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13th International Congress on Infectious Diseases

Kuala Lumpur, Malaysia June 19 ~ 22, 2008

Abstracts

International Scientific Exchange

2009

IMED

International Meeting on Emerging Diseases and Surveillance

Vienna, Austria

·

Fe b r u a r y 1 3 ­ 1 6 , 2 0 0 9

Co-sponsored by ProMED-mail, the Program for Monitoring Emerging Diseases European Centre for Disease Prevention and Control World Organization for Animal Health (OIE) The European Commission Wildlife Conservation Society Organized by International Society for Infectious Diseases

European Commission

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International Society for Infectious Diseases 1330 Beacon Street, Suite 228 · Brookline, MA 02446 USA · Phone: (617) 277-0551 Fax: (617) 278-9113 · E-mail: [email protected] · Web site: http://imed.isid.org

Preliminar y program will be available in July 2008 · Deadline for abstract submission is December 1, 2008

13th International Congress on Infectious Diseases

Kuala Lumpur, Malaysia June 19 ~ 22, 2008

International Scientific Exchange

Organized by the International Society for Infectious Diseases

13th International Congress on Infectious Diseases

Table of Contents

International Scientific Exchange

Antibiotics: New Agents, Mechanisms of Action, Resistance, Pharmacokinetics/ Pharmacodynamics and Appropriate Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Animal Models, Pathogenesis of Infectious Diseases and Host Defenses . . . . . . . . . . . . . . . . . . . . . . 10 Bacterial Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Diagnostics: Microbiology, Virology, Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Emerging Diseases, Zoonoses and Infections in Animals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Epidemiology, Public Health and Surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 HIV/AIDS and Other Retroviruses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Infection Control and Nosocomial Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Obstetrical-Gynecological, Surgical and Sexually Transmitted Infections . . . . . . . . . . . . . . . . . . . . . . . 90 Mycobacterial Infections (Including Tuberculosis). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Mycology (Including New Agents, Resistance and Mechanisms of Action of Antifungals). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Pediatric and Perinatal Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Parasitology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Tropical Medicine/Travel Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Vaccines and Vaccine Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Virology (Non-HIV), Including New Agents, Resistance and Mechanisms of Action, and Non-HIV Viral Opportunistic Infections in HIV-Infected Patients . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Index of Authors and Co-Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

International Scientific Exchange

Antibiotics: New Agents, Mechanisms of Action, Resistance, Pharmacokinetics / Pharmacodynamics and Appropriate Use

ISE.001 Urinary Tract Tuberculosis A. Sharif, M. Momenheravi. Kashan University of Medical Sciences, Kashan, Iran (Islamic Republic of) Introduction: TB is an endemic disease in Iran which may involve every organ and it must be considered in differential diagnosis of some diseases. we report a case of urinary tuberculosis who was admitted with primary diagnosis of UTI. Case Presentation: 85 year old man from Sistan and Baloochestan province was admitted on October 2002 because of fever, disuria and frequency 3 weeks before admission. There was pyuria and hematuria in urine analysis and serum ceratinine was 1.9 mg/dl. He was given intravenous antibiotic but his fever and urinary complaints continued. Urine culture was negative and PPD test was posistive with 20 mm indurasion. Acid fast bacillus was seen in his urine smear so anti tuberculosis treatment was began and after 3 days, fever stopped and urinay symptoms diminished. Left kidney stasis and the prominent inflammation of bladder mucous memebrane were reported in ultrasonography. Conclusion: TB must be considered in patients with urinary tract infections in which response to treatment is poor. Key Words: urinary tract infection, tuberculosis ISE.002 A Comparison of Antibiotic Susceptibility Patterns of Klebsiella Associated UTI Between Nosocomial and Spinal Cord Injured Patients F. Khorvash, K. Mostafavizadeh, S. Mobasherizadeh, M. Behjati, H. Salehi. Infectious Research Center,Medical University, Isfahan, Iran (Islamic Republic of) Background: The bulk of antibiotic resistant uropathogenes is now considered as a great disaster in clinical medicine, for both complicated and non-complicated urinary tract infected patients. Just regarding different risk factors such as urinary catheterization, current and past exposure to potent antibiotics, underlying organic diseases, poor hygiene of sexual contact, spinal cord injury, it seems justice to improve diagnostic power for drug resistant uropathogenes and well appropriate empirical therapy. Methods: 300 and 145 cases of clinicopathologically diagnosed nosocomial (group A) and SCI (group B) associated UTI, respectively, were considered as our samples included in our 24 months study (2005 and 2006). Mean age of them was 45±12 in group A and 40±10 in group B. 50 (16.6%) and 26(17.9%) correctly diagnosed Klebsiella, respectively, were cultured from our specimens. MIC pattern of this uropathogenes for 8 antibiotics was determined by gradient concentration method (E-Test; AB BIODISK Co. Sweden). Quality control was tested by E. coli ATCC25922. Data was analyzed by SPSS 13 and WHO net 5 software. Results: The prevalence of antibiotic resistant Klebsiella was more among nosocomial associated UTI rather than SCI UTI (P<0.05). According to susceptibility cut-off point criteria of CLSI M7-A6 (Clinical and Laboratory Standard Institute), Klebsiella resistance rate of nosocomial and SCI were 40% and 0 in Amikacin (P <0.0001 ), 86.2% and 16.7% in Ceftazidime (P<0.001), 69% and 25% in Ceftriaxon (P<0.005), 5.1% and 0 in Imipenem (P<0.0001), 50% and 25% in Ciprofloxacin (P< 0.05), 81% and 22.2% in Gentamicin 100% and 62.5% (p<0.001) in Trimethoprim/Sulfamethoxazole (P<0.05 ) respectively. Only resistance to Nalidixic acid was mildly higher in SCI Klebsiella (68.8%, 66.7%). MIC50 of all antibiotics except Nalidixic acid and Trimethoprim/ Sulfamethoxazole were higher in nosocomial Klebsiella (p<0.05). Conclusions: Although the whole risk factors for UTI in the cases of SCI associated UTI are more than for nosocomial UTI, interestingly, the prevalence of Klebsiella resistant UTI was more in the second group. More data is needed to identify the cause of such a sophisticated difference. Key Words: Klebsiella, Urinary Tract Infection, Nosocomial, Spinal Cord Injury, Antibiotic Susceptibility

ISE.003 The Extending Spectrum of Effective Weapons Against Multiresistant Gram-Positive Cocci R. Manfredi. Infectious Diseases, University of Bologna, Bologna, Italy Background: Multiresistant Gram-positive cocci, including Staphylococcus aureus, the group of coagulase-negative staphylococci, Enterococcus faecalis and Enterococcus faecium, as well as Streptococcus pneumoniae and other streptococci, represent emerging pathogens in the community, but especially in the setting of immunocompromised, hospitalized patients. Methods and Results: In these last conditions of elevated risk, multiresistant Gram-positive microorganism infections occur in particular when surgery, invasive procedures, or prosthetic implants are of concern, patients are admitted in intensive care units, or underlying chronic disorders and immunodeficiency are of concern, and broad-spectrum antibiotics are widely used in the environment. The spectrum of antimicrobial compounds now available for an effective management and treatment of these relevant infections is significantly threatened by the emerging and spread of methicillin-resistant and more recently glycopeptide-resistant microbial strains. The streptogramine association represented by quinupristin/dalfopristin, the oxazolidinone derivative linezolid, and the recently licensed lipopetide daptomycin and the glycilcycline tigecycline, together with a number of novel glycopeptides (including the once-weekly dalbavancin), novel fluoroquinolones, novel cephalosporins with a spectrum including also methicillin-resistant staphylococci, and a number of experimental compounds on the pipeline, represent an effective response to the majority of these problems, due to their innovative mechanisms of action, their maintained or enhanced activity against multiresistant pathogens, their effective pharmacokinetic/pharmacodynamic properties, their frequent possibility of synergistic activity with other compounds effective against Gram-positive pathogens, and a diffuse potential for a safe and easy administration, also in the setting of compromised patients. Conclusions: The most relevant microbiological, pharmacological, and therapeutic issues related to the epidemiology of multiresistant grampositive infection, the potential clinical indications of all recently available compounds compared with the standard of care of treatment of resistant Gram-positive infections, and an updated overwiew of data on efficacy and tolerability of all these compounds and those on advanced investigation, are updated and outlined on the ground of an extensive review of all available, recent evidences coming from the international literature and clinical trials databases. ISE.004 The Low-level Laser Irradiation as the Way to Increase the Antituberculous Activity of Isoniazid and Streptomycin E. Kulchavenya, G. Vanina. Research TB, Novosibirsk, Russia Introduction: The polychemotherapy for tuberculosis may be limited due to multi-drug resistance of Mycobacterium tuberculosis (MBT). No new antituberculous medicine was created at the end of the last century. So the problem of strengthening of activity available drugs is vital question. At the same time it is known, that the effect by radiation of lowintensity lasers on some drugs in vitro considerably increases their specific properties. Material and Methods: We have studied bacteriostatic activity of Isoniazid, Streptomycin also Rifampicin after irradiation with different lasers in some series of experiment. In experiment A we used He-Ne laser with energy 7,2 J/cm2­21,6 J/cm2, in experiment B, continuous infrared laser with dose 4,5 J/cm2­18 J/cm2, in experiment C, impulse (2000 Hz) laser with energy 6 J/cm2­18 J/cm2. 4-C series was as control for all. Then drugs were prepared in different concentrations. In each test we added 0,2 ml of culture MBT: H37RV, M. Bovinus - 8 and strain N 120 from the patient. The results were evaluated after an incubation within 21 days at t=37° C. In total 3,8 thousand of tests were executed. Results: The dose 18 J/cm2 of continuous and impulse infrared laser radiation increased antituberculous activity of Isoniazid and Streptomycin: the growth of MBT had ceased at concentration, in 2-3 folds less, than in control. Effect of helium-neon laser was not fixed. Also we didn't see any effect of laser irradiation on Rifampicin. Conclusion: Some regimes of laser irradiation of antituberculous drugs in vitro increase their bacteriostatic activity. Preliminary results are promising and demand to continue further researches in this field.

International Scientific Exchange · 1

ISE.005 First Report of Ctx-M Beta-Lactamases from Bosnia and Herzegovina B. Bedenic1, S. Uzunovic-Kamberovic2, J. Vranes3, N. Beader4, V. Plecko5, S. Kalenic5. 1Zagreb University Medical School, Zagreb, Croatia, 2Cantonal Institute of Public Health, Zenica, Zenica, Bosnia and Herzegovina, 3School of Medicine, University of Zagreb, Zagreb Institute of Public Health, Zagreb, Croatia, 4School of Medicine, University of Zagreb, Zagreb, Croatia, 5Clinical Hospital Center Zagreb, Zagreb, Croatia Background and Aim: Plasmid-mediated extended-spectrum -lactamases (ESBL) are most commonly of the TEM, SHV or CTX-M type. To date more than 120 TEM enzymes, more than 50 SHV enzymes, and more than 30 CTX-M have been reported (www.lahey.org/studies). CTX-M enzymes are increasingly found in eneterobacterial species around the world. They have a much higher level of activity against cefotaxime and ceftriaxone than ceftazidime. They are derived from the chromosomal -lactamases of the genus Kluyvera. Recently first E. coli strains with high resistance to cefotaxime and ceftriaxone have been isolated in Zenica-Doboj Canton in Bosnia and Herzegovina. The aim of this study was to characterize -lactamases produced by these isolates. Material and Methods: Two Escherichia coli strains with unusual resistance phenotype (no inhibition zones around cefotaxime and ceftriaxone disks) were isolated in the Laboratory for Sanitary Microbiology in Zenica, Bosnia and Herzegovian. Extended-spectrum -lactamases (ESBL) were detected by double-disk synergy test and CLSI combined disk test using both ceftazidime and cefotaxime disks. Susceptibility to a wide range of antibiotics was determined by the broth microdilution method according to CLSI. The transfer of the cefotaxime resistance determinants was determined by the broth mating method using E coli recipient resistant to rifampicin. ESBLs were characterized by isoelectric focusing, substrate profile determination, PCR and sequencing of blaCTX-M genes. Genetic relatedness between the strains was tested by PFGE. Results: The both isolates were highly resistant to cefotaxime, ceftraxone, cefuroxime, amoxicillin and gentamicin (MIC >128 mg/L). MICs of ceftazidime and aztreonam were also quite high (64 and 128 mg/L respectively). One isolate was resistant to cefoxitin. The strains were susceptible to ciprofloxacin and carbapenems. MICs of cefotaxime were strongly reduced in the presence of clavulanate (eight to ten dilutions). Resistance to cefotaxime was transferred to E. coli recipient from two of the strains with low frequency (2.6 and 6.3 x 10-7). Resistance to gentamicin, cotrimoxazole and cloramphenicol was cotransferred alongside with cephalosporine resistance. PCR has detected blaCTX-M genes in both isolates. Sequencing of blaCTX-M genes revealed CTX-M-15 lactamase in both isolates. The both isolates possessed an additional TEM-1 -lactamase. PFGE showed that the isolates were not clonally related. Conclusions: This is the first report of CTX-M -lactamases from Bosnia and Herzegovina. CTX-M-15 -lactamase was previously reported from many countries in the world such as Croatia,, Bulgaria, Austria, Poland, Switzerland, United Kingdom thus we can conclude that it is widespreas in Europe. Carbapenems and fluoroquinolones should be recommended as antibiotics of choice for the treatment of infections caused by our CTX-M producing bacteria. Since, there was no clonal spread of CTX-M producing E. coli strains in the community of Zenica -Doboj Canton according to PFGE, we could conclude that the CTX-M producing isolates ocurred independently. ISE.006 Efficacy of Anise Oil, Dwarf-Pine Oil and Camomile Oil Against Acyclovir-resistant Herpesvirus Strains H.K. Geiss1, C. Koch2, J. Reichling2, R. Kehm2, M.M. Sharaf2, H. Zentgraf2, J. Schneele2, P. Schnitzler2. 1Rhoen-Klinikum, Bad Neustadt, Germany, 2University of Heidelberg, Heidelberg, Germany Background: Like the ever increasing resistance of bacteria against antibiotics there is an imminent risk of resistance development in viruses as well. Therefore we tested the effect of anise oil, dwarf-pine oil and camomile oil against different acyclovir-sensitive and acyclovirresistant herpes simplex virus type 1 (HSV-1) strains. Methods: The DNA sequence of the acyclovir-resistance related thymidine kinase (TK) gene of HSV-1 acyclovir- resistant isolates 1246/99 and 496/02 was determined. Both viral isolates contain frameshift mutations in the TK gene in homopolymer stretches of guanines or cytosines.

An insertion in the TK gene of isolate 1246/99 and a deletion of one nucleotide in isolate 496/02 yield a truncated altered thymidine kinase enzyme resulting in a TK negative phenotype and clinical resistance against acyclovir. The inhibitory activity of three different essential oils against herpes simplex virus isolates was tested in vitro on RC-37 cells using a plaque reduction assay. Results: All essential oils exhibited high levels of antiviral activity against acyclovir-sensitive HSV strain KOS and acyclovir-resistant HSV isolates 1246/99 and 496/02 as well as acyclovir-resistant strain Angelotti. At maximum noncytotoxic concentrations of the plant oils, plaque formation was significantly reduced by 96.6% to 99.9%. Only a modest or no significant effect on viral infectivity could be achieved by adding these compounds during the adsorption phase or replication phase, respectively. Conclusions: These results indicate that anise oil, dwarf-pine oil and camomile oil affected the virus before adsorption and in a different manner than acyclovir. Thus the investigated essential oils are capable to exert a direct effect on HSV and might be useful in treatment of drugresistant viruses. ISE.007 Staphylococcus aureus Resistance to Antibiotics S. Josifova, V. Stefanovska, V. Dzartovska, A. Bajrami. General Hospital Kumanovo, Kumanovo, Former Yugoslav Republic of Macedonia Background: To present S. Aureus resistance to the mostly administrated antibiotics with patients in our hospital. Methods: Microbiological analyses of corporeal secreta and excreta, blood and smear taken from a patient`s body have been done. Disc diffusion method i.e agar plate, has been used for antibiograms. Results: Out of 532 isolates of S. aureus, 31.2% originates from lesion or skin; 33.3% from nose; 15.2% -throat; 10.4% urogenital tract and urinoculture; 5.6%-ear and eye; and 4.3%-chemoculture. Following these antibiograms it can be noticed that 88.5% of the S. aureus isolates are resistant to Penicillin; 9.1% are with mild sensitivity and 2.4% only are sensitive. This is due to the S. aureus ability to production of beta lactamasis. Something similar happens to Ampicillin with resistance of 79.5%. Resistance to cephalosporins (Cefalexin, Ceftriaxon, Cefixime) is significantly lower and counts 17.3%. The same refers to macrolide antibiotics (Erythromycin, Claritromycin and Azitromycin) as well, with resistance at 16.1%. 1/3 of the S. Aureus are resistant to Gentamicin and Cotrimoxasol, where more than a half (54.1%) are resistant to tetracyclines. Chloramphenicol has beneficial in vitro effect with 63.9%. The lowest percent i.e. 8.2% of the resistant types is to Klindamycin and 7.4% to Neomycin. Urethral smear and urinoculture isolates have been used in order to analyse the resistance of S. aureus to fluorokinolonies where a low percent of resistance has been noted. Conclusion: Occurance of a number of multi-resistant types of S. aureus keeps limiting the already existing treating options to these infections. Beta-lactamasis resistant antibiotics are still of great importance in treating them. As far as for severe, vitally endangering infections, combinations of two or more antibiotics have been used. ISE.008 Hospital Consumption of Antibiotics in Slovenia in 2006 M. Cizman, Slovenian Surveillance Antibiotics Consumption Study Group. University Medical Center, Ljubljana, Slovenia Background: To collect data on hospital use of antibiotics in Slovenia at national level. Methods: Consumption data of systemic antibiotics in Anatomic Therapeutic Chemical (ATC) class J01 were collected from all hospitals and expressed in defined daily doses (DDD) per 100 bed-days (HBD), per 100 admissions (HA) and per 1000 inhabitants per day (TID). Results: In 2006 Slovenia (2008516 inhabitants) had 361912 inpatients, 2571676 bed-days and average length of stay in 29 hospitals was 7.1 days. In 2006 the national hospital antibiotic consumption was 49.51 DDD/HBD, 325.26 DDD/HA and 1.70 DDD/TID respectively. In one teaching hospital the consumption was 63.04 DDD/HBD and in 11 general hospitals the mean consumption was 57.54 (46.79­69.22) DDD/HBD respectively. Penicillins (36.8 %), cephalosporins (20.4 %), quinolones (16.7 %) macrolides and lincosamides (9,6%) and aminoglycosides (4,78%) were five most commonly used classes of antibiotics. Conclusion: Hospital consumption of antibiotics in Slovenia is moderate. The data provide the basis for further surveillance and interventions.

2 · International Scientific Exchange

ISE.009 Lower Respiratory Tract Infections with Patients Treated at the Infectious Ward in Kumanovo V. Stefanovska, S. Josifova, V. Dzartovska, A. Bajrami. General Hospital, Kumanovo, Former Yugoslav Republic of Macedonia Aim: To show the coverage of the acute infections of the lower respiratory tract and its epidemiological and clinical characteristics with patients treated in hospital. Methods: Medical documentation of hospitalised patients at the Infectious Ward during the 2005­2007 period was analysed. Diagnosis was made on the basis of the epidemiological data, clinical picture fibrosis and cough predominant, standard haematology-biological analyses, Rtg of lungs, bacteriological analyses of sputum, smear of throat and nose and serological analyses detecting IgM antibodies by IIF method. Results: During the 3-year period, 838 patients suffering from acute lung disease were treated at the Infectious Ward i.e. 55.4% males Urban population, with 72.2% was predominant. Children at the age of 10 i.e 38.8% and adult over 40 i.e. 31.3% prevailed. The greatest number of diseased appeared to be in the period of December-February i.e. 34.7%. 79.3% appeared to have bronchopneumonia, 11.2% suffered from acute bronchitis and 9.4% suffered from segment or lobar pneumonia. Streptococcus pneumoniae, as bacterial isolate, was isolated at 13 patients. Haemophilus influence at 5 patients. Serology analysis carried out by the IIF method detecting IgM antibodies proved that 8 patients were positive to Mycoplasma pneumoniae, 5 patients to Coxiella burnetti and 6 patients to RSV and A and B Influence. 4.2 days, on the average, after being admitted to hospital the patients were febrile. Luekocytosis covered 8.9-17.2% of patients. The clinical course, at a number of patients was satisfactory and with fast regression of the symptoms. Hospitalisation took, on average, 7.1 days. Conclusion: Lower Respiratory Tract Infections are present in our environment and represent significant pathological entity. These infections are predominant in winter period (34.7%) 10-year old children and adults over 40 are the age groups that suffer mostly from these infections, with (79.3%) prevalence of bronchopneumonia. The duration of treatment, course and outcome were on reliance to the clinical picture, age and cause. ISE.010 Adverse Reactions to Antibiotics in Iranian Hospitalized Children F. Fattahi1, Z. Pourpak1, Z. Moinfar1, G.T. Khotaei2, K. Gholami3, M. Moin1. 1Immunology, Asthma and Allergy Research Institute, Medical Sciences/ University of Tehran, Tehran, Iran (Islamic Republic of), 2 Infectious Diseases Department, Children Medical Center, Medical Sciences/ University of Tehran, Tehran, Iran (Islamic Republic of), 3 Department of Clinical Pharmacy, College of Pharmacy, Medical Sciences/ University of Tehran, Tehran, Iran (Islamic Republic of) Background: Treatment with antibiotics is one of the bases of modern medicine. Adverse drug reactions (ADRs) related to antibiotics are frequent in children and make physicians prescribe more expensive antibiotics and consequently promote resistant microbial strains. We performed this study to determine the frequency of adverse reactions to antibiotics on organ-systems of hospitalized children in a main department of infectious diseases in Iran. Methods: All patients treated with antibiotic were evaluated daily for the presence of ADR(s) during above 5 months period. For each suspected ADR, a second questionnaire was completed containing all the information necessary for analysis of ADR. Results: Among 300 patients, 65 ADRs were seen in 36 patients (12%) during their hospitalization. Pneumonia was the most common cause of antibiotics administrating and Ceftriaxone and Rifampin were the most frequent antibiotics caused ADRs. There was a significant relationship between the number of drugs used and ADRs rate (P< 0.0001). The most common affected organ in ADRs was skin and appendages, and gastrointestinal systems respectively. Maculopapular rashes were the most frequent skin reactions related to ADR. Conclusion: As antibiotics are the most frequent drugs used in children group, and also because of significant relationship between the number of drugs used and ADRs, administrating limited number and suitable kind and dose of antibiotics and close observation for ADRs are very important. Thus, health care workers especially should be aware of ADR related signs and symptoms to manage it appropriately and diminish adverse consequences.

ISE.011 Antimicrobial Activity of Extracts from Erigeron floribunda (H. B. & K.) of Cameroon S. Metagne1, R.M. Ebelle Etame 2, F. Talla 3, M. Fotso 4, R.A. Ngono Ngane 2. 1Department of Biochemistry, Faculty of Science, University of Douala, Douala, Cameroon, 2University of Douala, Faculty of science, Douala, Cameroon, 3Laboratoire d Analyses Medicales LITTO-LABO, Douala, Cameroon, 4Laboratoire du Centre de Recherche en Alimentation et en Nutrition,IMPM Yaounde, Douala, Cameroon The fresh leaves from Erigeron floribunda play an inportant role in the folk medicine of West Africa and are used against infectious diseases (dental pain, diarrhoea, gastroenteritis, athlete's foot, influenza). This study was carried out to valorize the medicinal cameroonian plants based on antimicrobial suceptibility testing on gastroenteritis strains. Two crude aqueous extracts from leaves of Erigeron floribunda were investigated for their antimicrobial activity against two enterobacteria (Escherichia coli and Salmonella sp), and one yeast Candida albicans using the broth dilution method. Both cold soaked and boiled extracts showed antimicrobial activity. The cold soaked extract exhibited a partial inhibitory effect on microbial growth (E. coli, Salmonella sp and C. albicans) where as boiled extract, which showed to be the most active, exhibited both bacteriostatic and fungicidal effects with concentrations ranging from 50 to 100mg/ml. This study scientifically confirms the use of Erigeron floribunda in traditional medicine and its beneficial medicinal properties. The boiled leaves should be better recommended than the cold soaked extract. Key Words: Erigeron floribunda, Antimicrobial activity, Enterobacteria, Candida albicans ISE.013 The Activity of Immunomodulator Ferrovir Against Infection Caused by Tick-Borne Encephalitis Virus D.N. Nosik1, P.G. Deryabin1, I.L. Mironov2, E.A. Stenko2, E.N. Kaplina3. 1 The D.I.Ivanovsky Institute of Virology Russian Academy of Medical Sciences, Moscow, Russia, 2Chelyabinsk Medical Academy, Chelyabinsk, Russia, 3Technomedservice Company, Moscow, Russia Background: The new drugs for therapy of tick-borne encephalitis are very actual in Russia where cases of infection appear now not only in its traditional regions as Siberia and Far East but also at the European part of the country. Previously, it was found that immunomodulator Ferrovir (FV) (sodium salt of DNA from salmon's milt conjugated with Ferrum) was effective in patients with HIV- and HSV-infection. The aim of the study was to analyze the efficiency of FV against tick-borne encephalitis. Methods: The efficiency of FV was studied in cells infected with tickborne encephalitis virus (TBEV). The clinical study enrolled 2 groups (gr.) of patients (pts) with tick-borne encephalitis. Age: 17­67 years old, white race. 1st gr. of 78 patients (pts)--40 pts with fever (A), 38 pts-- with meningeal form (B) were treated traditionally with specific immunoglobulin. 2nd gr. of 35 pts--23 with fever (C), 12 pts--with meningeal form (D) were additionally treated with FV 5 ml 1,5% solution twice daily as i/m injections for 5 days. Results: Administration of 400 microg/ml FV 1 hour before the cells infection with TBEV reduced virus titer for 2 lg TCID50. Treatment of pts with FV resulted in reduction of fever period in gr.C - 4,3±0,5 day (gr.A - 7,3±1,6 day) and in gr.D - 7,8±1,0 day (gr.B - 12,1±1,2 day). FV administration was well tolerated and no side effects were observed. Conclusion: FV demonstrated antiviral activity against TBEV and more rapid reduction of infectious process when used in complex treatment of tick-borne encephalitis. FV was well tolerated by patients. ISE.014 In Vitro Susceptibility of Tigecycline Against Clinical Isolates in The Largest Hospital in Malaysia Z. Abdul Wahab1, A. Adnan2. 1Kuala Lumpur Hospital, Kuala Lumpur, Malaysia, 2Faculty of Medicine UiTM, Shah Alam, Malaysia Background: Tigecycline, a drug in the class of glycylcycline acts by inhibition of protein translation in bacteria by binding to the 30s ribosomal subunit and by blocking entry of amino-acyl tRNA molecules into the A site of ribosome. The antibiotic was introduced in Malaysia in 2007. The availability of tigecycline in our setting was considered timely as we search for therapeutic alternatives in the era of emerging antibiotic resistance.

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Objective: The study was carried out to determine the in vitro activity of tigecycline against clinical isolates at our laboratory prior to its introduction in our hospital. Methodology: Clinical isolates received at the Microbiology Laboratory of Hospital Kuala Lumpur, which is a 1200-bed hospital; the largest in the country were included in the study. Isolates were identified according to standard microbiological practices. The organisms were subjected to disk diffusion testing according to reference methods recommended by Clinical Laboratory Standard Institution. Results: The in vitro activity of tigecycline was evaluated against 747 isolates. The most prevalent pathogens tested were Acinetobacter spp. (13.8%), Staphylococcus aureus (49.3%), Streptococcus pyogenes (2%), Klebsiella spp. (21%), E. coli(7.4%), Enterobacter spp. (4.7%), and Citrobacter spp. (1.7%). All the isolates tested showed in vitro susceptibility against tigecycline. Tigecycline was active against all strains of Staphylococcus aureus, including MRSA. In addition, tigecycline activity was also active against Klebsiella spp. even if the isolates were ESBL-producers. Tigecycline was also shown to have excellent activity against multi-drug resistant Acinetobacter spp. Conclusion: Tigecycline demonstrated potent activity against both gram-positive and gram-negative organisms even among multi-drug resistant strains. Tigecycline can play an important role in the treatment of both community and hospital acquired infections. Continued surveillance is necessary to monitor the in vitro activity of tigecycline following the introduction into clinical practice in our hospital. ISE.015 Inhibition Effect of Allium Sativum Extract to Staphylococcus aureus and Shigella Dysenteriae Growths E. Suswati. Medical Faculty, University of Jember, Jember, Indonesia Goal: To know the inhibition effect of Allium sativum extract and inhibition concentration 50% (IC50) Allium sativum extract to Staphylococcus aureus and Shigella dysenteriae. The experimental laboratories research was used to count percentage of bacteria colonies which still grow after contact with Allium sativum extract on several concentrations with 0 second. Each bacteria was contact with Allium sativum extract that 0%, 12.5%, 25%, 50% and 100% concentration. Each concentration was replied for 8 times. To measure the inhibition effect we count the percentage of bacteria colonies which still grew after contact with Allium sativum extract and compared with the control. The data analyzed with probit regression analyzes with 0.05 significancy. The result of this study shown that inhibition effect of Allium sativum extract to Staphylococcus aureus and Shigella dysenteriae is significant with IC50 3.54% and 2.42%. Conclusion of this study is Allium sativum extract can inhibit the growth of Staphylococcus aureus and Shigella dysenteriae with IC50 3.54% and 2.42%. Key Words: inhibition effect, Allium sativum extract, Staphylococcus aureus, Shigella dysenteriae ISE.016 Large-Scale Surveillance of Azithromycin Usage in Poland M. Gasparic, T. Andabaka, A. Balazin, A. Welle-Jeras, L. Cvitkovic, M. Oremus. PLIVA Croatia Ltd., Zagreb, Croatia Background: Azithromycin (Sumamed®) was introduced to Central and Eastern Europe in 1988. It proved to be extremely effective antibiotic with expanded and enhanced antibacterial activity, prolonged and higher tissue concentration, lower incidence of gastrointestinal side effects compared to other similar antibiotics and increased patients' compliance due to one-, three- and five-day treatment courses. During the last twenty years, resistance of bacteria generally increased. However, reports on how resistance affects treatment results are still insufficient and controversial. Objectives: To analyze physicians' prescription habits in terms of indications, in which azithromycin is most commonly prescribed, as well as to assess azithromycin clinical effectiveness and safety. Methods: Data on 76,122 patients [47.8% pediatric (P) and 45.5% adult (A)] were collected by 1,108 physicians through multicenter surveillance, by applying two types of questionnaires; one oriented to physicians and their general experience with azithromycin, and the other focused on patients, their diagnoses and effectiveness of prescribed azithromycin therapy. Azithromycin effectiveness was assessed by physicians. Results: It was shown that patients were treated with azithromycin mostly due to respiratory tract infections (P: 34,288; A: 30,149), followed by skin and soft tissue infections (P: 494; A: 1,336) and sexually transmitted diseases (P: 48; A: 745). According to physicians' assessment of

effectiveness, 84.4% patients were considered cured and to 13.7% condition was improved following azithromycin therapy. These results also reflect azithromycin effectiveness in particular indications, when analyzed separately. Additionally, only 2.06% physicians observed adverse drug reactions to azithromycin therapy during their everyday practice, whereby rash was most commonly described. Conclusion: After 20 years of clinical use, azithromycin as an empiric therapy still demonstrates high effectiveness in the treatment of respiratory tract infections, skin and soft tissue infections, and sexually transmitted diseases, showing thereby very good safety profile. ISE.017 Anti-Helicobacter pylori and Anti-CagA Antibodies in Patients with Peptic Ulcer and Healthy Subjects A. Jafarzadeh, M. Nemati, M.T. Rezayati, M. Salari. Department of Microbiology, Rafsanjan University of Medical Sciences, Rafsanjan, Iran (Islamic Republic of) Background: H. pylori is considered to play an etiologic role in several gastroduodenal diseases including gastric ulcer, duodenal ulcer and gastric cancer. Several studies have suggested that H. pylori which express cytotoxin-associated gene A (CagA) may be more virulent than those that do not, but limited populations have been studied to date. The aims of the present study were to evaluate the anti-H. pylori IgG, IgA and anti-CagA antibodies in peptic ulcer (PU) patients and healthy individuals from Rafsanjan city of Iran. Methods: A total of 60 PU patients (30 males and 30 females, aged 17 to 60 years) and 138 age-matched healthy individuals (65 males; 73 females) were enrolled in this study. Diagnosis of PU disease determined on the basis of findings by gastrointestinal endoscopy. The control group was recruited among healthy blood donors referred to Blood Transfusion Center of Rafsanjan. A blood sample was collected from each participant and the sera were tested for the presence of anti- H. pylori IgG and IgA antibodies and antibody to bacterial virulence factor (CagA) by use of enzyme linked immunosorbent assay. Moreover, in each group the serum concentrations of anti-H. pylori IgA and anti-CagA antibody expressed as mean ± SD. Results: In PU patients the overall seroprevalence of anti-H. pylori IgG (95.8%), IgA (96.6%) and anti-CagA (91.6%) were higher than those observed in control group (73.2%%, P<0.003; 79%, p<0.002; 47.82%, p<0.0000001; respectively). In control group the prevalence of serum anti-CagA IgG antibodies were significantly higher in males compared to females (58.46% vs 38.35%; P<0.01). Moreover, the mean titer of anti-H. pylori IgA antibodies were significantly higher in anti-CagA+ subjects compare to anti-CagA- subjects (47.5 Uarb/ml ± 35 vs 27 Uarb/ml ± 18; p<0.01). Conclusion: These results show that the H. pylori-specific antibodies, specially anti-CagA were more prevalent among PU patients compare to control group. Moreover, it seems that the males are more susceptible to infection with cagA+ strains compared to females. ISE.018 Analysis of Tigecycline Activity Against Pathogens Isolated from Lower Respiratory Infections - The Global T.E.S.T. Program 2007 M. Hackel1, M. Renteria1, R. Badal1, S. Bouchillon1, J. Johnson1, D. Hoban1, B. Johnson1, M. Dowzicky2. 1International Health Management Associates, Inc., Schaumburg, IL, USA, 2Wyeth Pharmaceuticals, Collegeville, PA, USA Objectives: Tigecycline (TIG), a new glycylcycline, has been shown to have potent broad spectrum activity against most commonly encountered species responsible for community and hospital acquired infections. The Tigecycline Evaluation Surveillance Trial (TEST), a global longitudinal surveillance study, determined the in vitro activity of TIG and 13 comparators against gram positive and gram negative species isolated from lower respiratory infections. Methods: 6,266 lower respiratory pathogens from 42 countries were analyzed in this survey. The isolates were identified to the species level at the participating sites and confirmed by the central laboratory. MICs were determined by each site using supplied broth microdilution panels and interpreted according to CLSI guidelines. Results: TIG activity against pathogens isolated from lower respiratory infections is shown in the table.* Conclusions: Tigecycline showed excellent inhibitory activity against all pathogens from lower respiratory infections in this study, with the exception of P. aeruginosa Tigecycline demonstrated MIC90 values of <=0.5mcg/ml against gram-positive pathogens (including resistant

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phenotypes) and MIC50 values of <=1 mcg/ml against the Enterobacteriaceae and Acinetobacter spp., validating the potent inhibitory activity of TIG against these pathogens.

ISE.020 A Profile of Tigecycline Activity Against Clinical Isolates in Spain and Portugal 2004­2007 M. Hackel1, R. Badal1, S. Bouchillon1, M. Renteria1, B. Johnson1, J. Johnson1, D. Hoban1, M. Dowzicky2. 1International Health Management Associates, Inc., Schaumburg, IL, USA, 2Wyeth Pharmaceuticals, Collegeville, PA, USA Background: Development of bacterial resistance continues to cause concern world wide, but the availability of newer agents offers clinicians options for therapy. Tigecycline has a very broad spectrum of activity, including strains resistant to other drugs. As part of the global Tigecycline Evaluation Surveillance Trial, strains collected in Iberia from 2004 to 2007 were evaluated for susceptibility to several commonly used antimicrobials. Methods: 1710 strains were collected and identified at 9 sites in Spain and Portugal. MICs were determined at each site using EUCAST guidelines on microdilution panels. Results: The following table summarizes results. Conclusions: Tigecycline's in vitro activity was comparable to or greater than commonly prescribed antibiotics against both gram-negative and gram-positive pathogens, including resistant phenotypes. Tigecycline's MIC90 of 1 mcg/ml was the lowest of all comparator agents in this study.

ISE.018 *na = breakpoints not available. ISE.019 Comparison of in Vitro Activity of Tigecycline Against Vancomycin Resistant Enterococci (VRE) in the U.S. Analyzed by CDC Regions S. Bouchillon1, B. Johnson1, M. Renteria1, R. Badal1, M. Hackel1, J. Johnson1, D. Hoban1, M. Dowzicky2. 1International Health Management Associates, Inc., Schaumburg, IL, USA, 2Wyeth Pharmaceuticals, Collegeville, PA, USA Background: The percentage rates of vancomycin-resistant Enterococcus spp (VRE) vary by country and region. Tigecycline, a new glycylcycline, has been shown to have potent activity against commonly encountered species, including those with resistant phenotypes. The purpose of this study was to determine regional variations, if any, and the current activity of tigecycline (TIG) against VRE in the United States. Methods: 622 clinically relevant isolates of vancomycin-resistant Enterococcus faecalis and vancomycin-resistant Enterococcus faecium were collected from patients in 193 hospitals across the United States from 2004 - 2007. MIC's were determined by broth microdilution and interpreted following CLSI guidelines. Regions are defined by the CDC. Results: Results are summarized in the table below. Conclusions: Tigecycline demonstrated consistant potent activity against VRE in the United States, regardless of region of isolation, with an overall MIC90 of 0.12 mcg/ml. The exceptionally broad spectrum of tigecycline, which includes many other multi-resistant gram-positive and gram-negative bacteria in addition to VRE, will make it a very attractive addition to hospital formularies.

ISE.020 Table 1. ISE.021 New Therapeutic Management in Acute Uncomplicated Brucellosis A. Alikhani1, A. Heidarzadeh2. 1Tonekabon Medical faculty of Azad University, Tonekabon, Iran (Islamic Republic of), 2Guilan University of medical sciences and health services, Guilan, Iran (Islamic Republic of) Background and Objectives: Human brucellosis is a common bacterial zoonosis in I.R. Iran and with current therapy has significant relapse rate and side effects. However, the optimal duration of therapy has not been determined and side effects cause poor compliance. This study focused on comparison between effects, relapse rate and complications of two therapeutic regimens. Methods: In this single - blind randomized trial (in the clinic of Ramsar hospital during 2006-2007) 78 uncomplicated brucellosis patients were recruited and allocate into two tail of study by fixed block allocation method. Patients of doxycycline tail were treated with streptomycin, doxycyline plus rifampin (streptomycin plus doxycycline for first month and doxycycline plus rifampin for second and third months) and patients of ofloxacin tail were treated with streptomycin, ofloxacin plus rifampin (streptomycin plus ofloxacin for first month and ofloxacin plus rifampin for second and third months) for three months.

ISE.019 Table 1.

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Therapeutic outcome was evaluated by measuring efficacy, relapse rate and drug GI and skin side -effects. Active brucellosis diagnosed by serology (Wright and 2 ME tests) at the start, 3 and 6 month after drug therapy. The data were analyzed by stata 8.0 soft ware. The proportions were compared by fisher exact test. Significance level was 0.05. The results were reports as proportion ( standard error). Results: at the end of study the curative results were similar in doxycycline and ofloxacin tail (100%).. The complication rate had significant difference in doxycycline and ofloxacin tails, 48.6±8.3% versus 13.2±5.5%, respectively (p<0. 001, fisher exact test). The recurrence rate in both groups during six month follow up after complete treatment process was zero. Conclusions: It seems that duration is more important factor in the management of the brucellosis. Treatment of acute uncomplicated brucellosis in human for three month had no relapse and decreased side effects with ofloxacin included regimen. Key Words: Brucellosis, ofloxacin, doxycycline ISE.022 A Comparison of the Antibacterial Activities of Tigecycline and Other Agents Against Vancomycin Resistant Enterococci (VRE) from Western Europe R. Badal1, B. Johnson1, S. Bouchillon1, M. Hackel1, M. Renteria1, J. Johnson1, D. Hoban1, M. Dowzicky2. 1International Health Management Associates, Inc., Schaumburg, IL, USA, 2Wyeth Pharmaceuticals, Collegeville, PA, USA Objectives: Tigecycline (TIG), a member of a new class of antimicrobials (glycylcyclines), has been shown to have potent expanded broad spectrum activity against most commonly encountered species responsible for community- and hospital-acquired infections. The T.E.S.T. program determined the in vitro activity of tigecycline compared to amoxicillinclavulanic acid, piperacillin-tazobactam, levofloxacin, ceftriaxone, linezolid (LZD), minocycline (MIN), vancomycin (VAN), ampicillin (AM), penicillin (PEN), and imipenem against VRE collected from 94 hospitals in 22 Western European countries from 2004 through 2007. Methods: 76 VRE (15 Enterococcus faecalis, 61 E. faecium) clinical isolates were identified to the species level at each participating site and confirmed by the central laboratory. Minimum Inhibitory Concentrations (MICs) were determined by the local laboratory using supplied broth microdilution panels and interpreted according to EUCAST guidelines (tigecycline susceptible < 0.25 mg/L for enterococci). Results: %S of all VRE to TIG, LZD, and MIN were 100, 100, and 71.7, respectively. For E. faecalis strains, the most active drugs were TIG (100%), LZD (100%), PEN (93.4%) and AM (93.3%). For E. faecium, the three most active drugs were TIG (100%), LZD (100%), and MIN (78.7%). Conclusions: TIG exhibited outstanding activity against VRE, inhibiting 100% of strains at <=0.25 mg/L with an MIC90 of 0.12mg/L, which was 32-fold lower than the LZD MIC90 of 4ml/L. The exceptionally broad spectrum of TIG, which includes many other multi-resistant gram-positive and -negative bacteria in addition to VRE, should make it a very important addition to hospital formularies. ISE.023 A Trend Analysis of the in Vitro Activities of Tigecycline and Comparators in Eastern Europe from 2004-2007 R. Badal1, S. Bouchillon1, B. Johnson1, M. Hackel1, J. Johnson1, M. Renteria1, D. Hoban1, M. Dowzicky2. 1International Health Management Associates, Inc., Schaumburg, IL, USA, 2Wyeth Pharmaceuticals, Collegeville, IL, USA Objectives: The Tigecycline Evaluation and Surveillance Trial (T.E.S.T.) program is an ongoing global surveillance study designed to monitor the activity of tigecycline (TIG) and comparator drugs. TIG is a new broadspectrum antimicrobial that was marketed in mid 2005. This study reports TIG in vitro activity for the years 2004 (pre-marketing baseline) through 2007. Methods: 13 investigative sites in 8 Eastern European countries collected clinical isolates and determined MICs by broth microdilution according to EUCAST guidelines using identical panels. Results: Summary MIC data for TIG and key organisms are as follows: 1 No MIC90 calculated if n<10 Conclusions: TIG retained excellent in vitro activity over time against a broad spectrum of organisms, including drug-resistant strains such as ESBL-producers, multi-resistant Acinetobacter spp., and methicillinresistant S. aureus. Although in 2007 TIG MIC50/90 values for some

species increased by one doubling dilution compared to pre-marketing baseline levels, they remained in the "susceptible" category.

ISE.023

1 No

MIC90 calculated if n<10.

ISE.024 Epidemiology of Rabies in the Western Region of Romania S. Draghici, L. Daina, C. Laslau. University of Oradea, Oradea, Romania Introduction: The western region of Romania has a high rabies potential because of the epizooties in wild animals, especially fox, but in other species too. Cases of rabies have also been identified in domestic animals (cats, dogs), but fortunately none in humans. Methods: We have studied the cases of animal rabies in Bihor county over the past 7 years. We have identified human cases of animal bites and assessed the efficiency of prophylactic measures in animals and humans. Results: In the period 2001­2007, 32 animals were diagnosed with rabies, 16 wild (14 foxes - 44%, 1 badger - 3% and 1 wild cat - 3%) and 16 domestic (10 cats - 31% and 6 dogs - 19%, of which 3 were vagrant). Following the risk analysis, areas with rabies potential were identified: in rural environment locations near hill regions and forest margins, in urban environment outlying areas with stray dogs. We registered a low proportion of antirabic vaccination in domestic carnivores (under 50%), especially in rural environment, and a high number of stray dogs. We determined an inconsistence in antirabic vaccination of wild animals, inadequate purchase of vaccine doses, and yearly variation of the oral vaccination technique in foxes. During the studied period, 3792 people (90.3%ooo) were bitten by animals, of which 2910 (76.7%) by dogs, 674 (17.8%) by cats, and 206 (5.5%) by wild animals. 1547 people were prophylactically vaccinated after exposure, only 28 of these being bitten by proved rabies infected animals. 7 areas of rabies supervision were appointed. Conclusion: In Transylvania, the highest rabies potential exists in fox populations and unvaccinated domestic carnivores, mainly cats. Supplementary measures of prevention and control as well as environment protection are necessary. ISE.025 Trichinosis--An Important Public Health Problem in Transylvania S. Draghici1, Z. Bitea2, C. Laslau1. 1University of Oradea, Oradea, Romania, 2Public Health Authority Bihor, Oradea, Romania Introduction: Transylvania is situated in the west of Romania, where Easter and Christmas are celebrated by traditional meals with pork products. The breeding of pigs is done in private farms but also in individual households where deficiencies in monitoring the health state of domestic pigs exist. Other animals of this region infected with Trichinella spiralis are the wild boar and the Carpathian bear, whose meat is also used for food. Methods: We conducted a retrospective clinico-epidemiological study for the period 2001­2007 on trichinosis in Bihor county (600,000 inhabitants), one of the 12 counties of Transylvania. Clinical diagnosis was completed by blood tests (ELISA and Perilarval Precipitation Reaction). We noted a parallelism between human and animal morbidities of the same region and period. Results: During 2001­2007, 454 persons were diagnosed with trichinosis (75.5%ooo), mostly females - 241 (53.08%), adults - 374 (82.4%), from rural areas - 398 (87%). The source of infection was raw or undercooked meat products (sausages, ham, pastrami) from home reared trichinelloscopically unchecked pork. Women even consumed raw and minced meat for degustation. Infection with T. spiralis was subclinical in 203 people (44.70%); most clinical forms were mild - 144 cases (32.70%), but there was a significant number of moderate forms - 85 (18.74%) and

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severe forms - 22 (4.86%), with 2 fatalities (0.5%). The redoubtable complications were myocarditis, encephalitis and allergic polyneuritis. We identified 15 epizootic centers of trichinosis in wild boars, 5 centers in Carpathian bears, and 58 centers in domestic pig farms. Conclusion: Strict measures of sanitary-veterinary surveillance are needed for animal farms in the rural environment, obligatory trichinelloscopic examination in slaughtered pigs from individual households and eradication of the rodents which are hosts of the parasite. ISE.026 An United States Evaluation of Tigecycline and Comparator Antimicrobials Against Gram-negative and Gram-positive Isolates Derived from Community and Hospital Acquired Infections M. Hackel1, B. Johnson1, S. Bouchillon1, J. Johnson1, D. Hoban1, M. Renteria1, R. Badal1, M. Dowzicky2. 1International Health Management Associates, Inc., Schaumburg, IL, USA, 2Wyeth Pharmaceuticals, Collegeville, PA, USA Background: Tigecycline (TIG) possesses potent bacteriostatic/bactericidal activity against a variety of bacterial species. The T.E.S.T. program compares TIG and comparative agents to both gram positive and negative community and hospital pathogens. Methods: Between 2004­2007, 193 hospital sites collected over 35,194 clinically significant isolates from various infection sites. Following isolate identification MICs were performed and interpreted using CLSI guidelines and supplied broth microdilutions panels. Results: Selected U.S. pathogens tested against tigecycline are shown below: Conclusions: Tigecycline's in vitro activity was comparable to or greater than most commonly prescribed antibiotics against both grampositive and gram-negative pathogens, including a variety of resistant phenotypes. MIC90s of <=2 mcg/ml (excluding P. aeruginosa) clearly validate the potent activity of tigecycline against pathogens encountered in community and hospital settings in the United States.

Results: MIC90 of tigecycline and comparators to MDR groups 0 to 4+ are shown in the table below. Conclusions: Among nine antimicrobials tested, tigecycline exhibited the lowest MIC90 for S. pneumoniae strains isolated in the U.S. that were resistant to one or more drug classes. Its high level of activity was maintained even against strains with resistance to multiple drug classes.

ISE.027 1 MDR Group is defined as resistant to 0, 1, 2, 3, or 4 or more drug classes. ISE.028 European Bacteremia Pathogens Against Tigecycline and Comparators from 2004­2007 M. Hackel1, R. Badal1, M. Renteria1, S. Bouchillon1, B. Johnson1, J. Johnson1, D. Hoban1, M. Dowzicky2. 1International Health Management Associates, Inc., Schaumburg, IL, USA, 2Wyeth Pharmaceuticals, Collegeville, PA, USA Objectives: Bacterial resistance patterns vary by time and country. Surveillance studies help to identify those patterns to assist in therapeutic decisions. The Tigecycline Evaluation Surveillance Trial (TEST) is a multi-year global study that assists in the recognition of current trends in resistance on many levels. This report evaluates differences in susceptibility of bacteremia pathogens isolated in Europe from 2004 to 2007. Methods: 3762 bacteremia pathogens were collected and identified from 2004­2007 at 77 hospitals in 21 countries in Europe. MICs for each strain were determined per EUCAST guidelines at each facility using broth microdilution. Results: Tigecycline MICs are recorded in the table below Conclusions: Tigecycline showed excellent in vitro activity against all causative bacteremic pathogens with the exception of P. aeruginosa. Tigecycline demonstrated MIC90 values of <=0.5mcg/ml against grampositive pathogens (including resistant phenotypes) and MIC90 values of <=2mcg/ml against the Enterobacteriaceae including ESBL producers and Acinetobacter spp. Tigecycline possesses potent activity against bacteremic pathogens.

bEC

ISE.026 aVRE E. faecium/faecalis phenotypes ­ E. coli, KO ­ K. oxytoca, KP ­ K. pneumoniae cESBL producing EC, KO and KP

ISE.027 Evaluation of Tigecycline against Multi-Drug Resistant (MDR) Streptococcus pneumoniae in the United States M. Renteria1, R. Badal1, D. Hoban1, B. Johnson1, S. Bouchillon1, M. Hackel1, J. Johnson1, M. Dowzicky2. 1International Health Management Associates, Inc., Schaumburg, IL, USA, 2Wyeth Pharmaceuticals, Collegeville, PA, USA Background: Although overall rates of non-susceptibility to penicillin seem to have leveled off in the U.S., there is evidence of increasing resistance to macrolides. Multi-drug resistant (MDR) Streptococcus pneumoniae strains are not uncommon. Tigecycline, a new glycylcycline, offers the potential of enhanced activity against MDR S. pneumoniae. The Tigecycline Evaluation Surveillance Trial (T.E.S.T.) evaluated the activity of tigecycline and comparators to MDR S. pneumoniae isolated in the U.S. Methods: Between 2004 and 2007, 2,443 S. pneumoniae isolates were collected in 193 U.S. sites. MICs were determined at each site using broth microdilution panels and results interpreted as specified by CLSI. S. pneumoniae strains were categorized into groups according to the number of drug classes to which they were resistant (MDR groups 0 to 4+).

ISE.028 Table 1.

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ISE.029 HIV/AIDS a New Experience in Albania, Epidemiologic and Clinical Data H. Hoxha, G.J. Lito, E. Kallfa, A. Kallfa, R. Petrela, E. Hoxholli. University Hospital Center 'Mother Theresa', Department of Pediatric, Clinic of Infectious Diseases, Tirana, Albania Background: Until 1990 in our country has been a dictatorial political system, so we have been in a total isolation with other countries of the world and the prostitution was forbidden. For that reason the first case with HIV/AIDS was diagnosed in 1996 (post mortum). Aim: To tell the epidemiological and clinical data of the HIV/AIDS in our country. Method and Results: In this study were enrolled 16 children sick with HIV/AIDS( in all the country) from 1996 to 2007. From them 13 cases or 76,4% were diagnosed in last three years. Three cases were under one year old, 8 or 50% were 1 to 7 years old and 5 cases were 7 years old. 9 cases or 56,2% were boys and 7 cases or 43,8% were girls. 11 cases or 68,7% the diseases were taken with vertical transmission and in 5 cases with blood production transfusion. 5 cases were orphans, from which three cases were sisters and brother. In only three cases the diseases were diagnosed in the age under one year-old and in 13 cases or 81,2% from 2 to 8 years-old. 14 cases or 87,5% are with AIDS and are being treated with retroviral therapy. The mortality was seen in two cases: six and four months with severe pneumonia and toxic enteritis. The patients were complicated with these diseases: pneumonia, toxic enteritis, purulent otitis, septicemia, fotosensitivity, malnutrition. Here were isolated these main microbacterial agents: Staphyloccocus aureus, Mycoplasma Pneumonia, Salmonella, Mycobacterium Tuberculosis, etc. Conclusion: HIV/AIDS is a new experience in our country, the Albanian youth and girls are very predisposed to touch this diseases because they are more vulnerable. So our medical staff in the collaboration with the Representative of WHO in Albania will place at the disposal of them all information necessary to protect them. ISE.030 A Program to Identify in Vitro Activity of Tigecycline Against Acinetobacter Isolates Resistant to Other Antimicrobials: An European Perspective R. Badal1, J. Johnson1, D. Hoban1, M. Renteria1, B. Johnson1, S. Bouchillon1, M. Hackel1, M. Dowzicky2. 1International Health Management Associates, Inc., Schaumburg, IL, USA, 2Wyeth Pharmaceuticals, Collegeville, PA, USA Background: Tigecycline (TIG) has been shown to have potent activity against most commonly encountered species responsible for community and hospital acquired infections. The T.E.S.T. program determined the in vitro activity of TIG against Acinetobacter resistant to one or more of piperacillin-tazobactam (PT), levofloxacin (LVX), ceftriaxone (CAX), cefepime (CPE), amikacin (AK), minocycline (MIN), ceftazidime (CAZ), and imipenem (IMP). Study strains were collected from hospitals in Europe from 2004-2006. Methods: 1,029 clinical isolates were identified to species level in 78 participating sites in 22 European countries, and confirmed by the central laboratory. Minimum inhibitory concentrations (MICs) were determined by the local laboratories using supplied broth microdilution panels and interpreted according to EUCAST guidelines. Results: Resistance rates for comparator drugs were CAX 34%, CAZ 33%, LVX 38%, PT 25%, CPE 24%, AK 23%, IMP 11%, and MIN 2%. 1 mcg/ml of TIG inhibited >95% of all isolates without regard to specific resistance patterns. 17 strains had TIG MICs >1 mcg/ml. The TIG MIC50/90 values for strains resistant to 0, 1, 2, 3, 4, or 5+ drug classes were 0.12/0.25, 0.5/1, 0.5/1, 0.5/2, 1/2, and 1/2, respectively, showing an 8-fold diminishment of TIG activity as the level of multi-drug resistance increased. Conclusions: TIG had good in vitro activity vs. Acinetobacter strains resistant to other drugs; however, the higher TIG MICs seen for these strains, especially those resistant to >= 3 other drugs, cause some concern. Nevertheless, TIG's activity against multi-drug resistant Acinetobacter spp. was superior to that of the comparators in this study, further demonstrating its wide spectrum of activity vs. drug-resistant bacteria.

ISE.031 Relations Between Clinical, Laboratory Findings and Outcome in Adults with Pneumococcal Meningitis V. Kirova-Urosevic, K. Karovski, M. Cvetanovska, D. NaunovaJovanovska, P. Stojoska, K. Grozdanovski. Clinic of Infectious Diseases, Skopje, Former Yugoslav Republic of Macedonia Background: Bacteraial meningitis is a life-threatening disease. To determine associations between some clinical, laboratory findings and outcome in adults with pneumococcal meningitis, retrospective study was performed. Methods: From April 2004­April 2007, 31 patients with pneumococcal meningitis were admitted at the Clinic of Infectious Diseases. The diagnosis was confirmed by cerebrospinal fluid cultures. We analysed the relations between change in mental status, age of patients, CSF WBC, CSF protein levels, values od ESR, CRP and outcome. Results: The age group over 50 years was presented with 45.16%. On admission 51.61% were comatouse. Fatal outcome was present in 35.48%. In the initial lumbar CSF analysis, WBC count was 5679.74±6979.1, and CSF protein levels were presented with 2.99±1.01. Patients with low CSF WBC were most likely to have unfouvarable outcome (72%; P<0.001).We determined relation between WBC and protein values in CSF (r2=0.463; p<0.04). ERS and CRP values positively correlated with unfouvarable outcome (r2=0.473; p<0.035). Conclusion: The mortality rate in adults with pneumococcal meningitis is high and risk factors such as advanced age, low CSF WBC, altered mental status, an elevated inflamation markers are associated with the outcome. ISE.032 The In-Vitro Susceptibility of S. pneumoniae and H. influenzae to Levofloxacin - Results on the Isolates from Vietnamese Patients P. Hung Van1, P. Thai Binh2. 1University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam, 2University of Medicine and Pharmacy, Nam Khoa Co. Ltd., Ho Chi Minh City, Vietnam Background: Recent studies in Vietnam have demonstrated pneumococci were highly resistant to penicillin and macrolides. H. influenzae with beta-lactamase production were also reported. Objectives: Study the in-vitro susceptibility of levofloxacin to S. pneumoniae and H. influenzae isolated from Vietnamese patients with acute respiratory infection. Methods: From April 2003 to May 2006, 302 S. pneumoniae and 248 H. influenzae isolated were included. Among S. pneumoniae, 211 were non-invasive and 91 invasive origins. Among H. influenzae, 194 were non-invasive and 54 invasive. The E-test susceptibility to penicillin and levofloxacin, and the disc susceptibility to erythromycin, azithromycin, sulfamethoxazol/trimethoprim (SMX/TMP), linezolide, chloramphenicol and other fluoroquinolones were carried out on the S. pneumoniae. The beta-lactamase detection by using the nitrocefin, E-test susceptibility to levofloxacin and disc susceptibility to ampicillin, amoxicillin-clavulanic acid (Ac), cefuroxime, cefaclor, azithromycin and SMX/TMP were done on the H. influenzae. Results: Fourty-one percent S. pneumoniae are PRSP with MIC 2µg/ml, 41% are PISP. All are sensible to levofloxacin with MIC90 1µg/ml. No resistant but 2% and 6% were respectively intermediate to ofloxacin and gatifloxacin. All has not been resistant to linezolide, but been highly resistant to erythromycin, azithromycin, SMX/TMP, and chloramphenicol: 71%, 73%, 75%, and 30% respectively. Between PRSP and PSSP, there was no statistically significant differences in the resistance to macrolides and SMX/TMP. Fourty-nine percent of the H. influenzae were beta-lactamase producers; 60.5% were SMX/TMP resistance with the producer is higher than the non-producer (78% versus 44%). Only 8% were resistant to azythromycin, and most were sensible to Ac, cefaclor and cefuroxime. All were sensible to levofloxacin with MIC90 <0.125µg/ml. Conclusions: The results reported from this study can suggested the clinical practioners to consider levofloxacin as the first of choice antibiotic to adult patients with community acquired resipratory infection since this antibiotic showed the good susceptibility to the target pathogens.

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ISE.033 Therapy of Chronic Hepatitis 'C'-Efficacy and Tolerability G. Petkov1, Z. Milenkovic2, G. Atanasov3, R. Delev4, S. Trpkovska4. 1 Department of Infectius Diseasses,General Hospital-Gevgelia, Gevgelia, Former Yugoslav Republic of Macedonia, 2Clinic for Infectious Diseasses, Faculty of Medicine, Skopje, Former Yugoslav Republic of Macedonia, 3Department of Internal Diseasses,General HospitalGevgelia, Gevgelia, Former Yugoslav Republic of Macedonia, 4 Department of internal diseasses, Gevgelia, Gevgelia, Former Yugoslav Republic of Macedonia Background: lfa-2A(40KD),(Pegasys) plus Ribavirin (Copegus) represent the "gold standard" in treatment of chronic hepatitis "C" (CHC). Sustained viral response (SVR) is the ultimate goal of treatment six months after treatment ends. Early viral response (EVR) is a good predictor of achieving SVR. Aim: To estimate the efficacy and tolerability antiviral therapy with our patients. Methods: Used are biochemical analysis, ELISA-assays,RT-PCR to HCV, RT-PCR Monitor assay, TSH and Tiroxin free, ANA,ASMA and AMA to autoimmunity diseases and liver biopsies (Knodels scor). Results: 16 patients were treated with Peginterferon Alfa-2A + Ribavirin(RBV) (w/m-3/13;18-60 years) with CHC, subcutaneosly 180 mg/weekly and daily oral doses RBV according to patients genotype and body weight. Liver biopsies where performed in all 16(100%) patients. Knodells score was 3­16, with mild to moderate fibrosis. Patients with severe fibrosis and chirosis were not treated. With genotype 1(G1) were 5 patients and 11 patients with Genotype 3(G3). Mild to moderate chematology disorders there were 5 patients. Following reduced medicaments doses, treatment not interrupted. EVR was achieved in all patients (100%). SVR was achieved in 15 (93,7%) patients. There was only one non-responder. All patients with SVR had normal serum ALT levels. Conclusion: Antiviral treatment with Peginterferon Alfa-2A/RBV was very efficient of CHC in fine selected group patients with mild to moderate liver fibrosis. ISE.034 Global Health: Improving Healthcare Provision and Facilities in a Remote Hospital in Ghana, Africa A. Khan. Hospital Infection Research Laboratory, Birmingham, United Kingdom Background: Inadequate access to healthcare is one of the main problems facing the majority of the population in developing countries, particularly in rural areas. This is compounded with social and environmental issues such as lack of clean water and sanitation, poor education, poverty and subsequently malnutrition. Infectious diseases are a major cause of morbidity and mortality in these countries, particularly diseases such as HIV/AIDs, Malaria and tuberculosis. The Tropical Health and Education Trust (THET) is a registered charity addressing the healthcare and educational needs of developing countries through the establishment of health Links or Partnership between hospitals in the UK and African countries. The fundamental aim of every Link/Partnership is to respond to the needs of the overseas institution to improve workforce skills training and strengthening of health institutions by drawing upon the experience and expertise of UK healthcare professionals to work together with overseas healthcare workers. NHS healthcare professionals deliver targeted healthcare, skills training and education and advice to help meet the needs of the partner institution. Northampton General Hospital health Link/Partnership is with Nandom Hospital in the upper west region of Ghana. The hospital is 40 years old and serves a population of one million with just three doctors and 171 beds. At the moment there are no local facilities for extensive blood screening or microbiology analysis of specimens and the sick and debilitated have to travel many kilometres for clinical investigations and/or hospital treatment. Despite the prevalence of HIV in the region, bloods for CD4 count still have to be sent away to Komasi with considerable delays in the subsequent treatment regime. My remit within the group was to assess and formulate a plan for increasing the repertoire of tests available for overall improvement of the pathology services and patient care. This involves the procurement of vital equipment, training of staff to achieve maximum standards of knowledge and skills, formulation and delivery of Health and Safety and Infection Prevention and Control programme to all healthcare professionals and teaching medical students at University of Tamale.

The presentation is an account of the achievements of the first trip to Nandom Hospital, working in challenging surroundings with limited resources to transform the laboratory services. Commitment to this project is a life-time pledge and may take many years to flourish, but the improvements and foundations set in the first trip brought great satisfaction to all the team and the community of Nandom. ISE.035 Colistin and Rifampicin Combination in the Treatment of Ventilator-associated Pneumonia Caused by Carbapenem-resistant Acinetobacter baumannii J.Y. Song1, J. Lee2, J. Lee2, J. Lee2, Y.M. Jo1, W.S. Choi1, H.J. Cheong1, W.J. Kim1. 1Korea University College of Medicine, Seoul, Republic of Korea, 2Hallym University College of Medicine, Seoul, Republic of Korea Background: Multi-drug resistant (MDR) Acinetobacter baumannii has become a major nosocomial pathogen during the past years, and pneumonia is the most serious nosocomial infection with limited therapeutic options. Methods: We evaluated the safety and effectiveness of colistinrifampicin combination in 10 patients with ventilator-associated pneumonia (VAP) by carbapenem-resistant A. baumannii isolates. Clinical and microbiological response of colistin-rifampicin combination was evaluated. Follow-up cultures were taken after 7 day treatment, and in vitro activity of rifampicin was tested. Results: The mean duration of therapy was 7.9 ± 1.9 days. Seven of 10 patients (70%) benefits from colistin-rifampicin therapy; six patients were cured microbiologically, among whom one patient was complicated by superimposed infection after clinical improvement. Three patients died, two of whom were considered therapeutic failures. As for the antibiotic-associated adverse effects, recurrent hypomagnesemia was noted in a patient, and mild hepatitis was shown in another; modification of therapeutic regimen was not required. The MIC levels of rifampicin did not increase during treatment, but high level resistance (64mg/L) was related to poor microbiological response. Discrepancy among rifampicin susceptibility tests was noted: disc diffusion method, E-test and agar dilution method. Conclusions: The results suggested that colistin-rifampicin combination would be safe and effective against VAP by carbapenem-resistant A. baumannii, which could be treated successfully with 7-10 day antibiotics. Agar dilution method was recommended for the evaluation of high-level rifampicin resistance; rifampin-based combinations would be effective against carbapenem-resistant A. baumannii infections with low level rifampicin resistance (MIC, 16mg/L). ISE.036 Production of Antibacterial Substances by Lactobacillus Isolated from Traditional Dairy Products of Iran M. Tajabady Ebrahimi1, M.A. Hejazi2, A. Noohi3. 1Azad Islamic University - Parand Branch, Tehran, Iran (Islamic Republic of), 2 Agricultural Biotechnology Research Institute of Iran, Tabriz, Iran (Islamic Republic of), 3Azad Islamic University, Tehran, Iran (Islamic Republic of) Aim: Screening for antagonistic activities of total 22 strains of acid and bile tolerant Lactobacillus isolated from traditional dairy products, and identification them by molecular and biochemical methods. Antagonist activities were performed by bilayers and well-diffusion methods. In bilayers method 13 strains, coded C4i2, C1d2, Y2c4, D3b1, K1l4,C5i4, Y2l6, C2h1, K2l3, Y1m4, Y1l4, Y2p3 and C6l2, showed higher antagonist activities against E. coli, S. aureus, L. monocytogenes, Y. enterocolitica and L. inocua. Neutralized culture supernatants of these strains didn't inhibit indicators bacteria excepted Neutralized culture supernatants of C5i4 whom inhibit L. monocytogenes. The 16S rDNA gene of 4 selected strains C4i2, C1d2, Y2c4, D3b1 with highest antagonist activities were amplified and sequenced. Base of these data selected isolate identified as Lactobacillus pentosus, Lactobacillus brevis, Lactobacillus pentosus and Lactobacillus paraplantarum. ISE.037 In Vitro Activity of Ertapenem and Other Carbapenems Against Extended-Spectrum Beta-Lactamase Producing Escherichia Coli and Klebsiella Pneumoniae Clinical Isolates in a Tertiary Care Center in Turkey A. Kiremitci, E.C. Dinleyici, N. Erben, G. Durmaz, Z.A. Yargic, A.D. Aybey, G. Usluer. Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey

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Objective: The aim of this study was to evaluate in vitro effect of ertapenem, imipenem and meropenem in clinical isolates of extendedspectrum beta-lactamase (ESBL) producing strains of E. coli and K. pneumoniae. Design and Methods: We studied 82 consecutive clinical isolates of ESBL producing E. coli (n=49) and K. pneumoniae (n=33) identified in our tertiary care center between February 2006 to September 2007. The minimum inhibitory concentration (MIC) for each carbapenems was determined using the agar dilution method. Results: Eighty-two consecutive microorganisms were isolated from blood (n=40), broncho-alveolar lavage/tracheal aspirate (n=15), wound and surgical site (n=20), cerebrospinal fluid (n=3) and other (n=4). A 48.8% of 82 patients have a history of surgical intervention, 78.0% have urinary catheterization, 57.3% have vascular access and 40.3% of patients required mechanical ventilation, 7.3% of patients have neutropenia, and 70.7% have history to stay in intensive care unit. High resistance rates were shown for both E. coli and K. pneumoniae against cefepime (81.7%), ciprofloxacin (50.9%), tetracycline (75.0%), co-trimoxazole (47.4%), gentamicin (48.7%). In addition, most K. pneumoniae and E. coli isolates were susceptible to amikacin (78.3%) and piperacilline-tazobactam (91.5%). Meropenem and imipenem show activity against 100% of the isolates. Ertapenem shows activity against 100% of K. pneumoniae isolates and shows activity against 95.9% E. coli of isolates and 97.5% of total 82 ESBL producing microorganisms. Two E. coli isolates showed ertapenem resistance. Conclusion: In fact in the vast majority of published studies on ESBL producing Enterobacteriaceae, carbapenems were the most active antimicrobial agents in vitro like our study. In view of the continuous increase in the prevalence of ESBL strains, ertapenem could be a potentially good choice for the treatment of infections due to ESBL producing microorganisms with additional advantage as once a day regimen. Further in vivo clinical studies needed in Turkey. ISE.038 The Study of Antimicrobial Activity Two Euphorbia Species Mountain Region Golestan Province Against Frequent Bacterial Gram positive and Gram negative in North of Iran M. Aroodi1, M. Mazandarani2, E. Kiaie3, E. Ghaemi4, M. Sadegh4. 1Young Researchers club (member of Young Researchers club unit of Azad Islamic Gorgan branch), Gorgan, Iran (Islamic Republic of), 2Islamic Azad University of Gorgan branch(IRAN), Gorgan, Iran (Islamic Republic of), 3Young Researchers club (member of Young Researchers club unit of Azad Islamic Gorgan branch), Gorgan Iran (Islamic Republic of), Gorgan, Iran (Islamic Republic of), 4Microbiology Gorgan University of Medical Sciences (IRAN), Gorgan, Iran (Islamic Republic of) Introduction: The infectious diseases are important worries of human's society and take effort of numerous of medicine,hygiene and laboratory's master. In spite of discovery of different antibiotics because of the threatening of multi resistant pathogenic microorganisms,the search for development of new antibiotics has became more compelling than ever before. One of the important sources for finding new bioactive compounds are herbal medicines. For this reason, ethanolic and methanolic extracts two plants belong to Euphorbiaceae that distribution in North forest and height of Golestan province,Iran were investigated for antimicrobial activities against 12 pathogenic microorganism (gram + and gram -) in this study. Methods: The plants studied were Euphorbia helioscopia and Euphorbia paralias aggregated (May 2007) of mountain region Golestan province. Four concentrations of whole plants extract of each of the two plant were prepared. The antimicrobial effects of each concentration was measured by well assay, disc diffusion and MBC methods. Results: Methanolic extract of Euphorbia helioscopia and ethanolic extract of Euphorbia paralias had action against most of the tested microorganisms. Methanolic extract of E. helioscopia showed most antibacterial activity against Acinetobacter calcoaceticus, Staphylococcus aureus,Staphylococcus epidermidis,Enterococcus faecalis and Listeria monocytogenes, respectively. Also ethanolic extract E. paralias showed most action antibacterial against Acinetobacter calcoaceticus, Staphylococcus epidermidis, Staphylococcus aureus, Listeria monocytogenes and Shigella dysenteriae, respectively. Conclusion: The data obtained revealed that among the 12 tested microorganism, Acinetobacter calcoaceticus was, in general the most susceptible microb to methanolic and ethanolic extracts of the two plant studied According to this result, it is suggested that Euphorbia extracts is considered for treatment of bacterial infections in vivo.

Key Words: Antimicrobial activity, Euphorbia helioscopia, Euphorbia paralias, 12 frequent pathogenic, Golestan province (Iran) ISE.039 In vitro Animicrobial Activity of Extracts from Medicinal Plant against Selected Urinary Tract Infection Pathogens in North Iran E. Kiaie1, M. Mazandarani1, E. Gaemi2. 1Islamic Azad University, Gorgan, Iran (Islamic Republic of), 2Medicine University, Gorgan, Iran (Islamic Republic of) The purpose of this study was to examine the effectiveness of selected medicinal extracts for the control of growth and survival of pathogenic microorganisms of significant important in Urinary Tract Infection and to determine whether the antimicrobial was due to the major compounds of the oils. Ethtnolic and Aqueous extract of Plantago major, Sambucus ebulus, Juniperus communis, Equisetum arvensis L, Berberis vulgaris, Hypericum perforatom obtained by perculation method. MIC and MBC were determined by microdilution method. Inhibition ranged from the strong activity of Berberis vulgaris, Juniperus communis to no inhibition with Sambucus ebulus for each of the test strains: Staphilococcus aereus S. epidermidis, Listeria monocitogenesis, Bacillus sereus, Shigella disanterie, Psodomonas aeroginisa, Eshershia coli, Salmonella tayphimorium, Proteus, Kellebciella, Enterococcus, Acintobacter. Because some of the extracts were highly inhibitory in small quantities to selected pathogenic microorganisms, they may provide alternatives to conventional antimicrobial additives in patient suffering from UTI. ISE.040 Antibacterial Effects Ethanolic Exteracts of Plantago major L. Against UTIs Infection Bacteria in North of Iran E. Kiaie1, M. Mazandarani1, E. Gaemi2. 1Islamic Azad University-Young Researcher Club, Gorgan, Iran (Islamic Republic of), 2Medicine University, Gorgan, Iran (Islamic Republic of)

Plantago major L. bolongs to Plantaginaceae family is one of the most endemic medicinal plant with wild distribution, has been used by rural healers of Golestan province for treat of inflammatory, skin infection, wounds antibacterial, diarrhea, constipation and gasterointestinal infection. In this research ethanolic exteract of Plantago major obtained by perculation method in dillution in 1.2,1.4, 1.8, 1.16. Antibacterial screening by disc diffusion method against pathogenic bacteria Staphilococcus aereus, S. epidermidis, Listeria monocitogenesis, Bacillus sereus, Shigella disanterie, Psodomonas aeroginisa, Eshershia coli, Salmonella tayphimorium, Proteus, Kellebciella, Enterococcus is most irritant bacteria due to athanolic extract. Acintobacter Roots exteract of plant have most effective exteract especially against gram positive bacteria. Staphilococcus aereus, Acintobacter and S. epidermidis with 22,22.4 and 22.1 mm were the most sentetive bacteria in this research.

Animal Models, Pathogenesis of Infectious Diseases and Host Defenses

ISE.041 Birds Flu in Children in Europe-Imagination or Reality? A. Djurdjevic-Djulepa1, A. Bajraktarevic2, S. Maglajlija2, A. Skopljak2, Z. Jatic3, I. Kalkan4, F. Hadzagic-Catibusic4, Z. Begic4, A. Semic5. 1 General Hospital Sarajevo, Sarajevo, Bosnia and Herzegovina, 2Public Health Institution Sarajevo, Sarajevo, Bosnia and Herzegovina, 3 Medical Faculty of Sarajevo, Sarajevo, Bosnia and Herzegovina, 4 Pediatrics Clinic, Sarajevo, Bosnia and Herzegovina, 5Pediatrics Clinic Manchester, Manchester, United Kingdom Introduction: This article discusses current methods of identifying and treating the illness in children, and outlines principles of public health measures for preventing and containing an influenza pandemic in Europe. Avian influenza, an infectious disease of birds, is caused by type A strain of the influenza virus. Avian influenza viruses are mainly distributed by migratory birds. Various animals like birds, pigs, horses, sea mammals and, finally, humans are susceptible to influenza A viruses. Clinics: In humans, avian viruses cause similar symptomes to other types of flu.These include fever, cough, sore throat, muscle aches, conjuctivitis and, in severe cases, severe breathing problems and pneumonia that may be fatal. Most cases have occurred in previously healthy children and young adults.

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Therapy: Right now, the primary treatment option is the flu drug oseltamivir (Tamiflu), a neuraminidase inhibitor that works by preventing the virus from escaping its host cell. Another antiviral flu drug, zanamavir (Relenza), may be an alternative. Material and Methods: Therefore it is crucial to develop virologic surveillance programs for animal and human influenza, to limit the spread of the virus from infected poultry, and to develop efficacious vaccines by exploiting novel technologies such as reverse genetics. Results: The vaccine still needs to be tested over several months in adults older than sixty five and in children. Discussion: Because no natural immunity to the new strain exists, it can spread quickly, causing widespread illness and death. The virus is especially lethal, killing close to 100 percent of susceptible birds and more than half of infected people and children. Conclusion: Two groups at risk for developing complications or requiring hospitalization if they get the flu are adults over sixty five and children between half year and two years. But the greatest complication of bird flu is still hypothetical, that spreads easily from person to person.

ISE.043 The Comparison of HBs-Ab Serum Levels between Patients with Type 2 Diabetes Mellitus and Healthy Non-Diabetic Ones Following Vaccination M. Khademi1, M. Amini2, B. Ataei3, N. Kassaian3, Z. Nokhodian3, P. Shoaei3. 1Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran (Islamic Republic of), 2Endocrean and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran (Islamic Republic of), 3 Infectious Diseases Research Center,Isfahan University of Medical Sciences, Isfahan, Iran (Islamic Republic of) Background: It has been documented that diabetic patients are at risk to viral hepatitis. In the other hand, it has been reported that vaccination with routine doses isn't sufficient for diabetic patients especially type I, but there is some contradictions. Also, correlation between HBs-Ab and glycemic control have not been clearly understood. The aim of this study was the assessment and comparison of HBs-Ab titer in type 2 diabetic and non diabetic subjects after hepatitis B vaccination. Methods: In a semi-experimental study, 91 patient with type II diabetes mellitus and 55 non diabetic healthy individuals which were matched in age, sex, BMI and smoking by simple non randomize method were chosen. HBs-Ag, HBs-Ab and HBc-Ab were measured for all and the positive cases were excluded. Vaccination against hepatitis B (Euvax B) was carried in 3 times (0, 1, 6) with 20 µg dose. Then 3 and 6 months after that, Hb A1C and HBs-Ab were tested. HBs-Ab titers were compared between diabetic and non diabetic ones using Mann-witney (non parametric test) and the correlation between HBs-Ab and Hb A1C in two groups using paired samples correlation test and P<0.05 was considered as significant. Results: The results showed that HBs-Ab, 3 months after vaccination in diabetic and non diabetic ones were 335.8 ±275.7 and 420.1± 348.4 mIU/ml and 6 months after vaccination were 530.7±387.9 and 552.5±410.7 mIU/ml respectively which there was not statistically differences. There was a reversed correlation between Hb A1C and HBs-Ab in diabetics, but it wasn't significant. There was no statistically correlation between Hb A1C and HBs-Ab in non diabetic ones. Conclusion: We concluded that routine vaccination is sufficient for patients with type II diabetics and these patients have to vaccinate against hepatitis B such as the other ones. Key Words: Type 2 Diabetes Mellitus, hepatitis B, Vaccination against HBV, HBs-Ab, Hb A1C. ISE.044 Hemodynamic Changes in Critically Ill Patients with Leptospirosis H.S. Kulkarni, V.M. Kothari, D.R. Karnad. Seth GS Medical College and KEM Hospital, Mumbai, India Introduction: Critically ill patients with leptospirosis show diverse manifestations including hypotension, myocarditis, arrhythmias, pulmonary alveolar hemorrhages, ARDS, shock and renal failure. Two small studies have previously performed hemodynamic monitoring of these patients. Better understanding of pathophysiology and hemodynamic patterns of this disease may help reduce morbidity and mortality patterns. Methods: After the Institutional Ethics Committee permission, 17 patients with leptospirosis admitted to the Medical Intensive Care Unit of KEM Hospital, Mumbai, were recruited for the study. Clinical and biochemical profiles were documented. Hemodynamic variables were measured using a Swan-Ganz pulmonary artery catheter within 48 hours of admission. Hemodynamic patterns were characterized in patients with and without cardiac failure. Differences between survivors and non-survivors were compared using Mann-Whitney test. Results: We found two hemodynamic patterns-respiratory failure with left ventricular dysfunction (LVD) (n=1) and respiratory failure without left ventricular dysfunction (n=16). Patients without LVD showed a pattern like septic shock, with low systemic vascular resistance, normal or high cardiac index, normal pulmonary wedge pressure, and variable pulmonary vascular resistance index (PVRI) and mean pulmonary artery pressure (MPAP). There were 7 survivors and 9 non-survivors. The mean pulmonary arterial pressure of survivors was significantly lesser (P=0.007) as compared to the non survivors. The median PVRI of the non-survivors was much higher (281) as compared to the survivors (192). These could be important prognostic factors for determining survival in critically ill patients with leptospirosis. Conclusions: Critically ill patients with leptospirosis present with predominant pattern of septic shock. Some patients also have cardiac

ISE.041 Bird Flu Geographic Distribution, WHO. ISE.042 Compliance with Safety Guidelines to Prevent Transmission of Viral Hepatitis B in Hairdressers in Tonekabon F. Rahimaghaee1, M. Faghani1, K.H. Seylani2. 1Azad University, Tonekabon, Iran (Islamic Republic of), 2Ardebil Medical University, Khalkhal, Iran (Islamic Republic of) Background and Aim: Viral Hepatitis is a disseminated infectious disease associated with inflammation and necrosis of liver cells and can result in cirrhosis (with 20% mortality rate) and hepatocelluar cancer (with 6% mortality rate). Viral hepatitis, particularly Hepatitis B, can be transmitted through body fluids and especially blood. Studies revealed there are more than 350,000,000 carriers of Hepatitis B virus in the world who can contaminate others through body fluids and blood. Material and Methods: this research is a descriptive study whose subjects consisted 154 hairdressers workign Tonekabon and were selected by stratified randomized sampling. The data were collected through a questionnaire and a checklist the researchers created. The questionnaire collected demographic data and the checklist included 10 items related to compliance with safety guidelines based on a likert scale. The data were analyzed with SPSS software. To analyze the data, descriptive and inferential statistical methods have been used. Results: the findings of this study represented that all hairdressers had taps with warm and cool water, 99.35% had soap. 55.2% have appropriate disinfectants, but in 93.5% of cases there was no container for collecting sharp instruments. 98.5% of hairdressers do not have Hepatitis B. 52.6% of married subjects showed unfavorable compliance with safety guidelines. 59.74% of noncompliant hairdressers were male. Of the 59.1% of subjects who had completed vaccination, compliance with safety guidelines was also unfavorable. On the other hand, 43.5% of subjects whose compliance was unfavorable, had diploma degree or higher. Other findings revealed that 48.5% of subjects have knowledge about disease and it's complications, and 53.2% of them knew preventive principals. Most of them use TV and radio as an information resource (29.22%). Conclusion: according to our findings, most subjects have no knowledge of the disease, and do not comply with safety guidelines. Therefore, hairdressers professional group and health center can use this research finding to improve level of hairdressers awareness.

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involvement worsening their pulmonary edema and shock. Higher MPAP and PVRI in non-survivors suggests a role of pulmonary vascular injury in pathogenesis of the disease and portends a worse outcome. ISE.045 Toxic Influence of Antituberculous Drugs on Spermies E. Kulchavenya, M. Sherban, E. Brizhatyuk. Research TB Institute, Novosibirsk, Russia The purpose of our investigation was to learn possible negative influence of antituberculous drug on spermies. Material and Methods: 30 male mice were treated with Isoniazid. For the estimation of the influencing of Isoniazid on motility of spermatozoons in vitro the ejaculate of 11 volunteers was researched. Also we have studied spermograms and special questionnaires in 34 patients with tuberculosis (age 18­64). Clinical inspection: functional tests of a liver, spermogram: volume of an ejaculate, its viscosity, amount of spermatozoons, share of the mobile forms, number of leukocytes and erythrocytes. Results: Isoniazid direct toxic influencing on a spermatogenesis in mice does not render. However, the daily introduction of Isoniazid results in liver dystrophy that may negative influence on the sexual function. The amount of spermatozoons initially was 11,3±4,6; mobile forms was 66,9±14,2%. Volume of an ejaculate had not authentic differences. Introduction of Isoniazid 10 mg/kg intravenously daily, or 2 times per one week does not render direct toxic operation on a spermatogenesis in mice. 0,5% concentration of Isoniazid in a medium does not render negative influencing on motility of spermatozoons in vitro. In time of complex antituberculous therapy does not happen authentic modifications of the basic parameters of spermogram in patients with tuberculosis. Complex antituberculous therapy does not result in violation of the basic constituents of the copulative act. ISE.046 Experimental Mycobacterium bovis Tuberculosis in Guinea Pigs, Rabbits and Hens S.P. Martinov, C. Schoilev, M. Bonovska. National Research Veterinary Medical Institute, Sofia, Bulgaria Eight guinea pigs, eight rabbits and five young hens were inoculated with M. Bovis by peroral (p.o) subcutaneous(s.c), intramuscular (i.m) and intraperitoneal (i.p) way. Within 3 months were made clinical observations histopathological examinations and PCR. The guinea pigs were susceptible to infection by the four ways of inoculation. Bifragment amplificates in size of 600 bp and 320 bp were obtained from parenchymatous organs. Histologically were established tubercles with caseous matter, giant cells and epitheloid cells, severe granular degeneration of the cy-toplasm and lysis of the hepatocytes. The disease in rabbits was inapparent. The microscopic examination revealed tubercles in the lungs (i.p.), liver (i.p.) and intestinal serosa (p.o). DNA products /420 bp/ were obtained from lungs, livers (p.o., s.c., i.m., i.p) intestines (p.o.), spleen and kidney.The hens showed low susceptibility to M.bovis and had no clinical signs. Histologically most pronounced lesions were found in stomack and blind gut mucosa (i.p.) and in liver (p.o., s.c.). DNA with a size of 380 bp was obtained from livers and spleens of all hens. ISE.047 Studies on Experimental Mycobacterium avium Infection in Laboratory Animals C.I. Schoilev, S.P. Martinov, M. Bonovska, R. Petrova. National Research Veterinary Medical Institute, Sofia, Bulgaria Five pullets, 8 rabbits and 8 guinea pigs were infected with Mycobacterium avium by peroral/p.o./, intramuscular/i.m./, subcutaneous /s.c./ and intraperitoneal/i.p./route. The birds were susceptible to M.avium at the four ways of inoculations. The clinical and pathomorphological lesions were most expressive in the i.p. and i.m. infected pullets. The target organs were liver, spleen, lungs, kidney and intestines with different extent of the findings, mainly tubercles. Amplifications in size of 413 bp were obtained from livers and lungs/p.o.,s.c.,i.m.and i.p. infection/;spleen/s.c.,i.m.,i.p./; duodenum and mesenterium /p.o./ kidneys and intestines /i.p./. In the rabbits, the pathohistological changes were very characteristic after i.m. and p.o.inoculation affecting the liver,spleen, omentum, mesenterium, kidneys/i.p and intestines where numerous tubercles were found. The rabbits inoculated by i.m. or s.c. did not show characteristic histological findings. DNA products /420 bp/ were obtained from lungs, liver, spleen, kidneys,

intestines, mesenterial lymph nodes following i.p. or p.o. infection and also from omentum /i.p./, lungs and liver /i.m., s.c./ and kidneys /i.m./. The guinea pigs infected with M.avium did not manifest clinical signs and the necropsy showed slightly expressed changes in the organs: single tubercles, cell infiltration and haemorrhages. Monofragment amplificates in size of 600 bp were obtained from lungs,liver, spleen, kidneys and intestines. ISE.048 CRP Positivity in Pleural Effusion A. Moosavi1, A. Jamshidi1, G.H. Sallajeque3, M. Zangene4. 1Infectious Disease Research Center, Hormozgan University Of Medical Sciences, Bandar Abbas, Iran (Islamic Republic of), 1Infectious Disease Research Center, Hormozgan University of Medical Sciences, Bandar, Iran (Islamic Republic of), 3Kerman University of Medical Sciences, Kerman, Iran (Islamic Republic of), 4Azad University of Medical Sciences, Tehran, Iran (Islamic Republic of) Background: The first diagnostic approach to pleural effusion is differentiating between exudative and transudative effusion. CRP (C Reactive Protein) is an acute phase reactant and sometimes increase in pleural effusion. The purpose of this study is to determine the level of CRP in serum and pleural fluid in exudative and transudative plural effusions. Methods: In this prospective case series study 80 patients with pleural effusion that they had documented diagnosis were investigated. The patients divided in to two groups by light criteria (exudative and transudative). The CRP level was measured by latex agglutination method. Results: In 80 patients, 54 cases (67.5%) was exudative and 26 cases (32.5%) was transudative. CRP was positive in 72.2 % of exudative and 38.5% of transudative of pleural effusion. There is not significant correlation between CRP positivity level in infectious and non infectious or malignant and non malignant causes of exudative pleural effusion (p less than 0.05). Also plasma CRP positivity level was significantly increases in exudative against transudative pleural effusion (p less than 0.05). Conclusion: CRP level especially with quantitative methods can used as a marker for differentiating between exudative and transudative pleural effusion.

Bacterial Infections

ISE.049 Children's Rhinosinusitis in Bosnia Z. Jatic1, A. Bajraktarevic2, A. Skopljak2, A. Hadzimurtezic2, A. Katica3, A. Djurdjevic-Djulepa4, F. Hadzagic-Catibusic5, A. Semic6, M. Resic7. 1 Medical Faculty of Sarajevo, Sarajevo, Bosnia and Herzegovina, 2 Public Health Institution Sarajevo, Sarajevo, Bosnia and Herzegovina, 3 Public Health Institution New Town Sarajevo-ORL, Sarajevo, Bosnia and Herzegovina, 4General Hospital Sarajevo, Sarajevo, Bosnia and Herzegovina, 5Pediatrics Clinic, Sarajevo, Bosnia and Herzegovina, 6 Pediatrics Clinic Manchester, Manchester, United Kingdom, 7Clinical Medical Center-ORL Sarajevo, Sarajevo, Bosnia and Herzegovina Introduction: Acute rhinosinusitis is estimated to be one of the most common diseases in childhood. Rhinosinusitis in children is a multifactorial disease in which the importance of several predisposing factors changes with increasing age. Only a small percentage (1%) of viral rhinosinusitis is complicated by acute bacterial sinusitis in Sarajevo, Bosnia and Herzegovina. Materials, Methods and Results: We made retrospective studies during last ten years in Sarajevo on different pediatrics and otorhinolarynglogics Health-Center locations after the Bosnian war (1996-2006). These results showed a smaller number of cases and complications if we compare American and European studies. This work includes analyses in MicroSoft Word 97 and tables and diagrams in Excel. CLINICS: The most common complaints among parents seeking medical care for their children include: nasal discharge, cough, low-grade fever, fetid breath and painless morning periorbital swelling. Bacterial rhinosinusitis usually follows a viral infection or allergic rhinitis. DIAGNOSTICS: The diagnosis of pediatric rhinosinusitis is usually based on a combination of the history, physical examination, laboratory investigations, and radiological findings. THERAPY: Antibiotics are significantly more effective than placebo for treating acute bacterial rhinosinusitis, reducing the clinical failure rate by one-half. Children with acute rhinosinusitis often improve spontaneously following a course of empirical antibiotics. For young children with mild to moderate acute rhinosinusitis, amoxicillin is recommended at the normal or high dose. Duration of therapy is usually 10­21 days or until symptoms resolve plus seven days.

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Discussion: Most studies suggest that regardless of the data that indicate approximately 40% of cases of acute sinusitis will resolve without antibiotics, antibiotics allow for earlier resolution and may prevent recurrence. Conclusions: Pediatric sinusitis is a common problem treated by primary care pediatricians, physicians and otolaryngologists. Confirmation of the diagnosis of rhinosinusitis can be made by culturing an aspirate of the sinus secretions. Between 3 and 8 percent of the children in the primary care setting in Bosnia presenting with upper respiratory infections may have acute rhinosinusitis which is less then in USA and Western Europe. Complications of rhinosinusitis in children have steadily decreased over the years due to improvements in diagnostic aids and therapeutic techniques.

Diagnostic Evaluation: The clinical handling of a prolonged episode of fever should be on individual basis and should include the evaluation of the risks of serious bacterial infection. Therapy: Use of antibiotics is generally not indicated except in the neonate when they are administered parenterally following appropriate investigations including a lumbar puncture. Conclusion: Acute episodes of fever represent between 10 percent and 20 percent of outpatient paediatric consultations; occurring on the average between 4 and 6 times annually. There is usually an increase in winter months corresponding to an increase in respiratory and gastrointestinal viral infections. ISE.051 Comparison of Serum and Whole Blood PCR for Diagnosis of Goat Brucellosis V.K. Gupta, J. Vohra, R. Kumari, V.S. Vihan. Cent Instt for Res on Goats, Makhdoom Mathura, India

Brucella melitensis is the causative agents of brucellosis in goats. Brucellosis affects public health and agricultural economies worldwide because of its high infectivity rate In past PCR assays for the diagnosis of brucellosis in goats was performed either on serum or on whole blood, but results obtained with the two kinds of samples have never been formally compared. A PCR assay amplifying 1412bp sequence 16S rRNA of Brucella melitensis was developed and applied to serum and whole blood samples from 142 suspected brucellosis cases of goats. The PCR assay sensitivity was higher with serum samples (90%) than with whole blood samples (80%). The serum PCR assay specificity was 100%. These results suggest that serum is the sample of choice, which should be used preferentially over whole blood for the diagnosis of brucellosis in goats by PCR.

ISE.052 Differential Diagnosis of Brucella melitensis Infected and B. melitensis Rev1 Vaccinated Goats on the Basis of Humoral Immune Response against Lipopolysaccharide and Recombinant Outer Membrane Protein 31 V.K. Gupta1, R. Kumari1, J. Vohra2, V.S. Vihan1. 1Cent Instt for Res on Goats, Makhdoom Mathura, India, 2Cent Instt for Res on Goats, Makhdoom, Mathura, India ISE.049 Etiology of Rhinosinusitis in Bosnia & Herzegovina, Sarajevo ISE.050 Fever without Focus of Infection at Children in Bosnian Pediatrics Praxis L. Sporisevic1, A. Bajraktarevic2, M. Rovcanin2, N. Perva2, A. Skopljak2, A. Djurdjevic-Djulepa3, H. Boloban4, Z. Begic5, Z. Jatic6. 1First medical Aid Sarajevo-Pediatrics Department, Sarajevo, Bosnia and Herzegovina, 2Public Health Institution Sarajevo, Sarajevo, Bosnia and Herzegovina, 3General Hospital Sarajevo, Sarajevo, Bosnia and Herzegovina, 4Clinical Medical Centre Sarajevo Department of perinatology, Sarajevo, Bosnia and Herzegovina, 5Pediatrics Clinic, Sarajevo, Bosnia and Herzegovina, 6Medical Faculty of Sarajevo, Sarajevo, Bosnia and Herzegovina Introduction: Pyrexia of undetermined origin (PUO) is defined as fever with a temperature of over 38°C of less than 72 hours duration and its source is not found after a careful history and physical examination. Clinical handling is different depending on the age of the child. Methods: Different scales of observation have been developed that are aimed at identifying those children with underlying bacterial or viral illnesses. The diagnosis of PUO is determined by careful evaluation of the presenting picture. The induction of protective immunity through vaccination produces serological reactions to the immunodominant LPS-PS complexes of smooth Brucella spp. which complicate distinguishing between vaccinated and infected hosts. One of the most difficult tasks in the serological diagnosis of brucellosis has been the discrimination of infected from vaccinated animals The humoral immune responses against two different antigens of Brucella melitensis were monitored by enzyme-linked immunosorbent assay in goats vaccinated with B. melitensis Rev1 or experimentally infected with B. melitensis 16M. Immunoglobulin G (IgG) and IgM responses against B. melitensis lipopolysaccharide (LPS) and B. melitensis 28-31-kDa recombinant outer membrane protein 31 (omp31) were measured. Vaccinated and infected animals developed high anti-LPS IgM and IgG titers, which overlapped with those obtained with sera from B. melitensis-infected animals used as positive controls. In contrast, only a slight IgG and IgM response against the omp31 was detected in vaccinated or Brucella-infected goats, although its levels were always significantly lower than those of B. melitensis 16M-infected animals. These data indicate that omp31 of B. melitensis could be useful for the differential diagnosis of caprine brucellosis. ISE.053 Epidemiology of HbsAg Positive Carrier Among Blood Donor and Vaccination Against HBV of their Families H. Afzali, A. Taghavi Ardekani, M. Sharif, A. Honarpishe. Kashan University of Medical Sciences, Kashan, Iran (Islamic Republic of) Introduction and Objectives: Viral hepatitis is a inflammation of liver due to viruses hepatitis A,B,C,D and E. One of the most important viral hepatitis is hepatitis B because of it's chronic sequel such as cirrhosis & hepatocellular carcinoma. The most important ways for prevention is vaccination. Material and Methods: In blood donor HBsAg test were done and family of HBsAg positive cases were evaluated for past HBV vaccination, demographic and other data were obtained and collected data were analyzed by descriptive statistics.

ISE.050 Recommended modes of measuring body temperature in different age groups.

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Results: Among 28868 blood donors 167(0.57%) were HBsAg and the most age group was 20­29 year's (56.3 %). 67.7% of HBsAg positive donors were male and 33.3% were female. 128 (76.6% ) of HBsAg positive cases were married and 95 (56.9% ) their families were vaccinated against HBV. Conclusion: Regarding to importance of vaccination to prevent of HBV infection attemps for complete coverage vaccination of family HBV carrier must be considered. Key Words: Vaccination, Blood donor, Family, HBsAg positive ISE.054 Evaluation of Serologic Markers of Blood Born Diseases (HBsAg, HBcAb, HBsAb, HCVAb, HIVAb) in Dentists of Kashan Iran 2004 K. Esalatmanesh, Z. Soleimani, A. Khalifesoltani. Kashan University of Medical Sciences, Kashan, Iran (Islamic Republic of) Background: Blood born diseases such as Hepatitis B, C and HIV are of the most important problems in the entire world. More than 2 million people have hepatatis B and there are 350 million people in carrier state. Until now more than 36 million people have died from ADIS. In this study we decided to determine prevalence of these diseases among dentists in Kashan. Methods: In this study we evaluated the serologic markers of Hepatitis B, C and HIV in dentists in Kashan. We tested HbsAg, Anti-HBs, Anti HBC, Anti HCV ans Anti HIV in 45 dentists. Results: 45 dentists enrolled in this study. There were 7 females and 38 males with a mean age of 42.3 years. Most of dentists had history of complete vaccination against Hepatitis B. The immunization rate with Hepatitis B vaccine was 93.3%. Dentists who had not been immunized were older than 60 years old. None of the dentists in our study had HbsAg, and Anti-HBs was found in 63.6% of dentists. Age difference between HbsAg positive dentists and HbsAg negative subjects was significant (P.Value=0.005). Most of the Anti-HBs negative subjects have a history of 7 years or more of vaccination. In this study 22.2% of dentists has Anti-HBC but Anti HCV and HIV were negative in all of them. ISE.055 The Relationship Between Carcinoembryonic Antigen (CEA) and Anti-H. pylori in Patients with Peptic Ulcers A. Karbassian, N. Kassaian. Infectious Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran (Islamic Republic of) Objectives: Gastric cancer is the second leading cause of cancer deaths worldwide. One factor that had been proposed to be associated with the development of gastric cancer is infection with the bacterium H. pylori. Because one of the useful method for diagnosis of cancer is Carcinoembryonic Antigen (CEA), this study was designed to show if H. pylori is associated with CEA in patients with ulcer peptic. Methods: In a cross-sectional study, blood specimens of 25 patients with ulcer peptic. referred to Shafa Laboratory in Isfahan city in 2004 were collected. After that, their plasma isolated immediately for measurement of Carcinoembryonic Antigen (CEA) and anti - H pylori (IgG) tests. Enzyme Linked Immunossorbant Assay (ELISA) was used to determine the both tests. Correlation, Fisher Exact and t - student tests were used to data analysis and P<=0.05 was considered significant. Result: 20 of 25 patients (80%) had an anti - H. pylori level more than 30 Ru/ml which considered as positive. The mean of CEA was significantly higher in H. pylori > =120 Ru/ml than H. pylori < 120 Ru/ml groups (3.2±1.6ng/ml v.s 9.5± 5.4ng/ml, P=0.003). The mean of H. pylori and CEA levels were 76.8±53 Ru/ml and 6±4 ng/ml respectively which their correlation was significant (cor=0.76, P=0.000). Conclusion: The results of this study indicate a significant association between seropositive H.pylori IgG antibodies and elevated CEA in ulcer peptic patients. We conclude that significant CEA expression and high concentration of anti -H.pylori improve the prognostic of gastrointestinal cancer occurred during recurrent infection. Key Words: H. pylori, Carcinoembryonic Antigen, Peptic Ulcer. ISE.056 The Role of Mycobacterial and Anaerobic Bacterial Agents in Resistant Diabetic Foot Infections F. Fallah1, G. Eslami2, M. Habibi2, F. Mazaheri2, K. Rahim Hosseini2. 1 Shaheed Beheshti University, PIRC, Tehran, Iran (Islamic Republic of), 2 Shaheed Beheshti University, Tehran, Iran (Islamic Republic of) Objective: Diabetic foot infections are a potentially severe complication of diabetes. Diabetic foot infections can sometimes lead to long-term debilitation and, in the most severe cases, amputation. They are the

most common infections in patients with diabetes, whose weakened immune systems put them at an increased risk of acquiring antibiotic resistant infections. Method: In order to determine the microbiological characteristics of diabetic foot infection, 120 diabetic patients (30 women, 90 men; age between 45 and 65 years with a duration of diabetes from 0.5 to 37 years) were investigated. Immediately after the hospitalisation, specimens from infected foot lesions were taken using Thio and BHI as transport medium. Aerobic cultures were done in all cases according to conventional methods while anaerobic cultures were carried out when clinical signs indicated to perform it. After identification of agents, susceptibility tests were performed on isolated microorganisms. Result: Among of all diabetic patients in this study, we found the frequency of polymicrobial infections were 75% and monobacterial infections were 25%. We isolated gram positive cocci 95%, gram positive bacilli 35%, gram negative 55% and 10 % mycobacterium. Also, we found that 12.5% of our bacteria were anaerobic and 87.5% were facultative aerobic bacteria. In antimicrobial susceptibility testing Rifampin was the most effective antibiotic against S.aureus and peptostreptococcus. Surprisingly, E.coli was resistant to all the antibiotics we used. Conclusion: Diabetic foot infections have a polymicrobial nature. Antibiotic treatment of infections should be based on the results of microbiological investigation of diabetic foot. The mycobacterial agants are important too. ISE.057 The Study of Chlamydia pneumoniae in Atherosclerosis Patients in Iran by PCR Method G. Eslami1, F. Fallah1, M. Bootorabi2, H. Goudarzi2. 1Shaheed Beheshti University, PIRC, Tehran, Iran (Islamic Republic of), 2Shaheed Beheshti University, Tehran, Iran (Islamic Republic of) Cardiovascular disease (CAD) is the leading cause of death in developed countries. The cause is multifactorial. A substantial proportion of patients with CAD do not have traditional risk factors. Infectious diseases may play a role in these cases, or they may intensify the effect of the risk factors. The association of CAD and Chlamydia pneumoniae infection is firmly established, but causality is yet to be proven. Method: We investigated their presence in carotid atherosclerotic plaques. 102 plaque atherosclerotic in dead patients were available for examination in Tehran, Iran. The highly sensitive polymerase chain reaction method was employed with primers specific for this agent. Result: The presence of Chlamydia DNA was detected in 23 (22%) out of 102 examined samples. Conclusion: The presence of Chlamydia DNA in these patients supports the hypothesis that this agent has an association with atherosclerosis. ISE.058 Investigation About Prevalence of Bacterial Agents in Infectious Gastroenteritis in Children S.S. Seyed Javadi, H. Omidvar. Shahid Beheshti University (Medical Faculty), Tehran, Iran (Islamic Republic of) Gastroenteritis is an important problem in the world. Mortality of children who contracted gastroenteritis is very high. Major factors that produce gastroenteritis are infections (Chronic gastroenteritis due to bacteria, viruses and parasites), malnutrition, immune deficiency, mucus damage and Nat healing that and finally the intensification of malabsorbtion and Gastroenteritis of poor quality is always a great danger. The current descriptive study in 1384­85 has been performed in academic treatment Mofid center of 287 children who contracted gastroenteritis that refer to this center. After the diagnosis of disease by physician, as sampling is performed of 287 infected patients who has not taken antibiotics at least for 3 days. Then samples were transported to transport media culture (triptikase soy broth) in other to be the laboratory for bacteriologic investigation specially Entrobacteria case, samples in blood agar--McConkey EMB were culture and then were placed in ancobator for 24­48 hrs. After appearing the colonies, sampling was done for doubtful colonies, lam supplied, and then gram caloration performed. Then gram, negative cocobacillus were cultured in specific culture. For diagnosis of entrobacteria cease TSI, urea broth, and indal were used for bactery kind detection differential and supplemental tests were used of 287 samples, 267 to be caused by entrobacteri cease (92.5%), that Ecoli has first rate (31%) and proteus (25.8%) and salmonella (20.6%) has the rates after that. Morbidity of infection gastroenteritis is the same in the both sexes and the most range of being affected is 1­12 months that is equal 163.

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ISE.059 Empirical Therapy of Community Acquired Staphylococcus Infections K. Mostafavizadeh, F. Khorvash, M. Fasihi, Dastjerdi, S. Mobasherizadeh, B. Ataei. Infectious Research Center, Medical University, Isfahan, Iran (Islamic Republic of) Background: Staphylococcus aureus is one of the most important etiologic agents causing severe infection in human. Extravagant use of vancomycin as first line treatment of infections caused by this organism, has led to production of vancomycin resistant staphylococci and enterococci, as an important health problem. The goal of this study is determining sensitivity of S. aureus isolated from clinical specimens outside hospital using E-Test in order to find suitable primary therapeutic method and to reduce vancomycin use. Methods: In this study which was performed in cross-sectional method in 1385, 60 samples of community acquired S. aureus isolated from clinical specimens of patients presenting to Al- Zahra Hospital were studied. MIC (Minimal Inhibitory Concentration) for various antibiotics against organisms were determined by E- test method. Qualitative control was performed by staphylococcus ATCC29213 and statistical analysis was done by SPSS-13 and WHONET- 5. Results: The number of patients in this study is 60, including 10 women and 50 men. Samples studied, were 47% from blood, 30% from skin ulcer, 11.7% from evacuated abscess and 8.3% from synovial fluid. Sensitivity percentage of organisms based on break point used in CLSI M7A6 (Clinical & Laboratory Standard Institute) for various antibiotics was Co- Amoxiclav 88.6%, Amikacin 81.8%, Gentamicin 79.3%, Cephalothin 82.1%, Ciprofloxacin 75%, Clindamycin 75%, Oxacillin 76.7%, Rifampin 90.5% and Vancomycin 77.8%. Highest resistance was noted against Oxacillin (P<0.01), Clinidomycin (P<0.01) and aminoglycosides (P<0.05) and definite resistance against Vancomycin was present in only one sample. Discussion: Staphylococcus aureus which shows increasing resistance and is among most prevalent agents of hospital infection, still has acceptable sensitivity to Cephalothin, Oxacillin and other first- line treatment drugs in outpatients and empirical use of Vancomycin is not necessary in these patients. Key Words: Staphylococcus aureus, vancomycin, empirical treatment, MIC. ISE.060 Neonatal Bacterial Sepsis--Case Reports from India D. Kasana, R. Gaind. Safdarjang Hospital, Delhi, India Salmonella enterica serotype Typhi & Paratyphi A are major cause community acquired sepsis, with highest incidence in the 5­19 years age group. The disease is rare in the neonatal period; several studies on typhoid fever in young children do not include even a single neonate. Neonatal sepsis due to these serovars is thought to be a mild and often unrecognized illness and S. Paratyphi A has been implicated only rarely. We present 5 cases of neonatal septicaemia due to S.Typhi and S.Paratyphi A and are described because of their interesting clinical presentation and possible modes of acquisition of infection Results: All 4 babies presented with early onset sepsis with variable clinical presentation. One baby was symptomatic. There was H/o of fever in the mother in 4 cases and one mother was asymptomatic. The most likely mode of transmission was vertical as evident from clinical presentation and investigations. All isolates were sensitive to Ist line drugs. There was no mortality. Conclusion: Enteric fever must be included in differential diagnosis of temperature elevation in young women with pregnancy in endemic areas, so that neonates can be screened. Such cases can result in outbreaks in neonatal and maternity units through horizontal transfer in endemic areas. ISE.061 Common Infectious Diseases in a Government Tertiary Psychiatric Healthcare Facility in the Philippines B. Seludo. National Center for Mental Health, Department of Medicine, Mandaluyong City, Philippines Background: Currently, the above-mentioned tertiary psychiatric healthcare facility has an authorized bed capacity of 4,200 daily average of 3,400 in-patients and an average 140 days length of stay. it has a total of pavilions/cottages and 52 wards for emergency, forensic, acute and chronic care.

Methodology: This is a description and cross sectional study of the target population employing active surveillance of mentally-ill patients with infections from the general pavilions/cottages/wards admitted at pavilion 7 Infirmary through the complete accomplishment of a standard surveillance form for data collection, analysis and interpretation from JanuaryDecember 2006. Results: Based on the annual report of 2006, there were total of 1189 in-patients with mental disorders that contracted infections diseases. 1/2 of the population infected were male patients and 100% belonged to the group 50 and above. The 5 leading causes of morbidity were: 1) Intestinal Amebiasis; 2) Acute Gastroenteritis; 3) Upper Respiratory Tract Infections; 4) Pneumonia and 5) Pulmonary Tuberculosis. Diarrheal disorder (Intestinal Amebiasis and AGE) and PTB are prevalent at pavilion 4 (Forensic-Men) for age group 50 and above. URTI (14%) is prevalent at pavilion 3 (acute Care-Women) and Pneumonia (10%) at Pavilion 3 (Acute Care -Women), 5 and 8 (Chronic Care Women) for age group 50 and above. Conclusions: This study revealed that in general people with mental disorder belonging to age group 50 and above experienced rates of morbidity from infectious diseases attributed to patient related barriers to medical care such as cognitive and social skills deficits, poor adherence to personal hygiene and symptoms of disorganization, avoidance and paranoia. Also, the male population belonging to age group 50 and above as shown by the data gathered is at a greater risk of contracting diarrheal disorders whereas the female population of the same age group is more vulnerable to respiratory tract infections. ISE.062 Comparing Bacterial Etiology and Antimicrobial Resistance of Community-Acquired Pneumonia in the Elderly and Younger Adults in Hamadan, Iran S. Jamal Omidi, G. Soozanchi, S. Hashemi, R. Yousefi-Mashouf, M. Mamani. Hamedan University of Medical Sciences, Hamedan, Iran (Islamic Republic of) Background: Community-acquired pneumonia (CAP) is more frequent in the elderly and results in higher morbidity and mortality. The aim of this study was to compare the frequency of bacterial agents of CAP and their antimicrobial resistance in the elderly and younger adults admitted in a teaching hospital in Hamadan, Iran. Materials and Methods: During 2005­2006, all adult inpatients with CAP were included. The etiologic agents were determined by microscopic and culture methods. Antibiotic susceptibility of isolated bacteria was examined by disc diffusion. Results: A total of 150 cases of CAP including 69 elderly and 81 younger adults were evaluated. The most frequently identified pathogens in younger adults were Moraxella catarralis (11.5%), Streptococcus pneumonia (10.1%), and Staphylococcus aureus (10.1%); while the most in the elderly were S. pneumonia (12.3%), S. aureus (6.1%), and Pseudomonas aeruginosa (6.1%). Overall, the most isolates were resistant to cefazolin. Resistance of S. pneumoniae to penicillin was 20% in older and 57% in younger adults. Most S. pneumonia isolates were susceptible to vancomycin (90% in older and 100% in younger adults). All S. aureus isolates were sensitive to vancomycin, but 80% of the isolates in the elderly and 28.6% in younger adults were methicillin-resistant. Also, the most isolates of M. Catarrhalis and Haemophilus influenza were resistant to amoxicillin-clavulanate. No significant differences were observed between the frequency and antimicrobial resistance pattern of isolated pathogens in both age groups. Conclusion: There were no significant differences between the frequency and antimicrobial resistance pattern of bacterial agents of pneumonia in the elderly and younger adults. S. pneumonia and M. catarrhalis are the leading causes of pneumonia in our community. Increased resistance of these bacteria to the current antibiotics highlights the need for further investigation about the newer antibiotics for treatment of community-acquired pneumonia. ISE.063 A Serological Follow-Up Study of Acute Q Fever Infection M.N. Hung1, Y.C. Liu2, P.Y. Shu 3, M.Y. Hou3, P.S. Lin3, C.C. Lin 3, L.J. Lin 3 , H.Y. Lu3. 1Centers for Disease Control, Taipei, Taiwan, 2Department of Clinical Pathology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan, 3Centers for disease ocntrol, Taiwan, Taipei, Taiwan Background: After acute Q fever infection, it is well known that patients with certain predisposing factors are at risk to develop chronic Q fever. However, there are few reports describing the results of routine followup of acute Q fever infected patients.

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Methods: A prospective serological follow-up study was conducted from August to November 2007. Persons with onset of acute Q fever more than 6 months earlier than initiation of this study were eligible. The indirect immunofluorescence assay was used for serological testing; nested PCR was additionally performed on samples with anti-phase I IgG titer 800. Results: Of 92 (male: 85, female: 7) eligible persons enrolled with the interval between follow-up blood sampling and onset of acute Q fever ranging from 169 days to 1253 days (medium: 607 days), 17 subjects were found to have chronic Q fever by serology (titers of anti-phase I IgG: 1:12801:5120, medium: 1:1280). All these chronic Q fever subjects were asymptomatic and had negative PCR results. History taking revealed no pregnancy, immunocompromised status or valvular defects on these subjects when acute Q fever occurred. After medical consultation, continued serological and clinical follow-up was recommended for these subclinical subjects. Conclusion: Chronic Q fever may develop in a certain proportion (18% in this study) of patients after acute Q fever infection. It is suggested that history alone might be unreliable, highlighting the importance of routine serological follow-up of every acute Q fever infected patient.

ISE.064 Distribution of various infections in both the sexes.

ISE.063 Demographic characteristics in cases with and without chronic Q fever. ISE.064 Spectrum of Infections in Over Weight, Obese and Grossly Obese Individuals Who Are Non Diabetic and HIV Negative J. Rajesh, D. Rajasekaran. Madras Medical College, Chennai, India Background: Obesity has a clear but not yet precisely defined effect on immune response. Data suggest that obese are more likely than normal weight people to develop various infections. Hypothesis: Increased susceptibility to infections of obese patients may be related to decreased arginine and glutamine resulting in decreased TNF and increased NO release. Prolonged length of hospital stay may account for the nosocomial infections. Increased local trauma related to retraction and lengthened operative time may contribute to increased incidence of surgical site infections. Materials and Methods: Ours was a prospective observational study conducted on 50 patients. They were classified as overweight, obese, grossly obese based on Asian criteria of Body Mass Index. They were included in the study when they had symptoms suggestive of the suspicious infection and who proved positive for the same through appropriate investigations. In Asians normal BMI 18­23 Over weight 23.1­28 Obese 28.1­33 Grossly obese 33.1 (Hutchison's clinical methods; 22nd Edition) Diabetics and HIV Positive were excluded. Blood glucose estimated by glucose oxidase method and HIV serology by ELISA method. Patients with 1) Respiratory symptoms: underwent chest x ray, sputum grams staining, cytology, culture and sensitivity and blood culture. 2) Urinary symptoms: urinalysis and culture sensitivity. 3) Skin lesions: KOH mount and Saboraud's culture 4) Cellulitis: Pus and blood culture and sensitivity. Results: See tables attached below. Conclusions: 1) Most frequently observed infections were dermatological overall and also in males. 2) UTI was the commonest in females with 70% occuring postpartum 3) Most frequently encountered organism was E.Coli. ISE.064 Organisms encountered in the study. ISE.065 Population Pharmacokinetics of Levofloxacin as Prophylaxis for Febrile Neutropenia M. Ohshiro1, Y. Fujimoto2, Y. Kanbayashi2, K. Nomura1, M. Taniwaki1. 1 Kyoto Prefectural University of Medicine, Kyoto, Japan, 2Kyoto Prefectural Univerisity of Medicine, Kyoto, Japan, 2Kyoto Prefectural Univerisity of Medicine, Kyoto, Japan Background: Levofloxacin (LVFX) is widely used against a broad spectrum for bacteria. To prevent the emerging of resistance resulting from its abuse, an optimal method and dosage are needed. In the field of hematological malignancies, LVFX is one of the choices for prophylaxis for febrile neutropenia (FN). There is no consensus about the optimal dosage and method among hematologists. Goals: To determine the population pharmacological parameters based on the population pharmacokinetics of LVFX. We considered the optimal dosage and method of LVFX based on various simulations depicted by personal computer. Methods: We performed population pharmacokinetic analysis for seven patients receiving LVFX as prophylaxis (200mg, b.i.d.) for FN with blood sampling. One patient received 100mg t.i.d. All patients were treated at Kyoto Prefectural University of Medicine. Results: Clearance (CL) is 5.8 L/hr, distribution volume (Vd) is 58.5L, area under the blood concentration-time curve (AUC0-24) is 69.0 µg·hr/mL, t 1/2 is 6.9hr, Cmax is 3.4 µg/mL at administration of 200mg b.i.d. Cmax (peak) of 500mg, and q.d. is simulated as 8.54 µg/mL. Conclusion: 500mg q.d. is predicted to be the most effective dosage and method. Because the predicted Cmax value is similar to that of western countries, the frequency of adverse effects is thought to be same as in western countries. 500mg, q.d., may also be an optimal dosage and method for Japanese.

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ISE.066 Beta-Haemolytic, Beta-Lactamase and Antibiotic Susceptibility Activities of Plesiomonas shigelloides Isolated from Stool Samples in the Venda Region of South Africa J. Ramalivhana1, C.L. Obi2. 1University of South Africa, Pretoria, South Africa, 2Walter Sisulu University, Mthatha, South Africa This study determined the haemolytic, haemagglutiantion and antibiotic susceptibility activities of Plesiomonas shigelloides isolated from stool samples in the Venda region of South Africa. Stool samples were collected from patients visiting health centers in the Venda region. Plesiomonas shigelloides were isolated and identified using the API 20E, API 20NE systems. Antibiotic susceptibility profiles of the isolates were determined using the disc diffusion method and analyzed according to NCCLS standards. 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. A total of 89 (13%) Plesiomonas shigelloide were isolated from 660 samples. The hemolytic activities of the isolates were variable with no heamolysis on sheep red cells. 33 (37%) of isolates were beta lactamase producers. There was a high level of resistance to the penicilllins with 100% resistance to Penicillin G, Amoxicillin and Ampicillin. This study has demonstrated multiple resistances to different antibiotics and production of Beta lactamase. Most of the isolates demonstrated pathogenic characteristics based on their hemolytic activities. The genetic characterization of the isolates will further confirm their pathogenicity and the origin of multiple antibiotic resistance ISE.067 What is the Role of Mycoplasma pneumonia in Polypectomized Patients? A. Tabatabei, S. Noorbakhsh, M. Farhadi. Research Center of Pediatric Infectious Disease, Iran University of Medical Sciences, Tehran, Iran (Islamic Republic of) Introduction: Inflammation is relatively a documented pathogenetic cause of nasal polyps but the definite causes are still unknown. Mycoplasma Pneumonia is a common respiratory pathogen which is often found in our populations. Goal: To determine the role of Mycoplasma Pneumonia in Polypectomized patients Material and Methods: This case control study done in ENT clinics and ward of Hazrat Rasul Hospital in Tehran (2005­2006). This study had done on 51 nasal polyp patients and 19 healthy control (nasal fracture). Specific Mycoplasma p. antibodies (IgG & IgM-ELISA) detected in Blood samples for all cases and controls. Nasal polyp tissues in cases and inferior nasal turbinate mucosa in the control group tested for DNA-Mycoplasma (PCR) Results: The age range of the polyp cases was 12­72 years, Mean = 35 ± year. The age of the control group m was 18­41 years, Mean = 23 years. PCR Results: DNA- mycoplasma.P detected in 19.6% (10/51) of polyp cases. All controls had negative results for DNA mycoplasma. DNA- mycoplasma.P had significant difference between cases and control group (OR=9.9%; Pvalue<0.05). Serologic results in polyp cases detected acute infection (IgM) in 15.7% (8/51) and previous immunity (IgG) in 68.8% (35/51) of them. Acute mycoplasma infection (IgM) detected in 15.8% (3/19; previous immunity (IgG) in 47.4% (9/19) of control group. Acute and previous mycoplasma infection had not significant difference (OR=99%; Pvalue= 0.1) between cases and control groups. Conclusion: mycoplasma-DNA detection was detected significantly more in polyp cases than control group. It may has a significant correlation with nasal polyp formation in our cases. Further studies with larger saple sizes considering more confounding factors are needed. ISE.068 Some Factors Affecting on Rheumatic Fever Occurrence A. El-Bassiouy, A. El-Ged, A. El-Shafei. Faculty of Veterinary Medicine, Kafrelsheikh, Egypt, Faculty of Veterinary Medicine, Benha, Egypt A total of 1234 patients suffering from RF were selected for studying some epidemiological survey evaluating three methods used for diagnosis of RF which are CRP, ASO and ESR. Monthly geography, climate and environmental pollution). Monthly occurrence of RF in percentage among the year were: 5.6, 7.5, 12.7, 10.6, 9.4, 6.4, 7.6, 6.4, 5.7, 11.5, 9 and 7.6 respectively. Seasonal incidence of RF in percentage were: in

winter 20.7 in spring 32.6, in summer, 20.4 and in Autumn 26.3. Age incidence of RF in percentage were (18.8) in 6-8 year age, 57.8) in 8 - 10 year age and (23.4) in 10-12 year age. Sex incidence of RF in percentage were (43.7) in males and (56.3) in females. Effect of locality on RF occurrence in percentage were (37.1) in village and (62.9) in city. Effect of economic status on RF occurrence in percentage were (9) in high economic status (24.2) in moderate and (66.7) in low one. ISE.069 Mish Cheese as a Hazard of Man Brucellosis G. El- Olemy1, B. Lamiaa2, A. El-Ged1, M. Hussien1, A. El-Bassiouny1. 1 Faculty of Veterinary Medicine, Benha, Egypt, 2Health institution, Cairo, Egypt, 1Faculty of Veterinary Medicine, Kafrelsheikh, Egypt A total of 1723 cows, 430 buffaloes, 1315 sheep and 517 goats were examined serologically by Buffered Acidified Plate Antigen Test (BAPAT), Rose Bengal Plate Test (RBPT) and Tube Agglutination Test (TAT) to detect Brucella infection beside isolation from milk samples were carried. Expermint was done on mish cheese prepared from cheese contaminated with Brucella melitensis biovar 3 isolated from cows under investigation to detect the survival of brucella in this milk product.Suggestive control measures of the disease was studied. ISE.070 Resistance of Uropathogenic Bacteria in Children on Peritoneal Dialysis in Labbafinejad and Mofid Children Hospitals M. Fallah1, H. Behzadnia2, A. Moradi1. 1Shahid Beheshti University M.C.,PIRC, Tehran, Iran (Islamic Republic of), 2Pharmacy feculty of Azad Univ., Tehran, Iran (Islamic Republic of) Background: Growing antibiotic resistance demands the constant reassessment of antimicrobial efficacy, particularly in countries with wide antibiotic abuse, where higher resistance prevalence is often found. Knowledge of resistance trends is particularly important when prescribing antibiotics empirically, as is usually the case for urinary tract infections (UTIs) especially in children on dialysis treatment. Currently, in IRAN, amoxicillin, cotrimoxazole (trimethoprim/sulfamethoxazole) and third generation cephalosporins are used as "first-line" antibiotic treatment for UTI. Appropriate management strategies designed for specific groups of patients with UTI can maximize therapeutic benefit while reducing cost and incidence of adverse reactions. Objective: The aim of this study was to assess the kinds of isolated bacterial strains and their drug resistance to commonly used antimicrobials in children with terminal renal failure on peritoneal dialysis (PD) treatment who suffer from UTI. Methods: In this study, bacterial isolates from urine samples collected from pediatric patients (6 months­17 years) on PD with acute UTIs in Tehran from March to September 2006. Samples were tested for susceptibility to 13 antibiotics by the disk-diffusion method. Results: 36 bacterial isolates were derived from 34 culture positive UTI episodes (27 Escherichia coli). We found a high prevalence of resistance towards the drugs used as "first-line" when treating UTIs: amoxicillin and cotrimoxazole, (71.4%, 51.7%, resistance, respectively).The results showed that 70.4% of E. coli isolates were resistant to amoxicillin, whereas 55.6% of them were resistant to cotrimoxazole. Resistance towards third generation cephalosporins was also high (44.5% and 37% of E. coli to Cefixim and Ceftriaxone, respectively). Conclusion: We concluded that resistance of E. coli isolates to first-line treatment (amoxicillin, cotrimoxazole) of UTI was high, whereas most E. coli isolates were susceptible to Amikacin and nitrofurantoin. Key Words: Peritoneal dialysis, UTI, Antibiogram, Children ISE.071 The First Report of the Prevalence of O and H Serogroups of Escherichia Coli Strains Isolated from Children with Urinary Tract Infection in Iran F. Emamghorashi1, S.H. Farshad2, A. Japoni2, M. Kalani2, S.H. Rajabi1, M. Hosseini2. 1Jahrom Medical School, Jahrom, Iran (Islamic Republic of), 2Prof. Alborzi Clinical Microbiology Research Center, Shiraz, Iran (Islamic Republic of) Introduction: Nowadays E. coli generally is named by serogroups of O and H. As there is no data about the prevalence of different serogroups of uropathogenic E. coli in Iranian patients this study has been established to determine the prevalence of O and H serogroups of E. coli strains causing community acquired UTI in children in Iran.

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Materials and Methods: In this study 96 children with urinary tract infections referred to Motahary Hospital, Jahrom, Iran during the period of August 2005­August 2006 were enrolled. E. coli strain were isolated from urine samples and confirmed by conventional differentiation tests. Antibiotic sensitivities of the isolates were determined by disk diffusion method and serotypes of them were investigated by tube and slide agglutination tests. Results: In total 96 E. coli strains were isolated from urine samples of children with UTI aged from 1 month to 14 years. Cystitis was diagnosed in 49.2% and pyelonephritis in 50.8% of these patients. The most resistance was seen to ampicilin (80.2%) and the least to imipenem (1.1%). Twenty six isolates were positive for O antigen. The most prevalent type of O antigen was O1 (46.15%). There were significant correlation between presence of these O antigens and sensitivity to nalidixic acid and gentamicin (P<0.05). Thirteen isolates were positive for H antigen, from them 6 (46.15%) isolates were prevalently positive for H4 antigen. Conclusion: This is the first report of E coli serotying in children with UTI from south of Iran and their relationship with antibiotic resistance and clinical presentation. These results showed that O1 and H4 antigens in the genetic background of uropathogenic strains isolated from the patients under our study may contribute to the pathogenesis of E. coliin the urinary tract infections. However, it needs further investigation in other parts of Iran and for more other serotypes. ISE.072 Evaluation of Bacterial Flora from Paranasal Sinuses in Patients with Chronic Sinusitis A. Wojdas1, B. Zielnik-Jurkiewicz2, D. Jurkiewicz3. 1Otolaryngology Department, Military Institute of Health Services, Warsaw, Poland, 2 Otolaryngology Department, Children's Hospital, Warsaw, Poland, 3 Otolaryngology Department, Military Institute of the Health Services, Warsaw, Poland Objective: To investigate the bacteriological profile in patients with chronic rhinosinusitis. Materials and Methods: We enrolled to this trial 100 patients (56 females and 44 males) aged from 18 to 62 (mean 41,3), with chronic rhinosinusitis. Control group were 20 patients (9 females and 11 males) aged from 19 to 44 (mean 29,4) Results: In collected material from 87 patients (87%) growth of bacteria on 89 blood agar were received. In two cases mixed flora was observed. In 13 specimens there was no growth of any bacteria. Comparing results of studied cultures: in 78 patients pathological flora were discovered whereas in 8 patients saprophytic bacteria. In the group of pathological flora 71,57% cultured bacteria was aerobe, among it the commonest were: Staphylococcus aureus (13,73%), Streptococcus pneumoniae (10,78%), Haemophilus influenze (9,8%), Staphylococcus coagulase negative (9.8%). In anaerobe group most frequently bacteria isolated was Prevotelle sp. (6,86%). Conclusions: In our trial 15 different bacterial types were identified. In 72% cases aerobic bacteria were cultured. The most commonest pathogens were: Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenze, Staphylococcus coagulasenegative. ISE.073 Nasopharyngeal and Middle Ear Flora in Children with Acute Otitis Media B. Zielnik-Jurkiewicz1, A. Wojdas2, D. Jurkiewicz2. 1Otolaryngology Department, Children's Hospital, Warsaw, Poland, 2Otolaryngology Department, Military Institute of the Health Services, Warsaw, Poland Objective: Nasopharyngeal flora can be a reservoir of bacteria caused acute otitis media (AOM) in children. The aim of the study was to identify microorganisms and antimicrobial susceptibilities of pathogens from nasopharynx and middle ear in children with AOM. Material and Methods: The study comprised 128 children ages 1 year to 14 years with diagnosed of AOM with purulent discharge. The nasopharyngeal and middle ear samples were collected at the same time. Agar, chocolate, blood and Chapman plates were inoculated for isolation of bacteria. The plates were incubated at 240C and examined at 24 hours. The susceptibility of bacteria was determined by disk diffusion technique containing concentration gradients for following antibiotics: penicillin, amoxicillin/clavulanate, ampicillin/sulbactam, cefaclor, cefprozil, cefuroxime, erythromycin, azithromycin, clinadamycin and trimethoprim/sulfamethoxazole. Results: 196 organisms from nasopharynx and 325 organisms from middle ear were isolated. Most frequent cultured bacteria were:

Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis-75,6% in nasopharynx and 77,8% in middle ear. We observed statistically significant (p<0,01) increased of Moraxella catarrhalis in specimens from the middle ear than from nasopharynx. The most of organisms were susceptibility to amoxicillin/clavulanate 83,2% of bacteria from nasopharynx and 81,8% of bacteria from middle ear. The most of organisms presented resistance to trimethoprim/sulfamethoxazole - 60,7% of bacteria from nasopharynx and 62,6% of bacteria from middle ear. Penicillin resistance was observed in 25,0% of bacteria from nasopharynx and 25,6% of bacteria from middle ear. The correlation in resistance of bacteria between trimethoprim/sulfamethoxazole and erythromycin (r=0,4886) and between trimethoprim/sulfamethoxazole and penicillin (r=0,5027) was observed. Conclusions: Nasopharyngeal and middle ear flora in children with AOM is similar. In that case susceptibility of bacteria from the nasopharynx can be useful for empirical treatment of AOM in children. ISE.075 Osteoarticular Complication of Brucellosis N. Janmohammadi, M.R. Hasanjani Roushan, S.A. Asgharzadeh Ahmadi, M. Sadeghi Zavareh, M. Javanian. Infectious Diseases Research Center,Yahyanejad Hospital,Babol Medical University, Babol, Iran (Islamic Republic of) Background: Skeletal complication are frequently seen in endemic regions of brucellosis.The purpose of this study was to determine the prevalence of osteoarticular complication of brucellosis. Methods: From April 2001 to September 2007, 1162 cases of brucellosis were treated at the Research Center of Infectious Diseases of Babol Medical University in Iran and 232 (19.9%) cases had osteoarticular complication. The distribution of osteoarticular involvement was determined. Results: One hundred thirty eight (59%) were male and 94 (41%) were female.Polyarthritis, monoarthritis, spondyliitis and sacroiliitis were seen in 91 (39%), 60 (26%), 43 (18.5%) and 38 (16.5%) of cases, respectively.Spondylitis was seen in 43 (18.5%) of cases. Conclusion: Periphral joint involvement, spondylitis and sacroiliitis are the most common complications of brucellosis in our region. ISE.076 Associated Myasthenia Gravis, Thymectomy, Chron Disease, and Other Autoimmune and Dysreactive Disorders. Pathogenetic and Clinical Correlations, Immune System Involvement, and Systemic Infectious Complications R. Manfredi, G. Fasulo, C. Fulgaro, S. Sabbatani. Infectious Diseases, University of Bologna, Bologna, Italy Background: Since the mid-sixties, the association between miasthenia gravis, tymectomy performed for disease control, and development of autoimmune disorders, is known, while the relationshop with the occurrence of systemic infectious complications (underlying immunodeficiency, or jatrogenic immunosuppression?), is less evident. Methods and Results: A 26-year-old female patient (p), with a post-thyroiditis hypotireodism, polycystic oophoritis, and a diagnosis of masthenia gravis posed 4 y before, developed an ileal-colonic Chron disease treated since two months with corticosteroids. When moved to our Infectious Disease Division due to irregular, septic hyperpyrexia, not responsive to an initial empiric antimicrobial therapy, and with a presumed allergic-toxic rash, underwent a further workup. Upon admission, an evident leukocytosis was associated with increased ESR (86), mild hepatocytolisis, hemorrhagic conjunctivitis, and nodular erythema at lower limbs. Ultrasonographic and CT scans suggested a multifocal pyelonephritis, comfirmed by the isolation of E.coli at urinalysis. Combined, full-dose cefotaxime-metronidazole, was changed upon discharge with ciprofloxacin, and with the reintroduction of steroideal therapy for Chron disease. Discussion: A large number of predisposing conditions make all subjects suffering from autoimmune/dysreactive disorders prone to develop even severe infectious complications, including the frequent immunosuppressive treatments, and the multiple immunodeficiencies detected at the time of diagnosis of these conditions. In the reported p, an autoimmune thryroiditis, a miasthenia gravis, a Crohn disease, and an erytema nodosum were already disclosed in a young female p aged 26. Consultants should take into consideration the heterogeneic, systemic background of each disease presentation, and their possible complications, with a proportionally elevated risk of infectious diseases, which take advantage from the chronic administration of steroids or other

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immunosuppressive drugs, and in the unbalanced immune system, usually shifted towards a Th1 response, which tends to balance the increased Th2 activity typical of autoimmune disorders, as found in p with chronic inflammatory bowel diseases are associated with myasthenia gravis with a greater frequency compared with the general population. From a pathogenetic point of view, the intrathymic maturation process of T-lymphocytes is altered during myasthenia gravis, while intyrathymic B-lymphocyte alterations may contribute to the development of autoimmune disorders. In cases like ours, the concurrence of multiple disoders may complicate the differential diagnosis and hamper a prompt recognition and a timely treatment of infectious diseases which may be potentially severe in their course. ISE.077 Late Stage, Untreated HIV Disease Discovered After Diagnosis of a Pulmonary Nocardiosis R. Manfredi. Infectious Diseases, University of Bologna, Bologna, Italy Background: AIDS presenters are increasing worldwide, due to HIV infection lasting undiagnosed-neglected for many years. Case Report: A 43-year-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 only, and an initial AIDS-dementia complex. Hospitalized owing to a considerable body weight loss, fever, cough with blood emission, and pulmonary infiltrates, when undergoing a HRCT a consolidated 4-5 diameter lesion involving the apical-dorsal left upper pulmonary lobe was disclosed, accompanied by multiple subpleuric lesions, with tendency towards excavation. Either tubercular, bacterial, or other opportunistic infections were suspected, together with a malignancy. While waiting for microscopy, cytology, and culture examinations of respiratory secretions and bronchoalveolar lavage fluid, based on blood cultures which yelded a multi-sensitive Staphylococcus epidermidis strain, a broad-spectrum therapy including cefazoline, and later cefriaxone-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 antiretroviral therapy was conducted for 12 days, until an overwhelming anemialeukopenia needed a red blood cell transfusion and filgrastim administration, followed by a modified antimicrobial therapy (imipenenamikacin), in the suspect of cotrimoxazole intolerance. A slowly progressive clinical ameliorement occurred, as confirmed by chest X-ray and HRCT controls, in association with a partial immune recovery obtained thanks to the combined antiretroviral therapy. Discussion: In patients with a recently diagnosed HIV disease and a profound immunodeficiency, the differential diagnosis of multiple pulmonary infiltrates with tendency to excavation includes tuberculosis and atypical mycobacteriosis, but also bacterial-fungal infections, and malignancies. In our case, the diagnostic difficulties were complicated by the emerging of a cotrimoxazole intolerance which prompted to a severe pancytopenia, so that a second-line therapy for nocardiosis was performed favorably. Notwithstanding Nocardia spp. infects immunosuppressed hosts, however nocardiosis remains very infrequent during advanced HIV disease, when only sparse pulmonary, cerebral, and skin localizations were anecdotally described. Our case underlines that opportunism may go beyond the most usual disorders, and its treatment may be conducted effectively with second-choice agents, too. ISE.078 A Study of Bacterial Urinary Tract Infection in Misurata City, Libya A. Alhubge1, M. Edrah 1, L. EL-Majdoub1. 17 October University, Misurata, Lybia Arab Jamahiriya, 17 october university, Misurata, Lybia Arab Jamahiriya One of the most important bacterial infections is Urinary tract infection (UTI) and a bacterium is considered the main cause of UTI. The aim of the present study is to evaluate the most common bacterial causes of UTI and its spread among patients attending Misurata Central Laboratory and Alshefa Clinic. Samples of urine were collected during the period from January 2005 till the end December 2006 and included all ages and both sex. This study showed that the rate of UT infections among patients was 68% (3368 cases) of which 8.93% (301) males and 91.06% (3067) females. With regard to bacteria, 60.09% of the isolates were gram positive bacteria whereas gram negative bacteria recorded 35.03% and 4.86% represented normal bacterial flora.

The most common bacterial isolates were Staph. aureus which was higher in females than in males followed by E. coli representing 8.38% in male patients and 63.13% in females. From the present study, it has been noted that the prevalence of UT infection was much higher among female patients obviously due to the anatomical nature of the Urinary System and statistical analysis showed high significance at (P 0.05) in male patients. Results also showed that the age group between 20 to 30 years was the most vulnerable (the highest exposed) age group to UT infection recording about (49.9%) 1683 patients and the number of UTIs was greater during spring and summer presenting 935 cases (27.76%) and 912 (27.07%) respectively but with no statistical significance on other seasons. ISE.079 A Long-Term Antimicrobial Prophylaxis and Immunotherapy with Urovaxom or Luivac in Female Patients with Recurrent Urinary Tract Infections S. Krcméry1, J. Hromec2. 1Comenius University Faculty of medicine, Bratislava, Slovakia, 2University of Trnava, Dept. of Medicine, Trnava, Slovakia Background: It is accepted that continuous low-dose antimicrobial prophylaxis decreases recurrence of urinary tract infections (UTI). In recent years, the oral administration of immunotherapeutic agents has been considered an alternative approach. The objective of this multicenter study was to investigate the long-term preventive effect of chemoprophylaxis with low-dose fluoroquinolones and/or immunotherapy in women with recurrent UTI. Both Uro-Vaxom (OM-89) and Luivac are extracts of bacterial components with complex immunostimulating activity. Methods: Adult female patients with at least 3 documented episodes of UTI in previous year were enrolled in this 12-months, multicenter study. Patients received continuous chemoprophylaxis with low-dose ciprofloxacin and/or immunotherapy with either Uro-Vaxom 1 capsule daily for 90 days or Luivac 1 tablet daily in the month 1, 3 and 8. Primary efficacy criteria were UTI episodes over the 12 months treatment period. Results: A total of 101 patients were treated, 51 in the Uro-Vaxom and 50 in the Luivac group, respectively. Mean rate of post baseline UTIs decreased significantly in both treatment groups: In Uro-Vaxom group the mean number of UTI episodes decreased from 3.46 to 0.56 episode/patient/year and in Luivac group from 3.74 to 0.52 episode/patient/year, p < 0.001. 28 patients (54.9%) in the Uro-Vaxom group and 28 patients (56.0%) in the Luivac group were UTI-free in the 12 months period. There were no statistically significant differences between the treatment groups. In the subgroup receiving continuous antimicrobial prophylaxis with ciprofloxacin (125 mg orally every other day), selection of quinolone-resistant strains was observed in 5 patients (ESBL-producing strains of E. coli and Klebsiella pneumoniae). Conclusion: These results confirm long-term preventive effect of low dose fluoroquinolone prophylaxis and/or immunotherapy in female patients with recurrent UTI. ISE.080 Isolation and Characterization of Streptomyces in Composted Iranian Soil, Using Chemotaxonomy S. Eshraghi1, A. Najmolhoda1, F. Hajighasemi2. 1Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (Islamic Republic of), 2Department of Immunology, Faculty of Medicine, Shahed University, Tehran, Iran (Islamic Republic of) Background: The Actinomycetes are gram-positive organisms that tend to grow slowly as branching filaments. They were thought to be related to both bacteria and fungi, but in recent years it has been undoubtedly shown that they are prokaryotic organisms. Actinomycetes have proved to be causal agents of many human and animal infections. They also play as an important rule in producing new antibiotic agents. Methods: 50 soil samples collected from different regions of the country were analyzed to determine the presence and types of antibiotic-producing streptomycetes using dilution plating method. Starch casein agar and glucose yeast extract agar were used as culture media. 88 selected organisms from 140 isolates were subjected to chemotaxonomy determination. The isomeric form of diaminopimelic acid (DAP) was determined by thin-layer chromatography (TLC) of hydrolyzed whole-organism preparations. A sample of the hydrolysated extract was applied as a band 2 cm from the base of a TLC plates. A standard containing meso and LL-DAP was also run at both sides of the sheet for

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comparison with the test mixtures. The plates were developed for about 3.5 hours in a glass tank containing 40 ml methanol, 2 ml 6Mol HCl, 5ml Pyridine, and 13 ml water. Results: DAP appear as green/brown spots, changing yellowish with time. The LL-DAP, meso-DAP and hydroxy-DAP isomers have approximate Rf values pf 0.53, 0.42 and 0.34 respectively. Approximately 97% test strains contained LL-DAP and the remaining 3% contained mesoDAP. Conclusion: This study demonstrated the wide variety of streptomycete bacteria isolated which are capable to producing antibiotic and TLC is an appropriate method to determination of streptomycetes. ISE.081 In Vitro Activity of Tigecycline Against Strains of Methicillin Resistant Staphylococcus Isolated from Wound and Soft Tissue in An Iranian 1000 Bed Tertiary Hospital M. Rahbar1, M. Kabeh -Monnavar2, F. Savaheli Moghadam2, M. Yaghoobi2. 1Iranian Reference Health Laboratory, Tehran, Iran (Islamic Republic of), 2 Milad Hospital, Tehran, Iran (Islamic Republic of) Objective: The aim of this study was to evaluate the in vitro activity of tigecycline and other comparator agents against Staphylococcus aureus isolated from surgical wound and soft tissue infections in an Iranian 1000-bed tertiary hospital. Methods: In vitro activity of tigecycline against 67 Strains of Staphylococcus aureus isolated from different patients hospitalized at Milad hospital during last six month 2007 All strains identified according the routine bacteriological methods. Susceptibility testing were performed by disk diffusion methods as recommoned by Clinical laboratory standards institute. Cefoxitin (30µg) sed for detection of methicillin resistant strains of S.aureus. Results: In total during this study 67 strain of S.aureus were isolated from patients. The majority of patients were from surgical words including open heart, orthopedic ward and had post operation wound infections.. Of 67 strains 38.29%) were MRSA. All isolates including MRSA strains were susceptible to tigecyline, Linozolide and vancmycin. 100% stains were penicillin resistant. Resistance of S.aureus to other antibiotics including teicoplanine, ciprofloxacin, clindamycin, erythromycin, cotri-moxazole and rifampin were, 6.4%, 38.29%,40.42%, 27.6% and 19.4% respectively. All isolates were also susceptible to vancomycin and linozold. Conclusion: It is concluded that all strains of S.aureus, isolated from wound and soft tissue in our hospital were susceptible to tigecyline, linozolide and vancomycin. ISE.082 The Epidemiological, Microbiological, Nosological and Evolutive Classification of 213 Cases with Sepsis N. Como, A. Kica, D.H. Kraja, E. Meta, E. Muço, V. Ostreni, R. Petrela. Univeristy Hospital Center, Service of Infecious Diseases, Tirana, Albania Material: It has been comprised 213 cases, 15-85 years old group, from January 2000­May 2006. Methodology: The epidemiological study comprises case analysis according gender, age group, subject, season period and sepsis kind. The microbiological study is focused on sepsis classification according identified causes. Nosological aspect is based on group nosologies presented with sepsis. Evolutive aspect was based one cases sequence according to sepsis progress. Epidemiological Result: Gender male 107 (50.2%), female 106 (49.8%), age group: 15­20 years old 72 (33.8%), 26­35 years old 29 (13.6%), 36­45 years old 32 (15%), 46­55 years old 15 (7%), 56­65 years old 34 (16%), 66­75 years old 28 (13.2%), >76 years old 3 (1.4%); Immunecompetent subjects 200 (93.9%); Immunesupressed 13 (6,1%); Limphoma 4, SIDA 2, adenocarcinoma 2, colagenosis under corticoid therapy 2, leishmaniasis 1, chemiotherapy 1, untreated diabetis 1. Season period: Spring 62 cases (29.1%), summer 67 (31.5%), autumn 42 (19.7%), winter 42 (19.7%). We have distinguished (community sepsis 207 cases (97.2%) and hospital sepsis 6 cases (2.8%). Microbiological Result: We have identified in 123 cases (57.8%) as casual agents: staphylococcus aureus 22, staphylococcus epidermidis 6, streptococcus pyogenes 30 escherichia coli 9, salmonella spp.2, salmonella typhi 2, mycoplasma pneumoniae 3, leishmania visceralis 1, brucella spp.7, toxoplasma gondii 3, chlamydia trachomatis 2, entamoeba histolitica 1, parotitis virus 18, flu virus 11, VZV 1, EBV 4, plasmodium vivax 1 dhe 90 cases (42.2%), sepsis was unknown.

Nosological Result: cellulitis 9, varicella 1, erysipelas 5, staphylococxy 9, face malignant staphylococxy 2, sinusitis 1, tonsillitis 19, streptocoxy 6, flu 11, parotitis 4, mastoiditis 1, gastroenteritis 2, TAB 2, amebiasis 1, malaria 1, hepatic abscess 1, abscess of muscle psoas major 2, toxoplasmosis 3, arthritis 3, brucellosis 7, endocarditis 5, mycoplasmosis 3, pneumonia 6, abscessed pneumonia 2, subacut tiroiditis 1, meningitis 2, cerebral abscess 4, urine infection 43, renal abscess 1, SIP 3, Fournier gangrene 2. Evolution: sepsis 213, severe sepsis 19, septic shock 10; respective mortality: 2.8%; 31.6% and 60%. Conclusion: 1) The most affected age group was 15­25 years old with 33.8% of all cases. 2) Summer and spring were season period with higher number of cases, 31.5% and 29.1%. 3) In 6.1% of cases we faced sepsis on immunesupressed subjects. 4) We identified 17 kind of different microbes. 5) We have distinguished 31 sepsis cause nosologies. 6) We recognized severe sepsis in 8.9%, sepsis shock 4.9 % dhe deaths in 2.8% of all cases. 7) Sepsis mortality was 2.8%, for severe sepsis 31.6% and for sepsis shock 60%. ISE.083 Study of Knowledge and Attitudes of High School Students Toward Hepatitis, Shiraz, Iran, 2005-6 S. Daneshvar, R. Bahadorikhalili. School of Health, Shiraz, Iran (Islamic Republic of) Background: Hepatitis is a communicable, dangerous disease in the world that can affect humankind either as individuals or communities. The essential aim of this study was to investigate the relationship between knowledge and attitude of high school students (boys and girls) and this disease. Methods: A cross sectional study on Shiraz high school students (grades 1, 2, 3) was done. Samples were selected by multi stage random sampling. At the beginning two high schools (boys and girls) from each educational region were selected by simple random sampling. Then, from each grade one class was selected based on their major of study (mathematics, humanism, natural sciences). At third stage 20 students from each class were selected randomly and tested by knowledge and attitude questionnaire. Results: Among 600 questionnaires that were distributed, 576 were taken into consideration the data indicated that all students have a low level of knowledge and non logical attitude toward hepatitis (M=8.35). The girls knowledge and attitudes were better than boys, but the differences were non significant. The students that studied natural science course were better than the others (M=11.50) and the difference were significant (P<0.01). The third grades students were more aware than the others, but differences weren't significant. The parents job and educational level were effective on students knowledge and attitudes, but non significant. Conclusion: The results indicated that: 1) Information about hepatitis among Shiraz high school students were very low. They didn't believe that hepatitis is an important and dangerous disease. Therefore providing the educational programs for them is very essential. 2) Text books are very effective in providing information concerning health and sickness and should have more information about Hepatitis. 3) Teacher must emphasis more on health education, particularly hepatitis information. On the other hand, the students' health education must be a duty to teachers. ISE.084 Clinical Profile and Treatment Practices in Enteric Fever in a Tertiary Care Hospital in Manipal - India K.E. Vandana, P. Sugandhi Rao, Bikram Kabir, Ramachandra Kamath. Kasturba Medical College, Manipal, India Introduction: Enteric fever continues to be a scourge to modern health care. Typhoid and paratyphoid fever caused by S.Typhi and S. Paratyphi A are endemic in many developing countries. It has become difficult and expensive to treat this common disease due to emerging drug resistance. Methods: We retrospectively evaluated culture proven, hospitalized enteric fever cases during the year 2007. Diagnosis of enteric fever was made based on clinical features and blood culture positivity. Clinical presentation, disease course, laboratory parameters, antimicrobial susceptibility, antibiotic therapy and complications were recorded. Results: A total of 75 cases of enteric fever were studied. Blood culture positivity was detected between 24 to 72 hrs of incubation by BacT/Alert automated system. Of these 48 (64%) were males and 27 (36%)

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females. Sixty seven cases (89.3%) were adults and 8 (10.6%) children below 17 yrs. Paratyphoid fever (60%) was encountered more frequently than typhoid fever (40%). Maximum cases were recorded in September (24%) followed by August (21.3%), however cases were distributed throughout the year. Fever was the commonest presentation (100%) with an average duration of 9.2 days. Other symptoms were one or more of anorexia, nausea and vomiting in 32%, diarrhea (24%) and cough. (20%). Average duration of hospitalization was 8.6 days. Anaemia, leucopenia, abnormal liver function, and renal impairment were noted in 18.7%, 13.3%, 25.3% and 4% cases. Monotherapy with fluoroquinolone was used in 9.3%, ceftrioxone in 40% and amoxicillin in 6.6% of patients. Combination therapy with ceftrioxone and fluoroquinolone was received by 25.3%. Azithromycin monotherapy or in combination also was used in 9.3% patients. No MDR strains were isolated and all patients recovered fully. Conclusion: Enteric fever is endemic in India with seasonal outbreaks during monsoon. Paratyphoid fever is increasing over typhoid cases, may be partly due to increase in patients seeking medical advice for febrile illness and increased use of blood culture for definitive diagnosis. It is prudent to use antibiotics only after susceptibility testing to avoid emergence of drug resistance and clinical failures. ISE.085 Comparative Proportions of Tumor Necrosis Factor-Alpha and Interferon-Gamma in Healthy Blood Donors and HIV Infected Individuals R. Raju1, K.D. Sagili2, L.J. Ambaru2, R.V. Gutlapalli2, A. Sykam2, P.P. Reddy3, S. Suneetha2, L.M. Suneetha2. 1Infectious Disease Research Laboratory, Nireekshana-ACET; Institute of Genetics, Hyderabad, India, 2Infectious Disease Research Laboratory, Nireekshana-ACET, Hyderabad, India, 3Institute of Genetics, Hyderabad, India Objective: To compare the ratio of Tumor Necrosis Factor-alpha (TNF) and Interferon - gamma (IFN- ) levels in HIV infected and uninfected healthy individuals and to evaluate the role of TNF- and IFN- in the development of immune response in HIV infected and uninfected individuals. Methods: Blood was collected from healthy blood donors (n=114) & HIV infected patients [n=112; which includes HIV infected individuals (n=7); HIV infected with clinical neuropathy (n=39); HIV infected with pulmonary tuberculosis (n= 37) and HIV infected with extrapulmonary tuberculosis (n= 29)] after informed consent. Plasma was separated and stored at -700C till TNF- and IFN- levels were measured. The TNF- and IFN- levels were estimated by sandwich ELISA using Duo Set ELISA Development kit from R&D systems. Results: There was a wide variation in TNF- and IFN- levels in HIV infected and healthy blood donors. When the proportion of TNF-: IFN levels were compared in healthy and HIV infected individuals the ratio was 1: 0.67 respectively. Conclusion: Changes in the proportion of TNF- and IFN- levels could be important in the HIV to AIDS progression and also in the onset of secondary complications like tuberculosis and neuropathy in HIV infected individuals. ISE.086 Emerging Drug Resistant Nosocomial Acinetobacter Infection H. Zi, M. sein, T. Mar. University of Medicine (2), Yangon, Myanmar Genus Acinetobacter had confused taxonomic status and was named in 1970. Based on DNA homology, it comprises 23 species in 2006. In Myanmar it was noticed as nosocomial pathogen in 1999 from Yangon General Hospital. A cross-sectional descriptive study was determined among 100 patients (January to October 2006) with aims to study the occurrence and antibiotic susceptibility pattern of Acinetobacter in patients with nosocomial infections at North Okkalapa General Hospital, Yangon, Myanmar. A total of 112 different types of specimens from both sexes over 12 years were collected and cultured aerobically. Among them, 33 positive cultures from urine, 31 from wound, 19 from sputum and 3 from blood were obtained. Acinetobacter species was identified by API 20 NE (Biomerieux, France) test kit in addition to routine procedure. No report of species identification by API 20 NE was recorded before. 15 out of 100 isolates were detected as Acinetobacter species. Among them, 5 isolates of Acinetobacter baumannii and 1 isolate of Acinetobacter lwoffii from urine, 6 isolates of Acinetobacter baumannii from sputum, one isolate each ofAcinetobacter baumannii and Acinetobacter lwoffii from wound and one isolate of Acinetobacter bau-

mannii from blood were identified. Based on disk diffusion test, all Acinetobacter isolates were totally sensitive to Imipenem, totally resistant to Piperacillin, Co-amoxiclav, Cefuroxime, high susceptibility to Amikacin (80%), moderate susceptibility to Tobramycin (60%), Gentamycin and Doxycycline (53.3% each), Kanamycin (46.7%), Ciprofloxacin and Co-trimoxazole (40%each), and low susceptibility to Ceftazidime (20%) and Norfloxacin (13.3%) but highly resistant to Clindamycin (93.3%). The resistance rates of Ceftazidime, Ciprofloxacin, Amikacin, Kanamycin and Co-trimoxazole were more increasing than previous studies. Acinetobacter baumannii was more resistant than Acinetobacter lwoffii. This study will be useful to health care professionals regarding antibiotic cycling polices, analyzing the emergence of antimicrobial resistant strains of hospital pathogens and the effect of various control strategies.

ISE.087 Parenteral Antibiotics Usage at A. Wahab Sjahranie General Hospital Samarinda, Indonesia C. Gunawan1, E. Utami2, I. Fikriah3. 1Department of Internal Medicine, Mulawarman University School of Medicine/ A. Wahab Sjahranie General Hospital, Samarinda, Indonesia, 2Mulawarman University School of Medicine, Samarinda, Indonesia, 3Department of Pharmacotherapy, Mulawarman University School of Medicine, Samarinda, Indonesia Background: There are not many published studies about the use of parenteral antibiotics in Indonesia, although most hospitalized patients get parenteral antibiotics and sometimes antibiotics are used without any strong indication that causes high hospitalization cost and problems of antibiotic resistance. Objectives: to know the usage of parenteral antibiotics at A. Wahab Sjahranie General Hospital in Samarinda, Indonesia. Methods: A retrospective study was performed by collecting data from medical records of patients treated at the Department of Internal Medicine, Department of Pediatric, Department of Surgery, Department of Obstetric­Gynecology wards. Inclusion criteria were patients treated at one of these departments who got parenteral antibiotics during a period of 3 months (October­December 2006). Data analyzed included final diagnosis, use of parenteral antibiotics, culture and sensitivity test results. Results: There were 1.283 of 2.357 patients treated at these four departments got parenteral antibiotics (54.4 %). In the Department of Internal Medicine wards 263 of 468 (56.2 %) patients got parenteral antibiotics and use of antibiotics without proper indication 58 %, only 5 % based on culture results, 37 % of patients treated empirically. In the Department of Pediatric wards 202 of 573 patients (35.3 %) got parenteral antibiotics, use of antibiotics without proper indication 59 %, culture-based treatment 2%, empirical treatment 39 %. In the Department of Surgery wards 356 of 484 (73.6 %) patients got parenteral antibiotics, without proper indication 14 %, culture-based treatment 2 %, empirical treatment 84 %. In the Department of Obstetric - Gynecology wards 462 of 832 (55.5 %) patients got parenteral antibiotics, without proper indication 16 %, culture-based treatment 1 %, empirical treatment 83 %. Conclusions: The use of parenteral antibiotics at Internal Medicine, Pediatric, Surgery, and Obstetric - Gynecology wards is 54.4 %. Use of parenteral antibiotics in Surgery wards reaches above 75 % and in Pediatric wards 35.3 %. Use of parenteral antibiotics without proper indication is as high as 36 %, in the Internal Medicine wards and Pediatric wards above 50 %, while in Surgery and Obstetric-Gynecology wards below 20 %. Only 3 % of cases get antibiotics based on culture and sensitivity test results, while 61 % get empirical treatment. ISE.088 Serotype-Specific Invasiveness and Carriage Prevalence in Pneumococci in Relation to Growth Pattern in vitro M.N. Desa1, J. Vadivelu1, S.D. Sekaran1, N. Parasakthi2. 1University of Malaya, Kuala Lumpur, Malaysia, 2Monash University Malaysia, Bandar Sunway, Malaysia Background: Pneumococcal survivability at an infection site could be linked to growth capability of the individual strain, which may vary particularly among different serotypes. We took a preliminary study to investigate whether serotype-specific invasiveness and carriage prevalence in pneumococci could potentially correlate with the bacterial growth characteristics in vitro. Methods: Four non-clonal clinical isolates of pneumococci (as determined by PFGE) of vaccine-serotypes 1, 7F, 19F and 23F were studied. Serotypes 1 and 7F were categorized as 'invasive' whereas the later as

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'carriage' due to their high prevalence in the respective case as shown by epidemiological data. Bacterial suspensions were prepared and regrown in standard media - Todd Hewitt Broth (THB) with 0.5% yeast extract, as well as in the same media with 2% Fetal Bovine Serum (FBS) in CO2; growths were monitored by OD at 600nm for 10h period. Experiments were done in triplicate and averaged. Growth curves were plotted for comparison purposes using the Mann-Whitney and KruskalWallis tests for statistical analysis. Results: Growth pattern for each isolate showed a typical bacterial growth curve in both medium conditions. In standard media, lag-phase extended for 3h with some fluctuations whereby carriage isolates significantly grew faster than the invasive ones (P = 0.029); growth of all isolates steadily increased afterwards to reach a comparable stationary level at 7h post incubation. In presence of serum, differences in growth pattern for the carriage isolates were negligible but duration of the lag phase was reduced by 2h and 1h for the invasive isolates serotype 1 and 7F respectively. Conclusion: In view of the different growth response by the two groups of serotype-specific variations, it was possible for the invasive and carriage isolates, at certain extend, to differentially adapt and thrive during an infection. More studies are warranted to further address these matters. ISE.089 The Relationship Between Severity of the Systemic Inflammatory Response Syndrome (SIRS) and Its Etiology and Outcome A.A. Heydari, M.R. Sarvghad. Mashad University of Medical Sciences, Mashhad, Iran (Islamic Republic of) Introduction: SIRS is known as a disorder with presence of two conditions of these four parameters: 1- fever or hypothermia. 2- tachypnea. 3-tachycardia. 4- leukocytosis or leukopenia or bandemia. Sepsis is defined as the SIRS with an infectious etiology. Incidence rate is increasing during recent 15 years. The key point in treatment of sepsis is early diagnosis and beginning of treatment according to the signs before occurrence of complications like hypotension. Method: During 11 months we studied prospectively, with descriptive study 306 cases of SIRS referring to Infectious ward of Imam Reza hospital-Mashhad-Iran. The study was done through completing questionnaires and statistical data analysis by SPSS. The Results were arranged as charts and graphs. Results: Diagnosis according to the number of patients were pneumonia (n=56), meningitis (n=35), unknown origin infections (n=34), urosepsis (n=25) and miscellaneous etiologies as brucellosis, hepatitis, etc. We had 23 non-infectious patients and 17 mortal cases. The highest mortality rate in pneumonia (n=7) that often had severe leukocytosis. Severe SIRS has 20.1 % sensitivity and 95 % positive predictive value for diagnosis of infection. ISE.090 Rapid Diagnosis of Urosepsis by Molecular Biological Methods I. Barcs1, A. Horvath1, G. Kerecsen2, K. Nagy1. 1Inst. Medical Microbiology,Semmelweis University, Budapest, Hungary, 2National Med. Center, Budapest, Hungary Background: Efficacy of clinical microbiology laboratory should be increased by the use of molecular methods. These could be used for analysis of nosocomial infections and, also to determine clinical relevance of isolates obtained from different clinical sites or to identfy foci of infections. Methods: A 64-year-old male patient with previously diagnosed hypertonia, diabetes mellitus and a rectum neoplasia was admitted to Cardiology unit for percutan coronaria intervention. On the 3rd day after operation, the patient developed fever and three pairs of blood cultures and also urine sample for microbiological analysis were taken. Blood cultures were incubated and evaluated by Bact/Alert system. Positive samples were examined microscopically and by fluorescent in situ hybridization (BACTfishTM/BACTwaveTM) system using specific probes chosen according to Gram stain. FISH method utilizes fluorescent (FITC or Cy3) labelled oligonucleotides probes, targeting ribosomal RNA. The large number of ribosomes makes amplification step unnecessary. Isolates were compared by pulsed field gel electrophoresis (PFGE). Results: Abdominal ultrasound showed pyelectasia and nephrolithiasis. Microscopically, Gram negative rods and Gram positive diplococci were observed from flagged positive blood cultures, latex agglutination performed with streptococcus B reagent was positive. BACTfish identification revealed the presence of Eschericia coliand Enterococcus faecalis. Next day, E. coliand E. faecalis were isolated from both blood and urine

cultures. Typing of isolates of same species but with different sources by pulsed field gel electrophoresis documented their identity. Conlusions: Thus, use of molecular biology methods in clinical microbiology resulted in starting of adequate antimicrobial treatment two days earlier than final report was received, and helped to clear that origin of the septical situation which was an acute pyelonephritis. ISE.091 The Study of the Effect of the Treatment of Bacterial Meningitis with Ceftriaxion+Ampicilin Combination as An Empiric Therapy in Albanian Children H. Hoxha, E. Kallfa, G.J. Lito, R. Petrela, A. Kallfa, E. Hoxholli. University Hospital Center 'Mother Theresa', Department of Pediatric, Clinic of Infectious Diseases, Tirana, Albania Background: Since quick bacteriological test have a sensitivity very low in our country, the physician are forced to use an empirical therapy for treatment of bacterial meningitis. For that reason we undertake this study to show the effect of ceftriaxon + ampicilin regim on the treatment of bacterial meningitis (BM). Methods: We studied 28 cases of BM admitted in our ward from January 2006 to December 2007. Three cases (10,7%) were under one years old, 16 cases or (57,1%) were one to seven years old and 9 cases or 32,2% were 7 years old The diagnosis of BM were based on the clinical signs, blood parameters (CRP, WBS), cerebrospinal fluid parameters(proteine, glucose, WBC, neutrophiles). In all the cases we use as treatment a combination of ceftriaxon 100mg/kg/p with ampicilin 300mg/kg/p. A statistical correlation was performed between treatment and age, outcome, underlying conditions. Results: From 28 cases in only 4 (14.2%) cases the culture of CSF was positive, 6 cases (21.4%) were with meningocoxemia and in 6 cases (21.4%) bacterial meningitis was accompanied with abces cerebral (3 cases) and in 3 cases with septicemia (urosepsis, angiocolitis, gastroenteritis). This regim of treatment was very effective in 22 cases (78.5%) and in 4 cases (14.2%) that have underlying condition this treatment was not effective. In these cases we use another combination ceftazidin+vancomicin and in 1 case cefotaxim+ampicilin. The mortality was seen in only 2 cases or 7,2% (1 case with meningocoxemia and the other with septicemia) Conclusion: The treatment of bacterial meningitis with the combination of ceftriaxon+ampicilin as empirical treatment was very effective in our country. This protocol was also useful in all ages. In the cases where BM was accompanied with underlying condition another treatment regim will be taken in consideration. ISE.092 Usefulness of Inflamatory Markers in Patients with Severe Pneumonia P.S. Kalamaras, Z. Milenkovic, K. Grozdanovski, V. Kirova, M. Cvetanovska, D. Naunova, S. Mihova, K. Spasovska, J. Angelova. Clinic for Infectious Diseases, Skopje, Former Yugoslav Republic of Macedonia Aim: The usefulness of detecting CRP as a prognostic value in patients with severe pneumonia treated at the ICU department at the Clinic for infectiuos diseases Skopje Macedonia. Material and Methods: There have been studied 73 adult patients treated at ICU department of the Clinic for infectiouse diseases. The patients were divided in two groups: patients with survielence and non survialence outcome. Blood test for detecting the concentrations of CRP and neopterin was done in the both groups of patients within the first 24 hours of admission. The values of analysed markers where compared with T-test and ROC was done for evaluating the optimal cut- off for CRP and neopterin in prognosing the lethal outcome in patients with severe pneumonia. Results: From 73 analysed patients24(32,9%) were with lethal outcome and 49 (67,1%) survived. CRP in patients with lethal outcome was 288,7 ± 207,6 mg/L and 144,8 ± 171,7 in the patient with survive outcome. (p= 0,08) Area under the ROC was 0,73 with optimal cut- off for CRP from 224 mg/L. The mean concentration for neopterin was 141,6 ± 104,4 nmol in the patients with lethal outcome and 60,3 ± 57,5 nmol/L in the survival patients. ( p = 0,012 ) Area under the curve for neopterin was 0,73 with optimal cut-off of 87,5 nmol/L. Conclusion: Determination of the concentration of CRP and neopterin in the first 24 hours of admission is usefull in outcome prediction in patients with severe pneumonia. The value of CRP from 224 mg/L and neopterin from 87,5 nmol/L and upper are indicative for possibility of lethal outcome.

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ISE.093 Isolation and Insertional Inactivation of apy Gene of Shigella flexneri 2a: Towards the Development of Live Attenuated Vaccine M. Nisha1, B.S. Kirnpal-Kaur1, M.Z. Salleh2, C.A. Seah1, H.Y. Lau3, M. Ravichandran1. 1Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia, 2Faculty of Pharmacy, Universiti Teknologi Mara (UiTM), Shah Alam, Selangor,, Malaysia, 3 Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia The World Health Organization are emphasizing that the development of vaccines for Shigella is a priority. It is estimated that approximately 1.1 million global populations dies every year due to shigellosis. Despite many studies have been carried out on this pathogenic bacterium, but to date no vaccines are available for the public health purposes. Apyrase is a 27 kDa protein, encoded by apy gene in Shigella flexneri, has been associated as a pathogenesis-associated enzyme, possibly in mitochondrial damage and host cell death. In order to construct a live attenuated vaccine, the virulence plasmid-carried apy (phoN2) gene of Shigella flexneri 2a was cloned and mutated in this study. Apy gene (738 bp) was PCR amplified from the wild type Shigella flexneri 2a using ApyF1 and ApyR1 primers. The amplified gene was cloned into pTZ57R PCR cloning vector. A unique Hpa1 was identified in apy gene and a kanamycin resistant gene cassette (aphA) was inserted at the Hpa1 site of apy gene. This cassette contained a promoter, ribosomal binding site and kanamycin resistance gene flanked by Fse1 restriction enzyme site. The mutated gene (apy::aph)A was then subcloned into pWM91 conjugative suicidal vector at the Sma1 and Sac 1site. In this study, the apy gene has been successfully mutated using a kanamycin gene cassette and has been subcloned into a conjugative suicide vector. The construct of apy::aphA is an important approach towards the development of a vaccine strain of Shigella; as apy gene is a potential virulence gene candidate. Development of Shigella flexneri 2a apy mutant strain may form the basis of safe and effective live Shigella vaccine. ISE.094 Reproductive Tract Infections (RTIs) and Stillbirth in Vietnam H. Vu Thu. Institute for Reproductive and Family Health, Hanoi, Vietnam Introduction: RTIs cause amniotic membrane, placenta, foetus infection results in abortion, stillbirth, premature delivery, mother and newborn postnatal infection. RTIs of Vietnamese women account for more over 69%. Health workers, midwives even obstetricians do not have enough understand about the linkage between RTIs and stillbirth, perinatal loss and premature delivery. The treatment of RTIs during pregnancy not only at communal level but also in Obs/Gyn at district and central levels do not paid much attention. Methods: Observation pregnancy women from 2005- six month of 2007. Clinical examination including: Symptoms: discharge, pain, bleeding (dark); Vaginal speculum examination; Wet-mount, test sniff, lab analysis, clue cells, gram stain; Bacterial culture; Ultra-Sound diagnosis. Results: RTIs in pregnant women accounts for 80% and RTIs in 3rd trimester of pregnant women is 70,9 %; bacterial vaginosis: 44%; candida albicans: 43.4%; Chlamydia: 8.7%; gardnerella vaginalis: 3.6 % and others. There is a high incidence of stillbirth, in 2005, there were 994 stillbirth of 15553 delivery cases; in 2006, there were 921 stillbirth of 17443 delivery cases; in the first six month of 2007, alone, there were 583 stillbirth of 8424 delivery cases (National Obs/Gyn Hospital). Conclusions: Stillbirth is the main complication of untreated of RTIs before and during pregnant period. RTIs diagnosis and treatment during prenatal care services were neglected at all level of Obs/Gyn systems. In order to reduce stillbirth, all pregnant women should be evaluated RTIs, STIs and HIV screening test and treatment at initial pregnant visit. Promotion sexual health and safe motherhood, RTIs, STDs and HIV prevention awareness for communities and health workers. (Source: National Obs/Gyn Hospital) ISE.095 Comparative Analysis of Leptospiral Coding and Complete Sequence of (LipL32) Gene Encoding Lipoprotein - Novel Approach for Antigenic Determinant K. Vedhagiri1, K. Natarajaseenivasan1, J. Selvin1, P. Chellapandi1, T. Shenbagavalli2. 1Department of Microbiology, Bharathidasan University, Tiruchirappalli, India, 2Department of Microbiology, N G M College, Pollachi, Coimbatore, India

Background: Lepospirosis is a widespread zoonosis caused by members of the genus Leptospira. These highly invasive Spirochete pathogens are capable of infecting a broad range of mammalian hosts through either direct contact with an infected animal or indirect contact with soil or water contaminated with urine from a chronically infected animal. Tubulointerstitial nephritis is the main manifestation of acute renal damage in leptospirosis. Though 258 serovars in the genus Leptospira have been identified yet, they are antigenically very distinct due to the spatial arrangement of outer membrane lipoproteins, particularly viz OmpL1, LipL22, LipL32, LipL36, LipL41 and LipL45. Among these 32 kDa lipoprotein (LipL32) is highly conserved among the pathogenic leptospires. Methods: The coding and complete sequences of lipL32 are an evidence for antigenic determinant, important approach for development of immuno protection strategies and early detection of leptospirosis. The sequence specific amplification for this coding region (Forward primer 5'- TTACCGCTCGAGGTGCTTTCGGTGGTCTGC-3' & Reverse primer 5'-TGTTAACCCGGGTTACTTAGTCGCGTCAGA-3') and complete sequences amplification (Forward primer 5'-CTAAGTTCATACCGTGATTT-3' & Reverse primer 5'-ATTACT TAGTCGCGTCAGAA 3') were done and the comparative analysis was performed. The sequence similarity by BLAST analysis reveals that 99.9% homology between all leptospiral species especially L. interrogans serovar Autumnalis and L. borgpetersenii serovar Javanica. Results: The coding and complete sequence of lipL32 from genomo species viz L. interrogans, L. borgpetersenii, L. noguchii and L. weilliwere used to execute phylogenetic analysis and the segregation pattern is remarkably similar for both coding and complete sequence. The deduced amino acid sequence of lipL32 would encode a 272 amino acids out of the total polypeptide 19 aminoacids are highly conservative and it may be signal peptides for coding of the analogous lipoprotein. Conclusion: In further identification of 19 amino acid of coding sequence will be used to develop recombinant lipoprotein L32 and it can be adding an advantage to discover indigenous diagnostic formats, expand the vaccine production for leptospirosis. ISE.096 Sera from Patients Infected with Streptococcus pneumoniae Recognize a Unique 74 Kilo-Dalton Surface Antigen of the Bacterium C. Ahsan1, R. Khan2. 1University of Dhaka, Department of Microbiology, Dhaka, Bangladesh, 2Department of Microbiology, University of Dhaka, Dhaka, Bangladesh The Streptococcus pneumoniae is a common cause of pneumonia and is the second leading cause of meningitis in Bangladesh. Isolation of the pneumococci from blood or bronchial secretions obtained by trans-tracheal aspiration or broncho-alveolar lavage is proof of pneumococcal origin. However, most cases of pneumococcal pneumonia are not bacteremic. Pneumococci in sputum or the nasopharynx should not be considered proof of pneumococcal origin since the organism is found in the upper respiratory tract of healthy individuals. These difficulties in diagnosis pneumococcal pneumonia by culture have let to development of methods for detection of antibodies against surface proteins. Surface proteins from S. pneumoniae were isolated by the simple water extraction method. Sera from 36 pneumonia and meningitis patients infected with S. pneumoniae were reacted with surface proteins of the bacterium by the immunoblot technique, where sera from 12 normal healthy persons were used as control. All the 36 patient's sera recognized a 74 kilo-dalton (kDa) surface protein antigen of the S. pneumoniae in the immunoblot technique. However, no such antigenic bands were obtained from the control sera. Antibody against a unique 74 kDa surface protein antigen of S. pneumoniae is present in patients infected with the bacterium. Presence of this specific antibody could be used as a potential diagnostic marker for pneumonia and meningitis patients in Bangladesh. ISE.097 Effect of Plant Essential Oils on Growth, Cell Surface Hydrophobicity and Production of Virulence Factors in Drug Resistant Staphylococcus aureus I. Ahmad, M. Zahin, S. Ahmad, M.S.A. Khan. Department of Agricultural Microbiology, Aligarh Muslim University, Aligarh, India Development of multiple drug resistance in pathogenic bacteria has triggered immense interest in developing novel strategies to combat drug resistant pathogens. One possible strategy is to prevent the pathogen

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by blocking or inhibiting the virulence and pathogenicity of the bacterium i.e. use of antipathogenic drug without killing of bacterium. Plants have evolved numerous chemical strategies for deterring pathogen attack including production of bactericidal, bacteriostatic and antipathogenic compounds. We have tested plant essential oils for their anti staphylocoocal activity, cell surface hydrophobicity and production of virulence factors (haemolysin and coagulase) in S. aureus isolates of ocular origin. Broad spectrum anti staphylococcal efficacy of the tested essential oils observed maximum in eucalyptus oil, followed by Syzygium aromaticum, Elletaria cardamomum, Mentha arvensis, Foeniculum vulgare and Melaleuca alternifolia. At the sub MIC concentrations of the essential oils from S. aromaticum, E. globulus, M. arvensis, E. cardamomum and F. vulgare could inhibit production of haemolysin in 76.92%, 69.23%, 53.84%, 33.46%, and 30.76% of the test isolates respectively. Similarly, inhibition of coagulase production in one or more strains of S. aureus was recorded by the oils of S. aromaticum, E. globulus, E. cardamomum, F. vulgare and M. alternifolia in decreasing order. On the other hand hydrophobicity of the S. aureus cultures could be affected maximum by E. cardamomum oil, followed by oils of S. aromaticum, E. globulus, and F. vulgare detected by Salt Aggregation Test (SAT assay). Production of virulence factors by S. aureus strains could be inhibited to different extent by different essential oils. Further work on characterization of active constituents is needed to exploit in the management of bacterial infections. ISE.098 Detection of Pathogens Causing Community Acquired Pneumonia (CAP) Using with DNA-Reverse Hybridisation Method R. Kesli1, E. Kurtipek2, T.T. Bekci2. 1Konya Educational and Research Hospital, Microbiology Laboratory, Konya, Turkey, 2Konya Educational and Research Hospital, Pulmonology Department, Konya, Turkey Introduction: The objective of this study was to detect the most frequent pathogens causing Community Acquired Pneumonia (CAP) using with DNA-Reverse Hybridisation method. Materials and Methods: Selected sputum and pleural liquid samples obtained from the patients with the complaints of pneumonia (coughing, expectorating sputum, fever, etc) applied to our hospital's pulmonary disease outpatient during January 2007- January 2008. In order to maintain meaningful specimens sputum samples evaluated with the quantitative selection criteria before acceptance. Existence of the DNA belongs to the six different CAP-related pathogens (Streptococcus pneumoniae, Haemophilus influenzae, Moroxella catarrhalis, Chlamydia pneumoniae, Mycoplasma pneumoniae and Legionella pneumophila) investigated with reverse-hybridisation method with three steps. DNA isolation from sputum and pleural liquid specimens (RTP Bacteria DNA Mini Kit InvitekGermany), multiplex PCR with thermal cycler (Bioer XP Cycler, Japan) and finally the amplification products are selectively hybridized to the test stribs (GenID GmbH,Germany) contains sequence-spesific oligonucleotide probes with Auto-LiPA enstrument (Tecan ProfiBlot T48, Austria). Six different CAP pathogens identified with only one detection strib. Accepted sputum samples were also examined with Gram stain under light microscope. All the patients also evaluated with symptoms, physical examination, oscultation of the chest, chest X-ray screening and other laboratory findings(CBC, ESR, CRP). Results: Of 234 samples which 184 were sputum (79 %) and 50 were pleural liquid (21 %) 76 were positive for one or more than one pathogen DNA. Of 76 DNA positivity identified as fallows 62 were Streptococcus pneumoniae-DNA (82 %), 6 were Haemophilus influenzae-DNA (8 %), 16 were Moroxella catarrhalis-DNA (21 %), 4 were Chlamydia pneomoniae-DNA,(5 %) and 4 were Mycoplasma pneoumoniae-DNA (5 %). Legionella pneumophila-DNA was not detected.14 of 76 samples were found to be positive more than one pathogens together (18 %) 12 were two pathogen and 2 were three pathogen together. Conclusion: Streptococcus pneumoniae was detected and identified as the most frequent agent of CAP in our hospital. Moleculer diagnostic techniques should be used in the diagnosis of CAP agents especially for atypical and difficult to cultivate pathogens. ISE.099 Long Term Stability of Polysaccharide Conjugate Vaccine Candidate for Neisseria Meningitidis Serogroup C Using P64k as Protein Carrier (MenC/P64k) D. Quintana-Vazquez, A. Alvarez, L. Canaan-Haden, E. Coizeau, M. Guirola, T. Carmenate, L. Costa, M. Vega, M.A. Denis, J. Sotolongo, A. Rodriguez, J. Cremata, R. Silva, G. Guillen. Center for Genetic Engineering and Biotechnology, Havana, Cuba

Background: Polysaccharide-based conjugate vaccines commonly employ tetanus toxoide or a non-toxic mutant of the diphteria toxin as carrier. These vaccines are safe, immunogenic in infants and induce immune memory in a T-cell dependent fashion. The continued use of these carriers in humans has raised concerns regarding epitope overload and suppression. Also, natural infection might not effectively boost the generated T-cell memory. These aspects have prompted our group to search for new (homologue) carriers. The P64k of Neisseria meningitidis is a recombinant membrane-associated protein, produced by the Center for Biotechnology and Genetic Engineer, Havana, Cuba. It has been extensively characterized by physical-chemical and immunological techniques. The MenC/P64k vaccine was found to have a good safety profile, to be well tolerated and highly immunogenic towards the polysaccharidic component in a Phase I clinical trial. However, no data are currently available about the long term stability of this conjugate, a key concern with this kind of vaccines. Objective: Evaluation of long term stability. Methods: Three batches were analyzed for long-term stability. Vials were stored at 4°C and samples were taken at 3, 6, 12, 18 and 24 months of storage. The sialic acid polysaccharide and protein content were measured by Resorcinol and bicinconic acid-based colorimetric methods, respectively. Purity and retention time were performed by HPLC Gel Filtration chromatography. Other important parameters such as identity, pirogenicity, safety, humidity, and sterility were also monitored. Results: The study confirmed that MenC/P64k does not change its physical and chemical properties upon 24 months after manufacture. The product was highly immunogenic throughout this period as evidenced by 100% of seroconvertion in Balb/c mice. Conclusion: Results show that P64k meningococcal protein could be used as a homologue carrier in future conjugate vaccines without stability drawbacks in the first 24 months. ISE.100 Case Report of Bacteriaemia Caused by Pediococcus pedosaceus G.C. Michalopoulos, F. Rozi, I. Tzinieris, M. Vossou, D. Mavropoulos, G. Andrianopoulos. General Hospital of Argos, Argos, Greece Background: Presentation of a case of bacteriaemia by Pediococcus pedosaceus in young male patient. Methods: A 17-year-old male patient came to the emergency department with high fever 40 0C and shiver for about 8 hours. Lung auscultation revealed mild dry rales bilateral and chest X-ray was normal. Heart auscultation was normal, his abdomen was clear of pathology and his throat was also normal in examination. The patient had no neurological signs. The patient had BMI: 18. Ultrasound of liver, spleen, pancreas and kidneys was also with no findings. Laboratory investigation revealed WBC: 14,190 K/uL, with 90% neutrophils, CPK: 1138 IU/L, CRP: 11,2 mg/dl and urine analysis without pathological findings. Blood cultures were sent and antibiotic treatment with levofloxacin was started because of reported allergy to penicillins and cephalosporins. Result: The patient showed clinical and laboratory improvement within two days of hospitalization. ASTO, Vidal, Wright, antibody control for CMV, Epstein-Barr, Hep.B, Hep.C, Hep.A, HIV, rubella and toxoplasm were all negative. Blood cultures revealed Pediococcus pedosaceus and further tests were undertaken to exclude immunosupression ( globulin control and screening for neoplasia) which were all negatives. The patient left the hospital 5 days after in good clinical condition, without fever and continued the treatment with levofloxacin for 5 days. Blood cultures were sent again 20 days after and were negative. Conclusion: Pediococcus pedosaceus is a bacterium used in genetic engineering especially in food industry and is also found in some plants but is not believed to be a pathogen for humans. In bibliography was found only one report of bacteriaemia by Pediococcus pentosaceus in an immunocompromised patient. In our case no immunosupression factor was established except the fact that the patient had a very low BMI (18). ISE.101 Selecting Appropriate Methodology for Isolation of B. mallei Strain from Nasal Swab of Local Mongolian Horse O. Namkhaidorj. Central Veterinary Laboratory, Ulaanbaatar, Mongolia Introduction: The glanders are less studied in Mongolia. In the sixties and seventies of past century, a scientist Tsevegmid, having applied Russian research method of that time, had isolated strains of glanders from local horse and conducted a cultural, biochemical and morphology tests comparing with the strains of glanders used by Russians. In that

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period, the horse flesh was widely consumed in Russian army being supplied from Mongolia so that horses were tested for existence of glanders and healthy horses were shipped for meat. Since then or for over 30 years no studies on glanders have ever been made. The horse glanders are diagnosed in Mongolia by skin allergy test and Complement Fixation Test. Present research was made in Wellcome Trust laboratory which has been conducting B. Pseudomallei research for nearly 30 years and aimed at cultivation of production strain used for Glanders diagnostic kit, making a comparison with other glanders strains, and developing a Standard Operating procedures to be followed for isolating cultures of glanders from local horse. Materials and Methods: Applied B. Mallei cultural and differential methods comparing with cultural and biochemical methods used for isolation B. Pseudomallei and B. Mallei strains. Specific cultural and colony characteristics of B. Mallei shown following broth, semi solid and solid agar for B. Mallei /M1, M2/ local strains growth. 1) For the growth of B. Mallei in broth, 4% glycerol is recommendable for the enrichment of media (Wellcome unit). 2) TSB with 4% glycerol is recommendable for the growth of pure culture and strains of B. Mallei (Wellcome unit). 3) For the growing of pure culture and strains of B. Mallei onto Columbia with 4% glycerol agar is recommendable (Wellcome unit). Biochemical characteristics of M1, M2 is determined by biochemical test of API 20 NE (Wellcome unit). 1) M1 1042520 standard profile is 1042524. 2) M2 1042521 at 30°C. 3) M2 1142525 at 37°C. Standard profile is 1142524. Susceptibility test for B. Mallei - 14 antibiotics - CT (Colistin) M1 18mm, M2 16mm (growth inhibition zone) - KZ (Cephazolin) M1 13mm, M2 no zone - to others more than 30 mm Results: Developed a Standard Operating Procedures to be followed for isolation of B. Mallei from local Mongolian horse. ISE.102 Study of Coagulase-Negative Staphylococci Isolated from Clinical Specimens R. Adhikary1, N.K. Hazarika2. 1Wockhardt Hospital, Bangalore, India, 2 Gauhati Medical College, Guwahati, India Background: Coagulase-negative staphylococcus (CoNS) species although considered earlier as a normal flora of human skin and mucous membrane or culture contaminants, have now gained major importance in hospital set up as a pathogen even though they tend to be indolent. With the above aspect in view, a study of coagulase-negative staphylococci in clinical specimen was undertaken in the Department of Microbiology, Gauhati Medical College and Hospital, Guwahati, India over a period of one year from April 2005 to March 2006 with the following aims and objectives: to isolate and identify the species of coagulasenegative staphylococci in clinical specimens and to determine the antimicrobial susceptibility pattern of the various clinical isolates of coagulase-negative staphylococci. Methods: A total of 1035 samples were collected from a variety of clinical specimens. A battery of biochemical tests were carried out for species determination of CoNS such as alkaline phosphatase test, ornithine decarboxylase test, presence of urease, production of acetoin, novobiocin resistance and production of acid aerobically from D- trehalose, D- mannitol, D- mannose, maltose and sucrose. All the isolated CoNS strains were tested against 14 different antimicrobial agents by a modification of the Kirby-Bauer method. Results: A total of eighty (7.73%) yielded clinically significant coagulase-negative staphylococci. From the 80 isolates, 6 different species of CoNS were isolated. Most common isolated species was S. epidermidis (55.25%). In-vitro antimicrobial sensitivity tests showed that all of the 80 CoNS isolates were resistant to Penicillin G, while 78 (97.5%) isolates were sensitive to Vancomycin. Linezolid was sensitive in 76.25% isolates. Others showed variable sensitivity. Conclusion: The present study suggests that if the same species of coagulase-negative staphylococci with similar antibiogram are repeatedly isolated from clinical specimens of patients with infections, they should be taken seriously. ISE.103 Comparison of Exoenzymes Profile of Burkholderia pseudomallei Isolates from Different Origin A. Norzita, M.V. Kumutha, M. Vanitha, J. Vadivelu. Universiti Malaya, Kuala Lumpur, Malaysia

Burkholderia pseudomallei, the etiologic agent of melioidosis is a facultative aerobic, gram-negative motile bacillus that can infect both human and animals. This organism has been reported to produce several extracellular enzymes that may contribute to its virulence including lipase, lechitinase, peroxidase, protease, acid phosphatase and alkaline phosphatase. In this study, extracellular enzyme profiles of four animal isolates and four clinical isolates of B.pseudomallei were compared. All eight isolates were found to produce all these enzymes. One animal isolate OU 320/72 (orang utan) exhibited the highest alkaline phosphatase and acid phosphatase activities, while GT 4508/83 (goat) produced higher level of lechitinase and lipase in comparison to other isolates. In contrast, clinical isolate CHN produced the highest level of peroxidase. The role of these enzymes need to be further evaluated. Key Words: Burkholderia pseudomallei, extracellular enzymes, virulence

ISE.104 Preliminary Study of Bovine Brucellosis and Tuberculosis Prevalence in South Mozambique T. Mussa, J. Baptista, G. Mataveia, C. Tchamo, B. Moiane, M. Harun, A. Machado, C. Garrine. Veterinary Faculty, Maputo, Mozambique Background: Brucellosis and Tuberculosis are zoonoses of vital importance in Mozambique and elsewhere. Countries with high infection rate of those diseases experiment a decline of performance as a result of labor absence and low school productivity. At livestock level low feed conversion, meet condemnation, abortion, and etc, are the main consequences observed as result of those diseases. There also restriction of export livestock by products to free countries. Though the epidemic situation of these diseases in Mozambique still not well know, this fact become the major constrains to restocking programs. Considering the factors for the presence of brucellosis and tuberculosis in Mozambique, knowing the functional institutions difficult on control and eradication of diseases, only the stronger sanitation measures could allow the new or emergency creators to run business successfully. Therefore at the rural areas, great measures could be taken in order to protect not only ancient also juvenile population on risk of contracting these diseases. Methods: Each one of the involved provinces is defined as a conglomerate or independent agglomerate ("cluster"). Such 'cluster' takes common inclusion parameters that will be the same, where the predictive prevalence of brucellosis/tuberculosis was 12% with 5% of the precision degree and 95% of confidence level. The number of expected animals by herd is 10. In Maputo will be sampled 469 animals, 469 in Inhambane and 2158 animals in Gaza. For bias removal, the prevalence will be adjusted to the sex and stratified according to the size of the herd. The brucellosis test will be done using the agglutination plate test and tuberculosis will be done by one intradermal injection of 0,1ml Bovine Tuberculin PPD (5000 IU) in the tail flow and read in 48­72 hours later. The RBT positive samples will be submitted to Complement Fixation test. Results: Determine the prevalence of brucellosis and tuberculosis, identify free farms, aware farmers and healthy authorities about the importance those diseases, suggest Control and Eradication Strategies. ISE.105 Organisms Causing Septicaemia in Different Departments and Antibiotic Susceptibility at the Univesity Teaching Hospital, Lusaka, Zambia 1997 to 2003 C. Lukwesa, J.C.L. Mwansa. University Teaching Hospital, Lusaka, Zambia A retrospective descriptive study was carried out to determine the causative agents of septicaemia in different departments of the University Teaching Hospital (UTH)-Paediatrics, Neonatology, Medicine, Obstetrics and Gynaecology, and Surgery, and an overview of antibiotic susceptibility of the pathogens. The aim was to provide the clinician with infecting microorganisms and antibiotic susceptibility to help select appropriate antibiotics for empiric treatment of septicaemia. Blood culture results of patients were reviewed over a 7 year period (1997 to 2003). A total of 2,664 culture positive results from 1997 to July 2003 were analyzed, and the origin of the sample identified from the records. Over 14 different pathogens were isolated from the blood cultures, of these 60% were gram negative, 39% gram positive organisms and (1%) fungi. The most common isolates were Salmonella sp (26%), Staphylococcus aureus (23%), Klebsiella sp (14%), and coagulase negative staphylococci (13%). Most of these were from medicine department, whereas most Klebsiella sp (57%) were from the neonatology department. There was no significant difference of common organisms during the different periods.

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There was high resistance to readily available intravenous antibiotics penicillin (58%), and gentamicin (44%), (especially in gram-negative organisms) used in combination for empiric treatment of septicaemia at UTH as first line. Most of the organisms were multi-drug resistant. Some of these are suspected nosocomial infections-Staphylococci, Klebsiella sp, Pseudomonas sp and Acinetobacter sp. This poses a challenge in prevention and treatment, especially in immunocompromised patients and the neonates. There is need to change to second line cefotaxime which has low resistance (14%). Newer drugs e.g. carbepenems, imipenems, may need to be introduced in the Zambia formularly, to be used as second line. Measures are being put in place through Infection Prevention Committee to break chains of transmission of nosocomial infections and, appropriate use of antibiotics to prevent emergence of resistance. ISE.106 Issues in Measuring PPTCT Programme Effectiveness J. Lionel. Christian Medical College, Vellore, India Background: Vertical transmission of HIV is a concern that has been actively been addressed by healthcare community. In order to provide a continuum of care to the child, it is imperative that the family be followed up even after the perinatal period. We present our experience with a cohort of 356 HIV positive women who delivered at a tertiary care Hospital in Vellore in southern India between 1996 and 2005. Prospective followup of the children was undertaken to assess the effectiveness of the "Prevention of Parent To Child Transmission of HIV" program. Methods: Data was collected prospectively. The PPTCT programme provided social workers who made home visits to follow up patients and their children to provide continued testing and counselling. Social workers and field workers went to the addresses as provided by the patient on registration and attempted to contact the patient. If the patient was unavailable locally repeated attempts were made to contact them. Results: 356 HIV positive women delivered at Christian Medical College hospital between 1996 and 2005. 75% of them were registered for HIV specific antenatal care and received HIV specific interventions. We were able to follow-up 93 children (26%) to the age of 18 months when they received HIV testing. 88 (94.6%) of those tested were negative at 18 months.200 (56%) children could not be traced while 63(18%) children are yet to reach 18 months of age. Conclusions: HIV affected families tend to migrate for a variety of reasons. We find in this study that inability to follow up children to 18 months makes it difficult to assess true programme effectiveness. It also limits ability to provide adequate and appropriate care that would be associated with knowledge of HIV status in the child. Affordable tests that can be applied earlier in life to children would help improve the program.

15.2% of the total (51.7 DDD/103). Usage of carbapenems was >75th percentile when compared to medical-surgical ICUs in the NNIS 2004 report. Total fluoroquinolone and vancomycin use was quite low compared to NNIS figures making up 20% (67 DDD/103) and 4.7% (15.9 DDD/103) respectively. Newer agents for resistant gram positives including linezolid, tigecycline and daptomycin made up < 0.1% of the total. Conclusions: There is heavy use of 3rd generation cephalosporins and carbapenems at our hospital, which is likely representative of the pattern of use for the UAE in general. There is an urgent need to introduce the concept of antimicrobial stewardship in order to step the increasing antimicrobial resistance amongst gram negatives. On the other hand use of vancomycin and related agents remains low in keeping with the relatively low rates of MRSA in our facility. ISE.108 Rapid Identification of Tuberculosis Epididymo-Orchitis by QuantiFERON-TB and INNO-LiPA Rif TB Tests in Semen Samples M. Koziol-Montewka1, A. Magrys2, J. Paluch-oles2, E. Kot3. 1Medical University of Lublin, Department of Medical Microbiology, Lublin, Poland, 2Department of Medical Microbiology, Medical University, Lublin, Poland, 3District Hospital, Lublin, Poland Objective: Diagnosis of extra-pulmonary TB is often difficult, because of its non-specific clinical and laboratory findings. It can mimic numerous other disease entities. We report a patient with tuberculous epididymo-orchitis. Case Presentation: A 33-year-old male, HIV-negative, gave a history of left scrotal pain and progressively increasing swelling. There were no other systemic symptoms and no medical history of note. All laboratory tests were normal. Testicular tumor markers including--fetoprotein and--human chorionic gonadotropin were normal. At physical examination urologist found a tender mass within the left epididymis. Ultrasonography (US) of the scrotum was then performed showing focal lesion of the tail of epidydymis and calcifications. It was suggested to remove the epididymis and examine it histopatologically. The patient was treated with a course of broad-spectrum antibiotics with significant improvement. The patient returned approximately eight weeks later complaining of swelling and increased discomfort during ejaculation and blood in semen. A follow-up US examination was performed showing inflammatory process of the tail of epidydymis. It was decided to test the patient for tuberculosis. Tuberculin skin test revealed 15 mm induration. QuantFERON-Tb Gold, performed two times within a month, gave positive results (5,98 U/ml, 5,06 U/ml). Urinary acid fast bacilli smear test and the culture, repeated three times, were negative. Urine nested PCR (INNO-LiPA Rif Tb), repeated three times, was negative. PCR (INNO-LiPA Rif Tb - nested) examination of two semen samples gave positive results. The patient was diagnosed with tuberculosis and successfully treated with antitubercular drugs. Conclusion: In our case, tuberculosis was suggested because US showed progression of the disease despite antimicrobial therapy. Modern diagnostic methods of tuberculosis (Quanti FERON-TB and PCR) are useful tools for early prediction and identification of extrapulmonary tuberculosis. The methods are in accordance with WHO recommendations saying that TB diagnosis should be shorter then two days. ISE.109 Susceptibility of Escherichia coli Isolated from Children with Urinary Tract Infections A. Koteli, M. Andronoglou, S. Tsingene, A. Kakoulidou. 'G. Gennimatas' Thessaloniki General Hospital, Thessaloniki, Greece Introduction: UTIs are one of the most frequent bacterial infections in children. These infections are usually caused by Gram-negative bacteria and Escherichia coli is a major pathogen. More than 80% of human urinary tract infections (UTI) are due to the bacterium Escherichia coli. Aim: To record and study the antibiotic susceptibility of Escherichia coli which was isolated from urine cultures of minors treated in our hospital during 2004­2006. Materials and Methods: A total of 291 consecutive urine isolates from 307 children aged 1 month to 18 years with UTI were collected at our Hospital in 2004-2006. Identification and susceptibility tests were performed with both Vitek sytem (BioMerieux) and susceptibility disc diffusion method according to CLSI directions. Results: The most frequently isolated species from children with UTIs was Escherichia coli (n=169, 58% ), followed by Proteus mirabilis (n=44, 15.2%), Pseudomonas aeruginosa (n=16, 5.5%), Klebsiella pneumoniae (n=14, 4.8%), Enterococcus spp (n=13, 4.5%) and others (n=35,

ISE.106 Proportion of children born to HIV positive mothers available for followup. ISE.107 Surveillance of Antimicrobial Consumption in a Tertiary Care Hospital in the UAE 2005­2006 S. Salahuddin, K. Obeid, Y. Ibrahim, A. Khan, R. Hashmey. Tawam Hospital in Affiliation with Johns Hopkins Medicine, Al Ain, United Arab Emirates Purpose: As there are no available data on antimicrobial drug consumption in the United Arab Emirates (UAE). We calculated the inpatient antibiotic consumption at our 450 bedded tertiary care facility. Methods: Monthly total antibiotic use in grams was obtained for each antibiotic from the pharmacy at the end of each month from January 2005 through December 2006. Drug usage rates were calculated as Defined Daily Doses (DDD)/1000 inpatient days (DDD/103) according to guidelines from the WHO collaborating center for drug statistics methodology. Results: Total antimicrobial consumption was 341 DDD/103. Cephalosporins were the most heavily prescribed drugs making up 40% (126 DDD/103) of the total. Third and fourth generation cephalosporin's made up 21% (72 DDD/103). Antipseudomonal penicillin's comprised 11% (36.4 DDD/103). Carbapenems were heavily used making up

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12%). The susceptibility of Escherichia coli in 2004-2006 was to: ampicillin 50%, amoxicillin/clavulanic 83%, ampicillin/sulbactam 87%, cefaclor 68%, cefprozil 81%, cefuroxime 85%, trimethoprime/ sulfomethoxazole 78%, amikacin 100%, gentamicin 93%, netilmicin 100%, tobramicin 92%, ceftazidime 97%, ceftriaxone 95%. Conclusions: Escherichia coli is the primary bacterial pathogen causing UTIs in children. Amikacin was the most active aminoglycoside tested. No isolates resistant to amikacin and netilmicin were detected. Resistance rates to gentamicin and tobramicin were 7% and 8% respectively. Resistance rates to ampicillin was 50% and cefaclor 32%. ISE.110 Systematic Review of Hepatitis B Vaccination in HBsAg Negative Individuals: Evidence to Back Practice J.L. Mathew1, R. El Dib2, P.J. Mathew1. 1Postgraduate Institute of Medical Education and Research, Chandigarh, India, 2McMaster University, Hamilton, Canada Background: Despite widespread hepatitis B vaccination, there is no systematic review that provides robust evidence for its use among HBsAg negative people (general population. Objective: Systematic review to assess the efficacy of hepatitis B vaccination in HBsAg negative people. Methods: Randomised trials were identified from six databases through an exhaustive electronic search. Trials comparing hepatitis B vaccine versus placebo/another vaccine in HBsAg negative persons were included without restrictions on type, language, or date of publication. The primary outcome was hepatitis B infection (developing HBsAg or anti-HBc). Secondary outcomes were lack of sero-protection, antibody titre, clinical complications, adverse events, lack of compliance, and cost-effectiveness. Sensitivity analysis based on methodological quality of trials and intention-to-treat analysis using two different models were also applied. Results: Fourteen trials were included from 2964 citations. Hepatitis B vaccination markedly reduced the risk of developing HBsAg (RR 0.17, 95% CI 0.09-0.31, n=1341) and anti-HBc (RR 0.42, 95% CI 0.31-0.57, n=1235). Intention-to-treat analysis assuming favourable outcomes for missing data showed similar results; however analysis assuming unfavourable outcome for missing data showed significant but less dramatic effect (RR 0.87, 95% CI 0.80-0.94 for HBsAg and RR 0.69, 95% CI 0.57-0.82 for anti-HBc). There was reduced risk of lacking sero-protection following vaccination (RR 0.42, 95% CI 0.18-0.98) although ITT model assuming unfavourable outcome for missing data did not confirm this. Limited data showed that the risk of developing adverse events with hepatitis B vaccine was comparable to other vaccines used in routine immunization programmes. There was insufficient data to comment on compliance, clinical complications and cost-effectiveness. Conclusion: This systematic review suggests that Hepatitis B vaccination reduces the risk of developing hepatitis B infection in people who have not been previously exposed. This evidence can be used to initiate and/or continue vaccination programmes against hepatitis B.

ISE.111 Epidemiology Analysis of Norovirus Gastroenteritis Outbreak Between 2006 and 2007 in Guangdong Province R. Guo, H. Zheng, J. Li, L. Li, J. He. Institute of Epidemic Disease Prevention and Control, Center for Disease Control and Prevention of Guangdong Province, Guangzhou, China Objective: To understand the epidemiologic characteristic of norovirus gastroenteritis outbreaks occurred between 2006 and 2007 in Guangdong province of China, so as to improve the diagnosis and prevention and control capability in coping with non-bacterial gastroenteritis outbreaks. Methods: Using field epidemiology investigation method, combined with molecular microbiology technology, all norovirus gastroenteritis outbreaks reported between 2006 and 2007 from all over Guangdong province were investigated and analyzed. Results: 21 outbreaks of norovirus gastroenteritis from 9 of 21 prefectures in Guangdong were reported, with 1329 patients involved and total attack rate of 4.0%. Norovirus antigen/nucleic acid was detected in feces/crissum swab from part of patients in every outbreak. Norovirus gastroenteritis epidemic peak in Guangdong was from November to February of the next year; all age groups were the target population; there were a variety of outbreak settings, with the first 3 settings of high attack rate rest home, factory/corporation, primary school and kindergarten; person-to-person contact transmission and transmission via polluted drinking water/water supply system was the 2 major outbreak mode. Conclusions: Norovirus infection was prevalent in Guangdong province, with 3 types of outbreak mode co-existed as water-borne, person-to-person contact, and food-borne. Prevention and control in high risk setting such as rest home, kindergarten and primary school, factory/and corporation should be highly regarded and strengthened. Further study need to be done to explore the origin of norovirus infection in Guangdong. ISE.112 The Antibiotic Treatment for the Acute Sinusitis: The Comparison Between AMPC and LVFX H. Yoshinami1, Y. Kase1, M. Nakashima1, O. Shibasaki1, T. Takahashi1, M. Shinogami2. 1Saitama Medical University, Moroyama, Japan, 2Tokyo Metropolitan Police Hospital, Tokyo, Japan Background: In a respiratory infectious disease, the cases for that a quinolone becomes the first-line drug by the increase of drug resistant bacteria represented by PRSP. But, in the sinusitis, the evidence of the effectiveness is still insufficient. We examined the effectiveness of AMPC and LVFX for the acute sinusitis this time. Objects: The objects were 38 acute sinusitis cases from September 2006. to December 2007. They were 18 cases that used AMPC 750mg a day and 20 cases used LVFX 400mg a day, for 7 days. Method: 1) We detected the bacteria in the nasal cavity at first time of the inspection and the second one week later. 2) Evaluation of the severity of the sinusitis. Otolaryngology specialist estimated the severity by the clinical symptom and the nasal inspection with endonasalscope before and after taking the antibiotics by the sheet that made by ARhiS (Acute Rhinosinusitis group) in Japan. We confirmed the state of the patient, and score evaluated about each item. 3) We compared the curative effect between the AMPC group and the LVFX group. Result: The bacteria had been identified 35 cases of 38. Haemophilus influenzae was the most of them, 8 cases (22.9%). The drug resistant bacteria were 5 cases (62.5%). S. aureus and M. catarrhalis were each 7 cases (20%). S. pneumoniae were 6 cases (17.1%). LVFX group exceeded AMPC 750mg group at the clinical symptom score and the nasal inspection score although there was not significant difference between them. Conclusion: In acute sinusitis, it seemed that LVFX can be expected the utility as the first selective antibiotics. ISE.113 AIDS Patient Who Was Hard to Diagnose from an Initial Symptom of Interstitial Pneumonitis: Report of an Autopsy Case S. Hakoda, H. Shinya, S. Kiuchi. Department of Emergency Medicine, Kitano Hospital: The Tazuke Kofukai Medical Research Institute, Osaka, Japan

ISE.110 Efficacy of hepatitis B vacccine: development of HBsAg.

ISE.110 Efficacy of hepatitis B vaccine: development of anti-HBc.

Report of the Case: A 36-year-old male was admitted to the hospital because of fever and dyspnea. Chest X-ray on admission showed diffuse reticular shadows in the both lung fields. Chest CT on admission showed diffuse high density in the both lung fields. Chest X-ray on the

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6th hospital day showed diffuse reticular shadows worse than the first day. There was no elevation of the titers of antibodies to the Legionella pneumophila, Epstein-Barr virus, Influenza A virus, Influenza B virus, Mycoplasma pneumoniae, Chlamydia psittaci, Parainfluenza A1 virus, Parainfluenza A2 virus, Parainfluenza A3 virus, Cytomegalovirus, Herpes simplex virus 1, or Mumps virus. The antigen of Candida spieces was positive. On the 8th hospital day the patient turned out to be Human immunodeficiency virus (HIV) positive. Bronchoalveolar lavage fluids (BALF) on the 10th hospital day showed numerous cysts of pneumocystis could be detected by Grocott's stain. Although aggressive therapy was performed, the patient died of HIV related disease such as Pneumocystis carinii pneumonitis and Cytomegalovirus (CMV) infection which led to multiple organ failure 17 days after admission. Lung tissue (autopsy) showed frothy exudates filled alveolar space at the upper right corner and a few cytomegalic inclusion bodies could be seen in alveolar type II cells. We reported a case of AIDS (Acquired immunodeficiency syndrome) patient who was hard to to diagnose from an initial symptom of interstitial pneumonitis. ISE.114 Pharmacoeconomics in Pharmacotherapy for Erysipelas S. Stefan Mikic1, J. Jovanovic2. 1University of Novi Sad, Clinic for Infectious, Novi Sad, Serbia, 2Diseases, Novi Sad, Serbia Introduction: The Serbian health system does not have strict guidelines forthetreatment of bacterial infections. The choice of treatment is empirical which is not necessarily the same compared to treatment guidelines from countries with developed pharmacotherapeutic practice. In this study we compared the difference between current treatment and the treatment taking into account the latest pharmacotherapeutic and pharmacoeconomic guidelines. Phahrmacoeconomics is a new discipline, which aims to compare and recommend the best drug with best effect and lowest cost of treatment Aim: To estimate clinical efficiency of antibacterial drugs that were given in therapy of erysipelas and to evaluate pharmacoeconomic aspect of this therapy as well. Material and Method: Our study included 80 patients that were randomly chosen and divided into 2 groups: In the first group patients were treated in an ordinary way. In the second group patients were treated strictly by the guideline. In two these groups we compared length of hospitalization, combination of used antibiotics, progress as a whole clinical picture, laboratorial analyses, complications of erysipelas, unwanted effects of therapy, and the price of the whole treatment. Results: Analyzing these values independently and according to statistical tests we proved that there were no significant differences between these groups with regard to the progress a whole clinical picture and the length of hospitalization. Using economical analyses we compared prices of medical treatments and found significant savings in all aspects. According to this analysis, guideline suggested treatment showed a saving of 40,58% in comparison with usual system of choosing therapy. Conclusion: Comparing the efficiency and the price of these treatments we concluded that the treatment suggested in the guideline is equally efficient but materially economical. ISE.115 Diabetic Foot Infection Resistant Cases and Curative Procedures H.N. Aboud. Medical College/ Al-Mustansyriah University, Baghdad, Iraq Background: Despite considerable advance in Diabetic Foot (DF) managements, many diabetic patients eventually develop foot ulcers which are the principle portal of entry for infections. Range from simple cellulitis to chronic osteomyelitis and globally they are the most common cause of non-traumatic lower limb amputation. Aim: To know what are the predisposing factors and what kind of the arrangement could be applied to save more feet from amputation. Material and Methods: 240 patients with diabetic foot infection were evaluated throughout 5 years ago from 2003­2008 in prospective study done in orthopedic department and diabetic foot unit in two university hospitals Baghdad, Iraq. Patients age ranging from 35 to 75 years, with more or less equal male to female ratio. Those patients were divided into two equal groups A and B. 120 patients for each group and with same number of each type of infection whether it is mild, moderate, or severe. Our planning program was applied to both groups but in different way. Group A was treated by type 1 method of management and group B was treated by type 2 method. Results: Throughout 240 case of DF infection the overall number of each type of infection was found that 80 patients presented with mild infection and 120 patients presented with moderate infection (limb

threatening) and 40 patients with severe infection (life threatening). Result of group A management, showing that 15 patients ended with major amputation, 35 patients treated by minor amputation and 70 patient treated conservatively by surgical debridment. While results of group B management, showing that 25 patient treated by major amputation, 45 patient treated by minor amputation and 50 patient treated conservatively. From these figures, we can say that type 1 method of treatment have higher success rate (33.3 %) than type 2 method, that means additional or further 40 patient in group A more than in group B, were saved their feet from amputation by applying our preferred policy. Conclusion: The key stones for successful management of DF infections (in addition to supportive treatment of other underlying causes) include the following 3 procedures: 1) Identifying the exact causative microbes by direct superficial and deep swab plus cultured infected tissue especially devascularized bony tissue; 2) Proper surgical debridments, to remove and destroy the microbes protective barriers, which may prevent antimicrobial therapy to reach the infected devascularized bony tissue, that's why antimicrobial therapy alone cannot cure patient with chronic osteomyelitis without surgical debridments; and 3) Uses of most effective combined antimicrobial therapy for good duration period. ISE.116 Use of Improved TSB, SMAC Agar and PCRs for Isolation and Identification of Escherichia coli O157:H7 from Cattle Carcasses in Iran Y. Tahamtan1, A. Poorbakhsh 2, S. Shekarforoush3. 1Razi Vaccine and Serum Research Institute-Shiraz, Shiraz, Iran (Islamic Republic of), 2 Razi Vaccine and Serum Research Institute, Tehran, Iran (Islamic Republic of), 3School of Veterinary Medicine, Shiraz University, Shiraz, Iran (Islamic Republic of) Moreover, selective culture media such as sorbitol-MacConkey agar supplemented with cefixime and potassium tellurite (CT-SMAC) which are developed as the first selective medium for the screening and isolation of E. coli O157:H7. It grows in colorless colonies on SMAC and can be distinguished from most of the remaining intestinal E. coli strains that ferment sorbitol and grow as pink colonies. Some Enterobacteriaceae present in cattle faeces, such as Proteus, Providencia, Hafnia, Enterobacter, and E. hermanii, also grow in colorless colonies. Moreover, some of these species share common epitopes with O157 antigen. It seems that modification of SMAC medium is necessary. We have been improved SMAC agar for E. coli O157:H7 by the supplementation with cefixime (0.25 mg L-1) and potassium tellurite (12.5 mg L-1) (5 times more than before) to create CT-SMAC, which largely inhibits the physiological flora. However, sorbitol fermentative O157: H- STEC is sensitive against high tellurite concentrations and fails to grow on the medium.This modification also was carried out for modified Trypticase soy broth supplemented as an enrichment media. Some molecular methods based on the detection of Shiga toxins have been described. Recently, a new molecular method suitable for the screening and isolation of potential Shiga toxin-producing strains has been developed based on the gene detection. This method has allowed the detection of gene-carrying bacteria among coliform grown by using specific primers to detect a fragment of 779 bp and combined with a nested PCR which have 372 bp stx2 fragments. We investigated using a modification of CT-SMAC medium and PCR for isolation of E. coli O157:H7 carrying the stx2 gene in cattle carcasses from different slaughterhouses from Shiraz-Iran. E. coli O157:H7 were detected from 24 (15.58%) (by CTSMAC), 17 (11.03%) of this confirm by O157 antiserum and finally 14(9.09%) of 154 cattle carcasses confirm by PCR and Nested PCR. ISE.117 Study the Prevalence and Antimicrobial Susceptibility of Bacteria Isolated from Blood of Individual Refered to Ahwaz-JundiShapour University Hospitals in March 2005 to March 2007 S. Rafiei, Z. Absalan, S. Mortazavi, M. Mojadam. Jundi-Shapour University of Medical Sciences, Ahwaz, Iran (Islamic Republic of) Background: Bloodstream infection is one of the causes of mortality and morbidity around the world. Using antibiotic is the main approach of infectious disease. Appropirate and quick diagnosis can decrease the level of mortalitty due to these infections, as well as treatment expenditures. Increase of antimicrobial resistant among pathogenic bacteria in Iran can be regarded as a challenge in medical society. Design: This study surveyed the frequency of bacteria isolated from the paitients hospitalized in jundishapour medical sciences University hospitals, as a retrospective study from March 2005 to march 2007, on the basis of laboratory existing data. Sensitivity or antimicrobial of isolated bacteria to antibiotics was surveyed.

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Results: Overal 8% of total 33292 patients showed positive blood culture. The most frequent pathogenic bacteria isolated from blood culture were, E.coli 15.5% followed by Staphylococc aureus 15.3% Enterobacter spp 15.1%, Pseudomonas spp 14.2%, Acinetobacter spp 8.5% and klebsiella spp 5.7%. The rates of S.aureus oxacillin resistant was twice that of coagulase negative Staphylococci (87.6% versus 42.8%), also S.aureus showed the greatest of sensitivity to vancomycin (84.2%), of gram negative bacteria isolated from blood culture, E.coli 95.2% and Enterobacter spp, Klebsiella spp and pseudomonas spp each of them (100%) showed the greatest resistace to amikacin. Key Words: bloodstream infection,antimicrobial resistance, antimicrobial susceptibility. ISE.118 Salmonellosis and Ulcerative Colitis T. Skuhala, B. Desnica, A. Beus, N. Vickovic. University Hospital for Infectious Diseases, Zagreb, Croatia Salmonelloses are infections caused by different serotypes of Salmonella and they clinically present as acute gastroenterocolitis, enteric fever, bacteremia, localized infections and chronic carrier state. Ulcerative colitis (UC) is immunologically mediated chronic inflammatory bowel disease (IBD). The etiology of UC is unknown, but beside genetic and environmental factors, microorganisms (enteric pathogens) play an important role in initiating IBD by inducing a cascade of inflammatory events leading to chronic, relapsing disease in a genetically susceptible host. Patients with UC often present with the same clinical manifestations as patients with acute gastoenterocolitis caused by enteric bacterial pathogens. A total of 1136 patients (>7yrs) with Salmonella gastroenterocolitis and 70 patients with UC were hospitalized in a two-year period at the University Hospital for Infectious Diseases "Dr Fran Mihaljevic" (UHID) Zagreb, Croatia. There were 6 patients who developed first attack of UC after acute Salmonella gastroenterocolitis and 5 patients with a history of UC who acquired Salmonella infection. Altogether 13.64% of our patients with first attack of UC presented as acute Salmonella gastroenterocolitis in the first place. These cases were diagnosed by stool cultures (stool was examined for Salmonella, Shigella, Campylobacter, Yersinia and enterohaemorrhagic E. coli), ova, cysts, parasites, and toxin A Clostridum difficile. The diagnosis of UC was established by endoscopy and histologic examination. A total of 44 patients (62.86%) were hospitalized during first attack of UC and 26 patients (37.14%) as relapsing patients. Among patients with first attack of UC, Salmonella was isolated in 6 patients (13.64%) and acute Salmonella infection preceded UC. Salmonella was isolated in 5 relapsing UC patients (19.23%). We observed no difference in gender distribution among various groups of patients. Mean age of patient with UC was 39.68 (13­77) years, in the group with first attack of UC 38 (13­77) years and in relapsing group 45.14 (19­75) years. In 11 cases we found two different relationships between Salmonella infection and UC: either Salmonella infection aggravated clinical syndrome in patients with a history of UC or Salmonella infection triggered the first attack of UC. It is interesting that we did not observe that any other enteric pathogen preceded or triggered the first attack of UC in 2 years and it seems that Salmonella is a very potent microorganism for triggering UC. Only Salmonella was confirmed in patients with UC relapse and superimposed enteric infection. Patients with UC are not at an increased risk for Salmonella infection but they have prolonged or more severe form of disease. Antimicrobial therapy (ciprofloxacin) was indicated in 5/6 patients with first attack of UC after acute Salmonella infection and in 3/5 patients with UC and superimposed Salmonella infection. We want to point out a well known relationship between enteropathogenic microorganisms (including Salmonella) as a trigger for UC but also our observation that Salmonella is more potent in this process. Molecular mechanisms of this process are poorly understood and should be object of research in the future. ISE.119 Community Associated Isolates in Pediatric Patients at C.H. Baragwanath Hospital S. Vally1, M. Khoosal1, N. Mbelle1, 2. 1NHLS-C.H.Baragwanath Microbiology Department, Johannesburg, South Africa, 2NHLS C.H.Baragwanath Microbiology Department & University of Witwatersrand, Johannesburg, S.A., Johannesburg, South Africa

Background: The prevalence of resistant micro-organisms in the community is compromising the treatment of children presenting to hospitals for attention. In addition, the treatment of these drug resistant organisms impact negatively on resources, particularly in resource poor countries. Detection of patterns of antibiotic resistance in the community will enable informed intervention in the community as well as timeous choices in the treatment of patients admitted to pediatric wards. Objectives: To estimate the prevalence of significant micro-organisms in the community served by Chris Hani Baragwanath hospital. To determine the resistant patterns of significant community acquired isolates. Method: Laboratory records from January to December 2007 were received. Consecutive isolates from cerebrospinal fluid and blood cultures, collected from pediatric patients recently admitted to Chris Hani Baragwanath hospital were analyzed by CLSI methodology). The susceptibility patterns of these isolates were recorded. Results: Of 70 isolates of clinical significance during this period, Streptococcus pneumoniae (43%), Staphylococcus aureus (14%) and Neisseria meningitides (11%) were the most common isolates. Two (20%) of the Staphylococcal isolates were methicillin resistant and 90% were penicillin resistant. In addition, 3% of the Streptococcus pneumoniae were penicillin resistant and 46% intermediately resistant. Conclusion: Although the incidence of community associated strains of Streptococcus pneumoniae, Staphylococcus aureus and Neisseria meningitides causing infections is lower at Chris Hani Baragwanath hospital than in other related studies, the high incidence of resistance of Streptococcus pneumoniae to penicillin is of concern. Furthermore, the resistant patterns of the methicillin resistant Staphylococcus aureus isolated have shown to be similar to the hospital acquired strains suggesting recent discharge from hospital and the circulation of resistant strains indicating the potential seriousness of this emergence. Screening of potential carriers for significant isolates and their resistant patterns would benefit policy makers in allocating scarce resources efficiently. ISE.120 Antimicrohial Susceptibility Among Gram Negative Bacilli Isolated from Urinary Tract Infections M. Jamshidi, S. Jawad Pour, A. Karmostaji, P. DAwoodian. Infectious Disease Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran (Islamic Republic of), Infectious Disease Research Center, Hormozgan University of Medical Sciences, bandar abbas, Iran (Islamic Republic of) Objective: Survey of antibiotic susceptibility is important in urinary tract infections, because this is one of the most common infectious disease in community. Therefore, we determined antimicrobial susceptibility among gram negative bacilli isolated from urine cultures. Methods: In this prospective cross-sectional study, the minimum inhibitory concentrations (MIC) of 11 antibiotics(meroPenem, ImiPenem, cefePime, ceftazidim, Ceftriaxon, Cefotaxim, Cephalotin, Chloramphenicol, Ciprofloxacin, Amikacin, Gentamicin) for 85 isolates of gram negative Bacteria from Patients with urinary tract infection were determined by Etest. Results: The most frequently isolated organisms were Ecoli (64.7%) followed by Klebsiella Pneumonia (20%), Pseudomonas aeroginusa (15.3%). Among Ecoli were mostly resistant to cefepim (79.2%), Cefotaxime (61.8%), Cephalotine (98.7%), Klebciella Pneumonia were resistant to cefepim (82.4%), Cefotaxin and Ceftriaxon (70.6%), Cephalotion (100%), Pseudomonas aeroginsa were resistant to Cefepim (100%), Cefotaxim and Ceftriaxon (69.9%), Ceftazidim (61.5%). The most sensitive antibiotics were Meropenem, Imipenem, Amikacin and Ciprofloxacin. Conclusion: Monitoring of microorganism Atimicrobial susceptibility is recommended for all patients with urinary treat infections before starting antibiotics. ISE.121 Antimicrobial Resistance Pattern Among Nosocomial Gram Negative Bacilli from Intensive Care Unit Patients in One General Hospital, South East Iran in 2006­2007 A. Jamshidi1, F. Abedi2, M. Jamshidi2, P. Dawoodian2, T. Eqbal Eftekhaari2, M. Zangane2. 1Infectious Disease Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran (Islamic Republic of), 2Infectious Disease Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran (Islamic Republic of) Objective: Gram negative bacilli are frequently associated with nosocomial infections. In this study we determined antimibrobial susceptibility

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of isolated gram negative bacilli from Intensive care units patients with nosocomial infections. Methods: In Prospeetive cross-sectional study we evaluated Antimicrobial susceptibility among gram negative bacilli from patients with nosocomial infections by disc diffusion methods for six Antibiotics (Gentamicin, Amikacin, Ciprofloxacin, Imipenem, Ceftazidim, Cefepim). Results: A total of 347 gram negative bacilli were isolated from 501 positive cultures from patients with nosocomial infections. Most commonly islolated bacilli were Pseudomonas aeruginosa (42%) Klebciella pneumonia (32%), Acintobacter baumannii (13%), E. coli (12%). The main source was respiratory tract (54.2%). Among the P. aeruginosa, K. Pneumonia, E. coli were mostly sensitive to Amikacin 54%, 56% 60.9%, alternatively and the most sensitivite antibiotics in all gram negative bacilli were Amikacin, Imipenem, ciprofloxacin alternatively. And all isolated gram negative bacilli mostly resistant to cefpim (96­75%) and Gentamicin (93­61%). Conclusion: Gram negative bacilli are frequently associated with nosocomial infections and they showed high resistencey against broad specterum antibiotics. Therefore, antimicrobial susceptibitily monitoring special in ICU patients are strictly recommended. ISE.122 Interferon-Gamma Receptor 1 Gene Polymorphism in Patients with Lyme Disease O.O. Yanovich, L.P. Titov, V.V. Scherba. Research Institute for Epidemiology, Minsk, Belarus Introduction: Interferon-gamma is a key mediator of the host immune response, and the IFN-gamma receptor 1 subunite (IFNGR1) is essential for IFN-gamma binding and signaling. There are evidence suggests that single nucleotide changes in genes may not have dramatic effects but may lead to functional differences in gene expression and modify course of deseases. Aim: To assess SNP polymorphisms in the IFNGR1 gene in patients with Lyme desease. Material and Methods: The study included a control group (n=40) of healthy subjects and patients with Lyme disease (n=23). We investigated the role of three polymorphisms in the IFNGR1 (SNPs +95, -270 and -470) by allele-specific PCR. Result: Statistical analysis revealed a significant association between genotype CC for SNP +95 in patients with Lyme disease compared to controls (45% vs 13%; p< 0.05). The frequency of the -470del genotypes was significantly higher in Lyme disease patients (17.5%) than in controls (2.5%), and a significantly higher percentage of the deletion vs T alleles between patients and controls was revealed (33% vs 19%; p < 0.05). There was no statistically significant difference in SNP -270 IFNGR1 genotype frequencies between the two groups. Conclusions: This study demonstrates that patients with Lyme disease have a genetic defect in the IFNGR1 genotype. Our finding is the first step to reveal connection between Lyme disease and interferon genes function. ISE.123 PspA Sequence Diversity Among Invasive and Non-Invasive Isolates in India R. Verma, S. Sood, A. Kapil, B. Das. All India Institute of Medical Sciences, New Delhi, India Background: Streptococcus pneumoniae continues to be an important cause of life threatening invasive disease throughout the world. Pneumococcal surface protein A (PspA) is a potent candidate for protein vaccine. In this study, we analyzed the distribution different PspA type among invasive strains (n=33) and commensal pneumococcal strains (non invasive, n=106)) by molecular methods (PspA family PCR typing). We also sequenced the alpha-helical region of PspA among invasive and non-invasive isolates to determine the diversity among present among various PspA strains. Objective: To determine the PspA diversity among invasive and noninvasive isolates in India. Methods: We used three primer pairs to type PspA into families. Sequencing of PspA-alpha helical region was carried out using LSM-12 and SKH-2 primer pair using dye terminator chemistry. Results: In the study, PspA Family1 and PspA Family2 isolates are almost equally present, though PspA Family F1 isolates are slightly predominant. Among Invasive isolates, out of 33, 17 (52%) isolates are PspA Family1, 15 (45%) isolates are Family2 and only 1 isolate is positive for both the families. Among Non-invasive isolates, out of 106 isolates, 52 (49%) are Family1, 46 (45%) are PspA Family2, 6(5%) isolates

are positive for both the families and one isolate is positive for PspA Family3. Sequencing results of PspA alpha-helical region show that Indian and global isolates share high homology in PspA sequences. PspA alpha helical sequences can not decide whether the isolate is invasive or non-invasive. Many invasive isolates show very high homology with non-invasive isolates. PspA clade 4 is dominant among both, invasive and non-invasive isolates in India. Conclusion: We believe, this is the first such study that investigates the PspA diversity among Indian isolates. In India, two PspA families, family1 and family2 are predominant. Indian and Global PspA sequences show high homology. ISE.124 Distinct Patterns of Cytokines Released by Human Peripheral Mononuclear Cells in Response to Staphylococcus aureus and S. epidermidis A.I. Spiliopoulou, F. Kolonitsiou, M.I. Krevvata, I. Spiliopoulou, N.K. Karamanos, G.O. Dimitracopoulos, E.D. Anastassiou. University of Patras, Patras, Greece Background: S. aureus is an established major human pathogen, whereas, S. epidermidis has emerged as an important pathogen in immunocompromised individuals and in biomaterial-associated infections. In order to insight on the diverse pattern of clinical presentations, we investigated the potential of S. aureus and S. epidermidis strains to modulate adaptive immune responses, in terms of secreted cytokines. Methods: Five reference S. aureus (Fri913, ATCC119095, ATCC49775, HT20000195, and ATCC29213) and two reference S. epidermidis strains (ATCC35983, and ATCC12228) were used in the present study. Peripheral blood mononuclear cells (PBMCs) from healthy donors were isolated by standard procedures and co-cultured in 24-well flat bottom tissue culture plates with live bacteria at a ratio of 25:1. Cytokine measurements, using Luminex® xMAPTM technology, were performed in cell-free supernatants collected at 2, 4, 6, 12, 24 and 48 hrs. The 3-plex assay kit was used for simultaneous quantitative determination of the following cytokines: IL-12p40, IL-12p70, and IL-10, whereas, the 4-plex high-sensitivity(HS) assay kit was used for IL-2, IL-4, IL-12p70, and IFN-. Results: Kinetics of cytokine production in response to S. aureus revealed that all cytokines tested peaked at 4-6 hrs. In terms of S. epidermidis, IL-10 production peaked at 12 hrs, whereas, IL-12p40, IL12p70, IL-2, IL-4, and IFN- accumulation was higher between 12 and 48 hrs. S. epidermidis elicited higher IL-10 production as compared to S. aureus. In contrast, S. aureus was more efficient in eliciting IL-12p40, IL-12p70, IL-2 and IFN- production. Accumulation of aforementioned cytokines was as 10-fold higher, whereas IL-4 production was only 2fold, as compared to S. epidermidis' stimulation. Differences were statistically significant (p<0.05). Conclusion: S. aureus demonstrated higher potential in triggering Th1 immune response than S. epidermidis. This finding illustrates a high diversity of immune system responses depending on the pathogen encountered. Results may explain observed silent, persistent biomaterial-associated infections due to S. epidermidis as compared to more prominent clinical demonstrations following S. aureus infections. ISE.125 Urinary Tract Infections Among Inpatients at a Large Italian General Hospital. A Prospective Observational Study A. Nanetti1, R. Manfredi2. 1Dept. of Microbiology, University of Bologna, S. Orsola Hospital, Bologna, Italy, 2Dept. of Infectious Diseases, University of Bologna, S. Orsola Hospital, Bologna, Italy Background: A standardized, prospective microbiological surveillance study of urinary tract infection is ongoing at our Hospital. Materials and Methods: The temporal trend of microbial isolates from urines of inpatients hospitalized during the last calendar year (2007), was evaluated quarterly according to the main bacterial and fungal isolates. The same pathogens cultured more than once from the same patient within one month, have been considered only once. Results: Of 2,384 overall episodes (as defined above), 920 (38.6%) were determined by Escherichia coli, followed by Enterococcus fecalis (541 episodes: 22.7%), Pseudomonas aeruginosa (140 cases: 5.9%), Klebsiella spp. (134 episodes: 5.6%), Proteus mirabilis (118 cases: 4.9%), Enterococcus faecium (76 episodes: 3.2%), while the first fungal pathogen was Candida albicans (87 episodes: 3.6%). During the proportionally short observation period, no significant variations occurred in the frequency of isolation of each mentioned urinary tract pathogen, when excluding a mild increased frequency of Enterococcus faecium (p<.05).

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Conclusions: A prospective microbiological observation study significantly adds to the knowledge of local epidemiological figures and antimicrobial susceptibility pattern of hospital-associated infections, including urinary tract infections, which are responsible for considerable morbidity among inpatients. During the still limited observation time, modest variations occurred in the frequency of isolation of the most frequent microorganisms, with Escherichia coli representing nearly 40% of cultured organisms, followed by Enterococcus faecalis (which proved responsible of around 23% of overall episodes). The tendency towards an increased incidence of Enterococcus faecium is of concern, given the unpredictable antibiotic sensitivity profile of this last microorganism. ISE.126 Enterobacily by Infections with Surgical Patients and Dynamics of Their Antibiotic Resistance K.I. Iskhakova, K.H.A. Uldasheva, D.M. Sigalov, N.A. Shadmanova. Tashkent Institute of Postgraduate Medical Education, Tashkent, Uzbekistan Studying circulation and antibiotic sensitivity of enterobacily with surgical patients. Cultures separation and identification methods were conducted using traditional methods; also, we used quantity methods to study biomaterials from opened cavities (sputum, etc.), microbes revealed in more than 10 5 titres were referred to etiologically important. Disco-diffusion method using Muller-Hinton medium, commercial disks with antibiotics and criterions CLSI was used for antibiotic resistance determination. 2006 Results: 2074 cultures were separated while checking-up surgical patients with festering-septic infection (abdominal, thoraco-abdominal, burn, and resuscitation units), 1234 (59,5%) of which make up gram-negative bacteria, the leading ones are K. pneumoniae, P. aeruginosa, E. coli, and so on ( P. mirabilis, E. aerogenes, C. freundii), in total 2,6%. The majority of klebsiells was non-sensitive to cephasoline. Low activity was also discovered in cephalosporin of III - generation. Thus 86, 4% to cephatoxime, 72,7% of klebsiells were resistant to cephaperazone, 79,5% of klebsiells were resistant to cephthriaxone, 59,1% of klebsiells were resistant to cephtazidime. Probability to produce by these strains bettalactamose of extended spectrum confirms their associated resistance to kanamycine. The selective comparison of klebsiells resistance received in previous years (2002­2004) and in the first six months of 2007 showed resistance growth to cephtasidime--from 59,1% to 79,5%., to pefloxacine from 38,6% to 81,1%, to ampicillin from 40,9% to 65,9%. For E.coli the same comparison showed the growth of resistance strains to cephthreeaksone from 21,1% to 50%, to gentamicine from 21,7% to 76,9%, to pefloxacine from 26,1% to 61,5%, to amicacin from 30,4% to 57,7%. Conclusion: K. pneumoniae in studied area turned to be the major causes for festering-septic infection in surgical patients. One can mark enterobacily resistance growth to a number of antibiotics in observation dynamics. ISE.127 Erysipeloid Report of Two Cases S. Pai. Kasturba Medical College, Manipal, India Erysipeloid is an acute but slowly evolving infection caused by Erysipelothrix rhusiopathiae occurring at sites of inoculation, most commonly the hands and is often occupationally associated with those handling fish, shellfish, meat, poultry, hides and bones. We are reporting two rare cases of erysipeloid in a fish handler who responded to treatment promptly. Case Report: A 20 year old man working in a fishery presented with swelling and redness of the left hand for five days. The nature of his job involved cleaning and processing of fish. There was history of minor trauma due to injury by fish bones. On examination, erythema with slight violaceous hue and edema was present on left hand extending from tip of middle finger and index finger to dorsum of the hand. Similar erythema was present on the palmar aspect, which showed central clearance. Clinical diagnosis of erysipeloid was made and patient was started on oral cefadroxil 500mg 12th hourly. On follow up after a week, erythema and edema had subsided and mild scaling was present over the involved area on dorsal aspect. At this time, he brought a co- worker with similar complaints who was treated elsewhere with topical steroids without any improvement. This patient also showed improvement with cefadroxil. Discussion: Erysipeloid is an acute infection of traumatized skin caused by a slender, gram-positive rod, Erysipelothrix rhusiopathiae. An

infection to humans is by direct contact and usually affects butchers, cooks, fishermen, farmers and veterinary surgeons. Scratches or pricks with fish, rabbit or chicken bones are sources of infection in housewives. The most common form being mild localized cutaneous infection (Erysipeloid of Rosenbach) lacking constitutional symptoms. The erythema and painful edema develops within 1- 3 days at the inoculation site, which may be because of a trivial injury. The violaceous or purplish red lesion spread peripherally with central clearance. Our two patients had localized form of Erysipeloid who responded to cefadroxil. ISE.128 The Impact of LRT Inflammation on Serum Glucose Levels Among ID Patients with Diabetes L. Zabaznoska, L.J. Ilieva, V. Markovski, S. Bogoeva. Clinic of Infectious Diseases, Skopje, Former Yugoslav Republic of Macedonia Background: Through the last two decades most evident is the dramatically increasing number of diabetic patients, especially in developing countries. This enormous elevation of morbidity gets an epidemic proportions. The correlation between this chronic condition and its mutual impact to infections became obvious, especially to dermal, renal and low respiratory tract inflammations (LRTI). Aim: This investigation was established to estimate the impact of LRTI (Pneumonia, Pleuropneumonia, exacerbated COPD, Bronchiectasiones inflamata) to insulin daily doses among ID (insulin dependent) diabetic patients through the acute phase of the inflammation. Methods: In a 5 year long period a total number of 871 patients with LRT inflammation (2003-145; 2004-117; 2005-207; 2006-208; 2007-195 patients) were healed at the department of respiratory diseases in our hospital. 116(13.3%) of these patients had controlled and regulated ID diabetes before the time of hospitalization. The routine biochemical testing at the time of admission showed quite increased levels of serum glucose among 89(76%) patients, despite the correctly proceeded insulin therapy. Parallel with the antimicrobial therapy, correction of insulin doses was essential (in a consultation with endocrinologist, based on glucose profile) in a manner of increasing doses of prompt and lente insulin combination or the daily frequency of the dosed (individually) in a goal of serum glucose level normalization. Results: After resolving of inflammatory lung process within approximately 15 days of hospitalization (9­25 days) only 7(7.8%) patients needed a correction of the insulin doses up to levels that were established before the onset of the LRT inflammation. Conclusion: The impact of LRT inflammation on serum glucose levels among ID diabetic patients origins frequent and continuously careful glucose profile control and additional correction of the insulin therapy as needed at the time of admission to hospital, during the hospitalization and release, with further precise establishment of the insulin dosage control. ISE.129 Study of the Transferring and Regulatory Mechanisms of Vancomycin-Resistant Determinant in Staphylococcus aureus C.S. Fang, J.C. Shu. Graduate Institute of Medical Biotechnology, KweiShan, Taiwan

Staphylococcus aureus which has long been recognized as a major cause of nosocomial infections can result in from superficial infections to severe sepsis and septic shock associated with vascular damage and multiple organ failure. Vancomycin which blocks cross-linking between peptidoglycan intermediates by binding to the D-Ala-D-Ala termini (the substrate of transglycosylase/ transpeptidase) of bacterial cell wall precursors is the front-line therapy for treating infections caused by MRSA (methicillin-resistant S. aureus). The first clinical isolate of vancomycinresistant S. aureus (VRSA) had been reported in USA on 2002. This strain carries a transmissible element, Tn1546, obtained from a co-isolated vancomycin-resistant enterococci (VRE) which can undergo cell wall remodeling making the precursors terminate in D-Ala-D-Lac rather than D-Ala-D-Ala. Thus, vancomycin is not able to recognize its binding region on cell wall and loses its infections. There is no VRSA clinical isolates been reported so far in Taiwan even with higher prevalence of VRE and staphylococcal infections. This study is focused on investigating what are the underlying mechanisms confining the transfer of vancomycin-resistant determinant from VRE to S. aureus. We are also interested to understand whether the treatment of vancomycin to a VRSA strain will be seemed as a stimulus to activate the stress-response transcription factor, B, followed by the influence of the expression of many downstream virulence factors.

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ISE.130 A Clinicopathological Study of Hansens Disease R. Kudva. Kasturba Medical College, Manipal, India Background: Leprosy (Hansens disease) is a chronic disease caused by Mycobacterium leprae. It affects peripheral nerves, skin and certain other organs like eyes, bone etc. The disease manifests in different forms depending on the host immune response. The exact diagnosis of the type of leprosy is based on clinical, histopathological, bacteriological and immunological findings. Study: Conducted on 75 clinically diagnosed cases of leprosy over a period of 2 1/2 years. Aim: To review the clinicopathological profile of the disease and to correlate the clinical features with their histopathological diagnosis based on internationally accepted "Ridley Jopling classification" Discussion: In our study the most common clinical presentation was macular lesion followed by plaques and the most common location was in the extremities. The most common type of leprosy was Borderline Tuberculoid (BT) followed by Tuberculoid (TT) and Borderline lepromatous (BL) both clinically and histopathologically. Tuberculoid leprosy (TT) and Lepromatous leprosy (LL) showed good parity between clinical and histopathological diagnosis. Marked disparity was observed between the different types of borderline leprosy. Diagnostic value of Fite Faraco stain was also proved in this study particularly for Borderline Lepromatous (BL), Lepromatous Leprosy (LL) and Indeterminate Leprosy (IL). ISE.131 C-Reactive Protein and Procalcitonin as Markers for Early Diagnosis of Bacterial Meningitis M. Cvetanovska 1, K. Karovski1, Z. Milenkovic1, V. Kirova-Urosevic1, P. Kalamaras1, K. Grozdanovski1, D. Naunova-Jovanovska1, K. Spasovska1, V. Cvetanovski2, V. Semenakova1. 1Clinic for infectious diseases, Skopje, Former Yugoslav Republic of Macedonia, 2Clinic for Thoraco-vascular Surgery, Skopje, Former Yugoslav Republic of Macedonia Objective: To determine the serum levels of C-reactive protein (CRP) and procalcitonin (PCT) as markers for early diagnosis of bacterial meningitis. Material and Methods: During a 4-year period, patients diagnosed with bacterial meningitis treated at the Clinic for Infectious diseases, were enrolled in the study. All underwent clinical, biochemical and CSF examination to confirm the diagnose. Serum levels of CRP and PCT were measured during the first 24 hours from admission. Data were analysed using statistical software SPSS (version 13.0; SPSS Inc. Chicago, IL, USA). Results: one hundred and eighty patients were included in the analysis, 91 (43,7%) were adults with a mean age of 44,34±15,7 and 64,4,% were males. The average duration of symptoms before admission was 4,41 days. All analyzed patients had increased sedimentation rate, with mean value 52.14±30.2. Leucocytosis, defined as leucocyte count above 9X109L was recorded in 163(90%) patients. The serum level of CRP was increased in 137 patients with mean value of 128.7±162.71 mg/l. PCT was meassured only in 37 (20,6%) patients, of them, 20 or 54% had increased level > 0.5ng/ml. The mean duration of hospitalization was 18±10,0 days. The overal mortality was 6,7%. Conclusion: serum levels of CRP and PCT are increased in most patients in acute phase of bacterial meningitis. Therefore, measuring of these markers at admision is important for early diagnosis and early prediction of prognosis of this serious disease. ISE.132 Comparison of Immun Capture Agglutination Test (Brucellacapt) with ELISA Test in Serological Diagnosis of Brucellosis M. Ozdemir1, B. Feyzioglu1, H. Turkdagi1, M. Dogan1, S. Yuksekkaya1, R. Kesli2, B. Baysal1. 1Selcuk University, Faculty of Medicine, Department of Microbiology and Clinical Microbiology, Konya, Turkey, 2 Konya Educational and Research Hospital, Microbiology Laboratory, Konya, Turkey Introduction: In this study it was aimed to compare the diagnostic value of ELISA test with immuncapture aglutination test used in the serological diagnosis of brucellosis. Material and Methods: Referred to Microbiology Laboratory of Meram Medical School's Educational and Research Hospital, Selcuk University with the susceptibility to brucellosis, total 200 patients were simultaneusly evaluated as to their sera sampels related to ELISA Ig M and Ig G (Vircell, S. L. Spain) and Brucellacapt (Vircell, S.L. Spain). Siginificance rate was accepted as positive for Brucellacapt over 1/320 and for ELISA over cut-off value.

Results: 144 samples were provided with immunecapture positive, and 159 samples were provided with ELISA Ig positive (Ig M or IgG). Immunecapture consistency was similar for ELISA Ig M and Ig G. A significant positive correlation was obsorved between ELISA positivity and the increasing titer. Conclusion: Upon determined the positivity limit as 1/160 for immunecapture test, it is witnessed that immunecapture test is lower than ELISA Ig (Ig M or G) positivity rate. ELISA positivity rates existing in immuncapture 1/160 titer values culd indicate that this titer is logical when it is evaluated at least as suscepted positivity limit for immunecapture test.

ISE.132 Number of positivity of the tests performed. ISE.133 Isolation of Helicobacter pylori and Cytomegalovirus in Cardial G. Eslami, P. Safavi Naeini, M. Zangi, F. Fallah, M. Mottahedi. Shahid Beheshti Medical University, Tehran, Iran (Islamic Republic of) Background: The pathogenesis of atherosclerosis is a subject of much debate, but it is now generally thought to be a chronic inflammatory disease. Recently, a potential link between infectious agents and atherosclerosis has been suggested. The aim of this study was to investigate presence of helicobacter pylori and cytomegalovirus in carotid atherosclerotic plaques. Methods: 102 carotid atherosclerotic specimens were obtained during autopsy and the highly sensitive polymerase chain reaction method was employed with primers specific for each agent. Results: The presence of H pylori and CMV DNA were found in 34 (33.3%) and 18 (17.6%) of 102 examined samples respectively. Other atherosclerotic risk factors among patients with H pylori and CMV DNA positive include history of hypertension (24%), diabetes (25%), hyperlipidemia (70%) smoking (44%), and family history of premature cardiovascular disease (34%) that was not significantly different from other patients. Conclusion: The presence of H pylori and CMV DNA in these patients supports the hypothesis that these agents have an association with atherosclerosis. ISE.134 Urinary Infections in Renal Transplant Recipients M. Zangi, P. Safavi Naeini, E. Ghanei, M. Mottahedi. Shahid Beheshti Medical University, Tehran, Iran (Islamic Republic of) Background: Urinary tract infection (UTI) is the most common infectious complication following renal transplantation. The purposes of this study were to determine the causative agents of UTIs and the survival rate among renal transplant recipients. Methods: We evaluated 214 recipients who underwent transplantation in terms of their urine culture at first month and kidney function at the first year after kidney transplantation during the period 1995 to 2005 at shohada hospital. All patients received prophylaxis with co-trimaxazole. Medical records of the patients were reviewed retrospectively. Results: from all patients' urine cultures, urinary tract infections were confirmed among 96(44.9%) of them. Bacterial infections were the most frequent etiologies: gram-negative bacilli in 67 (69.7%), gram-positive cocci in 23 (24%), and six fungal (6.3%) infections. In fact, the causative microorganisms were E. coli as the principal isolated agent in 42 cases (43.8%). The survival rate of the graft at the end of the study period was 92.2%, and the survival rate of the transplant recipient's was 94.8%. Conclusion: The incidence of UTI in transplant patients who received antibiotic prophylaxis was high. E. coli was the main agent isolated. UTI, the most frequent post transplantation infection, showed a good prognosis.

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ISE.135 Obesity, Risk for Leg Erysipelas E. Gvozdenovic, O. Dulovic, N. Svirtlih, N. Popovic. Institute for infectious and tropical diseases, Beograd, Serbia Background: Erysipelas is clinically and microbiologically well defined form of superficial cellulites, caused by Streptococcus beta haemolythicus (in rare occasions some other bacteria). Streptococcus, usually unapparently present in upper respiratory ways, has to be injected in the skin by injury, or even scratching. The disease is self limiting, does not need hospitalization, but leave sequels on small lymph vessels, leading to chronic inflammation, lymphostasis and disposition for next episode of the disease. Treating patients with leg erysipelas as inpatients, we noticed that they were apparently fat. Aim: To examine our observation and to see how much does it influence on the length of hospitalization. Method: The study is done in a group of 63 patients, hospitalized during 2006 and 2007. The mean age was 64 years, mean length of hospitalization was 11.8 days. They were referring to doctor second or third day of the disease, (average 2.4) but they were hospitalized the next day or two days later (average 3.9 day from the beginning of symptoms). The average BMI was 29.06. Results: According to our results, as 3% of our patients did not have increased BMI, people with increased BMI are more sensitive to acquire erysipelas on legs, as they already have stasis in their legs caused by increased weight. They recognize the disease early end refers to doctor early, but inflammation is so pronounced that they were referred to hospital shortly after. The long hospitalization is the result of pronounced destruction of the skin, therefore they were not eager to leave hospital just after the secession of antibiotic therapy. ISE.136 Relation Between Bacteria in Urinary Infections and Urinary Calculi G. Eslami1, A. Taghavi1, J. Nowrouzi2. 1Shahid Beheshti University, Tehran, Iran (Islamic Republic of), 2Islamic Azad University of Tehran, Tehran, Iran (Islamic Republic of) Background and Goals: Urinary calculi are of the main and widespread problems in urinary organ. Different issues play role in its occurrence, such as nutrition, weather, sex, genes, and positive urease. The out break of such stones in patients of urinary calculi different societies range from 3 to 4%. This survey was accomplished in Labffie Nejad Hosptial. Materials and Methods: The urinary calculi which have been extracted out from 100 patients, using ESWL approach, have been handed over by the specialist physician. Then tiny fractions of a stones were put in tubes where bacteria have been planted (Thioglicoolat and T.S.B). Results: During the analysis of 100 samples which were planted, 53.88 percent of the stones were of mixed type. Meanwhile, the ratio of the stones in the comparison of the sex of the patients with regard to their age, there was a highlighted difference. The (P = 0.003) of isolated microorganism in planting stones were E. coli (37.5%), S.aureus (17.5%), Candida (12%), Enterobacter (10%), Klebsiella (10%), Providencia (5%), S. epidermidis (5%), Bacillus, subtilis (2.5%). There is a relation between E. coli and Calcium oxalat with a mean degree of 27.7 and Enterobacter nd urice and with a mean degree of 37.13, and from the point of view of statistics it is meaningful. (P= 0.034). Conclusion: Both ureas producers and non - producers of ureas bacteria are capable of gathering Calcium Crystals. How ever each bacteria can gather different amount of calcium and form a nuclei for calculi formation. Key Words: urinary calculi, bacteria, urinary infections, ESWL(extra corporal shock wave lithotripsy ISE.137 Hematologic Changes of Human Brucellosis in Mazandaran, Iran: 2005­2007 N. Naiafi. Mazandaran University, Infectious Department, Sari, Iran (Islamic Republic of) Background: Brucellosis is a systemic infection in which any organ or system of the body can be involved. We evaluate here hematologic changes of Brucella infection in hospitals of Mazandaran University, Iran. Material and Methods: We analyzed retrospectively 108 cases (43 female and 65 male) of brucellosis who were diagnosed and treated in the hospitals of Mazandaran University from 2005 to 2007. the diagnosis was based on clinical findings and serologic results.

Results: Mild hematologic abnormality, such as anemia and leukopenia were common, thrombocytopenia is less common. Anemia was present in 55%, leukopenia in 28%, thrombocytopenia in 18%, pancytopenia in 1.8%. Conclusion: Primary health care physicians should keep in mind the clinical and laboratory findings of brucella complications.

Diagnostics: Microbiology, Virology, Other

ISE.138 Orphan's Morbidity in Orphanage Sarajevo A. Hadzimurtezic1, A. Bajraktarevic1, A. Skopljak1, N. Perva1, M. Rovcanin1, Z. Jatic2, S. Uzicanin3, L. Sporisevic4, A. Djurdjevic-Djulepa5. 1 Public Health Institution Sarajevo, Sarajevo, Bosnia and Herzegovina, 2 Medical Faculty of Sarajevo, Sarajevo, Bosnia and Herzegovina, 3 Pediatrics Clinic, Sarajevo, Bosnia and Herzegovina, 4First medical Aid Sarajevo-Pediatrics Department, Sarajevo, Bosnia and Herzegovina, 5 General Hospital Sarajevo, Sarajevo, Bosnia and Herzegovina Introduction: The number of orphans and adopted children in the Bosnia and Herzegovina increased rapidly during the past decade after the aggression and war in Bosnia in new 'global world time'. Adopted and orphans children are at increased risk of infections acquired in their region of origin. Methods: A retrospective cohort study was performed. The patient medical records of orphans and adopted children were reviewed to determine the prevalence of and factors associated with several infectious diseases. Results: We find increasing number of visits doctors and more number of antibiotics and first examinations comparing for children's examinations in Public Health Institution Sarajevo. Discussion: Despite these changes in morbidity, some adoptionorphanage professionals have supposed that Bosnian children are 'healthier' than children who are adopted or than children in orphanages in other countries. The unique medical needs of adopted children and orphans have been recognized. Conclusion: Thus, ongoing surveillance of orphaned children, international trends in infectious diseases, and appropriate screening will ensure the long-term health of orphaned children as well as their 'nice and safety' staying in orphanage Bjelave Sarajevo. Directed screening tests should be a routine component of the medical evaluation of all children adopted from orphanage and before arrival in orphanage, regardless of age, sex, or Bosnian-Herzegovian regions of origin every child.

ISE.138 Percent of Orphan's Morbidity in Orphanage Sarajevo,1999­2006 ISE.139 Detection of Citrus psorosis Virus by using DAS-ELISA and PCR Method in Gorgan Area E. Ebadi. Golestan University, Gorgan, Iran (Islamic Republic of) Field surveys and laboratory tests were carried out to evaluate the incidence and the association with specific symptoms of Citrus Psorosis Virus (CPsV) and to detect latent infections in citrus growing area of Gorgan, using DAS-ELISA and RT-PCR. ELISA tests did not show any positive results when using CPsV monoclonal Antibody (Agritests®). The primers were synthesized on a 600 bp cloned fragment of the coat protein gene. The survey, regarded commercial groves of different citrus

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species and cultivars. Laboratory tests showed an infection in commercial groves. No relationship was observed between the commercial CPsV monoclonal antibody and positive CPsV isolates. There is the first report of CPsV occurrence in Golestan province. Key Words: Citrus Psorosis Virus, ELISA, PCR, Citrus ISE.140 Clinical Manifestation and the Pattern of Antimicrobial Resistance of Etiologic Agents of Soft Tissue Infection in Beheshti Hospital of Kashan, Iran M. Momenheravi, R. Moniri. Kashan University of Medical Sciences, Kashan, Iran (Islamic Republic of) Introduction: Antimicrobial resistance is very important because it causes many problems in treatment of infections. This study was conducted to determine frequency, clinical manifestations, laboratory examinations of soft tissue infections and antimicrobial resistance pattern of their microbial causes. Materials and Methods: This descriptive study carried out through existing data by reviewing medical records of 175 hospitalized patients with skin and soft tissue infections during 2002­2004. Data were collected and analyzed. Results: The soft tissue infections included cellulitis (72.5%), diabetic foot infection (17.7%), wound infection (10.2%), superinfection of cutaneous leishmaniasis (18.8%) and necrotizing fasciitis (0.5%). The majority of patients were in 30­49 age group (33.7%). 40 percent of patients had history of underlying disease. Only 2.8 % of patients were IV drug users. There were leukocytosis in 37.1% and increased ESR in 58.2% of cases. There was 39 positive wound culture. The most common isolated bacteria were S. aureus (51.2%), E.coli (15.3%), P. aeroginosa (10.2%). Resistance of S. aureous to cloxacillin and cepholotin were 60% and 75% respectively. 100% of S. aureus were sensitive to vancomycin. Resistance of P. aeroginosa to ceftazidim was 75%. Sensitivity of E.coli to ceftriaxone was 66.7%. Conclusion: Resistance of common bactrial causes of skin and soft tissue infections especially S.aureus, P. auroginosa to available antimicrobial agent is increasing. It must be considered to avoid unnecessary usage of antibiotic. Key Words: Clinical manifestation, Soft tissue infection, Antibacterial resistance ISE.141 PCR Detection and High Risk Typing of Human Papilloma Virus DNA in Cervical Cancer in Iranian Women G. Eslami, M. Golshani, M. Rakhshan, F. Fallah, H. Goudarzi. Shaheed Beheshti University, School of Medicine, Tehran, Iran (Islamic Republic of) Background: Cervical cancer is the second common type of cancer among women, worldwide and it is the second cancerous cause of death, particularly in women aged 25-65. In order to progress a cancer from dysplasia to invasive carcinoma, a series of cellular changes should occur. Since genital HPV carries oncogenes involving in these essential changes, today HPV has been considered as the most significant risk factor of cervical cancer. It is believed that HPV can increase the rate of cancer progression when associating with other risk factors such as smoking, taking contraceptive drugs, immunosuppression and etc. Materials and Method: Paraffin embedded cervical tissue of 70 patients with cervical cancer was analyzed by PCR method for presence of HPV. In addition, high risk typing of HPV positive samples was performed using HPV high risk typing PCR kit. Results and Conclusion: Among total patients 49% were positive for HPV. HPV16 was the most common HPV type detected from HPV positive cases. Investigation of age classification showed that the highest number of HPV positive cases belonged to age-group 35-44.We could not find any meaningful relation between HPV infection and neither educational status nor sort of job. Key Words: HPV, cervical cancer, PCR, biopsy ISE.142 The Clinical Significance of Serum A Polipopmteina-I in the Diagnosis of Acute Respiratory Infection Diseases X.W. Xu, D. Long. Shanghai First Hospital Attached to Jiaotong University, Shanghai, China Objective: To investigate the changes of serum apolipoprotein A-I and its clinical significance in acute respiratory infection. Methods: 44 patients with acute respiratory infection were divided into three groups according to various concentration of serum apolipoprotein

A-I. They were PCT<0.5ng/ml group,0.5 ng/mlPCT<2ng/ml group and PCT2ng/ml group. We measured apolipoprotein A-I, C-reactive protein, procalcitonin and albumin within 24 hours after admission. Results: With the increasement of concentration of serum PCT, the production of ApoA-I and albumin were down-regulated, while CRP up-regulated. Conclusion: Apolipoprotein A-I had a sound relationship with the acute respiratory infection. It can be used as one of the diadynamic criteria in severe infection patients who have disorders of lipometabolism. ISE.143 Detection and Identification of First Human Bocavirus (HBoV) Infection in Gungdong, China X.D. Lu, G.Y. Lin, Q. Wang, L. Huang. The Affiliated Shenzhen Futian Hospital of the Medical College of Guangdong, ShenZhen, China Background: A new human virus named human bocavirus (HBoV) was cloned from human respiratory tract samples and is considered to be pathogenic to humans in 2005. HBoV is currently being detected in patients with respiratory disease in several countries, such as Australia, Canada, France, China, Japan, Italy, suggesting that HBoV may be circulating worldwide. In this study, nasopharyngeal swab samples obtained from children with lower respiratory tract infections were investigated for the presence of HBoV and the first HboV have be finded in Guangdong, China. Methods: Human bocavirus was deteced by using PCR technology and was identified by using DNA sequences. Results: One strain of HboV was deteced and identified from 50 samples collected from children with acute respiratory tract infections. This HBoV was the first deteced from clinical samples in Guangdong. The VP gene amplified of HBoV from specimens was identified by sequencing and was compared with GenBank. The Guangdong HboV (GD-1) VP gene PCR products from the HboV positive samples was sequenced to confirm identity and construct phylogenetic trees. The nucleotides similarities were over 98% with Beijing strains, France strains, Canada strains and was over 36% with Korea KNIH-2K6GJ2713 strain and was over 77% with US NH4549 strain. Conclusion: HboV infection were existence in South of China and the detection it was a good starting point for an attempt to systematically explore. ISE.144 C-Reactive Protein as a Marker of Mortality in Intensive Care Unit M.F. Prieto1, S. Pezzotto2, J. Kilstein1, D. Bagilet1. 1Hospital Escuela 'Eva Perón', Granadero Baigorria, Argentina, 2Facultad de Ciencias Médicas, Rosario, Argentina Objective: To determine the prognostic value of C-reactive protein (CRP) and correlate it with the APACHE II score in patients admitted to the Intensive Care Unit (ICU). Design: Prospective, longitudinal study. Patients: We studied 879 patients who were admitted to the ICU for any cause during 2 years and were hospitalized at least for 24 hours. Method: The levels of CRP were determined at the admission time and the value of the APACHE II score at the 24 hours. We correlated the values of CRP with those of APACHE II score along with other variables (gender, age, disease al onset, length of stay). Results: The highest levels of CRP were those from subjects admitted for an infectious disease or shock-sepsis-multiple organ failure. Patients with CRP > 10 mg/dL were older, had higher APACHE II score, remained hospitalized for more time and the mortality rate was higher (p < 0.0001). The predictive value of CRP for mortality was higher as it increased in level with a specificity of 72.3% when these were over 10 mg/dL. Conclusions: CRP is an early and specific indicator of outcome, and along with its low cost it becomes a useful test at the admission to the ICU. Key Words: C-reactive protein, APACHE II, Intensive Care Unit, prognostic, mortality. ISE.145 Molecular Assessment of Antimalarial Drugs Resistance in Plasmodium Falciparum at Nuba Moutains, Southern Sudan R.U. Yusuf. Kenya Medical Research Institute, Nairobi, Kenya One of the major obstacles to the treatment of malaria is the emergence and spread of parasite resistant to antimalarial drugs. In most countries where malaria is endemic, P. falciparum malaria is on the rise. This is

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primarily due to the spread of drug- resistant strains of Plasmodium. Drug resistance is mediated by spontaneous change in the parasite genome that allows resistant parasites to escape the effect of the drugs. Due to increased Chloroquine resistance, the antifolate combinations are becoming increasingly important in the chemotherapy of falciparum malaria. However, resistant to antifolate exist and it is important to study it because they are still effective in the above combinations. Point mutations in the dihydrofolate reductace (DHFR) gene lead to resistance to the antifolate drugs. In this study, the efficacy of Artesunate in combination with SulfadoxinePyrimethamine (SP) or Amodiaquine will be evaluated. Detecting of Pfcrt and mdr1-86 will be employed to correlate the existing use and resistance to Chloroquine and Amodiaquine as monotherapy. Genotyping of MSP-1 and MSP-II antigenic marker will be employed to determine recrudescence cases and thus differentiate them from reinfection. It also considerable important to establish prevalence of the point mutation, codon 51, 59 and 108 among the field isolates of P. falciparum, and look for a correlation between these mutations and resistance of isolates to antimalarials. Nuba mountains, southern Sudan, an endemic malaria region will be the study site. The significance of the study will be to find out if indeed Chloroquine resistance exist as chemotherapy and combination of drugs improves SP therapy at the study site. ISE.146 Cervical Human Papillomavirus Carcinoma Screening in HIV Infected Cameroonian Pilote Study C. Doumbe1, L.C. Gouabe1, C. Djiepgan1, A. Ngono Ngane1, M. Koanga Mogtomo1. University of Douala, Douala, Cameroon, 1 University of Douala, Douala, Cameroon Cervical cancer is the second female widespread cancer in the world. It's the first death cause by cancer among women of developing countries. Cervical cancer constitutes a great problem in the reproductive health and affect women of all ages and social classes. It is induced by human papillomaviruses (HPV). HPV is responsible for more than 99% of cancer cases reported in the world. Women infected with human immunodeficiency virus may be at higher risk of developing cervical cancer than uninfected women. Cervical cancer is a sexual transmitted viral infection and is five times more under HIV co-infected women. We have studied the prevalence of cervical cancer among HIV infected under HAART and without therapy. To achieve this aims, we have conducted a routine cytological cervical cancer screening and CD4 count in 70 HIV infected women dived in two groups: 35 under HAART therapy and without therapy. The results divided were: 21/70 (30%) condyloma associated with HPV; within 13/21 (61.9%) and 8/21 (38.1%) were respectively under HAART and without therapy. CD4 count showed a relatively slow progression rate in HPV positive compared to HPV negative women in an equal length time of treatment. In conclusion, we noted that HIV and HPV co-infection increase the probability of progression towards an invasive cervical cancer, while HAART therapy slows it. Cofactors like early sexual activity, number of gravity and abortions and STDS', tend to increase cervical cancer risk. Key Words: Cervical Cancer, HIV, HPV, HAART ISE.147 Investigation of CMV by Shell Vial Antigenemia and Real Time PCR Methods S. Gokahmetoglu, G. Yagmur, F. Sariguzel, E. Deniz, Y. Ozbal. Erciyes University Medical Faculty, Department of Medical Microbiology, Kayseri, Turkey Serological tests, culture methods, CMV antigenenmia tests and molecular methods are applied in the diagnosis of CMV infection. In this study, our aim was to investigate CMV in blood specimens by antigenemia, shell vial and real time PCR methods. A total of 117 blood specimens from 72 patients were included in the study. Shell vial cell culture method was applied for CMV isolation. CMV antigenemia was investigated by indirect immunofluorescence method for the detection of pp65 in leukocyte. CMV DNA was tested by real time PCR (Fluorion, Iontek, Turkey) with primers and probes specific for the CMV glycoprotein B gene. Considering shell vial as the "gold Standard", the sensitivity, specificity of antigenemia methods and PCR were calculated. CMV was found positive in 68 (58 %) of 117 samples by shell vial, 75 (64 %) by antigenemia; 41 (35 %) by PCR. The sensitivity specificity were 85%, 63% respectively for antigenemia; and 39 %, 65 % respectively for PCR.

Three of the samples that CMV DNA was found negative in spite of CMV isolation and positive antigenemia were sequenced on Abi Prism 310 Genetic Analyzer (Perkin Elmer) and CMV DNA was found positive in these samples by DNA sequencing. When DNA sequencing of these samples were evaluated multiple mutations in the probe binding region were recognized. As a conclusion, DNA sequencing should be useful when CMV DNA was found negative in spite of CMV isolation and positive antigenemia. ISE.148 A Novel Antagonistic Relationship Between Human Sec3 Exocyst and West Nile Virus Capsid Protein R. Bhuvanakantham, M.L. Ng. Flavivirology Laboratory, Department of Microbiology, National University of Singapore, Singapore, Singapore Background: The Flaviviridae family consists of several medically important pathogens such as West Nile virus (WNV), Dengue virus and Yellow Fever virus. Flavivirus capsid (C) protein is a key structural component of viral particles. However the role of C protein in the pathogenesis of arthropod-borne flaviviruses is poorly understood. Methods: In order to elucidate the other non-structural functions of C protein in the pathogenesis of WNV, the host proteins that could interact with WNV C protein were screened using Y2H brain cDNA library. The combination of techniques such as mutagenesis, co-immunoprecipitation, RNA-immunoprecipitation, degradation assays were used to unveil the molecular mechanism underlying the virus-host protein interaction. Results and Conclusion: This study identified hSec3 exocyst protein as a hSec3p as a novel binding partner of WNV C protein. Mutagenesis studies delineated that the interaction occurred through SH2 domain binding motif of hSec3p and the first 15 amino acids of C protein. We report for the first time that hSec3p possesses intrinsic antiviral activity that impaired virus production by inhibiting viral RNA transcription and translation through the sequestration of Elongation factor 1 alpha. This study further elucidated the antagonistic mechanism by which WNV C protein negatively regulates the transcription, translation and the protein stability of hSec3p to circumvent the antiviral effects of hSec3p for successful infection. By revealing the molecular mechanism of WNV C and hSec3p interaction during WNV interaction, this study shed light on the new cellular functions of hSec3p. Currently, we are testing the outcome of virus infection by over-expressing the C protein-binding peptide of hSec3p. This study will subsequently pave the way towards the development of hSec3p-derived antiviral agent against WNV. ISE.149 Comparative study of Relative Frequency of HHV6 Genome in Malignant and Benign Lesions of Major and Minor Salivary Using PCR M. Razavi1, M. Shanehsaz2, S. Sharif3, N. Khodaeian4, M. Monirifard3. 1 Dental School, Isfahan University of Medical Sicence, Isfahan, Iran (Islamic Republic of), 2Dept. of Cytology & molecular Pathology Mohajer Lab., Isfahan, Iran (Islamic Republic of), 3General Dentist, Dental school, Isfahan University of Medical sciences, Isfahan, Iran (Islamic Republic of), 4Dental school, Isfahan University of Medical sciences, Isfahan, Iran (Islamic Republic of) Salivary gland neoplasms play a great role in maxillofacial pathology and have a global incidence record of 1­6.5 cases per 105 of the population while the record in Isfahan, Iran, is reportedly far greater at around 1.13%. Viral causes of neoplasm lesions are nowadays attracting more attention in the literature as a viable theory to explain these censers. A Variety of both malignant and benign. Herpes viruses related oral lesions have so far been identified, among which neoplasms closely related with HSV1, 2, CMV, EBV, HHV6 and more recently, leukemia, and cervical and oral cofactor carcinomas. Since no study had been conducted in Iran on the HHV6 impacts on benign or malignant salivary gland neoplasms despite the genetic, geographical, racial, dietary, and carcinogenic factors present in the population in this region, this study was designed to investigate the presence of HHV6 genome in benign and malignant tumors in both major and minor salivary in Iranian subjects. This analytical descriptive study was performed on 78 paraffin blocks of salivary gland tumors (38 benign salivary gland tumors including pleomorphic and monomorphic adenoma and 40 malignant salivary gland tumors including mucoepidermoid carcinoma and adenoid cystic carcinoma).

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Two pathologists were consulted for the verification of the diagnosis of lesions using the H-E lamella. Then all samples were examined by PCR and the data were analyzed with SPSS software and statistical tests of Chi-square. Fisher's exact and McNamara with Pvalue of 0.05. Among the 10 minor salivary gland mucoepidermoid carcinoma samples, 9 samples showed HHV6 genome positive and 2 samples of ACC in minor salivary showed HHV6 genome. In our study, we observed the HHV6 genome in 50% of the samples with malignant neoplasms and in 40 % of benign-positive samples. ISE.150 Identification HSV in CSF Samples via PCR Technique in Isfahan, Iran M. Shanehsaz1, R. Salehi2, M. Salehi2, N. Naghavi3, Z. Hojati4, R. Moradian5. 1Dept. of Cytology and Molecular pathology of Mohajer Lab., Isfahan, Iran (Islamic Republic of), 2Genetic and Biology school, Isfahan University of Medical sciences, Isfahan, Iran (Islamic Republic of), 3Islamic Azad University Branch Falavarjan, Isfahan, Iran (Islamic Republic of), 4Bilogy school of Isfahan University, Isfahan, Iran (Islamic Republic of), 5Genetic & Biologic school Isfahan University of Medical sciences, Isfahan, Iran (Islamic Republic of) Early recognition and treatment of HSV infection are important to reduce the mortality and incidence of serious neurological sequelae in patients. The polymerase chain reaction technique (PCR), used to detect herpes simplex virus DNA in cerebrospinal fluid (CSF), has greatly contributed to rapid non-invasive diagnosis, particularly of HSV infections in the central nervous system of both adults and neonates, emphasizing the importance of additional diagnostic tools for diagnosis of neonatal herpes. In this study, stored CSF and sera from patients with previously verified diagnoses of herpes simplex infections were analyzed retrospectively using highly sensitive nested PCR techniques for HSV a/HSV-2 DNA. The result were correlated with the patients' clinical data. Cerebrospinal fluid specimens from 40 patients with HSV infections, diagnosed between Mach 2003 and May 2007, were examined using the polymerase chain reaction techniques (PCR). HSV DNA was found in the cerebrospinal fluid of (65%) of 40 patients, and in the sera of 6 out of 1 patients (45%). In two patients HSV DNA was not demonstrable in either serum or cerebrospinal fluid. In sequential specimens from four patients, the persistence of HSV DNA after the end of intravenous treatment was associated with a poor prognosis. These findings indicate that HSV DNA detection in CSF and serum is highly sensitive for the diagnosis of HSV infections. ISE.151 The Validity of Acute Phase Protein Serum Amyloid A (SAA) as a Therapeutic Index of Acute Rhinosinusitis M. Shinogami1, M. Ohki2, S. Takamatsu3, Y. Murakami4, H. Yoshinami5. 1 Tokyo Metoroplitan Police Hospital, Tokyo, Japan, 2Musashino Red Cross Hospital, Tokyo, Japan, 3Takamatsu ENT clinic, Tokyo, Japan, 4 Sunamachi ENT Clinic, Tokyo, Japan, 5Saitama Medical University, Moroyama, Japan Background: As for much, to judge a curative effect for acute rhinosinusitis, we evaluate clinical symptoms, nasal endoscopy, radiography, C-reactive protein (CRP) and white blood cell counts. It is said that inspection is the most important in the diagnosis of acute rhinosisusitis. But it has much dispersion by the person. We think that an objective indicator is necessary in the diagnosis. CRP is a major indicator of inflammation, but CRP is not always elevated in acute rhinosinusitis. SAA is a candidate as another detector of inflammation. We investigated the diagnostic value of SAA in acute rhinosinusitis. Methods: 26 acute rhinosinusitis patients from November 2006 to August 2007 were enrolled in this study. All patients received antibiotics for 7 days. Clinical symptoms, nasal endoscopy, standard radiography, WBC, CRP and SAA were examined on the 1st day and the 7 days. One otolaryngologist checked all cases with an endoscope. Clinical scores were evaluated in the following items [headache, pain in upper teeth, facial pain, nasal obstruction, nasal purulence and postnasal discharge]. Results: Clinical improvement rates were 96 percent about clinical scores and SAA, 80 percent about standard radiography, 76 percent about WBC and 68 percent about CRP. As for the clinical scores and SAA, increase and decrease tendency corresponded with all cases. WBC was increased with 2 cases, didn't change with 4 cases. CRP was normal range with 4 cases, increased with 2 cases and didn't change with 2 cases.

Conclusion: We understood SAA was more sensitive test than WBC,CRP and standard radiography for acute rhinosisusitis. We think SAA is a useful indicator like clinical scores. ISE.152 The Effects of Aloe vera Juice on Lymphocyte Proliferation, Reactive Oxygen Intermediate Production and Bacterial Colony in the Liver of Salmonella typhimurium Infected Balb/c Mice I. Irmawati. Medical Faculty of YARSI University, Jakarta, Indonesia Background: Thypoid fever is serious illness caused by Salmonella thypimurium spread in the world such as Indonesia. This intracellular bacteria can stimulate immunity respon in the body such as cellular mediated immunity. Aloe vera is one of traditional herbal medicine which contains various active compounds like acemannan with immunomodulatory effect. Objective: This research was aimed to examine the effect of Aloe vera juice on lymphocyte proliferation, reactive oxygen intermediate production and bacterial colony in liver of Balb/c mice infected with Salmonella typhimurium. Method: This study was experimental study, using the post test only control group design in Balb/c female mice, 8-10 weeks and adapted for 1 week. Twenty four mice randomly divided into 4 groups: control group (K) and the 3 group was given A. vera juice, 0,1 ml/day (P1), 0,3 ml/day (P2) and 0,5 ml/day (P3) for 9 days. All groups were infected with dosage 105 cfu of S. typhimurium at 6th days. Samples were executed on 10th days for laboratory test: lymphocyte proliferation, ROI production and bacterial growth of the liver. Collected data were analyzed by using ANOVA and Kruskal Wallis test with significance p < 0,05. Result: The result showed that A. vera juice did not increase spleen weight (p= 0,705), but increased the count of lymphocyte significantly for P2 and P3 (p= 0,004), whereas P1 (p= 0,337) increased but not significant with control. The relative count of lymphoblast increased significantly in P2 (p= 0,011) and P3 (p= 0,002), but in P1 (p= 1,000) increased but not significant. ROI production of macrophage increased significantly in 3 group treatment with A.vera juice: P1 (p= 0,003), P2 (p= 0,004) dan P3 (p= 0,003). A. vera juice decreased bacterial count of liver significantly compared with control group: P1 (p= 0,037), P2 (p= 0,004) dan P3 (p= 0,004). Conclusion: A. vera juice administration in Balb/c mice infected with S. typhimurium can not increases spleen weight but is able to increase lymphocyte number, the relative count of lymphoblast, ROI production and could reduced the bacterial count in the liver significantly. ISE.153 A Experience to Treat the Patent with Lung Tuberculosis Complicated with Psycogenic Polyuria' K. Oshima, T. Nikaido, N. Nakagawa, S. Sekine, T. Ishii, J. Saito, T. Ishida, M. Munakata. Fukushima Medical University, Fukushima, Japan, Fukushima Medical University, Fukushima-pref., Japan Case: An 80-year-old man. He once had been misdiagnosed acute exacerbation of chronic obstructive pulmonary disease as acute heart failure. He was convinced that he had to keep a large amount of urinary volume. He was pointed out chest abnormal shadow in a private clinic. The smear of his sputum showed acid-fast bacillus. He was admitted to the ward for tuberculosis in our hospital. Therapy for tuberculosis has begun with Japanese standard regimen including 450mg of rifampicin, 300mg of isoniazid, 750mg of ethanbutol and 1200mg of pyrazinamide daily on admission. But he continued drinking a large quantity of water to make his urinary volume more after admission against our instruction. His average urinary volume was 6669±2844ml daily throughout admission. Bilateral infiltration due to tuberculosis on his chest CT scan showed no improvement after taking those drugs for three month. We thought that his drinking too much water and piles of his urinary volume decline the plasma concentration of anti tuberculous durgs. We measured the concentrations of isoniazid and rifampicin in his plasma. The result showed that the concentration of isoniazid is 1.8mcg/ml with the normal therapeutic range is 1-7mcg/ml, and that of rifampicin is 5.6mcg/ml with the normal therapeutic range is 4-32mcg/ml. Those values are near the lower limit. Therefore we increase the dose of isoniazid to 500mg and rifampicin to 600mg daily after three month of admission. Bilateral infiltration on chest CT showed was vastly improved. The smear of his sputum showed a few acid-fast bacillus and the culture of the bacillus turned negative. The patient with tuberculosis complicated with psycogenic polyuria is rare. The measurement of the concentration of antituberculous drugs is quite effective for such patient.

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ISE.154 Nucleoprotein Gene and Amino Acid Characterization Analysis of Genotype of Wild-type Measles Viruses Circulated in Wuhan of P.R. China Z. Zerong, W. Yuanhong. Virology Division of Wuhan Centers for Disease Prevention & Control, Wuhan, China Background: To explore the genetic characterization and amino acid mutation of nucleoprotein of wild-type measles viruses circulated in Wuhan city during Feb.­Apr, 2007. Method: RNA extracted from 87 throat swabs or urine specimens of measles patients was amplified by RT-PCR, 32 PCR products were selected to sequence for contrasting and analyzing. The 456 nucleotide sequence of COOH terminal of nucleoprotein (N) and phylogenic analysis were done among the wild-type and other representative strains with DNAMAN 5.2.9 Demo version. Result: The analysis indicated that 30 wild-type measles viruses belonged to H1a Sub-genotype. Another two strains were closed to H1a. The homology of nucleotide sequence among the wild-type strains was 98.03%-100%and the homology of amino acid sequence was 98.03%-100%. Compared with the representative strain H1a (AF045205, China 93-2), the homogeneity of nucleotide/amino acid was 97.4%- 99.1.%/95.4%- 99.3%, The homogeneity of nucleotide among the two wild-strains (Wuhan-57, Wuhan-63), H1a, H1b, H1c, H2 representative strains were 97.4%, 95.2%, 96.3%, 91.9%, 91.4%. There were about 61 nucleotides and 19 amino acids difference among the wildtype strains and China 93-2. Compared with H1a strain, There were two strains (Wuhan-57, Wuhan-63) that nucleotides had changed from G to A (142nd, 31 strains), A to G (247th, 31strains), C to A (301st, 32strains). Conclusion: It was the first time we knew that the genotype of measles virus circulation in Wuhan city were mainly belonged to H1a, and there were still two strains which we didn't know their sub-genotype. Compared with the H1a, the wild-type measles viruses had high-fidelity in nucleotide/amino sequences though three nucleotides had changed. We didn't know whether the mutation of nucleotide/amino sequences had led to the high incidence of measles in recent years. Key Words: Measles viruses, nucleoprotein gene, genetic characterization, sub-genotype ISE.155 Molecular Biology in the Diagnosis of Sleeping Sickness: Detection of Gambian Sleeping Sickness by PCR in Cameroon L. Kohagne Tongue, F. Louis, N.F. Dologuele. OCEAC, Yaoundé, Cameroon Background: Sleeping sickness or human African trypanosomiasis (HAT) is one of the major parasitic diseases of humans and its prevalence is increasing in many parts of the continent. This disease is caused by two sub species of protozoans, Trypanosoma brucei gambiense and T. b. rhodesiense. Diagnosis of Gambian sleeping sickness is problematic. Clinical signs are unspecific. Serological tests for specific antibodies such as the card agglutination test for trypanosomiasis (CATT) may be false negative if the specific Litat 1.3 antigen is not expressed or false positive during pregnancy or in the presence of tropical diseases. Parasitological diagnostic methods are more accurate but less sensitive because of the very low levels of parasitaemia encountered in the field. Case Report: A 25 year-old man was transferred to the regional HAT control program/OCEAC for a HAT suspicion. He had a progressive hypersomnia for two years. Clinical examination revealed a posterior cervical lymphadenopathy, drowsiness and otherwise normal condition. The patient resides in a former HAT focus called "Plaine des Mbos" in Cameroon. After a two month follow-up with a negative microscopic examination of lymph node aspirates, negative serological and parasitological tests, normal EEG but an elevated cerebrospinal fluid leukocyte count (25 cells/mm3) which is one of the criteria for the second stage HAT infection, PCR was used to confirm the diagnosis. DNA was prepared from the blood using the Ready Amp Genomic DNA Purification System kit (Promega) and amplified by PCR using specific primers TBR1 and TBR2 for T. brucei ssp, and TRBPA1 and TRBPA2 for T.b. gambiense. Differential banding was analyzed on a 2% ethidium bromide agarose gel. The result was positive. At present, the PCR is the most sensitive diagnostic method for HAT. Its application is more valuable in difficult cases.

ISE.156 Clinical, Biochemical Correlations and Viral Dynamics in Acute Hepatitis B A. Vata, C.M. Luca, D. Florea, M. Hurmuzache, V. Luca. UMF, Iasi, Romania Background: We aimed to identify the existing correlations between the different factors implicated in the evolution of acute infection with hepatitis B virus. Early indicators for the development of a severe/fulminant disease could be useful for an early appropriate therapeutic intervention. Methods: We studied the clinical, biochemical characteristics and viral markers of 133 patients diagnosed with AHB in the Infectious Diseases hospital from Iasi, Romania, between 2004 and 2006. The viral markers (HBsAg, HBeAg, HBcAc) were tested semi-quantitatively (sample/cutoff ratio) at admission using enzyme immunoassays (Cobas®). The hepatitis B virus DNA (HBV-DNA) was assessed in 19 patients (Roche Amplicor). Results: The initial IgM anti-HBc antibody titer (S/CO) was lower in the anicteric AHB and was correlated with the serum bilirubin level (SBL) (rs=0.37, p=0.018) in icteric cases. The initial concentration of HBsAg (S/CO) was lower in icteric AHB, in patients with severe disease and was correlated with the maximum SBL. HBeAg was present in 53.3% of patients at admission and correlated with higher ALT levels. The early loss of HBeAg was associated with severe AHB (p=0.027). The HBsAg titer (S/CO) was higher in HBeAg positive patients (p=0.045). HBV-DNA was detected in 84.2% of the patients tested, with a mean level of 4.32 log10 copies/ml. An intense correlation was observed between the HBVDNA levels, HBsAg titer (rs=0.58, p=0.037) and HBeAg titer (rs=0.73, p=0.0045). There were no correlations between the HBV-DNA and biochemical or clinical data. Conclusion: Anicteric AHB had lower initial levels of IgM anti-HBc and higher levels of AgHBs. The early loss of HBeAg was associated with severe AHB. The HBV-DNA was present at admission in most patients tested, at moderate levels and was correlated with HBsAg and HBeAg titer. ISE.157 Variability of the Reverse Transcriptase Domain in Treated Chronic Hepatitis B Patients M. Basaras1, E. Arrese1, S. Blanco2, M. Sota3, B. de las Heras4, R. Cisterna5. 1Dept. Immunology, Microbiology and Parasitology. University of Basque Country, Bilbao, Spain, 2Digestive Service. Basurto Hospital, Bilbao, Spain, 3Microbiology Service. Basurto Hospital, Bilbao, Spain, 4Digestive Service, Basurto Hospital, Bilbao, Spain, 5Dept. Immunology, Microbiology and Parasitology. University of Basque Country. Microbiology Service. Basurto Hospital, Bilbao, Spain Background: Different hepatitis B virus (HBV) variants carrying point mutation at level of the reverse transcriptase (rt) domain has been detected in patients under treatment with lamivudine (LAM) and adefovir dipivoxil (ADV). The aim of this study was to identify mutations associated to those antivirals in patients with chronic hepatitis B using rapid test detection. Patients and Methods: Fourteen serum samples from chronic HBV patients were analysed using INNO-LIPA HBV DR v2 assay (Innogenetics). Serum HBV nucleic acid was isolated and quantified using a real time PCR assay COBAS Taqman HBV test (Roche Diagnostics). Hepatitis B virus HBsAg, anti-HBs, HBeAg and anti-HBe were determined by ADVIA Centaur (Bayer). Results: Three of the 10 patients treated with ADV had ADV-resistant HBV mutations: one patient had dual mutations at rtA181V and rtN236T at 21 months of treatment with 4.3 log10 copies/mL; second patient had a single mutation at rtA181V at 3 years with 1.5 log10 copies/mL; and last one had also a single mutation at rtN236T at 4 months with 4.8 log10 copies/mL. The first two patients were women and had received prior LAM. Just the patient with dual mutations was HBeAg-positive. Only one of the 4 patients treated with LAM had HBV dual mutations (rtL180M and rtM204I) at 9 months of treatment with 4.1 log10 copies/mL. This patient is been treated with LAM plus ADV and had rapid virologic response with undetectable serum HBV DNA with 18 months. All patients with resistance were infected with genotype D. Conclusions: Our study is limited by the small number of patients. Nevertheless, it highlights the importance of resistance mutation testing using a rapid detection test in chronic HBV patients treated with nucleos(t)ide analogues. Resistance mutations are associated with rapid virological breakthrough and in one patient mutation were detected in just four months of treatment.

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ISE.158 Antigenic Activity of the HCV Recombinant Nucleocapside Polypeptide Containing the Two Similar Repeats B-Epitope E.G. Fomina, E.P. Scheslenok, T.V. Schkolina, P.A. Semizhon, A.S. Vladyko. Research Institute for Epidemiology and Microbiology, Minsk, Belarus In order to develop a reliable serodiagnostic method a nucleotide sequences coding antigenic determinants nucleocapside protein HCV (NP a.a. 6-21) was subsequently cloned into the polylinker T7 expression vector (pJC40). The resulting protein which includes two repeats antigenic determinants, was over expressed in E.coli and purified. It was interesting whether this protein showed high sensitivity and specificity for the detection of anti HCV antibodies in testing human plasma. An expression plasmid pJC2Mcorehcv was constructed using standard procedures. E.coli strain DH5 was used as recipients of recombinant plasmids and strain BL21(DE3) - as a host to produce HCV antigens. The recombinant protein was purified using metal chelate chromatography. Enzyme-linked immunosorbent assay and immunoblot were used to detect sensitivity and specificity the recombinant protein. The amino N-terminal of NP HCV a.a. 6-21 KPQRKTKRNTNRRPQD are highly conserved and strongly antigenic. This fragment was used as antigen to diagnose HCV infection. An expression plasmid pJC2Mcorehcv which produced two repeats antigenic part NP HCV was constructed. The recombinant polypeptide was over expressed in E.coli strain BL21(DE3) induced by 0,4 mM IPTG. A 3h induction was determined to be optimal to reach a maximal level of protein expression. The expression protein has 6xHis tag in the N-terminal and has been purified by using Ni-NTA purification system. In order to determine the sensitivity and specificity this polypeptide as an antigen for the detection of anti HCV antibodies in HCV positive human plasma the immunoassay was carried out. HCV positive plasma and normal control plasma were used as testing samples. Purified protein reacted only to antibodies in the HCV positive plasma showing a high sensitivity and specificity. These results suggest that this recombinant polypeptide may be included into the mixture of several antigens which were widely used in diagnostic procedures to increase the sensitivity of HCV infection detection. ISE.159 Cross-Reactivity of the BSA Fragment with HFRS Sera A.S. Vladyko, E.P. Scheslenok, E.G. Fomina, T.V. Schkolina. Research Institute for Epidemiology and Microbiology, Minsk, Belarus BSA-bovine serum albumin, the main protein of plasma, has a good binding capacity for water, Ca(2+), Na(+), K(+), fatty acids, hormones, bilirubin and drugs. Its main function is the regulation of the colloidal osmotic pressure of blood. HFRS - hemorrhagic fever with renal syndrome - human hantaviral infectious. Hantaviruses (Bunyaviridae family) are enveloped, single-stranded, negative-sense RNA viruses with a tripartite genome consisting of a small (S), a medium (M), and a large (L) segment, which encode the nucleocapsid protein (NP), the glycoprotein precursor (GPC) and the putative RNA polymerase (L-protein), respectively. Hantaviruses Hantaan (HTNV), Dobrava/Belgrade (DOBV), Seoul (SEOV), and Puumala (PUUV) are transmitted to humans through aerosols of excreta from small mammals, mice that have silent life-long infections. In humans fatality rate is from <1% to 30%. The similar antigenic determinants in BSA and NP proteins of hantaviruses were find. It was interesting to confirm a cross-reactivity between these peptides. In these experiments wxGenebee computer program, enzyme-linked immunosorbent assay (ELISA) as well as immunoblot (IB) tests were used. The computer hydrophobic amino acid analysis of PUUV NP and BSA proteins showed the presence of similar amino acids sequences. It was interesting to estimate the participation of the bovine serum albumin (BSA) fragment that contains the similar amino acid sequence in an antigenic activity with HFRS sera. It was showed that one of many BSA fragments, produced by hydrolysis with the chemotrypsin, contains three amino acids sequences: N'-HADICTLPDT-EKQIKKQ-TALVELLKHK-PKAT-EEQLKT-VMENF-C' (bold letters) similar to one of the four B-epitopes of NP: N'-EEKLKKKSS-C' of PUUV. IB test confirmed the reactivity of the BSA fragment with the sera, received from HFRS patients. We assume that the BSA peptide fragment may be used to detect of the PUUV antibodies in diagnosis of HFRS in patients.

ISE.160 c-myc Gene Expression and Helicobacter pylori Quantification in Biopsies from Patients with Gastric Cancer by Real Time PCR G. Castillo-Rojas1, O.R. Suaste-Villanueva1, F. Quiñones2, Y. LópezVidal1. 1Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Distrito Federal, Mexico, 2Instituto Nacional de Enfermedades Respitatorias, Distrito Federal, Mexico Background: Gastric inflammation induced by H. pylori chronic infection is associated with an increased risk for development of peptic ulcer disease and gastric adenocarcinoma. Tumor presence is detected in advanced stages of the disease in almost 80% of patients because there is not efficient tool to early diagnosis of the disease. Several studies evaluated different individual possible molecular markers in order to find the association between gastric cancer and H. pylori infection; however these molecules have not been useful as diagnostic or prognostic tools. We purpose was study the expression of c-myc and if this is an association with bacterial density of H. pylori. Methods: Nineteen patients (6 gastric cancer and 13 chronic gastritis) were studied. RNA and DNA were obtained from biopsies. RNA was used to evaluate c-myc gene expression by real time two step RT-PCR using pre-designed primers and Taqman probe, fluorescence results were normalized to 18S RNA gene expression. Genomic DNA was used to detected and quantify the bacterial number by real time PCR using primers and Taqman probe home designed to amplify a region from the H. pylori ureB gene. Results: Analysis of c-myc gene expression showed no significant differences between patients with gastric cancer and chronic gastritis. We were able to detect the DNA quantity equivalent to 100 H. pylori genomes, however, we found no significant bacterial density when comparing patients with gastric cancer and chronic gastritis. Conclusion: The detection of c-myc and bacterial density of H. pylori showed not association between gastric cancer and H. pylori infection. ISE.161 TT Virus Infection in Patients with Chronic Hepatitis B and Healthy Individuals in Iran S.R. Mohebbi, A. Jahangirnejad, D. Yasharal, N. Zali, F. Derakhshan, M.R. Zali. The Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Islamic Republic of) Torque Tenovirus (TTV) is a novel, non-enveloped DNA virus with a single-stranded, closed circular genome. This virus was classified under the Anellovirus genus; Circoviridae family. TTV DNA was detected in a high proportion of patients with chronic liver diseases but the clinical significance of infection with TTV alone or in combination with hepatitis B virus has been questioned. The aim of the present study was to investigate the rate of TTV infection in patients with chronic hepatitis B in comparison with Healthy individuals in Iran, and to examine its clinical significance. A total of 131 randomly selected serum samples were obtained (88 males, 43 females; 77 chronic HBV patients, 54 healthy, age ranged from 13 to 84 years; mean 36.9±15.5 years). All samples were rechecked for anti-HBc antibody, HBsAg and HBV DNA. ALT, AST and ALP levels were also determined. A nested-PCR was developed to amplify the UTR region of TTV DNA. Totally, 76 of 131 (57.6%) samples were positive (63.6% male, 46.6% Female). TTV DNA was detectable in 31 (57.4%) of 54 healthy individuals and 45 (58.4%) of 77 HBV infected patients. ALT, AST and ALP mean levels between HBV and TTV positive patients were 57±54.1, 49±35.5, and 245.6±96.2 but in HBV infected patients with TTV negative results were 55.2±44.7, 57.6±60.1 and 216.1±153.5. Results in the healthy individuals group with TTV infection were 21±7.2, 20.6±13.2 and 202.7±54.5 but in healthy individuals without TTV infection were 26.2±17.4, 18.9±8.3 and 222.6±70.2 IU/L. The results indicate that TTV infection is found frequently in patients with chronic hepatitis B or Healthy individuals in Iran. ALT and ALP levels were higher in chronic HBV patients infected with TTV compared to patients, who were TTV negative, but these differences weren't statistically significance. It seems that TTV doesn't have any effect on liver injury or disease severity. ISE.162 A Comparison of Standard Serological Tests with an ELISA Based on Recombinant BP 26 Protein, for the Diagnosis of Sheep Brucellosis in Iran S.D. Hosseini. Razi Vaccine & Serum Research Institute, Arak, Iran (Islamic Republic of)

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The diagnosis of brucellosis in cattle and small ruminants requires the use of more than one serological test. The complement fixation test (CFT), the rose bengal test (RBT), and the serum agglutination test (SAT) are among the most useful tests for routine diagnosis. Four serological assays: the Complement fixation, the Rose Bengal plate, the Serum agglutination, and the 2Mercaptoethanol (2ME) test were diagnostically evaluated for the diagnosis of Brucella infection in unvaccinated sheep with a known bacteriological status, and their diagnostic efficacy was compared with an indirect enzyme-linked immunosorbent assay (iELISA) test based on recombinant protein. To develop the iELISA, the recombinant BP 26 protein fused with His tag, was produced in Escherichia coli and purified for producing an BP26- ELISA. Test data consisted of results from 250 sheep in brucellosis-free herds, 620 sheep in reactor herds of unknown infection status. The complement fixation test had the highest specificity in both nonvaccinated and vaccinated sheep. The indirect enzyme immunoassay, if interpreted at a high threshold, also exhibited a high specificity in both groups of sheep. All tests showed 100% specificity when testing the sera from 250 Brucella-free sheep. When testing the sera from 219 Brucella melitensis culture-positive sheep, both the iELISA and CF tests were more sensitive (98.6% and 96.8%, respectively) than the RB, SAT and 2ME tests (95.0%, 93.7%, and 79.9% respectively). These results were similar when testing the sera from 98 animals belonging to infected flocks but found bacteriologically negative, suggesting that the iELISA based on recombinant BP 26 could advantageously replace the current RB procedure used as the screening test and BP26 protein may be an additional suitable antigen for serological diagnosis of brucellosis. ISE.163 Epstein-Barr Virus Infection in Patients with Persistent Lymphadenopathy T.A. Garanzha, A.L. Melikyan, D.S. Tikhomirov, E.Y.U. Varlamova, I.B. Kaplanskaya, L.G. Kovaleva, F.P. Filatov. Hematology Research Center (HRC) RAMS, Moscow, Russia Introduction: Lymphadenopathy (LAP) is one of the symptoms used for differential diagnostics in hematology. Histological analysis of lymph nodes bioptates from HRC patients indicated 21% of nontumor changes. Most of these patients have persistent relapsing LAP of unclear etiology, frequently with fever. The reliability of histological analysis was found to be insufficient. On the other hand viral diagnostic in most cases allowed to detect acute or reactivated EBV infection in these patients. Aim: To investigate relation between relapsing lymphadenopathy and active EBV infection. Materials and Methods: Target group included 62 ambulatory patients of HRC including 45 females and 17 males with nontumor lymphadenopathy followed from 2000 till 2006. LAP duration ranged from 3 months to 5 years. Qualitative IgM-VCA, IgG-EA and quantitative IgGEBNA-1 EIA was used. It was taken 42 lymph node bioptates. Histological and immunohistochemical analysis was done using antibody panel DakoCytomation, Denmark CD3, CD4, CD5, CD8, CD7, CD20, CD23, CD 26, CD 38, CD45RA, CD79a, CD138, MB2, antikappa, anti-lambda, cyclin D1, bcl-2, ALK, anti-EBNA-2. Total amount of IgA, IgM, IgE, IgG, circulating immune complexes (CIC), fractions of different proteins (alpha1-, alpha2-, beta- and gamma-globulins) in blood serum was found with the help of immunochemical methods. Results: Markers of active and latent EBV infections were found in blood serum samples of 57 patients with persistent relapsing LAP. Acute infection with presence of IgM-VCA, IgG-EA-antibodies was detected in 33 patients. In blood serum of 24 patients it was found only IgG-EBNA1 and only in 16 patients out of 24 the level of IgG-EBNA-1 was considerably above normal levels. All those patients were diagnosed with persistent EBV infection. Relapsing infectious mononucleosis was found in 8 patients. Diagnostic failed for 5 patients. Only 15 samples of bioptates out of 42 were EBV positive confirming unreliability of histological testing. It was found inverse correspondence between amount of betaglobulins (C3 component of complement) and the level of antibodies to EBNA-1: when the level of antibodies to EBNA-1 increases, the amount of betaglobulins decreases. Conclusions: EBV activation may lead to long lasting relapsing LAP. Patient immunodeficiency implies high risk of developing EBV infection which in turn may further suppress immune system. Viral diagnostics in lymph nodes requires more than one marker.

ISE.164 Reverse Transcriptase Multiplex PCR for Central Nervous System Infections V. Gopalakrishnan. UNIKL RCMP, Ipoh, Malaysia Viral infections of the central nervous system (CNS) may result in clinical syndromes like aseptic meningitis, encephalitis, and myelitis. These are often difficult to diagnose using conventional laboratory methods, such as viral culture and serology, because they are time consuming and unsatisfactory. Hence rapid techniques should be employed to detect the etiologic agent. The study was aimed to standardize reverse transcriptase (RT) multiplex PCR aimed to detect viral etiology in CNS infections. An RT multiplex PCR designed to detect, viral etiologies, enterovirus, herpes simplex and varicella zoster viruses in CNS infections has been standardized. Three sets of primers were been employed for their detection. Amplification of target sequences was qualitatively analyzed by looking for the presence or absence of amplicons on a 1.5% agarose gel. The RT multiplex PCR was standardized. Sensitivity of the PCR has been ascertained. The RT multiplex PCR standardized can be employed to detect infections caused by herpes, varicella and enterovirses. ISE.165 Adenoviral Infection Associated with Different Syndrome in Cuban Patients O. Valdes, B. Acosta, A. Piñon, C. Savon, A. Goyenechea, G. Gonzalez, G. Gonzalez-Baez, L. Sarmiento, M.G. Guzman. Tropical Medicine Institute Pedro Kouri, Havana city, Cuba Background: Adenoviruses are common pathogens which are responsible for a wide variety of infectious syndromes. Serosurveys suggest that virtually all people are exposed to these Ads during childhood. They can be retained in an asymptomatic carrier state until at least young adulthood and may be actively shed long after symptomatic infection. Objectives: The identification by PCR, molecular characterization by sequencing of different species adenoviruses and to describe the correlation of viruses and clinical syndromes Methods: 512 respiratory specimensfrom patients with Acute Respiratory Tract Infection were sent specifically to the National Reference Laboratory of Respiratory for testing respiratory viruses. In all cases, nucleic acid extracts (5 µL) were examined for influenza viruses A, B and C, Advs, RSV A and B, Parainfluenza viruses, Coronaviruses, Rhinoviruses, and EV using nRT-PCR. In addition, in a patient with encephalitis was used an assay multiplex nPCR for Herpesvirus Results. Our investigation identified 49 confirmed cases of human AdV infection. The most common diagnose was upper respiratory infection (44 %). The major subgenus found was subgenus D (59%). Adv 5 was the major serotype found producing bronchiolitis. Four isolates from clinical materials obtained from patients with encephalitis, acute flaccid paralysis and meningoencephalitis were identified as Adv D. Conclusions: Finally, our findings, combined with the existence of several reports concerning the association of adenoviruses with different syndromes confirm that adenoviruses, mainly the serotypes belonging to the species C are common causal agents of respiratory infection. In contrast, serotypes of species D might be involved in the aetiology of acute respiratory infection and neurological disorders. However, this observation needs to be confirmed in a larger study.

Emerging Diseases, Zoonoses and Infections in Animals

ISE.166 Rabies Infection of Children in Bosnia--Post-Exposure Prophylaxis A. Bajraktarevic. Public Health Institution Sarajevo, Sarajevo, Bosnia and Herzegovina Background: The recommendations for children given here are intended as a general guide, but each child has their own specific characteristics. Although rabies infections in childhood are rare, they can cause serious health problems. Methods: Post-exposure prophylaxis (PEP) is any prophylactic treatment started immediately after exposure child to a rabies disease in Bosnia and Herzegovina. The treatment consists of repeated injections of rabies vaccine and immunoglobulin.

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Results: PEP is commonly used, and very effective, to prevent the outbreak of rabies after a bite by a rabid animal. Post-exposure treatment, which consists of local treatment of the wound, followed by vaccine therapy (with human rabies immunoglobulin) should be initiated immediately with contacts of categories II and III, but for category I (touching or feeding animals, licks on the skin), no treatment is required in our cases in Bosnia. Discussion: Only the cell-derived vaccines that meet the WHO requirements regarding safety, potency and efficacy for this application may be considered for intradermal use. Conclusion: It has been shown that purified equine rabies immunoglobulin products cause adverse reactions in 3% of vaccinees in Sarajevo, even when sensitivity tests are performed prior to their administration. Unpurified anti-rabies serum should be avoided whenever possible especially in children. The rabies situation is very bad after Bosnian war (1992-1995); a large number of dog bites during last twelve years make a major pediatrics experience in this medical practice in Bosnia and Herzegovina. Key Words: Children, Kids, Rabies, PEP, Post-exposure prophylaxis (PEP), Bosnia. ISE.167 Zinc and Copper Concentration in Patients with Brucellosis and to Compare Control Group Come in to Imam Khomeini Hospital in 2006 S. Jafari1, A. Alipouran1, M. Haj Abdolbaghy1, A. Mobayen2, A.A. Saeedi1, B. Alaghy1, R. Sharififar1. 1Tehran University, Tehran, Iran (Islamic Republic of), 2Hamadan University, Hamadan, Iran (Islamic Republic of) Background: There are some reports about influence of rare nutrients such as copper and zinc on immune system. Serum concentrations of these nutrients have been evaluated in different diseases. Also, Serum concentrations of these nutrients alter in patients with brucellosis. Brucellosis is a common and endemic disease and a health problem in our region, so, we decided to compare serum concentrations of zinc and copper in patients with brucellosis and healthy individuals. Objective of this study was measuring alterations of serum zinc and copper concentrations in patients with brucellosis in comparison with healthy individuals. Materials and Methods: In a cross sectional study, serum concentrations of zinc and copper were measured in patients with brucellosis and control group. Eighty six subjects were enrolled in the study, including 43 patients with brucellosis (34 men and 9 women) and 43 healthy individuals. Serum concentrations of zinc and copper were measured by automatic absorptive spectrophotometer in patients with brucellosis and compared with control group. We used SPSS software for windows, version 11.5 for descriptive and inferencive analysis. Also we used a non parametrical test, kolmogrov-smirnov, to determine if data distribution is normal or not. Results: Mean age of patients with brucellosis was 40.14+15.10 years with the range of 14 up to 60 years old. Serum concentrations of copper in patients with brucellosis were significantly higher than healthy subjects (160.84 +54.61, 101.74 +27.37 micg/dl respectively, p<0.00). Serum concentrations of zinc, in patients with brucellosis were lower than those of healthy subjects, but there was no significant difference (91.47+46.91, 107.19 +35.18 micg/dl respectively, p<0.08).however, in women with brucellosis, serum concentrations of zinc were significantly lower than healthy women.(80.33 +44.20, 119.11 +28.17 micg/dl respectively, p<0.04) Conclusion: Serum concentrations of copper and zinc in patients with brucellosis showed significant alterations in comparison with healthy subjects. So, we recommended to use serum copper and maybe zinc concentrations in patients with brucellosis, before and after treatment, for following response to treatment. Key Words: brucellosis, copper, zinc ISE.168 Drug Resistance of Enterococcus E. Mirsamadi. Shahid Beheshty University, Tehran, Iran (Islamic Republic of) Enterococci are commensals of human and animal intestinal tract that have emerged in the last decades as a major cause of nosocomial infections of bloodstream, urinary tract and in infected surgical sites. The present prospective study was carried out to determine the antimicrobial susceptibilities of enterococci isolated from clinical samples in a tertiary care hospital of Iran. Enterococcus species isolated from urine

from mehr 1381 to mehr 1385 were identified by standard biochemical tests. Antimicrobial susceptibility testing was performed by the disk diffusion method. Susceptibility testing for 15 antibiotics was performed in a series of 228 clinical enterococci recovered in a teaching hospital shohada tajrish from mehr 1381. The percentages of antibiotic resistance detected were as follows: penicillin (71.6%), tetracycline (85.7%), cephalexin(85.2%), erythromycin (61.6%), cloxacillin (100%), steroptamycin (100%), trimethoprim-sulfamethoxazole (90.7%), ampicylin-amoxicylin (19%), vancomycin (11.5%), gentamicin (64.6%), nitrofurantoin (57.6%) and Amikasin (59.1%).ciprofloxacin (50.9%) doxycycline (75%) clindamycin (88.9%) cephalothin (84.1%) Infection control and monitoring of antibiotic sensitivity among isolated hospital strains may prevent the transmission of resistant strains in a hospital. ISE.169 Risk Infections and Threats for Bioterrorism K. Metodiev. Intl. Medical Association Bulgaria, Varna, Bulgaria The author depicts in details the history and present state of severe infections and the risk of their application for bioterrorism. The structure, collaboration and mutual projects of national and international clinical and laboratory institutions, as well as the coordination between health civil and military organizations is widely discussed. The role of the ARW of NATO on the topic is also presented, based on the author's experience as Director of one recent ARW. ISE.170 Current Status of Avian Influenza in Nepal and Control Strategy K. Sharma. Central Veterinary Laboratory, Kathmandu, Nepal Nepal lies between China in the north and India in the south where Highly Pathogenic Avian Influenza (HPAI) is already reported and outbreaks are occurring frequently. A surveillance program was conducted in 16 high risk districts of Nepal where high number of poultry and risk of getting disease was very high. Till now we are able to prevent this disease in the country. There are 8 quarantine offices and 16 quarantine check post are actively involved in patrolling and supervision of import export of poultry and poultry products. Four hundred and forty-six serum samples were collected from ducks, chickens and pigeons and tested for influenza A virus by competitive enzyme linked immunosorbent assay (C-ELISA) in Central Veterinary Laboratory (CVL). One hundred and thirty five cloacal swab from ducks and chickens were tested using commercially available Avian Influenza detection kits. The influenza virus was not detected in any of these tested swab and serum samples. Therefore we are free from HPAI virus infection in Nepal till to date. ISE.171 Rat Bite Fever: A Threat or Not? W. Gaastra1, L.J.A. Lipman2, H. Ho3. 1 Dept. Infectious Diseases and Immunology, Faculty Veterinary Medicine, University Utrecht, Utrecht, Netherlands, 2 Division Veterinary Public Health, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands, 3 Faculty of Animal Husbandry and Veterinary Medicine, Nong Lam University, Ho Chi Minh City, Vietnam Rat bite fever is a bacterial zoonosis transmitted through the bite of rats. Two unrelated etiological agents have been identified in rat bite fever: Streptobacillis moniliformis and Spirillum minus. The disease which is not reportable, is rare but very likely under diagnosed and occurs worldwide. Rat bite fever caused by Spirillum minus occurs mainly in Asia and Africa, whereas rat bite fever caused by Streptobacillus is more prominent in the rest of the world. Haverhill fever is a form of Streptobacillus moniliformis infection where ingestion of food or water contaminated by rat excrements is the route by which the disease is contracted. If not treated adequately rat bite fever may be fatal even in previously healthy individuals. Antibiotic therapy is however available and effective. The infectious agents, the clinical signs in animals and animal carriers, the potential transmission routes and prevention and the clinical signs in humans are discussed to answer the question: Rat bite fever a threat or not? ISE.172 Adherence and Invasive Potentials of Arcobacters Isolated from Humans, Chickens and Pigs Y.O. Adesiji1, K.O. Amisu2, A.O. Coker3. 1Ladoke Akintola University of Technology, Osogbo, Nigeria, 2Lagos State University, Ojo, PMB 1087, Lagos, Nigeria, Lagos, Nigeria, 3University of Lagos, Lagos, Nigeria

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Arcobacters are emerging food-borne bacterial pathogens with increasing evidence of zoonotic potential but specific virulence properties remain unknown. Adherence and invasive activities of the bacterial strains isolated from humans and animals were investigated using human colon carcinoma cell line, Caco-2. Broth cultures (2 x 108 CFU) of Real-Time PCR confirmed 10Arcobacter (A. butzleri and A. cryaerophilus) isolated from humans (4), chickens (4 ) and pigs (2 ) were added to confluent monolayer of caco2 in triplicate in 24-multiwell tissue culture plates under standardized conditions (stationary phase cultures, MOI: 100: 1). Minimal essential medium (MEM), 1% Fetal Bovine Serum (FBS) and 1% nonessential amino acids (Gibco) without antibiotics and incubated at 37°C for 3 and 48 hours in a 5% CO2 atmosphere respectively. Adhesion and invasion assays were evaluated by plating serial dilutions of cell lysates on nonselective blood agar plates, incubated and colonies formed were counted. The ten Arcobacter isolates were positive for adherence and 70% of them showed high invasiveness of >1,000 CFU ml-1. The number of bacteria that adhered ranged from 1.0 x 105 to 1.7 x 108 CFU ml-1, representing 0.001 to 1.9% of the bacterial inoculum. The number of invasive bacteria ranged from 1 x 103 to 6 x 105 CFU ml-1, representing 0.0001 to 0.05% of the bacterial inoculum. Adherence and invasive attributes of the test strains suggest Arcobacter is endowed with ability to compete favorably for host surface in initiation of infection and penetration of tissues apparently depend on strain type and inoculum dose. Inhibition of Arcobacter adherence by vaccination may provide effective control measure. Key Words: Arcobacters, Adherence, Invasion Acknowledgement: PCR confirmation of isolates, provision of cell line and tissue culture experiment was carried out with the assistance of laboratory support by Prof. Francis Megraud of Laboratoire de Bacteriologie, Hopital Pellegrin, Place Amelle Raba Leon, 33076 Bordeaux, France. ISE.173 Preventive Practice of Dengue in Salaya Community of Phuttamonthon District, Nakhon Pathom Province, Thailand A. Win, W. Tuntaprasart, C. Boonshuyar. Mahidol University, Bangkok, Thailand A cross-sectional study on preventive practices of dengue was conducted in Phuttamonthom District, Nakhon Pathom Province, Thailand between January 29 and March 2, 2007 by interviewing 201 villagers based on constructed questionnaires. The aims of the study were to identify the preventive practices of dengue and its associating factors. The results revealed that half of them had moderate level of knowledge and another half had high level. Over 60% had high level of knowledge about vector control measures and another 60% had moderate level of knowledge about dengue transmission. However, most of the respondents (95%) needed improvement for preventive practice whereas another 5% showed moderate level. All the respondents (100%) had high level of perception. Concurrently, larval survey was investigated and showed house index as 56.21%. No statistically significant association between general characteristic, knowledge, perception, container index and practice of dengue vector control measures was found in this study. Therefore, community participation should be emphasized and we should motivate people by short training or educational campaigns based on practical vector control measures. Key Words: Preventive Practice, Dengue, Nakhon Pathom Province. ISE.174 Rapid Diagnosis of Acute Meningitis Using Reagent Strips M. Mamani, S.H. Hashemi, A. Niayesh, S. Jamal-Omidi, J. Soheylifar, A. Monsef-Esfahani. Hamedan University of Medical Sciences, Hamedan, Iran (Islamic Republic of) Background: Examination of cerebrospinal fluid (CSF) glucose, protein and cells is necessary for diagnosis of acute meningitis. Reagent strips have been used for rapid CSF analysis with varying results. The aim of this study was to determine the usefulness of reagent strips in the evaluation of pleocytosis, CSF glucose and protein levels for early diagnosis of meningitis. Methods: CSF samples from 79 patients with clinical suspicion of meningitis were tested for protein, glucose and leucocytes with reagent strips. The results were compared with those obtained from the standard laboratory evaluation. Results: CSF analysis by standard laboratory method identified 21 cases of probable bacterial meningitis, 18 of aseptic meningitis and 40 with normal CSF.

By comparing the results of reagent strips we obtained that reagent strips leukocyte esterase test effectively distinguished bacterial from aseptic meningitis (sensitivity 95.2%, specificity 100%, P<0.001) and bacterial meningitis from normal CSF (sensitivity 95%, specificity 82/5% P<0.001). Conclusion: Reagent strips can be used for the rapid CSF analysis and distinguish normal from infected CSF and are of value in the diagnosis of meningitis. ISE.175 Methicillin and Vancomycin-Resistance in Clinical Isolates of Staphylococcus aureus from University Hospitals in Hamadan, Iran M. Mamani, S.H. Hashemi, R. Yousefi-Mashouf, M. Sayficar, S. JamalOmidi. Hamedan University of Medical Sciences, Hamedan, Iran (Islamic Republic of) Background: Staphylococcus aureushas long been recognized as a major pathogen of hospital acquired infections. Over the last decade, methicillin- resistant S. aureus (MRSA) strains have become endemic in hospitals worldwide. In addition S. aureus with reduced susceptibility to vancomycin have been reported in the last years. In this study, we assessed the antimicrobial susceptibility pattern and prevalence of methicillin and vancomycin resistance among S. aureus isolates from teaching hospitals in Hamadan, west of Iran. Methods: Clinical S. aureus isolates were collected from patients at 3 university hospital from April 2002 to March 2006, and antimicrobial susceptibility were determined by disc diffusion. Results: Among a total of 263 S. aureus isolates, 190 (72.2%) were MRSA. Resistance to penicillin was more common (95%). The MRSA prevalence was highest in surgical ward (92%), followed by neonatal and pediatric ward (83%) and the intensive care units (81%). A total of 64 (33.7%) isolates were recovered from wound samples, 39 (20.5%) from sputum, 15 (7.9%) from synovial fluid, and 19 (10%) from other sites. Twelve (6.3%) of MRSA isolates were intermediate and 19 (10%) were resistant to vancomycin. Conclusion: Our study reveals high prevalence of MRSA and vancomycin resistant S. aureus at university hospitals of Hamadan. We emphasize control measures to prevent the spread of MRSA and to avoid the indiscriminate use of broad - spectrum antibiotics. ISE.176 Symptomatic Parvovirus B19 Infection in Immunocompetent Adults. Epidemiological, Diagnostic, and Clinical Issues R. Manfredi, G. Marinacci. Infectious Diseases, University of Bologna, Bologna, Italy Background: Parvoviridae are part of air-, parenteral- and perinataltransmitted ubiquitous viruses, whose associated signs and symptoms strongly depend on patient's age and immune defence. Methods. All cases of symptomatic Parvovirus B19 infection in otherwise healthy adults which came to our attention since spring 2006 were prospectively investigated and followed-up. Results: In a 19-month period, 10 patients (7 females-3 males), with a mean age of 39.8 (range 27-46) years with a symptomatic Parvovirus B19 infection were recorded. Intrafamiliar exposure and occupational (health care) exposure were identified in 2 cases each. Clinical signs and symptoms included fever (100%), arthralgia (90%), followed by headache (80%), anemia (70%), and rash. A mild-to-moderate myelosuppression of all hematological lines characterized 7 cases, while increased serum transaminases were associated in 60% of patients. Three patients were hospitalized (mean 10.8 days of admission), and 4 more cases were followed on Day-Hospital basis (for a median 95-day period); in 3 patients treatment with i.v. high-dosage human immunoglobulins was performed. Elevated levels of specific serum antiParvovirus B19 IgM antibodies were detected in all cases. In a 33-yearold female a severe anemia and a persisting headache, vomiting, and neck stiffness, led to RBC transfusion and a diagnosis of meningoencephalitis, with positive search of IgM antibodies and Parvovirus B19 viremia (detected by RT-PCR) in the cerebrospional fluid which lasted 3 months, despite treatment with i.v. serum immunoglobulins. Conclusions: Parvovirus B19 infection may play a significant role also in the adult, immunocompetent subject, and the disease sometimes is not mild and self-limiting, requiring admission and/or frequent outpatient interventions in a significant number of cases. The causes supporting a persistant infection in immunocompetent subjects have not been investigated to date, as well as the pathogenesis of myelosuppression and

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severe artrhalgia. Symptomatic Parvovirus B19 infection is still an underestimated condition, and therapeutic perspectives are extremely limited. ISE.177 Avian Flu - Vaccination Options A. Alyabis. General hospital, Basra, Iraq Introduction and Objectives: Since 1970s, poultry industry uses two type of vaccines to control the viral diseases, particularly against contagious respiratory diseases viruses such as Newcastle, Infectious bronchitis, infectious laryngeotrachaitis, these two types are either Week live (attenuated) or Dead virus in oils The above mentioned vaccines were used in different vaccination program according to the type of poultry and epidemiology of the diseases mentioned in certain geographical area. The most practical successful program was to immunize the parents poultry with oil vaccine, which will reflected to the maternal antibodies passed to the off spring and then vaccinating the day old chicks with a weaken type half a dose, by spraying, this will provide the chicks with a solid immunity and prepare them for the next vaccination with a more stronger strain. Material and Method: Avian Flu vaccine is limited strictly to the oil dead vaccine, as the other choice of using the LPAIV as attenuated live vaccine is forbidden scientifically in that, this virus has the ability to mutate and initiating a pandemic threat. Has the oil dead H5N1 vaccine practical value in controlling avian flu virus spread, I say yes, it will not prevent infection in poultry premises but it surly will limit the density size of virus circulating in the area, as the shedding virus from vaccinated birds will be much less compare with diseased bird in which the virus take its ultimate limit periods for replication, beside the premises and its surrounding will be much less polluted with field virus, also economically will not lead to the killing of the birds. Infection bird-human will be minimized due to the amount of virion particles released and made available for transmission. The density of the virus circulating in the air will be minimized, since the virus causes airborne infection, the only routes of infection is through the upper respiratory system or the conjunctiva, speaking for another route is not proved yet, as the virus is enveloped, and infection via digestive tract in human will subject the envelope to be dissolve by gastric juice, beside that the sailic acids receptors for the virus haemoglutinins are not found in GI cells. Conclusion: In the vaccinated poultry premises the virus (airborne or droplets nuclei) density will not maintain the infectious doses that initiate infection in human. When and how the vaccine must be applied, the answer is mimic Marek disease, in one day old chicks in the Hatchery. ISE.178 Clinical and Serological Aspects of Infectious Mononucleosis Syndrome S. Miskova, S. Trajkova, S. Bisinova-Eftimova, T. Nedelkova, R. Stojanova. General Hospital, Department of Infectious Diseases, Veles, Former Yugoslav Republic of Macedonia Infectious mononucleosis syndrome, with its actuallity is always in focus of attention, because of many clinical symptoms and different viruses that cause it, like EBV,CMV, and the other viruses from time to time. 105 patients were analysed with this syndrome for the last 4 years. The diagnosis was confirmed by clinical, epidemiological, biochemical and serological data. From the whole number of presented patients, 62% were male and 38% were female. The most common age group was from 6 to 20 years, with 90 cases. Most of the patients were treated in our ambulance with dominant symptoms of high temperature, adenopathia and angina which were represented with 95%, splenomegalia at 50%, hepatomegalia 18%, skin exanthems 6% and icterus 3%. Biochemical analyses of white blood cells, confirmed lymfocitosis of 50-70%. From serological examinations were used Mononucleosis test, Paul-Bunnel test and RVK reaction, and they were positive at 59%. The treatment of our patients was symptomatic, but in some cases were used antibiotics and steroid therapy at strict indication. At all patients we noticed fast regression of clinical symptoms, without any complications. ISE.179 Seroprevalence of Toxoplasmosis in Women of Reproductive Age in the City of Brasilia, Capital of Brazil A.S.G. Cabral, F. Balbino, L.F. Abdalla, S.S.S. Costa, J.A.R. Vaz, S.F. Fonseca. Laboratório Sabin, Brasilia, Brazil

Background: T. gondii can cause transplacental fetal infection when the mother acquires the infection during pregnancy. The prevalence of seropositivy for toxoplasmosis in pregnant women varies according to geographic regions and climatic, cultural, and dietary characteristics. Some studies claim seropositivity of 10.9% in Norway, 18.8% in London, and 32% in New York. In Brazil, some studies exist about seroprevalence for anti-toxoplasma IgG in pregnant women in some cities, but not in Brasilia, the capital of Brazil. Objective: Determine the seroprevalence of toxoplasmosis in women of reproductive age in the national capital. Methods: 37,961 blood samples from women between the ages of 15 and 40 were studied in the Sabin Laboratory from January 2006 to December 2007. The seroprevalence was determined by quantitative detection of specific IgG antibody against Toxoplasma gondii, using a microparticle enzyme immunoassay (MEIA)--Abbott Diagnostics AxSYM SYSTEM Toxo IgG. Women who had a concentration of IgG higher than 9.9 UI/ml were considered seropositive for toxoplasmosis. Results and Conclusion: Seroprevalence for toxoplasmosis was 7.3%. The average age of the 2,771 women who were seropositive for toxoplasmosis was 29.5. The results point to a very low prevalence of toxoplasmosis infection and the existence of an important contingent of women susceptible to acquiring the disease during their pregnancy. The identification of these patients at the beginning of pregnancy allows for the adoption of hygienic and dietary measures aimed at avoiding contamination and possible fetal transmission during pregnancy. We suggest that systematic serologic screening for toxoplasmosis during prenatal care be implemented as a public health measure in the community we studied. ISE.180 Medical Illnesses Among the Exclusive Breastfed Babies During First 6 Months of Age M. Nurul Huq. Bangladesh Medical College, Dhaka, Bangladesh 53 exclusively breast fed babies up to 6 months of age visited 239 times at a paediatrician's surgery due to various reasons. Most of the visits (82.42%) were for routine follow up and vaccination only, having no physical complaints. Very small number of visits (7.6%) was due to respiratory infections, and out of this only 1 baby needed hospital admission. None of these babies had any diarrhoeal diseases. This study is consistent with the global consensus that exclusive breast fed babies get significantly less number of respiratory infection in comparison to bottle fed babies; and enteral infections are virtually absent in them. ISE.181 Azoles and Polyene In-Vitro Drug Susceptibility Profile of Candida spp from HIV/AIDS Patients, Nairobi Kenya O.M. Mashedi, C.C. Bil, E. Amukoye. Kenya Medical Research Center, Nairobi, Kenya Background: The current pandemic of HIV/ AIDS, has brought about very major complications leading to an increase in opportunistic infections, among these infections are mycological. For the management of these Fungal infections, antifungal drugs e.g., Polyenes, Azoles are usually administered. Polyenes and azoles have been documented to show resistance in the management of fungal diseases, The purpose of this study was to determine the Antifungal drug susceptibility profile of 41 Candida Spp from HIV/AIDS patients in Nairobi Kenya. Methodology: The isolates were obtained from swabs, urine, high vaginal swabs and sputum during the period of 2004­2006. The yeasts isolates were identified by the convectional method and the Antifungal susceptibility was determined in accordance to the CLIS standards. The isolates included Candida albicans; Candida parapsilosis, Candida glabrata and Candida famata were to broth microdilution susceptibility to Amphotericin B, Fluconazole and Miconazole. Results: The results showed that 51% of the Candida spp were susceptible (MIC < 8µg/ml)(S) to Fluconazole, 25% was susceptible dose dependant (SSD, MIC 16-32µg/ml), and resistant (64µg/ml) was observed in 22% of the isolates. Most of the isolates were susceptible to Amphotericin B with 74% of the isolates with MIC of 0.5µg/ml and 25% of the Candida spp showed MIC 1µg/ml. Eighty eight percent of the isolates demonstrated MIC of 0.5 µ to Miconazole while 12% had MIC 1µg/ml. Discussion and Conclusion: The results clearly shows that there is no indication of emerging resistance to Amphotericin B but due to the need for life long Fluconazole maintenance therapy, there is need to constantly monitor for emerging azole resistance in the context of expanding population of HIV/AIDS immunocompromised individuals

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ISE.182 Emergence of Dengue in Nepal B. Pandey1, K. Morita2, O. Shah3, R. Pun4, K. Pant4, A. Kurosawa5, I. Kurane6. 1Sukraraj Tropical and Infectious disease hospital, Kathmandu, Nepal, 2Institute of Tropical Medicine, Nagasaki, Japan, 3 National Institute of Science and Technology, kathmandu, Nepal, 4 Tribhuban University, kathmandu, Nepal, 5Pentax. Co. Ltd, Tokyo, Japan, 6National Institute of Infectious diseases, Tokyo, Japan Objectives: To know the sero-epidemiological, molecular information of dengue virus in Nepal and to characterize these viruses at molecular level Background: Dengue virus infection occurs in more than 100 countries and over 2.5 billion people live in the areas with a risk of infection. Up to 100 million cases of DF and 500,000 cases of DHF and several thousands deaths are estimated to occur annually worldwide. During the past decades, dengue virus emerged in South Asia and DF/DHF epidemics occurred in Bhutan, India, Maldives, Bangladesh and Pakistan. The dengue was first reported on 2004 and the outbreak was observed at 9 districts in 2006 posses a serious threat of future epidemic in Nepal. Methods: A total of 538 serum samples were collected from the patients suspected DF and other viral illness from August to November 2007 in Teria region of Nepal. IgM ELISA, IgG-ELISA was performed using Particle agglutination assay (PA) and IgM ELISA kit. RNA extraction was performed using QIAGEN kit followed by RT-PCR. Result: The result showed that 28% were positive for dengue infection out of 538 samples. Bardiya district showed highest percentage of positive dengue antibodies (64%). Among analysed IgM antibody positive cases, 69.06% were male and 30.88% were female and the highest numbers of positive cases were found in an age group 21­30 (29%). There was no significant difference between age, sex and occupations. PA and ELISA were used to compare their sensitivity and specificity for the detection of IgM antibody and the result showed that PA assay has sensitivity of 98% and specificity of 96%, a positive predicts value of 0.90 and negative predict value of 0.99 in comparison with IgM-capture ELISA. These results suggest that PA assay is simple, reliable and useful diagnostic tool to support clinical diagnosis in rural hospitals of Nepal. RT-PCR was also performed for confirmatory diagnosis and to know the dengue serotype prevalent in Nepal. ISE.183 Antigenic and Genetic Evolution of Pre-Pandemic H5N1 Candidate Vaccine Viruses Isolated from European, Middle Eastern and African Countries M.M. Ebrahimi, S. Shahsavandi. Razi Vaccine at Serum Research Institute, Karaj, Iran (Islamic Republic of) To evaluate the effectiveness of pre-pandemic H5N1 candidate vaccine viruses, the antigenic evolution of circulating viruses in Europe, Middle East and Africa (EMA clade) was studied from its introduction into Qinghai Province, China in 2005. H5N1 viruses in the clade are responsible for bird and human infections. In this study hemagglutinin (HA) amino acid sequences of all known EMA clade viruses defined through September were downloaded from GenBank and aligned with ClastalW. Potential linear and conformational B-cell epitopes exposed on the surface of HA protein were identified by using BepiPred and CEP. To identify the antigenic drift, amino acid replacements were detected in the epitope regions compared to replacements in the rest of the HA molecule. Amino acid substitutions were identified in HA epitope regions. To investigate the genetic basis of the antigenic evolution, a neighbour-joining phylogenetic tree was estimated by 1000 bootstrapping. A tree distance of 0.0005 corresponds to one amino acid substitution resulted in more punctuated antigenic evolution in this clade. Because this continues change may due to silent substitution the rates of non-silent (Ka) and silent (Ks) substitutions in the sequences under study were determined. These findings suggest that the single amino acid substitutions have not significant effect on antigenic properties of the H5N1 viruses of EMA clade. According to these bioinformatics data each of A/Bar headed goose/Qinghai/1A/2005, A/turkey/Turkey/1/2005 and or A/Whooper swan/Mongulia/224/2005 candidate vaccine viruses may give a significant degree of immune response to the H5N1 viruses since a reassortment virus has not been found.

ISE.184 Clinical Characteristics of Leptospirosis During an Observational Retrospective Hospital-Based Study in Jakarta, Indonesia O. le Polain de Waroux1, M.K. Sudaryo2, V.R. Louis3, C. Altare1, R. Makhota2, M.F. Prameswari2, D. Guha Sapir1. 1CRED, Catholic University of Louvain, Brussels, Belgium, 2HRCCD, University of Indonesia, Jakarta, Indonesia, 3EVAPLAN, Heidelberg University, Heidelberg, Germany Leptospirosis is a widespread zoonosis with protean clinical presentations, ranging from a mild flu-like illness ("anicteric form") to a fulminant disease, also known as the "Weil's disease" or "icteric form" characterized by multiple organ impairment. Methods: We retrospectively analyzed medical records from 5 major hospitals in Jakarta over a 7 month period and obtained clinical information for 208 confirmed cases (confirmation by IgM-M rapid immunochromatography dipstick assay). Results: Mean age was 39.2[36.7-41.1]years, with no difference between men and women (p=0.21).The most frequently reported symptoms was fever(86.5%), nausea (77.9%), vomiting (62.5%) and diarrhea (41.35%).The frequency of symptoms was not different in both sexes and in different age groups. Most patients presented high leucocytosis (12.5±1.6*103/mm3), thrombocytopenia (91.2±2.4*103/mm3) and elevated creatinin (2.5±2.5mg/dl) levels. Acute renal failure (ARF) was defined as a creatinin level >1.5mg/dl and was observed in 68.7% of our patients. Thrombocytopenia (<150*103/mm3) was also observed in 68.7%. Platelets <50*103/mm3 was observed in 21.7%. Twelve percent of our sample had ARF with completely normal bilirubin values (<1 mg/dl), showing that leptospirosis may lead to renal impairment without jaundice. More than half of these (6.25%) had concomitant thrombopenia. Thrombopenia alone was observed in 3.59% of the cases. Our study reveals that the severity of leptospirosis is unrelated to the presence of jaundice, and shows a high prevalence of ARF and thrombocytopenia in severe leptospirosis. Multivariate logistic regression demonstrated that leucocytosis (16*103/mm3 (OR 11.9[2.2-63.7]), thrombocytopenia (OR 30.2[3.5-259.2]) and creatinin >3.5mg/dl (OR10.2[1.289.6])was the best model for predicting fatal outcome (accounting for 48% of the variance in predicting fatality). Disease length was not statistically different(p=0.22) between deaths and survivors, indicating that death occurred late in the disease course. Overall case fatality rate was 6.25%. Leptospirosis was suspected in 31.7% of our confirmed cases, at entry, and confounded with dengue in 27.1% of the cases at entrance.

ISE.184 Table 1.

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ISE.185 Molecular Basics of the Pathogenetic Characteristics Changes During Adaptation of the Tick-Borne Encephalitis Virus to the Ticks A.S. Shevtsova1, L.I. Kozlovskaya1, L.I. Romanova1, G.G. Karganova1. Chumakov Institute of Poliomyelitis and Viral Encephalitides RAMS, Moscow, Russia Tick-borne encephalitis (TBE) virus has a significant clinical importance in Europe and Asia. Earlier it was shown during adaptation of TBE virus strain EK-328 to ticks appeared a variant M with small-plaque phenotype, high affinity of virions to glycosaminoglycans (GAGs) on cellular surface, low neuroinvasiveness in mice, and several amino-acid substitutions: in main envelope protein E, in non-structural proteins, and in 5'-NTR (Romanova et al., 2007). After one passage of variant M in mammalian cells was obtained set of revertants. We chose two large-plaque mutants loosing GAG-binding phenotype. The clones appeared to be almost identical genetically to variant M, except amino-acid sites in E protein. Clone 58 carried the reversed substitution as strain EK-328, clone 57 had the compensatory mutation. We examined the ability of the viruses to cause acute infection in mice after intraperitoneal inoculation of 1000PFU. Strain EK-328 and clone 58 caused acute form (high neuroinvasiveness), whereas variant M and clone 57-innapparent form (low neuroinvasiveness). Thus, the fact couldn't be interpreted only with the modified sorption on the cell GAGs. We determined the dynamics of interferon level in blood after intraperitoneal injection to mice of 1000PFU. We discovered that variant M and clone 58 provided high level of interferon induction. At the same time, strain EK-328 and clone 57 induced low degree of interferon. Then we showed that clone 58 had low interferon-sensitivity, clone 57 and variant M had medium sensitivity, and strain EK-328 expressed the highest sensitivity to interferon. Therefore, the non-structural proteins played an important role in interactions with interferon system, although, the structural proteins can be involved in the process. We conclude that during the reproduction of the tick-adapted variant in mammalian organism, appear set of revertants, differently interacting with host-defense system. It could play an important role in development of TBE virus infection. ISE.186 The Many Faces of IRIS: Revelation of Visceral Leishmaniasis (VL) After Initiation of HAART B.W. van der Spek1, M.E. Hillebrand-Haverkort2, P.A. Kager3, W. Bronsveld1. 1Medical Centre Alkmaar, Alkmaar, Netherlands, 2Vrije Universiteit Medical Centre, Amsterdam, Netherlands, 3Academic Medical Centre, Amsterdam, Netherlands Introduction: VL is caused by infiltration of the monocyte-macrophage system by Leishmania parasites. HIV-infected patients are particularly prone, presentation is often atypical and serologic titers lower than in immunocompetent patients. We report on a patient with clinical manifestation of disease after initiation of HAART, complicated by renal involvement. Case report: In October 2005 a 45-year-old male tested HIV-positive, 36 CD4-cells/mm3, HIV-bDNA 208.265 copies/ml and immediately commenced HAART with tenofovir, lamivudine, lopinavir/ritonavir. HIV-bDNA was undetectable within one month. He was also hepatitis B-infected, HBV-load 503 million cop/ml. This had decreased to <2000 cop/ml in December 2006 when he was admitted to hospital with haematuria and diarrhoea. Laboratory examination showed pancytopenia, renal insufficiency (CCr 25ml/min), proteinuria (5.3g/24hr), 112 CD4-cells/mm3, HIV-bDNA<50 cop/ml, hypergammaglobulinaemia and cryoglobulinaemia. In colonic biopsies intracellular Leishmaniae were seen. Gastric, duodenal and bone marrow specimens were also massively invaded. Light and electron microscopic examination of renal biopsy showed intra-capillary proliferative glomerulonephritis, with Leishmaniae in macrophages in interstitial space and glomeruli. Travel history, inquiring for Leishmania endemic areas, revealed a visit to Ibiza in 1996. Serology (titre 1:102400) and PCR were positive for L.donovani/infantum complex. Pre-HAART frozen serum was also found positive (1:12800). After treatment with liposomal amphotericin B (1,5mg/kg/od) for 21 days and additional high dose (3mg/kg/od) for 7 days renal and bone marrow functions had improved. Repeated gastric, duodenal and bone marrow biopsies were negative. Conclusion: We present an HIV/HBV-coinfected patient with visceral leishmaniasis. Travel history, serologic testing and onset of disease strongly suggest long latent infection with clinical manifestations after ini-

tiation of HAART, indicative of an immune reconstitution inflammatory syndrome. Asymptomatic Leishmania infection, converting to symptomatic disease in this context has been described only once. Renal involvement in VL is unusual in humans. To our knowledge this is the first report of Leishmaniae seen in renal tissue in a living HIV-infected patient. ISE.187 The Continuing Proliferation of West Nile Virus in the Western Hemisphere J.P. Dudley1, M.L. Bunning2, D.A. Enria3, D.J. Gubler4, M.A. Morales3, M. Pupo5, H. Artsob6. 1Science Applications International Corporation, Rockville, MD, USA, 2United States Air Force - Biomedical Sciences Corps for Public Health, Kelly, TX, USA, 3Instituto Nacional de Enfermedades Virales Humanas, Pergamino, Argentina, 4Asia-Pacific Institute of Tropical Medicine and Infectious Diseases, School of Medicine, University of Hawaii, Honolulu, HI, USA, 5PAHO/WHO Collaborating Center for Viral Diseases, Pedro Kouri Tropical Medicine Institute, Havana, Cuba, 6National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada West Nile Virus is an emerging zoonosis whose ecology and epidemiology spans the multidimensional interface between viral pathogens, arthropod disease vectors, wildlife, domestic animals, and human beings. Although primarily a mosquito-transmitted pathogen, horizontal transmission of WNV has been demonstrated among birds and human infections through blood transfusions and organ transplants have been recorded. WNV infections resulting from consumption of infected tissues have been documented in birds, mammals, and reptiles. The explosive episode of WNV transmission recorded among humans in the central Great Plains bioregion of North America during 2007 paralleled--and in some areas surpassed--recorded human WNV transmission during the first wave of mass human transmission during 2003. Numbers of human cases recorded in Canada during 2007 (n = 2381) were 50% higher than the previous record set in 2003 (n = 1495). Numbers of human WNV cases recorded in the Canadian provinces of Saskatchewan, Manitoba and Alberta during 2007 were 50%­400% above previous records for these provinces. Exceptionally high numbers of human WNV cases were also recorded in contiguous areas of the northern United States (Montana, North Dakota, Minnesota), while record or near-record human WNV case numbers were reported from the states of Oklahoma and Georgia. The record levels of WNV virus transmission in North America during 2007 are correlated with unusual weather patterns that favored mosquito population reproduction and survival. The patterns of human WNV infections recorded during 2007 in North America, South America and the Caribbean have important implications for the surveillance and management of public health threats from WNV in the Western Hemisphere. Serologic surveys conducted in areas of intense WNV transmission in the United States indicate low prevalence of antibodies to WNV among human populations, indicating that additional epidemic outbreaks of human disease from WNV can be expected in future. ISE.188 Emerging Infectious Diseases from the Economist's Point of View H. Schneider. Value Dimensions, Vienna, Austria Venezuela remained Spanish because of Malaria; Abkhazia is trying to break-away from Georgia only since the numbers of Tuberculosis have risen. Infectious diseases, especially if they are emerging, cause by far more than human suffering and scientific toil, they are also a source for economic difficulty and hence, social instability. Mad-cow, bird-flu and swine-fever are just some of the most actual examples for whole economies and a good bit of the global trade being jeopardized by outbreaks that could have been controlled if the flow of information had been more open. In this article the problem of emerging infectious diseases shall by assessed from an economist's point of view. Economics is the science that studies the optimization of the allocation of scarce resources using models. In this case, the scarce resource is information about the emerging infectious disease and what happens, if this resource is not allocated in an optimal way is the question. From the economic point of view, there are three different vectors of information, all a priori equally weighted: rumors, official information and news (good and bad); specifically, rumors and bad news are more likely to have a stronger impact than good news and official information, but exactly these could be managed if governments, scientists and technicians would take a more open approach. It

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will be furthermore assessed how the economic agents can play a larger role in the prevention of emergence and in crisis management. After a short introduction remembering some historical facts and economic figures, a model for the flow of information with its three vectors will be presented; this model will be used for explaining a non-cooperative and a fully cooperative cycle. The result urges to get all economic actors (including global trade and the WTO) involved in fighting emerging infectious diseases.

ISE.190 Epidemiologic Evaluation of Subacute Thyroiditis in Kashan, Iran, 1996­2006 H. Afzali, A. Ebadi, A. Taghavi Ardekani. Kashan University of Medical Sciences, Kashan, Iran (Islamic Republic of) Introduction: Subacute thyroiditis includes the inflammation of thyroid gland which usually happens after the infection of the upper respiratory system then it allays, a rare situation the reason of which is viral infection of thyroid gland. Attempt for finding out the virus causing this infection is not often successful and it doesn't effect the way of controlling and treating the disease. Subacute thyroiditis is not often detected since its symptoms are similar to pharyngitis. The purpose of treatment is to reduce pain and inflammation. Considering disease signs appearing unclearly and delaying disease detection and because we don't have any statistical information available in this regard, conducitng a research to investigate epidemiology of subacute thyroiditis in Kashan city seems necessary. Materials and Methods: This study was done in a descriptive way on all of the patients suspicious of subacute thyroiditis having referred to Shahid Beheshti hospital and specialized, private clinics of glands and infection from 1375-85 and their disease had been definitely as a subacute thyroiditis. The desired information such as age, gender, clinical symptoms, laboratory sings, radioactive Iodine uptake, consumed medicine for treatment, disease lifetime and bedridden period were extracted from their files and were entered in the questionnaire and were statistically analysis in a descriptive way. Results: From 22 patients suffering from subacute thyroiditis 18 of them were woman (81.8%), 4 of them men (18.1%) and their ratio was 4.5 to 1. The average age of the subjects was 40.7 and abundance of disease life time (period) was reported 2-4 weeks and its average was 8.6±7. An abundance of disease time (season) was spring (72.8%) and after that winter (18.2%). The most abundance of clinical signs was tremor (63.6%) and after that pain. The most abundance was 41-60 ESR (27.2%) with the standard deviation of 63. 6±28.9. there was one case of relapse (4.5%). The most abundance at treatment method was antiinflammation method (77.2%). 16 patients (72.7%) had two drugs treatment, 11 of them (68.7%) have consumed steroid is addition of that. The most abundance of CRP in sex and age was (45.4%)+1. Conclusion: According to the results at this research, we couldn't find any meaningful relation by the comparison at medicine consumption and gender (sex). Among patients having disease period more than 10 weeks,100% of them were treated with steroid and accordingly with the shortening of this period, this medicine was used less, signs at this disease appear differently in different patients and because of its similarity to pharyngitis in many cases before detection and any kinds of treatment, it is removed. Key Words: Subacute thyoroiditis, radioactive Iodine, uptake, ESR, CRP ISE.191 Epidemiology of Hepatitis in Hospitalized Patient in Beheshti Hospital of Kashan, 2001­2006 A. Taghavi Ardekani, A. Honarpishe, H. Afzali. Kashan University of Medical Sciences, Kashan, Iran (Islamic Republic of) Introduction and Objectives: Hepatitis is a inflammatory liver injury due to viral, drugs, toxins, and immune agents. Morbidity and mortality due to chronic hepatitis is one of the most important causes of death. This study was conducted to determine epidemiology of hepatitis in hospitalized patients in Beheshti hospital of Kashan, 2001-2006 Materials and Methods: This is a descriptive study which was performed by reviewing medical records of 500 patients with hepatitis.Samples were the patients with clinical symptoms and paraclinical findings compatible with hepatitis. Demographic, clinical, and laboratory information of patients were collected and collected data were analyzed and described by descriptive statistics. Results: 313 (62.6%) patients were male and 187 (37.4%) were female. The majority of patients (24.6%) were in the 20­29 age group. 390 (78%) of patient were urban and 110 (22%) were rural. 206 (41.2%) were married and 294 (58.8%) were single. The prevalence of hepatitis was: hepatitis A (37%), hepatitis B (18%), hepatitis C (16%), drugs (11%), autoimmune (9%) and alcoholic (9%). Conclusion: Regarding the high prevalence of viral hepatitis, especially hepatitis A, attemps for development and further studies must be considered. Key Words: Hepatitis A, Hepatitis B, Hepatitis C

Epidemiology, Public Health and Surveillance

ISE.189 Influenza of Children in Bosnia - Recommendation of Vaccination A. Bajraktarevic1, S. Putica1, A. Skopljak1, E. Hadzihasanovic2, A. Hadzimuratovic3, A. Drnda4, Z. Jatic5, A. Semic6, A. DjurdjevicDjulepa7. 1Public Health Institution Sarajevo, Sarajevo, Bosnia and Herzegovina, 2First medical Aid Sarajevo-Pediatrics Department, Sarajevo, Bosnia and Herzegovina, 3Pediatrics Clinic, Sarajevo, Bosnia and Herzegovina, 4Infective Clinic Sarajevo, Sarajevo, Bosnia and Herzegovina, 5Medical Faculty of Sarajevo, Sarajevo, Bosnia and Herzegovina, 6Pediatrics Clinic Manchester, Manchester, United Kingdom, 7General Hospital Sarajevo, Sarajevo, Bosnia and Herzegovina Background: Influenza is a common respiratory condition that has a history of developing into epidemics and pandemics. Some children are at particularly high risk from the complications of flu: for example, those who are immunosuppressed or have chronic lung or heart disease. Methods: Live attenuated influenza vaccine, trivalent (LAIV-T), was shown to be safe and efficacious in Bosnia as in the US. Results: Influenza infection rates are higher in younger children in Bosnia and Herzegvina, and even healthy children can end up quite sick as a result of the flu. Studies have shown that up top 40% of pre-school age children develop the flu. Discussion: The National Centers for Disease Control and Prevention (CDC) also recommend flu vaccination for healthy kids between 6 and 24 months. This recommendation is based on recent studies that show high hospitalization rates for children under the age of 24 months during the flu season. Conclusions: Complications of influenza include secondary bacterial pneumonia, post-influenza encephalitis, changes in electrocardiogram, and secondary bacterial infections such as Staphylococcus aureusinduced myositis. Unfortunately, current flu vaccines are ineffective in kids under 6 months of age though immunization of their household contacts (e.g. family members) may provide some protection against the flu and is strongly recommended.

ISE.189 Efficiacy of Influenza Vaccination in Bosnia.

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ISE.192 Risk Factors for Hepatitis B in Isfahan, Iran N. Kassaian1, M. Pourahmad2, Z. Nokhodian1, M. Amini3, B. Ataei1. 1 Infectious Diseases Research Center,Isfahan University of Medical Sciences, Isfahan, Iran (Islamic Republic of), 2Jahrom University, Shiraz, Iran (Islamic Republic of), 3Endocrean and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran (Islamic Republic of) Introduction: Despite international efforts for prevention, new cases of HBV infection are still being reported throughout the world. It is estimated that about 3% of Iranian people are chronic carriers for HBV. So to optimize counseling and prevention programs, knowledge of actual risk factors, which is vary in different parts of the world, is necessary. This study conducted to explore this subject and help to improve preventive measurers and national surveillance. Materials and Methods: This case-control study conducted from 2000 to 2005 and 182 units as cases and 186 ones as controls entered in the study. In this study every patients with positive HBsAg and/or anti HBc antibody test chose as case and everyone without these markers chose as control. Results: Two variables were independent risk factors that have had the most association with hepatitis B infection in our study: history of hepatitis B in patient's first degree relative (OR = 12.5, 95% CI= 5.12 - 30.54) and surgery(OR= 1.94, 95% CI= 1.26 - 2.98). Other significant risk factors were: transfusion (OR = 1.74), tattooing (OR = 1.81), dialysis (OR = 1.76). On the other hand, illegal sexual contact, imprisoning and cupping were not significant risk factors for HBV transmission in our study. Conclusion: With due attention to the results, we must focus on HBV transmission in family members of the Iranian patients with HBV infection and we should provide the better programs for socioeconomic conditions and education to improve the risky behaviors in them. The high odd's ratio for surgery may be due to incompetence of our study and/or negligible risk factors that we didn't evaluate them; and for more assessment, more accurate studies are needed to be done. ISE.193 The Comparative Survey of the Prevention from Tuberculosis Transmission for Persons Referring to the Medical-Health Center of Omidieh and Behbahan Cities During 2007 G. Sefidgran, L. Khosheh. Jondishapour Medical University, Ahwaz, Iran., Ahwaz, Iran (Islamic Republic of) Introduction: Tuberculosis disease is considered as a major factor for mortality in the developing countries. According to survey of WHO, the infection threatened by tuberculosis in various regions of the world is different. And there is this difference in the countries belonging to one region, even in different regions of one country. On the basis of latest statistical data, about one-third of the world population are infected by tuberculosis, and about 8 million cases appear infected per year and 3 million persons die yearly. Methods: This study in a descriptive and sectional form was done in Omidieh and Behbahan cities in the year 2007. Where all people referring to Health medical centers of above mentioned cities. And the study was done about the referred three indices by the closed questionnaire. Total sum attained from this investigation were in sum 975 cases. 429 out of 975 were related to Omidieh city and 540 out of 975 were related to Behbahan city, statistical methods were used, including, comparing the independent groups means, by using of T-test, One way variance analysis that was done by SPSS software. Discussion: 1. There is a significant difference between two the studied cities in terms of means of three factors. 2. There is not a significant between means of three studied factors and sex (man and woman). 3. There is a significant in terms of means of three studied on different education levels. Results: There is a significant difference in terms of tuberculosis and transfer was of tuberculosis and tuberculosis prevention in the mentioned cities. This difference is in favor of Behbahan city. ISE.194 Outbreak of Botulism Type A Associated with Home-Caned Fruit in a Family Group, Loghman Hakim Hospital, Iran, 2006 Z. Aminzadeh, P. Vahdani. Shaheed Beheshti Medical University, Tehran, Iran (Islamic Republic of)

Food-born botulism may develop after eating foods contaminated with botulinium toxin. Botulinium neurotoxins predominantly affect the peripheral neuromuscular junction and autonomic synapse, and its effects are primarily manifested as weakness. In 2006, 4 patients of a family group following ingestion of home-caned fruit developed clinical manifestations compatible with botulism. All of patients had weakness, diplopia, fixed and dilated pupil, dry mouth and ptosis. Two patients had severe weakness of respiratory muscles, so they needed intubation and admission in the ICU. Based on clinical findings all patients received 3 monovalent antitoxin A, B, C, and stool, gastric fluid, and serum samples was sent for toxicological evaluation with standard mouse bioassay. Type A toxin was detected in stool of one patient. All the patients were discharged with good condition. This study confirmed that prompt administration of antitoxin and appropriate supportive care can be life saving. In this outbreak, there was a different incubation period in the patients. There was not any death with improved respiratory and intensive care. Artificial respiratory support may be required for weeks in severe cases. ISE.195 Bacteriological Profile of Urinary Tract Infections in Patients Attending Nepal Medical College Teaching Hospital, Kathmandu J.P. Ghimire1, N.K. Acharya2, G. Karki2. 1SARC TB and HIV/AIDS Center,Thimi,Bhaktapur, Bhaktapur, Nepal, 2Nepal Medical College, Kathmandu, Nepal Background: This paper reports the urinary pathogens and their antibiotic patterns. Methods: A total of 1079 'clean cached' midstream urine samples received from the inpatients and outpatient departments of Nepal Medical College Teaching Hospital from April 25, 2006 to March 3, 2007 were included. Firstly, samples were subjected for culture using standard microbiological procedures then examined microscopically for pus cells and casts. Culture was done on the blood agar (BA) and MacConkey agar (MA) medium by standard calibrated loop and incubated at 37°C overnight. Culture results were interpreted as being significant (105 colony forming units/ml) and insignificant, according to the standard criteria. An antibiotic susceptibility test for bacterial isolates was done by Kirby-Bauer technique. Results: Significant growth positive was 25.6% (276/1079). Escherichia coli was the commonest isolates (77.5%) followed by Klebsiella spp (11.6%), Proteus mirabilis (7.6%), Pseudomonas aeruginosa (2.5%) and Staphylococcus sp. (0.7%). Amikacin was the most effective (99.2%) and was followed by tobramycin (96.5%), nitrofurantoin (86.7%) cefotaxime(85.7%) and ciprofloxacin (78.0%), all the pathogens isolated. E. coli was most sensitive to amikacin (96.8%), followed by tobramycin (96.1%), nitrofurontoin (81.7%), cefotaxime (80.3%), ciprofloxacin and ofloxacin (76.6%), nalidixic acid (52%), norfloxacin (49.2%) cephalexin (38.5) and cotrimoxazole (29.0%). Conclusion: Data presented in this study indicate that antibiotics commonly used for the treatment of UTIs are less effective. Since this was a cross-sectional study, further regular monitoring is required to establish reliable information about resistance pattern of urinary pathogens. Key Words: Urinary tract infection, Escherichia coli, Susceptibility ISE.196 Knowledge, Awareness and Practices Regarding Dengue Fever Among the Adult Population Presenting at Tertiary Care Hospitals in Karachi H. Khan, A. Itrat, A. Khan, M. Kamal, A.H. Khan, S. Javed, I. Sethi, I. Jehan. Aga Khan University, Karachi, Pakistan Introduction: WHO declares Dengue Fever to be endemic in South Asia. Despite the magnitude of the problem, no documented evidence exists in Pakistan on the awareness and practices of the country's population regarding Dengue fever, its spread, symptoms, treatment and prevention. This study was conducted to assess the level of knowledge, attitudes and practices regarding dengue fever. Methods: It was a cross-sectional pilot study conducted amongst people visiting tertiary care hospitals in Karachi. Through convenience sampling, a pre-tested, and structured questionnaire was administered via face to face unprompted interview to 447 visitors. Knowledge was recorded on a scale of 1­3. Results: Most of the people (89.9%) had heard of dengue fever. Sufficient knowledge about dengue was found to be in 38.5% of the sample, with 66% of these in Aga Khan University Hospital and 33% in Civil Hospital Karachi. People who were literate were more informed about dengue fever compared to illiterate people (p<0.001). Knowledge

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on preventive measures was found to be predominantly against mosquito bites (78.3%) rather than eradication of mosquitoes (17.3%). The use of anti mosquito spray was the most common (48.1%) preventive measure. Only 9 % of the people were not using any preventive measures against Dengue. Television was considered as the most important and useful source of information on dengue outbreak. Univariate analyses showed significant association between sufficient knowledge and education (p<0.001), income (p<0.001) and the hospital presented to (p<0.001). Using multinomial logistics, adjusted odds were calculated after a best-fit model was obtained. Income (p=0.05) and hospital (p=0.004) were factors determining knowledge scores independently. Conclusion: The population of Karachi demonstrates moderate level of knowledge and attitudes towards dengue fever. The recent outbreaks of dengue have resulted in exhaustive efforts on part of government, NGOs, and media to educate the people about the epidemic. ISE.197 An Evidence Against Relationship Between Cytomegalovirus and Unstable Angina S.M. Alavi, M.H. Adel, A.R. Rajabzadeh. Joundi Shapour Medical University, Ahvaz, Iran (Islamic Republic of) Purpose: We sought to determine whether unstable angina is related to cytomegalovirus infection. Background: Recent reports have suggested that cytomegalovirus (CMV) infection may contribute to risk of cardiovascular disease. However, relationship between CMV infection and unstable angina (UA) is controversial and studies about this subject in Iran and even region are lacking. Materials and Methods: We measured serum CMV IgG levels of 96 patients (mean age 56 years) with UA (according to American Heart Association Criteria) and 96 adjusted age, gender, and risk factors participants free of UA (mean age 58 years) in a case control study in CCU in Razi Hospital in Ahvaz (Iran) from 2004 to 2005. Serology results were studied in relation to UA. Using chi squared test, odds ratios (OR) and 95% confidence intervals (CI). Results: 93% of patients with unstable angina and 96.7% of control had positive anti CMV-IgG. OR was 0.6 with 95% CI: 0.4 to 0.9. There was no significant relation between CMV-IgG positivity and UA (P>0.05). There was no sex and age difference in CMV-IgG in patients and controls (P>0.05). There was also no differences in CMV-IgG positivity in clinical groups of UA (P>0.05). Conclusion: Our study discarded relationship between seropositivity of CMV-IgG and unstable angina. Key Words: Relationship, chronic CMV infection, unstable angina. ISE.198 Epidemiology and Antimicrobial Resistance of Gram-Negative Isolates Gained in Patients with Community-acquired Pneumonia A. Martynova. Epidemiology Department, State Vladivostok Medical University, Vladivostok, Russia Background: Despite of the results in diagnostics of gram-positive pathogens in community-acquired pneumonia, there is still the lack of data on role of the gram-negative bacteria. Aim of our study was to define role of gram-negative microorganisms in etiology of communityacquired pneumonia. Methods: We studied 62 isolates of different gram-negative bacteria gained in research project on study of etiology of community-acquired pneumonia. Antimicrobial agents resistance was studied on NCCLS standards. Results: On studying of etiology of community-acquired pneumonia we found that though the leading agent was S.pneumoniae (205 strains), gram-negative microorganisms were also significant (62 strains/23,2%). Among them were isolated Haemophilus influenzae (22\35,4%), Haemophilus parainfluenzae (4\6,45%), Escherihia coli (8\12, 9%), Klebsiella pneu-moniae (13\20,9%), Pseudomonas aeruginosa (12\19, 3%), Acinetobacter baumanni (2\3, 22%), Citrobacter freundii (1\1, 6%) and others strains. Among the prevalent microorganisms, H.influenzae strains, there were 36, 3% resistant to co-trimoxazole, 13, 6% to ampicilline, 18, 1% to erythromycine. P.aeruginosa strains were resistant to cefotaxim in 16, 6%; E.coli were resistant to erythromycin in 2 strains; K. pneumoniae was intermediate resistant to penicilline in 3 strains. Conclusion: Despite of the less significance of gram-negative isolates in etiology of community-acquired, there is the keen need in antimicrobial agents resistance monitoring and also in epidemiology surveillance on these pathogens as causative agents of community-acquired pneumonia.

ISE.199 Beyond DOTS: Evaluating the Strategies for Reducing the Burden of HIV-Associated Tuberculosis in India K. Walia. Indian Council of Medical Research, New Delhi, India Consequences of the human immunodeficiency virus (HIV) epidemic in India include the potential for increasing incidence of tuberculosis (TB) cases and an increase in TB-associated mortality. Strategies to address these two important challenges can be broadly classified into preventive measures (antiretroviral therapy, INH preventive therapy, contact tracing) and curative measures (active case finding and DOTS therapy). This presentation will evaluate the role that each of these strategies can play in controlling the spread of HIV-associated tuberculosis and reducing TB-associated mortality. DOTS therapy is the cornerstone of TB control program in India and is recommended for all the TB patients in India. DOTS therapy ensures high treatment completion rates, is effective in controlling drug resistance and enhances TB control. DOTS alone will be insufficient to mitigate a rising TB incidence and increased TBassociated mortality in India, resulting from increasing HIV prevalence. Reactivation of tuberculosis among people living with HIV can be reduced by anti-retroviral therapy and by INH prevention therapy (IPT). ART is now being provided under the National AIDS Control Program in India and would increase survival of HIV co-infected patients. However, ART is unlikely to have a major impact on prevention of new TB cases in India. Effective treatment of HIV-infected individuals with latent TB infection could eliminate a large reservoir of individuals at risk for progression to TB, reducing the numbers of new TB cases among HIVinfected persons and reduce TB-associated mortality among HIV-infected persons in India. Tracing the household contacts of HIV-TB cases for latent and active TB can reduce the incident TB cases as well as TB associated mortality. The presentation wil provide recommendations for optimal strategies for India. ISE.200 Quality Assurance in Diagnostic Laboratories--An Indian Experience D. Kasana1, M. Usta2. 1Safdarjang Hospital, Delhi, India, 2National AIDS Control Organization, Delhi, India Aims and Objectives: ­ To improve competency of laboratory staff ­ To identify and document problems related to quality ­ To monitor reliability of tests ­ To inspect and analyze the cost effectiveness and feasibility Methods: Internal and external quality assurance was introduced at national level for diagnostic laboratories. Laboratory staff was trained along with regular CME. SOP's were made and adhered to. A regular yearly fund was provided to each participating laboratory for the same. 10-20% of the total samples were sent to reference laboratory for EQAS. Results: Out of 120 participating laboratories 60 (50%) were found to be proficient and regular. Cost and the large number of unregulated laboratories are the bottlenecks. ISE.201 Epidemiological Tendency on Extrapulmonary Tuberculosis in Siberia E. Kulchavenya. Research TB Institute, Novosibirsk, Russia In Siberia there is an epidemic of tuberculosis (TB). The incidence rate was 126,1 in 2003 year--and in 2004 it increased up to 131,4. In the same time the incidence rate of extrapulmonary TB decreased from 4,4 on 100 000 population in 2001 to 4,3 on 100 000 population in 2003 and to 4,1 in 2004 year. So we could see "a scissor" between pulmonary and extrapulmonary TB. The structure of the incidence of extrapulmonary TB is identical for years. Tuberculosis of the genitourinary system is the 2nd common form of tuberculosis at whole and the first one between extrapulmonary forms (42,9% in 2001; 46,0% in 2003 and 41,5% in 2004), the next form is bone and joint TB (20,1% in 2003 and 22,6% in 2004); the next-- tuberculosis of the lymphonodus (14,7% and 15,7% respectively). There is significant difference between incidence also structure of extrapulmonary tuberculosis in the regions of Siberia: minimal incidence rate is 3,0 (Irkutsk) and maximal - 18,3 on 100 000 population (Tuva). Frequency of organ-removing operation among new-revealed patients with urogenital TB remains high (up to 60%), because the share of intime diagnosed patients is low. In 37% extrapulmonary tuberculosis is relapse of pulmonary TB; up to 47% alive patients have simultaneous lesion of some organs and systems, and after death in 77% pts with pulmonary TB the lesion of the prostate was found. International Scientific Exchange · 47

One reason of late diagnosis may be the absence of pathognomic symptoms of urotuberculosis. Also very often kidney TB masks under cancer, urolithiasis, and pyelonephritis, that hindering differential diagnostics too. Another reason is insufficient knowledge in people and medical workers about extrapulmonary tuberculosis. Conclusion: Extrapulmonary tuberculosis saves its significance. It is necessary to improve post-graduated medical education on extrapulmonary tuberculosis. ISE.202 Extrapulmonary Tuberculosis in Russia and in Europe E. Kulchavenya. Research TB Institute, Novosibirsk, Russia Introduction: The World Health Organization recognizes tuberculosis (TB) as a global problem. Nevertheless the incidence and structure of TB, especially extrapulmonary forms, are very different throughout the world. Material and Methods: We have analyzed statistical reports from 26 regions of Russia (Siberia and Far East) and have compared results with data from European countries. Results: 78% of all TB patients live in Romenia, Baltic countries and Russia. Epidemic level in Russia now is stably high (83,0 on 100 000 population), but in Siberia and Far East situation is more severe - incidence is 133,0 on 100 000 population. Share of extrapulmonary TB decreased from 10,2% in 1992 till 3,6% in 2006, but it is not real data, because the share of multi-organ TB increased up to 45%. Structure of extrapulmonary TB in Russia and in Siberia is identical: 38­35% accordingly--urogenital TB, 26­29%--lymphonodal TB and 17­16%--TB of bone and joints. In Europe (for example, in Germany and Macedonia) proportion is another. More often lymphonodal TB is diagnosed (50% and 54% accordingly), then--urogenital TB (21% and 13%) and bone and joints TB (17% and 18%). In Russia urogenital TB is common form for adult women (43%), and lymphonodal TB--for children (35%). Conclusion: Besides social property and insufficient medical care, especially HIV/AIDS epidemic is a cause of TB still counting among the most important infectious diseases of the world, more than 100 years after Robert Koch discovered its pathogen in 1882. Diseases such as tuberculosis (TB) and HIV/AIDS have reached such proportions worldwide that the development of civil societies is seriously endangered. ISE.203 Peculiarities of Extrapulmonary Tuberculosis in Siberia E. Kulchavenya. Research TB Institute, Novosibirsk, Russia Introduction: One of the main peculiarities of Siberia is epidemic of tuberculosis (TB) and cold climate (average temperature is minus 20C). These features leave traces on clinical picture of extrapulmonary TB; non-typical clinical picture makes more difficult duly diagnostic. Material and Methods: History cases of 420 patients with extrapulmonary TB were analyzed and compared with data of another authors, whom patients were from warm or moderate climate with benign epidemic situation. 76 patients suffered from neurotuberculosis; genitourinary TB was in another 344. All of them lived at Siberia 15 years and more or were born in Siberia. Results: Genitourinary TB and neurotuberculosis in benign regions have less-symptomatic, torpid clinical picture. In Siberia the acute beginning was found in 66,7% patients with male genitals TB that has resulted in ill-timed surgical intervention for 19,4%. Third of cases of kidney TB (36,7%) and neurotuberculosis (34,2%) also had the acute beginning. In Siberia the pain and hematuria are typical for kidney TB; the difference with benign regions is statistically significant. The course of extrapulmonary TB in Siberia is malignant, with inclination to the generalization. That leads to the higher mortality. Conclusion: Peculiarities of extrapulmonary TB in Siberia demands well-defined system for health service directed on as possible early diagnosis and treatment such patients. ISE.204 In Search of Natural Repellents Against Leptotrombidium Chiggers (Acari: Trombiculidae) the Vector of Scrub Typhus: A Laboratory Evaluation of 13 Aromatic Essential Oils from Thailand P. Eamsobhana, A. Yoolek. Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand Background: Scrub typhus, a rickettsial disease transmitted by several species of Leptotrombidium chiggers (larvae), is endemic in many areas

of Asia. The disease is best prevented by the use of personal protective measures including repellents. The deleterious effects associated with synthetic chemical repellents/acaricides have revived interest in plants as sources of natural products for medical protection application. Aim: To investigate whether the essential oils of 13 plant species would repel the larval trombiculid mite. Methods: Commercially produced aromatic, essential oils of 13 plant species (Syzygium aromaticum, Melaleuca alternifolia, Zingiber cassamunar, Eucalyptus globules, Pelargonium graveolens, Boesenbergia pandurata, Citrus aurantium, Citrus histrix, Curcuma longa, Cymbopogon nardus, Rosemarinus officinalis, Styrax torkinensis, Vetiveria zizanioides) were tested in the laboratory for repellency against the host seeking chiggers of Leptotrombidium imphalum Vercammen-Grandjean and Langston (Acari: Trombiculidae). A rapid, simple and economic in vitro test method developed at the Department of Entomology, U.S. Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand, was used to study the repellent efficacy of the essential oils and ethanol (control) by exposing the chigger for up to 5 min. Percentage of repellency of the plant extract was based on percentages of chiggers attracted to the test and control substances. Results: Four of the 13 essential oils tested showed promise as effective repellent against Leptotrombidium imphalum chiggers. Syzygium aromaticum (cloves) oil exhibited 100% repellency at 5% concentration (dilution with absolute ethanol), while Melaleuca alternifolia (Tea Tree) oil exhibited 100% repellency at 40% concentration. Only undiluted oils of Zingiber cassamunar (Plai) and Eucalyptus globules (Blue gum) exhibited 100% repellency. Of the remaining 9 essential oils in undiluted state, only Pelargonium graveolens (geranium) exhibited over 50% repellency, viz. 57.14%. Styrax torkinensis oil did not exhibit repellency, and the concentrated product appeared to attract the chiggers instead. Conclusions: The findings of this study show that several aromatic, essential oils of plants may be useful as chigger repellent for the prevention of scrub typhus. The ability of Syzygium aromaticum oil to repel chiggers at relatively low concentrations may represent a potential alternative to synthetic repellents for use in developing areas of the world. Moreover, their use may be safer and economical to prevent chigger attacks than the commercially available synthetic chemicals, such as DEET that could have harmful side effects. ISE.205 Antibiotic Susceptibility of Anaerobic Bacteria in Bulgaria, Eastern Europe M. Marina, K. Ivanova. National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria A lot of surveillance studies demonstrate a change in the susceptibility patterns of anaerobes and an increased resistance to certain antibiotics, especially in the B.fragilis group. We studied the susceptibility of 1103 strains of anaerobic bacteria isolated from clinical specimens in the referent for Bulgaria Anaerobic laboratory in a period of 25 years /1982­2007/ as a useful information for clinicians and a guidance for empirical treatment having no such studies in Bulgaria till now and with only few in Eastern Europe where antibiotic usage differs considerably. NCCLS-recommended agar dilution methods were used. -lactamase activity was determined with nitrocefin discs. The 29 antimicrobial agents included in the study were divided according to their in vitro activity against the anaerobic isolates into 4 main groups: 1st group of metronidazole, chloramphenicol, meropenem, imipenem and combinations of -lactam antibiotics with sulbactam--with very high activity and drugs of choice for treatment; 2nd group - with a good activity and low percent of resistant strains-- clindamycin /3% at 8 µg/ml/, cefoxitin /1% at 32 µg/ml/, carbenicillin /4 at 64 µg/ml/. 3rd group--of tetracycline and erythromycin--from 33% to 85% of the strains inhibited /including the new macrolides as josamycin, clarithromycin, roxithromycin and azithromycin/; 4th group--not suitable for treatment of anaerobic infections, with a very high percent of resistance to penicillins and cephalosporins. In the B. fragilis group--only up to 10% susceptible at 16 µg/ml, due to -lactamase activity in 81% of the strains. That is why a continued updating and a follow-up in the changes of antibiotic susceptibility is necessary in every country as resistance patterns vary not only between geographical regions but even among medical centers and hospitals.

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ISE.206 DOTS Versus Non-DOTS Strategies in Childhood Tuberculosis in Paco, Manila, 2006­2007 E.L. Baronia-Locson. Dr. Fe del Mundo Medical Center, Quezon City, Philippines Background: Children with TB rarely infect other children but they can transmit the disease. A study was done to compare effectiveness of DOTS against non-DOTS strategy (without direct supervision) in TB in children. Methods: A quasi-experimental non-randomized sampling design was used in the study which included selected patients of the researcher in her clinic in Makati City, Group A (foundation beneficiaries) under DOTS and Group B (walk-in patients) under non-DOTS. Newly diagnosed patients who met the criteria of TB Disease (Class III) based on the National Consensus for Childhood Tuberculosis from October 2006 April 2007 aged 2-12 years old were included in the study. Results: 395 patients were included and after six months of treatment, disappearance of initial signs and symptoms suggestive of TB, weight gain, improvement in well-being of the child and disappearance of pulmonary infiltrates or presence of hilar calcifications on chest radiograph were monitored. 85% of the subjects were cured under DOTS while 76% were cured under the non-DOTS. Test of association was done using the two by two Chi square test at 0.05 level of significance and based on the value obtained, the null hypothesis was rejected. Conclusion: It was therefore concluded that there was a significant difference in the effectiveness in terms of outcome in childhood TB between the two strategies used. Close partnership of parents and health workers served to enhance effectiveness and compliance with DOTS strategy. ISE.207 Selected Aspects of User Satisfaction and Associated Factors in Relation to Services Provided Through the Chest Clinic Galle, Sri Lanka H.A. Ubeysekara1, P. Fonseka2. 1Regional Director of Health Office, Galle, Sri Lanka, 2Faculty of Medicine, Galle, Sri Lanka A descriptive cross sectional study carried out at the district Chest Clinic Galle, Sri Lanka to describe the user satisfaction on selected aspects; waiting times, clarity of information received from the medical officer, facilities available and the cost incurred by the users. Data collected by an interviewer administered questionnaire. Sample consisted of 400 clinic attendees--41.3% tuberculosis patients, 36.0% bronchial asthma patients and the rest with other respiratory diseases. 82.0% of users were from Galle district. 20.3% were self referrals. The sex ratio was 1.1: 1. 78.5% clinic users were married and 67.5% belongs to the social class category IV and V. Users were satisfied with the waiting time for registration (64.0%), consultation (64.7%), taking chest X-ray (60.2%), obtaining sputum sample (71.7%) and blood (80.9%) for investigations and at the pharmacy (83.9%). Majority of users satisfied on information received from the attending medical officer about the disease (84.2%), drugs (83.1%), investigations (84.8%) and about follow up visits (83.5%). Follow up patients were more satisfied on information received on disease (90.3%) and drugs (90.9%) compared to first visits. 82.5% satisfied with ventilation, 69.0% with water facilities, 58% with seating facilities, 46.4% with toilet facilities and 42.8% on cleanliness of the clinic. Statistically significant associations found between the amount of money spent for drugs and the diagnosis (p<0.001) and between expenses for meals and distance from the residence (p<0.001). Overall satisfaction showed by 93.4% of respondents. A statistically significant association found between number of visits and overall satisfaction (p<0.05). The Chest Clinic in Galle district, Sri Lanka provides a satisfactory service to the region. It is a patient friendly institution which leads to a good patient compliance that will ultimately feedback on tuberculosis control in the country. ISE.208 Health Workers Ability to Realize Anopheles F. Rakhshani1, Z. Sepehri2, A. Hasanzehi3, A. Sakeni3. 1Associate Professor, Zahedan University of Medical Sciences, Research Center for Social Developement and Health Promotion, Zahedan, Iran (Islamic Republic of), 2Zahedan University of Medical Sciences, Zahedan, Iran (Islamic Republic of), 3Zahedan University of Medical Sciences, Province Health Center, Zahedan, Iran (Islamic Republic of)

Introduction: Sistan va Baloochestan is a province of Iran that considered as the oriental eco-epidemiological region of malaria. For the purpose of the disease control, all health workers have to realize anopheles. Methods: The study was designed to assess physicians, disease control technicians, rural health workers and malaria surveillance workers for realizing anopheles. Samples were selected randomly from all the rural and urban areas of the province. We prepared three container include different numbers of anopheles and culexes larvae and three containers include mature anopheles and culex. 131 health workers participated in the study: 29 physicians, 31 disease control technicians, 37 rural health worker and 34 malaria surveillance workers. Results: 23.3 % of disease control technicians had the ability of the complete diagnosis. The least ability was in malaria surveillance workers (6.3%). 13.8% of Physicians and 21.6% of rural health workers has complete ability in diagnosis of anopheles and larvae. Conclusion: although diagnosis ability of anopheles and larvae has an important role in malaria control but this skill is not in acceptable condition. It seems that we have to plan a program to develop these skills among health workers. ISE.209 Role for Partner Management in Microbicide Uptake K. Walia. Indian Council of Medical Research, New Delhi, India Partner notification, previously referred to as contact tracing, is the process of informing the contacts of persons with sexually transmitted infections (STIs) including, HIV infection, of their potential exposure to infectious disease and ensuring their evaluation and/or treatment. Partner notification has been justified means to reduce ongoing STI transmission and health on individuals. Many developed countries practice this with a very high success rate. In India however the success rate of partner management is dismally low. Although HIV prevention and control programs emphasize and counsel for partner management, the efficacy of this program is not known. Studies carried out in other countries have shown that improved partner management in other settings have increased condom uptake and antiretroviral uptake. Improving partner management in developing countries, including India, can provide an excellent opportunity to involve spouse in the HIV and STI prevention program. Having men to consent for women to use microbicide has been a very difficult question which socio-behavioral scientists and community leaders have been trying to address. Partner management if practiced in India can provide an opportunity to involve men in the HIV and STI prevention program thus impacting upon the condom and microbicide uutake. This paper will address the current state of partner management in India and other developing countries and the role it can play in improving condom and microbicide uptake. ISE.210 The Outbreak of Hospital Infection with Multi-Drug Resistant Bacteria A. Khalilpour1, M. Qorbanalizadegan2, M. Hajia3, M. Rahbar3, M. Izadi4, N. Jonaidi4. 1Young Scholars Club, Science and Research Group, Islamic Azad University, Tehran, Iran (Islamic Republic of), 2Research Center of Molecular Biology, Bagyiatallah Medical Sciences University, Tehran, Iran (Islamic Republic of), 3Research Center of References Laboratories of Iran, Tehran, Iran (Islamic Republic of), 4Research Center of Health, Bagyiatallah Medical Sciences University, TehranIRAN, Tehran, Iran (Islamic Republic of) Background: The Hospital Infection is a major challenge in modern medicine and contributes to increased resources that are used in health care systems. The purpose of this study was to determine hospital infection disease and multi-drug resistant, on the basis of the type of microorganism factors, wards and infection of the hospitalization who were confined to bed in the Baghyatallah University Hospital. Methods: The study was conducted prospectively during a period of 12 months from March to February of 2005 in the university hospital in Tehran, Iran. Standard tests for identification and susceptibility testing were performed. Results: The rate of hospital infection with multi-drug resistant was 3.9%. The prevalence was highest among in intensive-care wards (77.8%). Most of bacterial isolation was related to Staphylococcus aureus that included 11 cases (39.5%) and pseudomonas aeruginosa that was (20.8%). Conclusion: Hospital infection can be cured very difficulty and in some conditions it can cause dead. Control of hospital infection and multi-

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Drug resistant is so difficult and need to spend much money and time but it is necessary and profitable. Key Words: Drug resistance, Hospital Infection, Bacterial agents ISE.211 Assessment of Quality of life in Hepatitis B patients in Isfahan, Iran Z. Nokhodian, B. Ataei, N. Kassaian, P. Adibi. Infectious Diseases Research Center,Isfahan University of Medical Sciences, Isfahan, Iran (Islamic Republic of) Objectives: There are little researches related to the quality of life (QOL) in patients with chronic liver diseases in Iran. The aim of this study was to determine QOL in hepatitis B patients in compare with non hepatic healthy ones in Isfahan, Iran. Methods: In n an observational study, 61 patients with chronic hepatitis B (group 1) and 60 ones without any chronic diseases in their families (group 2) came to study. The validated standard liver specific questionnaire was used as instruments for QOL measurements. The mean of QOL scores in total and in different domains between 2 groups were obtained and analyzed using GLM (multivariate) and 2 tests and P 0.05 were considered statistically significant. Results: The mean (CIs 95%) score of QOL was 5.14 (4.84-5.45) in patients' group and 5.87 (5.57-6.18) in non patients' group (p<0.001). The significant differences were seen in fatigue, abdominal pain, systemic symptoms and activity domains between 2 groups (p<0.001). The fatigue and emotional function domains had the lowest score in patients' and non patients' groups respectively. The highest score belonged to activity domain for both of them. Conclusion: The results of this study support other evidences suggesting that in patients with hepatitis B, quality of life is decreased. Therefore it seems that training, informative and improvement in physical activity may due to better quality of life in these patients. ISE.212 Health Education as Control Method for Schistosomiasis Infections C.T. Wolmarans, K.N. De Kock. Northwest-University, Potcheftroom, South Africa The influence of health education on the prevalence and intensity of Schistosoma haematobium infections, as well as on the related morbidity, was studied in school children between the age of four and 14. Three groups of children were selected for this investigation. All the children in the experimental group received chemotherapy before health education was implemented, while those children in this group that got re-infected during the study were treated after every survey. Health education was presented in mother tongue and by means of a flip chart. The children in one of the control groups only received treatment after the study while the children in the remaining control group were treated as those in the experimental group, except that no intervention by means of education was applied. Health education, parasitological screens and snail surveys were done every three months between 2004 and 2006. The prevalence and intensity of infection, as well as, the morbidity (degree of haematuria) due to infections, were determined after the urine samples, collected from each child, were screened. From the results it was clear that the prevalence, intensity and morbidity of infection were significantly lower in the experimental group than in both of the control groups. ISE.213 Antituberculosis Activity of Some South African Plants Against Mycobacterium tuberculosis and M. smegmatis S.P.N. Mativandlela1, N. Lall2, J.J.M. Meyer2, T. Muthivhi1, M. Van der Walt1. 1Medical Research Council, Pretoria, South Africa, 2University of Pretoria, Department of Plant Science, Pretoria, South Africa Tuberculosis (TB) is an infectious disease of the lung caused by Mycobacterium tuberculosis. In recent years, TB has re-emerged as a major world health problem with an estimated annual death toll of 2 million. The pandemic of HIV/AIDS infection and the evidence of an association with TB, have caused marked increases in the incidence of the disease in some countries. Because of its ability to destroy the immune system, HIV has emerged as the most significant risk factor for progression of dormant TB infection to clinical disease. The recent increase in the incidence of TB with the emergence of multidrug-resistant (MDR) cases has lead to the search for new drugs that are effective against

MDR strains of M. tuberculosis and can augment the potential of existing drugs against TB. Ethanol extracts of seven ethnobotanically selected South African medicinal plants, Artemisia afra, Dodonaea angustifolia, Drosera capensis, Galenia africana, Prunus africana, Syzygium cordatum and Ziziphus mucronata were screened for their antimycobacterial activity against Mycobacterium smegmatis using the microplate dilution method. The MIC of A. afra, D. angustifolia, D. capensis and G. africana ranged from 0.781 to 6.25 mg/mL. G. africana showed the best activity exhibiting an MIC of 0.781 mg/mL and minimum bactericidal concentration (MBC) of 1.563 mg/mL. A drug sensitive strain of M. tuberculosis was found to be susceptible to the ethanol extracts of D. angustifolia and G. africana. (MICs 5.0 and 1.2 mg/mL respectively). Cytotoxicity of these extracts was done against monkey kidney Vero cells using XTT method. The IC50 value of the most active antimycobacterial extract, from G. africana was found to be 101.3 µg/mL. This study gives some scientific basis to the traditional use of these plants for TB-related symptoms. ISE.214 Two Doses of Hepatitis B Vaccine Can Differentiate Occult Hepatitis B Virus Infection Among Isolated Anti-HBC Cases M.R. Hasanjani Roushan, S.A. Asgharzadeh Ahmadi, H. Taheri, A. Farrokhzad. Infectious Diseases Research Center,Yahyanejad Hospital,Babol Medical University, Babol, Iran (Islamic Republic of) Background: Over time, the levels of HBsAg or anti-HBs decline and are not detectable with Elisa and named as isolated anti-HBc. The purpose of this study was to determine occult HBV infection among cases of isolated anti-HBc. Methods: From April 2000 to September 2007, the results of HBV markers on 2036 cases of previously infected individuals were recorded. Those who were HBsAg or anti-HBs negative but anti-HBc positive were selected and received two doses of hepatitis B vaccine one month apart.Anti-HBs antibody levels were determined one month of the later dose. HBV DNA was performed using Real time PCR on non-responders to hepatitis B vaccine. Results: Among 1160 males with past HBV infection, isolated anti-HBc was seen in 35(3%) cases. Isolated anti-HBc was seen in 44(5%) cases of 876 females with previous HBV infection (p=0.014). The prevalence of isolated anti-HBc was 79 (3.9%). The mean age of these cases was 33.8 ±13 years. Anti-HBs antibodies 10 mIU/ml was seen in 57 (72.2%) cases. The mean anti-HBs level was 425.5±317 mIU/ml.HBV DNA was positive in 22 (27.8%) cases of non-responder. Conclusion: The result of this study shows that with using two doses of hepatitis B vaccine we are able to differentiate occult HBV infected subjects among isolated anti-HBc individuals. ISE.215 Changing Epidemiology of Hepatitis A in Italy. Prophylactic Measures Targeted on Potential Sexual Transmission R. Manfredi, L. Calza. Infectious Diseases, University of Bologna, Bologna, Italy Background: Outbreaks of hepatitis A have been recently observed worldwide,with special attention focused on homosexual men, i.v. drug users,and also heterosexual partners. Patients and Methods: An observational survey of all hospitalizations due to hepatitis A occurred in the Bologna metropolitan area, performed from 1999 to mid-2007, was carried out. Results: One hundred and 76 consecutive patients (p) with acute HAV hepatitis were hospitalized. From October 2002 to September 2004,hepatitis A largely prevailed over acute HBV-HCV-HEV hepatitis. Adult female p and children represented only 15.9% of overall cases. Among the 176 p with ascertained acute hepatitis A,the prevalence of immigrants increased over time, from 1­3 cases/year from year 1999 to year 2001,up to 14 cases in the 21 months elapsed from 2003 to September 2004 (p<.02). Even 121 out of 176 p (68.7%) were represented by male adults,aged 22-56 y, who recognised unprotected homo-bisexuals contacts in the two months preceding hepatitis A onset in 83.5% of cases. Nobody was aware and/or underwent prior anti-HAV vaccination. Among the 121 adult males with acute HAV hepatitis,concurrent infections were found in 44 p (p<.003 versus other p with HAV disease): chronic hepatitis B in 8 cases, hepatitis C in 19, syphilis in 11,and HIV in 11 p. The temporal trend of male adults admitted for hepatitis A showed a significant increase from 1999 to the first 9 months of 2004: a ~300% increase versus the year 1999, leading to a crude rate of 7.7/100.000 residents/year.

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Conclusions: Despite the availability of anti-HAV vaccination, and information campaigns against the spread of STD and HIV, the epidemic of HAV recognizes an increased prevalence of homo-bisexual transmission. Epidemiological monitoring,targeted educational campaigns, and public health measures (such as an recommendation of immunoprophylaxis), may help contain the outbreak of hepatitis A by sexual route, and reduce the spread of other concurrent STDs. ISE.216 Hiv Infection and the Immigration. Consequences on Inpatient Hospitalization in an Italian Hospital, in the Last Seven Years R. Manfredi, L. Calza. Infectious Diseases, University of Bologna, Bologna, Italy Background: Immigration is a recent phenomenon in Italy, mainly caused by the sudden and unexpected arrival of waves of foreign citizens, refugees, and individuals escaping from war. This phenomenon is of great concern due to its serious socio-economic and health care impact. Patients and Methods: A prospective survey of all charts of patients (p) hospitalized or followed on day-hospital (DH) basis at our Infectious Disease ward until end-2006, allowed us to assess the frequency of admission of immigrants from extra-Western Europe (eWE), and to analyze multiple variables related to epidemiologic-clinical features. Results: The rate of p immigrated from eWE showed a significant increase among our inpatients, and at a lesser extent and later for DH admissions: 7.7% and 3.1% during the year 2000, 10.1% and 4.6% in 2001, 13.2% and 6.2% in 2002, 17.9% and 7.9% in 2003, 21.3% and 8.9% in 2004, 17.7% and 10,8% in 2005, up to 17.9% and 11.3% in the year 2006 (p<.0001 for inpatients; p<.001 for DH p). Over 60% of p came from Africa, followed by Eastern Europe, Asia, and CentralSouthern America. When comparing the admission features of WE citizens with those of p coming from abroad, no differences were found as to duration-intensity of assistance, with HIV disease prevailing among regular admissions (35.1%), and DH access (33.8%), followed by acutechronic hepatitis, pulmonary or other-site tuberculosis, central nervous system and respiratory tract infection, and sexually-transmitted diseases. HIV-infected immigrants were frequently (60.1% of cases) AIDS presenters, and less than 5% of them were already on anti-HIV therapy upon admission. While the frequency of HIV-associated admissions did not show differences in the considered 7-year period, p from eWE had an increasing frequency of tuberculosis, skin-soft tissue infection, exanthems, gastroenteric-parasitic diseases, and malaria (p<.05 to <.0001). Conclusions: A continued monitoring of this phenomenon is strongly warranted, to improve a sustainable social-cultural network, to plan health resource allocation, and to define adequate and well-targeted prevention and public health measures. ISE.217 How the Natural History of HIV Infection Modified During the HAART Era Acts on Evolving Assistance Issues at an Infectious Disease Day-Hospital Service (1994­2006) R. Manfredi, L. Calza. Infectious Diseases, University of Bologna, Bologna, Italy Background: Aim of our study is to evaluate frequency and features of admissions performed at a Day-Hospital service in Northern Italy. Patients and Methods: A retrospective evaluation of all admissions of the last 12 years (1994­2006), was performed. Results: Before HAART introduction (years 1994­1996), the proportionally low mean number of admissions (110/year), was linked to the elevated prevalence of HIV disease, which accounted for 89.4% of DayHospital 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), 347 (2004), 331 (2005), and 356 (2006) (p<.0001 versus the pre-HAART era), although this phenomenon paralleled a drop of percentage of HIV-related admissions (from 59.1% of 1997, to a minimum of 23.8% of 2005; 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 11.8 in 2006 (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 attention: from a low number of prolonged hospitalizations typical of patients with advanced HIV disease, the HAART era led to a progres-

sive 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 year 2000, to a mean 1.31 figure in 2006. 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, technical, and funding resources. ISE.218 The Increased Incidence of Pertussis in the Czech Republic and Europe--Changes in Vaccination R. Chlibek, R. Prymula, J. Smetana, M. Splino. Faculty of Military Health Sciences, Hradec Kralove, Czech Republic Background: Pertussis is a severe worldwide disease. The assumed incidence is 50 million cases and 300 thousand deaths annually. Resurgence of reported pertussis observed in the vaccination era in many countries. Age distribution of pertussis seems to have shifted towards older children, adolescents and adults. Methods: Descriptive data analysis. Results: In the Czech Republic, pertussis has been permanent increasing since 2002. In 1996­2006, 2358 cases were reported: 121 persons in 1996 (1.17/100 thousand), 414 persons in 2005 (4.3/100 thousand), which is 3.44 times more than in 1996. 90 % of all cases were vaccinated people. The highest rise is in 10- to 14-year-old children (4.39 times more in 2005 than in 2006). The increasing trend is also in adolescent (15­19 year). The causes for an increased incidence may be: changes of the circulating genotype B. pertussis, lower efficiency of the vaccine, better laboratory diagnostics, or waning vaccine-induced immunity. The vaccination schedule involves 5 doses: at the age of 3, 4, 5, 11­18 months and 5 years. The recommended intervals between individual doses are often not kept (in 18­83 % of cases). The incidence of pertussis in Europe is different - the lowest is in Portugal (0.1/100 thousand), the highest in Switzerland (123.9/100 thousand). In a number of countries, pertussis occurs mostly in adults (in Germany 60 % of cases). The vaccination schedules in Europe are different: 12 countries use the four-dose schedule, 18 countries the five-dose, 2 countries the six-dose, and 2 countries vaccinate also adults every 10 years. Conclusion: The increase of incidence can be lowered by changing the vaccination strategies: adolescent vaccination, adult vaccination, cocoon strategy, maternal vaccination, and improved current infant vaccination. Pertussis is no longer only a children's disease--it is necessary to think of it in the adult population as well. ISE.219 A Cluster of Delay Toxicity and Intermediate Syndrome of Insecticide Poisoning, Thailand 2007 V. Pawun. Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Nontaburi, Thailand Abstract: An outbreak investigation was launch after a suspected botulism outbreak was notified to Bureau of Epidemiology (BOE). We reviewed medical records of 3 admitted cases and interviewed 10 persons who potentially exposed to the suspected meals with case those are their household members and neighbors. We performed a retrospective cohort for all 13 persons who were interviewed. We trace back investigated and reviewed preparing process of suspected food items. The cases presented dizziness, nausea, vomiting and abdominal cramp. One severe case had respiratory failure, ptosis, pupil constricted, increase the salivation and need mechanical ventilator support. Antidote of organophosphate was only treated for one most severe case while the other cases were improved without specific treatment. The severe case needed mechanical respirator support for 9 days. The laboratory testing, DIG-ELISA, were positive for C. botulinum neurotoxin type E. However the mouse bioassay showed negative results for C. botulinum. The serum AchE activity of 3 cases ranged from 105, 187 and 41 mU/ml, respectively. All 13 persons had shared similar food during 3 days before the onset of the first case except the river turtle soup. This meal compose of 2 Kg of turtle meat and its' entrails favored with fish sauce and sugar. The turtles caught from the river nearby the rice farm those previously use the large amount of pesticide. This meal served on previously 2 days before onset of the first case. This meal showed the highest risk ratio (RR=9.6; 95%CI=1.40-65.94) and had statistical significant. However, at the time of our investigation, this

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suspected meal wasn't leftover so we couldn't send the sample test for the contamination of the organophosphate. The clinical, epidemiologic, and laboratory evidence suggested the organophosphate poisoning, delay toxicity for all cases and one case developed an intermediate syndrome. DIG-ELISA test kit was showed a false positive result with Clostridium botulinum neurotoxin type E. Although the results of investigation were not definitely conclusive regarding the source of organophosphate contamination, we suggested alerting the physicians to recognize the delay toxicity of organophosphate and the intermediate syndrome. Key Words: organophosphate poisoning, delay toxicity, botulism, intermediate syndrome ISE.220 MSMs, Their Sexual Behavior and Impact On Women L.N. Bhandari. National Vigilance Center, Kathmandu, Nepal Objectives: A higher rates of HIV infections are transmitted through homosexual contact. Most MSMs are youth and are an incredibly diverse group, in terms of both their economic circumstances and sexual attitudes and behavior, more economically disadvantaged than older youth, often more subject to peer. Most of them either are married or will become married, thus having an impact upon women's reproductive health. Methods: Government's different strategies for national health program in terms of sexual health and HIV/AIDS has shaded a negative impact among such vulnerable population in Asia region; due to socio-culturalreligious reasons, those behaviors are to a large extent invisible, often difficult to access in terms of standard sexual health promotion framework of the nations. Result: The most needing information, education and counseling are driven underground. Men and women are at not only greater risk of being infected, but also HIV/AIDS affects women also as caregivers in the family. Conclusion: An urgent need to promote behaviors, which enable to adopt a lifestyle without risk of HIV and to provide counseling services, is essential. When youth belong to an organization that helps them and provides opportunities, they better avoid risky behaviors, including those that might lead to HIV/AIDS. Not every social sector should discriminate/stigmatize them so that they can create an environment to change their behavior. Regardless, there should be ensured legal framework protections of human rights of those sexual minorities. ISE.221 A Study of Enteropathogenic Campylobacter in Diarrheal Patients at Alzahra S.A. Havaei1, R. Salehi1, S.A. Fazeli1, M. Bokaeian2. 1Isfahan University of Medical Sciences, Isfahan, Iran (Islamic Republic of), 2Zahedan University of Medical Sciences, Zahedan, Iran (Islamic Republic of) Background: Enteritis due to Campylobacter is the most common cause of acute bacterial diarrhea worldwide. Due to the mutation of bacteria and their resistance to antibiotics, therefore sensitivity test is needed. In this study we isolated C. jejuni and C. coil from the diarrheal patients and then antibiotic sensitivity of the isolates were done. Method: 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%. Conclusions: The results showed that erythromycin was the most effective on the Campylobacter species. ISE.222 An Investigation of Sporadic Indigenous Cases of Typhoid Fever in Taoyuan County, Taiwan 2006 C.L. Liu, C.S. Chiang, H.I. Wang, T.M. Huang, P.H. Wu. Centers for Disease control, R.O.C. (Taiwan), Taipei, Taiwan Background: In Taiwan, there are few indigenous cases of typhoid fever. In 2006, more than half of the cases (13/25, 52%) occurred in Taoyuan county where groundwater was commonly used by some residents and the number of foreign laborer was the highest among the nation. The investigation was conducted to identify possible sources of infection and to develop prevention measures.

Methods: We retrospectively performed a questionnaire to evaluate the characteristics of the patients. Besides, we applied PFGE analysis for Salmonella typhi isolates obtained from these patients to explore possible relationships among cases and also to compare PFGE patterns to the database in the Taiwan CDC. Results: Eight of the 13 cases were male (61.5%). Nine were between the ages of 21 to 50 years (69.2%). Eight were factory workers (61.5%) in Taoyuan city or nearby townships. Most of the patients had onset of illness between May and November (92.3%). The three leading symptoms were fever (100%), diarrhea (62%) and anorexia (54%). No evidence indicated that the cases were related to foreign laborer, flood, shortage or pollution of water supply system. Majority of the cases correlated with consumption of food not prepared at home. PFGE analysis demonstrated that these isolates were different from those obtained in other regions of Taiwan. The isolates showed a high degree of genetic diversity, 7 types for 13 isolates. The multiple isolates of 2 PFGE types could relate these cases to two lunch box shops. Conclusion: According to the contact history investigation and PFGE analysis results, it was demonstrated that these cases were exposed to variable vehicles, each responsible for few cases. To strengthen hygiene of vendors and public health education should be included in the prevention measures. ISE.223 Cost and Morbidity Associated with an Outbreak of Possible Cake Related Salmonella enteritidis in Singapore S.Q. Toh, C.W.M. Ong, R. Sridhar, K.T. Goh, R. Lin, L.Y. Hsu, P.A. Tambyah. National University Health System, Singapore, Singapore Background: Fifteen patients with Salmonella enteritidis (SE) presented to our hospital as part of a national outbreak of more than 200 cases resulting in 15 hospitalizations in November 2007. We determined the direct cost and morbidity associated with this outbreak. Methods: A retrospective case control study was done. Cases were patients with positive stool or blood cultures for SE from November 1 through 31 December 2007 at our institution. Age, gender and date of presentation matched controls were chosen. Data were extracted from clinical records. Results: Cases were similar to controls in terms of presenting heart rate (108 vs. 127/min, p = 0.113 ) and mean arterial pressure (85.2 vs. 84.1 mmHg, p = 0.861). There were no significant differences in white cell count (8.15 vs 9.75 x 109/L, p = 0.592) and hematocrit (36.3 vs 40.4%, p = 0.290). However, cases differed from controls in terms of presenting symptoms of diarrhoea (80 vs 6.7%, p < 0.001) and temperature on admission (38.7 vs 37.8 oC, p = 0.017). In addition, they were more likely to be hospitalized (86.7 vs 40 %, p = 0.02). The average length of hospitalization tend to be longer in patients with SE (6.8 vs 0.8 days, p = 0.085), resulting in a significantly higher cost (US$ 1,862 vs 147, p = 0.020). All patients were discharged. The outbreak ended after public health measures were implemented in a popular cake shop that was implicated by epidemiologic investigations. The epidemic curve is shown below. Conclusion: Even in developed settings, salmonella outbreaks continue to be associated with considerable morbidity and costs. Continued vigilance and collaboration between public health and infectious disease specialists remains critical in controlling these infections.

ISE.223 Epidemic curve of the Salmonella enteritidis outbreak.

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ISE.224 Antimicrobial Resistance in Selected Bacterial Enteropathogenes in Children of Bandarabaas, Iran A. Karmostaji, P. Davoodian. Hormozgan University of Medical Sciences, Bandar Abbas, Iran (Islamic Republic of), Hormozgan University of Medical Sciences, Bandarabbas, Iran (Islamic Republic of) Background and Objectives: The resistance of enteropathogenic bacteria to commonly prescribed antibiotics is increasing both in developing as well as in developed countries. The present study was therefore undertaken to report the current antibiotic resistance in common bacteria enteropathogenes isolated in Bandar Abbas children hospital in south IRA. Methods: Faecal samples from 105 patients were cultured for common bacterial enteropathogenes cultured for common bacterial enteropathogenes and identifies by standard methods antibiotic susceptibility was done by stocks disk diffusion method. The clinical and demographic profile of the patients was noted. Results: Stool samples from 105 patients (male & female) yelded enteropathogenic E. coli shigella, proteus vulgaris, proteus mirabilis, among all enteropathogenes Ep. E. coli was the most common 43.8% followed by shigella 11.8%). Resistance to antimicrobial agents was common all pathogens, among EP. E. coli the most sensitive antibiotic was ciprofloxasin (82.6%) and norfloxasin (82%) cephalotin (71.7%), nalidixic acid (65.2%). Overall resistance of 87% and 61% was observed for Amoxicillin and Cotrimoxasole among shigella, the most sensitive antibiotics are Quinolones, 91.7% were sensitive to Ciprofloxasin, 75% sensitive to Naldixic Acid and 58.3% sensitive to chloramphenicol and cephalotin. Overall resistance of (83.3%) was observed for Amoxicillin and Cotrimoxasole. Interpretation and Conclusion: Enteropathogens have developed high level resistance to first line agents used for empric treatment of diarrhea. Progressively increasing resistance to cotrimoxasole is a serious cause of concern. ISE.225 Determining the Effect of South African Parasitology Proficiency Testing Programmes, 2003-2007 B. Poonsamy, L. Dini, J. Frean. National Institute for Communicable Diseases (NICD), Johannesburg, South Africa Introduction: Clinical laboratories in South Africa, as elsewhere, understand the importance of quality assurance systems. Such a system ensures that clinical diagnostic laboratories offer accurate results to doctors, who in turn can correctly treat patients. A vital component of a quality assurance system is participation in external quality assessment (EQA) programmes (also known as proficiency testing schemes). We wanted to determine the effect, if any, of participation in 2 of our parasitology EQA programmes on laboratory performance. Methods: The results of all laboratories that participated in 2 of our EQA programmes (blood parasites and stool parasites) from 2003 through 2007 were analyzed. These include mostly South African laboratories (both public and private) as well as some laboratories from Namibia and other African countries. We calculated the percentage acceptable results (scores of 75%) for all 16 surveys of each programme, and analyzed them to identify any possible trends. Results: No substantial trend in the percentage acceptable results over the years was found for either EQA programme. We found that 13 surveys of the Stool Programme and 11 surveys of the Blood Programme had percentage acceptable results that fell between 35% and 65%. The average percentage acceptable results over the 5 year period were 50% for the Stool Programme and 54% for the Blood Programme. Discussion: Most laboratories, despite presumably giving their best effort, performed poorly in the EQA programmes. There are plausible reasons for the overall poor EQA performance, such as skill and training shortage, high staff turnover, and lack of suitable resources. These can serve as the source of the solution on how management can improve both EQA and routine patient results. From an EQA standpoint, participants need to be encouraged to use the valuable tools provided by EQA to their benefit. ISE.226 Assessment of Anti-tuberculosis Regimen at a Medical Center in Northern Taiwan Y.C. Lei, P.C. Chan, A.S. Huang. Centers for Disease Control, Taipei, Taiwan

Background: Using non-standardized regimen, under-dosage, and improper use of the second-line drugs may lead to development of tuberculosis (TB) drug resistance. In order to better understand antituberculosis regimens and dosages prescribed to TB patients at a medical center in northern Taiwan, we compared the regimens used at the medical center with standardized treatment specified in the second edition of Taiwan Guideline on TB Diagnosis and Treatment. Methods: We analyzed all TB patients monitored by First Branch of Taiwan Centers for Disease Control (CDC) under medical treatment at a medical center during September 2007. All patients were confirmed to have intra-pulmonary or extra-pulmonary TB. Patients' TB case management cards and records of prescription from yellow booklet were reviewed. Results: A total of 195 TB patients monitored by First Branch of Taiwan CDC were treated at the medical center during September 2007. Seventeen patients were excluded from analysis: two patients received no treatment because of other physical contraindications, and information could not be access for 15. Of the 178 cases reviewed, 30 (16.9%) received non-standardized regimen, including improper use of injectable agents or fluoroquinolones. There were 53 (29.8%) patients who were under-dosed. There were also 8 (4.5%) patients who were prescribed both under-dosed and non-standardized regimen. In addition, 6 (3.3%) were overdosed with ethambutol (EMB). Conclusion: The results revealed that non-standardized regimens use and under-dosage are problems in treatment of TB patients in northern Taiwan. There are also patients who had both non-standardize regimen and under-dosage. Patients receiving non-standardized regimens are in danger of treatment failure, relapse, and development of drug resistance in the future. Although Taiwan government launched Directly Observed Therapy (DOT) program to work towards the goal of halving TB by 2015, enhancing the accuracy of anti-tuberculosis regimen and dosage might be more critical. ISE.227 A Case of Brucella Endocarditis in Association with Superficial Artery Thrombosis R. Caylan, S. Keske, T. Durmaz, T. Keles, M.A. Tasyaran. Ataturk Education and Research Hospital, Ankara, Turkey Brucellosis is a zoonotic disease that is caused by Brucella spp. Endocarditis is a rare complication of brucellosis; however it has a high mortality rate. Thrombosis is an uncommon complication of brucellosis. A 34-year-old male patient visited the emergency service with a oneweek history of increasing effort dyspnea. During the first examination body temperature was 38.0 °C, a grade 3/6° systolic murmur and diastolic rub was detected at the mitral focus. Total white blood count of 14.000/mm3, ESR: 64 mm/h, and CRP: 86 mg/dl. After hospitalization both transthoracic and transesophageal echocardiography showed mobile vegetation on the mitral valve. A blood culture was obtained and empirical therapy consisting of penicillin G and gentamicin therapy was started. Six days later the blood culture grew Brucella spp. The fever continued during this period and the treatment was altered to rifampicin + doxycycline + trimetoprim-sulfametoxazol. The fever subsided on the seventh day and the general condition of the patient improved but the patient developed pain in the right leg and numbness of the great toe. Doppler ultrasonography of the lower extremity demonstrated a hyperechoic thrombus, totally occluding the lumen in the 1/3 proximal part of the right femoral artery. 300 mg/ day acetylsalicylic acid was added. Echocardiography at the end of the sixth months of therapy showed no vegetation, and doppler ultrasonography showed decrease in the size of arterial thrombus and therapy was stopped. At the 12th month of non-treatment follow-up the patient is well. Both Brucella endocarditis and arterial thrombosis are two different rare complications of brucellosis. These two complications were seen together in our case. Only medical treatment was used and although few in number, such cases of Brucella endocarditis have been reported previously in the literature. ISE.228 What Argentine Women Know About Vertical Transmitted Infection? L.M. Teston1, A.V. Sanchez2, M. Mayer Wolf1, V.E. Rodriguez1, C. Ezcurra1, C.B. Freuler1. 1Hospital Aleman, Buenos Aires, Argentina, 2 William Morris Primary Care Center, Buenos Aires, Argentina Background: Despite the increasing availability of prenatal screening test and interventions, intrauterine and perinatal transmitted diseases

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occur and have severely debilitating effects on pregnant women and their offspring. Public knowledge about these diseases is the starting point to prevention Objective: To evaluate the knowledge of child-bearing age women on transmitted infections and to compare two groups of women of different social economical status in Buenos Aires, Argentina. Methods: 16- to 39-year-old women who attended either the vaccination center of a private teaching hospital in the city--group A, or a primary care center in the suburbs--group B, were asked to respond if HIV, syphilis, cytomegalovirus, Chagas disease, toxoplasmosis, rubella and hepatitis B (VHB) could be transmitted vertically. Data were transferred to Epi-info® and a p value <=0.05 was considered significant. Results: 1064 women, 966 of high income class (group A) and 98 of lower income class (group B) answered the questionnaire. Knowledge was highest for HIV, 92 vs 84.8% right answers,VHB 61.3 vs 48% (p 0.02), Toxoplamosis 55 vs. 63% (p 0.0001), syphilis 30 vs 35.7% (p0.05), Chagas disease 25.1 vs. 43.8% (p0.02),rubella 92 vs.36.7%% (p 0.0001) and cytomegalovirus 9.3 vs.6.2 group A and B respectively. Discussion: Higher knowledge on syphilis, toxoplasmosis and Chagas disease in lower income class; the former probably due to compulsory syphilis testing before initiating free contraceptive treatment. Surprisingly, 37,5% of women who had participated in a national-spread free vaccination campaign against rubella, only 90 days prior to the questionnaire, did not recall the risk of vertical transmission regarding the latter. Conclusions: Regardless of the social status, knowledge on vertical transmitted diseases should be encouraged. Unexpectedly, higher education level does not correlate with the level of awareness. ISE.229 Cytomegalovirus IgG Antibodies among Blood Donors in Jos L. Nimzing1, H. Khantiok 2, A. Abubakar3. 1Department of Medical Microbiology, Faculty of Medical Sciences,University of Jos, Jos, Nigeria, 2Department of Microbiology, Faculty of Natural Sciences,University of Jos, Jos, Nigeria, 3Department of Hematology/Blood Bank. Jos University Teaching Hospital., Jos, Nigeria Background: In spite of donor screening for blood borne viruses, CMV can be transmitted by cellular products resulting in significant morbidity in immunocompromised patients. This study was carried out to determine the seroprevalence and risk factors for CMV in blood donors to establish CMV seronegative blood donors. Methods: Between November, 2005 and April 2006 136 apparently healthy male blood donors aged 24 to 50 years having been counseled were recruited by blood bank JUTH for HIV HBV and HCV testing to qualify for blood donation. After obtaining their consents, were concurrently enrolled to be screened for evidence of anti-CMV antibodies using immunocomb® IgG quantitative Kit (Yavne, Israel). Results: CMV antibodies were found in 116(85.3%) of the blood donors tested, The age group 26- 30 years had the highest CMV prevalence of 19.9% Our findings indicate that majority of the blood donors are seropositive for CMV resulting in limited availability of CMV seronegative blood products. We urge that care should be taken to administer CMV seronegative blood to seronegative infants, pregnant women and HIV patients in our community. ISE.230 Specific Serum Immunoglobulin G to Helicobacter pylori and CagA in Healthy Children and Adults (South-Eeast of Iran) A. Jafarzadeh, M. Nemati, M.T. Rezayati. Rafsanjan University of Medical Sciences, Rafsanjan, Iran (Islamic Republic of) Background: The acquisition of H. pylori influence by age of subjects. The aim of this study was to evaluate the serologic IgG response to H pylori and CagA across age groups and in healthy children and adults. Methods: Totally, 386 children aged 1-15 years and 200 adults aged 2060 years, were enrolled to study. The serum samples of participant were tested for presence of anti-H pylori and anti-CagA IgG by using ELISA method. Results: The seroprevalence of H. pylori in adults was significantly higher than that observed in children (67.5% vs 46.6%; P<0.000003). In children, the seropositivity rate in males (51.9%) was significantly (P<0.05) higher than that observed in females (41.7%). The prevalence of serum anti-CagA antibody was 72.8% and 67.4% in infected- children and adults, respectively. The mean titer of serum anti-CagA antibodies was significantly higher among children in comparison to adults (64.1 Uarb/mL vs 30.7; P<0.03). In infected-children and adults the prevalence of serum anti-CagA antibody was higher in males compared to

females (78.4% vs 66.3%; P= 0.07 and 75.6% vs 54.71%; P<0.04, respectively). The age-specific prevalence of anti-H. pylori and antiCagA antibody (in infected subjects) was 37.6% and 59.57% at age 1­5 years, 46.9% and 75% at age 6­10 years, 54.9% and 79.45% at age 11­15, 59.01% and 83.33% at age 20­30 years, 66.6% and 60.52% at age 31­40 years, 73.46% and 63.88% at age 41­50 years and 75.75% and 60% at age 51­60 years with mean titer of anti-CagA antibody of 75.94, 63.32, 57.11, 52.06, 23.62, 21.52 and 21.80 Uarb/mL, respectively. There was significant difference between mean serum anti-CagA antibody in age subgroups (P<0.001). Conclusion: These results showed that anti-H pylori and anti-CagA antibodies were common in the children and adults. The H pylori-specific antibodies influenced by age and sex of subjects. Moreover, it seems that the males are more susceptible to infection with cagA+ strains compared to females. The seroprevalence of anti-CagA antibody was increased with age, up to 30 years and then decreased. It was also found that the magnitude of the IgG response to CagA decreased with advanced age. ISE.231 Pattern Recognition for Indications and Warnings of Pandemic and Seasonal Influenza N.P. Nelson, A.R. Reilly, M.A. Cole, D.M. Hartley, J.M. Wilson. Georgetown University, ISIS Center, Washington, DC, USA Background: Project Argus at Georgetown University tracks global internet media for indications and warnings (I&Ws) of infectious disease. In light of current concerns about pandemic influenza, Argus has developed a Pandemic Influenza Research Group to analyze newspaper coverage of the three flu pandemics of the 20th century: 1918, 1957, and 1968. Our group hypothesizes that the I&W signal created during a pandemic influenza period is different from the I&W signal created during the seasonal influenza period in the year preceding the pandemic. Methods: We collected reports of respiratory disease that appeared in Chinese- and English-language newspapers published in Hong Kong and Southern China in 1967 and 1968. The sources, accessible at the Library of Congress, were selected for their full availability during the targeted time periods, resulting in a sample size of approximately 200 months. We developed a unique 116-parameter Pandemic Influenza Taxonomy based on Argus social disruption methodology and used it to identify and classify I&Ws within the collected articles. We established baseline I&W reporting rates for the targeted time periods. We are also performing multivariate analyses to identify which I&Ws differ significantly between seasonal and pandemic influenza periods. Results: After looking at approximately 100 months and analyzing 162 influenza-related articles, we identified that the I&W categories of "local perception of threat" and "integrity of infrastructure" may distinguish the pandemic influenza period from the seasonal influenza period. In addition, the calculus of I&Ws, meaning the volume and timing of aggregate I&Ws, appears to differ between seasonal and pandemic influenza periods. Conclusion: Through surveillance of open source media, Argus social disruption methodology provides a novel approach to the early detection of infectious disease. This case study suggests that modeling the signal of I&Ws from an historic influenza pandemic may provide early warning parameters for a future influenza pandemic. ISE.232 The Variability of Penicillin Resistance Rates of S. pneumoniae in the United States by CDC Regions: A Longitudinal Perspective S. Bouchillon1, B. Johnson1, R. Badal1, M. Hackel1, J. Johnson1, M. Renteria1, D. Hoban1, M. Dowzicky2. 1International Health Management Associates, Inc., Schaumburg, IL, USA, 2Wyeth Pharmaceuticals, Collegeville, PA, USA Background: The percentage rates of penicillin-resistant (PenR) S. pneumoniae (SPN) varies by country and region. Earlier studies have documented U.S. regional variations in PenR SPN. The purpose of this study was to determine changes in regional variations, if any, of PenR and PenNS strains of SPN, and the current activity of tigecycline (TIG), amoxicillin-clavulanic acid (AC), ceftriaxone (CFX), levofloxacin (LEV), linezolid (LNZ) and vancomycin (VAN) to pen-resistant isolates. Methods: 1,694 clinically relevant isolates of SPN were collected from patients in 137 hospitals from 2004­2007. MIC's to all agents tested were determined by broth microdilution and interpreted following CLSI guidelines. Regions are defined by the CDC. Results: PenNS rate was 41.8% for all regions varying from a high of 61.5% (East South Central) to a low of 23.2% (Pacific). PenR decreased in all regions but one (New England) with a corresponding increase in

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PenI rates in most regions. Regional changes from a 1999­2000 study to 2004­2006 study are noted. Tigecycline and vancomycin had the lowest MIC90s (mcg/mL) against PenR SPN at 0.5 followed by LEV and LNZ at 1 and CFX and AC at 2 and 8, respectively. Conclusions: PenNS for SPN has remained constant since 1999 but PenR has generally shifted from Pacific regions eastward. VAN, LNZ, LEV and TIG MIC90 values remain unaffected by pen phenotypes.

ISE.232 Paper: http://jac.oxfordjournals.org/cgi/content/full/45/5/623 ISE.233 Age Group Variation of Susceptibility Results in Isolates from Patients Collected in the USA from 2004-2007 R. Badal1, S. Bouchillon1, B. Johnson1, M. Hackel1, J. Johnson1, D. Hoban1, M. Renteria1, M. Dowzicky2. 1International Health Management Associates, Inc., Schaumburg, IL, USA, 2Wyeth Pharmaceuticals, Collegeville, PA, USA Background: The TEST project is an ongoing surveillance study designed to monitor the activity of tigecycline (tig), a new broad-spectrum antimicrobic, compared to other widely-used drugs. This report evaluates differences in susceptibility of strains from patients of different age groups, collected in the USA from 2004­2007. Methods: 22,540 strains were collected and identified from patients categorized into 4 age groups from 2004­2007 at 137 hospitals in the USA. MICs for each strain were determined per CLSI guidelines at each facility using broth microdilution. MIC50/90 and % S were analyzed to identify differences in susceptibility patterns. Results: Generally, %S was pediatric>young adult>adult>geriatric. Acinetobacter spp. in particular showed significantly higher rates of susceptibility (20-40%) with pediatric patients. Levofloxacin showed greater activity vs. pediatric strains of E. coli, Klebsiella, P. aeruginosa, non-VR enterococci, and MRSA. S. pneumoniae penicillin susceptibility was <65% for each age group, with pediatric isolates 13-16% lower than others. VRE faecalis rates ranged from 0% (pediatrics) to 4.5% (geriatrics). ESBL rates ranged from 1.3% (pediatrics) to 6.2% (geriatrics). Tig's activity was essentially the same for all age groups. Conclusions: Although many drugs showed little difference in activity among patient age groups, overall susceptibility levels were higher in the pediatric and young adult groups than in adults and geriatrics. Some of the problematic therapy issues seen in older patients (VRE, ESBL, reduced fluoroquinolone efficacy) are not as prevalent in younger patients. Tig's spectrum covers most of these resistant strains, and offers an effective alternative to clinicians faced with diminished potency of older agents. ISE.234 Sensitivity to Antibiotics in Escherichia coli Strains Isolated from Patients with Inflammatory and Oncological Diseases of Gastrointestinal Tract K. Curova1, M. Kmetova1, M. Bubanova1, L. Gombosova2, M. Zakuciova2, L. Siegfried2. 1Institute of Medical and Clinical Microbiology, University P.J.Safarik and L.Pasteur University Hospital, Faculty of Medicine, Kosice, Slovakia, 2I.Internal Clinic, University P.J.Safarik and L.Pasteur University Hospital, Faculty of Medicine, Kosice, Slovakia Introduction: The aim of this study was to determine and compare antimicrobial susceptibility patterns of Escherichia coli strains isolated from biopsy specimens of colon. E. coli are predominant bacteria of human colonic microflora. Of the other side E. coli have evolved the ability to cause a broad spectrum of human diseases. Enterovirulent E. coli (EVEC) have ability to cause gastrointestinal infections. Most frequently they are linked with diarrhea, sometimes with another clinical manifestation. Many investigators suppose an involvement of E. coli in the initi-

ation of early and chronic ileal lesions in inflammatory bowel diseases (Crohn disease-CD and ulcerative colitis-UC) and colorectal carcinoma. Methods: A total of 393 E. coli strains were isolated from biopsy specimens of 63 patients with gastrointestinal diseases (78 E. coli strains from Crohn disease, 94 from ulcerative colitis, 187 from noninflammatory bowel diseases--nonIBD, 34 from neoplasions and oncological bowel diseases--NO). E. coli isolates were evaluated for resistance to antibiotics (ampicillin, augmentin, cefalotin, cefotaxime, ceftriaxon, ceftazidim, cefepim, meropenem, aztreonam, gentamicin, amikacin, cotrimoxazol, ciprofloxacin). Results: E. coli strains showed sensitivity to most antibiotics used in the study. We observed increased resistance of E.coli against ampicilin, augmentin and cefalotin. The rate of resistance at 41,5 % was detected for cefalotin (41,2 % in CD, 57,7 % in UC, 13,3 % in nonIBD, 39,4 % in NO), 37,6 % for augmentin (27,8 % in CD, 53 % in UC, 42,9 % in nonIBD, 36,4% in NO) and 20, 6 % for ampicilin (10,3 % in CD, 25,6 % in UC, 40 % in nonIBD, 20,7 % in NO). Comparing all investigated groups of E. coli strains we observed statistical differences in resistance of E.coli to these antibiotics. Conclusion: We detected very good susceptibility of E. coli strains to most antibiotics used in the study. Increased resistance was observed against ampicilin, augmentin and cefalotin with statistical differences among CD, UC, nonIBD and NO groups of E. coli strains. This work was supported by VEGA grant 1/4254/07 and AV 4/0027/07 ISE.235 Antibiotic Sensitivity of Isolated Shigella spp. from Yazd Province, Iran M.M. Attarpour Yazdi. Shahed University(Faculty of Medicine), Tehran, Iran (Islamic Republic of) Background: Shigella species are the cause of acute infectious diarrhea. Approximately 40 million cases of shigellosis with 600,000 deaths are reported annually throughout the world. The highest incidence of disease occurs among young children from 1 to 5 years of age. There are four species of Shigella: S.dysenteriae, S.flexneri, S.boydii and S.sonnei with few exceptions the shigellae are harbored by humans and transferred by the fecal - oral rout. As many Shigella species show multiple antibiotic resistance markers on plasmid, if antibiotic therapy is undertaken, it is advised that isolated species should be subjected to invitro antibiotic susceptibility test. Methods: In this study fecal specimens of suspected diarrhea cases of three hospitals of Yazd province (central area of Iran) cultured by plating on various selective or differential media, from April 2007 to December 2007. Isolated samples then subjected to specific biochemical tests. Species that non motile, didn't ferment lactose and produce no gas from carbohydrate and fail to produce hydrogen sulfide confirmed by serological testing. Results: Results analyzed by chi-square and t-test. Out of 95 suspected dysenteric cases (male and female) 72 Shigella spp. were isolated with included S.flexneri38.9% (n=28), S.dysenteriae33.3% (n=24), S.sonnei20.8% (n=15), S.boydii7% (n=5). Reults and Conclusion: S.flexneri and S.dysenteriae were dominated serotypes (72.2%). There was no significant difference between male (54.2%) and female (45.8%) (P<0.3). The most cases were found in summer (51.4%) and the least in spring (7%). Most of the isolated strains were sensitive to ceftriaxone and ceftizoxime (95.8%), ciprofloxacine (93%) and Nalidixic acid (90%). They showed resistance to ampicilline, amoxicilline, furazolidone, SXT, tetracycline and neomycine. ISE.236 An Outbreak Investigation of Varicella, Hsinchu City, Taiwan, 2007 P.H. Lee1, C.H. Lin1, Y.N. Chao1, C.M. Wang2, P.C. Yu3, T.J. Yu3, S.E. Huang1, D.S. Jiang1. 1Seventh Branch, Centers for Disease Control, Taipei, Taiwan, 2Second Division, Centers for Disease Control, Taipei, Taiwan, 3Second Branch, Centers for Disease Control, Taoyuan, Taiwan Background: Varicella zoster virus infection, usually a benign disease in children, may induce severe complications in adults. In Taiwan, outbreaks of varicella seldomly occur among adults because of acquired immunity after natural infection in childhood. An outbreak of varicella in a hard disk manufacturer in HsinChu City occurred in October 2007. It was reported to the local health department on November 20, and then an investigation was initiated to find factors resulting in transmission and evaluate the effectiveness of control measures. Methods: A case-control study was conducted with questionnaires

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about varicella illness, exposure and immunization history. A case was defined as onset of generalized itchy vesicular rash, and varicella diagnosed by clinicians in the manufacturer located at HsinChu City during October 1, 2007 to January 10, 2008. Controls were selected from roommates of cases. Results: Of 1358 workers, 16 workers had varicella; 11 patients were Filipino and 5 were Taiwanese. There were 15 controls selected from roommates of cases. All Filipino workers resided in the dormitory and the attack rate was up to 60% in one room. Compared to controls, cases were more likely to have no past history of varicella (Odds Ratio [OR]= 22.8; 95% Confidence Interval [CI]: 1.1 - 478.8). Only one person had received varicella vaccination but this did not prevent disease. Persons with no history of exposure to varicella-infected person were more likely to develop illness (OR=1.9, 95%CI: 0.3-10.1) but not statistically significant. Conclusions: This investigation showed that individual history is reliable in predicting likelihood of developling varicella during this outbreak. Persons without history of varicella were more likely to develop illness. Because varicella vaccine is expensive and currently in short supply, strict isolation and control measures were implemented for susceptible individuals without vaccination. Although varicella is a highly contagious disease, the outbreak was controlled within 1.5 months. ISE.237 Trends in Causation of Encephalitis in NSW, Australia, 1979­2006 C. Huppatz1, P.M. Kelly1, C. Dalton2, C. Levi3, D.N. Durrheim2. 1 Australian National University, Canberra, Australia, 2Hunter New England Population Health, Newcastle, Australia, 3Hunter Medical Research Institute, Newcastle, Australia Background: Acute encephalitis is associated with a range of virulent pathogens, such as West Nile Virus, Australian Encephalitis and Japanese Encephalitis, that may emerge and re-emerge sporadically and without warning. Despite new laboratory techniques, it is not always possible to determine a causative organism. In Australia, encephalitis is not notifiable and attack rates and complications are not well documented, with implications for the timely recognition of emerging pathogens and public health action. We reviewed hospitalised encephalitis attack rates and mortality trends in New South Wales (NSW), Australia. Methods: Mortality and hospital discharge data were obtained from the NSW Government Health Department. In-hospital mortality and hospital discharge data were extracted using ICD-9 and ICD-10 codes that included "encephalitis", "meningoencephalitis", "panencephalitis", "encephalomyelitis"and "rabies". Results were analysed using SAS (version 8). Results: Between 1989 and 2005 there were 4,454 hospital admissions in NSW for which encephalitis was the primary diagnosis. The average annual hospitalisation rate was 4.2 per 100,000 population (range 2.95.7). Of the hospital admissions, 60% (range 47­74%) did not have a specific cause identified. During this period, there were 191 deaths from encephalitis, making the average case fatality rate 4.3% (range 2.36.8%). Forty-nine percent of deaths had no specific causative organism identified. There was a significant decrease in deaths from herpes encephalitis during the ten year period 1979­1988 (R2=0.66, p<0.05). Conclusions: The frequency of encephalitis due to unknown causes suggests that the emergence of novel pathogens presenting as encephalitis may be difficult to recognise in NSW, Australia. The fatality rate amongst encephalitis cases due to an unknown cause is noteworthy. Future research should review current practice in the investigation of unexplained encephalitis with a view to optimising diagnosis of both common and novel causes of encephalitis and the timely recognition of outbreaks. ISE.238 Molecular Typing of Dengue Virus During An Outbreak in the State of Kelantan Malaysia G. Vinomarlini, S. Zainah, N. Izati, T.G. Rogayah, J.B. Stella, L. Samuel. Institute for Medical Research, Kuala Lumpur, Malaysia Introduction: Dengue has become a major health problem worldwide affecting at least 50 million people annually and WHO has estimated that two fifths of the world's population are now at risk from dengue. In Malaysia, dengue has been endemic since 1902 with an incidence of 365 to 6,678 cases per year. All four dengue virus serotypes have been associated with dengue fever and dengue haemorrhagic fever in Malaysia.

Objective: The main objective of this study was to determine the prevalence of dengue serotype in the recent outbreak in Kelantan area from June­August 2007 by using Polymerase Chain Reaction (PCR) for detection. Methods: Blood samples from suspected dengue patients were obtained from 76 patients who were admitted in Hospital Raja Perempuan Zainab II, Kota Bharu. Serotype of the dengue virus was done by Real-Time PCR and was confirmed by direct sequencing. The detection of dengue virus was done using amplification of universal dengue primers while the serotype was identified using UTR_R and UTR_F primers. Results and Discussion: A total of 76 patient samples were tested for dengue virus infections but only 29% was found to be positive for dengue virus RNA. Of these, 27% was dengue serotype 1, 27% dengue 2, 23% dengue 3 and 9% dengue 4. 14% of the positive samples were untypable. From this study, it can be concluded that the incidence of dengue virus serotype 1 and 2 was much higher during the Kelantan outbreak compared to the rest of the serotype. and furthermore the infection occurred higher in the Malay Male patients. Conclusions: All four dengue serotypes were found circulating in Kelantan. ISE.239 Genetic Diversity Analysis of Salmonella typhimurium and Escherichia coli From Street Foods in Jakarta, Indonesia by ERIC-PCR Sequences D.E. Waturangi, A. Adriyadie, V.W. Sastra. Faculty of Biotechnology Atma Jaya Catholic University, Jakarta, Indonesia Background: Street foods are ubiquitous throughout Indonesia and are a vital source for food among Indonesian people. On the other hand, poor sanitation of street foods, may lead to the disease. Bacteria that usually present is Salmonella typhimurium and Escherichia coli. Methods: Street Foods samples were taken from several elementary school in Jakarta for Salmonella and E. coli isolation. Identification of the isolates were done using biochemistry and serology test. Genomic DNA of the isolates were subjected for enterobacterial repetitive intergenic consensus sequences (ERIC)- PCR analysis using ERIC 1 and ERIC 2 primers. Results: From biochemistry and serology test, we found 14 isolates of S. typhimurium and 18 isolates of E. coli, nine of them were classified as O26 and 6 isolates were O111. ERIC-PCR analysis demonstrated extensive genetic diversity within the E. coli and S. typhimurium isolates. Conclusions: Phylogenetic tree analysis indicated that in general E. coli and S. typhimurium isolates showed unique genetic fingerprints. ISE.240 Genotypic Characterization and Identification of Metallo-Lactamases (MBLs) Genes in Pseudomonas aeruginosa Y. Khosravi, S.T. Tay, J. Vadivelu. University Malaya, Kuala Lumpur, Malaysia Resistance to imipenem is an increasing problem among nonfermenting Gram-negative bacterial pathogens. Production of metallo--lactamases (MBLs) or bacterial Class B -lactamases have been identified in several pathogenic species notably Pseudomonas aeruginosa. In this study, we investigated the incidence of imipenem-resistant P. aeruginosa encountered at the University Malaya Medical Center (UMMC) over a four-month period. Various phenotypic and molecular approaches were used for detection of MBLs from P. aeruginosa in our collection. A total of 11(57.9%) of imipenem-resistant P. aeruginosa isolates were positive upon screening by imipenem-EDTA and imipenemmercaptopropionic acid double-disk synergy tests. All isolates demonstrated high MICs (16-192 µg/ml) to imipenem by Etest. BlaIMP gene was successfully amplified from one isolate by conventional PCR assay. Futher testing of these isolates for the presence of blaIMP, blaVIM, blaGIM, blaSPM, blaSIM is ongoing using various PCR approaches. Key Words: Pseudomonas aeruginosa, MBLs, synergy test, PCR. ISE.241 Prevalence of Eye Infection and Low Visual Acuity Among Primary School Children Rajasthan India S. Ranjan. NICD, Delhi, India Background: Eye infection, visual impairment Blindness in children is now recognised a priority by the blindness control programmes including vision 2020--the Right to Sight initiative.

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Aim: To estimate prevalence of eye infection and low visual acuity in one of the primary school children from Alwar, Rajasthan. Methodology: 240 school children of the class two to five and age group 6­10 years who were present were examined.(questionnaire, clinical examination, snellen's chart for V.A. Results: Out of 240 students 111 (46.25%)were females and 129 (53.75%) were males. More than 30 per cent of school children had eye infections and the overall prevalence of LVA was 11.7%. In the present study the prevalence of infection and LVA among female students (16.2%) was significantly higher than male students (7.8%). It is more than twice then that of males, X2 =4.15;df=1;p value=0.04. 34.4% children had low visual acuity at 6 years of age whereas only 4.4% had LVA at 10 years of age, X2=21.6;df=4;p value=0.0002. In class 2 prevalence (23.1%) of eye infection and LVA was significantly higher than class 5 (7.5%), X2=8.9;df=3; p value=0.03. The prevalence of eye infection and LVA among children with poor academic performance (35%) was significantly higher than students with average academic performance (11.6%) and students with good academic performance (6.1%),X2=13.03;df=2; pvalue=0.001. Conclusion: The data support the assumption that vision screening of school children in developing countries could be useful in detecting eye infection, correctable causes of decreased vision and in minimizing long term visual disability. More studies are required from different parts of India to know the prevalence of eye infection, LVA and attributable epidemiological factors. ISE.242 Study on Prevalence of Some of the Life Style Associated Risk Factors Amongst Adolescent Students in South Delhi, India S. Ranjan. NICD, Delhi, India Background: Lifestyle associated risk factors is growing public health problem in the developing country like India. There is paucity of data on lifestyle associated risk factors among school going adolescents in India. Methodology: 501 adolescent students were selected for the study by means of cluster sampling. They were surveyed through self administered questionnaire on life style associated health risk factors followed by height, weight and blood pressure measurements. I estimated prevalence of various risk factors and analysed the relations between various subgroups and prevalence of risk factors Reuslts: Lifestyle associated risk factors in adolescent students were in general related to government school students and less family income except for physical inactivity in girls which was related to public school and higher family income. 89% Students of government school and 42 % students of public school had at least one of the risk factors. Overall study indicated the inappropriate dietary practices low physical activity, experimentation with alcohol and a smoking, high prevalence of obesity were problem amongst students of both schools. This study shows that both under nutrition and over nutrition coexist in the same population (especially government schools). Conclusion: Prevention programmes should have a multi-level focus, including the individual, the family, and other social institutions. It is also important to identify subgroups of adolescents and young adults with unique risk behaviours and psychological and behavioural problems so that prevention programmes may be developed to specifically target them. Health behaviours and attitudes formed during youth lay a strong foundation for lifetime health related behaviour patterns. Sending health promoting messages through various organizations, such as the family, classroom, religious groups, hospitals and research institutions, mass media and governmental agencies, could prevent health risk behaviours during childhood and early adulthood. Imparting knowledge, inculcating preventive behaviour, and increasing adolescents value-expectancy towards a healthy lifestyle could ultimately aid in the prevention of cancer, heart disease, HIV infection, hypertension, obesity, (CNCD) and other health disorders In order to develop strategies for youth health risk behaviour reduction and in meeting calls for stronger adolescent health policies and indicators as put forth by organizations such as the United Nations, a surveillance strategy to measure youth risk behaviour change over time is needed. ISE.243 A Facility-Based Study on Self Awareness of HIV Serostatus in Lagos K.O. Wright1, A.A. Akinbami1, M.O. Dada1, A.O. Dosunmu1, T.A. Adeyemo2. 1Lagos State University College of Medicine, Lagos, Nigeria, 2Lagos University Teaching Hospital, Idi Araba, Nigeria

Background: The benefit of self awareness of HIV sero-status is crucial for the prevention and control of a condition which is capable of eroding the entire human race. Unfortunately, research findings have shown that most people are ignorant of their HIV status. This study was conducted to assess personal knowledge of HIV serostatus and its determinants in a sample of prospective blood donors at a tertiary health institution in Lagos. Materials and Methods: A descriptive cross sectional study was carried out on a sampled population of five hundred and eighty four (584) consecutively recruited prospective donors over a period of 10 weeks at the Lagos State University Teaching Hospital Ikeja, which is a tertiary health institution and a referral centre for both primary and secondary health institutions. Data was collected with the aid of a pre-tested and structured questionnaire and analysis was done with SPSS statistical software version 13. Results: Over two thirds (69.2%) of respondents had fore knowledge of their HIV serostatus prior to screening. In comparing educational level and HIV serostatus knowledge, a significant majority (71.5%) of those who knew their HIV status had tertiary education. Furthermore, marital status was also found to be statistically significantly associated with knowledge of HIV sero-status. (P<0.05) Conclusion: There is an apparent need for the key fighters of this pandemic health condition to redeploy resources to improve self awareness of HIV serostatus across board through enlightenment campaigns and provision of accessible screening services which will incorporate pretest and posttest counseling. ISE.244 Clinical and Microbiological Profile of Infections in Elderly Population Attending Hospital of Western Rajasthan, India A. Mathur1, H. Agarwal2, S. Mathur1, P. Prakash1, K.R. Haldiya3, N. Kishoria1, M. Kumar1, M. Gupta1, K. Suneet1. 1Dr SN Medical College, Jodhpur, India, 2MDM Hospital, Jodhpur, India, 3DMRC, Jodhpur, India Background: Despite the high incidence of morbidity and mortality due to infections in elderly population, there are sparse studies about their clinical and microbiological profile in western Rajasthan, India. Method: One hundred elderly patients of age 60 years or more attending a tertiary care hospital of western Rajasthan, India with sign, symptoms or investigations suggestive of infection were registered in the study. Detailed clinical and laboratory workup to identify the source and type of infection by Bact alert culture of blood and CSF, routine culture of urine, pus sputum and serological tests was undertaken. Clinical and microbiological diagnosis of the patient was established and patients were treated with antibiotics according to culture and sensitivity. Outcome of the disease was also recorded. Results: The common site of infections were Respiratory tract 34%, Urinary tract 30%, Skin & soft tissues 8%, ENT 8%, Gastro intestinal tract 7%, CNS 6%, Malaria 4% and site not found in 6% cases. Positive blood culture (bact-alert) was found in 24 elderly patients out of these organisms cultured were Enterococcus in 9, Staphylococcus in 6, Streptococcus in 3, Klabsella in 2, Proteus in 2, Pseudomonas in 1 and Candida albicans in one patient. Over all mortality was 6% in this age group. Conclusion: Since in developing countries where infectious diseases are still the major cause of morbidity and mortality, there is need for gender and age specific infection surveillance among elderly population. Findings of this study will be used for more specific and large studies in an effort to increase our understanding of infections among elderly populations and associated risk factors. ISE.245 New Therapeutic Approach to Persistent Fungal Infections in Neonatal Intensive Care Unit G. Corona1, A. Musolino1, S. Aversa1, V. Cordaro1, A. Nicolò2, I. Barberi1. 1 Department of Pediatrics, Neonatal Intensive Care Unit, A.O.U. 'G. Martino' University of Messina, Messina, Italy, 2Neonatal Intensive Care Unit, A.O. 'Bianchi e Melacrino Morelli', Reggio Calabria, Italy Background: Fungal infections are responsible for considerable morbidity and mortality in the neonatal period, particularly among premature neonates. Risk factors are mainly related to patient conditions and invasive devices. Observational studies showed a progressive increase in the proportion of non-albicans Candida bloodstream isolates, which is related with increasing prophylactic use of fluconazole and with therapeutic use of Amphotericin B in clinical practice.

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We performed our study to evaluate the effectiveness and tolerance of Caspofungin, an echinocandin antifungal, in the treatment of invasive neonatal candidiasis complicated by persistent fungemia despite antifungal treatment with Amphotericin B. Methods: The population consisted of 1 term and 6 premature neonates with invasive candidiasis caused by Candida krusei (n=6), Candida parapsilosis (n=1). Despite initial therapy with liposomal amphotericin B, blood cultures remained positive in all patients for 8­13 days. Amphotericin B was discontinued and Caspofungin initiated in all patients in a dosage of 2 mg/kg/d. Results: All positive blood cultures cleared on average in eighth day (range 3­20 days) after initiation of Caspofungin. The treatment was mean continued for 16 days (range 12­21 days). Renal function tests did not show any values above normal throughout Caspofungin therapy. One patient showed mild elevation of aspartate transaminase. Most common (4 neonates) was the increase of gamma glutamyl transpeptidase and direct bilirubin. There were no attributable clinical adverse events and severe hypercalcemia during the administration of caspofungin in any of the patients. Conclusions: These data suggest that Caspofungin may be considered an effective, safe and well-tolerated drug in infants with severe persistent fungal infections that are not responsive to or intolerant of traditional therapy. ISE.246 The Survey of Listeria monocytogenes Contamination in Minced Meat in Tehran City Z. Mashak1, B. Moradi2. 1Department of Food Hygiene, Faculty of Veterinary Medicine, Islamic Azad University of Karaj, karaj, Iran (Islamic Republic of), 2Department of Microbiology, Islamic Azad University of Zanjan, Zanjan, Iran (Islamic Republic of)

with reduction in the application of chemical products. This strategy started in 1986 in Colima and have been extended to other areas of the mexican western coast where Malaria declining is also observed. ISE.248 The Genotypes of Treated I.V. Drug Users with Chronic Hepatitis C with Peginterferon Alfa-2a (40 KD) Plus Ribavirin V. Grunevska, L.J. Ivanovski, B. Tosevski, M. Dimzova, B. Grunevska, C. Eftimovska, M. Gaseva. Clinic for Infectious Diseases and Febrile States, Skopje, Former Yugoslav Republic of Macedonia Introduction: Hepatitis C is common for population with risky behavior, such as i.v. drug users, susceptible to different virus genotypes. Efficacy of HCV chronic hepatitis treatment with peginterferon alfa-2a (40 KD) plus ribavirin is promising. Objectives: To investigate efficacy of treatment with peginterferon alfa2a (40 KD) plus ribavirin among drug users with chronic hepatitis C according to virus genotypes. Materials and Methods: Research started in 2003, at our Clinic. Past and present drug users were treated with peginterferon alfa-2a (40 KD) plus ribavirin, according to this therapy guidelines. Tests Used: ORTHO HCV 3.0 ELISA, ABBOTT HCV EIA 2nd GENERATION, HCV RNA and Amplicor (Hoffman La Roche), for genotyping with RT/PCR. Patients were grouped according to age, sex, nationality, genotype and ALT value at the beginning and end of therapy. Results: We tested 63 patients, from whom 50 (79.4%) male and 13 (20.6%) female. The mean age was 27.05 years. Genotype 1 was detected among 23 (36.5%), genotype 3 among 37 (58.7%), genotypes 1 and 3: 1 (1.6%) genotype 2b: 1 (1.6%) and 4a in 1 (1.6%). ALT mean value was 147.95 U/L at the beginning, and 39.18 U/L at the end of therapy. Conclusions: The silent, asymptomatic nature of HCV infection and clinical consequences impose active treatment with antiviral therapy, to motivate patients to stop using drugs and eliminate all psychosocial problems arising therefrom. ISE.249 Measles Outbreak in Serbia, Public Health Measures and Costs M. Vucic Jankovic. Institute of Public Health of Serbia, Belgrade, Serbia Background: In Serbia measles incidence rate decreased from 0.39 to 0.03 per 100,000 population in the period 2000 to 2006. The national official vaccine coverage for both doses of MMR was 96%. Methods: Descriptive method was used to analyze all measles cases reported to IPH of Serbia, evaluation of control measures and cost of all field activities. Results: A total of 200 measles cases were reported between 15/01/07 and 15/05/07 in Vojvodina Region (In 2.66 per 100,000). Virus was imported to Roma settlement near Novi Sad where 80 people was exposed during wedding ceremony. After 15 days, 7 measles cases were reported and outbreak was transmitted to four cities in Vojvodina, mostly among vulnerable unvaccinated people (Roma people and IDPs) but not to the other regions of Serbia. IPH of Serbia requested urgent control measures to contain transmission of virus. In Serbia surveillance system was improved by introduction of case definition and investigation of every suspected case. During February and March Ministry of Health funded activities with extra budget of about $500,000 (only 0.08% of annual budget for 23 IPH). Vaccine supply for additional immunization of 12,380 unvaccinated children from 12 month to 14 years of age costs 35% of budget. Field investigation in the unhygienic settlements showed that only 50% of 123,000 children from vulnerable groups have received previously two MMR doses. In door-to-door action 5,123 children were vaccinated. Mobile teams spent only 2% of budget for gasoline (20,000km drive). Cost of overtime for 987 health workers was 38% of budget, laboratory tests 10% and cost of cold chain and telephone calling was 8% of budget. Conclusion: The key for measles elimination is immunization of hard to reach children and appropriate surveillance. Field investigation and additional budget are necessary for those aims. ISE.250 Retrospective Analysis of TB/HIV Co-infection Rates from 2003­2005 in Nakuru, Kenya M. McBroom. University of North Texas Health Science Center, Fort Worth, TX, USA Objective: Measure incidence of TB/HIV Co-infection rates in urban/ rural Kenyan outpatient clinic.

Listeria monocytogenes is a gram-positive, foodborne pathogen in meat that caused Listeriosis in risk group's people. In this study, we collected minced meat from 12 zones in butchery market's Tehran city, and were used modified Canadian version of USFDA Listeria isolation method. The results evaluated with multiple Duncan test and completely randomized ANOVA in MSTATC system and showed that Listeria monocytogenes was detected from 2/12 zone of butchery market in Tehran city. According to this result the minced meat sold in Tehran city markets may be as a risk for contamination of Listeria monocytogenes that threatened for public health and hygienic quality control of this product must be recommended during the slaughtering, transportation carriage, other used devices and stuff carriers. Key Words: Minced Meat, Listeria monocytogenes, Tehran City

ISE.247 Malaria Disappearance in the Pacific Coast of México, the Case of Colima F. Espinoza-Gomez1, J.I. Arredondo-Jimenez2, O.A. Newton-Sanchez1, C.M. Hernandez-Suarez1. 1University of Colima, Colima, Mexico, 2 University of Guadalajara, Guadalajara, Mexico Malaria persists as a huge public health challenge around the world, with an increasing range of transmission as a consequence of global climatic changes. In contrast some places are showing significant reductions in its incidence. The Pacific coast of Mexico have been traditionally a place with endemic transmission for Plasmodiumm vivax. The state of Colima, at the central Pacific coast, with a population of 510,000 habitants, reported during the last 40 years an average incidence of 3,000 cases per year. This figures changed dramatically in 1990 when the reported cases drop to 145 in 1994, 87 in 1998 and 2 cases per year since 2002. Furthermore, recent probabilistic surveys have not yielded new cases and the spleen index in children is practically 0. This situation have occurred in spite of the persistence of significant populations of Anopheline mosquitoes (Ann albimanus, Ann pseudopunctipennis, Ann vestitipennis and Ann punctimacula) in the region. The health authorities assumes that this phenomenom is explained by the very efficient sanitary programs like rivers cleaning ("deslames") and the extensive and opportune use of chloroquine in the affected communities. Other hypothesis relies on the transition of many rural communities to a process of urbanization. However, many of the formerly affected communities remains in similar socioeconomic conditions than 20 years before. On the other hand, the climatic changes along the last 20 years have been analyzed and no correlation with Malaria declining have been found. Finally the most plausible explanation for this Malaria control is the coincidence in the use of Biologic control for agricultural pests

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Design: Retrospective cohort analysis of newly diagnosed TB/HIV co-infected patients from 2003­2005. Setting: Rift Valley Provincial General Medical Centre, Nakuru, Kenya. Subjects: Patients diagnosed with TB/HIV at the TB Clinic and Comprehensive Care Center. Intervention: Outpatient chart review of pulmonary TB diagnosis by Ziehl-Neelsen sputum smear staining; smear negative and extrapulmonary TB diagnosed by consistent clinical and radiological features; HIV-1 and HIV-2 patients with positive-TB smear. Results: There is an increase in the incidence of reported TB/HIV coinfection rates from 2003­2005 (2.3% to 8.1%). The proportion of patients diagnosed with extrapulmonary TB increased from 12.6% to 18.4% (OR=1.6; 95% CI 1.3-1.8). Conclusion: Pulmonary TB stability indicates that efforts to reduce TB incidence are effective. TB/HIV co-infection rates result from several systematic factors. Challenges include effectively treating both disaseas with limited resources and avoidance of multidrug resistant TB. ISE.251 Immune Response After Booter Measles Vaccination in 6 YearsOld Children in Haiduong, Vietnam 2006 P. Van Ca. Head, Dept for QC in Viral Vaccines, Hanoi, Vietnam 300 healthy children at the age of 6 in two district Tu Ky and Kinh Mon in the Hai Duong province, Vietnam were selected for booster measles vaccination program. These children had a blood test before vaccination and 1 month after vaccination to indentify anti-measles IgG by ELISA. There were 291 children (97.0 %) having 2 blood samples to compare before and after the booster vaccination. The results showed that the titre of anti-measles antibody increased from 76.2% before vaccination to 100% after vaccination at Tu Ky and from 74.1% before vaccination to 99.3% after vaccination at Kinh Mon: the percentage in both area increase from 73.0% before to 99.6% after vaccination (p<0.001). In the children who have not had anti-measles antibody, the immune response after the booster vaccination increased over 4 times which were 72.0% at Tu Ky, 74.5% at Kinh Mon and 73.2% in both districts. ISE.252 A Virtual Infection Control Department in one University Hospital Sofia, Bulgaria N. Hadjieva1, M.M. Petrov2, B. Korukov1. 1Queen Joanna Univ. Hospital, Sofia, Bulgaria, 2National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria For the first time a Virtual Hospital Infection Control Department (VICD) was implemented in "Queen Joanna" University Hospital in 2007, as a part of the Hospital Infections Control System, in order to support the departments in their aim to reduce nosocomial infections rate. This VICD was proposed by Prof. N. Hadjieva and was launched with an official order from the hospital manager, designated to protect both the patients and the staff and to save money/time in one limited resources Bulgarian hospital. The first step in "Queen Joanna" University Hospital was made in 1993 when a restrictive antibiotic policy was implemented as the basic component of this initiative. The revision in 2000 added a better balanced and functional system for infection control as an official guideline for the hospital, with four essential components as follows: 1) Infection Control Department; 2) Hospital guide of "Basic Principles of Infection Control"; 3) Hospital policies to standard and specific precautions; 4) Hospital "Antibiotic policy". The revised 2007 antibiotic policy defined old three groups of access to antibiotics, but with strong restriction of Cp III and Amikacin usage by reason of high resistance rates, registered to these agents in the last years in the hospital. Continuous monitoring and evidence based revisions are the most flexible part of the Hospital Infection Control Policy. Finally, in 2007 the VICD was created as a part of the microbiology laboratory and the microbiology laboratory information software system complex. VICD represents mono or two-way video/audio/PC link between every department in the hospital and the Infection Control Doctor, Hospital Epidemiologist or Hospital IC nurse through the IT administrator. VICD will be opened 24 hours a day and the personnel will be informed by SMS, e-mail or phone call in any case of urgency. VICD is planed to be working with only one system IT administrator, who is operating at anytime, on any signal, from any hospital department and has the task to secure maximally quick connection or reply to all hospital departments. There is no necessity to engage specially qualified personal (they are working in different hospital departments) and there is no need of special rooms or place in the hospital.

The funds that support Infection Control programs are very limited and only one extremely balanced and effective strategy, like VICD can play a leading role in the hospital strategy to control and prevent nosocomial infections and in the meantime can be cost-effective. ISE.253 Changing Trends of Oropharyngeal Carriage of Candida Species in HIV Patients in Chennai, South India T. Menon, V.G. Sivakumar. PG Institute of Basic Medical Sciences, University of Madras, Chennai, India Background: Oropharyngeal candidiasis (OPC) is an opportunistic fungal infection common in HIV infected persons. Though Candida albicans is considered to be the most common etiological agent, in recent years the incidence of oropharyngeal candidiasis caused by non albicans Candida species has increased. Knowledge of the prevalence of various Candida species in the oral cavity of HIV patients could enable appropriate antifungal administration and disease management. Methods: Oral swabs collected from 140 HIV-infected patients in Chennai, were inoculated into Sabourauds chloramphenicol agar. Yeast colonies were speciated by sugar assimilation and fermentation tests, germ tube test, chlamydospore formation and colony morphology on Chrom agar. Results: 71.4 %( 100/140) of the patients had oropharyngeal candidiasis. 135 strains of Candida species were isolated of which non albicans Candida species were significantly more (69.6%) than C. albicans isolates. However, C. albicans was the predominant species (30.4%) followed by C. krusei(29.63%) and C. guilliermondii(17.8%). 25% of patients were colonized with multiple species of Candida. 'C. albicans plus C. krusei' was the predominant multiple yeast combination. Conclusion: Non albicans Candida species are more common than C.albicans as etiological agents of OPC in HIV patients. ISE.254 Immigration Shapes the Evolution of Antibiotic Resistance and Its Pleiotropic Fitness Cost G.G. Perron1, A. Gonzalez2, A. Buckling1. 1University of Oxford, Oxford, United Kingdom, 2McGill University, Montreal, Canada Understanding the conditions that favour the evolution and maintenance of antibiotic resistance is a central goal of epidemiology. A crucial feature explaining the adaptation to harsh environments is the supply of beneficial mutations via migration from a 'source' population. Given that antibiotic resistance is frequently associated with antagonistic pleiotropic fitness costs, increased migration rate is predicted not only to increase the rate of resistance evolution but also to increase the probability of fixation of resistance mutations with minimal fitness costs. Here we report in vitro experiments using the nosocomial pathogenic bacteria Pseudomonas aeruginosa that support these predictions: increasing migration rate into environments containing antibiotics increased the rate of resistance evolution and decreased the associated costs of resistance. Consistent with previous theoretical work, we found that resistance evolution arose more rapidly in the presence of a single antibiotic than two, and when bacteria were exposed to two antibiotics sequentially (cycling therapy) compared with simultaneously (bi-therapy). Furthermore, pleiotropic fitness costs of resistance to two antibiotics were higher than for one antibiotic, and were also higher under bi-therapy than cycling therapy, although the cost of resistance depended on the order of the antibiotics through time. These results may be relevant to the clinical setting where immigration is known to be important between chemotherapeutically treated patients, and demonstrate the importance of ecological and evolutionary dynamics in the control of antibiotic resistance. ISE.255 2004-2007 Prospective Survey of Microbiological Isolates From Inpatients Admitted at a General Hospital of Northern Italy A. Nanetti1, R. Manfredi2. 1Dept. of Microbiology, University of Bologna, S. Orsola Hospital, Bologna, Italy, 2Dept. of Infectious Diseases, University of Bologna, S. Orsola Hospital, Bologna, Italy Background: A microbiological surveillance program is prospectively performed at our tertiary-care Hospital. Materials and Methods: The temporal trend of microbial isolates from patients admitted during the last four calendar years (2004 to 2007),is assessed according to the main bacterial and fungal cultures. The same pathogens cultured more than once from the same patient within one month, have been considered once.

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Results: On the whole, the main pathogen group remained that of Enterobacteriaceae (6,608 isolations of 19,666: 33.6%, with Escherichia coli retrieved in 60­75% of cases), with no significant difference over time. Staphylococci (4,150 isolates), and Enterococci (3,276 isolates), were the two largest groups after Enterobacteriaceae, but Staphylococci significantly declined in the four-year period (from 23.8% to 16.2%; p<.001), mainly due to a reduced isolation of coagulase-negative Staphylococci, while a slight increase of Enterococci occurred (from 15.4% to 18.6%; p<.05). Based on the frequency of isolation, Gramnegative oxydase-positive organisms accounted for 2,109 episodes,followed by other aerobe Gram-positive organisms other than Staphylococci-Enterococci (613 isolates), and anaerobes (583 isolates): no significant temporal variations occurred over time for these last microbial groups. With regard to Gram-negative oxydase-negative microorganisms (567 isolates),non-beta-hemolytic Streptococci (464 cases), and beta-hemolytic Streptococci (260 isolates),a significant trend towards a reduction of frequency occurred from the year 2004 to 2007 (p<.05 to p<.001). Finally, fungal infections accounted for 1,036 overall episodes, in over 80% of cases represented by Candida spp. Conclusions: A prospective microbiological monitoring is expected to significantly contribute to the knowledge of local epidemiological figures and antimicrobial sensitivity profile of hospital infections,and plays a relevant role in the selection of both chemoprophylaxis and treatment, especially on local-regional basis. Although the major causative agents of inpatient infection remain Enterobacteriaceae, however a significant decline of coagulase-negative Staphylococci, all Streptococci, and Gram-negative oxydase-negative organisms occurred over the examined four-year period, while Enterococci showed a mild increase over time (both Enterococcus faecalis and Enterococcus faecium). ISE.256 Prevalence of Bacterial Vaginosis Amongst Women of Child Bearing Age E.O. Emeghi. Ebonyi State University, Abakaliki, Nigeria Bacterial vaginosis, previously known as non-specific vaginitis or Gardnerella vaginitis, is the most common cause of vaginal discharge. It may be the cause of up to one half of cases of vaginitis in all women and the cause of from 10 to 30 percent of cases in pregnant women. The clinical syndrome is now recognized as a polymicrobial superficial vaginal infection involving a loss of the normal lactobacilli and an overgrowth of anaerobes. Bv has mostly been associated to sexual transmission, though some controversy remains over the sexual transmission of Bv. It occurs commonly in women with more than one sexual partners, and can also occur in women who are not yet sexually active. Recent studies have confirmed its association with pelvic inflammatory disease and adverse pregnancy outcome. The aim of the research was to determine the prevalence of Bv infection among women of child bearing age with the view of evaluating epidemiological factors and risk factors responsible for the infection among individuals within this category and identifying possible ideal control measures in Abakaliki and Ebonyi State. In this cross-sectional study, 102 women of child bearing age ( comprising both pregnant and non-pregnant women) in some selected hospitals and laboratory in Abakaliki and Afikpo, Ebonyi State, from December 2005­March 2006, were screened to determine the prevalence of Bv among them, using three standard diagnostic technique (wet mount, whiff test and gram stain). A structured questionnaire was also administered to 23 subjects in order to obtain vital epidemiological information necessary for the study. And to also link their laboratory result to the information and 16 (69.6%) tested positive. The data analysis was done using chi-square tests. Results show 49 (48.0%) were positive for wet mount, 58 (56.9%) for whiff test and 20 (23.5%) for gram stain. Age, douching. Use of IUD, and sexual activities of individual had no significant effect on prevalence of Bv, while symptomatology was a major indicator of infection. Risk factors associated with significant infection were linked to ignorance of women, gynaecologist and laboratory technicians of the existence of the infection resulting to non- diagnosis of Bv infection, also wearing of tight panties and poor hygiene conditions as well. Since Bv could be asymptomatic most time, routine Bv screening of women of child bearing age, visiting gynecology and fertility clinics as well as pregnant women during antenatal care are advocated.

ISE.257 Association of Fas and Fas Ligand Gene Polymorphisms with Herpes Simplex Virus Type 2 But not with Cervical Cancer K. Chatterjee1, M. Engelmark2, U. Gyllensten2, A.L. Williamson3. 1 Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa, 2Department of Genetics and Pathology, Uppsala University, Uppsala, Sweden, 3National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa Background: Herpes simplex virus type 2 (HSV-2) infections is a sexually transmitted disease that has spread worldwide. HSV infection is suggested as a co-factor for persistent human papillomavirus (HPV) infection leading to cervical cancer (CxCa). Fas and Fas-L genes play an important role in cell mediated immunity through the mechanism of apoptosis. Single nucleotide polymorphisms (SNPs) in those genes disrupt their ability to activate induced cell death leading to an unrestricted replication of the virus. These SNPs have been suggested to influence the susceptibility to several diseases and also development of CxCa. There has not been any study of these polymorphisms relating to HSV2 infections. Objective: The aim of this study was to determine if CxCa and HSV-2 seropositivity was associated with FAS (-1377, -670) and FAS-L (844) SNPs in South African women. Materials and Methods: The population consisted of 106 indigenous black and 341 mixed-ancestry CxCa cases and an equal number of age, ethnicity and urban/rural matched controls. DNA was isolated and quantified from the cases and controls. SNP genotyping was carried out and statistical analysis was done for alleles, genotypes and haplotypes using Haploview and IHG (Munich) software. Results: No significant association was found with CxCa and any of the polymorphisms. When the data was stratified for non-CxCa controls, a highly significant association (p=0.00021) was found with Fas-1377 A/AA and HSV-2 infected individuals. Fas-1377 and -670 AG haplotype also showed a significant association (p=0.0004). Stratifying the same group for mixed ancestry population replicated the result, but for blacks the association was not retained pointing a race specific susceptible effect of the allele. Conclusion: This is the first time a genetic link of HSV-2 infection is being suggested. Our novel results suggest that Fas-1377 A/AA and Fas-1377/-670 AG confer a susceptible effect to the infection with HSV2. ISE.258 Hospitalized Children Due to ParvoB19 and Coxsackie B1-B6 Viral Infection (March­December 2004). Comments, Approach, Suggestions A. Anastassiou1, K. Katsiardanis2, A. Michalopoulou1, A. Gerovassili3, K. Georgioy1, A. Pantazi1, A. Kalavrou1, J. Tassiou1, E. Petsiava1. 1 Paediatric Clinic, General Hospital, Volos, Greece, 2Health Care Society and Education, Volos, Greece, 3Biology and Genetics Department, Medical School, University Thessaly, Larisa, Greece Background: Parvo B19 (ParB19) and Coxsackie (coxs) viruses, are pathogenic for humans. ParB19 causes pestilent erythema, arthritis, prolonged fever, aplastic anemia and swollen lymph nodes while a significant number of cases remain uncharacterized and passe without symptoms. Coxs viruses cause rashes, prolonged fever, affect cerebral nerves, heart and children's lives into risk. Purpose: To summarize in a table the clinical picture of children with recent ParB19 and coxs infection. To comment on the subject in order to sensitize the related medical and nursing personnel special in an epidemic outbreak to be efficiently prepared to face and prevent complications than can put children's lives in danger. Materials and Methods: All the confirmed serum tests run by the university research laboratory of cases infected with the above mentioned viruses were recorded based on the log book of admission in the paediatrics clinic of AGHV for a period of 10 months (3rd­12th 2004). ResultsConclusions: 16 children, 10 boys (B) and 6 girls (G) between 0­10yo and median age 5.7 years were hospitalized. 9 children suffered from ParB19 infection and 7 children from coxs viruses B1-B6 confirmed by the methods of IFA and ELISA. As seen from the table made with the results of 2004, there was an epidemic for viruses ParB19 and coxs and their peak was during springtime. The clinical picture and season distribution is presented in the table that follows while more correlations regarding the age, sex and seasonal distribution of the patients is presented graphically with histograms which are extensively commented and suggestions are made.

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ISE.259 Comparison Dot Blot and Culture Methods to Detection Leishmania Antigen Within Naturally Infected Sandflies in Abardej, Iran H. Nekouie, A. Khabiri. Pasteur Institute, Tehran, Iran (Islamic Republic of) Leishmaniasis, a vector borne disease caused by obligate intramacrophage protozoa, is characterized by diversity and complexity. Of the 88 endemic countries, 26 are in the old world including Iran. Zoonotic cuntaneous Leishmaniasis (ZCL) is a major health problem in many rural areas and Phlebotomus papatasi is a well known vector of Leishmania major the causative a gent of cutaneous Leishmaniasis in Iran. We collected phlebotomus by funnel traps and CDC miniature light trop. Funnels were placed on rodent burrows and also light trop at early nights. The blood Fed females Papatasi were selected and immersed in 70% alcohol for remove surface bacteria. The specimens were transferred to 0.5 ml PBS and rushed their stomach. One drop of this suspension transferred to NNN culture media contain 200 IU penicillin and were incubated at 24°C, and one drop fixed in Nitrocellulose paper for DotBlot assay. 130 blood fed females papatasi of suspension were identified by this tow method. Of specimens 25% were positive in culture media, 41% were positive by dot immunoblot. We can detect 10 µl of leishmania antigen by Dot Blot. Dot blot assay is considered a very discriminatory system for detecting Leishmania infection in fielded study and screening test. The simplicity, high sensibility and high specificity of the dot assay should make it useful for field studies ISE.260 Confronting the Next Influenza Pandemic with Generic Agents: Can It be Done? D.S. Fedson. none, Sergy Haut, France Avian influenza A/H5N1 presents a serious and possibly imminent pandemic threat. Adequate supplies of affordable vaccines and antiviral agents will be unavailable to most people in the world. Given the overwhelming need for effective alternatives, generic agents that target the host immune response or the pandemic virus should be considered. Many scientists doubt these agents would be effective. Nonetheless, several studies suggest that statins improve outcomes in patients with bacteremia and pneumonia and might be similarly effective against influenza. An experimental study has shown that the fibrate gemfibrozil, a PPAR agonist, reduces mortality in H2N2 influenza virus-infected mice. There is considerable molecular cross-talk between statins and PPAR agonists, and their clinical effects are additive in patients with cardiovascular diseases. Chloroquine increases endosomal pH, impairing influenza virus release into the cytosol. Statins, fibrates and chloroquine are produced as generic medications in developing countries. They are inexpensive, could be stockpiled and would be available on the first pandemic day. Given the lack of realistic alternatives for confronting the next pandemic, we cannot afford not to undertake the research needed to determine whether these and other generic agents could mitigate the effects of what might otherwise become an unprecedented global public health crisis. ISE.261 Quality of Paediatric Blood Transfusion at District Level Hospitals in Low-Income Country, Tanzania D. Mosha. Kilimanjaro Christian Medical College, Moshi, United Republic of Tanzania Background: Blood transfusion (BT) can be lifesaving for children; however there is a risk with performing the procedure and monitoring the quality is important. The current study describes the quality of paediatric blood transfusion delivered in two district hospitals in North East (NE) Tanzania in order to find areas for improvement of blood administration. Methodology: All 166 children admitted in the paediatric wards, and having BT through April to June 2007 were prospectively observed. Medical records, request forms and registers in the laboratories were reviewed. Results: Malaria combined with anaemia accounted for 98% of the BTs. 92% of the children were assessed for paleness, but clinical signs as difficult in breathing or symptoms of cardiac failure were only assessed in respectively 67% and 15% prior to the BT decision, Pre-transfusion haemoglobin was recorded in 2/3 of the patients. Temperature was measured in 2/3 before transfusion but respiratory rate and pulse rate

were not routinely recorded. In 40%(66) of the BTs, the transfusion time exceeded 4 hours. Respectively, the zonal blood bank (ZBB) and local donors accounted for 10% and 90% of the blood. ABO and RhD typing was routinely performed in all donations, syphilis and HIV testing (using Capillus test) as well. Hepatitis B and C virus were not screened on the locally donated blood. Conclusion: There was lack of quality assurance and control in both hospitals. The criteria for blood transfusion were not always fulfilled. The time of transfusion was often unacceptable long and observation of the children during blood transfusion was poor. Blood from the ZBB was often not available and the blood transfusion depended often on local donors. It is recommended that an external supervision system should be established to monitor and evaluate the quality of performance in the laboratories and, within the wards. ISE.262 Electronic Integrated Disease Surveillance System T.G. Wahl, A. Burdakov. Black & Veatch, Overland Park, KS, USA EIDSS strengthens and supports monitoring and prevention of dangerous diseases by in-tegrating veterinary and human case and ag-gregated data, demographic information, geographical information including real time mapping of case events as these unfold, dis-easespecific clinical data (based on standardized case definitions), epidemiological information, sample tracking linked to each case and event, tests and test results linked to each sample into a cohesive information set that is continuously synchronized amongst all EIDSS sites within a country providing near real time information flow that can be then disseminated to the appro-priate organizations in a timely manner. EIDSS is based on a distributed data model with a hierarchical systems architecture con-sisting of four primary levels including from the top down the Global Data Repository, Central Data Repository, the final data host-ing place at a national level, Zonal Diagnos-tic Laboratories, Epidemiological and Labo-ratory Surveillance Stations, and other mobile installations. EIDSS incorporates a high level of security and includes reliable data replication across multiple administrative levels, multi-language localization support, data valida-tion and a unified data model. EIDSS is also designed with flexibility, allowing for easy expansion to include all reportable diseases and customization of case-investigation forms to match national and international requirements. EIDSS allows countries to comply with the IHR 2005 requirements through a data trans-fer module reporting diseases electronically to the WHO data center. The communications and computer infra-structure supporting EIDSS is designed on the widely available and supported off-the-shelf components, which makes the systems maintenance and support effort cost effec-tive. Virtual Private Network technology along with encryption, low bandwidth re-quirements allows the use of inexpensive land or radio links provided by existing ser-vice providers. EIDSS is currently deployed in the Repub-lics of Kazakhstan, Uzbekistan, Georgia and Azerbaijan as a part of the TADR Network created by Defense Threat Reduction Agency (DTRA). ISE.263 Influence of Sex for VZV Infection - Chicken-Pox and Zoster W. Rymer, A. Szymczak, M. Inglot. Clinic of Infectious Diseases Wroclaw's Medical University, Wroclaw, Poland Background: The incidence of varicella-zoster virus (VZV) infection is common in the whole world, but actual epidemiological situation is unknown, because of lack of the obligatory registration in most of the countries. This refers especially to herpes zoster cases. There are some publications dedicated to herpes zoster epidemiology, but in spite of more frequent zoster cases in females, this dependence weren't earlier thoroughly analyzed. Objective: Evaluation of sex in zoster incidence. Material and Methods: Retrospective analysis of records of all patients hospitalized because of VZV infection, in 1999­2003 period, in Province Specialistic Hospital in Wroclaw, Poland. Patients were divided into two groups: A - with chicken-pox (n=108, 62 men and 48 women) and B with zoster (n=329; 120 men and 209 women). Dates were statistical analyzed by chi-square test, and strength of dependence between sex and groups by V-Cramer test. Results: In group A incidence of chicken-pox was higher in males (57%), but it was not statistically relevant (p>0,05). In group B zoster was more frequently diagnosed in females (63%). In spite of weak

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strength of dependence (V-Cramer index was 0,183), it was statistically relevant (p<0,05). Such dependence was observed in all age groups. Conclusions: Incidence of chicken-pox is independent of sex. Sex can have influence for zoster incidence and further investigation for this influence are needed. ISE.264 Detection of Helicobacter pylori-Like in Water Sample from a Periurban Agricultural Area in Mexico City G. Castillo-Rojas1, M. Mazari-Hiriart2, N.I. Ortega-Hernández1, Y. López-Vidal1. 1Departamento de Microbiología y Parasitología, Facultad de Medicina. Universidad Nacional Autónoma de México., Distrito Federal, Mexico, 2Departamento de Ecología de la Biodiversidad, Instituto de Ecología. Universidad Nacional Autónoma de México., Distrito Federal, Mexico Background: It is estimated that over half of the world's population are carriers of H. pylori, making it one of the most common bacterial infections in the world. However, routes of transmission remain unclear, making it difficult to implement public health measures to prevent infection. Our purpose was H. pylori isolation using microbiological techniques to grow and isolate the microorganism from water samples that come from the Xochimilco canals, and important periurban agricultural area in Mexico City. Methods: Eight water samples were studied from Xochimilco; transported and stored following standard procedures. Samples were concentrated by centrifugation at 10 mL. H. pylori detection was performance by indirect immunofluorescence and PCR-Hybridization using 16S rRNA gene. Five mL were used for H. pylori isolating using Immunomagnetic separation and culture in horse serum plate and biphasic medium. Results: Two different sites were sampled three times each (Japón and Draga), moreover of Apatlaco and Riego in Xochimilco canals. Only one sample presented positive culture for microorganism with characteristics microbiological of Helicobacter pylori-like. H. pylori detection by indirect immunofluorescence showed coccoid forms and 16S rRNA gene was amplified by PCR. This PCR product (880 bp) is mandatory to be sequenced. Conclusion: The positive culture, indirect immunofluorescence and 16S rRNA amplification represents an evidence of water as one route of Helicobacter pylori transmission. ISE.265 Prevalence of Transfusion Transmissible Infections in Blood Donors of Blood Bank of Kasturba Hospital, Manipal-- 3-Year Analysis S. Bhat. Kasturba Medical College, Manipal, India Kasturba Hospital is attached to Kasturba Medical College, Manipal. The blood bank attached to Kasturba Hospital had 30428 donors during a 3-year period from 2004 to 2006. The number of HIV cases among these was 59, Hepatitis B positive cases were 201. HCV was positive in 12 donors and 55 tested positive for syphilis. No donor tested positive for malaria. These results are analysed. ISE.266 Antimicrobial Susceptibility Profile of Pseudomonas aeruginosa Strains Cultured at a Tertiary-Care University Hospital of Northern Italy A. Nanetti1, R. Manfredi2. 1Dept. of Microbiology, University of Bologna, S. Orsola Hospital, Bologna, Italy, 2Dept. of Infectious Diseases, University of Bologna, S. Orsola Hospital, Bologna, Italy Background: The increased rate of antimicrobial resistance among Gram-negative bacilli and Enterobacteriaceae is a general concern, especially in the hospital setting. A prospective microbiological monitoring including a continued surveillance of antimicrobial susceptibility rates of all relevant pathogens, is ongoing at our Hospital. Materials and Methods: The temporal variations of in vitro antimicrobial sensitivity rates were registered at quarterly intervals for all suitable Pseudomonas aeruginosa strains, during the year 2007. The same pathogen cultured more than once from the same patient within one month, has been considered once. Results: Among Pseudomonas aeruginosa isolates (493 strains tested on the whole), the best performance was obtained by the old colistin (colimycin), with a 100% susceptibility rate, followed by piperacillin-tazobactam (79.3­81.4% of tested strains), amikacin (72.8­82.6% of tested strains), imipenem (73.0­85.2% of tested strains), ceftazidime (from 75.6­82.9% of tested strains), tobramycin (from 57.0­77.9% of tested

strains). On the other hand, significantly less effective sensitivity profiles were shown by gentamicin (52.2%­71.8% of tested strains), ciprofloxacin (51.0­65.7% of tested strains), aztreonam (50.8­62.2% of tested strains), ticarcillin-clavulanate (49.1­59.5%), and mezlocillin (49.1­54.2% of tested strains). When examining temporal trends of antibiotic sensitivity figures, significant changes were observed only for ceftazidime and ciprofloxacin (p<.03) (with their drop of susceptibility, essentially due to the production of extended-spectrum beta-lactamases). Conclusions: A prospective surveillance study of antimicrobial susceptibility rates of a major hospital-associated organism like Pseudomonas aeruginosa is of some importance, to establish reliable guidelines of antibiotic treatment and prophylaxis, on local-regional basis. Despite a significant increase of resistance rates against ceftazidime and ciprofloxacin observed over the last year (attributable to a rise of spread of extended-spectrum beta-lactamase secretion by Pseudomonas spp. too), however piperacillin-tazobactam, amikacin, imipenem, and the same ceftazidime still maintain a reliable role in eventual, empiric regimens to be added pending microbial isolation and in vitro susceptibility studies, since they remained active in nearly 80% of hospital isolates of the last year 2007. Colistin maintained full in vitro activity against all Pseudomonas strains observed over time. ISE.267 Prevalence of Pediatric Bacterial Meningitis in Khartoum State M. Mahmoud1, M. Elkarsani2. 1Faculty of Medical Laboratory Sciences, Alzaiem Alazhari University, Khartoum North, Sudan, 2National Reference Laboratory, Khartoum, Sudan Introduction: A cross sectional hospital-based study was conducted in Khartoum state pediatric hospitals in the period from January 2006 to April 2006 to investigate the prevalence and study the pattern of antimicrobial susceptibility testing in the children less than 5 years of age, suspected to have meningitis. A284 CSF samples were collected, gram stain, culture, serology and PCR were done and antimicrobial susceptibility testing was studied using (WHO SOPS for diagnosis of meningitis 2006). Results: 58 (20.8%)and 60(21.1%) of the 284 CSF samples were culture and antigen positive respectively. N. meningitides was found 44(75.9%); H. influenzae (Hib) 10(17.2%); pneumococci (SPN) 3(5.2%) and S. aureus 1(1.7%) the maximum number of infection occurs during April, most of isolates showed pattern of resistant to many antibiotics. N.meningitides showed resistant to 36.4% Erythromycin, 20.5% Chloramphenicol, 11.4% Trimethprim/Sulphonate and 4.7% Ceftriaxone. Hib show resistance to 54.5% Refampin, 45.5% Ampicillin, 27.3% Chloramphenicol and 9.1% Ceftriaxone. SPN showed resistant to 33.3% vancomycin, 66.7% Oxacillin and 66.7% Erythomycin. Conclusion: Prevalence was high among the pediatric population in compare to the total 222 cases reported in Khartoum state by WHO in the same period,indicating that the epidemic is more common among the pediatric population. the risk of the antimicrobial drug resistance in childs less than 5 of age needs special care,misuse of antibiotics together with mutant strains of pathogens and poor vaccination program are expect to increase the prevalence rate.improving the laboratory facilities in early diagnosis of meningitis together with activation of meningitis control program recommended in controlling the epidemics. ISE.268 Hepatitis-B: Unnoticed Infectious Disease I. Bakare. Maids Club of Nigeria, Ibadan, Nigeria Background: In Nigeria today, the rate at which Hepatitis B Virus(HBV) is spreading now calls for a great concern. The level of awareness about this infection is very silent compared to what obtained about HIV. We at MAIDS therefore put up a campaign program to enlighten communities about this deadly but preventable infection. Method: In response to the low level of awareness of HBV, our organization, MAIDS CLUB OF NIGERIA decided to create a community based awareness about HBV to the people of Ibadan South-West area of Oyo state in December 2007. During the sensitization program, participants were able to know that the infection could be contacted through exposure to infectious blood or body fluids containing blood. Possible forms of transmission include (but are not limited to) unprotected sexual contact, blood transfusions, re-use of contaminated needles & syringes, and vertical transmission from mother to child during childbirth. At the end of the sessions, the people were given information handbills about the virus so as to share it among those that were not priviledged to attend. Internet based information sharing techniques was also employed.

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Conclusion: The awareness was able to let people realize that the infection can be preventable and unlike HIV, it has vaccination. Continuous enlightenment will go a long way in mitigating the spread of the infection. Recommendation: It is hereby recommended that Non-Governmental Organizations and Health institutions should incorporate the HBV awareness in their various areas of operations. ISE.269 Microbiological Features of Enterococcus faecalis and Enterococcus faecium Assessed According to an Hospital-Based Prospective Surveillance Program: In Vitro Antimicrobial Susceptibility Profile, and Temporal Trend A. Nanetti1, R. Manfredi2. 1Dept. of Microbiology, University of Bologna, S. Orsola Hospital, Bologna, Italy, 2Dept. of Infectious Diseases, University of Bologna, S. Orsola Hospital, Bologna, Italy Background: The increased temporal rate of antimicrobial resistance among Gram-positive cocci (including Enterococci) is a major concern, especially in hospital-based settings. Materials and Methods: The temporal trend of the in vitro antibiotic susceptibility rates was investigated for all Enterococcus faecalis and Enterococcus faecium strains, isolated at our tertiary-care Hospital during the year 2007. The same pathogen isolated more than once from the same patient within one month, has been considered once. Results: Among Enterococcus faecalis isolates (705 strains tested on the whole), the greater activity rate was achieved by linezolid (100% of tested strains), followed by nitrofurantoin (97.4­100% of strains), teicoplanin (94.8­100%), vancomycin (87.5­100%), ampicillin (89­92.4%), penicillin (87.9­91.0%), while appreciable, but irregular variations of sensitivity occurred over time for gentamicin, streptomycin, and tetracyclines. With regard to Enterococcus faecium strains (175 strains), both linezolid and teicoplanin maintained a 100% in vitro activity, followed by vancomycin (86.4­100% of strains), streptomycin (62.5­100%), gentamicin (52.9­63.6%), and tetracyclines (51.8­49.6%), while negligible efficacy was shown by ampicillin (7.5­18.5% of tested strains) and penicillin (7.5­18.5%). Eighteen strains of vancomycin-resistant Enterococcus faecalis strains were detected (12 concentrated in the July­September period), while vancomycin-resistant Enterococcus faecium strains were six through the entire observation year. No significant temporal modifications of antimicrobial sensitivity rates were observed, as well as no significant change in the emergence of vancomycin-resistant strains. Conclusions: A prospective surveillance monitoring of in vitro antimicrobial susceptibility rates of some relevant hospital-associated organisms like Enterococci represents an useful tool to address antibiotic treatment and prophylaxis, on local and regional basis. The emerging of resistance to the reference compounds like glycopeptides may be also well targeted on these basis, in order to preserve the clinical use of the majority of molecules which still guarantee effective activity of these difficult-to-treat Gram-positive cocci.

present for salmonella and clostridium perfringent in cow meat. The cow was dead by unknown diseases. Conclusion: This outbreak caused by cow meat that was infected by clostridium perfringent and salmonella. It is probably direct contamination with cow meat. First intervention is to stop use of this cow meat, hygiene and sanitation were educated promptly. All cases send to hospital immediately. Recommendation: Should not the eat meat of sick animals or dead animals of unknown causes. The meat should be cooked properly; clean utensils and appropriate hand washing should be practiced every time. If have abnormal even in the community should report to RRT at health center as soon as possible. Key Words: Kompongspeu, cow meat, salmonella, clostridium perfringent ISE.271 How to Prevent Severe Epidemics of Dengue Hemorrhagic Fever: Taiwan's Answer to Global Control C.C. King1, D.Y. Chao1, T.H. Wen2, C.L. Kao1, T.S.J. Wu1, Y.J.S. Huang3, M. Tipayamongkholgu1, C.S. Shang1, M.H. Wu1, C.C. Tseng1, W.K. Wang4, H.Y. Cheng5, K.J.J. Chang6. 1Institute of Epidemiology, College of Public Health (CPH), National Taiwan University, Taipei, Taiwan, 2Institute of Epidemiology, College of Public Health (CPH), National Taiwan Universityy, Taipei, Taiwan, 3Dept of Public Health, CPH, NTU,, Taipei, Taiwan, 4Inst. of Microbiology, CM, NTU, Taipei, Taiwan, 5Vector-borne Infectious Disease, Taipei, Taiwan, 6Centers for Disease Control and Prevention, Fort Collins, Colorado, USA., Taipei, Taiwan Dengue hemorrhagic fever (DHF), a more severe and fatal form of the disease, is increasing at an alarming rate in recent dengue epidemics in several parts of the world. Many lives could be saved if important epidemiological characteristics could be applied to distinguish between a regular outbreak of dengue fever (DF) and the other one in which DHF will emerge. Because dengue is not endemic to Taiwan, we have had an unprecedented opportunity to identify risk/prevention factors that can improve the prevention and control of dengue/DHF epidemics globally. Studying the three recent epidemics of dengue/DHF in southern Taiwan, we found that DHF cases emerged after a failure to control of the spread of DF cases and that once there was a sharp increase in DHF cases, containment became more difficult. In addition, using geographical information system (GIS), we also identified that the 2002 epidemic of dengue/DHF in Kaohsiung had two diffusion patterns (neighborhood spread and relocation diffusion) and that once relocation diffusion occurred, containment became further complicated. The longer the mean duration per epidemic wave and/or the greater the intensity of transmission at local sites, the higher percentages of DHF cases was identified at the epidemic foci. Once there is an occurrence of DHF or a large-scale DF outbreak, it is crucial to conduct virologic and serologic surveillance monitoring of high risk populations in high risk areas. Our discovery of hot spots in 2001­2002 and 2006 epidemics of dengue/DHF suggest that, even before the beginning of a dengue epidemic season, geographical information system (GIS) can be used to identify populations and areas at risk of a severe DHF epidemic. The recent discovery that daily monitoring of meteorological factors can help predict the location of future outbreaks makes it possible for our mostly responsive dengue surveillance system to become more proactive. With this knowledge, we believe that by improving ecologic/virologic/serologic/clinical/epidemiologic surveillance, implementing more comprehensive and integrated community-based prevention and control activities, and using GIS to closely monitor tempo-spatial trends of dengue clusters, the world can prevent or minimize severe epidemics of DHF.

ISE.270 Food Poisoning Outbreak in Kompongspeu, Cambodia, September, 2007 L. Som. Ministry of Health, PHD Kompongspeu, Chbamorn, Cambodia Background: September 3rd, 2007 a food poisoning outbreak, a patient died, was reported at Vealpong, Oudong, Kompongspeu, Cambodia by rapid response team (RRT) of Damnaksmach health center. Objectives: Identify the source, agents of the outbreak, mode contamination; set primary intervention, to stop the outbreak, control measure and prevention. Methods: Outbreak was response by RRT of Provincial Health Department Kompongspeu and join by Communicable Diseases Control Department of Ministry of Health to design a descriptive epidemiology study, an environment study, and laboratory study of rectal swab, cow meats, and blood specimens also were performed and supported by National Institute Public Health and Institute Pasteur Cambodia. A simple questionnaire was prepared adapted to this outbreak and demonstrated to investigators before start to interview and data entry was performed in Excel program. Results: We interviewed 157 patients, 49 female. Clinical symptoms: 136 abdominal pain, 8 nausea-vomit, 9 oppression chest, no diarrhea. Consultation at referral hospital 78 patients, admitted 11 patients. One case died at home. Specimens: ten bloods, a stool, two pieces (salty & fresh) cow meat, were sent to laboratory. Among those a specimen was

HIV/AIDS and Other Retroviruses

ISE.272 Zinc Plasma Level in Patient with Human Immunodeficiency Virus Infection that Come to High Risk Behavior Consult Center or Admit in Infectious Disease Ward in Imam Khomeini Hospital in Tehran and Compare to HIV Negative Group in 2006 A. Soodbakhsh1, A.A. Saeedi1, H. Khalili2, M. Haj Abdolbaghy1, M. Rasooli Nejad1, A. Alipouran3, R. Sharififar3. 1Tehran University, M.DMPH, Tehran, Iran (Islamic Republic of), 2Tehran University, Clinical Pharmacologist, Tehran, Iran (Islamic Republic of), 3Tehran University, Tehran, Iran (Islamic Republic of)

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Background and Objectives: Zinc is one of the essential micronutrients and its role in immune system function is an interesting matter for researchers. HIV/AIDS as an immune system disorder, presents with impairing in elements of immune system. This study was designed for assessment of zinc level of serum in a group of HIV+ patients and compare with non-HIV people. Determining relationship between zinc level of serum and count of immune cells was another aim of this study. Material and Methods: This cross-sectional study was conducted with 96 people in 2 groups: 48 HIV+ and 48 HIV-. HIV negative group was divided in 2 subgroups: IV Drug Users (IDUs) and non-IDUs. Zinc level of serum was measured with atomic absorption method and statistical analysis was conducted with SPSS for Windows. Levels of zinc were compared in different groups. Results: Overall means of main groups had significant differences, and HIV+ group showed a significant difference with 2 other groups too. In addition, 2 groups of HIV- had significant difference. There was a relationship between count of CD4 cells and zinc level of serum. Zinc showed lowest level in HIV+ IDUs, then HIV- IDUs and finally HIV- nonIDUs. Conclusion: Results demonstrate zinc level impairment in HIV+ cases and its association with decrease in determinant parameters of survival such as count of CD4 cells. Key Words: micronutrient, zinc, HIV, AIDS ISE.273 Evaluation of Total Lymphocyte Count, Hemoglobin and Hematocrit as Surrogate Markers of TL-CD4 Count in Clinical Staging of HIV Infection for Initiation of Antiretroviral Therapy in Resource Restricted Area, Ahvaz, Iran, 2005­2006 S.M. Alavi, F. Ahmadi, M. Farhadi. Joundi Shapour Medical University, Ahvaz, Iran (Islamic Republic of) Background and Objective: T lymphocyte CD4+ count (TL-CD4) is a standard laboratory test for clinical staging of HIV infection but, in most resource-restricted countries is expensive and unavailable, so total lymphocyte count (TLC) and hemoglobin (Hb) and hematocrite (Hct) are recommended as simple and inexpensive surrogates. The aim of this study was to assess the capability and predictive value of these parameters with TL-CD4 count to initiate anti retroviral therapy in HIV/AIDS patients. Method: One hundred HIV patients enrolled in this analytic descriptive study which was conducted in Razi hospital in Ahvaz a city southern Iran, from 2005­2006. They were tested for CD4 count, TLC, Hb, and Hct. The Cutoffs were determined as: 200 cells/µL,1200 cells/µL,12 gr/dl and 30% respectively. We used Sys Max SE 9500 for CBC, Flow cytometry for CD4 count and both positive and negative predictive values for direction on TLC, Hb and Hct changes as a marker for direction of CD4 changes. Data were analyzed in spss11 by using one sided t-test. Results: Two females (2%) and 98 males (98%) with range of age 2143 and mean of 32-5 years enrolled in this study. 87 cases (87%) were injection drug users. 76% of patients had correlation between CD4 counts and TLC, 18% had TLC more than 1200 despite of CD4 count lower than 200 and 6% had TLC lower than 1200 despite CD4 count upper than 200. There were also 72% correlations between CD4 count with Hb and 62% with HCT. Conclusion: This study showed that TLC is a suitable surrogate marker instead of CD4 count. But in the cases of TLC more than 1200, it is necessary to test TL-CD4 count to evaluate the staging of disease. Hb and Hct is not suitable surrogate marker of CD4 count. Key Words: TL-CD4 count, Total lymphocyte count, Hemoglobin, Hematocrite ISE.274 Screening of HIV Among Patients Attending IBN SINA Hospital in Sirte, Libya S.R. Bagar. Department Of Medical Microbiology, Faculty of Medicine, Sirte, Lybia Arab Jamahiriya Introducion: HIV was first described in 1981. The demographics of HIV endemics are changing rapidly. Globally, the majority of HIV infected individuals are asymptomatic or undiagnosed serologically. Material and Methods: In a retrospective study, 17 419 patients, Ibn Sina hospital, Sirte-Libya during the period 2000­2001 were seen either as outpatient clinics or for medical fitness or hospital admissions. All the patients were tested for HIV in order to estimate the incidence HIV positive cases among hospital patients. All patients were exposed to routine

ELISA technique and PCR analysis of HIV antibodies. Results: Results pointed out that 85 patients (0.49%) were positive for HIV by both ELISA and PCR techniques. 62 patients (72.9%) were males and 23 patients (27.1%) were females. 42% of patients were of age group 31­40 years, only 4.7% were 60 years. Conclusion: In spite of the low registered cases of HIV, the positivity could be explained by blood transfusion in the past, traveling abroad of young males and sexual exposure, therefore HIV screening from time to time is needed. ISE.275 Pancreatic Abnormalities During HIV Infection. Risk Factors and Clinical and Treatment Issues R. Manfredi, L. Calza. Infectious Diseases, University of Bologna, Bologna, Italy Background: After a decade of HAART availability, the epidemiologicalclinical features of HIV-associated pancreatic abnormalities changed over time. Methods: The frequency, risk factors, and clinical-therapeutic features of pancreatic alterations were assessed in an observational, prospective case-control study involving 1,081 HIV-infected patients followed for >12 months. Results: On the whole, 166 subjects with elevated and/or prolonged laboratory anomalies were focused, in order to trace the profile of pancreatic disease during the HAART era.The 435 patients (40.2%) who experienced >1 episode of confirmed pancreatic laboratory abnormality had a longer duration of seropositivity and exposure to protease inhibitors, a more frequent immunodeficiency, AIDS diagnosis, chronic liver-biliary disease, and hypertriglyceridemia, while no relation was found with antiretroviral administration, and the duration-type of administered nucleoside analogues, when compared with the 646 controls, who never developed pancreatic abnormalities. Among the above-mentioned 435 patients, elevated and prolonged laboratory alterations eventually associated with signs of organ involvement occurred in 166 cases (38.2%), and were related to the administration of didanosine, stavudine, lamivudine, pentamidine, cotrimoxazole, or anti-mycobacterial therapy, cytotoxic chemotherapy, substance-alcohol abuse, opportunistic infections, chronic liver-biliary disease, a protease inhibitor-based HAART, and hypertriglyceridemia. However, no difference occurred between the 46 patients with clinical-imaging evidence of pancreatic involvement and the remaining 120 asymptomatic cases, according to the same spectrum of potential risk factors. Although recurrences of enzyme alterations involved 69.6% of overall patients, in only 30.1% of cases a change of the underlying antiretroviral-antimicrobial therapy became necessary. An acute but uncomplicated pancreatitis occurred in 9/46 symptomatic subjects (19.6%). A 2-4-week gabexate and/or octreotide administration (performed in 79/166 cases:47.6%), achieved a significant laboratory, clinical, and imaging cure-improvement in 82.3% of episodes, with a better success rate of combined (gabexate mesilate+octreotide) versus single (gabexate mesilate or ocreotide) therapy. A significantly reduced tendency to disease recurrences, and a better tolerability of antiretroviral regimens, were also found. Conclusions: Epidemiological-pathogenetic studies are needed to assess the trend of pancreatic abnormalities in the HAART era, and their relationship with continued antiretroviral-antimicrobial chemotherapy. This research field appears somewhat neglected, so that multicentre observational studies and controlled trials are lacking. The indications to gabexate-octreotide during HIV disease, deserve further investigation. ISE.276 Increasing Evidence of Large Vessel Damage, But Improved Vascular Surgery for HIV-Infected Patients. A Life-Threatening, Relapsing, Ruptured Aortic Aneurism R. Manfredi, S. Sabbatani, C. Fulgaro, G. Legnani, G. Fasulo. Infectious Diseases, University of Bologna, Bologna, Italy Background: There is increasing evidence about life-threatening large vessel involvement during HIV disease, and the role of combined antiretroviral therapy (cART) versus that of endothelial involvement is still debated in the pathogenesis. Case Report: A very infrequent thoracic and abdominal aortic aneurism occurred in a 52-year-old male patient with an HIV infection well controlled by an effective combination antiretroviral therapy, already modified in order to minimize dysmetabolic abnormalities (tenofovir, emtricitabine, and efavirenz). No adjunctive risk factors for an acceler-

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ated atherogenesis were present (i.e. cigarette smoking, arterial hypertension, metabolic syndrome,diabetes mellitus), the personal and family cardiovascular history were mute, and no infectious foci supported a mycotic aneurism. Moreover, alternative statin-fibrate therapy was administered since 18 months, and a diet-exercise program, and a polyunsaturated fatty acids supplementation were recommended. Despite surgical positioning of an aortic endoprosthesis immediately after diagnosing the aortic aneurism, 11 months later an imminent aneurism rupture was avoided by the introduction of another endoprosthesis between the older thoracic graft and the suvrarenal prosthetic device, although a revascularization of renal and mesenteric arteries became needed. The subsequent, 7-month-long follow-up did not disclose complications or sequelae, while HIV infection remained under control (persistently undetectable viral load, and CD4+ count >350 cells/µL) with an once-daily, effective, and well tolerated antiretroviral regimen. Unfortunately, a fatal relapse of ruptured aortic aneurism led rapidly our patient to death. Conclusions: Caregivers following HIV-infected patients should be aware of the increased risk of complicated, accelerated atherogenesis in these subjects, even when cART is sufficiently well tolerated, and the great majority of known risk factors has been assessed and eventually monitored and treated. Severe gross vessel abnormalities (like aneurisms) deserve major attention and eventual specialistic treatment (both endovascular and open surgery, or combined techniques like in our patient), since these treatments are expected to play an effective role in life-threatening conditions. ISE.277 Investigation HIV/Aids Knowledge Situation Among the Mobile Employee Population in Shangluo, China D. Li, Y. Yongping, L. Songhe, X. Dan, L. Juan, S. Haixia. Department of Epidemiology, the Fourth Military Medical University, Xian, China Background: HIV/AIDS become a serious challenge to China in recent years. The mobile people are special population groups. They are main high risk people of HIV/AIDS. Health education and prevention remain the main health care priorities in HIV/AIDS prevention now, and today is the key period in preventing and controlling HIV/AIDS to all the states, especially to the mobile people's health education. This study sought to estimate the knowledge and attitude for AIDS high risk behaviors and awareness of self-precaution among the mobile population in Shangluo, China. Methods: Cluster sampling was collected from different mobile population which includes construction works, hotel or restaurant attendants, workers that employed in haircut and cosmetic services and business men. 892 cases were surveyed with the self-designed questionnaires, including the knowledge, attitude, and behavior questions of HIV/AIDS. Results: Mobile population knows little about HIV/AIDS. Their awareness to the transmission route was higher, but the awareness to the preventive knowledge and HIV/AIDS non-transmission factors were lower. The correct answer rate about the benefit of condom was only 69.1%. Most of mobile population lacked of protective abilities and consciousness on AIDS prevention. The attitude towards people with HIV/AIDS among mobile population was negative. Most of them were afraid of AIDS patients, but a great number of them would like to accept HIV/AIDS education. The routes mobile population obtaining HIV/AIDS knowledge was very little. They obtained HIV/AIDS knowledge mainly by watching TV. Conclusion: A majority of mobile population received less formal education and lacking health knowledge and individual measures for prevention of HIV/AIDS, and it is difficult to get them under effective management by the local departments of health, education, family planning and soon at various levels. Thus, it is quite important to conduct health education on the prevention and treatment of HIV/AIDS in this population. ISE.278 Breastfeeding to Prevent HIV Transmission in Infants: Balancing Pros and Cons M. Dubon. Martine Foundation, Kinshasa, Congo Purpose of Review: In industrialized countries avoidance of breastfeeding is among the cornerstones of prevention of mother-to-child transmission of HIV. Breastfeeding carries risk for HIV transmission but improves survival, whereas formula feeding carries zero risk for transmission but increased risk for mortality. We assesses breastfeeding is a rational and viable option for HIV-infected women in poor environments.

Recent Findings: A number of recent studies, mostly from Africa, have provided new data that enable health workers to offer HIV-positive women clear advice on infant feeding appropriate to their individual circumstances. The studies are grouped according to whether the evidence favours one or other feeding type and are considered under the following headings: equivalence of formula feeding and breastfeeding; breastfeeding, HIV disease progression and mortality in mothers; breast superior to formula; breastfeeding for HIV-infected babies; and reducing risk for transmission while breastfeeding. Summary: The weight of current evidence favours exclusive breastfeeding for 6 months to prevent mother-to-child HIV transmission for most HIV-infected mothers globally, most of whom live in poor communities; exclusive breastfeeding may also benefit HIV-infected babies. Formula feeding appears to be equivalent to breastfeeding in terms of survival and transmission risk during the first 2 years of life in some settings. ISE.279 Genetic Associations Highlighting Differences in the Response to HIV Infection M. Dubon. Martine Foundation, Kinshasa, Congo Purpose of Review: Genetic associations highlighting differences in the response to HIV infection and treatment have significantly furthered our understanding of the pathogenesis, pharmacokinetics and pharmacodynamics of antiretroviral drug action and toxicities and HIV disease itself. This review focuses on the current knowledge of associations between polymorphisms and treatment outcomes in HIV with particular emphasis on clinically relevant relationships likely to lead to the individualization of antiretroviral therapy. Recent Findings: Our understanding of the immunogenetic basis of drug toxicity has been furthered by human leucocyte antigen associations with hypersensitivities for the antiretroviral drugs abacavir and nevirapine. For abacavir in particular, the use of HLA-B*5701 as a screening test appears to be generalizable across racially diverse populations and has been supported by both observational, and blinded randomized controlled trials. Summary: Differences in HIV acquisition and progression as well as antiretroviral efficacy and toxicity will continue to provide the basis for research to define the genetic basis of such diversity. Despite the plethora of research in this area, numerous barriers exist to the successful operationalization of genetic testing to the clinic. HLA-B*5701 screening to prevent abacavir hypersensitivity is currently the most relevant to clinical practice and highlights that the promise of cost-effective testing can be facilitated by robust laboratory methodology and quality assurance programs that can be applied to diverse treatment settings. ISE.280 Factors Related to Hepatic Damage in Patients Infected with HIV-1 L.L. Dai. Youan Hospital, Beijing, China Objective: To investigate the risk factors of hepatic damage in HIV-1 infected patients. Methods: 161 HIV-1-infected patients hospitalized in You'An Hospital from 2005 to 2006 were retrospectively studied. The age, gender, routes of transmission, alcohol abuse, HAART exposure, other liver toxic drugs exposure, HBV/HCV co-infection were analyzed. Results: 90(56.2%) patients had elevated ALT and/or AST, among which more patients had HBV and /or HCV co-infection (67.8% VS 52.1%) or undergoing HAART compared with those who had normal liver function,p<0.05. Logistic analysis showed that HBV/HCV co-infection and HAART were two risk factors of liver damage in patients infected with HIV-1. Conclusion: HBV and/or HCV co-infection and HAART maybe are the most important risk factors of liver damage in patients infected wuth HIV-1 in China. ISE.281 Pre-Travel Health Advice Among HIV-Infected Travelers from Rio De Janeiro, Brazil R. Igreja. Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil Background: The total number of people with AIDS in Rio de Janeiro is over 30,000. Travel advice for HIV patients is becoming increasingly specialized, which includes travel vaccination and highly active antiretroviral therapy related issues. Previous studies reported the experience of HIV-infected travelers from temperate countries but little is known about HIV-infected travelers under antiretroviral therapy from

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tropical countries. Although Rio de Janeiro is a city located in the tropics, tropical diseases are not a major problem in Rio, except for dengue, and vaccine-preventable diseases like polio or measles were eliminated in 1988 and 1999, respectively. Methods: A retrospective study of HIV-infected travelers presenting to a Travel Clinic in Rio de Janeiro, Brazil. Results: A total of eleven journeys from ten people were recorded. All of them lived in Rio de Janeiro and there was just one woman. The ages ranged from 33 to 48 years old. Business was the main reason for travel. Brazil (Amazon Region and Northeast coast) was the destination for six (54.5%) journeys. Others destinations were Peru, Angola, Europe and Asia. Nine (90%) attendees were under antiretroviral therapy. Conclusions: Few HIV-infected people from Rio de Janeiro consulted a travel medicine expert before travel. As they travel to Brazilian and overseas regions with endemic diseases not encountered in Rio a pretravel preparation needs to be carefully planned. Strategies must be planned to increase frequency of pre-travel consultation such as a closer collaboration between HIV and travel health clinics. ISE.282 Challenges Faced by Prevention of Maternal to Child Transmission of HIV Programs in Tanzania F.C. Ngakongwa. ICAP, Dar es salaam, United Republic of Tanzania Background: PMTCT services started in 2000 in Tanzania in the five tertiary hospitals. 2002 the government scaled up the PMTCT services to reach more women. In the untreated population, the MTCT prevalence is 45%, in pregnancy it is 5­10%, at delivery it is 10­15% and during breastfeeding it is 5­20%. Rate of Transmission: Enhanced by viral factor, maternal factor, obstetrical/postnatal factor and fetal factor. Challenges Faced: 1) Literacy rate in women is very low as compared to men. Literacy rate of Tanzania is 67.8% of total population (Males: 79.4%, Females: 56.8%). 2) Poor male involvement in reproductive health, the uptake of male involvement is very low about 23.7% study done in Moshi urban, with the reason that pregnancy and child issues are women's arena. 3) Inaccessibility of PMTCT programs at primary level, The government scaled up the PMTCT services to reach more women, however, efforts are not yet complete and prioritizes the higher facility levels (referral, regional, district hospitals). Dispensaries are of lower priority. A survey done by AXIOs showed that most women 55% attend ANC at dispensaries compare to health centres 25% and hospitals 20%. Also deliveries were done more at hospitals 62% and dispensaries 21%. 4) Poor knowledge and skill about PMTCT services among health workers, In spite of scaling up the PMTCT services in the community there is a shortage of trained staff--this was reported by MOHSW in collaboration with CDC. 5) Poor infant feeding due to cultural norms, stigma/discrimination, poor partner involvement and poverty. Recommendations: ­ Training of staff ­ Scaling up PMTCT services at dispensary level ­ Community emphasis on education for all ­ Media involvement on provision of IEC on importance of male participation on RCH ­ Provision of support in small scale businesses to improve individual income ­ Stigma alleviation ISE.283 Mobile populations and HIV/AIDS J. Lundia. Diplofoundation, Kinshasa, Democratic Republic of the Congo The objective is to present a multi-centre study that analyses the socioeconomic, cultural and political contexts that give rise to population mobility, and its relationship to vulnerability to sexually transmitted infections (STI)/HIV/AIDS, in order to provide information that can be used to design appropriate and focused interventions. In each of 11 transit stations (border towns, port cities, areas where mobile populations congregate) in Central America and Mexico, a household survey of the local population was conducted to analyse demographic, socioeconomic characteristics, and information known and opinions held about HIV/AIDS and mobile populations. In-depth interviews with key informants, community members and mobile populations were held to ascertain knowledge about prevention and transmission of STI/HIV/AIDS. Likewise, an ethnographic study was undertaken to identify interactions

between local and mobile populations. The transit stations share low educational levels among the local population, few public services, repeated human rights violations, violence, poverty and corrupt authorities. Within this social context, transactional sex, sex for survival, rape and non-professional commercial sex happen in conditions that increase the risk of the transmission of STI/HIV, such as infrequent condom use. Migrant women and sex workers are particularly vulnerable in this context. A wide gap exists between information about STI/HIV transmission and reported prevention practices. Given the conditions that exist in these transit stations, interventions should be multisectoral, sustainable, and should defend the human rights of various groups, including women and people living with HIV/AIDS. ISE.284 Adverse Reactions of Trivalent Influenza Vaccine in HIV-Infected Individuals S. Jam1, M. Hajiabdolbaghi1, D. Sabzvari1, B. Moradmand Badie2, M. Mohraz1. 1Iranian Research Center for HIV/AIDS, Tehran, Iran (Islamic Republic of), 2Iranian Research Center for HIV/AIDS,Medical Scienses/University of Tehran, Tehran, Iran (Islamic Republic of), 1 Iranian Research Center for HIV/AIDS, Tehran, Iran (Islamic Republic of) To assess the frequency and type of the side effects after influenza vaccination in HIV-infected individuals, 203 adults were evaluated from October 2006 to February 2007. 80.3% of the subjects (163 persons) were male. The mean age of the subjects was 36.9±7.9 years (range 21-59 yr). Participants received one dose of influenza virus subunit vaccine inactivated with formaldehyde. Subjects were evaluated 48 h and 15 days after vaccination for symptoms and significant health events as possible side effects. Local and systemic reactions were reported by 61 (30%) and 62 (30.5%) persons, respectively. The most common adverse reactions to the influenza vaccine were included skin redness (37 cases), induration (32 cases), and pain (55 cases) as local reactions, and fever (22 cases), myalgia (46 cases), headache (12 cases) and weakness (35 cases) as general reactions. 1.4 % of the subjects had fever over 38.5°C. We found no relationship between adverse reactions and sex, history of smoking, allergy, alcohol, and drug usage, stage of HIV infection, antiretroviral therapies, anti TB medication and previous vaccination. We concluded that inactivated influenza vaccine administered in HIVinfected adults did not result in potential adverse events in this study population. However, it remains important to assess the clinical efficacy of influenza vaccine early in the influenza season. Key Words: influenza, vaccination, adverse reactions, HIV-infected individuals. ISE.285 A Cross-Sectional Study of Anemia in Human Immunodeficiency Virus (HIV)-Infected Patients in Tehran, Iran S. Jam1, A. Ramezani2, D. Sabzvari3, B. Moradmand Badie3, H. Jabbari3, M. Mohraz3. 1Iranian Research Center for HIV/AIDS, Tehran, Iran (Islamic Republic of), 2Pastoure Institue of Iran, Tehran, Iran (Islamic Republic of), 3Iranian Research Center for HIV/AIDS, Medical Sciences/University of Tehran, Tehran, Iran (Islamic Republic of) Objective: Anemia is a frequent complication of infection with human immunodeficiency virus (HIV). The causes of HIV related anemia are multifactorial. This study was conducted to evaluate the factors associated with anemia in HIV-infected patients. Methods: A total of 642 HIV/AIDS patients attending to HIV clinic at Imam-Khomeini University Hospital in Tehran, Iran were enrolled in this study. A detailed history and physical examination were obtained from all HIV patients. Investigations included CD4+ count, hemoglobin concentration (Hb), and red blood cell (RBC) morphology. Results: Among HIV-infected patients, 87% were male. The mean duration of anti-HIV therapy was 17.9±9.2 months. The mean Hb level was 12.9 mg/dL (2.31). RBC morphology showed macrocytosis in 11%, normocytosis plus normochromia in 41.1%, and microcytosis plus hypochromia in 47.9% of patients. The prevalence of anemia (defined as Hb < 10 mg/dL) was 10.3%.Anemia was positively associated with female sex (OR: 3.01), CD4 level (CD4 count of < 200) (OR: 3.49), and anti-TB drugs administration (OR: 4.57). Conclusion: Female sex, stage of HIV infection and anti-TB drugs use were the most important factors associated with anemia in HIV-infected patients in our study. Key Words: Anemia, HIV/AIDS, Risk factors, Hemoglobin

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ISE.286 Russia is Experiencing One of the Sharpest Increases in HIV Incidence in the World J. Lundja. RFC, Kinshasa, Democratic Republic of the Congo Background: Russia is experiencing one of the sharpest increases in HIV incidence in the world. Almost no research has examined patterns of risk behavior among Russian men who have sex with men (MSM). Design and Methods: A total of 434 MSM were surveyed in all of St. Petersburg's gay-identified clubs during June 2000. Men completed questionnaires about their sexual practices, AIDS risk knowledge, safer sex attitudes, behavior change intentions, perceived safer sex norms, and fatalism. Results: Most MSM were bisexual; 79% had female partners in their lives and 37% had female partners in the previous 3 months. Sexually transmitted disease treatment was reported by 32% of the men, 23% had sold sex to gain money, and knowledge about critical HIV riskreduction steps was low. Of all men surveyed, 38% had unprotected anal sex in the previous 3 months, consistent condom use was reported by only 30% of men, and most recent anal intercourse occasions 37% of particpants'. Regression analyses showed that high-risk behavior was predicted by poor safer sex attitudes, weak behavior change intentions, low knowledge about AIDS risk, perceived peer norms that did not support safer sex, and having a boyfriend. Conclusion: To avert a widespread epidemic, HIV prevention interventions for Russian MSM are critically needed. Factors predicting risk were consistent with those found among MSM in other countries early in the HIV epidemic. However, unique cultural factors, including frequent bisexual behavior, the 'newness' of openly gay communities in Russia and lack of community experience in dealing with AIDS, require HIV prevention program tailoring.

common bacterial agents and their antibiotic susceptibility pattern in this group. Methods: In this study, 324 HIV-positive patients were evaluated in Sina hospital during 5 years and isolated organism from blood, wound, synovial and pleural fluid, BM, sputum, stool and urine were assessed and their antibiotic susceptibility were determined. Results: Blood culture was positive in 13.96% and S. aureus was most common isolated. Skin wound culture positive in 63.7% (59% S. aureus). Synovial culture positive in 20% (100% S. aureus). Sputum culture positive in 63.5% (71.5% pneumococcus). Pleural fluid culture positive in 18.25% (all S. aureus). BM culture positive in 20% (all S. coagolase neg). Klebsiella.P was sensitive to ceftriaxone, ceftizoxime, cephalexin and co-trimoxazole and resistant to gentamicin. Pneumococcus was sensitive to ceftriaxone, ceftizoxime, cloxacillin, ciprofloxacin, vancomycin and resistant to cotrimoxazole, ampicillin, erythromycin and cephazoline in 50%. S. aureus was sensitive to vancomycin in 72%, ceftriaxone in 74%, ciprofloxacin in 70% and cloxacillin in 50%. E.coli was sensitive to ceftizoxime, amikacin, gentamicin, cotrimoxazole, nalidixic acid and resistant to nitrofurantoin and ampicillin. Conclusion: Since HIV-infected patients are susceptible to severe and life threatening infections, results of this study may help to correct choosing of antibiotics in this group. It seems that antibiotic susceptibility pattern is not very different from non-HIV cases. Key Words: Staphylococcus, Klebsiella, Antibiotic ISE.289 Adherence to Antiretroviral Therapy Among Patients Receiving Therapy in a Resource Poor Setting: The Case of Kericho District Hospital in Kenya D.W. Njeru. Kenya Medical Research Center, Nairobi, Kenya Background: The protocol objective was to establish the level of antiretroviral therapy (ART) adherence, factors that hinder or promote adherence, the role of demographic and psychosocial factors in adherence among patients receiving therapy at the Kericho District Hospital (KDH). The study was intended to help KDH formulate strategies that can be employed to improve current and future ART programs so as to optimize overall therapeutic goals. Methods: The study was a cross-sectional survey in which all patients who met the inclusion criteria were included. A total of 398 volunteers were interviewed. Purposive sampling was used in the selection of the focus group discussion (FGD) participants at the Matobo Live with Hope HIV support group. Interviewer administered questionnaires were used to collect quantitative data, while FGD and key informant interviews were employed to collect qualitative data. SPSS/PC programme was used to enter and analyze data. Results: The study found a mean adherence level of 98.8%. Majority of the participants (95.7%) reported being 100% adherent to therapy. There was a statistically significant relationship between adherence and knowledge (P<0.013), adherence and level of education (P< 0.005), adherence and income (P< 0.035), adherence and attitude to ART (P< 0.028) and adherence and stigma (P< 0.044). Important barriers to ART adherence included: drugs side effects, long distance to the clinic, long waiting time and stigma. Patients perceived that a good understanding of the importance to adhere, timely refills, use of organizational aids, social support from family members, support groups and health care workers and belief in drug efficacy were key in facilitating adherence. Conclusions: The levels of adherence in patients receiving ART at the KDH are comparable to levels in resource rich settings. It is possible for patients to achieve near perfect levels of adherence with elimination of costs related to ART coupled with thorough counseling, patient support, use of reminders, tailoring the regimen to the patient's life style and addressing issues related to side effects. ISE.290 Newly Diagnosed HIV Infection at a Metropolitan Reference Centre of North-Eastern Italy R. Manfredi, L. Calza, C. Biagetti. Infectious Diseases, University of Bologna, Bologna, Italy Background: To assess prospectively all newly diagnosed cases of HIV infection at our reference centre, which serves >800,000 inhabitants of the Bologna metropolitan area. Methods: All patients with a newly diagnosed HIV infection were initially assessed according to several demographic, epidemiological, diagnostic, clinical, and laboratory features.

ISE.287 Staphylococcalnasal Carriage and Its Antibiotic Susceptibility Pattern in HIV Positive Patients in Kermanshah, Iran A. Janbakhsh1, F. Mansouri1, B. Sayad1, S. Vaziri1, M. Afsharian1. 1 Kermanshah University of Medical Science, Kermanshah, Iran (Islamic Republic of) Objective: Nasal carrier state play a significant role in pathogenesis of staphylococcal infections. Multiple factors such as HIV infection and stage of disease can increase nasal colonization rate. This study was conducted to determine rate of nasal colonization and its related factors in HIV-infected patients. Methods: This study was conducted among 300 HIV-infected patients in Kermanshah Behavioral Counseling Center. Results: Among 300 cases 93% was male and 7% female. Mean age was 32-years-old and 39.2% were in the 31- to 40-year age group. 51 cases (17%) were nasal carrier of Staphylococcus aureus. Colonization rate was more in female (23.5%) than male (76.5%) and carrier rate was 50.9% in female and 14.4% in male that was statistically significant. 49% of carriers were in the 31- to 40-year age group. Difference in age groups was not significant. 87% of total and 89% of carriers were IV drug injectors, that this factor had not significant role in colonization rate. 25 cases of carriers (49%) had CD4>500/mm3, 20 cases (39.2%) 200500/mm3 and 6 (11.8%) <200mm3. Decreased CD4 count had statistical significant role in carriage rate. S. aureus was sensitive to penicillin in 3.4%, 9.7% to oxacillin, 72.3% to methicillin, 83.2% to vancomycin and 100% to gentamicin. Conclusion: This study showed that nasal carrier state of S. aureus was not different among HIV-infected and non-infected HIV patients and colonized organism had good antibiotic sensitivity. It seems that antibiotics such as carrier state is not needed to be treated in outpatients but in admitted cases should be evaluated. Key Words: MRSA, vancomycin, methicillin ISE.288 Common Isolated Organisms and Their Sensitivity to Antibiotics in HIV-Infected Patients in Kermanshah Sina Hospital A. Janbakhsh1, F. Mansouri1, B. Sayad1, S. Vaziri1, M. Afsharian1. 1 Kermanshah University of Medical Science, Kermanshah, Iran (Islamic Republic of) Background: HIV-infected patients are susceptible to opportunistic and other bacterial infections because of decreased immunity, drug injecting, low economic and health levels. This study was conducted to evaluate

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Results: From June 2006 up to September 2007 (15 months), 81 patients were first diagnosed with HIV disease (mean 5.4 novel cases per month), and 56 of them were judged to have a recent infection (as established on the ground of a specific "avidity" serologic testing). Males greatly prevailed over females (47 versus 9 cases), while homosexual exposure (40 cases) was prevalent over heterosexual one (16 patients), and no novel case was registered among i.v. drug users. The median age at diagnosis was 37 years, while the main laboratory parameters showed a mean CD4+ count of 604/µL, and a mean HIV-RNA load of 1.05x105 copies/mL. Although subtype B virus greatly prevailed (53 cases: 94.6%), also subtypes A1, and recombinant virions of HIV were found among newly infected patients. When conducting a genotypic resistance assay including all available antiretroviral agents, the overall prevalence of primary mutations accounted for 16% of newly infected patients: 10.7% of them had one/more mutations of the reverse transcriptase gene, and 7.6% of subjects had one/more mutations of the protease gene (including one case of multiple mutations, probably conferring resistance extended to the third-generation protease inhibitor tipranavir). The majority of patients with recent infection (43 of 56:76.8%) were asymptomatic or paucisymptomatic, while a full-blown AIDS or a symptomatic disease were present in 3­10 cases, respectively. Conclusions: Not withstanding the massive prevention campaigns of the last two decades, HIV infection continues to spread predominantly via sexual route, and may increasingly involve immigrants. A delayedmissed recognition of HIV infection poses patients at a very high risk to develop HIV-related disorders (since these subjects could not take advantage from antiretroviral therapy). Non-subtype B viruses, recombinant viruses, and HIV strains already encoding for resistance against antiretrovirals are of concern. A permanent, active monitoring of this phenomenon and its correlates, is strongly warranted. ISE.291 A Significantly Different Dysmetabolic Profile of the Two Available Non-Nucleoside Reverse Transcriptase Inhibitors: Nevirapine Versus Efavirenz R. Manfredi, L. Calza. University of Bologna, S. Orsola Hospital, Bologna, Italy Background: Altered metabolism represents an emerging feature of HIV-infected patients (p) treated with combined antiretroviral therapy (cART), but a different profile involves the two non-nucleoside reverse transcriptase inhibitors (NNRTI): efavirenz (E), and nevirapine (N). Patients and Methods: Among >1, 100 p treated with cART 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 2-10 therapeutic lines (but still NNRTI-naïve); the third included p who added for the first time a NNRTI only on late rescue therapies with at least 4 drugs (and including protease inhibitors). Results: 441 p treated with E were compared with 378 p taking N in our prospective observational survey lasting 12­44 months, by a multivariate analysis of serum lipid-glucose levels, and other metabolic abnormalities. Among the 241 p naïve to antiretrovirals, an altered triglyceridemia was more common (p<.001) in the E versus the N group. Considering the 386 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 192 p receiving salvage HAART, the rate of hypertriglyceridemia-hypercholesterolemia-hyperglycemia tested greater among p treated with E versus N (p<.03 to p<.001), and the time to peak alterations was shorter in the E group (p<.03). Comparing the 441 p receiving E with the 378 p on N, the frequency of elevated triglyceride, cholesterol, and glucose levels was greater in E-treated p (p<.0001 to p<.005). Lipodystrophy was present in 311 pre-treated p, but an appreciable ameliorement occurred after NNRTI introduction in 21 p of the E group, versus with 63 p on N (p<.002). Conclusions: 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 prospective pathogenetic and preventive investigations.

ISE.292 Non-AIDS Defining Malignancies in the Era of Combined Antiretroviral Therapy R. Manfredi. Infectious Diseases, University of Bologna, Bologna, Italy Background: The introduction of combined antiretroviral therapy (cART) contributed to a rapid, significant drop of frequency of all AIDSdefining opportunistic infections and some selected AIDS-related tumors (like Kaposi's sarcoma), with a consequent, remarkable reduction of both morbidity and mortality rates associated with these disease complications. Patients and Methods: Our cohort of >1,700 HIV-infected patients followed in two connected outpatient centres by the same physician staff were prospectively followed since the year 2000 (8 years), with special interest focused on the diagnosis, treatment, and outcome of non-AIDS related malignancies. Results: Among haematological malignancies other than nonHodgkin's lymphoma and primary central nervous system lymphoma, we observed three cases of acute myelogenic leukaemia and 2 episodes of Hodgkin's lymphoma. A greater number of solid tumors involved different organs and sites: laryngeal cancer (5 cases, with 3 episodes of papillomatous laryngeal cancer), rhinopharyngeal squamous carcinoma (2 cases), adenocarcinoma of the lung (3 cases), gastric adenocarcinoma (2 episodes), esophageal carcinoma (one patient), prostate cancer (3 cases), bladder adnocarcinoma (2 episodes), pancreatic adenocarcinoma (one case), and pheochromocytoma (one episode). Some of these malignancies have been reported with extremely rare frequency until now (usually as single-case anecdotal reports), in particular before the cART era. The patient's age ranged from 34 to 67 years, the mortality rate of these last 23 episodes was very elevated (78.3%), and occurred 4­38 months after diagnosis, despite appropriate surgical and/or cytotoxic chemotherapy. Discussion: The significantly increased life expectancy of HIV infected patients in the cART era was characterized by a proportionally increase of non-AIDS-defining tumors, which may depend on the advanced mean patients' age, their prolonged exposure to risk factor, the persisting functional immune system imbalance, and probably some direct oncogenic property of HIV itself, even when a "quantitative" recovery of CD4+ lymphocyte count has been achieved thanks to cART. The differential diagnosis of non-AIDS-associated tumors may be delayed by the low clinical suspicion, and their frequency to mimick and/or overlap infectious complications.Further epidemiological and clinical investigation is strongly warranted, to increase the awareness of this emerging phenomenon. ISE.293 Switch from Lopinavir-Ritonavir Towards Atazanavir-Based Combinations in Patients with Sustained VirologicalImmunological Control, and Predominant Dysmetabolic Abnormalities R. Manfredi, L. Calza. Infectious Diseases, University of Bologna, Bologna, Italy Background: Among the long-term untoward effects of antiretroviral therapy, metabolic abnormalities are the most frequent. The metabolic syndrome, and especially hypertriglyceridemia-hypercholesterolemia are a major concern during protease inhibitor (PI)-based regimens, where lopinavir/ritonavir (L/r) represents a standard of care for its potency-durability, whereas the more recent PI atazanavir (A) is expected to show a reduced metabolic toxicity. Patients-Methods: In an observational, prospective, case-control (1:2) study involving our cohort of >1, 000 patients (p), among 162 p treated with 2 NRTI and L/r since >12 months and with undetectable viremia since >6 months, who developed hypertrigyceridemia and/or hypercholesterolemia, 54 p (33.3%) switched to A/r (39 p) or unboosted A (15 p), and were compared with the remaining 108 p who continued L/r. For this interim analysis, p who completed >12 months of follow-up were evaluable. Results: Although the mean initial levels of triglyceridemia and cholesterolemia were significantly greater in the p group switched to A (p<.01 and p<.04, respectively), just these p experienced a significantly higher drop of serum lipid levels during the 12-month follow-up: -91.2±53.8 mg/dL for triglyceridemia (p<.003), and -33.6±26.9 mg/dL for cholesterolemia (p<.01), versus the L/r control group. Even more favorable figures were recognized among the 15 p treated with unboosted A (-143.2 mg/dL for triglyceridemia, -56.7 mg/dL for cholesterolemia), but statistical assessment was not feasible. During the 12-month follow-up, no virological-immunological failure occurred. The substitution of L/r with A/r or A contributed to maintain the stable virological-immunological

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response already reached under L/r-based HAART, while significant metabolic advantages were observed in p switched to A/r and A alone, when considering total triglyceridemia-cholesterolemia, from the 6th to the 12th month of follow-up. No significant benefits were observed with regard to the HDL-LDL cholesterol fractions. Conclusions: Further studies are needed to assess the role of A/r and A also in PI-naïve p, taking into consideration the role of the different nucleos(t)ide backbone, and examining extensive p samples followed for a longer time, with in-depth laboratory and instrumental monitoring. ISE.294 Exceptional Long-term Non-Progression of HIV Infection. Over Eight Years of Follow-Up Without any Detectable Viremia R. Manfredi, S. Sabbatani, G. Fasulo, C. Fulgaro. Infectious Diseases, University of Bologna, Bologna, Italy Background: It is still unclear whether the virological-immunological steady-state observed among the small number of HIV-infected patients defined "long-term non-progressors" may have a prolonged-undefined duration, or it simply represents the extremity of a gaussian curve. Methods and Results: A 40-year-old asymptomatic female patient is followed since the age of 23 (year 1990) for her HIV-HCV co-infection. During periodic monitoring, performed at least quarterly, HIV viremia always remained under the detectability threshold (<200 copies/mL until 2003, <40 copies/mL since 2004), in absence of any viremic "blip", while the CD4+ T-lymphocyte count ranged from 597-794 cells/µL (with a percentage of 28-36% of overall CD4+ T-lymphocytes), in concurrence with an always contained expansion of CD8+ T-lymphocyte subset (52- 56% during the entire follow-up). A genotypic resistance testing was never feasible, due to the persistingly undetectable viremia.On the ground of the excellent virological-immunological situation of HIV disease and the strong patient's motivation, a treatment for the concomitant chronic HCV infection has been started four months ago with combined peginterferon-ribavirin. Discussion: In our patient followed since the age of 23 (year 1990), a HIV infection repeatedly confirmed by Western Blot assays was never associated with a detectable viremia, or a quantitative drop of CD4+ cell count, while the CD4+ percentage, although proportionally elevated (2836%), always remained below that of CD8+ lymphocytes, which had only a moderate expansion (52-56%). Rodés et al. [AIDS 2004;18:1109] assessed five "long-term non-progressor" patients with a persistingly negative viremia during 6 years (1997­2003), also demonstrating a reduction of replication capacities related to the retrieval of R5 HIV strains, or the R77Q mutation of viral gene "vpr", while an homozygosis for the delta-32 variant of the CCRC co-receptor was not found. From the immunological point of view, the Author underlined a reduced expansion of CD8+ lymphocyte subset in these five subjects. Case reports like ours, although rare and therefore not representative of the entire population of HIV-infected individuals, should deserve in-depth virologicalimmunological assessment, to enhance informations on the network supporting a so prolonged HIV infection latency.

Surprisingly, viremia remained for over one decade at non-detectable values, so that a genotypic resistance testing was never feasible, while CD4 cell count ranged from a nadir of 382 cells/µL (year 2001), to 525-794 cells/µL since 2003. A second male p with a body weight of 69-72 Kg, since 2002 always took all combined antiretroviral therapy at half dosage (3TC 150 mg/die, AZT 300 mg/die, lopinavir-ritonavir 2 cp/day for 5 years, as a single daily dose), without showing detectable viremias, and a CD4 count 650 cells/µL. In both these last 2 p, genotypic resistance testing was not feasible due to undetectable viremia. Discussion: The long-term maintenance of an excellent virologicimmunological situation in 3 p with an adherence voluntarily limited to 50% of recommended dosages notwithstanding the counselling of health care personnel, introduces some points of discussion. A 50% compliance is considered absolutely inadequate in the treatment of HIV disease, so that someone claimed a forced interruption of therapy a so limited adherence is of concern. On the other hand, all our 3 p are somewhat "adherent" to their self-made 50% dosage regimens, and are re-enforced in their wrong consideration by checking at least every three months their excellent clinical-laboratory situation, and by their longterm, unchanged therapeutic response. ISE.296 Recent Availability of Two Novel, Fixed Associations of Antiretroviral Nucleoside/Nucleotide Analogues (Nrti). A 12-Month Prospective Analysis of Their Therapeutic Perspectives R. Manfredi, L. Calza. Infectious Diseases, University of Bologna, Bologna, Italy Background: The recent introduction of novel, fixed NRTI combinations (emtricitabine-tenofovir, E-T, and lamivudine-abacavir, L-A) expanded the spectrum of available compounds and increased patient's adherence. Patients and Methods: A prospective survey of the use of these two fixed combinations was performed in our cohort of over 1000 HIVinfected patients (p). Results: During 12 consecutive months, 66 p (67.3%) received for the first time E-T, or L-A (32 p). Among the 42 p naïve to all antiretrovirals, E-T was goven to 36 p (85.7%), mostly associated with efavirenz (21 p), or different PI (20 p), whereas L-A was administered to 6 p only (5 with PI). In the remaining 56 p E-T or L-A therapy replaced a prior regimen, predominantly associated with PI (29 p), vs efavirenz (14 p), or oher combinations (13 p). Among the 56 pretreated p, E-T (30 p), strictly prevailed over L-A (26 p), and the therapeutic change was due to failure and resistance (29 p), or toxicity-poor tolerability (21 p). Both fixed combinations were well tolerated, with only one case of L-A suspension due to abacavir hypersensitivity. Conclusions: From our preliminary experience, a major role seems played by E-T in first-line treatments (preferably among "compact" regimens based on efavirenz), while the increased L-A prescription to pretreated p is attributable to the high genetic barrier of abacavir (often associated with PI). The present availability to two more fixed NRTI combinations advantaged by once-daily administration strongly encourages "head to head" studies in both first-line and experienced p, in order to better exploit and target their therapeutic potential. ISE.297 Ritonavir-Lopinavir Hypersensitivity Confirmed by a Specific Allergometric Testing of in Vitro Cell Stimulation. First Application in the Field of Antiretroviral Drugs R. Manfredi1, S. Sabbatani1, S. Bergonzi2. 1Infectious Diseases, University of Bologna, Bologna, Italy, 2Clinical Pathology Laboratory, Maggiore General Hospital, Bologna, Italy Background: Drug-induced untoward events are increasingly reported among HIV-infected patients (p), compared with the general population. Compared with other classes of antiretrovirals, PI show a lower incidence of acute hypersensitivity reactions. Methods and Results: A HIV-infected p treated since 8 years with all antiretroviral classes save boosted PI, at the time of changing therapy due to an emerging genotyping resistance to non-nucleoside reverse transcriptase inhibitors, experienced repeated episodes of hypersensitivity reactions to all available boosted PI. After documenting a combined ritonavir and lopinavir hypersensitivity by means of a specific in vitro cellular antigen stimulation test (CAST), antiretroviral therapy was safely continued with unboosted atazanavir. Conclusions: During the last few years, novel allergometric techniques allow to test inhalants, food, and drugs. A flow cytometry assay based

ISE.295 Voluntary 'Self-Adjusted' Treatment with 50% of Recommended Dosages of Antiretroviral Drugs. Surprising Full and Sustained Virological and Immunological Efficacy, Up to Over Ten Years R. Manfredi, S. Sabbatani, L. Calza. Infectious Diseases, University of Bologna, Bologna, Italy Background: Antiretroviral adherence issues are intensely investigated, as an essential target for successful and sustained efficacy of antiretroviral therapy, and viral resistance prevention. Methods and Results: A first case regards an ex-IVDA patient (p) with HIV infection known since 1985. Due to a severe HIV-related immunosuppression (CD4:37 cells/µL), in January 1997 3TC-d4T-indinavir was effectively started, achieving after 3 months undetectable viremia and a CD4 count of 315 cells/µL, but multiple episodes of symptomatic urolithiasis occurred, and regimen modification recommended. Since April 1997, 3TC-d4T-ritonavir were suggested for 5 years, followed by 3TC-d4Tlopinavir-ritonavir (10 months), and 3TC-AZT-lopinavir-ritonavir (5 years). However, all proposed regimens were voluntarily taken by our p (whose body weight was 75­78 Kg) at half-dosage, as a single daily dosage, against any recommendation, and also refusing the resort to efavirenznevirapine, although our p always maintained his maximum "adherence" to his self-made empiric regimen, as assessed by monthly visits, direct drug distribution and accountabilty, and adherence questionnaires.

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on the search of sulphidoleukotrienes LCT4, LTD4 and LTE4 released by basophils stimulated in vitro by IL-3 in presence of the examined antigens (CAST test), has 80­90% sensitivity-specificity rates, and become particularly useful when prick tests are not applicable, and allergic reactions not mediated by allergen-specific IgE are of concern. According to our knowledge, we report the first case of application of the in vitro CAST assay to antiretroviral intolerance, and the subsequent, specific regimen selection in a HIV-infected p who showed multiple allergy to all boosted PI. Further, controlled investigation is strongly needed to implement in vitro allergometric testing in p with HIV infection, who are prone to show unpredictable drug intolerance reactions. In fact, HIV-infected p may suffer from frequent allergic drug reactions which may be difficult to be systematically recognized (due to the frequent, multiple concurrent pharmacotherapy), while eventual drug rechallenges are potentially dangerous. ISE.298 Liver Toxicity and Administration of Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI). No Correlation with the Female Gender and a CD4+ Lymphocyte Count Greater than 250 Cells/µL R. Manfredi, L. Calza. Infectious Diseases, University of Bologna, Bologna, Italy Background: Some recent reports focused their attention on a potentially increased hepatotoxicity of nevirapine in female patients with a CD4+ count >250 cells/µL (especially when pregnancy is of concern) [FDA advisory on nevirapine. AIDS Treat News 2005;409:7]. Methods and Results: In an open-label comparison performed in 742 patients (p) treated with an HAART based on NNRTI (either efavirenz or nevirapine) introduced into therapeutic regimens for the first time, or already treated with 2­10 prior therapeutic lines (but still naïve for NNRTI), or in p on salvage regimens (but still naïve for NNRTI), we did not observe any significant increase of liver toxicity in the nevirapine group, on the ground of the two main variables considered (females vs. male gender, and CD4+ count above vs. below 250 cells/µL). Pregnant women were excluded from our study, since efavirenz is contraindicated under this circumstance. Conclusions: Nevirapine-containing regimens are more hepatotoxic than those based on efavirens, and a key role is played by concurrent liver-biliary disorders. No adjunctive risks related to the female sex and a rather elevated CD4+ lymphocyte count (>250 cells/µL), have been found.

(p) already HIV-positive since 10 years, with a complete post-surgery disease-free follow-up of 9 years, is described. Case report: An unexpected weight loss prompted an esophagogastroduodenoscopy (EGDS), which allowed an early diagnosis of an antral ulcerative gastric adenocarcinoma, which was immediately submitted to a subtotal distal gastrectomy-omentectomy. Abdominal imaging excluded secondary lesions, and biopsy specimens did not show neoplastic infiltrations. The prosecution of an appropriate HAART allowed the maintenance of an undetectable viral load and a significant gain of CD4+ count (>600 cells/µL since the year 2000). During subsequent years, our p underwent several EGDS exams, confirming the cure. Discussion: HIV-associated neoplasms may involve organs-sites which are not included in the "old" 1993 list of AIDS-defining diseases, and may have an aggressive behavior, also presenting at a lower mean age. A literature search allowed us to report only 9 cases of HIV-associated gastric cancer. Seven occurred in the pre-HAART era, and were burdened by a rapid disease evolution, while only two p were reported in the HAART era and obtained surgical cure, but detailed data regarding complications, sequelae, and survival are not given. Notably, even 4 published cases of 9 came from Japan, and an early disease development represented the rule (37­50 years of age at diagnosis). Only 2 p of 10 (including ours) were diagnosed in a proportionally more favorable condition of early gastric cancer, which benefited from elective, radical surgery, while all p reported in the pre-HAART era had a rapidly lethal course. Due to its relevant differential diagnosis implications with many other HIV-related gastrointestinal disturbances due to functional-organic diseases, and the possibility to maintain an adequate life expectancy when diagnosis and treatment are not delayed, also gastric cancer should be carefully taken into consideration by all clinicians dealing with HIV disease, due also to the expanding role of non-directly-AIDS-related tumors, which are emerging in the last decade, just after the availability of HAART. ISE.300 Cost-Effectiveness Issues of Diagnosis and Prevention of Osteopenia-Osteoporosis in the Setting of Haart-Treated HIV Disease R. Manfredi, L. Calza. Infectious Diseases, University of Bologna, Bologna, Italy Background: Osteopenia-osteoporosis (O) are emerging untoward effects of HIV infection, especially when treated with HAART. The pathogenesis is multifactorial, involving all classes of anti-HIV drugs, although protease inhibitor (PI) use, overall HAART duration, and the male sex, seem related to a greater risk. Methods and Results: In a preliminary DEXA screening assessing lumbar spine and femoral head of 100 out of 1000 single-centre patients (p), the frequency of osteopenia-osteoporosis (based on lumbar Tscore) was around 48%. An increased risk was found in p treated with PI vs p receiving NNRTI or triple NRTI. Discussion: Prospective studies of extensive p samples are needed, to elucidate the epidemiology, pathogenesis, clinical issues, and evolution of HIV-associated bone metabolism abnormalities. When planning strategies for their early diagnosis, prevention, and management, also cost-effectiveness issues should be taken into consideration, since no pharmacoeconomic data still exist in this setting. Although severe consequences (pathological fractures, prosthetic implants), are expected to be infrequent, their consequences in terms of length-intensity of hospitalization, related costs, and especially consequences on the patient's quality of life, play a notable role. Anyway, the most reliable diagnostic procedure (DEXA) has affordable costs (around Eur 43.40 for a scan which also offers a body composition assessment), as well as the firstline drugs for osteopenia, e.g. supplementation with calcium (Eur 6/month), and vitamin D (Eur 7/month). These costs cannot be compared with the standards costs of an asymptomatic HAART-treated p (Eur 471 to 774/month), and the immunological, virological, laboratory, and clinical controls made at least quarterly in these p. Conclusions: Like postmenopausal O, also HIV disease should be investigated from multiple cost-effectiveness points of view, to establish which p are the preferred, early candidates for a DEXA screening, when this examination is more useful during HIV disease course-therapy, when the exam should be repeated, and when-how to intervene pharmacologically, to prevent serious and potentially invalidating complications.

ISE.298 Hepatotoxicity of nevirapine versus efavirenz. ISE.299 HIV-Associated Early Gastric Adenocarcinoma Followed During Nine Years. An Exceedingly Rare Case Report, and Literature Review R. Manfredi, S. Sabbatani, G. Fasulo. Infectious Diseases, University of Bologna, Bologna, Italy Background: A rare case report of HIV-associated gastric adenocarcinoma surgically treated in the year 1998 in a 37-year-old male patient

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ISE.301 The Phenomenon of 'AIDS Presenters'. Opportunistic Infections Associated to a Late, First Diagnosis of Aids, After a Decade of HAART Availability R. Manfredi, L. Calza. Infectious Diseases, University of Bologna, Bologna, Italy Background: Notwithstanding the availability of HAART, AIDS notifications continue to occur, with increasing prevalence for patients (p) who missed-neglected their condition. Patients and Methods: All cases of AIDS notified since the year 2001 were compared with those found in the decade preceding HAART availability (1986­1995). Results: Compared with the pre-HAART era, a significant drop of frequency of overall AIDS cases occurred: from a mean 58.3±11.2 patients-year observed in the decade 1986­1995, to 14.9±6.2 patientsyear during years 2001­2006 (p<.001), together with an increased mean age (p<.002), female gender (p<.01), sexual vs i.v. transmission (p<.001), and proportion of immigrant vs resident p (p<.03). In the HAART era, the most evident drop of frequency interested opportunistic diseases linked to a CD4 count below 50­100 cells/µL, while a proportional rise of tuberculosis, pneumonia, lymphomas, and other neoplasms was observed. The frequency of both Candida esophagitis and Pneumocystis carinii pneumonia remained stable, as the first two AIDSrelated conditions. After HAART availability, the following diagnoses were neurotoxoplasmosis, wasting syndrome, AIDS-dementia complex, and non-Hodgkin's lymphomas. P with multiple AIDS-defining diseases, and also AIDS diagnoses made at death, even showed a paradoxically increased frequency and absolute number during the HAART era vs the prior decade (p<.001 and p<.02), while no difference was found as to HIV-associated immunodeficiency. Surprisingly, an underlying anti-HIV therapy was a more common event until 1995, vs p observed in the HAART era (p<.001), since during recent years AIDS notification tends to be increasingly associated with the first diagnosis of HIV infection. Discussion: When facing p with opportunism, clinicians should maintain an elevated suspect for an advanced (but missed-untreated) HIV disease. A continued attention will help a more rapid recognition and an appropriate management of p who could not take benefit from HAART, since they remained unaware of their disease, or refused controls and treatment.

results), and a substantially stable disease in the remaining 9 p, in absence of spontaneous regression, even when the initial HAART was modified. Discussion: Subcutaneous lipomas have not been reported with increased frequency during HIV infection, including the HAART era. The frequent association of lipomatosis with other clinical-metabolic disturbances related to HAART, should deserve further epidemiological and pathogenetic studies, to better investigate their eventual, mutual relationship, and to identify and plan eventual prevention strategies.

ISE.303 HIV and HCV Co-Infection and Immune Recovery During HAART R. Manfredi. Infectious Diseases, University of Bologna, Bologna, Italy Background: A recent metanalysis conducted by M.F. Miller [CID 2005;41:713] claimed a significantly reduced immune recovery in HCVHIV patients (p) undergoing HAART, as measured by a simple mean absolute CD4+ lymphocyte difference. In our opinion, the study design, data analysis, statistics, and main clinical inferences are seriously influenced by multiple drawbacks. Methods and Results: Of the only eight trials extracted from a database of 152 (5.3%), only five are prospective in structure, and p enrollment covered a very long 1992­2002 period, with only 4/8 studies limited to naïve p. The statistical assessments appear forced to obtain greater p samples, but failed to report the cumulative mean CD4+ levels±SD or ±SE of the two p groups of 3,317 and 1,579 p respectively, while a broad dissertation exists about the mean 30 CD4+ cell decrease (with more detail, from 151.6 versus 113.8 cells/µL), without considering that these figures cannot prescind from (ungiven) baseline CD4+ counts. The sample size strongly influences statistical comparisons, and even minimal differences may be magnified, by artificially increasing study samples. When doubling 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, etc.), is influenced by multiple variables: circannual-circadian courses, gender, ethnicity, transitory viral-inflammatory processes, HCV genotype, and assay limitations, which make a 5% difference absolutely 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 (but not clinically) relevant. Finally, a difference limited to around 30 (C.I.23.5-43.4) CD4+ cells/µL, cannot play whatsoever role on hard end-points of HAART treatment. Discussion: Relevant questions should be addressed by "prospective cohort studies...that account for...degree of liver disease, duration of HIV-HCV infection, baseline HIV load, and different treatment regimens", as recognized by Miller itself. The Authors failed to add significantly to the knowledge of the multifactorial HIV-HCV-HAART interferences. Indeed, this study overestimates a minor laboratory figure, enforced by a misleading and forced use of statistical assessments. ISE.304 Severe, Mixed Lipodystrophy in a Young Boy with Congenital HIV Infection Treated for 14 Consecutive Years with HAART R. Manfredi, L. Calza. Infectious Diseases, University of Bologna, Bologna, Italy Background: 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 morphologic changes are expected to be particularly devastating in development ages. Case Report: Our p was born 16 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 four years ago, a bilateral symmetric lipomastia appeared, associated in the past two years with a bilateral, dorsal lipid accumulation (both confirmed by ultra-

ISE.302 A Prospective Surveillance of Lipomatosis in Patients Treated with HAART, and Its Pathogenetic Correlates R. Manfredi, L. Calza. Infectious Diseases, University of Bologna, Bologna, Italy Background: As a consequence of HAART availability, the lipodystrophy syndrome and a broad spectrum of metabolic abnormalities progressively emerged in the last decade (1997­2007). Localized fat accumulation may occur as visceral adipositiy, increased breast size, gynecomastia, lipomastia, and the so-called buffalo hump, although very limited reports are to date available on the role of lipomatosis during HIV infection. Patients and Methods: Nineteen patients (p) out of >1,000 treated with HAART as of end of December, 2007 (>1.5%) (15 males and four females, aged 36­58 years), experienced multiple ultrasonographyconfirmed subcutaneous lipomas (three to over 20 lesions), predominantly involving the trunk and upper and lower limbs, usually associated with local discomfort. Results: Among involved p, the duration of HIV seropositivity at lipomatosis onset varied between 32­116 months, and no p had developed AIDS.Our 19 p experienced 5­14 different anti-HIV therapeutic lines:almost all available protease inhibitors (PI) and nucleoside analogues had been used previously or during the occurrence of lipomatosis, while a NNRTI was used by in five p only. All p were given a PI-based HAART since 16­74 (mean 28.2±13.9) months. While the virological-immunological situation of HIV disease remained favorable, a broad spectrum of concurrent lipodistrophy syndrome- and dysmetabolic-related alterations were found. In detail, an evident lipoatrophy was present in 15 p of 19, associated with central adiposity in 12 p. Hypertriglyceridemia, hypercholesterolemia, and hyperglycemia were detected at in 15, 10, and three p, respectively. The subsequent followup (8­70 months), was characterized by the occurrence of further lesions in 10 p (with five p undergoing plastic surgery with satisfactory

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sonography), which were responsible for severe psychological disturbances. Hormonal-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, HDLand LDL-cholesterolemia, apolipoproteins, C-peptide, insulin, fruttosamin, glycosilated hemoglobin, lactate, and bicarbonate). Discussion: While in adult p the prolonged course of HIV infection and HAART usually induces a combined dysmetabolic sindrome and lipodystrophy, 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 around 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 short-mid term the particular, focal lipoaccumulation features of our young p. A surgical option (liposuction), is currently under evaluation. ISE.305 Fusion Inhibitors and Salvage Antiretroviral Therapy. A Four-Year Experience with Enfuvirtide R. Manfredi, L. Calza. Infectious Diseases, University of Bologna, Bologna, Italy Background: The need of rescue antiretroviral regimens is progressively increasing. Patients and Methods: An open-label study featured the administration of the fusion inhibitor enfuvirtide (T-20) as a part of a salvage anti-HIV therapy in a cohort of hardly pretreated and multiresistant patients (p) with advanced HIV disease, followed until three consecutive years, is presented. Results: Efficacy and safety of enfuvirtide adjunct to an optimized background were assessed monthly in 11 severely compromised p, with a baseline viremia ranging from 64000 to over 500,000 HIV-RNA copies/mL, and a CD4+ lymphocyte count ranging from 11 and 213 cells/µL. At the time of enfuvirtide introduction, the background HAART was modified according to both genotypic-virtual phenotypic resistance assays, but only 6 of 11 p could rely on at least one in vitro effective drug. A rapid and significant drop of viremia (at least one Log10 HIVRNA copies/mL), associated with a 30­250% increase of CD4+ cell count vs baseline was observed in all p, although the only 5 p who could rely on an optimized background had a sustained response (12-36 months). In 7 p, a surprising dissociation between a favorable virological response and a progressive loss of CD4+ cells was observed. Although frequent, local injection site adverse effects never represented the major cause of treatment interruption. Discussion: Expectations and concerns on the use of enfuvirtide as a novel anti-HIV compound in daily practice are still debated, since no specific recommendations have been produced, and enfuvirtide appears significantly more effective when administered concurrently with 1­2 other active antiretrovirals, although the reported experiences often included p on late rescue therapies. The management of the frequent site injection reactions represents an adjunctive concern for these multi-problematic HIV-infected p ISE.306 A Pilot Initiative on Adherence and Psychosocial Support Through Community and Peer-Based Networks in Kagera Region, Tanzania T.A. Twalipo, B.T. Kasambla. International Center for HIV/AIDS Care and Treatment Programme (ICAP), Dar Es Salaam, United Republic of Tanzania Background: Adherence to antiretroviral therapy (ART) is critical to the success of care and treatment initiatives. Yet obstacles that preclude strong adherence include--stigma and discrimination, lack of understanding, use of alternative remedies and poor nutrition. A pilot initiative in Kagera region was designed to help ensure ART adherence of >95% via community-based partnerships in providing psychosocial and adherence support to PLHAs. Method: In September 2006, an assessment and mapping of existing community resources in Kagera region was completed and linkage of some of these NGOs with facilities was established. Data collection tools

were created, including the questionnaire and home visits forms. Qualitative Data was collected through in-depth interviews and Focus Group discussions with key stakeholders at CTCs and community influential. Results: A total of 118 Community Based Care Workers (CBCWs) were trained as peer educators (PE), for four days in February 2007, amongst whom 80% are PLHAs. CBCWs conduct home visits to patients, link patients with various social support services in the community, and defaulters tracing. At facilty level CBCWs assist in non clinical activities to enhance a smooth flow of services, e.g. accompanying clients to and from various units in the facility i.e.VCT, laboratory, CTC and etc. By October, 2007, 161 out of 582 defaulters were traced and 101 among them were re-engaged into care. Challenges to implementation include inadequate knowledge of ART adherence by HCWs, increasing work load, lead to poor counseling sessions. Stigma and Unfriendly geographical settings pose difficulties in tracing Loss to Follow Up (LTFU), especially pregnant mothers and children in hard to reach areas. Conclusions: Effective interventions through psychosocial support networks encompassing families, community and health facility levels can help ensure ART adherence and decrease the number of defaulters and LTFU. ISE.307 Effects of Immigration on the Pattern of HIV Infection in Dublin, Ireland: A Dublin HIV Cohort Study W.L. Chung1, A.M. Shaban1, P. Coakley1, M.B. Codd2, S.J. McConkey1. 1 Royal College of Surgeons in Ireland, Dublin, Ireland, 2School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland Background: Ireland has experienced significant immigration in recent years. This phenomenon may affect the epidemiology of HIV infection. Patterns of HIV infection have been described worldwide, and Ireland is uniquely placed to study this. The objective of our study is to record, if any, differences of the pattern of HIV infection between Irish-born and immigrant patient groups. Methods: For volunteers at Beaumont Hospital who agreed to participate in the Dublin HIV Cohort Study (ethics reviewed, Jan 2007), we obtained demographic and medical data through patient interviews and chart review. 125 patients were included. Results: 62 (51%) patients were Irish-born. Mean age was 37 years. 77 had at least one documented reason for testing. Of these, the Irish-born predominated in the groups that sought testing due to symptoms of HIV, perceived risky sexual behaviour and drug use, while detection through antenatal screening was almost exclusive to the migrant group. 70% of the Irish-born patients were male; this was 30% in the migrant group (p < 0.001). The Irish-born patients had a median duration of 7.1 years from time of diagnosis to participation in the study, compared with 4.4 years among the migrants (p < 0.05). 18% of the Irish-born patients were men who have sex with men (MSMs) while 6% of the migrant patients were intravenous drug users (p > 0.05). 39% of Irish-born patients were heterosexual, compared with 58% in the migrant group. Conclusions: These findings show a significant difference in various aspects of the HIV epidemic between Irish-born and migrant groups and allow for comparison with similar data in other health-care settings. These results could be used to inform public health approaches and to focus interventions that prevent spread of HIV infection and provide treatment services to those who need it. ISE.308 How HIV Could be Eradicated in Rural and Urban Areas J.Y. Gatete. Youth Innovation Forum, Bujumbura, Burundi Here in Burundi after a bic crisis, we observed a big number of affected persons especially women and young people in rural areas, now many initiatives are being by public and private and NGO corps to assist in that primordial area of the country. But because of poverty, hunger, lack of education and support, we are under a big task where everyone is called to assist that people and government to give helpful options and policies to help in that health area. When not coming there it will be the all people which will be puted at struggle. New ways now trying to be implemented by our organizations are to use new methods of ICT to connect local people and underserved people to have access to informations, knowledge and connectivity, that will help so much even to affected persons, sharing also their ideas. Then we still call all the entities to arrive and support without lying also to finance such things which bring conflicts and which increase the HIV epidemy.

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ISE.309 Could We Hope Support from Public and Private Institutions to Eradicate HIV/AIDS? J.Y. Gatete. Youth Innovation Forum, Bujumbura, Burundi Burundi's teachers are calling for more HIV/AIDS education in schools, to ensure that older primary school pupils and secondary school students, many of whom are sexually active, are properly equipped with the facts about the pandemic. At their discretion, teachers could include snippets about HIV in lessons for older children, but there were no formal classes in the subject. "If we come across a reading text during a French class dealing with HIV/AIDS, then we talk about it...a reading text like 'symptoms of diseases' or 'how to prevent HIV infection'," said Jean Michael Hassan, a primary school teacher at Kabondo Primary School in the Burundian capital, Bujumbura. "In this way we bring the children to talk about sexually transmittable diseases, including HIV, but I cannot get time to teach HIV/AIDS separately." HIV/AIDS information in secondary schools is given as part of civic education. Richard Ngendakuriyo, principal of Bujumbura's Mutanga Secondary School, said teenagers were more interested in sexuality and usually expressed a specific interest in learning about HIV. The ministry of education also has a peer education system, in which some children in state schools are taught about HIV and then encouraged to hold sessions with their classmates, fostering open discussion about sexuality and HIV/AIDS. Nevertheless, Ngendakuriyo said there was an urgent need to find a firm and formal place for education about HIV and responsible sexuality in the secondary school curriculum. "So far, in the first term of 2008, two pupils have been found to be pregnant and two others have abandoned school, probably for the same reasons." Then with that, our organization try to lie and push public and private entities to work and to bring together their efforts to support campaign of HIV/AIDS countrywide so that we could arrive to a succesful achievement and safety of community. We also see an urgency to collaborate with national, regional and international institutions to organize many workshops and try to give a consideration in working in rural areas at underserved and unconnected populations so to use new methods and ICT in education of HIV and AIDS networks.That will be a big task in this year. Now we are trying to collect all Burundian medicines to bring their effort in researching HIV. HIV/AIDS is a task of everyone, every entity and every government to protect its population. ISE.310 Evaluation of Beliefs and Behaviors of Teenage Girls About AIDS F. Fayyazjahani. ZDMS, Zahedan, Iran (Islamic Republic of) Background: The number of people living with HIV continues to rise, despite the fact that effective prevention strategies exist. Information alone is not enough to produce sustained behavior change. Our purpose investigate behavior among teenage girls that use them for next programs. Method: This is a kind of qualitative research, done on the basis of interviews of teenage girls in Urmia, interviews were designed semiorganized to study complex aspects of interviewees' talks. Results: Most of the interviewees have mentioned television, teachers and mothers as their source of information, less than 10% have mentioned sexual behaviors as the main reason for acquiring AIDS. Behaviorist prevention has been mentioned as a prophylactic in less than 10% of the interviews. In some of the interviews, prevention by vaccination or definite treatment have been mentioned. Less than 50% have suggested free distribution of syringe. In none of the interviews condom has not been suggested as a means of prevention from AIDS. Their response to the question of their reaction in facing the AIDS, persons are as follow: I escape, become shocked, would be careful, go away, don't talk. A kind of stress have been noticed in their faces in answering this question. 100% disagree with marrying the addicted person and they were more eager to have tests before marriage. Discussion: Results were showed beliefs and common behaviors among teenagers should be changed and for changing them, life skilledbased-education and programs should be taken teenagers to reduce the number of AIDS. Key Words: AIDS, beliefs, behaviors, teenage girls ISE.311 Modifying HIV Risk Behavior Among Students in University of Lagos, Nigeria F. Durueke. Health Matters Incorporated, Lagos, Nigeria

Background: The HIV prevalence rate in the country is estimated to be 4.4% with the country bearing about 20% of the African burden on HIV/AIDS. It has been reported that 60% of the country HIV positive population constitute of young people between the ages of 15­39. The promotion of HIV prevention among university students will indeed address the need of young people at large as the students are expected to disseminate the knowledge acquired to family members, peers and general public. HIV prevention activities were carried out in university of Lagos using a mobile clinic with support from AIDS Prevention Initiatives Nigeria (APIN) and National Action Committee on AIDS (NACA) Objective: ­ To equip the students in the target university with information on HIV/AIDS ­ To provide HIV voluntary counseling and testing for the students in the target universities using the mobile clinic ­ To promote behaviour change in the area of HIV-related risk behaviour among the students Methods: The strategies adopted included: ­ Mobilization/Sensitization of the university community ­ Distribution of IECs with appropriate information on HIV/AIDS. ­ Musical performance by upcoming musicians ­ Mobile HIV voluntary counseling and testing using a mobile clinic accompanied with pre- test and post-test counseling. ­ Rapid assessment questionnaires were administered to assess students HIV/AIDS knowledge, risk perception and attitude Results: ­ High level of HIV awareness among the students. ­ Students' willingness to know their HIV sero- status was high but very few knew where to access VCT. ­ Detailed analysis of the questionnaires would be presented. Conclusion: University centered HIV prevention intervention is a vital step in promoting HIV prevention among the young people, since the knowledge acquired by the students will be disseminated to family members, peers and the general public. ? ISE.313 Application of Serology, Biology and Molecular Methods in Diagnosis of Chicken Toxoplasmosis B. Esmaeilzadeh1, M.H. Motazedian2, G.H.R. Hatam2, M. Kalantari2, F. Akrami Mohajeri1, Q. Asgari2. 1Rafsanjan University of Medical Sciences, Rafsanjan, Iran (Islamic Republic of), 2Shiraz University of Medical Sciences, Shiraz, Iran (Islamic Republic of) Background: Toxoplasmosis is an important zoonotic disease with worldwide distribution. Sixteen to forty percent of Central Americans and 50­80% of Europeans are infected. Congenital infection, AIDS and infection in individuals with immunodeficiency well signify the importance of the disease. Since eating insufficiently cooked or raw chicken is one of the routs of transmission of this disease, and rate of infection among local chickens was estimated more than 30% with IFAT test, the present study was undertaken to evaluate IFAT, using molecular and biological Methods. Methods: First, 231 chickens from different areas of Shiraz were randomly selected, and among them, those with + titer by IFAT method were picked as infected. Samples from heart, brain and liver of the infected chickens were taken, some parts were examined by PCR and the rest were used to make suspension with acid pepsin method. Then 1ml of the suspension was injected into the peritoneum of 192 healthy Balb/c mice. All of dead mice and 50% of live mice were randomly dissected. Smears were prepared from liver, brain and peritoneum then stained with Giemsa and checked for parasite. PCR was performed on the samples. The rest of infected mice were fed to cats. Results: Of 231 tested chickens, 58 (24.5%) had anti-toxoplasma antibody and 29 had + titers were examined with biological and molecular methods. PCR performed on the samples take from these chickens revealed the rate of infection to be 84.4% in liver, 81.2% in brain and 50% in heart. PCR results on infected mice showed an overall 82.25% positive samples with the following distribution: 82.1% in heart and liver, 75% in brain, and 65.7% in peritoneum. With parasitological methods there were 46.9% positive samples from liver, 28.1% from brain and 25% from peritoneum. Infecting the 7 cats, resulted in only one documented (oocyst passing, infection). Conclusion: PCR techniques have sensitivity (90%) and specificity (100%) in compare to serological tests so it could be used as an useful test for evaluation of food quality.

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ISE.314 HIV Cervicovaginal Shedding During the Menstrual Cycle in Seropositive Women Under Care at a Brazilian Center C. Lima1, W. Kleine2, I. Linhares1. 1School of Medicine, University of Sao Paulo, Sao Paulo, Brazil, 2Sao Paulo ProBlood Foundation,, Sao Paulo, Brazil The sexual route is the main means of HIV transmission. With the increasing numbers of HIV-infected women, the investigation of biological features of HIV infection in the genital tract has become more important. To evaluate HIV genital shedding during the menstrual cycle, we collected cervicovaginal lavages (CVL) from 17 women, assisted at an HIV outpatient clinic in Sao Paulo, Brazil, in different hormonal phases, during 2 cycles. HIV-RNA and proviral DNA shedding were quantified using RT-PCR and TaqMan real-time PCR assays, respectively. In addition, patients were screened for genital coinfections and had their HIV plasma viral loads and CD4+ cell counts assessed. Cell-free RNA and proviral DNA shedding were found in 18.8% and 31.3% of women. All patients who shed HIV-RNA were also shown to present detectable proviral DNA in their CVL, including one woman with undetectable HIV plasma viral load. No significant difference in viral shedding was seen among menstrual cycle phases. Six patients who exhibited genital coinfections prior to admission to the study, had their HIV shedding compared at time of coinfection and after its resolution. In two of them, proviral DNA shedding was higher at time of coinfection caused by Streptococcus sp. and Ureaplasma sp. No cell-free HIV-RNA shedding was detected in coinfected patients. Our results may contribute to the understanding of HIV sexual infectivity from women and emphasize the need for adherence to protected sexual practices in order to avoid HIV transmission. ISE.315 Histoplasmosis in HIV-Observations From Eastern India B. Saha1, S. Mallik1, D.K. Neogi1, S. Basak1, S. Biswas2. 1Calcutta School of Tropical Medicine, Kolkata, India, 2Midnapur Medical College, Midnapur, India Background: Histoplasmosis is an endemic fungal infection in Eastern India. HIV disease is reported to a risk factor for histoplasmosis. With scaling up of HIV epidemic in Eastern India, authors planned to study the clinical presentations, diagnostic modality and outcome of treatment of Histoplasmosis in HIV infected persons. Methods: After excluding more common diagnoses, HIV infected patients with PUO, mucocutaneous lesions, lymphadenopathy, hepatosplenomegaly were evaluated for possibility of Histoplasmosis. Once diagnosed, treatment comprised of Amphotericin B followed by Itraconazole/Itraconazole. HAART was added when patient was stable. Results: During 2004 to 2007, Histoplasmosis was diagnosed in 14 out of 4178 HIV infected persons (0.335 %). Age range: 21­30 years-4, 31­40-8, 41­50-1, >51-1. 13 were male, 1 female. Prolonged pyrexia and weight loss seen in 13 each, 5 had cough, 4 pain abdomen. 9 had skin and 5 mucosal lesions. 9 had lymphadenopathy, 5 hepatomegaly, 7 hepatosplenomegaly. 4 had oral candidiasis, 2 extra pulmonary TB. Chest X-Ray normal in 5, patchy infiltrate, reticulo-nodular shadow & hilar/mediastinal lymphadenopathy in 4,2 and 3 respectively. USG abdomen showed lymhadenopathy in 4, ascites in 2 & adrenal SOL in 1. Diagnosis was obtained by skin/lymph node/mucosal biopsy in 8, 5 and 1 patients respectively. Bone marrow culture was attempted in all cases, positive in 11. Out of available records of 12, CD4 was <50 cells/µl in 7, 51­100 in 2, 101­150 in 2, 151­200 in 1.10 patients are continuing treatment, 3 died,1 lost to follow up. Conclusion: ­ Histoplasmosis is not uncommon among middle aged HIV-infected persons presenting with PUO and weight loss and having mucocutaneous lesions/ lymphadenopathy/ hepatomegaly/ hepatosplenomegaly. ­ Bone marrow aspiration and culture give diagnosis in most of the cases. ­ Skin/lymph node/mucosal biopsy are other options. ­ CD4 count is always below 200. ­ Treatment is successful in most of the cases ISE.316 Molecular Epidemiology of HIV from Musina, South Africa: Preliminary Analysis of the vif Gene T.M. Masebe, B.C. Iweriebor, P.O. Bessong. AIDS Virus Research Laboratory, Department of Microbiology, University of Venda, Thohoyandou, South Africa

Background: Periodic monitoring of the genetic landscape of HIV is important for therapeutic purposes. The objective of this study was to describe the HIV genetic variability in Musina for the first time. Methods: Whole blood was obtained from 26 drug naive individuals in EDTA vacutainer tubes. RNA was isolated with the Qiagen QiAmp Viral RNA Mini kit. Viral DNA encompassing the vif, vpr, and the vpu regions of approximately 1.3 kbp was generated by reverse transcriptase PCR (RT-PCR), followed by a nested reaction. Oligonucleotides 5'-GAC AGC AGT ACA ATG GCA G-3'(forward) and 5'-GTA CCC CAT AAA TAG ACT GTG ACC-3' (reverse) were used in the RT-PCR step. The nested reaction made use of 5'-GGG GTA CAG TGC AGG GGA AAG-3' (forward) and 5'-GGG TCT GTG GGT ACA CAG GC-3' (reverse). Generated nested products were sequenced by the dideoxy method using the nested primers. Derived nucleotide sequences of the vif region were edited with the SeqMan Pro software. Reliably edited sequences were aligned with reference HIV-1 nucleotide sequences from the Genbank using ClustalX and a phylogenetic tree generated by neighbour-joining method. Results: Nested PCR products were obtained from 21 of 26 samples (81%). Reliably edited vif nucleotide sequences were obtained for 18 of the 21 viral DNA (85.7%). phylogenetically, the vif nucleotide sequences clustered with reference HIV-1 subtype C sequences, and did not form a separate cluster from previous Southern African HIV vif sequences. Conclusion: This is the first report of sequence analysis of HIV-1 based on the vif region from Musina, a border town with a high HIV prevalence. The result indicates that HIV-1 subtype C may be the predominant variant among the heterogenous population of Musina. Examination of a larger number of individuals and other gene regions will confirm this finding. ISE.317 Knowledge, Attitudes and Practices Towards HIV/AIDS of the Community Members Attending Mutolere Hospital, Kisoro, Uganda J.K. Kabami. Uganda Research Institute, Mbarara, Uganda Two thirds of the HIV infections in the world occur in sub-Saharan Africa and young people are the most severely affected part of the population. Uganda is one of the sub-Saharan African countries and a developing country which is faced with a strong wave of HIV/AIDS. The prevalence rate of HIV/AIDS in Uganda is 6.1% and the medical/nursing services and other health services are already inadequate for the existing needs (UNAIDS, June 2000.) The study was conducted under the community health department, Mutolere Hospital, Kisoro district in Uganda to assess the knowledge, attitudes and practices of the community towards HIV/AIDS. Data was obtained by use of structured questionnaires for both individual interviews and focus group discussions. The study was descriptive and cross-sectional in nature and random sampling method was used to select the participants. The age range was 19­50 years with 80% females and 20% males. The prevalence rate was found to be 24% considering HIV statistics from 2001­2003. All the participants (100%) knew that HIV/AIDS is sexually transmitted but were not sure of the other modes of transmission. More than 52% of the participants did not know about vertical transmission of HIV/AIDS and only 30% of the participants had knowledge about safe sex. The study also revealed that there is a lot of stigmatization and discrimination of people living with HIV/AIDS in the community. There is still a lot of silence about HIV/AIDS as evidenced by only 6% of the participants that had ever gone for an HIV test and 94% that had never tested. In conclusion, the findings provided a deeper assessment and understanding of the knowledge, attitudes and practices of the community towards HIV/AIDS. The findings will be used to design further interventions for prevention of HIV/AIDS in the rural communities. ISE.318 Who Do HIV Infected Persons Disclose Their Positive Status to and Why? M.A. Al-Mansur1, C. Mukan1, J. Idoko2, P. Kanki3. 1APIN Clinic, Jos, Nigeria, 2AIDS Prevention Initiative Nigeria, Jos, Nigeria, 3Harvard School of Public Health, Boston, MA, USA Background: Early disclosure of HIV positive status to sexual partners and family members will promote early introduction of treatment, care and support and prevention interventions for HIV positive individuals.

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This study was designed to identify the time at which HIV infected individuals disclosed their status to someone and whom they chose to disclose to. Methods: As part of a larger pool of HIV infected persons attending a HIV clinic in Jos, Nigeria, anonymous surveys were completed by 165 participants who had just started taking antiretroviral drugs. 71% were females, 64% married, 72% were between 25-40 years, 56% had tertiary education. Results: 85% of the participants had disclosed their status to someone, 8% had not yet disclosed their status to anyone. Of the number that had disclosed their status, 28% did so after one year of testing positive and 59% of them disclosed to family members only, 15% disclosed to spouse/partner, 10% were indecisive. Regarding reasons for disclosure, 92% felt insecure disclosing their statuses to their partner, 4% were afraid of being discriminated against. Conclusions: This survey shows that educational background did not influence the decision for disclosure of HIV status. Also, the age interval of the participants showed that they were old enough to make informed decisions. A greater number of the participants were married females who expressed fear of insecurity in their marriage, should they have disclosed their status to their partners. Couple HIV counseling and testing for people newly diagnosed with HIV infection will serve as a good strategy for discussing treatment, care and psychosocial support to couples. It also serves as a good avenue for implementing targeted prevention Interventions e.g. safer sex practice. ISE.319 Endoscopical Examination in Human Papillomavirus Infection at HIV- Positive Patient Using Highly Antiretroviral Therapy: Case Report Z. Sopova, M.Stevanovic, Z.Milenkovic, M.Bosilkovski, Lj.Krteva, K.Spasovska. Clinic for Infectious Diseases and Febrile Conditions, Skopje, Former Yugoslav Republic of Macedonia Context: Highly active antiretroviral therapy (HAART) has turned human immunodeficiency virus (HIV) infection into a chronic condition, and this has led to increased incidence of anal dysplasia among HIVpositive patients. Routine anal evaluation and endoscopical examination it is considered to be a valid method in diagnosing of sub-clinical human papillomavirus (HPV) infection, all with aim in detection of anal intraephythelial neoplasya (AIN), oftenly seen at these patients. Case Report: A 54-year-old heterosexual man, diagnosed with HIV infection in 2006. Except oral candidiasis other HIV associated symptoms are not detected, abnormalities in laboratory biochemical examinations are not detected, microbiological and immunological examinations made. After five months treatment with HAART at patient's are detected 3­4 perianal condilomas which in the following 3 moths will progress into cauliflower tumorouse formation wreath with dimensions 5,5 x 3,5 cm in the perianal region, covering the anus, painful, indurate, bleeding from time to time, causing pain during the defecation. Conservative treatment is initiated with Podophilin in duration of 3 months, however without improvement. Colonoscopical examination made in the unobstructed anal canal, sessile tumour found in the flexura linelis with dimensions of 0,5 cm. From the histological biopsies made, displasia from light to medium level is stated (in addition of specific HPV infection). After surgical treatment the same histological diagnosis is stated again. After 6 months, this patient still has the same displasia, which is needed to be followed as well as HPV DNA, typisation and given therapy promptly. ISE.320 Clinical Presentation and Risk Behaviors of Patients with Acquired Immunodeficiency Syndrome in Taiwan, 1984­2005 C.H. Yang, Y.F. Huang, H.R. Liu. Centers of Disease Control, Taiwan, Taipei, Taiwan Background: This study aimed to describe the spectrum of AIDSdefining diagnoses (ADD) among HIV-infected persons in Taiwan from 1984 to 2005. Method: Both HIV infection and AIDS have become reportable diseases in Taiwan since 1984. Patients' demographic data, date of HIV and AIDS diagnosis, risk factors, and date of death is mandatory reported. Registered data from Taiwan CDC were reviewed. Results: Among 10,162 reported cases of HIV infection in Taiwan, 2,647 (26.0% developed AIDS and 1,108 (41.9%) of the AIDS cases had died. About 92.8% of cases were males, and the major transmission routes were through men who have sex with men (46.1%), followed by

high-risk heterosexuals contacts (45.3%), injecting drug use accounting for 5.1% only. The ADD as the first presentation of HIV infection in were noted in 1,542 cases (15.0% of total HIV-infected persons), and the proportion declined with time, from 38% in 1994 to 10.6% in 2005. The leading initial ADDs were: PCP 912 (34.5%), esophageal/bronchial candidiasis 556 (21%) and tuberculosis 375 (14.3%). The mean CD4 counts at the time of diagnosis of AIDS, PCP, candidiasis and tuberculosis were 78, 53, 73 and 63 respectively. After introduction of HAART into Taiwan in April 1997, the proportion of AIDS among HIV-infected persons declined from 36% to 25% and the mortality rate also declined from 82.1% to 33.6%. Case number of all forms ADD showed significant decrease except tuberculosis. Among the ADD, cases with lymphoma had highest fatality rate followed by cytomegalovirus and cryptococcus infection. Heterosexuals group had a higher mortality rate and higher incidence of tuberculosis infection as initial ADD. Conclusions: Earlier diagnosis and effective antiretroviral therapy improved the prognosis of AIDS cases in Taiwan. Despite the significant decrease in the ADD, tuberculosis remained the common opportunistic illness in HIV-infected persons in Taiwan. ISE.321 State of Health of Migrants 2007--Mandatory Testing (Hong Kong Report) T.Y. Lai1, E. Fung2. 1St. John's Cathedral, Hong Kong, China, 2St. John's Cathedral HIV Education Centre, Hong Kong, China In November 2006, CARAM Asia (Coordination of Action Research on AIDS and Mobility Asia) and its 16 country partner organizations initiated a regional action research on State of Health of Migrants 2007Mandatory Testing, which aims to consider the law and policy environment pertaining to migrant workers and their rights regarding mandatory health testing for employment purposes. The Hong Kong part of the regional report is focused on the 'health testing' experiences (screening tests for apparent healthy persons) of documented foreign domestic workers from the Philippines and Indonesia, with additional information provided from other stakeholders. Data were collected through Hong Kong Government publications and fieldwork. The report suggested: (a) addressing the health rights of migrant workers through bilateral agreements and MOUs negotiated between origin and destination countries, to include migrant workers' rights with regards to health testing, access to treatment and inclusion under insurance policies; (b) providing proper counseling to migrant workers taking into account gender and cultural differences; (c) informed consent should be obtained from the migrant workers as they are entitled to know the content and items of the health test, and can refuse items unrelated to their work; (d) migrant workers should be allowed to read or receive a copy of the health test report; (e) the elimination of the discriminatory practice of employers who use HIV status as an exclusionary condition for employment, by monitoring private employment agencies and health clinics and ensuring that they do not conduct mandatory HIV testing on migrant workers; (f) migrant workers should be given the opportunities to continue working, and should not be stigmatized and marginalized because of their HIV status; (g) the authorities should publish and distribute general information on health and hygiene to the migrant workers in the language they can understand. ISE.322 Influence of Combination Antiretroviral Therapy (cART) on Methadone Dose and Its Plasma Concentration J. Gasiorowski1, L. Lapinski2, B. Knysz3, M. Biskup1, K. Glowacka2, H. Czarnik-Matusewicz2, B. Szetela1, A. Wiela-Hojenska2, A. Gladysz3, K. Orzechowska-Juzwenko2. 1Department of Infectious Diseases Wroclaw Medical University, Substitution Therapy Daycare Centre, Wroclaw, Poland, 2Department of Clinical Pharmacology Wroclaw Medical University, Wroclaw, Poland, 3Department of Infectious Diseases Wroclaw Medical University, Wroclaw, Poland Background: Opioid dependence results in significant health problems. Major health consequences of intravenous opioid use include HIV, HCV and HBV infections. Methadone is widely prescribed for opioid dependent patients as maintenance treatment (MMT). However MMT is complicated by methadone pharmacokinetic variability in the population. After administration of the same dose, considerable differences in its concentration and pharmacological response are obtained in the patients, e.g. treatment with inductors of methadone metabolism may decrease its concentration and appearance of withdrawal symptoms

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Aim: To investigate the influence of cART on methadone dose requirements and its blood concentration after 2 and 4 months of routine MMT. Material and Methods: The study was carried out in 61 MMT patients21 HIV infected patients on cART and 40 non-HIV infected persons as a control group. Minimum 1 drug used in cART was CYP3A4 inductor (lopinavir/ritonavir, nevirapine or efavirenz). Methadone blood concentration was measured by FPIA (fluoropolarization immunoassay) method. Results: We have not observed a statistically significant influence of cART on methadone dose requirements and its blood concentration after 2 and 4 months of methadone treatment. These results were not dependent on cART type. However the methadone blood concentration in the group of patients treated with cART after fourth month of MMT was smaller that in the control group (243,10±153,23 vs. 371,50±187,44, p=0.07). In both groups the methadone dose and its concentration after 2 and 4 months were not significantly different. Conclusion: A large dose and concentration variability in MMT patients with and without HIV infection were found, what suggests that other factors may influence methadone pharmacokinetics. No change of methadone dose requirements and its concentration during investigated period may suggest lack of influence of used drugs on its own metabolism. Prospective studies in a greater and more homogeneous group treated with the same drugs should be carried out. ISE.323 Antibiotic Resistance Pattern of Diarrheagenic Escherichia Coli and Shigella Strains Isolated from Patients with Acute Diarrhea F. Jafari, M. Hamidian, M. Rezadehbashi, N. Hosseinkhan, S. Salmanzadeh_ahrabi, M. Bolfion, M.R. Zali. Research Center for Gastroenterology and Liver Diseases, Tehran, Iran (Islamic Republic of) Background: Diarrheagenic Escherichia coli and Shigella spp. are most commonly isolated in clinical samples from patients with diarrhea in Iran. The purpose of this study was to determine the prevalence of diarrheagenic E. coli and Shigella and their antimicrobial resistance pattern in patients with acute diarrhea in Tehran. Methods: 1120 stool specimens of patient with acute diarrhea collected from different hospitals in Tehran. The fecal samples were analyzed for diarrheagenic E. coli, Salmonella spp., Campylobacter spp., and Shigella spp. by using specific primers and standard biochemical methods. Shigella isolates were grouped serologically by slide agglutination. Antibiotic susceptibility of all isolates was determined by the disc diffusion method. Results: Of all stool specimens, the etiologic agents was isolated from 564 (50.3%). The enteropathogens isolated included 305 (54%) diarrheagenic E. coli, 157 (27.8%) Shigella spp., 60 (10.6%) Campylobacter spp. and 42 (7.5%) Salmonella spp. The highest isolation rate of enteropathogens was observed in patients less than 5 years of age (97%) and dry seasons (68.6%). The most common isolates of E. coli and Shigella were STEC (34.5%) and S. sonnei (56%), respectively. Among isolates, 57.9% of Shigella spp. and 40.5% of E. coli was resistant to at least 4 different antibiotics. The largest number of antibiotics to which E. coli strains and Shigella spp. were resistant was 9 and 7, respectively. The highest proportion of antibiotic resistance in E. coli strains was observed to trimethoprim-sulfamethoxazole (63.3%), ampicillin (58%) and tetracycline (54.1%). Shigella strains showed high rates of resistance to tetracycline (95%) and trimethoprim-sulfamethoxazole (91.7%). Discussion: This study has revealed high rate of antimicrobial resistance among S. sonnei and STEC isolates. A high proportion of multidrug resistance was observed that would be a matter of concern. The emergence of multiple drug resistance requires continuous monitoring of the resistance patterns in the country and design of comprehensive strategies for antibiotic usage. ISE.324 The Predictive Value of Cerebrospinal Fluid Epstein-Barr Viral Load as a Marker of Primary Central Nervous System Lymphoma in HIV-Infected Persons C. Corcoran1, K. Rebe2, H. van der Plas3, L. Myer4, D.R. Hardie1. 1 National Health Laboratory Service & University of Cape Town, Cape Town, South Africa, 2G.F. Jooste Hospital & University of Cape Town, Cape Town, South Africa, 3Tygerberg Hospital, Cape Town, South Africa, 4 University of Cape Town, Cape Town, South Africa Background: The presence of Epstein-Barr virus (EBV) DNA in cerebrospinal fluid (CSF) has been recommended as a marker of HIV-asso-

ciated primary central system lymphoma (PCNSL). In our setting, EBV DNA is frequently detected in the CSF of HIV-infected patients with miscellaneous neurological diseases and thus its presence in CSF is a poor predictor of PCNSL. Methods: To determine whether quantification of EBV DNA in CSF would improve its diagnostic specificity for PCNSL, EBV viral loads were determined on CSF samples from 55 HIV-infected patients from Cape Town who presented with central nervous system disease. Final diagnoses were made on clinical, radiological, microbiological and pathological data (where biopsied). Results: In 35 patients the CSF EBV viral load was below the detectable limit. None of these patients were diagnosed with PCNSL. Twenty of the 55 patients had detectable EBV DNA in their CSF (median viral load 6120 copies/ml, range 336 to 1 034 000 copies/ml). Two of these patients received a final diagnosis of PCNSL and had CSF EBV viral loads of 1 034 000 copies/ml and 15 460 copies/ml respectively. EBV viral loads were higher in patients with PCNSL compared to patients with other diagnoses (p=0.04). Using a cut-off viral load of 10 000 copies/ml improved the specificity for the diagnosis of PCNSL to 96% from 66% for a qualitative result. The positive predictive value at this cut-off was too significantly better than that of a qualitative result (50% vs. 10%). Conclusion: EBV DNA in the CSF of HIV-infected patients with various neurological diseases was a common finding in our setting. Using a quantitative assay improved the diagnostic specificity, however, the positive predictive value remains too low to be used as an isolated marker to diagnose PCNSL due to the low prevalence of the condition in our patients. ISE.325 Complete Sequence Analysis of Two Reticuloendotheliosis Virus Strains Contaminated in HVT and RE-FPV Vaccine Respectively Q.F. Liu, J.X. Zhao, J.L. Su, J. Pu, G.Z. Zhang, J.H. Liu. Laboratory of Infectious Disease, China Agricultural University, Beijing, China Reticuloendotheliosis virus (REV)an avian oncornavirus, belongs to avian gamma retroviruses, which contaminated commercial vaccine frequently. Reticuloendotheliosis virus infection can result in lymphomas, running disease syndrome, high cull birds and mortality rate, atrophy of lymphoid organs, immunosuppression, proventriculitis, and abnormal feathers and so on. Our lab found two avian commercial vaccines (HVT vaccine, RE-FPV vaccine) contaminated REV in 1999 and 2006 respectively. The two vaccines contaminated with REV resulted in immunosuppression and high mortality (10­80%) in flocks inoculated these vaccines and caused great economic losses to the poultry industry. For studying the biological properties and phylogenetic relationship of the two stains REV contaminated different vaccines in different years, the complete proviral sequence of the two REV isolates (called REV-1999 and REV-2006 respectively) were determined in this paper. Complete sequence analysis indicated the complete proviral sequences of REV1999 and REV-2006 were 8286 nucleotides in length and contained two identical long terminal repeats (LTR), a complete set of genes including gag, gag-pol and env, so both of REV-1999 and REV-2006 were nondefective REV. And the complete proviral sequences of the REV-1999 and REV-2006 was 99.8% identical. Phylogenetic analyses of the nucleotide sequences among REVS suggested the two REV isolates shared closest relationship with the prototype of CSV, REV sequences inserted in fowl poxvirus and marek's disease virus. In agreement with previously reported, the protein-coding genes were relatively conserve, while the LTR was divergent region with various deletions and insertions among REVS. The data represent the first report of complete proviral sequences of REV that contaminated commercial vaccines and the sequence analysis indicated that the REVs contaminated vaccines belong to the prototypes of CSV. ISE.326 Seroprevalence of HBV, HCV and HIV in Patients with -Thalassemia Major in Larestan, Iran M. Rasouli1, A. Daneshmand2, S. Kiany1. 1Immunology DepartmentClinical Microbiology Research Center-Shiraz University of Medical Sciences, Shiraz, Iran (Islamic Republic of), 2Larestan Transfusion Organization, Shiraz, Iran (Islamic Republic of) Background: Transfusion-dependent patients are at risk to acquire various transfusion-transmitted infections due to their need for multiple blood transfusion. Of these infections, hepatitis B, hepatitis C and immunodeficiency virus infections are more important.

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Objectives: This study was conducted to evaluate the rate of seropositivity of mentioned viruses infections among patients with -thalassemia major receiving multiple transfusion in Larestan, southern Iran. Methods: This study was carried out on 134 multitransfused patients with -thalassemia major registered by Larestan Transfusion Organization. HBsAg, HCV Ab and HIV Ab were determined using ELISA method. HIV Ab positive tests were confirmed by western blots. Results: Of total 134 patients included in this study 69 (51.1%) were female and 65 (48.5%) were male. HBsAg and HCV Ab were positive in 3 (2.2%) and 13 (9.7%), respectively. None of 134 patients had HIV Ab positive. There was not any statistical difference between sex and seropositivity of HBV (Chi=0.28, P=0.50) and HCV (Chi=0.03, P=0.85). Discussion: As data showed, HCV infection is the major problem of multitransfused patients with -thalassemia major in the studied region. Therefore, more careful pretransfusion screening of blood for anti-HCV must be applied in the stations of Transfusion Organizations. ISE.327 Assessment of Nutritional Status of Patients with Hepatitis C (HCV) Attended the Institute of Infectologia Emilio Ribas (IIER), from 2003 to 2005 C. Carvalho1, R. Focaccia2. 1Instituto Infectologia Emilio Ribas, São Paulo, Brazil, 2Instituto de Infectologia Emilio Ribas, São Paulo, Brazil Objective: To study the nutritional status of adults carry HCV, attended the clinic of IIER. Materials and Methods: Observational study, cross-sectional descriptive of the nutritional status of patients with HCV. Assessed 165 adults by circumference of the arm, skin fold triciptal, body mass index (BMI) and the arm muscle circumference (CMB). Results: It was observed that 57.6% were male, age> 40 years. BMI: 40.6% eutrophy, 35.2% overweight and 24.2% obese. CMB: 75.8% eutrophy and 24.2% obese. There were significant associations between: a) BMI> 30 kg/m2 with sex (p + 0042), diabetes (p + 0012), hypertension (p = 0001) and CMB (P = 0000); b) CMB> 110% (obesity), dyslipidemia (p = 0058), c) esteatose with gender and age (p <0.05), d) with esteatose viral genotype (p <0.05), e) with fibrosis age, medicine and inflammatory activity (p <0.05). It was the multiple logistic regression model of the response to esteatose. The independent variables were genotype and age, adjusted by gender. In Hosmer and Lemeshow test, p = 0.7418. Conclusion: the nutritional status of the population was within the limits of eutrophy muscle and energy reserves, and is not associated statistically to: degree of hepatic fibrosis, viral genotype, necro inflammatory activity and hepatic steatosis. ISE.328 Assessment of Nutritional Profile of Patients with HIV and Dyslipidemia Attended at the Institute of Ambulatory Infectologia Emilio Ribas C.L. Carvalho, A.Z. Paulo. Instituto de Infectologia Emilio Ribas, São Paulo, Brazil Objective: To identify the nutritional status of individuals with acquired immunodeficiency syndrome--AIDS with dyslipidemia with and without the use of anti-retroviral therapy, as to the weight and body mass treatment in the clinic of the Institute of Infectologia Emilio Ribas. Materials and Methods: Cross sectional observational study, describing the nutritional status of adults, carriers of the Acquired immunodeficiency syndrome--AIDS and to submit dyslipidemia. Assessed 102 patients over 12 months by the arm circumference (CB), skin fold triciptal (PCT), body mass index (BMI) and the arm muscle circumference (CMB). Result: We evaluated 102 patients, where 60% were male. The ages of often were 41 to 50 years (38%) and 31 to 40 years (29%). Diagnosis of nutritional status by BMI: 53.9% overweight eutrophy followed by 42.2% and 3.9% of malnourished. Diagnosis of body fat mass (PCT): 40.2% depletion moderate, eutrophy 18.6%, 15.7% of severe depletion, depletion discrete 15.7% and 9.8% of overweight, body mass protein: (CB) 66, 7% of eutrophy, 19.6% depletion of discrete, 7.8% of overweight and 5.9% of depletion moderate; (CMB) 74.5% of eutrophy, 12.7% depletion of discrete, 11.8 % overweight and 1.0% depletion moderate. Resulted in 97.05% of patients using anti-retroviral therapy. Conclusion: The nutritional status of this population is above the limits of eutrophy, with a higher frequency of overweight, but presents risk of depletion of moderate body mass fat.

ISE.329 Prevalence of HIV Infection Among Women Who Underwent Studying for HIV in Sabin Laboratory, 2006­2007, Brasilia, Brazil S.S. Costa, A.S.G. Cabral, J.A. Vaz, L. Abdalla, A.L. Araujo, F. Balbino, S.F. Fonseca. Sabin Laboratory, Brasilia, Brazil Background: HIV infection is a public health problem worldwide, including in Brazil. In the early years of the HIV epidemia, few women were diagnosed with the disease. Today, women account for more than one quarter of all new HIV/AIDS diagnoses. The "feminization" of AIDS appears to reflect a maturing of the epidemic, suggest the authors of the annual AIDS update prepared by the United Nations, the World Health Organization and the World Bank. Most women are infected with HIV through high-risk heterosexual contact. Objective: Determine the prevalence of HIV infection among women who underwent studying for HIV in Sabin Laboratory between January 2006 and December 2007, city of Brasilia, the national capital. Methods: A retrospective study was conducted with a population of 42,188 blood samples from women between the ages of 20 and 65, who underwent testing for HIV in Sabin Laboratory between January 2006 and December 2007. Detection of HIV antibodies in the serum was obtained using a enzyme immunoassay (MEIA) -Abbott Diagnostics 4th generation and by quimioluminescence - Modular Analitics E170 Roche 4th generation. Western blot was performed on all samples, as a recognized confirmation method for HIV-1 antibody seropositivity (National Program of AIDS - Brazil). Results and Conclusion: 42,188 serum samples were tested. Sixty six patients (0,16%) were positive for HIV antibodies.

Infection Control and Nosocomial Infections

ISE.330 Sepsis Meningococcemia at Eleven-Month-Old Boy with Complications, Necrosis Fingers and Nails in Austria A. Skopljak1, A. Bajraktarevic1, S. Skaljic1, S. Maglajlija1, A. DjurdjevicDjulepa2, Z. Jatic3, L. Sporisevic4, Z. Begic5, H. Haas6. 1Public Health Institution Sarajevo, Sarajevo, Bosnia and Herzegovina, 2General Hospital Sarajevo, Sarajevo, Bosnia and Herzegovina, 3Medical Faculty of Sarajevo, Sarajevo, Bosnia and Herzegovina, 4First medical Aid Sarajevo-Pediatrics Department, Sarajevo, Bosnia and Herzegovina, 5 Pediatrics Clinic, Sarajevo, Bosnia and Herzegovina, 6Krankenhaus Schwarzach in Pongau-Kardinal Schwarzeberg`shes Krankenhaus Abtailung für Kinder und Jungendheilkunde, Schwarzach, Austria Case Report: Showed in Austria, Children Hospital Schwarzach in Pongau, at 11-month-old baby boy with septic complications caused bacteria Neisseria meningitides. One of the most serious complications of childhood meningococcal disease is purpura fulminans which is characterized by widespread intravascular thrombosis and hemorrhagic infarction of skin, digits and limbs. Approximately 16­20% of children with meningococcal disease develop purpura fulminans which may progress to severe skin necrosis requiring grafting or to digital or limb ischemia requiring sometimes amputation. Children with meningococcal disease develop severe skin and muscle necrosis, whereas others have minimal vascular and skin involvement even with profound septic are unclear. Children with sepsis meningococcemia complicated by purpura fulminans have a case fatal rate of 50­60%. ISE.331 Evaluation of Sensivity and Resistance to Antibiotics in Children 2 Months­12 Years with Urinary Tract Infection Who Were Hospitalized in Pediatric Wards in Beheshti Hospital in Kashan in 2004­2007 A. Honarpishe, M. Sharif, H. Afzali, A. Taghavi Ardekani. Kashan University of Medical Sciences, Kashan, Iran (Islamic Republic of) Background and Goals: According to high prevalence of UTI and increasing microbial resistance to antibiotics and serious complications due to inappropriate treatment, we evaluated sensitivity and resistance to antibiotics in children with UTI who were hospitalized in pediatric wards in Beheshti Hospital in Kashan in 2004­2007 in order to make an appropriate decision in empiric antibiotic therapy. Materials and Methods: This study is a descriptive study with existing data. In this study we selected 100 children with diagnosed UTI who were hospitalized in pediatric wards in Beheshti Hospital in Kashan in 1382-85 and information such as symptoms, age, sex, sonographic

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data, type of organism and antibiogram collected from their records and registered in checklist and statistical analysis. Results: In this study we evaluated 100 children with UTI. 87% of these cases were female and 11% were male. The most common symptom in both sexs and all ages was fever (85%). The majority of patients have normal sonography (61%). The most prevalent microorganism causing UTI was Ecoli (85%) and the highest antibiotic sensitivity rate was for third generation of cephalosporins such as ceftriaxone and ceftizoxime (91%). Conclusions: According to this research, the best empiric antibiotic therapy in pediatric UTI are intravenous Ceftriaxone and Ceftizoxime. Key Words: UTI, Antibiotic, sonography, prevalence ISE.332 Prevalence of Vancomycin Resistant Enterococci (VRE) in University Hospital of Kashan, Iran A. Khorshidi, A. Sharif, G. Mossavi. Kashan University of Medical of Science, Kashan, Iran (Islamic Republic of) Background and Objective: A rapid increase in the incidence of infection and colonization with Vancomycin resistant enterococci (VRE) has been reported from America (USA) hospitals from 1989 through 1993 (0.3% to 7.9%), This increase poses several problems, including the lack of available antimicrobial for therapy, since must VRE are also resistant to multiple other drug (amino glycosides, ampicillin) previously used for the treatment of infections due to these organism, considering to inaccessibility of accurate information of incidence of VRE in Kashan, this study was done during (2003­2005). Material and Methods: A descriptive study was performed over 90 positive cultures of hospitalized patients, clinical isolates were from a variety of body site (blood, urine, wound discharge, ascites) that were referred to Central Laboratory of Kashan Hospital University during (2003­2005). The antibiotic resistant pattern of 90 positive cultures was determined by disk diffusion method (Kirby-Bauer), the results and demographic characteristic were registered and presented by descriptive analysis. Results: Research showed the rate of frequency of VRE was 6 (6.8%). From 90 positive culture 13(14.4%) belong to blood, 72(80%) to urine, 3(3.4%) to truchea, 1(1/1%) to wound discharge, resistant pattern to different antibiotics were determined: 52(59%) were resistant to gentamycin, 58(83%) to erythromycin, 55(78.6%) to penicillin, 8(19%) to nitrofurantoein, from 90 positive cultures 15(16.7%) Belong to infectious ward, 4(4.5%) to children ward, 52(57.8%) to internal ward, 6(6.7%) to surgical ward, 4(4.5%) to CCU, 5(5.6%) to infant ward, 4(4.4%) to ICU ward. Conclusion: Resistance pattern of Entercocci to various antibiotics especially vancomycin is to ward increasing trend, therefore preventing the emergence of antibiotic resistance among VRE due result also the need for further investigation using a high number of specimens representing a wider variety of locations to determine more precisely the resistance pattern in our hospitals. ISE.333 Analysis on Nosocomial Infections for Patients with Multiple Myeloma Z. Li. Beijing Jishuitan Hospital, Beijing, China Background: To clarify the features of nosocomial infections for patients with multiple myeloma (MM). Methods: One hundred and seventy eight cases of MM treated in our hospital from October 1982 to December 2006 were analyzed retrospectively. Results: 85 patients (47.8%) suffered from nosocomial infections. The nosocomial infection took place more frequently on respiratory tract. Eld, granulocytopenia, hypoproteinemia, severe anemia, and diabetes were risk factors. Totally 91 pathogen were islated. Gram-negative bacilli accounted for 45.1%, were the major pathogen. Fungal accounted for 37.4%, gram-positive accounted for17.6%. The ESBLs producing strains accounted for 31.6% in K.pneumoniae and E.coli. Vancomycin resistant strains were found. The frequently presented organism was the Candida albicans Conclusions: Nosocomial infections for patients with multiple myeloma have a high incidence. There were more risk factors. The resistance of commonly encountered bacteria to antimicrobial agents is a serious problem. Immunity protection and the rational use of antimicrobial agents should be emphasized. Key Words: multiple myeloma; nosocomial infections; analysis

ISE.334 Incidence of Surgical Site Infections: Our Experience L. Izzo, M. Caputo, P. Meloni, A. Bolognese, P. Di Cello, P. Izzo, R. Buffone, I. D'Angeli, F. Bisogno, D. Pietrasanta. Policlinico Umberto I University Hospital, Rome, Italy Background: The aim of this study is to determine surgical wound infection (SWI) rates in surgical patients using the National Nosocomial Infections Surveillance system (NNIS), to monitor current surgical antimicrobial prophylaxis, and to identify possible modifiable risk factors for SWI. Materials and Methods: Main criteria for hospital wards inclusion were: more than 20 surgical procedures per week, and use of amoxycillin/clavulanate (Augmentin) among prophylactic options. Each patient operated from December 1st 2005 to July 31th 2006 was surveyed for 30 days after surgery. SWI cumulative incidence rates and 95% confidence intervals (95%CI) were calculated. Results: During the study period, 2068 surgical procedures were performed in 2050 patients. A total of 147 SWI were diagnosed in 142 patients: 82 (57.7%) were at superficial incision, 31 (21.8%) were at deep incision and 42 (29.6%) were at organ-space site. Incidence of SWI every 100 operations was 6.4%. About 86.5% of the operated patients received antimicrobial prophylaxis, mainly with amoxicillin/ clavulanate (Augmentin) (28.3%) or with imipenem/cilastatin (Tienam) (11.4%). Pre-operative hospital stay > or = 48 h, diabetes, obesity, and HIV/AIDS infection were statistically significantly associated with increased risk of SWI. Conclusions: The SWI rates found are comparable with European studies and can be a benchmark for national incidence data and for inter- and intra-hospital SWI rate comparisons. ISE.335 Bacterial Nosocomial Infections Among Hospitalized Patients of Hamadan and Their Antimicrobial Resistance Pattern, 2006 S. Jamal Omidi, G. Soozanchi, S.H. Hashemi, R. Yousefi-Mashouf, M. Mamani. Hamedan University of Medical Sciences, Hamedan, Iran (Islamic Republic of) Background: Nosocomial infections lead to long-term hospital residences, extensive use of antibiotics, increased economic burden, and a high rate of morbidity and mortality among patients. 5-10% of hospitalized patients develop nosocomial infections in North America and Canada, and over 40% in some Asian, Latin American and African countries. Thus we conducted this study aiming at understanding the frequency, mortality and antibiotic resistance pattern of bacterial nosocomial infections in hospitals of Hamedan, during year 2006 as an indicator of the state of the problem in IRAN. Methods: In this descriptive study, all hospitalized patients with secondary nosocomial infection during year 2006 were included. Diagnosis was made by strong clinical symptoms with or without cultures of all relevant areas of infection plus to blood urine cultures and CXR. Then antimicrobial sensitivities and resistances were identified by means of antibiograms for all positive cultures. The above data mentioned and the demographic data for every patient were then registered in the appropriate questionnaire. Results: 197 cases were diagnosed, out of which 170 patients had positive cultures, 12 had more than one infected area and 41 had polymicrobial cultures. ICU patients consisted 57.4% of all patients. Klebsiella, Pseudomonas, E-coli were the most prevalent microbes discovered. 13.2% died as a result of the infection. Antimicrobial resistances were determined for extracted pathogens. Conclusion: Higher nosocomial infections among the young can be contributed to higher rate of accidents and crash injuries among them that leads to ICU and surgical wards admissions; and the fact that inappropriate use of antibiotics has led to high and even dangerous antimicrobial resistances, brings forward the problem of inappropriate prescription or unauthorized use of antibiotics. Taking in mind that the rate of nosocomial infections in Hamadan, IRAN, has been compared to other countries. ISE.336 Incidence of MRSA in Neonatal Department of Kanti Children Hospital Katmandu, Nepal K. Poudel, S. Dahal. Kanti Children Hospital, Bagmati, Nepal, Kanti Children Hospital, Kathmandu, Nepal

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Nasal carriage of Staphylococcus aureus is a sensitive indicator of staphylococcal colonization and is considered a source of subsequent infection. When the incidence of S. aureus colonization increased in our neonatal intermediate care unit (NIMCU), resulting in many methicillinresistant Staphylococcus aureus (MRSA) infections(more than 20 cases) over a three-month period, we sought to further our understanding of S. aureus epidemiology and response to infection control practice. The purpose of this investigation is to study the methicillin-susceptible Staphylococcus aureus (MSSA) and further determine the clonal spread of MSSA strain types. Since few studies have analyzed the clinical profile of MSSA in neonates, we hypothesize the incidence of MSSA colonization will follow a mixed endemic and epidemic pattern over the period of the study. We are further planning to compare the MSSA colonization data to that of MRSA, in order to get a more complete picture of the S. aureus strains circulating in the NIMCU. This retrospective longitudinal study will consist of infants hospitalized in a NIMCU (30 beds) from June 2008 to May 2010. Nasal surveillance cultures of all infants will be obtained on admission and weekly. Thereafter, epidemiologic data such as birth weight, age, therapeutic modalities, length of admission, and antibiotic use will be obtained from clinical summaries and will be used to characterize patients with MSSA colonization. During the 23-month study period, around 1,000 infants will be screened for S. aureus. At the end of the project. ­ Find out the incidence of MSSA and MRSA colonization in neonates admitted in hospital ­ Find out the cost effective surveillance strategies in order to monitor progression from colonization to endemic infections. ­ To know the pattern of healthcare-associated infections for the intensification of infection control measures and the updating of antibiotic usage guidelines ISE.337 A Knowledge Discovery Approach for Controlling Nosocomial Infections S. Rajasekaran1, S.K. Uma Maheswaran2. 1B S Abdur Rahman Crescent Engineerig College,Mathematcs Department,Vandalur, Chennai-600048, India, 2Sri Sai RamEngineering College,Department of Mathematics & Computer Applications, Chennai-600044, India Nosocomial or hospital acquired infections are diseases that are developed during an admission to hospital and are a consequence of treatment, procedures of treatment or work of the hospital staff. These infections are dangerous because they are caused by bacteria that are developed and transmitted within the hospital, where they may reach a high level of resistance to antibiotics. Surveillance of antibiotic resistance and nosocomial infections are the most important factors of the hospital infection control program. We make an attempt to design an infection control surveillance system using new approaches of the knowledge discovery techniques. We also introduce association rule data mining technique and APRIORI algorithm for obtaining alarm rules to be used for microbiological validation. Further, an outline of knowledge discovery approach and its relevance and importance to research are also analyzed thus providing vivid discussion to emerging issues facing data mining. ISE.338 Prevention of Peripheral Intra Venous Catheter Complications: 48 Hour Replacement IV Catheter to Reduce Phlebitis B. Indah. Siloam Hospitals Surabaya, Surabaya, Indonesia Background: Plebitis is common troublesome of intravenous therapy. The incidence of phlebitis had been reported by Infection control surveillance (in June­August 2004 ) in Siloam Hospitals Surabaya 191 patient over 3 month have peripheral intravenous catheter, 53.4% get phlebitis. The risk factor of phlebitis is more often the influence of time by the duration of cannulation replacement in patient (avarage 5­7 days ). Methods: We perfomed surveillance in 876 patient have peripheral intravenous catheter for six month. This study had been possible to furnish proof influence of time on phlebitis due to Peripheral Venous Catheter. The study compared the duration of cannulation in 24 hours, 48 hours, 72 hours and > 72 hours. Observed by nurse who has in charge in patient with peripheral intravenous catheter were reviewed catheter site daily ; finding were applied to a scoring system to define the score of phlebitis.The data were collected by Infection Control Link Nurse in each dept/unit. The data would be analyze and classified suitable with the duration of cannulation.

Results: We classified the data of phlebitis according to the duration of cannulation: 0­24 hours (13.47%), 25­48 hours (17.04%), 49­72 hours (33.33%), 72 hours (44.10%). The data surveillance of Pheripheral intravenous catheter were show patient were replacement peripheral IV catheter in 72 hours or 72 hours have increase of phlebitis than patient were replcement in 24 hours and 48 hours. Conclusions: Evaluation of the questionnaires reavealed that there was significant increase in the incidence of phlebitis in line with an increasing duration of the indwelling periode of between 72 hours and 72 hours. Timely replacement of the catheter appeared to be the most important factor in reducing the occurance of complication in phlebitis. Note: This article has been cited by other articles. The influence of hand hygiene prior to insertion of peripheral venous catheter on the incidence of complications. ISE.339 Accelerated Detection of ESBL Producing Organisms K. Angamuthu. Almana General Hospital, Al-Khobar, Saudi Arabia Infections by extended-spectrum beta-lactamase (ESBL)-producing organisms, particularly E. coli, K. pneumoniae and P. mirabilis, are causing significant diagnostic and therapeutic problems in afflicted patients. The ESBLs are enzymes capable of inactivating -lactam drugs, including broad-spectrum penicillins, third-generation cephalosporins and monobactams. The ESBL-producing organisms are often multi-drug resistant, as the plasmids producing ESBLs can carry resistance to other antibiotics. The ESBL-producing bacteria are increasingly causing varied infections both in hospitalized patients and outpatients. The increasing drug resistance among these bacteria has made therapy of above infections difficult and has led to increased use of expensive broad-spectrum antibiotics. Drug resistance of this form is often difficult to recognize using conventional antimicrobial susceptibility methods. Delay in the detection and reporting of ESBL production by gram-negative bacteria is associated with long hospital stay, increased morbidity, mortality and health-care costs. Failure to identify ESBL-producing organisms also contributes to their uncontrolled spread. ESBL-mediated resistance can be detected by several methods, including the Clinical Laboratory Standards Institute (CLSI), confirmatory disk diffusion and the double-disk synergy methods. CLSI recommends a two-step approach of initially screening for ESBL production and then performing confirmatory tests on screenpositive isolates. We in the clinical microbiology laboratory at Almana General Hospital, Khobar and Dammam devised an accelerated method for detecting ESBL in isolates of E. coli, K. pneumoniae and P. mirabilis. The accelerated test results were highly concordant with that of the standard CLSI confirmation test, as they showed high sensitivity (100%) and specificity (100%). The accelerated test allowed the detection of ESBL-producing organisms on the same day the first line antimicrobial susceptibility results were read, thus reducing the ESBL detection time from two days to one day with no added cost. The earlier availability of the positive results ensured appropriate antimicrobial therapy of infections caused by the ESBL-producing organisms. It also allowed timely implementation of the appropriate infection control measures. We have incorporated the accelerated protocol as a routine procedure on our antimicrobial susceptibility benches. ISE.340 Comparison of Two Regimen of Empiric Therapy of Ampicilin Plus Gentamycin and Ampicilin Plus Amikacin on Culture of Tip of Umblical Catheter in Newborns Y. Zahed Pasha, M. Ahmadpour Kacho, M.. hajiahmadi, S. Banihashamian, T. Jahanghir. Babol University of Medical Sciences, Babol, Iran (Islamic Republic of) Background: Umblical vessel catheterization (UVC) often used for care of critical neonates in neonatal intensive care unit (NICU). Risk of infections associated with UVC is high and increases morbidity and mortality. The aim of present study was to compare two empiric treatment regimen of Ampicilin plus gentamycin to Ampicilin plus Amikacin on the culture results of the tip of UVCs. Materials and Method: This was a quasi experimental study conducted in NICU at Amirkola children hospital, in Babol, Iran. One hundered and four neonates recruited in this study; 50 neonates with UVC in gentamycin group and 54 in Amirkacin group. The tip of the catheters were cultured after removal on biphasic medium B.H.I agar made in Kusha Far Avarghity Co(Iran). At the end of study, the results of culture were compared together.

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Results: At Baseline the weight (2.55± 0.9 vs, 2.42 ± 0.7 kg, p.v = 0.69) and day of catheter remain in umbilical vessels (4.7± 0.7 vs, 5.6 ± 3.7 day, p.v = 0.72) of two groups were not differd significantly. The number of positive culture results for a pathogenic bacteria in gentamycin group were significantly more than the Amikacin group (16% vs 10%, p.v = 0.013). The most common bacteria isolated were enterobacter (2.9%)coaglualase negative Staphylococcus (1.9%), Staphylococcus aureus (1%) and E. coli (1%). Conclusion: The result of this study showed that Amikacin plus Ampicilin regimen reduces the bacterial grown on tip of UVC more than the gentamycin plus Ampicilin regimen Key Words: Amicacin, gentamycin, catheter, umblical vessel, empiric therapy ISE.341 A Prospective Study of Ventilator-associated Pneumonia in an Adult Intensive Care Unit at a Tertiary Care Referral Centre in India M. Sharma, N. Taneja, M. Biswal, M. Singh, I. Bala. Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India Background: Ventilator-associated pneumonia (VAP) is a major threat to the recovery of patients receiving mechanical ventilation, and is one of the most important intensive care unit (ICU)-acquired infections in mechanically ventilated patients. Materials and Methods: A total of 87 patients were enrolled prospectively from June to November 2005 and followed up till discharge or death. The patients visited daily by resident doctors and CDC case definitions followed to assign the cases. Results: Thirty episodes of VAP occurred in the 87 patients with a rate of 45.3 infections/1000 ventilator-days. Ten (32.1%) patients died. Of these 5 had polymicrobial infections. Twenty patients had early VAP and 10 had late VAP. Multi-drug resistant nonfermenters caused most of the VAP (Acinetobacter and Pseudomonas aeruginosa) followed by enterobacteriaceae. Staphylococcus aureus was not a common cause. Prior antibiotic usage was an important risk factor for death. On an average, patients received 2.9 courses of antimicrobials prior to development of VAP and 3.2 courses after development of VAP. Inappropriate combinations of antibiotics were given in 4 out of 10 patients who died. A reservoir for the Acinetobacter was found in stored distilled water used for humidification and nebulisation. Conclusions: Improper storage of distilled water, improper endotracheal suctioning and inappropriate antibiotic policy were found to be the most important factors responsible for development of VAP in this study. ISE.342 Molecular Epidemiology of Tuberculosis (TB) in Guinea Bissau N. Tafah 1, B. De Jong1, M. Antonio1, P. Rabna2, C. Wejse2, R. Adegbola3. 1 Medical Research Council (MRC) Laboratories, Fajara, Banjul, Gambia, 2Bandim Health Project, Banjul, Guinea-Bissau, 3Medical Research Council (MRC) Laboratories, Fajara, Gambia Background: Tuberculosis remains the most common cause of adult death from a curable infection worldwide. In West-Africa, Mycobacterium africanum, member of the M. tuberculosis complex, causes up to half of TB. We sought to describe the molecular epidemiology of TB in Guinea Bissau. Methods: We processed sputum from 109 patients who had received a clinical diagnosis of TB as part of a clinical trial on TB treatment with and without vitamin D. Sputum samples had been stored at -20C with inconsistent power supply prior to shipment to the Gambia. After decontamination and staining for acid fast bacilli, sputum was inoculated in liquid and solid medium. Aliquots of decontaminated sputum were heat-killed and used in PCR for spoligotype analysis, including positive and negative controls. Results: Of the 109 samples, 14 (15%) were smear positive and 34 (37%) culture positive on either or both liquid and solid media. In contrast, spoligotype analysis identified M. tuberculosis complex signals in 85 (78%) of samples, with clear patterns for genotypic classification in 50 (46%). Of these, 22 (20% of total) were M. africanum and 28 (26%) M. tuberculosis. Conclusion: The molecular test performed on sputum lysates indicated the presence of M. tuberculosis complex DNA in 80% of suspected TB cases, in contrast to 37% culture positivity. The low yield of culture likely resulted from repeated freeze- thawing of sputum samples prior to analysis. M. africanum type I, West-African type 2, is a common cause of TB in Guinea Bissau.

ISE.343 A Cluster of Chronic Bone-Joint-Prosthetic-Soft Tissue Infection Due to Multiresistant Acinetobacter Baumanii Strains in a Tertiary Care Orthopedics Setting. Effective Treatment with Associated Colistin Plus Tigecycline R. Manfredi. Infectious Diseases, University of Bologna, Bologna, Italy Background: Like other Gram-negative non-fermenting bacteria, Acinetobacter spp. is an environmental organism characterized by a low intrinsic virulence, but a concurrent, broad-spectrum and high-level resistance to the majority of available antimicrobial agents. Methods and Results: Four unrelated cases of A.baumanii infection interesting bone, joint, prosthetic devices, and close soft tissue occurred during October­November 2007, at three different Divisions of a highly specialized Orthopedics Hospital of Bologna, Italy. In all cases a concurrent, local polymicrobial infection including Gram-positive organisms (Staphylococci-Enterococci), and Gram-negative agents (Escherichia coli, Citrobacter freundii, Enterobacter cloacae, Pseudomonas aeruginosa, and Proteus mirabilis), was diagnosed during the long-term admission (32­78 days). While concurrent microorganisms were controlled by appropriate antimicrobial chemotherapy and the implant of antibiotic-impregnated cement, A.baumanii showed complete resistance to an enlarged panel of anti-infective compounds, save colistin and tigecycline (the only agents which showed MIC values <0.5 µg/mL). Both these compounds were administered at full dosage and by i.v. route, in association with carbapenems, rifampicin, amikacin, and even cotrimoxazole, to exploit the potential synergistic activity against A.baumanii demonstrated by in vitro studies performed with colistin. In the meantime, an active, systematic surveillance program interested the entire Hospital (with special focus on surgery rooms, intensive care units, and diagnostic and therapeutic devices), but no apparent foci of environmental colonization were found. The cluster of multiresistant A.baumanii infection was cured after 16­45 days of combined colistin-tigecycline therapy, and neither relapses nor novel episodes of infection occurred at the Hospital during the subsequent follow-up. Conclusions: Both the oldest and the newest antimicrobial compounds are expected to play a crucial role in the treatment of multiresistant infections caused by challenging pathogens like A.baumanii. A 50-yearold compound like colistin, together with a newly introduced molecule like tigecycline, perfectly traced the target organism, and successfully resolved long-lasting infections burneded by multiple morbidity, forced patients' inability, and extremely prolonged hospitalization times. The selection of synergistic agents may be conducted empirically, or better with the aid of enlarged in vitro antimicrobial susceptibility assays. A strict co-operation among specialistic surgeons, Infectious Diseases consultants, clinical Microbiologists, and Pharmacists, is strongly warranted to contain the impact of these increasing environmental infections in a highly specialistic surgical setting. ISE.344 An Active Bacteriological Surveillance Project at a Metropolitan Hospital of Bologna, Italy. Recent Epidemiological Trends, and Antimicrobial Susceptibility Rates A. Nanetti1, R. Manfredi2. 1Dept. of Microbiology, University of Bologna, Bologna, Italy, 2Infectious Diseases, University of Bologna, Bologna, Italy Background: An active bacteriological surveillance project is part of the necessary basic knowledge on the local microbial isolation and their resistance maps. Materials and Methods: The trend of microbial isolations from patients admitted in the last 15 months (July 2006­September 2007) at our Hospital is reported on quarterly basis, together with updated antimicrobial sensitivity testing. Results: As a whole, Gram-negative agents showed an increasing trend of isolation, regardless of the examined clinical specimens, while the epidemiology of Staphylococci remained unchanged, and the methicillin resistance rate remained under control (around 38% of overall isolates from blood cultures). When considering Enterococci, the active surveillance of VRE strains successfully acted against the potential nosocomial spread of these organisms: the only 9 cases of "Van A" Enterococcus faecalis strains were not related with each other, and glycopeptide resistance remained limited to less than 3% of overall Enterococci. An increasing number of ESBL-producing Enterobacteriaceae was noticed (with a 23.4% rate for Escherichia coli, and up to 39% for other organisms, as a whole). The overall resistance rate against fluoroquinolones is on steady increase: the last quarterly report shows a 39.3% rate for E. coli, 35.5% for Enterobacteriaceae, and 47.5% for Pseudomonas aeruginosa.

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Conclusions: An active, prospective microbiological monitoring may notably add to the knowledge of local epidemiological figures and antimicrobial sensitivity trends, and plays a role of paramount importance when selecting chemoprophylaxis and therapeutic strategies, on a local and regional background. ISE.345 Evolution of Multi-Drug Resistant Microorganisms in Tertiary Care Hospital H. Badawi1, L. Aboul Fadl 2, M. Diab2, M. El Said 1. 1Microbiology Department,Infection Control Unit,Theodor Bilharz Research Institute, Giza, Egypt, 2Microbiology Department,Theodor Bilharz Research Institute, Giza, Egypt Background: Antimicrobial resistance is steadily rising among bacterial pathogens associated with both community- and healthcare-associated infections. Infections caused by resistant pathogens result in significant morbidity and mortality. Despite the availability of newer antibiotics, emerging antimicrobial resistance has become an increasing problem in many pathogens throughout the world. Objectives: This study was designed to assess the epidemiological evolution of ESBLs and MRSA clinical isolates in Theodor Bilharz Research Institute (TBRI) hospital. Methods: A total of 53 and 72 clinical isolates collected from hospitalized patients with hospital acquired infections in TBRI during a period of 3 months from September to November in 2006 and matched period in 2007 respectively, were screened for the presence of ESBLs and MRSA. Enterobacteriaceae isolates were tested with Double disk synergy test (DDST) and E test-ESBL strips for detection of ESBL. Staphylococci were tested for their susceptibility to oxacillin and cefoxitin for detection of MRSA using disk diffusion and E-test. Results: The hospital infection decrease from 4.1% in 2006 to 3.7% in 2007. The prevalence of MRSA was lowered from 5.7 % in 2006 to 1.8% in 2007, while the prevalence of ESBL was 22.6% in 2006 compared to 8.3 % in 2007. ESBLs represented 38.7% of enterobacterial isolates in 2006 compared to 10.7% in 2007. Conclusion: Our results underscore the importance of periodic screening for MDRO among patients. The nosocomial infection rates and prevalence of MRSA and ESBLs infections in patients were lowered in 2007 compared with that in 2006. Early discovery on applying convenient and time-saving methods for detection, together with implementation of strict infection control measures, adoption of an antibiotic policy to limit the overuse of antimicrobials and continuous education of healthcare workers are crucial in controlling MRSA and ESBLs spread in our institute hospital. ISE.346 Antimicrobial Resistance Pattern of Common Bacterial Isolates: A 4-Year Retrospective Study at the Pediatric Intensive Care Unit of Chong Hua Hospital T.F. Cerna, J. Lim. Chong Hua Hospital, Cebu, Philippines Background: Infections caused by resistant pathogens result in significant morbidity and mortality and contributes to escalating health-care costs worldwide. Hence, it is very important to be aware of bugs in each hospital setting or locality. The objectives of this study were: To determine the common bacterial pathogens isolated in the Pediatric ICU of Chong Hua Hospital and their corresponding resistance pattern; To compare the bacterial pathogens isolated and their antibiotic resistance pattern each year. Methods: The culture results of patients (less than 19 years of age) who were admitted in the Pediatric Intensive Care Unit (PICU) of Chong Hua Hospital and were taken at or more than 48 hours of PICU stay were included in the study. The different isolates and their resistance pattern to the commonly used antimicrobials were tabulated and presented as percentages. Results: Forty one isolates were identified from 33 patients. Twenty two (56%) of the bacterial isolates grew in tracheal aspirates, 11 (28%) were from blood cultures, and the rest were from other sites. Pseudomonas aeruginosa was the most common organism isolated (41% of the pathogens), followed by Escherichia coli (14.6%) and Klebsiella pneumoniae (12.1%). Among the antimicrobials tested, cefuroxime (60.5%) has the highest resistance followed by trimethoprim/sulfadiazine (60%), amoxicillin/clavulanic acid (57.1%) and ampicillin (50%). There is an increasing rate of resistance among the commonly used antibiotics such as cefepime, whose resistance rate increased by 7% within two years

while both Meropenem and imipenem have a 9% increase. Ciprofloxacin, linezolid, and vancomycin have relatively low resistance rate. Conclusion: Pseudomonas aeruginosa is the most common bacterial isolate in the PICU of the institution. Antimicrobials such as penicillin, cefuroxime, trimethoprim-sulfadiazine, amoxicillin-clavulanic have high resistance rate to ICU pathogens. Pathogens have high susceptibility to Meropenem, Imipenem and Cefepime, although increasing annual trend of resistance was noted. ISE.347 Genetically Marked Salmonella enteritidis Populations in Northern Regions of the Far-East of Russia A.V. Rakov, F.N. Shubin. Research Institute of Epidemiology and Microbiology Siberian Branch of Russian Academy of Medical Sciences, Vladivostok, Russia Application in Primorye Region the centralized microbiological monitoring for Salmonella enteritidis has allowed performing genetic marking of pathogen population and showing the degree of its heterogeneity. The aim of study is the research of plasmid characteristics of S.enteritidis in northern regions of the Far East and formation mechanisms of genetically marked pathogen populations. Plasmid characteristics of S.enteritidis strains isolated from August, 2003 till September, 2004 from 464 patients and 9 samples of food products in Vladivostok and from 97 patients and 9 samples of food in Magadan Region were studied in the process of comparative centralized monitoring. It is established, that S.enteritidis populations from patients in Vladivostok and Magadan Region are submitted 10 main plasmidovars of pathogen. The comparative analysis of strains has showed significant similarity in pathogen population in both regions. Moreover, the shift of pathogen plasmidovar dominating in etiology of disease in Vladivostok synchronously led to the same kind change of pathogen population in Magadan Region. At the same time there are pathogen plasmidovars specified to separate regions. Hence, we can tell about distribution of genetically related part of S.enteritidis population in the studied territories. The formation mechanism of pathogen population relative part is connected with transportation products of industrial poultry farms contaminated S.enteritidis to Magadan Region. Realization of the actions directed to decreasing of population illnesses in northern regions, assumes necessity of the optimization of food delivery directions and application of the centralized monitoring on salmonellas in Siberian-Far Eastern Region. ISE.348 The Influenza Vaccine Coverage to People Older 65 Years Old. Canary Islands 2001­2007 A.J. Garcias Rojas, J. Solis Romero, P. Garcia Castellano, D. Trujillo Herrera. Public Health Service, Las Palmas de Gan Canaria, Spain, Public Health Service, Santa Cruz de Tenerife, Spain Background: The population older 65 years has a fundamental place in revielle group towards influenza vaccine is directed. Instead this, the historical vaccine coverages got in Canary Islands low. After 2003­2004 season there was designed an intervention strategic to increase the coverage. We present the obtained results Methods: We studied the influenza vaccine coverage in population older than 65 years, in Canary Islands, during temporal period 2001­2007. As numerator we used the number of administrated vaccines to this population and as denominator the living population older 65 years, as Estatistical Canarian Institute report Results: During the seasons 2001­2002 and 2002­2003 the obtained coverages were always lower 45%. After the becoming of the intervention strategic, the coverages raised near the 50% in 2003­2004 and 2004­2005 season, to get higher in 2005­2006 being 60,4% in the 2006­2007 season Conclusion: The growing tendency in the analyzed influenza vaccine, can get us to conclude the acceptability of established specific element to this end and strengthen the need of making this kind of actions ISE.349 Prevalence of Hepatitis A and Hepatitis E Antibodies in a Group of Iranian Individuals with Gastrointestinal Symptoms S.R. Mohebbi, M. Rostami Nejad, N. Zali, M.A. Pourhoseingholi, A. Zarghi, M. Habibi, R. Mashayekhi, F. Derakhshan, M.R. Zali. The Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Islamic Republic of)

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Hepatitis A virus (HAV) is a RNA virus that belongs to the Picornaviridea family, genus Hepatovirus. HAV is one of the common causative agents for acute hepatitis worldwide. HEV has recently been classified as the type species of the new genus Hepevirus in the family Hepeviridae. HEV shares several characteristics with HAV, and these non-enveloped RNA viruses are both transmitted via the fecal-oral route by contaminated food or water and epidemics are common in regions where sanitation is poor. The aim of present study was to investigate the seroprevalence of Anti-HAV and Anti-HEV antibodies in a group of Iranian individuals with gastrointestinal symptoms. 670 Serum samples were collected randomly from a total of 5176 individuals from Tehran province, with gastrointestinal symptoms during one year (2006­2007). Mean age of this group (62.7% female and 37.3% male) was 41.1±19.9. The prevalence of antibodies against HAV and HEV was determined by third generation enzyme-linked immunosorbent assays. Overall, antiHAV antibody was detected in 606 (90.4%) of 670 individuals. The prevalence of anti-HAV antibody was similar among males (92%) and females (89.5%). HEV antibody was detected in 62 (9.2%) of 670 individuals. No significant association was found between HEV infection, sex, age, and anti-HAV seroprevalence in these individuals. Our results demonstrate high prevalence of HAV and HEV antibodies in Iranian population who had gastrointestinal symptoms. It is clear that improvements in hygiene and cleanliness are determining factors of the prevalence of HAV and HEV infections in the community. Because of the potentiality of extensive outbreaks and associated mortality in pregnant women, concerted efforts must be taken to have an effective vaccine against HEV. In contrast, it seems that HAV vaccination is not necessary for Iranian population, at least in near future. Vaccination is strongly recommended for visitors from non endemic regions of the world. ISE.350 Escherichia coli Resistance Patterns in a Regional Hospital in Greece T. Chimonas, F. Rozi, K. Mitrakou, E. Chounta, G. Tzinieris, M. Pavlaki. Argos General Hospital, Argos, Greece Background: Escherichia coli is the most frequently isolated pathogen in urinary tract infections (UTIs). The widespread empirical use of newer antibiotics has contributed to rising drug resistance rates. Objectives: To study the resistance patterns of E. coli isolates in the setting of a regional hospital in Greece. Methods and Results: During the period from 1/1/05 to 13/11/07 a total of 4964 inpatient and outpatient urine specimens were collected at the Argos General Hospital in Argolis, Greece. Identification and susceptibility testing was performed using the VITEK 2 compact automated (MIC) system, BioMerieux, France. A total of 812 E. coli strains were isolated (51,8% of all positive cultures and 16,4% of all specimens). Resistance to new generation quinolones (namely ciprofloxacin) reached 8%, 9% and 11% in 2005, 2006 and 2007 respectively. Resistance to amoxicillin/clavulanic acid (AM/C) was 17%, 18% and 18%, to cefuroxime axetil 6%, 7% and 3% and to trimethoprim-sulfamethoxazole (TMP-SMX) 23%, 20% and 21% during the same period. Discussion: The rate of antibiotic resistance has remained practically stable during this three-year period. Resistance to ciprofloxacin was found to exceed by almost double the rates previously reported for Greece, of 5,5% to 8,5% for inpatient and 3,6% to 5% for outpatient urine cultures. This probably reflects the worldwide trend of rising resistance rates of E. coli to quinolones. Resistance to cefuroxime is generally lower. Conclusions: The high resistance rates to AM/C and TMP-SMX seem to limit their use as first-line agents in the empirical treatment of UTIs in this region, while the increasing resistance to quinolones warrants close monitoring in the future. ISE.351 Uropathogen Epidemiology and Antibiotic Resistance in a Regional Hospital in Greece T. Chimonas, K. Mitrakou, P. Papageorgiou, G. Tzinieris, G. Mavras, F. Rozi. Argos General Hospital, Argos, Greece Background: Most of the studies of urinary tract infection (UTI) pathogens are conducted in large, tertiary hospitals in major urban centers. However, their results do not always reflect the offending organisms seen in smaller hospitals that service rural areas. Objectives: To study the organisms responsible for UTIs in a small regional hospital in Greece and to describe their resistance to some of the most commonly used antibiotics.

Methods and Results: During the period from 1/1/05 to 13/11/07 a total of 4964 inpatient and outpatient urine specimens were collected at the Argos General Hospital in Argolis, Greece. Identification and susceptibility testing was performed using the VITEK 2 compact automated (MIC) system, BioMerieux, France. Culture results were positive in another 31,7% and 26,8% of all specimens from women and men respectively. A total of 1568 strains were isolated. The most commonly isolated pathogens included Escherichia coli (51,8%), Proteus mirabilis (6,9%), Klebsiella pneumoniae (6%), Enterococcus spp (5,6%), Pseudomonas aeroginosa (5,4%), Staphylococci spp (3,6%), Candida spp (3,1%) and Enterobacter spp (2,4%). Among the isolates, in vitro resistance rates to newer quinolones (ciprofloxacin or ofloxacin) reached 17,7%. Almost 54% of all Staphylococci spp isolated strains were resistant to anti-staphylococcal penicillins, but all were sensitive to vancomycin. Excluding the staphylococci, resistance to broad-spectrum penicillins (ampicillin or amoxicillin/clavulanic acid) was observed in 35,5% of all isolated strains. Furthermore, 5,4% of all enterococci isolates were vancomycin resistant and 7,5% of all P. aeroginosa isolates were resistant to imipenem. Conclusions: The resistance of common uropathogens to the antibiotics most widely used in the empirical treatment of UTIs remains significant in rural areas, albeit lower than that seen in large urban centers. This reinforces the need for careful selection of antibiotics and diligent use of urine cultures as guides to pathogen-specific treatment. ISE.352 Candida Dubliniensis Nosocomial Respiratory Tract Infection S. Basu1, S. Dey2, I. Roychowdhury1, S. Das1. 1Peerless Hospital, Kolkata, India, 2West Bengal University of Technology, Kolkata, India Background: Being recognized in 1995 there is gradually increasing reports of Candida dubliniensis infection throughout the globe. Initially in most of the cases these were isolated from immunocompromised, AIDS patients and in patients enduring chemotherapy and with organ transplants. However, recently they have been isolated from patients with normal immunity. It has been also found that 18% diabetes mellitus patients with insulin therapy harbor C. dubliniensis in their oral cavity as commensals. We were engaged with special attention on this study as there is no report of C. dubliniensis infection from eastern part of India. Methods: All isolates of C. albicans were studied retrospectively throughout one year. Out of 76 C. albicans isolates two were positive for C. dubliniensis, exhibiting absence of growth at 42oC, multiple chlamydiospores and chrome agar changes. Details regarding the patients with C. dubliniensis infection were analyzed from the records. Results: The two adult male patients were with C. dubliniensis infection of lower respiratory tract, both were diabetic and with insulin therapy. They were also associated with other nosocomial gram negative bacterial infection. One of them was suffering from uremia and the other from astrocytoma grade IV. One peculiar finding was that both the patients showed plenty RBCs in their urine without increase of pus cells and urine cultures were sterile. Their chest X'rays showed patchy opacities in both the lungs. They were HIV test negative and with normal immunoglobulin levels in blood. Conclusion: All hospitalized diabetic patients should be monitored to prevent C. dubliniensis infection as this is very easy for them to get infected. ISE.353 Nosocomial Hepatitis B Outbreak in Slovenia Z. Simonovic1, J. Regvat2, K. Turk1, M. Kovacevic1. 1Institute of Public Health Maribor, Maribor, Slovenia, 2University Medical Center, Maribor, Slovenia Background: Estimated prevalence of hepatitis B virus (HBV) in Slovenia is below 1%. Incidence of acute HBV infection in 2005 was 1,0/100.000. Around 20 acute HBV infection cases are reported yearly. In August and September 2006 three cases of acute hepatitis B, all treated at the same time in specific ward in regional hospital, were reported and epidemiological investigation was conducted. Methods: Retrospective cohort study with serological survey and reviews of medical records and medical practices was conducted among patients hospitalized in the same ward at the same time as cases. Results: In period of 5 days 39 patients were treated. 71% of 34 still alive patients were tested and besides 3 already known HBV infected patients 5 acute asymptomatic HBV patients were identified. No HBs- or HBe-antigen carrier was confirmed among tested patients nor among

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medical and nursing staff. All the infected patients received intravenous therapy and were exposed to blood sampling and all except one were treated with inhalation therapy using nebulizers. Among all medical procedures reviewed only exposure to inhalation therapy showed significantly higher HBV infection rate (RR 8.4; p= 0,03). We identified infection control procedure lap in a way inhalation therapy had been performed - reusage of syringes which had had contacts with already used inhalation masks as well as with needles permanently staying in multidose bottles of medicines used for inhalation therapy. No other lapses in infection control procedures were identified. Conclusion: Nosocomial hepatitis B outbreaks may occur when infection control measures are not strictly performed. Besides well known medical practices responsible for HBV transmission in nosocomial HBV outbreaks in presented outbreak also indirect transmission of HBV by permucosal exposure via inhalation therapy could have occured, but further epidemiological and microbiological investigation will be needed to determine transmission routes of HBV in this case. ISE.354 Seroprevalence of HBV and HCV Infections Among Pregnant Women in Iran S.R. Mohebbi1, M. Rostami Nejad1, N. Zali1, K. Cheraghipour2, M.A. Pourhoseingholi1, R. Mashayekhi1, F. Derakhshan1, M.R. Zali1. 1The Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Islamic Republic of), 2Medical science university of Hamadan, Hamadan, Iran (Islamic Republic of) There have been few data on the prevalence of serological markers of hepatitis B and hepatitis C viruses among pregnant women in Iran. The epidemiology of viral hepatitis during pregnancy is essential for health programme managers. Also, identification of the infected pregnant women to HBV allows prevention of newborn infection by active and passive immunization soon after birth. This study was designed to assess the prevalence of HBV and HCV infection among Iranian pregnant women. Serum samples from 496 pregnant women, who lived in rural (35.1%) and urban areas (64.9%) of Iran (Jan. to July. 2007), were collected. Data were obtained through questionnaires distributed during pregnancy. The mean age of this population was 25.8±5.2 years and mean period of pregnancy was 4.8 months. Samples were first screened for anti-HBc and anti-HCV antibodies by Third generation enzyme linked immunosorbent assay and those found positive for antiHBc antibody were further tested for HBsAg. Statistical analyses were done to explore the association of demographic variables with anti-HCV and anti-HBc antibodies. Anti-HBc was found in 23 of the 496 women (overall prevalence, 4.6%; 11 of 166 from rural areas, 6.2%; 12 of 307 from urban areas; 3.8%). Of these 23 positive samples, 5 (2.1%) were positive for HBsAg. Only one sample (0.2%) was anti-HCV positive. Anti-HBc prevalence in rural was higher than urban areas but this difference was not significant. The presence of anti-HBc antibody is a marker of exposure to HBV. Therefore, the present study establishes HBV infection rate in a specific group of women. These results emphasize the need for prenatal screening for HBV infection in pregnant women and treatment of the newborns from HBsAg positive mothers. In the case of HCV, more studies are needed to identify risk factors of HCV infection and the importance of HCV screening and treatment programmes. ISE.355 Vancomycin Screening Agar (VSA) for the Rapid Detection of Coagulase-Negative Staphylococci with Reduced Susceptibilities to Vancomycin (CoNS-RSV) in the Clinical Laboratory Y.F. Chiew, R. Broadbent, D. Perez, C. Musuka, C. Beresford, H. Mangos. Dunedin Hospital, Dunedin, New Zealand Introduction: In 2006, nine clinical cases of CoNS-RSV were detected over 6 months in Dunedin Hospital of New Zealand by means of the VSA Method (Chiew et al, accepted for publication by Pathology in 2006). Unfortunately, it could not be recommended for the routine laboratory because the gold standard of population analysis was not carried out to justify the proposal. Nevertheless, the proposal was pursued by reviewing works of other investigators subsequent to 2006. What about the clinical implications using this approach? Methods: Literature search through PubMed revealed that such a work by Nunes AP et al was published by Braz J Infect Dis in June 2007. A comparison of two methods using VSA by Nunes and Chiew will be tabled in the presentation.

Results: Nunes et al found that 6.1% of bacteraemic staphylococci (n=213) were CoNS-RSV that increased to 18.37% if only CoNS bacteraemias were considered. Moreover, vancomycin concentration at 4 mg/ml was better than 6 mg/ml for their detection which was supported by the population analysis profile method. Chiew et al found clonal spread and predominance of isolates in the intensive care units. Conclusion: CoNS-RSV is increasing rapidly and one of the reasons is greater awareness of the emerging trend. The need for cost-effective and rapid method in the routine laboratory for their detection becomes urgent and important. The VSA Method is recommended for this purpose. An algorithmic approach for the interpretation of laboratory results of CoNS-RSV will be presented for discussion. The macro-Etest breakpoints for CoNS have to be established as well, a vital test for confirmation of CoNS-RSV (cf to Staphylococcus aureus with heteroresistance) and may reflect the in-vivo inoculum size in diseased patients. ISE.356 Characterization of Quinolone Resistance Genes in Different Enterococci Species Isolated from Uti Paints, Tehran B. Shaghaghi, M. Saifi, M.R. Pourshafi.. Pasteur Institute of Iran, Tehran, Iran (Islamic Republic of) Introduction: The enterococci are a cause of nosocomial urinary tract infections (UTIs). Quinolones have good activity against urinary pathogens and are valuable agents in the treatment of complicated UTIs.The main mechanism of antibacterial action of quinolones is the inhibition of the target enzymes DNA gyrase and topoisomerase, that are both composed of two subunits, GyrA, GyrB, ParC and ParE, respectively. Methods: Samples collected from paints of some clinical center in Tehran between 2005 and 2006 were studied. Enterococci were defined as gram-positive cocci, grew at 44°C, and grew in 6.5% NaCl, and grew on bile esculin agar. All isolates were tested for their resistance by ciprofloxacin (5µg) antimicrobial disks and minimal inhibitory concentrations MICs of ciprofloxacin were determined by the micro dilution method. The gyrA, gyrB, parC and parE genes were targeted with specific primers. Result: All strains were identified by biochemical tests followed by PCR using species-specific primers. 39% of E. faecalis isolates and 85% of E. faecium were ciprofloxacin resistance, respectively. gyrA gene was present in 75% of isolates and parC gene was present in 67% of isolates, just one E. faecalis isolate out of all carried gyrB and parE gene was present in 45% of isolates. All enterococci isolates with gyrA or parC showed high level resistance (MIC 32) for ciprofloxacin and isolates which was carried parE or gyrB genes showed low level resistance MIC between 4 and 16 for ciprofloxacin. Conclusion: The antibiotic resistance profiles of uropathogens in both community- and hospital-acquired infections have been changing in recent years and antibiotic resistance has become a major concern. Increasing incidence of multidrug-resistant bacteria and the possibility of requiring 'second choice' antibiotics for effective therapy, it is imperative that antimicrobial susceptibility test results be as accurate as possible, enabling consideration of alternative therapy where necessary. ISE.357 Evaluation of Legionella Urinary Antigen Enzyme Immunoassay for Rapid Detection of Legionella Pneumophila H. Goudarzi, G. Eslami, F. Fallah, R. Khanipour Roshan. Shaheed Beheshti University, Tehran, Iran (Islamic Republic of) Background: Legionnaires' disease is an uncommon but important cause of life-threatening Community Acquired or nosocomial Pneumonia and despite advances in pretreatment techniques,recovery of Legionella from different samples can still be quite low,difficult and time consuming. We performed this study to present the antigen test as a useful, simple and rapid test for early diagnosis of legionella pneumophila. Materials and Methods: we enrolled 118 patients (32 Female and 86 Male) with acute respiratory infection in Masih daneshvari Medical center during 2006­2007. Clinical and microbiological evaluations were performed. For microbiological purposes sputum culture and legionella urinary antigen were carried out. Results: Different types of bacteria were isolated from 118 patients. The most frequently isolated respiratory microorganisms were: Streptococcus pneumonia (88%), Candida spp. (76.2%), beta-hemolytic Streptococcus (61.8%), Neiseria spp. (44.4%), Staphylococcus (40.6%), Klebsiella spp. (27.1%), Fungi (16.1%), E. coli (8.4%), Pseudomonas Spp.

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(5.1%). No legionella was detected from sputum specimens. Legionella urinary antigen testing was revealed to be positive in 3 Males. Conclusion: This is important to notice that urinary antigen test is particularly useful, simple and rapid test because it is often easier to obtain urine in patients and the results can be available with in hours and also reliable to start treatment. ISE.358 Occupational Health Hazards Among Health Care Workers of an Iranian 1000-Bed Tertiary Hospital M. Rahbar1, M. Yagioobi2, A. Soultani2, M. Kabeh-Monnavar2. 1 Reference Health Laboratory, Tehran, Iran (Islamic Republic of), 2Milad Hospital, Tehran, Iran (Islamic Republic of) Background and Objective: Contaminated sharps such as needles, lancets, scalpels, broken glass, specimens tubes and other instrument can transmit pathogens such as HIV hepatitis B, hepatitis C to health care workers. The aim of this study was to determine to describe self reported cases of needle sticks, injuries and other exposures to patients blood or body fluids in Milad hospital of Tehran. Methods: In our hospital extensive training programs are conducted on universal safety precaution for prevention nosocomial infections, However in spite of our training program a numbers needle sticks and other accidental exposures to body fluids are reported every year. The Milad hospital is a 1000-bed non-teaching hospital in north west of Tehran. Over a period of one year 1.5 year June 20006-2007 a total number of 119 cases of accidental exposure were self reported. Results: During our study period we had 119 needle sticks and other accidental exposures. Of 119 cases, 90 individuals were female, and 29 male. The breakup categories were as follows: nurses­45, nurse assistant­10, paramedical technician­23, house keeping staff­37, and physician­4 cases. Of 119 reported cases, 87 were needle sticks during vein puncture, 7 cases during suturing, 21 cases during handling disposable material and 4 cases were splashing body fluids. All exposed health care workers were tested for HBs antigens and prevention measures performed for suspected cases. Conclusion: Our studies emphasize that needle stick injuries is the single greatest risk to medical personnel and importance of increased awareness and training in universal safety precautions for prevention of nosocomial infection. ISE.359 Mortality and Morbidity Due to Malnutrition and Associated Infection in Indian Chlidren M.L. Sharma. WHO NPSP India, Bikaner, India Malnutrition is one of the major health problems in developing countries. Associated infection worsens the problem and are a major cause of mortality and morbidity in malnourished children. Objectives: 1) To know about the various infections associated with malnutrition. 2) To know the effect and out come of infection in malnutrition Methods: 150 children (72 males and 78 females) with malnutrition inter-linked with infections age range 6 months to 12 years were studied. A detailed physical examination and clinical evaluation of children with malnutrition was done and the various infections associated with malnutrition evaluated by detail history, clinical examination. Relevant laboratory investigation was done. Results: The incidence of malnutrition inter-linked with infection was 8%. About 80% of children belonged to low socio-economic class with poor hygienic and sanitary condition. 70% parents illiterate. Most mothers continued to breast feed their babies up to 1 year and weaning done at 4 months. 50% children were bottle fed--faulty feeding with diluted milk. Children were not fully vaccinated. Primary vaccination was 70% in urban area. Rural patient having 24% that too partially immunized. The prevalence of malnutrition was higher in girls, under 2 years and in 2­3 siblings. 20% had more moderate and severe malnutrition, Marasmic Kwashiorkor constituted 40% of cases. Diarrhea and dysentery 50%. Recurrent upper and lower respiratory in 55%. Malaria 5%. Children having P.U.O. Primary complex was diagnosed in 4 children, worm infestation measles, chickenpox and enteric fever. The most common cause of mortality in malnutrition is chronic diarrhea and respiratory infections. Conclusion: Poverty, illiteracy, ignorance, poor sanitary conditions, faulty feeding habits were major contributory factors. The cumulative effect of reduced energy and nutrient intake cause of mortality and morbidity chronic diarrhoea and respiratory infection commonest infection.

ISE.360 Molecular Identification of Methicillin Resistant Staphylococcus aureus (MRSA) in Endotracheal Aspirates of Mechanically Ventilated Patients in Kenyatta National Hospital Nairobi L.W. Muita1, T. Ouko1, A. Mohammed1, B. Obanda1, C. Bii1, E. Amukoye1, D.R. Siika2. 1Kenya Medical Research Institute, Nairobi, Kenya, 2Kenyatta National Hospital, Nairobi, Kenya Introduction: Staphylococcus aureus is a human opportunistic pathogen causing both nosocomial and community acquired infections such as pneumonia, endocarditis among others. Patients in a given facility will be colonized or infected with MRSA. Data from CDC show that by the year 2000, infections by MRSA in 300 participating surveillance hospitals had increased to 54% and Kenya reported a prevalence of 27.7% from surgical patients. In the intensive care Unit (ICU) MRSA mediated nosocomial infections are associated with high mortality and morbidity. The -lactams resistance of MRSA is mediated by the production of an altered penicillin binding protein. (PBP2') which exhibits resistance of the cells to all - lactam antibiotics. Objectives: 1) To compare PCR assay, Latex Agglutination and E-Test methods for MRSA detection. 2) To determine the Prevalence of MRSA in ICU. Methods: Eighty-three Staphylococcal isolates obtained from endotracheal aspirates were screened initially by Coagulase, Catalase haemolysis and mannitol fermentation. Confirmation to species level was done by analytical profile index (API). Minimal Inhibition Concentration (MIC) was performed using oxacillin and cefotaxime E-Test strps. MRSA latex Agglutination Test kit (Denka Seiken co ltd Japan) was used for detection of PBP2'. Boiling did DNA extraction. PuRe Taq Ready To-Go PCR beads were used for the assy. Primers sequence used was S - 5'GGTGGTTACAACGTTACAAG-3' and R - 5'GCATTGTAGCTAGCCATTCC-3'. Detection was by gel electrophoresis. Results: Of the 83 isolates screened, 72(86.7%) were Staph aureus by API web biomiurex. 22 (30.5%) of the 72 isolates were MRSA by both PCR assay and E-Test methods. PBP2' was expressed in 19 (26.3%) of the isolates. Three of the isolates that were PBP2' negative were MRSA by PCR and had intermediate MIC results for both oxacillin and cefotaxime. Conclusion: From the above results, it is ideal to confirm MRSA by PCR so as to detect low levels of resistance. Phenotypic methods are however ideal for routine screening of MRSA. Early screening for MRSA is fundamental to modern day nosocomial and opportunistic infections control both for epidemiological investigation and day-to-day decision on barrier isolation. ISE.361 Study of lasB and toxA Genes in Pseudomonas aeruginosa Isolated from Wound and Burn Infections in Iran M.M. Aslani1, F. Shahcheraghi1, G.H. Ebrahimipour2, Z. Sharafi1, V.S. Nikbin1. 1Pasteur Institute of Iran, Tehran, Iran (Islamic Republic of), 2 Shahid Beheshti University, Tehran, Iran (Islamic Republic of) Background: In recent decades, following the introduction of antibiotic therapy, Pseudomonas aeruginosa has emerged as one of the most important nosocomial pathogens, resulting in high mortality rates. This organism possesses a large number of virulence factors that may contribute to its pathogenicity. ExotoxinA (ETA), encoded by toxA gene, inhibits protein biosynthesis. Elastase (LasB), a zinc metalloprotease encoded by lasB gene, has an elastolytic activity on lung tissue. Aim: To identification of lasB and toxA genes in P. aeruginosa isolated from wound and burn infections in Tehran by using PCR method. Methods: A total of 150 P. aeruginosa isolates (100 burn, 50 wound isolates) was obtained from patients during 1999­2007 of Imam-Khomeini, Tohid and Motahari hospitals in Tehran. The isolates were identified as P. aeruginosa by using PCR method for oprI and oprL genes. Chromosomal DNA of the isolates was extracted by Phenol-Chloroform method and used for PCR of oprI, oprL, toxA and lasB genes. Results: Among 150 P. aeruginosa isolates identified by oprL and oprI genes, 95% carried toxA gene and 97% of them carried lasB gene. Conclusions: The high prevalence of toxA and lasB genes in P. aeruginosa isolated from wound and burn infections indicate that these genes play a major role in infections caused by these isolates. In addition, incidence of toxA and lasB genes in P. aeruginosa obseved almost in 95% of studied isolates. Therefore, these genes are reliable to directly detect of P. aeruginosa from clinical samples in this research.

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ISE.362 Hepatitis B Post Booster Anamnestic Response in Adolescents Exposed to Neonatal Primary Immunization in Republic of Moldova A. Vranceanu-Benes, P. Iarovoi, C. Spinu, O. Benes. National Center for Preventive Medicine, Chisinau, Republic of Moldova Background: Primary vaccination of infants against hepatitis B (HB) virus infection proved effective in prevention of the disease transmission during the childhood. Would it continue protecting efficiently during the adolescence and adulthood or booster doses should be considered for enhanced protection--requires further research. Methods: Prevalence of HB surface antigen (HBsAg), pre- and post booster titers of antibodies against HB surface antigen (anti-HBs), antibodies to HB core antigen (anti-HBc) and anti-HBc-IgM was assessed during 2006 in a national representative sample of 620 children 6­8 and 9­11 years after their complete primary neonatal vaccination. Anti-HBs levels after vaccination were unknown. Results: Pre-booster anti-HBs were undetectable (< 10 IU/L) in 67±4%(CI 95%) of the total sample with no significant variation by age groups. HBsAg was identified in 1%, anti-HBc in 2% and anti-HBc-IgM was present in 0.5% of apparently healthy children. The prevalence of HB markers was slightly higher in children 9­11 years of age comparing those 6­8 years old: HBsAg-0.8% and 0.2%, anti-HBc-1.2% and 0.8% and anti-HBc-IgM-0.3% and 0.2% accordingly. After a booster dose of HB vaccine, proportion of children with undetectable anti-HBs constituted 9±3% (IC-95%). Among children with undetectable pre-booster anti-HBs 13%±4% (IC-95%) did not respond to the booster dose. Proportion of children responding with titers higher than 250 UI/L after the booster dose was 95% for those with detectable pre-booster antiHBs versus 57% for children with undetectable pre-booster anti-HBs. Conclusions: 6­11 years after neonatal primary HB immunization a large proportion of children showed undetectable anti-HBs. Three percent of children developed breakthrough and subclinical infection. Following a single booster dose, more than one in ten children with prebooster undetectable anti-HBs remained unprotected during adolescence. Majority of children with detectable pre-booster anti-HBs developed high post booster titers comparing to six in ten children with undetectable pre-booster anti-HBs. ISE.363 Clinical and Molecular Epidemiological Characterization of Rotaviruses Isolated from a Hospital Neonatal Unit in Korea J.H. Lee1, S.Y. Lee1, J. Lee2, J.H. Kim1, J.H. Kang1. 1Department of Pediatrics, College of Medicine, The Catholic University, Seoul, Republic of Korea, 2Department of Pediatrics, Han-Il Hospital, Seoul, Republic of Korea Background: In Korea, high utilization of new type of facility (called a "postdelivery facility"), in which newborn babies and newly delivered women stay for 2­3 weeks after discharge for the sake of convenience, has led to a marked increase in rotaviral infection in hospital neonatal wards. The purpose of this study is to examine clinical characterization and sequence analysis of rotaviruses for control of nosocomial rotaviral infections at neonatal wards in Korea. Methods: The P and G genotypes of the rotavirus isolates were distinguished based on the results of a reverse-transcription polymerase chain reaction (RT-PCR). The second-round PCR products of the isolates having the same genotype were sequenced and analyzed with reference to sequences obtained from GenBank. Results: Of 988 fecal samples, 8.7% were RV positive. The distribution of disease was divided into 2 periods. The incidence of nosocomial infection decreased from 14.3% (19/133) to 3.4% (9/268) throughout the 2 periods. Although most neonates were infected with viruses having the G4P[6] genotype, the isolates were categorized into several clusters based on nucleotide and amino acid homology. The nosocomial G4 isolates showed remarkably high nucleotide and amino acid sequence homology with community-acquired isolates originated from particular postdelivery facility in same period. Conclusions: To prevent nosocomial rotaviral infections, it is necessary to detect the rotavirus antigen prior to or immediately after admission to the neonatal ward; it is also necessary to restrict the admission of newborns from postdelivery facilities and observe universal precautions as well in Korea.

ISE.364 Antimicrobial Sensitivity Patterns of Staphylococci Isolated Over 4-years from Different Clinical Samples of Patients Contracted with Nosocomial Infections T. Ijaz1, M.A. Muneer2, A.R. Khawaja3, M.A. Khan4, M.K. Shahzad4, M. Imran5. 1Mirobiology Laboratory Mayo Hospital, Lahore, Pakistan, 2 University of Veterinary and Animal Sciences, Lahore, Pakistan, 3 Director Research Cell Mayo Hospital, Lahore, Pakistan, 4Department of Epidemology and Public Health UVAS, lahore, Pakistan, 5Department of Physiology and Biochemistry UVAS, lahore, Pakistan Background: A broad range of diseases are associated with Staphylococci especially Staphylococcus aureus infections whose clinical management has become a worldwide problem for clinicians due to increase in resistance of S. aureus against a number of antimicrobial agents. Although antimicrobial susceptibility and prescription measures to combat Staphylococci infections have been reported for prosperous countries, the same task yet remains to be undertaken in most of the hospitals of developing countries like Pakistan. The present study describes about sensitivity patterns of 1287 Staphylococci isolates to various antibiotics prescribed over a 4-year (March 1999­May 2005) period in the Mayo Hospital Lahore, Pakistan. Methods: A total of 1287 Staphylococci isolates from different clinical samples of patients assigned to various wards of the hospital were categorized into S. aureus (78%) and S. epidermidis (22%) on the basis of their morphological, biochemical and hemolytic characteristics. In-vitro antimicrobial sensitivity of these isolates was tested against 16 antibiotics belonging to various groups using disk-diffusion techniques. Results: Of 1004 S. aureus isolates 555 (55%) were resistant to methicillin (MRSA) and 449 (45%) were sensitive to methicillin (MSSA), and of 283 S. epidermidis isolates 41 (14%)were resistant to methicillin (MRSE) and 242 (86%) were sensitive to methicillin (MSSE). MRSA was found sensitive to vancomycin, while MSSA showed sensitivity to tienam and vancomycin. The same antibiotic sensitivity pattern was seen for MRSE and MSSE isolates. Conclusion: Low sensitivity rates (<50%) of Staphylococci against augmentin, cefuroxime, doxycyclin, erythromycin and klarithromycin suggest that the future use these antibiotics would not be reliable for the treatment of Staphylococci infections. Due to continuous emergence of multidrug resistance in Staphylococci, continuous surveillance on antimicrobial sensitivity of these bacteria could be a better option for the improvement of antimicrobial prescription measures. Key Words: Staphylococci, Antimicrobial sensitivity, Pakistan ISE.365 Bartonella Henselae Infection Presented as a Tender Groin Swelling M.Y.W. Kwan, C.W. Leung. Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong, China An 8-year-old boy enjoyed good past health presented acutely with a painful left groin swelling. There was no other site of lymphadenopathy. The pain was so severe that the initial diagnosis was incarcerated inguinal hernia. Urgent operation was performed and intraoperatively, multiple enlarged inguinal lymph nodes were identified. The lymph nodes were matted together with perinodal inflammation and fibrosis. Histologically, there were aggregates of histiocytes with central prominent necrosis in which variable neutrophilic infiltration and karyorrhexis were seen. Other areas showed marked lymphoid follicular hyperplasia and scattered epithelioid histiocytes. Caseous necrosis and Langerhan's giant cells were absent. There was no evidence of malignancy. Special stains including Ziehl-Neelsen, PAS, Warthin-starry stains were all negative. The overall features were consistent with suppurative granulomatous lymphadenitis. Immunological staining for B artonella Henselaedemonstrated many short bacilli in the centers of the suppurative granulomas. Serological test for Bartonella antibody was positive. The diagnosis was confirmed to be Cat-scratch disease. To document other lymph nodes involvement, CT thorax and abdomen was performed and found no other site of lymphadenopathy. Azithromycin was prescribed for 2 weeks. There was no recurrence of the disease during subsequent follow up. On detailed questioning, the parent revealed a history that the family kept a cat at home but the boy cannot remember whether he was being scratched by the cat or not. Bartonella Henselae infection was rare in Hong Kong. It mostly present as regional lymphadenopathy which suppurates in 30% of cases. Cat is

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a common reservoir of the bacteria, 90% of infected individuals have history of contact with apparently healthy cats or kittens. Histological examination of the lymph node mostly commonly showed the presence of epithelioid granulomas. Diagnosis required the demonstration of the Bartonella organisms in the histological sample or a positive serum antibody to the bacteria. ISE.366 Persistent Atypical Varicella in Renal Transplant Patients and Its Relation to Mycophenolic Acid D. De, S. Dogra, A. Sharma, M. Minz, S. Handa. PGIMER, Chandigarh, India Background: Mycophenolic acid (MPA) is a recently introduced immunosuppressant. Though there are now many reports revealing increased incidence of varicella infections with the use of mycophenolate mofetil (MMF), none have described the altered cutaneous manifestations and course of varicella. Observations: We describe two post renal transplant patients, being treated with tacrolimus, MPA and prednisolone to prevent graft rejection, who presented with bizarre cutaneous manifestations of varicella in the form of multiple papules and plaques studded with tiny necrotic areas having spiny feeling on palpation persisting for a long time. Conclusions: Such atypical manifestations and course of illness may be encountered more frequently in future, when MMF would more commonly be used in post transplant patients, autoimmune diseases and various dermatoses. Dermatologists should have high vigil to diagnose such potentially fatal but treatable infection in time. ISE.367 Antimicrobial Activity of Twenty Antibiotics Against Common Pathogens Associated with Hospital-acquired Infections T. Ijaz1, M.A. Khan2, M.D. Ahmad3, M.K. Shahzad2, S. Ijaz4, M. Imran5, N. Ijaz1. 1Microbiology Laboratory Mayo Hospital, Lahore, Pakistan, 2 Department of Epidemology and Public Health UVAS, Lahore, Pakistan, 3University of Veterinary and Animal Sciences, Lahore, Pakistan, 4Services Institute of Medical Sciences, Lahore, Pakistan, 5 Department of Physiology and Biochemistry UVAS, Lahore, Pakistan Due to extensive use, several antibiotics are continuously losing their activity against common infectious microbes. To evaluate the antimicrobial efficacy of twenty antibiotics, amikacin, ampicillin, ampiclox, augmentin, cephradine, cefoparazone, cefrome, ciprofloxacin, cefuroxime, doxycylin, erythromycin, fucidin, gentamicin, klarithromycin, sparfloxacin, tazocin, tetracycline, tienam, unasyn and vancomycin, an observational study was carried out in a largest tertiary care hospital of the Punjab, Pakistan. A total of 4502 out of 32,620 patients who were hospitalized during 1999­2004, contracted with nosocomial infections. Microbial isolates were identified in 1040 pus and wound swabs, 109 blood samples, 115 pleural fluid samples, 286 peritoneal fluid samples, 37 cerebrospinal fluid samples, 1398 urine samples, 988 sputum and endotracheal secretion samples, 329 burn swabs, 99 patient body devices (catheters, CVP lines, shunts, IV canulae, joint prosthesis etc.), and 101 fecal and drainage tube material samples from these patients. The antimicrobial resistance of the identified isolates was tested against antibiotics of routine use. All of the isolates including Staphylococcus, Streptococcus, Enterococcus, Pseudomonas, Enterobacter, Acinetobacter, Klebsiella, Proteus, Escherichia, Serratia, Haemophilus, other uncommon Gram-positive bacteria, uncommon Gram-negative bacteria, and yeasts and fungi showed resistance (10-80%) to all the tested antibiotics. Most of the isolates were resistant (>30%) to amikacin, ampicillin, ampiclox, augmentin, cefoparazone, cefrome, ciprofloxacin, doxycylin, erythromycin, klarithromycin, sparfloxacin, and tetracycline. The maximum antimicrobial activity was observed for fucidin, tienam, tazocin and vancomycin. The antimicrobial susceptibility patterns of different isolates varied widely against different tested antibiotics (P<0.05). The result of this study would be helpful for Pakistani doctors to choose better prescription options for the treatment of diseases associated with the isolated microbes. Key Words: antibiotics, hospital-acquired infections, Pakistan ISE.368 Measles Surveillance Based on Laboratory Confirmed Cases in Tirana, Capital of Albania During 2006 R. Petrela, H. Hoxha, E. Kallfa, G.L. Lito, A. kallfa, N. Como, E. Skenderi. University Hospital Center 'Mother Theresa', Department of Pediatric, Clinic of Infectious Diseases, Tirana, Albania

Background: Measles is one of the most contagious diseases spread all over the world. Over the last ten years uncontrolled movement of the population in and outside the country, low levels of the hygiene sanitation system, inefficient infrastructure and lack of proper health education in most of the population in our country resulted in the appearance of new cases of this disease in the form of endemics and epidemics every 2­4 years after 18 year extint. Aim: To study some of the epidemiologic data of measles cases during 2006 in Tirana. Materials and Methods: 32 suspected measles cases have been studied aged 0­14 years (30 cases and 2 cases older than 40 years; presented in the infective disease ward with maculopapular rash, high temperature, conjuctivitis, nasopharyngeal secretions). Serum is examined with ELISA by the Health Public Institiute. Results: From the study resulted that all the patients had not been vaccinated for measles. The median age is 1,5 years. From 32 cases 14 of them gypsies. The median serial interval 2 days (time between consequtive rashes). Serologic results were positive in 28 cases and negative in 4 cases; 18 cases lived in urban areas, the other 14 were rurals; 20 males vs. females. Conclusion: Malfunction of the health organization system, low standards of the health education of the population brings about obstacles in proper vaccination the preschool population and are the cause of these outbreaks. Proper vaccination of the child with MMR and booster dose in the school. ISE.369 Phenotypic Detection and Occurrence of Extended-Spectrum Beta-Lactamases in Clinical Isolates of Klebsiella pneumoniae and Escherichia coli at a Tertiary Hospital in Trinidad & Tobago P.E. Akpaka, W.H. Swanston. The University of the West Indies, St. Augustine, Trinidad and Tobago Background: The incidence and distribution of ESBL producing microorganisms such as E. coli and K. pneumoniae have been demonstrated and varies in different health care facilities and as well as other countries. This study was carried out to phenotypically determine the frequency of occurrence and antimicrobial susceptibility pattern of ESBL producing E. coli and K. pneumoniae species from clinical isolates at a tertiary hospital in Trinidad and Tobago. Materials and Methods: Standard microbiological procedures and automated MicroScan System was used to identify, screen for putative ESBL production and determine antimicrobial susceptibility of 1,118 clinical isolates of Enterobacteriaceae species at the microbiology laboratory of the Eric Williams Medical Science Complex, Trinidad & Tobago over a 36 months period. All ESBL producing isolates flagged by the automated system were further confirmed by Etest method. Results: The Etest confirmed a 15.2% ESBL rate among the K. pneumoniae isolates and 9.4% among the E. coli isolates. There was also a 1.8% rate of ESBL production in K. pneumoniae and 0.2% in E. coli isolates from specimens received from community health facilities into the laboratory. Isolates recovered from the intensive care unit of the hospital had 2.1% E. coli and 8.2% K. pneumoniae ESBL producers. Although all ESBL positive isolates were completely susceptible to imipenem and meropenem; and all positive K. pneumoniae isolates were susceptible to amikacin, there was a low susceptibility of ESBL positive E. coli to the aminoglycosides. However, susceptibility of these ESBL producing isolates to the fluoroquinolones varied. Conclusions: There is a high rate of ESBL production among isolates of E. coli and K. pneumoniae at this hospital that is linked to the extensive inappropriate use of third generation cephalosporins in the country. Further molecular studies are needed to characterize the types of these ESBL prevailing in the country. ISE.370 Prevalence Study on Nosocomial Infections in 10 University Hospitals in the Czech Republic B. Cecetkova1, M. Kolarova2, Z. Kancelova1, J. Kratochvilova3, J. Kohoutova4, E. Mickova5, V. Prikazsky6, M. Podzimkova7, H. Sramova8, J. Jirous9, I. Sipova10, J. Kapek11, R. Chlibek12. 1University Hospital of Thomayer, Prague, Czech Republic, 2University Hospital (Brno), Brno, Czech Republic, 3Saint Anne Hospital, Brno, Czech Republic, 4University Hospital (Olomouc), Olomouc, Czech Republic, 5 University Hospital (Hradec Kralove), Hradec Kralove, Czech Republic, 6 State Health Institute, Prague, Czech Republic, 7University Hospital Bulovka, Prague, Czech Republic, 8University Hospital Motol, Prague, Czech Republic, 9University Hospital (Plzen), Plzen, Czech Republic,

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NCB Hospital, Ceske Budejovice, Czech Republic, 11General University Hospital, Prague, Czech Republic, 12University of Defence, Military Medical Faculty, Hradec Kralove, Czech Republic Background: Surveillance of hospital infections includes collection of data on their incidence and ongoing analysis of such data. A group of hospital epidemiologists performed the one-day prevalence studies in 10 University Hospitals in the Czech Republic in the years 2005­2007. The point-prevalence studies included 6 different departments--surgery, urology, neurology, cardiology, neurosurgery and otorhinolaryngology. Aim: To try the simple questionnaire method, easy to perform, easy to repeat, which allows obtaining of cheap, descriptive and clear data in the time line. In each of the 10 University Hospitals, the medical files of all patients hospitalised in the given department of the hospital at the date of prevalence study were checked. Method: From each medical file, the specific information for the unique questionaire were obtained: 1) Descriptive data, patient identification, diagnosis, in case of surgery intervention, also information related to the surgery; 2) Information related to the nosocomial infection and preceeding risk factors (diagnosis of NI according to the CDC criteria); 3) Laboratory and microbiology findings; 4) Information about ATB treatment and prophylaxis Results: Data obtained from the questionnaires was transfered to Excel files, followed by further processing and statisitcs analysis using MS Excel and Epi Info. 1,822 hospitalized patients were checked during these studies. 95 nosocomial infections were found in 6 different departments, i.e. prevalence 5,2 patients with NI on 100 hospitalized patients. The highest rate of NI was found in neurology (7, 2%), followed by surgery (6,5%), neurosurgery (5,9%), cardiology (5,2%) and urology (4,5%). The lowest rate was reported from otorhinolaryngology (0,4%). The high rate in neuorology was reported due to the peak in occurrence of NI in one of the hospital (21,4% of NI). Conclusion: We have confirmed that prevalence studies are optimal tool to determine the NI and define NI control priorities when resources are limited. ISE.371 Antibiotic Resistance in An Oncological Hospital A. Jovicevic Bekic, S. Ristic, D. Jovicevic. Institute for Oncology and Radiology of Serbia, Belgrade, Serbia

ISE.372 CTX-M-15 Extended-Spectrum Beta-Lactamases Detected from Intensive Care Unit of an Egyptian Medical Research Institute N.S. Fam, M.M. El-Damarawy. Theodor Bilharz Research Institute, Cairo, Egypt Several studies from Egypt have pointed to a high prevalence of Enterobacteriaceae producing extended-spectrum -lactamases (ESBLs) among hospitalized patients and in intensive care settings. However data regarding the molecular types of ESBLs are scarce. The study was conducted to investigate this issue and the utility of introducing the one-step modified double synergy test (MDDST) for detection of ESBLs in different bacterial species. Methodology: We studied 85 Gram negative bacterial isolates isolated from the ICU. Phenotypic characterization of ESBLs was detected by the double disc synergy test (DDST), combination disc test (Oxoid CDO2) and by the modified version of the DDST (MDDST. Isolates showing resistance to cefoxitin were also tested by cloxacillin agar dilution test (300µg/ml). Molecular analysis was performed for a subset of the ESBL-producing isolates.Genes for bla TEM, bla SHV and bla CTXM genes were amplified by PCR and genetic sequencing was performed by the ABI 3100 DNA sequencer. Results: Phenotypic characterization identified a high ESBL rate of 65.8%. ESBLs were detected among the following species: Klebsiella pneumoniae (46.4 %), Escherichia coli (35.7 %) Klebsiella oxytoca (8.9 %), Proteus mirabilis (5.3%), Serratia marcescens (1.7%) and Citrobacter freundii (1.7%). The DDST and MDDST easily detected all ESBL-positive isolates except the Serratia and Citrobacter isolates that were detected as ESBL-positive by the MDDST only. Cefotetan was a better indicator of sensitivity to cephamycins than cefoxitin. All the ESBL-positive isolates were multidrug resistant (MDR). PCR amplification showed that the ESBL-producers analyzed were positive for the bla CTX-M and the bla CTX-M1 genes. Within the CTX-M1 group only one type of enzyme, CTX-M-15, was found. Conclusions: The MDDST is a rapid and cost-effective method for ESBL testing. It is superior to the DDST in detecting ESBL-production in bacterial species other than E. coli and Klebsiellae. The detection of the CTX-M-15 emphasizes that this enzyme is one of the most common worldwide. The high prevalence of MDR ESBL-positive isolates calls for the judicious use of imipenem, especially in developing countries where antibiotics are available without prescription. ISE.373 Sequential Changes of Serum Interleukin-18 Levels and Their Clinical Significance in Pegylated Interferon Alpha 2a-Treated Patients with Chronic Viral Hepatitis C S.M. Lin, Y.L He, T.Y. Chen, T.G. Zhao. Hepatology Institution, xi'an city, China, Hepatology Institution, Xi'an city, China Aim: The aim of this work was to analyze the serum levels of proapoptotic interleukin (IL)-18 in patients with chronic hepatitis C (CHC), at baseline and after treatment with pegylated interferon alpha-2 (PEGIFN). Methods: Thirty-one patients with CHC were studied, at baseline and after treatment with pegylated interferon alpha-2a (PEG-IFN) for 24 weeks. A group of 15 healthy sex- and age-matched individuals was selected as control. Evolution of the serum concentrations of IL-18 was analyzed after treatment. Response to treatment was assessed according to clinical and virological changes. Results: Fifteen (48.3 %) achieved sustained response by 24 weeks PEG-IFN treatment, while 8 (25.8 %)patients were relapsers and 8 patients were non-responders (25.8 %). All patients with CHC had raised IL-18 levels comparing control (113.4±30.4 pg/ml versus 66.9±19.5 pg/ml; P<0.01). Serum IL-18 levels showed a positive correlation with serum ALT levels(r=0.66, P<0.05). In sustained responding group, a significant decrease of IL-18 serum levels was observed at week 12 and 24. Increased levels persist in those in whom the HCV infection was not eliminated by the therapy. Conclusion: The trend of the serum levels of IL-18 show the severity of liver inflammation, but also can be used as the index of investigating the therapeutic effect of PEG-IFN treatment. The patients whose serum level of IL-18 is higher before treatment are more possible to get lastingrespondence

Background: For oncology patients, infectious diseases are important causes of morbidity and mortality. Neutropenia, other treatment-induced conditions (immunodeficiency related to high dose corticosteroids, disruption of mucosal barriers by chemotherapy or radiation therapy, etc.), conditions related to malignant disease itself or to comorbidity can predispose patients to severe or recurrent infections. At the Institute for Oncology and Radiology of Serbia, one of the components of the hospital infection control program is constant organized surveillance of all microbiological findings including the monitoring of bacterial antibiotic resistance. Objectives: The goal of the study was to analyze bacterial antibiotic resistance in microbiological findings of cancer patients. Methods: Antibiotic resistance in bacteria isolated from patients at the Institute for Oncology and Radiology of Serbia in the 18 months period, from January 2005 to June 2006 was analyzed. Six strains were included in the analysis: Staphylococcus aureus, Enterococcus, Streptococcus pneumoniae, Streptococcus beta haemoliticus, Pseudomonas and Acinetobacter. Results: During the 18 month period, there were overall 1323 isolates from surgery, chemotherapy, radiotherapy and intensive care departments of the Institute. More than half (720 i.e. 54%) were isolates with six strains that were included into analysis. Out of 386 isolates of Staphylococcus aureus, 84 (22%) were methicillin-resistant. As for Pseudomonas, there were 60 resistant strains out of 158 (38%); for Acinetobacter 19 out of 24 (79%), for Enterococcus 9 out of 112 (8%), and for Streptococcus pneumoniae 2 out of 12 (17%). No resistant strains were found among 28 isolates with Streptococcus beta haemoliticus. Resistant strains were most frequently isolated from wounds (83), tracheostoma (56) and urine (22) specimens, depending of the department. Conclusion: In our study, we found antibiotic resistance in one fourth of isolates of six strains included into analysis. Highest share of resistant strains was found for Acinetobacter, Pseudomonas and S. aureus. Antibiotic resistance has been causing major problems in the last few years and, therefore, constant surveillance is necessary.

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ISE.374 Nosocomial Reservoirs: Are Staff Involved? S.P. Gunasekara1, J. Faoagali2. 1Teaching Hospital, Karapitiya, Galle, Sri Lanka, 2Princess Alexandra Hospital, Brisbane, Australia Background: Nosocomial or Health Care Associated (HCA) infections are a major source of morbidity and mortality in hospitalised patients. The majority of HCA infections are transmitted by the contact route, primarily by health care workers. This study was carried out to determine the density, type and antibiotic resistance of bacteria found on name badges, wristwatch sites and neck ties of the health care workers. Method: This was a prospective study carried out over three months. Samples were obtained from name badges, neck ties and wrist watch sites of duty staff. A total of 168 samples were collected from 90 name badges, 44 wristwatch sites and 34 neck ties. Samples from the name badges and wristwatch sites were obtained using a sticky tape technique. The sticky tape was imprinted onto the site and then onto the centre of a blood agar plate in the work area. For neck tie sampling the end of the neck tie were pressed onto a blood agar plate. All plates were incubated for two days in air at 370C. Bacterial colonies of each inoculum were counted and identified by colony morphology, gram stain and standard biochemical tests. Antibiotic resistance of the isolates were tested by antibiotic agar screen method. Results: 25% of the name badges, 27% of wrist watch sites and 73% of neck ties were colonised with potentially pathogenic microorganisms. Discussion: This study showed that name badges, neck ties and wristwatch sites can harbour pathogenic micro-organisms. Routine cleaning of name badges is being investigated. In the case of neck ties previous studies confirmed that they can be colonised with micro-organisms. Health care workers should be encouraged to wear bow ties. It is well documented that wearing a wrist watch reduces effectiveness of hand washing. Watches clipped to clothing would be an alternative. ISE.375 Typing of Human Enterovirus Isolated from Outbreak of Aseptic Meningitis in Japan A. Yamada1, K. Yamazaki2, Y. Yokota3, N. Sakon2, H. Yoshida4. 1The University of Shiga Prefecture, Hikone, Shiga, Japan, 2Osaka Prefectural Institute of Public Health, Osaka, Japan, 3Ritsumeikan University, Kyoto, Japan, 4National Institute of Infectious Diseases, Tokyo, Japan Background: An outbreak of aseptic meningitis including adults occurred in Shiga Prefecture, Japan in 2000. Isolates from the outbreak could not be typed by neutralization assay using commercial antiserum. Further genetic analysis of the partial VP1 region encoding a surface protein suggested that they were echovirus type 4.The objective of this study is to analyze the base sequences of isolates and characterize isolates of echovirus type 4. Methods: Thirteen cerebrospinal fluid (CSF) samples and ten throat swab samples from 14 patients were examined in this study. Sequences of isolates from these samples were compared with sequences of other samples of echovirus type 4 isolated in different years and/or from different places. Phylogenic trees were constructed from the aligned nucleotide sequences by the maximum likelihood and neighbor-joining methods. Results: Echovirus type 4 was isolated from the four samples of CSF and one throat swab sample from five out of 14 patients during the outbreak. The patients from whom the virus was isolated ranged in age from 5-50 years old. Partial VP1 region sequences were determined, and all were 316 nt in length. Analysis of the phylogenic trees demonstrated that the echovirus type 4 sequences segregated into two distinct major groups based on the country of isolation. The first group included echovirus type 4 prototypes, Pesascek, and the isolates in Western countries. The second group included viruses isolated in Japan and China. Moreover, the viruses isolated in Japan belonged to this same group even though the viruses were isolated in different years, 1989, 1996 and 2000. Conclusion: 1) Different genotypes of echovirus type 4 are circulating in different countries. 2) There might be a concentration of echovirus type 4 in circulation in a limited area.

ISE.376 Increased Rate of Methicillin Resistance Among Staphylococcus aureus Isolates at a Major General Hospital Located in Northern Italy A. Nanetti1, R. Manfredi2. 1Dept. of Microbiology, University of Bologna, S. Orsola Hospital, Bologna, Italy, 2Dept. of Infectious Diseases, University of Bologna, S. Orsola Hospital, Bologna, Italy Background: The increased rate of methicillin resistance among Grampositive cocci is a general concern,especially in the hospital setting. A prospective microbiological monitoring including a continued surveillance of antimicrobial susceptibility rates,is ongoing at our General Hospital,located in Bologna,Italy. Materials and Methods: The temporal variations of in vitro antimicrobial sensitivity figures were examined quarterly for all suitable Staphylococcus aureus, during the year 2007. The same pathogen cultured more than once from the same patient within one month,has been considered one time only. Results: Among Staphylococcus aureus isolates (357 strains tested on the whole),both available glycopeptides (vancomycin and teicoplanin), maintained a full 100% sensitivity profile over time, while the rate of methicillin resistance showed a significant growth from January-March 2007 (40.7% of tested strains), to April­June 2007 (47.5%), to JulySeptember (42.2%), up to October­December 2007 (56.0% of tested strains) (p<.01). When considering antibiotics other than beta-lactam ones, cotrimoxazole maintained a consistently elevated activity over time (92.3% to 100% of microbial strains tested during the study period), followed by choramphenicol (82.7% to 87.8% of tested strains), and rifampin (67.6% to 73.5% of tested strains), while clindamycin showed a worse sensitivity profile (48.1% to 57.9% of tested strains), as well as erythromycin (48.8% to 57.9% of tested strains), and gentamicin (40.4% to 52.5% of tested strains). Among antimicrobial compounds other than beta-lactam derivatives, no significant rates of antibiotic susceptibility rates were observed during the study period, against Staphylococcus aureus isolates. Conclusions: A prospective bacteriological surveillance of antimicrobial susceptibility rates of a major hospital-associated microorganism like Staphylococcus aureus is relevant to establish reliable guidelines of antibiotic treatment and prophylaxis, on both local and regional basis. Despite a significant increase of methicillin resistance rates, "older" compounds like cotrimoxazole, chloramphenicol and rifampin, may still play a role in selected clinical instances, while the activity of vancomycin and teicoplanin remains fully preserved until now. ISE.377 Frequency and Antibiogram Pattern of Coagulase Negative Staphylococci in Clinical samples in a Teaching Hospital, Bandarabbas, Iran S. Javadpour 1, M. Jahed2, N. Moradi2, E. Karimi2. 1Infectious Disease Research Center Hormozgan University of Medical Sciences, Bandarabbas, Iran (Islamic Republic of), 2Hormozgan University of Medical Sciences, Bandarabbas, Iran (Islamic Republic of) Background: Coagulase Negative staphylococci (CoNs), commonly known as part of normal biota of human body (skin and mucosa) have become a predominant pathogens over the last decades. Due to the vast use of antibiotics for therapy or prophylaxis, those CoNs strains acquired in the hospitals have become resistant to various antimicrobial agents. According to this regard, the aim of this study was to determine frequency and anti-biogram pattern of CoNs in clinical specimens transferred to Shahid Mohammadi Hospital laboratory. Methods: A descriptive cross-sectional study was carried out from December 2005 to June 2006 on 5063 clinical samples. Identification of CoNs was performed by routine microbiological methods using gram staining, catalase and coagulase tests. Susceptibility of microorganisms to 15 antibiotics was determined by Kirby-Bauer Method. Results: Among 1573 positive cultures, 17.5% of isolates were CoNs. 73.9% of isolates belonged to OPD and 26.1% were obtained from hospitalized patients. Most of CoNs were isolated from Internal (38.9%) and Internal emergency wards (34.7%). Among different clinical samples, CoNs were mainly isolated from urine cultures (78.6%) in women. Vancomycin (100%) and Imipenem (94%) were found to be the most effective antibiotics. Conclusions: Due to the increasing prevalence of CoNs infections, and multi-resistant strains, it is of great important to attention to frequency and anti-biogram pattern of this microorganism.

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ISE.378 The Anti Psedomonas and Shigella Effects of Some Lactic Acid Bacteria that Present in Home Made Youghurt in North of Iran E. Kiaie1, N. Amirmozafari2. 1Islamic Azad University, Gorgan, Iran (Islamic Republic of), 2Medicinal University of Iran-Tehran, Tehran, Iran (Islamic Republic of) The antimicrobial effect of twenty lactic acid bacteria isolated from home made youghurt was detected on Psedomonas aeroginosa and Shigella dysenteria during seven assays. These assays include: The direct exposure to lactic acid bacteria; the exposure to the supernatant of lactic acid bacteria; spot culture of lactic acid bacteria; usage of paper disc contaminated with lactic acid bacteria isolation of bacteriocin like substances by ethanol 95%; the usage of soft BHLA; and the preparation of an inhibition curve and PH. Except the last method, in all other tests the lactic acid bacteria were examinated in the media contaminated with 103 CFU Psedomonas aeroginosa and Shigella dysenteria. The seven bacteria showed anti Psedomonas and Shigella effects. Four of them (Lactobacillus lactis, Lactobacillus Fermentum, Lactobacillus delbrukii, Lactobacillus sake) with less amounts (20 microne) had anti bacterial effect too. In 28+1°C amore rapid inhibition acitivity was observed for these four bacteria than in 4°C. ISE.379 A Four-Year Trend of in vitro Sensitivity Profile of Staphylococcus aureus Strains Cultured at a Teaching Hospital of Northern Italy A. Nanetti1, R. Manfredi2. 1Dept. of Microbiology, University of Bologna, S. Orsola Hospital, Bologna, Italy, 2Dept. of Infectious Diseases, University of Bologna, S. Orsola Hospital, Bologna, Italy Background: The increased rate of drug resistance among Gram-positive cocci is a general concern, especially in hospital settings. A prospective bacteriological monitoring including a continued surveillance of antimicrobial susceptibility rates, is ongoing at our General Hospital, since the year 2004. Materials and Methods: The temporal variations of in vitro antimicrobial sensitivity figures were examined quarterly for all suitable Staphylococcus aureus strains, and followed from 2004 to 2007. The same pathogen cultured more than once from the same patient within one month, has been considered once. Results: Among overall Staphylococcus aureus isolates (1,863 strains tested on the whole), a complete (100%) sensitivity was shown against vancomycin and teicoplanin, while some compounds retained interesting activity (92.0­97.1% for cotrimoxazole, 76.1­88.7% for chloramphenicol, 64.1­69.5% for rifampin). Oxacillin (methicillin) resistance ranged from 46.2% of year 2007, to 53.3% of year 2005. As a consequence, beta-lactam derivatives proved an in vitro activity of 46.7­54.1% for co-amoxiclav, 46.6­54.1% for cefotaxime, and only 7.3­11.2% for penicillin. Among other tested molecules, clindamycin reached a comprehensive 50% susceptibility rate (40.8­54.3% of all tested strains), followed by erythromycin (40.3­54.7%), and gentamicin (42.6­49.5%). No statistically significant temporal variations of antimicrobial susceptibility rates occurred during the four-year study time Conclusions: A long-term bacteriological surveillance of antimicrobial susceptibility rates of relevant hospital-related microorganism like Staphylococcus aureus is important, to found reliable guidelines of antibiotic treatment and prophylaxis, in common clinical settings. Despite a stable, significant rate of methicillin resistance rates (mean value around 47% of all Staphylococcus aureus isolates), we have to underline that "older" compounds like cotrimoxazole, chloramphenicol, and also rifampin, may still play some role in selected clinical situations, while the activity of available glycopeptides is 100% maintained presently. ISE.380 Escherichia Coli and Other Enterobacteriaceae. Antimicrobial Susceptibility Trends in a Four-Year Prospective Surveillance Hospital Monitoring A. Nanetti1, R. Manfredi2. 1Dept. of Microbiology, University of Bologna, S. Orsola Hospital, Bologna, Italy, 2Dept. of Infectious Diseases, University of Bologna, S. Orsola Hospital, Bologna, Italy Background: The changed rate of drug resistance among Enterobacteriacera is a relevant issue, especially in hospital facilities. A prospective microbiological surveillance based on a continued monitoring of in vitro antimicrobial susceptibility rates, is ongoing at our General Hospital, since the year 2004.

Materials and Methods: The temporal variations of in vitro antimicrobial sensitivity trends were updated quarterly for all suitable Enterobacteriaceae strains, followed from year 2004 to year 2007. The same pathogen cultured more than once from the same patient within one month, has been considered one time only. Results: Among overall Escherichia coli isolates (4,413 strains tested on the whole), imipenem and colistin maintained a full (100%) in vitro activity, followed by amikacin (97.3­99.5% of tested strains), nitrofurantoin (89.2­94.8%), piperacillin-tazobactam (89.0­93-9%), gentamicin (81.9­89.4%), ceftazidime (78.3­89.5%), cefotaxime (78.0­89.8%), and ciprofloxacin (63.8­73.9%). When considering Enterobacteriaceae other than Escherichia coli, imipenem and colistin remained 100% active, followed by amikacin (94.9­97.2%), piperacillin-tazobactam (78.4­86%), cotrimoxazole (72.1­78.0%), gentamicin (74.0­77.3%), norfloxacin (66.4­76.2%), ceftazidime (62.7­69.7%), and cefotaxime (62.3­69.0%). The emerging spread of enlarged-spectrum beta-lactamase production significantly reduced the activity of third-generation cephalosporins over time (from a mean of 89.7% of susceptible Escherichia coli strains in the year 2004, to 78.1% in the year 2007; p<.001; and from a mean of 69.7% of sensitive Enterobacteriaceae strains in the year 2004, to 62.4% in the year 2007; p<.03). Also fluoroquinolones and protected beta-lactams suffered from a drop of their in vitro sensitivity rates (p<.02 to p<.005). Conclusions: A long-term prospective bacteriological monitoring of antimicrobial susceptibility rates of relevant hospital-related microorganisms like Enterobacteriaceae is of paramount importance, to plan antibiotic treatment and prophylaxis schedules, in common, local clinical settings. Despite a maintained activity of carbapanems the old colistin, a significant trend toward increased resistance rates was found over a four-year observation period, with extended-spectrum beta-lactamase secretion playing a major role. ISE.381 Pseudomonas aeruginosa and the Hospital: Antimicrobial Susceptibility Trends Over a Four-Year Observation Period A. Nanetti1, R. Manfredi2. 1Dept. of Microbiology, University of Bologna, S. Orsola Hospital, Bologna, Italy, 2Dept. of Infectious Diseases, University of Bologna, S. Orsola Hospital, Bologna, Italy Background: A prospective microbiological surveillance monitoring including culture and systematic in vitro antimicrobial susceptibility studies of all relevant pathogens, is ongoing at our Hospital. Particular attention has been deserved to Pseudomonas aeruginosa, and a leading Gram-negative, often multiresistant organisms in hospital settings. Materials and Methods: The temporal variations of in vitro antimicrobial sensitivity rates of all isolated Pseudomonas aeruginosa strains were collected for all suitable isolates, during the four-year period ranging from January 2004, up to December 2007. The same pathogen cultured more than once from the same patient within one month, was considered one time only (one episode). Results: Among Pseudomonas aeruginosa isolates (2,083 evaluable tested strains), the best performance was obtained by the old colistin (colimycin), with a sustained 100% susceptibility rate, followed by amikacin (72.8­81.2% of tested strains), imipenem (76.8­80.8%), piperacillin-tazobactam (70.9­78.7%), ceftazidime (68.9­77.1%), and tobramicin (64.6­70.9%). On the other hand, gentamicin (55.1­63.5% of tested strains), aztreonam (57.5­66.8%), ciprofloxacin (55.7­65.0%), ticarcillin-clavulanate (53.7­60.5%), and mezlocillin (48.4­55.2%), proved less affordable. A significant temporal trends towards a reduced antibiotic sensitivity was found for the majority of tested molecules, but it resulted significant for aztreonam, ciprofloxacin (p<.001), ticarcillinclavulanate (p<.02), and mezlocillin and tobramicin (p<.04). Conclusions: A prospective monitoring of antimicrobial susceptibility rates of a major hospital-associated organism like Pseudomonas aeruginosa is relevant, to add to local and national guidelines of antibiotic treatment and prophylaxis. Despite a significant increase of resistance rates against the majority of compounds which usually test active against Pseudomonas aeruginosa, however amikacin, carbapanems, piperacillintazobactam, amikacin, imipenem, and ceftazidime still maintain a reliable role in eventual, empiric regimens to be added pending microbial isolation and in vitro sensitivity assays, since they remained active in at least 70% of hospital isolates of the last four years (2004­2007). Colistin, which maintains full in vitro activity against all Pseudomonas strains, remain as a possible component of combined antimimicrobial strategies, when multiresistant pathogens are of concern.

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Obstetrical-Gynecological, Surgical and Sexually Transmitted Infections

ISE.382 Current Therapy Bosnian Neonatal Herpes Simplex Virus Infections A. Semic1, A. Bajraktarevic2, M. Miokovic2, A. Skopljak2, A. DjurdjevicDjulepa3, Z. Jatic4, Z. Begic5, I. Kalkan5, H. Khatib6. 1Pediatrics Clinic Manchester, Manchester, United Kingdom, 2Public Health Institution Sarajevo, Sarajevo, Bosnia and Herzegovina, 3General Hospital Sarajevo, Sarajevo, Bosnia and Herzegovina, 4Medical Faculty of Sarajevo, Sarajevo, Bosnia and Herzegovina, 5Pediatrics Clinic, Sarajevo, Bosnia and Herzegovina, 6Pediatrics Clinic Doha, Doha, Qatar Introduction: Neonatal herpes simplex virus (HSV) infections are transmitted from an infected mother, usually vertically, during delivery. Newborns can develop herpesvirus infections through contact with infected secretions in the birth canal. Materials and Methods: Diagnosis is made by culturing the blood, cerebrospinal fluid, urine and fluid from eyes, nose and mucous membranes. Results: The incidence of infection is approximately one per 3,000 to 20,000 live births. Most of these infections are caused by HSV-2, but 15 to 30 percent are found to be caused by herpes simplex virus type 1 (HSV-1). Clinics and Therapy: The diagnosis of neonatal HSV can be difficult, but it should be suspected in any newborn with irritability, lethargy, fever or poor feeding at one week of age. All infants suspected to have or who are diagnosed with an HSV infection should be treated with parenteral antiviral therapy. Discussion: Neonatal herpes simplex virus infections can result in serious morbidity and mortality. Conclusion: The duration of disease before antiviral therapy is initiated is significantly correlated with morbidity and mortality. All HSV-exposed neonates should be monitored closely for any signs of infection, and cultures for HSV-1 and HSV-2 should be obtained quickly.

Hospital (outpatient and inpatient) consecutively in the year 2005 were tested for the presence of cytomegalovirus antibodies. The diagnosis of cytomegalovirus infection was based on the presence of elevated IgG or IgM antibodies. Results: Out of the 75 women tested, 14 (18.7%) had elevated antibody levels. Conclusion: The prevalence of CMV is not well documented in Libya. The present study showed a CMV seroprevalence among reproductive age group women of 18.6 percent. Key Words: Cytomegalovirus, prevalence, women in reproductive age group, IgG, IgM ISE.384 Correlates of Sexually Transmitted Infections (STI) Among Young Ghanaian Women S.A. Ohene1, I. Osei-Akoto2. 1National AIDS/STI Control Programme, Accra, Ghana, 2University of Ghana, Accra, Ghana Background: Though the highest STI prevalence has been recorded among 15­24 year old Ghanaian women, there is little research on correlates of STI in this population. The study sought to identify factors associated with a history of STI in Ghanaian women 15­24 years. Methods: The study was a cross-sectional secondary data analysis of 1280 sexually experienced females from the 2003 Ghana Demographic Health Survey. Using chi square and t-test, those with a history or symptoms of STI were compared with those denying such a history on demographic, individual and partner level variables. Significant variables were entered into logistic regression to identify variables associated with STI. Results: More than 60% of the study population did not know where to get condoms and less than 20% used a condom at the last intercourse. Compared to those denying a history of STI, the STI group was less likely to know where to get condoms (23% vs 37%, p=.001) but the STI group was more likely to use a condom at their last sexual encounter (27% vs 17%, p=.003). Women in the STI group were significantly less likely to discuss family planning with their partners and more likely to have 2 or more partners in the preceding 12 months. Logistic regression showed that factors associated with STI among sexually active Ghanaian female youth included lack of knowledge of source of condoms and not discussing family planning with partner. Conclusion: Three out of five sexually experienced Ghanaian female youth do know where to get condoms. Lack of knowledge of source of male condoms was identified as a risk factor for STI for these women. This study highlights the need for providers of reproductive health services to female youth to include specific information on where to obtain condoms as part of STI prevention interventions. ISE.385 Tuberculosis of a Genitourinary System--Is Surgical Intervention Inevitable? E. Kulchavenya. Research TB Institute, Novosibirsk, Russia Genitourinary tuberculosis saves an importance till now. As in newrevealed patients cavernous nephrotuberculosis predominates, standard chemotherapy is insufficient, as rule, different surgical intervention is necessary. Aim: To study if it is possible to reduce or avoid operation in complex treatment of genitourinary tuberculosis. Methods: 668 patients with genitourinary tuberculosis were enrolled in our investigation. 518 were treated with standard polychemotherapy (1 group) and 150 in addition received complex pathogenetic therapy, including laser (2 group). Among 518 patients 318 (61,4%) had cavernous and polycavernous nephrotuberculosis. In 2 group cavernous nephrotuberculosis was diagnosed in 48 (32%); polycavernous - in 46 (30,7%). Thus, the extensive injury of kidneys was estimated in 69,3% patients. Destruction in both kidneys was revealed in 58 patients (38,7%). Laser therapy was conducted with red and infra-red lasers, indications were as follows: destruction of kidney parenchyma, infiltrative-tubercleous and erosive-ulcerous tuberculosis of an urocystis, ulcerous ureteritis, formed stricture of ureter. Results: Standard conservative therapy in 518 patients in 1 group was effective totally in 40,4±6,3%; among 318 with cavernous nephrotuberculosis 262 patients (82,4%) were operated, mainly nephrectomy. In 2 group the efficiency of complex therapy was 76,5±4,7%; only 45,3±6,8% underwent surgical intervention. Conclusion: Application complex pathogenetic treatment including laser at the same time with standard chemotherapy improved total efficiency on 36,1% and allowed reduce the need of surgical intervention twice.

ISE.382 Antivirotics medicaments in Bosnia. ISE.383 Prevalence of Cytomegalovirus Antibodies Among Young Women Attending Ibn-Sina Hospital, Sirte, Libya A. Mohamed Elahwel, S. Bagar, S. Alani, R. Bayou. Faculty of Medicine, Sirte, Lybia Arab Jamahiriya Background: Cytomegalovirus (CMV) is the most common virus causing congenital infections of the foetus. The high risk of foetal infection makes it important to study the prevalence of CMV among women in the reproductive age group (15­45 years) in different populations. Patients and Methods: Seventy-five women in the reproductive group attending the Department of Obstetrics and Gynaecology at Ibn Sina

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ISE.386 Prostate Tuberculosis--New Sexual Transmitted Disease E. Kulchavenya. Research TB Institute, Novosibirsk, Russia Introduction: Urogenital tuberculosis is most widespread between extrapulmonary forms. Tuberculosis of the prostate is not rare disease-- up to 5% prostatitis in Siberia are tuberculous. Combination nephrotuberculosis with tuberculosis of a prostate is much more often. 52,2% of the men with kidney tuberculosis has genital tuberculosis also. Unfortunately, as rule, inspection of patient with prostatitis doesn't include investigation on tuberculosis that results in late diagnosis and incorrect treatment. Materials and Methods: 84 patients with tuberculosis of prostate were involved in our study. The diagnosis was verified by bacteriological or pathomorphological methods. The age of patients was from 20 till 68 years. Infiltrative tuberculosis of prostate was in 52 patients, and cavernous tuberculosis--in 32. In 5 cases (5,9%) sexual partners of the patients also had genital tuberculosis. All patients received chemotherapy (Isoniazidum + Streptomycinum + Rifampicinum). 43 patients from them were as control, and 41 were treated with low intensity laser. The results of treatment estimated by following criteria: sanation of prostate secretion, the termination of growth of Mycobacteria Tuberculosis, local immunological tests, and functional tests. Results: Laser Therapy in combination with chemotherapy promotes to increase of Isoniazidum concentration in lesion twice and Rifampicinum concentration--in 6,5 time. Complex treatment allows to save functional possibilities of genital system and to increase efficiency of therapy on 42,1%. In 80% patients receiving only chemotherapy tuberculous prostatitis became chronic disease, with constant latent inflammation in prostate, and only 20% were cured. Whereas the efficiency in laser group was 62,1%. Conclusions: Tuberculous prostatitis is sexual transmitted disease, so both partners should be treated simultaneously. Patients with prostatitis exactly need special examination on tuberculosis. The treatment of tuberculous prostatitis has to include laser therapy. ISE.387 Syphilis Has No Virological-Immunological Interference with the Course of HIV Disease R. Manfredi, S. Sabbatani, L. Calza. Infectious Diseases, University of Bologna, Bologna, Italy Background: The reciprocal influence of HIV infection and syphilis are not completely understood. Patients and Methods: After the recent evidences of a recrudescence of sexually-transmitted diseases (STD) during HIV infection, since the year 2001 we carried out an observational study on a cohort of over 1000 HIV-infected patients (p). Fifty-four p (36 homo-bisexuals and 18 heterosexuals, aged 23­58 years) were identified as novel cases of syphilis (S) (secondary S in 39 cases, primary or latent disease in the remaining episodes). Results: All p were assessed and treated based on standardized protocols, and followed for the 12­24 subsequent months. Immunological data including at least 6 months preceding S and at least 9 months following S were available. All p save six took HAART, according to current international recommendations. During the over-18-month observation period, no statistically significant trend of laboratory parameters of HIV disease was seen in our HIV-infected p co-infected with S. Discussion: Although interactions between S and HIV were not deeply investigated until now, the HIV-related quantitative and functional damage of cell-mediated immunity could modify the course of S. Concurrently, during S an impairment of cellular migration and clearance, and 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 mechanisms capable of infuencing significantly the HIV disease course, especially when an effective HAART treatment concurs. While we agree with the concerns related to STD in p with HIV or exposed to HIV, differently from 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 givers should take into consideration all suspected STD in HIV-infected p, only prospective case-control studies may answer questions associated with the potential existence of bidirectional pathogenetic-clinical interactions between S and HIV infection.

ISE.388 Severe, Hyperacute Luetic Hepatitis Heralding the Detection of HIV Infection R. Manfredi. Infectious Diseases, University of Bologna, Bologna, Italy Background: Only anecdotal cases of patients (p) with initially overlooked-missed syphilis, who developed a predominant hepatic involvement, were described to date. Case Report: A recent case of acute hepatitis was observed in a p with unsuspected syphilis and HIV infection. A p at risk for sexually-transmitted diseases (STD) came to our attention three weeks after the appearance of a diffuse erythematous-papular 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. Discussion: 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.389 Prevalence of Cervical Chlamydia trachomatis and Neisseria gonorrhoeae in Indonesian Female Sex Workers Using Gen-Probe's Aptima Combo2 Test J. Schachter1, J. Moncada1, D.N. Wirawan2, P. Muliawan2, E.A. Donegan1. 1University of California, San Francisco, San Francisco, CA, USA, 2Kerti Praja Foundation, Denpasar, Bali, Indonesia Objective: In previous studies, we have reported extremely high prevalences of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) cervical infection among female sex workers (FSWs) in Jayapura, Surabaya and Timika, Indonesia using nucleic acid amplified tests (NAAT). Similar high rates of infection among FSWs were found in Denpasar (CT 41%, GC 61%). We screened the same population of FSW in Denpasar seven years later by AC2 (APTIMA Combo2, GenProbe Inc) test for CT and GC. Methods: Symptomatic and asymptomatic FSWs were tested at a STI clinic in Denpasar, Bali, Indonesia during a three-month period. We collected 600 cervical swabs and froze them at -20° C within 24 hrs of collection. Samples were sent on dry ice to UCSF for AC2 testing. A random selection of positives were confirmed by repeat testing and either the ACT (APTIMA Chlamydia trachomatis) or the AGC (APTIMA Neisseria gonorrhoeae) test. The latter two NAATs have alternate targets. Results: Overall, prevalence of CT and GC was 45% (272/600) and 35% (212/600). There were 22% (131 /600) concomitant infections. We confirmed 100% of the CT (77/77) and GC (75/75) select positives. Conclusions: We found high rates of CT and GC in Indonesian FSWs attending the Denpasar STI clinic by the AC2 test. Compared to results found seven years ago by the LCx (Abbott Laboratories--discontinued NAAT) test, CT prevalence by AC2 (45%) was similar (41%) to LCx. However, GC prevalence (35%) was lower than those reported in the past (61%), possibly due to active counseling, condom promotion and syndromic management of STIs among FSW. This strategy appears to have no impact on the reduction of chlamydia infection, and rates of GC are still extremely high. Clearly, new local strategies, implementation of sensitive CT and GC detection tests and effective treatment of STIs are needed in the Indonesian FSW population.

International Scientific Exchange · 91

ISE.390 Endocervical Swab Versus Evacuated Conceptus in Isolation of Bacteria Among Septic Abortion Cases Y. Htwe, W. Maw, M. Lwin, K. Myint, M. Aung. University of Medicine, Yangon, Myanmar Septic abortion remains one of the most serious threats to the health of women throughout the world, including Myanmar. The bacteriological profile and antimicrobial susceptibility pattern of endocervical swabs and evacuated conceptus from septic abortion cases admitted to North Okkalapa General Hospital were studied. The study was started from March to August, 2006. Cross sectional descriptive study: standard isolation and identification of bacterial pathogens from thirty samples of endocervical swabs and also evacuated conceptus tissues from the same cases were carried out aerobically. Endocervical swab specimen can be taken during vaginal examination, ie.on admission to hospital.Some Obstetricians and Gynecologists suggested to take evacuated conceptus as an alternative sample for isolation of bacteria in septic abortion cases. On admission to hospital, depending upon the patient's clinical condition, the evacuated conceptus can't be taken if the patient is in shock or high fever and in that case endocervical swab is more preferable to take as a choice of specimen for isolation of bacteria. Antibiotic susceptibility pattern of bacterial pathogens were determined by NCCLS guide line: twenty three out of thirty specimens yielded bacterial growth, of which five specimens obtained mixed growth of bacteria. Organisms isolated from evacuated conceptus were Escherichia coli (8), Staphylococcus aureus (7), Enterococci (3), Coagulase negative staphylococci (2), Pseudomonas species (2), Klebsiella species (2), Citrobacter species (2), haemolytic streptococci (1) and Acinetobacter species (1).Organisms isolated from endocervical swabs were Escherichia coli (9), Staphylococcus aureus (8), Acinetobacter species (3), Coagulase negative staphylococci (2), Klebsiella species (2), Citrobacter species (2) and Pseudomonas species (2). Majority of pathogenic isolates obtained in this study were sensitive to most of antibiotics used. The study provides antimicrobial resistance pattern of septic abortion cases which were probably community acquired infections. ISE.391 Migrants: Much Concern of STI L.N. Bhandari. National Vigilance Center, Kathmandu, Nepal Background: Migrant people are the world's greatest health concern not only of Nepal. 46% of 70,256 HIV/AIDS reported Nepalese people are caused from foreign employment which is a large number of 2.4 million adult populations. Six hundred Nepalese people per day go abroad for employment other than to India and there are a large number of persons being affected by STI/HIV/AIDS. Likewise, according to WHO, 510 thousand Nepalese young women per year are sold in Indian sexual markets; 50% are affected with STI/HIV/AIDS, and forced back their home. Those men and women have an increased risk of infection because they are more likely to be in poor general health to begin with and to leave STD untreated; migrate to find work, and thus increase their chances of risky sex. Their behaviors compound the vulnerability of other young migrant men to HIV/STI infection and bring economic crises. Method: The youth health framework based on National Reproductive health 1998, current national planning, concerned world treaties, strategies for sexual health and HIV/AIDS are ineffective to take future programmes to include them. There are neither effective informative treatment programmes, nor unity between studies/investigations, nor formal statistics of those migrant population. Results: Those most needing information, education and counseling are driven underground and statistically unidentified because they go to private hospitals other than to governmental hospitals looking for discreet, proper behavior and practice. A survey says: 15% are youth; 90% people perform unsafe sex; 14% girls are pregnant; 13% got STI; and 22% boys got STI; UNICEF Report 2001 says, one among 5 boys and one among 10 girls have already involved in sex before they marry; and most of them will become married, thus having an impact upon women's reproductive health. Conclusion: Before they loose their employment opportunities and women become affected also as caregivers in the family, the state should co-ordinate and help owns stakeholder agencies for community support mechanisms to launch the result-oriented programme targeting that vulnerable population to control STI/HIV/AIDS for helping them to solve their educational, social and economical problems. It should develop capacity enhancement tools like direct research and information sharing mechanism, high levels testing and counseling service, models of good practice. 92 · International Scientific Exchange

ISE.392 Multidisciplinary Management for Early Diagnosis of Prosthetic Joint Infection: Our Experience A. Tedesco, A.M. Azzini, M.C. Danzi, E. Concia. Infectious Diseases Department, Verona, Italy Background: The management of prosthetic joint infections (PJI) is less standardized. The aim of this retrospective analysis is to evaluate the importance of multidisciplinary management for early diagnosis of PJI. Methods: We reviewed all PJI that had been treated in our institution from 2004 to 2006 and analysed the clinical and laboratory presentation, imaging and microbiological diagnostics. According to the diagnostic delay, the diagnosis was defined as immediate (within 3 months), late (after 6 months), very late (over 12 months). The collegial management was defined in case of collaboration between the infectious disease specialist and orthopaedic one. Results: We studied consecutively 48 PJI. The characteristics are presented in table 1. The diagnosis were immediate in 50.0% of the cases and very late in 33.4%. The collegial management was significantly associated to the early diagnosis (21/27 versus 3/21, p<0.05). In case of pain alone, sedimentation rate and C-reactive protein were increased in 8/12 and 12/12 patients (p=.06). The preoperative microbiological procedures detected infections in 54.5% of the cases. In 45.5% of apparent infections, suspected by nuclear scintigraphy, no microorganisms were detected. In 66.7% of the cases the leukocyte scintigraphy diagnosed infections immediately, if compared to microbiological studies (33.4%) and other diagnostics procedures (40%). Conclusion: PJI must be suspected on the basis of local signs and symptoms of inflammation. The increase of sedimentation rate and Creactive protein are the most important laboratory tests. Leukocyte scintigraphy has become the "gold standard" in the diagnosis of PJI. The diagnostic delay causes problems and particularly psychological distress. The combination of collegial management and the use of leukocyte scintigraphy provide excellent early diagnosis. To improve results of the management and treatment of PJI, we will propose integrated ambulatory supported by a multidisciplinary team (infectious disease specialist, orthopaedic surgeon, microbiologist and imaging specialist).

ISE.393 The characteristics of PJI.

ISE.393 Assessment of the Prevalence of HIV Infection in TB Patients P. Davoodian, H. Dadvand, B. Baghestany, F. Fakhar, M. Sadeghian Nadooshan. Hormozgan University of Medical Sciences, Bandarabbas, Iran (Islamic Republic of) Introduction: Infection with HIV causes CMI deficiency and morbidity to various infections that TB is the most of them in poor communities. Infection with HIV increases the risk of changing TB infection to TB disease. The possibility of TB infection to TB disease in HIV positive patients are 10 times more than HIV negatives. In communities that HIV and TB infections are prevalence synchronously, case finding to TB is more to five times. Aim: With regard to the fact that increase in HIV and TB in Hormozgan province in Iran is high than other regions of Iran, and with respect of WHO proposal in which in communities that more than five percent of TB patients are infected with HIV program of treatment would be integrated. So we conducted this research to study the prevalence of HIV infection in TB patients. Materials and Methods: We had TB patients in one year and half study. From December 2005 to June 2007. 184 of patients were evaluated for HIV infection with ELISA and Western Blot methods. Results: 23 from Minab city and Bandar-Abbas were positive for HIV 10% of TB patients in Bandar-Abbas and 18.8% in Minab were HIV positive. More than 90% of HIV positives were IV drug abuse. Conclusion: Studies in other regions of Iran showed that there is any relationship between TB and HIV infection. Possibility it is because of low prevalence of HIV infection in that regions. With regard to high prevalence of HIV and TB together in Hormozgan, its is recommended that program of TB and HIV treatment integrated in this region and all TB patients should be checked about HIV. ISE.394 Assessment of Measles IGM on Infant Cord Serum of Vaccinated Mothers Who Were or Became Pregnant Within 3 Months Before or After MR Campaign M.S. Ziaei1, M.S. Khoddam1, M.S. Khoori1, M.S. Baniaghi1, M.S. Ziaei2. 1 Medical Sciences University, Gorgan, Iran (Islamic Republic of), 2 Educational Office, Gorgan, Iran (Islamic Republic of) Background and Aim: Measles vaccine should not be given to a woman known to be pregnant or who is considering becoming pregnant within the next few months. This precaution is based on the theoretical risk of fetal infection, even though there is no evidence of this occurring. In spite of this risk, during a mass campaign for MR vaccination(Iran, Dec 2003)some women were or became pregnant within 3 months before or after vaccination. Then, this study was done with the aim of evaluating IGM on their infant cord serum. Material and Methods: This cohort study was done on pregnant mothers who were admitted to Deziani hospital to deliver their babies. Case group were mothers who received MR vaccine during the mass campaign in Iran and control group were mothers who with the same age as the above did not receive MR vaccine. Also the control group matched with the case group in gestational age, history of being in contact with infected people, still birth or abnormal child. In both groups IGM was measured by Eliza and cut off of point >0/315 was positive. Data was analyzed by chi-square and T test (p< 0.05). Results: According to the findings, there were no significant differences from the point of educational level, job, number of pregnancies and abortion between two groups (116 samples: case group, 137 samples: control group). Also there was not any positive case of IGM in both groups. Conclusion: In spite of the fact that there was no positive IGM, if a pregnant woman is inadvertently vaccinated or if she becomes pregnant within 1 to 3 months after MR vaccination, she should be advised about the concern which theoretically exists for the fetus. However, MR vaccination during pregnancy should not ordinarily be a reason to terminate pregnancy. Key Words: IGM, measles, infant ISE.395 Prevalence of Hepatitis C Antibodies in Lankan Rural Community of Plateau State, Nigeria J. Okopi1, L. Nimzing2, B. Dawurung 3, B. Badung4, L. Gwamzhi5. 1 Harvard APIN Plus University Teaching Hospital Jos, Jos, Nigeria, 2 Department of Medical Microbiology, Faculty of Medical Sciences,

University of Jos, Jos, Nigeria, 3Faculty of Natural Science, University of Jos, Jos, Nigeria, 4APIN/PEPFAR Center, Jos University Teaching Hospital, Jos, Nigeria, 5Department of Medicine, Faculty of Medical Sciences, University of Jos, Nigeria, Jos, Nigeria Background: Viral hepatitis is a major global public health problem. Documentations on prevalence and modes of transmission in rural settings in Nigeria are scanty. This study was conducted to determine the prevalence of hepatitis C virus (HCV) antibodies and possible risk factors in a rural community in Nigeria. Methods: This was a descriptive study conducted in Lankan community of Plateau State, Nigeria between March­July 2005, after obtaining ethical clearance. Information regarding 278 consenting volunteers (1674years) was obtained using a structured questionnaire. Third generation enzyme-linked immunosorbent assay (ELISA) [Biomeda TM anti- HCV used to screen all the samples for antibodies to HCV. Simple proportions were used to determine prevalence and univariate associations between variables were carried out using Chi-square tests. A logistic regression model was used to determine the significance of associations between demographic variables and HCV positivity using SPSS (version.11) statistical software. Results: Two hundred and seventy eight (52.9% males and 37.4% females) were recruited. The overall prevalence of anti-HCV in this population was 37.4% with (18% males and 19.40% females). The highest prevalence among the male age group was between 35-44 years while the females were between 55-64years. While the single unmarried had 27.9 % prevalence, we found 40.9% among the married and widowed64.3%. Multiple sexual partners had 58.6% against single sexual partner 30.6%. The rate of infection was also high among those who had blood transfusion as well as those subjects not using condom. Conclusion: From this study, there is high prevalence of hepatitis C infection in Lankan rural community of Plateau State, Nigeria. Adequate preventive measures need to be put in place to reduce the transmission rate. ISE.396 Prevalence of C. trachomatis Infection Among Roma Population, Patients with Chronic Hepatitis and IVDU P. Jarcuska1, L. Balogova1, M. Pilatova1, D. Volosinova2, R. Novotny3, L. Rosocha4, S. Toporcerova1, P. Kristian1, I. Schreter1. 1Medical Faculty UPJS, Kosice, Slovakia, 2FDR Hospital, Banska Bystrica, Slovakia, 3 Faculty Hospital, Presov, Slovakia, 4FNLP University Hospital, Kosice, Slovakia Background: There are no data from prospective point of view about incidence of C. trachomatis infection in Roma population (RP) in Central Europe, and also there are no C. trachomatis prevalence data in pts. with chronic hepatitis B and C (CHBC) and IVDU in Slovak republic. Aim: To determine the prevalence of chlamydial genital infection in selected population risk groups (risk in regard of poor resource settings, low education level, higher promiscuity and drug abuse) and to identify risk factors statistically associated with chlamydial infection. According to this selection participants were classified into 3 groups: 1. RP(n=46), 2. CHBC patients (n=60) 3. IVDU (n=36). Because of statistical reasons we performed testing in control group of women from general population (n=102). Methods: Self-collected vaginal swab from women and urine specimens from men were collected and tested for C.trachomatis using a polymerase chain reaction (PCR - Amplicor Roche). Participants filled out a questionnaire related to sexual and sociocultural behavior. Results: We analzyed first data of prevalence of C.trachomatis infection in RP in Central Europe. The prevalence reached 4,4%. Prevalence in CHBC patients was 3,3%, prevalence in IVDU was 5,5%. Prevalence of C. trachomatis in all risk population groups was 4,2%, prevalence of C. trachomatis infection among control group was 1,96%. Participants with genital chlamydial infection had lower age of first sexual intercourse (p<0,01), higher number of sexual partners (p<0,01) and low/intermediate education compared with participants without C. trachomatis infection (p<0,01). Conclusion: We found a low prevalence of C. trachomatis infection in risk groups--Roma population, in CHBC pts and in IVDU. Despite the fact that Slovakia is country with low prevalence of C. trachomatis infection (data from CTSG) screening among general and risk population is feasible and may be a valuable tool for limiting the spread of genital chlamydial infection.

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ISE.397 Providing Community Home-Based Care (CHBC) Including Anti-Retroviral Therapy and other commodities J.C. Ondoa-Onama. Arua Regional Referral Hospital, Arua, Uganda Introduction: There is an overwhelming rise in hospital admissions from chronic HIV/AIDS associated illness, beyond the capacity of most medical institutions to cope. About 50% of these patients are willing to be looked after at home according to an assessment done. The goal of CHBC is to provide care and support to people living with HIV/AIDS in their homes. In Uganda, Arua District piloted CHBC in one of the HSD in June 2002. CHBC Achievements: Many service providers were trained and local leaders sensitized in CHBC. Community mobilization and involment of PLWA has increased hence reducing stigma. There has been improvement in referrals, communication and adherence to ART. Challenges: In CHBC implementation, service providers for the CHBC program are few. Transport inadequacy, irregular kit supply and interdistrict transfer of CHBC trained health workers affect program outcome. Drugs for the OI management in most health facilities are indequate. Opportunities to Improve: Training more service providers in CHBC and ART; increasing transport facilitation and support supervision; scale up of ART and CHBC to other HSD and establishing an effective referral system. Conclusion: All relevant care providers should be empowered with knowledge and skills needed to ensure long term care and support to chronically ill people. The CHBC including ART increases poeple's acceptability of PLWA, improves ART adherence and reduces stigma. It gives opportunity for family members to continue performing their domestic obligations while they care for the sick person. It also streamlines the patient referral from from the health institution into the community and vice visa. ISE.398 Acute Hepatitis and Prepartum HELLP Syndrome N. Çomo, E. Meta, D.H. Kraja, R. Bojdani, E. Muço, A. Kica, O. Gliozheni, V. Ostreni. Univeristy Hospital Center, Service of Infecious Diseases, Tirana, Albania Introduction: HELLP (Hemolisis Elevated Liver enzymes Low Platelet count) syndrome is an obstetrical complication that occurs at prepartum and postpartum. It consist on multisystemic vascular tonus disorder. Objective: Contributing on knowing and treating at early stages as Hepatitis- like of it. Material: It consist of two primipare,16 and 23 years old, admitted in infective care as hepatitis during 2006. Method: It was based on clinic aspects, laboratory examination and their course co-operating with an obstetrician. Cases presented: L.H. 26 years old 31 weeks pregnant: S.S. 23 years old 26 weeks pregnant presented as viral hepatitis with icter, fever, nausea, vomiting, myalgia, abdominal pain for which they had been checked ua before. Laboratory: Case 1: RBC 3 880 000/mm3, HgB 11.6 g/dl, PLT 235 000/mm3, WBC 14 300/mm3, AST 45 u/l, ALT 113u/l, Total bilirubin 1.9 mg/dl, ESR 62 mm/h, BP 113/71 mmHg. Case 2: RBC 4 310 000/mm3, HgB 13.6 g/dl, PLT 97 000/mm3, ESR 50mm/h AST 316 u/L, ALT 398 u/l LDH 729 mg/dl, Total bilirubin 2.7 mg/dl, WBC 22 300/mm3, BP 133/82 mmHg. In both cases ELISA HBsAg; HAV IgM; HCV IgM; HDV IgM; HEV IgM were negative. CMV IgM negative, HSV(1+2) IgM negative. Tests of Autoimun Hepatitis ANA and SMA negative. Abdominal ultrasounds was normal. Discussion: The difficulties of cases consist of correct nosology determination for a febril icter at pregnant women has elevate gravity. Hepatitis A,B,C,D,E;CMV; and HSV are more common. HELLP syndrome occurs rare 0.1­1% whereas icter gravity isn't febril. Treatment method differs a lot in each nosology. Ruling out of infectious made possible the hypothesis of HELLP partial syndrome, fact that was supported by obstetrician and spectacular recovery of general situation, and hepatitis syndrome after obstetrical intervention. Conclusions: 1) Obstetrical intervention in HELLP syndrome must be led by infection specialist opinion. 2) The protocol of hepatitis serology is an emergency diagnoses.

ISE.399 Sero-Prevalence of Syphilis Among HIV and Non-HIV Patients at Institute of Infectology Emilio Ribas, São Paulo M. Eira, R.J. Costa Silva, E.J. Boccardo, I.M. Moreira, M.B. Rossi. Instituto de Infectologia Emilio Ribas, São Paulo, Brazil Background: Sexually transmitted diseases (STDs) remains a major public health problem in the world. Last decade syphilis incidence has increased in many countries, particularly among persons living with HIV infection. The objective of this study was to assess the prevalence of Treponema pallidum infection (syphilis) among HIV-seropositive, HIVseronegative and patients with unknown status for HIV at Institute of Infectology Emilio Ribas, São Paulo. Methods: This retrospective study included all patients with routine serological tests for syphilis (veneral disease reference laboratoryVDRL and Treponema pallidum hemagglutination-TPHA) and HIV-1 infection (HIV-1/HIV-2 third generation ELISA and Western-blot confirmation assay) performed from January trough to July 2007. The average time needed for results was 7 days. Results: Among the 965 subjects tested for syphilis (mean age 28.9 years, range 14­68 years), 342 (35.44%) were women and 623 (64.55%) men. Overall prevalence of syphilis was 16.37%. HIV seroprevalence was 35.9% (227/631). 334 patients had unknown status for HIV infection. Of the 177 HIV-seronegative men, 8.47% (15/177) had serological status of syphilis, and from 178 HIV-seronegative women, 6.74% (12/178) were VDRL and TPHA reactives. Of the 179 HIVseropositive men, 25% had HIV/syphilis co-infection, while from the 48 HIV-seropositive women, 8.3% had HIV/syphilis co-infection. Prevalence of syphilis in patients not tested for HIV was 25.14%. Conclusion: The prevalence found of syphilis was more than estimated in our hospital, and the population is predominantly male and young. A relatively high prevalence of HIV-1 infection was found among patients, and co-infection was more common in male patients. Early identification of the HIV infection among patients with STDs must be improvement. Information about transmission of HIV/STDs needs to be targeted. Multiple strategies in prevention based on specific groups could be applied in our HIV/STDs voluntary counselling and testing outpatient clinic. ISE.400 Biochemical Markers of Fibrosis in Patients with Chronic Hepatitis C S. Gramatyuk. Kharkiv State Medical University, Kharkiv, Ukraine Purpose: Research of immune response dynamics in patients with wite acute and chronic viral hepatitis C depending on form of the disease. As an alternative to liver biopsy, an index of five biochemical markers (transferrin, haptoglobin, ceruloplasmin, gamma-glutamyl-transpeptidase) has been shown to predict the severity of hepatitis C-related fibrosis. The objective of this study was to compare this index with other markers frequently used for this purpose (prothrombin time, total bilirubin, alanine aminotransferase ALAT). Materials and Methods: Analysis of 70 patients in age from 17 to 49 years with 9 patients by acute viral hepatitis C, 61 is patient by chronic hepatitis C was conducted. Males predominated (58,6%) and patients older than 21 years (56,1%) were more often affected. Determination of level of haptoglobin, ceruloplasmin, gamma-glutamyl-transpeptidase and transferrin conducted at 40 patients of the affected group of patients. Characteristic of immunological disturbances is completed with quantitative assay of degree of immune disturbances of the indexes and their diagnostic value (Kj). Studied proteins were detected by the method of immunofluorescense with "Beckman" set, USA. Results: Most expressed disturbances of immunological indexes of qualitative and quantitative character in patients with chronic hepatitis C were detected. In this group of patients, insufficiency of cellular immunity was accompanied by the relative increase of B - lymphocytes, that can attest to the activating and ineffectiveness of humoral response during a acute viral hepatitis C. Also changes of indexes ceruloplasmin, gamma-glutamyl-transpeptidase, transferrin, haptoglobin which were certainly higher than at patients chronic hepatitis C with that can attest to the changes in the morphologic and functional state of tissue of liver. Conclusions: The addition of the latter markers to the marker index proved unhelpful for increasing its accuracy. In conclusion, an index of five biochemical markers accurately predicts significant hepatitis Crelated fibrosis and is superior to traditional markers.

94 · International Scientific Exchange

Mycobacterial Infections (Including Tuberculosis)

ISE.401 Brucellosis: The Factor Inducing Postoperative Fever and Hemorrhage M. Momenheravi, A. Sharif. Kashan University of Medical Sciences, Kashan, Iran (Islamic Republic of) Introduction: Brucellosis is an endemic disease in Iran. Its prevalence has been increasing in recent years. It has very different atypical clinical features so it makes its diagnosis very difficult. We present a case of brucellosis who presented with fever, hemorrhage from surgical wound after bone plate implantation. Case Presentation: A 30-year-old man from Kashan was admitted because of open right femor neck fracture at the orthopedy ward in a teaching hospital of Kashan in July 2003. He had no high temperature at the time of admission.External traction and antimicrobial therapy was done. One week later plate implementation was done. The patient develops fever after surgery that continued for several days in spite of wide spectrum antibiotic taking. Profound wound hemorrhage and decreased hemoglobin level was developed Laboratory examination showed increased reticulocyte count and FDP and decreased PT and platelet count given DIC diagnosis vitamin K and FFP was prescribed. The patient became more ill and there was no alteration in his condition seroaglutination tests for brucellosis was performed which were positive (wight:1/1280, 2ME:1/640). Rifampin and doxycyclin were given. He was unfebrile after 3 days and coagulation disorders were discontinued after 7 daysHe was discharged with good health. In out patient follow up one month later brucella antibodies titers was decreasing and he was in good health. Conclusion: Brucellosis can causes many different manifestation hematologic disorders such as DIC might be one of rare presentations of brucelosis. So it must be considered in any febrile patients with hematologic disorders with unknown etiology Key word: brucellosis, hemorrhage, postoperative ISE.402 Effect of Active Education on Awareness of Avian Influenza in Health Care Workers of Golestan University of Medical Sciences A. Jabbari1, S. Besharat1, D.R. Bojary Nasrabadi 2. 1Golestan University of Medical Sciences, Gorgan City, Iran (Islamic Republic of), 2 Iran University of Medical Sciences, Department of Microbiology, Tehran, Iran (Islamic Republic of) Objectives: The main goal of medical education is preparing experts in health fields. Medical education should answer the population needs and adapt itself with technology changes. Aim: Evaluating effect of active education on awareness about avian influenza in health care workers of Golestan University of medical sciences. Methods: In 2005­2006, this semi-experimental study was done in before-after method.At the beginning, entering behavior of the subjects was evaluated with self-administered questionnaire. Then after the active intervention, the questionnaires were distributed once more. Data were entered in SPSS-13 statistical software and non-parametric tests (Wilcoxon, Mann-Whitney, Kruskal-Wallis) were used to evaluate the effect of active education on awareness of Avian Influenza in subjects. Results: The mean level of awareness increased significantly after educational intervention (P-value< 0.001). Previous information was significantly related to pretest scores. Level of awareness was not related to gender and age, significantly. Conclusion: According to the results, educational workshop methods are effective while a new disease appears. While educational programs in the Medias are effective in the awareness of the health care workers, but it doesn't seem suitable for them. More scientific educations are needed for this group. ISE.403 Abdominal Tuberculosis in Golestan-Iran A. Jabbari1, S. Besharat1, P. Baghaei2, S. Semnani1. 1Golestan University of Medical Sciences, Gorgan City, Iran (Islamic Republic of), 2 Shahid Beheshti University of Medical Sciences-Masihe Daneshvari Medical Center, Tehran, Iran (Islamic Republic of)

Background and Objectives: Various studies demonstrated that 1520% of TB cases are extra pulmonary tuberculosis (EPTB). Signs and symptoms of abdominal TB are unspecific because it affects multiple organs in the abdomen. We identified all GI TB cases in Golestan province (Iran) to determine their demographic characteristics. Methods: We reviewed all new cases of TB, reported between 1999 and 2003 from TB centers of Golestan. Then we selected EPTB and especially GITB cases from the list. Looking up the addresses in the patients' charts, we completed a questionnaire containing demographic information. The information entered in SPSS-13 and data was analyzed with appropriate tests. Results: 30 patients had been treated for GITB, most of them were women (22 cases, 73.3%).Mean age was 32.03±13.73, with higher incidence in age before 40 years old (70%). 66.7% of patients had documented pathologically diagnosis. Conclusions: Data suggest that 38.46% of all TB cases in Golestan province were EPTB. This percentage is higher than other studies. In this study, GI TB cases were higher than the world reports (3%). These results should be mentioned by physicians and healthcare providers in this area and considered in programs of disease controlling and preventing centers. ISE.404 Laser Therapy for Urogenital Tuberculosis E. Ekaterina. Research TB Institute, Novosibirsk, Russia Introduction: In the incidence rate the genitourinary tuberculosis stays on the second place after pulmonary one. Unfortunately, the treatment of urogenital tuberculosis is not optimized. Excessive scar as outcome of tuberculosis may results in loss of kidney function. Materials and Methods: 150 patients with nephrotuberculosis were enrolled in study: 62 (control grope) received only chemotherapy with 4 drugs and 88 patients (laser grope) alongside with identical chemotherapy underwent the radiation of the low-level laser (wave length 0,620,86 mkm). The tuberculosis of ureter was diagnosed in 34 patients (22,7%), tuberculosis of a bladder--in 37 (24,7 %). Chronic renal insufficiency complicated process in 58 patients (38,7%). Results: In control group the efficiency of therapy was 40,4%. In laser group the complex treatment was effective in 76,5%. In these patients on data of radioisotope renography in 57,9% total improving of functions was fixed; the stimulation of urine passage was marked in 79%. The secretory function was improved in 63,1%. The essential distinction in volume of the operations was marked in groups. In control group to 41 patients with cavernous and polycavernous nephrotuberculosis 33 surgical interventions were executed: 24 nephrectomies; 6 cavernectomies of a kidney, from them 3--with a simultaneous plastics of ureter; 3 plastics of ureter. In laser group the widespread destructive process in kidneys was diagnosed at 53 patients. They executed on 24 operations only: 20 nephrectomies; 3 cavernectomies of a kidney; 1 ureterolisis. 29 patients due to using laser therapy were cured conservatively, without surgical intervention. Conclusions: The application of the low-level laser therapy in complex treatment of nephrotuberculosis raised the efficiency up 36,1%, resulted in quick negativation of urine in 100%, permitted to avoid surgical intervention for 35,2%. ISE.405 Regional Lymphotropic Therapy for Kidney Tuberculosis E. Kulchavenya. Research TB Institute, Novosibirsk, Russia Background: Among extrapulmonary tuberculosis, urohenital one has large part. In more than half of kidney tuberculosis cases it requires surgical intervention, because the efficiency of conservative therapy is insufficient. Aim: To increase the efficiency of complex treatment for kidney tuberculosis. Methods: 143 new-revealed patients with nephrotuberculosis were enrolled in this study. 114 from them (control group) were treated with standard chemotherapy (H+R+S+Z per os and i.m.). 29 patients (experience group) received streptomycin and pyrazinamid like control patients, but isoniazid and rifampicin were administered by lymphotropic method: isoniazid was inserted in paranephral fat tissue and rifampicin--in microclysters with Dimexidum. The efficiency of treatment was estimated by urinalyses, cupping of intoxication, termination of mycobacteriuria, dynamic of renal functional tests, dysuria and flank pain.

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Results: The level of isoniazid in blood was the same in both groups, but in urine it was 1,75 times higher in experience group. In experience group flank pain and dysuria, also intoxication reduced more quickly, than in control (p<0,01). Termination of mycobacteriuria became in experience group in 100% in the first month of the therapy, but in control MBT saved for 5 months. Total efficiency of the therapy was 61,5% in control group and 96,5%--in experience group. Regional lymphotropic therapy has allowed avoiding surgical operation in experience group at all, but 23,5% patients in control group were operated. 22,8+3,9% patients in control group had toxic side effect on isoniazid, but none--in experience group. Conclusion: Regional lymphotropic therapy is high effective method with well tolerance. ISE.406 The Rare Cases of Tuberculosis E. Kulchavenya, E. Brizhatyuk, V. Khomyakov. Research TB Institute, Novosibirsk, Russia In time of epidemic of tuberculosis in same countries unusual localization of this disease are diagnosed more often. For past 3 years in our clinic 18 patients were accepted with following forms of tuberculosis: tuberculosis of hepar and gallbladder, tuberculosis of salivary gland, tuberculosis of mammary gland, tuberculosis of suprarenal (adrenal) gland, tuberculosis of pancreas, skin tuberculosis, lymphonodus tuberculosis, tuberculosis of peritoneum and intestines. Genitourinary tuberculosis (kidney, ureter, bladder, urethra, prostate gland, organs of scrotum) was more usual; such lesion was diagnosed in 112 patients. The age was from 24 to 68 years; social statement of patients was different (both poor people, migrants and successful people); male: female approximately 1: 1. As rule, one organ or system was affected with TB, but 24 patients (18,5%) had simultaneous lesion of some systems, for example tuberculosis of skin and lymphonodus, pulmonary and peritoneum tuberculosis etc. Patients with rare localization of tuberculosis had unusual clinical picture; more then in half of cases diagnosis was verificated by pathomorphological investigation after surgical intervention. In case of multi-organ tuberculosis clinical picture was more severe, in 9 patients fistulas were formed. All of these 9 patients had drug-resistant mycobacteria in discharge of fistula. Such patients required more long chemotherapy with 4­5, sometimes 6 drug; mostly they were operated. Thus, in countries with trouble epidemic situation on tuberculosis there is possible tuberculous lesion of any organ or system, both single and multiple. There is necessary to remember a tuberculosis always when meet unusual clinical picture. ISE.407 Evaluation of Frequency of Beijing Genotype of Mycobacteriuom tuberculosis in Mashhad,Iran M. Rohani1, P. Farnia2, M. Torfeh3. 1Kashan University of Medical Science, Kashan, Iran (Islamic Republic of), 2Shahid Beheshti University of Medical Science, Tehran, Iran (Islamic Republic of), 3Kashan University of Medical Sciense, Kashan, Iran (Islamic Republic of) Background: Beijing genotype of Mycobacterium tuberculosis is one of the strains that concerned with antibiotic resistance that was responsible for several kinds of epidemies in the different sides of the world. This genotype is the cause of TB epidemy in Germany, Russia, Cuba, Estonia and Canary Islands. The reported prevalence of this genotype in Asia was 37 to 86%. Therefore, we tried to analyze the prevalence of M. tuberculosis Beijing family in Khorasan province. The Khorasan province has high number of TB cases (26/per 100000). Materials and Methods: DNA extracted from 113 culture positive specimens. On all of them PCR-based method (Spoligotyping) was performed. The technique detects the presence or absence of spacers in DR locus of Mycobacterium tuberculosis complex genome. Furthermore, drug susceptibility testing was performed on identified Beijing strain. Results: Beijing genotype was detected in 8 specimens. The overall prevalence of Beijing family was 7.8%. Three (37.5%) isolates were sensitive to first line drugs and five isolates (62.5%) were resistant to at least two of the first line drugs. Conclusion: Although the rate of Beijing family is low in Iran in comparison to other Asian countries, but we have to adapt a suitable policy to prevent its spread.

ISE.408 Adding up Corticosteroid to Standard Regimen of Tuberculosis may be Effective in Prevention of Drug Toxicity M. Rostami, I. Karimi, A.R. Emaminaeini. Isfahan university of medical sciences, Isfahan, Iran (Islamic Republic of) Objectives: We know that drugs used in treatment of tuberculosis may cause hepatitis. Toxicity of rifampin will appear early and that of INH and PZA may appear later. Drug toxicity and mostly hepatitis will come very soon in patients aged >50 years. Corticosteroids are usually used as adjunctive drug in treatment of tuberculosis associated with inflammation and fibrosis such as tuberculous pleurisy or meningitis, because their anti-inflammatory effect is thought to minimize reactivity and thereby reduce residual thickening. The purpose of this study is to evaluate the efficacy and safety of low dose oral prednisolone in management and prevention of hepatitis in older patients with tuberculosis. Methods: This prospective study was done in Esfahan (IR) during 6 years (2001 to 2006). Among 1863 patients 34 patients aged more than 60 years old were divided into two groups randomly. Group one with 15 individuals and group 2 with 17 patients. All were documented tuberculosis according to the sputum smear or culture and few were biopsy proven. Group 1 took the standard treatment for tuberculosis (INH+RMP+PZA+EMB or rarely SCM) and group 2 went under treatment with the same regimen as well as 5 to 10 mg of prednisolon. Results: Before the end of aggressive phase, first two months, 8 patients in group 1 developed clinical hepatitis and 2 others had only elevating liver enzymes while in group 2 there was only two cases of clinical hepatitis who needed discontinuation of drugs and 4 other cases of liver enzyme elevation more than four fold. In those with severe hepatitis in group 1 treatment was quit immediately, but for those with mild clinical hepatitis or enzyme elevation prednisolon was added to the previous regimen and all revived. We had only two cases of death due to hepatitis in group 1. Statistical Difference between two groups for toxicity was significant. Conclusion: Decision for adding up prednisolon to the regimen of patients more than 60 years old was based on the clinical finding of better result in combined regimen of patients with TB and coexistent adrenal deficiency. Many reports say that even in pure pulmonary tuberculosis there may be 50% deficiency of adrenal gland simultaneously. In the other hand we know that Rifampin accelerates metabolism of hormones such as cortisol, so that, depletion will become deeper. We came to this conclusion that adding prednisolon to the standard regimen will cure hepatitis due to drug toxicity and choosing it as complementary drug from the first in older patients may be effective in prevention of severe drug toxicity. Key Words: Prednisolon, Hepatitis, Liver Enzymes ISE.409 Pathogenic Attributes of Aeromonas hydrophila Isolated from Foods of Animal Origin of Mhow and Indore Area of Madhyapradesh in India M. Kaskhedikar, D. Chhabra. College of Veterinary Sc., Mhow (M.P.), India Aeromonads, pathogenic or non pathogenic, are common contaminants of wide spectrum of foods like seafoods, fish, eggs, meat, meat products and milk and milk products, and therefore may be a potential threat to the public health. A total of 18 (17.14%) Aeromonas hydrophila were isolated from 105 samples of foods (15 each) viz. fish, chevon, chicken, buffoon, mutton, cow milk and buffalo milk. No isolate was recovered from cow milk samples. Haemolytic activity of A. hydrophila isolates was assayed on 5% blood agar plates, comparing and using RBC's of five animal species viz. rabbit, sheep, horse, buffalo and chicken. Haemolytic activity of all A. hydrophila isolates was also assayed by titration of cell free filtrates obtained from respective isolates using sheep erythrocytes. Out of 18 isolates, 16(88.88%) showed -haemolysis on 5% rabbit, horse and sheep blood agar plates within 24 hrs, while only 14(77.77%) isolates were -haemolytic on 5% chicken blood agar plate. No additional strain showed haemolysis on subsequent incubation of plate's upto 72 hrs. 87.50% of fish isolates showed haemolysis on rabbit, sheep and horse blood agar plates while only 75.00% fish isolates were haemolytic on chicken blood agar. 75% of mutton and 100% of chicken, chevon and buffon isolates were positive for haemolysis on rabbit, horse, sheep and chicken blood agar. A. hydrophila isolated from buffalo milk sample was found to be haemolytic on rabbit, horse and sheep blood agar but not on chicken blood agar. None of the isolates from any source showed haemolysis on buffalo blood agar. Titration of CFFs revealed that 15 (83.33%) isolates showed positivity for haemoly-

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sis with haemolysin titre ranging from 8 to 128. Out of 18 A. hydrophila tested by mouse paw oedema test, 13(72.22%) isolates were found to be toxigenic. The maximum enterotoxigenicity (100%) was shown by the isolates recovered from chicken, buffon and buffalo milk followed by those from mutton (75%), fish (62.5%) and chevon (50%). Testing of Aeromonas hydrophila isolates for amylase, lipase and caesinase production revealed 77.77%, 94.44% and 72.22% positivity on starch agar, egg yolk agar and skim milk agar, respectively. ISE.410 Detection of Mycobacterium tuberculosis (TB) via PCR Technique in Respiratory Affected Afghani Habitants in Isfahan, Iran M. Shanehsaz1, M. Salehi2, R. Salehi2, N. Tajedin3, N. Naghavi3. 1Dept. of Cytology and Molecular pathology of Mohajer Lab., Isfahan, Iran (Islamic Republic of), 2Genetic and Biology school, Isfahan University of Medical sciences, Isfahan, Iran (Islamic Republic of), 3Islamic Azad University Branch Falavarjan, Isfahan, Iran (Islamic Republic of) Tuberculosis is a major cause of morbidity and mortality throughout the world in both industrialized and developing countries inspite of availability of anti tubercular therapy (ATT) for many years. in 1990, an estimated 8 million people developed TB worldwide with 2.6 to 2.9 million deaths. The majority of theses cases occurred in Asia and Africa with an increasing number among HIV infected individual. One of the major obstacles of diagnosing this disease in Afghani habitants in Isfahan (Iran) is the absence of sensitiveness, poverty and rapid method of diagnosis. Clinical signs and symptoms are less helpful, as more than 50% show no symptoms at all the time of presentation. This hampers the early initiation of therapy or results in over-diagnosis and unnecessary treatment. To evaluate efficacy of polymerase chain reaction (PCR), using the insertion sequence IS6110 as target for DNA, to detect Mycobacterium tuberculosis in respiratory affected Afghani habitants in Isfahan, Iran. A total of 40 patients were evaluated. Cases were defined by specific clinical criteria. PCR was done on the sputum and compared with clinical findings, radiological features, AFB staining. 8 cases were positive with AFB staining 30 (75%) cases of probable TB were positive for PCR and test repeated after 10 days did not show any change. In 10 cases of probable pulmonary TB showing pulmonary infiltrates on radiological examination. M. tuberculosis was grown on culture on only 9 specimen. PCR technique may become a valuable diagnostic tool for the diagnosis of tuberculosis and many of the Afghan people were infected. ISE.411 Diagnostic Accuracy of ESAT-6 Synthetic Peptides in Detecting Pulmonary Tuberculosis Z. Araujo1, F. Giampietro1, J. Isern2, M.A. Patarroyo3, M. Vanegas3, C. Reyes3, C. Fernández de Larrea4. 1Instituto de Biomedicina, Universidad Central de Venezuela, Caracas, Venezuela, 2Escuela de Medicina J.M. Vargas, Universidad Central de Venezuela, Caracas, Venezuela, 3Fundación Instituto de Inmunología de Colombia, Bogotá, Colombia, 4Hospital Vargas de Caracas, Caracas, Venezuela Background: This study aimed at assessing the usefulness of antibody reactivity in the diagnosis of pulmonary tuberculosis. Methods: Several IgG-ELISA methods using 5 ESAT-6 synthetic peptides (12033, 12034, 12035, 12036 and 12037), the recombinant ESAT6 antigen (rESAT-6), and purified protein derivative (PPD) were used for evaluating the presence of specific antibodies in sera samples collected from tuberculosis patients and healthy individuals belonging to two different populations. A total of one hundred twenty adults were studied. The patient group consisted of 20 Warao indigenous patients (WP) and 20 non-indigenous patients (CP), whilst control group consisted of 40 Warao healthy indigenous controls (WC) and 40 non-indigenous healthy controls (CC). The diagnostic accuracy of these methods was assessed by using receiver operating characteristic (ROC) curve analysis. Results: The method using anti-12035 IgG reached a high sensitivity of 95.0% (negative predictive values (NPV= 94.1), but a low specificity of 40.0% (PPV= 44.2) in the Warao population. However, even though the anti-PPD IgG method showed lower sensitivity, it was the most specific (92.5% positive predictive values (PPV)= 82.4), followed by the anti12036 IgG method (82.5%, PPV= 63.2). Within the non-indigenous population, ESAT-6 peptides, rESAT-6 and PPD methods revealed low specificities, although these remained limited between 40.0%and 77.5%.2; whilst the two remaining methods, anti-12033 IgG and anti-

12034 IgG, showed highest sensitivities of 100.0% (NPV= 100.0). Conclusion: The use of highly sensitive and specific peptides may obviate the need for a M tuberculosis culture in the initial diagnostic approach to pulmonary tuberculosis, especially within the non-indigenous population; whilst other potentially more specific peptides need to be further refined to improve their accuracy. ISE.412 Significant Re-Emerging of Tuberculosis in Italy. Relationship with HIV Infection and Other Risk Factors, and Comparison Between Native Residents and Foreign Immigrants R. Manfredi, S. Sabbatani, L. Calza. Infectious Diseases, University of Bologna, Bologna, Italy Background: Tuberculosis (T) is burdened by increasing morbiditymortality rates, due to changes of epidemiologic scenario, and diffusion of resistant strains. The recent, profound modifications occurred among predisposing factors (increase mean patient [p] age, concurrent diseases, iatrogenic immunosuppression, alcoholism, drug addiction, migration, and HIV pandemic), played a key role in this process. Patients and Methods. Among the 182 consecutive p hospitalized due to T since 1996, we compared the 101 p from Italy with the 81 immigrants from extra-European and/or developing countries, in relation of a number of risk factors, including HIV infection. Results: Compared with immigrants, Italian p had a higher frequency of HIV-AIDS (33.7%; p<.001), and a predominant pleuro-pulmonary involvement versus lymph node and/or disseminated T among HIVinfected p versus non-HIV-infected ones (p<.01). Moreover, Italians had a greater mean age (p<.001), and an increased frequency and a broader spectrum of predisposing conditions (positive history, chronic lung, heart, liver, kidney disease, diabetes mellitus, malignancies, and collagen vascular disease; p<.02), while foreigners had a lower frequency of more generic supporting factors (low income, economicsocial problems, cigarette smoking, and alcohol-drug abuse; p<.03 versus natives). Our decade experience shed light on two different patterns of T. Local p are predominatly represented by elderly with frequent concurrent disorders and specific T risk factors, a more frequent HIV infection, and a predominant involvement of sites other than pulmonary ones, while immigrants are represented by otherwise healthy younger p, who develop prevalent lung localizations. Conclusions: The clinicians awareness of T needs increased attention, in order to obtain a rapid diagnosis and treatment, and reduce transmission risks. The progressive integration of immigrants with local population may lead to increased risks of T dissemination, especially among the local, more vulnerable and older p population. ISE.413 Severe Pulmonary Tuberculosis Re-Activated During Interferon Pegylate Plus Ribavirin Administered for Chronic Hepatitis C Treatment R. Manfredi, L. Calza. Infectious Diseases, University of Bologna, Bologna, Italy 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. Patients and Results: 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-ribavirin were started with good tolerability for 7 months, until a sudden occurrence of cough-hemoptisis associated with a pulmonary lesion 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 M.tuberculosis (susceptible to all tested compounds), while a positive 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 7 consecutive weeks of isoniazide-ethambutol-rifampicin-pyrazinamide administration, sputum examination remained positive, thus confirming the role of immunodeficiency is prompting a difficult-to-treat T. The adjunct of levofloxacinamikacin-linezolid prompted clinical and bacteriological cure, achieved after 12 weeks.

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Discussion: Waiting for human experimental data, 2 animal models demontrated that an increased release of immunosuppressive cytokines (IL-10-TGF-), 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. 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, thus playing a role in T reactivation. ISE.414 Non-Bacillary Mycobacterium tuberculosis Pneumonia Preceding Cryptococcus neoformans Co-Infection in an Otherwise Healthy Young Girl R. Manfredi, B. Piergentili, L. Calza. Infectious Diseases, University of Bologna, Bologna, Italy Background: The concurrence of cerebral tuberculosis and cryptococcosis is an exceedingly rare event without a severe underlying immunosuppression. Case Report: A 25-year-old student recently immigrated from China was admitted due to a presumed meningoencephalitis. Epidemiological features and clinical history were mute. Since cerebrospinal (CSF) fluid examination showed pleocytosis with lymphocyte predominance, increased albumin content, and low glucose, and all microscopic, culture, and antigen search for Cryptococcus neoformans tested positive, an antifungal treatment was started with high dose fluconazole. HIV serology tested negative, but a moderate impairment of CD4+ lymphocyte count was detected (299 cells/µL). Due to a persisting clinical-neurological-CSF impairment, liposomal amphotericin B replaced fluconazole. The appearance of cranial nerve deficits paralleled the culture isolation of Mycobacterium tuberculosis from the first CSF specimen, while intradermal tuberculin testing remained negative, and cryptococcosis was microbiologically cured. Serial contrast-enhanced brain CT scans showed the appearance and the worsening of multiple flogystic frontal, hypothalamic, and ponto-cerebellar leptomeningeal lesions, confirmed my MRI scans. A 5-drug anti-tubercular therapy was immediately started and subsequently potentiated with quinolones and linezolid. After 5 months of hospitalization, thanks to an extensive rehabilitation program, a slow ameliorement of clinical-neurological picture allowed discharge, while all repeated testing for both cryptococcosis and tuberculosis became negative, and CD4+ count rose to 399 cells/µL. Discussion: One single case report of a concomitant cerebral criptococcosis-tuberculosis was described in an AIDS patient from South Africa [Silber E, Neurology 1998;51:1213]. The present report, which exceptionally included an apparently concurrent, severe cryptococcal and tubercular meningoencephalitis in absence of evident underlying immunodeficiencies, represents a warning again underestimation of combined, rare infectious illnesses. From a pathogenetic point of view, an initial, slowly progressing meningeal tuberculosis (although diagnosed later in the disease course), probably prompted some grade of immunodeficiency, thus supporting the occurrence of brain cryptococcosis. ISE.415 Recent Pathomorphism of Pulmonary Tuberculosis. Slow Clinical, Bacteriological, and Imaging Response to Specific Treatment. Which Place for Linezolid? R. Manfredi1, A. Nanetti2, P. Dal Monte2, G. Battista3, C. Sassi3, L. Miglio3, F. Toni3, B. Piergentili1, L. Calza1. 1Infectious Diseases, University of Bologna, Bologna, Italy, 2Dept. of Microbiology, University of Bologna, Bologna, Italy, 3Dept. of Radiology, University of Bologna, Bologna, Italy Background: During recent years, a progressive emerging of tuberculosis (T) occurred, related to the overall increased age of general population, primary-secondary immunodeficiencies, the availability of invasive procedures, surgical-intensive care supports, bone marrowsolid organ transplantation, and recent immigration flows of people often coming from areas endemic for T.

Methods and Results: Since Jan 2006, we hospitalized 43 cases of pulmonary T, in majority (79.8%) occurred in patients (p) immigrated from developing countries. In only two p resistant or multiresistant (MDR) T strains were found, while two more p had a multi-resistant (XDR) T. Although enforcing all possible measures to increase p' adherence to treatments (empowerment, delivery of oral drugs under direct control, use of i.v. formulation whenever possible), over one third of p had a very slow clinical-imaging ameliorement (2­4 months), with persistance of sputum-bronchoalveolar lavage (BAL) fluid positive for M.tuberculosis for over 2­4 months (mean 2.3±0.7 months), during apparently adequate treatment. When excluding XDR-MDR p, in 5 p we observed that off-label linezolid adjunct together with at least three drugs with residual activity against T, led to a rapid clinical-radiological improvement and negative microbiological search, with consequent possibility to led to a protected discharge, supported by a sequential, oral therapy. Linezolid was also successfully employed in p with XDRMDR T, when a temporarily negativization of respiratory secretions was achieved only after linezolid adjunct. Discussion: Notwithstanding the maintained, extensive microbiological susceptibility of M.tuberculosis strains responsible of the great majority of cases of pulmonary T, an unexpected tendency of p to have a persistingly positive sputum-BAL and experience prolonged hospitalization for cure-isolation, has been recognized in the last years. No particularly suggestive imaging seems predictive of a so prolonged course, so that we presently lack of clinical-radiological elements predictive of this slow treatment response. Linezolid is characterized by an affordable activity against M.tuberculosis, and an extremely elevated intracellular concentration in respiratory tissues. The increasing microbiological, pharmacological, and clinical evidences may recommend the use as an off-label salvage treatment of pulmonary T refractory to treatment, although not necessarily determined by resistant (MDR-XDR) strains. Randomized clinical trials including initially p with chemioresistant T, are warranted. ISE.416 AIDS-associated Atypical Mycobacteriosis Other than Mycobacterium avium-Intracellulare: A 14-Year Survey R. Manfredi, L. Calza. Infectious Diseases, University of Bologna, Bologna, Italy Background: A prompt and effective diagnosis and a timely treatment of atypical mycobacteriosis and especially Mycobacterium kansasii and Mycobacterium xenopi disease, remains a serious challenge for clinicians engaged in the management of the immunocompromised host, including HIV disease. Patients and Methods: Sixteen and eleven HIV-infected patients with a microbiologically-confirmed M. kansasii and M. xenopi respiratory infection respectively, have been observed in a 14-year period, out of over 4.100 hospitalizations performed because of HIV-associated disorders. These episodes were carefully evaluated from an epidemiological, bacteriological, clinical, and therapeutic point of view. Results: In 12 out of 27 cases (44.4%) a bacteremia was also retrieved. The proportionally reduced crude frequency of atypical mycobacteriosis as HIV-related complication, which virtually disappeared after introduction of potent antiretroviral combinations (HAART) in 1996, is underlined. In early nineties, the lack of effective antiretroviral regimens made frequent the association of this opportunism with full-blown AIDS, a mean CD4+ lymphocyte count of around 20 cells/µL, and an extremely variable chest X-ray features. The recent detection of two further episodes was due to a late recognition of a far advanced HIV disease (so-called AIDS presenters), complicated by multiple opportunistic disorders. Discussion: M. kansasii and M. xenopi respiratory and/or disseminated infection continues to occur, and pose relevant diagnostic problems, including late or missed identification due to slow culture and frequently concurrent opportunistic disease. Serious therapeutic difficulties, due to the unpredictable in vitro antimicrobial susceptibility profile of these organisms, and the need to start as soon as possible an effective combination therapy which should not interfere with other medications (especially HAART), are also discussed. ISE.417 Pustular ENL--Rare Presentation of ENL A. Goel, S. Dogra, I. Kaur. PostGraduate Institute of Medical Education and Research,, chandigarh, India A 44-year-old businessman hailing from Dehradun suffering from lepromatous leprosy (known diabetic and hypertensive) presented with fever, joint pains, pustular lesions along with diffuse infiltrated plaques all over

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the body of 8 days duration. Smear for acantholytic cells ruled out an autoimmune bullous disease. Histopathology of a lesion showed features of erythema nodosum leprosum. The patient was managed with high-dose steroid and antibiotics; the ENL lesions improved. ISE.418 Tuberculosis (TB) in a Third Level Reference in Guatemala C. Mejia, M. Luarte, C. Poron, M.C. Palacios, M.R. Gordillo, J. Orozco. Infectious Diseases Division, Hospital Roosevelt, Guatemala, Guatemala Objective: To describe the clinical presentation in HIV+ and HIV- admitted in Hospital Roosevelt in Guatemala city. Methods: A prospective and descriptive study of all the admitted cases of TB was planned during 2007. Information about demographics, HIV co-infection, site of TB: pulmonary or extrapulmonary, previous treatment and mortality during the hospitalization was collected. Results: 213 patients were detected, 145 Male (68%), 108 had Lung TB (51%) and 92 (43%) were HIV co-infection. 14 patients (6.5%) had previously treated for TB. 14 (6.5%) had history of family contacts with TB. The global mortality was 16%. HIV + 17% and HIV- 13% (NS). Conclusion: We documented a high rate of TB-HIV co-infection 43% and 49% of extra-pulmonary TB sowie a global mortality 16%, that shows the very complicated cases the need admission in reference hospitals in Guatemala ISE.419 Early Identification of Mycobacterium tuberculosis by PCR Restriction Analysis in Clinical Samples M. Varma Basil, K. Singh, S.K. Dhar Dwivedi, R. Pathak, S. Kumar, M. Bose. Dept. of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India Objectives: Conventionally, identification of mycobacteria grown in culture is achieved by culture and biochemical tests that are time-consuming and lack sensitivity. The high cost and technical expertise required for rapid genotypic assays have restricted their large-scale use in many clinical laboratories, especially in high burden countries endemic for tuberculosis. Our aim was to use PCR-restriction fragment length polymorphism (PRA) as a rapid and technically less demanding method for detection and identification of Mycobacterium tuberculosis directly in sputum samples to reduce the turn around time in a Mycobacteria diagnostic laboratory. Methods: We studied 166 sputum samples from the same number of patients. Of these, 125 sputum samples were collected from clinically suspected patients of pulmonary tuberculosis admitted at Rajen Babu TB Hospital, Delhi, India, between September 2005 and December 2006, while 41 sputum samples were collected from patients with respiratory diseases other than tuberculosis. Hsp65 PRA was applied on the DNA extracted directly from the sputa. The sputum samples were also subjected to smear examination by Ziehl Neelsen staining and cultured on Lowenstein Jensen medium. Fifty culture positive samples were further analyzed by niacin, nitrate reduction and catalase tests. These isolates were also subjected to IS6110 typing. The results of direct PRA were confirmed by performing PRA on these culture isolates. Results: We could detect and identify M. tuberculosis in 86% of the AFB smear positive samples (n=116) and 22% of AFB smear negative samples (n=9) by PRA. PRA did not detect M. tuberculosis in any of the forty one samples obtained from patients suffering from respiratory diseases other than tuberculosis. To test the sensitivity of the assay, a smear negative sample was spiked with serial dilutions of H37Rv. The assay could detect up to 100 organisms/ml. Conclusion: We found PRA to be a simple and reproducible method for early detection of M. tuberculosis from sputum samples. Effort is on to apply the method on extra-pulmonary clinical samples also. ISE.420 Effects of Micronutrient Supplementation on Tuberculosis Treatment in Calabar, Nigeria: A Randomized Controlled Trial R.I. Ejemot1, M.O. Bukie2, I.B. Umoh3, E.H. Itam3, M. Meremikwu4, E.N. Ezedinachi4. 1Dept. of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria, 2Laboratory Department, Dr. Lawrence Henshaw Memorial Hospital, Calabar, Nigeria, 3Nutrition and Food Science Unit, Department of Biochemistry, University of Calabar, Calabar, Nigeria, 4Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria

Background: The prevalence of tuberculosis (TB) raises huge concern and requires emergency response. This response should be based on reliable evidence of effectiveness. Malnutrition and micronutrient deficiencies are known to be common in TB. We assessed the potential benefits of micronutrient supplementation in TB treatment and its effects on TB-HIV co-infection in Calabar. Methods: Eighty-one adults that fulfilled the enrollment criteria were randomly assigned to group A (intervention group); received micronutrient supplements (n = 41): vitamin A (10,000 IU given at alternate days), vitamin C (50mg/day) and zinc (25mg/day) plus TB chemotherapy, and 40 to group B (control group) received TB chemotherapy only. Clinical, bacteriological, biochemical and nutritional assessments were undertaken at diagnosis and 2 months of TB treatment. Results: After 2 months of TB treatment, group A had statistically significant (p< 0.05) lower proportion (22%) of subjects with BMI< 18.5kg/m2 against 40% in group B. Similarly, subjects in group A had 17% with serum retinol < 30µg/dl; 7% with ascorbate levels <0.4mg/dl and 12% had serum zinc < 10.7µmol/L; as compared to group B's 43%, 25% and 25% respectively; indicative of low/deficiency states of these parameters. Subjects in group B had lower values of anthropometric indices as compared to subjects in group A. These were independently associated with lower serum micronutrient concentrations. Risk reduction of 41% for AFB positivity in favor of group A was observed (RR 0.59, 95% CI 0.23 to 1.46). When adjusted for TB-HIV co-infection, it was 46% (RR 0.54, 95% CI 0.17 to 1.72). Conclusion: Micronutrient supplementation reduces risk of AFB sputum smear positivity by about 40%. These data support the hypothesis that micronutrient supplementation potentiates the effects of anti-TB drugs irrespective of TB-HIV co-infection. This may represent a response approach not only to fast recovery but also of reduced cost to patients and programs. ISE.421 Study to Determine Resistance to Second Line Anti-Tuberculosis Drugs in Kenyan Isolates V. Asiko, W. Githui. Kenya Medical Research Institute, Nairobi, Kenya Background: Tuberculosis (TB), as yet, is far from being controlled. Several reasons can be attributed to this, a major contributing factor being the development of resistance to the currently available drugs due to the successful adaptation of the pathogen to drugs being used. Second line anti-tuberculosis drugs are being used in the treatment of patients who show treatment failure to first-line drugs and also for treatment of Multi Drug Resistant tuberculosis (MDR-TB). Objective: To investigate the presence of drug resistant strains of Mycobacterium tuberculosis (MTB) to second line anti-tuberculosis drugs in isolates obtained from different studies carried out at the Centre for Respiratory Diseases Research (CRDR). Methods: A total of 216 isolates including 78 first line drugs resistant isolates and 138 first line drugs susceptible isolates of MTB were selected for this study. All isolates were tested for susceptibility using resistant ratio and proportional methods to four second line drugs that include cycloserine, gatifloxacin, ethionamide and kanamycin. MDR strains of MTB isolates were also used to determine whether there were any Extensively Drug Resistant (XDR) strains of MTB. Results: Preliminary findings show that there is presence of resistance to some of the second line anti-TB drugs being analysed in the Kenyan population. Conclusion: This shows that basic TB care should be strengthened to prevent the spread of drug resistant TB strains in Kenya and to improve policy measures in control of TB in Kenya to curb the spread of drug resistant strains of TB. Key Words: Extensively Drug Resistant (XDR-TB), second line antituberculosis drugs, Drug susceptibility testing. ISE.422 HIV/AIDS-associated Tuberculosis Recurrence in a Suburban General Hospital, Buenos Aires A.M. Reniero1, M.C. Latini2, M.A. Beltran1, M.D. Sequeira3, O. Latini3, V. Ritacco2. 1Hospital Central de San Isidro, Buenos Aires, Argentina, 2 INEI ANLIS Malbrán, Buenos Aires, Argentina, 3INER E. Coni ANLIS, Santa Fe, Argentina Background: During the mid 90s, nearly 80 new cases of HIV/AIDS and 40 of tuberculosis (TB) were diagnosed yearly in our 120-bed hospital. At that time, 26% of our TB patients were HIV-infected and HAART was still not available. This retrospective study was aimed to determine frequency

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and strain genotype of HIV-associated TB recurrence in patients whose initial TB diagnosis was made in such period and setting. Methods: We reviewed medical records of all 36 HIV/AIDS patients whose TB was diagnosed between May 1993 and December 1996. TB culture served to monitor treatment outcome and to confirm suspected TB recurrence until 2006. M. tuberculosis IS6110 RFLP was used for geonotyping. Frequency of TB recurrence was compared with that observed in all 104 HIV-negative TB patients treated in our hospital in the period. Results: 20/36 HIV/AIDS patients died without evidence of TB recurrence within 30 months of initial TB diagnosis and 3 more were lost to follow-up. Recurrent TB was documented in 23% of the 13 remaining patients (3/13 HIV/AIDS vs. 5/104 HIV-negative, p<0.05, Fisher test). In all 3 HIV/AIDS patients, recurrent TB was caused by a strain different from that isolated initially. The second TB episode occurred 25, 92 and 102 months after initial TB diagnosis. One patient underwent a third episode (month 109) caused by a TB strain different from those isolated in his previous two episodes. Conclusions: Recurrent TB was significantly more frequent in HIV/AIDS patients than in HIV-negative persons. Re-infection rather than endogenous reactivation was the cause of TB recurrence in our patients living with HIV/AIDS. If confirmed in further studies, these findings might have implications on HIV/AIDS-associated TB patient management and control strategies. In particular, treatment of latent TB would not suffice to prevent TB recurrence in our patients living with HIV/AIDS. ISE.423 Generation of T cell Hybridomas Specific Against PE_PGRS33 (Rv1818c) Protein of Mycobacterium tuberculosis P.C. Gastélum-Aviña1, C. Velázquez1, C. Espitia2, A. Garibay-Escobar1. 1 Universidad de Sonora, Hermosillo, Mexico, 2Universidad Nacional Autónoma de México, México, Mexico The importance of the cellular immune response in vaccine design and in the combat of tuberculosis is well known, thus the identification of immunodominant antigens of Mycobacterium tuberculosis that induce such answer, is of great interest. PE_PGRS33 protein of Mycobacterium tuberculosis is considered one of the sources of antigenic variability of the mycobacteria and of great immunologic relevance, because it is found on the cell surface and displays both a polymorphic sequence and a constant amino terminal domain, responsible for the induction of the cellular immune response. The goal of this study was to generate specific T cell hybridomas against PE_PGRS33 protein in an in vitro antigen processing and presentation system, using a murine model. The generation of T cell hybridomas was made by fusion of the BW5147 - - cell line with popliteal lymph node cells of C3H/HeJ mice immunized, using polyethylene glycol 1500. Mouse immunization was made on footpad with a protein and CFA emulsion. The selection of PE_PGRS33 specific hybridomas was carried out by an in vitro antigen presentation system, with M12Ak. C3F6 cell line as APC. Activation of T cell hybridomas was evaluated by proliferation of CTLL-2 cells that are dependent on IL-2 for growth, using the MTT cell proliferation assay by spectrophotometry at 570-655 nm. Identified specific T cell hybridomas were subcloned and also evaluated using the CTLL-2 proliferation assay. In this study, we generated 5 specific T cell hybridomas against PE_PGRS33 protein: 3C2, 2F9, 7E7, 2B6 and 7E7, which will helped to identify the main epitopes responsibles for the induction of cellular immune response, as well as the chemical and immunological characterization of the protein for future investigations. ISE.424 Tigecycline Against Multi-resistant Organisms: A Review in Central America and Mexico R. Badal1, S. Bouchillon1, B. Johnson1, M. Renteria1, M. Hackel1, J. Johnson1, D. Hoban1, M. Dowzicky2. 1International Health Management Associates, Inc., Schaumburg, IL, USA, 2Wyeth Pharmaceuticals, Collegeville, PA, USA Background: Tigecycline, the first member of the glycylcyclines, was marketed in 2005 and has demonstrated success against multiplyresistant species and phenotypes. Due to its chemical structure, resistance to tigecycline is reportedly difficult to produce even in the laboratory. The T.E.S.T. program is an ongoing global surveillance with the first post-marketing prospective report of tigecycline and comparator in vitro activity for the years 2004 through 2007; however, as there

were few Central American T.E.S.T. sites in 2004, this analysis covers 2005­2007. Methods: 2,062 clinical isolates were collected from 12 investigative sites in 6 countries in Central America and Mexico. MICs were determined by broth microdilution according to CLSI guidelines using identical panels. Results: Are given by year for all pathogens and antimicrobials. Summary data for tigecycline and key species are as shown below. Conclusions: For most organism groups, tigecycline demonstrated no shift in MIC50/90 values over two years from its pre-marketing baseline values. Furthermore, tigecycline remained active against strains resistant to other antimicrobials, including ESBL+ enterics, Acinetobacter spp., methicillin-resistant S. aureus, vancomycin-resistant enterococci, and penicillin-resistant S. pneumoniae.

ISE.424 Table 1. ISE.425 Characterization of pncA Mutations of Pyrazinamide-Resistant Mycobacterium Tuberculosis in Turkey P. Yuksel1, O. Tansel2, A. Sanic3. 1Microbiology and Clinical Microbiology Department, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey, 2Trakya University School of Medicine, Departments of Clinical Microbiology and Infectious Diseases, Edirne, Turkey, 3Mayis University School of Medicine, Departments Microbiology and Clinical Microbiology, Samsun, Turkey Tuberculosis still remains one of the leading causes of morbidity and mortality worldwide. Controlling tuberculosis becomes more difficult because of the drug-resistant Mycobacterium tuberculosis. Pyrazinamide has become one of the first-line drugs for the treatment of tuberculosis. Mycobacterium tuberculosis converts pyrazinamide to its active form by using the enzyme pyrazinamidase. This enzyme is coded for on the pncA gene, and mutations in the pncA gene result in absence of active enzyme, conferring resistance to the drug pyrazinamide. In the present study, the strains were identified as M. tuberculosis complex by cord factor, NAP test and PCR-RFLP. Then, pyrazinamide susceptibility was studied by BACTEC methodology and pyrazinamidase test. The mutations of pncA gene have been detected with DNA sequencing. Our aim was to identify the mutation of pncA gene in pyrazinamide resistant isolates detected by the classical susceptibility tests and to compare our results with the mutations in literature reported before. In two PZA susceptible and in three of 10 pyrazinamide resistant strains, no mutations were determined. Two of the pyrazinamide resistant strains had mutations in the same region (GGC 71 GAC). Two of the yrazinamide resistant strains had different mutations (ACA 479 AAA), (CAC 152 CCC). Three of the pyrazinamide resistant strains had deletion in the same region (CTG-AAT (102-269)). As a result, mutation in 152. codon was reported in previous studies; two new mutations and a deletion were determined responsible for pyrazinamide resistance in our study. ISE.426 Drug Resistance of Mycobacterium tuberculosis in Trakya Region, Turkey: Results of the Last Six Years P. Yuksel1, O. Tansel2, A.D. Celik2. 1Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey, 2Trakya University School of Medicine, Edirne, Turkey Tuberculosis still remains one of the leading causes of morbidity and mortality worldwide. Control of tuberculosis becomes more difficult day by day due to the drug resistant Mycobacterium tuberculosis. The aim

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of this study was to determine the rates of M. tuberculosis complex and their resistance to antituberculous agents from the specimens accepted to the Microbiology Laboratory, Trakya University Hospital, between November 1999 and November 2005. For this purpose, 9804 specimens were examined using BACTEC 460 method and M. tuberculosis complex was identified in 248 (96.8%) of them and nontuberculous mycobacteria were identified in eight (3.2%). Resistance rates of M. tuberculosis complex isolates were 11%, 5%, 2.5 % and 2.5 % for isoniazid (INH), rifampin (RIF), streptomycin (SM), and ethambutol (EMB) respectively. Resistance rate to one or more drugs was 13 %. Multidrug resistant tuberculosis (MDR-TB) rate was 3.2 %. The number of the isolates sensitive to four major antituberculous agents was 216 (87%). The results of this study show the presence of drug resistant and MDR strains of TB in Trakya Region, European part of Turkey. ISE.427 Antibiotic Resistance Among Blood Isolates in Sihanouk Hospital Centre of HOPE, Cambodia R. Seilavath1, L. Kruy1, T. Sopheak1, S. Teav1, C. Kham1, E. Vlieghe2, L. Lynen2, J. Jacobs2. 1Sihanouk Hospital Centre of HOPE, Phnom Penh, Cambodia, 2Institute of Tropical Medicine, Antwerp, Belgium Background: Antibiotic resistance in Cambodia is a concern although no surveillance data have been published. SHCH installed bacterial culture since 2005. Objective: To describe the antibiotic resistance pattern in blood isolates during 2007. Methods: Blood cultures were made in febrile patients in SHCH by means of 2 vials of 50 ml Brain Heart Infusion Broth to which 5 ml blood was added. Incubation was 7 days. Standard methods were used for identifications. Susceptibility was tested by disk diffusion. Results were analyzed retrospectively. Results: During the year 2007 we received 918 blood samples for culture. Growth was noted in 116 (12.6%). The most frequent significant isolates were Staphylococcus aureus (n=8), Streptococcus pneumoniae (n=4) and beta-haemolytic Streptococci (n =3) in the grampositive group and Escherichia coli (n=12), Salmonella paratyphi and non-typhoid Salmonella (n=13), Klebsiella pneumoniae (n=7) and Burkholderia pseudomallei (n=5) among the gramnegatives. All S. aureus isolates were sensitive to oxacillin, 3 (37.5%) were resistant to lincomycin, 1 (12.5%) to ciprofloxacin, and 2 (25%) to gentamicin. All 12 E. coli isolates were resistant to ampicillin, 4 (33.3%) to amoxycillin/clavulanate, 9 (75%) to ceftriaxone, 10 (83.3%) to ciprofloxacin, 7 (58.3%) to gentamicin; all those were sensitive to amikacin. Seven of 10 Salmonella sp. isolates were resistant to ampicillin (70%), 1 (10%) was resistant to ceftriaxone, and 2 (20%) to gentamicin but all were sensitive to amoxicillin/clavulanate and ciprofloxacin. All 7 Klebsiella pneumonia isolates were resistant to ampicillin (100%), 1 to amoxicillin/clavulanate (14%), 3 to ceftriaxone (43%), 2 to ciprofloxacin (28.5%), and 4 to gentamicin (57%). Discussion and Conclusion: Antibiotic resistance is of concern, especially among Gram-negative bacteria. E. coli is extensively resistant to first-line antibiotics. At present, we are conducting further studies to document combined resistance and we are screening isolates for extended spectrum beta-lactamases. No MRSA isolates were found. Nationwide bacterial resistance data are urgently needed. ISE.428 Survey on Listeria monocytogenes Contamination in Traditional Butter in West Tehran Province, Iran B. Radmehr. Islamic Azad University-Karaj Branch, Karaj, Iran (Islamic Republic of) Listeria monocytogenes is one of the most important pathogen in food safety and it frequently contaminates foods. In recent years, many studies have been done to assess this contamination in foods, so in this way risk of danger from the pathogen can be estimated. Dairy products are the most important food groups related to this contamination. Therefore in this survey amount of Listeria monocytogenes contamination in traditional butter was evaluated. Food hygiene principles probably are not mentioned in production of traditional butter in comparison with industrial butter. In this survey two largest and mostly utilizing traditional diary products cities, Karaj and Shahriyar, in west Tehran province were chosen. Fifty samples of traditional butter (30 samples from Karaj and 20 samples from Shahriyar) were collected randomly.

After enrichment, selective media culture and other complementary tests, Listeria monocytogenes was isolated from three samples. All of contaminated samples were related to Shahriyar. Results showed that total contamination was 6%, but in Shahriyar this amount reaches to 15% that was high comparatively. It was also found that all of the Listeria monocytogenes strains isolated in this study belonged to serogroup 1. It seems that more hygienic controls must be over production of this kind of butter. ISE.429 Access of DOTS to TB Patients During Natural Disasters Like Flood in Bihar, India R. Kumar, S. Prakash. Peoples College of Medical Science and Research Centre, Bhopal, India In India 40 % of the populations are infected with TB and over 1000 die every day. It is increasingly being threatened by the multi drug resistant TB. patients who are under treatment in these flood prone areas may have more risk of developing Multi drug resistant TB due to irregularity in treatment of antituberculosis drug. This pilot study attempts to look at pattern and problem of adherence to DOTS by TB patient during flood. Cross sectional survey was undertaken among 21 (female - 9) TB patients on DOTS. Mean discontinuity period due to flood was 26.90 days (SD - 23.97). Female TB Treatment beneficiaries were more affected than their male counterparts (P =0.024). TB control programme should take appropriate measures to address the issue due to natural disasters like flood. ISE.430 Evaluation Effect of Choloformic Garlic Extract on Growth Inhibition and Morphologic Changes Mycobacterium tuberculosis A.A. Imani Fooladi1, M. Sattari2, K. Ghazisaeidi3, M. Nourani4. 1 Research Center of Molecular Biology, School of Medicine, Baqiyatalla University of Medical sciences, Tehran, Iran (Islamic Republic of), 2 Department of Bacteriology, School of Medical Science. Tarbiat Modares University, Tehran, Iran (Islamic Republic of), 3Department of Pathobiology, School of health. Tehran medical Sciences University, Tehran, Iran (Islamic Republic of), 4Research Center of Chemical Injuries, Baqiyatallah University of Medical Sciences, Theran, Iran (Islamic Republic of) Tuberculosis is one of the ancient diseases in human societies which it's treatment is the major problem of world health. Drug resistance of mycobacterium tuberculosis to antimicrobial agent has strongly emerged the need to achive new drugs. Use of medical plants as a natural source has long been taken under advisement. Garlic extract cotains allicine. Allicine (thio-2-propen-sulfonic acid-s-allil ester) is one of the effective substance of garlic. Antimicobacterial effect of allicine had been investigated the pervios studies. In our study, the effect of different concentrations of chloroformic garlic extract on the standard strain of mycobacterium tuberculosis H37RV and clinical isolated strains was studied. The antimycobacterial effect garlic exteract was done in different time period of 12,24,48 hours in the middle broke 7H9 broth. Morphologic changes of mycobacterium was inspected during experiments with macroscopic and microscopic studies. The results showed that garlic exteract caused conversion of rough colonies to smooth and mucoid colonies and also in microscopic studies morphologic change of mycobacterium from bacilli form to coccobacilli and cocci was observed. Also, our results show that 0.67mg/ml of garlic exteract on 48 h period can inhibite both of sensitive (standard strain of H37RV ) and resistance (clinical strains) mycobacterium tuberculosis. Key Words: mycobacterium tuberculosis, garlic exteract, drug resistance, morphologic change

Mycology (Including New Agents, Resistance and Mechanisms of Action of Antifungals)

ISE.431 Perioperative Antimicrobial Therapy in Gastro-Intestinal Surgery: A Study L. Izzo, D. Pietrasanta, M. Caputo, P. Meloni, A. Bolognese, P. Di Cello, P. Izzo, A.L. Casullo, I. D'Angeli, F. Bisogno. 'Policlinico Umberto I' University Hospital, Rome, Italy Background: The guidelines for antimicrobial prophylaxis include that infusion of the first antimicrobial dose should begin within 60 minutes

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before surgical incision, and that prophylactic antimicrobial agents should be discontinued within 24 hours after the end of surgery. Aim of this study was to assess the use of antibiotics in general, and of Ertapenem sodycum (Invanz) in particular, and their association with antifungine administration, as a prophylactic tool in the perioperative period in gastro-intestinal surgical procedures, especially those involving colon and rectum. Methods: A prospective study was undertaken. Each patient was evaluated from antibiotic commencement, at the time of his/hers surgical procedure, until the treatment was discontinued. Results: Out of 143 examined patients, a total of 63 patients (44%) were given antibiotic therapy, with 61 (97%) of these uses being prophylactic. 30 patients were administered Ertapenem sodycum (Invanz) as the only antibiotic therapy; this antibiotic proved to be effective as a prophylactic tool: none of these patients developed infectious complications. Furthermore, being the drug administrated at the dose of 1 mg once a day, it proved to be very comfortable and well tolerated by the patients. The other 33 patients were given Sulbactam/Ampicillin (Unasyn), 3 g twice a day for 4 days. Among these patients, two showed a Surgical Wound Infection, and hence underwent surgical wound medications every second day for one week, while continuing antibiotic therapy with Sulbactam/Amoxicillin (Unasyn) tablets, 750 mg three times a day for one week. In both groups of patients, an antifungine therapy with Fluconazole (Diflucan), 200 mg once a day for 5 days, was associated in order to minimize infectious complications rate. Conclusions: We conclude that antibiotic prophylaxis associated with antifungine administration is a good strategy, allowing an important decrease in infectious complications following surgical procedures. ISE.432 Zoonotic Aspect of Candidiasis in Gharbia Governorate, Egypt W. El-Tras. Faculty of Veterinary Medicine, Kafrelsheikh, Egypt Aim: Epidemiological study for candidiasis and how to control. Methods: In this study the following samples were examined for detection of candida species in Gharbia governorate, Egypt;180 vulvovaginal swabs of pregnant and non pregnant women claiming for vulvovaginitis;100 skin swabs from the diaper area in infants suffering from dermatitis in the diaper area; 200 chicken comb swabs from chicken farms and chicken homes; 90 air samples were collected from the chicken farms that have comb candidiasis, human hospitals in which their patients infected with vulvovaginal or diaper candidiasis and patient's homes and 90 swabs from equipments and instruments were collected from the same places in which the air samples were collected. Result: indicates that the infection rate of vulvovaginal candidiasis in the pregnant women was 53.3%, in non pregnant women 23.3% and in the pregnant women administrated the Yoghurt (Probiotic) during the pregnancy was 28.3%. The rate of infection by diaper candidiaisis in infants used the cloth diapers was 44% and14% in infants used superabsorbant disposable diapers. In comb candidiasis the infection rate in chicken administrated antibiotics was 37% and 6% in chicken without antibiotics use. The rate of candida pollution in the air of chicken farms was 23.3% and in the air of human hospitals and patient's homes were 16.6% and 13.3% respectively. Equipments and instruments contamination in the chicken farms was 23.3%; in the human hospitals and patient`s homes were 26.6% and 10% respectively. Conclusions: Pregnant women were more susceptible to vulvouaginal candidiasis than non pregnant. The using of Yoghurt as a Probiotic during the pregnancy is recommended to give the protection to the pregnant women against vulvovaginal candidiasis.Using of superabsorbant disposable diapers in infant is more hygienic and protective against diaper candidiasis.Wise use of antibiotics is recommended to protect the chicken against comb candidiasis.Candida species polluted the air and contaminated the instruments and equipments of the of hospitals and patient's homes as well as chicken farms act as exogenous source of candidiasis. The public health importance of candidiasis was discussed as well as suggestive control measures. ISE.433 Treatment of Tinea capitis in Belarus I. Tsikhanouskaya, V. Kazlouskaya. Vitebsk State Medical University, Vitebsk, Belarus Zoofilic fungi Microsporum canis is the main causative agent of tinea capitis that is most frequent fungi infection in children in Belarus. Its morbidity during last five years makes up to 45,6 for 100 000. Because of the economic situation after the USSR disintegration and change of

social system and, to some extend, peculiarities of Microsporum, treatment of tinea capitis is not always effective. Children infected with Microsporum canis are treated in the hospital. Isolation of children for a long time causes negative reaction of a child family and psychological problems in children. Middle age of children who are infected are 7, 9±2, 3 years. As we noticed 38% of children live in rural areas and 62% in the city region. Cats are considered to be the main transmitters of the disease, but in 56% cases we couldn't find the source of the infection. Animals are mainly killed but not treated that causes stress in a child. Griseofulvin is considered to be a standard of treatment for tines capitis. But in Belarus terbinafin is a drug of choice. We observed 82 children with tinea canis caused by Microsporum canis treated with terbinafine. Terbinafin was given in the following dosages: weight less than 20 kg--94 mg per day; 20­40 kg--187 mg per day, more than 40 kg--250 mg per day; that is 50% more than a dosage recommended by the pharmaceutical brands. But we agree with Russian scientists that previously stated that increase of dosage is necessary. Duration of treatment before the first negative microscopically analysis was 32,8±10,7 days, but 3% of children responded to the therapy only after 16 weeks of the treatment. We conclude that unless terbinafin is effective against tinea capitis further studies are necessary to define the duration and the dosage of therapy. ISE.434 Prevalence of Tuberculosis Infection Among Health Care Workers in Hamedan, West of Iran S.H. Hashemi, M. Mamani, S. Jamal-Omidi, N. Alizadeh, M. Nazari. Hamedan University of Medical Sciences, Hamedan, Iran (Islamic Republic of) Background: Tuberculosis has been recognized as a risk to health care workers for several decades. Nevertheless, little information is available about the situation of tuberculosis infection in health care workers in Iran. The aim of this study was to ascertain the prevalence of latent tuberculosis infection and pulmonary tuberculosis, and to assess the risk factors for tuberculosis infection among health care workers in Hamedan, Iran. Methods: Tuberculin skin test was conducted among 245 health care workers in two educational hospitals in Hamedan. The reaction was reported as "positive" if the diameter of induration was 10 mm. Individuals with a positive test more than 15mm were encouraged to seek further medical evaluation, including a chest-x-ray, and smear and culture of the sputum for acid-fast bacilli in those with radiographic changes indicating tuberculosis. Results: Out of 245 health care workers included in this study, 92 (38%) had positive tuberculin test. There was a significant association between the increase of age and tuberculin positivity. In addition, there was a significant association between the length of employment and tuberculin positivity. Ward attendants had higher rates of positive test than the other occupational groups. Fifty-six subjects showed tuberculin reaction of more than 15mm, 4 (7.1%) of them had calcification on radiograph. No cases of active pulmonary tuberculosis were found in the subjects. Conclusion: Latent tuberculosis infection is common among health care workers. Age, occupational group, and length of employment are strongly associated with risk of tuberculin positivity. More emphasis on tuberculosis control measures and regular staff screening may be needed. ISE.435 Inhibitory Effect of Honey on Germ Tube Formation by Candida albicans M. Riazipour1, Z. Mottaghian2. 1Department of Microbiology, Medical School and Molecular Biology Research Center,Baqiyatallah University of Medical Sciences, Tehran, Iran (Islamic Republic of), 2Azad University of Qom, Qom, Iran (Islamic Republic of) Background: Germ tube plays an important role in Candida albicans pathogenesis. In vitro effects of honey on germ tube formation was objective of the present study. Methods: Fresh C. albicans yeast cells were suspended in different concentrations of a dried honey sample (from Khansar area of Iran) diluted in human pooled serum, and incubated at 35° C for 2 h. By microscopic examination of at least 200 yeast cells, percentage of germ tube formation was calculated.

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Results: There was a significant correlation between honey concentration and germ tube formation. The results showed that honey could reduce germ tube production at concentrations as low as 2%, and the phenomenon is completely inhibited in tubes containing up to 40% honey. Conclusion: Honey inhibits in vitro germ tube production and may reduce virulence of C. albicans in vivo. Key Words: Candida albicans, Honey, Germ tube ISE.436 Hand Hygiene Practices in Hospital Roosevelt in Guatemala City C. Mejia, V. Vanegas, C. Mazariegos, F. Alvarado. Hospital Roosevelt, Guatemala, Guatemala Objective: To determine adherence to Hand Hygiene in medical and paramedical Health Care Workers (HCW). Methods: An observational, descriptive study was planned, based on the recently recommended principles of the 5 critical moments of Hand Hygiene (M1 to M5): M1: Previous to contact with patient, M2: Before antiseptic contact, M3: After body fluids contact, M4: After contact with patient, and M5: Patient enviromental contact. A discrete and confidential observation of HCW, doctors and nurses in the different hospital wards was done. We used the instrument recommended by WHO (Pittet D.), in the campaign: Clean Care is Safer Care and The International Alliance for Patient Safety. Results: We observed 605 HCW and 2,735 moments, distributed in the following services: Anesthesia: 170, Surgery: 649, Internal Medicine: 470, Obstetrics: 501, Pediatrics: 441, Trauma: 138, PICU: 165 and Adults ICU: 199. The global adherence was 24% for at least 1 of the moments, but for specific adherence to the five critical moments, the results were as follows: 15%­46%, M1(5.8­21.4%), M2(7.8­32%), M3(5.8­19.2%), M4(5.2-21.2%), M5(6­22.1%). Even though the wide availability of opportunities for Hand Hygiene in the wards exists--sinks, water, antiseptic soaps and alcohol-based solutions or gels--88.4% of the times the products were available. Conclusions: We found a low adherence to Hand Hygiene in hospital wards. A strong intervention to modify the current situation is needed. A multimodal intervention as D. Pittet and WHO recommend could be succesful with the authorities support. ISE.437 A Study of Subcutaneous Mycoses in Coastal Karnataka (India) J. Martis, N. Kishore, R. Bhat, D. Sukumar, G. Kamath. Dept. of Dermatology, Venereology & Leprosy, Fr. Muller Medical College Hospital, Kankanady, Mangalore-575002, Karnataka, India, Mangalore, India Background: Subcutaneous Mycoses are a heterogenous group of fungal infections that develop at the site of transcutaneous trauma, commonly seen in tropical and subtropical regions. Aim: To evaluate various types of Subcutaneous Mycoses in Coastal Karnataka (India). Methods: This Clinico-Pathological study was conducted for a period of two years (2005­2007) at Fr. Muller Medical College Hospital, Mangalore, Karnataka, India. Patients attending out patient dept. were included in the study.A detailed history and meticulous examination is carried out in all patients. Skin biopsy was performed in all the suspected cases of Subcutaneous Mycoses. Culture and special staining is done as confirmatory. Results: A total of 7 cases of Subcutaneous Mycoses were diagnosed during the study period. The patients were aged between 40 and 70 years, while male: female ratio was 1:2. Duration of the symptoms varied from 4 months to 5 years. Farming was the commonest occupation. Six patients gave h/o prior trauma. The skin lesions commonly involved the lower extremities. Routine haematological and biochemical investigations were within normal limits. The present study revealed 2 cases of Sporotrichosis on histopathological examination showed granuloma, culture on Sabouraud's dextrose agar showed white-grey colonies, Lactophenol cotton blue stain revealed delicate hyphae & daisy like clustering of small oval conidia from the sides and tip of conidiophores. Three cases of Chromomycosis on histopathology, showed dermis with mixed infiltrate and dark brown, thick walled round to ovoid spores with septations (sclerotic bodies). One case diagnosed as Rhinoentomophthormycosis, skin biopsy revealed foreign body reaction and Splendore Hoeppli phenomenon on geimsa stain. Histopathology confirmed the diagnosis of Actinomycetoma in another patient.

Conclusion: These cases are presented for its rarity in this part of the world. Rhinoentomophthormycosis is a rare form of deep mycosis with an added feature of mutilation. ISE.438 Neonatal Candida Infection in Tertiary Care Hospital in Kolkata I. Roychowdhury, S. Basu, S. Das. Peerless Hospital & B. K. Roy Research Centre, Kolkata, India Background: Candida infection is increasing throughout the globe and there is gradual increase of non-albicans Candida spp. In South-East Asian countries there are reports of significant increase of C. tropicalis infection. Candida infection in neonates showed very high morbidity and mortality rates. Thus, in this study we have analyzed retrospective Candida infection in neonates in a tertiary care hospital in Kolkata, India. Methods: All Candida isolates from neonatal patients in the year 2007 were analyzed to find out common isolated species and other investigation findings were also analyzed to find out any specific change. Results: Seven Candida infections were found in 2007 in our hospital. One neonate died due to Candida pneumonia (14.3%). 42.7% isolates were from blood, 57.1% isolates were from throat swab and 14.3% isolates were from stool. In one neonate Candida spp. isolated from more than one clinical material. All isolated Candida spp. were C. tropicalis, which is very significant, and five of them were resistant to fluconazole although all were sensitive to Amphotericin B. Associated bacterial infection was present in 5 cases (71.4%). Central nervous system infection was found in one case with candidaemia, average CRP was 13.5 mg/L; jaundice and leucocytosis with eosinophilia were also present. Conclusion: Neonatal Candida infection in Kolkata is mostly due to C. tropicalis and most of them were fluconazole resistant. One neonate ( 14.3%) died due to C. tropicalis infection in 2007. ISE.439 Incidence of Dermatophytes in Children Infected with HIV/AIDS O.M. Mashedi, K.R. Korir, C.C. Bii. Kenya Medical Research Institute, Nairobi, Kenya Background: Dermatophytes are a group of fungi that cause infections: dermatophytoses. It has been documented that the occurrence of episodes of deep or superficial fungal infections is usually 60% percent of HIV/AIDS patients as result of impairment of cell immunity. It is from this aspect that we decided to find out the prevalence and variations of dermatophytoses in HIV infected patients. Methodology: A total of 36 skin scrapings from HIV positive children in children's home were examined by mycological direct microscopy and culture methods. Identification was based on morphological characteristics. Results: From the results (26/36) 72% were KOH positive for fungal elements, (10/36) 27% was KOH negative. (20|36) 55% of the specimens were culture positive for Trichophyton, Microsporum, Candida, Malassezia, Aspergillus and Fusarium species. The children ranged between 2 months to 16 years-old, with the sex ratio of female to male: 40:50. Discussion and Conclusion: We can conclude that the rate incidence of Dermatophytoses among these children is high due to the fact that their immunity is low; this is attributed to the fact that infection of dermatophytoses is linked with cell mediated immune system of the body. The fact that HIV/AIDS makes the patients especially the children more susceptible to infection of the skin and also, that these children were in a home, the rate of infection was increased due to fomites from clothing's combs from sharing and contact with each other. If the dermatophytes are not treated early enough, they open route for more secondary infection thus leading to morbidity and mortality rate increases amongst the patient. Lack of documentation, proper treatment and management of dermatophytoses brings about the need for more studies especially to isolate, identify and to determine the antifungal drug profile the dermatophytes in HIV/AIDS, hence proper treatment and management of the patients. ISE.440 Invasive Mycoses Due to Filamentous Fungi: Case Series S. Levidiotou1, G. Vrioni1, H. Gessouli1, H. Boboyianni1, C. Pappa1, D. Papamichail1, C. Gartzonika1, D. Stefanou2, S. Constantopoulos3. 1 Department of Microbiology, Medical School, University of Ioannina, Ioannina, Greece, 2Department of Pathology, Medical School, University of Ioannina, Ioannina, Greece, 3Department of Pneumonology, Medical School, University of Ioannina, Ioannina, Greece

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Invasive mycoses due to filamentous fungi have recently assumed great importance and their incidence has increased especially in immunocompromised patients. We describe two cases of invasive aspergillosis, one case of pulmonary mucormycosis and one case of disseminated fusariosis with endocarditis. All cases occurred between 2001 and 2005. The associated underlying conditions of aspergillosis included malignancy (a 38-year-old man with pancreas adenocarcinoma) and valvular surgery (a 58-year-old man with metallic prosthetic valves). First patient had pulmonary aspergillosis with productive cough and cavitary pulmonary lesion, and the second one infective endocarditis with embolic episodes. Diagnosis of invasive aspergillosis was based on serological detection of antigen (galactomannan by Platelia Aspergillus) and culture either of BAL, sputum and fine needle aspiration (FNA) for the first patient, or blood cultures for the second one. Two different Aspergillus species were isolated: A. fumigatus from the first patient's cultures, and A. flavus from those of the second one. Susceptibility testing by E-test diffusion method showed A. fumigatus to be amphotericin B and voriconazole susceptible, while A. flavus to be voriconazole and ketoconazole susceptible. The patient with pulmonary mucormycosis was receiving high doses of corticosteroids due to autoimmune vascular disease. Mucor was isolated from BAL and sputum cultures. The patient with disseminated fusariosis and endocarditis had three positive for Fusarium solani blood cultures. Echocardiography revealed vegetations on aortic and bicuspid valves. Outcome was fatal in all cases despite appropriate antifungal and aggressive symptomatic treatment. ISE.441 Fungal Strains Isolated from Blood of Heamatological Patients Hospitalized in Clinical Hospital of Medical University of Warsaw in 2007--Etiological Agents and Their Susceptibility to Antifungals Agents E. Swoboda-Kopec1, S. Blachnio1, B. Sulik-Tyszka1, E. Stelmach1, D. Kawecki2, W.W. Jedrzejczak3, M. Luczak2. 1Medical University Dept. of Medical Microbiology, Warsaw, Poland, 2Medical University Dept. Medical Microbiology, Warsaw, Poland, 3Medical University Department of Hematology and Oncology, Medical University of Warsaw, Warsaw, Poland Introduction: During the last decade the increase of fungal infections have been observed in patients with immunodeficiencies. The blood infections are occurred in patients: with immunosuppressive therapy, central venous or urinary catheters as well as dialyzed patients and with total parenteral nitrition. The etiological factors of fungemias are mostly yeastlike fungi from Candida genus which can colonize digestive, urinary and respiratory tracts mucosa. Aim: Identification and susceptibility tests of strains isolated from blood samples of patients hospitalized in Department of Haematology in 2007r. Material and Methods: From January to the end of December 2007 in Mycology Laboratory the 427 positive mycological cultures from clinical samples of patients hospitalized in Department of Haematology were identified. Fifteen (3,5%) of all specimens were the blood positive samples. The clinical material was examined according to the standard mycological procedures. The isolated strains were incubated on Sabouraud medium plates with addition of gentamicin and chloramphenicol (Becton Dickinson). The identification of the isolates was performed on CHROMagar Candida medium and automatic test of ID32 C (bioMerieux). The susceptibility tests for antifungal agents: Amphotericin B, Itraconazole, Fluconazole, Voriconazole, Caspofungin and Posaconazole, was done using E-tests (AB Biodisk). Results: From the whole number of 427 samples from Department of Haematology, the positive blood samples were 3,5% - 15. The most common isolates were yeastlike fungi- 14 strains (99%). The dominant strais from Candida genus were C. glabrata -4 (28,5%), C. krusei - 4 (28,5%), C. albicans - 2 (14,3%), C. tropicalis 1 (7,2%), C. parapsilosis - 1 (7,2%). Other fungal strains: Cryptococcus neoformans isolated in 2 cases (14,3%) and Aspergillus fumigatus - 1 strain- 6,7% out of the total number of cultures. The susceptibility of isolates for Amphotericine B i Voriconazole was 100%. In 13 strains which were tested for Itraconazole, 6 (46%) were resistant, the 16,7% of analyzed spesies were Flukonazole resistant. 100% of C. glabrata isolates were susceptible for Caspofungin and Posaconazole. Conclusions: 1) The performed analyses indicated that yeastlike fungi had the highest contribution in fungemias (99%). 2) The main etiological factors of fungemia in immunodeficient patients were non-albicans spesies - 66,7% 3) The dominant spesies from Candida genus with increased resistance for antifungal agents were C. glabrata - 33.3% C.

krusei - 33.3%. 4) The most efficient antifungal agents were in vitro Amphotericin B i Voriconazole.

ISE.442 Epidemiology of Fungemia in Patients Hospitalized in the Infant Jesus Clinical Hospital in Warsaw 2005­2007 M. Sikora, E. Swoboda-Kopec, I. Netsvyetayeva, D. Kawecki, M. Luczak. Medical University Dept. of Medical Microbiology, Warsaw, Poland Introduction: Blood stream infections are frequent complications occurred in patients with immune system disorders. In case of catheter related fungemia the main cause of infection could be the blood vessels catheters surface with adhered cells of yeastlike fungi. Aim: Characterization of clinical isolates cultured from blood samples and blood vessels catheters tips. Analysis of the susceptibility of cultured strains to antifungal agents. Materials and Methods: Clinical material taken to the analysis consisted of blood samples and blood vessels catheter tips from patients hospitalized in Clinical Hospital of Medical University in Warsaw from 2005 to the end of 2007 from Department of: General Surgery and Intensive Care Unit. The blood samples were examined in automatic system-Bact/Alert Microbial Detection System (Organon). Microbiological tests of venous catheter tips were performed by semi quantitative Maki's and/or quantitative culture method. The susceptibility testing was done according to quantitative method of E-tests (AB Biodisk). Results: During analyzed period of time for mycological testing there have been taken over 2,733 of clinical specimens. The positive cultures were obtained from 41 blood samples and/or catheter tips (1,5% of the total number of mycological cultures). 83 fungal strains were isolated: from blood samples 66 (79,5%), and from blood vessels catheter tips 17 (20,5%). There were separated the following groups of isolates: Candida parapsilosis - 46 (56%) isolates, C. albicans - 15 (18%), Candida glabrata - 6 (7%), Candida tropicalis - 4 (5%), C. guilliermondii4 (5%), C. krusei - 1 (3%), C. inconspicua - 1 (3%), C. lusitaniae - 1 (3%) and 4 isolates of Cryptococcus neoformans (5%) and 1 isolate of Rhodotorula glutinis (1%). All isolates (100%) were susceptible for Amphotericin B and Caspofungin. Fungal strains n=16 (19%) were resistant to Fluconazole, n=12 (14%) were Itraconazole resistant and n=4 (5%) were Voriconazole resistant. Conclusions: 1) The most often isolated species was Candida parapsilosis - 56%. 2) Candida albicans formed group of 18% from all isolated strains. 3) All analyzed strains were Amphotericin B and Caspofungin susceptible. ISE.443 The Susceptibility Analysis of Fungal Strains to Posaconazol in Vitro Isolated from Clinical Specimens of Patients Hospitalized in Warsaw Medical University Central Clinical Hospital E. Swoboda-Kopec, S. Blachnio, E. Stelmach, D. Kawecki, M. Luczak. Medical University Dept. of Medical Microbiology, Warsaw, Poland Introduction: The increasing resistance of fungal strains to antifungal agents is the main reason of research on the new antimicotics. Aim: The susceptibility analysis of fungal strain isolated from patients hospitalized in Warsaw Medical University Central Clinical Hospital in 2007 to Posaconazole in vitro. Materials and Methods: The clinical material was consisted of: blood samples- 33 (43,4%), respiratory tracts specimens- 18 (23,7%), wound swabs - 16 (21%), urine samples - 4 (5,3%) and other- 5 (6,6%). Strains were cultured on Sabouraud and CHROMagar media and identify by ID32C tests. The susceptibility analysis to Posaconazole was done according to E-tests. Results: From the total number of 76 positive samples we cultured 87 of fungal strains. The following species were cultured C. galbrata - 41 (47%), C. albicans - 12 (14%), C. krusi - 10 (11,5%), C. parapsilosis - 6 (7%), C. inconspicua - 4 (4,5%), Saccharomyces cerevisiae - 4 (4,5%), other- 10 (11,5%). We isolated 83 strains of the yeast like fungi (95% out of all isolates) and two species of molds (5% of all isolates): Aspergillus fumigatus - 2 strains and Fusarium incarnatum - 2. Our results were analyzed according to ARTEMIS Program. The final Posaconazole concentration was 0,008 to 32µg/ml. In our study the break point was 1 µg/ml and it was established as the agent activity. Posaconazole was active for 83 isolates (95% casus) and it had the break point 1 µg/ml. The all resistant isolates were from the same species of C. glabrata. Posaconazole had not been active for 4 (5%) of isolates. Conclusions: 1) 10% of C. glabrata isolates were Posaconazole resistant. 2) Posaconazole was active for 95% of isolated strains.

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ISE.444 Identification of Medically Important Yeasts Using Sequence Variability ITS2 Genetic Region V. Hrabovsky, M. Sabol, M. Kmetova, L. Siegfried. Institute of Medical and Clinical Microbiology, University P.J.Safarik and L.Pasteur University Hospital, Faculty of Medicine, Kosice,, Slovakia, Institute of Medical and Clinical Microbiology, University P.J.Safarik and L.Pasteur University Hospital, Faculty of Medicine, Kosice, Slovakia Introduction: Variability of the internal transcribed spacer 2 (ITS2) region of fungi is potentially useful in rapid and accurate diagnosis of clinical yeasts isolates. PCR with universal primers for fungi targeted towards conserved sequences of the 5.8S and 28S ribosomal DNA (rDNA) results in amplification of the species-specific fragments, which are variable in amplicon length and sequence. Goals: The goal of the study was reidentify the yeast organisms collected from samples which had been executed using conventional routine methods. Material and Methods: Strains of yeasts (n = 210) were collected using standard swabs, alternativelly blood was cultivated in Bactec Mycosis IC/F (BD) system. For identification of yeasts Chromagar Candida (MAST) and Auxacolor 2 (Bio-Rad) test were used. Results of phenotypic identification were compared to genetic determination of yeasts species. Capillary electrophoresis ABI PRISM 3100 Avant genetic analyzer was used for determination of the lenghts of the fragments ITS 2 genetic region amplified by PCR using universal primers set. Control sequencing reference fragments of known strains were done. Results: Overall, 92 % of isolates were identified correctly (in examined group of non-albicans species of yeast 22%). Resistance to antifungals is often associated with non-albicans species of yeasts and incorrect identification could have result to incorrect characterisation of antifungal resistance. All resistant strains (usually susceptible species) which had been previously tested to antifungal susceptibility (six antimycotics by CLSI M27-A2) were reidentified as primary resistant species. Conclusion: The fragments length of amplified ITS2 genetic region that had been determined by capillary electrophoresis could be suitably used for rapid confirmation results of identification medically important species of yeasts achieved by conventional methods. The work was supported by Grant AV 4/0027/07. ISE.445 Tinea corporis Caused Bymicrosporum canis and the Effect of Antimycotic Agents in Its Treatment A. Srivastava. Dayalbagh Educational Institute, Agra, India A 40 year old male patient presented himself with a red inflammatory skin lesions. The lesions appeared as a small papule, dry or wet with sever itching which covered almost half of the belly and legs. The direct microscopic examination of the skin scrapping revealed thick walled,412 celled, spindle shaped rough macroconidia. In vitro three antimycotics were tested against Microsporum canis (MTCC 3270) by dilution method. Among three antimycotics ketoconazole was found to be more effective at 30µg /ml after 15 days of incubation period followed by griseofulvin while oxiconazole was found to be less effective. ISE.446 A Survey of Potential Pathogenic Fungi in Sea-Water from Swimming Area of Selected Beaches of Caspian Sea in Iran S.R. Aghili, S. Gholami, M.T. Hedayati, B. Salmanian, Y. Esfandiari. Mazandaran University of Medical Sciences, Sari, Iran (Islamic Republic of) Background: One of the amusement places for swimming in Iran is the beaches of Caspian Sea. Other studies have shown that a greater number of substrates found in Sea-Water can create favorable conditions for fungal growth. The objective of this study was to isolate and identify medical important fungal species found in sea-water in swimming area in beaches of Caspian Sea in Iran. Methods: The samples of sea-water in swimming area investigated in this study originated from seven different locations, including 7 times sampling from public swimming area of beaches in Mazandaran province in active seasons (June to September). The membrane filtration technique was used for determination of the presence of fungi. Results: The fungi in sea water samples were identified as: Aspergillus flavus (63.6%), A. niger (48.5%), A. fumigatus (12.1%), Candida albicans (15.1%), Candida non-albicans (48.5%), Penicillium sp. (48.5%), Trichoderma sp.(45.4%), Fusarium sp. (42.4%), Cladosporium sp. (27.3%), Alternaria sp. (15.1%), Mycelia sterilia (42.4%), Geotrichum candidum (24.2%) and other fungi included Mucorales, Curvularia and Nigrospora.

Conclusion: River water, which can wash out microbes from surrounding soil, and micro flora of surface of swimmers body cause fungi pollution in sea water. However, sea water can offer a transmission route and fungi may constitute a potential health hazard. Key Words: medical important fungi, sea water, Caspian beach, health care ISE.447 Isolation of Griseofulvin Resistant Strains of Dermatophytes in Isfahan, Iran M. Chadeganipour, S. Shadzi, J. Chabavizadeh. Isfahan University of Medical Sciences, Isfahan, Iran (Islamic Republic of) Background: The emergence of drug resistance in dermatophytes would affect the incidence of infection in the society and causes difficulties for both physician and patient. With report of cases of griseofulvin resistant dermatophytes, the use of new antifungal drugs is recommended which are more expensive or somehow rare in Iran. Therefore, the necessity of griseofulvin sensitivity pattern of dermatophytes in Isfahan is perceived which could lead to a more effective and less expensive treatment for recalcitrant dermatophytoses. Methods: 50 isolates of the most prevalent dermatophytes in Isfahan were isolated from patients and then the standard homogenized suspension from them were prepared for future inoculation. The minimum inhibitory concentration (MIC) of griseofulvin was determined by modified microdilution method for each isolate and then results were compared and analysed with standard values of MICs of dermatophytes and resistant strains identified. Results: All 100% tested isolates had MIC mode of <0.25,90% had <8 and 50% ranged between <0.25-1 ug/ml. From all isolates,10% of them including three Trichophyton verrucosum, one Microsporum canis and one T. mentagrophytes had MIC out of standardized range therefore, they considered as griseofulvin resistant isolates. Conclusions: Although MIC values of drugs at in vivo and in vitro are somewhat different but in vitro values could be used as additional parameters in the decision making of treatment for dermatophytoses, in particular it's recalcitrant types or in areas which the resistant species may have high prevalence. ISE.448 The Need to Introduce Fast and Modern Molecular Diagnosis Methods for the Identification of Dermatophytosis L.M. Junie. University of Medicine and Pharmacy, Cluj Napoca, Romania Background: Dermatophytosis (tinea or ringworm) are caused by dermatophytes. The presence of the dermatophytes on the scalp, skin, and nails and its metabolic products usually induces an allergic and inflammatory eczematous response on the host. The type and severity of the host response is corelated to the species and strain of dermatophyte causing the infection. The aim of our study was to determine the prevalence of different clinical forms of the dermatophytosis in our area. Methods: The diagnosis made based on clinical symptoms and using mycological examination of patient samples. Results: 209 patients hospitalized in hospitals for cutaneous infections were evaluated in order to establish the incidence of fungal aetiology. 132 patients (63,2%) had cutaneous mycosis, from which 122 presented dermatophytosis and 3 patients (1,4%) pityriasis versicolor. Dermatophytosis occurs in different clinic forms, tinea pedis being the more incident, responsible for 63.9% of dermatophytosis. Other dermatophytosis have lower incidence: tinea unguium (15.6%), tinea cruris (7.4%), kerion celsi (4,9%), tinea barbae (3,3%); tinea corporis (1,6%), tinea manus (1,6%), favus (1,67%). For Tinea capitis, Microsporum canis was the most prevalent etiologic agent and the preschool age group the most attacked. For others dermatophytosis Trichophyton, Epidermophyton, Microsporum (T. interdigitalis, T. rubrum, E. floccosum, M. canis) were the agent etiologic. Conclusion: Our study indicates a high incidence for dermatophytosis. The incidence and prevalence of the dermatophytosis is increasing, especially of tinea pedis and tinea unguium (15.6%), which are the most common clinical forms of dermatophytosis in our area. It is important to stress that only 50% of dystrophic nails have a fungal aetiology, therefore, it is essential to establish a correct laboratory diagnosis, before treating a patient with a systemic antifungal agent. Because the culture may take weeks, it is needed to introduce for the identification, fast and modern molecular diagnosis methods.

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ISE.449 A Rare Cause of Intestinal Obstruction Mucormycosis A. Kudva. Kasturba Medical College, Manipal, India Mucormycosis is a sporadic opportunistic infection that occurs in patients with underlying disorders such as diabetis, acute leukemia and in patients treated with corticosteroids or cytotoxic drugs. The common forms are the rhinocerebral,pulmonary and subcutaneous mucormycosis. Gastrointestinal mucormycosis is rare. Stomach is involved most frequently followed by colon and small intestine. This is a a case of mucormycosis of the jejunum which presented with intestinal obstruction in a 40-year-old male. Segment of jejunum with the mesentry was resected. Jejunum on cut section showed a circumferential thickening of the wall. Histopathological examination showed granulomatous reaction with thin walled broad aseptate fungal hyphae. Thrombosed vessels with hyphal invasion was also seen. This case is being presented because of its rarity. Successful treatment is control of underlying disease coupled with radical debridement of devitalized tissue and systemic antifungal chemotherapy with Amphotericin B. Greater awareness of this opportunistic infection is required for prompt diagnosis and treatment. ISE.450 Decreasing Trends of Utilization of Fluconazole and Miconazole During Last Five Years in Kolkata, India S. Basu1, S.K. Dey2, I. Roychowdhury1, S. Das1. 1Peerless Hospital, Kolkata, India, 2West Bengal University of Technology, Kolkata, India Background: During the last five years there is a dramatic change in the incidence of different Candida spp. In Kolkata, India--Incidence of Candida albicans infections was gradually decreased while incidence of C. tropicalis infections was gradually increased during the period, most of which were fluconazole resistant. Thus antifungal drug utilization during the period should have some impact according to this changing pattern of incidence of Candida species. In this paper, we have studied the utilization of some common antifungal drugs in this locality during last five years. Methods: Retrospective analysis of the consumption of different antifungal drugs in the local pharmacy shops and changes in the incidence of different Candida spp. have been done during last five years and it has also been compared with the corresponding incidence of human fungal infections in the locality during the period. Results: During the last five years isolation of C. tropicalis has been gradually increased and regarding utilization of common anti-fungal drugs. although utilization of clotrimazole has been increased but utilization of fluconazole and miconazole have been decreased during the period. Conclusion: There is a gradual decreasing trend of utilization of fluconazole and miconazole during last five years in this locality while utilization of clotrimazole has been increased.

administration of acetaminophen in groups A, B and C, respectively. Conclusion: High dose rectal acetaminophen is much more effective in reducing fever of children in comparison of regular dose of acetaminophen, orally or rectally. Key Words: Oral acetaminophen, Rectal Acetaminophen, Reducing fever, Children ISE.452 Investigation of Herpes Simplex Virus in Children with Meningoencephalitis G. Eslami, F. Fallah, S. Taheri, M. Golshani, M. Najafi, H. Goudarzi. Shaheed Beheshti University, School of Medicine, Tehran, Iran (Islamic Republic of) Background: Herpes simplex Encephalitis (HSE) is a life-threatening consequence of Herpes simplex virus (HSV) infection of the central nervous system (CNS). Although HSE is rare, mortality rates reach 70% in the absence of therapy and only minority of individuals return to normal function. Antiviral therapy is most effective when starting early, necessitating prompt diagnosis. Methods: In this study, clinical files of seven patients admitted to a referal medical center with clinical suspicion of Herpes simplex Encephalitis have been reviewed and clinical, paraclinical and therapeutic data have been assessed. Results and Conclusion: Fever presented in all patients. Signs of Meningeal irritation was an uncommon presentation. Recurrent Apnea as a sign of brain stem involvement was seen in one case. A case with multifocal brain involvement including thalamus and basal ganglia was reported in CT scan. PCR was positive in one case. Owing life-threatening nature of HSE, if there is a delay in diagnostic test results, therapy should not be withheld until they become available. CSF PCR is the diagnostic method of choice for HSE and if PCR be unreachable, Neuroradiologic and neurophysiologic assays are useful. ISE.453 Case Report of 19 Years Old Boy with Cystic Fibrosis, Bronhiectasis, Pleuropneumotorax and Reccurent Pseudomonas aeruginosa Infection A. Bajraktarevic1, S. Penava2, E. Haxhija3, L. Sporisevic4, K. Karavdic5, Z. Zvizdic5, Z. Jatic6, Z. Begic7, A. Djurdjevic-Djulepa8. 1Public Health Institution Sarajevo, Sarajevo, Bosnia and Herzegovina, 2Public Health Institution New Town Sarajevo-ORL, Sarajevo, Bosnia and Herzegovina, 3Pediatrics Clinic Graz, Graz, Austria, 4First Medical Aid Sarajevo, Sarajevo, Bosnia and Herzegovina, 5Children's Surgery Univ. Clinic, Sarajevo, Bosnia and Herzegovina, 6Medical Faculty of Sarajevo, Sarajevo, Bosnia and Herzegovina, 7Pediatrics Clinic, Sarajevo, Bosnia and Herzegovina, 8General Hospital Sarajevo, Sarajevo, Bosnia and Herzegovina Background: Colonization with Pseudomonas aeruginosa (PA) is common in older kids with cystic fibrosis (CF) and there is increasing evidence that transmissible strains may cross colonise patients. PA colonization is usually difficult to eradicate with antimicrobial therapy and, in some children and younger patients, infection is associated with rapid decline in pulmonary function, increased hospitalization. Diffuse bronchiectasis is seen in patients with cystic fibrosis. Case Report: An 19 year-old male with CF severe lungs disease and liver insufficiency presented with coughing and breathing difficulties with wheezing progressed to generalized bad situations and Pseudomonas aerigenosa opportunic suprainfection. An HRCT (chest) with virtual bronchoscopy was done that showed left sided cystic bronchiectasis with fibrosis with compensatory hypertrophy of left lung with shift of mediastinum to right side. Effect of combined three antibiotics therapy were very successfull as eridication of Pseudomonas aerigenosa. Lungs physiologics tests were pathologics changed with opstructive and restrictive reductions of vital pulmonal paramethers. If the symptoms cannot be controlled by antibiotic therapy and postural drainage and disease is progressive and localized, resection may be indicated and lungs transplantation. Discussion: Cystic fibrosis (CF) is the most common potentially lethal genetic disease in the white population. Improvements in life expectancy have led to an increasing recognition of lungs and hepatobiliary-pancreatics complications from CF. Conclusions: Cystic fibrosis is a genetic disease usually diagnosed by abnormal sweat testing. As for many other human monogenic diseases, high variability in disease expression is found among young patients, children. Despite the best efforts of CF clinicians pediatricians, patients

Pediatric and Perinatal Infections

ISE.451 Comparison of Oral Versus Normal- and High-Dose Rectal Acetaminophen for Reducing Fever in Children A. Talebian. Background: According to high incidence of fever and its side effects in children and also because of different effects of drug regiment on reducing fever, we decided to investigate three kinds of administration of acetaminophen (oral with regular dosages, Rectal with regular and high dosages) in children whom were admitted in Shahid Beheshti hospital in Kashan, Iran (Islamic Republic of) in 2004. Materials and Methods: This randomized clinical trial was performed among 120 patients aged 6 months to 6 years with fever (axilliary temperature 38°C). Patients divided in three groups. Group A (40 patients) received oral acetaminophen with dose of 10-15 mg/kg acetaminophen. Group B and C received acetaminophen rectally with dose of 10-15 mg/kg and 30-60 mg/kg, respectively. Recovery was defined as reducing axilliary temperature at least 1°C. Data analysis was performed using Chi Square test. Results: The frequency of recovery in group A, B and C after 1 hour of administration of acetaminophen was 34(85%), 32(80%) and 36(90%), respectively (p<0.05) it was 37(92.5%), 38(95%) and 39(97.5%) after 3 hour (p<0.001); 10(25%), 14(35%) and 22(55%) after 6 hours (NS) of

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with CF eventually reach the point of respiratory insufficiency, and lung can no longer sustain. The timing of transplant is optimal if it occurs just before life with disease become unbearable. ISE.454 Profiles An Occurency of Measles Disease After Basic Measles Immunization in Pediatric Department of Medical Faculty Lambung Mangkurat University/Ulin General Hospital Banjarmasin E. Hartoyo. Ulin General Hospital, Banjarmasin, Indonesia Background: Measles is one of health problem in Indonesia, even through Indonesia Universal Child Immunization in 1991. Who (2002), measles incidence increase from 14.492 to 26.818. Measles diseases have severe complication (pneumonia, meningitis, pan encephalitis). 32% of children were vaccinated with basic measles vaccination will become clinically ill at the age of 5 year. Method: Descriptive analytical research. Measles patients were hospitalized in Pediatric Department of Ulin General Hospital Banjarmasin between January 2005 to December 2005. Immunization profile data were collected by questionaire and interview with the parents. Statistic analysis using independent T. test. Results: From 167 children, boys are 187 (52%) and girls are 80 (47%). 95 (59%) got basic measles immunization and 72 (41%) without basic measles immunization. Clinical appear rash (99,2%), fever (98,7%), cough (93,2%), nasal discharge (77%), conjunctivitis (56,8%), headache (27%) and koplic spot (2,7%). 48,7% children got diarrhea complication and 27,3% got pneumonia. Mean of children age that got measles immunization will get measles 64, 74 ± 34, 99 month, children without immunization 41, 25 ± 29, 19 month and statically significant p<0,01. Mean of rash appear 3, 84 ± 1,32 days. Body mass index of children that got measles immunization 14, 53 ± 3, 51 compare without immunization 17, 76 ± 4,48 statically significant P0,14. Conclusions: Clinical features of measles are rash, fever, cough, nasal discharge and conjunctivitis. Just few sample showing complic spot children did not get basic immunization the onset of clinically measles at the age under 4,25 ± 24, 19 month. No significant relationship between immunization profile with the onset of rash appear. ISE.455 Etiology of Acute Neonatal Bacterial Meningitis in Kanti Children Hospital, Kathmandu, Nepal S. Dahal. Kanti Children Hospital, Kathmandu, Nepal Purpose: 1) Determine the number of cases of meningitis in the neonates with the diagnosis of neonatal sepsis, 2) Find out the most common causative organism of acute bacterial meningitis in Nepal, 3) Develop the treatment protocol of neonatal meningitis according to the sensitivity of organism to particular pharmaceutical agent. We will perform lumber puncture of every neonate admitted in our hospital with the diagnosis of neonatal sepsis. We will enroll more than 1000 subjects in our study. The procedure will be performed with informed consent of the parents to participate in research study. Cerebral spinal fluid (CSF) will be sent for cytology study and microbiological study in hospital laboratory. We will document the result of CSF study. Analysis of obtained data will be done half yearly. Background: Treatment protocol of neonatal meningitis in our hospital has been adopted according the research works conducted in developed western countries. As we know neonate most commonly acquire infection as they pass through birth canal. So the etiology generally depends on what kind of organism is colonizing there. If mother had multiple sex partners, pathogens including Group B streptococci and mixed flora may colonize in vagina and they can disseminate in the blood of newborn causing sepsis. E.coli and Listeria Monocytogens are other bacterium that causes neonatal sepsis and meningitis. Other Streptococci, nontypeable haemophilus influenza, both coagulase- positive and coagulasenegative Staphylococci, Kebsela, Enterobacter, Pseudomonas, Treponoma Pallidum and mycobacterium tuberculosis may also produce acute bacterial meningitis. Many organisms like E.coli colonize in vagina from rectum because of the close proximity of the vagina with anus. So it is related to the hygiene. So we can assume that because of the cultural difference those organism which are associated with multiple sex partners and unsafe sex will be lower in our community while organisms associated with hygiene will be high. Till now it is only assumption, and at the end of this research we'll be able to assertion or deny it and make a new treatment protocol of neonatal meningitis. Preliminary Studies: 101 lumber puncture of neonates admitted in ward with the diagnosis of neonatal sepsis has been performed in the

month of July. Out of them 30 were found to have meningitis. Only 6 have culture positive. 5 of them have E.coli positive and sensitive to Amicacin, cefotaxim and cefriaxone. 1 is staph.aureus positive resistant to all antibiotics available in our hospital expect vancomycin.The preliminary result shows around 15% neonatal `sepsis are meningitis. Most of them are culture negative. We can assume that these are the cases of aseptic meningitis where the etiological cause is not bacteria, most probably viruses. Research Design and Methods: Average number of patients admitted in neonatology ward is around 150/month.We will perform lumber puncture to all of these patients as a part of septic screening, with the informed consent of their parents and according to the indication set up by Kanti Children Hospital. Permission will be taken from the parents that their children will participate in the research. Cerebro-spinal fluid thus obtained will be sent for cytology study and culture and sensitivity of organism to antibiotics. Meningitis in neonate is considered when total leucocytes count exceeds 30/ml with 57­61% neutrophils. With this we can find out what portion of neonates with provisional diagnosis of neonatal sepsis have meningitis. We will also send CSF for bacterial culture. So we can find the causative organism. Sensitivity of these organisms to particular antibiotics gives us opportunity to modify our treatment protocol if needed. Progress report will be reviewed every 6 months. Final report will be submitted at the end of the year. Limitations: The study only covers acute bacterial meningitis and its etiology. It does not cover meningitis due to causative organism other than bacteria. ISE.456 A Study of Influencing Factor to Early Onset Sepsis in Offspring of PROM Women N.S. Borghei. Boyeh Faculty, Gorgan, Iran (Islamic Republic of) Background and Objectives: Premature rupture of membrane (PROM) is one of the complications of pregnancy that affect the mothers and newborns. Neonatal sepsis is the most important complication in newborns after PROM. The aim of this study was determination of influencing factor to early-onset sepsis in the offspring of women PROM in Dezyani hospital of Gorgan at the year of 2006. Materials and Methods: In our retrospective study, we recorded the information of 2006 women with PROM and their term newborn that was admited in Dezyani hospital and then we analyzed information with SPSS, chi-squar and Mann withney tests. In this study we determined the correlation between early-onset neonatal sepsis in term newborn and the time form PROM to delivery, sex of newborn, ethinity, weight of newborn, age of mother, gravity, clinical sign of sepsis and CRP. Results: The time between PROM and delivery in new born with sepsis was 2 times of this period in the newborn without sepsis. we found that the early onset sepsis was common in males and in the ethinity of Afghan. The clinical signs of sepsis and positive CRP were common in new born with sepsis. Conclusion: According to our study PROM was one of the risk factors for early-onset neonatal sepsis in term newborn. We found that increase the time between ROM and delivery, increase the incidence of sepsis. Key Words: PROM, sepsis, early-onset sepsis ISE.457 Laboratory Confirmation of Clinically Diagnosed Measles: the Experience from Rivers State A. Frank-Briggs. University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria Introduction: Measles infection has remained an important contributor to under 5 morbidity and mortality, especially in developing countries with poor immunisation services and coverage. As part of the effort to attain the fourth Millennium Development Goal, the Federal Ministry of Health in collaboration with development partners, conducted some rounds of mass measles immunisation campaign for children aged 9180 months irrespective of previous measles immunisation status. To assess the impact of this activity, laboratory confirmation of all clinically diagnosed measles was introduced. This paper presents the experience from Rivers State for January­November 2007. Materials and Method: Children with clinically diagnosed measles from all local government areas (LGA) of Rivers State whose blood samples were taken by the LGA Disease Surveillance Officer for the estimation of measles antibody levels were retrospectively analysed. The blood samples were taken within 2 weeks of the rash and sent to the Medical Research Laboratory in Yaba, Nigeria using the reverse cold chain within 24 hours of collection. Results were retrieved from the WHO

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Office in Rivers State for analysis using Excel Spreadsheet for data entry and SPSS for analysis. Result: Of the 158 children studied, 68.4% were under-fives and 57(36.1%) confirmed to have measles. There were 111(70.3%) males and 47(29.7%) females and two deaths. One hundred and fifteen (72.8%) children received at least a dose of valid measles vaccine. Conclusion: Clinical diagnosis of measles results in overdiagnosis hence the need for laboratory confirmation. The mass immunization campaign significantly increased the measles vaccine coverage rate in the state. ISE.458 Hepatitis in Childhood Leukemia After Cessation of Induction Chemotherapy M. Tahamtan. Pathology Dept., Shiraz, Iran (Islamic Republic of) Objectives: Leukemia is the most common malignancy in children. Five years survival of these patients is 70% after cessation of therapy. Chemotherapy drugs with hepatocellular injuries cause liver dysfunction in the patients. Methods: In this study 74 patients with acute lymphocytic leukemia (77.4% were ALL-L2) with average age of 4.5 years old (74.3% male) that received induction of chemotherapy at least 6 months ago were observed to determine the presence of hepatitis B and C viruses. Also Liver Function Tests (LFT) before and after chemotherapy compared and analyzed. Results: ELISA tests for hepatitis B and C viruses were negative in all patients. Liver enzymes rised after chemotherapy as compared with control group and patients before chemotherapy. Conclusion: Because the results of ELISA tests for hepatitis B and C viruses were negative despite the rising of liver enzymes we suggests more accurate methods(such as PCR) as least for the patients with elevated liver enzymes. ISE.459 Clinical and Epidemiological Aspects of Kala-azar Diagnosed Children Refer to Children Medical Center from 1991 to 2003 L. Sharifi1, S. Bokaie2, S. Mamishi3, A. Nadim4. 1Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran (Islamic Republic of), 2Veterinary Medicine Faculty of Tehran University, Tehran, Iran (Islamic Republic of), 3Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran (Islamic Republic of), 4Iran Medical Academy, Tehran, Iran (Islamic Republic of) Background and Objectives: Kala-azar is a parasitical disease which belongs to Metazoonoses (a communicable disease which requires at least to an invertebrate host), In Iran canines are major reservoir for it and most of patients are 6 months to 2 years old. The aim of this study was evaluation of clinical and epidemiological aspects of visceral leishmaniosis in patients who referred to Children Medical Center in 12 past years. Methods: In the inspection of 106 Kala-azar patients records that of children was confined to bed since 1991 to 2003 in Children Medical Center this case series study was carried out. We recorded geographical location, background factors, clinical and Para clinical signs, response to medical treatment and Glucantime-side effects as a database and analyzed them descriptively. Results: The greatest cases relevant to 1992 and the lowest relevant to 1993 and 2003. Spring was the most refer season. Illness in the 12 to 48 months age group is plenteous and references to Children Medical Center for boys are more than girls (82.1% to 17.9%). In occupational classes of head of family, workers have the most reference. In the laboratory examination, Anemia, ESR increasing and thrombocytopenia are counted as clearest symptoms and in clinical signs fever, splenomegaly, hepatomegaly are most obvious symptoms. 83% of patients have gained in health, 1.9% died and 15.1% returned. 52.8% of ill kids became well in 2­4 week treatment with Glucantime and side effects of Glucantim (as myocarditis, rash and vomiting) were low. Khoramabad, Karaj and Saveh cities had the most refer to hospital. Conclusion: The results show an increasing in the male's infection and some changes in clinical and par clinical signs in comparison to other studies. However the most important achievement of this research was identification of south region of central Alborz mountains, Saveh and northwest of Ghom province, Khoramabad and Ardabil province as endemic areas in addition to other sporadic areas. Key Words: Kala-azar, Clinical Aspects, Epidemiological Aspects, I.R. Iran

ISE.460 Primary Prophylaxis with Cotrimoxazole for HIV-Exposed Infants. A Prospective Programmatic Evaluation G. Tindiwegi, H. Barigye, J. Levin, E. Atuhumuza, D. Maher. The Medical Research Council, Entebbe, Uganda Background: The World Health Organization recommends that in resource-poor settings, children born to HIV-infected women should receive daily cotrimoxazole starting at 6 weeks after birth until the infant is not at risk of acquiring HIV and infection has been ruled out. No study has documented if this can be achieved in sub-Saharan Africa. Methods: We prospectively evaluated a community-based service that provided cotrimoxazole to caregivers for administration to HIV-exposed infants from 6 weeks until 18 months of age in rural South Western Uganda. Adherence was measured by pill count and reasons for poor adherence documented at drug-refill home visits. We calculated the Drug Possession Ratio (DPR) on 734 drug-refill visits from 2003 to 2007 Results: Median age at starting was 2 (IQR 1­3) months and the median age of stopping was 14.4 (IQR 7-18) months. Girls stopped younger (median age 11 Vs 15 months (p=0.048). 69/82 (84%) of the children started on prophylaxis. Children whose HIV status was unknown (28.6%) were unlikely to start prophylaxis, than those who were HIV infected (10%) or negative (3.7%) p=0.021. Girls were also less likely to start on cotrimoxazole (23% versus 7.7%, p=0.054). In 50%, 75% and 90% of drug-refill visits; the DPR was 100%, 93% or more and 80% or more respectively. Reasons for failing to administer cotrimoxazole were: mother forgot (29%), mother was away (24.3 %) or run out of medications (14.5%), loss to follow up (7.5%), parent /child refused medication (5.8%), side effects (5.2%) and other (13.7%). Conclusion: In this setting, care givers were able to provide cotrimoxazole prophylaxis to HIV-exposed infants most of the time though girls were less likely to start on prophylaxis and stopped younger. Caregivers need to be supported with skills to enable them remember to give medications and continue with prophylaxis when they are away from home. ISE.461 Morbidity Pattern in Breast-Fed and Formula-Fed Infants of HIV-1 Infected Women in Jos, Nigeria M. Ochoga1, S. Okolo1, S. Pam1, J. Idoko1, A. Okolo2, P. Kanki3. 1AIDS Prevention Initiative Nigeria, Jos, Nigeria, 2University of Benin Teaching Hospital, Benin, Nigeria, 3Harvard School of Public Health, Boston, MA, USA Background: Breastmilk contains antibodies which protect infants from infections. It has been shown that babies who are not exclusively breastfed in the first six months are more likely to develop a wide range of infectious diseases including otitis media, diarrhoea and respiratory infections. This study was carried out to describe the pattern of morbidity amongst the two feeding groups. Methods: The subjects consisted of infants of HIV positive mothers aged 0­6 months delivered at Jos University Teaching Hospital (JUTH) over the period March 2003 to May 2004.The babies were products of a programme on prevention of mother to child transmission (PMTCT) of HIV.They attended the Paediatric infectious disease clinic. These infants were followed up from birth till six months. Physical examination was carried out and anthropometric measurements were taken on each infant at each visit. History of common infections was assessed at each visit. Results: 164 mother/infant pairs were recruited, 14 of the infants died before the end of the study and 10 were excluded because they practiced mixed feeding. The most common morbidity among the exclusively breastfed infants was upper respiratory tract infection (URTI) coryza which occurred in 23(0.59 episodes per child).The other morbidities included diarrhoea 14(0.36 episodes per child) and lower respiratory tract infection (LRTI) 6(0.15 episodes per child).For the infants on formula URTI (coryza) occurred in 70(0.69 episodes per child), while diarrhoea and LRTI occurred in 69(0.68) and 12(0.12) episodes per child respectively. The frequencies of occurrence of URTI amongst the EBF and formular was not statistically significant, (X2=2.17 p=0.14). Occurrence of diarrhoea was significantly higher amongst the infants on formula compared with EBF, (X2 =20.51 p=0.001).LRTI was significantly more frequent among the formula fed infants than EBF, (X2=20.73 p=0.001). Conclusion: Morbidities occurred more among the infants on formula than EBF Infants.

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ISE.462 Pneumococcal Invasive Disease in Baja-California, Mexico: Demographic, Clinical and Comparative Characteristics in Children E. Chacon-Cruz, J.L. Lopez-Viera, C.A. Lara-Muñoz, R.M. RivasLanderos, M.C. Duran-Hernandez, M.L. Voelker, J.A. HurtadoMontalvo. General Hospital of Tijuana, Tijuana, Mexico Background: In Mexico, Streptococcus pneumoniae (SPn) has been reported as the major cause of bacterial meningitis (BM), communityacquired pneumonia (CAP) and septicaemia. There are no reports of Pneumococcal invasive disease (PID) in Baja-California, Mexico, a Mexican region that borders with California, USA, and with less than 1% coverage of heptavalent conjugated pneumococcal (HCP)vaccine. Methods: From Oct/15th to Jan/15th, an active search for PID was performed prospectively at the General Hospital of Tijuana, BajaCalifornia, Mexico. Patients between 1 month and 16 years of age were included. Clinical, demographical and microbiological characteristics were analyzed. Results: A total of 15 cases were found, 8 with empiema, 5 with meningitis (2 with blood cultures + to SPn), and 2 with mastoiditis. Avg. age was 5.1 years (7m - 14y), all but one patient were not vaccinated with the HCP vaccine, and all were local. 68% of patients received oral antibiotics before admission. From patients with Pneumococcal meningitis, 80% had previous upper respiratory tract infection. Surprisingly, Pneumococcal meningitis was less common than Meningococcal meningitis (5 vs. 12, respectively), but SPn in children with BM was not associated with clinical purpura and mortality when compared to Meningococcal meningitis (0 vs 58%, and 0% vs. 25%, respectively). SPn was the major cause of empiemas (at least 47% of all), and no other causes of empiemas were found (negative cultures). 62% of Pneumococcal empiemas ended in pleural decortication. Followed by N. meningitidis, SPn was the 2nd cause of confirmed septicaemia. Conclusions: PID is the main cause of confirmed empiemas, the 2nd cause of BM, and the 2nd leading cause of confirmed septicaemia in our Hospital. Further studies need to be done, in order to serotype and evaluate the usefulness of massive pediatric vaccination in this Mexico-US border region. ISE.463 A Rare Zoonosis in Pediatric Infectious Diseases Pathology-- Leptospirosis C. Manciuc, C. Dorobat, M. Hurmuzache, R. Fantanaru, C. Luca. The 'Gr. T. Popa' University of Medicine and Pharmacy, Iasi, Romania Background: The aim of study was to identify the leptospirosis in the pediatric pathology in a 15 years period, 1993­2007. Methods used: Retrospective study of the patients' files for the above mentioned period. Results: 24 cases of leptospirosis pediatric age were admitted; male and suburban area were predominant; a total of 75% of cases are included in the 11- to 15-year group of age; wild forms of disease were noticed and no patient with renal failure. Meningial syndrom was observed in 6 cases. Serological data were positive for Leptospira ictrohaemoragiae - 50 %; pomona 25%; wolfii - 12, 5 % canicola 8,3 % and Sax Koebing - 4,15%. The treatment was performed with Betalactamius in 22 cases with no lethal ones. Conclusion: Because for our area leptospirosis is a rare ethiologic entity in childhood, sometimes the positive diagnosis could be difficult for an inexperienced practitioner. ISE.464 Combined Antiviral Therapy of Chronic Hepatitis C (CHC) in Children Cured from Cancer O. Geludkova1, I. Borodina1, E. Gracheva1, T. Ishkova2, N. Filippova2. 1 Federal Research Clinical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia, 2Department of Rehabilitation of Sanatorium 'Russkoe pole', Chehov, Russia Aim: To investigate efficacy and safety PEG-INF-alpha in combinations with Rebetol in treatment of CHC (1b-genotype) in children cured from cancer. Materials and Methods: in study include 50 pts with CHC at the age from 6 to 16 years (median 10,6), which finished the chemoradiotherapy. 26 pts got combined antiviral therapy and 24 ps did not get no treatments and only observed. All pts were with 1b-genotype and with the level of viremiea in blood greater than 2 mln copy/ml. Among pts which

got combined antiviral therapy 12 had normal level of ALT, 14 increased level (1,5-2 N). All pts of the checking group had normal level of ALT. Combined antiviral therapy included: PEG-INF-alpha 1.5 mg/kg per week and Rebetol 11-15 mg/kg/day. Duration of therapy continued by 48 weeks at achievement of the full effect. Failing for 24 weeks - the treatment cancelled. Among 12 pts with normal level of ALT 7 of them (58,3%) had complete response at 24 weeks of the treatment, among 14 ps with increased level of ALT - 10 pts (71,4%). Stable virusological answer was saved for 6 months of the observation after completion of therapy in all pts with complete response at 24 weeks of the treatment. In 24 pts from checking groups replication of virus (HCVRNA-positive) was saved in 100% of cases for 12 months of the observation. The side effects: increasing of the temperature for 38 centigrade degrees after 1-4 injections were noted in all 26 pts, I degree of anemia existed in 10 pts, I-II degrees of thrombocytopenia - in 8 pts, I-II degrees of leukopenia - in 12 pts. Hematologic side effects stopped after reduction of the dose of PEG-INF-alpha on 20%. Conclusion: Combined antiviral therapy is effective in children with CHC (1b-genotype). The best results are received in pts with increased level of ALT (p=0,004). The sex and age did not influence upon effect of the therapy. The side effects stopped by symptomatic treatment and did not require cancelling of the combined antiviral therapy. ISE.465 Quality of Life Impact on Caregivers of Children Hospitalized for Acute Gastro-Enteritis D. Strens1, C. De Vos1, M. Lamotte1, B. Standaert2. 1IMS Health, Brussels, Belgium, 2Health Economics, GSK Biologicals, Wavre, Belgium Background: Acute gastroenteritis (AGE) is a common clinical problem affecting children worldwide. The objective of this study was to assess the Quality of Life impact on caregivers of children hospitalized for acute gastro-enteritis (AGE). Methods: Caregivers of children under 2-years admitted for AGE (defined as 3 or more loose stools in 24 hours) completed an anonymous self-administered questionnaire on the day of discharge. The survey covered socio-economic aspects of the family (demographic data, family composition, education level, net income) plus questions related to the child's AGE (symptoms, behaviour) and the effect of these on the quality of life of the caregiver in terms of level of anxiety or impact on daily living. Results: 33 centres in total across Argentina, Columbia, Egypt, Malaysia, Philippines and Thailand recruited 763 caregivers of children hospitalized for AGE. The survey subjects included 57% boys, the overall mean age being 371 days (SD 181). Regarding the AGE symptoms: the mean duration of diarrhoea was 3.98 days (SD: 1.98), vomiting 2.2 days (SD: 1.65), fever 1.74 days (SD: 1.53). Overall the symptoms lasted for 4.31 days (SD: 1.89), the child required constant care for 4.22 days (SD: 2.10), mean length of the hospital stay 4.0 days (SD: 2.3). The majority of caregivers (69.6%) were overall 'very worried' regarding their child's gastro-enteritis. Caregivers reported the greatest level of concern regarding fever, vomiting, diarrhoea and dehydration. 58.7% reported being 'extremely' heart-broken to see the child ill. Working parents (64.9%) reported missing work for 3.21 days (SD: 2.09) due to the child's illness. Conclusion: Hospitalization of a child for acute gastro-enteritis has a significant impact on the quality of life and daily activities of their caregiver.

Parasitology

ISE.466 Pediatrics Practice in Bosnia and Herzegovina-Scabies F. Alendar1, A. Bajraktarevic2, M. Rovcanin2, S. Putica2, A. Skopljak2, N. Perva2, A. Djurdjevic-Djulepa3, E. Hadzihasanovic4, I. Kalkan5, Z. Jatic6. 1Clinical Medical Center Sarajevo-Dermatologics Clinic, Sarajevo, Bosnia and Herzegovina, 2Public Health Institution Sarajevo, Sarajevo, Bosnia and Herzegovina, 3General Hospital Sarajevo, Sarajevo, Bosnia and Herzegovina, 4First medical Aid SarajevoPediatrics Department, Sarajevo, Bosnia and Herzegovina, 5Pediatrics Clinic, Sarajevo, Bosnia and Herzegovina, 6Medical Faculty of Sarajevo, Sarajevo, Bosnia and Herzegovina

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Background: Clinical symptoms of scabies infestation can appear up to two months after exposure. It is highly contagious infection caused by the itch mite Sarcoptes scabiei. Scabies spreads rapidly under crowded, bad conditions where children have frequent skin to skin contact. Materials, Methods and Results: Every eleventh child in pediatrics offices with skin disease has had sciabes after the war compared to during the war (every seventh child), and before the war (every fifteenth kid). Authors used a retrospective cohort study where kids were reviewed to determine the prevalence of and factors associated with scabies infectious disease. Bosnian pediatrics practices used frequently diagnostics physical-clinical exanimations, where burrow is pathognomonic and presents in only 25% cases. Results of epidemiologic studies of children in Sarajevo, Bosnia and Herzegovina provide strong evidence that exposure of children to bad non-hygienics crowded conditions during and after the Bosnian war where scabies is associated with increased rates at kids. Discussion: Because of their ease of use and high efficacy, oral antiscabies medications are useful option, especially for recalcitrant or severe scabies infestations. Topical antiscabies medications continue to be quite effective, and so far, there is little evidence of resistence. Conclusion: Higher Bosnian rates during and five after the war are history now, but rates in children stay too high comparing others European countries. Children living in the same apartment or room should be treated concomitantly, even if they are asymptomatic. All topical treatments must be properly applied to include the head area, the edges of all body orifices, and under the fingernails. Key Words: Scabies; Bosnia; Therapy, Kids ISE.467 Antimalarial Effects of Nitric Oxide Synthetic Metabolite (S-Nitrate) as a Novel Therapy for in Vivo Treatment of Plasmodium Berghei in Mice H. Nahrevanian1, S. Esmaeilnejad 2, S. Khatami 3, R. Hajihosseini 2, Z. Aghighi 1, S. Javadian 3, S. Nahrevanian4. 1Department of Parasitology, Pasteur Institute of Iran, Tehran, Iran (Islamic Republic of), 2 Payame Nour University, Tehran Center Unit, Tehran, Iran (Islamic Republic of), 3Department of Biochemistry, Pasteur Institute of Iran, Tehran, Iran (Islamic Republic of), 4IA University, North Tehran Unit, Tehran, Iran (Islamic Republic of) Background: Malaria is one of the most common parasitic diseases in the world, which is caused by a protozoan parasite of the genus Plasmodium. Potential effector mechanisms of immunity in malaria include antibodies, macrophages, cytotoxic T-cells, cytokines and a variety of soluble mediators. In addition to numerous cytokines, nitric oxide (NO) is thought to be an important mediator and critical signaling molecule in infections and a target for immunomodulation as a novel drug therapy. Methods: This study has investigated the involvement of stable metabolites of NO, which is increased by synthetic S-nitrate in murine malaria (Plasmodium berghei NY), in order to evaluate whether changes in NO metabolite are beneficial or detrimental to the host. The effects of P. bergheiwas studied on NO production and essential trace elements (Zn, Cu) and alterations during successful synthetic S-nitrate therapy in vivo. NO was measured by Griess Microassay (GMA) and Zn/Cu levels were detected by Flame Atomic Absorption Spectrophotometer (FAAS). Synthetic S-nitrate therapy was used for its ability to modify malaria infection, in order to evaluate the effects of NO metabolite on percentage of parasitaemia, hepato/splenomegaly, survival rate and trace elements. Results: Results of this study indicated differences between control and test groups and a partial involvement of NO in the cytotoxic activity of host against malaria. Data of NO and Zn/Cu values resulting from GMA and FAAS respectively indicated the efficacy of S-nitrate therapy on malaria infected animals. The treatment was able to decrease parasitaemia and increase survival rate and had no pathophysiological effects on liver and spleen. Conclusion: Synthetic nitrate is introduced as a novel malaria therapy; however it may be protective or pathologic, which need further investigations. Key Words: Malaria, Plasmodium berghei, Nitric oxide, NO, RNI, Cu, Zn

ISE.468 Study on the Prevalence of Cryptosporidium parvum in Breastfeeding Children in Rural Areas in Shahrekord H.R. Azizi1, M. Yadollahi2, N. Taghizadeh1, M. Taghdiri1, M. Gholami3. 1 University of Shahrekord, Sharekord, Iran (Islamic Republic of), 2 Medical department of Shahrekord, Sharekord, Iran (Islamic Republic of), 3Veterinary College, University of Shahrekord, Sharekord, Iran (Islamic Republic of) Cryptosporidium parasites infect the microvillus border of the gastrointestinal epithelium of a wide range of vertebrate hosts, including humans. However, only six to eight species of Cryptosporidium have been named: Cryptosporidium parvum, C. muris, C. wrairi, C. felis, C. meleagridis, C. baileyi, C. serpentis, and C. nasorum. C. parvum is the species that infects immunocompetent humans and most mammals. During spring and summer in 2007, 200 fecal specimens collected from breastfeeding children (Below 2 years) for periodic study and weight and stature. Then fecal specimens prepared whit floating and concentrating methods whit saturated sugar solution and provided smear and used modified acid-fast staining for detection. From 200 fecal specimens, 13 specimens contained cryptosporidium parvum oocytes (6.5%), from 200 achieved fecal specimens, 115 number of specimens related to boys and 85 number of fecal specimens related to girls, from statistical viewpoint there is no relation between sex and infection (p>0.05). 3 number of positive specimens related to age group of 0-6 months. The 8 number of positive specimens related to age groups of 12-18 months. Infection related to children below one years-old that was a significant relationship from statistical viewpoint (p<0.05). ISE.469 Endemic Vivax Malaria in Basra Southern Iraq-- Reviewing 1998 Epidemic A.S. Alvabis. General Basra Hospital, Basra, Iraq Background: Malaria endemic in Basra southern Iraq was mentioned in the History before Christianity, one of the Alexander the Macedonians leaders died in Basra of malaria infection. The famous Arabian potter Abu-Alteab Almotanabi in 800 A.C. got malaria, and described his symptoms clearly in one of his pouter. High incidence of Sickle-cell disease, Thalassaemias, among population of Basra, reflect the endemicity of Malaria in this area. The attempt of WHO to eradicate Malaria, resulted in establishing a center for malaria control in Basra in 50th of the previous century. Epidemiological Investigation Method: Before 1970 each year there were Malaria cases reaching same time to an epidemic. Local cases tracing resulting in identifying of Malaria vivax, imported cases in foreign workers from India and other parts of Asia, were diagnosed as Malaria falciparum, even the health authorities were worried, that Malaria F. may transmit locally and became endemic in the area, tracing of different cases led to blind end, indicated that only M. V. transmitted locally. Result: The predominant malaria vector in these area is the Anopheles Stephansi, the next less active vector is A. Polychromous, both vectors are zoophilic and the stephansi is potent anthropophylic. Globally there is no evidence that A. St. is a vector of other malaria species, rather than vivax, further epidemiological evidence indicate that this vector is potent biological transmitter to only the local strains of P. vivax, tracing to all the cases that causes epidemic, led to the index case, mostly soldiers serving in Krkuk northern Iraq. Even the neighboring area in Iran, the city of Abadan which is also endemic in malaria vivax, but persons who got infection in Abadan, and returned to Basra, remain individully effected until diagnosed and play no role in transmiting malaria in the area. 200 cases were registered in Hartha Northern Basra, epidemiological investigation shows that the index cases were also imported from Northern Iraq, Southern krukook area particularly Takrit & Samara, these cases identified in workers from Basra whom were working in the vegetable farms in the mentioned areas and they were back again to live in Basra. Conclusion: From 1999 Malaria in Basra was not diagnosed, due to the restriction of people movement to northern parts of Iraq.

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ISE.470 Imported Malaria in Kuwait (1985­2005) J. Iqbal, N. Khalid. Faculty of Medicine, Kuwait University, Kuwait city, Kuwait Objective: To document status of malaria infection and efficacy of preventive measures on the epidemiological profile of imported malaria cases in Kuwait during 1985­2000. Methods: The study included screening of two groups of individuals for malaria infection by microscopy; 1) all migrant workers from malaria endemic countries on their first entry to Kuwait, 2) all suspected malaria cases already residing in the country. The study period was between 1985 to 1990; pre war (1985­1990), post war (1992­1997) and proactive preventive (2000­2005) periods Results: The annual incidence of malaria cases detected during pre war, post war and proactive preventive period ranged between 4651229, 746­1379, and 343­399 respectively. P. vivax infection was detected in 71% and P. falciparum in 27% of the cases. The number of malaria cases detected increased to >1300 cases after the war during 1992­1993. However, the number of malaria cases dropped significantly to less than 400 during 2000­2005 (p 80%) of malaria patients were young male adults between 23­40 years of age. The data on drug resistance was not well defined due to limited testing. Conclusion: This study suggests that the proactive preventive program to screen all intending immigrants for malaria infection in their home countries significantly reduced the numbers of imported infections to <400 cases per year, a drop by 45.2%. In addition, it also identified a group of settled immigrants at high risk for malaria infection during their visit to home countries. This group needs to be targeted for prevention strategies. Key Words: Imported malaria, prevention, malaria screening Kuwait University provided the financial support for this study (Research Grant MI 109 & 03/03) ISE.471 Emerging Adults Visceral Leishmaniasis in Basra, Southern Iraq A. Alvabis. General Basra Hospital, Basra, Iraq Introduction: Leishmania is the second-largest parasitic killer in the world (after malaria), responsible for an estimated half-million deaths worldwide each Leishmania currently affects 12 million people in 88 countries. It is known that the incidence of Visceral leishmaniasis in Iraq more than 1000 case per year, all detected cases were in children under 5 years of age, the causative agent is known to be leishmania donovani.This study indicate that a hidden undiagnosed cases in adults could be emerging without been clinically noticed or diagnosed, or miss diagnosed as a liver diseases, particularly this infection is not officially registed, and this is the first case diagnosed clinically confirmed by laboratory serological and immunological positive tests. A 45-year-old patient was clinically suffering from, pallor jaundice, Hepatosplenomagaly, its provisional diagnosis was leukemia, or secoundry metastasis. Material and Methods: Hematological examination indicate that the patient is suffering from Pancytopenia Sternal bone marrow aspiration identified leshmanial infection. Two other serological tests were performed, Formal-gel precipitation, and dipstick, both were seropositive and visceral leihmaniasis was confirmed. Further tests were performed to estimate the total protein, immunoglobulins values. Results: The case was then reported to the DDC of Basra as Visceral Leishmaniasis and the patient was treated accordingly, but the treatment was to late and the patient was died. Discussion and Conclusions: No previous records for such infection in Iraq, whoever epidemiological investigation suggest that there were two other cases had the same clinical pictures and haematological examination were missed. The immunoglobulins value excluded that the patient was immunocomprimised, or the case was due to an opportunistic infection.Further epidemiological investigation suggest that such an infection could be due to the emerging strain of VL parasite in southern Iraq, or to the introduction of the Indian strain leishmania donovani donovani, this possibility was shown up, due to the link between the patient work as a port worker and a huge numbers of wooden ships coming directly from India and reside in the mentioned port for along period of time.

ISE.472 Kids Coverage Vaccination in Bosnia - Complications of Hepatitis A Vaccina A. Junuzovic1, A. Bajraktarevic1, A. Skopljak1, S. Trninic1, A. DjurdjevicDjulepa2, Z. Begic3, Z. Jatic4, A. Drnda5. 1Public Health Institution Sarajevo, Sarajevo, Bosnia and Herzegovina, 2General Hospital Sarajevo, Sarajevo, Bosnia and Herzegovina, 3Pediatrics Clinic, Sarajevo, Bosnia and Herzegovina, 4Medical Faculty of Sarajevo, Sarajevo, Bosnia and Herzegovina, 5Infective Clinic Sarajevo, Sarajevo, Bosnia and Herzegovina Background: Hepatitis A can occur in situations ranging from isolated cases of disease to widespread epidemics. Viral hepatitis A is infection and inflammation of the liver caused by a virus hepatitis A. This type of hepatitis is usually spread in Bosnia by fecal-oral contact, or fecalinfected food and water, and may also be spread by blood-borne infection which is rare. Methods: Blood test results can usually determine exactly what type of hepatitis child has, but the test takes several days in capital city. Results: Sarajevo: Children under 6 years old often have no symptoms. Teens and adults usually have symptoms. Complications are fulminant hepatitis is rare: 0.25% of cases in Sarajevo. Hepatitis A vaccination coverage rates for children aged 1.5-3 years are lower than overall rates for other vaccines recommended for children in Sarajevo, Bosnia and Herzegovina. Higher coverage among Gypsy population, Chinese and Bosniacs refugees children, because vaccination is not obligate in schedule program. Discussion: Vaccination coverage also varied by ethnicity, urban economics situations, epidemiologics situations and pediatrics departments in public health system in each part of Canton Sarajevo. Finally, although national estimates are reliable, estimates for urban areas and for ethnic populations should be interpreted with caution. Conclusions: A hepatitis A vaccine is available, but is not routinely given as part of a child's normal immunization schedule. Usually this vaccine (Havrix) is given to children in areas at high risk for getting the disease or to children over age two years traveling outside the Bosnia. If a child has been exposed to hepatitis, an antibody preparation can be administered to help protect them from contracting the disease. ISE.473 Anti-Parasitic Activity Studies of Some Selected Medicinal Plants from Kenya E.V.M. Kigondu1, I.O. Ndiege1, G.M. Rukunga1, J.M. Keriko2, W.K. Tonui1, J.W. Gathirwa1, P.G. Kirira1, B.N. Irungu1, J.M. Igonga1. 1 KEMRI, Nairobi, Kenya, 2Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya In search for new anti-parasitic drugs, screening of 6 selected plant species used as medicinal plants by indigenous local communities in Kenya was undertaken. The medicinal plant extracts were screened for in vitro anti-plasmodial activity against 2 laboratory-adapted Plasmodium falciparum isolates (D6, CQ-sensitive and W2, CQ- resistant). The methanol extract of the leaves of Suregada zanzibariensis exhibited the highest anti-plasmodial activity (IC50 4.66 and 1.82 µg/ml) against D6 and W2, respectively. Albizia coriaria had moderate and low anti-plasmodial activity (IC50 37.83 and 71.17 µg/ml) against D6 and W2, respectively. Acacia tortilis methanol extract exhibited low anti-plasmodial activity against W2 (IC50 85.73 µg/ml). Water extract of Aloe nyeriensis v. kedogensis had low anti-plasmodial activity (IC50 87.70 and 67.84 µg/ml) against D6 and W2, respectively. The rest of the extracts exhibited no anti-plasmodial activity. All extracts were not cytotoxic at the effective concentrations (CC50 > 500 µg/ml). Leishmania major (Strain IDU/KE/83 = NLB-144) infected macrophages treated with methanol extract of S. zanzibariensis had an infection rate of 28% compared to 40% for pentostam® indicating good anti-leishmanial activity. Multiplication indices for L. major amastigotes treated with methanol extracts of S. zanzibariensis and A. coriaria were found to have 29.4 and 28.5 %, respectively, while that of pentostam® was 44%, indicating good activity.

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ISE.474 Serodiagnosis of Clinically Inapparent Toxoplasmosis Among Patients Infected with Human Immunodeficiency Virus in Southern Taiwan R.J. Ben1, C.M. Su2, C.D. Yang3, D. Chao4. 1Division of Infectious Diseases, Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, 2Department of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan, 3 Agricultural Biotechnology Research Center, Academia Sinica, Taipei, Taiwan, 4Department of Biological Science, National Sun Yat-sen University, Kaohsiung, Taiwan Background: Toxoplasma gondii is an obligate intracellular protozoan, which can be life-threatening in immunocompromised individuals. In order to elucidate clinically inapparent toxoplasmosis among HIVinfected patients in a regional hospital in southern Taiwan, serodiagnosis of T. gondii infection were conducted. Methods: Serum samples were taken from 82 selected individuals. Among them, 34 serum samples were taken from HIV-infected patients and 48 from healthy adults. These samples were analyzed by commercial enzyme-linked immunosorbent assay (ELISA) kit including anti-T. gondii IgG and IgM and were tested by Western blotting for confirmation. Results: Among the 82 subjects, none was positive for anti-T. gondii IgG and IgM in healthy adults, 9 (26.5%) of the 34 HIV-infected patients showed positive for anti-T. gondii IgG, only 3 (8.8%) showed positive for anti-T. gondii IgM in HIV- infected patients. Of the 3 positive tests for IgM in HIV-infected patients, 2 were positive for IgG. Detection of antigens at a band of 30 kDa was found in 4 of 9 anti-T. gondii IgG positive patients by Western blot analysis. In addition, two bands at 38 kDa and one band at 97 kDa were also discovered. One serum sample positive for anti-T. gondii IgM revealed detectable antigen calculated as 30 kDa by IgG Western blot but not IgM Western blot. One of three HIV-infected patients with positive anti-T. gondii IgM antibody was confirmed at a band of 26 kDa by IgM Western blot. Conclusion: HIV-infected patients are at risk for Toxoplasma infection. IgG antibodies appeared to react with all of the antigens recognized by IgM antibodies. 30 kDa by IgG Western blot was the most common band. ISE.475 A Comparison of Two Diagnostic Methods (ME & ELISA) for Detection Cryptosporidium in Calves H. Rajabi1, G. Kojouri2, A. Jalali3. 1Research Center of Agriculture and Natural Resources, Shahr-e-kord, Iran (Islamic Republic of), 2Shahr-ekord university, Shahr -e-kord, Iran (Islamic Republic of), 3Tehran university, Tehran, Iran (Islamic Republic of) Cryptosporidium has found as a zoonotic agent and domestic animals have an important role in environmental contamination with oocyst. In this study, the compared evaluation of two diagnosis methods, Microscopic Examination and ELISA test to detect the cryptosporidial diarrhea in calves was conducted. Therefore, the fecal samples were directly taken from calves' rectums with swab and after smear obtaining and modified acid-fast staining were observed under light microscope, and the results were recorded. As well as, commercially produced enzyme immunoassay (Bio-X Digestive ELISA Kit) was used for obtaining the infection with Cryptosporidium. Statistical analysis was performed using the McNemar test by SPSS software. The results of both Microscopic Examination and ELISA test showed there was no significant different between the two diagnostic methods to detect the cryptosporidium infection (P>0.05). While the ME method is more economical and easily for Cryptosporidium detection.1 ISE.476 Malaria: An 8-Year (1999­2006) Retrospective Study of Malaria Cases Treated in Namazi Hospital, Shiraz, Fars Province, Iran S. Saboori1, M.J. Yavari Barhaghtalab2, M. Ekrahi2, S. Inaloo3. 1Bushehr University of Medical Sciences, School of Medicine, Bushehr, Iran (Islamic Republic of), 2Fasa University of Medical Sciences, School of Medicine, Fasa, Iran (Islamic Republic of), 3Shiraz University of Medical Sciences, Department of Pediatrics, Namazi Hospital, Shiraz, Iran, Shiraz, Iran (Islamic Republic of) Background: Malaria is a serious protozoan disease transmitted by the bite of infected female Anopheles mosquitoes. Malaria is still the most important parasitic and vector-borne disease in Iran. In the past, malaria was highly endemic in most parts of Iran, but there has been a decreas-

ing trend in the malaria incidence in recent years. It is one of the main health problems in south-east provinces, Fars, Boushehr and Ardebil as new active foci in which the disease was controlled for long periods and also influx of the Refugees. During 1997, 38766 patients were found to be positive and 434 cases were hospitalized, which may serve as an approximate indicator of the number of severe cases. The aim of the present study was to elucidate the epidemiological and clinical aspects of patients who were hospitalized as severe malarial infection in Namazi hospital (a referred hospital in south of Iran in Fars province, Shiraz). Material and Methods: A review of malaria cases over an eight year period from 1999-2006 at the Namazi Hospital, Shiraz, Iran is presented. A total of 16 cases were recorded. All the patients were confirmed by microscopic examination of thick and thin peripheral blood smears. The following data were registered: Age and sex distribution, nationality, previous history of malaria, chemoprophylaxis, symptoms, physical findings, parasitaemia, laboratory records, treatments, and complications. Results: 11(68.75%) patients were Iranian and others were Afghanian refugees. Peak case incidences occurred yearly in the June-August period. No patient was hospitalized during winter. Male/female ratio was seven. 2 (12.5%) patients were children less than ten years old. The youngest patient was 2 years old and the oldest one was 44. Mean age was 20.5±6.8. No patient had been taking chemoprophylaxis. The most common symptoms were: fever in 16 (100%), nausea and vomiting (N/V) in 10 (62.5%), jaundice in 9 (56.25%), headache in 9 (56.25%), shaking chills in 6 (37.5%) and generalized body pain in 5 (31.25%) of the patients. The most common physical findings were fever in 16 (100%), splenomegally in 7 (43.75%) and hepatomegally in 6 (37.5%) of the patients. From 11 cases whose strain of plasmodium noted, only one had plasmodium falciparum and others had plasmodium vivax as the primary source of parasitemia. One of the patients had illness during pregnancy. Salmonella bacteremia was seen in 5(%31.25) patients and 2 (12.5%) patients had kalaazar as a concomitant infection. The most common complications were anemia and thrombocytopenia in 14 (47.5%), jaundice in 9 (56.25%), leucopenia in 8 (50%), cerebral malaria in 2 (12.5%) Liver function test was applied in 11 patients and was abnormal in 9. All the patients were treated by chloroquine and premaquine, chloroquine resistancy was seen in the patient who had plasmodium falciparum. There were no reported deaths. Discussion and Conclusion: Malaria affects comparatively the males and younger adult population. Imported malaria occurs frequently in Afghanian refugees and usually results from the failure to use appropriate prophylaxis. Health care providers should consider this diagnosis in patients who have recently traveled or arrived from Afghanistan or endemic malaria areas in Iran, presenting with fever, N/V, jaundice, headache, and other constitutional symptoms. The need for a reorientation of malaria control in the Islamic Republic of Iran would serve as a prerequisite for eventual eradication of malaria, from the country, in the future. Intensive training of experienced staff for stimulation and promotion of relevant researches and training activities in malaria control is highly recommended. ISE.477 A Survey of Sand Flies in Fuxing Township, Taoyuan County with Establishment of a Diagnostic Method of Sand Fly Infection H.J. Teng, L.C. Lu, S.W. Jian, D.D. Ji, C. Lin. Center for Disease Control, Taipei, Taiwan Leishmaniasis is caused by the protozoan parasites of Leishmania spp., which are transmitted by the bites of female sand flies. In addition, these small flies can also transmit other diseases such as bartonellosis and sandfly fever. A one-time survey was conducted in a house of a 2006 patient and its surroundings at the Fushin Township, Taoyuan County, Taiwan to understand the species of the sand flies and the possible infections of Leishmania spp. In a total of 3 teams, each team used two kinds of light traps, castor oil sticky traps, emergence traps, backpack aspirators, and human mouth tube collection. A total of 102 sand flies (62 female, 40 male) were collected and identified as Sergentomyia iyengari taiwanensis. CDC light traps (39 female, 31 male) captured the highest number of sand flies and followed by blacklight light traps (16 female, 5 male), human mouth tube collection (7 female, 2 male) and caster oil sticky traps (1 male). Forty-seven female sand flies were subject to detect Leishmania infection by fluorogenic real-time PCR and all showed negative results. The sensitivity of this test was 3.42 Leishmania donovani for one single sand fly.

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ISE.479 The Effect of Filarial Infection in Pregnant Women to Their Newborn's Immune Responses on BCG Immunization E. Donanti. Yarsi University, Jakarta, Indonesia Background: Some studies indicate that BCG eficcation is less in tropical than temperate regions because filariasis, schistosomiasis and other helminth infections are prevalent in tropics area. In general, helminth infection and pregnancy induces Th2 responses and increase Treg activity with impairment of Th1 responses. Otherwise, BCG immunization will cause the newborn's immune respons differentiate to Th1 responses. In the pregnant women with have helminth infection either intestinal helminth or filarial infection, transfer parasite spesific antibodies, parasite antigens and parasite migrations transplacentally may sensitize newborn prenatally. Objective: To investigate whether filarial infection in pregnant women can impact their newborn's immune response to BCG immunization. Methods: The pregnant women were interviewed for the educational and socioeconomic status. Immunochromatography test was used to screen filariasis and measured the levels of IgG4, Th1 cytokine (IFN-), Th2 cytokine (IL-5 and IL-13) and Treg (IL-10) that have stimulated with Brugia malayi Adult worm antigen and Purified Protein Derivat antigen. The measurement was also did on their newborns before and after BCG immunization. Result: There was a tendency that filarial infections are prevalent on pregnant women with low education and socioeconomic status than with high education and socioeconomic status. Although not all were significant statistically, BmA stimulation induced Th2 responses and PPD stimulation induced Th1 responses. But on the five month's babies that born from mother with filarial infection, PPD stimulation also induced Th2 responses. The increasing of Th1 responses that are characterized by the production of IFN- will add the BCG scar diameter's and these would be stronger on the baby that born from mother with no filarial infection. Conclusion: Filarial infection in pregnant women can supresse their newborn's immune response to BCG immunization. Key Words: filarial infection, tuberculosis, cytokine, IgG4 and BCG scar. ISE.480 Leishmania Major: Surface Repeated Epitope Determination Via Monoclonal Antibody A.R. Khabiri, F. Bagheri. Pasteur Institute of Iran, Teharn, Iran (Islamic Republic of) Surface glycoproteins on the leishmania Sp. play an important role in development and survival of parasites in the sand fly vector and mammalian host macrophages. Comparison of parasite surface glycoproteins among species could be important in evaluating the potential significance of these structures to parasite pathogenicity It has been shown that monoclonal antibodies (mAbs) are useful tools for biochemical and immunopathological characterization of the parasite itself. In this study, we prepared a monoclonal antibody (mAb) that recognized a repeated epitope on Leishmania major ( L.major) surface. It recognized an epitope on the 56 kDa antigen in heating and reducing condition, but in the absence of reducing agents, antibody reacted with epitopes that repeated on 56-, 58-, 80-, 94- and 97 kDa on L.major surface antigens. The reactivity of mAb during parasite differentiation showed mAb recognized four bands of 97-, 94-, 80-, and 56 kDa in logarithmic phase and 58 kDa epitope appeared during the stationary growth phase of the parasite. These finding suggest that repeated epitope express on parasite surface may be an important factor in leishmania pathogenicity and could be constitute a new target for anti-leishmania immunotherapy. ISE.481 Evaluation of Toxoplasma gondii IgM & IgG Antibodies Among Pregnant Women by ELISA in Tabriz, Iran M. Pashazadeh, B. Tagizadeh, K. Rezaee Dorostkar. Islamic Azad, Tabriz, Iran (Islamic Republic of) Toxoplasmosis is a disease caused by the organism Toxoplasma gondii. Common sources of this organism include cats or birds, and undercooked meat, lamb, or venison. droppings or kitty litter than contains cat droppings is a major source of infection. Toxoplasmosis is a serious concern for pregnant women, and patients receiving immunosuppressive treatments. Congenital transmission may occur when a pregnant mother acquires T. gondii infection for the first time in her life during pregnancy. Detection of anti- Toxoplasma immunoglobulin M (IgM) and IgG is essential for the diagnosis of Toxoplasma infection in pregnant International Scientific Exchange · 113

ISE.477 Leishmania genomic DNA detection by TaqMan ® real-time polymerase chain reaction. Nine 5-fold diluted DNA extracted from Leishmania tropica were used as DNA templates in the assay. Nontemplate controls (water) are shown under the detectable line.

ISE.477 Leishmania infection test of 47 female sand flies by real-time PCR and all revealed negative results. a: positive control of DNA extraction and fluorogenic real-time PCR. b1, b2.: positive control of fluorogenic real-time PCR with different Leishmania DNA concentrations. c.: negative control of DNA extraction and fluorogenic real-time PCR d.: 47 female sand flies showed negative results. ISE.478 Efficacy and Safety Profile Investigation of Some Plants Used Traditionally in Treatment of Malaria in Uganda E. Katuura, P. Waako, R. Ziraba-Bukenya, J. Ogwal-Okeng. Makerere University, Kampala, Uganda, Makerere University, kampala, Uganda Little evidence exists on the effectiveness and safety of traditional antimalarial practices. We carried out a study to investigate the efficacy and safety of some plants traditionally used to treat malaria in Uganda. Study species were selected on the basis of their traditional use, from amongst species that had been identified in an earlier ethnobotanical study (Katuura et al, 2007). Mature plants/ parts without defects or parasitic infection were collected, during daytime. The dry powdered plant materials were extracted by sequential cold maceration using petroleum ether, chloroform and ethanol solvents respectively. The crude extracts were concentrated under vacuum using a rotary evaporator. Extracts were subjected to in vitro antiplasmodial screening against wild strains of Plasmodium falciparum using the nitro-tetrazolium blue-based Plasmodium lactate dehydrogenase assay (Markler et.,al 1993). Acute toxicity profile of the four active extracts was determined by using the method described by turner While sub acute toxicity values of B.longipes were obtained from predetermined sub lethal dose obtained by a modification of the methods descried by Ghosh(1984) and Smith(1950). The chloroform leaf extract of Bothclines longipes showed the highest activity (EC50 3.66µg/ml.), followed by the petroleum ether extract of Trimeria bakeri Gilg. root (3.955µg/ml). Extracts of B. longipes were safe in rats. It is recommended that efficacy studies be carried out in vivo. Characterization of the active compounds is also being done in order to ascertain the active compounds in the plant. It is hoped that the study yields an important molecule that might play a lead role in drug development.

women. The current study is one of the prime investigations to evaluate the prevalence rate of T. gondii among pregnant women in the city of Tabriz and to consider some of the environmental and personal factors that may contribute to infection. Serum samples of 197 pregnant women aged 17 to 45 years attending the Emam Khomeine Hospital in Tabriz were tested for anti-Toxoplasma IgG and IgM antibodies using ELISA. Serological results, reflecting T. gondii prevalence rate, were statistically analyzed and linked to epidemiological data collected through a standard questionnaire. The seroprevalence of anti-Toxoplasma IgG was 29.4% (58 out of 197), whereas IgM seropositivity was 5.6%. The highest IgG and IgM seroprevalence were among participants aged 35 to 43 years (48.8% and 12% respectively). No statistically significant relation was observed between T. gondii seroprevalence and the other variable factors studied. The current study indicates that there is a considerable rate of Toxoplasma infection among pregnant women in Tabriz and support the concern that Iranian women may be vulnerable to that infection. Moreover, it shows the need to provide health education to pregnant women in order to prevent primary infection during pregnancy. Key Words: Toxoplasma gondii, ELISA, IgG, IgM, Tabriz Iran ISE.482 Açaí Pulp Does not Intervene with the Trypanosoma cruzi Trypomastigotes Virulence L.A.C. Passos1, V.L. Dias1, A.R. Salgado1, F.L. Schimdt2, K.S. Pereira2, R.M.B. Franco3, J.C. Da Silva4, A.M.A. Guaraldo3. 1UNICAMP/CEMIB, Campinas, Brazil, 2UNICAMP/FEA, Campinas, Brazil, 3UNICAMP/IB, Campinas, Brazil, 4Brazil Health Ministry, Brasilia, Brazil The açaí (Euterpe oleracea) pulp is the main supply of poor community diet in Brazilian Amazon region and performs an important income source. Once detected microepidemics of Acute Chagas Disease (ACD) due to açaí ingestion, the people can lose the nutritional and financial status. However, there is no scientific proof that açaí pulp interfere on T. cruzi transmission. In order to test this hypothesis, 1x105 trypomastigotes of Y strain, collected from CBA/Uni mice, were mixed into the 100 µL of açaí pulp and administrated in C.B17scid/Uni, female, with 10 to 12 weeks. The scid were divided into 4 groups, respectively named, pure pulp (Negative control -group A); intraperitoneal injection of plasma with T. cruzi (Positive control -group B); oral administration of plasma with T. cruzi (Positive control of oral infection -group C); oral administration of plasma with T. cruzi + açaí pulp (Test -group D). The animals were daily observed during 40 days. Groups of animals presented respectively death: day 14 (B) day 18 (C) and day 24 (D). No mortality was observed at the group A. A/Uni strain (immuno competent) and C.B17/scid and NOD scid (immuno deficient) were also submitted to gavage, intraperitoneal and oral infection. After 40 days, no mortality was observed in animals that received pure pulp. On the other hand, in the gavages' group, death at day 8 to A/Uni and at day 7 to the scid and NOD scid. For the intraperitoneal infection, death was observed at day 6 to scid mice, while A/Uni and NOD scid, deaths were observed at day 8. In contrast, animals that received oral plasma, deaths occurred at days 12 to scid and NOD scid strains and at day 13 to A/Uni. These results suggest that the açaí pulp does not interfere on the T. cruzi capability inducing disease. ISE.483 The Influence of Açaí Pulp on Trypanosoma cruzi Performance J. Da Silva1, V.L. Dias2, A.M.A. Guaraldo3, A.P. Gimenes2, M.A.F. Corat2, R. Gilioli2, D.P. Alves2, L.A.C. Passos2. 1Brazil Health Minister, Brasilia, Brazil, 2UNICAMP/CEMIB, Campinas, Brazil, 3UNICAMP/IB, Campinas, Brazil Açaí is a fruit with excellent nutritional properties, very appreciated in Amazonia but also consumed in all Brazil and even in other countries. Due the high productivity in poor north Brazil regions, its commercialization is fundamental to the local economy. In 143 cases of registered Acute Chagas Disease (ACD) in Brazil between January/2006 and April/2007, more than 80% has been occurred in Amazonia Bazin and the majority is related to the ingestion of T. cruzi infected açaí pulp. Meanwhile, there are no scientific data that give evidence of ACD transmitted by this way. In order to evaluate the performance of T. cruzi in açaí pulp, CBA/Uni mice plasma with 1X105 Y strain of T. cruzi trypomastigotes were mixed to the pulp and kept at room temperature for 28 hours. The trypomastigotes vitality has been observed at each hour in the first 6 hours and then after 8, 12, 24 and 28 hours. Two different methodologies were adopted to find the parasite. The first one consisted of a direct inspection of a mixture and also of a trypan blue stain. The

second methodology employed a forced straining process in wool to isolate the parasite. Aliquots of 5 µL, from both methodologies, were observed on light microscope. The straining process allowed getting free pulp residues suspension. The adopted rule to the analysis was done according to the trypomastigotes movements: Very Active (VA), Active (A) and Slow (S). After 6 hours, 100% of parasites has been classified as (VA), while with 28 hours, 67% of them were considered as (A) and 33%, as (S), suggesting that the açai pulp does not interfere on the vitality of T. cruzi trypomastigotes. ISE.484 Amebic Colitis: Clinical and Endoscopic Features in a United States-Mexico Border City R.V. Fleming, M.J. Zuckerman, R. Ramirez, D. Lee, M. Trevino, J. Medina, D. Boman, E. Variyam. Texas Tech University Health Sciences Center, El Paso, TX, USA, Texas Tech University Health Sciences Center, Lubbock, TX, USA Background: Invasive amebiasis is common worldwide, but is seen infrequently in the United States. It is associated with significant morbidity in patients residing in or traveling to endemic areas. There is no recent review of amebic colitis in the United States and a study of amebic colitis in a United States-Mexico border city has not been previously reported. Methods: In order to characterize the clinical and endoscopic manifestations of amebic colitis, we conducted a retrospective chart review of patients who presented to Thomason General Hospital in El Paso, Texas between 10/99 and 7/07. Criteria for amebic colitis included demonstration of motile hematophagous trophozoites of Entamoeba histolytica in stool or by histologic confirmation of invasive amebiasis in colonic tissue. Results: A total of 8 patients were diagnosed with amebic colitis. Median age was 53 years (range, 38­83), 50% were male, and 100% were Hispanic. The main symptoms were diarrhea (75%), abdominal pain (25%), hematochezia, abdominal distension, and fever. Median duration of symptoms was from 7 to 14 days. The main physical finding was abdominal tenderness in 5/7 patients (71%) and an abdominal mass was palpable in 1 case. Colonoscopy was done in 6/8 (75%) patients and 1 patient was diagnosed after right hemicolectomy. There was histologic confirmation of colonic amebiasis in 6/7 (86%) cases. On colonoscopy, all had inflammation with rectosigmoid involvement and 5/6 (83%) had ulcerations. Outcome results included resolution of the infection after treatment with metronidazole in 4/6 (67%) and development of liver abscess or colonic perforation in 2/6 (33%). Conclusions: The incidence of amebic colitis in this United StatesMexico border city county hospital setting was low. The most common symptom was diarrhea, but presentations with gastrointestional bleeding or a surgical abdomen were also seen. Rectosigmoid involvement was found in all patients who had colonoscopy. ISE.485 Latent Toxoplasmosis Frequency Found in Subjects Involved in Traffic Accidents: A Retrospective Case-Control Study in Turkey (in the City of Istanbul and Its Suburbs) B. Kocazeybek1, Y.A. Oner2, R. Turksoy3, C. Babur4, H. Cakan5, N. Sahip2, A. Unal6, A. Ozalan5, S. Kilic4, M. Aslan1, A. Taylan4, S. Saribas1, S. Koc5, V. Oz5, O. Kucukbasmaci1, A. Dirican7, H.B. Uner5, C. Ertekin8. 1Cerrahpasa Medical Faculty, Microbiology and Clinical Microbiology Department, Istanbul University, Istanbul, Turkey, 2Istanbul Medical Faculty, Microbiology and Clinical Microbiology Department Istanbul University, Istanbul, Turkey, 3Capa Anadolu High School, Istanbul, Turkey, 4Refik Saydam Hifzisihha (Public Health) Medical Center, Parasitology Laboratory, Istanbul, Turkey, 5Institute of Forensic Sciences, Istanbul University, Istanbul, Turkey, 6IETT Office of the General Management, Istanbul, Turkey, 7Biostatistical Department, Istanbul University, Istanbul, Turkey, 8General Surgery Department, Istanbul University, Istanbul, Turkey Background: Traffic accidents are always life threatening consequences due to serious injuries, and have a negative impact on the economy of a country. For years, the accidents have been blamed on the road conditions, vehicles and especially drivers. In addition to most common factors affecting drivers such as being tired, weary, sleepy and absent-minded, another critical factor has emerged as driver's mental state and reflexes. Mental state and reflexes of a driver who suffered from latent toxoplasmosis (LT) caused by Toxoplasma gondii, have been shown to be deteriorated, by the actions of the paracytic cysts.

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The cysts can change the level of the neurotransmitters such as dopamin in the brain and by doing so extend the muscle response time and changing personality profiles. Aim of the Study: To determine the seroprevalance frequency of the LT in the driver population who were either injured or died in traffic accidents. We compared the results with a control group and discussed the relationship between the LT and the traffic accidents. We included 218 (89.7%) non-fatal, 25 (10.3%) fatal cases in our study. Total 243 subjects were as alcohol negative cases in our study and compared them with 200 control group who had no traffic accident before and no toxoplasmosis history.. As serologic tests, enzyme immunoassay (EIA) kits for IgG and IgM, and microimmunoflorescence (MIF) kits for IgG were used; as the reference test Sabin-Feldman Dye Test (SFDT) was used. In our study, according to serologic test results, latent toxoplasmosis seroprevalance in the study group was 130 (53.5%) and in the control group 56 (28%) (p<0.0001). The mean antibody titration in the study group was 86±172, and in the control group 34±107 (p0.05). LT was present in 126 out of 234 (53.8%) males in the study group, and 54 out of 191 (28.3%) males in the control group (p<0.0001). In the 31-44 year age group, there was a significant difference with regard to toxoplasmosis between the subjects and control groups (p<0.0007). In conclusion: The results of this retrospective study suggested that LT in drivers could be an increased risk factor for getting involved in an accident. In a prospective study, toxoplasma positive and negative subjects can be monitored before they are involved in a traffic accident to clarify the cause and result relationship. We think that, the results obtained from both retrospective and new prospective studies will bring a new and different perspective in developing strategies in effort to prevent traffic accidents in Turkey. ISE.486 Fertility and Viability Rates of Hydatid Cysts in Slaughtered Sheep and Cattle in Sari, Iran A. Daryani1, M. Sharif1, A. Amouei1, F. Askarian1, H. Ziaei1, S.H. Gohardehi1, G.H. Ettehad2, R. Bastani1. 1Mazandaran University of Medical Sciences, Sari, Iran (Islamic Republic of), 2Ardabil University of Medical Sciences, Ardabil, Iran (Islamic Republic of) Aim of the Study: To determine the fertility and viability of hydatid cysts in slaughtered sheep and cattle. Methods: Cysts were collected from the liver and lungs of 169 sheep and 171 cattle infected with Echinococcus granulosus when slaughtered in industrial abattoir in Sari, Iran 2007. Fertility was determined by the examination of cyst fluid for the presence of protoscolices. The viability of the protoscolices was assessed by staining with 0.1% aqueous eosin solution. Results: The fertility rates of hepatic cyst of sheep and cattle were 47.1% and 1.4%, respectively and the fertility rates of pulmonary cyst of sheep and cattle were 39.4% and 8.1%. In the sheep, the fertility of cysts in the liver was higher than that in lungs, but in the cattle the fertility of cysts in lungs was higher than liver. The viability of protoscolices of fertile cysts for sheep and cattle were about 76.9% and 82.5%, respectively. Conclusion: Based on the finding in the present study, effort should be made to control transmission of cystic echinococcosis by safe disposal of Echinococcus cysts such that dogs cannot have access to the cysts. ISE.487 Frecuency of Toxoplasma gondii Infection in Pork Meat of Rural and Urban Zones of Mexico M.L. Galván-Ramirez1, A.L. Madriz Elisondo2, C.P. Rico Torres3, H. Luna-Pastén3, L.R. Rodríguez Pérez1, A.R. Rincón-Sánchez4, R. Franco5, A. Salazar-Montes6, D. Correa3. 1Laboratory of Neurophysiology, CUCS, University of Guadalajara., Guadalajara, Jalisco, Mexico, 2University of Guadalajara, Ocotlan, Jalisco, Mexico, 3 Laboratory of Experimental Immunology of National Pediatrics Institute SS., Mexico, D.F., Mexico, 1Laboratory of Neurophysiology, CUCS, University of Guadalajara., Guadalajara, Jalisco., Mexico, 4Institute of Chronic and Degenerative Diseases, CUCS, University of Guadalajara., Guadalajara, Jalisco, Mexico, 5Laboratory of Pathology of OPD Civil Hospital Juan I Menchaca., Guadalajara, Jalisco, Mexico, 6Institute of Molecular Biology and Gene Therapy, CUCS, U de G., Guadalajara, Jalisco, Mexico Background: Toxoplasmosis is an infection caused by Toxoplasma gondii, an intracellular obligate parasite. Its transmission has usually been attributed to ingestion of undercooked or raw meat. The frequency

of T. gondii in pork, the commonest meat used for human consumption in Jalisco, Mexico, is unknown; in this region, high prevalence of human toxoplasmosis has been documented. Aim of the Study: To determine the frecuency of T. gondii infection in pork meat. Methods: Forty eight samples of pork meat from butcher shops were analyzed, 24 from the Ocotlan city and the rest from rural areas close to it. Fifty grams of tissue were individually homogenized in an acidic pepsin solution and inoculated i.p. to previously immunosuppresed mice. Blood was taken from their tail vein to analyze anti-Toxoplasma IgM and IgG antibody kinetics by indirect ELISA. On the other hand, samples from brain, heart, muscle, and lungs were processed for histopathology. Also, DNA was extracted from the pork meat for PCR amplification of the B1 gene. Results: Even though all pork samples were negative by histopathology and PCR, IgG and IgM antibodies against T. gondii were detected in only one of 48 mice, reflecting a frequency of 2.08% positive pork meat, which is similar to that found in other regions. Conclusion: The frequency of T. gondii infection in pork meat for human consumption was 2.08% and the only positive case was found in a butchery of an urban zone. ISE.488 Assessment of Different Alcohol Based Hand Disinfectants on S. aureus, E. coli and Normal Skin Microbiota S. Awni, R.E. Siam. American University in Cairo, Cairo, Egypt Background: Hand hygiene and the use of hand disinfectants is an important issue in infection control and are continuously re-addressed because of continual emergence of resistant strains. The CDC guideline for hand hygiene in health care setting illustrates the importance of alcohol based disinfectants. Although disinfectants are useful in eradicating pathogenic bacteria concerns on there use in eradicating the useful bacterial microbiota put disinfectants use under debates. Previous studies determined that alcohol is the most effective antibacterial disinfectant. We compared the effectiveness of three different alcohol based antibacterial hand gels against different types of bacteria; Staphylococcus aureus, Escherichia coli and selected bacteria isolated from skin of healthy volunteers. These bacteria were incubated separately in liquid media with individual disinfectants and bacterial growths were comparatively monitored. Replica plating of bacterium was also performed on media containing the antibacterial hand gels and by rubbing the gels into the hands of a random sample of 10 people, and culturing residual bacteria. Results: The triclosan containing disinfectant was consistently the most effective in particular against S. aureus and E. coli. Our results also indicate that all three disinfectants killed the normal skin microbiota. Conclusions: Concern on disinfectant use in eradicating a central component of the primary immune response should be weighed with disinfectants importance in eradicating pathogenic bacteria. ISE.489 Screening for Toxoplasma Gondii Antibodies Among Women of Childbearing Age, in Timis County, Romania T.R. Olariu1, O. Cretu1, G.H. Darabus2, I. Marincu3, O. Jurovits4, V. Erdelean4, L. Tirnea3, R. Neghina3, I. Iacobiciu3, C. Petrescu3, A. Koreck3. 1Victor Babes University of Medicine and Pharmacy, Municipal Clinical Hospital Timisoara, Timisoara, Romania, 2Faculty of Veterinary Medicine, Timisoara, Romania, 3Victor Babes University of Medicine and Pharmacy, Timisoara, Romania, 4Municipal Clinical Hospital, Timisoara, Romania Background: Toxoplasma gondii is an obligate intracellular parasite that causes infection in most mammals worldwide. Infections by T. gondii are usually asymptomatic in immunocompetent humans, but serious or lethal complications may occur when the parasite is transmissited to the fetus via transplacental means by its asymptomatic infected mother, resulting in congenital toxoplasmosis. Aim of the Study: To evaluate the prevalence of T. gondii antibodies in women of childbearing age, in Timis County, Romania. Methods: Serum samples were examined with Pastorex Toxo test, useful for the determination of serum antibodies to T. gondii, by latex particle agglutination. This test allows the simultaneous detection of IgG and/ or IgM antibodies to T. gondii. We investigated sera of 328 consecutive women, aged between 14 and 45 years, in whom laboratory tests have been performed at the Municipal Clinical Hospital in Timisoara, Romania.

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Results: T. gondii antibodies were demonstrated in 190 (57.6%) of 328 women and their presence appeared to increase with age: 40.6% in women aged <20 years versus 66.1% in women 40 years of age. High prevalence of T. gondii antibodies has been determined in rural areas (68.8%) in contrast with results obtained from urban regions (49.5%). Conclusion: Our results suggest a high prevalence of T. gondii antibodies among Romanian women of childbearing age. ISE.490 Identification of Entamoeba histolytica with PCR Y.A. Oner. Istanbul Medical Faculty, Istanbul, Turkey Amebic infections are serious parasite diseases that causes invasion and damage in organs like liver, lungs and brain besides intestinal kolonisation. For long years diagnosis of amebiasis was confirmed by microscopic identification af E.histoloyica cysts and trophozoites in stool. But then, it is realised that there are nonpatogen Entamoeba species in a similar morphological structure with E. histolytica, so ELISA and PCR are used for diagnosis more often nowadays. In our study, we used a multiplex PCR method to distinguish E. histolytica and E. dispar and compare the results with the ones of ELISA and microscopy. 83 microscopily positive stool samples were examined, 40 were positive with ELISA and 60 were positive with PCR. It is clear that microscopy is not a sensitive method to identify E. histolytica because of the microscopic similarity of the pathogen and nonpathogen species. ISE.491 Toxopasmic Parotid "Tumor" N. Çomo, E. Meta, D.H. Kraja, E. Muço, A. Kica, B. Tila, V. Ostreni. Univeristy Hospital Center, Service of Infecious Diseases, Tirana, Albania Objective: Demonstration of toxoplasmosis nature of parotid "tumor". Case: The patient F.G. a 47-year-old, female, was admitted in infective care with a history of 3 months of high fever, sore throat, swollen of left parotid gland, asthenic resistant by amoxicillin and ceftriaxoni. The ultrasound confirm edema of left patotid gland and presence of hypoechogen formation 23mm in it. The maxilar-facial surgeon suspected parotid tumor and ordered cytology of the formation. Cito-pathology showed proliferation of lymphoreticular elements and some rare histoepithelial cells. Thus, the open biopsy was needed to determine the nature of lymphoid nature. Histo-pathologic examination (biopsy) discovered: Lymphoide structure of mass with chronic inflammation phenomena(chronic lymphadenitis) as well as salivvare glang formation with chronic inflammation(chronic sialadenitis) Laboratory: RBC-4 470 000/mm3, WBC-5 570/mm3, PLT-344 000/mm3, HCT-37%, HgB-12 g/dl, ERS-16 m/h, Neutrophil-54%, Eosinophil-1%, Lymphocit-44%, ASO-94.1 (negative). Serology: ELISA TOXOPLASMA resulted IgM-positive 1.14 UI/ml, IgGpositive>300 UI/ml and AVIDITY-low. Treatment: With pyrimethamine+sulfadiazine+folinic acid for three weeks was successful. Intensive follow-up, ultrasounds, and laboratory check up showed a full recovery during 1-years time. Discussion: This case demonstrates the capability of protozoa to be localized inside parotid gland creating this pseudotumor. In these case histo-pathologic examination is decisive because Mediterranean countries are at high risk of toxoplasma infection. In this case the histology structure of intraparotid lymphonudul (extended lymphadenitis, chronic) and of parotid gland (no acute inflammation, no purulent) are touched. Indeed, we are dealing with Toxoplasmic lymphadenitis and sialadenitis Conclusion: In "tumor" of parotid gland protozoa nature must be considered for differential diagnosis. ISE.492 Imipenem/Cilastatine for Pseudomonas meningitis I. Bakalli, R. Petrela, S. Sallabanda, E. Kola, R. Lluka, F. Zavalani, I. Bujari. University Hospital Center, Service of Infectious Diseases, Tirana, Albania Background: The treatment of meningitis caused by Gram-negative bacilli in neurosurgical patients is a major challenge because of the complexity of these patients, the emergence of antibiotic resistance in many of the causative organisms and the restricted choice of antibiotics suitable for use. Gram negative CNS infections are becoming more common and tend to be more aggressive and resistant to multiple antibiotics. Hence resistance to these agents is growing, new strategies must be pursued.

Case Summary: Four children (1 month, 3 months, 4 months and 6 months) with previous placement of an ventriculo-peritoneal device, developed meningitis secondary to P. aeruginosa. Given the resistance of pseudomonas to multiple antibiotics (included Ceftazidime the antibiotic of choice in pseudomonas meningitis) and the severity of illness, the patients were treated with intravenous Imipenem/cilastatine (100mg/kg/day) and concomitant Gentamicine (i/v and intrathecal), for three weeks, until cerebrospinal cultures remained negative, although the potential of imipenem for seizure activity (which was 33% in one study of children with bacterial meningitis) argues against its use in most patients with bacterial meningitis. Central nervous system toxicity was not seen in our cases. They didn't experience any adverse effects as a result of the administration of imipenem/cilastatine. Conclusion: In patients with meningitis due to P. aeruginosa, the use of imipenem/cilastatine as systemic antibiotic with concomitant gentamicine (intrathecal and intravenous) may be an option for therapy, especially when clinical options are limited by resistance and severity of illness. We think that imipenem have a lower degree of neurotoxicity than prescribed and therefore can be given at high doses and usefully in the treatment of infections in the central nervous system (CNS). Key Words: imipenem, antibiotic resistance, meningitis, pseudomonas aeruginosa. ISE.493 Epidemiological, Clinical and Therapeutic Features of Adult Visceral Leishmaniasis (Kala-azar) at the Namazi Hospital in Shiraz, Iran, 2003-2007 M.J. Yavari Barhaghtalab1, S. Saboori2, S. Inaloo3, M. Ekrahi4. 1Fasa University of Medical Sciences, School of Medicine, Fasa, Iran (Islamic Republic of), 2Bushehr University of Medical Sciences, School of Medicine, Bushehr, Iran (Islamic Republic of), 3Shiraz University of Medical Sciences, School of Medicine, Shiraz, Iran (Islamic Republic of), 4Department of Internal Medicine, Division of Infectious Disease, Fasa, Iran (Islamic Republic of) Introduction: Visceral leishmaniasis (VL; kala-azar) has been among the most important health problems in Iran, particularly in the main endemic area in the south regions (Fars Province). The purposes of this study were to describe the characteristics of VL diagnosed in adults. Material and Methods: Hospital records of 14 adult patients with VL were retrospectively reviewed at Namazi hospital (the main referral hospital affiliated to Shiraz University of Medical Sciences in Fars Province) during a 5-year period from 2003 to 2007. Demographic data, previous or underlying diseases, clinical and laboratory features and therapeutic findings were considered. The diagnosis was based on symptoms and signs of the disease plus a positive serological test (indirect immunofluorescence assay or direct agglutination test) and, in some cases, the finding of parasites in bone marrow smears. Results: New cases were diagnosed throughout the year, but mostly from January till April. Twelve patients developed an acute clinical state and two patients, a subacute-chronic state. Fever and hepatosplenomegaly were observed in all cases and half of them had constitutional symptoms. Immuno-fluorescence antibody (IFA) test was positive in 13 patients (92%) and smears from bone marrow aspirate were positive at microscopy in 13 cases (92%). Common laboratory abnormalities included anemia, leukopenia, thrombocytopenia, hypoalbuminemia, hypergammaglobulinemia and elevated erythrocyte sedimentation rate. Liver function tests were deranged in 10 of patients (71%). None of the cases were associated with HIV infection. Ten patients (71%) received meglumine antimoniate (MA) (20 mg SbV/kg per day) during 21 consecutive days and 4 (28%) patients liposomal amphotericin B (AB) (0.5-1 mg/kg per day) for an average period of 25 days (10-49 days). Both groups' clinical and laboratory findings improved, but patients on AB therapy had a faster recovery. There were no recurrences and no reported deaths. Discussion and Conclusion: VL is rare in adults but its incidence would increase everywhere in the world, because of HIV-related cases. Its prognosis depends on the precocity of diagnosis and treatment. AB therapy may be considered the treatment of choice for any adult patients with VL, since it permits a faster recovery. ISE.494 Bioassay Evaluation of Infectivity and Viability of Toxoplasma Tachyzoites Maintained in Acetic Conditions Q. Asgari, M.H. Motazedian, B. Deghan Khalili, M. Kalantari. School of Medicine, Shiraz, Iran (Islamic Republic of)

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Background: Toxoplasma gondii is an obligate intracellular protozoan that infects human and a wide range of warm-blooded animals. The parasite is known to cause congenital disease and abortion both in human and livestock. Milk as a dietary food may serve as a potential source of infection for human toxoplasmosis. Since tachyzoites in milk are believed to be rapidly killed by stomach acetic condition, this study was undertaken to evaluate the viability of tachyzoites in acidic media by bioassay methods. Methods: Tachyzoites were kept in different acidic media (pH=1.5, 2 and 3), for different times (2, 10 and 30 minutes). Viability and infectivity of tachyzoites were evaluated by vital stain (methylene blue) and intra-peritoneal inoculation to different groups of inbred BALB/C mice (2 mice in each group). Moreover tachyzoites were inoculated to four mice as positive controls. Animals were maintained at an average temperature of 22°C and 40-50% humidity. Results: Results of this study showed more than fifty percent of tachyzoites in all media were stained by methylene blue which indicates the same rate of parasite viability. 16 out of 18 mice died in 6-18 days. Post infection two animals which were survived were belong to groups of which received tachyzoite kept the time=30 minutes and pH=1.5 and 2 for 30 minutes. Our findings showed that tachyzoites are not only resistant to acidic condition but also more or less conserve their infectivity for up to 30 minutes. Conclusion: Considering the above mentioned results, the duration of acid pH treatment seems to influence the infectivity of the organism. Moreover the ingestion of tachyzoites must be considered as a possible route of transmission of toxoplasmosis to human. ISE.495 Echinococcosis in Croatia N. Vickovic, A. Beus, B. Desnica, N. Makek, T. Skuhala. University Hospital for Infectious Diseases, Zagreb, Croatia Echinococcosis is a disease that has been present in Croatia at all times. In the last 20 years the number of patients with echinococcosis has increased due to more improved and more accessible diagnostic methods. From epidemiological point of view, the majority of these patients came from Dalmatia. The disease was localized mostly in the liver, and in a smaller number of patients in the spleen, lungs, peritoneum, kidneys, brain (three patients) and bones (one patient). In the period from 1998 until 2007, altogether 242 patients with echinococcosis were treated at the University Hospital for Infectious Diseases "Dr Fran Mihaljevic", Zagreb, Croatia. Various antiparasitic drugs are used for the treatment of echinococcosis (mebendazole, praziquantel, albendazole). According to our experience, the best results are achieved with the use of albendazole. We believe that the treatment should be combined with aggressive methods (surgical procedure, PAIR method, thermoablation). In case of surgical procedure, only one cycle of albendazole therapy lasting for 28 days is sufficient, however, surgical procedure must be performed within five days from the end of chemotherapy. Such preoperative procedure has shown to be sufficient because no disease recurrence was recorded in any of the patients. A good cooperation between infectious disease specialists and surgeons is important for such favorable outcome. In patients who did not fulfill surgical, anesthesiologic and internist criteria for operation, after albendazole preparation, a percutaneous puncture of the echinococcal cyst under ultrasound guidance, the so called PAIR (puncture, aspiration, injection and respiration) method was performed. After evacuation of cyst content, a 90% ethanol is instilled into the cyst, and aspirated for 20 minutes. On the average, six ultrasound guided punctures of echinococcal cyst are performed per year at the University Hospital for Infectious Diseases "Dr. Fran Mihaljevic" in Zagreb, Croatia. Patients' tolerance to this procedure was much more favorable than to surgery. After this method, no disease relapse was recorded. ISE.496 Heterodistribution of Trypanosoma evansi Ro Tat 1.2 Antibody Levels in General Population of West Bengal, India A. Sarkar1, S.K. Dey1, S. Das2. 1West Bengal University of Technology, Kolkata, India, 2Das Research Centre, Kolkata, India Background: Although Trypanosoma infection in West Bengal is not reported so far but recent studies showed positive Trypanosoma antibodies in blood of general population which is probably due to cross reactive antibodies. In this study blood collected from general population of different geographical areas of West Bengal were studied for Trypanosoma evansi antibody levels.

Methods: The antibody levels were measured by CATT/T. evansi kit was obtained from Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium. This is a highly specific card agglutination test for trypanosomiasis that uses Ro Tat 1.2 - a predominant variable antigen type of T. evansi. Results: In different geographical areas positive results varied from 0% to 70%. There is no significant sex difference regarding positive results, however, there is a distinct seasonal variation with increased positive results in between July to September. Conclusion: There is a heterodistribution of positive Ro Tat 1.2 T. evansi antibody levels in general population of West Bengal. ISE.497 Vitamin B12 and Serum Mineral Levels in Children with Enterobius vermicularis Infection J. Sadraei, J. Jbbarei. Tarbiat Modares University, Tehran, Iran (Islamic Republic of) Background: Intestinal parasitic infections are widespread in the general populations and enterobiosis is one of the common parasitic diseases in the world. Aim of the Study: Investigating if there is a correlation between parasitic infection to Enterobius vermicularis and the absorbing levels of Vitamin B12 and the minerals such as Copper, Zinc, and Magnesium. 968 stool samples and cellotapeanal swales were collected from 3­6 year old children in Tehran. From the whole population, 60 children were chosen for case group who had only Enterobius vermicularis infection. We have also chosen 30 children without parasitic infection as the control group. Both groups had no record of serum shortage of mentioned factors and malnutrition. Amount of Copper, Zinc and Magnesium along with Vitamin B12 measured in both groups. Comparison of the case and control groups showed a significant increase in all measured parameters (Copper, Zinc, Magnesium, Vitamin B12) P< 0.001. Early detection and treatment of intestinal parasitic infection could avoid these serum mineral and Vitamin B12 deficiencies. Key Words: Vitamin B12, Copper, Zinc, Magnesium, Enterobius vermicularis

Tropical Medicine/Travel Medicine

ISE.498 Magnesium for Tetanus - A Systematic Review P.J. Mathew, J.L. Mathew. Postgraduate Institute of Medical Education and Research, Chandigarh, India Background: Magnesium depresses neurotransmitter release at the neuromuscular junction; thereby producing muscle relaxation. This mechanism could be useful to control muscular spasms in tetanus. Objective: Systematic review to assess the benefits and harms of magnesium for controlling spasms in tetanus. Methodology: Pubmed and CENTRAL databases were searched on 17 February 2008 using the terms "magnesium tetanus", to identify all publications. The primary outcome measures were failure to control spasms, need for ventilation, duration of ventilation and dose requirement of sedatives. Secondary outcome measures were mortality, duration of ICU stay and incidence of hypocalcemia. Results: Pubmed yielded 111 citations of which 23 were relevant. These included one RCT, 4 cohort studies, 3 reviews, 7 case reports and 8 comments. CENTRAL yielded two RCTs; one was not relevant and the other was identified through Pubmed as well. The single RCT compared intravenous infusion of magnesium sulphate versus placebo infusion in adults with severe tetanus. The RCT did not report control of spasms as an outcome. The need for ventilation was comparable (RR=0.71, 95% CI 0.36-1.40) but the dose requirement of midazolam (p= 0.026) and muscle relaxant (p= 0.005) were significantly less with magnesium. The duration of ventilation and incidence of hypocalcemia were not reported though duration of ICU stay (p=0.299) and mortality (RR-0.80, 95% CI 0.41-1.58) were similar in both the groups. The cohort studies in adults did not report the severity of illness at inclusion in a validated scale. The need for ventilation varied from 42.5% to 62.5% with magnesium. The other 18 publications identified through Pubmed did not contribute meaningful data. Conclusion: The limited data suggests that intravenous magnesium infusion does not control spasms to improve the outcome in severe tetanus. However, there is no robust data in less severe forms of tetanus.

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Vaccines and Vaccine Development

ISE.499 NASVAC, A Nasal Vaccine Candidate for Chronic Hepatitis B Immunotherapy J.C. Aguilar, V. Muzio, A. Aguilar, Y. Lobaina, D. Garcia, E. Penton, E. Iglesias, D. Pichardo, G. Guillen. Center for Genetic Engineering and Biotechnology, La Habana, Cuba Background: Current antiviral therapies are still unable to completely cure the Hepatitis B chronic infection. A great interest appeared on therapeutic vaccination to treat chronic diseases. Several results suggesting that specific enhancement of T-cell responses is possible in persistently infected patients; the effective control of HBV infection mediated in part by non-lytic mechanisms (cytokine-mediated clearance) as well as the ability to effect clearance by passive transfer of bone marrow from a naturally HBV immune donor, constitutes the rationale for developing therapeutic vaccines in Hepatitis B. Current Hepatitis B vaccines have been used with limited results in therapy. New strategies should be taken into account in the improvement of cell-based immune responses in order to control or clear the virus. In patients under antiviral therapy, it has been considered that enhancing immune responses through vaccination would control or eventually clear the virus. Aim of the Study: To present preclinical and clinical results of NASVAC, a vaccine candidate able to stimulate mucosal as well as systemic immunity against HBV. The very early results evidenced that the Hepatitis B core antigen (HBcAg) is able to induce a strong immune response after nasal administration in mice. In addition, the immune response obtained was biased in a Th1 sense against the core antigen. A second set of experiments evidenced that the HBcAg was able to immunoenhance the humoral and cellular immune responses against the HBsAg -nasally coadministered in a simple mixture- as measured by LPA and IFN-g ELISPOT assays. Interestingly, the surface antigen was able to improve the cell-based immune response against HBcAg to significant levels also as well. The resulting responses against both antigens were comparable to the response reached after parenteral administration. Conclusion: Our studies in humans with nasal formulations evidenced that it is possible to induce a protective immune response against HBV through nasal vaccination. ISE.500 Occurrence of ESBL Producing Klebsiella p in a Patient with Sle Post- Splenectomy A.T. Olayinka, F.J. Giwa, M. Abdulaziz, F. Adeyanju. Ahmadu Bello University Teaching Hospital, Zaria, Nigeria Background: Extended spectrum beta lactamases are becoming an increasing clinical problem.they are enzymes produced by many organisms especially the Enterobacteriaceae. Klebsiella pneumoniae is said to be the most common ESBL producing organism and lacks a chromosomal AmpC gene. Systemic lupus erythematosus (SLE)is a chronic multifaceted autoimmune disorder. This patient was a 26 year-old woman diagnosed as having SLE 13 years ago and had been on steroid therapy on and off since then. On the 5th day post-up the patient developed a fever and the patient was investigated. Method: The catheter sample of urine grew K. pneumoniae which was identified using standard biochemical tests. The organism was resistant to Gentimicin 10ug, Amoxicillin 10ug,Ceftazidime 30ug, Cefotaxime 30ug, Ceftriaxone 30ug using the disc diffusion method. Screening for ESBL production was by the double-disc synergy test using amoxicillinclavulanate, ceftazidime and cefotaxime discs. Results: The ESBL screening test demonstrated positive synergism. The patient was managed using Amoxicillin-clavulanate in combination with ceftazidime, got well and was discharged. Conclusion: The peculiarity of this indicates the necessity of routine screening for ESBL producers in patients on immunosuppresive therapy in order to optimize antimicrobial chemotherapy. ISE.501 HBV and HCV Infection - Perception on the Workers' Profile and the Need for Prophylaxis at the Employees of the Haemodialysis Department S. Josifova, V. Stefanovska, V. Dzartovska, A. Bajrami. General Hospital Kumanovo, Kumanovo, Former Yugoslav Republic of Macedonia

Background: To present the workers profile for Hepatitis B virus (HBV) infection, and Hepatitis C virus (HCV) infection at the employees of the Haemodialysis Department, and the need for vaccinoprophylaxis of HBV infection with the same. Methods: Serological analyses for HBV and HCV (HBsAg, anti HCV, Anti HBs, Anti HBc-IgG) with the employees of the Haemodialysis Department have been done by the help of ELISA, RIA and EIA techniques at the Microbiology Department of the Public-Health Institute, and Polymerasa Chain Reaction (PCR) done at the Macedonian Academy of Science and Art. Results: 24 people are employed at the Haemodialysis Department, where 66.7% as medical personnel (doctors and nurses ) and 33.3% as assistant personnel (cleaners, drivers, and technicians). 54.2% of the people are at the age from 30 - 40 years old. 91.7% are in matrimony, and 87.5% are with descendants. 45.8% have been working for this Department more than 10 years. After serological analyses had been done, all workers proved to be Anti HBV. At 20.8%, high titre and Anti HBs antibodies and Anti HBc-IgG was discovered, as the did have HBV infection. While, at 16.7%, low titre and Anti HBs antibodies was found, and at 58.3%, all the markers tested, appeared to be negative. One of the employed (4.2%), was Anti HCV positive with permanently increased values of the aminotransferases in the period longer than one year, with proved chronic active Hepatitis Type C with liverbiopsy and genotypification, done with PCR.She cought the HCV infection after she had pricked herself with a needle where the patient was carrier of the HCV infection. Out of all the employees, only 29.2% have been vaccinated with 2 dosages of the Engerix vaccine in the period before 7 - 8 years. Conclusion: 75%, working at the Haemodialysis Department are without or with low titre of Anti HBs antibodies. Vaccinoprophylaxis for HBV infection, has been partly realised with small number of the employees. Considering the fact that these people work with patients who belong to a high risk group in relation to HBV and HCV infection, complete vaccination for prophylaxis of HBV infection should start as soon as possible. Standard hygienic-technical protective means should keep to satisfactory level in protection from HCV infection. ISE.502 Accelerating Routine Immunization Initiatives to Achieve MDG- 4 in India V. Bhatia1, N. Hettiaratchy2. 1Department of Community Medicine, Govt Medical College, Chandigarh, India, 2Chief, UNICEF, Uttar Pradesh, Lucknow, India Background: Achieving MDG-4 globally needs to ensure a success in India with one-sixth of the world population. Reducing Infant, child mortality rates and enhancing Measles coverage are three indicators which needs to achieved by 2015. Battleground states in India remains a challenge for Child survival initiatives particularly Accelerating Routine Immunization coverage. Can we achieve results in states with huge population, poor social, health indicators and lagging in social development programs such as Uttar Pradesh? Methods: Rapid household surveys in 1998­1999 and 2002­2003 reported a decline of Full Immunization rates in 76% of the districts surveyed in the country, Nationally, one-third infants are not FI with 90% in Bihar and 81% in Uttar Pradesh (UP). UP is most populous state with 183 million people and IMR of 73/1000LB. Statewide programming involving Govt from policy level to grass root level, UNICEF, WHO other stakeholders, Strengthening monitoring, facilitating program implementation, introducing AD Syringes, Capacity building and other innovations and implementing the national Universal Immunization Program under the flagship program of National Rural Health Mission. Results: Statewide, 7 catch-up rounds (Immunization weeks) with 750,000 outreach sessions were conducted with focus on poor performing areas, left-outs, missed sessions and underprivileged communities in addition to conducting regular RI sessions between February 2006­February 2007. Building the capacity of the state with strengthened management structure, 2100 Medical Officers and over 7000 Health workers trained, placement and involvement of 100,000 ASHA's (village level women health volunteer) in mobilization, Universalization of Auto-Disabled Syringes, ensuring vaccine availability, strengthened monitoring mechanism and review of the progress at district, division and state level and many more efforts led to an increase from a stagnating FulI Immunization level of 20­25% (surveys upto 2004) to 40% by 2006. With initial Utilization (BCG) reaching to over three-fourth of the 5.5 million target infants, high BCG-Measles drop-out rate of 35­40% remains a challenge. Efforts are being made in other states with variable

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response but success story in UP will certainly make a difference nationally and globally as one-fourth of infant mortality is contributed by one single state. Conclusion: With intensive, focused and accelerated efforts in poor performing regions such as UP can achieve results. Achievement levels must be maintained and further improved in better performing states while keeping focus in battleground states in terms of high level of commitment, strong management, financial, supply chain support and building the capacity of the states can help in achieving the set target of GOI by reducing the measles mortality to two-third in 2010 compared to 2000 level and thus achieving MDG-4.

ISE.504 Pathogenicity Related Changes in Plesiomonas shigelloides Treated with Carbapenems A. Hostacka, I. Ciznar. Slovak Medical University, Bratislava, Slovakia Background: The genus Plesiomonas with only the single species Plesiomonas shigelloides belongs to the expanding group of water and food born pathogens. As a new emerging pathogen it is implicated in both intestinal and extraintestinal infections in humans. Surface hydrophobicity, motility, lipase activity, production of N-acyl homoserine lactone signal molecules (HSLs) and response to oxidative stress of two P. shigelloides strains isolated from human (H) and from water (W) were evaluated after treatment with sublethal concentrations (sub-MICs) of imipenem (IM) and meropenem (ME). Methods: In vitro tests for hydrophobicity, motility, lipase activity, HSLs and oxidative stress were used for study of potential factors of pathogenicity of P. shigelloides. Results: Both antibiotics at all sub-MICs tested decreased hydrophobicity in H strain in a concentration dependent manner. The most effective concentration of IM (1/4 of the MIC) shifted significantly bacterial surface hydrophobicity towards the hydrophilic state. The decrease of hydrophobicity in W strain was observed after effect of IM at 1/4 and1/8 of the MIC (to 29.0% and 83.3% of the control value) and of ME at1/4 of the MIC to 50.5%. Both antibiotics reduced lipolytic activity of the tested strains to 82.6-98.2% of the control values (with the exception of ME at 1/16 and 1/4 of the MIC in strain W), too. Carbapenems at all tested concentrations in H strain and IM in W strain enhanced bacterial motility. The highest increase was found in H strain incubated with 1/4 and 1/8 of the MIC of IM (to 321.2 and 328.5% of the control value). Both strains treated with ME showed only mildly enhanced sensitivity to hydrogen peroxide (to101.9-106.3% of the control values). To the contrary, IM at some sub-MICs decreased sensitivity of both strains to the oxidative substance (to 83.3-99.0% of the control values). Short chained HSLs were not detected in the strains and carbapenems did not evoke their production. Conclusion: Carbapenems at concentrations that did not kill P.shigelloides in the majority of cases decreased hydrophobicity and lipase activity, increased motility and did not unambiquously affect oxidative stress. This work was supported by EU Centre of Excellence in Environmental Health, Work Package 4--New Emerging and Rare Pathogens. ISE.505 Prophylaxis of influenza and parainfluenzal diseases by homoeopathic drug product Oscillococcinum S.E. Selkova, I.N. Lytkina, I.A. Leneva, A.S. Lapitskaya. Russia Federal State Scientfic Organization G.N. Gabrichevsky, Moscow, Russia Introduction: Recently the high emphasis is placed on the investigation of homoeopathic drug products efficacy in treatment and prophylaxis of influenza and parainfluenzal diseases annually affecting up to 90% of all age people groups. The efficacy of Oscillococcinum application for treatment of influenza and parainfluenzal diseases was studied in Russian national randomized controlled study. Materials and Methods: The participants of epidemiological studies were chosen from 2 subpopulations: 1) Students of medical college (Kaluga) - 227 persons (110 18.6 ±1.4 years old persons in experimental group, and 117 17,9± 0,9 years old persons in control group); 2) Children from psychoneurological hostel (Moscow) - 315 persons (187, 6­9 years old persons in experimental group, and 127, 11­14 years old persons in the control). Comparative estimation of sickness rate and epidemiological efficacy of treatment in control and experimental groups was performed The follow criteria for patients selection were used: signs of acute viral respiratory infection (AVRI) observed for last 1­2 days and absence of previous immunization against influenza. Results: In the first study AVRI led to 1,62 times decrease of influe