were: stools (6),
secretions (4), abdominal fluid (2), external ulcers (2), wounds (2) and
blood (1). Isolated species were: A. hydrophila (9), A. caviae (3),
Aeromonas sp. (3) and A. sobria (2). Antimicrobial resistance was 71.4%
for ampicillin, 66.7% for cefazolin, 53.8% for cephalotin, and 42.9% for
ampicillin/sulbactam. Better antimicrobial activity was seen with
ciprofloxacin (91.7% of susceptibility), gentamicin and amikacin (92.9%
for both), ceftazidime (93.3%) and imipenem (100%).
Conclusions: Although fluoroquinolones have been reported as the first
choice treatment for Aeromonas infections, microorganisms resistant to
nalidixic acid and susceptible to ciprofloxacin are known to already have
a mutation in the gyrA gene, and can easily develop a second mutation
of resistance, generating a MIC of ciprofloxacin above the breakpoint.
Although, giving this, some authors not recommend fluoroquinolones for
the treatment of infections produced by Aeromonas spp. resistant to
nalidixic acid; we found an acceptable susceptibility for ciprofloxacin, but
imipenem should be the drug of choice.
ISE.032
Antimicrobial Activity Profile of Selected Drugs Against
Enterobacter spp. Isolated in a General Hospital of Venezuela Over
12-Year-Period
2
Instituto Experimental Jose Witremundo Torrealba, Universidad de Los
Andes, Trujillo, Venezuela
Background: Enterobacter spp. is an important clinical pathogen that
frequently exhibits resistance to third-generation cephalosporins. Its
resistance is usually due to derepression of the AmpC locus, whereas
plasmid-encoded extended-spectrum β-lactamases (ESβLs) are primarily responsible for resistance in Klebsiella spp.
Methods: We analyzed patterns of susceptibilities to different antimicrobial agents in a general hospital (West General Hospital) in Caracas,
Venezuela over an 12-year period, 1993-2004 (also including ESβLs producer strains). Antimicrobial susceptibility was evaluated with disk diffusion technique according to NCCLS.
Results: A total of 1141 strains of Enterobacter spp. were isolated in
1081 patients. Clinical samples were: secretions (21%), tracheal aspirate
(12.33%), abdominal fluid (8%), urine (7.6%), wounds (7.3%), blood
(7.2%), and catheters (6.2%), among others. From the total, 62.2% corresponded to E. cloacae, 30.5% to E. aerogenes, 6.6% to Pantoea
(Enterobacter) agglomerans. Enterobacter cloacae was highly resistant
to penicillins and cephalosporins (up to 99.2%) (figure); overall better
activity was observed with carbapenems (99.0% of susceptibility for
meropenem and 99.4% for imipenem) (figure). No resistance was
observed with ertapenem. For E. aerogenes similar patterns were
observed for penicillins and cephalosporins (up to 95.6%); better activity
was observed with carbapenems (98.3% of susceptibility for imipenem
and 98.9% for meropenem) (figure). No resistance was observed with
ertapenem. Significant differences in resistance rates were observed for
cephalosporins (p<0.05) (figure). From the total Enterobacter spp.
isolated strains, 9.99% were producer of ESβL, 12.39% of Enterobacter
cloacae and 6.9% of E. aerogenes were producer of ESβL.
Conclusion: In summary, production of ESβLs is an important resistance mechanism in Enterobacter spp.. Enterobacter spp. are becoming
increasingly important nosocomial pathogens. To prevent further emergence of multidrug resistance it may be prudent to avoid third generation
cephalosporins and instead combination therapy may be used.
ISE.033
Invitro Activity of Cefepime Against Clinical Isolates Before
Introducing to Marketing in Iran
A. Rastegar Lari1, S.H. Razavi1, H. Mostafavi2, G.H. Farzandi2, M.
Habibi1. 1Iran Medical University, Tehran, Iran; 2Exir pharmaceutical co,
Tehran, Iran
Background: Infections caused by resistant bacteria pathogens, including Gram positive and Gram negative bacteria, have become an increasing problem with respect to therapy in large medical center in Iran, which
has highly effectiveness against these organisms. The purpose of this
study was to determine invitro activity of this antibiotic against isolated
from patients, before introducing to the market, in Iran.
Materials and Methods: Invitro activity of Cefepime were tested against
304 clinical isolates samples including Escherichia coli(n=167),
Klebsiella(n=49), Staphylococcus(n=52), Psudomonas(n=18) and other
isolates(n=18), obtained during January - May 2005 from patients of
Hazrat Rasoul hospital in Tehran, Iran. MIC concentrations of Cefepime
was established using an agar dilution method, described by NCCLS.
Results: The overall resistance rate for Cefepime against all isolates was
28% and resistance by disc diffusion method was 25%. The percent of
resistance against Amoxicillin, Amikacin, Ciprofloxacin, Tetracycline,
Gentamicin and Co-trimaxazol was 97%, 12%, 25%, 38%, 10%, 13%,
65%, 21% and 52%, respectively.
Conclusion: Cefepime could be a valuable alternative for the treatment
of infections due to multiply resistant organisms in Iran especially in neutropenic patients. Hence, it seems very suitable for empiric coverage of
serious nosocomial infections.
ISE.034
Vancomycin Resistant Enterococci faecalis in Clinical Specimens
of Patients in Tehran (Iran)
A. Ramezani1, M. Mohraz2, M. Banifazl3. 1Pasteur, Tehran, Iran; 2Tehran
Medical University, Tehran, Iran; 3Iranian Society for Support Patients with
Infectious Diseases, Tehran, Iran
Objective: Recently, Vancomycin-resistant enterococci (VRE) have
become important nosocomial pathogens in the world. The drug resistant patterns of species Faecalis is variable in different parts of country.
This study was conducted to determine frequency of vancomycin resistant Enterococci faecalis in Iranian hospitals.
Methods: 296 isolates of enterococci cultured from patients during
October 2000 to September 2003 at three university hospitals in Tehran.
we identified strain's characteristics by gram stain, catalase, bile esculin,
growth in different condition 10 And 45 degree, Nacl 65%, P H: 9/6, tolerance to methylen blue, Azide Na (%0/05), tolerance 60 degree for 30
minute, optochin test. We detected species of strains by Acid production
from manitol, sorbitol, surbose, Rafinose, Ribose, Sacarose, Glyserol
All isolates were screened for their susceptibility to vancomycin(resistant
strains MIC>64µ/ml) using microbroth dilution test with standard method
(NCCLS) and disk diffusion test. We checked Beta lactamase by iodometry for all strains (Nitrocefin BBL MARYLAND USA)
Results: we detected 296 Enterococcus includes 240 E. fecalis. All isolates of this species were susceptible to vancomycin. None of the strains
produced Beta lactamase.
Conclusion: Unlike to E. faecium isolates, we didn't observed vancomycin resistant E. Faecalis isolates at Tehran hospitals. Nevertheless
we should limit antibiotic usage in our patients.
ISE.035
Serious Clinical Manifestations VZV Infection Treated With Acyclovir
N. Vucinic1, O. Dulovic2, L.J. Lesic2, B. Andric2, B. Dupanovic2. 1Clinical
Center of Montenegro, Podgorica, Serbia and Montenegro; 2Clinic
for Infectious disease, Belgrade, Serbia and Montenegro
Objective: To analyse clinical spectrum of different complication VZV
infection and effect of Acyclovir.
Materials and Methods: The study enrolled a total of 126 patients with
complicated VZV infection treated at the Institute of Infectious Disease
Belgrade (75) and in Clinical for Infectious Disease Podgorica (51) in the
period of 1993–2000. The ethiological diagnosis had been confirmed:
Clinicaly. Serologicaly (IgM to VZV positive) with lab. Investigations and X
ray the chest. All the patients treated with Acyclovir 10–15 days.
Results: 1. CNS complications of VZV were registered in 55 cases
(43,38%): Cerebelitis 33, Aseptic Meningitis 14, Meningoencephalitis 5
and Encephalitis 3. The patients had moderate neurological disorders.
Cerebrospinal findings showed moderate elevation of cells with normal
protein and sugar level. EEG and Scan of the brain were normal.
2. Varicella Pneumonia were noted in 47 cases (37,15 %). The patients
had typical sings of VZV pneumonia (miliary) with clinical evident hypoxemia. Two cases had interstitials lung fibroses as consequence. 3. The
third group in our study were patients with complications-Otitis med. Ac
in 24 (19,47 %) cases. All patients were treated with Acyclovir from the
beginning of the hospitalization during 10–15 days.
Conclusion: We conclude that incidence of CNS complications and
Pneumonia VZV were higher than in our previous experiences, as in the
next period 2000–2005. year. The course of illness was satisfactory, graditude to the treatment with Acyclovir. The outcome was within 15–40 days.
ISE.036
Resistant Enterococcus Species from Stools of Imunocompromised
Hosts
I. Zurak. University Hospital, Zagreb, Croatia
Background: Enterococcus spp. are common bacteria among the mammalian intestinal flora, billiard tract, vagina and the male urethra. Stool
with Enterococcus spp. could serve as a reservoir of endogen infection,
especially during the preoperative and postoperative intestine decontamination. Therefore, the aim of this study was to determine the species and
antimicrobial susceptibility of Enterococcus spp., the most vital and with
the highest increase of colonies on the blood agar, isolated from stools
of immunocompromised patient’s undergone intestinal decontamination.
Materials and Methods: The total 260 strains of Enterococcus spp. were
identified by standard methods. Standardized BBLTM disk diffusion
antimicrobial susceptibility test were performed using the disc diffusion
method on the Mueller-Hinton agar, as recommended by the NCCLS.
Results: The Enterococcus spp. isolates were identified as: E. faecalis,
E. faecium, E. casseliflavus, E. avium, E. hirae, E. saccharolyticus, E. gal-
linarum and E. durans. Resistance were are follows: CTX 85%, AZM
83,6%, E 73,3%, CC 72%, NOR 71,3%, CIP 69,9%, P 63,2%, Te 58,4%,
GM 57,9%, AM 48%, S 43,9 %, C 37,9%, RA 36,8%, TEI 23,8%, VA
23,5%, LZD 3,8% and FM 2,7%.
Conclusion: Frequent use of antimicrobial therapy in practice develops
resistance to antimicrobics, often causing significant therapeutic dilemmas. Emergence of multiple-antibiotic-resistant Enterococcus spp.
reflects recent changes itself and the general indiscriminate use of antibiotics in treatment of infections. Multiple resistances (from 3 to 9 antibiotics discs) were noticed in group of immunocompromised patients.
Moreover, Enterococcus has been shown to transmit these genes to
other bacterial species in turn. Enterococcus is an important group of
potentially pathogenic bacteria. Antimicrobial susceptibility surveillance
of Enterococcus species is essential for appropriate treatment of
Enterococcus infections. Vancomycin and teicoplanine resistant is
endemic in the hospital, by immunocompromised patients. Cooperation
between physicians, microbiologist is of major importance in establishing
a definitive antibiotic treatment.
ISE.037
Antibiotic Sensitivity of Typhoid Strains in Iran
M. Zangeneh1, P. Gooran1, M. Jamshidi2. 1Azad Islamic University,
Tehran, Iran; 2Hormozgan niversity, Bandar-Abas, Iran
Background: Enteric fever remains an important public health probleme
in many countries of the world and antimicrobial resistance is another
probleme. Typhoid fever is endemic in developing countries. Since regional differences in susceptibility may exist, we sought to determine the frequency of antimicrobial resistance among Salmonella isolates from
patients in Tehran.
Methods: A Retrospective Cross-Sectional Study on all patients who
had positive culture for Salmonella typhi and paratyphi from 1998 to
2003.Antimicrobial susceptibility test were donne on all cultures for 19
antibiotics for each year separately.
Results: A total number of 91 positive culture with antibacterial susceptibility patern we collected. S.typhi = 57(62.9%), S.paratyphi=34(37.4%),
male=48(52.7%), female= 43(47.3%). Overal antibiotic resistance for
each antibiotic includ: ampicillin 60.5%,
co-trimoxazol 20.9%, chloramphenicol 18.6%, ofloxacin 0.0%,
ciprofloxacin 6.8%, nalidixic acid 4.3%, cefteriaxon 8.0%, cefexim 6.7%,
ceftisoxim 0.0%, cefotaxim 3.4%, tobramicin 10%, gentamicin 4.9%,
amikacin 9.5%, tetracyclin 11.5%, erytromicin 91.4%.
Conclusion: We demonstrated the presence of decreased ciprofloxacin
susceptibility and 100% resistance to ampicillin after 6 years. It may be
necessery to alert clinicians to recognize the existance of the strains
showing decreased fluoroquinolon susceptibility.
ISE.038
Antibiotic Resistance of Staphylococcus aureus Strains Isolated
from Invasive Infections in aHospital from Romania 2002-2005
S. Iacob1, G. Ene2, M. Delagramatic1, I. Ene2, I. Macovei3, M. Popoiu1, S.
Botea1, I. Badicut1, M. Furtuna1. 1Prof. Dr. Matei Bals National Institute of
Infectious Diseases, Bucharest, Romania; 2Carol Davila University,
Bucharest, Bucharest, Romania; 3Central Military Hospital, Bucharest,
Romania
Background: Due to the increase of multidrug resistance S. aureus is
responsible for invasive life-threatening infections difficult to treat. The
aim of the study was establishing the antimicrobial resistance spectrum
of S. aureus isolated from invasive infections in 2002–2004 in comparison with 2005 in order to optimize the therapy.
Methods: The retrospective study was made on 351 patients hospitalized
at the ‘M. Bals’ National Institute of Infectious Diseases in Bucharest,
between 2002–2005, with invasive infections (sepsis or endocardithis).
Among these, 69 patients had positive blood cultures for S. aureus. The
strains were tested with E-test and the results were interpreted according to the NCCLS standards as: Susceptible (S), Intermediary (I),
Resistant (R). The following antibiotics were used for the testing: penicillin
(P), oxacillin (O), gentamicin (G), amikacin (Ak), erythromycin (E),
ciprofloxacin (Cp), levofloxacin (Lvx), moxifloxacin(Mxf), rifampicin (Rif),
clindamycin (Cd), vancomycin(Va), teicoplanin (T).
Results: Staphylococcus aureus was isolated from 69 blood cultures,
representing 19,65% of the total amount of positive blood cultures
between 2002 and 2005. Among these, 28 (40,5%) isolates were methicillin resistant (MRSA) with a constant percentage in 2005 (41%) compared to 2002–2004 (40%). No strains resistant to vancomycin or
teicoplanin were isolated. The level of resistance to other anti-staphylococcal agents is represented below (Comparative Resistance for
2002–2004 and 2005). (See Table.)
Conclusions: Classical anti-staphilococcal antibiotics usage in invasive
All strains were sensitive to vancomycin and linezolid.
S aureus infections without having an antibiogram is unsafe, due to the
high level of S. aureus resistance (>40 %) for Ox, G, E and to the moderate resistance (>15%) for Cp, Rif, Ak. A low resistance was noticed for
Cd (7,5 %) and also a lack of resistance for Va and T.
ISE.039
Comparative Susceptibility of Invasive E. coli Strains to Beta-lactamine Antibiotics Alone or Associated with Different Beta-lactamase
Inhibitors (Davulanic Acid, Sulbactam, Tazobactam)
S. Iacob1, G. Ene2, M. Delagramatic1, I. Ene2, I. Macovei3, M. Popoiu1, S.
Botea1, I. Badicut1, M. Furtuna1. 1Prof. Dr. Matei Bals National Institute of
Infectious Diseases, Bucharest, Romania; 2Carol Davila University,
Bucharest, Romania; 3Central Military Hospital, Bucharest, Romania
Background: Co-administration of Betalactamase inhibitors (BLI) and
beta-lactam antibiotics leads to a variable increase of antibacterial activity on beta-lactamase producing isolates like E. coli. The aim of the study
was to compare the increase of E. coli susceptibility for ampicillin (A),
ticarcillin and piperacillin after different BLI associations, respectively
ampicillin/sulbactam (A/S), amoxycillin/clavulanic acid (A/C),
ticarcillin/clavulanic acid (T/C), and piperacillin/tazobactam (P/T).
Methods: The study was performed on patients hospitalized with invasive infections at ‘Prof. Dr. Matei Bals’ National Institute of Infectious
Diseases in Bucharest (2002–2005). The E. coli strains sensitivity was
tested with E-test and the results were interpreted according to NCCLS
standards as: Susceptible (S), Intermediary (I), Resistant (R) for A, A/C
and A/S, Pi, P/T, Ti, T/C.
Results: From the total amount of 351 positive blood cultures, 70
(19.94%) were E. coli positive, representing the most frequent gram-negative rod isolated from blood cultures (61,8%). The compared susceptibility of E. coli strains for A, Ti, Pi and their associations with BLI is presented bellow. In vitro activity of A/C, P/T and T/C exceed those of A/S
especially for resistant E. coli. The resistance of E. coli strains is 5 times
lower for A/C then for A, 4 times lower for P/T then for Pi, 2 times lower
for T/C then for Ti and only 1.44 times lower for A/S then for A.
Conclusions: A/C and P/T were the most efficient of the tested associ-
Pen
Imp
Cro
Van
Tsk
Ery
Ofl
Lnz
R%
20
0
0
0
14
60
0
0
I%
40
46
26
0
21
6
0
0
S%
40
54
74
100
65
34
100
100
Conclusion: High resistance to penicillin and erythromycin are attributed
to empiric treatment of pneumococcal infections. Newer agents
(linezolid) are introduced for resistant strains to β-lactamic antibiotics.
ISE.041
Resistance Patterns of Resistant to Amoxicillin-Dlavoulanic Acid
E. coli and Proteus mirabilis Urine Culture Isolates During the Year
2005
A. Tsouri1, P. Karagianni2, E. Papadomanolaki1, G. Aleuraki1, A. Tsafaraki1,
A. Koutsopoulou1, P. Chatzilias3, S. Kastanakis2. 1Microbiology
Department Saint George General Hospital, Chania, Greece; 21st
Medical Department Saint George General Hospital, Chania, Greece;
3
Infectious Diseases Control Committee Saint George General Hospital,
Chania, Greece
Aim: Compare resistance patterns of resistant to amoxicillin-clavoulanic
acid E.coli and Proteus mirabilis isolates from urine cultures during the
year 2005.
Method: During last year we received 13586 urine cultures at our laboratory. Quantitative culture of specimens to appropriate nutrient substrates was performed. Identification was performed with API 20E and
system Vitek2 (Bio Merieux). Sensitivity testing took place with disk diffusion method Kirby Bauer and MIC with system Vitek 2 (Bio Merieux)
E.coli strains were isolated.
Results:
1579 E.coli strains were isolated.65 were resistant to Amc (4,11%)
225 Proteus strains were isolated.40 were resistant to Amc (17,8%)
Resistence Patterns (%)
AMP
CN
CXM
CAZ
TSU
NOR
CIP
E.coli
100
64,6
30,8
23,1
54,7
26,2
24,6
Proteus m.
100
100
85
45
82,5
75
74,4
Conclusion:Proteus mirabilis strains presented higher resistance than
E.coli to cephalosporins, trimethoprim- sulfamethoxazole, quinolones. It
is notable that resistant to Amc, E. coli and Proteus mirabilis, strains also
presented high resistance to alternative antibiotics commonly used to
treat urinary tract infections.
ations between Beta-lactam antibiotic/ BLI for invazive E. coli strains.
ISE.040
Resistance Patterns of Streptococcus pneumoniae Strains to Older
and Newer Antimicrobial Agents During 2005 at Saint George
General Hospital Chania
G. Aleuraki1, P. Karagianni2, A. Tsafaraki1, A. Tsouri3, E. Papadomanolaki3,
A. Koutsopoulou3, S. Kastanakis2. 1Microbiology Department Saint
George General Hospital, Chania, Greece; 21st Medical Department
Saint George General Hospital, Chania, Greece; 3Microbiology
Department Saint George General Hospital, Chania, Greece
Aim: Register resistance patterns of Streptococcus pneumoniae during
2005
Materials and Method: 16 strains of streptococcus pneumoniae were
isolated at General Hospital of Chania during 2005. Material used included blood cultures, cerebrospinal fluid, sputum, bronchial secretions, pus
collections. Culture, isolation and identification took place with classical
microbiological methods. Susceptibility to optocin was used (the presence of zone of growth inhibition of 14mm around a 6mg disk after incubation, identified the organism as pneumoniococcus) along with GP Vitek
2 (Bio Merieux). Minimal inhibitory concentration was determined with
Vitek2 system. Additionally E- test was performed. (Bio- Merieux)
Results: Resistance to penicillin G was found in 20% and Intermediate
in 40% of strains. Increased resistance to erythromycin 60% and to TSX
14% was notable.
ISE.042
Resistance Patterns of E. coli, Proteus mirabilis and Klebsiella
pneumoniae Isolated from Urine Cultures During 2005 at General
Hospital Chania, Greece
A. Tsafaraki1, A. Tsouri1, P. Karagianni2, E. Papadomanolaki1, G. Aleuraki1,
M. Athanasaki1, P. Chatzilias3, S. Kastanakis2. 1Microbiology Department
Saint George General Hospital, Chania, Greece; 21st Medical
Department Saint George General Hospital, Chania, Greece; 3Infectious
Diseases Control Committee Saint George General Hospital, Chania,
Greece
Aim: Compare resistance to antibiotics of main urine culture isolates
(E.coli, Proteus mirabilis, Klebsiella pneumoniae)
Materials and Method: During the year 2005, 13500 urine cultures were
performed out of which 3293 were positive (24,4%). Quantitative culture
of specimens to appropriate nutrient substrates was performed.
Identification took place with API 20E. Sensitivity testing was performed
with disk diffusion method Bauer-Kirby and MIC with Vitek 2 (BioMerieux).
Results: From 3293 positive urine cultures we isolated:
- 1596 E.coli strains (48,4%)
- 226 Proteus mirabilis (6,86%)
- 163 Klebsiella pneumoniae (5,25%)
- 40 Klebsiella oxytoca (5,25%)
Resistence Patterns (%)
AMP AMC CEC CXM AKN TSU
NOR CIP
E.coli
32
24
5
5
Proteus m.
48
18
22
17
2
35
18
18
Klebsiella spp
94
17
24
24
7
24
17
11
4
6
4
0,5
Conclusion: Most frequently isolated pathogen was E.coli (48,4%).
Proteus and Klebsiella presented higher resistance to Amp, Amc, 2nd
generation cephalosporins and quinolones than E. coli. Knowledge of
prevalent organisms and their current resistance are essential for efficient infection control and prudent use of antibiotics.
ISE.043
Antimicrobial Susceptibility of Isolated Escherichia coli from Urine
Specimens
G. Eslami1, F. Fallah2, H. Goudarzi3, J. Mardaneh3. 1Medical Faculty of
Shaheed Beheshti University, Tehran, Iran; 2Pediatric Infectious Research
Center, Tehran, Iran; 3Medical Faculty of Shaheed Beheshti Univ, Tehran,
Iran
Background: The objective of this study was identified antimicrobial susceptibility of Escherichia coli strains were isolated from urine specimens.
Materials and Methods: In this investigation 98 Escherichia coli strains
were isolated by culture of urine specimens on bacterial culture media
such as blood agar and EMB agar. Fore identified of antimicrobial susceptibility used from Kirby Bauer method according recommendations of
National Committee of Clinical Laboratory standards.
Results: 81.6% of Escherichia coli strains were susceptible to cefizoxim,
77.5% to jentamycin, 73.4% to ciprofloxacin, 71.4% to cefteriaxon, 51%
to sulfamethoxazol, 48% to nalidixic acid and 47.9% to cefexime.
Conclusion: Our data indicate that susceptibility of Escherichia coli
strains to third generation of cephalosporin is decreasing thereby is
essential to select antibiotics and to establish guidelines for treatment of
Escherichia coli urinary tract infections.
ISE.044
Genotyping of Vancomycin-resistant Isolates of Enterococcus faecium in Iran
K. Borhani, A. Ahmadi, N. Lofti, M. Pourshafie. Pasteur Institute of Iran,
Tehran, Iran
Introduction: Enterococci are the most important members of gut normal flora and it is one of the most important causes of community acquired infections. The bacterium is the third causes of nosocomial
infection and causes UTIs, bacterimia and endocarditis. Resistance to
vancomycin has become an major obstacle in the treatment vancomycin
resistant enterococci (VRE). This study was accomplished on the genotyping of VRE isolated from the sewage treatment plants in Iran.
Methods: Fifty seven vancomycin resistant isolates of Enterococcus faecium were studied. Plasmid profiling was done and the presence of vanA
and vanB genes were determined. RFLP of the vancomycin cassette was
also performed.
Results: The results showed that the isolates could be grouped into 13
different profiles. Several plasmid bands were common among the isolates. The number of strains carrying vanA and vanB genes were 96 and
14%, respectively.
Conclusion: An increase in the level of VRE deposited in the environment in Iran is alarming.
ISE.045
Evaluation of Cotrimoxazole MIC for Echerchia coli by E-test in
Clinical Samples of lmam Reza Hospital, Khorasan, Province of Iran
A.A. Heydari, T. Rashed, M. Khalilizadeh, M.R. Sarvghad. Mashad
University of Medical Sciences, Mashad, Iran
Introduction: The method of Etest is a acceptable method in determination of MIC of bacteria for antibiotics that can use for evaluation of
microbal resistance in a region with attention to increasing rate of bacterial resistance.
Method: This study have been carried out on 79 patients with positive E.
coli urine cultures in Khorasan Province of IRAN, since 1383 for one year
and the sensitivity of this bacterium to cotrimoxazole have been investigated via Etest method.
Results: 68.35 % of patients were men and 31.65% were women from
whom 40.51% were outpatients cases and the rest of them were hospitalized in different departments of the hospital.75.3% of the urine cultures
were resistant to cotrimoxazole. The average MIC of cotrimoxazole for
the whole population was 23.8.
Conclusions: The resistance rate of E. coli to cotrimoxazole is very high
and it can not be advised for treatment of urinary tract infections due to
E. coli.
ISE.046
An in Vitro Activity of Cefoperazone/Sulbactam Against Clinical
Strains of ESBL Producers Isolated in Poland
A. Sawicka-Grzelak, A. Rokosz, M. Luczak. Medical University of
Warsaw, Warsaw, Poland
To determine an in vitro acivity of cefoperazone/sulbactam against
ESBL-positive clinical strains of Gram-negative rods isolated from hospitalized patients.
Experiments were performed with ESBL-positive strains of Gram-negative rods isolated from clinical samples during three months (November
2005-January 2006). The strains were identified in automatic ATB
Expression system (bioMerieux sa) using biochemical ID 32 GN and ID
32 E tests. Extended-spectrum beta-lactamases (ESBLs)were detected
by three methods: the double-disc synergy test (DDST), the diagnostic
disc test (DD, Oxoid Ltd, UK) and Etest ESBL (AB Biodisk, Sweden).
Susceptibility ESBL producers to cefoperazone/sulbactam was determined with gradient diffusion method Etest and with disc diffusion
method according to CLSI (NCCLS) recommendations. MIC value of cefoperazone/sulbactam was assessed for each strain.
Eighty four ESBL-positive strains of Gram-negative rods (14.5% of all
strains) were detected. The greatest number of these strains (63) were
isolated from urine samples of patients hospitalized in transplantology
(28 strains) and urology (14) wards. Among 84 ESBL-producing strains,
74-belonged to enteric rods and 10-to non-fermentative rods. The greatest number of strains belonged to the species Serratia marcescens (19
strains) and next-to the species Enterobacter cloacae (18). Forty strains
(47.6%) were susceptible (S) in vitro to cefoperazone/sulbactam, 20
(23.8%) - intermediately susceptible (I) and 24 (28.6%) - resistant (R)
using Etest. Thirty seven strains (44%) susceptible to cefoperazone/sulbactam, 31 (37%) - intermediately susceptible and 16 (19%) - resistant
were detected by disc diffusion method.
Cefoperazone/sulbactam demonstrated an in vitro quite high activity
against nosocomial ESBL-positive strains of Gram-negative rods. Some
inconsistent results (Etest vs disc diffusion method) concerning cefoperazone/sulbactam activity were observed. Cefoperazone/sulbactam may
be applied in therapy of infections caused by ESBL producers susceptible in vitro to this combination according to the Etest results.
ISE.047
Comparison of the Etiologic Agents and their Antibiotic
Susceptibilities in Pediatric and Adult Patients in Community
Acquired Urinary Tract Infections
O.A. Aydin1, M.S. Alan2, K.K. Yasar2, F. Aydogan3. 1JFK Hospital Istanbul
and Haseki Training and Research Hospital, Istanbul, Turkey; 2Haseki
Training and Research Hospital, Istanbul, Turkey; 3Malatya State
Hospital, Malatya, Turkey
Background: The microorganisms isolated from urinary cultures and differences of antibiotic susceptibilities in adult and pediatric groups were
investigated.
Methods: In JFK Hospital urine specimens of 2084 pediatric and 773
adult patients were investigated. The antibiotic susceptibilities were tested by Kirby-Bauer disc diffusion test according to CLSI standards.
Results: In 425 of 2084 pediatric urine specimens (20.3%) and in 136 of
adult urinary specimens (17.5%) an agent was isolated. Both in pediatric
(70.6%) and adult (82.4%) groups Escherichia coli was the most frequently isolated agent. The other most frequently isolated agents in the
pediatric group were Proteus spp (11.8%), Klebsiella spp (5.9%),
Enterobacter spp (5.6%), Pseudomonas spp (5.6%) and Enterococcus
spp (0.5%). In the adults the other most frequently isolated agents were
Pseudomonas spp (5.9%), Klebsiella spp (5.1%), Enterococcus spp
(2.9%), Enterobacter spp (2.2%) and Proteus spp (1.5%). Ciprofloxacin
is frequently used in adults. Resistance to ciprofloxacin was 19.5% in the
adult and only 3% in the pediatric group (p<0.001). The resistance to
cefixime and ceftriaxone which is frequently chosen in the pediatric
patients was 22.5% and 14.5%. In the adult group the same ratios were
14.1% and 7.3%. Cefixime and ceftriaxone resistances are significantly
higher in the pediatric group (p<0.05 and p<0.05). Gentamicine resistance rate was 2.8% in pediatric and 0.8% in adult patients. The difference was not significant (p>0.05).
Conclusion: There is a tendency to development of resistance to firstline antibiotics which are more frequently used. Urinary cultures should
be done before instituting the empirical treatment. Both the treatment and
its possible success can be reassessed with the antibiogram and the
evolving resistance patterns can be followed up.
ISE.048
Papilledema—An Unusual Finding—in a Patient with Herpes
Encephalitis
A. Sudbakhsh, M. Mashayekh, S. Ghazvinian, B. Omidzohur. ATIEH
Hospital, Tehran, Iran
Herpes simplex virus accounts for 10 to 25% of sporadic viral encephalitis throughout the world among people of different age with two peaks,
one at 5 to 30 and the other at >50 years of age. Pathologic process
includes focal brain tissue inflammation and necrosis (predominantly
Temporal lobe).Therefore local neurological signs and symptoms will
ensue. Although CSF pressure rising due to inflammation is expected,
papilledema which is defined as a noninflammatory congestion of optic
disk due to raised intracranial pressure has not yet been mentioned as a
sign of focal encephalitis. In this article we report a 24 year-old patient
with headache, fever and some degree of cognition disorder who was
definitely diagnosed (with MRI and PCR technique) and treated for herpes encephalitis. Unexpectedly he had papilledema which led to more
investigation. Most signs and symptoms disappeared during two weeks
of intravenous acyclovir therapy as did papilledema to some extent. In
this case, positive CSF PCR test for HSV confirmed the diagnosis.
However it seems that along with starting acyclovir therapy, performing
other supplementary studies (e.g. CT scan, MRI with and without I.V.
contrast, CSF cytology and serologic tests for HIV) to rule out other conditions that may be associated with papilledema and focal neurological
signs (like malignancies), is mandatory.
ISE.049
Investigation of the Extended-Spectrum Beta-Lactamase
Production of Escherichia coli and Klebsiale pneumoniae Strains
Isolated from the Urine
K.K. Yasar, G. Sengoz, F. Yildirim, O. Nazlican. Haseki Training and
Research Hospital, Istanbul, Turkey
Background: The extended spectrum beta lactamase (ESBL) production of the E.coli and K. pneumoniae strains isolated from the urine samples referred to our laboratory by the urology clinics from January 2004
to August 2005, were investigated.
Methods: Of the patients whose middle flow urines were taken, age,
underlying disease, catheterization, urological operation and existence of
antibiotic usage history were clinically investigated. Urine cultures were
implanted in the suitable mediums and incubated at 35 to 370 C for 24 to
48 hours. The strains isolated by conventional biochemical methods and
API ID 32E (Bio Merieux France) and at the level of species, were tested about antibiotic sensitivities through disk diffusion method and, by
double disk diffusion method, related to ESBL production.
Results: From the urine samples sent to our laboratory 224 E.coli and
16 K. pneumoniae were produced. ESBL was observed in 16 of the E.coli
strains (7%) and 7 of the K. pneumoniae strains (44%). 6 of the 23 strains
producing ESBL were female, 17 were male, 4 were children and 19
were between the ages 24 to 82. 7 of the patients (30%) had previous
antibiotics use, 13 had stones in the urinal tract, urinary tumors, catheterization and urological operation history. In 81% of the E. coli strains producing ESBL ciprofloxacin and 44% had aminoglycoside, 57% of the K.
pneumoniae strains had ciprofloxacin and 71% had aminoglycoside
resistance.
Conclusion: ESBL production is a very significant resistence mechanism for the gram negative enteric bacteria. Use of the 3rd generation
cephalosporine is a preparative factor for ESBL and provides the
grounds for colonization of strains producing this enzyme in the patients,
and infection by such strains after catheterization and significant surgeries. In such enteric bacteria producing ESBL, the agents such as kinolon,
aminoglicosyte also would be multi-drug resistant while there are restricted options in treatment.
ISE.050
Ribotyping of Multidrug Resistant E. Faecalis and E. faecium
Strains Isolated from Clinical Samples in Iran
M. Saifi1, M.H. Solltandalal2, M. Pourshafie1. 1Pasteur Institute of Iran,
Tehran, Iran; 2University of Tehran, Medical Sciences, Tehran, Iran
Background: Enterococci have gained increasing clinical importance
because of changes in nosocomial infections and antibiotic use patterns.
The emergence of multidrug resistant strains of Entercocci is the serious
problem in therapeutic aspects. In this study we determined the ribotyping pattern for the multiple drug resistant (MDR) strains of E. faecalis and
E. faecium isolated from the clinical samples.
Methods: 120 Enterococci isolates from various sites were obtained during 10 month-period from June 2005 to January 2006. The strains were
screened for the resistance to ampicillin, gentamicin, vancomycin,
ciprofloxacin, nitrofurantoin, tetracycline, erythromycin and chloramphenicol by disk diffusion method. The genomic DNA from the isolates was
extracted with mutanolysin and ribotyping with BamHI digestion was done.
Results: Of the 120 enterococci isolates, a total of 49 strains were MDR.
Strain distribution was E. faecalis 32 (72%) and E. faecium 17 (18%).
Resistance to 2, 3, 4, 5 and 6 antibiotics simultaneously were 12%, 10%,
22%, 15% and 22%, respectively. Ribotyping of the isolates using DIGlabelled probes following by digestion with BamH1 restriction enzyme
showed that the strains contained between 6 to 10 DNA bands.
Discussion: The results suggested that about 40% of the isolates were
MDR in Iran. E. faecalis showed higher level of MDR strains than E. faecium. The ribotyping of the isolates indicated that the strains are polyclonal and the E. faecium and E. faecalis could be grouped into several,
but limited number of ribotyping patterns.
ISE.051
Mupirocin Resistance in Methicillin-resistant Staphylococcus
aureus Isolates in Two Turkish Hospitals
I. Dolapci1, Z.C. Karahan1, A. Tekeli1, E. Koyuncu1, A. Azap2, R. Adaleti3.
1
Ankara University School of Medicine Department of Microbiology and
Clinical Microbiology, Ankara, Turkey; 2Ankara University School of
Medicine Department of Infectious Disease, Ankara, Turkey; 3Istanbul
Haydarpasa Numune Hospital Microbiology and Clinical Microbiology
Laboratory, Istanbul, Turkey
Background: Methicillin-resistant S. aureus (MRSA) has emerged as an
important pathogen in community-acquired and nosocomial infections.
The unique bactericidal action of mupirocin makes it one of the few
antibiotics still effective against MRSA. The purpose of this study was to
determine mupirocin resistance in Methicillin resistant-Staphylococcus
aureus(MRSA) which were isolated from skin wounds of in- and outpatients from two distinct hospitals located in Ankara and Istanbul.
Methods: A total of 143 MRSA strains were investigated at Ankara
University, School of Medicine, Department of Microbiology Laboratory.
We examined mupirocin resistance with modified Kirby-Bauer disk diffusion method according to the NCCLS standarts and confirmed by MIC
determination with E-test strips.
Results: Among 143 MRSA isolates, mupirocin resistance was not
detected with disk diffusion and E-tests, and overall mupirocin sensitivity
was 100%.
Conclusion: It is known that both MRSA and mupirocin resistant MRSA
were the most diagnosed isolates from the clinical wound cultures. During
the last few years the number of mupirocin resistant S.aureus, particularly MRSA, has risen up dramatically with the increased topical usage of the
agent. We carried out this study to investigate the incidence of mupirocin
resistance among MRSA in two distinct hospitals in Turkey. The results
suggest that there is no resistance to mupirocin in our hospital isolates.
ISE.052
Regional Differences in Activity of Tigecycline Tested Against
Acinetobacter Spp.: Results from a Global Surveillance Programme
(2003-2005)
T.R. Fritsche, H.S. Sader, P. Strabala, R.N. Jones. JMI Laboratories,
North Liberty, IA, USA
Background: Acinetobacter spp. (ASP) can cause serious nosocomial
infections that have emerged in most geographic regions, often displaying resistance (R) to expanded spectrum agents, including carbapenems. This study compares the activity of tigecycline (TIG), a novel broadspectrum glycylcycline recently approved for treatment of skin and soft
tissue and intra-abdominal infections, with comparator agents against a
large collection of ASP recovered from patients in Europe (EU), North
America (NA) and Latin America (LA).
Methods: All clinically significant ASP strains(1,029) collected from a
TIG global surveillance program (2003–2005) were centrally processed
using CLSI reference broth microdilution methods and interpretive criteria. In the absence of ASP TIG breakpoints, those for Enterobacteriaceae
(2/4/8 mg/L for S/I/R) were used for comparative purposes.
Results: TIG was the second most active agent tested against all ASP
isolates (MIC50/90, 0.5/2 mg/L) with 94.8% of strains being inhibited by ≤
2 mg/L; only polymyxin B (PB) displayed greater activity (MIC50/90, ≤1/≤1
mg/L; ≥ 99.2% S [see Table]). Imipenem coverage varied from a low of
66.8% S in EU to a high of 93.4% in NA. TIG was least active against
ASP from NA (MIC90, 4mg/L; 89.3% S), and most active against those
from LA (MIC90, 2 mg/L; 98.5% S), a situation reversed for all other
agents. All comparators (other than PB) were more active against NA
strains (49.0-93.4% S) than against those from EU (33.7-66.8%) or LA
(25.9-84.3%, see Table), reflecting the significant emergence of R patterns recognized by other studies.
Conclusions: Remarkable inhibitory effects (94.8% at 2 mg/L, >99%
at 4 mg/L) of TIG was observed against this inherently-R population of
ASP; only PB exhibited greater activity (> 99% S). TIG may represent
a welcome addition to the few remaining parenteral agents highly active
against this pathogen group, especially in regions where multidrug-R limits therapeutic options.
ISE.053
Prevalence of Markers of Viral Hepatitis Among Blood Donors
L.J. Pockova1, S. Bisinova-Eftimova2, S. Miskova2. 1Department of
Transfusion, Veles, Former Yugoslav Republic of Macedonia;
2
Department of Infectious Diseases, Veles, Former Yugoslav Republic of
Macedonia
Background: Viral hepatitis infections belong to the most widely spread
viral infections in Republic of Macedonia and they are serious medical
and social problems. The aim of this study is to analyse the prevalence
of Hepatitis B and Hepatitis C infections in voluntary blood donors in
Department of Transfusion in Veles.
Methods: This work is five years retrospective analysis. We examined 11
948 blood units from healthy voluntary donors, 80% male and 20%
female, aged between 20–40 years. Serological detection of HBsAg and
antiHCV with ELISA methods on IMX machine with ABBOT diagnostic
tests III and IV generation were used.
Results: In the period between 2001–2005 of total 11 948 blood units,
HBsAg positive were 135 (1,228%) and 19 (0,173%) were antiHCV positive. We have found both HBsAg and antiHCV at neither of the analysed
units.
Conclusion: Prevalence of HBsAg positive (1,228%) among vonluntary
blood donors with different religious and nationally belonging in our city
is in correlation with statistics in literature. Prevalence of antiHCV positive (0,173%) is higher in comparison with other European people. That
is why improvement of public and medical measures and preventive
working with young population by health education and imunisation
against hepatitis B are the only way to prevent these infections.
ISE.054
Comparative Investigate of resistance in Ureaplasma urealyticum
from different samplers of the same patients
E. Manasievska1, S. Makrevska1, S. Josifovska2. 1Public Hospital,
Kumanovo, Former Yugoslav Republic of Macedonia; 2Public Hospital
Kumaovo, Kumanovo, Former Yugoslav Republic of Macedonia
Urogenital mycoplasmas are the smallest high pleomorf bacterias without cell wall, whose very success in lab autoreplication. As part of the
normal flora, they are opposite in number > 10, were caused genital
infections. Ureaplasma urealyticum (U.urealyticum ) is present in genital
tract at 5-20% of sexual active male and 40-80% of active female.
Aim of the Study: Comparative investigate of U.urelyticum isolate and
present of difference resistance into the antimycrobs results with frequency in resistance of uretral isolate, especially to the patients in recidivate. There is a question in validity of urine as a sample.
Materials and Methods: On 23 species of U.urelyticum isolate (comparative) in the same patients we saw a difference in resistance of standardizing antibiotics who were covered on commercial strip: Mycoplasma IST
2 (bioMerieux - France).
Results: All of the examined urine isolate species were resistant to
ciprofloxacine. Ten (10) from them had the same reaction on erythromycin. The higher resistance than mentioned below, were with tetracyclin,
ofloxacin, azithromycin and claritromycin.
Susceptible of the prystinamicin and josamicin were 100%.
Conclusion: Origin of the rezistation in U.urealyticum, were in common
with the difference of antimycrobs agents. Resistance of erythromycin
and flurokinolorite were caused by the mutation of the chromosomes.
Tetracycilne resistance was in transmission of genes from resistant to
normal floral of those different resistance were caused because "target"
of drugs were not “touched,” and there were no stronger concentration of
medication. Because of all those it results with persistent of resistant
mutant in vital organ as urethra in this case. At least we can conclude that
this empiric therapy was not satisfied with the results what we reach.
ISE.055
MRSA in Children
S. Noorbakhsh, M. Farhadi, S.H. Rimaz, A. Tabatabaei. Iran Medical
University, Research Center of Ped. Infectious Diseases, Tehran, Iran
Introduction: The changing epidemiology of MRSA became evident in
the 1990s when community-acquired MRSA cases were first reported.
Increasing prevalence of MRSA will inevitably increase vancomycin use,
adding further to the problem of antimicrobial resistance.
Previous retrospective study during 1996–1998 years in Rasool Akram
hospital determined increasing prevalence of MRSA. The goal of this
prospective descriptive study is to determine the antibiotic resistance of
Staphylococci spp responsible for upper respiratory infection in children.
During Dec 2001, to Dec 2003, we surveyed seventy three Staphylococci
spp (78.1 %s.aur; 21.9% coagulase negative) obtained from children
(1month-14y) after ENT surgery (otitis media; mastoiditis; sinusitis; tracheostomy). All isolates (blood; CSF or other sterile boy fluid) after culturing and antibiogram evaluated first by disc diffusion and then Etesting
for MIC detection.
It results increasing resistance to penic (100% vs 70%); genta (56.3% vs
30%); but decreasead for erythro (47% vs 66%); oxaci(11.6%vs40%);
chloram (15.4% vs22%). Only 6.8% of s.aur and 25% of coagulase negative staph are MRSA. MRSA prevalence is (6.4%) similar to previous
study (5.4%) and not significant increasment during 4 years. Sensivity of
oxa; chlora not differ with vanco as gold standarden but significant for
erythro; Thrime/sulfa; Amox/clav. Probably; resistance (>50%) of
Staph.spp are due to penicillinase producing by these organisms. By
using of penicillinase inhibitor or other non beta lactame antibiotics more
than 80% antibiotic coverage will achieve; in minority (6.8%) of cases
vancomycin is needed.
We conclude MRSA prevalence is rare in present study. Therefore, vancomycin is not appropriate for empiric therapy in all Staphylococcal suspected infection. Penicillin is not appropriate for Staphylococcal suspected children. PRP plus one of the Genta; Rifam; clinda; chloram or
Trime/Sulfam in severe disease recommend. Where staphylococci may
be involved in more extensive infections, the empiric use of clindamycin
provides appropriate coverage, including the majority of communityacquired MRSA strains. Limiting broad spectrum antibiotic use will minimize the antibiotic pressure that favors selection of resistant strains. In
severe, invasive staphylococcal infections, such as severe pneumonia or
toxic shock syndrome, inclusion of vancomycin in an empiric antibiotic
regimen may be prudent initially, particularly among children with predisposing risk factors for MRSA carriage.
ISE.056
Characterization of Resistance to Fluoroquinolones in E. coli Isolates
from Urinary Tract Infection
S. Sellaoui, R. Ghozzi, S. Ben Redjeb. Laboratoire de Recherche
''Résistance aux Antibiotiques'' Faculté de Médecine, Tunis, Tunisia
Background: The resistance of E.coli to quinolones has remained rare
until recently, when the widespread use of fluoroquinolones as therapy
for urinary tract infections has been associated with the emergence of
resistant. In most cases, quinolone resistance was correlated with mutations located in the quinolone resistance determining region (QRDR) of
gyr A where the mutations were sites ser 83 and asp 87 were located.
The aim of this study was to determine the level of resistance and the
involved mechanisms.
Methods: 111 quinolone resistant E.coli strains were recovred from urinary tract infection (UTI) at Charles Nicolle hospital of Tunisia during
2003. Isolates were identified by Api system 20E. Antibiotic susceptibility
was determined using the disc diffusion method according to the NCCLS
guidelines, MICs of nalidixic acid, ofloxacin, ciprofloxacin and norfloxacin
were determined by agar dilution method. E.coli ATCC 25922 was used
as control strain. Detection of mutations was done by RFLP-PCR using
Hinf I restriction enzyme. E.coli ATCC 25922, E.Coli lmf E7 and E.coli
Nor E6 were used as control strains.
Results: The isolates were recovered especially from urology (54,7) followed by medicine (11.9) wards. All strains had the same phenotype
Nalidixic acid R, Ofloxacin R, Ciprofloxacin R.The MIC confirmed the
high level resistance. MICs results were reported in the table below:
Quinolones
MIC range (µg/ml) MIC50 (µg/ml)
Nalidixic acid
64 - >2048
2048
2048
MIC90 (µg/ml)
Ofloxacin
16 - >256
64
256
Ciprofloxacin
16 - 1024
64
256
Norfloxacin
8 - 2048
256
2048
The Hinf I restriction enzyme digestion showed that all our strains carried
a double mutation at positions ser 83 and asp 87.
Conclusion: A high level of quinolone resistance of E.coli isolates from
UTI was observed, mainly due to the presence of mutations in the DNA
gyrase gene, and can be attributed to the extensive use of these antimicrobials.
ISE.057
Monitoring of Antimicrobial Resistance in Bacteremic Isolates from
Slovakia During 2002–2004
J. Blahova, K. Kralikova, V. Krcmery Sr., M. Babalova. Slovak Medical
University, Bratislava, Slovakia
Background: The aim of this study was to monitor the prevalence of
pathogens and development of resistance in bacteria isolated from bacteremic patients in Slovakia.
Methods: Six University Clinics and/or Regional Hospitals in Slovak
Republic participated in the study and a total of 2214 isolates were collected from July 2002 till December 2004. Microbiological diagnosis was
performed according to standardized methods. Antimicrobial resistance
of selected antibiotic was estimated by the disc diffusion method.
Results: The most prevalent grampositive organisms were coagulase
negative staphylococci (CONS) (29,2%), followed by Staphylococcus
aureus (13,9%), and enterococci (5,7), among Gram-negative bacteria
Escherichia coli (14%), Klebsiella pneumoniae (8,8%), Pseudomonas
aeruginosa (6,8%) followed by Enterobacter spp. and Acinetobacter spp.
Resistance to oxacillin was observed for 55% to 74% of CONS and for 219% of S. aureus isolates. Resistance to amoxicillin-clavulanate
increased from 9 to 48% and to ciprofloxacin from 7 to 29% in E. coli!
Resistance of K. pneumoniae to ciprofloxacin increased from 19% to
62%. The most effective antibiotics against P. aeruginosa were meropenem, amikacin, piperacillin-tazobactam. The resistance to ceftazidime
increased from 13 to 40% and striking is low activity of ciprofloxacin to P.
aeruginosa during study period (40–60%). Imipenem retained 100%
activity against Enterobacter spp. isolates; however, considerable was
increasing of resistance to ciprofloxacin (from 15 to 58%). Resistance
rates in Acinetobacter spp. to ceftazidime and ciprofloxacin was 60–83%,
respectively 60–88%.
Conclusion: CONS, E. coli and S. aureus have been identified as the
most frequent causal agents of bacteraemia. The most significant rise in
resistance has been observed in ciprofloxacin against Enterobacter spp.,
E. coli and K. pneumoniae. These results urge us to apply decisive measures to restitute and maintain the efficacy of fluoroquinolones in Slovakia.
Considerable is still good activity of carbapenems in gramnegative and
100% efficiency of vancomycin and teicoplanin in grampositive bacteria.
ISE.058
Emerging Clone of Methicillin-Resistant Gentamicin-Susceptible
Staphylococcus aureus as Agent of Nosocomial and Community
Infections, in Uruguay: 13 Years Surveillance Study
W. Pedreira1, M. Mansilla2, M. Gonzalez2, M. Dotta2, L. Batista2, I. Guider2,
G. Machado1, W. Vicentino1, F. Buela1, M. Viola1, S. Benaderet1, A.
Rodriguez1, V. Mendez1, M. Oficialdegui3. 1Centro de Asistencia Sindicato
Medico. Seccion Microbiologia. Uruguay, Montevideo, Uruguay; 2Centro
de Asistencia Sindicato Medico.Comite de Control de Infecciones.
Uruguay, Montevideo, Uruguay; 3Centro de Asistencia del Sindicato
Medico del Uruguay. Seccion Microbiologia. Uruguay, Montevideo,
Uruguay
Methicillin-Resistant staphylococcus aureus (MRSA) is the most frequent
cause of nosocomial infections, showed a homogeneous resistant to
methicillin and: gentamicin (GM), cotrimoxazol (SXT) erythromycin, clindamycin, ciprofloxacin. In 1993 we found 2% of MRSA GM and SXT susceptible in older patients with skin infections. Following the epidemic of
CA-MRSA infections (2003) and the increase use of ciprofloxacin, clindamycin and mupirocin the GMS MRSA reach a predominant level.
Institution: 420 beds, 42 ICU. MRSA strains isolated in 1993, 2004–2005
from clinical samples were classified as nosocomial or community
acquired according CDC risk factors.
Disk diffusion method (NCCLS) and CLSI guidelines for oxacillin (1µg)
cefoxitin (10-30µg), erythromycin, clindamycin, ciprofloxacin, SXT, GM,
rifampin, vancomycin, Fusidic acid and mupirocin according to French
and British breakpoints. Tobramycin, kanamycin and streptomycin were
added for GM susceptible (GMS) isolates. MIC to mupirocin were determined by E. test. Random selected strains were study with SCCmec
types by PCR at Juntendo University, Japan 2004.
MRSA N: 540, 20 in 1993, 35: 1998, 395: 2004/2005.
GMS MRSA N: 424: blood 25 (6%), deep infections 27 (6%), traqueal secretions 89 (21%), wounds and purulent lesions 283 (67%). 65% in outpatient.
MR MRSA 1993: 13%, 1998: 20%, 2004: 2.4%, 2005: 10%. Brazilian clone
GMS MRSA: tobramycin, kanamycin, erythromycin, clindamycin,
ciprofloxacin, mupirocin resistant MIC 8-64 mg/l Low Level. This phenotype increase 1993: 2%, 2003: 2.4%, 2004: 50%, 2005: 87%.
Genotypic Results: MR MRSA cassette III (4 strains) y GMS MRSA
cassette II (8 strains)
Patients mean age: 73 years (39–93) 80% males, all with risk factors:
health care related, chronical illness: diabetic foot infections, vascular
insufficiency, malignancy.
Like worldwide, we have a replacement of multi resistant MRSA clones
toward more susceptible strains by lost of resistant genes codified in
transposons plasmids and virulence genes in favor of fitness. Determine
changes in infections control policy.
ISE.059
Antimicrobial Susceptibility of Pseudomonas aeruginosa from
Cystic Fibrosis Patients
M. Perez-Monras1, M.C. Battle-Almodovar1, J. Verdera-Hernandez2, A.
Llop-Hernandez1. 1Pedro Kourí Institute, Havana, Cuba; 2William Soler
Hospital, Havana, Cuba
Ninety strains of Pseudomonas aeruginosa species, isolated from pediatric patients from William Soler Hospital, suffering from cystic fibrosis and
respiratory infections were studied, as part of a Joint Research Project
between this hospital and the Pedro Kouri Tropical Medicine Institute.
Susceptibility to 10 antimicrobial drugs (azlocillin, ceftazidime, cefotaxime,
ceftriaxone, gentamicin, tetracycline, ciprofloxacin, ofloxacin, chloramphenicol and trimethoprim/ sulfemethoxazole) was studied through the
Kirby-Bauer disk diffusion method. This method was standardized, using
the reference strain Pseudomonas aeruginosa ATCC 27853. The values
of the antimicrobial susceptibility fell within the accepted limits. An
increased resistance to chloramphenicol (87,03%) and to
trimethoprim/sulfamethoxazole (92,28%) was observed. While a high susceptibility was found with azlocillin (85,0%), ceftazidime (87,09%), gentamicina (94,09%), ciprofloxacin ( 94,8%) and ofloxacin ( 92,5%).
ISE.060
Activity of Disinfectants to Clinical and Environmental Strains of
Bacteria and Fungi
A.E. Laudy1, A. Kowalczuk1, B. Podsiadlo2, K.W. Pancer3, H.
Stypulkowska-Misiurewicz3, A. Gliniewicz3, E. Mikulak3, B.J. Starosciak1.
1
Medical University of Warsaw, Warsaw, Poland; 2Marie SklodowskaCurie Memorial Cancer Center and Institute of Oncology, Warsaw,
Poland; 3National Institute of Hygiene, Warsaw, Poland
The biocide resistance is an emerging problem in recent years, but little
is known about the microorganisms susceptibility to disinfectants. The
other problem is the presence of German cockroaches (Blattella germanica L.) in hospital and home environment. Cockroaches play role in carrying pathogens in environment.
The aim of this study was to determine the activity of two disinfectants
(glucoprotamine GT and monopotassium persulfate MPS) to bacteria
and fungi isolated from different environments - there were clinical isolates, strains from the body of cockroaches caught in hospitals and in
houses. Fungal strains were isolated from hospital environment only.
Those products are commonly used for surface disinfection in Poland.
Antibacterial and antifungal activity was examined by the MIC method
according to NCCLS.
Totally, the sensitivity of 160 microorganisms was determined: 100
strains of Gram-negative rods (80 enterobacterial strains, 20 of non-fermentative Gram-negative bacteria), 45 strains of Gram-positive cocci, 12
strains of Candida sp. and 3 strains of mulds.
Generally, strains of bacteria and fungi were more susceptible to glucoprotamine than to monopotassium persulfate (Enterobacteriaceae and
Pseudomonas sp. 16- or 8-fold, Stenotrophomonas maltophilia 2-4-fold,
Staphylococcus sp. 8-16-fold, Enterococcus sp. 4-fold, mould 166-fold
and yeast 16-32-fold). Moreover, both disinfectants were more active to
Gram-positive cocci (MIC of GT 1.95-31.25 mg/L, MIC of MPS 7.8-62.5
mg/L) and fungi (MIC of GT <1.95-125 mg/L, MIC of MPS 31.25-125
mg/L) than Gram-negative rods (MIC of GT 31.25-125, MIC of MPS 5001000 mg/L).
The obtained results showed that the activity of tested disinfectants to
bacteria and fungi depended on the kind of examined microorganism, not
on place of their isolation. It might be connected with different mechanisms of action or microorganisms cell wall structures. The Gram-negative rods cell are less sensitivity to many antibiotics and maybe also disinfectants.
ISE.061
Antimicrobial Susceptibility and Plasmid Profiles of Pseudomonas
Aeruginosa Isolated from Surgical Patients in Northern Nigeria
A.T. Olayinka1, B.O. Olayinka1, B.A. Onile2. 1Ahmadu Bello University
Teaching Hospital, Zaria, Nigeria; 2University of Ilorin, Ilorin, Nigeria
A total of 92 strains of Pseudomonas aeruginosa were isolated during
the study period. Isolates obtained from urine and wound swabs formed
92.4% of the total. From all the isolates 94.6%, 90.2% and 89.1% were
sensitive to Imipenem, Ciprofloxacin and Amikacin respectively. Seventy
eight point three percent were sensitive to Ceftazidime, while only 36%
were sensitive to Ofloxacin. More than 80% and 70% of isolates from
wound and urine, respectively, were sensitive to Imipenem, Amikacin,
Ciprofloxacin and Ceftazidime. Sensitivity to Gentamicin was positive in
64.2% of the isolates, while 21.7% were resistant. No cross resistance
was observed between Gentamicin and Amikacin, nor also between
Ciprofoxacin and Ofloxacin. Multiresistance of the isolates to at least
three of the antibiotics used was 19.6%. These multiresistant trains were
mainly obtained from urine, wound swabs and catheter tip. Out of which
87.5% were found to harbour plasmids; most of which were low to medium intermediate molecular weights and 50% of which had similar band
patterns suggesting source relatedness of the isolates.
ISE.062
Prevalence and Characterisation of the mef Gene from
Erythromycin Resistant M Phenotype Strains of Streptococcus
pneumoniae in Hong Kong
C. Cheung, M. Boost, M. O'Donoghue. The Hong Kong Polytechnic
University, Hong Kong, China
Introduction: Active efflux, mediated by the mef gene is a common
mechanism for erythromycin resistance in S. pneumoniae. Strains carrying the mef gene express a resistance pattern known as the M phenotype
that is characterized by resistance to 14- and 15-membered macrolides,
but susceptibility to 16-membered macrolides, lincosamides and streptogramin B. The mef gene has two subclasses mef (A) and mef (E). This
study aimed to investigate prevalence, molecular and phenotypic characteristics of the mef(A) and mef E gene from M phenotype strains of
S. pneumoniae.
Methods: One hundred and forty-six clinical isolates of S. pneumoniae
were obtained from 5 district hospitals in Hong Kong. Resistance to a
range of antibiotics was determined by disc sensitivity testing following
CLSI guidelines and strains resistant or intermediately resistant to erythromycin and clindamycin susceptible were further tested against
azithromycin and spiramycin. DNA extracted for detection of the mef
gene was further analysed by restriction fragment length polymorphism
(RFLP) to determine the prevalence of the mef (A) and mef (E) genes.
Successful amplification of the DNA was confirmed by inclusion of a
pneumococcal housekeeping gene for pneumolysin, ply.
Results: Twenty-nine strains of S. pneumoniae were identified as M phenotype, of which 27 were found to harbour mef. In the remaining two
strains, only the ply gene was amplified. RFLP analysis showed these all
to be the mef (E) variant, mef (A) not being detected in any strain. The
majority of mef (E) positive strains were resistant to oxacillin, tetracycline
and sulphamethoxazole-trimethroprim and susceptible to chloramphenicol, vancomycin, ciprofloxacin, rifampicin, imipenem and levofloxacin.
Conclusion: The mef (E) gene seems to predominate in Hong Kong as
no mef (A) gene was detected in the 29 strains tested. The genetic background of the two strains which tested negative for the mef gene has not
been determined. Further amplification failed to detect the erm (B), gene
the other gene commonly associated with erythromycin resistance. There
appears to be a novel erythromycin resistance mechanism in two M phenotype strains which requires further study.
ISE.063
Antimicrobial Activity of Tigecycline and Other Broad-Spectrum
Agents Tested Against Bloodstream Infection Isolates Collected in
France, Germany, and Italy
H.S. Sader1, M.G. Stilwell1, T.R. Fritsche1, R. Mallick2, A. Kuznik2, P.
Bradford2, R.N. Jones1. 1JMI Laboratories, North Liberty, IA, USA; 2Wyeth
Pharmaceuticals, Collegeville, PA, USA
Background: We assessed the activity of tigecycline (formerly GAR936), a novel glycylcycline, against recent bloodstream infection (BSI)
pathogen isolates from 3 European countries as an indication of potential coverage of serious infections.
Methods: Bacterial isolates (1 per patient) were consecutively collected
during the period 2000–2005 from documented BSI in 16 medical centers located in France (6), Germany (7), and Italy (3). Frequency of occurrence of BSI pathogens was determined and their antibiograms
assessed using reference broth microdilution methods according to the
CLSI. A tigecycline-susceptible (S) breakpoint was defined as ≤ 2 mg/L
for Gram-negative bacilli; ≤ 0.5 mg/L for staphylococci, and ≤ 0.25 mg/L
for streptococci and enterococci following interpretive criteria established
by the US-FDA.
Results: A total of 13,432 strains were tested, 6301, 3705, and 3046
from France, Germany, and Italy, respectively. The frequency of pathogen
occurrence and susceptibility rates to tigecycline are summarized in the
table.
Tigecycline was highly active against the main pathogens isolated from
BSI, except for P. aeruginosa and some P. mirabilis. Tigecycline was consistently active against the 3 ranking pathogens, including E. coli (99.8100.0% S), S. aureus (99.6-100.0% S) and CoNS (98.4-100.0% S), representing 58% of all strains evaluated. The main resistance phenotypes
detected were methicillin-resistant S. aureus (14.8-38.2% of isolates)
and CoNS (71.5-81.5%), ciprofloxacin-resistant E. coli (7.0-21.0%),
extend-spectrum beta-lactamase (ESBL)-screen-positive Klebsiella spp.
(7.6-28.9%), imipenem-resistant P. aeruginosa (IRPSA; 1.3-8.9%) and
vancomycin-resistant enterococci (1.0-10.3%). Tigecycline showed
excellent activity against these resistant pathogens, except IRPSA.
Conclusions: Tigecycline exhibited a wide-spectrum of activity and
potency versus BSI isolates collected in three European countries.
Resistance to tetracycline or other antimicrobial classes did not adversely influence tigecycline activity. Treatment options for serious infections in
nosocomial environments should benefit from the availability of tigecycline.
ISE.064
Antimicrobial Activity of Some Probiotics Strains Against Classical
Pathogens
C. Voidaru1, A. Tzora2, K. Fotou2, A. Alexopoulos3, E. Bezirtzoglou3. 1T.E.I.
of Epirus,Laboratory of Animal Health and Infections Diseases,
Department of Animal Production, Arta, Greece; 2Laboratory of Animal
Health and Infections Diseases, Department of Animal Production, Arta,
Greece; 3Democritus University of Thrace, School of Agricultural
Development, Microbiology Lab, Orestiada, Greece
Objectives: Probiotics strains have a reputation to be beneficial to
health, especially to improve the human gastrointestinal and vaginal
flora. Moreover, the beneficial effect of probiotics includes nutritional
improvement of foods, inhibition of enteric pathogens, hypocholestemic
action, anticancer activity and stimulation of the immunity. In order to
investigate the role of some probiotics isolated from food stuff, samples
were collected from the following preparations: 30 samples of unpasteurized milk, 30 samples of pasteurized milk and 30 samples from fish (coming from cultures and never submitted in an antibiotherapy.
Methods: Selective media were spread and incubated both aerobically
and anaerobically. Identification was carried out according to Bergey's
manual. Microscopic examination of Gram stained alls, catalase, oxidase
and biochemical tests were performed. Identification of the lactic acid
bacteria was performed by gallery API method. All isolated wild strains
Lactobacillus sp. and Lactococcus sp. were examined for their antimicrobial activity against classic human pathogens such as; E.coli, S.aureus,
S. enteritidis, S. typhi, S. ancona, S. typhimurium. The immunodiffusion
agar method including both incubation of supernatant liquid after centrifugation of the culture was used. Incubation was performed at both
37˚C and 45˚C for 6, 24 and 48 hours.
Results: All strains of Lactococcus isolated from fishes presented better
antimicrobial activity against E.coli, S.aureus, S. enteritidis, S. typhi, S.
ancona, S. typhimurium. The Lactobacillus strains also osolated from
unpasteurized milk showed an important antimicrobial activity againstS.
enteritidis, S.typhi, S. ancona,S. typhimurium.Finally, all lactobacillus and
Lactococcus strains isolated from the pasteurized milk have not showed
any antimicrobial activity to all the above pathogenic stains tested.
Conclusions: In conclusion, the thermic effect of the pasteurization
treatment in milk seems to affect the antimicrobial capacity of the probiotics used against classical pathogens.
ISE.065
Extended Spectrum Beta-lactamases in Gramnegative Bacteria
Isolated from Two Hospital Work Places
M. Bubánová1, M. Tamalli1, K. Havrisová1, M. Kmetová1, Z. Szovenyiová2,
L. Kudernácová3, M. Molokácová4, L. Siegfried1. 1Institute of Medical
Microbiology, P.J.Safarik University, Faculty of Medicine, Kosice,
Slovakia; 2Avilab, s.r.o., Kosice, Slovakia; 31st Private Hospital, KosiceSaca, Slovakia; 4Department of Clinical Microbiology, L.Pasteur
University Hospital, Kosice, Slovakia
Extended-spectrum beta-lactamases (ESBL) may mediate resistance of
gramnegative bacteria against wide spectrum of beta-lactam antibiotics.
In this study we detected and characterised both TEM and SHV ESBL
and AmpC in selected genera of enterobacteria and non-fermenting
gramnegative bacteria.
Specimens were isolated from patients in Clinic of Anesthesiology and
Intensive Medicine- CAIM (n=123) and I. Internal Clinic (n=51) at university hospital in Kosice. Among isolates 69, 34, 32, 12, 12, 9, 6, 3, 1
belonged to Klebsiella sp., Pseudomonas sp., Acinetobacter sp., Serratia
sp., Enterobacter sp., Escherichia sp, Citrobacter sp., Proteus sp.,
Alkaligenes sp., respectively.
In the strains sensitivity to selected antibiotics (ampicilin, amoxycillin/
clavulanic acid, cefalotin, cefotaxim, ceftriaxon, ceftazidim, cefepime,
meropenem, aztreonam, gentamycin, amikacin, sulfometoxazol and
ciprofloxacin), as well as production of AmpC beta-lactamases and TEM
and SHV extended spectrum beta-lactamases (ESBL) was investigated.
We employed agar dilution method for determínation of minimum
inhibitory concentration. Double-disk synergy test and combination disk
diffusion test were used to demonstrate ESBL production, while three
dimensional test was employed to detect AmpC enzymes. Polymerase
chain reaction was used to demonstrate blaTEM and blaSHV genes in
strains showing ESBL production in phenotype.
Among CAIM isolates using PCR we demonstrated blaTEM gene in 10.5
% of strains, blaSHV gene in 14.04 % of isolates and both genes were
detected in 57.9 % of isolates. None of strains isolated from I. Internal
Clinic was demonstrated to carry both blaTEM and blaSHV genes.
Results obtained show significant differences in the incidence of blaTEM
and blaSHV genes among bacteria isolated from two work places at
University Hospital.
ISE.066
Heterogenous Resistance to Cefotaxime in a Beta-lactamase
Negative Ampicillin Sensitive Haemophilus influenzae Strain from
Turkey
N. Gürkan Aydin1, S. Ercis1, S. Kocagöz2, G. Hascelik1. 1Hacettepe
University Faculty of Medicine Dept of Microbiology, Ankara, Turkey;
2
Yeditepe University Faculty of Medicine Dept of Microbiology, Istanbul,
Turkey
Background: Cephalosporin resistance in Haemophilus influenzae has
been reported in beta-lactamase negative- or positive-ampicillin resistant
isolates. However, although resistance to second-generation
cephalosporins has been reported in clinical H.influenzae isolates, to our
knowledge, there is no clinical isolate reported until now that is resistant
to a third generation cephalosporin.
Methods: We have identified a H.influenzae strain from sputum specimen of a patient that has applied to the outpatient clinic in Hacettepe
University Hospital. The antibiotic susceptibility testing of the isolate was
done by disk diffusion and Etest methods. Beta-lactamase production of
the isolate was examined by nitrocefin-based disk test and ESBL activity was determined by cefotaxime/cefotaxime-clavulanic acid (CT/CTL)
and ceftazidime/ceftazidime-clavulanic acid (TZ/TZL) Etest. The presence of beta lactamase enzyme was determined by isoelectric focusing.
Results: The isolate was identified as H.influenzae serotype b. During the
antibiotic susceptibility testing, the strain was found to be sensitive to
ampicillin (2µg), trimethoprim-sulfamethoxazole, chloramphenicol, aminoglycosides, tetracycline, erythromycin and quinolones; homogenously
resistant to only clindamycin; and heterogenously resistant to aztreonam,
carbapenems and to all cephalosporins excluding cefepime. MIC values
of the isolate was 0.38 µg/ml for penicillin G (sensitive), 6µg/ml for clindamycin (homogenously resistant), 4 µg/ml for cefoxitin (heterogenously
resistant), >16 µg/ml for cefotaxime (heterogenously resistant), >32µg/ml
for imipenem (heterogenously resistant). The isolate was beta-lactamase
negative with nitrocefin disk. Inducible beta-lactamase was negative with
imipenem, ESBL was negative with CT/CTL and TZ/TZL. No beta-lactamase enzyme was detected with isoelectric focusing.
Conclusion: Hereby we report the first clinical isolate of beta-lactamase
negative ampicillin sensitive and heterogenously cefotaxime resistant
H.influenzae strain from Turkey, which is also heterogenously resistant to
aztreonam and carbapenems. Our findings can be indicating the emergence of a new pattern of resistance in H. influenzae.
Bacterial Infections
ISE.067
Dynamics of Bacterial Isolations in A General Hospital of Western
Caracas, Venezuela, 1990-2005
Rodriguez-Morales2. 1Laboratory of Microbiology, Jose Gregorio
Hernandez West General Hospital, Caracas, Venezuela; 2Instituto
Experimental Jose Witremundo Torrealba, Universidad de Los Andes,
Trujillo, Venezuela
Background: Role of a microbiology laboratory in a general hospital is
of considerable importance. The surveillance of antimicrobial susceptibility and resistance is of mayor relevance for clinical decisions. Given this,
is important to periodically study the changing patterns of bacterial infections in the time. For these reasons we analyzed the dynamics of bacterial isolations in our institution between 1990 and 2005.
Methods: Microbiological diagnosis is made on the base of gram and
other staining, but fundamentally in confirmation by culture and biochemical tests for species identification. Antimicrobial susceptibility is made
with disk diffusion technique on Müller agar with the Kirby-Bauer method
according the criteria of NCCLS. Additionally we used reference strains
(ATCC) for quality control. Annual isolation incidence of all organisms is
analyzed, classified by group; most common isolated species are analyzed and its linear trends and variation significance calculated. Finally,
selected changing situations are evolutionary defined: incidence of
MRSA strains, ESβL producer strains of E. coli and K. pneumoniae.
SPSS 10.0 and MSVP 3.13 were used for statistical analysis.
Results: For this 15-year-period, almost 20 thousand organism strains
were isolated (19,609) (mean 1100±753 strains/year). Sixty four per cent
corresponded to gram-negative bacilli (12,673 strains). Most common isolated organisms in our institution were: E. coli 22.6%, S. aureus 10.9%, P.
aeruginosa 9.2%, K. pneumoniae 8.1%, Staphylococcus coagulase-negative 8.0%, A. baumannii 5.6%, E. cloacae 3.6%, P. mirabilis 3.5%, and E.
faecalis 3.4%, among others. In study period, 187 different organism
species have been identified. Across the period, predominance of gramnegative organisms over gram-positive was constant, but both type of
organisms are significantly increasing (figure 1). Increase in species such
as E. coli, S. aureus, P. aeruginosa, K. pneumoniae, Staphylococcus
coagulase-negative, A. baumannii; has been statistically significant
(p<0.05). Antimicrobial resistance patterns have published by our group
elsewhere, particular situations such as the incidence of MRSA is of great
interest, between 1994 and 1997 we observed a high incidence (ranging
21 to 32.5%), decreasing for the period 1998-2003, but since this year
begun to increase again reaching for year 2005 again 32.7% (period overall incidence is 14.4%). ESβL producer strains of E. coli have been
increasing discretionally reaching a 10.9% for year 2005, although the
global rate for the period was 6.5%. Finally for ESβL producer strains of
K. pneumoniae, its incidence is higher than the observed for E. coli, which
reach a 35% in year 2002 (global rate for the period was 21.2%).
Conclusion: Changing epidemiology of bacterial infections is an important issue to consider in every hospitalary institution. Microbiological
identification of clinical infectious diseases as well the isolates antimicro-
bial susceptibility tests should be done in every case, and all the clinicians should be aware of the epidemiological importance of this given the
emergence of resistance in almost all bacterial species, especially those
acquired in hospitals, which made significant differences in the outcomes
of patient's treatments.
ISE.068
Isolation and Detection of Legionella Pneumophila in Patients
Reffered to Esfahan Medical Centers
H. Lashkarian, K. Shahzamani, R. Yazdani. Medical University of
Esfahan, Esfahan, Iran
Introduction: Wide and universal distribution of Legionnaires disease
and the abundance of reports about Legionnaires disease and Pontiac
fever prevalence from various countries and also lack of report of presence or isolation of any species from different Legionella species or the
occurance of Legionnaires disease in Iran, led to the present research.
This agent is the most important causative agent of atypical pneumonia,
producing a sever disease in vulnerable individuals with a high fatality
rate (50–80%), and causes a remarkable mortality rate for nosocomial
infections (up to 50%).
Methods: In the present research for isolating and detecting of L.p in
respiratory system, bronchoalveolar specimens of patients, two methods
(culture and DFA) were used.Since this agent doesn’t grow on general
culture media, we used non-selective medium (BCYE-agar)and selective
medium (MWY-agar). After treating the specimens with 0.2N HCl-KCl in
order to remove contamination with normal flora of respiratory tract, they
were inoculated into the above media and after 3-5 days of incubation in
37C, and humidity (about 95%),thin, convex and round colonies with
blue-gray to blue-green appearance developed.Slides were prepared
from these colonies and stained with Gram, Gimenez methods which displayed as Gram-negative, small successive coccobacilli.
Results: Finally, we could isolate 4 strains of Gram-negative bacilli from
cultivating 96 bronchoscopic specimens after inoculating them onto general media, no growth of strains on the above 4 mediawas observed, and
since their colonies were morphologically similar to those of Legionella,
as a result we further investigated them by means of specific DFA-Kit.
The obtained results indicated that all of the 4 strains belong to
Legionella spp. Biochemical experiments performed, which characterized the identity of isolated organizems and showed that the features of
them all is consistent with Pneuomophila (with positive Catalase and
Oxidise, and strong positive Hiporate hydrolysis). In vitro drug resistance
and sensitivity tests of Legionella showed that this bacteria were sensitive to Erythromicin, Riphampicin, Gentamicin, Daxycyclin and
Tubramicin, the sensitivity being more pronounced against Erithromicin
than against the others. The above mentioned organisms were resistant
against Tetracyclin and Ampicilin.
Discussion: The whole results of this research which was accomplished
on a number of Isfahan medical centre patients, demonstrated for the
second time the occurance of pneumonic Legionellosis in a number of
these patients (4.2%) in Iran and led to isolation of L.p (serogroups 1-14)
from clinical specimens and also showed that L.spp, accounting for 8590% of Legionella from pneumonias and being the cause of high mortality rate in patients of other countries, has also been the only isolated
species in several medical centers of Isfahan in this research.
ISE.069
Multidrug Resistance Pseudomonas aeruginosa Causing High Ear
Piercing Infection in a Universitary Young Adult
A.J. Rodriguez-Morales1, J. Vargas2, P. Rifakis3. 1Instituto Experimental
Jose Witremundo Torrealba, Universidad de Los Andes, Trujillo,
Venezuela; 2Collaborative Group of Clinical Infectious Diseases
Research, Caracas, Venezuela; 3Perez de Leon Hospital, Caracas,
Venezuela
Background: Infections caused by different multidrug organisms in relation with ear piercing are increasingly reported. The risk of infection following piercing through the avascular cartilage of the helix and tragus of
the pinna is greater than following piercing of non-cartilaginous tissue
such as the ear lobe. (Peri) chondritis leads to chondral necrosis and
subsequent deformities.
Case: We report a case where the patient developed an auricular infection due to multidrug resistant strain of Pseudomonas aeruginosa two
weeks after undergoing to high ear piercing. A 20-year-old boy, universitary student, had his right auricular helix pierced in a commercial store.
Two weeks after this the piercing site began to feel pain, hot and pruritus. Although analgesics were taken by him, symptoms continue. For this
reason he consulted us. On physical examination a marked auricular
inflammation of right high ear was noted, the piercing was surrounded by
pus. Piercing was, then, removed; surgical drainage and debridement
was done. Samples were taken for culture and antimicrobial susceptibility tests. Ciprofloxacin was indicated; 500 mg po bid x14d. Clinical
improvement was observed in less than 48 hrs. Pseudomonas aeruginosa was isolated from ear cultures. Antimicrobial susceptibility tests of
the isolate showed susceptibility to ciprofloxacin, imipenem and
meropenem, but resistance against piperacillin, ticarcillin, cefoperazone,
ceftazidime, amikacin and gentamicin.
Conclusion: It is important to recognise the early features of perichondritis, which include local heat, erythema and pain, before swelling
appears. Treatment should focus on eradicating Pseudomonas aeruginosa and Staphylococcus aureus, more on given the features and possibilities of isolate drug-resistant organisms, as occurred in our case.
Surgical intervention is required at the earliest sign of an abscess.
Reconstruction for a post-piercing deformity can be considered at a later
stage. The literature review and cases presented show that piercing is
not harmless and that regulation of the piercing business would seem to
be desirable, because even outbreaks of Pseudomonas aeruginosa
infections caused by commercial piercing of ear have been reported.
ISE.070
Actinomycosis Mimicking Carcinoma of the Maxillary Sinus: A Case
Report
S. Dickson1, R. Barbella1, A.J. Rodriguez-Morales2, D. Mota1, S. Mata3.
1
Instituto Anatomopatológico José A. O'Daly, UCV, Caracas, Venezuela;
2
Instituto Experimental JWT, ULA, Trujillo, Venezuela; 3Tropical Medicine
Institute, UCV, Caracas, Venezuela
Background: Human actinomycosis may pose a diagnostic problem at
times and is often mistaken for a neoplasm. Actinomycosis involving the
maxilla usually is seen as a localized intraoral infection in contrast to classical cervicofacial actinomycosis. Formation of draining sinuses, local
swelling, and pain are the most common presenting symptoms. Many of
the cases are diagnosed following endodontic procedures, suggesting
that such procedures might be responsible for introducing the organisms
into the periapical tissues or that the organisms might be responsible for
some cases of endodontic failure. Recent reports have been highlighting
the importance of bearing in mind the fact that certain rare, chronic, suppurative granulomatous infections, like actinomycosis, may mimic malignancy. For this reason we report a case of maxillary actinomycosis that
was previously diagnosed as a maxillary sinus carcinoma.
Case: A fifty-nine year old male was clinically diagnosed as a case of
carcinoma of the maxillary sinus on the basis of history, clinical presentation and radiological findings. Tissue biopsy realized 10 years ago diagnosed a periapical cyst, and a second one performed 6-months ago concluded as chronic sinusitis with moderated epithelial dysplasia vs a maxillary sinus carcinoma. The lesion was a tumor of 2.5 cms in diameter. A
new biopsy was performed finding a chronic severe inflammation with an
ulcerated mucosa, bits of granulation tissue and gram-positive sulfurcontaining bacteria, compatible with infection due to Actinomyces sp.
Patient was successfully treated with amoxicillin/clavulanate.
Conclusion: The diagnosis was based on histological report because of
location and development of the lesion with unusual history. In cases of
persistent oral infection the diagnosis of actinomycosis should be actively attempted through microbiological and histological examination. As is
shown by hematoxylin and eosin stain, in contrast to the Nocardia
species, Actinomyces species histopathologically are basophilic in
nature and terminate in eosinophilic clubs as a predictive feature. The
clinical and radiological findings in these cases closely resemble
metastatic tumors and other infectious processes. Histopathological
diagnosis of actinomycosis is important because the clinical and microbiological studies cannot always demonstrate the causative microorganism and primary infection source. Ampicillin, amoxicillin or penicillin associated with surgical excision is the best therapy, but high doses must be
used for a long time. Doxycicline, ceftriaxone, clindamycin, erythromycin
and chloramphenicol have been reported with satisfactory response as
alternative treatments.
ISE.071
Evaluation of ELISA for the Diagnosis of Human Leptospirosis in a
High Endemic Area Using Recombinant Ompl1 and Lipl41 Proteins
K. Natarajaseenivasan1, P. Vijayachari2, S. Sameer2, A.P. Sugunan2, M.
Krishnan1, S.C. Sehgal2. 1Department of Microbiology and Biomedical
Diagnostic Centre, Bharathidasan University, Tiruchirappalli, India;
2
Regional Medical Research Centre (ICMR), Port Blair, India
Leptospirosis is an important public health problem in India evidenced by
recent outbreaks in various parts of the country. Early and accurate diagnosis of leptospirosis is important for proper and prompt treatment.
However, the existing methodologies for the serodiagnosis of leptospirosis need the maintenance of live leptospiral strains. Moreover the antigen
used in such tests is crude in nature and from a single serovar with lippopolysaccharide (LPS) as the major component, which is serovar specific and may not cross react with patients infected with other serovars.
The leptospiral outermembrane proteins (Omps) like OmpL1 and LipL41
were found to be conserved and antigenic in nature. In this study the
recombinant OmpL1 and LipL41 were expressed using E. coli expression
system and purified and evaluated for the serodiagnosis of leptospirosis.
Fifty-six paired serum samples from patients with leptospirosis and 37
paired serum samples from patients clinically suspected but found to be
negative for leptospiral serology, and 132 single sera from other diseases. Paired sera were collected in a mean interval of 23 days. 176
apparently healthy individuals were also included to determine the cut off
OD. The recombinant OmpL1 ELISA achieved a sensitivity of 66.1%,
specificity 91.9%, positive predictive values (PPV) 92.5%, negative predictive value (NPV) 64.2% among the samples collected during the first
phase of leptospirosis. Among the sera samples collected during the second phase of leptospirosis sensitivity was 91.1%, specificity 86.5%, PPV
91.1%, NPV 86.5%. In case of recombinant LipL41 ELISA the analysis
showed a sensitivity of 62.5%, specificity 89.2%, PPV 89.7%, NPV
61.1% among the phase I samples. Among the phase II samples it
showed a sensitivity of 89.3%, specificity 89.2%, PPV 92.6%, NPV 84.6.
The high PPV and NPV values showed the sensitivity and specificity of
the test system, which may be routinely used for the diagnosis of leptospirosis.
ISE.072
Susceptibility to Brucellosis is Associated with Lymphotoxin-Alpha
(+252) Gene Polymorphism
M. Rasouli, S. Kiany, M.A. Dehyadegari. Immunology DepartmentClinical Microbiology Research Center-Shiraz University of Medical
Sciences, Shiraz, Iran
Background: Brucellosis is a zoonotic infection caused by the genus
Brucella. Macrophage activation has an important role in controling
Brucella infection by secreting some cytokines such as IFN-γ and TNF-α.
LT-α has approximately 30% homology to TNF-α and serves many of the
same functions. It was shown that an A to G substitution at position +252
in LT-α gene has an association with a high production of the cytokine.
Thus the aim of the present study was to investigate the possible influence of the LT-α gene polymorphism on the susceptibility to brucellosis.
Methods: One hundred and ninety four patients involved with brucellosis
and 81 healthy animal husbandmen who kept infected animals and consumed their contaminated dairy products were included in this study. LTα genotyping at position +252 was carried out using polymerase chain
reaction-restriction fragment length polymorphism (PCR-RFLP).
Results: The frequency of AA genotype which is associated with low
production of LT-α is significantly higher in patients than controls (63.9%
vs 40.7%, P=0.0004).
Conclusion: LT-α can activate macrophages through TNFRI and
TNFRII. Then it can induce nitric oxide production to eliminate intracellular parasites such as Brucella. LT- αalso activates neutrophils which are
important component of the innate immune system against bacteria.
According to the results, it may be deduced that patient individuals who
had more frequency of LT-α (+252) AA genotype couldn't produce
enough LT-α in response to Brucella infection. In other words, inheritance
of AG or GG genotypes can be considered as a genetic factor confering
resistance to brucellosis.
ISE.073
Meningococcal Meningitis: An Update - Problems in Children
M.L. Luminos, G. Jugulete, A. Visan, R. Mantescu, R. Iagaru. Institute of
Infectious Diseases Matei Bals, Bucharest, Romania
Objective: to assess the evolution and clinical aspects leading to a high
morbidity and mortality rate in acute meningococcal meningitis (AMM),
since in West Europe and USA the disease is under control by protective
immunization with anti meningococcal vaccine.
Methods: A retrospective study was performed upon 15 cases of AMM
out of 19 invasive meningococcal disease, hospitalized in Institute of
Infectious Diseases Matei Bals between 01.01.2004 - 31.12.2005. We
reviewed the following aspects regarding meningococcal meningitis: epidemiology, clinical course, treatment and evolution.
Clinical diagnosis was confirmed by laboratory tests such as: Gram
smears, cultures, latex agglutination.
Results: Mean age at onset was 1.5 years (range 3 months-13 years).
In 50% of case meningococcal disease was in close connection with high
risk factors such as: complement deficiency, protein-energetic malnutrition or accompanying pathology (bronchopneumonia, otitis, severe anemia). Purpura fulminans was registered in 9 cases out of 15 at the onset
of the disease. In 10 cases laboratory tests were able to identify the
serogroup involved, as follows: serogroup A (3 cases), serogroup B (4
case) and serogroup C (3 cases). Clinical-etiological correlations pointed
out a close relation between severe clinical forms and meningococcal
serogroup B and C (coma, seizures, complications, fatal outcome).
Meningococcal septicemia was present in 6 cases.
Conclusions: 1) Meningococcal meningitis was recorded in 37% of cases
admitted in our hospital during the year 2004 with acute bacterial meningitis in children. 2) The most affected age was < 2years old, especially
infants, with severe clinical status, due to N. meningitides subgroup B or C.
3) Alarm signal providing vaccination against meningococcal disease.
ISE.074
Sepsis Caused by Globicatella Sulfidifaciens
V. Hasseltvedt1, E. Aandahl1, L. Hesstvedt1, G. Chedid1, C. Grub1,
I. Haavemoen1, K. Odegaard1, D. Caugant2, A. Høiby2. 1Lab. for
Microbiology, Sykehuset Innlandet Trust, Lillehammer, Norway; 2The
Norwegian Institute of Public Health (NIPH), Oslo, Norway
Background: Our laboratory serves Oppland an Hedmark counties,
Norway. We performed 353 000 analyses in 2005. As an ongoing activity our laboratory is trying to strengthen the capability to detect seldomly
occuring bacteria. We here describe an unusual finding in a case of sepsis in a male born 1928 - caused by Globicatella sulfidifaciens.
Globicatella was described as a new genus by Collins et al in 1992 (1).
Globicatella sulfidifaciens was seen as a cause of purulent infections in
domestic animals published by Vandamme et al in 2001 (2). Globicatella
spp. are Gram positive, catalase negative cocci. A MEDLINE search as
of January 15, 2006 showed 11 hits for Globicatella and one hit only for
Globicatella sulfidifaciens.
Method: Blood cultures from an elderly patient with sepsis were cultivated in our laboratory on standard media, i.e. blood, chocolate and lactose
agars under aerobic and anaerobic conditions.
Results: Gram positive, catalase negative cocci were detected. The
specimens were tested by 16S RNA sequenecing at NIPH - as a national reference laboratory showing 99% homology with Globicatella sulfidifaciens.
Conclusion: The findings above suggest that a county laboratory can
detect even seldomly occurring bacteria in close co-operation with a reference unit on a national level
References: 1) Collins, M. D et al (1992). Globicatella sanguinis gen.
nov., sp. nov., a new Gram-positive, catalase-negative bacterium from
human sources. J Appl Bacteriol 73, 433–437. 2) Vandamme, P et al.
Globicatella sulfidifaciens sp. nov., isolated from purulent infections in
domestic animals. International Journal of Systematic and Evolutionary
Microbiology (2001), 51, 1745–1749
ISE.075
Incidence Rate of Chronic Brucellosis in a Prospective Study in
Chaharmahal and Bakhtyari Province—Iran
R. Imani Rastabi, R. Khadivi. Medical Science University of ShahrekordIran, Shahrekord, Iran
Background and Objectives: The aims of this study are, determination
of incidence rate of chronic brucellosis in tribal patients of Kuhrang
district in Chaharmahal and Bakhtyari province after one year whom had
treated.
Methods: Following an outbreak of human brucellosis in 2003, all
patients were determined, then upon filling the questionnaires, all
patients underwent standard tube agglutination tests (STA test) and 2
mercaptoethanol tests (2ME test ). Then they were treated. After one
year, a second time, the same questionnaires in addition the clinical
course of disease and residual signs and symptoms were evaluated. STA
test and 2ME were reexamined. Titer =>1/160 has been indicated as
positive test. All data were introduced in SPSS 11.0 software and were
analyzed with descriptive (frequency, mean,..) and analytic (T test, Chi
square, Regression) tests.
Results: In brucellosis outbreak at 2003, 119 tribal persons have been
infected. After one year follow up, 97 individuals of them have been determined. 63.9% patients were male and 36.1% were female. 30.3%
patients were animal husbandry. Arthralgia in 88.7% and fever in 78.54%
of cases as the commonest sign and symptom in acute brucellosis, have
been seen. In second visit 17.5% of cases, had STA test titer >=1/160
and 15.5% had 2ME test titer >= 1/160. In another way 55.7% if cases
had no sign or symptom 15.5% had recurrence signs and symptoms,
11.3% had mild symptoms and 15.4% had any complain that have no
relation to brucellosis.
There were significant statistical relationship between antimicrobial regimen and final titer of STA and 2ME tests and clinical course in following
year. (t=4.635, P Value <0.000), (Chi 2=124.2, df=28, P Value <0.000).
Conclusion: Based on the results of this study, the incidence rate of
chronic brucellosis in tribal patients is higher than such index in another
region. Failure in accurate taking of antimicrobial drugs from the patients,
no standardized drug regimen, lower training patients and low access to
health facilities are the main problems that causes the high incidence
rate of chronic brucellosis.
Key Words: Chronic brucellosis, Incidence, Chaharmahal and Bakhtyari,
**infectious and tropical diseases specialist, Assistant Professor,
Shahrekord.
Conclusion: Etiological diagnosis of smaller example of SFRD in
Montenegro show direct attention to frequency of co infections.
Between rickettsial diseases, SFRD group are range into group of issuer
short time lasting febrile exanthematic diseases with good prognosis.
Envoy they should be take seriously because no mother of early diagnosis and treatment /with tetracycline/ in this small group with mortality of
9%. Co infection corresponding of rickettsial and other agents from vector borne transmits agents / borrelia burgdorferi and other/, which are in
global expansion, demands more careful prognosis.
ISE.076
Therapeutic Modalities in Acute Erysipelas - A Review of the
Literature with Special Emphasis on Evidence-based Medicine
N. Huber, M.D., M. Binder, M.D.. Dep. of Dermatology, Div. of Gen.
Dermatology, Medical University of Vienna, Vienna, Austria
ISE.078
Severe Necrotic-gangrenous Sequelae and Multiple Amputations
During Severe Meningococcal Septicemia, Despite Prompt
Recognition and Appropriate Treatment
R. Manfredi, S. Sabbatani, G. Marinacci, F. Chiodo. Infectious Diseases,
University of Bologna, Bologna, Italy
Background: Erysipelas is a superficial skin infection with lymphatic
involvement. In many studies during the last three decades
Streptococcus pyogenes was determined to be the causative agent in
most cases. Due to the bacterial etiology erysipelas is treated with antibiotics worldwide. According to the directions of evidence-based medicine
(EBM) Na-Penicillin G is supposed to represent first line-treatment in
streptococcal infections. However, as we could show in a recently conducted small retrospective study, Na-Penicillin G is often replaced by
other antibiotic substances or combinations of antibiotics (i.e.
Flucloxacillin + Penicillin G).
Methods: A formal review of randomised controlled trials (RCTs), reviews
and meta-analyses has been carried out, in which the evidence in the literature concerning the indication and efficacy of various therapeutic
strategies in acute erysipelas is discussed. Data sources included electronic searching of MEDLINE and hand searching of the English and
German literature on erysipelas. Studies about the use of antibiotics in the
therapy of cellulitis and skin and soft tissue infections were not included.
Results: Since 1984 only 2 prospective RCTs regarding the efficacy of
various antibiotic substances in therapy of acute erysipelas have been
published. The use of a Standard-Penicillin-Regime was compared to the
macrolide Roxithromycin and the streptogramin Pristinamycin, respectively. No statistical significant difference between the two groups has
been found for Roxithromycin, while for Pristinamycin an advantage has
been detected. In consideration of the form of administration (oral, intravenous, intramuscular) no significant difference has been found for
Penicillin.
Conclusion: There is only little evidence about the use and efficacy of
different antibiotic substances in the therapy of acute erysipelas available
in the literature. Good evidence is available for Penicillin, which should be
first line-treatment in acute erysipelas and also for Roxithromycin and
Pristinamycin. No evidence in the literature has been found for other
antibiotic substances and for combinations of antibiotics, respectively.
ISE.077
Characteristics of Spotted Fever Rickettsial Diseases in Montenegro
B. Andric1, A. Andric2, N. Vucinic1, N. Malisic3, E. Ristanovic4. 1Clinic for
Infectious Disease, Podgorica, Serbia and Montenegro; 2Medical Faculty
Nis, Nis, Serbia and Montenegro; 3Institute for Health in Montenegro,
Podgorica, Serbia and Montenegro; 4Military Medical Academy,
Belgrade, Serbia and Montenegro
Introduction: Spotted fever rickettsial diseases /SFRD/ include in group
of tick borne typhus. They are distributed in European, African and Asian
Mediterranean area and coast of the Black Sea. In Montenegro first
cases of human are registries 1996. The 36 cases more ware diagnostic
until 2005.
Aim of Study: We presented the characteristics and manning of SFRD
in Montenegro.
Material and Methodology: On Clinic for infectious Disease in
Podgorica are analyzed 36 cases with SFRD. Diagnosis of the disease
woos committed on basis of epidemiological, clinical characteristics.
Etiological confirmation of diagnosis by IIF method, ware made on VMA
Belgrade.
Results: Epidemiological examination presented tick bite in 87%
patients. The different category of population is exposed to infection.
Clinical manifestations and course, wore basis to know of the disease.
Etiological diagnostic was problem because in all cases in diagnostically
titer we find more subtypes of rickettsial agents of spotted fever group,
who may be vivificated as equal etiological factors in pathogenesis basis
of the disease. /R.conorii, R.typhi, R.acarii/. We could not define the level
of important of these agents on difficulty and prognosis of the diseases.
Our examination showed mean foul frequency of hard clinical shapes
with affection of CNS in 58% cases with 3 death cases, respiratory system in 82% cases, and cardiovascular system in 76% cases.
Background: Meningococcal sepsis-meningitis with a life-threatening
course are clinical entitied burdened by an extremely high mortality,
despite a prompt diagnosis and a rapid-adequate therapy. The case of a
young man who survived a meningococcal sepsis with extremely severe
reliquates, serves as a reminder to all health care workers to maintain an
elevated suspicion for this potentially fatal disease.
Case Report: A young patient (p) referred to a primary-care hospital
because he had pyrexia, headache and vomiting,f ollowed by diffuse skin
petechial lesions, altered mentation,a nd signs of peripheral hypoperfusion. Microbiological studies on both CSF and blood confirmed a
meningococcal meningitis-sepsis, but despite immediate high-dose ceftriaxone administration a neurological deterioration occurred, leading to
coma, ventilation, and a dramatic evolution of skin lesions towards extensive necrotic areas involving all limbs, face and trunk, and associated
with toxemia. Although 5 days later an improvement of consciousness
allowed to stop mechanical ventilation, after moving to our Division a progressive extension of grangrenous lesions occurred, and multiple surgical amputations of both forefeet, a number of hand fingers and phalanxes,a nd an extensive debridement of large, deep areas of necrotic
escarae involving thighs, legs, and trunk became necessary. Later our p
suffered from a second episode of respiratory insufficiency requiring ventilation, while antimicrobial therapy was continued with meropenem-vancomycin-clindamycin,t ogether with supportive measures and local medications. A further extension of necrotic eschars need the resort of multiple plastic surgery interventions, and the subsequent implant of handfeet prostheses, followed by a specific rehabilitation program.
Discussion: A meningococcemia followed by septic shock may rapidly
evolve into death, regardless of an accurate diagnosis-treatment. The
occurrence of severe hypotension, respiratory, kidney, and multiorgan
failure, and the continued extension of necrotic skin lesions caused by a
massive DIC, are potentially responsible for an extremely severe course,
which led our p very close to death in at least three occasions: initial
meningococcemia, septic shock associated with respiratory and multiorgan failure, and multiple gangrenous lesions formation, which progressed despite a maximal antibiotic and supportive therapy. The proportionally low absolute incidence of meningococcemia should not be underestimated, since a minor delay of management may not preserve from a
fatal evolution, and/or severe, permanent remnants.
ISE.079
Aspiratory Actinomycosis with Thoracic Wall Involvement Without
Obvious Pneumonia
M. Djordjevic1, I. Uckay2, I. Djordjevic3, V. Kostic4. 1Infectious Diseases
Clinic of Clinical Center, Nis, Serbia and Montenegro; 2Infectious
Diseases Service of University Hospital, Geneva, Switzerland; 3Clinical
Center, Nis, Serbia and Montenegro; 4Infectious Disease Clinic of Clinical
Center, Nis, Serbia and Montenegro
Objective: Actinomycosis is a well-known clinical entity in alcoholic
patients. As far as we know no cases of secondary thoracic wall involvement without obvious pneumonia have been mentioned in the literature.
We describe such a case.
Report: A 58-year-old man with severe alcohol and nicotine abuse was
admitted to hospital because of a weight lost of 7kg in one month, subfebrile temperatures and right thoracic pain. He didn't complain of cough,
expectorations nor night sweating. Physical examination revealed 38,3 C,
an important asthenia and right low thoracic skin abscess of 14 cm diameter which could be visualized on his skin. Dental examination revealed
dental caries and gangrened tooth Lung auscultation was normal.
Laboratory exams showed a leucocytosis of 15,9 G/l with a C-reactive
protein of 299 mg/dl. A thoracic CT scan revealed an abscess, prolonged
from the outer parts of the middle lobe to the infradiaphragmatic region
and to the skin. Excision of the abscess and resection of thoracic wall
was performed. It attached for the wall of the middle lobe right Histology
showed necrosis of diaphragmal cupola and thoracic wall. Hemocultures
revealed aerobic and anaerobic germes. Auramine stain of soft-tissue
biopsy showed acido-resistent bacilli. Auramine stain of punction of
abscess and of soft-tissue biopsy showed acido-resistent bacilli and
microbiologic cultures confirmed Actinomyces meyeri. He was treated
with Clamoxyciline i.v., 4x3g, 6 weeks followed by 4x750mg peroral during additional 6 months Teeth were taken out. Subsequently, the patient's
clinical status improved.
Conclusion: As saprophytes, Actinomyces species are generally low
pathogenicity and cause disease only in immunocompetent persons but
may occur in persons with diminished host defences. Routes of infection
in thoracic actinomycosis include aspiration of oropharyngeal secretions
or gastric contents. We considered a case of thoracic actinomycosis at
an alcohol and nicotine abuser, that was suspected to have spread
directly by aspiration from the mouth to the lung, then to the chest wall
and skin with complicating subcutaneous abscess. In the context of risk
factors for actinomycosis, i.e. severe alcoholism, physicians should be
aware of the possibility of this infectious entity and exclusion the dental
focus. Even if rare, thoracic wall abscesses by actinomyces sp may occur
without underlying pneumonia.
ISE.080
Community-acquired Septicemic Pneumonia Caused by a
Multiresistant Staphylococcus aureus> Strain, Resulting in Multiple
Organ Involvement Exacerbated by Extensive Immune Activation
Background: Antibiotic-resistant Gram-positive cocci are of increasing
concern, and immune activation promped by microbial products (bacterial superantigens) may play a major role in the pathogenesis of disseminated, life-threatening S. aureus infection.
Methods: An exceptional case report of community-acquired, severe
infection caused by a methicillin-resistant S. aureus strain, responsible
for pneumonia, septic shock, and scattered septic embolism, and accompanied by diffuse polyvisceritis and thrombophlebitis as signs of an
extensive immune system activation, was observed in a otherwise
healthy 40-year-old man.
Results: The striking features of S. aureus polyvisceral disease (pneumonia, sepsis, and pulmonary and hepato-splenic septic embolism),
were associated with multiple immune-mediated focal manifestations
(massive pleuric-pericardial effusion, mycocarditis, and multiple lower
limb thrombophlebitis). In vitro resistance to all beta-lactams, fluoroquinolones, macrolides, and aminoglycosides, apparently did not justify
the clinical-microbiological failure of a glycopeptide-based combination
therapy. Only the administration of linezolid-rifampicin-tetracycline
together with intensive care support, achieved a slowly progressive ameliorement, while the polyvisceritis (associated by an immune-activation
syndrome documented by increased CD4+, CD34+, and CD4-CD8- Tlymphocyte subsets), caused dyreactive disease at multiple body sites,
and required a prolonged high-dose steroid therapy. A complete clinical,
laboratory, and instrumental recovery was reached only three months
after admission.
Conclusions: This report raises multiple questions about the epidemiology, pathogenesis, manifestations, and management of complicated S.
aureus infection, with special focus on the immune system activation triggered by microbial antigens, and the therapeutic role of steroids and
novel antibiotics targeted against resistant Gram-positive cocci.
ISE.081
Legionella pneumophila Survived and Reproduced in Free-living
Amoeba from Environmental Water Sample
Q.W. Jiang1, H.Y. Chen1, Y. Bai2, Q.X. Li1, H.Y. Wu2. 1Department of
Epidemiology, School of Public Health, Fudan University, Shanghai,
China; 2Center for Disease Prevention and Control, Pudong District,
Shanghai, China
Legionella in environment lives in the man-made water borne such as
cooling water of central air conditioners, and it's one of the three main
pathogens of atypical pneumonia. It have been reported that there is
some relationship between Legionella and free-living amoeba (FLA) in
water borne. But it is hard to find legionella in the trophic amoebae isolate from environment.
In this experiment, legionella and FLA were separately isolated from the
same water sample of an air conditioner cooling tower in a hospital. The
sample was filtered through the Millipore membrane (0.22 m), and then
processed with hydrochloric acid (0.1mol/l Ph0.2), FLA was also deposited with antibiotic(penicillin-streptomycin) under 4 for 12 hours. legionella
was inoculated on BCYE-medium and FLA was cultured with PYB712
medium in flasks.
One strain of Legionella pneumophila serology type I and one strain of
acanthamoeba were identified. Legionella and FLA were cocultured
under 28. Changes were investigated in morphological way by using
inverted microscopy and Gimenes staining of the cover glass picking up
from the flask about every 24h. Gimenes staining showed that legionella
was obsevered in the amoebae cocultured after 8 hours, and the number
of legionella was increased after 24 hours. The control (legionella cultured without amoeba) compared with the legionella cocultured with FLA
showed legionella could not grow in PYB 712 medium, because the number of legionella decreased from 10-6 to 10-4CFU/ml. Trophic amoebae
were highly parasited, and the remains of amoebae which had been
lysed were observed The control of amoeba under the same condition
without legionella grew well, and the structure kept integrated.
Conclusions: Legionella can survive and multiple in free-living amoebae
isolated from the same water sample, which suggested free-living amoebae were the natural host of legionella pneumophila in environment
water.
ISE.082
Early Diagnosis of Tuberculous Meningitis with TB PCR Test in A 3year Old Girl
A.Q. Feng, M. Howidi, G. Ritchie. SKMC Hospital, Abu Dhabi, United
Arab Emirates
The diagnosis of TB meningitis is often delayed because many patients
initially present with vague, seemingly minor signs and symptoms. We
describe a 3-year old girl who was previously healthy and also vaccinated with BCG. She presented with a 9 day history of fluctuating sleepiness
associated with low grade fever and headaches. She had no meningeal
signs, no focal neurological deficit and generally appeared well on presentation. Head CT was normal. CSF study showed mild pleocytosis (15
WBC / cmm) with lymphocyte predominance, normal protein and glucose. CSF bacterial culture and PCR for EV and HSV were negative.
CSF for TB PCR was positive. Chest X-ray was negative and PPD was
negative. Repeated CSF 4 days later showed an increased pleocytosis
(35 WBC / cmm), and TB PCR remained positive. The child was started
on standard treatment for TB meningitis and clinically well in subsequent
follow up. This report indicates that initial presentation of TB meningitis
can be subtle and high vigilance of the diagnosis is important. PCR for
TB meningitis in CSF is greatly beneficial for early diagnosis.
ISE.083
Multiple Pulmonary Nocardia Asteroides Infection in the Setting of
End-stage, Untreated HIV Disease. A Puzzling Diagnostic and
Therapeutic Issue
Background: AIDS presenters are increasing worldwide, due to HIV
infection lasting undiagnosed-neglected for many years.
Case Report: A 43-y-old drug-alcohol abuser was recently diagnosed
with HBV-alcohol-related liver cirrhosis, and an advanced, untreated HIV
infection with a CD4+ count of 14 cells/µL,and an initial ADC.
Hospitalized owing to >15% weight loss, fever, cough with blood emission, and multiple pulmonary infiltrates, when undergoing a HRCT a consolidated 4-5 diameter lesion involving the apical-dorsal left upper lobe
was accompanied by multiple subpleuric lesion, with excavations at right
lower lobe. Either tubercular, bacterial, or other opportunistic infections
were suspected, together with a malignancy. While waiting for
microscopy, cytology, and culture examinations of respiratory secretionsBAL, based on blood cultures which yelded a multi-sensitive S. epidermidis strain, a broad-spectrum therapy including cefazoline, and later
cefriaxone and fluconazole was attempted without clinical improvement.
After the microscopic-culture isolation of Nocardia asteroides (testing
susceptible in vitro to co-amoxiclav-chloraphenicol, cotrimoxazole, and
gentamycin, while it proved resistant to cefotaxime), treatment was
adjusted to include cotrimoxazole, and a triple HAART was conducted for
12 days, until an overwhelming anemia-leukopenia needed RBC transfusion and G-CSF adminiatration, followed by a modified antimicrobial therapy imipenen-amikacin), in the suspect of cotrimoxazole intolerance. A
slowly progressive clinical ameliorement occurred, as confirmed by
repeated X-ray-HRCT controls, in association with a partial immune
recovery obtained thanks to HAART.
Discussion: In patients with recently diagnosed HIV disease and a profound immunodeficiency,the differential diagnosis of multiple pulmonary
infiltrates with tendency to excavation includes tuberculosis-atypical
mycobacteriosis, but also bacterial infection and malignancies. In our
case, the diagnostic difficulties were complicated by the emerging of a
cotrimoxazole intolerance which prompted to a severe anemia-leukopenia, so that a second-line therapy for nocardiosis was performed
favourably. Notwithstanding Nocardia spp. infects immunosuppressed
hosts, however nocardiosis remains very infrequent in advanced HIV disease, when only sparse pulmonary, cerebral, and skin localizations were
anecdotally described. Our case underlines that opportunistism may go
beyond the most usual disorders, and its tratment may be conducted
effectively with second-choice agents, too.
ISE.084
Melatonin Decreases Nitric Oxide Production and Lipid
Peroxidation Induced by Venezuelan Encephalitis Equine Virus in
Neuroblastoma Cell Cultures
J. Mosquera, N. Valero, L.M. Espina. Instituto de Investigaciones
Clínicas "Dr. Americo Negrette", Maracaibo, Venezuela
Background: Increased expression of inducible nitric oxide synthase
has been shown in murine Venezuelan equine encephalitis (VEE) virus
infection. In this experimental model, melatonin (MTL) treatment has
shown to be beneficial. The aim of this study was to determine the effect
of VEE virus on the nitric oxide (NO) production and lipid peroxidation
(TBRS) in neuroblastoma cell cultures, and to investigate the role of MTL
during cell-virus interaction.
Methods: Neuroblastoma cells were co-cultured with VEE virus and
treated with MTL at doses ranging from 0 to 1.8 mM, for 6, 12, 24 and 48
hours. NO and lipid peroxidation were measured in culture supernatants
and in the cellular content by nitrite concentration and tiobarbituric acid
assay, respectively.
Results: Increased production of NO and lipid peroxidation products were
found in supernatants and cellular contents (lipid peroxidation) of VEE virus
treated cultures. Both NO and lipid peroxidation were decreased by MTL
treatment in supernatants in a time dependent manner.
MTL on VEE cultures (48h)
Supernatant
NO
TBRS
Cellular content
NO
TBRS
0
58 9 *
65 12 *
3 0.5
0.025
10 2
11 1
81
7.5 2.5
0.1
81
10 1
7.5 2
10 3
0.25
8.2 0.5
9 0.5
71
82
8.5 2
0.5
81
82
5 0.5
11 1
1
8.1 1
10 0.5
5 0.5
82
1.8
91
8.5 0.5
93
7.5 2.5
Uninfected cultures
37 5
3 0.5
6 1.5
3 1 **
Conclusions: These results could be related to the beneficial role of
MTL in the VEE experimental disease and address the possible therapeutic potential of the hormone in human VEE virus infection.
ISE.085
Focal Bacterial Infections of Central Nervous System—Our
Experience Over a Five-Year Period
V. Turkulov1, N. Madle - Samardzija1, J. Vukadinov1, D. Dankuc2, R.
Doder1, S. Sevic1, G. Canak1. 1Clinic for Infectious Diseases, Novi Sad,
Serbia and Montenegro; 2Clinic for Ear, Nose and Throat Diseases, Novi
Sad, Serbia and Montenegro
During the 2001–2005 period, 114 patients have bean treated for CNS
bacterial infections at the our Clinic. 20 patients exhibited the signs of
focal endocranial infection, such as cerbritis, abscesses, mastoiditis, or
sinusitis. In all patients the diagnosis had been based on the clinical features, and confirmed by neuroradiological imaging-computerised tomography or nuclear magnetic resonance. During the last year of the follow
up, an increase in the frequency of focal endocranial infections had been
spotted out (8 of 15 patients).
Etiological cause was identified in almost half (55 - 48.25 %) of the
patients. Haemocultures were positive in 18 (15.79 %) patients. Most
commonly isolated etiological agent was Streptococcus pneumoniae in
29 (25.44 %) patients, then Neisseria meningitidis in 11 (9.65 %) cases,
less frequent were Haemophylus influenzae in 3, Streptococcus viridans
and Listeria monocytogenes each in 2 patients, finaly Staphylococcus
aureus and Acinetobacter - each in 1 case.
Nine patients with focal CNS infections were treated only conservatively,
by antibiotics together with symptomatic therapy, while 11 patients, were
submitted to surgical treatment, in addition to the conservative therapy.
Most of the patients were operated at the Clinic for ear, throat and nose
diseases, while few of them were treated at the Neurosurgical clinic.
The duration of the antibiotic therapy administration varied from two
weeks to three months. Most commonly a combination of two or more
antibiotics was used parenterally, including ceftriaxone, amikacin,
metronidazole, vancomycin, meropenem, ciprofloxacin, clindamycin,
chloramphenicol and others. All patients who had been submitted to surgery got either cured or recuperated, while among the conservatively
treated patients 3 were cured and 6 died. The early diagnosis and appropriate therapy, which implies a surgical intervention besides antibiotic
treatment, provides the high recovery rate for these patients.
ISE.086
Clinical and Epidemiological Aspects of Salmonella Infections and
Their Treatment
T. Nedelkova, S. Trajkova, R. Stojanova, S. Bisinova, S. Miskova, N.
Balova, E. Balova. Department of Infectious Diseases, Veles, Former
Yugoslav Republic of Macedonia
Background: Salmonella infections are very often illnesses in our hospital in Veles. We are going to descript clinical and epidemiological
aspects of these infections and to define their treatment.
Material and Methods: We analyzed the patients treated in our department. Material of our examination was medical documentation of patients
with different salmonella infections. We analyzed these parameters: clinical investigations, season, age and sex of the patients. The diagnose
was based on clinical examination, epidemiological analysis and microbiological investigation of patients and food.
Results: In a period from 1996–2005, in our department were treated
5681 patients with different intestinal communicable diseases and 386 of
them were with salmonella infections (6,8%). In this period we signed 4
bigger epidemics with 207 patients. First was in one factory restaurant
(72). The second was in primary school restaurant (80). Third was in public restaurant during the wedding celebration (34), and the forth was on
private home party (21). Diagnosis was based on clinical manifestation,
epidemiological signs and microbiological tests. Incubation was short 13 days. Most of the patients had an ordinary clinical manifestation as a
result of their good health. Only at five patients we notice acute renal
insufitenty as a complication. In most of samples was isolated salmonella enteritidis group D. We used symptomatic therapy and oral and intravenous rehidration. Only 25% of patients were treated with antibiotics
based on the antibiogram. Hospitalization was about one week.
Conclusion: Salmonella infections are really actual problem today,
because of using collective food in schools, factories, restaurants e.t.c. It
is necessary to use efficient hygiene prophylactic methods in preparing
and keeping the food, to prevent developing of these illnesses.
ISE.087
Severe Respiratory and Extrapulmonary Manifestations Related to
Mycoplasma pneumoniae Infection
E. Cecchini1, S. Acuna1, M.M. Greco2, M.R. Agosti2, S.E. González
Ayala2. 1University Institute for Infectious Diseases, School of Medicine,
La Plata National University, La Plata, Argentina; 2Department for
Infectious Diseases, School of Medicine, La Plata National University, La
Plata, Argentina
Background: Mycoplasma pneumoniae usually produces mild respiratory illness and the diagnosis is clinical, but it may have extrapulmonary
involvement or can lead to a severe respiratory disease requiring etiological diagnosis. The aim of this study is to present atypical and/or severe
pulmonary manifestations of Mycoplasma pneumoniae infection.
Methods: A longitudinal prospective epidemiological study was performed in 138 patients, 50 patients < 15 years of age (y) and 88 older,
period 01/01/2000 - 31/12/2005 at the University Institute for Infectious
Diseases. Patients with compatible clinical findings and positive serology
test (IgM antibody) and/or PCR were included. Most frequent etiologies
were ruled out according to the clinical presentation in all cases. p value=
opposed hypothesis.
Results: Percentage frequency was respectively for age group 16y,
severe respiratory disease 12, and 6.8; severe pneumonia 2, and 5.7;
pleural effusion 8, and 1.1; mucocutaneous manifestations 34, and 5.7
(<0.000001); Stevens Johnson Syndrome 6, and 3.4; erythema multiforme 28, and 2.3 (<0.000001); neurologic involvement 4, and 5.7;
meningitis/encephalitis 2, and 4.5; polyradiculitis/Guillain Barré
Syndrome 2, and 1.1; cardiac complications 0, and 2.3; pericardial effusion 0, and 2.3; hematologic disorders 0, and 6.7; hemolytic anemia 0,
and 2.3; bicytopenia 0, and 1.1; thrombocytopenia 0, and 2.3; hepatic 2,
and 0; hepatitis 2, and 0; fever 90, and 93.2; malaise 90, and 92; interstitial pneumonia and upper respiratory tract symptoms 74, and 65.9;
headache 10, and 87.5 (p=0.00001); myalgias 2, and 81.8; enanthem 58,
and 17 (p=0.0001).
Severe manifestations were observed in 35.5%. Mucocutaneous manifestations were more frequent in children. Two cases of Stevens Johnson
syndrome had not respiratory symptoms (one with encephalitis).
Conclusions: M. pneumoniae is a causative agent in patients with severe
pneumonia as well as in those with extrapulmonary complications involving any major organ system even in absence of respiratory disease.
ISE.090
Antimicrobial Susceptibilities and Molecular Epidemiology of
Salmonella typhi Strains Isolated in Belgaum, South India from 2000
to 2004
M.B. Mutnal, C.S. Patil, M.B. Nagamoti. Jawaharlal Nehru Medical
College, Belgaum, India
ISE.088
Isolated Native Nonrheumatic Tricuspid Valve Endocarditis in the
Absence of Intravenous Drug Use
A.A. Heydari, S. Mogahi, V. Booriazadeh. Mashad University of Medical
Sciences, Mashad, Iran
The antimicrobial susceptibilities and molecular epidemiology of 80 S.
Typhi strains isolated in this locality between 2000 and 2004 were studied. All the isolates of the year 2000 were Chloramphenicol resistant with
minimum inhibitory concentration values (MICs) of 2000-5000 mg/ml. In
the following years decrease in frequency of Chloramphenicol resistance
was noticed: 2001 (50%), 2002 (32%), 2003 (15%) and 2004 (0%). The
strains isolated in the year 2003 and 2004, showing reduced susceptibility of (towards) ciprofloxacin, were nalidixic acid resistant, but were sensitive to the third-generation cephalosporins (ceftriaxone and cefotaxime). Based on randomly amplified polymorphic DNA (RAPD) patterns, all isolates had identical or similar RAPD patterns, suggesting that
a predominant clone of S. typhi is circulating in Belgaum, south India during the period of study.
Isolated native nonrheumatic tricuspid valve endocarditis rarely is
described in the absence of intravenous drug use, intracardiac catheters,
or cardiac anomalies. In the absence of a history of intravenous drug use,
the disorder mimicking chronic illness and community-acquired pneumonia and diagnostic delays are common. We diagnosed tricuspid valve
endocarditis in two nonaddicted patients. The first patient was a 38-yearold diabetic female with; fever chills, anemia, and microscopic hematuria
and pyuria that occurred during several weeks. The plain radiography of
chest was normal and high resolution computed tomography (HRCT) of
chest, was done because of predominant pulmonary symptoms and
signs, that revealed consolidation and cystic formation in the left prynchyma.Based on the above finding we decided to start anti-tuberculosis
treatment but no significant response was seen, except body temperature which subsided. Tran's thoracic echocardiography (TTE) was done
and revealed large vegetation of tricuspid valve.
The second patient was a 45 -year-old man who admitted with acute
fever and left lower lobe infiltrate and systolic murmur. TTE was normal
but trans esophageal echocardiography showed a large vegetation on
the tricuspid valve. staphylococcus aureus grew in 2/3 blood cultures. We
concluded that isolated tricuspid valve endocarditis in nonaddicted
patients rarely occur and mimics chronic illness and community-acquired
pneumonia of acute or chronic onset. In the absence of a history of intravenous drug use, diagnostic delays are common. We suggest that rightsided endocarditis must be considered in any patient with fever and
recurrent pulmonary symptoms and signs, with or without abnormal
chest X ray, heart murmur or a history of intravenous drug addiction.
ISE.089
Causative Microorganisms of Acute Pharyngo-Tonsillitis in Adults
N. Yamanaka1, K. Fujihara1, M. Hotomi1, Y. Harabuchi2. 1Wakayama
Medical University, Wakayama, Japan; 2Asahikawa Medical University,
Asahikawa, Japan
Objective: Acute pharyngo-tonsillitis is an important disease in adults
and little is known about the causative agents, especially virus and
mycoplasma and the relationship between causative agents of this disease. Patients with pharyngo-tonsillitis are treated by doctors of several
specialties, including internal medicine, pediatrics, and otolaryngology,
suggesting that data from one specialty would be unable to reflect whole
clinical spectrum of this disease. The aim of this study: (1) to evaluate the
efficacy of antimicrobial drugs for the proper treatment and (2) to find out
causative agents of adult pharyngo-tonsillitis.
Subjects and Methods: We conducted a survey of microorganisms
causing acute pharyngo-tonsillitis as a joint project of above three specialties (Phatons: Pharyngo-tonsillitis Study Group) between May 2004
and June 2005. Two hundred and thirty six adult patients with pharyngotonsillitis who attended our hospital and 34 other institutions belonging to
Phatons group were includes in this study. These patients underwent
bacteriological examination, rapid diagnosis tests for adenovirus and St.
pneumoniae, examination for atypical organisms (Mycoplasma pneumoniae and Chlamydia pneumoniae), and polymerase chain reaction (PCR)
for adenovirus, human metapneumovirus, influenza virus, respiratory
syncytial virus. Symptoms and local finding of pharyngo-tonsillitis were
assessed by scoring and the severity (maximum score 12 points), and
the relationship between the severity score and each causative organism
was also evaluated.
Results: Among 236 adults, 57.4% had bacteria at >= 105 CFU/ml.
Infection with bacteria or virus alone was found in 43.8% and 8.8%
patients respectively whereas mixed infection was detected in
10.0%.There were no difference of bacterial detection rates among
groups stratified by severity score, but detection of ß-hemolytic streptococci increased with a higher score (0-3: 15%; 4-8: 27.1%; 9-12: 40.6%).
Conclusion: ß-hemolytic streptococci was the major pathogen of acute
pharyngo-tonisillitis in adults as same as children, however, viral infections might not contribute to the disease as compared to children.
ISE.091
Brucellosis—Epidemiological Characteristics and Treatment at
Patients in Department of Infectious Disease in Veles
S. Miskova, S.B. Eftimova, T. Nedelkova, S. Trajkova, R. Stojanova, L.
Maninska. Department of Infectious Diseases, Veles, Former Yugoslav
Republic of Macedonia
Background: Presentation of epidemiological characteristics at patients
with acute form of brucellosis and their treatment from 2001 to 2005 at
region of Veles commune.
Material and Methods: For period of five years (2001-2005), at the
department of infectious disease in Veles are treated 136 patients with
acute form of brucellosis. We've done retrospective analysis which was
based on disease history, questionnaire parameters, biochemical investigations and serological tests (BAB, Wright). The patients are analysed
on age, sex, profession, the place of living and the way of transmission.
Results: Most of the patients are registered in 2005 (33%) on age from
20 to 60 years old 93 (68, 3%). Male are dominant with 110 (80, 9%). 110
(74%) of patients are from rural communities because of their contact
with livestock. The way of transmission is a result of direct contact with
diseased livestock 113 (83, 1%) and only 23(16, 9%) are infected by consuming milk and milk products. 87(64%) are sheep-breeders. Brucellosis,
like an infection with season characteristics, is most common in spring.
All the patients are treated with tripple therapy: aminoglicozides, tetracyclines and sulfonamides. Some of them were treated with physiotherapy.
After that the most of the symptoms were regressed and the serological
tests were decreased too.
Conclusion: At the region of Veles commune in period of five years
(2001–2005) were registered 136 patients with acute brucellosis. Rural
population is dominant, the age group from 20 to 60, the male are more
represented. The most common profession are sheep-breeders. The way
of transmission is a direct contact with diseased livestock. This infection
has season characteristics, with greatest incidence in spring months.
Because of continual presents of acute form of brucellosis in our region,
it's still a serious medical and economic problem in Republic of
Macedonia.
ISE.092
Clinical Clues to the Presence of Pyogenic Liver Abscess in
Community-acquired Klebsiella pneumoniae Bacteraemia
B.N. Kim1, Y.G. Kwak1, E.S. Kim2, S.W. Park 3. 1Inje University College of
Medicine, Seoul, Republic of Korea; 2Dongguk University College of
Medicine, Goyang, Republic of Korea; 3Dankook University College of
Medicine, Cheonan, Republic of Korea
Background: Community-acquired Klebsiella pneumoniae bacteraemia
is often associated with pyogenic liver abscess (PLA) in some Asian
countries. This retrospective study was conducted to investigate clinical
clues to the presence of PLA in adult patients with pure communityacquired K. pneumoniae bacteraemia.
Methods: We identified patients with K. pneumoniae bacteraemia at
three hospitals during the period 2001-2004. Excluding pediatric, nosocomial, and healthcare-associated cases, only community-acquired
cases that underwent abdominal ultrasonography and/or computed
tomography studies were analysed for this study.
Results: Of 131 adults with pure community-acquired K. pneumoniae
bacteraemia, PLA was identified in 38 (29.0%); other sources of the bacteraemia included biliary tract (49 patients), unknown source (17), urinary tract (16), lung (5), peritoneum (3), bone and joint (2), and skin and
soft tissue (1). A past medical history of PLA or biliary infection was not
more common in PLA group than in non-PLA group (15.8% vs. 6.5%; p
= 0.2). Symptoms including fever, chill, malaise, myalgia, and headache
were more common in PLA group than in non-PLA group (all, p 1.5
mg/dL) and anaemia (haemoglobin 400 IU/L) was more common (all, p
<0.05).
Conclusion: Clinical findings above were not specific clues to the presence of PLA. A clinical consideration for possible PLA should be taken in
adults without explainable source of community-acquired K. pneumoniae
bacteraemia.
ISE.093
Recurrent Scalded Skin Syndrome by Exfoliative Staphylococcus
aureus and High Usage of Steroids - Health Problems for Hiv/aids
and Non-HIV/Aids People in Kenya
M. Wanjiku. Health Promotion, Nakuru, Kenya
Introduction: Skin infection due to opportunistic pathogens has become
a major problem to HIV, AIDS and non- HIV/AIDS people in Kenya as HIV
prevalence keeps rising in the world. It represents as recurrent itchy rashes. It mimics various dermatology conditions (eg. Cellulites, acne etc),
allergy and asthma like conditions. This has resulted to high use of
steroids, antibiotics and anti fungal without success. The immuno suppression effect of steroids could be worsening these conditions on
HIV/AIDS patients. A collaborative community based programme was initiated by infection Control Association of Kenya (ICAK) and NGPS taking
care of the sick to investigate causative agents, control antibiotics and
steroids / anti fungal high usage, by giving health providers effective
alternative.
Method: Itchy cases attending skinchnics were investigated.
Chlorhexidine, cetrimide, chlorhexidine,+ Cetrimide, Benzalkoniumchloride, providone iodine, were tested for bacteria / fungal inhibition. Isolates
were identified. Various locally available antiseptics were tried on patients
with bacterial infection to eliminate the bacteria and itching and development of normal skin was monitored for three years. Steroids / antibiotics
and anti fungal were withdrawn.
Results: Pure growth of Exfoliative Staphylococcus aureus was isolated
from 80% of recurrent itchy cases while normal skin mixed growth of skin
normal flora were isolated.
This strain produces Exfloative toxins A,B and epidermolytic toxins which
cause scalded skin syndrome and itching conditions. The ointment,
which is composed of chlorhexidine gluconate and cetrimide, liquid
paraffin and petroleum jelly was able to control itching while others did
not control itching, eliminate the Exfoliatiove Staphylococcus aureus and
prevent deformation of the skin. The use of this has drastically reduced
the suffering of patients and use of steroids and antibiotics.
Conclusion: The use of this very low concentration of chlorhexidine/
cetrimide ointment by NGOs, (Church Health providers MSFS - Belgium
-Spain - France) has drastically reduced the suffering of patients,
reduced use of topical steroids, antibiotics and anti fungal. This antiseptic has become the most effective treatments for these patients who have
been on conventional drugs without response.
ISE.094
Management of Food Poisoning Caused by Enterotoxigenic E. coli
Producing Heat Steable Toxins in Community in Low Resource
Countries - Kenya
M. Wanjiku. Health Promotion, Nakuru, Kenya
Background: The emerging entero pathogens that is toxic E.coli and
Shigella organisms transmitted by untreated water and unhygenically
prepared foods is creating a major problem in the community.
The 14 years study in Kenya shows food and waterborne diseases are
still a major problem. The use of antibiotics has not reduced morbidity
and morality. The main cause of this problem of toxin producing E. Coli.
This calls for a new approach by management toxin producing food poisoning agents and neutralize toxins already produced.
Methods: From 1983, food poisoning agents were investigated during
the outbreak in Kenya. Sensitivity was done, toxin produced was investigated, and model of transmission was studied. Health providers were
advised on drugs to use for management i.e antibiotics with toxin neutralizing agents (attapulgite) and those without.
Results: From 1983, new food poisoning toxin producing agents have
been discovered and added to conventional ones thus making management of food poisoning more expensive and difficult. 23% of food poisoning was found to be due to Heat stable toxin producing E. Coli. These
organisms continued, developing resistance to new drugs through plasmid resistant factors. Food poisoning due to toxigenic agents (E. Coli)
responded better with antibiotics combined with activated attapulgite
(magnesium aluminum silicate). This is a chemical that has a high
absorbent power to neutralize toxins produced. Those treated with antibiotics continued to have stomachache and constipation.
Conclusions: Our study shows that antibiotics with attapulgite are one
pf the cheapest drugs for food poisoning due to food and water borne
toxin-producing agent. Eating freshly prepared food for the family.
Raw foods (salads) are not safe in low-resource countries. Chlorination
of water at ‘Point of use’ is recommended in controlling food / waterborne
diseases in low-resources countries. Women can play a major role in
Africa to control this problem because they take care of the family.
ISE.095
First Isolation of Vancomycin-resistant Enterococcus faecium in a
Hospital of North Greece
F. Polydorou1, A. Papa2, E. Kampilaki1, F. Pastore1, F. Rezoudi1, C.
Alexiou1. 1Agios Dimitrios Hospital, Thessaloniki, Greece; 2Microbiology
Department of Medical School, Thessaloniki University, Thessaloniki,
Greece
Over the past 20 years, multidrug-resistant enterococci have emerged as
a leading cause of nososcomial infections. The most important characteristics of these organisms are their inherent resistance to several antimicrobial agents and their ability to acquire resistance to some other
groups of grugs as b-lactams, macrolides, aminoglycosides and recently
glycopeptides.
We present the first almost simultaneous, two cases of Van-resistant
Enterococcus faecium in our hospital. The two patients were hospitalised
in the surgical ward and in the Intensive Care Unit.
Enterococci were isolated from infected patients by classical microbiologic techniques. The identification of the strains and the antimicrobial susceptibility testing were performed using the Wider system. The resistance
to the glycopeptides was confirmed using E-test.
For species identification of enterococcal strains, the genes encoding Dalanine-D-alanine ligases specific for E.faecium (ddl E.faecium) and
E.faecalis (ddl E.faecalis) were detected by a multiplex PCR assay using
rrs primers as internal control. In addition, specific primes were used for
detection of VanA, VanB, VanC1, VanC2/C3 genes.
1st case: A 72-years-old man with total resection of the stomach in the
past, cause of cancer, was admitted to the surgical ward for gallbladder
resection. Three days after the operation an infection developed in the
surgical wound. From the wound swab sample we isolated Enterobacter
aerogenes, Klebsiella pneumoniae and E.faecium resistant to glycopeptides and sensitive only to Linezolid and Quinupristin/Dalfopristin. The
same microorganisms were also isolated from blood cultures.
2nd case: A 75-years-old man was admitted to the surgical ward for gallbladder resection and pancreatectomy due to pancreas head cancer.
From the material of an abcsess in the surgical wound E.faecium resistant to glycopeptides was isolated.
From the fecal speciment culture E.faecalis sensitive to glycopeptides
was isolated.
Molecular identification by PCR showed that the two isolates were E.faecium. The VanA gene was detected in both isolates, in agreement with
the antimicrobial susceptibility test (highlevel resistance to both
Vancomycin and Teicoplanin).
The VRE appearance in our hospital indicates that strict surveillance programs for antimicrobial resistance of Enterococci are needed to avoid the
emergence and spread of highlevel glycopeptide resistance in invasive
eneterococcal isolates which leave the clinician with limited therapeutical
options.
ISE.096
Capnocytophaga: Clues to Diagnosis
H. Orth1, R. Hoffmann1, L. Hofmeyr2, H.W. Prozesky2, J.J. Taljaard2, A.
Els3. 1Department of Medical Microbiology, Tygerberg hospital, NHLS and
Stellenbosch University, Cape Town, South Africa; 2Department of
Medicine, Tygerberg hospital, Stellenbosch University, Cape Town, South
Africa; 3Department of Haematology, Tygerberg hospital, NHLS and
Stellenbosch University, Cape Town, South Africa
We report two cases of Capnocytophaga septicaemia. In both the history
of a preceeding dog bite was not apparent at presentation and only elicited after indicative findings on peripheral blood smear were made or a
positive blood culture was found.
Case 1: A 37-year-old postman presented with generalized arthralgia,
myalgia and diarrhoea. Clinical findings were that of an acutely ill,
hypotensive patient with tachycardia, tachypnoea, generalized lymphadenopathy and confluent skin ecchymoses. Laboratory investigations
showed renal failure, hepatocellular damage and DIC. Rod-like organisms, indicative of Capnocytophaga, were seen within polymorph leucocytes on the peripheral blood smear. Subsequent inquiry confirmed a
trivial dog bite 15 days prior to presentation and a history of alcohol
abuse. Capnocytophaga spp. was later also cultured from blood culture.
He recovered on intravenous Co-Amoxiclav, although he required bilateral above knee amputations because of gangrene.
Case 2: A 41-year-old builder with a history of alcohol abuse was
referred with suspected infective endocarditis. He presented with fever,
myalgia and arthralgia and was found to be mildly confused with a lowgrade fever, tachycardia, splinter haemorrhages, a murmur of aortic
regurgitation and microscopic haematuria. Laboratory investigations
showed neutrophilia, raised CRP and low serum complement levels.
Transthoracic echocardiography revealed a large vegetation on the aortic valve with complete destruction of the valve. Following isolation of
Capnocytophaga spp from blood culture, further inquiry revealed that he
had recently been bitten by a dog. He was prepared for aortic valve
replacement and initially responded to intravenous penicillin, but died
before surgery.
Capnocytophaga is a slow-growing organism necessitating extended
incubation time therefore knowledge of recent animal bite wounds, risk
factors such as alcohol abuse, and in some cases rod-shaped organisms
on peripheral blood smear may facilitate an earlier diagnosis and successful treatment.
ISE.097
Pseudomonas aeruginosa: Characterization and Virulence Factors
in Cystic Fibrosis Patients
M.C. Batlle1, J. Ayala2, C. Herrera1. 1Institute Pedro Kourí, Havana, Cuba;
2
Severo Ochoa Center, UAM, Madrid, Cuba
Background: In cystic fibrosis patients CF), chronic lung infection with
Pseudomonas aeruginosa:leads to progressive respiratory failure. This
condition remains a mayor cause of morbidity and reduces life expectancy.
Methods: Sixty Three isolates of P. aeruginosa: were obtained from: 14
CF patients attending pediatric Hospital William Soler,in Havana, from
March 2000 to January 2003. The reference strain used was P.aeruginosa ATCC 27853. The phenotypic markers (serotyping and phagotyping) were used to characterize the strains. Antimicrobial susceptibility to
11 different antibiotic was determinated by MIC. The virulence gen for
Pseudomonas aeruginosa (ETA) was detected by PCR in resistant
strains.
Results: The serotype O: 4 is the more representative (26,6%) and O:15
(17,2 %).The phagotyping technique were used the secondary markers
in our strains. No direct relationship between antibiotic resistance and
serologic results could be proved. Piperacillin, Meropenem and
Tobramicin are highly effective; Aztreonam and Ticarcillin are the most
resistant antibiotics in this study. The virulence gen was detected in
91,6% resistant strains analyzed by PCR.
Conclusions: The serotyping and phagotyping were the practical technique in characterization Pseudomonas aeruginosa: strains. On the next
years, beta-lactams antibiotic should be more rationally used as to prevent the emergency of the multiresistant strains in Cuba in Cystic fibrosis patients.
References: 1-Kato K, Iwai S, Kurnasaka K.Survey of antibiotic resistance in Pseudomonas aeruginosa: by Tokio Johoku Association of
pseudomonas studies. J.Infect.Chemoter, 2001 Dec;7 (4) :258–62.
ISE.098
Awareness of Urine Sample Collection Procedures Among Nurses
in a Rural Tertiary Care Hospital of South India
B.V. Navaneeth, K. Suresh. PES Institute of Medical Sciences and
Research, Kuppam, India
Background: Urine for culture constitutes about 38.8% of microbial culture samples received at our laboratory. Between 2004-05, it was documented that 14.6% of these samples were contaminated. This prompted
us to survey nurses, with an objective to educate, on urine sample collection procedure, as they are the key personnel who advise patients on
such procedure.
Methods: The study was conducted in a 750-bedded rural tertiary care
center in south India. Fifty nurses working in diverse clinical areas of the
hospital were included. A multiple-choice questionnaire on prior collection instructions, type of container used, method of collection in adults,
children, and catheterized patients, storage, time required to obtain culture reports, commonest bacteria involved in urinary tract infections
(UTI), risk factor/s for nosocomial UTI and method of disposal of urine
sample as infected waste was framed. All the nurses responded to the
written questionnaire and were subsequently educated on correct urine
sample collection procedure.
Results: 63.8% felt prior collection instructions are critical in sampling.
63.8% picked sterile containers for collection. 12.5% were aware of the
closed system collection in catheterized patients. 69.4 % opted for collection after detaching the catheter from the bag. 30.5% responded for aspi24 • International Scientific Exchange
ration of voided urine on the rubber sheet as the non-invasive method of
collection in children. Only 4.1% selected to store the urine inside the
refrigerator if delay is expected. Forty percent were aware of the processing time to obtain a report. Only 4.1% chose E.coli as the commonest
agent of UTI. Eighty percent were aware of catheterization as an important risk factor for UTI. 69.4% discard the urine into draining sink and
flush with water without any prior treatment.
Conclusions: Inadequate knowledge among nurses, especially in rural
areas, of urine sampling procedures for microbial culture calls for appropriate training and education.
ISE.099
The Prevalence of Listeria monocytogenes in Neonetal Sepsis in
Tehran, Iran
H. Goudarzi, A.A. Soleimani Rahbar, G. Eslami, F. Fallah, F. Fayaz, S.
Taheri, M. Mousavi. Shaheed Beheshti University, Tehran, Iran
Background: Neonatal sepsis is a clinical syndrome characterized by
systemic signs and symptoms and bacteremia during the first month of
life. Listeria monocytogenes is one of the newborn sepsis causes. The
incidence is relatively low(one to eight cases /1000 live birth), yet the risk
mortality is approximately 25%. Recent seroepidemiologic studies show
that the infection is foodborn.
Methods: This study were performed in Tajrish hospital during 2003-04.
Between 1680 hospitalized neonatals 910 cases which suffered from
sepsis were admitted to NICU. These newborn were evaluated according
to: birth weight, sex, blood group, clinical and laboratory evidences and
recent antibiotics therapy.
Results: Between 910 sepsis cases, 7(0.76%) of them were Listeria
positive according to positive blood culture or positive CSF culture. Out
of these 7 patients 4(57%) were male and 3(42%) were female. Among
them 5(72%) had low bearth weight and 2(28%) were weighted more
than 2500 gram.
Conclusion: The most frequent symptoms were, positive CPR: 6(85%),
Positive Icter: 5(71%), Thrombocytopenia: 5(71%), PCRP& low PLT:
3(42%) and Leukopenia: 2(28%). Through these patients 14% were
Ampicillin resistance, 28% were Gentamicin resistance and 14% were
Amikacin resistance.
ISE.100
The Prevalence of Klebsiella sp. in Urinary Infections in Tehran, Iran
H. Goudarzi, A.A. Soleimani Rahbar, G. Eslami, F. Fallah, F. Fayaz, M.
Habashizadeh, R. Khanipourroshan. Shaheed Beheshti University,
Tehran, Iran
Background: Urinary tract infections represent the most common genitourinary disease in children and second most common infection in
them.Failure to recognize and treat acute urinary tract infections may
result in recurrent infection and progression to Chronic
Pyelonephritis,chronic Renal Failure and Hypertension.
Methods: This study performed on 1038 positive urine cultures. The aim
of this study is to determine the prevalence of Klebsiella pneumonia in
urine culture in Mofid children hospital in Tehran between 2004-05.
Results: This study showed that among 1038 positive urine cultures
Klebsiella pneumoniae is the one of most cause of UTI in 13.8% of positive urine cultures.
Conclusion: Klebsiella pneumoniae is second only to E.coli as a urinary
tract pathogen.Klebsiella infections are common in hospitals where they
cause pneumonia(characterized by emission of bloody sputum) and urinary tract infections in catheterized patients. Urine culture and
Antibiogram is the best paraclinical tests to recognize the cause of infection and help us to treat the patients more effectively.
ISE.101
Prevalence, Antibiotic Resistance, Plasmid Profiling and Van Genes
of Enterococci Species Isolated from Environment in Tehran
F. Rahimi, M. Saifi, M. Pourshafie. Pasteur Institute of Iran, Tehran, Iran
Background: Enterococci are members of the normal gut flora of animals and humans and which are released into the environment directly
or via sewage outlets. The aim of the study was to detect and to analyze
the biochemical diversity of the Enterococci strains in Tehran sewage and
to determine the genetic characterization of VRE.
Methods: A total of 390 isolates of Enterococci were selected on m E
agar medium. All of the isolates were identified at the species level by the
common biochemical tests. Antibiotic susceptibility test of isolates was
done by disk diffusion method with 6 antibiotics vancomycin, erythromycin, gentamicin, tetracycline, chloramphenicol and ciprofloxacin. The MIC
was also done by E test and broth macro dilution assay. Analysis of the
plasmid profiles and the PCR tests for vanA and vanB genes were done.
Results: The results showed that 200, 113, 57, 7, 4, 3, 2, 2 and 1 isolates were E.faecium, E.hirae, E.faecalis, E.mundtii, E.gallinarum E.raffinosus, E.dispar, E.casseliflavus and E.avium, respectively. The antibiotic
resistance to the isolates were as follow: 5, 5, 17, 20, 32, 6% of the isolates were resistant to vancomycin, gentamicin, tetracycline,
ciprofloxacin, erythromycin and chloramphenicol, respectively. MIC test
showed that 18 of the isolates were highly resistant, 5 isolates were intermediate and 12 isolates were sensitive to vancomycin. The plasmid profiles of the isolates showed 4 strains lack plasmids, 14 strains having five
different profiles. PCR analysis showed that from 18 VRE, 100% had
vanA gene and 33% had vanB gene.
Conclusion: Enterococcal species, in general, was considered to have
a high distribution in Tehran sewage with E.faecium as the most predominant strain. Overall, there was a 5% VRE in the Tehran sewage treatment
plant. The presence of VRE was limited to E.faecium.
ISE.102
Knowledge, Attitudes and Practices of Primary Care Physicians
About Pertussis
A. Benabdellah. CHU.ORAN, Oran, Algeria
Background and Aim: Lifetime protection against pertussis has been
adopted as a goal of immunization programs in Algeria.
Aim of this study: to exam physician's knowledge, attitudes and practices
about pertussis.
Methods: We developped a questionnaire and interveiwed pediatricians,
general practitionners, rural and urban physicians. The physicians were
selected by a random process.
Results: 180 physicians responded. All the physicians thought that
Algeria is a country of low incidence for pertussis. They beleived that pertussis is not a resurgent disease. They thought that Bordetelle pertussis
is not the main cause of death among the children less than 2 months of
age. 33% of them evoked pertussis in an adult with a persistant cough
more than 7 days. 66% of the physicians thought that the children were
infected by a member of their family. 22% of the physicians thought that
the children are protected against pertussis by maternal antibodies and
3 doses of vaccine. 10% of the physicians believed that the antibodies
conferred by pertussis or by immunization endures less than 12 years.
66% of the physicians thought that an acellular vaccine for adults is useful for protection of adults and children. 66% of them will propose the
acellular vaccine to adults systematicly.
Conclusion: Personal risk perception and physician recommandation
are important to adults when considering pertussis immunization.These
factors may be relevant as immunization programs are expanded to
include more adults.
ISE.103
Epidemiological and Clinical Aspects of Boutonneuse Fever—
A 3-Year Study
C. Cristea, E. Ceausu, S. Erscoiu, P. Calistru. Hospital Victor Babes
Bucharest, Bucharest, Romania
Objective: Epidemiological features, clinical manifestations and course
of 98 cases with boutonneuse fever (BF) are presented.
Methods: 98 cases of boutonneuse fever were diagnosed in our clinic
during 2002-2005.The diagnosis was based on clinical, epidemiological
and serological criteria (antibodies to specific antigen of Rickettsia
conorii were detected by the use of immunofluorescence assay).
Results: Median age was 46 years. 70% of cases were recorded in the
warm month. A contact with dogs was established in 79% of patients.
Fever and exanthema were presented in 100%, headache 61% and
myalgia 45%. The black scar was noticed in 66% of patients.
Characteristic laboratory data were: leukocytosis in 25%, high levels of
erythrocyte sedimentation rate 69%, increased concentrations of aspartate transaminase 39%. In 8 patients cerebrospinal fluid examination was
performed: normal parameters in 4 cases, mild lymphocytic pleocytosis
(30 cells/mm⁄) in 4 patients, moderate pleocytosis (150 cells/mm⁄) in 2
patients. The patients received treatment with chloramphenicol (42%),
doxycycline (53%), ciprofloxacin (5%).
Conclusions: The mild and moderate forms of BF represented 93%. The
clinical course of BF was improved in 98,6%.
ISE.104
Vancomycin-resistant Enterococci Colonizing the Intestinal Tract of
the Hospitalized Patients
M. Jovanovic1, B. Stosovic1, T. Tosic1, S. Pavic2, G. Stevanovic1, B.
Milosevic1, M. Pelemis1. 1Institute for Infectious and Tropical Diseases,
Belgrade, Serbia and Montenegro; 2General Hospital Uzice, Uzice,
Serbia and Montenegro
Background: In 2002, the first clinical vancomycin-resistant
Enterococcus faecalis was reported in Clinical Center of Serbia in
Belgrade. There have been increasing reports of VRE infection or colonization since then. We investigated the rate of carriage of vancomycinresistant enterococci (VRE) from stool cultures in hospitalized patients in
this institution as well as in healthy subjects.
Methods: Specimens were cultured on selective media for the isolation
of enterococci (sodium-azide agar) and confirmed by Gram stain, catalaze test, growth on bile-esculin agar, growth on 45°C and in presence of
6,5% NaCl. Vancomycin resistance was confirmed by agar-screening
with 6 mcg/ml of vancomycin. VRE were identified using API Strep assay
and their MIC for vancomycin was determined by agar-dilution method.
Susceptibility to other antibiotics (ampicillin, high-level resistance to gentamycin and streptomycin, tetracyclin, ciprofloksacin, rifampicin and vancomycin and teicoplanin) was also investigated by disk diffusion method.
Results: In the survey that was conducted between January to May
2005 we collected 300 isolates of enterococci, and 8 (2.66%) of them
were VRE. Two of VRE isolates were found in repeated sample of stool
culture. All of them were Enterococcus faecium and highly resistant to
vancomycin (MIC90=256mg/l). All of them were resistant to high-level
doses of gentamycin and streptomycin and also resistant to ampicillin,
teicoplanin, ciprofloksacin and streptomycin, while 4 isolates (50%) were
resistant to tetracyclin. No one sample from healthy subjects (128) yielded VRE.
Conclusion: The study demonstrates that our VRE isolates were also
multiresistant to majority of therapeutic antimicrobial classes. The
patient's gastrointestinal tract is a possible reservoir for VRE, especially
since some of them might be the carriers, having the bacteria in repeated samples of stool cultures. Infections control precautions and restriction of glycopeptide usage may be key issues in limiting the emergence
and spread of nosocomial VRE infections.
ISE.105
Comparison of Bacterial Isolates from Patients in ICU and Non-ICU
Settings
N.C. Bodonaik, N. Smith. University of the West Indies, Kingston,
Jamaica
Background: Frequency of occurrence and antimicrobial resitance of
bacterial isolates vary in different parts of the world, in different hospitals
in a country and also in different clinical service areas within an
Institution (Arch Surg 13:1041-1045, 1998). Hence it is suggested that
recommendation for empirical antibiotic therapy should be guided by
focal unit-based surveillance data and not on cummulative hospital wide
antibiogram (J Intesive Care Med 20:296-301, 2005). In this report, we
examine 228 bacterial isolates from 169 in-patients with clinical diagnosis of pneumonia at the University Hospital of the West Indies (UHWI) in
Kingston Jamaica and compare the isolates from ICU with those
obtained from general wards in the Hospital.
Methods: Consecutive and unduplicated bacterial isolates obtained from
lower respiratory tract specimens (sputum, bronchial aspirate etc) from
in-patients with diagnosis of pneumonia in 6 months (June-Nov, 2005)
were analysed. Only isolates from specimens which revealed pus cells
on Gram stained microscopy were included.
Results: There were a total of 228 bacterial isolates, 106 from 77
patients in ICU and 122 from 92 patients in non-ICU settings. The common isolates from ICU in order of frequency were Pseudomanas aeruginosa 32((30.2%), Acinetobacter Sp 27(25.5%), Stenotrophomonas multophilia 10(9.4%) and Klebsiella pneumoniae 7(6.6%). On the other
hand, the most common isolate from patients in non-ICU setting was
Haemophilus influenzae 37(30.6%). It was followed by Pseudomonas
aeruginosa 25(20.6%),Klebsiella pneumoniae 17(14%) and
Acinetobacter Sp 10(8.3%). In general, isolates from ICU were more
resistant than those obtained from non-ICU areas.
Conclusion: The finding reinforces the suggetion that recommedations
for accurate empirical antibiotic therapy should be guided by focal unitbased surveillance data rather than a hospital wide antibiogram.
ISE.106
Streptococcus bovis Spondilodyscitis and Endocarditis - A Due to
Malignancy
J. Fernandes, I. Fernandes, H. Carmona, G. Carmo. Department of
Infectious Diseases - Santa Maria Hospital, Lisboa, Portugal
Streptococcus bovis is the main human pathogen among nonenterococcal group D streptococci. S. bovis infection is a well documented cause
of infective endocarditis and bacteraemia; less frequently, urinary tract
infections, meningitis and spontaneous bacterial peritonitis; and, rarely,
septic arthritis and vertebral osteomyelitis.
Case Presentation: 78-year-old man, with recent history of fever, fatigue
and low back pain.
History of Present Illness: one month prior to presentation the patient
noted temperature elevation, fatigue and low back pain.
Past medical history: The patient has a past medical history of diabetes,
hypertension and ischemic cardiopathy.
Hospital Course: Admission physical exam revealed painful percussion
of the lumbar vertebra and muscle atrophy of the lower limbs. Laboratory
test showed elevated inflammatory parameters. Upon hospitalization CT
and MRI were performed and revealed spondilodyscitis L3-L4 and paravertebral abscess. Culture from the pus was positive for S bovis.
Echocardiogram showed vegetation and abscess of the mitral valve.
Colonoscopy was performed, and a vegetation in the caecum was found.
Biopsy was consistent with adenocarcinoma. The patient was treated
with penicillin and gentamicin with resolution of the infective lesions, and
a partial colectomy was performed.
Discussion: The portal of entry of S. bovis is mostly the GI tract. A strong
association exists between S. bovis bacteraemia and underlying malignancy or premalignant lesions of the colon, and its exclusion is mandatory.
ISE.107
Analysis of Bacteraemia in a Tertiary Hospital, Sofia, Bulgaria
E. Keuleyan, S. Tete, T. Anakieva. Medical Institute-Ministry of the
Interior, Sofia, Bulgaria
Background: The aim of this work is surveillance of patients with clinically significant bacteraemia (CSB).
Methods: A 3-year retrospective analysis of Bactec, BD, blood-culture
isolates; microbial identification through Crystal, BD, or API, bioMerieux
biochemical panels; antimicrobial susceptibility testing according to CLSI
(NCCLS, 2002).
Results: CSB has been proven in 245 patients, mean age 66 y (range
27–93y); male: female = 4: 3. The number of the Gram-positive
pathogens was a little bit higher than the Gram-negative: 39 S. aureus,
.51 CoNS, 18 Enterococcus spp, 12 beta-hemolytic streptococci, 5 S.
pneumoniae. vs. 33 E. coli, 18 K. pneumoniae, .6 Serratia.spp, 4
Enterobacter. spp, 2 C. freundii, .12 P. aeruginosa, .18 A. baumannii. and
11 other GNNFs. The rate of fungemia was 4% and that of anaerobic
bacteraemia 1 %. The isolates from nosocomial bacteraemia were more
antibiotic resistant than the developed in ambulatory. Among staphylococci, methicillin-resistant strains represented 30 % in S. aureus . and 70
% in CoNS, respectively. No glycopeptide resistant staphylococci and
enterococci were found. All but one S. pneumoniae. (MIC 2 mg/L) were
penicillin susceptible. It is worth noting that 30 % of K. pneumoniae . and
some strains of Serratia . and Enterobacter . spp produced ESBLs; carbapenem-resistant were 4 strains of . P. aeruginosa . and during 2005
carbapenem-resistant Acinetobacter. did arise; none of them produced a
metallo-beta lactamase. Although most of CSB pathogens were susceptible to antibiotics, important mechanisms of resistance were documented, as ESBLs in Enterobacteriaceae, carbapenem-resistance in GNNFs;
significant part of staphylococci were methicillin-resistant.
Conclusion: the precise microbiologic diagnosis together with specified
mechanisms of resistance would improve the prognosis through more
optimal therapeutic and epidemiological management of patients with
CSB.
ISE.108
The Identification of Microorganisms from Children with UTI
G. Eslami, F. Fallah, H. Goudarzi, R. Osanlo, S. Taheri. Medical Faculty
of Shaheed Beheshti University, Tehran, Iran
Background: Urinary tract infection (UTI) is common in practice and an
important cause of morbidity in people infected urine stimulated an
immunological and inflammatory response leading to renal injury and
scarring ultimately leading toend stage renal failure. The present study
identifies the microorganism causing urinary tract infection in suspected
cases at Shohada teaching Hospital. The aim of this study was to assess
the prevalence of UTI pathogen and analyze its admit ion stature.
Materials and Methods: A prospective clinical and laboratory study
from2004 throgh 2005. 15056 suspected pediatrics from either sex, age
were studied at shohada teaching hospital. The urine specimens were
sent to the laboratory from all department of hospital and outpatient. Urine
colony count and culture were done on suspected case. Cases were divided into few groups as(outpatient, inpatient),(male, female) divided by
result of the urine culture into eight groups which were compared.
Result: From 15056 urine speicimens (55%), 2557(17%) were positive.
55% of positive culture were from female suspected case and 64% from
inpatient suspected cases. E. coli (53.3%) was the most prevelant
pathogen followed by suspected cases. Staph (8.1%) klebsiella (7.9%),
enterococci (5.2%), sterp (3.7%), proteous (3.1%) pseudomonas (6.4%),
Proteus and klebsiella and pseudomonas were more commonly found
in male.
Conclusion: UTI a significant problem and requires a large scale study
a regular interval in order to identify organism from time to time and recommend prompt treatment reduced UTI related morbidity.
ISE.109
Interferon Plus Lamivudine in Treatment of Chronic Hepatitis B in
Patients Unresponsive to Lamivudine Monotherapy
M. Panahi, A.A. Heydari, F. Rokni, N. Tymur - Zadeh. Mashad University
of Medical Sciences, Mashad, Iran
Introduction: Interferon alfa - 2b has anti - viral and immunomedulatory
effects that can induce virologic and bio chemical remission in chronic
hepatitis B (CHB) infection.
Methods: Lamivudine 100 mg per day and interferon Alfa 2b 10 mega ut
three times per week were given for 26 weeks to 22 adult patients with
liver biopsy—proved chronic hepatitis B who had been treated with
lamivudine at least 52 weeks. The virologic, immunophoresis, liver function tests and hematologic assays were evaluated.
Results: The aim of this study was to evaluate The efficacy of high
dosages of interferon a -2b combined with standard dosages of lamivudine in precore mutant or lamivudine resistant chronic hepatitis B. We
selected patients to three groups. Group I: HBeAg Neg, HB e Ab posit,
HBVDNA PCR posit CHB (6 patients). Group II: HBeAg posit, HBeAb
Neg, HBVDNA PCR posit CHB (11 patients). Group III: HBeAg Neg,
HBeAb Neg, HBVDNA PCR positive CHB (5 patients).
Clearance of HBVDNA occurred in three patients in group II and One
patient in each group I and III. Aminotrasferase normalization occured in
nine patients in group II and four patients in group I and III.
Conclusions: A six-month’s course administration of 10 mega ut of interferon Alfa - 2b 3 times per week in combination with lamivudine in atients
with chronic Hep B infection made a sustained depression of CHB in HBe
Ag posit posit patients. Significant studies with more patients are needed
to confirm this study.
ISE.110
Prevalence of Antibodies to Enterobacterial Common Antigen In
Patients with Yersiniosis and Blood Donors
W. Rastawicki, R. Gierczynski, M. Jagielski. National Institute of
Hygiene, Warsaw, Poland
Background: Enterobacterial common antigen (ECA) is shared by all
Enterobacteriaceae, including strains of Y. enterocolitica and Y. pseudotuberculosis causing yersiniosis. Previous studies have demonstrated
that ECA could stimulate production of antibodies both in immunized animals and in naturally infected humans. The aim of this study was to comparison of prevalence of antibodies to ECA in patients with yersiniosis
and blood donors.
Methods: The IgM, IgG and IgA class antibodies to ECA, obtained from
E. coli O14, were measured by ELISA in 293 serum samples collected
from patients suspected for yersiniosis and 100 blood donors. The
obtained results were compared to the results of ELISA with Yop proteins
and LPS isolated from the Y. enterocolitica and Y. pseudotuberculosis.
Results: The IgA antibodies were found in 15,4%, IgG in 23,2% and IgM
antibodies in 14,7% of sera obtained from patients with yersiniosis. In the
case of serum samples obtained from blood donors the IgA antibodies
were found in 3%, IgG in 11% and IgM antibodies in 6%. The titres in all
classes of immunoglobulins were found to be much higher in adults than
in children and youngsters. Also the prevalence of positive IgG antibody
levels was higher in patients with long term yersiniosis particularly complicated with arthritis. Generally, despite that prevalence of antibodies to
ECA were significance lower than antibodies to Yop and LPS, the level of
the anti-ECA antibodies was strictly connected with the level of specific
Yersinia antibodies.
Conclusion: Antibodies to ECA are intensively produced during infection
caused by Yersinia and may be useful in serodiagnosis of yersiniosis.
Nevertheless the presence of antibodies in the sera of blood donors may
indicate many subclinical infections caused by Enterobacteriaceae in
healthy population. Most of the antibodies belong to immunoglobulin G,
indicating that these healthy blood donors had experienced infections in
the past.
ISE.111
Escherichia coli, as the First Microbial Agent on Urinary Tract
Infections at Dr. Shariati Hospital, Tehran, Iran
P. Behzadi1, E. Behzadi2. 1Azad University, Shahriyar Branch, Tehran,
Iran; 2Azad University, Parand Branch, Tehran, Iran
ISE.114
Staphylococcus, the Fifth Microbial Agent on Urinary Tract
P. Behzadi1, E. Behzadi2. 1Azad University, Shahriyar branch, Tehran,
Iran; 2Azad University, Parand branch, Tehran, Iran
The motile gram-negative bacterium of Escherichia coli belongs to the
large family of Enterobacteriaceae. This organism is placed in the
gamma group of Proteobacteria and is the most important bacterial
agent of Ureogenital tract infections in human.
The most important aim in this project was the study of the prevalence of
Urinary tract infection caused by Escherichia coli, in patients who
referred to the Central Laboratory of Dr. Shariati Hospital in Tehran, during 6 months. So, data were collected by the questionnaires, which were
edited by the authors. The questions of questionnaires were absolutely
upgraded to the newest studies in the world. Finally, the statistical analyses were done by SPSS software version 11.5.
The results of this study indicate that, the prevalence of Urinary tract
infections caused by Escherichia coli in mentioned hospital is 54%.
Totally, 25% of Urogenital infections are seen in men and 75% are seen
in women.
In this project, the disposable factor was estimated as Sex of patients;
which the statistical method of Chi Square has shown the significant relation between Sex and Infection (P<0.05).
Staphylococcus is a genus of gram-pasitive, catalase-pasitive,
chemoorganotrophic, characteristically halotolerant bacteria of the family Micrococcaceae, which are usually highly sensitive to lysostaphin.
These non-motile cocci occur as commensal/parasites and pathogens in
man and animals. This genus is an important bacterial agent of
Ureogenital tract infections in human.
Urinary tract infection caused by Staphylococcus, in patients who
infections caused by Staphylococcus in mentioned hospital is 5.4%. From
this percentage, Staphylococcus saprophyticus causes 5%,
Staphylococcus haemolyticus 13%, Staphylococcus aureus 13%,
Staphylococcus epidermidis 31% of infections, and the left 38% are
caused by other strain of Staphylococcus. Totally, 60% of Urogenital
infections are seen in men and 40% are seen in women.
The disposable factor in this study was estimated as Sex of patients,
because the statistical method of Chi Square has shown the significant
relation between Sex and Infection (P<0.05).
ISE.112
Streptococcus spp., as the Second Microbial Agent on Urinary Tract
Streptococcus is a genus of gram-pasitive, asporogenous, chemoorganotrophic, facultative anaerobic, catalase-negative and oxidase-negative
cocci, which generally occur in pairs or chains and non-motile. This
genus is an important bacterial agent of Ureogenital tract infections in
human.
Urinary tract infection caused by Streptococcus spp., in patients who
infections caused by Streptococcus spp. in mentioned hospital is 15.2%.
From this percentage, group D causes 38.7% infections and the left
61.3% are caused by other groups of Streptococcus. Totally, 45% of
Urogenital infections are seen in men and 55% are seen in women.
The disposable factor in this study was not estimated as Sex of patients;
because the statistical method of Chi Square has not shown the significant relation between Sex and Infection (P>0.05).
ISE.113
Klebsiella, as the Fourth Microbial Agent on Urinary Tract Infections
at Dr. Shariati Hospital, Tehran, Iran
Klebsiella is a genus of gram-negative bacterium of the
Enterobacteriaceae. They are non-motile and capsulated bacteria, which
are one of the important bacterial agents of Ureogenital tract infections
in human.
Urinary tract infection caused by Klebsiella, in patients who referred to
the Central Laboratory of Dr. Shariati Hospital in Tehran, during 6
months. So, data were collected by the questionnaires, which were edited by the authors. The questions of questionnaires were absolutely
infections caused by Klebsiella in mentioned hospital is 5.8%, which is
placed in fourth. From this percentage, Klebsiella oxytoca causes 5%
infections and the left 95% are caused by Klebsiella pneumoniae. Totally,
46% of Urogenital infections are seen in men and 54% are seen in
women.
In this project despite of other investigations about Klebsiella, the disposable factor was not estimated as Sex of patients; because the statistical
method of Chi Square has not shown the significant relation between Sex
and Infection (P>0.05).
ISE.115
Acinetobacter, as the sixth microbial agent on Urinary tract infections at Dr. Shariati Hospital, Tehran, Iran
Acinetobacter is a genus of strictly aerobic, oxidase-negative, catalasepositive, gram-negative, non-motile (but may exhibit twitching motility)
bacteria, which belongs to the family of Moraxellaceae. They are one of
the important bacterial agents of Ureogenital tract infections in human.
Urinary tract infection caused by Acinetobacter, in patients who referred
to the Central Laboratory of Dr. Shariati Hospital in Tehran, during 6
months. So, data were collected by the questionnaires, which were edited by the authors. The questions of questionnaires were absolutely
infections caused by Acinetobacter in mentioned hospital is 3.8%, which
is placed in sixth. Totally, 65% of Urogenital infections are seen in men
and 35% are seen in women. Acinetobacter is a fast antibiotic resistance
bacterium.
Thus, in this project, the disposable factor was estimated as Sex of
patients, because the statistical method of Chi Square has shown the
significant relation between Sex and Infection (P<0.05).
ISE.116
Klebsiella pneumoniae Bacteremia: A Prospective Study in 34
Consecutive Episodes
A.A. Heydari, H. Malvandi. Mashad University of Medical Sciences,
Mashad, Iran
Background: Klebsiella pneumonia is a common hospital-acquired
pathogen, causing urinary tract infections, nosocomial pneumonia, and
intraabdominal infections. K. pneumoniae is also a potential communityacquired pathogen.
Method: From July 1, 2004, to March31, 2005, 34 episodes of klebsiella pneumoniae bacteremia in 34 patients were treated in our hospital. In
this study, we evaluated different aspect of Klebsiella pneumonia bacteremia including epidemiologic,clinical and antibiotherapy in community
and hospital-aquired infections.
Result: The disease was nosocomially acquired in 58.8% and community acquired in 41.2%. The different types of infection, were sepsis(44.1%), burn wounds(26.5%), pneumonia (11.8%) endocarditis
(2.9% ) urinary tract infection (2.9%), and hepatic abscesses (2.9%).
Burn which was found in 9(45%) patients, was the most common underlying disease, followed by renal failure in 3(15%), Diabetes mellitus in
2(10%) leukemia in 2(10%), and intravenous drug abuse in 1(5%). The
most frequent clinical findings in adult patients were fever (100%).
Leukocytosis (75%), thrombocy topenia (45%) and jaundice (40%).
Cough (30%), tachycardia (30%), tachypnea (25%), rigors(25%),
Hemoptysis (15%) and anemia (11.1%) was seen in our patients.
Carbenicillin and ciprofloxacin were the most active antibiotics.
Coclusion: Most episodes of K. pneumoniae bacteremia during the study
period were hospital-acquired cases and most of these patients had serious underlying disease.
ISE.117
The Determination of Relationship Between the Severity of
Systemic Inflamatory Response Syndrome and It's Etiology
A.A. Heydari, H. Esmaili, F. Khademi, M. Hajipour. Mashad University of
Medical Sciences, Mashad, Iran
Introduction : SIRS is known as a condition with two criteria among: 1fever or hypothermia. 2- tachypnea. 3- tachycardia. 4- leukocytosis or leucopenia. Sepsis is defined as the SIRS with infection etiology. The key
point in the treatment of sepsis is the early diagnosis and beginning of
treatment according to the signs before occurance of complications like
hypotension.
Method: In this descriptive study, all of the clients to the infectious disease department of Imam Reza's hospital were investigated during 11
months and 306 cases of SIRS were selected.
Results and Conclusion: Most of the patients were in the group of
pneumonia (n=56), then meningitis (n=35), unknown origin infections
(n=34), urosepsis (n=25). We had 23 non-infection patients and 17 mortale cases. In the comparison of infection and noninfection cases not any
statistically significant difference was found between primary vital signs
and laboratory findings, age, sex and mortality rate. We had the highest
mortality rate in pneumonia (n=7) that often had severe leukocytosis.
Severe SIRS has a 20.1 % sensitivity and 95 % positive predict value to
diagnosis of infection. The mortality rate didn't have any relationship with
thrombocytopenia, increased ESR or sex but had relationship with
hypotension, severe leukocytosis and severity of SIRS.
According to primary vital signs and laboratory finding, severe SIRS has
a clear correlation with mortality rate. So it is recommended that much
attention should be paid to the vital signs and routine laboratory finding
for the early diagnosis and treatment.
ISE.118
Acute Otitis Externa in Adolescents Due to Pseudomonas
aeruginosa as a Predominant Bacterial Opportunist Pathogen
M. Hajjartabar. Faculty of Industrial Safety and Health, Tehran, Iran
External otitis (OE), or swimmer's ear, is an inflammation, irritation, or
infection of the outer ear canal skin and can occur in acute and chronic
forms. OE is fairly common in children above age two. Also patients with
an upper respiratory infection and immunocompromised individuals, or
diabetics are at higher risk for this infection.
Although Pseudomonas aeruginosa, as the most causative common
bacterial of otitis externa is well known, and it is often considered as the
major cause or one of the important considerations in the treatment of
otitis externa, but inadequate treatment of OE due to this opportunist
pathogen, may result to an aggressive bacterial (Pseudomonas) infection
of the base of the skull. Therefore standard treatments and preventative
procedures of OE due to P. aeruginosa, require to identifying and isolating of this bacterium from external ear. To assess if P. aeruginosa can be
isolated and identified in ear swabs of adolescents with a history of ear
problem during two weeks before the exam, in the area of East and
North-East of the city of Tehran, during summer months of 2005, samples from external ear of 129 high school boys (ages 15-17) were taken.
A complete history of each participant was taken too. Adequate control
group of 31 other boys were chose randomly which never had a history
of ear problem too. Samples of ear swabs were examined for P. aeruginosa according to the Standard Method 20th edition. The assays were
performed in duplicates. Appropriate controls were included in each
experiment. P. aeruginosa was isolated out from the ear swabs of 87
(67.4%) of the cases, as well as from 6 (19.3%) of the controls. In addition, 24 (18.6%) of the samples showed high rates of the total bacterial
counts too. Results were matched for age, signs, symptoms, duration and
kinds of treatments and other useful information. Although results of this
research showed that otitis externa was strongly associated with P.
aeruginosa, but an extensive follow-up study is needed to determine the
other possible health risk associated with OE.
ISE.119
Simultaneous Cases of African Tick Bite Fever in a South African
Family
H.W. Prozesky1, C.W. Retief-Zarrabi2, M.F. Cotton3, J.J. Taljaard1, C.A.B.
Nash4, A. Madide3. 1Infectious Diseases Unit, Department of Medicine,
University of Stellenbosch and Tygerberg Academic Hospital, Cape
Town, South Africa; 2Department of Paediatrics and Child Health,
Town, South Africa; 3Paediatric Infectious Diseases Unit, Department of
Paediatrics and Child Health, University of Stellenbosch and Tygerberg
Academic Hospital, Cape Town, South Africa; 4Department of Medicine,
Town, South Africa
African tick bite fever (ATBF) is considered a mild illness affecting travellers to Sub-Saharan Africa. We describe simultaneous infection in a
South African family causing severe illness in both adults.
The husband, a farm labourer, presented with fever, headache, myalgia
and diarrhoea. On admission he was severely ill, encephalopathic, in
multiorgan failure with severe thrombocytopenia and early DIC. Other
findings were fever and relative bradycardia, an eschar on his left calf,
generalised maculopapular rash and hematuria. He was treated with
intravenous chloramphenicol. He rquired mechanical ventilation and
hemodialysis. He made a full recovery. Both Rickettsial indirect fluorescent antibody (IFA) IgM and IgG were negative on admission and positive 20 days later.
The wife, working on the same farm, presented with the same symptoms
at the same time. She was hypotensive with fever and relative bradycardia. She had a generalised rash and hematuria, but no eschar and less
severe thrombocytopenia. She was treated successfully with oral doxycycline. The Rickettsial IFA became positive after initially being negative.
The 6 year old daughter presented with the same symptoms. She had a
fever and lymphadenopathy, but no rash or eschar. Oral doxycycline was
initiated for suspected ATBF with a good response. Although both initial
and follow up Rickettsial IFA were negative, she is thought to have had
the same illness.
The family have 2 dogs both with ticks on a regular basis and one sleeping on the bed at night.
African tick bite fever cases differ in severity of illness. Serological tests
may become positive only later in the illness and do not differentiate
between causative organisms. More specialised laboratory investigations
are required to define the specific pathogen. The extent of ATBF and the
role of domestic animals in its spread is probably underappreciated.
ISE.120
Chlamydia pneumoniae Infection and Asthma
S.P. Martinov1, V. Youroukova2. 1National Research Veterinary Medical
Institute, Sofia, Bulgaria; 2Hospital of Pulmonary Diseases, Sofia, Bulgaria
Chlamydia pneumoniae can cause development of asthma as well as its
exacerbation and/or lead to persistence of the symptoms of asthma. We
investigated 26 patients with asthma, 5 of them with a new diagnosed
asthma (Group 1) and 21 ones with exacerbated non-atopic asthma slight persisting and mild persisting asthma (Group 2). We analysed titre
of the specific IgG antibodies through undirected hard phase enzyme
immunoassay (EIA). We used 10 healthy non-asthmatic controls as a control group. Group 1 had anamnestic data for pneumonia during previous
two months and Group 2 - for poor control of asthma. 3 patients from
Group 1 and 9 patients from Group 2 were serologically positive for
Chlamydia pneumoniae. 1 patient from Group 1 and 4 patients from
Group 2 showed data for an acute infection caused by Chlamydia pneumoniae. Persistent low titres for Chlamydia pneumoniae, a sign of a chronic infection, were found in 2 patients from Group 1 and in 5 patients from
Group 2. After antibiotic treatment all patients showed negative IgG found
in 1 patient. By a control analysis of spirometry we found improvement in
FEO1 of 14 per cent than the initial one (p<0,05). The data showed as follows: 1. Chlamydia pneumoniae probably can cause asthma and/or lead
to exacerbation of the symptoms of asthma. 2. Serological analysis for
chlamydias can be considered in resistant asthma and adequate antibiotic therapy should be applied when samples are positive.
ISE.121
Detection of IcaAD Gene and Biofilm Formation in Staphylococcus
aureus Isolates from Wound Infections
M. Oshaghi1, R. Yazdani2, A. Havayi2, E. Pishva2, R. Salehi2, M.
Sadeghizadeh3, H. Foroohesh4. 1University of Iran, Tehran, Iran; 2Isfahan
University, Isfahan, Iran; 3Tarbiat Modarres, Tehran, Iran; 4Iran university,
Tehran, Iran
Detection of icaAD gene and biofilm formation in Staphylococcus aureus
isolates from wound infections Wound infections are a common cause of
staphylococcal infections. One of the virulence of S.aureus is ability to
adhere and form biofilm on host surfaces. Biofilm is an exopolysaccharide, a slime matrix around multiple layers of cells and is mediated by
expression of the icaADBC operon. The present study evaluated the
biofilm forming capacity and the presence of icaAD gene among
S.aureus isolated from wound infections. Slime production assay was
performed by cultivation on Congo Red Agar plate. Also,Quantitative
biofilm formation determined by microtiter plate assay.PCR method used
for detection icaAD gene. A total of 50 strains were identified, 54% of the
isolates produced black colonies on CRA plate and 52% were positive
biofilm forming and all strains carried the icaAD gene. Regarding to the
ability of S.aureus to form biofilms helps the bacterium to survive hostile
environments within the host, suggest that biofilm production is a risk factor for infection. t is important rapid diagnosis and treatment biofilm forming strains, because biofilm formation may lead to increased antimicrobial resistance and create a significant impediment to wound healing.
ISE.122
Prognostic Factors in Sepsis
D.F. Tatulescu1, M. Turdean1, M. Flonta2, L. Ursu2, M. Horvat1, I. Badila3.
1
Iuliu Hatieganu UMPh, Cluj-Napoca, Romania; 2Clinical Hospital
Infectious Diseases, Cluj Napoca, Romania; 3Clinical Hospital of
Infectious Diseases, Cluj-Napoca, Romania
In a clinical group of 77 cases diagnosed as severe sepsis (Ss) at the
Clinic of Infectious Diseases Cluj-Napoca (CID) between 2004-2005, the
presence of some risk factors was evaluated in order to: i) show their
prognostic value in the evolution of Ss; ii) identify potentially lethal risk
factors.
The studied cases included 2 groups: group I (57 cases with favorable
evolution); group II (20 deceased cases of Ss). The causative agent was
identified using the BacTAlert technique. Depending on the case, procalcitonin (PCT) levels were determined and examinations were performed
for the confirmation of the presence of MSOD. The following risk factors
with prognostic value were identified: a) age: 32 cases with favorable evolution and 13 deceased cases were aged > 61 years; b) context of acquisition of the disease: in group I (32 cases) community-acquired Ss was
dominant, in group II (13 deceased cases) nosocomial Ss; c) antibiotic
therapy administered prior to admission to CID (inadequate antibiotics in
terms of family and/or dose/day, for 3-7 days): of 77 cases, 48 cases
(group I/II) were submitted to underdosed antibiotic therapy/kg/day,
which resulted in an undefined etiology, and 15 cases deceased; d) etiology of cases: the causative agent involved was identified in 36 cases,
of which: 1d) the isolation of gram positive cocci (23 cases of which 13
strains multiresistant to antibiotics (MRSA, Enterococcus); 2d) in 13
cases, ESBL gram negative bacilli (GNB) were isolated; e) PCT was
measured in 43 cases, of which: PCT 2-5 ng/dl (26 cases) demonstrated
a diagnostic value, and PCT > 10 ng/dl was a potentially lethal risk factor (17 deceased cases).
In conclusion, we consider the following as lethal risk factors: age > 70
years; early onset infectious shock; nosocomial Ss; PCT value > 10 ng/dl;
involvement of (±ESBL) strains multiresistant to antibiotics.
ISE.123
Septic Encephalopathy - The Value of Clinic and Neurophysiologic
Parameters
R. Raicevic, M. Surbatovic, L.J. Markovic. Military Medical Academy,
Belgrade, Serbia and Montenegro
Introduction: Septic encephalopathy (SE) is a common term pointing to
development of brain dysfunction signs in correlation with presence of
microorganisms and their toxins in blood. SE is most often not isolated
and is frequently accompanied by damage of many organs.
Objective and Methods: We analyzed the frequency of these manifestations in quantitative aspect of conscience disorders and prognosis in
survival in 60 patients with SE. We included patients with positive haemocultures and signs of septic syndrome according to known criteria (fever,
clinical signs, respiratory rate, heart rate, plasma lactate, oliguria). We
excluded all patients with proved trauma of brain, hemorrhage or brain
ischemia. All patients underwent neurological examination by the same
neurologist, and electrophysiological and neuroradiological examinations. Conscience disorders were graded according to Glasgow coma
scale.
Results: Results show that 30 (50%) patients had mild conscience disorders somnolent), 18 (30%) had sopor and 6 (10%) patients had deep
coma. Severity of conscience disorders was in positive correlation with
association electroencephalograph changes. In patients with deep coma
despite intensive antibiotic, metabolic and symptomatic therapy lethal
outcome was registered.
Conclusion: Syndrome SE if it doesn't include macroscopic organic
lesion of the brain parenchyma and signs of distribution of microorganism in CNS has a good prognosis. It is represented with change in conscience status due to metabolic-electrolyte disbalance, which needs to
be urgently, and forcefully treated.
ISE.124
Legionella Pneumophila Identified with PCR Method in BAL
Specimen Obtained from Patients Hospitalised with Respiratory
Tract Infection (RTI)
K.W. Pancer1, E. Golab1, E. Podsiadlo1, A. Pietraszek2, K. Piech2, R.
Wlodarczyk2, H. Polowniak-Pracka2, K. Kacperski2, J. Skrzydlewska2, M.J.
Krzakowski2, H. Stypulkowska-Misiurewicz1. 1National Institute of
Hygiene, Warsaw, Poland; 2Marie Sklodowska-Curie Memorial Cancer
Center and Institute of Oncology, Warsaw, Poland
Background: Bacteriological culture is a 'gold standard' for identification
of legionnaires' disease, however more useful, faster and modern methods of diagnosis using molecular biology methods seems necessary. The
aim of this study was to find out the Legionella pneumophila infections
among patients hospitalised with respiratory tract infection.
Methods: 30 BAL samples collected from patients with severe pneumonia or with chronic respiratory problem were examined. Among them 10
samples were collected from patients hospitalized at one oncology intensive care unit. Specimens were inoculated on different culture media,
also on media selected for Legionella spp, according to classical bacteriological methods. The PCR examinations were done retrospectively
(samples were frozen in -70C). Semi-nested PCR method was used for
L.pneumophila and/or Pneumocystis jirovetzii detection. For detection of
Chlamydia pneumonia infection the Real-Time PCR method was used
Results and Discussion: Bacteria Legionella spp. was found in no one
of samples examined by culture methods. The growth of other, antibioticresistant bacteria like: Acinetobacter sp, E. cloacae, K. oxytoca, E. coli,
E. faecalis was observed. However, using semi-nested PCR, the specific
for L. pneumophila fragment 16S rDNA was found in 12 samples (40%)
out of 30 tested. The 4 positive BAL samples were collected from the one
unit. Only one out of examined patients was a P. jirovetzii carrier. After the
antibiotic treatment analysis, it was found that before BAL collection the
patients had been treated with antibiotics, especially with cephalosporins
and carbapenems. It was found that on this unit the antibiotics belonging
to new quinolons, tetracyclines, macrolides (to which legionellae are generally sensitive) were rarely used.
Conclusions: PCR offers rapid results for detection of Legionella infection and seems to be promising method. Interpretations of obtained
results and it significance for diagnosis of patients and for public health
needs further evaluation.
ISE.125
Prevalence of Chlamydia Pneumoniae in Patients with Respiratory
Tract Infections with Cell-culture and DFA Methods
B. Hajikhani1, G. Eslami1, N. Badami2, F. Fallah1, F. Aminharati2. 1Shahid
Beheshti university of medical science, Tehran, Iran; 2Tehran University,
Tehran, Iran
Background: Community-acquired pneumonia (CAP) continues to be a
major medical problem. Insufficient and incomplete treatments, especially in atypical cases may lead to several outcomes. Chlamydia pneumoniae is a common atypical pathogen that causing approximately 10% of all
community-acquired pneumonias.
The aim of Current study is to investigate the prevalence of this organism in our community.
Material and Method: from 80 patients (47 female-33 male) throat
swabs were collected and refer to laboratory in transport media. (4sp
medium for isolation of Chlamydia in cell-culture - TSB medium for other
bacteria in routine cultures).
The diagnosis of bacterial agent in samples was based on culture in
blood agar and EMB agar media and in Hep-2 monolayer cell line and
also Chlamydia direct immunofluorescence test.
Results: From 54 patients (67.5%) the bacterial agent were diagnosed
as follow: Streptococcus pneumoniae 40.7% - Klebsiella Spp. 11.1% Pseudomonas- aeruginosa 16.6% - Other gram negative bacteria 11.1%
- Moraxella Spp. 3.7% - Haemophilus Spp. 11.1% - Staphylococcus
aureus 11.1% - Other streptococci 14.8% - Neisseria Spp. 16.6% Streptococcus pyogenes A 5.5%
In clinical presentation, shortness of breath and cough were the most
common signs. Most patients in both sexes were belonged to 40-50
years old group.
Conclusion: Regarding our results, in our community, like most others,
streptococcus pneumoniae is the most common agent in pneumonia.
Chlamydia pneumoniae pneumonia contains 7.4% of bacterial pneumonia and 5% of all pneumonia cases. This rate is almost high but in contrast to western countries is on lower level.
Key words: Pneumonia, Chlamydia pneumoniae, DFA- Cell culture
ISE.126
Prevalence of Oral Bacteria in Endocarditis
G. Eslami, F. Fallah, H. Goudarzi, B. Hajikhani. Shahid Beheshti
University of Medical Science, Tehran, Iran
Background and Aim: Infective endocarditis is a serious disease that is
associated with infectious disease an important element of the evaluation
of patients with infective endocarditis is the determination of its ethiology.
Many studies show that healthy persons frequently experience a transient bacteremia during dental treatment that may be innocuous in normal persons but can lead to IE in patients with abnormal heart valves.
The aim of this study was to determine the prevalence of oral bacteria in
bacterial endocarditis.
Material and Methods: This study was carried out in 2003-2002 in hospitals of Shahid Beheshti University of Medical Science. The diagnosis of
endocarditis is based on the clinical feature, laboratory tests and
echocardiography imaging. The most precise examinations of patients
with infective endocarditis are transesophageal and blood culture. The
blood samples were transferred in to the culture bottles. The blood cultures were sent to the laboratory and were placed in the incubator for 24
h. If no growth was seen, the media were incubated for longer period.
Results: In 97 patients (38 female and 59 male) suspected to have infective endocarditis, causative organisms were: Viridans streptococci,
S. sanguisI (9%), S. sanguisII (7%), S. mitis (3%), S. mutant (3%),
S. pneumoniae (3%), S. bovis (2%), S. salivarius (2%), enterococcus faecalis (2%), Staphylococcus aureus (12%), S .epidermidis (10%), Brucella
melitensis (6%), Escherichia coli (5%), Kebsiella pneumoniae (5%),
pseudomonas aeruginosa (2%), Neisseria mucosa (1%) and the rest of
culture (28%) were negative.
Conclusion: The results suggested that Infective endocarditis due to
streptococcus sanguis is more than another Strep.group. Since this bacteria is one of the important bacteria in dental plaque, so infective endocarditis can be associated with dental disease and treatment.
Key Words: Infective endocarditis, bacteria, dental plaque
ISE.127
Double Aetiology Meningitis After Prostatic Biopsy
C. Oliveira, F. Freitas. Hospital Infante D. Pedro, Aveiro, Portugal
Introduction: Meningitis of double aetiology is, to our knowledge, a very
rare clinical entity, apart of severe immune suppression. The authors
present a case of meningitis due to E.coli and M.tuberculosis following a
prostatic biopsy.
Case Report: A 71-year-old man was admitted with fever, headache and
temporal disorientation. Three days earlier he was submitted to a prostatic biopsy. On physical examination he was alert, confused and febrile
(38.7). Meningeal signs were evident. Except for a tachycardia of
100/min, further examination was normal. Blood analysis revealed raised
peripheral leukocytes, urea and creatinine elevation (177 mg/dL and 4
mg/dL, respectively), slightly raised aminotransferases and a protein C
reactive of 17 mg/dL. Head CT scan was normal. CSF results were as follows: glucose - 1 mg/dl, protein - 423 mg/dl, cell count - 1600/mm3; culture yielded polissensitive E.coli. IV Cefotaxime (12 g/day) and
Dexamethasone were administered. After an initial worsening of patient's
condition (Glasgow score of 6), he had gradual improvement of consciousness and general status but he persistently complained of
headache and low fever. Cranial MRI, thoracic, abdominal and axial CT
as well as heart ultrassonography were all normal. Repeated lumbar
punctures (at 4th/5th/6th week of IV cefotaxime) showed persistent moderate pleocytosis, low level glucose and raised protein level, as well as
elevated ADA, these findings being consistent with tuberculous meningitis. He was prescribed antibacillary drugs and metilprednisolone, with
progressive clinical improvement and normalization of CSF. PCR for
M. tuberculosis and Lowenstein-Jansen of CSF were negative. Prosthatic
biopsy was consistent with a non invasive prosthatic adenocarcinoma.
Conclusions: Despite no identification of BK on CSF we can assume
that the patient had a simultaneous infection of CNS by E. coli and M.
tuberculosis, a fact that, as far as we know, is quite a rarity among nonseverely immunocompromised patients.
ISE.128
Hematological Manifestations of Brucellosis in Hospitalized
Patients in Imam Hospital During 1998-2002
Z. Abdi Liae, A. Soudbakhsh, S. Jafari, H. Emadi, H. Bagherian, K.H.
Tomaj. Tehran Medical University, Tehran, Iran
Background: Although brucellosis has been controlled in many developed countries, it remain a health problem in IRAN.
As no characteristic constellation of symptoms and signs exists, diagnosis may be readily missed.
In this study, the frequency and diversity of hematological abnormalities
occurring in brucellosis were investigated in our patients, which could
help for rapid diagnosis of the disease.
Methods: Records of the preceding 5 years (from 1998-2002) of 85
patients with brucellosis were studied retrospectively.
All met the standard and case definition of this descriptive study.
On the basis of Questionnaire, demographic records of patients and
results of laboratory (serology and blood culture and hematologic
records) selected and studied.
Results: Anemia was detected in 43.5% patients, leukopenia in 13.6%,
thrombocytopenia 12.5% and pancytopenia in 2.4% of patients.
Unusual complications were detected in two patients, one with mouth
bleedings, the other with purpuric skin lesions of the lower extremities,
both patients had endocarditis.
Conclusion: As brucellosis is common in our region it may be considered in patients whose blood picture reveals hemolytic anemia, leukopenia, thrombocytopenia or pancytopenia, particularly when the disease is
epidemiologically suspected.
ISE.129
Management of Pneumonia in Under-five Children at Community
and Health Facility Levels in a Rural District of Uganda
E.A. Mworozi, J. Rujumba. Makerere University Medical School,
Kampala, Uganda
Introduction: Pneumonia is a major cause of morbidity and mortality
worldwide and is the second leading cause of morbidity and mortality in
Africa. In Uganda, ARI accounted for 11% of childhood deaths in selected hospitals (Alnwick 1982). In 1998, 15% of the paediatric deaths at
Mulago National Referral Hospital were due to pneumonia. There is limited information on prevalence, recognition, management of pneumonia
in children under five in rural settings. With accelerated health intervention measures e.g. vaccination this picture might have changed.
Objective: Establish the prevalence, caretakers' recognition of pneumonia in under-five children and its management at community and health
facility levels in Mubende District Uganda.
Methods: A cross sectional study using multi-stage sampling technique
was used to select study villages in Mubende District. One hundred sixty
nine caretakers of under-five children and 8 Health Unit Staff were interviewed. Qualitative data was collected using key informant interviews
and focus group discussions.
Results: Prevalence of pneumonia was 6% (community) and 5.9%
(health facility). Cough (90%), difficult breathing (40%), hot body (50%)
and blocked nose (40%) were the common symptoms by which caretakers recognize pneumonia in children.
Majority of the caretakers (80%) first gave western medicine at home.
Affordability of treatment, availability of money, nearness to services,
availability of free treatment facilitated treatment seeking for pneumonia.
Lack of money, decision making in homes, limitation of Government
health facilities and self medication delayed treatment seeking for children with pneumonia.
Conclusions: 1) The prevalence of pneumonia was 6% and 5.9% at
community and health levels respectively both lower than the national
prevalence rates. 2) Most sick children were treated at home. They are
taken to health facilities if sickness persisted. 3) Lack of money, decision
making in homes, lack of drugs in Government health facilities and self
medication delayed treatment seeking.
ISE.130
Limited Access Dressing (LAD) Design
P. Kumar. Kasturba Medical College, Manipal, India
Limited Access Dressing has been designed by the author to reduce the
pain and discomfort of conventional dressings, to reduce the chances of
wound infection and to improve the results obtained by negative pressure
dressing. Author intends to present his design of the dressing after doing
over 1000 dressings. LAD combines the principles of moist wound healing and topical negative pressure dressing along with a provision of an
additional port (12-14Fr tube) for instilling anti-microbial solution of
choice / gas (to make wound environment aerobic/anaerobic) without
any need to change the dressing. Intermittent negative pressure produces leech effect that controls SIRS (Systemic Inflammatory Response
Syndrome) and side by side during rest period (period of no negative
pressure by suction machine) allows local cytokines to act locally and
produce maximum local beneficial effects on granulation tissue, epithelialization etc. LAD application is easy and can be applied even at the site
of accident by using different sizes of ethylene oxide sterilized bags. LAD
design may be classified in to two categories: a) LAD design where
wound is covered with hydrocolloid material (LAD I; Fig.1), and b) LAD
designs where wound is covered with plastic sheet (LAD IB; Fig.2 and
LAD II; Fig.3-4).
Limited access dressing retains all the advantages of moist wound healing and negative pressure dressings. By manipulating the wound environment through tubes (using liquids and gases) or through transparent
plastic sheet (use of light), it tackles all the disadvantages of moist wound
healing and topical negative pressure techniques. Additional advantages
are better visibility through plastic /transparency, intra LAD early physiotherapy and saline wash of the wound. Intra LAD tissue expansion is possible to facilitate further reconstruction.Split skin graft take under LAD is
excellent. Preliminary observations and investigations appear to reduce
incidence of multiple organ dysfunction and failures. Theoretically and initial experiences of the author indicated that it might be helpful in reducing hospital acquired infection minimizing the risk of spreading infection
like HIV and Hepatitis B to health care givers.Also multi drug resistant
bacteria problem may be tackled by using physical agents like LASER,
U-V light and changing environment of the wound (like pH, aerobic to
anaerobic and vice versa) inside the closed space of LAD.
ISE.131
Mycoplasma pneumoniae, Common Cause of Lower Respiratory
Tract Infections
V. Markovski, L.J. Ilieva, L. Zabaznoska, D. Naunova, S. Bogoeva, K.
Spasovska. Clinic for Infectious Diseases, Skopje, Former Yugoslav
Background: Mycoplasma pneumoniae is common cause of community-acquired respiratory tract infections. Mostly infections appear among
outpatients, yet it`s a significant cause of pneumonia requiring hospitalization. The purpose of the study was to analyse epidemiology and clinical characteristics in hospitalized patients with Mycoplasma pneumoniae
pneumonia.
Methods: We studied patients with pneumonia hospitalized during 2005
at the Department for respiratory infections at Clinic for Infectious
Diseases in Skopje. Pneumonia was diagnosed according to clinical,
radiological and laboratory findings. Indirect immunofluorescency was
used to detect Mycoplasma pneumoniae IgM antybodies in pared-sample serum specimens. All patients were followed up two times after
discharge
Results: Mycoplasma pneumoniae pneumonia was diagnosed in 41
patient, representing 10,62% of all hospitalized patients (n=386), or
19,24% of those with pneumonia (n=213). 30 patients (73,17%) were
admitted from October to December. The average age was 19,74 years
(rang from 1 to 75); 41,46% (n=17) children up to 6 years old; 14,63%
(n=6) school children.8 patients (19,51%) had comorbid illness (3 with
significant anemia, 2 with congenital heart failure and 2 with paralysis
cerebralis). The average of leucocytes count was 9,5x109/L; in 9 patients
sedimentation rate was increased over 40mm/h; the average of C-reactive protein (CRP) was 48,20IU/ml. 14,63% (n=6) had severe and
85,47%(n=35) moderately severe pneumonia. The average of body temperature at admission was 38,9ºC; X-ray showed multiple patchy infiltrates in 22 as bilateral and in 16 as unilateral pneumonia. Pleural effusion occurred in 2 patients. Patients were treated with macrolides. The
mean duration of hospitalization was 11,19 days. The average regression
of pulmonary finding was 23,36 days All patients were discharged recovered
Conclusion: Mycoplasma pneumoniae pneumonia is a common cause
for hospitalization especially in children, with highest frequency during
the cold months. Presented as moderately severe, the infection has
advantageous clinical course with recovery of all hospitalized patients.
ISE.132
Evaluation of Diabetes Mellitus in Patients with Sepsis
M. Barati, M.A. Eshaghi. Iran University of Medical Science, Tehran, Iran
Diabetes mellitus is one of the most common diseases in community and
induced immunodeficiency with multiple mechanisms. Infections also can
induce hyperglycemia and ketoacidosis.
We have tried to evaluate the frequency of sepsis in diabetic patients and
factors that related to final outcome in these patients. This study is a
descriptive-cross sectional analysis and selects 300 persons with random sampling of patients that admitted to Rasol-e-Acram hospital with
sepsis diagnosis in 2001-2004.
Mean ages of patients were 52.7years (SD= 28.4). 158(52.7%) persons
of 300 patients had diabetes. The most common site of infection was respiratory tract and then urinary tract. The final outcome of patients in two
diabetic and nondiabetic groups demonstrate statistical differences
(P.value= 0.001). Mortality of patients increased with aging and delay in
beginning of treatment (P.value= 0.001).
88 person had 2, 156 person had 3 and 56 person had 4 sign of 4 sign
of SIRS in time of admission. 16 person (18.2%) of the first group, 116
person (74.4%) of the second group and 47 person (84%) of third group
had died (P.value= 0.001).
Of 158 patients with diabetes, 67 persons had upper than 250 mg/dl
average blood glucose that 97% of them had died and 55 persons had
average blood glucose between 180-250 mg/dl that 84% of them had
died and 36 persons had average blood glucose under 180 mg/dl that
42% of them had died. These 3 groups demonstrate statistical differences (P.value= 0.001).
This study demonstrates that aging can increase the rate of sepsis and
mortality of it in the diabetic and nondiabetic group. Also mortality of sepsis in diabetics is more than nondiabetics and quick treatment of them
can decrease this mortality. With increase of severity of disease (more
SIRS criteria), mortality increase and with strict control of blood glucose
patients have better prognosis
ISE.133
Clinical Picture of Lyme Disease - 10 Years of Experience in Warsaw
Hospital of Infectious Diseases
E. Marcinkowska1, J. Buratowska1, J. Iwaszkiewicz1, A. Horban1, H.
Zarnowska2. 1Hospital of Infectious Disease, Warsaw, Poland; 2Medical
University, Warsaw, Poland
Background: Clinical picture of Lyme disease differs according to countries where it occurs.
Methods: A retrospective study regarding epidemiological investigations, clinical aspects and treatment results was analyzed during a period of 10 years.
Results: In years 1995–2005 1140 patients (pts) with Lyme disease
were observed (715 women, 425 men, mean age 46 y., range 15–80 y.).
Among 1140 pts in 137 cases II/III stages were diagnosed. The group of
98/137 had history of tic bite, 95 pts demonstrated earlier erythema
migrans EM (53 of them were untreated).
Ninety pts had symptoms of Lyme arthritis in form of arthralgias or arthritis. All pts with Lyme arthritis had been detected the specific antibodies
against B. burgdorferi in serum. Symptoms of neuroborreliosis appeared
in 35 cases. The specific antibodies were detected in serum of every
patient and in CNS fluid of 28 pts. Cardiac involvement in form of thirddegree atrioventricular heart blok was found in 2 patients and myocarditis in 1 case. Acrodermatitis chronica atrophicans was diagnosed in 9 pts.
In this group of pts very high titres of IgG antibodies were found without
presence of IgM antibodies. All pts with II/II stages of disease were treated with antibiotics. Forty two pts required retherapy due to recurrence of
symptoms. Twelve cases of Lyme disease of pregnant women were
reported. All women had EM and were treated with antibiotics. The
course of pregnancy was normal in all pts. Newborns were delivered at
term without abnormalities on physical examination and without serological data of B.burdorferi infection.
Conclusions: 1) Majority of pts with II/III stages of Lyme disease had
Lyme arthritis. 2) Forty two pts with late stages of disease required
retherapy. 3) Antimicrobial therapy of EM of pregnant women prevents
abortion, preterm delivery or congenital Lyme disease.
ISE.134
Catheter Related Infections in a General Hospital
L. Carnival, M. Serafia, P. Ladelfa, I. Martinez. Police Federal Hospital
Churruca Visca, Buenos Aires, Argentina
Introduction: The sepsis related to a catheter constitutes one of the first
hospitalary infections, representing a significative tool to the morbidity
mortality and hospitalary expense.
Objectives: We study the incidence of catheter related sepsis and the
presence of associated germs to it.
Materials and Methods: In this study were included 203 adult patients
admitted during the year 2003 in different specialists areas of our hospital. The requirements to fulfils were the following ones: more than 3 days
in hospital and to take into account to have a connected periphery
venous catheter or central of short permmel. Bacteriologic studies were
performed on the catheter and a series of 2 samples of withdrawn Blood
cultures before to remove it. The catheters were processed by Brun
Buisson technique and the blood cultures by hand technique according
to the rules of CDC-CUMITECH 11 b.
Outcomes: The sepsis related to a Catheter (RCS) was considered in
the following case: the patient showed clinical evidence of systemic infection. A germ at the end of catheter and in the blood sample was
isolated, without other evidence focus of infection. Out of 203 patients
studied, 73 had culture of catheter with positive result, but only 24 RCS
were documented.
All cultures were monomicrobian and they showed identical antibiogram
for the isolated Bacteria in the hemocatheter of the same patient. The
main etiological agent was Staphylococcus aureus (45%) followed by
bacilis gram negative (33%) Candida sp (12,5%) and Staphylococcus
coagulasa negative (4,5%).
Conclusions: RCS values in our hospital are in the order of 12% (studies made in other centers are around 2.5 and 27%). Out of 8 catheters,
one can derive in RCS, therefore, we recommend for an accurate diagnosis, deliver the end of the catheter and two blood cultures. Seeing the
prevalence of S. aureus we must emphasize in the necessity of paying
attention to some good practice maneuvers like, hand-washing, site of
insertion and careful management of the biosecurity rules that should be
applied to the catheter connection.
ISE.135
Emerging of Streptococcus suis Meningitis from Non-pig Source,
November 2005, Petchburi, Thailand
S. Guharat. Prachomlaom Hospital, Muang, Thailand
Background: In 2005, in Thailand we had some sporadic cases of streptococcus suis meningitis of which the source of infection was pigs.
Petchburi Province had a young Thai male student who got meningitis.
The first diagnosis was to rule out meningococcal meningitis. We were
notified of the case by nurse in IPD. We investigated for verification diagnosis, active case finding in the community, finding sources of infection
and mode of transmission and recommendation for control and prevention of this event.
Methods: We conducted a descriptive epidemiological study by reviewing a case from medical records in hospital and laboratory findings, interviewing doctors, nurses, relatives, teachers and friends. Community and
environment surveys were conducted for reservoirs and other cases.
Results: A young Thai male student was 16 years old and studied in an
urban school. He got fever, headache, chill and coma in one day. Signs
were fever, stiffness of neck, stupor, vomiting, with no skin rash or ecchymosis. CSF WBC 240/cu.mm., PMN 67%, gram stain found no
pathogens and culture no growth. Blood culture found streptococcus suis
type 2 that was resistant to clindamycin and erythromycin but sensitive to
vancomycin, co-trimoxazole and chloramphenicol. Community and environment survey found no other cases. The patient's house is far, 150meters, from pig cage but no history of contact pork or pigs within four
days. The case and friends had a history of a party at 10-meter from a
cattle area every evening, and one day before his illness and in his house
were two dogs. Nasal and palatine swab were collected from 4/19 pigs
and 12/50 cows, but all of them were E. coli, Klebseilla pneumoniae and
staphylococcus coagulase negative. Streptococcus suis was not found
from anywhere in animals.
Conclusion: This streptococcus suis meningitis case was confirmed by
Thai NIH. We tried to locate reservoirs in many animals but we could not.
We gave close surveillance to that area for new meningitis cases for two
times the incubation period. No new case were found until now.
ISE.136
An Investigation on the Incidence of Clostridium difficile Among
Diarreic Patients in Afyonkarahisar/Turkey
M. Altindis, S. Usluer, Z. Cetinkaya, I.H. Ciftci, O.C. Aktepe. Afyon
kocatepe University Scholl of Medicine Dept of Microbiology, Afyon,
Turkey
Background: Clostridium difficile is an anaerobic spore forming bacteria
which is the major cause of pseadomembranous colitis (PMC), antibiotic
associated diarrhea and fulminate colitis /toxic megacolon. When normal
intestinal flora is altered generally due to the overuse of antibiotics especially at intensive care unit we see these clinical spectrum. In this study
we examine whether or not C.difficile is a responsible agent of diarrhea
after using antibiotics on either outpatient or inpatient basis, including
intensive care unit.
Methods: During 2005, patients seen on outpatient clinics, admitted to
wards or intensive care units, aging 1 to 80, their caring staff were included into the study. In this term, 103 patients (50.5% men/52 men) and 27
control group (77.8% men/21 men) were studied. C.difficile,
culture(Oxoid Clostridium difficile Agar Base), latex agglutination which is
a colony springs up culture, searched by toxin A latex (Oxoid, UK) and
toxin A+B ELISA (Seramun GmbH, Serazym C.difficile Toksin A+B).
Results: In the 14 (13.5%) of samples culture, in the 5(4.8%) of samples
toxin A latex, in the 14(13.5%) of samples ELISA toxin A+B were found
positive.
Conclusion: As a result; at diarrhea situations which is a reason of intensive antibiotics usage C.difficile is important agent, so investigating it by
culture or toxin A+B ELISA.
ISE.137
SAPNA Sri Lanka: Pneumococcal Surveillance at the Largest
Tertiary Paediatric Care Facility in South Asia - Lady Ridgeway
Hospital, Colombo Sri Lanka
B.K.R. Batuwanthudawe1, D.D.S. de Silva 2, K. Karunarathne3, M.K.
Lalitha 4, K. Thomas4, M. Steinhoff5, M.R.N. Abeysinghe1. 1Epidemiology
Unit, Ministry of Health, Colombo, Sri Lanka; 2Lady Ridgeway Hoapital for
Children, Colombo, Sri Lanka; 3Lady Ridgeway Hospital for Children,
Colombo, Sri Lanka; 4Christian Medical College and Hospital, Vellore,
India; 5Johns Hopkins University, Maryland, USA
Objective: To describe invasive pneumococcal infections among children admitted to the largest Paediatric Hospital (Bed strength 850) of
South Asia: Lady Ridgeway Hospital (LRH) for Children - Colombo, Sri
Lanka
Methodology: Sri Lanka is a member of South Asian Pneumococcal
Surveillance Alliance (SAPNA) and uses standard procedures in patient
recruitment and laboratory testing along with India and Nepal. Admitted
children 2 months–5 years of age presenting with fever and signs and
symptoms suggestive of infections in nervous, respiratory and circulatory systems were studied. CSF and blood culture were carried out and a
latex agglutination (LA) test (Wellcogen, Murex for Remel /UK) which
detected five bacterial antigens in CSF was also performed on all CSF
specimens to identify infections.
Results: During the year 2005, 41,398 children were admitted to the six
Consultant Paediatric Units of the hospital out of which 25,847 (62%)
were between 2 months and 5 years of age. A total of 3183 blood cultures (rate - 8%) were carried out over the year and 1259 were recruited
to the study. Of the 920 lumbar punctures (LP) performed (LP rate of
2.2%) 402 were recruited to the study. Fourteen streptococcus pneumonia isolates were yielded (10 from blood, 2 from CSF, one from pus culture and one from an eye swab). Latex detected 23 more Streptococcal
infections in 1291 CSF specimens. The commoner serotypes detected
were 23F (3 isolates), 19F (3 isolates) and 14 (2 isolates). Thirteen isolates (93%) were resistant to penicillin and 10 (71%) were resistant to
Erythromycin.
Conclusions: This is the first time the Sri Lankan pneumococcal
serotypes are described and commoner serotypes and antibiotic resistance are found to be of special interest.
Acknowledgments: PneumoADIP through SAPNA for technical and
financial assistance for Pneumococcal surveillance in Sri Lanka.
ISE.138
Pyogenic Sacroiliitis - An Uncommon Diagnosis
S. Simoes, J. Sousa, A. Santos, C. Filipe, M. Alexandre, R. Santos, A.
Porto. University Hospital of Coimbra, Coimbra, Portugal
Acute septic arthritis is caused by bacterial invasion into the synovial
space, through several mechanisms, including direct inoculation from
penetrating trauma or surgical incision, spread from a contiguous focus
of soft tissue infection, or haematogenous seeding from a distant focus.
The pyogenic sacroiliitis is an uncommon entity that occurs usually in
immunocompromised patients and is associated with gram-positive
cocci.
We report a case of a 14-year-old female, admitted to hospital with an
intense and persistent pain in the right buttock and hip, for 3 days, with
partial relief in rest and NAIDS. She mentioned otorrhea 1 month before,
with spontaneous resolution, and chronic otitis. She denied drugs, alcohol or smoke, local trauma, surgery or hospitalisation.
On admission the body temperature was 37.6ºC and the abdominal palpation elicited pain in the lumbar and right sacral region. The palpation of
sacroiliac joints was very painful at right. White blood cell count (WBC),
13.500/µl, with 77% segmented neutrophils; haemoglobin, 11.5 g/dl; erythrocyte sedimentation rate 82 mm/h. The blood cultures were positive for
Staphylococcus aureus. The thorax and lumbar spine X-ray, the electrocardiogram, the abdominal and right hip soft tissue ultrasound were normal. The sacroiliac joints X-ray showed moderate sub-condral densification, compatible with inflammatory injury of sacroiliitis. A focal uptake in
the right sacroiliac joint was seen in the 99TC-labelled WBC scan. The
Magnetic Resonance Imaging confirmed the existence of sacroiliitis on
the right side, with local muscular swelling and moderate joint effusion.
The patient was treated with flucloxacillin for 6 weeks, naproxen and tramadol, having a good clinical evolution. She started a rehabilitation program, with total functional recovery.
ISE.139
Serologic Follow-Up with Agglutination Test in Brucellosis After
Treatment
S. Jafari1, A.R. Soudbakhsh1, R. Razmandeh1, F. Ensani1, H. Emadi1, Z.
Abdi1, M. Hasibi1, F. Bagherian1, M. Haji Abdolbaghi1, A.R. Yalda2. 1Tehran
Univercity of Medical Science, Imam Khmeini Hospital, Infectious
Disease Departement, Tehran, Iran; 2Tehran univercity of medical
Science, Imam khmeini hospital, Infectious Disease Departement,
Tehran, Iran
Background: In the most of patients with brucellosis, signs and symptoms resolve by treatment, but in some patients, they stay up to end of
treatment, and in others they reoccur after treatment. Changes of serologic titers are unpredictable during and after treatment. This study was
designed to assess value of serologic tests in follow- up of patients with
brucellosis after treatment.
Patients and Method: In a descriptive, Analytic cross- sectional study,
26 patients with brucellosis, presenting to Imam Khomeini Hospital from
2003 to 2005, were included. Blood culture and serologic tests (Wright,
Coombs Wright and 2ME) performed for all the patients before treatment.
Serologic tests were repeated at the end of treatment and in follow- up
period-3, 6, 9 and 12 months after treatment.
Results: 25 patients (96.1%) had Wright titer >=1:160 before treatment
which was seen at the end of treatment and 12 months follow-up in 7
patients (42.3%), respectively. In 20 patients (76.93%), Wright titers after
treatment were reduced comparing Wright titers before treatment
(P=0.000). 22 patients (84.6%) had Coombs Wright titer >=1:320 before
treatment which was seen at the end of treatment and 12 months followup in 8 patients (30.8%), respectively. In 15 patients (57.7%), Coombs
Wright titers after treatment were reduced comparing Coombs Wright
titers before treatment (P=0.001).24 patients (92.3%) had 2ME titer
>=1:80 before treatment which was seen at the end of treatment and 12
months follow up in 14 patients (53.8%), respectively. In 16 patients
(61.54%), 2ME titers after treatment were reduced comparing 2ME titers
before treatment (P=0.004).Reduction of Wright titer (P=0.003) and 2ME
titer (P=0.01) were significant at twelve months after treatment, comparing at the end of treatment.
Conclusion: Serum agglutination tests (Wright, Coombs Wright and
2ME) are not suitable for patient follow-up, since titers can remain high
for a prolonged period.
ISE.140
Genes Study of Virulent cagA and vacA of H. pylori Isolated from a
Tunisian Population
K. Ben Mansour, M. Zribi, N. Hammami, A. Masmoudi, A. Filali, T. Najjar,
C. Fendri. Rabta Hospital, Tunis, Tunisia
H. pylori infections are frequent in Tunisia in the course of gastric pathologies: symptomatic children (60%) and ulcerous adults (70 to 80%).
The vacA toxin, as a precocious factor known in gastric cancerigenis, its
prevalence in the Tunisian population merits to be recognized. The aim of
our prospective study is to establish the cagA status and vacA toxin of 37
strains of H. pylori isolated from antral and/or fundus mucosa biopsies
taken from Tunisian symptomatic patients having different gastric
pathologies, and others who are asymptomatic models.
A PCR, using a couple of primers (F1, B1), was performed in order to
describe the cagA status of all our strains. The vacA genotyping and the
status fragments m1, m2, s1/s2, s1a and s1b were obtained by PCR
using specific primers and PCR conditions as published by Atherton in
1995. The prevalence of cagA associated to vacA was 50% with asymptomatic models and 56% with symptomatic patients, which is not statistically significant. Contrary to peptic ulcer, where this prevalence is 31%,
71% were adjoined to gastritis cases. According to Atherton, 100% of
vacA m2s2 strains were cagA negative; this conclusion was not checked
in our study. Indeed, 58% m2s2 strains were cagA positive (17% peptic
ulcer, 17% asymptomatic models and 8% gastritis). Moreover, s1 and s2
phenotypes seem not to be correlated with a given pathology; they are
isolated from ulcers and/or gastritis and asymptomatic models. This preliminary study is very crucial and does not already allow the establishment
of a correlation between genotyping variants and virulence in Tunisia. This
may indicate that the determination of the disease development is highly
complex and involves multiple bacterial and/or host factors.
ISE.141
Is Atopy a Potential Risk Factor for Listeriosis?
K. Kawamoto, S. Matsubara, H. Tokuji, S.I. Makino. Obihiro University of
Agriculture and Veterinary Medicine, Obihiro, Japan
Listeria monocytogenes is a gram-positive bacterium that causes
meningitis, bacteremia, and febrile gastroenteritis. The outcome of liste-
riosis is dependent on host factors such as age, pregnancy, and HIV
infection, which influence host immunocompetency. A Th-1 type cytokine
IFN-γ plays an important role in the innate immune response against
intracellular bacterial pathogens. In contrast, Th2-biased immune
responses often associate with most atopic diseases. In this study, we
examined whether atopy affected the immune response to L. monocytogenes infection. NC/Nga is a model mouse for human atopic dermatitis,
which has a genetic predisposition to develop atopic skin lesion. We compared the susceptibility to L. monocytogenes infection of NC/Nga mice
with BALB/c and C57BL/6 mice. The course of infection was characterized by monitoring survival of mice, and determination of bacterial numbers in the organs. NC/Nga mice were highly susceptible to L. monocytogenes infection: the 50% lethal dose was significantly lower and the
number of bacteria in livers, spleens and brains were higher in NC/Nga
than those for other inbred mice. The increased permeability of bloodbrain barrier was observed in NC/Nga brains at day 3 post infection, but
not in BALB/c and C57BL/6. As compared to BALB/c and C57BL/6 mice,
plasma IFN-γ levels of NC/Nga were comparative. However, markedly
increased IL-10 levels were detected in NC/Nga plasma early in the
course of infection. Pretreatment with neutralizing antibodies to IL-10
partially protected mice but retarded the clearance of bacteria. Yet the
molecular mechanisms by which the infection of L. monocytogenes
induces overproduction of IL-10 in NC/Nga mice remain unknown, our
results suggest that the differential cytokine production may at least partially underlie the higher susceptibility to L. monocytogenes in NC/Nga
mice. Considering the increased prevalence of atopic diseases, an atopic
phenotype may be a potential risk factor for listeriosis.
ISE.142
Severe Course of Leptospirosis Associated with Elevated Heparinbinding Protein and Reduced TLR2 Expression
O. Beran1, M. Kettnerova1, O. Dzupova2, H. Herwald3, Z. Janyskova1, M.
Holub1. 1Charles University, First Faculty of Medicine, Prague, Czech
Republic; 2Charles University, Third Faculty of Medicine, Prague, Czech
Republic; 3Lund University, Dept. of Cell and Molecular Biology, Lund,
Sweden
Background: Leptospirosis is an important zoonosis with a worldwide
distribution. The pathogenesis of the disease is partly influenced by leptospiral lipopolysaccharide (LPS), which activates monocytes (Mo) via
Toll-like receptor (TLR) 2 instead of stimulation of more conventional
TLR4 pathway. The ability of Mo to bind LPS was shown to be reduced
two-fold by heparin-binding protein (HBP). Here we report a case of a 26y-old patient with severe course of infection due to Leptospira interrogans, which was associated with a rapid development of multiple organ
failure (MOFS). For characterization of the early innate immune response
we determined TLR2 expression on Mo together with cytokine and HBP
concentrations in the peripheral bood (PB). Also, we assesed association
of these parameters with the clinical course and routine laboratory
parameters.
Methods: CD14 and TLR2 expressions on Mo were analyzed by flow
cytometry (FC) using monoclonal antibodies anti-CD14 and anti-TLR2.
Inflammmatory cytokines interleukin (IL)-6, IL-8, IL-10, TNF-α, IL-1β and
IL-12 were determined in PB by cytokine bead array (CBATM) and FC.
HBP was analyzed by sandwich ELISA. All these parameters together
with routine laboratory and clinical markers were evaluated at day (d)1,
d2, d3, d4, d8, d14 and before the discharge from the hospital.
Results: On admission, the levels of IL-6, IL-8 and IL-10 were 419, 324
and 54 pg/mL, respectively. Despite the progression of MOFS, the concentrations of all cytokines decreased to undetectable levels within 24 h
of institution of antimicrobial therapy. Unlike the cytokine and CRP concentrations, HBP level increased during first 24 h from 155 to 942 ng/mL,
and subsequently declined to 39 ng/mL after 48 h. In parallel, the intensity of TLR2 expression on Mo rapidly decreased (it was restored gradually within 4 weeks).
Conclusion: These findings indicate rapid development of immunoparalysis and a role of HBP in organ failure during acute stage of leptospirosis. Additionally, our observation suggests a possible importance of HBP
as a sensitive laboratory marker of the disease severity.
Acknowledgement: The study was supported by the grant GA CR Nr.
310/05/H533.
ISE.143
The Comparison of Listeria.monocytogenes Seroprevalence
Between Women With and Without Abortion from Shahrekord, Iran
M.R. Nafisi. Sharekor university of medicl scinces, Sharekord, Iran
Background and Aim: Listeria monocytogenes is a Gram positive rod
shape bacterium that causes septicemia, meningitis and inflammation of
the brain. The high risk groups are newborns, pregnant women and their
fetuses, and the elderly persons lacking a competent immune system. It
is also, one of the etiologic agents of food poisoning in human. This is a
case control study conducted to determine both the prevalence of antiL. monocytogenes in women suffering from abortion during pregnancy,
and the possible role of it in the abortion studied in Shahre-Kord, Iran.
Method: An analytical study was carried out on 120 pregnant women, 60
with abortion (cases) and 60 without abortion (control). Using indirect fluorescent antibody (IFA) method, a serum sample from the women was
assayed for specific antibody to Listeria.
Results: 10 of 60 (16.7%) samples from cases, and 4 of 60 (6.4%) samples from control were found to be positive for Listeria monocytogenes
specific antibody. It is worth notice that all the positive sera were from
women who suffered from abortion in first trimester. Statistically, based
on these results there was no relevance between age and abortion, but
between first 3 months of pregnancy and abortion.
Conclusion: Our results showed that there was no significant relationship between seropositivity and abortion in this study (p=0.068). This
might be due to low number of cases studied. Alternatively, the other
infectious agents might be involved in these abortions. Conclusively, this
bacterium could have role in abortion happened in our province and
more comprehensive study have to be carried out to determine the role
of each of the agents in them.
ISE.144
Skin Infection in a Cat-bite Victim Refractory to Erythromycine
(Case Report)
E. Gvozdenovic, N. Popovic, M. Jovanovic, O. Dulovic. Institute for
Infectious and Tropical Diseases, Beograd, Serbia and Montenegro
Woman, 53-years-old, came to outpatient clinic with clinical signs of
erysipelas cruris. Seven days before she was bitten by her own cat. As
the cat was vaccinated against rage she got anti-tetanus prophylaxis and
erythromycine 500 mg qid x 10 days. The wound was slightly inflamed,
but that did not bother her, until the 5th day (after the bite) when she got
temperature of 39.2˚C, without nausea and vomiting, or other systemic
symptoms. At that moment the wound was crusted, with slight
serosangvilent discharge, without local signs of inflammation. Fever was
considered as flu syndrome. The next day she was still febrile. Prominent
swelling appeared around bite-crust with lymphagitis and ingvinal lymphadenitis. The present state was considered as erysipelas.
Erythromycin was stopped and started penicillin 1 600 000 U. (Le 13.9 x
10/9/l, Nt 82%, fibrinogen 6.2 g/l, CRP 43 iu, SE 30) and wound shwab
was taken. Three days later there was no more lymphadenitis and lymphangitis, no wound discharge, no surrounding erythema, but oedema
persisted. Pasteurella multocida was isolated, resistant to erythromycine.
At the 7th day of penicillin the crust was surrounded with slight infiltration,
no signs of inflammation, Le 5.1 x 10/9/l, Nt 52% CRP 24u, fibrinogen 5.2
g/l SE 32.
There are no reports from our medical literature describing P.multocida
infection in man, but there are studies of infections in animals in which it
is sensitive to oral cephalosporins.
Considering that P.multocida is saprophit in dog (40–60%), cat (50–70%)
and many other animal mouth, we recommend cephalosporins as
empyric therapy for animal-bite infections.
ISE.145
Temporal Evaluation of Bacterial and Fungal Colonization of Burn
Wounds
J.L.S. Macedo1, S.S.S. Costa2, G.R. Martins2, S.T.A. Gomes2, L.F.R.
Velasco3, J.B. Santos4. 1Hospital Regional da Asa Norte, HRAN and
Nucleo de Medicina Tropical, UnB, Brasilia, Brazil; 2Laboratorio Sabin de
Analises Clinicas - Instituto Sabin, Brasilia, Brazil; 3Laboratorio Sabin de
Analises Clinicas - Instituto Sabin, Brasilia, Brazil; 4Nucleo de Medicina,
UnB, Brasilia, Brazil
The infectious complications are a major cause of death in burned
patients. The determination of the bacterial and fungal microbiota in burn
wounds is very important to decide the precocious antibiotical therapy.
We evaluated the burn wounds from 278 patients admitted consecutively at the Burn Unit from Hospital Regional da Asa Norte in Brasilia.
Swabs from wounds were collected weekly for 28 days. The culture medium used were blood agar, chocolate agar, MacConkey agar and
Sabouraud agar. The antibiotical sensitivity was evaluated by automized
method Vitek-bioMérieux. The confirmation of the bacterial pattern was
done by ATCC. The study was approved by ethical comitee in human
research. From 278 patients, 60,1 % were male and 59,9% were female
with mean age of 24 years.The agents involved in burns were open flame
54,7%, hot liquids 34,5%, 9% electricity, 1,8% chemical agents. The type
of microorganism isolated was variable, and the most common bacteria
in the first week after burn was S. aureus (28,4%). However at the third
week, P. aeruginosa was more prevalent (26,9%). The incidence of resistance to oxacyline was 44,6% concerning the Staphylococcus coagulase
negatives and 4,7% among the S. aureus. The only fungal specimen isolated from swabs of wounds was Candida sp. The fungal colonization
was stronger after 3 or 4 weeks after burn. All the Staphylococcus were
sensitives to vancomicine. All gram-negative were resistant to the majority of antimicrobians. The Gram-positive bacteria were more prevalent initially, but it was replaced by the Gram-negative. The fungal colonization
was more frequent after three or four weeks of colonization. A continuous
evaluation of the burn wounds is very important to prevent and control
cutaneous infections in burned patients.
ISE.146
Case Report: Ralstonia Pickettii Bacteremia in a Previously Healthy
Biologist
G.R. Martins1, P.G.G. Costa1, A.F.A. Bastos1, T.A.C. Lamounier1, S.S.S.
Costa2, H.M.S. Pinhati3, S.M. Domingues Jr3. 1Laboratorio Sabin Analises
de Clinicas - Instituto Sabin, Brasilia, Brazil; 2Laboratorio Sabin Analises
Clinicas - Instituto Sabin, Brasilia, Brazil; 3Hospital Santa Luzia, Brasilia,
Brazil
Ralstonia pickettii is a non-fermenting Gram-negative bacillus that is an
infrequent pathogen. It can be isolated from water, soil and plants, and
can also form part of the commensal flora of the oral cavity and the upper
respiratory tract of healthy individuals. Infections may occur in immunocompromised patients, caused by contaminated solutions, respiratory
therapy solutions, skin disinfectants, blood culture mediums, and water
supplies. We report a case of Ralstonia pickettii bacteremia in a 21 years
old previously healthy woman, biologist that works in a research laboratory. The patient presented recurrent fever, arthragias for two weeks and
the blood culture suggested gram-negative bacilli. She was treated with
cyprofloxacin for 7 days without remission of symptoms. Clinical investigation was performed and endocarditis, pneumonia, and infectious, rheumatic and oncologic causes of immunodeficiency were excluded. The
blood culture isolated Ralstonia pickettii in agar medium but not in Mac
Conckey medium. She was than successfully treated with ceftriaxone. In
order to clarify the possible sources of the bacteria, we investigated all
solutions used on the research laboratory were the patient works, and all
cultures were negative.The misinterpretation and non recognition of
Ralstonia pickettii as a pathogen may cause a considerable delay in the
diagnostic process. This bacteria must be considered as an important
pathogen in people that work with potential contaminated solutions.
ISE.147
Urinoculture Analyses in Renal-transplant Recipients in Clinical
Center - Skopje
I. Hadzi-Petruseva Meloska1, G. Jankoska1, B. Kurcik1, A. HadziPetruseva Jankijevic2, M. Petrovska1. 1Institute of Microbiology and
Parasitology, Skopje, Former Yugoslav Republic of Macedonia;
2
Secondary Medical School, Skopje, Former Yugoslav Republic of
Macedonia
Background: Urinary tract infections (UTIs) as a complication after renal
transplantation are important for graft survival. The aim of this study was
to review the most frequent isolates from urinoculture taken from renal
transplant patients (RTP).
Methods: In total 100 urine samples from 37 RTP, admitted in the
Urology and Nephrology Clinic in Skopje, were received in the Institute of
Microbiology and parasitology in a period of six months. A detection of
antimicrobial presence was preformed on all urine samples. Urinoculture
were analyzed respecting the conventional microbiology techniques for
isolation, identification and determination of the number of bacteria or
fungi in ml urine. Susceptibility testing towards 16 antimicrobials was performed using disc diffusion technique and VITEK automatised system
(bioMerieux, France).
Results: The positivity rate was 23 (62.2 %) out of 37 patients, all with
100 000 or more bacteria in ml urine. The rest 14 (37.8 %) patients had
negative urinoculture; 12 (85.7 %) positive for antimicrobial in the urine.
Isolated bacteria were 10 (43.5 %) E. coli (out of which 2 were mixed
infections with Kl pneumoniae and 1 with Enterococcus, 5 (21.7 %) Kl
pneumoniae and 2 (8.7 %) coagulase-negative staphylococci. The
remaining 6 findings comprised one of the following microorganisms
Enterococcus, Acinetobacter spp, Ps. aeruginosa, Proteus mirabilis,
Citrobacter freundi and Candida albicans. All Gram negatives showed
high resistance to all examined quinolones and to co-trimoxazole, 21
(91.3%) and 17 (73.9%) strains respectively. The best antimicrobial effect
showed amikacine, imipenem and nitrofurantoine, 20 (87.0 %), 19 (82.6
%) and 16 (69.6 %) susceptible isolates, respectively.
Conclusion: UTIs are a very common cause of morbidity in kidney graft
recipients, with the predisposing factors as: pretransplantational UTI,
catheterization, urethral complications, leucopenia and immunosuppression. The isolated bacteria and their susceptibility in RTP differs from
bacteria isolated in community acquired urinary infections.
ISE.148
In vitro Study of Local Antibiotic Medication Against Odontogenic
Infection
S. Kinoshita, R. Iwai, Y. Matsumoto, K. Matsumoto, M. Tabushi, Y. Murata,
Y. Shinoda, T. Iseki, S. Morita. First Department of Oral and Maxillofacial
Surgery, Osaka Dental University, Osaka, Japan
Background of the Study: Local antibiotic medication is supposed to
cumulate higher dose concentration at the focus of infection than oral
and intravenous administrations. We examined the effect of local antibiotic medication by relating the kinds, concentration and the reaction time
with some odontogenic infectious diseases.
Methods: Six pus samples from patients suffering odontogenic infection
and six saliva samples from healthy persons, totally 12 samples, were
gathered for the present study. The effect of six types of antibiotics,
piperacillin (PIPC), cefmetazole (CMZ), imipenem (IPM), minocycline
(MINO), clindamycin (CLDM) and dibekacin (DKB), were studied; saline
solution was used as a control. Each antibiotic was prepared into a low
concentration solution (LCS: ordinary concentration for intravenous medication) and a high concentration solution (HCS: 10 times concentration
of LCS). The samples were mixed with each antibiotic solution for 5, 30
and 60 minutes (min) and cultured in anaerobic condition after spreading
on agar plates. After cultivation, the number of colony was counted.
Occurrence of colonies under 1/10 of the control plates indicated significant effectiveness of the antibiotics.
Results: HCS was more effective than LCS in all samples. Both HCSMINO and HCS-CLDM for 60 min mixing were the most effective for the
pus samples. On the other hand, mixing with IPM for 30/60 min was the
most effective in saliva samples. The results indicated that all the conditioned antibiotics were effective, but there was not any specific antibiotic
being effective for all the pus and saliva samples.
Conclusion: HCS was more effective than LCS, and 60 min mixing
group was more effective than the 5 min mixing group. We concluded that
a high concentration with long treating time was the most effective
against oral floras. Further study is needed to select more effective condition for local antibiotic medication against odontogenic infectious diseases.
ISE.149
Virulence Factors and Resistance to Antibiotics in Escherichia coli
Strains Isolated from Urinary Tract Infections and Inflammatory
Bowel Disease
M. Tamalli1, M. Bubánová1, K. Havrisová1, M. Kmetová1, J. Firment2, L.
Gombosová3, L. Valansk˛4, L. Siegfried1. 1Institute of Medical
Microbiology, P.J.Safarik University, Faculty of Medicine, Kosice,
Slovakia; 2Clinic of Anesthesiology and Intensive Medicine, L.Pasteur
University Hospital, P.J.Safarik University, Faculty of Medicine, Kosice,
Slovakia; 3I.Internal Clinic, L.Pasteur University Hospital, P.J.Safarik
University, Faculty of Medicine, Kosice, Slovakia; 4Urology Clinic,
L.Pasteur University Hospital, P.J.Safarik University, Faculty of Medicine,
Kosice, Slovakia
Escherichia coli is well known bacteria causing different extraintestinal
infections. Recent studies have suggested that E. coli could also be
involved in the pathogenesis of inflammatory bowel disease´s (IBD).
Presented study was aimed to evaluate selected virulence factors and
resistance to antibiotics in E.coli isolated from patients with urinary tract
infections-cystitis and IBD-Crohn´s disease and ulcerative colitis.
In the study we investigated total of 168 E.coli; 138 were isolated from
cystitits and 30 from biopsy specimens of patients with Crohn's disease
or ulcerative colitis. In the strains sensitivity to selected antibiotics (ampicilin, ampicillin/sulbactam, amoxycillin/clavulanic acid, azlocilin, ticarcilin,
cefotaxim, ceftriaxon, ceftazidim, cefadroxil, cefoperazon, amikacin, sulfometoxazol and ciprofloxacin) was investigated. We employed agar dilution method for determínation of minimum inhibitory concentration. In the
strains selected virulence factors were determined. Using PCR we
demonstrated virulence genes hly, afa, aer, cnf1, sfa, and pap.
The agar dilution method for determination of minimum inhibitory concentration revealed 53.7%, 49.3%, 41.1%, 51.4%, 41.5%, 26.3%, and
27.7% rate of resistance among E.coli isolates to ampicillin,
amoxycillin/clavulanic acid, ampicillin/sulbactam, azlocilin, tikarcilin,
cefadroxil, and cefoperazon, respectively. We did not find significant
differences in resistance to antibiotics comparing IBD and UTI strains, as
well as we could not demonstrate any significant association between
distribution of virulence factors and resistance to antibiotics in IBD strains
investigated in our work. Contrary among cystitic strains we found significantly higher incidence of cnf1 and pap genes in ampicillin-resistant isolates than in ampicillin-sensitive E.coli strains.
ISE.150
Transmission of Brucellosis from Breast Milk to a Newborn
L. Maninska, T. Timova, S. Miskova, S. Bisinova. Medical CentreDepartment of Infectious Disease, Strumica, Former Yugoslav Republic
of Macedonia
Introduction: Brucellosis is primarily a zoonotic infection which can be
transmitted to humans trough direct contact with infected animals, by
ingestion of unpasteurized dairy products or by inhalation. Human- tohuman transmission is rare.
Case: A 3-month-old child with acute brucellosis is reported. Seven days
after delivery, the mother became acutely ill, with fever, sweating, and
general weakness. She was treated by her physician with antibiotics and
ketoprofen. But in the next period she had progressive malaise and left
hip pain. Because of that she was hospitalized in our department.
Diagnosis was based on a positive Brucella serology-agglutination titre in
serum was significant. She exclusively breastfed the infant during the illness. The mother was treated with doxycycline, rifampicin and trimetoprim sulfamethoxasol for 6 weeks. At the same time, when we confirmed
diagnosis of brucellosis in mother, we measured the infant blood ( 3
month old child). But he was healty, without fever, the physical examination was normal and his brucella serologic test were negative.
2 weeks after mother was diagnosed, the infant became ill.The infant had
fever (39,8 degrees Celsius) for 3 days, he was irritable and did not feed
very well at the breast. His brucella agglutination titer was Wright 1:320
and Coombs antihuman globulin test was 1:640, also liver function test
were high. His condition improved quickly after we started the treatment
of brucellosis (ceftriaxon for ten days followed by trimetoprim sulfamethoxasole and rifampicin for 6 weeks).
Conclusions: Clinical manifestations of brucellosis vary. Therefore, in
areas where brucellosis is endemic, it is important to consider it especially in pregnant women and children who were breast feeding in mother
recently infected.
ISE.151
Severe Sepsis and Its Impact on the Course of Purulent Meningitis
Z. Milenkovic1, K. Karovski1, R. Naumoski1, M. Petrovska2, P. Stojovska1,
K. Grozdanovski1, G. Mircevska2, K. Marangozova1. 1Clinic for Infectious
diseases, Skopje, Former Yugoslav Republic of Macedonia; 2Institute for
Microbiology and Parasitology, Skopje, Former Yugoslav Republic of
Macedonia
The impact of severe sepsis on the course of purulent meningitis (p.m.)
has been investigated in the prospective study on 336 patients with p.m.
conducted at the Clinic of infectious diseases in Skopje, during the 7-year
period 1999-2006. Clinical criteria for severe sepsis, presented with bacteremia (35.7% - 35/98), systemic inflammatory response syndrome
(100.0%), organ (62.2% - 61/98) and multiorgan (28.6% - 28/98) dysfunction, hypoperfusion abnormalities (25.5% - 25/98) and/or hypotension (20.4% - 20/98), fulfiled 98 (29.2% - 98/336) patients with purulent
meningitis. The etiology of the disease was confirmed by bacterial isolation from the CSF in 64.0% (215/336), with higher percent in test (septic
pts.) vs. control group (70.4 vs. 61.3%), and, with Str.pneumoniae
(57.2%), N.meningitidis (19.1%) and H.influenzae (12.6%) being the
most frequent agents. In 18,1% (39/215) of etiologicaly confirmed cases,
the agent was isolated from the blood culture, as well. Out of patients
with audiological sequelae (deafness), the blood culture was positive in
46.7% (7/15). The petechial rash in 42 (12,5%; 42/336), and cardiopulmonary disfunction in 56 (16,7%) patients, were clinicaly registered. Out
of the laboratory-biochemical parameters it is important to highlight
increased enzim activity of aminotranspherases (43.9% - 43/98) within
the septic state and increased levels of bilirubinaemia, as the result of
multifactorial patogenesis (hipoxia, liver inflamation and RBC haemolysis) in 49,0% (48/98), as well as the CSF characteristics with relatively
higher pleocytosis over the proteinorachy in test group (septic pts.). Fatal
outcome and sequelae were registered in 13,7% (46/336) and 9,7%
(28/290), respectively, being worse in test (27.6% vs. 8.0%, and 18.3%
vs. 6.8%, respectively) group. Severe sepsis was present more frequently in patients with p.m. with fatal outcome, and particularly in patients with
pneumococcal etiology.
ISE.152
Psittacosis—A Clinical Case
J.M. Macedo, P. Santos, J.A. Freire Soares. Hospital Padre Américo Vale do Sousa, Penafiel, Portugal
Psittacosis is primarily an infectious disease of birds and mammals,
caused by C. psittaci. Transmission of infection from birds to humans
results in a febrile illness characterized by pneumonitis and systemic
manifestations.
This is a case of a 45-year-old man, farmer and with no significant medical history, brought to the emergency service with cough, mucopurulent
sputum and fever that had started 10 days before. He presented with
fever, polypnea, with crepitations audible on both pulmonary inferior
thirds, and no other changes in the physical examination. Laboratory
results showed an elevation of the C-reactive protein, mildly elevated
transaminases, without leukocytosis or neutrophilia. Arterial blood gas
showed a type 1 respiratory insufficiency. The chest x-ray showed a bilateral difuse infiltrate. He was then admitted to the Medicine ward, starting
treatment with an empiric broad-spectrum antibiotic. During the initial
days there was a worsening of the respiratory dysfunction with the need
for invasive ventilatory support. He was transfered to the Intensive Care
Unit, where he was mechanically ventilated for six days. During this time,
his wife refered to two other similar cases in the family and the recent buy
of an ill parrot, with which these three people had had contact (including
this patient). The antibiotic therapy was then changed to doxycycline and
a Chlamydia psittaci serology was requested. The patient had a good
response to the new antibiotic treatment, being discharged from the ICU
and admitted to the Medicine ward, where he continued a good clinical
evolution and was discharged home. The first C. psittaci serology was
positive (IgG 1/65), confirmed with a higher second positive serology
(IgG 1/128). Since then he is being followed in the ambulatory, where he
remains asymptomatic.
Psittacosis has an extremely variable course and clinical manifestations,
but should always be suspected when there is a history of contact with
birds, especially psittacine birds (parrots, parakeets and budgerigars),
because of the possibility of evolution to a severe case with extensive
pulmonary involvement.
ISE.153
Disseminated Rhodococcus equi Infection During Chemotherapy in
Patient with Hodgkin's Lymphoma
D. Mikic1, B. Tomanovic2, Z. Djordjevic3, T. Takic1. 1MMA - Clinic for
Infectious and Tropical Diseases, Belgrade, Serbia and Montenegro;
2
MMA - Institute for Microbiology, Belgrade, Serbia and Montenegro;
3
MMA - Institute for Radiology, Belgrade, Serbia and Montenegro
Rhodococcus (R) equi is an opportunistic, uncommon human pathogen
that most frequent causes infection in immunocompromised hosts.
Overall a few hundred cases of R equi infections are reported in the literature. About 15% of the patients have haematopoietic and other malignancies. The disease is usually appears as a subacute pneumonia that
is usually cavitary and sometime bacteremic.
We report the especial case of 43-year-old women with Hodgkin's lymphoma, who developed R equi pulmonary infection after receiving multiple courses of chemotherapy. Secondary, she developed bacteremia,
leading to overwhelming sepsis and dissemination of R equi infection in
many extrapulmonary sites. At the time of admission to our hospital
patients was febrile, tachypnoic, tachycardic, hypotensive, with facial
oedema, splenomegaly, positive meningeal signs, left haemiparesis and
paraparesis. Laboratory data included ESR > 140 mm/h, CRP 143,0
mg/L, RBC 2,14x1012/L, WBC 2,8x109/L, LDH 706 U/L, serum albumin 26
g/L and serum electrolytes disbalance. Blood culture and culture of specimens of sputum and empyema were positive for R equi. Imaging studies
demonstrated a large right pneumonia, mediastinal and paraaortic lymphadenopathy, pericarditis, pulmonary, brain and psoas abscesses,
osteomyelitis and spondylodiscitis. The patient recovered completely
after the 12 months treatment with combinations of parenteral and oral
antibiotics, including drainage of abscesses.
This work represents the first clinical case of R equi infection described
in Serbia and Montenegro.
ISE.154
The Role of T-Cell Subsets in Burns Patients
K. Entezami, A. Khosravy, T. Mousavi, M.A. Bahar, P. Danesh. Iran
University of Medical Sciences, Tehran, Iran
In all societies, burn continue to constitute a medical, psychological, economic and social problem in terms of morbidity and long term disability,
throughout the world. Changes in lymphocytes count and injury of skin
are important immunopathological symptoms after burn accident.
Our aim is the study of peripheral blood lymphocyte subsets; CD3 (T
cells), CD4 (T helper), CD8 (T cytotoxic) in different days of burn
patients.
Methods: 67 male subjects aged between 18-60 years with major burn
injury were studied. Whole blood samples were collected (Three and
seven dags of post burn accidence ).The samples were first stained with
appropriate monoclonal antibodies and then lysed using DAKO lysing
solutions. Partec flowcytometry system and reagents, as recommended
by manufacturers, DAKo (company products), triple color were used. All
results were analysed by using the SPSS program.
Results: The range and distribution of T cell subsets; (CD3,CD4,CD8) of
burned patients in seven and three days after burn accident were found
with mean percent ages significant (P<0.05). There was also significant
correlation between age groups and cause of burns (P<0.05).All Results
were compaired with controls.
Conclusion: This study indicates that significant changes of lymphocyte
subsets count, in different age groups with percentage of burn could be
important role in immunosuppressive and development of sepsis. Cell
and cytokine therapy should be a consideration in the evaluation of the
immune status and may be a way completed for more specifce treatment
in burn injuries.
ISE.155
New Pathogens - How Useful Are 'Classic' Drugs?
I. Villamil-Cajoto1, L. Rodriguez-Otero2, M.J. Villacián Vicedo3, A. Van
den Eynde1, M.A. García-Zabarte2. 1Internal Medicine Department.
Hospital Clínico, Santiago de Compostela, Spain; 2Microbiology
Department. Hospital Clínico, Santiago de Compostela, Spain; 3CS Palas
de Rei, Lugo, Spain
Background: Recent data evaluated the usefulness of pre multirresistent era antimicrobials, to treat those pathogens. Staphylococcus
aureus strains with MIC > 32 µg/mL to vancomycin shoot the alarm and
gave the feeling of a real hurry to obtain new drugs. But some strains
even resistant to reserve antibiotics are in vitro sensible to classic drugs
such as co-trimoxazole and doxycycline among others. We present data
of five Staphylococcus aureus methicillin resistant (SAMR) bacteraemia
treated successfully with these drugs.
Methods: Five patients with SAMR bacteraemia were first line treated
with either co-trimoxazole or doxycycline according to antibiogram.
Results: Three woman and two males of ages between 28 and 93 years
were treated. All patients except a 28 years old male were terminal disease patients. Bacteraemia causes were: in two cases tracheobronchitis
(treated with doxycyline), one endocarditis (cotrimoxazole), one septic
arthritis and one more with no identified focus (co-trimoxazole in both). In
all but septic arthritis, bacteraemia resolved in three weeks. Antibiotic
treatment was fulfilled in three cases at home. Once hemocultures
became negative.
Conclusion: New drugs are not catching the emerging resistant
pathogens. It was in 1943 that the work of Fleming, Florey and Chain
could isolate and modified Penicillium chrysogenum. But already in 1952,
three out of five Staphylococcus spp. were resistant to the antibiotic.
Extensive and incorrect use raised new resistances. The reappearance
of sensitivity to particular antimicrobials could be related to the removal
of the selection pressure among other hypothesis. Co- trimoxazole use
has been documented in some jobs but after failing to respond to linezolid. In our patients, comfortable, not aggressive and easy to switch regimen was accomplished, becoming effective. Measures to counter the
threat of rapidly escalating antimicrobial resistance include surveillance
of susceptibility to and consumption of antibiotics, better compliance with
measures to control infection, and as in our proposal, rational use of
antibiotics.
ISE.156
Epidemiology of Brucellosis in India
D.P. Singh. Dist. V. Hospital, Diagnostic Laboratory, Sawai madhopur,
India
Prevalence of Brucellosis Caused by Bruculla melitensis and
Veterinarian has been reported highly Pathogenic in shepherds who are
closely associated with aborted sheep / goat or by consumption their un
boiled milk bi product of milk, meat, Inhalation, Contact and accidental
inoculation during handling in Laboratories and field where syringes,
needles, live vaccine are handled and assisting animal during parturition
or abortion or manual removed of the Placenta.
This Research paper describes the status, isolation and distributions
(See Table A and B) of bruculla species and their biotypes in human
being and animals as well as economic losses, Public health hazard and
suggest exhaustive surveillance preventive measures and advance
research work in India.
TABLE A
MAN SHEEP GOAT CATTLE BUFFALO WILD ANIMAL
SPECIES
SEROLOGICAL
EVIDENCE
+
+
+
+
+
+
CULTURE
ISOLATION
+
+
+
+
+
–
TABLE B
INDIAN STATES
HOST
Rajasthan
Hariyana
P.b
U.P
Delhi
HUMAN
M1
M 123
–
M1
M1
SHEEP
A1M,13
A1M,13
–
M1
–
GOAT
A1M123
A1M123
–
M1
–
CATTLE
A1M,
A,3M
A13,M
A13
–
BUFFALO
A1
A1
A1
–
–
–
INDIAN STATES
HOST
Chandigarh
Maharastra
A.P
T.Nadu
Karnatak
HUMAN
M1
–
–
M1
M1
SHEEP
–
M1
–
–
–
GOAT
–
–
–
M1
–
CATTLE
–
A1
M1
A1469
M1
BUFFALO
–
A1
–
–
–
A = Brueela abortus,
M = Brulla Mellitensis, 1 to 9 B 10 types ab Brucella Speeies
ISE.157
Diabetic Foot: Easy Evaluation
M. Barati, A. Madjidpour, F. Golgiri. Iran University of Medical Science,
Tehran, Iran
Infection is a common complication of diabetic foot that needs hospital
admission and surgical intervention. Diabetic foot occurs in one of each
10 diabetic patients. Diabetic foot complications are osteomyelitis, arthritis and abscess formation. Radiography, isotope scan, MRI and CT-scan
are the procedure that help diagnosis of these complications but these
are not always cost effective or available. If ESR and CRP level could
help us to determine depth and width of diabetic foot ulcer and the possibility of presence of osteomyelitis, we can cost saving and begin appropriate therapy very soon.
A retrospective chart review of 35 diabetic patients admitted to the
Rassol Akram Hospital in Tehran (Iran) with diagnosis of osteomyelitis or
cellulites of the foot during a 2-year periods (2002–2004) was performed.
Depth and width of ulcer, presence or absence of osteomyelitis, ESR and
CRP level are compared in this group. A retrospective review of 35 diabetic patients that admitted to this hospital only for control of blood glucose also was performed as control group.
In this survey ESR and CRP level in diabetic foot group was higher than
control group( P.value=0.00), and in diabetic foot with osteomyelitis was
higher than diabetic foot without osteomyelitis) P.value=0.001 for ESR
and p.value=0.00 for CRP). CRP level in large ulcers were higher than
small ulcers (P.value=0.001). ESR and CRP level in patients with long
duration of admission were higher than patients with short duration
(P.value=0.00 for ESR and P.value =0.001 for CRP).
We concluded that higher ESR and CRP level is seen in diabetic foot
with osteomyelitis and higher CRP level is indicated of the presence of
large ulcer and if patient with diabetic foot has a high ESR and CRP level,
need a long period of treatment. We concluded that in diabetic foot only
when ESR and CRP level is high, investigation for presence of
osteomyelitis could be necessary.
ISE.158
Group A Streptococcal Purulent Tenosynovitis of the Hand:
A Disease of Substantial Morbidity
L. Lutwick. SUNY - Downstate Medical School, Brooklyn, New York,
USA
Group A beta-hemolytic streptococcus (GAS) infections of skin and soft
tissues are commonly seen. Deeper soft tissue infections due to GAS
related to necrotizing fasciitis are commonly publicized but purulent
tenosynovitis of the hand due to GAS, although less common, can result
in substantial morbidity despite prompt intervention.
Case: A 53-year-old female presented to a medical facility within 18 hours
of onset of pain and swelling of her left hand. The day before, after preparing onions for a stew she sustained minor trauma to the thenar eminence
of the hand. Within 6 hours, she developed local pain, soft tissue swelling
and redness and spread across the hand distally to the fingers associated with pain on flexion of the 2nd, 3rd and 4th fingers with chills.
Her temperature was 39.6˚C and her peripheral WBC was 24.5 K and
she was taken directly from the Emergency Facility to the OR for debridement. At surgery, she was found to have purulent tenosynovitis primarily
involving all the digits except the fifth. Numerous incisions were made for
aggressive debridement and drainage of the tendons. She received intravenous ceftriaxone. OR cultures from several sites grew GAS. Despite
the aggressive debridement, antimicrobial therapy and physical therapy,
she was left with a claw hand with little functionality. No throat culture had
been obtained from the patient who had had no symptoms of pharyngitis but two of her grandchildren had been diagnosed with GAS pharyngitis during the previous week.
GAS purulent tenosynovitis of the hand is an uncommon cause of
skin/soft tissue infection with substantial potential for significant morbidity.
The clinical clues for rapid diagnosis will be presented as well as the surgical techniques needed.
ISE.159
Bacterial Meningitis in Adult Population: 25 Years Survey of the
Etiology Structure in Saint-Petersburg, Russia
Y. Lobzin1, V. Pilipenko1, A. Yakovlev2. 1Saint-Petersburg Medical
Academy of Postgraduate Studies, Saint-Petersburg, Russia; 2SaintPetersburg City Infection Diseases Hospital n.a. Botkin, SaintPetersburg, Russia
Background: The number of case-fatality rate (CFR) and cases with significant neurological sequels in patients with bacterial meningitis (BM)
remain high. Etiology structure data influence significantly medical care
and antibacterial tactics and serves as a rational strategy for infection
control and risk group vaccination.
Methods. Retrospective analysis of diagnostics ant treatment sporadic
BM adult cases in St. Petersburg for the past 25 years.
Results: Total number of cases was 2484 with 17,35% CFR (n=431).
Mean patient age ranged from 38,1±4,1 in 1997 up to 49,2±3,9 in 2003,
with no significant male prevalence (52%). Etiology of BM was confirmed
by cultural and immunological methods in 1794 cases (72,2%). In 690
BM cases the culture was negative. The etiology was as follows: N.
meningitidis (mostly and serogroups) - from 79% (2000) to 87% (1997)
of confirmed cases, total number of meningococcal meningitis cases 669; Str. pneumoniae from 14% to 17%, 288 cases, L. monocytogenes 4%, Hib - 5%, St.aureus - 5%. CFR in meningococcal meningitis (MM)
cases was ranged from 9% (2001) up to 16% (2003). About 93% of lethal
outcomes of BM of meningococcal etiology were due to fulminant
meningococcal sepsis. Lethality analysis (n=73) revealed risk factors for
age group 16-30 such as lymphogranulomatosis and lymphomas, anemia, asplenia, diabetes and age > 60 was considered as a risk factor
also. Pneumococcal and Hib meningitis CFR did not exceed 7%, Listeria
caused lethality in 27% of cases with patients age > 65.
Conclusions: In past 25 years BM etiology in St.Petersburg is mostly
meningo- and pneumococcal. Vaccination against N. meningitides
serogroup B and C in risk groups in St.-Petersburg was not performed
previously. Vaccination against N. meningitides serogroup B and C in risk
groups will benefit in morbidity and mortality rate of meningococcal
meningitis and BM generally.
ISE.160
Reactivity of Different Salmonella Antigens with Alcoholic Extracts
of Different Plants
P. Banerji1, P. Banerji1, G.C. Das1, S. Das2. 1PBH Research Foundation,
Kolkata, India; 2Das Research Centre, Kolkata, India
Background: Extracts of different plants are being used in tribal populations against typhoid fever since a long time. In this regard the efficacy of
the extracts of Baptisia tinctoria is well known. In an initial study by us we
found that Baptisia extract could react with Salmonella antigens in vitro.
Thus in this study we explored whether Salmonella antigens could also
react with other plant extracts.
Methods: Alcoholic extracts of 53 different plants were prepared as per
standard pharmacological protocols. Twenty Salmonella serotypes with
known antigenic formula were used as Salmonella antigens as per prescribed antigen preparation methods in suspensions. After this they were
allowed to react in vitro under suitable temperature, pH and ionic environments.
Results: Some plant extracts showed non-specific reactions against all
Salmonella serotypes, some specifically showed reactions with typhoidal
Salmonella serotypes only, and many others showed specific reactions
with a single serotype only.
Conclusions: These reactivities of different plant extracts with
Salmonella antigen suspensions may help in immunological and therapeutic ventures in future.
ISE.161
Bacteria Cultured from Cerebrospinal Fluids of Patients in a Tertiary
Care Hospital - A Six Year Experience
M. Wroblewska1, H. Marchel2, A. Milner2, M. Luczak1. 1Department of
Medical Microbiology, Medical University of Warsaw, Warsaw, Poland;
2
Microbiology Laboratory, Central Clinical Hospital of the Medical
University of Warsaw, Warsaw, Poland
Aim of the Study: Analysis of bacterial strains isolated from cerebrospinal fluid (CSF) cultures of patients hospitalised in 2000 - 2005 in a
tertiary care hospital (1200 beds).
Material and Methods: Cultures of the CSF samples were done with
standard microbiological methods, some of them using a computerised
BacT/Alert system (bioMerieux). Identification of the isolates was done
with API or VITEK tests (bioMerieux). Antimicrobial susceptibility testing
was assessed with a disk-diffusion technique or ATB and VITEK system
(bioMerieux), as well as E-tests (AB Biodisk). Special tests were applied
for detection of methicillin resistance in staphylococci, high level resistance to aminoglycosides (HLAR) of enterococci and extended spectrum
beta-lactamase (ESBL) production by Gram-negative rods.
Results: In the analysed period 1085 CSF samples were cultured, out of
which 295 were positive (27.2%). In total 236 bacterial strains and 5
strains of fungi were isolated. Predominated strains of coagulase-negative staphylococci (CNS)- 138 (57.3%). Strains of Staphylococcus aureus
amounted to 8 (3.3%), while enterococci - 9 (3.7%). Among Gram-negative bacteria the most common were strains of Acinetobacter spp. - 32
(13.3%), Pseudomonas aeruginosa and other non-fermenters - 10
(4.1%) and Klebsiella pneumoniae - 7 (2.9%). Methicillin resistance was
detected in 80/138 (58.0%) strains of CNS (MRCNS) and 4/8 (50.0%) of
S. aureus (MRSA). All the isolates of enterococci were HLAR strains. Six
strains out of seven (85.7%) of K. pneumoniae were ESBL-positive. None
of P. aeruginosa strains was resistant to imipenem, however, emergence
of imipenem-resistance in Acinetobacter spp. was observed in 2004.
Conclusions: 1. Gram-positive cocci represent the most prevalent group
of bacteria isolated from CSF of hospitalised patients. 2. The majority of
these strains are multi-drug resistant: MRCNS, MRSA, HLAR. 3. Non-fermenting rods constitute an important group of pathogens, amounting to
over 17% of all isolates. 4. During the study resistance to imipenem has
emerged in the strain of Acinetobacter baumannii.
ISE.162
Helicobacter pylori Infection and Hepatitis A Virus (HAV): H.pylori
Fecal-Oral Transmission in Sao Luis-MA, Brazil
J.M. Bezerra, F.F.C. Campelo, A.V. Vale, M.D.S.B. Nascimento, M.G.S.
Viana, R.P. Macau, E.G. Mochel. UFMA, São Luís, Brazil
In 1896 had been observed spiraled bacteria in humains and animals
intestines. The permanence in the interior of the stomach was disprovid
by cientific evidency. In 1985 scientists gathered data of spiraled bacteria in the human stomach as a result of self-infection by these bacteria
houw occurs withHepatitis A. In order to evaluate this correlation, 143
patients were treated in the Digestive Endoscopy Center of the University
Hospital at the Federal University of Maranhao-Brazil. H. pylori infection
was determined through a urea hydrolysis test and histopatho-microbiological biopsies of the anterior and posterior antral walls. The HAV infection was determined by sorology through the ELISA method. We used
the Chi-squared and the Fisher's Exact Test for the analysis of association and the Kappa Coefficient as a measure of agreement. H. pylori
infection rates reached 75.5% using one or both methods, and HAV
infection rates, 94.0%. The patients ages ranged from 14 to 20 years of
age, averaging 34.4 years. The highest incidence of H. pylori infection
occurred in the 41-50 age group (88.0%). For this same cohort, the inci38 • International Scientific Exchange
dence of HAV was 100% (p<0.05). The lowest incidence occurred in the
14-20 age group (56.3% and 75%) to H. pylori and HAV respectively
(p<0.05). In the 50 and above age group, the incidence was 82.4% for the
bacteria and 100% for the virus (p0.05) for both H. pylori and HAV. There
was not a significant association between the two types of infection either
(p>0.05, kappa=0.07). Therefore, we concluded that HAV infection is not
a factor for the prediction of H. pylori fecal-oral transssion. The incidence
of both infections is high in Sao Luis-MA.
ISE.163
Women Leptospirosis in Tribal Areas of West Central Iran
A. Ebrahimi. Dept. of Pathobiology of Faculty of Vet. MedicineShahrekord University, Shahrekord, Iran
Background: Leptospiroses is a zoonotic disease caused by many leptospiral serovars belonging to a single species leptospira interogans.
Rodents, dogs and farm animals are the most common sources of
human diseas.Most human infections result from recreational exposure
to contaminated water or occupational exposure to infected animals. The
reference method for all serological tests is the microscopic agglutination
test (MAT)
Methods: 201 women blood serum samples from 8 tribal areas of
Farsan and Koohrang cities (in Chahar Mahal province in west cenre of
Iran)were collected from apparently healthy adult women. The MAT was
carried out at the Leptospira Research Lab. of the Faculty of Vet.
Medicine of Tehran University.The serum samles were tested for antibody to 5 serovars of leptospira interogans.
Results: The result of MAT demonestrated 109 (56.18%) positive samples at serum titres of 1:100 or more. The most seroprevalent in these
areas was serovar hardjo.
Conclusions: This study indicates high seroprevalence of women leptospirosis that is probably due to geographical factors or traditional life
systems.Closed contacts of women and animals in tribal life may be considered as a supportive factor.
ISE.164
A Epidemiologic Study on Hospitalized Brucellosis Patients Iran
Kashan
H. Afzali, M. Momen Heravi. Kashan University of Medical Sciences,
Kashan, Iran
Introduction and Objective: Regarding to high prevalance of brucellosis and lack of knowledge about its situation in this area this study was
conducted due to update our information and determine the frequency of
clinical and serological findings of hospitalized brucellosis patients in
Beheshti Hospital in kashan.
Materials and Methods: This descriptive study was performed through
existing data on 380 admitted brucellosis patients using records of
patients during1996-2003. Demographic, clinical and laboratory findings
were extracted and collected data were analyzed.
Results: (59%) of the patients were male and (41%) were female. The
most patients 80(21%) were in 10-19 age group. 68.4% of patients were
urban and the rest were rural. The most patients(36.8%) were admitted
in summer. Duration of hospitalization was less than 9 days in the most
patients. 15.8% of the patients had previous history of brucellosis and
9.7% had positive history in their family. The most common chief complaint of the patients were fever (19.2%) and low back pain (14.6%)
respectively.
The most common general complaints were fever(75%), arthralgia 70%,
sweating (59.7%), anorexia (33.6%), myalgia (23.9%), Weight loss
(33.6%).
There were 2 case of neurobrucellosis, 13 case of arthritis, 2 case of
chronic brucellosis. The most frequent titer of wright, coombs wiright test
and 2ME was 1/160 (20.4%) and 1/320 (17.1%), 1/80(25.6%) respectively. Brucella was obtained from only 6 blood cultures.
Conclusion: Because of high frequency of fever and low back pain and
arthralgy in our patients, brucellosis must be considered in differential
diagnosis in any prolonged febrile disease with low back pain and artheralgy. Sensitivity of wright test was high so it can be used as a reliable and
sensititve test for diagnosis of brucella.
ISE.165
Prevalence of Gram-negative Infections and Determine of Their
Antibiotic Resistance Pattern in Loghman Hospital-1383
Z. Aminzadeh, B. Hajikhani, H. Shahhosseini. Shaheed Beheshti
University of Medical Science, Tehran, Iran
Background: Bacterial Resistance to antimicrobial agents in whole
regions is one of the basic problems in therapeutic procedures and it can
be more dangerous in nosocomial infections. Recognition of susceptibil-
ity and Resistibility of microorganisms, especially gram negative bacteria, in hospitals can lead to choose of effective antibiotics to treatment of
infections. The aim of current study is to determine bacterial resistance
pattern to some important antibiotics in Loghman hospital.
Materials and Methods: The research method was descriptive and its
technique was observed. All samples, including blood, urine, sputum-tracheal tube secretions, wound and skin lesions and CSF transported to
hospital laboratory at appropriate conditions. After that, the process was
based on the culture in suitable media. Then, the isolated microorganisms were assessed for susceptibility based on disk diffusion (Bauer &
Kirby) method antibiogram. Finally, the results were extracted with
descriptive analytic methods and SPSS13 software program.
Results: Samples of 867 patients (47% male, 53% female) were studied.
The most common culture- positive cases were from poisoning ward (330,
38.1%) and urine samples (411). The most common microorganisms were
E.Cloi (403, 40.7%) and Klebsiella (301, 30.4%) respectively.Maximum
resistance of E.coli observed to ampicillin (70.7%) and Co-trimoxazole
(57.3%) and the lowest rate was to Amikacin (9.9%), also the maximum
resistance of klebsiella reported to Ampicillin (79.7% ) and Ceftazidime
(74%) and the lowest resistance was to Ciprofloxacin (27.5%).
Conclusions: Early beginning and inappropriate dosage of antimicrobial
agents may be associated with an increased likelihood of the development of multiresistant bacterials. So it is highly recommended to prohibit unnecessary prescription of antibiotics.
ISE.166
Human Brucellosis in Republic of Srpska - Bosnia and Herzegovina
S. Golubovic1, T. Roganovic1, J. Maric2, V. Santrac2. 1Clinical Center,
Banja Luka, Banja Luka, Bosnia and Herzegovina; 2Veterinary institute Dr. Vaso Butozan, Banja Luka, Bosnia and Herzegovina
Introduction: Until end of 2005-th in Bosnia-Herzegovina were confirmed 330 cases of human brucellosis. The proportion of recognized and
estimated cases of brucellosis is 1:26, so the human brucellosis indicates the existence of animal illness. The first outbreak of human brucellosis in Bosnia and Herzegovina was in late 1984-th lasted till middle
1986th, in military farm near Banja Luka city with 49 cases in close contact with animals.
The causing agent was identified as Brucella melitensis. After Bosnian
civil war thru the uncontrolled donations and import of animals in the
country, imported brucellosis spreads quickly, mainly in the middle counties of state. So, in Federation of BH (one of the Bosnian entities) human
brucellosis before the end of 2005th was confirmed in 269 cases, and in
Republic of Srpska (other entity) in 12 cases, which results, together with
earlier outbreak all together 330 cases. The disease varies in clinical feature as: myositis, arthritis, hepatitis, endo-pericarditis, meningoechephalitis, lymphadenopathy, long-term febrile illnesses, 'rheumatism', mental disorders, at CT. We refer the on 29 patients treated in Banja Luka
Clinical center, mainly in 1984-1986th period.
Objective: To review the main symptoms and therapeutic problems in
our patients.
Patients and Methods:
a. Retrospective analysis of histories
b. Classification of symptoms by frequency
c. Analysis of efficacy of applied therapy
d. Retrospection of used serological methods
Results: The frequency of symptoms observed by 29 persons:
1. weakness 29 (100%)
2. fertility 29 (100%) lasted 2 to 60 days (monophasic in 9(31%), biphasic or undulant in 20 (69%) cases. By two persons the fertility was
repeated twice, in 4-6 months after onset, and on in three times in 10
months period
3. sweating(mostly profuse) 25 (86,2%), regression phase
4. headaches 22 (75,9%)
5. arthralgias(predominantly big joints in late regression phase) 14
(48,3%)
6. chIlls 13 (48,3%)
7. hepatomegaly 13(48,3%)
8. myalgias 11 (37,9%)
9. red urine 10 (34,5%)
10. back-pain 8 (27,6%)
11. splenomegaly 7 (24,1%)
12. diarrheas 6 (20,7%)
13. mental-depression 3(10,3%), one with suicidal tendency.
Laboratory findings were not significant.
Serology: The complement fixation (CF) in pear sera was positive ranging between 1/40 and 1/2.048. Hemoculture was done in one person
only: positive - Br. Melitensis.
Therapy: Oxytetra cycline 2,0 p.o./24 h, 3 weeks in 29 cases combined
with streptomycin 1,0 i.m./24 h in 10-14 days. No other regimen was
done. The effects: completely resolution after 3 weeks in 19 persons, and
incomplete resolution in 10 cases. So, in 7 cases we repeated therapy in
next 10 days with satisfactory results, and in two persons, after 30 days,
repeated completely. In one patient the therapy was repeated twice, in 10
months period. The main duration of first hospitalization was 21,8 days.
Discussion: Brucellosis obligatory makes diagnostic and therapeutic
confusions. In the time of 1st outbreaks the therapeutic protocol was oxytetracycline and streptomycin 2-3 weeks, so we did, but without satisfactory result. Recently the protocol suggest the use of gentamycin,
rifampicin, doxycyclin and/or chinolons in 6 weeks period. Rose-Bengal
and CF were only possible as serological methods and we used CF.
Today, even we use SAT and CF, we found that ELISA and PCR are still
good methodologies.
Conclusion: Brucellosis is progressing serious epidemiological problem
in Bosnia and Herzegovina. The most preferable method in diagnostic
are ELISA, Rose-Bengal and CF, and in therapy we accept the recommendations of CDC, and WHO.
Clinical Trials
ISE.167
Prevention of Postoperative Infection Using Chx 0,05% in Oral
Surgery
S.S. Secic, T.S. Trninic, T.G. Gojkov. School of dentistry, Sarajevo, Bosnia
and Herzegovina
Background: CHX is antimicrobial substance that effectively affects wide
spectrum of G+ and G- bacteria, fungus, and viruses. That is exactly why
it is effective for treatment of frequent pathological oral cavity conditions.
Methods: Scope of this project is to analyze influence of 0,05% concentration od CHX on incision healing after oral surgery. Solution is applied
to 60 operated patients. The recommendation was to use suspension for
oral cavity rinsing for five days during postoperative period.
Results: Our expectations were proven true in 52 cases, where postsurgical stiches were removed fifth day postoperativly.
Conclusion: CHX at 0,05% concentration level is a powerful remedey
whose usage helps faster incision healing in oral surgery.
ISE.168
Effects of Vitamin A and Iron Supplementation on the treatment of
malaria in Cameroonian Preschool Children
D. Zofou, C.M. Teugwa, P.H. Amvam Zollo. University of Yaounde I,
Yaounde, Cameroon
This study investigated the effect of vitamin A and iron on the treatment
of malaria, when they are given as supplements to infected preschool
children.
In a placebo-controlled supplementation trial, 132 children aged between
6 and 60 months were recruited and divided into 4 groups: the first group
received 68g (6 to 30 months) or 102g (30-60 months) iron daily and the
second, 30mg (6 to 12 months) or 60mg (12 to 60 months) of vitamin A
in single dose at the beginning of the treatment. The third group received
both vitamin A and iron while the placebo received no supplement.
Completed data on parasitemia and clinical parameters (weight, vitality),
haematological parameters ( red blood cells, white blood cells and
haemoglobin) and micronutrients status (serum vitamin A and iron) were
determined
From this study, it was observed that about 40.15% of the children suffering of malaria were anaemic (haemoglobin level from 9.02±1.60 to
10.72±1.21 g/dl and red blood cells level less than 3500000/ mm3 among
40,15% of infants recruited). They also had moderate to severe vitamin A
deficiency (serum vitamin A between 0.53±0.14 and 0.66±0.24µmol/l).
Compared with placebo group, infants receiving supplements improved
considerably, for clinical and sub clinical parameters (weight gain from
0.49±1.48 to 0.64±1.97 Kg, as against minus 0.76±2.17Kg in placebo
group), iron status (haemoglobin level varied from 0.63±1.33 to
0.94±1.2g/dl, compared with minus 0.68±0.98g/l). A significant improvement of vitamin A status was observed within groups receiving vitamin A
supplementation (serum level 0.08±0.20 to 0.11±0,17µmol/l), while there
was a notable decrease in the non supplemented group (minus
0.04±0.05µmol/l within the group that received iron, and minus
0.07±0.13µmol/l in the placebo group). There was no significant difference
among the groups for red blood cells and white blood cells. The improvement was most important in the group receiving either vitamin A or iron
supplements than those who received iron or vitamin A alone.
This study showed that vitamin A and iron could remarkably improve the
treatment of malaria when they are given as supplements to infected
children.
ISE.169
Efficacy of Hepatitis B Vaccination (3 Doses) Schedule and
Comparing to Complete Regimen in Hemodialysis Patients of Iran
A Ramezani1, A. Eslami far1, F. Ahmadi2, S. Maziar2, E. Razeghi2, E.
Kalantar3, A. Amirkhani1, M. Banifazl4, M. Hazrati1, M. Mohraz2, A.
Velayati5. 1Pasteur Institute of Iran, Tehran, Iran; 2Tehran Medical
University, Tehran, Iran; 3Iran Medical University, Tehran, Iran; 4Iranian
Society for Support Patients with Infectious Disease, Tehran, Iran;
5
Shaheed beheshti medical university, Tehran, Iran
Background: Many differing hepatitis B vaccination (HBV) regimes have
been described but often eliciting only a poor immune response. We
aimed to compare efficacy of vaccine after 3 (primary vaccination) with 4
doses (complete regimes) of HBV vaccine in hemodialysis patients
Methods: 61 patients that was HBV antigen and antibody negative,
received primary vaccination (Heberbiovac Cuba 40, vaccine administered at 0, 1, 2 months) and 56 patients completed the regime, receiving
a 4th dose at month 6. Measuring antibodies to HBs Ag 6 weeks after
receiving the third and fourth doses assessed patients response.
Subjects were divided into 3 groups according to the level of antibody
(HBsAb): nonresponders (100 i.u/L)
Results: A total of 61 patients enrolled to our study, aged 56/9±16/02.
The patient distribution with regard to anti-HBs titers after 6 weeks of primary and complete vaccination was as follows respectively: 8(13/1%)
and 18(29/5%)patients with 0 to 9 mIU/ ml; 10(24/6%) and 18(29/5%)
patients with 10 to 99 mIU/ml; 38(62/3%) and 25(41%) patients with ≈100
mIU/m.
The response rate (anti-HBs>10Miu/ml) to primary vaccination and complete regime was% 70/5 and 86/9% respectively and this difference was
significant (p<0/05).Similarly Mean HBsAb level achieved by those who
had responded on completion of the regime (266/83±324/79) were significantly better than those found after three doses(120/97±195/66).
(p<0/05).
We found significant correlation between c3, c4, Fasting blood sugar,
CRP, PTH, cholesterol and mean anti-HBs titer level and response to
vaccine in both primary and complete vaccination groups (p<0/0001) but
we didn't find any significant relation between the other parameters age,
sex, race, weight, anti HCV ab, (Kt/V), duration of dialysis, smoking,..).
Conclusion: This study confirmed the importance of fourth dose of HBV
vaccine in improvement of hepatitis B vaccine response rate.
ISE.170
Efficacy of Hepatitis B Vaccine in the Prevention of Infection in the
Spouses of Chronic HBVCarriers
M.R. Hasanjani Roushan, M. Hajiahmadi, M.J. Soleimani Amiri.
Yahyanejad Hospital,Babol Medical University, Babol, Iran
Background: Interspous transmission of hepatitis B virus (HBV) is one
of the most important routes of transmission of hepatitis B virus. The purpose of this study was to evaluate the efficacy of HBV vaccine in the susceptible spouses at the time of marriage.
Methods: From April 2003 to September 2005, 60 cases of susceptible
wives of infected husbands and 32 cases of susceptible husbands of the
infected wives received the first dose of hepatitis B vaccine at the time of
marriage and repeated one and six months later. Post vaccinations tests
for HBsAg, Anti HBs and anti HBc were assessed two months of the later
dose. HBs antibody levels >10mIU/ml were considered to be protective.
Results: The mean age of the infected husbands was 26.4± 6 years and
for infected wives was 22.7±4.7 years. Seventy (76.1%) cases were
HBsAg and anti HBe positive and 22 (23.9%) cases were HBeAg+. The
mean age of the females in vaccine recipients was 19±3.8 and in males
was 25.2± 4.8 years (p=0.007). HBs antibody levels>10 mIU/ml were
detected in 79 (85.9%)cases. HBs antibody levels>100 mIU/ml were
developed in 76.7% males and in 75% females (p=0.430). Twelve (13%)
cases were non-responder and among them 11 (91.7%) cases responded to the second course of HBV vaccination. HBs and HBc antibodies
were developed in one case.
Conclusion: The results of this study show that administration of hepatitis B vaccine at the time of marriage prevents the interspouse transmission of hepatitis B virus infection.
ISE.171
Cephalic Herpes Zoster
N. Como, D. Kraja, R. Shkjezi, V. Halili. Univeristy Hospital Center,
Service of Infectious Diseases, Tirana, Albania
Objectives: The recognation of clinical - epidemiological aspects and
complications of Cephalic Herpes Zoster CHZ).
Methods: The study is composed of 24 cases of 11-81 years old people
with CHZ identified from 1985- 2005. There were 212 patients treated by
us with Herpes Zoster over that time. We specified for each case the age,
gender subject, symptoms, localization, number of affected dermatoma
and complications. We have used lumbal puncture for 12 cases.
Results: Epidemiology: gruoup - ages: 9-14 years 1 case; 21-30 years 1
case; 51-60 years 9 cases; 61-70 years 10 cases; over 70 years 2 cases.
By gender: 9 males and 13 females. Immunologic state : immunodepressive subjects 9 ( HIV infection 2 cases, stomach cancer 1 case, under
chemiotherapy 1 case, myeloid leukemia 1 case, limphoma 1 case drug
abuser i.v. 1 case. Clinic: temperature 8 cases (subfebrile 2 cases, febrile
6 cases ); pungent pain 24 cases; exanthema; insomnia; irritabillity 24
cases; meningeal syndrome 4 cases. Localization : n.trigeminus, n.ophtalmicus 9 cases; both n.ritrigeminus, n.ophtalimicus and n.maxillaris 6
cases; n.trigeminus, n. mandibularis 2 cases; n.vagus, n.auricularis 1
case; n.trigeminus, n.ophtalmicus and n.cervicalis 2 in 2 cases; n.trigeminus, n.ophtalmicus, n.maxillaris and n.cervicalis 2-3 in 2 cases; n.trigeminus, n.ophtalmicus and n.cervicalis 2-3 in 1 case and n.cervicalis 2-3-45 in another case. Complications: post herpetic neuralgia 3 cases; conjuctivitis 2 cases; aseptic meningitis: 8 from 12 cases where we used
lumbal puncture.
Conclusions: CHZ was present in 11.32 % of all ours herpes zoster. The
most affected age - groups resulted those between 51-60 years and 6170 years old, respectively with 37.5 % and 41.6%. Oportunistic herpes
resulted in 37.5 % of the cases. In 62.5 % of the cases more than one
dermatoma was affected. Lymphocitar meningitis resulted in 66.6 %.
ISE.172
Probiotics in Multimodality Therapy of Chronic Heart Failure
G.P. Arutyunov1, L.I. Kafarskaya1, N.A. Bylova1, T.K. Chernyavskaya1,
Z.A. Chernaya1, M.I. Korsunskaya2. 1Russian State Medical University,
Moscow, Russia; 2Moscow city hospital #4, Moscow, Russia
Current ideas on the pathogenesis of chronic heart failure include development of endotoxemia due to the increased permeability of intestinal
wall for endotoxin of gram-negative bacteria. Studies have demonstrated
the inefficiency of selective decontamination alone in this group of
patients.
Aim of our study was evaluating the efficacy of probiotics in the multimodality treatment of patients with III-IV NYHA FC CHF.
Study enrolled 30 patients with III-IV NYHA FC CHF of ischemic genesis. All patients were admitted to Municipal Clinical Hospital No. 4 for
decompensated CHF. Patients were randomized to 2 groups. Group 1
(n=15) received a standard therapy (ACEI, diuretics, cardiac glycosides,
beta-blockers) and group 2 (n=15) received probiotics (Bifidumbactrin) in
addition to the standard therapy. All patients underwent blood tests for
CRP, IL-6, TNF-alfa (EIA method) and endotoxin (LAL test) and faeces
plating on selective growth media on Days 1 and 14.
The following results were obtained. In the beginning of study both
groups showed increased proinflammatory plasma cytokines and endotoxin. Faeces analysis showed excessive growth of gram-negative organisms (1010 CFU/g) as compared to normal level (107 CFU/g). After 14
days of therapy the probiotic treatment group showed statistically significant decreases in the level of faecal gram-negative bacteria and plasma
endotoxin. At the same time however, a significant increase in proinflammatory cytokines was observed (CRP, 10.1±0.3; IL-6, 11.5±0.1 units/ml;
TNF-alfa, 6.6±0.1 units/ml) as compared to baseline (CRP, 10.1±0.3; IL6.2±0.2 units/ml; TNF-alfa 1.5±0.2 units/ml), p <0.05.
The data obtained demonstrate that despite normalization of intestinal
flora by the probiotic therapy, systemic inflammation processes become
even more active. This fact may be explained by that probiotics interact
with Toll-like receptors on enterocytes, which in turn activate the immune
system and trigger systemic inflammation. Therefore the probiotics treatment alone is not warranted. Correction of endotoxemia and changes in
large intestinal microflora require more thorough development.
ISE.173
Prevalence of Penicillin Resistance Among Streptococcus pneumonia Isolated in Northeast of Iran
A. Heydari, K. Ghazvini, T. Rashed, K. Seddighy, M. Bakhshaei. Mashad
University of Medical Sciences, Mashad, Iran
Background: Decline in the susceptibility to penicillin among
Streptococcus pneumonia is becoming an important problem worldwide
so the necessity of knowing the susceptibility pattern of this bacterium is
apparent.
Purpose: The intent of the present surveillance was to evaluated the susceptibilities of S. pneumonia strains to penicillin in northeast of Iran.
Method: During 2003 and 2004, 56 isolates of S. pneumonia from different samples (blood, CSF, pleura, sputum) were subjected to quantitative
MIC testing against penicillin by using antimicrobial gradient strips (Etest)
in Mashhad, Iran.
Results: Among tested strains, 39.3% of the isolates were sensitive to
penicillin, 51.8% of the isolates showed intermediate resistance to penicillin and 8.9% of the isolates were resistant to penicillin. There was no
correlation between age, sex and sample type with resistance.
Conclusion: These findings demonstrate that the rate of penicillin resistant among pneumococci is relatively low in Iran compared to these of
other Asian countries. High rate of intermediate resistance to penicillin in
this study should emphasis the importance of choosing more appropriate
strategy for chemotherapy and brought empiric use of penicillin into
question.
ISE.174
The Significance of Timely Diagnosis of Acute Central Nervous
System Viral Infections
R. Raicevic, L.J. Markovic, O. Perisic, E. Dincic. Military Medical
Academy, Belgrade, Serbia and Montenegro
Introduction: Although the viral infections of the central nervous system
(CNS) are unusual complications of systemic viral infections, they are of
great importance because of their seriousness and destructive action on
affected brain parenchyma. The aim of our study was to point out the significance of timely diagnosis of the CNS viral infections with consequent
prompt beginning of adequate therapy.
Methods and Results: 15 patients, with clinically, serologically, EEG, CT
and/or MRI proves of the Herpes simplex virus (HSV) encephalitis, were
followed. In 2 of the cases, HSV encephalitis was also confirmed
histopathologically. All patients were treated with identical antiviral and
immuno-modulator therapy protocol: Acyclovir (5 mg/kg IV q8h for 5
days) and Interferon alpha-2a (6.000.000 units IM every second day for
l0 days). Related to final treatment results, promptness in diagnostic evaluation with adequate therapy beginning as well as inflammation extensively of affected brain tissue have been compared. Total mortality rate,
in evaluated patients' group was 22,2%. In the survivors' group, significant correlation between the early diagnosis, inflammation extensively
and patients functional recovery was noticed.
Conclusion: The present study emphasized that early diagnosis is crucial prognostic factor in patients with the HSV infection of the CNS.
ISE.175
Etiology and a Clinic Course of An Infection of CNS at Older People
G. anak, R. Doder, N. Samardija, J. Vukadinov, V. Turkulov, S. Sevi. Clinic
for infectious diseases, Novi Sad, Serbia and Montenegro
Objective: a clinic course and the etiology of an infection of CNS is tested at older people.
Material and Methods: In this survey 18 patients are involved in the
period from 2003 till 2005 which are separated in two groups:
I group: 13 patients with bacterial infection (meningitis 7 patients,
meningeoncefalitis 6) and II group: 5 patients with viral infection (meningitis 1, encefalitis 3, meningoencefalitis 1). An average age of patients
was 70,5 years (min 65, max 75), group I:69, 7, group II: 71,4. It was
researched: the way of beginning of illnesses, fever, the time of the beginning of the disease, prehospital antibiotic therapy, meningeal signs, the
state of consciousness, etiological carrier, komorbiditet, complication and
the outcome.
Result: The disease is shown through the hasty beginning at 61,1% of
patients, equally. Fever at the reception of the patients was normal and
usual at 50% of patients. In the first three days of disease, there were
received 22 5 of patients equally. 50% of patients were received on clinical cure, four till seven days from the beginning of the disease, group I
46,2%, group II 60%. Prehospital antibiotic therapy started at 27,7%,
group I 23,1%, group II 40%. Positive meningeal signs were present at
majority of patients 84,2 %. A consciousness disturbance was visible at
50% of patients, group I 69,2% (somnolonecia 7, sopor 2), group II 60%
(somnolonecia 2,coma 1). Neurological excesses were registered at
22,2%,equally. From the liquid liquor there were isolated: E.Coli,
N.Meningitidis, St. Pneumoniae at 23,1% of patients. Komorbiditet was
present at 38,8 % of patients, equally. Complications were developed at
55,5% of patients, group I 46,2%, group II 80 %: acute respiratory insufficiency 3, psychoorganic syndrome 3,but convulsions, massive pneumonia, CVI and an infection of urinated tract in some cases, equally. An
average length of hospitalization was 20 days (min.1 day, max. 55 days),
equally. An outcome of the disease was suitable at 77,7%, equally. With
sequels 27,7% of patients were dismissed,g roup I 23,1%, group II 40%.
A fatal outcome appeared at 22 % of patients, equally.
ISE.176
The Correlation Between Activity of Alanin Aminotransferasis and
Hystopatology Findimg in HCV RNK Positive Patients with Hepatitis
C Virus Infection
N. Popovic1, I. Bojicic2, D. Delic1, J. Simonovic1, K. Bojovic1. 1Institute for
tropical and infectious disease, Belgrade, Serbia and Montenegro;
2
Institute for patology Medical school of Belgrade, Belgrade, Serbia and
Montenegro
Background: The aim of this paper was to determinate the predictive
value of alanin aminotransferase (ALT) levels for histologic findings in
patients with chronic hepatitis C virus (HCV) infection.
Methods: We analized 186 anti HCV positive patients. Histologic results
were scored using the Metavir system.
Results: Among all patients 39,47% of those with elevated ALT levels
had score of at list F1 (portal fibrosis without septa). Among patients with
persistently normal ALT values 44,11% had a score Fo (no fibrosis).
Among all patients with normal ALT 94,11% had a mild activity ilness,
and 91,44% with elevated ALT had a mild activity ilness.
Conclusion: An important proportion of patients with persistently normal
ALT levels also show some histologic signs of fibrosis; the degree of
fibrosis is usually mild but sometimes more marked, and in rare cases
cirrhosis may be present.
ISE.177
New Approaches in the Development of Modulators of Immune
Response to Infectious Pathologies
F.I. Ershov. Gamaleya Research Institute of Microbiology and
Epidemiology RAMS, Moscow, Russia
This study was aimed at answering those questions. The goal of this
study was to demonstrate antiviral activity of AFLUBIN, as well as the
possibility to use it to prevent and control respiratory viral infections in the
preschool and school environments.
Morbidity from influenza and ARVI in children who there treated with
AFLUBIN decreased 3.46 folds as compared to the placebo group, and
was comparable to the group treated with specific anti-influenza vaccine
GRIPPOL (16.6% and 19% correspondingly). However, there were no
complication cases of infections registered among the group of patients
treated with AFLUBIN.
Therefore, preventive medication not only decreases morbidity from
influenza virus and ARVI, but also decreases the number of complications. It results in the decrease of the sick-leave days, and it shows effectiveness of used medications as well as the necessity of their use during
peak-time of illness. The use of AFLUBIN demonstrated its marked
antiviral and interferon-inducing properties in the in vitro model, as well
as provided effective protection against respiratory infections during the
epidemiological peak-time. Thus, AFLUBIN can be recommended as an
effective countermeasure against acute respiratory viral infections
among children.
ISE.178
Assessment of Vaccination Efficacy Against Hepatitis B in Patients
with Morbid Obesity
J. Bialkowska, M. Jablkowski. Clinic for Infectious Diseases of Medical
University, Lodz, Poland
Background: After vaccination, 95% of normal subjects produce antibodies against hepatitis B virus, which protect human organism against
the disease.
Aim of the Study: The study aimed at evaluating the efficacy of vaccination against HBV infection in a group of patients with morbid obesity.
Patients and methods. The studies were performed in a group of 21 adult
patients, their age: 18-51 years (the mean age: 37.2), treated at the
Department of General and Transplant Surgery because of morbid obesity. There were 11 women (F) and 10 men (M) in that group. The body
weight of those patients varied between 105 and 220 kg (the mean value:
138). Body mass index (BMI) of the patients was 35-65 (the mean value:
46.38). Diabetes, renal diseases, and the history of HBV/HCV infection
were excluded in all the patients. All the patients were three times vaccinated with Engerix B 20 mg vaccine in 0-1-6-month intervals. The efficacy of administered vaccination was evaluated after 1 month from the last
vaccine application.
Results: In the group of studied 21 patients, the efficacy of vaccination
was found in 6 (28 %) patients only (2 M, 4F), while no anti-HBs antibodies were found in the remaining 15 patients. In vaccination-responsive
persons, the titres of anti-HBs antibodies were very low. Only in one 1
person was a high antibody titre found (>100 IU/ml), being very low in the
remaining five 5: 29-70 mIU/ml (the mean value: 50 mIU/ml).
Conclusions: Routine vaccination against hepatitis B in morbid obese
persons turns out ineffective. It seems that it is caused by too small vaccine doses (against body mass) and/or by the use of too short needles,
preventing the vaccine from reaching the muscles. In this situation, the
vaccine is administered into the adipose tissue only, what decreases the
general efficacy of applied vaccination.
Emerging Infectious Diseases
ISE.179
Detection of Enteroviruses by Afp and Environmental Surveillances
In Sistan-Balouchestan Province for Assurance no Poliovirus
Importation from Contiguous Endemic Countries to Iran
S.H. Khodaei1, S.S. Razavi1, M. Kargar1, H. Tabatabaie2, R. Nategh2.
1
Jahrom University, Isfahan, Iran; 2Tehran University, Tehran, Iran
Background of the Study: Enteroviruses are a group of enteric viruses,
which can be spread in the environment through feces. Therefore, isolation of Enteroviruses from sewage shows the quality and quantity
aspects of circulation of these viruses in the society. In some countries,
despite lack of wild Poliovirus isolation from clinical specimens, there are
evidences of silent circulation of wild virus in sewage system. On the
other hand, based on WHO recommendations, if there is any probability
of wild virus entrance from endemic countries, to complete AFP (Acute
Flaccid Paralysis) surveillance, environmental surveillance should be
performed.
Because Iran has borderlines with Afghanistan and Pakistan, in both of
which wild Polioviruses are still circulating, in this research we simultaneously performed AFP and environmental surveillance in SistanBalouchestan province to confirm wild Poliovirus eradication.
Method: For AFP surveillance, 21 stool specimens of AFP cases were
collected in a one year period (2004)and evaluated using L20B, RD and
Hep2 cell lines. To perform environmental surveillance, 86 samples from
urban and hospital sewage disposal systems were collected. Using direct,
Pellet and Two-Phase methods for virus concentration, Enterovirus existence was investigated in above-mentioned cell lines. Then the isolated
viruses were serotyped by Microneutralization method and differentiated
intratypically by ELISA and Probe Hybridization techniques.
Result: Non-Polio Enteroviruses and Polioviruses were isolated from
53.49% and 20.93% of sewage specimens, respectively. Sabin-Like
Polioviruses and Non-Polio Enteroviruses were isolated from 9.52% and
14.28% of AFP cases, respectively.
Conclusion: Poliovirus type2 and Poliovirus type1 were not isolated
form stool and sewage specimens, respectively. The results of this
research confirm the accuracy of environmental surveillance and
Poliovirus eradication in Sistan-Balouchestan Province.
ISE.180
Evaluation Of Environmental Circulation Of NPEVs In SistanBalouchestan Province Of Iran With RD And Hep-2 Cell Lines, Using
2 Sewage Concentration Methods: Pellet And Two-Phase
S.S. Razavi1, S.H. Khodaei1, M. Kargar1, M. Sarijlou2, R. Nategh2. 1Jahrom
University, Isfahan, Iran; 2Tehran University, Tehran, Iran
Background: Enteroviruses are one of the most important enteric viruses and cause a broad spectrum of diseases in humans including: meningitis, acute flaccid paralysis (AFP), myocarditis, conjunctivitis, infants'
infections, diarrhea and sometimes diabetes. Non-Polio Enteroviruses
(NPEVs) easily circulate in the population through sewage. The aim of
this research is isolation and serotype identification of NPEVs from
sewage specimens and evaluation of environmental circulatin in Sistan
and Balouchestan province. Also, these viruses are proper indicators of
environmental surveillance and evaluation of virus isolation and concentration from water and sewage specimens after Polio eradication.
Method: In this research, 86 specimens from 8 areas of Sistan and
Balouchestan province were collected by Grab sampling during 4 seasons in 2004 year. The specimens were inoculated into RD and Hep-2
cell lines directly and also two concentration methods: Pellet and Twophase. The isolated viruses were identified by microneutralization
method.
Result: From all surveyed specimens, 12.79%, 36.05% and 51.16%
NPEVs were isolated from Direct, Pellet and Two-phase methods,
respectively. The most frequent NPEVs were Echo4 (20%), Coxsackie B
(16.36%) and Echo11 (14.55%).
Conclusion: The results of this research confirm the accuracy of Pellet
method and validity of environmental surveillance in Sistan and
Balouchestan province. A survey on relation between NPEVs disease
and their environmental circulation of these viruses is suggested.
ISE.181
Gulf War Syndrome, Arboviral Etiology
A. Alyabis. General Basra Hospital, Basra, Iraq
Gulf War Syndrome or Gulf War Illness has been used to describe a collection of chronic signs and symptoms reported by U.S., British, Canadian,
Czech, Danish, Saudi, Egyptian, Australian and other Coalition Armed
Forces that were deployed to Operation Desert Storm in 1991.
Jawets, 1987, mentioned, that more than 2000 cases, of unknown disease, called Hemorrhagic Fever and Kidney Syndrome, was noticed
among UN coalition forces fought in northern Korea 1956, the agent of the
disease was not identified at that time, but after 20 year, precisely 1976,
the causative agent was borne virus ( Hanta virus ) harbored by a rodent
ofthe identified as a rodent genus Apodoms Agrairus.
Paul B., Benson 1990, stated that Japanese B Encephalitis virus attacked
USA troops in SE Asia in a rate of 1/25, the losses by this disease was
more than the losses by the Japanese weapons.
During the 2nd world war, the coalition forces, deployed in Sicily, suffered
from a sudden attack of a febrile illness, lasting three days, without any
complication, the disease is Known in the area as Papataci or
Mediterriann Fever, it is caused by a virus transmitted by the sand flies.
Another disease which may be classified within the mentioned group, or
what l suggest to categorized, as war time diseases, is the Tasu Tasu
Komatchi, which caused by certain types of mite and it attacked the US
army in Vietnam with mortality rate exceeded 35%. Its worth to say that
the new Jewish migrants whom settled in Palestine 1942, were attacked
by the West Nile virus, while the native people in the area, were not getting that disease, the explanation is that, they had already, circulating antibodies from a previous attack, this also explain why the native armed
forces are immune against the endemic disease in their areas.
All the diseases mentioned previously were Vector borne diseases, or
arthropods borne, and the term borne indicate that the infectious agents
multiply, or has a life cycle within their arthropods host, this transmission
of infectious agent is called biological transmission which different from
the mechanical one in which the domestic flies or cockroaches transmit
microbes from one place to another.
Over 100,000 American veterans of Desert Storm /Desert Shield (approximately 15% of deployed U. S. Armed Forces) returned from the Arabian
Gulf and slowly (6-24 months or more) and presented with a variety of
complex signs and symptoms characterized by disabling fatigue, intermittent fevers, night sweats, arthralgia, myalgia, impairments in short-term
memory, headaches, skin rashes, intermittent diarrhea, abdominal bloating, chronic bronchitis, photophobia, confusion, transient visual scotomata, irritability and depression and other signs and symptoms that until
recently have defied appropriate diagnoses. These symptoms are not
localized to any one organ, and the signs and symptoms and routine laboratory test results are not consistent with a single, specific disease.. The
multisymptoms and the picture of the arthropods borne diseases, particularly those under lined as arboviruses are widely apart, ranging from,
slight rise in body temperature, or rash lasting few days to sever,
encephalitis or hemorrhagic fever or permanent neural damage, depend
on the infected individual, his or her immune state, rout of infection, the
dose of the infective agents. These symptoms were clearly obvious in
those whom were suffered from what was known as Gulf War Syndrome.
The question which should be answered, is Gulf war syndrome is an
arbovirus diseases, that's what we are trying to reach in this comparative
epidemiological study, it is worth to mention that, we could not reach the
area in which the infection occurred nor had the ability to investigate
infected person due to military causes, neither had laboratory facilities
which were so sophisticated and out of reach in that time in my country.
However US, Naval Medical Research Unit No.3, Cairo, Egypt. Has done
the research, which was published, in Am-J-Trop- Med- Hyg. 1996, Jan;
54(1):49–53. This research was under the title, assessment of arthropod
vectors of infectious in areas of U.S. troop deployment in the Gulf,the
research concluded that, there was substantial concern about arthropodborne diseases, and for evaluation the risk of these diseases, an entomological survey's conducted, in 12 areas of Kuwait and Saudi Arabia. A total
of 1,556 arthropods gathered which were later identified as vectors of
coetaneous lishmania, sand fly fever, West Nile fever, Rift Valley fever, and
Crimean Congo hemorrhagic fever, within the specimens collected 51
trapped rodent, however the paper denied the identification of any infectious agent in the specimens collected, the conclusion of research was,
the risk of arthropod borne diseases in the area were classified as a low
risk, although strict preventive measure were taken to protect the troop
from them, among which, using of insecticides, repellents, and the deployment of the ground forces to cooler areas.
In 1997, a seroepidemiological investigation performed by me with
effort to maintain, the possible rout through which the Crimean Congo
hemorrhage fever invaded Iraq, epidemiological evidence, guided to
search the north area of Saudi Arabia, the same area where the US Naval
Medical committee did the assessment trial, its astonishing that a group
of Saudi scientist, from the department of Zoology, college of science,
king Saud University, conducted a surveys involving Acari; Ixodidae,
infesting domestic, animals, and these ticks proven to be efficient hosts,
for many arboviruses, such as Crimean Congo Hemorrhagic fever, Kadam
virus, Thogoto virus, Wanowrie virus, these viruses have been isolated in
Saudi Arabia, according to Hoogstraal 1973, William et at 1973, Darwish
and Hoogstraal 1981. Further more livestock's imported from Africa to be
slaughtered in pilgrims season, were proved to harbor infectious agents
hazardous to human, and animal health, and spread many infectious diseases in Saudi Arabia, a recent research suggest that Dengue virus is
endemic in the Kingdome, and is spreading toward the north.
The results of this research indicated; The existence of many vectors to
Arboviruses (US. Naval, research); evidence of circulating Arboviruses in
the area (Saudi research committee); obscure multi symptoms presume
unknown course of disease; and previous medical history of such infections in military USA campaign in many parts of the world.
Conclusion: Arboviruses could be recognized as an etiological agent of
the Gulf War Syndrome.
ISE.182
Concurrent Nasopharyngeal Squamous Cell Carcinoma and
Lymphoproliferative Disorder During HIV Infection. Possible
Pathogenetic Interactions Among Retroviral Infection, Epstein-barr
Virus (EBV) Infection, and Inhalatory Cocaine Abuse
R. Manfredi1, S. Sabbatani1, U. Gianelli2, F. Chiodo1. 1Infectious Diseases,
University of Bologna, Bologna, Italy; 2Department of Pathology,
University of Milan, S. Paolo Hospital, Milan, Italy
Background: Only two human cells types allow the replication of EBV:
they are B-lymphocytes and squamous epithelium. Burkitt lymphoma
recognizes a pathogenetic role for both EBV, and multiple co-factors,
influenced by geographic issues, too.The nasopharyngeal carcinoma
predominates in South-Eastern Asia where the exposure to some
inhalants (i.e. phenoles) seems more frequent, but antibodies against the
early EBV antigen VCA are commonly found, as well as the isolation of
EBV genomic sequences from neoplastic cells. The staging of rhinopharyngeal carcinoma also includes a poorly differentiated variety with a
prominent lymphoid infiltrate,which may raise the suspect of an extranodal lymphoma, although the resident T-cells are not malignant. During
HIV disease, malignant lymphomas and EBV-associated lymphoproliferative disorders prove more frequent than in the general population,but
nasopharingeal carcinoma remains an extremely infrequent occurrence,
with only anecdotal cases reported.
Case Report: Our patient, HIV-infected for 20 years and with a long history of inhalatory cocaine abuse,18 months ago developed a remarkable
laterocervical lymphadenopathy, whose histopathologic study disclosed
a polymorphic EBV-associated B-cell lymphoproliferative disorder. A TC
scan concurrently showed a right nasopharyngeal mass, and detected
multiple cervical, axillary, and ilar-mediastinal lymphadenopathies. A
biopsy of rhinopharingeal lesion disclosed a poorly differentiated squamous carcinoma,also EBV-positive at biomolecular testing. A cytotoxic
chemotherapy was performed with ten consecutive cycles of cisplatinumfluorouracil-bleomycin, associated with HAART, which achieved disease
remission. A CT re-staging performed four months later showed sparse
parapharyngeal and paravertebral infiltrates, so that the suspected recurrence prompted a still ongoing radiotherapy course, while the immune
recovery was not attained, as expressed by a CD4+ count of 83
cells/µL,despite HIV virologic control.
Conclusions: Our patient suffered from two distinct malignant and pre-
malignant disorders, with some intriguing pathogenetic associations
mainly linked to EBV, but also HIV and related immunodeficiency, and
perhaps the chronically inhaled cocaine. Both squamous carcinoma and
lymphoproliferative disorder of the nasopharynx are more frequent in the
immunocompromised host, and deserve further pathogenetic investigation to clarify and eventual shared or addictive role of some viral and
environmental risk factors.
ISE.183
Complications of Measles on Children
G.H. Jugulete, M. Luminos, R. Mantescu, R. Iagaru, G. Constantinescu,
D. Duma, A. Stancescu. Institute of Infectious Diseases Matei Bals,
Bucharest, Romania
Background: Measles is endemic throughout the world. In 2005 an epidemic in Romania cause more than 4.000 cases of measles in children,
becouse susceptibile populations wasn't vaccined.
Method: In Institute of Infectious Diseases Matei Bals were hospitalized
1245 children with measles during year 2005. The children admitted in our
clinic with measles were beetwen 1 month–14 year old. We have monitorised the complications of measles appeared during acute disease.
Results: We have registred 3 fatal cases (0,24%). This cases were a lot
of complications: 2 cases - biliary atresia, bronchopneumonia with acute
insuficience respiratory, myocarditis and enteritis with rotavirus. The third
cas have cronic encephlopaty, myocarditis, bronhopneumonia, otitis
media, enteritis and encephalitis. The most common complications of
measles were interstitial pneumonia (67,8%), bronchopneumonia
(32,2%), purulent conjunctivitis (48,3%), otitis media (20,4%), enteritis
(80,4%), hemoragic rash (4,8%), trombocipenic purpura (6,7%), hepatitis (2,2%) and encephalitis (0,32%).
Conclusions: Measles is an infectious disese with severe complications
and fatalities in some cases (immunoupresion, deficit of immune system,
congenital disease). Prophylaxis of measles is very important, the immunization of populations throughout vaccination also.
ISE.184
Hemorrhagic Fever with Renal Syndrome - Case Report
S. Maslak, D. Zilovic, M. Markovic, J. Maksin, B. Jakovljevic, L.J. Mijovic,
R. Katanic. General Hospital Pancevo, Department of Infectious Disease,
Pancevo, Serbia and Montenegro
Case Report: A 38-year-old man, treated from August 29th to October
the 1st in 2004. Subjective pains: high temperature, very exhausted,
pains in his muscles, nausea, vomiting, diarrhea, a pain in the upper part
of his stomach, rare dry cough.
Physical Result: Temperature 38,4˚C, dehydrated, hyperemia of the
conjunctiva, hyperemia of the pharynx. Breathing reduced of the right,
basal side of the lungs, blood pressure 9/6 kPa. Epidemiological poll:
He worked as a woodcutter in the mountains of Republic Macedonia; he
returned home in August 24th in 2004. Biochemical analyses:
Triglycerides are 87x10/l, urea 21,4 mmol/l, glycemia 11,1 mmol/l, in
urine the proteins are ++. X- ray of the lungs: from both sides of the lungs
peribronchioles are enlarged. Ultrasound of the abdomen: Enlargement
of liver and spleen. Thrombocytopenia lasts until the end of the second
week, urea and creatinin reached maximum level on the tenth day of his
disease and these nitric substances have become normal gradually to
the 4th week of the disease, kaliemia is normal all the time. At the end of
the first week the muscle enzyme enlargement (CK, LDH), ALT, AST. All
proteins are 51,2g/l. The coagulation is normal all the time. On the 10th
day the proteins in urine are 460mg/l according to Buireth's method. IIF
IgG on Hantaviruses: Hantaan 1:2048, Puumala 1:512, Seoul 1:2048,
Belgrade 1: 2048. In the clinical course the hematoma appeared at the
parts where the vein puncture has been done, oliguria lasted until the 8th
day, and polyuria until the end of the 4th week (max. diuresis is 9700ml.)
Conclusion: In our area there has not been a HFRS since 1985. Thanks
to the diagnosis and therapy at the right time the patient has recovered
successfully.
ISE.185
Lyme disease in the area of South Banat from 2003 to 2005
D. Zilovic, M. Markovic, B. Jakovljevic, S. Maslak, J. Maksin, L.J. Mijovic,
R. Katanic. General Hospital, Department of Infectious Diseases,
Pancevo, Serbia and Montenegro
Aim of the Study: surveying the epidemiology situation in the area of
South Banat
Method: The data is used from the evidence of a bite from a tick for the
ill who saw a doctor, and the data used from the register of the ill treated
with diagnosis: Lyme disease
Results: From January in 2003 to December 2005 the evidence leaded
about the bites from ticks in patients who came to our department, and
about the appearance manifestations Lyme disease, as well. The number
of bites has been reduced gradually (94-71-64) and the number of the ill
reduced proportionally, too (28,72%; 14, 08%; 12,5%) during the years of
examination. There was no correlation between the frequency of illness
and the geographical distribution of the tick bites. Neither the correlation
was found between the disease appeared and the localization of the bite
on a body. The biggest number of bites and patients with any manifestations of Lyme disease appeared from May to August. The most frequent
manifestation was Erythema migrans, but the only one ill person treated
with the clinical form of serous meningitis. No one case of Lyme disease
of the second or the third stadium was recorded.
Conclusion: The infection from a tick is rare and there is no tendency of
increasing in our region, then Lyme disease appears in people from time
to time.
ISE.186
Avian Influenza: Haseki Training and Research Hospital in Istanbul,
Turkey Experience
G. Sengoz, F. Yildirim, K.K. Yasar, Y.B. Durdu, O. Nazlican. Haseki
Training and Research Hospital, Istanbul, Turkey
Background: In the globalizing world, the epidemics irritate us as much
as they did centruies ago. An epidemic that could be encountered in a
city like Istanbul, with a population more than 10 million, could cause significant results.
Methods: The first final positive animal cases related to Avian influenza,
which attracts world's attention since 1997, were reported from Manyas
on October 9th 2005. We have examined the process faced after positive
testing of the Avian Influenzae in the poultry animals.
Results: At the same time when the first human cases were encountered in Turkey on January 4th 2006, reported positive animal cases in
Istanbul forced us to take serious measures. In this term, in our hospital
no positive results were found in the travellers who had a contact history
or who came from the regions of the positive cases.
Conclusion: In our city, through which the wild water birds immigrate
and stay at the water basins, this disease will always be a risk. The measure to be taken is to break the infection chain and to create public awareness.
ISE.187
A Case of 'Imported' Measles Infection in Bulgaria
A. Gotzeva1, L. Andonova1, T. Tcherveniakova1, Z. Mihneva2. 1Medical
University, Sofia, Bulgaria; 2NCIPD, Sofia, Bulgaria
Summary: According to the priorities set by the WHO/ERB in 2003,
Bulgaria is carrying out a National program for eradication of measles,
thus accomplishing the elimination of the spread of measles in the country. After a three year ( 2002-2004 ) measles- free period in Bulgaria
towards the end of April 2005 a 28 year old man was diagnosed with the
disease in Sofia after his return from a trip to an endemic area in China.
The aim of this study is to present the typical clinical manifestation, the
possibilities for serologic and virologic diagnostics, the necessity of specific prophylaxis and the arisen epidemiological issues. The diagnosis
measles- primary infection ( positive ELISA IgM, negative ELISA IgG
result from the first serum and positive ELISA IgG from the second serum
) was confirmed serologically in the "Measles, parotitis, rubeola" National
laboratory of the NCIPD with two independent ELISA IgM tests. The virological material: blood plasma, nasopharyngeal and conjunctival swabs
and urine samples were sent in accordance with the requirements on the
WHO / ERB in the Regional referent laboratory for Bulgaria- Robert Koch
Institut, Berlin. With a nested PCR test ( amplification in the N- gene section ), the presence of the measles virus was confirmed in the nasopharyngeal and conjunctival swabs and urine samples. The genotype of the
virus was affiliated to the genotype H1 strand, which is know to circulate
in China, Mongolia and Korea. An epidemiological research comprised
52 people, with followed up immune and immunizational status. The case
was followed by two more cases with proven contact, which are no an
object of this study.
ISE.188
Clinical, Epidemiological, Radiological and Laboratorial Aspects of
Confirmed 4 Cases of Hantavirus Infection Attended in A Reference
Hospital of Southeastern Region of Brazil
R. Angerami. State University of Campinas, Campinas, Brazil
Introduction: Human cases of hantavirus (HTV) infection exists in Brazil
from 1993. Since that, cases notified are increasing in many cities and
states of Brazil. Clinically, the disease in Brazil is associated to a signifi-
cant morbimortality, like a consequence of respiratory insufficiency,
hemodynamic instability frequently observed.
Objectives: Describe the clinical, epidemiological, radiological and laboratorial aspects of confirmed 4 cases of hantavirus infection treated at
Regional Service on Infectious Diseases in Brazil.
Methodology: Retrospective, descriptive study analysing medical
records, epidemiological informations from a data bank, laboratorial and
radiological exams of HTV infection
Results: From 4 cases, all were males, age from 18 to 71 years old
(median 30). 3 cases were considered autochthones in State of São
Paulo and 1 case imported from Mato Grosso State. Exposure—places
infested by rodents in rural area with agricultural activities—all patients.
Unspecific signs/symptoms—fever (100%), muscle pain (75%) and
headache(25%) and of the major frequency; hypotension—100% of
cases and shock—2 cases. Coughing, chest pain and respiratory distress—all cases. The evolution to ARDS—2 cases that had evolution to
death. (2 from 4). Jaundice and hemorrhagic manifestations not
observed. 4 patients—ventilator supporting; 2 cases of oro tracheal intubations. Lethality were—2 cases (50%). Laboratory—platelets decreasing, hematocrit increasing and leukocytosis—75% of cases and lymphopenia and hypoxemia—100%. Laboratorial confirmation—ELISASNV IgM+—3 cases; 1 case confirmed—immune hystochemical analyses—lung fragment.
Conclusions: Cases studied - similar laboratorial, clinically to the Cardio
Pulmonary Syndrome related to HTV described in other countries of the
American continent—elevate mortality. Thus, how observed in other
regions of Brazil, the risk infection were associated—exposition to the
rural ambient infested by rodents; significative binding—occupational
activities.
ISE.189
The Military-affiliated Laboratory: Its Role in the Management of
Disease Outbreaks in Singapore
B.H. Tan. DSO National Laboratories, Singapore, Singapore
Background: This presentation aims to share our experience from a military-affiliated laboratory, DSO National Laboratories, in disease outbreak investigation with the Singapore public health laboratories.
Methods: Samples from the public health laboratories that provided
diagnostics for routine surveillance are sent to our laboratory. These
samples are clinical specimens that we received from the Singapore hospitals. We also receive specimens of animal origin. These specimens will
be processed, and specific diagnostics performed to the request of the
frontline clinicians, or veterinarians. Different detection platforms such as
real-time polymerase chain reaction, virus culture set-ups at biosafety
level 2 were employed for these investigations. In the case of an
"unknown sample", we employ electron microscopy, tissue culture isolation at the Biosafety level 3 laboratory, and DNA microarray viral chip.
Results: There are a few ways that the capability and capacity of the military-affiliated laboratories could be fortified to handle disease outbreaks.
The military-affiliated laboratories could provide specific tests that the
public health laboratories lacked. Manpower could be expanded at a brief
notice to increase the national capacity to rapidly diagnose the sudden
surge of specimens. And lastly, cutting-edge technologies in the militaryaffiliated laboratories could be used effectively for the complete identification of the novel agent. Our lessons leant for the investigation of disease outbreaks will be discussed in this presentation.
Conclusion: Vertical programs will continue to form and strengthen
Singapore's capability and capacity by integrating the public health laboratories with the military-affiliated and research laboratories. Our experience strongly indicates that the laboratory could be translated to a
national laboratory to provide diagnostics for exotic pathogens.
ISE.190
Immnunity to Viral Exanthemathic Immnunopreventable Diseases in
Paez Municipality of Zulia State, Venezuela
J. Gotera1, N. Valero1, J. Hernández1, A. Levy1, A. Mavárez1, Y. Larreal1,
L. Espina1, M.B. Maldonado1, M. Nardone2, M. Fereira3, N. Prieto3.
1
Clinical Investigations Institute "Dr. Américo Negrette". Faculty of
Medicine. University of Zulia, Maracaibo, Venezuela; 2Regional Direction
of Epidemiology. Health Ministery, Maracaibo, Venezuela; 3Public Health
Laboratory. Health Ministery, Maracaibo, Venezuela
Background: The exanthematics diseases are a group of syndromes
mainly caused by acute virals infections. Objective: To know the prevalence of immunopreventable viral exanthematics diseases in the Páez
Municipality of Zulia State-Venezuela.
Methods: 87 serum samples were taken from children, to whom specific antibodies of IgG type anti-rubella and 44 for the virus of measles and
varicella were determined by the ELISA technique.
Results: It was observed greater immunity for the rubella virus (94.25%)
followed by measles (56.8%) and varicella (45.45%). As far as the distribution by sex, it was demonstrated that the feminine population presented a greater percentage of immunity for the rubella virus (60.97%)
(p<0.0001) and measles (52%), whereas after varicella it only reached a
25%. In relation to the age groups the high seropositivity for measles was
found in the group of 12 and 13 years old with a 56%. For varicella and
rubella most of the immunized cases were found between 10 and 11
years of age with a 65% and 59.75%, respectively.
Conclusions: It was confirmed the presence of anti-rubella IgG antibodies, measles and varicella in variable proportions. The relatively low
immunity for measles is emphasized, in view of the goal of eradicating
this inmunopreventable disease. It is necessary to increase the vaccinal
cover in this population.
ISE.191
Prevalence of Viral Agents in Children with Central Nervous System
Affectation in Zulia State, Venezuela
A. Mavárez, N. Valero, J. Bermúdez, J. Gotera, A. Levy, K. González,
L.M. Espina, Y. Larreal, M.B. Maldonado. Clinical Investigations Institute
“Dr. Américo Negrette”. University of Zulia, Maracaibo, Venezuela
Background: The incidence of viral encephalitis in children is considered to be around 8–10 casos/100.000 people/year, being more frequent
in children under 2 years old. The regional statistics register a great number of cases of neurological diseases of unspecific cause.
Objetives: to determine the implication of viral agents in Central Nervous
System infections (CNS) in children of the Zulia state, Venezuela.
Methods: 109 paired samples of cerebrospinal fluid (CSF) and serum,
were collected from patients with ages between 1 day to 14 years old,
which presented suggestive clinical symtomatology of affectation of the
CNS and whose conventional bacteriological study of CSF was negative.
The ratio CSF /serum albumen was determined in order to discard blood
contamination, being 24 optimal pairs for the determination of specific
IgM antibodies for Simplex Herpes virus (SHV), Epstein Barr Virus
(EBV), Dengue, Rubella, Measles, and Venezuelan Equine Encephalitis
(VEE) by ELISA.
Results: From the 24 studied cases, 15 (62.5%) were positive. The
encephalitis causative agents were: Dengue 11 cases (45.8%), Simplex
Herpes virus 3 cases (12.5%) and 1 of Epstein Barr Virus (4.2%). Cases
of Rubella, Measles or Venezuelan Equine Encephalitis were not detected. The group of nursing babies was the most affected (58.8%) followed
by the newborn ones (32.8%). Pleocitocis with the predominance of lymphocytes was the most frequent finding in the cases confirmed with viral
encephalitis, without difference when relating it to the infectious viral
agent.
Conclusion: It is evidenced that a significant proportion of the children
with encephalitis is due to viral agents and to an increase in the cases of
Dengue with affectation of the SNC in the region.
ISE.192
An Outbreak of leptospirosis in Eastern South of Caspian Sea in
Iran
R.O. Golsha, B.E. Khodabakhshi. Golestan medical university, Gorgan,
Iran
Background: Leptospirosis is considered an important reemerging
infectious disease worldwide.
This study was the first report of leptospirosis from Golestan an agricultural and fishery area in the south of Caspian sea in IRAN.
Methods: From July until September of 2005, the patients with similar illness and compatible to leptospirosis was admitted in Golestan General
hospital and their serum samples for leptospira antibody were sent to
Reference laboratory.
Results: Twelve patients with mean age of 25-41 years with fever,
Headache, myalgia, conjunctivitis #177; icter with positive IFA antibody
were studied. 9 (75%) patients were male. All Patients had fever and
myalgia. 9 (75%) patients had conjunctivitis, 3(25%) patients were icteric.
Increased bilirubin was seen in 4 (33/3%) patients with indirect bilirubinemia and few elevation (2-3 fold) in liver transaminases. Increased creatinin was detected in 1 (8/8%) Patient. Thrombocytopenia (platelet <
100000) was seen in 5 (41.6%) patients. Increased CPK was seen in 8
(66.6%) patients.
All patients had contact with stagnant water within 1-2 wk prior admission, when they worked in rice farms, 10 (83/3%) patients had foot abrasions.
Serum samples of all patients were sent to Reference laboratory and all
patients had positive IFA antibody titer 1/200-1/400. All patients recovered after penicillin therapy.
Conclusion: History of fever, headache, myalgia, especially with con-
junctivitis or icter in patients who have been in contact with stagnant
water of rice fields, should be raise the possibility of leptospirosis.
ISE.193
The Fight Against the Emerging New Infectious Diseases - Hong
Kong's Experience
S.H. Lee. The Chinese University of Hong Kong, Hong Kong, China
In recent years Hong Kong has experienced a number of major outbreaks of infectious diseases. The first outbreak of avian influenza
(H5N1) in human beings in Hong Kong occurred in May 1997. The outbreak lasted up to the end of December. A total of 18 human cases were
reported with 6 deaths. Before the occurrence of human cases, outbreaks of avian influenza among chickens have been reported in the
poultry farms and poultry markets in Hong Kong and H5N1 virus were
detected among the dead chickens The control measures undertaken
include mass culling of chickens, strengthening the surveillance system,
prompt investigation of influenza-like-illness outbreaks. Mass cleaning up
campaign in markets, vaccination of poultry workers against human
influenza, vaccination of chickens against the avian influenza virus and
publicity and education of the public.
The outbreak of Severe Acute Respiratory Syndrome (SARS) occurred
in Hong Kong in February 2003. A total 1,755 cases with 299 deaths
were reported. The source of infection was due to the corona virus isolated from civet cats. The lessons that have been learnt from the SARS
outbreak include problem of timely and transparent information sharing
with neighboring city, the economic impact as a result of the outbreak,
inadequate surge capacity, poor public health infrastructure, inadequate
infection control practices in hospitals, multi-sectorial coordination and
communication. Despite the above short-comings, Hong Kong stood well
against the SARS outbreak, due largely to the dedication and hard work
of the medical and health staff, and the whole-hearted support of the
community.
In less than one year after the SARS outbreak, Hong Kong has made
good progress in strengthening the prevention and control of infectious
diseases including the establishment of the Centre for Health Protection
(CHP), emergency preparedness, improved information and data management, cross-boundary and international cooperation, enhanced isolation facilities, infectious control training, research and development.
As people live in an increasingly inter-connected world, local health problems have global impact and global problems have local impact. There is
a used for all countries when dealing with infectious diseases to adopt
the strategies of fast detection, fast reporting, fast communication and
fast action, at national, regional and international levels.
ISE.194
Erythma Nodosum in Crimean-Congo Haemorrhagic Fever (CCHF):
Drug-induced or Diseases Manifestation?
M. Mardani, B. Bijani. Infectioius Diseases Research Center Shaheed
Beheshti, Tehran, Iran
Crimean-Congo haemorrhagic fever (CCHF), is a potentially fatal viral
infection caused by a tick-borne virus, nosocomial outbreaks with high
mortality among hospital staff have been documented. 61 out of 69
(89%) confirmed CCHF cases survived with oral Ribavirin in Iran
between 1999 and 2001.
We report a confirmed case of CCHF who was treated with oral Ribavirin
and developed Erythma Nodosum,three days after beginning the treatment.
A 43-year-old housewife from Golestan province, North of Iran, was
admitted to hospital with intractable gastrointestinal bleeding associated
with jaundice and fever. She had history of close contact with domestic
animals, especially sheep and reported patients with similar manifestation in the region of her residence area. On Clinical examination, she presented fever (temp= 38.8ºc) and yellowish discoloration of sclera. Twelve
hours after admission, she developed maculopapular rash which was
transformed to ecchymosis later on. Her blood culture revealed no any
microorganisms.
In Laboratory Examination; Hb was 6 mg% and WBC=2800mm3 and
Platelet count was 40000 per/mm3. Total Billirubin was = 8.8 mg %
(Direct=4.5mg %), AST= 440, and ALT= 560. Abdominal Sonography
and upper GI Endoscopy were normal. The diagnosis of CCHF was confirmed with positive IgG and IgM Anti CCHF antibody Elisa test and RT
PCR. Oral Ribavirin was administered with the loading dose of 30mg/kg
and followed by 15mg/kg for Q6h˙4 days and then 7.5 mg/kg for 6
days.Three days after starting treatment patient developed Erythma
Nodosum which was confirmed by biopsy which revealed
paniculitis.Complete recovery was achieved with oral Ribavirin and erythema nodosum disappeared two weeks after treatment.
Whether the manifested Erythma Nodosum is induced by the Ribavirin or
the CCHF manifestation is debated. However this is the first report of
such manifestation in CCHF patient undergoing drug treatment in the
literature.
ISE.195
Melioidosis in the Portuguese-speaking World
D.B. Rolim1, A.Q. Sousa2, D.C.L.F. Vilar3, J.L.N. Rodrigues4, T.J.J. Inglis5.
1
Hospital São José de Doenças Infecciosas, Fortaleza, Brazil;
2
Universidade Federal do Ceará, Fortaleza, Brazil; 3Secretaria da Saúde
do Estado do Ceará, Fortaleza, Brazil; 4Universidade Federal do Ceará,
Fortaleza, Brazil; 5PathWest Laboratory Medicine WA, Western Australia,
Perth, Australia
Melioidosis is a bacterial infection of the tropics which has only recently
been recognised in the lusaphone world. Three clusters of infections
were recognised in northeastern Brazil and one travel-associated case
was reported from Portugal. There are possible historic cases from Timor
Leste and Capo Verde. Despite their proximity to known melioidosisendemic locations, there appears to be no record of melioidosis from the
former Portuguese enclaves of Goa, Malacca and Macao and no cases
have been reported from Angola or Mozambique. It is possible that
melioidosis has gone unrecognised in some or all of these locations. The
genotypic resemblance between B pseudomallei strains isolated from
the Western Australian melioidosis outbreak of 1997 and the Brazil outbreak of 2003 raise questions about the possibility of trans-shipment of
environmental bacterial via former colonial trade routes. These considerations provide further reason to search for the disease in other parts of
the Portuguese-speaking world.
ISE.196
Respiratory Sincitial Virus Infection in an Adult Patient. Case Report
M.C. Redondo, M.E. Landaeta, D. Gentile, E. Essenfeld, H. Essenfeld, A.
Aponte, R. Mohawechi, P. Monsalve, M.J. Nunez. Policlinica
Metropolitana, Caracas, Venezuela
The importance of RSV infection as cause of hospitalization in previously healthy adults has been recently recognized. A case of RSV severe
infection in an adult patient is reported.
A healthy 19-year-old female patient presented with flu-like symptoms: pain
in left ear, productive cough, malaise, progressive dyspnea, worsening at
day 7. Additionally, chest pain, which caused hospitalization. X-ray showed
condensation images in both lungs. At first day of hospitalization, bad general conditions, respiratory rate 36 per minute, cyanosis, hypoxemia, oxygen saturation 65%. Inhaled bronchodilators, oxygen, Ceftriaxone and
Levofloxacin were started. She required ICU due to deterioration of conditions, and appearance of subcutaneous emphysema. Vancomycin,
Clarithromycin and Ceftriaxone were indicated. Mechanical ventilation was
started. Labs: ESR 97 mm/h, WBC: at entry 2.300 ICU: 18.200 x mm3, Hb
8,8 gr, LDH 583. Pulmonary function: slightly restrictive pattern. Blood,
urine, and bronchial secretion cultures: no bacterial growth. Serology: CMV,
EBV: negative. Immune serology testing: in normal range. Right lung biopsy: histological findings compatible with Bronchiolitis Obliterans. Severe
inflammatory process, acute and subacute interstitial pneumonitis with
septal alveolar fibrosis. Pneumocytes with hyperchromatic nuclei, suggestive of viral cithopatic effects were observed. Chronic Pleuritis with
mesothelial hyperplasia. No granulomas. Gram stain, Groccott, Ziehlnielsen, PAS were negative. Pneumocystis jiroveci (carinii) investigation
was negative. Lung tissue PCR reported RSV. The patient had a progressive improvement. She remained in ICU for 14 days, and was discharged.
At the moment, she remains asymptomatic.
RSV infection in adults is poorly characterized, infrequently diagnosed
and clinically similar to other viral diseases. However it must be suspected and investigated in adult patients with severe respiratory processes.
ISE.197
Frank's Encephalitis in a Patient with Scleroderma. Case
Presentation
R. Bermudez, J. Semeco, B. Ortega, H. Mago, A. Chacin. Universidad de
Carabobo. Faculty of Health Sciences. Internal Medicine Service A.
CHET, Valencia, Venezuela
Introduction: Frank's encephalitis is a rare infection of CNS caused by
enteroviruses: Coksackie or Echovirus. It represents 11 to 22% of all
cases of viral encephalitis. His clinical manifestations are lethargy, personality changes, paresis, partial convulsions hemicorea, ataxia and
coma. CSF findings are similar to those of aseptic meningitis. No specific treatment is recommended, however Pleconaryl is still under research.
Objectives: We present a 48 y.o. female patient with scleroderma diagnosis treated regularly with Prednisone, Penicilamine, Colchicine, whose
actual diseases started two months before admission with fever, chills
and pain in the right hypochondria that causes repetitive consultations
with different treatment indications and without amelioration. 5 days
before admission he starts with drowsiness. Labs showed generalized
cytopenia, increased levels of AST and ALT and IgM positive for CMV.
There was no laboratory evidence of activity of his scleroderma. She
remains hospitalized for 5 days, after which she presented an episode of
polyserositis and is admitted again. Treatment with Ganciclovir is started
since the diagnosis of CMV infection and during 13 days, with posterior
change to Valganciclovir. Two days before his second admission she has
an episode of intense headache, disorientation and psycho-motive agitation, retrograde amnesia and suckling movements. Fondoscopy shows
retina hemorrhages and CT scan was normal. LP was performed and
CSF analysis with PCR is positive for enteroviruses.
Electroencephalographic studies reported a non-specific anomalous
paroxysmal generalized layout compatible with encephalitis.
Epidemiology and Public Health
ISE.198
Lack of Knowledge About Individual`s HIV Status : the Risk Factor
for the Spread of Aids/hivamong Youth in Developing Countries
O.I. Olawuyi, B. Omoniyi. University College Hospital, Ibadan, Nigeria
Issue: The percentage of AIDS/HIV is increasing every year in the third
worlds, and this is reinforced by the factor that majority of youth in third
worlds do not know his/her HIV status.
Description: A self developed validated and reliable questionnaire [r=
0.87] was used to collect the data, and percentage was used to analyze
the data. The population of the study was made up of youth [female and
male] in higher institutions, working places, market places and community streets in Nigeria, 50,000 sample size, selected through simple random sampling technique. The average age is 25.5 years old. Relative
Risk [RR] calculated is 3.1, i.e. RR >1, indicating that the factor is the risk
factor, and the Confidential Interval [CI] for RR at 95% Significant level is
2.61< 3.1 <3.90 from the formula,
CI Lower limit < RR < CI Upper limit.
Lessons Learned: 70% of the sample population did know his/her HIV
status and had had sexual intercourse in the past before, out which 20%
had the unprotected intercourse once or more, 25% had protected sex
while 25% were not sure of using protection means. While, 20% have
knowledge about self HIV status and had had sexual intercourse before.
10% have no knowledge about self HIV status and had no sexual intercourse before.
Conclusion: AIDS/HIV still remains a killer disease in the third world.
However, the lack of knowledge of individual's HIV status remains the
only highest risk factor for the spread of the disease in the third worlds.
ISE.199
A Primary Response to Pandemic Influenza: Ordering Flu Patients
to Stay at Home is Very Difficult in Japan
A. Ehara, T. Tono-oka. Otaru City Government, Otaru, Japan
Background: The best way to minimize morbidity and mortality by
influenza seems to be, regardless of pandemic flu or not, to order flu
patients with mild symptoms to stay at home and not to visit the medical
facilities to avoid close contact with other people. However, Japanese
people, especially children, tend to visit clinical offices as soon as they
have symptoms of flu-like illness because of an excessive reliance on
medical prescriptions. Many clinics tend to test the presence of flu
pathogens by a rapid kit and prescribe Tamiflu to patients with a positive
result. At the peak of Japanese flu season, above 50 patients with flu-like
illness visit a clinic per week on average, and sometimes, above 100 sick
children visit a pediatric department per day. If a new H5N1 flu virus
becomes infectious among the public in winter, it is very difficult to diagnose a new H5N1 flu case among a lot of seasonal flu patients.
Methods: Supply of Tamiflu in Japan by Chugai Pharmaceutical Co., Ltd.
(Japanese branch of Roche Laboratories Inc.) was compared with
Japanese population.
Results: Tamiflu dry syrup was prepared to supply for 5,200,000 of
patients in 2003–04 flu season, which was about 50% of the Japanese
population of the children from 1 to 10 years old.
Conslusion: The Japanese public is not trained to stay at home to cure
themselves and tend to be dependent on physicians. In order to contain
and avoid a nosocomial infection of pandemic flu, Japanese specialists of
public health must persuade Japanese people thoroughly to be at home
and avoid spreading the germs unless they do not have a severe illness.
ISE.200
Ear Spiculum Infections of ENT offices in Isfahan City
A. Okhovvat1, M. Chadeganipour2. 1ENT Department Medical School
Isfahan University of Medical Sciences, Isfahan, Iran; 2Mycology and
Parasitology Department Medical School Isfahan University of Medical
Sciences, Isfahan, Iran
Background: Speculum is one of the most important instruments in the
ENT offices. Consideration and comparison of the ear speculum to
microbial infection (bacteria, fungi ) before and after disinfection is very
important. In this study contamination of speculum of ENT were evaluated by microscopic and culture media before and after disinfection.
Material and Methods: Samples were collected from 35 offices of ENT
in Isfahan city. Direct microscopic examination, and specific culture
media were used for fungi and bacterial infections before and after disinfection.
Results: 12 out of 35 had bacterial infection, 5 samples had fungal infection. All of samples had no infection after disinfection of speculum by
physicians.
Conclusion: According to the results most of speculum had contamination to pathogens and desinfection in the offices in Isfahan are effective.
ISE.201
Malaria in Iran
M.A. Moslehi1, S. Ketabchi 2, S. Moslehi1. 1Shiraz Medical University,
Shiraz, Iran; 2Shiraz Azad University, Shiraz, Iran
Malaria is one of the most important infectious diseases in developing
countries. Worldwide, over 40% of the population lives in malaria transmission areas (i.e., Africa, Asia, the Middle East, Central and South
America, and...). It is estimated that 300-500 million cases of malaria
occur each year resulting in 750,000 deaths. About 1,000 years ago,
Iranian physicians such as Avicenna (979-1037) were acquainted with
the clinical features of the disease. Iran has been categorized as
Epidemiological Category Group 3 (countries with a moderate endemicity and relatively well established control programmes). Malaria was
found to be hyperendemic in some littoral parts of the Caspian Sea in the
north and Persian Golf in the south and hypo-or meso-endemic in the
central parts of the country. We report epidemiologic distribution of malaria and its major vectors in Fars (Iran's provinces)in recent years.
ISE.202
A Bilateral Hearing Loss Case Due to Mumps
H. Gedik1, M. Fincanci1, A. Karimova2, M. Yahyaoglu1, G. Eren1. 1S.B.
Istanbul Education and Research Hospital, Istanbul, Turkey; 2I.U.
Cerrahpasa Medical Faculty, Istanbul, Turkey
Mumps is an acute generalized viral infection that occurs primarily in
school-age children and adolescents. Permanent unilateral deafness
occurs once per 20,000 cases of mumps (1). A bilateral hearing loss
case due to mumps is described in this article.
A twenty-eight-year-old male patient had been exposed to his son with
mumps for fifteen days, refered bilateral parotid tenderness. He
complained of hearing problem and after two days being hospitalised,
we evaluated his hearing by audiogram. In the left ear, air conduction
level was 68 dB, bone conduction level was 48 dB. In right ear, air conduction level was 110 dB, bone conduction level was 70 dB. Prednisolone
60 mg/day, heparine 2500 IU/ day, penthoxifylline 100 mg/ day and symptomatic treatment were performed for five days. Hearing loss did not
recover despite treatment. Hearing level was attempted to scale up by
hearing-aid.
Immunisation of people without implemented mumps vaccine or infected
by mumps virus should be determined for serious complications like
deafness oriented our case due to mumps.
ISE.203
An Acute Viral Hepatitis Case where the Hepatitis A and B Virus
Serological Markers Were Positive
H. Gedik1, M. Fincanci1, M. Yahyaoglu1, A. Karimova2, A. Izat1. 1S.B.
Istanbul Education and Research Hospital, Istanbul, Turkey; 2I.U.
Cerrahpasa Medical Faculty, Istanbul, Turkey
Hepatitis A and hepatitis B infections rarely occur together because their
transmission routes and common ages are different. Acute hepatitis A
infection can develop as a superinfection in chronic hepatitis B and C
patients(1,2). In this article, a case of acute viral hepatitis in which hepatitis A virus and hepatitis B virus serological markers were positive is presented.
A thirty-three-year-old male patient was diagnosed with jaundice, dark
urine, anorexia, malaise, and clay-colored stool. There was no pathologic sign except from jaundice in the physical examination. Liver enzymes
were elevated 60 times, prothrombin time was prolonged, and total bilirubin was 15 mg/dl. HBs Ag, anti-HAV IgM, anti-HBc IgM and anti-HBc IgG
were positive. Results were proved positive again when they were redetermined in the Reference Laboratory and ours. Liver enzymes, bilirubin level did not become higher and coagulation tests did not become
prolonged during the hospitalization period. In follow-up total bilirubin,
direct bilirubin and prothrombin time got back to the normal range in the
first month, and so did AST, ALT, ALP, GGT levels in the second month.
Romatoid factor and anti-nuclear antibody were negative.
In conclusion, our case, in which hepatitis A virus and hepatitis B virus
serological markers were positive, did not differ from other hepatitis A or
B cases in clinical and biochemical aspects.
CHART-1: PATIENT’S LABORATORIAL VALUES
ADMISSION 1. WEEK 2. WEEK 3.WEEK 4.WEEK 5.WEEK
ALT (U\lt)
2700
2854
1730
819
413
212
AST (U\lt)
1580
1620
1210
795
315
186
ALP (U\lt)
147
136
160
122
98
83
LDH (U\lt)
1586
1287
606
507
423
383
GGT (U\lt)
304
178
153
111
97
76
PTT (sn)
16,4
15,5
15,3
15,6
13,2
12,8
98
PTT (%)
61
73
75
72
94
Aptt (sn)
50,4
42,7
43
42,1
36,5
35
TBIL (mg\dl)
17,6
21,2
33,04
24,76
16,42
9,6
DBIL (mg\dl)
7,9
9,82
14,48
11,44
8,54
4,1
CPK (U\lt)
190
GLUCOSE(mg\dl)
107
63
65
65
83
86
T.PROTEIN (mg\dl)
7,2
7,4
8
7,8
7,8
ALBUMIN (mg\dl)
4
3,8
4,2
4,1
4,2
GLOBULIN (mg\dl)
3,2
3,6
3,8
3,7
3,6
Na (mEq\lt)
136
K (mEq\lt)
4,2
Ca (mEq\lt)
10,2
UREA (mg\dl)
39
20
23
19
20
21
CREATININ
(mg\dl)
1,2
1
1,1
1
1
0,9
CRP (gr\dl)
5,6
1,2
1,1
SEDIMENTATION
15
9
10
LEUCOCYTE
5,9
6,9
7,4
ERYTHROCYTE
4,86
4,66
5,21
45
41,7
42
HAEMOGLOBIN
(\mm3)
14,6
14,4
14,1
PLATELET
(\mm3)
158000
147000
152000
(mm\sa)
(X10 6 \mm3)
HAEMOTOCRYTE
(\mm3)
HBs Ag
Positive
Anti HBc Ig M
Positive
Anti HBc Ig G
Negative
HBe Ag
pozitif
Anti HBe
Negative
Anti HAV Ig M
Positive
Positive
Anti HAV Ig G
Negative
Negative Negative
Positive
Anti delta total Negative
Anti HCV
Negative
Anti HIV
Negative
ANA
Negative
RF
Negative
References: 1) Vento S, Garofano T, Renzini C, et al. Fulminant hepatitis associated with hepatitis A virus infection in patients with chronic hepatitis C. N Engl J Med 1998;338:286. 2) Vento S. Fulminant hepatitis
associated with hepatitis A virus superinfection in patients with cronic
hepatitis C. J Viral Hepat 2000; 7:7–8
ISE.204
Reliability of Antibiogram and Plasmid Profiling in Detection of
Epidemic Strains of Shigella Spp
S.H. Farshad1, R. Sheikhi2, E. Basiri2, A. Alborzi1, A. Japoni1, M. Kalani1,
J. Nasiri1. 1Prof. Alborzi Clinical Microbiology Research Center, Shiraz,
Iran; 2Department of Microbiology, Medicine School, Shiraz University of
Medical Sciences, Shiraz, Iran
Background: Epidemiological investigations of Shigella members have
been hampered by the lack of suitable markers for strain discrimination.
The aim of this study was to investigate reliability of drug sensitivity patterns and plasmid profiles in discrimination of epidemic strains of
Shigella spp. isolated from epidemics of bacillary dysentery in Iran.
Methods: Eighty two Shigella strains isolated from OB+ stools of
patients during the period of May-Sep 2004 were investigated. Shigella
species were identified by serological tests. Drug sensitivity of these isolates to antibiotics of gentamycin, nalidixic acid, cephalothin, ceftriaxone,
ceftazidime, ciprofloxacin, cotrimoxazole and amikacin was determined
by disc diffusion method. Plasmids were extracted from isolates by a
modified alkaline lysis method. These plasmids were then fractionated in
0.8% agarose gel.
Results: Serological tests identified 61 (74.39%) S. sonnei, 16 (19.51%)
S. flexneri, 3 (3.1%) S. boydii, and 2 (2.4%) S. dysenteriae. Totally, from
82 isolates, 90.24% were resistance to co-trimoxazole, 7.31% to
cephalothin, 4.87% to nalidixic acid, 3.65% to amikacin and 2.43% to
gentamicin. Resistance to ceftriaxone, ciprofloxacin and ceftazidin was
not detected. Multiple resistances to nalidixic acid, caphalotin, co-trimoxasole or nalidixic acid, amikacin, co-trimoxasole were seen in 1.25 and
3.65 percent of the isolates respectively. Only 6.09% of the strains were
susceptible to all tested antibiotics. The remaining strains were resistance to one or two antibiotics. All 82 isolates harbored multiple plasmids
with an average of 9.5 plasmids in each isolate (range from 5-14). Among
these strains 52 different plasmid profile patterns were revealed. Plasmid
analysis identified 42, 14, 3 and 2 genotypes for S. sonnei, S. flexneri, S.
boydii and S.dysenteriae, respectively.
Conclusion: These data mandate local monitoring of resistance and its
consideration in empirical therapy of Shigella infections. These results
also demonstrate that plasmid profiles analysis method is more reliable
in identification of Shigella epidemic strains than drug sensitivity patterns.
ISE.205
Epidemiology of E. coli O157:H7 Isolated From Humans, Water and
Food- laboratory Based Study
S. Uzunovic-Kamberovic. Cantonal Public Health Institution Zenica,
Zenica, Bosnia and Herzegovina
Background: The aim of this prospective, laboratory-based study was to
research the epidemiology of E. coli O157:H7 isolated from humans, food
and water, and to estimate appropriateness of routine diagnostic in stool
samples.
Methods: In the period January 2003 to September 2004, all consecutive stool samples of outpatients with diarrhoeal simptoms were examined for the presence of E. coli O157:H7. One stool sample per patient
was analyzed. All E. coli isolated from water and food samples, which
were mandatory examined for microbiology appropriatenes in the
Laboratory, further tested for E. coli O57:H7. Sorbitol McConkey agar and
latex slide test were used. Antibiotic susceptibility testing was performed
by disc-diffusion method according NCCLS recommendation.
Results: E. coli O157:H7 isolated from 59/1550 (3.8%) patients. Most
affected population were 20-64 age group (49.1%), followed by 0-6 age
group (24.5%). E. coli O157: H7 were represented in 13/313 (4.6%) of E.
coli isolates, and in 13/5405 (0.2%) of total number water samples. E. coli
O157: H7 detected in 6/69 (8.7%) of E. coli food isolates, and in 6/5952
(0.1%) of total number food samples. Nine ( 69.2%) water isolates were
originated from the wells. Four (66.7%) food isolates were from dairy
products Antibiotic resistance rates to both, ampicillin and thrimethoprimsulphometoxasole were three times higher in humans than in other isolates. Resistance to ciprofloxacin noted only in humans (3.9%), while
nalidixic acid has shown three times lower activity in human than in other
isolates (31.6% and 10.%, respectively).
Conclusion: Screening for this pathogen in clinical laboratoties is too
labors intensive to be practical. Education and legislation should promote
safe food-preparation and food-handling practices. Research should be
directed at reducing the carriage of E. coli O157:H7 at its bovine source,
minimizing the microbial content of food and water.
ISE.206
Hepatitis B Virus Infections in 2002-2004 In Kujawsko-Pomorskie
Voivodeship
A. Kuziemski, E. Narolska, M. Borowiecki. V.S.E.D., Bydgoszcz, Poland
The aim of this study was to review epidemiological status of HBV infections in our province by using new clinical findings. 1,836 reported cases
of infection HBV were analysed on the basis of available documentation.
Diagnosis of the acute, chronic or carrier infection were agreed on the
basis of interview and presented clinical, biochemical and immunoserological exponents. 152 cases of acute hepatitis B were reported in
analysed period. Among them one child under 9. Remaining cases were
new detected chronic infections. The registered morbidity of acute hepatitis B was 58% lower during 3 years. All together 17,671 persons were
infected HBV in our province and the prevalence was 0, 85%.
Conclusions: The incidence of acute hepatitis B in 2002–2004 demonstrated a strong tendency for decrease, especially among children under
9. The prevalence of hepatits B was comparable with European average.
The results of our analysis demonstrated that epidemiological status of
HBV infections in our province presented in previous publications was
incorrect. Statistical data did not differentiate new cases of hepatitis B for
acute and chronic which resulted in incorrect outcomes.
ISE.209
Vaccination Against hepatitis B Within Twelve Hours Of Birth In
Maternities Of Buenos Aires, Argentina
A. Ellis. Secretary of Health, Buenos Aires, Argentina
ISE.207
Serotype of Influenza in Saudi Arabia 2005
D.R. AlMazroa. Ministry of Health, Riyadh, Saudi Arabia
Objective and Background: Evaluation of global and discriminated coverage of vaccination against hepatitis B in Maternities (M) of Buenos
Aires, following the Ministry of Health Resolution 940/00, complementary strategy aimed at the elimination of the disease. It was intended to
reach a goal of 98% in 4 years.
Methods: Between 2001 and 2004 a close survey was performed comparing M included in the Immunization Program of Buenos Aires (IPBA):
13 public M (PU), 4 social security M (SS), 7 community hospitals M
(CH), 4 army M (FFAA) to 21 private (P) M not included in the IPBA (the
latter do not receive vaccines from the Health Ministry, there is not a strict
surveillance of these).
Results: Total 2001-4 newborns infants in M were: 71.476, 73.978,
74.237 and 73.642. Total coverage in children within 12 hours of birth
were 76% in 2002, 88.77% in 2003, and 94,06% in 2004. The M in IPBA
reached the goal in 4 years (97.58%): PU 97.67%, SS: 99.14%, CH:
95.06% and FFAA: 91.27%. In 2001 a substantial gap was detected
between vaccination performance in M included in the IPBA and P M:
88,8% vs. 39,1% OR: 12,44 (2,45-72,13). At the end of 2002, 2003 y
2004 52,17%, 76,2% and 76,5% of P M were vaccinating vs. 100% of
IPBA since 2002. In the years 2002, 2003 and 2004 newborn infants at
PU had a better chance of been vaccinated than in P M: 84.3% vs. 67.3%
OR: 2.61 (2.51-2.72), 93.07% vs. 81,16% OR: 3.11 (2.95-3.29) and
97.67% vs. 88,78% OR: 5.30 (4.86-5.77) Similar results were obtained
when comparing IPBA M to P M in 2002-4: 83.67% vs. 67.3% OR: 2.41
(2.33-2-50), 93.73% vs. 81.16% OR: 3.47 (3.31-3.64) and 97.58% vs.
88,78% OR: 5.11 (4,76-5.49)
Conclusion: 1- A strict supervision in the IPBA maternities has contributed to reaching its goals 2 - Periodic information to private maternities not included in IPBA, helped for a gradual acceptance of vaccination
proposal against hepatitis B.
Introduction: influenza is a contagious respiratory illness caused by
influenza viruses. It is an acute, usually self limited, febrile illness caused
by infection with influenza type A or B virus that occurs in outbreaks
which varying in severity almost every winter.
The aims of this study are: to identify the serotypes of influenza cases
presenting to MOH-KSA health care facilities during Hajj season in
Makkah and Mina, and to provide baseline information for understanding
epidemiology of influenza in Hajj.
Methods and Materials: A cross sectional study was conducted during
Hajj period (12/15/2005–01/05/2006) within the MOH health care facilities in Makkah and Mina. The case was defined as any patient who is suffering from fever of at least 38°C, in combination with either cough or
sore throat and time of onset of fever within the last 72 hours, and age
one year and above. Trained staffs were involved for collection, storage,
transportation of specimen (throat swab) and filling the required structured questionnaire. Cross tables were constructed to compare different
risk factors.
Results: 415 suspected influenza cases which fulfilled the criteria of
case definition were identified interviewed and throat swab was taken for
them. The specimen of the suspected cases were collected in Makkah
and Mina, and then analysis of the specimen was done in the lab of King
A.Aziz University in Jeddah. The symptoms which are reported by the
suspected influenza cases were fever (100%), then sore throat and the
least one is blocked nose (21.1%). The mean age of the cases was 39.3
± 15.65 year. They were of 36 nationalities. 86.7% of cases were Hajjis,
14.2% of suspected influenza cases diagnosed to have influenza viruses either type A or B, and it found the most predominant types of influenza viruses were type B (67.8%) and influenza type A (25.4%) and most
predominant influenza viruses serotypes among the isolates were flu B
Sichuan then flu A not typed and flu A type H1N1.
Conclusion: Influenza viruses are important pathogens during Hajj season and are responsible for a variety of respiratory tract infections and
this could be prevented by giving the influenza vaccine especially to
those high risk groups, also it is recommended to give influenza virus
vaccine to those who are going to Hajj.
ISE.208
Profile Of Patients With Dengue Hemorrhagic Fever Admitted At
DLSUMC AND JPRNMRC: A Two Year Review
L. Zoleta, N. Macalalad. De La Salle University Medical Center,
Dasmarinas, Cavite, Philippines
Background: This study was done to determine the geographic distribution and clinical profile of DHF cases admitted at DLSUMC and JPRNMRC from January1, 1997 to December 31, 1998.
Methods: A descriptive study using a retrospective chart review of all
hospital admission of DHF at DLSUMC and JPRNMRC from January 1,
1997 to December 31, 1998.
Included in the study were all cases which fulfilled the WHO classification
of DHF.
Results: About 0.45% and 2.20% of the total combined admissions from
DLSUMC and JPRNMRC were seen in 1997 and 1998 respectively.
There was a 5-fold increase in the total combined population of DHF
cases from 1997 to 1998. Majority of admissions were in the 5-18 years
of age with no sexual predilection. Only 27.7% of the male population
and 4.4% of the female population were adults. Patients usually consulted in the first 6 days of fever with an average hospital stay of 4 days.
Admissions of DHF were seen to be highest in the months of October
and November of 1997 and August and September of 1998. Most of the
morbidities and mortalities were seen in the 5-12 age group. The combined mortality for the 2 hospitals was 3.18%. Of the 22 patients who
died from DHF, 91% were due to massive bleeding manifestations (gastrointestinal and intracranial bleeding ) and 9% due to acute respiratory
distress syndrome. Most of the admissions were from Dasmarinas
(43%), followed by the towns of Imus, Amadeo and General Trias.
Conclusion: DHF admissions increased between 1997 and 1998. The 5fold cases increase of DHF may be due to worsening environmental sanitation of the province, rapid increase in population secondary to industrialization of the province, accessibility and improved diagnostic capabilities of the two hospitals and the comprehensive information campaign
by the government, specifically the DOH.
ISE.210
A Survey about Prevalence of Intestinal Parasites in Primary School
Students of Isfahan
H. Mohammadi1, M. Mokhtari2, F. Amiri1. 1Trauma Research Center,
Rasht, Iran; 2Univercity of Medical Science of Isfahan, Isfahan, Iran
Introduction: Parasitic infections are considered as one of the important
health indices of societies. However in recent decade the morbidity and
mortality of infectious diseases decreased significantly but the variability
of the types of these infections in different areas and times, explains the
need for the periodic study of their prevalence in particular geographical
regions.
Object:The aim of this study was evaluating the prevalence of intestinal
protozoas and worms in primary school students in Isfahan city.
Method and material: For this purpose we performed a cross sectional
study on 1500 primary school students from five educational regions of
Isfahan city between October, 2003 and April,2004. The schools and students were selected randomly. Information about sex, level of study, educational zone were collected by a form. The stool samples were collected and processed with formalin ether and direct smear too. Analyzes
were performed using chi square and t-test.
Results: The overall prevalence of intestinal protozoas was 9.66%.
Giardia had the highest prevalence (9%). Overall prevalence of intestinal
worms was 10.8% which 5.1% was due to Ascaris lumbricoides. The difference between educational regions about infection with protozoa was
significant(pv:0.02%) and also differences between boys and girls who
were infected with intestinal worms(pv<0.05).
Conclusion: The prevalence of intestinal protozoan infection in students
decreased but it still needs more attention from organizations and agencies involved with this issue and well coordination of them.
ISE.211
Seroepidemyological Study on Human Alveolar Echinococcosis in
Rural Population of Moghan Plain, Northwestern Iran
M. Siavashi1, S.H. Habibzadeh2, A. Hovanessian1, A. Mortazazadeh2, M.
Shaabani2, M. Assmar1. 1Pasteur Institute of Iran, Tehran, Iran;
2
Northwestern Infectious Diseases Research Center, Ardabil, Iran
Alveolar Echinococcosis (AE) caused by metacestode of Echinococcus
granulosus as the most lethal helminthiasis of human beings is confined
to the northern hemisphere.
In Iran, all of confirmed AE cases were reported from a limited area,
Moghan plain in Ardabil province, northwest of the country. So, for establishment of a control program, we needed to know the prevalence of the
disease derived from serological screening in the region.
To perform that, six hundred residents from thirty villages including 25
stable and 5 nomad complexes in Moghan plain were selected randomly. After filling up the questionnaire, 5 ml of blood samples was collected
from each person. The sera were examined by using a commercial Kit of
ELISA (Bordier® Affinity products, Switzerland) at parasitology laboratory of Pasteur institute of Iran.
As the result 1.5% (9/600) cases were positive for AE. The most infected
age group was 21-30 years old with 44% (4/9) cases. Sixty seven percent
(6/9) were female and all housewives and 33% (3/9) were male and animal keepers. With respect to risk factors, 67% (6/9) were dog owners,
89% (8/9) had used to consume self- grown vegetables and fruits and
11% (1/9) had a history of a contact to red fox skin. Non of the positive
cases were hunters.
Finally 89% (8/9) of cases were living in villages and 11% (1/9) were
nomads.
In conclusion, the results showed the high rate of prevalence and so, the
importance of AE in Moghan plain which made it necessary for establishment a suitable control program for the disease in this region.
ISE.212
Chronic Aseptic Meningitis: A Rare Presentation of Acute
Promyelocytic Leukemia
N. Taebi, M. Farzadni, S. Amoian, B. Memar, A. Attarzadeh, H.R. Rahimi,
B. Abasi, S.H. Golasetani. Mashad University of Medical Sciences,
Mashad, Iran
Introduction:The occurrence of extramedullary disease (EMD) at presentation or at relapse has long been considered a rare event in Acute
Promyelocytic Leukemia (APL).
Our purpose from recent reports of EMD at presenting in APL have
raised increasing concern about one of causes of chronic meningitis.
Material and Method: We describe a case of acute promyelocytic
leukemia (APL) in a 25 year old female patient was admitted in emam
reza hospital, presenting severe headache and vomiting and showed
signs of meningeal irritation as well as papilledema. Cytocentrifuge
examination of CSF showed an excess of promylocytes, but peripheral
blood didn't show any abnormal cell or blasts whereas BMA show
increase of promyelocyte with multiple rod. After 2 weeks of aleukemic
phase, this patient developed hematologic picture of APL diagnosed
myeloid origin cells with myelopperoxidase stain. She was diagnosed as
having leukemic meningitis and after 3 week in spite of chemotherapy,
she died.
Conclusion: Leukemic relapse or first presentation of leukemia may be
the etiology of aseptic meningitis. Rarely central nervous system
leukemia and leukemic meningitis are associated with normal bone marrow and sometimes patients at Aleukemic phase presents with meningitis. Therfeore we suggested that in patients with aseptic meningitis cerebrospinal fluid cytospine smear should be evaluated for neoplasic and
leukemic cells.
ISE.213
Changing Assistance Issues at A Reference Infectious Disease
Day-hospital Service, Compared with the Natural History of HIV
Infection in the HAART Era
R. Manfredi, L. Calza, G. Salvucci, F. Chiodo. Infectious Diseases,
Objective:To evaluate frequency and features of admissions performed
at a Day-Hospital service in Northern Italy, a retrospective evaluation of
all admissions of the last decade (1994-2004) was performed.
Methods and Results: Before HAART introduction (years 1994-1996),
the proportionally low mean number of admissions (110/year), was linked
to the elevated prevalence of HIV disease, which accounted for 89.4% of
Day-Hospital hospitalizations, their recurrence, and their prolonged duration. Immediately after HAART introduction, the number of Day-Hospital
admissions showed a significant increase, from 171 (year 1997), to 318
(2002), 338 (2003), and 347 (2004) (p<.0001 versus the pre-HAART
era), although this phenomenon paralleled a drop of percentage of HIVrelated admissions (from 59.1% of 1997, to a minimum of 25.6% of the
year 2001; p<.0001). While HIV-associated hospitalizations decreased, a
temporal increase of admissions due to chronic liver disease occurred
(p<.0001). The reduction of admission duration allowed an increase of
overall number of hospitalizations of each examined year (p<.0001), and
the mean bed occupation rate showed a continued rise (8.2 in the year
2000, to 10.9 in the year 2004 (p<.0001).
Discussion: The modifications occurred at our Day-Hospital service during the last years are largely attributable to the significant changes
occurred in the spectrum of infectious disorders which came to our atten-
tion: from a low number of prolonged hospitalizations typical of patients
with advanced HIV disease, the HAART era led to a progressive broadening of the spectrum of disease, and a notable reduction of admission
time. Notwithstanding this situation, no significant modification was
observed as to mean weight of diagnosis-related group (DRG) features:
from a mean 1.03 rate per patient of the year 2000, to a mean 1.05 figure in 2004. The evolution of assistance features in a Day-Hospital setting, seems strictly linked to the modification of prevailing disorders. A
permanent monitoring of the features of health care provision at an
Infectious Disease Day-Hospital service may allow to consider significant
temporal modifications, and contribute to ensure adequate assistential
planning, including the eventual revision of structural, professional,
techinical, and funding resources.
ISE.214
Need of inpatient assistance for HIV diease and AIDS at an
Infectious Diseases tertiary care centre located in North-Eastern
Italy
R. Manfredi, L. Calza, F. Chiodo. Infectious Diseases, University of
Bologna, Bologna, Italy
Background: Notwithstanding the HAART-induced modifications of natural history of HIV, the hospitalization potential of Infectious Diseases
(ID) wards remains inadequate, according to the unpredictable modification of epidemiology and disease spectrum.
Methods: A surveillance study of patients (p) needing hospitalization at
our ward and their outcome,was performed since five years.
Results: From 1/2000 to 6/2002 our inpatient unit could rely on 16 beds8 rooms, while since 6/2002 (after joining with the other ID unit of our
500,000-inhabitant metropolitan area), beds rose to 35 (18 rooms). The
ID specialist acts as a consultant for every p with a suspected ID, to
assess need of hospitalization/isolation, and eventually search an adequate place, when beds at our ward are not available. The rate of p admitted elsewhere dropped from 2000 (34.3%), to 2001 (26.9%), 2002
(12.9%), reaching a plateau from 2003 to June 2005 (mean 12.4%; p30%
of p, but the unification into a single Division partially reduced the need
of transferts 40-115 Km far, stabilizing the rate around 12.5% in the last
three years. Among the 285 HIV p not accepted at our ward, 24.9% had
a place at the other (pre-existing) ID ward, 58.6% at our Hospital, 4.9%
at Bologna metropolitan Hospitals, while 11.6% needed a transfert to
other cities.
Conclusions: ID wards still play a key role, although a continuous reassessment based on the predominant ID and available resources is
needed. The lack of suitable beds for p needing admission remains a
remarkable problem, especially when p with acute-severe illnesses are
involved, and a long-distance transfert may result in a breakdown of isolation, and especially adjunctive risks for p health.
ISE.215
The Role of Patients with Chronic Ear, Nose and Throat Diseases as
a Possible Source of MRSA
Y.R. Nazinyan, A.D. Hambardzumyan, K.S. Baghdasaryan, T.A.
Karapetyan. Yerevan State Medical University, Yerevan, Armenia
Background: Staphylococci are one of the main causative agents of
chronic ear, nose and throat (ENT) diseases. Beta-lactam antibiotics are
frequently used for the above mentioned diseases therapy. The patients
with chronic ENT diseases can be carriers of methicillin-resistant coagulase-negative staphylococci (MRCNS) and S.aureus (MRSA). Therefore,
these patients can play the essential role in spreading methicillin-resistant staphylococci in community and be one of the sources of MRSA
infection.
Materials and Methods: Specimens for culture were collected from the
anterior nares and throat of 131 patients with chronic ENT diseases at
medical center Med-Cryonika in Yerevan. The strains were identified and
testing for susceptibility to antibiotics was performed by standard methods according to NCCLS recommendations.
Results: It was revealed that all patients were carriers of staphylococci.
Eighty five (64.9%, 95% CI 60.7-69.1%) strains belonged to S.aureus
and 56 (35.1%, 95% CI 30.9-39.3%) belonged to coagulase-negative
staphylococci. Of the isolated S.aureus strains 17 (20.0%, 95% CI 15.724.3%) and 30 (57.7%, 95% CI 51.1-64.3%) of coagulase-negative
staphylococci strains were also resistant to oxacillin. Thus, 13.0% (95%
CI 11.1-15.9%) of the overall patients were MRSA and 22.9% (95% CI
19.2-26.6%) were MRCNS carriers. Multiresistance was observed in 8
(6.1%, 95% CI 4.0-8.2%) MRSA strains and in 13 (9.9%, 95% CI 7.212.5%) MRCNS of tested staphylococci strains.
Conclusion: There is a high prevalence of MRSA and MRCNS in
patients with chronic ENT diseases in Armenia. There is also a significant
prevalence of multiresistant MRSA and MRCNS strains in the mentioned
population. These facts indicate on the important role of these patients in
MRSA and MRCNS spreading in community.
ISE.216
Candida albicans, as the Third Microbial Agent on Urinary Tract
Candida albicans is ubiquitous yeast and is the most common fungal
pathogens that affect humans. The growing problem of mucosal and systemic candidiasis reflects the enormous increase in the pool of patients
at risk and the increased opportunity that exists for Candida albicans to
invade tissues normally resistant to invasion.
The most important aim in this project was to study of the prevalence of
Urinary tract infection caused by Candida albicans, in patients who
referred to the Central Laboratory of Dr. Shariati Hospital in Tehran, during 6 month. So, data were collected by the questionnaires, which were
infections caused by Candida albicans in mentioned hospital is 7%. The
urinary tract infection caused by Candida albicans in women (71%) is
absolutely much more than men (29%).
The most important disposable factor in this study was estimated as Sex
of patients, which the statistical method of Chi Square has shown the significant relation between Sex and Infection (P<0.05).
ISE.217
Enterococcal Species Identification and Determine their Antibiotic
Sensitivity in Iran
B. Shaghaghi1, N. Lotfi1, S. Asharghi2, M. Pourshafie1. 1Pasteur Institute
of Iran, Tehran, Iran; 2University of Tehran, Medical Sciences, Tehran, Iran
Introduction: In recent years, the rapid rise in the vancomycin-resistant
entrococci (VRE) has become a danger for public health. The aim of the
present study was to detect and determine the antibiotic sensitivity of the
different strains of enterococci that has been isolated from Tehran
sewage plants.
Methods: Isolating VRE strains was done by direct plating on ME agar,
supplemented with 4µg/ml vancomycin. The isolates were identified by
the biochemical tests, growth at 45°C and NaCl 6.5%. Antimicrobial susceptibility testing was done by disc diffusion method using vancomycin
(Van), chloramphenciol (C), Ampicllin (Am), erythromycin (Ery),
Ciprofloxacin (Cip), Gentamicin (Gm), Tetracycline (Te). The MICs for the
above antibiotics were also determined by micro dilution broth method.
Result: Out of 49 isolates, the percent E. faecium, E. gallinarum, E. casseliflavus and E. avium were 33, 59, 6 and 2%, respectively. Forty four
percent (22 samples) of the isolates were VRE with (MIC>32). Included
E. faecium (73%), E. gallinarum (23%) and E. casseliflavus (4.5%). The
level of antibiotic resistant were as follow; Gm, C, Te, Cip, Am and Ery
were 39, 15, 39, 73, 49 and 49%, respectively, of the samples were
resistant to more than one antibiotic.
Conclusion: The results showed that E.faecium and E.gallinarum were
the most common enterococcal species in the Tehran sewage treatment
plants. E.casseliflavus has the least prevalence.
ISE.218
Viral Hepatitis - Epidemiology, Clinical Forms and Treatment,
Retrospective Analysis 200-2005
S. Trajkova1, T. Nedelkova1, S. Miskova1, S. Bisinova1, N. Balova2, E.
Balova2, R. Stojanova1. 1Depatment of Infectious Diseases, Veles, Former
Yugoslav Republic of Macedonia; 2Depatment of Infectious Diseases,
Stip, Former Yugoslav Republic of Macedonia; 1 Depatment of Infectious
Diseases, Veles, Former Yugoslav Republic of Macedonia
Background: The aim of our study is analyzes to the number of different
types of Viral Hepatitis, their specifics diagnosis and treatment. We have
done retrospective analyzes from 2000-2005 year.
Material and Methods: All patients were treated in Department of
Infectious Diseases in Veles. We used the material from disease history.
The patients were analyzed on these parameters: age, sex, profession,
place of living, transmissions and season of infection. The diagnoses are
based on clinical signs, epidemiology parameters, biochemical investigations and serological tests.]
Results: From 364 patients with viral hepatitis, 228 (62.7 %) of them
have viral hepatitis type A (HAV); 118 (32.4 %) type B (HBV) and 18 (4.9
%) are with hepatitis type C (HCV). 201 (55.2 %) are male and 163 (44.8
%) are female. The school children are dominated at HAV infection with
173 (75.8 %). Students and age group more than 30 are represented with
79 (66.9 %) of HBV. It is same case with patients with HCV. The HAV
infection was occurred epidemically in 2000 year, with 79 cases. It was
noticed like a hydric form of epidemy in our region. HBV infection in this
study includes these risk groups: transmission with blood productions 10,
dentists interventions 14 patients; i.v. drugs users 4; patients on hemodualises 7; people who are active in health care 5; and unknown way the
others. HCV infections is registrated at 10 (55.5 %) i.v. drug users and 2
(11.1%) are patients on hemodialisis. The diagnosis was confirmed by
biochemical investigations and serological tests (anti HAV IgM, HBsAg,
anti HBc IgM, HBeAg, anti HCV and HCV-RNA).
Conclusion: All patients with these tree types of viral hepatitis were
treated in our department. The number of HAV infections decreased
every year, but it is not the same with HBV and HCV. So our intension
must be focused on real time diagnosis and adequate treatment.
ISE.219
Infectious Morbidity of Children and Technogenic Environmental
Pollution
E. Savilov1, S. Il'ina2. 1The Institute of Epidemiology and Microbiology,
Irkutsk, Russia; 2Irkutsk State Medical University, Irkutsk, Russia
Background: Nowadays, a correlation between ecological contamination
and morbidity of population has become the subject of interest for scientists of different specialties. However, the problem of infectious morbidity
and a change in flow of infectious diseases among children from regions
with a high level of man-caused contamination is not well known yet.
Methods: The authors conducted the research of infectious morbidity
and clinic-laboratory peculiarities of most often appeared infectious diseases among children who live in ecologically contaminated cities of East
Siberia. There was analyzed the morbidity from viral hepatitis A, dysentery, salmonellesis, and acute respiratory diseases for the last twenty
years. The examination was conducted over 2050 children, who suffer
from diseases mentioned above.
Results: It was determined that children from ecologically contaminated
regions have peculiarities in epidemiological process of viral and bacterial infections which reveals in increase in morbidity level, distortion of
cyclic multiplier of epidemiological process in Acute Respiratory Viral
Infection and viral hepatitis A, intensification of morbidity during the years
of its cyclic upsurges in Zonnea's dysentery. Also, it was revealed that
man-caused contamination of atmosphere is a factor that affects heaviness, duration, and clinical symptoms of viral and bacterial infections. It
was noted that children from ecologically contaminated regions have the
heaviest forms of all observed infections. Clinical and laboratory symptoms of infectious diseases are directly connected to quantitative level
and qualitative composition of xenobiotics that pollute the atmosphere.
Conclusion: It was revealed that technogenic environmental pollution is
a factor that affects Infectious morbidity of children. It was determined
that children from ecologically contaminated districts mostly have heavy
and durable forms of diseases.
ISE.220
A Case Control of Epidemiological Status of Hepatitis B Positive
Cases Among Shirazian Blood Donors in 2005
L. Kasraian, A. Torab Jahromi, B. Farahangiz. IBTO Research Center,
Shiraz, Iran
Hepatitis B virus infection is an important blood borne infection. To support safe blood understanding the prevalence and epidemiological status, of HBS+ cases for recognition of high risk blood donors is essential.
Materials and Method: This is a case-control study that was done on
Shiraz blood donors on 2005 then we selected 600 of HBS cases and
1200 control of blood donors who has negative HBS_ results randomly
then we compare the epidemiological status of case and control by chisquare and T-test.
Results: In this study the mean age of HBS+ group was 38/98±11/96
(16-71), 93/2% of them were male, 79/5% was married, 28/4% was first
time blood donors and 23/3% was collected blood from mobile BTS.
Mean age of control group was 34/37±11/62 (17-68).
86/3% were male 67/1% were married 29/1% were first time blood
donors and 47/1% was collected their blood from mobile BTS. the prevalence of HBS in male and married blood donors was more(P. /05). The
prevalence of HBS in mobile transfusion center was lower than fix BTS
(P<. /05).
Conclusion: It seems that the prevalence of HBS was more in male and
married blood donors and fixed BTS. So we must be more careful when
selecting these.
ISE.221
A Survey of Epidemiological Status and Prevalence Rate of HIV
Cases in Blood Donors During 2005 in Shiraz Blood Transfusion
Organization
L. Kasraian, A. Torab, B. Farahangiz. IBTO Research Center, Shiraz, Iran
Introduction: AIDS is a major blood borne disease. To estimate the
residual risk of HIV transmission through blood and blood products
understanding of HIV prevalence in blood donors is essential.
Materials and Methods: In this cross sectional retrospective study, we
reviewed 134893 donor forms to find out of HIV+ cases (is one who has
positive results in Elisa and western blot tests) in blood donors in 2005 in
Shiraz blood transfusion service and then epidemiological status of HIV+
cases were studied with respect to sex, age, marital status, number of
blood donation, HBS Ag and HCV Ab. Chi square and t test were used
for analysis of data.
Results: 1) Out of these reviewed 12 HIV cases were found to be HIV+
with a mean age of 35.75+4.2. The youngest case of HIV was 28 and the
oldest of them was 48 years old. 2) In this study 8.3% HIV cases were
female and 91.4% were male. 3) 83.3% HIV cases were married and
16.7% of them were single. 4) 75% of HIV cases were first time blood
donors. 5) HIV cases has more prevalence among male and first time
and married blood donors. (P<0. 05). 6) In 83.3% of HIV cases, HCV Ab
was positive and in non of them were HBS positive. 7) Prevalence rate of
HIV positive in blood donors in 2005 was 0.0007%.
Discussion: The finding of the study reveals prevalence rate of HIV in
blood donors is low that is maybe because of predonation counseling
and appropriate donor selection and low rate of HIV in general population. The lower rate of HIV in regular blood donors emphasizes the importance of recruitment of regular blood donor to support safe and adequate
blo
ISE.222
Risk Behaviour and Motivation of Hepatitis C Cases in Blood
Donors During 2005
L. Kasraian, A. Torab, B. Farahangiz. IBTO Research Center, Shiraz, Iran
Background: Hepatitis C infection is one of the most significant blood
borne pathogen that threaten safe blood supply. It is essential to know
the risk factor of getting HCV in HCV cases and their motivation of HCV
cases for blood donation.
Material and Method: This is a cross sectional retrospective study that
was done on HCV positive cases that was done their blood in Shiraz BTO
in 2005 then we called them and fill out a questionnaire that was contained about epidemiological status, risk factor of getting infection and
motivation for blood donation.
Result: In this study we called to 220 HCV cases and invited them to
refer to BTS and fill out questionnaire for them. In this sample the mean
age of HCV+ cases was 34.7±9.29 and 87.5% was male and 58.8% was
married and 58.1% was first time blood donor. Motivation of them for
blood donation was 16% altruistic reason, 32% positive effect on their
health 44% health check up and 4% without any motivation and 4%
curiosity about blood donation.
Risk factor of getting HCV was 40% IV drug abuse, 24% sexual contact,
4% history of blood transfusion 4% hepatitis history in their family and in
28% don't have any risk factor.
Conclusion: The most risk factor for getting HCV in blood donors was IV
drug abuse. The motivation of HCV+ cases for blood donation was more
for health check up or positive effect on their health than altruistic reason.
ISE.223
The Effectiveness of Vaccination Against Viral Hepatitis A in the
Armed Forces of Russian Ministry of Domestic Affairs (MDA)
U.A. Sabanin, V.V. Richter, R.M. Artukov, S.N. Kuzin. Research Institute
of vaccines and sera named by I.I. Mechnikov, Moscow, Russia
Background: The type of epidemiological process of viral hepatitis A
(HAV) in a population is depended not only on morbidity in the certain
population but also on seroprevalence of HAV. The evaluation of risk of
HAV infection in recruits and development of vaccination schedule in the
armed forces should be based on this information. In the previous study
70% of 4058 recruits had no antibodies to HAV, so they could be infected if anyone had a contact with the disease. The high susceptibility to
HAV in recruits is likely to be a condition for disease burden in the army.
Methods: The prophylactics of acute HA in armed forces of Russian
MDA includes one dose of vaccine Avaxim, Sanofi Pasteur, France. The
postvaccinal immunity was accessed in 50 soldiers who had no anti HAV
antibodies before vaccination.
Results: The titers of anti HAV antibodies were more than 500 IU/L in all
subjects in a month after vaccination. There were no registered cases of
acute hepatitis A in 2004 - 2005 in those military sub-units where vaccination with Avaxim was performed.
Conclusion: The effectiveness of one dose of Avaxim is very high in military population.
ISE.224
HBV and HCV Infections and Patients Undergoing Hemodialysis
S. Bisinova-Eftimova, S. Miskova, T. Nedelkova, M. Alceva, L.J.
Pockova. Department of Infectious Diseases, Veles, Former Yugoslav
Background: Dialysis patients belong to the highest risk group. HBV and
HCV could be transmissed by blood, transfusions and blood components, and during dialysis procedure (HD). The aim of this work is to
present detection of HBV and HCV ifection and the possible correlation
between duration of dialysis treatment and the number of blood transfusions.
Methods used: In the study 48 patients (30 male and 18 female) were
examined (in 2005) aged 19-79 years with duration of HD between 1-19
years. 3 of them returned after rejecting the transplanted kidney. 24
patients received blood and blood components. 8 patients are vaccinated against Hepatitis B. IMX machine with ABBOT diagnostic tests III and
IV generation were used.
Results: Out of 48 patients in department of hemodialysis in Veles 4
were HBsAg positive, 22 were antiHCV positive and 4 HBsAg and
antiHCV positive at the same time. Our results showed no correlation
between the prevalence of HCV and HBV positive patients and number
of received blood units, but significant by positive was the correlation with
duration of HD treatment.
Conclusion: Hepatitis viral infections are serious problem in dialysis
centres. That is why preventive measures and regular screenings are the
only way to prevent transmition of these infections and the cheapest way
to prevent further complications. Because of the even compulsory testing
of blood from blood donors, using protective gloves, regular disposition of
needles and medical waste, vaccine for Hepatitis B with health care
workers and patients, proper disinfection and use of dialysis machines
must be an imperative.
ISE.225
Seroepidemiology of Crimean-Congo Haemorrhagic Fever (CCHF)
in Domestic Animals in Isfahan Province, Iran in 2005
H. Salehi1, K. Mostafavizadeh1, S. Chinikar2, B. Ataei3, M. Darvishi4, M.
Izadi5, M.A. Davarpanah6. 1Isfahan University of Medical Sciences,
Isfahan, Iran; 2Laboratory of Arboviruses and Viral Haemorrhagic Fevers
(National Center), Pasteur Institute of Iran, Tehran, Iran;
3
IDTMRC,Isfahan University of Medical Sciences, Isfahan, Iran; 4Army
University of Medical Sciences, Tehran, Iran; 5Baqiyat Allah University of
Medical Sciences, Tehran, Iran; 6Shiraz University of Medical Sciences,
Shiraz, Iran
Background: Crimean- Congo Hemorrhagic Fever is a viral zoonotic
infection which several cases of that have been reported in Iran and during these recent years the nature of the pathogen has been revealed. The
purpose of this study was determination of the seroprevalence of CCHF
IgG among local and imported domestic animals of the Isfahan province
during the year 2004.
Materials and Methods: This cross sectional study has been performed
among 232 animals regarding to the presence of IgG antibody of
Crimean-Congo Hemorrhagic Fever. The study was made with the special helps of Arbovirus laboratory of Iranian Pasteur Institute on 2004.
Results: 88 (%37.9) of animals had seropositive results in which the
most prevalent was within ovine (53.3%) and after that bovine (38.5%)
and caprine (18.6%). With increasing age the chance of seropositivity
was increased and the most common range of age belonged to 4-5 years
old animals. The most infected grassland was Borkhar region and after
that Qom, Natanz, Fereydan, Falavarjan and Isfahan, respectively. No
infected case was noticed among animals belonging to the Kordestan
region grasslands.
Discussion: The results of this study revealed the endemic spreading of
CCHF in the animals in Isfahan province and it needs special attention to
prevent the infection in the communities and occupational exposure.
ISE.226
Vaccination
and
Epidemiology
of
Methicillin-Resistant
Staphylococcus aureus Nasal Carriage in Children with Allergy
S. Kuznecovs, G. Kuznecova. Preventive Medicine Research Institute,
Riga, Latvia
Objectives: There is an opinion that side effects of vaccination constitutes an increase in the incidence of IgE-mediated disorders and unvaccinated children are healthier than their vaccinated peers.
Staphylococcus aureus (SA) and methicillin-resistant Staphylococcus
aureus (MRSA) enterotoxins have been suggested to have an impact on
specific local IgE production. The aim of the present investigation was to
detect the amount of MRSA carriers among vaccinated and unvaccinated children with allergy.
Methods: Nasopharyngeal swabs for SA and MRSA and nasal tissue
samples were taken from 1020 children (ages 2-3, 4-7, 8-12) with NP
(456 persons) and AR (564 persons) and 980 healthy children (ages 212) enrolled for long-term study from 1999 through 2005. Patient's age,
gender, diagnosis of allergy, therapy, IgE levels use of antibiotics and
vaccination schedule was recorded. Antibiotic resistance was determined with the disc diffusion method. Nasal tissue samples were analyzed for total and specific IgE to SA and MRSA.
Results: The rates of nasal carriage of SA were found to be 15%
(147/980) in the control group and 62% (632/1020) in patients with allergy. (57% unvaccinated). MRSA was found in 2% of control and in 29% of
patients with allergy in 1999, 3% and 32% in 2000, 2% and 37% in 2001,
1% and 40% in 2002, 1% and 52% in 2003, and 1% and 66% patients in
2004. (49 % unvaccinated). Children ages 4-7 years (p<0.02), missed
vaccination (p< 0.02) and specific local IgE level (p< 0.001) were significantly associated with MRSA colonization.
Conclusion: The nasal carriage of MRSA in children with allergy is high,
undetectable, and growing. It is possible that allergy maybe the cause of
nasal carriage of MRSA. Unvaccinated children with allergy are an
unidentified and less well studied group at high risk for spreading MRSA
in children's hospitals, day-care centers, and schools.
ISE.227
An Epidemy of El-Tour in Golestan Province, Northeast of Iran
(Summer 2005)
B. Khodabakhshi1, R. Golsha2, S. Besharat1, A. Jabbari1. 1Golestan
Research Center of Gastroenterology and Hepatology(GRCGH),
Gorgan, Iran; 2Golestan University of Medical Sciences, Gorgan, Iran
Background: Seven El-tour pandemy are reported in the world, yet.
Thus global fear from this infectious disease, lead to public rapid reporting of the infected cases. In 2005 (summer) an epidemy occurred in
Golestan province, Northeast of Iran.
Methods: All cases with diarrhea and dehydration admitted in referral
hospitals in Gorgan and Gonbad, were introduced in this study.A checklist about demographic and paraclinical characteristics was completed for
all of them.
Results: 40 cases (mean age 42.27 years) were admitted in this period.
Most of the cases (57.5%) were resided in rural areas. Fars ethnicity
(65%) females and illiterates were the major groups. Diarrhea, nausea
and vomiting, malaise and weakness were the main complaints. Two
cases progressed Acute Tubular Necrosis (ATN) and one death was
occurred. Positive stool culture was reported in 25% of them.
Conclusion: Due to endemicity of El-tour in our region, more awareness
of general population is needed.
ISE.228
Hepatitis Need Assessment Among Jordanian Healthcare Workers
Z. Hassan. Hashemite University, Zarqa, Jordan
Background: Hepatitis infections which caused by hepatitis A, B, and C
virus are considered as an important health problem worldwide. Based
on the available data from the Jordanian Ministry of Health, the incidence
rates of hepatitis A and B in 2003 were 10.2 and 0.8 per 100,000 per year
respectively.
Research objectives: Assessing Jordanian health care workers hepatitis
training needs.
Methods: Three hundred and thirty nine healthcare workers from private
and public Jordanian health care settings participated in this descriptive
study. Minnesota Primary Care Practitioners Survey Viral Hepatitis was
utilized.
Results: Two thirds of the respondents expressed that they did not have
adequate and current training in issues related to hepatitis infections. A
total of 70.5% of healthcare workers indicated an interest in receiving
information and training about hepatitis B and C.
Conclusion: The results of this study showed that the majority of
Jordanian healthcare workers reported a need for hepatitis training.
ISE.229
Hepatitis B Vaccination Coverage in a Major Greek Hospital Workers
A. Antypa-Theothoropoulou, M. Pouyiouka, V. Karabassi, P. Fostira, E.
Spanos, N. Alexandropoulos, M. Toutouza. H.G.H.A., Athens, Greece
Objective: To evaluate the vaccination coverage and rates of seroconversion and seroprotection among health care workers in a major Greek
hospital.
Material and Methods: A sero-prevalence study was carried out on 576
subjects who were examined at the Biosafety Department of the hospital. The tests were performed by MEIA (ABBOTT) at the Microbiology
Department.
Results: 576 workers of a major greek hospital were tested for hepatitis
B and C markers: (HBsAg, anti-HBs,anti-HBe,anti-HBc and anti- HCV).
280(48.6%) persons were found seropositive for anti-s due to previous
vaccination, 82(14.2%) workers were seropositive for both anti-s and
anti-total HBc caused by past HBV infection. 21(3.6%) workers were
HBsAg positive: (specifically 11 nurses, 2 technical staff, 4 cleaners and
4 doctors).The remaining 193(33.5%) workers who were seronegative for
any hepatitis markers, were vaccinated. 169 of them developed a high
antibody titer while the remaining 24 persons with an inadequate
response (anti-HBs 10 IU/l. Our policy is to encourage further development of vaccination programs to the rest of the personnel.
ISE.230
Bacterial Contamination of Salt-Free Fresh Cheese in Jahrom,
South of Iran
M. Rasouli1, A. Daneshmand2, S. Kiany1. 1Immunology DepartmentClinical Microbiology Research Center- Shiraz University of Medical
Sciences, Shiraz, Iran; 2Iranian Blood Transfusion Organization-Larestan
Branch, Larestan, Iran
Background: Milk serves as an excellent culture medium for the growth
and multiplication of many kinds of microorganisms. Thus during the
process of cheese production, some kinds of microorganisms may contaminate the products. Cheese contamination with microorganisms such
as Salmonella and Brucella cause severe diseases, and with S.aureus
cause mild to moderate ones. Traditional cheese (un-pasteurized) is produced in rural and urban regions in south of Iran. Thus, the aim of this
study was to investigate the rate of contamination in salt-free fresh
cheese in Jahrom, south of Iran.
Methods: We collected 200 samples of salt-free fresh cheese from
urban and rural areas of Jahrom. All samples were evaluated to find
microbial contamination using microbiological standard methods.
Results: Among 200 samples collected for this study, 22(11%) samples,
were made from cow milk, 170(85%) samples from sheep milk, and 8(4%)
samples from mixed cow and sheep milk. Of total 200 samples 121(60.5%)
were contaminated with E. coli, 101(50.5%) with S.aureus, 8(4%) with
Brucella melitensis, and 5(2.5%) with Brucella abortus. The frequencies of
E.coli and S.aureus were significantly higher in rural areas than urban
ones. There was a correlation between the incidence of brucellosis and the
frequency of contaminated cheese with Brucella in different areas.
Conclusion: Considering the high contamination rate of this kind of
cheese in Iran, it's production and distribution should be forbidden, and
people should be informed about the harmfulness of this product.
ISE.231
Vancomycin-resistant Enterococci Isolated from Wastewaters in
Tehran
A. Ahmadi1, M.H. Solltandalal2, M. Pourshafie1. 1Pasteur Institute of Iran,
Tehran, Iran; 2University of Tehran, Medical Sciences, Tehran, Iran
Background: Vancomycin resistant enterococci (VRE) are important
pathogens with limited therapeutic options. In this study, we isolated vancomycin resistant Enterococci from wastewaters and analyzed them for
the presence on predominant vancomycin resistant genes, vanA and
vanB.
Material and Methods: In this study a total of 53 vancomycin resistant
Enterococci were isolated from several sewage treatment plants in
Tehran, Iran. After performing complete biochemical identification, antimicrobial susceptibility testing, and MIC determination of the isolates, PCR
assays were used for detection of vanA and vanB genes.
Results: As a result, 53 VRE strains were isolated and all identified as
vancomycin resistant Enterococcus faecium. Antimicrobial susceptibility
test revealed that the strains were 100% resistant to vancomycin and
erythromycin, 98% resistant to ciprofloxacin and ampicillin, 94% resistant
to gentamicin, 21% resistant to chloramphenicol and 15% resistant to
tetracycline. MICs of all strains for vancomycin were - 256. Molecular
analyzes on these strains revealed that all of them demonstrated vanA
gene while vanB was detected only in 7 strains.
Conclusion: The results showed that the wastewater is good setting in
studying of the possibility of resistance spread of vancomycin resistant
genes especially transposon carrying vanA gene among the bacteria in
the environment.
ISE.232
Application of BCG in Childhood, Istanbul, Turkey Results
G. Sengoz, M. Bakar, T. Colakoglu, E. Celikkol, N. Kuzgunkaya, C. Uca.
Provincial Health Directorate of Istanbul, Istanbul, Turkey
Background: In our country's national vaccination program, BCG vaccine is applied in two doses ;at birth and as booster dose at primary
school first class. Our country has a mid-level incidence for tuberculosis.,
but in Istanbul the incidence is more then the country incidence as it is in
other metropolicies of other countries.
Methods: The target population of Istabul primary first classes is
213,944 in 2005–2006 education year. 127,455 cildren were tested with
PPD before they have got BCG.
Results: According the PPD results 100,499 children have 0–5 mm,
21,805 have 6–10 mm and 5,069 have 11mm and over. When the children are evaluated according to their BCG scares, 93% have one scar,
3,5% have have no scar or one.
According the PPD results and BCG scares, 105,348 children got BCG
vaccine.
Conclusion: In countries with mid-level incidence for tuberculosis to prevent from severe forms of tuberculosis, applying two doses of BCG is
important, after PPD test is done.
ISE.233
Compliance to Tuberculosis Treatment: Study of DOTS Strategy at
São Paulo City-sp/Brazil
M.R. Bertolozzi1, A.I.M. Sánchez2. 1School of Nursing of University of
São Paulo, Sao Paulo, Brazil; 2Post-Graduate Program at School of
Nursing of University of São Paulo, Sao Paulo, Brazil
The compliance to the treatment is one of the main aspects in the tuberculosis control, and it is linked to the AIDS epidemic, the progressive
drugs multi-resistance, the increasing deterioration of life conditions and
the limitations to clinical access. Aiming to ensure an increase in the
compliance rates, efforts have been taken worldwide by the implementation of the DOTS (Directly Observed Treatment Short-Course). This
study, supported by FAPESP (Fundação de Amparo à Pesquisa do
Estado de São Paulo), aims to contribute to the production of knowledge
in relation to the topic, also aiming to identify the meanings of the DOTS
strategy according to patients and health professionals in the central and
regional areas in the city of São Paulo, Brazil, highlighting its positive
aspects and its limits. 23 workers and patients from the 'Sé Health
Coordination' in the city of São Paulo, Brazil (where the tuberculosis incidence is higher), were interviewed. Also, there are testifies from workers
of the Center of Prevention and Control of Diseases of Health Vigilance
of São Paulo's Health Department, from September, 2004, to January,
2005. The empirical material, after being de-codified through a technique
of speech analyses, was interpreted according to HermeneuticsDialectics. As a result of peoples condition in terms of labor and lives,
those who are ill tend to experience their illnesses by establishing life
projects, in which the overcoming of their illnesses is a target to be
reached and the reason why they decide to confirm their compliance to
the treatment. The latter is a complex issue involving the relationship
between health workers and patients where the accessibility is fundamental. The DOTS, despite some limited points, has proven to be a strategy that allows an increase in the compliance rate, on top of all, it was
considered as a possibility of social inclusion for the studied patients.
ISE.234
The Growing Crisis of Tuberculosis in Ile Ife, Nigeria
O.O. Adewole, G.E. Erhabor. OAUTHC, Ile Ife, Nigeria
Introduction: TB is a disease of great antiquity.Despite the advaces
made in detection and treatment, mortality is still unjustifiably high.
This study was to determine the patterns of TB in Ile Ife, Nigeria.
Method: A prospective review of all cases of Tb seen at the chest clinis,
OAUTHC, Ile Ife was anlysed with a view to determine the epidemiolgical profile of tb.
Results: During 2000–2005, about 550 patients with TB were seen. Their
agee range from 16–65 with a mean of 32 and a modal age of range
20–3. Male to female ratio was 3.2.86% of them were in social class
V.89% were new cases while the remainder were relapse. PTB was the
commenstformwhile Abdominal TB was the most common EPTB. 90%
were sputum positive while the prevalence of co infection with TB ranges
from 6–17%. Average duration of symtome before reporting at the clinic
was 4.5 months. Cough and weight loss were the most common symp-
toms. Cure aret wsa 85% while death rate overall was 5% which ranges
from 5–9%.There were 10 patients with treatment failure
Conclusion: TB is cureable. However, attention still needs to be paid to
social and economic problems that are underlying factors. More education is needed about TB
ISE.235
Idiopathic CD4 Lymphocytopenia: A Case Report From I.R.Iran
M. Barari1, M. Mirsaeedi1, P. Tabarsi1, O. Eilami2, M. Darvishi3, D.
Mansouri1. 1Shahid Beheshti University of Medical Sciences, Tehran,
Iran; 2Yasooj University of Medical Sciences, Yasooj, Iran; 3Army
Opportunistic infections are common in patients with cell mediated
immune deficiency.
We report here a case of multiple opputunistic infections and lymphoproliferative disease in a patient with idiopathic CD4 lymphocytopenia. A 45
years-old man was admitted in our hospital due to respiratory distress
and diffuse skin lesions. BX of skin lesion and culture of synovial fluid
showed TB infection and prepared smear of synovial fluid contained
Aspergilusis. leukocyte count was 1000/ml with PMN 0.3%,and lymph 28
% with CD4 10.4 percent. Persistent CD4 lymphocytopenia below 300/ml
and lack of evidence for HIV-1,2 infection and also HTLV-1,2 infection
suggests that immunosuppression was due to idiopathic CD4 lymphocytopenia (ICL).
The patient was treated with antifungal and antibiotics and clinically
improved. One year later he admitted again due to left hemiparesis. In
brain MRI a lesion was seen in frontal lobe, also there was multiple lymph
nodes in inguinal region. BX of lymph node showed lymphoproliferative
disease. Unfotunatly despite treatment, he died.
Conclusion: In patients with unusual opportunistic infection without
any underlying condition idiopathic CD4 lymphocytopenia must be
considered.
ISE.236
Lyssophobia Or Real Threat?
E. Gvozdenovic, N. Popovic, D. Krstic, M. Djonin-Nenezic, O.
Damjanovic, M. Glidzic. Institute for Infectious and Tropical Diseases,
Beograd, Serbia and Montenegro
Rage (lyssa) is spreading through Europe, from north to south. During
recent years silvatic rage is more and more present in Srbija. The point
is that veterinary service is discovering enraged foxes in areas that were
rage-free for many decades.
Territory of Belgrade has urban and suburban, even uninhabited parts,
with approximately two million inhabitants. All persons bitten from any
kind of animal should come to Outpatient service of Institute for
Infectious and Tropical Diseases where they are examined by a specialist who decides, primary on the basis of epidemiological grounds,
whether serro et vaccinoprophylaxis are going to be performed.
During past six years 2500 to 3500 persons were registered, from which
61 to 380 (2% to 9.6%) were protected against rage, according to guidelines for rabies prophylaxis. The most bites were in strictly urban areas
(parks, near garbage bins, etc.). 95% of patients had a dog bite, others
were bitten by cats. No one was bitten by a wild animal. Among animals
that were examined for rage (known unvaccinated animals) none was sick.
During past year 15 enraged foxes were identified on the territory of
Beograd. Four people were protected because they had contact with one
of those foxes, but they were not bitten, nor had skin lesions.
Last human rage in Srbija was in 1972. in Kosovo and Metohija region.
The most prophylaxes were performed because the animal was
unknown, skin was broken, clothes splitted and the involved person had
almost lyssophobia, even when no enraged animals were found on that
teritory.
We are very much aware that rage is a lethal disease. We are proud that
we have no more urban rage and no more human rage, but we think that
guidelines for rabies prophylaxis should be revised for strictly urban area.
ISE.237
Dengue Control: Importance of New Approaches Towards Health
Promotion
S. L. Santos, A. L.G. Silva. Aggeu Magalhães Research Center -CPqAM
FIOCRUZ, Recife, Brazil
Background: Dengue has proved to be a complex problem. The illness
vector is present in an ample region of the planet in countries with low
socio economics levels, fast urbanization, and deficiency of sanitation,
what favors the increase of breeding locations. Some control programs
had been implanted in Brazil—with focus in the chemical control of the
vector—that have not achieved the transmission control. This can be evi-
denced by the recurrent epidemics has been occurring. This study aims
to present the control approaches adopted in the world and in Brazil,
reflecting on the importance and the elements related to its occurrence
(vector, virus and host).
Method: A documentary research was carried through to identify the
control strategies and the innovative approaches adopted to control the
illness. It is presented the ecosystem friendly approach in health and the
necessary methodological challenges to its implementation.
Results: Countries of the Asian and American continents present verticalized chemistry-dependents control models. Some countries present
sporadical strategies that incorporate the understanding of the complexity of illness' causality, such as the Integrated General Strategy and the
biological control of the vector. The ecosystem friendly approach is being
sporadically tried in Cuba, Argentina, Uruguay and Brazil. The innovation
of this approach is its anthropocentric, sustainable and integral elements,
thus leading to questioning on the positive and negative impacts of the
chemical insecticides use.
Conclusion: The necessity of deep change in the dengue control model,
in the conceptual bases, in the practices of public health in the local
level—individual and collective—and in global ones. In order to surpass
the chemistry-dependent model in favor of an ecological sustainable
approach.
ISE.238
Climatic Variability and Its Importance in the Risk Assessment of
Malaria at Sucre State, Venezuela
L. Delgado1, K. Córdova2, A.J. Rodriguez-Morales3. 1Laboratorio SIMEA,
Instituto de Zoología Tropical, Facultad de Ciencias, Universidad Central
de Venezuela, Caracas, Venezuela; 2Instituto de Geografía y Desarrollo
Regional. Facultad de Humanidades y Educación, Universidad Central
de Venezuela, Caracas, Venezuela; 3Centro Trujillano de Investigaciones
Parasitológicas José Witremundo Torrealba, Universidad de Los Andes,
Caracas, Venezuela
Background: Metaxenic diseases such as malaria, dengue, leishmaniasis, Chagas' disease, are complex systems, where environmental,
socioeconomical and cultural variables interact in synergy, affecting its
dynamic. Among environmental variables, the climate with its components: rainfall, temperature and humidity, constitute important elements
in the characterization and modeling of the problem. Alterations in the
expression patterns of these climatic elements is what is defined as climatic variability; according to the inter-governmental panel on climate
change (IPCC) this is being affected by global climate change, and consequently producing emergence and reemergence in these diseases.
Increase in temperature and modifications in the rainfall patterns, as well
in relative humidity; accelerate the development of life cycles of some
involved vectors. For these reasons, these diseases are a public health
threat and then it is necessary to assess the vulnerability of communities
in endemic zones, trying to reduce the risk of transmission.
Methods: We have developed a research at Sucre state, in a medium
regional scale; given this is one of the endemic malaria zones, trying to
characterize its dynamics. Different climatic and epidemiologic methodologies have been employed in these analyses.
Results: In different analyses, we have found evidenced of association
between malaria incidence and climatic variables (rainfall and temperature) as well with climatic variability indicators (SOI, ONI) (p<0.05),
explaining the relations between climate variability and disease epidemiology. Other variables (such as altitude, slope, topography, among others) have a modifier effect, contributing to the climatic heterogeneity of
this geographical region. This is translated as a spatially differentiated
response either on climatic variables as spatial expression of disease.
This differential response is also expressed in terms of vulnerability of
human populations living in these endemic areas.
Discussion: Knowledge derived from this and previous studies done by
us, have let us, defining the dynamics and the conditionating variables in
a given geographical as well its effect, to help healthcare authorities to
design control measures and to apply them with the objective to assess
the risk and reduce the vulnerability of these populations against malaria.
ISE.239
Constructing a Novel Model System for Field Investigation, the
Amoebic e-Questionnaires System
J.S. Wu, C.H. Chiu, C.M. Chang, J.H. Chou. Taiwan CDC, Taipei, Taiwan
The epidemics of severe acute respiratory syndrome stroke many countries not only shortens the public health supply but also lead to mass jobleaving and retirement of public health workers, 2003. The shortage
of public health personnel by the outbreak leads to the experience gap of
outbreak investigation, prevention, control. The threat of global
pandemic influenza could bring even worth situation than SARS did. To
counter the impact of upcoming bioterrorism and emerging infectious diseases, Taiwan CDC initiated efforts in constructing a comprehensive and
flexible epidemiologic investigation system, the Amoebic eQuestionnaires System (AeQS), with concepts of a uniformed comprehensive infectious disease investigation system with advantages of timely data collection, can accommodate the future needs including generating situation-suitable questionnaire within seconds, mobile field investigation, filling up experience gap, chronologically analyzing the same disease, syndrome, and scenarios or individuals over time. This system consists of thirty basic modules into a flexible module question bank to cover
the investigation needs of 53 notifiable diseases, three reporting infectious diseases, six acute and severe syndromes from the syndrome surveillance systems and an uncountable scenarios covered by the
Investigation Taskforce for Diseases of Unknown Causes. In the AeQS,
the contacts were linked with the case-patients and could assess transmission tree and basic reproductive number through the investigation
and contact tracing data from this system which meets the suggested
minimum dataset of accessing the basic reproduction rate, case status
and criteria, symptoms, outcomes and effectiveness of intervention and
transmission dynamics easily. With the urgent need for understanding the
knowledge and attitude of general public toward avian influenza, we conducted 780 person telephone interviews through the AeQS system to
both test the performance of the system and analyze for policy making
suggestion. This system will definitely be crucial preparedness for bioterrorism, emerging infectious diseases and unexplained outbreaks.
ISE.240
Caterpillar Urticaria - Thaumetopoea Solitaria in Action
E. Miron1, A. Strulov1, Y. Kandlik2, M. Cohen-Dar2. 1School of Public
Health, Faculty of Social Welfare and Health Studies, Haifa, Israel;
2
Northern Region, Ministry of Health, Zfat, Israel
Much has been written in recent years about the pine processionary
walker (Thaumetopoea Wilkinsonii) - it has been implicated in urticaria
outbreaks among groups of tourists in pine populated forests and control
measures have been selected and implemented to prevent such outbreaks.
Its lesser known relative is the Thaumetopoea Solitaria—its host plants
being of the Pistaccia family. Thaumetopoea Solitaria has been
described as occurring in almost all areas of natural distribution of its two
main hosts in Israel—P. Palaestina and P. Atlantica, but has also been
described as occurring on P. Vera.
Since in the medical literature there have been no publications on outbreaks of urticaria brought on by contact with Thaumetopoea Solitaria
this article will describe two such outbreaks in schoolchildren touring the
Golan Heights Region and Mt. Miron in the Upper Galilee region.
The symptoms of the patients being similar to the urticaria and conjunctivitis of pine processionary walker induced reactions, the etiologic cause
for the outbreaks was identified on the basis of the natural flora of the two
regions which does not contain the host plants for the pine processionary walker.
Control measures may be required for infected host plants but most
important are public awareness and precautions and medical teams'
awareness to the possibility of caterpillar allergies other than pine processionary walker.
The regional health office and the forest authorities are co-operating on
the dissemination of information to the public touring infected areas during the seasonal occurrence of mature larvae and throughout the year.
ISE.241
Costs Estimation of Tuberculosis Cases Detection, La Habana Vieja
Municipality, 2002
M. Peralta Perez, A.M. Galvez Gonzalez, E. Gonzalez Ochoa. Tropical
Medicine Institute, Havana, Cuba
Background: La Habana Vieja municipality reported the highest
Tuberculosis incidence rate in Havana City province. To estimate the
costs of tuberculosis cases detection in this territory; becomes indispensable to asses the interventions toward its elimination as a public health
problem.
Methods: Was carried out a retrospective descriptive study of costs estimation (partial economic evaluation), from social point of view, in 2002.
TB cases detection included: clinical investigation, sputum smear microscopes (SSM), cultures, thorax x-ray, registration and notification. “Down
-Top” method was applied in costs estimation of salary, reagent, expendable materials, buildings, equipments and general expenses; were estimated in equivalent Cuban pesos to American dollars (1 CUC = 1 USD).
The information was obtained from health centers and interviews to
workers and patient with cough/expectoration 14 days
Results: Unitary costs in CUC: clinical investigation 0.37; SSM 2.25; culture 7.05; thorax x-ray 1.67; notification 3.07; register 0.36 and TB cases
detection cost in average 12.55.
Conclusions:These results could be extrapolated to other municipalities
of the country with similar social and economic conditions; having present: first, application of standardized procedures of the control program;
second doctors, technicians and other assistants have salaries similar
nationwide according to their categories; third, there is stability of the
prices all them regulated by a common state supplier and fourth, there
are not good previous estimates tuberculosis program cost.
ISE.242
Infectious Diseases as Cause of Hospital Admission. Analyses of
620 Cases Admitted in an Internal Medicine Service in Venezuela
M. Mendoza1, J. Semeco1, D. Goyo1, A. Chacin1, H. Mago2. 1Servicio de
Medicina A. Ciudad Hospitalaria Dr. Enrique Tejera., Valencia,
Venezuela; 2Universidad de Carabobo. Unidad de Infectología CHETUC., Valencia, Venezuela
Objectives: to evaluate demographic characteristics, type of infection
and mortality attributed to infection in 620 patients attended in an internal medicine service.
Patients and Methods: A retrospective descriptive analysis was performed on 1606 charts from 2.003 to 2.005. 620 patients were admitted
or had an infection during hospitalization. Demographic variables were
analised as well as microbiological findings, average of stay, comorbidities, type of infection and cause of dismiss.
Data obtained were expressed in relative and absolute frequencies
according to descriptive epidemiologic criteria.
Results: 40% of cases were between 40 and 69 y.o. no diferences were
found in gender. UIT regard to co-morbidities, 85% of patients had one.
28% had cardio-vascular diseases, 18% Diabetes mellitus and 12% were
HIV positive. Pneumonia was rhe most frequent infection, (58%), followed by ITU (23%) and soft tissue infections (20%). Cultures were performed in 43% of cases with 46% of positive findings. S.aureus was isolated in 17% of cases, followed by K.pneumoniae and Ps. Aeruginosa (
16% each). 52% of cases had less than 10 days of stay, and 92% were
dismissed because of improvement.
Conclusions: Infectious pathologies are still the most important cause
of hospital admissions in our service, in patients younger than 69.
Respiratory infections were the most frequent, and 85% of cases had a
co-morbidity at the moment of admission.
ISE.243
Morbidity and Mortality Secondary to Infections in Patients Older
Than 65 Attended in a Venezuelan Hospital
M. Mendoza1, M. El Sarrouh1, R. Bermudez1, A. Chacin1, H. Mago2.
1
Universidad de Carabobo. Faculty of Health Sciences Internal Medicine
"A" Service CHET, Valencia, Venezuela; 2Universidad de Carabobo.
Faculty of Health Sciences Infectious Diseases Unit CHET, Valencia,
Venezuela
Objectives: to stablish demographic,caractheristics, tipe of infection and
cause of mortality in 170 patients older than 65 y.o. in an internal medicin srevice.
Patients and Methods: a descriptive retrospective analisis was done on
1.430 charts of patients hospitalizad from 2.004 to 2.005. 301 (21%)
were older than 65 and 170 ( 56%) had an infection. An análisis was performed of demographic variables, co-morbidity, tipe of infection, microbiological findings, time of hospital stay and cause of dismiss.
Data obtained were expressed in absolute and relative frequencies
according to descriptive epidemiological criteria.
Results: 46% of patients were between 65 and 74 y.o. 51% were male.
The most frequent co-morbidities were Diabetes mellitus (
27%),Cardiovascular disease ( 26%) and COPD ( 19%). Pneumonia was
the most frequent cause of infection, (70%), and it was community
acquired in 76% of cases. Urinary Tract infection were present in 29% of
cases, and sofá tissue infections in 17% of patients. Microbiological diagnosis in only 17% of cases with 72% of positive cultures.
71% of patients had an hospitalization period below 10 days, and 91%
egressed for recovery of the proccess,while 13% died, 7 ( 53%) of wich
had hospital acquired pneumonia.
Conclusions and recomendations: more than half of patients older
than 65 had an infection as cause of hospitalization, ann the most frequent was community acquired pneumonia. Hospital aquired pneumonias had a significant association with mortality in these patients.
Efforts most be done to increase inmunization against agents of respira-
tory diseases in this population in order to reduce incidence of hospitalization and and complications.
ISE.244
The Inclusion of the Patients of Projeto PERI, Sao Paulo, Brazil
E. Rossetto, O. Pinto Filho. Prefeitura Municipal de Cosmópolis,
Cosmópolis, Brazil
Issues: Cosmópolis, 50,366 inhabitants, Southwest region of Brazil,
176ª position compared to the others 645 cities of the São Paulo´s State
from the longevity dimensions, education and income in the Index
Municipal Human Development. According to São Paulo´s Index of
Social Vulnerability (IPVS) 15.3% of the population presents high vulnerability. Since 2002, the patients of HIV/aids, viral hepatitis and opportunist infections received monthly basic basket to stimulate the adhesion
to the treatment (to prevent gastrointestinal problems, adverse reactions,
inadequate feeding). PRD is a governmental benefit of temporary concession for families in situation of social risk identified by the IPVS, with
monthly income until USD 45,45 aiming at the improvement of subsistence of the families integrated with partner-educative actions and of
generation of income.
Description: The cadastre of the patients in the PRD made possible to
improve the adhesion to the treatment, to contribute with the rescue of
the citizenship and human rights, incentive to the return of adults to the
studies, information about contraceptive methods and offers, with qualification, of masculine and feminine condoms. The enclosed patients had
started gratuitously to acquire foods adjusted for its necessities, medicines not distributed for the government, to quit personal expenditures.
Lessons learned: The importance of epidemiologic´s data, the rescue of
the identity, dignity and insertion of the patient carrying through the coresponsibility in the management of its health and its life, not submitted
the choices of the next one.
Recommendations: The continuity receiving the benefit their will be tied
with the attendance in consultations, adhesion to the treatment and participation in therapeutical groups. The presence of the familiar nucleus
also is important for the concretion of these processes.
ISE.245
Capacitation of Municipal Managers from DST/HIV/Aids Areas on
Health Regional Management of Botucatu and Campinas, Searching
for the Strength of the Management in the 'Sistema Unico de Saúde'
(SUS)
V. Stanise1, E.V. Rossetto2, V. Cervantes3, M.A. Bersani3, L.M.M.P.
Santos3, S.M.F.J. Cruz4. 1Regional de Saúde Campinas, Campinas,
Brazil; 2Prefeitura Municipal de Cosmópolis, Cosmópolis, Brazil;
3
Coordenacao Estadual DST AIDS, Sao Paulo, Brazil; 4Regional de
Saúde Botucatu, Botucatu, Brazil
Introduction: In May of 2004, one year after beginning of the implantation of Action Plan and goals (PAM), for the National Program of
IST/Aids, we observed that the control of the epidemic was inserted on
the tasks and abilities of the managements of this area in the local level,
as well as in the actions they could produce. In June of 2005 through the
partnership between the institutions was unchained the process of
organization of capacitation occurred between October and December,
2005. The proposal was to motivate in each individual, which have manager position, the perception of their real paper and the possibility to
transform your professional and instituccional vision insered in SUS.
Objectives: To fortify the management of the municipal and regional
Programs, starting from epidemiologist and strategical thinking, inserting
routinely they issues in the context of the health politics, searching for
quality improvement of the attention with users. To execute management
based on the situational strategic planning, identifying the working
process in health in the perspective of reorganization. To recognize and
use the negotiation as practical inherent to the management strategy,
mainly in the management of services and people, searching for the
humanization and the strenght of professionals.
Method: It was used methodology of the problems, based on a daily
reflection, in a process of outbuilding and seeking for different knowledge
that will possibility new construction daily. The professionals had
moments of concentration and dispersion with 120 full hours, reading
texts of Collective Health, group and forum discussions, producing project of intervention in a fictitious city, but with real data for the study.
Conclusion: The students have showed a high level of understanding of
their tasks and their work areas in the SUS context, they built a project
of intervention to the city based on the confection of PAM 2006
ISE.246
Public Politics in the Control of Transmissible Diseases: One Study
on the Tuberculosis in the Municipal District of Salvador, Bahia
S. Ramos de Cerqueira. Health Department, Satate Government of
Bahia, Brazil/Nursing College, Federal University, Salvador, Brazil
The presented results are of a descriptive exploratory study, with a qualitative approach, developed with objective of analyzing the factors that
interfere in the implementation of the public politics in relation to the control of the tuberculosis in the municipal district of Salvador, Bahia, in the
period from 2004 to 2005. Involves as informers 12 social actors (coordinators of the sanitary districts, managers of the basic units of health and
professionals of the net of services). It is adopted as specific objective: to
identify the factors that interfere in the implementation of the public politics in relation to the control of the tuberculosis in the municipal district of
Salvador. The collection of the data obeyed the norms of the resolution
n°196 /96 of ministry of Health and it was used of different techniques:
semi-structured interview and documental analysis, which allowed the
obtaining of subsidies for the crossing of information, and, therefore, to
enlarge the understanding on the object in study. In the accomplished
analysis it is looked for to identify themes and categories, starting from
the interviews, organized and classified at synthetic head offices. The
results confirm that the norms of the Program of Control of the
Tuberculosis cannot be enough for implementation of a public politics in
the control of the tuberculosis a Program to be effective, his action should
be driven in an integrated way and organized, inside of an administration
model that propitiates an interaction among several actors involved in the
control of the disease.
Key Words: political; program; control; tuberculosis;
1. Delay in impact and targeting adolescents
The costs of HPV vaccine may be high and, even at greatly subsidized
costs, delivery of the vaccine to the target group will itself be much more
difficult and costly than was the case for HBV vaccine. Delivery systems
were effectively in place for HBV vaccine because of the emphasis that
all countries have placed on infant vaccination. For HPV vaccine, it is likely that the first target group will be adolescents, a group for which there
is little experience, or infrastructure in developing countries, on which to
base vaccination programmes.
2. Uncertainty about efficacy
While HPV16/18 probably are the predominant oncogenic types found,
more data are required in order to make firm estimates of the impact that
an efficacious vaccine might have on disease rates.Moreover, The
immune response to, and adverse reactions to HPV vaccines might be
influenced in developing country populations by the high prevalence of
other endemic infections, such as malaria, helminth infections, tuberculosis and other sexually transmitted infections (STIs), including especially HIV infection. There is also a need to set up systems for monitoring
changes in the immune response over time and also to monitor the long
term impact on disease rates.
3. Suggestions for research
The World Health Organisation and others have promoted the idea that
HPV vaccine demonstration projects should be set up to understand the
modalities of application and to address issues related to the epidemiological impact, the systems impact, the economic impact and the societal impact of HPV vaccine programmes.
Experimental Infections
ISE.247
Primary Prevention of HPV Infection in Developing Countries
Y.A. Simen Kapeu. University of Tampere, School of Public Health,
Tampere, Finland
ISE.249
Biological Control of Mosquito Culex Quiquefasciatus by the Fish
Poecilia reticulata in the Surface Drains of Calcutta
D.C. Saha, A.K. Hati. Calcutta School of Tropical Medicine, Kolkata, India
Background: Human papillomavirus infection (HPV) causes 90% of cervical cancer in the world and recent estimates indicate that 83% of new
cases occur in developing countries. Sexually active adolescent and
young adult females are biologically more susceptible and data show that
50 to 75% of them are HPV positive.
Objective: To evaluate the effectiveness of community-based prevention
strategies to reduce the burden and impact of sexually transmitted infections (STIs), particularly HPV infection among adolescents in LowIncome Countries.
Methods: An analysis of published data from interviews, focus groups
and previous interventions trials in the southern region of Africa.
Results: A preliminary review of the literature reveals that intrapersonal,
socio-cultural, and environmental factors explain differences in the prevalence and incidence of STIs across societies and subgroups of populations. In settings were screening programmes are weak, primary prevention strategies involving and empowering the community are powerful.
Efforts to increase adolescent awareness of HPV, to increase age of first
coitus, and to decrease numbers of sexual partners are more effective for
HPV prevention. The best deterrents to sexual activity among adolescents involve parental influence, moral and religious training, community
influences, traditional healers, and appropriate peer influences. The
World Health Organisation also advocates the importance of education
and empowerment of women to recognise warning signals and seek
treatment. Research on HPV vaccines is underway. Developing countries
have the greatest need for an HPV vaccine and a prior assessment at
community level of vaccine acceptance, distribution, funding and administration for each country is important for effective implementation of
immunization programmes.
Significance: Our study will provide valuable information for future primary prevention strategies, especially in young, socially disadvantaged,
and sexually active women from less developed countries in whom high
HPV infection rates are an ever-present problem.
The potential to achieve Biological control of mosquito Culex quiquefasciatus by the fish Poecilia reticulata in the surface drains of Calcutta is
now more feasible than ever before, as the efficacy of Poecilia reticulata,
a newly introduced predator proved successful and hence the suitability
of Poecilia reticulata as a classical biological control agent for mosquito
larvae is a reality. The high feeding capacity of Poecilia reticulata on the
mosquito larvae, low cost for its application as well as high pollution and
resistance problem related to larvicides remarkable assessment in the
understanding for the application of this agent in the drains of the study
area (Krishnapur and Narkeldanga). The plan of work was to assay the
larval densities of the study area and then release of Poecilia reticulata
in those drains for the bioassay of larval fauna.
A comprehensive degree of control was attained. Significant reduction of
larval density occurred in the drains. Natural habitat of Poecilia reticulata
and mosquito larvae in drains of the study area pointed out that larval
densities were significantly lower in presence of Poecilia reticulata.
Season wise variation in the larval density related to survival of Poecilia
reticulata was also studied. The distribution of fish fauna in drains did
appear to substantiate that Poecilia reticulata survived and contributed to
the total biological control efforts.
Another observation was noticed in drains of Krishnapur where the larval
density was high. The application of chemical methods using larvicides
(diesel oil) caused a drop in the larval density of Culex quiquefasciatus
but some level of resistance developed in the Culex quiquefasciatus.
Physical and chemical factors of the water of different breeding places
where estimated by standard methods and correlation of these factors
with the larval density of Culex quiquefasciatus was sought. For the survival of Poecilia reticulata the suitable temperature was between 20.5
degree centigrade and 30.5 degree centigrade, suitable pH from 6.8 to
7.2, dissolved oxygen content varied from 0 to 4.42 and salinity from 4.2
to 178.9 mg/l.
ISE.248
The Challenge of Rolling Out HPV Vaccination in Resource-poor
Settings
M. Lehtinen1, Y.A. Simen Kapeu2. 1National Public Health Institute,
Finland, Oulu, Finland; 2University of Tampere, School of Public Health,
Tampere, Finland
ISE.250
Susceptibility of Mycobacterium Tuberculosis to Beta-Lactamase
with or without Beta-Lactamase inhibitors
F.D. Fatemi-Nasab1, K. Ghazi-Saidi2, Z. Eslami-Nejad2. 1Dept. of
Immunology, School of Medicine, Iran University of Medical Science.,
Tehran, Iran; 2Dept. of Pathobiology, school of Public Health, Tehran
University of Medical Sciences., Tehran, Iran
Developing countries have the highest invasive cervical cancer incidence
rates and nearly 80% of global deaths. Results from ongoing HPV vaccine trials and studies in developed countries are promising. However,
there are manifold challenges of rolling out HPV vaccination in lowincome countries.
Background: Re-emergence of tuberculosis along with drug-resistant
strains has made both the treatment of affected patients and the
progress of eradication programs a real struggle. Most second-line drugs
are toxic and expensive it is necessary to search foe effective anti-tuber-
culosis drugs which are safer and less expensive. Due to their structure
and production of Beta-Lactamase enzyme, mycobacteria are considered as Beta-Lactam resistant.
Methods: We studied the effect of Beta-Lactamase inhibition on the susceptibility of mycobacterium to Beta-Lactamase changes in Minimal
Inhibitory Concentration (MIC) of four Cephalosporin, Cephapirin,
Ceftriaxone, Cefotaxim, and Cefoperazone in the presence of sulbactam
in both sensitive and resistant mycobacteria.
Results: Beta-Lactamase production was assessed with the Nitrosfin
method and all strains were Beta-Lactamase. Resistant strains showed
less sensitivity to Beta-Lactamase and both groups were most sensitive
to Cephapirin. Equal doses of sulbactam added to the Cephalosporins
reduced their MICs from zero to 16 times. MIC reduction was more pronounced with Ceftriaxone in the sensitive group and with Cefoperazone
in the resistant group.
Conclusion: Although anti mycobacterial effects of Beta-Lactamase
such as cephalosporin in combination with Beta-Lactamase inhibitors,
could not be compared with first-line anti TB drugs. We are still hopeful
these drugs with the least side effects could be considered as secondline anti TB drugs in near future.
ISE.251
Intranasal Immunization with Stag and CT Adjuvant Enhanced
Cellular Immune Responses of NALT and GALT
G.R. Yin, X.L. Meng, Y.B. Yang. Department of Parasitology, Shanxi
Medical University, Taiyuan, China
To study the nasal and gut mucosal cellular immune responses and the
duration after intranasal immunization with STAg (soluble tachyzoite antigen) and CT (cholera toxin) adjuvant, mice were intranasally immunized
with 20µg STAg and 1µg CT twice at an interval of two weeks. On weeks
1, 2, 3, 4, 6, 8, 10 and 12 after the last immunization, lymphocytes in
nasal-associated lymphoid tissue (NALT), Peyer's patches (PP) and
intestinal epithelial tissues (IEL) were isolated and counted and the percentage of CD4+ and CD8+ T lymphocytes were determined. During the
experiment, lymphocytes proliferated significantly on weeks 1, 2, 6, 8 and
12 (P<0.05) in NALT, on weeks 1, 2 and 3 (P<0.05) in PP, from week 1
to 4 in IEL. The major isotype of the proliferated T lymphocyte was CD4+
T subset in PP and CD8+ in IEL. In NALT, CD4+ T cells increased significantly from week 1 to 6 (P<0.05), as did CD8+ on weeks 1 and 2
(P<0.05) and the CD4+:CD8+ ratio was down-regulated on weeks 2 and
3 (P<0.05). In PP, CD4+ increased from week 1 to 8 (P<0.05), as did
CD8+ from week 1 to 4 (P<0.05) while the CD4+: CD8+ ratio didn't
change much. In IEL, CD4+ increased on weeks 2 and 3 (P<0.05) as did
CD8+ from week 1 to 6 (P<0.05) and the CD4+:CD8+ ratio was downregulated on weeks 1 and 2 (P<0.05). Intranasal immunization with STAg
and CT adjuvant can effectively induce the immune responses of NALT
and GALT that may persist for a relatively long time.
ISE.252
Significance in Determining Etiological Agents of Hepatocellular
Damage with Patients Examined and Treated at the Infectious Ward
in Kumanovo
S. Josifova, V. Stefanovska, V. Dzartovska, S. Makrevska, J. Dzimrevski.
General Hospital, Kumanovo, Former Yugoslav Republic of Macedonia
Background: Significance in determining etiological agents of hepatocellular damage with patients examined and treated at the Infectious
Ward in Kumanovo.
Methods: Medical history of patients suffering from hepatocellular damage treated in hospital was analysed. Epidemiological data, clinical finding standard haematological biochemical and micro-biological testing,
ultra sound and computer tomography was taken into consideration. ALT
and AST values are presented in U/L and determined by IFCC enzyme
method.
Results: Medical documentation of 278 patients suffering from hepatocellular damage was analysed. 62.6% was males. Urban population
appeared as predominate i.e. 80.2%; 47.1% up to age of 20; 36% from
20-50; and 16.9% over 50. According to the etiological agent 54.7% were
patients where the agents for increased ALT and AST values appeared
to be Viral Hepatites. 40.1% suffered from Hepatitis A; 34.9% Hepatitis B;
7.9% Hepatitis C; 14.5% non-defined; 2.6% Chronic Hepatitis; 45.3% suffered from increased Aminotransferases values within other primary disease and to some extent led to necrosis of hepatocytes. Upper and
Lower Respiratory Tract infections were most common in number i.e.
36.5%; Gastrointestinal infections-17.5%; Mononucleosis infectiosa
15.9%; Rikcettsioses 11.1%; Cholecystis and Cholecystopancreatitis
10.3%; Brucellosis 5.5%; Cirrhosis 2.4%; Primary and metastatic
tumours 2.4% and LES and snake bite 0.8%. 27% of the cases appeared
to have simultaneous presence of two or more agents.
Aminotransferases values were of great importance in stating diagnosis.
High levels of ALT and AST, over 1000 U/L were characteristic for acute
Hepatitis and levels from 100-200 U/L for other diseases. Hospital treatment, its length and outcome depended on etiological agent.
Conclusion: At 54.7% patients admitted at the Infectious Ward in
Kumanovo, Viral Hepatitis was considered to be the agent for necrosis of
hepatocytes. Aminotransferases values were significant indicators for the
possible agent. Therapeutic approach, course and outcome of the disease was in relation to etiological agent.
ISE.253
Immune Responses Induced by Intranasal Immunization with
Different Doses of CpG ODN Plus Soluble Tachyzoite Antigen in
BALB/c Mice
G.R. Yin, R. Shi, J.J. Liu, X.L. Meng. Department of Parasitology, Shanxi
To investigate the immune responses induced by intranasal immunization with different doses of CpG ODN plus soluble tachyzoite antigen
(STAg) and determine the optimal dose of for intranasal immunization in
BALB/c mice. Fifty 5- to 6-week-old BALB/c mice were randomly divided
into five groups. The mice of experimental groups were immunized
intranasally two times at 14-day intervals with 20µg STAg plus 0µg, 1µg,
5µg or 10µg CpG ODN, respectively. The mice of control group were
immunized intranasally with PBS at the same time. All animals were
killed on day 30 after the last immunization. Lymphocytes of spleen,
Peyer's patch, mesenteric lymphocyte code (MLN) and intraepithelial
lymphocyte (IEL) were counted. The content of IgA antibody in the feces
and IgG in the sera were detected by ELISA. The proliferative responses
were observed in gut-associated lymphoid tissue and spleen lymphocytes in the 10µg CpG ODN group, and higher than the control group and
0µg CpG ODN group (P<0.05). In compared with the control, the titer of
IgG in 10µg CpG ODN group was increased significantly (P<0.05). The
level of IgA in 10µg CpG ODN group was higher than that of control
(P<0.05). The CpG ODN can act as the mucosal adjuvant of STAg and
10µg is the optimal dose.
ISE.254
Cellular Immune Responses Induced by Intranasal Immunization
with Soluble Tachyzoites Antigen of Toxoplasma gondii Plus IFNgamma and Propolis in Mice
G.R. Yin, C.F. Liu, Y.B. Yang, X.L. Meng. Department of Parasitology,
Shanxi Medical University, Taiyuan, China
To investigate the protective role of IFN-gamma and propolis intranasally administrated against Toxoplasma gondii infection, and explore the
combined result of propolis with IFN-gamma as adjuvant for intranasal
immunization. Sixty 5-to 6-week-old female BALB/c mice were randomly
divided into four groups, fifteen mice of each group were immunized
intranasally two times at 14-day intervals with 20µg STAg alone, 20µg
STAg plus 40µg propolis, 20µg STAg plus 1000U IFN-gamma or 20µg
STAg plus 40µg propolis+1000U IFN-gamma. The PBS containing 4˙104
tachyzoites of RH strain in each 0.5-ml volume were orally administered
to all animals on day 10 after the last immunization. The health and survival of mice were observed day by day. Survivors were killed on day 43
after infection, the CD4+ and CD8+ T lymphocytes of IEL, Payer's patches and spleen were determined by immunocytochemistry. In the groups
of IFN-gamma and propolis+IFN-gamma, the percentages of CD4+ T
lymphocyte and CD8+ T lymphocyte in Payer's patches, IEL or spleen
were higher than STAg group, the CD4+/CD8+ ratio was reversed. IFNgamma or propolis+IFN-gamma intranasally immunized were prior to
propolis as adjuvant; it can be applied to mucosal adjuvant for intranasal
immunization. In combination with two adjuvants is one of new ways to
resist against Toxoplasma gondii infection.
ISE.255
Persistent Cellular Immune Responses of Peyer's Patches Induced
by Intranasal Immunization with Toxoplasma gondii Mucosal
Vaccine in Mice
X.L. Meng, G.R. Yin, Y.B. Yang. Department of Parasitology, Shanxi
To study the mucosal immune responses of Peyer's patches (PP) after
intranasal immunization with mucosal vaccine for Toxoplasma gondii, and
to observe the duration of the responses. Ninety six 5- to 6-week-old
BALB/c mice were randomly divided into two groups: immunized group
and control one, 48 mice per group. Mice were intranasally immunized
with 20µg STAg and 1µg CT per mouse twice at an internal of two weeks,
while control mice were given PBS solution instead. Six mice of each
group were killed respectively on week 1, 2, 3, 4, 6, 8, 10, 12 after the
last immunization. The PPs were separated and lymphocytes were isolated and counted. Percentage of CD4+ and CD8+ T cells was determined by ICC. The number of PP in two groups had no significant
changes. Lymphocytes in PP significantly increased after immunity.
Lymphocytes in PP of immunized mice were higher than that of control
on week 1, 3 (P<0.05), 2 (P<0.0001), getting its maximum number on
week 2. The CD4+ T subset was increasing on week 1, 2, 3, 4, 6, 8
(P<0.01), while CD8+ T cells increased on week 1, 2, 3, 4 (P<0.01). And
the ratio of CD4+ and CD8+ T had no changes. Intranasal immunization
with mucosal vaccine for Toxoplasma gondii can effectively induce
immune responses of PP to protect mice against T. gondii.
ISE.256
Observation on the Duration of Cellular Immune Response of NALT
and GALT Following Intranasal Immunization with Stag and CT
Adjuvant
Y.B. Yang, G.R. Yin, X.L. Meng, H.L. Liu. Department of Parasitology,
Shanxi Medical University, Taiyuan, China
To investigate the nasal and gut mucosal cellular immune responses and
the duration after intranasal immunization with Toxoplasma complex
mucosal vaccine. Ninety six 5- to 6-week-old BALB/c mice were randomly divided into two groups. Mice in were experimental group were
intranasally immunized with 20µg soluble tachyzoite antigen (STAg) and
1µg cholera toxin (CT) twice at an interval of two weeks while those in
control group were as given PBS solution. On weeks 1, 2, 3, 4, 6, 8, 10
and 12 after the last immunization, mice were killed respectively and lymphocytes in nasal-associated lymphoid tissue (NALT), Peyer's Patches
(PP) and intraepithelial lymphocytes (IEL) were isolated and counted, the
percentage of CD4+ and CD8+ T lymphocytes in which were determined
by immunocytochemistry. The lymphocytes in NALT, PP and IEL in experimental group proliferated significantly. And those in PP and IEL peaked
on week 2, and then declined. Compared to the control, lymphocytes in
experimental group increased significantly on weeks 1, 2, 6, 8 and 12
(P<0.05) in NALT, on weeks 1, 2 and 3 (P<0.05) in PP, from week 1 to 4
in IEL. The major isotype of the proliferated T lymphocyte was CD4+ T in
PP and CD8+ in IEL. Intranasal immunization with Toxoplasma complex
mucosal vaccine has enhanced the immune responses of NALT and
GALT which may persist for a relatively long time.
HIV
ISE.257
Trends in Mortality Due to Pneumocystis jirovecii Pneumonia (PJP)
in HIV Patients from Venezuela
J. Benitez1, A.J. Rodriguez-Morales2, C. Rodriguez3, P. Meijomil3.
1
Ministry of Health, Maracay, Venezuela; 2Instituto Experimental JWT,
ULA, Trujillo, Venezuela; 3West General Hospital, Caracas, Venezuela
Background: The causes of death in AIDS have evolved since 1988 following the widespread use of prophylactic and antiretroviral therapies in
patients with HIV infection. Although this, PJP remains as an important
cause of illness and death in HIV-infected persons.
Methods: Therefore, a review of PJP mortality in HIV patients from
Venezuela, between 1996-2002, was done. For this period, 8030 patients
died from HIV, 83.2% were males and 16.8% females (p<.01). Annual
mean number of deaths from HIV was 1123.8±108.3 deaths/year.
Results: From total HIV death patients, 20.7% were 30-34 y-old, 19.3%
35-39 y-old, 16.8% 25-29 y-old (p<.01). Deaths from HIV in children (<5
y-old) were recorded in just 1.97% patients. From total deaths, 7.32%
(588) were attributed to PJP. Annual mean number of deaths from PJPHIV was 84.0#177;25.3 deaths/year. From total PJP-HIV deaths, 83.8%
were males and 16.2% females (p<.01); according age: 22.8% were 3034 y-old, 21.9% 35-39 y-old, 16.8% 25-29% (p<.01). PJP deaths in <5 yold occurred in 1.7%. Although treatment availability HIV and PJP-HIV
mortality in this period has been withouth significant changes (linear
regression: r2=.51, p=.071; r2=.136, p=.415).
Conclusions: PJP has not been the leading cause of death in our country since many years ago, but the frequency of PJP and its mortality rate
should be continously reduced; throughout the developing world, the rate
of coinfection with Mycobacterium tuberculosis and PJP is high, ranging
from 25% to 80%, evidencing that PJP remains as significant problem in
HIV-infected patients, although the HAART availability.
ISE.258
Clinical Trial Interferon Omega Against HIV/AIDS
A.B. Koung Bellet1, P.H. Amvam Zollo2, P. Ndumbe2, J.Y. Gauchet3.
1
Besafca/sosDoctors, Yaounde, Cameroon; 2University, Ngoundere,
Cameroon; 3Institut d'Immunostasie, Toulouse, France
Patent AOIP Nbr. 1200300287 on Feb. 19th 2003 and WIPO on Oct. 10th
2004.
The present invention concerns an immunotherapeutique agent based
on Interferon Omega associated to vasodilators, antioxidatives agents
and anticoagulants against HIV/AIDS, asthma and cancer, also its use in
human and veterinary medecine.
This therapy is the new way of therapeutic transduction of the targeted
and controlled intranuclear signal witch will lead to the modulation of
polyaminic metabolism, foundation of the new continue immunotherapeutic processes based on our invention. We here present our pharmaceutical composition named ACTIVAX witch will be proved effective at at
least 89% complete immunotherapeutic by activating both cellular and
humoral immunity in human and veterinary medecine, its protocole of
use and its therapeutic indications.
This new pharmaceutical composition injected sub cutaneously and
intramuscularly in well determined sites of the lymphoid system and ganglionar areas of the patient's body produces a progressive and perennal
immunotherapeutic effect both cellular and humoral.
The pharmaceutical formular of our composition is based on lymphocytar Interferon Omega associated with adjuvants actions like: vasodilators,
antioxidatives agents, anticoagulants and corticosteroids. The synergic
action of cytokines and adjuvants is meant for therapies as follow: chronic viral affections especially HIV I, HIV 2, AIDS and viral hepatitis; affections associated to intracellular parasites like: Leishmaniosis,
Trypanosomiasis, bacterial tuberculosis, syphilis, Chlamydiae and
Mycoplasmosis; Chronic allergic affections like asthma; treatments of
lymphoids and mesodermique cancerous processes.
Our invention and its directives of use are meant for the treatment of the
above affections both in human and veterinary medecine.
ISE.259
Antiretroviral Drugs Versus Omega Interferon against HIV/AIDS:
ACTIVAX
A.B. Koung Bellet1, P.H. Amvam Zollo2. 1Besafca/sosDoctors, Yaounde,
Cameroon; 2University of Ngaoundere, Ngaoundere, Cameroon
The present invention concerns an immunotherapeutic agent based on
Omega Interferon associated to vasodilators, antioxidatives agents and
anticoagulants against HIV/AIDS, asthma and cancer, also its use in
human and veterinary medicine.
This therapy is the new way of therapeutic transduction of the targeted
and controlled intranuclear signal which will lead to the modulation of
polyaminic metabolism, foundation of the new continue immunotherapeutic processes based on our invention. We here present our pharmaceutical composition named ACTIVAX witch will be proved effective at at
least 89% complete immunotherapeutic by activating both cellular and
humoral immunity in human and veterinary medecine, its protocole of
use and its therapeutic indications.
This new pharmaceutical composition injected sub cutaneously and
intramuscularly in well determined sites of the lymphoid system and ganglionar areas of the patient's body produces a progressive and perennal
immunotherapeutic effect both cellular and humoral.
The pharmaceutical formular of our composition is based on lymphocytar Omega Interferon associated to adjuvants actions like: vasodilators,
antioxidatives agents, anticoagulants and corticosteroids. The synergic
action of cytokines and adjuvants is meant for therapies as follows:
- Chronic viral affections especially HIV I, HIV 2, AIDS and viral hepatitis.
- Affections associated to intracellular parasites like: Leishmaniosis,
Trypanosomiasis, bacterial tuberculosis, syphilis, Chlamydiae and
Mycoplasmosis.
- Chronic allergic affections like asthma
- Treatments of lymphoids and mesodermic cancerous processes.
Our invention and its directives of use are meant for the treatment of the
above affections both in human and veterinary medicine.
ISE.260
Pandemic of HIV/AIDS: The Case of Togo
The National Programme of Fight Against AIDS (PNLS. Reseau SIDA
Afrique, Lomé, Togo
The first case of AIDS be to evoke in Togo into 1981. since this time the
pandemic of AIDS keeps causing important damages. More than 6% of
the population is affected by this disease. 3.2% children become orphans
and 4% women become widowed. in the young mediums what want to
say targets it AIDS, the teenage girls are to touch because they are more
vulnerable. The Network Africa AIDS has to adopt a system of prevention
by information and the communication technology with traver all Frenchspeaking Africa to eradicate this plague. party of this symposium us our
experiment has will grow and we will place at the disposals of Togolese
youth all information which we will have to acquire cordially.
ISE.261
Early and Sustained Viral response To Peginterferon alfa 2a Plus
Ribavirin In Western Part Of Romania
M. Curescu. University of Medicine and Pharmacy Timisoara, Timisoara,
Romania
Background: Evaluation of viral response (Early Viral Response and
Sustained Viral Response) in therapy of chronic hepatitis C, after treatment with Peginterferon alfa 2a (40 KD) plus Ribavirin, 48 weeks and a
follow up period of 24 weeks, regarding age, sex, viral load, risk factors
and fibrosis score.
Methods: The study was performed in the Clinic of Infectious Diseases
Timisoara, Romania, in the years 2001 -2005. The group of patients is
represented by 89 persons with chronic hepatitis C, from which 35
received standard therapy with interferon alfa 2a plus Ribavirin and 54
received Peginterferon alfa 2a, 180 µg/wk plus Ribavirin 1 - 1,2 g/day for
48 weeks. In the group of patients with standard therapy, 18 were nonresponders or relapsers and further on, these patients received
Peginterferon alfa 2a plus Ribavirin.
Results: Regarding the sex of the patients, women exceeded males in a
ratio of 2:1. The modality of infection was identified in 54% of patients, as
follows: blood transfusions with an average of 21 years before the diagnosis of chronic hepatitis C in 20%, surgery in 30%, professional risk in
4% and unidentified in 46% of patients. 72% of the patients were aged
between 46 and 65 years. Abnormal values of transaminases were
observed in 96% of the patients. Advanced fibrosis F3 in Metavir score
was present in 34% of the patients and the viral load had low values
(lower than 2 000 000 UI/mL ) in 69% and high values ( more than 2 000
000 UI/mL ) in 31% of the patients.
Conclusion: Sustained viral response was obtained, generally, in 67%
of the patients treated with the combination of Peginterferon alfa 2a plus
Ribavirin. In naïve patients, not treated before with standard therapy consisting in Interferon alfa 2a plus Ribavirin, the percentage of nonresponders was 30%, which is lower than in patients nonresponders or
relapsers to standard therapy, retreated with Peginterferon plus Ribavirin,
where the percentage of nonresponders was 45%.
ISE.262
Barrier Factors in Effective Family/Community Participation in
HIV/AIDS Education
O. Abiodun Olakelan. Sapon, Nigeria
Nigeria like many former colonial African countries has come to realize
the importance of equalizing educational opportunities for all. Before now
people with HIV/AIDS were neglected because of societal attitude,
beliefs and misconceptions. Government policy statements ushered in
charge although still insignificant. The family and the community groups
have been identified as important in the education of people with
HIV/AIDS. This paper puts into research focus the "Barrier factors in
Effective participation of the Family and community groups in the
HIV/AIDS Education". Five research questions guided the study. The
instrument for data collection were based on an open - ended questionnaire and interview. The subjects used for the study are 1000, combing
family members and community groups.
There are three main reasons for AIDS education, the first of which is to
prevent new infections from taking place. This can be seen as consisting
of two processes: Giving people information about HIV - what HIV and
AIDS are, how they are transmitted, and how people can protect themselves from infection. Teaching people how to put this information to use
and act on it practically. The second reason that AIDS education is needed is to improve quality of life for HIV positive people. The third reason
people need AIDS education is to reduce stigma and discrimination.
The study was carried out in fifteen local Government Areas of three
states. Data were analysed using mean and statistics. Using a survey
approach the paper reports and identifies funds, personnel, societal attitude and lack of seriousness on the part of government as barrier factors
for effective participation of family and community groups in the education of disabled persons. Based on the findings the paper recommends
mounting awareness campaign directed towards a change in attitude
and governmental support through proper funding and implementation of
policy statements among others.
ISE.263
Lipodystrophy Syndrome with Predominant, Focal Lipid
Accumulation in a Young Patient with Perinatal HIV Infection Treated
for Twelve Consecutive Years with Combined Antiretrovirals
(HAART)
Introduction: Although with some latency compared with adults,also
pediatric HIV-infected patients (p) are prone to suffer from a lipodystrophy syndrome, usually accompanied by dysmetabolic disorders. The psychological consequences of the often severe morphologic changes are
expected to be particularly devastating in development ages.
Case Report: Our p was born 15.5 years ago from an African woman
recognized as HIV-positive after delivery, and received antiretrovirals
since his third year of age, due to a lowering CD4 count. Until now, our p
received 12 different therapeutic lines, conducted during the first 30
months with 1-2 NRTI, and thereafter with different protease inhibitorbased combinations. Notwithstanding a cumbersome anti-HIV management, the immune-virological situation was maintained under control (the
last laboratory assays showed a viremia of 720 HIV-RNA copies/mL, and
a CD4 count of 749 cells/µL), and our p never suffered from AIDS-related complications. Unfortunately, starting 4 years ago, a bilateral symmetric lipomastia appeared, associated in the past 2 years with a bilateral,
dorsal lipid accumulation (both confirmed by ultrasonography, which
were responsible for severe psychological disturbances. Hormonal and
metabolic workup failed in disclosing relevant abnormalities,as to serum
FSH,LH,testosteron, estradiol, estrone, progesteron, dehydroepiandrosterone and prolactin levels, thyroideal profile (TSH, fT3, fT4, and anti-thyroid antibodies), as well as metabolic pattern (fasting glicemia, triglyceridemia, total cholesterolemia, HDL- and LDL-cholesterolemia,
apolipoproteins, C-peptide, insulin, fruttosamin, glycosilated haemoglobin, lactate and bicarbonate).
Discussion: While in adult p the prolonged course of HIV infection and
HAART usually induces a combined dysmetabolic sindrome and
lipodytrophy, characterized by co-existing peripheral lipoatrophy and visceral adiposity, usually accompanied by a mixed dyslipidemia and insulin
resistance, our young p surprisingly developed an isolated mammary
and dorsal lipid hyperaccumulation syndrome with lipomastia prevailing
over gynecomastia. A recent French study carried out on 130 children
estimated at ≈25% the frequency of pediatric lipodystrophy, usually associated with a dysmetabolic syndrome [Beregszaszi M, J AIDS
2005;40:161-8]. Also the recent advice to further modify HAART regimen
(by including a NNRTI), is not expected to modify significantly in shortmid term the particular, focal lipoaccumulation features of our young p.A
surgical option (liposuction), is currently under evaluation.
ISE.264
Protease
Inhibitors
Boosterized
with
Ritonavir: Daily
Administrations, Pill Burden, and Some Pharmacoeconomic
Aspects
R. Manfredi, S. Sabbatani, F. Chiodo. Infectious Diseases, University of
Background: Novel and modified protease inhibitors (PI) are now available, especially co-administered with ritonavir (R).
Methods. We aim to compare the seven available PI-R combinations,
focusing on the differences regarding the number of daily doses, the pill
burden, and the crude costs of a standard daily therapy.
Results: The daily pill burden is extremely varied, from a minimum 3
pills/d for atazanavir-R, up to 12 pills/d for both R-associated saquinavir
formulations, followed by 10 pills/d for amprenavir-R, 6 pills/d for both
indinavir-R and lopinavir-R, and 4 pills/d for fosamprenavir-R. A twicedaily dosing regards 6 PI-R combinations out of 7, with only the
atazanavir-R combination conceived for once-daily use. Considering the
daily crude expenses of each PI-R combination, the association with an
expected, more favorable adherence profile (atazanavir-R:22.7 Eur/d), is
burdened by the greatest cost, 79.23% higher than the more convenient
PI-R association (indinavir-R: 12.7 Eur/d), while the expense of the only
co-formulated association (lopinavir-R) is 18.1 Eur/d. The most expensive PI-R combination after atazanavir-R is fosamprenavir-R (Eur
21.1/d), followed by saquinavir hg-R (Eur 19.7/d), saquinavir sg-R (Eur
14.5/d), and amprenavir-R (Eur 14.1/d). Compared with the costs of all
PI-R combinations, efavirenz (which is a potent and convenient first line
non-PI drug), may be administered with one pill once daily, with a cost of
Eur 15/d.
Discussion: In the very complicated scenario including multiple variables not always independent from each other, which has to consider
antiviral potency-long term efficacy-resistance barrier-nucleos(t)ide
backbone-safety-tolerability-patient's adherence, and quality of life, also
some basic convenience and pharmacoeconomic issues should be
addressed. The frequently updated recommendations of anti-HIV therapy display several first-line choices (including almost all R-boosterized PI,
and efavirenz), although with different evidence levels, due to the limited
head-to-head randomized clinical trials available to date. Anyway, when
offering an anti-HIV therapy individualized as far as possible on the basis
of eventual, prior treatments, resistance, and toxicity issues, a significant
role should be played by reducing the pill burden and especially the number of daily dosing, to favor patient's compliance (a key feature for success). Also a very simplified evaluation of crude costs related to the sole
antiretroviral administration, may add significantly to the present debate.
ISE.265
Accelerated Atherogenesis and Large Vessel Damage During HIV
Disease. Sudden Rupture of an Abdominal Aortic Aneurism in a
Patient with HIV Infection, who already Underwent a Thoracicabdominal Prosthetic Implant
Background: Accelerated atherosclerosis and its multiform clinical correlates are of increasing concern among HIV-infected patients (p) undergoing HAART.
Case Report: A 55-y-old HIV-infected heterosexual male had HIV infection known since 4 y, and started anti-HIV therapy 19 mo before,with
associated ddI-ABC-EFZ. Save a moderate dyslipidemia after 6 mo of
HAART (maximum cholesterol level 255 mg/dL with LDL cholesterol 147
mg/dL, and maximum triglycerides 474 mg/dL), controlled by alternate
statins-fibrates, no risk factors for heart-large vessel diseases were present, with a mute personal-family history, no tobacco-alcohol consumption, hypertension, diabetes, and overweight. Eleven months after
HAART initiation (8 mo ago), abdominal pain and a pulsating mass at
palpation led to a ultrasonography and CT-scan diagnosis of a thoracicabdominal type III aortic aneurism. At that time, HIV viremia was undetectable, and CD4 count was 253/µL. An endoprosthesis was positioned,
and complications were carefully excluded by imaging and functional
techniques. Seven months later, a sudden abdominal pain was due to the
rupture of an abdominal-suprarenal aortic aneurism, which deserved
immediate positioning of an endoprothesis type Talent between the older
thoracic graft and the suvrarenal aortic prosthesis, and the revascularization of renal and upper mesenteric arteries. As repeatedly checked by
doppler-ulstrasonography and CT-MRI scans, no sequelae occurred, and
a normal kidney, gut, liver, and heart function were maintained. HAART
was successfully continued (with undetectable viremia and a CD4 count
of 317 cells/µL),daily gemfibrozil was given for hypertriglyceridemia (232
mg/dL) together with ticlopidine, while beta-blockers were suspended 3
mo after surgery.
Discussion: Asymptomatic, symptomatic, and ruptured aortic-large vessel aneurisms were anecdotally described in HIV-infected p (~30 reported cases), but a double intervention after rupture of a pre-treated aortic
aneurism has no precedents. While in the HAART era mycotic
aneurysms followed the drop of opportunism, the increasing life
expectancy, the dysmetabolism,and the endothelial dysfunction due to
possible direct effects of HIV and multiple drug-related variables (especially when multiple-recurring aneurisms occur), could represent risk factors for an increased morbidity of large vessel vasculopathy. Clinicians
should not underestimate these disorder, while therapeutic guidelines
should be the same of non-HIV-infected p [J Endovasc Ther
2005;12:405].
ISE.266
Efavirenz versus Nevirapine, Their Significantly Different Profile on
Lipid Metabolism and its Correlates
Background: Altered metabolism represents an emerging feature of
HIV-infected patients (p) treated with HAART, but limited informations are
avilable regarding the two non-nucleoside reverse transcriptase inhibitor
(NNRTI): efavirenz (E) and nevirapine (N).
Methods. Among over 1000 p treated with HAART for >12 months, the
metabolic pattern of NNRTI was assessed according to three different
backgrounds.The first one included antiretroviral-naïve p starting a
NNRTI-based regimen;the second included a large spectrum of p experienced with 2 to 10 therapeutic lines (but still NNRTI-naïve); the third
group included p who added for the first time a NNRTI only on late rescue therapies with >=4 drugs (and including protease inhibitors).
Results: 386 p treated with E were compared with 334 p taking N in our
prospective observational survey lasting 12 to 30 months, by a multivari-
ate analysis of serum lipid-glucose levels,and other metabolic abnormalities. Among the 213 p naïve to antiretrovirals, an altered triglyceridemia
was more common (p<.001) in the E versus the N group. Considering the
344 antiretroviral-experienced p who introduced a NNRTI for the first
time, the frequency of hypertriglyceridemia appeared greater in the E
group (p<.0001), with earlier development of this feature in p on E versus
N (p<.0001). Also in the 163 p receiving salvage HAART, the rate of
hypertriglyceridemia-hypercholesterolemia-hyperglycemia tested greater
among p treated with E versus N (p<.04 to p<.005), and the time to peak
alterations was more rapid in the E group (p<.04). Comparing the 386 p
receiving E with the 334 p on N, the frequency of elevated triglyceride,
cholesterol, and glucose levels was greater in E-treated p (p<.0001 to
<.005).Some grade of lipodystrophy was present in 276 pre-treated p, but
an appreciable ameliorement occurred after NNRTI introduction in 14 p
of the E group,versus with 39 p on N (p<.005).
Conclusion: A sufficiently prolonged follow-up shows that E may not
resolve dysmetabolism., but might also prompt metabolic abnormalities
with more frequency and intensity compared with N. The two available
NNRTI have a significantly different dysmetabolic profile, which leads to
an increased interest in pathogenetic and prevention studies.
ISE.267
Frequency, clinical role, monitoring, managing, and prevention
issues of pancreatic toxicity in the era of highly active antiretroviral
therapy (HAART)
Background: The epidemiologic-clinical features of HIV-associated pancreatic anomalies are evolving significantly during HAART availability.
Methods: The frequency, risk factors, and clinical-therapeutic features of
pancreatic alterations were assessed in a case-control study.
Results: Around 1000 patients (p) were assessed for pancreatic abnormalities during the whole follow-up period of each p; 138 p with high
and/or prolonged laboratory anomalies were assessed with better
detail,in order to outline the profile of pancreatic disease before and during the HAART era. Compared with control p,the 345 p (35.6%) who
experienced at least one episode of pancreatic laboratory abnormality
had a longer duration of seropositivity, protease inhibitor use, a more frequent immunodeficiency and AIDS diagnosis, concurrent liver-biliary disease, and hypertriglyceridemia. Among these 345 p,high and/or prolonged alterations eventually associated with signs of organ involvement
occurred in 133 p,and were associated (with descending frequency) with
the administration of didanosine, stavudine, a PI-based HAART (and the
frequently related hypertriglyceridemia),and lamivudine, or with substance-alcohol abuse, opportunistic infections, liver-biliary disease, and
(at a lower extent), with the use of combined anti-tubercular therapy, pentamidine, or cotrimoxazole. However, no difference was noticed between
the 34 p with clinical and/or diagnostic imaging (ultrasonographic and/or
CT) evidence of pancreatic involvement, and the remaining 99 asymptomatic p. Although recurrences of enzyme alterations involved >70% of p,
in only 33.8% of p a change of antiretroviral-antimicrobial therapy proved
necessary.An acute but uncomplicated pancreatitis occurred in 8 of the
34 symptomatic p (23.5%).A 2-4-week gabexate and/or octreotide
administration (performed in 48.1% of p), attained a significant laboratory, clinical,and imaging cure or improvement in 71.9% of p, with a better
success rate of combined versus single pharmacologic therapy.
Conclusion: Epidemiological-pathogenetical studies are strongly needed to assess the significance and the outcome of HIV-associated pancreatic abnormalities in the HAART era,considering that a broad spectrum
of direct and indirect pancreatic toxicity may occur. Gabexate and/or
octreotide indications warrant controlled studies, also on a cost-effectiveness point of view. Finally, the frequent persistence of altered serum pancreatic enzymes is of concern when prosecuting HAART in these p.
ISE.268
Epocal Modification of Re-imbursement Facilities of All Lipid-lowering Drugs in Italy. Lack of Consideration of HIV-infected Patients
with HAART-related Dyslipidemia, Who Loss Their Right to Free
Access to Statins, Fibrates, and Omega-3 Derivatives
Background: The significant HAART-prompted advances achieved in
the management of HIV disease are at risk to be frustrated by the modified re-imbursement modalities of all lipid-lowering drugs (LLD) available
in Italy. The remarkably increased life expectancy attained thanks to
HAART, is burdened by significant risks to develop a diet- and exerciseuncontrolled hypercholesterolemia-hypertriglyceridemia, often concomi-
tant with insulin resistance and visceral adiposity, factors which strongly
predispose to cardiovascular events and stroke.
Methods: The novel prescribing rules of LLD based on a computer-generated score, were matched with the present situation of ~1000 HIVinfected patients (p) treated with HAART, in order to assess the frequency and type of dyslipidemia, and the estimated rate of need of LLD prescriptions.
Results: The rate of hypertrigyceridemia and hypercholesterolemia
exceeded 28% and 19% of p respectively, while around 22% of p had a
mixed dyslipidemia. Over 200 p were currently treated with statins and/or
fibrates, with the eventual adjunct of omega-3 fatty polyunsaturated
acids. When applying the risk score proposed for the general population,
20% risk of a major vascular event in the next decade (due to the proportionally lower mean age, the absence of familial dyslipidemia, diabetes
mellitus, elevated systolic pressure, and anti-hypertension therapy),
while only very few p needed a secondary prophylaxis. As a result, >90%
of HIV-infected p presently treated with LLD due to present antiretroviral
therapy recommendations have lost all rights to LLD re-imbursement in
Italy, and are at serious risk to give up LLD due to not sustainable linked
costs.
Conclusion: The recent dispositions of the Italian Health Care System
did not consider HIV-infected p, who are exposed to a frequent, severe,
jatrogenic dyslipidemia, and an elevated major vascular risk despite their
lower mean age, and the lack of multiple generic risk factors. Most
HAART benefits might be blunted by the sudden lack of LLD re-imbursement, which is estimated to regard the majority of treated HIV-infected p.
A comparison with LLD re-imbursement facilities in other countries is
also warranted, to draw some epidemiological and pharmacoeconomic
elements suggesting a re-extension of re-imbursement facilities of these
life-saving drugs to HIV-infected p.
ISE.269
HIV-HCV Co-infection, and Immune Restoration Under Highly Active
Antiretroviral Regimen
Background: A recent metanalysis by M.F.Miller [CID 2005;41:713]
claimed a significantly reduced immune recovery in HCV-HIV patients (p)
undergoing HAART, as measured by a simple mean absolute CD4
difference.
Methods and Results:The study design, data analysis, statistics, and
main clinical inferences are seriously influenced by multiple drawbacks.
Of the only 8 trials extracted from a database of 152 (5.3%), 5 are
prospective, and p enrollment covered a very long 1992-2002 period,
with only 4 studies limited to naïve p. Statististics appear forced to obtain
greater p samples, but failed to report the cumulative mean CD4
levels±SD or ±SE of the 2 p groups of 3317 and 1579 p, while a broad
dissertation exists about the mean ≈30 CD4 cell decrease (from 151.6 vs
113.8 cells/µL), without considering that these figures cannot prescind
from (ungiven) baseline CD4. The sample size strongly influences statistical comparisons, and even minimal differences may be magnified, by
increasing p samples. When making the exercise to double the p samples of the Miller study, we obtain a significant p=.048 difference still
when the absolute difference between groups is 2.6 CD4 cells/µL.
Technically, the absolute CD4 count (regardless of total lymphocyes, cell
subset percentages), is influenced by multiple variables:circannual-circadian courses, gender, ethnicity, transitory viral-inflammatory processes,
HCV genotype, and assay limitations, which make a 5% difference negligible. Multiple adjunctive variables should be added when HIV-HCV-coinfected p undergoing HAART are assessed, so that a mean difference
of ≈30 absolute CD4 cells/µL is only academically relevant. Finally, a difference limited to ≈30 (C.I.23.5-43.4) cells/µL, cannot play whatsoever
role on hard HAART end-points.
Conclusion: Relevant questions should be addressed by "prospective
cohort studies that account for degree of liver disease, duration of HIVHCV infection, baseline HIV load,and different treatment regimens", as
already recognized. However, we cannot absolutely agree with the conclusive Authors' statement: "This meta-analysis shows that p with HIVHCV coinfection do... have less immune reconstitution, as determined by
CD4 cell count after 48 weeks of HAART, than p with HCV infection
alone". Moreover, we believe that the Authors failed to add significantly to
the knowledge of the multifactorial HIV-HCV-HAART interactions.
Actually, this study overestimates a minor laboratory figure, enforced by
a misleading use of statistics.
ISE.270
Disseminated, Lethal Prostate Cancer During HIV Infection
Presenting with Non-specific Features. Open Questions for
Urologists, Oncologists, and Infectious Disease Specialists
R. Manfredi, C. Fulgaro, S. Sabbatani, N. Dentale, G. Legnani. Infectious
Diseases, University of Bologna, Bologna, Italy
Background: Prostate cancer is a very infrequent occurrence in persons
aged <55 years, and it has been rarely reported in HIV-infected patients
(p) (10 overall cases so far), therefore an increased incidence compared
with the general population was not established, although a younger age
seems more frequent among HIV-infected p.
Case Report: We report a case of metastatic prostate cancer occurred
in a 53-year-old HIV-infected p, admitted due to non-spcific signs-symptoms:impaired general conditions, fever, weight loss, fatigue, and dyspnea. A remarkable anemia and an aortic systolic murmur were the prominent initial findings, while AIDS-related conditions were not suspected
due to a sustained CD4+ count and a contained viremia, which never
required antiretroviral therapy. Repeated red blood cell transfusions and
an empiric, combined antimicrobial therapy were promptly performed,
under the suspicion of infectious endocarditis,
but no appreciable improvement occurred. Subsequently, our p complained of a increasingly severe pain at the root of his left thigh, with overcoming dysuria and urgency, but also an urinary tract infection was
excluded. During the diagnostic workup for an HIV-associated fever of
undetermined origin, a bone marrow biopsy disclosed a metastatic prostatic cancer, with elevated PSA and acid phosphate levels. An abdominal-pelvic ultrasonography and CT scan allowed to detect a dyshomogeneous endopelvic expansive mass which extrinsic compression of the
urinary bladder, and involvement of the last lumbar vertebra, large portions of pelvis, and the proximal epiphysis of the right femur. A skeleton
scintigraphy disclosed multiple hypercaptation areas with involvement of
cranial, cervical, dorsal, lumbar, sacral vertebrae, and the pelvis and
upper portions of both femurs. Despite therapeutic attempts, our p
deceased after seven weeks due to an overwhelming disseminated
intravascular coagulation (DIC).
Conclusions: The non-specific clinical presentation of our case (mimicking other generalized or focal illnesses), and the final, lethal complication
(DIC) pose striking problems related to the differential diagnosis during
HIV disease, while the rapid evolution into an advanced, complicated,
and widely metastatic disease which preceded the appearance of local
signs-symptoms, and the lethal overwhelming DIC, deserves careful
attention by specialists who care for HIV-infected p.
ISE.271
Prevalence of Mycobacterium tuberculosis infection in HIV Positive
individuals in Shiraz: Iran
M.A. Davarpanah1, M. Darvishi2, B. Ataei3, H.A. Allishah4, A.S. Saeeidi4, A.
Japoni1. 1Shiraz University of Medical Sciences, Shiraz, Iran; 2Army
University of Medical Sciences, Tehran, Iran; 3IDTMRC,Isfahan University
of Medical Sciences, Isfahan, Iran; 4Tehran University of Medical
Sciences, Tehran, Iran
Background: Tuberculosis is a contagious infectious disease and in HIV
Positive individuals is a common opportunistic infection. Primary infection
result in PPD skin test reactivity and secondary infection is result of reactivation of latent infection.
In HIV positive patients, extra Pulmonary form of disease is more common than HIV Negative individuals.
Methods: The present study investigated HIV Positive Patients. PPD
skin test and CXR was done for all patients. Also acid fast stain and TB
culture of sputum was done for all patients with history of productive
cough. Also tissue biopsy and pathologic examination was done in
patients with suspicious extra pulmonary diseases ( such as lymph node
and pericardial biopsy). Induration of at least 5mm is considered as positive.
Results: Of 244 investigated patients, 34 persons (10.4%) had positive
PPD skin test.
6 patients had smear positive pulmonary tuberculosis.
3 patients had miliary tuberculosis, one patient had TB Lymphadenitis
and one patient had TB pericarditis. Also 4 patient had been considered
as smear negative pulmonary tuberculosis according to clinical presentation and radiographic evidence. 11 patients had abnormal chest X-ray.
Conclusion: Tuberculosis is a common opportunistic infection in HIV
positive individuals. Thus PPD skin test should be done in all HIV infected persons as initial workup. INH should be prescribed prophylactically in
patients with positive skin test.
ISE.272
HIV Infections - AIDS: The Challenges of Control and Prevention in
the Developing Countries of Sub Saharan Africa
F. Munema. Muhimbili Medical Centre, Dar es Salaam, Tanzania
Background: The un abating spread of the HIV-Infections AIDS pandemic, particularly in Sub-Saharan African countries has posed and portrayed as a salient challenge identifiably until now depictedly invincible.
The objectives of the abstract (presentation) is to suggest practically feasible measures to be taken necessary and obligatory in order to control
and prevent or reduce the spread at community level
Methods: Comparative noteworthy observations and studies in reviews
of the global literature on the spread, control and prevention of the pandemic in developed countries of Europe and North America, Asia,
Oceania and that of Sub- Saharan Africa have been done. Drawn elicited
conclusions pertaining to constraints, obstacles and problems contributing to the paradoxical situations still prevailing in Sub-Saharan African
countries, despite the scientific and technological medical advances now
attainable and available, to arrest the spread of the pandemic
Results: Impediments are (1) apathy - fidelity and cleanliness are not
fully appreciated by all (2) Lack of knowledge (general and scientific
especially at grass root levels) (3) Poverty - Lack of resources, Lack of
Water and food-Lack of Good health (see flip chart), multicolored one will
be available)
Conclusion: To control and prevent spread of the pandemic substantially, we need actively to conquer and defeat Apathy, ignorance (about HIV)
and Poverty. This is within our powers.
ISE.273
The Role of IV Drug Users`s Control in Prevention of AIDS
M. Esmaeelzadeh, M. Ghanbari. Mums, Mashhad, Iran
Background and Issues: AIDS and drug addiction are the most serious
health problems facing the world today. Particularly, almost of people
involved to these problems aged 20-40 years, that is time of development, blooming and social activities.For example,we have very problems
related to them, because Iran is neighbors of the largest source producing opium and the other narcotics in the World (Afghanistan). Many of
social crimes are related to the addiction. But there is an important subject about addiction, relationship between IV drug using and raising incidence of HIV.
Method and Description: The main way for HIV transmission is IV drug
users (IVDUs) in many countries. Iran has about 3 milions drug addicts
that about 300000 of them are IVDUs. Most of IVDUs have a low cultural and economic level, corruption and irresponsible in ethic. Infected
IVDUs can transmit AIDS by high risk sexual relations in addition to
injecting way with contaminated shared syringes. It means they are hidden HIV source for community.
With due attention to over 65-70% of HIV transmission is by IVDUs in
Iran, control of them have a great role in prevention of AIDS. We have
studied relations between HIV and addiction.
Results: One of important ways for prevention of AIDS in many developing countries is control of IVDUs. Therefore, effective activities against
HIV are about different from western countries that sexual way is the
most common way.
Conclusion and Recommendation: According to this research, we
recommend: 1) education to afflicted HIV and high risk people about:
transmission ways and complications of AIDS,sexual behaviors, risks of
IVDUs. 2) Cooperation and support of international programs against
HIV especially in IVDUs (syringe exchange, bleach program).
3) Learning parents, social and religious leaders for supervision and
emotional support of youth. 4) The global campaign against addiction,
collecting drug addicts for giving up addiction and support them socioeconomically.
ISE.274
Knowledge,Behaviour and Pratices of infected HIV Women against
HIV/AIDS
A. Benabdellah. CHU.ORAN, Oran, Algeria
Background: HIV-infected women in Algeria constituted 50% of all
patients infected with HIV/AIDS.
Objective: To identify health promotion needs.
Patients and Methods: We developped a questinnaire and interviewed
women with HIV infection.
Diagnosis and data were abstracted from medical reports.
They were selected by a random process.
Results:
52 women were interviewed.
92% have good knowledge about HIV infection.
50% were aged from 20 to 39 ans.
25% lived in Oran.
42% were married.
75% have gone to school.
57% have one sexual partner.
30% used preservative.
Conclusion: Improved HIV-related care for HIV-infected women, in
Algeria,is needed to reduce rates of HIV infection in children and to prevent maternal mortality.
ISE.275
Shigella Sonnei as the Reason for Chronic Diarrhea in an AIDS
Patient
F. Yildirim, G. Sengoz, K.K. Yasar, S.N. Karabela, O. Nazlican. Haseki
Background: Diarrhea is observed in more than half of the AIDS
patients, in the course of the disease, particularly in the terminal period,
and becomes a significant reason for morbidity and mortality.
Case: 54-year-old male patient, who is found to be HIV positive 9 months
ago, applied to clinics with the complaints of nausea-vomiting and forgetfulness. From the history of the patient, it was found that his cognitive
functions were lost for a long time, suffered fever for 3 months, with diarrhea, urine-feces incontinence and a weight loss of 15 kgs. From the physical examination, the patient revealed orientation and cooperation loss,
with a drop in verbal reply and intellectual functions. With a weak appearance, the patient had pale skin and conjunctivitis, increased intestinal
sounds and sensitivity in the abdomen with palpation. Primary consideration was HIV Wasting Syndrome and HIV Encephalopathy. After the examinations held to find out the factor for the chronic diarrhea, leukocytes
were found in the feces microscopy. The patient was administered
trimethoprim-sulfamethoxazole 2x 800/160 mg, empirically. In his cranial
MRI, lacunary infarcts and dilatation in the ventricular system were found.
In his cerebrospinal fluid examination, protein increment was found. In the
feces culture of the patient, Shigella sonnei isolated. According to the
results of the antibiogram, the patient was found to be resistant to
trimethoprim-sulfamethoxazole, so his treatment was shifted to
ciprofloxacin 2x500 mg. On the 10th day of treatment, the patient's diarrhea and feces incontinence were recovered. The patient was administered indinavir, lamivudine and zidovudine as an antiretroviral treatment.
Conclusion: The factors frequently causing the gastroenteritis in the
AIDS patients are the bacteria which cause infection in the society with
an invasive course. The most common ones encountered in Turkey are
Salmonella, Shigella and E.coli. In AIDS patients, protozoon and opportunistic pathogens should also be considered as a disease agent.
ISE.276
Toxoplasmosis in HIV/AIDS Patients in Shiraz, Iran
M.A. Davarpanah1, M. Darvishi2, M. Ghahremanpouri1, B. Ataei3, H.
Nobari2, M. Barari4. 1Shiraz University of Medical Sciences, Shiraz, Iran;
2
Army University of Medical Sciences, Tehran, Iran; 3IDTMRC,Isfahan
University of Medical Sciences, Isfahan, Iran; 4Shahid Beheshti
Introduction: Toxoplasma gondii is an intracellular protozoan parasite,
and causes zoonotic infection. Human latent toxoplasmosis occurs in
about half of the world's population though most cases are asymptomatic. Toxoplasma encephalitis has become one of the most frequent
opportunistic infection in HIV infected patients.
Materials and Methods: This retrospective and descriptive study was
carried out at the referral behavioral counseling and modification center
in Shiraz, Iran. We were able to review the medical records of 207 HIV
infected patients. They were examined and their records were screened
via on the standardized data collection sheet for demographic characteristics. Diagnoses of TE were made based on the presence of at least two
of the following findings: A history of neurological symptoms, neurological signs, suggestive CT, clinical and radiological response to anti-toxoplasma medication.
Results: The seroprevalence of toxoplasmosis among 207 of HIV/AIDS
patients was 37(17.8%):3(8.1%) and 34(91.8%) showed toxoplasma
seropositivity with and without toxoplasmic encephalitis respectively.
The majority of these patients were in the 25-34 age groups, male,
unemployed, single and resided in Shiraz.
Discussion: Toxoplasmosis is a silent disease which poses many diagnostic and therapeutic challenges. Based on findings of this study, we
support a screening program of toxoplasma infection. Primary chemoprophylaxis should be routinely given to all HIV infected with toxoplasma
seropositive status. Also HIV infected individuals with toxoplasma serpnegative status may be advised about preventive behavioral practice.
ISE.277
Diagnostic Problems and Evolution Factors in Tuberculosis at HIV
Infected Children
V. Musta, T. Moisil, D. Stanescu, N. Nicolescu, E. Nicoara, V. Lazureanu,
R. Laza. University of Medicine and Pharmacy, Timisoara, Romania
Objective: To study diagnostic and evolution features in tuberculosis
associated HIV infection in children.
Method: We studied 48 patients, hospitalized between 1995-2005, in
Clinical Hospital of Infectious Disease, with HIV infection and tuberculosis.
Results: The rate of tuberculosis in HIV infected children followed up in
our clinic was 8% (48 cases). Pulmonary tuberculosis was found in 27
patients, pleuropneumonia in 5 cases, systemic tuberculosis in 4 cases,
lymph nodes tuberculosis in 5 cases and meningoencephalitis tuberculosis in 7 patients. Specific positive smears for BK were found only in 14
sputum, pleural fluid and 5 lymph nodes. We obtained positive cultures
for BK in 23 sputum, 5 CSF and 2 pleural fluid. The antibiogram revealed
4 cases resistant to HIN and RIF and 1 cases resistant only to HIN. There
were only 7 patients with positive PPD test. Radiological findings were
characteristic in 36 cases and atypical in 12 patients. One characteristic
finding was the concordance between low level of CD4 and the occurrence and evolution of tuberculosis. Those patients with high level of
CD4, treated before and after the occurrence of tuberculosis with ARV
therapy, evolves favorable with no recrudescence of tuberculosis. The
most important factors in the evolution of tuberculosis at HIV infected
children was the CD4 level and the adherence, compliance and the
resistance to TSS and ARV therapy.
ISE.278
Neopterin and 2-microglobulin in the Monitoring of HIV Infection in
Children
L.R. Shostakovich-Koretskaya1, H.V. Bratus1, Z.A. Chykarenko1, N.N.
Petric1, A.A. Kusnetsova2. 1Dnepropetrovsk State Medical Academy,
Dnepropetrovsk, Ukraine; 2Dnepropetrovsk Center for AIDS and HIV
infection, Dnepropetrovsk, Ukraine
Background: The evaluation of neopterin and 2-microglobulin levels in
human blood serum may be the monitoring method of the diseases progression, because these proteins are connected with the activation of cell
immunity. It is determined that the increase of the neopterin and 2microglobulin levels at some infections can be present earlier that the
clinical signs
Methods: The quantitative evaluation of serum Neopterin and 2microglobulin in 25 children, born of HIV infected mothers, was performed by the immunoenzyme analysis by the test-systems of the companies IBL and ORGENTEC (Germany) with the usage of the half-automatic fotometer "Humareader" (Germany). 13 of them (the 1-st group)
were finally confirmed to be infected after 18 months of age; 12 of them
(the 2-nd group) were shown to have no antibodies to HIV. The control
group consisted of 10 healthy children, who were born of HIV-negative
mothers.
Results: As the obtained data showed, the level of 2-microglobulin in
healthy children was 1,2±0,04 mkg\ml, but in HIV-infected children it was
5,43±0,8 mkg/ml (Group 1). This level was less- 3,16±0,2 mkg/ml in children, who were born of HIV-infected mothers, but were later confirmed to
be negative (Group 2). So, 2-microglobulin level in the second and third
groups was significantly higher in comparison to this level in the control
group. Neopterin level in the children from the control group was 5,5±1,3
ng/l, but at the same time it was 22,4 ±3,2 ng/l, four times as high, in the
group of HIV-infected children.
Conclusion: Consequently the increase of neopterin and 2-microglobulin levels can be used as an early diagnostic marker of HIV infection in
children, as well as for the estimation of the prognosis of the diseases
progression
ISE.279
The Role of Private Universities in Kenya in Combating HIV/AIDS: A
Case Study of Daystar University
P.K.N. Ngugi. Daystar University, Nairobi, Kenya
HIV/Aids pandemic and its impact on the demand and supply of education seriously threaten the gains made by private universities in subSaharan Africa in offering quality education. These universities depend
on donor funding and fees paid by students to run their programmes. In
Kenya, efforts to curb HIV/Aids in public universities have been documented. However, private universities have been left behind.
This paper highlights the role of private universities in Kenya in the fight
against HIV/Aids using Daystar University as a model. Daystar University
is a distinguished private Christian University with a population of 2,800
students and staff drawn from 20 different countries. Three quarters of
the population are women. In line with the Education Sector policy of
2004 on HIV/Aids, Daystar University has started several initiatives
geared to the fight, control and management of HIV/Aids within the university and its environs. They include the establishment of the AIDS
Control Unit, HIV/Aids awareness through sports, drama, seminars, and
talks by experts. We have mainstreamed HIV education in the curriculum
in courses such as general biology, HIV and Development, HIV Care and
Counselling, Environmental Science and short courses offered to
churches.
The University works closely with an NGO called I Choose Life (ICL) that
teaches and trains peer educators on HIV/Aids and runs a VCT on campus. The research department carried out a baseline survey on
Knowledge, attitudes and beliefs on the control and prevention of
HIV/Aids. We have initiated collaboration with other stakeholders in order
to enhance our ability to cope with the challenges of HIV/Aids. The university currently faces a number of challenges in addressing HIV/Aids related issues. They include shortage of specialized personnel, inadequate
funding and limited access to medical facilities, reluctance in behavioural
and attitudinal change and an overloaded curriculum. There is an urgent
need to increase funding for HIV/Aids related activities and devise ways
to encourage staff and students to practice safe sex. HIV education should
be enhanced and be mandatory for both staff and students.
ISE.280
Burkitt Lymphoma in HIV(+) Patient
T. Cabral. Hospital Militar Belém, Lisboa, Portugal
The incidence of Non- Hodgkin Lymphoma (NHL) in HIV patients is higher than in general people. The most common are Diffuse Large B-Cell
Lymphoma and Burkitt Lymphoma.
The author report a clinical case of a 64 years old caucasian woman,
HIV1 seropositive known at 1996 and with AIDS criteria since 2003 on
basis of extra-pulmonary tuberculosis. Before hospitalization, she was
doing HAART (Tenofovir, Lamivudine and Efavirenz) and presented Linf.
TCD4- 327 cel/mm, viral load < 50 cp/ml. Three weeks before she complained a painful left buttock, 5 kg weigth loss, nausea and vomits.
Physical examination was unremarkable, except marked weight loss and
depression related with this symptomatology. She was apyretic and without palpable mass. As laboratory abnormalities, the patient had anemia
(Hgb-8,8) and elevated LDH (1021-1742). Toraco-abdomino-pelvic CT
scan and NMR revealed widespread involvement of retroperitoneal area
by great solid vascularized lesions mainly around kidneys and tail of the
pancreas. Suddenly, appeared enlargement cervical lymph nodes which
were biopsyed. The histologic exam demonstrated High Grade NonHodgkin Lymphoma, suggesting Burkitt Lymphoma.
At the end of CHOP 1º cicle, the patient died.
The main point of the case is the well-known aggressive behaviour of the
Burkitt Lymphoma, its extra CNS localization less frequent in HIV
patients and the reasonable immunological/virological condition of the
woman.
ISE.281
The Distributional Impact of HAART Therapy on CD4+ Count: a
Quantile Regression Approach
C. Louro1, P. Portugal2. 1FCM-UNL, Lisbon, Portugal; 2FE-UNL, Lisbon,
Portugal
Background: The treatment of HIV using combination therapy, also
known as HAART, has a definite effect on the individual patient's CD4+
cell count.. Immunological recovery accessed by the amount of increase
on baseline CD4+ and nadir counts achieved, over elapsed time, have
been used as hallmarks of clinical prognosis and benchmarks of maximally achievable therapeutical success. Until now, models that incorporate these surrogate markers do not address the distributional impact of
HAART therapy on CD4+ count, rather they use location shift estimates
(say, for the mean or median). Furthermore, being able to look and
describe the whole distribution without and with the treatment effect is
anticipated to allow us to appreciate if the gain is constant across baseline values or is asymmetric (quantitatively larger for lower baseline values /quantitatively smaller for higher CD4+ baseline values). The treatment effect can also be considered when controlling for other cofactors
such as age, transmission groups, gender, clinical stage or region.
Objectives: Study of the (distributional) impact of HAART therapy on
CD4+ count. Build a regression model that allows the incorporation of
other cofactors across the entire conditional distribution of CD4+ count.
Criteria: Patients that were enrolled prior to exposure to HAART (defined
as a minimum of three drugs including a PI, NNRTI or abacavir) with at
least one recorded CD4+ cell count naive or at baseline before starting
HAART and follow-up information including CD4+ count for a minimum of
twelve months.
Statistical analysis: Quantile regression analysis. Unlike conventional
regression analysis, which basically impose a location shift in the distribution of the outcome variable, the use of a non-parametric regression
model allowing for different effects at different quantiles of the outcome
variable (in this case the CD4+ count) will be performed. Information for
the outcome variable (CD4+ cell count), for control variables (age, gender, etc.) and for intervention variables (use of HAART therapy, use of
other drugs, etc.).
In addition analysis will be split according to (latter observed or prospective) life status.
Data: From the EuroSIDA prospective study.
Patient Selection: Portuguese patients ever reported to the EuroSIDA
observational cohort study from all the participating Portuguese Centres.
Data comes from any cohort I, II, III, IV and V enrolees.
Variables: demographics, centre ID code, clinical status and CD4+ lymphocyte counts at baseline from starting HAART and subsequent until
latest follow-up or change of treatment.
Results: Not yet available. Ongoing analysis will be supervised by the
European Centre and submitted as soon as allowed.
References:
1. Koenker and Basset (1978) "Regression Quantiles," Econometrica,
vol. 46, pp 199–220.
2. Basset and Koenker (1982) "An Empirical Quantile Function for Linear
Models with IID Errors," JASA, vol. 77, pp 407–415.
3. Koenker and Hallock (2001) "Quantile Regression: An Introduction,"
mimeo
(available
at
Roger
Koenker
web
page:
www.econ.uiuc.edu/~roger/research).
4. Lipitz et al. (1997) "Quantile Regression Methods for Longitudinal Data
with Drop-outs: Application to CD4 Cell Counts of Patients with Human
Immunodeficiency Virus," Applied Statistics, vol. 46, No. 4, pp 463–476.
ISE.282
Sarcoidosis in an HIV Infected Patient
J. Fernades1, M. Doroana1, A.C. Mendes2. 1Department of Infectious
Diseases - Santa Maria Hospital, Lisboa, Portugal; 2Department of
Pulmonary Diseases - Santa Maria Hospital, Lisboa, Portugal
Introduction: Sarcoidosis is a disease of unknown cause resulting in the
formation of distinctive granulomas. In a person with HIV infection, highly active antiretroviral therapy leads to a rapid increase in T lymphocytes
and restoration of pathogen-specific immunity. In some patients, sarcoidosis is a manifestation of this immune restoration.
Case Presentation: 31-year-old black man, HIV1 positive since 1997,
with multiple HAART regimens and multiple toxicities (diabetes, dislipidemia and lipodistrophy). Suspeded HAART between July 2003 and May
2004, and after its reintroduction, the immune status was restored. In May
2005 develops cutaneous non pruriginous nodules on face, neck and
shoulders, progressively increasing in size and number. Further investigation revealed Chest X-ray with parenchymal micronodules, thoracic CT
with pulmonary parenchimal nodules and mediastinal adenopathies, and
ventilation perfusion mismatch with a restrictive pattern. Cutaneous and
lung biopsies were performed showing non caseating granulomas, and
immunohistochemistry confirmed the diagnosis of sarcoidosis
(CD4/CD8>3,5). The proposed treatment was steroids (40 mg/day).
Discussion: The altered V/Q ratio and the exuberance of cutaneous
manifestations impose the treatment with steroids. Nevertheless the
authors discuss the interference of this treatment in an HIV infected
patient, who, after multiple HAART regimens, has finally restored the
immune status; and its effect in the iatrogenic diabetes.
ISE.283
The Prevalence of Fungal Opportunists Infections at Patients with
HIV/AIDS
I. Marincu, L. Negrutiu, R.T. Olariu, C. Oancea. University of Medicine
and Pharmacy, Timisoara, Romania
Background: The diversity of clinico-etiological forms of fungal opportunists infections at patients with HIV/AIDS can cause major problems of
early diagnosis and efficient therapy.
Methods: There have been clinically and biologically monitorized 30
adult patients with HIV/AIDS, from the data base of the Department of
Infectious Diseases Timisoara. The positive diagnosis was established
based on the physical examination (prolonged feverish syndrome associated with weight loss, malaise, peripheral lymphadenopathy, fatigue,
white depots on the tongue, headache, photofobia, etc.) and biological
samples (number of leukocytes, leukocytary formula, ESR, ELISA test,
Western blot test, glossal exudate and culture on Sabouraud medium,
CSF culture, etc.).
Results: Out of a total of 30 monitorized patients, 17 (56.66%) have presented glossal candidiasis, 4 (13.33%) have had oropharingial candidiasis, 3 patients (10.00%) with esophageal candidiasis, 2 patients (6.66%)
with tinea capitis and 4 (13.33%) with meningitis with Criptococcus neoformans; there have been isolated 21 species of Candida albicans, 5
species of Candida glabrata and 4 species of Candida Krusei. The isolation of these species, along with the sensitivity at antifungal drugs test
have allowed the beginning of a adequated antifungal treatment, with
satisfying results. The patients with glossal candidiasis had CD4 average
250 cells/mmc, oropharingial candidiasis had CD4 average 235
cells/mmc, esophageal candidiasis had CD4 average 215 cells/mmc, the
ones with fungal infections with tricophyton CD4 average 330 cells/mmc
and the ones with meningitis with criptococcus under 200 CD4/mmc.
Conclusions: The knowledge of the prevalence of fungal opportunists
infections at patients with HIV/AIDS permits the different application of
prophylaxis measures and adequate treatment, which can ameliorate the
prognosis of these diseases.
ISE.284
Update of HIV and AIDS in Islamic Republic of Iran(2005)
M. Mardani1, M. Goya2. 1Infectious Diseases Research Center Shaheed
Beheshti, Tehran, Iran; 2Ministry of Health, Tehran, Iran
Based upon a report by health authorities of Ministry of Health, Therapy
and Medical Education, about 11930 cases of HIV and AIDS have been
registered from Oct 1985 up to Sep 2005. Although it seems that the
actual statistics are higher than this. Of total number of, HIV and AIDS
patients 94.6% are men and 5.4% are women. The most frequent routes
of transmission of HIV in Iran are IV drug user and use of shared syringe
(61.5%), Sexual contact (7.6%), blood transfusion (2%), Mother to child
transmission (0.5%). It is worth mentioning that in about 3391 registered
cases, no obvious route was found for HIV transmission. The most frequent age of HIV and AIDS was between 25 to 44 years old (70% of total
number). Unfortunately the age of acquiring HIV has been declined in
recent years. The total number of AIDS case were 539 case (93% male
and 7% female). Investigation of transmission routes of AIDS disease in
Iran reveals that of 539 AIDS patients registered in Iran, about 47.7%
have been affected by IV drug users, 22% by sexual contact, 21% by
blood and blood products usage. From beginning of the epidemic till now
1323 case have deceased, most of them died in third and fourth decade
of their lives. We conclude that the HIV is one the most important health
issues in this region and IV drug addiction and use of shared syringe are
the most prevalent transmission route of HIV and AIDS transmission in
Iran most attention should be done for Improving better education of preventive measures in young adult in Iran.
ISE.285
HIV/AIDS Care. Beyond ARVs and Advocacy
G. Idowu Micah. Obafemi Awolowo University, Ile-Ife, Nigeria
Beyond the growing numbers and the grim statistics, the human dimension of the HIV/AIDS is never in doubt. It is a moving human story, redolent with pathos, the slow and sudden wastages, the lives abbreviated
midstream, the village and communities littered with untimely graves and
the growing colony of disoriented orphans.
Dealings with HIV/AIDS on a continental basis in Africa, is of great importance as 70% of the people infected with the disease world wide are from
Sub-Saharan Africa, and the current United Nations Development
Programme (UNDP) statistics show that over 20 million Africans have
died of the epidemic, hence it is imperative for Africans to come together to fight the pandemic which is already taking a huge toll on the human
development in Africa.
Speaking recently in Calabar, South Eastern Nigeria, the former
American Ambassador to Nigeria, His Excellency, Mr. Howard Jeter,
while debunking the very spurious allegations that President George
Bush's recent visit to Africa, and particularly Nigeria was to carve a
sphere of influence for the United States, also called our attention to the
fact that Africa has the highest percentage of HIV/AIDS in the world and
that something urgent has to be done to arrest the situation. One cannot
agree less. It has therefore become very necessary to address the twin
issues of access to care for HIV/AIDS and what manners of care, in order
to evolve effective approaches to the issue of HIV/AIDS care, especially
in Africa.
In order to ensure more access care, the fundamental elements of any
effective response to HIV care should be embedded in a code of conduct
for HIV/AIDS care, which must be humane in approach, universal in its
application, adaptable in every circumstance and affordable to the patient
community.
ISE.286
AIDS Helpline Breaks the Silence: The AIIMS Experience
B. Singh. AII India Institute of Medical Sciences, New Delhi, India
India is projected to be the AIDS Capital of HIV/AIDS in next 5 years. All
out efforts must be made to contain this epidemic in India. Creating
awareness about the disease remains the main tool to prevent and contain this disease. The general level of awareness of common public about
HIV/AIDS in India is still low. Many people want to know about prevention
of HIV/AIDS but can not do so because of lack of easily accessible
source of information. As AIDS is still erroneously considered a "sex"
related disease and sex is a taboo to talk about in Indian society, many
people especially women don't feel comfortable asking questions on
HIV/AIDS despite their keen desire to do so. Telephone helplines provide
a good alternative to address these two issues. The AIDS helpline of All
India Institute of Medical Sciences, New Delhi is appropriately named
"Shubhchintak" (literal meaning "a well wisher"). This has become a very
popular helpline in Northern India mainly because it is individualised and
interactive. The paper deals with experiences of this helpline which has
indeed helped in breaking the silence.
ISE.287
Cryptosporidiosis in Brazilian HIV/AIDS Outpatients
M.I. Hernandez Lopes1, L.L. Pires2. 1Secretaria de Saúde. Gerencia
DST/AIDS, Brasília., Brazil; 2Faculdade de Medicina. Universidade de
Brasília, Brasília, Brazil
Background: Cryptosporium is an important protozoal infection in
HIV/AIDS patients producing high morbidity, especially in low CD4+ Tlymphocytes count (< 200 cell/ mm⁄), even though in HAART era.
Methods: An observational study of a series of cases was performed
with 112 HIV/AIDS patients, assisted in Taguatinga Polyclinic, Brasilia
DF, Brazil. After sign the written informed consent, each patient answered
a questionnaire and supplied one faecal sample to be analyzed by the
researcher in the parasitology laboratory of the Tropical Medicine in
University of Brasilia. Two smears were prepared with each stool samples and stained with auramine O and Kinyoun carbolfuchsin acid-fast
stains, which are specifics to analyze Cryptosporidium spp. parasites.
Slides were examined by fluorescence and optical microscopy. Chisquare test was used to analyze the variables independence, with a
probability value (p-value) less than 0.05 to reject de null-hypothesis.
Results: Cryptosporidium spp infection prevalence was 3.6%. Most of
the evaluated patients were men (64.3%), mean of age were 35.6 yearold, incomplete fundamental level (30.4%) and workers without specialization (68.8%). Sexual behavior was heterosexual (69.6%), homosexual (24.1%) and bisexual (6.3%). Only 65.2% mentioned the use of preservatives in their sexual intercourse. 48.2% related among 1 to 4 partners
in the last 2 years. Most referred gastrointestinal symptom was diarrhea
(32.1%). Cryptosporidium spp. finding in the stools samples were associated with CD4+ T-lymphocytes cell count < 200 cell/mm⁄, viral load >
10.000 /ml, high number of partners, opportunistic disease and diarrhea.
There were not association of cryptosporidiosis with drinking treated or
filtrated water.
Conclusions: Study findings present the importance in diagnosis the
cryptosporidiosis infection in patients living with HIV/AIDS, always considering the risk behaviors and the immunological profile.
Molecular Biology/Diagnosis of Viral, Mycotic,
and Parasitic Infections
ISE.288
Classification and Identification of a Clinical isolate Using the
Analysis of the 16S rRNA Gene and The 16S-23S rRNA Intergenic
Transcribed Region Sequences
Q. Chen, Q. Ye. National Institute for the Control of Pharmaceutical and
Biological Products, Beijing, China
A clinical isolate, numbered CMCC(B)29108, was difficult to be classified
by classical phenotypic identification based on either metabolic, enzymatic, or serological methods. Therefore, the 16S rRNA gene and the
16S-23S rRNA intergenic transcribed spacer (ITS) sequencing were
used. The 16S rRNA gene and the 16S-23S rRNA intergenic transcribed
spacer were gained respectively by the PCR method with two pairs of
bacterium-specific universal primers. They were sequencing and alignment. The results show that the 16S rRNA gene sequences similarity of
Strain CMCC(B)29108 and Acinetobacter sp., including Acinetobacter
anitratum and Acinetobacter baumanni is above 99%. And compared
with Acinetobacter anitratum, the ITSs sequences similarity of CMCC(B)
29108 and Acinetobacter baumanni is higher (above 98%).
Simultaneously, phylogenetic tree analysis of 16S rRNA sequences
using the neighbor-joining method was done. Phylograms shows that
CMCC(B)29108 belongs to the cluster of the 16S rRNA sequences from
Acinetobacter sp., and the cluster of the 16S-23S rRNA intergenic transcribed spacer from Acinetobacter baumanni. We had conclusion that
Strain CMCC(B)29108 is classified to Acinetobacter baumanni.
ISE.289
A Sensitive RT-nested PCR for Detection Human Immunodeficiency
Virus (hiv) Infection
M. Ravanshad, J. Doozandeh, F. Sabahi, S. Amell. Department of
Virology, Faculty of Medical Sciences, Tarbiat Modarres University,
Tehran, Iran
Human Immunodeficiency Virus (HIV) type 1 and 2 are the etiologic
agent of acquired immunodeficiency syndrome (AIDS) disease and
demonstration of virus genome in samples accepted an evidence of
infection. Transmission of HIV through blood transfusion and diagnosis of
infection in hospitals and public health settings prior to antibody production "Windows period" continues to be a worldwide concern.
A highly sensitive nested RT-PCR was carried out in order to detect gag
gene of HIV-1 and 2 conserved sequence. This "in house" nested PCR is
very sensitive, and is feasible for routine tests. In order to reduce the time
of reactions and crossover contamination, the possibility was explored to
carry out a single step nested PCR, in which the two successive amplification rounds are carried out in the same tube. This single step nested
PCR has the same sensitivity of the two-step nested and is easy to conduct and requires a short time of reaction. The two different PCR methods were compared and the clinical use of monitoring gag gene in HIV-1
and 2 infected patients with undetectable plasma viral load is discussed.
About 35 serum samples from different stages of infection
(Asymptomatic and AIDS) as well as 10 negative serum samples was
collected and tested with the developed method. The developed method
had high sensitivity and specificity and could detect viral genome prior to
seroconversion and detectable antibodies and hence could shorten the
window period of infection.
ISE.290
Seven Human Immunodeficiency Virus (HIV) Antigen-Antibody
Combination Assays: Evaluation of HIV Seroconversion Sensitivity
and Subtype Detection
M. Ravanshad1, F. Sabahi1, F. Mahboudi2, S. Bayanolhagh2. 1Department
of Virology, Faculty of Medical Sciences, Tarbiat Modarres University,
Tehran, Iran; 2Biotechnology Research Center, Pasture Institute of Iran,
Tehran, Iran
In this study, we evaluated the performance of two prototype human
immunodeficiency virus (HIV) antigen-antibody (Ag-Ab) combination
assays, one from Abbott Laboratories (AxSYM HIV Ag-Ab) and the other
from bioMerieux (VIDAS HIV Duo Ultra), versus three combination
assays commercially available in Middle East. The assays were
Enzygnost HIV Integral, Genscreen Plus HIV Ag-Ab, Murex HIV Ag-Ab
Combination, VIDAS HIV Duo, and Vironostika HIV Uniform II Ag-Ab. All
assays were evaluated for the ability to detect p24 and gp41 antibody
from HIV-1 groups M and O, antibody-positive plasma samples from HIV1 groups M and O, HIV-2, and 32 HIV seroconversion panels. Results
indicate that although all combination assays can detect antibodies to
HIV-1, group M, subtypes A to G, circulating recombinant form (CRF)
A/E, and HIV-1 group O, their sensitivity varied considerably when tested
using diluted HIV-1 group O and HIV-2 antibody-positive samples.
Among combination assays, the AxSYM, Murex, and VIDAS HIV Duo
Ultra assays exhibited the best antibody sensitivity for detection of HIV-1
group M, subtypes A to G and CRF A/E, and HIV-1 group O isolates.
However, the VIDAS HIV Duo Ultra assay had a lower sensitivity for HIV1 group M and subtype C. The HIV antigen sensitivity of the VIDAS HIV
Duo and Genscreen Plus combination assays was high for detection of
all HIV-1 group M isolates except HIV-1 group O while the sensitivity of
Vironostika HIV Uniform II Ag-Ab and Enzygnost HIV Integral Ag-Ab
assays for all the group M subtypes was. Among the combination assays,
the AxSYM assay had the best performance for detection of early seroconversion samples, followed by the Murex and VIDAS HIV Duo Ultra
assays.
ISE.291
Cytokine Single Nucleotide Polymorphisms in Iran
M. Bagheri, M.D. Omrani, I. Abdi Rad. Genetic Department, Faculty of
Medicine, Uremia Medical Sciences University, Uremia, Iran
Background: Overall expression and secretion of cytokines are dependent on genetic nucleotide variations within or adjacent to regulatory
regions of cytokine genes. Association of Cytokine Single Nucleotide
Polymorphisms with infectious disease including Helicobacter pylori and
susceptibility to gastric cancer was reported. The genotyping of patients
during early signs with infection may be necessary for diagnosing susceptibility to infectious disease.
Methods: In 40 Iranian healthy subjects, cytokine single-nucleotide polymorphisms (SNPs) were used to determine allelic and genotypic frequencies for the cytokine genes. All typing were performed with PCRSSP assay.
Results: In Iran, Almost all allele frequencies were in Hardy-Weinberg
equilibrium: the exceptions were + 1902 IL 4RA (χ2= 20.11; P <0.001),
UTR5644 IFN-Alpha (χ2= 36.1; P <0.001), 590 IL 4 (χ2= 19.86; P <0.001)
and -1082 IL 10 (χ2= 17.36; P <0.001).
Conclusion: Iranian and non-Asian populations (Italian, English,
Germany, Greek) had similar cytokine profiles but in some cases, Iranian
allele and genotype frequencies were significantly different compared
with those of other Asian and African-American populations for the
majority of the polymorphisms. The genetic study of cytokines is likely to
provide relevant information on their polymorphisms and a possible relation with these polymorphisms and natural selections.
ISE.292
Investigation of Herpes smplex Virus (HSV)-DNA by Real Time PCR
in Patients with Aseptic Meningitis
S. Gokahmetoglu, Y. Ozbal. Medical Faculty of Erciyes University,,
Kayseri, Turkey
Background: HSV is one of the causative agents of aseptic meningitis.
PCR is becoming the new standard for virological diagnosis of the infections of the central nervous system. In this study our aim was to investigate HSV DNA in cerebrospinal fluid (CSF) specimens of patients with
aseptic meningitis.
Materials and Method: Sixty-six patients with aseptic meningitis were
included in the study. HSV DNA was investigated by real time PCR
(‘Cycler’ Q Real time PCR detection system, BIORAD) in CSF specimens of patients.
Results: HSV DNAs were found positive in 7 (10.61%) of 66 the patients.
All of them were typed as HSV-1.
Conclusion: HSV DNA should be searched by PCR in patients with
aseptic meningitis.
ISE.293
Semi-quantification Analysis of Dot Blot Assays for Human
Immunodeficiency Virus Type 1 and 2 Antibodies
M. Ravanshad1, F. Mahboudi2, F. Sabahi1, S. Bayanolhagh2. 1Department
of Virology, Faculty of Medical Sciences, Tarbiat Modarres University,
Tehran, Iran; 2Biotechnology Research Center, Pasture Institute of Iran,
Tehran, Iran
Dot blot (DB) strips for antibodies directed to human immunodeficiency
virus (HIV) type 1 and 2 were analyzed by a densitometer. This method
was used to quantify the antibody response to different HIV proteins in
infected patients. In order to increase reproducibility, reagents and protocols were accurately standardized and internal controls were added. In
the first format, an internal control band consisting of Human IgG was
added to each dot to minimize the effects of band intensity variation.
In the second format, antibody concentrations were calculated from the
ratio of the dens ities produced by test sera and by positive and negative
standard sera. The sera under scrutiny were also examined by standard
enzyme-linked immunosorbent assay (ELISA) and the results obtained
compared with those of the corresponding DB. A statistically significant
positive correlation was found between the results obtained with the two
methods, and this was especially evident when ELISA titers were compared to corrected DB values (P = 0.001). Densitometric analysis of DB
assays allowed to quantify the antibodies against HIV-1 and 2 Gag and
Env proteins and might be useful to investigate possible humoral immune
correlates of production in HIV vaccine studies and antibody production
in the early phase of infection.
ISE.294
Effects of Temperature and Toxins on Adherent Cell Cultures
J. Hassan, P. Kingori, J. Muchiri, M. Nthiwa, P. Borus, F. Okoth. KEMRI,
Nairobi, Kenya
Introduction: Adherent cells in cell culture vessels continue growing in
vitro until a monolayer is achieved if supplied with the appropriate nutrients and conditions. Cultures contain cells of one type. A clone, which is
homogenous population of cells derived from a single parental cell, are
genetically identical. Growth-inhibiting factors affect cell growth in a cell
culture causing difficulties in virus isolation. This paper outlines measures undertaken to identify inhibiting factors including toxicity and temperature fluctuations during cell growth.
Aims:To identify growth inhibiting factors in a cell culture.
Procedure: Two cell lines were revived, L20B P-26 mouse cell genetically engineered expressing receptors for poliovirus, RD P-231 human rhabdomyosarcoma cell for entero virus, growth media containing L-glutamine 200mM-1%, Sodium bicarbonate (7.5%) -1.5%, fetal bovine serum10%, Penicillin/streptomycin-10,000IU, HEPES 1M, toped up with minimal essential media (1x) was used to grow the cells. There was media
change after 3days to maintenance media containing L-glutamine
200mM-1%, Sodium bicarbonate (7.5%) 2.5%, Fetal bovine-2%,
Penicillin/streptomycin-10, 000IU, HEPES 1M, toped up with minimal
essential media (1x).
Cells were viewed using inverted microscope to assess growth, washed
twice with
Phosphate Buffered Saline (free of ca++ /mg++ ions)
Trypsin/EDTA was used to detach monolayers and incubated at 36°c for
1-2minutes.
Cells were counted and subculture in tissue culture flask150cm2 and in
culture tubes for virus isolation.
Observations
Growth in flasks of both RD and L20B were good. L20B was good in
tubes
Peeling in RD cell appeared 4 days after subculture, affecting cells in
tubes.
Conclusion: Temperature should be monitored daily and should be
between 34–38˚C. Forescent and UV light degrade HEPES and FBS.
ISE.295
Trace Element and Trace Element Proteins and the Respiratory Tract
Infections
A. Kyriakopoulos, K. Bukalis. Hahn-Meitner-Institrut, Berlin, Germany
Most of the trace elements are metals or metalloids which are bound to
proteins. Trace elements may have either beneficial or harmful effects.
Their behaviour depends to a large extent on their concentrations in the
body compartments, and the determination of their tissue levels is therefore an important step in trace element research. It is well known the surface of the lung and trachea is continuously exposed to gases, particular
matter and infections present in the atmosphere. In order to be protected
against exposure to oxidants, a specific antioxidant defence system is
required. Several enzymes with antioxidant functions are known to contain metals or metalloids as essential constituents of their active centre.
In addition, there may be further protective trace-element containing proteins not yet identified. It is therefore of great interest to determine the
trace elements present in the respiratory tract and to obtain information
on their biological effects. In this study several trace elements and trace
element proteins like selenoproteins, arsenic- and chromium-binding proteins in the whole organs of lung and trachea were detected. In the present study specific characteristics of the trace element proteins concerning their relationship to the infection and inflammatory processes in the
respiratory tract are present and discussed.
ISE.296
Use of a Genus- and Species-specific PCR for Identification of
Enterococci Isolated from Tehran Sewage
F. Rahimi, M. Saifi, M. Pourshafie. Pasteur Institute of Iran, Tehran, Iran
Background: Enterococci are important not only because they are a
leading cause of nosocomial infections, but also because they may have
a significant role in dissemination and persistence of antimicrobial resistance. The 16S rRNA gene has previously been used to develop genusspecific PCR primers for identification of enterococci. In addition, the
superoxide dismutase gene (sodA) has been identified as a potential target for species differentiation of enterococci. In this study, we have examined the specific-specific PCR for rapid and specific identification of enterococcal species.
Methods: 410 Isolates of Enterococcus were selected on m E agar
medium. All of these Isolates were Identified to the Species level by common conventional bacteriological tests. Enterococcus genus-specific
primers were incorporated with species-specific primers based upon the
superoxide dismutase (sodA) gene for development of a PCR. This assay
provides simultaneous genus and species identification of 8 species (E.
faecalis, E. faecium, E. hirae, E. gallinarum, E. mundtii,
E. casseliflavus, E. raffinosus, E. dispar and E. avium) of enterococci
using different reaction mixtures. Accuracy of identification of the PCR
was determined by comparisons to standard biochemical testing.
Results: The biochemical tests showed that 210, 111, 54, 20, 7, 3, 2, 2
and 1 isolates were E. faecium, E. hirae, E. faecalis, E. gallinarum,
E. mundtii, E. raffinosus, E. dispar, E. casseliflavus and E. avium, respectively. Isolates were evaluated and, overall, results for 100% of
E. faecalis, E. faecium, E. hirae, E. casseliflavus, E. mundtii, E. dispar and
E. avium isolates tested by PCR agreed with results obtained using standard biochemical tests; but about E.gallinarum it was 50%. The percent
agreement for PCR was higher than or equal to any other pair wise comparison.
Conclusion: PCR for genus and species determination of enterococci
provides an improved, rapid and specific method for identification of this
group of bacteria in contrast to Biochemical tests.
ISE.297
Concentration of Antioxidants: Vitamin A, E and C in Serum and
Cerebrospinal Fluid of Patients with Aseptic Meningitis
S. Pancewicz1, E. Skrzydlewska2, T. Hermanowska-Szpakowicz1, A.
Stankiewicz2, M. Kondrusik1, J. Zajkowska1, S. Grygorczuk1, K.
Rutkowski1, A. Moniuszko1. 1Department of Infectious Diseases and
Neuroinfections, Medical University, Bialystok, Poland; 2Department of
Analitic Chemistry, Medical University, Bialystok, Poland
Objective: To estimate vitamin A, E and C serum and cerebrospinal fluid
(csf) concentrations.
Methods: Study group consisted of 20 patients with aseptic meningitis
(mean age 41,7 years). Control group consisted of 10 patients (mean
age 40,97) in whom inflammatory condition within central nervous system was excluded. Vitamins A and E serum and cerebrospinal fluid concentrations were measured by RP-HPLC with spectrophotometric
method. Vitamin C was detected by RP-HPLS with spectrophotometric
method. The results were statistically analyzed and p < 0,05 was considered significant.
Results: In serum, concentrations of vitamins A (1,54 mmol/l), E (24,44
mmol/l) and C (60,93 mmol/l) were increased before treatment in comparison with control group (A - 1,32, E - 17,87, C - 55,21 mmol/l). After
treatment they fell significantly (A - 1,44, E - 21,40 i C - 50,07 mmol/l),
however, they remained higher than in control group. In csf vitamin A concentration was significantly lower in study group before treatment than in
control group (0,89 vs 1,17 mmol/l) and increased significantly during
treatment. Vitamin E was present in csf in concentration significantly
higher than in control group before treatment (10,56 mmol/l vs 9,91
mmol/l) and fell to significantly lower level after treatment (9,22 mmol/l).
Csf concentration of vitamin C was significantly increased before treatment (25,56 vs 24,63 mmol/l in control group), and exhibited further significant growth to 29,32 mmol/l after treatment.
Conclusions: We observed dynamic changes in antioxidant levels in
serum and csf in patients with aseptic meningitis. In serum vitamin A, C
and E concentrations were increased both before and after treatment. In
csf initial concentrations of vitamins C and E were increased, while of
vitamin A decreased when compared to healthy controls.
ISE.298
Development and Investigation of New Monoclonal Antibodies to
Avian Influenza Viruses
T.R. Tsareva, E.V. Sorokin, A.A. Sominina. Research Institute of
Influenza, St-Petersburg, Russia
Avian influenza viruses are zoonotic agents recognized as a growing
threat to both veterinary and human public health. During last years infection of humans with avian influenza viruses subtypes H5, H7 and H9 has
been detected on multiple occasions as result of evolution of the viruses
and acquisition of the capacity to infect humans directly without prior
adaptation in mammalian hosts. Influenza H5N1 virus appeared to be the
most pathogenic both for avian and humans and mortality often exceeds
50%. Research set in motion by WHO,s surveillance network, national
authorities and laboratories need in better preparedness to act for early
determination of transmission of the agents in humans.
The goal of our investigation was to develop new panel of monoclonal
antibodies to avian influenza viruses. Apathogenic influenza A(H5N2)
strain was used as immunogen. As result of these investigations two
MAbs directed according to western blot analysis to epitopes of HA1 molecule (HA1 MAbs) and two MAbs to NP determinants (NP MAbs) were
obtained. HA1 MAbs interacted in ELISA test and at immunofluorescent
analysis (IFA) with influenza A(H5N2) virus and were nonreactive with
A(H5N1) virus. NP MAbs were broadly reactive with human, swine and
avian influenza A viruses H1N1, H2N2, H3N2, Hsw1N1, H5N1, H5N2,
H7N3 and H9N2 subtypes both in ELISA and IFA tests.
ISE.299
Ecology and Risks of Hajj Related Arboviral Zoonoses
S. Fagbo. Genomic Medicine Unit, King Fahad Medical Center King
Abdul Aziz University, Jeddah, Saudi Arabia
The Hajj, an annual event where over 2 million Muslims gather for pilgrimage rites in Makkah, Saudi Arabia, provides challenges not only for local
health care providers but for physicians attending to returning pilgrims.
With one of the main rites involving slaughtering of animals, the risk of
zoonotic transmission of infectious agents is further enhanced. Amongst
this group of pathogens, endemic arboviruses, most of which are haemorrhagic and/or neurologic, pose special challenges. This paper examines
the ecology of these arboviruses (Rift Valley fever, Crimean Congo
Haemorrhagic fever and Alkhurma Haemorrhagic fever) vis a vis the Hajj
and the peculiar risks to local and foreign pilgrims, the latter group being
often in the vast majority. Most of these arboviruses have incubation periods that may lead to clinical expression of infection until well after pilgrims'
departures from Saudi Arabia. However, the poorly understood Alkhurma
Haemorrhagic fever gives more challenges as this parameter, amongst
many other factors, is presently unknown. We have recently Alkhurma
Fever Haemorrhagic fever virus (AHFV) in the endemic cryptic soft tick,
Ornithodoros savignyi. There is an overlap of risks with other endemic
zoonotic pathogens (such as Q fever and brucellosis) similar protean clinical manifestations, though with greatly reduced risks of nosocomial transmission and mortality. A better understanding of the interaction of pilgrims
with the ecological factors during Hajj that lead to these infections may
facilitate prompt and better clinical management of these illnesses by
physicians attending to returning local and foreign pilgrims.
ISE.300
Bactec is Useful in Detection of Bacteria from Sterile Body Fluid in
Children
F. Ebrahimi Taj, S. Noorbakhsh, H.R. Mortazavi. Iran University of
Medical Science, Tehran, Iran
The Bactec 9240 system (Becton Dickinson Europe, Meylan, France) is
a fully automated continuous culture monitoring system. In this analytic
cross sctional study; an automated culture system, was compared with
conventional system in hospitalized pediatric aged less than 14y. Each
single normally sterile body fluids drown for culture from hospitalized children was evaluated by both system simultaneously.
Of 143 specimens evaluated, totally 30% of cultures were considered
contamination; 21% yielded positive cultures only by Bactec culture and
were considered to be clinically significant; mean age were higher in positive group (0.01); Positive bactec culture were related to age group (0.04)
but no difference in type of micriorganisms. There was significant difference in type of micriorganisms and vial (0.04) sampling site (0.03) type of
micriorganisms and vial (0.03). Overall, culture in the Bactec system
showed higher sensitivity for the isolatation of microorganisms (P<0.000).
The Bactec system and conventional system were equally effective in
detecting microorganisms in patients reciving antibiotic therapy.
These finding indicate that Bactec system significantly improved both
detection and time to positivity of normally sterile body fluids cultures.
ISE.301
Citomegalovirus and Epstein Barr Virus Infection in Viral Hepatitis
Patients from Maracaibo, Zulia State, Venezuela
L. Costa de León1, F. Castillo de Monsalve1, J. Estevez2, L. Porto3, M.
Araujo3, R. Atencio3, Y.N. Carrero 4. 1Universidad del Zulia.Facultad de
Medicina.Escuela de Bioanálisis.Cátedra de Virología, Maracaibo,
Venezuela; 2Universidad del Zulia.Facultad de Medicina.Instituto de
Investigaciones Clínicas, Maracaibo, Venezuela; 3Universidad del
Zulia.Facultad de Medicina.Escuela de Bioanálisis.Laboratorio Regional
Referencia Virológica, Maracaibo, Venezuela; 4Universidad del
Zulia.Facultad Experimental de Ciencias.Maestria en Biologia mención
Inmunología Básica, Maracaibo, Venezuela
Background: Hepatitis is caused generally by hepatotropic viruses, but
there are few reports about the hepatitis produced by no hepatotropic
viruses such as Citomegalovirus and Epstein Barr virus. This study was
carried out to determine the prevalence of the no-hepatotropic viruses in
the viral hepatitis patients.
Methods: One hundred thirty four patients with symptoms and signs of
hepatical illness were studied. The presences of acute disease blood
markers by hepatotropic and no-hepatotropic viruses were tested.
Results: The hepatotropic viruses were detected in 81 (60.4%) patients,
and in the rest samples, CMV was determined in 13 (9.7%) and EBV in
6 (4.5%), while in 34 (25.4%) samples was not detected the etiologic
agent.
Conclusion: These findings show the CMV and EBV infections have a
low frequency in the viral hepatitis, but these cases are not scarce since
in the small sample of studied patients rose 14.2% of all hepatitis. As
CMV and EBV infections are widely spread in the populations, these
viruses have to be considered in the differential diagnostic of ever hepatitis.
Mycobacterial Infections
ISE.302
A Case of Simultaneous Vertebral and Liver Tuberculosis
S. Lourenço1, N. Germano1, J. Coelho1, P. Mendonça1, C. Loureiro1, A.
Murinello1, H. Peres2, T. Pina2, J. Serra2, C. Teiga3, C. Campos4, N. Diogo5.
1
Hospital de Curry Cabral, Internal Medicine 1 Unit, Lisboa, Portugal;
2
Hospital de Curry Cabral,Bacteriology Unit, Lisboa, Portugal; 3Hospital
de Curry Cabral,Radiology Unit, Lisboa, Portugal; 4Hospital de Curry
Cabral,Pathology Unit, Lisboa, Portugal; 5Hospital de Curry
Cabral,Orthopaedics Unit, Lisboa, Portugal
Objective: To present a case of associated spinal and liver tuberculosis.
Introduction: Spinal tuberculosis, although the commonest bone
tuberculosis, is rarely seen in industrialized countries. The incidence of
clinical hepatic tuberculosis is low and it's association with Pott’s disease
is rare.
Clinical Report: A 64-year-old man native of Cape Vert islands living in
Portugal for 25 years, with a history of secondary diabetes mellitus due
to chronic ethanolism treated with insulin, was admitted because of two
weeks of fever, anorexia, weight loss and, on the day before admission,
lower back pain and paresthesias of the lower right limb. At presentation
he showed weakness of the lower right limb and pain on palpation of the
right lumbar region. Laboratory tests: Hb 12mg/dl, ESR 84 mm/h, TGO
155UI/L (N 14-36), TGP 156UI/L (N 9-52), γGT 577U/L (N12-43),
Alk.phosph. 302U/L (N 38-126) and serology for HIV, HBV, HCV and
Brucella were negative. Spine x-ray: lytic lesion of L4. Spine CT scan:
spondylitis with involvement of the intervertebral disc L3-L4, epidural
extension and right psoas abscess. Aspirative biopsy of abscess allowed
for isolation of Mycobacterium tuberculosis identified by molecular testing. Liver biopsy showed many granulomas consistent with diagnosis of
tuberculosis. He was treated initially with isoniazid, rifampicin, ethambutol and streptomycin, but due to showing primary isoniazid resistance on
susceptibility tests isoniazid and streptomycin were substituted for pyrazinamide and ofloxacin. After 3 months of chemotherapy and surgical
spinal stabilization there was restored mobility of lower right limb and
walking capacity. Hepatic function tests normalized quickly.
Conclusion: Extra-pulmonary tuberculosis is now uncommon in developed countries, specially in non-HIV population, although not unusual in
underdeveloped countries and patients with situations like diabetes.
Our patient had spinal and liver infection, an association rarely
described. Treatment allowed for recovery of neurological damage and
liver disease.
ISE.303
An Exceedingly Rare Infectious Complication of Repeated
Orthotopic Liver Transplantation (OLT): Tubercular Peritonitis
R. Manfredi. Infectious Diseases, University of Bologna, Bologna, Italy
Introduction: Myc. tuberculosis infection is a very infrequent complication in patients (p) undergoing solid organ transplantation (1-2% of p with
OLT), and usually involves lungs (~50% of p), followed by disseminated
disease (~30%), while extrapulmonary disease is exceedingly rare. A
tubercular peritonitis follows a multivisceral disease, or a primary gastrointestinal localization, and is burdened by a ~80% mortality. The aspecific picture of abdominal pain, fever, and ascites, should be differentiated by focal complications and a spontaneous bacterial peritonitis.
Case Report: A p with a concurrent kidney insufficiency underwent OLT
due to a HCV-related liver cirrhosis, in absence of personal/familial risk
factors for tuberculosis. A novel OLT became necessary 4 years later
because of liver failure due to a relapsing HCV infection,despite combined interferon-ribavirin treatment. Upon admission, relevant abdominal
pain, asthenia, abundant ascites formation, and diffuse edema became
apparent,a nd M. tuberculosis (susceptible to isoniazid, ethambutol,
rifampicin, streptomycin, and cycloserine, was detected from ascetic
fluid). Chest X-ray proved negative for present and older tubercular
lesions. The laboratory examination showed leukopenia and lymphocytosis, associated with a moderate alteration of ESR and C-reactive protein,
while predominant lymphocytosis was the marker of ascetic fluid.
Repeated stools and urine cultures tested negative (for M. tuberculosis
too). An abdominal ultrasonography showed an hepatosplenomegaly
without focal lesions. While continuing the cyclosporine immunosuppressive treatment, our patient underwent a combined chemotherapy including isoniazid, ethambutol, streptomycin and levofloxacin, the last one
changed with cycloserine after 5 weeks. Upon discharge, the M. tuberculosis search on su ascetic fluid (conducted by culture and biomolecular
assays), tested negative. Two months later ethambutol was withdrawn
due to an initial, suspected optical neuritis. A 12-month antitubercular
therapy led to a compleye clinical and bacteriological resolution, without
relevant toxicity.
Discussion: The standardized anti-tubercular chemotherapy showed
favorable efficacy and safety characteristics also in a very critical and
unexpected underlying condition, due to the ongoing recurrence of HCV
infection, and the cumbersome problems of a p who received two subsequent OLT, and the related, continued immunosuppression.To ensure an
early diagnosis,culture examinations of ascitic fluid extended to
mycobacteria is needed, by maintaining an elevated suspicion also for
this infrequent OLT complication.
ISE.304
Decompensated Liver Cirrhosis Complicated by a Severe
Mycobacterium Avium-complex Lung Localization. Intolerance to
Multiple Attempts of Anti-mycobacterial Chenmotherapy, Followed
by Spontaneous Long-term Resolution
Background: Based on the broad specrum of anatomic-functional
abnormalities of the enteric tract and portal system, the eventual ascites
formation, and the underlying immunodeficiency including leuko-neutropenia, an altered cytokine network, antibody response and opsonization mechanisms, a decompensated liver cirrhosis is a risk factor for
infectious complications, usually bacterial in origin,and intrabdominal in
location. Animal models also demonstrated an increased susceptibility
just to atypical mycobacteriosis, due to macrophage dysfunctions,p
rompted by a dysregulated IL-12 release.
Case report: We report an exceptional episode of severe and estensive
pulmonary Mycobacterium avium-complex disease repeatedly confirmed
by cultures, which involved a patient (p) with decompensated cirrhosis,
and evolved into spontaneous clinical-bacteriological cure after 18
months, notwithstanding the impossibility to perform an effective
chemotherapy, due to repeated p's intolerance to multiple therapeutic
attempts. A chest HRCT examination showed numerous micro- and
macronodular lung lesions (0.2-8 mm diameter), confirmed by a scintigraphy performed with marked leukocytes, while repeated cultures of M.
avium-complex from bronchoalveolar lavage (BAL) fluid allowed to study
in vitro sensitivity. Such an episode extraordinary evolved towards a very
slow spontaneous cure,as documented by negativization of repeated
BAL, cultures, HRCT,s cintigraphy, until a further 2-year follow-up.
Discussion: Only two episodes were described as possible cases of
spontaneous resolution of a Myc. terrae respiratory infection: both p had
an advanced liver disease, but received specific antimicrobial therapy for
appreciable periods (Peters EJ, Chest 1991; 100:1449-50; Spence TH,
South Med J 1996; 89:414-6). Although liver cirrhosis may be frequently
complicated by peritoneal bacterial infection, atypical mycobacteriosis
proves extremely rare, so that the reported case represents the first
described episode of a severe M. avium-complex in this setting. In p with
multiple micro- and macronodular pulmonary infiltrates an atypical
mycobacteriosis should be excluded, even though this infection remains
rare in otherwise healthy p, and during advanced liver disease.Clinical
diagnosis and monitoring are based on invasive examinations
(BAL),sophisticated imaging techniques (HRCT),and morphofunctional
techniques (scintigraphy). When excluding very infrequent episodes like
ours,a 3-4-drug combination chemotherapy with clarithromycinazithromycin, plus ethambutol, amikacin, rifabutin, quinolones,a nd clofazimine, is indicated. Taking into account of the reduced available therapeutic options, the limited reliability of in vitro antitubercular drug assays,
and the poor relationship with the in vivo therapeutic response, this
pathologic association may expose to multiple traps on diagnostic and
therapeutic sides of management.
ISE.305
Acute Reactivation of A Severe Pulmonary Tuberculosis During
Associated Interferon Pegylate-ribavirin Treatment Carried Out for A
Known Chronic Hepatitis C
Background: Tuberculosis (T) may be reactivated also after many years
through a primary silent and unknown T infection, when immunodeficiency (often jatrogenic in origin), or other risk factors (eg cancer,cachexia),
become apparent. Post-primary T episodes were described also decades
after a primary Myc. tuberculosis infection, in patients (p) who show
apparently limited radiograophic signs at chest X-ray. Some grade of
immunodeficiency may also depend on the administration of associated
IFN-ribavirin for an underlying chronic HCV hepatitis, as expressed by the
frequent emerging of leuko-neutropenia, and altered cytokine network.
Case Report:In a p aged >50 years with negative history of T, an occasional chest X-ray showed fibrous-calcified infiltrates at upper right lobe.
After 11 years, due to a progressive chronic HCV hepatitis, pegylated
IFN plus ribavirin were started with good tolerability for 7 months,until a
sudden occurrence of cough and hemoptisis associated with a pulmonary lesion highly suggestive of T became apparent,in the same area
where some reliquates of a primary T were demonstrated 11 years
before. A HRCT examination pointed out 2 different excavated infiltrates.
Both direct microscropy and culture of sputum-BAL proved positive for
Myc.tuberculosis (susceptible to all tested compounds), while a positive
of Mantoux reaction also became evident. An absolute lymnphopenia
(nadir 966 cells/µL), prompted a T-cell subset study, which showed an
imbalance of the CD4/CD8 ratio (30/45%), and an absolute CD4+ count
of 290 cells/µL. Notwithstanding 5 consecutive weeks of isoniazide,
ethambutol, rifampicin and pyrazinamide administration, sputum examination remained positive, thus confirming the role of immunodeficiency is
prompting a difficult-to-treat T.
Discussion: Waiting for human experimental data, 2 animal models
demontrated that an increased release of immunosuppressive cytokines
(IL-10-TGF-β), may prompt a T reactivation, while a maintained T-cell
competence enhances the T latency. From a clinical point of view,
although a few cases of non-infectious lung involvement, interstitial pneumonia, and bronchiolitis obliterans were described during IFN therapy
administered to transplant p, no episodes of reactivated T were reported.
Although our disease association seems unique, the expected increase
of therapeutic use of IFN and potent agents for the management of
chronic hepatitis or other diseases, might support the reactivation of
latent T. A careful medical history, Mantoux reaction, and a chest X-ray,
are mandatory before starting IFN therapy. In fact, the jatrogenic
immunosuppression related to IFN-ribavirin may go beyond the expected leuko-lymphopenia, and also act against the quantitative and functional role of CD4 lymphocytes. This last circumstance may play a key role in
the T reactivation, when a latency is present.
ISE.306
Life-threatening Mediastinal Localization of Tuberculosis with
Bronchial and Thoracic Aortic Compression and Long-term
Esophageal Fistulization, in a Patient with Negative History and
Pulmonary Signs and Symptoms of Tuberculosis
Background: Tuberculosis (TB) is increasing significantly in its frequency, especially among immigrants, where non-pulmonary localization are
of diagnostic-therapeutic concern.
Case Report: A 30-year-old male recently immigrated from Bangladesh,
was hospitalized in an Internal Medicine Dept with a mute TB history, due
to a worsening dysphagia and severe weight loss: a malignancy was initially suspected. Laboratory testing showed an isolated ESR increase, in
absence of positive tumoral markers. A routine chest X-ray proved normal, but an esophagoscopy showed an extrinsic visceral compression.
Later, an ultrasonographic-endoscopic study and repeated thorax CTs
disclosed a mediastinal mass with a colliquative centre of ~3 cm diameter which ulcerated the esophageal lumen, compressed the left
bronchus, leaning on the thorax aortic tract. Multiple sparse lymphnodes
undergoing colliquation completed the mediastinal involvement, while a
contrast-enhanced esophagogram showed an extensive fistulization
between the esophagus and the necrotic, colliquated mediastinal
abscess. After negative sputum examinations, the culture diagnosis of TB
was obtained by a transbronchial bronchoscopy, while skin TB test
proved intensely positive. A well-tolerated 4-drug classical anti-TB therapy was performed for 3 months, followed by a 3-drug combination still
ongoing since 3 more months, together with proton pump inhibitors to
contain dysphagia. At the last chest CT scan and esophagogram, the
mediastinal lesion and the reactive lymphnodes were significantly
reduced in size, calcific lesions substituted colliquative areas, while a
narrow esophageal fistulization was still present.
Discussion: Our rare case of mediastinal TB abscess with extensive
esophageal fistulization, treated favourably with conservative medical
therapy, reminds that TB mimicks multiple pathologic conditions, with
diagnosis and treatment often reached despite the absence of both Tcompatible history and pulmonary lesions. The differential diagnosis of
TB lesions involves a broad spectrum of diseases, and TB should be
never neglected, even when an evident history and lung involvement are
absent. The recent, explosive rise of TB among immigrants in Italy, is a
serious epidemiologic and social health concern when summarized with
the increased life expectancy and the greater risk of immunosuppressive
conditions in the general population. A strict monitoring of TB is strongly
needed, to plan adequate diagnostic-preventive measures, and allocate
the needed resources.
ISE.307
Extrapulmonary Tuberculosis Found at Two Different Localization at
the Patient with Fever of Unknown Origin
K.K. Yasar, F. Yildirim, G. Sengoz, S.B. Kutlu, O. Nazlican. Haseki
Background: Extrapulmonary tuberculosis is the most common infectious reason for the fever of unknown origin (NBA) in Turkey.
Case: 60 years old diabetic woman who complained for high fever, nodules on the neck, lack of appetite and weight loss applied to our clinic. In
the history, she reported that for 2 months she had a fever after shivering, which lasted 3 to 4 hours and dropped at night after sweating. The
patient realized that she had nodules on both sides of the neck without
pain for 1 month, and in the last 6 months, she had lost 3 to 4 kg. In this
period, the patient was subjected to non-specific antibiotic treatment,
which failed to solve problems. In her physical examination, there was a
multiple palpation in the right and left submandibular regions and post
cervical region, accompanied by painless, hard and mobile lymphadenopathies. The erythrocyte sedimentation rate was 120 mm/h, a
sterile pyuria was found. Non-invasive methods could not yield a diagnosis. Then, excisional biopsy was taken from the left submandibular lymphadenopathy (LAP). The histopathological examination was found compliant with tuberculosis and the patient was administered isoniazid,
rifampin, ethambutol, pyrazinamide. The urine sample taken from the
patient as well as the LAP biopsy samples were inoculated in the
Löwenstein Jensen medium. The isolated acid resistant bacteria was
identified as M. tuberculosis.
Conclusion: Tuberculosis incidence in Turkey is at medium level.
Particularly, the extrapulmonary tuberculosis is frequently observed in
the patients who complained for NBA. This case was particularly interesting with the finding of tuberculosis at two different localizations in an old
age patient accompanied by diabetes.
ISE.308
A Case Report of Valvular Tuberculous Endocarditis
H. Emadi, A.R. Soud Bakhsh, L. Tadayyon, S. Strobl. Tehran University of
Medical Sciences, Tehran, Iran
Tuberculous valvular endocarditis is rare and when observed It is usually manifest in the context of miliary tuberculosis, and usually diagnosed
at autopsy.
This report describes a case of disseminated tuberculosis with Tricuspid
valvulitis and small vegetation (5˙2 mm) in the tricuspid valve that
resolved on antituberculous therapy. In the follow up period of 12 months,
in the echocardiography which was accomplished, there were no vegetations observed and he remained free of recurrence.
In conclusion, to our knowledge this is a rare case report of disseminated tuberclusis with endocarditis
ISE.309
Glutathione Metabolism as a Measure of Oxidant Stress in Leprosy
Patients Undergoing Dapsone Therapy
S. Girish1, P. Bulakh2, R. Melinkery1. 1BMJ, Medical college, Pune, India;
2
Bharati Vidyapeeth,Pune, Pune, India
Background: Dapsone is the drug of choice for the treatment of leprosy
patients. The ability of dapsone to remove potent oxygen intermediates
as well as inducing inhibition of the myeloperoxidase -hydrogen peroxide
halide system is reported to be accompanied by the accumulation of
superoxide radical(02 -). Reports of side effects of dapsone treatment
such as hemolysis, a fall in hemoglobin levels prompted us to study lipid
peroxidation and glutathione metabolism in erythrocytes of leprosy
patients.
Methods: The susceptibility to lipid peroxidation of erythrocytes, when
stressed by an oxidant substance such as dapsone in leprosy was studied by estimating erythrocyticmalondialdehyde levels and antioxidant
enzymes like superoxide dismutase and catalase. The glutathione
metabolism was studied by measuring erythrocytic glutathione concentration and enzyme activities of glutathione peroxidase and reductase in
all types of leprosy patients.
Results: The significantly elevated lipid peroxide levels and diminished
activities of antioxidant enzymes like superoxide dismutase, catalase,
Glutathione peroxidase and Glutathione reductase demonstrated.
Conclusion: Increased erythrocytic susceptibility to dapsone induced
hemolysis due to lower glutathione stability as compared to normal
subjects.
ISE.310
Extrapulmonary Manifestation of Tuberculosis
J. Maglajlic1, Z. Dizdarevic1, E. Beslagic2, J. Mornjakovic1. 1Clinic for
Pulmonary Diseases and TB, Sarajevo, Bosnia and Herzegovina;
2
University of Sarajevo, Faculty of Medicine, Sarajevo, Bosnia and
Herzegovina
Aim: All kinds of tuberculosis, which are located outside lung tissue are
defined as an extrapulmonary tuberculosis (EPTB). Most common manifestations are linked to pleura and lymph nodes, but very often there are
new locations occurings (skin, genitourinary tract, gastrointestinal tract).
Relation between pulmonary (PTB) and extrapulmonary (EPTB) tuberculosis in Federation of Bosnia and Herzegovina in year 2003 was
88%:12%, and in 2004 92%:8%.
Material and Methods: Diagnostics of EPTB is a clinical problem. Very
often, from first symptoms of disease until diagnosing and starting the therapy, passed several months. Reason probably lays in the fact that clinicians
often do not think to tuberculosis that is located outside lungs and do not
apply adequate diagnostical procedures. In mycobacteriological laboratory
of Clinic for pulmonary diseases and TB Sarajevo, we used punctions, urin,
liquor, biopsy material menstrual blood and feces. In bacteriology diagnostics we used Ziehl-Mielsen method, cultivation on solid and liquid media,
biochemical tests, and sensitivity tests on antituberculotics. Most of bacteriological diagnosis were confirmed with PH diagnosis.
Results: In this work we are going to show results of our laboratory in
diagnosing EPTB in 2003 and 2004. In 2003, we diagnosed 18 cases of
EPTB, (8 pleural, 3 urinary, 3 bone, 2 gastrointestinal, 1 liquor and 1 skin
TB). In 2004, we bacteriologicaly diagnosed 25 cases of EPTB (7 pleural, 6 urinary, 4 lymph node, 2 bone, 3 liquor and one genital, skin and
gastrointestinal TB). Results will be presented by sex and age of the
patient. We will also show relation of bacteriologicaly diagnosed PTB and
EPTB in our laboratory.
Conclusion: The goal of our work is to show that there is significant possibility that the tuberculosis could be located on different organs, and that
clinicians should think more in that way, and send more samples to laboratories for mycobacteriology diagnostics. That will give is exact diagnosis
on time, as well as start the therapy and avoid eventual complications.
ISE.311
Tuberculous Pleuritis
M.J. Esquillor, M.C. Gonzalvo, R. Caballero, I. Sanjoaquín, J. Cuesta,
M.J. Crusells, S. Letona, J.A. Amiguet, P. Cia. HCU Lozano Blesa,
Zaragoza, Spain
Introduction: There is a resurgence in the rate of tuberculosis. Disease
patterns have changed, with a higher incidence of disseminated and
extrapulmonary disease. Extrapulmonary forms of tuberculous infection
include lymph nodes, pleura, and osteoarticular areas, although any
organ can be involved. OBJECTIVE:To describe an inusual case report
of a young healthy female diagnosed of tuberculous pleuritis.
Material and Methods: Case report: 25-year-old female visited the outpatient clinic of our hospital refering fever > 38ºC and cough. In chest
radiography and thoracoabdominal computerized axial tomography we
objetived right hydrothorax. The pleural effusion obtained by thoracocentesis was negative for bacilloscopy and mycobacterium tuberculosis culture. We practised a galium gammagraphy that demonstrated diffuse
right infectious pleuritis. Another serologies and cultures obtained were
negative. Antitubercular therapy was started under suspicion of tuberculous pleuritis.
Results: Necrotic tissues were obtained by pleural biopsy.
Histopathologically, these lesions were were considered to be granulomatous lesions.The pleural effusion obtained was positive for
Mycobacterium tuberculosis complex DNA. The patient was diagnosticated of tuberculous pleuritis, and was treated with antitubercular drugs in
combination (pirazinamide, rifampicin and isoniazid). Her clinical signs
disappeared.
Conclusions: The diagnosis of extrapulmonary tuberculosis can be very
difficult, necessitating a high index of suspicion. A negative smear for
acid-fast bacillus, a lack of granulomas on histopathology, and failure to
culture Mycobacterium tuberculosis do not exclude the diagnosis. In certain forms of extrapulmonary tuberculosis new diagnostic modalities
such as adenosine deaminase levels and polymerase chain reaction can
be useful. In general, the same antitubercular drugs combinations are
used to treat pulmonary and extrapulmonary tuberculosis, and responses to antituberculous therapy are similar.
ISE.312
Resolution of MDR Disseminated Tuberculosis (including CNS
Tuberculosis) in an AIDS Patient with Advanced Immunodeficiency
in Rio De Janeiro
T.R.C. Vergara1, B. Scarpellini1, M. Dalcolmo2. 1Oncohiv, Rio de Janeiro,
Brazil; 2Centro de Referência Hélio Fraga, Rio de Janeiro, Brazil
Background: Disseminated tuberculosis (TB) is more frequent among
AIDS patients. Resistance to treatment (MDR) is correlated with worse
treatment prognosis.
Objective: Case report of a case of MDR disseminated TB and AIDS with
good treatment response.
Case: 26 years old, male, presenting on october 2002 with esophageal
candidiasis and pneumonia, HIV+, non-reagent PPD, and baseline CD4
count of 10 cells/mL and CD8 309 cells/mL; HIV PCR 687,000 copies/mL
(5,8log). Despite some respiratory symptons improvement with antibiotics, he still presented malaise, wasting, headache, fever, and abdominal pain. After 1 month he was submitted to an intra-abdominal abscess
drainage. The peritoneal fluid stain revealed AFB positive. The culture
demonstrated M. tuberculosis. HAART was initiated, as well as
Rifampin+Isoniazid+Pyrazinamide. After 20 days, he still presented
malaise, headaches, and liver swelling. TB treatment was changed to
Rifampin+Isoniazid and Ethambutol. After 1 month, he did not present
fever anymore but had persistent headache. The CSF demonstrated
moderate pleocytosis, neutrophilic predominance, the protein was 84,
glucose 42, AFB stain was negative, negative M. tuberculosis PCR. On
February he was still complaining of headache but meningeal signs were
absent. A MRI showed leptomeningitis and Circle of Willis artheritis, suggesting TB. Steroids were initiated. After one month, he presented weight
gain and and reduction of headache episodes. On April, ethambutol was
discontinued and culture results of January 2003 CSF sample came positive to M. tuberculosis. The antibiotic sensitivity test showed resistance
to rifampin, isoniazid, pyrazinamide, ethambutol, and cycloserine.
Despite this result, he continued the same TB treatment. On July 2003
the neurological symptoms worsened. A new CSF sample showed CNS
TB activity. A more potent and bactericidal regimen with rifampin, pyrazinamide, ethambutol, and streptomycin was initiated. MRI showed
increased meningeal thickening with nodular enhancement areas; toxoplasmosis treatment was then associated. He developed hepatotoxicity.
For this reason, the treatment was changed to a less hepatotoxic (streptomycin, ofloxacin, terizidone, and ethambutol. On June 2004, a peritoneal-ventricular shunt was performed as he developed hydrocephalus.
Results: Resolution after 15 months treatment for disseminated MDR
tuberculosis.
Conclusion: Culture identification of M. tuberculosis and sensitivity tests
made possible the institution of appropriate therapy and were fundamental factors to the patient outcome.
ISE.313
Tuberculosis Treatment Profile: Short Course Chemotherapy - Dots
to Dots Plus - Essence, Impact and Hindrances to Cure in developing Countries, Tanzania
F. Munema. Muhimbili Medical Centre, Dar es Salaam, Tanzania
Background: Objectives are to highlight on the importance, essence
and impact of adequately proper training on the outcomes of TB treatment and vindicatively identify the hindrances to the short course
chemotherapy DOTS and DOTS-Plus strategies to cure TB in developing
countries.
Methods: Reviewed contemporary, available literature by IUATLD, MOH
and WHO; conducted very keen personal observations during clinical
practice, environment aspects of life style and community hygiene.
Prospectively made comparatively assessment of treatment practice of
the personnel. Enthusiastic and knowledgeable providing perfunctorious
service and less knowledgeable rendering perfunctory service are noted.
Reached indicatively tangible conclusions.
Results/Findings: The Government of Tanzania in 1977 launched a
‘World Model Programme’ to treat TB and Leprosy. Standard treatment,
elaborated was countrywide given. Short course chemotherapy regimens
were implemented since 1984. Cure rates improved from 34% to 79% in
1989. Detection rates remained steady from 11,000 to 66,000 in 2001. In
1979/80 DOTS was not only mooted but born in Tanzania implemented,
launched in 1980s, DOTS-Plus when the AIDS pandemic had set in.
1993, April, WHO declared Tuberculosis a global Emergency Disease
NTLP in Tanzania still a model, well managed, properly run services, but
was deficient of highly qualified personnel to replace those pending
retirement, contemporary advanced modern knowledge and diagnostic
facilities. Advent of AIDS in. 1983, the emerging drug resistance and multidrug resistance TB globally made the situation deteriorate drastically.
Tanzania was among the twenty-two countries listed as overburdened by
tuberculosis in the World, in 1996. The situation has been gradually
improving, after the implementation of the health sector reforms.
Hindrances identified, elicited, tackled. Detection and cure rates for 2004
are below WHO standard/targets.
Conclusion: The NTL Programme in Tanzania is in the network of
IUATLD and partnership of WHO to eradicate TB globally. It has an uphill
task to regain lost glory.
ISE.314
Tuberculosis
A.T. Beheeh. Community Medicine Department, Tripoli, Libya
Tuberculosis (TB) is an infectious disease caused by the bacterium,
Mycobacterium tuberculosis. TB can affect any organ of the body, but
most commonly attacks the lungs (pulmonary TB).
TB is spread through the air by droplets produced by a person suffering
from pulmonary TB by coughing, sneezing or speaking. Patients who produce sputum in which the bacteria can be seen with a light microscope
are the most infectious and are called smear-positive.
It is estimated that after infection, only 10% of infected healthy individuals will develop active TB disease throughout their lifetime, the majority
within the first two years after infection. However, co-existing infection
with the human immunodeficiency virus (HIV) significantly increases the
chance of a person developing active TB.
The risk of infection, and the development of subsequent disease,
depend on factors associated with the bacteria (viability, transmissibility,
virulence, the size of infecting dose), the host (strength of immune system, genetic susceptibility, length and intensity of exposure, previous
exposure) and the host-bacteria interaction (site of involvement, severity
of disease).
In general, people who have been infected with Mycobacterium tuberculosis are thought to be less susceptible to subsequent infections,
although re-infection can occur and result in disease.
ISE.315
High Report of Tuberculosis Among Brick Workers Could Be an
Occupational Risk Factor?
F. Eslami1, M. Avijgan2, F. Farid1. 1Isfahan University of Medical Sciences,
ISfahan, Iran; 2Shahr-e-kord University of Medical Sciences, Shahr-ekord, Iran
Aim:At present and after HIV epidemic, TB is the second infectious disease in the world. Somebody is high risk for TB involvement and they
could be involved under some occupational factors. One of them is Brick
workers who are exposed for some occupational and environmental factors which are irritant for lung. The main purpose of this study is passive
case finding and report of incidence and prevalence of TB among Brick
workers of Isfahan Province, Iran.
Materials and Method: By considering of data of centre of health
department of Isfahan (2000-2005) and also data of TB for Brick workers
of Isfahan, their demographics characteristic have been recorded.
Results: On The base of results of this study, the brick workers are situated in 3 areas of Isfahan. In these areas the report of incidence of TB
among Brick workers are as follow: Isfahan (16.2%, 33.9%), Aran-Bidgol
(9.1% -20%) and Borkhar-Meymeh (14.7% -44.4%).
Conclusion: By considering of these results, Borkhar-Meymeh and
Aran-Bidgol are reported to have highest (44.4%) and lowest (9.1%) of
TB report.
It seems this finding have a direct relation with number of brickers and
number of non residential workers (Afghanis) in these areas. On the base
of these reports and also the probable relation of TB incidence and occupational factor, it suggests having a more observation and following up
for these workers.
Mycoses
ISE.316
Epidemiology of Fungal Infections in a General Hospital of Caracas,
Venezuela
Meijomil1, I. Jimenez1. 1West General Hospital, Caracas, Venezuela;
2
Background: Fungal infections are emergent diseases in hospital institutions. Increase on immunosuppressive diseases and conditions have
been influencing the epidemiological pattern of mycoses in hospitalized
patients. For these reasons we studied the epidemiology of fungal infections in a general hospital of Caracas, Venezuela, in a ten-year period,
between 1992 and 2003.
Methods: All clinical samples were processed at the microbiology culture, with special stains and conventional cultures, then identifying the
organisms by morphology and with automated systems.
Results: In this period, 893 patients with fungal infections were evaluated, 56.7% female and 43.3% female. Mean age was 39.7±24.9 y-old,
11.5% belong to the group <10 y-old. Most common clinical mycotic
infection was urinary tract infection (34.2%) followed by vascular
catheter-related infection (11.4%), vaginal infections (10.8%), lower respiratory tract infections (10.8%), fungemia (7.6%), among others. In
these patients were identified 17 species of fungi, for a total of 1002
strains: Candida albicans (47.3%), Candida sp. (45.0%), Torulopsis
glabrata (2.0%), C. parapsilosis (1.1%), T. candida (1.1%), C. tropicalis
(1.0%), C. intermedia (0.6%), Cryptococcus neoformans (0.6%),
Aspergillus sp. (0.4%), C. guillermondii (0.2%), C. catenulata (0.1%), C.
krusei (0.1%), C. lusitaniae (0.1%), Mucor sp. (0.1%), Sporothrix
schenckii (0.1%), Trichophyton mentagrophytes (0.1%), Trichosporon sp.
(0.1%).
Conclusions: The presence of Candida species in the urine is frequent
among hospitalized patients. It represents a major challenge to the physician because it is unclear whether candiduria represents colonization or
infection, whether the bladder or the kidney is involved in infection, or
whether it represents a surrogate marker for systemic infection. This picture is more complicated because there are few prospective studies
addressing the issue of when and how to treat a patient with candiduria,
possibly with fluconazole as the drug of choice, provided the agent is not
a resistant species.
ISE.317
Primary Laryngeal Paracoccidioidomycosis: A Case Report
I. Garcia1, S. Diaz1, S. Dickson1, R. Barbella1, A.J. Rodriguez-Morales2,
M. Ravelo3, E. Pichelbauer1, A. Hernandez1. 1Instituto Anatomopatológico
José A. O'Daly, UCV, Caracas, Venezuela; 2Instituto Experimental Jose
Witremundo Torrealba, Universidad de Los Andes, Trujillo, Venezuela;
3
Collaborative Group of Clinical Infectious Diseases Research, Caracas,
Venezuela
Background: Paracoccidioidomycosis (PCM) is a chronic granulomatous disease caused by the dimorphic fungus Paracoccidioides brasiliensis which characteristically produces a primary pulmonary infection, but
extra-pulmonary primary disease is uncommonly reported. For these
reasons we describe a case of a primary laryngeal PCM that was firstly
diagnosed as a laryngeal carcinoma; in which, a subsequent examination of biopsy specimens proved that the disease was a chronic laryngitis due to P. brasiliensis.
Case Report: A 41-year-old male was evaluated at the Hospital
Universitario de Caracas with a history of several months presenting a
progressive dysphonia. Previous history was unremarkable. His pul-
monary clinical and radiographical evaluations showed no alterations.
Laryngoscopic examination showed a diffuse infiltration and a severe
inflammation of the laryngeal surface of the left aryepiglottic fold (in its
two posterior thirds), being clinically diagnosed as a laryngeal carcinoma
of the left fold. Tissue samples were taken via direct laryngoscopy under
general anaesthesia and sent to our Pathology Institute for its histopathological evaluation. Those samples consisted of 7 irregular fragments; size
of the larger of them was 4x3x1mm. These tissues were of white colour
with lightly brown areas and of soft consistence. At microscopical examinations those tissues showed a marked chronic granulomatous inflammation. Tissue slide staining with ZN showed no organisms, but with
Grocott showed a significant number of yeast cells of different sizes, oval
to elongated with multiple budding cells, with the characteristic form: the
pilot's-wheel appearance giving the histological diagnosis of
Paracoccidioides brasiliensis infection of the larynx.
Conclusion: Differential diagnosis of PCM includes carcinoma, tuberculosis, lupus erythematosus, North American blastomycosis, histoplasmosis, coccidioidomycosis, sarcoidosis, syphilis, Wegener's granulomatosis, granuloma inguinale, actinomycosis, leishmaniasis and other granulomatous disorders. As is reported in the literature, differentiation
between laryngeal carcinoma and PCM may be difficult, and even cases
of paracoccidioidomycosis associated with carcinoma in the larynx have
been reported. Despite the observation of cases that mimic cancer, PCM
should be suspected in individuals who have had previous contact with
endemic areas. This case shows the importance of taking into account
the diagnosis of PCM in all patients with problems in the larynx, especially those who inhabit or inhabited endemic areas for P. brasiliensis.
ISE.318
Mycoflora of Peanut Seeds in Zanjans Market - Iran 2004
H. Badali, A.A. Nourian, A. Haniloo, M. Khodaverdi, S. Mohseni, R.
Rostami. Department of Parasitology and Mycology, Faculty of medicine,
zanjan University of medical sciences., Zanjan, Iran
Background: Undoubtedly, one of the most important health issues is
food hygiene. Research has shown that food products such as corn,
wheat and peanut have high potential for contamination with fungi in
case of suitable environmental conditions like temperature and humidity.
Regarding toxins, Aspergillus flavus and Aspergillus parasiticus are highly important that they can produce aflatoxin.
Methods: In this survey, 20 samples of 50gr salted peanuts and 16 samples of 50gr unsalted peanuts were collected from Zanjan market randomly. Environmental conditions such as light intensity, temperature and
air current were measured on the spot, then the samples were transferred to the laboratory and humidity was also measured. In the laboratory, 5 peanuts were selected randomly from each 50gr sample, cultured
on media culture (Sabouraud Dextrose Agar plus Chloramphenicol) and
were conserved at 27-30°C for a week. The samples were examined for
fungal colony and in case of growth, were diagnosed using slide culture
technique.
Results: Mold fungi were dominant among the colonies with following
percentages Aspergillus flavus. 39.1%, Penicillium. 9.2%, Rhizopus
7.2%, Mucor. 2.5%, Alternaria. 1.03% and Nigrospora 0.5%. Furthermore, Aspergillus flavus was more frequent in unsalted peanuts than in
salted samples. On the contrary in salted samples Aspergillus niger was
more frequent than in unsalted samples. In this study, temperature and
sample humidity were over standard range. The results indicated a significant relation between environmental humidity, light intensity, temperature and peanut type with level of fungal contamination.
Conclusion: According to above findings the most frequent fungal contamination belonged to mold fungus Aspergillus flavus. This fungus can
cause aflatoxin under certain conditions. With regard to the fact that higher percent of Aspergillus flavus pertained to unsalted peanuts, we can
conclude that the risk of unsalted peanut contamination with aflatoxin is
higher than that of salted peanuts. Moreover, humidity rate of unsalted
peanuts is more than standard level approximately 6.81%. As a result, we
can suppose that there is a relationship between the fungi growth in salted peanut and amount of humidity. On the other hand, there is inverse
relationship between light intensity and fungi. Overall, if government has
a management on store and distribution, contaminated fungi will control.
ISE.319
Effect of Cyclophosphamide on the Course OfCandida albicans in
Normal and Vaccinated Mice
A. Japoni1, D. Mehrabani2, A. Alborzi1, S.H. Farshad1, M.A. Dehyadegari1.
1
Iran;
Shiraz,
Clinical
Microbiology
Research
Center,
2
Gastroentrohepathology Research Center, Shiraz, Iran
Background: To evaluate the immunomadulating effect of cyclophosphamide (Cy) on the course ofCandida albicans
Methods: Five groups of 10 mice (vaccinated group) was respectively
immunized by 5 equal injections of 2x105, 2.5x105 and 3x105 of the organism intraperitonealy. Then, the group received Cy on day zero and was
challenged with lethal doses of C. albicans (7.74x105 CFU) on days zero,
1, 3, 6 and 12 post-Cy injection, respectively. Another 5 equal groups of
10 mice (non-vaccinated group) received Cy on day zero and similar to
vaccinated ones were challenged with lethal doses of the organism too.
The control groups received just Cy on day zero and were sacrificed on
days zero, 1, 3, 6 and 12 days post-Cy injection. Hemogram were performed and the spleen and renal tissues were studied microscopically
and macroscopically.
Results: In vaccinated group, an increase in survival time and in spleen
and renal weights were visible while in non-vaccinated ones, a significant
decrease was observed on days 1 and 3 and increased on days 6 and
12 post-Cy injection. In these two groups, atrophy and necrosis were
seen in the spleen while inflammation and necrosis were also observed
in the kidneys on days 1 and 3. On days 6 and 12 post-Cy injection, a significant hyperplasia in the white pulp was noticed.
Conclusion: We conclude that hyperplasia in the white pulp of spleen
and the increase in peripheral polymorphonuclears due to selective
effects Cy could effectively protect the animal against C. albicans infection.
ISE.320
Catheter-Related Candidemia
V. Dokoska, D. Dokoski, S. Mena. Institute of Nephrology, Struga, Former
Yugoslav Republic of Macedonia
Background: Several kinds of Candida species may initiate different
opportunistic diseases, especially to immunity-deficient patients.
Candidemia means presence of this funga in the blood. The intravascular catheters are the most important and most common source of
Candida. Our aim is to present a case with Candidemia and favor the
blood-culture as a diagnostic procedure for discovering the etiology of
high-temperature and fever states.
Methods: A 37-year old patient (A.T.) is presented as a case with CRF
(Chronic Renal Failure), who was under treatment of chemo-dialyses for
17 years. Three years ago, a tunnelised jugular catheter was applied as
a vascular access. Because of the high temperature, a blood-culture was
processed and Hemoline-Biomerieux containers were used. After the
proper incubation, grown colonies were identified as Candida spp. A wide
range of examinations were made in order to find inner sources, but none
was positive. The whole procedure was repeated after one week.
Because of the patient's condition and the lack of other methods for
chemo-dialyses, we started with a conservative therapy (Flukonazol).
Results: During the treatment some improvements were achieved, but
not a complete remission i.e. the blood-culture was positive again.
Conclusion: IV catheter-related Candidemia should not be treated with
the conservative treatment as the results are not successful. Therefore,
the removal of the catheter was inevitable.
ISE.321
Changes in Epidemiology of Dermatophitosis in Bosnia and
Herzegovina
A. Prohic, F. Alendar. Department of Dermatology, University Clinical
center, Sarajevo, Bosnia and Herzegovina
The spectrum of agents of dermatophytosis varies throughout the world
and is constantly changing under the influence of various factors. This
change is remarkable especially in the case of zoophilic dermatophytes.
Dermatophytes flora in Bosnia and Herzegovina in period 1964-1978
was characterized by T. violaceum and T. tonsurans as the agents of
superficial trichophytosis and T.schoenleini as the agent of the favus.
Zoophilic dermatophytes were represented by T. Mentagrophyte var.
granulare and T. verrucosum, but no isolate of M.canis was found in clinical patients. Microsporiasis was detected only from affected animals and
no one case of human infection was noted until 1998.
Since than, the number of infected persons has been constantly growing
to up 508 positive isolates in 2005. Now M.canis dominates over all isolated dermatophytes (80.2%) followed by another zoophilic species,
T.mentagrophytes (11.4%), whereas T.verrucosum was less frequently
isolated (0.7%).
This dramatically changes in dermatophytes flora of our patients could be
explained as the results of antimycotic campaign in Bosnia and
Herzegovina carried out by griseofulvin. Those few cases of T. violaceum
and T.schoenleini as well as T. tonsurans reflect migration of rural population from occupied territories in urban regions. The prevalence of
M. canis is probably related to the increase in the number of domestic
animals particularly cats living outside of homes and consequently an
increase in the phenomenon of animals stray and semistray. Presumably
stray cats are the most important carriers and transmitters of M.canis.
Our findings indicate constantly increase of zoophilic dermatophytes,
especially M. canis. Like in many countries in southern Europe, in Bosnia
and Herzegovina as well, antropophilic dermatophytes were replaced by
zoophilic species.
ISE.322
Common Pediatric Dermatoses: An Epidemilogical Study
E. Kasumagic-Halilovic, M. Kantor, A. Prohic, F. Alendar. Department of
Dermatology, University Clinical center, Sarajevo, Bosnia and
Herzegovina
Dermatomycoses account for the majority of skin diseases and are of
particular interest in pediatric patients as fungal elements can be easily
spread from one carrier to the next.
This study was conducted to determine the prevalence of skin mycoses
and their causative agents among children under 14 years.
Samples were collected from 1225 children attending the Department of
Dermatology in Sarajevo during the period 2000-2005 and were submitted to a mycology laboratory for analysis. Fungus elements were demonstrated by microscopic examination in 873 (71.3%) cases and the etiology was determined by culture in 699 (80.1%) cases. Dermatophytes were
demonstrated in 251 (35.9%), candidiasis in 375 (53.6) and pityriasis
versicolor in 73 (10.4%) samples. The most common dermatophyte infection included tinea capitis (112; 44.6%) and tinea corporis (56; 22.3%).
The most prevalent species were Microsporum canis (221; 88.0%) and
Trichophyton mentagrophytes (22; 8.7%). Candidiasis was observed the
most often in infants in the first year of their life (250; 66.6), in groin region
as diaper dermatitis. The most common species was Candida albicans
(297; 79.2). Pityriasis versicolor was diagnosed in 73 children, 91%
between 10 and 14 years. Among seven different isolated species,
Malassezia globosa in its mycelial phase was found to be the most frequent species, as well as in adults.
ISE.323
Fulminant Fungal Peritonitis and Ascites in A HIV-infected Patient
with HCV-related Chronic Hepatitis. A Role for Prolonged
Nimesulide Self-administration?
Background: The mortality rate of HIV-infected patients (p) with liver disease is substantially increasing.
Methods: An exceedingly rare case of Candida albicans fulminant peritonitis and ascites in a p with HIV-HCV-coinfection and stable cirrhosis,
and possibly related to exaggerated self-administered nimesulide, is
reported.
Results: A 46-year-old p with HIV infection known since 14 years
received isolated 3TC-d4T since six years with a favorable laboratory
response: HIV-RNA 480 copies/mL,CD4+ lymphocyte count 428 cells/µL.
Neither liver biopsy nor specific treatment were performed for a concurrent stable HCV liver cirrhosis. Two months before admission, our p had
a shoulder fracture, and uncontrolled nimesulide self-medication was
performed during six weeks. A rapidly worsening ascites and oliguria led
to admission. Slightly increased ALT, amylase, and bilirubin were detected, but a rapidly increasing ascites and diffuse edema occurred, paracentesis, and diuretic-albumin administration failed, and the worsening
ascites-anuria evolved into kidney failure. One day later our p deceased
and necropsy examination showed a diffuse polyvisceritis and a micronodular hepatitis with abundant ascites, in absence of kidney-urinary tract
anomalies and other signs of decompensated cirrhosis. After p's death
multiple ascites cultures yielded isolated Candida albicans.
Conclusions: HIV-infected p have increased risks of liver toxicity. NSAID
are implicated in severe, and possibly lethal hepatotoxicity. The exceedingly rapid and severe evolution towards a Candida-infected ascites
associated with refractory anuria, in absence of decompensated cirrhosis, acute hepatotoxicity, and kidney involvement at autopsy, was never
observed after NSAID/nimesulide use. Animal models showed a NSAIDinduced increased enteric vascular permeability causing infectious peritonitis. Clinicians facing p with advanced chronic hepatitis but no decompensated cirrhosis, should remind that NSAID may act on liver-bowel
function, and could prompt a liver-kidney damage, possibly complicated
with infectious ascites.
ISE.324
Fungal Infections in a Pediatric Burn Care Unit
M. Rosanova, M. Villasboas, C. Rodriguez, P. Santos, J. Finquelievich, F.
Guarrecino, H. Basilico, G. Berberian. Hospital Garrahan, Buenos Aires,
Argentina
Fungal infections is an important cause of morbidity and mortality in burn
patients. The objetive of this study was to describe fungal infections in a
burn intensive care unit. We performed a retrospective review of medical
records of all patients with fungal infections from January 2002 to March
2004. We included 29 p. The mean age of patients was 36 months (r: 2144), 21 p (72%) were boys. The burn surface affected was between 15
and 85% (mean 45%). Localization of burns was in upper limbs 29 p
(100%), Lower limbs 23 p (79%), Trunk: 24 p (83%) and perineal area 14
(48%). Central and arterial catheterization was present in 28 p (97%) for
a median time of 15 days (r: 4-90 d), vesical catheterization in 28 p (97%)
for a median time of 13.5 d (r: 4-90 d ); 27 p (93%) had received previous antibiotics.
None of the patients had received parenteral nutrition. The time lapse
between admission and adquisition of fungal infections was between 4
and 90 days (mean 14 d). The most frequent site of isolation was deep
wound in 26 p (90%) and in blood cultures in 3 p (10%)
In all patients except 2 (27 p; 93%) with fungal infections, bacterial infections were also found. The predominant fungus recovered was Candida
species: (12p). Anfotericin B was the drug of choice at the begining of
treatment followed by azoles.The median time of complete treatment was
23 days (r: 9-90 ). One p died (3%).
Conclusion: Fungus play an important role in burn infections. Candida
sp was the most frequent. Special cultures for yeast are recommended
for all cases with burn infection.
Nosocomial Infections and Infection Control
ISE.325
Factors Influencing Hospital Infection Control Policies in Shiraz
Hospitals 2005
S. Moslehi1, M.A. Moslehi2. 1Healthcare Management School of Shiraz
University of Medical Sciences, Shiraz, Iran; 2Shiraz Medical University,
Shiraz, Iran
This study was undertaken to determine the resources available in all
Shiraz hospitals for the control of nosocomial infections and the factors
favoring a successful approach. A questionnaire about infection control
was sent to the hospital health director of all public and private hospitals.
An active program was defined as a hospital infection control committee
(HICC) meeting at least four times in 2004, the presence
of a doctor with infection control responsibilities, a nurse employed in
infection control and at least one surveillance activity and one infection
control guideline issued or updated in the past two years.
There was a response rate of 100%. Almost 56% of hospitals had an
active program
for Infection Control and 100% had a HICC. 100% had infection control
nurses. 30%
reported at least one surveillance activity and 56% had issued or updated at least one
guidance document in the last two years. The need for improved surveillance and appropriate guidance documents is necessary for Shiraz hospitals.
ISE.326
Evaluation Of Nosocomial Infections With Positive Cultures In
Hospitalized Patients In Kashan, Iran
A. Khorshidi, A. Sharif. Kashan University of Medical Sciences, Kashan,
Iran
Background: Gram negative bacteria remain important hospital
pathogens, particularly for critically ill patients and appropriate antibacterial treatment is often critical to decreasing morbidity and mortality
among hospitalized patient with infection.
Regarding to inaccessibility of accurate prevalence NI in university hospital of Kashan (Iran) and no information of the bacterial agents and
antibiotics pattern of them, this study was done from Sep 2003 to April
2004.
Material and Methods: A descriptive study was preformed over existing
data of positive cultures in patients that were hospitalized more than 4872 hrs after according positive cultures with clinical symptoms and signs,
the results and demographic characteristic were registered, then results
were presented by descriptive analysis.
Results: Research showed that rate of prevalence of NI was 1% (41
cases of 4297 admitted patients), 43.9% (18 cases of 41 patients)
belonged to old adults, the most rate of NI belonged to neonatal ward
(12.6%), the lowest rate belonged to urgency ward (%), the most prevalence of NI was Bacterimia (46.8), urinary tract infection(21.3%),pneumonia(19.2%),surgical wounds infection (6.4%) and other (6.3%).
The most common pathogen were Escherichia coli (31.9%),
Pseudomonas(19.8%), klebsiella(19.1%), Enterobacter(6.5%). E.coli
showed the most resistance to ampicillin(86.6%) and the most sensitivity to amicacin(76.9%). Pseudomonas aerogynosa showed the most
resistance to ampicillin (100%), cefexim (100%), ceftriaxon (90%) the
most sensitivity to amicacin (76.9%).
mentioned ward and Improved attention to hygienic principles, it is better
the empiric treatment started on the basis of last information about bacterial agents resistance.
Conclusion: Considering to the high prevalence of NI and increasing of
antibiotic resistance particularly in neonatal ward and ICU, it is necessary
to consider the predisposing factors of NI in mentioned ward and
Improved attention to hygienic principles, it is better the empiric treatment
started on the basis of last information about bacterial agents resistance.
ISE.327
Using of Flourocarbon and Gentamicin for Producing of
Antibacterial Fabrics
M. Sattari1, K. Karami2, R. Khajavi2. 1Tarbiat Modarres University, Tehran,
Iran; 2Azad Islamic University, Tehran, Iran
Most of nosocomial infections is related to fabrics which used for bed
patients. In these days, some fabrics are treated by different chemical
compounds to change their ability for resistance against bacterial
biofilms.
In this study synergistic effect of Flourocabon and Gentamicin against
different species of pathogenic bacteria was evaluated. After each fabrics
treated with Flourocarbon and Gentamicin (separately and in combination with different concentrations), they challenged with Staphylococcus
aureus, Pseudomonas aeruginosa for their biofilm formation. The
inhibitory effect of treated fabrics were determined by agar diffusion test.
Our results showed thatt he use of antibacterial fabrics could decrease
the rate of bacterial transferring in bed patients.
ISE.328
Hepatitis B and Hepatitis C Virus Infection in Hemodialysis:
Prevalence and Treatment in the Regional Institute of Nephrology
N. Sela, M. Zabzun, S. Mena, L. Klasninovska. Institute of Nephrology,
Struga, Former Yugoslav Republic of Macedonia
Background: Hepatitis B (HBV) and hepatitis C (HCV) virus infection is
highly prevalent in patients on hemodialysis (HD). These infections are
associated with many complications among HD population and have a
significante impact on quality of life and survival in HD patients.
Aim: The aim of this study is to analyze the prevalence of HBV and HCV
virus infection in HD pts. in south-western region of R.Macedonia, to analyze the serological markers of HBV, to prevent a transmission of HBV
and HCV among HD pts. and analyze the efects of treatment of HCV
infection with peginterferon alfa - 2a ( Pegasys).
Methods: 160 pts. on regular HD treatment were included in this
prospective open-label study. Detection of HBV markers and HCV antibodies were performed by micro ELISA and HCV RNA by the method of
PCR. Anti-HCV positive and negative pts.have been separated in different HD units. The group of 8 HCV-RNA positive pts. were included in
peginterferon alfa - 2a treatment in a doses of 135 mcg/week for 48
weeks.
Results: 9,4% of HD pts. in this regional study were HbsAg positive and
thay were dialysed in separate HbsAg positive units. Since 1988 year
Hepatitis B vaccination ( Engerix - B ) regularly have been performed in
HD pts. There is a significant reduction of a new cases of this infection in
HD pts. 70,6 % of HD pts. were anti HCV positive. 78 pts(69 %) had no
clinical signs of infection. 29 pts (25,7 %) were with mild clinical signs
(malaise, anorexia,vomiting) and 6 pts. (5,3%) had severe disease
(ascites, cirrhosis). In a group of pts. treating with peginterferon alfa-2a (
Pegasys) we found a stable virusologigal answer with undetectable HCV
- RNA.
Conclusion: Hepatitis C virus infection remains an important clinical
issue in pts. on HD. High prevalence in HD population suggest nosocomial transmission of HCV within the dialysis centre. Adequate screening of
HD pts.and blood for transfusion, separate HD units and universal infection control practices are required. Peginterferon alfa - 2a administration
leads to clinical improvement and clearence of HCV- RNA from serum.
ISE.329
The Study of Nosocomial Microbiologic Organisms Isolated from
Venous Periferal Catheters
H. Hoxha1, S. Bitincka2, G.J. Lito1, E. Foto2. 1Univeristy Hospital Centre
“Mother Theresa”, Tirana, Albania; 2University Hospital Centre "Mother
Theresa", Tirana, Albania
The aim of study was to show the spread of nosocomial microbiologic
organisms isolated by venous periferal catheter and to determine their
resistence against antibiotics.
Methods: This was a porspective study performed in the patients admitted in UHC from March - November 2004. In this study were enrolled 150
patients admitted in the surgery ward and intensive carer unit (ICU). We
analysed the kinds of isolated microorganisms, their resistence against
antibiotics, age, the mean length of catteter etc.
Results: From 150 Patients admitted in the hospital, in 48 cases (28%)
were isolated nosocomial microorganisms as following: staphiloccocus
aureus in 22 cases (52.2%), gram negative microorganisms in 17 cases
(41.4%), Proteus mirabilis in 1 case (2.1%) and pseudomonas auroginosae in 2 cases (4.2%). 27 cases (64.2%) were children and 15 cases
(35.8%) were adults, 18 (42.8%) patients were admitted in surgery and
24 patients (57.2%) in the ICU. The mean length of venous catteter was
4 days. The resistence in 2004 about antibiotics is shown below:
Ampicilin--> 84.4%; Meticilin--> 57.1%; Gentamycin--> 63.9%;
Trimetoprin--> 94.4%; Vancomycin--> 18.4%; Cefotaxim--> 5.6%;
Ceftriaxon--> 5.2%; Perfloxacin--> 5.6%
Eritromicin-->61.1%
In years 1986-1990 was:
Penicilin-->83.7% Ampicilin-->88.7%
Meticilin-->9.02%
Gentamicin-->15.89%
Bactrin-->6.28%
Eritromicin-->75.38%
Conclusion: The sensibility of the microorganisms by the antibiotics
changes. Now we recommend to use the antibiotis with high sensibility to
prevent and treat the nosocomial infections in our country.
ISE.330
Frequency and Knowledge of Health Care Workers About Hepatitis
B Vaccine
D.R. Afhami, L. Sayadi, N. Esmailpour, M. Mohagheghi, M.
Hajiabdolbaghi, M. Rasoulinejad, H. Soleimani. Tehran University of
Background: Health care workers (HCWs) are exposed to different
bloodborn pathogens especially hepatitis B virus (HBV). Therefore
knowledge of HCWs regarding HB vaccine status is important. The goals
of this study were to assess the frequency and knowledge of HCWs
about their HB vaccine status and immunity.
Methods: This study was taken out from 2004 through 2005 among
HCWs of a teaching hospital in Iran. Data on number of HB vaccine injection and HBs-Ab titer were collected.
Results. Among 1477 personnel who answered the questionnaires,
35.4% were nurses, 24.9% physicians, 9.5% were lab and radiology personnel, 30.1% other personnel. 60.5% of HCWs have been received at
least three doses of HB vaccine, 23.6% had a history of HBs-Ab testing,
and 11.71% remembered HBs-Ab titer.
Conclusion: Although 100% immunization of HCWs against HBV is necessary to prevent HBV infection, vaccination coverage is not optimal.
Education of HCWs may increase vaccine coverage.
ISE.331
Td Vaccine Frequency and Coverage among Health Care Workers
N. Esmailpour, L. Sayadi, D.R. Afhami, M. Rasoulinejad, M.
Hajiabdolbaghi, M. Mohagheghi, M. Tahmasebi. Tehran University of
Introduction: Health care workers (HCWs) are exposed to different
pathogens including Tetanus and Diphtheria. Although injection of booster dosage of Td vaccine is necessary for hospital personnel, this strategy is not achieved in most health care settings. To increase Td vaccine
coverage among HCWs, this study was done.
Methods: This study was performed in a teaching hospital in Iran during
one year period. Based on data collected from questionnaires completed
by hospital personnel, booster dosage of Td was injected to those who
had not been received Td vaccine for more than 10 years.
Results: Among 1477 personnel, 53.3% had a history of Td vaccine
booster injection. After intervention, Td vaccine coverage reached 90%.
Conclusion. Although periodic injection of Td vaccine booster dosage
should be considered in health care settings, usually this policy is
ignored.
ISE.332
Bacterial and Fungal Infections in Haemathology Patients: 4 Year
Period
B. Kurcik, K. Popovska-Jovanovska, Z. Cekovska, V. Kotevska, I. HadziPetruseva, M. Petrovska. Institute of Microbiology and Parasitology,
Skopje, Former Yugoslav Republic of Macedonia
Background: Immunocompromised patients are considered at high risk
for severe infections. We compared pathogens isolated from lower respiratory tract specimens, blood cultures and central venous catheter
smears from patients hospitalized at Clinic of Hematology, Clinical center, Skopje, Macedonia, during four year period (from September 2000 to
September 2004).
Methods: 143 patients with neutropenia, hospitalized at Clinic of
Hematology were chosen for having positive microbiological findings
both in sputum and in blood culture. 23 of them had positive findings in
sputum, blood culture and in central venous catheter. Cultivation, isolation and identification of sputum and central venous catheter smears
were made using standard microbiological laboratory methods.
Automatized techniques were used for hemoculture proceeding.
Antimicrobial susceptibility testing was made by disc diffusion method to
twelve antibiotics.
Results: Thirty three (33) patients had identical findings both in their
sputa and blood cultures: Pseudomonas aeruginosa 9, Staphylococcus
aureus 8, Acinetobacter spp. 7, Klebsiella pneumoniae 3, Klebsiella
aerogenes 2, E. coli 1 and Candida albicans 3. Four patients had identical pathogen isolated in their sputa, blood cultures and central venous
catheter: Pseudomonas aeruginosa 2, Staphylococcus aureus 1 and E.
coli 1. The antimicrobial susceptibility testing of isolated bacteria showed
similar resistance pattern.
Conclusion: Identical findings, in all three specimens, showing same
susceptibility to the antimicrobials suggest same origin.
ISE.333
Isolated of Staphylococcus epidermidis to Vancomycin and
Oxacillin from Nosocomial Infections
G. Eslami, F. Fallah, H. Goudarzi, J. Mardaneh. Medical Faculty of
Shaheed Beheshti Univ, Tehran, Iran
Background: Staphylococcus epidermidis isolated from hospital specimens often is the most multiple difficult drug resistant, there fore traetment is problematic and drug pervention of infection is the greater concern. This microorganism has become a major cause of nosocomial
infections. The aim of this study was to determine S.epidermidis resistanc
to Vacomycin and Oxacillin in nosocomial specimens.
Material and Method: In this descriptive study that performed during a 6
month, 109 S.epidermidis Strains isolated from various nosocomial specimens including blood, urine, wound, throat swabs, cerebrospinal fluid,
corneal ulcer, catheter and dialysis fluid of hospilized patients in Imam
Hossein Hospital Tehran-Iran. There organisms were tested in vitro for
their resistance to Vancomycin (30 mcg per disc) and Oxacillin (1 mcg per
disc) by disc diffusion method according to National Committee for clinical Laboratory Standards (NCCLS) recommendations.
Result: Among 109 strains of S.epidermidis 37.6% (41 strains) isolated
from blood, urine 33% (36 isolates), wound 14.6% (16 isolates), throat
swabs 5.5% (6 isolates), cerebrospinal fluid 2.7% (3 isolates), corneal
ulcer 2.7% (3 isolates), Catheter 1.8% (2 isolates) and dialysis fluid 1.8%
(2 isolates). Rate of ncomycin resistant and Oxacillin was 11% (12 isolates) and 86.2% (94 isolates), respectively (p<0.00001).
Conclusion: Our data demonstrate that incidence of oxacillin resistance,
however, is so high and resistance to Vancomycin that is the antimicrobial Choice for treatment of staphylococcal infection is major problem and
continiues to increase Speedily.
ISE.334
Risk Factors for Urinary Tract Infections in Hospitalized Elderly
Patients
A. Stavrianou, E. Athanasopoulou, M. Christou, M. Apostolakis, P.
Tsiodra, S. Chini, C. Keramidas. Athens General Hospital "G.
Gennimatas", Athens, Greece
Background: Urinary tract infection(UTI) is common in hospitalized elderly patients. The purpose of our study was to assess the relationship
among the levels of serum uric acid, serum creatinine, urine pH and UTI
as it was proposed by other authors (Mantani et al)
Methods: We prospectively studied two groups of patients,over 65 years
old, who were admitted in our department. We excluded patients with
acute or chronic renal failure. The levels of serum uric acid (UA), serum
creatinine and urine pH were compared among pyuria positive and
pyuria negative patients.
Results: We studied 2 groups of 161 patients each, 172 women(53,42%)
and 150 men (46,58%), over 65 years old (mean age 78,20 ± 13,20
years ), the first group, pyuria positive
patients(A) and the second group, pyuria negative patients(B).
Our results were:
Group A
Group B
Creat.(mg/dl)
0,85±0,3
1,19±0,51
Ur.ac.(mg/dl)
4,09±7,2
5,61±7,39
Urine.pH
6,3±2,2
5,5±1,7
From group A (161 patients), 135 (83,85%) patients developed UTI confirmed by urine culture and in this group, the levels of the studied parameters were creatinine 0.76 (± 0,4 mg/dl), uric acid 4,4(±5,6 mg/dl) and
urine pH 6,4 (± 2,4)
Conclusions : The results of this study seem to confirm the hypothesis
that geriatric patients with pyuria, higher urine pH and lower serum uric
acid are prone to develop UTI.
ISE.335
Interplay of Two or More Infectious Diseases on Course and
Outcome with Patients Treated at the Infectious Ward in Kumanovo
V. Stefanovska, S. Josifova, V. Dzartovska, S. Makrevska, J. Dzimrevski.
General Hospital, Kumanovo, Former Yugoslav Republic of Macedonia
Background: Interplay of two or more infectious disease, present at a
patient at the same time, interplay upon the severity of clinical finding,
treatment and outcome.
Methods: Medical documentation of 3114 patients admitted and treated
at the Infectious Ward in Kumanovo from 2001-2005 was analysed.
Epidemiological data, clinical finding and standard haematological, biochemical and microbiological were used while analysing.
Results: 3114 patients, over a span of 5 years, were hospitalised at the
Infectious Ward in Kumanovo. 199 (64%) patients suffered from upper
and lower respiratory system and gastrointestinal system problems. Out
of 199, 143 (71.8%) were children up to 2 years old; 12.6% from 2-10;
and 15.6% over the age of 10. Both sexes were equally included. Urban
population was pre-dominant i.e. 56.8%. According to clinical finding,
infectious syndrome was clearly expressed. 73.8% of the patients were
highly febrile. Almost all were dehydrated, intoxicated and suffered from
diarrhoea which lasted 3-4 days as well as coughing over 6-7 days. All
those symptoms were especially emphasised with the youngest patients
where mild range of anaemia could be registered at 49.2%.
Streptococcus beta haemolyticus, Streptococcus pneumoniae,
Haemophylus influenze, Staphylococcus aureus, Salmonella spec.,
Shigella spec., Rota virus, whose presence was bacteriologically and
serologically proved, appeared to be the causes of the infections.
Therapeutic approach depended on etiological agent. Duration of treatment was approximately 7.1 - 2.4 days longer than with patients with one
system (upper and lower respiratory or gastrointestinal) attacked only.
Conclusion: Out of 199 patients, suffering from simultaneous infection
on upper and lower respiratory and gastrointestinal system, 71.8% were
children up to 2 years old. Infectious syndrome was predominant with all
patients. Duration of treatment, which approximately lasted longer than
2.4 days, and the more severe clinical finding, was a result of interplay of
simultaneous presence of two infectious diseases.
ISE.336
Ventilator-associated Pneumonia. Blood Culture Sensitivity for
Etiologic Diagnosis
L. Marsola, R.C. Medeiros, M.H. Costa, J. Nogueira, A.T. Carvalho, G.C.
Bahia, R.A. Brito. Barros Barreto Hospital, Belem, Brazil
Background: Ventilator-associated pneumonia (VAP)is the most common nosocomial infection in intensive care unit (ICU) patients. Identifying
the organisms causing such infections will help to treat such patients.
Blood culture has been related as a low-sensitivity test (less than 20%)
to diagnosis this infection, even though has a good positive preditive
value.
Objective: evaluate the sensitivity of blood culture to make the etiological diagnosis of VAP.
Methods: observational study conducted in a 10-bed surgical-medical
ICU at a university hospital in Belem city, Brazil, from January 2003 to
July 2004. All suspect ICU patients of having VAP following NNIS/CDC's
definitions had a blood culture set collected before starting antibiotic therapy to treat VAP. Blood culture were processed using manual process
and suscetibility test used was disk diffusion test.
Results: Thirty-seven VAP episodes in 35 patients were diagnosed using
clinical and radiological criteria. All patients have been receiving antibiotics before their VAP diagnosis. Only two patients (less than 6%) had
their etiological diagnosis made by blood culture.Extended-spectrum
Beta lactamase K.pneumoniae and multiresistant P.aeruginosa were isolated.
Conclusions: blood culture has a very low sensitivity as VAP etiologic
diagnosis method mainly if antibiotic has been used before it.
ISE.337
Antibacterial Activity of Rubia Tinctoria on Staphylococcus
Epidermidis in UTI
F. Fayaz1, S. Saremi2. 1Shaheed Beheshti University, Tehran, Iran;
2
Shaheed Beheshti University and Infectious Diseases and Tropical
Medicine Research Center of SBMU and Health Services, Tehran, Iran
Background: This project was designed to evaluate the antibacterial and
anti-inflammatory activity of extract herbal plant, Rubia tinctoria (R.t) on
Staphylococcus epidermidis in patients with urinary tract infection.
Methods: Staphylococcus epidermidis were isolated from 30 patients
admitted to hospitals of Shaheed Beheshti University. This bacteria is
known as microorganism which can be cause of UTI. Extract of the R.t
root were sterilized and dissolved. MIC (Minimum Inhibitory
Concentration) test were done with the extract and isolated bacteria.
Results: According to previous researches, R.t had been used in the traditional medicine for UTI. In our research concentration of 400 milligram
of R.t extract was effective on the isolated bacteria, and showed
detectable antimicrobial activity.
Conclusion: By fractionation of R.t root it can be possible to extract the
most effective antibacterial part of the root. As our research was on the
whole root, so we intend to have further studies on this herbal medicine
which is the center of interest, specially in local environment.
ISE.338
Bacterial Contamination Degree of Dentistry Units in Dentistry
Surgury Ward in Azad University of Tehran
F. Fayaz1, M. Kalantar Motamed1, F. Navi2, M. Mozafaripour2. 1Shaheed
Beheshti University, Tehran, Iran; 2Dentistry Faculty of Azad University of
tehran, Tehran, Iran
Background: Dentistry equipment contamination such as units surfaces,
with aerosols, saliva, blood and contaminated fingers should be controlled in all dentistry wards, espicially surgury ward.
Methods: 72 samples were taken from light handles, tablet handels and
position changing units switches from operation dentistry units. Samples
were taken by sterile swabs and liquid transport media and bacterial
smears, culture and isolation were done in microbiology laboratory.
Results: From 72 samples, 69(95.8%) have bacterial growth and 4.2%
have not bacterial growth. 72.9% of positive cultures were related to nonpathogenic bacteria and 21.6% were related to pathogenic bacteria.
Conclusion: Bacillus subtilis were the most between nonpathogenic
bacteria (78%) and alpha hemolytic Streptococci have got most frequency between pathogenic bacteria (21.1%).Therefor special care to instructions using antiseptics and bacterial contamination controlling are recommended in these dentistry wards.
ISE.339
A New Method for Preservation of Bacteriain Macrophages Cell as
Container
N. Mosafa1, S. Taheri2, F. Labibi1, F. Miraghasee2. 1Immunology Depart,
Shaheed Beheshte University, Tehran, Iran; 2Microbiology Depart,
Shaheed Beheshte University, Tehran, Iran
Introduction: Peritoneal cavity is biological space and corresponding
macrophages are potent reservoir for particular and microbiological component. This area can be ideal status for preservation for all kind
cells/specially for bacteria. In order to this point we suggested to use
these cells for storage of bacteria with out losing vitality and pathogenesity and proliferation power.
Methods: In this study we used 13 inbred balb/c mice with 8 week age
and 25±4gr weight. We obtained 13 souche of standard bacteria (Ecoli,
serratia marcecens, pseudomonas auroginos, salmonella typhi, shigella
sonei klebseilla pneumoniae, Lysteria monocytogenes staphylococcus
aureus, staphylococcus epdermidis staphylococcus uricolaris, streptococues group A, Entrococcus fecalis) with ./5mL macfarland standard
culture. Then we inoculated bacterial suspension into peritoneum of animals. Two weeks after /they killed by cervical dislocation and tried to harvest pertoneal macrophages by lavage technique in sterile condition. All
of the material and cells stored in-72°c in complete tissue culture medium and DMSO. After 2 week we thaw all samples and revive recultured
bacteria, with injection bacterial suspension Onside pm peritonea. After
2 weeks the animal were cervical dislocation then by Lavage technique
we peritoneal contain by absolutely sterile condition extracted then
Macrophages incubated in -70°C Freezer by complete medium CRPMI +
FBS) and DMSO. After 2 weeks the cells defreeze and were culture in
specific medium depend on bacteria.
Results: All the bacteria recover from those materials. Specific media
but the recovery in gram positive bacteria were so much clearer than
gram negative.
We presume this matter maybe for the strength structure of their cell
walls.
Discussion: We determined that bacteria can survive in macrophages in
special cold condition. We deduced that macrophages can be very useful and suitable preserver for save pathogenisity and proliferative properties. This method can be useful for storing the specific bacteria for long
term without any differentiation on for research purpose. Cytoplasmic
properties with anti crystallization effect of DMSO could be rise vitality of
bacteria.
ISE.340
Hospital Sepsis - The Risk Factors
N. Koluder1, E. Beslagic2, S. Krkic-Dautovic1, N. Bajramovic1, L. Lukovac1,
A. Mesic1. 1Clinic for Infectious Diseases, Clinical Center Sarajevo,
Sarajevo, Bosnia and Herzegovina; 2Institute of Mycrobiology and parasitology, Faculty of Medicine University of Sarajevo, Sarajevo, Bosnia and
Herzegovina
Introduction: Hospital sepsis presents a special clinical entity. The special feature of this sepsis is the severe clinic picture, etiologic polymorphology, multi-resistentiality of the antibiotic treatment which directly
influences the result of the treatment. The different factors induct hospital sepsis.
Aim: Identify the influence of the preexistent disease and aggressive
medical procedure on appearance of clear determinated hospital sepsis
among two hundred patients selected by random method, with clinical laboratory signs of sepsis and mono-microbial aerobic blood culture.
Methodology: The sample of septic patients has been statistically
processed using Hi2 test and contingency coefficient C.
Results: We obtained a statistical significant results when we correlated
Gram-negative hospital sepsis and preexistent disease (Hi2=39,819, p
less than 0,001, C=0,609), while this significance was absent in Grampositive hospital sepsis (Hi2=2,59). There is statistical significant difference between Gram-positive (Hi2=86,282, p less than 0,0001,
C=0,681)as well between Gram-negative(Hi2=94,483, p less than
0,0001, C=0,696) hospital sepsis and aggressive medical procedure.
Conclusion: Preexistent disease and aggressive medical procedure are
important risk factors of the hospital sepsis.
ISE.341
A 12-year Longitudinal Assessment for Changes in Methicillinresistant Staphylococcus aureus Strains Isolated in A Japanese
Teaching Hospital
H. Baba1, T. Nada2. 1Department of Infectious Diseases, Nagoya
University Hospital, Nagoya, Japan; 2Department of Clinical Laboratory
Medicine, Nagoya University Hospital, Nagoya, Japan
Background: Methicillin-resisitant Staphylococcus aureus (MRSA) is an
important pathogen that is a major nosocomial infection problem in
Japan since the early 1990s. To control the outbreak of MRSA among
inpatients, especially in ICU, the infection control team was organized in
1992 and an infection control nurse was placed in 1995 at Nagoya
University Hospital, although infection control programs had been generally uncommon in Japan at that time. In this study, we evaluated trends
in annual number of MRSA isolates and antibiotic susceptibility at our
hospital since 1992.
Methods: We reviewed the records concerning the 7544 strains of
MRSA isolated from April 1992 through March 2004 in the clinical microbial laboratory at Nagoya University Hospital that is a tertiary teaching
hospital with 1035 beds in Japan.
Results: The annual number of MRSA isolates showed a tendency to
decrease after 1998 although that increased from 1992 to 1998, and the
MRSA isolates in 2003 was nearly equal to in 1992. This trend was well
associated with the change in the number of MRSA isolated among inpatients, not outpatients. The annual susceptibility rate among MRSA isolates to gentamicin significantly increased from 36.9% in 1992 to 62.2%
in 2003, whereas the annual rates of susceptibility to minocycline and fluoroquinolones gradually decreased. There were no vancomysin-resistant
strains, whereas one strain was resistant to teicoplanin, and 0.2 to 4.5%
of MRSA strains were resistant to arbekacin that is an aminoglycoside
used for the treatment against MRSA infections in Japan. Conclusion:
The implementation of infection control measures may have contributed
to the decrease of MRSA isolates in recent years because this decrease
was strongly related with that among inpatients. The susceptibility rate
among MRSA isolates to gentamicin significantly increased from 36.9%
to 62.2%, that has also been reported recently from many countries,
especially France.
ISE.342
Comparision of Gram-positive Cocci Contamination in the Lines of
Shahid Beheshti Dental School Units and Drinking Water Supply of
Local Area
F. Abbasi. Shaheed Beheshti University, Dental School, Tehran, Iran
Background: Contamination of dental unit water lines had been discussed to be source of bacterial infection specially in immuncompromized and old patients in resent years.This study carried out in order to
evaluate gram positive cocci contamination in the water lines of shahid
Beheshti Dental School units and drinking water supply o local area during 1381.
Methods: The study was descriptive and its technique was observation
and data Questionnaire usage.15 units from dental school and 15 ones
from local area were selected randomly before the beginning of daily
work. The samples were carried into transport media and sent to microbiology lab then. Smears of the samples were stained with gram staining
and all specimens were cultured on blood and nutrient agar. The cases
were incubated for 18 hours at 37 C and microbial colonies were counted for the purpose.
Results: No case of gram positive cocci contamination was observed in
drinking water samples. In the examination of dental units water units
water contamination of gram positive cocci and gram negative bacillus
were seen. Entrococcus in periodontic dep. staphyloccus epidermides in
orthodontic dep. staphyloccus in crown and bridge dep.
Conclusion: The peak of contamination level was found in orthodontic
dep.Existence of gram negative bacillus in third floor and enterococcus
in first floor was probably for the contamination of water be fece,while
staphylococcus epidermidis existence can be discussed by black flow of
saliva via suction or water supply line of the unit through hand Piece
hoses.
ISE.343
Ramezan Month Diet and Mouth Microbial Flora
H. Semiyari. Shahed University,Dental School, Tehran, Iran
Background: Normal microbial flora of mouth has consisted from different microbes such as Streptococcus sanguis, Streptococcus mutans and
other ones. According that in holy Ramezan month diet, hygienic oral
habits, frequency of eating food and quantity of that usually change, so
changing in the aim of this study was comparing of salivary microbial
flora in different people who are fasting and non fasting on the base of
form and gram reaction.
Method: In this study 100 people in the range of 15-20 year old were
studying in two sections of fasting and non fasting in the area of Roodbar
Ghasran. Salivary of these people were sample in both section of fasting
and non-fasting and then were send to laboratory for gram coloring and
searching for different kinds of bacteria.
Results: The results showed that the rate of gram (+) coccies, gram (+)
bacillus and gram (-) bacillus in fasting and non fasting were different but
the rate of gram (-) coccies, diplococcus and yeasts didn't have any significant difference.
Conclusion: According to the results of this study changing in salivary
microbial flora in fasting causes a significant decrease in effective
microbes of periodontal diseases.
ISE.344
Evaluation of Helicobacter pylori Influence on Oral Lesions
A. Darbandi. Shahed University,Dental School, Tehran, Iran
Background: The goal of this research was evaluation of Helicobacter
pylori influence on oral lesions (Aphthous ulcer (RAS), oral lichen planus
(LP), Bearning mouth syndrom (BMS), Geographic tongue (GT).
Methods: In this research 26 patients with oral lesions were selected (7
RAS, 7 LP, 6 BMS and 6 GT Patients). Beside this case group, 25 healthy
patients with no oral lesion were selected as a control group. Two different
samples were prepared from each case. (from the depth of the lesion and
subgingival plaque) and one sample was got from subgingival plaque in
control group. Then we transferred the samples into specific cultures,
which were: in microaerophilic area, 37°C, 5% CO2 and saficient humidity and after 3 to 5 days we observed the plates and applied the suplemental tests. (ureas test, catalase test and proxidase test).
Results: The results showed that among 26 patients, only 3 samples
were HP positive (12%) and in 25 patients in control group, we had no
HP (+). (0%).
Statistical results showed that there was no significant relation between
two groups, so, HP can't have any influence on oral lesions and it's not
recognize as normal flora in oral cavity.
Discussion: All of HP(+) cases were in Geographic tongue group. (50%
of the G.T. patients.) Although, we considered the G.I disorders in our
groups. As the results, 35% of cases and 40% of control group indicated
G.I disorders in their history.
ISE.345
Determination of the Effects of Different Cleaning and Storage
Conditions on the Microbial Contamination of Contact Lens Cases
M. O'Donoghue, M. Cheung, M. Boost. The Hong Kong Polytechnic
University, Hong Kong, China
Background: Contact lens (CL) use is the major risk factor for microbial
keratitis and poor compliance with lens care routines is an important risk
factor for eye infection... The CL case is the most commonly contaminated item of CL accessories. In this study the effects of several cleaning,
drying and storage methods of CL cases on colonization with bacteria
were examined.
Methods: The effect of using different cleaning solutions, viz. tap water,
sterile water, and multipurpose solution (MPS), on the cleaning process
of CL cases was compared. Simultaneously, the consequences of two
drying methods of cases, air drying and drying with toilet paper were
investigated. Two locations for subsequent storage of the cases, on top
of toilet cistern, and on bathroom shelf, in both public toilets (air-conditioned) and home bathrooms were used. Cases were sampled using a
cotton swab and cultures performed on blood agar. Organisms were enumerated and identified using standard methods.
Results: Regardless of the location of storage or the method of drying,
use of MPS resulted in lower contamination levels of cases. Cases stored
in home bathrooms had more contamination than those in the public toilet. Use of toilet paper for drying increased contamination and there were
considerable numbers of Escherichia coli present in several samples.
The most common pathogens isolated were Staphylococcus aureus and
Pseudomonas aeruginosa.
Conclusions: Several practices were associated with higher levels of
contamination in particular, use of toilet paper for drying, use of tap water
for rinsing, and storage of the cases in warm and humid conditions. A
recent study in Hong Kong reported that toilet paper was contaminated
with E. coli even before exposure to the bathroom environment, supporting the finding of increased contamination with its use. The contamination of toilet paper may also be increased by aerosols in the bathroom.
Patients should be advised to clean cases with MPS solution, air dry or
dry with facial tissues, and store lens cases in a cool, dry environment.
ISE.346
Behaviour of Intrahospital Infections in Our Hospital
B. Pèrez, S. Mendoza, C.A. Huergo, C.J. LLapur, R.O. Garcìa. Centro
Intern. Retinosis Pigmentaria, Ciudad Habana, Cuba
Introduction: Through this paper the authors present their working
experience in reference to the behaviour of morbility in intrahospital infections atCamilo Cienfuegos Hospital.
Method: The period of time considered in this paper comprises from
June 1992 to December 2005. During this period, 11000 patients were
hospitalized and 9700 of these patients received some type of surgical
treatment, mainly Ophtalmological, Aesthetic, Orthopedic, Maxillofacial,
and Dermatological Surgeries.
Results and Discussion: According to frequency, the predominant
infections took place in Ophtalmology, due to the fact that our hospital is
mainly an ophtalmological hospital. Then, these infections were followed
by aesthetic and orthopedical infections. The infections morbility was of
0,1%,being under the international standards.
The authors explain in the paper the control measures taken to reach the
previous parameters, emphazising the accomplishment of the micro-epidemiological measures among others.
Conclusions: The authors signal and emphazise the importance of control measures in order to avoid infections, which are mainly responsible
of the negative evolution of patients and their surgeries.
ISE.347
Vibrio cholerae Non-01 Isolated in a Bilio-bronchial Fistula: Case
Report and Review
C.N. Rodriguez1, B. Pastran1, A. Garcia1, I. Jimenez1, C. Marchan2, A.
Flores2, D. Sanchez3, A.J. Rodriguez-Morales4. 1Laboratory of
Microbiology, West General Hospital, Caracas, Venezuela; 2Div. Surgery,
West General Hospital, Caracas, Venezuela; 3National Institute of
Hygiene, Caracas, Venezuela; 4Instituto Experimental JWT, ULA, Trujillo,
Venezuela
Background: Vibrio cholerae non-O1 (VCNO1) serogroups, with the
exception of serogroup O-139 "Bengal", are recognized as non-epidemic strains that have been isolated in gastroenteritis, septicemia, wound
infection, meningitis, and cholecystitis, but non from a bilio-bronchial fistula. For these reasons we report the isolation of a VCNO1 from biliobronchial fistula in a patient with a Roux-en-Y end-to-side choledochojejunostomy.
Case: A 27-y-old woman with previous cholecystectomy and right lobe
hepatectomy consulted presenting jaundice and bilioptysis. An ultrasound revealed a choledochal stenosis with signs of pleural effusion and
extrahepatic cholestasis. Fewly after admission WBC counts were 14.8
x103 cells/mm3 (83.4% polymorphonuclear cells); TB, 6.9 mg/dL; DB, 4.1
mg/dL; ALP, 131 U/dL; AST, 15 U/dL; ALT, 16 U/dL; and GGT, 57 U/dL.
Blood samples for culture were taken. Clinical conditions evolved badly,
with dyspnea, jaundice and bilioptysis. Patient was surgically intervened
(biliary laparotomy with a deviation of hepatojejuno anastomosis lake
and drainage) to correct the bilio-bronchial fistula. Amikacin and metronidazole were indicated. A sample of bile from the fistula was taken for culture, in which Vibrio cholerae non-O1 was isolated and identified (with
Vitek)(confirmed at the national reference bacteriology center). In this
culture also grow E. coli (ampicillin resistant), P. mirabilis (ampicillin
resistant), A. baumannii (all tested drug resistant) and P. aeruginosa
(ciprofloxacin resistant). V. cholerae was susceptible to all tested drugs
(ampicillin, ciprofloxacin, imipenem, tetracycline and TMP-SMX). E. coli
was also isolated from respiratory and abdominal liquids and from a vascular catheter. Ciprofloxacin and imipenem were indicated at this time.
After 3-mo patient was successfully discharged without signs of infection
or additional biliary complications.
Discussion: To the best of our knowledge, this is the first case report of
VCNO1 isolated in a bilio-bronchial fistula. In vitro susceptibility of
VCNO1 strains appears that are generally susceptible to most of the
antimicrobial agents, including ampicillin, gentamicin, cefotaxime, and
ceftazidime. Early appropriate antibiotic therapy is critical, because the
mortality rate of VCNO1 septicemia may be as high as >50%. To date,
there are no published guidelines for antibiotic therapy of VCNO1 infections, this should be furtherly addressed.
Parasitic Infections
ISE.348
Serum Cholinesterase Activity Among Workers of A Malaria Vector
Control Program: the Need for Surveillance
A. Bueaño1, O. Rodriguez1, M. Herrera1, M. Arria1, A.J. RodriguezMorales2, J. Benitez3, J.G. Rojas-Mirabal3. 1Regional Malariology Office,
Carupano, Venezuela; 2Instituto Experimental JWT, ULA, Trujillo,
Venezuela; 3Environmental Health Office, Ministry of Health, Maracay,
Venezuela
Background: Vector-borne diseases are an increasing cause of death
and suffering in tropical countries. Efforts to control these diseases have
been focused on the use of chemical pesticides, but with this, serious
intoxications and incidences due to misuse of susbstances such as
organophosphorus insecticides have been reported for over three
decades. For this reason we report on the first systematic surveillance
approach of possible cholinesterase activity depression among Sucre
malaria program pesticide applicators.
Methods: All the personnel working as pesticide applicators at the
malaria vector control program in an endemic area were surveyed herein. We determined the activity of serum cholinesterase (%ChE) obtained
from this group and from 4 normal controls (not related to the malaria
vector control program). Sucre is an endemic area for malaria in which
pyrethroids (such as malathion and fenithrotion) but also organophosphorus insecticides are used for the vectorial control.
Results: Forty one individuals working in 4 different insecticide-application areas were analyzed (plus 4 controls). Mean age of workers was
41.7 y-old (±9.5) (and for controls, 38.8±0.5 y-old). Mean weight of workers was 84.1 kg (±13.2) (and for controls, 75.8±6.7 y-old). All controls
were normal (as expected) and in the workers group, all had normal
serum ChE activity. In controls all had 100 %ChE, whilst in the workers,
mean serum %ChE was 91.2 (±8.0); 51.2% of workers had 87.5 %ChE,
39.2% had 100%ChE and 9.8% had 75%ChE. None of the workers presented related-illness.
Conclusions: Prevention of potentially toxic organophosphate exposure,
particularly amongst employees in the control of vector-borne diseases
should be sought wherever possible. Chronic toxicity, particularly the
neuropathic effects, merits further study because it contributes substantially to the long term morbidity in cases of severe acute, or chronic,
exposure. This laboral aspect of the malaria vector control should be considered elsewhere and proper surveillance should be periodically done.
ISE.349
Burden of Malaria Imported Cases in Venezuela during 2004
A.J. Rodriguez-Morales1, J. Benitez2, P.M. Rifakis3, G. Provenza3.
1
Instituto Experimental Jose Witremundo Torrealba, Universidad de Los
Andes, Trujillo, Venezuela; 2Ministry of Health, Maracay, Venezuela;
3
Perez de Leon Hospital, Caracas, Venezuela
Background: Venezuela is an endemic country for malaria, with three
well established endemic areas in the western, northeastern and southern regions. Although this, differences in strains pathogenicity, epidemiology and particularly antimalarial drug resistance with other endemic
countries, indicate the need to assess the impact of imported cases of
malaria, which was done in this report for year 2004.
Materials and Methods: Through the national malaria program, belonging to the Ministry of Health and Social Development of Venezuela, all
cases of malaria (autochthonous and imported) were analyzed to asses
the importance of malaria cases proceeding outside the country. The
study period was from first epidemiological week (jan 4-jan 10, 2004)
until fifty-second epidemiological week (dec 26, 2004-jan 1, 2005) of year
2004. All cases in the record were microscopically confirmed at least
twice by a system of quality control.
Results: During year 2004, a total 46,655 cases of malaria were registered in Venezuela, with a mean of 895.4 ± 206.1 cases/week (range
382-1620 cases). From this total, 46,244 (99.1%) cases were autochthonous and 411 (0.9%) were imported. Cases came from Colombia
(64.9%), Guyana (31.6%) and Brazil (3.5%). A mean of 7.4 ± 5.5 imported cases per week was observed during the year (range 0-24 cases).
Distribution of autochthonous cases through the year was normal (the
expected proportion of cases if all week have the same number of cases
is 1.92% per week [100% in 52 weeks]) occurring a mean of 2.0% (±0.5)
of year's total cases per week (ranging 0.8-3.5%); but with the imported
cases occurred a mean of 2.3% (±1.7) (ranging 0.0-7.5%), with three
important peaks that were observed during weeks 5°, 23° and 46° (these
three weeks accounted 20.63% of the year's imported cases). The 5°
corresponded to 23 cases from Colombia (and one case from Brazil); the
23° to 17 cases from Guyana (and 5 from Colombia), and the 46° to
Colombia (13 cases) and Guyana (7 cases).
Discussion: The concept of imported malaria has been recognized for
more than half a century, and has progressively increased in countries
that were classified as being free of this disease due to human migration
and the growing number of tourism to endemic areas. In already endemic areas, strengthened surveillance such as the carried out by this study
would help us prevent or identify earlier the introduction of other
Plasmodium species or resistant strains that may subsequently spread
through transmission of local mosquitoes, from other countries where
malaria is endemic as occurs with all the border countries of Venezuela.
ISE.350
Seroepidemiological Study of Hydatidosis in Zanjan (Iran)
A. Haniloo, H. Badali, M.B. Ghavami, J. Mohammadi. Dept. of
Parasitology and Mycology, Faculty of Medicine, Zanjan University of
Medical Sciences, Zanjan, Iran
Background: Hydatidosis is one of the most important parasitic zoonosis, which is endemic in Iran like many other countries. However, no comprehensive data are available about its prevalence rate, especially in
Zanjan (North West of Iran). Awareness of epidemiological aspects of
disease is of great value in prevention and control of the infection.
Considering this subject, this study was carried out for seroepidemiology
of human hydatidosis in Zanjan.
Methods: A total of 2367 human serum samples randomly were collected from residents during 2002. Hydatid fluid antigen was prepared from
sheep livers and lungs infected with hydatid cysts. Using this antigen, all
serum samples were tested by indirect-ELISA. Data were analyzed by Ttest and Chi-squire.
Results: Out of 2367 sera, 71 (3%) samples were positive. Positive rate
among age groups was different, but not statistical, as the highest rate
belonged to 10-19 and 20-29 years old with 3.6% and 3.3%, respectively. Infection rate was low in the ages over 50 years old (p>0.05). Positive
rate in males and females were 2.7% and 3.2%, respectively. Also
no correlation was seen between positive rate and education of the
population.
Conclusions: Regarding remarkable prevalence of positive cases
among this population like many regions of country, prevention and control of diseases should be considered as one of the health priorities in
this area. Moreover, for identification of transmission routs and infection
sources, more studies should be conducted in this area.
ISE.351
Evaluation of the Effects of Schistosoma Mansoni Infection in
Balb/C Mice: Immune Responses, Pathological Changes and the
Effects of Treatment with Praziquantel (Biltricide) on Pathology
M. Odiere1, D. Yole2. 1University of Nairobi, Zoology Department, Nairobi,
Kenya; 2Institute of Primate Research (IPR), Infectious Diseases
Department, Nairobi and University of Nairobi, Zoology Department,
Nairobi, Kenya
Background: Schistosomiasis affects an estimated 200 million people,
500–600 million are at risk and 20,000–100,000 die annually worldwide.
Disease is produced primarily by acute and chronic inflammatory
responses to eggs.
Hypothesis: There was no difference in pathology and number of worms
recovered from Infected-treated and Infected-untreated mice.
Methodology: 3 sets A, B and C were performed. Groups A and C were
infected with cercariae, Group B mice were control. Samples were
obtained from A and B for Immunological assays. Perfusion and ELISA
were performed on A, B and C and Praziquantel treatment for C only.
Results: There were significant differences in pathology and number of
worms recovered between A and C at week 7 post-infection (p<0.05).
Praziquantel resulted in significant decrease in pathology and mean
number of worms recovered in C (15.73%) compared to A (34.8%).
Stimulative index (SI) for Lymph nodes was 56.4%, Spleen 57.82%, Con
A (Spleen) 78.75% and Con A (Lymph nodes) 74.97%. Antibody titres
were higher in A mice compared to C.
(GROUP A)
WORMS RECOVERED
(GROUP C)
WORMS RECOVERED
M
F
M
F
22
11
29
15
24
13
33
18
13
7
17
6
38
28
0
0
14
4
0
0
111
63
0
0
79
39
Discussion: Pathology increased progressively in the absence of treatment, often leading to mortality. Few worms still remained alive in the
mesenteries after treatment. Low numbers or lack of females results in
absence of eggs in the liver, and consequently classical pathological features may have been missed.
Conclusion: The higher regression in pathology and clearance of worms
demonstrated efficacy of Praziquantel. Higher SI displayed by cells from
Infected mice indicated that lymphocytes play a major role in cell-mediated immunity to S. mansoni.
ISE.352
Study n the Increase of Specific Antibodies IgG and IgE in
Hydatidosis Patients
B. Haghpanah1, H. Taherkhani2, Z. Ghaiur3. 1Isfahan University of Medical
Sciences, Isfahan, Iran; 2Hamadan University of Medical Sciences,
Hamadan, Iran; 3Isfahn University of medical Sciences, Isfahan, Iran
Introduction: Cyctic hydatidosis is recognized as one of the world's
zoonosis. This is caused by an infection with the metacestode stage of
Echinococcus granulosus parasite. Diagnosis is important from both
healthy and economical point of view. Therefore, in this study titer of specific immunoglubulins (IgE,IgG) in cyctic echinococcusis patients was
evaluated.
Methods: Blood samples were taken from 43 hydatidosis patients who
were under operation. The Immunofluorescence antibody test (I.F.A) was
performed for the titer of specific antibodies (IgE,IgG) titer.
Results: An increase in the serum of IgG and IgE were seen. The titer of
specific IgE was higher than IgG. Results also indicated that specific
antibody titers were higher in patients with liver cysts in comparison with
lung cysts.
Conclusion: The measurement of specific immunoglubulines (IgE,IgG)
with IFA technique is a useful method for the diagnosis of hydatidosis.
High level of IgE as compared to IgG can help more in terms of diagnosis and follow up.
ISE.353
Lymphotoxin-alpha Gene Polymorphism and Susceptibility to
Visceral Leishmaniasis
S. Kiany, M. Rasouli, M.A. Dehyadegari. Immunology DepartmentClinical Microbiology Research Center-Shiraz University of Medical
Sciences, Shiraz, Iran
Background: Visceral leishmaniasis (VL) is caused by Leishmania spp.
The protective immune response against this infection is mediated by a
strong cell-mediated immunity. Macrophage activation and nitric oxide
production induced by IFN-γ and TNF-α has an important role to kill the
parasite. There are some structural and functional similarities between
TNF-α and LT-α. In LT-α gene a substitution of A for G allele at position
+252 is associated with a higher production of this cytokine. Thus, the
aim of this study is to investigate the relationship between polymorphism
of LT-α (+252) gene and susceptibility to VL.
Methods: One hundred and twenty one patients presented with VL, 62
patients' healthy siblings and 102 healthy individuals who were resident
in endemic area and had positive leishmanin skin test were included in
this study. LT-α (+252) gene polymorphism was determined by PCRRFLP method.
Results: There were no statistical significant differences between studied groups in regard to alleles and genotypes of LT-α gene polymorphism
at position +252 (G/A).
Conclusion: Although an important role in macrophage activation and
elimination of the parasite can be considered for LT-α, we didn't find any
significant differences between the study groups. Therefore, genetic
analysis of the LT-α receptor and intracellular molecules responsible for
signal transduction seems to be necessary to clarify its role in controlling
the infection.
ISE.354
Control of Coccidiosis in Poultry
M.M. Ayaz1, M. Akhtar2. 1Livestock Dept., D.G.khan, Pakistan;
2
Immunoparasitology Lab. Uni.Agri.FSD, Faisalabad, Pakistan
An egg adapted gametocytes, E. tenella, vaccine(s) were used against
coccidiosis in chickens. On day five chicks were divided into four groups
and administered vaccine(s) orally viz; Vaccine I (gametocytes), Vaccine
II (gametocytes inactivated), Vaccine III (gametocytes sonicated inactivated) and fourth group was served as control given normal saline. On
day fifteen immunized chicks were challenged with 60,000-70,000 sporulated oocysts of mixed species of Eimeria. A total of one hundred and
twenty six birds were used in this study out of them ninety four birds were
scarified and thirty two chicks died during challenge response. On day
21st post vaccination birds were subjected to postmortem and their
lesions score were recorded. A maximum of 46 birds having lesions in
intestine and caeca of Group-IV birds were observed while a minimum of
17 birds having lesions in intestine and caeca were observed in GroupIII. There was non-significant difference (P>0.05) in lesions score of
Group-I, II and IV. Lesions scores in Group-III were significantly different
(P>0.05) from Group-I, II and IV.
ISE.355
The Significance of Anti Toxoplasma IgG and Ig M Antibodies
Detection in Toxoplasmosis Diagnosis
L.M. Junie1, Z. Coroiu2, A.N. Ferke1, P. Ciobanca1. 1University of Medicine
and Pharmacy "Iuliu Hatieganu", Cluj Napoca, Romania; 2Institute of
Hygiene and Public Health, Cluj Napoca, Romania
Methods: The incidence of antitoxoplasma antibodies was studied by
ELISA to detect Ig G and Ig M antitoxoplasma antibodies.
Results: Screening on 446 young females by serology performed for the
prenuptial examination, we diagnosed 15.5% of them as having anti
Toxoplasma Ig G antibodies. A study effectuated on 474 pregnant women
has demonstrated a possible acute Toxoplasma infection in 11.2% of
them. Investigating Ig M and Ig G antibodies, we have stated that in
38.2% of the pregnant women Ig G antibodies have been present in the
absence of the Ig M ones, revealing the protective immunity of those
women's. In 3.5%, of the pregnant women, we have found only Ig M antibodies in the absence of the Ig G ones, fact that seriously brings into discussion the acute toxoplasmic infection during pregnancy, and so of a
possible congenital transmission. In 7.7% of the cases Ig M and Ig G antibodies were present, demonstrating a toxoplasmic infection, probably in
evolution, a situation in which the infection moment is harder to be
detected, therefore existing a greater risk of congenital infection.
The toxoplasmosis is the cause for 8.5% of the tested congenital
malformations.
Conclusions: Prenuptial serologic examinations show that 84.5% of
young women are susceptible to an acute infection during pregnancy.
Toxoplasma gondii is responsible for 11.2% of pregnancy pathology. In
the case of pregnant women that have Ig M antibodies it would be very
useful to perform supplementary tests, such as the Ig A antibodies detection or the avidity towards the Ig G test, in order to establish precisely a
possible risk of a congenital infection. Our results emphasize the need for
a national surveillance and control program, due to the seriously consequences of these illness on children, family and society.
ISE.356
A Strongyloides Stercoralis Gastrointestinal Infection Burdened by
An Extraordinary Treatment Resistance, Probably Supported by An
Underlying Sjogren Syndrome Which Required Long-term
Corticosteroid Treatment
R. Manfredi1, S. Sabbatani1, P. Baccarini2, G. Marinacci1, F. Chiodo1.
1
Infectious Diseases, University of Bologna, Bologna, Italy; 2Department
of Oncological Sciences, Histopathology Unit, University of Bologna,
Bologna, Italy
Background: In the majority of otherwise healthy patients (p), strongyloidiasis (S) remains underestimated: only when some primary-secondary immunodeficiency occurs, S may involve multiple organs, outside the
more obvious gut localization,towards disseminated-relapsing manifestations.
Case Report: A female p who suffered from Sjogren syndrome treated
since over 20 y with cyclic oral steroids, due to dyspeptic signs-symptoms
underwent an endoscopy which detected a histopathology-confirmed gastroduodenal S. After a 3-day albendazole a repeated endoscopy-histology
showed a persisting S, so that a further albendazole cycle was administered, but 2 subsequent controls (4 and 10 months after) demonstrated
the persistence of S. stercoralis infection. Upon Hospital admission (9
months later), our p suffered from weight loss and anemia. Stool, sputum,
and urine search for S.sterocoralis tested negative,as well as HIV and
HTLV-1 serology, and tumoral markers. A 2-day ivermectine at 12
g/day,preceded a 3-day albendazole course performed the subsequent
week,and a 3-day mebendazole one week later. Repeated endoscopy
was performed one and 2 months after discharge,confirming a sustained
cure of S, associated with improved general conditions and a body weight
regain. During the entire evaluation-treatment period,the concurrent
steroid therapy (prednisone, 25 mg/day), deemed necessary for the concurrent Sjogren disease, was never interrupted.
Discussion: S is endemic in tropical-subtropical regions, where severe
associations were demonstrated in HTLV-1-infected p. In developed
countries, p with a broad spectrum of underlying diseases, or receiving
immunosuppressive drugs, may suffer from S refractory to first-line therapy, due the frequency of re-infestation. Although anecdotal reports
regarded p with chronic disorders and collagen vascular disease,no p
with Sjogren syndrome was reported to date. The described report is
therefore an unique association of a difficult-to treat S occurring in a p
with a steroid-controlled Sjogren syndrome. Since controlled trials and
definite recommendations are lacking, either albendazole, thiabendazole, ivermectin, or mebendazole at different dosages-schedules were
used, while the management of relapses lacks of evidence-based guidelines. Clinicians should also consider that S is expected to increase its
frequency, based on environmental changes (increased temperaturehumidity), just in countries where an increasing number of p become at
risk for opportunism.
ISE.357
Hiv-related Leishmaniasis Treated with Liposomal Amphotericin B
(LAB). Concerns on Nephrotoxicity and Administration Schedule
R. Manfredi, S. Sabbatani, G. Marinacci. Infectious Diseases, University
of Bologna, Bologna, Italy
Background: lAB is the 1st-line therapy of HIV-related visceral leishmaniasis (VL), based on favorable experiences, although often presented
small patient (p) series, and no agreement exists about is schedule of
administration.
Methods: Despite HAART, a HIV-infected p had a limited immune recovery (106 CD4 cells/µL), and VL was diagnosed after a 2-month history
of fever-fatigue-hepatosplenomegaly. An increasing leukopenialymphopenia (3660-620 cells/µL, respectively), and anemia, developed
subsequently.
Results: A short (6-day) course of lAB was administered at 3 mg/Kg/day.
Immediately after the end of therapy, moderate signs of both kidney and
hematological toxicity became apparent: increase of creatinine and urate
levels, associated with worsening anemia-leukopenia. Increased fluid
administration allowed the control of kidney impairment, and repeated
single administrations of lAB (3 mg/Kg), were performed after two and
four weeks. A bone marrow biopsy repeated 5 weeks after disclosed a
complete disappearance of Leishmania parasites, but a significantly
reduced marrow cellularity was shown (40% versus prior 85-90%;
p<.001).
Conclusions: lAB therapy of HIV-associated VL is a real advance.
However, our report raises different problems:
1. During HIV disease, VL may mimick opportunistic infections, and diagnosis may be hampered by a negative serology. An elevated clinical suspicion should prompt bone marrow biopsy.
2. Kidney-hematological toxicity even after short-term (6-day) administration of lAB recommends frequent monitoring. Nephrotoxicity must be recognized early,while bone marrow toxicity may occur later.
3. Our treatment schedule treatment included a 6-day attack, followed by
two single doses at 14th and 28th day, but other authors delivered 3-5
further doses according to varied schedules, since no uniformly recognized consensus exist. A standardization of therapeutic strategies of VL
is therefore needed.
ISE.358
Risks of Parasitological Infection Linked at Blood Transfusion
M. Tabi Zambo. Faculty of Medicine and Biomedical Sciences, Yaoundé,
Cameroon
This work has as aim to put into light the presence of parasites in donors
blood and their impact on the health of the persons transfused. It was
carried out in the blood bank of the Yaounde Central Hospital. The random sampling method used was that of non likelihood of convenience.
151 bags of blood destined for transfusion were analysed. Parasites such
as plasmodium, Microfilaria and trypanosoma were searched for. The
techniques used were thick film and thin film.
In whole, out of 151 bags, 50 contained parasites and 101 did not. This
gives 33% as against 67% respectively. The parasites identified in our
preparation were Plasmodium and microfilaria. Trypanosoma was not
present in any of the bags. Of the 50 bags having parasites, 45 of them
contained Plasmodium and 5 Microfilaria giving respectively 90% and 5%.
We noticed that of the 151 bags, 20 of them were from free donors and
131 were from family donors and the latter represents the group mostly
infected with parasites giving 86%.
These results permit us to confirm that blood transfusion represents a
great risk of parasitic infection and consequently represents higher therapeutic risk.
Key words: Blood transfusion, parasites, risk.
ISE.359
Current Therapy of Severe Imported Malaria
M. Pavlovic, G. Stevanovic, L.J. Dokic, J. Poluga, M. Pelemis, L.
Lavadinovic, B. Milosevic, Z. Dakic, I. Ofori. Institute for Infectious
Diseases, Belgrad, Serbia and Montenegro
A total of 141 patients with imported malaria were treated in the period
of 1994–2004.
According to WHO definitions 70% of this patents belong to the group of
severe/ complicated malaria.
Until 1998 all patients with severe forms of malaria were treated with quinine-tetracycline combinations. From 1998 quinine was replaced in therapy schedules with artemisinins. During 1998–2004 years 47 pts. aged
14–65 with severe forms of imported malaria were treated with
artemether in combinations with mefloquine or sulfadoxin/
pyrimethamine. Artemether was perforemed in 24 pts. i.m. in a dose of 80
mg twice a day at day one, whereas in the next 4 days single dose of 80
mg was administered. In 11 extremly ill pts. drug was performed three
days in a dose of 2 x 80 mg daily, while in 12 pts beta-artemether was
performed 300 mg at day one, and after that in next four days 100 mgr.
In 10 pts. artemether was performed after lack of fast parasitologic and
clinical response on other antimalarial drugs at the secon day of therapy,
while in all other artemether was admistered on the first day, combined
with sulfadoxine-pyrmethamine (1500/75 mg) or mefloquine. In four
extremly ill patients with parasitema> 30% artemether was addied to quinine therpy with excelent clinical success. Adequate fluid balance, controlled oxygen therapy, correction of anaemia with red blood cells transfusions (10 pts.), exchange transfusions (3 pts), in addition with antibiotic therapy (25 pts.), were important measures in the treatment of these
patients. Therapy was successfull in 46 pts (98%).Only one patient died,
immediately after exchange trasfusion.
Conclusion: Artemisins therapy of severe malaria has eqaul succesa
like quinin therapy, have less side events, is shorter and more confortable
for patients.
ISE.360
Cases of Giardiasis Labelled 'Asymptomatic' Are Not Always
Asymptomatic: An Insight into Atypical Presentation
I.A. Khan. Department of Community Health Sciences, Muhammad
Medical College, Mirpurkhas, Pakistan
Giardia lamblia, the aetiological agent of Giardiasis, is a fascinating, highly communicable most commonly encountered enteric protozoan pathogen
occurring worldwide, from tropics to Arctic Greenland with a global incidence of up to 30%. It has been customary to divide its clinical picture into
'symptomatic' (those with detectable gastrointestinal symptoms) and
'asymptomatic' (those without). This classification, however, could not
stand the test of time and has been subjected to debate. The present study
was conducted on 100 laboratory proven cases of Giardiasis which were
subjected to thorough clinical evaluation to correlate their symptomatology
with the infecting parasite. Typical clinical picture was found in 72%, gastrointestinal plus atypical in 21% and entirely atypical in 7% of the cases.
Eradication of the pathogen with specific antiprotozoal therapy resulted in
100% freedom from the symptoms (typical and atypical) in 100% of cases.
It was justifiably concluded that significant number of Giardiasis present
atypically but their clinical manifestations are attributed to other pathology
subjecting the patient to sophisticated investigations with resultant delay in
the management. This message, if well taken, would save the patient from
avoidable prolongation of the course of illness, physical agony, mental
anguish and unnecessary financial burden.
ISE.361
A Clinical Case of Fulminant Cerebral Malaria
C. Valente1, M. Ferreira1, J. Almeida2, L. Ribeiro2, L. Castro3. 1Serviço de
Doenças Infecciosas - Centro Hospitalar de Coimbra, Coimbra, Portugal;
2
Serviço de Hematologia - Centro Hospitalar de Coimbra, Coimbra,
Portugal; 3Serviço de Anatomia Patológica - Centro Hospitalar de
Coimbra, Coimbra, Portugal
Background: Plasmodium falciparum malaria is the most important parasitic disease infecting the CNS in humans. Cerebral malaria (CM)
occurs in 2% of patients and is rapidly progressive, pottentially fatal,
complication of that parasite.
Clinical Case: The authors describe a case report of a previously healthy,
caucasian 36-year-old male, who worked in Angola for 8 years, and travels to Portugal three times a year for vacation. He complained of low fever,
nausea and muscular pain since his arrival (15th December), symptoms
he attributed to a probable GI disturbance. On the 31st December there
was worsening of the symptoms with abdominal pain and vomit, reason
he went to the hospital. At time of admission he was dehydrated, afebrile,
with polypnea, periods of impairment of consciousness and macroscopic
haemoglobinuria. Blood analysis revealed metabolic acidosis, hypoglycemia, thrombocytopenia, renal and hepatic abnormalities with severe
hyperbilirrubinemia. Suportive care with fluids was done and later, blood
smears identified the presence of massive parasitemia due to
Plasmodium falciparum. In spite of all medical measures, including
Quinino e.v., coma, cardiovascular shock and acute respiratory distress
syndrome with ventilatory support occur and he died 4 hours later.
Conclusions: The mortality rate of CM is between 25-50%. If a person
is not treated CM could be fatal in 24-72 hours. This entity shoud always
be considered in the differential diagnosis of patients with fever, abdominal pain or nonspecific flu-like symptoms after travelling to endemic
areas, in order to perform a precocious diagnosis.
ISE.362
Survey of Fertile and Sterile Hydatid cyst in Intermediate Host
S. Rouhani Kalagari. Parasitology Dept., Faculty of Medicine, Shaheed
Beheshti University of Medical Sciences, Tehran, Iran
418 cows, 544 sheep, and 451 goats were studied in order to find out
prevalence of fertile and sterile hydatid cysts in liver and lungs. Puncture
of cysts in liver and lungs were carried out for diagnosis of fertile and
sterile hydatid cysts. Hydatid fluid was centrifuged for detection of protoscolices. Overall, in sheep 72.34% of cysts were fertile. Most of fertile
cysts were seen in the liver. In goats and cows, there are significant differences between the location of cysts ( in lungs and liver ) and type of
cysts (fertile and sterile). In goats, a significant percentage of cysts
(77.6%) were fertile. Majority of fertile cysts (68.20%) and most of sterile
cysts (56.38%) were seen in liver (p<0.005). In cows, majority of cysts
(61.76%) were sterile. Most of fertile cysts (71.85%) and most of sterile
cysts (66.06%) were seen in lungs (p<0.00 5). Polymorphism in parasite
and host in different areas could explain the above differences.
ISE.363
Oriental Sore: A Case of Cutaneous Leishmaniasis
G. Sengoz, K.K. Yasar, F. Yildirim. Haseki Training and Research
Hospital, Istanbul, Turkey
Background: Cutaneous leishmaniasis is zoonotic infectious disease
encountered in the Southeastern Anatolia endemically. According to the
health ministry data, 2497 cases were observed in Turkey in the year
2003, of which 2283 (91%) were reported from 4 provinces in the
Southeastern Anatolia Region. Istanbul is the largest metropolis of our
country where import 6 cases were observed.
Case: The case was a 23 years old patient who resided in Istanbul. He
had a history of traveling to Iraq 3 months ago. The patient applied to our
clinic with the multiple cutaneous lesions appearing on left cheek, left
arm and right leg. From the histopathological examination of the lesions,
tuberculoid granulomas with an appearance compliant to acute cutaneous leishmaniois were observed. Touch preparations were made from
skin, stained with a Wright-Giemsa preparation and examined for
amastigotes. On the skin lesions, Wright-Giemsa dyes revealed amastigots. The patient was administered topical stibogluconat treatment. The
lesions of the patients followed up recovered at the end of third month
with sequela.
Conclusion: The patient had worn undershirt and short while he was in
Iraq. We found the lesions in the exposed zones. The patient stated that
he had taken no protection. In the zoonotic infections where immunizer
protection is unavailable, simple protection measures can be taken to
prevent infection against zoonotic infections which pass through arthropods.
ISE.364
Cryptosporidiosis and Immunological Status in Children with
Malignant Diseases
N. Mahdi, G. Hasan, M. Al-Alsadoon. College of Medicine, Basrah, Iraq
Background: Cryptosporidium is one of the opportunistic disease, its
severity is related to the immunological status of the host. This is to investigate the relationship of this organism with malignant disease in children.
Methods: Stool samples were collected from 101 children with malignant
disease and 107 apparently healthy children. Direct smear method and
the formalin-ether sedimentation method were done for all stool samples
to recovery of intestinal parasites. Fecal smear were prepared from the
dsediment and stained by the modified acid-stained method for the
recovery of Cryptosporidium. Phagocytic activity, complement C3 and C4
estimation, Igg and CD3, CD4, CD8, CD19 phenotyping were carried out
for 30 patients with acute lumhocytic leukemia and 20 contro group.
Results: Leukemia was the major type (47.5%) of malignant cases. The
other type ranged from 0.99% to 10.9%. Out of the 101 patients,
50(12.15%) of the control group (P<0.01). Ceyptosporidium oocysts were
found to be excreted by 10 (9%) patients and 1(0.93%) of the control
group (P<0.01). The phagocytic activity, levels of IgM, IgA, IgG, C3, C4
and CD3, CD4 cell numbers were lower in patients than in control group
while higher in case of C3, C4, CD8 and CD19.
Conclusion: Children with malignancy are immunocompromised. Thus,
Cryptosporidium and other intestinal parasites must be considered in the
differential diagnosis in the risky groups in order to reduce the suffering
often faced by those children.
ISE.365
Prevalence of Giardia Species in People of Hamadan Rurals (West
of Iran) and their Dogs
K.H. Sardarian1, A. Dalimi2, H. Taherkhani1, A.H. Zahirnia1. 1Hamadan
University of Medical Sciencies, Hamadan, Iran; 2Tarbiat Modares
University, Tehran, Iran
Background: Since Giardia lamblia is a zoonotic parasite and in the
other hand, has been recognized as the most common intestinal
pathogen worldwide in human and some animals. Therefore, the aimed
to survey on the prevalence of Giardia in dogs and rural populations of
Hamadan (west of Iran).
Methods: In 2003, a total of 614 stool specimens from residents of the
rurals and 1500 from their dogs were taken. Stool samples by flotation
procedure with zinc sulfate solution and formol-ether examind.
Results: We identified Giardia in 65 (10.6%) of 614 people of rurals and
20 (1.3%) of 1500 their dogs. In age group of 7-11 the most prevalence
of Giardia was founded. Dogs with one and under one year old were the
highest infected age groups.
Conclusion: Prevalence of Giardia in dogs in this area to compare of
other regions relatively was low. Also, a few percent of my investigative
community infected with Giardia. Therefore, in this area, Giardia in both
of dogs and human is founded and rate prevalence of parasite is little.
However, to detect Giardia isolates in dogs and human (in this region) in
order to control of transmission parasite between dogs and human, further research is necessary to determine the rate of similarity and pathogenicity of Giardia species.
ISE.366
The Effect of Salinity and Low temperature on the Hatching of
Fasciola Ova
S. Rouhani Kalagari. Parasitology Dept., Faculty of Medicine, Shaheed
Beheshti University of Medical Sciences, Tehran, Iran
The effects of salinity and low temperature (4°C and 0°C) on the hatchability of miracidia were studied. Adult Fasciola were obtained from condemned livers at Ziyaran abattoir. The eggs were removed from the
uterus and placed in dechlorinated tap water. They were washed three
times to removed all the debris. Then, we prepared saline solution with
varying concentrations (0.2 - 2%). Each different concentration of saline
solution was placed in a 10 well culture plate. Afterwards, about 100 eggs
were transferred to each well culture plate (10 eggs/well). 100 eggs were
also placed in dechlorinated tap water, as control.
All the plates were wrapped in foil paper to avoid hatching. After 15 and
25 days, the eggs were exposed to light in order to trigger simultaneous
hatching of the miracidia. The percentage of the eggs which hatched on
the 15th and 25th days were counted. For the study of hatchability of
miracidia in low temperature, eggs of Fasciola gigantica were maintained
for 3 and 5 days at 0ºC and for 1 and 2 months at 4ºC. Then, they were
transferred to 22-26ºC (laboratory temperature). The rest of this method
is similar to the saline solution method. Miracidia of Fasciola hepatica are
able to hatch at any saline concentrations even at levels much above
physiological levels. However, an observable reduction in the hatching
rate was seen in 1-2 % saline solution. Moreover, the hatching rate of
miracidia in 0.2% was similar to control groupe. The hatching rates of
Fasciola gigantica ova at 0°C for 3- 5 days were 29% and 13% respectively. The hatching rates of miracidia after being placed at 4°C for 2
months (25%) was lower than for 1 month (37.5%). Even though, salinity and low temperature (0°C and 4°C) can affect the hatching rates of
Fasciola eggs, they are not able to inhibit the hatching. In any case, different environmental conditions could influence and cause various
effects on biology, life cycle and life process of organisms in the nature.
ISE.367
Influence of Agricutural and Social Activities on Suceptibility of
Agricultural Workers to Infectious Diseases
O. Dipeolu. American University of Antigua, School of Medicine, St.
John's, Antigua and Barbuda
The country of Antigua and Barbuda is one of the islands in the East
Caribbean region. In one of our investigations, infectious diseases common among farmers belonging to farming cooperatives and agricultural
workers which they employed were monitored for a period of 12 months.
Results indicate a predominance of geohelminth parasites especially
Ascaris lumbricoides and hookworm, intestinal protozoan parasites
including Entamoeba histolytica, pyogenic cocci, especially
Staphylococcus aureus and Streptococcus pyogenes, enterococci and
coliform bacteria, especially Escherichia coli. Some microorganisms
which can be pathogenic to humans were isolated from dissected houseflies and cockroaches collected from the homes. Large quantities of parasitic eggs and larvae as well as protozoan cysts were found in soil samples collected around most of the houses.
Although monthly analysis of the results indicated generally high infection rates especially with geohelminths and intestinal protozoa characterized by low numbers of parasitic eggs and intestinal protozoan cysts, the
agricultural workers showed increased numbers of parasitic eggs and
protozoan cysts in their feces on occasions such as after festivities, periods of intense agricultural activities in the farms ( such as land preparation for planting, harvesting etc) and occasions when they have bacteria
concomitant infection with heavy bacterial load, suggesting a breakdown
in immunity and state of endemic stability.
A 12 month investigation which is to show how widespread this phenomenon is among the agricultural workers in the country is now in its 10th
month. Consequently, a total of 10 farming cooperatives are now involved
each consisting of 50-250 members and each employing at least 20 agricultural workers. A list of 20 periods within the 12 months which consists
of occasions of intense agricultural activities, festivities when many of the
agricultural workers are subjected to alcohol exposure and stressful
sleepless nights, have been drawn up. The 12 month investigation will finish in April, 2006 and full results will be presented at the Conference in
Portugal.
ISE.368
Disseminated Echinococcosis Involving Brain, Spine, Spleen and
Heart
Y. Tezer, K.O. Memikoglu. Ankara University, Faculty of Medicine
Infectious Diseases Department, Ankara, Turkey
Hydatid disease also known as Echinococcosis, is a parasitic disease
and is caused by infestation of the tapeworm Echinococcus granulosis.
Although hydatid disease has been entirely eradicated in some countries, it remains a serious health problem in certain parts of the world as
in endemic in Turkey.
Most hydatical cysts occur in the liver (75%), followed in frequency by the
lung (15%). Involvement of the kidney(3%), bone (1-4%), brain(1-2%)
and heart (0.2–2%) are rare. Other sites such as the spleen, pancreas
and the muscle are rarely invoved, but it may develop in any part of the
body. This case is reported because of the rare localization of the disease
in same patient.
Case Report: A 31-year-old woman had been admitted to the neurosurgery clinic due to three years history of pain in her legs and had pins
and needles. Neurological and physical examination demonstrated normal findings. There had been no history of handling dogs or having
reared sheep. Magnetic resonance imaging of lumbasacral region had
been determined a cystic lesion on L4-S2 level. Then she had been operated for cystectomy. Histopathological examination had been reported as
hydatic cyst cuticula. After that indirect hemaglutination test had been
performed and it has been positive in 1/8192. And she treated with albendazole for 3 months. During her control examination, cystic mass was
detected in her left occipital lobe. Then treatment was planned to 6
months. At the fourth month of treatment she complained of dyspnea on
exertion. On physical examination systolic murmur had been heard. Left
ventricular cystic mass was detected in echocardography. So she had
been operated for cystectomy. Histopathological examination was confirmed the diagnosis. Then whole body was scanned for other cystic
masses. The cyst at spleen was detected. Then treatment protocol
changed with combination of albendazole and praziquantel.
Conclusion: No other organ involvement has been detected during a 2
year follow up. When faced with a hydatid cyst in any part of the body is
preferable to examine other parts of the body by radiological imaging
techniquies..
ISE.369
Retrospective Enteric Parasithological Study at a Buenos Aires City
Hospital
S. Zadcovich, V. Clementel, L. Carnival. Police Federal Hospital
Churruca Visca, Buenos Aires, Argentina
Introduction: Parasitological studies carried out in large clinics or City
Hospitals can be useful tools to monitories the state of health of populations living in endemic areas. Therefore, epidemiologist scientists have
the possibility to obtain representative cases and other additional information about factors that affect the onset of disease: availability of drinking water, waste systems and overall, the sanitary conditions. The goal of
this study is to determine the prevalence of enteric parasites by analyzing data of patients who attended to the Churruca-Visca Hospital.
Experimental: Between 1997 and 2002 we studied 12.225 patients.
Samples of anal mucus and feces were collected in 10% formalin. And
also, for some cases, one sample fixed in PVA was analyzed as well. The
samples were processed with the following techniques and analyzed
through optic microscopy: Ritchie's concentration, Sedimentation/
Centrifugation, Willis and Faust flotation techniques. To identify intestinal
Protozoa in trophozoite stage, like D.fragilis, we used Gomori Wheatley
Trichomic coloration and Ziehl-Neelsen's modified coloration was performed to identify coccidies, like Cryptosporidium spp. or Isospora sp.
Results: Due to the high proportion of patients under 12 years old, there
were several cases of Enterobius vermicularis (20.4%). We diagnosed 28
patients with Strongyloides Stercoralis. All of them were from endemic
areas from Argentina or others endemic countries. The cestodes
Hymenolepis nana and Taenia sp. are the most commonly founded in the
population. However, in this study there were found in low percentages,
0.11 % and 0.22%. One case of Hymenolepis diminuta infection was
diagnosed.
A significant decrease of infections due to Blastocystis Hominis from
44.41 % in 1997 to 20.94 % in 2002 was observed. There were fifteen
cases of coccidie infection (Cryptosporidium sp) in patients six year old
or younger. Dientamoeba fragilis (15.76%) was accurately diagnosed;
throw the Gomori-Wheatley trichromic coloration.
Conclusion: A sistematic and acurate parasithological study should be
carried out to improve the health of the population and to solve some clinical recurrent complications.
ISE.370
Education as Method to Control Schistosomiasis Infections in
Children
C.T. Wolmarans, L.R. Tiedt. North-West University, Potchefstroom
Campus, Potchefstroom, South Africa
Schistosomiasis is an endemic helminth parasitic disease present in the
rural areas of the Limpopo-, Mpumalanga- and Kwazulu-Natal Provinces
of South-Africa. These areas are characterised by a tropical climate and
numerous settlements lacking safe water and sanitation fascilities. The
disease is detrimental to the health of more or less three million people
living in these areas of which most are children between 4 and 15 years
old. People get infected while they are in direct contact with natural water
bodies, harboring the infected intermediate host snails. Controlling this
disease includes chemotherapy, snail control, provision of safe water and
sanitation fascilities and health education. The existance of other more
serious health problems such as HIV, malaria and tuberculosis are often
the cause that schistosomiasis control is not a main priority for the local
health departments. Controlling schistosomiasis must therefor be done
as cost effective as possible. We are currently busy evaluating the potential of different education methods including puppit shows, flip charts,
information bords, posters as well as by using caretakers trained on various aspects regarding the prevention of contracting this disease. By
making use of these methods we hope to change the children's behaviour in water which may possibly result in a decrease in the prevalence
and intensity of infections. The results of this investigation will be discussed.
ISE.371
Tegumentary Leishmaniasis and HIV: Lack of Association Between
Clinical Expression and Immunological Conditions
M. Hueb, A.B. Barros, G.V. Pazin, L.S. Campos. Federal University of
Mato Grosso, Cuiaba, Brazil
Background: Tropical areas usually have high prevalence of parasitic
infections. If HIV prevalence is also high the overlap is possible.
Visceral leishmaniasis/HIV co-infection has emerged mainly in
Mediterranean area of Europe but in India, Africa and Brazil, too. The latter shows a high prevalence of leishmaniasis as well as of HIV but not so
much cases of co-infection are reported. It could be supposed that in bad
immunological conditions the normal clinical expression of leishmaniasis
would be modified. Twenty three cases of tegumentary leishmaniasis
(TL) and HIV co-infection are reported as long as this condition has few
reports.
Methods: Patients were attended in a universitary hospital. Data about
epidemiological and clinical findings, blood analyses, including CD4 cells
counts at the moment of co-infection diagnose are presented.
Parasitological methods and Montenegro test were performed.
Results: Twenty one of patients were men, from 19 to 65-years-old.
Leishmaniasis expression range from isolated cutaneous (5 cases) to
disseminated form (4 cases, 2 with mucous involvement); there were 7
cases of espundia and 7 cases of mucocutaneous disease. HIV infection
was suspected and confirmed after Leishmania finding in 15 patients.
The minor CD4 count was 72 cel/mm3 in a mucocutaneous form; a
patient with mucous form showed the higher CD4 count (645 cel/mm3).
Disseminated form was presented in a patient with 74 CD4 cells but also
in another patient with 451 CD4 cells. Eight patients showed less than
200 CD4 cells, six of them with non-responsive Montenegro test.
Conclusion: In some co-infected patients TL develops as isolated form,
similar from the lesions in non-immunosupressed people. Disseminated
TL not always are present in immunosupressed patients. Mainly coinfected cases with TL strains should be closely monitored in order to
improve co-infection understanding.
ISE.372
Leishamaniosis Visceralis in the Republic of Macedonia
Z. Sopova, L.J. Krteva, S. Caparovska, M. Bosilkovski, M. Stevanovic, S.
Stojkovska, B. Joksimovic, L.J. Ilieva. Clinic for infectious diseases and
febrile conditions, Skopje, Former Yugoslav Republic of Macedonia
Aim: To show the basic demographic, clinical and laboratory characteristics and therapeutically effects among patients with Leischemaniosis
Visceralis.
Methods: In a retrospective study we follow 30 patients with Kala Azar
treated at the Clinic for infectious diseases in Skopje, Macedonia during
last five years. Leschmaniosis Visceralis was diagnosed with sternal
punction or with IIF.
Results: the patients were at average age 39 rank 3-69 years old. There
were 28 (93%) males in the study. In all of them motive for hospitalization
was FUO. Dominant symptoms without temperature in 30 (100%), dizziness in 23 (77%), lack of appetite in 15 (50%), weight loss and sweating
in 13 of each (43%) patients. All the patients had liver and lien enlargement, 20 of each (67%) lien enlargement was 4-10sm below costal margin. Main lab analysis were: elevated serum globulins 30 (100%) and
hypo albumins had 28 (93%) of the patients, anemia were register
among 27 (90%), leucopenia had 22 (73%), increased level of liver
enzymes had 22 (73%) of the patients. All of the patients were treated
with Glucantine, 60mg per kg. At the end of the treatment 28 (93%)
patient were queered with no sequels, two patients past away on the
beginning of the treatment.
Conclusion: FUO characterized with enlargement of liver and lien, anemia, leucopenia and elevated serum globulins should be tested on
Lischmania Visceralis, since this diseases is present in the region.
ISE.373
Evolution of Clinical and Biochemical Parameters Among Patients
with Kala Azar
M. Stevanovik, Z. Milenkovic, Z. Sopova, K. Spasovska. Clinic for
Infectious Diseases and Febrile Conditions, Skopje, Former Yugoslav
Aim: Evaluation of the clinical and biochemical parameters changes
among patients with Kala Azar before and after the treatment.
Method: Retrospektiv study of 30 patients with Kala Azar treated at the
Clinic for infectious diseases and febrile condition, Skopje in the period
from 1999 till 2005. All patients were initially checked up and after the
treatment with physical exam, lab analysis, serology analysis, and
abdominal ultra sound examination. Diagnosis was confirmed with positive IIF test and or bone marrow biopsy. All of the patients were treated
with Glucantime 60mg per kg during 28 days.
Results: All of the patients were febrile on the day of admission; they
were febrile average of 57 days before admission with median of the temperature 39,5C, defervescence median was after 3,7 days from the
beginning the treatment. All of the patients had enlarged liver palpable
about 2,6 sm and lien 4sm palpable below costal margin. Median of the
sedimentation rate on admission was 72mm/h before the treatment and
after the treatment 44mm/h, hb was 99gr/l before and after the treatment
120gr/l, Er- before the treatment 3,8x1012 and after the treatment
4,2x1012, WBC was median 3,5x109 before the treatment and after
5,6x109, ALT/AST on admission was median 94/187IU/L, and after the
treatment 86/50 IU/L, total proteins 76,5 gr/L and after 70 gr/L.
Conclusion: According the results of the sudy, all of the patients with
Kala Azarbefore the treatment are febrile, with enlarged liver and lien,
anemia, leucopenia, hepatic lesion and protein disorder. After the treatment there is a complete normalization of the clinical findings and biochemical disorders.
ISE.374
Epidemiological characteristics of Leischmaniosis Visceralis in R.
Macedonia
M. Paspalovska1, M. Stevanovic2, Z. Sopova2, K. Spasovska2, Z.
Karadzovski3. 1Medical Center - Bitola, Skopje, Former Yugoslav Republic
of Macedonia; 2Clinic for Infectious Diseases and Febrile Conditions,
Skopje, Former Yugoslav Republic of Macedonia; 3Republic Institute for
Health Protection, Skopje, Former Yugoslav Republic of Macedonia
Aim: Epidemiological characteristics of Leischmaniosis Visceralis in R.
Macedonia during the past 10 years.
Material and Methods: Analisis is made in the period between 19952005. Data is collected from the register for infectious diseases fom the
Republic institute for health protection, Skopje. We used descriptive and
analytic method analyze the data.
Results: In the period between 1995–2005, 60 patients with Kala Azar
were registered. Highest annual morbidity was registered in 2002 (9
patients). Higest specifics morbidity was noted among patients 15–19
years old and it is 16,7 (1/100 000). Analysis shows that population from
the city’s has the diseases more often then the population from the rural
area. Man are twice more then female: 41 (68,3%) of the patients are
man and 19 (31,7%) are female. Moust of the registered patients are on
age from 0–6 years: 30 (50%).
Conclusion: According the data, R. Macedonia as a Mediterranean
country, has Kala Azar as a diseases mostly among kids.
ISE.375
Hematological Complications in Patients with Imported Malaria
Hospitalized at the Margarita Island, Venezuela, 2001-2004
M.V. Ferrer1, M.A. Barrera1, M. Pacheco1, A.J. Rodriguez-Morales2, C.
Franco-Paredes3. 1Hospital Central Luis Ortega (HCLO), Porlamar, Isla
de Margarita, Venezuela; 2Center for Parasitological Research JWT,
Universidad de Los Andes, Trujillo, Venezuela; 3Div. Infectious Diseases,
Emory University, Atlanta, GA, USA
Background: Imported malaria constitutes an important public health
problem in many countries, even in those with endemic zones of malaria, where disease could be acquired in these areas and then seen in nonendemic regions. Non-immune populations are susceptible to complications due to malaria infection. In addition, P. vivax the predominant
Plasmodium spp. in Venezuela can cause severe malaria.
Methods: We describe the clinical features of patients diagnosed with
imported malaria at our institution in Margarita Island (a non-endemic
area), Venezuela, in a 4-y period.
We conducted a retrospective observational study to identify the clinical
and epidemiological features among hospitalized patients at HCLO with
imported malaria acquired at various endemic locations in Venezuela
during 2001-2004.
Results: During this period, 7 patients with imported malaria were hospitalized at our Institution. Diagnosis was confirmed by thin and thick
peripheral blood smears. Mean age was 28 years old; 71 % were males;
86% corresponded to Plasmodium vivax infection (acquired in Sucre,
northeastern Venezuela) and 14 % to P. falciparum (acquired in Bolivar,
southern Venezuela). All patients presented fever, malaise; 86 % myalgia, 71 % chills, 57 % headache, 42 % jaundice and coluria, 27 %
hematemesis and epistaxis, and 14 % hematuria, among others. Mean
Hb levels on admission were 8.0 g/dL (100% <12 g/dL); platelets: 66,000
cells/mm3 (100% had platelets below 150,000; but 29% <60,000); total
leukocyte count: 3.1 x103 cells/mm3 (85% had leukopenia). Laboratory
values after discharge included a Hb: 8.6 g/dL (t=-2.065; p=0.084);
platelets: 72,142 cells/mm3 (t=-1.153; p=0.293); and total leukocyte count:
4.9 x103 cells/mm3 (t=-4.333; p=0.005). Fifty seven percent of patients
required blood transfusions. All patients with P. vivax received CQ+PQ
and with P. falciparum Q+PQ. Mean hospitalization stay was 10 days.
One fatality was identified (CFR=14%) associated to severe malaria due
to P. falciparum.
Discussion: Imported malaria due to P. vivax and P. falciparum in our
population are associated with significant hematologic complications
such as severe thrombocytopenia and leukopenia (observed in 100%
and 86% of our patients). Our findings illustrate the importance of educating non-immune populations about malaria risk; and from a pubic
health perspective, the need to develop malaria prevention strategies at
a national level to avoid cases of imported malaria.
Pediatric Infections
ISE.376
Upper Respiratory Tract Infections Due to Haemophilus influenzae
in Children, West General Hospital, Caracas, Venezuela, 1993-2004
2
Background: Haemophilus influenzae is the most frequent bacterial
pathogen of respiratory tract infections in children. Detection of antimicrobial susceptibility of H. influenzae is necessary for institution of appropriate antibiotic treatments, especially for the emergence of resistant
strains. For these reasons we evaluated the antimicrobial susceptibility of
H. influenzae isolated from upper respiratory tract (URT) infections in
children in our hospital for the last 12 years.
Methods: Samples from upper respiratory tract infections in children in
our hospital (between 1993-2004) were evaluated for bacterial
pathogens, where, H. influenzae were selected for antimicrobial susceptibility evaluation. Antimicrobial susceptibility was evaluated with disk diffusion technique according to NCCLS.
Results: During study period, 85 strains were isolated from URT infections in 85 patients <12 y-old. Haemophilus influenzae was the 5th most
common species isolated in URT infections in children for the study period (5%). Mean age was 1.92±1.88 y-old (31.8% 6 y-old), corresponding
57.6% boys and 42.7% girls. Four per cent of patients were hospitalized
at PICU, rest corresponded to other pediatric wards. Isolates corresponded to: 75.3% ear, 12.9% nose, 8.2% throat, 2.4% tracheal aspirate and
1.2% tracheal. Isolated strains of Haemophilus influenzae were resistant
to trimethoprim/sulfamethoxazole (32.5%), tetracycline (29.5%), chloramphenicol (9.6%), and ampicillin (9.2%). No resistant strains were
observed for ampicillin/sulbactam, aztreonam, cefotaxime, ceftriaxone,
cefuroxime, ciprofloxacin and imipenem.
Conclusion: Considerable development of antimicrobial resistance has
occurred in the major pediatric bacterial pathogens, such as
Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus
influenzae. However, most of the respiratory infections that children suffer are viral and self-limiting, and only a small percentage of them will
develop secondary bacterial infections with the pathogens listed. The
challenge for rational antibiotic use is to determine which patients can be
treated conservatively and which require antimicrobial intervention to
avoid prolonged discomfort or development of permanent sequelae.
ISE.377
Primary Sclerosing Cholangitis As a Manifestation of Hyper IgM
Syndrome
M. Nabavi1, M.H. Bemanian2. 1Semnan Medical University, Semnan, Iran;
2
Yazd Medical University, yazd, Iran
Primary sclerosing cholangitis (PSC) is a chronic liver disease characterized by inflammation, destruction and fibrosis of the intrahepatic and
extrahepatic bile ducts that leads to cirrhosis of the liver. PSC is often
complicated by recurrent episodes of bacterial cholangitis. The cause of
PSC is unknown but many investigators suspect that it is an autoimmune
disease. Other etiologies, such as infectious agents, toxins or recurrent
infections of the bile ducts are also possible causes. About 30 % of
patients with PSC have elevated serum gamma-globulin concentrations
and about half have elevated serum IgM concentrations. About half of
patients have serum antibodies against a perinuclear antigen in neutrophil cytoplasm (ANCA) Although primary sclerosing cholangitis may
be asymptomatic, the most common symptoms are fatigue, jaundice,
pruritus, and abdominal pain. PSC is said to progress relentlessly to cirrhosis, although a patient's condition may remain stable years.
We report a 12 years old female diagnosed as a case of hyper-IgM syndrome who presented with recurrent infections and sclerosing cholangitis. She developed also Evans syndrome (autoimmune hemolytic anemia
and thrombocytopenia). Immunological evaluation showed decreased
levels of serum IgG and IgA with elevated levels of IgM. Liver biopsy
demonstrated the presence of idiopathic sclerosing cholangitis. The
patient was started on monthly IVIG therapy at 400 mg/kg and also prophylactic antibiotics, prednisolon and vitamin E with normalization of her
IgG and IgM levels and a decrease in the incidence of infections and normalization of liver function.
ISE.378
Actual Etiology of Acute Bacterial Meningitis in Children (ABMC) in
Cluj-Napoca, Romania
R.O. Iubu, D. Tatulescu, C. Jianu, C. Marcu, M. Flonta. Clinical Hospital
of Infectious Diseases, Cluj-Napoca, Romania
Background: The etiology of ABMC changed in the last 25 years and it
is varying with patient age, geographic area and socio-economic conditions. The etiology knowledge is essential to choice an adequate initial
antimicrobial therapy in order to reduce the risk of serious neurological
sequelae.
Aim: To determine the main etiological pathogens of ABMC, depending
on group-age and to evaluate the etiology changes from the last 25
years, in Cluj-Napoca city and neighbourhood regions.
Methods: The etiology of ABMC was prospectively analysed in 169
patients admitted in Paediatric Department of Clinical Hospital of
Infectious Diseases Cluj-Napoca, between 1999 and 2005. For etiological diagnosis we performed bacterial isolation from CSF and blood with
automatic BacT/Alert assay (Organon Teknika) and latex-agglutination
CSF with Murex Diagnostics tests. The results were compared with the
findings of 198 children with ABM studied 25 years ago, for the same
zone.
Results: The overall incidence of ABMC was 23 cases/10000 admissions, with 10,63% lethality rate. The median age was 3,7 years (range,
2 days to 16 years), male: female ratio 1,2/1. Majority of cases were registered in 3 month to 5 years group-age, 56,21% (95). The etiology was
determined in 82,84% (140) cases: by CSF culture 72,86% (102), gram
staining 7,14% (10), latex-agglutination CSF 16,43% (23), blood culture
3,57% (5). From 29 cases with unknown etiology, 72,41% (21) had
received previous antibiotic therapy. The main etiological agents were:
Neisseria meningitidis 42,14% (59), especially serogroup B (45,76%),
Streptococcus pneumoniae 18,57% (26), Haemophilus influenzae type b
11,43% (16), Gram-negative bacilli 10,71% (15), (E. coli 9 cases),
Streptococcus agalactiae and Staphylococcus aureus each 5 cases,
double etiology in 7 cases and other germs in 7 patients.
Conclusion: In the last 25 years the incidence of ABMC maintained
almost constant, but the highest incidence depending on age was moving to the right. The most frequent yielded germ remained Neisseria
meningitidis, but the incidence of Streptococcus pneumoniae, Gramnegative bacilli and Streptococcus agalactiae meningitis increased. The
raise of Hib meningitis incidence in our geographic area requires introducing Hib vaccine into the routine program of vaccination in Romania.
ISE.379
Serum Level of Anti-Measles IgG in Pregnant Women Higher Than
25 Years of Age and Their Newborns
A. Mohsenzade, K. Shahkarami, V. Almasi. LUMS-Madani Hospital,
Khoramabad, Iran
Background: Measles (rubeola) is a highly contagious and potentially serious viral infection, with a characteristic viral prodrome and rash. It was once
one of the most common and important infections worldwide, but it has
become very rare in developed countries where vaccine use is prevalent.
Approximately 30 million measles cases are reported worldwide annually. In Iran some Measles epidemis have happened in several times and
the new epidemia happened in 2002 and 2003 between children younger
than 9 months of age and after this epidemia all of Iranian people
between 5 to 25 years of age were vaccinated. The base of this study
was about the role of Maternal anti-Measles IgG as important factor in
protection against Measles in infants younger than 1 year before vaccination.The purpose of this study was determining the serum level of antiMeasles IgG in pregnant women higher than 25 years of age and their
newborns.
Methods: In this cross-sectional study, the data were collected by questionair and IgG antibodies in165 pregnant women higher than 25 years
of age and 165 newborns were measured through ELISA. Finally the
data were analysed by SPSS program and analytical tests.
Results: Among 165 studied pregnant women, 81.2% had low protective
level of anti-Measles IgG and Unprotective levels were found in the newborns too(81.2%).There was a direct relation between Maternal and
newborn IgG levels.(r=0.918)There was no relation between Maternal
IgG levels and sexuality of newborns. (PV>0.005)
Conclusion: According the results of this study, we use to suggest a new
anti measles vaccination for women higher than 25 years of age whould
like a new pregnancy in the future.
Key Words: Measles- IgG-Vaccination
ISE.380
Clinical Characteristics of Acute Surgical Abdomen and Mesenteric
Lymphadenitis in Children with Acute Abdominal Pain
J.K. Chang1, S.H. Cha2, J.S. Yoo1, C.H. Kim3, J.M. Hong2. 1Department of
Pediatrics, Hanil General Hospital, Seoul, Republic of Korea;
2
Department of Pediatrics, Kyunghee University, Seoul, Republic of
Korea; 3Department of Pediatrics, Sooncheonhyang University, Buchoen,
Republic of Korea
Background: Acute appendicitis (AP) and mesenteric lymphadenitis
(ML) in children is difficult to distinguish because of similar to clinical
symptoms and physical examinations, and non-specific findings. The purpose of this study is to find out useful clinical symptoms and signs to differentiation of AP and ML, and to know usefulness of abdominal sonography in children with acute abdominal pain.
Materials and Methods: This retrospective study included 185 patients
under 18 years old who visit Hanil General Hospital and Kyunghee
University Hospital with acute abdominal pain and examined with
abdominal sonography from Jan. 2004 to Dec. 2005. Patients were divided 4 groups; group A was ML without associated diseases, group B was
ML with associated diseases, group C was AP, group D was other diseases neither ML nor AP.
Results: Right lower abdominal tenderness and rebound tenderness
were more frequent in AP group than ML group (p<0.05). There was no
statistical significance in clinical symptoms, but recent history of URI was
more frequent in ML group than AP group (p<0.05). The mean white
blood cell counts, ESR and CRP values were more higher in AP group
than ML group (p<0.05). The mean sizes of mesenteric lymph nodes
were 10.6±3.7 mm, 11.3±4.5 mm, 9.1±2.5 mm in group A, B, and C,
respectively, but there was no statistical significance in sizes. Abdominal
sonography for detecting AP had a positive predictive value of 93.5%.
Conclusions: In children who visited to the hospital for acute abdominal
pain, if patients have either right lower quadrant tenderness or rebound
tenderness by physical examinations, then check for white blood cell
counts, ESR and CRP values. Further differential diagnosis work-up
should be taken such as abdominal sonography because of it's very fast,
safe, cost-effective, non-invasive and high accuracy detecting for AP and
ML, and detecting for other associated diseases.
ISE.381
Clinical Features of Acute Respiratory Distress Syndrome in
Children: A Retrospective Single-Center Analysis
T.J. Lee, D.S. Kim. Severance Hospital, Seoul, Republic of Korea
Acute respiratory distress syndrome(ARDS), an acute form of severe
alveolar-capillary injury evolving after a direct or indirect lung insult, is
thought to be a common cause of respiratory failure though not many
clinical studies on the subject have been made yet.
Between January 1992 and December 2005, we conducted a retrospective study on 44 children who fulfilled the ARDS recommended by the
American-European Consensus Conference in 1994.
A total of 44 patients(28 boys and 16 girls) were selected. Their age
ranged from 4 months to 12 years with eight children younger than 1
year. Concerning seasonal variation, incidence of the ARDS increased in
spring(39%). The overall mortality rate was 77.3% and no significant difference was not noted based on age or sex. Pneumonia(68.2%) was
found to be the most common risk factor of the ARDS followed by sepsis(22.7%) and aspiration(4.5%). In neutropenic children(seven cases),
including a recipient of bone marrrow transplantation, the mortality rate
was 100%. Compared with children with nonpulmonary organ dysfunction recording a 100% mortality rate, those with isolated respiratory failure, showed a lower mortality rate of 69.7%(p=0.040). Between survivor
and non-survivor groups, significant differences were shown in
PaO2/FiO2 and P(A-a)O2 on the third and seventh day after the onset of
the ARDS(p<0.01).
Factors whose presence can be used to predict the risk of death at the
time of diagnosis of ARDS include nonpulmonary organ dysfunction.
Initial indexes of oxygenation and ventilation do not predict outcome.
However, the failure of pulmonary function to improve during the first
week of treatment is a negative prognostic factor.
ISE.382
Etiological Aspects of LRT Inflammation Among Immunocompetent
Children
L. Zabaznoska, L. Ilieva, V. Markovski, V. Semenakova. Clinic of
Infectious Diseases, Skopje, Former Yugoslav Republic of Macedonia
Introduction: Acute infection of LRT indicating an inflammation of the
pulmonary parenchyma caused by microorganisms, determinate few
groups of LRTI named as: CAP, NP, PAID, AP, etc. This classification also
indicates thew etiological moment of the supposed microorganism as a
general standard for a prompt and appropriate antibiotic therapy before
the etiological improvement.
Aim: Retrospective study of etiological aspects of LRTI among hospitalized infant patients (<16 aged) in our department in a 2 year long period.
Material and Methods: A series of 57 infant patients with LRT inflammation, radiological confirmed, with at least presence of three main signs for
a pulmonary acute infection like fever, cough, fatigue, inapatentia,
increased sedimentation, lecocytosis, was proceeded. Among the Seri of
bacteriological testings, IIF (IgM) as a serological test, gave the ethiological confirmation, dividing this group of patients as: 42 confirmed, 15 with
no ethiologic confirmation, pointing out Haemophylus influenzae-12
cases, Mycoplasma pneumoniae-9, Pneumoccocus-6 Streptococcus
haemoliticus-7, Chlamydia psitacci-1, Staphylococcus-2, Legionella-0;
viral Influenza-5, Parainfluenza-9, Parapertussis-2, Varicellae-4 cases,
with paralel findings of viral/bacterial IgM for pneumonia/bronchopneumonia in 11 children.
Conclusions: From the group of 57 patients with LRTI, etiological confirmation was obtained in 42(73.7%), with bacterial identification of
37(64.9%), pointing out the domination of Haemophylus influenza
(28.6%) and Mycoplasma pneumonia (21.4%), viral confirmation in 20
cases (35.1%), including the 11 infants with IgM positive antibodies to
both viral/bacterial microorganisms. Rigorous assessment of the parameters characterizing LRTI, the etiological data for the acute lung inflammation, our experience as well as the data given by WHO and ERS gave
us the competency for the first antibiotic choice effective as the initial
therapy.
ISE.383
Screening Gipsy Children for Infectious Diseases
N. Manakou, A. Giannisi, O. Gkika, P. Anastasopoulou, S. Liosi, G.Z.
Zantopoulos, K. Gantas, C. Rossas, P. Pantazi, Z. Patrona. Paediatric
Department, General Hospital of Korinthos, Korinthos, Greece
Background: Infectious diseases are a frequently encountered problem
in childhood. This study was conducted to investigate retrospectively the
types and rates of infectious diseases in all gypsy children which were
hospitalised in our Paediatric Department during the last year and correlation of their admissions and season.
Methods: Medical data of 299 gypsy children, aged 3 months to 14
years old, which were hospitalized in our paediatric department over a
year period, were studied. The mean age of the population was 6.2±1.2
years.
Results: A number of 215 (71.6%) children of total amount were hospitalized for a type of infectious disease. 79% of patients had incomplete
age-appropriate vaccination coverage. Respiratory infections represented 37.8% of all types of infectious diseases, gastroenteritis 52.3%, urinary tract infections 4.7%, meningitides 1.0%, vaccine-preventable infections 3.2% and others 1%. The infection rate recorded in winter was significantly reduced in other seasons. The mean duration of hospitalization
was 2.27 days, whereas the outcome was over ally favourable.
Conclusion: The results of this study confirmed high rates of infections
in gypsy children, particularly in winter, which proceeded from the deficient hygienic conditions and overcrowding in their camps. Despite the
appropriate immunization status of gypsy children, vaccine-preventable
infections are rare. Paediatricians must give the best possible care for
these children and act as their advocates.
ISE.384
Complications of the Children Mononucleosico Syndrome (SMI)
A. Valera, P. Magdaleno, T. Vanegas, Y. Aguilar, S. Sevilla. Hospital
Universitario Dr Angel Larralde, Valencia, Venezuela
Introduction: It is been know by fever, lymphaadenopathypathy, pharyngitis, rahs, muscle pain, hepatoplenomegaly more lymphocytos and atypical lymphocytes in peripheral blood. Complications include: no
Neurological; Prolonged and serious Thrombocytopenia, leukopenya,
pneumonitis, myocardioperycarditis, retinitis, Oncogenesis (lynfophoproliferative syndrome, Burkiit lymphoma), Serious Mononucleosis and respiratory Obstruction; Neurological: Encephalomielytis, Meningoencephalytis, Guillian Barré Syndrome, Neuryitis and convulsions
Methods: Descriptive and prospective investigation. Format was made
to collect the data of each patient hospitalized by complicated SMI,
January 2004-2006, the sample was 50 patients
Objective: Establish involved of the etiologic agents SMI. Determine the
age and sex. Determine the complications. Establish the specify treatment.
Results: Sex: male 62.22%. Age: prescholar 28,88% and scholar
22.22%. EBV(Epstein-Bar virus (EBV) 50%, CMV(Citomegalovirus)
22%, VIH (Virus of Human Inmunodeficy) 6% and others (Toxoplasmosis
4 cases, VHA 1 case, Herpesvirus 6, 1 case). Nonneurological complications l 86,45% and neurologica 13,94%; Prolonged and severe anemia,
leukopenia 23,65%, th, rombocytopenia burdens 20,43%, intrahepátic
cholestasis 9,65%, encephalomylitis more convulsions 9,67% myocardioperycarditis 6,02 %, Oncogenic (2) + of relapse LLA (2) 4.30%.
Prolonged and severe Leukopenia, thrombocytopenia burden, myocardioperycarditis and oncogenic + relapse LLA was associated to EBV
100%, encephalomylitis and convulsions associate 50% and CMV and
EBV associate meningoencephalytis, EBV 80% CMV and associated
intrahepatic cholestasis to CMV and toxoplasmosis 80%. Diagnostic:
Serology 80 %, blood RPC (80%), RPC LCR (10%), RPC tissue Biopsy
(2%), viral load (2%). Treatment: EVB: metilprednisolone 100%, antineoplastic drugs in leukemia and lymphoma 20%; CMV: ganciclovir and/or to
valganciclovir more metilprednisolone 100%; Antirretroviral VIH (AZT,
3TC, Lopinavir-ritonavir); 4 (8%) patients passed away (1 carrier
Lymphoma of Burkitt and 1 abdominal lymphoma non Hodking, 1 severe
patient VIH pancytopenic, 1 myocardiopatia expanded with refractory
cardiac insufiency
Conclusions: The complications SMI were in hematopoyetic system;
they specially lead to relapses and death in paediatric hematooncology
patients.
ISE.385
Changes of Antibiotic Resistance Rates of Acinetobacter baumanii
in Pediatric Burn ICU During the 5 Years
K.N. Kim1, S.M. Lee1, D.S. Jo2, J.K. Hur3. 1Department of Pediatrics,
Hallym University, Seoul, Republic of Korea; 2Department of Pediatrics,
Chonbuk National University, Jeonju, Republic of Korea; 3Department of
Pediatrics, The Catholic University, Seoul, Republic of Korea
Background: Acinetobacter baumanii is a gram-negative coccobacillus
that is usually resistant to antimicrobials, mainly B-lactams, aminoglycosides and fluoroquinolines. A.baumanii is a relatively frequent cause of
epidemics in burn units, although it is not always associated with an
increase of mortality. Nosocomial infections caused by multi-drug resistance A.baumanii is very difficult to treat.
Method: We monitored the micorbial flora evolution and their resistance
to antibiotics by cultures of burn wound in Pediatric Burn ICU. Bacterial
identification and antimicrobial susceptibility test were performed by ATB
and Vitek system in 88 strains(49 pateints) of A.baumanii. This study was
designed to investigate the antimicrobial resistance characteristics since
1999 thru 2004 in Han-Gang Burn Center, Korea.
Result: 49 burn children(88 strains) were infected at some sites by
A.baumanii. There are burn wound (65%),sputum (20%),IV site (9%),
endotracheal tube (3%) and blood (3%). More than half of them are
under 5 years of age. Ampicillin resistance rate against A.baumanii was
71% in 1999 but the resistance rate was changed to 96% in 2004.
Ampicillin-sulbactam sesistance rate was increased from 71% to 93%.
Ceftazidime resistance rate increased from 37% to 90%. Cefepime 12%
to 61%. Gentamicin 87% to 90%. Amikacin 37% to 90%. Ciprofloxacin
25% to 90%. Imipenem 25% to 90%, respectively.
Conclusion: Acinebobacter baumanii strains are rapidly changes to
multi-drug resistant microorganism in our burn PICU during the 5 years.
We need the education on infection control and effective surveillance for
antibiotic resistant organisms. These are important measures in the prevention and control of such multi-drug resistant infections in burn ICU.
ISE.386
Re-Investigation on The Clinical Impact of HCV MTCT
A. Ikeda, N. Inaba, K. Oshima, M. Nishikawa, Y. Okajima, A. Shoda, T.
Okazaki, Y. Okazaki, K. Tada, N. Tadokoro, H. Watanabe, H. Takamizawa.
Dokkyo Medical University School of Medicine, Mibu, Japan
Background: We concluded that the clinical impact of HCV MTCT was
not so significant due to the lower MTCT rate (7.2%) and higher infantile
recovery rate from HCV carrier-state (66.7%) in the 5th World Congress
of Perinatal Medicine held in Barcelona, 2001. However, Shiraki group,
which is supported by the Ministry of Health, Labor and Welfare and
involves us, has recently reported the much higher HCV MTCT rate and
the lower infantile recovery rate from carrier-state. Thus, we re-investigated the various factors of HCV MTCT in the two groups, ie, the new era
(1995-2004) and the old era (1989-1994).
Methods: One hundred and five and 55 infants born to HCV carrier
women were respectively involved to the old and new era groups. The
pregnant women and those infants were tested for HCV-related antibodies and finally for HCV RNA by nested RT and real time PCRs. These two
groups were compared with the HCV carrier rate of pregnant women,
MTCT rate, manifestation of abnormal liver function and the prognosis of
the carrier infants.
Results: In the both groups, the HCV carrier rate of pregnant women,
the frequency of abnormal liver function in the carrier infants and the
MTCT rate were respectively 0.60/0.68%,66.7/66.7% and 14.7/7.3% (the
old/new eras).
Conclusion: In the two groups, the HCV carrier rate of pregnant women
and the manifestation of abnormal liver function in the carrier infants
were almost similar. However, the MTCT rate markedly increased in the
new era group while the infantile recovery rate from carrier- state
decreased also in the same group. These data strongly indicates the further group study to evaluate the precise clinical impact of HCV MTCT.
ISE.387
IgM Antibodies Against L. pneumophila Sg 1 in Children
Hospitalised with Community-acquired Respiratory Tract Infection
in IP CZD from June 2005 to January 2006
K.W. Pancer1, A. Pawinska2, J. Ksiazek2, J. Friedman-Gruszczynska2, D.
Dzierzanowska2, H. Stypulkowska-Misiurewicz1. 1National Institute of
Hygiene, Warsaw, Poland; 2The Chldren's Memorial Health Institute (IP
CZD), Warsaw, Poland
Background: Legionellosis is usually diagnosed in adult patients
belonged to risk group like: diabetics, smokers, patients after long antibiotics or steroids treatment, elder people. However, little is known about
legionellosis among children, the incidence rate and symptoms.
Methods: In our study serum samples from 44 admitted to hospital children were tested for L. pneumophila sg 1 and Mycoplasma pneumoniae
infections using EIA commercial tests. The children were hospitalized
from June 2005 to January 2006 because of respiratory tract infections.
The age of children was in range from 1 month to 14 years, 50% of
patients were 4 years old or younger.
Results: The significant level of IgM antibodies to L. pneumophila sg 1
was found in serum samples collected from 9 (20,5%) patients, the
equivocal result was found in additional 3 (6,5%) patients sera. In the
0–4 years old children group: 3 out of 22 had the significant IgM level to
L. pneumophila antibodies, two - showed equivocal result.
The significant level of IgM to M. pneumoniae was found in sera of two
patients (4,5%) only. Those two patients had the significant level of IgM
to L. pneumophila sg 1 also. It might be due to co-infection of L. pneumophila sg 1 and M. pneumoniae
Conclusions: Our study shows that L. pneumophila may frequently be
unrecognized as an aetiologic agent of atypical respiratory tract infection
among children.
ISE.388
Meningoencephalitis: A Rare Presentation of Epstein Barr Virus
Infection
G. Jesus, D. Sá, F. Freitas, J. Rente, C. Oliveira. Hospital Infante D.
Pedro, Aveiro, Portugal
Introduction: Epstein Barr virus (EBV) infection is usually a mild disease. Rare and fatal complications have, nevertheless, been described.
Neurological presentation of the disease occurs in less than 1% of infection, mostly in paediatric patients. Occasionally, neurological involvement
is the unique manifestation of E.Barr infection and it can present as
meningoencephalitis, acute cerebritis, Guillan-Barré neuropathy, transverse mielitis and cranial nerve palsy.
Case Report: A previous healthy 16-year old boy presented with fever,
obtundation and psychomotor agitation. He complained of sore throat
and cervical bilateral nodal enlargement since two weeks earlier. He presented meningeal signs and he rapidly evolved to coma (Glasgow 6),
with no focal neurological signs. Further physical examination was normal. A head CT scan showed no abnormalities. Blood cell analysis presented raised lymphocyte and monocyte count with atypical lymphocytes. He also had mild raised aminotransferases. CSF analyses disclosed slightly raised protein, normal glucose, 14 cells/mm3 and yelded
no growth. He empirically started IV Acyclovir and Dexamethasone. CSF
PCR for Herpes virus (including E.Barr), T. gondii and M. tuberculosis
was negative. Electroencephalography showed global lentification. On
MRI putamen and basal ganglia gave low signal on T1 and high signal
on T2 weighted images with no abnormal contrast enhancement. At 7th
day of hospitalization his condition gradually began to improve. He was
discharged at day 15, revealing psychomotor lentification and bradicinesia, which were fully reverted at consultation, two months later. Epstein
Barr blood serology was consistent with acute infection.
Conclusion: EBV meningoencephalitis pathogenesis is usually attributable to direct lesion of CNS by the virus or to post-infectious autoimmune
deregulation phenomena. In our patient, the time of presentation of neurological signs, the absence of EBV in CSF as well as the imagiological
findings may suggest that the second mechanism was probably involved
and that steroid therapy was relevant.
ISE.389
Infectious Diseases as Severe Illness in Under Fives: Recognition
and Health Seeking Behaviours in Mubende District Uganda
J. Rujumba1, E.A. Mworozi1, R. Azairwe2, B. Mpeka3. 1Makerere
University Medical School, Kampala, Uganda; 2World Health
Organization (Uganda), Kampala, Uganda; 3Ministry of Health, Kampala,
Uganda
Introduction: Uganda is one of the countries conducting a WHO/TDR
funded multi centre study on the early and controlled deployment of
Rectal Artesunate in the management of severe malaria in under-five
children at community level. Children-under five years suffer from various
illnesses, malaria being the commonest. This study was conducted to
identify the common severe illnesses at community level and inform the
deployment phase of the study.
Objective: Establish the manifestations of severe illnesses in children and
caretakers treatment seeking behaviours.
Methods: The rapid assessment study selected Mubende district. A
multi-stage cluster sampling technique was used to select study subcounties and villages. Qualitative methods were predominantly used
including focus group discussions and in-depth interviews with community key informants, health workers, traditional healers and mothers
whose children were admitted due to severe illness.
Results: Severe illnesses mentioned included; malaria/fevers, cough,
diarrhea and vomiting, HIV/AIDS and anaemia. Fever ranked highest as
a cause of illness and death in under five children. Convulsions, failure to
eat, lethargy, anemia, dehydration, coma and difficult breathing were
indicators of severe illness.
Most sick children were first managed at home using both modern and
herbal medicines and taken to health facilities when illnesses progressed. Few caretakers took their children to traditional healers.
Conclusions: 1. Commonest reported severe illnesses were, malaria,
RTI and diarrhea and vomiting. These findings depict a high burden of
infectious diseases. 2. Symptoms associated with severe illnesses were
fever, convulsions, difficult breathing, lethargy, anemia and dehydration.
3. Most sick children were treated at home. Those with severe illness
were taken to health facilities. 4. Above findings informed the IEC deployment strategy.
ISE.390
Kawasaki Syndrome: Our Experience
G. Kuli-Lito, E. Kallfa, H. Hoxha, R. Petrela, A. Kallfa, F. Plaku, I. Bujari.
University Hospital Center "Mother Teresa", Tirana, Albania
Kawasaki syndrome is not often encountered in our country. Since
January 1995 to December 2005, only 9 children met the diagnostic criteria of the disease.
Aim: To analyze epidemiological data, clinical manifestations, time of the
diagnosis, outcome and complications of Kawasaki Syndrome (KS).
Material and Methods: The diagnosis of KS was established based on
CDC criteria. The children were followed up to 1 year after the recovery.
Results: Seven boys and two girls aged 10 months to 5 years had suffered by KS during this period. The disease was more frequent at spring
time. All cases represented persisting fever more than 10 days, changes
in extremities (eritema, edema, periungual peeling of fingers), polymorphous exanthema, enlarged cervical lymph nodes, changes in lips and
oral cavity. Bilateral conjunctivitis was found at 7 patients, while arthritis
and diarrhea at 4 of them.
Laboratory findings showed trombocytosis, leokocytosis with left shift,
elevated ERS. Half of patients had abormal values of liver enzymes.
Involvement of CNS with moderate pleocytosis was found in one patient.
The diagnosis of KS was established during the second ten days after
the onset of the symptoms. All children were treated with acetylsalicylic
acid in seven cases combined with intravenous immunoglobulin therapy.
No one of the children receiving combined therapy, developed cardiac
complications. One patient had coronary aneurism after three months.
Conclusions: Low incidence of KS in our country is similar with references from the other European countries. Immune therapy was successful and efficient for an outcome without complications.
ISE.391
A Report on HIV-infected Child with Recurrent Parotitis
S.H. Armin1, S. Rafiee Tabatabaei2. 1Faculty member of Shaheed
Beheshti University of Medical Sciences, Tehran, Iran; 2Faculty member
of Arak University of Medical Sciences, Tehran, Iran
Human immunodeficiency virus (HIV) infection in children causes a
broad spectrum of diseases and a varied clinical courses. Parotitis is one
of the manifestations of paediatric HIV infection, that occurs in 4-47% of
children. We present a 4 year old boy with recurrent bilateral parotitis.
This patient was admitted 2 times in Mofid with diagnosis of Iron deficiency anaemia and chronic hepatitis. During the last admission for recurrent
parotitis, based on clinical and paraclinical findings, he was suspected to
HIV infection that was confirmed with laboratory tests. The source of
infection was his mother and HIV was transmitted perinatally. His father
has had illegal sexual contact previously. So we should be careful of
AIDS in children.
ISE.392
Be Careful of AIDS in Children: A Report on HIV-Infected Child with
Recurrent Parotitis
S.H. Armin, S. Rafiee Tabatabaei. Pediatric Infectious Research Center,
Tehran, Iran
Human immunodeficiency virus (HIV) infection in children causes a
broad spectrum of diseases and a varied clinical courses. Parotitis is one
of the manifestations of pediatric HIV infection, that occurs in 4-47% of
children. We present a 4 year old boy with recurrent bilateral parotitis.
This patient was admitted 2 times in Mofid hospital for pallor and abdominal distention during 2 past years and was discharged with diagnosis of
Iron deficiency anemia and chronic hepatitis. During the last admission
for reccurent parotitis, based on clinical and paraclinical findings, he was
suspected to HIV infection that was confirmed with laboratory tests. The
source of infection was his mother and HIV was transmitted perinatally.
His father has had illegal sexual contact previously.
ISE.393
Incidence of Streptococcus pneumoniae in Neonatal Intensive Care
Unit
A. Szumala-Kakol1, I. Wojsyk-Banaszak2, J. Szczapa2, A. Kornacka2, J.
Gadzinowski3. 1Bacteriological Laboratory, Gynecological-Obstetrics
University Hospital, Poznan, Poland; 2Department of Neonatal Infectious
Diseases, Univesity of Medical Sciences, Poznan, Poland; 3Department
of Neonatology, Univesity of Medical Sciences, Poznan, Poland
Background: Streptococcus pneumoniae is a well established infectious
agent in infants and younger children. It also seems to be an emerging
pathogen in the neonatal infections
The aim of this study was to evaluate the incidence of Streptococcus
pneumoniae in the Neonatal Intensive Care Tertiary Level of Care Unit.
Material and Methods: Data were collected prospectively from medical
records of patients hospitalised from 1st January to 31st December
2005. Susceptibility testing of Streptococcus pneumoniae was performed
using disc agar diffusion method. For isolates resistant to penicillin MIC
was determined using Etest
Results: Streptococcus pneumoniae was isolated from 73 neonates
which is 1.05% of all neonatal patients in this period. It was isolated from
endotracheal tube in 6 cases and from bronchial aspirate in 10 cases.
Remaining isolates were retrieved from pharynx. The total of 14
neonates presented with pneumonia, three of them with early-onset
infection. No other systemic infection caused by Streptococcus pneumoniae was diagnosed in our Department. Mean gestational age of affected neonates was 32 weeks (range 25-40), mean birth weight was 1906
grams (range 650-4600). There were 45 boys (62%) and 40 newborns
(55%) were delivered by cesarean section. 21 neonates (29%) were
transported to our Department from other hospitals and 86% required
mechanical ventilation in the course of their hospitalisation.
Streptococcus pneumoniae was isolated on average on the 25th day of
life (range 1st-131st day). 6.3% of pharyngeal isolates were sensitive to
penicillin, cotrimoxazole and tetracycline 4.2% to erythromycin, 10.4% to
clindamycin, 81.2% to ofloxacine, 75% to quinpristine/dalprostin and
100% to rifampicin. 5,5% of bronchial/tracheal isolates were sensitive to
penicillin, 38.9% to ofloxacine, 11.1% to quinpristine/dalprostin and
77.8% to rifampicin. All isolates were sensitive to wancomycin,
teicoplanin and linezolid.
Conclusions: Streptococcus pneumoniae seems to be an important
pathogen both of early-onset and late-onset neonatal pneumonia.
ISE.394
Antibiotic Sensivity (MIC) of Agents in Bacterial Meningitis of
Children
F. Khodapanahandeh, S. Noorbakhsh, A. tabatabaei. Iran Medical
University, Tehran, Iran
Introduction: Bacterial meningitis is one of the most serious infection in
infants and children. Three organisms include S.Pneumo; N.mening;
H.Influ are the most common cause of meningitis in children between
2M-14y age. Etest is a new method for determination the MIC of some
antimicrobial drugs in agarose. This method is useful for some organisms
like as S. Pneumo; N. mening; H. Influ; sensitive Streptococcus and
anaerobic; aerobic gram negative.
Method and Material: In this descriptive cross-sectional study (57 suspected meningitis cases in children) organisms were isolated from blood,
CSF, or other sterile body fluid. After culturing and antibiogram, MIC of
some organisms was detected by Etest method.
Results: Streptococcus was the most prevalent (70%) and S.pneumon
(90% of all Streptococcus); H.infl 2%; N.mening 4% and L.monocyt 6%
(more than expected); Gram negative (Ecoli; Klebsiella; entrobacter and
pseudomona)18%. There was significant difference (P =0.01) in type of
organisms between age groups. S.pneumonia was more frequent in children > 2 year; N.meningitis in > 4yr old. Site of isolation: blood; CSF
(35.8*;28.3%) other sterile site 18.4%; concomitant positive culture in two
site: 17%. Mean age in Streptococcus was significantly different with
Listeria(p=0.05); N.meningitis(p=0.04); H.influ(p=0.04); but no difference
with Staphylococcus; Klebsiella and E.coli
Two type of H.inf were sensitive to Ampici or chloram; both of them were
sensitive to ceftiaxon.
GBS were sensitive to PNC or Ampici
Strep.nonAnonBnon-Cotrimoxazol>32mic/ml/PNC
>256mic/ml/Vanco>256mic/ml
Strep.D:
Cotrimoxazol>0.062mg/ml PNC >0.016mic/ml/Imipenem>0.032mic/ml.
Strep Pneumonia:
All fo them were sensitive except 3 cases
Cotrimoxazol>2mic/ml /PNC =0.01mic/ml/Vanco>0.125mic/m
Vanco>0. 25mic/ml/Cotrimoxazol>2ic/ml/PNC =0.01mg/ml
Vanco>0.125mic/ml/Cotrimoxazol>2mic/ml/MIC-PNC >0.016mic/ml
Therefore high dose of PNC is adequate for S.pneu because of Interm
resistance to PNC. All 3 N.menin were sensitive to PNC;Chlora;Ceftria
and vanco resistant to all drugs and high MIC for
cefotaxime;CIPRO>32mic/ml. E coli:
Pseudomona Aerogenosa::
Ceftriaxon>256mic/ml/Genta>0.038mg/ml
Imipenem>32mic/ml.
Klebsiella; only Sensitive to Cipro
Staph. aureus: Sensitive to Clinda; Cipro; Chlora; Resistant to Ceft; PNC
and Cotri
Conclusion: Most type of N.meningitidis; H.inf and S.pneumonia were
sensitive to many drugs. Only minority of them were resistant to
Ampicillin but sensitive to chloramphenicol and vice versa. limited number of pneumococcal resistance to penicillin is medium resistance
(MIC:0.1-1). We can treat this resistant type by increasing of penicillin
dosage. The others were sensitive to all drugs. Therfore ampicillin and
chloramphenicol are the drug of choice in empiric treatment of bacterial
meningitis after neonatal period.
ISE.395
Bactec System is Very Helpful for Culturing of Any Sterile Body
Fluid in Children
F. Ebrahimi, S. Noorbakhsh, H.R. Mortazavi. Iran Medical University,
Tehran, Iran
Introduction: The Bactec 9240 system (becton dickinson europe,meylan, france) is a fully automated continuous culture monitoring system.
Methods and Material: In this analytic cross sctional study; an automated culture system, was compared with concentional system in hospitalized pediatric aged less than 14y.
Each single normally sterile body fluids drown for culture from hospitalized children was evaluated by both system simultaneously.
Results: Of143 specimens evaluated, totally 30% of cultures were considered contamination; 21% yielded positive cultures only by Bactec culture and were considered to be clinically significant; mean age were higher in positive group (0.01); Positive bactec culture were related to age
group (0.04) but no difference in type of micriorganisms. There was significant difference in type of micriorganisms and vial (0.04)sampling
site(0.03) type of micriorganisms and vial (0.03). Overall, culture in the
Bactec Bactec system showed higher sensitivity for the isolatation of
microorganisms ( P<0.000).
Conclusion: The Bactec system and conventional system were equally
effective in detecting microorganisms in patients reciving antibiotic therapy. These findings indicate that Bactec system significantly improved
both detection and time to positivity of normally sterile body fluids
cultures.
ISE.396
Immunoprophylaxis of Hepatitis B in Children with Malignancy at
the Time of Anti-cancer Treatment
O. Geludkova1, M. Rusanova1, N. Predeina2, E. Zhukovskaya2, I.
Borodina1, M. Getmanova3, V. Pastushenko4, E. Golubeva3. 1Research
Institute For Pediatric Hematology, Moscow, Russia; 2Regional Children
Clinical Hospital, Chelyabinsk, Russia; 3Russian Children Clinical
Hospital, Moscow, Russia; 4Morozovsky Children Clinical Hospital,
Moscow, Russia
Background: The high frequency contamination of virus hepatitis B
(HBV) in children with malignancy is detected. Among them 80-90 % of
patients developed chronic hepatitis. In the future this patients have risk
of development of cirrhosis of liver in 20-40 % of cases and hepatocellular carcinoma in 5-10 % of cases. Thus, the successes achieved in treatment malignant diseases, can be levelled by heavy defeats of the liver
and essential deterioration of the quality of life in this patients.
Until now was considered, that vaccination of the patients with malignancy is inexpedient in connection therefore impossibility of formation antibodies (anti-HBs) at the background of anti-cancer treatment.
Purpose: To appreciate efficacy of immunoprophylaxis of hepatitis B in
children with malignant diseases.
Materials and Methods: 250 children with different malignancy from 0
to 16 years of age (median 6 yrs), at the time of anti-cancer treatment,
were enrolled into the study.
13 patients received a combined immunoprophylaxis (group A) by
scheme: «Hepatekt» 20 MU/kg weight 0-1-2-3-4-5 monthes at the same
time with doubled age doses recombinant vaccines («Engerix B» or «HBVax II») 0-1-2-6 monthes.124 pts received an active immunization by the
recombinant vaccines (group B) by scheme 0-1-2-6 months: doses
accordingly age - in 21 pts (group B1), doubled age doses - in 103 pts
(group B2). Vaccination was conducted in the children without serologic
marker of hepatitis - at the first 3-7 day after the diagnosis of malignancy. 113 children with malignancy, which not received the immunoprophylaxis of hepatitis B, formed a control group.
Results: After 6 months after start of immunization the protective level
anti-HBs (> 10 mMU/ml, titre median 15,3 mMU/ml) was observed in
25% of pts of the group B1 and in 66% of pts of the group B2 (p<0,05).
The protective anti-HBs titre in the group A was appeared earlier, then in
the group B (p<0,05). The median of anti-HBs titre at 3, 6 and 12 months
after start of immunization were accordingly 193,5 mMU/ml, 126,2
mMU/ml and 47,4 mMU/ml.
Frequency of contamination of HBV in groups A and B was 13,7%, in
control group - 41%, (p<0,05).
Conclusion: The combined immunoprophylaxis of hepatitis B or vaccination by doubled age dose vaccines in children with malignancy at the
time anti-cancer treatment were effective.
ISE.397
Complications of Community Acquired Pneumonia in Children
V. Maresova1, Z. Blechova1, B. Horova2, K. Soltysova3, M. Podojilova4.
1
Charles Univ., 2nd Medical Faculty, 1st Clinic for Infect. Dis., Prague 8,
Czech Republic; 2Department of Microbiology, Univ. Hosp. Bulovka,
Prague 8, Czech Republic; 3National Healths Institute, Prague 10, Czech
Republic; 41st Clinic of Infectious Diseases, Univ. Hosp. Bulovka, Prague
8, Czech Republic
Objectives: Community-acquired pneumonia (CAP) usually has a
benign course in children. Aim of this study was the to determinate frequency and severity complications of CAP in immunocompetent children.
Data obtained in this study also serves as a background for elaboration
of guidelines for primary-care settings in Czech Republic.
Patients and Methods: 172 children (0-18 years, median age 5 years,
117 males, 55 females) admitted to the clinic of infectious diseases were
included in the study ( 1999-2005). The diagnosis of pneumonia was
established during the first 48 hours of hospitalization and verified by Xray examination. Etiological agent was established by blood culture, serological response and in few cases by PCR. Clinical symptoms, laboratory parameters, complications, mortality and therapeutic approach were
monitored. Complications were classified as serious or mild and were
divided to following groups: pulmonary, gastrointestinal, ENT, CNS and
skin involvement.
Results: Severe complications were observed in 21 cases (12,2%)
including 8 cases pleural cavity exudate, 4 of atelectasis, 1 of pericarditis, 2 of purulent meningitis, 2 cases of febrile seizures and 3 cases of
encephalopathy. Concomitant tonsillitis was present in 9 children, sinusitis in 7 children and gingivostomatitis in 1 child. Rashes were observed
in 14 patients and diarrhea in 34 patients. Etiological agent was detected
only in 29 cases (15 Streptococcus pneumoniae, 7 Mycoplasma pneumoniae, 3 Varicella, 1 Legionella pneumophilla, 1 Neisseria meningitidis,
1 Haemophillus influenzae, 1 Streptococcus mitis and probably 3 cases
of RS virus and 2 cases of influenza).
Conclusions: Approximately 20% of admitted adults patients suffered
one or more complications. The number of complications in children is
lower. The majority of several complications (pleuropneumonia, empyema) were caused by S. pneumoniae in 4 cases, only one by M. pneumoniae and Legionella.
This study is supported by grant IGA Ministry of Health NR/8297-3
ISE.398
Immuninogenicity and Reactogenicity After MMR Vaccination to
Mumps Part of Vaccine in Seronegative Persons
M. Avijgan, M. Moghni, F. lalehgani. Shahr-e-kord University of Medical
Sciences, Shahr-e-kord, Iran
Aim: Mumps is one of the communicable diseases of childhood period
which in preventive by vaccine. If the herd immunity of mumps could
reach to 95% in population vaccination will failed. The aim of this study
was to evaluate the efficacy of Iranian national vaccination program for
mumps which is established from 2004.
Materials and Method: This study include 44 seronegative children, who
undertaken for mumps vaccination (made by Iranian serum institute of
Razi). At the time of vaccination and 3 month later the blood samples
were taken and stored in -20 °C. The test used for this study was IgM and
IgG ELISA ( USA).
Results: Male to female ratio was 1 to 1.5. the was a 83% of seroconversion rate after vaccination of mumps. This seroconversion rate had a
significant statistical meaningful with age (P<0.05) but no with sex. The
main complication after vaccination were parotiditis in 2 children.
Conclusion: By considering of 83% seroconversion rate of this Iranian
vaccine although the rate is high and acceptable but it may not expect
that the natural infection of mumps can be eradicated in near future.
ISE.399
Herpetic Infection Diagnosed by PCR Techniques in a Pediatric
Population. Spectrum of Diseases
O. Castillo de Febres1, L. Granella1, R. Naveda2, M. Sanchez de
Naveda3, M. Robertis4. 1Carabobo University and Metropolitan Hospital,
Valencia, Venezuela; 2Insalud, Valencia, Venezuela; 3Carabobo
University, Valencia, Venezuela; 4 Metropolitan Hospital, Valencia,
Venezuela
Herpesviridae family is subdivided into three subfamilies: (1) alphaherpesviridae (HSV and VZV); (2) Betaherpesviridae, (CMV) (3)
Gammaherpesviridae (EBV and herpesviruses 6, 7, and 8.) PCR assays
has been applied successfully to the diagnosis of herpetic infections,
mainly for HSV encephalitis and less often for diagnosis of CMV and EBV
Objectives: To describe clinical manifestations, main outcome of children diagnosed with herpetic infections by PCR techniques
Methods: We reviewed the chapter of patients attending the pediatric I
D clinic at the Metropolitan Hospital, from 2003 to 2005, with the diagnosis of CMV,HSV,EBV infections, made by PCR, based methods, either in
blood,CSF or both.
Results: 24 patients were detected: 18 CMV (congenital infection), 4
HSV and 2 EBV. Among CMV, infected children 50% had neurological
symptoms: seizure 3 (33%) psychomotor retardation 7 (77.7%) microcephaly 5 (55.5). All of them had PCR-CMV positive in blood and one in
CSF ; 50% of children had other signs and symptoms : hepatitis (10)
nephritis (3) anemia (3).Their outcomes were: 4 severe retardate (all had
brain calcifications) 4 had mild to moderate psychomotor retardation, 3
children originally diagnosed as hepatitis, also developed later, moderate
psychomotor retardation. Four children had CNS -HSV infection (2
meningitis and 2 encephalitis). All had abnormal EEG. Their outcomes
were: one had severe sequel, one had cognitive alteration and two are
doing well.EBV PCR was detected in both CSF and blood of two children
with meningitis. they were lost of follow up.
Conclusion: 1) PCR, based method, either in blood, CSF or both, is a
useful tool for the diagnosis of herpetic infection; 2) Any grade of psychomotor retardation were seen in 61% of CMV congenital infection; 3)
More sequels were seen in herpetic encephalitis than in meningitis.
Sexually Transmitted Diseases
ISE.400
Results of HLA Typing in Patients with Urogenital Chlamydiosis
S. Koshkin1, G. Zaitseva2, T. Chermnykh1. 1Kirov State Medical Academy,
Kirov, Russia; 2Kirov Research Institute of Hematology and Blood
Transfusion, Kirov, Russia
Purpose: The study was to investigate immunogenetic parameters (HLAantigens) in urogenital chlamydiosis (UGC) patients. 189 patients (133
males, 56 females) were evaluated. The age range:18 - 60 years. Over
50% of the patients had urethritis, prostatitis, cervicitis, and adnexitis.
Methods: The etiology was verified by means of direct immunofluorescence, immunoenzyme analysis and polymerase chain reaction. The
control group included 795 healthy donors of the same population. The
findings of their HLA-typing were considered.
Results: The comparative analysis of the typing revealed reliable
increase of incidence of occurrence of HLA-B16 (χ2 = 4.3; RR = 1.9) and
HLA-B17 (χ2 = 4.4; RR = 1.9). There was a tendency to reduction of incidence of HLA-B40 (χ2 = 2.8; RR = 0.5). As compared to the control group,
the patients had antigen combinations B22-B35 (χ2 = 7.7; RR = 6.2), A1B7, A9-B17, A10-B16 much more frequently. B7-B35 (χ2 = 2.2; RR = 0.3),
A2-B12 occurred more rarely. As compared with the control group, analysis of the results of typing in females showed insignificant prevalence of
B16 (χ2 = 3.8; RR = 2.3), B12 (χ2 = 2.8; RR = 1.8) and combinations B8B17 (χ2 = 4.5; RR = 9.8); B12-B-13 (χ2 = 9.7; RR = 11.1); B12-B16 (χ2 =
6.6; RR = 7.4); A1-B16; A1-B35; A2-B35; A19-B12; A19-B17. Analysis of
frequency of distribution of HLA-antigens in UGC patients showed a
number of antigens common both to males and females. A number of
antigens and their combinations occurred in females but did not occur in
males. There may be predisposition to peculiarities of HLA- antigen distribution in UGC. This may depend on sex.
Conclusion: UGC morbidity is associated either with presence or
absence of certain antigens. This is to be taken into consideration in
treatment and prevention.
ISE.401
Analysis of Morbidity of Urogenital Infections in Patients Who Were
Admitted to the Dermatology Room
O. Zonov, S. Koshkin. Kirov State Medical Academy, Kirov, Russia
The purpose of the study was to investigate incidence of urinary tract
infections (UTI) such as chlamydia, mycoplasma, ureaplasma in patients
who were admitted by a dermatovenerologist.
Methods: The material included examinations that were performed
between 1994 and 2003. 2,578 patients were evaluated during the above
period. To verify chlamydia, methods of direct immunofluorescence and
polymerase chain reaction (PCR) were used. For mycoureaplasmal
infections, the bacteriological method and PCR were used.
Results: Different UTI were discovered in 1,289 patients (49.9%). UTI
incidence was high: 60.3% in 1994 and 44.2% in 2003. 2,408 patients
were evaluated for chlamydia. The infection was revealed in 722 patients
(29.9%). Of 1,115 patients who were evaluated for mycoplasma, the
infection was detected in 231 patients (20.7%). Of 1,106 patients who
were evaluated for ureaplasma, this infection was detected in 336
patients (30.4%). In the structure of the pathogens, C.trachomatis
(p<0.01) and U.urealyticum (p<0.01) prevailed as compared to M.hominis. Of 1,717 males and 691 females who were examined for C.trachomatis, this infection was detected in 552 males (32.2%) and 170 females
(24.6%). The 10-year analysis for urogenital chlamydiosis showed that
chlamydiosis was diagnosed more frequently in males (p<0.01). Of 838
males and 268 females who were examined for ueraplasma, this infection was detected in 226 males (27.0%) and 110 females (41.0%). It was
noted that urogenital ureaplasmosis was diagnosed more frequently in
females (p<0.01). There was no reliable difference between the males
and females in mycoplasmosis. The UTI percentage remains high in the
patients who were admitted by the dermatovenerologist. It was revealed
that the males were infected more frequently with C.trachomatis as compared with the females. High U.urealyticum incidence in the females can
be explained by females physiological and hormonal peculiarities and
immune status.
ISE.402
Syphilis Infection Does not Interfere with Laboratory Markers of HIV
Disease Co-infection
R. Manfredi, S. Sabbatani, L. Calza, F. Chiodo. Infectious Diseases,
Objective: After the recent evidences of a recrudescence of STD during
HIV, since 2001 we carried out an observational study on a cohort of
>1000 HIV-infected patients (p).
Methods: Fourty-nine p (33 homo-bisexuals and 16 heterosexuals, aged
23-58 years), were identified as novel cases of syphilis (S) (secondary S
in 39 cases of them), assessed and treated based on standardized protocols, and followed for 12-21 months.
Results: Immunological data including >6 months preceding S and >9
months following S were available. All p save 6 took HAART, according
to current recommendations. During the >15 months observation period,
so statistically significant trend of laboratory parameters of HIV disease
were seen in our p co-infected with S.
Discussion: Although interaction between S and HIV were not deeply
investigated, the HIV-related quantitative-functional damage of cell-mediated immunity could modify the course of S. Concurrently, during S an
impairment of cellular migration and clearance, cytokine network, were
documented, together with an increased lymphoid cell apoptosis.
However, it remains difficult that a non-opportunistic disease like S may
trigger pathogenetic mechanims capable of infuencing significantly the
HIV disease course, especially when a HAART treatment concurs. While
we agree with the concerns related to STD in p with HIV or exposed to
HIV, differently from recent literature data (Buchacz K,AIDS
2004;18:2075), in our experience syphilis does not seem to modify the
laboratory course of HIV infection. Although health care providers should
take into careful consideration all suspected STD in HIV-infected p, only
prospective case-control studies may answer questions associated with
the potential existence of bidirectional pathogenetic and clinical interactions between S and HIV infection.
ISE.403
Acute, Serious Syphilis Hepatitis in A Patient with Missed HIV
Disease
R. Manfredi, S. Sabbatani, L. Attard, F. Chiodo. Infectious Diseases,
Background: Only anecdotal cases of patients (p) with initially overlooked-missed syphilis, who developed a predominant hepatic involvement, were described to date.
Methods: A recent case of acute hepatitis was observed in a p with
unsuspected syphilis and HIV infection.
Results: A p at risk for sexually-transmitted diseases (STD) came to our
attention three weeks after the appearance of a diffuse erythematouspapular exanthem. A secondary syphylis was disclosed by serologic
assays, but the subsequent jaundice prompted further exams, which
detected a severe liver involvement, based on serum AST-ALT values of
506-1053 U/L, and elevated gamma-GT and ALP (314 and 317 U/L,
respectively). All examinations for hepatotropic viruses and autoimmunity tested negative. HIV infection was also disclosed, with a viremia of
9,400 copies/mL and a CD4+ lymphocyte count of 579 cells/µL. One
week later, persistingly increased AST-ALT (880-1474 U/L, respectively),
were associated with elevated bilirubin, ALP, and gamma-GT levels. The
histopathologic study showed an acute lobular hepatitis with diffuse
hepatocyte involvement, and a poor lymphomonocytic infiltrate. Penicillin
G was immediately started, but a very prolonged hepatic cytolisis characterized the clinical course: 25 days after admission, our p still showed
AST-ALT levels of 306-658 U/L, and these abnormalities persisted until
96 days.
Conclusions: Our report focuses on the severity and duration of liver
disease due to secondary syphilis, in a p who was unaware of HIV disease. Which immune-mediated mechanism could have prompted the
severe syphilitic hepatitis? HIV causes a quantitative-functional damage
of the CD4+ T-cell subset, which could lead to a broad immune system
derangement. Syphilis has an enhanced expression upon impairment of
cell-mediated immunity in animal models, and just cell-mediated defence
acts against Treponema pallidum. Was our severe hepatocytolisis related
to direct damage by T.pallidum during impairment of immune system, or
a was it a dysreactive immune-mediated toxicity responsible for an exaggerated treponemal hepatitis?
ISE.404
Concealed Chlamydia trachomatis Infection in General Practice and
Its Diagnosis by Patients - Blood Leukocyte Culture Method
T. Saralidze1, L. Mokhevishvili2, T. Shvelidze1, F. Gabunia3, M. Enukidze1.
1
Institute of Hematology and Transfusiology, Tbilisi, Georgia; 2Children's
Hospital, Tbilisi, Georgia; 3Center of AIDS and Infective Diseases, Tbilisi,
Georgia
Chlamydia (C.) trachomatis is most common infection among sexually
transmitted diseases. Because of minimal clinical symptoms it often
remains untreated and becomes reason of pelvic inflammatory diseases
and infertility. Due to its unique developmental cycle invading not only
epithelial cells, but mesencimal and connective tissue as well in cases of
inadequate treatment C.trachomatis bacteria persists in organism chronically evolving various different symptoms and syndromes. For diagnosis
of concealed clamydial infection in adults and in children we have worked
out and inculcated in clinical practice blood and bone marrow leukocyte
culture method that supports propagation of this bacteria in vitro and
enables to diagnose infection while direct or indirect immunofluorescein
tests or even PCR are negative (Clinical Atlas of C.trachomatis in
Hemopoietic Cell Cultures, Saralidze, Shvelidze 2005). Origin of chlamydial inclusions in vitro was confirmed cytochemically by PAS-positivity
and electron-microscopy study. On electron photomicrographs different
stages of chlamydial life cycle in leukocyte cultures were revealed. We
investigated 230 patients with unresolved clinical diagnosis who applied
to general practitioner. In 200 patients C.trachomatis appeared to be the
main reason of such different symptoms and syndromes as fatigue, subfebrilitetis, paradontosis, reactive arthritis, frequent tonsillitis and pneumonias, chronic and obstructive bronchitis, trombophlebitis, mild
leukopenia, taking sometimes the severe clinical onset, such as
Rheuter's disease or refractory anemia and pancytopenia displaying
myelopdysplastic syndrome(MDS). Notable that after diagnosis of
C.trachomatis infection by leukocyte culture method antichlamydial treatment evolved disappearance of symptoms with clinical recovery in most
patients or remission for several months in 2 MDS patients. Data of our
research show that leukocyte culture method may be successfully used
for detection of concealed chlamydial infection in every day clinical practice as screening test in adults and in children, for estimation of the effectiveness of treatment and for the examination of new antichlamydial
drugs in vitro.
ISE.405
HIV and Associated Genital Infections Among Patients Attending a
Genitourinary Clinic of a Teaching Hospital in Northern Nigeria
A.T. Olayinka, A. Ibrahim, A.S. Opaluwa, B.O. Olayinka, F.J. Giwa.
Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
A ten-year review of patients of a genitourinary clinic of a university
teaching hospital in Nigeria was carried out. Out of a total of 1,563 new
patients who attended the clinic during this period, 89 (5.69%) of those
considered at risk, counselled and tested were seropositive for the
Human Immunodeficiency virus. Seventy-six (85.4%) of which were
seropositive to HIV-1, 12 (13.48%) for HIV 1and 2 and only one (1.12%)
to HIV-2. The age group of peak prevalence was 21 -25years for females
and 31-35years for males. The most common associated presenting genital infection among them was genital warts (22.47%) followed by genital
candidiasis (13.48%). The least common presenting infection was
syphilis (2.24%). No case of HIV presenting with gonorrhoea was seen.
ISE.406
Impact of Latent Chlamydia trachomatis Infection on Immune
Reactivity of Organism Revealed by Leukocyte Culture Methods
T. Saralidze1, L. Mokhevishvili2, T. Shvelidze1, M. Sheklashvili1, E.
Saralidze1, K. Saralidze2. 1Institute of Hematology and Transfusiology,
Tbilisi, Georgia; 2Children's Hospital, Tbilisi, Georgia
Several specific and nonspecific immunological reactions take place during chronic chlamydial infection in organism. Concealed Chlamydia(C.)
trachomatis infection in 200 patients with different clinical onset was diagnosed by patient's blood leukocyte culture method. Considering influence
of this infection on immune system macrophage-lymphocyte rosette
(MLRos) formation in vitro (N. Saralidze 1994) was also investigated.
According to MLRos amount patients with C. trachomatis were divided
into 5 groups: Patients with very low immune reactivity constitute 28% amount of MLRos was under 14%. Patients with low immune reactivity
constitute 32% - amount of MLRos fell in the range of 15-24%. Patients
with comparatively low immune reactivity constitute 15%, amount of
MLRos - 25-34%. Patients with normal immune reactivity constitute 14%,
amount of MLRos - 35-45%. Patients with high immune reactivity constitute 11% - MLRos quantity was above 45%. Investigation in dynamic
showed improvement of MLRos indices. Amount of MLRos in patients
with very low or low immune reactivity increased up to 25-30%, and in
patients with comparatively low immune reactivity up to normal values.
Normal and comparatively low indices of MLRos revealed mainly patients
with minor clinical symptoms. Patients with arthritis or Reiter's syndrome
revealed mainly high or normal values of MLRos. Taking in mind that C
trachomatis multiplies in macrophages in vitro and evolves their damage
that results in reduction of rosette formation, amount of MLRos over 40%
points to increased immune sensitivity of organism. Leukocyte cultures
are useful for detection of concealed chlamydial infection and estimation
of immune reactivity of organism to decide the correct strategy of treatment for eradication of infection and its consequences. Original 30 color
photomicrographs and 51 electronogramms representing propagation
and developmental cycle of C. trachomatis in leukocyte cultures are presented in Clinical Atlas of C. trachomatis published by the authors in
2005. saralidzet@yahoo.com
ISE.407
Syndromic Approach Through Paulo Freire´s Method with Stretch
Workers on the Area of Cosmópolis - Sao Paulo, Brazil
E.V. Rossetto, O. Pinto Filho. Prefeitura Municipal de Cosmópolis,
Cosmópolis, Brazil
Background: The area of Cosmópolis (in the Southwest Region of
Brazil) has a caracteristic of an intensive migration, where the workers go
from one city to the other looking for jobs, which makes it a "sleeping
city". People work on the cities around and sleep in this área. Most of the
population which migrates to this area, do not have qualified work and
are coming from North and Northwest of Brazil, leaving your mother land,
families and small acquisitions seeking for better living conditions. They
are lonely and have as fun go to night bars. The old inhabitants are distrustful with them causing preconception, discrimination and social exclusion to them. They are called stretch workers once they travel around
Brazil, as a third part works, executing projects in maintenance and construction of the Unidades das Refinarias da Petrobras, moving successively to the areas where it has offers. The goal was to define the best
form of syndromic approach for the Sexually Transmitted Infections, HIV
and hepatits B and C to the workers of the Refinaria do PlataltoREPLAN due to the vulnerability, missing information and difficulty to
access the governmental health system.
Methods: The workers epidemiologic´s profile has been raised, their
social and human interactions, analysis of their speech, narratives and
knowledge on prevention. For this syndromic approach´s process, it was
used liberating education based on Paulo Freire´s method, which the
reality is the mediating and of its the contents are extracted, being the
education centered in the dialogue, valuation of knowledge educative
understanding of the situation.
Results: 10% of the workers we had contact had presented signals and
symptoms.
Conclusions: The syndromic approach for Paulo Freire´s method
allowed us to realize the precocious diagnostics, the migrated population
accessed the health public service, promoting a significantly break on
chain transmission.
Surgical, Obstetric and Gynecologic Infections
ISE.408
Microbiology and Drug Susceptibility of Amniotic Bacterial
Pathogens
Meijomil1, N. Goncalves3, I. Jimenez1, P. Rifakis3, O. Hernandez3. 1West
General Hospital, Caracas, Venezuela; 2Instituto Experimental JWT, ULA,
Trujillo, Venezuela; 3Perez de Leon Hospital, Caracas, Venezuela
Background: Intraamniotic infection (IAI) is a term used to describe a
clinically diagnosed infection of the contents of the uterus. It is found
most often after rupture of the membranes. The most useful diagnostic
tests are physical examination, amniotic fluid glucose determination, and
amniotic fluid Gram's stain. The aim of this study was to evaluate the
antimicrobial resistance of pathogens responsible for IAI in Caracas,
Venezuela.
Material and Methods: A study on IAI antibiotic resistance was conducted at our institution in Caracas, Venezuela, from 1995 to 2003.
Antimicrobial susceptibility was evaluated with disk diffusion technique
according to NCCLS.
Results: The results showed that 90 pregnant women had developed
IAI. The most commonly isolated microorganisms were, in descending
order: Staphylococcus coagulase-negative (55.6%), S. aureus (11.1%),
Escherichia coli (11.1%), Klebsiella pneumoniae (11.1%) and
Enterobacter cloacae (11.1%). These isolates were highly resistant to
penicillin (100%), but not for cefazolin (25.0%), cefoxitin (25.0%),
cephalotin (25.0%), ciprofloxacin (25.0%) and chloramphenicol (20.0%).
Better in vitro activity was observed for vancomycin (gram positive)
(100% susceptibility) and for aminoglycosides and carbapenems (100%
susceptibility).
Conclusions: Ampicillin or penicillin plus gentamicin are the most extensively tested antibiotics for treatment before delivery. Clindamycin or
metronidazole should be added if a cesarean section is performed. In
summary, acute intra-amniotic infection or chorioamnionitis is a relatively common complication of pregnancy and may be associated with significant maternal and neonatal morbidity. Maternal mortality is rare, as is
mortality in term infants. Mortality in premature infants is probably related to prematurity itself rather than infection per se.
ISE.409
Epidemiology of Genital Candidiasis in Caracas, Venezuela
C. Rodriguez1, A. Garcia1, B. Pastran1, P. Meijomil1, N. Goncalves2, P.
Rifakis2, A.J. Rodriguez-Morales3, I. Jimenez1, O. Hernandez2. 1West
General Hospital, Caracas, Venezuela; 2Perez de Leon Hospital,
Caracas, Venezuela; 3Instituto Experimental JWT, ULA, Trujillo,
Venezuela
Background: Genital candidiasis is the most common gynaecological
infection and has the potential to produce considerable long-term sequelae especially with regard to sexual health. The aim of this study was to
describe epidemiology of genital candidiasis in women attending the outpatient service of our institution in Caracas, Venezuela, between 1992
and 2003.
Material and Methods: Vaginal samples from clinical suspected women
were taken and processed at our laboratory, where all samples were cultured and identified.
Results: The results showed that 101 women had developed confirmed
genital candidiasis. Mean age was 39.7 year-old. The most commonly
isolated organisms were, in descending order: Candida albicans
(65.3%), Candida spp. (32.7%) and Torulopsis (Candida) glabrata
(1.98%). No identifiable predisposing factors were identified. Most
patients received just topical antifungal treatment. Around 25% of women
presented recurrent vulvovaginal candidiasis.
Conclusions: Genital candidiasis occurs commonly in otherwise healthy
women with no identifiable predisposing factors. Recurrent vulvovaginal
candidiasis (RVVC) is a prevalent opportunistic mucosal infection, caused
predominantly by Candida albicans, which affects a significant number of
otherwise healthy women of childbearing age. Since there are no known
exogenous predisposing factors to explain the incidence of symptomatic
vaginitis in most women with idiopathic RVVC, it has been postulated that
these particular women suffer from an immunological abnormality that
prediposes them to RVVC. In addition to the study of newer antimycotic
agents, new strategies of therapy are required and must be individualized
for patients with recurrent vulvovaginal candidiasis.
ISE.411
Practice of Antibiotics Use During Cesarean Section in Belarussian
Hospital
M. Mily. State Medical University, Vitebsk, Belarus
Background: Excessive use of antimicrobials, including in surgical practice is well-known problem for Belarus. Cesarean section is recognized
as operation widely suitable for preoperative antibiotic prophylaxis only.
Objectives: To evaluate degree of acceptance of antibiotic prophylaxis
and existing pattern of antimicrobials use during cesarean section in typical belarussian delivery house.
Methods: Retrospective chart review of 53 patients undergone cesarean section during 3 months period was performed with collection of information of antibiotics utilized, their cost, character of breastfeeding.
Results: 22 cases were labeled as elective cesarean section.
Preoperative antibiotic prophylaxis was not administered to any woman.
All women were treated with antibiotics postoperatively. In 21 cases three
antibiotics were administered, in 24 cases - two antibiotics. Most widely
utilized antimicrobials were cefazolin (25% of administrations), gentamicin (24.2%), cefotaxime (12.9%), metronidazole (9.1%). Median cost of
antimicrobial therapy was 14 231 (quartile range 8 044 - 20 571) rubles,
what markedly higher than in case of standard preoperative prophylaxis
(508-1016 ruble corresponding to 1-2 g of cefazolin). In 11 cases breastfeeding was started during first day after operation, in 18 cases—during
second day.
Conclusions: Preoperative antibiotic prophylaxis typically is totally neglected in practice of belarussian health care, what fuels excessive antimicrobials use and increases expenses. Administration of antibiotics often
coincides with breastfeeding and carries certain therapeutic risk for
newborns.
ISE.410
Cefapime (Maxipime) a Fourth Generation Cephalosporin for
Severe Intraabdominal Infections
M. Leova1, S. Trajkova1, P. Kodovski1, R. Pejovski1, V. Vishinov1, E. Vilarova
Ambarkova2, J. Hristova3, P. Krstev1. 1General Hospital Veles, Veles,
Former Yugoslav Republic of Macedonia; 2Cardio Surgery Filip II, Skopje,
Former Yugoslav Republic of Macedonia; 3University Hospital Skopje,
Skopje, Former Yugoslav Republic of Macedonia
Introduction: In our study is reviewed the clinical experience with
Cefapime - a fourth generation cephalosporin for severe intraabdominal
infections caused by Beta-lactamase producing gram negative microorganisams.
Material and Methods: In two open studies of 128 patients with severe
peritonitis: 78 are treated with combination of Cefapime (2g/24h) and
Metronidazol 0,5g/8h,and 50 with Clindamycin 0,6/12h and Perfloxacin
0,4/12h.The duration of treatment depends on 3-12 days with midle 5
days for Cefapime and Metronidazol and 6 days for Clindamycin and
Perfloxacin. At patients with diffuse peritonitis we have succesfully treating with combination of Cefapime and Metronidazol 95% compared with
group of Clindamycin and Perfloxacin.
Results: Cefapime has exellent activity towards gram positive and gram
negative bacteria that causes infection in hospitalised patients.
Staphilococcus, Streptococcus (included very resistent group),
Enterobacteriaceae, Pseudomonas aeruginosa. The concentration of
Cefapime in plasma and the other body liquids and tissues is kept over
minimal inhibitory concentration. Tissue saturation with the medication is
considered to be effective in treatment (but not established corelation
between the tissue, concentration and therapeutic effect.
Conclusion: The fourth generation of cephalosporines confirmed their
effect in various clinical situations, low percentage od side effects, and
very good relation cost effect. They are very good alternative for treatment of severe infections and septic condition.
AUTHORS INDEX
12 t h I n t e r n a t i o n a l C o n g r e s s o n I n f e c t i o u s D i s e a s e s
Aandahl, E. ISE.074
Abasi, B. ISE.212
Abbasi, F. ISE.342
Abdi, Z. ISE.139
Abdi Liae, Z. ISE.128
Abdi Rad, I. ISE.291
Abeysinghe, M.R.N. ISE.137
Abiodun Olakelan, O. ISE.262
Acuna, S. ISE.087
Adaleti, R. ISE.051
Adewole, O.O. ISE.234
Afhami, D.R. ISE.330, ISE.331
Afzali, H. ISE.164
Agosti, M.R. ISE.087
Aguilar, Y. ISE.384
Ahmadi, A. ISE.044, ISE.231
Ahmadi, F. ISE.169
Akhoundi-Lavassani, B. ISE.002
Akhtar, M. ISE.354
Aktas, Z. ISE.012
Aktepe, O.C. ISE.136
Al-Alsadoon, M. ISE.364
Alan, M.S. ISE.047
Alborzi, A. ISE.204, ISE.319
Alceva, M. ISE.224
Alendar, F. ISE.321, ISE.322
Aleuraki, G. ISE.040, ISE.041,
ISE.042
Alexandre, M. ISE.138
Alexandropoulos, N. ISE.229
Alexiou, C. ISE.095
Alexopoulos, A. ISE.064
Allamanos, Y. ISE.019
Allishah, H.A. ISE.271
Almasi, V. ISE.379
AlMazroa, D.R. ISE.207
Almeida, J. ISE.361
Altindis, M. ISE.136
Alurralde, C. ISE.023
Alyabis, A. ISE.181
Amell, S. ISE.289
Amiguet, J.A. ISE.311
Aminharati, F. ISE.125
Aminzadeh, Z. ISE.165
Amiri, F. ISE.210
Amirkhani, A. ISE.169
Amoian, S. ISE.212
Amvam Zollo, P.H. ISE.168,
ISE.258, ISE.259
Anakieva, T. ISE.107
Anastasopoulou, P. ISE.383
Andonova, L. ISE.187
Andric, A. ISE.077
Andric, B. ISE.035, ISE.077
Angerami, R. ISE.188
Angulo-Molina, A. ISE.010
Antypa-Theothoropoulou, A.
ISE.229
Aponte, A. ISE.196
Apostolakis, M. ISE.334
Araujo, M. ISE.301
Ardic, N. ISE.015
Armin, S.H. ISE.391, ISE.392
Arria, M. ISE.348
Artukov, R.M. ISE.223
Arutyunov, G.P. ISE.172
Asharghi, S. ISE.217
Assmar, M. ISE.211
Ataei, B. ISE.225, ISE.271,
ISE.276
Atencio, R. ISE.301
Athanasaki, M. ISE.042
Athanasopoulou, E. ISE.334
Attard, L. ISE.403
Attarzadeh, A. ISE.212
Avijgan, M. ISE.315, ISE.398
Ayala, J. ISE.097
Ayatollahi, A. ISE.006
Ayaz, M.M. ISE.354
Aydin, O.A. ISE.047
Aydogan, F. ISE.047
Azairwe, R. ISE.389
Azap, A. ISE.051
Baba, H. ISE.341
Babalova, M. ISE.057
Baccarini, P. ISE.356
Badali, H. ISE.318, ISE.350
Badami, N. ISE.125
Badicut, I. ISE.038, ISE.039
Badila, I. ISE.122
Baghdasaryan, K.S. ISE.215
Bagheri, M. ISE.291
Bagheri Bejestani, F. ISE.002
Bagherian, F. ISE.139
Bagherian, H. ISE.128
Bahar, M.A. ISE.154
Bahia, G.C. ISE.336
Bai, Y. ISE.081
Bajramovic, N. ISE.340
Bakar, M. ISE.232
Bakhshaei, M. ISE.173
Balasingam, S. ISE.022
Balova, E. ISE.086, ISE.218
Balova, N. ISE.086, ISE.218
Banerji, P. ISE.160
Banerji, P. ISE.160
Banifazl, M. ISE.034, ISE.169
Barari, M. ISE.235, ISE.276
Barati, M. ISE.132, ISE.157
Barbella, R. ISE.001, ISE.070,
ISE.317
Barrera, M.A. ISE.375
Barros, A.B. ISE.371
Basilico, H. ISE.324
Basiri, E. ISE.204
Bassos, D. ISE.019
Bastos, A.F.A. ISE.146
Batista, L. ISE.058
Batlle, M.C. ISE.097
Battle-Almodovar, M.C. ISE.059
Batuwanthudawe, B.K.R. ISE.137
Bayanolhagh, S. ISE.290,
ISE.293
Becker, H. ISE.021
Beheeh, A.T. ISE.314
Behzadi, E. ISE.111, ISE.112,
ISE.113, ISE.114, ISE.115,
ISE.216
Behzadi, P. ISE.111, ISE.112,
ISE.113, ISE.114, ISE.115,
ISE.216
Bemanian, M.H. ISE.377
Ben Mansour, K. ISE.140
Ben Redjeb, S. ISE.056
Benabdellah, A. ISE.102, ISE.274
Benaderet, S. ISE.058
Benitez, J. ISE.257, ISE.348,
ISE.349
Beran, O. ISE.142
Berberian, G. ISE.324
Bermúdez, J. ISE.191
Bermudez, R. ISE.197, ISE.243
Bersani, M.A. ISE.245
Bertolozzi, M.R. ISE.233
Besharat, S. ISE.227
Beslagic, E. ISE.310, ISE.340
Bezerra, J.M. ISE.162
Bezirtzoglou, E. ISE.019, ISE.064
Bialkowska, J. ISE.178
Bijani, B. ISE.194
Binder, M.D., M. ISE.076
Bisinova, S. ISE.086, ISE.150,
ISE.218
Bisinova-Eftimova, S. ISE.053,
ISE.224
Bitincka, S. ISE.329
Blahova, J. ISE.057
Blechova, Z. ISE.397
Bodonaik, N.C. ISE.105
Bogoeva, S. ISE.131
Bojicic, I. ISE.176
Bojovic, K. ISE.176
Bokaeian, M. ISE.009
Booriazadeh, V. ISE.088
Boost, M. ISE.062, ISE.345, 9.020
Borhani, K. ISE.044
Borodina, I. ISE.396
Borowiecki, M. ISE.206
Borus, P. ISE.294
Bosilkovski, M. ISE.372
Botea, S. ISE.038, ISE.039
Bradford, P. ISE.063
Bratus, H.V. ISE.278
Brito, R.A. ISE.336
Bubánová, M. ISE.065, ISE.149
Bueaño, A. ISE.348
Buela, F. ISE.058
Bujari, I. ISE.390
Bukalis, K. ISE.295
Bulakh, P. ISE.309
Buratowska, J. ISE.133
Bylova, N.A. ISE.172
Caballero, R. ISE.311
Cabaniel, G. ISE.004
Cabral, T. ISE.280
Calistru, P. ISE.103
Calza, L. ISE.213, ISE.214,
ISE.263, ISE.266, ISE.267,
ISE.268, ISE.269, ISE.402
Campelo, F.F.C. ISE.162
Campos, C. ISE.302
Campos, L.S. ISE.371
Canak, G. ISE.085
Canak, G. ISE.175
Caparovska, S. ISE.372
Cardoso, E. ISE.023
Carmo, G. ISE.106
Carmona, H. ISE.106
Carnival, L. ISE.134, ISE.369
Carrero, Y.N. ISE.301
Carvalho, A.T. ISE.336
Castillo de Febres, O. ISE.399
Castillo de Monsalve, F. ISE.301
Castro, L. ISE.361
Caugant, D. ISE.074
Ceausu, E. ISE.103
Cecchini, E. ISE.087
Cekovska, Z. ISE.332
Celikkol, E. ISE.232
Cervantes, V. ISE.245
Cetinkaya, Z. ISE.136
Cha, S.H. ISE.380
Chacin, A. ISE.197, ISE.242,
ISE.243
Chadeganipour, M. ISE.200
Chang, C.M. ISE.239
Chang, J.K. ISE.380
Chatzilias, P. ISE.041, ISE.042
Chedid, G. ISE.074
Chen, H.Y. ISE.081
Chen, Q. ISE.288
Chermnykh, T. ISE.400
Chernaya, Z.A. ISE.172
Chernyavskaya, T.K. ISE.172
Cheung, C. ISE.062
Cheung, M. ISE.345
Chini, S. ISE.334
Chinikar, S. ISE.225
Chiodo, F. ISE.078, ISE.080,
ISE.083, ISE.182, ISE.213,
ISE.214, ISE.263, ISE.264,
ISE.265, ISE.266, ISE.267,
ISE.268, ISE.269, ISE.304,
ISE.305, ISE.306, ISE.323,
ISE.356, ISE.402, ISE.403
Chiu, C.H. ISE.239
Cho, P. 9.020
Chou, J.H. ISE.239
Christou, M. ISE.334
Chykarenko, Z.A. ISE.278
Cia, P. ISE.311
Ciftci, I.H. ISE.136
Ciobanca, P. ISE.355
Clementel, V. ISE.369
Coelho, J. ISE.302
Cohen-Dar, M. ISE.240
Colakoglu, T. ISE.232
Como, N. ISE.171
Constantinescu, G. ISE.183
Córdova, K. ISE.238
Coroiu, Z. ISE.355
Costa, M.H. ISE.336
Costa, P.G.G. ISE.146
Costa, S.S.S. ISE.145, ISE.146
Costa de León, L. ISE.301
Cotton, M.F. ISE.119
Cristea, C. ISE.103
Crusells, M.J. ISE.311
Cruz, S.M.F.J. ISE.245
Cuesta, J. ISE.311
Curescu, M. ISE.261
Dakic, Z. ISE.359
Dalcolmo, M. ISE.312
Dalimi, A. ISE.365
Damjanovic, O. ISE.236
Danesh, P. ISE.154
Daneshmand, A. ISE.230
Dankuc, D. ISE.085
Darbandi, A. ISE.344
Darvishi, M. ISE.225, ISE.235,
ISE.271, ISE.276
Das, G.C. ISE.160
Das, S. ISE.160
Daugavietis, M. ISE.016
Davarpanah, M.A. ISE.225,
ISE.271, ISE.276
de Silva, D.D.S. ISE.137
Dehyadegari, M.A. ISE.072,
ISE.319, ISE.353
Delagramatic, M. ISE.038, ISE.039
Delgado, L. ISE.238
Delic, D. ISE.176
Dentale, N. ISE.270
Diaz, S. ISE.001, ISE.317
Dickson, S. ISE.001, ISE.070,
ISE.317
Dincic, E. ISE.174
Diogo, N. ISE.302
Dipeolu, O. ISE.367
Dizdarevic, Z. ISE.310
Djonin-Nenezic, M. ISE.236
Djordjevic, I. ISE.079
Djordjevic, M. ISE.079
Djordjevic, Z. ISE.153
Doder, R. ISE.085, ISE.175
Dokic, L.J. ISE.359
Dokoska, V. ISE.320
Dokoski, D. ISE.320
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Nazinyan, Y.R. ISE.215
Nazlican, O. ISE.049, ISE.186,
ISE.275, ISE.307
Ndumbe, P. ISE.258
Nedelkova, T. ISE.086, ISE.091,
ISE.218, ISE.224
Negrutiu, L. ISE.283
Ngugi, P.K.N. ISE.279
Nicoara, E. ISE.277
Nicolescu, N. ISE.277
Nishikawa, M. ISE.386
Nobari, H. ISE.276
Nogueira, J. ISE.336
Noorbakhsh, S. ISE.055, ISE.300,
ISE.394, ISE.395
Nourian, A.A. ISE.318
Nthiwa, M. ISE.294
Nunez, M.J. ISE.196
O'Donoghue, M. ISE.062, ISE.345
Oancea, C. ISE.283
Obi, C.L. ISE.014
Odegaard, K. ISE.074
Odiere, M. ISE.351
Oficialdegui, M. ISE.058
Ofori, I. ISE.359
Okajima, Y. ISE.386
Okazaki, T. ISE.386
Okazaki, Y. ISE.386
Okhovvat, A. ISE.200
Okoth, F. ISE.294
Olariu, R.T. ISE.283
Olawuyi, O.I. ISE.198
Olayinka, A.T. ISE.061, ISE.405
Olayinka, B.O. ISE.061, ISE.405
Oliveira, C. ISE.127, ISE.388
Omidzohur, B. ISE.048
Omoniyi, B. ISE.198
Omrani, M.D. ISE.291
Onile, B.A. ISE.061
Opaluwa, A.S. ISE.405
Ortega, B. ISE.197
Orth, H. ISE.096
Osanlo, R. ISE.108
Oshaghi, M. ISE.121
Oshima, K. ISE.386
Oxford, J.S. ISE.022
Oyeka, C.A. ISE.020
Ozbal, Y. ISE.292
Ozyurt, M. ISE.015
Pacheco, M. ISE.375
Panahi, M. ISE.109
Pancer, K.W. ISE.060, ISE.124,
ISE.387
Pancewicz, S. ISE.297
Pantazi, P. ISE.383
Papa, A. ISE.095
Papadomanolaki, E. ISE.040,
ISE.041, ISE.042
Park, S.W. ISE.092
Paspalovska, M. ISE.374
Pastore, F. ISE.095
Pastran, B. ISE.023, ISE.024,
ISE.025, ISE.026, ISE.027,
ISE.028, ISE.029, ISE.030,
ISE.031, ISE.032, ISE.067,
ISE.316, ISE.347, ISE.376,
ISE.408, ISE.409
Pastushenko, V. ISE.396
Patil, C.S. ISE.090
Patrona, Z. ISE.383
Pavic, S. ISE.104
Pavlovic, M. ISE.359
Pawinska, A. ISE.387
Pazin, G.V. ISE.371
Pedreira, W. ISE.058
Pejovski, R. ISE.410
Pelemis, M. ISE.104, ISE.359
Peralta Perez, M. ISE.241
Peres, H. ISE.302
Pèrez, B. ISE.346
Perez-Monras, M. ISE.059
Perisic, O. ISE.174
Petrela, R. ISE.390
Petric, N.N. ISE.278
Petrovska, M. ISE.013, ISE.147,
ISE.151, ISE.332
Pezeshki, M. ISE.008
Pichelbauer, E. ISE.317
Piech, K. ISE.124
Pietraszek, A. ISE.124
Pilipenko, V. ISE.159
Pina, T. ISE.302
Pinhati, H.M.S. ISE.146
Pinto Filho, O. ISE.244, ISE.407
Pires, L.L. ISE.287
Pishva, E. ISE.121
Plaku, F. ISE.390
Pockova, L.J. ISE.224
Pockova, L.J. ISE.053
Podojilova, M. ISE.397
Podsiadlo, B. ISE.060
Podsiadlo, E. ISE.124
Polowniak-Pracka, H. ISE.124
Poluga, J. ISE.359
Polydorou, F. ISE.095
Popoiu, M. ISE.038, ISE.039
Popovic, N. ISE.144, ISE.176,
ISE.236
Popovska-Jovanovska, K. ISE.332
Porto, A. ISE.138
Porto, L. ISE.301
Portugal, P. ISE.281
Pourshafie, M. ISE.044, ISE.050,
ISE.101, ISE.217, ISE.231,
ISE.296
Pouyiouka, M. ISE.229
Predeina, N. ISE.396
Prieto, N. ISE.190
Prilutsky, D. 57.044
Prohic, A. ISE.321, ISE.322
Provenza, G. ISE.349
Prozesky, H.W. ISE.096, ISE.119
Rafiee Tabatabaei, S. ISE.391,
ISE.392
Rahimi, F. ISE.101, ISE.296
Rahimi, H.R. ISE.212
Raicevic, R. ISE.123, ISE.174
Ramalivhana, J. ISE.014
Ramezani, A. ISE.034, ISE.169
Ramos de Cerqueira, S. ISE.246
Rashed, T. ISE.045, ISE.173
Rasouli, M. ISE.072, ISE.230,
ISE.353
Rasoulinejad, M. ISE.330, ISE.331
Rastawicki, W. ISE.110
Rastegar Lari, A. ISE.033
Ravanshad, M. ISE.289, ISE.290,
ISE.293
Ravelo, M. ISE.317
Razavi, S.H. ISE.033
Razavi, S.S. ISE.179, ISE.180
Razeghi, E. ISE.169
Razmandeh, R. ISE.139
Redondo, M.C. ISE.196
Rente, J. ISE.388
Retief-Zarrabi, C.W. ISE.119
Rezoudi, F. ISE.095
Ribeiro, L. ISE.361
Richter, V.V. ISE.223
Rifakis, P. ISE.023, ISE.069,
ISE.408, ISE.409
Rifakis, P.M. ISE.004, ISE.349
Rimaz, S.H. ISE.055
Ristanovic, E. ISE.077
Ritchie, G. ISE.082
Robertis, M. ISE.399
Robles-Zepeda, R.E. ISE.010
Rodrigues, J.L.N. ISE.195
Rodriguez, A. ISE.058
Rodriguez, C. ISE.023, ISE.024,
ISE.025, ISE.026, ISE.027,
ISE.028, ISE.029, ISE.030,
ISE.031, ISE.032, ISE.067,
ISE.257, ISE.316, ISE.376,
ISE.408, ISE.409
Rodriguez, C. ISE.324
Rodriguez, C.N. ISE.347
Rodriguez, O. ISE.348
Rodriguez-Morales, A.J. ISE.001,
ISE.004, ISE.023, ISE.024,
ISE.025, ISE.026, ISE.027,
ISE.028, ISE.029, ISE.030,
ISE.031, ISE.032, ISE.067,
ISE.069, ISE.070, ISE.257,
ISE.316, ISE.317, ISE.347,
ISE.348, ISE.349, ISE.375,
ISE.376, ISE.408, ISE.409
Rodriguez-Morales, A.J. ISE.238
Rodriguez-Otero, L. ISE.155
Rogachev, B. 57.044
Roganovic, T. ISE.166
Rojas-Mirabal, J.G. ISE.348
Rokni, F. ISE.109
Rokosz, A. ISE.046
Rolim, D.B. ISE.195
Rosanova, M. ISE.324
Rossas, C. ISE.383
Rossetto, E. ISE.244, ISE.245,
ISE.407
Rostami, R. ISE.318
Rouhani Kalagari, S. ISE.362,
ISE.366
Ruiz-Bustos, E. ISE.010
Rujumba, J. ISE.129, ISE.389
Rusanova, M. ISE.396
Rutkowski, K. ISE.297
Ryazantseva, G. ISE.016
Sá, D. ISE.388
Sabahi, F. ISE.289, ISE.290,
ISE.293
Sabanin, U.A. ISE.223
Sabbatani, S. ISE.078, ISE.080,
ISE.083, ISE.182, ISE.264,
ISE.265, ISE.270, ISE.304,
ISE.305, ISE.306, ISE.323,
ISE.356, ISE.357, ISE.402,
ISE.403
Sadeghizadeh, M. ISE.121
Sader, H.S. ISE.021, ISE.052,
ISE.063
Saeeidi, A.S. ISE.271
Safirman, D. ISE.022
Saha, D.C. ISE.249
Saifi, M. ISE.050, ISE.101,
ISE.296
Saleh, M. ISE.002
Salehi, H. ISE.225
Salehi, R. ISE.009, ISE.121
Salvucci, G. ISE.213
Samardzija, N. ISE.175
Sameer, S. ISE.071
Samie, A. ISE.014
Sánchez, A.I.M. ISE.233
Sanchez, D. ISE.347
Sanchez de Naveda, M. ISE.399
Sanjoaquín, I. ISE.311
Santos, A. ISE.138
Santos, J.B. ISE.145
Santos, L.M.M.P. ISE.245
Santos, P. ISE.152
Santos, P. ISE.324
Santos, R. ISE.138
Santrac, V. ISE.166
Saralidze, E. ISE.406
Saralidze, K. ISE.406
Saralidze, T. ISE.404, ISE.406
Sardarian, K.H. ISE.365
Saremi, S. ISE.337
Sarijlou, M. ISE.180
Sarvghad, M.R. ISE.045
Sattari, M. ISE.327
Savilov, E. ISE.219
Sawicka-Grzelak, A. ISE.046
Sayadi, L. ISE.330, ISE.331
Sayiner, H. ISE.011
Sayiner, H. ISE.012
Scarpellini, B. ISE.312
Secic, S.S. ISE.167
Seddighy, K. ISE.173
Sehgal, S.C. ISE.071
Sela, N. ISE.328
Sellaoui, S. ISE.056
Semeco, J. ISE.197, ISE.242
Semenakova, V. ISE.382
Semiyari, H. ISE.343
Sengoz, G. ISE.049, ISE.186,
ISE.232, ISE.275, ISE.307,
ISE.363
Serafia, M. ISE.134
Serra, J. ISE.302
Sevic, S. ISE.085
Sevic, S. ISE.175
Sevilla, S. ISE.384
Shaabani, M. ISE.211
Shaghaghi, B. ISE.217
Shahhosseini, H. ISE.165
Shahkarami, K. ISE.379
Shahzamani, K. ISE.068
Sharif, A. ISE.326
Sheikhi, R. ISE.204
Sheklashvili, M. ISE.406
Shi, R. ISE.253
Shinoda, Y. ISE.148
Shkjezi, R. ISE.171
Shoda, A. ISE.386
Shostakovich-Koretskaya, L.R.
ISE.278
Shvelidze, T. ISE.404, ISE.406
Siavashi, M. ISE.211
Siegfried, L. ISE.065, ISE.149
Simen Kapeu, Y.A. ISE.247,
ISE.248
Simoes, S. ISE.138
Simonovic, J. ISE.176
Simsek, F. ISE.012
Singh, B. ISE.286
Singh, D.P. ISE.156
Skrzydlewska, E. ISE.297
Skrzydlewska, J. ISE.124
Smith, N. ISE.105
Soleimani, H. ISE.330
Soleimani Amiri, M.J. ISE.170
Soleimani Rahbar, A.A. ISE.099,
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Solltandalal, M.H. ISE.050,
ISE.231
Soltysova, K. ISE.397
Sominina, A.A. ISE.298
Sopova, Z. ISE.372, ISE.373,
ISE.374
Sorokin, E.V. ISE.298
Soud Bakhsh, A.R. ISE.308
Soudbakhsh, A. ISE.128
Soudbakhsh, A.R. ISE.139
Sousa, A.Q. ISE.195
Sousa, J. ISE.138
Spanos, E. ISE.229
Spasovska, K. ISE.131, ISE.373,
ISE.374
Stancescu, A. ISE.183
Stanescu, D. ISE.277
Stanise, V. ISE.245
Stankiewicz, A. ISE.297
Starosciak, B.J. ISE.018, ISE.060
Stavrianou, A. ISE.334
Stefanovska, V. ISE.252, ISE.335
Steinhoff, M. ISE.137
Stevanovic, G. ISE.104, ISE.359
Stevanovic, M. ISE.372, ISE.374
Stevanovik, M. ISE.373
Stilwell, M.G. ISE.063
Stojanova, R. ISE.086, ISE.091,
ISE.218
Stojkovska, S. ISE.372
Stojovska, P. ISE.151
Stosovic, B. ISE.104
Strabala, P. ISE.052
Strobl, S. ISE.308
Strulov, A. ISE.240
Stypulkowska-Misiurewicz, H.
ISE.060, ISE.124, ISE.387
Sudbakhsh, A. ISE.048
Sugunan, A.P. ISE.071
Surbatovic, M. ISE.123
Suresh, K. ISE.098
Szczapa, J. ISE.393
Szovenyiová, Z. ISE.065
Szumala-Kakol, A. ISE.393
Tabarsi, P. ISE.235
Tabatabaei, A. ISE.055, ISE.394
Tabatabaie, H. ISE.179
Tabi Zambo, M. ISE.358
Tabushi, M. ISE.148
Tada, K. ISE.386
Tadayyon, L. ISE.308
Tadokoro, N. ISE.386
Taebi, N. ISE.212
Taheri, S. ISE.006, ISE.008,
ISE.099, ISE.108, ISE.339
Taherkhani, H. ISE.352, ISE.365
Tahmasebi, M. ISE.331
Takamizawa, H. ISE.386
Takic, T. ISE.153
Taljaard, J.J. ISE.096, ISE.119
Tamalli, M. ISE.065, ISE.149
Tan, B.H. ISE.189
Tatulescu, D. ISE.378
Tatulescu, D.F. ISE.017, ISE.122
Tcherveniakova, T. ISE.187
Teibo, T. ISE.007
Teiga, C. ISE.302
Tekeli, A. ISE.051
Tete, S. ISE.107
Teugwa, C.M. ISE.168
Tezer, Y. ISE.368
The National Programme of Fight
Against AIDS (PNLS, ISE.260
Thomas, K. ISE.137
Tiedt, L.R. ISE.370
Timova, T. ISE.150
Tokuji, H. ISE.141
Tomaj, K.H. ISE.128
Tomanovic, B. ISE.153
Tono-oka, T. ISE.199
Torab, A. ISE.221, ISE.222
Torab Jahromi, A. ISE.220
Tosic, T. ISE.104
Toutouza, M. ISE.229
Trajkova, S. ISE.086, ISE.091,
ISE.218, ISE.410
Trajkovska-Dokic, E. ISE.013
Trninic, T.S. ISE.167
Tsafaraki, A. ISE.040, ISE.041,
ISE.042
Tsareva, T.R. ISE.298
Tsiodra, P. ISE.334
Tsouri, A. ISE.040, ISE.041,
ISE.042
Turdean, M. ISE.122
Turdean, M.I. ISE.017
Turkulov, V. ISE.085, ISE.175
Tymur - Zadeh, N. ISE.109
Tzora, A. ISE.064
Uca, C. ISE.232
Uckay, I. ISE.079
Ursu, L. ISE.122
Usluer, S. ISE.136
Uzunovic-Kamberovic, S. ISE.205
Valansk˛, L. ISE.149
Vale, A.V. ISE.162
Valente, C. ISE.361
Valera, A. ISE.384
Valero, N. ISE.084, ISE.190,
ISE.191
Van den Eynde, A. ISE.155
Vanegas, T. ISE.384
Vargas, J. ISE.069
Velasco, L.F.R. ISE.145
Velayati, A. ISE.169
Velázquez-Contreras, C.A. ISE.010
Verdera-Hernandez, J. ISE.059
Vergara, T.R.C. ISE.312
Viana, M.G.S. ISE.162
Vicentino, W. ISE.058
Vijayachari, P. ISE.071
Vilar, D.C.L.F. ISE.195
Vilarova Ambarkova, E. ISE.410
Villacián Vicedo, M.J. ISE.155
Villamil-Cajoto, I. ISE.155
Villasboas, M. ISE.324
Viola, M. ISE.058
Visan, A. ISE.073
Vishinov, V. ISE.410
Voidaru, C. ISE.019, ISE.064
Vucinic, N. ISE.035, ISE.077
Vukadinov, J. ISE.085, ISE.175
Wanjiku, M. ISE.093, ISE.094
Watanabe, H. ISE.386
Wlodarczyk, R. ISE.124
Wojsyk-Banaszak, I. ISE.393
Wolmarans, C.T. ISE.370
Wroblewska, M. ISE.161
Wu, H.Y. ISE.081
Wu, J.S. ISE.239
Yahyaoglu, M. ISE.202, ISE.203
Yakovlev, A. ISE.159
Yalda, A.R. ISE.139
Yamanaka, N. ISE.089
Yang, Y.B. ISE.254, ISE.255,
ISE.256
Yasar, K.K. ISE.047, ISE.049,
ISE.186, ISE.275, ISE.307,
ISE.363
Yazdani, R. ISE.068, ISE.121
Ye, Q. ISE.288
Yildirim, F. ISE.049, ISE.186,
ISE.275, ISE.307, ISE.363
Yildirmak, T. ISE.011, ISE.012
Yin, G.R. ISE.253, ISE.254,
ISE.255, ISE.256
Yole, D. ISE.351
Yontem, B. ISE.012
Yoo, J.S. ISE.380
Youroukova, V. ISE.120
Zabaznoska, L. ISE.131, ISE.382
Zabzun, M. ISE.328
Zadcovich, S. ISE.369
Zahirnia, A.H. ISE.365
Zaitseva, G. ISE.400
Zajkowska, J. ISE.297
Zanc, V. ISE.017
Zangeneh, M. ISE.037
Zantopoulos, G.Z. ISE.383
Zarnowska, H. ISE.133
Zhukovskaya, E. ISE.396
Zilovic, D. ISE.184, ISE.185
Zofou, D. ISE.168
Zoleta, L. ISE.208
Zonov, O. ISE.401
Zribi, M. ISE.140
Zurak, I. ISE.036

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