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					Final abstract number: 64.001
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Hospital Contamination with Resistant Pseudomonas aeruginosa
                1            2
A. Ahani-Azari , A. Danesh
1                                                                            2
 Islamic Azad University - Gorgan Branch, Gorgan, Iran (Islamic Republic of), Golestan Public
Health Department (GPHD) - Golestan University of Medical Sciences (GOUMS), Gorgan, Iran
(Islamic Republic of)

Objectives: Since bacterial pathogens with antibiotic resistance are important concerns from the
clinical perspective in hospital settings, we examined the inanimate objects of a referral hospital
in Gorgan for the possibility of contamination with Pseudomonas aeuroginosa. We further
examined antibiotic and antiseptic sensitivity of the isolated bacteria for the effectiveness of
current hospital protocols in fighting against nosocomial infections.
Methods: Since this microorganism is one of the opportunistic agents that is highly compatible
with its environment, we sampled some of the inanimate objects in the hospital that were in close
contact with patients. Sampling was performed by sterile gauze pad for dry surfaces and swab for
wet surfaces. To differentiate and identify P.aeuroginosa, various culture media such as Brain
Heart Infusion Agar, Citrimide Agar and Triple Sugar Iron Agar were used.
Antibiotic sensitivity of the isolated strains was determined by disk diffusion test using Muller-
hinton Agar medium. Moreover, antiseptic sensitivity of the strains to Decosept and Povidone-
Iodine as the main antiseptic agents was identified by determining Minimal Bactericidal
Concentration and Minimal Inhibitory Concentration using Nutrient Agar and Nutrient Broth
media.
Results: Fifty-five of the total 292 samples were positive for P.aeuroginosa. Based on the ratio of
the number of positive samples to the total samples, Thalassemia ward (38.5%) was the most
infected ward and taps (61.1%) was the most infected sampling place. None of the samples from
room atmosphere and intensive care equipments were positive for P.aeuroginosa. Twenty
percent of the samples were resistant to ceftazidim, 32.7% resistant to piperacillin, and 10.9% to
both ceftazidim and piperacillin.
Conclusion: Results of the study showed that contamination with P.aeuroginosa and antibiotic
resistance of the isolated bacteria are the main challenges that this medical center is facing.
Taking appropriate preventive measures such as using suitable antiseptic materials and installing
pedals for tap waters could have major impacts on reducing hospital contamination with
P.aeuroginosa and possibly other bacteria.
Keywords: Pseudomonas aeuroginosa, nosocomial infections, antibiotic resistance
Final abstract number: 64.002
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Biofilm Production and Molecular Epidemiology of P.aeruginosa by RAPD Isolated from
Intravascular Catheters in Tertiary Care Hospital
          1                 2               3
A.S. Rao , C.V. Raghuveer , I. Karunasagar
1                         2                       3
 KMC-IC, Manipal, India, KMC, Mangalore, India, UNESCO Center for Marine Biotechnology,
KVAFSU College of Fisheries, Mangalore, India

Background: P.aeruginosa infection associated with intravascular devices represents a serious
but potentially preventable source of morbidity and mortality in hospitalized patients. Cross
infection and prevalence of P.aeruginosa is common. In this study we isolated and characterized
bacteria associated with catheter samples. The biofilm forming ability of P.aeruginosa by
adherence to microtiter plates was measured and molecular typing was done by RAPD method.
Methods: 1149 catheter samples were analysed by standard procedures for bacteria associated
with them.
Biofilm production by P.aeruginosa isolated from intravascular catheters was demonstrated by
the quantitative microtiter plate method at 570 nm using immunosorbent assay reader and RAPD
typing was done for epidemiological studies.
Results: Bacteria was isolated from 841 (73 %) of 1149 catheter samples analyzed.
105 cultures were confirmed as P.aeruginosa (12%) and these were from intravascular catheter.
In this study 105 isolates of P.aeruginosa displayed a range of adherence capabilities in the
standard TSB medium. It was observed that adhesion is medium dependent, being enhanced to
slight extent by the addition of glucose. Mucoid strains showed strong adherence (63%)
compared to non mucoid strain (33 % showing strong adherence). RAPD typing generated 34
different RAPD profiles.
Conclusions: Most of the catheters (e.g. intravenous, central line and urinary catheters) serve as
potential surface for biofilm formation. Some of the RAPD fingerprints generated were similar for
the P.aeruginosa isolated from different clinical conditions of patients admitted in the hospital.
RAPD profile 26 was seen in diverse conditions such as post surgical cases, carcinoma,
diabetics, respiratory disease, fever, UTI and other complications indicating that it could be a
hospital strain.
Final abstract number: 64.003
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Infectious Complications after Renal Allotransplantation: Differentiatative Diagnosis with Rejection
Crisis and Possibilities for Prediction by Immunologic Monitoring
             1               2              3
P. Lazarova , K. Metodiev , A. Kisselova
1                                                     2
 Clin.Lab., Univ.hospital 'St. Anna', Varna, Bulgaria, Dept. Immunology, Medical University,
                  3
Varna, Bulgaria, Dental School, Medical University, Sofia, Bulgaria

It is widely known that 2 major complications are manifested after any organ transplantation:
rejection crisis (due to immune conflict) and infectious processes (bacterial, viral, fungal). The
differentiation between each of both is strictly required because of the contrastingly different
therapeutic approach: immunosuppression (rejection) and specific antimicrobial treatment with
possible immunostimulation (infection).
The present long-term international study is based on a dynamic immunologic monitoring (IM)
including major immunologic tests for humoral, cellular, specific and non-specific
immunoreactivity.
A total of 115 patients are examined before and 3 years after renal allotransplantation:
preliminary period (patients on haemodialysis), intraoperative period, early post-operative period
(2 weeks after transplantation), adaptation period (1-3 months), stable period and long-term
screening (1-3 years). Dynamic changes of the simultaneously applied methods are registered,
thus looking for correlation between the altered immunoreactivity and both, rejection and
infection.
The type of immunoreactivity (high or low) is also analyzed, allowing prognosis for development
of each of the two post-operative complications.
The complex evaluation of simultaneously performed tests of IM provides definite possibility for
prediction of infectious complications (or rejection) after transplantation.
Final abstract number: 64.004
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Administration of Preoperative Oral Antibiotics is a Risk Factor for Postoperative MRSA
Enterocolitis
             1           1          1            1                  1              1    1
Y. Yoshida , S. Kusachi , Y. Arima , H. Tanaka , Y.O. Nakamura , R. Watanabe , T. Saito ,
       1          1          1             1                1
J. Sato , J. Nagao , Y. Saida , Y. Okamoto , M. Watanabe
1                                                                                    1
 Third Department of Surgery, Toho University School of Medicine, Meguro, Japan, Third
department of Surgery, Toho University School of Medicine, Meguro, Japan

During in the 1980-90's, an outbreak of postoperative MRSA enterocoitis occured in Japan, and
staphylococcal enterotoxin may be involved in the septic shock and MRSA enterocolitis. It has
been suggested that various factors, such as the administration of preoperative oral antibiotics,
administration of third generation cepharosporin group of antibiotics, and gastric acid inhibition
due to the administration of histaminergic H2 receptor antagonists (H2RA), may be involved in
the development of MRSA enterocolitis. When male Wistar rats were bred by total parenteral
nutrition (TPN), and were continuously administered famotidine 4mg/kg/day, the gastric acidity
was observed to decrease to pH 6.4+/-0.1. MRSA was able to cross over to the small intestine
only during the famotidine medication. If rats were intravenously administered moxalactam (MOX)
after an oral inoculation of MRSA, then the viable MRSA counts in the intestine decreased on day
4. In contrast, if the gastric acidity decreased and the rats were treated by an oral administration
of kanamycin and metronidazole before an oral inoculation of MRSA and thereafter were
administered LMOX, then the MRSA count significantly increased. It is thus concluded that a
suppression of gastric acid and a great disorder of the intestinal flora is indispensable for the
colonization of MRSA into small intestine, while in vitro the propagation of MRSA requires a
continuity of suppression omit in the bacterial flora.
Final abstract number: 64.005
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Nosocomial Bacterial Infections and Their Antimicrobial Resistance Patterns in University
Hospitals of Hamadan, Iran
S. Jamal-Omidi, S.H. Hashemi, M. Mamani, F. Keramat, A. Niayesh, S. Rahimi
Hamedan University of Medical Sciences, Hamedan, Iran (Islamic Republic of)

Background: Nosocomial infections constitute a global health problem, particularly by multi-drug
resistant bacteria, leading to long-term hospital residences, increased economic burden, and a
high rate of morbidity and mortality. The distribution of pathogens and antimicrobial residence
patterns vary among countries and different hospitals within a country. The aim of this study was
to determine the frequency and antimicrobial resistance patterns of nosocomial infections in
university hospitals of Hamedan, Iran.
Methods: During a 1-year period from April 2006 to March 2007, all patients with culture-proven
nosocomial infection were included. Diagnosis was made according to the Centers for Disease
Control and Prevention criteria. Antimicrobial susceptibility testing of isolated bacteria was
performed by disc diffusion method.
Results: A total of 197 cases of nosocomial infection were diagnosed, out of which 170 patients
had positive bacterial cultures, 12 had more than one infected area and 41 had polymicrobial
cultures. Most cases were in intensive care units (57.4%). The common sites of infection were
lower respiratory tract (51.8%), urinary tract (31.9%), and surgical wounds (11.9%). Klebsiella
pneumoniae, Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus areus were the
most prevalent pathogens (32.7%, 22.9%, 14.8%, and 11.2% respectively). Most
enterobacteriacea isolates were resistant to third generation cephalosporins. The resistant rates
were 75.5% for K. pneumoniae, 76% for E.coli, and 85.7% for Seratia and Proteus. Among P.
aeruginosa isolates, 26.5% were resistant to ceftazidim, and 36% to ciprofloxacin. Among
S.aureus isolates, 80% were methicillin-resistant and 16.6% vancomycin-resistant.
Conclusion: The patients in the ICU are at a higher risk of nosocomial infection. The high
prevalence of antimicrobial resistance in our hospitals, highlights the need of further infection
control activities and serveilance programs that may leed to proper selection of antibiotic therapy
for nosocomial infections.
Final abstract number: 64.006
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Effective Intervention and Vaccination Strategies Against Nosocomial Infection Based on Network
Analysis
         1            2
T. Ueno , N. Masuda
1                                                          2
 Tokyo Metropolitan Hiroo General Hospital, Tokyo, Japan, Graduate School of Information
Science and Technology, The University of Tokyo, Tokyo, Japan

Background: Nosocomial infection raises a serious public health problem, as indicated by large
mortality rates of representative nosocomial pathogens such as methicilin-resistant
Staphylococcus aureus (MRSA) and recent community and world-wide outbreaks of influenza
and severe acute respiratory syndrome involving community hospitals. Epidemic modeling for
general communities based on contact networks of individuals is a powerful tool for
understanding those large-scale epidemic outbreaks. However, disease propagation may occur in
health care facilities in a manner different from in a community because of different contact
patterns in the two situations. We explore effective containment strategies against nosocomial
infection by numerical simulations of epidemic dynamics on contact networks of a real hospital.
Methods: We construct contact networks of patients, nurses and doctors in a community hospital
in Tokyo, Japan. We simulate the stochastic susceptible-infected-recovered model to investigate
epidemic spreads in the hospital. We also simulate the effect of network-based intervention and
vaccination protocols.
Results: Intervention methods that restrict communication between doctors and visits of doctors
to different wards shrink final epidemic size more than the intervention method that directly
protects patients. Vaccinating doctors with priority rather than patients or nurses is also effective.
We also find that regardless of which occupation is vaccinated first, vaccinating those with many
contacts to other individuals or randomly chosen individuals is inferior to vaccinating those with
large so-called betweenness centrality, which measures how much an individual mediates
communication between individuals. These results stem from the hierarchical and modular
structure of the contact network of the hospital, in which dense substructure such as
departments, wards, and rooms are globally but only loosely connected.
Conclusion: This study sheds light on the effect of network structure on nosocomial infection. By
removing shortcuts between wards, which are owned by doctors, it is possible to reduce the risk
of nosocomial outbreaks.
Final abstract number: 64.007
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Health Care Worker Immune Status and Risk Perception of Acquisition of Vaccine Preventable
Diseases
M.I.S. Dinelli, T.N.F. Moreira, E.R.C. Paulino, M.C.P. Rocha, F.B. Graciani, M.I. de Moraes-Pinto
Federal University of São Paulo, São Paulo, Brazil

Background: Health care workers (HCW) are more exposed to infectious diseases than the
general population. They can become infected or transmit infection to patients and other HCW.
Many infections can be prevented by vaccination. This study evaluated HCW immune status and
risk perception of acquiring vaccine preventable diseases from a tertiary university hospital in São
Paulo, Brazil.
Methods: Questionnaires were distributed to 187 HCW (physicians, nurses and housekeepers)
equally distributed among hospital units. Individuals were chosen at random, in a convenience
sample. Participants were asked about the risk perception of acquisition of vaccine preventable
diseases in the workplace. After an open-ended questionnaire, close-ended queries were posed.
HCW who reported diseases in the past or were previously vaccinated were considered
immunized.
Results: Participants mean age was 33.2 years, 74% were female, 16% were housekeepers,
49% were nurses or nurse assistants and 35%, physicians. The diseases most spontaneously
mentioned as at risk for acquisition in the workplace were: hepatitis B (77.5% of individuals),
tuberculosis (47.6%), meningococcal disease (32.8%), influenza (21.9%) and varicella (20.3%).
When specifically asked about each disease, the most commonly mentioned were hepatitis B
(94.1%), influenza (92.5%), meningococcal disease (90.3%), tuberculosis (85.0%) and varicella
(72.7%). Previous disease or vaccination were referred for tetanus (87.7% of individuals),
measles (86.6%), mumps (85.6%), rubella (85.0%), hepatitis B, (82.4%), varicella (82.9%),
diphtheria (81.8%). Only 51.3% were vaccinated against influenza during the last season.
Housekeeping staff were less immunized than nurses and physicians (p<<0.05 for hepatitis B,
measles, mumps, rubella, varicella, diphtheria), except for tetanus (p=0.912) and influenza
(p=0.214).
Conclusions: HCW have a good risk perception of acquiring vaccine preventable diseases.
Coverage rate was high for most vaccines. However, educational programs should aim at
housekeeping staff in order to increase their vaccination coverage.
Final abstract number: 64.008
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Health Care Workers Occupational Accidents in a Brazilian Hospital
T.N.F. Moreira, M.I.S. Dinelli, E.R.C. Paulino, M.C.P. Rocha, F.B. Graciani, M.I. de Moraes-Pinto
Federal University of São Paulo, São Paulo, Brazil

Background: Percutaneous or mucosal contact with infective materials can potentially be a
source of transmission of infectious agents such as hepatitis B, hepatitis C and human
immunodeficiency virus. Health care workers (HCW) are more exposed to accidents with blood,
tissues or body fluids than the general population.
Methods: One hundred and eight-seven HCW from the Federal University of São Paulo, Brazil,
were interviewed. They were divided into three professional categories: physicians, nurses and
housekeeping staff. The questionnaire was equally distributed in different hospital units and
individuals were chosen at random as a convenience sample. Information on accidents involving
biological material at their workplace and procedures was collected.
Results: Sixteen percent of HCW were housekeepers, 49% were from the nursing staff and 35%
were physicians. The majority of them were female (74%) with mean age of 33.2 years (range:
22.2 to 63.8). Sixty-one professionals (32.6%) reported percutaneous or mucosal accidents.
Nurses had a tendency to more occupational injuries (38.5%) than physicians (31.8%) and
housekeepers (16.7%) (Chi-squared test: p=0.087). After the accidents, 83.6% of HCW referred
having notified the Hospital Control Infection Committee. The percentage of notifications by
nurses (94.3%) was higher than by housekeepers (80.0%) and physicians (66.7%) (Fisher's
exact test: p=0.022). Upon accident notification, individuals were submitted to serological tests,
two HCW received hepatitis B vaccine, one received hepatitis B immune globulin and 11 received
antiretroviral prophylaxis. Of note, among 187 participants, 2 had already had hepatitis B through
natural infection, 152 had received 3 or more hepatitis vaccine doses, 31 received 1 or 2 doses
and 2 professionals had not received any vaccine dose.
Conclusions: In our sample, nursing staff had more percutaneous or mucosal accidents than
other professional categories. Despite recommendations, some HCW did not notify their
occupational accidents, especially physicians. Professionals had high hepatitis B vaccination
coverage.
Final abstract number: 64.009
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Underreporting of Occupational Exposures to Sharp Injuries
Z. Hassan
Hashemite University, Zarqa, Jordan

Background: Sharp Injuries are one of the serious problems that face healthcare workers; it is the
bridge for occupational exposure to blood-borne pathogens such as hepatitis B, hepatitis C, and
human immunodeficiency virus. Surveys of healthcare workers indicate that 50% or more of
healthcare workers do not report their occupational exposure to sharp injuries.
The objectives of this study were; a) examine the relationships between the demographic
variables (age, gender, agency, education level, occupation, working area, and shift) and
reporting rates of sharp injuries; and b) determine the reasons for underreporting of sharp
injuries.
Methods: Cross-sectional study with multi-stages cluster sampling was carried out in June 2006
till June 2007. Data were collected using a survey that was developed by the Centers for Disease
Control and Prevention. Two thousand surveys were distributed to healthcare workers who were
working in private and public hospitals.
Results: One thousand and sixty eight healthcare workers filled out the surveys. Overall reporting
rate was 15.6% (ranged from 5.3% to 25.9 %). Highest reporting rates were found among the
following subgroups; female (15.4%) , who hold Diploma degree (15.9%); working in public
settings (15%) , working in pediatric floor (17.9%), dialysis workers (25.9%), and working between
3 pm -11 pm (16.2%).
The main reasons for underreporting were: care did not give in timely manner; insufficient
information given about blood-borne pathogens; their questions about blood-borne pathogens
and screenings were not answered; no encouragement to call; place where care was given was
not good, and staffs feel rushed.
Conclusion: Underreporting of occupational exposures to sharp injuries is a significant problem
facing Jordanian healthcare workers. Universal precautions should be included in the curricula
and in-service programs. Procedures for reporting sharp injuries must be available and clear to all
healthcare workers.
Final abstract number: 64.010
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Clinical, Microbiological, and Epidemiologic Characteristics of Acinetobacter Infections in a
University Hospital, Tehran, Iran
           1                1                1          2
M. Barati , S. Noorbakhsh , M. Talebi-Taher , R. Abasi
1
 Pediatric Infectious Diseases Reaserch Center of Iran University of Medical Science, Tehran,
                            2
Iran (Islamic Republic of), Rasol-e-Acram Hospital, Tehran, Iran (Islamic Republic of)

Background: The control of infectious diseases is seriously threatened by the steady increase in
the number of microorganisms that are resistant to antimicrobial agents. Since the 1970s, the
spread of multidrug resistant (MDR) Acinetobacter strains among critically ill, hospitalized
patients, and subsequent epidemics, have become an increasing cause of concern. Therefore,
we performed this prospective observational study to determine clinical and resistance pattern of
Acinetobacter in blood stream infection.
Method: This observational, prospective study was conducted in a 250-bed Rasol-e-Acram
university hospital from April 2006 to April 2007. All patients with positive Acinetobacter blood
culture were eligible.
Antimicrobial susceptibility testing was performed using disk diffusion and E-test MIC for
amikacin, gentamicin, imipenem, meropenem, ceftriaxone, ceftazidime, ciprofloxacin, ampicillin
and co-trimoxazole.
Results: Of the 93 Acinetobacter strains identified, 31.2% were nosocomial, 41.9% were isolated
from patients with previous antibiotic usage, 47.3% were isolated from patients hospitalized in
internal wards and 23.7% in intensive care units. More than half of the patients had at least one
underlying disease such as diabetes (19.4%), malignant neoplasm (18.3%), chronic corticosteroid
use (14%), addiction (11.8%) and renal failure (5.4%). Primary bacteremia (33.3%) was the most
frequent infection encountered, followed by respiratory tract infection (24.7%) and urinary tract
infection (9.7%).The mean ± SD age of the cases was 50.27 ± 23.1 years, and 54.8% were male.
Resistance to the antibiotic tested was in the 8.6% to 92.5% range; ciprofloxacin was the most
effective and ceftriaxone was the least effective antibiotic.
Conclusion: Our results indicated that prevalence of Acinetobacter infections in our hospital is
rising and this infection mainly affected patients with underlying diseases. Ciprofloxacin was the
best antibiotic as far as bacterial resistance was considered.
Final abstract number: 64.011
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Pretreatment of Catheter with Biosurfactant for Inhibiting Biofilm Formation
Z.P. Bhathena, A.D. Mule
Bhavan's College, University of Mumbai, Mumbai, India

Medical insertional materials are made up of inert substances which are inserted in to body for
various reasons like tracheotomy, as voice prosthesis, for speech rehabilitation, and as catheter
during kidney dysfunction. Over a period of time these insertional materials are often colonized by
various normal or opportunistic pathogens specially Gram negative bacteria. Growth which
occurs on such insertional material is in form of biofilms or bio-aggregates which acquire unique
properties like antibiotic resistant making their removal important. Preventing such sessile biofilm
growth onto catheter material can be undertaken by conditioning the material before insertion.
Biosurfactants formed interstitial films on the insertional material; known as a 'conditioning film',
can change the properties (wetability and surface energy) of the original surface thus prevents
colonization In this study 'conditioning film' of biosurfactant was attained by pre-treating catheter
material with 10% biosurfactant obtained from environmental isolate BM-10, at 35O C for 60 min.
In this work hospital acquired Pseudomonas aeruginosa was used in development of biofilm.
Such a conditioned biomaterial when used for Pseudomonas aeruginosa biofilm colonization
studies through flow cell showed 42 % reduction to biofilm as determined by confocal scanning
laser microscopy along with two fold log reduction in its viable count. Chemical characterization of
the biosurfactant was done using GC-MS analyzer with HPCHEM library identified presence of
1,2-Benzenedicarboxylic acid, bis (2-propytheptyl) ester moieties. Thus this paper envisages use
of biosurfactant as biomaterial coat enabling reduction in Pseudomonas aeruginosa biofilm on
biomedical implants.
Final abstract number: 64.012
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

What is the Role of Stethoscope in Transmitting Infection at aTertiary Care Saudi Center?
A. Alothman, A. Bukhari, H. Maimony, S. Al Johani, A. Muhanna
King Abdulaziz Medical City, Riyadh, Saudi Arabia

BACKGROUND: It has been proven that stethoscopes can carry several nosocomial isolates, in
previous studies. We initiate a study at our institution to find the magnitude of stethoscopes in
transmitting nosocomial isolates between patients.
METHODS: Randomly a health care worker (HCW) in the hospital was given a questionnaire.
The HCW was asked to give his/her stethoscope to be swabbed and cultured "Diaphragm of the
stethoscope".
RESULTS: 151 stethoscopes were collected "the study is still ongoing". The health care were
divided into male (69) and female (82). The total percentage of contamination was 47% (72/151).
Consultants were 11(81.8% contaminated). Residents were 47(65.9% contaminated). Interns
were 21 (66.6% contaminated). Nurses were 51 (21.5% contaminated). Medical students were 15
(40% contaminated).
The most common organism is coagulase-negative staphylococcus at 66/72 (91.6%). The second
commonest organisms was Diptheroids (27.7%). 45.8% (33/72) of HCWs with contaminated
stethoscopes had more than one organism per diaphragm.
DISCUSSION: The diaphragm of the stethoscopes can work as a carrier of nosocomial isolates.
Our results is 47.7% of stethoscopes are contaminated despite the recommendation of cleaning
diaphragm of stethoscopes between patients.
We recommend that disinfecting medical instrument should be mandatory and closely
supervised.
Final abstract number: 64.013
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Four Years Surveillance of Antimicrobial Susceptibility in Pseudomonas aeruginosa Nosocomial
Isolates from a Central Hospital in Portugal
             1           2             1
O. Cardoso , A.F. Alves , R.M. Leitão
1
 Laboratory of Microbiology, Centro de Estudos Farmacêuticos, Faculty of Pharmacy of
                                                    2
University of Coimbra, Portugal, Coimbra, Portugal, Laboratory of Microbiology, Centro
Hospitalar de Coimbra, Portugal, Coimbra, Portugal

Background: Pseudomonas aeruginosa (PA) is one of the leading causes of nosocomial
infections. Surveillance of antimicrobial susceptibility of PA clinical isolates has been monitored in
this study, since determination of guidelines for empirical regimens and prompts enforcement of
infection control measurers are of great importance.
Methods: Isolates (N=907) were collected during April 2003 - April 2007. They were identified
with API32GN (BioMérieux) and MicroScan WalkAway (Dadebehring) and susceptibility patterns
were determined with these panels. Susceptibilities to Piperacillin (PIP), Piperacillin plus
Tazobactam (TZP), Aztreonam (AZT), Ceftazidime (CAZ), Imipenem (IP), Meropenem (MP),
Amikacin (AMK), Gentamicin (GN), and Ciprofloxacin (CIP) were guideline by CLSI. Results: The
best agent was TZP (82.6% of susceptibility) followed by AMK (82.5%), MP (81.7%), PIP
(79.4%), CAZ (75.5%), AZT (71.4%), IP (70.9%), GN (62.6%), and CIP (60.5%). Resistance to
beta lactams had increased, especially to IP that had diminished its susceptibility from first year to
last year (21.2%), CAZ decreased 19.3% and MP 16.2%, and only the aminoglycosides had
improved the activity. Multidrug resistance was observed in 18.2% isolates from nosocomial
infections (resistance to three or four of follow agents: PIP, CAZ, IP, and CIP), where 35.8% of
these were resistant to all agents, and 60.6% were from respiratory products.
Conclusion: Increased resistance to last generation of beta-lactams is of great concern, therefore
susceptibilities should be determined and effective antibiotics usage policy should be performed.
Final abstract number: 64.014
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Changes in the Incidence of Central Venous Catheter Related Infection in Surgical Patients
Receiving Total Parenteral Nutrition
J. Kotsikoris, A. Zygomalas, M. Souchlakis, P. Terzakis, M. Manousi, V. Alivizatos
'St Andrew' General Hospital, Department of Surgery, Patra, Greece

Background. In patients receiving Total Parenteral Nutrition (TPN), central venous catheter
related infection (CRI) represents a serious complication which conduct to increased morbidity
and cost of hospital stay. The aim of this study was to assess if there was any change regarding
the incidence of CRI during the last decade, comparing two consecutive 5-year periods.
Method. Data of all adult patients referred to our Nutrition Unit for TPN administration between
1/1/1998 and 31/12/2002 (P1) and between 1/1/2003 and 31/12/2007 (P2) were retrospectively
collected and compared (x2 test).
Results. 84 patients (42 M, 42 F) were included in P1, and 141 (70 M, 71 F) in P2. The median
age was 71.3 years (26 - 91) in P1, and 73.5 (19 - 95) in P2; 65 patients in P1 and 105 in P2
were > 65 years old. During P2, insertion and care of all central venous catheters was done by
the Nutrition Support Team of our Department. Indications for TPN were similar throughout the
two periods. The duration of TPN was 1035 days in P1, and 1966 in P2. Incidence of CRI was
14.5 episodes in P1 and 10.1 in P2 for every 1000 days of TPN. CRI was significantly more
frequent in patients > 65 years old: 8 episodes in P1 (p < 0.05) and 16 in P2 (p < 0.05). The
responsible pathogens were similar throughout the two periods (coagulase-negative
staphylococci: 60% of the cases).
Conclusion. The results of this study suggest that incidence of CRI has significantly decreased in
our Nutrition Unit during the last 5 years; this may be attributable to the concentrating experience
in the hands of few dedicated individuals forming our Nutrition Support Team.
Final abstract number: 64.015
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Level of Knowledge Consciousness, and Practical Knowledge of Hospital Infection Among Health
Care Providers at a Long-Term Care Facility
           1             2           2            2          2
Y. Yoshida , Y. Kumagai , Y. Kumagai , K. Shikoshi , T. Dazai
1
 Third Department of Surgery, Toho University School of Medcine, and Keihin Hospital, Tokyo,
       2
Japan, Keihin Hospital, Tokyo, Japan

Background: An outbreak of gastrointestinal disease (nausea, vomiting or diarrhea) occurred
among residents in a long-term care facility (LCTF) in Tokyo, during 22-25 January 2008.
Methods: Infection control team was convened, and an educational lecture and the opportunity for
consultation were provided, and the health care providers in the LCTF completed a questionnaire
on their personal practical knowledge about hospital infection.
Results: Their level of knowledge in the standard precautions before educational was 66.7% /
after educational lecture was 82.8% (p=0.35) and norovirus 74.1%/96.6% (p=0.02), however,
their level of knowledge unsatisfied in the exogenous infection 22.2%/96.6% (p<0.01),
handwashing 51.9%/89.7% (p<0.01), and sterilization and disinfection 22.2%/96.6% (p<0.01).
The level of knowledge was gained after the educational lecture. There was a moderate level of
knowledge consciousness about practical knowledge of hospital infection among the health care
providers in the LCTF surveyed, with a mean level for subjects ranged from "having heard it" to "I
know somehow" out of possible answers.
Conclusions: Despite reporting moderate level of knowledge consciousness about practical
knowledge of hospital infection, the health care providers in the LCTF demonstrated unsatisfied
level of knowledge about practical knowledge about hospital infection. Educational lecture of
hospital infection needs to be strengthened for the measure against an outbreak.
Final abstract number: 64.016
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Perioperative Risk Factors for Chest Surgical Site and Leg Infections after Cardiac Surgery
Z. Hassan
Hashemite University, Zarqa, Jordan

Background: Surgical site infections after cardiac surgery are associated with high mortality and
morbidity rate. The objectives of this study were to: 1) evaluate the prevalence rates of chest
surgical site and leg infections, and 2) identify the predictors for development of the infections.
Methods: Data were collected using medical abstracting. Three hundred and sixty three patients
who went under cardiac surgery during January 2004 and January 2007 participated in this study.
Data analyses were performed using SPSS. Stepwise logistic regression was used to predict the
risk factors for development of chest surgical and leg infections post cardiac surgery.
Results: off the 363 patients, 72.7 % (n= 264) were men and 27.3% (n=99) were women with a
mean age of 52.77 years (SD =16.6). 54.5 % (n=198) BMI was above 25. The patients had the
following illnesses: 62.3% (n=226) diabetes, 66.1 % (n= 240) hypertension and 23.4% (n=85)
COPD. Chest surgical site infection rate was 4.1% (n=15), and leg infection rate was 6.9%
(n=25). The risk factors for chest surgical: obesity (odds ratio [OR] 1.4, p=.000, 95% CI, 1.1-1.6),
smoking (OR, 34; p =.013; 95% CI, 2.1- 551.5), and previous cardiac surgery (OR, 3.5 p = .051,
95% CI, 2.2- 488). The risk factors for leg infection were; hypertension (OR, 8.3; p =.046; 95% CI,
1.0-67.4); COPD (OR, 3.1; p =.025; 95% CI, 1.15- 8.4), previous cardiac surgery (OR, 4.8; p
=.018; 95% CI , 1.0-13.5); using steroid (OR, 4.78; p =.002, 95% CI 1.7-13.1); obesity (OR,1.1, p
=.035, 95% CI ,1.0-1.26), and high creatinin level (OR,1.5 , p =.006, 95% CI , 1.1- 2.0)
Conclusion: Identification of modifiable risk factors for chest surgical site and leg infections can
serve as baseline data for healthcare workers to develop interventions that enhance positive
outcomes post cardiac surgeries.
Final abstract number: 64.017
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Transmission and Control of MRSA Infection in Dermatology Indoor Patients
B. Mehta, M. Dhingra, S. Amladi, C. Nayak, S. Savant
B.Y.L.Nair Charitable Hospital and T.N.Medical College, Mumbai, India

Background and objectives: Methicillin resistant staphylococcus aureus (MRSA) is the most
important multidrug resistant strain to have emerged globally in recent years. The objectives of
the study were to quantify the MRSA outbreak in our dermatology ward, ascertain the
demographical profile, find the link of transmission and assess control measures.
Methods: Dermatology indoor patients testing MRSA positive (Jul 06-Sep 07) were evaluated.
Cultures were sent from fingertips of healthcare workers and medical equipment. Nasal swabs of
patients were tested for carrier states.
Results: Staphylococcus aureus isolates detected MRSA positive increased to 40% as compared
to 7% in previous year. In the study period, 17 patients were detected to be MRSA positive (10
males, 7 females). All the MRSA isolates were Vancomycin and Linezolid sensitive. 13 patients
were on chronic immunosuppressive therapy with compromised skin barrier (Pemphigus 8.
bullous pemphigoid 1, pyoderma gangrenosum 3, erythroderma 1), 3 HIV seropositive, 1 cellulitis.
Only 1 patient had community-acquired MRSA while rest were hospital-acquired MRSA.
Affected patients showed deterioration of pre-existing dermatosis or decreased response to
therapy. MRSA positive patients were isolated in separate room and treated with oral linezolid or
intravenous vancomycin, with marked clinical improvement. 2 patients were found to be nasal
carriers and treated with mupirocin. Finger tip culture of 4 health care workers was positive.
MRSA-positive healthcare providers were removed from direct patient care until negative culture.
Contact precautions and hand hygiene measures were followed. Fumigation of the room after
discharge of patient was done. Although incidence decreased, new MRSA positive cases
continued to be detected.
Conclusion: MRSA infection is an emerging problem in indoor patients, leading to poor disease
response, higher costs and increased hospital stay. Control is possible but difficult, requires high
motivation and is expensive.
Final abstract number: 64.018
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Uropathogen Resistance to Aminoglycosides in a Regional Hospital in Greece
T. Chimonas, F. Rozi, P. Papageorgiou, E. Chounta, M. Pavlaki, M. Vossou
Argos General Hospital, Argos, Greece

Background: Aminoglycosides have traditionally been used in the empirical treatment of serious
and complicated urinary tract infections (UTIs). Although their use has been waning, they still
remain an important choice in our therapeutic arsenal.
Objectives: To study the resistance to aminoglycosides of organisms responsible for UTIs in a
small regional hospital in Greece.
Methods/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. Resistance to aminoglycosides was determined for the most
common gram negative uropathogens. The number of isolated strains and their resistance to
amikacin, garamicin, netilmicin and tobramycin is presented in Table 1.
Conclusions: Resistance of gram negative uropathogens to aminoglycosides varies, but is
especially high among K. pneumoniae and P. aeroginosa isolates. However, their relative
effectiveness against the most common bacteria and their possible synergistic action has
preserved their role in the management of complicated UTIs.
Final abstract number: 64.019
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Risk Factors and Outcome for Nosocomial Infections in Pediatric Cardiac Surgery
           1         2            1           1          3           4
Y.F. Huang , P.Y. Liu , C.W. Tang , K.S. Hsieh , Y.C. Liu , J.Y. Pan
1
 Department of Pediatrics,Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,
2
 Department of Pediatrics,Kaohsiung Veterans General Hospital, Taiwan, Kaohsiung, Taiwan,
3
 Department of Internal Medicine,Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,
4
 Department of Surgery,Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

Nosocomial infections (NIs) in the pediatric cardiac surgery patients remain important and
challenge prognostic problems. Compared with adult patients, few previous publications
described the frequency of nosocomial infection in pediatric group who underwent cardiac
surgery. So, we evaluated the NIs in pediatric patients who received cardiothoracic surgery and
to recognize the related risk factors. The clinical data were retrospectively collected From January
1, 2004 to May, 31, 2007. Definition of nosocomial infections were according to the US Centers
and for Diseases Control and Prevention criteria. A total 246 patients of who underwent cardiac
surgery at Kaohsiung Veterans General Hospital were enrolled in the study. The average age
was 5.6 year old. 205 (83.3 %) of the all 246 patients received cardiopulmonary bypass during
surgery. Of the 246 patients, 51 patients (20.7%) developed NIs. The sites infections involved
mostly were respiratory tract. The most causative pathogen was Staphylococcus aureus.
Important risk factors included length of preoperative days, preoperative invasive procedure,
opened sternum wound after surgery, cardiopulmonary uses, and cyanotic heart diseases. The
rate of NI was 3.5 per 100 days of hospitalization. The highest rates NIs lies in the patients who
undergo complex surgical operations as correction of complex cyanotic heart defects. According
to our results, our rate of NIs is lower than previous published series. To reduce rates of NIs,
decreasing the preoperative stay, reduce preoperative invasive procedure could essentially be
effective. As for opened sternum wound, related to more complex heart defects, an alternative
strategy would be perhaps effective.
Final abstract number: 64.020
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Clinicoetiological Study of Nosocomial Sepsis in Dermatology Ward
D.P. Asati, V.K. Sharma, S. Khandpur, G.C. Khilnani, A. Kapil
All India Institute of Medical Sciences, New Delhi, India

Background: Patients admitted in dermatology ward are highly susceptible to nosocomial sepsis
due to extensive denudation of skin with loss of protective barrier in several dermatoses and
frequent and prolonged use of corticosteroids and other immunosuppressives. The mortality in
dermatology ward can predominantly be ascribed to sepsis, directly or indirectly. There is paucity
of data on epidemiological and etiological profile of sepsis in dermatology inpatients. This study
was undertaken to study the incidence, etiology and antibiotic sensitivity profile of nosocomial
sepsis in skin ward.
Methods: All patients developing nosocomial sepsis, defined as presence of two or more SIRS
(Systemic Inflammatory Response Syndrome) criteria plus detection of focus of infection after 48
hours of admission, were inducted. They were assessed for risk factors, monitored for systemic
complications and blood and other relevant specimens were sent for culture and antibiotic
sensitivity testing.
Results: During study period, 40 of 860 inpatients (4.65%) developed nosocomial sepsis, majority
suffering from vesicobullous diseases (42.5%), erythroderma (25%) and toxic epidermal
necrolysis (22.5%). Of these, 17 (42.5%) developed severe sepsis and 15 (37.5%) died. Total
number of deaths during study period due to all causes were 22; thus sepsis contributed to 68.2%
of deaths. Significant risk factors included use of immunosuppressives, presence of fever before
admission, diabetes, smoking and concomitant systemic illness. The commonest gram positive
organism isolated from all specimens was methicillin resistant staphylococcus aureus (MRSA).
Gram negative isolates were acinetobacter, pseudomonas and klebsiella. On sensitivity testing,
MRSA showed high sensitivity to vancomycin, linezolid, teicoplanin and rifampicin. Gram negative
organisms were sensitive to cefoperazone+sulbactum, piperacillin+tazobactum, imepenem and
meropenem.
Conclusions: Sepsis incidence was 4.65% in dermatology ward. Death occurred in 37.5% of
these cases. Sepsis developed in patients with dermatoses involving large body surface area.
MRSA was the commonest organism isolated. Antibiotic sensitivity pattern helped to formulate
appropriate treatment guidelines.
Final abstract number: 64.021
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Knowledge and Performance of the Universal Precautions Among Yemeni Nurses
              1            1            2           1              1
A.A.K. Thabet , A. Abdulrab , S. Awdhaly , F. Amrani , N. Al-Jaber
1                                    2
 College of Medicine, Thamar, Yemen, Ccollege of Medicine, Thamar, Yemen

Objectives: The purpose of this study was to examine the level of knowledge and performance of
the universal precautions among Yemeni nurses, to outline educational and training needs and
focus on possible activities to remedial action.
Methods: this survey was carried out at Al-Whadah University Hospital in Thamar governorate
during May through July 2007. A total of 84 nurses participated in this study and completed the
written questionnaires. The response rate was 100%.
Results: The average knowledge of the universal precautions was 173.77± 47.02 (scores ranged
from 75 to 225). The performance level average of the universal precautions was 54.18± 14.53
(scores ranged from 28 to 70). The findings of these 3 items ("I do not dispose the needles as
crooked or cut", " I always wear a mask when there is a risk of being contaminated with the blood
or body fluid of a patient", "I always wear a protection goggle when there is a risk of being
contaminated with patient blood or body fluid") showed that the level of knowledge and
performance of the nurses were very low.
The correlation between knowledge and performance of the universal precautions showed strong
and positive correlation (r= 0.707, p = 0.001)
Conclusion: This study demonstrated that nurses' knowledge and performance level of the
universal precautions was relatively high, but at the same time, they had a wrong understanding
of some items. So that it reveals a definite need of stepping up educational and motivational
methods for the use of the universal precautions by health workers in hospitals.
Keywords: universal precautions, Yemen.
Final abstract number: 64.022
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Estimation of Occupational Exposure to Blood and Body Fluid Among Healthcare Trainees
K. Lionel, J. John, J. Muliyil
Christian Medical College, Vellore, India

Introduction: Blood and body fluid (BBF) exposure is among the most important occupational
hazard that medical personnel face each day. The risk for such exposure is greatest during the
training and initial years of professional practice. Stressful work situations and cumbersome
procedures for reporting often contribute to under reporting of such injuries. This study from
Christian Medical College, a training institution in southern India, attempts to estimate the
incidence of such occupational injuries amongst trainee doctors.
Methods: Institutional rules mandate reporting of all occupational exposure BBF. HIV and HbsAg
status of index cases are performed under this program. A retrospective analysis of reported
exposure to BBF in a six month period between January and July 2006 was done. HbsAg testing,
while not routine, is done for patients undergoing interventional procedures and where indicated.
Results: 192 episodes of exposure to BBF were notified. The annual incidence of occupational
exposure to BBF among trainee doctors was reported at 67 episodes per 100 person-years. In
149 (77.6%) episodes the HBsAg status of the index case was determined. 18 (12.1%) (95% CI
6.8 to 17.3) of them were positive for HBsAg. During the same period the HBsAg positivity rate for
all inpatients who had the test done was 3.5% (95% CI 3.09 to 3.92). Correction for under-
reporting by comparing HBsAg surface antigen rates among index cases and prevalent hospital
estimates provided a revised conservative estimate of incidence of exposure to BBF among
trainee doctors of 130 episodes per 100 person-years. Trainee doctors were 2.3 times more likely
to report injuries in the first three months of their training as compared to the last three months.
Conclusion: Under-reporting of occupational exposure to BBF is common in training institutions.
Estimates of the true burden can be arrived by comparison of HBsAg rates amongst index cases
to prevalent rates.
Final abstract number: 64.023
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Detection and Characterization of Metallo Beta-Lactamases in Clinical Isolates of Pseudomonas
aeruginosa from Different Hospitals in Delhi, India
S.P. Singh, M. Shariff, S.S. Thukral
V.P. Chest Institute, Delhi, India

Background: Metallo Beta-lactamases (MBLs) mediated resistance to carbapenems in
Pseudomonas aeruginosa is of serious clinical concern since these drugs represent the last
therapeutic resort available. Several phenotypic tests for detection of MBLs in various species of
bacterial pathogens have been advocated. Most of the available phenotypic tests have never
been evaluated using Indian clinical isolates. The present study was therefore, undertaken to
evaluate various available phenotypic tests for detection of MBLs in Indian clinical isolates of P.
aeruginosa.
Methods: Two hundred non replicate clinical isolates of P. aeruginosa from different hospitals of
Delhi were screened for susceptibility to imipenem and ceftazidime using the CLSI disk diffusion
method. All imipenem nonsusceptible and/ or ceftazidime resistant isolates were tested by
Modified Hodge test on Mueller Hinton Agar (MHT-MH), Modified Hodge Test on MacConkey
agar (MHT-MA), IPM-EDTA+SMA Double Disk Synergy Test (DDST), Combined Disk Test
(CDT), Extended Disk Synergy test (eEDST) and EDTA-IPM Microbiological Assay (EIMA).
Polymerase Chain Reaction (PCR) using family specific primers was employed to confirm the
presence of MBL genes.
Results: As many as 76/200 (38%) of the isolates were screen positive. MHT-MH detected 41/76
(54%), MHT-MA 63/76 (83%), eEDST 62/76 (82%), CDT 55/76 (72%), DDST 51/76 (67%) and
EIMA 45/76 (62%) of the screen positive isolates as MBL producers. PCR confirmed the
presence of bla VIM / bla IMP genes in all the phenotypic test positive isolates.
Conclusion: A very high proportion (32%) of our isolates of P. aeruginosa were MBL positive.
There is thus, a need to test MBL production in clinical isolates routinely for continuous
monitoring. Of the phenotypic tests evaluated Modified Hodge Test on McConkey's Agar (MHT-
MA) was most sensitive. The MBLs encountered were of VIM and IMP type, the common types
prevalent all over the world.
Final abstract number: 64.024
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

What does it take for a Doctor to Wash?
              1                  2
J.B. Suchitra , N. Lakshimidevi
1                                       2
 Freedom Foundation, Bangalore, India, Dept of microbiology, mysore university, Misore, India

INTRODUCTION: Hand Hygiene, remains the single most significant measure to prevent
nosocomial infections. However, the importance of this simple procedure is not sufficiently
recognized by health care workers. We undertook this study in order to probe into reasons for
non-compliance, which would be useful in impacting 'Infection Control Practices' in hospitals.
MATERIALS & METHODS: An observational study, the participants are Doctors (N=150) working
in different wards at three different hospitals in Karnataka, India. They were observed for
compliance with handwashing practices and interviewed on probable reasons for non-
compliance.
RESULTS: The study participants were doctors aged 23-42 (mean age=29.6) years; 60% (N=90)
and 40% (N=60) were males and females respectively. The average years of work experience in
a hospital was 5.4 years. Handwashing compliance observed was 42.6%. Non-compliance
among males and females was 52.2% and 26.6% respectively. All participants expressed the lack
of institutional guidelines and support as the reason for non-compliance and in turn the
prevalence of Nosocomial infection rates. Other factors were the lack of encouragement 80%;
high workload 80%; understaffing or downsizing of staff 70%; lack of a role model among the
senior staff 60% and working in a critical care setting 50%. It is interesting to note that 80% of the
doctors felt that it was not necessary to wash hands between patients and 30% claimed to have
never washed hands between patients. Universal precautions were perceived as protective by
58% and expensive by 16%.
CONCLUSION: Many studies investigating interventions designed to improve handwashing may
have initial improvements in compliance. However, long-term continued compliance has been
disappointing. It is therefore nessecary to apply interventions that focus on identifying risk factors
for non-compliance, and designing interventions geared toward sustainability such as 'Infection
Control Programmes' and a link between monitored Nosocomial infection rates and prevention
efforts.
Final abstract number: 64.025
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Cost and Infection Control Implications of Inappropriate Urine Bacterial Cultures
M. Hamadeh, K. Obeid, A. Khan, M. Kaabi, R. Hashmey
Tawam Hospital in Affiliation with Johns Hopkins Medicine, Al Ain, United Arab Emirates

Hypothesis: Urine culture in unselected individuals with negative urine dipstick is unwarranted.
Physicians often order urine cultures inappropriately, resulting in false positive cultures and
unnecessary antimicrobial use.
Methods: Retrospective review of patients who had positive urine culture despite negative
dipstick from Jan-Mar 2006. Data were collected on patient demographics, past medical history,
presence of urinary symptoms, and documentation of request and results of urinalysis, urine
culture and treatment given.
Results: 4977 urine specimens were received of which 1570 (31.5%) were negative on dipstick
but processed for culture by order of the physician. 113 (7.2%) of these resulted in a positive
urine culture. Ninety-seven charts were available for review. The mean age was 28 (median 25,
range 1-87). Suspected urinary tract infection was listed as a reason for culture in 45/97 (46.4%)
patients. Only 18/68 (26.5%) had urinary symptoms (excluding 29 preschool aged children). The
order for urine culture was not recorded in 37/97 (38%) and result was not documented in
64/97(66%) of patients. 29/97 (30%) received antibiotics for a total of 285 DDD (Defined Daily
Doses) (average 9.8 DDD/patient). A total of 254 DDD of antibiotics were prescribed for which no
clear indication could be established from the medical record. Estimated excess material cost to
the microbiology laboratory in absence of sieving strategy for urine culture was estimated at
$1030/month.
Conclusions: We found poor documentation of reasons for urine culture and results by
physicians. In addition, in a majority of cases no clear reason could be found for dispensation of
antibiotics other than a positive urine culture. Introduction of positive urine dipstick as a sieving
strategy for urine culture in low risk patients would reduce inappropriate antibiotic use and lower
laboratory costs.
Final abstract number: 64.026
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Molecular and Phenotypic Characterization of Metallo-Betalactamases Producing Bacteria in a
Tertiary Care Hospital
                    1          2        2          2
H.T. Samarasekara , J. Branley , B. Roy , M. Leroi
1                                                    2
 Cancer Institute, Maharagama, Kaduwela, Sri Lanka, Nepean hospital, Sydney, Australia,
2
 Nepean Hospital, Sydney, Australia

An ongoing outbreak of bla IMP-4 positive Gram negative rods in the Neonatal intensive care unit
prompted us to look at improved screening for these organisms using a mix of phenotypic and
molecular methods. These organisms present a challenge to the routine microbiology laboratory
because of variable phenotypic expression, the range of organisms involved and the need for
rapid results. As this genetic element is relatively new a greater understanding of the problem in
our local environment was required. As such 3 groups of isolates were studied.
A total of 300 none duplicate consecutive gram negative clinical isolates were recovered from the
department of Microbiology, Nepean hospital, Western Sydney were selected for the study. The
300 isolates comprised of 100 isolates sensitive to third generation cephalosporines and
aminoglycosides, 100 isolates resistant to either or both of the drugs and 100 isolates collected
from Neonatal intensive are unit where it was thought an ongoing out break of MBL positive
bacteria was occurring. Historical specimens from early in the outbreak was reviewed.
The bacterial isolates were identified to the species level and antibiotc susceptibility testing as
performed by Vitek 1system(Biomeroix). Isolates were subjected to phenotypic testing using MBL
inhibitors, 2-mercaptopropionic acid and EDTA.
The real time PCR was performed using Corbett rotor gene 3000.The primers were designed by
primer 3 software targeting the IMP4 gene in order to shorten the product size an make the
detection by Syber green a possibility. The expected size of the amplicon was 192bp.
Product specificity was assessed by the melt curve and confirmed by product seqencing.
Bla IMP-4 was found to be present in up to 40% of our neonatal screening isolates but was not
found frequently in specimens from patients outside the unit. We discuss a suggested approach
to screening for IMP4 metallo-betalactmases in a hospital setting.
Final abstract number: 64.027
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Enterococcus Infections: Epidemiology, Mortality and Risk Factors in a Regional Hospital in
Greece
P. Papageorgiou, T. Chimonas, K. Mitrakou, M. Vossou, F. Rozi
Argos General Hospital, Argos, Greece

BACKGROUND: Enterococci are an important source of infection in hospitalized patients,
especially in elderly individuals with several comorbidities.
OBJECTIVE: To study the epidemiology and resistance of enteroccocus strains that were
isolated from inpatients at the Department of Internal Medicine, Argos General Hospital, Argolis,
Greece.
MATERIAL-METHODS: During the period from 23/11/04 to 21/10/07 a total of 24 different strains
were isolated from urine, blood and sputum samples from 22 patients. Identification and
susceptibility testing was performed using the BacT/ALERT analyzer and the VITEK 2 compact
automated (MIC) system, BioMerieux.
RESULTS Fourteen (58,3%) of these strains were identified as E. faecalis and 10 (41,7%) as E.
faecium. Ten (45,5%) of the patients were men and 12 (54,5%) women. Their mean age was
81,6 years old (range 63-87). The mean length of their hospital stay was 14,3 days. Their
mortality rate was 27% (6 patients). Almost 82% of the patients had at least one risk factor for
enterococcus infection: 13 (59%) had an indwelling urinary catheter, 10 (45,5%) had received
antibiotic treatment for >7 days, 9 (40,9%) were immunocompromised (malignancy, neutropenia,
corticosteroid use etc). Bacterial antibiotic resistance is presented in Table 1. There were no
cases of vancomycin-resistant enteroccocus (VRE) in 2005, one case in 2006 and three in 2007.
CONCLUSIONS: Resistance to vancomycin in our hospital was slightly lower than that seen in
the whole of Greece (0 vs 5,2% for E. faecalis and 40% vs 42,5% for E. faecium), but seems to
be rising. Linezolid continues to be an effective treatment for VRE. The possibility of
enteroccocus infection should be considered in the management of every patient with relevant
risk factors.
Final abstract number: 64.028
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Catheter Related Blood Stream Infection - Affecting Factors
E. Kasal, P. Pelnar, T. Bergerova, I. Chytra, J. Benes, H. Vanousova
Charles University Hospital, Plzen, Czech Republic

Background: Increased incidence of CRBSI was observed at our interdisciplinary ICU in 4th
quarter 2006 (group 1). To identify and avoid affecting factors, we initiated an open prospective
comparative study in 3 consecutive quarters of 2007. Obtained data were compared with group 1.
The aim of the study was to assess, whether the type of used central venous catheter (CVC),
kind of disinfectant and technique of cannulation can influence incidence of CRBSI.
Methods: All patients having CVC in these periods were included to the study. Disinfectant with
PVP-iodine used in the group 1 was replaced by 2% chlorhexidine in ethanol in all consecutive
groups. The coated catheters (chlorhexidine acetate + silver sulfadiazine) were used in the 1st
quarter 2007 (group 2), identical catheters and coated catheters (polyurethane with biquanide)
were used in the 2nd quarter 2007 (group 3), the both coated kinds were used together with non-
coated catheters in the 3rd quarter 2007 (group 4) like in the group 1. The technique of
cannulation was under strict supervision in groups 2 and 3. Total number of involved patients in 4
groups was 274. There is no statistical difference among groups characteristics (number of
patients. age, APPACHE II, SOFA, LOS, catheter days). Catheters were removed due to positive
blood cultures or general or local sings of infection. Removed catheters were cultivated by Maki's
method.
Results: We observed statistically significant decrease of CRBSI incidence in groups 2, 3 and 4.
Chlorhexidine was used in all these groups. The cannulation supervision was done in groups 2
and 3 only.
Conclusion: In our study Chlorhexidine used as a disinfectant is responsible for decreased
incidence of CRBSI and more precise technique of central venous cannulation plays a role.
Unlike other studies, type of CVC (coated vs non-coated) was not found as important factor for
CRBSI.
Final abstract number: 64.029
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Five Cases of Nosocomial Antibiotic-Associated Diarrhea Due to MRSA (Methicillin-Resistant
Staphylococcus aureus) at a VA Hospital in the USA
T.S. Lo, S.M. Borchardt
Veterans Affairs Medical Center, Fargo, ND, USA

Background: Most nosocomial antibiotic-associated diarrhea cases associated with MRSA
reported are from Japan, and this entity is rarely documented in North America. We report five
cases of nosocomial antibiotic-associated diarrhea caused by MRSA at a Veterans Affairs (VA)
Medical Center in North Dakota, USA.
Methods: We conducted a chart review and data analysis of five hospitalized patients with MRSA-
associated diarrhea from March 2002 to January 2008. We abstracted the data from electronic
medical records and laboratory reports.
Results: The stools of all five patients were watery with a heavy growth or pure culture of MRSA.
The stools all tested negative for Clostridium difficile toxin A/B, enteric bacterial pathogens, or
ova/parasites. Four patients' diarrhea resolved rapidly after starting oral vancomycin. One
patient's (case 1) diarrhea subsided slowly without taking oral vancomycin. All patients were
discharged home following subsidence of the MRSA-associated diarrhea.
Characteristics of the five cases of MRSA-associated diarrhea are shown in the following table.
Conclusion: Should a hospitalized patient exposed to antibiotics develop watery, green stools,
suspicion of MRSA-associated diarrhea should be high and stool sent for culture to rule out
MRSA. Even before the stool culture results are known, we suggest starting oral vancomycin
empirically if diarrhea is severe or life threatening.
Final abstract number: 64.030
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Handwashing Behaviors in Rural Bangladesh
           1           1           1             2           1              2
A.K. Halder , S.P. Luby , A. Bhuiya , C. Tronchet , S. Akhter , R. Johnston
1                               2
  ICDDR,B, Dhaka, Bangladesh, UNICEF, Dhaka, Bangladesh

Background: Diarrhea and pneumonia account for 36% of under-five mortality in Bangladesh.
Regular handwashing with soap can reduce both diarrhea and pneumonia. We observed the
proportion of persons who washed their hands, compared this to the proportion who reported
washing their hands and explored the difference in handwashing behavior by socioeconomic
group.
Methods: The study was conducted in 100 randomly selected communities in 34 out of 64
districts in rural Bangladesh. Trained data collectors performed 5-hour structured observations of
handwashing behavior in 1000 sampled households. They noted handwashing behavior at key
times, i.e. before preparing food, before eating, after defecating and after cleaning a child's anus.
Two months later, field workers conducted survey that included questions on handwashing
behavior in these same 1000 households, and an additional 700 neighboring households. Socio-
economic status was categorized using principal component analysis of household assets.
Results: Household residents were observed to wash their hands at most key times (58%11,800
of 20,428) but usually only used water (11,335, 55%) . Thirteen percent (213/1692) of persons
reported washing both hands with soap/ash before eating, but only 0.4% were observed to do so
(0.4%, 29/7006). Again, 53% (891/1692) reported washing both hands with soap/ash after
defecation, while 17% (61/349) were observed to do. Moreover, 64% (217/338) from the richest
wealth quintile reported washing both hands with soap/ash after defecation compared to 42%
(114/338) in the poorest, but in reality, 23% (22/95) and 9% (5/56) respectively from the richest
and poorest quintiles were observed practicing.
Conclusions: Although handwashing is fairly common in rural Bangladesh, the use of soap is not.
Reported handwashing behavior especially with soap or ash overestimates observed rates.
Efforts to improve handwashing should focus particularly on the poor who could benefit most from
improved rates.
Final abstract number: 64.031
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Antibiotic Prophylaxis for Complex Spinal Surgery: Impact of a Protocol Change at a Children's
Hospital
         1               2               3           4
K. Tash , S. Chewning , C. Somboonwit , J. Sinnott
1                                           2
 Harvard Medical School, Boston, MA, USA, Tampa Shriners' Childrens' Hospital, Tampa, FL,
      3                                                                  4
USA, University of South Florida College of Medicine, Tampa, FL, USA, University of South
Florida School of Medicine, Tampa, FL, USA

Background: Despite evidence that antibiotic prophylaxis for spinal surgeries is beneficial, the
relevant studies have involved a diverse set of antibiotic regimens, and the literature offers little
evidence to recommend one approach over another. In 1998, our 60-bed pediatric hospital
changed its protocol for antibiotic prophylaxis of spinal surgeries in children with neuromuscular
and congenital pathologies. Here, we analyze the impact of the regimen change on infectious
complications.
Methods: We analyzed infection rates among consecutive cases of complex spinal surgery
performed for neuromuscular and congenital pathologies at a pediatric hospital between 1995
and 2007. From 1995 through November 1998, hospital policy prescribed that all cases receive
prophylaxis with 2g cefazolin infused in a single dose. From December 1998 to 2004, patients
received vancomycin q6h (10mg/kg up to 500mg per dose) plus cefepime q12h (1g/dose for
patients <70kg, 2g/dose if >70kg). In 2004 vancomycin was replaced with po linezolid q12h (10
mg/kg/dose up to 400mg) to improve the convenience of the regimen; cases receiving
vancomycin and those receiving linezolid were pooled for analysis. Patients were followed for at
least two years after surgery or until they turned 18 and transferred to an adult service.
Results: We identified a total 220 consecutive surgeries meeting study criteria; 11 (5%) of these
were complicated by infection. The most common indication for surgery was scoliosis, and most
surgeries involved spinal fusion with rod placement. There was a nonsignificant trend toward
improvement under the new protocol: infection rate dropped from 6.9% (n=115) under the old
protocol to 2.8% (n=107) since implementation of the new prophylactic regimen (p=0.15).
However, two of the three infections since implementation of the vancomycin+cefepime protocol
occurred in patients who did not receive the protocol. When these two cases were excluded, the
reduction in infection rates was significant at p=0.04.
Conclusions: A change in hospital policy which replaced cephazolin with vancomycin/linesolid
plus cefepine for prophylaxis of complex spinal surgeries appeared to reduce the rate of
infectious complications among children with neuromuscular and congenital pathologies, although
our result was significant only when two breaches in protocol were excluded. The potential
positive implications of our study underscore the need for continued research on prophylactic
options for pediatric spinal surgery, especially given the paucity of data comparing regimens.
Final abstract number: 64.032
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Prevalence and Resistance Patterns of Gram Negative Nosocomial Pathogens in an Adult
Intensive Care Unit in Malaysia
            1            1                 1                 1             2
M. Mansor , G.S.Y. Ong , S. Shamala Devi , M.Y. Mohd Yasim , N. Parasakthi
1                                                            2
 University of Malaya Medical Centre, Kuala Lumpur, Malaysia, Monash University Malaysia,
Bandar Sunway, Malaysia

Background: Management of critically ill patients with infections in intensive care units poses
many challenges. The use of broad spectrum antibiotics in such settings is high and may
predispose to the development of resistant organisms that may then disseminate by nosocomial
transmissions. Infections with gram negative bacilli are common in intensive care units and
extended spectrum beta lactamase (ESBL) producing organisms, inducible enterobacteriaceae
and carbapenem resistant Pseudomonas aeroginosa and acinetobacters are of particular
concern as nosocomial pathogens.
Aims: A study was carried out to determine the species prevalence and microbial susceptibility
patterns among gram negative bacilli in the adult intensive care unit of the University Malaya
Medical Centre, Kuala Lumpur.
Methods: Between 1997 and 2006, a 4 phase study was carried out. Phase I was carried out in
1997, Phase II in 2000, Phase III in 2003, and Phase IV in 2005. A total of 498 isolates were
obtained from 220 patients, of which 396 were unique or nonduplicates. There were 225 isolates
from respiratory sites, and 41 isolates from blood and 36 isolates from central venous catheters.
Results: Acinetobacter species , P aeroginosa and Klebsiella prenumoniae were the most
prevalent organisms isolated in all 4 phases followed by inducible enterobacteriaceae, E. coli and
Stenotrophomonas maltophilia. The cephalosporins, gentamicin and ciprofloxacin had reduced
activity against the acinetobacters. The susceptibility of acinetobacters to imipenem decreased
from 96% to 35 % in a decade, although amikacin retained its effectiveness, susceptibility ranging
from 83% to 65%.
For P. aeroginosa, susceptibility to imipenem was 88% in Phase I, 63% in Phase II, 42% in
Phase III and 83% in Phase IV. The corresponding rates of susceptibility to ceftazidine were 81%,
50%, 67% and 87% ; and that to amikacin were 98%, 97%, 70% and 91%. Susceptibility of
inducible enterobacteriaceae to all ranges of antibiotics was retained , all isolates were sensitive
to imipenem and ciprofloxacin, gentamicin and amikacin in the last phase.
Resistance to ceftazidine in Klebsiella and E. coli was frequent in the first two phases and was
predominantly due to EBSL production. The incidence of EBSL producing Klebsiella spp and E.
coli was variable over the 4 phases, showing a decrease in the last two phases for EBSL
producing Klebsiella and an absence in the third phase for the EBSL producing E. coli.
Conclusion: The above findings will have a significant impact on the empiric treatment of sepsis in
critically ill patients. Emerging problems of multiresistance in P. aeroginosa and Acinetobacters
and the growing threat of EBSL producing organisms in Malaysian hospitals is of concern to all
and calls for a concerted effort towards the control of emergence and spread of antimicrobial
resistance.
Final abstract number: 64.033
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Epidemiology of Enterobacteriaceae with reduced susceptibility to third-generation
cephalosporins isolated from stool screening at entry to a tertiary care hospital
       1        2          3           4            5           5             5
J. Chan , D. Lye , Y.S. Leo , T.H. Koh , W.Y. Tang , A. Singh , P. Krishnan
1                                                                                  2
 Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore, Singapore, Infectious
                                                           3
Disease, Tan Tock Seng Hospital, Singapore, Singapore, Tan Tock Seng Hospital, Singapore,
           4
Singapore, Department of Pathology and Laboratory Medicine, Singapore General Hospital,
                       5
Singapore, Singapore, Departments of Laboratory Medicine, Tan Tock Seng Hospital,
Singapore, Singapore

Background: Enterobacteriaceae with reduced susceptibility to third-generation cephalosporin is
common at our institution accounting for about 39% of all Enterobacteriaceae isolated. The
purpose of this study is to determine the species, antibiotic susceptibility patterns, and the
genotypic characterisation of resistance in Enterobacteriaceae present in patients at the time of
presentation to hospital.
Methods: Stool and rectal swab specimens from adult patients presenting to the Emergency
Department and subsequently hospitalised were screened for Enterobacteriaceae with reduced
susceptibility by culturing on agar containing third-generation cephalosporins. The
Enterobacteriaceae were identified and antimicrobial susceptibility tested by conventional
methods. The presence of extended-spectrum beta-lactamase (ESBL) and AmpC beta-lactamase
was screened using double-disc synergy and resistance to cefoxitin respectively. Multiplex
polymerase chain reaction (PCR) assays for detection of CTX-M and plasmid AmpC genes were
performed on representative isolates according to published protocols.
Results: Two hundred twenty-seven isolates of Enterobacteriaceae with decreased susceptibility
to 3rd generation cephalosporin were obtained from 1003 patients, some patients carrying
multiple isolates. These isolates have decreased susceptibility to gentamicin (19%) and
ciprofloxacin (42%). Of the 135 isolates tested for CTX-M multiplex PCR, 98 (72.6%) carried the
CTX-M gene, of which 89 (66%) belonged to CTX-M group 1 and 43 (32%) to CTX-M group 9. Of
the 68 isolates tested for AmpC genes, 51 (75%) were positive, of which 39 (57%) carried the
CMY-2 gene.
Conclusions: The data from our institution showed that Enterobacteriaceae with reduced
susceptibility to 3rd generation cephalosporins is prevalent in patients presenting for admission to
the Emergency Department. CTX-M ESBL appears to be the predominant ESBL in this group of
isolates. Multidrug-resistant Enterobacteriaceae is also present in significant numbers. Further
work is needed to confirm the presence and to determine the epidemiology of ESBL-producing
Enterobacteriaceae in the community.
Final abstract number: 64.034
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Can We Prevent Surgical Site Infections During Cardiac Surgery by Additional Use of a Microbial
Sealant?
P.M. Dohmen, D. Gabbieri, J. Linneweber, A. Weymann, W.F. Konertz
Dept. of Cardiovascular Surgery, Charite Hospital, Berlin, Germany

Background of this study: Surgical site infection (SSI) is still a serious complication after cardiac
surgery. This study was performed to evaluate a new microbial sealant to prevent surgical site
infection in patients undergoing cardiac surgery.
Material and Methods: Between March 2006 and November 2007, 378 patients underwent
cardiac surgery at our institute by a single surgeon. Two patient groups were definited. The
standard institutional preoperative preparation was performed in 189 patients (control group)
whether 189 patients received additionally a microbial sealant (InteguSeal group). Both groups
were evaluated by patients characteristics and evaluated by a pre-operative and intra-operative
risk scores. End-point of this study was freedom of SSI.
Results: Follow up was 100% completed. A significant higher rate of carotid artery disease
(p<0.015), previous valve replacement (p<0.001) and bilateral internal mammary artery use
(p<0.002) was seen at the InteguSeal group.
The values of the pre-operative risk factor to develop SSI was 10.3 ±1.7% and 10.0 ± 1.5%
(p=0.070) for respectively the control group and the InteguSeal group. The prediction to develop
a SSI due to the combinated-operative risk score was significantly higher (p<0.001) in the
InteguSeal group compared with the control group, namely 9.1 ± 1.0% vs. 8.7 ± 0.8%.
The clinical end-point, however showed a significant decrease of SSI in the InteguSeal group
1.1% (n=2) compared with the control group 4.8% (n=9), which was statistical significant
(p<0.032).
Conclusion: Thus, early results show a significant reduction of SSI by the use of a microbial
sealant.
Final abstract number: 64.035
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Many Viruses Are Present in Infants During Winter - Impact for Isolation Procedures
            1              2
H.A. Nielsen , L.P. Nielsen
1                                                                          2
 Department of anestesiology, Gentofte Hospital., Copenhagen, Denmark, National influenza
Laboratory, Statens Seruminstitut, Copenhagen, Denmark

Background: Respiratory syncytial virus (RSV) is a major pathogen in infants leading to multiple
infections and admissions to hospital during the wintertime in temperate countries. In many
clinical departments the results of rapid tests for RSV are used in deciding whether to isolate a
given child with respiratory infection.
We question such procedures as we experience many nosocomial infections despite the use of
rapid RSV diagnostics.
Methods: We evaluated 498 samples from children with respiratory infection during a winter
where RSV was prevalent. Rapid testing was evaluated against 2 RT-PCR methods. All
secretions were analyzed by RT-PCR for an array of other respiratory viruses (influenza A and B,
parainfluenza, coronaviruses, adenoviruses, metapneumovirus, bocavirus, polyomavirus KI and
WU) as well as atypical bacterial pathogens: B. pertussis, M. pneumonia and chlamydia species.
Results: We found that a membrane ELISA test (Directigen, Becton-Dickenson) only had a
sensitivity of 45% whereas direct immunofluorescence staining had a sensitivity of 95%. Forty-
five percentages of all samples were PCR positive for RSV. Next to RSV rhinovirus and bocavirus
were the most common. Eighty percentage of the samples contained at least one virus. Twenty
percent of the children had double infection and 4% were positive for two or more viruses.
Conclusions: The membrane ELISA used had a very low sensitivity and should not be used
unless the negative samples are submitted to other tests. Routine diagnostics performed only for
RSV is inadequate for viral diagnostics in a population of small children with respiratory
symptoms. Testing for many respiratory viruses will be expensive and the results will not have a
impact on the decision to isolate or not, as many different viruses are present in the winter
season and it will not be possible to isolate the children according to the viral diagnosis. Infection
control and especially hand washing may in daily routine be more important than viral
diagnostics.
Final abstract number: 64.036
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Epidemiology of Vancomycin Resistant Enterococcus (VRE) in a Singapore Tertiary Hospital
R. Sridhar, C. Ong, S.Q. Toh, K.T. Goh, R. Lin, T.M. Ng, D.A. Fisher, P.A. Tambyah
National University Health System, Singapore, Singapore

Background: At our 900 bed Singapore teaching hospital, VRE surveillance was initially restricted
to patients from two other hospitals with previous VRE outbreaks or contacts of non-isolated VRE
cases as our hospital was presumed not to have endogenous transmission of VRE.
Methods: A retrospective case control study was performed to determine the efficacy of this
strategy. Cases were patients with VRE positive cultures from rectal swab, stool, urine or blood
specimens. Controls were matched for age and month of hospitalization. Clinical data were
analyzed for risk factors for VRE carriage.
Results: Twenty-five cases and 75 controls were identified from 1st January to 31st December
2007. These represented 5 different patterns by variable nucleotide tandem repeat (VNTR)
typing. There were 1 vanB E. faecalis, 2 vanA E. faecium and 22 vanB E.faecium. One patient
had bloodstream infection, the rest were rectally colonized. Significant risk factors for VRE
colonisation by multivariate analysis included hospitalization within the same room for 24 hours or
more with an unrecognised VRE carrier [Odds ratio (OR) 4.89; 95% confidence interval (CI) 1.95
- 19.19), presence of diabetes mellitus (OR 4.26, 95% CI 1.41 - 15.85) and hospitalization of 10
days (OR 7.04 ; 95% CI 2.20 - 22.57). Prior hospitalization in other hospitals with previous VRE
outbreaks was not associated with VRE colonisation (OR 0.27; 95% CI 0.08 - 0.87). (Epidemic
curve below)
Conclusion: We identified independent risk factors for VRE carriage that suggest local
transmission rather than simply importation. We have since modified our screening strategy to
screen patients with a high composite risk score rather than those from hospitals with previously
reported outbreaks and intensified infection control measures in the wards.
Final abstract number: 64.037
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Daily Management of Antimicrobial Prescribing Leading to Reduction of Clostridium difficile
Infections in Elderly Patients
W. Al-Wali, M. Asensio, C. Hughes, S. Ahuja
Rotherham General Hospital, Rotherham, United Kingdom

Background: The incidence of C. difficile infections in the Elderly wards of a British District
General Hospital has been higher than comparable hospitals. An audit was carried out to
ascertain the risk factors behind the increased rate of these infections. The aim was to target the
causative factors and formulate an action plan to reduce the rate of this hospital- acquired
infection.
The findings of the audit has demonstrated an association between the use of third generation
cephalosporins namely ceftriaxone and other antimicrobials and the occurrence of C. difficile
diarrhoea.
Furthermore, patients with C.difficile had a longer hospital stay than those who did not acquire
this infection.
Methods: Third generation cephalosporins were removed from the formulary.They were only
allowed to be prescribed following advice of the Microbiologists.
A red alert action plan was put in place to reduce antimicrobial usage in general and particularly
cefuroxime and broad-spectrum antimicrobials.
To this effect the antimicrobial policy was reviewed and the following methodology was
implemented with the aim of reducing intravenous antimicrobials and encouragement of the use
of oral antimicrobials:
1. Daily lists of all patients on antimicrobials in the Elderly wards were faxed to the Microbiology
Department.
2. The Medical Microbiologists then contacted the relevant clinicians to discuss antimicrobial
treatment with the aim of rationalizing antimicrobial therapy to reduce and control C. difficile
infections.
Results: As a result of this intervention the outcome has been the following:
1. Reduction in the use of antimicrobials.
2. Reduction in the duration of antimicrobial treatment.
3. More conversion of intravenous therapy to oral therapy.
4. Discontinuation of ceftriaxone and third generation cephalosporins.
5. Reduction in the incidence of C. difficile infections in Elderly patients by more than 45%.
6. Better clinical management of patients and on-going education of junior doctors.
Conclusion: The daily communication of patients who are on antimicrobials to the Microbiologists
and their active intervention has led to the reduction in antimicrobial usage, more rational use of
antimicrobials,more switch from intravenous to oral therapy, reduction of C.difficile diarrhoea and
better clinical management of patients.
Final abstract number: 64.038
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Journey of Infection Control in a Tertiary Care Hospital
             1              1              1               1
R. Adhikary , K.R. Kulkarni , B.N. Gokul , M. Chakravarthy
1                                        1
 Wockhardt Hospital, Bangalore, India, Wockhardt hospital, Bangalore, India

Background: Hospital programmes of infection control should include surveillance to detect
healthcare associated infections (HAI), to reduce the incidence and thus to reduce the associated
morbidity, mortality, and costs. With this aim in mind, Wockhardt Hospitals, Bangalore, India
started its surveillance programme for four healthcare associated infections such as surgical site
infection (SSI), blood stream infection (BSI), urinary tract infection (UTI) and ventilator associated
pneumonia (VAP), analyzed and monitored the trend, compared it with sister hospital and took
interventions as and when required.
Methods: An active on-going systematic surveillance is done by analysis of laboratory reports of
culture and sensitivity, regular visits to patient care areas by the infection control team and clinical
monitoring of all hospitalized patients through the infection control worksheets. The analysis of
the data showed that the rates of all HAI were very high in the month of June and July 2007. SSI
rate was 3.3%, UTI rate was 15/1000 catheter days, VAP was 17/1000 ventilator days in the
month of June and BSI rate was 19/1000 indwelling catheter days in July. Interventions like
regular and specialized training of infection control protocols, isolation of infected patients, barrier
nursing, environmental cleaning, upgrading the hand wash stations, implementing alcohol hand
rub in each patient bedside, monitoring of adherence to hand hygiene practices, VAP bundle etc
were taken immediately and the rates were brought down over a period of 8 months.
Results: HAI rates were brought down to 0.2% for SSI, 4.2/1000 catheter days for UTI, 2.2/1000
ventilator days for VAP and 1.6/ 1000 indwelling catheter days for BSI in the month of January
2008.
Conclusion: The surveillance results are fed back regularly to the clinical staff and the
management to prioritize the plan of action to bring down the rates to as minimum as possible.
Final abstract number: 64.039
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Impact of Ventilation System Design on Airborne Infectious Disease Control in an Emergency
Room
J. Chang, P. Harght
University of Kansas School of Architecture and Urban Planning, Lawrence, KS, USA

In healthcare settings, air distribution systems play a vital role in providing and maintaining indoor
air quality that is safe for patients, staff, and visitors. Emergency rooms contain multiple patients
who share the same setting and are in close proximity to each other making them more
susceptible to other illnesses caused by the transmission of airborne contaminants. It is therefore
necessary to provide an indoor environment that is designed to minimize the spread of airborne
contaminants from patient to patient and patient to staff. One means of addressing this issue is
through the proper selection and design of air distribution systems.
This study examined the influence of air distribution systems (overhead and displacement) and
return and supply grille locations on ventilation effectiveness and contaminant distribution control
of a typical North American emergency room. Emphasis was placed on the isolation and removal
of air in the immediate vicinity of the patient to minimize the possible spread of airborne infections
in the multi-patient environment.
The study employed numerical simulations using computational fluid dynamics (CFD) to
investigate the airborne contaminant control performance of the air distribution system designs.
CFD provided a means to analyze the ventilation performance of the emergency room through
both numerical and visual results. Contaminant distribution was modeled with the patient's mouth
serving as the source. Local air quality index (LAQI) was used to measure the effectiveness of
contaminant removal. Local mean age of air (LMA) was used to analyze the general ventilation
performance of the emergency room. Analyses of the data showed that displacement ventilation,
with a localized return grille placed near the patients' head, provided a higher LAQI and lower
LMA around the patients than possible with a traditional overhead system indicating better control
and containment of airborne contaminants.
Final abstract number: 64.040
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Follow Up for Nosocomial Infections (NI) in 1200 Post Surgery Patients at a Teaching Hospital in
Guatemala
         1               2              1            2
I. Cazali , J. Passarelli , J. Maldonado , J. de Leon
1                                               2
 Hospital Roosevelt, Guatemala, Guatemala, Universidad Francisco Marroquin, Guatemala,
Guatemala

Objective: To determine the incidence of nosocomial and early surgical site infection (eSSI) in
1200 patients
Methods: 1200/8000 subjects who had elective or emergency surgery during a five month follow
up in 2007 at Roosevelt Hospital, a third level reference and University Hospital in Guatemala
were followed. Demographic, surgical procedure, antibiotic use surgical time and surgeon skill
were collected. Patients were clinically evaluated at 24, 48, 72 and 120 hours after surgical
intervention and complementary blood work up was performed following CDC guidelines to detect
signs and symptoms of hospital acquired infections. The CDC (1982 and 1992) definitions for
Nosocomial infections were applied. Gynaecological, paediatrics drainage of abscesses and
immunocompromised patients were excluded. A data base in Excel was used and a descriptive
analysis was done.
Results: 49/1200 (4.1%) patients showed clinical findings of infection, 77.6% SSI, 12.2% UTI and
10.2% catheter related infections. 319/1200 (5.3 %) SSI in clean contaminated procedures was
determined. Orthopaedic surgery of the low limbs showed the highest rate of infection (31/49).
Factors such as length of surgery; less or more than one hour and surgeon experience were
statistically significant for nosocomial Infection. (p<0.005)
Conclusion: A general incidence of 4.1% nosocomial infections, 77.6% early surgical site infection
in clean and clean contaminated procedures were showed. The incidence of NI and eSSI is
higher then in developed countries. Interventions to reduce the risk are urgently needed and
strongly recommended
Final abstract number: 64.041
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Transmission of Vancomycin Resistance E. faecium Between Patients and the Environment in
Iran
          1                   1                2
M. Talebi , M.R. Pourshafie , S.S. Eshraghi
1                                                              2
 Pasteur Institute of Iran, Tehran, Iran (Islamic Republic of), Tehran Medical University, Tehran,
Iran (Islamic Republic of)

Background: Vancomycin and teicoplanin are important antibiotics in the treatment of severe
nosocomial infections caused by staphylococci and enterococci. The spread of vancomycin
resistance among E. faecium is attributed to two processes: clonal dissemination of the isolates
carrying resistance determinants and horizontal transfer, is involved in resistance of vancomycin-
resistant enterococci (VRE).
Methods: VRE isolates were collected from hospitalized patients, urban sewage, hospital sewage
and surface water in Tehran. The identification of isolates was performed by conventional tests,
and species identification was confirmed by using species-specific PCR for. The susceptibility
tests of the isolates were performed and interpreted according to the guidelines from CLSI. The
isolates were typed and screened using the PhP-RF plates and the representative of PhP typing
method were selected for other tests. All of isolates were typed by Pulsed- field Gel
Electrophoresis (PFGE) using SmaI.
Results: All of VRE isolates were E. faecium and harbored vanA resistance gene. The MIC of
vancomycin and teicoplanin were 128 and 24 g/ml, respectively. All E. faecium were resistant
to at least two antibiotics (ampicillin and erythromycin). All of isolates were susceptible to linezolid
and dalfopristin-quinupristin. The isolates were extremely heterogeneous. The analysis
distinguished 54 different PFGE types among 143 E. faecium isolates. One hundred and thirteen
isolates belonged to 24 common types. The remaining 30 isolates (29.6%) were highly diverse,
belonging to 30 clonal types. Isolates obtained from patients (49) were classified into 29 distinct
PFGE types while all environmental samples (99) classified into only 25 types.
Conclusion: Among all isolates from different patients and environmental samples, 13 patient
isolates along with 6 and 2 urban and hospital sewage samples were respectively
indistinguishable. In the same way, 15 and 8 isolates from hospital and urban sewages had
indistinguishable patterns. No identical patterns were seen between surface water samples and
other samples. This result may suggest a possibility of transmission of VRE isolates between
sewage and patients.
Final abstract number: 64.042
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Occurence of Extended-Spectrum Beta-lactamases in Gramnegative Bacteria Isolated From
Hospitalised Patients in Period 2005-2006
              1              1             2           3                 1           1           1
L. Siegfried , J. Gajdosova , E. Sinajova , M. Marcin , M. Molokacova , K. Curova , M. Sabol ,
              1
M. Kmetova
1
 Institute of Medical and Clinical Microbiology, University P.J.Safarik and L.Pasteur University
                                                  1
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,
2                                                                              3
 Department of Clinical Microbiology, FNsP J.A.Reimana, Presov,, Slovakia, Department of
Clinical Microbiology, NsP S.Kukuru, Michalovce, Slovakia

Introduction. Extended-spectrum beta-lactamases (ESBL) are enzymes produced by some
bacteria and are responsible for their resistance to beta-lactam antibiotics like penicillins,
cephalosporins, cephamycins and carbapenems. Numerous chromosomal and plasmid-mediated
types are known and may be classified by their sequences or phenotypic properties. This work
presents the occurence of beta-lactamases in two tertiary-care teaching hospitals and two
regional hospitals hospitals during 2 years period 2005-2006.
Methods. In strains investigated we demonstrated minimum inhibitory concentration for selected
group of antibiotics (Ampicilin, Augmentin, Cefalotin, Cefotaxim, Ceftriaxon, Ceftazidim, Cefepim,
Meropenem, Aztreonam, Gentamycin, Amikacin, Sulfometoxazol a Ciprofloxacin) using dilution
agar procedure according to CLSI recommendations. Moreover we demonstrated ESBL
phenotype using double disk synergy test, three dimensional test, CDS procedure and procedure
to detect production of metallo-betalactamases and genes encoding for production of TEM, SHV,
OXA, CTX-M and AmpC beta-lactamases.
Results. Of total 531 isolates in the phenotype we demonstrated ESBL production in 122
Klebsiella pneumoniae, 6 Enterobacter sp., 18 Acinetobacter sp., 20 Escherichia coli, 5 Serratia
sp., 3 Pseudomonas sp. a 2 Stenotrophomonas maltophilia. Production of AmpC was
demonstrated in 21 Klebsiella pneumoniae, 5 Enterobacter sp., 37 Acinetobacter sp. and 1
Pseudomonas sp. Metallo-betalactamase production was demonstrated in 5 Klebsiella
pneumoniae, 5 Escherichia coli and 1 Acinetobacter spp. The occurence of ESBL was
significantly higher in teaching hospitals compared to regional hospitals. Compared to period
2002-2004 we found simultaneous production of more than one extended-spectrum beta-
lactamases in one bacterial strain.
Conclusion. Results obtained indicate progresivelly increasing number of bacteria producing
extended-spectrum beta-lactamase types TEM, SHV, predominantly in genera Klebsiella
pneumoniae and Escherichia coli. In some isolated bacterial strains we demonstrated co-
incidence of more than one antibiotic resistance mechanisms, i.e. production of AmpC, TEM
ESBL, CTX-M and metallo-betalactamases.
The work was supported by grant AV 4/0027/07.
Final abstract number: 64.043
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Bloodstream Infections (BSI) in the Pediatric Oncology Unit at C.H.Baragwanath Hospital
           1            1               2          2
M. Khoosal , J. Wadula , L. Wainwright , G. Naidu
1
 NHLS -C.H.Baragwanath Microbiology Department, Johannesburg, South Africa,
2
 C.H.Baragwanath Hospital - Pediatric Oncology Department, Johannesburg, South Africa

BACKGROUND: Bloodstream infections (BSI) are a major cause of morbidity and mortality in
neutropenic patients globally and are increasing in incidence. The generally reported trend during
the last two decades has been a gradual replacement of Gram- negative bacilli by Gram-positive
cocci as the major causes of bacteraemia in neutropenic hosts
OBJECTIVE: To study the incidence of bloodstream infections (BSI) in patients that were treated
in the paediatric oncology unit with underlying haematological disorders. Furthermore to clarify
pathogen trends and antimicrobial resistance patterns.
METHODS: A retrospective study of blood cultures was carried out over a two year period from
2005-2006 .Laboratory data and clinical records were investigated in patients admitted to the
paediatric unit at C.H.Baragwanath Hospital.within this period. 267 patients were included in the
study .

RESULTS: Gram-positive bacteria accounted for 54% of the cases, followed by Gram-negative
bacteria ( 36% ) and (fungi 10%). In decreasing frequency, Coagulase negative
staphylococcus( CoN) (34%), Klebsiella species (10%), Viridans streptococcus (8%),
Enterobacter species (8%), Escherichia coli (6%), Staphylococcus aureus (4%),
Pseudomonas species (4%), Methicillin resistant staphylococcus( MRSA) (3%),
Stenotrophomonas species (3%), Acinetobacter species (3%), Proteus species (3%),
Enterococcus species (3%),
Glycopeptide resistant isolates of enterococci and staphylococci were not documented in the
oncology unit. Of concern is rifampicin resistance (87%) in MRSA, penicillin intermediate
resistance in Streptococcus pneumoniae (83%) and the emergence ESBL- producing gram
negative bacterial isolates (13%). None of the Acinetobacter isolates were pan resistant
CONCLUSION: Gram- positive bacteria are the major causes of bacteraemia in the paediatric
oncology unit at C.H.Baragwanath hospital.The emergence of ESBL organisms (13%) is a major
concern and therefore continuous
multidisciplinary surveillance of bloodstream infections is warranted in this high risk
group of patients in order to develop strategies for antimicrobial resistance control and treatment
of infectious complications and to institute strict infection control measures
Final abstract number: 64.044
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

The Role of Infectious Disease Specialist (ID) in Antibiotic Policy in Hospital
          1         2         3             1
B. Beovic , S. Kreft , K. Seme , M. Cizman
1
 Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia,
2                                                                     3
 Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia, Institute of Microbiology and
Imnunology, Medical School Ljubljana, Ljubljana, Slovenia

Background. Antimicrobial consumption is driving force for antimicrobial resistance that
compromises the quality of healthcare. Three different methods of antimicrobial control in a large
university hospital have been compared.
Methods. Totally ID guided antimicrobial prescribing (unit A) has been compared to the ID
authorization of restricted antimicrobials (unit B) and no ID antibiotic control (unit C) from 1998
(pre-intervention year) to 2005. Antimicrobial consumption (ATC JO1 and JO2) was measured in
defined daily doses (DDD) per bed-days and patients. Statistical analysis was performed using
14.0 statistical package.
Results. A statistically significant downward trend in total antimicrobial consumption in DDD per
patient-days was observed in unit A (p=0.001), a significantly decreasing trend in DDD per patient
was observed in unit A and B (p=0.0003 and p=0.007). No trend was observed for the restricted
antimicrobials, in un-restricted antimicrobials per patients a trend was observed in unit A and B
(p=0.0001 and p=0.006). The cost of antimicrobials decreased in unit A (p=0.029). The mortality
in all three units remained the same. The length of stay decreased in unit A (p=0.0004) and unit B
(p=0.021).
Conclusion. Antimicrobial consumption control was most effective in totally ID controlled unit.
Final abstract number: 64.045
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Pseudo-outbreak of Rhizobium radiobacter Resulting from Contaminated Diluting Saline
          1          2         2       2             1               1
L. Pereira , D. Chan , T.M. Ng , R. Lin , D.A. Fisher , P.A. Tambyah
1                                                          2
 National University of Singapore, Singapore, Singapore, National University Hospital,
Singapore, Singapore

Rhizobium radiobacter, a common environmental organism has been recognized as a rare cause
of opportunistic infection in humans, usually associated with indwelling devices. We report a
pseudo-outbreak of R. radiobacter infection in patients at a teaching hospital in Singapore.
Eleven culture positive specimens were isolated from 9 patients from the 14th January to the 1st
February, 2008. All isolates were susceptible to ampicillin, gentamicin, cotrimoxazole and
ciprofloxacin. Seven patients were adult and 2 were children, with a median age of 44 years
(range: 2 months - 78 years). The 9 isolates from the adult patients were grown from tissue
specimens collected during surgical procedures. The 2 paediatric isolates were grown from
catheter tips. Patients were from 6 different orthopaedic, rheumatology, paediatric and
otorhinolaryngology wards. There were 6 elective and 3 emergency procedures, 4 clean, 2 clean
contaminated and 3 contaminated operations performed in 8 operating rooms by 6 different
surgeons with 6 different anaesthetists. Skin preparation included povidone iodine (6),
chlorhexidine (2) and alcohol (1). None of the patients were immunocompromised. None of the
culture results were specifically treated and there were no documented complications on close
follow-up except for one delayed surgical procedure. A review of the specimen processing
techniques revealed that prior to plating, all specimens had been mixed with a commercial saline
solution from a common dispenser in the microbiology laboratory. R. radiobacter was cultured
from the saline from the dispenser as well as from the dispenser tip. Routine laboratory practices
and precautions including autoclaving the dispenser routinely and boiling of the saline before use
were resumed and the pseudo-outbreak ended. This pseudo-outbreak demonstrates the
importance of prompt investigation of unusual organisms and the need for careful review of all
laboratory procedures in parallel with thorough epidemiologic investigations.
Final abstract number: 64.046
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Microbiology of Bacteremia among Patients in an Intensive Care Unit of a Tertiary Care Hospital
in South India
S.S. Rajkumar, S. Kamesh, S. Padma, M. Mallika
Sri Ramachandra University, Chennai, India

Background: Hospital and community acquired infections leading to bacteremia add to the
morbidity and mortality of ICU patients. Local data on the characteristics of pathogens that cause
bacteremia would guide the clinician on choice of empiric antibiotics. Hence a study was
undertaken to profile these organisms, their susceptibility patterns to antimicrobials and describe
co-morbid conditions and clinical outcome of these patients.
Method: Retrospective analysis of patients with bacteremia (cultivation and identification by
standard conventional methods, susceptibility by Kirby-Bauer) and sepsis (CDC criteria) of 919
consecutive patients admitted in 2007 was done. Hospital records were referred for patient
details. Graphs of sensitivity patterns with time were made using appropriate software.
Results: Of 919 patients, 87 patients provided 112 positive cultures, none were polymicrobial.
Most cultures isolated gram negative organisms (72.72%) of which Enterobacteriaceae (55.5%)
were predominantly Klebsiellae (70.4%). Non-enterobacteriaceae constituted Acinetobacter spps
(56.6%) and Pseudomonas aeruginosa (43%).
Among Gram negative organisms 77.2% were resistant to 3rd generation-cephalosporins ,
91.78% susceptibile to imepenem/meropenem and amikacin (75%). All coliforms were
susceptible to meropenem/imipenem, showed greater susceptibility to amikacin (95%) than non-
enterobactericeae (46.7%).
Assessment of variation of antibiotic susceptibility of gram negatives with time showed a
continuous oscillation in susceptibility, pronounced for ciprofloxacin and amikacin, reflecting their
relative frequency of use. Higher antibiotics showed linear graphs with random falls, possibly
related to their usage.
Among Gram positive isolates (27.27%), 50% were Staphylococcus aureus, half of which were
MRSA. Three cultures grew CONS (2.6%). No VRE was detected.
Average duration of hospital stay was 7.22 days and mortality 29.5%.
Conclusion: Gram negatives predominate episodes of bacteremia. Among Enterobacteriacea
majority (70.4% )are Klebsiellae being susceptible to Imipenem. Pandrug resistant Acinetobacter
(23.5%), multi-drug resistant Pseudomonas were documented (46.1%). One third of bacteremia
were caused by Gram positives (27%), 10% of which were MRSA. Antibiotics show great
variation in susceptibility patterns. This knowledge plays an important role in antibiotic policy
formulation.
Final abstract number: 64.047
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Cats and Cockroaches from Premises of a Hospital as Pathogen-loaded Bullets for Nosocomial
Infections
       1           2              2              3          4           5
T. Ijaz , M.A. Khan , M.K. Shahzad , M.A. Muneer , M. Imran , R. Hussain
1                                                         2
 Microbiology Laboratory, Mayo Hospital, Lahore, Pakistan, Department of Epidemology and
                                      3
Public Health UVAS, Lahore, Pakistan, University of Veterinary and Animal Sdiences, Lahore,
           4                                                                  5
Pakistan, Department of Physiology and Biochemistry UVAS, Lahore, Pakistan, Medical
Genetics Lab CEMB, University of the Punjab, Lahore, Pakistan

Background: Non-human inmates within the hospital premises are important vectors of
nosocomial infections, which, if left resided in the hospital, can freely cause spread of pathogens
from on place to the other. Huge numbers of patients who bring bundles of eatables with them
help non-human inmates like cats and cockroaches stay at the public hospitals of developing
countries. No ample information regarding the prevalence of pathogens causing nosocomial
infections is available for non-human inmates living in the premises of Pakistani public hospitals.
Methods: Fifty cats from the Mayo hospital premises were trapped to collect 25 swabs of each of
nasal and fecal excreta, and eighty-eight samples from each of legs and intestine of hospital-
resided cockroaches were also collected for bacteriological analyses performed in routine.
Results: An average 4 pathogens were isolated from the leg samples of cockroaches and 5 from
the intestine samples. In cats' nasal and fecal samples, single or duplicate isolates were
identified. From the total samples, 101 (44.7%) isolates of Staphylococcus (25 Staph. aureus; 16
Staph. epidermidis), 146 (64.6%) of Streptococcus (61 Strep. pyogenes; 37 Strep. pneumoniae,
48 Strep. viridons), 166 (73.45%) of Enterococcus (101 Entercoc. faecalis; 65 Enterococ.
faecium), 74 (32.74%) of Pseudo. aeroginosa, 124 (54.86%) of Enterobacter (96 Enterobact.
cloacae; 28 Enterobact aerogenes), 47 (20.79%) of Proteus (22 Prot. mirabilis; 25 Prot. vulgaris),
163 (72.12%) of Escherichia coli, 29 (12.83%) of uncommon Gram positive bacteria, 86 (38.05%)
of uncommon Gram negative bacteria, and 30 (13.27%) isolates of Yeast and Fungi were
obtained.
Conclusion: The results show that cats and cockroaches living in the hospital premises are key
reservoirs of multiple pathogens and suggest that their immediate removal from the Pakistani
hospitals could be a useful strategy to lessen the load of nosocomial infections.
Keywords: Non-human Inmates, Nosocomial infections, Pakistan
Final abstract number: 64.048
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Etiological Agents of Nosocomial Infections Isolated from Hospital Staff of a Tertiary Care Public
Hospital
       1             2              3         1          2               2
T. Ijaz , A.M. Akhtar , A.R. Khawaja , N. Ijaz , M. Imran , M.K. Shahzad
1                                                            2
 Microbiology Laboratory Mayo Hospital, Lahore, Pakistan, Department of Epidemology and
                                        3
Public Health UVAS, Lahore, Pakistan, Mayo Hospital Research Cell, Lahore, Pakistan

Background: The disease transfer in form of pathogens is associated with psychological and
behavioral escape of the hospital staff from keeping their clothing and body in hygiene. In the
present study, isolation of pathogens from clothing, throat and nasal swabs obtained from the
hospital staff of the Mayo Hospital Lahore, Pakistan was performed between Jan 2004-Sep 2004
to assess whether the hospital staff follows basic precautions regarding sanitation to avoid
contracting and transmitting nosocomial infections.
Methods: Culture isolation of pathogens from 635 samples, 127 of throat and nasal swabs, 254 of
hand swabs, 254 of gloves and apron swabs from the hospital staff was carried out in aseptic
conditions. The isolated pathogens were identified with microbiological techniques of routine use.
Results: Various pathogens were identified in 374 out of the total samples. The identified
pathogens included 79 Staphylococcus aureus, 40 Staph. epidermidis, 41 Streptococcus
pyogenes, 15 Strep. pneumoniae, 51 Enterococcus faecalis, 22 Enterococ. faecum, 22
Pseudomonas aeruginosa, 11 Pseudo. cepacia, 13 Enterobacter cloacae, 2 Enterobact.
aerogenes, 17 Klebsella pneumoniae, 3 Kleb. aerogenese, 25 Escherichia coli, 13 Haemophilis,
12 other uncommon Gram positive (11) and Gram negative bacteria (1). The number of
pathogens isolated from throat, nasal and hand swabs was higher than those isolated from
gloves and apron swabs.
Conclusion: The results indicate rare use of masks and improper hand cleanliness in the hospital
staff members. Implementation of proper sanitary measures could reduce the rate of nosocomial
infections in the hospital staff. This would ultimately reduce the rate of nosocomial infections
among patients.
Keywords: Hospital Staff, Nosocomial infections, Pakistan
Final abstract number: 64.049
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Isolation of Etiological Agents of Nosocomial Infections from a Hospital Environment and
Iatrogenic Spread of These Infections
       1               2              2             3             4               3
T. Ijaz , F.A. Ranjha , A.R. Khawaja , M.A. Akhtar , M.A. Muneer , M.K. Shahzad
1                                                            2
 Microbiology Laboratory Mayo Hospital, Lahore, Pakistan, Mayo Hospital Research Cell,
                    3
Lahore, Pakistan, Department of Epidemology and Public Health UVAS, Lahore, Pakistan,
4
 University of Veterinary and Animal Sciences, Lahore, Pakistan

Background: Presence of pathogens in the hospital environment is widely explained in the terms
of space constraints and number of patients/day served in a hospital. We conducted a 1-year
(2005) observational study to determine the prevalence of etiological agents of nosocomial
infections in environment of a tertiary care Pakistani hospital.
Method: Morphological and biochemical identification of microbes was undertaken for 2677
samples obtained from the hospital environment including 126 air samples from the operation
theater, 65 from the ward environment, 610 from saline water and 1876 from surgical
instruments. Microbial pathogens were isolated with the help of culturing techniques.
Results: The most prevalent of pathogens were Staphylocooci followed by Pseudomonas in
samples from sterilized water and surgical instruments. Out of the total samples, 110 (4.11%)
were positive for Staphylococcus (91 Staph. aureus; 19 Staph. epidermidis), 34 (1.27%) for
Streptococcus (14 Strep. pyogenes; 9 Strep. pneumoniae and 11 Strep. viridans), 59 (2.2%) for
Enterococcus (37 Entercoc. faecalis; 22 Enterococ. faecium), 53 (1.98%) for Pseudomonas (42
Pseudo. aeroginosa; 11 Pseudo. cepacia), 25 (0.93%) for Enterobacter (16 Enterobact. cloacae;
9 Enterobact aerogenes), 35 (1.31%) for Klebsiella (11 Kleb. pneumoniae; 14 Kleb. aerogenese
and 10 Kleb. oxytoca), 22 (0.82%) for Proteus (9 Prot. mirabilis; 13 Prot. Vulgaris), 55 (2.05%) for
Escherichia coli, 41 (1.53%) for uncommon Gram positive bacteria, 19 (0.7%) for uncommon
Gram negative bacteria, and 18 (0.67%) for yeast and fungi. The average number of various
pathogens found in each sample collected from the ward environment was 4.5; while only eight
isolates were present in 25 samples obtained from outside of the wards.
Conclusion: Identification of a few isolates in samples collected from the surgical instruments,
saline water and the surgery theater points out improved disinfection strategies implied in the
surgery theaters of the hospital. The difference in prevalence of pathogens in in-ward and out-
ward environments could be a sign of space constraints within the hospital.
Keywords: Hospital Environment, Nosocomial infections, Pakistan
Final abstract number: 64.050
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Rubbing It in: A Time-Effective Hand Hygiene Protocol for Daily Hospital Practice
A. Chow, B.F. Poh, C. Wu, J. Chan, P. Krishnan, Y.S. Leo, B. Ang
Tan Tock Seng Hospital, Singapore, Singapore

Background: Good hand hygiene is the single most important measure that can prevent hospital-
associated infections. However, compliance rates worldwide have remained <50%. High
workload and insufficient time are common reasons cited for poor compliance.
This paper's objective is to evaluate the effectiveness of 3 hand hygiene protocols during routine
practice and determine the actual time spent on hand hygiene during hectic patient care activities,
with the aim of identifying the most time-effective hand hygiene protocol for daily hospital
practice.
Methods: We conducted a prospective randomised controlled trial during the busiest time of
patient care activities in 20 general wards at Tan Tock Seng Hospital, a large tertiary-care
hospital in Singapore, from 8th Oct to 7th Nov 2007. A total of 120 medical and nursing staff was
randomly assigned to: hand-rubbing with alcohol covering all hand surfaces (CDC protocol), or
hand-rubbing with alcohol using the standard 7-step technique (WHO protocol), or hand-washing
with chlorhexidine using the standard 7-step technique (WHO & CDC). Using the glove-juice
technique, hand samples were taken after patient-contact but before hand-hygiene, and after
hand-hygiene. Bacterial counts were quantified blindly and time taken for hand hygiene
measured.
Results: The median percentage reduction in bacterial contamination among the three hand
hygiene protocols were very similar (93.8% vs 91.7% vs 94.0%). During routine patient care, time
spent on chlorhexidine hand-washing (median duration 80.1 seconds) was twice that of the WHO
alcohol hand-rubbing protocol (38.6 seconds) and almost quadruple that of the CDC alcohol
hand-rubbing protocol (22.5 seconds). The CDC alcohol hand-rubbing protocol required
significantly less time than chlorhexidine hand-washing (p<0.01) and the WHO alcohol hand-
rubbing protocol (p<0.05).
Conclusion: The CDC alcohol hand-rubbing protocol is the most time-effective among the three
hand hygiene protocols. Promoting this hand hygiene protocol can enhance hand hygiene
compliance and reduce hospital-associated infections, improving patient safety and outcomes.
Final abstract number: 64.051
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Methicillin Resistant Staphylococcus aureus (MRSA) detection at admission and during
hospitalisation at the Brussels Burn Centre
             1            2             3          2         3             1
D. De Vos , P. Bosmans , P. Persoons , T. Pieters , S. Jennes , J.P. Pirnay
1
 Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Brussels,
           2                                                                         3
Belgium, Hospital Hygiene Team, Queen Astrid Military Hospital, Brussels, Belgium, Burn
Centre, Queen Astrid Military Hospital, Brussels, Belgium

Background: Worldwide MRSA infections pose life-threatening problems among critically ill and
elderly.
In Belgium the proportion of MRSA/MSSA is 23%., increasing to 35% on Intensive Care Units
(ICU). Seen the consequences on morbidity, mortality and cost anti-nosocomial infection
strategies are implemented. Collecting and analyzing those data is essential for evaluating and
monitoring the situation.
Methods: At admission all patients are systematically screened by nasal and peri-anal /or groin
region. The swabs are cultured on Chapman medium and consecutively put on Vitek for
antibiotic-susceptibility testing. During hospitalization a screening is done two times weekly.
Results: From January 2002 till December 2007, 703 patients were admitted at our ICU and 1494
at our Medium Care Unit (MCU). Nasal swabs showed to be the best screening sampling
procedure. The mean MRSA positive carriage at ICU admission is 1.5%. An increased trend was
observed since 2004 (1 to 4%). At the MCU however a remarkably lower mean admission
incidence of 0.5% was observed, with also the same trend for increase since 2004 (0.1 to 0.5).
The nosocomially acquired MRSA infection rate is 5% on the ICU and 4% on the MCU.
The higher incidence at the ICU admission is probably due to the fact that this patient population
includes patients who are referred from another ICU, beside two other risk factors in this
population, the age and often a marginal origin from a social-economic lower class.
Conclusion: We observe a trend for increase the last 3 years which reflects the presence of
MRSA in the community. This increase however is in contrast with the recently reported decrease
of MRSA nosocomial infections in the global Belgian hospitalization population. Our nosocomial
infection rate stayed at the same level and warrants an improved infection control in the future
Reference: European Antibiotic Resistance Surveillance System (EARSS), 2004.
Final abstract number: 64.052
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Surveillance of Multidrug Resistant Organisms (MDRO) in a Tertiary Care Centre in Chennai,
India
            1             1          1         2              2          2
P. Srikanth , A. Ramesh , V. Kamat , A. Kumar , A. Manoharan , D. Mathai
1                                                                      2
 Sri Ramachandra Medical College & Research Institute, Chennai, India, Christian Medical
College, Vellore, India

Background: Emergence and spread of MDROs are among the most important global health
threats. Surveillance of these pathogens helps to generate local data, to formulate specific
infection control procedures. This study was conducted to describe risk factors for acquiring
MDRO,their antimicrobial susceptibility pattern, classifying type of ESBL produced using
molecular methods in representative E. coli and Klebsiella spp.
Methods: Consecutive strains resistant to third generation cephalosporins from HAI / CAI
infection were included in the study. A proforma was used for risk factor analysis. Antibiotic
susceptibility pattern was determined by Kirby-Bauer disk diffusion method. In 20 strains
phenotypic, ESBL detection using cefotaxime, ceftazidime with clavulanic acid by double disk
synergy test & E-test (AB. Biodisk, Sweden) was done & genotypic characterisation was done by
PCR for TEM, CTX-M, SHV genes.
Results: Among 254 patients enrolled (91 %HAI & 9% CAI) 258 MDRO'S were isolated. Gram-
negative bacilli (84%) were predominant-Enterobacteriaceae (61%) and non - enterobacteriaceae
(23%) 14.7% of which are pan drug resistant. No VRE was detected. Diabetes mellitus (43%)
was the commonest comorbid condition,92 patients had an indwelling urinary catheter, 80 a
central venous catheter, 87 mechanical ventilation, 21 had undergone dialysis. Cefotaxime
clavulanic acid detected 75 % of ESBL, Ceftazidime clavulanic acid detected 55 %. Among 15
strains detected as ESBL phenotypically 14 were ESBL genotypically CTX-M is the predominant
93.3% ESBL genotype. TEM was detected in 80% of isolates, However no SHV was detected.
Conclusion: HAI account for majority of MDRO,most Gram-negative Enterobacteriaceae. Majority
of ESBL's were detected when cefotaxime with clavulanic acid disc than when ceftazidime
clavulanic acid was used. CTX-M is the predominant genotype. Excessive usage of Cefotaxime in
clinical practice may account for the prevalence CTX-M genotype.
Final abstract number: 64.053
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

The Mobile Phone in a Tropical Setting - Emerging Threat for Infection Control
           1          2             3            3              3             3
P. Srikanth , R. Ezhil , S. Suchitra , I. Anandhi , U. Maheswari , J. Kalyani
1                                                      2
 Sri Ramachandra Medical College , Chennai, India, National University of Singapore,
                        3
Singapore, Singapore, Sri Ramachandra Medical College & research institute, Chennai, India

Background: Mobile phones act as perfect habitat for microbes to breed, especially in high
temperature and humid conditions. and may serve as vectors in transmitting nosocomial
infections. This study was conducted to determine the potential of mobile phones to harbour
microorganisms in health care workers in hospital environments and to compare with
contamination among mobile phone users in a corporate office.
Methods: Surface samples were taken from mobile phones of health care workers (HCW) and
personnel from a corporate office. Sterile swabs were moistened with sterile demineralised water
and rotated over both the surfaces of the mobile phone. Swabs were inoculated in thioglycollate
broth and streaked over Blood agar and MacConkey agar plates. Plates were incubated
aerobically at 37 °C for 24 - 48 h. Gram-positive and Gram-negative bacteria were identified as
per standard microbiological procedures. Antibiotic susceptibility test by Kirby Bauer Disk
Diffusion method was done. A questionnaire was submitted to owners regarding awareness and
usage of mobile phones.
Results: In all 51 HCW mobile phones and 36 from a corporate office were sampled, Pathogens
isolated from mobile phones from HCW were Staphylococcus aureus (4), MRSA (2), Escherichia
coli (1), Pseudomonas aeruginosa (1) and Klebsiella pneumoniae (1) and Coagulase negative
staphylococci (43). Though 78 bacterial isolates were isolated from 36 samples fewer pathogens
were isolated from corporate users. Polymicrobial growth (2 species) was detected in 58% of
HCW mobile phones and 44%, (3 species) of office users. Among HCW, 74.51 % and 36.7% of
corporate users were aware that mobile phones harbour microorganisms and transmit infections.
Only 11.77 % HCW's use disinfectants to wipe their mobile phones.
Conclusion: The study indicates that there is potential threat of mobile phones spreading
infections and the importance of hand hygiene to prevent infection.
Final abstract number: 64.054
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Nurses Are Facing the Threat of Infection from Blood Borne Pathogens Due to Needle Prick
Injuries (NPI) During Patient Care
L.I. Zungu
University of Limpopo, Pretoria, South Africa

BACKGROUND AND OBJECTIVES: Nurses are facing the threat of infection from blood borne
pathogens due to needle prick injuries (NPI) during patient care. Adequate knowledge and
adherence to safety practices could prevent the occurrence of NPI and related consequences.
This study was conducted to determine and describe the experiences of NPI among nursing
students of a medical university, to identify factors that contribute to NPI among these students
and to assess their knowledge of NPI.
METHODS: A quantitative descriptive, cross-sectional survey was done among nursing students
from 2nd to fourth year, using a self-administered semi-structured questionnaire. Data collected
included factors contributing to NPI and high risk procedures leading to NPI as perceived by
students. Knowledge assessment of NPI guidelines, policies and protocols and prevalence of NPI
among these students was done.
RESULTS: A total of 96 respondents with average age of 23 years minimum being 18 and
maximum 35 years. Sample consisted of 80.2% females and 19.8% males. Majority of
respondents (35.4%) belonged to the 2nd year of study. The majority (56%) rated needle
recapping, disposing used needles (28.1%) and cleaning sharp instruments (56.3%) as extremely
high risk procedures. 30.2% of respondents thought suturing and blood taking (33.3%) were high
risk procedures to NPI. 25% of respondents rated administering injections, blood transfusion
(35.5%) and labour ward procedures (25%) as having moderate risk to NPI. 61.5% of
respondents rated the lack of knowledge about NPI (policies and protocols) at institutions for
clinical training as an extremely high risk followed by the lack of accompaniment and in-service
training (43.8%). Only 16.0% of respondents had NPI and only 8.3% reported the incident.
CONCLUSION: Appropriate guidelines and adequate knowledge could reduce the incidence of
NPI among nursing students and protect them from being infected with serious diseases such as
AIDS, Hepatitis and syphilis.
Final abstract number: 64.055
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Gender Trend of Septicaemic Deaths in University Teaching Hospital in Kelantan
C.Y Ruhana, A. Sarimah, N.N. Naing, M.N.S. Suraiya
USM Health Campus, kota bharu, Malaysia, USM Health Campus, Kota Bharu, Malaysia

Malaysia was one of the countries reported increasing in septicaemic deaths year by year and it
was the leading cause of death for the past few years. Objectives: This study was conducted to
describe the trend analysis based on gender and to forecast the pattern for the future. Methods:
This study used population data of septicaemic deaths in University Teaching Hospital in
Kelantan, HUSM from 1987 to 2006. Time series plots were used to identify the pattern of the
cases and time series model was used for forecasting prediction. The models involved were
Exponential smoothing, Holt, Winters, Decomposition Method and ARIMA. Results: We studied
2170 cases with female (59%) predominant compared to male 41%. Time series plots were
showed the increasing trend in for males and females. The Decomposition Method was identified
to be the best prediction model for forecasting for all variables with the smallest error among the
other models as measurement of accuracy which involved mean absolute error (MAE), sum
square error (SSE), mean square error (MSE) and mean error (ME) nearest to zero. This model
gave the ME values which underlying between -0.03 to 0.91, from 0.14 to 2.70 for MAE, 5.25 to
1265.11 for SSE and 0.07 to 16.22 for MSE. Forecasting results for male and female have shown
that the cases of septicaemic deaths will be increasing in next five years.
Conclusion: Forecasting can be a reference model for government to make a move in planning
for the future and to perform better health strategic planning especially in patient management
related to septicaemic deaths.
Key words: Septicaemic deaths, time series, prediction, forecasting
Final abstract number: 64.056
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

The Etiology of Hospital-Related Central Vascular Catheter Infections. A Prospective
Microbiological Study
          1              2
A. Nanetti , R. Manfredi
1                                                                                 2
 Dept. of Microbiology, University of Bologna, S. Orsola Hospital, Bologna, Italy, Dept. of
Infectious Diseases, University of Bologna, S. Orsola Hospital, Bologna, Italy

Background: A prospective microbiological surveillance program is ongoing at our tertiary-care
Hospital located in Northern Italy.
Patients and Methods: The trend of microbial isolations from patients admitted during the last
calendar year (January to December 2007), with a clinically- and microbiologically-confirmed
central venous catheter (CVC) infection, is regularly reported on quarterly basis.
Results: The trend of CVC infections monitorized among our inpatients moderately varied during
the observation period (149 cases in January-March, 169 episodes in April-June, 129 cases in
July-September, and 134 episodes in October-December). Among the most frequent organisms,
Staphylococcus epidermidis accounted for the majority of isolates (183 cases: 31.5%), followed
by Escherichia coli (49: 8.4%), Staphylococcus aureus (45: 7.7%), Pseudomonas aeruginosa (36:
6.2%), Enterococcus faecalis (30: 5.2%), Enterococcus faecium (25: 4.3%), Klebsiella
pneumoniae (21: 3.6%), and Enterobacter cloacae (15: 2.6%), while the yeast Candida albicans
accounted for a minority of episodes (17 only: 2.9%). When analyzing the available figures
according to calendar months, only some Gram-negative pathogens showed an increasing
incidence over time: Pseudomonas aeruginosa from 5.4% in the first three months of 2007 up to
7.5% in the last three months of 2007, and Enterobacter cloacae (from 2.0% in January-March
2007, up to 2.68% in October-December 2007), as well as other environmental Gram-negative
organisms.
Conclusions: A prospective microbiological monitoring may notably add to the knowledge of local
epidemiological figures and antimicrobial sensitivity trends of CVC infection (which represent
relevant causes of hospital-related morbidity), and plays a highly significant role in the selection
and planning of chemoprophylactic and therapeutic choices, on both local and regional settings.
Although the major causative agents of CVC-related infection among hospitalized patients remain
staphylococci as a group, however the progressive emerging of Gram-negative pathogens is
appreciable also over a proportionally short (12-month) observation period, and deserves major
attention by Microbiologists and Clinicians.
Final abstract number: 64.057
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Prospective Monitoring of in Vitro Antimicrobial Susceptibility Testing of Major Pathogens at a
Large Tertiary Care Metropolitan Hospital. A Guidance for Both Therapeutic and Prophylactic
Choices
          1              2
A. Nanetti , R. Manfredi
1                                                                                  2
 Dept. of Microbiology, University of Bologna, S. Orsola Hospital, Bologna, Italy, Dept. of
Infectious Diseases, University of Bologna, S. Orsola Hospital, Bologna, Italy

Background: Prospective microbiological surveillance studies including a continued monitoring of
antimicrobial sensitivity rates, have been performed at our Hospital since the year 2004.
Materials and Methods: The temporal variations of in vitro antibiotic susceptibility rates were
examined for the main hospital isolates, represented by Staphylococcus aureus,
Enterobacteriaceae as a whole, Pseudomonas aeruginosa, and Enterococci. The same pathogen
cultured more than once from the same patient within one month,has been considered once.
Results: Among Staphylococcus aureus isolates (1,869 tested strains), the rate of methicillin
resistance remained elevated, but ranged from 46.2% (year 2007),to 53.3% (year 2005).
Consistently elevated sensitivity rates were found for vancomycin-teicoplanin (100%), followed by
cotrimoxazole (92.3%), chloramphenicol (81.7%),and rifampin (66.3%). With regard to
Enterobacteriaceae as a group (4,428 tested strains), carbapenems and colistin maintained full
(100%) in vitro efficacy, followed by amikacin (96.4%), piperacillin-tazobactam (85.7%),and
ceftazidime (78.3%), while less than 65% of strains were sensitive to ciprofloxacin and
amoxycillin-clavulanate. Among Enterobacteriaceae, Escherichia coli showed a significantly
better sensitivity profile compared with other organisms, especially when co-amoxyclav,
ceftazidime, piperacillin-tazobactam, and gentamicin were of concern. On the other hand,
Pseudomonas aeruginosa (2,063 tested strains), was 100% sensitive to colistin, followed by
imipenem (78.3%), ceftazidime (75.5%), amikacin (73.7%), and piperacillin-tazobactam (73.2%).
Finally, among Enterococci as a whole (2,734 tested strains), vancomycin resistance accounted
for 8.1% of cases, while linezolid proved 100% effective. Compared with Enterococcus
faecium,Enterococcus faecalis tested more sensitive to penicillin, ampicillin, streptomycin, and
nitrofurantoin, while it proved less susceptibile to tetracyclines.
Conclusions: A prospective bacteriological surveillance of antimicrobial susceptibility rates of
major hospital-isolated microorganisms is extremely important, to establish reliable guidelines of
antibiotic treatment and prophylaxis,on local-regional basis. Pending in vitro susceptibility testing
of each bacterial isolate, a correct initial, empiric choice and a prophylactic regimens, should be
based on the established antimicrobial sensitivities, in order to avoid extensive emergence of
resistance and cross-resistance of different compounds, and to save and preserve existing and
future therapeutic options.
Final abstract number: 64.058
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Commensals of Mucous Surfaces Used to Control Nosocomial Diseases: Efficacy and Possible
Acting Mechanisms
          1         2          1         2             3           2                 2
N. Boyko , J. Szabo , H. Koval , A. Kulja , K. Kritsky , I. Kalapos , E. Rajnavolgyi
1                                                    2
 Uzhhorod National University, Uzhhorod, Ukraine, University of Debrecen, Debrecen, Hungary,
3
 University of Pennsylvania, Philadelphia, PA, USA

Background: Nosocomial infections caused by multi-resistant opportunistic pathogens are more
frequently observed in patients with detected immune system disorders. Commensal bacteria
play a crucial role in the maintenance of the host's mucosal immune responsiveness as
determined by complex molecular mechanisms. Therefore, new knowledge of host/bacterial
interaction is required to implement alternative methods to control nosocomial diseases.
Methods: Identification of the selected clinical isolates was performed using VITEK2 automatic
system. Their genetic congeniality and correspondingly etiological role in the registered
nosocomial infections were confirmed by PCR and PFGE. The antibacterial efficacy of
commensal bacteria against dominative pathogens was tested in vitro and in vivo. The level of
cytokines secreted by different subsets of epithelial (mice) and dendritic (human) cells were
assessed by ELISA. The level of SP-D and REG III beta/gamma genes expression in lungs and
colon correspondingly was detected by qRT-PCR.
Results: The following clinical isolates were referred to as the agents of nosocomial infection:
MRSA, S.warnery, S.pneumoniae, E.cloaceae, K.pneumoniae, K.oxytoca, P.morganii,
Acinetobacter spp., P.aeruginosa. B.subtilis 090 and L.salivarius ASF 361 demonstrated
inhibitory activity against pyogenic coccus (in concentrations of 50 MIO of CFU/ml) and Gram-
negative bacteria (300 MIO of CFU/ml), but not against Acinetobacter or P.aeruginosa.
Schaedler's E.coli and E.coli 058 were active against E.cloaceae, K.pneumoniae and K.oxytoca
(50 MIO of CFU/ml). The B.subtilis 090 and Shaedler's E.coli stimulated IL-10 production by
human DC after 5- and 10-hour-long bacterial exposure up to 70 and 45pg/ml, correspondingly.
K.pneumoniae R mutant non-virulent strain differed in stimulation of TNF-alpha, but not of IL-10
and IL-6, compared with the wild virulent strain. L.salivarius stimulated expression of SP-D and
REG III beta/gamma genes, and Shchaedler's E.coli induced the highest level of the locally
produced IFN-gamma.
Conclusion: Our results provide a new insight into the mechanisms of probiotic and/or vaccine
protection of human nosocomial diseases.
Final abstract number: 64.059
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Role of Patients' Attendants in Transmission and Prevention of Nosocomial Infections in
Bangladeshi Public Hospitals
R. Sultana, N.A. Rimi, M.S. Islam, N. Nahar, S.P. Luby, E.S. Gurley
ICDDR,B, Dhaka, Bangladesh

Background: Public hospitals in Bangladesh are commonly characterized by limited human
resources and infrastructure as well as crowding. Other studies have suggested that most hands-
on care for patients is provided by patient attendants, who are usually close family members. The
aim of this study is to understand the role of patient attendants in transmission and prevention of
nosocomial infections.
Methods: The study was conducted in one adult male medicine and one pediatric medicine ward
at each of three public tertiary care hospitals of Bangladesh. To identify the care giving pattern
and risk exposures, 7-10 hours of structured and unstructured observation was done in each
ward. Eighteen indepth interviews with patients and attendants were conducted to understand
attendants' knowledge about infection control and role as caregivers.
Result: Attendants provide round-the-clock care to hospitalized patients. They are responsible for
keeping the patient clean, including cleaning urine, vomit, saliva, feces, and blood, which is
usually done with bare hand or using cloth from their own clothes. Handwashing with soap among
patient attendants is uncommon. Attendants are also responsible for feeding, bathing, and giving
oral medication to the patient. Patients and attendants share food and sleep in the same hospital
bed. Generally, attendants' knowledge about contagious disease and disease transmission is
rooted in religious and the cultural belief models rather than medical one. In their perception
disease is God's will and it spreads if someone fears it, despises the infected person or has an
empty stomach.
Conclusion: Traditionally, infection control in hospitals focuses on hospital staff. In Bangladesh,
family attendants provide most of the hands on care, and so are at greatest risk for infectious
disease transmission. Efforts to reduce their risk will need to account for their different conception
of communicable disease risk and mechanism.
Final abstract number: 64.060
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Surveillance of Nosocomial Infections at a Saudi Arabian Military Hospital for a One-Year Period
M. Abdel-Fattah
Al-Hada Armed Forces hospital, Taif, Saudi Arabia

Background: The objectives of the current study are to define how many and what kind of
nosocomial infections are occurring, what are the causative microbes and what kind of drugs can
be used in treatment of infection at Al-Hada Armed Forces Hospital, Taif, Saudi Arabia during the
year 2007.
Methods: A prospective study was implemented for all cases admitted at Al-Hada Armed Forces
Hospital during the period 1st January, 2007 till 31st December, 2007 and which developed
infection. Determination of nosocomial infections was performed using standardized CDC criteria.
Results: A total of 1382 patients had developed infection during hospital admission and were
included in the study. Of them, 668 (48.3%) had nosocomial infection and 714 (51.7%) had
community-acquired infection. Among those who developed nosocomial infections, 216 (32.3%),
172 (25.7%) and 124 (18.6%) had respiratory tract (RTI), urinary tract (UTI) and blood stream
infections (BSI) respectively. Surgical site infection (SSI) was reported in 86 cases (12.9%). The
overall nosocomial infection rate along the study period was 4.98 per 100 discharged patients.
Gram-positive organisms were reported in 31.8%. MRSA (Methicillin-resistant S. aureus) was the
commonest (10.2%), followed by coagulase negative staphylococci (8.5%) and MSSA
(Methicillin-susceptible S. aureus, 7.4%). While Gram-negative organisms were reported in
66.2%, E. coli was the commonest (22.3%), followed by Pseudomonas aeruginosa (17.6%) and
Klebsiella pneumoniae (9.9%). Acinetobacter spp. and MRSA were highly sensitive to Imipenem
(88.6%) and Vancomycin (98.5%) respectively. E. coli were highly sensitive to most of the
antimicrobial agents except ampicillin (26.6%).
Conclusions: Pneumonia, urinary tract infections, and blood stream infections made up the great
majority of nosocomial infections. There is a need for further risk assessment associated with
main types of infection.
Final abstract number: 64.061
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

An Outbreak of Pseudobacteremia Due to Burkholderia Cepacia in the Emergency Room of a
Tertiary Hospital in Trinidad & Tobago
             1                  1          2
P.E. Akpaka , W.H. Swanston , S. Mayers
1                                                            2
 The University of the West Indies, St. Augustine, Trinidad , Eric Williams Medical Sciences
Complex, Mount Hope, Trinidad & Tobago

Background: Bulkholderia cepacia, formerly Pseudomonas cepacia is a gram negative rod with a
long association with contaminated disinfectants and medical devices; and has been responsible
for nosocomial infections as well as pseudobacteremias. This paper documents isolation of
Bulkholderia cepacia from in house prepared disinfectants; and from the blood and urines of
patients seen at the emergency room (ER) of a tertiary hospital in Trinidad and Tobago.
Materials and Methods: Eighteen isolates of B. cepacia were recovered from urine and blood
specimens of patients seen at the ER of the hospital. Medical records of these patients seen in
the ER and on the wards were reviewed. Blood and urine cultures were performed and examined
according to standard procedures recommended by the Clinical Laboratory Standards Institute
(CLSI) using automated system for isolation and identification of micro-organisms. Samples of
Povidone-iodine and Savlon were analyzed by the same techniques. The biochemical profile and
antibiogram of the B. cepacia isolates from the ER and the disinfectants were compared with
those of B. cepacia strains isolated in the past from the ICU and wards.
Results: The eighteen B. cepacia isolates from patients seen at the ER and the isolates from the
disinfectants had a biochemical profile that was compatible with B. cepacia Group 1. The
antibiogram of the isolates from the ER were all identical but distinctly different from the
antibiograms of B. cepacia strains from the ICU and wards. Patients from ER from whom these B.
cepacia isolates were recovered had no history and no clinical features suggestive of infection
with this organism. All the patients had a negative repeat blood cultures and had clinical course
that was incompatible with B. cepacia bacteremia or septicaemia.
Conclusions: The identical biochemical profile and antibiogram of the isolates from the ER point
to the same organism and therefore a common source of contamination. This report therefore
highlights the danger of using bulk centrally prepared disinfectants that are frequently opened for
use over a period of days. Contamination during this process leads to costly investigations,
unnecessary antibiotics and has the potential for causing nosocomial infection. Proper
preparation and management of disinfectants need to be emphasized.
Final abstract number: 64.062
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Ventilator Associated Pneumonia: A 22-Month Prospective Observational Study from a Tertiary
Care Centre in United Arab Emirates
M. Rahman, R. Hashmey, S. Abuhasna
Tawam Hospital in Affiliation with Johns Hopkins Medicine, Al Ain, United Arab Emirates

Objectives: To describe the demographics, microbiology and antibiotic use in Ventilator
Associated Pneumonia (VAP) in a 20 bedded mixed medical and surgical intensive care unit.
Methods: Prospective surveillance among all patients who developed VAP while receiving
mechanical ventilation for at least 48 hours, from April 2006 through January 2008. VAP Inclusion
criteria were based on National Nosocomial Surveillance (NNIS) system definitions.
Results: There were 2162 admissions during the study period and a total of 2490 ventilator days.
Twenty-five patients met the criteria for VAP. The majority (23/25, 92%) were males. Mean age
was 41 years. The VAP rate was 10.36/1,000 ventilator-days with a ventilator utilization ratio of
0.36. Most of patients (17/25, 68%) were surgical of which severe head trauma (13/17, 76%). was
the commonest underlying diagnosis. Early VAP (<96 hours of mechanical ventilation) occurred
in 14/25 (56%) patients. Head trauma cases comprised more than half of early VAP (8/14,
57.1%). There was no growth in 6/25(40%). Klebsiella pneumoniae was the commonest organism
(4/19, 21%), followed by Staphylococcus aureus (3/19, 16%) and Pseudomonas aeruginosa
(3/19, 16%). 20/25(80%) patients were receiving antibiotics at the time of diagnosis. Empiric
treatment of choice was piperacillin-tazobactam alone or in combination with a quinolone (14/25,
56%), followed by meropenem (8/25, 32%). In 11/25 cases antibiotic was changed after culture
results. In unit mortality rate for VAP patients was 12%.
Conclusions: The mean VAP rate and VAP associated mortality at our hospital was less than that
reported by NNIS System surveillance. Head trauma was the major risk factor for development of
VAP. Prophylactic antibiotic use is prevalent in our unit. Etiologically, gram negatives
predominated with MRSA being uncommon. Piperacillin-tazobactam and carbapenems were the
favoured treatment choices. Additional studies are necessary for comparison and establishing
antibiotic guidelines for treating ventilator associated pneumonia in the UAE.
Final abstract number: 64.063
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

VRE Surveillance; the Challenge of Preventing Endemnicity in a Singapore Teaching Hospital
T.M. Ng, K.L. Ooi, X.Y. Sun, R. Lin, D.A. Fisher
National University Hospital, Singapore, Singapore

Background: The aims of this study were to develop a sensitive VRE screening procedure at
National University Hospital (NUH), Singapore. The processes needed to be practical and to
utilise available resources optimally.
Methods: The study was conducted in specific high risk wards of NUH notably, haematology-
oncology, ICUs, long-term care, neurology and nephrology . The intervention involved active
surveillance and focused on 3 major components to determine who would be swabbed; a risk
index score for all patients., universal screening for all patients admitted from specific locations in
Singapore and interval swabbing of all long stay patients.
The risk index score was undertaken by assigning weighted point values based on local
experience of risk factors associated with patients' harbouring VRE. No pre emptive isolation was
included but strict contact precautions were emphasised for patients with results pending.
The (pre intervention) comparison group in this study were patients that were screened for VRE
from specific hospitals on admission to NUH, patients who had contact with VRE patients and
patients whose was stool sent for Clostridium difficile cytotoxin assay between Apr 2005 and Oct
2007. These had been cultured for VRE as part of a research project.
Results: The VRE detected was 11.09 per 1000 VRE swabs compared to 15.4 per 1000 VRE
swabs before the intervention; p=0.428. Average cost of isolation ranging $157 to $798 post
intervention compared to before intervention, $1968 to $3985.
Conclusion: A larger sample size is required to evaluate efficiency of VRE screening procedure.
However, the intervention has resulted in better bed allocation, identification of high-risk patients
for VRE from external facilities and within NUH; and reduction in the hospitalization cost for the
patients.
Final abstract number: 64.064
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Clinical Characteristics of Permanent Pacemaker and Implantable Defibrillator-Related
Endocarditis: An Eleven Years Experience (1996-2006)
J. López-Contreras, N. Hernández, M.L. Gálvez, N. Benito, V. Pomar, R. Pericas, A. Cotura,
P. Domingo, M. Gurguí
Infectious Diseases Unit. Internal Medicine Department and Microbiology Department. Hospital
de la Santa Creu i Sant Pau. University Autonoma of Barcelona, Barcelona, Spain

Background: Permanent pacemaker (PPM) and implantable desfibrillator-cardioverter (IDC)-
related endocarditis is a infection that is associated with a substantial morbidity and mortality and
also with a significant financial cost.
Methods: Observational and retrospective study. Setting: 700-bed tertiary hospital. Period:
January 1996 to December 2006. PM and IDC inserted during this period were 1224 and 188
respectively. Cardiac device-related infective endocarditis (CDIE) was defined as the presence of
both vegetation on a device lead or valve and clinical or microbiological evidence of CDIE.
Results: 27 patients fulfilled the CDIE criteria, 20 had a PPM and 7 an IDC. Incidence of PPM and
ID related endocarditis were 1.8% and 3.1% respectively. Mean age 70 (range: 24 to 86 years).
70% were male. 12 had underlying cardiac conditions. 59% had early local complications (7
displacements, 9 hematomas or seromas). 52% had previous manipulations of the generator
and/or the leads. Mean time between insertion and CDIE was 66 months (SD±57). 23 patients
had late endocarditis and 4 early one.
Most frequent pathogens were coagulase negative staphylococcus 37%, Staphylococcus aureus
30% and Enterococcus faecalis15%.
Most frequent antibiotics used were: cloxacillin 11, vancomycin 5, teicoplanin 2 and ampicilin 5.
89% of patients received combined treatment with an aminoglucosid (21) or rifampin (3).
Intravenous treatment length was 34 days (±8). 52% patients prolonged antibiotic therapy by oral
route. In 16 patients leads were replaced (44% by traction and 56% by open surgery).
Complications were 2 septic emboli, 7 septic shock and attributable mortality was 1%.
Conclusion:
- Incidence of PPM and ID related endocarditis were 1.8% and 3.1% respectively.
- 60% of patients have had precocious local complications time before cardiac device-
endocarditis diagnosis.
- Most were caused by grampositive cocci.
- More than 50% received prolonged courses of oral antibiotics after completing intravenous
treatment.
Final abstract number: 64.065
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Prospective Study of Candida sp Bloodstream Infection Rates and Susceptibility Profile in a
Tertiary Hospital in Salvador, Brazil: 2003-2007
A.C. Bandeira, M.G. Barberino, K. Barreiro, C. Campos
Hospital Alianca, Salvador, Brazil

Background of the study: To estimate Candida sp bloodstream infection rates from 2003 through
2007 along with the definition of species and antifungal susceptibility profile of the isolates.
Methods: Setting: Private tertiary facility in Salvador, Brazil
Study type: Laboratory-based prospective study started in January 2003 and ended in December
2007 of all isolates of Candida sp.
Blood cultures were processed in BacT/ALERT and positive cultures were plated in Chocolate
Agar, incubated in microaerophilia at 35oC for 18-24 hours. Gram-stained cultures showing
yeasts were emulsified in 0.5mL of human serum, incubated at 37oC for 2 hours and a drop of
the mixture was examined microscopically for the presence of germ tubes. The colonies were
sent to a Reference Laboratory in Sao Paulo (Fleury Medicina Diagnostica, Sao Paulo) where the
microorganisms were identified using VITEK System (BioMerieux) and antifungal susceptibility
tests done using E-tests for Amphotericin B, Fluconazole, and Itraconazole (E-test, AB Disk).All
criteria were based in NCCLS/CLSI M27A. Just the first episode of candidemia was considered
for each patient. Subsequent episodes for the same patient were not included in the present
study.
Sex, age, and discharge informations were collected.
Results: 72 patients had positive blood cultures for Candida sp during the study period.
Age and sex distribution: 40 male, 32 female.
Median age was 69 yr-old
Most patients - 53% - were at the ICU at the time of diagnosis.
Distribuition of Candida isolates: 45.8% albicans; 23.6% tropicalis; 13.9% parapsilosis; 2.8%
glabrata; 1.4% guillermondi; 1.4% famata; 9.7% spp.
Antifungal susceptibility: Amphothericin-B 98.3%; Fluconazole 94.9%; Itraconazole 95.6%.
Conclusion: In our prospective study the non-albicans species predominated in episodes of
candidemia. We found a low resistance profile for azoles probably due to the low frequency of
isolates of Candida krusei and Candida glabrata in our sample.
Final abstract number: 64.066
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Implementation of Basic Infection Control Guidelines in Major Hospitals of Karachi-Pakistan
              1         1           2              3
M.R. Khanani , A. Agha , S. Ahmed , A.A. Siddiqui
1                                                       2
 Dow University of Health Sciences, Karachi, Pakistan, Sindh Government Hospital New
                           3
Karachi, Karachi, Pakistan, Liaquat College of Medicine and Dentistry, Karachi, Pakistan

Objective: To assess the status of implementation of fundamental infection control guidelines
Methods: We conducted a cross sectional survey of 20 hospitals having more than 100 beds in
the year 2007.
Results:
Twenty facilities volunteered the consent and responded to the questions. Total number of beds
in these 20 facilities were 8329. Although 95% of facilities have Infectious Diseases Physicians
and 90% microbiologists only 20% have one IC Nurse irrespective on number of beds. Twenty
percent have an Infection Control Committee. Only 10% hospitals have a designated Infection
Control Doctor.
Only one hospital compiles IC reports which are kept confidential and shared only with hospital
CEO or equivalent authority. Only three incidents of investigations for nosocomial infection
outbreaks were conducted by two hospitals during last year and findings not disclosed.
Incidences of hospital acquired infections are calculated by only one hospital but findings are kept
confidential. Hand washing facilities were available at easily accessible locations in only 2
facilities and alcohol hand rubs at one. Hand hygiene training to health care providers was
provided by 2 hospitals occasionally. One hospital reported having an antibiotic prescribing policy
but it was only partially implemented. Antibiotic susceptibility was performed by 18 (90%)
facilities. Infection prevention and control training was not provided to health care professionals
regularly by any facility. Information on hand hygiene, antibiotic consumption and infection
prevention was not provided to patients or visitors by any facility.
Conclusion: Importance of Infection Control is not realized by majority of hospitals as less than
10% facilities implement standard recommendations. Peri operative and post operative antibiotic
use is very high and post operative infections are quite common. Implementation of Infection
Control Guidelines is highly desirable.
Final abstract number: 64.067
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Knowledge and Performance Toward Universal Precautions Among Nurses in University-
Affiliated Hospitals of Mazandaran, Iran
R. Ghasemian, N. Najafi
Mazandaran University of Medical Sciences, Sari, Iran (Islamic Republic of)

Objective: Health care workers (such as nurses, midwives and auxiliary nurses) have great risk of
occupational hazards as they perform their clinical activities in the hospitals. Universal and
standard precautions are a set of guidelines aim to protect them against blood-born infections
and the other hazardous infectious agents. The purpose of this study was to investigate the
knowledge and performance of nurses regarding isolation precautions and universal precaution in
Mazandaran University affiliated hospitals in Iran.
Method: In this cross-sectional study, knowledge and performance related to universal precaution
among nurses of 10 hospitals in Mazandaran state were assessed using a questionnaire. The
questionnaire was designed by infectious disease specialist based on standard precaution
guideline approved by CDC. In each hospital, at first, infection control's nurse monitored their
practice, and then the participant nurses filled the questionnaire by themselves. The statistical
analysis was performed by using SPSS -10.
Results: A total of 400 nurses (352 female and 48 male) participated in our study. Response to
knowledge and performance questions concerning universal precaution in general were
acceptable in accordance with the CDC guidelines (mean score approximate 73.62% and 70.6%
respectively).no significant correlation was found between age, sex, marital status and previous
education about infection control. Also we found a positive linear correlation between knowledge
and practice level. The level of performance was decreased in higher educational levels.
Conclusion: Specific training programs may have to target all of the nurses regularly to establish
acceptance of appropriate practices that will enable them to adopt and adhere to universal
precaution while their older counterparts may require more intense continuous assistance.
Final abstract number: 64.068
Session: Infection Control and Nosocomial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

The Effect of Extended-Spectrum Beta-Lactamase Production On Antimicrobial Suceptibility
Figures Among Escherichia coli and other Enterobacteriaceae Isolated in one Year of
Prospective Hospital Surveillance Program
          1              2
A. Nanetti , R. Manfredi
1                                                                                 2
 Dept. of Microbiology, University of Bologna, S. Orsola Hospital, Bologna, Italy, Dept. of
Infectious Diseases, University of Bologna, S. Orsola Hospital, Bologna, Italy

Background. The increased rate of antimicrobial resistance among Gram-negative rods and all
Enterobacteriaceae as whole is a major concern,especially in the hospital setting. A prospective
microbiological surveillance of antimicrobial susceptibility rates of all relevant pathogens is
ongoing at our Hospital,together with an analysis of the relationship with the emergence of
extended-spectrum beta-lactamase secretion.
Materials-Methods. The temporal variations of in vitro antimicrobial sensitivity rates were
assessed at quarterly intervals for all suitable Escherichia coli strains and other
Enterobacteriaceae, 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 Escherichia coli isolates (493 strains tested on the whole), imipenem tested in
vitro effective in 100% of cases, followed by piperacillin-tazobactam (86.6-90.6% of tested
strains), nitrofurantoin (86.1-91-7% of strains), ceftazidime (75.8-79.8%), cefotaxime (75.7-
79.8%), co-amoxiclav (61.7-69.8%), ciprofloxacin (61.0-64.3%), and norfloxacin (64.5-70.2%).
Both cefotaxime and ceftazidime sensitivity (affected by the production of extended-spectrum
beta-lactamases), had a drop from a 79.8% mean susceptibility rate of the first quarter of year
2007, to a mean 75.7% of the last quarter of the year. With regard to Enterobacteriaceae as a
whole (other than Escherichia coli), among 753 comprehensive isolates, both imipenem and
colistin retained full (100%) in vitro activity, followed by piperacillin-tazobactam (72.5-81.5% of
tested strains), cotrimoxazole (71.6-77.6%), gentamicin ( 71.6-76.1%), ciprofloxacin (64.1-
68.6%),ceftazidime (60.8-64.5%), norfloxacin (60.2-69.8%),and cefotaxime (59.7-62.7%),with
cephalosporins moderately affected by extended-spectrum beta-lactamase production,although in
absence of significant temporal modifications.
Conclusions. Prospective surveillance studies of in vitro antimicrobial sensitivity rates of some
relevant hospital-associated organisms like Escherichia coli and Enterobacteriaceae are an
useful guidance to plan antibiotic treatment and prophylaxis,on local and regional basis. This last
Gram-negative organism group also allows a reliable study of the temporal trend of extended-
spectrum beta-lactamase production,which significantly affects the activity of multiple broad-
spectrum antimicrobial compounds.
Final abstract number: 65.001
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Prevalence of Intestinal Parasites and Related Factors in Primary Schools Children, Varamin
City, Iran
Z. Aminzadeh, B. Hosseinzadeh
Shaheed Beheshti Medical University, Tehran, Iran (Islamic Republic of)

Intestinal parasitic diseases, especially among children, are very common in Iran, and the statistic
shows that the prevalence of these pathogens among primary school students, in comparison
with other age group, is more common. For the purpose of determining the rate of the outbreak of
these pathogens in the city of Varamin, the students at primary schools in the academic year
1999-2000 were studied. The method of research was descriptive and the technical study was
observational - interviewing. The simple sampling method was carried out over 293 students at
primary schools in the city of Varamin. The samples were tested by direct Laboratory methods
and sedimentary concentration. For the purpose of finding cryptosporidum, Ziel Nelson medified
method (88 samples out of total samples) was used. Out of 293 primary students, 139 students
(47%) for intestinal parasitism were reported positive of which 116 students (83%) had one
parasite, 21 students (15%t) had two parasites and 2 students (2%) had 3 parasites. Giardia
contamination was seen in 78 cases (49 percents) which has shown highest contamination. From
cryptosporidium point of view 88 samples were reported negative. There was no significant
difference among students of rural and urban schools for parasitism. There was no significant
difference between sexes and the rate of contamination. There was a significant difference
between mother's and father's occupation with the rate of contamination among students and that
based on tchouprov test the above said correlation found to be weak (14 and 15 percents
respectively). There was a significant difference between parent's educational level and the rate
of contamination. All students were drinking hygienic water (from Pipeline) and 99% of these
students were washing their hands with soap and water after using toilet.
This study suggested that there was significant relationship and weak correlation between mother
& father occupations and the rate of contamination among students and also a significant
difference, existed between parents educational level with the result of stool examination and this
has shown the importance of awareness and general knowledge in preventing intestinal parasitic
diseases
Final abstract number: 65.002
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Health-Seeking Behavior and Out-of-Pocket Expenditure in Patients with Visceral Leishmaniasis
in Nepal
T. Shrestha
NGO, Kathmandu, Nepal

Leishmaniasis is endemic in 88 countries and 350 million people are at risk for acquiring one or
the other form of leishmaniasis with an overall prevalence of 12 million worldwide. The visceral
type, visceral leishmaniasis (VL) or kala-azar was known to be endemic in Southern Terai (plain
region) of Nepal since 1953. Approximately 5.5 million inhabitants are estimated to be at risk of
VL in Nepal at present.
We conducted a study to investigate the health seeking behavior and out-of-pocket expenditure
for health in patients with VL in Nepal. A sample of VL patients was interviewed at B.P. Koirala
Institute of Health Sciences (BPKIHS), a hospital located within the endemic region for Kala-azar
in Nepal.
Between September and November 2004 one hundred sixty patients were confirmed with a
diagnosis of Kala-azar at BPKIHS. Out of these, 60 [37.5 per cent of 160] patients were enrolled
for the study; among them 52 per cent were males. Age of the study population ranged between
18 to 75 yrs, with mean age of 32.3 yrs (SD ±15.1).
Almost half of the patients delayed seeking care for VL for more than 100 days. In addition, the
factors playing a significant role in making delayed health seeking were found as gender,
perception of disease and the stigma attached. The study got evidence that the severity of the
disease and its immediate economic and social impacts determines the decision making
regarding the health seeking behavior more than knowledge about the disease.
Almost all of the patients (95 per cent) had visited traditional healers followed by private health
care providers [46.7 per cent] for treatment of illness. Their visit to government health care
providers and referral center is either fourth or fifth which explains delays in the adequate
management of the patient.
The out of pocket expenditure of the patient is maximum in the treatment of kala-azar. The mean
total expenditure in VL is 105 US$. An average of 100 days of working days (maximum 210 days
and minimum 14 days) was lost due to the disease.
The findings of the study reflects on the advocacy, sensitization and develop skill of protection
and control measures to the individuals. The advocacy/awareness intervention is most essential
part to reduce the kala-azar morbidity and mortality.
Some major interventions are recommended in this study to reduce morbidity and mortality of VL
is given below.
Advocacy, orientation and health education should be provided regarding Kala-azar disease, its
transmission, and preventive & control measures to family level, child and youth group, mothers
groups and school students as well as community level. It should be in multi disciplinary
approach.
Educational programs focused on reducing stigma and increasing control over the resources of
females and decision making process in health seeking behaviors of VL and to be conducted in
formal and informal settings.
As there is a strong stigma regarding the traditional healers in the population, the use of
traditional healers for health education and development of awareness of the disease can be
implicated.
Training and orientation to traditional healers on modern treatment systems should be provided to
increase the utilization of modern health facility.
Final abstract number: 65.003
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

A Survey on the Effects of Leishmania Major TSA -Encoded DNA Vaccine Against Experimental
Leishmaniasis in BALB/c Mice
              1                1               1            2
F. Tabatabaie , F. Ghaffarifar , A. Dalimi Asl , Z. Sharifi
1                                                                 2
  Tarbiat Modares University , Tehran, Iran (Islamic Republic of), Research Center of Iranian
Blood Transfusion Organization, Tehran, Iran (Islamic Republic of)

Background: Leishmaniasis, caused by an intracellular protozoan parasite, Leishmania major
which is transmitted through the bite of sand flies. The disease is prevalent in many parts of the
world. TSA is the immuno-dominant antigen of Leishmania major which is considered as the most
promising molecule for a recombinant or DNA vaccine against leishmaniasis.
Materials and Methods: In the present study, we evaluated TSA -encoded DNA vaccine against
Leishmania major in BALB/c mice. The first was done the genomic DNA extraction and then,
done PCR amplification and recombinant plasmid construction and tranfection of recombinant
pcTSA into the eukaryotic cells and then done SDS-PAGE and Western blot analysis.
The mice were grouped to be based on administration content as follows: 1-PBS (as control
group), 2-pcDNA3 (as control group), 3-pcTSA (as vaccinated group) (100 g of pcTSA ). The
mice were immunized via intramuscular (i.m.)into both quadricepses with 100 L of administration
content according to their grouping. Three inoculations were employed at two weeks interval.
Three weeks after the last immunization, mice of each groups (vaccinated and unvaccinated
mice) were challenged at the base of tail by the intradermal (i.d.) route with 2x 106 Leishmania
major promastigotes (Strain MRHO/IR/75/ER). The measuring of the diameter of lesion at the site
of inoculation was monitored weekly by a Vernier caliper thereafter. Also the measuring of the
weight was monitored weekly by a scale. All groups of mice were evaluated for lesion
development and weight increasing for up to 7 weeks after challenge with Leishmania major.
Then, animals were sacrificed and was done determination of parasite burden in their spleen.
The statistical comparisons between experimental groups were carried out with an analysis of
variance (ANOVA) and post hoc Tukey test. Statistical analysis of survival time was carried out
with Kaplan-Meier (Log-Rank) test.
Results: The immunized mice with this DNA vaccine presented an important reduction in
diameter of lesion and increasing of weight compared to the control mice and was indicated a
significant difference between the immunized group and the control groups (p<0.05). The survival
time of the immunized mice was significantly higher than the control groups (p<0.05) after
challenge with Leishmania major. The immunized mice had significantly lower parasite load
compared to the control mice(p<0.05).
Conclusion: The findings of this study, indicated that the TSA -encoded DNA vaccine induced
protection against infection with Leishmania major in mice. In this study, we demonstrated that,
the TSA -encoded DNA vaccine may be an excellent candidate for futher vaccine development.
Keywords: DNA vaccine, Leishmania major, TSA, Survival time, Parasite burden.
Final abstract number: 65.004
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

HIV-associated Cutaneous Dissemination of Visceral Leishmaniasis, Despite Negligible
Immunodeficiency. Failure of Liposomal Amphotericin B Administration, Followed by Successful
Pentamidine-Paromomycin Administration
             1            2               1         1
R. Manfredi , B. Passarini , G. Marinacci , L. Calza
1                                                           2
 Infectious Diseases, University of Bologna, Bologna, Italy, Dermatology Clinic, University of
Bologna, Bologna, Italy

Background. In endemic countries, Kala-Azar (K) acts as an opportunistic infection, when a deep
HIV-related immunodeficiency is present; infrequently, a cutaneous spread was described.
Case report. An atypical episode of HIV-associated K complicated by a diffuse, aspecific macular-
papular cutaneous involvement was characterized by absent epidemiological clues, a prolonged
course, and no response to repeated cycles of liposomal amphotericin B (lAB), despite a CD4+
lymphocyte count >500 cells/ L, maintained thanks to a concurrent antiretroviral treatment.
Despite a negligible immunodeficiency, K serology proved negative.Only a prolonged
administration of the second-line i.v. pentamidine (12 weeks), together with oral paromomycin (7
weeks), led to a cure of K and its related skin dissemination, in absence of toxicity and disease
relapses.
Discussion. The differential diagnosis of skin dissemination of K (which may appear as single,
multiple, or disseminated macules, papules, plaques, nodules, ulcers), enters in a broad
spectrum of possible HIV-associated complications, and may be the clue of a missed K, so that a
biopsy with histopathology-culture becomes mandatory, since serology is not reliable also when
immunodeficiency is limited. The first-line treatment of HIV-associated K is debated. Pentavalent
antimony compounds were the mainstay in the past 70 years, but lAB seems effective and safe,
especially when administered in short courses. Like in our case, failure of AB in treating K was
anecdotally documented. In our particular episode, a prolonged pentamidine-paromomycin
treatment became necessary, after multiple failures of lAB. An effective antiretroviral therapy may
restore the immune function and significantly help anti-protozoal treatment, but it was not the
case of our patient, who was virologically suppressed and reached a CD4+ count of >500 cells/ L
before of the cutaneous spread. Also in the HAART era, clinicians facing patients with a well
controlled HIV disease, should carefully assess a non-specific rash, which may enter in
differential diagnosis with an elevated number of infectious, allergo-toxic, and dysreactive
disorders. Randomized clinical trials are needed to aid selection of therapeutic regimens of K
with/without a concurrent immunodeficiency, and with/without cutaneous-other complications, due
to the increased frequency of both K and HIV disease, especially in developing countries.
Final abstract number: 65.005
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Use of Toxoplasma gondi Specific IgG Avidity Assay for Diagnosis of Acquired Toxoplasmosis in
Pregnant Women
             1              2              3
A. El-Moamly , I. Al-Khalife , M. El-Swify
1                                                                                      2
 Parasitology Department, Faculty of Medicine, Suez Canal University, Ismailiya, Egypt, King
                                         3
Saud University, Riyadh, Saudi Arabia, Microbiology and immunology department, faculty of
medicine, Suez Canal University, Riyadh, Saudi Arabia

Background: Fetal infection by Toxoplasma gondii develops when non-immune mother becomes
infected during pregnancy. Accurate dating of infection is mandatory to prevent complications.
T.gondii IgM persists in serum for months after infection, hence, not suitable as an evidence of
recent infection, beside its lack of specificity. T.gondii IgG avidity assay is expected to distinguish
recent and past infection. High avidity excludes recent infection in the preceding 16-20 weeks,
while low avidity doesn't differentiate recent from old infection. This study evaluated the use of
IgG-avidity assay and IgG and IgM to detect recent toxoplasmosis in early pregnancy.
Methods:Sera from 2070 asymptomatic Saudi Arabian pregnant women at different gestational
stages were first screened for T.gondii IgG by indirect hemagglutination test (Toxocell IHA, biokit,
Spain). Enzyme linked fluorescent assay (ELFA, VIDAS, BioMerieux, France) was used to detect
T.gondii IgM and to measure total IgG and IgG-avidity index (AI).
Results Out of 401 IHA-positive sera, 151 (37.7%) samples were positive for T.gondii IgM, among
which AI was low in 17 samples (11.3%), intermediate in 1 (0.6%), and high in 133 samples
(88.1%). The possibility of recent infection in IgM-positive sera was excluded with a high IgG AI
(95% CI, 83-93%). High AI was shown in 97.8% of IgM-negative sera. These finding minimized
the value of a positive IgM finding as single indicator for acute recent infection. Actually, it
highlighted the value of IgG avidity assay to exclude recent infection. No significant correlation
between level of IgG, and presence of either low or high AI; or between IgG level and presence of
IgM in serum (r 0.092) (p<0.05.)
Conclusion: For early diagnosis of T. gondii infection, pregnant women should be initially
screened for IgG, to determine the patient's immune status; followed by IgM assay of IgG-positive
sera. Absence of serum IgM excludes recent infection. Regardless of IgG serum value, AI assay
should be done to exclude recent infection in past 16-20 weeks. Assays should rely on accurate
techniques (e.g., ELFA). This will reduce the cost of repeated assays in majority of pregnant
women during first trimester, and avoid unnecessary examinations, antibiotic therapy, and anxiety
burden.
Final abstract number: 65.006
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Transmission of Trypanosoma cruzi Infection by Organ Transplantation, Los Angeles County,
2006
             1       1          2           2             2           3                4
L. Mascola , H. Kun , A. Moore , F. Steurer , G. Lawrence , B. Kubak , S. Radhakrishna ,
         5          5         6           7             2
D. Leiby , R. Herron , T. Mone , R. Hunter , M. Kuehnert
1
 Los Angeles County Dept. of Public Health Acute Communicable Disease Control Program, Los
                    2                                                              3
Angeles, CA, USA, Centers for Disease Control and Prevention, Atlanta, GA, USA, University of
                                   4
California, Los Angeles, CA, USA, University of Southern California, Los Angeles, CA, USA,
5                                           5                                            6
 American Red Cross, Rockville, MD, USA, American Red Cross, Los Angeles, CA, USA, One
                                 7
Legacy, Los Angeles, CA, USA, California Dept. of Public Health, Sacramento, CA, USA

Background: Trypanosoma cruzi infection is an unusual complication after solid-organ
transplantation and can result in severe illness or death. In 2006, two heart transplant recipients
in Los Angeles were reported with acute trypanosomiasis in the same month. We conducted an
investigation to determine the source of these infections.
Methods: We reviewed medical, organ procurement, and donor transfusion and transplantation
records. The two heart recipients were interviewed about natural exposures, tested for T. cruzi
antibodies, and screened for parasites by buffy coat examination, culture and polymerase chain
reaction (PCR) of blood and other tissues. Organ donor tissues were examined using PCR and
immunohistochemical staining. Organ and blood donor sera were tested by immunofluorescence
assay (IFA) and radioimmunoprecipitation assay (RIPA). Other recipients of organs from the
same donors were monitored for T. cruzi infection with PCR and IFA.
Results: Neither heart recipient had apparent risk factors for preexisting T. cruzi infection. Both
were seronegative and parasite positive, indicating recent infection. Both recipients expired
despite treatment. Each organ donor tested positive for T. cruzi antibodies by RIPA; blood donors
were seronegative. Six other patients received a liver or kidney from these organ donors. None
have evidence of T. cruzi infection.
Conclusions: This is the first report of T. cruzi transmission associated with heart transplantation.
T. cruzi prevalence in the Los Angeles organ donor population may be higher than previously
appreciated. Clinicians and public health authorities should be aware that manifestations of
Chagas disease may occur after transplantation, requiring rapid evaluation, diagnosis, and
treatment.
Final abstract number: 65.007
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

School Prevalence Surveys on Soil Transmitted Helminths and Schistosomiasis, Rwanda
        1          2             2           2           2          2           3              4
R. Josh , K. Blaise , M. Denise , R. Eugene , R. Nadine , K. Gaspard , K. Corine , M.A. Deville ,
           4
A. Fenwick
1                                                          2
 Columbia University,Earth Institute, New York, NY, USA, Neglected Tropical Disease
                               3
Programme, Kigali, Rwanda, National Malaria Control Programme, Kigali, Rwanda,
4
 Schistosomiasis control Initiative, London, United Kingdom

Background: The effective control of intestinal helminthic infections requires identifying their
prevalence and the local contributing factors, particularly among high-risk groups. Very little
and/or recent data are available in Rwanda, where intestinal helminthic infections are thought to
be a major health issue.
Objectives: To obtain an accurate estimate of prevalence for schistosomiasis and soil-transmitted
helminths (STHs) infections among school children in 8 selected districts. The prevalence
estimates will be used to produce maps of predicted risk for each infection.
Methods: A cross sectional study, involving 3052 school children, was conducted between
September and October 2007. Stool specimens were examined using the Kato-Katz method in
order to determine the prevalence of intestinal schistosomiasis and STHs. The prevalence of
urinary schistosomiasis was established by testing for micro-haematuria using dipsticks.
Results: A total of 3100 school children from 48 schools in 8 districts were randomly selected to
participate in the study. Only 3052 children (49.7.% male and 50.3% female) presented
themselves with the proper consent forms, provided proper stool samples and completed the
information form, with an overall response rate of 98.4%. Six species of intestinal helminths were
identified with an overall prevalence of 64.5% for STH infections. The predominant parasite was
Ascaris lumbricoides which was observed in 37.1% of the students, followed by Trichuris trichiura
in 28.3%, Ankylostoma duodenale in 27.8% and. Schistosoma mansoni infection was found in
2.7% of the students overall but the prevalence per district varied from 0% to 44%. No case of
urinary schistosomiasis was found.
Conclusion: In these 8 districts surveyed, Mass Drug Administration (MDA)with Albendazole
against STHs is required targeting preschool and school age children, women of childbearing age
and other high-risk groups. For schistosomiasis, MDA with Praziquantel shall target the school
age children, women of childbearing age and other high-risk groups only in the endemic areas.
Final abstract number: 65.008
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Seroprevalence of Toxoplasma gondi Antibodies in HIV/Aids Patients and Healthy Blood Donors
in Port Moresby General Hospital, Papua New Guinea
        1            2           3           4          5        1
L. John , I.H. Kevau , J. McBride , K. Wilson , J. Milan , G. Tau
1                                                                   2
 Port Moresby General Hospital, Port Moresby., Papua New Guinea, UPNG School of Medicine
                                                          3
and Health Science, Port Moresby, Papua New Guinea, Cairns Base Hospital, Cairns, Australia,
4                                                                 5
 National Reference Serology Laboratory, Melbourne, Australia, National HIV/AIDS Council
                                                 1
Secretariat, Port Moresby, Papua New Guinea, Port Moresby General Hospital, Port Moresby,
Papua New Guinea

A seroepidemiological survey was conducted at Port Moresby General Hospital (PMGH) over a
24 month period(1st March 2003-31st March 2005). The aim of the study was to determine
seroprevalance of toxoplasma gondi in HIV infected patients and seronegative healthy blood
donors. The population was unmatched but complete data was obtained for some important
sociodemographic characteristics. These were compared to see if there were any risk factors for
acquisition of toxoplasmosis seropositivity. Blood samples of 181 consecutive HIV infected
patients and 120 consecutive healthy blood donors were tested for toxoplasma IgG and IgM
antibodies using the enzyme - linked immunoassay (ELISA) technique.
The study showed that 59.7% of the HIV infected population and 40.1 % of the Healthy Blood
donors were positive for toxoplasma antibodies, giving the overall prevalence of 52.2%, for the
study population. The two important independent risk factors that showed significant correlations
with toxoplasma antibody positivity were regional grouping (Highlands origin) and exposure to
cats.
This study revealed that toxoplasma antibody is prevalent in the community and would be a major
health problem amongst the immuno-compromised population, notably the HIV infected patients.
Toxoplasma infection is anticipated to increase with the current HIV/AIDS epidemic in PNG. The
Health Authorities need to be made aware of this problem, now, so they can formulate preventive
and management policies for PNG, for the future.
Final abstract number: 65.009
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Simple Sensitive Diagnosis and Genome Analysis of Wuchereria bancrofti microfilariae and
Wolbachia endosymbiont Archived from Membrane Filters by Nested PCR
                  1              1                  2            2             3              1
A. Bhumiratana , P. Wiboonjak , C. Sangkamanee , S. Koyadun , P. Yongyuth , P. Mahannop
1
 Department of Parasitology, Faculty of Public Health, Mahidol University, Bangkok, Thailand,
2
 Office of Disease Prevention and Control 11 (Nakhon Si Thammarat), Department of Disease
                                                                   3
Control, Ministry of Public Health, Nakhon Si Thammarat, Thailand, Thapput Hospital, Ministry of
Public Health, Phangnga, Thailand

Background: Membrane filtration technique (MFT) has been used for diagnosis of Wuchereria
bancrofti in microfilaremic (Mf) patients either untreated or treated with diethylcarbamazine (DEC)
or in a combination of albendazole (ABZ) or ivermectin, as parts of the Global Programme to
Eliminate Lymphatic Filariasis (GELF). The MFT-based genomic DNA recovery of W. bancrofti Mf
and Wolbachia endosymbiont has however never been developed for diagnostic purpose and
genome analysis.
Methods: Mf blood (1 to 3 ml) of individual patients, collected at time close to peak hour (0100 h)
before and after DEC+ABZ treatment, was filtered using polycarbonate membrane, 5 um pore
size and 25 um diameter. The filters retaining Mf were used for gDNA extraction or stored in 0.9%
normal saline solution for months at cold temperature until use.
Results: Parasite gDNAs archived from the membranes were efficiently amplified using primers
specific for W. bancrofti beta-tubulin gene isotype 1 and of Wolbachia ftsZ gene by nested PCR.
Also, all the samples can be amplified using primers specific for human beta-tubulin gene
homologue (210 bp amplicon) for internal control. Amplification of W. bancrofti gave amplicon
sizes 607 bp of the first reaction and 141 bp (exon 4) and 174 bp (exon 5) of the separate second
reactions, as the Wolbachia 681 bp and 300 bp, respectively.
Conclusion: Amplicons of W. bancrofti and Wolbachia-specific nested PCR using filter-archived
parasite gDNAs can be inserted into cloning plasmid and subsequently sequenced towards the
corresponding exons that are associated with benzimidazole resistance involving amino acid
substitutions. This will be beneficial for the GELF at country level to evaluate and monitor drug
resistance of W. bancrofti populations in target areas and, in particular, it will help to standardize
laboratory investigation performance in cost-effective manner in the endemic countries as the
GELF partners.
Final abstract number: 65.010
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Prevalence of Onchocerciasis and IgG3 Response among the population of Poli(North
Cameroon)
M. Zamio Biloa
Faculty of Medecin and biomedical Sciences, Yaounde, Cameroon

Poli is one of the areas with high endemicity of onchocerciasis in Cameroon. Invermectin
distribution campaign started there since 1993 but there has been no evaluation of the
contribution of this measure to the decrease of the prevalence of the disease in the covered area.
This study sort to determine the prevalence of onchocerciasis the microfilarial load and IgG3
levels of randomly chosen indigenous (112) who spent most of their lifetime in the Poli area. All
persons retained for examination had either never taken ivermectin or had their last dose of
ivermectin more than six months before the starting of the present study. The overall prevalence
of human onchocerciasis in the eight villages studied was 65.18%. The prevalence was higher
(68%) in males than females (59.45%). The microfilarial (mf) density was also higher in the male
population (1.48mf/mg of skin) than the females (1.34mf/mg of skin). The prevalence of
onchocerciasis for the four age groups: 5-20 years. 21-30 years. 31-50 years. >50 years 58.33%,
53.57%, 75.00%, 70.83% respectively while the microfilarial density for these same age groups
(1.15mf/mg of skin, 1.46mf/mg of skin, 1.68mf/mg of skin respectively. IgG3 response was higher
in females than males and globally, IgG3 levels increased with age in onchocerciasis patients.
Sex and age significantly influence the prevalence (P<0.001 and P0.05). Only age significantly
influence the microfilarial density (P 50 years. IgG3 levels did not however, show any correlation
with microfilarial density (r = 0.006; P>0.05). It is evident from this study that after close to a
decade of onchocerciasis control in Poli, the disease is still highly endemic there. Health personal
in Poli, high authorities of Cameroon Ministry of Public Health and the W.H.O are therefore
alerted to visualise new strategies to reinforce control measures in view of the eradication of
"river blindness" in Poli using the present epidemiological picture
Key words: onchocerciasis, onchocerca volvulus, prevalence, microfilarial density,
immunoglobulin gamma 3.
Final abstract number: 65.011
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Clinical Spectrum of 67 Cases of Toxoplasmosis in Tehran : 2000-2004
                  1            1                2
M. Tehrani Sharif , E. Khaksar , B. Hooshmand
1
 Islamic Azad University, Science and Research Branch, Tehran, Iran (Islamic Republic of),
2
 Health & Medical Education Ministry of Iran, Tehran, Iran (Islamic Republic of)

Objectives: Toxoplasma gondii is a zoonotic protozoa which infects a vast variety of warm
blooded animals & human. Toxoplasmosis is usually minor and self-limiting but can have serious
or even fatal effects on a fetus whose mother first contracts the disease during pregnancy or on
an immunocompromised human or cat. The aim of this study is to evaluate the clinical spectrum
of clinical toxoplasmosis in Tehran.
Methods: In order to determine the clinical pattern of toxoplasmosis in Tehran, 67 cases of clinical
toxoplasmosis were analyzed from 2000-2004.
Results: 64% of patients were female & only 36% were male. The percentage of toxoplasmosis
incidence in age groups 0-10, 10-19, 20-29, 30-39, 4049, 50-59, 60-69, >69 years old were 5.97,
29.85, 35.82, 11.94, 5.97, 5.97, 2.98, 1.49 respectively. The percentages of incidence in
housewives were 46.24 %. The mean percentage of lymphadenopathy, ocular lesions, abortion &
neurological manifestations were 47.76, 25.73, 17.91, 8.95 respectively.
Conclusion: The incidence of toxoplasmosis were more common in women. The high incidence of
toxoplasmosis in housewives might be due to direct exposure to raw meat. Lymphadenopathy
were the most common clinical pattern in this study & neurological manifestations were lower in
comparison to other studies.
Keywords: Toxoplasma, Clinical patterns, Iran.
Final abstract number: 65.012
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

The Epidemiology of Amebiasis in Mentally Retarded Institutions in Taiwan
H.H. Hsiao, C.L. Chen, J.J. Huang, T.M. Huang, C.H. Chen
Centers for Disease Control, Department of Health, Taipei, Taiwan

Background: In Taiwan, resident in mentally retarded institutions is high risk group for amebiasis.
Entamoeba histolytica may reside in the intestinal tract in symbiosis with the host and remain
dormant for years. So it is possible the parasite circulates in the institution silently and
continuously. We conducted this study to understand the epidemiology of amebiasis in these
institutions.
Methods: Eleven mentally retarded institutions were selected with stratified cluster sampling.
Stool samples were obtained from residents to screen for amebiasis with enzyme-linked
immunosorbent assays (ELISA). Positive case was tested to confirm the diagnosis using
polymerase chain reaction (PCR) technique. Those who share the same room with the case will
be selected as control group. Questionnaires interview was performed for cases, control group
and managers of institutions to explore related risk factors.
Results: There were 15 ELISA positive from 1,996 residents, and 8 of them were PCR positive
with prevalence rate 0.4%. Analysis of questionnaires showed that case group was tendentiously
older (OR=0.18, 95% CI 0.01-1.95, lower educational level (OR=4.67, 95% CI 0.43-117.12) , and
shorter years of residence (OR=0.95, 95% CI 0.11-9.03) . Self-feeding, self-cleaning after using
restroom, self-bathing and capable of asking for needy help were related to infection. Results are
not statistically significant due to too few cases though, they did indicate that the inmate could
take care of daily living but with insufficient capability to maintain personal hygiene will be the
potential victim assuming the parasite exist in the environments.
Conclusion: The prevalence of E. histolytica infection among mentally retarded institutions in
Taiwan was not as high as estimated, though 8 asymptomatic carriers found. To prevent the
disease, those institutions should be screened periodically, and asymptomatic carriers should be
treated. Implementation of personal hygiene for the inmates is crucial.
Final abstract number: 65.013
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Survey of Hydatid Cyst in Tabriz Slaughter House Killed Animals and Infected Human Cases in
Health Center of Tabriz in 2006 - 2007
M. Khabbaz
Azad university, Tabriz, Iran (Islamic Republic of)

Hydatid cyst is produced by Echinococous granulosous and it is one of the most important
zoonotic infections distributed in the world. Definitive host of this parasite is carnivores and it s
Intermediate host is wild and domestic ruminants. In Iran Hydatid cyst infection rate is reported
between 11.2% to 64 %. By notice to much important of Hydatidosis and many different reports of
infection distribution in Iran a survey was developed about the hydatid cyst infection rate in
animals and humans of Tabriz city. Based on results of survey hydatid cyst infection rate in 2006-
2007 in Tabriz was: In 2006, of the 294540 sheep, infection liver rate were 22190(7.5%) and
infection lung rate were 30238(10.2%). Of the 62780 cattle, infection liver rate were 2982(4.7%)
and infection lung rate were 5377(8.5%). Of the 16960 buffalo, infection liver rate were 620(3.6%)
and infection lung rate were1074 (6.3%). Of the 57845 goat, infection liver rate were 2726(4.7%)
and infection lung rate were 3269(5.6%). Of the 97 camel, infection liver rate were 11(11.3%) and
infection lung rate were 20(20.6%). In 2007, of the 137437 sheep, infection liver rate were 16402
(11.9%) and infection lung rate were 22244(16.1 %). Of the 33227 cattle, infection liver rate were
2600(7.8%) and infection lung rate were 4343(13%). Of the 7582 buffalo, infection liver rate were
535(7%) and infection lung rate were 760(15.2%). Of the 19969 goat, infection liver rate were
1777(8.8%) and infection lung rate were 2253(11.2%). And of the 17 camel, infection liver and
lung rate were 0(0%).
Based on Tabriz health center reports, human infection case rate in 2006 was 15 and in 2006,
infection case rate was 20. With our result in this study because the high prevalence of hydatid
cyst in Tabriz it s very important to control and preventing the hydatid cyst infection in definitive
and intermediate hosts in Tabriz city.
Key words: Tabriz, hydatid cyst, human, slaughter house killed animals
Final abstract number: 65.014
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Prevalence of Toxocara canis in Stray Dogs in Northern Iran
            1          1          1               1        1                2             2
A. Daryani , M. Sharif , A. Amouei , F. Askarian , H. Ziaei , S.H. Gohardehi , R. Bastani
1                                                                               2
 Mazandaran University of Medical SAciences, Sari, Iran (Islamic Republic of), Mazandaran
University of Medical Sciences, Sari, Iran (Islamic Republic of)

Background and objective: Toxocara canis is one of the most common parasites living in the
intestine of domestic and stray dogs. A dog eliminates thousands of eggs into the environment
that are potential etiological factor for human toxocariasis. The present study was undertaken to
determine the prevalence of T.canis in stray dogs in Mazandaran, Iran.
Methods: In this cross-sectional study, during the period from April to September 2007, 50
juvenile and adult stray dogs were collected by shooting from urban areas of Sari city, Northern
Iran. They were necropsied and the gastrointestinal tract was opened. Recovered parasites were
fixed in alcohol and stained in carmine. Faecal specimens also were examined by the formalin
ether concentration method.
Results: A total of 27 adult and 23 juvenile dogs were examined with 11 adults (40.7%) and 19
juveniles (82.6%) being infected with T. canis with an overall prevalence of 60%. There were
significant differences in the prevalence of infection between adult and juvenile dogs (P= 0.003).
There were no significant differences in the prevalence of infection between male and female
dogs (P>0.05).
Conclusion: Considering the high prevalence of this zoonotic parasite and its hygienic
significance in causing human toxocariasis, particularly in children, plus the lack of control of stray
cat populations, there is a need to improve personal and food hygiene as well controlling stray
dogs in these urban areas.
Final abstract number: 65.015
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

CD 28 Gene Polymorphism and Plasma Concentration of Soluble CD 28 in Iranian Patients with
Visceral Leishmaniasis
               1           1          1            2
S.H. Hashemi , M. Hajilooi , M. Fallah , B. Naghili
1                                                                                2
 Hamedan University of Medical Sciences, Hamedan, Iran (Islamic Republic of), Research
Center for Infectious Diseases,Tabriz University of Medical Sciences, Tabriz, Iran (Islamic
Republic of)

Background: It has been demonstrated that CD 28 plays an essential role in the effectiveness of
T-cell immune responses. In visceral leishmaniasis (VL), the resolution of infection and the
development of protective immunity are associated with expansion of leishmania-specific T-cell
responses. In this study we aimed to investigate the CD 28 gene polymorphism and plasma
levels of soluble (s) CD 28 molecule in Iranian patients with VL.
Methods: In a cross-sectional study, plasma concentrations of CD 28 in 88 patients with VL, 132
individual with subclinical leishmaniasis, and 100 seronegative healthy controls were measured
by enzyme-linked immunosorbent assay. Genotyping of CD 28 gene polymorphism was
performed by polymerase chain reaction based allotyping method using allele-specific primers for
C or T at intron 3 position +17 in three groups.
Results:The frequency of CC genotype was significantly higher in subclinical VL patients (42.4%)
than active VL group (27.3%) and healthy controls (16%) (p < 0.001). Also, the frequency of allele
C among subclinical VL group (57.6%) was significantly higher than active VL (40.9%) and
control groups (34%) (p = 0.003). No significant differences were observed between the plasma
levels of sCD 28 in three groups.
Conclusion: Our findings suggest that the CD 28 gene may have significant role in the protection
of active VL in the Iranian population.
Final abstract number: 65.016
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Proteases Secreted by the Infective Larvae of Toxocara canis and Partial Purification of a 50kDa
Protease
                   1                 2                    1
Y.L.P. Jayananda , S.B.P. Athauda , R.P.V.J. Rajapakse
1
 Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Kandy, Sri Lanka,
2
 Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka

Toxocara canis is a nematode parasite of dogs, a causative agent for human toxocariasis. It has
become a major zoono-parasitic infection in Sri Lanka. Infective second-stage larvae of T.canis
secrete proteolytic enzymes which are thought to be instrumental in their tissue-migration
process. Therefore, this study aimed at identifying proteolytic enzymes which are involved in the
metabolic pathway of these parasites and thereby targeting a specific enzyme for the control of
the infection.
Proteolytic activity of these larvae during culture in vitro was determined by gelatin -zymography,
pH optimum and substrate and inhibitor specificity. A partial purification of a 50 kDa protease was
done using DEAE-anion exchange chromatography which was characterized for its optimum pH,
temperature and inhibitor sensitivity.
Excretory-secretory products of infective larvae showed proteolytic activity as seven bands in
gelatin zymography with their molecular weights lie between 175 kDa to 20 kDa. The optimal pH
value for these protease activities was observed between pH 5.5 to 6.5 and activity was optimum
in albumin over gelatin and casein. These activities were inhibited by serine, cystein and metallo
protease inhibitors. 50 kDa protease was partially purified by using DEAE-anion exchange
chromatography and its activity was optimum in pH 8.5 at 70°C .This protease activity was
inhibited by serine, cystein and metalo protease inhibitors.
Proteases secreted by T.canis infective larvae exhibit diversity in classes of proteases, based on
the differential migration in polyacrylamide gels containing gelatin. This result clearly
demonstrates the heterogeneity of larval proteases so might be involved in different functions
during the larval migration. Partially purified 50kDa protease might involve in a specific function
by which, inhibition of this enzymes activity may arrest the activity of infective larvae. Therefore,
this enzyme could be target candidate to control of toxocariasis by inhibition with chemical or
immunological methods.
Final abstract number: 65.017
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Seropervalence Toxocariasis in Children Aged 2-15 Referring to the Hospitals and Medical
Centers in Zanjan, Iran During the Year 2007
A. Nourian, M. Amiri, A. Ataeian, A. Hanilo, N. Mousavinasab
zanjan university of medical sciences, Zanjan, Iran (Islamic Republic of)

Background: Toxocariasis is a cosmopolitan disease with a high prevalence among children. Oral
entrance of the parasite eggs into the body and release of the larva in intestine and their entering
to bloodstream results in visceral larva migrans (VLM) and ocular larva migrans (OLM).This study
is a aimed to study the amount of serum IgG against Toxocara in children aged 2-15 who referred
to the hospitals and health centers of Zanjan province in 2007.
Method: In this cross - sectional study, blood samples from 810 children aged 2 - 15 referring to
the medical centers and hospitals were collected. The presence of IgG against stage 2 larva was
detected by ELISA. Data related to age and degree, education of parents and children, history of
illnesses, washing hands and contact with cats and dogs were collected through questionnaires.
The collected data were analyzed by SPSS 11.5 for windows package using Chi-square test.
Results: The overall seroprevalence of Toxocariasis in children aged 2 - 15 years, was found to
be 2.7% (22 cases). The titer of IgG in rural and urban population was 4.4% and 1.6%
respectively. Contact with cats and infectious were statistically significant. No significant relation
was found between the infectious and the level of education of children and their parents, hand
washing, contact with dogs and history of disease and location . ( P> 0.05)
Conclusion: This study shows that Toxocara exists in Zanjan, and can effect children aged 2-15.
Thus, informing parents and children about the risk factors of infection transmission and related
complications is recommended. Moreover, we should draw physician attention to the disease and
symptoms that are similar to other infections diseases. Keywords: Toxocariasis , VLM, OLM ,
ELISA, Zanjan .
Final abstract number: 65.018
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

The Identification of Cryptosporidium Species by PCR-RFLP Analysis of the 18s rRNA Gene
                             1          1           2           2
D. Dorostkar Moghaddam , M. Azami , R. Salehi , M. Salehi
1                                                                             2
  Isfahan University of Medical Sciences, Isfahan, Iran (Islamic Republic of), Isfahan uiversity of
Medical Sciences, Isfahan, Iran (Islamic Republic of)

Background: Cryptosporidium is an important protozoa that cause diarrheal illness in humans and
animals.In immuoncompetent individuals,infection is usually self-limiting,but in
immunocompromised patients infections which can be life threatening may
develop.Cryptosporidium may account for 10 to 20% of the cases of diarrhea in
immunocompromised patients living in developed countries and as much as 50% in
underprivileged countries. Different strains of Cryptosporidium have been reported and it is
belived that strain characteristics are an important factor to be cosidered is strategic planning for
the control of cryptosporidiosis disease.In this study human and animal isolates of
Cryptosporidium ooccysts were examined by PCR-RFLP for identifying strain variation in isfahan.
Methods: A total of 624 fecal samples of children under 5 years of age,immunocompromised
patients and high risk persons and 480 rectal specimens of cow and calves selected
randomly.After identification of the samples contaminated with the parasite,oocysts were purified
from this samples and their DNA were extracted.These DNAs were use for the detection of
Cryptosporidium species using PCR-RFLP analysis of a 1750bp region of 18s rRNA.
Results: Microscopic results showed that 4.7% of human samles and 6.2% of animal samples
contaminated with Cryptosporidium.18s rRNA gene of all isolates were amplified by PCR and 18s
rRNA fragment size of all isolates were identical approximately 1750bp.
RFLP results showed the samples contaminated with C.parvum
II,C.baileyi.C.serpentis,C.muris.C.wrairi and three new genotype of Cryptosporidium.
Conclusion: PCR-RFLP results indicates the occurence of most strains of Cryptosporidium
specially C.parvum.The results also imply extensive polymorphism in this parasites and the
occurrence of mutant strains of it.
Furthermore,the occurrence of animal species of the parasite in human samples shwos the
important of animal-human cycle of it.
Final abstract number: 65.019
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Epidemiology study of Entamoeba histolytica / Entamoeba dispar in bloody diarrhea in Iran
                  1                  2                     1           1           1         1
M. Rostami Nejad , K. Cheraghipour , E. Nazemalhosseini , E. Abdinia , M. Vahedi , H. Dabiri ,
         1
M.R. Zali
1
 Research Center of Gastroenterology and Liver Disease, Shaheed Beheshti Medical
                                                              2
University,Foodborne dep., Tehran, Iran (Islamic Republic of), Medical science university of
Hamadan, Hamadan, Iran (Islamic Republic of)

Background:Amebiasis is still an important health problem in Iran, which is characterized by low
socioeconomic status and poor hygiene that favor the indirect fecal-oral transmission of the
infection. The aim of this study represented the distribution of E. histolytica and E. dispar in
bloody diarrheal patients who were referred to health care center in Aleshtar, the northern city of
Lorestan province.
Methods: During the period of 2004-2006, Ninety eight patients (2004:( 25.5%), 2005:( 36.7%)
and 2006 (37.8%) with bloody diarrheal were referred to health care centers in Aleshtar. 53
(54.1%) urban and 45(45.9%) rural. We used microscopic and staining method to examine the
stool samples for presence of trophozoites, ova, cysts, larvae and oocysts of intestinal parasites
by standard techniques.
Results: Out of 98 fecal samples (62.2% male and 37.8% female), with mean age of 15.51 and
SD 13.35, the microscopy results of bloody diarrhea exams showed a frequency rate of 91
positive samples (92.9%) for cyst of E. histolytica/E. dispar complex, 5(5.1%) and 2(2%) for
Giardia lambelia and Shigella spp. respectively. Fourty eight (48.9%) of these samples were
children. There were significant relationship between sex, occupation and age of patients with E.
histolytica/E. dispar complex (p<0.01, 0.000 and p<0.000 respectively).
Conclusion: There were significant difference between referred month to health care center and
the prevalence of E. histolytica/E. dispar complex in bloody diarrhea. July and August were the
highest contaminate month (p<0.000), it is due to low level hygiene to increase the disease.
Microscopy is not a sensitive and reliable technique for diagnosing intestinal amebiasis as well as
differentiation of E. histolytica from E. dispar. This result clearly indicates the difficulty faced by
technicians in morphologically differentiating of the cysts of Entamoeba and other species by
using microscopy for routine diagnosis. Molecular technique is necessary for differentiating of E.
histolytica from E. dispar as non-pathogenic amoeba.
Keywords: Aleshtar, bloody diarrhea, E. histolytica/E. dispar
Final abstract number: 65.020
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Rodents as Museum of Helminthic Parasites of Public Health Importance in Punjab, India
         1             2          1
N. Singla , L.D. Singla , R. Kaur
1                                                                       2
 Department of Zoology, Punjab Agricultural University, Ludhiana, India, Department of
Veterinary Parasitology, Guru Angad Dev Veterinary and Animal Science University, Ludhiana,
India

Besides causing direct and indirect damages to agricultural produce both at pre- and post-harvest
stages, rodents are held responsible for transmitting various diseases to humans and livestock.
Infection in humans generally occurs directly through contact with rodent excrement, through
ingesting food contaminated with their fur, feet, urine or fecal droppings, through rodent bites and
indirectly through bites from ectoparasitic vectors such as fleas and ticks.
To determine the kind of helminthic species infesting rodents and their site of infection, three
rodent species namely, Bandicota bengalensis, Tatera indica and Rattus rattus predominant in
irrigated and dry land agriculture and commensal situations, respectively in Punjab (India) were
live trapped with multicatch rat traps. Their organs such as liver, stomach, small and large
intestine and reproductive tract were examined for the presence of parasites. Collected parasites
were preserved either in 10% formal saline or in 70% alcohol and were identified after staining
with haematoxylin-carmine (cestodes) and clearing in lacto-phenol (nematodes). Fecal
examination was also carried out for presence of eggs of different parasites.
Individual rats were mostly found infected with more than one species of parasites. Different
helminthes recovered included Cysticercus fasciolaris, Hymenolepis diminuta, H. nana,
Railletiena spp., Moniliformis moniliformis, Trichuris spp. and an unidentified Trichostrongylid
nematode. The C. fasciolaris was found in all the three rodent species in the form of multiple
metacestodes of Taenia taeniaeformis in liver. In one T. indica, ectopic metacestodal infection of
T. taeniaeformis attached to mesentery and abdominal wall was found concurrent to an
unidentified Trichostrongylid nematode in cauda epididymal fluid. Similarly in B. bengalensis, dual
infection of C. fasciolaris and an acathocephalan, Moniliformes moniliformis was found. One R.
rattus was found to have tripple infection in the form of metacestodes of T. taeniaeformis in liver
and numerous adult parasites of H. diminuta and H. nana entangled in small intestine.
Examination of fecal droppings revealed the presence of eggs of helminthes.
Since the majority of parasites recorded are zoonotic to humans and are also known to infect
domestic/pet animals, the best prevention is to minimize rodent infestations in close proximity to
human and animal dwellings by improving environmental sanitation, public hygiene and other
rodent control efforts.
Final abstract number: 65.021
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

The Correlation Antibodies Antitoxoplasma - Histopatologic Repert in Subacute and Acute
Lymphoadenopathy
N. Como, E. Muço, D.H. Kraja, E. Meta, A. Kica, R. Petrela, V. Ostreni
Univeristy Hospital Center, Service of Infecious Diseases, Tirana, Albania

The material: 60 patients with lymphoadenopathy in age group of 16-58 years old, during 1995 -
2005 period.
The methodology: The cases were completed with: IFT, ELISA IGM and IgG antitoxoplasma
histopatological exam of lymphoadenitis (cytologic exam 15, biopsy 33, both cytology +biopsy 12
cases ). We have analised the correlation serology histopatology by the point of view fo
toxoplasmosis and lymphoma.
The results: We have distinguished 5 correlative variations:
A-High titrations - reactive/inflammation lymphoadenopathy 13 cases: 10 toxoplasmosis
(IgM>IgG), 1 Lymphoma ( IgG>IgM), 2 neither toxoplasmosis nor lymphoma ( IgG>IgM).
B-Medium titrations - normal lymphoadenopathy 15 cases: 8 toxoplasmosis (4 IgM > IgG, 2 IgM =
1 IgG, 2IgG > IgM). 1 limfoma (IgG>IgM), 6 neither toxoplasmosis nor lymphoma ( 1 IgM>IgG, 5
IgG > IgM ).
C-Negative serology - normal histopathology 11 cases: 0 toxoplasmosis, 1 lymphoma, 10 neither
toxoplasmosis nor lymphoma.
D-Low and medium titrations - reactive/ inflammation lymphoadenopathy 11 cases: 2
toxoplasmosis ( ( 1 IgM > IgG, 1 IgG > IgM ) 5 lymphoma ( 1 IgM > IgG, 4 IgG > IgM), 4 neither
toxoplasmosis nor lymphoma ( 1 IgM = IgG, 3 IgG > IgM).
E-Lymphomatosis histopathology 10 cases - medium titrations, 3 cases low titrations. The
titrations of antibodies antitoxoplasma resulted: 1 IgM = IgG, 2 IgG > IgM in none of then we had
diagnose movement during the time.
Conclusions:
- In 25 % lymphoma with reactive/inflammation histopatologic repert, antitoxoplasmosis serology
may cause diagnostic mistakes.
- We have had false - normal histopatologic repert in 6.6% of lymphoma with medium positive
serology.
- Subjects with lymphomatic histopatologic repart in 33.3.% of cases were seropositive for
toxoplasmosis.
- Biopsy repetition and serology on suspicious cases is indispensable.
Final abstract number: 65.022
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Study of Prevalence of Echinococcus multilocularis Infection in Carnivores of Moghan Plain
,North West of Iran in 2007
M. Siavashi, M. Zarea
Pasteur Institute of Iran, Tehran, Iran (Islamic Republic of)

Echinococcus multilocularis (EM) parasitizes the small intestine of red foxes (Vulpes vulpes) and
other carnivores and has wide distribution throughout the northern hemisphere. In Iran, All of
human cases infected with metacestode (alveolar echinococcosis) of EM are reported from
Moghan plain in north west of our country . Therefore, following the study of seroepidemiology of
alveolar echinococcosis in residents of this region we decided to study of prevalence of EM in
definitive hosts infected by adult worms.
In this way ,two valid and highly sensitive tests, nested PCR and copro- ELISA were used for
detection of EM infection in 155 carnivores including 95 red foxes(Vulpes vulpes) , 40 stray dogs
and 20 jackals . All of the carnivores were hunted under the governmental control program in the
region.
The final results showed the prevalence of 2.58% for EM infection in Moghan plain (4 out of 155
cases). All of the positive cases were among red foxes, and none of the other carnivores showed
positive with both tests.
The results gained by both tests (Copro-ELISA and Nested PCR) were similar for positive and
negative cases.
In conclusion , according to our study Echinococcus multilocularis in red foxes and human
alveolar echinococcosis are endemic infections in Moghan Plain in north western part of Iran,
although the infection of regional rodents with metacestode is not proven yet.
Final abstract number: 65.023
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Biochemical Changes in the Fertile and Sterile of Hydatid Cyst Fluid in Sheep
            1              2
S. Rouhani , A. Vatankhah
1
 Shahid Beheshty University of Medical Sciences, Tehran, Iran (Islamic Republic of),
2
 Parasitology Dept.Pasteur Institute of Iran, Tehran, Iran (Islamic Republic of)

Introduction: Hydatid cyst involves vital organs such as, liver, lungs, spleen, kidneys and so on.
Hydatidosis could be seen in many ruminants and accidentally in human.
Hydatidosis causes impairment physiological functions. This disease disturbs the balance of
biochemical compounds.
Material and methods: Eighty five livers and lungs from sheep having Hydatid cysts were taken
from Ghaem Abattoir. Five milliliters of Hydatid fluid was taken from each from fertile and sterile
cyst. Protein, cholesterol, glucose, phosphate, calcium and enzymes like alkaline phosphatase
(ALP), lactate dehydrogenase (LDH), alanine aminotransferase (ALT) and aspartate
aminotransferase (AST) have been measured by Autoanalyzer apparatus. Flamphotometry has
been used for Na and K measurement.
Results: The mean of biochemical compound such as, protein, cholesterol, glucose and enzymes
like ALP, LDH, ALT and AST was different in the fertile and sterile cysts of lung and liver in
sheep.
The total protein, cholesterol, glucose and LDH, ALP, AST enzymes differed significantly between
fertile and sterile in liver.The above mentioned compounds of lung except cholesterol and alanine
aminotransferase also differed significantly between sterile and fertile cysts.
Mineral elements such as, Na+, K+, Ca 2+ were different in fertile and sterile cysts in accordance
to their location. Na, K and Ca in fertile cyst of liver were higher than sterile cyst.
Conclusion: These results lead us to this idea that ability of the wall of sterile and fertile is
different and this could be used as a hypothesis for biochemical control of Hydatidosis.
Key words: Hydatid fluid, fertile cyst, sterile cyst, biochemical compound
Final abstract number: 65.024
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Relapse After Treatment with First Stage Drug in Human African Trypanosomiasis: Contribution
of Molecular Biology
L. Kohagne Tongue , F. Louis, N.F. Dologuele
OCEAC, Yaoundé, Cameroon

Chemotherapy of Trypanosoma brucei gambiense human African trypanosomiasis (HAT) relies
on only a few drugs: suramin or pentamidine for the first stage of the disease, melarsoprol and
eflornithine for the second stage. Drug treatment failures are mainly reported for melarsoprol and
have alarmingly increased in many epidemic foci, such as Uganda (30%), Sudan (16-21%), and
Angola (25%). Relapse after pentamidine treatment has not yet been described. In March 2006, a
parasitological survey was carried out in Mandoul focus (Chad). 76 HAT cases were diagnosed,
of which 54 were in the first stage. Six months later, white blood cells (WBC) in the cerebrospinal
fluid were found to be increased in 24% of first-stage patients. After excluding factors of treatment
failure such as low/wrong dose or poor quality drugs, we concluded that these patients were in
relapse. Pentamidine treatment failure rarely occur in the field. Reasons for relapse could be
parasite-related factors such as drug resistant-trypanosomes. It has been shown that
trypanosome resistance is a result of reduced net drug uptake. Generally, it is believed that
pentamidine enters the trypanosome via the P2 purine transporter, but also via at least two other
transporters, HAPT1 and LAPT1. Based on this hypothesis, it has been proposed that resistance
to pentamidine is quite difficult to develop since the function of several transporters must be
inhibited. We think that it would be very interesting to analyze isolates from patients with
treatment failure. By using the techniques of molecular biology, the presence or absence of these
transporters can be determined in "resistant parasites". Pentamidine treatment failure is emerging
in HAT foci. It is urgent to take control measures and prevent its spread to other foci.
Final abstract number: 65.025
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

The Distrubution of Intestinal Parasites Prevalance at Five Years of Sex and Species of the
Osmangazi University Medical Faculty
N.D. Dogan
Microbiology, Eskisehir, Turkey

Background: In this study, patients (outpatients and in patients) with various gastrointestinal
system complaints presenting at various clinics of the Eski ehir Osmangazi University medical
Faculty, from February 2003-December 2007 were investigated for intestinal parasites.
Prevalence of intestinal parasites was evaluated according to species, gender and the years in
which cases were seen.
Material and method: 34.733 stool samples prepared by formal-ethyl acetate concentration and
after saline and iodine preparations for microscopic examination under 10x and 40x
magnification. Also trichrome stained preparations in ambiguous amoebas cases and modified
Erlich Ziehl Nielsen stained preparations for Cryptosporidium spp. Were examined by oil-
immersion objectives (100x).
Results: One or more parasites were found in 1252 of the 34.733 stool samples (included
nonpathogenic parasites).The overall prevalence of intestinal parasitic infection rate was 3.6%, of
these 52.5% were female and 47.5% male. Predominant parasites was Entamoeba
histolytica/dispar group amoebas with which 31% (397/1252), fallowed by Giardia lamblia 19%
(236/1252) and Blastocystis hominis 7% (108/1252), Cryptosporidium parvum %4.5 (56/1252).
Selophan band method is used in a few cases, therefore distinct ratios from other studies are
detected in helmint cases. The ratios of Entamoeba vermicularis 2.3% (29/1252), were as Taenia
saginata 0.8% (10/1252) and Strongyloides stercoralis 0.4% (5/1252) respectively. In a previous
10 years retrospective study which was performed in our hospital, we detected important
decrease in prevalence of parasites. But intestinal parasites are still important problems.
Final abstract number: 65.026
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Seroepidemiology of Toxoplasma gondii in Workers of Slaughterhouse in Zapopan, Jalisco
                      1                      2                     3
M.L. Galván-Ramírez , C.M. Flores Orozco , J.L. Soto Mancilla
1
 Laboratory of Neurophysiology, CUCS, University of Guadalajara, Guadalajara, Jalisco, Mexico,
2                                                                            3
 Hospital of Mexican Institute of Social Security , Ocotlan, Jalisco, Mexico, Chief of pediatric
neurosurgery Hospital Civil Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico

Background:Toxoplasma gondii was discovered by Nicolle and Manceaux in 1908, and it is the
causal agent of human and animal toxoplasmosis. Slaughterhouse workers can acquire the
infection inadvertently through wounds when they handle raw meat contaminated with
Toxoplasma gondii. In Mexico there is no previous study of slaughterhouse workers; The aim of
this study was to find the prevalence of anti-Toxoplasma antibodies in these workers and to
evaluate risk factors.
Methods: IgG antibodies were identified through the ELISA immunoassay (Biokit) in 145 workers
of the Municipal Slaughterhouse in Zapopan, Jalisco, Mexico.
Results:The prevalence of anti-Toxoplasma IgG antibodies was found in 104 (72%). The antibody
levels were positively related to the time spent working in the slaughterhouse. The data analysis
showed no statistically significant difference in the prevalence of anti-Toxoplasma antibodies
when we compare other risk factors such as the habit of eating raw meat, consuming unwashed
vegetables, or having cats, for which we consider the principal risk factor is working in the
slaughterhouse and being in contact with raw meat contaminated by T. gondii.
Conclusion:
The prevalence of anti-Toxoplasma IgG antibodies was greater than that found in other study
populations in Mexico, suggesting a considerable occupational risk in slaughterhouse workers.
Final abstract number: 65.027
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Analysis of PGF2a Synthase in Old and New World Species of Leishmania
           1             2
J. Majanja , B.K. Kubata
1                           2
 USAMRU-K, Nairobi, Kenya, BECA Secretariat, International Livestock Research Institute,
Nairobi, Kenya

Background: Leishmaniasis is characterized by an increase in prostaglandin (PG) levels in the
host, which accounts for some of the symptoms of the disease. The molecular mechanisms for
the up-regulation of PGs during infection are poorly understood. Identification of the enzymes
which catalyze the production of PGs provides a basis for better understanding of PGs' role in
Leishmaniasis.
Methods: To investigate the distribution of Prostaglandin F2a (PGF2a) synthase in Leishmania,
isolates of L. major, L. donovani, and L. tropica (Old World species) and L. amazonensis, L.
braziliensis, L. mexicana, and L. chagasi (New World species) were cultured in vitro.
Promastigotes were harvested by centrifugation, washed with Phosphate buffered saline and
genomic DNA (gDNA) extracted. The PGF2 a synthase gene was amplified using LmPGFS gene
specific primers. 25 g of total protein was extracted from each species, analyzed on 13% SDS-
PAGE gels, and transferred onto an Immun-Blot PVDF membrane.
Results: We detected the PGF2 a synthase gene in the Old World species (855 bp) but failed to
detect it in any of the New World species except for a 2 Kb fragment corresponding to L.
braziliensis. The Western Blot analysis detected the PGF2 a synthase enzyme exclusively in the
Old World strains.
Conclusion: The PGF2a synthase gene was only detected in one of the New World species, and
none expressed the synthase enzyme even though most species of New World Leishmania retain
the ability to synthesize PGF2a. Evidently, different genes and enzyme systems have evolved to
synthesize PGF2a in the Old and New World species. This divergent evolution of the synthase
genes in disparate geographical locations may suggest an important role for PGF2a in differing
Leishmania vector compatibility between the Old and New Worlds.
Final abstract number: 65.028
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Diarrhoeagenic Protozoan Parasites in Rural Persons and Links to HIV Infection and Drinking
Water Sources
               1           1            1         2               1             1
S. Zinyowera , V. Ruhanya , C. Berejena , N. Midzi , M. Mapingure , T. Mduluza ,
                  1
P. Nziramasanga
1                                           2
 University of Zimbabwe, Harare, Zimbabwe, National Institute of Health of Health Research,
Harare, Zimbabwe

Diarrhoea accounts for most of the global morbidity and mortality. It is mostly waterborne and
causes an estimated 2.2 million deaths yearly. Ninety percent (90%) of HIV/AIDS patients in
developing countries suffer from episodic diarrhea.
This study enrolled 113 subjects who volunteered in a rural community in Zimbabwe. Thirty-four
(30%) were males, 79(70%) were females whose ages ranged from 2-89 years. HIV counseling
and testing was done. Stool samples were collected from 104 subjects as well as 1 litre water
samples from their drinking water sources. Examinations for parasitic infections were done on all
samples using the sandard parasitology operating procedures for proessing samples.
Methods used were wet preparations, formal ether concentration method, gomori/trichrome
staining and the cold Ziehl Neelson staining. The same methods as described above were also
done for water samples, except the formal ether method was replaced by the zinc sulphate
technique.
Twenty-nine (25.7%) of the study subjects were HIV positive and 84 (74.3%) were negative by 2
rapid serology tests. Seventeen participants (18.3%) produced diarrheic stool samples of these
6(26%) were HIV seropositive. The remaining 76 (81.7%) had formed stools. Eighty (76%) of
subjects had protozoan parasites. The parasites identified in stool were Giardia lamblia 4(2%),
Entamoeba histolytica/dispar 20(11%), Cryptosporidium parvum 9(5%) and Cyclospora
cayatanensis 24(13%). Non-pathogenic species found were 92 (52%) of which 49 (26.9%) were
Entamoeba coli. Polyparasitism was evident with 21(20%) harboring 2 different species of
protozoan parasites, 15 (14%) harboring 3 different species and 7 (6.7%) harboring 4 different
species. Only one person was infected with a helminth, Schistosoma mansoni. Water samples
from deep protected wells that were being used by 34(33.6%) of the people, yielded a significant
association (p<0.05) with G. lamblia, E. histolyticar/dispar, C. cayatanensis and unidentified water
flagellates. The water sources were being used without treatment and were shown to pose a risk
for acquiring diarrhoeagenic protozoan parasites.
Final abstract number: 65.029
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Effects of Intestinal Parasite Infections on Cardiovascular Functions
N. Dogan, K. Uzuner, S. Arkan
Osmangazi University Medical Faculty, Eskisehir, Turkey

Background: Since Intestinal parasites have ability to allergenity, malabsorption and psychosocial
disorders of the host. They might also interfere cardiovascular function directly or indirectly
depending on physiological status of the host, and content and variety of parasitic exposure.
The aim of our study was to investigate whether helminths or protozoon infections may interfere
cardiovascular functions in anesthetized rats.
Material and Method: Three groups of individually caged Sprague-Dawley female rats, control
(n:15), with helminths(n:11) and with protozoons (n:11), weighing 200-220 g were anesthetized
with Xylasine HCl (10 mg/kg) + Ketamine HCl (50 mg/kg) (i.p) and placed on a warmed surgical
plate to maintain body temperature at 37 ± 0.5 °C throughout the experiment. The femoral artery
was catheterised with PE 50 tubing for monitoring cardiovascular parameters (intra-arterial
systolic pressure-ST, diastolic pressure-DT, mean arterial pressure-MAP and heart rate-HR) via a
pressure transducer connected to a data acquisition system. Cardiovascular parameters were
recorded at 45 minute periods following a one-half hour stabilization period. The femoral vein was
catheterised for fluid replacement via an infusion pump (25 l/min of %0.9 NaCl). At the end of
the experiment, Colon and small intestine samples were excised and put into saline filled beaker
for parasitic examinations.
Results: ST, DT,MAP and HR were significantly high in Helminth infected rats compared to
values of the control and protozoon infected rats. But the inspected cardiovascular parameters in
protozoon infected rats were not significantly different from the control's.
Conclusions: Our results suggest that helminth infections but not protozoon infections have an
important cardiovascular effects in rats. Thus, Helminth infections might carefully examined in
especially hypertensive conditions.
Final abstract number: 65.030
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Intestinal Schistosomiasis and Soil-Transmitted Helminthiasis in a Peri-Urban Community in Rio
De Janeiro State, Brazil
            1              2               2              2             3            2
O.K. Seck , M.F. Gusmão , M.G.M. Barreto , M.T. Paulino , R.P. Igreja , M.S. Soares
1                                                              2
 Instituto Fernando Figueira, FIOCRUZ, Rio de janeiro, Brazil, Lab. de Avaliação e Promoção da
                                                   3
Saúde Ambiental, FIOCRUZ, Rio de janeiro, Brazil, Faculdade de Medicina/UFRJ, Rio de
Janeiro, Brazil

Background: Schistosomiasis and soil-transmitted helminthiasis are ancient diseases that
continue to cause misery and disability in poor populations. About 10-12 million people were
infected with S. mansoni in Brazil by the 1970's. Ongoing control programmes have successfully
reduced mortality, morbidity and transmission. Nevertheless, there are still around 2.5 million to
6.3 million infected people in Brazil. In Rio de Janeiro State, there are some areas of low
endemicity of schistosomiasis or even isolated foci and a predominance of light infections, i.e.,
less than 100 eggs/gram stool (epg). Paracambi, a county in the State of Rio de Janeiro, has
many peri-urban and rural communities with poor sanitation where occurs active transmission of
schistosomiasis and soil-transmitted helminthiasis. The aim of the present study was to evaluate
the prevalence of schistosomiasis and soil-transmitted helminthiasis in Sabugo, a peri-urban
community of Paracambi.
Methods: The study was performed between January and July 2005. One stool sample was
collected from each individual and two slides were examined by Kato-Katz and free
sedimentation methods.
Results: 1356 individuals were enrolled in the study. We found 52 (3.8%) patients with hookworm,
45 (3.3%) with Trichuris trichiura, 35 (2.6%) with Ascaris lumbricoides, 19 (1.4%) with
Strongyloides stercoralis, 13 (1.0%) with Schistosoma mansoni and 8 (0.6%) with Enterobius
vermicularis. Among the patients with schistosomiasis, 10 were men, 12 were over 15 years old,
leisure was the main reason for infection and at least 11 individuals were infected in Sabugo. All
patients had the intestinal or hepato-intestinal form of schistosomiasis and 8 patients had light
infections.
Conclusions: Although the prevalence of schistosomiasis is low and light infections predominate
active transmission still occurs in Paracambi. Schistosomiasis control measures should be
directed to young men during leisure time.
Final abstract number: 65.031
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Inherited Variability in Tumour Necrosis Factor Production and Potential Susceptibility to
Cutaneous Leishmaniasis in the Sri Lankan Population
T.N. Samaranayake, S.D. Fernando, R.W. Jayasekara, V.H.W. Dissanayake
Faculty of Medicine,University of Colombo, Colombo, Sri Lanka

Introduction: Tumour necrosis factor (TNF) a and b are critical mediators of many inflammatory
and immune-stimulatory responses. Inherited variability in TNF production due to genetic variants
have been implicated in the susceptibility to many infectious and non infectious conditions,
including visceral leishmaniasis caused by Leishmania donovani - the causative parasite of
cutaneous leishmaniasis in Sri Lanka. The objective of this study was to determine the
prevalence of alleles of TNFa -308G>A and TNFb +252A >G polymorphisms in the Sri Lankan
population.
Methods: 90 (50% Male) Sinhalese (30), Sri Lankan Tamil (30) and Moor (30) random volunteers
were genotyped at the two polymorphic sites using published PCR/RFLP methods.
Results: The genotype and allele frequencies are given in the table. The genotype frequencies at
the TNFb +252A >G polymorphic site differed significantly between Sinhalese and Tamils
(P=0.04) and between Sinhalese and Moors (P=0.02).
Conclusions: This data shows that these two polymorphisms are indeed polymorphic in the Sri
Lankan population rendering them potentially susceptible to cutaneous leishmaniasis. The ethnic
differences in the TNFb +252A>G are interesting in view of the observation in epidemiological
studies that cutaneous leishmaniasis is almost exclusively found in Sinhalese.
Conflicts of interest: The authors have no conflicts of interest concerning the work reported in this
paper.
Final abstract number: 65.032
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Inherited Susceptibility to Cutaneous Leishmaniasis in Sri Lanka
T.N. Samaranayake, S.D. Fernando, R.W. Jayasekara, V.H.W. Dissanayake
Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

Background: Cutaneous leishmaniasis (CL) is recognized to be an endemic disease in ri Lanka.
The majority of patients with CL have been observed to belong to the Sinhalese ethnic group.
Inherited variability in Tumour Necrosis Factor (TNF) production has been implicated in the
susceptibility to visceral leishmaniasis caused by Leishmania donovani - the causative parasite of
CL in Sri Lanka. Our previous work has shown a significant difference in allele frequencies for
polymorphisms of TNF b among different ethnic groups in Sri Lanka. We carried out a case
control study to determine the association of alleles of TNFa -308G‡A and TNFb +252A >G
polymorphisms with CL in the Sri Lankan population. The preliminary findings are presented.
Methods: 200 consecutive patients presenting to a tertiary referral centre for confirmation of
diagnosis of leishmaniasis and 200 matched controls from the same endemic regions were
recruited. 50 patients and 50 controls have so far been genotyped at the two polymorphic sites
using published PCR/RFLP methods.
Results: The genotype and allele frequencies are given in the table. Although TNFb +252A >
allele, the allele associated with susceptibility to leishmaniasis as found to be more in cases than
controls, the difference in allele frequency distribution was not significant (P>0.05).
Conclusions: The preliminary analysis of 50 cases and controls is underpowered to support or
refute the hypothesized association. Genotyping the rest of the sample collection is on going in
our laboratory.
Conflicts of interest: The authors have no conflicts of interest concerning the work reported in this
paper.
Final abstract number: 65.033
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Geographic Factors Associated to Trypanosoma cruzi Infection in Western Mexico
F. Espinoza-Gomez, O.A. Newton-Sanchez, V. Melnikov, A. Maldonado, F. Rojas-Larios
University of Colima, Colima, Mexico

Some regions in Latin America still have continuous transmission of Trypanosoma cruzi (TC) and
could serve as reservoirs for reinfection of Chagas disease. This could be the case of Mexico,
where TC infection have been recently documented. With the purpose to estimate the incidence
of infections with TC and to explore its association with geographic and demographic factors, a
double cohort study was done in Colima, at the western coast of Mexico. The first cohort
comprises a group of 195 persons previously negative for T. cruzi infection in a survey done 5
years before. The second cohort is a group of 468 infants from 1 to 5 years old. The pressence of
TC infection was determined by means of Indirect Hemagluttination test at titres 1: 16. The
analysed factors were: Age; Sex; Domestic animals; Type of housing; Geographic situation
(GPS); Type of location (rural or urban); Knowledge about bugs and Contact with them.
In total 18 individuals resulted positive for IHA in both groups for the 5 year period (estimated
minimal annual incidence of TC infection: 440/ 100,000 habitants). A Fisher exact test showed
                                                            2                                   2
significant association with the age groups: 12 years (c = 10.6, p= 0.001) and 2 years (c =
                                                             2
2.9, p < 0.05). As well as Contact with triatomine bugs (c = 4.25, p= 0.04). Meanwhile the other
factors did not showed significant association. The drawing of positive cases upon a Google
                                                                       2
Earth map showed a clustering in an area of approximately 50 Km , closely related to Sugar Can
fields.
These data indicates that TC infection is an active and probably increasing problem in this area of
Mexico. The clustering of cases around sugar can fields suggests that the continuous burning of
crops could have implications in the movement of TC vectors and hosts toward human
settlements.
Final abstract number: 65.034
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Seroprevalence of Entamoeba histolytica Infection in China
         1         2         1         1       2              3
X. Cheng , Y. Chen , B. Yang , M. Feng , L. Xu , H. Tachibana
1                                                       2
 Fudan University School of Medicine, Shanghai, China, Chinese Center for Disease Control and
                             3
Prevention, Shanghai, China, Tokai University School of Medicine, Isehara, Japan

Amebiasis cased by infection with Entamoeba histolytica is one of the most problematic parasitic
diseases in developing and developed countries. E. histolytica infection is also related to diarrhea
in patients with HIV infections and AIDS. However, the prevalence of E. histolytica and E. dispar,
which is morphologically indistinguishable from E. histolytica but nonpathogenic, is not well
known in China. In the present study, seroprevalence of E. histolytica infection was examined in
healthy individuals. A total of 1,349 serum samples were obtained in Beijing city, Shanghai city,
Guangxi province, Guizhou province, Sichuan province, Qinghai province, and Xinjiang province.
Seropositivity to E. histolytica was examined by using three methods; ELISA using crude antigen,
ELISA using a recombinant fragment of C terminus of intermediate subunit lectin of E. histolytica
(C-Igl), and indirect fluorescent-antibody test (IFA). Total positive rates evaluated by these
methods were 13.9, 6.3 and 2.1%, respectively. Among the 7 areas, positive rates in Guizhou
(37.9% in ELISA using crude antigen, 15.3% in ELISA using C-Igl, and 9.5% in IFA) were
significantly higher than those in other areas. On the other hand, no positives were found by IFA
in samples from Shanghai. These results demonstrate that prevalence of E. histolytica infections
in China seems to be quite different between urban and rural areas. Further epidemiological
study in high-prevalent areas is early requisite for the control of amebiasis in China.
Final abstract number: 65.035
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Clinical Features of Cutaneous Leishmaniasis in Sri Lanka and Molecular Identification of L.
donovani as the Cause
                      1             2               3                        4             3
H.V.Y.D. Siriwardana , H.A. Noyes , N.J. Beeching , A.R. Wickremasinghe , M.L. Chance ,
            3                  1
P.A. Bates , N.D. Karunaweera
1
 Department of Parasitology, Faculty of Medicine, University of Colombo, Sri Lanka., Colombo,
            2
Sri Lanka, School of Biological sciences, University of Liverpool, UK,, Liverpool, United
           3
Kingdom, Liverpool School of Tropical Medicine, University of Liverpool, UK., Liverpool, United
           4
Kingdom, Faculty of Medicine, University of Kelaniya, Sri Lanka. , Kelaniya, Sri Lanka

Background: Cutaneous leishmaniasis (CL) is a newly established disease in Sri Lanka with over
1500 locally acquired cases reported since year 2001.
objectives: To study the clinical profile, associated risk factors and genetic analysis of the
causative parasite of CL in Sri Lanka.
Methodology: Clinical evaluation was carried out on patients who visited the Department of
Parasitology, Faculty of Medicine, Colombo for diagnosis using a pre-tested questionnaire. Light
microscopy and/or PCR were performed on lesion material to confirm diagnosis. Formol gel test
(FGT) was done on all patients. The causative species was identified by sequencing of the partial
6PGDH gene, followed by microsatellite analysis to study the phylogenetic relationships.
Results: There were 401 patients (78.9% males, out of which 57.4% were soldiers) with at least
549 lesions. Most infections were acquired in Northern (55.7%) or Southern (39.3%) Sri Lanka.
Several lesion types were noted: papules 23.4%, nodules 25.4%, ulcerating nodules 19.6%,
ulcers 23.7%, plaques 6.4% and other 1.7%. Nodules with 5-9 months duration had the highest
parasite positivity (n= 100, 75.5%). Sporotrichoid spread (n=44, 11.9%), satellite lesions (n=35,
8.9%) and lymphatic spread (n=109, 27.7%) were commonly observed. No patients had visceral
features and the FGT was negative in all subjects. Male sex, 20-40 years of age and over 5
hours/day spent outdoors were identified as risk factors, but not household clustering. The
causative species was identified as L. donovani, belonging to a distinct genetic group within that
complex.
Conclusions: A dermotrophic variant ofL. donovani causes cutaneous leishmaniasis in Sri Lanka.
The ability of the local Leishmania parasite to visceralize, self heal or develop drug resistance is
yet to be determined. In spite of the generally accepted anthroponotic nature of L donovani, in
this study favours zoonotic transmission of the local species.
Acknowledgements: Mr. RL Ihalamulla, Mr. S Jayasinghe for technical assistance. Financial
support for this study was from Sri Lanka National Science Foundation and the Commonwealth
Scholarship Association.
Final abstract number: 65.036
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Establishing the Role of Latent Toxoplasmosis in the Ethiopathogenesis of Schizophrenia
           1                 1           2          3         4                 1        4
P. Yuksel , B. Kocazeybek , N. Alpay , C. Babur , R. Bayar , A.R. Karaköse , C. Aksoy ,
         1                4        3             4              1                  1         5
M. Aslan , S. Mehmetali , S. Kilic , I. Balcioglu , O. Hamanca , O. Kucukbasmaci , Y.A. Oner ,
           6
A. Dirican
1
 Microbiology and Clinical Microbiology Department, Cerrahpasa Medical Faculty, Istanbul
                               2
University, Istanbul, Turkey, T.C Health Ministry, Bakirkoy Psychiathry (Ruh ve Sinir) Diseases
                                      3
Hospital, Istanbul, Istanbul, Turkey, Refik Saydam Hizisihha (Public Health) Medical Center,
                                             4
Parasitology Laboratory, Ankara, Turkey, Psychiathry Department, Cerrahpasa Medical Faculty,
                                        5
Istanbul University, Istanbul, Turkey, Microbiology and Clinical Microbiology Department,
                                                                  6
Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey, Biostatistical Department,
Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey

Schizophrenia is a pervasive, neuropsychiatric disease of uncertain cause. Genetic factors play a
role in its etiology, environmental factors are also important. Epidemiologic studies suggest
infections as risk factors for the disease developing in later life. In this cross-sectionally designed
study we focused on evidence specifically linking infection with Toxoplasma gondii to the etiology
of schizophrenia. Three different group were examined; 300 schizophrenic patients, 150 control
individuals with other psychiatric diagnosis (OPD), 150 healthy control (HC) were enrolled in this
study. IgG antibody to T.gondii were measured by ELISA (Meddens Diagnostics BV,
Netherlands) Toxoplasma IgG antibody was quantified using the Sabin-Feldman dye test as
reference test. In the schizophrenic group 60.7% of patients, in the first control group including
OPD 36.7% of patients and in the second control group including HC 45.3% of the sample were
found to be positive for Toxoplasma IgG. The seropositivity rate for anti-Toxoplasma IgG
antibodies in schizophrenia patients was significantly higher than OPD and HC groups (X2
=25,16, p=0.000). No statistically significant differences were found between male and female
patients in patient group for Toxo-IgG positivity rates(p>0.05) whereas significant differences
were found in male and female patients between schizophrenic and OPD group and HC groups
(p=0.05). Toxoplasma IgG positivity was detected significantly higher in the 51 to 65 age group
than patients in the 25 to 34 and 35 to 50 age group. Only in the 51 to 65 age group Toxoplasma
IgG positivity rates was significantly different as compared to the two other control groups in the
same age group. In the other age groups no significant differences were found between
scizophrenic patients and control groups for IgG positivity rates.
In conclusion, our study indicates that Toxoplasmosis may contribute to the etiopathogenesis of
schizophrenia, this effect is particularly remarkable in the 51-65 age group. No particular gender
effect was observed.
Final abstract number: 65.037
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Overexpression and Protective Role of Interleukin-6, Tumor Necrosis Factor-Alpha and Nitric
Oxides in Experimental and Clinical Ocular Toxoplasmosis
         1          2
J. Prada , T. Ngo-Tu
1
 Biomedical Research Center, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin,
                                               2
Humboldt University of Berlin, Berlin, Germany, Department of Microbiology, University of Hanoi,
Hanoi, Vietnam

The cytokines interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha), as well as the
accumulation of nitric oxides (NO), have been studied with regard to a possible role in protection
against the development of ocular toxoplasmosis. In a murine model of ocular toxoplasmosis,
mRNA transcripts for inflammatory mediators, such as IL-6, TNF-alpha and inducible NO-
synthase, were increased during chronic infection. In further studies, mice treated with TNF-alpha
were not protected against lethal challenges with Toxoplasma parasites, but mice treated with
anti-TNF-alpha antibodies showed increases in trophozoite numbers and transient signs of
illness. Moreover, the inhibition of NO production with aminoguanidine in mice infected with
Toxoplasma parasites resulted in a marked increase in the symptoms of ocular inflammation. In
the clinical situation, increased levels of IL-6, TNF-alpha and NO were often found to correspond
with critical events during ocular toxoplasmosis, such as extended conjunctivitis, vitreous turbidity
and/or temporary blindness. In the analysed patients, IL-6 and TNF-alpha bioactivities were
routinely analysed by the B9 and WEHI164 bioassays, respectively, and NO was evaluated as
concentration of nitrite by a compensated Griess reaction. Statistical analysis was performed by
using the t-Student test and the Pearson's correlation coefficient (PCC). The highest levels of IL-
6, TNF-alpha and NO were recorded during critical episodes of ocular toxoplasmosis. The levels
of IL-6 were higher than those of TNF-alpha or NO, and were statistically significant (p = 0.0049)
when compared to the rest of recorded IL-6 values. The best correlation was always observed
between TNF-alpha and NO (PCC: 0.4), whereas IL-6 presented a PCC of 0.3 either with TNF-
alpha or with NO. As described in the murine model, the increased levels of IL-6, TNF-alpha and
NO may represent a protective role for the host by controlling the number of Toxoplasma
parasites and the further development of ocular complications.
Final abstract number: 65.038
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Detection of Acanthamoeba in Tap Water and Contact Lens Cases Using PCR
P. Cho, M.V. Boost, S. Lai, W.M. Sun
The Hong Kong Polytechnic University, Hong Kong, China

Background: Acanthamoeba keratitis is a rare but devastating corneal infection, with almost 90%
of cases associated with contact lens wear. Infections in patients with contact lens-related AK
have been associated with the use tap water in the care of contact lenses, rinsing the lens case
with tap water, handling lenses with wet hands, and washing the face whilst wearing lenses.
Acanthamoeba can colonise lens cases exposed to tap water. To determine the presence of
Acanthamoeba in tap water in Hong Kong, and of contamination of contact lens cases using a
polymerase chain reaction (PCR) detection method.
Method: Tap water was collected from the bathroom sink of 100 households in Hong Kong and
tested for the presence of Acanthamoeba by means of PCR amplification. Characteristics of
homes were noted with respect to age, building type, and location. A sample of 100 contact lens
cases were collected from regular users of contact lenses. The inner surface of the case was
swabbed and tested for the presence of Acanthamoeba by PCR.
Result: Ten per cent of water samples were contaminated by Acanthamoeba. The risk for
contamination was significantly higher in older properties, those located in the older urban area of
Kowloon, and those in which the bathroom tap was served by a water tank. Only one contact lens
case yielded Acanthamoeba and this subject admitted poor compliance with lens care routines.
Conclusions: Levels of Acanthamoeba detected using PCR were somewhat higher than
previously reported in Hong Kong. Older plumbing and poorly maintained water storage tanks
may increase the risk of Acanthamoeba contamination. Poor compliance with care of the lens
case, allowing for the build up of biofilm may increase the risk of Acanthamoeba contamination of
the case and possible Acanthamoeba keratitis.
Final abstract number: 65.039
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Molecular Diagnosis of Babesia Infection Among Rodents Collected from the Offshore Kinmen
Island of Taiwan
C.M. Shih, W.C. Yu, L.L. Chao
Dept. Parasitology & Tropical Medicine, National Defense Medical Center, Taipei, Taiwan

Babesiosis is an emerging tick-transmitted zoonotic infection caused by intraerythrocytic
protozoan parasites of the genus Babesia and rodent-borne B. microti was recognized as the
major causative agent for human infection. In order to realize the prevalence of Babesia infection
among rodent hosts in the offshore Kinmen island of Taiwan. We conducted a whole-year survey
to investigate the Babesia infection among rodent hosts and identify the Babesia genospecies in
the Kinmen island. Genomic DNA were extracted from blood specimens of 283 rodents and
further amplified by PCR using specific primers of Piro A/B and Bab 1-4, targeting a specific
fragment of the gene encoding the nuclear small-subunit ribosomal RNA (18S rRNA) of Babesia
spp. and B. microti, respectively. Results indicate that the seasonal prevalence of Babesia
infection among rodent hosts was observed with an average infection rate of 25.4% (72/283),
ranging from 9.5% to 50%, and B. microti was identified in 12.4% (35/283) of rodents. The higher
seasonal prevalence was observed on April (50%) and May (43.8%). The highest infection rate
was also observed at the district of Kinning township (33.3%). Thus, our results not only reveal
the prevalence of Babesia infection among rodents in the Kinmen island but also primarily identify
the persistence of B. microti in the natural hosts of Taiwan.
Final abstract number: 65.040
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Reactivity of Antibodies to Hookworm Excretory-Secretory Antigens from Hookworm Infected
Patients in Northern Nigeria
              1                   2            2
B.O.P. Musa , G.C. Onyemelukwe , A.A. Ahmad
1                                                          2
 Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, Ahmadu Bello University, Zaria,
Nigeria

Background: Little is known about the antigens of hookworms or the possibility of stimulating
protective immunity in infected patients. However, in order to develop effective antimicrobial
therapy, it is necessary to understand the molecular nature of parasite antigens and host
response. Necator americanus, which is prevalent in northern Nigeria, has been shown to
express a range of excretory-secrectory (ES) protein antigens. In this study, sera from patients
infected with Necator americanus were tested at a 1:100 dilution against radiolabelled Necator
americanus excretory-secretory products. The purpose was to determine whether the immune
system of hosts harbouring Necator americanus is capable of identifying epitopes expressed by
the parasites.
Methods: Serum was collected from 10 patients diagnosed as infected with Necator americanus
on the basis of faecal egg counts. Sera from a pool of hookworm infected Australian aboriginals
(Aussie pool) and normal human sera (NHS) from non-infected persons served as controls.
Immunoprecipitation of antigenic polypeptides was done by the addition of 10 L of serum from
infected and non-infected individuals to 100 L of 10mM Tris (pH7.4), 5mM EDTA, 0.9% (w/v)
NaCl, 0.05% (v/v) Tween 20 containing 1.5x 105 cpm of labeled ES products. Immune complexes
were precipitated by incubation for 1 hour at 22°C with protein A Sepharose, followed by
extensive washing in the same buffer at 0°C.
Results: Sera from infected Nigerian patients recognized and bound Necator americanus ES
products and was precipitated. Response from the Nigerian sera against hookworm ES products
showed great variability but was similar to that from the pool of hookworm infected patients from
Australia. Normal human serum (NHS) showed a negative response to hookworm ES products.
Conclusion: Sera from hookworm infected patients is capable of reacting against defined
hookworm antigens. The response elucidated however, is diverse in antigen recognition. This has
implication for immunodiagnosis and for therapy.
Final abstract number: 65.041
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Preliminary Analysis of the Molecular Phylogenetics of Toxocara canis (Nematoda: Ascaridoidea)
Using Nuclear Ribosomal Second Internal Transcribed Spacer Sequences
                        1                      2          3
A.J. Rodriguez-Morales , R.A. Barbella-Aponte , M. Arria
1
 Immunoparasitology Section, Tropical Medicine Institute, Universidad Central de Venezuela,
                      2
Caracas, Venezuela, Pathology Service, Consorci Hospital General Universitari Valencia,
                3
Valencia, Spain, Genetics, Venezuelan Institute for Scientific Research, Caracas, Venezuela

Objectives: Toxocariasis is a zoonotic disease caused by Toxocara canis and T. cati. Human is
their paratenic host. Although many clinico-epidemiological aspects have been studied in almost
60 years after the discovery of human disease, many biological and molecular aspects are still
lack of knowledge and research. After a careful review of literature we did not found any study
describing the phylogenetics of Toxocara using any molecular marker.
Methods: For these reasons, nuclear internal transcribed spacer 2 (ITS2) rDNA sequences were
used for the first molecular phylogenetic analysis and tree of five Toxocara species. ITS2 rDNA
sequences were already available from GenBank (accession numbers AB110034, AB110033,
EU189085, AM231609 and AB027152), corresponding to T. canis, T. cati, T. vitulorum, T.
malaysiensis and T. tanuki. Phylogenetic analysis was made after aligned these sequences using
GeneDoc 2.7, using the method of Maximum Parsimony and the bootstrap test for phylogeny with
MEGA 4.
Results: As expected, T. canis and T. cati ITS2 alleles are monophyletic, as well T. malaysiensis
with T. vitulorum. As expected also, we observed a high nucleotide diversity (p=0.705825; Tajima
test=0.461359) between the studied species.
Conclusions: The nuclear ITS rDNA sequence has been extensively used to define genetic
markers for different species of nematodes and the aims of this study were to use the ITS2 to
investigate the levels of genetic variation within Toxocara and generate a first phylogenetic tree
(Figure). If there are normal levels of gene flow between populations (or species), these
populations are likely to be similar in their overall genetic characteristics, and genes for important
characteristics are likely to spread easily. ITS2 of other Toxocara species should be included in
further analysis (eg. T. genettae, T. lyncis, T. vincenti, among others), to better define the
evolutionary relationships and phylogeny of the genus Toxocara.
Final abstract number: 65.042
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Intestinal Parasites in Patients with Celiac Disease: A Clinical Study
                    1             2                     1           1
M. Rostami Nejad , K. Rostami , E. Nazemalhosseini , M.R. Zali
1
 Research Center of Gastroenterology and Liver Diseases, Shaheed Beheshti Medical University,
                                     2
Tehran, Iran (Islamic Republic of), University of Birmingham, Medical School, Birmingham,
United Kingdom

Introduction: Intestinal parasites not only cause diarrheal diseases but also significant
malabsorption. Literature on the role of parasites, such as intestinal coccidia and microsporidia in
malabsorption syndrome is limited but some studied show that Giardia, strongyloides and
capillaria are definitive causes of malabsorption of many nutrients. The aim of this study was to
determine the prevalence of intestinal parasites in celiac disease (CD) patients.
Material & Method: Twenty five stool samples from adults and children patients with CD (15 adult
and 10 children) were examined for intestinal parasites such as coccidia, Giardia, and other
parasites during 2007 by wet mount, modified acid-fast and terichorom staining and chromotrope
2R staining.
Results: Out of 25 celiac patients (61.2% female and 35.8% male), with mean age of 41.66 years,
7 (28%) patients were infected with pathogen and non pathogen parasites.
The frequency rate of Giardia lamblia, Entamoeba coli, Endolimax nana, Blastosystis hominis,
cryptosporidium parvoum were 3 (0.75%), 2 (0.5%), 1 (0.25%), 2 (0.5%), 2 (0.5%), respectively.
Both cryptosporidium parvoum positive were children with acute diarrhea.
Conclusion: Celiac disease is the most common cause of malabsorption syndrome in both adults
and children. In this study we found that, intestinal parasites are associated with malabsorption
syndrome, particularly in CD patients. In the other word, these patients are harbor for pathogenic
parasites and are more frequently colonized with harmless commensals as compared to healthy
people.
Keywords: celiac disease, intestinal parasites, malabsorption
Final abstract number: 65.043
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Preparation and Characterization of Live Attenuated Strain of L. major
A.R. Khabiri
Pasteur Institute of Iran, Teharn, Iran (Islamic Republic of)

Leishmaniasis is prevalent in 88 countries throughout the word, 21 in the new world and 66 in the
old world; 16 of them are developed countries and the other 72 are developing countries.
Leishmaniasis caused by different species of protozoan parasites belonging to the genus
leishmania. The combination of leishmaniasis and co-infection with HIV has been a major
problem. Attempts to produce an effective vaccine have so far failed, and treatment of the
disease in regions still primarily on the use of pentavalent antimonials, but the Resistance to drug
is so high in some parts of the world and second - line drugs have not experienced wide spread
use due to toxicity and cost. In this study a species-specific monoclonal antibody (mAb) recognize
component on surface and culture supernatant of leishmania major (L. major). In ELISA and
Western blotting this component is species-specific to L. major without cross-reactivity with other
leishmania species, L. donovani, L. infantum and L. tropica. Since the mAb, can not reacted with
component of medium, it is questionable that the parasite acquire unknown component from the
growth medium and /or post translation modification antigens that parasite express on the surface
or secrete to medium. We shown that the mAb can disrupt component(s) to parasite surface
according to the presence of mAb in culture medium and un-coated parasite could not induce
infection in susceptible BALB/c mice. Immunized mice compare with control groups could not
induce infection after challenge with standard stain of L. major. In vitro results shown that
vaccinated mice induce high level of IFN-gamma, low Parasites load and resistant to L. major
infection for at least 12 month. These observation explain a novel option that parasite acquire
virulence factor as a post-translation modification of antigens.
Final abstract number: 65.044
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Relationship Between Toxocariasis and Asthma: A Prospective Study Among Peruvian Children
          1               2            1             2             1
L. Getaz , F. Samalvides , J.P. Breña , C.P. Maguiña , E. Gotuzzo
1
 Instituto de Medicina Tropical 'Alexander von Humboldt', Universidad Peruana Cayetano
                      2
Heredia, Lima, Peru, Instituto de Medicina Tropical 'Alexander von Humboldt', Universidad
Peruana Cayetano Heredia. Hospital Nacional Cayetano Heredia, Lima, Peru

Background: The zoonotic ascarid Toxocara canis has been suggested as a possible etiologic
agent of asthma. We aimed to determine the association between T. canis infection and asthma
in children seen at the Hospital Nacional Cayetano Heredia, Lima, Peru, and to evaluate other
factors associated with T. canis infection and asthma in the population studied.
Methods: This is a case-control study involving 75 asthmatic and 75 nonasthmatic children, from
2 to 13 years who were evaluated at the Hospital Nacional Cayetano Heredia in 2002. A
questionnaire was applied referring to the interest variables. Seroprevalence of T. canis was
determined through a T. canis ELISA IgG test for. Chi-square test, t of Student and logistic
regression analysis were used. A p value lower than 0.05 was considered to be statistically
significant.
Results: The seroprevalence of toxocariasis was 16%. No significant association was found
between the seropositivity for T. canis and asthma in univariate and multivariate analysis (OR:
1.48; 95% CI 0.56-3.88). Although, there was a significant association between a higher
frequency of nocturnal sibilance crises and a positive serology for of T. canis (p=0.005). The
factors associated to toxocariasis were contact with dogs (p=0.004), particularly with puppies
(p=0.0017), and parents without university education (p=0.015). The factors associated to asthma
were infrequent contact with dogs (p=0.046) and parents with a university education (p=0.012).
Conclusions: There was no association between the presence of positive serology for T. canis
and asthma, but there was an association between a higher frequency of crises of nocturnal
sibilance and a positive serology for T. canis.
Final abstract number: 65.045
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Epidemiologic Considerations About Visceral Leishmaniosis in Albania
R. Petrela, H. Hoxha, E. Kallfa, G.J. Lito, A. Kallfa, N. Como
University Hospital Center 'Mother Theresa', Department of Pediatric, Clinic of Infectious
Diseases, Tirana, Albania

Objective: Aim of this study was to analyze some epidemiologic features of visceral leishmaniosis
of children in Albania.
Materials and methods: In this study we included 1210 children aged 0-14 years, all admitted and
treated for visceral leishmaniosis since 1994-2006 in Infectious Disease Ward Tirana Albania.
We studied the distribution of the disease in regard to age, gender, living area, time.
Results were shown at the following table:
Conclusions; Visceral leishmaniosis is a frequent disease in Albania presented with a
considerable number of cases per year. The most affected age group is 1-4 years, male gender
more affected, urban areas also are predominant over rural ones.
Final abstract number: 65.046
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Plasma Levels of Interferon-gamma, Interleukin-10, and Interleukin-12, Before and After
Treatment in Visceral Leishmaniasis
A. Khoshdel
Medical University of Shahrekord, Shahrekord, Iran (Islamic Republic of)

Background: Various strains of Leishmania donovani, L. infantum and L. chagasi can cause
visceral leishmaniasis. Cytokines have a crucial role in the pathogenesis of the disease.
Objective: Our purpose was to evaluate the plasma levels of INF- g, IL-10, and IL-12 in the
course of the disease to predict the prognosis of the disease and the proper time to consider the
patients as "cured".
Method: Thirty two patients with visceral leishmaniasis were involved in this study. The Plasma
levels of IL-10, IL-12 and INF- g were tittered by Sandwich ELISA method, before treatment, after
fever subsided, at discharging the patient from hospital, and two months after treatment. Data
were analyzed by Chi-Square method and Non-Parametric Wilcoxon Signed Rank Test.
Results: The levels of IL-10 were 77.5, 55.9, 18.3 and 1.9 before treatment, after subsiding of
fever, at the time of discharging the patient, and two months after treatment respectively. As for
INF- g the levels were 37.6, 5.9, 0.18, 0.005 and for IL-12 the levels were 798.3, 865.2, 841.2 and
479 respectively.
Conclusion: We concluded that normalization of the plasma levels of INF- g and IL-10 can serve
as a reliable parameter in considering the patients as "cured" and determining the duration of the
treatment.
Key words: visceral leishmaniasis, interleukin, interferon- g
Final abstract number: 65.047
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Detection of Acute Toxoplasma gondii infection in early pregnancy by IgG-avidity and PCR
analysis
J. Iqbal, N. Khalid
Faculty of Medicine, Kuwait University, Kuwait city, Kuwait

Objective: To detect acute Toxoplasma gondii (T. gondii) infection in early pregnancy
Introduction: Acute Toxoplasma gondii (T. gondii) infection in early pregnancy carries the risk of
transmitting the infection to the fetus with serious sequelae. However, serological testing for
IgG/IgM anti-Toxoplasma antibodies may fail to differentiate between a recent and past infection.
Methods: 224 Kuwaiti women in their first trimester were screened for IgG/IgM antibodies by Vitek
Immuno Diagnostic Assay System (VIDAS) and VIDAS IgG-avidity tests.
Results & Discussion: On serological screening, 119 (53.1%) women were IgG-positive
antibodies and 31 (13.8%) for IgM antibodies. Nine of the IgM-positive and 7 IgM-negative
women had low avidity antibodies. However, IgG avidity test detected low avidity antibodies only
in 9 (29%) of the 31 IgM-positive women suggesting a recent infection; and 19 (61.3%) women
had high avidity antibodies indicating the infection was acquired in the distant past. Based on IgM
serology alone, at least 31 IgM-positive women may have been wrongly labeled with acute
Toxoplasma infection thus warranting appropriate therapeutic intervention. All the 19 IgM-positive
women with high avidity were confirmed negative for Toxoplasma DNA on PCR analysis.
Compared with PCR analysis the VIDAS avidity test was a helpful tool for the diagnosis of recent
Toxoplasma infection in IgM-negative women with low-avidity and IgM-positive women with high
avidity, specificity >85% to 100% respectively.
Conclusion: The VIDAS avidity test when used in combination with VIDAS IgG/IgM tests is a
valuable assay for the exclusion of ongoing or recently acquired T. gondii infection in pregnant
women in their first trimester and that it decrease significantly the necessity for follow-up testing
and unnecessary therapeutic intervention.
Final abstract number: 65.048
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

A 6 Year Geohelminth Infection Profile of Children at High Altitude in Western Nepal
                  1           2            1            1                  3
C. Mukhopadhyay , G. Wilson , K. Chawla , V.S. Binu , P.G. Shivananda
1                                                                2
 Kasturba Medical College, Manipal University, Manipal, India, Al-Khor Hospital, Hamad Medical
                         3
Corporation, Doha, Qatar, Sikkim Manipal Institute of Medical Sciences, Manipal University,
Gangtok, India

Background: Geohelminth infections are a major problem of children from the developing
countries. Children with these infections suffer from developmental impairments and other serious
illnesses. This study aimed to measure the prevalence of geohelminth infection, infection intensity
as well as the change in the intensity in children from Western Nepal over years.
Methods: This 6-year hospital based prospective study at the Manipal Teaching Hospital,
Pokhara included children (<15 years) visiting the hospital from Kaski and 7 surrounding districts.
Samples were also collected from children in the community from different medical camps. Three
stool samples from every child were processed using direct and concentration methods. The
Kato-Katz technique was used for measuring the intensity of infection.
Results: The overall prevalence in hospital-attending children was 9.2% with 7.6% in preschool (0
- 5 y) and 11.0% in school-age (6 - 15 y). Ascaris lumbricoides, Trichuris trichiura, Ancylostoma
deodenale and Strongyloides stercoralis were the common geohelminths with a gradual decrease
in worm load over the years. School-age children were found to be significantly more prone to
geohelminth infection as compared to preschool children, but no statistical difference was
detected by gender, district as well as season.
Conclusion: This heavy infection of geohelminths in children should be corrected by appropriate
medication and maintaining strict personal hygiene. Health education, clean water, good sewage
management and a congenial environment should be ensured to minimise infection.
Final abstract number: 65.049
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Production of Monoclonal Antibody Against Toxocara cati Second Stage Larvae and Its
Application for the Detection of Circulating Antigens
          1               2            2              3      3
M. Zibaei , S.M. Sadjjadi , B. Sarkari , S. Ishiyama , S. Uga
1                                                                                   2
 Lorestan University of Medical Sciences, Khoram Abad, Iran (Islamic Republic of), Shiraz
                                                                   3
University of Medical Sciences, Shiraz, Iran (Islamic Republic of), Kobe University School of
Medicine, Kobe, Japan

Background: Toxocariasis is a zoonotic disease caused by the migration or presence of Toxocara
canis or Toxocara cati larva in human tissues or organs. Human become infected by ingestion of
soil or contaminated meat containing Toxocara larvae. Diagnosis of larval migrans is mainly
based on detection of specific antibodies determined by enzyme-linked immunosorbent assay
(ELISA), using larval excretory-secretory (ES) antigens. The aim of this study was to produce a
monoclonal antibody against Toxocara cati second stage larvae antigens for possible
immunodiagnosis of human toxocariasis.
Methods: Mice were immunized with T. cati L2S antigens in a 35 day course. Spleen cells from
immunized mice were fused with P3U1 cells. Hybridoma cells were screened against T. cati
larvae antigens, and positive antibody producing cells were selected and monoclonal antibody
was purified from supernatant of hybridoma growing cells. The antibody was used in a sandwich
ELISA system for detecting of T. cati antigen.
Results: The isotype of produced monoclonal antibody (TCTMAB) was IgG3. The produced
monoclonal antibody reacted with T. cati larvae antigens while no cross reaction was found with
antigens of both sexes of Toxocara cati adult worms, Dirofilaria immitis, Ascaris sum adult worm
and metacercaria of Centrocestus aromatus. However the monoclonal antibody cross reacted
with antigen of Trichinella spiralis larvae.
Conclusion: Our introduced sandwich ELISA seems to be a useful method for detection of T. cati
antigen and could be used for proper serodiagnosis of human toxocariasis. The ELISA system
had a sufficient sensitivity to detect 5 ng/ml of antigen.
Final abstract number: 65.050
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

In Vitro Encystment of Entamoeba histolytica by Oxidative Stress and Oligoelements
               1           2               1               1
H. Aguilar-Díaz , N. Moreno , J.P. Laclette , J.C. Carrero
1
 Depto de Inmunología. Instituto de Investigaciones Biomédicas, UNAM, Ciudad de México,
         2
Mexico, Depto de Biología Celular y Fisiología. Instituto de Investigaciones Biomédicas, UNAM,
Ciudad de México, Mexico

The inhibition of Entamoeba histolytica encystment represents a target to block the amoeba life
cycle and impede its spreading. Unfortunately, the amoeba has not been encysted in vitro and
drugs against the cyst are not available. Variation in the oxygen tension when the trophozoites
move from the ascending to the descending colon could be within the luminal factors involved in
the in vivo encystment. The formation of toxic reactive oxygen species in combination with other
factors could activate cellular mechanisms of defense, including encystment. Therefore, we
treated axenic cultures of HM1:IMSS trophozoites with a mix of hydrogen peroxide and several
oligoelements (necessary for the activity of encystment enzymes) that resulted in the
transformation of trophozoites to rounded and refringent-small structures which exhibited
resistance to different detergents. Fluorescein diacetate treatment demonstrated that the viability
of these cyst like-structures started to decrease after 6 hours post-induction, reaching 100% of
death after 24 hours. Ultraestructural analysis by using scanning and transmission electron
microscopy showed multinucleated structures (2, 3 and even, with 4 nuclei) with a smooth and
thick membrane and multiple vacuoles. A decrease in the glycogen stores and a net of fibers
similar to chitin was also observed. The presence of this polymer of N- acetilgalactosamine in the
structures was demonstrated by intense blue fluorescence staining with white calcofluor as well
as by positive lectures in a wheat germ agglutinin-based ELISA, two reagents that specifically
binds to chitin. The expression of the E. histolytica Gln6Pi, rate-limiting enzyme in the chitin
synthesis pathway, was evaluated by RT-PCR assay in untreated trophozoites and cyst-like
structures. Results demonstrated the over-expression of this enzyme (6 folds) in the cyst-like
structures, suggesting that the encystment route was activated in the trophozoites when exposed
to our treatment.
Final abstract number: 65.051
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Evaluation of Lower Molecular Mass (10-30KDa) T. Solium cysticerci antigen by Western blotting
for the diagnosis of neurocysticercosis in children
A.V. Subba Rao, P.D. Singhi, N. Khandelwal, N. Malla
Postgraduate Institute of Medical Education and Research, Chandigarh, India

Background: Neurocysticercosis (NCC), the most common neurological disorder of parasite
etiology results from lodgement of T. Solium cysticerci in the central nervous system. The
confirmed diagnosis is based on radiological findings and serodiagnostic technique(s). The
sensitivity and specificity of various serological techniques varies, depending upon the technique
and antigen used. Lower molecular mass antigenic fraction of T. Solium cysticerci (Tso) have
been found highly specific. Urine has been reported as better diagnostic sample than Serum in
many microbial diseases due to advantage of collection by non-invasive method. The present
study was aimed to evaluate LMM antigens for antibody detection in serum and urine samples by
western blot for the diagnosis of NCC.
Methods: Serum and urine samples were collected from 125 clinically suspected and
radiologically proven NCC patients and 125 control (60 other neurological diseases, 40 other
parasitic diseases, 25 healthy) subjects. The Tso crude soluble extract antigen was prepared
from naturally infected pigs and subjected to SDS-PAGE. Lower molecular Mass antigen (10-
30KDa) fraction was eluted and subjected to SDS-PAGE analysis followed by western blotting
with the use of all the serum/urine samples.
Results: The analysis of western blot results by UVIPhotoMW software revealed four highly
immunoreactive bands (24.7, 26.6, 28.8 & 30KDa) with serum samples. Out of 125 NCC and 125
control serum samples, 24.7, 26.6, 28.8 & 30KDa antigenic fractions were immunoreactive with
28.8%, 52%, 44%, 71.2% NCC samples and 8%, 20%, 16.8% & 27.2% control samples
respectively. Out of 125 NCC and 125 control urine samples, 32% and 54.4% respectively were
immunoreactive with only 30KDa antigenic fraction.
Conclusion: The study suggests that 30KDa antigenic fraction appear to be the best diagnostic
fraction for detection of antibody in serum samples and the urine sample may not be a good
diagnostic specimen, due to its low sensitivity and specificity.
Final abstract number: 65.052
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Serodiagnosis of Neurocysticercosis in Children with the Use of T. solium cysticerci Excretory
Secretory Antigens by Elisa and Immunoblotting
A.V. Subba Rao, P.D. Singhi, N. Khandelwal, N. Malla
Postgraduate Institute of Medical Education and Research, Chandigarh, India

Background: Neurocysticercosis (NCC) caused by T. solium (Tso) cysticerci is a leading cause of
seizures and epilepsy in the developing world and is an increasingly important health issue in
Indian children. Although CT/MRI is considered as a gold standard for the diagnosis of NCC,
because of its unavailability and high cost, its application was limited in the developing countries.
The sensitivity and specificity of various available serological techniques was low in case of single
cysticercus granuloma cases which is a more common feature in Indian children than
multilesional neurocysticercosis cases. Excretory Secretory (ES) antigens have been proved as a
better diagnostic antigen than crude soluble antigen in many parasitic infections. The present
study was aimed to evaluate the ES antigens for antibody detection in serum by ELISA and
immunoblotting for the diagnosis of NCC.
Methods: Serum samples were collected from 125 clinically suspected and radiologically proven
NCC patients and 125 control subjects. The Tso cysticerci was isolated from the naturally
infected pigs and cultured in RPMI 1640 medium and ES antigen was prepared by (NH4)2SO4
precipitation method. The ES antigen was used in ELISA and immunoblot for the diagnosis of
NCC in children.
Results: The sensitivity and specificity of the ES antigen ELISA was 61.6% and 76.8%
respectively. In SDS-PAGE analysis of ES antigen, 29 antigenic fractions were identified in
between the molecular weight 20-325KDa. The analysis of immunoblot results revealed one
highly immunoreactive antigenic fraction with the molecular weight of 74.9KDa with serum
samples. Out of 125 NCC and 125 control serum samples, the immunoreactivity of 74.9KDa
antigenic fraction was 67.2% and 28% respectively.
Conclusion: The study suggests that ES antigens appear to be the best diagnostic antigen than
crude and other antigens available for detection of antibody in serum samples for the diagnosis of
neurocysticercosis in children.
Final abstract number: 65.053
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Quantitative Study of Structure-Activity Relationship (Q.S.A.R.) of Antimalarial Compounds
Isolated from Solanum nudum and Derivatives Synthesis
A. Pabón, A. Mesa, L. Zuluaga, F. Echeverri, S. Blair
Universidad de Antioquia, Medellín, Colombia

Malaria is the main parasitic desease, responsible for more than 300 million cases and more than
two million annual dead, causing major human and economic losses. In addition, there are more
than 2,400 million people at risk of contracting this infection according to a report of the Pan
American Health Organization (PAHO). Colombia presents 195.719 cases of malaria. New
alternatives for treatment of malaria are needed and one is searching new drugs from natural
products.
A steroidal sapogenin (diosgenon) and five steroids compounds from the plant S. nudum have
been isolated. They are similar to progesterone, with in vitro antimalarial activity and no
mutagenic effect. This supports the need for additional studies of molecular design with methods
as QSAR to recognize the structural and functional factors involved in the antimalarial activity of
these compounds, by means of the synthesis of derivatives and analysis of relations it structures
activity, jointly with in vitro antiplasmodial activity and cytotoxic assays that support to the
potential antimalarial use as isolated steroids from S. nudum.
Diosgenone was modified (OH-1, Met-1, NB-1, PTSN-1, diosgenine, dicarbonilic diosgenine, and
both reduced diosgenin and diosgenone). Also SN-2 was modified (diacetate, aldehyde, ketone-
aldehyde, aldehyde-alcohol and alcohol-ketone). It was found that diosgenone derivatives had
low toxicity similar to natural compounds, except for the dicarbonilic derivative (47 ppm vs. 100.9
ppm) and SN-2 steroid derivatives (924 ppm for natural steroid Vs 19.3. for the derivative
Aldehido-ketone).
The antimalarial activity were also measured in vitro, using FCB-2 and NF-54 strains (chloroquine
resistant and chloroquine sensitive, respectively) using incorporation of hypoxanthine [8-3] to
compounds modified diosgenone and SN-2 were made. The antimalarial activity in vitro for
diosgenone derivatives is less than the natural compound when replacing the carbonyl and
antimalarial activity in diosgenin, which has no activity antimalarial after of addiction carbonyl
group. An IC50 of 0.3 ppm for derivative diacetate SN-2 and 4.1 ppm for acetate present in the
reaction of SN-2 compared to 222.8 ppm for natural compounds was found. All of SN-2
derivatives that undergone changes in their acetate functional group showed a better antimalarial
activity than natural compounds.
These results demonstrate that the carbonyl group is necessary for the antimalarial activity of
diosgenone, but repeat testing antimalarial activity associated with SN-2 using a different reactive
oxidation is necessary to corroborate these results and a change in the functional group and not
by contamination of the sample in the process of synthesis or purification.
Final abstract number: 65.054
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

The Genome Project of Taenia solium
                  1           2            2               3            2                3
A. Garciarrubio , R.J. Bobes , J.C. Carrero , M.A. Cevallos , G. Fragoso , V.M. González ,
            2          4           2             2                   2          1           2
M.V. José , A. Landa , C. Larralde , L. Mendoza , J. Morales-Montor , E. Morett , E. Sciutto ,
              1             2
X. Soberón , J.P. Laclette
1
 Instituto de Biotecnología, Universidad Nacional Autonoma de Mexico, Cuernavaca, Mexico,
2
 Instituto de Investigaciones Biomédicas, Universidad Nacional Autonoma de Mexico, Mexico,
                3
D.F., Mexico, Centro de Ciencias Genómicas, Universidad Nacional Autonoma de Mexico,
                        4
Cuernavaca, Mexico, Facultad de Medicina, Universidad Nacional Autonoma de Mexico,
Mexico, D.F., Mexico

A consortium of key laboratories at the National Autonomous University of Mexico is carrying out
a full genomic project for Taenia solium. This project will provide powerful resources for the study
of taeniasis/cysticercosis. The nuclear DNA content estimated through cytofluorometry on
isolated cyton nuclei was of about 270 Mb. Two probabilistic calculations based on shotgun
sequenced genomic clones, resulted in size estimates for the haploid genome of 120-140 Mb. A
combined strategy with 454 and capillary sequencing is under process. So far, we have achieved
10X coverage by 454 pyrosequencing and 3.6X coverage by capillary sequencing. Results
suggest that T. solium genome is not highly repetitive (< 7%). One small 53 bp tandem-repeat
and different tetranucleotide repeats represented 0.5% and 4.5% of the genome, respectively.
Current assemblage still shows tens of thousands contigs, however, estimates suggest that 90%
of the genes are already included.
Besides genomic sequencing, more than 34,000 ESTs have been obtained: 14,113 from adult
cDNA libraries and 9,157 from larval libraries, which have been made public through GenBank.
Additional 10,000 5' end sequenced ESTs from a larval full-Length cDNA library are already
available. Unique genes were identified by clustering all EST-fragments with an assembler
(minimus). We have identified around 7,000 "genes", some of them are highly expressed in both
adult and larvae stages. Thus, there are 349 "genes" with 10 or more sequences that account for
50% of all transcripts. Approximately one third (2,038) of the 7,000 genes have a significant
match in SwissProt and about 27% of the genes have no match in SProt + TREMBL, and could
constitute new genes.
The consortium for the T. solium genome project wishes to use this International Congress of
Infection Diseases to make a worldwide call for collaborative research. This project is supported
by a special grant IMPULSA-UNAM.
Final abstract number: 65.055
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Low Degree of Genetic Diversity Within and Among Taenia solium Cysticerci from Natural
Infected Pigs of Central Mexico
             1             1         1                  2                    2         1
R.J. Bobes , G. Fragoso , M. Ávila , M.R. Reyes-Montes , E. Duarte-Escalante , R. Vega ,
         3            1            1            1
A. Aluja , J. Morales , C. Larralde , E. Sciutto
1
 Instituto de Investigaciones Biomédicas, Universidad Nacional Autonoma de Mexico, Mexico,
                2
D.F., Mexico, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Mexico, D.F.,
          3
Mexico, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autonoma de
Mexico, Mexico, D.F., Mexico

Taenia solium is responsible for porcine cysticercosis, and human taeniasis. The parasite
constitutes a serious public health problem in endemic areas of Latin America, Asia and Africa.
The eggs can infect humans, resulting in cysticercosis or neurocysticercosis. Neurocysticercosis
is a serious disease resulting in high morbidity and, in some cases, death. Random amplified
polymorphic DNA markers (RAPDs) was employed to assess genetic variation within 13 T. solium
muscle cysticerci collected from 14 naturally infected pigs. Using six different random primers and
a total of 181 cysticerci, 88 different loci were amplified, among which 77 (85%) were polymorphic
between pigs and from 0 to 24% within pigs indicating the polymorphism of the population. The
phenogram grouped the cysticerci population into 8 major clusters with low differences in the
genetic distances among and within pigs' parasites (ranged from 0.78 to 1.00) mainly grouping
according to the pigs' origins.
Genetic similarities amongst the cysticerci from different pigs were estimated using the Jaccard
algorithm. A cluster analyses were performed using UPGMA and neighbor joining methods.
Principal components analysis was also employed. The high cophenetic correlation coefficient
obtained for the Jaccard algorithm and the UPGMA clustering method corroborated small
variability observed of isolates from Central Mexico.
Both, the association (0.0 to 0.089) and the genetic diversity indexes (0.009 to 0.073), support the
idea that DNA diversity is mainly due to a recombination process. Diversity, possibly due to
different infection within pigs was also found albeit exceptionally.
Final abstract number: 65.056
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Intestinal Parasitic Infections Among Children and Their Medical Staff in a Romanian Pediatric
Care Unit
             1             1         1           1             2           1            1
T.R. Olariu , T.R. Olariu , O. Cretu , I. Marincu , O. Jurovits , L. Tirnea , R. Neghina ,
            1            1             1
I. Iacobiciu , A. Koreck , C. Petrescu
1                                                                              2
 Victor Babes University of Medicine and Pharmacy, Timisoara, Romania, Municipal Clinical
Hospital, Timisoara, Romania

Parasitic diseases represent an important public health problem. Digestive parasitosis are
characterized by high prevalence and a variety of clinical manifestations, being especially
frequent in institutionalized children.
The aim of the present study was to investigate the prevalence of intestinal parasitic infections in
a Romanian Children Care Unit. Stool examinations were performed using the iodine staining for
the identification of protozoan cysts and the Willis-Hung method, a special technique for the
identification of helminth eggs. We investigated 80 institutionalized children aged 2 to 8 years.
Parasitic infections were identified in 22 cases (27.5%). Giardia lamblia (17.5%), Blastocytis
hominis (1.2%), Entamoeba coli (3.7%), Ascaris lumbricoides (5%), Trichuris trichiura (6.2%),
Enterobius vermicularis (6.2%) and Hymenolepis nana (2.5%) were diagnosed. We have
determined associations of two (27.3%) and more than two parasites (13.6%) among the children
with intestinal parasitosis.
We have also evaluated 16 adults, members of the medical staff, working in this unit. Parasitic
infections were diagnosed in 6 cases (37.5%). Giardia lamblia (25%), Blastocytis hominis (12.5%)
and Trichuris trichiura (12.5%) were also identified in adults. Association of two parasites was
observed in 33.3% of the positive cases among the members of the medical staff.
Clinical examinations were conducted to investigate the presence of symptoms in patients.
Clinical signs (diarrhoea, weight loss, abdominal pain and cutaneous manifestations) were
present in children and their medical staff as well. Our results suggest a possible transmission of
the parasites within this pediatric unit.
Final abstract number: 65.057
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Investigations of Clinical and Demographical Findings of Children with Positive Stool Specimen
with Nonpathogenic Intestinal Parasitic Infections
              1            2                1
E.C. Dinleyici , N. Dogan , S. Reyhanioglu
1
 Eskisehir Osmangazi University Faculty of Medicine, Department of Pediatrics, Eskisehir,
        2
Turkey, Eskisehir Osmangazi University Faculty of Medicine, Department of Parasitology,
Eskisehir, Turkey

Background: Some parasites have been considered nonpathogenic, but this classification has
some limitations according to recent reports indicating it could be the cause of different intestinal
symptoms and signs. In order to understand the clinical significance of Blastocystis hominis and
other non-pathogenic protozoons, it is important to estimate the characteristics of cases, probably
infected with non-pathogenic intestinal parasites. This aim of this study was to evaluate clinical
characteristics of children with positive stool-specimen with these intestinal parasites.
Material and Method: In this study, 46 children (22 boys, 24 girls) aged between 7-203 months
(mean 105.0 ± 50.4 months) whose stool examination revealed B. hominis, Dientamoeba fragilis,
Endolimax nana, Cryptosposidium spp., were evaluated for clinical symptoms and demographical
findings. For parasitological examination, stool samples prepared by formol-ethyl acetate
concentration and after saline and iodine preparations for microscopic examination under 10x and
40x magnification. Also trichrome stained preparations in ambiguous amoebas cases and
modified Erlich Ziehl Nielsen stained preparations for Cryptosporidium in order to determinate
characteristics of non-pathogenic intestinal protozoons infections. Children with other
bacteriological and parasitological agents were excluded.
Results: B.hominis was the most common intestinal parasite. The frequency rate of intestinal
symptoms was 88.4% in the B. hominis cases and 63% of total group. Abdominal pain was the
most frequent symptom (76.9%). Diarrhea and distention followed at a rate of 50.0% and 32.6%.
Weight loss and loss of appetite are the following main findings of these children. 39.1% of these
patients have been received treatment and responded favorably to treatment with metronidazole
for 10 days.
Conclusions: Some non-pathogenic parasites are responsible of gastrointestinal symptoms when
it is found in high numbers in the stool and when there no other parasites. It is important to
estimate the characteristics of cases with B.hominis and other non-pathogenic protozoons for
treatment options.
Final abstract number: 65.058
Session: Parasitology (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

American Cutaneuos Leishmaniasis in the Urban Area from Ilhéus Cit, Bahia State.
Characterization of Autochthones Human Cases and Risk Factors Associated
Y.B. Souza, P.D. Bevilacqua
UFV, Viçosa, Brazil

Brazil currently confronts the spreading and urbanization of American Cutaneous Leishmaniasis
(ACL), in big and middle-sized cities, which is primally zoonotic and related to forest
environments. The present work valued the epidemiologic aspects of ACL in Ilhéus, and the
possible risk factors associated to its appearance in the urban area of this city. A revision of all
investigation cards of ACL cases in Ilhéus, registered by the SVE/SMS/Ilhéus from January 2000
to December 2006 was performed, analyzing the follows information about the referred cases:
age, sex, clinical forms, diagnostic date and illness evolution. A study on phlebotomine sand fly
occurrence in the urban area of Ilhéus was carried out from March to August 2006, using CDC
light traps. The canine infection was investigated through indirect fluorescent antibody test (IFAT)
and BIOGENE enzyme-linked immunosorbent antibody test (ELISA) for calazar canine.
Additionally, a matched case-control study was carried out involving the human population.
Analysis of investigation records showed that ACL affects mainly adult subjects, with cutaneous
lesions as the principal clinical form. The seasonality analysis showed the probable infection
period to be quarter September-November (Spring). No statistically significant correlation was
observed (p< 0.05) between case number and climate data (rain fall, humidity and temperature).
On the other hands, periods with high rainfall and humidity showed a smaller number of cases.
Lu. Cortelezzii was the one species collected in urban area. Three seropositive dogs were
identified by the immunofluorescence assay. The case-control study showed that the age group
13 to 44 years (p= 0.0061; OR=0.13; 95% CI= 0.076-0.22), living close to woodlands, was
associated with decreased risk; the habit of going to the rural area of Ilhéus showed to be a risk
factor to ACL (p= 0.003; OR= 5.5; 95%; CI= 1.75-17.29). With these results, we can conclude
that ACL in Ilhéus is not urban, since no typical vector species were found, and the human cases
were associated to the habit of going to the rural area. Additionally, the case profiles, adult males,
showed that the subjects exposed demonstrate non-compatible characteristics with a wider-
ranging exposure, as should be expected to happen if the illness transmission cycle took place in
Ilhéus urban area. We also note the importance of maintaining a strict registry of human cases,
with maximum rigidity, to guarantee specific diagnostic for ACL, making possible epidemiological
analysis more trustworthy.
Final abstract number: 66.001
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Pattern of Organism and Antimicrobial Resistance Bacterial Enteric Pathogens from Kashani
Hospital of Iran
E. Moghtadai Khorasgani
Islamic Azad University of Shahrekord, Shahrekord, Iran (Islamic Republic of)

Background: Antimicrobial resistance in enteric bacteria is increasing worldwide. Little data is
available on epidemiology and the antimicrobial susceptibility pattern of enteric pathogens in
Shahrekord city of Iran.
Method: A 2-year prospective surveillance study was performed on bacterial pathogens isolated
from stool specimens from community acquired gastroenteritis submitted to Kashani Hospital in
Shahrekord. The organisms were identified using conventional laboratory methods. Antimicrobial
susceptibility tests for Salmonella spp and Shigella were performed.
Results: There were 275 cases of bacterial gastroenteritis. Salmonella spp accounted for 42.1%,
Shigella spp 33.1%, Campylobacter 24%. Resistance to ciprofloxacin was uncommon in
Salmonella spp(1.8%) and not detected in Shigella spp. However ciprofloxacine resistance was
high in Campylobacter (50%). Cotrimoxazole resistance was high in Shigella spp with a highest
rate in S.Sonnei(92%). In Salmonella spp cotrimoxazole resistance was 6.3%. Erythromycine
resistance in Campylobacter was uncommon. The pattern of infection and resistance rate were
similar for adults and children.
Conclusion: The pattern of infection and antimicrobial resistance in bacterial enteric pathogens in
Iran has features in common with both the developing and developed world. Cotrimoxazole
should not be used as empirical therapy for dysentery. Quinolones should be used with caution
as empirical therapy for gastroenteritis because of the high incidence of ciprofloxacin resistance
in Campylobacter. Erythromycin remains the agent of choice for Campylobacter infection.
Final abstract number: 66.002
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Comparison of Gatifloxacin Versus Levofloxacin in the Treatment of Adults with Bacterial
Infections: A Double-Blind, Randomized Trial in China
       1          2            3           4            5        6         7       1
P. Hu , Z. Yuan , X.D. Zhou , E.Q. Xiong , G.S. Qian , H. He , Z.H. Peng , H. Ren
1
 The Institute of Viral Hepatitis, Department of Infectious Diseases, The Second Affiliated
                                                               2
Hospital, Chongqing Medical University, Chongqing, China, Department of Infectious Diseases,
                                                                                3
The First Affiliated Hospital, Chongqing Medical University, Chongqing, China, The Second
                                                                       4
Affiliated Hospital, Chongqing Medical University, Chongqing, China, Xinan Hospital, Third
                                                 5
Military Medical University, Chongqing, China, Xinqiao Hospital, Third Military Medical
                                 6
University, Chongqing, China, The First Affiliated Hospital School of Medicine, Xian Jiaotong
                          7
University, Xian, China, The Second Affiliated Hospital School of Medicine, Xian Jiaotong
University, Xian, China

Objectives: Bacterial infections are a serious health problem worldwide. We compared the
efficacy and safety of gatifloxacin, a new 8-methoxy fluoroquinolone, with that of levofloxacin in
the treatment of bacterial infections.
Methods: A randomized controlled multicentre clinical trial was conducted, with levofloxacin
serving as the control drug. A total of 506 patients were enrolled in the study, 254 in the
gatifloxacin group and the other 252 in the levofloxacin group.
Results: The cure rates of gatifloxacin and levofloxacin were 84.46% and 82.73%, and the overall
efficacy rates were 96.41% and 95.58% respectively. The bacterial clearance rates were 95.52%
in gatifloxacin group vs 93.69% in levofloxacin group. The adverse drug reaction rates of
gatifloxacin and levofloxacin were 10.63% and 10.71% respectively. There was no statistically
significant difference between the two groups. The results of in vitro activities of gatifloxacin and
other 4 antibacterial agents showed that gatifloxacin had good activities against Staphylococcus
spp. and was more potent than those of levofloxacin, sparfloxacin, ciprofloxacin and cefotaxime.
The activities of gatifloxacin against Streptococcus spp. were generally higher than those of
levofloxacin, sparfloxacin, ciprofloxacin, and similar to those of cefotaxime. The activities of
gatifloxacin against Gram-negative organisms were similar to or better than the other antibacterial
agents.
Conclusion: Gatifloxacin is an effective and on the basis of this trial, a safe broad-spectrum
antibacterial agent for the treatment of bacterial infections.
Final abstract number: 66.003
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Nationwide Surveillance of Doripenem Susceptibility among Clinical Isolates in intensive care
units in Taiwan: SMART Program 2004 data
           1               2        3           4            5           6            7       8
S.S. Jean , P.R. Hsueh , W.S. Lee , H.T. Chang , M.Y. Chou , I.S. Wang , J.H. Wang , C. Lin ,
          9            10       11       12             13          14          15
J.M. Shyr , W.C. Ko , J.J. Wu , Y.C. Liu , W.K. Huang , L.J. Teng , C.Y. Liu
1
 Departments of Intensive Care Units and Internal Medicine, Min-Sheng General Hospital ,
                     2
Taoyuan, Taiwan, Departments of Laboratory Medicine and Internal Medicine, National Taiwan
                                      3
University Hospital, Taipei, Taiwan, Department of Internal Medicine, Taipei Municipal WanFang
                             4
Hospital, Taipei, Taiwan, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei
                   5
County, Taiwan, Department of Internal Medicine, Cheng Hsin Rehabilitation Medical Center,
                 6
Taipei, Taiwan, Department of Internal Medicine, Cardinal Tien Hospital, Taipei, Taiwan,
7
 Department of Internal Medicine, China Medical College Hospital, Taichung, Taiwan,
8
 Departments of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan,
9
 Departments of Clinical Pathology, Taichung Veterans General Hospital, Taichung, Taiwan,
10
  Departments of Internal Medicine, National Cheng-Kung University Hospital, Tainan, Taiwan,
11
  School of Medical Technology, National Cheng-Kung University College of Medicine, Tainan,
                  12
Tainan, Taiwan, Departments of Clinical Pathology, Kaohsiung Veterans General Hospital,
                        13
Kaohsiung, Taiwan, Department of Internal Medicine, Kaohsiung Veterans General Hospital,
                        14
Kaohsiung, Taiwan, School of Medical Technology, National Taiwan University Hospital,
                                                                15
National Taiwan University College of Medicine, Taipei, Taiwan, Department of Internal
Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

Background: To survey in vitro susceptibilities of doripenem and other three carbapenems
against clinically important isolates from patients hospitalized in intensive care units
Methods: A total of 1311 isolates were studied. MICs were determined by the agar dilution
method (CLSI)
Results:
(please see the following table)
Conclusions: In comparison with other carbapenems, doripenem exhibited better in vitro activity
than imipenem and similar in vitro activity to meropenem against the Enterobacteriaceae. It also
showed better in vitro activity than meropenem and imipenem against Pseudomonas aeruginosa.
The activity of doripenem was similar to imipenem against Acinetobacter baumannii and better
than that of meropenem.
Final abstract number: 66.004
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Odds Ratios of Antimicrobial Susceptibility in Nosocomial and Non-Nosocomial Infections in
Environments with Low and High Prevalence of Resistant Pathogens
             1         2          3                 1             2
A. Zalounina , M. Paul , K. Kofoed , S. Andreassen , L. Leibovici
1                                       2                                         3
 Aalborg University, Aalborg, Denmark, Rabin Medical Center, Petah-Tiqva, Israel, Hvidovre
Hospital, Copenhagen, Denmark

Objectives: To compare the difference between antimicrobial susceptibilities in non-nosocomial
and nosocomial infections in a region with low (Denmark [DK]) versus a region with high
prevalence of resistant bacterial strains (Israel [IL]).
Methods: The study was based on in-vitro susceptibilities of clinically significant bacteremic
isolates collected from adults between 2005-2006 at Copenhagen University Hospital, Hvidovre
(DK) (n=1308) and between 1988-2004 at Rabin Medical Center (IL) (n=7589). The isolates
included Escherichia coli, Klebsiella spp., Streptococcus pneumoniae, Streptococcus viridans,
Coagulase-positive staphylococci, Coagulase-negative staphylococci, Enterococcus spp.
Bacteremia was defined as nosocomial if it occurred 48 h or more following hospital admission.
For each pathogen and antibiotic we calculated the Odds Ratios (OR) for non-nosocomial
infection being more susceptible than nosocomial.
Results: Nosocomial infections were less frequent in DK than in IL (25% vs. 43% of all infections).
The results for E. coli (the most prevalent pathogen: 43% in DK and 34% in IL) and Coagulase-
negative staphylococci are shown in the table below. The highest ORs for E. coli in DK (15.3) and
IL (3.7) were observed for Ceftazidim and Ceftriaxone, respectively. The ORs for E. coli in DK
differed statistically from the ORs in IL for Ceftazidim and Cefuroxime (P<0.05). For ampicillin and
E. coli the ORs were 1.0 in DK and 1.3 in IL, indicating that for this drug/pathogen combination
both hospitals reached the same equality in resistance between hospital and community. The
observed ORs for Klebsiella spp., S. pneumoniae and Enterococcus spp. for most drugs were
higher in DK. In the case of Coagulase-positive staphylococci and S. viridans all ORs in DK were
statistically non-significant and did not differ significantly from the corresponding ORs in IL.
Conclusion: ORs in the environment with low prevalence of resistant pathogens (DK) are
generally higher than in the environment with high resistance (IL). A possible explanation of the
large difference between antimicrobial susceptibilities in non-nosocomial vs. nosocomial
infections in DK is a low consumption of antibiotics in community in this country.
Final abstract number: 66.005
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Application of Human Recombinant Granulocyte Coloni-Stimulating Factor (rHU-G-CSF) Onto
Patients with Medicamentally and Radiately Provoked Neutropenia and Aplastic Anaemia
             1            2                3             4
L. Gercheva , P. Lazarova , G. Kyuchukov , K. Metodiev
1                                                              2
 Dept. Hematology, Univ.hospital 'St. Marina', Varna, Bulgaria, Clin.Lab., Univ. hospital 'St.
                       3                                                                 4
Anna', Varna, Bulgaria, Dept. Neurosurgery, Univ. hospital 'St. Anna', Varna, Bulgaria, Dept.
Immunology, Medical University, Varna, Bulgaria

The effect of rHu-G-CSF on neutrophile restoration in 85 patients was studied.The patients were:
29 with acute lymphoblastic leucemia (ALL), 6 with acute non-lymphoblastic leucemia (ANLL), 1
with chronic myelogeneic leucemia in blast-transformation, 12 with non-Hodgkin lympho-ma
(NHL), 16 with carcinoma, 10 with aplastic anaemia (AA), 10 with post-radiation neutropenia
(PRN) and 1 with Kostmann's syndrome. The daily dose of rHu-G-CSF was 5 mcg/kg for all
cases with haematologic malignancies, whereas the patient with Kostmann's syndrome was
treated with higher dose, up to 20 mcg/kg, due to lack of effect at the end of first week. A dose of
10 mcg/kg was applied to patients with aplastic anaemia and post-radiation neutropenia. The
mean back-ground level of leucocytes just before treatment was 0.73+0.13 x 10 /l and that one of
neutrophiles was 0.17+0.09 x 10 /l. Meanwhile the therapy the authors registered constantly:
leucocyte and granulocyte quantity, some enzymes, body temperature and clinical status of the
patients. The treatment was discontinued when the absolute neutrophile spectre reached over 1.0
x 10 /l. Shortest application was reported for the carcinoma cases: 4.3 days averagely, followed
by ALL: 5.8 days, NHL: 6.3 days, ANLL - 7.4 days, PRN: 10.3 days, AA: 14.5 days. One (with
ALL) of treated 75 patients had a lethal issue meanwhile the therapy, another one (with ALL too)
shew a recidival manifestation; 68 of the rest 73 patients demonstrated a total recovery and 5 - a
particular one (increase of ANC with over 100%). Only 5 patients of the group registered rapidly-
progressive side effects: 2 with muscular-skeletal pain, 2 with headaches and 1 with vomitting.
The nosologic cases were thoroughly analysed which proved that rHu-G-CSF shortened
considerably the time for recovery from leucopenia (opportunity for the so called 'antibiotic
umbrella' in neutropenic patients), thus allowing effective results from the treatment of clinically
manifested infectious complica-tions and intensification of chemotherapy.
Final abstract number: 66.006
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Susceptibility of Oral Anaerobic Bacteria to Fluoroquinolones of Various Generations and
Molecular Characterization of Resistant Strains
V. Tsarev, V. Chuvilkin , E. Ippolitov
Moscow State University of Medicine and Dentistry, Moscow, Russia

Background: Resistance among anaerobic bacteria is increasing and posing a major problem for
clinical periodontology, maxillo-facial and cardiovascular surgery. In the present study, we
attempted to determine susceptibility of clinical strains of anaerobic bacteria to fluoroquinolones
(FQ) and the frequency for FQ-resistant isolates and to study some mechanisms of resistance.
Methods: We evaluated 408 strains of anaerobic (Actinomyces israelii, Bacteroides forsithus,
Fusobacterium nucleatum, Peptostreptococcus anaerobius, Porphyromonas gingivalis, Prevotella
intermedia, Streptococcus intermedius) and microaerophilic bacteria (H. actinomycetemcomitans,
A. naeslundii, S. milleri) from different patients with oral diseases, which were collected and
tested. The cultivation was carried out in an anaerobic jar with gas mixture (80% N2; 10% CO2;
10% H2). MICs were determined in vitro for Gemi-, Gati-, Moxi-, Levo-, Spar- and Ciprofloxacin
against these bacteria according to NCCLS, using dilution method. Besides, then we have
examined the chromosomal mutations in the FQ-resistance-determining region of gyrA, gyrB
genes and parC, parE.
Results: Establishment of the variability of anaerobic bacteria susceptibility to FQ of various
generations. High level of susceptibility to the generations III-IV FQ was demonstrated for the
tested strains. Gemifloxacin was the most active and potent regarding all strains of anaerobic
bacteria (susceptibility 100%, MIC90 0,012-0,05 mg/L). In comparison: Moxi - 98,5%, MIC90
0,025-0,25 mg/L, Gati - 86,1%, MIC90 0,05-0,5 mg/L (generation IV), spar - 85%, MIC90 0,25-0,5
mg/L, Levo - 85%, MIC90 0,25-1 mg/L (generation III), and Ciprofloxacin - 70%, MIC90 1-2,5
mg/L (generation II). In FQ-resistant isolates we determined nucleotide sequences of the FQ-
resistant regions of gyrA, gyrB genes and parC, parE. In 18 clinical FQ-resistant isolates
(S.intermedius and P. gingivalis) we have revealed mutations in the FQ-resistance-determining
region of gyrA and parC genes - substitutions of serine 83 and 85 to Leucin. Clinical FQ-resistant
isolates showed a wide variation in MIC, ranging from 2,5 to 12,5 mg/L.
Conclusion: Generation IV FQ were found more effective. Among the group Gemifloxacin
demonstrated excellent activity regarding all anaerobic bacteria. The most common mechanism
of oral anaerobic bacteria resistance to FQ is the modification of type II (DNA gyrase) and IV
topoisomerase. However, the difference in the level of resistance could not be explained only on
the basis of mutations in gyrB or parE
Final abstract number: 66.007
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Antibiotic Use in a Brazilian City
F. Del Fiol, S. Barberato Filho
University of Sorocaba, Sorocaba, Brazil

The indiscriminate use of antibiotics has contributed to increase the antimicrobial resistance
around the world. In Brazil, there is no control regarding antibiotics use, once it is possible to
obtain any antibiotic without medical prescription. The aim of the present study was to observe
the quality of the antibiotics use (prescription, orientation and use) in a large Brazilian city. A
survey (50 questions) were divided into three parts: 1)questions about medical appointment and
prescription; 2)about patients' pathology; 3)about the level of information of the patient regarding
antibiotics. 403 patients answered right before they received the antibiotics. 3 pharmacies were
included in the sample: a) commercial; b)public; c)University's pharmacy. 28% of the patients
aged from 0to10 years-old, 71% of the medical appointments were performed in the free-public
healthy service and 40% of the person responsible for giving antibiotics to the children had less
than four years of scholarity. 21% of all users have been using other drugs that could cause drug
interactions and induce therapeutic failure (51% of patients aging 60 years or more have been
using other drugs). 40% of the patients did not complete the antibiotic course due to economical
reasons and 20% due to disappearance of symptoms (fever). The majority of patients used water
to ingest the drug, but 32% used milk. 60% of the patients did not present fever during the
medical appointment. 15% did not receive any medical orientation regarding antibiotic use. The
information level of the patients regarding antibiotics was 50% of correct answers, which shows
the deficiency of knowledge of the doctors and patients regarding this issue. We concluded that
the necessity of educational campaigns to inform the medical staff and the patients is very urgent
in order to promote the rational use of antibiotics and to inhibit the bacterial resistance. Supported
by FAPESP.
Final abstract number: 66.008
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Bacterial Resistance in Argolis, Greece
K. Mitrakou, I. Mitrakos, G.C. Michalopoulos, E. Xounta, G. Mavras, M. Pavlaki, F. Rozi
General Hospital of Argos, Greece, Argos, Greece

Objectives: To study the antibiotic resistance in the microorganisms isolated from blood cultures
at the General Hospital of Argos, Greece during the period 01/01/05 to 31/10/2007
Methods: 791 blood cultures were studies. The identification and the antimicrobial susceptibility
tests were performed using the analysis Bact/ALERT and the automat system VITEK 2 compact
(BIOMERIEUX)
Results: From the 791 blood cultures 661(83,56%) were negative and 130(16,43%) were positive.
CONS-coagulase negative staphylococci were the most common isolated bacteria [50 samples
(38,46%)], followed by E. coli [25 samples (19,23%)], Brucella melitensis [21 samples (16,15%)],
Staphylococcus aureus [12 samples(9,23%)], Pseudomonas auroginosa [7 samples (5,38%)],
Klebsiella pneumoniae [3 samples (2,3%)], Enterobacter cloacae [3 samples (2,3%)],
Enterococcus faecalis [2 samples (1,53%)]. The resistance of E. coli to Ampicillin,
Amoxicylin/clavulanic, ciprofloxacin and 3rd generation cephalosporins were 36%, 12%, 8% and
0% respectively. CONS and Staphylococcus aureus presented 48% and 16,66% resistance to
Oxacillin respectively and 0% resistance to Vancomycin. Pseudomonas aureginosa presented
28,57% resistance to ceftazidime, aminoglycosides and imipenem and 42,85% resistance to
ciprofloxacin and piperacillin. For Klebsiella pneumoniae the resistance rate was 0% to imipenem,
33,33% to aminoglycosides, 66,66% to ciprofloxacin and 3rd generarion cephalosporins. The
enterococcus faecalis strains presented 0% resistance to vancomycin and linezolid.
Conclusions: Comparing these results to those of EARSS (European Antimicrobial Resistance
Surveillance System), 2006, was observed that the antibiotic resistance prevalence of E. coli was
lower in this region than that of the rest of Greece and European countries (fluoroquinolones 8%
in Argolis, 14,5% in Greece, 29,2% in Germany, 28% in Spain, 13,8% in France, for
cephalosporins in Argolis 0%, in Greece 6,1%, UK 7,7%, Italy 7,4%). The resistance to
vancomycin of Staphylococcus aureus 0% is similar to that seen in European countries.
Pseudomonas auroginosa and Klebsiella pneumoniae presented significant resistance rate to
other countries. Greece has the higher resistance rate to imipenem, 47,6% for pseudomonas and
32,9% for Klebsiella and also to Ceftazidime for Pseudomonas 34,1% but in Argolis it was
28,57% resistance to imipenem for Pseudomonas, 0% for Klebsiella and 28,57% resistance of
Pseudomonas to ceftazidim.
Final abstract number: 66.009
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Prevalence of Integrons in Malaysian Isolates of Antibiotic Resistant Bacteria
          1              1              2
S.Y. Chia , S. Muniandy , N. Parasakthi
1                                               2
 University of Malaya, Kuala Lumpur, Malaysia, University of Monash, Kuala Lumpur, Malaysia

Integrons are capable of scavenging transcriptionally silent antibiotic resistance gene cassettes
and converting them into functional genes. This study characterizes the resistance gene
cassettes carried by integrons in clinical isolates of multiresistant Enterobacteriaceae. Class 1
integrons were shown to be present in 34 out of the 38 multiresistant strains by PCR screening
for the intI1 gene. The qacED1 & sul1 genes were present in 28 of these strains. PCR
amplification of the 5'- and 3'-conserved segments, close to the gene cassette crossover points
showed that 23 of the intI1-positive strains carried an integron with inserted gene cassettes in
their variable regions. The full sequences of the inserted gene cassettes were studied by
restriction mapping and gene cassettes were classified into 8 groups. Representative gene
cassettes of each group were then sequenced. Gene cassettes were found to carry genes
encoding resistance to streptomycin and spectinomycin (aadA1, aadA2, aadA5 and aadB),
trimethoprim (dfrA1, dfrA15, dfr16, dfr17 & dhfrXII) and chloramphenicol (catB3) and correlated to
their antimicrobial susceptibility phenotypes. A new combination of gene cassettes (dfrA15-
aadA1) was found in one of the strains studied. The complete sequences of these gene cassettes
have been submitted to the GenBank and Accession Numbers have been assigned.
Final abstract number: 66.010
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Risk Factors for Nephrotoxicity associated with Continuous Vancomycin Infusion in Outpatient
Parenteral Antibiotic Therapy
            1           2              1           2          3           1
P.R. Ingram , D.C. Lye , P.A. Tambyah , W.P. Goh , V.H. Tam , D.A. Fisher
1                                                    2
 National University Hospital, Singapore, Singapore, Tan Tock Seng Hospital, Singapore,
           3
Singapore, University of Houston, Houston, TX, USA

Background: Continuous vancomycin infusion is increasingly used for outpatient management of
infections, but the relationship between vancomycin and nephrotoxicity is controversial. We
investigated the risk factors associated with nephrotoxicity in this setting.
Methods: A retrospective cohort study of patients receiving continuous vancomycin infusion as
Outpatient Parenteral Antibiotic Therapy (OPAT) was performed. The likelihood of developing
nephrotoxicity ( 50% increase in serum creatinine from baseline) was evaluated in relation to
demographic variables, underlying co-morbidities, infectious disease diagnoses, concomitant
drug exposures and vancomycin concentration. Logistic regression was used to determine the
association of various variables. Classification and regression tree analysis was used to
determine the most significant breakpoint for continuous variables.
Results: We examined 102 adult patients between January 2004 and June 2007. The mean ± SD
age, baseline serum creatinine and steady state vancomycin concentration were 48.2 ± 17.6
years, 78.0 ± 32.5 mmol/L and 15.5 ± 10.8 mg/L, respectively. The majority of the patients
(66.7%) were treated for bone and joint infection. The cumulative incidence of nephrotoxicity was
15.7%. Nephrotoxicity was found to be associated with hypertension [odds ratio (OR) 5.302 (95%
confidence interval {CI}1.159 - 24.246), p=0.031], exposure to aminoglycosides [OR 6.594 (95%
CI 1.026 - 42.385), p=0.047], loop diuretics [OR 8.123 (95% CI 1.449 - 45.528), p=0.017], and
steady state vancomycin concentration 28 mg/L [OR 21.236 (95% CI 2.687 - 167.857),
p=0.004].
Conclusion: We have identified independent risk factors for nephrotoxicity in patients receiving
continuous infusion vancomycin in OPAT. A serum steady state vancomycin concentration 28
mg/L markedly increases this risk.
Final abstract number: 66.011
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Comparative Study of Piperacillin/Tazobactam and Cefepime in Cancer Patients with Febrile
Neutropenia
        1           1             1         1
Y.M. Wi , D.R. Chung , J.H. Song , K.R. Peck
1                                                  1
 Samsung Medical Center, Seoul, Republic of Korea, samsung medical center, seoul, Republic
of Korea

Background: To compare the efficacy and safety of piperacillin/tazobactam with cefepime as an
empirical monotherapy for adult cancer patients with febrile neutropenia.
Method: A prospective, randomized, open-labelled, comparative trial was performed. If clinically
preferable, the test article may be changed to oral ciprofloxacin at 72 hours. Clinical and
microbiological responses were determined at 72 hours and at the end of therapy.
Results: A total of 89 cases were enrolled. 48 patients received piperacillin/tazobactam (PT
group) and 41 patients received cefepime (CA group). Demographic and clinical characteristics
were similar in two groups (p>0.05). Clinical success rate at 72 hours in PT group (91.7%) was
similar to that in CA group (85.4%) (p=0.31). At the end of therapy, clinical success rate in PT
group (91.7%) was also similar to that in CA group (100%) (p=0.15). Adverse events including
liver dysfunction (21.3%) and renal dysfunction (2.2%) were similar in two groups (p=0.87).
Conclusion: piperacillin/tazobactam monotherapy was as effective and safe as the cefepime as
an empirical treatment for cancer patients with febrile neutropenia.
Final abstract number: 66.012
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Bioprospecting for Antimicrobial Peptides
K. Philip, S.K. Sinniah, S. Muniandy
university of malaya, kuala lumpur, Malaysia

Cationic antimicrobial peptides (AMPs) are important mediators in the primary host defense
system against pathogenic microorganisms and are widely distributed in nature. The occurrence
and characterization of low-molecular-mass AMPs from a wide variety of organisms have been
accumulating at a rapid rate because of their biochemical diversity and broad specificity against
bacteria or fungi and even some being anti-viral or possessing wound-healing effects. This has
biopharmaceutical applications especially in view of the increased bacterial resistance to
antibiotics in the clinical setting over the past decade. There is a growing need to discover and
introduce new drugs, and AMPs provide new promising candidates as new antibiotics. The
objective of this study has been to isolate novel peptides from native microbial and plant sources
including fermented extracts. The antimicrobial properties of these extracts were initially tested
using Escherichia coli, Staphylococcus aureus and Bacillus subtilis. This paper shows the initial
results of the inhibition obtained on these microorganisms using plant and fermented extracts.
The extracts were fractionated using cation exchange chromatography and antimicrobial tests
were conducted with the fractions obtained. High pressure liquid chromatography was attempted
with one of the extracts and some preliminary results were also obtained. Further studies that are
in progress are also briefly outlined to indicate the potential of developing these compounds into
biopharmaceuticals.
Final abstract number: 66.013
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Evaluation Results of 21th Iranian External Quality Assessment Schemes (EQAS) of Microbiology
laboratories in 2007
M. Rahbar, M. Saremi, M. Mir Mohammadi Roodaki, R. Sabourian, S. Hekmat Yazdi
Iranian Reference Health Laboratory, Tehran, Iran (Islamic Republic of)

Objective: The aim of this study was to determine ability of Iranian microbiology laboratories for
identification and susceptibility testing of two unknown microorganisms.
Methods: In Feb 2007 21th run of proficiency testing of Iranian microbiology laboratories carried
out by Iranian health reference laboratories. In this survey two unknown microorganisms including
Salmonella Paratyphi B and Staphylococcus aureus were submitted to 1305 microbiology
laboratories. We asked all laboratories to identify each microorganism and performance of
susceptibility testing just for S. paratyphi B against tetracycline, nalidixic acid, ciprofloxacin,
ampicillin and trimethoprim-sulfamethoxazole. Scoring of results performed according to WHO
criteria. The maximum score of point for identification of each bacterium was 3 score and 5 score
for susceptibility testing (each antibiotic one score). The results were analyzed by SPSS.
Results: Of 1305 laboratories only 1122 (.86%) laboratories participated in our survey and 183
(14%) laboratories did not participated in this study. Of 1122 laboratories, 523 (46.6%)
laboratories identified S. paratyphi B correctly and obtained maximum 3 score of points and 488
(43.5%) laboratories partially identified this microorganism (1-2.5 score) and 111 (9.9%)
laboratories misidentified this microorganism. The mean score was 2.6. The results of
susceptibility testing of S. paratyphi B were relatively satisfied for nalidixic acid, ciprofloxacin and
trimethoprim-sulfamethoxazole. However the results of susceptibility testing for tetracycline and
ampicillin were unsatisfied and only the results of 578 (52.5%) of 1122 were correct for
tetracycline and 558 (49.7%) of laboratories reported correct answer for ampicillin. The mean of
score for susceptibility testing was 3.88. Regarding to identification Staphylococus aureus of 1122
laboratories 767 (68.4%) identified this organism correctly and obtained maximum three score,
211 (18.8%) laboratories reported partially correct answer ( 1-2.5 score) and 114 (12.8%)
laboratories could not identified S.aureus. in total mean score for identification of this
microorganism was 2.3.
Conclusions: This study revealed that the majority of microbiology laboratories were able for
identification of S. parathyphi B and S. aureus. Nearly 50% of laboratories produced incorrect
susceptibility testing answer according to S. paratyphi B for tetracycline and ampicillin.
Final abstract number: 66.014
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Multicenter Evaluation of Tigecycline Activity in India: Report from the SENTRY Antimicrobial
Surveillance Program (2006)
          1       2             2           3
R. Jones , J. Bell , J. Turnidge , D. Mathai
1                                          2
 JMI Laboratories, North Liberty, IA, USA, Women's and Children's Hospital, Adelaide, Australia,
3
 Christian Medical College Hospital, Vellore, India

Background: Tigecycline, the initial representative of the glycylcyclines, presents a therapy option
for emerging multidrug-resistant (MDR) pathogens. India, a nation rarely monitored in global
surveillance programs, appears in need of agents active against MDR isolates of
Enterobacteriaceae (ESBLs), Acinetobacters (carbapenem-resistant) and Gram-positive cocci
(MRSA, VRE). Numerous sites were sampled using reference susceptibility methods.
Methods: Eleven sites forwarded 1,714 strains to a regional monitor (WCH, Adelaide, Australia)
that susceptibility tested 27 antimicrobials by CLSI methods (M7-A7, 2006). Identifications were
confirmed and interpretive/screening criteria were also by CLSI guidelines (M100-S18, 2008),
except for tigecycline where United States - Food and Drug Administration breakpoints were
applied. Major pathogens were: S. aureus (250), coagulase-negative staphylococci (CoNS; 228),
enterococci (93), Enterobacters (76), E. coli (217), K. pneumoniae (268), Salmonella spp. (55)
and Acinetobacters (108).
Results: Tigecycline was active against 98-100% of indicated/tabulated species, lowest for
Acinetobacter spp. S. aureus tigecycline MIC90 values were not influenced by oxacillin
susceptibility patterns (0.25 mg/L; 100% S). Increased resistance patterns noted were:
tetracycline-resistant (4-100%; average 53%), AmpC, ESBL- and fluoroquinolone resistance in
Enterobacteriaceae (8-70, 14-78, 1-91%, respectively), VRE (1%), MRSA (36%) and
Acinetobacters carbapenem-resistant (38%). S. typhi and S. paratyphi were common (tigecycline
MIC90, 0.5 mg/L), and 84% were nalidixic acid-resistant. Carbapenem resistance in
Enterobacteriaceae (1-7%) was consistent with harbouring metallo-b-lactamases; confirmed by
PCR testing.
Table
Conclusions: Although MDR rates across Gram-positive and -negative species (particularly
among enteric bacilli and Acinetobacters) was high in India, tigecycline remained active (MIC90, 1
mg/L overall) against these MDR strains. Tigecycline exhibited promising spectrum/potency
exceeding currently available agents against sampled isolates from India.
Final abstract number: 66.015
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Antibacterial and Antifungal Activity of Different Honeys
       1             2                 3            3        3       1          4
T. Ijaz , F.A. Ranjha , M.K. Shahzad , M.A. Khan , M. Imran , N. Ijaz , S. Ijaz
1                                                           2
 Microbiology Laboratory Mayo Hospital, Lahore , Pakistan, Chairman Research Cell Mayo
                             3
Hospital , Lahore, Pakistan, University of Veterinary and Animal Sciences, Lahore, Pakistan,
1                                                          4
 Microbiology Laboratory Mayo Hospital, Lahore, Pakistan, Services Institute of Medical
Sciences , Lahore, Pakistan

Background: With the irrational and massive use of Antibiotics in underdeveloped and developing
countries, resultantly there was increased Resistance to Antibiotics and with the increased
interest in herbal medicine and use of honey for various therapeutic purposes has led to the
search for new antibacterial honeys. Hence a study was conducted to assess the antibacterial
and fungicidal activity of six honeys locally produced under natural and farm environment and
their comparison with the commercially available therapeutic honeys (including Medihoney® and
rewa rewa honey).
Methods: An agar dilution method was used to assess the activity of honeys against 15 bacteria
and one yeast. The honeys were tested at eight concentrations ranging from 1% to 50%.
Results: All 15 bacteria were inhibited by all honeys used in this study with only the yeast
Candida albicans not inhibited by the honeys at 20%. Little antibacterial activity was seen at
honey concentrations <5%, with minimal inhibition at 5%. No honey was able to produce
complete inhibition of bacterial growth at concentration up to 20% but with the increase in
concentration 40% honey obtained from wild bee produces remarkable inhibition. Although
Medihoney® and rewa rewa had the overall good activity but the activity of naturally produced (by
wild bee) local honey was even better than those. But the locally produced honeys by commercial
beekeepers had poor inhibitory activity for some, but not for all bacteria.
Conclusions: Honeys other than those commercially available as antibacterial honeys can have
equivalent antibacterial activity if they produced through hygienic methods. The newly identified
antibacterial honeys may prove to be a valuable source of future therapeutic honeys.
Keywords: Antibacterial,wild bee, Agar dilution, Medihoney®.
Final abstract number: 66.016
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Multicenter Evaluation of Tigecycline: An in Vitro Update Against Clinical Pathogens from Japan
(2006-2007)
         1                1           2                2
S. Kohno , K. Yanagihara , R. Jones , M. Castanheira
1                                                           2
 Nagasaki University School of Medicine, Nagasaki, Japan, JMI Laboratories, North Liberty, IA,
USA

Background: Tigecycline, a novel glycylcycline class agent (first in class), has been utilized for
serious multidrug-resistant (MDR) pathogen infections in several global locations for 1-3 years.
This prospective in vitro multicenter trial evaluates nearly 4,000 pathogens from Japan (2006-
2007).
Methods: A total of 3,902 isolates (19 medical centers) were processed by reference broth
microdilution methods in a single central laboratory. CLSI methods were applied and breakpoints
found in CLSI M100-S18 (2008) or USA-FDA Tygacil® package insert were used. The most
prevalent organisms were: S. aureus (SA; 1,198), S. pneumoniae (SPN; 459), E. coli and
Klebsiella (199 each), CoNS (198), Enterobacters (197), enterococci (195) and Acinetobacters
(193). All concurrent QC was acceptable.
Results: Against Gram-positive cocci, tigecycline MIC50/90 values were: SA (0.12/0.5 mg/L),
enterococci and CoNS (0.12/0.25), SPN ( 0.03/0.06), and b-haemolytic (BHS) or viridans group
streptococci ( 0.03/0.06); all susceptible except 3 MRSA (MIC at 1 mg/L). Among
Enterobacteriaceae, tigecycline inhibited 100.0, 99.0 and 100.0% of E. coli, Klebsiella and
Enterobacters at 2 mg/L, respectively. P. mirabilis and S. marcescens were less susceptible to
tigecycline (MIC90 range, 1 to 4 mg/L). Acinetobacters (193) had MIC values ranging to 4 mg/L;
99.0% at 2 mg/L and 1.6% carbapenem-resistant. P. aeruginosa were generally tigecycline-
resistant (MIC90, >4 mg/L). 14.5% of group B were levofloxacin-resistant (clonal with multiple
QRDR mutations in 7 sites). ESBL rates were only 2.0-6.5% in E. coli and Klebsiella, and
fluoroquinolones and trimethoprim/sulfamethoxazole resistances were highest (20.1-21.1%) in
E.coli.See Table
Conclusions: Tigecycline was observed to be active against nearly all tested species from
Japanese medical centers for year 2003-2004 strains, and in this prospective sample report
remains similarly active (2006-2007 isolates). Resistant subsets (MRSA, ESBL enteric bacilli,
MDR Acinetobacters) were generally inhibited at USA-FDA-susceptible breakpoints for
tigecycline. Possible use of tigecycline for some serious MDR infections in Japan should be
considered.
Final abstract number: 66.017
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Study of Antibacterial Activity of a Green Alga, Caulerpa Sertularioides from the Persian Gulf
              1          1                1           1            2             3
S. Tajbakhsh , K. Zandi , P. Bahramian , M. Pooyan , K. Sartavi , G. Asayesh
1
 The Persian Gulf Tropical Medicne and Infectious Disease Research Center,Bushehr University
                                                          2
of Medical Sciences, Bushehr, Iran (Islamic Republic of), Jahad Keshavarzi Research Center,
                                      3
Bushehr, Iran (Islamic Republic of), The Persian Gulf Tropical Medicine and Infectious Disease
Research Center,Bushehr University of Medical Sciences, Bushehr, Iran (Islamic Republic of)

Background: Development of antibiotic resistance is one of the most common problems in
medicine. Thus, discovering of new antibacterial compounds is interesting. Marine algae are rich
sources of bioactive metabolites that could be effective as antimicrobial agents. The aim of this
in-vitro study, was to test for antibacterial activity of a green alga, Caulerpa sertularioides from the
Persian Gulf.
Methods: The extract from C. sertularioides was prepared by 20 minutes boiling of alga in 20%
glycerine solution and it was then sterilized using the filteration. A bacterial concentration of
500000 colony forming units (CFU)/ml of Staphylococcus epidermidis (ATCC 14990) as a gram
positive or Escherichia coli (ATCC 25922) as a gram negative bacterium were tested with
different concentrations of the extract in Mueller-Hinton broth for evaluation of antibacterial effect.
Controls without the extract were treated by the same way.
Results. The extract showed antibacterial activity against S. epidermidis and E. coli in the
concentrations of 34 mg/ml and 27.2 mg/ml, respectively.
Conclusion: C. sertularioides could be a suitable source for isolation of antibacterial compounds
and furthert in-vivo investigations.
Keywords: Caulerpa sertularioides, antibacterial activity, alga
Final abstract number: 66.018
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Clinical and Microbiological Efficacy of Continuous Versus Intermittent Administration of
Meropenem in Critically Ill Patients
          1           1               2         1          1          1            1
I. Chytra , M. Stepan , T. Bergerova , E. Kasal , P. Pelnar , R. Pradl , A. Zidkova
1
 Dept. of Anaesthesiology and Intensive Care Medicine, University Hospital, Plzen, Czech
            2
Republic, Dept. of Microbiology, University Hospital, Plzen, Czech Republic

Background: Beta-lactam antibiotics efficacy depends on the duration of time in which serum
concentration exceeds MIC. The aim of open prospective randomized study was to compare
clinical and microbiolgical efficacy of continuous infusion versus intermittent administration of
meropenem in critically ill patients.
Methods: Patients admitted to interdisciplinary ICU suffering from severe infection indicated to
meropenem administration were randomized to receive either a 2 g iv loading dose of
meropenem followed by a daily 4 g continuous infusion (CONTINUOUS group) or intermittent
administration of 2 g of meropenem iv in every 8 h (INTERMITTENT group). Antibiotic therapy
was stopped at improvement of clinical state and signs of subsidence of infection (body
temperature below 38,3°C, white blood count < 10000/mm3 or decrease below 25% of maximal
value, C-reactive protein - CRP 100 mg/l). Microbiological efficacy was evaluated as success
(eradication or presumed eradication) or failure (persistence or rezistence development). The
age, gender, APACHE II score, SOFA score, length of ICU stay, length of mechanical ventilation,
type of infection were assessed. Success, failure and length of meropenem therapy and total
dose of meropenem were evaluated. Mann-Whitney, unpaired t-test and Chi-squared test were
used accordingly; p<0,05 was considered statistically significant.
Results: A total of 84 patients (55 men and 29 women) were enrolled and randomized in
CONTINUOUS (n=42) and INTERMITTENT (n=44) group. No significant differences between
CONTINUOUS and INTERMITTENT group in assessed parameters were found except for total
dose of meropenem (Table).
Conclusion: Continuous infusion and intermittent administration of meropenem in critically ill
patients provided equivalent clinical and microbiological outcome. Compared with intermittent
application, continuous infusion significantly decreased the total dose of meropenem.
Grant acknowledgment: This study is supported by the Czech Ministry of Education (project
MSM0021620819)
Final abstract number: 66.019
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Longitudinal Analysis of Tigecycline Activity against US isolates of Enterobacteriaceae and
Acinetobacter spp. Based on Patient Location and Specimen Source
            1              1                 1           1                2           1
D.C. Draghi , M.K. Torres , C. Thornsberry , C.M. Pillar , M.J. Dowzicky , D.F. Sahm
1                                             2
 Eurofins Medinet, Inc., Herndon, VA, USA, Wyeth Pharmaceuticals, Collegeville, PA, USA

Background: In 2005, tigecycline (TIG) a novel glycylcycline was approved in the US for
treatment of complicated skin and skin structure infections (cSSSI) and complicated intra-
abdominal infections (cIAI). As such, it is important to continue to monitor TIG activity against
target pathogens for these indications. This study reports the in vitro activity of TIG against
Enterobacteriaceae (EN) and Acinetobacter spp. (AC) as observed during development ('01-'04),
and during the years following its approval for use ('05, '06 and '07). The results were further
stratified to determine whether any potential variability in TIG activity against EN and AC exists
according to patient location (PL) and specimen source (SS).
Methods: EN and AC isolates were collected from multiple locations across all nine US Bureau of
Census regions during the following years (Y): '01-'04 (EN: 1330, AC: 224), '05 (EN: 1151, AC:
77), '06 (EN: 958, AC: 255), and '07 (EN: 599, AC: 114). Isolates were centrally tested using
broth microdilution according to current CLSI standards. TIG activity was analyzed by patient
location (PL; outpatient [OP], intensive-care unit [ICU], and inpatient non-ICU [IP]) and by
specimen source (SS; blood [BL], respiratory [RP], urine [UR: EN only], and skin and skin
structure [SST]). EN FDA breakpoints (BPs) were used to interpret all TIG MIC results (as BPs for
TIG against AC do not currently exist).
Results: Against EN overall, TIG had an MIC90 of 1 mg/L in each study period ('01-'04, '05, '06,
and '07), and EN isolates were 99% susceptible (S) to TIG throughout. The activity of TIG for
each study period was consistent by MIC90, regardless of PL (MIC90 = 1 mg/L against OP, ICU,
and IP) or SS (MIC90 = 1 mg/L against BL, RP, and SST, 0.5-1 mg/L for UR isolates). In the most
recent period evaluated ('07), EN isolates were 99% S to TIG for all PL and SS evaluated.
Against AC overall, TIG had an MIC90 of 2 mg/L in '01-'04 and '07 and 1 mg/L in '05 and '06. The
% S of AC went from 97% in '01-'04 to 99.5% in '05, '06 and '07. For each study period, little
variation in TIG MIC90 was observed either by PL or SS (1-2 mg/L). In '07, 100% of tested
acinetobacter were susceptible to TIG (EN BPs were utilized for AC).
Conclusion: Little to no alteration in the in vitro activity of TIG against EN and AC was apparent
by MIC90 over the years of study which span its introduction to use in 2005. The activity by MIC90
was also consistent in each study period, regardless of the PL and SS of the tested isolates.
Continued surveillance is warranted both to support the further clinical development of TIG and to
detect any emerging resistance among target pathogens for indications which TIG is currently
approved (cSSSI and cIAI).
Final abstract number: 66.020
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Dalbavancin Tested Against Staphylococcus spp. and Streptococcus spp. Isolates collected from
Five European Counties: Comprehensive DECIDE Program Results (2007)
D. Biedenbach, R. Jones
JMI Laboratories, North Liberty, IA, USA

Background: Dalbavancin is a novel lipoglycopeptide with an extended half-life and intended for
treating complicated skin and skin structure infections caused by S. aureus (SA) and b-
haemolytic streptococci (BHS). The DECIDE Program was initiated to assess the activity of
dalbavancin compared to vancomycin or teicoplanin (Italy only) against recent (2007) clinical
isolates from across Europe (EU).
Methods: Eighteen sites in France, Germany, Spain, Italy and UK utilized standardized,
reference-quality agar diffusion methods including Etest and CLSI (M2-A9) disk diffusion (DD)
tests with concurrent QC (CLSI M100-S18, 2008). 1,127 strains were tested against dalbavancin
and comparison glycopeptides by Etest. DD was used for linezolid, cefoxitin, levofloxacin,
gentamicin, tetracycline, erythromycin, clindamycin (plus D-test), penicillin and ceftriaxone.
Dalbavancin susceptibility was defined at 0.25 mg/L.
Results: Dalbavancin exhibited potent activity against the SA and coagulase-negative
staphylococci (CoNS; MIC50/90, 0.064/0.19 mg/L), and BHS (MIC50/90, 0.016/0.047 mg/L).
Overall, vancomycin and teicoplanin were eight-fold less potent. Italy had higher dalbavancin
MIC values (two-fold) for SA and the highest MRSA rate (44%) compared to other nations (8-
36%). Dalbavancin MIC90 values were slightly higher for group B (0.047 mg/L) compared to group
A (0.032 mg/L) streptococci. Nearly 4% of BHS isolates were levofloxacin-non-susceptible.
Among SA, resistance rates were: erythromycin (29%), clindamycin (13%), gentamicin (10%),
and levofloxacin (29%) with higher resistance rates among MRSA. Inducible clindamycin
resistance was high among SA (72%) and CoNS (48%) and less among BHS (25%). Rare strains
had non-susceptible MIC values for linezolid (0.3 %) and vancomycin (0.1 %).
Conclusions: Dalbavancin demonstrated pronounced activity (MIC, 0.25 mg/L) against
staphylococci and BHS from European countries. Due to dalbavancin's high molecular weight,
like other peptides, care must be taken when interpreting Etest-generated MICs (false
resistance). Dalbavancin provides coverage of contemporary Gram-positive pathogens, including
resistant isolates recovered from patients in Europe, confirming earlier USA reports.
Final abstract number: 66.021
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

In-vitro Activity of Ertapenem against Bloodstream Isolates of Bacteria at the National University
Hospital, Singapore
          1                2              2                  2          1
S. Vasoo , W.M.C. Ong , P.A. Tambyah , G. Kumarasinghe , K. Singh
1                                                    2
  Rush University Medical Center, Chicago, IL, USA, National University Hospital, Singapore,
Singapore

Background: Ertapenem is a relatively new carbapenem with broad activity. There are however
limited studies regarding its efficacy in bacteremic patients. We evaluated the in-vitro activity of
Ertapenem against blood culture isolates (community onset and nosocomial) at a tertiary hospital.
Methods: Bacteria isolated from blood cultures from hospitalized patients admitted to the National
University Hospital, Singapore (Dec 2003-May 2004) were identified using the Vitek instrument
(bioMerieux, NC) and Microbact 12A and 12B (Oxoid Australia). Gram-stain, catalase, coagulase
(Pastorex Staph Plus, Bio-Rad, CA) and PYR disk testing were done for Staphylococcusand
Streptococcus spp. Ertapenem susceptibilities were determined using the Kirby-Bauer disk
method on cation-adjusted Mueller-Hinton plates according to the CLSI performance standards.
Burkholderia pseudomallei (B. pseudomallei) isolates were further tested using the E-test (AB
Biodisk, Sweden).
Results: 333 blood stream isolates were studied, including 157 Enterobacteraciae (73 Extended
spectrum beta-lactamase (ESBL) positive) and 29 isolates of B. pseudomallei. All 157
Enterobacteraciae isolates were Ertapenem susceptible. 26 B. pseudomallei strains were
susceptible and 3 strains intermediate to Ertapenem by disk testing, but the E-test showed that
only 5 of the 29 strains were susceptible (MIC 2 mcg/ml). Of the non-fermenting gram-
negatives, 26 of 64 isolates were susceptible (including 4/6 B. cepacia, 8 /26 A. baumanii and
3/10 P. aeruginosa isolates). All isolates of S. maltophila (9/9) were resistant. Of the gram-
positives, 2/2 L. monocytogenes and all S. viridans (5/5), beta-hemolytic Streptococci (11/11), S.
pneumoniae (6/6), methicillin susceptible S. aureus (32/32) were susceptible. All 12 strains of
penicillin susceptible E. faecalis were non-susceptible to Ertapenem, whilst 9 of the 10 B. fragilis
strains tested were.
Conclusions: Ertapenem demonstrates excellent activity against enterobacteraciae including
ESBL producing strains at our institution but is lacking against A. baumannii, P. aeruginosa, S.
maltophilia and E. faecalis. It also has poor activity against B. pseudomallei and cannot be
recommended as therapy for melioidosis.
Final abstract number: 66.022
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Activities of Tigecycline against Clinical Isolates of Acinetobacter baumannii in Taiwan: Broth
Microdilution Method vs. Disk Diffusion Method
            1           2          3          4         5            6          7       8
C.H. Liao , H.C. Kung , G.J. Hsu , P.L. Lu , Y.C. Liu , C.M. Chen , C.M. Lee , W. Sun ,
            9             10
T.N. Jang , P.C. Chiang
1                                                                                    2
 Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan, Department of
Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan,
3                                                                                4
 Department of Internal Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan, Department of
Internal Medicine, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung,
          5
Taiwan, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung,
          6
Taiwan, Department of Internal Medicine, Tungs' Taichung Metro Harbor Hospital, Taichung,
          7
Taiwan, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan,
8                                                                          9
 Department of Infection Control, Pao-Chien Hospital, Pingtung, Taiwan, Department of Internal
                                                                       10
Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, Department of Internal
Medicine, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan

Background: The Tigecycline In-Vitro Surveillance in Taiwan (TIST), initiated in 2006, is a
nationwide surveillance program designed to monitor longitudinally the in vitro activities of
tigecycline against commonly encountered resistant bacteria in Taiwan. This study aims to
compare the in vitro activities of tigecycline against clinical isolates of Acinetobacter baumannii by
using two susceptibility methods.
Methods: A total of 393 isolates of A. baumannii were collected from various sources of patients
treated at 20 teaching hospitals. Minimum inhibitory concentrations (MICs) and diameters of
inhibitory zone for tigecycline were determined by the broth microdilution methods and the disk
diffusion method, respectively. The results were interpreted by the MIC criteria provided by U.S.
FDA tigecycline susceptibility breakpoints listed for Enterobacteriaceae (S, 2 g/mL; I, 4 g/mL;
R, 8 g/mL) and by the disk diffusion breakpoints (S, 16 mm; I, 13-15 mm; R, 12 mm)
recommended by Jones et al (J. Clin. Microbiol 2007;45:227-30). A very major error (VME) rate of
<1%, major error (MaE) rate of <5%, and a total error rate of <20% were considered acceptable.
Results: Percentages of susceptible, intermediate, and resistant isolates determined by the broth
microdilution method (disk diffusion method) are 81.7% (88.3%), 12.0% (8.9%), and 6.3% (2.8%),
respectively. VME, MaE, minor error, and total error rates were 0.5% (2/393), 8.9% (35/393),
37.4% (147/393), and 46.8% (184/393), respectively.
Conclusion: Comparison with the broth microdilution method for tigecycline against A. baumannii,
the disk diffusion method tends to have a high false-susceptibility rate and have an unacceptable
high VME
Final abstract number: 66.023
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Nationwide Surveillance of in Vitro Activities of Tigecycline Against Clinical Isolates of Resistant
Gram-Negative Bacteria in Taiwan: Broth Microdilution Method vs. the E Test
        1              2         3           4             5       6              7          8
C.T. Lu , Y.C. Chuang , W. Sun , Y.C. Liu , Y.J. Cheng , P.L. Lu , C.M. Chen , G.J. Hsu ,
          9          10
T.N. Jang , C.M. Lee
1                                                                               2
 Department of Infectious Diseases, Lotung Poh-Ai Hospital, Yilan, Taiwan, Department of
                                                               3
Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan, Department of Infection Control,
                                       4
Pao-Chien Hospital, Pintung, Taiwan, Department of Internal Medicine, Kaohsiung Veterans
                                        5
General Hospital, Kaohsiung, Taiwan, Department of Internal Medicine, Changhua Christian
                               6
Hospital, Changhua, Taiwan, Department of Internal Medicine, Chung-Ho Memorial Hospital,
                                                      7
Kaohsiung Medical University, Kaohsiung, Taiwan, Department of Internal Medicine, Tungs'
                                                        8
Taichung Metro Harbor Hospital, Taichung, Taiwan, Department of Internal Medicine, Chia-Yi
                                    9
Christian Hospital, Chiayi, Taiwan, Department of Internal Medicine, Shin Kong Wu Ho-Su
                                    10
Memorial Hospital, Taipei, Taiwan, Department of Internal Medicine, Mackay Memorial Hospital,
Taipei, Taiwan

Background: The Tigecycline In-Vitro Surveillance in Taiwan (TIST), initiated in 2006, is a
nationwide surveillance program designed to monitor longitudinally the in vitro activities of
tigecycline against commonly encountered resistant bacteria in Taiwan. This study aims to
compare the in vitro activities of tigecycline against clinical isolates of Gram-negative bacteria by
using two susceptibility methods.
Methods: A total of 1207 isolates of Gram-negative bacteria (Table 1) were collected from various
sources of patients treated at 20 teaching hospitals. Minimum inhibitory concentrations (MICs) for
tigecycline of these isolates were determined by the broth microdilution methods according the
guidelines described by Clinical and Laboratory Standards Institute (CLSI) and the E test as
manufacturer's description. The results for Enterobacteriaceae and A. baumannii were interpreted
by the MIC criteria provided by U.S. FDA tigecycline susceptibility breakpoints listed for
Enterobacteriaceae (S, 2 g/mL; I, 4 g/mL; R, 8 g/mL). Agreement (±1 log2 dilution) and
error analysis of results generated by two methods were also evaluated.
Results:Susceptibility rate (agreement of two methods) for tigecycline was 99.6% (89.1%) for E.
coli, 98.5% (72.4%) for K. pneumoiae, 73.3% (86.6%) for P. mirabilis, 81.7% (75.6%) for A.
baumannii, and NA (89.1%) for S. maltophilia. Very major error (0.5%) was found only for A.
baumannii isolates.
Conclusion: About 20% of A. baumannii isolates in Taiwan were resistant to tigecycline. The
agreement between the results obtained for tigecycline was limited (<80% agreement) for ESBL-
K. pneumoniae and A. baumannii.
Final abstract number: 66.024
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Bacterial Resistance Patterns of Isolates from Various Body Sites: The European T.E.S.T.
Program
              1          1         1               1            1            1         1
M. Renteria , M. Hackel , R. Badal , S. Bouchillon , B. Johnson , J. Johnson , D. Hoban ,
               2
M. Dowzicky
1                                                                          2
  International Health Management Associates, Inc., Schaumburg, IL, USA, Wyeth
Pharmaceuticals, Collegeville, PA, USA

Objectives: Bacterial resistance patterns vary over time and geography. Surveillance studies help
to identify those patterns to help guide therapy. The Tigecycline Evaluation Surveillance Trial
(TEST) is an ongoing global surveillance study that serves to recognize current trends in
resistance. This report evaluates differences in susceptibilities of strains from different body sites,
collected in Europe 2004-2007.
Methods: 21,381 strains isolated from 8 body sites were collected and identified from 2004-2007
at 79 hospitals in 22 countries in Europe. MICs for each strain were determined per EUCAST
guidelines at each facility using broth microdilution. MIC50/90 was analyzed to identify any
significant differences in antibiograms from different sources.
Results: Tigecycline (TIG) MIC50 values for almost all organism/specimen pairings were +/- 2 log2
dilutions of each other, with no single source giving a higher MIC50 than the others. The same
was seen for TIG MIC90 values, which were also almost always within 1-2 log2 dilutions of the
MIC50, except for S. pneumoniae, whose TIG MIC90 were 3-4 fold higher than the MIC50 for all
specimen sources. Comparator drugs also generally showed no variability in susceptibility of
isolates from various body sites. A notable exception was E. faecium vs. vancomycin, for which
the MIC90 of blood isolates was significantly higher than other sources.
Conclusions: Bacteria isolated from more than 8 different body sites had generally similar
antibiograms, with no isolates from any single source showing significantly different sensitivity
patterns. TIG's broad spectrum of activity and consistently low MIC90/MIC50 ratios, including
strains resistant to other drugs, may make it an excellent therapeutic option when treating
infections often caused by strains refractory to treatment with other agents.
Final abstract number: 66.025
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Nationwide Surveillance of in vitro Activities of Tigecycline against Extended-Spectrum-b-
lactamase-Producing Enterobacteriaceae in Taiwan
             1        2           3              4            5        6         7       8
C.H. Huang , Z.Y. Shi , Y.C. Liu , Y.J. Cheng , C.M. Chen , W. Sun , G.J. Hsu , P.L. Lu ,
           9            10
T.N. Jang , P.C. Chiang
1                                            2
 Cathay General Hospital, Taipei, Taiwan, Department of Internal Medicine, Taichung Veterans
                                      3
General Hospital, Taichung, Taiwan, Department of Internal Medicine, Kaohsiung Veterans
                                        4
General Hospital, Kaohsiung, Taiwan, Department of Internal Medicine, Changhua Christian
                               5
Hospital, Changhua, Taiwan, Department of Internal Medicine, Tungs' Taichung Metro Harbor
                             6
Hospital, Taichung, Taiwan, Department of Infection Control, Pao-Chien Hospital, Pintung,
         7
Taiwan, Department of Internal Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan,
8
 Department of Internal Medicine, Chung-Ho Memorial Hospital, Kaohsiung Medical University,
                    9
Kaohsiung, Taiwan, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital,
                10
Taipei, Taiwan, Department of Internal Medicine, Chang Gung Memorial Hospital Linkou
Branch, Taoyuan, Taiwan

Background:The Tigecycline In-Vitro Surveillance in Taiwan (TIST), initiated in 2006, is a
nationwide surveillance program designed to monitor longitudinally the in vitro activities of
tigecycline against commonly encountered resistant bacteria in Taiwan. This study aims to
determine the in vitro activities of tigecycline against clinical isolates of Extended-Spectrum-b-
lactamase-(ESBL)-producing Enterobacteriaceae in Taiwan.
Methods: A total of 620 isolates of ESBL-producing isolates, including Escherichia coli, Klebsiella
pneumoniae, K. oxytoca, and Proteus mirabilis were collected from various sources of patients
treated at 20 teaching hospitals. Minimum inhibitory concentrations (MICs) for tigecycline and
ESBL phenotype of these isolates were determined by the broth microdilution methods according
the guidelines described by Clinical and Laboratory Standards Institute (CLSI) and interpreted by
the MIC criteria provided by U.S. FDA.
Results: The results are shown in the table 1.
Conclusion: Tigecycline exhibited excellent in vitro activities against ESBL-producing
Enterobacteriaceae(susceptible >98%) in Taiwan, except for P. mirabilis (73%) isolates.
Final abstract number: 66.026
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

In Vitro Potency of Tigecycline Against Pathogens from Most Common Body Sites: A Study in
Asia/Pacific Rim
           1            1             1            1           1             1         1
R. Badal , M. Renteria , S. Bouchillon , B. Johnson , M. Hackel , J. Johnson , D. Hoban ,
              2
M. Dowzicky
1                                                                          2
  International Health Management Associates, Inc., Schaumburg, IL, USA, Wyeth
Pharmaceuticals, Collegeville, PA, USA

Objectives: Surveillance studies can identify patterns of resistance and assist in empiric antibiotic
choices as resistance can vary by organism and body site isolation. The Tigecycline Evaluation
Surveillance Trial (T.E.S.T.) is an ongoing global study that can serve to help recognize
resistance by body site. This report evaluates differences in susceptibility of strains from different
body sites, collected in Asia/Pacific Rim 2004-2007.
Methods: 4057 strains isolated from 8 specimen types were collected and identified from 2004 to
2007 at 23 hospitals in 9 countries in Asia/Pacific Rim. MICs for each strain were determined per
CLSI guidelines at each facility using broth microdilution. MIC50/90 values were analyzed to
identify any significant differences in antibiograms from different sources.
Results: Tigecycline (TIG) MIC50 values for almost all organism/specimen pairings were +/-2
dilutions of each other, with no single source giving a higher MIC50 than others. The same was
seen for TIG MIC90 values, which were almost always within 1-2 dilutions of the MIC50.
Comparator drugs generally showed similar absence of variability in activity vs. isolates from
various body sites; however, their MIC90/MIC50 ratios were usually much higher than those of TIG.
Even imipenem had such high ratios with Acinetobacter and Enterococus spp.
Conclusions: Bacteria isolated from more than 10 different body sites had generally similar
antibiograms, with no single source showing significantly different sensitivity patterns. TIG
demonstrated a broad spectrum of activity and consistently low MIC90/50 ratios, including strains
resistant to other drugs (MRSA, ESBL-producers, and imipenem-resistant Acinetobacter).
Final abstract number: 66.027
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Evaluation of 11 Antimicrobial Agents Against Australian Bacteremia Isolates: The T.E.S.T.
Program
           1             1          1            1          1             1            1
R. Badal , S. Bouchillon , M. Hackel , J. Johnson , D. Hoban , B. Johnson , M. Renteria ,
              2
M. Dowzicky
1                                                                          2
  International Health Management Associates, Inc., Schaumburg, IL, USA, Wyeth
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 T.E.S.T. program determined the in vitro activity of TIG and 10
comparators against bacteremia pathogens. Isolates were collected from 9 hospital sites in
Australia throughout 2004-2007.
Methods: 533 bacteremia isolates were identified to the species level at 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: Susceptibility of selected pathogens to tigecycline is summarized below.
Conclusions: TIG demonstrated a broad spectrum of antimicrobial activity, including
Acinetobacter spp., Enterobacteriaceae (incl. ESBL phenotypes), S. aureus (incl. MRSA), S.
pneumoniae (all phenotypes), and both Van-S and Van-R Enterococcus spp. The wide spectrum
of activity of tigecycline provides enhanced antimicrobial coverage of pathogens causing
bacteremia.
Final abstract number: 66.028
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Efficacy of Tigecycline Against Worldwide Levofloxacin-Resistant Pathogens
           1            1             1            1           1             1         1
R. Badal , M. Renteria , S. Bouchillon , B. Johnson , M. Hackel , J. Johnson , D. Hoban ,
              2
M. Dowzicky
1                                                                          2
  International Health Management Associates, Inc., Schaumburg, IL, USA, Wyeth
Pharmaceuticals, Collegeville, PA, USA

Objectives:Tigecycline (TIG) is the first member of the glycylcycline class of anti-infectives to be
marketed, exhibiting a broad spectrum of antibacterial activity against many commonly-isolated
pathogens. This study evaluates the in vitro activity of TIG versus levofloxacin (LEV)-resistant
strains in a large set of isolates collected globally from 2004-2007.
Methods: 4,335 LEV-resistant isolates were identified to the species level at 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: Percentages of LEV-resistant isolates susceptible to TIG are summarized in the table
below.
Conclusions: LEV resistance was rare in this study, with less than 1% observed among the
species evaluated. When resistance to LEV was seen, however, TIG retained activity in the vast
majority of such strains. TIG's broad spectrum of activity, including strains resistant to other
drugs, makes it a valuable tool for treating serious infections caused by bacteria that may be
refractory to treatment with commonly-used antimicrobials such as LEV.
Final abstract number: 66.029
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

An Evaluation of Tigecycline and Comparators in Asia/Pacific Rim for Often Difficult to Treat
Pathogens
             1          1           1               1          1          1               1
J. Johnson , D. Hoban , B. Johnson , S. Bouchillon , M. Hackel , R. Badal , M. Renteria ,
              2
M. Dowzicky
1                                                                         2
  International Health Management Associates, Inc., Schaumburg, IL, USA, Wyeth
Pharmaceuticals, Collegeville, PA, USA

Background: Tigecycline (TIG), a new glycylcycline demonstrates enhanced activity against many
multi-drug resistant phenotypes of community and nosocomial pathogens causing serious
disease. The T.E.S.T. program was designed to elucidate the activity of TIG vs. comparators in
clinical use to worldwide organisms.
Methods: Between 2004-2007, over 3880 organisms deemed clinically significant isolated from
both inpatients and outpatients in 23 Asia/Pacific Rim centers underwent site directed CLSI
specified MIC testing utilizing supplied broth microdilution panels. Results: Selected Asia/Pacific
Rim pathogens tested against TIG are shown below:
Conclusions: Tigecycline MIC90 of <=1 mcg/ml and % susceptible of 100% (at <=2 mcg/ml B.P.)
for gram positive pathogens (including resistant phenotypes) and MIC90 of >=95% of gram
negative pathogens (excluding P. aeruginosa) validate the potent activity of TIG against
community/hospital pathogens isolated in 23 Asia/Pacific Rim centers.
Final abstract number: 66.030
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Tigecycline and Comparators Against Extended Spectrum Beta-Lactamase (ESBL) Isolates
Worldwide
              1          1          1           1         1            1               1
M. Renteria , M. Hackel , J. Johnson , D. Hoban , R. Badal , B. Johnson , S. Bouchillon ,
               2
M. Dowzicky
1                                                                         2
  International Health Management Associates, Inc., Schaumburg, IL, USA, Wyeth
Pharmaceuticals, Collegeville, PA, USA

Background: 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 TIG compared to amoxicillin-clavulanic acid,
piperacillin-tazobactam (PT), levofloxacin, ceftriaxone, cefepime, ampicillin (AMP), amikacin (AK),
minocycline, ceftazidime and imipenem (IMP) against ESBL isolates collected from hospitals
globally throughout 2004-2007.
Methods: A total of 1,387 ESBL clinical isolates were identified to the species level from
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 CLSI guidelines with tigecycline susceptible breakpoint defined as <= 2
mcg/mL.
Results: %S for all ESBL-producing isolates vs. TIG, IMP, and AK was 94.1, 98.3, and 86.2%,
respectively; %S for other comparators ranged from 61.2% (PT) to 0.6% (AMP).TIG and IMP had
the lowest % of resistant strains(1.8% and 0.7%) respectively compared to 6.9% for AK. MIC50/90
for TIG, IMP, and AK were 0.5/2, 0.25/1, and 4/32 mcg/ml; the MIC90 for all other drugs was in the
resistant range. There were minor regional differences in levels of activity, with either TIG (North
America) or IMP (Europe, Asia/Pac) being the most active.
Conclusions: TIG exhibited similar in vitro as IMP against ESBL strains. Its expanded broad
spectrum of activity, including strains resistant or multiply-resistant to other agents, should make
it a useful treatment option for a wide range of gram-negative and gram-positive pathogens.
Final abstract number: 66.031
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Evaluation of Tigecycline in the United States Against Antimicrobial Resistant Acinetobacter
           1            1            1          1            1                1         1
R. Badal , J. Johnson , M. Renteria , D. Hoban , B. Johnson , S. Bouchillon , M. Hackel ,
              2
M. Dowzicky
1                                                                           2
  International Health Management Associates, Inc., Schaumburg, IL, USA, Wyeth
Pharmaceuticals, Collegeville, PA, USA

Background: Tigecycline (TIG) has 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 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 the United States from 2004-2007.
Methods: A total of 2,367 clinical isolates were identified to species level from participating sites
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 CLSI guidelines.
Results: Resistance rates for comparator drugs were CAZ 42%, CAX 41%, LVX 41%, CPE 34%,
PT 17%, AK 7%, MIN 7%, and IMP 2%. TIG inhibited 98% of all isolates at = 8 mcg/ml. TIG
MIC50/90 for strains resistant to 0, 1, 2, 3, 4, or >= 5 drug classes were 0.12/0.5, 0.5/1, 0.5/2, 1/2,
1/2, and 1/4, respectively, demonstrating a gradual diminishment of TIG activity in strains
resistant to multiple drug classes.
Conclusions: TIG had good in vitro activity against most Acinetobacter strains resistant to one or
more other drugs in this study, although the higher TIG MICs seen for these strains suggests
some linkage to resistance mechanisms for other drugs (efflux). TIG remained effective in
inhibiting multi-drug resistant Acinetobacter spp., further demonstrating its wide spectrum of
activity vs. drug-resistant bacteria.
Final abstract number: 66.032
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Prophylactic Nurturing of Antibiotic Resistance Genes
S. Soleimani-Connolly, S.N. Connolly
University of Teesside, Middlesbrough, United Kingdom

Prophylaxis with the anti-staphylococcal antibiotic mupirocin (Mup) introduced to Iran during 1995
led to the rapid emergence of resistant strains. This study reports that conjugative plasmids in
                                                                                           R
coagulase negative staphylococci (CNS) act as a reservoir of mupirocin resistance (Mup ) genes.
The resistant elements are transferable to pathogenic S.aureus strains leading to the
dissemination of resistance.
Staphylococci (1404 strains) were isolated from patients attending a renal dialysis clinic over a
period of 12 months pre- and post-prophylactic application of Mup. Plasmid profiles &
                      R
antibiograms of Mup strains were determined and the resistance plasmids eliminated by curing.
                             R
Conjugative transfer of Mup involved filter mating to a reference S.aureus strain. Pulsed field gel
                                                 R                   R
electrophoresis (PFGE) demonstrated the Mup plasmid. The Mup gene was cloned into
S.carnosus and a digoxigenin labeled 13.4 kb HindIII fragment was used as a probe to screen
other staphylococcal isolates.
Staphylococcal strains consisting of S.epidermidis (1119) and S. hominis (285) were isolated over
a period of 14 months. Nasal decolonisation with Mup involved topical application for 12 days.
                                              -1
Eight high level resistance strains (2000 mgL ) emerged within 4 months of clinical application of
the antibiotic. PFGE separated a large plasmid from chromosomal DNA. Curing experiments
                                                      R
confirmed that this plasmid was responsible for Mup as its elimination in the cured strains
                                               R
rendered them Mup sensitive. High level Mup was attributed to a 34kb conjugative plasmid
                                                                                             -7   -
transferable between CNS and S.aureus. The frequency of transfer was of the order of 10 to 10
9                                R
 . A 3.9 kb fragment of the Mup plasmid hybridised to the probe DNA.
     R
Mup develops during topical application of the antibiotic and the transfer of the Mup gene occurs
between CNS and pathogenic staphylococci. This suggests that antibiotic prophylaxis nurtures
dormant genes thus leading to the spread of resistance in non-endemic regions.
Final abstract number: 66.033
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Antibacterial Activity of Terminalia catappa Against Bacteria Isolated from Burn Wounds and
Comparison with Effects of Selective Antibiotics in vitro
                         1                2
M.M. Attarpour Yazdi , M. Kamalinejad
1                                                                            2
 Shahed University(Faculty of Medicine), Tehran, Iran (Islamic Republic of), Shahid Beheshti
University(Faculty of Pharmacy), Tehran, Iran (Islamic Republic of)

Background: Burn wound is suitable site for incidence of resistant infections. Thus, the research
for finding of effective drugs against this problem is necessary. Medicinal herbs with antimicrobial
activity have been important role in traditional medicine. The purpose of this study was determine
of antibacterial activity of methanolic extract from fruit ofTerminalia catappa against bacteria
isolated from burn wound infections and comparison with effects of selective antibiotics in vitro.
Methods: First, a sample of methanolic extract of the plant fruit was prepared and then its
antibacterial activity against 8 cases of bacteria isolated from 100 samples of burn wound
infections was evaluated by well diffusion and agar serial dilution methods for determining of MIC
(minimum inhibitory concentration). Also, we studied the activity of selective antibiotics on them
by disk diffusion method.
Results: The frequency distribution tables, diagrams, Kay square, fisher exact and t test (by
applying spss computer programs)were used to describe and analyze the data. The results from
the antibacterial tests demonstrated that the T.catappa methanolic extract had been effected
against more than 80% of Staphylococcus aureus/epidermidis/saprophyticus ,Pseudomonas
aeruginosa , Acinetobacter and against 50% E.coli. The MIC of the extract against all the bacteria
was 20 mg/ml.
Conclusion: This study demonstrated that methanolic extract of T.catappa have excellent
antibacterial activity against most of bacteria isolated from burn wound infections and its effect is
more better than selective antibiotics. However, we need more investigation in vitro and in vivo.
Final abstract number: 66.034
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

An AUC Based Method for Aminoglycoside Dosing Adjusting for Drug Excretion During Infusion
and Allowing Early Recognition of Drug Accumulation
M.R. Loewenthal
John Hunter Hospital, Newcastle, Australia

Background: Once daily aminoglycoside dosing is now standard. Area Under the curve (AUC) is
the best predictor of bacterial killing and toxicity. Formulas or applications based on two
concentration measurements are widely used to optimise the AUC. Published methods do not
account for excretion during the infusion which varies greatly with infusion duration. Drug
accumulation may not be apparent from the AUC calculated after an initial inappropriately small
dose. Formulas simple enough to be put on any spreadsheet application or handheld device were
developed to deal with these problems.
Methods: Excretion during infusion and the effect of impaired excretion were restated as linear
differential equations which have standard solutions. These formulas were then applied to a set of
data used previously to dose cystic fibrosis inpatients based on published AUC formulas. This
allowed recalibration of the target value. This new target was then applied to simulated data (1)
derived from our database of cystic fibrosis home therapy patients who administer their doses
over 5 minutes and (2) for patients with impaired renal function. The formulas are supplied on the
poster and can be freely used.
Results: The target AUC was recalibrated from 110 to 100 mg.h/l. An estimated 50% of home
therapy cystic fibrosis patients had initial AUCs more than 10% above the new target. This
increased to 64% after dosage adjustment based on the older method. Potential for drug
accumulation was more readily apparent in the simulated data using the new formulas. The
spreadsheets used for the two methods appeared practically identical.
Conclusion: Consideration should be given to using these AUC formulas and adjusted targets
unless all infusions are given strictly over 30 minutes.
Final abstract number: 66.035
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Activity of Tigecycline against Clinical Pathogens Collected in Indonesia (2006)
                1         1             2           3          4               5               6
J.D. Turnidge , J.M. Bell , D. Subekti , R.N. Jones , I. Yusuf , L. Kusumawati , M.J. Dowzicky
1                                                        2
 Women's and Children's Hospital, Adelaide, Australia, ALERTAsia Foundation, Jakarta,
             3                                         4
Indonesia, JMI Laboratories, North Liberty, IA, USA, Hasanudin Hospital, Makassar, Indonesia,
5                                             6
 Haji Adam Malik Hosp, Medan, Indonesia, Wyeth Pharmaceuticals, Collegeville, PA, USA

Background: There are no published information on tigecycline potency and spectrum from
isolates from Indonesia. As a component of the SENTRY Antimicrobial Surveillance Program
(Asia-Pacific Region), we evaluated the activity of tigecycline tested against recent (2006)
isolates from Indonesia by reference MIC methods.
Methods: Non-duplicate strains were consecutively collected from three medical centres in
Indonesia. All isolates were tested against tigecycline using validated commercial broth
microdilution panels (TREK Diagnostics), with concurrent acceptable quality control and CLSI
interpretations (M100-S18) for comparison agents. Tigecycline breakpoints published by the
United States - Food and Drug Administration were applied for each indicated species or genus,
and the proposed/provisional Acinetobacter spp. breakpoint (_ mg/L) per Jones et al. (2007) was
applied.
Results: A total of 383 (307 Gram-negative and 76 Gram-positive) isolates were evaluated.
Tigecycline was highly active against the top 10 most frequently isolated non-pseudomonal
pathogens which comprised 82% of all strains. The highest tigecycline MIC90 results (2 mg/L were
recorded for non-indicated species, Proteus-Providencia. P. aeruginosa was also not significantly
inhibited by tigecycline (MIC90, >8 mg/L; data not shown).
Conclusions: Tigecycline demonstrated excellent activity against all the commonly isolated
pathogens from Indonesia, including those being multidrug-resistant to other antimicrobial
classes. Tigecycline shows promise for therapy of indicated, antimicrobial-resistant species in this
nation and indeed, the entire Asia-Pacific region.
Final abstract number: 66.036
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Tigecycline Activity Against Isolates from Medical Centers Located in China, Hong Kong and
Taiwan (2006): A SENTRY Antimicrobial Surveillance Program Report
         1          2               2            3               4
M. Chen , J.M. Bell , J.D. Turnidge , R.N. Jones , M.J. Dowzicky
1                                                        2
 Peking Union Medical College Hospital, Beijing, China, Women's and Children's Hospital,
                     3                                        4
Adelaide, Australia, JMI Laboratories, North Liberty, IA, USA, Wyeth Pharmaceuticals,
Collegeville, PA, USA

Background: Tigecycline is a glycylcycline class agent recently introduced into clinical practice
worldwide as an alternative therapy for various evolving multidrug-resistant (MDR) bacterial
infections. China, Hong Kong (HK) and Taiwan medical centers (14) were monitored in 2006 by
the SENTRY Program for tigecycline spectrum/susceptibility and compared to more than 25
agents.
Methods: CLSI methods were used for testing 2,595 isolates with US-FDA (tigecycline product
package insert) and CLSI (M100-S18) breakpoints applied. Resistance phenotypes were
screened per CLSI M100-S18 and genotypic-resistances by sequencing when required.
Tigecycline was not active against P. aeruginosa (MIC50, >4 g/ml), data not shown.
Results: Among 2,595 strains processed, the most frequently tested pathogens and resistance
patterns were: S. aureus (545, 40% MRSA) > E. coli (366, 52% ESBL) > K. pneumoniae (265,
33% ESBL) > E. faecalis (218, linezolid resistance detected) > A. baumannii (211, 29%
carbapenem-resistant) > S. pneumoniae (175, 27/80% penicillin/macrolide-resistant) > E. faecium
(169, 2.4% VanA-type glycopeptide resistance). Fluoroquinolone resistance was very high among
E. coli(64%), K. pneumoniae (21%) and A. baumannii (62%). MRSA rates varied by nation: Hong
Kong and China (38%) and Taiwan (69%), but oxacillin resistance did not effect tigecycline
activity. Metallo-b-lactamases were noted in Enterobacteriaceae (<1%). Tetracycline resistance
was frequent (30-86%) in Gram-positive and -negative organisms; but no tigecycline-resistant or
non-susceptible strains were detected among indicated species except for enterococci (2.3%)
Conclusions: Tigecycline retained high activity and treatment potential against MDR pathogens
tested from China, Hong Kong and Taiwan. Continued monitoring of the tigecycline class agents
in these nations appears prudent as the glycylcyclines become widely used.
Final abstract number: 66.037
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Antimicrobial Activity of Tigecycline Tested against Contemporary Bacterial Isolates Collected in
Australia (2006)
          1                1            2              3
J.M. Bell , J.D. Turnidge , R.N. Jones , M.J. Dowzicky
1                                                       2
 Women's and Children's Hospital, Adelaide, Australia, JMI Laboratories, North Liberty, IA, USA,
3
 Wyeth Pharmaceuticals, Collegeville, PA, USA

Background: Tigecycline has been marketed in Australia for over one year. As part of the
SENTRY Antimicrobial Surveillance Program (Asia-Pacific Region), we evaluated the activity of
tigecycline against recent (2006) bacterial isolates across Australia.
Methods: Non-duplicate strains were consecutively collected from five medical centres in 5 states
using isolates from bacteraemia (n=253), pneumonia (n=146), complicated skin and skin
structure infections (n=264), and other infections (n=269). All isolates were tested against
tigecycline using validated commercial reference broth microdilution panels (TREK Diagnostics),
with concurrent quality controls and CLSI (M100-S18) interpretations for comparison agents.
Tigecycline breakpoints published by the US-FDA were applied for each indicated species or
genus group.
Results: A total of 932 (268 Gram-negative and 664 Gram-positive) isolates were processed.
Tigecycline was highly active against the top 10 non-pseudomonal pathogens which comprised
88% of all tested isolates. Tigecycline MIC90 results ranged from 0.12 to 1 mg/L, highest for
Klebsiella spp. and Proteae (data not shown). At US-FDA published breakpoints, tigecycline
exhibited complete inhibition of indicated species except for a single strain of E. cloacae (MIC, 4
mg/L). Over 28% of Staphylococcus aureus were oxacillin-resistant, and one Enterococcus
faecium was vancomycin-resistant. Tigecycline was highly effective against these strains.
Table
Conclusions: Tigecycline has potent activity against all the common pathogens isolated in 2006
from Australian patients, including those resistant to other drug classes. Documented acquired
resistance was rare among indicated pathogens, however, Pseudomonas remains refractory to
potential tigecycline therapy.
Final abstract number: 66.038
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

An Asia/Pacific Rim Perspective of Enterobacteriaceae Multi-drug Resistant (MDR) Isolates
Against Tigecycline
              1             1          1            1            1          1          1
B. Johnson , S. Bouchillon , M. Hackel , J. Johnson , M. Renteria , R. Badal , D. Hoban ,
              2
M. Dowzicky
1                                                                         2
  International Health Management Associates, Inc., Schaumburg, IL, USA, Wyeth
Pharmaceuticals, Collegeville, PA, USA

Objectives: Worldwide the prevalence of MDR Enterobacteriaceae are increasing, including
ESBLs, AmpC, fluoroquinolone and carbapenem resistant strains. The T.E.S.T. program
determined the in vitro activity of tigecycline compared to amoxicillin-clavulanic acid, piperacillin-
tazobactam, levofloxacin, ceftriaxone, cefepime, ampicillin, amikacin, minocycline, ceftazidime
and imipenem against
Enterobacteriaceae
species collected from hospitals in Asia/Pacific Rim 2004-2007. This study evaluated the activity
of tigecycline against multi-resistant microorganisms associated with nosocomial infections.
Methods: A total of 2778 clinical isolates were identified to the species level at each site and
confirmed by the central laboratory. Minimum Inhibitory Concentration (MICs) were determined by
each site using supplied broth microdilution panels and interpreted according to CLSI guidelines.
Tigecycline breakpoint is defined as susceptible MICs <=2mcg/mL.
Results: The table illustrates the %S and MIC90 of tigecycline to MDR pathogens.
Conclusions: Multi-drug resistance is common in health care acquired pathogens. The presented
data indicate that tigecycline is highly potent against nosocomial pathogens including MDR
isolates.
Final abstract number: 66.039
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Evaluation of Multidrug Resistant (MDR) Isolates Against Tigecycline: A Canadian Perspective
            1          1            1            1            1           1            1
M. Hackel , R. Badal , S. Bouchillon , B. Johnson , J. Johnson , D. Hoban , M. Renteria ,
              2
M. Dowzicky
1                                                                          2
  International Health Management Associates, Inc., Schaumburg, IL, USA, Wyeth
Pharmaceuticals, Collegeville, PA, USA

Objectives: Tigecycline (TIG) is a new glycylcycline with enhanced activity against many
multidrug resistant (MDR) pathogens including ESBL and AmpC producing Enterobacteriaceae,
methicillin-resistant S. aureus (MRSA), carbapenem resistant Acinetobacter and fluoroquinolone
resistant gram-negative rods. The TEST study evaluated the activity of TIG and comparators to
pathogens in Canada 2004-2007.
Methods: A total of 1675 pathogens were collected from 8 participating sites in Canada from
2004-2007. Isolates were identified to the species level and CLSI specified MICs were performed
at each site. CLSI or FDA breakpoints were used, where applicable, to determine %
susceptibility.
Results: Tigecycline MICs are recorded in the table below.
Conclusions:Tigecycline showed excellent in vitro activity against a diverse collection of
pathogens isolated in Canada between 2004-2007. MIC90 values of <=0.5mcg/ml against most
Enterobacteriaceae including ESBL and MIC90 of <=0.12mcg/ml against gram-positive pathogens
document the in vitro potency of tigecycline, a new glycylcycline.
Final abstract number: 66.040
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

One Year Survey and Resistance Analysis in 757 Isolates Causing Urinary Tract Infections
A. Koteli, A. Kakoulidou, M. Andronoglou, S. Tsingene
'G. Gennimatas' Thessaloniki General Hospital, Thessaloniki, Greece

Aim: To assess the antimicrobial resistance patern in pathogens responsible for urinary tract
infections in nosocomial patients over a period of one year.
Material and Method: From January 2006 to December 2006, 3665 urine cultures from
nosocomial patients were collected. All positive cultures with a colony count 105 CFU/ml for
Gram-positive and Gram-negative bacteria and 103 CFU/ml for Candida species were selected
for the analysis. Duplicate isolates were not considered.
Results: Among the 757 positive cultures n= 135 belonged to I.C.U., n=58 to Surgical Dept, n=
347 to Internal Medicine Dept and n=217 to Outpatien Dept.
Among the 757 positive cultures n= 523 belonged to female and n= 234 to male patients. Among
the Gram-negative Escherichia coli n=337 presented the highest prevalence, followed by Proteus
mirabilis n=97, Pseudomonas aeruginosa n=67, Candida species n=65, Klebsiella pneumoniae
n=45 and Acinetobacter baumannii n=22. Among Gram positive isolates Enterococcus faecalis
was the most prevalence n=28, followed by coagulase negative staphylococci n=16,
Enterococcus faecium n=11 and Staphylococcus aureus n=5. They were 4 VRE strains
(Enterococcus faecium) in the urine. All Gram positive cocci were sensitive to linezolide.
Resistance rates to Gram-negative are presented. All Gram-negative were susceptible to colistin.
All strains of Acinetobacter baumannii were susceptible to doxycyclin while they appeared
susceptible to ampicillin/sulbactam to a percentage of 90%. The largest number of fungus
positive samples were taken from the Internal medicine departments.
Conclusions: Escherichia coli is the primary bacterial pathogen causing UTIs in nosocomial
patients. Candida albicans was isolated from the majority of the samples, compared to non
albicans.
Final abstract number: 66.041
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Impact of Educational Efforts on Antimicrobial Prescribing and Bacterial Resistance Rates in a
Community Hospital
O.H. DeTorres
Palomar Medical Center, Escondido, CA, USA

PURPOSE: The prescribing of quinolones in the outpatient setting has resulted in widespread
quinolone resistance among gram-negative organisms. Because of this, quinolones should no
longer be used as empiric therapy in the management of urinary tract infections within our
hospitals. The objectives of this study were to evaluate how educational efforts would impact
antimicrobial prescribing in the treatment of urinary tract infections and whether the change in
prescribing habits would result in a change in bacterial susceptibilities to quinolones within our
hospitals.
METHODS: Data was collected on all hospitalized patients admitted with a diagnosis of urinary
tract infections, urosepsis, or pyelonephritis (n = 113) during January - May 2005. Antimicrobials
selected for empiric and targeted therapy were reviewed. Twenty-nine percent of community-
acquired infections and 41.2 % of institutionally-acquired infections were found to be resistant to
the quinolones, while only 15.6 % and 17.1 % of the respective infections were resistant to
cefazolin. The results were presented to the Antibiotic Subcommittee of the Pharmacy &
Therapeutics Committee, Emergency Medicine Department, and hospitalists physician group.
This was followed by an article published in the physician newsletter on the management of
urinary tract infections. Empiric prescribing guidelines encouraging the use of cefazolin were
incorporated into the system-wide antibiogram. Educational posters were created and displayed
at all of the nursing units and Emergency Rooms. A follow-up study was conducted in January -
March 2007 (n = 75) to evaluate the impact of the educational efforts on antibiotic prescribing.
Finally, the bacterial susceptibilities were compared before and after the educational efforts.
RESULTS: The empiric prescribing of quinolones for the treatment of urinary tract infections,
urosepsis, or pyelonephritis decreased from 67.2 % of patients in 2005 to 46.5 % in 2007. The
fraction of patients discharged on a quinolone also decreased, 73 % in 2005 to 47.7 % in 2007. A
comparison of the 2005 to 2006 microbial data found that there was a increase in the
susceptibility of Pseudomonas aeruginosa to quinolones from 65 -67 % to 78 % at PMC and 54
% to 62 % at POM, while there was no change in antimicrobial susceptibilities at PPH facilities
that did not have an educational program in place.
CONCLUSIONS: Educational efforts modestly improved the selection of empiric antimicrobials in
the treatment of urinary tract infections at our community hospitals. Furthermore, the bacterial
susceptibilities to the quinolones within our hospitals improved.
Final abstract number: 66.042
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Is Ciprofloxacin Effective in the Treatment of Mycoplasma Pneumonia? A Case Report
S. Kalimuddin, M.L. Kang, B.H. Tan, J. Choo, H.N. Leong
Singapore General Hospital, Singapore, Singapore

A 22-year-old male army officer cadet presented with a three day history of high fever, cough with
haemoptysis, sore throat, myalgia and severe diarrhoea. Investigations on admission showed a
normal total white cell count, hyponatraemia, a raised creatine kinase, pyuria and a normal chest
radiograph. He was administered oral ciprofloxacin for three days with no resolution of fever or
symptoms. Repeat chest radiograph done on Day 4 of admission showed multilobar pneumonia
with worsening of laboratory results. Antibiotic therapy was changed to intravenous penicillin,
ceftazidime and azithromycin. His fever and symptoms resolved promptly within 48 hours.
Subsequent serological studies revealed a nine-fold increase in Mycoplasma pneumoniae
antibody titre, and the patient was diagnosed with Mycoplasma pneumonia. Ciprofloxacin is
generally considered as an effective treatment against Mycoplasma pneumoniae based on in-
vitro susceptibility to ciprofloxacin. Till date there has been only one case report of its effective
use (Masayoshi et al. Antibiotics and Chemotherapy. 18(12), p1835-1839 Japanese). This case
report is the first in the literature to suggest clinical failure. Ciprofloxacin may not be effective in
the treatment of Mycoplasma pneumonia.
Final abstract number: 66.043
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Monitoring of Antibiotic Prophylaxis Usage in a Tertiary Care Hospital
R. Adhikary, B.N. Gokul, K.R. Kulkarni, M. Chakravarthy
Wockhardt Hospital, Bangalore, India

Background: It is a common knowledge that antibiotics are used indiscriminately. They should be
used for actual infections and not for colonization or prolonging the duration of surgical
prophylaxis for clean cases. This inappropriate antibiotic usage increases the selective pressure
favoring the emergence of antimicrobial resistance and colonization of drug resistant strains.
Judicious use of antibiotics is thus essential.
Methods: A prospective study was carried out in 2 surgical units in Wockhardt hospital,
Bangalore, India to evaluate the prescription pattern of antibiotic prophylaxis and to determine the
impact of prolonged antibiotic usage. Standardized recommendations were developed for
prophylactic antibiotic usage. Cardiac and orthopedic cases undergoing clean surgical
procedures were included in the study. By reviewing the infection monitoring worksheets the
incidence of healthcare associated infections were detected.
Results: A total of 120 cases, 60 of each unit were evaluated. It was noticed that although all
cases received a single pre-operative prophylactic injectable antibiotic, it was not consistent as to
the timing of the dose and the repetition of another dose intra-operatively if required. For
orthopedic cases antibiotic was continued for 24 hours and more than 72 hours for cardiac cases.
Antibiotic chosen for cardiac cases were either a third generation cephalosporin or a combination
of third generation cephalosporin with a b lactamase inhibitor and for orthopedic cases only a
second generation cephalosporin was used. The impact of prolonged antibiotic usage was
monitored by the rate of healthcare associated infection. The rate for cardiac cases was 5% and
there were no infections for orthopedic cases.
Conclusion: There is need for change from these conventional practices of prolonged
"prophylactic" antibiotic usage to prevent post operative infections in clean cases.
Final abstract number: 66.044
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Synthesis and Antibacterial Activity of Piperazinyl Oxazolidinones Containing 5-(4-methyl-1,2,3-
triazole)
O.A. Phillips, E.E. Udo, M. Abdel-Hamid, R. Verghese
Kuwait University, Safat, Kuwait

Introduction: The bioisosteric replacement of the 5-acetamidomethyl group of linezolid by 5-
triazolylmethyl yielded compounds with superior antibacterial activity against Gram-positive
bacteria strains. Replacing morpholine by acylpiperazinyl yielded compounds including PH038-
PH047 with improved activities compared with PH-027 and linezolid. Furthermore, methyl
substitution at 4-position of the triazole exhibited reduced monoamine oxidases and mitochondrial
protein synthesis inhibition, while retaining good antibacterial potency. In this study we
investigated the antibacterial activity of novel 5-(4-methyl-1,2,3-triazolyl)methyl oxazolidinones
(PH-series) bearing morpholine and acylpiperazinyl moieties.
Methods: Novel 5-(4-methyl-1,2,3-triazole)methyl oxazolidinones were synthesized and evaluated
against Gram-positive clinical isolates in comparison to linezolid, vancomycin and PH-027.
Organisms tested included methicillin-susceptible (MSSA, n=10) and -resistant S. aureus (MRSA,
n=10); methicillin-susceptible (MS-CNS, n=6) and -resistant coagulase-negative staphylococci
(MR-CNS, n=3); and vancomycin-susceptible (VSE, n=6) and -resistant enterococci (VRE, n=4)
and standard reference strains (n=3). Minimum inhibitory concentrations (MIC's, ug/ml) were
determined by agar dilution method on Mueller Hinton agar with the medium containing dilutions
of antibacterial agents ranging from 0.12 - 64 ug/ml, with and without 50% human plasma.
Results: The most active compound, isopropylcarbonylpiperazino derivative (PH-121, ClogP: -
0.097) with MIC range 0.5-1 ug/ml showed comparable activity to linezolid and PH-27 (MIC, 0.5-1
ug/ml) against all strains. This was followed by the morpholino (PH-84, Clog P: 0.900) and
dichloroacetylpiperazino (PH-119, Clog P: 1.494) derivatives with MIC ranges of 0.5-2 ug/ml,
respectively. Substitution with bulky acyl groups at the distal piperazine 4-position gave PH-108
(R=tert-butoxycarbonyl), PH-128 (R=heptanoyl) and PH-131 (R=trans-cinnamoyl) with reduced
antibacterial activity and MIC ranges of 2-8, 4-8 and 8-16 ug/ml, respectively. Most of the new
compounds showed increased MIC values in the presence of 50% human plasma suggesting
plasma instability or binding.
Conclusion: All the compounds tested exhibited moderate to strong antibacterial activity against
all Gram-positive cocci evaluated. The study highlighted significant structure-antibacterial activity
relationships.
Project is funded by the Research Administration, Kuwait University, Grant numbers PC01/05
(OAP) and GS01/01 and GS03/01 [Science Analytical Facilities (SAF)].
Final abstract number: 66.045
Session: Antibiotics and Resistance (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Changing Trend of Antimicrobial Resistance Toward Salmonella Isolates of Nepal: Findings of
Antimicrobial Resistance Surveillance Program, Nepal
S. Malla, S.P. Dumre
National Public Health Laboratory, Kathmandu, Nepal

Background of the study: Enteric fever caused by Salmonella is the most common febrile illness
in Nepal and increasing/changing trend of antimicrobial resistance (AMR) in Salmonella species
has constituted a serious threat to the public health.
Methods used: This study was conducted at 10 major hospitals/laboratories of Nepal during 2006
under AMR surveillance program. Standard microbiological methods including serotyping were
used for identification. Resistance screening was also carried out by standard Kirby-Bauer disk-
diffusion method.
Results: Of the total 1611 Salmonella strains isolated in 2006, 1147 isolates (63.7%), 448 isolates
(24.9%) and 16 isolates (0.9%) were confirmed to be Salmonella typhi, S. paratyphi A and other
Salmonella species respectively. Salmonella typhi isolates showed 100% susceptibility to
Ceftriaxone and Ofloxacin, but high (67%) resistance to Nalidixic acid followed by 3% resistance
to Ampicillin. For S. paratyphi A, 100% susceptibility was observed with Tetracycline only and the
resistance rate was higher (89% resistance to Nalidixic acid, 10% to Ampicillin and 3% to
Ofloxacin) than that observed with S. typhi. Similar resistance trend for both serotypes was found
towards Chloramphenicol, Cotrimoxazole and Ciprofloxacin. AMR surveillance revealed that the
prevalence of multi-drug resistant (MDR) Salmonella (resistant to three or more at a time) has
been decreasing gradually (30% in 2002, 13%in 2003, 5% in 2004 and 2% each in 2005 and
2006) in Nepal.
Conclusions: Although the number of MDR Salmonella has been decreasing in Nepal, the total
number of Salmonella isolates has been increasing. The increasing trend of S. paratyphi A with
high resistance rate of Nalidixic acid can be regarded as a worrisome situation and may reflect
the emergence of fluoroquinolone resistance. Continued surveillance and inclusion of appropriate
antimicrobials in the routine susceptibility testing for Salmonella are necessary in Nepal.
Key words: Salmonella, Multi-drug resistance, surveillance, Nepal
Final abstract number: 67.001
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

A Comparison Research of Hepatitis B Virus Large Surface Protein with HBV DNA Detecting
Z.L. Wu, X.D. Lu, X.Q. Zhong, L.F. Ling, G. Lin, G.C. Xiao
Department of Clinical Laboratory, The Fourth people's hospital of ShenZhen, ShenZhen, China

Background: The hepatitis B virus (HBV) is an enveloped DNA virus with an icosahedral capsid
replicating via reverse transcription. The crystal structure of the capsid is known. The viral
envelope contains three different coterminal proteins (S, M, and L proteins) spanning the
membrane several times. Hepatitis B virus large surface protein 'LHBs' has the unusual property
of accumulating in a particulate form within a preGolgi compartment, leading to marked
proliferation of intracellular membranes.
Objective: The aim of this study was to investigate the clinical value of LHBs used for diagnosis of
the clinical hepatitis B patient and relativity with replication of hepatitis B virus.
Methods: A total of 600 HBsAg positive patients in The Fourth people's hospital of Shenzhen
between April-December 2006 were included to the study. The patients were classified into two
groups according to their serological patterns (Group 1: HBeAg positive 300 cases; Group 2:
HBeAg negative 300 cases). The age and gender distributions of the groups were similar. HBV
serological markers and LHBs have been detected by Enzyme Linked Immunosorbent Assay
(ELISA), and viral load (HBV-DNA) were investigated by real-time polymerase chain
reaction(PCR).
Results: No significant difference of positive rate was observed between HBV DNA
                                                       2
76.17%(457/600) and LHBs 77.33% (464/600) (X =0.696, P>0.05) in 600 HBsAg-positive serum
samples; Postive rate of HBV DNA and LHBs were 95.0 (285/300) and 96.0 (288/300) in HBeAg
postive samples and were 57.33 (172/300) and 58.67 (176/300) in HBeAg negative
            2                   2
samples(X 0.725, P>0.05; X 0.253, P>0.05); Serum LHBs levels were correlated with the serum
HBV DNA copies (r=0.948).
Conclusion: The results demonstrated that there is a perfect correlation between the copies of
HBV-DNA and the levels of LHBs, and LHBs expression can reflect the replication of HBV.
Final abstract number: 67.002
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Trial of Lamivudine in Inactive HBsAg Carriers with Persistent Hepatitis B Core IgM Antibody
H. Ali
College of Medicine, University of Dohuk, Dohuk, Kurdistan Region, Iraq

Objective: The persistence of Anti-HBc IgM among inactive HBsAg carriers may be with hidden
dangers anf forecasts the existence of liver damage. A trial of lamivudine in such carriers was
carried out for the first time in this study.
Patients and Methods: A total of 62 Inactive HBsAg carriers (age range; 25-45 years) with
persistence of anti-HBc IgM were randomized to receive either 100 mg lamivudine (32/62) or
placebo (30/60) daily for 6 months. The studied carriers were regular attendees of the Virology
Center in Mosul, North Iraq for follow-up. Enzyme-linked immunosorbent assay techniques were
performed to detect the different markers of HBV infection.
Results: Among the lamivudine group, anti-HBc IgM serolclearance rate was 81.3% and HBsAg
seroconversion rate was 9.4% compared to 6.3% and 3.3% among placebo group. Number of
adverse clinical events were observed, but were of mild nature and tolerable by the participants
who completed the study.
Conclusions: The trial of lamivudine in this group of inactive HBsAg carrier state cases proved to
be safe and efficacious.
Final abstract number: 67.003
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Therapy of Chronic Hepatitis C in Intravenous Drug Users - Efficiency and Problems
M. Bozic, K. Bojovic, M. Djonin-Nenezic, I. Milosevic
Institute for tropical and infectious diseasae, Belgrade, Serbia

Background: HCV infection is very common in intravenous drug usres (IDUs) and it has more
often progression in chronic hepatitis. Inspite of that, just small percent of these patients with
chronic hepatitis C (CHC) is treated with antiviral therapy. Interruption of therapy was common in
IDUs due to low compliance and adverse reactions, usually psychiatric.
Methods: This is a 5-year retrospective analysis of 37 IDUs with CHC who were treated in
Institute for Infectious and Tropical Diseases, Clinical Center of Serbia in Belgrade. HCV RNA
and HCV genotype (G) were determinated by PCR. Liver biopsy was performed in 34 (91,89%)
patients. All 37 patients were treated with pegilated interferon alpha 2a + Ribavirin according to
standard protocols.
Results: There were 37 IDUs with CHC in the age from 17-54 years. They abused heroin iv for 1-
21 years. HCV infection was diagnosed 1-18 years before treatment. All patients were HBsAg
and anti-HIV negative. 18 patients (48,64%) also consumed alcohol. AST level ranged from 35-
248 IU/L. Liver biopsy showed cirrhosis in 5 (14,7%) patients and fibrosis in 29 (85,3%) patients.
Steatosis was confirmed in 9 (24,32%) patients. Viral load ranged from 100.000 to 33.750.000
HCV RNA coppies/mL. HCV genotype were found: G1 in 19, G2 in 2, G3 in 9, G4 in 2 and mixed
G in 5 patients. Sustained viral response (SVR) was achived in 21/27 (77,77%), relapse (R) was
found in 4 (14,81%) patients and 2 patients (7,40%) were nonresponders (NR). Therapy was
definitly interrupted in only one patient. We had to stop treatment temporaly and to reduse dose
of antiviral drugs in 10 (27%) patients. Adverse effects of therapy were found in 30 (81,1%)
patients.
Conclusions: Treatment of CHC in IDUs was successful and it shows that more IDUs should be
treated with antiviral therapy.
Final abstract number: 67.004
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Nosocomial Chronic Viral Hepatitis
           1           2            3
F. Sirmatel , H. Peksel , B. Gursoy
1                                             2
 Abant Izzet Baysal University, Bolu, Turkey, Kiziltepe Goverment Hospital, Mardin, Turkey,
3
 Medical Faculty of Harran University , Sanliurfa, Turkey

BACKGROUND: It is known that the nosocomial viral hepatitis agents Hepatitis B (HBV),
Hepatitis D (HDV), and Hepatitis C (HCV) viruses are transmitted by the close contact and
invasive procedures. The nosocomial viral hepatitis (NVH) transmission cases were followed for
last seven years period.
MATERIALS AND METHODS: Between 1999 to 2006; 28 NVH cases were followed for 12-72
months at the Research and Application Hospital that is committed to the University. It was taken
the notice of the negative chronic viral hepatitis markers and normal value of transaminases of
the cases. The cases that were considered of transmission of HBV, HCV, and HDV at the outside
of the hospital were excluded from the study. All the cases were evaluated for the acute viral
hepatitis markers for HBV, HCV and HDV, after 15th and 90th day of the suspected transmission.
The cases who were known that transmission of HBV, HDV and HCV was occurred were re-
evaluated for the medical status of before transmission and present.
FINDINGS AND RESULTS: There were totally 28 cases (eighteen were man, ten were women)
ages between 20 to 67 were suspected of the transmission of nosocomial viral hepatitis. Six of
them were doctors, six of them were nurses, four of them were medical stuff and twenty were
patients that were hospitalized for another medical reason. It was determined that all the hospital
stuff had their viral hepatitis agent transmission because of needle-sticks and ten of the patients
had their transmission because of endoscopic and invasive procedures.
From these 28 cases: 5 cases (four medical staff, and one patient) exposured HBV, previously
known 4 chronic hepatitis B patients exposured nosocomial HDV transmission and 19 cases (6
doctors, 6 nurses, 7 patients) exposured nosocomial HCV transmission.
At the end of the observation; from the 4 medical stuff and one patient who didn't get any
prophylaxis two of them got Anti-HBs seroconversion, but the other two stuffs got their diseases
chronically HBV carriers. Four patients who were previously known that were chronic viral
hepatitis B, acquired their HDV exposure and transmission because of the endoscopic
procedures and superinfection were occurred at all four of them. These four HDV superinfection
patients were given interferon treatment (10 million IU/ 3 times a week) for one year. After the
treatment their transaminases decreased to the normal values and HDV-RNA of all four patients
were negative. The two of four nosocomially HDV exposured patients had Anti-HBs
seroconversion and all four patients had negative Anti-HDV tests. After one year, the two patients
who had Anti-HBs seroconversation and got HBsAg positivity again. HCV exposured 12 items (6
doctors, 6 nurses) got nor transaminase elevation neither Anti-HCV or HCV-RNA positivity. From
the HCV exposured 7 patients; the two of them got spontaneous clearance, five of them got acute
HCV infection and treated for one year. But one male patient with acute HCV infection who didn't
tolerate the treatment got a decomposed liver disease after two years. At one acute HCV infected
female and spontaneously cleared patient got a flare of HCV infection during an
immunosuppresive treatment because of her temporal arteritis. The other four patients who had
received pegilated interferon treatment for one year got sustained response to the treatment.
CONCLUSIONS: As a result from five nosocomial HBV infections two had a chronic hepatitis B
infection. From 19 nosocomial HCV infection there was one chronical infection. From four
nosocomial HDV infection were treated successfully. The viral hepatitis agents causes chronic
illness at immun compromised patients. These patients must be evaluated for prophylaxis after a
HBV exposure. Although HCV is still an important viral pathogen for nosocomial transmission; it
makes chronic viral hepatitis that has long progression time period at healthy people.
Final abstract number: 67.005
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Sexual Transmission of Hepatitis C Virus Among Female Sex Workers in India
P. Barua, N. Laskar, G.K. Medhi, B. Apum, J. Mahanta
Regional Medical Research Centre, Indian Council of Medical Research, Dibrugarh, India,
Regional Medical Research Centre, Indian Council of Medical Research, Dibruagrh, India

Background: Although several blood borne viral infections are transmitted sexually, yet acquiring
hepatitis C virus (HCV) infection by this route is debated. Risk of chronicity with HCV infection is
high and increases co-morbidity when present along with HIV in high risk groups.
Methods: We recruited 426 female sex workers (FSWs) who consented by Respondent Driven
Sampling (RDS) technique in a Linked Anonymous strategy. The respondents provided
behavioral data and biological samples. Serum samples were tested for HIV and HCV by ELISA.
To assess the associated risk factors, samples were also tested for HSV-2 and syphilis. Urine
samples were tested for gonorrhea and chlamydial infections by Aptima Gen probe. Data were
analyzed using SPSS 10.0 statistical software.
Results: Of the 426 FSWs enrolled, the overall anti-HCV antibody positivity was 9.6%; 45.9%
among those who were IDUs and in 7.5% with no history of injecting drug abuse, blood
transfusion or tattooing. HIV-1 antibody was positive in 13.6% while 2.3% had detectable HBsAg.
HIV-HCV co- infection was present in 36.2%. Among the STIs, HCV was significantly associated
with HSV-2 in 15.5 % (OR 2.9, 95% CI 1.5-5.5, p< 0.02). Risk of acquiring HCV infection was
found to be 1.8 times more among FSWs who had any one STI and practiced anal sex (p 0.05)
and the risk increased 12.8 times in the presence of injecting drug use (p 0.05). Within the
control group, HCV antibody was present in only 1% of antenatal mothers in monogamous
relationship and in 0.2% of blood donors in the region.
Conclusion: HCV antibody was found among FSWs in the absence of the established risk factors
known for transmitting HCV infection. Strong association with HIV and HSV-2 indicate that the
presence of these infections along with other risk factors facilitate sexual transmission of HCV in
this setting.
Final abstract number: 67.006
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Genotype Distribution in Chronic Hepatitis C Patients in Greece
G. Totos, M. Stamouli, D. Kairis, A. Michopoulou, I. Panagiotou
Athens Naval Hospital, Athens, Greece

Background: Hepatitis C virus (HCV) genotypes and subtypes are distributed differently in
different parts of the world. HCV genotype information is important because it can be used as a
predictor of treatment response and outcome. In this study we evaluated the genotypes of
patients with HCV in a Greek hospital.
Methods: Specimens from 61 patients (35 males and 26 females) with HCV were tested. HCV
RNA viral load was determined by PCR (Cobas Amplicor™ HCV Monitor v2.0, Roche Molecular
Diagnostics). HCV genotype and subtype were determined by direct sequencing of the 5' NC
gene fragment (Trugene™ HCV 5' NC Genotyping Kit, Siemens Healthcare Diagnostics).
Results: Genotype 1 was present in 21 patients with most common subtype 1b (16/21), while
genotype 3 was present in 24 patients with most common subtype 3a (23/24). Genotype 2 was
present in 8 patients, genotype 4 in 7 and genotype 5 in 1. In males genotype 3 was the most
frequent (19/35), while in females genotype 1 (13/26). Genotype 3 was the most frequent (43%)
in patients younger than 50 years, while genotype 1 was the most frequent (47%) in those older
than 50 years. Twenty-one patients had a baseline high viral load (above 800,000 IU/ml): six with
genotype 1b, two with 1a, five with 2, seven with 3a and one with genotype 4. High baseline viral
load was observed in 37% of patients aged less than 50 years and 42% aged over 50 years.
Conclusion: Genotypes 1 and 3 had almost equal distribution and represent together 73% among
the study population. Genotype 1 was more frequent in older patients and genotype 3 among
younger patients.
Final abstract number: 67.007
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

A Study of Anxiety Status and Influencing Factors on Patients with Chronic Hepatitis B
         1      2             1         1           1
F.J. Du , H. Gao , F.L. Wang , Y.L He , Y.L. Zhao
1
 Infectious Department of the First Affiliated Hospital, Xi'an JiaoTong University, Xi'an, China,
2
 Xi'an Health School, Xi'an, China

Background: Chronic hepatitis B is a public health problem in China, till to now few data are
available to define psychological state of those patients, which is extremely important to provide
psychological support for them. The aim of the study was to explore the anxiety status and
influencing factors in patients with chronic hepatitis B for the purpose of providing theoretical
evidences to psychological nursing.
Methods: Sixty-seven patients with chronic hepatitis B from the First Affiliated Hospital of Medical
College of Xa'an JiaoTong University from June to December in 2006 were enrolled to complete
State-Trait Anxiety Inventory (STAI) questionnaire and questionnaire of own designing; the items
include name, sex, age, occupation, course of disease, economic position, marital status and
education.
Result: Statistic analysis indicated that state anxiety and trait anxiety of patients with chronic
hepatitis B show significant increasing in comparison with Chinese average level, SA:
42.70±10.32, the male SA: 42.17±10.27 (P=0.04), the female SA: 44.05±10.33 (P=0.02); TA:
44.03±9.17, the male TA: 43.81±8.61 (P=0.028), the female TA: 46.06±8.79 (P=0.02). Factors
associated with SA include age (P=0.036), occupation (P=0.034), economic position (P=0.000),
level of received education (P=0.001); factors associated with of TA include marital status
(P=0.023), economic position (P=0.000), level of received education (P=0.044).
Conclusion: SA and TA are very widespread in clinic hepatitis B patients, the common factors
include age, occupation, economic position, level of received education, marital status. It is
necessary for nurses to know about patients' psychological status and provide targeted care to
them according to influencing factors.
Final abstract number: 67.008
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Psychological Stress, Cortisol and Immune Status in Patients with Chronic Hepatitis B
          1         2             1          1
H. YingLI , G. Heng , Z. YingRen , W. Ke
1
 Infectious Department of the First Affiliated Hospital,Xi'an JiaoTong University, Xi'an, China,
2
 Xi'an Health School, Xi'an, China

Background: Chronic hepatitis B is a public health problem in China, HBV infection results in
approximately 280 thousand deaths per year, mainly caused by chronic hepatitis, cirrhosis, and
hepatocellular carcinoma (HCC). Accumulating evidence has linked psychological factors to the
onset, progression, and outcome of chronic and latent viral infection. Psychological factors
modulate immune system by initiating neuroimmune axis responses. Thus, we examined the
association between the immune status and the psychological (perceived) stress in patients with
chronic hepatitis B, and the involvement of cortisol.
Methods: Forty patients with chronic hepatitis B completed the Perceived Stress Scale-14 (PSS-
14) and State-Trait Anxiety Inventory (STAI-Form). These two scales are self-report
questionnaires to measure psychological stress, state anxiety and trait anxiety. We measured two
types of T cell-derived cytokines level (IL-10 and IFN) and plasma cortisol. Correlation analysis
was employed to explore the relationship among psychological scores, cortisol and cytokine level.
Results: Our results show that the level of IL-10 was related to psychological stress (P=0.03),
state anxiety (P=0.01) and trait anxiety (P=0.03). No correlations were found between
psychological stress and IFN- g levels. Also no correlations were developed between cortisol and
psychological stress, anxiety, IL-10, and IFN- g.
Conclusion: From the results, it can be concluded that psychological stress depresses the
immune reaction in patients with chronic hepatitis B, which is disadvantage of HBV r esolve.
Those patients were in great need of psychological support. Cortisorl plays little role between
psychological stress and immune state in patient with hepatitis B.
Final abstract number: 67.009
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Association Between HLA-A, B, DRB1 Alleles and Susceptibility or Resistance to Chronic
Hepatitis B
              1                            2           3              1             4           5
A. Ramezani , M.R. Hasanjani Roshan , E. Kalantar , A. Eslamifar , M. Mohraz , M. Banifazl ,
              1           1               6
A. Aghakhani , J. Taeb , A.A. Velayati
1                                                               2
 Pasteur Institute of Iran , Tehran, Iran (Islamic Republic of), Babol University of Medical
                                                3
Sciences , Babol, Iran (Islamic Republic of), School of allied medical sciences, Iran medical
                                                  4
university, Tehran, Iran (Islamic Republic of), Iranian Research Center for HIV/AIDS , Tehran,
                             5
Iran (Islamic Republic of), Iranian society for support patients with infectious disease, Tehran,
                             6
Iran (Islamic Republic of), Masih Daneshvari Hospital, Tehran, Iran (Islamic Republic of)

Objective: Hepatitis B virus (HBV) infection is a major public health problem worldwide. The
mechanism of susceptibility to chronic persistent HBV infection is not well clarified, while the
outcome of HBV infection mainly depends on the host immune response. Different HLA class I
and II alleles may play roles in HBV infection outcome. In this study, the association between
HBV infection and HLA alleles was studied.
Methods: HLA-A, B and DRB1 alleles in 33 patients with chronic hepatitis B and 31 healthy
carriers collapsed as persistent group, and 30 subjects who had spontaneously recovered from
HBV infection were analyzed by using PCR-sequence specific primer (PCR-SSP) technique.
Results: The frequency of HLA-A*33 allele was higher in persistent group than recovered group
(P<0.008); the frequency of DRB1*13 allele was lower in persistent group than in recovered
group (P<0.03). The frequency of B*52 allele was higher in CHB patients than healthy carriers
(P<0.05).
Conclusion: HLA-A*33 was related with susceptibility and HLA-DRB1*13 was related with
protection against persistency of hepatitis B. Our survey also showed that the frequency of B*52
allele was higher in CHB patients than healthy carriers which further confirmed the role of HLA
alleles in clinical presentations of HBV infection. The above results suggest that host HLA class I
and II alleles are important factors in determination of the outcome of HBV infection.
Final abstract number: 67.010
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Long Term Immune Response to Hepatitis B Vaccine in Haemodialysis Patients
              1                1            2           3             4         4            4
A. Ramezani , A. Eslamifar , M. Mohraz , M. Banifazl , F. Ahmadi , S. Maziar , E. Razeghi ,
            5             1              1              1
E. Kalantar , M. Hazrati , A. Amirkhani , A. Aghakhani
1                                                               2
 Pasteur Institute of Iran , Tehran, Iran (Islamic Republic of), Iranian Research Center for
                                                  3
HIV/AIDS , Tehran, Iran (Islamic Republic of), Iranian society for support patients with infectious
                                                 4
diseases , Tehran, Iran (Islamic Republic of), Tehran University of Medical Sciences , Tehran,
                             5
Iran (Islamic Republic of), School of allied medical sciences, Iran University of Medical Sciences,
Tehran, Iran (Islamic Republic of)

Objective: Hepatitis B (HB) vaccine is effective in producing protection against HB virus infection
in hemodialysis (HD) patients, but the persistence of immunity remains largely unknown. In this
study we aimed to evaluate the persistence of hepatitis B vaccine immunity in HD patients.
Methods: In this study we had followed 54 HD patients up to 1 year after primary hepatitis B
vaccination [four doses vaccination schedule 40 g injections intramuscularly in the deltoid
muscle at 0,1,2,6 months] to evaluate the persistence of immunity [as indicated by serum levels
of antibody to hepatitis B surface antigen (anti-HBs) higher than or equal to 10 IU/l].
Results: At 1 year after vaccination, 18.18% of patients had lost their anti-HBs (transient
responders) while 81.82% of them had detectable antibody in the serum (persistent responders).
From 81.82% of persistent responders 11.5% and 88.5% were weak and high responders
respectively. There was no significant difference between persistent and transient responders
regarding age, sex and nutritional factors (serum albumin, triglycerides, and cholesterol),
hemoglobin, parathyroid hormone (PTH), fasting blood sugar (FBS), C3, C4 and anti-HCV.
Conclusion: Our study supported this fact that an antibody titer above 100 IU/l following primary
vaccination is necessary in order to maintain that level of antibody 1 year later.
Final abstract number: 67.011
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Intrafamilial Transmission of Hepatitis C Virus Infection in Iran (Markazi Province)
A. Fani, M. Sofian, P. Adeli ran-kuohi, M. Fathollahi, B. Eshrati, P. Fani, A. Rostampoor
Arak medical university, Arak, Iran (Islamic Republic of)

Objectives: The role of Intrafamilial Hcv transmission is still controversial, the aim of the present
study is to determine intrafamilial transmission (Sexual and non sexual contacts) of Hcv in Iran.
Methods: In this historical cohort study, we enerolled 270 first degree relatives of hepatits c
patients as the exposed group and 270 first degree relative of normal subjects (with negative
Hcv) compared as the unexposed group.
Positive Hcv and negative Hcv subjects were selected of blood donors reffered to the Regional
Blood transfusion organization in Arak from August 2001 to August 2007.
First degree relatives were who lived with the index case at least for one year in the same house.
Subjects were interviewed using a standard questionnaire acquiring demographic and risk factor
information. Then serum samples were obtained from each subject.
Antibodies to Hcv were detected employing by commercially available second - generation
enzyme immunoassay. Positive serum specimens were retested using a second generation
recombinant immunoblot assay.
Data analysis was carried out with spss for intra-hous hold clustering. We used fisher exact test in
order to detect association between the exposure and out come of the study.
Results: The mean age of exposed group was 27.11 ± 19.84 years and 38.1% were male. The
mean age of unexposed group was 29.38 ± 16.70 years and 51.9% were male. There was not
any significant difference about sex, age ,familial relation and candom use between exposed and
unexposed subjects. sexual partner subjects formed 24.8% of first degree relatives in the case -
group.
In exposed group, there is no Hcv positive but in unexposed group we had 2 cases of Hcv
positive who were intravenous drug abuser.
The prevalence of positive Hcv antibody among household contacts of two groups was not
significantly different. (Pvalue=o.25)
Conclusion: The results of this study demonstrate that intrafamilial transmission of Hcv is not the
significant transmission route and sexual transmission does not seem to play a role in the
intrafamilial spread of Hcv infection.
Final abstract number: 67.012
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Epidemiological Screening of Hepatitis E Virus in Bile Specimens from Livestock in Northwest
China
Z.J. Saho, J.H. Li
Department of EPI, The fourth military medical University, Xian, China, Department of EPI, The
fourth military medical University, Xi'an, China

Hepatitis E virus (HEV) is an important causative agent of epidemics and sporadic cases of acute
hepatitis in many regions. Some strains of HEV have been detected in swine, deer, and wild boar,
and specific antibodies against HEV have been detected in livestock. However, there have been
no definite conclusions about which livestock, other than swine and deer, primarily contribute to
HEV infection in humans. In this study, 1295 bile specimens were collected from slaughter
houses located in Xi'an (Shaanxi province), Kashi city (Xijiang autonomous region), and Datong
(Shanxi province). Reverse transcription-polymerase chain reaction (RT-PCR) and partial
nucleotide sequencing were performed to detect the HEV RNA. Eleven HEV positive samples
were from swine. Both phylogenetic analysis and Genetic analysis based on the alignment of an
amplified 150-nt ORF2 sequence indicated that the HEV strains belonged to genotype IV. We
postulate that swine are the main reservoir of HEV.
Final abstract number: 67.013
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Immunity to Hepatitis B Vaccine in Children Less Than 5 Years Vaccinated Using Hepatitis B
Vaccine Attending RCH Clinics Dar Es Salaam, Tanzania
J. Metodi, A. Said, E. Munubhi
MUHIMBILI, Dar Es Salaam, United Republic of Tanzania

Background: In 1991, the World Health Organization (WHO) called for all children to receive the
hepatitis B vaccine. Since then 116 countries have added this vaccine to their routine
immunization programmes and the remaining countries are either planning its introduction or
studying its feasibility. In Tanzania, Hepatitis B vaccination has been introduced into
immunization programme since 2002.It is given in combination with DPT (diphtheria, Pertusis,
Tetanus). It is given at 4th, 8th and 12th week of life. The Expanded Programme on Immunization
(EPI) in Tanzania was launched in 1975.The goal is to reduce infant and childhood morbidity and
mortality due to vaccine preventable diseases, one of them being hepatitis B infection.
Objective: To determine Immunity to Hepatitis B vaccine in children aged 2-59 months,
vaccinated using hepatitis b vaccine attending RCH clinics in Dar es Salaam, Tanzania
Methodology: A cross-sectional hospital based study was done.
Setting: MCH clinics at 3 district hospitals in Dar Es Salaam, Tanzania.
Study population: Children less than five years who has received hepatitis B vaccine.
Results: 296 children aged 2m to 59 months were studied, 205 children had immunity to hepatitis
B vaccine.-70% (Antibodies level of 10mIu/L or above were considered as protective).
Multivariate analysis revealed number of DPT HB doses, nutritional status and time interval since
last vaccination had significant association with mounting adequate immune response.
Conclusion and Recommendation: It was concluded that number of DPT HB doses, nutritional
status and time interval since last vaccination have influence in these children to mount adequate
immune response. We reccommended a booster dose of Heb vaccine at 2nd decade so as to
prevent these children from getting infection,hence complications such as liver cirrhosis and
hepatocellular carcinoma.
Final abstract number: 67.014
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

The Prevalence of Hepatitis B and Hepatitis C Among Street Children in Tehran, Iran
         1              2          3            3                       3
F. Fallah , H. Goudarzi , A. Karimi , G. Esllami , R. Radmanesh Ahsani
1                                                                                    2
 Shaheed Beheshti University of Medical Sciences, Tehran, Iran (Islamic Republic of), Shahid
                                                                            3
Beheshti University of Medical Sciences, Tehran, Iran (Islamic Republic of), shahidbeheshti
university of medical sciences, Tehran, Iran (Islamic Republic of)

Summary: Nowadays the issue of street children is one of the most important issue facing society
,among big ,industrial and under developed cities .there are approximately one hundred million
children spending their life in the streets. With the last description of the International
Organization for street children , many of documental statistics and numbers are less than the
actual figures .many countries are suffering from an individual relation the issue of street children
despite possessing common properties , and by controlling this phenomenon each country will
get in specific picture.
Materials and methods: The study was taken place on 203 street children that were picked up
from different places of Tehran and were shelter at welfare center , which provides shelter for
street children. These children were clinical examined by pediatrician then they were requested to
answer the questionnaire (gender; age; birth place; educational status; the origin of the family;
sleeping place; education, occupation, income and social security of parents; number of siblings;
reasons for being in the streets; period of living in the streets; street friends; income; means of
earning money; substance use. Smoking was grouped as heavy (10 and more per day), medium
(1-9 per day) and rare (a few in a week).) In order to determine the existence of hepatitis B , 3 ml
of blood was taken. we used ELISA and PCR method
Results: Among 203 street children that studied in this research 196 children were boys and 7
children were girls. 6 cases (3%) were HBsAg positive .all of the positive cases were boys . there
were 3 Iranian and 3 Afghanian kids among positive cases , there were no smokers . they did not
have tattoo ,all of them had family , one of them lived alone and other 5 cases lived with their
family and their average age was and 8cases were 14 < years
Conclusion: According to this results , additional laboratory examination for screening aquired
infectious disease such as Hepatitis which clinical symptoms may appear few months after
exposure to virus but can transmission in this period ,are recommended.
Key words: Hepatitis B, Hepatitis C, street children
Final abstract number: 67.015
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Assessment of the Selected Cytokines Among Patients Treated for Chronic Hepatitis Type C
M. Dudziak, A. Zakrzewski, J. Kruszewski
Department of Infectious Diseases and Allergology, Military Institute of Medicine Warsaw,
Warsaw, Poland

During the last years the possibilities of researching the cytokines coding genes were observed. It
was revealed that the relation exists between their polymorphism and susceptibility to
autoimmune diseases, inflammatory processes.
The study was made on 41 patients, diagnosed as having Hepatitis C. The patients had the
standard treatment with interferon and ribavirin (48 weeks). During the following period of time
lasting at least one year, the patients were observed. After this period of time, the tests on
detection of RNA virus were performed. Additionally, the lymphoid blood cells were tested for the
polymorphism of the cytokines coding genes (TNF alpha, INF gamma, IL-6, IL10) conditioning
predisposition towards capability of generation of their different concentration. The results of our
study suggest that there is no relation between polymorphism of the tested cytokines coding
genes and the response for the HCV infection treated with interferon.
Final abstract number: 67.016
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Efficacy of Pegylated Interferon Alpha-2a and Ribavirin Treatment in Chronic Hepatitis C Patients
Depends on Various Baseline Parameters and Early Viral Kinetics
         1             1             1              2           1
P. Husa , P. Slesinger , H. Stroblova , A. Svobodnik , L. Husova
1
 Faculty Hospital Brno and Faculty of Medicine Masaryk University, Brno, Czech Republic,
2
 University of Brno, Brno, Czech Republic

Background: to compare efficacy and viral kinetics during treatment in various chronic hepatitis C
patients (CHC) and to find some baseline parameters which can predict sustained viral response
(SVR).
Methods: 216 CHC pts - 140 men; 142 naive, 37 relapsers, and 37 non-responders. 172
genotype 1 (G-1), 4 G-2, 34 G-3, 1 G-4 or G-6, and 4 unknown genotype - were treated with
PEG-IFN alpha-2a 180 g/wk and RBV 1000 or 1200 mg/day. Quantitative detection of HCV
RNA was done at baseline (216 pts), 24 hours (83 pts), 14 days (85 pts), 28 days (88 pts), and 84
days (211 pts) after treatment initialization.
Results: 195 pts have completed the treatment period and 179 pts the 24-weeks follow-up period
yet. The probability of SVR was significantly higher (P<0.001) in naive patients (74/114, 64.9%)
and relapsers (22/30, 73.3%) than in non-responders (9/35, 25.7%); and in G-3 patients (23/28,
82.1%) than G-1 patients (77/143, 53.8%) (P=0.02). The mean log decline of serum HCV RNA
was more considerable in pts with SVR. Undetectable serum HCV RNA at week 12 was more
predictive of SVR than early viral response (EVR) - 98/122 (80.3%) versus 104/141 (73.1%) of
SVR. The patients with SVR has significantly lower weight (mean 72.8 kg vs. 79.1, P=0.008),
were younger (mean 36.2, vs. 45.5, P<0.001), and had lower baseline viremia (mean 1.014 x 106
IU/mL vs. 2.415 x 106 IU/mL, P<0.001). SVR was more frequent in women than in men (43/63,
62.8% vs. 62/116, 53.4%) (P=0.059).
Conclusion: 1) Negative serum HCV RNA at week 12 is more predictive of SVR than EVR. 2) The
probability of SVR was significantly higher in patients with lower baseline viremia, body weight
and younger adults. 3) Gender was not significant for the efficacy of treatment.
Final abstract number: 67.017
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Prevalence of Hepatitis C Virus (HCV) Genotype 3a in the Infected Population of Lahore,
Pakistan
       1           2            3             4                   2          2              2
T. Ijaz , M.A. Khan , S.A. Jafri , F.A. Ranjha , K. Asim Mehmood , M. Imran , M.K. Shahzad
1                                                           2
 Microbiology laboratory Mayo Hospital , Lahore, Pakistan, University of Veterinary and Animal
                               3
Sciences , Lahore, Pakistan, Institute of Molecular Biology and Biotecnology,University of
                            4
Lahore, Lahore, Pakistan, Chairman Research Cell Mayo Hospital, Lahore, Pakistan

Hepatitis C virus (HCV) major public health concerns in Pakistan. A molecular study was
conducted to investigate the prevalence of Hepatitis C Genotype 3a in the infected population of
Metropolitan. By using primers against the 5' non coding region of the viral RNA was reverse
transcribed into cDNA and for qualitative analysis, the amplification of cDNA was done by first
round PCR. Nested PCR was performed with first round PCR product. Amplification of HCV
cDNA for genotyping by regular PCR was carried out. For HCV genotyping second round PCR,
two different primer mixtures were prepared. Detection of genotype specific band was performed
through gel electrophoresis. 232 bp specific band of HCV 3a genotype was determined by
comparing with 100bp DNA size of marker. Our result showed, out of 28 HCV PCR positive
samples, fifteen samples have HCV genotype 3a. The prevalence of genotype 3a HCV RNA was
found to be 55 % in local population of Lahore.
Keywords: Hepatitis C virus, Genotype 3a, PCR, Lahore.
Final abstract number: 67.018
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Diagnosis Dilemma of Chronic Hepatitis
A. Zakrzewski, M. Dudziak, J. Kruszewski, M. Abramowicz
Department of Infectious Diseases and Allergology, Military Institute of Medicine , Warsaw,
Poland

One of the most frequent reasons of hepatitis is HCV virus infection. There are two methods of
infection detection: immunological and genetic ones.
The study was made on 361 patients with the features of liver pathology admitted to the Clinic
during the years of 2000 - 2004. Besides standard methods aimed to determine disease aetiology
and the level of liver damage, the blood serum tests were made simultaneously. There were as
follows: detection of anti-HCV antibodies by the quality method Architekt System; Innogenetics
test as the confirmation test, and detection of RNA-virus by PCR method, Cobas Amplicor 2.0
test. The tested population underwent outpatient observation for at least six months.
The anti-HCV antibodies were detected among 256 patients, RNA-virus was detected among 212
patients. The results of both of these tests were negative for 102 patients and positive for 209
patients. The RNA-virus was not detected among 47 patients with presence of the anti-HCV
antibodies. The RNA-virus was detected for three patients without presence of the anti-HCV
antibodies. The following observation and performing the tests such as liver biopsy led to
diagnose hepatitis virus infection among all the patients with detected at least single infection
marker. Four patients were diagnosed as the acute infection cases and 255 as chronic infection
cases. The following next months' observation did not led to detect any changes for the infection
status of patients without infection markers.
The detection of the anti-HCV antibodies in the blood serum with the third-generation tests should
be treated as the standard procedure in the liver infection diagnosis.
The detection of HCV RNA can be reasonable in the following cases: suspected acute HCV
infection, unclear clinical picture; particularly when the possibility of infection related claims occur,
drug addicts and patients suspected for taking drugs, review of antiviral therapy effectiveness.
Final abstract number: 67.019
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Hepatitis B Virus in Chronically Infected Patients
             1          1            2         3               4             5
M. Basaras , E. Arrese , S. Blanco , M. Sota , B. de las Heras , R. Cisterna
1
 Dept. Immunology, Microbiology and Parasitology. University of Basque Country, Bilbao, Spain,
2                                                   3
 Digestive Service. Basurto Hospital, Bilbao, Spain, Microbiology Service. Basurto Hospital,
               4                                                  5
Bilbao, Spain, Digestive Service, Basurto Hospital, Bilbao, Spain, Dept. Immunology,
Microbiology and Parasitology. University of Basque Country. Microbiology Service. Basurto
Hospital, Bilbao, Spain

Background: Genomic mutations presented during hepatitis B virus (HBV) reverse transcription
could explain its genetic diversity and account for genetically distinct eight genotypes which show
distinctive geographically distribution. The main objectives of this study were to determinate the
prevalence of hepatitis B virus genotypes in patients with chronic hepatitis B, and to look for a
relationship between genotypes and risk transmission factors according to HBeAg state.
Patients and methods: A total of 14 serum samples from chronic HBV patients were analysed
using INNO-LIPA HBV Genotyping assay (Innogenetics). The presence of mixed genotype
infection was verified by sequencing using the BigDye Terminator Cycle Sequencing Kit on an
ABI Prism 3130 Genetic Analyzer. Hepatitis B virus HBsAg, anti-HBs, HBeAg and anti-HBe were
determined by ADVIA Centaur (Bayer).
Results: Genotype D was the most prevalent (64.3%) followed by genotype A (28.6%). There was
a coinfection case (D/E genotypes) that was confirmed by sequencing PCR product. All patients
except one were HBeAg-negative and anti-HBe-positive. The only patients with HBeAg-positive
showed genotype D and had a previously seroconversion but latter had a new reactivation. About
risk factors for HBV acquisition, in half of cases was unknown; in the other half there was sexual
(21.4%), transfusion (14.3%), maternal (7.1%) or interfamilial (7.1%) transmission.
Conclusions: These result showed that genotype D is the most prevalent accompanied with
genotype A in chronically infected patients in our hospital. Moreover, we did not found any
evidence about HBeAg state and identified genotype.
Final abstract number: 67.020
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Prevalence of Hepatitis C Virus (HCV) Genotypes in the Population of Brasilia, DF, Capital of
Brazil
S.F. Fonseca, G.B. Barra, L.F.R. Velasco, L.F. Abdalla, A.S.G. Cabral, S.S.S. Costa, J.A.R. Vaz
Laboratório Sabin, Brasília, Brazil, Laboratório Sabin, Brasilia, Brazil

Background: HCV comprises a heterogeneous family of viruses, with at least six genotypes and
countless subtypes. HCV infection is a public health problem worldwide, including in Brazil. The
World Health Organization estimates that approximately 3% of the Brazilian population is infected
with HCV. Identification of the HCV genotype is important for epidemiology, prognosis, and
determining the course of treatment for the infection; there is data that suggests a poorer
prognosis and the need for more aggressive therapy for genotype 1.
Objective: Determine the prevalence of different HCV genotypes in the population of the city of
Brasilia, the national capital.
Methods: A retrospective, cross-sectional study was conducted with a population of 213
individuals, comprising 128 men and 85 women between the ages of 21 and 81, who underwent
genotyping for HCV in Sabin laboratories between 2005 and 2007. Repeat cases were excluded
from the study. Detection of viral RNA in the plasma was obtained by the nested-RT-PCR
technique and genotyping by the RFLP technique.
Results and Conclusion: Genotype 1 was observed in 149 individuals (70%), genotype 3 in 53
individuals (25%), genotype 2 in 9 individuals (4%), and genotype 4 in 2 individuals (1%).
Subtypes 5 and 6 were not found in this population. The results obtained in the Federal District
population are similar to those published in other states in the Southeast and Northeast regions of
Brazil and to the distribution of HCV genotypes in the western world.
Final abstract number: 67.021
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Occult Hepatitis B Virus Infection Among Chronic Liver Disease Patients in the United Arab
Emirates
               1             2            2                2
M.I. Al-Moslih , A. El Sayed , H. Youssef , A.A. El Majeed
1                                                                                  2
 University of Sharjah, College of Health Sciences, Sharjah, United Arab Emirates, Al-Noor
                                             2
Hospital, Abu Dhabi, United Arab Emirates, Al-Noor Hospital, Abu Dhabi, Abu Dhabi

Background: About, two billion people in the world have been infected by Hepatitis B virus (HBV),
350 million of whom are chronic carriers of the virus. Occult hepatitis B virus (HBV) infection is
characterized by presence of HBV infection with undetectable hepatitis B surface antigen
(HBsAg). Diagnosis of occult HBV infection requires sensitive HBV-DNA polymerase chain
reaction (PCR)assay. Scanty information is available about the etiology of viral chronic diseases
in the United Arab Emirates (UAE). Therefore a study was carried out for detecting and
genotyping of Hepatitis B Virus (HBV) in patients with chronic liver diseases (CLD) as well as
determining the prevalence of occult HBV in CLD patients in the UAE.
Methods: A total of 248 serum samples from CLD patients and 139 healthy individuals were
tested by polymerase chain reaction (PCR) in determining DNA in serum samples . Liver biopsies
were taken from randomly selected 71 HBV infection from CLD patients were tested by
immunohistochemistry( (IHC) staining for HBsAg and HBcAg . Genotyping of HBV-DNA was
carried out by commercial kit.
Results: The results indicated the prevalence of HCV, HBV, Mixed (HBV & HCV) and Occult HBV
infections at a rate of 51.2%, 31.8%, 4.0%, and 8.9% in CLD patients respectively. On the other
hand Healthy subjects were found to be positive for HBV at a rate of 2.9% ( P=0.001).
The most prevalent genotypes of HBV infection in CLD patients were D and E (60.6% & 26.8.0%
respectively). Whereas the prevalence of other genotypes (B, C and A) were in the range of
3.8%, 1.9% and 0.9% respectively. IHC results of randomly selected 71 CLD patients with HBV
revealed that 98.6% (70/71), of the liver biopsies were positive for HbsAg & HbcAg whereas
95.8% (68/71) of the serum samples and liver biopsies among occult HBV patients with CLD
were positive for HBV-DNA by PCR .
Histopathological studies of liver biopsies revealed that patients with HBV infection were more
likely to have necroinflammatory activity and fibrosis than patients without HBV infection.
Conclusion: Occult HBV is relatively frequent among patients with CLD in UAE
It maybe associated with more advanced liver pathology and more aggressive clinical course.
Genotype D appears to be the dominant genotype circulating in UAE population with CLD.
Genotypes C and A appeared to be the minor genotypes. IHC staining could be of a help in the
diagnosis of occult HBV in CLD patients beside PCR.
Final abstract number: 67.022
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Evaluation of Prevalence of RT-PCR Based HCV Infection in Thalassemia and Hemodialysis
Patients in Kerman Province (Iran)
G. Hassanshahi, B. Esmaeilzadeh, M. Kazemiarababadi, A. Sadeghi
Rafsanjan University of Medical Sciences, Rafsanjan, Iran (Islamic Republic of)

Background: Patients suffer from thalassemia and chronic renal failure on maintenance
hemodialysis; have been exposed to blood-born infections, especially hepatitis C due to long-
term transfusion. Recently, hepatitis C is one of the main health concerns in these patients. The
aim of this study was to determine the prevalence of hepatitis C and related risk factors in
thalassemic and hemodialysis patients in Kerman province of Iran.
Methods: in this cross-sectional we have totally examined 384 patients (203 hemodialysis cases
and 181 thalassemia cases) by RT-PCR in Kerman. The information was obtained by question
are then followed by blood sampled obtaining and RT-PCR. Statistical analysis were done using
t-test and Chi-square methods.
Results: We found that 130 cases out of 384 were infected by HCV. Our finding also showed that
16 cases were female (17%) while we found 114 (83%) cases of infected male patients.
Conclusions: The prevalence of hepatitis C infection is very high in thalassemia and hemodialysis
patients and based on other studies our results showed that the prevalence of HCV infection in
Kerman is more than other provinces of Iran. Hepatitis C in these patients, is more higher in
Kerman province than other provinces of Iran.
Keywords: hepatitis C, thalassemia, hemodialysis patients.
Final abstract number: 67.023
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Molecular Epidemiology of Hepatitis C Virus in Southern China
       1        2          2           2           1           1
Y. Tan , M.Q. Li , Q.H. Wei , L.J. Chen , P.C. Chan , S.S. Lee
1
 Stanley Ho Centre for Emerging Infectious Diseases, Chinese University of Hong Kong, Hong
             2
Kong, China, Liuzhou Centre for Disease Control and Prevention, Liuzhou, Guangxi, , China,
2
 Liuzhou Centre for Disease Control and Prevention, Liuzhou, Guangxi , China

Hepatitis C virus (HCV) infection has become a significant public health problem in Southern
China. Guangxi is one of the provinces hardest hit by the virus. Molecular epidemiology of HCV
infection in injection drug users (IDUs) in Guangxi Province would be important for understanding
the epidemiology and be beneficial for improving prevention and control.
Methods: IDUs were recruited from Liuzhou methadone clinic, Guangxi, Southern China. Blood
samples were collected. HIV and HCV serology was determined. HCV RNA was extracted and
NS5B region was amplified using RT-PCR. HCV genotype was determined by phylogenetic
analysis (MEGA 3.0).
Results: A total of 96 samples yielded adequate PCR product for sequencing and genotyping
(86%). Twenty subjects were HIV/HCV coinfected, and 76 were HCV monoinfected. Overall,
subtype 6a (46%) was predominant, followed by 3a (20%) and 3b (16%). There was no
significant difference in HCV genotype distribution between HIV/HCV coinfection group and HCV
monoinfection group (p>0.05). The genetic distance of genotype 6 between individuals is shorter
than that of other genotypes.
Conclusion: Genotype 6a is the predominant of HCV in IDUs in Southern China. It represents a
relatively recent introduction of the genotype to the region. Because of the needle-sharing in IDUs
in South-eastern Asia and the higher rate of viral mutation, more subtypes may be identified.
Phylogenetic analysis shows the even distribution of HCV sequences in coinfection group and
monoinfection group. This may indicate that HIV and HCV have spread during a relatively short
period.
Final abstract number: 67.024
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Characterisation of Complete Hepatitis B Virus Genomes Isolated from Black Southern Africans
with HBV-associated Hepatocellular Carcinoma
            1          2             2          3
M. Skelton , G. Kimbi , A. Kramvis , M.C. Kew
1                                                                                2
 Division of Medical Virology, University of Cape Town, Cape Town, South Africa, Department of
                                                                               3
Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa, Department of
Medicine, University of Cape Town, Cape Town, South Africa

Hepatitis B virus (HBV) infection is endemic in Africa. As many as 98% of black Africans are
infected during their lives and about 10% (65 million) have chronic HBV infection, which is the
cause of 70-80% of all hepatocellular carcinoma (HCC) cases. Despite this high prevalence of
HBV and the high incidence of HCC in Africa, relatively few complete HBV genomes from African
HCC cases have been deposited in international data bases. In order to gain a clearer
understanding of the role of genetic variants and mutants in the development of HCC, the
complete genomes of HBV isolated from southern African HCC patients were amplified and
molecularly characterized. HBV DNA was extracted from forty HBsAg-positive HCC patients.
Twenty six complete genomes were successfully amplified, cloned and sequenced from nine
HCC patients. Phylogenetic analyses of the complete genomes and the individual open reading
frames of HBV isolates from the HCC patients, led to the classification of all the isolates within
subgenotype A1. No isolates belonging to subgenotype A2 and genotype D were identified even
though these genotypes/subgenotypes have been shown to circulate in South Africa. Seventy-
eight percent of the patients carried HBV strains with the double basic core promoter (BCP)
mutation (1762T/1764A), previously shown to reduce HBeAg expression. All five HBV genomes
isolated from one patient contained novel complex BCP rearrangements, which introduced 2
HNF1 and 1 putative HNF3 transcription factor binding sites. These mutations can enhance viral
replication and simultaneously abolish HBeAg expression at a transcriptional level. The envelope
genes were characterised in a total of 18 HCC patients, the pre-S gene was mutated in 72% of
the patients. Deletions across pre-S1/pre-S2, pre-S2 initiation codon mutations with internal
deletions and S gene nonsense mutations were prevalent. The HBV mutations described in this
study have been associated with increased risk for HCC.
Final abstract number: 67.025
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Seroprevalence of Human Immunodeficiency Virus, Hepatitis B and C Viruses Among Blood
Donors in Chabahar, Iran
           1            2          3         4           4
H. Jabbari , S. Karami , F. Fattahi , S. Jam , M. Mohraz
1
 Center for Environmental Research, Medical Sciences/ University of Tehran, Tehran, Iran
                      2
(Islamic Republic of), Blood Transfusion Center, Chabahar, Iran (Islamic Republic of),
3
 Immunology, Asthma and Allergy Research Institute, Medical Sciences/ University of Tehran,
                                   4
Tehran, Iran (Islamic Republic of), Iranian Research Center for HIV/AIDS, Medical Sciences/
University of Tehran, Tehran, Iran (Islamic Republic of)

Background: Transfusions can be a quick and easy route for the transmission of infectious agents
such as HIV, HBV and HCV. Evaluation of the prevalence among blood donors (BDs) is a
common and easy method to obtain the epidemiology of these infections in a community. We
performed this study to determine HIV, HBV and HCV seroprevalence among BDs in one of the
main commercial ports in Iran.
Methods: The sample included 5409 consecutive donors (17-65 years) who donated blood from
2002 to 2003. HBsAg, anti-HCV and anti-HIV were investigated by ELISA in blood samples. If the
results of ELISA samples were reported to be positive in the HIV and HCV cases, the
confirmation was done with RIBA/Western blot.
Results: Most of BDs were motivated ones with 42%; who donate at regular intervals, 38% were
first-time voluntary and 20% were voluntary donors with the history of at least one donation.
Among BDs, 95.7% were male. The seroprevalence of HBsAg, HCV-Ab and HIV-Ab among BDs
was 2.4%, 3.7% and 1.3% respectively in the first evaluation while 78.1% of positive HCV-Ab and
92.3% of positive HIV-Ab were negative in RIBA (Western blot). The prevalence of HBsAg and
HCV infections among first BDs differ from other donors significantly. Also married persons were
infected with HBV and HCV more than singles.
Conclusion: HIV and hepatitis transmission through blood transfusion is a major concern in
developing countries such as Iran where economic constraints limit blood supply safety. On the
other hand, demand for blood transfusion is high and despite tremendous strides in preventing
viral infection through careful donor screening and viral testing, it is remain the risk transfusion-
transmissible viral diseases.
Final abstract number: 67.026
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Phylogenetic Analysis of a Hepatitis C Virus Nosocomial Outbreak
M.L.C. Panait, A.M. Oprisoreanu, C. Szmal, R. Negrea, I. Codita, G.R. Oprisan
'Cantacuzino' National Institute for Research and Development of Microbiology and Immunology,
Bucharest, Romania

Background: Chronic viral hepatitides, their long-term consequences, the great number of
individuals passed through infection and socio-economic implications represent arguments for
comprehensive studying of these diseases. Hepatitis C virus (HCV) infection is endemic all over
the world, its prevalence varying between 0.5% and 5%. HCV genotype and viral load affect
treatment response. HCV genome is conserved among genotypes but the variability of the virus
variants allows tracing infections by sequence analysis. In order to evaluate the nosocomial
transmission of HCV infection in a urology clinic, a phylogenetic analysis of HCV strains was
performed in the core genomic region.
Methods: Using COBAS CORE II ELISA technique for detecting anti-HCV antibodies we tested
ten sera prelevated from a urology clinic. We performed COBAS AMPLICOR HCV MONITORTM
test in the positive sera for the viral load. We found a significant viral load in seven cases, which
were submitted to Neighbor-Joining phylogenetic analysis and interpreted with MEGA 3 Program.
The phylogenetic analysis, based on the HCV core region, was realized by comparing the
amplified sequences from the four sera with other Romanian sequences from genotype 1b strains
and with other different geographic genotypes' sequences, selected from data bases.
Results: We found a strong recent epidemiological link for three genotype 1b strains, which form
a group, the genetic distance between them being very short (0.004-0.007). The other HCV
strains served as controls and manifested different lineage degrees between themselves or
compared with other analyzed strains.
Conclusion: This study confirmed the strong relationship between three HCV strains and the
nosocomial transmission of the infection. Phylogenetic analysis in the core region represents a
useful tool for tracing infections and routes of viral transmission.
Final abstract number: 67.027
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Molecular Epidemiology of HCV Genotypes in Injecting Drug Users in Hong Kong
K. Lee, D. Chan, S.S. Lee
Stanley Ho Centre for Emerging Infectious Diseases, Chinese University of Hong Kong, Hong
Kong, China

Background: Previous studies have shown that both genotypes 1b and 6a HCV were common
among injecting drug users (IDU) in Hong Kong, but absence of subjects characteristics make
further understanding of the molecular epidemiology difficult. We earlier reported a high
prevalence of 85% of HCV in local IDUs. The present analysis was subsequently conducted to
characterize the HCV genotypes of these anti-HCV positive cases; and to identify any
relationships with injecting behaviours.
Methods: A community-based HCV survey was conducted in methadone clinics in Hong Kong in
2006. Only injectors were included. Demographics and drug use pattern were collected through a
questionnaire survey. Blood were collected for anti-HCV tests. RT PCR on NS5B region was then
performed for anti-HCV positive cases.
Results: Serums of 393 anti-HCV positive IDU were available for genotyping. About 70% (273)
were HCV RNA positive; the rate is higher in male (78%) than female (48%). Altogether the
commonest genotype was 6a (143, 52%), followed by 1b (104, 38%) and 3a (13, 5%). Genotypes
2a, 3b, 6h were also detected. Genotype 1b became less common among those started injection
more recently and those reported to have continued sharing injecting equipments in the last
decade. A trend for greater diversity was observed. There is no discernable difference noted in
genotype distribution regarding injections history in various parts of China and Hong Kong (Table
1).
Discussion: Both subtype 1b and 6a have been circulating among IDU in Hong Kong in the 60s
and 70s. In subsequent decades genotype 1b has become less dominant while genotype 3a is
getting more common especially among the younger injectors, an observation similarly reported
in China and elsewhere during growth of IDU epidemic in the 80s. These sequences will be
valuable for evolutionary analysis supporting the identification of ancestry of the currently
identified genotypes.
Final abstract number: 67.028
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

The Role of Predicitve Factors Over Virological Response in Patients with Chronic Hepatitis C
Treated with Pegylated Interferon alfa 2a
M. Gaseva, L.J. Ivanovski, C. Evtimovska, V. Grunevska, B. Tosevski, M. Dimzova
Clinic for Infectious Diseases and Febrile Conditions, University 'St Cyril and Methodius', Skopje,
Former Yugoslav Republic of Macedonia

Background: The introduction of pegylated interferon alfa 2a with ribavirin in therapy of chronic
hepatitis C (CHC) has increased the sustained virological response (SVR) defined as
undetectable HCV RNA six months post treatment. SVR depends on virus (genotype, viral load)
and patient associated factors (age, sex, obesities, cirrhosis).
Aim: To evaluate the role of predictive factors: genotype, viral load and demographic
characteristic, age and sex, over SVR in patients with CHC.
Material and Methods: 75 patients with histological confirmed CHC, positive anti HCV and HCV
RNA, were treated at the Clinic for Infectious Diseases. 53 males and 22 females from 20 to 66
years of age were divided into two groups: under vs. above 40 years (55 vs. 20 patients). 41
patients were with genotype 1 and 33 non-1 genotype (2 genotype 2, 32 genotype 3).
Quantitative PCR (Roche Amplicor HCV Test v 2,0) during the screening protocol quantified the
HCV RNA level over vs. below 600.000 IU/ml (36 HLV, 39 LVL) Qualitative PCR was performed 6
months after therapy. Patients received peginterferon alfa-2a (40KD) 180 g/weekly and ribavirin
800/1000/1200 mg/d according to genotype.
Results: The overall SVR rate in treated group was 80,0% (60/75). SVR in patients with genotype
1 was 70,7% (29/41) and in non-1 genotype 91,2% (31/34) (p = 0,028). SVR in patients with HVL
was 83,3% (30/36) and 84,6% (33/39) with LVL (p = 0,880). 43/53 (81,1%) male patients and
17/22 (77,3%) female patients had SVR (p = 0,704). In young group SVR was 89,0% (49/55) and
in older than 40 years 55,0%. (11/20) (p = 0,001).
Conclusion: The efficacy of pegylated interferon alfa 2a and ribavirin in therapy of CHC was
confirmed in our patients as well. Significantly higher SVR rates were obtained in non-1 genotype
patients and in younger population group, regardless of the sex. Patients infected with genotype 1
and older patients require individual approach and specific evaluation concerning the rapid and
early virological response.
Final abstract number: 67.029
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

The Study on the Characters of HBV-specific T Cells and Liver Damage between HBeAg(+) and
HBeAg(-) CHB Patients
         1       2         2         2          3         2
G. Peng , W. Wu , X. Tan , Z. Sun , Y. Chen , Z. Chen
1
 National Key Laboratory of Infectious Diseases, Institute of Infectious Diseases, First Affiliated
                                                                      2
Hospital, Medical college, Zhejiang University, Hangzhou, China, National Key Laboratory of
Infectious Diseases, Institute of Infectious Diseases, First Affiliated Hospital, Zhejiang University,
                   3
Hangzhou, China, Institute of Immunology,Zhejiang University, Hangzhou, China

Aims: To study the quantity and quality of HBV-specific T cells in chronic hepatitis B (CHB)
patients with different HBeAg status, and to investigate the extent of liver damage between
HBeAg(+) and HBeAg(-) CHB patients.
Methods: A total of 103 CHB patients were selected and divided into two groups according to the
HBeAg status. The serum HBV markers, liver damage (necroinflammation gradation) were
analyzed. The frequency and Foxp3 expression of CD4+CD25+ regulatory T cells (Treg), the
HBV-pentamer(+) T cell frequency and the expression levels of PD-1, CTLA-4 on HBV-specific T
cells were measured. HBV antigens specific T-cell responses including cellular proliferation and
IFN- g production, with or without anti-PD-1 mAb and/or anti-CTLA-4 mAb blocking, were also
tested in vitro.
Results: The demographic characters, serum ALT levels, the frequency and Foxp3 expression of
Treg were similar between HBeAg(+) and HBeAg(-) patients, and the serum HBV DNA levels
were higher in HBeAg(+) patients (P <0.05). The liver necroinflammation was comparatively
severe in HBeAg(-) patients (P =0.052), while the median percentage of liver cirrhosis was much
higher in HBeAg(+) patients (P <0.05). The difference of HBV-specific T-cell frequency was not
significant between HBeAg(+) and HBeAg(-) patients, whereas the expression levels of PD-1 and
CTLA-4 on HBV-pentamer(+) T cells were significantly higher in HBeAg(+) patients (P both
<0.05). Combined using of anti-PD-1 and anti-CTLA-4 mAb could significantly increase the
cellular proliferation in either HBeAg(+) or HBeAg(-) patients, and markedly enhanced the IFN-g
production in HBeAg(+) patients.
Conclusion: The persistency of HBeAg could induce higher expression of PD-1 and CTLA-4 on
the HBV-specific T cells, which may associate with the low ability of HBV-specific T-cell
responses, high serum HBV DNA levels and high percentage of liver cirrhosis in HBeAg(+) CHB
patients.
Final abstract number: 67.030
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Clinical and Virological Features and Course of Acute Hepatitis B (AHB) in Italy
           1            1             2        3              4                5             5
E. Spada , M.E. Tosti , L. Romanò , C. Galli , A. Mariano , L. Germagnoli , F. Dorigatti ,
             5            2         1
M. Marinelli , A. Zanetti , A. Mele
1                                          2
 Istituto Superiore di Sanità, Roma, Italy, Istituto di Virologia, Università di Milano, Milano, Italy,
3                                  4
 Abbott Diagnostici, Roma, Italy, Istituto Nazionale di Malattie Infettive - Spallanzani, Roma, Italy,
5
 Diagnostica e Ricerca San Raffaele S.p.A., Milano, Italy

Background/aims: In order to define the clinical, serological and virological aspects, including viral
genotypes and mutations, of acute hepatitis B virus infection (AHB) a prospective study has been
carried out in Italy.
Methods: AHB cases referred to 17 hospitals were recruited over 1 year and followed-up for 6
months. Biochemical and virological assessments were done 7, 15, 30 days after disease onset,
and then at 3-month interval.
Results: Overall, 111 patients were enrolled. All patients were IgM anti-HBc+, 108 were HBsAg+
and 70 of the 72 patients tested for HBV-DNA were positive.
A preliminary analysis was performed on 99 of 111 cases: 21 were followed-up for>6 months, 25
for 3-6 months, 53 for 6 months (95.2%).
HBV-DNA negativization occurred after HBsAg negativization, but after a 6-month follow-up
results on HBsAg and HBV-DNA were concordant.
The frequency of HBV genotype in 49 patients was: genotype D, 59.2%; genotype A, 36.7%;
genotype F, 4.1%. Core/pre-core mutants, detected in 21of 34 patients examined (61.8%), were
more frequent in genotype D infection.
Conclusion. The frequent detection of anti-HBe+ and anti-HBe/HBeAg+ patients in the early
disease phase, as well as the long-lasting persistence of IgM anti-HBc, represents novel findings
in the field of AHB. The correlation between HBsAg and HBV-DNA makes HBsAg a useful marker
of virus clearance. Genotype distribution and core/per-core mutations frequency confirm previous
findings.
Final abstract number: 67.031
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Incidence, Risk Factors and Control of Hepatitis A in Italy
M.E. Tosti, E. Spada, A. Mele
Istituto Superiore di Sanità, Rome, Italy

Introduction: Improvements in hygiene and sanitation standards have determined a dramatic
decrease in HAV circulation in Italy. HAV exposure is now less common during childhood, while a
growing number of susceptible young adults has developed. Using data of the Italian surveillance
system of acute hepatitis (SEIEVA), we evaluated the incidence of and risk factors for acute
hepatitis A (AHA).
Methods: We performed a case-control study within a population-based surveillance for acute
viral hepatitis. AHA incidence was estimated since 1991; the association with considered risk
factors was analysed during 2001-2006, using cases of acute hepatitis B (AHB) as controls.
Results: The incidence declined from 4/100,000 in 1991 to 1.4/100,000 in 2006, peaking during
1996-97 due to an outbreak in South Italy. The incidence was higher in persons aged 15-24
years. The lethality was 2.9/10,000. During the period 1991-2006 82 cases were notified among
vaccinated subjects: 95% of these HAV cases received vaccine within 1 months from the onset.
Contact with individuals with AHA (ORadj=3.8; 95%CI 2.7-5.5) travelling to endemic areas
(ORadj=3.1; 95%CI=2.6-3-8) ingestion of raw shellfish (ORadj=1.8; 95%CI=1.6-2.1) and
cohabitation with a day-care child (ORadj=1.3; 95%CI=1.01-1.7) were the most important risk
factors. In 2003 intravenous drug use caused an outbreak, with high lethality in a central Italian
town. In this analysis, male homosexuality was not associated with AHA, while a weak
association was found by using acute hepatitis C cases as controls (ORadj=1.44 CI,
95%CI=1.06-1.95).
Discussion: HAV infections is nowadays more frequent in adults, in which the disease is more
severe. Travel in endemic areas and contact with AHA cases are the most important risk factors,
while shellfish consumption has become a less frequent way for acquiring AHA. Vaccination of
individuals at increased risk of infection combined with surveillance of retail outlet of shellfish are
efficient control measures.
Final abstract number: 67.032
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Risk of Parenteral Transmitted Hepatitis Following Exposure to Invasive Procedures (IP): Results
from the Hepatitis Surveillance System in Italy
E. Spada, M.E. Tosti, A. Mele
Istituto Superiore di Sanità, Rome, Italy

Background and aims: Invasive procedures (IP) are frequently reported risk factor for both acute
hepatitis B (AHB) and C (AHC). We estimated the association between parenteral viral hepatitis
and specific types of IP.
Methods: Data from the surveillance for acute viral hepatitis during 2000-2006 were used. The
association of AHB and AHC with different IP was estimated comparing 3,506 AHB and 769 AHC
cases with 4,874 hepatitis A cases, used as controls.
Results: For AHC, the strongest associations were with urological [Adjusted Odd Ratio
(ORadj,17.5; Cinfidence Interval (CI), 1.6-187.1), neurological (ORad, 16.2, CI, 2.7-97.7), and
minor surgery (ORad,10.9; CI,3.6-32.6). A lower but significant risk (from 3,7 to 4,7 times higher
respect to no intervention) was found for oral surgery, Gynaecological, cardiovascular, abdominal
interventions and for biopsy or endoscopy. Only minor (ORad,3.0; CI, 1.3-7.1), oral (ORad, 2.6;
CI,1.5-4.6) and dermatological surgery (ORad, 2.9; CI, 1.1-7.5) were associated with AHB instead
(Table), instead.
Conclusion: Although AHB and AHC incidences are declining, IP still represent important risk
factors. The differences in risk estimation between AHB and AHC is likely due to the higher HCV
prevalence in the general population; admitting a person-to-person transmission by breaks in
universal precautions, the larger pool of subjects infected with HCV than HBV makes more likely
the exposure to HCV. The increasing proportion of HBV-immunized young adults and vaccination
of high risk groups, further explain these differences. The high risk found for minor surgery, might
suggest that healthcare providers underrate the risk connected with this procedure. Since a lot of
people is exposed to IP and an effective HCV vaccine is not yet available, these findings
underscore the importance of implementing non-immunologic preventive measures to control
iatrogenic HBV and HCV transmission.
Final abstract number: 67.033
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Evaluation of Early Predictors of Successful Therapy in HCV Infected Patients from Romania
            1                2          2
C. Sultana , L. Manolescu , S. Ruta
1                                                           2
 'St. S. Nicolau' Institute of Virology, Bucharest, Romania, 'Carol Davila' University of medicine
and Pharmacy, Bucharest, Romania

Background. The ability to predict a favorable outcome of treatment is a major issue in the
management of hepatitis C. Based on results of the viral kinetics studies, which indicated a two-
phase reduction in HCV RNA levels after IFN treatment initiation, with the first one appearing to
be predictive of response, we monitored the utility of the rapid virological response (RVR),
defined as undetectable HCV RNA at week 4.
Methods: Samples from 38 patients (all females, mean age 48,4+/- 5 ys) with chronic hepatitis C,
but without signs of cirrhosis, were tested for HCV viral load by quantitative Rt- PCR (COBAS
Amplicor HCV Monitor, Roche Diagnostics) before initiation of treatment with PEG-IFN-alpha-2a
(180 mcg/week) in combination with ribavirin (800 mg/day) for 48 weeks, at week 4 and at 6
month after the completion of therapy. Genotyping was performed using a commercial Line Probe
Assay (Innogenetics).
Results: All patients had high baseline viral load (>700 0000 IU/ml) and were infected with
genotype 1b. Despite these negative predictors for treatment success, 21 patients (75%)
achieved a sustained virologic response (SVR)- undetectable viral load at 6 month after
discontinuation of treatment. At week 4 after treatment initiation, 18 patients (64%) had
undetectable viral load HCV. Out of these rapid responders 17 (95%) achieved a SVR and only
relapsed at 6 month.By contrast, only 4 patients (36.4%) with HCV RNA 600 IU/ml at week-4
achieved an SVR.
Conclusion: The RVR may be a useful indicator for the duration and long term outcome of
treatment among patients with chronic HCV infection, even in countries like Romania, where
genotype 1b is the most common. Lack of RVR can justify discontinuation of therapy, with
important reduction in associated costs and adverse effects, while a good response at week 4
indicates a low risk of relapses, even in the presence of a less-sensitive genotype.
Final abstract number: 67.034
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Genotyping and Viral Load Measurements in Patients with Major Thalassemia and Positive
Hepatitis C Virus Antibody in Mazandaran Province, Iran
                    1               1                    2          1
F. Babamahmoodi , M. Kosarian , A.R. Babamahmmodi , M. Adnani
1                                                                           2
 Mazandaran University of Medical Science, Sari, Iran (Islamic Republic of), Narges Clinic
Shariati Street, Tehran, Iran (Islamic Republic of)

Introduction: Hepatitis C virus (HCV) infection has reached epidemic proportions. Worldwide,
more than one million new cases of infection are reported annually, and HCV is believed to be
more prevalent than hepatitis B virus infection and 80 % of the affected will be chronically infected
and are at risk of serious chronic sequel including cirrhosis and hepatocellolar carcinoma.
Genotyping of HCV is becoming increasingly important for clinical management of chronic
infection and as an epidemiological marker. At least six major genotypes of HCV, each
comprising multiple subtypes, have been identified. Substantial regional differences appear to
exist in the distribution of genotypes. Although HCV genotypes 1, 2, and 3 appear to have a
worldwide distribution, their relative prevalence varies from one geographic area to another.
subtypes 1a and 1b in the United States and Europe, In Japan, subtype 1b, in northern Italy
Subtype 2c, Genotype 4 in North Africa and the Middle East, genotypes 5 and 6 in South Africa
and Hong Kong are the most common genotypes. Genotypes 7, 8, and 9 have been identified
only in Vietnamese patients, and genotypes 10 and 11 were identified in patients from Indonesia.
We conducted this study to detect the most common genotype in major thalassaemics patients.
Methods and materials: We enrolled 52 patients of HCV positive in a cross-sectional study. we
used ELISA, Restrictive-Fragment length polymorphism analysis and PCR methods.
Result: 51.9% were men and 48.1% women. The mean age (±SD) was 22± 4.48. Genotype 1a
was the most common type (53%) after that 3a (42%) and 1b (5%).average of viral load in
patients with 1a genotype was 363501.1 and in patients with 3a was 346621.3 that shows no
significant difference.
Conclusion: The most common genotype was 1a that it was accordant to studies that conducted
in general population in Iran.
Final abstract number: 67.035
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Silibinin May Abolish the Enhanced Expression of Fibrosis-Related Molecules Cause by Hepatitis
C Virus E2 Protein
            1           2            1           3
M.J. Hsieh , T.Y. Chen , Y.S. Hsieh , H.L. Chiou
1
 Institute of Biochemistry and Biotechnology, Chung Shan Medical University , Taichung, Taiwan,
2                                                                                    3
 Department of Internal Medicine, Chung Shan Medical University , Taichung, Taiwan, School of
Medical Laboratory and Biotechnology, Chung Shan Medical University , Taichung, Taiwan

Background: Chronic infection of hepatitis C virus (HCV) may lead to hepatic fibrosis and the
precise mechanisms remain unclear. Our previous study indicated that E2 protein may involve in
the hepatic fibrogenesis via an up-regulation of fibrosis-related proteins.
Methods: To further confirm this finding, E2 gene silencing and a treatment with silibinin was
conducted on E2-expressing cells and RT-PCR analysis was performed.
Results: E2-enhanced expression of fibrosis-related molecules, including alpha-SMA, collagen
alpha(I), TGF-b1, connective tissue growth factor (CTGF), IL-6 and IL-1b, MMP-2, were all
abolished by a treatment with siRNA specific for E2. Furthermore, a treatment with silibinin, a
potent antioxidant, was conducted to gain similar results.
Conclusion: These results further prove that E2 protein may involve in the process of hepatic
fibrogenesis and E2-related fibrosis may be, at least in part, through an oxidative damage-related
pathway.
Final abstract number: 67.036
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

TGF-Beta1 Down-Regulates NKG2D Killer Activator Receptor Expression on Peripheral Blood
Cytotoxic Cells in Patients with Chronic Hepatitis C
      1         1         2             2              3            3           4            5
G. Par , A. Par , T. Berki , L. Palinkas , L. Szereday , J. Szekeres , A. Miseta , G. Heged s ,
            1
B. Hunyady
1                                                                   2
 University of Pecs First Department of Medicine, Pecs, Hungary, University of Pecs Department
                                                     3
of Immunology and Biotechnology, Pecs, Hungary, University of Pecs Department of
                                 4                                                        5
Microbiology , Pecs, Hungary, University of Pecs Laboratory Medicine, Pecs, Hungary, Baranya
County Hospital, Department of Pathology, Pecs, Hungary

Introduction: Impaired natural killer (NK) cell activity contributes to viral persistence in HCV
infection. Recent studies demonstrated that in tumors regulatory T cells (Treg) - via secreting
TGF-beta1 - down-regulate NKG2D killer activator receptor and are responsible for poor NK
cytoxicity. Since in chronic hepatitis C plasma TGF-beta1 level is increased, we analyzed the
expression of NKG2D on NK and T cells and its correlation with the percentage of Treg cells and
TGF-beta1 levels.
Methods: The peripheral CD4+CD25high+ Treg cells, NKG2D+ NK and T cells were determined
by FACS, plasma TGF-beta1 levels by ELISA. Forty three patients with active chronic hepatitis C,
10 sustained virological responders (SVR) and 15 healthy controls were enrolled.
Results: In patients with chronic hepatitis C the NKG2D expression was down-regulated both on
NK (7,9 vs. 20,9%) and T cells (18 vs. 26,3%) compared to controls. Impaired expression of
NKG2D was associated with increased proportion of CD4+CD25high+ Treg cells (4,6 vs.3,1%)
and increased TGF-beta1 levels (15 vs.9 pg/ml) compared to controls. TGF-beta1 inversely
correlated with NKG2D expression on NK cells. In SVR group, the percentage of Treg cells
(1,7+/-0,2%), TGF-beta1 levels (11,6 pg/ml) and NKG2D expression (NK:17%, T:20,9%) were
comparable to controls
Discussion/Conclusion: Our data suggest that TGF-beta1 - secreted by regulatory T cells - may
be responsible for impaired NK cell function via down-regulating NKG2D. Thus, TGF-beta1
antagonism or soluble NKG2D ligands may provide the basis of a novel immunotherapy to
improve the function of NK and T cells in chronic hepatitis C.
Final abstract number: 67.037
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Seven-Year Experiences on Antiviral Treatment for Chronic Viral B and C Hepatitis in Hungary -
A Nation-Wide Study
       1          2           3
A. Par , I. Tornai , F. Szalay , Hungarian Viral Hepatitis Treatment Study Group
1                                                                   2
 First Department of Medicine, University of Pecs, Pecs, Hungary, Second Department of
                                                          3
Medicine, University of Debrecen, Debrecen, Hungary, First Department of Medicine,
Semmelweis University, Budapest, Hungary

Objective: A nation-wide retrospective analysis has been performed in order to assess the
efficacy of antiviral therapy for patients with chronic hepatitis B and C representing the entire
population that needed treatment in Hungary, during a seven-year period. In addition, results of a
prospective study including patients with chronic hepatitis C are also presented.
Patients and Methods: Of 220 patients with hepatitis B, 112 were treated with standard interferon-
alpha (IFN), 23 with pegylated interferon-alpha-2a (PEG-IFN) and 85 with lamivudine (LAM), and
the ratio of HBeAg seroconversion and/or undetectable HBV-DNA has been assessed. Of 2442
patients with hepatitis C, 333 were treated with IFN monotherapy, 1122 with IFN + ribavirin (RBV)
and 987 with PEG-IFN + RBV for 6 - 12 months. In the prospective study, 69 patients with chronic
hepatitis C were enrolled and treated with PEG-IFN alfa-2a + RBV. The rate of sustained
virological response (SV), the predictors of outcome and the adverse effects of treatment were
evaluated.
Results: For HBV patients IFN, PEG-IFN and LAM provided 31, 30, and 33% SVR rate,
respectively. In chronic hepatitis C, a continuous improvement was noted in sustained virological
response, from 13% with IFN monotherapy to 31% with PEG-IFN + RBV, while even a 48%
sustained virological response has been achieved in the prospective trial. The predictors of
outcome were the 4-week 'rapid' and 12-week 'early' virological responses, female gender, age,
BMI and adherence. The most frequent complications of the treatment were cytopenia,
haemolysis and depression, occurring in 9% of patients.
Conclusion: Unlike in HBV infection, in HCV hepatitis the efficacy of antiviral treatment has
gradually improved in our everyday clinical practice. To manage the growing populations of hard-
to-treat patients with chronic viral hepatitis, there is a need for more effective treatment
modalities, including optimised, individualised dosing and novel antiviral agents.
Final abstract number: 67.038
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

PEG-IFN Plus Ribavirin Treatment Down-Regulates Serum Fibrosis Markers Independently of
Virological Response in Chronic Hepatitis C
       1       1          2            2          3            4            5            5
A. Par , G. Par , T. Berki , P. Balogh , A. Miseta , G. Heged s , B. Hunyady , A. Vincze
1                                                                    2
 First Department of Medicine, Univeristy of Pecs, Pecs, Hungary, Department of Immunology
                                                         3
and Biotechnology, Univeristy of Pecs, Pecs, Hungary, Department of Laboratory Medicine,
                                     4
Univeristy of Pecs, Pecs, Hungary, Department of Pathology, Baranya County Hospital, Pecs,
          5
Hungary, First Department of Medicine, University of Pecs, Pecs, Hungary

Aims: Since in the outcome of chronic hepatitis C virus (HCV) infection the progression of hepatic
fibrosis is essential, and interferon (IFN) treatment is supposed to inhibit fibrogenesis, we wanted
to compare changes in three non-invasive fibrosis markers in chronic HCV hepatitis.
Methods: Plasma levels of TGF-beta1 and hyaluronic acid (HA) were determined by ELISA,
procollagen-III-peptide (P-III-P) levels by RIA in 49 patients with chronic hepatitis C before the
antiviral treatment and 1, 3, 6 and 12 months thereafter. Twenty two patients became responders
(R), 27 patients were non-responders (NR). Thirty healthy controls were also studied. Correlation
between TGF-beta1, HA, P-III-P levels and the histological activity and the fibrosis score in liver
biopsy was evaluated.
Results: Pretreatment plasma TGF-beta1, HA and P-III-P levels were significantly (p<0,01)
increased in both responder and non-responder patients compared to controls. HA levels
correlated with fibrosis score, TGF-beta1 with histological activity index. PEG-IFN + ribavirin
treatment decreased both TGF-beta1 and HA levels, not only in responders but also in non-
responders. The reduction of fibrosis marker levels was more considerable after 6 months of
antiviral therapy, and remained sustained even 6 months after the treatment. No correlation was
found betwen fibrosis markers and HCV RNA levels.
Conclusion: PEG-IFN plus Ribavirin treatment decreased TGF-beta1 and hyaluronic acid levels
independently of virological response. These data suggest that antiviral treatment may have
antifibrotic effect even in virological non-responders.
Final abstract number: 67.039
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Influence of Occult HBV Infection on Chronic Hepatitis C
M. Inglot, A. Szymczak, W. Rymer
Clinic of Infectious Diseases Wroclaw's Medical University, Wroclaw, Poland

Infections with HBV and HCV are the most common cause of chronic hepatitis and their
consequence may be liver cirrhosis and/or hepatocellular carcinoma. Co-infection with these
viruses is relatively common and it remains serious epidemiological and clinical problem.
Objective: Evaluation of impact of co-infection with HBV and HCV on clinical picture of chronic
hepatitis.
Material and Methods: retrospective analysis of 238 patients among 1330 patients hospitalized in
years 2001-2005 in Department of Infectious Diseases in Wroclaw due to diagnostics of chronic
hepatitis C. Patients were divided into groups according to their serological status: group A - anti-
HCV positive, anti-HBc negative patients (n=123), group B - anti-HCV positive, anti-HBc positive,
HBsAg negative patients (n=115). Groups A and B were randomly selected according to age,
sex, duration of HCV infection. Some biochemical features, histological pattern (modified HAI
scale) and virological status were evaluated. Dates were statistical analyzed by chi-square Wald
test.
                                                          6                              6
Results: Median value of viral load in group A was 1,4x10 and in group B was 1,0x10 (p>0,05).
There were no statistical correlation of GOT, GPT, GGTP and PLT values in these two groups.
Grading in group A was 1,64 and in group B was 1,62 (p>0,5). Relevant differences in fibrosis
stage was observed between the groups - staging in group A was 1,87 and in group B 1,37 (p
<0,05)).
Conclusions: Past HBV infection and possible minireplication has no impact on HCV viremia.
Fibrosis of the liver was surprisingly higher in HCV monoinfection patients.
Further investigation in large and homogenous groups of patients are needed.
Final abstract number: 67.040
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Evolution of Interferon Therapy Resistance in Hepatitis C Virus
            1            2                 1            2
P.J. Planet , P.S. Pang , S.O. Kolokotronis , J.S. Glenn
1                                                            2
 American Museum of Natural History, New York, NY, USA, Stanford University Hospital and
Clinics, Palo Alto, CA, USA

Background: Current therapy for HCV consists of a combination of synthetically-modified
interferon, pegylated interferon, and ribavirin, to which nearly 50% of patients do not respond.
Clinical trials have demonstrated that this clinical response rate is genotype specific in chronic
infections, even after accounting for host factors such as sex, age, degree of fibrosis and
ethnicity. The difference in clinical response rates among HCV genotypes has yet to be
explained. Because HCV genotypes likely diverged hundreds of years ago, viral elements that
confer clinical resistance would be relatively ancient and subsequently conserved by natural
selection.
Methods: We used the full-length genome sequences of all 346 full-length HCV genomic
sequences to perform a comprehensive, rigorous phylogenetic analysis using distance, maximum
likelihood and parsimony-based optimality criteria. We then used the robust phylogeny as a
template for mapping clinical resistance data and inferring an evolutionary pattern of genotype
specific change. In addition, we used character reconstruction methods to infer sequence
changes that correlate with changing resistance. We also applied population genetic methods to
infer the relative ages of HCV genotypes for comparison with our phylogenetic methods.
Results: The phylogeny that resulted from our analyses, depicting the evolutionary history of HCV
and the relative branching order of each of the major genotypes, shows a trend toward increasing
interferon resistance as each new genotype diverged from a common ancestral lineage. We
identified several key amino acid residues that may be responsible for increasing interferon
therapy resistance.
Conclusion: Our results suggest that the branching age of each genotype is predictive of the
relative rates of response to therapy. The apparent paradox of how the modern therapy of
interferon injections could select for an ancient, adaptive trait, may be explained by ancient
selective pressure from natural innate immune systems.
Final abstract number: 67.041
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Prevalence of Hepatitis G Virus Among Chronic Liver Disease Patients and Voluntary Blood
Donors in Kerala, India
R. Rajan, V. Balakrishnan, E.M. Elango
Amrita Institute of Medical Sciences and Research Centre, Kochi, India

Background: The role of Hepatitis G Virus (HGV) in the pathogenesis of chronic liver disease has
long been debated. HGV positivity has been reported at varying rates from around the world;
however, there is insufficient data regarding co-infection status and prevalence in our part of the
world. Hence, the primary objective of this study was to determine the prevalence of HGV among
chronic liver disease (CLD) patients and apparently healthy voluntary blood donors in Kerala. The
secondary objective was to evaluate the co-infection status of HGV along with HBV and/ or HCV.
Methods: The study group consisted of 60 serum samples of which 26 were from patients with
chronic liver disease and 34 from healthy voluntary blood donors. Viral RNA isolated from the
serum samples was amplified and tested for HGV by nested RT-PCR using primers. The positive
samples were subjected to RFLP analysis and sequencing of amplicons to confirm the presence
of HGV RNA. The HBV/HCV positivity of all samples were collected and compared with HGV
RNA positivity to establish co-infection status. Results: Out of 60 samples studied, 28 (46.7%)
were positive for HGV RNA. Between the study groups, CLD patients exhibited higher prevalence
(50%) compared to the voluntary blood donors (44%). Co-infection of HGV with HBV/HCV was
more among the CLD patients (61.5%) as compared to voluntary blood donors (36.3%) whereas
isolated HGV infection was more common in the voluntary blood donor group (58.3%) as
compared to CLD patients (38.4%). Among the CLD patients, HGV positivity was observed in
71.4% of the HCV positive samples compared to 50% of the HBV positive samples. Conclusion:
Our study reports a higher incidence of HGV RNA positivity among both CLD patients and
voluntary blood donors in Kerala as compared to reports from other parts of India. The study also
reflects a higher incidence of HGV co-infection with HCV/ HBV among the CLD patients as
compared to a higher rate of isolated HGV infection among apparently healthy voluntary blood
donors. These observations probably point to a role for HGV in increasing the risk for chronic liver
disease as a co-infection though it may not be a causative agent on its own.
Final abstract number: 67.042
Session: Viral Hepatitis (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Hepatitis C Virus E2 Protein May Enhance the Expression of Fibrosis-Related Molecules of
Hepatic Stellate Cells
             1           2           3           3
M.J. Hsieh , T.Y. Chen , Y.S. Hsieh , H.L. Chiou
1
 Institute of Biochemistry and Biotechnology, Chung Shan Medical University , Taichung, Taiwan,
2                                                                                 3
 Institute of Internal Medicine, Chung Shan Medical University , Taichung, Taiwan, Institute of
Bic, Chung Shan Medical University , Taichung, Taiwan

Background and aim: Chronic infection of hepatitis C virus (HCV) may lead to hepatic fibrosis and
the precise mechanisms remain unclear. Methods: In this study, hepatic stellate cells (HSC) were
transiently transfected with a HCV E2-expression vector and subjected to semi-quantitative RT-
PCR and western blotting to see the impact of E2 protein on the expression levels of certain
molecules involved in fibrogenesis. Results: The expression of E2 protein may promote the
expression of alpha-smooth muscle actin, and collagen alpha(I) in a time-dependent fashion.
Furthermore, mRNA levels of several pro-fibrosis or pro-inflammatory cytokines, including TGF-
b1, connective tissue growth factor (CTGF), IL-6 and IL-1b, were significantly increased in E2
transfected-HSC cell lines, while the protein level and activity of MMP-s are also considerably
increased. Conclusion: Taken together, E2 protein may involve in the hepatic fibrogenesis via an
up-regulation of fibrosis-related proteins.
Final abstract number: 68.001
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Impact of a Community-Based Hand Hygiene and Safe Water Campaign on Knowledge and
Practices of Caregivers, Fayoum Governorate, Egypt, 2006
                1            1         2             3            1
W. El-Shoubary , A. Lohiniva , M. Saied , N. El-Sayed , M. Talaat
1                                                                   2
 U. S. Naval Medical Research Unit No. 3 (NAMRU-3), Cairo, Egypt, Fayoum Health Directorate,
                3
Fayoum, Egypt, Ministry of Health and Population (MOHP), Cairo, Egypt

Background: Typhoid fever remains a serious public health problem in Egypt. In Fayoum
governorate, where the annual incidence is 0.1%, population-based studies showed that unsafe
water storage and lack of hygienic practices are risk factors for infection. To reduce transmission,
a community-based intervention campaign was implemented in 12 randomly selected villages in
Fayoum to promote safe water storage and hand hygiene practices. The campaign included
personal communications, village-wide meetings, and distribution of educational materials. The
objective was to measure the impact of the campaign on the knowledge and behavior of
caregivers in the household.
Methods: Two separate random samples of households were chosen and surveyed before and
after the community intervention. Caregivers within the selected households were interviewed in
each targeted village. Data was collected on knowledge of typhoid fever symptoms, methods of
prevention and proper management of illness. Household water storage and hand hygiene
practices were observed.
Results: We interviewed 942 caregivers at baseline and conducted a final evaluation of 764
caregivers in the same villages. In the pre-intervention survey, 36% of caregivers reported proper
knowledge of symptoms and management of typhoid compared to 94% following the intervention
(P<0.0001). Similarly, the proportion of caregivers who demonstrated proper hand washing
technique increased from 2 % to 42% (P<0.0001). The proportion of caregivers who stored water
safely increased from 3% to 19% (P<0.0001).
Final abstract number: 68.002
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Seroprevalence of Blood-Borne Infections Among Blood Donors in Venezuela, 2001-2002
             1                        2
J.A. Benitez , A.J. Rodriguez-Morales
1                                       2
 Ministry of Health, Maracay, Venezuela, Universidad de Los Andes, Trujillo, Venezuela

Background: From the data collected at the Ministry of Health from whole nation public and
private blood banks (BB) find out the proportion of blood units discarded for being seropositive
HBV, HCV, HIV, syphilis and Trypanosoma cruzi, and the seroprevalence of these infections
among their donors.
Methods: ELISA serological testing was done with 715, 393 donors seen at 535 blood banks
between 2001 and 2002. Samples that were repeat reactive (RR) with the ELISA underwent
supplementary Western blot (WB) testing.
Results: Of the 715, 393 blood banks donors, 9,294 of them (1.3%) were positive for syphilis
(VDRL), 6,107 (0.85%) for HBV (anti-HBc), 4,825 (0,67%) for T. cruzi, 3,859 (0.54%) for HCV and
1, 870 (0.26%) for HIV. In the Figure a summary of the seroprevalence of these infections, among
public and private blood banks, per year, is presented.
Conclusion: Although syphilis or Treponema pallidum infection was the most important blood-
borne disease found in this study, the seroprevalence found is lower than others reported in other
countries in the region (e.g. Goiânia, Brazil, 1989, 4.1%). For HBV and HCV, the seroprevalence
estimates were also similar than those found in other countries in the region (such as Río de
Janeiro, Brazil, where in 2005 the anti-HBc was 2.05% and 0.79% in 2004 for HCV), indicating
high rates of infection by HBV and HCV and a persistent risk of HBV and HCV transmission by
transfusion. For Chagas disease is also lower than others reported in other countries in the region
(e.g. Goiânia, Brazil, 1989, 3.3%). Finally for HIV the found seroprevalence is similar to that
reported in Mexico (Irapuato, Mexico, 2003,0.24%). But as seen herein, those seroprevalences
are regional, and our report is nationwide. Further epidemiological research is expected.
Final abstract number: 68.003
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Progress Towards the Global Prevention of Hepatitis B
             1               2            2
S.T. Wiersma , M. Gacic-Dobo , C. Shapiro
1                       2
 CDC, Atlanta, GA, USA, WHO, Geneva, Switzerland

Background: In 1992, the World Health Assembly passed resolution 45.17 calling for Member
States, '...to integrate cost-effective new vaccines, such as hepatitis B vaccine, into national
immunization programs in countries where it is feasible..." The same year, the World Health
Organization (WHO) recommended that all countries integrate hepatitis B vaccine (HepB) into
national immunization programs by 1997. Unfortunately these goals were not met, mostly due to
financial barriers; by 1997 only 65 Member States had introduced HepB nationwide.
Following creation of the GAVI Alliance in 2000, financial support was made available to the less
developed member states and Alliance partners set new milestones calling for HepB to be
introduced in these countries 2007.
Methods: We reviewed programmatic data reported to WHO as part of the Joint Reporting Form
to determine the number of countries that provide HepB and the coverage of this vaccine. Data
were analyzed to provide information on program achievements over time.
Results: As of 2006, 164 of 193 (85%) WHO Member States reported having integrated HepB
into their routine infant immunization schedules. The remaining 29 countries include those with
historically low HBV prevalence and those countries gradually introducing HepB. The remaining
countries include 14 GAVI-eligible countries, of which the majority (10) are in the WHO Africa
Region (AFR). Global coverage of three doses of hepatitis B vaccine in 2006 was 60%, compared
with 1% in 1990. Coverage by WHO region was as follows: AFR 49%; Region of the Americas
89%; Eastern Mediterranean Region 78%; European region 74%; South-East Asia Region 28%;
and Western Pacific Region 85%.
Conclusions: Tremendous progress has been made in introduction of the first anti-cancer vaccine
into routine immunization programs globally. The world is on track to meet the 2007 goal of
introduction of hepatitis B vaccine in the world's poorest countries. These achievements are likely
the result of global advocacy, decreasing vaccine prices, and availability of resources to the
poorest countries.
Final abstract number: 68.004
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Nonpharmaceutical Interventions Implemented by US Cities During the 1918-1919 Influenza
Pandemic
          1          1           2
H. Markel , A. Stern , M. Cetron
1                                            2
 University of Michigan, Ann Arbor , MI, USA, CDC, Atlanta, GA, USA

Context: A critical question in pandemic influenza planning is the role nonpharmaceutical
interventions might play in delaying the temporal effects of a pandemic, reducing the overall and
peak attack rate, and reducing the number of cumulative deaths. Such measures could potentially
provide valuable time for pandemic-strain vaccine and antiviral medication production and
distribution. Optimally, appropriate implementation of nonpharmaceutical interventions would
decrease the burden on health care services and critical infrastructure.
Objectives: To examine the implementation of nonpharmaceutical interventions for epidemic
mitigation in 43 cities in the continental United States from September 8, 1918, through February
22, 1919, and to determine whether city-to-city variation in mortality was associated with the
timing, duration, and combination of nonpharmaceutical interventions; altered population
susceptibility associated with prior pandemic waves; age and sex distribution; and population size
and density.
Design and Setting: Historical archival research, and statistical and epidemiological analyses.
Nonpharmaceutical interventions were grouped into 3 major categories: school closure;
cancellation of public gatherings; and isolation and quarantine.
Main Outcome Measures: Weekly excess death rate (EDR); time from the activation of
nonpharmaceutical interventions to the first peak EDR; the first peak weekly EDR; and cumulative
EDR during the entire 24-week study period.
There were 115 340 excess pneumonia and influenza deaths (EDR, 500/100 000 population) in
the 43 cities during the 24 weeks analyzed. Every city adopted at least 1 of the 3 major
categories of nonpharmaceutical interventions. School closure and public gathering bans
activated concurrently represented the most common combination implemented in 34 cities
(79%); this combination had a median duration of 4 weeks (range, 1-10 weeks) and was
significantly associated with reductions in weekly EDR. The cities that implemented
nonpharmaceutical interventions earlier had greater delays in reaching peak mortality (Spearman
r = -0.74, P <.001), lower peak mortality rates (Spearman r = 0.31, P =.02), and lower total
mortality (Spearman r = 0.37, P =.008). There was a statistically significant association between
increased duration of nonpharmaceutical interventions and a reduced total mortality burden
(Spearman r = -0.39, P =.005).
Conclusions: These findings demonstrate a strong association between early, sustained, and
layered application of nonpharmaceutical interventions and mitigating the consequences of the
1918-1919 influenza pandemic in the United States. In planning for future severe influenza
pandemics, nonpharmaceutical interventions should be considered for inclusion as companion
measures to developing effective vaccines and medications for prophylaxis and treatment. We
will present both our quantitative findings and ongoing qualitative research on the 1918-19
pandemic in the urban United States.
Final abstract number: 68.005
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Legionella Pollution in Cooling Tower Water of Air Conditioning System in Shanghai, China
H. Lin
Taizhou Municipal Center for Disease Control & Prevention, Taizhou, China

Background: Legionella disease (LD) is believed to be an environmentally acquired disease,
inhaled as contaminated aerosolized water containing Legionella, and gains entry into the lungs.
Cooling towers of air conditioning systems have been recognized as the primary source for
Legionella.
Objective: to determine Legionella pollution prevalence, describe the amount of Legionella
respect to temperature in CTWs of various type of public place.
Methods: 321 cooling tower water (CTWs) from target sites were sampled, using probability
proportion (around 1/500) to size (PPS) sampling.
Results: It was found that of the samples, 58.9% (189/321) samples were observed positive with
Legionella, 19.9% were isolated as over 100 CFU/ml, and 0.9% even exceeding 1000 CFU/ml.
Lp-1 was the most frequently isolated species (155/189, 82.0%), followed by L-mic that is at the
second (44/189, 23.3%). In addition, the mean CFU/ml of Legionella in CTWs reached its peak in
July, August and September (mean CFU/ml was 180, 170 and 170 respectively), and begins to
drop gradually in October and November, down to 39.3 and 0.33 respectively. 15.4% of samples
with exceeding 100 CFU/ml were observed in a hospital setting; 18.9%, 27.7%, 12.3%, and
22.7% of the samples exceeding 100 CFU/ml were from office buildings, subway stations, hotels,
and stores respectively.
Conclusion: The problem with Legionella pollution in CTWs, especially in subway stations and
hospitals, is worrying. A significant correlation was found between the positive rate and CFU/ml of
Legionella in CTWs and air temperature. To deal with the potential risk of LD, improved control
and prevention strategies are urgently needed.
Keywords: Legionella; pollution; cooling tower water of air conditioning system
Final abstract number: 68.006
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Cellular Automaton Model for Epidemiology with Vaccination Strategy
S. Rajasekaran
B. S. Abdur Rahman Crescent Engg. College, Department of Mathematics, Chennai, India

Vaccintion plays a vital role in controlling infectious diseases. This paper presents the spatial and
temporal rates of disease spread in a spatially distributed heterogeneous population with
vaccination using lattice gas cellular automata(LGCA). This model describes the scenarios of ring
vaccination,which is more effective if the infectious cases are diagnosed rapidly.Expressions for
the basic reproduction number and effective reproduction number have been derived which help
to find the critical vaccination coverage needed to control the epidemic. We investigate the
effectiveness of ring vaccination depends on the time until diagnosis of a symptomatic case, the
time to identify and vaccinate contacts. However, because of the inherent stochastic nature of the
epidemic outbreaks, both the size and duration of the epidemic outbreaks highly vary. A special
strategy that includes case isolation is discussed and sensitvity analysis is carried out to
understand the initial phase of the epidemic. Specifically, how a ring of vaccinated susceptible
population of sufficient thickness can halt the spread of infection across space is analyzed. This
model can also incorporate geography, demography, and environment and migration pattern into
the interaction measure between cells on a global neighborhood level. Hence LGCA model is
more flexible to determine the effect of vaccination in epidemic spread through simulation using
several simplified data.
Final abstract number: 68.007
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Knowledge and Practice about Aids, Hepatitis B and C in Barbers
B. Ataei, A. Saidi, N. Kassaian, Z. Nokhodian, M. Jalali
Infectious Diseases Research Center,Isfahan University of Medical Sciences, Isfahan, Iran
(Islamic Republic of), Infectious Diseases Research Center,Isfahan University of Medical
Sciences, isfahan, Iran (Islamic Republic of)

Introduction: In Barber's shop, care lessens of simple points of hygiene can lead to control of
infectious diseases such as AIDS and viral hepatitis. As knowledge and practice have a critical
role in prevention of these diseases, this study was carried on to assess them in barbers in
Isfahan, Iran.
Methods: The level of Knowledge and Practice in 240 barbers who were chosen randomly from
1200 barber's shop were evaluated in this study. Validated questionnaire including 20 questions
about knowledge and 10 about practice were filled and the answers were analyzed using SPSS
software.
Results: The average score of knowledge was 15.7±3 with no statistically differences in the 3
diseases. There was no correlation between the knowledge score and area. The average score
of practice was 16.6± 1.7. There was direct correlation between knowledge and practice scores
with education levels and inversely correlation with age and experience. TV and radio were the
most sources of barbers' knowledge about the 3 diseases.
Conclusion: The role of TV and radio for control of AIDS, Hepatitis B and Hepatitis C seems to be
important. Also ,more educational programs specially for old aged and experienced groups must
be done.
Key words: HBV, HCV, AIDS, Barber, knowledge, practice.
Final abstract number: 68.008
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

General Morbidity Profile of Rural and Periurban Population in Selected Localities of Patna
District: Household Survey
             1             2             3
G. Kumari , R.A.M. Singh , V.K. Saxena
1                                                                                  2
 Centre for epidemiology and parasitic disease, NICD, Delhi-110054, Delhi, India, National
                                                  3
Institute of communicable Diseases, Patna, India, Centre for Medical Entomology and Vector
Management, NICD, Delhi-110054, Delhi, India

Background: Research question: What is difference in prevalence of morbidity and its association
with education, occupation, income (EOI) & age of individuals in rural & periurban area? The
baseline data of disease burden and its pattern for acute and chronic diseases is a prerequisite
for any health planning and optimum use of resources. Health seeking behavior of a population is
equally important element in the process. This becomes more important in case of rural & peri-
urban populations, as there is a significant mismatch between resources and disease burden.
Despite the achievements of better health in India, there is a large gap between the health of
urban and rural community. Bearing in mind the inadequacy of epidemiological data on general
morbidity pattern, the aim of this study was to estimate prevalence of morbidity in rural and
periurban communities.
Objectives:
1. To estimate self- reported morbidity pattern among households and treatment seeking
preferences of rural & periurban communities of Patna, Bihar.
2. To analyze association between EOI and age of individuals with the prevalence of morbidity.
Methods:Design: Analytical Cross-sectional study. Study population: All the members of each
household. Study tool: Structured interview schedule filling up of information about individual's
demographic profile and morbidity. Survey method: Alternate households were interviewed. Data
consisted of 237 households, 1347 individuals.
Results: 49.8% & 14.3% subjects were illiterate and 21.8% & 4.02% were unskilled workers in
rural and periurban areas respectively. Acute morbidity was higher in rural (10.79%) than in
periurban (7.74%). Chronic morbidity was higher in periurban (16.84%) than in rural (10.35%).
Conclusion: Prevalence of morbidity was higher in periurban community than in rural and more
prevalent in females than males. Morbidity was associated with the age of an individual and not
with EOI of the family head. Most households prefer private medical facilities. Assessment of
morbidity profiles will help in timely application of correct intervention/strategies to improve the
health status & quality of life of the community.
Final abstract number: 68.009
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Investigation of (DMF) Index in First and Second Grade of Elementary School in Fars Province,
Iran, (2006-7)
R. Bahadorikhalili
Shiraz University of Medical Scienses, Shiraz, Iran (Islamic Republic of)

Introduction: Tooth decay is one of the afirmanth of catching cold among students. Controlling
this problem is one of the duties of Health and Safety Administrators. DMF index is very important
index both regional and nationally. This index should not exceed than at 3 age at twelve. In this
study the DMF index is being investigated particularly in tooth number six.
Methods: in this study 2000 first and first and second grade elementary students were piched
randomly according to cluster random sampling. Their teeth, beginning of tooth decay and DMF
index of tooth number 6 were investigated.
Results: Among all these students only 19% didn't have tooth decay. 40.9% of them have decay
for tooth number 6.DMF index for number six tooth among these students were 0.87. 47.2% of
them have between one to four decayed tooth. Based on place living (Rural or City), sex,
occupation of father, no meaningful differences were found in DMF and tooth decay.
Discussion: Epidemy of teeth decay and DMF index of tooth number 6 is an indication of the lack
of knowledge and attention among parents at these students. Even though the dentists and
health workers have been active for decades the problem still exists because it is mostly based
on cultural backwardness and there is no differences between rural and city students. Most
parents don't know that teeth number 6 is a permanent teeth. We believe that a grate educational
program is needed to teach both parents and their children. This education should be
administrated by employees of Ministry of Health, particularly health instructors, the mass media
also could play a major role in this education.
Final abstract number: 68.010
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Knowledge, Attitudes and Behavior Towards Antibiotic Use Among Parents in Al-Ain City, United
Arab Emirates
          1             1           1            1           1              1         2
A. Tenaiji , K. Al Redha , F. Khatri , S. Darmaki , S. Hosani , M. Al Neaimi , A. Khan ,
              2
R. Hashmey
1                                                                 2
 United Arab Emirates University, Al Ain, United Arab Emirates, Tawam Hospital in affiliation with
Johns Hopkins Medicine, Al Ain, United Arab Emirates

Introduction: Unnecessary antibiotic use is a well-documented risk factor for infection with
resistant bacteria. There are increased concerns about antibiotic-prescribing patterns worldwide.
With a goal of changing the present beliefs and practices about antibiotic use, the aim of this
study is to assess the current knowledge, attitudes and behavior towards antibiotic use among
parents in Al-Ain city, United Arab Emirates.
Methods: A cross-sectional study involving 250 parents of children <13 years visiting primary
health centers from September 17 to October 12, 2006. An interviewer-administered
questionnaire was used and data was analyzed using SPSS.
Results: Knowledge Assessment: Fifteen percent of participants knew that antibiotics are used to
treat bacterial infections. 71% percent had no concept of antibiotic resistance and those who
knew the concept were of higher educational levels (p=0.001). Half of the participants did not
know that using antibiotics in every febrile illness could lead to antibiotic resistance. The study
showed that the main source of information about antibiotic use was from leaflets (84%).
Knowledge score increased with increasing age and educational level. Attitude Assessment:
Forty-eight percent thought that antibiotics are always or usually needed for common cold
symptoms and they were the least satisfied when not prescribed antibiotics. 38% had requested
antibiotics and 20% had consulted another doctor to get antibiotics. Behavior Assessment:
Twenty-one percent had given their children antibiotics without doctor's prescription. 31% did not
follow their doctor's instructions, 24% did not complete the full course and 21% shared antibiotics
between their children. Those who receive information about antibiotics had a higher behavior
score (p=0.002).
Conclusion: This study showed that parents often have inadequate knowledge regarding
antibiotic use. Providing antibiotic awareness was found to significantly improve parents'
behavior. Therefore, improved public and parental education is needed to reduce unnecessary
antibiotic prescription and antimicrobial resistance in the community.
Final abstract number: 68.011
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Prescribing Habits and Associated Factors in the Event of the New Antimalarial Treatment Policy
in a Rural Ugandan Hospital
            1              2             2
J.A. Achan , P. Ucakachon , J. Nakayaga
1                                                             2
  MU-UCSF Malaria research collaboration, Kampala, Uganda, Makerere university department
                                2
of Pharmacy, Kampala, Uganda, Makerere university department of pharmacy, Kampala,
Uganda

Objectives: We sought to describe the prescribing habits of health care providers for malaria
treatment in a rural Ugandan hospital following implementation of a new antimalarial policy and to
determine factors associated with these prescribing habits.
Methods: A review of 715 prescriptions for patients clinically diagnosed as having malaria during
the months of October 2006 to January 2007 was done. The prescriptions were selected using
systematic sampling from the Outpatients register. We collected data on patient demographics,
prescriber factors and prescription patterns. Prescriptions were considered to conform to the
2005 antimalarial policy if Artemether- Lumefantrine (AL) was prescribed for uncomplicated
malaria or if Quinine was prescribed for treatment failure or complicated malaria.
Results: The most prescribed antimalarials for uncomplicated and complicated malaria were
Coartem (n = 564, 88.5%) and Quinine (n = 66, 84.6%) respectively. Chloroquine, SP,
Chloroquine+SP, Coartem+QNN were prescribed in some cases. Prescribers conformed to the
2005 antimalarial treatment policy in 88.1% (n = 630) of the prescriptions. Independent predictors
of conformity to the 2005 antimalarial treatment policy were: duration in service of more than 6
years (OR = 3.40. CI = 1.24-9.33), prescriber's level of training (OR = 97.51, OR = 27.29-348.34)
and diagnosis of uncomplicated malaria (OR = 1.99, 1.22 -3.26).
Conclusions: The majority of health workers conformed to the new treatment policy, however, a
few prescriptions were contrary to the treatment guidelines. It is important to ensure that pertinent
information, education and communication with health workers is done to promote behavior
change and effective uptake of policy changes.
Final abstract number: 68.012
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Comprehensive Family Hygiene Promotion in Peri-Urban Cape Town: Gastrointestinal and Skin
Disease Reduction in Children Under Five
        1             1          2         2              3           1
E. Cole , M. Hawkley , J. Rubino , K. McCue , B. Crookston , J. Dixon
1                                           2                                   3
 Brigham Young University, Provo, UT, USA, Reckitt Benckiser, Montvale, NJ, USA, University
of Utah, Salt Lake City, UT, USA

Previous studies have confirmed effectiveness of handwashing on diarrheal reduction in
developing countries, yet few are comprehensive in addressing a spectrum of gastrointestinal,
skin, and respiratory illnesses that mark the burden of infectious disease for families, especially
children <5 years. Addressing illnesses through a program of family hygiene promotion
(education plus the regular use of key hygiene products) could result in marked reduction of
morbidity and mortality, fewer healthcare visits, and related costs.
Effects of intensive hygiene education alone and in combination with the use of hygiene products
(soap, surface cleaner/disinfectant, and antiseptic) were assessed. Four communities, 685
households participated: two of government (RDP) housing (indoor tap/flush toilet) and two of
informal (INF) housing (communal tap/latrines). Community facilitators monitored illness
symptoms weekly and reinforced disease-prevention behaviors established through participatory
learning and action focusing on handwashing/bathing with soap, cleaning toilet and food
surfaces, and treating skin problems with antiseptic. RDP and INF communities were co-located
in two geographic areas, with one area receiving education and products (intervention), and the
other receiving education only (control). Illness data were gathered from Jun-Nov 2006
(baseline), and for the same 2007 period following education and product introduction
(intervention). Children <5 in all communities had significant reductions in gastrointestinal and
skin illnesses over time. RDP controls were more likely to experience gastrointestinal (HR=1.27,
CI: 1.10-1.46) and skin (HR=1.26, CI: 1.10-1.44) illnesses at follow-up than intervention
counterparts. INF controls were more likely to experience gastrointestinal (HR=1.43, CI: 1.26-
1.62) and skin (HR=1.46, CI: 1.29-1.66) illnesses at follow-up than intervention counterparts.
While hygiene education alone showed meaningful reduction of gastrointestinal and skin
diseases across all communities, families with education plus the use of key hygiene products
saw significant illness reduction in children <5.
Final abstract number: 68.013
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Knowledge, Attitudes and Intended Behaviour of Hospital Health Care Workers Around Pandemic
Influenza
         1               1         2          2
H. Seale , C.R. MacIntyre , R. Booy , J. Leask
1                                                 2
 University of New South Wales, Sydney, Australia, National Centre for Immunisation Research
and Surveillance of Vaccine Preventable diseases, Sydney, Australia

Background: Hospital health care workers (HCW) are key to effective pandemic response.
Important issues including the behavioral responses of HCW in the event of an outbreak of
pandemic influenza have the potential to undermine current plans for disease control and health
care delivery. Work attendance and avoidance, staff quarantine, limited supplies of vaccine and
antivirals and sharing of prescribed antivirals with family members may all impact on the
workforce. Understanding their attitudes and intended behaviour in a pandemic will assist with
workforce issues around pandemic planning.
Methods: A cross sectional survey was conducted between May and November 2007, among a
sample of hospital staff working at two tertiary-referral hospitals (one adult and one paediatric) in
Sydney, New South Wales, Australia.
Results: The overall response rate was 63% (885/1400). The majority (863/885) surveyed
considered that pandemic influenza (PI) would be "very serious" if one were to occur. In the event
of PI, 83% (734/885) of respondents indicated that they would work if a patient in their
department had an influenza-like illness. 80% (716/885) of respondents indicated that they would
properly adhere to procedures regarding antiviral medications which may be provided to them,
with only 6.9% (73/1069) indicating that they would divert the medications to family members.
However, only 42.7% (377/885) of respondents considered that antiviral medications would
protect them. During a PI, 73% (646/885) of respondents intend to comply with quarantine
measures; although 38% (336/885) would be "very unhappy" about cooperating with the
measures.
Conclusion: Work attendance, staff quarantine, limited supplies of vaccine and antivirals and
sharing of prescribed antivirals with family members may all impact on the workforce. It is
apparent from our findings that there are several issues that must be addressed as part of health
system preparedness for a coming influenza pandemic.
Final abstract number: 68.014
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Factors Associated with Maternal Mortality in Nyakabande Subcounty, Kisoro District in Uganda
J.K. Kabami
Uganda Research Institute, Mbarara, Uganda

Pregnancy and childbirth should be viewed as a happy and joyous event but the majority of
women who become pregnant experience pain, fear, suffering and even death. About one million
women are estimated to get pregnant every year. Out of these, at least 1600 women die every
day from pregnancy-related complications and childbirth. Of all maternal deaths that occur
globally, 99% are in developing countries compared to 1% that occurs in developed countries
(WHO, 1996; UNICEF 1996; CARE, 1998).
Uganda is a developing country with a very high maternal mortality rate. The revised
UNICEF/WHO 1990 global, regional and individual country estimations maternal mortality rates
put the Ugandan rate at 1200 maternal deaths per 100,000 live births
The study was conducted in Nyakabande Sub County in Kisoro district in South Western Uganda
to establish the main factors associated with maternal mortality. The study also sought to identify
the socio-economic, cultural, physical and health care factors associated with maternal mortality.
Data was obtained from the office of the District Director of Health Services (DDHS) from 1998-
2002, health units, health workers and pregnant women by means of pre-tested questionnaires
and focus group discussion guides.
The study was descriptive and cross-sectional in nature. The population under study included
women of reproductive age, pregnant women, nurses and midwives.
The main causes of maternal deaths (N=29) were malaria in pregnancy (34.9%), post-partum
haemorrhage (17.4%) purpueral sepsis (17.4%), cerebral malaria (4.3%). Amniotic embolism
(4.3%) pulmonary embolism (4.3%) pre-eclampsia (4.3%) HIV in pregnancy (4.3%).
There were frequent deaths among women with the third to sixth pregnancy: 3-4 pregnancies
(30.4%), 5-6 pregnancies (26.1%). Most of the maternal deaths occurred in the age group of 20-
29 years (52.2%).
The findings indicate a high maternal mortality in Nyakabande Sub-county that is related to
several personal, socio-economic and health care factors.
Final abstract number: 68.015
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Vaccine Preventable Zoster Burden of Illness and Health Care Resourse Utilization: An
Australian Perspective
          1                2          3             3             1                 4
A.N. Stein , C.R. MacIntyre , H. Britt , C. Harrison , E.L. Conway , A. Cunningham
1                                     2
 CSL Limited, Melbourne, Australia, School of Public Health and Community Medicine,
                                         3
University of NSW, Sydney, Australia, General Practice Statistics and Classification Centre,
                                           4
University of Sydney, Sydney, Australia, Westmead Millennium Institute, University of Sydney ,
Sydney, Australia

Background: In Australia the zoster vaccine has recently been approved for people aged 50 years
and older. The aims of this study were to determine the health care burden and expenses
associated with herpes zoster in this population, important background data to enable analyses of
the impact and cost-effectiveness of the introduction of the zoster vaccine.
Methods: Incidence of zoster and post herpetic neuralgia (PHN) and associated health care
resource utilisation were investigated using data from Bettering the Evaluation and Care of Health
(BEACH) (April 2000 -September 2006), pharmaceutical prescribing data, and hospital morbidity
and emergency department databases (1998 -2005).
Results: The BEACH database recorded 379 encounters for new zoster and 57 for new PHN in
subjects aged 50+, extrapolating to ~58,350 zoster and 8,800 PHN cases/year throughout
Australia. The estimated zoster incidence rate was 9.7/1,000 persons (95% CI: 8.7 - 10.7)
increasing from 6.5/1,000 at 50-59 to 15.6/1,000 at age 80+. PHN incidence was 1.45 (1.1 -
1.8)/1,000, with risk in zoster cases increasing from ~11% at 50-59 to ~20% at 80+ years.
Between 1998 - 2005 there were 4,058 zoster hospitalizations/year, an estimated rate of
0.67/1,000, with herpes zoster recorded as principal diagnosis in ~41%. There were estimated
averages of ~340 admitted and ~1900 non-admitted emergency department visits/year
(~0.38/1,000). Zoster or PHN were managed at 901 encounters, extrapolating to 139,000 annual
general practitioner consultations (~2.4 visits/case) with referrals to specialists recorded in 1.8%
of cases. Antivirals were prescribed for 73.5% of new zoster cases. Other medications included
opioids, other analgesics, antidepressants and antiepileptics. Total costs of zoster and PHN to
the health care system were estimated as ~33.3 million/year.
Conclusions: The substantial burden of zoster and PHN described in this study supports the case
for inclusion of the zoster vaccine in the Australian National Immunisation Program.
Final abstract number: 68.016
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Health Behaviour and Infectious Disease Risk in Travellers Departing Australia
              1           2               3                  4                 1
A. Heywood , R. Watkins , K. Nilvarangkul , S. Iamsirithawan , C.R. MacIntyre
1                                                  2
 University of New South Wales, Sydney, Australia, Curtin University of Technology, Perth,
          3                                               4
Australia, University of Khon Kaen, Khon Kaen, Thailand, Bureau of Epidemiology, Ministry of
Public Health, Bangkok, Thailand

Background: The volume and widespread nature of modern international travel is a factor in the
emergence of infectious diseases. Through the surveying of departing passengers we aimed to
describe traveller behaviour, providing relevant data to support prevention and control activities in
travel-related infectious disease importation and spread.
Methods: Between August-September 2007, we conducted a survey of travellers departing from
Sydney International Airport, including Australian residents and visitors to Australia. Passengers
were randomly selected for participation from the departure area with over-sampling of Asian
destinations, due to interest in the region as a possible source of pandemic influenza. Participants
completed a self administered survey which was collected at the airport.
Results: Respondents perceived the risk of disease transmission by coughing as carrying the
highest risk (198/878; 22.6% medium-high risk) while sexually transmitted infections (STIs) the
lowest (18/878; 2.1% medium-high risk). 214/878 (24.4%) respondents reported seeking travel
health advice from a GP prior to departure. Pre-travel vaccination rates were low in both
Australian travellers and residents of other countries, with 46/364 (12.6%) and 48/514 (9.3%)
reporting at least one pre-travel vaccine respectively. Overall, the most frequently reported
vaccines were for Hepatitis B (5.4%) and Hepatitis A (5.2%). There was a significant difference in
reporting influenza vaccination between Australian residents and residents of other countries
(17/364, 4.7% 95% CI 2.9-6.4% and 10/514, 1.9% 95% CI 0.5-3.4% respectively, p=0.021).
Conclusion: Diseases can arise in areas of heavy tourism; travellers may undertake activities
which place them at increased risk; and travellers can act as vectors to transport new diseases
across borders. For these reasons, understanding travel behaviours can inform disease control
efforts. In over 800 surveyed travellers, the perceived risk of infection and vaccination rates in
general was low. Opportunities exist for intervention to increase traveller awareness and
modifying behaviour.
Final abstract number: 68.017
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

High Rate of Recent Infections in International Travelers Departing Bangkok
              1             2                    1             1         1            3
S. Pattanasin , A. Heywood , S. Iamsirithaworn , R. Buathong , H. Yang , R. Watkins ,
                2
C.R. MacIntyre
1                                                                          2
 Bureau of Epidemiology, Ministry of Public Health, Nonthaburi, Thailand, University of New
                                 3
South Wales, Sydney, Australia, Curtin University of Technolohy, Perth, Australia

Background: In 2006, over half a million of travelers departed Thailand to Australia. A concern of
upcoming influenza pandemic poses a challenge for public health professionals to find effective
measures for delaying a global spread. We conducted a study to determine potential risk of
transmission and factors related to the spread of infection across international border.
Methods: During November-December 2007, 114 travelers aged over 15 years who departing
Thailand to Australian were randomly selected at Suvarnabhumi International Airport in Bangkok.
A self-administered questionnaire was used for collecting data on demographics, traveler
patterns, diseases status and risk of acquiring infection.
Results: Of 114 surveyed, 74 (64.9%) entered Thailand for holidays. The majority of travelers
(65.8%) spent less than 2 weeks in Thailand. Over half (55.3%) were males and the mean age
was 37 years (SD 13.9). Common illnesses in the past 2 weeks reported were URI, (34.5%,
38/110) and diarrhoea, (12.7%, 14/110). For URI, 75.8% perceived that coughing/sneezing is a
risk factor. Half of travelers believe that consumption of food and water is a possible cause of
diarrhoea. About 39% (45/114) were never vaccinated against influenza. For various places
visited, transportation used and events attended, only a history of visiting farm in the past two
weeks increased a risk of having URI (adjusted OR 5.6; 95% CI=1.2, 27.0). Type of
accommodations and length of stay were not associated with any specific disease.
Conclusion: Nearly half of all travelers departing Thailand for Australia reported infections within 2
weeks of departure. URI was common among recent farm visitors. The possibility of a major
antigenic shift and the emergence of human pandemic influenza, as well as emerging infections
such as SARS, make the study of travellers and their role as vectors for infection important.
Final abstract number: 68.018
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Evaluation of Maternal and Child Health Services at Block PHC Harduaganj, Aligarh, (UP)
         1            1             2
S. Singh , D.C. Jain , R.C. Chaddha
1                                                          2
 National Institute of Communicable Diseases, Delhi, India, Chief Medical Officer, Aligarh, India

Background: India has an excellent infrastructure for the delivery of MCH services in the
community, but this system does not function effectively because of limited resources,
communication delays, lack of commitment on the part of health professionals, political will and
community participation. Keeping in view of all things present study was proposed with the
following objectives-
• To study the MCH services coverage at PHC level and its utilization pattern.
• To study barriers in MCH programme utilization.
Material and Methods: A cross- sectional study was done at block PHC Harduaganj, Aligarh (UP)
on women who were pregnant or in puerperium or having children of age of 12 months to 23
months and service providers in state Govt. sector from 1st August to 31st December 2007.
Presence of staff, infrastructure, working equipments, availability of drugs and kits were also
seen. Primary as well as secondary data were collected. 72 postnatal mothers, 181 antenatal
women and 152 mothers having children of age 12 month -23 month were interviewed as per pre
designed Performa. 3 medical officers, 28 ANMs, 14 ASHA and 12 AWW were also studied.
Results: Block PHC Harduaganj was serving a population of 2, 60000 against the IPH standards
of 1, 20000. Regarding input indicators, 3 posts of ANMs were vacant against the sanctioned
posts, 50% Sub centres were running in rented building and all PHCs were lacking in facility for
ambulance, laboratory, separate toilet for patient and staff, telephone and water supply. The
ANMs was maintaining only 1 register instead of twelve registers as per IPH standards.
Regarding process indicators, early registration was 10%, 3 ANC visits were 1.4% and PNC visits
were only 31.9%. Two doses of TT 75% and consumption of 100 IFA tablets were 23.6% among
postnatal women and among antenatal women 15.5% consumed IFA tablets and 51.9% received
two doses of TT according to their trimester. 78.9% among antenatal women and 75% among
postnatal women complained about Reproductive tract infection and only 50% consulted any
health personnel.
Out of 62.5% deliveries conducted at home, 26.4% were conducted by untrained health
personnel. Only 37.5% mothers did breastfeeding initiation within first two hrs of birth, 13.9%
discarded colostrums and 68.1% gave pre lacteal feed to their child. 75.75% and 78.9% antenatal
and postnatal women used Nirodh respectively. 65.8% children were fully immunized & 65.1%
had received Vitamin- A doses .IMR was 64.5.
Barriers in utilization of MCH services identified were lack of knowledge both among health
personnel and service users, unawareness about TT immunization 50 % among postnatal women
&, 8.47% among antenatal women, non availability of IFA tablets 75.8% and 69.1% among both
group, fear of fever and infection to their child 38.5% followed by unawareness and busy 25%
each. 5.8% each were discouraged by any family member and having false perceptions regarding
immunization and place of immunization. Poor health seeking behavior (50%), desire for more
children (47% among antenatal and 33.3% postnatal women showed their desire for at least 3
children) were also observed as a barrier in low utilization of MCH services.
Conclusion: By providing Refreshment training, ensuring availability of working instrument and
their proper utilization, posting of at least one lady medical officer at PHC level and utilizing
missed opportunities we can achieve goals as stated.
Final abstract number: 68.019
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Knowledge, Attitudes and Practices About Measles Among Mothers in Urban Slum Area of
District Aligarh, UP
S. Singh, U. Chawla
National Institute of Communicable Diseases, Delhi, India

Background: Though Measles deaths have fallen by 60 per cent worldwide since 1999, Measles
remains one of the major causes of significant morbidity and mortality in the Member Countries of
South-East Asia. In the present study an attempt was made to collect data on the attitude, belief
and customs of mothers regarding occurrence of measles among children in an Urban Slum area
in Aligarh with the following objectives.
To assess the current level of awareness regarding measles.
To assess the factors responsible for low measles immunization coverage.
Material and methods: A cross-sectional study was done in Urban Slum Area of Aligarh (UP) on
women having children of age less than five year in Nov. 2006 via using a pre structured
Performa. Total 90 mothers were interviewed regarding their demographic profile, symptoms of
measles, and awareness regarding measles vaccine.
Results: All studied women were from Muslim community and mostly were housewives (99%).
87.7% mothers were illiterate. 84.4% mother was aware of infectious nature and only 52.2%
mothers were aware of symptom of measles. 77.7% mothers were aware of its complications,
pneumonia being the commonest (57.7%) followed by diarrhea (16.66%). Almost every mother
(95.5%) was having knowledge that measles commonly involve children. Their knowledge and
attitude regarding measles vaccine was not favorable. Only 56.6% mothers were able to tell that
that we can prevent our child through Measles vaccine. Only 13.9% Children were found
immunized against measles vaccine. Major reason for this much of low immunization was non
awareness about age & place of vaccination (56.5%), Fear of infection and far vaccination site
16.1% each and 4.8% mothers did not find it necessary to have measles vaccine. Long Que and
absenteeism of health staff was also observed as a barrier in low vaccine coverage(3.2% each).
76.6 mothers gave no response, whether their child should be vaccinated or not. This reflects
their poor Knowledge & attitude towards measles vaccine. Their attitude towards food was also
not found favorable, as 84.4% mothers will restrict their child from Roti &Milk during measles
illness. This will cause children more prone develop complications resulting in increase in
mortality & morbidity. Out of 90 two children had contracted measles in the past and all consulted
Vaidya. Mother's preference for Vaidya for consultation, reflects their belief in indigenous
systems, though It is not scientifically proved that vaidya are able to treat measles, it will cause
further increase in disease morbidity & mortality.
Conclusion: As India is looking forward to eradicate measles in the coming years, it becomes very
important to increase knowledge regarding measles & improve attitude towards measles vaccine.
This study brings out the scope of health education in the eventual goal of eradicating measles in
the country.
Final abstract number: 68.020
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Factors Associated with Preventive Behavior on Dengue Hemorrhagic Fever Among Family
Leaders in One Sub-District of Bangkok, Thailand
                  1                2            1             1
C. Chanyasanha , S. Teetipasatit , S. Sujirarat , W. Kaewpan
1                                                                2
 Faculty of Public Health, Mahidol University, Bangkok, Thailand, Public Health Center 48,
Bangkok Metropolis Office, Bangkok, Thailand

This cross-sectional study was aiming to examine preventive behaviors on dengue hemorrhagic
fever (DHF) among family leaders in Ban Chang-lo Sub-district, Bangkok-noi District, Bangkok,
Thailand during February 2005. The sample was comprised of 414 family leaders who were
interviewed by trained public health officers. Data were collected with questionnaires and were
subsequently analyzed by descriptive and analytic statistics.
Results found that 65.2 % of the 414 family leaders surveyed were at moderate risk in prevention,
while 14.7 % were at high risk group. There were significant associations between religion,
knowledge, adequate resources, media information, and support and supervision from health
officers with preventive behavior on DHF among family leaders (p 0.01).
It was concluded that public health officers, participation of the family leaders and outsourcing
from other media have a role in preventive behavior use among people in the community.
Emphasizing supervision and support will be effective in prevention and control of DHF.
Final abstract number: 68.021
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

The Rapid Dispensing and Delivery of Oseltamivir API during Influenza Pandemic Phase: An
Exercise Experience in Taiwan
S.E. Yang, Y.C. Chih, S.M. Chou, C.H. Chen
Centers for Disease Control, Taipei, Taiwan

Background: Less storage space and longer shelf life have made Oseltamivir API a good choice
for stockpiling as countermeasure against influenza pandemic. However dispensing before use is
needed. To examine the efficiency of the processes from activation, packaging, dispensing to
distribution, we conducted functional exercise and drill on August 2006 and November 2007
respectively.
Methods: The central government establishes the stockpiles of antivirals. During the pandemic,
the Taiwan association of clinical pharmacy (TACP) together with 105 dispensing sites
nationwide will dispense and distribute API. The scenario for functional exercise assumed 4
clusters of A/H5N1 infection were detected and 400,000 doses of antivirals dispensed at 5 sites
were indicated. We examined the time needed for each processes. Drill was conducted to test the
accuracy and efficiency of dispensing and management through Material Information System
(MIS) for 50 sites randomly selected. Dispensing skill and time was evaluated with a checklist by
committee. The performance of operating MIS was recorded automatically by the system.
Results: TACP needed 6 to 8 hours to mobilized the personnel and activate the dispensing
operation on receiving order. Simultaneously, the central government needed 11 hours to
transport the antiviral to GMP factory for packaging and then to dispensing sites. All the
dispensing sites completed the dispensing within 6 hours and antiviral was sent to designated
place within 3 hours. The dispensing skill was evaluated at 5 dispensing sites with 100%
accuracy and mean dispensing time was 60 minutes. Seventy-six percent (38/50) of the hospitals
feedback the information through MIS, and 79% of them completed in time.
Conclusion: The mechanism in place can distribute the antiviral to designated place within 24
hours which will be in time for cases to use . Most of the units can use the MIS successfully
indicates that this system effectively facilitate the management, though more training may be
needed.
Final abstract number: 68.022
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Pandemic Influenza Preparedness: is the Community Really Prepared?
           1         2             3           2            4
H. Marshall , P. Ryan , D. Roberton , J. Street , M. Watson
1                                                                                2
 Women's and Children's Hospital and University of Adelaide, Adelaide, Australia, University of
                              3                                        4
Adelaide, Adelaide, Australia, Otago Univesity, Dunedin, New Zealand, Department of Health,
Adelaide, Australia

Background: The latest outbreaks of avian influenza A (H5N1) have scientists concerned that an
influenza pandemic is imminent. Governments globally have prepared protocols for rapid
response and containment of infection that aim to stop or at least limit spread of pandemic
influenza (PI). Community engagement in PI preparedness has been minimal. The aim of this
study was to assess community awareness of pandemic influenza (PI) and acceptance by the
community of government strategies to control the spread of infection.
Methods: A cross-sectional study was conducted by Computer Aided Telephone Interviews
(CATI) in April 2007 in South Australia. Statistical analyses were performed using data weighted
to the South Australian population.
Results: Of 1,975 household interviews conducted, less than a third (32.0%) of adults believed
that enough was being done to prepare for PI with a further 44.7% unsure. Only one third (33.9%)
of the community surveyed were able to provide the meaning of pandemic influenza with 8.4 % of
interviewees having never heard of PI. Acceptance of a vaccine for protection was high both for
adults (81.4%) and for children (78.6%). The majority of adults (83.4%) would agree to wear a
mask if advised that this would reduce the risk of transmission of infection. Almost two thirds
(61.7%) of employed adults interviewed reported that they would currently stay home if they
experienced flu-like symptoms. However this proportion increased to 98.2% if home quarantine
was part of a national strategy to prevent spread of infection.
Conclusion: Despite publicity about pandemic influenza a large proportion of the community are
unaware of this global threat. Our study results show there is strong support within the community
for government strategies to prevent the spread of infection but timely education of the public is
essential if these strategies are to be effective.
Final abstract number: 68.023
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Potential Cost Impact in the Netherlands Due to Different Waning Patterns of Cervical Cancer
Vaccines
R.M. Rogoza, D. Debicki, M. Kohli
i3 Innovus, Burlington, Canada

Background: Cervical cancer vaccines are now available. Since some uncertainty regarding their
HPV type-specific antibody waning profiles exists, we examined the clinical and economic impact
of different waning scenarios in the Netherlands.
Methods: A Markov cohort model, populated using Netherlands epidemiological, cervical cancer
screening, treatment pattern, and cost data was used to perform the analysis. Societal lifetime
costs were included at 2006 prices. Initial vaccine efficacy of 95% against HPV-persistent
infection with HPV-16/18 plus 30% efficacy against other oncogenic HPV types ("cross-
protection") was assumed in the base case.
Reduction in cancer cases, associated quality-adjusted life years (QALYs) and costs for a
vaccine against HPV-16/18, and other oncogenic HPV types with lifetime cervical cancer
protection were compared with vaccine scenarios having less than lifetime protection. These
scenarios included: 1) alternative combinations of HPV types that wane (HPV-18 alone,
oncogenic non-vaccine HPV alone, HPV-18 + oncogenic non-vaccine HPV); 2) alternative
durations of protection (range: 5-30 years); 3) alternative patterns representing the time of decline
to 0% protection (linear 5-year, linear 10-year, other); 4) alternative rates of booster vaccine
coverage (range 0% - 100%) and protection (i.e. double original vaccine protection vs. lifetime
protection).
Results: In the hypothetical vaccine scenarios, overall duration of vaccine protection had the
largest impact, followed by HPV-type-specific waning, then the pattern of waning decline. Waning
impact depended on the relationship between age and HPV infection rate, as well as on HPV-
type distribution in cervical cancer. Adding a booster increased the overall costs, but improved
clinical outcomes and QALYs.
Conclusion: Vaccine waning is an important characteristic to consider when assessing a
vaccine's effectiveness against cervical disease related morbidity and mortality; a vaccine with
more sustained protection is predicted to have better clinical outcomes at lower total costs.
Final abstract number: 68.024
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Successful Experience of Harm Reduction Program in Taoyuan County
         1           1            1          2
S.R. Lin , T.M. Huang , H.C. Huang , L.C. See
1                                                               2
 Public Health Bureau of Taoyuan County, Taoyuan County, Taiwan, Chang Guang University,
Taoyuan County, Taiwan

Background: HIV infections terribly increased in Taiwan since 2004. The number of new infected
doubled annually and 70% of them was IDU. Therefore, a harm reduction program started in
Taiwan to fight against HIV/AIDS since 2006.
Methods: A harm reduction campaign, including methadone treatment, syringe exchange
program, HIV screening and counselling services started in Taoyuan County, Taiwan in 2006. In
addition, various health education programs designed for students, inmates, IDUs and general
public were carried out simultaneously. Behavioral science survey was also implemented to
evaluated the impact of harm reduction campaign.
Results: In 2007, a total of 3,299 IDUs enrolled in methadone program; meanwhile 109 stations
were set up to provided free syringes exchange and counselling. Through two year's efforts, the
epidemic of HIV infection reversed dramatically in Taoyuan, Taiwan. In 2006, the number of HIV
new infected decreased 43% in comparison with that in 2005; furthermore, the number,
decreased 44% in 2007 compared with that in 2006. In addition, the crime events related to drugs
dropped significantly in recent two years.
Conclusions: Harm reduction program is highly effective to prevent HIV infection and improve
public security. Medical workers and pharmacists involved harm reduction program also show
good support on this program. However, without IDUs' participation in strategies planning, the
program in Taoyuan won't succeed.
Final abstract number: 68.025
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Prevalence of Infectious Diseases Among Immigrants Detected in Kuwait
        1           2          3           3                4               4              5
A. Sher , S.A. Latif , J. Iqbal , P.R. Hira , Y. Al-Mandaka , R.A. Al-Owaish , S. Al-Mufti
1                                                         2                                  3
 Malaria Laboratory, Ministry of Health, Kuwait, Kuwait, York University, Toronto, Canada, Dept.
                                                        4
of Microbiology, College of Medicine, Kuwait, Kuwait, Dept. of Public Health, Ministry of Health,
                5
Kuwait, Kuwait, Virology Laboratory, Ministry of Health, Kuwait, Kuwait

Background: More than 400,000 immigrants come to Kuwait every year and majority of them from
developing countries where infectious diseases are endemic. Our aim was to evaluate the
prevalence of six infectious diseases among immigrants and to control the spread of these
infections in Kuwait.
Methods:. Blood samples from all the immigrants were checked for infectious diseases like,
malaria, filaria, HIV, hepatitis B and C and chest x-ray for tuberculosis.
Results: The total population screened for malaria and filaria were 682,713; for HIV, tuberculosis,
hepatitis B and hepatitis C were 1354,151, respectively. Over all incidence of positivity for these
diseases were 9,444 (0.5%). About 226 (0.033%) individuals were infected with malaria and the
same number with filaria; 301 (0.022%) with HIV; 3,182 (0.23%) with hepatitis B; 3,247 (0.24%)
with hepatitis C and 2,262 (0.17%) with tuberculosis. Most of these infectious diseases were
found among Indians, Bangladeshis and Pakistanis, respectively.
Conclusion: The infected individuals with malaria were treated in Infectious Diseases Hospital,
whereas, those with filaria, HIV, hepatitis B and C were sent back to their countries because of
the risk of transmission. The dominant species of malaria was Plasmodium vivax followed by
Plasmodium falciparum.
Keywords: Malaria, filaria, human immunodeficiency virus, hepatititis, tuberculosis
Final abstract number: 68.026
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Coping Strategies for Financial Burdens in Families with Pneumonia
             1           1            2           3
N.I. Alamgir , A. Naheed , R.J. Khan , S.P. Luby
1
 Programme on Infectious Diseases and Vaccine Sciences (PIDVS), Health Systems and
Infectious Diseases Division (HSID), International Centre for Diarrhoeal diseases Research
                                 2
(ICDDR,B), Dhaka, Bangladesh, Graduate Groups of Epidemiology, University of California,
                                          3
Davis, Davis 95616, California, CA, USA, ICDDR,B, Dhaka, Bangladesh

Background: Pneumonia is the leading cause of childhood deaths in Bangladesh and a common
cause of hospitalization. Limited studies have assessed the treatment cost of pneumonia and the
mechanisms adopted by families to cope with the financial burden. We determined the out of
pocket expenditure and coping strategies adopted by the families of children admitted in a
hospital with pneumonia.
Methods: We conducted a cross sectional survey with parents of 90 children below 5 years of
age, who were admitted in the only referral pediatric hospital in Bangladesh with pneumonia. We
estimated total cost of illness of the event of hospitalization and conducted in-depth interviews
with six families.
Results: The mean expenditure of the families for the illness episode was US$ 91.25 (±SD 52.49)
and 66% reported to spend more than half of their total monthly expenditures on this
hospitalization. Three fourth (68/90, 76%) families had to manage the expenditure by borrowing,
selling or mortgaging assets; 64% had to borrow the full cost and 38% of them had borrowed
from formal sectors (bank, money lender etc.) with a monthly interest rate of 8 to 10%. Families
with lower socio-economic status (monthly expenditure < US$ 57 dollars) were 10 times more
likely than the families with middle or higher socio-economic status (monthly expenditure >US$
57 dollars) to borrow money (OR= 10.0 (95% CI: 2.8-38.8). Half of the respondents were planning
to repay loans by reducing spending on the type and amount of food, while 22% had planned to
work extra hours.
Conclusion: The out of pocket expenditure for treating children with pneumonia in hospital is high
and the coping strategies adopted by the poor attributes to hardship in the future. Administration
of effective vaccines (HIB, pneoumococcal) may reduce the disease burden of pneumonia and
eventually the economic burden of the families.
Final abstract number: 68.027
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Baseline Assessment of knowledge, Attitude and Practice of Population in a Rural Community in
Bangladesh about Dog Bite and Treatment Seeking Behaviour
          1             2          3              4           5
R. Rashid , A.A. Sayeed , A. Bashar , M.R. Rahman , M.A. Faiz
1                                                                                 2
  Gausul Azam Urban Dispensary,Chittagong. Bangladesh, Chittagong, Bangladesh, Chittagong
                                                                 3
Medical College, Chittagong,Bangladesh, Chittagong, Bangladesh, NIPSOM, Mohakhali,Dhaka,
                                4
Bangladesh, Dhaka, Bangladesh, Begum Khaleda Zia Medical College,Dhaka, Dhaka,
             5
Bangladesh, Director General of Health Service,Mohakhali, Dhaka, Dhaka, Bangladesh

Background: Dog bite is a predominant emergency health problem of the rural poor. An estimated
number of ~1500 deaths happen due to rabies in Bangladesh. Rabies is a preventable illness
provided appropriate measures including post exposure vaccination is being given following
animal bite like dog bite. The knowledge, attitude and practice prevailing in the community
following dog bite is important to know in order to take any measures for intervention.
Methods: A community based study were conducted in an Upazilla (Chandanaish, Chittagong)
from September, 2006 to February, 2007 to find out the existing practice related to dog bite in a
rural community through face to face interview with an adult member of the set number
households from five villages.
Results: The mean age of the respondents was 34.4 years with SD + 16 years. About 68 percent
were females and rest 32 percent were males.
This study showed that about 7.3 % of the respondents or their family members bitten by dogs
and among them about 10 percent were bitten two times. About 65%had awareness about the
disease of rabies and among them 99.1% express dog bite is the source of rabies. About 71 %
were knowledge about rabies medication, 77.5% of the respondents opined that rabies can death
lives. About 90 % of the dog victims were received treatment and among them, mode of pattern
of treatment were traditional and only about 25 % of the victims treated by rabies vaccine. Among
the victims 2.1 % were died.
Conclusion: Dog bites represent a significant part of avoidable accidents. The development of
primary and secondary prevention measures can be seen as an important goal in the issue of
dog bites. In order to achieve that goal, we would like to stress the need for multidisciplinary
research in the field of preventive educational tools.
Final abstract number: 68.029
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Evaluation of Local Preparedness for Influenza Pandemic in Taiwan
C.C. Chang, Y.M. Chou, C.H. Chen, S.M. Chou, M.S. Lu, C.R. Du
Centers for disease control, Department of Health, Taipei, Taiwan

Background: Asia countries have been most affected by H5N1 influenza since 2003, and would
be possibly the first to face the next pandemic. Taiwan, situated in Asia, has formulated the
strategic plan for pandemic influenza. But according to SARS experience, the implementation of
the local governments will be the crucial element.
Methods: Twenty-five local governments were asked to complete their preparedness and
response plan by 2004. In 2005, we evaluated those plans with 4 indicators, including cross-
sectoral coordination, surveillance, medical resources mobilization, and personal protective
equipments (PPE) management.
In 2006, an exercise assuming a cluster of H5N1 cases occurred in their prefectures was
conducted to examine their implementations. An expert committee was organized to observe the
performances.
Results: The average score of evaluation was 78%. The governments in central area got highest
scores which seems to be consistent with their performance during SARS outbreak wherein the
impact were minimized. All scored high in cross-sectoral coordination. 92% of them were familiar
with surveillance system. Although the Material Information System controls the stockpile and
usage of PPE was developed after SARS epidemic, only 56% could utilize efficiently. The major
gap was in medical resource mobilization. Only 52% local governments could totally grasp the
health-care workers, ambulances, medical equipments, alternative medical facilities and funeral
capacity. Fourteen governments attended the exercise all could run the mechanism smoothly and
conduct early containment, but outsourcing was needed for larger clusters.
Conclusion: Most local governments in Taiwan had included essential elements in their plans, but
the executive and technical procedures have to be further practiced and promoted continually.
Evaluation, exercise and then comparison among peers can facilitate the revision of the plans
and better practice. We conclude that these processes are valid to improve the overall
preparedness.
Final abstract number: 68.030
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Comprehensive Family Hygiene Promotion in Peri-Urban Cape Town: Reduction of Respiratory
Illness in Children Under Five
         1             2          3           3           1           1
E. Cole , B. Crookston , J. Rubino , K. McCue , M. Hawkley , J. Dixon
1                                           2
 Brigham Young University, Provo, UT, USA, University of Utah, Salt Lake City, UT, USA,
3
 ReckittBenckiser, Montvale, NJ, USA

Previous studies have confirmed effectiveness of handwashing on diarrheal reduction in
developing countries, yet few are comprehensive in addressing a spectrum of gastrointestinal,
skin, and respiratory illnesses that mark the burden of infectious disease for families, especially
children <5 years. Addressing illnesses through a program of family hygiene promotion
(education plus the regular use of key hygiene products) could result in marked reduction of
morbidity and mortality, fewer healthcare visits, and related costs.
Effects of intensive hygiene education alone and in combination with the use of hygiene products
(soap, surface cleaner/disinfectant, and antiseptic) were assessed. Four communities, 685
households participated: two of government (RDP) housing (indoor tap/flush toilet) and two of
informal (INF) housing (communal tap/latrines). Community facilitators monitored illness
symptoms weekly and reinforced disease-prevention behaviors established through participatory
learning and action focusing on handwashing/bathing with soap, cleaning toilet and food
surfaces, and treating skin problems with antiseptic. RDP and INF communities were co-located
in two geographic areas, with one area receiving education and products (intervention), and the
other receiving education only (control). Illness data were gathered from Jun-Nov 2006
(baseline), and for the same 2007 period following education and product introduction
(intervention). Respiratory illnesses assessed included symptoms of cold, pneumonia, flu, otitis
media and strep throat.
Children <5 in all communities had significant reductions in respiratory illnesses over time. RDP
controls were more likely to experience respiratory (HR=1.25, CI: 1.08-1.43) illnesses at follow-up
than intervention counterparts. INF controls were more likely to experience respiratory (HR=1.26,
CI: 1.11-1.44) illnesses at follow-up than intervention counterparts.
While hygiene education alone showed meaningful reduction of respiratory diseases across all
communities, families with education plus the use of key hygiene products saw significant
respiratory illness reduction in children <5.
Final abstract number: 68.031
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Educational Lecture Contributed to Control the Outbreak While It Did not Solve Insecurity of
Health Care Providers in a Long-Term Care Facility
           1             2            2             2         2
Y. Yoshida , Y. Kumagai , Y. Kumagai , K. Shikoshi , T. Dazai
1
 Third Department of Surgery, Toho University School of Medcine, and Keihin Hospital, Tokyo,
       2
Japan, Keihin Hospital, Tokyo, Japan

Background: Although most nosocomial norovirus outbreaks take place in geriatric wards
endemically, still outbreaks may cause tremendous problems for health care systems with which
closure of the unit was associated. Health care providers in a long-term care facility (LCTF) in
Tokyo were educated about norovirus in 16 November; however, they experienced an outbreak
of gastrointestinal disease (nausea, vomiting or diarrhea) among residents during 22-25 January
2008.
Methods: Twenty-nine health care providers in the LCTF educated for an hour on January 25,
2008. They were asked to fill in a questionnaire on their personal practical knowledge to hospital
infections, with self-evaluated score (scale of 7; 1 = minimal, 4 = middle, 7 = maximal) on risk
cognitions and insecurities. We judged level of knowledge to be "enough" when the answer
corrected over 60%, while under 60%, judged to be "not enough".
Results: We received responses from 27 before and 29 after the educational program (male 6,
female 20, no answer 3, average age 46+/-13).
1. Risk cognition: No significant change was observed before and after educational program. The
highest score was observed at "I became sensitive at disposal, hand hygiene, etc" in 6.0 before
the educational program, and in 5.7 after the program.
2. Degree of insecurity to an outbreak: There was no significant change by the educational
program. Middle level insecurities were observed. After educational program, replies
presupposed to "I felt invasion-re-remembrance of outbreak." (Sample sharpness = 3.2).
3. The knowledge to standard precautions and to norovirus before the educational program was
judged to be "enough." But the knowledge to antiseptics and sterilization, to hand hygiene, and to
exogenous infection were judged to be "not enough". All have improved after the educational
program.
Conclusions: The degree of risk cognitions was high, but the educational program did not solve
health care providers' insecurity to an outbreak. It was thought that improving knowledge level
contributed to control the outbreak.
Final abstract number: 68.032
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Microorganisms in Wastewater Reused for Irrigation in a Mexico City Periurban Area
M. Mazari-Hiriart, A.C. Espinosa García, G. Castillo, Y. López Vidal, M.J. Aguilar Medina,
R. Arredondo Hernández
Universidad Nacional Autónoma de México, México, Distrito Federal, Mexico

Background: Wastewater represents a water source for irrigation in periurban areas, with water
recycling as a response to water shortage, related to public health risk of microbiological
contamination. Mexico City (MC) periurban areas reuse water for irrigation. In order to explore the
public heath impact in a periurban agricultural area south of MC, the presence of total coliform
(TC), fecal coliform (FC), fecal enterococci (FE), Helicobacter pylori (Hp), RNA F-specific
bacteriophages (MS2) and enterovirus (EV) in residual water, surface reused water and drinking
were determined.
Methods: Water samples were taken, three from a wastewater treatment plant (RW), three from
canal system that receives the treated water reused for irrigation (IW) and four drinking water
samples (DW). All samples were processed for TC, FC and FE by standard methods of
membrane filtration; Hp detection was performed by PCR-Hybridization, MS2 was counted by the
double agar layer method ISO 10705-1; EV genomes by elution concentration method and
detection by RT-PCR.
Results: A significant reduction in TC and FC counts in RW was observed. FE, MS2 and EV were
not removed, showing tolerance to the wastewater treatment. In IW all bacteria counts were high,
related to water discharge from irregular settlements and livestock, as a second microbial water
contamination, MS2 and EV were positive in all IW samples. Only two water sample were positive
to Hp after water treatment (IW). Water reused in the canal system represents a potential health
risk for agricultural workers and crop consumers.
Conclusions: FC and TC are not adequate microbial indicators. Hp was present after water
treatment. The treatment tolerance of EV and MS2 was evident by their presence in IW. EV and
MS2 could be used as viral contamination indicators and complement the indicator bacteria
presence. Water quality monitoring should be used for a better management, including control of
pathogen distribution.
Final abstract number: 68.033
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Solar Radiation and Enteric Virus Presence in Irrigation Water
A.C. Espinosa-Garcia, M. Mazari-Hiriart
Instituto de Ecologia, Universidad Nacional Autonoma de Mexico, Mexico, Mexico

Background: The most important use of treated wastewater is agricultural production. Potential
health risk associated with it is of great concern, mainly for agricultural workers and vegetable
consumers. Enteric viruses are more resistant to environmental conditions than indicator bacteria;
therefore, it is important to know about their presence and survival under field conditions. Solar
UV-B radiation has an effect on viral nucleic acids by dimers formation, inhibit replication and
transcription, turning virus into non-infectious.
Methods: Samples were taken from the periurban agricultural area, south of Mexico City, where
treated and non treated wastewater is used for irrigation. Water samples were taken and
processed to detect rotavirus (RV), astrovirus (AST) and enterovirus (EV) presence by RT-PCR.
The sampling period comprised two years, covering the cold-dry (November-February) and the
warm-rainy seasons (June-October). The frequencies of enteric viruses were compared with UV-
B radiation data base, registered by Meteorologic Web of Mexico City Government (REDMET).
Results: The higher viral frequencies in irrigation correspond to lower periods of UV-B radiation,
which were during the cold-dry period for both years. The 40% and 30% of samples were
positives for RV in the first and second years respectively. AST was detected in 10% of samples
for both cold-dry periods. For EV 80% and 70% of the samples were positive in the same periods.
During the March-May period, UV-B radiation is higher; this opens the possibility of larger
removal of enteric viruses before the warm-rainy period as shown by the lower frequency of
positive samples.
Conclusion: Under field conditions the effects of environmental factors on the pathogens are
poorly understood. Our observations suggest an effect of natural UVB radiation on enteric viruses
presence; however, it is necessary to carry out additional experimental work supporting this idea,
relevant for tropical countries.
Final abstract number: 68.034
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Fear, Stress, and Reported Pandemic Influenza Response among University Students in the US
V. Perez, A.E. Aiello, G.F. Murray, R. Coulborn, A.S. Monto
University of Michigan-School of Public Health, Ann Arbor, MI, USA

Background: Although vaccines and non-pharmaceutical interventions (NPIs), such as quarantine
and mask use, are considered important aspects of pandemic response to influenza, few studies
have investigated the influence of fear and stress in relation to compliance with NPIs.
Methods: A computer survey assessing demographic factors, vaccination rates, reported levels of
fear related to pandemic influenza and compliance with recommended NPI procedures, such as
mask use, social distancing and quarantine, and a validated perceived stress scale, were given to
participants (N=1,092) from January to February 2008. Survey questions were analyzed using
chi-squared tests and logistic regression to estimate Odds Ratios (OR) and 95% Confidence
Intervals (95%CI).
Results: Among survey respondents, 45% were male and 55% female. 85% of respondents
reported that they must be very or somewhat afraid to wear a face mask during a pandemic.
Females were significantly more afraid of pandemic influenza than males (p= 0.02). However,
females reported needing to feel more afraid in order to change daily activities during a
pandemic, including avoiding air travel, public events, religious services, and self quarantine,
compared to males (all p < 0.05). The odds of being more fearful of a pandemic were significantly
higher among those with greater stress levels (OR=1.53, 95%CI 1.24-1.89, for a 10 unit increase
in stress scores), adjusting for age and gender. Subjects with greater levels of stress reported
needing significantly lower levels of fear to self quarantine (OR=0.67, 95%CI: 0.48-0.94) and
reduce contact with people outside of their residence (OR=0.72, 95%CI:0.54-0.96), compared to
those with lower stress levels.
Conclusions: This study identified significant stress-related differences in response to pandemic
influenza related questions. Further studies are needed to determine how to target pandemic
preparedness measures among young adults in the US with a consideration of perceived stress.
Final abstract number: 68.035
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Expanding Corticosteroid Use in the Developing World as a Factor in the Epidemiology of
Emerging and Reemerging Infectious Diseases
M.L. Lyon
Australian National University, Canberra, Australia

BACKGROUND: The continually expanding use of corticosteroids and other steroidal products in
many parts of the developing world is an important factor impacting on the immune-competence
of large numbers of people, and thus a potential variable in human susceptibility to various
emerging and reemerging infectious diseases, including influenza A(H5N1). Immune-
compromised individuals also provide ideal hosts for the further evolution of disease-causing
organisms. In many countries, corticosteroids are common-often covert-components in a rapidly
expanding range of products including those labeled as herbal or traditional (e.g., jamu), as well
as in over-the-counter and prescription medicines. Such usage patterns act to enlarge the already
significant numbers who are immune-compromised due to diseases such as tuberculosis and
HIV/AIDS. In poor populations, steroid use can but compound the problems of reduced health
status due to poverty, e.g., under-nutrition, crowded living conditions, and the lack of the
infrastructure necessary to provide clean water, good sanitation, and adequate shelter.
METHODS: Extended ethnographic research on the procurement, distribution, sales, and uses of
jamu and other types of steroid-containing medicines in both urban and rural populations.
RESULTS/ CONCLUSIONS: This illustrated presentation provides: (1) frontline, fieldwork-based
information on the scale and frequency of consumption of corticosteroids in various forms
(whether as covert or overt ingredients); (2) an account of the perceived desirability of steroid-
containing medicines, their dominant uses, and key effects/ side-effects in the dosages commonly
used; (3) brief consideration of the scientific literature on the immune-modulating effects of
corticosteroids, and its implications regarding current use patterns in the developing world; and
(4) an argument for the inclusion of questions regarding herbal and traditional medicine use, as
well as use of other steroid-containing medicines, in the epidemiological investigation of emerging
and reemerging infectious diseases, including in the WHO guidelines for research on Influenza
A(H5N1).
Final abstract number: 68.036
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Female Genital Mutilation: Medical Complications of a Human Right Violation
P. Karimi, S. Yari, N. Loghmani
Campaign for elimination of discrimination against women, Tehran, Iran (Islamic Republic of)

Background: Female genital mutilation (FGM) is a deeply rooted cultural tradition observed
primarily in Africa and among certain communities in the Middle East and Asia. According to
estimates by WHO, up to 140 million girls and women have undergone FGM, and each year
another 4-5 million are thought to be at risk of this human right violation. The aim of this study
was to evaluate the medical complications of this procedure in order to attract healthcare
professionals' attention to this problem.
Methods: This cross-sectional study has been performed on more than 340 women undergo this
procedure in south of Iran during 2004-2007. Demographic data and complications of FGM in
each woman have been gathered carefully by interviews, history taking and physical
examinations in a few women
Results: The mean age of participants were 23 ± 4 y/o and 84% married. All of them forced to
undergone FGM by their parents at mean age of 3.3 y/o. The result of this study demonstrates
different immediate and delayed complications. 57% of the interviewed women had experienced
significant immediate complications such as bleeding, shock, wound infection and swelling.
Delayed complications were reported in 32% of these women reported as painful and difficult
menstruation, pelvic infections, urinary tract infections, massive hemorrhage after delivery and
obstructed and prolonged labor. Terrible life-long psychological trauma should be added to these
physical complications that presented in all of women. None of these women reported experience
of orgasm during their sexual life. In addition, prevalence of HIV/AIDS was significantly higher in
these women.(P<.0001) Fortunately no mortality has been reported in these women in period of
study.
Conclusion: Findings of this study highlight the need for heightened awareness of issues around
FGM so as to better provide adequate physical and psychological support to affected women.
Different kinds of interventions should be considered, starting with the development of informative
campaigns, training of health workers, institution of a tollfree number, international cooperation
programs and the responsibility of the family where the crime is committed. The result of this
study discusses the possible relationship in terms of health risk between HIV/AIDS and FGM in
the south of Iran and calls for more concerted efforts, including further research in order to
address this potential risk. Particularly, health care professionals' can play a key role in
eliminating FGM, as a violation of a person's fundamental rights to physical and mental integrity
of women and girls.
Key Words: Female genital mutilation, Human right, HIV/AIDS, tradition, complication
Final abstract number: 68.037
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Childhood Infections and Vaccination History as a Risk of Multiple Sclerosis
          1          2             3
P. Karimi , A. Bayati , M. Mehrabi
1
 Immunology, Asthma and Allergy Research Institute, Medical Sciences/University of Tehran,
                                   2
Tehran, Iran (Islamic Republic of), Iranian Center of Neurological Research, Medical
                                                                   3
Sciences/University of Tehran, Tehran, Iran (Islamic Republic of), Neurology Department of Iran
University of Medical Sciences, Tehran, Iran (Islamic Republic of)

Background: Multiple sclerosis(MS) is an inflammatory and autoimmune demyelinating disease of
the CNS and one of the most common neurological disorders among young adults. The etiology
and pathogenesis of MS has not been fully defined but it has been hypothesized to be the result
from an aberrant immune response possibly triggered by delayed exposure to a common
childhood infection. The aim of this study was to analyze the role of childhood infections and
vaccination history in patients with MS.
Methods: This case-control study conducted on 400 cases with definite MS according to
McDonald criteria, in whom onset symptoms occurred up to 2 years prior to the interview. An
equal number of controls, individually matched by sex, age and area of residence, were included,
too. Demographic data and past medical history of both case and control group were recorded
through a face to face interview.
Results: The total number of some common childhood viral infections including measles, rubella,
chickenpox, and mumps at age 7 years was significantly higher in MS cases than in controls.
(OR = 1.8, 95% CI 1.4-2.5) Furthermore, we did find a relationship between mumps after 15
years of age(OR=2.3, 95% CI 1.2-4.3) or measles after 15 years of age(OD=2.8, 95% CI 0.8-9.1)
and MS. Our results demonstrated that individuals who suffered from infectious mononucleosis, a
marker of late infection with the Epstein-Barr virus, have an increased risk of MS. Concerning
vaccinations, no statistically significant differences were found between groups. However, the age
at which MS patients were immunized against poliomyelitis was significantly higher than the
corresponding age for controls (15.8±8.9 years, P<0.01). In addition, the risk of MS was not
associated with birth order or social class or other demographic data.
Conclusion: In conclusion, our findings suggest that measles, rubella, chickenpox, and mumps at
age 7 years and measles and mumps 15 years and individuals with mononucleosis infectious
have higher risk of MS. These findings support the hypothesis that individuals who suffered from
childhood infectious disease have an increased risk of MS although further studies seem to be
needed.
Key words: Multiple sclerosis, measles, rubella, chickenpox, mumps, mononucleosis infectious
Final abstract number: 68.038
Session: Public Health and Prevention (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

World Rabies Day: A collaborative initiative to...Make Rabies History!
             1            2            3                2         2          2
C.A. Hanlon , P.J. Costa , A. Tumpey , S. Cleaveland , K. Doyle , D.J. Briggs
1                                                 2
  Kansas State University, Manhattan, KS, USA, Alliance for Rabies Control, Midlothian, United
          3
Kingdom, Centers for Disease Control and Prevention, Atlanta, GA, USA

Background: Although the word alone evokes a highly charged response, rabies remains a
severely neglected disease. The continuing loss of lives to rabies infection is entirely preventable
and directly related to economic and educational disparity.
Methods: The World Rabies Day initiative arose from a group of rabies prevention professionals
who built partnerships with the World Health Organization, the World Organization for Animal
Health (OIE), the Centers for Disease Control and Prevention, Pasteur Institute, and other
organizations. This initiative advocates for improving the health of the whole population, human
and animal, - a 'One Medicine Approach' - by raising awareness about the need to control rabies
in the main global animal reservoir, the domestic dog, and prevent human rabies through
education and appropriate medical prophylaxis.
Results: During the inaugural year, at least 74 countries participated through a wide variety of
events including vaccination clinics, educational seminars, media outreach, museum and zoo
exhibits, parades, festivals, dances, puppet shows, runs, and dog walks. Summary data indicates
that nearly 400,000 people participated in a World Rabies Day event, over 600,000 animal
vaccinations were administered and more than 54 million people were educated worldwide. In
some countries, rabies experts convened to discuss goals and plans for rabies prevention and
control, with several initiating a national program. Veterinary colleges joined forces towards this
effort, with activities at 24 in the US, 15 in India, 5 in Indonesia, and several in Mexico, Peru, The
Philippines and other countries.
Conclusions: The first World Rabies Day was a major achievement for the rabies prevention
community. These efforts are envisioned to be part of comprehensive human and animal health
delivery that would develop and augment public health and veterinary infrastructure in regions of
greatest need. Now is the time for 'Working Together to Make Rabies History!'
Final abstract number: 69.001
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Investigation of Common Microorganisms in Patients with Brain Abscess
G. Eslami, F. Fallah, M. Lotfi, M. Golshani, H. Goudarzi
Shaheed Beheshti University, School of Medicine, Tehran, Iran (Islamic Republic of)

Background: Brain abscess is a Focal collection within the brain parenchyma. Despite the
technological advancements in diagnostic and neurosurgical procedures, brain abscess
continues to remain a potentially fatal central nervous system infection.
Methods: In a descriptive study, we evaluated 30 cases of brain abscess were treated at
Loghman Hakim hospital from March 2003 to December 2006.
Results and conclusion: Out of 30 patients 20 (66.7%) were males and 10 (33.3%) females.
Mean age was 32 years (range 8 years to 70 years). There was a peak at 20 to 29 years.
Predisposing factors were identified in 20 (66/7%) patients. The common predisposing factors
were otic infection (26.7%), I.V. drug use (16.7%), neurosurgery (13.3%) and penetrating head
trauma (6.7%). The most frequent presenting signs and symptoms were headache (73.3%),
nausea and vomiting (70%), fever (50%), focal neurologic defects (50%) and mental status
changes (46.7%). Triad of fever, headache and focal deficit were seen in 20% of patients. Solitary
abscess was found in 70% of the cases while in 30% of the cases multiple abscess were found.
Frontal lobe and parietal lobe were the commonest sites involved.
Cultures were found positive for microorganism in 66.7% of the cases. 45% of which were
aerobic and 55% anaerobic bacteria.
Staphylococci (30%), peptostreptococcus (25%), bacteroids (20%) and streptococcus (15%),
were the commonest isolates.
Third generation cephalosporins and metronidazole and vancomycin were used most often for
empirical therapy. Burr hole aspiration was done in only 50% of the cases. Overall mortality was
23.3% in this series. Mortality rate was 33.3% in patients with medical treatment.
Final abstract number: 69.002
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Incidence of Brucellosis in Shazand County, Iran, 2006
M.R. Hosseini, M. Sadeghi, E. Khondabi, H. Bakhshali, A. Jamal-Omidi
Shazand Health Center, Shazand, Iran (Islamic Republic of)

Background: Brucellosis is a major zoonosis with a worldwide distribution and represents a
serious public health problem in many developing countries. The aim of this study was to figure
out the annual Incidence rate of Brucellosis in Shazand County.
Materials and Methods; All patients living in Shazand county, with a clinical picture compatible
with Brucellosis plus to positive laboratory results were included in this study. Positive laboratory
results were defined by the Ministry of Health as Wright agglutination titer 1/80 and 2ME titer
1/40. A questionnaire including Demographic data, symptoms and onset of the problem were
filled in by every patient. The data was analyzed by means of SPSS software version 14.
Results: In this questionnaire based study, out of the 145 patients, who participated in this study,
95 were male and 50 were female. 72 patients were above 40 years old, 73 had less than 40
years of age and among them 3people were under 10 year old (2%). 40% of patients had
presented during summer months. Incidence rate was 13.1 per 10000 population.
Conclusion: The incidence rate in Shazand County was 13.1 per 10000 population and thus has
not changed much compared to a year before (13/10000). The incidence rate in Markazi state,
where our county is located, has been 7.3 per 10000 population, so the prevalence of Brucellosis
in Shazand county has been much higher than expected.Unfortunately in IRAN there is no annual
rate avalable,we just know that it had been 24 per 10000 about 8 years ago. Incidence of
Brucellosis in European countries is far less than that (0.01/100000) which indicates the need for
further preventive measures for vaccination of the cattle and better diagnostic policies for
Brucellosis among cattle and sheep.
Final abstract number: 69.003
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

A Large Outbreak of Water-Borne Typhoid Fever Attributed to Contaminated Well in a Coastal
City, China
H. Lin
Taizhou Municipal Center for Disease Control , Taizhou, China

Background: On October 15, 2006, the China information system for disease control and
prevention revealed typhoid fever (TF) cases increasing greatly from October 7, comparing with
the same period of the previous year, in a coastal city, P.R. China.
Objective: To identify its epidemiological cause, and develop its control measures.
Methods: TF case was defined as any case involving onset of fever between October 7 and
December 15, 2006, plus the following: high fever (>38.5°C), headache, malaise, intestinal
hemorrhaging, myalqia, or rose-colored spots on the skin, and with the laboratory result of the
decreasing Eosinophil cell or Widal test (+) in Jiaojiang district. The first 25 cases from October 7
and 100 controls randomly chosen from neighborhood of each case, age referring to +5 year old,
were selected to carry out a case-control study, through questionnaire. Well water was randomly
selected to detect the total bacteria, Coliform group. The chi-square test and non-conditional
logistic regression analysis was used for statistical analysis. Statistical significance was assessed
by the two-sided test with the test level equaling 0.05.
Results: Totally 58 typhoid cases, including 29 confirmed and 29 probable cases were identified
between October 7 and December 15, 2006. The cases were mainly non-residents. Through non-
conditional logistic regression analysis, the result showed that mode to use well water (Odds
Ratio[OR] =5.71, 95%. Confidence interval [95% CI]=2.23-14.59) and eat outside (OR=8.18, 95%
CI=1.51-44.26, AR=0.27) was the main causation of this outbreak. In addition, through chi-square
test, the result also shows that Xiama market (OR=5.46, 95% CI=1.61-20.37, AR=0.23), cooked
food taking(OR=4.13, 95% CI=1.44-11.92, AR=0.27 may also the suspected risk factors of this
outbreak. The number of total bacteria and Coliform group in well water both far outnumber the
national drinking water standards. Further more, through field investigation, a public toilet was
found 5 meters far from a well in the Xiama market.
Conclusion:This TF outbreak was mainly caused by the inappropriate manner to use
contaminated well water system, probably by septic tank seepage into storage well and unhealthy
food habits. The epidemic was controlled by the effective measures.
Keywords: typhoid fever, outbreak, waterborne, field epidemiology
Final abstract number: 69.004
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Epidemiological Risk Factors of Urban Leptospirosis in North Chennai (Tamil Nadu) - A South
India Study
N. Loganathan, S. Shivakumar
Govt. Stanley Medical College & Hospital, Chennai, India

BACKGROUND: Leptospirosis is under diagnosed and under reported in India due to lack of
awareness of the disease and lack of appropriate laboratory diagnostic facilities in most parts of
the country. Out of 28 States and 7 Union Territories in India, leptospirosis is endemic in 5 States
[Tamil Nadu, Kerala, Gujarat, Karnataka and Maharashtra] and in one Union Territory, Andaman
and Nicobar Islands. Chennai (formerly Madras) is an important coastal metropolis in South India
and has a land area of 172 kilometersquare with a population around 6 million. The average
yearly rainfall is about 1500 mm, with most rainfall coming from North East Monsoon (September
- December).This study was undertaken to study the epidemiological profile of urban leptospirosis
in North Chennai.
PATIENTS AND METHODS: Patients with fever admitted in Government Stanley Medical
College and Hospital, tested positive for leptospirosis utilizing Macroscopic Slide Agglutination
Test (MSAT) titers of 2+ and above with Modified Faine's score of > 25 [Clinical (A) +
Environmental (B) + Laboratory (C)] were taken up for study [confirmed by Microscopic
Agglutination Test (MAT)]. These patients were evaluated for epidemiological risk factors as
shown in Table below in addition to relevant clinical and lab profile. Other causes of fever were
excluded with relevant investigations. This prospective study was undertaken from February 2006
to May 2007.
RESULTS: 90 patients were analyzed. Males - 56 (62.2%); Females - 34 (37.7%) Age range: 13 -
74 years, Mean Age: 37.5 years.
All cases came from North Chennai, where majority of lower socio economic population reside.
There were 86.6% outdoor manual workers, 7.7% housewives & 5.5% were students. 51 %
cases occurred between September to December. Contact with contaminated environment
contributed to cases in other months. The epidemiological profile of our study group was shown in
Table. The important factors in the contact with contaminated environment were, poor sanitation:
95.5%; walking barefoot: 85.5%; poor drainage facilities: 78.8% and contact with rodents in
33.3% cases.
Fever, Headache, Myalgia were the common presenting features and jaundice (23.3 %), renal
failure (16.6%) were the important complications noted. Mild cases were treated with oral
Doxycycline and severe cases (with organ dysfunctions) with parenteral penicillin. One patient
was dialyzed. There were no mortality.
CONCLUSION: This study revealed that,
a) Poor sanitation, walking bare foot, inadequate drainage facilities were the important
epidemiological risk factors due to contaminated environment in acquiring leptospirosis in North
Chennai.
b) Rodents were the main animal source of contact.
c) Rainfall was another important epidemiological risk factor.
Final abstract number: 69.005
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

A Seroepidemiologic Survey of Brucellosis in Human and Animals in Birjand, East of Iran
           1          2             3
S. Bokaie , L. Sharifi , H. Alizadeh
1
 Veterinary Medicine Faculty of Tehran University, Tehran, Iran (Islamic Republic of),
2
 Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences,
                                    3
Tehran, Iran (Islamic Republic of), Faculty of Veterinary, Garmsar Branch, Islamic Azad
university, Tehran, Iran (Islamic Republic of)

Background and Objectives: Brucellosis is a major bacterial zoonosis of global importance. In Iran
human brucellosis is endemic in all parts of the country and Brucellosis is a significant health
problem in Iran. The aims of this study were determination of seroprevelance of brucellosis in
sheep, goat, cattle and human and evaluate the correlation between human and animal
brucellosis in Birjand, a sub-tropical city in east of Iran.
Methods: Among 472106 patients referred to hygiene centers and 12113 cattle and 7199 sheep
and goat sera samples which tested by veterinary organization of South Khorasan province, Iran
during 2002-2006, statistical analysis was performed to show the prevalence rate of brucellosis.
Pearson correlation coefficient was used to evaluate the correlation between animal and human
brucellosis.
Results: Results shows that the prevalence rate of brucellosis during 2002-2006 in Human was
37 per 100,000, in sheep and goat were 340 per 10,000, and in cattle were 56 per 10000.
Statistical analysis showed that Pearson correlation coefficient of cattle and sheep
brucellosis(r=+0.746), cattle and human(r=+0.228), human and sheep(r=+0.304) are positive but
incomplete
Conclusion: According to the results of this study prevalence of brucellosis in the Birjand
population was much lower than in the reports of other countries of the region. Higher correlation
between sheep and human brucellosis is due to consumption of sheep raw milk, cheese and
meat or direct contact with sheep in Birjand.
Keywords: Brucellosis, Birjand, Seroprevalence
Final abstract number: 69.006
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Epidemiology and clinical predictors of GAbHS among students in Alexandria, Egypt
M. Abdel Moneim, M. Hashish
Alexandria University, Alexandria, Egypt

Pharyngotonsilitis in one of the most common respiratory diseases in the community among
childhood. Nearly 28% - 40% are estimated to be caused by GAbHS which is considered the
most important etiological pathogen in the terms of complications.
Objectives: To study the epidemiology and to determine the clinical predictors of GAbHS
pharyngitis. Methods: A cross- sectional study was conducted over a period of one year where
primary and preparatory school children (600) attending school health insurance clinics and
suffering from pharyngotosilitis were screened . The data collection tools included questionnaire
interview inquiring about demographic data, clinical data and a throat swab was taken for culture
on a 5% sheep blood agar plate then subjected to Bacitracin susceptibility. Chi square tests were
used, Logistic regression analysis was performed to predict the significant variables that were
significantly associated with GAbHS.
Results: the overall prevalence of GAbHS pharyngitis was 30.3%, and the peak prevalence was
in spring. The Prevalence of GAbHS decreased with age , positive cultured cases reported family
history of rheumatic fever, recent contact with pharyngotosilitis cases. The predictive clinical
criteria for GAbHS pharyngitis were tender anterior cervical lymph node, enlarged lymph node, a
history of contact with cases, limb pain and enlarged tonsils.
Conclusion: further researched are needed to reevaluate continually the clinical sings associated
with GAbHS in the light of epidemiologic and demographic characteristics.
Final abstract number: 69.007
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Seroepidemiology of Helicobacter pylori Infection Among Health Care Workers
M. Metanat, B. Sharifi-mood, S. Izadi, M. Miradi, A. Ghorbani-Vaghei, S.H. Dawudi, F. Fayyaz-
Jahani
Research center for infectious diseases and tropical medicine,Zahedan medical university,
Zahedan, Iran (Islamic Republic of)

Introduction: Helicobacter pylori is a worldwide infection. Helicobacter pylori has now been well
recognised to play a significant role in the pathogenesis of gastroduodenal disease. The
prevalence is low in developed countries but high in developing countries. However very few data
are actually available on H. pylori seroprevalence in Zahedan city. To determine the
seroprevalence of Helicobacter pylori (H pylori) among health care workers and to assess the
relationship between H pylori infection, age, sex, education stand, number of family, water
source.
Methods and materials: This was a cross-sectional study which conducted on 97 healthy
individual of health care workers in Zahedan .These subjects were chosen randomaly. Socio-
demographic information was collected using questionnaires.The diagnosis of H. pylori infection
was based on serological test using ELISA technique and measurement of IgG with 94%
sensivity and 98% specificity. These data were analyzed using SPSS (Chi-square, Odds ratio,
pearson, linear regression).
Results: A total of 97 individuals were included in the study. 64 patients (66%) were females and
33 (34%) were males.In general, the prevalence of H. pylori infection was 34%. No significant
difference in the prevalence between males and females. Also there was no correlation between
H. pylori infection and age, family member and water source (p=0.965). There was a significant
correlation between education and H. pylori infection. (p=0.04)
Conclusion:Upon the result emerged from our study , the prevalence of H. pylori infection was
34%. H. pylori infection is endemic in Zahedan, although the prevalence recorded was lower than
those observed in similar developing regions. Improvement in hygienic conditions and
socioeconomic status, can decrease the rate of This infection. It should however be noted that
only health cares workers were studied and the possibilities of having higher prevalence in other
health settings and/or in the general population is not unlikely.
Final abstract number: 69.008
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

High Rate of Meningococcal Disease in Baja-California, Mexico: An Unknown Endemic Disease
with a Rate Similar to the USA
E. Chacon-Cruz, J.L. Lopez-Viera, C.A. Lara-Muñoz, R.M. Rivas-Landeros, M.C. Duran-
Hernandez, M.L. Voelker, J.A. Hurtado-Montalvo
General Hospital of Tijuana, Tijuana, Mexico

Background: Meningococcal Disease (MD) is reported with a rate of 0.06/100,000 in Mexico,
much lower than the 0.44/100,000 reported in the US. Tijuana, Baja-California, is a Mexican city
that borders with San Diego, California, with a daily 50,000 people transit through the border. The
real incidence of MD is unknown in this region.
Methods: From Oct/15th to Jan/15th, an active search for MD was performed prospectively at the
General Hospital of Tijuana, Baja-California, Mexico. Patients between 1 month and 16 years of
age were included. Clinical, demographical and microbiological characteristics were analyzed.
Results: A total of 14 confirmed (an approximate rate of 0.45/100,000) and 6 probable MD cases
were found. From confirmed cases, 5 had clinical purpura (CP) and meningitis, 2 CP without
meningitis and 7 meningitis without CP. Avg age was 5.2 years (5m - 16y), all children were local.
Most cases were seen during winter and autumn, and a previous upper respiratory infection was
present in 50% of cases. Incidence of serogroups found were C (64.3%), B (14.3%), Y (7.1%)
and unknown (14.3%). Overall mortality was high (21%), and the presence of CP,
trombocytopenia and prolonged clotting factors at admission were associated with poor
prognosis. Furthermore, N. meningitidis was the major cause of confirmed bacterial meningitis.
Conclusions: MD is endemic in Baja-California, Mexico, with similar rates to the US, but much
higher when compared to Mexican-National reports. Serogroup C was the most prevalent, and
immunization should be a Public Health issue in this Mexican region.
Final abstract number: 69.009
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Prevalence and Predictors of Methicillin-Resistant Staphylococcus aureus (MRSA) and
Extended-Spectrum Beta-Lactamase (ESBL) Gram-Negative Bacteria at Hospital Presentation in
Singapore
       1         1            2          2           3         4          1          6
S. Pada , D. Lye , P. Krishnan , J. Chan , S.P. Chan , G. Cham , B.S. Ang , Y.S. Leo
1                                                                                  2
 department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore, Laboratory
                                                           3
Medicine, Tan Tock Seng Hospital, Singapore, Singapore, Clinical Research Unit, Tan Tock
                                       4
Seng Hospital, Singapore, Singapore, Emergency Medicine, Tan Tock Seng Hospital,
                       1
Singapore, Singapore, Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore,
           6
Singapore, Tan Tock Seng Hospital, Singapore, Singapore

Background: Methicillin resistance occurs in 66% of nosocomial Staphylococcus aureus while
ESBL in 21% Escherichia coli and 51% Klebsiella pneumoniae at our institution. Community-
onset MRSA and vancomycin-resistant enterococci (VRE) occur locally. We wish to determine
the prevalence and predictors of colonisation by MRSA, VRE and ESBL-positive Gram-negative
bacilli (GNB) in patients admitted from our Emergency Department.
Methods: All adult patients >16 years of age consenting to participation underwent nasal, axilla,
groin and rectal swabs, processed by validated published methods to screen for MRSA, VRE and
ESBL-positive GNB. A questionnaire was used to record age, gender, co-morbidity, nursing home
residence, contact with healthcare workers; hospitalisation, visit to hospital outpatient, general
practitioners or government polyclinics within 3 and 12 months; and oral antibiotic use within 1
and 3 months. Univariate and multivariate analysis were performed to determine independent
predictors of colonisation by MRSA, VRE and ESBL-positive GNB.
Results: Of 1003 patients recruited, mean age was 47 years; male comprised 65% and nursing
home residents 2.2%. Diabetes mellitus occurred in 21%. Hospitalisation within 3 and 12 months
was noted in 17% and 27% respectively. Visit to hospital outpatient, government polyclinics and
general practitioners within 12 months occurred in 48%, 44% and 48% respectively. Oral
antibiotic was taken by 28% within last 3 months. MRSA colonisation occurred in 1.8% and
ESBL-positive GNB 12% while none had VRE. The only independent predictor of MRSA
colonisation was hospitalisation within 3 months (adjusted odds ratio 3.9, p=0.04) and of ESBL-
positive GNB colonisation was oral antibiotic within 1 month (adjusted odds ratio 1.9, p=0.02).
Conclusions: MRSA and VRE colonisation remain a nosocomial problem while oral antibiotic use
in the community has selected for alarmingly high ESBL-positive GNB colonisation rate. Hand
hygiene to control nosocomial MRSA transmission and prudent antibiotic prescribing are needed.
Final abstract number: 69.010
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

A large point-source outbreak of Salmonella typhimurium Phage Type 9 in Sydney, Australia,
March 2007
           1          1         2             1                     1         2          3
T. Mannes , L. Gupta , A. Craig , A. Rosewell , C. Aimers-McGuiness , J. Musto , Q. Wang
1                                                                            2
 Sydney South West Area Health Service Public Health Unit, Sydney, Australia, NSW Health
                                3
Department, Sydney, Australia, Centre for Infectious Diseases and Microbiology, ICPMR,
Westmead, Sydney, Australia

Background: This paper reports one of the largest point-source Salmonella outbreaks in Australia.
Methods: Following initial notification of 5 cases who had purchased food from a shop, 319 cases
were identified by active and passive surveillance through health care providers and laboratories.
Using a standardised telephone questionnaire, we interviewed 283 people (89%). The
questionnaire collected demographic data, exposure history and illness details. We confirmed
symptoms of the other 36 cases by record review or clinician interview. Follow-up interviews were
conducted on randomly-selected cases (n=45) after 6 weeks to obtain information on illness
duration and severity. Data were analysed using SAS version 9. A separate food authority
reviewed food handling practices, collecting environmental and food samples. Eight food handlers
were screened. Results of Salmonella cultures, phage typing and Multi-Loci Variable Number of
Tandem Repeats Analysis were collated.
Results: The epidemic curve is at Figure 1. All cases ate food from the shop, with 312 consuming
food purchased on one of 4 consecutive days. Incubation periods ranged from 1-118 hours
(median 10 hours). Table 1 describes characteristics of cases. 43% required hospital admission.
Follow-up of the subset of 45 cases identified prolonged symptoms (mean duration 14 days). 173
cases (54%) had laboratory confirmed S. Typhimurium on stool or blood culture. Six food
handlers had positive stool cultures, including one who was asymptomatic. Environmental
investigation identified poor food handling practices, including cross-contamination of cooked
food with raw egg products. Isolates from human, food and environmental samples were
identical. Traceback investigating whether eggs were the initial source of S. Typhimurium in this
outbreak was inconclusive. Following intervention by authorities, the food outlet closed.
Conclusion: This outbreak caused significant morbidity and high hospitalisation rates. It provides
an argument for increased regulation of small premises that handle raw egg products.
Final abstract number: 69.011
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Prevalence of Beta Hemolytic Group Streptococci Among Elementary School Children in Zanjan
B. Amini
Medical University, Zanjan, Iran (Islamic Republic of)

Background: Pharyngitis and rheumatic fever caused by Beta Hemolytic group A streptococci
possess the prominent importance among common infectious diseases.
Since the carriers play an important role in its transmission among the susceptible individual
,specially school child , this study was conducted to determine the prevalence of pharyngeal
colonization of Streptococci among elementary school children in Zanjan.
Material and methods: the studying population include 1345 randomly selected school student
from four different boy schools ,each comprising of five standard grade, during spring 2005.
Pharyngeal swabs were collected from each asymptomatic individual and subsequently cultured
on blood agar media . following incubation at 37 degree ,with the help of morphological assay and
standard biochemical tests , the visible colonies were examined for confirmative diagnosis.
Results: the prevalence of pharyngeal beta hemolytic streptococci was determined as 41% , in
spied of difference in infection rate of different schools and grades , the statistical analysis,
revealed no significant difference in obtained results from socioeconomic and demographic point
of view.
Conclusion: the obtained results seeks a great attention toward implication of organized planning
and schedules ,in order to reduce the incidence of streptococcal pharyngitis and its proceeding
sequels.
Final abstract number: 69.012
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Meningococcal Disease Epidemiology in Asia
            1             2             1
J. Leimkugel , L.J. Silva , G. Pluschke
1                                             2
 Swiss Tropical Institute, Basel, Switzerland, Novartis Vaccines and Diagnostics, Siena, Italy

Background Awareness of meningococcal disease has increased in Europe, the Americas, and
Africa, leading to the development and introduction of new meningococcal vaccine formulations.
Despite repeated epidemics in many Asian regions, in particular China, with pandemic spread of
hypervirulent clones, meningococcal disease epidemiology in Asia is only partially known.
Methods We collected and reviewed studies and surveillance data on a national or regional level
by performing searches on PubMed, regional WHO homepages, and the websites of the
ministries of health with "meningitis", "meningococcal disease", "- outbreak", "- incidence", and
the name of country as search phrases.
Results Hyperendemic meningococcal disease of hypervirulent serogroup A clones was typical in
China and parts of what was then the USSR (including Mongolia), which spread to the Indian
subcontinent, until the late 20th century, and is being replaced by endemic serogroup B and C
disease.. In contrast, very low meningococcal disease has been recorded in Japan and Taiwan in
recent years, mostly caused by local clones (expressing B serogroup). Scarce data of disease
incidence indicate moderate endemic incidence levels of up to 2 yearly cases/100,000 inhabitants
in some near-eastern countries. Saudi Arabia reveals an interesting epidemiology, with usually
low endemic disease rates disrupted by outbreaks in Mecca during the Hajj pilgrimage in certain
years, most recently caused by serogroup W-135 in 2000 and 2001. Almost nothing is known of
disease in South-East Asia and some regions of Central Asia.
Conclusions Scarce data from most regions make Asian meningococcal disease epidemiology
poorly understood. Yet, from the available data, trends in the different regions of Asia appear
highly variable. Increasing mobility of man and recent global changes in the epidemiological
pattern of meningococcal disease demand a comprehensive meningococcal disease surveillance
to understand meningococcal disease globally and prepare for intervention strategies, ideally with
broad protection by vaccination.
Final abstract number: 69.013
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Epidemiological Characterization of Clostridium difficile Strains in Shanghai, China
            1        1          1          1        2                 2             2       2
H. Huang , S. Wu , M. Wang , Y. Zhang , H. Fang , A.C. Palmgren , A. Weintraub , C.E. Nord
1                                                                                2
  Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China, Karolinska
Institute, Karolinska University Hospital, Stockholm, Sweden

Background: Clostridium difficile remains the leading cause of nosocomial-acquired diarrhea. The
number of outbreaks of Clostridium difficile-associated diarrhea (CDAD) that are severe or
fulminant has risen markedly in many North American and European hospitals since 2003 despite
breakthroughs in clinical diagnosis, effective treatments and infection control programs. However,
there is still a paucity of epidemiological data on CDAD in China.
Methods: A 1-year prospective study of C. difficile infections was conducted in Huashan hospital
in order to obtain an overview of the phenotypic and genotypic features of clinical isolates of C.
difficile.
Results: Of 58 isolates from diarrhoeagenic patients with suspected CDAD, 46 were toxigenic: 36
were positive for both toxins A and B, and 10 were toxin A-negative toxin B-positive. All strains
were binary toxin negative. The minimum inhibitory concentrations of 12 antimicrobial agents
were determined using the agar dilution method. All strains were fully susceptible to
metronidazole, vancomycin, meropenem and piperacillin/tazobactam. Resistance to moxifloxacin,
ciprofloxacin, levofloxacin, erythromycin, clindamycin, tetracycline, rifampin, fusidic acid was
found in 41.4%, 100%, 50%, 72.4%, 72.4%, 34.5%, 24.1% and 6.9% of the isolates, respectively.
Co-resistance to erythromycin, tetracycline and moxifloxacin was found in 12 strains. Resistance
to moxifloxacin or tetracycline was associated with resistance to erythromycin. Ten different
ribotypes were identified by PCR, with four ribotypes (SH I, SH II, SH III and SH IV) accounting
for 66.7% of the strains. None of them was the same as the strain BI/NAP/027.
Conclusion: The present study is the first China survey of C. difficile isolates from patients with
CDAD. Ongoing epidemiological surveillance of cases of CDAD is required to detect clustering of
cases and to monitor the emergence of specific highly virulent clones in China.
Final abstract number: 69.014
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Massive Salmonella Poisoning in a Prefecture of Central Greece, Incidence Detailed Presentation
                   1                 1          1               2            1           1
E. Vlachaki-Taveli , A. Anastassiou , P. Patra , K. Katsiardanis , K. Kouraki , D. Krikou ,
                 1                3           4
E. Papadopoulos , A. Gerovassili , G. Mitsiou
1                                                                  2
  General Hospital, Volos, Hellenic Health System, Volos, Greece, Accident and Emergency
                                          3
Clinic, General Hospital, Volos, Greece, Biology and Genetics Department, Medical School,
                                        4
University of Thessaly, Larisa, Greece, Greek Society of Social Pediatric and Health Promotion,
Larisa, Greece

Background: Salmonella is transmitted through infected food from animals or infected humans or
infected subjects. Its culture time is between 6-72 hours. This study aims to give a detailed
description of massive gastroenteritis infection due to Salmonella enteritidis (S.e.) in the
prefecture of Magnesia among people of all ages and to evaluate the medical services of the
Achillopoulio General Hospital of Volos (AGHV) in the instance of an emergency incident.
Materials and Methods: S.e. was transmitted to church goers of memorial services on the 23/5/04
due to consumption of infected boiled wheat that originated from the same patisserie and had the
same infected ingredients. The collection of the necessary information was made mainly through
the record books of the A&E, the microbiology laboratory, the hospital inflammation committee
and the admission centre of the AGHV.
Results: 430 people (0-86yo) with symptoms of gastroenteritis sought medical help at the AGHV
with more than 500 visits in total between 23-26/05/04. 387 of these patients took part in the
current study aged over 15 yo, residents mainly of the city of Volos (70%). 103 (26.6%) patients
were hospitalized specially of the ages over 60yo (39%). The patients sought medical help mainly
on the second 24h since the consumption of the infected food which is in agreement with the big
size of the number of admissions on the 24/5/04 (53%). Median hospitalization time was 1-2 days
(56.9% while only 5% needed to stay in the hospital for over 5 days. Patients who had had stool
culture did not stay longer than 3-4 days.
Conclusions: The emergency incident put the AGHV personnel in a test to which they responded
efficiently, promptly and successfully even though there was a system overload. It is also proven
that in situations like these the readiness and collaboration between the different clinics is
essential.
Final abstract number: 69.015
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Emergence of Clonally Related SHV-5 ESBL-producing Escherichia coli Strains in the
Community
          1            2                 3
J. Vranes , B. Bedenic , A. Bauernfeind
1                                                   2
 Zagreb Institute of Public Health, Zagreb, Croatia, Zagreb University Medical School, Zagreb,
        3
Croatia, MICOER, Munich, Germany

Background: Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli is an
emergent cause of urinary tract infections in nonhospitalized patients in different countries. The
aim of this study was the molecular characterization of ESBL-producing E. coli strains isolated
from urine of outpatients in Zagreb region.
Materials and Methods: During the five-month study period a total of 2, 451 E. coli strains were
isolated from urine of nonhospitalized patients with significant bacteriuria. ESBL production was
detected by double-disk diffusion technique and by < 3-dilution reduction in the minimal inhibitory
concentration of ceftazidime in the presence of clavulanate. A total of 39 ESBL-producing E. coli
strains (1.59%) were collected and characterised. Molecular relatedness between the strains was
analyzed by pulsed-field gel electrophoresis (PFGE) and isolates were considered to be
genetically related if the Dice coefficient correlation was > 80%. Beta-lactamases were
characterized by isoelectric focusing, substrate profile determination, polymerase chain reaction
and sequencing of blaSHV genes. PCR products were subjected to PCR Nhe test to distinguish
between SHV-1 and SHV-ESBL. Plasmids were extracted by alkaline lysis method and digested
with EcoR1 enzyme.
Results: Chromosomal DNA analysis by PFGE exhibited a great genomic similarity among ESBL
strains. The Dice coefficient of similarity for 25 strains was equal or more than 83.49%. All strains
produced a beta-lactamase with the isoelectric point of 8.2. Enzymes produced by the strains
antagonized the activity of the disks containing ceftazidime, cefotaxime, ceftriaxone and
aztreonam but not cefoxitin and imipenem. All strains yielded an amplicon with primers specific
for SHV beta-lactamases. PCR Nhe test demonstrated SHV-ESBL in all tested strains. Fifteen
strains possessed an additional TEM beta-lactamase. No CTX-M beta-lactamases was found.
Based on sequencing of blaSHV genes enzymes of five strains were identified as SHV-5 beta-
lactamase which conferred on the producing isolates high level of ceftazidime and aztreonam
resistance. Mutations at the Ambler positions 238 and 240 were found in all gene sequences. The
blaSHV genes were encoded on related plasmids which also carried resistance genes for
aminoglycosides. Plasmids were assigned to nine fingerprinting patterns (A-F).
Conclusion: The study demonstrated community-associated emergence of clonally related SHV-5
beta-lactamase-producing E. coli strains. Other studies on ESBLs in the outpatient populations
reported CTX-M ESBLs to be most prevalent in the community setting. The fact that the strains
were clonally related, that produced the same type of ESBL and that the high proportion of strains
were resistant to aminoglycosides which are not prescribed outside of hospitals, could indicate
the possible food origin of ESBL E. coli strains.
Final abstract number: 69.016
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Botulism - A Risk of Traditionalist or Underdeveloped Countries?
            1           2            1
S. Draghici , V. Coldea , I. Lenard
1                                          2
 University of Oradea, Oradea, Romania, Emergency Clinical County Hospital Oradea, Oradea,
Romania

Background: In the past 4 years the number of patients diagnosed with botulism has increased in
Bihor county, situated in the western region of Romania. The hospitalized cases presented
medium and severe forms, fortunately not leading to death due to timely administration of
antitoxic serum. Meat and vegetables products (cans) are incriminated as a source of infection,
being manipulated in conditions of deficient hygiene.
Methods: We conducted a retrospective clinico-epidemiological study of botulism cases
hospitalized in Bihor county during 2004-2007. Diagnosis was based on clinical signs,
epidemiological data and in a small number of cases (6) on identifying botulinum toxin through
biological tests.
Results: In the period 2004-2007, 29 persons were diagnosed with botulism in Bihor county
(4.83% inhabitants), with an almost equal distribution on sexes, mostly adults - 22 cases (75%).
Clinical forms of disease were: mild - 7 cases (24%), moderate - 13 cases (44.5%) and severe - 9
cases (31.5%). The frequently encountered symptoms were: mydriasis, xerostomia, diplopia,
palpebral ptosis, dysphonia, digestive disorders, in severe forms respiratory muscles paralysis
with respiratory failure. Administration of bivalent antitoxin A+B immediately after admission and
supportive care stopped paralyses' progression and prevented death. The source of infection was
identified in 93% of consumers, consisting in smoked ham, other home-made meat dishes and
vegetable cans. In the close vicinity of those households or rural areas, bovines and equines are
reared, which are intestinal carriers of Clostridium botulinum.
Conclusion: The preparation of vegetable cans and keeping of smoked meat products in
unhygienic conditions in the presence of vectors (flies, cockroaches) is the cause of botulism
cases in Transylvania. This traditional practice is interwoven with the economical rationale of
impoverished Romanian peasants, who should, however, respect alimentary hygiene.
Final abstract number: 69.017
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Validation of a Manual Blood System and the Distribution of Organisms Causing Bacteremia in a
Resource-Limited Setting, SHCH, Phnom Penh, Cambodia
              1       1            1         1         1            2          2            2
R. Seilavath , L. Kruy , T. Sopheak , S. Teav , C. Kham , E. Vlieghe , L. Lynen , J. Jacobs
1                                                              2
 Sihanouk Hospital Centre of HOPE, Phnom Penh, Cambodia, Institute of Tropical Medicine,
Antwerp, Belgium

Background: In Cambodia, information about microorganisms causing bacteremia is limited. A
manual blood culture system was installed in Sihanouk Hospital Center of HOPE, an urban
referral hospital.
Objective: To validate the manual blood culture system and to describe the distribution of
organisms causing bacteremia.
Methods: A blood culture set consisted 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.
Results, entered in a Microsoft Access database, were analyzed retrospectively.
Results: Between February 2005 and December 2007, we received 2281 samples. For 1452
samples, antibiotic administration was recorded: 812 (35.6%) with and 640 (28.0%) without. Most
frequently recorded presumed foci of bacteremia (total = 2736) were gastrointestinal (36%),
respiratory (27%) and genitourinary (27%).
Growth of contaminants and clinically significant organisms (CSO) occurred in 88 (3.8%) and 294
(12.8%) samples respectively. Grampositive bacteria (n=62) accounted for 21.1% of CSO, with,
amongst others, Staphylococcus aureus (n = 30), Streptococcus pneumoniae (n = 8) and beta-
hemolytic streptococci (n = 7). Enterobacteriaceae (n = 158, 53.7% of CSO) included, amongst
others, Escherichia coli (n = 35), Salmonella Typhi/Paratyphi A (n = 29), non-typhoid Salmonellae
(n = 24), Klebsiella spp. (n = 20) and Enterobacter spp. (n = 18). Among the nonfermentative
Gramnegative rods (n = 16, 5.4% of CSO) there were 6 isolates of Burkholderia pseudomallei.
For 42 (15.0% of CSO) Gram-negative isolates no identification was generated. There was no
significant difference in yield of CSO in samples with versus without antibiotics.
Conclusion: The manual blood culture system performed excellent in terms of yield of CSO, with
predominance of Enterobacteriaceae. Measures are implemented to reduce the contamination
rate and to improve the identification of Gramnegative rods. The use of antibiotics must not
preclude sampling of blood cultures.
Final abstract number: 69.018
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Identification of Class 1 Integron of Salmonella typhimurium From Street Foods in Jakarta,
Indonesia
D.E. Waturangi, V. Gustiani
Faculty of Biotechnology Atma Jaya Catholic University, jakarta, Indonesia

Background: Salmonellosis is one of the foodborne disease that caused by Salmonella and
transmitted through water and contaminated foods. Selecting antibiotic for treatment of this
pathogen is more essential nowdays since changes in the drug sensitivity pattern and discoveries
of integron as mobile genetic element associated with antibiotic resistance genes as gene
cassettes.
Methods: In this study, we isolated bacteria from street foods in Jakarta continued for
identification through biochemistry and serological test. All of the isolates were continued for
antibiotic resistance analysis using disc diffusion agar test. PCR amplification using 5'-CS and 3'-
CS primer were done for integron class 1 detection.
Results: We recovered fourteen isolates of S. typhimurium. All of the isolates showed resistant to
ampicilin (10 g) (7.14%), trimetophrim (5 g) (35.71%), tetracycline (30 g) (14.28%),
streptomycin (10 g)(35.71%), and kanamycin (30 g) (7.14%). All of the isolate were screened
for the presence of class 1 integrons using 5'-CS and 3'-CS primer. The detection showed that
seven isolates possess class 1 integron with ~1000 bp of amplicon size. One of them was
continued for DNA sequencing and showed class 1 integrons bearing streptomycin and
spectinomycin resistant gene cassete of aadA1.
Final abstract number: 69.019
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Epidemiology of MRSA in Children with Allergy
I. Kuznecovs, I. Joksta, S. Kuznecovs, K. Jegina
Preventive Medicine Research Society, Riga, Latvia

Objectives: Staphylococcus aureus (SA) enterotoxins have been suggested to have an impact on
specific local IgE production in nasal polyps in patients with allergy. Hypothetically high level of
the local IgE during long period maybe associated with methicillin-resistant Staphylococcus
aureus (MRSA) formation in the upper respiratory tract in this enlarging group of children with
allergy. The aim of the present investigation was to detect the amount of MRSA carriers among
children with allergy: nasal polyposis (NP) and allergic rhinitis (AR).
Methods: Nasopharyngeal swabs for SA and MRSA and nasal tissue samples were taken from
652 children (ages 2-3, 4-7, 8-12) with NP (313 persons) and AR (339 persons) and 475 healthy
children (ages 2-12) enrolled for long-term study from 2002 through 2007. Patient's age, gender,
diagnosis of allergy, therapy, IgE levels, and use of antibiotics was recorded. Antibiotic resistance
of the strains was determined with the disc diffusion method. Nasal tissue samples were analyzed
for total and specific IgE to SA.
Results: The rates of nasal carriage of SA were found to be 12% (57/475) in the control group
and 69% (449/652) in patients with NP and AR. MRSA was found in 1% of control and in 40% of
patients with NP and AR in 2002, 1% and 52% in 2003, 1% and 66% in 2004, 1% and 43% in
2005, 0,5% and 57% in 2006, and 1% and 58% patients in 2007. B1 MRSA strain was
predominant. Children ages 4-7 years (p<0.02), glucocorticoid use in NP (p< 0.02), rate of
hospitalization (p=0.005), and specific local IgE level (p< 0.001) were significantly associated with
MRSA colonization.
Conclusion: The nasal carriage of MRSA in patients with nasal polyposis is high, undetectable,
and growing. It is possible that allergy and specific IgE levels maybe the cause of nasal carriage
of MRSA. Children with NP and AR are an unidentified and less well studied group at high risk for
spreading MRSA in children's hospitals, day-care centers, and schools.
Final abstract number: 69.020
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Escherichia coli Pathotypes Isolated in Inflammatory Bowel Diseases and Oncological Diseases
of Gastrointestinal Tract
              1           1                2               2             2           1           1
M. Kmetova , K. Curova , L. Gombosova , M. Zakuciova , I. Lazurova , M. Sabol , L. Siegfried
1
 Institute of Medical and Clinical Microbiology, University P.J.Safarik and L.Pasteur University
                                                  2
Hospital, Faculty of Medicine, Kosice,, Slovakia, I. Internal Clinic, University P.J.Safarik and
                                                                         1
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: In the literature there are many informations reporting on the relationship between E.
coli and their ability to cause gastrointestinal diseases (Sooka et al., 2004). Some investigators
(Boudeau et al., 2001) even indicate possible role of E. coli in the initiation of colorectal cancer.
The aim of our study was to indicate a possible association between E.coli and both inflammatory
and oncological diseases analysing presence of E.coli pathotypes using demonstration of
virulence genes in isolated strains.
Materials and Methods: For demonstration of virulence genes ipaH and iucC protocol according
Kuhnert et al. (1997) was used. Demonstration of a-hly, afa, aer, cnf1, sfa, pap genes was
performed according Le Bouguenec, et al (1992) and Yamamoto et al. (1995). stx1, stx2, ehly
genes were detected according Paton & Paton (1998) and ial, st, lt, eae, bfpA genes were
detected according Lopez-Saucedo et al. (2003). Specific gene products were detected using
electrophoresis on 2.0 % agarose gels and visualized by staining with ethidium bromide under UV
light.
Results. Total of 437 E. coli strains were isolated from colon biopsy samples of 63 patients with
inflammatory bowel disease (IBD): 85 strains in Crohn`s disease (CD), 119 strains in ulcerative
colitis (UC), 193 in non-inflammatory bowel disease (NonIBD) and 40 strains in colon cancer
(NO). Adherent-invasive E. coli (AIEC) strains were found in the following frequencies: NO (73
%), UC (50 %), CD (35 %) and 6.7 % in non-inflammatory bowel disease. This result indicates
possible role of AIEC in the pathogenesis of inflammatory bowel diseases and colon cancer.
Classical enteroinvasive E. coli (EIEC) were not present in our study. Cell-detaching E. coli
(CDEC) were isolated in patients with UC (24.1 %) and CD (4.7 %). No CDEC strains were
isolated in NO patients. Gen pCVD432 typical in enteroaggregative E. coli (EAggEC) was
detected only in 2.5 % of tested E. coli. Results obtained indicate that CDEC may play role in
pathogenesis of CD. Enteropathogenic E. coli (EPEC) and enterotoxigenic strains (ETEC)
represented 1.2 %, and 1.8 %, respectively of all isolated E. coli strains. Enteroinvasive (EIEC)
and shiga toxin-producing E. coli (STEC) were not found in our collection of samples.
Conclusion. Compared to other E. coli pathotypes a higher incidence of adherent-invasive E. coli
isolated from biopsy samples from colon cancer and inflammatory bowel disease indicates
possible role of the E. coli pathotype in the pathogenesis of these gastrointestinal diseases.
The work was supported by grant VEGA 1/4254/07 and AV 4/0027/07.
Final abstract number: 69.021
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Carriage of Staphylococcus cureus in Cats and Their Owners
M.V. Boost, S.P. Wong, M.M. O'Donoghue
The Hong Kong Polytechnic University, Hong Kong, China

Objectives: The role of dogs, horses, and pigs as carriers of Staphylococcus aureus and sources
of infection in humans is well recognized, but less attention has been paid to carriage in cats,
though human infections from colonized feline sources have been reported. MRSA has been
isolated from infections in cats, but there have been no large-scale studies of colonization of cats
and their owners.
Methods: Nasal swabs, collected from 231 clinically-normal domestic cats and their owners (218)
attending one of five veterinary clinics, were cultured on blood agar, mannitol salt agar (MSA),
MSA with 6 g/ ml oxacillin, and enriched in brain heart infusion broth with 5% salt. S. aureus was
identified using Staphaurex and resistance to 8 mg/ml acriflavine. Susceptibility to a range of
antibiotics was determined by disc diffusion. MRSA was confirmed by the presence of mecA
using PCR. Pulsed field gel electrophoresis (PFGE) was performed to determine if owners and
their pets were co-colonized by similar S. aureus strains.
Results: 5.6% of cats and 24% of their owners were nasally colonized with S. aureus, two owners
carrying MRSA. PFGE revealed that of the four co-colonized owner-cat pairs, three were
indistinguishable, and the fourth differed by only one band Two of these owners were health care
workers (HCW), and a third had a household member who had recently been hospitalized and
received antibiotics. Of the two MRSA colonized owners, one was a HCW, colonized by a multi-
resistant HA-MRSA. The second owner's strain was resistant only to beta-lactams and
chloramphenicol.
Conclusions: Nasal carriage of S. aureus in cats was lower than the 8.8% we found in dogs, none
being MRSA carriers. Carriage in cat owners was similar to the general population, with 0.9%
carrying MRSA. Co-colonization of cat and owner may be associated with owner's occupation in
health care.
Final abstract number: 69.022
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Imported Baby Corn Causing Outbreaks of Shigellosis in Denmark and Australia
           1              1             1          2              2        3             4
H.C. Lewis , S. Ethelberg , K.E.P. Olsen , M. Lisby , S.B. Madsen , M. Kirk , R. Stafford ,
             5            1
K. Ungchusak , K. Mølbak
1                                                2
 Statens Serum Institut, Copenhagen, Denmark, Fødevareregion Øst (Regional Veterinary and
                                                       3
Food Control Authority East), Copenhagen, Denmark, OzFoodNet, Department of Health ,
                     4
Canberra, Australia, OzFoodNet, Communicable Diseases Branch, Queensland Health,
                    5
Brisbane, Australia, Bureau of Epidemiology, Ministry of Public Health, Nonthaburi, Thailand

Background:Outbreaks of foodborne shigellosis are rare in developed countries. Concurrent
outbreaks of Shigella sonnei infection were detected in Denmark and Queensland, Australia in
mid-August 2007. Baby corn or sugar snaps imported from Thailand were suspected to be the
vehicle after preliminary interviews in Denmark. Both foods were recalled in Denmark on 17
August. Collaborative investigations were undertaken in Denmark, Australia and Thailand to
pinpoint the source of the outbreaks.
Methods:Sh. sonnei cases were ascertained through national surveillance systems in Denmark
and Australia (01/08/2007-30/09/2007). In Denmark, we conducted a retrospective cohort study
amongst employees in one affected workplace to identify the source of infection. The outbreak
strain was characterised using pulsed field gel electrophoresis (PFGE) and shared using
Pulsenet International. We undertook food trace-back and microbiological investigation of
samples from implicated batches.
Results:215 cases were laboratory-confirmed in Denmark and 12 in Australia, along with a further
43 epidemiologically-linked cases. In the cohort study, we identified 27 symptomatic cases
amongst 117 respondents (response rate 69%). The attack rate was 56% among employees who
ate baby corn on 6 or 7 August (RR 4.0 95%CI: 1.8-8.9 and 3.7, 95%CI: 1.6-8.1 respectively) and
in a multi-variable analysis, baby corn was the only independent risk factor. PFGE profiles of
outbreak strains in Denmark and Australia were indistinguishable We did not detect Shigella spp.
in baby corn, but isolated high levels of Escherichia coli and Salmonella enterica. We identified a
packing house in Thailand, which supplied baby corn to both Denmark and Australia.
Conclusion:Epidemiological, microbiological and trace-back evidence identified baby corn
imported from one packing house in Thailand as the source of large Sh. sonnei outbreaks in
Denmark and Australia. These outbreaks highlight the importance of international communication
for linking outbreaks and pinpointing the source. We recommend improving hygiene standards for
raw exotic vegetables and blanching before consumption.
Final abstract number: 69.023
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Overlook on Epidemiology and Causative Agents of Ricketsia in Adults in Albania
N. Çomo, E. Muço, D.H. Kraja, A. Kica, E. Meta, K. Duraku
University Hospital Center, Service of Infectious Diseases, Tirana, Albania

Objective: Knowning the epidemiology and causative agents of ricketsia.
Materials: Study involved 202 cases with ricketsia ages 14-70 years old during 1986-2006. The
identification was achieved through ELISA, Comlement, Indirect Imunofluoreshence and Weil-
Felix Reaction.
Methods: Epidemiologic View - We have analyzed the distribution in years, seasons and group
ages of ricketsiose Causative agents. Ricketsia were classified based on patogen and clinical
presentation.
Results: Epidemiologie -The number of cases with Ricketsie varies from 6-84 yearly with a
prevalence in months June-September. The incidence was consist with peaks every 4-5 years.
The more affected group ages were 20-40 years old, but 14-70 years old were affected as well.
Causative Agents: Exantematike Typhos (Murine Typho) 142 cases. Mediterran Butunose Fever
50 cases. Q Fever 10 cases.
Conclusions:
• Ricketsioses are yearly diseases
• In Albania there are 3 causative group of Ricketsie: Murine Typho, Mediterran Butunose Fever,
Q Fever
• The most common our is the Typho Murine 70.3% (142 cases)
Final abstract number: 69.024
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

100 Years of Trachoma in the State of Sao Paulo, Brazil
              1            2              2
E.J.A. Luna , N.H. Medina , M.A. Mauricio
1                                                      2
 Instituto de Medicina Tropical USP, Sao Paulo, Brazil, Sao Paulo State Health Department, Sao
Paulo, Brazil

Trachoma was introduced in the State of Sao Paulo with the immigrants from Mediterranean
countries, in late XIX century. It soon reached high prevalence rates in the whole State. In 1907
the State government organized the first "Trachoma Campaign". The aim of the present study
was to recover the "epidemiologic history" of trachoma in Sao Paulo, as its recognition as a public
health problem turns a century old.
A descriptive study on the trends of trachoma occurrence was undertaken. Data on trachoma
occurrence were gathered from all identified sources. The main source was the archive of Sao
Paulo State Health Department. There was no systematic data collection in the early years of the
program. From 1938 until 1976 the State Trachoma Institute maintained a routine information
system. From 1983 on, data were obtained from the State's epidemiologic surveillance system,
and published studies.
Peak incidence rate was in 1951. Incidence rates gradually decreased from 429 per 100,000 in
1951 to 25 in 1967. In 1976 trachoma was considered eradicated in the State, and the control
program was interrupted. In 1983 cases of chronic conjunctivitis in children started being reported
again, and subsequent studies showed trachoma had never been truly eradicated. State's
trachoma control program was re-established, and in the past twenty years several studies have
redesigned its distribution in the State.
From hyperendemic prevalence levels in the first half of the century, trachoma rates gradually
decreased in Sao Paulo. Prevalence survey among schoolchildren detected a rate of 4,4% in
2002. Endemic trachoma is still found in most municipalities of the State, in some of them
reaching as high as 10% prevalence among children, threshold for the recommendation of mass
treatment. This neglected disease remains as a public health problem in the State, especially
among the poorer segments of the population.
Final abstract number: 69.025
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Study of Severe Community-Acquired Pneumonia in Adults - Etiology, Prognosis, and Antibiotic
Therapy
          1            2          1           1
S. Hakoda , N. Matsuo , H. Shinya , S. Kiuchi
1
 Department of Emergency Medicine, KITANO HOSPITAL: The Tazuke Kofukai Medical
                                 2
Research Institute, Osaka, Japan, Kobe Shukugawa Gakuin university, Kobe, Japan

Objective: A retrospective study of 128 patients with severe community-acquired pneumonia was
carried out to determine the causative agents, the impact foreknowledge of the etiology has on
the outcome, the value of clinical and radiologic criteria in predicting the evolution, and the
efficacy of empirical therapy.
Method: From the beginning of 1999 until 2006, we studied 128 patients who required
hospitalization for severe community acquired pneumonia. The clinical criteria for admission to
the study were respiratory failure (PaO2<60mmHg), septic shock, extrapulmonary septic
complications, radiographic evidence of more than one affected lobe, cavitation, or an initial
pleural effusion greater than the occupation of the lateral costophrenic angle.
Result:The study group included 84 men and 44 women (mean age:70.2 ± 12.3 yr), and 67.2 %
suffered from a concurrent debilitating disease. The cause of pneumonia was diagnosed in 61
cases, and the most common pathogens were Streptococcus pneumoniae (36.1%), Mycoplasma
pneumoniae (14.8%), Methicillin-resistant Staphylococcus aureus (9.8%), Haemophilus
influenzae (8.2%), Chlamydia psittaci (6.6%), Legionella pneumonia (4.9%), and the other gram-
nagative bacilli. (19.7%). The fact that fungal infections were present in six patients and
Pnemocystis carinii in two are worthy of note. The overall death rate was 32.8%. A fatal outcome
was related to the age of the patient (p<0.05), the presence of debilitating disease (p<0.05), and
septic shock (p<0.0001). Diagnosis of the causative agents did not aid in increasing the survival
rate, but it did allow for better patient management. Most of the patient (75%) initiated on
treatment with Ampicillin Sodium plus New Quinolone (Levofloxacin Hydrate) recovered, but only
66.4% of the subjects commenced on treatment with other therapeutics survived.
Conclusions: Gram-negative bacillary pneumonia was a frequent finding among the patients who
did not recover, making empirical treatment with Betamipron plus New Quinolone most advisable
for severe cases of community-acquired pneumonia.
Final abstract number: 69.026
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

A Four-Year Prospective Observational Study of Bacteremias and Fungemias in a Large, Tertiary
Care Hospital of Northern Italy
          1              2
A. Nanetti , R. Manfredi
1                                                                                 2
 Dept. of Microbiology, University of Bologna, S. Orsola Hospital, Bologna, Italy, Dept. of
Infectious Diseases, University of Bologna, S. Orsola Hospital, Bologna, Italy

Background: A prospective microbiological surveillance study of bacteremias is ongoing at our
Hospital since the year 2004.
Materials and Methods: The temporal trend of microbial isolates from blood cultures of inpatients
hospitalized during the last four calendar years (2004 to 2007),was evaluated 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 4,606 overall episodes, Staphylococcal epidermidis remained the leading organism
(983 cases: 21.3%), but a dramatic drop in its frequency occurred during the observation time
(from 26.1% of cases in 2004, to 14.3% in 2007; p<.0001). The second cause of bacteremia was
Escherichia coli (463 episodes: 10.1%), followed by Staphylococcus aureus (327 cases: 7.1%),
Enterococcus faecalis (245 episodes: 5.3%), Pseudomonas aeruginosa (170 cases: 3.7%),
Klebsiella spp. (123 episodes: 2.7%), and Enterococcus faecium (117 cases: 2.5%). Significant
time-based modifications occurred only for Pseudomonas aeruginosa (temporal increase: p<.02),
Klebsiella spp. (temporal increase: p<.001), and Enterococcus faecium (temporal increase:
p<.05). Among fungi, Candida albicans was the most represented organism, with 104 episodes
(2.3%),without changes in its frequency in the 2004-2007 period.
Conclusions: A prospective microbiological monitoring is expected to significantly add to the
awareness of local epidemiological figures and antimicrobial sensitivity profile of hospital
infections, including bacteremias, which are responsible for considerable morbidity and mortality
rates among inpatients. Although the main ethiological agents of inpatient bacteremias are still
represented by coagulase-negative Staphylococci, these microorganisms significantly declined
during the four-year study period, thus confirming a positive trend toward a progressively reduced
incidence of contaminated blood cultures. On the other hand, an appreciable increased frequency
occurred over time for Pseudomonas Klebsiella, and Enterococcus spp. A major,persisting role
as agents of hospital bacteremic episodes is still exerted by Escherichia coli among Gram-
negative pathogens, and Staphylococcus aureus among Gram-positive ones.
Final abstract number: 69.027
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Outbreak of Halophilic Vibrio Infections Associated with a Major Environmental Disaster
               1          2         3
O. Oluwatade , S. Hand , L. Mena
1                                                             2
 University of Mississippi Medical Center, Jackson, MS, USA, Mississippi State Department of
                            3
Health, Jackson, MS, USA, Mississippi State Department of Health, University of Mississippi
Medical Center, Jackson, MS, USA

Background: In the United States, isolated pathogenic vibrios have a marked seasonal peak.
More than 90% of cases occur between April and October, presumably reflecting seasonal
changes in shellfish consumption, recreational water use and documented increase in the
densities of vibros in Gulf coast water during warmer months.
Method: We report an unusual cluster of noncholeragenic Vibrio infections reported to the
Mississippi State Department of Health, Jackson, Mississippi, United States of America (USA) in
the immediate aftermath of Hurricane Katrina.
Results: A total of 12 patients were admitted to Gulf area hospitals from August 29th through
September 1st 2005. The median age of patients was 76 years (range= 60-83 years), sex
distribution consisting of 9 males and 3 females. Blood and/or wound cultures revealed 8 cases of
V. vulnificus, 2 cases of V. parahemolyticus, one case of V. fluvialis, and one case of Vibrio
species. Nine patients had visible skin wounds that probably served as the portal of entry for the
Vibrio bacteria present in flood waters. Chronic medical conditions that could increase
susceptibility to Vibrio infection were present in 75% of patients (namely: diabetes [n = 3], heart
disease [n = 7], renal insufficiency [n = 2], human immunodeficiency virus (HIV) [n=1] and alcohol
abuse [n = 4]). Majority of patients had sepsis and required intensive care, including respiratory
support (n = 5). All patients were covered with appropriate antibiotics (cephalosprins, doxycyline,
Vancomycin, aminoglycosides, and fluoroquinolones). Four patients died on admission, one
patient was transferred to another facility, and three persons recovered and were discharged
home. The disposition of the remaining 4 patients remains unknown.
Conclusion: Health care providers should be aware of the possibility of Vibrio wound infections in
high-risk persons in natural disaster settings and the importance of early diagnosis and treatment
in such patients.
Final abstract number: 69.028
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

A Serological Follow-Up Study of Acute Q Fever Infection
           1          1           1         1        1          1         1           2
M.N. Hung , P.Y. Shu , M.Y. Hou , P.S. Lin , C.C. Lin , L.J. Lin , H.Y. Lu , Y.C. Liu
1                                              2
 Centers for Disease Control , Taipei , Taiwan, Kaohsiung Veterans General Hospital ,
Kaohsiung , Taiwan

Background: After acute Q fever infection, patients with certain predisposing factors are at risk to
develop chronic Q fever. However, there are few reports describing the results of routine
serological follow-up for patients infected with acute Q fever.
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 before the date of follow-up blood
sampling were eligible. The indirect immunofluorescence assay was used for serological
diagnosis. PCR testing was performed only on samples suggestive of chronic Q fever with anti-
phase I IgG titer 1:800.
Results: Of 92 (male: 85, female: 7) eligible persons enrolled with the interval between onset of
acute Q fever and follow-up blood sampling ranging from 169 days to 1,253 days (medium: 607
days), 17 subjects (18%) were found to have serological evidence of chronic Q fever (titers of
anti-phase I IgG: 1:1280~1:5120, medium: 1:1280). All these 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. Medical consultation suggested
only continued serological and clinical follow-up for these subjects.
Conclusion: Approximately 18% subjects were found to have serological profiles indicative of
chronic Q fever after acute infection. It suggested that routine serological follow-up might need to
be practiced on patients after acute Q fever infection whether history taking revealed relevant risk
factors.
Final abstract number: 69.029
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Epidemiology, Invasiveness and Comparative Proteomic Analysis of Group B Streptococcus
(GBS) of Indian Origin
           1          1       2          1         3         4
A.K. Johri , P. Yadav , A. Ali , H. Jaint , M. Dua , G. Mehta
1                                                                       2
 School of Life Sciences, Jawaharlal Nehru University, New Delhi, India, Department of
                                                      3
Biosciences, Jamia Milia Islamia , New Delhi, India, School of Environmental Sciences,
                                                 4
Jawaharlal Nehru University, New Delhi, India, Department of Microbiology, Lady Hardinge
Medical College, New Delhi, India

GBS causes life threatening diseases like pneumonia, meningitis, sepsis in newborn babies.
Although, lot of information is available in developed countries but there is very limited knowledge
about the prevalent serotype and pathogenesis of GBS in India. Serotyping is important for our
understanding of the epidemiology of GBS disease and in determining the prognosis of the
disease in infants. Maternal colonization at delivery is the most important prognostic factor for
vertical transmission to neonates. The present study was done to compare GBS colonization
between an urban and a rural society in National Capital Region of New Delhi and also to find out
the capsular polysaccharide type distribution in the two communities. Therefore samples were
routinely collected from the pregnant women's from July 2004 to July 2007. From each woman
samples were taken from hypo-vaginal as well as rectum areas. We have collected total 200
samples (100 each from rural as well as urban areas). An analysis was also conducted to collect
data on socio-economic, demographic, history of current pregnancy and obstetric history. In the
rural areas more women were found colonized by GBS (30 %) as compared to the urban areas
(20 %). Serotype, Ia (25 %), III (18 %) and II (15 %) were the dominating serotypes seen in the
two areas. GBS type Ia was found the predominant type in both areas. To check the invasiveness
of the Indian predominant serotype (Ia), the adherence to and invasion of the human lung
epithelial cell line A549 by GBS serotype Ia (India) were compared with those of serotype III
(USA) strains by a conventional method. The maximum invasive efficiency was found to be 2 %
in case of type Ia as compared to 1.8 % in case of type III. Additionally, comparative proteomics
analysis using MALDI-TOF was also performed between Indian (type Ia) and USA (type III)
strains for differential expression in protein profile of the two predominant serotypes. These
findings will be presented.
Final abstract number: 69.030
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Comparison Between Official Figures and Exact Incidence Rate of Human Brucellosis in Qom
Province of Iran
               1          2
A.R. Bahonar , M. Dakhili
1                                                      2
 Tehran university, Tehran, Iran (Islamic Republic of), Islamic Azad university, QOm, Iran
(Islamic Republic of)

Background: Brucellosis remains an important zoonotic disease which persists in all provinces of
Iran. Since in Iran both direct and indirect transmission is the potential sources of human
brucellosis, epidemiological studies have revealed that true numbers of cases has huge
difference with official figures that reports by health systems.
Methods: The study area located in central of Iran with a population about 1046737 in 2006. All
patients with clinical signs (examined by physicians) and confirmed in laboratory tests during
October 2005 to September 2006recruited in the study. Official numbers of human brucellosis in
this province was provided from ministry of health and medical education.
Results: In the period of investigation we found a total of 2061 confirmed case (51/45 male and
48/6% female).Geometric mean for Wright, 2ME and Coombs wright was 1: 339/8, 1:212/6 and
1:348/5 respectively. Incidence rate in this period is 196/9(per 100000 person), on the other hand
according to official reports we had 140 cases in this period (I.R.=13/4per
100000person).Maximum number of cases were in May, June and July.
Conclusion: Although human brucellosis is a notifiable disease in many countries, official figures
do not fully reflect the number of people infected. Surveillance program base on medical
laboratory diagnosis can be a potential good program for field evaluation and control of disease.
Final abstract number: 69.031
Session: Epidemiology of Bacterial Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Escherichia coli Isolates from Cases of Japanese Travelers with Reported Diarrhea
K. Ito, M. Shigematsu
National Institute of Infectious Diseases, Tokyo, Japan

Eschetichia coli was widely known as major course of travellers' diarrhea. However, it was not
targeted disease of investigation under Quarantine Law in Japan since the pathogen is normal
flora of human. The prevalence of this pathogen among Japanese travellers reported diarrhea
has not looked into until today. Samples obtained from returned passengers arrived in Centrea
Airport in Nagoya, Japan was examined for E. coli isolation. Over 600 samples screened and
sampled. Around 150 were isolated as pilot study to look into the prevalence of different groups of
pathogenic E. coli. PCR and traditional biochemical analysis revieled representation of every
group but with significant numbers of EAggEC. The result supported previous studies from other
countries and also revealed that EAggEC diarrhea seems to share significant portion among the
cases. We are currently looking into the origin of strains where cases are travelled immediately
prior to isolation and symptoms.
Final abstract number: 70.001
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Differentiation Bacterial from Viral Infection-Advantage of Procalcitonin
           1                  2              2            2                     3           4
H. Khatib , A. Bajraktarevic , A. Skopljak , M. Miokovic , A. Djurdjevic-Djulepa , I. Kalkan ,
        5           6           7
Z. Jatic , A. Semic , B. Djukic
1                                        2
 Pediatrics Clinic Doha, Doha, Qatar, Public Health Institution Sarajevo, Sarajevo, Bosnia and
               3                                                               4
Herzegovina, General Hospital Sarajevo, Sarajevo, Bosnia and Herzegovina, Pediatrics Clinic ,
                                       5
Sarajevo, Bosnia and Herzegovina, Medical Faculty of Sarajevo, Sarajevo, Bosnia and
               6                                                            7
Herzegovina, Pediatrics Clinic Manchester, Manchester, United Kingdom, First medical Aid
Sarajevo-Pediatrics Department, Sarajevo, Bosnia and Herzegovina

Background: Procalcitonin is prohormone of calcitonin containing 116 amino acids. It is also a
useful indicator of severity of bacterial infections.
Methods and Materials: We compare other studies and articles about procalcitonin (PCT) and its
effects and important for quickly distinguishing between bacterial and viral infections in children
and infants.
Results: We found that the procalcitonin (PCT) concentrations increases in bacterial infections
but remains low in viral infections and inflammatory diseases. The change is rapid and molecule
is stable, making it as potentially useful marker for distinguishing between bacterial and viral
infections.
Discussion: Its advantages over CRP, IL-6 and INF alpha are clear but it doesn't mean that those
methods, despite some disadvantages earlier explained, should be rejected.
Comclusions: PCT may be useful in an emergency room for differentiation of bacterial from viral
infections in children and for making decisions about antibiotic treatments. The change is rapid
and the molecule is stable, making it a potentially useful marker for distinguishing between
bacterial and viral infections. Comparing PCT with CRP (C reactive protein), interleukin 6, and
interferon alpha demonstrates increased values for PCT than for the others for and thus may be
better for differentiation between bacterial and viral infections.
Final abstract number: 70.002
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Diagnostic Value of Brucella ELISA (IgG and IgM) in Patients with Brucellosis in Kashan, Iran -
2004
K. Esalatmanesh, Z. Soleimani, A. Soleimani
Kashan University of Medical Sciences, Kashan, Iran (Islamic Republic of)

Objectives: Brucellosis is an important disease with many complications that is almost frequent in
Kashan. This study was designed to compare the diagnostic value of ELISA test (IgM, IgG) with
that of serologic agglutination tests (Wright and Coombs Wright) in patients with brucellosis in
Kashan. Early diagnosis of disease is very important and these tests very useful.
Method and material: This study was a case control study and 31 patients with brucellosis and 29
controls were enrolled. ELISA and Wright and Coombs Wright tests were done before and end of
treatment and the results were analyzed.
Results: Sensitivity of ELISA IgM and IgG were 76% and 75% respectively and specificity of them
was 100%. Positive predictive value of both was 100% and negative predictive value of them was
80% and 79% respectively.
Conclusion: Thus ELISA test considering sensitivity and specificity of it is a reliable and
appropriate test in the diagnosis of patients with Brucellosis. Therefore, ELISA can be used for
better diagnosis.
Keywords:Brucellosis, Wright, Coombs Wright, 2ME, ELISA (IgM, IgG)
Final abstract number: 70.003
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Prevalence of Typhoid Fever in Kathmandu Valley and Its Rapid Diagnosis by Detection of IgM
Antibodies, Using Commercial Kit
             1               2
J.P. Ghimire , R.R. Upadhyay
1                                                   2
  SAARC TB and HIV/AIDS Center, Kathmandu, Nepal, Nepal Medical College, Kathmandu,
Nepal

Background: Aim of this study was to find out effectiveness of commercial testing kit for
Salmonella typhi IgM in early diagnosis of enteric fever.
Methods: A total 81 patient 34 females and 47 males and age group between 5 to 78 years,
during 25 July 2006 to 30 December 2006 were subjected to study. All samples were tested for S.
typhi IgM (Enterocheck-WB testing kit), total WBC count, hemoglobin and alanine
aminotransferage (ALT) and subjected to culture for salmonella.
Results: Among all suspected typhoid fever clients, the disease was confirmed bacteriologically in
11 (13.6%), where as 20 (24.7 %) were considered to have typhoid fever on clinical backgrounds
and rise or fall in the titer of salmonella antigens through widal test. The Enterocheck-WB showed
its diagnostic specificity and sensitivity 57 % and 71 %, respectively which were lower than those
of widal test (70 % and 95 %, respectively), but combined culture and S. typhi IgM assay
(sensitivity 96% and specificity 98 %) were superior to combined culture and widal test (sensitivity
87% and specificity 95 %).
Conclusion: The major advantages of the dipstick assay are; easy to use, not require special
equipment or training, and uses stabilized components. It therefore, has a potential high degree
of acceptability for patients with suspected typhoid fever but cultures are negative or in areas
where culturing facilities are not available.

Keywords: Salmonella typhi, immunochromatography, culture, widal test
Final abstract number: 70.004
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Detection of E.coli O157:H7, V.cholerae, and S. typhimurium by Multiplex PCR
              1          1             2                 2
S.L. Mousavi , I. Rasooli , S. Nazarian , J. Jafar Amani
1                                                      2
 Shahed University, Tehran, Iran (Islamic Republic of), Imam Hussain University, Tehran, Iran
(Islamic Republic of)

Escherichia coli O157:H7, Vibrio cholerae, and Salmonella typhimurium are pathogenic bacteria
found in contaminated water and food. No assay method is currently available on simultaneous
detection or identification of all the three pathogens. Our aim was to develop a rapid and reliable
method for this purpose. A protocol for sample collection, and a PCR procedure was designed
specifically for the assay. Selected fragments of 239 bp, 432 bp, and 360 bp for E. coli O157
lipopolysaccharide (LPS) gene (rfbE), V.cholerae cholerae toxin gene (ctx), Salmonella
typhimurium putative cytoplasmic protein gene (STM4497) respectively, were amplified from the
extracted bacterial DNA samples in a single tube by multiplex PCR. The multiplex PCR products
were analyzed by gel electrophoresis. All unknown samples were verifiably identified. The assay
was sensitive enough to detect and identify as few as 100 cells of E. coli O157:H7, V.cholerae
and Salmonella typhimurium. The presence of other bacteria did not interfere with the analysis.
This assay is a specific and reliable tool that allows cost-effective detection of all three bacterial
pathogens in one reaction tube.
Final abstract number: 70.005
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Multiplex Technology for Detection Respiratory tract Infection in Clinical Specimens
X.D. Lu, L.Z. Yang, J. Liu, L. Huang, Q. Wang
The Affiliated Shenzhen Futian Hospital of the Medical College of Guangdong, ShenZhen, China

Background: Respiratory tract infections are a significant cause of morbidity and mortality in
young children, elderly subjects, and immunocompromised patients. Rapid diagnosis is important
to patients on admission and implement proper infection control measures. Epidemic respiratory
infections can be caused by a wide variety of pathogens , including bacteria, Mycoplasma
pneumoniae, Chlamydophila pneumoniae , or viruses such as influenza virus, adenovirus,
rhinovirus, or coronaviruses etc. Although various culture methods, molecular techniques, and
serologic diagnostic tests exist, for many epidemics the causative microorganism(s) are never
determined. Furthermore, there has been no practical method for examining the broad pathogens
ecology of respiratory infections to dissect the complex polymicrobial interactions that occur
during explosive outbreaks of disease. We have developed a method for rapid detection of
multiple respiratory pathogens in clinical specimens.
Methods: Using specific tiny microspheres, multiplex PCR technology and Luminex xMAP
(flexible Multi-Analyte Profiling) have combined for rapid detection of 14 respiratory pathogens(18
typing) by DNA or RNA.
Results: The specificity of the diagnostic system have be validated by 15 pathogens (19 typing)
from ATCC. There are not cross-reaction in each other. In 138 samples collected from clinical
respiratory tract infections, Bacteria were detected in 26 (37.68%) of 69 pathogens from 112
bronchoalveolar lavage, including 13 (18.84%) M. tuberculosis infections and viral pathogens
were detected in 44.93%. M. pneumoniae and C. pneumoniae were in 17.39%. Influenza A virus
detected in bronchoalveolar lavage and 26 nasopharyngeal swab was 21 of 112 (18.75%) and 7
of 26 (26.92%) by flexible Multi-Analyte Profiling.
Conclusion: Luminex xMAP Multi-Analyte Profiling were highly sensitive and accurate, high
throughput and increased assay speed for detecting multiple respiratory pathogens in clinical
specimens. It is useful tool for epidemiology yet.
Final abstract number: 70.006
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Evaluation of Agglutination as Serodiagnosis Test in Brucellosis
B. Asghari
Dep Medical Microbiology, Karaj, Iran (Islamic Republic of)

Brucellosis which is a significant public health problem is a zoonotic disease that seen throughout
the world as well as in Iran. This study was carried out to show the sensitivity and specificity of
the serum agglutination test (SAT).Blood and serum sample were collected from 52 patients were
included to the study. Blood cultures and SAT were performed from all the patients.50 patients
with similar clinical presentation that the disease ruled out by blood culture and SAT and they
were symptoms free without any medication for brucellosis in follow up, were as true negative
samples. 54.2% of cases had positive unpasteurized dairy consumption history. Chief complaint
was joint pain or fever 56.7% and 41.3% respectively. There was history of perspiration in 61.5%
of patients. Brucella spp were isolated in 20 (38.4%) of patients. SAT was found positive in 50
samples (96.1%). When blood culture accepted as the gold standard, sensitivity, specificity,
positive predictive value and negative predictive value of the test were calculated as follows:
sensitivity 90%, specificity 75.7%, positive predictive value 36% and negative predictive value
98%. we found that SAT was still efficient method for serodiagnosis of brucellosis.
Final abstract number: 70.007
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Pleural Fluid Cholesterol and Bilirubin Value in Diagnostic of Exudative from Transudative Pleural
Effusion
B. Ataei, A. Araghi, N. Kassaian, Z. Nokhodian, I. Karimi
Infectious Diseases Research Center,Isfahan University of Medical Sciences, Isfahan, Iran
(Islamic Republic of), Infectious Diseases Research Center,Isfahan University of Medical
Sciences, isfahan, Iran (Islamic Republic of)

Backgrand:Differentiating exudates from transudate is a primary step in examination of pleural
effusion, besides it is a guide to determination of pathologic trend of background disease,
differential diagnoses and diagnostic measures.
Although criteria are considered as standard in differentiating exudates from transudate in some
studies pleural fluid cholesterol, ratio of pleural fluid cholesterol to serum and ratio of pleural fluid
bilirubin to serum have been suggested.
This study has been performed in order to investigate the diagnostic efficacy of pleural fluid
cholesterol and bilirubin in differentiating exudate from transudate.
Method: this study was performed in Al-Zahra Hospital, Isfahan in 2006, and 86 cases of pleural
effusion were investigated by consecutive sampling method. First, after differentiation of exudates
from transudate based on light's criteria, parameters considered in this study were measured,
and patient's data were entered into SPSS-13 table, then using ROC (Receiver Operative
Characteristics) curves, area under the curve was determined.
Afterwards sensitivity, specificity and positive and negative predictive values were determined
and results were tested by McNemar test and compared with each other.
Results: From 86 patients, 59 cases were exudates and 27 cases were transudates. The criterion
of pleural cholesterol above 43 mg/dl had sensitivity of 73.8% and specificity of 92% that with
decreasing criterion level to 35.5 mg/dl, sensitivity increased and reached 81.4%.
Ratio of pleural fluid cholesterol to serum more than 0.3 had 65% sensitivity, 88% specificity and
85% efficiency. Ratio of pleural fluid bilirubin to serum more than 0.6 had 76.3% sensitivity,
74.1% specificity and 75.6% efficiency.
Conclussion: The criterion on 3 g/dl protein still had highest sensitivity and specificity in
differentiating exudate from transudate and can be used as best determinant a lone.
Also pleural fluid cholesterol more than 35.5 mg/dl has suitable sensitivity and specificity and the
combination of pleural fluid protein and cholesterol can be used as best practical determinant.
The criterion of pleural fluid cholesterol to serum ratio more than 0.3 has low sensitivity and with
reduction of this radio to 0.14 , its sensitivity increases but its specificity will decrease.
Final abstract number: 70.008
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Procalcitonin, C-reactive Protein ESR and WBC Count: Marker of Sepsis in Burn Patients
           1            2           3                        3           3           3
M. Barati , F. Alinejad , M.A. Bahar , M. Satar Zadeh Tabrisi , N. Bodohi , H. Karimi
1
  Pediatric Infectious Diseases Research Center of Iran University of Medical Science, Tehran,
                            2
Iran (Islamic Republic of), Burn & Reconstruction Research Center of Iran University of Medical
                                             3
Science , Tehran, Iran (Islamic Republic of), Burn & reconstruction Research Center of Iran
University of Medical Science, Tehran, Iran (Islamic Republic of)

Background: Diagnosis of sepsis is difficult, particularly in the burn patients where signs of sepsis
may be present in the absence of a real infection. So we attempted to assess PCT, CRP, ESR,
and WBC in burn patients and compared their clinical informative values for sepsis diagnosis.
Method: We investigated the serum concentration of PCT, CRP, ESR and WBC of 30 burn septic
patients and 30 burn patients without infection in a burn center hospital, Tehran, Iran.
Results: A statistically significant higher PCT level was observed in patients with sepsis
compared to those without sepsis (8.45±7.8 versus 0.5±1.0, respectively, P< 0.001). No other
differences were observed in CRP, WBC, neutrophil count and ESR between these two groups of
patients. The area under the ROC curve in the diagnosis of septic patients versus nonseptic
patients was 0.97 for PCT (cutoff, 0.5 ng/ml) (P < 0.001) with sensitivity of 100% and specificity of
89.3 %. Non-survivors had a mean PCT level of 6.37±5.26, significantly higher than that
measured in survivors (2.18±5.26).
Conclusion: The value of WBC, Neutrophil count, ESR, CRP in the diagnosis of infection and
sepsis were very poor in our study. But PCT is highly efficient laboratory parameter for the
diagnosis of severe infectious complications after burn injury.
Final abstract number: 70.009
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Evaluation of Enteroaggregative Escherichia coli (EAEC) Isolates by Multiplex PCR among HeLa
Cells Adherent Isolates
S. Bouzari, A. Davoudabadi, M. Abaszadeh, A. Jafari, M. Oloomi
Pasteur Institute of Iran, Tehran, Iran (Islamic Republic of)

Background: Diarrhea continues to be one of the most common causes of morbidity and mortality
among infants and children, especially in developing countries. Among the bacterial pathogens,
diarrheagenic Escherichia coli (DEC) is an important agent of endemic and epidemic diarrhea
worldwide. DEC strains can be classified into six main pathotypes on the basis of their specific
virulence properties, association with some serotypes, and different epidemiological and clinical
features. The importance of enteroaggregative Escherichia coli (EAEC) strains in public health
around the world is becoming increasingly clear. The pathogen was initially defined by the
presence of a characteristic stacked brick pattern, designated aggregative adherence (AA) in the
HEp-2 cell adherence assay. EAEC diagnosis has long been problematic. Several PCR methods,
with both single and multiple target genes, have been reported for detecting the different DEC
pathotypes. In the present study adherent E.coli strains were evaluated with multiplex PCR for
the detection of EAEC isolates.
Methods: The HeLa cells adherence assay was employed for the determination of adherence
property of E. coli isolates from children with diarrhea. Moreover the specific multiplex PCR assay
designed for the detection of EAEC isolates was used.
Results: Of the 330 isolates that exhibited adherence patterns (i.e. typical aggregative adherence
(AA), diffuse adherence (DA), or AA like) other than localized adherence (LA), on PCR assay 254
isolates (77%) yielded products corresponding to the genes detectable by the multiplex PCR. Of
these isolates 134 isolates (40.6%) were determined as typical EAEC and 120 isolates (36.4%)
were detected as atypical EAEC and only 76 isolates (23%) could not be characterized by this
PCR.
Conclusion: Based on the data obtained from this study, it could be concluded that the multiplex
PCR assay for the detection of EAEC isolates is suitable and accurate technique and compared
to the tissue culture assay is not laborious; it is fast, and reliable.
Final abstract number: 70.010
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Rapid Detection of Bla Shv ESBL in Blood by Real Time PCR
                      1             2              3
S. Palasubramaniam , S. Muniandy , N. Parasakthi
1                                           2
 MAHSA College, Kuala Lumpur., Malaysia, University of Malaya, Kuala Lumpur., Malaysia,
3
 Monash University Malaysia, Kuala Lumpur, Malaysia

Background: Septicemia is a pathological condition in which viable bacteria maybe present in the
bloodstream. Therefore appropriate information on the causative agent should be available to the
clinician as soon as possible and their rapid identification is important for an improved clinical
outcome.
Method: In this study rapid detection of SHV subtype ESBL genes of blood borne E. coli was
carried out using real-time PCR with allele-specific PCR primers. The amount of target gene
amplified was measured by the CT value. Bacterial strains were obtained from University Malay
Medical Centre and were grown overnight in BACTEC aerobic plus media. Positive controls
included SHV-1 producing E. coli, SHV-5 producing E. coli and an E. coli strain that was
characterized to be an SHV-ESBL producer. All reactions were performed using the ICycler RT
PCR thermocycler.
Results: The SHV-5 ESBL producing E. coli strain had a higher CT value with wild-type primers
when compared to the CT value of the PCR amplified by mutant-type primers. Since SHV-ESBL
gene is based on mutation at codon 238 which is detected by the mutant-type primer, the high
level of relative gene dosage of the mutant-type allele compared to the wild-type allele further
suggests that this strain is an ESBL producer. A second discontinuity or mismatch at codon 240
by the interrogation of both primer sets specific to this codon, also corresponded. The detection
procedure takes only one hour when compared to the standard screening methods which takes
about 24 hours.
Conclusion: The above findings suggested that RT-PCR is a rapid and sensitive method for the
detection of ESBL genes from bacteria in blood culture.
Final abstract number: 70.011
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Survay of Cerebrospinal Fluid (CSF and C-Reactive Protein (CRP) for Differentiation of Bacterial
and Viral Meningitis in Loghman Hakim, Aliasghar and Valiasr Hospitals of Zanjan
           1           1
D.R. Asadi , B. Amini
1                                                       1
 Medical University, Zanjan, Iran (Islamic Republic of), medical university, Zanjan, Iran (Islamic
Republic of)

Background: Bacterial meningitis is a medical emergency which require rapid diagnosis and
appropriate therapy. Since the presenting signs and symptoms might be inclusive, laboratory
tests are essential in establishing a definite diagnosis. Rapid diagnosis of bacterial meningitis is
an important task of most laboratories and is usually based on microbiologic, cytologic and
biochemical assays. Measuring serum and CSF C-reactive protein by specially for the countries
lacking sophisticated laboratory services. slide latex agglutination is a simple accurate test and is
of great value.
Material and method: Sixty patients with early symptom of meningitis were hospitalized and
subsequently divided in to tow equal groups of bacterial and viral meningitis. CSF and serum
samples were collected and required serologic and biochemical testes were performed.
Results: As compare to viral ,bacterial meningitis showed higher increase in CSF routine tests
(WBC count, protein) and CPR (P<0.0001). Glucose showed significant decreased in bacterial
meningitis as compare to viral. No significant impact of duration of illness, age, sex and body
temperature on CRP value was observed.
Conclusion: CRP latex test dose not require expensive equipment or technical expertise and can
be performed in any diagnostic laboratory. The simplicity and specificity of this test (sensitivity of
100% in serum and 93.33% in CSF) would encourage its use as a rapid diagnostic test for
bacterial meningitis specially in places lacking adequate laboratory facilities.
Final abstract number: 70.012
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Comparison of Fine Needle Aspiration Cytology with Excisional Histology in Diagnosis of Neck
Masses
               1           1                     2             3            1              1
M. Zangeneh , N. Shariati , M. Jamshidi Makiani , S.D. Siadat , M. Yarjanly , G. Manshoory
1                                                            2
 Azad Islamic University, Tehran, Iran (Islamic Republic of), Hormouzgan University, Bandar
                                 3
Abas, Iran (Islamic Republic of), Department of Bacterial Vaccine , Tehran, Iran (Islamic
Republic of)

Intoduction: A mass in the neck is a common clinical finding that presents in all age groups.
Although most masses are benign, malignant disease must not be overlooked. Currently, FNA
(fine needle aspiration) is the standard of diagnosis for neck masses and is indicated in any neck
masses. FNA prevent unnecessary surgery. The objective of the study is evaluation of value of
fine needle aspiration (FNA) in the diagnosis of neck masses in a general hospital.
METHODS: 32 patients during 2004 - 2006 underwent FNA biopsy and open surgical biopsy for
diagnosis of neck mass and to compare FNA cytology with surgical pathology in diagnosis of
neck mass.
RESULTS: From these 32 patients, 14 patients male (43/8%) , 18 patients female(56/3%) ; 5
patients < 15 years old(15/6%) , 15 patients 16 - 40 years old (46/9%), 12 patient > 40 years
old(37/5%) ; diagnosis by excisional biopsy was 3/1% toxoplasmosis, 31/3% tuberclosis, 9/4%
bacterial infection, 3/1% lipom, 40/6% cancer, 12/5% reactive adenitis. The histologic diagnosis of
the surgical excision confirmed the FNA biopsy cytologic diagnosis in 53% of patients (P=0.077).
FNA cytologic diagnosis included reactive lymphnode(4) 100%, bacterial infection 100%(3),
tuberclosis 30% (3), cancer 46/2% (6).
CONCLUSIONS: FNA is a valuable diagnostic tool in the management of patients with neck
mass with reactive adenitis & bacterial infection but is not valuable in the management of neck
mass with other ethiology.
Final abstract number: 70.013
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Procalcitonin in Early Detection of Postoperative Infectious Complications. the Comparison with a
Set of Cytokines, Soluble Cytokine Receptors and Acute Phase Proteins
            1           2           2
P. Maruna , R. Frasko , J. Lindner
1
 Institute of Pathological Physiology of the 1st Faculty of Medicine, Charles University, Prague,
                  2
Czech Republic, General Teaching Hospital and the 1st Faculty of Medicine, Charles University,
Prague, Czech Republic

Background: Infections and sepsis are relevant complications in patients undergoing large
abdominal surgery and still constitute a diagnostic challenge. Only limited markers can
differentiate incipient postoperative sepsis from uncomplicated early postoperative reaction. A
prospective clinical study was performed to examine the accuracy of procalcitonin (PCT), set of
cytokines, soluble cytokine receptors and acute phase proteins in patients following major
abdominal surgery.
Subjects and Methods: Between January 2006 and February 2008, 48 patients with febrile
episode of the early postoperative period after abdominal surgery were entered into the study.
Blood samples were obtained on the first day of fever for the measurement of plasma PCT
(Kryptor), TNFalpha, IL-1beta, IL-1ra, IL-2, IL-6, sIL-6R, IL-8 (ELISA), and 10 acute phase
proteins (nephelometry). Data were compared with reference group: 24 patients with the planned
resection of colorectal cancer at stage Ib-IV and uncomplicated healing; venous blood samples
were obtained repeatedly before surgery, 6, 12, 18, 24, 48, and 72 h after start of surgery.
Results: Febrile reaction of 26/48 patients was linked with positive blood culture results. PCT and
IL-6 concentrations of blood culture positive subjects differed significantly from non-bacteremic
patients (p < 0.01 for both parameters) as well as from uncomplicated patients (p < 0.003 and p <
0.001). Cutoff levels to distinguish blood culture positive and negative subgroups using ROC
were 0.96 ng/ml for PCT and 345 pg/ml for IL-6. Other inflammatory parameters showed high
sensitivity but lower specificity for bacterial complications in relation to uncomplicated postsurgical
course. PCT and monitored cytokines culminated 18-36h following uncomplicated surgery and
postoperative PCT levels did not exceed 1.02 ng/ml in this group.
Conclusions: Simultaneous PCT and IL-6 examination is a reliable approach to distinguish
incipient infectious complications in early postoperative period. Their measurement is well
founded for daily monitoring of high-risk patients after large abdominal surgical procedures.
Supported with grant IGA-MZ-CR-4825-3.
Final abstract number: 70.014
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Diagnostic and Prognostic Value of Procalcitonin in Patients with Sepsis
O. Gunal, F. Ulutan
Gazi University Medical Faculty, Department of Infectious Diseases and Clinical Microbiology ,
Ankara, Turkey

Background: Severe generalized bacterial, parasitic or fungal infections with systemic
manifestations are associated with increased procalcitonin (PCT) serum levels. PCT is a marker
of severity of sepsis at the same time. We investigated the value of PCT levels on different days
for identifying of severity of sepsis.
Methods: In this study 50 patients who were diagnosed as sepsis and followed up in intensive
care units of Gazi University Medical Faculty were included. In the patients who were diagnosed
as sepsis, serum PCT levels were determined before beginning the antibacterial treatment on the
first day, then after the diagnosis on the days 3 and 5. Illness severity was measured using
APACHES II scores. PCT was quantified by use of a specific immunoluminometric assay
(LUMItest procalcitonin, Brahms Diagnostica, Berlin ).
Results: Serum PCT levels were determined as high for the patients diagnosed as sepsis. There
has been a significant statistical difference among the three measurements in the surviving
patients on the aspects of repeated measurements. We determined a statistical difference on the
aspects of PCT levels between the surviving and died patients when the patients are separated
into two groups as patients with high risk and low risk according to PCT levels. While it is not
determined a difference between measurements of PCT levels on the days 1 and 3, because of
the determination of a difference between the PCT levels measured on the days 1 and 5 in the
surviving patients, it was thought that measurements of PCT levels on the days 1 and 5 can give
sufficient data.
Conclusion: As a result of the study, it was viewed that with the patients who have sepsis, PCT
can be used as not only a diagnostic but also a prognostic marker.
Final abstract number: 70.015
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Analysis of Bordetella pertussis Agglutinin Titer in the Patients with Adolescent/Adult Pertussis
            1        1           1               2            3         4           5             5
H. Kamano , T. Mori , H. Maeta , N. Kishimoto , T. Katami , M. Sato , K. Kamachi , Y. Arakawa
1                                         2                                              3
 Kagawa University, Takamatsu, Japan, Takamatsu City Hospital, Takamatsu, Japan, Katami
                           4                                          5
Clinic, Takamatsu, Japan, Hyakoku Hospital, Takamatsu, Japan, National Institute of Infectious
Diseases, Tokyo, Japan

Background: Bordetella pertussis is a gram-negative bacterium that infects a respiratory tract and
causes pertussis. B. pertussis contains agglutinogen. Major agglutinogen, Agg2 and Agg3 is
derived from Tohama strain (vaccine strain) and Yamaguchi strain (epidemic strain) respectively.
Pertussis is diagnosed by nasopharyngeal culture, PCR and serologic tests for B. pertussis. As a
serologic test, the agglutinin titers against Tohama and Yamaguchi strain are measured widely in
Japan. The criterion for infants pertussis established by the National Institute of Infectious
Diseases was employed: a 1:40 agglutinin titer of Yamaguchi strain has a diagnostic value. But
there is not a universal criterion of the agglutinin titer for adolescent /adult pertussis. We describe
about epidemiologic circumstance of a sudden rise in the incidence of pertussis in our University,
and the distribution of the agglutinin titers against Tohama and Yamaguchi strain in the patients
with adolescent/adult pertussis.
Patients and Methods: We analyzed an agglutinin titer against Yamaguchi and Tohama strain for
patients with prolong cough.
Results and Conclusion: In mid-May, an index case was diagnosed as suspecting pertussis. Until
early July, a total of 361 students/faculty members visited the Health Science Center for a chief
complaint of cough, and about 80% people were diagnosed as pertussis. It was considered that
pertussis is spreading over the university. Patients diagnosed with pertussis were treated with
macrolides. We analyze the agglutinin titers in the patients with pertussis. The agglutinin titer
against Yamaguchi strain of 1:40 was detected in 290 students/faculty members. Maximum
agglutinin titer against Yamaguchi strain was 1:5120, and the class with the largest frequency
was 1:160.
Final abstract number: 70.016
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Application of An Innovative Seminested PCR Test for Identification and Detection of Ten
Medically Important Candida Species
             1        2            1            1
L.T.L. Than , K.P. Ng , P.P. Chong , H.F. Seow
1                                             2
 Universiti Putra Malaysia, Serdang, Malaysia, University of Malaya, Kuala Lumpur, Malaysia

Candida is a genus of yeasts that is now the fourth highest contributor to nosocomial bloodstream
infections in the United States. Identification of the species is crucial in the clinical management
of these infections as some of the species are not susceptible to the "gold standard" antifungal,
fluconazole. Thus, an innovative seminested PCR test for identification of ten medically important
Candida species was invented. The species are C. albicans (CA), C. dubliniensis (CD), C.
glabrata (CGL), C. guilliermondii (CGU), C. kefyr (CKE), C. krusei (CKR), C. lusitaniae (CL), C.
parapsilosis (CP), C. rugosa (CR) and C. tropicalis (CT). Briefly, DNA was extracted using
conventional method and subjected to two rounds of PCR with a common set of primers for the
former and species specific reverse primer for the latter. The PCR products were then subjected
to gel electrophoresis. Specificity testing was determined by using DNA of the ten Candida
species (ATCC strains) and six Aspergillus species (ATCC strains). Sensitivity testing was
determined by performing the PCR using a factor of ten times serial diluted DNA extracted from
one million cells/conidia. No amplicons were observed for all the species tested other than the
targeted ones. Thirty-one Candida clinical isolates were also tested and they were identified
accurately according to the species. Amplicons were seen from as low as 1 cell (CP and CR), 10
cells (CA, CD, CGL, CKR, CL and CT) and 100 cells (CGU and CKE). The total reaction time
taken from DNA extraction to gel visualisation can be performed within one working day which is
relatively shorter than culture method and the cost per test is as low as RM 1 or USD 0.30. This
simple and economical method yet with considerable specificity and sensitivity will certainly offer
another alternative in detection of these pathogenic yeasts.
Final abstract number: 70.017
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Variation in Pilus Encoding Gene Cluster between O1 and Non-O1 Serogroups of Vibrio cholerae
in Iran
H. Mohammadi Barzelighi, B. Bakhshi, A. Rastegar Lari, M.R. Pourshafie
Pasteur Institute of Iran, Iran University of Medical Sciences, Tehran, Iran (Islamic Republic of)

Background: Two important virulence factors in Vibrio cholerae are cholera toxin (CT) and toxin
co-regulated pilus (tcp) in VPI. VPI is one of the initial factors required for the emergence and
pathogenesis of epidemic V.cholerae. The central segment of VPI contain of TCP gene cluster
that is approximately 13kb in size and including proteins involved in synthesis of tcp. Tcp is an
important protein that involve in intestinal colonization of bacteria, microcolony and biofilm
formation. The aim of this study was to detect the presence and diversity of VPI genes in O1and
Non-O1 serogroups of vibrio cholerae that isolated from patients and environment in Iran.
Materials and methods: Twenty clinical and forty environmental isolates of V. cholerae obtained
and serogrouped using O1 and O139 antisera. The identity of isolates was investigated using
conventional biochemical tests and confirmed by a species-specific PCR. Eight pair of primers
used to analysis VPI cluster which is approximately 41 kb in size. Each pair of primers amplifies
within the internal region of the individual genes in the cluster. PCR products were confirmed by
restriction fragment length polymorphism (RFLP).
Result: Specific biochemical tests and serogrouping of isolates showed that 25% of clinical
isolates were O1-Ogawa and 75% were O1-Inaba while 100% of environmental strains were non-
O1, non-O139. PCR analysis indicated that 100%, and 90% of clinical strains were positive for RJ
and LJ genes and prevalence of the int, ald, tcpA, tagA, toxT and acfB-C were 95% in this group
of isolates. Only one of the environmental isolates (2.5%) contained the whole cluster the whole
cluster and the remaining 97.5% did not carry any of the genes within the cluster.
Conclusion: This study demonstrates the presence of critical virulence genes or other
homologues in clinical strains and emphasizes the importance of monitoring V. cholerae non-O1,
non-O139 serogroup strains for their virulence gene content in order to assess their epidemic
potential.
Final abstract number: 70.018
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Introduction of a New Housekeeping Gene Sequences for Rapid Identification of Vibrio cholerae
Strains in the Clinical Samples
A. Dashtebani, B. Bakhshi, M. Oskui, M.R. Pourshafie
Pasteur Institute of Iran, Tehran, Iran (Islamic Republic of)

Background: Vibrio cholerae is a noninvasive, gram-negative bacterium responsible for severe
epidemics of cholera and endemic diarrhea in many parts of the world, especially developing
countries. Vibrio cholerae strains may produce a variety of atypical biochemical reactions which
may pose some difficulties in rapid identification and recovery of these bacteria from mixed
samples isolated from clinical or environmental sources. To best of our knowledge dnaE gene is
widespread among all Vibrio cholerae strains. Our study is aimed at developing the use of PCR
amplification of dnaE housekeeping gene as a screening tool for identification of Vibrio cholerae
among mixed clinical samples and comparison with the time consuming conventional biochemical
methods.
Methods: A total of 24 Vibrio cholerae isolates of clinical origin isolated and subjected to
serogrouping and subsequent PCR analysis using primers which specifically chosen to amplify
within the dnaE gene in the genome of the Vibrio cholerae isolates. Vibrio cholerae ATCC 14035
and Pseudomonas aeruginosa ATCC 27853 were used as positive and negative controls in each
assay.
Results: Among 24 Vibrio cholerae isolated, 21% identified as Ogawa and the remaining 79% as
Inaba serogroup. PCR analysis of the dnaE housekeeping gene revealed the presence of this
gene in 100% of isolates examined and approximately 300 bp product was obtained from the
isolates. The identity of the product was further confirmed using RFLP assay.
Conclusions: The result of this study suggest the use of dnaE housekeeping gene as a molecular
marker for rapid identification of Vibrio cholerae in mixed clinical samples.
Final abstract number: 70.019
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Bacterial DNA Load in Cerebrospinal Fluid During Treatment of Bacterial Meningitis
            1               2         1            1
N.V.T. Tran , M.H. Nguyen , J. Farrar , C. Schultsz
1                                                               2
 Oxford University Clinical Research Unit, Ho Chi Minh, Vietnam, Hospital for Tropical Diseases,
Ho Chi Minh, Vietnam

Background: Bacterial meningitis is an important cause of morbidity and mortality in Vietnam. The
diagnosis can be difficult to establish, e.g. due to frequent pretreatment with antimicrobial agents.
We developed a quantitative real-time PCR (qRT-PCR) to determine the bacterial DNA load in
CSF during treatment of four major pathogens causing bacterial meningitis in Vietnam.
Methods:CSF samples were collected from 445 patients with suspected bacterial meningitis on
hospital admission, after 48 hours, and 6-15 days after admission. Primers and probes for
detection of Steptococcus pneumoniae (Sp), Haemophilus influenzae b (Hib) and Neisseria
meningitidis (Nm) were as described previously by Corless et al. Primers and probe for
Streptococcus suis type 2 (SS2) detection were designed using Primer Express. PCR fragments
were cloned in TA cloning vector. Serial 10 fold-dilutions of purified plasmid served as external
standards for real-time quantitation.
Results:SS2 was detected in 149 (33.5%) of samples collected on admission, Sp in 79 (17.8%),
Nm in 29 (6.5%) and Hib in 5 (1.1%) using RT-PCR. The median bacterial DNA load on
                        6                                 3         8                  5
admission was 1.48x10 DNA copies/ml (range 1.0x10 - 1.1x10 ) for SS2, 4.98x10 DNA
                         3           9                  6                             3         8
copies/ml (range 1.0x10 - 9.1x10 ) for Sp, 3.37x10 DNA copies/ml (range 1.0x10 -1.13x10 ) for
Nm. Clearance of bacterial DNA was gradual. Median bacterial DNA loads of SS2, SP and Nm
were similar at each of the sampling times. DNA was still detectable in 69/156 (44.2%) samples
collected 6-10 days after start of treatment and in 17/53 (32.07%) samples collected after 11-15
days.
Conclusions:Median bacterial DNA loads are similar in meningitis caused by SS2, Sp and Nm but
are highly variable when comparing individual patients. DNA loads decline only gradually during
treatment, enabling diagnosis by PCR even after start of antimicrobial treatment. qRT-PCR can
be used to study the association between bacterial DNA load and clearance and outcome.
Final abstract number: 70.020
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

A Comparative Western Immunoblot Antibody Titration Test for Evaluation of Bartonella Therapy
W.D. Hardy, Jr., E.E. Zuckerman
National Veterinary Laboratory, Inc., Franklin Lakes, NJ, USA

Introduction: Bartonella are zoonotic pathogens mainly transmitted by cats and occasionally dogs.
They are difficult to isolate and most Bartonella infections of animals or people are diagnosed by
detection of coexisting antibody (IgG).
Methods: We developed a single dilution western immunoblot (WB) for detection of Bartonella
antibodies (IgG 1:100) for determination of Bartonella spp. infection. We adapted this test in a
comparative titration format (pre and 6 months post therapy) to assess the elimination of
Bartonella from cats, dogs and people.
Results: Bartonella was isolated from 7 seropositive pet cats before doxycycline therapy. All 7
cats were culture negative 1 month post therapy but at 6 months only 5 of the 7 cats remained
culture negative. All 5 of the culture negative cats had a titer decrease of 4 fold (n=4) and 2 fold
(n=1) whereas the 2 cats where Bartonella was isolated 6 months post therapy had no titer
decrease. In contrast, there was no titer decrease in 21 untreated Bartonella-seropositive pet cats
observed for more than 1 year. 9,782 titrations were performed on Bartonella-seropositive pet
cats 6 months after treatment with: azithromycin (n=9,162), rifampin (n=469) and doxycycline
(n=151). A 2 fold titer decrease occurred in 1,119 cats (11.4%) and a 4 fold or greater titer
decrease occurred in 7,583 cats (76.5%). Thus, post therapy titer decreases (treatment success)
occurred in 87.9% of Bartonella-infected cats. 78 of 88 (88.6%) Bartonella-seropositive dogs had
post therapy titer decreases (2 fold n=8, 4 fold or greater n=70) as did all 3 people with CSD (4
fold or greater).
Conclusion: Antibiotic therapy of Bartonella-seropositive cats, dogs, and people can be effectively
monitored using a comparative WB titration test.
Final abstract number: 70.021
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Development of a Slide Latex Agglutination Assay for Identification and Confirmation of
Burkholderia pseudomallei from Cultures
S. Jeyanthi, J. Thimma, J. Vadivelu, C.S. Hung
University Malaya, Kuala Lumpur, Malaysia

Culture and biochemical assay remain as ''gold standard'' for identification and confirmation of B.
pseudomallei. However confirmation by API 20NE biochemical assay is time consuming as the
identification can only be done 24 hours onwards up to a week. Consequently, treatment of the
patients suspected for melioidosis can be delayed and increases mortality rate as death can
occur within 24 hours onset of the disease. Therefore there is a need to develop an assay that
can shorten the time for identification and confirmation of B. pseudomallei from cultures. In this
study, a rapid slide agglutination assay was developed using a specific monoclonal antibody
raised against culture filtrate antigen of B. pseudomallei in Balb-C mice. The purified monoclonal
antibody was tagged onto 0.8 um latex particles by means of passive adsorption. Latex
agglutination assay was performed on a total of 45 B. pseudomallei strains and additional of five
other Burkholderia species on glass microscope slide. Cross reactivity studies were performed on
control panel strains which consisted of various gram-negative and gram-positive organisms. The
latex agglutination assay was able to identify correctly 44 of 45 B. pseudomallei strains with a
remarkable sensitivity of 97.8% and specificity of 100%. No cross reaction was observed with the
control panel strains. In addition, latex agglutination assay was also performed on various B.
pseudomallei antigen and compared with the developed assay. It was found that the developed
latex agglutination assay is useful in identification and confirmation of B. pseudomallei from
cultures.
Keywords: Latex particles, monoclonal antibody, sensitivity, specificity
Final abstract number: 70.022
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Pneumocystis jiroveci Pneumonia (PCP) Diagnosis by Direct Fluorescent Antigen Detection
W. Wootta, P. Panyaruggit, P. Sawanpanyalerd
National Institute of Health, Nonthaburi, Thailand

Background: To compare the results of Direct Fluorescent antigen detection (DFA) with the
routine direct examination as Giemsa stain, Toluidine blue O stain and Ammoniacal silver stain
for detecting Pneumocystis jiroveci pneumonia (PCP) in bronchoalveolar lavage spacimens (BAL)
taken from symptomatic HIV seropositive patients.
Methods: Bronchoalveolar lavage specimens were examined from 57 symptomatic HIV
seropositive patients sending to National institute of Health, Thailand. Specimens were examined
for PCP using routine direct examination as Giemsa stain, Toluidine blue O stain and
Ammoniacal silver stain and by Direct Fluorescent antigen detection (DFA).
Results: Of the 57 specimens analysed were 24 positive by DFA. An addition two specimens
were routine direct examination negative and DFA positive. Compared to routine direct
examination, the sensitivity and specificity of the DFA assay for the detection of P. jiroveci from
BAL specimens sensitivity, specificity of were 100 and 94.3%. By the way positive predictive
value (PPV), negative predictive value (NPV) and efficiency were 91.7 and 100 and 96.5%,
respectively.Conclusions: this study has shown that DFA assay for the detection of P. jioveci has
a high sensitivity and specificity and can be adapted for use in the clinical microbiology laboratory
reqire fluorescent microscopy.
Final abstract number: 70.023
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Construction of the Internal Controls Using the Same Primers of the Target to Verify PCR and
QPCR Results for Diagnosis
              1                2                 2            1                 1
P. Hung Van , V.D. Xuyen An , H.T. Thuy Loan , H. Hieu Ngoc , L. Thuy Quyen
1                                                                  2
 University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam, Nam Khoa Co. Ltd., Ho Chi
Minh City, Vietnam

Background: Current PCR and qPCR methods used in detecting and/or quantifying pathogenic
agents present in patient sample have become the essential application for most diagnostic
laboratories. Despite these methods have high sensitivity, technical issues are currently the most
influencing factors for the quality of these present in-house methods. Therefore, development of a
good quality control protocol has now become the vital next step.
Objectives: To develop and to construct the internal control using the same primers of the target
in order to standardize the quality of PCR and qPCR results used in pathogen diagnosis.
Methods: Based on the molecular biotechnology, we designed and developed the internal
controls which can be used with the same primers as for the target. After that, the LOD (limit of
detection) concentration that can give detectable signal without inhibiting amplification of the
target, were determined for these internal controls. These LOD determinations are very essential
since the input of the internal control at the LOD to the samples and to the negative control
sample can control the sensitivity of the nucleic extraction, the amplification; can detect the
contamination as well as the inhibition without the need of multiple controls as usual.
Results: Using the mentioned methods, various designed internal controls have been designed
and constructed for PCR and qPCR detection of HCV, HBV, Dengue, HIV, HSV, H5, CMV, M.
tuberculosis, C. trachomatis and N. gonorrhoeae. This method has been being employed for all
PCR diagnostic tests carried out at our laboratory, as well as at other diagnostic laboratories
where our PCR diagnostic kits are being used.
Conclusion: This method has a broad application potential since it can be used in diagnostic
laboratories which are capable of doing PCR to detect human pathogens. Additionally, it can be
helpful for developing the standard criteria for diagnostic PCR.
Final abstract number: 70.024
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Variations of Procalcitonin Serum Levels in Neonatal Period
           1               2           1               1              2             1          1
G. Corona , G. Giogianni , S. Aversa , N. Decembrino , A. Artemisia , V. Cordaro , I. Barberi
1
 Department of Pediatrics, Neonatal Intensive Care Unit, A.O.U. 'G. Martino' University of
                          2
Messina, Messina, Italy, Institute of Biochemistry, A.O.U. 'G. Martino' University of Messina,
Messina, Italy

Background: Systemic inflammatory response syndrome (SIRS), severe infection and sepsis are
the problems of present interest in contemporary neonatal medicine. The specificity and
sensitivity of widespread clinical and laboratory parameters are insufficient for diagnosing these
diseases. A new marker for diagnosing of infective etiology of SIRS, severe infection and sepsis
which allows early diagnosis and begin specific treatment is procalcitonin (ProCT). We perfomed
our study to evaluate the specificity of ProCT as marker of neonatal infection and we have
determined serum ProCT concentration in conditions associated to inflammatory response:
Sepsis, Asphyxia, RDS, Localized Infection and in uninfected patients.
Methods: The study includes 131 newborns admitted to the Neonatal Intensive Care Unit and
divided in 5 groups: Sepsis, Asphyxia, RDS, Localized Infection and in uninfected patients. ProCT
was determined by Biochemistry Laboratory using an immunoluminometric assay, Lumi test,
monoclonal antibodies on specific region of ProCT.
Results: Serum ProCT value correlates with the severity of Sepsis: the more severe the Sepsis,
the higher the level of ProCT (p <0.002). Serum ProCT values were highly variable in other
groups. In RDS and Asphyxia groups the serum ProCT levels does not elevate or increases
moderately. Comparison between groups showed a statistical significant Sepsis vs Asphyxia,
Localized Infection, RDS (p < 0.0001).
Conclusion: At birth newborns adaptations and metabolic changes influence haematologic index.
Sensitive tests are of great utility in NICU where patients present a wide variety of neonatal and
perinatal disorders with laboratory values similar to those caused by infections. Our study showed
that ProCt value was significantly higher in infected than in non infected newborns (p <0.002).
ProCT is considered as a marker of severe bacterial and viral infection. However, in neonatal
period, the monitoring of PCT allows a rapid diagnosis of infection and is most valuable for
evaluating treatment effeciency and prognosis.
Final abstract number: 70.025
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

A Rapid and Simple Dry-Reagent Biosensor for Visual Detection of Amplified DNA Using
Microsphere Based Lateral Flow Technology
          1          2          1                  2            1
A.L. Chua , K. Balqis , B.H. Lim , M. Ravichandran , P. Lalitha
1                                                                               2
 School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia, Department of
Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia,
Kubang Kerian, Malaysia

Nucleic acid assays based on PCR amplification employ agarose gel electrophoresis and
ethidium bromide staining for detection. Ethidium bromide is harmful and electrophoresis requires
at least one hour to perform. Though real-time PCR allows continuous monitoring of the PCR
product by fluorometric hybridisation, it requires highly specialized, expensive equipment along
with costly reagents. In this work, we report a simple dry-reagent disposable biosensor for the
visual detection of amplified PCR product. The bacterial model system used to develop this assay
was Enterococcus faecium. A pair of primers modified at the 5'end with either hapten (biotin or
fluorescein) was designed to amplify a specific region of the 16S RNA of E. faecium. The
amplified hapten-labelled DNA was directly applied to a membrane immobilized with dry form of
streptavidin-coated microsphere test line (T) and anti-mouse IgG antibody-coated microsphere
control line (C). The streptavidin captured the biotinylated PCR product while visual signal was
generated by using anti-fluorescein conjugated gold nanoparticles. The final result was read in 3-
5 minutes. One single (C) line in the membrane indicated the absence of E. faecium; two lines of
both (T) and (C) indicated the presence of E. faecium. Occurrence of a line in (C) indicated that
                                                                                         4
the test worked properly. The analytical sensitivity of the biosensor was found to be 10 CFU/ml
and 13 ng at DNA level. The analytical sensitivity was one log lower than that detectable by
agarose gel electrophoresis. The assay showed 100% and 95.65 % sensitivity and specificity
respectively when tested with 9 E. faecium strains and 23 non-E. faecium strains. Thus this
disposable dry-reagent biosensor (a) offers a cheap alternative for rapid visualization of amplified
DNA; (b) eliminates the multiple incubation and washing steps in current hybridization assays (c)
is cost-effective and environmental friendly.
Final abstract number: 70.026
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Enhanced Patient Serum Immunoreactivity to Recombinant Mycobacterium tuberculosis CFP32
Produced in the Yeast Pichia Pastoris Compared to Escherichia coli and Its Potential for
Serodiagnosis of Tuberculosis
                  1                      1               1             2        2        1
M.R. Barbouche , C. Benabdesselem , M.D. Fathallah , R.C. Huard , H. Zhu , M.A. Jarboui ,
       2            1
J.L. Ho , K. Dellagi
1                                           2
 Pasteur Institute of Tunis, Tunis, Tunisia, Cornell University, New York, NY, USA

CFP32 is a Mycobacterium tuberculosis complex-restricted secreted protein that was previously
reported to be present in a majority of sputum samples from patients with active tuberculosis (TB)
and to stimulate serum antibody production. CFP32 (annotated as Rv0577) was therefore
considered a good candidate target antigen for the rapid serodiagnosis of TB. However, the
maximal sensitivity of CFP32 serorecognition may have been limited in earlier studies because
recombinant CFP32 (rCFP32) produced in Escherichia coli was used as the test antibody-capture
antigen, a potential shortcoming stemming from differences in bacterial protein posttranslational
modifications. To further investigate the serodiagnostic potential of rCFP32 synthesized in
different heterologous hosts, we expressed rCFP32 in the yeast Pichia pastoris. Compared to E.
coli rCFP32, yeast rCFP32 showed a higher capacity to capture polyclonal antisera in Western
blot studies. Likewise, yeast rCFP32 was significantly better recognized by sera from TB patients,
in enzyme-linked immunosorbent assay (ELISA), than E. coli rCFP32. In subsequent testing, the
yeast rCFP32-based antibody-capture ELISA had a sensitivity of 85% and a specificity of 98% for
the discrimination of active TB cases (n = 40) from BCG vaccinees (n = 39). The sensitivity was
surprisingly high for a single-antigen TB serodiagnostic test compared to tests using E. coli-
expressed antigens. Overall, the trans-production of rCFP32 in P. pastoris significantly improved
the serologic detection of CFP32-specific antibodies in patient sera, thereby offering a new,
possibly better, modality for producing antigens of diagnostic potential for use in the development
of immunoassays for both TB and other infectious diseases (International patent request CA
2,551,537 of July 3rd, 2007).
Final abstract number: 70.027
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

One year experience of APTIMA COMBO 2 Transcription Mediated Assay (TMA) for detection of
Chlamydia trachomatis and Neisseria gonorrhoea in a large private pathology laboratory in
Queensland
P. Lowe, P.B. Bartley, P. O'Loughlin, D. Drummond, R. Vohra
QML Pathology, Brisbane, Australia

Between June 2005 and July 2006, a total of 90898 samples including urine and non urine
specimens were processed using the Aptima Combo 2 Assay (AC2) which has the ability to
detect both Chlamydia trachomatis (CT) and Neisseria gonorrhoea (GC) in the same sample.
Results: Overall CT was detected in 6.8% of samples. CT was detected in 7.8% of urine
specimens and 5.3% of genital specimens. CT was also detected in 69 tampon samples (12%),
34 Thin Prep samples (3.2%), 30 eye swabs (5.2%), 30 rectal swabs (8.7%), 14 throat swabs
(1.4%) and 1 seminal fluid (1.1%).
Overall GC was detected in 0.7% of samples. GC was detected in 0.6% of urines specimens and
0.45% of genital swabs. GC was detected in 50 throat swabs (5.1%), 41 rectal swabs (12%), 11
tampons (1.9%) and 3 eye swabs (0.5%). Dual infections with CT and GC were detected in 0.7%
of all samples. Overall prevalence of GC by culture was 0.3%. None had a positive GC culture
and a negative AC2 assay result. 21% of specimens positive for GC by AC2 did not have a formal
request for GC by AC2 (GCNR: GC Not Requested). 29% GCNR GC positive specimens by AC2
did not have a simultaneous culture request. 18% GCNR GC positive specimen had concurrent
CT infection.
Conclusions: CT and GC were detected by AC2 assay in a wide range of sample types. AC2 was
more sensitive than culture for detection of GC. The ability of the assay to detect both CT and GC
in one sample has emphasised the importance of testing for dual infections and enabled the un-
requested GC to be detected. The data suggests that clinicians are opting for molecular- based
testing for GC rather than culture- based methods.
Final abstract number: 70.028
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Application Molecular Methods on Escherichia coli and Ornithobacterium rhinotracheale
Infectious in Commercial Flocks of Southern Khorasan Province in Iran
              1              2           2          2                  2            2
M. Farhoodi , M. kianizadeh , M. Banani , R. Toroghi , S.A. Pourbakhsh , H. Farzin ,
                2
A. sadrebazzaz
1
  Department of Animal Diseases Diagnosis, Razi Vaccine & Serum Research Institute, Mashhad,
                           2
Iran (Islamic Republic of), Razi Vaccine & Serum Research Institute, Mashhad, Iran (Islamic
Republic of)

Introduction: Ornithobacterium rhinotracheale (ORT) is a pleomorphic gram-negative Rod-shaped
bacterium that has been isolated from chickens manifesting severe respiratory problems in many
countries. ORT can be associated with high economic losses in poultry. Only 10 to 15% of
Escherichia coli (E. Coli) intestinal coliforms are pathogenic (APEC). The aims of this study were
the isolation of Ornithobacterium rhinotracheale and Escherichia coli from poultry and
identification of the isolates by Polymerase chain reaction (PCR) for ORT and serology for E.
Coli.
Materials: Samples.
In this study Samples collected from lung and trachea from 13 commercially chicken flocks
showing respiratory disease symptoms were pooled, homogenized and stored at -80°C until
required.
Bacteriology.
ORT:
Samples were aseptically inoculated on blood agar supplemented with 7% sheep blood and 10
  g/ml gentamicin (to inhibit growth of other bacteria) to isolate and identify the causative bacteria
from lung and trachea samples by routine both culture and PCR. The plates were incubated in a
5-10% CO2 atmosphere at 37°C for at least 48 hours.
E. Coli:
All bacterial strains were stored in brain heart infusion broth with 20% glycerol at -80°C prior to
use. In preparation for amplification, bacterial strains were grown on either MacConkey or nutrient
agar overnight at 37°C. E. coli strains.
DNA extraction:
Samples of The tissue followed by DNA extraction by using standard procedure according to
manufacturer's instruction.
Polymerase chain reaction (PCR):
Methodologies for PCR analysis are described elsewhere.
Results: All ORT suspicious isolates were negative in PCR. Serotypes of 13 E. coli isolates from
flocks' colibacillosis revealed most to be O2. There were three untypable strains in the present
study.
Discussion: The purpose of this study was to examine ORT and E. coli from chickens by culture
and PCR tests. A better understanding of the virulence mechanisms of the causative APEC
strains are needed to guide the development of preventive measures.
Final abstract number: 70.029
Session: New Approaches to Bacterial and Fungal Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Comparative Evaluation of Eight Methods for the Detection of Methicillin-Resistant
Staphylococcus aureus (MRSA)
           1            1              2             1               1                 1
H. Al-Talib , Y.Y. Chan , A. Al-Khateeb , H. Habsah , K. Al-Jashamy , M. Ravichandran
1                                                                                      2
 Dept. of Microbiology and Parasitology, University Sains Malaysia, Kelantan, Malaysia, Human
Genome Center, University Sains Malaysia, Kelantan, Malaysia

Emergence of Methicillin-resistant Staphylococcus aureus is responsible for nosocomial and
community-acquired infections worldwide. Hence, a rapid and accurate diagnosis of methicillin-
resistant S. aureus in the laboratory is a vital constituent in enabling control measures and early
therapeutic decisions. The present study evaluated the performance and ability of 8 different
methods for the identification of methicillin-resistant S. aureus. A total of 207 S. aureus clinical
isolates consisting of 89 MRSA strains (oxacillin MIC 8 mg/L), 118 methicillin-susceptible S.
aureus (oxacillin MIC 4 mg/L) were included in the study. The S. aureus strains were further
confirmed by Staphylase-latex agglutination and tube coagulase tests. MRSA strains were
evaluated by six different susceptibility testing methods namely, Chromogenic MRSA agar
(CMRSA), Oxacillin resistance screen agar base (ORSAB), Kirby-Bauer disc diffusion test using 1
  g oxacillin disc (MHA-O), Mannitol salt oxacillin agar (MSO) and Mannitol salt cefoxitin agar with
two different concentrations of cefoxitin [4 mg/L (MSC-4) and 6 mg/L (MSC-6)]. MRSA strains
were further evaluated with two additional methods, namely, MRSA-screen latex agglutination
test and mecA PCR. All these 8 tests results were compared to oxacillin E-test as gold standard.
The mecA PCR and MRSA-screen latex tests results showed 100% sensitivity, specificity, PPV
and NPV. After 24 h of incubation on CMRSA, ORSAB, MSO, MSC-4 and MSC-6 medium,
96.6%, 97.8%, 94.4%, 100% and 97.8% of the MRSA strains, respectively, were detected. The
sensitivities and specificities of the six different media are the following, CMRSA (96.6% and
95.8%), ORSAB (97.8% and 96.6%), MSO (97.5% and 96.6%), MSC-4 (100% and 83.1%), MSC-
6 (97.8% and 94.9%) and MHA-O (98.3% and 97.8%). It was found that MSO was the
inexpensive test ($0.70) while MRSA latex was the most expensive method ($4.00). In
conclusion, mecA PCR is the most accurate, reliable and low-priced ($1.60) method for the
detection of MRSA from clinical samples.
Final abstract number: 71.001
Session: Viral Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Detection of the Rate and Genotyping of Hepatitis C Virus (HCV) Infection in Haemophilia and
Thalassemia Patients in Iran
               1                2           3             2                   3
N.S. Naghavi , K. Samimi Rad , M. Salehi , R. Nategh , M. Shanesazzadeh
1                                                                           2
 Islamic Azad University of Falavarjan, Isfahan, Iran (Islamic Republic of), Tehran University of
                                                      3
Medical Science, Tehran, Iran (Islamic Republic of), Isfahan University of Medical Sciences,
Isfahan, Iran (Islamic Republic of)

Background: Hepatitis C is one of the blood transmitted infectious diseases. The virus belongs to
flaviviridae and has 6 major genotypes. Haemophilia and thalassemia patients, dialysis and drug
injecting patients are at high risk of acquiring hepatitis C virus infection.
Methods: The rates of HCV infection were detected among 103 anti-HCV positive haemophilia
and thalassemia patients in Isfahan province (Iran) by nested PCR. Then the genotypes of the
isolated viruses detected by Reverse hybridization (Lipa) method.
Results: 41% of the total 103 samples showed negative PCR results and 59% of them had
positive PCR results. The rates of HCV infection was 60% in hemophiliacs and 58% in
thalasemics. Also genotyping analysis in hemophiliacs and thalassemics detected type 1 in 59%,
type 3a in 29% and type 6a in 8% of samples studied.
Conclusion: In the present study the predominant types of HCV in the patients were type 1 and
3a which is similar to results obtained from investigations in the other areas in Iran, but we
detected mixed types in some patients and the type 6a in one patient. The type 6a is not a
common type in Iran and not seen in previous studies. The origin of this type which detected in a
hemophilia patient, may be from foreign concentrated clotting factors at the times in which the
factors were not decontaminated with heating processes.
Final abstract number: 71.002
Session: Viral Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Analysis of Ocular Disease by Laboratory Surveillance from May to September 2007 in Incheon,
Korea
         1           1           1         1             1          1        1         1
M.Y. Lee , H.Y. Kim , Y.W. Kong , B.Y. Oh , K.W. Whang , Y.J. Koh , J.H. Kim , S. Jegal ,
        1          1           1           2
J.M. Lee , J.M. Go , Y.H. Kim , Y.S. Chung
1                                                                      2
 Incheon Institute of Health & Environment, Incheon, Republic of Korea, Korea Center for
Disease Control & Prevention, Seoul, Republic of Korea

The study carried out a molecular biological character of Epidemic Kerato-Conjunctivitis (EKC)
and Acute Hemorrhagic Conjunctivitis (AHC) virus which used 52 specimens of 3 ophthalmic
clinics in Incheon between May 2007 and September 2007.
This study confirmed CPE (Cytopathic Effect) from conjunctival specimen of opthalmic patients
after inoculating A549 cell and HeP2 cell and observing for 7 days. we extracted DNA and RNA
from CPE confirmed cell soups and carried out reverse transcription-PCR.
From a total 52 specimens, 29(55.8%) were virus-positive and the isolated viruses were found to
be 12 adenoviruses (41.4%), which were serotype 8 (11 isolates) and serotype 37 (1 isolates)
and 17 enteroviruses (32.7%), which were confirmed Coxsackievirus A 24 serotypes.
This research confirmed that Adv 8 and 37 caused the prevalence of adenoviral conjunctivitis and
Coxsackievirus A 24 caused the prevalence of Acute Hemorrhagic Conjunctivitis during May
2007 to September 2007 in Incheon.
Final abstract number: 71.003
Session: Viral Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Detection and Identification of Human Metapneumovirus Infection in ShenZhen, China
X.D. Lu, C.D. Lu, Q. Wang, Y.H. Lu, J. Liu
The Affiliated Shenzhen Futian Hospital of the Medical College of Guangdong, ShenZhen, China

Background: Human metapneumovirus (HMPV) is a newly discovered and identified negative-
sense RNA virus thought to be associated with respiratory disease in 2001. Acute respiratory
tract infections with HMPV have been reported in Europe, America, Australia, Japan, China,
Canada, Tailand, HangKong. The clinical syndrome of the infected children ranges from mild
respiratory problems to bronchiolitis and pneumonitis. In this study, for rapid , multiplex detection
of respiratory tract virus in clinical specimens with respiratory infections caused by HMPV. HMPV
was identified by molecular biology technique.
Methods: 7 respiratory tract virus (11 typing) were deteced by using multiplex PCR technology
and a flexible Multi-Analyte Profiling (suspension array). Human Metapneumovirus was identified
by using a real-time reverse transcriptase PCR (RT-PCR) assay and RNA sequences.
Results: The virus were detected in 40.23% (19/47) of. 47 samples collected from clinical
respiratory tract infections, including 8 (42.11%) HRSV, 36.84%) Influenza virus, 1 (5.26%)
Parainfluenza virus , Rhinovirus, Coxsackievirus and Human Metapneumovirus infections. This
hMPV was the first deteced from clinical samples in ShenZhen. The N genes amplified of hMPV
from specimens was identified by sequencing and was compared with GenBank. The ShenZhen
hMPV N genes nucleotides similarities were over 98% with JPS03-187, JPS03-176, JPS03-240,
JPS03-178, BJ1887, NED01-22, NED01-17.
Conclusion: Multiplex PCR technology and flexible Multi-Analyte Profiling were high sensitive and
throughput and increased assay speed for multiplex detecting respiratory pathogens in clinical
specimens. It is useful tool for epidemiology yet.
Final abstract number: 71.004
Session: Viral Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Viral Hepatitis-Serologic Patterns
S. Bisinova-Eftimova, S. Miskova, S. Trajkova, R. Stojanova, T. Nedelkova, M. Alceva
General Hospital, Veles, Former Yugoslav Republic of Macedonia

Background of the study: There is a high incidence of viral hepatitis in our region, especially
hepatitis A, but the other types of hepatitis are also important because of their course and
prognosis. The serological markers have great and important place in determination, following
and treatment of the viral hepatitis. The aim of this study is to accented the point of these
investigations. We will present serologic patterns of viral hepatitis cases treated in the
Department of infectious diseases, General hospital-Veles, during the five years.
Methods used: We analyzed 155 viral hepatitis patients with these parameters: age, profession,
epidemiological characteristics and serologic patterns. Immunological detection was performed
by ELISA test, VIDAS-viomerieux and PCR.
Results: Positive antiHAV IgM was found in 94 patients (60,6%), that suggests the highest
prevalence of acute hepatitis A. HBV markers were detected in 41 patients (26,4%), while HCV
markers were detected in 7 patients (4,5%). Viral hepatitis serologic markers were not detected in
the samples from 13 patients (8,5%). Four of them were HBsAg carriers with acute hepatitis A,
while in three of them both HBcIgM and antiHAV total were detected, that suggests previous
hepatitis A.AntiHCV positive patients in our study are drug addicts and HBI patients with an
undergoing haemodialysis.
Conclusion: Detection of the serologic markers of viral hepatitis enables early diagnosis and
management, as well as progression to chronicity and carriers identification. The exact and on
time usage of these detectors cancels the epidemiological circle of viral hepatitis.
Final abstract number: 71.005
Session: Viral Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Role of Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) as a Better Tool for Early
Diagnosis of Human Rabies
            1          2            3
B. Mishra , M. Biswal , R.K. Ratho
1
  Dept. of Virology, Postgraduate Institute of Medical Education & Research, Chandigarh, India,
2                                                                                   3
  Dept.of Virology, Postgraduate Institute of Medical Education , Chandigarh, India, Dept. of
Virology, Post Graduate Institute of Medical Education , Chandigarh, India

Background: For more than three millennia, rabies has been one of the most feared human
diseases. An early confirmation of rabies is important for timely immunization and to prevent
unnecessary post-exposure prophylaxis. The conventional viral antigen detection by direct
immunofluorescence (DIF) and seller staining are less sensitive and the gold standard MIT
however is laborious and time consuming. Thus, the present study was carried out i) to compare
RT-PCR result with DIF and seller staining, and ii) to determine its role in early diagnosis of
rabies.
Methods: Skin biopsies and corneal impression smears were collected ante mortem and brain
tissue and CSF were collected at autopsy, from suspected rabies patients. Reverse transcriptase
polymerase chain reaction (RT-PCR) was done to detect viral RNA in patients and infected mice
tissues. To determine the earliest appearance of rabies virus RNA in the mouse tissues, fixed
virus and clinical isolates were inoculated intracerebrally into mice. Two newborn mice per day
were sacrificed at two day intervals from day 2 - 8 for fixed virus and day five till death in clinical
isolates. Mice brain tissue and muzzle skins were subjected to DIF, Seller and RT-PCR.
Results: Of 10 samples, six postmortem brain tissues were positive by RT-PCR followed by 5 by
DIF and 4 for negri bodies. Rabies viral RNA could be detected as early as the 3rd day of
infection by RTPCR in brain as well as muzzle tissues followed by rabies viral antigen by DIF on
day 5th and symptoms on day 7 in fixed rabies virus infected mice, where as no qualitative
difference was observed between 3 techniques when examined 5 days onwards.
Conclusion: The present study thus highlights the importance of RT-PCR as a more sensitive
technique with the potentiality for early confirmation of rabies as compared to conventional
techniques.
Final abstract number: 71.006
Session: Viral Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Development of Serodiagnostic Method for the Detection of Serotype-Specific Anti-
Coxsackievirus Antibodies
M.D. Mavrouli, N. Spanakis, A. Tsakris, J.G. Routsias
Department of Microbiology, Medical School, National and Kapodistrian University of Athens,
Athens, Greece

Coxsackieviruses (CV) are associated with several clinical manifestations ranging from mild
upper respiratory infections to meningitis and myocarditis. Different serotypes have been
implicated in the appearance of different manifestations. Nowadays, virus identification depends
on virus isolation and cultivation and the use of neutralization tests. In this study, we developed
an Enzyme-Linked Immunosorbent Assay (ELISA) with the ability to discriminate among different
serotypes of Coxsackie viruses.
Fifteen-mer peptides were synthesized in order to include the sequences where the antigenic
protein VP1 differs among Coxsackie B3, B4 and A24 serotypes (pepB3, pepB4 and pepA24,
respectively). The peptides were synthesized in conjunction with an oligopeptide carrier (MAP)
and applied in the ELISA assay. In parallel, a commercial ELISA based on the VP1 protein of
Coxsackieviruses B1/B5 as antigen was used. Sera were obtained from 200 healthy donors and
examined for the presence of antibodies against pepB3, pepB4, pepA24 and VP1-B1/B5.
IgG antibodies against peptides of Coxsackie B3, B4 and A24 were detected at 23%, 33% and 36
% of sera tested, respectively, while IgG antibodies against the VP1 of Coxsackie B1/B5 were
found at 20,5% of the samples. Inhibition experiments demonstrated that (i) pepB3, pepB4 and
pepA24 inhibited their homologous recognition by antibodies in ELISA at 57-87%, (ii) anti-pepA24
possess a distinct antigenic specificity, producing a heterologous inhibition of <35% in anti-pepB3
and anti-pepB4 assays and (iii) anti-pepB3 and anti-pepB4 are distinct but their activities are
related (demonstrating a heterologous inhibition of 8-68%, depending on serum, r=0,49,
p<0,0001). Urea dissociation experiments demonstrated that anti-pepA24 antibodies can react
specifically with high avidity with their peptide substrate, resisting even to the treatment of 8M
urea.
The peptides pepB3, pepB4 and pepA24 can be used for the detection of antibodies against
Coxsackieviruses enabling the discrimination among different coxsackieviruse serotypes.
Final abstract number: 71.007
Session: Viral Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Real-time Diagnosis and Monitoring of Cytomegalovirus Infections Using TaqMan-MGB Probe
Technology
S. Pholampaisathit
National Institute of Health, Nonthaburi, Thailand

Background: Cytomegalovirus (CMV) is an important pathogen in morbidity and mortality in
immunocompromised patients including AIDS patients, infants, and transplant patients. In these
patients, early detection and monitoring of CMV infection before clinically significant disease
occurred may be useful for antiviral therapy and also allow detection of antiviral drug resistance.
Today, nucleic acid detection assays are generally preferred over culture-based methods for
detection of CMV infection. A real-time PCR assay based on highly conserved CMV glycoprotein
B (gB) was developed to quantify the cytomegalovirus genome load.
Methods: CMV glycoprotein B containing plasmid was constructed by using the TOPO TA cloning
procedures with plasmid pCRR2.1 (Invitrogen, Carlsbad, Calif.). The standard curve was
established by plotting the CMV plasmid DNA input against the corresponding threshold cycle
(Ct) values. TaqMan polymerase chain reaction assays based on CMV gB was developed for
quantifying CMV DNA in immunocompromised patients.
Results: The detection limit of TaqMan polymerase chain reaction assay for CMV-DNA was 10
                                                                                            2
genome per reaction and the linear measure interval was 1 to 107 copies per reaction (r =
0.999). The reproducibility of the TaqMan assay was initially evaluated by interassay (between-
runs) and intraassay (within-run). The interassay and intraassay coefficients of variation were
9.79% and 10.85%, respectively. The specificity of the assay was determined among
herpesviridae subfamily. No positive signals were detected. Initial application of the quantitative
real-time PCR to serum of infant indicated the effective of assay for CMV quantitation with 100%
sensitivity (n = 5).
Conclusion: In-house TaqMan assays may potentially serve as a useful tool for rapid
quantification of CMV infections in immunocompromised patients.
Final abstract number: 71.008
Session: Viral Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Evaluation of Different Storage Conditions on Detection of Influenza A Virus Subtyping by
Multiplex PCR Assay
         1              1         1            2
W. Kania , A.I. Susanti , T. Retno , G.T. Brice
1                                                               2
 US Naval Medical Reseacrh Unit 2, Jakarta Pusat, Indonesia, US Naval Medical Reseacrh Unit
2-Jakarta, Biomedical Research & Development Liasion Office of Defense Coorporation,
Singapore, Singapore

Isolation of influenza A virus by tissue culture is the traditional gold standard for laboratory
detection and is important for tracking antigenic changes of the virus. However, viral isolation is
not useful for rapid clinical diagnosis of infection and is not practical for large-scale
epidemiological studies. The application of molecular diagnostics overcomes these limitations
and increases the detection rate of influenza virus by 3 - 60%. Although optimal parameters for
specimen storage to support subsequent virus isolation have been determined, these parameters
have not been defined for nucleic acid testing. In order to define these parameters, we evaluated
the ability to detect influenza A virus by molecular assays under different storage conditions,
including temperature, storage medium, and time. We analyzed samples kept in different storage
temperatures (4 °C , -20 °C , -70 °C), storage time (1, 7, 14 and 28 days) and different storage
medium (viral transport medium or ethanol). These conditions were evaluated for both swabs and
extracted RNA samples. The Luminex multiplex bead-based assay was used for molecular
detection of influenza A virus matrix gene and hemagluttinin subytping. Although we were able to
detect influenza A virus in all storage conditions, there was a 25- 42% decrease in the mean
fluorescent intensity (MFI) signal over time for both matrix and hemaglutinnin for swabs stored in
VTM at 4 °C. Loss of MFI signal by swabs stored in VTM was minized by storage at either -20 °C
or -70 °C. We did not observe a loss of MFI signal in swabs stored in ethanol at either 4 oC or -20
oC, although a slight decrease in MFI signal was observed in samples stored at -70 °C.(This
really needs to be repeated, does not agree with other results). Results of our study suggest that
ethanol storage of specimen may provide an optimal transport medium for samples collected at
remote sites where maintenance cold-chain requirements may be difficult. Results from other
respiratory viruses will also be presented.
Final abstract number: 71.009
Session: Viral Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Virological and Immunological Monitoring of Human Cytomegalovirus Infection in Heart and Small
Bowel/Multivisceral Transplantation
               1                1           1            2          2           1        1
T. Lazzarotto , A. Chiereghin , L. Gabrielli , A.D. Pinna , A. Lauro , P. Monari , S. Pop ,
           3              1
L. Potena , M.P. Landini
1
 Clinical Unit of Microbiology, St.Orsola Malpighi GH, University of Bologna, Bologna, Italy,
2
 Department of Surgery and Transplantation, St.Orsola Malpighi GH, University of Bologna,
                 3
Bologna, Italy, Cardiology Institute, St. Orsola Malpighi GH, University of Bologna, Bologna, Italy

Background: this study was carried out to assess the diagnostic and prognostic value of
cytomegalovirus (CMV) determination in whole blood (heart and intestinal recipients) and in
biopsy tissue samples (intestinal recipients) from transplant patients during virological
surveillance and analyse the CMV T cell response after transplantation.
Methods: we monitored 30 heart transplant recipients (HTR) comprising three R-/D+ and 34
intestinal/multivisceral transplant (SBMTR) comprising three R-/D+ by CMV pp65 antigenemia
and Real Time PCR .
Immunological surveillance was done in 12 HTR and 9 SBMTR. T lymphocyte suspensions
obtained using a Ficoll gradient were processed by ELISPOT, an immunoenzyme assay based
on the search for T cells with viral specific antigens of one of the protein markers of cell activation
(IFN-gamma).
Around 2000 blood samples and 1200 intestinal biopsy specimens were processed for virological
tests and 56 were analysed by ELISPOT.
Results: 70% (21/30) and 44% (15/34) of HTR and SBMTR developed active CMV infection,
respectively. Of the 21 HTR infected four had a mild-moderate symptomatic infection (leucopenia
and fever). Of the 15 SBMTR infected patients two had a severe symptomatic CMV infection
(pneumonia, enteritis and rejection) which led to the patient's death and three had a mild infection
(fever).
Conclusion: quantitative determination of CMV in blood and organ biopsy by molecular tests is
the elective assay for monitoring viral load, since it directly correlates with viral replication and
clinical symptoms.
The preliminary outcome of immunological monitoring shows i) a CMV T-cell immune response in
the first month after transplantation was associated with a reduction in mean and peak CMV viral
load and; ii) a good and early reconstitution or development of the CMV-specific T-cell response
can shorten the duration of CMV infection and control the risk to incur repeated episodes linked to
a recurrent infection.
Final abstract number: 71.010
Session: Viral Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Detection of hepatitis B virus DNA in oral fluid by using an optimised nested PCR
                  1            1           1              2                3            1
M.I. Micalessi , C. Gérard , I. Thomas , P. Michielsen , P. Van Damme , R. Vranckx ,
              1
B. Brochier
1                                                           2
  Scientific Institute of Public Health, Brussels, Belgium, University Hospital of Antwerp, Antwerp,
            3
Belgium, University of Antwerp, Antwerp, Belgium

Background: Conventionally the detection of hepatitis B virus (HBV) DNA is carried out on serum
using commercial or in house PCR assays. Oral fluid obtained by use of commercial collection
devices offers several advantages compared to venepuncture: it is non invasive, painless, safe
and less expensive.
Methods: Seventy-three HBV DNA positive and 74 HBV DNA negative paired serum/oral fluid
samples, drawn from patients visiting university hospitals, were analysed. The detection of HBV
DNA in oral fluid was carried out through an optimised nested PCR with a 95% detection limit of
457 copies/ml.
Results: A clinical sensitivity and specificity of 69.9% (95%CI: 58.6%-79.2%) and 100% (95%CI:
95.1%-100.0%) respectively was achieved. A statistically significant association was found
between the serum HBV DNA viral load and the detection of HBV DNA in oral fluid (p<0.001). In
                                                 5
samples with a minimum concentration of 10 copies/ml (high viraemia), it was possible to detect
                                                                                            5
the virus in oral fluid in 91.8% (95%CI:80.8%-96.8%) of the cases. A concentration of 10
copies/ml being considered as the minimum level needed for the transmission of HBV via
needlestick or mucosal scratch, the optimised nested PCR could be used in epidemiological
surveys for mapping of active replicating carriers.
Conclusion: An optimised nested PCR for HBV detection, with a 95% detection limit of 457
                                                                                              5
copies/ml and a sensitivity of 91.8% in patients with a minimum serum concentration of 10
copies/ml, was developed. The use of serum remains the golden standard for individual
diagnosis, monitoring of anti-viral treatment or detection of occult infections. However, oral fluid
sampling by oracol collection device offers through all its advantages versus venepuncture a
good alternative in epidemiological and surveillance surveys.
Final abstract number: 71.011
Session: Viral Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Screening for Influenza A H5N1 Haemagglutinin and Neuramidase Mutations Using the New
Alignment & Mutation Analysis Tool in Bionumerics
B. Pot, J. Goris, M. Vauterin, K. Janssens, P. Vauterin, L. Vauterin
Applied Maths NV, Sint-Martens-Latem, Belgium

The haemagglutinin (HA) and neuramidase (NA) genes are considered to be responsible for the
major part of the antigenic variability of influenza A viruses. Reportedly, specific amino acid
changes might even serve as molecular markers for the pandemic potential of avian influenza
isolates.
We recently developed an Alignment & Mutation Analysis tool as an extension library for the
BioNumerics software. Here, we illustrate the use of this versatile and powerful tool with publicly
available sequences and trace files. The latter were automatically assembled into contigs and
imported with the batch assembly plugin. Optimized settings for trimming and assembly
minimized manual editing. Strain information was parsed along with the import and all data were
stored in a single relational database.
Using this plugin, we were able to assemble 22,000 influenza A genome sequence trace files
from the NCBI Trace Archive (http://0-ww.ncbi.nlm.nih.gov.catalog.llu.edu/Traces/trace.cgi) in
less than 30 minutes. For the HA and NA gene sequences of influenza A virus serotype H5N1, a
multiple alignment was created and the nucleic acid sequences were translated into amino acids.
Mutations were searched relative to a consensus sequence, which made "hot spots" for
mutations to become immediately apparent. For each mutation, its position, type (silent,
missense, indel), nucleotide change and amino acid change was listed. When browsing through
the mutation list, the cursor jumps automatically to the corresponding position on the alignment
and curves, allowing the researcher to visually evaluate the mutation in its context.
Overall, performing the complete mutation analysis within a single software package offers much
added flexibility, in comparison with online analysis tools.
Final abstract number: 71.012
Session: Viral Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Universal Virus Detection
C. Uhlenhaut, A.M. Sierra-Honigmann, S. Nanda, S. Tang, P.R. Krause
FDA/CBER, Bethesda, MD, USA

Reliable and fast assays are prerequisite for rapidly identifying infectious agents such as
emerging viruses, zoonotically transmitted or otherwise rare and unusual viruses in order to take
appropriate epidemiologic actions and/or to choose the best treatment. However, detection and
identification of viruses without specific knowledge about their genome can be challenging.
We developed an assay that combines virus capsid preparation with generic PCR. The first step
is the physical and biochemical purification of a given sample by targeted digestion of
contaminating host nucleic acids. This is followed by a degenerate oligonucleotide primer (DOP)
PCR. The primer population is optimized for the detection of virus-sized genomes. Products can
be identified by cloning and sequencing or by subjecting the PCR products to high throughput
sequencing.
Various DNA viruses (including HSV, VZV, SV40, AAV, EBV, parvoviruses and hepatitis B) and
RNA viruses (including HTLV-1 and HTLV-2, several animal retroviruses, poliovirus, hepatitis A, a
human corona virus, human metapneumovirus and influenza virus) were detected in cell cultures
and clinical samples.
This novel technique requires no prior sequence information to amplify viral genomes, but
nonetheless be able to amplify at least a portion of each viral genome. It can detect viruses in a
variety of samples using only one aliquot of the sample per assay. These features render it ideal
for virus discovery and detection of virus in samples for which other methods have failed. The
ability of the DOP to detect all viruses, human and zoonotic, in parallel, is also a useful asset in
the context of emerging infectious diseases, which often are of zoonotic origin. Another
application is the identification of viral agents in immuno-compromised patients, who often suffer
from unusual infections. Moreover, generic detection of viral agents maybe useful in assuring the
safety of regulated products such as cell culture based vaccines.
Final abstract number: 71.013
Session: Viral Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Molecular Diagnosis of Common Viral Infectious Diseases Based on Real Time PCR
              1            2
N. Mohamed , J. Bloomberg
1                                                                                 2
 Microbiology Department, Virology Section- Alneelain University, Khartoum, Sudan, Uppsala
University, Uppsala, Sweden

Molecular biology has become an integral part of the diagnosis of infectious diseases. Recently,
quantitative real-time PCR (QPCR) methods have been developed for the diagnosis of a wide
range of infectious diseases. The use of QPCR as a tool for diagnostic virological and viral
research laboratories has greatly increased in recent years. It often replaces conventional PCR
and amplicon detection systems which are more complex and laborious, with a higher risk of
amplicon carry-over contamination.
The new QPCR methods presented here utilize broadly targeted primers and probes for rational
and sensitive detection and quantification of variable RNA viruses. They take advantage of the
dual properties, both RNA and DNA dependent DNA polymerase activities, of the rTth
thermostable polymerase, and thermolabile UNG with dUTP to protect against inadvertent
contamination of samples with amplimers.
Specimen collection and delivery to the laboratory without delay and with minimal losses are vital
components for reliable RNA measurements in a diagnostic service. 62 Cerebrospinal fluid, 71
stool specimens & 203 human nasopharyngeal aspirates involved in this study.
We describe broadly targeted QPCRs which use several alternative conserved sequences. The
assays developed will be useful tools for performing infection surveys. The development of
broadly reactive QPCRs assays for RNA viruses was challenging due to the extensive genetic
diversity among the different viruses. The assays in the present study were able to detect all or
most of the intended target viruses in less than 3 hours, to achieve the ideals broad targeting,
high sensitivity, high specificity and quantitative results
The technologies described in this study have common features. They are a platform for further
development of diagnostic tools for screening and detection of viruses in known viral diseases,
maybe also for discovering new viruses.
Final abstract number: 71.014
Session: Viral Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Detection of Minute Changes in Influenza Genome Fragments by Single-Strand Conformational
Polymorphism Technique
               1            1              2         2
B. Gromadzka , B. Szewczyk , K. Smietanka , Z. Minta
1                                      2
 University of Gdansk, Gdansk, Poland, The National Veterinary Institute, Pulawy, Poland

Single-stranded DNA fragments attain a number of conformational forms which may be separated
by electrophoresis in native polyacrylamide gels giving a characteristic pattern of electrophoretic
bands. Minute sequence changes (e.g. point mutations) may have significant effect on
electrophoretic pattern of single-stranded DNA. Changes of gel temperature during
electrophoresis increase the sensitivity of mutation detection in PCR products; this technique, a
modification of SSCP technique, was named MSSCP (where M stands for "multitemperature").
This method modified in our laboratories was applied for characterization of influenza A cDNA
fragments. A series of primers were synthesized after the comparison of the hemagglutinin,
neuraminidase and PB2 gene sequences of different origin. PCR reactions were run using these
primers and the products were denatured. Single-stranded DNA fragments were subjected to
MSSCP electrophoresis where, after silver staining, they gave characteristic ssDNA band
patterns. This technique was applied to analyse hemagglutinin, neuraminidase and PB2 gene
fragments from recent isolates of avian flu. Minor differences within a serotype were detected
which makes the MSSCP technique a valuable tool for quick preliminary characterization of
influenza variants.
Final abstract number: 71.015
Session: Viral Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Evaluation of Two Commercial Enzyme Immunoassays for Rapid Detection of Noroivrus Antigen
in Human Stool Specimens
X.L. Bai, S.H. Lim, E.H. Seng, W.L. Loke, K.P. Chan
Singapore General Hospital, Singapore, Singapore

Two commercial enzyme immunoassay kits: Ridascreen Norovirus (3rd generation, R-Biopharm
AG, Germany) and Denka Seiken NV-AD (II) (Denka Seiken Co. Ltd., Tokyo, Japan), that detect
norovirus antigen in human stool specimens, were evaluated to access whether they can be used
in routine diagnosis and outbreak investigation. A total number of 154 stool specimens collected
from young children from primary schools who suffered from acute gastroenteritis were tested for
norovirus antigen by the two ELISA kits and by Real Time-PCR method. The Ridascreen kit
revealed a high sensitivity of 90.8%, a specificity of 95.5%, and an efficiency of 95.2%. The
Denka ELISA kit had a sensitivity of 72.3%, a specificity of 82.9%, and an efficiency of 87.0%.
The precision for Ridascreen is 1.6% for positive control whereas it is 7.7% for Denka kit. These
findings indicate these ELISA kits may be used as alternative methods for screening of norovirus
in stool specimens.
Final abstract number: 71.016
Session: Viral Diagnostics (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

The Loop-Mediated Isothermal Amplification-Based Diagnostics for Monkeypox Virus Infection
I. Iizuka, M. Saijo, Y. Ami, Y. Suzaki, N. Nagata, H. Hasegawa, T. Shiota, M. Ogata, K. Sakai,
S. Fukushi, T. Mizutani, I. Kurane, S. Morikawa
National Institute of Infectious Diseases, Tokyo, Japan

Introduction: Monkeypox virus (MPXV), a member of the genus Orthopoxvirus, causes a
smallpox-like disease, human monkeypox. This infection is endemic to central and western
Africa. A sporadic outbreak of human monkeypox occurred in the USA in 2003, indicating the
necessity of development of diagnostics for monkeypox even in countries free from this infection.
MPXV is divided into two genetically different groups, Congo Basin and West African groups. A
real-time quantitative MPXV genome amplification system, which differentiates the two groups,
was developed using the technology of loop-mediated isothermal amplification (LAMP) (Nucleic
Acid Res 28: E63, 2000).
Materials and methods: Primers used in the LAMP for MPXV genome amplification of Congo
Basin (C-LAMP), West African (W-LAMP), and the two groups (COM-LAMP), were designed
according to the nucleotide sequences of Congo Basin-specific D14L gene, the West African-
specific partial A-type inclusion body (ATI) gene, and the partial ATI gene that was shared by
both groups, respectively. The sensitivity and specificity of the LAMP were evaluated compared
to the sensitive nested PCR using peripheral blood and throat swab samples collected from
MPXV Zr-599- (Congo Basin) or Liberia (West African)-infected monkeys.
Results: C-LAMP, W-LAMP, and COM-LAMP specifically detected Congo Basin, West African,
and both groups, respectively. The sensitivity and specificity of COM-LAMP, C-LAMP, and W-
LAMP were 79% (38/48) and 100% (62/62); 79% (19/24) and 100% (24/24); and 78% (18/23)
and 100% (38/38), respectively. Furthermore, the more severe the level of monkeypox-
associated symptoms, the higher the viremia level determined with the LAMP.
Discussion: The newly developed LAMP might be a valuable tool for diagnosis of human
monkeypox. Congo Basin MPXV was reported to be more virulent than West African MPXV.
Therefore, discrimination of the MPXV groups with the LAMP should be useful not only for
diagnosis but also treatment of human monkeypox.
Final abstract number: 72.001
Session: Mycobacterial Pathogenesis, Immunology and Vaccines (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Analysis of Compensatory ahpC Promoter Region Mutations and Relative Fitness of Inh-
Resistant M. Tuberculosis
            1            1            2                3
A. Mache , Y. Mengistu , S.E. Hoffner , D.A. Anderson
1
 Department of Medical Microbiology, Immunology and Parasitology, Medical Faculty, Addis
                                         2
Ababa University, Addis Ababa, Ethiopia, Swedish Institute for Infectious Diseases Control (SMI)
                       3
, Stockholm, Sweden, Swedish Institute for Infectious Diseases Control (SMI); Karolinska
Institute, Stockholm, Sweden

Background and objectives: Studies to date have not fully resolved whether the transmission
dynamics of drug-resistant M. tuberculosis (M. tb) strains are different from sensitive strains,
especially for isoniazid (INH). M. tb strains resistant to INH reported to be heterogeneous in a
kind of KatG mutation they manifest possibly with a variable impact on the fitness. This study was
intended to determine the fitness of INH resistant and katG mutant M.tb strains using
compensatory ahpC promoter region mutation analysis and in vitro competition.
Material and Methods: A total of 44 in vitro selected INH resistant (MIC >0.2 mg/ L) and katG
codon 315 and 463 mutant isogenic M. tb strain Harlingen were used. Strains were characterized
into six classes based on the catalase activity, INH MIC values, mutations in katG and ahpC
promoter. Relative fitness of mutants was determined by measuring in vitro growth rates by
competition experiment with the wild strain and by single culture.
Results: Six strains lacked catalase activity while the activity ranged from 5 to 55 mm for the
remaining. Strains with no catalase activity and high MIC values as well as most strains with low
catalase activity and high MIC values manifested mutations in both katG and ahpC promoter with
few irregularities. The relative fitness of the mutants ranged from 0.83 to 0.91 and 0.85 to 0.94
respectively in competition and single culture.
Conclusions: The wild strain had slightly shorter doubling time than mutant strains, but the
difference was not statistically significant (P> 0.05). It could be argued that M. tb strains which are
resistant to INH due to mutations in the codon 315 of katG gene containing ahpC promoter region
mutations (with few irregularities) are as fit as the wild strain because of compensatory mutations,
no cost resistance mutations or both.
Final abstract number: 72.002
Session: Mycobacterial Pathogenesis, Immunology and Vaccines (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Immunophenotyping Analysis of Peripheral T and B Lymphocytes in Patients with Chronic
Pulmonary Tuberculosis
                   1                      1             1               2
A. Garibay-Escobar , P.C. Gastélum-Aviña , C. Velázquez , J. Hernández
1                                           2
 Universidad de Sonora, Hermosillo, Mexico, CIAD, AC., Hermosillo, Mexico

Cellular immune response plays a critical role in the containment of persistent Mycobacterium
tuberculosis infection. However, the immunological mechanisms that lead to the control are not
complete identified. The goal of this study was to evaluate CD3+ (T) and CD19+ (B) lymphocytes
profiles, and, CD4+ (helper T lymphocytes), CD8+ (cytotoxic T lymphocytes) and
CD3+CD4+CD25+ (regulatory T lymphocytes or Tregs) subsets in patients with chronic
pulmonary tuberculosis (CTB).
Peripheral blood mononuclear cells (PBMC) from patients and healthy donors were isolated by
Histopaque-1077 gradient centrifugation. PBMC were stained with a combination of mAbs as
follow: to analyze T and B cells, double labeling was performed using anti-CD3PerCP and anti-
CD19FITC. To evaluate T cells subpopulations, a triple labeling were made using: anti-
CD4FITC/anti-CD8PE/anti-CD3PerCP or anti-CD3PerCP/anti-CD4FITC/anti-CD25PE. For
isotype controls, cells were stained with Simultest g2aFITC/g1PE. Cells were acquired and
analyzed with a fluorescence activated cell sorter FACScalibur using the CellQuest software.
Differences between patients and healthy were analyzed by a non-parametric method of U-Mann
Whitney using SPSS version 10.00 for windows, and significance differences were considered
with a P < 0.05.
Percentages of CD3+ cells were similar in CTB and healthy donors (P = 0.6). In contrast,
percentage of B lymphocytes was significant lower in CTB than in healthy subjects (P = 0.03). A
significant predominance (P = 0.0006) of CD4+ T cells over CD8+ T cells was observed on both
groups. No significant changes on CD4+ (P = 0.2) or CD8+ (P = 0.5) T cells between CTB
patients and healthy controls were observed. However, percentage of Tregs lymphocytes was
significant higher in CTB than in healthy donors (P = 0.009).
According with these results we suggest that low percentage of CD19+ cells and high percentage
of Tregs lymphocytes (CD3+CD4+CD25+) can be a mark of patients with chronic TB.
Final abstract number: 72.003
Session: Mycobacterial Pathogenesis, Immunology and Vaccines (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Neonatal BCG Bacteremia - Thailand 2006-2007
         1                      1                   1                3            4             4
N. Marin , C. Pittayawonganon , P. Thammawijaya , W. Kiatkulwiwat , P. Prapasiri , H. Baggett ,
           4                4
L. Peruski , S. Thamthitiwat
1                                                                        1
 Bureau of Epidemiology, Ministry of Public Health, Nonthaburi, Thailand, Bureau of
                                                              3
epidemiology, Ministry of Public Health, Nonthaburi, Thailand, Nakae Hospital, Ministry of Public
                                    4
Health, Nakhon Phanom, Thailand, International Emerging Infections Program, Thailand MOPH-
                                                     4
US CDC Collaboration, Nakhon Phanom, Thailand, International Emerging Infections Program,
Thailand MOPH-US CDC Collaboration, Nonthaburi, Thailand

Background: In May 2007, a recently enhanced microbiological surveillance system reported 3
cases of Mycobacterium tuberculosis (TB) complex bacteremia among neonates from Nakhon
Phanom province. An investigation was conducted to confirm the etiology and identify risk factors.
Methods: We reviewed the medical records of the patients and their mothers, and observed
vaccination, blood collection and laboratory procedures. Family members and health-care
workers were screened with chest x-ray for TB disease. Repeat physical examination and chest
x-ray were performed on the case-patients. Biochemical analysis and genotyping were performed
on one available isolate.
Results: The 3 neonates were born to HIV-negative mothers in the same hospital April 2006 -
March 2007; each received BCG vaccination within 24 hours of birth. Vaccines were from 3
different lots but were administered by the same nurse. Each neonate was discharged within 24
hours and returned to the hospital for routine hypothyroid screening 48 hours later. At follow-up,
each patient exhibited jaundice and two had fever. All were re-hospitalized and had hemocultures
collected. Symptoms resolved and all were discharged without complication after 2-5 days.
Isolates identified as M. tuberculosis complex were recovered from each patient's hemoculture
after incubation for 28-32 days. Subsequent interviews and testing found no active TB cases
among patients' mothers and close contacts. The neonates had normal chest x-rays, negative
repeat hemocultures, and appeared healthy at the time of investigation. Genotyping of the only
available isolate recovered from the initial hemocultures confirmed M. bovis BCG.
Conclusion/interventions: We report the first 3 cases of transient BCG bacteremia after
vaccination in otherwise healthy neonates in Thailand. Clinical implications of BCG bacteremia
are unclear. As mycobacterial hemoculture is relatively new in this setting, further analysis and
investigation are necessary to understand the scope and significance of BCG bacteremia.
Keywords: BCG vaccine, Mycobacterium tuberculosis, bacteremia, neonates, Thailand
Final abstract number: 72.004
Session: Mycobacterial Pathogenesis, Immunology and Vaccines (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

The PPE Protein Rv1196 of Mycobacterium tuberculosis Exploits the TLR2 Signaling in
Macrophages Eliciting an Anti-Inflammatory Response by Producing IL-10
S. Mukhopadhyay, S. Nair, S.C. Mande, S.E. Hasnain
Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India

Introduction: Though PE and PPE families have been thought to play important roles in
mycobacterial pathogenesis from an antigenic as well as immunological view point, there has not
been much information available regarding their physiological relevance, more so in the light of
the fact that mycobacteria have been highly successful in devising strategies of immune evasion.
One of the PPE proteins, Rv1196 (PPE18 or mtb39a) was found to be expressed during infection
and present exclusively in M. tuberculosis and M. bovis BCG but not in other mycobacterial
species. Further, the microarray studies indicate that Rv1196 is one of the proteins involved in
maintaining long term survival of M. tuberculosis within the host. Since Th2 plays an important
role in activating M. tuberculosis pathogenesis, we have evaluated the role of Rv1196 protein to
interact with macrophage and affect the Th2 balance.
Method: Cytokine induction was measured by enzyme immunoassay (EIA). Interacting receptor
on macrophages were identified by flow cytometry and co-immunoprecipitation assay using
specific antibody. The p38 MAPK and ERK 1/2 and JNK signaling was examined by Western
blotting and flow cytometry.
Results: We demonstrate that the PPE protein, Rv1196 stimulates macrophages to secrete
interleukin (IL)-10 cytokine, which favors a Th2 T-cell response congenial for mycobacterial
survival. However, it does not significantly affect the production of inflammatory cytokines like IL-
12, TNF-a as well as nitric oxide production. IL-10 induction was found to be dependent on
specific interaction of Rv1196 protein to the toll-like receptor (TLR) 2 on membrane. We found
that an early and sustained activation of p38 MAPK (but not ERK 1/2 and JNK) downstream of
TLR2 was critical for triggering of IL-10 by Rv1196.
Conclusion: Our data suggest a unique role of the M. tuberculosis PPE protein in eliciting an anti-
Th1 response critical for survival of the bacteria.
Final abstract number: 72.005
Session: Mycobacterial Pathogenesis, Immunology and Vaccines (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

BCG Vaccine Reaction in Infants
S. Rafiee Tabatabaei , S. Mohebatti, H. Behbod
Pediatric Infectious Research Center, Tehran, Iran (Islamic Republic of)

B.C.G vaccine with over 80 years antiquity is still the most used vaccine around the world. Since
In 1993, WHO declared tuberculosis a global emergency, reflecting the magnitude of the concern
about the TB epidemic. Immunization of infants with Bacille Calmette-Guérin vaccine (BCG) can
protect against TB meningitis and other severe forms of TB in children less than five years old.
BCG vaccine is not recommended after 12 months of age because the protection provided is
variable and less certain. On the average, 83% of children around the world received this vaccine
at birth in 2005. Immunity induction and the rate of effectiveness of this vaccine was reported
differently between 2- 83 % in various studies.
This study was done for evaluating the effect of B.C.G vaccine in infancy period. The tuberculin
skin test is the only practical tool for determining the response to BCG vaccination, but the
diameter of the skin test following immunization is not a good predictor of protection against
Mycobacterium tuberculosis disease.
This study was a cross-sectional study in 794 infant that born in Taleghani hospital in Arak city
during 6 months. After B. C. G vaccination at birth, in 3 months infants (~ 90 days) the establish
scar diameter and tuberculin test with 5 units has been measured by a trained person. B.C.G scar
diameter in 96 % of cases was equal or more than 3 mm. (scar positive) and 4% less than 3 mm.
(scar negative). Response to tuberculin test has been negative (<5 mm.), in 309 persons (39%),
suspected or vicinal positive (between 5- 9 mm.) in 436 persons (55%) and positive ( 10 mm) in
49 persons (6%).
We found that scar negative cases were only in two groups who had induration less than 5 mm.
(n=26) and between 5-9 mm. (n=5). We did not have any scar negative cases in third group ( 10
mm.).
In addition, we did not see any local reaction and complication at the site of BCG vaccination or
development of regional lymphadenopathy.
The present study concludes that about 96 percent infants have successful BCG vaccination
response (scar positive). There has been correlation between the size of B.C.G scar and the
severity of indurations of skin test. However, some evidences in abortive reactors and positive in
vitro leucocyte migration inhibition test (LMIT) in babies with scar failure strongly suggest that
these infants may have developed immunity to BCG. Therefore, there is a need to redefine the
criteria for revaccination in abortive reactors who show preliminary response stages but do not
develop a scar.
Final abstract number: 72.006
Session: Mycobacterial Pathogenesis, Immunology and Vaccines (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Chemokine Receptor-Mediated Delivery of Mycobacterial MPT51 Protein Efficiently Induces
Antigen Specific T-Cell Responses
M. Uchijima, T. Nagata, Y. Koide
Hamamatsu University School of Medicine, Hamamatsu, Japan

Background:Mycobacterium tuberculosis, primary agent of tuberculosis (TB), is responsible for
the three million deaths annually worldwide. The only TB vaccine currently available is the
attenuated M. bovis strain bacillus Calmette-Guerin (BCG) which has been reported to have a
variable protective efficiency. The emergence of multi-drug-resistant strains of M.tuberculosis has
given urgency to the need for novel agents and development of more effective vaccines.
Methods & Results:Here we evaluated the effects of immunization with a DNA vaccine encoding
fusion protein consisting of macrophage inflammatory protein-1 a(MIP-1a) and MPT51 (a major
secreted protein from Mycobacterium tuberculosis) on induction of specific CD8+ T cells.
Tetramer assay revaled that the DNA vaccine encoding the fusion protein could induce
significantly higher number of the antigen specific CD8+ T-cells in mice than DNA vaccine
encoding MPT51 alone. Also, splenocytes from mice immunized with the fusion DNA vaccine
expressed higher level of IFN-g mRNA and protein upon stimulation with an epitope peptide
derived from MPT51 than those from mice immunized with a mixture of two DNA vaccines
encoding either MPT51 or MIP-1a.
Conclusion:These results suggest that DNA vaccine encoding MIP-1a-antigen fusion protein is
able to be efficiently internalized into antigen-presenting cells via the chemokine receptor and
induce higher level of antigen specific CD8+T cell responses.
Final abstract number: 72.007
Session: Mycobacterial Pathogenesis, Immunology and Vaccines (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Mutation in Alkylhydroperoxidase D Gene Dramatically Decreases Persistence of Mycobacterium
bovis Bacillus Calmette-Guerin in Infected Macrophage
                        1          1        2
T. Naserpour Farivar , P. Johari , A. Borji
1
  Research Institute for Tropical Medicine and Infectious Diseases, Zahedan Uni.Med.Sci.,
                                      2
Zahedan, Iran (Islamic Republic of), School of Medicine, Zahedan Uni.Med.Sci., Zahedan, Iran
(Islamic Republic of)

Background: Mycobacterium tuberculosis is the leading cause of death from a single bacterial
species in the world and in its host macrophage is subjected to a highly oxidative environment
and consequently has evolved protection mechanisms against reactive oxygen and nitrogen
intermediates. Alkyl hydroperoxidase D (AhpD) is a molecule from these mycobacterial defense
systems that has a dual function. It not only works with Alkyl hydroperoxidase C (AhpC) in
mycobacterial defense system against Oxidative stress but also has a role in oxidation/reduction
of succinyltransferase B (SucB), dihydrolipoamide dehydrogenase(LPD) and AhpC. As known
inhibitors of AhpD, do not completely suppress the in vitro activity of AhpC/AhpD, using
competitive precursor for AhpD could not inactivate the AhpC/AhpD complex and little is known
about the effects of site specific mutagenesis in ahpD gene in the persistence of Mycobacterium
bovis Bacillus Calmette-Guerin(BCG) in infected Macrophages.
Results: We did site specific mutagenesis in Mycobacterium bovis BCG and evaluate the effects
of this mutagenesis in intracellular persistence of wild type BCG strains and ahpD mutant ones by
comparing Colony Forming Units(CFU) of macrophage culture lysates infected by these strains.
Our results showed a sever decrease in the CFU's of ahpD mutant BCG strains in comparison
with wild type bacteria.Also our finding showed that ahpD mutant strains can grow in ordinary
mycobacterial media only in the presence of supplementary materials.
Conclusion: Mutagenesis in ahpD gene may leads to a deficiency in pyruvate dehydrogenase
pathway and also may impairs mycobacterial defense system against oxidative and nitrosative
stress.
Final abstract number: 72.008
Session: Mycobacterial Pathogenesis, Immunology and Vaccines (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Anti-PPD T-Cell Response in TB Patients is Modulated by Mycobacterium tuberculosis Heat
Shock Protein 60
S. Ghousunnissa, K. Nooruddin, A. Kaiser, S. Mukhopadhyay
Centre for DNA Fingerprinting and Diagnostics-CDFD, Hyderabad, India

Introduction: Various studies have revealed that the anti-PPD T cell response in tuberculosis
patients is biased towards the T-helper 2 (Th2) type. However, the mechanism by which
Mycobacterium tuberculosis establish a Th2 response is not clearly known. The interleukin-12 (IL-
12) is known to activate the Th1 T-cell response and therefore, inhibition of IL-12 production by
M. tuberculosis is likely to induce a Th2 response. Interestingly, an attempt to monitor gene
expression patterns of mycobacteria residing within macrophages revealed up-regulation of M.
tuberculosis heat shock (Mtbhsp60) protein suggesting that this might offer a survival advantage
to mycobacteria within the host. Again, immunization of mice with Mtbhsp60 protects them when
challenged with M. tuberculosis suggesting that Mtbhsp60 may be involved in M. tuberculosis
pathogenesis. Therefore, in this study, we have examined whether Mtbhsp60 inhibits IL-12
induction in macrophages and skews the anti-PPD T cell response towards the Th2 type.
Methods: PBMC from heparinized blood samples were isolated using nylon wool, IL-12p40/IL-10
levels were estimated by two-site sandwich ELISA, Western blotting and EMSA was used to
check the levels of c-rel, p65 and p50 NF-kB, transient transfection, Flow cytometric analysis and
Immunoflourescene were used.
Results: We demonstrate that Mtbhsp60 skews the anti-PPD T-cell response towards the Th2
type (Fig. 1). We further demonstrated that the Mtbhsp60 inhibited IL-12p40 induction in response
to PPD (Fig. 2). Mtbhsp60 upregulated both p65 and p50 NF-kB but inhibited c-rel transcription
factor. Over-expression of c-rel in macrophages restored Mtbhsp60 mediated inhibition of IL-
12p40 indicating that Mtbhsp60 targeted c-rel signaling to inhibit IL-12p40 in PPD-activated
macrophages. Interestingly, we found that Mtbhsp60 utilizes the toll like receptor (TLR) 2 to inhibit
IL-12 since blocking of TLR2 by using either anti-TLR2 neutralizing antibody or TLR2 siRNA
resulted in up-regulation of both nuclear c-rel and IL-12p40 levels.
Conclusion: The involvement of Mtbhsp60 in pushing the balance to a Th2 response has
therapeutic implications.
Final abstract number: 72.009
Session: Mycobacterial Pathogenesis, Immunology and Vaccines (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Bioinformatics Study of Iron Dependent Transcriptional Regulator, IdeR, from Mycobacteria
          1           2
S. Ranjan , A. Ranjan
1                                                               2
 LEPRA Society Blue Peter Research Centre, Hyderabad, India, Computational and Functional
Genomics Group & Sun Centre of Excellence in Medical Bioinformatics, Centre for DNA
Fingerprinting and Diagnostics, EMBnet India Node, , Hyderabad, India

Tuberculosis (TB) continues to be a major worldwide health problem and kills millions of people
around the world. Lack of compliance to the strenuous multi-drug therapy regimen has resulted in
multidrug-resistant TB. Hence novel drug targets are urgently needed to prevent and treat this
killer disease. Mycobacterium tuberculosis, the causative agent of tuberculosis, requires iron for
essential metabolic pathways. Because iron is not freely available in the host, pathogens must
actively acquire this metal to establish an infection but they must also carefully regulate iron
acquisition as excess free iron can be extremely toxic to the bacteria. Recent studies have
demonstrated that failure to control iron uptake or to assemble the iron acquisition machinery has
lethal effects for M. tuberculosis. In M. tuberculosis Iron dependent regulator-IdeR-regulates the
expression of genes in response to intracellular iron levels. Loss of IdeR mediated repression
leads to iron overload and oxidative damage. In contrast, enhanced IdeR repression at low iron
levels attenuates M. tuberculosis virulence in mice.
Sequence comparison shows that orthologs of IdeR are present in all the sequenced genomes of
mycobacteria. We have used a bioinformatics approach to characterize structure, function and
evolution of the iron dependent regulator protein (IdeR) sequence identified from 16 genomes.
Our study shows different levels of sequence conservation in different functional domains of the
IdeR molecules. Our study reveals how IdeR selects its DNA targets, how IdeR dimerizes and
how Iron controls IdeR activity.
This study will help in understanding the basis for different transcriptional responses of
pathogenic and non -pathogenic mycobacteria in iron stress, which, in turn, may help in designing
better drugs against pathogenic mycobacteria.
Final abstract number: 73.001
Session: HIV/AIDS Opportunistic Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Association Between Human Immunodeficiency Virus Infection and Cerebral Malaria in Children
Below 12 Years Attending Mulago Hospital, Uganda: A Case-Control Study
P.D. Imani, J.K. Tumwine, P. Musoke, J. Byarugaba
Department of Paediatrics and Child Health, Makerere University Medical School, Kampala,
Uganda

Background: Malaria and HIV are important paediatric problems in sub-Saharan Africa. There is
hardly any data on association between HIV infection and childhood cerebral malaria.
Objective: To determine the association between HIV infection and cerebral malaria in children
below 12 years attending Mulago hospital.
Methods: In this unmatched case control study, 352 children were enrolled, 100 with cerebral
malaria, 132 with uncomplicated malaria and 120 had no malaria.
Results: The overall prevalence of HIV infection among the 352 children was 4.3%. The
prevalence of HIV infection in cerebral malaria was 9% compared to 2.3% in those with
uncomplicated malaria (OR 4.3 [95% CI=1.1-16.1] p=0.022); and 2.5% in children with no malaria
(OR 3.9 [95% CI= 1.0-14.7] p= 0.035). Overall, the prevalence of HIV infection in cerebral malaria
was 9.0% compared to 2.4% in the two control groups with an odds ratio of 4.1 (p= 0.006; 95%
CI= 1.4-11.7). After adjusting for confounding factors, the risk for cerebral malaria in the HIV
positive children was 5.7 (95% CI 1.7-19.4) times more than in those who tested HIV-negative.
Conclusion: HIV infection was significantly associated with cerebral malaria in children admitted
to Mulago Hospital and the prevalence of HIV infection among those with cerebral malaria was
9%.
Recommendation: Malaria prevention should be an important component of education and
counselling of HIV infected children and their caretakers. A large study is recommended to
establish whether there is a correlation between the level of HIV immunosuppression and
cerebral malaria.
Final abstract number: 73.002
Session: HIV/AIDS Opportunistic Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Hepatitis G Virus Infection in Patients Infected with the Human Immunodeficiency Virus
              1              2                1       2             3            1              1
A. Ramezani , M. Mohraz , R. Vahabpour , S. Jam , M. Banifazl , A. Eslamifar , F. Mahboudi ,
              1            1            1
A. Aghakhani , R. Edalat , S. Hekmat
1                                                              2
 Pasteur Institute of Iran, Tehran, Iran (Islamic Republic of), Iranian Research Center for
                                                3
HIV/AIDS, Tehran, Iran (Islamic Republic of), Iranian society for support patients with infectious
diseases, Tehran, Iran (Islamic Republic of)

Background: Hepatitis G virus (HGV) and human immunodeficiency virus (HIV) show similar
modes of transmission. The purpose of this study was to determine the prevalence and
associated factors of HGV infection in HIV infected patients.
Methods: The presence of HGV-RNA was determined in sera of 100 HIV-positive patients with
mean age of 36.6±9.6 years by reverse transcriptase-nested polymerase chain reaction. All of
cases were also screened for Hepatitis B surface antigen (HBsAg), Hepatitis B surface antibody
(anti-HBs), hepatitis C antibody (anti-HCV), HIV viral load and CD4 cell counts.
Results: Prevalence of HGV-RNA was 11% in our subjects. The most common rout of HIV
acquisition was injection drug use (52%) followed by transmission from infected husband (25%)
and IDU and heterosexual contact (6%). The mean CD4 counts of HGV-positive patients were
283.64±108 cells/mm3 and HGV-negative patients were 356.74±186.67cells/mm3 (not
significant). The mean log10 HIV viral load was 2.49±1.94 vs. 1.91± 2.04 in HGV-positive and
negative patients respectively (not significant). The mean AST levels in the HGV positive and
negative patients were 37.8±15.7 IU/l vs. 37.5±31.1 IU/l and for ALT, 33.9± 20.4 IU/l vs. 36.5±
30.7 IU/l, respectively. There was not any significant difference between ALT and AST levels in
HGV positive and negative groups. HGV Co-infection with HCV and HBV presented in 7% and
1% of cases respectively. No significant correlation was observed between Co-infection with HBV
and HCV in HGV positive and negative subjects. There was no significant difference between the
HGV-positive and negative patients regarding to age, sex, route of transmission and taking
antiretroviral treatment.
Conclusion: HGV infection was relatively common in our HIV-infected patients and it was
frequently observed in patients with older age, lower CD4 cell counts and higher viral load.
Final abstract number: 73.003
Session: HIV/AIDS Opportunistic Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Frequency of Mycobacterium tuberculosis Infection Among HIV/AIDS Patients in Tehran, Iran
        1           2             1                  1           1                      2
S. Jam , M. Mohraz , D. Sabzvari , M. Hajiabdolbaghi , H. Jabbari , B. Moradmand Badie
1                                                                         2
 Iranian Research Center for HIV/AIDS, Tehran, Iran (Islamic Republic of), Iranian Research
Center for HIV/AIDS,Medical Scienses/University of Tehran, Tehran, Iran (Islamic Republic of),
2
 Iranian research Center for HIV/AIDS,Medical Scienses/University of Tehran, Tehran, Iran
(Islamic Republic of)

Objective: This study was done to determine the frequency of tuberculosis infection among
patients with HIV/AIDS using PPD skin test as a diagnostic parameter for TB infection.
Methods: A total of 262 HIV/AIDS patients attending the outpatient clinic at the University Hospital
Imam-Khomeini (Tehran, Iran) in 2003 were enrolled in this study. By reviewing the patient files,
clinical information was recorded.
Results: Out of these 262 patients, a total of 63 patients were shown to have tuberculosis
infection based on a positive PPD skin test. Of the patients with tuberculosis, 22 (8.4%) had
pulmonary tuberculosis, and 2 (1.1%) extrapulmonary tuberculosis, 12.6% had history of long
term residency in a foreign country, 51.6% have exposed to an index case, and 33.3% had
clinical manifestations while only 14.2% had history of pulmonary tuberculosis. In the present
study there were no resistant strains of M. tuberculosis.
Conclusion: We found that more than 24% of patients with HIV/AIDS were infected with M.
tuberculosis in Tehran. It becomes evident the need to improve the preventive measures and
prompt treatment of this type of infection in the HIV infected individuals.
Key words: HIV infected patients, Mycobacterium tuberculosis infection, PPD skin test
Final abstract number: 73.004
Session: HIV/AIDS Opportunistic Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Protean Manifestations of Herpes (HSV) Infection in AIDS Cases
S. Nagpal, Y. Marfatia
Department of Skin and VD, Government Medical College, S.S.G. Hospital, Baroda, India

OBJECTIVES: HSV accelerates and facilitates HIV replication and thereby HIV disease
progression. Atypical presentations of herpes in HIV positive cases help in suspecting /
diagnosing HIV. 32 cases presenting with muco-cutaneous herpes were studied to observe
clinical manifestations of herpes in immuno-compromised state due to HIV.
METHODS: 32 cases were studied in the Department of Skin & VD, Medical College, Baroda. On
the basis of history and clinical features muco-cutaneous herpes was suspected in HIV positive
cases which were retrospectively diagnosed on the basis of responsiveness to Acyclovir therapy.
All the cases were given Acyclovir and response to treatment was noted on follow up.
RESULTS: Out of 32 cases there were 23 male and 9 female cases. Atypical features observed
were nasal bleeding, tongue ulcer, cervical herpes, giant ulcer over sacral region, giant ulcer over
vulva, herpes esophagitis and herpetic whitlow. In one patient Kaposi's Vericiliform eruption was
observed. All the cases responded to Acyclovir therapy, none of them were on Antiretroviral
Therapy (ART).
CONCLUSIONS: Diagnosis of herpes requires high index of suspicion particularly in atypical
presentation and subclinical reactivation. Prompt diagnosis of atypical herpes screening of
females for cryptic herpes and early institution of Acyclovir will be of immense benefit to the
patients particularly not on ART.
Final abstract number: 73.005
Session: HIV/AIDS Opportunistic Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Prevalence and Co-Existance of Diabetes with HIV and Hcv Infection in Kermanshah-Iran
A. Janbakhsh, F. Mansouri, S. Vaziri, B. Sayyad, M. Afsharian, S.S. Meigouni
kermanshah university of medical science, kermanshah, Iran (Islamic Republic of)

Background: Diabetes Mellitus (DM) comprises a group of common metabolic disorders that
share the phenotype of hyperglycemia. Increasing age, family history, race, obesity,
hypertension, and history of vascular disease are known predisposing factors for diabetes. It
seems that chronic hepatitis C and HIV/HCV co-infection and anti-retroviral treatment (ART)
especially regimen contains protease inhibitors may predispose to diabetes. Regard to more
prevalence of diabetes in HCV infected patients in other studies and also increasing number of
HIV infected cases and HIV infected patients treating with antiretroviral drugs in the country and
importance of early diagnosis and control of chronic disease in these patients, this study was
conducted to determine prevalence of diabetes in patients with HIV and HCV infection.
Methods: In this descriptive cross-sectional study, the registries of 150 HCV patients and 50 HIV
patients and 90 HIV/HCV co-infected patients in hepatic clinics and consulting center for
behavioral disorders of Kermanshah University of Medical Science in 2007 which selected by
convenience sampling, were studied. Data of age, sex, duration of disease, history of injection
drug user (IDU), liver enzymes level, CD4 count, ART, treatment with interferon (IFN), and blood
sugar level were collected. If they had two fast blood sugar (FBS) 126 or random blood sugar
(BS) 200 were described diabetic. The data analyzed by SPSS software with chi-square, Fisher
and Z tests.
Results: The prevalence of diabetes was 2.7% among patients infected with HCV, and 4% in
patients infected with HIV and 2.2% in patients co-infected with HIV/HCV. None of the variables
including age, sex, liver enzyme, injecting drug usage, CD4 count, antiretroviral treatment, and
interferon were determined as risk factors for diabetes.
Conclusion: Although we didn't find any significant correlation between HIV and HCV infection
and HIV/HCV co-infection with increasing risk of diabetes, but according to previous studies and
incomplete information about some diabetes risk factors in our registries such as BMI, staging of
cirrhosis, HCV viral load and nutrional status of HIV infected cases and exclusion of subjects with
only one abnormal FBS from our samples, we recommended regular measurement of FBS for
HIV, HCV infected and HIV/HCV co-infected patients and designing supplement studies
considering these risk factors.
Key Worlds: HIV, HCV, Diabetes, Kermanshah
Final abstract number: 73.006
Session: HIV/AIDS Opportunistic Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Unusual Cutaneous Infections in HIV
B. Mehta, M. Dhingra, S. Amladi, C. Nayak, S. Savant
B.Y.L.Nair Charitable Hospital and T.N.Medical College, Mumbai, India

We discuss four unusual cutaneous infections in HIV positive patients.
Case 1: A 45 year old female presented with complaints of multiple ulcers with foul smelling
discharge in perigenital region since 1 month. There was history of recurrent fever, diarrhoea and
weight loss since 1 year, past herpes zoster and abdominal tuberculosis. On examination there
were multiple round to oval , deep ulcers with undermined edge and thick yellowish slough in the
perigenital region and on the buttocks. CD4 counts was 173. Pus swab grew Staphylococcus
aureus. Edge biopsy from the ulcer showed presence of gram positive cocci in clusters; PAS
stain showed Michaelis-Gutmann inclusion bodies confirming the rare presentation of cutaneous
MALAKOPLAKIA due to Staphylococcus aureus. She was treated with intravenous antibiotics
with complete healing of ulcers.
Case 2: A 30 year old male presented with multiple red raised painful lesions on face, trunk and
extremities associated with pain 1 month after starting 3 drug ART (d4T + 3TC + NVP). Sensory
loss, multiple nerve thickening, edema of the feet and knee joints, along with biopsy findings,
indicated Type I reaction in Tuberculoid leprosy. CD4 count at start of ART was 162, and
increased to 264, indicating Immune Reconstitution Inflammatory response (IRIS). This was a
rare presentation of reaction in leprosy as a manifestation of IRIS. The patient responded well to
multidrug therapy.
Case 3: A 33 year old male acutely developed multiple large pus filled ulcerated lesions since 15-
20 days without pain and constitutional symptoms. He had multiple large carbunculoid ulcers on
nape of neck, chest and upper extremities, which grew S.aureus. CD4 count was 127. The
unusual presentation led to detection of HIV in this patient. Patient responded to iv antibiotics.
Case 4: A 60 year old male presented with 10 days history of multiple, painful, oozing lesions
over both hands and feet associated with swelling of hands and feet. He had tender, tense
haemorrhagic bullae and multiple erosions with central eschar distributed over dorsae of hands,
extensors of forearms and elbows, dorsal aspect of right foot and lateral aspect of right leg. CD4
count of 18. Pus swabs grew E.coli. A final diagnosis of Echthyma gangrenosum was reached.
Despite appropriate therapy, he succumbed to death due to septicemia.
Final abstract number: 73.007
Session: HIV/AIDS Opportunistic Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

HCV Treatment with Pegylated Interferon and Ribavirin in Patients with Haemophilia and
HIV/HCV Coinfection: A Retrospective Review
               1            1         2                 1
J.T. Denholm , E.J. Wright , A. Street , J.J. Sasadeusz
1                                                                    2
 Infectious Diseases Unit, The Alfred Hospital, Melbourne, Australia, Haemophilia, Haemostasis
and Thrombosis Units, The Alfred Hospital, Melbourne, Australia

Background: Adult patients with haemophilia are frequently coinfected with HIV and HCV, usually
due to blood and plasma factor transfusion prior to effective screening programs. The current
standard therapy for HCV is pegylated interferon and ribavirin (PEG+RBV), which has been
investigated in HCV monoinfection and HIV/HCV coinfection. Little data exists regarding the
effectiveness of HCV therapy in coinfected patients with haemophilia. We reviewed HCV
treatment outcomes in our cohort of patients with haemophilia and HIV/HCV coinfection.
Methods: We performed a retrospective review of all patients with haemophilia and HIV/HCV co-
infection treated with PEG+RBV at the Alfred Hospital between 2001-2007 (n=13). Patient
histories and medical records were reviewed for demographics, adverse events and
effectiveness, including early, end of treatment and sustained virological response (EVR, EOTR
and SVR, defined as undetectable HCV viral load/PCR at 12, 48 and 72 weeks respectively) of
HCV.

Results: All patients were male with haemophilia A, and a median age of 43 (range 27-62) at
initiation of HCV therapy. Nine of thirteen (69%) patients had genotype (gt1) 1 HCV (gt3=3,
gt4=1). Due to bleeding tendencies, only 1/13 patients underwent liver biopsy prior to HCV
therapy. Twelve of 13 (92%) were receiving ART, with a mean CD4 count of 428 cells/uL (range
175-928 cells/ L) at initiation of HCV therapy. Six of 11 (55%) patients achieved EVR (3 x gt1, 2 x
gt3) at 12 weeks, 4/13 (31%) had EOTR (2 x gt1, 2 x gt3) and 1/13 (8%) achieved SVR (gt1).
7/11 (64%) patients normalised ALT during therapy wherein mean ALT fell from 101 to 76 U/L.
Only 1/13 (8%) patients prematurely stopped therapy prematurely due to side effects. CD4 cell
counts and HIV viral load remained stable during HCV treatment, with a mean 437 cells/uL and
<50 copies/mL at 48 weeks, respectively.
Conclusions: Treatment responses in patients with haemophilia and HIV/HCV coinfection were
significantly lower from that reported in other coinfected populations. This is despite a low drop
out rate and suggests that haemophilia is an independent risk factor for poor treatment response.
Risk factors in this cohort for poor response may include long duration of coinfection, advanced
liver disease and unfavourable genotype profile. Prospective studies in this patient population are
needed to further evaluate HCV treatment efficacy.
Final abstract number: 73.008
Session: HIV/AIDS Opportunistic Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Continuing Evidence Supporting the Role of Early Kinetic Monitoring (RVR) in Predicting SVR for
HIV/HCV Coinfected Patients
A. Jackson, D. O'Shea , E. de Barra, G. Farrell, J. Thornhill, F. Mulcahy, C. Bergin
St James's Hospital, Dublin, Ireland

Introduction: Hepatitis C virus (HCV) is a major cause of cirrhosis and need for liver transplant.
With common risk factors for acquisition, HIV co-infection is common, and leads to faster
progression of liver fibrosis. We have previously reported that combination therapy for HCV can
result in comparable sustained virological response (SVR) rates for co-infected patients when
compared to Hep C monoinfected patients. Monitoring viral kinetics, specifically baseline HCV
viral load and week 4 HCV PCR (rapid virological response (RVR)) can allow tailoring of
treatment duration for specific patients and give prognostic information regarding likelihood of
primary treatment success.
Methods: Data for 80 HIV-HCV co-infected patients treated with pegylated-interferon and ribavirin
between 2001 and 2007 was collected. Genotype 2/3 infected patients were treated for 24 weeks
only with weight-based ribavirin. Baseline characteristics and viral kinetics were analysed using
Excel and Epi info.
Results: 80 co-infected patients were treated, 84% male. 45% patients had Genotype 1 disease.
Overall SVR rate was 53% using an intention-to-treat (ITT) analysis. Baseline HCV viral load was
                                                         6              6
noted to be lower in those who achieved a SVR (6 x 10 iu vs 13 x 10 iu) (p<0.05). In ITT
analysis 33% achieved a RVR response. These patients were significantly more likely to have a
SVR than those without a RVR (96% vs 29%) (p<0.05). Using an on-treatment analysis 100% of
patients achieving RVR achieved SVR. Predictors of achieving RVR were HCV viral load at
baseline (p<0.05) and HCV genotype (p<0.05).
Conclusion: Monitoring of early viral kinetics can be used to accurately predict those patients who
will achieve SVR, especially those for whom only 24 weeks of therapy is required.
Final abstract number: 73.009
Session: HIV/AIDS Opportunistic Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Prevalence of High-Grade Anal Intraepithelial Neoplasia (AIN) in Anal Lesions in HIV+ Men Who
Have Sex with Men (MSM) from a Venezuelan Private Medical Center
                         1          1            2          2                3
S.M. Dickson-Gonzalez , M. Uribe , R. Alfonzo , M. Correnti , M.E. Cavazza , A.J. Rodriguez-
        4
Morales
1                                                                              2
 Pathology Laboratory, Hospital de Clinicas de Caracas, Caracas, Venezuela, Oncology and
                                                              3
Hematology Institute, Ministry of Health, Caracas, Venezuela, Biomedicine Institute, Central
                                               4
University of Venezuela, Caracas, Venezuela, Experimental Institute JWT, Los Andes University,
Caracas, Venezuela

Background: anal intraepithelial neoplasia (AIN) is frequent in HIV-1-infected men-who-have-sex-
with-men (MSM). High-grade AIN is considered the precursor of invasive anal squamous cell
cancer. Anal condylomata, high-grade AIN, and anal squamous cell cancer are more common in
MSM, particularly those with HIV. This study investigates the prevalence of histologically and
molecularly confirmed high-grade AIN within anal lesions of MSM.
Methods: we studied 188 MSM evaluated at Hospital de Clinicas, one of main private Venezuelan
medical centers. Coloproctological exam was performed and anal samples were collected for
cytological, histological analyses, HPV-DNA-PCR and hibridization detection methods. Anal
biopsy was performed with abnormal coloproctological exam. Cytology results were reported
using two main categories: low-grade (LG-AIN) and high-grade (HG-AIN) anal intraepithelial
neoplasia. Anal squamous cells of unknown significance (ASCUS) were reported. CD4+ T-cell
counting and HIV-1-RNA viral level were evaluated. Low-risk HPV (6 and 11) and high-risk HPV
(16/18/31/33/35) probes were used for HPV DNA amplification. Variables were analyzed with
SPSS.
Results: main patient age was 40.5±1.5 y-old, main CD4 counts 354.7±28.8 cells/mm3, geometric
mean viral load 3.21±0.16 log HIV-RNA copies. From the total, 41.6% presented HG-AIN at
cytology, 41.6% were normal, 0.5% LG-AIN(p<0.05). HPV DNA presence was detected in 56.3%
of patients, in 75% of patients with SIL (p0.05), 13.7% classified as high-risk HPV, 15.8% low-
risk, 5.8% mixed, 20% negative. Anal condylomata were found in 1.6% of patients, 2.6%
presented ASCUS.
Conclusions: high-risk and low-risk HPV were detected. There was no relationship between
specific HPV types identified and variables tested. Anal HPV was nearly universal in men infected
with HIV and often caused by multiple types. High-grade AIN contained a HPV types greater
burden. These data demonstrate high prevalence of HPV in HIV-infected MSM and suggest the
need to develop HPV screening protocols for males.
Final abstract number: 73.010
Session: HIV/AIDS Opportunistic Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Epidemiologic and Immunologic Characters of HIV/TB Co-infected Patients
F. Almasi
Tehran University of Medical Science /Paris 5 University, Paris, France

Background: Tuberculosis is the only opportunistic infection in HIV infected patients which
presents by it itself. Tuberculosis is a contagious infection which can be a threatening infection for
non HIV infected population as well as HIV infected people and a public health problem.
Prevention, diagnosis and treatment of tuberculosis as soon as possible are important.
Methods: All 455 western blot confirmed HIV infected patients in VCT (voluntary counseling
testing) clinic of Tehran Univesity of Medical Science in a two-year interval (April 2004-March
2006), are screened for tuberculosis.
Results: Among 63 cases of TB/HIV co-infected patients there are 32 cases of pulmonary
tuberculosis (51% of TB/HIV co-infection) mean age is 37.5 years (R=26-51). Mean CD4 count
and CD4% are 207 (R=8-1000) and 14% (R=1-60%), Mean CD8 count and CD8% are 770
(R=187-1611) and 57% (R=28-81%) respectively.19 of 32 (60%) have positive sputum smears.
26 cases suffer from extra-pulmonary tuberculosis. 11 cases present isolated extra-pulmonary
tuberculosis (17.5% of TB/HIV Co-infection) (pleural effusion, peripheral adenopathy,
osteoarticulaire tuberculosis, Meningitis). Mean age is 38.5 years (30-50). Mean CD4 count and
CD4% are 256 (R=5-632) and 15% (R=2-28%), mean CD8 count and CD8% are 911 (R=164-
1833) and 52% (R=31-67%) respectively. 15 cases present disseminated tuberculosis (24%).
Mean CD4 count and CD4% are 125 (R=25-365) and 10% (R=1-21%), mean CD8 count and
CD8% are 1063 (R=120-2680) and 61 (R=24-76) respectively.
Conclusions: One of seven (63 of 455) HIV infected patients experience symptomatic clinical
tuberculosis (incidence=14%) and one of nine TB/HIV co-infected die of tuberculosis
(Mortality=11%). More than 50% of TB/HIV co-infected patients suffer from pulmonary
tuberculosis and 60% of them have positive sputum smears. One of four (15 of 63) (24%) suffer
from disseminated tuberculosis. Pulmonary and Isolated extra-pulmonary tuberculosis patients
suffer from moderate immune deficiency (mean CD4>200) while disseminated tuberculosis
occurs in severe immune deficient patients.
Final abstract number: 73.011
Session: HIV/AIDS Opportunistic Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Growth Retardation and Anemia Among HIV-Infected Children in South India: Need for Targeted
Nutritional Interventions
        1                 2                3           1                1            1
A. Shet , N. Rajagopalan , E. Rameshkumar , C. Dinakar , C.K. Indumathi , S. Muthayya ,
           1
A. Kurpad
1                                                                2
 St John's National Academy of Health Sciences, Bangalore, India, Freedom Foundation,
                   3
Bangalore, India, Government District Headquarters Hospital, Namakkal, India

Background: Growth retardation and anemia are manifestations of pediatric HIV infection and are
independent risk factors for death among infected children. We sought to describe nutritional
status, anemia burden and HIV disease correlates among infected children in India.
Methods: We analyzed retrospective data from 248 HIV-infected children aged 1-12 years
attending four outpatient clinics in South India (2004-2006). Standard WHO definitions were used
for anemia, HIV staging and growth parameters. A subsection of children with prospective
haemoglobin assessments were also included in the analysis. Statistical analysis included chi
square, t test, and univariate analyses.
Results: The overall prevalence of anemia was 62.5%, and 8.1% had severe anemia (Hb <7
gm/dl). The proportion of underweight and stunted children in the population was 55.3% and
46.2% respectively. Poor growth (WAZ, HAZ < -2) was significantly associated with anemia and
advanced HIV disease status (p<0.005). Risk factors for anemia included advanced HIV stage
(OR=5.2; CI 2.9-11.2; p<0.005) and severe immunodeficiency (OR=4.5; CI 2.01-10.0; p<0.005).
Anemia was independently associated with pulmonary tuberculosis; hemoglobin in those with and
without tuberculosis was 8.9 and 10.2 g/dl respectively (p<0.005). Anemia was not significantly
associated with age, gender, multivitamins, cotrimoxazole, presence of ART, or ART type
(zidovudine versus stavudine). Among 45 anemic children with available prospective data who
received at least 6 months of ART along with nutritional supplements, subsequent mean
hemoglobin improved significantly by 1.5 gm/dl (CI 0.8-2.3, p<0.005).
Conclusions: The high prevalence and strong interrelationship of growth retardation and anemia
among HIV-infected children in India underscores the need for incorporating targeted nutritional
interventions during national scale up of care, support and treatment among children.
Final abstract number: 73.012
Session: HIV/AIDS Opportunistic Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Spectrum of Clinical Presentation and Opportunistic Infections in HIV: An Indian Scenario
B.C. Pruthvi, S. Vikram, S.K. Suman, B. Jayaprakash, N.R. Rau
Kasturba Medical College, Manipal, India

The clinical course of Human Immunodeficiency Virus (HIV) and pattern of opportunistic
infections varies from patient to patient and from country to country. HIV infected persons in India
are exposed to an environment very different from that in many other countries. Hence the
manifestations of HIV are also likely to be different from other countries. Disease progression
correlates with clinical features such as fever, cough, diarrhea, significant weight loss, oral
Candidiasis and Tuberculosis. Patients with CD4 counts less than 200 cells/ l have increased
mortality than those with counts greater than 350 cells/ l. The progression and outcome of HIV is
influenced by factors such as baseline health, nutritional status, environment, endemic diseases
and access to therapy. To understand the presentation of HIV in Indian scenario, a study of
clinical profile, trends of opportunistic infections and clinical categories of HIV at presentation was
undertaken. 100 newly diagnosed adult HIV patients were taken up for the study. Symptoms at
presentation, laboratory parameters, opportunistic infections and absolute CD4 counts were
analyzed. Clinical categorization of the disease was done as per CDC criteria. 81% of the
patients were males and 19% were females. Fever (68%) was the commonest presenting
symptom. Oral Candidiasis (71%) was the commonest opportunistic infection followed by
Tuberculosis (55%). 67% of the patients had CD4 counts less than 200 cells/ L. 58.6% of the
patients were in category C3 at presentation. HAART was started for 58% of the patients. HIV in
India has a diverse range of clinical presentation involving multiple organ systems. As the HIV
epidemic is advancing, it is important to create more awareness about varied clinical
presentations of HIV among primary care physicians as well as specialists for early diagnosis.
Early detection of HIV optimizes chemoprophylaxis for opportunistic infections and provides an
opportunity for secondary HIV prevention.
Final abstract number: 73.013
Session: HIV/AIDS Opportunistic Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Isolation of Cryptosporidium meleagridis in a HIV- Positive Female- the First Report from Poland
                 1                    2         3                4            3
M. Wesolowska , B. Szostakowska , B. Knysz , J. Gasiorowski , A. Gladysz
1
 Department of Biology and Medical Parasitology Wroclaw Medical University, Wroclaw, Poland,
2
 Inter-Faculty Institute of Maritime and Tropical Medicine Department of Tropical Parasitology
                                                  3
Medical University of Gdansk, Gdynia, Poland, Department of Infectious Diseases Wroclaw
                                        4
Medical University, Wroclaw, Poland, Department of Infectious Diseases Wroclaw Medical
University, Substitution Therapy Daycare Centre, Wroclaw, Poland

Background: Cryptosporidium is a protozoan parasite invading a wide range of vertebrates
including humans. It can cause cryptosporidiosis with chronic diarrhea and can be life threatening
in immunocompromised patients, particularly in individuals with low CD4 T cell count. We present
an infection of Cryptosporidium meleagridis in a HIV positive female.
Material and Methods: A 39-year-old woman suffering from water diarrhea for eight months, with
CD4 T cell 15 cells/ml. DNA was isolated from her stool. Three fragments of nuclear DNA were
amplified and sequenced: a part of the gene that codifies for the variable region of the small
subunit of the ribosomal RNA (SSU rRNA) as well as two parts of the gene that codifies for the C-
terminal and N-terminal portions of the oocyst wall protein (COWP).
Results: The lenghts of PCR products obtained were approximately 435, 580 and 550 base pairs,
respectively (data not shown). The comparison of obtained sequences with data from GenBank
showed that isolate was Cryptosporidium meleagridis. The sequence of the analyzed fragment of
SSU rRNA, as well as the sequence of the fragment of the gene that codifies for N-terminal
portion of COWP protein were in 100% agreement with the similar sequences of Cryptosporidium
meleagridis which have already been deposited in GenBank. The sequence of the second
fragment of the gene COWP was similar in 95% to the analogical sequence of C. parvum, C.
hominis and C. wrairi. Data analysis from GenBank showed that the sequence of this fragment of
the gene COWP in C. meleagridis has not been earlier deposited. The sequences have been
deposited in GenBank under accession numbers EU284595 and EU310392.
Conclusion: This is the first isolation of C. meleagridis in HIV-1 infected patient in Poland.
Final abstract number: 73.014
Session: HIV/AIDS Opportunistic Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Evaluation of Cerebrospinal Fluid (CSF) in Patients with HIV/Syphilis Co-Infection Followed at
Institute of Infectology Emilio Ribas, Brazil
E.J. Boccardo, M. Eira, R.J. Costa Silva, I.M. Moreira, T.A. Matos
Instituto de Infectologia Emílio Ribas, São Paulo, Brazil

Background: Sexually transmitted diseases (STDs) among HIV-infected patients are a huge
public health challenge in the world. Co-infection HIV/syphilis may be responsible for an
acellerated and fulminant course of syphilis, including neurosyphilis. The aim fo this research was
to assess the prevalence of neurosyphilis in co-infected patients and analyse their clinical
situation.
Methods: From January 2007 to December 2007, a total of 861 examination of cerebrospinal fluid
(CSF) was performed at Clinical Laboratory from Institute of Infectology Emílio Ribas, São Paulo
city. Of these 861 patients, 21 were reactive for neuroshyphilis and for HIV. Retrospective
analysis of clinical records and laboratory findings of these co-infected patients were carried out.
Syphilis serology was performed on both CSF and serum (VDRL and TPHA assays).
Neurosyphilis was defined by positive TPHA test in CSF.
Results: Overall prevalence of neurosyphilis was 2.34%. Clinical data of 21 co-infected patients
were analyzed. 15 males (71.42%) and 6 females (28,57%). Median age was 42 years. Mean
CD4 cout was 324 cells/ L (range: 34-940). 11 (52.38%) patients were using HAART and 1
patient had stopped ARV therapy. Eight (38%) patients showed clinical manifestations of
secondary syphilis. Neurological symptoms were observed in 7 (33.3%) patients. Mean CSF
VDRL was 1:4 (range: negative-1:8); mean CSF TPHA was 1:117 (range: 1:40-1:640); mean
CSF cell count was 49 (range: 1-400); mean CSF protein concentration was 87 (range: 31-439);
mean CSF glucose concentration was 52 (range: 17-61). In all patients, positive VDRL in serum
was detected in routine screening test and confirmed by haemagglutination assay.
Conclusion: Many countries are observing re-emergence of STDs, including Brazil. In our hospital
neurosyphilis is more common in male patients with HIV infection. A significative number of
patients had dermatological symptoms. During the course of HIV infection the natural course of
syphilis can be modified - syphilis could contribute to brain barrier injury. Improved information
and targeted education programs mut be improvement, to avoid delayed syphilis recognition.
Final abstract number: 73.015
Session: HIV/AIDS Opportunistic Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Use of Multicopy and Single Copy Genes for Detection of Pneumocystis jirovecii and Subsequent
Analysis of Genotypes of Indian Isolates
R. Gupta, B.R. Mirdha, R. Guleria, S.K. Kabra, S.K. Agarwal, A. Mohan, K. Luthra, V.K. Iyer
AIIMS, New Delhi, India

Background: Pneumocystis carinii Pneumonia (PCP) caused by an opportunistic agent
Pneumocystis jirovecii is one of the most serious respiratory infections in immunocompromised
patients including HIV infected individuals. Enormous gaps still exist in understanding the basic
biology of the organism and epidemiology of PCP due to non-availability of an appropriate
propagation system. In the present study, we carried out molecular detection of the organism
using two multicopy and one single copy gene. Further genotypic study was performed on some
of the isolates to assess the genotypes.
Methods: From November 2005 to October 2006, 114 different respiratory specimens were
collected from 90 patients with various underlying conditions and a clinical suspicion of PCP.
PCR was done for three independent gene loci including two multicopy i.e. Major Surface
Glycoprotein (MSG) and mitochondrial Large subunit rRNA (mtLSUrRNA) and one single copy,
internal transcribed spacer (ITS) region.
Results: Single round MSG and mtLSUrRNA PCR showed 9 positive isolates. External round of
ITS PCR detected 6 cases while only nested round could detect all 9 cases. On applying nested
PCR for mtLSUrRNA and ITS PCR we detected 5 additional cases. We further sequenced six
isolates for mtLSUrRNA gene. Different genotypes of Pneumocystis were distinguished by
identifying polymorphisms at position 85 and 248 of mtLSUrRNA. Two genotypes i.e. type 2 (5/6)
and 3, (1/6) were observed among the six isolates. Also, one of our previous isolate showed
genotype 1.
Conclusion: Thus, among multicopy genes, MSG and mtLSUrRNA appears to be equally
sensitive while in case of single copy ITS a nested PCR assay is required. In our present study,
genotype 2 was more frequently detected (5/7), followed by type 3 and 1(1/7) and a prospective
study with large number of patients is being carried out in our centre to address this issue. To our
knowledge this is the first study from South Asia describing genotypes of isolates of P. jirovecii .
Final abstract number: 73.016
Session: HIV/AIDS Opportunistic Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Hearing Loss in HIV Positive Patients
       1          2               2          2            2            2           2
M. Ohki , O. Katoh , A. Yamauchi , S. Kishida , Y. Kumagai , H. Fukuoka , N. Tayama
1                                              2
 Masashino RedCross Hospital, Tokyo, Japan, International Medical Center of Japan, Tokyo,
Japan

Background: Hearing loss in HIV positive patients have been reported. However, these reports
were hearing loss caused by sudden hearing loss, Ramsay Hunt syndrome, and so on. We
investigated hearing loss in HIV positive patients to know hearing loss possibility other than
sudden hearing loss, Ramsay Hunt syndrome, and so on.
Methods: One hundred fifty seven patients were enrolled in this study. They consulted our
hospital from April in 2006 to March in 2008. Some patients suffered from sensorineural hearing
loss caused by sudden deafness, Ramsay-Hunt syndrome and so on. This study also includes
patients which do not complaint of hearing loss. Usual otolaryngological examination and blood
tests were examined. Their ear membranes, nasal cavity and oral cavity were checked up. Pure-
tone audiometry was examined in all patients. Electronystagmogram including caloric testing
were done in some patients suffered from hearing loss. In addition, CD4 T-cell counts and RNA
copy numbers were investigated by blood test.
Results: Patients suffered from sudden deafness, Ramsay-Hunt syndrome or Meniere's disease
revealed ipsilateral sensorineural healing loss. Some patients other than these patients showed
bilateral sensorineural hearing loss. Usually their high-tone hearing levels were deteriorated. We
investigated the relationship between hearing levels and CD4 T-cell counts. The hearing loss was
more severe in patients with low CD4 T-cell counts.
Conclusion: Severe HIV positive patients more often suffered from sensorineural hearing loss.
Final abstract number: 73.017
Session: HIV/AIDS Opportunistic Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

HIV-TB Coinfection: The South Australian Experience
           1               2         3
M.M. Sehu , R. Stapledon , D. Shaw
1                                                                                      2
 Mater Misericordiae Health Services Brisbane, South Brisbane, Queensland, Australia, South
                                                                     3
Australia Tuberculosis Service, Adelaide, South Australia, Australia, Royal Adelaide Hospital,
Adelaide, South Australia, Australia

Tuberculosis (TB) is the most common opportunistic infection in Human Immunodeficiency Virus
(HIV) / Acquired Immunodeficiency Syndrome (AIDS). There is an estimated 11.5 million people
co-infected with HIV/TB with the highest burden in Sub-Saharan Africa. The accessibility of world
travel, the displacement of communities because of conflict, war and famine as well as changes
to Australian Government's immigration policies have meant that Australia is not immune to this
world trend. Three subjects that were HIV positive and had suspected or confirmed
Mycobacterium tuberculosis disease on the South Australian Tuberculosis Service database were
retrospectively studied. The diagnosis of TB was made after the diagnosis of HIV in all three
cases. Two had typical x-ray findings consistent with TB. The possible place of acquisition
differed between all three. One was treated for TB prior to HIV, the remaining had HIV treatment
commenced prior to TB treatment. All three had similar triple therapy for HIV. Two had confirmed
M tuberculosis on culture with one showing partial resistance to isoniazid. All three were
commenced on standard quadruple therapy, moxifloxacin and streptomycin was added until drug
susceptibility confirmation for the third. Treatment was halted temporarily in two due to
complications arising from HIV/TB therapy. The duration of therapy ranged from six months to
two years. Each of the three subjects highlighted the difficulties to adequately manage the HIV/TB
patient and the infrastructure needed to support this level of care. With the HIV/AIDS pandemic
threatening to destabilize control of TB we should be supporting initiatives to improve TB and HIV
programs in resource poor settings with a focus on preventive measures.
Final abstract number: 73.018
Session: HIV/AIDS Opportunistic Infections (Poster Presentation)
Date/time: 6/22/2008, 12:30-13:30 hrs
Room: Ballroom (Exhibition Area)

Integration of Routine HIV Testing with TB Diagnosis Among Medical Inpatients in Mulago
Hospital, Uganda
               1             1              1           1             2               1
V. Gwokyalya , D. Mwesigire , C. Nawavvu , J. Ssenkusu , A.S. Namale , R. Wanyenze ,
           1
M. Kamya
1
 Mulago Teaching Hospital, Mulago-Mbarara Teaching hospitals' Joint AIDS Program (MJAP),
                    2
Kampala, Uganda, CDC-Uganda, Kampala, Uganda

Background: TB is the most common and serious HIV related complication. It is estimated that
about half of TB cases in Uganda are co-infected with HIV and about 30% of the HIV-related
deaths are attributed to TB. However, HIV and TB diagnosis programs are not traditionally
integrated. The recently launched national policy guidelines for TB/HIV collaborative activities are
aimed at integrating diagnosis, care and treatment for TB/HIV co-infected patients. The Mulago-
Mbarara Teaching Hospitals' Joint AIDS Program (MJAP) has been providing integrated routine
HIV testing and counselling, and TB screening for medical inpatients in Mulago hospital since
March 2005.
Method: All patients on medical wards in Mulago are routinely offered HIV testing and
counselling. Patients presenting with a history of cough for more than three weeks are also
screened for TB by sputum microscopy. Patients with HIV infection are started on cotrimoxazole
prophylaxis, those who are co-infected with TB and HIV are referred to the TB_HIV clinic were
they receive both TB and HIV care and treatment. We analysed data for 379 patients to assess
the number of new TB and HIV infections identified.
Result: Among the 379 patients, 200 (53%) did not know their HIV/TB status on admission, and
received both HIV testing and TB screening. Of these, 24 (11%) were co-infected with TB and
HIV, 70 (35%) had HIV infection alone while 22 (11%) had TB infection alone. Out of the 159
patients who were known to be HIV-Infected on admission, 40 (25%) had TB infection. Overall,
64 out of the 379 patients (17%) were co-infected with TB and HIV. Among the 253 HIV infected
patients 64 (25%) had smear positive TB.
Conclusion: Integration of TB and HIV diagnosis is feasible and provides an opportunity for
appropriate linkage to care for TB-HIV co-infected patients.

				
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