6

th
Edition of World Congress on

Infectious
Diseases
EXHIBITOR

24-26 Venue:
JUNE, 2024 Hotel CIS Paris Ravel
6 Av. Maurice Ravel, 75012, Paris, France
PARIS, FRANCE

1
BOOK OF ABSTRACTS
24-26
JUNE

6th Edition of World Congress on

Infectious
Diseases

BOOK OF
ABSTRACTS

3
BOOK OF ABSTRACTS
 INDEX Page No
Keynote Speakers 6

Speakers 7

Welcome Messages 11

About Magnus Group 15

About Infection 2024 16

About Exhibitor 17

About CPD Accreditation 18

Table of Contents 19

Keynote Presentations 29

Oral Presentations 47

Poster Presentations 190

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 Keynote Speakers

Claudia Ferreira Daniel A. Lichtenstein Krzysztof Skowron

Biophytis, Sorbonne University, Ambroise Pare Hospital, Nicolaus Copernicus University in
France France Torun, Poland

Prabha Chandrasekaran Ranjan Ramasamy Reza Nassiri

NIAID, National Institutes of Health, IDFISH Technology, Michigan State University,
United States United States United States

Seki Masafumi Silvia Giono Cerezo Stephen Hsu

Saitama Medical University ENCB Instituto Politecnico Augusta University, United States
International Medical Center, Japan Nacional, Mexico

Xiaoyun Zhao
Tianjin University Chest Hospital,
China

6
 Speakers

Aaron Briggs Abdallah Musa Abdallah Ahmad Subhi Ahmed Abdalla Ahmed Esam Mahboub
University of California San Diego, Qatar University, Al Qassimi Hospital, Wexford General Hospital, Tawam Hospital,
United States Qatar United Arab Emirates Ireland United Arab Emirates

Ahsan Ehtesham Aji Antony Alexis Torres Rodriguez Alvaro J. Vivas Salinas Amitabha Majumdar
Hamad Medical Corporation, Government Medical College, Universidad Central del Caribe Clínica Central del Quindío, Unilever R&D, United Kingdom
Qatar India Internal Medicine Residency, Colombia
Puerto Rico

Amy Hesketh Anastasiia Panova Andreas Christodoulou Andressa Moreira Giusti Andrew Kimera Angelica Ludena
BIOASTER, France Bauman Moscow State Technical Serres General Hospital, University of Beira Interior, Makerere University, Universidad Central del Caribe,
University, Russian Federation Greece Portugal Uganda Puerto Rico

Anil Budania Anne Morris Anju Kaushal Anupma Harshal Wadavlikar Aparna M Menon Arjun Chadha
All India Institute of Medical North Bristol NHS Trust, New Zealand Organization for Consultant-Kotak Education Government Medical College, Michigan State University,
Sciences, India United Kingdom Quality, New Zealand Foundation & Ashoka University, India United States
India

Ashin Mehta Ashley Zhou Aung Sitt Naing Camila Melo de Freitas Cara Spence
Medical College of Wisconsin, Mayo Clinic, United States Eastern Virginia Medical School, uldade Pitagoras de Medicina de University of Saskatchewan,
United States United States Eunapolis, Brazil Canada

Caroline Ballet Comfort Oluladun Aiki Raji Daniela tirotta David Geiner Mejia Zavala David Stiles
Fabentech, France University of Ibadan, Nigeria Internal Medicine Forli, Universidad Peruana Cayetano Recursion Pharmaceuticals,
Morgagni-Pierantoni Hospital, Italy Heredia, Peru United States
Demboux Lyelet Jordy Exauce Dian Wulandaru Dong Hyun Kim Dorarca Lynch Edeline Anne Dondonilla
National Public Health Laboratory, Sukmaning Pertiwi Hallym University College of Galway University Hospital, Ospital ng Makati,
Congo University of Indonesia, Indonesia Medicine, Korea, Republic of Ireland Philippines

Eduardo Ferracioli Oda Elinam Adzo Agbobli Elizabeth Yvonne Flores Elucir Gir Eric Brownhill
University of Sao Paulo, Noguchi Memorial Institute for Boston University School of University of Sao Paulo, Ribeirao Jacobi Medical Center,
Brazil Medical Research, Ghana Medicine, United States Preto College of Nursing, Brazil United States

Filip Razga Fiona Murphy Franciela Golden Francisco Borges Costa Hamza Rashid
Selecta Biotech SE, Slovakia Mayo Clinic, United States Mayo Clinic, United States State University of Maranhao, Peterborough City Hospital,
(Slovak Republic) Brazil United Kingdom

Hatice Turk Dagi Helmi Ernandes Hideliz Marie G. Pascua Himani Agri Huiyi Feng
Selcuk University, Turkey Mohamed Kassab Institute of Baguio General Hospital and Medical ICAR_Indian Veterinary Research Shenzhen Tianyou Medical Institute,
Orthopedics, Tunisia Center, Philippines Institute, India China

Ihtisham Ul Haq Jonathan Lambo Joo Hee Waelzlein Julia Nowak Julissa Soto
Federal University of Minas Gerais, Avalon University School of Medicine, Robert Koch-Institute, Maynooth University, Julissa Soto Latino Health Equity
Brazil United States Germany Ireland Consulting, United States

Karen Ivy Bacsain Katarzyna Grudlewska-Buda Kathleen Maguire Keekok Lee Khalid Muneer Albalushi
Universidad de Santa Isabel Health Nicolaus Copernicus University in University of California, University of Manchester, Sultan Qaboos University,
Services, Philippines Torun, Poland United States United Kingdom Oman

8
 Komal Mushtaq Kristine Mae D. Barredo Laura Fermiano Bastos Lauren Middlebrooks Lauren Panny
DHQ Sheikhupura, Zamboanga City Medical Center, University Center Assis Gurgacz Emory University, US Army Medical Research Institute
Pakistan Philippines Foundation, Brazil United States of Infectious Diseases, United States

Lilishia Gounder Luis Felipe Vargas Garcia Maria Aguilar Amaya Maria de Fatima Ferreira Melanie Rosado Michele de Leon Jauregui
National Health Laboratory Service & Hospital Christus Muguerza Alta Arizona State University, da Cruz University of Utah, University of Utah,
University of KwaZulu-Natal, Especialidad, Mexico United States Fundacao Oswaldo Cruz, United States United States
South Africa Brazil

Mohammad Alshomrani Moussa-Al-Rufayie Muhammad Amjad Khan Nadine Bacalangco Suerte Namiz Damani Nawal AlKaabi
Riyadh Regional Laboratory and Imperial College London, National Institutes of Health, West Visayas State University Infection Prevention & Control Abu Dhabi Health Services Company
Blood Bank, Saudi Arabia United Kingdom Pakistan Medical Center, Philippines Department, Mater Dei Hospital, (SEHA), United Arab Emirates
Malta

Netty Santoso Nicole Abdullah Nikki Kasal Parvin Dehghan Patrone Rebecca Risenga
Ohio State University, Faculdades Pequeno Príncipe, University of Chicago Pritzker School Isfahan University of Medical University of South Africa,
United States Brazil of Medicine, United States Sciences, Iran (Islamic Republic of) South Africa

Pedro Plans Rubio Pere Domingo Pedrol Petersian M. Alcazaren Preslava M. Hristova Quennie Bien Bien C. Yu Reem Abdulla AlSaadi
Public Health Agency of Catalonia, Hospital De Sant Pau, West Visayas State University Medical University - Pleven, St. Luke’s Medical Center- Global Cleveland Clinic Abu Dhabi,
Spain Spain Medical Center, Philippines Bulgaria City, Philippines United Arab Emirates

Reem Alblooshi Renata Karina Reis Rigoberto Fimia Duarte Ro Janna Jamahari Jamiri Rosshini Kummararaj Saliha Gokce Alagoz Shweta Chelluboina
Cleveland Clinic Abu Dhabi, University of Sao Paulo, Ribeirao University of Medical Sciences of Sarapuddin Yenepoya Medical College, Gaziantep University, Bharati Vidyapeeth
United Arab Emirates Preto College of Nursing, Brazil Villa Clara, Cuba Ospital ng Maynila Medical Center, India Turkey (Deemed to be University), India
Philippines

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 Simona Yoffe Deri Sinisa Skocibusic Sira S. Owibingire Sneha Thatipelli Sukki Ho
Sheba Medical Center, Center for Prevention and Outpatient Muhimbili University of Health and University of Pennsylvania, The Hong Kong Polytechnic
Israel Treatment of Addiction Mostar, Allied Sciences, Tanzania, United States University, Hong Kong
Bosnia and Herzegowina United Republic of

Susannah Colt Tania Ayllon Santiago Tran Lam Tu Quyen Valerie Pourcher Veronika Nemethova
Pitie-Salepetriere Hospital, Selecta Biotech SE, Slovakia
Warren Alpert Medical School of Alfonso X El Sabio University, China Medical University,
France (Slovak Republic)
Brown University, United States Spain Taiwan

Vineeta Arora Weixi Shen Xiaohua Li Yen Chin Liu Yuhang Liu
AIIMS-New Delhi, Shenzhen Tianyou Medical Institute, Henan Provincial People’s Hospital, Chang Gung University, Biostatistician, Moderna Inc.,
India China China Taiwan United States

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 Welcome Message

PROF. DR. Daniel A. Lichtenstein

Ambroise Pare Hospital, France

Dear congress visitors,

It is an honor and pleasure to write a few welcome notes. This conference deals with a wide subject
of prime importance in the field I work with (critical care medicine, where sepsis is one of the
major concerns). I am impressed so see so many countries involved, making this congress a really
international one. Infections concern all countries regardless their income, and this conference is
welcome. The topics cover a wide area, with a fine mingling between experts talks and more basic
ones. In this perspective, my topic, equivalent so to speak to “how to diagnose pneumonia [using
ultrasound]” may appear oversimplistic, so likely, I will learn more than teach. This is all the more
true that the topics seem much more clinical than fundamental, with the advanges for the patients
one can imagine.

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 Welcome Message

Stephen Hsu, PhD

Augusta University, GA, USA

Dear Colleagues,

On behalf of the Organizing Committee, we would like to welcome you to participate in the 2nd
Edition of World Congress on Infectious Diseases – INFECTION 2022 in Rome, Italy, during June
17-18. I understand it is a very challenging time when we are facing an unprecedented SARS-CoV-2
pandemic. On the other hand, it is also an extraordinary time to witness the collective effort to combat
this deadly infectious disease with rapid development of prophylactic and therapeutic methods.
The unique theme of this event “Stepping Stones in Infectious Diseases Prevention, Control and
Cure” will bring us together to share our discoveries and achievements aiming to improve human
health globally. Your participation will certainly contribute to the fight against infectious diseases
worldwide.

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 Welcome Message

Krzysztof Skowron
Nicolaus Copernicus University in Torun, Poland

Dear Conference Attendees,

It is with great pleasure and honor that I extend a warm welcome to all of you participating in the session entitled "Antimicrobials/
Antibiotics/Antibacterial". In the face of the escalating challenge posed by antimicrobial resistance, particularly the growing resistance
of bacteria to antibiotics, our collective efforts are crucial to explore innovative solutions.

In recent years, the urgent need for new and effective antimicrobial agents has become apparent. This session aims to delve into the diverse
spectrum of problems associated with antimicrobial resistance and present cutting-edge techniques for combatting microorganisms,
not limited to traditional antibiotics. Recognizing the gravity of the situation, a multidisciplinary approach is imperative, combining
the exploration of novel drugs with both basic and clinical research. The pursuit of groundbreaking interventions is essential to secure
therapeutic success, especially in the context of infections caused by multidrug-resistant strains. This session provides a unique platform
for participants, ranging from seasoned researchers to budding scholars, scientists, clinicians, and academics, to foster an exchange of
ideas and knowledge.

Several key topics will be addressed in our session, including:

1. Novel Antimicrobial Agents: Exploring innovative drugs and treatments beyond traditional antibiotics to tackle evolving resistance
challenges.
2. Multidisciplinary Research: Encouraging collaborative efforts in basic and clinical research to develop a comprehensive
understanding of antimicrobial resistance mechanisms.
3. Alternative Therapies: Delving into non-antibiotic approaches for combating pathogenic microorganisms and their potential
applications in clinical settings.
4. Global Perspectives on Antimicrobial Resistance: Discussing the varying degrees of antimicrobial resistance across regions and
exploring strategies for global collaboration.
5. Clinical Implications and Challenges: Examining the practical implications of antimicrobial resistance in clinical settings and
addressing the challenges faced by healthcare professionals.

Our conference serves as a unique opportunity for all participants to not only gain insights into the latest research on antimicrobial drugs
but also to engage in meaningful discussions that can shape the future of antimicrobial therapies.

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 Welcome Message

Masafumi Seki MD, PhD.

Saitama Medical University International Medical Center, Japan

Dear Colleagues and Friends,

It is our great pleasure to invite distinguished researchers to the Infection 2024 on June 24-26,
2024 at Paris, France. Science about infectious diseases field today makes unprecedented progress
since the pandemics of novel influenza 2009 and COVID-19. This opens new opportunities to adapt
new era to social change, to achieve higher treatment and prevention efficiency, and to introduce
intelligent, differentiated methods to works against these infectious diseases. It is obvious that both
basic and clinical research could go together, and these studies based of precise microbiological and
clinical evidence will be the future basis for success.

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ABOUT
MAGNUS GROUP

Magnus Group, a distinguished scientific event organizer, has been at the forefront of fostering
knowledge exchange and collaboration since its inception in 2015. With a steadfast commitment
to the ethos of Share, receive, grow, Magnus Group has successfully organized over 200
conferences spanning diverse fields, including Healthcare, Medical, Pharmaceutics, Chemistry,
Nursing, Agriculture, and Plant Sciences.

The core philosophy of Magnus Group revolves around creating dynamic platforms that facilitate
the exchange of cutting-edge research, insights, and innovations within the global scientific
community. By bringing together experts, scholars, and professionals from various disciplines,
Magnus Group cultivates an environment conducive to intellectual discourse, networking, and
interdisciplinary collaboration.

Magnus Group's unwavering dedication to organizing impactful scientific events has positioned
it as a key player in the global scientific community. By adhering to the motto of Share, receive,
grow, Magnus Group continues to contribute significantly to the advancement of knowledge
and the development of innovative solutions in various scientific domains.

15
ABOUT
Infection 2024

6th Edition of the World Congress on Infectious Diseases is a prestigious global event scheduled
to take place in Paris, France, from June 24-26, 2024. This congress unites scientists, researchers,
healthcare professionals, industrialists, and industry experts to exchange knowledge and
explore advancements in the field of infectious diseases.

The Infection 2024 Summit centers around the theme "Global Strategies in Infectious Disease
Control: Challenges and Innovations." It emphasizes the critical role of infection control in
preventing the spread of infectious agents, improving healthcare outcomes, and promoting
overall well-being. The aim of Infection 2024 is to address contemporary challenges faced by
societies worldwide and to find innovative solutions.

Attendees can look forward to a comprehensive agenda featuring keynote sessions, workshops,
oral and poster presentations, and networking events. The Infection 2024 Conference offers a
unique opportunity for meaningful discussions, experience sharing, and establishing professional
connections. Renowned speakers from academia, industry, and research institutions will share
their expertise on cutting-edge research, emerging trends, and breakthrough technologies
in the field of infection. This event brings together like-minded individuals from around the
globe, fostering collaboration and interdisciplinary discussions to shape a promising future for
humanity through advancements in infectious diseases and related fields.

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 EXHIBITOR

For over 40 years, Randox has developed an expertise in molecular diagnostics,

offering a range of QC solutions for comprehensive infectious disease testing.
Our molecular innovations include the Discovery and Vivalytic analysers,
capable of testing for a range of targets ranging from respiratory, genitourinary,
and gastrointestinal and hospital-acquired infections. In addition, we are also
a leading provider of molecular quality-controls, with Qnostics’ expansive
molecular IQC portfolio and our world-leading molecular EQA scheme: QCMD
with its variety of programmes, Randox is leading the way to meet the needs of
today’s molecular laboratories.

Contact Information:
Website: https://randoxhealth.com/en-GB/
Email: [email protected]

17
ABOUT
CPD Credits

Continuing Professional Development (CPD) credits are valuable for Infection 2024 attendees as
they provide recognition and validation of their ongoing learning and professional development.
The number of CPD credits that can be earned is typically based on the number of sessions
attended. You have an opportunity to avail 1 CPD credit for each hour of Attendance. Some
benefits of CPD credits include:

Career advancement: CPD credits demonstrate a commitment to ongoing learning and

professional development, which can enhance one's reputation and increase chances of career
advancement.

Maintenance of professional credentials: Many professions require a minimum number of CPD

credits to maintain their certification or license.

Increased knowledge: Attending Infection 2024 and earning CPD credits can help attendees
stay current with the latest developments and advancements in their field.

Networking opportunities: Infection Conference provide opportunities for attendees to network

with peers and experts, expanding their professional network and building relationships with
potential collaborators.

Note: Each conference attendee will receive 20+ CPD credits.

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 Table of Contents
Title: An imitation game: Syphilis infection and increased odds of neurologic morbidity 191
Aaron Briggs, University of California San Diego, United States

Title: Immune transcriptomic analysis of COVID-19 patients with varying clinical 48

presentations
Abdallah Musa Abdallah, Qatar University, Qatar

Title: The impact of SARS-COV2 pandemic on the prevalence and the outcome of Candida 49
Auris infections, admitted to a tertiary hospital in United Arab Emirates (UAE), in 2022
Ahmad Subhi, Al Qassimi Hospital, United Arab Emirates

Title: Severe adenovirus infection in an immunocopemtment host 51

Ahmed Abdalla, Wexford General Hospital, Ireland

Title: HHV6 Encephalitis in an immunocompetent host 53

Ahmed Esam Mahboub, Tawam Hospital, United Arab Emirates

Title: A rare case of Aortic Aspergillosis in an immunocompetent patient with no pre-existing 192
cardiac pathology – A case report
Ahsan Ehtesham, Hamad Medical Corporation, Qatar

Title: A case of disseminated histoplasmosis presenting as fever of unknown origin in a patient 55

with Diabetes Mellitus
Aji Antony, Government Medical College, India

Title: HIV associated vasculopathy presenting as cerebrovascular accident in a young girl with 57
HIV
Aji Antony, Government Medical College, India

Title: Abrupt and lethal rare complication: A case report of a 32 year-old male who suffered 58
from pyogenic ventriculitis
Alexis Torres Rodriguez, Universidad Central del Caribe Internal Medicine Residency, Puerto Rico

Title: Acute HIV infection presenting as Eczema Herpeticum and Herpes Simplex Keratitis: A 193
case report
Alvaro J. Vivas Salinas, Clínica Central del Quindío, Colombia

Title: Sustainable soap bars delivering skin health and hygiene benefits for infection protection 60
Amitabha Majumdar, Unilever R&D, United Kingdom

Title: Multi-omics workflow for the identification of discriminant markers associated with 195
Trypanosoma cruzi populations
Amy Hesketh, BIOASTER, France

Title: Initial SARS-CoV-2 infection in a group of individuals with their social behavior 62
Anastasiia Panova, Bauman Moscow State Technical University, Russian Federation

19
 Title: Evaluation of two minicircle DNA vaccines encapsulated in peptide nanoparticles against 64
HPV-16
Andressa Moreira Giusti, CICS-UBI Health Sciences Research Centre, Portugal

Title : A case of late onset prosthetic valve ndocarditis with cerebral thrombo-embolic episodes 197
and aseptic meningitis
Andreas Christodoulou, Serres General Hospital, Greece

Title: Immune response to Hepatitis B vaccination among children under 5 in a highly endemic 199
country in Sub-Saharan Africa; Uganda
Andrew Kimera, Makerere University, Uganda

Title: Hepatitis B vaccination uptake and associated factors among communities targeted for 201
mass vaccination in Gulu, Uganda
Andrew Kimera, Makerere University, Uganda

Title: Is Plasmapheresis the future treatment for Leptospirosis? Case report of a 75-year-old 58
patient with complete recovery after Plasmapheresis therapy
Angelica Ludena, Universidad Central del Caribe, Puerto Rico

Title: A new insight in the clinical profile of Indian patients of urethritis and cervicitis with the 68
help of molecular characterization of the causative organisms
Anil Budania, All India Institute of Medical Sciences, India

Title: RNA interference, its applications and benefits 70

Anju Kaushal, New Zealand Organization for Quality, New Zealand

Title: Implementing the Covid-19 vaccination programme in the Southwest of England: 71

Lessons from a normalisation process theory perspective
Anne Morris, North Bristol NHS Trust, United Kingdom

Title: Awareness of antimicrobial resistance: Evaluating the impact of a foldscope-based 73

workshop
Anupma Harshal Wadavlikar, Consultant-Kotak Education Foundation & Ashoka University, India

Title: Unraveling a case of tubercular thyroiditis presenting as thyrotoxicosis 75

Aparna M Menon, Government Medical College, India

Title: Ocular Syphilis with concomitant neurosyphilis and tuberculosis: A case report 76
Arjun Chadha, Michigan State University, United States

Title: PD-associated peritonitis: A case first for Aquamicrobium 203

Ashin Mehta, Medical College of Wisconsin, United States

Title: An unusual case of multidrug-resistant Klebsiella Pneumoniae and vancomycin-resistant 77

Enterococcus Faecium skin and soft tissue infection in an immunocompromised host
Ashley Zhou, Mayo Clinic, United States

Title: Uncharted territory in mycobacterial world: The second reported case of Mycobacterium 79
Shimoidei in the United States
Aung Sitt Naing, Eastern Virginia Medical School, United States

20
 Title: An unexpected twist under the microscope: Schistosomiasis masquerading as 77
endometriosis
Aung Sitt Naing, Eastern Virginia Medical School, United States

Title: Repercussions of Pasteurella Multocida infection in humans: A case report 83

Camila Melo de Freitas, Faculdade Pitagoras de Medicina de Eunapolis, Brazil

Title: Repercussions of monkeypox infection in humans: A case report 84

Camila Melo de Freitas, Faculdade Pitagoras de Medicina de Eunapolis, Brazil

Title: SHIVER: A Syphilis/HIV ‘Test and Treat’ POCT intervention trial to reach rural/remote 86
and underserved populations in Saskatchewan, Canada
Cara Spence, University of Saskatchewan, Canada

Title: Equine Polyclonal F(ab)’2 as a rapid and strong therapeutic answer against potential new 89
SARS-CoV-2 surge
Caroline Ballet, Fabentech, France

Title: Will the Seine River water jeopardize the athletes' health during the sporting events of 30
the 2024 Olympic games in France?
Claudia Ferreira, Biophytis, Sorbonne University, France

Title: Molecular detection and charcterization of protoparvoviruses in bats and lion in Ibadan, 204
Nigeria
Comfort Oluladun Aiki Raji, University of Ibadan, Nigeria

Title: Ultrasound for diagnosing Pneumonia. The place of the BLUE-protocol 32

Daniel A. Lichtenstein, Ambroise Pare Hospital, France

Title: Hemophagocytic lymphohistiocytosis syndrome and syndrome of inappropriate 91

Antidiuretic Hormone ADH release: Keep in mind visceral leishmaniasis. Case report and
literature review
Daniela Tirotta, Internal Medicine Forli, Morgagni-Pierantoni Hospital, Italy

Title: Current situation of Cystic Echinococcosis in Peru 205

David Geiner Mejia Zavala, Universidad Peruana Cayetano Heredia, Peru

Title: REC-3964, a first-in-class molecule for the prevention of recurrent Clostridioides 207
Difficile infection
David Stiles, Recursion Pharmaceuticals, United States

Title: Viral profile of respiratory infections according to age in hospitals in Brazzaville, 93

Republic of Congo
Demboux Lyelet Jordy Exauce, National Public Health Laboratory, Congo

Title: Risk factors for bacterial infection in children following liver transplantation in 95
Indonesia: A preliminary study
Dian Wulandaru Sukmaning Pertiwi, University of Indonesia, Indonesia

Title: Korea seroprevalence study of monitoring of SARS-COV-2 antibody retention and 96

transmission (K-SEROSMART): A community-based longitudinal seroprevalence survey
Dong Hyun Kim, Hallym University College of Medicine, Korea, Republic of

21
 Title: 1 + 1 = 0: Challenges in managing early lyme disease with anaplasmosis co-infection 98
Dongsheng Jiang, Pennsylvania State University, United States

Title: HAV-ing a moment 209

Dorarca Lynch, Galway University Hospital, Ireland

Title: Five year profile and outcomes of pediatric patients diagnosed with tuberculosis at a 211
tertiary hospital in Makati, Philippines (2016-2020)
Edeline Anne Dondonilla, Ospital ng Makati, Philippines

Title: Low-volume direct multiplex PCR for etiological diagnosis of infectious uveitis 213
Eduardo Ferracioli-Oda, University of Sao Paulo, Brazil

Title: Assessment of tick diversity and potential pathogen transmission in two ecological 216
niches: Implications for zoonotic disease surveillance
Elinam Adzo Agbobli, Noguchi Memorial Institute for Medical Research, Ghana

Title: An iPSC-derived organoid-based model of intestinal filovirus infection 99

Elizabeth Yvonne Flores, Boston University School of Medicine, United States

Title: Prevalence of physical and/or mental health symptoms for four weeks or more due to 218
covid-19 among Brazilian nurses
Elucir Gir, University of Sao Paulo, Ribeirao Preto College of Nursing, Brazil

Title: Prevalence of COVID-19 diagnosis among Brazilian nurses after complete vaccination 219
schedule
Elucir Gir, University of Sao Paulo, Ribeirao Preto College of Nursing, Brazil

Title: Treatment of iron-deficiency anemia reduces pneumonia- and bacteremia-associated 220

hospitalizations
Eric Brownhill, Jacobi Medical Center, United States

Title: Effective reduction of SARS-CoV-2 RNA levels in transfected lung cells using a tailor- 222
made therapeutic oligonucleotide
Filip Razga, Selecta Biotech SE, Slovakia (Slovak Republic)

Title: Rare fungal infection in chronic lymphocytic leukemia: Scopulariopsis as a clinical 223
challenge
Fiona Murphy, Mayo Clinic, United States

Title: Native aortic valve endocarditis secondary to Streptococcus Gordonii: A rare 226
presentation
Franciela Golden, Mayo Clinic, United States

Title: Epidemiological aspects of rabies in an Amazon-Cerrado transition region of 101

Northeastern Brazil
Francisco Borges Costa, State University of Maranhao, Brazil

Title: Investigation of wild canid-mediated human rabies death, Brazil, 2021 103
Francisco Borges Costa, State University of Maranhao, Brazil

Title: A fish farmer's encounter with Leptospirosis: A case report 105

Hamza Rashid, Peterborough City Hospital, United Kingdom

22
 Title: Colonization and infection in admitted patients with vancomycinresistant Enterococcus 227
in a tertiary hospital
Hatice Turk Dagi, Selcuk University, Turkey

Title: Ralstonia Pickettii periprosthetic joint infection 106

Helmi Ernandes, Mohamed Kassab Institute of Orthopedics, Tunisia

Title: Gram-negative bacillary arthritis following arthroscopy 108

Helmi Ernandes, Mohamed Kassab Institute of Orthopedics, Tunisia

Title: Foreign fungus: Candida duobushaemulonii bloodstream infection in an 108

immunocompromised host at Baguio General Hospital & Medical Center: A case report
Hideliz Marie G. Pascua, Baguio General Hospital and Medical Center, Philippines

Title: A comparative study on uroculturome antimicrobial susceptibility in apparently healthy 112

and urinary tract infected humans
Himani Agri, ICAR_Indian Veterinary Research Institute, India

Title: Evaluation of the clinical effectiveness of an early marker system for differentiating 116
between viral or bacterial respiratory infections or febrile infections in a children's hospital
during the first post- pandemic season
Hornei Britt, Evangelisches Krankenhaus Oberhausen, Germany

Title: Antimicrobial activity of peptides derived from lycosa erythrognatha spider venom 228
against quinolone-resistant Uropathogenic Escherichia Coli (UPECs)
Ihtisham Ul Haq, Federal University of Minas Gerais, Brazil

Title: The descriptive epidemiology of adverse events following two doses of mRNA COVID-19 118
vaccination in Curacao
Jonathan Lambo, Avalon University School of Medicine, United States

Title: Establishment of a human lung organoid method platform for infectious disease 230
modelling
Joo Hee Waelzlein, Robert Koch-Institute, Germany

Title: Stability and disinfection studies for risk group 4 pathogens: Improving biosafety 232
measures for laboratories and patient management
Joo Hee Waelzlein, Robert Koch-Institute, Germany

Title: Diagnosis of neonatal sepsis using a rapid lateral flow test to detect Serum Amyloid A. 234
Julia Nowak, Maynooth University, Ireland

Title: The power of cultural validation a global innovative strategy when working with vaccines 120
Julissa Soto, Julissa Soto Latino Health Equity Consulting, United States

Title: Pulmonary manifestations of chronic melioidosis in a patient with Type 2 Diabetes 122
Mellitus: A case report
Karen Ivy Bacsain, Universidad de Santa Isabel Health Services, Philippines

Title: Pheno- and genotypic characterization of Enterococcus Spp. isolated from the animal 123
farm environments
Katarzyna Grudlewska-Buda, Nicolaus Copernicus University in Torun, Poland

23
 Title: Peritoneal Coccidioidomycosis presenting as treatment resistant tuberculosis 235
Kathleen Maguire, University of California, United States

Title: Assessing COVID-19 in the context of geopolitics 125

Keekok Lee, University of Manchester, United Kingdom

Title: Prevalence of co-infections among hospitalized patients with COVID-19 at a tertiary- 236
care Hospital, Muscat, Oman: A retrospective study
Khalid Muneer Albalushi, Sultan Qaboos University, Oman

Title: Measles outbreak – Another post- Covid phenomenon: Lessons to be learnt 126
Komal Mushtaq, DHQ Sheikhupura, Pakistan

Title: Epidemiological and clinical features of COVID-19 among the pediatric patients 238
admitted in the Zamboanga City Medical Center and other facilities handling COVID patients
Kristine Mae D. Barredo, Zamboanga City Medical Center, Philippines

Title: Antibiotic resistance of Enterococcus spp. strains isolated from wild and farm animals - 34
An important non-clinical problem
Krzysztof Skowron, Nicolaus Copernicus University in Torun, Poland

Title: Analysis of the influence of the COVID- 19 pandemic on reported malaria cases in 133
Brazilian macroregions between 2018 and 2022
Laura Fermiano Bastos, University Center Assis Gurgacz Foundation, Brazil

Title: Implementation of opt-out human immunodeficiency virus screening in pediatric 135

emergency departments
Lauren Middlebrooks, Emory University, United States

Title: Improved techniques for validation of inactivated virus and RNA of positive sense RNA 240
viruses for containment research
Lauren Panny, US Army Medical Research Institute of Infectious Diseases, United States

Title: Assessing HIV-1 drug resistance in patients with virological failure amid the rollout of 241
Dolutegravir in hyperendemic KwaZulu-Natal, South Africa
Lilishia Gounder, National Health Laboratory Service & University of KwaZulu-Natal, South Africa

Title: Diseminated lyme disease: A rare presentation of bilateral optic neuritis and Sinus 243
Bradycardia without any conduction defects
Luis Felipe Vargas Garcia, Hospital Christus Muguerza Alta Especialidad, Mexico

Title: Advancing sexual health education: A methodological triangulation in the development 245
and impact of the DISH-AZ academic detailing program
Maria Aguilar Amaya, Arizona State University, United States

Title: A snapshot of a representative Brazilian state of illegal mining in indigenous areas during 246
the era of malaria elimination
Maria De Fatima Ferreira Da Cruz, Fundacao Oswaldo Cruz, Brazil

Title: Use of intravenous immunoglobulin in neonatal enteroviral sepsis 247

Melanie Rosado, University of Utah, United States
Michele de Leon Jauregui, University of Utah, United States

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 Title: Isolation of Staphylococcus Aureus urinary tract infections at a community-based 137
healthcare center in Riyadh
Mohammad Alshomrani, Riyadh Regional Laboratory and Blood Bank, Saudi Arabia

Title: An unusual presentation of a case of syphilitic posterior uveitis 138

Moussa Al-Rufayie, Imperial College London, United Kingdom

Title: Overcoming the challenges of drug resistant fungal infections in developing countries 139
Muhammad Amjad Khan, National Institutes of Health, Pakistan

Title: Have the Gambia met the enrolment target for HIV, the Gambia, 2017-2021? 141
Musa Corr, The Gambia Armed Forces, Gambia

Title: Clinical characteristics and outcomes of breakthrough COVID-19 infection among 142
vaccinated patients admitted in a tertiary hospital
Nadine Bacalangco Suerte, West Visayas State University Medical Center, Philippines

Title: Improving compliance with local guidelines for antibiotic prescriptions using PDSA 144
methodology
Namiz Damani, Infection Prevention & Control Department, Mater Dei Hospital, Malta

Title: Clinical use of AZD7442 as pre-exposure prophylaxis for COVID-19 in the real-world 145
setting – interim analysis of the EVOLVE study
Nawal AlKaabi, Abu Dhabi Health Services Company (SEHA), United Arab Emirates

Title: Metabolic reprogramming of KSHV infection and tumorigenesis 147

Netty Santoso, Ohio State University, United States

Title: Mechanisms Of SARs-COV-2 neurovirulence in chemosensory dysfunction and 148

prognosis of affected patients: Systematic review
Nicole Abdullah, Faculdades Pequeno Príncipe, Brazil

Title: Designing a Pre-Exposure Prophylaxis (PrEP) training for providers to increase PrEP 248
awareness and prescription for black cisgender women
Nikki Kasal, University of Chicago Pritzker School of Medicine, United States

Title: Does switching from triple (or quadruple)-drug regimen to double-drug regimen 250
with oral INSTIs reduce Drug-Related Adverse Events (DRAES) and toxicity in virologically
suppressed people with HIV? Satisfaction study
Pere Domingo Pedrol, Hospital Universitario de la Santa Creu i Sant Pau, Spain

Title: Implementing an electronic screening tool to improve antimicrobial prescribing 150

decision-making for paediatric patients with suspected sepsis at an academic hospital in
England: A before and after study
Nouf Alaboud, University College London, United Kingdom

Title: Evaluation of the antifungal activity of metabolites produced by soil actinomycetes on the 152
Candida species isolated from Candidemia
Parvin Dehghan, Isfahan University of Medical Sciences, Iran (Islamic Republic of)

25
 Title: Determining the frequency of Trichosporon species and tracking yeast in urine clinical 154
samples using gold nanoparticles
Parvin Dehghan, Isfahan University of Medical Sciences, Iran (Islamic Republic of)

Title: The lived experiences of HIV-positive young adults regarding adherence to antiretroviral 156
treatment in Tshwane District, Gauteng
Patrone Rebecca Risenga, University of South Africa, South Africa

Title: Adapted mRNA COVID-19 vaccines have a limited ability to establish herd immunity in 157
the population against Omicron BA.1 and BA4-5 variants of SARS-CoV-2
Pedro Plans Rubio, Public Health Agency of Catalonia, Spain

Title: Factors associated with non-adherence to tuberculosis (TB) preventive treatment among 159
adult contacts of pulmonary TB cases with latent TB infection in Spain
Pedro Plans Rubio, Public Health Agency of Catalonia, Spain

Title: Factors affecting the outcomes of patients with coronavirus disease (COVID-19) 161
admitted in a tertiary hospital in Iloilo City: A retrospective cross-sectional study
Petersian M. Alcazaren, West Visayas State University Medical Center, Philippines

Title: A case report of a 22 year old male diagnosed with SLE, with concomitant infections of 163
COVID 19 moderate disease and HIV-AIDS
Petersian M. Alcazaren, West Visayas State University Medical Center, Philippines

Title: Assay identifies rVSV?G-ZEBOV-GP vaccination status and correlates ebola virus 36
glycoprotein with vesicular stomatitis Indiana virus nucleoprotein antibodies
Prabha Chandrasekaran, NIAID, National Institutes of Health, United States

Title: Catheter-related Atlantibacter Hermannii sepsis in a hemodialysis patient 252

Preslava M. Hristova, Medical University-Pleven, Bulgaria

Title: Kluyvera Cryocrescens central line associated bacteremia in a hemodialysis patient: A 254
case report and review of literature
Quennie Bien Bien C. Yu, St. Luke's Medical Center- Global City, Philippines

Title: Societal factors constraining the application of advances in biological sciences for 38
controlling COVID-19 and mosquito and tick-borne diseases
Ranjan Ramasamy, IDFISH Technology, United States

Title: Disseminated Echinococcus infection with cardiopulmonary involvement 256

Reem Abdulla AlSaadi, Cleveland Clinic Abu Dhabi, United Arab Emirates

Title: Patterns of Chlamydia Trachomatis and Neisseria Gonorrhoeae in different anatomical 258
sites among Pre-Exposure Prophylaxis (PrPE) users in Brazil
Renata Karina Reis, University of Sao Paulo, Ribeirao Preto College of Nursing, Brazil

Title: Predictors of vaccination rates in people living with HIV/AIDS followed at a specialty 260
care Clinic Ribeirao Preto, Sao Paulo, Brazil
Renata Karina Reis, University of Sao Paulo, Ribeirao Preto College of Nursing, Brazil

Title: Objective regressive regression methodology in terms of infectious entities and more 262
Rigoberto Fimia Duarte, University of Medical Sciences of Villa Clara (UMS-VC), Cuba

26
 Title: Clinical significance and global burden of antibiotic resistance 39
Reza Nassiri, Michigan State University, United States

Title: Clinical characteristics and outcomes of pediatric patients with suspected and confirmed 165
coronavirus disease 2019 (Covid-19) infection admitted in a tertiary government hospital in
the Philippines
Ro Janna Jamahari Jamiri Sarapuddin, Ospital ng Maynila Medical Center, Philippines

Title: The role of Epstein-Barr Virus in upper respiratory tract diseases 167
Saliha Gokce Alagoz, Gaziantep University, Turkey

Title: Clinical features of adult, hospitalized, non-vaccinated COVID-19 patients during the 40
omicron variant surge in Japan
Seki Masafumi, Saitama Medical University International Medical Center, Japan

Title: Dynamics of maternal dengue virus antibodies in Indian infants 168

Shweta Chelluboina, Bharati Vidyapeeth (Deemed to be University), India

Title: Acinetobacter Baumannii blaOXA-143-like and blaOXA-72 with global international 264
clone (IC) 2 and the Latin America endemic IC5 exhibiting strong biofilm formation in a
Mexican Hospital
Silvia Giono Cerezo, ENCB Instituto Politecnico Nacional, Mexico
María Dolores Alcantar-Curiel, Universidad Nacional Autonoma de Mexico, Mexico

Title: Carbapenemase-producing multidrug-resistance gram negative bacilli causing 41

Bacteremiaat the General Hospital of Mexico
Silvia Giono Cerezo, ENCB Instituto Politecnico Nacional, Mexico

Title: The presentation of Rhabdomyolysis in Influenza B patients – A case series 265

Simona Yoffe Deri, Sheba Medical Center, Israel

Title: Early versus late onset necrotizing enterocolitis in very low birth infants in the neonatal 266
intensive care unit
Simona Yoffe Deri, Sheba Medical Center, Israel

Title: An effective strategy for eliminating chronic Hepatitis C in individuals with an opioid 170
addiction
Sinisa Skocibusic, Center for Prevention and Outpatient Treatment of Addiction Mostar, Bosnia
and Herzegowina

Title: Need of monitoring Human Papillomavirus infection among oral and oropharyngeal 172
squamous cell carcinoma patients from setting with high incidence of cervical cancer
Sira S. Owibingire, Muhimbili University of Health and Allied Sciences, Tanzania, United Republic
of

Title: Perspectives of OBGYN clinicians on integrating PrEP in routine women’s health care: A 267
qualitative analysis
Sneha Thatipelli, University of Pennsylvania, United States

Title: Efficacy and safety studies of EC16 nanoformulations against human coronavirus 42
Stephen Hsu, Augusta University, United States

27
 Title: Effect of a multimodal infection control programme in the reduction of bacterial 174
contamination in the nasogastric feeding tube hubs in residential care homes for elders
Sukki Ho, The Hong Kong Polytechnic University, Hong Kong

Title: Inflammation-adjusted vitamin A deficiency is associated with higher Schistosoma 176

Japonicum infection intensity among children and adolescents in the Philippines
Susannah Colt, Warren Alpert Medical School of Brown University, United States

Title: Insights into West Nile virus seroprevalence in wild birds and equines: A focus on 178
Madrid Province, Spain
Tania Ayllon Santiago, Alfonso X El Sabio University, Spain

Title: Story of the wandering worm 180

Rosshini Kummararaj, Yenepoya Medical College, India

Title: Investigation of molecular epidemiology of carbapenem-resistant Acinetobacter 181

Baumannii group in Taiwan
Tran Lam Tu Quyen, China Medical University, Taiwan

Title: Efficacy of Oral 20-hydroxyecdysone (BIO101) in adults with severe COVID-19 (COVA): 182
A randomized, placebo-controlled, phase 2/3 trial
Valerie Pourcher, Pitie-Salepetriere Hospital, France

Title: An unconventional therapeutic oligonucleotide effectively reduces SARS-CoV-2 RNA 269

levels in preclinical animal studies
Veronika Nemethova, Selecta Biotech SE, Slovakia (Slovak Republic)

Title: Profiling, prescribing patterns and infection rates among inpatients at orthopedics 183
wards: Prospective interventional implementation study (AMSP-PIIS)
Vineeta Arora, AIIMS-New Delhi, India

Title: To identify and distinguish cytokine storms based on manifestations and to protect 185
human from infectious disease by targeting cytokines
Weixi Shen & Huiyi Feng, Shenzhen Tianyou Medical Institute, China

Title: The mechanism of the suppression of experimental fungal Keratitis by histone 187
deacetylases inhibitors
Xiaohua Li, Henan Provincial People's Hospital, China

Title: Clinical characteristics analysis of Bordetella Pertussis infection in adult cough patients 44
Xiaoyun Zhao, Tianjin University Chest Hospital, China

Title: SARS-CoV-2 omicron nucleocapsid effectively suppresses interferon beta expression via 271
interaction with host HSPA4
Yen Chin Liu, Chang Gung University, Taiwan

Title: Estimating the effectiveness of non-pharmaceutical interventions during Covid-19 189

Yuhang Liu, Biostatistician, Moderna Inc., United States

28
24-26
JUNE

6th Edition of World Congress on

Infectious
Diseases

KEYNOTE FORUM

29
Infection 2024

Will the Seine river water jeopardize the athlete’s health

during the sporting events of the 2024 olympic games in
France

After describing the situation in which the athletes of the XXXIII Olympiad
in France in 2024 from 26 July to 11 August, will find themselves namely,
the city of Paris, the Seine River, the medical infrastructure, the past
experience with SARS, and giving data on hygiene, pathogens in rivers,
vectors (rats), and briefly presenting the Olympic and paralympic games
and their medical organization, the risks to the athletes and parathletes, Claudia Ferreira1*, Marie
the authors present diseases that pose a real or potential risk to the Francoise Doursout2, Yann
competitors and others who will swim in the river. A. Meunier3
They start with the transmission of pathogens and broach the following Biophytis, Sorbonne University
1

diseases with their mode of transmission, symptoms, and complications: 75005 Paris, France
(1) viral diseases, including enteric viruses, hepatitis A and E, the 2
Anesthesiology, The University
lymphocytic choriomeningitis virus, (2) bacterial diseases, starting with of Texas Medical School,
water disease outbreaks due enterococci, escherichia coli, salmonella, Houston, TX 77004, United States
including leptospirosis with examples of outbreaks, Escherichia coli
International Institute of
3

157, salmonellosis, shigellosis, campylobacter, enterococcus faecalis, Medicine and Science, Rancho
and parasitic diseases including amebiasis from free amebas, ascariasis, Mirage, CA 92270, United States
giardiasis, trichuriasis, cryptosporidiosis, and balantidiasis.
Biography
In conclusion, they provide recommendations regarding how to eliminate
Dr. Claudia Ferreira is an MD, PhD,
rats with maintenance measures and offer general considerations
graduated in medicine from the
concerning global health. University of Cordoba in Argentina,
The author’s goal is to ensure that anyone who swims in the Seine River followed by a fellowship from the
Harvard AIDS Institute and the
during the Olympic and paralympic games can do it as safely as possible
University of Texas Health Science
vis a vis the risk of contracting an infectious or parasitic disease.
Center in Houston, TX, USA. Dr.
Audience Take Away Notes Ferreira has dedicated the last 25
years of her career to the fields
• The preparation of the Seine River to protect the health of the
of infectious diseases, tropical
olympic athletes competing in it may be insufficient
diseases, and gastroenterology. Dr.
• The data available are too few to be reassuring Ferreira was also a medical editor of
• The unknown creates risks to the athletes a web portal related to community
awareness for bioterrorism after
• There are ways to do much better
9/11. Dr. Ferreira also worked as an
• By informing their colleagues and friends investigator for the National Agency
• By showing the scope of what is needed in such circumstances for AIDS Research, a branch of the
National Center for Research Science,
• Depending on their subject area, this could be integrated into their
and for several pharmaceutical
teaching laboratories in France. She recently
• It provides solution to a problem and make a designer’s job more joined Biophytis, a Sorbonne
efficient University branch, developing a new
drug to against organ damages due to
• This will improve accuracy and assist in design problem
aging related muscular disorders and
restauration of pulmonary damage
caused by infectious diseases such as
Covid-19 and Influenza.

30
Infection 2024

• Other benefits
o Awareness of the risks
o General description of the risks
o Short descriptions of the diseases (mode of transmission, symptoms, complications)
o Recommendations for solutions
o Considerations regarding global health

31
Infection 2024

Ultrasound for diagnosing Pneumonia. The place of the

BLUE-protocol

The BLUE-protocol is an ultrasound approach of lungs and veins,

allowing with fine accuracies an immediate diagnosis of an acute
respiratory failure among the six causes which regard 97% of patients
seen in critical settings: Hemodynamic pulmonary edema, pulmonary
embolism, pneumonia, COPD, asthma and pneumothorax, mainly.

The BLUE-protocol is a fast protocol (less than 3 minutes). It requires a

simple unit, uses the ten basic signs of lung ultrasound, and associates Daniel A. Lichtenstein
signs with locations. Three standardized points per lung are used. BLUE- Medical intensive care unit,
protocol includes a venous analysis, different from usual habits (we don’t Hopital Ambroise Pare, Paris-
detail), done in the case of normal anterior lung surface. West University, France

The BLUE-protocol generates eight profiles, half devoted to diagnose Biography

pneumonia. The A-profile is a “pre-profile”, designing anterior lung
Daniel Lichtenstein, medical
sliding with anterior A-lines. It shows normal lung surface, and rules intensivist, Ambroise-Pare Hospital
out immediately pneumothorax and hemodynamic pulmonary edema. (Paris), created holistic critical
It generates three profiles. The A-DVT profile means that a DVT was ultrasound in 1985 (Intensive Care Med
detected, and is 99% specific to pulmonary embolism. 1993;19:353-355), defined by simple
equipments, one universal probe
The A-V-PLAPS-profile. The PLAPS (posterior or lateral alveolar and/ for whole body, emphasis on lung,
or pleural syndrome) indicates the presence of alveolar and/or pleural holistic cardiac sonography, veins,
change, uni- or bilateral, at a subposterior point accessible in supine procedures (venous canulation...)
patients with short probes, called PLAPS-point. Alone, a PLAPS has no extrapolable to multiple disciplines
specificiy. Associated to the A-profile, when the venous network is free, (pediatrics, pulmonology...), settings
it indicates (posterior) pneumonia with 89% accuracy. (ICU, austere areas...). Six hundred
conferences. Six textbooks since
The nude profile, defined by the A-profile, absence of visible DVT and 1992 (latest “Lung ultrasound in the
absence of PLAPS. It is usually associated to asthma or COPD (two criticall ill - the BLUE-protocol”
diseases gathered because therapy is roughly similar). The B-profile, - Springer 2016). Original articles
designing anterior lung sliding with anterior lung rockets indicates including: BLUE-protocol (acute
respiratory failure), FALLS-protocol
usually hemodynamic pulmonary edema. It rules out asthma, COPD,
(lung ultrasound in circulatory
pulmonary embolism.
failure), SESAME-protocol (cardiac
The B-prime profile is a B-profile with abolished lung sliding. It is quite arrest), lung ultrasound in neonates.
specific to pneumonia (100% in). The A-prime profile is an A-profile President of CEURF (training center
with abolished lung sliding. It is highly suggestive of pneumothorax. The at bedside in I.C.U.).

detection of a lung point will confirm the diagnosis and indicate the size
of the pneumothorax.

The A/B profile is an half A-profile at one lung, and an half B-profile
at the other. It is quite specific to pneumonia. The C-profile indicates
anterior lung consolidation, regardless size and number. A minima, it
can just give the illusion of an irregular pleural line. It is quite specific to
pneumonia (98% in).

32
Infection 2024

Many questions are answered. one of the most frequent questions regards the non inclusion of the heart
in the decision tree. This analysis is associated, not included, to the BLUE-protocol, which makes a direct
analysis of the lung (the suffering organ). A simple cardiac sonography, without Doppler, will provide, at
this step, major information, if needed. All these data are gathered in a traditional clinical approach, the
aim is to provide quick relief of acute dyspnea, and decrease of use of irradiating tests. The BLUE-protocol
is at best taught in authorized centres. It uses simple machines, one whole body probe for lungs, veins,
heart, others. The BLUE-protocol is a typical illustration of holistic ultrasound.

Audience Take Away Notes

• By performing critical holistic ultrasound (this term also implies a simplified approach for steep
learning curve)

• By finding immediately strong arguments or more for diagnosing pneumonia

• This research that other faculty could use to expand their research or teaching

• This provide a practical solution to a problem that could simplify or make a designer’s job more efficient

• It improve the accuracy of a design, or provide new information to assist in a design problem

• Other benefits

o All the benefits of ultrasound (immediate, bedside, not invasive, repeatable at will, unexpensive,
keeps contact with patients and others). Provides visual approach to the lung and most other
structural disorders (in abdomen, heart, venous system...). Visual medicine to the point that some
call ultrasound the stethoscope of tomorrow (and for us the stethoscope of ever, as we have been
using it since 1985)

33
Infection 2024

Antibiotic resistance of enterococcus spp. strains isolated

from wild and farm animals - An important non-clinical
problem

The increase in the transfer of pathogenic microorganisms between

humans, livestock, wildlife and their environment observed in recent
years, as well as the irrational use of antibiotics, makes it increasingly
difficult to combat the growing multidrug resistance of bacteria such as
Enterococcus spp.
Krzysztof Skowron1*,
The aim of the study was to evaluate the prevalence and antibiotic
resistance of Enterococcus Faecalis (EFA) and Enterococcus Faecium
Katarzyna Grudlewksa
(EFM) strains isolated from the environment of pig farms and Buda1, Natalia Wiktorczyk
Enterococcus spp. strains isolated from fecal samples of wild animals. Kapischke1, Anna
Material for the study was collected in a piggeries and within forested Budzynska1, Wiktor
areas and ecotone zones in the Kuyavian-Pomeranian Voivodeship. Borkowski1, Julia Czuba1,
Samples were inoculated onto selective media, and grown bacteria Justyna Bauza Kaszewska2,
were identified using the MALDI TOF system. Antibiotic susceptibility Zbigniew Paluszak2,
was assessed using the disc-diffusion method, according to EUCAST Eugenia Gospodarek
recommendations. Komkowska1
In total, 475 and 98 samples were collected from the pig husbandry Department of Microbiology, L.
1

environment (swabs from troughs, feeding passages and corridors, Rydygier Collegium Medicum in
manure channels, and faeces samples) and from 12 wildlife species (faeces Bydgoszcz, Nicolaus Copernicus
samples), respectively. Of the samples from a pig farm environment, University in Torun, Poland,
82 (17.3%) EFA strains and 28 (5.9%) EFM strains were identified. The 2
Department of Microbiology
highest percentage (19.5%) of EFA strains showed resistance to high and Food Technology, Jan and
concentrations of gentamicin (HLGR phenotype), followed by high Jedrzej Sniadecki University of
concentrations of streptomicin (HLSR phenotype) and imipenem (9.8% Technology in Bydgoszcz, Poland
and 8.5% of strains, respectively). In the case of EFM, an equally high Biography
percentage (17.9%) of strains were characterized by the HLGR phenotype
Dr. Hab. Inz. Krzysztof Skowron,
and resistance to ampicillin, in addition, 14.3% of strains were resistant to
prof. UMK, obtained his Ph.D. in
vancomycin (VRE phenotype). In 10.7% of EFM strains was present HLSR agricultural sciences in 2011 from
phenotype, while 6.1% of EFA was characterized by VRE phenotype. All UTP University of Science and
strains tested showed sensitivity to tigecycline. Technology in Bydgoszcz, Poland.
Since 2011, he has been affiliated
Among 92 out of 98 fecal samples from wild animals tested, 118 strains
with the Department of Microbiology
of Enterococcus spp. belonging to 9 species were isolated (EFA, EFM, E. at L. Rydygier Collegium Medicum
hirae, E. mundtii, E. casseliflavus, E. faecium, E. durans, E. gallinarum, in Bydgoszcz, Nicolaus Copernicus
E. avium and E. thailandicus). The most frequently isolated (32.2% of University in Torun, Poland. In 2019, he
strains) EFA species was detected in 38 collected samples. The remaining earned the habilitated doctor degree
species were isolated with a frequency ranging from 1.0% to 22.4%, in medical sciences, specializing in
among which EFM accounted for 7.6% of the isolated strains. The highest medical biology. Currently, he holds
percentage of antibiotic-resistant strains from different chemical groups the position of associate professor.
Dr. Hab. Inz. Krzysztof Skowron,
was found among EFA and EFM. The former was most often resistant
prof. UMK, focuses his research
to eravacycline (50.0% of strains) and linezolid (39.5% of strains), while
on various aspects of antimicrobial

34
Infection 2024

EFM was resistant to quinupristin-dalfopristin (44.4% of strains). VRE,

activities, microbial tolerance to
HLGR and HLSR phenotypes were found in 13.2%, 31.6% and 2.6% of
stress factors, antibiotic resistance,
EFA strains, respectively. In the case of EFM, only the HLGR phenotype
and the detection and expression
was found (11.1% of strains). The lowest percentage (0.9%) among the assessment of genes primarily
Enterococcus spp. strains tested was resistant to ampicillin. associated with virulence and
responses to environmental stress.
The conducted research has shown that both in the pig faeces and various
His interests extend to emerging
production sectors of the pigsty, as well as in the feces of wild animals,
pathogens, zoonotic pathogens, and
there are microorganisms potentially pathogenic to humans, which may the transmission of microorganisms
constitute a reservoir of resistance genes to various antibiotics. between animals and humans. Dr.
hab. inż. Krzysztof Skowron, prof.
Audience Take Away Notes
UMK, has authored 108 full-text
• The presentation highlights that the livestock and wildlife publications and contributed to 6
environment can also be an important reservoir of multidrug- chapters in monographs.
resistant strains and a pathway for the transmission of antimicrobial
resistance genes from commensal zoonotic bacteria to clinical
strains

• Wide spread of antibiotic resistance makes therapeutic options for

various types of human and animal infections increasingly limited

• Non-clinical monitoring antibiotic resistance in an era of increasing

antimicrobial resistance in bacteria is of great importance for public
health

• The presentation is intended to draw attention to the rational

management of antibiotics in animal production and veterinary
medicine, as well as to monitoring antibiotic residues in the
environment and the phenomenon of carriage of antibiotic-resistant
strains in animals

35
Infection 2024

Assay identifies rVSV∆G-ZEBOV-GP vaccination status

and correlates ebola virus glycoprotein with vesicular
stomatitis Indiana virus nucleoprotein antibodies

In the absence of well-defined correlates of protection, the quantity and

duration of the main vaccine-antigen-induced Immunoglobulin G (IgG)
antibodies are often used as proxy indicators of vaccine efficacy; IgG
responses to vaccine vector antigens are less well-characterized. Here,
we describe the concomitant kinetics of IgG responses to the vaccine
vector (Vesicular Stomatitis Indiana Virus) Nucleoprotein (VSIV N) and Prabha Chandrasekaran1*,
the inserted Ebola virus glycoprotein (EBOV GP1,2) components of the Irina Maljkovic Berry1,
“rVSV∆G-ZEBOV-GP” vaccine. We also evaluate their use as biomarkers Viviane Callier2, Scott
to confirm self-reported vaccination status. M. Anthony1, Krystle
Longitudinal samples from 212 participants through one-year post- Hensley1, Jens H. Kuhn1,
vaccination from the Partnership for Research on Ebola Virus in Liberia Kathryn ShawSaliba3,
I (PREVAIL I) clinical trial were selected. Anti-EBOV-GP1,2 IgG and Stephen B. Kennedy4, Mark
anti-VSIV-N IgG titers were measured using the established Filovirus Kieh4, Sarah M. Browne4,
Animal Non-Clinical Group (FANG) Enzyme-Linked Immunosorbent Ian Crozier2, Richard T.
Assay (ELISA) and a newly developed single-molecule array (Simoa) Davey5,6, H. Clifford Lane3,
immunoassay, respectively. Lisa E. Hensley1, Dean A.
Following vaccination, anti-EBOV-GP1,2 IgG and VSIV-N IgG were first Follmann7
detected at 10–14 d. Antibody levels further increased by 28 d and then Integrated Research Facility at
1

remained stable through 360 d post-vaccination. Significantly higher Fort Detrick, National Institute of
antibody titers were measured in samples from female participants Allergy and Infectious Diseases,
compared to those from male participants. Anti-EBOV-GP1,2 and anti- National Institutes of Health, Fort
VSIV-N IgG titers were significantly correlated (p<0.001) at day 28 Detrick, Frederick, MD, United
States
(r=0.47), day 180 (r=0.45), and day 360 (r=0.59). At 28 d, the Area Under
the Receiver Operating Curve (AUROC) discriminated vaccinated from 2
Clinical Monitoring Research
unvaccinated patients with high accuracy (AUROC=0.965 for anti- Program Directorate, Frederick
VSIV-N IgG; AUROC=0.945 for anti-EBOV-GP1,2 IgG [p<0.001]). National Laboratory for Cancer
Research, Frederick, MD, United
We conclude that the newly developed assay reliably measures vector- States
targeted humoral responses after rVSV∆G-ZEBOV-GP vaccination and 3
Collaborative Clinical Research
can confirm vaccination status in individuals with unknown or self- Branch, Division of Clinical
reported vaccination status. Reliable detection of anti-VSIV IgG may Research, National Institute of
be useful for similar queries of VSIV-vectored vaccine candidates in Allergy and Infectious Diseases,
development for other infectious diseases. National Institutes of Health,
Bethesda, MD, United States
Audience Take Away Notes 4
Partnership for Research on
• Currently, there are no unambiguous reports of the antibody Ebola Virus in Liberia (PREVAIL),
responses kinetics of vector-induced versus the vector-encoded Monrovia, Liberia
EBOV GP1,2 antigens. In a Western African population vaccinated 5
Laboratory of
with rVSV∆G-ZEBOV-GP, we addressed this gap by determining the Immunoregulation, National
IgG response kinetics to VSIV using the Simoa assay in tandem with Institute of Allergy and Infectious
anti-EBOV GP1,2 IgG in the same study participants. The anti-VSIV-N Diseases, National Institutes of
and anti-EBOV-GP1,2 IgG titers significantly correlated at 28 and Health, Bethesda, MD, United
States

36
Infection 2024

360 d after vaccination, indicating a coordinated antibody response 6

Division of Clinical Research,
to the vaccine vector and the antigen of interest National Institute of Allergy and
Infectious Diseases, National
• A novel assay was developed using Simoa Planar Technology to
Institutes of Health, Bethesda,
identify rVSV∆G-ZEBOV-GP vaccination status. This assay can be MD, United States
utilized for any vaccine candidate that uses N VSIV as the vector to
7
Biostatistics Research Branch,
(a) confirm vaccination status in individuals with unknown or self-
National Institute of Allergy and
reported vaccination status and (b) to understand and clarify the
Infectious Diseases, National
relationship between vaccination and subsequent infection and/or Institutes of Health, Bethesda,
disease MD, United States
• Sex differences in the rVSV∆G-ZEBOV-GP vaccine IgG responses
was observed. Female vaccinees had significantly higher IgG levels Biography
than males at earlier time points Dr. Prabha Chandrasekaran, M.Sc.,
Ph.D., M.P.H., is an Associate Study
Director (contractor) at the Integrated
Research Facility at Fort Detrick,
a National Institute of Allergy and
Infectious Diseases biosafety level 4
facility. Dr. Chandrasekaran’s role is
to support clinical research studies
pertaining to high-consequence
and emerging pathogens in
international settings. She designs
and executes the diagnostic/assay
countermeasures and develops and
deploys high-throughput sequencing
and bioinformatics approaches
towards outbreak preparedness. Dr.
Chandrasekaran is a multidisciplinary
scientist with over 40 peer-reviewed
research publications and has served
as a principal investigator (PI) or co-
PI on several projects.

37
Infection 2024

Societal factors constraining the application of advances in

biological sciences for controlling COVID-19 and mosquito
and tick-borne diseases

While many advances in biological sciences have been applied in

medicine, agriculture and industry with great benefit, some recent
trends in society, governance structures and communications, appear to
be hampering the use of new scientific findings for controlling infectious
diseases. These limitations are illustrated with examples related to (i) the
adaptation of fresh water mosquito vectors of major arboviral diseases to Ranjan Ramasamy
salinity in coastal areas with consequences for disease transmission, (ii)
ID-FISH, 556 Gibraltar Drive,
understanding the implications of reduced dengue transmission during
Milpitas, CA 95035, United States
the COVID-19 lockdown for dengue control, (iii) causes underlying the
rapid spread of the malaria vector Anopheles stephensi in South Asia
Biography
and Africa, (iv) the application of serodiagnostic techniques for Lyme
disease and tick-borne relapsing fever caused by tick-borne bacteria of Ranjan Ramasamy graduated in 1971
the genus Borrelia, and (v) COVID-19 prevention. and then a PhD in 1974 from the
University of Cambridge, UK. He was
Audience Take Away Notes the Chairman of the National Science
Foundation of Sri Lanka, Professor
• Better understand relevance of recent biological advances for
of Life Sciences at the Institute of
controlling important infectious diseases Fundamental Studies in Kandy in Sri
Lanka, Professor of Biochemistry in
• Participants will usefully consider the relevance to their own local
the University of Jaffna in Jaffna Sri
context
Lanka, Professor of Immunology in
• The knowledge will be valuable for teaching and research into the University Brunei Darussalam
infectious diseases, vaccines and vector control Medical School and held institute
appointments at the Babraham
• Knowledge gained can be applied directly to better control infectious Institute, Cambridge, UK and Scripps
diseases in a public health context Clinic and Research Foundation, La
Jolla, USA. He has more than 280
• Stimulate innovative thinking in infectious diseases control
publications.

38
Infection 2024

Clinical significance and global burden of antibiotic

resistance

Antibiotic Resistance (AR) is both clinical and global public health

concerns. In numerous countries, physicians have very few other
options available to treat MDR and XDR infections. The World Health
Organization (WHO) acknowledges AR is one of the top global public
health and development threats. Indeed, AR is a leading cause of
mortality worldwide, with the highest burdens in resource limited
countries. Understanding the depth of global AR impact can help identify
Prof. Dr. Reza Nassiri
the current gaps and mitigate measures to control its spread. It’s been
estimated 12 major infectious syndromes, 23 bacterial pathogens and Departments of Pharmacology/
Toxicology and Community
18 antibiotic regimens (targeted and empirical) currently contribute to
Medicine, Michigan State
the global AR. Prior to COVID-19 pandemic (2019), it’s been reported six University, East Lansing,
additional pathogen-antibiotic combinations each was responsible for Michigan, United States
nearly 100,000 AR-attributable deaths primarily due to third-generation
cephalosporin-resistant E coli, carbapenem-resistant A baumannii, Biography
fluoroquinolone-resistant E coli, carbapenem-resistant K pneumoniae,
Prof. Dr. Nassiri is a former dean of
and third-generation cephalosporin-resistant K pneumoniae. Based global health at MSU, East Lansing,
upon numerous recent studies, nosocomial MDR K. pneumoniae isolates Michigan, USA. He is a French-trained
has been recorded from 28 countries in six regions of the world. For hematologist with expertise in global
example, one study reported the estimates of ESBL- producing K. health, infectious diseases, and
pneumoniae in Ethiopia were 61.8% and the pooled proportion estimates antibiotic resistance. He is currently
of MDR isolates for both K. pneumoniae and E. coli were 82.7%. China is a professor of clinical pharmacology
another concern due to overuse and abuse of last-resort antibiotics in at MSU. He is on the editorial
board of 4 medical journals and has
human medicine, veterinary medicine, and animal husbandry. Currently,
written extensively (viewpoint) about
there is a prevalence of gram-negative bacteria multidrug resistance in
COVID-19 and emerging variants.
China such as CRAB, carbapenem-resistant P. aeruginosa (CRPA), and
CRE. A. baumannii has a higher carbapenem resistance rate than P.
aeruginosa and Enterobacter spp. with a proportion of more than 50% among Chinese isolates. The rates of
resistance to imipenem and meropenem differ by region in China with Henan Province recorded as highest
(78.5%) and Hubei Province recorded as lowest (64.1%). Nosocomial AR in Iran deserved global attention.
In a recent study conducted in the southwestern region of the country, the investigators concluded
“Considering widespread empirical antibiotic therapy in Iran, the rate of increasing resistance to common
antibiotics prescribed for ambulatory and hospitalized patients is concerning.” Most commonly antibiotic
resistance was seen with cephalexin (100%), cefotaxime (100%), cefazolin (100%), amoxicillin (80%), and all
cases of oxacillin were resistant. Vancomycin resistance was higher than 50% in this study. The authors
have also reported a widespread resistance for azithromycin (94.4%) and erythromycin (63.6%) in Yasuj
metropolitan area which is alarming. To address rapid spread of AR in human and animal communities and
their environmental impacts, efforts must be focused on educations healthcare professional for making
appropriate therapeutic decisions, improving surveillance and laboratory infrastructure particularly
molecular epidemiological methods and genetic analysis of resistant pathogens as an urgent priority
to combat global AR. In the meantime, the current clinical protocol vis-à-vis principles of antimicrobial
stewardship adherence is a practical approach for minimizing the incidence of AR in outpatient and
inpatient settings.

39
Infection 2024

Clinical features of adult, hospitalized, non-vaccinated

COVID-19 patients during the omicron variant surge in
Japan

Background: The mortality of SARS-CoV-2 infection in non-vaccinated

patients is still thought to be high despite the appearance of the omicron
subvariant. A total of 36 adult, non-vaccinated patients who were
hospitalized with SARS-CoV-2 infection during the omicron variant
surge were included in this study.

Case Series: Severity of illness at admission was mild, moderate, and Masafumi Seki, MD, Ph.D
severe in 0 (0%), 29 (80.6%), and 7 (19.4%) patients, respectively, and Division of Infectious Diseases
three (3/36=9.1%) patients died. The patients who died were as follows. and Infection Control, Saitama
(Case 1) A 64-year-old man on hemodialysis developed severe pneumonia Medical University International
caused by SARS-CoV-2 infection. His pneumonia did not worsen, but he Medical Center, Hidaka City,
Saitama, Japan
developed septic shock on Day 5 with a catheter-related blood stream
infection due to Methicillin-Resistant Staphylococcus Aureus (MRSA)
Biography
and Extended Spectrum Beta-Lactamase (ESBL)-producing Escherichia
Professor Masafumi Seki has been
coli. (Case 2) An 87-year-old man with a history of esophageal cancer
graduated from Department of
had moderate pneumonia at admission, but suddenly developed massive
Medicine, Nagasaki University, as
brain hemorrhage on Day 6. (Case 3) A 94-year-old man with a history Medical Doctor, with the specialties
of brain infarction and atrial fibrillation had moderate pneumonia on including Internal Medicine,
admission. His pneumonia was improving, but he died on Day 7 of acute Infectious Diseases, and Infection
renal failure and suspected recurrent brain infarction. Control. Later on he obtained his
post-graduation, started working
Conclusions: These data and cases suggest that non-vaccinated patients at Osaka University. After the
showed high mortality, especially elderly male patients with underlying professor of Tohoku Medical and
diseases. They died due to reasons other than respiratory failure and/ Pharmaceutical University, presently
or pneumonia, and impairment of blood vessels, especially in the brain, he has been working at the Saitama
heart, and kidneys, by SARS-CoV-2 infection was thought to have Medical University Internatinal
occurred, though the omicron variant has generally low pathogenicity. Medical Center, Hidaka City, Saitama,
Japan.
Audience Take Away Notes
• We need more vaccination for COVID-19
• Vascular diseases, including heart attack, stroke, and acute renal
dysfunction should be carefully managed in unvaccinated and/or
less vaccinated persons for COVID-19
• Early diagnosis and start treatment by antiviral agents is critical
• In addition, not only COVID-19, but also the other viral and bacterial
diseases, including influenza, respiratory syncytial virus diseases,
and pneumococcal diseases should be prevented by vaccine

40
Infection 2024

Carbapenemase-producing multidrug resistance of gram

negative bacilli causing bacteremia at the general hospital
of Mexico

Bloodstream infections due to Gram-negative bacilli is a highly

consequential nosocomial infection with serious consequences and
even more so because the organisms are usually highly resistant to
antimicrobials. The aims of this study were to describe incidence of
bacteremia caused by Gram-negative ESKAPE bacteria during COVID-19
pandemic, the clinical and microbiological characteristics, and the Giono Cerezo S*, Alcantar
Antimicrobial Resistance (AMR). A total of 115 Gram-negative ESKAPE Curiel, MD, Huerta Cedeno
isolates were collected from patients with nosocomial bacteremia in M,
a tertiary care center in Mexico between January – December 2020.
ENCB Instituto Politecnico
A. baumannii (34%) and K. pneumoniae (28%) were the most frequent
Nacional, Mexico
followed by P. aeruginosa (23%) and Enterobacter spp (16%). A. baumannii
showed the highest levels of AMR (100%), followed by K. pneumoniae
Biography
(87%), Enterobacter spp (34%) and P. aeruginosa (20%). Furthermore,
Dr. Silvia Giono Cerezo PHD National
the 27 K. pneumoniae isolates resistant to beta-lactams carried the
School of Biological Sciences
blaCTX-M-15 and blaTEM-1 genes, while 33/39 A. baumannii isolates
Instituto Politecnico Nacional- IPN
were carriers of the blaTEM-1 gene. In isolates resistant to carbapenems,
Chemist Bacteriologist Parasitologist
29/39 A. baumannii were carriers of blaOXA-398 and 4 of blaOXA-24. Doctor of Science Member of the
In P. aeruginosa, only one isolate was a carrier of the blaVIM-2 gene, National Academy of Medicine
while the 2 K. pneumoniae and 1 Enterobacter spp carried the blaNDM Member of the Mexican Association
gene. Among colistin-resistant isolates mcr-1 gene was not detected. of Infectious Diseases Collegiate
The clonal relatedness assessed by Pulsed-Field Gel Electrophoresis Member of the Postgraduate Studies
(PFGE) and by Multi-Locus Sequence Typing (MLST) demonstrated Professor of Medical Bacteriology and
Host-Parasite Relationship Theory
two outbreaks caused by A. baumannii ST208 and ST369 and a genetic
and laboratory also Problems of
diversity for K. pneumoniae, P. aeruginosa and Enterobacter spp.
Medical Bacteriology Tutor, Director
Remarkably, the ST136 and ST208 belonged to the clonal complex CC92
Advisor of Bachelor's, Master's and
and IC2. A. baumannii was associated with a high mortality rate of 72%, Doctorate students Lines of research:
mainly in patients with COVID-19 75% cared for in the Respiratory Ward. Diagnostic Medical Microbiology
There was no statistically significant association between MDR profile of and Antimicrobial Resistance of the
Gram-negative bacteria and in COVID-19 and non-COVID-19 patients. ESKAPE group diagnosis and analysis
In summary, the results points to the important role of Gram-negative of the genome of Helicobacter pylori
MDR causing bacteremia in nosocomial settings before and during the MLST of Stenotrophomonas spp
several publications.
COVID-19 epidemic. In addition, the COVID-19 pandemic had no local
impact on antimicrobial resistance rates in the short term. Already
publish Gram-negative ESKAPE bacteria bloodstream infections in
patients during the COVID-19 pandemic.

41
Infection 2024

Efficacy and safety studies of EC16 nanoformulations

against human coronavirus

Background: Severe Acute Respiratory Syndrome (SARS) coronavirus

2 (SARS-CoV-2) is responsible for the 2019 coronavirus epidemic
(COVID-19). SARS-CoV-2 infection is associated with high mortality and
morbidity worldwide. A common sequela is chronic neurologic diseases,
which severely impact the quality of life and increase the burden on
healthcare systems. The Post-COVID, or Long COVID neurologic
symptoms are due to the robust replication of SARS-CoV-2 in the nasal Stephen Hsu1,2*, Douglas
neuroepithelial cells, leading to neuroinvasion and inflammation of the Dickinson2, Nicolette
Central Nerve System (CNS). Currently used medications and vaccines
Frank2
are not targeting the neuroinvasion of SARS-CoV-2, and these methods
do not inhibit the robust SARS-CoV-2 replication in the nasal epithelial Department of Oral Biology
1

& Diagnostic Sciences, Dental

cells. Therefore, a significant gap in treatment/preventive strategies
College of Georgia, Augusta
that needs to be filled is to rapidly inhibit SARS-CoV-2 replication in University, Augusta
the nasal cavity to block viral invasion to CNS, in order to minimize
Camellix Research Laboratory,
2
neurologic damages. We recently invented a method to facilitate self-
Camellix, LLC, Augusta, Georgia,
assembling of EGCG-palmitate (EC16) nanoparticles. This technology
United States
allows us to utilize the antiviral, anti-inflammatory, antioxidant and
neuroprotective properties of EC16 as a nasal drug to be formulated in Biography
aqueous nanoformulations to treat Long COVID symptoms.
Dr. Stephen Hsu earned a Ph.D.
Method: Formulations suitable for intranasal applications were developed degree from University Cincinnati
College of Medicine. He joined
and tested in vitro against human α coronavirus 229E (CoV-229E) and β
Memorial Sloan-Kettering Cancer
coronavirus OC43 (CoV-OC43) using TCID50 assay. Formulations met
Center as a Research Fellow and
the FDA standard with the highest antiviral activity were selected for
served as a lecturer in the National
further improvement in stability and homogeneity. The final formulation University of Singapore. He is
(F18D) suitable for animal and human tests was selected and tested currently a tenured professor in
in comparison to vehicles in cell culture infection systems following Dental College of Georgia, Augusta
two test protocols (with or without direct contact with the virus). The University. Dr. Hsu invented several
cytotoxicity was performed in MRC-5 cells and primary human nasal technologies and products to treat
epithelial cells. In addition, nasal nanoformulations were evaluated on various diseases and conditions such
as xerostomia and viral infections
the tissue integrity, cytotoxicity, and cilia beat frequency in a 3-D human
based on results from phase II clinical
nasal epithelia model.
trials. Dr. Hsu’s current NIH support
Results: The initial results demonstrate that EC16 formulations in normal is on novel virucidal disinfectants
saline, phosphate buffered saline, and cell culture medium effectively against bacterial spores, and nasal
inhibited human coronavirus infection (>99%) after a single application, nano-drug intervention on Long
COVID associated neurologic
with or without direct contact with the virus. The final formulation F18D
symptoms such as anosmia.
was able to inhibit viral infectivity by >99.9999%. Viral replication was
reduced by 99% after a single 10-min application in a post-infection assay
in human primary nasal epithelial cells. Cytotoxicity and 3-D human nasal
epithelia model study demonstrate the nanoformulations are suitable
for human use. To the best of our knowledge, this result represents the
first approach using EC16-containing nasal nanoformulations to rapidly

42
Infection 2024

inhibit human coronavirus without toxicity. Future studies are planned to determine product suitability
for clinical trials toward new drug application.

Conclusion: With its antiviral, antioxidant, anti-inflammatory, and neuroprotective properties, EC16 in
nasal nanoformulations could be further developed for clinical applications to patients for minimizing
Long COVID neurologic symptoms such as anosmia.

Audience Take Away Notes

• Understand the “facilitated self-assembled” nanoparticles and their advantage over conventional
nanoparticles

• Disadvantages in current interventions for Long COVID patients

• Learn the unique beneficial properties of EGCG, a catechin-derivative found in green tea

• Understand the advantage to use nasal application to deliver a drug vs. oral application

• Learn the potential mechanisms of “persistent viral infection” is association with Long COVID

43
Infection 2024

Clinical characteristics analysis of Bordetella Psertussis

infection in adult cough patients

Purpose: In contemporary epochs, the prevalence of pertussis has been

progressively on the rise, persisting as a formidable health concern.
The manifestations following pertussis infection lean towards the
atypical, making them easily disregarded or subject to misdiagnosis.
Our aim is to ascertain the pertussis infection rate among individuals
presenting with a cough and scrutinize the clinical attributes of the
infected. Xiaoyun Zhao*, Jingjing
Materials and Methods: Screening transpired between July 1, 2023, and Zhao
September 20, 2023, at Tianjin Chest Hospital and the Second People's Tianjin University Chest Hospital,
Hospital of Tianjin. It focused on individuals seeking medical attention Tianjin, China 300222
due to cough symptoms or those in contact with presumed pertussis
cases. A cohort of 1025 patients was assembled, and nasopharyngeal Biography
swabs were procured for polymerase chain reaction (PCR) analysis. Dr. Xiaoyun Zhao studied Clinical
Medicine at the Nankai University and
Results: 1. In accordance with the pertussis case definition, 417 cases
got his MM degree in 2004, and then
(40.7%) were diagnosed as clinically suspected, and 145 cases (14.1%)
received his MD degree at the Tianjin
exhibited epidemiological correlations. The median duration of Medical University. His fellowship
symptoms before hospitalization was 15 days. Following PCR testing, was supervised by Dr. Richard
163 individuals tested positive for pertussis, comprising 38 adults Castriotta at the Texas University
(≥18 years old) and 125 infants and children (0~17 years old). Within Health Science Center at Huston.
our study cohort, the pertussis infection rate stood at 15.9%. The Now he serve as the chief doctor
infants and children included in our investigation were all suspected and the discipline leader of National
pertussis cases, yielding a pertussis infection rate of 45% among this Respiratory Medicine Clinical Key
Specialty at Tianjin University Chest
demographic. Among the enrolled adult cases, 139 cases (18.6%) were
Hospital. Also he serve as a professor
deemed suspected, resulting in a pertussis infection rate of 5.1%
of Clinical Medicine and Biomedical
among adults presenting with cough symptoms. Engineering at the Tianjin University,
2. Primary Clinical Manifestations: Among children, all presented Tianjin Medical University, Tiangong
University, China. He has published
with paroxysmal coughing; 94 cases (75.2%) experienced post-cough
more than 70 research articles in
vomiting, 115 cases (92%) had nocturnal coughing, 57 cases (45.6%)
journals.
manifested a whooping cough-like sound, 103 cases (82.4%) had a
cough duration of ≥2 weeks, 64 cases (51.2%) exhibited inspiratory
pause after coughing, 115 cases (92%) had nocturnal coughing, 21
cases (16.8%) had low-grade fever, 7 cases (5.6%) had pneumonia, and 25 cases (20.0%) experienced
weight loss. In adults, 33 cases (86.8%) had paroxysmal coughing, 20 patients had a cough duration
of ≥2 weeks (52.6%), 25 cases (65.8%) had nocturnal coughing, 1 case (2.6%) experienced post-cough
vomiting, 2 cases (5.3%) had a whooping cough-like sound, 1 case (4%) exhibited inspiratory pause
after coughing, and additional observations included 1 case (4%) with syncope after coughing, 3 cases
(7.9%) with perspiration after coughing, 1 case (2.6%) with low-grade fever, and 3 cases (7.9%) with
pneumonia.

3. Comparative Analysis of Hematological Parameters Across Various Age Groups and Immune States:
White blood cell counts exhibit elevation in the non-immune cohort, with a statistically significant
difference observed between distinct immune groups (P<0.01); Neutrophil levels progressively rise
with advancing age, demonstrating statistical significance across different age brackets (P<0.01);

44
Infection 2024

Lymphocytes display a marked elevation in the non-immune group (P＜0.01), with a statistically significant
variance noted among diverse age groups (P<0.05); Monocytes exhibit elevated values in the non-immune
group, showcasing a statistically significant difference across various immune statuses (P<0.01); Platelet
counts show heightened values in the non-immune group, with statistically significant disparities apparent
between distinct immune statuses and age groups (P<0.01).

Conclusions: Pertussis, identified as a causative agent of persistent coughing, affects both immunized
children and adults, presenting with atypical clinical symptoms. Our study suggests a potential
overestimation of the diagnostic efficacy of blood routine tests in infants aged 0-3 months. Furthermore,
the existing vaccine immunization strategy proves inadequate in preventing pertussis, emphasizing the
imperative for the development of novel diagnostic criteria and a comprehensive immunization approach.

Key Words: Bordetella Pertussis, Adults, Clinical Features, Polymerase Chain Reaction, Hemogram.

45
BOOK OF ABSTRACTS
24-26
JUNE

6th Edition of World Congress on

Infectious
Diseases

SPEAKERS

47
Infection 2024

Abdallah Musa Abdallah1*, Hifzur Rahman2, Hadi Yassine3,

Mohamed A. Elrayess1,3, Mohamed M. Emara1, Farhan S. Cyprian1
1
College of Medicine, QU Health, Qatar University, Doha, Qatar
2
Guard-Health Affairs, King Abdulaziz Medical City, Jeddah, Saudi Arabia
3
Biomedical Research Center (BRC), Qatar University, Doha, Qatar

Immune transcriptomic analysis of COVID-19 patients with varying

clinical presentations
Background: Coronavirus disease (COVID-19) is an infectious disease with a heterogeneous clinical
presentation caused by the novel coronavirus, the severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2). The distinctive features of COVID-19 infection encompass a clinical spectrum ranging from
asymptomatic forms to severe illness involving diverse underlying pathophysiological processes such
as dysregulated inflammation, endothelial dysfunction, thrombotic pulmonary microangiopathies, and
multiple organ failure. However, the underlying molecular mechanisms of host responses to this infection,
particularly systemic inflammation and the host immunity against SARS-CoV-2, remain largely undefined.

Methods: In this prospective study, Ribonucleic Acid (RNA) sequence analysis from venous blood of 228
COVID-19 patients (comprising 188 males, aged 21-87 years), was performed using a shotgun sequencing
pipeline and subsequently clustered using an unsupervised algorithm. Differential gene expression was
assessed, integrated pathway and network data, along with clinical information between clusters, as well
as estimating circulating cell populations from the sequencing data and investigating its correlation with
disease severity and mortality.

Results: This research identified various transcriptomic clusters and globally dysregulated immune-
related pathways, leading to distinct host inflammatory cytokine profiles in severe and critical SARS-
CoV-2 infected patients. This underscores the association between COVID-19 pathogenesis and excessive
cytokine release. Additionally, our results reveal variances in circulating cell populations and the activation
of apoptosis and the P53 signaling pathway in lymphocytes induced by SARS-CoV-2 infection.

Conclusions: The transcriptomic dataset of COVID-19 patients with diverse clinical presentations holds
promise as a valuable resource for guiding clinical decisions regarding anti-inflammatory intervention,
offering potential insights into the molecular underpinnings of the disease.
Biography

Dr. Abdallah received his PhD in Molecular Biology from the VU University Amsterdam, in 2008. His dissertation work
focused on several aspects of protein secretion mechanisms in mycobacteria. Following postdoctoral appointments
at the VU medical Centre and The Netherlands Cancer Institute, he started his academic career at the King Abdullah
University of Science and Technology, KSA. Dr. Abdallah is an expert Molecular biologist and his research interests
are in the area of Microbial Genetics, host-pathogen interaction and molecular pathogenesis of infectious agents. Dr.
Abdallah joined the Qatar University, College of Medicine as an Assistant Professor of Genetics on August 2019.

48
Infection 2024

Ahmad Subhi¹*, Salma O. Alshamsi1, Akram Harazeen², Aulin

Vitus³
1
Adult Infectious Diseases, Department of Medicine, Al-Qassimi Hospital,
Emirates Health Services, United Arab Emirates
²Department of Internal Medicine, Al-Qassimi Hospital, Emirates Health Services,
United Arab Emirates
³Prevention and control of infection Department Al-Qassimi Hospital, Emirates
Health Services, United Arab Emirates

The impact of SARS-CoV2 pandemic on the prevalence and the outcome

of candida auris infections, admitted to a tertiary hospital in United Arab
Emirates (UAE), in 2022

I n 2016, according to the United States Centers for Disease Control and prevention (CDC), and Public
Health England, Candida auris, has been labeled as an emerging Multidrug-Resistant (MDR) yeast.
Despite causing significant mortality, there are still no available Minimum Inhibitory Concentration (MIC)
breakpoints for C. auris. When breakpoints of other candida species were applied, almost all C. auris isolates
were noted to have high resistance to fluconazole. A substantial number of isolates were resistant to
voriconazole and amphotericin B. Thus, leaving echinocandins as the empirical treatment of choice. Since
its discovery, C. auris has caused hospital outbreaks in multiple countries in all continents. Interestingly,
significant genetic variability of isolates has been identified depending on geographic location. Besides
causing bloodstream, and wound infections, C. auris has also been isolated from cultures from urine and
respiratory tract.

In terms of the UAE, C. auris was first reported in 2018, in the blood of an elderly lady requiring prolonged ICU
stay due to septic shock from multiple sources with persistent fungemia. Therefore, aggressive infection
control measures should be implemented for early identification and to avoid any potential transmission
given the vulnerable status of the patients at risk of invasive C. auris infection.

The United Arab Emirates (UAE) has borne the devastation of COVID-19 in terms of the number of infections
in the population. It is important to emphasize the impact of the SARAS COV2 pandemic on Candida auris
infection in the United Arab Emirates, and Al-Qassimi Hospital is an example of this. As a result, other
health centers will be encouraged to do the same.

The main aim of our research is to determine the prevalence and the outcome of Candida auris infections
in patients admitted to our tertiary hospital during the year 2022. While also, identifying the body
sources/ sites from which Candida auris infection was isolated, and assessing the risk factors related to
poor outcomes in patients with isolated C. auris.

The statistical process of this research also seeks to evaluate the burden of candidemia cases on the health
and social care system in terms of epidemiological findings. This is through evaluating the length of stay
and ICU admissions of patients from confirming the diagnosis and identifying the Mortality Rate at 7 days
from confirming the diagnosis of candidemia.

This retrospective study reviewed medical files for a total of almost 100 patients. Sampling was done on
the basis of all adults/adolescents who were admitted to the Hospital and confirmed to have candida auris
isolated from a body site.

49
Infection 2024

Audience Take Away Notes

• Identify potential co-infections. Besides understanding Co-Infections and Complications
• Achieving more effective patient care and infection control measures
• A better understanding of the outcomes of patients with both infections regarding the impact on
mortality rates and long-term morbidity
• Our data would encourage more research opportunities such as exploring the immunological,
molecular, and clinical interactions between SARS-CoV-2 and Candida auris for potential therapeutic
targets or preventive strategies
Biography

Ahmad Subhi is a graduate of the University of Baghdad, College of Medicine, in 1997. He finished his training in internal
medicine at Hahnemann hospital- Drexel University in Philadelphia-Pennsylvania, and he completed his fellowship in
Infectious Diseases at Cooper University Hospital in New Jersey State. He has more than eleven years of experience
as a licensed physician in the USA. His background was in Internal Medicine and Infectious diseases, with a particular
interest in the Hepatitis C virus, HIV, and infectious diseases in immune-compromised patients. He is a member of
the Infection Control and Central antibiotic stewardship committee, the Emirates Infectious Diseases Society and the
American College of Physicians. He is board certified by the American Board of Internal Medicine & Infectious Disease.

50
Infection 2024

Ahmed Abdalla*, Anna, Kelly, R. Deignan, C. Quigley

Wexford General Hospital, Co. Wexford, Ireland

Sever adenovirus infection in an immunocopemtment host

A denovirus is a frequent cause of mild respiratory tract infection and gastroenteritis in children, it
can cause severe respiratory illness in immunocompromised patients. Outbreaks and aggressive
respiratory symptoms have been reported in military camps. Epidemics are well known to occur in close
or crowded settings.

We report a case of severe adenovirus pneumonia in a young 38 year old immunocompetent female who
lives in a refugee camp in Co. Wexford. Ireland. She presented with fever associated with mild respiratory
symptoms that progressed rapidly to severe pneumonia with bilateral consolidation on chest x ray and
ground glass opacities on high resolution Computed tomography.

On admission, she was febrile at 40oC, other vital signs were normal, she did not require oxygen support.
Initial bloods showed high C – reactive protein with normal White Cell counts and differential and Chest
X ray showed patchy right lower lobe infiltration. Full cultures, throat swab, Pneumococcal and legionella
urinary antigen in addition to viral serology and immunoglobulin levels were requested, and she was started
on broad spectrum antibiotics. 48 hours later, she deteriorated clinically and required oxygen support,
she was continuously spiking fever and her chest x ray showed worsening of the pneumonic patches to
multilobar pneumonia. By day 4 of admission, she required high flow oxygen with Fi02 up to 80 % to
maintain her partial pressure of oxygen around 10. High resolution CT thorax showed multiple ground glass
opacities. Echocardiography excluded any cardiogenic causes for her respiratory deterioration. Adenovirus
was detected in the nasopharyngeal swab with adenovirus PCR DNA of 1.31x10^7 in serum. Sputum culture
and serial blood cultures were negative. Tuberculosis cultures and B-D glucan level / galactomannan
level were negative. Serum immunoglobulins and HIV test were negative. HBA1c was normal. Our patient
improved successfully, she recovered by day 15 with supportive management, no antiviral was given.

Severe adenovirus infection is rare in immunocompetent adults. This case demonstrates a rapidly
progressive respiratory course. Specific groups including refugee camps, military recruits etc, should be
evaluated and assessed cautiously to prevent outbreak and poor outcomes. Signs of mild viral illness in the
population should be handled carefully with a high index of suspicion and early isolation of specific groups
including immunocompromised patients is advisable.

Audience Take Away Notes

• Be open to different kind of viral illness
• Close assessment for viral illness should be taken in acute viral illness in specific group of people

51
Infection 2024

Biography

Abdalla Ahmed, a dedicated physician, embarked on his journey in the field of medicine after graduating from the
prestigious University of Khartoum in 2011. His passion for serving others led him to Saudi Arabia, where he worked
tirelessly for six years, gaining invaluable experience and honing his skills. Driven by a desire to expand his knowledge
and make a difference in the field of infectious diseases, Abdalla set his sights on Ireland. With unwavering determination,
he pursued his dream of becoming a proficient clinician Dr. Ahmed's commitment to excellence is evidenced by his
attainment of full membership in the Royal College of Physicians UK and certification by the Educational Commission
for Foreign Medical Graduates (ECFMG). Currently serving as a medical registrar at Wexford General Hospital in
Ireland, Dr. Ahmed continues to make significant contributions to the medical community. Abdalla Ahmed's journey
serves as an inspiration to aspiring physicians and researchers alike, illustrating the profound impact that dedication,
perseverance, and a genuine passion for healing can have on the lives of others.

52
Infection 2024

Ahmed Mahboub1* M.D; Ghassan Ghattash2 M.D; Nidal Al

Hashykeh3, M.D; Ibrahim Badaineh3, M.D; Iqbal Chaudhry4, M.D
1
Paediatric Resident – Tawam Hospital, United Arab Emirates
2
Paediatric Infectious Disease Consultant – Tawam Hospital, United Arab
Emirates
3
Paediatric ICU Consultant – Tawam Hospital, United Arab Emirates
4
Paediatric Neurology Consultant – Tawam Hospital, United Arab Emirates

HHV6 encephalitis in an immunocompetent host

Introduction: A previously healthy and a fully vaccinated 5-year-old pre-schooler-aged male who presented
to the ER with an insidious onset of decreasing level of consciousness and headaches before developing
Status Epilepticus, and requiring admission to the PICU; with a final diagnosis of HHV6 Encephalitis based
on the BioFire CSF testing.

HHV6 is known to cause CNS infections in immunocompromised individuals, particularly oncology patients;
thus, its diagnosis in a previously healthy and an immunocompetent host sheds light on the suspicion,
diagnosis, and treatment options for the aforementioned individuals.

Case Description: Presented was initially seen on the same day of the symptoms’ onset in a PHC, where he
was prescribed Augmentin treating a throat infection.

Throughout the illness's course, he was becoming progressively more tired, confused, had developed
decreasing eye-to-eye contact, and sleepiness.

He was later referred to our facility for further evaluation, when he started to have convulsions, and later
on, Status Epilepticus.

Subsequently, he was transferred to the PICU, loaded with Phenytoin, and started on Midazolam IV. A Brain
MRI showed diffuse cortical/deep cortical changes along with DWI restriction and ADC changes, and was
suggestive of Hypoxic-Ischemic changes.

His initial CSF studies (analysis, culture, and viral panel were normal); however, based on his greatly
worrying symptom progression, repeated CSF samples were taken, which came to be positive for HHV6.

He was started on Foscarnet and Ganciclovir; and started to show great improvement and return to his
neurological baseline, with a repeated CSF study being negative for the virus.

Followed later on in the clinic, where he was on Keppra prophylaxis and on regular follow-up with
Occupational Therapy and Speech-Language Pathology.

Discussion: Viral encephalitis is a medical emergency. It is an aseptic inflammatory process of the brain
parenchyma associated with clinical evidence of brain dysfunction, significant morbidity, and mortality
(Michael and Solomon 2012).

HHV6 is usually associated with Roseola, which manifests with high fever, URTI symptoms and the
development of a rash after the fever subsides.

In immunocompromised patients (haematological malignancies and transplantation), reactivation of

roseoloviruses may cause severe, lethal organ dysfunctions, including damage to the limbic system, brain
stem, and hippocampus; thus, it could potentially lead to life-long disability.

Moreover, an HHV6 infection may lead to a chromosomally integrated human herpesvirus 6 status, in which
the HHV-6 genome is integrated into the host’s genome and is vertically transmitted in a Mendelian manner;

53
Infection 2024

that itself may cast doubt on the recently utilized BioFire technology as it could lead to misdiagnose the
causation of the illness, and the unnecessary initiation of antiviral therapy that requires strict monitoring
and might lead to serious side effects.

The main purpose of presenting the case is to highlight the unique presentation of HHV6 Encephalitis in an
immunocompetent host, and to discuss the challenges associated with suspecting the diagnosis, reliability
of testing for the infection with a recently utilized technology, and the decision to proceed for, and types
of management.
Biography

Dr. Ahmed Mahboub is a dedicated Pediatric Resident and Chief of Interns and External Learners at Tawam Hospital
in Al Ain, United Arab Emirates. He graduated from United Arab Emirates University's College of Medicine & Health
Sciences (CMHS) in Al Ain, where he obtained his medical degree in 2019. After completing his primary medical
education, Dr. Mahboub pursued an internship at Tawam Hospital, where he gained valuable clinical experience
and developed a deep understanding of patient care. He then went on to specialize in Pediatrics and is currently in
the residency program at Tawam Hospital, where he continues to enhance his skills and knowledge in the field. Dr.
Mahboub is passionate about providing personalized and holistic care to the pediatric community. He firmly believes in
the significance of nurturing and supporting the well-being of children as they are the future generations of humanity.
Through his dedication, he strives to make a positive impact on the lives of his young patients and their families.
In addition to his medical pursuits, Dr. Mahboub has diverse interests outside of medicine. He is an avid writer of
poetry in both Arabic and English, allowing him to express his creativity and emotional depth. He also keeps himself
updated on the latest developments in Information Technology, Artificial Intelligence, and Virtual Reality, recognizing
their potential to revolutionize healthcare and improve patient outcomes. Furthermore, Dr. Mahboub takes pleasure
in the art of hospitality, appreciating the importance of creating a warm and welcoming environment for patients
and their families. Looking ahead, Dr. Ahmed Mahboub has ambitious goals for his career. He aspires to pursue a
fellowship in Pediatric Infectious Disease, aiming to specialize further in this critical area of pediatric medicine. By
acquiring specialized knowledge and expertise, he aims to contribute to the field and make a significant impact on
the prevention, diagnosis, and treatment of infectious diseases in children. Dr. Ahmed Mahboub's commitment to
pediatric care, his pursuit of knowledge, and his diverse interests make him a valuable asset to the medical community.
His dedication to providing holistic care, combined with his passion for innovation and personal interests, sets him
apart as a well-rounded and compassionate healthcare professional.

54
Infection 2024

Aji Antony1*, M. Praveen2, B. Jithesh3, Anupama A. Manjula4, P.

Jayesh Kumar2
1
Resident
2
Professor
3
Assistant Professor, Department of General Medicine
4
Professor, Department of Pathology Government Medical College, Kozhikode,
India

A case of disseminated histoplasmosis presenting as fever of unknown

origin in a patient with diabetes mellitus
Background: Histoplasmosis is an endemic mycosis that is usually asymptomatic but occasionally
results in severe illness. While it is endemic in some regions of the world, including America, Africa, and
parts of Asia, it is considered rare in India. Most patients who develop disseminated histoplasmosis are
immunosuppressed (eg, AIDS, solid organ transplantation, treatment with tumor necrosis factor-alpha
inhibitors) or are at the extremes of age. Here, we present a case of disseminated histoplasmosis in patient
with diabetes mellitus.

Case Presentation: A man in his 40s presented with fever and cough for one month duration. The fever was
high grade, predominantly in the evening hours and not associated with any periodicity or rhythmicity. He
also had minimally productive cough with a mucoid sputum and occasional hemoptysis. His past medical
history is notable for Alcoholic Chronic liver disease (Child Pugh grade B) and Type 2 diabetes mellitus. He
also had history of treated pulmonary tuberculosis in his childhood. He frequently visits a nearby forest and
had significant exposure to bird droppings. Physical examination revealed pallor and features of volume
overload. Examination of the respiratory system showed coarse inspiratory crepts in the right mammary,
infraaxillary and infrascapular areas. Patient was clinical diagnosed with Fever of unknown origin with
a respiratory focus. His lab reports showed pancytopenia with a high Erythocyte Sedimentation Rate
(ESR). HRCT thorax revealed minimal bronchiectasis in right lower lobe and subpleural fibrotic nodule.
Bone marrow biopsy showed non caseating granulomas and yeast forms of fungi, as evidenced by positive
Grocott's methenamine silver staining. Meanwhile his urine histoplasma antigen turned positive. The
patient was diagnosed with disseminated Histoplasmosis and received a 14 day course of Amphotericin B,
followed by a plan for oral itraconazole for one year. He became afebrile of Day 5 of antifungal treatment
and is currently doing well.

Discussion: Histoplasmosis is a disease usually seen in immunocompromised individuals in endemic areas.

The incidence of the disease is increasing in India, mainly due to better recognition of the disease. In
a place where tuberculosis is endemic, the diagnosis of Histoplasmosis which has overlapping clinical
features remains challenging. Hence early suspicion and prompt investigations help in the recognition
of this deadly disease. Moreover there are increasing case reports, where diabetes has been the sole risk
factor for the disease. Our patient too, didn’t have the classical risk factors associated with Histoplasmosis.
Hence further research into the possible relationship between diabetes and incidence of Histoplasmosis
is also warranted.

Audience Take Away Notes

• This case shows the diagnostic difficulties in histoplasmosis especially in a non endemic area. This will
help in the better awareness and recognition of the disease
• The case also opens novel research opportunities like the role of diabetes as a risk factor for
histoplasmosis and the need for better non invasive markers for early diagnosis

55
Infection 2024

• This case may also create new avenues in the recognition of fungal infections in cases of prolonged
fever
Biography

Dr. Aji Antony studied his MBBS from Coimbatore Medical College, Tamilnadu and is currently doing his Internal
Medicine residency in Government Medical College Kozhikode. He has attended and presented papers in numerous
international and national conferences. He has published three papers in renowned journals and has an excellent
academic record.

56
Infection 2024

Aji Antony1*, Aquil Kakinad2, U. Kripesh2, P. Jayesh Kumar3

1
Resident
2
Assistant Professor
3
Professor, Department of General Medicine Government Medical College,
Kozhikode, India

HIV associated vasculopathy presenting as cerebrovascular accident in a

young girl with HIV
Introduction: Stroke in a case of HIV, occurs by various mechanisms. The mechanisms include vasculitis
secondary to opportunistic infections, HIV associated vasculopathy, cardioembolic stroke and HIV
associated coagulopathy. Of these, the HIV associated vasculopathy is a diagnosis of exclusion. Here we
present a case of HIV associated vasculopathy in a young girl with HIV.

Case Presentation: The patient is a 14-year-old HIV infected girl, diagnosed at the age of 1 and has been drug
default for the past 3 years. 1 month back, she was diagnosed with Ileocecal Tuberculosis and was started
on Antitubercular Therapy (ATT). 1 week later, patient developed ATT-induced hepatitis and modified ATT
regimen was started. The next week, patient presented to us with acute onset weakness of right upper and
lower limbs. Patient was clinically diagnosed with cerebrovascular accident. MRI head showed an acute
infarct in the left corona radiata and fusiform ectasia of Left terminal Internal carotid artery, left middle
cerebral artery and left anterior communicating artery. Cerebrospinal fluid analysis revealed a lymphocytic
pleocytosis (cells = 70, lymphocytes – 70%) and elevated protein (70 mg/dl). Workup for tuberculosis,
varicella zoster, toxoplasmosis and neurosyphilis turned out negative. Echocardiogram of the patient was
also normal. Since the secondary causes were considerably ruled out, patient was diagnosed with HIV
vasculopathy. The role of antiplatelets in HIV vasculopathy remains controversial. The patient was started
on Anti-retroviral therapy. Her general condition improved, but she had residual weakness of her limbs.

Discussion: The incidence of stroke in HIV varies from 1-5%. Stroke in HIV patients were seen in younger
individuals compared to those in normal population. Ischemic stroke appears to be the predominant type
comprising around 90% of individuals. HIV vasculopathy is a rare cause of stroke in HIV patients. The
diagnosis requires significant vessel wall changes after ruling out opportunistic infections. Effective ART
plays a significant role in the prevention of HIV vasculopathy.

Keywords: HIV, Vasculopathy, Cerebrovascular Stroke.

Audience Take Away Notes

• HIV vasculopathy is rare neurological complication of HIV. This case describes the presentation and
management of the condition
• The management of HIV vasculopathy remains challenging. This case may provide novel
• research opportunities for the various treatment options in this condition
• This case also highlights the need for early diagnosis of HIV and good drug compliance to prevent such
complications
Biography

Dr. Aji Antony studied his MBBS from Coimbatore Medical College, Tamilnadu and is currently doing his Internal
Medicine residency in Government Medical College Kozhikode. He has attended and presented papers in numerous
international and national conferences. He has published three papers in renowned journals and has an excellent
academic record.

57
Infection 2024

Alexis Torres Rodriguez1*, MD, MPH; Angelica Ludena De Freitas1,

MD; Liana Medina2, MD
1
Universidad Central del Caribe, Internal Medicine Residency Program, Bayamon,
Puerto Rico
2
Dr. Ramon Ruiz Arnau University Hospital, Bayamon, Puerto Rico

Abrupt and lethal rare complication: A case report of a 32- year-old male
who suffered from pyogenic ventriculitis
Introduction: Pyogenic ventriculitis is characterized by ependymal lining inflammation of the cerebral
ventricular system and presence of suppurative fluid in the ventricles. Risk factors include a compromised
immunity such as human immunodeficiency virus, diabetes, and cancer. This infection could arise as a
complication from deep-seated cerebral abscesses, carrying a higher mortality rate, ranging from 30%
to 85%, and leaving 60% of survivors with lasting neurological sequelae. Early recognition is crucial but
data on clinical and neuroimaging features are scarce. Our case report sheds light on specific clinical and
neuroimaging aspects for pyogenic ventriculitis in a young male adult, at in-hospital setting and, as a
complication of extensive multiloculated cerebral abscesses involving atypical locations.

Case Presentation: We present a case of a 32-year-old male with a history of intravenous drug abuse and
homelessness who arrived at the Emergency Department for muscle aches, sore throat, and multiple infected
ulcers. Participating in a methadone rehabilitation program, they were concerned for noticing episodes of
hypoactivity. Initial examination revealed a mildly hypoactive, afebrile patient with a Glasgow Coma Scale
(GCS) of 14/15, stable vital signs, and no meningeal irritation or focal neurological findings. Multiple infected
ulcers were noted on his upper extremities. General laboratories were mostly unremarkable, except for
mild elevated erythrocyte sedimentation rate. Head Computer Tomography (CT) reported no intracranial
abnormalities. Therefore, the patient was admitted for infected ulcers management and further workup
investigations.

On day ten, the patient experienced a sudden clinical deterioration that was remarkable for peaks fever,
decreased alertness, apathy, withdrawal, and a reduced GCS of 10/15. Focal neurological deficits were
noted, including horizontal nystagmus, leftward eyes deviation, vertical gaze palsy, and right nasolabial
fold flattening. A new head CT with and without contrast revealed ill-defined lesions in the right frontal
and occipital lobes surrounded by edema and communicating hydrocephalus. A subsequent Magnetic
Resonance Imaging (MRI) diagnosed multiple intraparenchymal brain abscesses and ventriculitis.
Unusual features included abnormally enhancing patterns involving the fourth ventricle and left frontal
periventricular region. Lesions were identified in both infra and supratentorial regions, including the
midbrain and prepontine cistern. The largest lesion was located at the right side of the genu and splenium
affecting the corpus callosum. Moreover, serial blood culture results remained negative, and transthoracic
and transesophageal echocardiogram reported no vegetations. The patient’s cognitive decline abruptly got
worsened by the third week of admission leading to comma.

Conclusion: Pyogenic ventriculitis might present lethally as a severe complication of extensive

multiloculated abscesses and it requires early recognition and timely intervention. Additionally, it can
present with diverse infectious origins or unknow primary sources. MRI of the brain is essential for a
comprehensive evaluation of this complication and known as the most reliable neuroimaging study
for establishing diagnosis, management guidance, and prognosis. Furthermore, this life-threatening

58
Infection 2024

infection often requires prolonged antibiotic treatment combined with external ventricular drainage and
intraventricular antibiotics for the most favorable outcomes.

Audience Take Away Notes

• The audience would be able to use the discussion of this case to expand their clinical knowledge and
skills, specifically on early recognition, prognosis, and management strategies of pyogenic ventriculitis
in a setting of multiloculated brain abscesses. They would benefit from my presentation not only in
their jobs for a better making decision capacity but on gaining special skills and getting specialized
knowledge about the Magnetic Resonance Imaging study on this specific setting and when it comes
to specific unusual findings presenting on this complication. To our knowledge, this is the only case of
Pyogenic Ventriculitis in a young male adult with these specific clinical settings. Therefore, this case
report would offer an investigational window for future collaborations and new study designs. There
are other academic benefits that would be offer during my presentation, including previous research
analysis, most common pathogens involved, and discussion of scientific limitations
Biography

Dr. Alexis Torres studied Biology at the University of Puerto Rico, in 2002-2007. He then received his medical degree
in 2014 at the Autonomous University of Guadalajara in Jalisco, Mexico. Has a diverse experience in multiple clinical
settings, serving patients from all socioeconomic backgrounds. About to complete his post-graduate medical training
in Internal Medicine, at the Universidad Central del Caribe in Puerto Rico, United States of America. Has prepared
and presented several seminars regarding high-yield topics in medicine and public health. He is currently focused on
clinical research, Infectious Disease, and debuting as a youth speaker of the medical community.

59
Infection 2024

Amitabha Majumdar5*, Harshinie Jayasekera2, Gu Xuelan5, Xiao

Xue5, Sudipta Ghoshdastidar1, Swapnil Hegishte4, Morris Waskar1,
Sandip B. Pathak1, Sayandip Mukherjee1, Lincy Sherin4, Carol
Vincent3, Meenakshi Swaminathan4, Nitish Kumar4, Janhavi Raut1,
Naresh Ghatlia3
1
Unilever Research and Development Centre, Whitefield, Bangalore 560066, India
2
Unilever Sri Lanka Limited, Colombo 14, Sri Lanka

3
Unilever Research and Development, Trumbull, CT 06611, USA
4
Hindustan Unilever Limited, Mumbai, India
5
Unilever R&D Port Sunlight, UK
6
Unilever R&D, Shanghai, China

Sustainable soap bars delivering skin health and hygiene benefits for
infection protection
Background: As the world returns to pre-pandemic behavior patterns, surges in infections caused by
antibiotic-resistant bacterial strains and seasonal viruses are a cause of serious concern. Persistent
circulating infections exert socio-economic burdens on public health systems and affect all age groups,
with a higher risk of complications in children and elderly. Frequent handwashing has been recommended
by global health authorities as the most effective way to reduce transmission of pathogens in a community
setting and a bar of soap offers one of the most affordable mass hygiene interventions for frequent use.
However, the carbon footprint of a soap bar is high due to elevated usage of natural oils in formulations.
In alignment with multiple United Nation’s Sustainable Development Goals, it is a global imperative to
develop and implement technologies for manufacturing soap bars with uncompromised efficacy against
germs along with skin benefits that will serve public health at large, whilst reducing their environmental
impact.

Objective: Conventional soap bar formulation comprises of high percentages of oils (termed Total Fatty
Matter -TFM) where approximately 70-80% of soaps are fatty acids derived primarily from oils. A large
percentage of this oil is derived from palm and this usage is a large contributor to the non-edible global
palm oil/fat usage footprint. The soap industry needs to innovate for reduced palm oil consumption by
lowering TFM in bars, creating more environmentally sustainable cleansing solutions. Our research offers
a soap bar technology with lower TFM without compromising hygiene and skin benefits.

Methodology: The novel low TFM soap bars were evaluated against higher TFM soap bars on cleansing
efficiency, hygiene efficacy, skin barrier health, and skin mildness with industry wide accepted methods of
testing. Further, Zein test for mildness and in-vitro and ex-vivo 2D and 3D bioassays to evaluate skin bio-
markers relevant to skin barrier health were also conducted.

Results: The results demonstrated that the novel low TFM technology-based soap bars deliver superior
cleansing, superior antibacterial efficacy, and advanced skin benefits compared to higher TFM soaps.
Through in-vitro assays on skin 3D models, the low TFM soap bars were found to significantly upregulate
skin barrier markers, these low TFM technologies are calculated to have upto ~ 40% lower greenhouse gas
footprint (due to reduced palm oil usage).

Conclusion: The results challenge existing regulatory frameworks that mandate high TFM levels in a soap
bar as means of classification rather than functional properties. We would like to argue that low TFM soap
bars which utilize significantly a lower amount of palm oil will continue to contribute to public health as an
accessible and affordable preventative intervention for regular infections and outbreaks while being more
sustainable as a technology.

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Infection 2024

Key words: Low TFM Soap bar, Germ efficacy, Sustainable, Hygiene, Skin Mildness

Audience Take Away Notes

• Soaps have been known for centuries by man for their cleansing ability. Dating back to almost 2500 BC
soaps are natural cleansing products used for personal hygiene
• Hand washing with soap is mandated by WHO as one of the key interventions for protection against
infections
• Design of soap bars with a lower TFM (total oil) content allows efficient incorporation of several skin
benefit agents leading to milder formula which is proven to deliver superior skin hygiene benefits
• Low TFM bars thus present a dual advantage - they improve skin hygiene & health while significantly
reducing environmental impact
Biography

Dr. Amitabha Majumdar received his PhD from the Department of Biochemistry in the University of Calcutta on
Molecular Virology. After finishing his PhD, he joined the Department of Biochemistry at the Weill Medical College of
Cornell University in New York and worked there as a Post Doctoral Associate. Following his post doc, Dr. Majumdar
joined Unilever R&D and he has been working on various aspects of infection biology, hygiene, and skin health and
immunity

61
Infection 2024

Anastasiia Panova*, Igor Derevich

Faculty of Fundamental Sciences, Department of Applied Mathematics, Bauman
Moscow State Technical University, National Research University of Technology,
Moscow, 105005, Russia

Initial SARS-COV-2 infection in a group of individuals with their social

behavior

C OVID-19 type virus infection in a group of individuals results from the uptake by the lungs of these
individuals of virions from the local atmosphere created by infected members of the group. The
concentration of virions is determined by the social activity of group members and the stage of disease
development in infected members. For example, in the case of panic, increased numbers of people near
exits can significantly elevate the concentration of virus microparticles in the atmosphere and lead to
infection of a significant number of group members. The presence of socially attractive areas or localized
areas within a room that are dangerous to visit also contributes to the active spread of infections. It is
important to be able to predict the dynamics of primary infection in order to evaluate different scenarios
of disease development after evacuation of people from the danger zone.

Scientific Objective: Creation of a simulation model that predicts the evolution of viral infection in the
human body during the period of movement in a group taking into account social behavior and after
leaving an area with polluted atmosphere. Estimation of the probability of serious disease progression
after evacuation from a danger zone or natural degeneration of the virus in the organism depending on
the level of initial immunity. Predicting health care need and vaccination efficacy based on disease stage.

Research Methods: Mathematical cellular microbiological models of pathogen dynamics in the organism,
a macromodel simulating the behavior of a group of individuals in different social conditions and a model
of virus microparticle spreading in a turbulent atmosphere. The modified SARS-CoV-2 microbiologic
model takes into account the level of baseline immunity and the flux of virions into the body from the
local atmosphere. The modified cell model is validated against experimental data from the literature. The
macromodel of the movement of a group of individuals uses modern methods of the theory of random
processes and computer modeling technologies. The results of modeling the social dynamics of a group in
an obstacle course room under different conditions are compared with empirical observations from the
literature.

Research Results: The results of simulation modeling and analysis of different infection scenarios of a
group of individuals including infected and susceptible individuals to COVID-19 are presented. It has
been established that the crucial factor, on which the dynamics of the disease after leaving the zone with
polluted atmosphere depends, is the level of pathogen concentration in the organism at the moment of
evacuation. If the concentration of pathogen in the body is less than the critical level, the virus in the body
will degenerate after leaving the danger zone, if the concentration of pathogen is higher than the critical
level, the disease will be passed in a severe form. The intensity of virus microparticle absorption by the
lungs of an individual depends on the scenario of movement of individuals in a group under different
conditions. For example, during a panic, an increased concentration of individuals near an exit from a room
significantly enhances the probability of absorbing virions with concentrations above a critical value. The
probability of active infection is also much higher if the room has socially attractive or dangerous areas
for people to be in. A methodology has been developed to estimate the proportion of infected individuals

62
Infection 2024

who will have natural viral degeneration or severe disease. The results of simulation modeling of vaccine
administration that reduces the probability of the virus microparticles damage to the target cells of the
organism are presented.

Audience Take Away Notes

• The presentation will demonstrate the practical importance of simulation modeling for predicting the
probability of SARS-CoV-2 infection in a group of individuals in different social situations
• The results of the study can be used in the development of restrictive measures to reduce the risk of
infection of groups of individuals in places of entertainment, supermarkets, educational institutions,
etc
• The methodology of a unified mathematical description of microprocesses occurring at the cellular
level and macro-processes of movement of groups of individuals in different social conditions can
serve as a new element of education in the course of bioinformatics
• Estimating the fraction of infected people who are more likely to develop the disease after evacuation
from an infected area will enable estimates to be made of the number of vaccines, the medical care
necessary, and the required police response
• The results of simulation modeling of the movement of a group of people in a room with internal
obstacles will allow to evaluate design specifics and recommendations during evacuation to reduce
the possible proportion of infected people with a severe course of the disease after leaving the danger
zone
• Other benefits
o If mathematical models of other viral infections are available, the proposed modeling methods can be
used to predict the dynamics of disease dynamics in persons who have left the territory with polluted
atmosphere. In addition, the proposed approach can be used in assessing the risks of terrorist acts
using biologically active substances
Biography

Panova A. A. studied Applied Mathematics at the Bauman Moscow State Technical University and graduated as MS in
2019. Now she is postgraduate student of BMSTU and currently preparing to defend her PhD on the topic “Mathematical
modeling of the spread of viral infections in groups of people taking into account their social behavior”. During her
scientific career, more than 20 articles were published, included in the RSCI, WoS, Scopus. Also Panova took part in 10
international conferences held in Moscow, Novosibirsk, Saratov, as well as in Greece, Spain and the Republic of Belarus.

63
Infection 2024

Andressa Giusti1*, Dalinda Eusebio1, Milan Paul2, Swati Biswas2,

Zhengrong Cui3, Diana Costa1, Angela Sousa1
1
CICS-UBI - Health Sciences Research Centre, University of Beira Interior,
Covilha, Portugal
2
Nanomedicine Research Laboratory, Department of Pharmacy, Birla Institute
of Technology and Science-Pilani, Hyderabad Campus. Jawahar Nagar, Medchal,
Hyderabad 500078, India
3
The University of Texas at Austin, College of Pharmacy, Division of Molecular
Pharmaceutics and Drug Delivery, Austin, TX 78712, United States

Evaluation of two minicircle DNA vaccines encapsulated in peptide

nanoparticles against HPV-16

I nfection with the Human Papilloma Virus (HPV) is known as the main cause of the development of several
types of cancer, especially cervical cancer. Due to the presence of oncoproteins, mainly E6 and E7, in
HPV-16 and HPV-18 strains, this virus has a great capacity to suppress apoptosis and stimulate abnormal cell
proliferation and angiogenesis, which contributes to the malignant transformation of cervical epithelium
cells.

Until now, the only available option to avoid cervical cancer is the prevention of the HPV infection, but
commercial prophylactic vaccines cannot treat an established cancer. DNA vaccines encoding HPV
oncoproteins genes have been promising approach, due to numerous advantages such as stability, cost-
effectiveness and mainly the potential to activate immune system pathways that can lead not only to the
prevention of infection but also to the specific elimination of cancer cells as a therapy.

Therefore, the aim of this work is to evaluate the delivery of two nanovaccines against HPV-16 formulated
with peptides nanoparticles to Antigen Presenting Cells (APCs). This work explored two different delivery
systems based on RALA (a cell-penetrating peptide), functionalized with octa-arginine mannose (R8M)
to encapsulate two minicircle DNA (mcDNA) vectors: one encoding the E6 mutated oncoprotein alone
(mcDNA/E6mut), and a multigenic vector with both E7 and E6 mutated oncoproteins (mcDNA/E7-E6mut)
of HPV-16. For comparative purposes, two different systems were evaluated: RALA and RALA-R8M. The
systems were prepared at various Nitrogen-to-Phosphate group (N/P) ratios and characterized in terms
of size, Polydispersity Index (PDI), surface charge, morphology and encapsulation efficiency. Moreover,
the systems stability was evaluated after incubation in 10% FBS and MEM-α medium. In vitro transfection
studies of dendritic cells (JAWS II) were performed, along with viability studies for 24 and 48h to ensure the
biocompatibility of all nanocarriers.

Delivery systems encapsulating mcDNA/E6mut presented sizes of 87.05 nm (± 8.16) and 101.79 nm (± 17.94),
PDI of 0.234 (± 0.03) and 0.253 (± 0.04) and surface charge of -7.49 (± 0.19) and -12.35 (± 0.42) for RALA and
RALA/R8M, respectively. For the multigenic vector, the results were in the same order 106.73 (± 12.07) and
132.77 (± 20.54), 0.294 (± 0.03) and 0.292 (± 0.05), -13.25 (± 2.88) and -12.71 (± 3.09). RALA systems have a
spherical shape, with a smoother morphology due to the addition of R8M. Encapsulation efficiencies for all
nanovaccines were above 99%.

The systems showed stability in the presence of 10% FBS and MEM-α medium and biocompatibility after
transfection of JAWS II cells. Regarding the E6 expression, both vectors encapsulated with RALA/R8M
demonstrated the highest levels of transcripts in JAWS II cells, with no statistical differences between them.
Mannosylated systems have shown promise in delivering mcDNA to APC cells, but with a multigenic vector is
expected to induce a stronger and more complete immune response against HPV-16 virus. At this moment, the
RALA mannosylated system containing mcDNA/E7-E6mut is under studies to convert the nanovaccine into
a dry-powder by the Thin-Film Freezing (TFF) technique, aerosol performance and intranasal administration
in animals.

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Infection 2024

Audience Take Away Notes

• The audience will learn about the advantages of using minicircle DNA vaccines as a preventive and
therapeutical approach against HPV-16
• The advantages of exploring the use of cell-penetrating peptides, such as RALA, in DNA vaccines
• The applications of mannosylated delivery systems to improve the targeted distribution of these vaccines
to APCs
• This work can clarify some of the techniques used in the production of DNA vaccines on a small scale, but
with cost-benefit and easy reproducibility
• The advantages of converting a liquid vaccine into dry powder using the Thin-film freezing technique
Biography

Andressa Giusti graduated in biology from the University of Vale do Itajai, Brazil in 2020 and is currently a master's
student of Biomedical Sciences at the University of Beira Interior, Portugal. Before moving to Portugal, she worked in
research and clinical practice in the area of Assisted Reproduction and taught Biology in secondary education. During
her master, she joined the research group of Prof. Angela Sousa at CICS-UBI at the Faculty of Health Sciences and is
currently a research fellow within the Research Project DryVac, which is currently being carried out at the University
of Texas at Austin (USA).

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Infection 2024

Ludena Angelica*, MD; Negron Merliz, MD; Cruz Kattya, MD;

Colon Melba, MD; FACP, FIDSA
Universidad Central del Caribe, Puerto Rico

Is plasmapheresis the future treatment for leptospirosis? Case report

of a 75-year-old patient with complete recovery after plasmapheresis
therapy

L eptospirosis is a zoonotic disease produced by spirochetes of Leptospira, with an incidence ten times
higher in tropical regions like Puerto Rico, in comparison to the rest of the world. The principal
reservoir are rats, dogs, cats and farm animals with excreted infected urine, contaminated soil or water
that produces the disease through direct contact of broken skin, mucosa or conjunctivas. During the first
infective phase, Leptospira are found in blood and cerebrospinal fluid and the course is asymptomatic,
followed by an immune phase where Leptospira are excreted in the urine. Ten percent or less progress to
septic shock and multi-organ dysfunction (Weil’s Disease) presenting with acute kidney injury, pulmonary
hemorrhage, Acute Respiratory Distress Syndrome (ARDS), bleeding diathesis, impaired hepatic functions,
jaundice, thrombocytopenia, circulatory collapse or even death.

This is the case of 75-year-old female with major depressive disorder with psychotic features, who arrived
with fever of 400 C, decreased appetite and lower extremities myositis, who practiced daily farming and
rose gardening and had direct contact with horses, cats, dogs and recently found dead animals. Upon
admission, the patient was acutely ill, awake, alert, oriented and was tachycardic, with a blood pressure of
84/50 mm Hg, and a negative Tourniquet test. Within 24 hours, marked deterioration was noted and she
was admitted to intensive care unit (ICU) for suspected leptospirosis and viral syndrome. Acute Kidney
Injury (AKI), sepsis, leukocytosis of 14,500 10^3/uL, moderate thrombocytopenia, elevated transaminases,
hyperbilirubinemia, severe dehydration, and moderate hyponatremia developed, therefore empiric
intravenous antibiotic was started. After four hours in the ICU, she was intubated and thirty six hours
later developed ARDS and pulmonary hemorrhage. Jaundice, increased leukocytosis of 24.5K, severe
thrombocytopenia of 29K, elevated liver enzymes and AKI stage 3 were present, therefore hemodialysis
was started. By day eleven Leptospira DNA PCR was confirmed. During hospitalization, a total of seven
plasmapheresis, six hemodialysis, one fresh frozen plasma, seven platelet transfusions, and three packed
red blood cell transfusions were given. By day ten, after clinical and renal improvement the patient was
extubated successfully.

Plasma exchange may interrupt the mechanisms causing tissue damage in severe sepsis. Renal injury in
leptospirosis might be caused by activation of Toll-Like Receptors (TLR) 2 and 4 by Lipopolysaccharides
(LPS) causing interstitial edema and a tubulointerstitial nephritis with cellular infiltrate. Also, lung injury
is thought to be induced by deposition of IgM, IgA, IgG and C3 in the alveolus. The outer membrane of
Leptospira shares characteristics of both Gram-positive and Gram-negative bacteria and the binding of
LPS to TLR4 on the surface of B lymphocytes results in the activation of B-cells and the production of IgM
against the LPS of Leptospira. Activation of B-cells and T-cells, which promote the killing of Leptospira,
also produces pro-inflammatory cytokines and tissue inflammation. Plasma exchange may prevent immune
complex-mediated tissue injury.

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Infection 2024

As a result, anytime a patient with septic shock and multi-organ failure with a history of dead animals or
suspected infected water contact is revealed, leptospirosis should be considered, and plasma exchange
could be the preferred therapy.
Biography

Angelica M. Ludena De Freitas, Medical Doctor PGY-1 at Internal Medicine Residency, ACGME accredited program
Universidad Central del Caribe, Puerto Rico. She is graduated from Universidad Autonoma of Guadalajara Jalisco
Mexico and did her Internship at Hospital Auxilio Mutuo San Juan, Puerto Rico and she is originally from Lima, Peru.
Angelica M. Ludena De Freitas recently won 1st place at American College of Physicians Annual Oral Presentation
Puerto Rico.

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Infection 2024

Dr. Anil Budania1*, Dr. Kumar S Abhishek2, Dr. Sarika Kombade2,

Dr. Naveen K H3, Dr. Gautam Ram Chaudhary4, Dr. Charu Sharma5,
Dr. Akriti Agrawal6
1
Department of Dermatology, Venereology & Leprology, All India Institute of
Medical Sciences, Jodhpur, Rajasthan, India
2
Department of Microbiology, All India Institute of Medical Sciences, Jodhpur,
Rajasthan

3
Department of Community Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
4
Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
5
Department of Gynaecology & Obstetrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan,
India
6
Department of Dermatology Venereology & Leprology, JIPMER, Puducherry, India

A new insight in the clinical profile of Indian patients of urethritis and

cervicitis with the help of molecular characterization of the causative
organisms
Introduction: Urethritis and cervicitis, in the majority of cases, are caused by sexually transmitted agents.
They presents as discharge, pain, burning sensation but sometimes the patient may remain asymptomatic.
Neisseria gonorrhoeae (Gono-coccal) and chlamydia trachomatis (Non-gonococcal) are considered
classical causative organisms of urethritis and cervicitis in developed and developing world respectively.
Other causes are Mycoplasma genitalium, Ureaplasma Urealyticum, Trichomonas vaginalis and Herpes
simplex etc. Number of newly diagnosed urethritis and cervicitis cases are increasing worldwide leading
to many complications like prostatitis, epididymitis, pelvic inflammatory disease and infertility. Non-
gonococcal urethritis and cervicitis cases are difficult to diagnose because of minimal visible discharge.
Treatment is done with empirical antibiotics when the causative organism cannot be isolated. So basically
urethritis and cervicitis are difficult to diagnose and treat which may lead to significant morbidity specially
in the developing countries.

Objectives: To study the profile of patients presenting with symptoms of urethritis and cervicitis and to
elucidate the various etiologic agents.

Methodology: Patients within 15-45 years (both sexes) with history of urethral or cervical discharge,
dysuria and dyspareunia were included in the study. Urethral or cervical samples were collected with the
help of dacron swabs for multiplex real time polymerase chain reaction analysis of Neisseria Gonorrhoeae,
Chlamydia Trachomatis, Mycoplasma Hominis & Ureaplasma Urealyticum.(TRUPCR STD Panel kit 3B
BlackBio Biotech India Ltd.

Results: A total of 70 patients were included and analyzed. Analysis was done using the SPSS version 21 for
Windows (Chicago, Illinois, USA). Out of 70 patients, 64.3 % were female and 35.7% were male. Around 59%
patients were in the age group of 18-30. Around 15.7 % had history of multiple sexual partners. PCR showed
positivity for Ureaplasma urealyticum in 37.7%, Neisseria gonorrhoea in 15.9%, Chlamydia trachomatis
in 10.1 %, Trichomonas vaginalis in 5.8 % cases. Rest of the samples showed mixed growth of multiple
organism including Gardnerella Vaginalis and HSV 2.

Discussion: Prevalence of urethritis/cervicitis is increasing worldwide and it varies around the globe.
Especially the drug resistance strains of various gono-coccal and non-gonococcal pathogens are
growing. Empirical treatment without knowing the exact pathogen can lead to persistent infection and
complications. NAAT and species specific PCR test are recommended to decide etiology based treatment.

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Infection 2024

We found Ureaplasma urealyticum as the major pathogen causing urethritis and cervicitis. This is in
contrast to western data where we see chlamydia as the major pathogen Though initially considered as
commensal, Ureaplasma urealyticum is considered a significant pathogen causing persistent urethritis and
cervicitis after 1950 AD. This is in contrast to western data where we see chlamydia as the major pathogen.
Significant numbers (40%) had mixed infections also. So we wish to emphasize the role of PCR and etiology
based regimen in the management of urethritis and cervicitis.

Audience Take Away Notes

• Urethritis and cervicitis cases are increasing worldwide and causing significant morbidity
• Microbiological profile of urethritis and cervicitis is changing and non-gonococcal organisms are
leading in developing world (India) also where we usually follow syndromic management
• PCR and then etiology based management can help in reducing the number as well as complications
of urethritis and cervicitis
• This study can help to plan further research not just in the field of Dermatologuy but also in Microbiology,
HIV medicine, Urology, Gynaecology and obstetrics etc
• More simplified, user friendly and cost effective PCR kits to diagnose multiple organism can be devised
Biography

Dr. Anil Budania studied Dermatology and Sexually transmitted infections at PGIMER Chandigarh and received his
post-graduation degree in Dermatology, Venereology & Leprology. Then he joined VMMC & Safdarjung Hospital which
is a premier institute for STI and HIV medicine in India. He joined AIIMS Jodhpur in 2017 as Assistant Professor and
promoted to the post of Additional Professor in July 2023. This study is the product of an intramural institute funded
project on sexually transmitted infections. Apart from STI, his area of interests is superficial cutaneous fungal infection.
He has published more than 40 research articles in pubmed indexed journals.

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Infection 2024

Anju Kaushal, PhD

Auckland, New Zealand

RNA interference, its applications and benefits

T he activation of double stranded interference RNA occurring in the host cell is a natural phenomenon
to control the over transcriptional effects of genes that could suppress the translational patterns. This
genetic ability is currently being exploited in making the medicines to suppress the lethal post-translational
effects as an outcome of aberrant or disease related genes. This revelation has been made to treat those
inherent diseases were rendered untreatable in the past. RNAi therapeutics silence the lethal/adverse effects
of a gene function. The modulation of siRNA can be brought by changing some chemical patterns in RNA
chains. The phosphorylation and off target effects are greatly reduced during phosphonate modifications,
ribose sugar effects and base substitutions. Additionally, these modifications are likely to control the immune
stimulation and hyper activation of the innate response. The universal pattern and advanced patterns have
been used in various therapeutics. The heavy modifications in the anti-sense & sense strands are used using
2-OMe, L-DNA, UNA, N-acetyl glucosamine etc. Innate immune regulations can be established through TLR
receptors’ signaling, but PKR and RIG are also capable to carry out the IFN induction in the absence of TLR
sensors. This presentation will walk us through the immune modulation of siRNAs to reduce toxicity and
regulate the innate and adaptive immune response to produce the favorable effects.

Audience Take Away Notes

• The audience will learn about siRNA medicines and how this mechanism can be explored for various
medicines
• This presentation will provide the insights of novel therapeutics and their involvement to establish the
protective immune response.
• It is evidence-based research, thus, providing a practical solution to a problem that could simplify or
make a designer’s job more efficient
• It improve the accuracy of a design, or provide new information to assist in a design problem
• Other benefits
o This is an advanced novel field of research
o These medicines can be utilized to treat various gene related diseases and other infectious diseases
o These therapeutics give hope to people who suffer from untreatable diseases
o Besides, this emerging field open the door for many other opportunities to use these modalities to
make medicines and diagnostics
Biography

Dr. Anju Kaushal is PhD in Science from Panjab University. She is a current-member of NZOQ and a Research Topic
Coordinator–Frontiers in Antibiotics. She worked on Rabies, Aspergillus, Candida, HIV, enzymes, fermentation
technologies etc. Her areas of interest include vaccines, sera, diagnostics and novel therapeutics. Her expertise is
in R&D, Productions and Quality in biologicals, diagnostics and academia, including marketing, information and
communications, and small business management. She has assisted many scientists in their careers. She has authored
15 articles in peer reviewed journals, published >40 articles on LinkedIn, and peer reviewed a variety of research
around the globe.

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Infection 2024

Ilhem Berrou1, Laura Hobbs2, Sue Jones3, Sian Hughes4, Anne

Morris5*, Thomas Manning6, Hannah Bailey3
1
College of Health, Science and Society, University of the West of England,
Bristol, United Kingdom
2
Science Communication Unit, School of Applied Sciences, College of Health,
Science and Society, University of the West of England, Bristol, United Kingdom
3
Bristol, North Somerset and South Gloucestershire Vaccination programme,
North Bristol NHS Trust, Bristol, United Kingdom
4
Insights and Public Engagement, Bristol, North Somerset and South Gloucestershire Vaccination
Programme, North Bristol NHS Trust, Bristol, United Kingdom
5
Bristol, North Somerset and South Gloucestershire Integrated Vaccination Programme, North Bristol
NHS Trust, Bristol, United Kingdom
6
Business Intelligence (Transformation), NHS Bristol, North Somerset and South Gloucestershire
Integrated Care Board, Bristol, United Kingdom

Implementing the COVID-19 vaccination programme in the Southwest of

England: Lessons from a normalisation process theory perspective
Background: Vaccination remains one of the most successful public health interventions in preventing
severe disease and death. The roll-out of Covid-19 vaccination programmes has helped protect billions of
people around the world against Covid-19. Most of these programmes have been unprecedented in terms
of scale and resources, and have been implemented at times of significant humanitarian crisis. This study
aims to outline the lessons learnt from the implementation of a regional Covid-19 vaccination programme.
These will help inform emergency preparedness and future crisis management.

Methods: This qualitative study sought to explore the key drivers to the successful implementation of
the Covid-19 vaccination programme in a region in the Southwest of England, applying the Normalisation
Process Theory lens (NPT) to examine multi-stakeholder perspectives. Data collection involved semi-
structured interviews with 75 participants. Document analysis was also used to corroborate the findings
emerging from the interviews. Inductive thematic analysis of the data was used to identify the key drivers
for the successful implementation of the programme. The NPT lens was then applied to map the themes
identified to the domains and constructs of the framework.

Results: Ten key drivers to the successful implementation of the Covid-19 vaccination programme
locally were identified. These include the clarity and consistency of the programme’s goal; the diverse
representation of stakeholders within the programme leadership team and the mechanisms created
by this team to ensure psychological safety, autonomy, operational flexibility and staff empowerment;
Communication and data specialists’ input, and collaboration with local communities to maximise the
reach of the programme; and allocating funding to tackle health inequalities.

Conclusions: This study highlights the lessons learnt from the implementation of the Covid-19 vaccination
programme at a local level, and the mechanisms that can be used in future crises to respond efficiently to
the needs of individuals, communities and governments.

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Infection 2024

Audience Take Away Notes

• This paper provides a blueprint for responding to a crisis and how to achieve the necessary goals
• The study provides information which will enable colleagues to develop emergency preparedness and
organizational resilience
• Audience will be informed of the key drivers to success and how this can be transferable
• The study provides practical solutions describing how data was used extensively to reinforce targeting
of activity and the roles played by communications and insight in support of this
• The study also describes the importance of creating a skilled team and how asset based community
development was used to tackle health inequalitie
Biography

Anne Morris is an experienced senior nurse and leader who has worked in many roles within the local health system.
She qualified as a registered general nurse in 1984 and then went on to study renal nursing and gained an MSc in
Leadership and Management at Bath Spa University in 2010. Anne has presented papers at national and international
conferences.

72
Infection 2024

Anupma Harshal W.1*, Anand Sharma2, Ashwini Nandoskar3, Dr. N.

Baratha Jyothi4
1
Woman in STEM, Consultant -Science Communication & Public Engagement,
India
2
Consultant Medical Oncologist, Mount Vernon Cancer Centre, London, United
Kingdom
3
Neurologist, Imperial NHS Healthcare and The Hillingdon Hospitals, London,
United Kingdom
4
Assistant Professor in Zoology, Department of Zoology, Maris Stella College
(Autonomous) Vijayawada, AP, India 520008

Awareness of antimicrobial resistance evaluating the impact of a

foldscope based workshop
Background: Antimicrobial Resistance (AMR) is a global public health concern that threatens the
effectiveness of antibiotics and other antimicrobial drugs. As a result of drug resistance, antibiotics and
other antimicrobial medicines become ineffective and infections become difficult or impossible to treat,
increasing the risk of disease spread, severe illness, disability and death. It is imperative to address this
issue by increasing awareness and knowledge among young adults, as they are a crucial demographic in
shaping future healthcare practices.

Purpose: This study aims to evaluate the effectiveness of a hands on workshop on spreading awareness
of antimicrobial resistance. The workshop aimed to educate the students about the importance of
understanding different types of cells and microorganisms, their interactions and co-existence. Thus
assess the impact of the workshop on participants' knowledge related to microbes, infections caused by
microbes, and antimicrobial resistance.

Methodology/Approach: A portable paper folding microscope, Foldscope was used to enable the students
explore the microflora around them. Using the tool, students gained a better understanding of different
types of cells by making observations. The samples included the onion cell, potato cell, pollen grains,
squamous epithelia and more. These observations helped them explain various sources of fever, that
include bacteria, viruses, fungi, and parasites. An online survey link was sent to all the participants to
assess changes in self-reported knowledge and behavior (outcomes) following the workshop, that included
questions about the causative agents of fever, the remediation of fever, consuming antimicrobials without
a prescription, and having leftover formulations. Of the 400 students who attended the workshop 60 %
responded, 93.58 % participants' felt confident in using a microscope effectively, 82% responded that the
experience bettered their understanding of microbes and their knowledge about antimicrobial resistance.
A significant number 82.57% felt their likelihood of incorporating the workshop's content into their life as
caregivers.

Findings: The dataset incorporates responses from individuals across various demographics, providing
insights into the level of understanding and perception regarding AMR. The analysis of survey responses,
aims to identify key factors influencing awareness, such as educational background, geographic location,
and access to healthcare resources. The findings reveal varying degrees of awareness among the surveyed
population, highlighting potential gaps in knowledge that need attention. Additionally, the study investigates
the impact of media, educational campaigns, and healthcare professionals in shaping public awareness
and understanding of AMR. The results of this research contribute valuable information for policymakers,
healthcare professionals, and public health organizations to design effective strategies aimed at enhancing
awareness and promoting responsible antimicrobial use. Addressing gaps in knowledge is crucial in the
global effort to combat the growing threat of antimicrobial resistance and preserve the effectiveness of
existing antibiotics.

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Infection 2024

Conclusion: This study contributes to the literature by evaluating the effectiveness of these workshops on
spreading awareness of antimicrobial resistance among young adults. The findings highlight the workshop's
positive impact on participants' knowledge and skills, indicating its potential value in promoting awareness
and understanding of antimicrobial resistance. It emphasizes the importance of incorporating hands-on
activities and interactive sessions to enhance participants' learning experience and skills development.

Audience Take Away Notes

• The audience will be able to plan hands-on training sessions for young adults using a low cost tool
(Foldscope), if we want to augment the outreach/impact of AMR to young adults. They will learn
practical skills in microscopy, sample preparation, and data interpretation. Participants will understand
the relevance of anti-microbial resistance (AMR) and how microscopic analysis can contribute to
identifying potential microbial threats
• Understanding AMR through practical applications will empower healthcare workers to make informed
decisions on antibiotic usage, contributing to more effective treatment strategies
• The hands-on approach fosters an engaging learning environment that can be adapted for different
educational levels, from high schools to universities
• The Foldscope, being a cost-effective and portable tool, can simplify the process of microbial analysis,
making it accessible in various settings
• The workshop can enhance the accuracy of designs related to medical diagnostics, environmental
monitoring, and other fields where microbial analysis is crucial
• Other benefits
o Increased Awareness: Participants will gain a deeper understanding of the global issue of
antimicrobial resistance and its implications
o Community Engagement: The workshop fosters community involvement and awareness, potentially
leading to collaborative efforts in addressing AMR
o Skill Development: Attendees acquire valuable skills in microscopy, sample preparation, and data
interpretation, which can be applied in diverse professional settings
o Interdisciplinary Collaboration: The workshop encourages collaboration between professionals
from different fields, fostering a holistic approach to addressing AMR
o Cost-effectiveness: The use of Foldscopes makes microscopy more affordable and accessible,
especially in resource-limited settings
Biography

Dr. Anupma Harshal W. is a high-achieving teacher, mentor who has steered Under Graduate Research, engaging
students in research projects. She has a Ph.D. in BIochemistry from Mumbai University, a collaboration between
Hindustan Unilever Research Centre, National Centre for Cell Science and B.Y. Nair Hospital & Topiwala Medical College.
As a woman in STEM she has 28 research projects with Undergraduate students at Kishinchand Chellaram College,
Mumbai University of which 11 have received funding from the Ministry of Science & Technology, Mumbai University,
U.G.C., and other private labs. She is a certified trainer for STEM teachers training on Research-Based Pedagogy
and an avid Foldscoper. She uses the tool to explore the microscopic world conducting Awareness of Antimicrobial
Resistance workshops in schools pan India. Have been a reviewer for several International Journals and have also
reviewed a few books on Pedagogy. She has contributed to the coursework for M.B.A. program in Sanitation & Hygiene,
Waste Management, WASH & Nutrition by MGNCRE, MHRD, and two books on Foldscope and its applications. She
has contributed to several Govt. of India Projects as a Consultant on Biocuration, Scholarships, Public engagement
and Science Communication. She travels pan India and conducts Awareness of Anti-Microbial Resistance workshops,
raising funds for the same.

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Infection 2024

Dr. Aparna M. Menon1*, Dr. Danish Ekkalayil2, Dr. Jayachandran N.

V3
1
Junior Resident, Department of General Medicine, Government Medical College
Kozhikode, Kerala, India
2
Assistant Professor, Department of General Medicine, Government Medical
College Kozhikode, Kerala, India
3
Professor, Department of General Medicine, Government Medical College
Kozhikode, Kerala, India

Unraveling a case of tubercular thyroiditis presenting as thyrotoxicosis

Introduction: Tuberculosis is chronic infection caused by mycobacterium tuberculosis and primarily
attacks the lung. Tuberculosis of thyroid gland is an uncommon entity as the gland is resistant to infection
due to bactericidal property of colloid high iodine content and extensive vascularity.

We hereby present the case of 34 year old male who presented to us with fever, loss of weight and tremors
of both upper limbs for past 2 months. Fever was intermittent with one to two spikes per day associated
with evening rise of temperature and night sweats. He gave history of significant weight loss of around 7kg
loss over past 2 months which was associated with loss of appetite. He also had tremors of both the hands
which aggrevated on activity that affected his daily routine life. His past history was unremarkable. On
examination he had pallor cervical and axillary lymphadenopathy and anterior neck swelling moving with
deglutition and had tachycardia. Systemic examination revealed hepato-splenomegaly. On investigating
he had anaemia with elevated ESR. Thyroid function test revealed low tsh and elevated ft4 suggestive of
hyperthyroidism, ultrasonography of neck was suggestive of thyroiditis and initial FNAC showed Bethesda
category 2. Whole body Pet-Ct scan revealed bulky right lobe of thyroid gland and increased metabolically
activity in axillary, gastrohepatic, perigastric, paratracheal lymphnodes and segment 6 and 8 of liver.
Histopathological examination of axillary lymph node revealed sinus histiocytosis and thyroid gland
revealed multiple caseating granulomas consistent with tuberculosis. Patient was hence diagnosed as case
of tubercular thyroiditis presenting as thyrotoxicosis with disseminated tuberculosis and was initiated on
antitubercular drugs.

Discussion: Tuberculosis is endemic in India and can affect any organ of the body Tubercular involvement
of thyroid gland maybe either primary or as a part disseminated disease process in immunocompromised
individuals and most cases are euthyroid. Tuberculosis of thyroid gland should be considered in differential
diagnosis when evaluating a thyroid nodule especially in presence of lymphadenopathy organomegaly and
anemia with elevated ESR and should be extensively evaluated.
Biography

Dr. Aparna M Menon, completed her MBBS from MVJ Medical College Karnataka and is currently doing Internal
Medicine Residency in Government Medical College Kozhikode.

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Infection 2024

Arjun Chadha*, Anthony Ognjan

Michigan State University, United States

Ocular syphilis with concomitant neurosyphilis and tuberculosis: A case

report

S yphilis is a venereal or vertically transmitted infectious disease caused by Treponema pallidum, a

corkscrew shaped, motile spirochete. It generally progresses via stages and, if left untreated, can result
in devastating cardiovascular and neurological sequelae.

Ocular syphilis refers to infectious inflammation within any portion of the eye. It typically results in uveitis,
but can also cause optic neuropathy, retinal vasculitis and interstitial keratitis. It presents as diminished
visual acuity and delayed treatment may result in permanent vision loss. Similar to neurosyphilis, ocular
syphilis can occur during any infectious stage.

Towards the end of the 20th century, significant progress in syphilis prevention resulted in an all time
low prevalence in high income countries, such as the United States. This rare complication only had an
annual incidence of 0.3 cases per million adults between 2009 to 2011. However, there have been concerns
of increased prevalence in syphilis in the past decade. The prevalence of syphilis complications has also
increased during this time span, including ocular syphilis. This trend is consistent globally, with noteworthy
data arising from Europe, North America, and South America. In 2016, the World Health Assembly adopted
a strategy with the intention to reduce the incidence of global syphilis by 90% from 2018 to 2030.

We present a rare case of ocular syphilis in a 61 year old, immunocompetent male. The patient’s ocular
syphilis manifested as left chorioretinitis, resulting in progressive monocular vision loss. The patient cited
concerns for memory loss, and lumbar puncture confirmed concomitant neurosyphilis. His condition was
complicated with latent tuberculosis. Administration of penicillin resulted in improvement of symptoms.

This report highlights the reemergence of ocular and neurosyphilis. Emphasis should be placed on
appropriate identification of ocular syphilis in a timely manner. In doing so, swift antibiotic management
can subsequently prevent morbid visual and neurological sequelae.

Audience Take Away Notes

• Recognize the increasing prevalence of Syphilis on the global scale and its feared complications
• Understand the management of Ocular Syphilis and Neurosyphilis to facilitate early treatment
• Emphasize the importance of documenting cases of Syphilis to facilitate its proper surveillance
• Increase visibility on the lack of research revolving syphilis complications
Biography

Dr. Arjun Chadha graduated with Honors distinction from Wayne State University with a B.S. in Biological Sciences.
During this time, he worked meticulously on basic biophysics research. He received his M.D. at Michigan State
University College of Human Medicine (MSU-CHM). He pursued a residency program with Michigan State University
College of Osteopathic Medicine (MSU-COM) at McLaren Macomb, allowing him to focus on clinical medicine by
accessing a wide array of pathologies. His professional passions include medical education and personal interests
include dancing.

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Infection 2024

Ashley Zhou1*, Ayesha Samreen2, Matthew J. Thoendel2

1
Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States
2
Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, United States

An unusual case of multidrug-resistant Klebsiella pneumoniae and

vancomycin-resistant enterococcus faecium skin and soft tissue
infection in an immunocompromised host

S kin and Soft Tissue Infections (SSTI) represent an uncommon source of infection (<10%) in patients with
persistent or recurring fever and neutropenia. Worldwide, the prevalence of immunocompromised
hosts is increasing even as the incidence of gram-negative and of Multidrug-Resistant (MDR) SSTI are also
increasing, exacerbating existing challenges in treating infection in neutropenic patients.

A 43-year-old male with B-cell Acute Lymphoblastic Leukemia (B-ALL) (on treatment with R-hyper-CVAD
[rituximab, cyclophosphamide, vincristine, doxorubicin, dexamethasone] with intrathecal cytarabine) and
schizophrenia (on multiple psychiatric medications) presented with neutropenic fever. He had a history
of three MDR Klebsiella pneumoniae bloodstream infections within the last six months alone. Indeed,
his blood cultures were positive for Klebsiella pneumoniae again and meropenem was started, with
therapeutic drug monitoring used to optimize dosing. The source, however, remained unclear. CT of the
chest, abdomen, and pelvis was unremarkable. An echocardiogram performed to evaluate for endocarditis
revealed neither vegetations nor valvular changes. He continued to be febrile and vancomycin therapy was
added empirically.

Then, the left gluteal lesion that had been present on admission ruptured and began draining purulent
material. The abscess itself had an unusual appearance with dark purple coloring, initially suggestive
of ecthyma gangrenosum. Bedside incision and drainage was performed. However, the surrounding
erythema and induration continued to progress even after presumed source control. Empiric antifungal
therapy was considered but deferred given the potential interactions with both his chemotherapy and
antipsychotic medications. Vancomycin was switched to daptomycin, and he was taken to the operating
room for surgical exploration of the abscess. Intraoperative deep tissue cultures ultimately grew both
MDR Klebsiella pneumoniae and vancomycin-resistant Enterococcus faecium. Both meropenem and
daptomycin were continued and he improved clinically. For the management of his B-ALL, in order to avoid
future neutropenia, he was switched from chemotherapy to bispecific T-cell engager therapy.

We present a case of a mixed MDR SSTI in an immunocompromised host, with SSTI as a presumed source
of recurrent gram-negative bloodstream infection. Both Klebsiella pneumoniae and Enterococcus faecium
are uncommon culprits in SSTI. Broad-spectrum antibiotics, source control, and species identification
were critical in managing infection in an already vulnerable host.

Audience Take Away Notes

• We present a case of a mixed multidrug-resistant skin and Soft Tissue Infection (SSTI) in an
immunocompromised host causing recurrent gram-negative bloodstream infection. Both Klebsiella
pneumoniae and Enterococcus faecium are uncommon culprits in SSTI
• Therapeutic drug monitoring is a useful tool, with antimicrobials such as meropenem, to optimize drug
dosing

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Infection 2024

• Skin and Soft Tissue Infections (SSTI) represent an uncommon source of infection (<10%) in patients with
persistent or recurring fever and neutropenia. However, given the increase in immunocompromised
hosts worldwide and the increase in co-morbidities such as obesity and diabetes, consider SSTIs as a
source in a patient with persistent or recurring fever
Biography

Ashley Zhou, M.D. studied Neuroscience at Duke University for her undergraduate degree and graduated with a B.S. in
2019. She went on to study at the Johns Hopkins University School of Medicine for her medical training and received
her M.D. in 2023. She is currently undergoing residency training in the Department of Ophthalmology at the Mayo
Clinic in Rochester, Minnesota.

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Infection 2024

Aung Sitt Naing1*, Harrison Dai2, Abby Hargis2, Catherine Derber3

1
Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia
2
Medical Student, Eastern Virginia Medical School, Norfolk, Virginia
3
Infectious Diseases, Eastern Virginia Medical School, Norfolk, Virginia

An unexpected twist under the microscope: Schistosomiasis

masquerading as endometriosis
Introduction: Schistosomiasis is a parasitic infection endemic to Asia, Africa, and South America, and can
be an unusual cause of pelvic pain in women. Due to similar symptoms with endometriosis, the diagnosis
is often missed in regions of the world where Schistosomiasis is uncommon. We present a rare situation
with longstanding schistosomiasis due to a misdiagnosis and delayed treatment.

Case Presentation: A 24-year-old woman presented with chronic pelvic pain, dysmenorrhea, and
dyspareunia. She had no prior history of sexually transmitted infections. She had no fever, urinary
symptoms, irregular menstrual cycles, vaginal bleeding or discharge. Her pelvic exam was notable for
tenderness on the right uterosacral ligament with a 1-2 cm nodule. Diagnostic laparoscopy revealed a small
amount of endometrial implants on the anterior cul-de-sac, which was cauterized. She was then prescribed
oral contraceptives. However, her pelvic pain persisted for several months. Pelvic MRI was normal without
any findings of endometriosis. A second laparoscopy demonstrated an enlarged uterus and endometriotic
tissues on the colonic serosa associated with surrounding fibrosis and scarring. Excised tissues were
sent for pathology. Light microscopy of the specimen did not show endometriotic characteristics but a
background of granulomatous inflammation interspersed with calcified Schistosoma eggs, later identified
as Schistosoma mansoni. Upon reviewing her exposure history, she reported spending two months in
Uganda and Rwanda, during which she participated in baptisms in Lake Victoria, about 2 years prior to the
onset of symptoms. Notably, she never had eosinophilia but had an elevated Schistosoma IgG level. She was
started on a 60mg/kg dose of praziquantel over 24 hours together with a course of oral prednisone. She
completed a second dose of praziquantel 4 weeks later. She had two subsequent stool studies which were
negative for ova and parasites. Unfortunately, her pelvic pain did not improve.

Discussion: Schistosomiasis is a chronic parasite infection that is not common in the United States.
Schistosoma mansoni enters the host via the skin, migrates through blood and settles in mesenteric
vessels. It can present as an acute hypersensitivity reaction or a chronic granulomatous inflammation.
The prolonged inflammation and fibrotic changes on laparoscopy due to delay in treatment explain why
this patient did not improve after laparoscopy and anthelminthic therapy. The diagnosis of schistosomiasis
can be made through various approaches including parasite egg-microscopy in urine or stool samples,
parasite antigen, or antibody assays. Praziquantel is the preferred treatment option for Schistosomiasis
with relatively few adverse effects. A second dose is often recommended to kill juvenile worms 3-6 weeks
after the initial treatment. Steroids are sometimes added to reduce the risk of complications related to the
host inflammatory response.

Conclusion: Due to varying clinical manifestations of the disease, diagnosing schistosomiasis can be
difficult or even mistaken for another pathology when it is encountered outside of endemic regions. This
case emphasizes the importance of obtaining a comprehensive exposure history in patients with long-
standing unexplained pelvic pain.

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Audience Take Away Notes

• To increase recognition of untreated Schistosoma mansoni as a potential source of chronic pelvic pain
• To highlight the pathogen’s transmissibility, clinical presentation, and identification on tissue pathology
• To emphasize the potential result of chronicity of pain in cases of delayed treatment
Biography

Dr. Naing finished his medical studies at the University of Medicine, 1, Yangon, Myanmar and graduated in 2019. He
worked as a small group teacher for USMLE Step 1 and Step 2 CK at Kaplan Medical Center, New York and as a clinical
assistance at Essen Healthcare, New York, in 2020. Then, he started his internal medicine residency at Eastern Virginia
Medical School, Norfolk, Virginia, in 2021, and he is in the last year of residency training.

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Infection 2024

Aung Sitt Naing1*, Erin Bartholomew1, Nadeem Inayet2

1
Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia
2
Pulmonary and Critical Care Medicine, Sentara Healthcare, Norfolk, Virginia

Uncharted territory in mycobacterial world: The second reported case of

mycobacterium shimoidei in the United States
Introduction: Mycobacterium shimoidei is a rare, slow-growing nontuberculous mycobacterium, first
isolated in Japan in 1968. Only one case was reported in the United States, out of a total of fifteen cases
reported worldwide. Due to its rarity and the current understanding of its pathogenicity, identifying
predisposing risk factors and providing effective treatment is limited. We present a case of macrolide-
resistant Mycobacterium shimoidei infection causing a cavitary lung requiring surgical resection.

Case Presentation: A 68-year-old male with a history of heavy cigarette smoking and COPD presented with
a six-month-long hacking cough with sputum production, night sweats, weight loss, and malaise. He was
treated with multiple courses of azithromycin for community-acquired pneumonia without improvement.
He had a history of asbestos exposure as a shipyard worker. He did not travel outside of the US and
had no known exposure to TB. Imaging of the chest revealed a complex left upper lobe cavitary lesion
with surrounding consolidation and nodular densities in the left upper and lower lobes with background
emphysematous changes. He underwent a bronchoscopy due to concerns for lung cancer. Bronchoalveolar
lavage cultures later grew Mycobacterium shimoidei, identified based on gene sequence analysis. Sputum
was positive for acid-fast-bacilli and cultures also grew Mycobacterium shimoidei. He was started on
clarithromycin, rifabutin, and ethambutol. He had mild side effects of treatment, including nausea, fatigue,
hair loss, and dry skin, but he managed to continue therapy. Cultures showed sensitivity to ethambutol
and rifabutin but resistance to clarithromycin. On a 6-month follow-up, he continued to have a persistent
low-grade fever and cough with purulent sputum speckled with black particulate matter. COPD symptoms
had worsened, causing persistent wheezing and shortness of breath. Repeat CT of the chest showed
progression in the size of the cavitary lesion with surrounding ground glass opacities. It was deemed
that the antibiotic treatment had failed. After a multidisciplinary discussion with pulmonary, infectious
disease, and cardiothoracic surgery teams, a decision was made to proceed with left upper lobectomy. The
patient's recovery was without any complications, and his symptoms improved significantly. Pathology of
the resected specimen showed non-caseating granulomatous inflammation. On follow-up visits over the
next 5 years, he remained symptom-free, and repeat sputum AFB tests continued to be negative. CT scans
of the chest showed no recurrence of the disease.

Discussion: Mycobacterium shimoidei predominately affects middle-aged men with immunosuppression,

preexisting pulmonary disease, previous tuberculosis, and lung cancer. The mycobacterium has been
reported in Japan, Germany, Australia, Canada, Croatia, and Italy with only one case reported in the US.
There is no evidence of human-to-human transmission or clear environmental sources. The infectious
presentation is similar to tuberculosis, and it predominantly causes pulmonary disease. However, renal
complications have also been reported. There is no current consensus on established therapy, but the triple-
drug regimen, including clarithromycin, rifabutin, and ethambutol, has been effective in most reported
cases. Additionally, Moxifloxacin and Levofloxacin, Sulfamethoxazole, Pyrazinamide, as well as Clofazimine
have been reported to be potentially useful. There is limited experience with cases of macrolide resistance

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Infection 2024

and therapeutic failure. There have never been any case reports requiring surgical resection which might
be a potentially curative option for appropriately screened patients.

Conclusion: There are limited guidelines for treating Mycobacterium shimoidei infection with drug
resistance. Due to their extreme rarity, our knowledge on surgical options for such cases with antibiotic
failure is limited. Our case highlights that surgical resection might be a curative option after a careful joint
decision-making process among patients and multidisciplinary teams.

Audience Take Away Notes

• To actively contribute to the advancement of medical knowledge on a rare case of Mycobacterium
shimoidei
• To enhance practice-based learning by sharing the natural history of drug-resistant Mycobacterium
shimoidei
• To emphasize the potential curative treatment with surgical resection
Biography

Dr. Naing finished his medical studies at the University of Medicine, 1, Yangon, Myanmar and graduated in 2019. He
worked as a small group teacher for USMLE Step 1 and Step 2 CK at Kaplan Medical Center, New York and as a clinical
assistance at Essen Healthcare, New York, in 2020. Then, he started his internal medicine residency at Eastern Virginia
Medical School, Norfolk, Virginia, in 2021, and he is in the last year of residency training.

82
Infection 2024

Guilherme Lima Honorio Bonfim, Camila Melo de Freitas*, Leticia

Jacon Vicente
Department of Infectious Diseases, Faculdade Pitagoras de Medicina de
Eunapolis, Eunapolis, Bahia, Brazil

Repercussions of pasteurella multocida infection in humans: A case

report

P asteurella multocida is a gram-negative bacterium commonly found in the respiratory and

gastrointestinal tracts of animals, such as cats, dogs and birds. This bacterium is known to cause a
variety of infections in animals and can occasionally be transmitted to humans, resulting in infections
known as pasteurellosis. In humans, it generally occurs after direct contact with infected animals, such
as bites, scratches or licks. Some of the manifestations caused by this bacteria include skin, respiratory
and/or systemic infections. Patient, 14 years old, male, mixed race, student, presented to the emergency
room, accompanied by his mother, presenting with tachycardia, tachypnea, hypotension, polyarthralgia
with edema on the right upper limb and lower limbs that started a week ago, after dog bite to the second
finger on the right and fall followed by injury to the right knee. On physical examination, retroauricular
and cervical lymph node enlargement, jaundice (Kramer zone 3), calf enlargement, board-like abdomen
and significant hepatomegaly. The patient was taken to the Intensive Care Unit, where imaging tests such
as Joint and Abdomen Computed Tomography were requested. Furthermore, his laboratory tests showed
significant leukocytosis and a slight change in bilirubin. His serologies for HIV, syphilis and hepatitis B and C
were non- reactive. Joint puncture was performed and purulent secretion was drained. Vigorous hydration
and empirical broad-spectrum antibiotic therapy (ceftriaxone with metronidazole) were initiated until the
test results were obtained. The patient improved after three days of treatment. There was a case of sepsis,
with a focus on the skin, which was unusual, which presented a favorable outcome at first, however, after 6
months, the patient returned to the office for follow-up, with a characteristic picture of osteomyelitis, on
imaging examination, which was possibly disseminated hematogenously.

Audience Take Away Notes

• With the presentation of the case report, the public will be able to learn more about Pasteurella
multocida, which is rare in humans; about the evolution of the condition and possible complications.
This way, they will be able to early diagnose similar cases that they may encounter in clinical practice
and intervene accurately in order to prevent complications. As it was a rare case, it was shown as a case
report, however in the future it is possible to expand the research and carry out an intervention with
a larger sample, in order to promote greater accuracy in the treatment
Biography

Dr. Camila is a physiotherapist, a business administrator and studied Medicine at the Faculdade Pitagoras de Medicina
de Eunapolis, Brazil and graduated as a doctor in 2024. She then joined the research group of Prof. Guilherme Bonfim
at the Faculdade Pitagoras de Eunapolis. She has published more than 50 research articles in different journals and
congress.

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Infection 2024

Guilherme Lima Honorio Bonfim, Camila Melo de Freitas*, Leticia

Jacon Vicente and Rodrigo Almeida Souza
Department of Infectious Diseases, Faculdade Pitagoras de Medicina de
Eunapolis, Eunapolis, Bahia, Brazil

Repercussions of monkeypox infection in humans: A case report

M onkeypox (Mpox) is an emerging viral zoonosis that has gained increasing attention due to its
clinical similarity to smallpox and its ability to cause sporadic outbreaks in human communities. This
condition, caused by the Monkeypox virus (MPXV), belonging to the Poxviridae family and Orthopoxvirus
genus, is characterized as an acute febrile disease with skin rashes. The infection has a restricted
geographical distribution, mainly in Central and West Africa, but global concern has increased due to the
possibility of its spread beyond these borders. Thus, it poses a significant threat to public health, especially
in regions where the interaction between humans and wild animals is common, particularly rodents, which
serve as natural reservoirs for the virus. This report is about a 35-year-old male patient, black, freelancer,
with a diagnosis of B24 since 2012 under outpatient follow-up at ICOM. He presented to the emergency
room reporting that in October 2023, he started developing vesicular skin lesions initially around the anus,
progressing to the entire body, raising suspicion of Monkeypox. A PCR test for Monkeypox was collected.
He complained of intense pain in the anal region, with lesions already in the crusting phase throughout the
body, painful to the touch, with no evidence of local purulent discharge, associated with constipation. The
patient also had yellowish discharge from the anus and crusted lesions in the perianal region. He reported
a history of herpes in the anal region. He mentioned using Ibuprofen and Paracetamol/Codeine for pain
control, but significant anal pain persisted. He had taken Ceftriaxone 500mg and Azithromycin 1000mg
prescribed in a previous consultation. He reported unprotected sexual intercourse at the end of September
and continued to experience pain, worse in the perianal region. Therefore, this zoonosis represents a
significant threat to public health, especially in regions where there is frequent interaction between
humans and wild animals, such as rodents, acting as natural reservoirs of the virus. Although initially
restricted to the regions of Central and West Africa, global concern has increased due to the possibility
of its spread beyond these borders. The presented case highlights the importance of monitoring and
controlling this disease, emphasizing the need for preventive strategies and interventions in communities
prone to outbreaks, especially when there are risk factors such as unprotected sexual relations and a
history of anal herpes. Additionally, it illustrates the clinical complexity of the infection, emphasizing the
importance of epidemiological surveillance and preventive measures to contain the spread of Monkeypox.

Audience Take Away Notes

• With the presentation of the case report, the public will be able to learn more about the monkeypox
virus and its associated symptoms, about the evolution of the condition, even when the fetus is removed
and possible consequences. This way, you can early diagnose similar cases that may be encountered
in clinical practice and intervene with results to prevent complications. As this is a rare case, it was
presented as a case report, but in the future it is possible to expand the research and carry out an
intervention with a larger sample, in order to promote greater precision in the treatment

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Infection 2024

Biography

Dr. Camila is a physiotherapist, a business administrator and studied Medicine at the Faculdade Pitagoras de Medicina
de Eunapolis, Brazil and graduated as a doctor in 2024. She then joined the research group of Prof. Guilherme Bonfim
at the Faculdade Pitagoras de Eunápolis. She has published more than 50 research articles in different journals and
congress.

85
Infection 2024

Cara Spence1,2*, Ph.D; Mary Zettl1, MA; Nikki Williamson2, RN;

Susanne Nicolay2, RN; Stu Skinner1,2, MD; Sean Rourke3, Ph.D;
FCAHS
1
Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan,
Canada
2
Wellness Wheel Clinic, Regina, Saskatchewan, Canada
3
University of Toronto, Toronto, Ontario, Canada

Shiver: A syphilis/HIV ‘test and treat’ poct intervention trial to reach

rural/remote and underserved populations in Saskatchewan, Canada
Context: An alarming increase of infectious and congenital syphilis rates is being seen in Saskatchewan
and the prairie provinces of Canada. According to the Public Health Agency of Canada, the national rate
of infectious syphilis increased from 5.1 per 100,000 population in 2011 to 30 per 100,000 population in
2021, with the prairie provinces reporting the greatest relative increases from 2017 to 2021 (1346% in
Saskatchewan and more than 400% in Alberta and Manitoba). Confirmed early congenital syphilis cases
in Canada have considerably increased from prior years, with 50 cases reported in 2020 and 96 cases in
2021, compared with 7 cases in 2017. In 2020, Saskatchewan reported 10 confirmed cases of congenital
syphilis, and two stillborn babies. In 2022, 67 congenital cases were reported. Syphilis carries serious life-
threatening complications for the individual and the unborn child, if left untreated.

In March 2023, Wellness Wheel Clinic launched the Syphilis HIV Early Rapid Test (SHIVER) project, with
the support of the REACH Nexus, collaborating First Nations communities and participating provincial
sites, aimed to address the urgent need for faster testing and treatment, and reduce access barriers to
treatment for rural/remote areas and underserved inner city groups.

Objective: To understand how Point of Care Testing (POCT) options, along with culturally responsive care
interventions, offer opportunities for immediate treatment and linkage to care for syphilis for undiagnosed
individuals in inner city, remote, rural and underserved populations in Saskatchewan.

Research Question: How does the implementation of a “test and treat” model of POCT, delivered as a
culturally informed and responsive interventional team approach, offer immediate treatment and linkage
to care for syphilis, and reach those undiagnosed in sites across Saskatchewan?

Method: This project is a multiplex point-of-care “test and treat” intervention study based on a successful
2020 study in Alberta, Canada. The program demonstrated the clinical utility in diagnosing and linking
underserved and hard to reach individuals into care. The SHIVER approach offers 3 rapid finger prick test
options (syphilis only, HIV only, or syphilis and HIV) with education and participant experience survey.
Additional blood is drawn for confirmatory results and screen for false positive/negative. In the event of
a positive diagnosis, treatment, and linkage to care for follow-up is immediately carried out. The POCT
device was found to be >98 per cent accurate in detecting active syphilis. Test kits provide a test result
in under five minutes using a fingerstick blood specimen. Acting on the device’s instantaneous nature,
connecting participants to care and early treatment was a key priority of the study. This initiative aims to
enroll 1,500 individuals for testing of HIV and/or syphilis.

Results: As of November 2023, SHIVER has recruited 20 sites, including 10 First Nations on-reserve
communities, 1 northern community health centre, 8 community organizations providing harm reduction
care and support services to people living in inner-city settings, and the Saskatchewan Federal Penitentiary.
Preliminary numbers report 443 participants have taken part in the project across the 9/10 participating
sites. 71/443 participants testing positive for syphilis, and 14/71 also receiving a positive HIV diagnosis (co-

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Infection 2024

infection). Within those testing positive, 35/71 were of male biological sex and 36/71 were female biological
sex. Among those women with a positive syphilis result, 2 were pregnant. Biological sexed women, aged
18 to 39, had the highest diagnosis rate with 29/36 individuals being between ages of 18 and 39. Biological
sexed men were older with 29/35 of the positive diagnoses being among those aged 30-49. No one over the
age of 59 years had a positive result for either disease. 12 women and 12 men (total n=24) had a positive HIV
result along with a negative syphilis result. Most POCT and positive results were among inner city harm
reduction community organization cohorts. Efforts are underway to increase testing rate in communities
through testing events and culturally tailored public awareness campaigns. Data reporting is ongoing and
additional sites will be onboarded throughout 2024 to expand the POCT program.

Audience Take Away Notes

• Gain insight on the utility and efficacy of POCT rapid blood tests to improve quick treatment starts and
linkage to care, especially for groups that are harder to reach or not engage in care
• Rapid test and treat care intervention can be done by nursing and frontline community provider staff
quickly and with ease, reducing the time and blood quantity required by conventional testing methods
• Rapid results enable care providers to link a patient to care and treatment immediately, improving the
engagement of care along the continuum and reducing transmission
• Closing the time gap between testing/diagnosis and treatment reduces the challenges care providers
may face in following up or contacting the patient once they have left the facility
• Other faculty will be able to use this research in their own research or teaching by
• Undertaking a similar type of project to reach street involved and rural/remote groups who are at
highest risk for STBBI-related infections and/or hardest to reach or not engage in care
• Understanding how to integrate and tailor health interventions to be more culturally appropriate for
populations they wish to reach
• Facilitate easier access to a proven simplified testing that requires fewer resources with improved
reach, especially during times of health crisis
• This provide a practical solution to a problem that could simplify or make a designer’s job more efficient
• This project was established in response to the syphilis and STBBI-related health crisis emerging in
Saskatchewan and the prairie Canadian provinces. Prior to 2017, syphilis rates were low in Saskatchewan
and resources were focused on other priorities, such as HIV and HCV. Saskatchewan is also sparsely
populated with First Nations communities spread across the province in rural and remote locations.
This presents a barrier to accessing timely resources, care and treatment for any illness. The SHIVER
project brings testing, rapid start treatment and linkage to care to these communities
• It improve the accuracy of a design, or provide new information to assist in a design problem
• This project will inform on the efficacy of rapid HIV/Syphilis testing and allow others to tailor and
implement similar interventions to reduce access barriers, facilitating broader uptake of STBBI
screening, education, and treatment among hard to reach and underserved locations
• This project will also glean insight into how to improve treatment adherence among cohort populations
that are street-involved or experience resistance to screening and seeking medical care
• Finally, a portion of this project will develop a robust portfolio of culturally tailored educational
resources for frontline providers and the target population through a collaborative integrated
knowledge mobilization initiative

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Infection 2024

Biography

Dr. Cara Spence received her Ph.D. in Global Health at the University of Saskatchewan in Saskatoon, Saskatchewan,
Canada in 2020. She has worked in the field of infectious diseases since 2012, and completed her post-doctoral
research at McGill University, faculty of medicine. Dr. Spence conducts both community-based and clinical research,
and is the Research Director for infectious diseases for Wellness Wheel Clinic – a non-profit health organization
providing comprehensive culturally responsive STBBI care in rural/remote and on-reserve First Nations communities.
She currently holds an Associate Researcher position at the College of Medicine at the University of Saskatchewan.

88
Infection 2024

Caroline Ballet1*, Rafael Delgado2, Fatima Lasala2, Nuria Labiod2,

Veronique Juillard1
1
Fab’entech, Lyon, France
2
Instituto de Investigación Hospital 12 de Octubre, Madrid

Equine polyclonal F(ab)’2 as a rapid and strong therapeutic answer

against potential new SARS-CoV-2 surge

S uccessive sub-lineages of Omicron have spread since the occurrence of BA.1 in November 2021.
Identified in July 2022, BQ.1 and BQ.1.1 expanded dramatically in Europe and North America. XBB
and XBB.1 were first identified in India in mid-August 2022 and quickly spread to become predominant
worldwide. The XBB lineage originated from a recombination of two BA.2-derived variants (BJ.1 and BM.1.1.1)
and progressively replaced most of previous Omicron strains. Members of this lineage are characterized
by enhanced transmissibility rates and immune evasion properties. The rapid rise of these subvariants and
their extensive array of spike mutations raised concerns that they will further compromise the efficacy
of current COVID-19 vaccines and monoclonal antibody (mAb) based therapeutics. This was confirmed
by many publications showing that human convalescent plasma from patient having received 3 shots of
Wuhan-based vaccines were not able to efficiently seroneutralize XBB.1, XBB, BQ.1.1 and BQ.1 variants.
Confirming this continuous drift in SARS-CoV-2 mutants, the BA.2.86 lineage first detected in August 2023
has rapidly evolved and led to the emergence of the JN.1 sublineage in September 2023. As of December
2023, JN.1 was sharply increasing in frequency in Europe and USA.

Both BQ and XBB sublineages are now completely resistant to bebtelovimab, leaving us with no authorized
antibody for treatment use.

Leveraging its equine polyclonal F(ab')2 platform, Fabentech has developed FBR-002 product, purified
from Immunoglobulins obtained after horse immunization with SARS-Co2 Wuhan spike protein. FBR-002
represents a pertinent therapy candidate for treating patients hospitalized with COVID-19 because of its
polyclonality, which enables the targeting of multiple epitopes of the spike protein, limiting the risk of viral
escape if new strains emerge.

Although FBR-002 showed a decreased activity level for the seroneutralization of D614G mutant-related
strains compared to the last variants, the Fab’entech developed polyclonal F’(ab)’2 was still able to neutralize
BQ.1.1, XBB.1.5 and XBB.1.16 strains with strong potency. In comparison, Sotrovimab seroneutralisation was
barely detectable.

Fabentech is currently evaluating the seroneutralisation activity of FBR-002 against the latest variant JN.1
derived from BA.2.86.1 in comparison to the activity of various human convalescent plasmas.

In a context of rapid evolution and adaptation of emerging Covid-19 variants, and a lack of activity of mAbs,
the polyclonal antibody approach should be considered as a particularly relevant therapeutic product for
the treatment of high-risk populations such as immunocompromised patients.

Audience Take Away Notes

• Covid-19 sub-lineages are still arising and remain of major concerns in case of new surge. Vaccination
with the original strain is poorly efficient against last variants and there are no more monoclonal
antibodies in the market, leaving people at high risk with very few therapeutic solutions in case of
emergence of a new highly pathogenic strain

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Infection 2024

• Contrary to mAbs, Fab’entech Equine polyclonal F(ab)’2 FBR-002 still cross-neutralizes with high
potency newly emergent Covid-19 variants and offers an unprecedent treatment of emergency against
Covid-19
• A better understanding of immune mechanisms at stake during the horse immunisation process would
foster the design of horse immunisation protocols to reinforce the specific immune response to targets
of interest
• Research to characterize the polyclonal antibody response would allow the design of innovative “broad
spectrum” treatments
Biography

Dr. Caroline Ballet has studied Cellular Biology at the University of Nantes. After 3 years fellowship supervised by
Pr. Jean-Paul Soulillou, she was graduated as PhD in 2008. She joined biotechnology companies as project leader in
the field of Infectious diseases, Oncology and transplantation. Since 2022, she coordiantes National and European
programs in the field of Emergent Infectious diseases at Fab’entech.

90
Infection 2024

Daniela Tirotta1*, Maurizio Nizzoli2, Francesca Martelli1,3, Claudia

Lena1,3, Paolo Muratori1,3
1
Internal Medicine Forlì, Morgagni-Pierantoni Hospital, AUSL Romagna/Forli',
Italy
2
Endocrine Unit, Morgagni Pierantoni Hospital, Forli', AUSL Romagna, Forli', Italy
3
Internal Medicine, S Orsola University Hospital, Bologna, Italy

Hemophagocytic lymphohistiocytosis syndrome and syndrome of

inappropriate antidiuretic hormone ADH release: Keep in mind visceral
leishmaniasis. Case report and literature review
Introduction: Visceral leishmaniasis is an potentially fatal and neglected tropical disease, according to
the World Health Organization’s: mortality is still very high (95%) when untreated. This disease presents
a broad spectrum of symptoms (oligosymptomatic infection, but also life-threatening chronic condition).
Shorter (≤30 days) diagnostic delay and treatment completion are associated with less mortality.

Case report and Literature review: We present the case of a 72-year-old woman came to our observation
for asthenia, episodes of confusion, fever, liver function derangement, hyperferritinemia, biological
inflammation syndrome, pancytopenia resulted secondary to hemophagocytic lymphohistiocytosis and
severe hyponatremia. HS score 141. Anamnesis was positive just for dysmetabolic syndrome (overweight,
diabetes mellitus II, hypertensive heart disease). Abdominal ultrasound showed hepatosplenomegaly.
Our diagnostic hypotheses were: a dysmetabolic liver disease with secondary splenomegaly due to
portal hypertension, a splenomegaly due to haematological aetiology (rare blasts in peripheral blood), an
infectious hepatosplenomegaly. An hypercortisolism was present.

The case was characterized by two points:

• A severe hyponatremia associated to hypo-osmolality in normovolemic patient, resulted secondary
to Syndrome of inappropriate ADH secretion (SIADH). A sensitive search on Pubmed (Mesh term
‘Hyponatremia’ and ‘visceral leishmaniasis’) shows only 6 analogous cases.
• A Hemophagocytic lymphohistiocytosis syndrome. In this context, the Leishmania PCR from peripheral
blood and bone marrow was positive, negative serology for toxoplasma, HIV, CMV, EBV, Parvovirus,
HZV, HHV 6-8. A sensitive search on Pubmed (Key-words ‘Hyponatremia’ and ‘visceral leishmaniasis’)
shows other 43 anlaogous cases (limits: ‘adults’). The patient was treated with Amphotericin with
progressive clinical remission.

Conclusions: The pathogenesis of hyponatremia in Leishmaniasis is very complex and is associated to

several hemodynamic and hormonal factors (reduced body water, especially if present vomiting, diarrhea
and dehydration associated to vasopressin release, as well as renin-angiotensin-aldosterone system
activation, renal Na+ loss, tubular dysfunction, polyclonal activation of B lymphocytes with secondary
pseudo hyponatremia). SIADH in Leihsmaniasis most likely derives from the intense inflammatory response
associated to activation of hypothalamic-pituitary axis and antidiuretic hormone release. -Hemophagocytic
lymphohistiocytosis syndrome is more common associated to malignancy and infection. Mortality is 29%
in study cohort and so it should be considered a lethal disease. It is important to keep in mind a leismaniasis
etiology in the presence of these 2 conditions, to clearly improve the prognosis of patients.

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Infection 2024

Audience Take Away Notes

• The audience will be able to think early about the diagnosis of Leishmaniasis in the presence of the two
points (hyponatremia and Hemophagocytic lymphohistiocytosis syndrome)
• The description of the case can help doctors to treat these patients early, with a marked improvement
in the prognosis
• This case and the literature review could be a starting points for cohort studies related to the evaluation
of hyponatremia and the syndrome in the prognosis of visceral Leismaniasis
Biography

Dr. Daniela Tirotta studied Internal Medicine at the Ancona University, Italy. He worked as an internist in the Rimini
AUSL, then in the Forlì AUSL. He attended the Clinical Governance master's degree in Internal Medicine, at the Carlo
Cattaneo University, Milan. She has published more than 22 research articles in SCI (E) journals, HI 22.

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Infection 2024

Jordy Exauce Demboux1*, Pembe Issamou Mayengue1,2, Felix

Koukouikila Koussounda1,2, Eric Maurice Leroy3, Pierre Becquart3,
Fabien Roch Niama1,2
1
Faculte des Sciences et Techniques, Universite Marien NGOUABI, Brazzaville
BP69, Republique du Congo
2
Laboratoire National de Sante Publique, Brazzaville BP120, Republique du Congo
3
Institut de Recherche pour le Développement, Unite Mixte de Recherche
Mivegec, Montpellier BP34090, France

Viral profile of respiratory infections according to age in hospitals in

Brazzaville, Republic of Congo
Context: Respiratory Tract Infections (RTIs) are one of the most common infectious diseases in children
and represent a major cause of morbidity, hospital admission and mortality worldwide, with an estimated
3-5 million deaths per year. Although children are most at risk, adults are also vulnerable to RTIs. There
are multiple etiologies of RTIs, with viruses accounting for almost 80%. The most common viruses are
HRV, HRSV, HAdV, HCoV, HBoV, HPIV, and FluA/B. In Africa, little is known about respiratory infections in
adults and the prevalence of these infections is often underestimated in hospitals due to the small amount
of data available. The aim of this study was to determine the viral profile of respiratory infections and its
correlations with age in hospitals in Brazzaville, Republic of Congo.

Method: The study was conducted between March 2022 and April 2023 in Brazzaville. Nasopharyngeal
samples were collected from patients with respiratory syndrome and enrolled in the study at the Hôpital
de Référence de Talangai and the Hopital de Référence de Makelekele. These samples were analyzed for
detection of respiratory pathogens using the FTD-21 panel, a commercial multiplex Real-Time Polymerase
Chain Reaction (RT-PCRm) kit targeting 21 pathogens. As the kit does not targets SARS-CoV-2, the TaqPath
kit was used specifically for its identification, following the manufacturer's instructions.

Results: A total of 643 patients were enrolled and tested, and 461 of them were found to be infected with
at least one respiratory pathogen. Out of these positive patients, 300 (300/461; 65%) were under 5 years
old (0-4), 53 (53/461; 11%) were 5-15 years old and 108 (108/461; 23%) were 16-87 years old. Viral diversity
was highest in the under 5 years, with the most prevalent and statistically significant pathogens being
HRV (120/384; 31.2%), HAdV (83/384; 21.6%), HBoV (57/384; 14.8%) and HRSV (38/384; 9.8%). HPIV-3
(36/384; 9.3%), FluA (34/384; 8.8%) and SARS-CoV-2 (26/384; 6.7%) and many other viruses (with very low
proportions) were not significant. For 5-15 years, the most prevalent viruses were FluA (15/70; 21.4%), HRV
(12/70; 17.1%), HAdV (10/70; 14.2%), HBoV and SARS-CoV-2 (8/70; 11.4% each). In the oldest age group (16-87
years), the most prevalent viruses were HRV (32/189; 16%), FluA (23/189; 12.1%), HAdV (18/189; 9.5%) and
SARS-CoV-2 (11/189; 5.8%). We found 199 cases of co-infection, including 146 (146/199; 73%) in children
under 5 years of age (0-4), 20 (20/199; 10%) in those aged 5 to 15, and 33 (33/199; 17%) in older children
(16-87).

Conclusion: Respiratory infections were more prevalent in children under 5, with a more varied viral
profile. However, adults were found to be as vulnerables as children. The most prevalent viruses in all age
groups were HRV, FluA, HAdV and SARS-CoV-2.

Key Word: Respiratory Infections, Viruses, Age, Hospital, Brazzaville.

HRSV: Human Respiratory Syncytial Virus ; HRV: Human Rhinovirus ; HAdV: Human Adenovirus ; Flu A/B:
Influenza viruses A/B type; HPIV 1-4: Human Parainfluenza viruses 1-4 types; HCoV: Human Coronavirus;
HBoV: Human Bocavirus; SARS-CoV-2: Severe Acute Respiratory Syndrome Coronavirus-2 ; FTD: Fast
Track Diagnostics ; RTIs: Respiratory Tract Infections (RTIs).

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Biography

Jordy Exauce Demboux is a PhD student at the Marien Ngouabi University in Brazzaville, Republic of Congo, and
obtained a Master's degree in Biology and Applied Microbiology in 2020. He joined the technical team at the National
public health laboratory, set up by the Congolese government as part of the response to COVID-19. He then joined
the JEAI project (Jeune Equipe Associee a IRD) to complete his doctoral thesis on respiratory infections under the
supervision of Professor Pembe Issamou Mayengue and Doctor Becquart Pierre.

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Infection 2024

Dian Wulandaru Sukmaning Pertiwi1*, Fatima Safira Alatas1,

Rosalina Dewi Roeslani1, Novie Amelia Chozie1, Tri Hening
Rahayatri2, Amanda Soebadi1, Ari Prayitno1
1
Department of Child Health, Cipto Mangunkusumo Hospital-Faculty of Medicine,
University of Indonesia, Jakarta, Indonesia
2
Division of Pediatric Surgery, Department of Surgery, Cipto Mangunkusumo
Hospital-Faculty of Medicine, University of Indonesia, Jakarta, Indonesia

Risk factors for bacterial infection in children following liver

transplantation in Indonesia: A preliminary study
Objective: Survival rate and quality of life of children with chronic hepatobiliary disease has improved
since the development of liver transplantation. Incidence of bacterial infection is 36– 79% at 6 months
post-transplantation and mortality of 3.0–10.6% at 3 months post- transplantation. Adequate prevention of
bacterial infection will reduce morbidity and mortality and increase survival. This study aimed to determine
the risk factors for bacterial infection in children who underwent liver transplantation in Indonesia.

Methods: This retrospective cohort study includes pediatric recipients who underwent liver transplantation
in Cipto Mangunkusumo Hospital (CMH) during December 2010 – April 2023 with total sampling method.
Subjects were classified into groups with and without bacterial infection.

Results: Prevalence of bacterial infection of the 63 subjects was 84.13%. A majority of the bacterial
infection cases were healthcare-associated infections (HAIs), comprising of surgical site infections
(29.63%), ventilator-associated pneumonia (14.81%), and catheter-related urinary tract infections (13.58%).
Multivariate analysis showed ICU length of stay ≥20 days (RR 1.212; CI 95% 1.028−1.426; p = 0.022) and
volume of blood loss during surgery ≥70 mL/kg (RR 1.283; CI 95% 1.009 −1.631; p = 0.042) were risk factors
for bacterial infection following liver transplantation. Subgroup analysis presented ICU length of stay ≥20
days increased risk of multi- drug resistance bacterial infection by 2.479 times (CI 95% 1.185 – 5.187; p =
0.016).

Conclusion: Bacterial infection prevalence at six-months post-liver transplantation of children in CMH

was 84.13% with ICU length of stay ≥20 days and volume of blood loss during surgery ≥70 mL/kg as risk
factors. Further studies with better design and larger samples are needed.

Keywords: Bacterial infection, risk factor, post-liver transplantation, children, pediatric.

Audience Take Away Notes

• Adding information about risk factors of bacterial infection at 6 months following liver transplantation
in children from liver transplantation centers in developing countries, especially in Southeast Asia
• The first study from Indonesia regarding this topic
• Prevention of bacterial infection post-liver transplantation in children
• Baseline study for future prospective researches regarding this topic
Biography

Dian Wulandaru Sukmaning Pertiwi, MD. studied Medicine at the Brawijaya University, Indonesia and graduated as
MD in 2015. She then studied at Department of Child Health, University of Indonesia, Indonesia and graduated as
Pediatrician in 2023. She has experienced being in 4 researches so far, and presented study and case reports in national
and international conferences. She currently works as Pediatrician in a Public Hospital in West Java, Indonesia.

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Infection 2024

Seunghyun Lee1, Suyoung Jo2, Hyunji Won1, HeeSeon Kim2, Dong

Hyun Kim3*
1
Department of Preventive Medicine, Chung-Ang University College of Medicine,
Heukseoro 84, Dongjak-gu, Seoul, Republic of Korea
2
Institute of Health & Environment, Seoul National University, Bldg 220 Rm 712, 1
Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
3
Department of Social and Preventive Medicine, Hallym University College of
Medicine, 1 Hallymdaehak-gil, Chuncheon, Republic of Korea

Korea seroprevalence study of monitoring of SARS-CoV-2 antibody

retention and transmission (K-Serosmart): A community-based
longitudinal seroprevalence survey

T he primary objective of this investigation is to estimate the population prevalence of SARS-CoV-2

antibodies, monitor the waning pattern of seroprevalence, and develop forthcoming vaccination
strategies through a longitudinal study using a population-representative sample over time in Korea.

In August 2022, the initial survey targeted 10,000 individuals aged 5 and above, selected through two-
stage probability random sampling. Subsequently, a follow-up was conducted on participants from the
first wave. The third survey involved a cross-sectional study of 10,000 new household members. Lastly, the
fourth survey conducted longitudinal follow-up on Wave 2 and 3 participants. Various methods such as
mobile web, telephone, and face-to-face surveys were employed to collect data on health status, COVID-19
history, and demographic information. Blood samples were collected and analyzed for anti-S and anti-N
antibodies using electrochemiluminescence immunoassay. Population prevalence was estimated using
PROC SURVEYMEANS with weighting reflecting demographic data at each survey time point.

The first survey involved 9,945 individuals in 258 communities. 74.9% follow-up rate from Wave 1 in the
second survey. The third survey involved 9,798 individuals. Subsequent surveys involved 11,271 in the
fourth, with follow-up rates of 74.4% and 57.8% from Waves 2 and 3 participants, respectively. The overall
population-adjusted prevalence rates of anti-S antibodies from 97.5% in the first to 99.8% in the fourth
survey. Anti-N antibodies increased gradually from 57% in the first survey to reaching 84.9% in the final
survey. Unreported rates of antibodies remained relatively stable at approximately 20%-25%, with the
highest rates observed in the 50s and 60s age groups. Furthermore, the titers of anti-S antibodies tended
to decline over time following the last immunological event, particularly noticeable after a span of six
months.

This study provides estimates of population seroprevalence and highlights the decline in antibodies
against SARS-CoV-2 over time in a nationally representative sample. It furnishes essential epidemiological
evidence for formulating national COVID-19 vaccine policies and underlines the necessity of continuous
surveillance for COVID-19.

Audience Take Away Notes

• The methodology employed in estimating the population prevalence of SARS-CoV-2 antibodies,
including the use of longitudinal studies and representative sampling
• The waning pattern of seroprevalence over time, including insights into how antibody levels change
following immunological events and the duration of their persistence
• The development of vaccination strategies informed by longitudinal data, offering insights into the
effectiveness and longevity of immune responses
• The demographic patterns of COVID-19 antibodies, including prevalence rates across different age
groups and any disparities observed

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• The implications of the study findings for national COVID-19 vaccine policies and the importance of
continuous surveillance for monitoring the pandemic's trajectory
Biography

Dr. Dong-Hyun Kim has served as the Dean of Hallym University Graduate School of Health Sciences, and professor
at the Department of Social and Preventive Medicine at Hallym University since 1995. He received his M.D. from the
Seoul National University College of Medicine. He was also a visiting scholar at the Department of Epidemiology at
Harvard School of Public Health for two years, from 1999 to 2001. He was the past president of the ‘Korean Society of
Epidemiology’ during 2018~2020. He is a principal investigator of Korea Seroprevalence Study of Monitoring of SARS-
COV-2 Antibody Retention and Transmission (K-SEROSMART).

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Infection 2024

Dongsheng Jiang1*, MD, MS; Joanna Jiang2, MD; Juan Qiu1, MD, PhD
1
Department of Family and Community Medicine, Penn State Health, Milton S Hershey Medical Center,
Pennsylvania State University, State College, PA, United States
2
Internal Medicine Residency, Ohio State University Columbus, OH, United States

1 + 1 = 0: Challenges in managing early lyme disease with anaplasmosis

co-infection

L yme disease, the leading vector-borne illness in the United States, impacts roughly 476,000 individuals
each year. As its geographical reach expands, healthcare providers face increasing hurdles in diagnosing
and treating the disease, especially in its early stages. Despite being nationally notifiable since 1991, Lyme
disease presents ongoing challenges, highlighting the imperative for more effective management strategies.
This clinical case underscores some of these challenges and offers practical insights for improving the
management of early Lyme disease with concurrent anaplasmosis infection. Tickborne Rickettsial Diseases
(TBRD) can result in severe illness and fatalities in otherwise healthy individuals, despite the wide availability
of effective and affordable treatments. The primary barrier lies in promptly diagnosing these diseases and
administering appropriate treatment. Given the rising prevalence of LD and other tick-borne illnesses,
alongside the potential for significant long-term health consequences, healthcare providers require better
guidelines for diagnosis and treatment. Existing clinical reference tools often lack the necessary depth or
efficiency to address this growing demand, leaving primary care providers grappling with these challenges.
This paper aims to illuminate some of the obstacles and crucial considerations in the management of early
Lyme disease, particularly when co-infection with anaplasmosis is suspected.

Audience Take Away Notes

• Current issues in Lyme disease diagnosis and treatment
• Its co-infection makes the already complicated disease more difficult to manage
• Issues with guidelines
• Some practical insights on Lyme disease and co-infection management
Biography

Dongsheng Jiang, M.D. Trained and board certified in family medicine, Dr. Jiang works as family physician and an
associate professor at department of family and community medicine, Penn State Health, Milton S Hershey Medical
Center, College of Medicine, Pennsylvania State University, State College, PA, USA.

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Infection 2024

Elizabeth Yvonne Flores1*, Adam Hume2, Judith Olejnik2,

Pushpinder Bawa3, Elke Muhlberger2, Gustavo Mostoslavsky1
1
Center for Regenerative Medicine (CReM), Boston University and Boston Medical
Center, 670 Albany Street, Suite 209, Boston, MA 02118; 2National Emerging
Infectious Diseases Laboratories (NEIDL), Boston University, 620 Albany Street,
Boston, MA 02118, USA; 3Department of Medicine, Boston University School of
Medicine, 670 Albany Street, Boston, MA 02118, United States

2
National Emerging Infectious Diseases Laboratories (NEIDL), Boston University, 620 Albany Street,
Boston, MA 02118, USA; Department of Microbiology, Boston University School of Medicine 700 Albany
Street, Boston, MA 02118, United States
3
Center for Regenerative Medicine (CReM), Boston University and Boston Medical Center, 670 Albany
Street, Suite 209, Boston, MA 02118

An iPSC-derived organoid-based model of intestinal filovirus infection

A ffected Ebola Virus Disease (EVD) patients lose copious amounts of fluids in a matter of days, rapidly
deteriorating into hypovolemic shock and death. Similar intestinal manifestations were also reported
for Marburg Virus (MARV) disease, another filovirus. At present, available animal models insufficiently
recapitulate the gastrointestinal symptoms of EVD patients. To fill this gap, we have established an
induced Pluripotent Stem Cell (iPSC)-derived Human Intestinal Organoid (HIO) model that can be primed
towards proximal (small intestine) or distal (colonic) intestinal lineages. Three-dimensional tissue-
specific organoids recapitulate the heterogeneity, architecture and cellular functions of the primary
tissue, thus representing a powerful tool to study development and disease. The generation of a hiPSC
CDX2-GFP reporter line highlights the role of CDX2 as a marker for the emergence of hindgut intestinal
progenitors during our differentiation protocol. This platform can facilitate the study of late-stage EVD
gastrointestinal symptoms, including diarrhea. Single-cell RNA sequencing characterization of the HIOs
revealed a significant number of CDX2 and Villin 1 expressing cells as well as separate clusters indicating
the major transcriptional changes in cell identity that are known to occur during the stages of intestinal
differentiation. The HIOs exhibit a distribution of the different cell types that physiologically resemble
the human intestinal epithelium. We employed the generation of these organoids to study the effects of
filovirus infection on intestinal epithelial integrity. Successful robust EBOV and MARV infections of hiPSC-
derived HIOs, affecting mostly epithelial CDX2+ enterocytes was achieved. The infected cells showed signs
of cell damage. Transcriptomics analysis indicated the modulation of cell junction pathways and a set of
ion transporters known to play a role in the induction of diarrhea. Taken together, these data suggest that
EBOV and MARV compromise barrier integrity of the intestinal epithelium and cause abnormal ion flux as
the basis for gastrointestinal dysfunction and diarrhea.

Audience Take Away Notes

• Novel induced pluripotent stem cell (iPSC)-derived human intestinal organoid (HIO) three-dimensional
models to study filoviruses or other viral infections of the gastrointestinal tract
• Established methods and also some exciting novel perspectives on organoids in the fields of
gastroenterology and infectious diseases, specifically how these models may be used address questions
that are not feasible in other cellular models
• A 3D model has the potential to recapitulate the physiology of the desired organ of study, offering
novel avenues for experimental design and exploration

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Infection 2024

Biography

Elizabeth Yvonne Flores is a fourth year PhD candidate at Boston University School of Medicine in Boston, MA, USA.
She is currently a National Institute of Health F31 fellow and is conducting her dissertation project in the laboratories
of Dr. Gustavo Mostoslavsky at the Center of Regenerative Medicine and Dr. Elke Muhlberger at the National Emerging
and Infectious Diseases Laboratories, specifically in the Biosafety Level 4 (BSL-4) laboratories.

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Infection 2024

Eric Takashi Kamakura de Carvalho Mesquita1, Washington Carlos

Agostinho2, Ana Karoline Sousa Mendes Simas1, Lidio Lima Neto3,
Enio Mouri4, Paulo Eduardo Brandao2, Francisco Borges Costa1*,
MV, PhD
1
Department of Pathology, Faculty of Veterinary Medicine, State University of
Maranhao, CEP 65055-310, Sao Luis - MA, Brazil
2
Department of Preventive Veterinary Medicine and Animal Health, University of
São Paulo, CEP 05508-270, Sao Paulo, SP, Brazil
3
Virology Laboratory, CEUMA University, CEP 65075-120, Sao Luis - MA, Brazil
4
Instituto Pasteur de Sao Paulo, CEP 01311-000, Sao Paulo - SP, Brazil

Epidemiological aspects of rabies in an Amazon-Cerrado transition

region of Northeastern Brazil

R abies is an acute viral disease that affects mammals, caused by an RNA virus belonging to the family
Rhabdoviridae and the genus Lyssavirus. The disease is transmitted through bites or scratches from an
infected animal. Rabies was one of the first infectious diseases to be scientifically studied, with a detailed
description of symptoms and clinical course. The global incidence of rabies varies among different regions,
and it is estimated that it causes around 60,000 deaths worldwide each year, with a higher prevalence
where there are no effective control measures. Most cases occur in developing countries where animal
vaccination and proper post-exposure prophylaxis are less accessible. The rabies virus has several variants
that are specific to each animal reservoir, and in Brazil, five of these variants have already been identified.
This study aimed to better understand the epidemiological aspects of the rabies virus variants circulating
in the Amazon-Cerrado transition region through immunological and molecular assays, as well as their
reservoirs and distribution in the biomes. To achieve this, 62 biological samples sent to reference laboratories
in the state of Maranhão between 2015 and 2022 were analyzed using the Fluorescent Antibody Test (FAT)
and Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) techniques. Primers 504 (sense) and 304
(reverse) were used for the N gene in the RT-PCR reactions, amplifying 240 bp, and the positive samples
were submitted to Sanger sequencing to identify the antigenic variant. Of all the samples, 74% tested
positive in FAT and 63% tested positive in RT-PCR. Among FAT-negative samples, 19% were detectable for
the rabies virus by the RT-PCR. Of all samples that tested positive in both tests, only 28% were successfully
sequenced, revealing antigenic variants of Desmodus rotundus and Cerdocyon thous. It was observed that
these variants circulate in both the Amazon and Cerrado biomes, with the bat variant being more prevalent
in the Amazon biome with human cases of rabies in the early 21st century, while the wild canid variant
was more prevalent in the Cerrado, as there are reports of this variant in domestic dogs and humans
in this Amazon-Cerrado transition region northeastern Brazil. Thus, these results guide epidemiological
surveillance procedures that can be used in each specific case with a one health approach.

Audience Take Away Notes

• They will be able to carry out more precise epidemiological surveillance according to the variant
circulating in each biome
• They will learn a little about the dynamics of the variant mediated by wild canids and bats that circulates
in the Amazon-Cerrado biomes
• They will learn the importance of One Health in these cases
• Optimize financial resources for more specific epidemiological surveillance work
• Understand the dynamics of the virus in its regional ecological niche, especially in Latin America
• Once you understand the dynamics of the disease, it will be easier to plan future actions within the
scope of “One Health”

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• The information provided so far addresses new directions in future on the surveillance system projects
• Other benefits
o It will bring together professionals from other areas of knowledge with a focus on the One Health
approach
Biography

Dr. Francisco Borges Costa graduated in Veterinary Medicine from the State University of Maranhao, Sao Luis,
Maranhao - Brazil, and pos-graduated as Master Science in 2009. He then joined the research group of Prof. Marcelo
Bahia Labruna at the Department of Preventive Veterinary Medicine and Animal Health of the School of Veterinary
Medicine and Animal Science of the University of Sao Paulo, where he obtained his Ph.D degree in 2014. After two years
postdoctoral fellowship supervised by Dr. Labruna in the Program in Experimental Epidemiology Applied to Zoonoses,
he obtained the position of Professor at the PPGCA/UEMA. He has published more than 80 research articles in various
areas.

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Infection 2024

Eric Takashi Kamakura de Carvalho Mesquita1, Washington Carlos

Agostinho2, Ana Karoline Sousa Mendes Simas1, Lidio Lima Neto3,
Enio Mouri4, Paulo Eduardo Brandao2, Francisco Borges Costa1*,
MV, PhD
1
Department of Pathology, Faculty of Veterinary Medicine, State University of
Maranhao, CEP 65055-310, São Luis - MA, Brazil
2
Department of Preventive Veterinary Medicine and Animal Health, University of
Sao Paulo, CEP 05508-270, Sao Paulo, SP, Brazil
3
Virology Laboratory, CEUMA University, CEP 65075-120, Sao Luis - MA, Brazil
4
Instituto Pasteur de Sao Paulo, CEP 01311-000, São Paulo - SP, Brazil

Investigation of wild canid-mediated human rabies death, Brazil, 2021

R abies is an acute viral disease with extremely high lethality, still causing approximately 59,000 human
deaths worldwide every year. Despite being a disease studied for many years and having a very efficient
prophylaxis, a high incidence rate is observed in developing countries. Because the rabies virus has various
reservoirs (all mammals), controlling viral circulation is not an easy task for health surveillance teams,
especially in rural areas, as domestic animals (dogs and cats) actively participate in the virus's infectious
cycle, and wild animals such as bats and foxes also enter in this ecological niche. And right now, we report
a case of a 2-year-old boy who tragically succumbed to human rabies in northeastern Brazil. Initially, the
child had a history of being attacked on the legs by a cat, according to the family`s report. Some nervous
symptoms appeared 35 days after the aggression by the animal, but there was an association with an
allergy to the polio vaccine two days before the onset of symptoms, and the cat was still alive. Through
Sanger sequencing and on-site epidemiological investigation, we have confirmed, for the first time, this
case of human rabies linked to the wild canid variant in an area of the Amazon-Cerrado transition. Despite
attempts at treatment following the Recife protocol, the child passed away on November 3, 2021. Our
findings highlight the interrelationship between humans, the variant virus, and animals, focusing on the
importance of thorough medical history-taking by medical services in these rural areas. This highlights the
impact on global public health in the Amazon-Cerrado transition region of northeastern Brazil, due to the
re-emergence of wild canid-mediated human rabies, sounding a significant alert for health surveillance
services in remote areas away from urban centers.

Audience Take Away Notes

• They will be able to apply the experience reported in future clinical cases
• They will learn a bit about the dynamics of attacks by rabies-infected foxes
• They will learn the epidemiological surveillance procedures used in this specific case
• They will learn the importance of One Health in these types of cases
• The listeners' perception to conduct a more careful medical history taking in children will improve
• They will learn the importance of One Health in cases of rabies
• The perception of an in situ epidemiological investigation will improve
• This could use to expand their research or teaching, since wild canids exist in all countries
• The issues to be reported could be observed in future cases, and the identified errors would not be
made in similar cases
• The strengths and weaknesses of this specific case will be addressed
• Other benefits

o Exchange of experience among professionals in the fields of agricultural defense, epidemiological

surveillance, public health, diagnostic laboratory professionals, among others

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Biography

Dr. Francisco Borges Costa graduated in Veterinary Medicine from the State University of Maranhao, Sao Luis,
Maranhao - Brazil, and pos-graduated as Master Science in 2009. He then joined the research group of Prof. Marcelo
Bahia Labruna at the Department of Preventive Veterinary Medicine and Animal Health of the School of Veterinary
Medicine and Animal Science of the University of Sao Paulo, where he obtained his Ph.D degree in 2014. After two years
postdoctoral fellowship supervised by Dr. Labruna in the Program in Experimental Epidemiology Applied to Zoonoses,
he obtained the position of Professor at the PPGCA/UEMA. He has published more than 80 research articles in various
areas.

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Infection 2024

Hamza Rashid1*, Ayooluwa K. Omoloye1, Siraj Yasser Abualnaja1,

Samson O. Oyibo2, Olugbenru O. Akintade3
Peterborough City Hospital, United Kingdom

A fish farmer's encounter with leptospirosis: A case report

L eptospirosis is a zoonotic bacterial infection primarily caused by Leptospira species. This disease,
characterized by a wide range of symptoms, is uncommon in the UK, with an incidence of 0.14 cases per
100,000. This oral presentation is the case of a 56-year-old male fish farmer who arrived at the emergency
department with thigh pain, immobility, and symptoms of a flu-like illness, including fever, muscle pain,
and dark red urine.

Initial tests revealed renal impairment, metabolic acidosis, hepatitis, thrombocytopenia, and inflammatory
markers suggestive of severe sepsis. Early diagnosis of leptospirosis was made through clinical history
and blood tests, leading to prompt treatment with intravenous ceftriaxone and rehydration. The patient's
condition improved rapidly, and subsequent tests confirmed the diagnosis.

This case highlights the importance of clinical history, particularly occupational exposure, in diagnosing
leptospirosis. It underscores the need for low clinical thresholds for this disease, as rapid deterioration can
occur without timely intervention.

Audience Take Away Notes

• Clinical History Importance: How detailed clinical history, particularly regarding occupational
exposure, is crucial for early leptospirosis detection and treatment
• Diagnostic and Treatment Protocols: How to interpret preliminary investigations and implement
immediate treatment to prevent rapid deterioration
• Low Clinical Threshold: The importance of a low clinical threshold for leptospirosis, even in developed
nations, to ensure timely medical intervention
Biography

Hamza Rashid is a graduate of Imperial College London and a Doctor completing his foundation years (Intern) in
the UK. His interests include general surgery alongside a fascination with tropical diseases and epidemiology, with
a particular emphasis on zoonotic infections like leptospirosis. Dr. Rashid has been involved in clinical research and
teaching, taking part in several systematic reviews and meta-analyses throughout his university education.

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Infection 2024

Helmi Ernandes1*, Salma Kaoual2, Ameni Bellaaj1, Sahar Sallem1,

Ikbel Kooli1, Sophia Besbes2
1
Infectious diseases department, Mohamed Kassab Institute of Orthopedics,
Manouba, Tunisia
2
Human Biology Laboratory, Mohamed Kassab Institute of Orthopedics,
Manouba, Tunisia

Gram-negative bacillary arthritis following arthroscopy

Background: The rate of septic arthritis after arthroscopy ranges from 0.15% to 1%. Staphylococci are the
leading causative organisms after knee arthroscopy whereas Cutibacterium acnes is often the causative
organism after shoulder arthroscopy. Gram-negative bacillary infections are uncommon. Our aim was
to describe the clinical, biological, therapeutic characteristics and outcome of gram-negative bacillary
arthritis following arthroscopy.

Cases Description: We report 9 cases of gram-negative bacillary arthritis following 8 arthroscopic

knee ligament surgery and one arthroscopic shoulder rotator cuff repair. Over this period (18 months),
93 arthroscopies were performed. The sex-ratio was 8 with a mean age of 24 [18-43] years. Risk factors
for infection were smoking (n=7), diabetes (n=2), obesity (n=2) and complex surgical procedures (n=2).
The mean time to onset of clinical signs was 20 [3-33] days. In all cases, symptoms were not specific
including persistent pain (9/9), persistent effusion (5/9) and a low-grade fever (4/9). Laboratory evidence
of systematic inflammation was noted in all cases (high C-reactive protein value with a mean value of
49mg/L). Pseudomonas aeruginosa was identified for all patients in joint aspiration collected fluid and deep
specimens collected during arthroscopic lavage. All patients underwent emergent abundant arthroscopic
lavage with synovectomy in 4 cases. Combination of 2 effective antibiotics, piperacillin- tazobactam
or imipenem with ciprofloxacin, was administered intravenously for an average duration of 15.3 [14-21]
days. Oral treatment was ciprofloxacin monotherapy. Mean total antibiotic duration was 66 [42-90] days.
Eradication of infection was achieved for all patients and functional outcomes were satisfying according
to surgeons.

Conclusions: Gram-negative bacillary arthritis following arthroscopy is a healthcare associated infection

and a therapeutic emergency. Pseudomonas aeruginosa is an extremely rare causative organism identified
in less than 0.2% of cases. Infection is often particularly challenging to diagnose as the clinical symptoms
may resemble those often produced by the procedure itself. Consequently, emergent joint aspiration
is essential. Outcome depends on an early diagnosis. The treatment must combine emergent abundant
arthroscopic lavage with synovectomy as indicated by the stage of infection and administration of effective
antibiotics for at least 6 weeks. Early diagnosis and treatment lead to eradication of infection and satisfying
functional outcome. Prevention based on asepsis and risk factors control is essential.

Keywords: Healthcare Associated Infections, Septic Arthritis, Bacterial Infections, No Conflicts of Interest.

Audience Take Away Notes

• Septic arthritis after arthroscopy is extremely rare and challenging to diagnose and treat. There are
several ways our work could benefit the audience, including
• Providing medical professionals with more accurate and effective methods for diagnosing post-
arthroscopy septic arthritis. This could improve patient outcomes and reduce healthcare costs
• Enhancing the understanding of post-arthroscopy septic arthritis among healthcare professionals,
medical students, and researchers. This could contribute to the development of new treatments and

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prevention strategies for this condition

• Offering a potential source of new research ideas for other faculty members who are interested in
studying septic arthritis or related topics
• Providing a practical solution to a problem that could simplify or make a designer's job more efficient
by improving the design and implementation of medical devices or equipment used in the diagnosis or
treatment of nosocomial septic arthritis
• Improving the accuracy of a diagnosis of nosocomial septic arthritis through the development of more
sensitive and specific diagnostic tools, which could reduce the need for unnecessary treatments or
procedures and improve patient outcomes
• Overall, our research on septic arthritis could provide numerous benefits to the medical community
and potentially have a significant impact on patient outcomes
Biography

Dr. Helmi Ernandes studied at the faculty of medicine of Tunis, Tunisia and graduated as MD in 2020. He obtained
the position of Assistant Professor at the same institution. He works in the infectious diseases department of The
Mohamed Taieb Kassab Institute of Orthopedics and is specialized in the field of bone and joint infections. He is an
ESCMID member, a member of ESCMID Study Group on implants associated infections, ESCMID Study Group on
biofils and ESCMID study group on clinical parasitology.

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Helmi Ernandes1*, Salma Kaoual2, Ameni Bellaaj1, Sahar Sallem1,

Ikbel Kooli1, Sophia Besbes2
1
Infectious diseases department, Mohamed Kassab Institute of Orthopedics,
Manouba, Tunisia
2
Human Biology Laboratory, Mohamed Kassab Institute of Orthopedics,
Manouba, Tunisia

Ralstonia pickettii periprosthetic joint infection

Background: Periprosthetic Joint Infection (PJI) is the most common and feared arthroplasty complication.
Ralstonia pickettii is an opportunistic Gram-negative bacterium, causing nosocomial infections in
immunocompromised patients. It is an environmental bacterium that has been also identified in biofilms.
However, it remains an extremely rare cause of PJI. We report a case of Ralstonia pickettii PJI following
total hip arthroplasty.

Case Description: We present the case of a 62-years-old male patient, that underwent a left cemented
total hip replacement surgery. Four weeks later, the patient presented with fever and groin pain.
Laboratory findings showed hyperleukocytosis and elevated C-Reactive Protein (CRP). Blood cultures
were performed. Radiograph of the pelvis and a horizontal beam lateral hip radiograph of the left hip
revealed signs of loosening at the level of both the acetabular and femoral components. An early PJI
was diagnosed. An ultrasound guided joint aspiration was performed with a negative microbiological
examination. Debridement and change of mobile parts with the retention of fixed prosthetic components
were performed. Soft tissues surrounding the implant and periprosthetic interface membrane were taken
for microbiological testing. Post-operatively, the patient received empiric intravenous antibiotic therapy
based on cefotaxime 150 mg/kg/day and vancomycin 40 mg/kg/day after a loading dose of 15 mg/kg.
Evolution was marked by a persistent fever and high CRP. Bacteriological examination of the tissues
sampled intraoperatively was negative. The retrieved mobile parts were sonicated. Ralstonia pickettii was
isolated from the sonication fluid culture after 8 days of incubation and from blood cultures after 10 days of
incubation. The isolated strain was sensitive to imipenem, meropenem, ciprofloxacin and cotrimoxazole.
A long-term antibiotic therapy was prescribed based on intravenous imipenem and per os ciprofloxacin
(750 mg bid) for 2 weeks followed by 10 weeks of oral ciprofloxacin monotherapy. The clinical and biological
evolution was favourable.

Conclusions: R. pickettii remains an extremely rare cause of PJI. Bacteria culture of sonication fluid remains
the gold standard in PJI diagnosing. However, when an opportunistic pathogen of low virulence such as
Ralstonia is isolated, differentiating contaminant from true pathogen must be based on the clinical context.
Optimal management of R. pickettii PJI has not been established.

Keywords: Implant-Associated Infections, Periprosthetic Joint Infection, Bacteria and Bacterial Infections,
No Conflicts of Interest.

Audience Take Away Notes

• Ralstonia pickettii periprosthetic joint infections are extremely rare and challenging to diagnose and
treat. There are several ways our work could benefit the audience, including:
• Providing medical professionals with more accurate and effective methods for diagnosing and treating
periprosthetic joint infections caused by Ralstonia pickettii. This could improve patient outcomes and
reduce healthcare costs

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• Enhancing the understanding of periprosthetic joint infections caused by Ralstonia pickettii among
healthcare professionals, medical students, and researchers. This could contribute to the development
of new treatments and prevention strategies for this condition
• Offering a potential source of new research ideas for other faculty members who are interested in
studying periprosthetic joint infections caused by Ralstonia pickettii or related topics
• Providing a practical solution to a problem that could simplify or make a designer's job more efficient
by improving the design and implementation of medical devices or equipment used in the diagnosis or
treatment of periprosthetic joint infections caused by Ralstonia pickettii
• Improving the accuracy of a diagnosis of periprosthetic joint infections caused by Ralstonia pickettii
through the development of more sensitive and specific diagnostic tools, which could reduce the need
for unnecessary treatments or procedures and improve patient outcomes
• Overall, our research on periprosthetic joint infections caused by Ralstonia pickettii could provide
numerous benefits to the medical community and potentially have a significant impact on patient
outcomes
Biography

Dr. Helmi Ernandes studied at the faculty of medicine of Tunis, Tunisia and graduated as MD in 2020. He obtained
the position of Assistant Professor at the same institution He works int the infectious diseases department of The
Mohamed Taieb Kassab Institute of Orthopedics and is specialized in the field of bone and joint infections. He is an
ESCMID member, a member of ESCMID Study Group on implants associated infections, ESCMID Study Group on
biofils and ESCMID study group on clinical parasitology.

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Hideliz Marie G. Pascua*, MD, Samantha Bartolo, MD

Baguio General Hospital and Medical Center, Philippines

Foreign fungus: Candida duobushaemulonii bloodstream infection in an

immunocompromised host at baguio general hospital & medical center: A
case report

C andida duobushaemulonii is a yeast that belongs to the Candida haemulonii species complex.
Similar to Candida auris which is an emerging global health threat, C. duobushaemulonii is a major
concern in the healthcare system as it is often multidrug resistant. Presenting the 1st reported case of C.
duobushaemulonii in the Philippines. This is the case of an 80 year old German national, a long standing
immunocompromised patient, who received several cycles of broad spectrum antibiotics due to recurrent
bouts of nosocomial infections who eventually presented with fungemia. Initial idenitification of the yeast
revealed C. auris but on manual biochemical testing reveled C. duobushaemiulonii which was resistant
to all available antifungal therapy in this institution and the Philippines for that matter. As healthcare
professionals, we have to be vigilant in suspecting and diagnosing this rare fungal infection in order to
give prompt and appropriate treatment. Therefore, it is vital to be vigilant in the proper identification and
diagnosis of such opportunistic pathogen and to have the specific antimicrobial agents available.

Introduction: Candidiasis remains as one of the top 5 healthcare-associated bloodstream infections in the
world and still causes high mortality rates. It covers a wide range of diseases, from mild clinical infections
to invasive and even disseminated forms. In humans, Candida species colonizes the skin, oropharynx and
lower respiratory, gastrointestinal, and genitourinary tracts. (Yapar, 2014). Candida duobushaemulonii is a
yeast that belongs to the Candida haemulonii species complex. Yeasts in this complex are closely related
Candida auris, which is an emerging global health threat because it is often multidrug resistant (MDR) and
can cause outbreaks in health care settings (Chawdhary 2014). In the Philippines, there were no reports
isolated C. duobushaemulonii bloodstream infections. We report the first documented case of Candida
duobushaemulonii fungemia in the Philippines.

Case: The patient is an 80 year old male German national who had been residing in the Philippines for
about ten years. His last travel back to Germany was on 2017. He was bedridden since February 2020
from a history of Cerebrovascular disease. He is a known diabetic who had recurrent admissions in our
institution due to repeated bouts of pneumonia. His last admission was on June 2020 wherein he was
managed as a case of nosocomial pneumonia on top of community acquired pneumonia, complicated
UTI, infected sacral decubitus ulcer, UGIB drug induced and dementia and was discharged and improved.
Interval history revealed intermittent episodes of productive cough with thick, white to yellowish sputum
and noted a progression of the sacral ulcer prompting readmission on October 16, 2021. He was septic
and intubated upon admission and went into cardiopulmonary arrest however was revived. He underwent
several debridement for his sacral ulcers and underwent tracheostomy.

During the course in the ward, he had several bouts of nosocomial infections such as Catheter Associated
UTI (C. albicans), Ventilator Associated Pneumonioa (Carbapenem resistant P. aeruginosa), and infected
pressure ulcer (Carbapenem resistant P. aeruginosa). Culture guided therapy was initiated and he was
pulled out of septic shock several times. Patient received the following antibiotics: amikacin, amphotericin

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B, aztreonam, colistin, vancomycin, meropenem, polymyxin B however, despite culture guided therapy, he
succumbed to recurrent hospital infections and into septic shock. On the 120th hospital day, patient still
showed no improvement. He had persistent hypotension hence fluconazole was started. Furthermore,
blood cultures were collected from revealing Candida auris on two peripheral sites identified via Vitek 2
with no susceptibility testing. Fluconazole was shifted to amphotericin B as empiric therapy. The blood
plate containing the fungal colonies was sent for manual biochemical testing and species identification
which revealed Candida duobushaemulonii. Despite maximal medical management, his hypotension
persisted, his immune response did not recover and overwhelming sepsis led to his demise.

Candida auris is what was initially identified in our microbiology laboratory using the VITEK2. Because
this organism is reportable to the national reference laboratory of the country due to the healthcare
burden it brings, the isolated species was regrown and was sent to an outside laboratory for confirmation
via fungal culture and drug susceptibility testing. C. auris and C. duobushaemulonii are almost alike in
microbiological properties. The final isolated candida species turned out to be Candida duobushaemulonii
which is also a rare fungal isolate in the Philippines. The identification of Candida duobushaemulonii was
done in an outside lab using The Vitek 2 automated identification system (bioMerieux) and was confirmed
using biochemical testing.

It is important to note that this paper was written with the consent of the patient’s partner as the patient
was encephalopathic.

Discussion: This is the first reported case of C.duobushaemulonii in the Philippines. Despite extensive
literature search in medical search engines such as PubMed etc, I have not come across any reports on
this organism. However, I have come across similar cases from international journals such as Primary
deep cutaneous candidiasis caused by Candida duobushaemulonii in a 68-year-old man: the first case
report and literature review by Szu-Yun et al., Deep tissue invasion was confirmed by skin histopathology
examination. The pathogen was initially identified as C. haemulonii using the VITEK® 2 system for microbial
identification, but was later determined to be C. duobushaemulonii based on sequencing of the internal
transcribed spacer region of ribosomal DNA and D1/D2 region of 26S rDNA.

On the issue of drug Multi Drug Resistance and cases on fungemia, a journal published Ramos et al on
Emerging Multidrug-Resistant Candida duobushaemulonii Infections in Panama Hospitals: Importance of
Laboratory Surveillance and Accurate Identification similiar case was noted in Panama wherein 17 isolates
were obtained from 14 patients at six hospitals. Ten patients, including three children, had bloodstream
infections, and MICs for fluconazole, voriconazole, and amphotericin B were elevated. Another fungal
infection caused by this organism in an immunocompromised patient is written by Frias-De-Leon et al.
entitled Superficial candidosis by Candida duobushaemulonii: An emerging microorganism.

Wherein molecular reidentification of two clinical isolates that was recovered from a patient with total
dystrophic onychomycosis and isolate from a patient with mucocutaneous candidiasis. patients had
diabetes mellitus as baseline disease. These isolates were initially identified as C. haemulonii by the VITEK®
2 system but were later determined to be C. duobushaemulonii based on the amplification and sequencing
of a 115-bp fragment of the region of 26S rDNA.

C. duobushaemulonii is an emerging opportunistic fungi which can be an agent for hospital acquired
outbreaks especially for immunocompromised patients with prolonged hospital stay. It is a reportable
organism to the national health authority and therefore should not be taken for granted. It is typically multi
drug resitant and with high level of resistance typically to amphotericin B and azoles. Due to its complex
phenotype only molecular-based methods guarantee their accurate identification in most fungal isolates
for that matter. Globally C. duobushaemulonii imposes a great threat to the health care community since
it can cause ac wide array of invasive infections including blood stream infection such as this encountered
to our patient. Furthermore, this pathogen co exists with other pathogenic bacteria which causes a rapid

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decline in the health status of the patient leading to poor prognosis. This infection is an emerging global
health threat and therefore once with high index of suspicion, we must be vigilant to be quick in its
identification and immediately report and alarm the national health authority. In our institution, the initial
identified organism from the blood isolates was Candida auris, being it a rare isolate, we sent the colonies
identified to an outside laboratory for susceptibility testing which later on revealed C. duobushaemulonii
using the Vitek 2 which is a compact system uses a fluorogenic methodology for organism identification
and a turbidimetric method for susceptibility testing using a 64 well card that is barcoded with information
on card type, expiration date, lot number and unique card identification number which identifies some
species of different organism for our patient revealed C. duobushaemulonii. Susceptibility testing was
done using only antimicrobial available which were Voriconazole, Amphotericin B to which the organism is
resistant with and Minimum Inhibition concentration of 8 and 16 ug/ml respectively (Fig. 4). Fluocytosine
was included, which had an MIC of 1ug/l interpreted as susceptible. However, the said antifungal is not
currently available in the Philippines. The interplay of the unavailability of the specific treatment along
with his overwhelming sepsis lead to the demise of the patient.

Fig. 1a. C. duobushaemulonii under light microscopy shows oval shaped yeast cells in clusters.

Fig. 1b. C. duobushaemulonii under light microscope shows oval shaped yeast cells in clusters.

Fig. 3. Sabouraud’s Dextrose Agar showing white to creamy colonies of Candida duobushaemulonii after
72 hours of incubation.

Fig. 3. Antimicrobial Sensitivity test result of C. duobushaemulonii.

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Conclusion: As health care professionals, we must always consider the possibility of opportunistic pathogens
such a C. duobushaemulonii especially for patients with prolonged hospital stay, chronic broad spectrum
antibiotic usage and in an immunocompromised state. A high index of suspicion for such infections is
vital. We must always practice antimicrobial stewardship to avoid multi drug resistant pathogens which is
a consequence of prolonged antibiotic use. C. duobushaemulonii is a reportable organism to the national
health authority as it imposes a heavy burden in the health care system.

Acknowledgements: The authors thank the staff of Baguio General Hospital and Medical Center
microbiology laboratory department for their cooperation and support.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethics Statement: This manuscript has not been published in whole or part elsewhere; Authors have been
personally and actively involved abundantly leading to the manuscript and hold themselves jointly and
individually responsible for its content.

Funding: This research is a stand-alone project and was financed by the investigators.
Biography

Dr. Hideliz Marie G. Pascua of Baguio General Hospital and Medical Center Philippines. She graduated Doctor of
Medicine in 2019 with a Bachelor in Medical Laboratory Science as her pre medical course. She recently finished her
residency training in December 2023. She is currently on her Post Residency Deployment Program in Cagayan Valley,
Philippines.

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Himani Agri
ICAR-Indian Veterinary Research Institute, Izatnagar-243 122, India

A comparative study on uroculturome antimicrobial susceptibility in

apparently healthy and urinary tract infected humans

T he uroculturome indicates the profile of culturable microbes inhabiting Urinary Tract Infections
(UTIs). UTIs are often caused by opportunistic pathogens and it is necessary to do urine culture to
find an effective antimicrobial to treat UTIs. This study targeted to understand the profile of culturable
pathogens in the urine of apparently healthy (128) humans and those with clinical UTIs (161). All the urine
samples were analyzed for bacteria and fungi to quantify their numbers, their species and antimicrobial
susceptibility following standard microbiological methods. In all cases of UTIs microbial counts were
never less than 6000 (1.2×104 ± 2.32×103) Colony-Forming Units (cfu)/ mL even from samples where more
than one types of bacteria were detected, while in urine samples from apparently healthy humans count
ranged from one to 3.33± 1.34×103/ mL. In eight samples (six from UTI cases and two from apparently
healthy people) of urine, Candida (C. albicans 3, C. catenulata 1, C. krusei 1, C. tropicalis 1, C. parapsiplosis
1, C. gulliermondii 1) and Rhizopus species (1) were detected. Candida krusei was detected only in a single
urine sample from a healthy person and C. albicans was detected both in urine of healthy and clinical UTI
samples. In all the samples where fungal strains were detected also had one or more types of bacteria
indicating bacterurea. Gram-positive bacteria were more commonly (OR, 1.98; CI99, 1.01-3.87) detected in
urine samples of apparently healthy humans (96) than in samples from UTI cases (97). In contrast, Gram-
ve bacteria were more common (OR, 2.74; CI99, 1.44-5.23) in urines of UTI cases (117) than in urine of
apparently healthy humans. In urine samples, a total of 130 types of microbes were detected. Of the 161
samples from UTI cases, a total of 90 different types of microbes were detected and, 73 had only single
type of bacteria while 49, 29, 3, 4, 1 samples had 2, 3, 4, 5, 6 and 7 types of bacteria, respectively. The most
common bacteria detected as cause of UTI was Escherichia coli detected in 52 samples, in 20 cases as the
sole cause of UTI, other 34 types of bacteria were detected as sole cause of UTI in 53 cases. In 128 urine
samples of apparently healthy people, too, 89 different types of microbes were detected either singly or in
association with others, from 64 urine samples only a single type of bacteria was detected while 34, 13, 3,
11, 2 and 1 sample yielded 2, 3, 4, 5, 6 and seven types of microbes, respectively. However, similar to urine
from UTI cases in the urine of apparently healthy humans E. coli was the most common bacteria detected
in pure culture from 10 samples followed by Staphylococcus haemolyticus (9), S. intermedius (5), and S.
aureus (5), and similar types of bacteria also dominated in cases of mixed occurrence, E. coli was detected
in 26, S. aureus in 22 and S. haemolyticus in 19 urine samples, respectively. A total of 41 species of microbes
were exclusively detected in urine of UTI cases, and among them the most prominent was Alcaligenes
faecalis (6), Acinetobacter indicus (4) and Streptococcus pyogenes (3), others were detected from one
(34) or two (4) samples only. Similarly, 40 types of microbes were detected only from the urine of healthy
people, the most common being Mammaliicoccus sciuri and S. cohnii ssp. urealyticus (3 samples each),
others were detected from two (7) and one (27) samples respectively. Of the forty microbes detected only in
the urine of apparently healthy subjects 28 were Gram+ve bacteria, 11 were Gram-ve bacteria (Aeromonas
media, A. trota, Citrobacter amalonaticus, Escherichia vulneris, Hafnia alvei, Leclercia adecarboxylata,
Providencia haemabachae, P. stuartii, Pseudomonas testosteronii, Roseomonas rosae and Xanthorhabdus

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poinarii). The bacteria detected only from the urine of healthy humans, do they have some health benefit or
inhabit urinary tract commensally is an area of further investigation. Gram+ve bacteria isolated from urine
samples' irrespective of health status were more often (p, <0.01) resistant than Gram-ve bacteria to ajowan
oil, holy basil oil, cinnamaldehyde, and cinnamon oil, but more susceptible to sandalwood oil (p, <0.01).
However, for antibiotics, Gram+ve were more often susceptible than Gram-ve bacteria to cefalosporins,
doxycycline, and nitrofurantoin. On comparing antimicrobial susceptibility of Gram+ve bacteria isolated
from urine samples of healthy humans and those suffering from UTI, bacteria from cases of UTI were more
often (p, ≤ 0.01) resistant to lemongrass oil, carbapenems, cefalosporins, tetracycline, gentamicin, amikacin,
cotrimoxazole, ciprofloxacin, chloramphenicol, and vancomycin but more susceptible to nitrofurantoin
(p, <0.01). Gram-ve bacteria from urine of UTI cases was more often (p, ≤ 0.03) resistant than those from
healthy humans to cinnamaldehyde, carvacrol, thyme oil, cinnamon oil, more often produced extended-
spectrum β-lactamases, carbapenemases, and resisted cefalosporins, tetracycline, amikacin, gentamicin,
cotrimoxazole, ciprofloxacin, chloramphenicol, amoxicillin, and colistin but were more often susceptible
to lemongrass oil (p, <0.01). The results of the study and their implication in therapeutics of UTIs may be
discussed in detail during the presentation.
Biography

Dr. Bhoj R. Singh, after doing BVSc & AH in 1985 (Mathura Veterinary College), He completed his master's degree in
Veterinary Public health in 1990 (ICAR-IVRI) and Ph.D. in 1997 (GBPUA&T, Pantnagar). He pursued a year of PDF at
IAH Compton, UK and a P.G. Diploma in IPR (IGNOU, Delhi) in 2007. Joined as a scientist in 1991 and progressed as
senior scientist (2000), Principal Scientist (2005) and Head of the Division in 2007 in the Indian Council of Agricultural
Research and worked at different institutions of the Council. He had published 19 Review articles, 6 books and more
than 200 research papers in internationally reputed journals besides contributing 17 book chapters, and 33 technical
reports, and drafted the Veterinary vaccines and vaccination policy of India. He has guided 7 PhD and 12 MVSc Students.
His important contributions are development of a genetically defined oral vaccine for the control of salmonellosis in
equids, a toxoid vaccine for the control of klebsiellosis in fur animals, a toxoid vaccine for control of salmonellosis in
poultry birds, a synthetic milk detection kit, a pen-side test for detection of canine parvovirus infection, an ELISA for
diagnosis of salmonellosis and germinating seeds model, mouse paw oedema model for toxicity assays and guinea
pig model for salmonellosis abortions. His work on the kinetics of zoonotic Salmonella in vegetables and feed and
fodder crops, carriage and spread of zoonotic Salmonella by cockroaches, the microbiome of ethnic foods of Nagaland,
India (Axone) to identify the probiotic strains, the microbiome of house geckos reproductive tract to understand the
vertical transfer of microbes, the microbiome of apparently healthy Mithun and pig reproductive tract to identify
potentially pathogenic bacteria carried by them, the microbiome of Azadirachta indica and Ocimum sanctum to
establish a relationship with environmental contamination and pathogens residing on plants, genetic regulation of
herbal antimicrobial resistance in bacteria and emergence of herbal antimicrobial resistance are the most cited works.
He has a long experience as a scientist and administrator while working as scientist, senior scientist and principal
scientist in ICAR, director of the National Institute for Animal Health, Baghpat (DAHD) meant for vaccine quality
control and quality analysis, in-charge of the National Salmonella Centre, Head Division of Epidemiology, chairman of
the Board of Studies of Veterinary Public Health and Epidemiology at ICAR-Indian Veterinary Research Institute, Head
of the Department of Animal Sciences at ICAR Port Blair, Act. Joint Director, at ICAR Research Complex Jharnapani
Centre, Nagaland, and Chief Bacteriologist NRC on Equine, Hissar. He is a visiting professor of Veterinary Microbiology
at GADVASU, Ludhiana, visiting faculty at Times PG Institute, Dehradun, Uttrakhand, and international faculty on
Enteric Diseases at the University of Sassari, Italy. His recent work is on the synergy between antibiotics and herbal
antimicrobials and the epidemiology of the emergence of antimicrobial drug resistance. He is the most read Veterinary
Scientists in India and one of the Topmost e-health Influencers in the world.

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Britt Hornei*, Christine Schonfeld, Dilara Ceyhan, Katharina Nadolski, Hassan Issa
Institiut fur Klinische Mikrobiologie und Labormedizin, Germany

Evaluation of the clinical effectiveness of an early marker system for

differentiating between viral or bacterial respiratory infections or
febrile infections in a children's hospital during the first post- pandemic
season

T he aim of the study is the clinical evaluation of an diagnostic marker system that is able to distinguish
between bacterial and viral infection, with focus on the influences on therapeutic regimes in primary
care and inpatient care.

Material and method: The MeMed- BV® Scores (Diasorin) measures the three non-microbial proteins
TRAIL, IP-10 and CRP using CLIA technology on the LiaisonXL. The test result is determined as a score,
while a low score indicates a viral and a high score a bacterial infection.

The study included children presenting to emergency departments, as well as inpatients from the children's
hospital with suspected acute bacterial or viral infections. The results of the MeMed-BV are compared with
the results from cultural and molecular biological routine diagnostics including multiplex PCR systems
(MAGPIX-System, Diasorin). A total of 49 patients were included.

For the clinical evaluation, a score was developed that describes whether the various aspects of diagnostics
and therapy correlate with the results of the MeMed-BV test and whether options for optimizing the use of
antibiotics can be derived from this.

Results: After the patients were discharged, the test results were compared with the case data and the
score was applied. All cases were evaluated together with the treating physicians.

The majority of patients showed respiratory symptoms with and without fever. In 30 cases, 34 viral
respiratory pathogens were detected and in 8 cases bacterial infectious agents. Gastroenteritis occurred
in 12 patients (5 x viral pathogens, 1x bacterial pathogen) Urinary tract infections, appendicitis, otitis and
tonsillitis also occurred.

The assignment to bacterial or viral infection was possible in almost all patients; in only 2 cases the result
was not clear. The self-developed evaluation score was also able to differentiate well for the majority of
patients (Fig. 1) and shows the potential for improvement.

Analyzing the cases we eliminated gastroenteritis, appendicitis and urinary tract infections, due to bad
concordance. The new evaluation was additionally stratified according to “bacterial” and “viral” (fig. 2).

We found a good concordance between the MeMed-BV and the clinical picture respectively the diagnostic
results. Only the laboratory findings for “bacterial” didn’t matched well, caused by a lack of cultural
examinations. Checking the antibiotic therapy, the MeMed BV gave the best results for bacterial infections
and viral diseases with high CPR. Viral diseases with low CRP therefore have the highest potential for
adaptation to antibiotic therapy.

Conclusions: The MeMed BV assay is a powerful tool in clinical practice when used for respiratory diseases
with and without fever. Especially in the case of viral respiratory diseases, despite the use of multiplex PCR
systems and the associated improved pathogen detection in clinical management, there is still uncertainty
about the assessment of the results and the potential of bacterial superinfections. The MeMed assay
has proven to be very helpful and can therefore become an important tool for antibiotic stewardship in
pediatrics.

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MeMed BV® Score value number of patients

High Viral 32
Modal Viral 5
Modal Bacterial 6
High Bacterial 4
undetermined 2
Total 49

Table: 1 Results of MeMed-BV

Abb1. Results of clinical Scoring

Abb2. Mean value of Scoring after strafication

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Jonathan Lambo*, Sirving Keli, Shaheen Khan Kaplan, Temiloluwa

Njideaka Kevin
Avalon University School of Medicine, Willemstad, Curacao Jonathan Lambo, MD,
MSc, MPH, BSC. (Hons), DTM&H (RCP), United States

The descriptive epidemiology of adverse events following two doses of

mRNA COVID-19 vaccination in Curacao
Background: Globally, over 13 billion COVID-19 vaccine doses have been administered, which increases the
risk of vaccine-related safety concerns. BNT162b2 and mRNA-1273 COVID-19 vaccines have been used for
mass vaccinations in Curacao, but information on Adverse Events (AEs) in this population is unavailable.
This study describes the characteristics of vaccines that incurred AEs, explores the associations between
AEs by vaccine and doses, and estimates the rate of AEs.

Methods: In this retrospective cohort study, data for persons aged 5 years and older who received at
least one dose of COVID-19 vaccine at 78 vaccination centres in Curacao between February 21, 2021, and
April 5, 2023, were analysed. AE were reported by vaccinees and categorized according to the Brighton’s
collaboration criteria. Wilson 95% Confidence Intervals (CIs) were calculated for rates of AEs per 100,000
persons vaccinated. Descriptive analysis included frequencies and proportions to describe patterns in
rates by age, sex, and number of vaccines.

Results: During the study period, 260,670 doses of COVID-19 mRNA vaccines (59.7% BNT162b2, 40.3%
mRNA-1273) were administered to 150,000 individuals (mean age of vaccinees 51 years, 55% females). The
vaccines differed significantly in frequency distribution of vaccinees by age, age groups, sex, AEs, and
prior COVID-19 infection. Females were more likely to be vaccinated compared to males. Of the 209,720
persons who received two doses of COVID-19 mRNA vaccine, a total of 84 AE reports related to COVID-19
vaccine were received for the study period (overall rate of 40.1 per 100000 persons (95% CI 32.4-49.6)).
BNT162b2vaccinees (58.3 per 100000 persons, 95% CI 45.4-74.9)) incurred substantially significant higher
AE rate than mRNA-1273 vaccinees (21.9 per 100000 persons, 95% CI 14.6-32.8). There were statistically
significant differences in AE rates between males and females. AE rates also varied by the number of doses
and by mRNA vaccine group. In addition, overall and by mRNA vaccine group, the rates for AE defined
as systemic were higher than those for AE defined as local. By age group, the highest rates were among
age group 45-54 years (158 per 100000 persons vaccinated for BNT162b2 vaccine compared with (62 per
100000 persons vaccinated for mRNA-1273 in the same age group (Figure 1). Male BNT162b2 vaccinees has
the highest AE rates in the age group 15-24 years (48 per 100000 persons vaccinated) and higher rates
than male mRNA-1273 vaccinees in age groups 25-34, 35-44, and 55-64 years. Occurrence of AEs was
strongly associated with mRNA vaccine group, sex, number of doses, but not with age, age group, and prior
COVID-19 infection. mRNA-1273 was associated with a significantly lower risk of AEs.

Conclusions: AE reporting varied by age, sex, and vaccine used as well as the number of doses. Female
predominance of higher rates may be due to biased reporting, although females had higher number of
vaccinations administered than males. Future studies should allow for follow up and longer-term reporting
of AEs.

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Audience Take Away Notes

• We recommend more real-world studies comparing the effects of different vaccines to reassure the
public that the benefits of vaccination outweigh the risks

• Studies should include large sample size, better representation of real-life vaccine populations such as
elderly, those with a history of COVID-19, comorbidities, or allergies, all of which are known to increase
the risk of AEs, as well as safety profiles, and limited missing information

• This study suggests that there is underreporting and reporting bias for AEs related to COVID-19
vaccination. Future research should be directed at factors that influence reporting and non-reporting
of AEs
Biography

Dr. Lambo studied medicine at the University of Vienna and trained as a family physician at General Hospital Linz,
Austria. He completed a two-year fellowship in Epidemiology and Public Health at the London School of Hygiene and
Tropical Medicine and trained at the Hospital for Tropical Diseases where he obtained his DTM &H RCP (Diploma in
Tropical Medicine and Hygiene Royal College of Physician). He served as a Medical Officer at UNICEF and WHO. He is
a Professor of Epidemiology and Public Health at the Avalon University School of Medicine. His research group works
on surveillance of infectious diseases.

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Julissa Soto
Julissa Soto Latino Health Equity Consulting, United States

The power of cultural validation a global innovative strategy when

working with vaccines

A t the onset of the COVID-19 Pandemic, policymakers and public health officials often cited “vaccine
hesitancy” as a key challenge to reaching vulnerable populations, including immigrants, Spanish-
speaking communities, Latino communities, and others who have been marginalized. Yet, community-
based programs utilizing “Cultural Validation” techniques, such as “Vaccine Sundays,” and “One School,
One Vaccine at a Time,” quickly demonstrated that barriers to access – not hesitancy – were the true
culprits.

Cultural Validation is a technique that works to increase access and break down barriers for what many
policymakers and public health officials see as “hard to reach populations.” The model encourages
policymakers and public health officials to research communities, meet communities where they are, and
to connect with communities in languages they can not only understand, but also relate to. Demonstrative
programs like “Vaccine Sundays” and “One School, One Vaccine at a Time,” are also successful because they
focus on relationship. Community and public health workers build trust and genuine relationships with
principles, school board members, school nurses, or pastors, preachers and other faith leaders. Vaccination
events are then held at local schools or churches, with an emphasis on building genuine relationships with
community leaders and influencers, as well as culturally relevant marketing strategies, prior to the events.
During the event, public health partners and providers focus on providing genuine customer service that
demonstrates kindness, caring and cultural validation. As importantly, “Vaccine Sundays,” and “One School,
One Vaccine at a Time,” events are designed around the idea of making vaccinations fun, not scary. Events
are often referred to as “vaccine parties” instead of “vaccine clinics”. Successful strategies have included
providers in superhero costumes, as well as brightly colored mobile vans, among other activities.

This model was proven highly effective during the COVID-19 Pandemic. While Latino and immigrant
communities had been described as “vaccine hesitant”, events using the Cultural Validation method
provided immediate results. The first event saw more than 1297 vaccines administered in what had been
described as “vaccine hesitant” communities. In fact, supplies had to be bussed in to keep up with demand,
and vaccines were being administered throughout the night. Over the last few years, Cultural Validation
techniques have resulted in more than 30,000 vaccinations and the distribution of more than 130,000
testing kits and 100,000 masks.
Biography

Julissa Soto Latino Health Equity Consulting has been a leader in the field of vaccines and immunizations in Colorado
and throughout the nation since the onset of the COVID-19 Pandemic. The deployment of her signature community-
based intervention strategy, Cultural Validation, has already resulted in more than 30,000 vaccinations and the
distribution of more than 130,000 COVID-19 testing kits and 100,000 masks. In fact, her strategies and techniques
have earned numerous awards across the country. Governor Jared Polis proclaimed September 20, 2021 as “Julissa
Soto Day,” for her efforts during the pandemic in Colorado, and in 2023, she received the Immunization Champions
Award from the Association of Immunization Managers for the State of Colorado based on the recommendation from

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the Colorado Department of Health and Public Environment. She was also recognized with the 2023 Distinguished
Service Award from the CU Anschutz Medical Campus, an Honorable Mention at the 2023 Immunization Neighborhood
Immunization Champion Awards from the National Adult and Influenza Immunization Summit (NAIIS), the 2022 Award
for Excellence in the Promotion of Health Equity from the Colorado Public Health Association, the 2022 Equity in
Immunization Award from the National Coalition for Immunization Coalitions and Partnerships, the 2022 Big Shot of
the Year Award from Immunize Colorado, and the 2022 Heroines of the Pandemic Award from Pikes Peak Women. She
received accolades from U.S. Senators Michael Bennet and John Hickenlooper, as well as from many others.

Over the last three years, Julissa Soto Latino Health Equity Consulting has organized and hosted more than 300
community-based vaccine clinics. This success comes from not only from Julissa Soto Latino Health Equity Consulting’s
specialization in vaccines and immunizations, but also the CEO’s own personal and professional connection to
communities that face health disparities and barriers to vaccine accessibility. As a Spanish-Speaking, first generation
immigrant herself, Julissa is dedicated to forming genuine relationships with the communities she serves as well
as the partners she works with; Her background and experience enable her to meet communities where they are
and connect with them in culturally relevant languages and methods they can understand and relate to. Her ability
to effectively engage diverse and underserved communities has also been widely recognized, earning the 2022 DEI
Champions in Advocacy Award from the Colorado Springs Independent, Colorado Springs Business Journal, Southeast
Express and Colorado Spring Military Newspaper Group, the 2022 Victor Smith Memorial Award from Colorado Cross-
Disability Coalition, the 2017 Centers for Disease Control and Prevention (CDC) Best Practices Award, the 2016 People
Who Make a Difference Award from Wells Fargo, and the 2015 William Funk Award for Building Stronger Communities
from the Colorado Nonprofit Association.

By combining her lived experience with more than twenty years of community-based health programming experience,
Julissa Soto Latino Health Equity Consulting has also become a renowned expert in bridging the gap between providers
and communities. Julissa Soto holds key positions as a Vaccine Community Advisory Member at University of Colorado’s
Children’s Hospital and as a Cultural Advisory Board Member at Vaccinate Your Family – a national nonprofit agency
that strives to protect people of all ages from vaccine-preventable diseases – and where she shares her extensive
health equity expertise to aid in the development of outreach plans to increase pediatric COVID vaccine uptake in
marginalized communities. She is also a member of the following organizations and workgroups: the Immunization
Workgroup at the National Association of County and City Health Officials, the Health Equity Commission at the
Colorado Department of Public Health and Environment, the Denver Catholic Medical Association, the National
Hispanic Medical Association, the National Association of Community Health Workers, the Kansas Community Health
Worker Coalition, the Conference for Immunization Coalitions and Partnerships National Coalition Conference
Planning Committee, the Colorado Department of Health Care Policy and Finance Ambassador Team, the Colorado
Suicide Prevention Commission, the Behavioral Health Equity Steering Committee at the United States Substance
Abuse and Mental Health Services Administration (SAMHSA).

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Karen Ivy Bacsain1*, M.D; Jose Manuel Ranola III2, M.D, FPCP;
Charissa Divinagracia3, M.D, FPCP; Floranie Paredes4, M.D, FPCP
Universidad de Santa Isabel Health Services, Naga City, Philippines

Pulmonary manifestations of chronic melioidosis in a patient with Type

2 Diabetes Mellitus: A case report
Background: The Philippines, being a tropical country, makes for an interesting reservoir for diverse
bacterial flora. One such pathogen is the Burkholderia pseudomallei, a Gram-negative pathogen, found in
moist soil and rainwater. Cases increase during the monsoon rains, which occur bi-annually from June to
September as well as November to February. Highly susceptible are patients with Type 2 Diabetes Mellitus
who are already affected by the presence of chronic inflammation and immune dysfunction.

Objective: To present a case of melioidosis presenting with a two-month history of intermittent episodes
of fever associated with generalized body weakness, and chills.

Case: A 55-year-old Filipino female with poorly controlled Type 2 Diabetes Mellitus was admitted in severe
cardiorespiratory distress and placed on high flow nasal cannula. Patient was RT-PCR negative and was
initially started on Meropenem. Blood Culture and Sensitivity results came out positive for Burkholderia
pseudomallei. Meropenem was completed for 7 days. Patient was also started on Ceftazidime, thereafter,
the patient gradually improved and was discharged.

Conclusion: Melioidosis is a lesser diagnosed disease entity in the Philippines. Despite advances in
antibiotics, it may still be a formidable disease as it is still associated with significant mortality due to
sepsis and difficulty of diagnosis.

Keywords: Melioidosis, Type 2 Diabetes Mellitus, Burkholderia Pseudomallei, Sepsis, Community- Acquired
Pneumonia.

This presentation will give insights on the treatment and diagnosis of sepsis secondary to Burkholderia
pseudomallei in a vulnerable population. In this clinical scenario, rapid recognition and prompt treatment
correlates with good outcomes.
Biography

Dr. Karen Ivy Bacsain is a graduate of the University of Santo Tomas Faculty of Medicine and Surgery, Class 2019. She
had her post-graduate internship in 2019-2020 in the Manila Doctors Hospital. She is currently in her third year of
residency training in the Universidad de Santa Isabel. Health Services, Naga City.

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Katarzyna Grudlewksa Buda*, Julia Czuba, Agnieszka Ratajczak,

Natalia Wiktorczyk Kapischke, Anna Budzynska, Krzysztof
Skowron
Department of Microbiology, L. Rydygier Collegium Medicum in Bydgoszcz,
Nicolaus Copernicus University in Torun, Poland

Pheno-and genotypic characterization of Enterococcus spp. isolated

from the animal farm environments

B acteria of the Enterococcus genus are opportunistic microorganisms widely prevalent in the
environment. An important source of pathogenic strains of Enterococcus spp. are farm animals
and their living environment. Enterococcus faecium and Enterococcus faecalis species are most often
responsible for causing infections in humans. Increased antibiotic resistance of strains is often associated
with the presence of various virulence factors.

The aim of this study was the assessment of drug susceptibility of Enterococcus spp. isolates from livestock
farming environment and the frequency of genes encoding selected Virulence Factors (VFs).

Material for the study consisted of 364 isolates Enterococcus spp. strains from the pig (200, 54.9%),
poultry (132; 36.3%) and cattle (32; 8.8%) husbandry environment in the form of swabs and faeces. Species
identification of obtained strains was performed using MALDI- TOF MS technique. Antibiotic susceptibility
of isolates was assessed by disc diffusion method according to the EUCAST v. 14.0 recommendation. The
study evaluated the presence of the selected VFs genes (ebpABC, pil, efaAfs and gelE) was made using PCR
method for 40 strains E. faecalis and E. faecium isolated from poultry farm.

The isolated strains belonged to 8 species of Enterococcus spp. with the highest frequency: E. hirae - 144
(39.6%), E. faecium - 120 (33.0%) and E. faecalis - 77 (21.2%). Evaluation of drug susceptibility showed that
279 (76.6%) of the strains were resistant to at least one antibiotic. The highest number of strains showed
resistance to streptomycin (n=199, 54.7%). The lowest percentage of resistance was reported for teicoplanin
(n=3, 0.8%). Also, high-level aminoglycoside resistance (HLAR) was detected in 6.04% of E. faecalis strains.
One vancomycin-resistant E. faecium strain was detected. The study showed the presence of Multidrug -
Resistant (MDR) (103; 28.3%) and Extensively Drug Resistant (XDR) (9; 2.5%) strains.

The presence of selected virulence genes was found in 6 isolated strains among 40 tested. Five represented
E. faecalis species, and one E. faecium. The study found one strain of E. faecalis carrying all VFs genes
included in the study.

The irrational use of antibiotics in agriculture and veterinary practice is considered to be one of the
key reasons for the rapid spread of antibiotic resistance among microorganisms. Owing to the fact that
farm environments can be a reservoir of antimicrobial resistance and transmission route of antimicrobial
resistance genes from commensal zoonotic bacteria to clinical strains, it is of a great importance to public
health to monitor trends in this research area.

Audience Take Away Notes

• The presentation highlighted that the livestock environment can be an important reservoir of multi-
drug resistant strains and virulence genes
• Characterization of strains present in the livestock environment is extremely important to limit the
spread of antibiotic resistance which has public health implications

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• The presentation aims to highlight the problem of resistance in commensal strains in the animal
husbandry environment
Biography

Dr. Katarzyna Grudlewska-Buda studied biotechnology at L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus
Copernicus University in Torun in Poland and graduated as MS in 2014. She received her PhD degree in 2020 at the
same institution. Her research is focused on study of antimicrobial activities, microbial tolerance to stress factors,
antibiotic resistance, and assessment of expression levels of virulence genes of clinically important pathogens.
Her interests extend to Enterococcus species and characterization of these bacteria from non-clinical sources. Dr.
Katarzyna Grudlewska-Buda has published 63 full-text publications and contributed to 5 chapters in monographs.

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Keekok Lee
University of Manchester, United Kingdom

Assessing COVID-19 in the context of geopolitics

T his contribution is an attempt to clarify some of the issues raised by the COVID-19 pandemic when it
hit the globe roughly between 2020 and 2022 from the perspective of geopolitics. It is, therefore, per
se, not a discussion from the narrow medical point of view but the political and to argue that Epidemiology,
in particular, cannot be adequately understood unless it is explored in a wider context which includes the
history, culture, ethics, politics of each nation-state and the relationship between them. This exploration
chooses to concentrate on two countries and their respective strategies to cope with the pandemic, namely,
the USA on the one hand and the People’s Republic of China on the other – the former is paradigmatically
a liberal democracy while the latter an autocracy/authoritarian regime. The PRC adopted two strategies
(lockdown and mask-wearing) to control the spread of the disease. The USA did not, on the grounds that
they were morally and politically abhorrent. American culture, in general, prioritises individual freedom
above all other values, including safety and security about health. Chinese culture, in general, prioritises
collective freedom above other values and hence endorse restrictions on personal freedoms when these
are deemed necessary to ensure health security, such as lockdown, mask-wearing, keeping an appropriate
distance from others in public spaces, even avoiding public spaces altogether (even including not going
out to shop). Politics apart, how effective are these respective strategies in saving lives? Mortality rates
as officially reported by these two countries appear to show that the Chinese approach is more effective.
Biography

Keekok Lee is a graduate in philosophy at the University of Singapore (BA), of Oxford (B.Phil.) as well as of Manchester
(PhD). She taught philosophy at the University of Singapore before joining the University of Manchester in 1966, taking
early retirement in 1999. Since then, she has continued to research and to publish in numerous domains such as the
philosophy of law, politics, genetics, medicine (both Biomedicine and Classical Chinese Medicine) and now geopolitics,
using the techniques of analytical philosophy to clarify pressing issues raised in each of these domains. She practises
what may be called practical philosophy.

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Komal Mushtaq
DHQ Sheikhupura, Pakistan

Measles outbreak – another post- COVID phenomenon: Lessons to be

learnt
Introduction: Measles virus is an aerosol borne and one of the most Contagious Pathogens1. Almost every
measles virus Infection becomes Clinically manifest, furthermore, it can cause fatal complications and has
high morbidity and mortality. Measles virus infection is a vaccine preventable disease. This strategy is also
used in developed countries as well because of naturally expected epidemic of measles after few years2.
The first symptoms of Measles are fever, cough and coryza followed by maculopapular rash. Mortality in
measles is due to complications and under 5 years of age, measles complications are higher.3 Measles
cause serious complications among them Pneumonia, otitis media and diarrhea are in acute phase,
furthermore, Tuberculosis activation, malnutrition after measles, T-Cell anergy here as well before SSPE
(Subacute sclerosing panencephalitis) is a non-treatable and fatal neurological complication which leads to
worsening of higher mental functions and eventually cause Death4. In Pakistan, mass immunization against
measles in 2018 and Measles-Rubella IMMUNIZATION Campaign was done in 20215. More than 386,000
health professionals, including 76,000 vaccinators and more than 143,000 social mobilizers are mobilised
for the two-week campaign supported by Gavi, the Vaccine Alliance, UNICEF, WHO and partners. The
children aged between 9 months and 15 years, those aged up to five will also receive the oral polio vaccine,
were targeted by the Campaign 6.

In national Study, the number of cases of measles in 2012 was reported to be 14,000 with 210 patients
dying of it. Unfortunately, due to a lack of proper surveillance infrastructure, the demographic statistics,
including ages of the patients affected by measles in the current epidemic in Pakistan are unknown7. The
Covid-19 Pandemic causes disruption in routine EPI services along-with inequality in access to Vaccines.
Although WHO emphasize the importance of EPI Vaccinations, however, countries with resource limitation
as in Pakistan current Epidemic COVID-19 vaccination was done by EPI Staff which affects routine EPI
Vaccination Program 8.

Materials and Method: Study Design: Cross-sectional study. It’s a multi-centric study and will be conducted
in Mayo Hospital Lahore and Mother Children Complex Sheikhupura.

Sampling Technique: Non- Probability Convenience sampling.

Sample Size: All measles cases in both setup.

Inclusion Criteria: All measles cases which are admitted in Mayo Hospital Lahore and Mother and Children
Complex Sheikhupura.

Exclusion Criteria:
• Rash without fever.
• Rash disappear within 72 hours.
• Children admitted with measles in hospital 21 days prior measles infection. Medical record available.

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Data Collection Procedure: Measles patients admitted in Mayo Hospital Lahore and mother children
complex Sheikhupura were admitted in this study. Patient’s gender, age and contact details were taken
after their consent. Measles clinical spectrum, vaccination and malnutrition association will be assessed
by predesigned Questionnaire performa by researchers.

Data Analysis: All the data will be entered and analysed by SPSS 22.

Objective: To assess the clinical spectrum of measles infection including its complications, association
with malnutrition and positive Ig M results.

Operational Definitions:

Suspected Measles Case: A suspected case is one in which a patient with fever and maculopapular (non-
vesicular) rash or in whom a healthcare worker suspects a measles.

Confirmed Case: A suspected case of Measles that has been confirmed positive by testing in a WHO
accredited Laboratory and vaccine associated Illness has been ruled out.

Pneumonia: pneumonia is an acute respiratory infection that affects the lungs.

Meningo- Encephalitis: Meningo-encephalitis is a serious infection of the meninges (membranes covering

the brain and spinal cord) and brain parenchyma.

Diarrhea: Diarrhea is defined as the passage of three or more loose stools or liquid stools per day.

Malnutrition: Malnutrition refers to deficiencies, excess or imbalance in a person’s intake of energy or

nutrients. In our study, malnutrition refers to deficiency of nutrients which can be classified by using WHO
classification. Z score along with anthropometric measures used to classify malnutrition as

Mild -1.0 to 1.9

Moderate -2.0 to 2.9

Severe< -3.0

Questionnaire for the Research entitled as:

Measles Outbreak – Post Covid Phemeneon: Lessons to be Learnt.

A - Demographic Details:

Name ----------------------------------------- Age ---------------------- Gender ----

------------

Address-------------------------------------------------------------------------------------------------------------------

Parents Occupation & Monthly Income --------------------------------------------------------------

----------

B - Clinical Spectrum of Measles:

Measles case
1. Suspected case
2. Confirmed case (Ig M / PCR)

Complication of Disease
1. Meningo-encephalitis
2. Pneumonia
3. Diarrhea

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4. Other
Co-Morbidities
1. Malnutrition

Yes

No

If yes than
o Mild
o Moderate
o Severe

2. If Known case of any other disease ---------------------------------------------------------------

Vaccination Status:
1. Vaccinated
2. Unvaccinated
3. Catch-up vaccination

• Age ---------------------

• How many months earlier ----------------------

• Routine / SNID -----------------------

Hospital Stay (In Days) -------------------------------------------------------------

Zinc Supplementation
a) Yes
b) No

Vitamin A Supplementation
a) Yes
b) No

H/O Measles exposure

a) Family
b) Neighbor/Guest
c) School
d) Hospital
e) None
Biography

Dr. Komal Mushtaq, did Bachelor of Medicine and Bachelor of Surgery from Faisalabad Medical University in 2013.
I did my Post-Graduation training from Children Hospital Lahore. I passed my fellowship examination in 2019 with
flying colours. I am awarded as Paediatric Ambassador by prestigious Institution, College of Physicians and Surgeons
Pakistan. I joined District Headquarter Hospital Sheikhupura as Consultant Paediatrician. Furthermore, I voluntarily
support UNICEF Projects for Child diseases management. I have special interest in Preventive Paediatric and Research
Projects to improve child care and this very project on Measles reflects ‘From Little acorns mighty oaks do grow.’

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Bastos L. F
University Center Assis Gurgacz Foundation, Brazil

Analysis of the influence of the COVID- 19 pandemic on reported malaria

cases in Brazilian macroregions between 2018 and 2022

T his article aims to identify the impact of the novel coronavirus pandemic on malaria cases in the North,
Northeast, Midwest, Southeast, and South regions of Brazil, given the similarity of initial symptoms,
the need for reallocation of resources, and the burden on public health systems, factors that may have
affected the proper differentiation and timely treatment of both diseases.

Introduction: Malaria is an infectious disease caused by parasites of the genus Plasmodium, which are
transmitted to humans through the bite of infected mosquitoes of the genus Anopheles. These parasites
multiply in the liver and then infect red blood cells, leading to symptoms such as fever, chills, sweating,
headaches, and, in severe cases, potentially fatal complications.

In contrast, Covid-19, officially identified in Wuhan, China, in December 2019, is caused by the SARS-CoV-2
virus. It immediately became a global concern due to its rapid spread, uncertainty surrounding preventive
measures, and potential devastating impacts on global healthcare systems. The resulting pandemic has
driven intensive research efforts and international collaboration to understand, control, and develop
effective vaccines against the disease.

The correlation between the diseases exists since initial symptoms such as fatigue, high fever, difficulty
breathing, and myalgia can coexist in both cases. Moreover, malaria prevention and control measures such
as distribution of insecticide-treated bed nets and epidemiological surveillance in endemic areas were
hindered by the Covid-19 pandemic due to the fact that social isolation was initially the primary measure
to reduce the spread of the novel coronavirus.

It is worth noting that hydroxychloroquine was widely considered as a potential therapy, despite the lack
of solid scientific evidence initially, for its use in the treatment of Covid-19. This hasty approach led to
the indiscriminate administration of the medication, in many cases, raising a series of medical and ethical
concerns. One of the less discussed consequences of this practice was the potential underdiagnosis of
malaria cases, a disease with similar symptoms, which is effectively treated with this drug. The rampant
use of this medication in the context of COVID-19 may have caused confusion in diagnoses, obscuring the
distinction between the two diseases and impairing the ability to properly identify and treat malaria.

Metodology: For this study, the absolute numbers of reported Malaria cases were analyzed in the
Department of Health Informatics of the Unified Health System (DATASUS), from the years 2018 to 2022,
across the Northeast, Midwest, Southeast, and South regions of Brazil. Data from the North region were
analyzed using the Epidemiological Surveillance System platform (SIVEP). The number of malaria cases
was tallied annually in each region covered by the study from 2018 to 2022. It's worth noting that all utilized
data were de-identified, lacking patient identification. The obtained data were allocated, tabulated, and
processed into spreadsheets and graphs using Microsoft Excel® software.

Keywords: Malaria, COVID-19, Pandemic.

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Results: To elucidate the obtained results, the data analysis was subdivided into two distinct categories: the
extra-Amazon region, which encompasses the macro-regions Northeast, Midwest, Southeast, and South,
and the Amazon region, consisting exclusively of the North macro-region. This approach was adopted due
to the significant disparity in the number of malaria cases recorded in the Amazon region compared to the
other regions, which could potentially confound the results of this article by obscuring the incidence of
malaria in other regions of Brazil.

3.1 TOTAL MALARIA CASES REPORTED IN THE EXTRA-AMAZON REGION (NORTHEAST, MIDWEST,
SOUTHEAST, AND SOUTH) BETWEEN 2018 AND 2022.

Analyzing the total number of malaria cases reported in Brazil (extra-Amazon region) between 2018 and
2022, a decrease of 41% in the number of reported cases is observed when comparing 2019 to 2020. The
320 cases reported in 2020 represent a reduction of 38.1% compared to the absolute average of all the
years analyzed in the study.

Graph 1: Assessment of the absolute number of malaria cases reported to the Unified Health System (SUS)
in the extra-Amazon region between 2018 and 2022 and recorded in the DATASUS platform.

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3.2 TOTAL MALARIA CASES BY EXTRA-AMAZON MACRO-REGION (NORTHEAST, MIDWEST, SOUTHEAST,

AND SOUTH) BETWEEN 2018 AND 2022.

Graph 2: Assessment of the absolute number of malaria cases reported to the Unified Health System (SUS)
in the extra-Amazon region annually from 2018 to 2022, recorded in the DATASUS platform.

Upon analyzing each extra-Amazon macro-region individually, it was noted that the region with the
greatest decrease in the number of reported cases was the Southeast. In Graph 2, we can observe an 85.6%
reduction in the number of reported cases between 2019 and 2020 in the Southeast region, with 242 cases
reported initially and only 132 the following year.

Conversely, the Midwest region had the smallest decrease in the number of compulsory notifications of
the disease, with a reduction of only 18.3% when comparing 2019 to 2020.

In the South region, 93 cases of the disease were reported in 2019, and the following year, 62 notifications
were recorded, resulting in a 33.3% decrease in the number of malaria cases.

Lastly, in the Northeast region, between 2019 and 2020, there was a 58.1% decrease in reported malaria
cases, and between 2021 and 2022, the reduction was 47.3%, with 173 cases recorded in 2021 and only 91
cases the following year.

3.3 TOTAL MALARIA CASES REPORTED IN THE AMAZON REGION BETWEEN 2018 AND 2022.

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Graph 3: Assessment of the absolute number of malaria cases reported to the Unified Health System (SUS)
in the Amazon region annually from 2018 to 2022, recorded in the SIVEP (Epidemiological Surveillance
System).

Analyzing Graph 3, a reduction of 21.36% in the number of reported malaria cases in the Amazon region
is observed when comparing 2019 to 2020. Furthermore, in relation to the average number of cases, a
decrease of 17.1% in the number of notifications was noted in 2020.

The results, depicted in Graph 2, analyze the absolute values of malaria cases by macro-region, before
the COVID-19 pandemic (years 2018 and 2019) and during the pandemic (years 2020, 2021, and 2022). It
confirms a decrease of 85.6% in the Southeast region, 58.1% in the Northeast region, 33.3% in the South
region, and 18.3% in the Midwest region, between 2019 and 2020.

Graph 3 examined the absolute values of malaria cases in the Amazon region between pre-pandemic years
(2018 and 2019) and pandemic years (2020, 2021, and 2022), confirming a reduction of 21.3% in the number
of cases when comparing 2019 to 2020.

Discussion: The COVID-19 pandemic has brought about a profound transformation in the global medical
landscape, indirectly impacting infectious diseases such as Malaria. Resource allocation, medical research,
and epidemiological surveillance have been redirected to combat COVID-19, affecting the continuity of
efforts to control other infectious diseases.

The decrease in the number of reported malaria cases, particularly between 2019 and 2020, involves various
factors, including the strain on healthcare systems in Brazil and worldwide caused by the pandemic. It is
assumed that this scenario negatively affected the capacity for malaria diagnosis, as the initial symptoms
of both COVID-19 and malaria often resemble each other. (3) The high demand for tests, hospital beds, and
medical resources for COVID-19 sometimes diverted attention from efforts to diagnose and treat malaria,
leading to underreporting of the disease and potentially undiagnosed cases.

This scenario, combined with the indiscriminate use of hydroxychloroquine in the treatment of COVID-19,
lacking robust scientific basis, likely resulted in the inappropriate management of cases that actually
corresponded to malaria due to the initial similarity in symptomatology between both diseases.

Another factor predisposing to the reduction in reported cases was the period of social isolation, travel

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restrictions, and limitations on outdoor activities during the COVID-19 pandemic, which may have played
a role in the decrease in the number of reported malaria cases. With the limitation of human mobility and
the decrease in social interactions, exposure to malaria-transmitting mosquitoes was potentially reduced.
These pandemic containment measures may have contributed to the decrease in malaria transmission,
resulting in a temporary underreporting of the disease.

An epidemiological study conducted in Mexico, analyzing the indirect impact of COVID-19 on the incidence
rates of vector-borne diseases, demonstrated that certain measures such as social distancing and home
confinement contributed to temporarily reducing the number of cases of vector-borne diseases, including
malaria. The research showed that 609 malaria cases occurred in Mexico in the year 2019, and in 2020,
345 cases of the disease were recorded, corresponding to a 43.4% decrease in the number of cases. During
the same period, the extra-Amazonian Brazilian macro-regions also exhibited a similar reduction of 41%
between the years 2019 and 2020.

The same article, "Indirect Impact of COVID-19 on Incidence Rates of Vector-Borne Diseases in Mexico" (7),
mentions that the Amazon region of Peru also experienced a drastic reduction in malaria cases during the
pandemic, which was correlated with the increase in COVID-19 cases that overwhelmed Peru's healthcare
systems and public medical institutions. This impact can also be observed in the Brazilian Amazon region,
which recorded 159,916 malaria cases in 2019 and 123,387 cases the following year, a decrease of 21.3%.

Another article linking malaria and COVID-19 in native communities of Rio Santiago, Condorcanqui
province, in the Amazon region of Peru in 2020, demonstrated that prior malaria infection significantly
associates with COVID-19 symptoms such as fever, odynophagia, and respiratory difficulty. During the
pandemic, efforts to reduce the transmission of the novel coronavirus led to neglect of other diseases like
malaria, a situation similar in Brazil, as evidenced by the reduction in the number of reported cases of the
disease in Brazilian macro-regions.

The underreporting of malaria cases was investigated in a study that analyzed the incidence of
hospitalizations and mortality related to febrile syndromes and parasitic diseases during the COVID-19
pandemic in Brazil. The results indicated that in 2020, the number of malaria-related hospitalizations in
the country represented only 29.31% of the total; however, the mortality rate among hospitalized cases
reached 82.55%. This high mortality rate is likely due to underreporting of the disease and late diagnosis,
supporting the downward trend in notifications mentioned in this article.

Conclusion: The author successfully achieved the intended goal, which aimed to evaluate the impact of
the Covid-19 pandemic on the number of malaria cases in the North, Northeast, Midwest, Southeast, and
South macro-regions of Brazil from 2018 to 2022. The results demonstrated that indeed, the pandemic led
to a negative variation in the number of reported malaria cases in all macro-regions analyzed in the study,
especially when comparing the years 2019 and 2020.

Regarding the total variation in the number of reported malaria cases in the Northeast, Midwest, Southeast,
and South regions, a global negative variation of 41% was obtained in the number of compulsory notifications
when comparing the pre-pandemic year of 2019 with the pandemic year of 2020. In other words, during
the onset of the pandemic (2020), the number of reported malaria cases saw a significant reduction. In the
Amazon region, between the pre-pandemic years (2018 and 2019) and the pandemic years (2020, 2021, and
2022), there was a 21.3% reduction in the number of cases when comparing 2019 with 2020.

It is assumed that this decrease may be explained by the overload of the public health system with Covid-
19-infected patients, similar symptomatology between the diseases complicating diagnosis, treatments
for the new coronavirus lacking scientific evidence leading to underreporting of malaria cases, and social
isolation possibly reducing population contamination by the vector.

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Infection 2024

Biography

Dr. Laura Fermiano Bastos, a physician graduated from the Fundacao Assis Gurgacz in 2024, is recognized for her
commitment to academic excellence in cardiovascular surgery. As a speaker, she has presented at significant events
such as the 49th Brazilian Congress of Cardiovascular Surgery and the 31st World Congress of Cardiovascular and
Thoracic Surgery in 2023. She was awarded for her research on the Impact of Covid-19 on cardiovascular surgery in
state of Parana, showcasing her dedication to advancing medicine and addressing challenges in the medical field.

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Infection 2024

Mark A. Griffiths1,2, Sandy Francois1, Melissa N. Cameron1, Jordan

E. Daniel1, Bridget A. Wynn1, Sara P. Brown2, Sarah Thompson2,
Rebeka G. Carter2, Kelly DeNaples2, Swaminathan Kandaswamy1,
Evan Orenstein1,2, Andrés Camacho-González1,2, Claudia R.
Morris1,2 and Lauren Middlebrooks*1,2
1
Department of Pediatric, Emory University School of Medicine, Atlanta, GA,
United States
2
Children’s Healthcare of Atlanta, Atlanta, GA, United States

Implementation of opt-out human immunodeficiency virus screening in

pediatric emergency departments

T he Centers for Disease Control and Prevention recommends HIV screening for all patients ≥13 years.
Parts of Metro Atlanta have HIV positive rates at 8-times the national average. Adolescents are the
least likely group to know their HIV status and have the lowest rate of linkage to care and viral suppression.
Children’s Healthcare of Atlanta (Children’s) implemented an opt-out HIV testing program in its emergency
departments (ED) for patients ≥13 years undergoing venipuncture for any chief complaint at 2 of their 3
sites. The objective is to increase testing in adolescents leading to earlier HIV diagnosis and linkage to care.

Children’s electronic medical record EPIC and its population discovery tool were used to compare HIV
testing volumes of 13–24-year-olds, 8 months pre-(November 5–July 5, 2023) and 8 months post (July 6–
March 6, 2024) clinical implementation. Data for all 3 sites was reviewed and all sites received educational
promotion. Results were cross-referenced to determine newly diagnosed adolescents living with HIV
(ALHIV) from known positives. The data was compared using descriptive statistics.

A total of 966 patients were tested pre-implementation, 697(72%) girls and 269(28%) boys. Six new ALHIV
were identified, 1 male coinfected with syphilis, the average age was 17 and the assignment at birth was (3)
male and (3) female. After 8 months of implementation, a total of 1600 patients were tested: 1101(69%) girls
and 499(31%) boys. Six new ALHIV were identified; the average age was 16 and the assignment at birth was
(5) male, 2 coinfected with syphilis, and (1) female. This demonstrates an overall positivity rate of 0.4% and
1 in 100 boys tested positive (1%). At sites receiving education for 1 week, 5 and 8 months, testing increased
by 8%, 72% and 88% respectively. All newly diagnosed cases were linked to care within 1-48 days.

Atlanta remains a hotspot for new HIV cases. Six cases in 8 months highlights the importance of universal
HIV testing of adolescents and reflects a public health crisis. The new initiative significantly increased HIV
screening among adolescents and will likely identify ALHIV at an earlier stage of infection, facilitating timely
access to medical care. This can lead to improved clinical and immunological outcomes and a reduced risk
of secondary transmission.

Audience Take Away Notes

• Compare and analyze HIV testing numbers with opt out screening option
• Identify adolescents living with HIV and explore the possibly of coinfected with other sexually
transmitted infections
• Assess rate of linkage to care of adolescent newly diagnosed with HIV
• Inform other faculty how to implement something similar in their hospitals and/or clinics
• Provide practical solution to some challenges you may encounter with new clinical implementation in
an children’s hospital emergency department

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Infection 2024

Biography

Dr. Lauren Middlebrooks, is an Assistant Professor of Pediatric Emergency Medicine at Emory University and Children’s
Healthcare of Atlanta. Dr. Middlebrooks received a Bachelor of Arts degree in psychology from Spelman College in
Atlanta, Georgia. She then earned a doctorate of medicine from Meharry Medical College in Nashville, Tennessee,
where she was inducted into the Alpha Omega Alpha honor medical society. Dr. Middlebrooks remained in Tennessee
to complete residency training in Pediatrics at Monroe Carroll, Jr. Children’s Hospital at Vanderbilt University, where
she served as vice-president of the Minority House-staff for Academic and Medical Achievement and co-chaired the
residency’s global health interest group. Dr. Middlebrooks then went on to complete fellowship training in Pediatric
Emergency Medicine at Emory University, where she cultivated an interest in health equity by working to improve
HIV testing in adolescents in the pediatric emergency department. Dr. Middlebrooks, who also serves as chair of her
division’s faculty recruitment committee, and member of two PECARN sub-committees, was recently awarded a grant
from Gilead Sciences, Inc. FOCUS program. She has been working effortlessly and has successfully implemented
routine opt-out HIV testing across 3 different pediatric emergency department sites in Atlanta.

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Infection 2024

Mohammad K. Alshomrani1*, Ahmad A. Alharbi2, Abdullah A.

Alshehri3, Muhammad Arshad4, Saeed Dolgum5
1
Microbiology, Riyadh Regional Laboratory and Blood Bank, Riyadh, South Asian
University,
2
Pathology, Majmaah University, Al Majma'ah, South Asian University
3
Laboratory, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, South Asian
University

Laboratory, Dr. Sulaiman Al Habib Hospital in Al Takhassusi, Riyadh, South Asian University
4

Pediatric Infectious Diseases, Dr. Sulaiman Al-Habib Hospital in Al Takhassusi, Riyadh, South Asian
5

University

Isolation of staphylococcus aureus urinary tract infections at a

community-based healthcare center in Riyadh

A lthough S. aureus UTI is known to be associated with other risk factors such as urinary catheterization,
long hospital stay, or complicated UTI, our results show the community-acquired presentation of UTI.
Trimethoprim-sulfamethoxazole may be used as an effective treatment for UTI caused by S. aureus. S.
aureus UTI could be an alarming sign of more invasive infections such as S. aureus bacteremia, though
clinical evaluation and finding the source of S. aureus are crucial for effective treatment and prevention of
further complications.

The aim of this presentation is to assess the clinical manifestation, risk factors, and comorbidities of the
patients with Staphylococcus aureus bacteriuria, and to analyze the antimicrobial susceptibility data of
S. aureus isolated from their urine samples. I will discuss the detailed data of 90 isolates of S. aureus
were collected from patients with Urinary Tract Infections (UTIs) including their full identification and
susceptibility testing, and urinalysis results.

Audience Take Away Notes

• The prevalence of S. aureus as a causative agent of UTI, in comparison to other uropathogens
• Differentiation between community-acquired and hospital-acquired S. aureus UTI, and associated risk
factors
• Is S. aureus a true UTI pathogen or a colonizer? Recommendations will be provided to clinicians how
to evaluate such cases of S. aureus from urine samples
• Could S. aureus be an alarming sign for a serious infection? Instructions and recommendations will be
provided to the treating physicians how detect and manage systemic infections related to S. aureus
UTI
• Guidance of antimicrobial therapy based on our antibiogram data
Biography

Mohammad Alshomrani studied at College of Medicine, King Saud University and graduated as medical doctor in 2007.
He joined King Saud University Fellowship of Pathology (Microbiology) and received fellowship degree in Pathology
(Microbiology) in 2013. He is working now as consultant microbiologist and Head of Microbiology Department in
Riyadh Regional Laboratory. He published several studies in different fields of microbiology, including bacteriology,
virology, and mycology. He has a special interest in bacterial infections and antimicrobial resistance.

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Infection 2024

Moussa Al Rufayie
Hillingdon Hospital, London, United Kingdom

An unusual presentation of a case of syphilitic posterior uveitis

Purpose: To highlight different presentations of syphilitic uveitis and macular pathologies.

Setting: Medical retina clinic in Western Eye Hospital, Imperial College Healthcare NHS Trust.

Methods: We studied a case of unusual presentation of syphilitic uveitis. A 51 year old male patient presented
to our accident and emergency with a 5 day history of seeing a grey shadow with flashes of light in the left
eye, he was diagnosed as haemorrhagic Posterior Vitreous Detachment (PVD). Maculae were flat then with
some reticular changes over the Retinal Pigment Epithelial (RPE) layer on Optical Coherent Tomography
(OCT) of the left eye only. Two weeks later we saw him in our clinic, he was then complaining of acute
drop of the vision in the left eye, he has no medical history, he denies any sexual activity, denies taking
any medications or supplements. On examination his vision was 6/6 in the right eye, 6/7.5 in the left eye,
normal intraocular pressure, anterior segment exam was unremarkable, fundus of the right eye showed
pale macula with haemorrhagic spots and subretinal inflammatory areas and fluid, left eye macula was pale
with reticular RPE changes. Fundus Fluorescein Angiography (FFA) showed disc leakage in both eyes with
periphelbitis at the macula and on the peripheral retinae in both eyes, there was transillumination of the
choroidal fluorescein in the macular areas of both eyes.

Results: We sent him for general blood tests including uveitic work-up, all came back negative except
for serology test for syphilis was positive, RPRGU was 1:64. We referred the patient to the genitourinary
medical clinic in our trust for further management.

Conclusion: Uveitis can have an atypical presentation of macular haemorrhage and PVD, careful history
taking, and a thorough exam could highlight uveitis of any kind. Treatment options are different with
different kinds of uveitis.

Financial Disclosure: No Financial Interest.

Syphlitic Pan: Uveitis.

Audience Take Away Notes

• Recognizing Atypical Uveitis: Identify unusual signs like macular hemorrhage and PVD
• Comprehensive History and Examination: Importance of detailed history and thorough examination
in diagnosis
• Interdisciplinary Referral: Referral to specialised clinics for comprehensive care
• Research and Teaching Implications: Foundation for further research and teaching on atypical uveitis
• Enhanced Diagnostic Protocols: Include serology tests for syphilis in the uveitic work-up
Biography

Dr. Moussa Al-Rufayie is a dedicated medical professional from the United Kingdom, having graduated with an MBBS
from Imperial College London. He also completed an intercalated BSc in Business Management at Imperial College
London. Currently practising in the NHS in London, Dr. Al-Rufayie has gained extensive experience through various
jobs in ENT, ophthalmology, paediatrics, geriatric medicine, emergency general surgery, and colorectal surgery. This
diverse background has equipped him with a comprehensive understanding of patient care across multiple specialties.
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Infection 2024

Muhammad Amjad Khan*, Mumtaz Khan, Afreenish Amir, Amna

Ali, Tarbia Aamir, Muhammad Waleed, Rabia Tabassum, Kiran
Nisa, Aamer Ikram
CEOH, Center for Environmental & Occupational Health National Institutes of
Health, Islamabad, Pakistan

Overcoming the challenges of drug resistant fungal infections in

developing countries

O ver the past few decades fungal infections have emerged as a constantly on the rise global health
challenge, resulting in approximately 1.7 million deaths every year. Moreover, the long-term therapeutic
application and prophylactic use of antifungal drugs in high-risk patients has promoted the emergence
of (multi) drug-resistant fungi, including the extremely virulent strain Candida auris. Therefore, fungal
infections have become increasingly severe and an even bigger challenge for developing countries which
are more vulnerable to its impacts. High burden of infectious diseases, poverty, weak governance and
health systems, and low awareness remain major challenges in the fight against AMR leading to increased
prevalence of HAIs including fungal infections, and superbugs like C. auris. Infection-Prevention-Control
(IPC) is a key to enhancing healthcare outcomes against such challenges.

National Institutes of Health (NIH)-Pakistan with the support of CDC, initiated a study to improve the early
diagnosis and surveillance of C. auris. The study focused on capacity building in laboratory diagnostics, IPC
strategies and implementing robust learning data dashboards with provincial stakeholders. After thorough
Gap-assessments through site visits and detailed mixed methods at 12 sentinel sites, representing all
regions/provinces of Pakistan. Using a phase-wise approach, capacity at each site was enhanced by
providing hands-on-trainings and materials to enhance fungal diagnostics, IPC and surveillance of fungal
infections at the healthcare facilities.

In two years following the launch of the study, in Microbiology Diagnostics all 12 sites initiated reporting
fungal infections to NIH and 5 of the sites have been enabled in confirming their diagnosis independently
apart from being the part of the collective reporting system. Data dashboards were developed and
implemented ensuring robust data collection and sharing from all sites. A total of 1323 samples have been
received at NIH for final identification indicating different fungal pathogens in isolates by March ‘2024 out
of which 21 have been C. auris. Moreover, IPC programs have been initiated at 3 of the sites where they
previously did not exist and capacity building activities have been performed to improve the IPC programs
at all sentinel sites particularly in terms of outbreak preparedness against fungal pathogens (particularly
C. auris).

C. auris is a multidrug-resistant pathogen and is prone to misidentification by available conventional

methods, it becomes difficult to detect and manage C. auris infection and also limits the therapeutic
options against this deadly pathogen. The emergence of multidrug-resistant C. auris advocates and
amplifies the vigilance of early diagnosis and appropriate treatment and management of fungal infections,
particularly in developing countries to prevent outbreaks and adverse healthcare outcomes. Through
this study a successful and sustainable model for National Fungal Disease Surveillance System (NFDSS)
has been devised to enable rapid diagnosis and surveillance of prevalent fungal pathogens throughout
Pakistan. Antimicrobial stewardship involving robust IPC methods should be established in hospitals to
ensure judicious and appropriate antimicrobial use. Adoption of these strategies will assist developing
countries overcome their increased vulnerability to growing AMR.

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Infection 2024

Audience Take Away Notes

• First of all it highlights the importance of Fungal Pathogens which are generally ignored by healthcare
practitioners and prophylactic use of antifungal drugs in high-risk patients leading the emergence of
(multi)drug-resistant fungi
• Moreover, it presents a functional and sustainable model for diagnosis, surveillance and management
of prevalent fungal pathogens for developing countries which if adopted would not only aid in providing
information on burden of fungal infections but also would help combat AMR through targeted treatment
and management
• The Model shared also includes robust IPC Measures linked to surveillance to prevent healthcare
outbreaks contributing to overall patient and healthcare worker safety
Biography

Dr. Muhammad Amjad Khan, has over 42 years of experience as a Health care professional. He has done fellowship
training from University of Kentucky in cardiothoracic Transplantation Pathology and is a Harvard fellow in Infection
Control and designing of high containment facilities. He has re-designed and upgraded numerous labs and Tertiary
care hospitals all over Pakistan in the Government for management of drug resistant TB cases. Since 1985 he has
trained innumerable laboratory staff and healthcare workers in Infection Control and has many publications to his
credit. At present he is serving as Coordinator CEOH-NIH Islamabad.

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Infection 2024

Musa Corr1*, PeterAdewuyi1, Ousman Badjie2, Lamin Badjie2, Bah Sadou2, Mustapha
Bittaye3
1
The Gambia Field Epidemiology Training Program, Banjul, Gambia
2
National AIDS Secretariat, Banjul, the Gambia
3
DHS, MOH, Gambia

Have the Gambia met the enrolment target for HIV, the Gambia, 2017-
2021?
Background: In 2016, the United Nations General Assembly’s Political Declaration on Ending AIDS
committed countries to the 90–90–90 targets, which aim to bring HIV testing and treatment to many
people living with HIV by the end of 2020. Globally as of 2019, 81% of people living with HIV knew their HIV
status, and more than two thirds (67%) were on antiretroviral therapy (ART). This study assessed if HIV/
AIDS intervention in The Gambia met the enrolment target between 2017-2021.

Method: We conducted a study among those who sort healthcare at the 45 HIV sentinel sites in The Gambia.
The data we extracted from the DHIS 2 included demographic information, HIV test results (positive/
negative), and treatment enrollment. We conducted univariate and bivariate analyses.

Results: Of the 177,832 persons tested for HIV, 14,863 (8.4%) were positive. Of the 14,863 persons who were
positive for HIV, 56.7% enrolled in HIV treatment. Of the positive, female was 60.9%, Western 1&2 had
66.9% and ages <49 years formed 15.5%. Of those who enrolled, 60.9% are female, 68.1% were from Western
1&2 regions and 70.7% were age 15-24 years. Enrolment was higher among 24 years and below (67.3%) as
compared than 25 years and above (53.8 %) [PR=1.7 (95% CI 1.6148-1.9411)]; females (60.6%) enrolled more
than males (48.4%) [PR: 1.6 (95% CI 1.5344-1.7517)]; and Western 1&2 regions (68.1%) enrolled for treatment
more as compared to other regions (39.9%) [PR: 1.1 (95% CI 1.0272-1.0929)]

Conclusion: The Gambia did not meet the 90% target for enrolment into treatment. Further studies need
to be conducted to know why there were low enrolment among males, ages less than 25years and among
those living in Western 1&2 Regions. We recommend to National AIDS Secretariat to develop innovative
strategies to motivate positive cases to enroll in treatment.

Keywords: HIV/AIDS, Enrollment, positive tests, The Gambia

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Infection 2024

Nadine D. Bacalangco Suerte*, MD; Mary Leslie S. Eregia, MD;

Analyn G. Jumeras, MD, FPCP, DPSMID; Patricio P. Palmes, MD;
FPCP, FPCC, FPSE, FPSVM
Department of Internal Medicine, West Visayas State University Medical Center,
Jaro, Iloilo City, Philippines

Clinical characteristics and outcomes of breakthrough COVID 19

infection among vaccinated patients admitted in a tertiary hospital
Background: Vaccination across countries against COVID-19 have shown to be effective against infection
and mortality in different settings. However, recent data describe breakthrough COVID-19 infection among
vaccinated individuals. Risk factors and clinical characteristics have been reported in several international
settings, but local data are needed to characterize these infections and define correlates of breakthrough
and infectivity.

Objectives: To establish the clinical profiles and outcomes of vaccinated patients with breakthrough
COVID-19 infection requiring hospitalization in a tertiary hospital.

Methodology: A retrospective cross-sectional study was conducted in a tertiary hospital with 123 patients’
record reviewed between December 2021 to December 2023.

Results: Majority of patients were elderly, female sex, married, and with comorbidities. Of the comorbidities,
Hypertension, Diabetes Mellitus type II and Chronic Kidney Disease were predominant. Fever was the
most prominent symptom but significantly reduced on patients with booster dose. Majority of patients
had no infiltrates on chest Xray and no evidence of hypoxemia, with higher probability of these findings
among those with booster dose. qSOFA scores of <2 was seen in both study groups. Low to moderate
viral load were seen among patients who received booster dose compared to those with primary series
alone, regardless of the disease severity. Disease severity on admission were mostly mild to moderate
cases. Inflammatory markers such as CRP, ferritin, procalcitonin, ESR, and LDH were shown to be of
normal value among vaccinated patients. Low Procalcitonin (PCT) level showed a significant association in
patients who received booster dose. Most common complications noted were bacterial pneumonia, acute
kidney injury and sepsis but the probability of getting these complications is lesser in patients receiving at
least one booster dose compared to those with primary series. Majority of patients had less than 21 days
hospitalization with improved disposition upon discharge. Hospital-acquired pneumonia in five patients
and myocardial infarction in one patient were the causes of death.

Conclusion: Majority of breakthrough infections were seen among patients withincreasing age, female
sex, and presence of comorbidities. Disease severity on admission were mild to moderate, with very few
presenting severe or critical disease. Risk factors noted with high disease severity and with poor outcomes
were increasing age and presence of comorbidities, elevated inflammatory markers on admission, and
high qSOFA scores, regardless of whether booster doses were received or not. There was no significant
correlation noted on vaccination status and the clinical profiles of breakthrough COVID-19 infection.

Keywords: COVID-19 Breakthrough Infection, Clinical Presentation and Demographics, Outcomes.

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Infection 2024

Biography

Dr. Nadine D. Bacalangco Suerte completed her bachelor’s degree in Biological Sciences at West Visayas State
University-Magna Cum Laude in 2014 and finished her post graduate degree in Doctor of Medicine on the same
institution in 2018. She completed her residency training inInternal Medicine in December 2023. During her residency
training, she was able to receive awards related to research and was a co-author in a study published in European
Society of Cardiology and Interventional Cardiology: reviews, research, resources.

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Infection 2024

Namiz Damani*, Michael Borg, Peter Zarb

Infection Prevention & Control Department, Mater Dei Hospital, Malta

Improving compliance with local guidelines for antibiotic prescriptions

using PDSA methodology

A ntimicrobial resistance is a major threat to global health, and primarily occurs due to the overuse of
broad-spectrum antibiotics. If not addressed, we are headed towards a post-antibiotic era. To address
this issue, in 2015, the World Health Organisation developed a Global Action Plan1 to counter antimicrobial
resistance.

A pilot baseline audit was conducted at the emergency department in Mater Dei Hospital, Malta demonstrated
that co-amoxiclav, a broad-spectrum antibiotic, was widely prescribed for most infections and was not
in line with local and international guidelines. Despite local and international guidelines stating that for
CURB ≤1 Community Acquired Pneumonias (CAPs), amoxicillin should be used as a first-line therapy, the
broad-spectrum antibiotic co-amoxiclav was prescribed as the first-line therapy in approximately 60% of
patients.

To address the issue of inappropriate antibiotic use, a quality improvement project was conducted and
centered around the implementation of three PDSA2 (Plan Do Study Act) cycles.

The first PDSA intervention consisted of several posters strategically placed in areas of the emergency
department. The posters indicated that S. pneumoniae was the most common causative organism of CAP and
that less than 1% of S. pneumoniae isolates taken from this specific emergency department were resistant
to amoxicillin. The efficacy of this intervention was somewhat limited; we found that 9% of antibiotic
prescriptions for CAPs fell in line with our guidance by the end of this cycle. The second intervention
involved a video presentation displayed to ED clinicians hosted by the trainee and the head of the infection
control department. By the end of this second intervention, compliance with local guidelines increased to
18%. The third PDSA intervention, rather than focusing on education, targeted prescribing behaviour; it
involved amending all ED treatment charts and briefly stating the appropriate antibiotic choice for CAPs.
This behaviour-oriented intervention was directly integrated with antibiotic prescribing. As a result, by the
end of the third cycle, we saw the largest cumulative improvement, with 33% of prescriptions in compliance
with local guidance for CAPs.

In summary, we noted a significant improvement in compliance with local guidelines for antibiotic
prescriptions in the emergency department following three PDSA cycles. Our findings conclude
that prescribers best respond to behaviour-targeted interventions as opposed to education-related
interventions in order to elicit a tangible improvement in antibiotic prescribing practices in line with
local guidelines. Such measures can help reduce the use of broad-spectrum antibiotics and prevent the
emergence of antimicrobial resistance.
Biography

Dr. Namiz Damani is an internal medicine trainee in the UK, having graduated in 2019. He has delivered presentations at
infection prevention and control conferences, both nationally and internationally. He has been awarded a Postgraduate
Certificate in Medical Education from the University of Dundee and is currently pursuing an MSc.

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Infection 2024

Nawal AlKaabi1*, Jehad Saleh Abdalla1, Suad Hannawi2, Dima

Ibrahim3, Mustaqeem Siddiqui4, Hussni Al Hateeti4, Salah Eldin
Hussein5, Mohammed Bhyat5, Eva Turgonyi6, Ahmad Bdair6, Sana
Qamar6, Sabada Dube7, Wael El Hallak8
1
Sheikh Khalifa Medical City, Abu Dhabi Health Services Company (SEHA), Abu
Dhabi, United Arab Emirates
2
Al-Kuwait Dubai (AL Baraha) Hospital, Emirates Health Services (EHS), Dubai,
United Arab Emirates

3
Burjeel Medical City, Abu Dhabi, United Arab Emirates
4
Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
5
Sheikh Khalifa Medical City, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, United Arab
Emirates
6
Medical Affairs, AstraZeneca Gulf Corporation Council, Dubai, United Arab Emirates
7
Epidemiology, Vaccines & Immune Therapies, Biopharmaceuticals Medical, AstraZeneca, Cambridge
United Kingdom
8
Medical Affairs, Vaccines & Immune Therapies, AstraZeneca Middle East Africa, Dubai, United Arab
Emirates

Clinical use of AZD7442 as pre-exposure prophylaxis for COVID-19 in the

real-world setting – interim analysis of the evolve study
Background: In response to the COVID-19 pandemic, innovative treatments and preventive measures
continue to be pivotal. This interim analysis examines the use of AZD7442, a Long-Acting Antibody (LAAB),
as a Pre-Exposure Prophylactic (PrEP) agent against the SARS-CoV-2 virus, aiming to contribute valuable
insights into its clinical outcomes in United Arab Emirates and broader applicability.

Methods: This is a multicenter, single-arm, observational prospective study aimed to describe the real-
world use of AZD7442 as PrEP against SARS-CoV-2. 408 (87.2%) of the 468 total eligible participants received
an initial dose of 600mg, whereas 60 participants (12.8%) received 300mg dose. Participants were followed
for up to 12 months to describe COVID-19-related outcomes (medically attended COVID-19, hospitalization,
and death), healthcare resource utilization, and quality of life (PROMIS Global-10 for assessing Global
Physical Health (GPH), Global Mental Health (GMH) & EQ-5D UK Crosswalk utility). Moreover, data on AEs
were collected.

Results: The majority of participants were males (60%) and of Arab ethnicity (73%). Most participants (68.4%)
had prior SARS-CoV-2 infection, and the majority (91.5%) were vaccinated with at least one dose of SARS-
COV-2 vaccine, 90%, 79%, with two and three doses, respectively, at the study's onset. Following AZD7442
administration, the infection rate of SARS-CoV-2 stood at 3.6%, with 1.7% requiring medical intervention or
hospitalization. No COVID-related ICU admissions or COVID-19-related deaths were reported. No adverse
events leading to drop-out were reported. Post-enrollment, participants exhibited improvements in both
GPH and GMH, as evidenced by T-score elevations at 1, 3, and 6 months. Additionally, EQ-5D UK Crosswalk
utility scores displayed marked enhancements in overall health quality following enrollment.

Conclusion: This study underscores the use of AZD7442 as COVID-19 PrEP in a real-world context. The
data reveal its utility across a diverse population, including immunocompromised individuals and those
with prior vaccination. Notably, it also highlights improvements in physical and mental health post-
administration, reinforcing the potential of monoclonal antibodies in COVID-19 prophylaxis.

Funding Statement: This study was funded by AstraZeneca FZ LLC.

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Infection 2024

Audience Take Away Notes

• The study shows a real-world practice of using mono-clonal antibody AZD7442 as COVID-19 PrEP;
the data reveal its utility across a diverse population, including immunocompromised individuals and
those with prior vaccination
• This data will help physicians treating immunocompromised patients demonstrate the role of passive
immunization in PrEP and provide more confidence in using upcoming generations of long-acting
antibodies in COVID-19 PrEP
• Research that other faculty could use to expand their research or teaching
• A practical solution to a problem that could simplify or make a designer’s job more efficient
• It will improve the accuracy of a design or provide new information to assist in a design problem
Biography

Dr. Nawal Al Kaabi is a pediatrician and infectious diseases consultant. She has been the Chair of the Seha Infectious
Diseases and Infection Control Council since 2012. She served as the Chief Medical Officer at Sheikh Khalifa Medical
City and Chair of the Clinical National COVID-19 Committee. Dr. Al Kaabi graduated from the United Arab Emirates
University and completed her Fellowships in Pediatrics and Pediatric Infectious Disease in Canada. She is an American
Board-Certified Pediatrician, trained in global research at Harvard University, and American Board-certified in Quality.
She obtained a Certified Physician certificate from the American Association for Physician Leadership.

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Infection 2024

Netty Santoso, PhD

Department of Pathology, Ohio State University College of Medicine, Columbus,
OH, United States

Metabolic reprogramming of KSHV infection and tumorigenesis

K aposi’s Sarcoma-Associated Herpes Virus (KSHV), one of human gamma-herpesviruses, is a large

double-stranded DNA virus that establishes long-term persistent infection. Primary infection of
KSHV is usually asymptomatic, but its infection causes cancer under immunocompromised states, such
as Acquired Immunodeficiency Syndrome (AIDS) and organ transplantation. KSHV highly associates with
certain AIDS-defined tumors. KSHV causes Kaposi’s Sarcoma (KS), the most common AIDS-defined soft
tissue tumor. KSHV is also the etiologic agent of Primary Effusion Lymphoma (PEL), a rare but aggressive
B-cell Non-Hodgkin Lymphoma (NHL) that primarily affects HIV-infected individuals as well. Additionally,
KSHV associates with the Multicentric Castleman's Disease (MCD), a distinct lymphoproliferative disorder
that most often presents in HIV-infected individuals, which can further lead to the rise of large B-cell
lymphoma. There are currently no effective therapies to treat KSHV-associated, AIDS-defined tumors,
nor eliminate persistent KSHV infection. Our recent results showed that polyamine biosynthesis and
its downstream eIF5A hypusination are required for KSHV viral infection and tumorigenesis, and that in
return KSHV regulates the dynamics of these metabolic processes. Furthermore, hyp-eIF5A is required for
translation of key KSHV viral proteins, including LANA that is required for KSHV viral episome tethering
and its persistent infection. In addition, we demonstrated that certain FDA-approved drugs targeting these
metabolic processes are effective to block KSHV persistent infection and growth of KSHV-infected tumor
cells. These findings are novel, as it has never been examined that the polyamine-hypusine-eIF5A (hyp-
eIF5A) pathway plays a role in regulating KSHV viral infection and tumorigenesis previously.

Audience Take Away Notes

• The audience will learn the polyamine-hyp-eIF5A pathway as a novel host regulatory mechanism of
KSHV infection and tumorigenesis
• The audience will be introduced to the therapeutic potential of polyamine-hyp-eIF5A inibition for
treating KSHV infection and KSHV+ tumors
• Gives a new insight into mechanisms of KSHV pathogenesis
Biography

Dr. Santoso studied Pharmaceutical Sciences at Purdue University, USA and graduated in 2005. She then pursued
research by joining the group of Prof. William Guggino at Johns Hopkins University to study genetic kidney diseases
and received her PhD degree in 2011. She joined Dr. Raju Kucherlapati’s group at Brigham and Women’s hospital for
a postdoctoral fellowship, where she was involved in TCGA consortium. She obtained the position of an Assistant
Professor at the Ohio State University in 2021. Her research has been funded by US Army, NCI, NIDCR. She has published
29 research articles in journals such as Nature, Cell, Science Advances, Nucleic Acid Research, PLos Pathogens.

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Nicole Abdullah*, Oona Salomao Erdmann, Sophia Trompczynski

Hofmeister, Nicole Kovalhuk Borini, Beatriz Essenfelder Borges,
Francisco Beraldi de Magalhaes
Department of Medicine, Faculdades Pequeno Principe, Curitiba, PR, Brazil

Mechanisms of SARS-CoV-2 neurovirulence in chemosensory

dysfunction and prognosis of affected patients: Systematic review
Introduction: Severe acute respiratory syndrome coronavirus-2 virus (SARS-COV-2) was officially
identified on January 2020 following investigations of pneumonia cases of unknown origin. Clinical
presentation presents variations in symptom duration, severity, and complications. Among the most
frequent symptomatic manifestations are chemosensory dysfunctions such as anosmia and ageusia. Also,
it may influence an individual's nutrition and culminate in disorientation and social withdrawal. Therefore,
the scope of this review is to identify the neurovirulence mechanisms related to chemosensory dysfunction
presented by SARS-COV-2 and to evaluate how the remission of olfactory symptoms and their prognosis
develop in COVID-19 patients.

Methods: A systematic review of the literature was made, using databases such as PUBMED, VHL, MEDLINE,
LILACS, and ScienceDirect. The keywords were consulted on DECS/MESH: (COVID-19 or SARS-COV-2)
AND (ANOSMIA OR AGEUSIA) AND (MECHANISM OR DISORDER).

Results: They were elucidated according to the PRISMA methodology. In addition to the flow chart, a table
was developed with all the articles included in this review, their respective objectives, study methodology,
samples, and results. 13 articles were included.

Discussion: The pathogenesis of SARS-COV-2-related chemosensory dysfunctions includes the destruction

of the Olfactory Receptor Neurons (ORNs). The damage results from the action of toxic inflammatory
factors, due to an inflammatory storm, such as TNF-α, Interleukin-1B (IL-1B), IL-6 and infiltrating
inflammatory cells. Recent histopathological studies showed findings such as leukocyte infiltration in the
lamina propria, focal atrophy of the olfactory mucosa, and neuronal fibres in the acute phase of infection.
When analysing a patient with persistent anosmia, a massive disruption of the olfactory epithelium and mild
chronic inflammatory infiltrate were found. Studies point out that IL-6 acts as an endogenous substance
that regulates the olfactory neuronal activity and directly inhibits olfactory function. Both the peripheral
and central actions of IL-6 contribute to the pathogenesis of anosmia and ageusia. Peripheral IL-6 acts
on the levels of infected cell receptors. Central IL-6 acts at the level of the intermediate taste and smell
pathways, especially in the thalamus. The taste (ventral posteromedial nucleus) and smell (dorsomedial
nucleus) pathways converge. These nuclei are located close to the hypothalamus, which houses the
thermoregulatory centre, an important target of IL-6. In a sample of 67 patients diagnosed with COVID-19,
65.7% reported olfactory dysfunction alone and 8.95% reported an association between olfactory and taste
dysfunction. Most patients restore smell perception within 1–2 weeks, likely due to the differentiation of
progenitor cells into mature ORNs. However, opposing arguments state that this period is too short to
achieve complete neuronal regeneration. A prospective randomised multicentre study demonstrated the
effectiveness and speed of olfactory function recovery with corticosteroids therapy in patients with long-
term severe olfactory disturbances post-COVID.

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Conclusion: Thus, the mechanisms of neurovirulence of SARS-COV-2 involves ACE-2 activity and injury
to the olfactory bulb are triggered by the inflammatory cascade with the action of pro-inflammatory
cytokines. The prognosis of COVID-19 infection is directly related to the patient's comorbidities but tends
to be better in patients who present with anosmia and ageusia early. Female patients were more affected.

Audience Take Away Notes

• The audience will gain a better understanding of the pathophysiological aspects of anosmia and
the possibilities of providing more attentive care to patients with the condition. Given the higher
prevalence of post-COVID-19 sequelae, where anosmia can last for months or even ad eternum
• Due to the persistence of COVID-19 cases, even after worldwide vaccination campaigns, it is essential
for infectious disease doctors to deal with neurosensory sequelae and adequate psychological
management for patients suffering from this comorbidity. As well as encouraging a wider range of
research in this area
• This area allows us expand studies in the field of prophylaxis, drug treatment and holistic support for
COVID-19 patients and those with post-infection sequelae
• With the expansion of studies around pharmacological management of post-COVID-19 sequelae
and the increase in reports of patients struggling to overcome the new comorbidity, this study will
help professionals to better understand the context of patients in their situation and solidify new
pharmacological aspects that can improve the comorbidity
Biography

Miss. Nicole Abdullah is a last year medical student from Faculdades Pequeno Principe, Curitiba, Brazil. Had already
published articles correlated with infectious diseases, such as biofilm formation in cardiac devices and nosocomial
infections. This research was guided by masters in Infectious Disease and Microbiology: Dr. Francisco Beraldi Magalhaes
and Dr. Beatriz Essenfelder Borges.

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Nouf Alaboud1,2*, Yogini Jani1,2, Bryony Dean Franklin1,3

1
Research Department of Practice and Policy, School of Pharmacy, University College London
2
Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS
Foundation Trust
3
Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust

Implementing an electronic screening tool to improve antimicrobial

prescribing decision-making for paediatric. Patients with suspected
sepsis at an academic hospital in England: A before and after study
Background: Sepsis is one of the most common leading causes of death in paediatric patients worldwide.
The WHO has defined sepsis as “a life-threatening organ dysfunction caused by a dysregulated host
response to infection”. Early recognition of the sepsis plays a critical role in reducing mortality rate.
Electronic Health Record systems (EHR) are powerful platforms on which screening tools with Clinical
Decision Support Systems (CDSS) can be developed and implemented to expedite the sepsis recognition
process.

Aim: To examine the impact of using Paediatric Sepsis Screening Tool (PSST) on antimicrobial prescribing
decision-making in paediatric patients with suspected sepsis in an academic hospital in England.

Method: Uncontrolled before and after study using data extracted from the EHR system. We included all
paediatric patient (≤ 16 years old) who admitted to the Emergency Department (ED) with suspected sepsis
from September 2021 to February 2023. Data analysis involved descriptive and comparative statistical
analysis were performed by using SPSS version 29.0.

Results: Out of 27,475 ER admissions 820 (3%) patients were recognised as suspected sepsis. In total, 447
(55%) were male, 668 (81%) aged 5 years or less, 301 (37%) admitted in the Autumn, 507 (62%) has fever as
chief complaint, 370 (45%) has prescribed antimicrobial medications, penicillins and cephalosporins were
the most common used antibiotics (n=194, 52% and n=132, 36%, respectively). The PSST has significantly
delayed the screening of sepsis (mean difference=232 minutes, P=<0.001), and prolonged stay at the ED
(mean difference=98 minutes, P=<0.001), decreased sepsis documentation rate (Percentage difference=
16%, P=<0.001).=

Conclusion: The utilisation of the PSST has been associated with significant delays in screening patients
with suspected sepsis, prolonged stay at the ED, and decreased sepsis documentation rate, highlighting
the need for frequent follow-ups with the end users to ensure its potential effectiveness. One major
challenge in evaluating screening tools and CDSS within EHRs is the lack of standardised guidelines on
how and when to conduct evaluations, leading to inconsistency in evaluation methods and results, making
it difficult to compare the effectiveness and impact of different CDSS designs. Therefore, further studies
are needed to develop evaluation frameworks and guidelines for EHRs.

Audience Take Away Notes

• Our study shows example of the use of screening tool within EHR system for paediatric patients, its
impact, consequences and further recommendations for improvement
• They will clearly notice a major challenge in evaluating screening tools and CDSS within EHRs
• Yes, because most of the hospital nowadays are using integrated EHR systems which has CDSS, that
makes our result applicable in most of these hospitals

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• It will state the current situation, show the gap in practice and also it will provide suggestions for
improvement
• Yes, it will show the needs for evaluation frameworks and guidelines for EHRs

Biography

Nouf Alaboud is a registered clinical pharmacist and academic lecturer from Saudi Arabia. She completed
a PharmD and a Master in clinical pharmacy from King Saud University. She is currently pursuing a PhD in
health informatics at UCL School of Pharmacy. Her research interest is to study the electronic prescribing
system's design features and information content and their impact on prescribing decisions.

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Infection 2024

Parvin Dehghan*, Raheleh Mostafavi Youssof Abad, Mehrnoush

Maherolnaghsh
Department or Mycology and Parasitology, School of Medicine, Isfahan
University of Medical Sciences, Isfahan, Iran

Evaluation of the antifungal activity of metabolites produced by soil

actinomycetes on the candida species isolated from candidemia
Background: Excessive and inappropriate use of antibiotics can lead to increased antibiotic-resistant
strains of microorganisms. Actinomycetes, a versatile microbial group, are well known for producing
important metabolites such as antibiotics, enzymes, herbicides, and anticancer substances. This study
aimed to identify the bioactive actinomycetes isolated from the soil against Candida species separated
from the blood of patients with candidemia.

Materials and Methods: In this study, 12 soil samples were collected from the southwest of Iran. The soil
samples were cultured on a special culture medium (Starch Casein Agar) to look for desired actinomycetes.
Antifungal activity of seven species of actinomycetes with the best anticandidal activity were chosen
by modified overlay agar. Five species of Candida isolated from candidemia patients including Candida
albicans, C.glabrata, C.lusitania, C. tropicalis and C. parapsilosis were used for antifungal activity using
well diffusion agar. Seven actinomycetes with the best bioactive effects were identified by sequencing of
16SrDNA gene. This gene sequence is then compared by the BLAST program to the gene sequences in the
NCBI's databases.

Findings: From the total of 12 soil samples 52 actinomycetes were identified, among them seven showed
more bioactive potency against Candida isolates. After doing sequencing, four genera of actinomycetes were
identified. Crossiell with four species was the most abundant actinobacteria. Streptomyces, Saccharothrix,
and Amycolatopsis were the rest genera of them (one of each).

Two isolates of the genus Crossiella and one isolate of the genus Saccharothrix deserti showed more
inhibitory effects on C. parapsilosis. So Crossiella cryophila inhibited this Candida with a halo diameter of
42.5± 13 mm, on the contrary, Streptomyces showed a weak inhibitory effect on all the rest tested yeasts
but on the C. parapsilosis with a halo diameter of 35 ±17.3 mm (P≥0/05). Amycolatopsis alba significantly
showed a weaker Antifungal effect on C. lusitana compared to the other species of Candida (P≥0/05).

Conclusion: The results showed that the soil of southwest Iran is rich in bioactive actinomycetes against
pathogenic Candida species that are capable of producing new antifungal metabolites.

It needs more wide investigations to evaluate the metabolites of these new species of actinomycetes. So it
is possible to introduce a step towards the acquisition, production, and development of broad-spectrum
and effective antimicrobials in the treatment of infectious diseases caused by resistant microorganisms.

Audience Take Away Notes

• They learn more about natural metabolites with anti-fungal effects on different kind of Candida species;
the etiologic agents of candidemia
• They will find the interaction of Microorganisms on each other. This lecture will open new ways and
new options for search antimicrobial components from the actinomycets around us
• The scientists from biochemistry or pharmacy departments will use to expand their research on this

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subject. Excessive and inappropriate use of antibiotics can lead to increased antibiotic-resistant strains
of microorganisms
• I believe we are on the first steps of producing new antifungals and we need to cooperate with the
other scientists to solve the problem of antifungal drugs against resistant pathogenic microorganisms
• There are insufficient antifungal drugs and also not all the yeasts respond equally to antifungals. Today
finding new antifungals is critical
• List all other benefits
o The soil is rich in bioactive actinomycetes against pathogenic Candida species that are capable of
producing new antifungal metabolites
o It needs more wide investigations to evaluate the metabolites of these new species of actinomycetes.
So it is possible to introduce a step towards the acquisition, production, and development of broad-
spectrum and effective antimicrobials in the treatment of infectious diseases caused by resistant
microorganisms
Biography

Parvin Dehghan studied Medical Mycology at Tehran University of Medical Sciences (TUMS) in Iran. and graduated
as MS in 1988. She then joined as instructor to Pathobiology Department in Isfahan University of Medical Sciences
(IUMS). She was as lecturer and trained medical Mycology to different medical students. She received her PhD degree
of Medical Mycology in 2007 at the TUMS. After raduation, she came back to IUMS and More than 30 post graduate
thesis has been supervised by her up to present. She is full Professor at the present and has published more than 60
research articles in scientific journals.

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Infection 2024

Parvin Dehghan*, Iman Zareie, Hossein Yousofi Darani

Department or Mycology and Parasitology, School of Medicine, Isfahan
University of Medical Sciences, Isfahan, Iran

Determining the frequency of trichosporon species and tracking yeast in

urine clinical samples using gold nanoparticles
Introduction: Timely identification and treatment of trichosporonosis is important due to the severity of
pathogenesis and different treatment from candidiasis and as a result of its high mortality. In this study,
in addition to determining the abundance of this fungus in clinical urine samples using past experiences
in the function of gold nanoparticles, identification of this yeast based on serological methods for rapid
detection of yeast in urine samples has been presented.

Methods: 249 samples of people suspected of urinary fungal infection were analyzed using morphological and
molecular PCR-RFLP methods. Antigenic suspension was prepared from different species of Trichosporon.
This mixture was injected with complete adjuvant to a healthy rabbit. After injecting 4 booster doses using
incomplete adjuvant, blood was drawn from the rabbit. The anti-fungal antibody ability in the rabbit serum
was confirmed using the ELISA method. Then the antibody was placed chemically on the surface of gold
nanoparticles and the performance of the method was investigated.

Findings: C. glabrata and C. albicans were the most common yeasts isolated from the urine samples. Among
isolated yeasts, 4 cases (1.6%) of Trichosporons pp. were reported. The sensitivity and specificity of the
gold nanoparticle method in the identification of Trichosporon was determined to be 100%.

Conclusion: Abundance of urinary tract colonization due to Trichosporon was 1.6% during the study
period. The results showed that if there is one Trichosporon yeast in five microliters of the urine sample,
the mentioned method will be able to identify it within one minute through agglutination.

Audience Take Away Notes

• They learn which yeasts other than candida species can involved urinary tract. How much is the
prevalence of Trichosporon in suspected individuals
• Identification and treatment of trichosporonosis is important due to the severity of pathogenesis and
different treatment from candidiasis
• The scientist should be pay attention that trichosporon may also isolated from urine and this yeast is
resistant to urinary candidiasis antifungals
• We used gold nanoparticle to find this yeast in urine rapidly
• Gold nanoparticles can help to track the trichosporon Yeasts rapidly. It can differentiate trichosporon
from the other yeasts
• List all other benefits
o This method (agglutination using gold nanoparticles to find antigens) has been used on the blood
samples suspected to candidemia in previous research and it was successful to track candida in
blood samples

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Biography

Parvin Dehghan studied Medical Mycology at Tehran University of Medical Sciences (TUMS) in Iran. and graduated
as MS in 1988. She then joined as instructor to Pathobiology Department in Isfahan University of Medical Sciences
(IUMS). She was as lecturer and trained medical Mycology to different medical students. She received her PhD degree
of Medical Mycology in 2007 at the TUMS. After graduation, she came back to IUMS and More than 30 post graduate
thesis has been supervised by her up to present. She is full Professor at the present and has published mor than 60
research articles in scientific journals.

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Infection 2024

Prof. P. R. Risenga
University of South Africa, South Africa

The lived experiences of HIV-positive young adults regarding adherence

to antiretroviral treatment in Tshwane District, Gauteng
Human Immunodeficiency Virus creates disruption in the lives of individuals, families, organisations, and
communities at large. The introduction of the antiretroviral treatment brought hope but also brought
challenges, especially around the issue of adherence which is important for improved health outcomes. The
study intended to gain an understanding of the lived experiences of HIV-positive young adults regarding
adherence. The study setting was an antiretroviral clinic situated within a regional hospital in the Tshwane
district.

The target population for this study was patients who were receiving antiretroviral treatment at the
antiretroviral clinic situated in a regional hospital. The researcher drew a sample of 15 young adults who
were on Antiretroviral Treatment (ART) from January 2019 to December 2020 and who defaulted but
returned to care. Purposive sampling was used to select participants and the sample was determined by
data saturation. A qualitative approach was utilised to conduct the study, using in-depth phenomenological
telephonic interviews to collect data. All interviews were digitally recorded and transcribed. Thematic
analysis was used to analyse the data.

The findings of the study revealed participants were knowledgeable about the importance of adherence
of antiretroviral treatment. There were existing barriers which influenced disclosure, lack of support and
difficulties of taking antiretroviral treatment. It was concluded that there is a need to intensify established
programmes, encourage people to adhere to their antiretroviral treatment and on-going support
and counselling. Understanding adherence patterns of young adults and factors that cause barriers to
adherence may help design strategies that can strengthen adherence. Improved adherence results in
improved outcomes, decrease opportunistic infections as well as HIV-related mortality.

Key Concepts: ART, HIV, and Adherence.

Biography

Prof. P. R. Risenga passed her Diploma in Nursing Science at the former Gazankulu Nursing College with distinction.
Did her basic degree in Nursing, Honours Degree, and Master’s degree at UNISA. Did a second master’s degree: Masters
for International Health Professions and Education: at Maastricht University in the Netherlands and a Doctoral degree
at the University of Venda. Published 31 articles in accredited journals including five chapters book. Working at the
University of South Africa as a Professor.

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Infection 2024

Pedro Plans Rubio*, Sofia Godoy, Joan Cayla, Angela Dominguez,

Pere Godoy, Diana Toledo, Joan Pau Millet, Ignasi Parron
Public Health Agency of Catalonia, Department of Health of Catalonia, Barcelona,
08005, Spain, Ciber of Epidemiology and Public Health (CIBERESP), Madrid
28028, Madrid, Spain

Factors associated with non-adherence to Tuberculosis (TB) preventive

treatment among adult contacts of pulmonary TB cases with latent tb
infection in Spain

T he aim of this study was to identify factors associated with non-adherence to Tuberculosis (TB)
preventive treatment among contacts with latent TB infection for new cases of pulmonary TB cases
reported in Catalonia in 2019–2021. All contacts aged 18 years or older with a latent TB infection who
received a TB preventive treatment were included in the study. Multiple logistic regression analysis was
used to detect the independent factors associated with TB preventive treatment non-adherence; a p <
0.05 was considered statistically significant. The percentage of non-adherence to TB preventive treatment
found in this study was 23.7%. A multivariable logistic regression analysis determined that the following
factors were significantly associated with TB preventive treatment non-adherence among adult contacts:
“exposure at school or workplace” (aOR = 3.34), “exposure to an index case without laboratory confirmation
of TB” (aOR = 2.07), “immigrant contact” (aOR = 1.81), “male gender” (aOR = 1.75) and “exposure duration
< 6 h per week or sporadic” (aOR = 1.60. By contrast, the factor “short-term TB preventive treatment
regimen” (aOR = 0.38) was significantly associated with a lower treatment non-adherence. Adherence to
TB preventive treatment should be improved among adult contacts of TB pulmonary cases with latent TB
infection by recommending short-term treatment regimens and by developing health education activities,
with a greater focus on contacts with factors associated with treatment non-adherence.

Audience Take Away Notes

• The audience will know how the factors associated with non-adherence to TB preventive treatment
among adult contacts with latent TB infection can be identified
• The audience will know the research strategy necessary to identify and assess the factors associated
with TB preventive treatment adherence
• The audience will know the challenges that TB programs must overcome to improve adherence to TB
preventive treatment among adult contacts with latent TB infection

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Biography

Pedro Plans Rubio is responsible for Health Registries, Public Health Agency of Catalonia, Health Department of
Catalonia, Spain. He received his MD from the School of Medicine, University of Barcelona; his PhD from the School
of Medicine, University of Barcelona, his MSc in Health Economics from the School of Economics, University of
Barcelona, and his MSc in Design of clinical and epidemiological studies from the School of Medicine, University of
Barcelona. Specialist in Preventive Medicine and Public Health. Specialist in Labor Medicine. Member of the research
group CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain. Member of
the research group “Pertussis transmission in Catalonia and Navarra”. Member of the research group “Global Burden
of Metabolic Risk Factors of Chronic Diseases”. He has published more than 100 articles in scientific journals on the
epidemiology of infectious diseases, epidemiology of risk factors for chronic diseases and for infectious diseases,
seroepidemiology, cost-effectiveness analysis of medicines and health programs, vaccination programs, and health
policy. He has published more than 100 articles in scientific journals. He has published the book “Application of the
cost-effectiveness of medicines and health programs in the health planning”, Elsevier, 2015. Editor-in Chief of Section
“Vaccine Efficacy and Safety” of the journal Vaccines and Editor of several Special Issues of the journal Vaccines.
Member of the Editorial Board of the journals Pharmacoeconomics Open.

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Infection 2024

Pedro Plans Rubio

Public Health Agency of Catalonia, Department of Health of Catalonia, Barcelona,
08005, Spain, Ciber of Epidemiology and Public Health (CIBERESP), Madrid
28028, Madrid, Spain

Adapted mRNA COVID-19 vaccines have a limited ability to establish

herd immunity in the population against Omicron BA.1 and BA4-5
variants of SARS-CoV-2

T he emergence of novel SARS-CoV-2 variants has raised concerns about the ability of COVID-19
vaccination programs to establish adequate herd immunity levels in the population. Adapted mRNA
COVID-19 vaccines against BA.1 and BA.4-5 Omicron variants can provide a greater immunity against
emergent SARS-CoV-2 variants than vaccines against the original variant. This study assessed the
effectiveness of adapted vaccines in preventing SARS-CoV-2 infection and the ability of the adapted
vaccines to establish herd immunity against emerging Omicron variants. Firstly, a systematic literature
review was conducted to estimate the absolute Vaccine Effectiveness (aVE) in preventing SARS-CoV-2
infection using adapted vaccines targeting Omicron variants. Secondly, the ability of the adapted vaccines
to establish herd immunity was assessed by taking into account the following factors: aVE, Ro values of
SARS-CoV-2, and the use of non-pharmacological interventions (NPIs). The study found a meta-analysis
based aVE in preventing severe disease and SARS-CoV-2 infection of 56−60% and 36−39%, respectively.

Nevertheless, the study found that the ability to block SARS-CoV-2 transmission was limited because they
could not block the transmission of viruses with greater transmissibility. Firstly, the adapted vaccines
could not establish herd immunity against the Omicron BA.1 and BA.4-5 variants without using Non-
Pharmacological Interventions (NPIs). Secondly, the adapted vaccines could establish herd immunity
only by achieving >80% vaccination coverage, using NPIs with greater effectiveness and when a 20−30%
percentage of individuals were already protected against SARS-CoV-2 in the population. New adapted
COVID-19 vaccines with greater effectiveness in preventing SARS-CoV-2 infection must be developed to
increase herd immunity levels against emerging SARS-CoV-2 variants in the population and reduce the
health impact of emerging SARS-CoV-2 variants.

Audience Take Away Notes

• The audience will know how vaccines can prevent and block transmission of infectious agents
• The audience will know what are the critical parameters that must be monitored to assess the ability
of vaccines to prevent severe disease and infection
• The audience will know the challenges that COVID-19 vaccination programs must overcome to establish
herd immunity against emerging SARS-CoV-2 variants in the population

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Biography

Pedro Plans Rubio is Responsible for Health Registries, Public Health Agency of Catalonia, Health Department of
Catalonia, Spain. He received his MD from the School of Medicine, University of Barcelona; his PhD from the School
of Medicine, University of Barcelona, his MSc in Health Economics from the School of Economics, University of
Barcelona, and his MSc in Design of clinical and epidemiological studies from the School of Medicine, University of
Barcelona. Specialist in Preventive Medicine and Public Health. Specialist in Labor Medicine. Member of the research
group CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain. Member of
the research group “Pertussis transmission in Catalonia and Navarra”. Member of the research group “Global Burden
of Metabolic Risk Factors of Chronic Diseases”. He has published more than 100 articles in scientific journals on the
epidemiology of infectious diseases, epidemiology of risk factors for chronic diseases and for infectious diseases,
seroepidemiology, cost-effectiveness analysis of medicines and health programs, vaccination programs, and health
policy. He has published more than 100 articles in scientific journals. He has published the book “Application of the
cost-effectiveness of medicines and health programs in the health planning”, Elsevier, 2015. Editor-in Chief of Section
“Vaccine Efficacy and Safety” of the journal Vaccines and Editor of several Special Issues of the journal Vaccines.
Member of the Editorial Board of the journals Pharmacoeconomics Open.

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Infection 2024

Petersian M. Alcazaren*, MD; Helmar Soldevilla, MD

Department of Internal Medicine, West Visayas State University Medical Center,
Iloilo City, Philippines

A case report of a 22 year old male diagnosed with SLE, with concomitant
infections of COVID 19 moderate disease and HIV-AIDS
Background: As the world presently navigates the coronavirus disease 2019 (COVID-19) pandemic, there
is a growing need to assess its impact in patients with underlying immunocompromised states, including
autoimmune rheumatic diseases, such as Systemic Lupus Erythematosus (SLE), and HIV. Patients with
SLE and People living with HIV (PLWH) are unique populations, when considering the risk of contracting
COVID-19 and infection outcomes.

Clinical Case: We report a rare case of a 22 year old male, newly diagnosed with COVID 19 moderate
disease, SLE in flare, and HIV AIDS, at the same time, in one hospital admission. He initially experienced
gradually progressive symptoms of easy bruisability with associated persistent bicytopenia (anemia and
thrombocytopenia) and leukocytosis, despite oral corticosteroids, with nonproductive distressing cough,
undocumented low grade febrile episodes, and unintended weight loss, thus appropriate referrals to both
hematologist and rheumatologist were done. ANA IF titre was significantly elevated, and was managed as
Interstitial Lung Disease with Mycophenolate Mofetil, outpatient basis, with relief of symptoms. However,
recurrence of previous nonspecific signs and symptoms with accompanying abdominal pain, prompted
hospital admission. After a multidisciplinary approach to management of this patient, he was discharged
well.

Conclusion: In this report, we highlight the overlapping immunopathogenic mechanisms of COVID, SLE,
and HIV AIDS, and how it could provide insight into immune responses occurring between SLE and severe
cases of viral infections, as well as it might preempt PLWH about the potential of COVID to affect them in
various ways, including the increased risk of COVID-19 acquisition and interruptions of their treatment
and care.

Keywords: COVID 19, SLE, HIV AIDS, Immunopathogenic Mechanisms.

Audience Take Away Notes

• This case will show us the impact of COVID 19 in patients with underlying immunocompromised states,
including autoimmune rheumatic diseases, such as Systemic Lupus Erythematosus (SLE), and Human
Immunodeficiency Virus (HIV)
• This case emphasizes the uniqueness of special population (Patients with SLE and People living with
HIV (PLWH)), in terms of the risk of contracting COVID-19 and disease outcomes, hence helping the
health care providers in innovating and individualized yet holistic treatment strategies for such patients
• This case will provide an avenue for further researches and studies on the convergence of the
immunopathogenesis of COVID 19, or other viral infection, SLE and other autoimmune diseases, and
HIV

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Infection 2024

Biography

Dr. Petersian Alcazaren graduated from West Visayas State University- College of Medicine in 2018, and acquired her
license as a physician after passing the Philippine Physician Licensure Examination last September 2019. She then
proceeded to a 3-year residency training in Internal Medicine at West Visayas State University-Medical Center, which
she completed last December 31, 2022. She then served as the Chief Resident for Clinical Affairs of the department from
January 1, 2023 to December 31, 2023. She has several case reports authored and co-authored which were published
last 2023 in some international journals, and were also presented in two international research fora on Rheumatology.

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Infection 2024

Petersian M. Alcazaren*, MD; Tracy Roz P. Mallorca, MD; Lina

Amsua, MD; Marie Grace Dawn T. Isidro MD; Aretha Liwag,
Helmar Soldevilla, MD
Department of Internal Medicine, West Visayas State University Medical Center,
Iloilo City, Philippines

Factors affecting the outcomes of patients with Coronavirus Disease

(COVID-19) patients admitted in a tertiary hospital in Iloilo city: A
retrospective study
Background: Covid-19 is a viral respiratory illness caused by SARS-CoV-2, confirmed with RTPCR testing.
Considering the heterogeneity of clinical picture of COVID-19 disease, and the threats of its variants, the
review of current clinical data and outcome of available management strategies will have an impact on
future management and recommendations in the local setting.

Objective: This study generally aimed to determine the factors affecting the outcomes of COVID-19 patients
admitted in a tertiary hospital in Iloilo City. Specifically, this study aimed to describe the clinicodemographic
profile as to severity, outline the baseline diagnostic results, and describe the management strategies of
COVID- 19 confirmed cases, determine the distribution of the disease severity as to length of hospital stay,
complications, discharge outcomes, and identify significant associations between variables.

Methodology: This retrospective cross-sectional study involved RT-PCR confirmed COVID- 19 cases aged
19 years old and above admitted in a tertiary hospital from January to December 2021. The data were
obtained from chart review. Respective statistical tools were used to outline the variables of this study and
to determine significant differences between variables, across different groups. A 5% level of significance
was used.

Results: There were 229 patients enrolled in this study. Among variables, age, sex, day of illness, and presence
of comorbidities, were significantly related to disease severity. Severe and critical cases administered with
different management strategies tend to have longer hospital stay, > 10 days, compared with those who
did not receive treatment. Mild (28%) and moderate (36%) COVID cases improved or recovered more than
more severe cases. Patients with severe disease (50%) at baseline experienced more complications, which
are primarily acute respiratory distress syndrome (14.4%), acute kidney injury, (6.1%) and steroid- induced
hyperglycemia (3.5%). Patients with lower oxygen saturation (58.2%) and PF ratio (59.7%), higher values
of inflammatory markers, and those with infiltrates on their chest X-ray (36.1%) upon admission, were
significantly noted to have higher risk of acquiring complications.

Conclusion: Patients who belonged to the higher age group, males, with longer days of illness, and with
comorbidities, with lower oxygen level and PF ratio, elevated levels of serum inflammatory markers with
findings of infiltrates on chest X-ray, were likely to have a more severe disease, and experienced statistically
significant complications. The number of days of illness, and disease severity were also found to be
significantly related to the occurrence of complications, as well as administration of various management
strategies. Severe and critical patients were significantly identified to have received several management
strategies, hence, had higher average hospital stay. Lastly it has been found out that disease severity
and occurrence of complications were significantly associated with discharge outcomes. Most patients,
regardless of severity at baseline improved, and those with more severe disease on baseline developed
complications.

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Audience Take Away Notes

• Healthcare providers: The results of this study will give a clearer picture of the corresponding
outcomes of patients based on their initial characteristics during their admission in the institution.
It will improve the health care workers’ decision on requesting evidence-based diagnostic tests and
providing strategic management for the patients
• Patients and their families: The results of this study may help patients and their families understand the
reason behind the diagnostics requested and the management administered by the healthcare team.
Sufficient knowledge and understanding of these evidence-based practices may increase compliance
to the diagnostic requests and prescribed therapeutic regimen
• Research Community: The results of this study will provide evidence- based data on the local
epidemiological and clinical characteristics, and the management strategies utilized for patients with
Covid 19, with their corresponding clinical outcomes. It may aide in formulating future recommendations
• Policy makers and health officials: The results of this study will help our policy makers and health officials
in making evidence-based health education and scientifically sound regulations and recommendations
concerning Covid 19 disease, to be provided to the locality
Biography

Dr. Petersian Alcazaren graduated from West Visayas State University- College of Medicine in 2018, and acquired her
license as a physician after passing the Philippine Physician Licensure Examination last September 2019. She then
proceeded to a 3-year residency training in Internal Medicine at West Visayas State University-Medical Center, which
she completed last December 31, 2022. She then served as the Chief Resident for Clinical Affairs of the department from
January 1, 2023 to December 31, 2023. She has several case reports authored and co-authored which were published
last 2023 in some international journals, and were also presented in two international research fora on Rheumatology.

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Infection 2024

Ro Janna J. Jamiri Sarapuddin*, RN, MD; Jennie A. Wong, MD,

MPH, FPPS; Lorraine Marie S. Item, MD, FPPS, DPSHBT, DPSPH,
FPSPO; Kris Ian B. Mendoza, MD, FPPS
Department of Pediatrics, Ospital ng Maynila Medical Center, Manila, National
Capital Region, Philippines

Clinical characteristics and outcomes of pediatric patients with

suspected and confirmed coronavirus disease 2019 (COVID-19) infection
admitted in a tertiary government hospital in the Philippines
Background: While there is evidence that the burden of COVID-19 infection in hospitalized children is
lesser than in their adult counterparts, currently, there are limited reports describing clinical data on
COVID-19 patients particularly in pediatric population.

Objective: To describe the clinical characteristics and outcome of Suspected Coronavirus Disease 2019
(COVID-19) infection in pediatric patients admitted at a tertiary government hospital from March 2020-
February 2021.

Study Design: Retrospective, descriptive study.

Setting: A Tertiary Government Hospital (Ospital ng Maynila Medical Center) in Manila, Philippines.

Population: Pediatric patients aged 1 day to 18 year old with Suspected/ Confirmed COVID 19 Infection.

Results: The total number of patients included in the study is 213 pediatric patients. There are 7 (3.29%)
patients who have tested positive on COVID-19 based on the result of the RT-PCR while 206 (96.71%) have
tested negative. The mean age is 5 years old. Majority were male 53.05% while female 46.95%. In COVID-19
positive patients, where 71.43% were male and 28.57% were female. Large portion were from Manila 81.22%
and Non-Manilan 18.78%. In terms clinical presentation, most patients had fever 153 (71.83%), cough 109
(51.17%) and dyspnea 86 (40.37%). All COVID-19 positive have varied comorbid conditions while there are 66
(32.03%) COVID-19 negative. Patients were managed with antibiotics 155 (72.77%), inotropes 15 (7.04%), and
steroids 51 (23.9%). The median days on the length of stay is around 6 days. In terms of severity of disease,
most patients had moderate 179 (84.0%), followed by severe 19 (8.92%) and critical 15 (7.04%). The mean
length of stay was 8 days. Majority of patients were discharged improved 91.55%.

Conclusion: The COVID-19 pandemic has had a catastrophic effect on global health which can affect
pediatric patients and can cause mortality among them. But most pediatric patients have moderate disease
and discharged improved.

Audience Take Away Notes

• The Coronavirus Disease 2019 (COVID-19) pandemic had taken an alarming toll among all age population
across the world. While there is evidence that the burden of COVID-19 infection in hospitalized
children is lesser than in their adult counterparts, currently, there are only few studies describing
COVID-19 in pediatric population. This is a serious public health issue and remains to be a significant
cause of morbidity and mortality among Filipino children. Thus, there is a need for further studies for
recognition of the disease. This study was designed to review the clinical characteristics and outcomes
of Suspected Coronavirus Disease 2019 (COVID-19) in tertiary government hospitals to contribute to
the knowledge of COVID-19 in children. The researcher recommend that further studies is required

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to determine the cause for age-related variations in COVID-19 clinical characteristics, to examine the
involvement of children in community transmission, and to develop therapy and vaccinations for the
illness
Biography

In 2016, Dr. Ro-Janna Jamahari Jamiri-Sarapuddin received her medical degree from the De La Salle Health Sciences
Institute in the Philippines. In 2022, she completed her Pediatric residency training at the Ospital ng Maynila Medical
Center in the Philippines. She is currently a visiting lecturer at Western Mindanao State University College of Medicine
in the Philippines and a consultant at the Edwin Andrews Airbase Hospital of the Philippine Air Force in Zamboanga
City.

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Infection 2024

S. Gokce Alagoz*, Mustafa Saglam, Tekin Karslıgil

Gaziantep University, Turkey

The role of epstein-barr virus in upper respiratory tract diseases

Objective: Ebstein-Barr virus asymptomatically infects about 95% of adults worldwide. It is the main
cause of infectious mononucleosis, which is observed most frequenty in adolescents. Because EBV is an
opportunistic virus, it is more difficult to diagnose. It is not the first factor that comes to mind. However,
its presence seriously threatens health. It is very important to detect EBV together with other upper tract
disease factors.

Material and Method: 184 patients were included in our study. EBV DNA isolation and PCR were performed
on throat swab samples in which upper respiratory tract disease agents were detected.

Results: 184 patients (95 women, 89 men) admitted to our hospital with suspected upper respiratory tract
disease were included in our study. The average age of female patients was 50, 4 and male patients was 43.
The kit we use for upper respiratory tract disease screening includes Adenovirus, Severe Acute Respiratory
Syndrome Coronavirus 2 (SARS-CoV-2), human Metapneumovirus, human Rhinovirus / Enterovirus,
Influenza A virus, Influenza B virus, Parainfluenza virus, Respiratory syncytial virus, and Bordetella
parapertussis, Bordetella pertussis, Chlamydia pneumoniae, Mycoplasma pneumonia from the bacterial
group. EBV positivity was detected in 43 patients with EBV PCR in the throat swab sample of these 184
patients. The EBV PCR lower limit is 157 copy/ml. 9 out of 43 patients are below 157 copy/ml.

Of the 34 EBV (+) patients, 17 were ex. Of the 17 patients, 6 were women (mean age: 57), 11 were men (mean
age: 39). Influenza A in 1 of the 17 patients who died; 6 of them were Human Rhinovirus, Enterovirus; 2 had
Adenovirus; 1 in Respiratory Synctial Virus; 2 of them were H. influenza, Streptococcus pneumonia was
detected in 3 patients and Bocavirus in 1 patient.

Conclusion: Although EBV is an opportunistic and very common virus seen in the community, it does not
come to mind in the preliminary diagnosis. These gaps urgently need to be filled, especially regarding the
epidemiology and pathogenesis of the virus since more than 90% of the population eventually becomes
infected.
Biography

Dr. Gokce Alagoz studied Biology at the Ankara University, Ankara and graduated in 2007. Then I started to MS in
hepatology laboratory at the Institute of Biotechnology, Ankara University. I received my PhD degree in 2017 at the
Biology, Gaziantep University. I am lecturer at Microbiology department of Medicine Faculty of Gaziantep University.
I studied about viruses, molecular microbiology, sequencing and other molecular methods. I have published research
articles in SCI(E) journals.

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Infection 2024

Shweta Chelluboina*, Darshan Kshirsagar, Akhilesh Chandra

Mishra, Vidya Arankalle, Shubham Shrivastava
Communicable Diseases Department, Interactive Research School for Health
Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra, India

Dynamics of maternal dengue virus antibodies in Indian infants

D engue is a mosquito-borne viral disease endemic in many countries particularly in the tropical and
sub-tropical regions of the world. It is caused by one of the four serotypes of Dengue Virus (DENV).
As the four serotypes are co-circulating, multiple encounters with heterologous dengue infection are
highly prevalent. The enhanced risk of disease severity associated with secondary infection is mediated by
one of the mechanisms known as Antibody-Dependent Enhancement (ADE) in dengue. The pathogenesis
of dengue infection is determined by the interplay of neutralizing and infection-enhancing antibodies,
particularly relevant in infants and young children. Infants born to dengue-immune mothers acquire
maternal antibodies to dengue. Maternally acquired DENV-specific antibodies in infants, though initially
protective, decline during the first year of life making them susceptible to primary dengue infections.
Because of the introduction of the dengue vaccine in the near future in endemic countries like India,
there is an urgent need to generate data on the kinetics of maternal antibodies that may offer a better
understanding of the optimal age for dengue vaccination. In this study, we aimed to initially optimize
plaque reduction neutralization test and antibody enhancement assay in a 96-well plate for the detection of
neutralizing and infection-enhancing antibodies respectively for each of the four dengue virus serotypes.
Next, we determined DENV-specific neutralizing and enhancing antibodies in Indian infants at birth, 3, 6
and 9 months of age. All anti-DENV IgG-positive samples showed the presence of neutralizing antibodies
against 3 or 4 serotypes at birth. Neutralizing antibody levels decline with the increasing age of infants.
Similarly, all anti-DENV IgG-positive samples showed enhancement of infection at a particular dilution
against 3 or 4 serotypes at birth. With the increasing age of infants, fold enhancement of infection was
highest in 6-month-old infants. In summary, our data suggests that DENV infection–enhancing activity
coincided with the decline of neutralizing antibodies. Sub-neutralizing levels of maternally acquired
DENV-specific antibodies showed DENV infection–enhancing activity highest at 6 months of age in infants.
These maternal antibodies might interfere with the response to dengue vaccines. Therefore, such studies
may provide insights into the appropriate age for dengue vaccination in infants born to dengue-immune
mothers in endemic countries like India.

Audience Take Away Notes

• This presentation would help the audience to understand the complexities associated with the antibody
response to dengue virus infections in infants
• This study emphasizes on the methodologies used to evaluate the antibody response to dengue virus
infection
• This study will contribute information about the prevalence of neutralizing and infection enhancing
antibody levels in a pediatric population which is most susceptible population to severe dengue
infection
• Such a study on a larger scale will provide a practical solution around the age at which the vaccine
should be given to children in dengue endemic countries

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• It can be used as a starting point to conduct large-scale age-stratified population studies to understand
the problems associated with disease severity in dengue infection
Biography

Shweta Chelluboina studied Clinical Virology at Manipal Institute of Virology, India and obtained her Master’s degree
in 2017. There she worked on the project entitled “Persistence of antibody response in Chikungunya.” She then joined
the Communicable Diseases department headed by Dr. A.C Mishra and Dr. Vidya Arankalle at the Interactive Research
School for Health Affairs, Bharati Vidyapeeth, India. She is in the final year of her Ph.D. working on “Development and
comparative assessment of antibody-dependent enhancement assays for dengue viruses” under the guidance of Dr.
Shubham Shrivastava. Recently, she was awarded for best poster at VIROCON-2023 and has published two research
articles in high impact journals.

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Infection 2024

Sinisa Skocibusic1,2*, Milena Latincic1, Dario Icanovic1, Maja Karin3

1
Center for Prevention and Outpatient Treatment of Addiction Mostar, Mostar,
Bosnia and Herzegovina
2
Institute for Public health of Federation of Bosnia and Herzegovina, Mostar,
Bosnia and Herzegovina
3
Clinic for Internal Diseases with Dialysis Center, University Clinical Hospital
Mostar, Mostar, Bosnia and Herzegovina

An effective strategy for eliminating chronic Hepatitis C in individuals

with an opioid addiction
Background: The healthcare system in Bosnia and Herzegovina continues to face a significant burden due
to the presence of chronic hepatitis C. Individuals who engage in the use of injectable drugs represent a
substantial reservoir of the hepatitis C virus, hence presenting an enduring public health concern.

Methods: A novel paradigm encompassing motivation, preparation, treatment, and monitoring of chronic
hepatitis C was established with the aim of enhancing patient accessibility and reducing barriers to
treatment. The study conducted by the Center for the Prevention and Outpatient Treatment of Addiction
in Mostar involved an examination of medical records in order to investigate the sociodemographic and
beginning treatment factors for chronic hepatitis C in individuals receiving opioid substitution therapy
in the IDU, as well as their family members. These individuals underwent standardized procedures in
accordance with the Mostar model.

Results: The research findings indicate a significant success rate (94.7%) in effectively eliminating HCV
infection in individuals with addiction through the use of DAA. A cohort of 25 patients underwent diagnostic
treatment, with just one patient voluntarily terminating the treatment and one patient succumbing to the
condition. Patients who received treatment had an average starting viremia of 795,104 IU/mL. The results
of the genotyping analysis indicated a nearly equal distribution of genotypes 1 (52%) and 3 (48%).

Conclusion: This study enhances the comprehension of optimal approaches in the treatment of individuals
with opioid addiction and contributes to the investigation of strategies for efficiently managing infectious
diseases in susceptible demographics. The model exemplifies a relevant instance of a successful public
health initiative, and its implementation can serve as a source of inspiration and direction for other
communities in Bosnia and Herzegovina grappling with the task of eliminating HCV among this vulnerable
population.

Audience Take Away Notes

• This presentation will add to fresh viewpoints and ideas for the effective treatment of blood-borne
infections, particularly chronic hepatitis C among hard-to-reach population, in nations where access
to contemporary hepatitis C treatment is restricted. A treatment that works well can serve as a helpful
example for listeners when it comes to potential improvements to the health system or local working
circumstances

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Biography

Sinisa Skocibusic is a healthcare practitioner by profession. The individual embarked on a postgraduate program in
"Medical Care and Public Health" with a particular focus on infectious diseases. He performed a crucial role during
the COVID-19 epidemic as a subspecialist in intensive care medicine. Aside from his clinical practice, he imparts
knowledge to aspiring physicians at the Medical School in Mostar. The individual in question has held the position
of director at the Center for Addiction Prevention and Outpatient Treatment in Mostar since 2015 and subsequently
assumed the role of director at the Institute of Public Health of the Federation of Bosnia and Herzegovina since
2021. He has authored or co-authored an additional 11 scientific papers that have been published in journals that are
indexed in relevant databases. Furthermore, he has contributed to the publication of five scientific publications in
other journals and has made contributions to two edited volumes.

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Infection 2024

Sira S. Owibingire1*, Elison N. M. Simon1, Iren Kida Minja1, Siren

Fromreide3, Innocent J. Mosha2, Edda A. Vuhahula1, Daniela E.
Costea3
1
Muhimbili University of Health and Allied Sciences (MUHAS), Tanzania
2
Muhimbili National Hospital, Tanzania
3
University of Bergen Haukeland - University Hospital, Norway

Need of monitoring human papillomavirus infection among oral and

oropharyngeal squamous cell carcinoma patients from setting with high
incidence of cervical cancer
Background: There has been a global upsurge of Oropharyngeal Cancer (OPC) cases associated with
increased Human Papillomavirus (HPV) infection. In Tanzania and Sub-Saharan African countries data on
the same is lacking and HPV among OPC patients is not investigated routinely. The recommended practice,
however not practiced in most LMICs, is to determine HPV infection status to oral and Oropharyngeal
Squamous Cell Carcinoma (OPSCC) before treatment since the positive cases are treated with de-escalated
regime because they respond better to treatment.

While the burden of HPV in cervical cancer is well established the role of HPV is not well documented in
countries where cervical cancer is endemic. Without baseline data it may be difficult to later quantify the
effect of HPV vaccination in reduction of OPC. It is better to start now establishing means of monitoring
the prevalence of HPV in both OPC patients and where possible the health individuals in settings where
HPV related cervical cancer is more prevalent.

Aim: This study aimed at determining the occurrence of HPV status to OPSCC through p16
Immunohistochemistry (IHC) and In Situ Hybridization (ISH).

Materials and Methods: The study was done at Muhimbili National Hospital (MNH) and MUHAS Dental
Clinic from August 2020 and Dec 2022. The biopsies were taken from the cases clinically suspected to
have OPSCC. Following confirmation of OPSCC histologically, the blocks of 218 patients were obtained and
screened for possibility of obtaining quality tissue materials for Tumour Microarray (TMAs) for IHC and
ISH whereby blocks for 172 patients qualified. Tissues were transferred to Haukeland University Hospital
(Norway) where TMAs were prepared, and then IHC and ISH were done. In addition, IHC for p53 was
performed to search for association of occurrence of these biomarkers.

Results: Out of 172 cases of OPSCC the p16 overexpression was found in 15 cases (8.72%) which had over
70% of cells in the specimen stained. In-situ hybridization was done in all cases and only 2 (1.16%) were
positive. The majority of p16 positive cases showed only weak stains on ISH. The majority of the 15 cases
which showed p16 overexpression were located on the tongue followed by mandibular gingiva and buccal.
Two thirds were males and 40% were aged below 60 years with almost all at clinical stage IV.

Conclusion: Findings concur with research done elsewhere in sub-Saharan Africa showing that HPV
infection among OPSCC is low. Among these few cases males dominated. Given the current situation of
genital HPV infections, there is a need for constant surveillance of the same for oral and pharyngeal area.

Recommendation: There is a necessity to routinely determine HPV status using p16 IHC and RNA ISH
among OPSCC cases in Tanzania before initiation of treatment for the sake of estimating prognosis and for
constant surveillance of HPV burden.

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Audience Take Away Notes

• HPV infection is not determined routinely in OPC patients in most of the LMICs
• Up-to-date the complete staging of OPC as the 8th AJCC edition is not possible in settings where HPV
infection is not determined
• The role of HPV infection among OPC patients is low but should not be ignored
• While the burden of HPV in cervical cancer is well established the role of HPV is not documented in
countries where cervical cancer is endemic
• Without baseline data it may be difficult to later quantify the effect of HPV vaccination in reduction of
OPC
• It is better to start now establishing means of monitoring the prevalence of HPV in both OPC patients
and where possible the health individuals in settings where HPV related cervical cancer is more
prevalent
Biography

Dr. Sira Owibingire graduated with Doctor of Dental Surgery (DDS) degree from the University of Dar es Salaam,
Tanzania and later MDent in Oral and Maxillofacial Surgery from the Muhimbili University of Health and Allied Sciences
(MUHAS) in 2017. He received Fellowship in Head and Neck Oncology at Tata Memorial Centre in India in 2019. He is
a Senior Lecturer and Oral and Maxillofacial Surgeon at MUHAS School of Dentistry. He is conducting studies in oral
and pharyngeal cancer (OPC), among other objectives he examined the role of HPV. He has published over 45 research
articles in SCI(E) journals.

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Sukki Ho
School of Nursing, The Hong Kong Polytechnic University, Hong Kong

Effect of a multimodal infection control programme in the reduction

of bacterial contamination in the nasogastric feeding tube hubs in
residential care homes for elders

N asogastric Tube (NG tube) feeding in Residential Care Homes for the Elderly (RCHEs) carries the
risk of contamination at the NG tube hub, a crucial connection point in the enteral feeding process.
This contamination can lead to the spread of harmful microorganisms, potentially resulting in serious
complications such as mortality. However, there is limited research on the effectiveness of Infection
Control Programs (ICPs) in reducing NG tube hub contamination.

This study aimed to assess the impact of a comprehensive ICP on reducing bacterial contamination in NG
tube hubs, enteral milk, and the hands of RCHE staff, while also evaluating its effectiveness in enhancing
the staff's knowledge and skills in NG tube feeding. The research utilized a single-blinded cluster-
randomized controlled trial involving eight RCHEs. The intervention group received a 12-week multimodal
ICP, including educational sessions on infection control measures related to NG tube feeding, while the
control group did not receive this intervention.

The ICP sessions, which involved various teaching methods such as PowerPoint presentations, videos,
group discussions, and practical workshops, were tailored to accommodate the staff's shift schedules.
Bacterial samples were collected from residents' NG tube hubs, enteral milk, and staff's fingertips for
analysis. Pre- and post-intervention data on NG tube feeding knowledge and skills were also gathered and
compared between the two groups.

Eight RCHEs with 140 residents and 250 RCHE staff participated in the study. Results showed a significant
reduction in the total bacterial counts of the NG tube hubs within the intervention group before and after
the intervention (p=0.04), as well as between groups (p=0.001). Both groups had 19 contaminated NG tube
hubs at baseline. After intervention, the number of contaminated NG tube hubs was reduced to 13 in the
intervention group but no changes were found in the control group. In addition, the total bacterial counts
of the enteral milk was significantly reduced between groups (p=0.001) while there was no enteral milk
contamination in either group before and after intervention.

The knowledge and skills in NG tube feeding was increased significantly in the intervention group (p=0.001)
and was significantly improved compared with the control group after intervention (p=0.001). There were
significant reductions in the total bacterial counts in right and left fingertips of the RCHE staff of the
intervention group within group (p=0.001) and between groups (p=0.001) after intervention. Also, the
number of fingertips contaminated was significantly reduced within the intervention group (p=0.001) and
between groups (p=0.001). These findings underscore the effectiveness of the multimodal ICP in minimizing
bacterial contamination and enhancing infection control practices in NG tube feeding.

In conclusion, the study highlights the positive impact of the ICP on reducing bacterial contamination in NG tube
hubs and promoting proper hand hygiene among RCHE staff. Continuous implementation of such programs in
RCHEs is recommended to sustain and further improve infection control practices in NG tube feeding.

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Audience Take Away Notes

• This study on infection control programs (ICPs) in NG tube feeding at residential care homes for the
elderly (RCHEs) demonstrates significant reductions in bacterial contamination at NG tube hubs,
enteral milk, and staff's hands. The findings highlight the effectiveness of comprehensive ICPs in
enhancing staff knowledge and skills, reducing contamination risks, and promoting proper hand
hygiene. Healthcare professionals in RCHEs can benefit from implementing similar multimodal ICPs
tailored to their schedules to improve infection control practices, minimize bacterial contamination,
and ultimately enhance patient safety in NG tube feeding. his research that other faculty could use to
expand their research or teaching?
• The research on the impact of the comprehensive infection control program (ICP) in reducing bacterial
contamination in NG tube feeding in residential care homes for the elderly provides valuable insights
that can improve the accuracy of future research designs and assist in addressing design problems in
similar studies. The study's findings offer new information on the effectiveness of ICPs in minimizing
contamination, enhancing infection control practices, and improving staff knowledge and skills in NG
tube feeding. This information can guide the development of more targeted and effective interventions
in future research, helping researchers design studies that aim to reduce risks associated with NG tube
feeding and improve overall care quality in residential care settings. The study's results can inform
the design of interventions and protocols aimed at reducing bacterial contamination and promoting
proper infection control measures in similar healthcare settings, ultimately contributing to better
patient outcomes and quality of care
Biography

Dr. Sukki Ho is an Associate Professor of Practice of the School of Nursing, The Hong Kong Polytechnic University (The
PolyU). Her expertise is infection control nursing, teaching and research. She has contribution in nursing research
with publications in the areas of N95 respirator fit test. Her doctoral research topic is related to infection control
nursing care for chronically ill patients in the residential care homes for elders. Besides, she obtained the outstanding
academic awards during her doctoral study in infection control specialty. Dr. HO has reinforced and brought new
information of the hospital infection control practice specific to the prevention of COVID-19 infection to the staff and
students of The PolyU during COVID-19 pandemic. She obtained Faculty Award/ Prizes for outstanding achievement
in services (Team member) from the Faculty of Health and Social Sciences, The PolyU. She also serves as clinical
coordinator of the Master of Nursing Programme.

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Infection 2024

Susannah Colt1,2*, Hannah W. Wu1,2, Mario A. Jiz3, Blanca R. Jarilla3,

Jonathan D. Kurtis1,4, Jennifer F. Friedman1,2
1
Center for International Health Research, Rhode Island Hospital, Providence, RI,
United States
2
Department of Pediatrics, The Warren Alpert Medical School of Brown
University, Providence, Rhode Island, United States
3
Research Institute for Tropical Medicine, Department of Health, Manilla, The
Philippines
4
Department of Pathology and Laboratory Medicine, The Warren Alpert Medical
School of Brown University, Providence, Rhode Island, United States

Inflammation-adjusted vitamin A deficiency is associated with higher

schistosoma japonicum infection intensity among children and
adolescents in the Philippines
Background: Children with intestinal schistosomiasis are at risk for undernutrition, anemia, linear growth
stunting, and impaired cognitive development. Vitamin A deficiency impairs immune function against
parasitic pathogens. In rodents, dietary-induced vitamin A deficiency causes higher schistosome worm
and egg burden, higher mortality, and a reduced immune response compared to replete vitamin A status.
In humans, applying an inflammation-adjustment strategy to vitamin A blood biomarker measures is
necessary to estimate vitamin A status during periods of infection or inflammation. To our knowledge, this
is the first study to examine relationships between inflammation-adjusted vitamin A status and human
schistosomiasis burden.

Methods: This is a secondary analysis using stored sera collected from a cohort of children and adolescents
with Schistosoma japonicum infection from Leyte, The Philippines who were followed for 18 months. The
original study, conducted from 2002-2003, measured S. japonicum infection intensity by Eggs Per Gram of
stool (EPG) using the Kato-Katz method, measured C-Reactive Protein (CRP) in blood sera, and collected
demographic information of age, sex, and Socio-Economic Status (SES). The current analysis added ELISA
measures of vitamin A Retinol-Binding Protein (RBP) and alpha-1-Acid Glycoprotein (AGP) from stored
sera collected at baseline. The Thurnham Correction Factor (TCF) inflammation-adjustment method was
applied to measures of RBP using co-circulating measures of CRP and AGP to estimate vitamin A status.
A sample of N=40 participants was randomly selected based on S. japonicum EPG distribution. Statistical
analyses, including multivariate linear regression, was conducted using SAS Studio 3.8 (SAS Institute Inc.,
Cary, NC).

Results: There were 39 participants with S. japonicum infection included for analysis. The median age
was 13.4 years (9.9-16.3 IQR) and 61.5% were male. The median infection intensity at the baseline visit was
83.3 EPG (23.3-206.7 IQR), and the proportions of infection intensity categories were 53.8% light (1-99
EPG), 35.9% moderate (100-399 EPG), and 10.3% heavy (≥400 EPG). After applying the TCF correction to
RBP values, 14 participants (35.9%) were categorized as vitamin A deficient (RBP < 0.7 µmol/L). Using a
multivariate regression model adjusting for age, sex, and SES, vitamin A deficiency was associated with
higher S. japonicum infection intensity (EPG) compared to those with replete vitamin A at the baseline visit
(p=0.0172). Baseline vitamin A status was not found to be associated with S. japonicum infection intensity
(EPG) at subsequent visits (1, 3, 6, 9, 12, 15, or 18 months after baseline).

Conclusions: After adjusting for inflammation, more than one third (35.9%) of the sample was vitamin
A deficient. We report an association between vitamin A deficiency and increased schistosomiasis
egg burden at the baseline visit. These results agree with findings reported from animal studies and
represent an important discovery for our understanding of nutritional modulation of infection, specific

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to schistosomiasis. There is often an overlapping geographical burden of micronutrient deficiencies and

neglected tropical diseases. In combination with preventive chemotherapy for schistosomiasis, nutritional
interventions improving vitamin A status may lead to reduced morbidity for children and adolescents
living in endemic areas.

Audience Take Away Notes

• This study demonstrates how to estimate vitamin A status in the context of infection. Inflammation-
adjustment is an important technique because hepatic secretion of vitamin A into the bloodstream is
reduced by inflammatory cytokines during the acute phase response, which can invalidate assessment
during infection. Inflammation-adjustment should also be applied to ferritin measures for the
assessment of iron status
• Improved estimation of vitamin A status using inflammation-adjustment allows for widespread
investigation of vitamin A deficiency and the immunologic response to all types of human infections–
previously hampered by the inability to estimate status during an acute phase response
• Better understanding for how undernutrition and micronutrient deficiencies impact immunopathology
from infections can offer opportunities for improved interventions and reduced long-term morbidities
Biography

Dr. Colt holds bachelor’s degrees in biology and anthropology from the University of Rhode Island (2006) and a
postgraduate diploma in public health from the University of Auckland (2009). She earned her doctoral degree in
the concentrations of nutrition, epidemiology, and infectious disease immunology in 2019 from Cornell University.
In 2020, Dr. Colt joined the Center for International Health Research (CIHR) at the Warren Alpert Medical School of
Brown University where she studies schistosomiasis-related morbidities among pregnant women and children. In
recent years, she received awards from the Thrasher Foundation (2022) and the National Institutes of Health (2023) to
investigate relationships between vitamin A deficiency and schistosomiasis immunopathology.

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Richard AJ. Williams1, Hillary A. Criollo Valencia2, Irene Lopez

Marquez3, Fernando Gonzalez Gonzalez3, Francisco Llorente4,
Miguel Angel Jimenez Clavero4, Nuria Busquets5, Marta Mateo
Barrientos6, Gustavo Ortiz Diez7, Tania Ayllon Santiago1,2*
1
Departamento de Genetica, Fisiología y Microbiologia, Facultad de Biologia,
Universidad Complutense de Madrid, Spain
2
Facultad de Ciencias de la Salud, Universidad Alfonso X el Sabio, Madrid, Spain
3
Grupo de Rehabilitacion de la Fauna Autoctona y su Hábitat – GREFA, Madrid,
Spain
4
Centro de Investigacion en Sanidad Animal (CISA-INIA), CSIC, Madrid, Spain
5
IRTA, Campus de la Universitat Autonoma de Barcelona, Spain
6
Departamento de Microbiologia y Parasitologia. Facultad de Farmacia. Universidad Complutense de
Madrid, Spain
7
Departamento de Medicina y Cirugia, Facultad de Veterinaria, Universidad Complutense, Madrid, Spain.
3
Clinic for Internal Diseases with Dialysis Center, University Clinical Hospital Mostar, Mostar, Bosnia and
Herzegovina

Insights into West Nile Virus seroprevalence in wild birds and equines: A
focus on Madrid province, Spain

W est Nile Virus (WNV), classified under the Orthoflavivirus genus and Flaviviridae family, is a re-
emerging flavivirus perpetuated in an enzootic cycle between avian hosts and mosquito vectors.
Periodic outbreaks of WNV in humans and horses can result in neuroinvasive disease and fatalities. Spain,
particularly Andalusia, Extremadura, and Catalonia, has experienced numerous WNV outbreaks. In 2020,
an outbreak in Andalusia and Extremadura reported seventy-seven human cases, including eight fatalities.
WNV seropositivity has been identified in horses in the Community of Madrid, but, to the best of our
knowledge, wild bird transmission remains unreported in this region. To assess WNV seroprevalence, wild
birds from a wildlife rescue center and privately owned equines were sampled. Results showed thirteen
birds (8.2%) and one equine (4.0%) positive using a WNV competitive Enzyme-Linked Immunosorbent
Assay (cELISA). Four avian samples (2.5%) and one equine (4.0%) were confirmed positive for specific
WNV antibodies through microneutralization testing (VNT). Positive birds comprised both migratory and
resident species, including juveniles and adults. The presence of seropositive resident and juvenile birds,
particularly a nestling and a fledgling, suggests local flavivirus transmission within Madrid. The potential
circulation of flaviviruses, including WNV, within Madrid Community raises concerns, necessitating further
surveillance in mosquitos, wild birds, and horses.

Audience Take Away Notes

• The audience can increase their knowledge on WNV situation in Spain in both wildlife and horses
• This research aids professionals in public health, wildlife management, and veterinary medicine by
providing insights into WNV transmission dynamics and seroprevalence in Madrid
• Other faculty members can utilize this research to expand their knowledge on WNV epidemiology,
wildlife disease dynamics, and the effectiveness of surveillance strategies
• It offers a practical solution by identifying potential WNV circulation in an urban environment
and underscores the importance of targeted surveillance in mosquitos and wild birds to mitigate
transmission risks
• It enhances design accuracy by offering new data on WNV seroprevalence in various avian species,
contributing to better-informed decision-making in disease management
• Other benefits include raising awareness about WNV transmission risks and promoting collaboration
between different researchers in this area

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Infection 2024

Biography

Dr. Ayllon completed her degree (2005) and PhD in Veterinary Medicine (2009) at the Complutense University of
Madrid, Spain and is currently Lecturer at Complutense (UCM) and Alfonso X el Sabio (UAX) Universities in Spain
and collaborating researcher at Fiocruz, Brazil. Her research experience includes the study of infectious diseases
that impact both veterinary and human health and antimicrobial drug- resistant microorganisms. She has held two
postdoctoral positions at Free University of Berlin, Germany (2012-2013) and Oswaldo Cruz Institution, Brazil (2015-
2019), focused on the entomo-virological surveillance of different pathogens. She has published 23 research papers
in SCI Journals and is member of different research groups: Health Surveillance (UCM); Diagnosis and Control of
Zoonoses in Carnivores (UAX); Antimicrobial Resistance (UAX); Spanish Society of Microbiology (SEM); AVEPA and
ESCMID.

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Dr. Anupama Bappal, Dr. Atul Kamath, Dr. Vidya Hegde, Dr.
Rashmi Jain, Dr. Rashmi S, Dr. Rosshini Kummararaj*
Department of ophthalmology, Yenepoya Medical College, Mangalore, Karnataka,
India

Story of the wandering worm

Introduction: A parasite may look docile and harmless but it can create havoc in human eyes. Early
detection and timely treatment can prevent blindness. We report three cases of parasites in the eye with
varying presentations.

Case 1: A 76-year-old gentleman, a pet lover and a gardening enthusiast reported with complaints of foreign
body sensation in his left eye. Examination showed subconjunctival mobile worm in the inferior bulbar
conjunctiva which was removed under topical anesthesia.

Case 2: A 10-year-old boy reported with complaints of gradual painless diminution of vision in his left
eye for 6 months. Posterior segment examination showed a motile subretinal nematode with multimodal
grey-white lesions in the outer retina suggestive of Diffuse Unilateral Subacute Neuroretinitis (DUSN). The
worm was photocoagulated and the child was given a course of antihelminthic treatment.

Case 3: 40 year old gentleman a trekker, came with complaints of difficulty while reading. Visual acuity was
6/6 in each eye. The posterior segment of the left eye showed Retinal pigment epithelial track in a criss-
cross fashion throughout the retina-sparing fovea(path taken by the nematode). An immobile coiled worm
was seen in the pars plana region suggestive of a dead nematode.

Conclusion: It is important to suspect nematodes in tropical countries and refer patients to ophthalmologists
for early detection and prevention of blindness.

Audience Take Away Notes

• As a clinician, it is important to rule out and consider parasites as a differential diagnosis for unilateral
vision loss
• As seen in case one it is important for clinicians to consider parasites as a differential diagnosis when
patients presents with non specific foreign body sensations
• These reports show how parasites can affect human eyes
Biography

Dr. Anupama Bappal graduated from Kasturba Medical College,Mangalore in1999. She has done Comprehensive
Ophthalmology fellowship from Sankara Eye Hospital, Coimbatore. She is a fellow of Medical Retina from Sankara
Nethralya Chennai. She has a special interest in Retinopathy of prematurity and innovations in ophthalmology education.
She has conducted instruction courses in state conferences and has publications in National and International Journal.

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Infection 2024

Tran Lam Tu Quyen1,2*, Yi Jiun Pan2

1
Department of Biological Science and Technology, College of Life Science, China
Medical University, Taichung, Taiwan
2
Department of Microbiology and Immunology, School of Medicine, College of
Medicine, China Medical University, Taichung, Taiwan

Investigation of molecular epidemiology of carbapenem-resistant

acinetobacter baumannii group in Taiwan

T he Acinetobacter baumannii group (AB-group), encompassing A. baumannii, A. pittii, A. nosocomialis,

along with recent additions A. seifertii and A. dijkshoorniae, have emerged as prominent nosocomial
pathogens with a global presence. Infections with antibiotic-resistant Acinetobacter spp., especially
carbapenem-resistant A. Baumannii (CRAB) or multidrug-resistant A. baumannii, are associated with
an elevated risk of mortality compared to susceptible strains, and their prevalence in nosocomial
infections has been steadily rising. CRAB strains were categorized as a critical priority pathogen by the
World Health Organization toward combatting increasing antibiotic resistance and developing advanced
therapy. Molecular characterization techniques, such as blaOXA-51-like PCR and rpoB sequencing, exhibit
superior discriminatory capability compared to conventional approaches for the AB group. A total of 492
Acinetobacter spp. strains were collected from two hospitals in Taiwan and were classified using MALDI-
TOF MS, blaOXA51-like PCR and rpoB sequencing: 94.5% (n=465) of A. baumannii and 5.5% (n=27) of Non-A.
Baumanniii (NAB). Out of 492 isolates, 49.3% (n = 240) were defined as Carbapenem-Resistant (CR) strains
with the MIC value of Imipenem (IMP) and Meropenem (MEM) ≥ 4 mg/L, including CRAB (n = 237) and
Carbapenem-Resistant NAB (CR-NAB) (n = 3). All CRAB and CR-NAB were screened carbapenemase genes
by multiplex PCR assay. All CR isolates were negative for blaOXA-143-like, blaKPC, blaGES, blaVIM, blaSPM,
blaGIM, and blaSIM. Out of 237 CRAB strains, 72.6% carried blaOXA-23-like, 22.8% carried blaOXA-24-like,
3.3% were co-carriage of blaOXA-23-like-blaOXA-24-like and 1.3% harbored blaOXA51-like only. Among
CR-NAB strains, 2 strains were co-carriage of blaOXA58-like and blaIMP, and one strain carried blaNDM-1.
The rates of the predominant carbapenemase genes from 2015 to 2021 were further compared and showed
slight changes during these years. Interestingly, we found a strain with harbored blaNDM-1, featuring the
rpoB allele (rpoB-85) closely aligned with A. seifertii, and exhibiting remarkably high MIC levels of 128
mg/L for both IMP and MEM. Whole-genome Sequencing indicated that the strain harbored a plasmid-
borne blaNDM-1, designated pAS39-2 (approximately 47 kb). pAS39-2 also carried genes conferring
resistance to aminoglycosides and bleomycin and featured a Ti-type conjugative operon. This plasmid was
transferred effectively from A. seifertii to A. baumannii strains by in vitro conjugation. Moreover, pAS39-2
closely resembled plasmidsfound in A. soli and A. pittii in Taiwan, harboring the potential for transmissible
multidrug resistance and contributing to the escalating spread of antimicrobial resistance. The current
study reports on the molecular epidemiology of AB group isolates collected over a span of 6 years, revealing
the carriage rate and types of carbapenemases present in A. baumannii and NAB strains in Taiwan. These
findings offer valuable insights for monitoring the epidemiology and dissemination of this pathogen.
Biography

Dr. Quyen studied Biotechnology at HCM City University of Technology, Vietnam, and graduated with a Bachelor of
Engineering in 2014. She then joined the research group of Associate Professor Pan in the International Biomedical
Science (IBS) Master's program at China Medical University, Taiwan, from which she received her master's degree
in 2020. Following six months of research assistance supervised by Dr. Pan at the Microbiology and Immunology
Laboratory, she began her Ph.D. program at the same university in the Biological Science and Technology department
in 2021, where she continues to study. She has published 5 research articles in SCI(E) journals.

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Infection 2024

Prof. V. Pourcher1*, Arnaud Desclaux2, Estevao Nunes3, Alpesh

Amin4, Stephane De Wit5, Edouard Devaud6, Bertrand Lioger7, Jean
Mariani8,9, Rene Lafont8,10, Claudia Ferreira8, Rob van Maanen8,
Serge Camelo8, Waly Dioh8, Cendre Tourette8, Sandrine Rabut8,
Jeffrey Gray11, Suzana Lobo12
1
CHU Pitie-Salpetriere, Paris, France
2
Centre Hospitalier Departemental de Vendee, La Roche-sur-Yon, France
3
Instituto Nacional de Infectologia Evandro Chagas/ Fiocruz, Rio de Janeiro,
Brazil
4
University of California, United States
5
CHU Saint-Pierre Belgique
6
Centre hospitalier Rene Dubos, Cergy Pontoise, France
7
Service de medecine Interne et Polyvalente, Centre Hospitalier de Blois, Blois, France
8
Biophytis - Sorbonne Universite, France
9
Sorbonne Universite & CNRS - Institut de Biologie Paris Seine, France, UMR 8256
10
Sorbonne Universite & CNRS - Institut de Biologie Paris Seine (BIOSIPE), 75005 Paris, France
11
United Health Services Hospitals, 33-57 Harrison Street Johnson City NY 13790 United States
12
Faculdade de Medicina de Sao Jose do Rio Preto, Sao Paulo, Brazil

Efficacy of oral 20-hydroxyecdysone (BIO101) in adults with severe

COVID-19 (COVA) : A randomized, placebo-controlled, phase 2/3 trial
Background: SARS-CoV-2 infects human cells through interaction between its spike protein, and ACE2,
a key element of the RAS. Thus SARS-CoV-2 may induce an imbalance of the RAS leading, among other
symptoms, to severe pneumonia associated with COVID-19. We hypothesized that MAS-receptor activation
by 20-hydroxyecdysone (20E) could modulate the protective arm of the RAS, leading to a reduced rate of
respiratory failure and early death among hospitalized patients with COVID-19.

Methods: Double-blind, randomized, placebo-controlled phase 2/3 trial. Randomization: 1:1 oral 20E
(350 mg BID) or placebo, up to 28 days or until an endpoint was reached. Primary endpoint: mortality
or respiratory failure requiring high-flow oxygen, mechanical ventilation, or extra-corporeal membrane
oxygenation. Key secondary endpoint: hospital discharge following recovery.

Results: 238 patients were randomized between August 26, 2020, and March 8, 2022. At day 28, a reduction
in the risk of early death or respiratory failure was observed: 43.8% (p=0.0426) (HR 0.44) in the ITT
population; and HR 0.41 (p=0.037) in the PP population. On day 28, proportions of patients discharged after
recovery were 80.1%, and 70.9% in the 20E and placebo groups respectively, (adjusted difference 11.0%,
95% CI [-0.4%, 22.4%], p=0.0586). Treatment emergent adverse events of respiratory failure were more
frequent in the placebo group (22.7% vs. 31.7%) respectively.

Interpretation: 20E significantly reduced the risk of death or respiratory failure. This finding suggests that
20E is an important drug candidate to treat adults hospitalized with severe respiratory symptoms due to
COVID-19.
Biography

Professor Valerie Pourcher is Head of the Department of Infectious Diseases at the Pitie-Salpetriere Hospital, Paris. Her
areas of research concern immunocompromised patients: patients infected with HIV, patients who have undergone a
transplant and those with infectious complications from chemotherapy or biotherapies. Her top areas of expertise are
AIDS, COVID-19, Kaposi sarcoma, HPV, HBV, JC virus.

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Infection 2024

Vineeta Arora1*, Prof. Richa Aggarwal2, Prof. Purva Mathur3, Prof.

Kamran Farooque4, Prof. Vivek Trikha4, Prof. Vijay Sharma4
1
Department of Critical Care Medicine, Research Scientist-III, Critical Care
Medicine, JPNA Trauma Centre, All India Institute of Medical Sciences, New
Delhi, India
2
Department of Critical Care Medicine, Professor, Critical Care Medicine, JPNA
Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

3
Department of Laboratory Medicine, Professor, Laboratory Medicine, JPNA Trauma Centre, All India
Institute of Medical Sciences, New Delhi, India
4
Department of Orthopedics, Professor, Department of Orthopedics, JPNA Trauma Centre, All India
Institute of Medical Sciences, New Delhi, India

Profiling, prescribing patterns, and infection rates among inpatients at

orthopedics wards: Prospective interventional implementation study
(AMSP-PIIS)
Background: Trauma represents a significant public health issue in India, with substantial morbidity and
mortality. Rapid access to appropriate care is essential for favorable post-injury outcomes. However, resource
allocation strategies ensuring equitable access in developing nations are not well defined. Orthopedic
surgeries are significant contributors to Surgical Site Infections (SSIs) globally. The inappropriate use of
antibiotics contributes to Antimicrobial Resistance (AMR), a critical global health concern. Antimicrobial
stewardship is advocated as a key strategy to address AMR, yet practical examples of stewardship in trauma
centers are limited. This study aims to assess profiling, prescribing patterns, and infection rates among
inpatients in orthopedics wards at a level 1-trauma center in India.

Methods: This prospective interventional study focused on patients admitted to orthopedic wards following
traumatic injuries.

Results: Over a 6-month period, 408 patients with traumatic injuries were included in the study. The
demographic profile revealed a mean age 38.7+13.7, with 80% male and 20% female patients. Lower
limb fractures were the most common injury, followed by spinal injuries. The majority of patients were
prescribed antibiotics prophylactically. The mean length of stay was 10.96 days. Patients who developed
confirmed surgical site infections were 4.4%, with Klebsiella pneumoniae and Escherichia coli being the
most commonly isolated organisms. Most patients were discharged from the hospital.

Conclusion: This study highlights the necessity of implementing antimicrobial stewardship programs
tailored to orthopedic patients. Such programs are critical for optimizing antibiotic use, combating AMR,
and reducing the incidence of Hospital-Acquired Infections (HAIs). Addressing implementation challenges
and enhancing prescribing practices are vital steps toward mitigating antimicrobial resistance and
advancing patient care within orthopedic settings.

Audience Take Away Notes

• Our study focuses on Profiling, prescribing patterns, and infection rates among inpatients admitted to
the Orthopedic Ward of our trauma center
• Antibiotic stewardship activities play a crucial role in infection control, emphasizing appropriate
prescribing practices
• Evaluate current prescribing patterns for inpatients in the Orthopedic Ward

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Infection 2024

• Assess infection rates and their correlation with prescribing practices

• Implement an antibiotic stewardship intervention focused on appropriate prescribing and transitioning
from intravenous to oral therapy when feasible
• This study serves as an implementation-focused intervention aimed at improving prescribing practices
and infection control across our trauma center. We aim to optimize patient outcomes and reduce
healthcare-associated infections in the Orthopedic Wards
Biography

Dr. Vineeta Arora completed her studies in Clinical Pharmacology at KLE University, India, graduating in 2012. She
later earned her PhD from JLN Medical College -KLE University in 2021 and later completed a Master in Public Health.
Dr. Vineeta Arora is currently a Research Scientist III at the JPNA Trauma Center, All India Institute of Medical
Sciences, New Delhi, India. She has published more than 10 research articles in SCI (E) journals in different areas of
research.

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Infection 2024

Weixi Shen*, Huiyi Feng*

Hong Kong Tianyou Medical Research Institute, Hong Kong, China; Shenzhen
Hospital of Southern Medical University, Shenzhen Tianyou Medical Research
Institute, Shenzhen, China

To identify and distinguish cytokine storms based on manifestations, and

to protect human from infectious disease by targeting cytokines

T he recent global outbreaks of infectious diseases such as SARS and COVID-19 have inflicted damage on
both individuals and societies worldwide. To develop scientific strategies for prevention and precise
treatment measures to counteract such outbreaks is imperative. After 28 years of research, we have
formulated a novel medical theory and precision treatment model aimed at infectious disease outbreaks.
This groundbreaking theory has undergone rigorous scrutiny of the underlying concepts governing the
progression and dynamic evolution of infectious diseases. Moreover, it has successfully addressed the
longstanding scientific enigma of cytokine storms, which has eluded resolution in modern medicine for the
past half-century. By establishing a framework for the precise diagnosis and treatment of cytokine storms,
our research represents a significant advancement in the field of medicine with profound implications
for the diagnosis and treatment of various human diseases. The elucidation of the scientific complexities
surrounding cytokine storms signifies a monumental milestone in medical progress and holds immense
potential to revolutionize global healthcare practices. Our theory stands poised to rapidly discern critical
features of cytokine storms associated with any outbreak, present or future, thereby equipping the medical
community, the World Health Organization (WHO), and governmental bodies with the necessary tools
to devise strategic interventions and implement precise diagnosis and treatment protocols. Given the
recurrent emergence of new epidemics worldwide, the expeditious dissemination of this groundbreaking
theory is paramount.

Cytokines are unique polypeptides that serve as primary messengers, exerting significant influence in
the development, progression, and evolution of diseases, particularly infectious ones. Comprising various
cytokines, receptors, and associated molecules, the cytokine network plays a pivotal role in regulating
physiological responses. Despite decades of study, cytokine storms have remained a perplexing challenge
in the medical community for over 50 years. Our research introduces novel concepts regarding cytokine
storms: they manifest through diverse abnormal patterns and intensities, representing a comprehensive
dysfunctionality within the cytokine network, rather than mere irregularities in individual cytokine levels.
The ultimate dysfunctionality within the cytokine network and the disease manifestations hinge on the
predominant cytokines within the imbalanced network, or the cytokine storm itself. Identifying the
features of a cytokine storm relies on recognizing the disease manifestations it induces.

According to our new theory, the cytokine profile of COVID-19 reflects an imbalance and dysfunctionality
stemming from heightened activity of TGF-β and platelet-derived growth factor (PDGF), with a notable
emphasis on the excessively elevated activity of TGF-β. A defining symptom of this profile is fatigue. The
pathogenesis of these symptoms follows a specific mechanism: TGF-β binds to its receptors, triggering
a series of pathological processes and resultant manifestations. Fatigue arises from mitochondrial
dysfunction and decreased Na+-K+-ATPase activity induced by TGF-β. Additionally, TGF-β promotes
the secretion of bronchial mucus, leading to the production of thick mucus and pulmonary sputum
embolism, impairing normal respiratory function and potentially precipitating severe complications such

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as life-threatening infections and shock. Furthermore, TGF-β acts as a potent immunosuppressive agent,
significantly dampening immune function and impeding recovery. Its inhibitory effects on lymphocyte
proliferation and differentiation contribute to reduced peripheral blood lymphocyte counts. These findings
were disseminated by Chinese media and supported by various publications, including an article published
in Frontiers in Public Health in 2021.

In summary, we propose that the characteristics of a cytokine storm can be discerned through the
manifestations of diseases. We have unravelled the abnormal regulations and dynamic patterns of
cytokine storms in human illnesses. This breakthrough enables us to identify the cytokine storm feature
and administer precise treatment for any future infectious diseases worldwide. For instance, we can now
identify the cytokine storm feature of the current dengue fever outbreaks occurring in numerous countries.
This discovery serves to protect human from the severe consequences of infectious disease outbreaks,
facilitating precise diagnosis and treatment for viral infectious diseases and making personalized, precise
pathophysiological treatments.
Biography

Dr. Shen graduated from Peking University as MS in 1989 and from Peking Union Medical College, Chinese Academy of
Medical Sciences with MD in 1999. He is president of Shenzhen Anti-cancer Association, Shenzhen Chairman of Tumor
Prevention and Treatment Union, Council Member of Tumor Committee of World Chinese Medicine Union. Over 100
papers have been published in national and international journals. His specialization focuse on medical oncology and
comparative research on TCM and western medicine. He is director of Hongkong Tianyou Medical Research Institute
and Shenzhen Tianyou Medical Institute, professor of Shenzhen Hospital, Southern Medical University.

Dr. Feng has been engaged in clinical research on malignant tumors since 2009. Her major achievements include a
randomized prospective cohort study on the prophylactic use of antiviral drugs in HBV carriers during chemotherapy,
as well as a study on the high-risk factors of local recurrence after breast-conserving surgery in HER-2 positive breast
cancer. Dr. Feng received her Ph.D. degree in 2018 with a focus on tumor biology and drug development. In 2019, Dr.
Feng was appointed as the Vice-Chairman of the Clinical Oncology Nutrition and Metabolism Branch of the Shenzhen
Anti-Cancer Association.

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Infection 2024

Xiaohua Li*, Ruijie Yin, Min Yuan, Xiaohui Liu

Opthalmology Department of Henan Provincial People’s Hospital, Zhengzhou
City, Henan Province, China

The mechanism of the suppression of experimental fungal keratitis by

histone deacetylases inhibitors

F ungal keratitis is one of the leading causes of blindness of infected corneal diseases, but the pathogenesis
of fungal keratitis is not fully understood and therefore the treatment of the disease by medication is still
under investigation. In the current study, we sought to study the effect of HDAC inhibitor Suberoylanilide
Hydroxamic Acid (SAHA) on experimental fungal keratitis in mice. SAHA (25 mg/kg) (n = 30) or vehicle
(DMSO) (n = 30) was delivered through Intraperitoneal injection (IP) 24 hours after the fungal inoculation,
and the same amount of SAHA injection or DMSO was followed at day 2. The expression of histone H3 (H3),
Acetylated Histone H3 (AC-H3), Histone Deacetylase 1 (HDAC)1, Tumor Necrosis Factor-α (TNFα), and Toll-
Like Receptor 4 (TLR4) in surgically excised specimens from the patients and mice with fungal keratitis
were detected by immunohistochemistry. The expression of mRNAs for Interleukin-1β (IL-1β), TNFα, and
TLR4 were evaluated in the corneas of the mice with fungal infection and the control corneas by real-time
PCR. The quantification of IL-1β and TNFα in the corneas of the mice with fungal infection was determined
by ELISA. The inhibitory effect of SAHA on mice fungal keratitis was revealed by GMS and H&E staining.
We found that the downregulation of histone acetylation and upregulation of HDAC1 expression were
associated with the increased inflammation response in fungal keratitis not only in humans but also in
experimental animals. SAHA was able to inhibit experimental fungal keratitis in mouse by suppressing
TLR4 and inflammatory cytokines such as TNFα and IL-1β; the inhibition of HDAC may be a potential
therapeutic approach for the treatment of fungal keratitis.

Audience Take Away Notes

• Anti-fungal therapy is the common approach to control fungal induced inflammation. Unfortunately,
medications for anti-fungal infection have limited efficacy and drug-resistance rapidly develops,
suggesting that fungal keratitis is a complex disease and other mechanisms may participate in the
pathogenesis of the disease. Recent studies have demonstrated that epigenetic mechanisms can affect
numerous pathologic conditions, including infectious diseases, we also observed the inhibitory effect
of SAHA on mice fungal keratitis. Our study, to the best of our knowledge, is the first to investigate the
effects of HDACi in a mouse model of fungal keratitis. The usage of HDACi in fungal keratitis may be a
promising venue and alternative treatment to traditional antifungal therapy. So other faculty could use
this research to expand there research
• Through this research, we found that the usage of HDACi in fungal keratitis may be a promising venue
and alternative treatment to traditional antifungal therapy
• It will improve the accuracy of a design, or provide new information to assist in fungal keratitis research

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Biography

Dr. Xiaohua Li studied Ophthalmology at Zhongshan University, China and graduated as M.D and Ph.D in 2005. She
then worked in Ophthalmology department of Henan Provincial People’s Hospital. After one year fellowship supervised
by Dr. Narsing Rao at the Pathology Laboratory of Doheny Eye Institute, USC, USA, and one year fellowship supervised
by Dr. Deming Sun at the Immunology Laboratory of Doheny Eye Institute, UCLA, USA, she obtained the position of an
chief physician at the Henan Provincial People’s Hospital. She has published more than 20 research articles in SCI(E)
journals.

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Infection 2024

Yuhang Liu*, Wei Zhu

Department of Applied Mathematics and Statistics, Stony Brook University,
New York, United States

Estimating the effectiveness of non-pharmaceutical interventions

during COVID-19

D uring the initial outbreak of COVID-19, governments worldwide implemented various Non-
Pharmaceutical Interventions (NPIs) to help control the spread of the virus. Our study focused on
assessing the impact of these interventions in the United States during the first wave of the pandemic.
We conducted three separate analyses. First, a prototypical Bayesian hierarchical model was employed
to gauge the effectiveness of five NPIs - gathering restriction, restaurant capacity restriction, business
closure, school closure, and stay-at-home order, in the 42 states that experienced over 100 deaths by
the end of the wave. The effectiveness of a sixth NPI, the mandate to wear facemasks, was assessed using
counterfactual modeling which is a variant of the prototypical Bayesian hierarchical model that allows
us to answer the question what if the state had imposed the mandate or not. The third analysis used an
advanced Bayesian hierarchical model to evaluate the effectiveness of all six NPIs in all 50 states and
the District of Columbia, and thus provide a full-scale estimation of the effectiveness of NPIs and the
relative effectiveness of each NPI in the entire USA. Our results reinforce earlier results on the general
effectiveness of NPIs in arresting the spread of the disease.

Audience Take Away Notes

• The audience will be equipped with evidence-based knowledge about the effectiveness of various NPIs
• The use of Bayesian hierarchical models provides a framework that can be adapted and applied to
other diseases or in different contexts
• Educators can use the evidence from this work to communicate the importance of NPIs to the public,
which can lead to better compliance with public health guidelines and a more informed citizenry that
understands the rationale behind such measures
Biography

Dr. Yuhang Liu studied Applied Mathematics and Statistics at Stony Brook University and received her M.S. in 2017.
She then joined the research group of Dr. Wei Zhu at the Center of Excellence Wireless and Information Technology
(CEWIT) at Stony Brook University. She received her Ph.D. degree in 2022 at the same institution. Dr. Liu's research
interests cover a broad spectrum of public health issues related to infectious diseases. Utilizing advanced statistical
and machine learning methodologies, Dr. Liu aims to provide data-driven insights that can enhance strategies for
managing and mitigating infectious disease outbreaks. Following her doctoral graduation, Dr. Liu obtained a role as a
Biostatistician with Moderna Services, Inc.

189
24-26
JUNE

6th Edition of World Congress on

Infectious
Diseases

POSTERS

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Infection 2024

Briggs AM*, Risser JA

University of California San Diego, United States

An imitation game: Syphilis infection and increased odds of neurologic

morbidity
Background: The World Health Organization (WHO) estimated the global incidence of syphilis among
adults to be approximately 7.1 million in 2020. The following year, the American Centers for Disease Control
and Prevention (CDC) reported a 32% increase in the incidence of primary/secondary (early) syphilis in
the United States between 2020-2021. Treponemal Central Nervous System (CNS) invasion is estimated to
occur in approximately 25-60% of cases, however, the current WHO/CDC standard of care for early syphilis
does not achieve CNS clearance. This raises concern for a preventable burden of neurologic morbidity
secondary to treponemal CNS persistence and subsequent neurosyphilis. Our central hypothesis is that
individuals with history of syphilis infection will experience greater odds of neurologic morbidity relative
to their uninfected counterparts.

Methods: An FQHC-based, preliminary 10-year retrospective analysis (01/2013-12/31/2022) of deidentified

Electronic Medical Records (EMR) was undertaken in summer of 2023. The exposure of interest consisted
of grouped ICD-10 codes representative of early syphilis infection with neurologic outcomes defined as
ICD-10 diagnoses reflective of the principle clinical manifestations of neurosyphilis. Unadjusted, bivariate
analysis was performed for preliminary assessment of exposure-outcome association.

Results: 3,711,053 EMR from an academic health system were included in final analysis. 5,981 patients were
found to have a diagnosis of syphilis. Patients with syphilis exposure had significantly higher odds for
stroke (OR = 5.14; 95%CI = 4.71-5.61), dementia (OR = 20.68 ; 95%CI = 19.27–22.19 ), sensorineural hearing loss
(OR= 5.75; 95% CI= 5.07-6.2), and blindness (OR= 15.74 ; 95%CI = 14.31-16.54) relative to unexposed patients.

Conclusion: Syphilis infection was associated with significantly increased odds of neurologic morbidity
across all representative outcome measures queried. These data are concerning as they suggest a clinically
significant limitation to the current WHO/CDC standard of care for early syphilis. We plan to more
rigorously evaluate our hypothesis in a follow-up study that will utilize regression analysis to determine
the independent effect of syphilis exposure adjusting for multiple confounders.
Biography

Dr. Aaron Briggs studied Biology at Dartmouth College, USA. During his course of study he was accepted early to Geisel
School of Medicine (SOM) at Dartmouth through the Early Assurance Program. Dr. Briggs graduated from Dartmouth
College with a BA in biology in 2015 and began medical school at Geisel shortly afterward. In 2019 Dr. Briggs graduated
Geisel SOM with honors as the elected president of Dartmouth Alpha Omega Alpha and went forward to pursue
general pediatrics residency at the Children’s Hospital of Philadelphia. Learning that a public health approach would be
required to address disease and health disparity at the population level, Dr. Briggs adjusted his training to Preventive
Medicine in 2022 and is now a PGY3 senior resident physician with the University of California San Diego General
Preventive Medicine Residency Program.

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Infection 2024

Dr. Ahsan Ehtesham1*, Dr. Ahmed Abdelghafar Masaad Alsayed2,

Dr. Samah Farouk Abdullah Mohamed3, Dr. Zubair Shahid4, Dr.
Tamer M. M. Abdalghafoor1
1
Department of Cardiothoracic surgery, Hamad Medical Corporation, Qatar
2
Department of Internal Medicine, Hamad Medical Corporation, Qatar
3
Department of Radiology, Hamad Medical Corporation, Qatar
4
Department of Cardiology, Hamad Medical Corporation, Qatar

A rare case of aortic aspergillosis in an immunocompetent patient with

no pre-existing cardiac pathology – A case report
Background: Cardiac aspergillosis is a rare form of Invasive Aspergillus infection that carries high mortality
despite aggressive treatment. It usually occurs in patients with underlying cardiac abnormalities such as
cardiac lesions, prosthetic valves, cardiac devices, and heart transplants.

Case Summary: A 30-year-old male with right-sided body numbness had a CT Head revealing a suspected
neurocysticercosis lesion. Initial labs showed mildly elevated CRP and normal procalcitonin. Echocardiogram
found a mass on the aortic valve and a thick left atrial wall. PET CT revealed a hypermetabolic mass around
the heart and aortic root. IgG4 levels were high and tissue biopsy was needed for confirmation. However,
the patient developed bilateral lower limb ischemia and weakness, requiring emergency surgeries. The
biopsy showed invasive aspergillosis, treated with Amphotericin B. Unfortunately, the patient deteriorated
into septic shock despite treatment.

Discussion: This clinical case accentuates several challenges encountered in the management of aortic
aspergillosis in a patient with a low suspicion of invasive aspergillosis. Firstly, it emphasizes the importance
of considering the rare possibility of invasive aspergillosis in immunocompetent patients, even with
no known risk factors. Secondly, it brings out the recognition of the rapid progression of Aspergillosis
endocarditis with poor outcomes. Finally, it emphasizes that early surgical treatment and early histological
diagnosis with early initiation of antifungals can save lives.

Keywords: Aspergilloma, Aspergillosis, Endocarditis, Disseminated, Heart, Infection, Mortality, Limb

Ischemia, Embolectomy, Case Report.

Acknowledgments: Department of Pathology, Hamad Medical Corporation for providing the histopathology
images.

Funding Information: Nothing to declare.

Conflict Of Interest: Nothing to declare.

Biography

Dr. Ahsan Ehtesham graduated from Dow University of Health Sciences in 2016. He is currently a resident in training
in cardiothoracic surgery since 2020 at the prestigious Hamad Medical Corporation. He is an active researcher with a
growing portfolio of articles, researches, and case reports. Currently he has 4 published articles, with 5 more projects
underway.

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Infection 2024

Alvaro J. Vivas Salinas1*, Cristian Botache Serna2

1
Department of Emergency Medicine, Clinica Central del Quindio, Armenia,
Colombia
2
Department of Hematology, Fundacion Valle del Lili, Cali, Colombia

Acute HIV infection presenting as eczema herpeticum and herpes

simplex keratitis: A case report
Introduction: Eczema Herpeticum (EH), also known as Kaposi’s varicelliform eruption, is an unusual,
severe manifestation of herpes simplex infection. It usually presents in pediatric patients with history of
atopic dermatitis. It can be a life-threatening disease with mortality risk due to complications of systemic
infection. Herpes simplex keratitis is a potentially blinding disease due to infection and inflammation of
the cornea. Persons with immune deficiencies and Human Immunodeficiency Virus (HIV) infection are
at increased risk for herpes keratitis. We present a case of eczema herpeticum and herpes keratitis in a
Colombian patient with acute HIV infection.

Case Presentation: A 30 year-old Colombian male with past medical history of atopic dermatitis presented
to the emergency room with complaints of three days of a facial rash and eye pain. He initially had pruritus,
edema and palpebral erythema of the right eye. On the third day of symptoms, he presented fever and noted
a painful erythematous rash on his right frontal region, right periorbital region and dorsum of the nose,
with multiple umbilicated papules and vesicles, and some superficial ulcers. Additionally, he experienced
severe pain in the right eye, with blurry vision and epiphora.

On physical examination, erythema, multiple vesicles, papules and “punched-out” erosions were noted on
the nose, right upper eyelid, right frontal and cigomatic region, and the scalp. Cervical lymphadenopaties
were noted. Conjunctival injection, chemosis, and decreased corneal sensation were noted on eye
examination. Oral examination was unremarkable

Polymerase Chain Reaction (PCR) for Herpes Simplex Virus-1 (HSV-1) was positive. Intravenous and
ophthalmic acyclovir were started. Laboratory studies revealed White Blood Cells (WBC) count of
4970/uL, neutrophils were 3830/uL, lymphocytes were 480/uL; platelet count was 127000/uL. Human
Immunodeficiency Virus (HIV) testing was positive. Viral load was 26712 copies/mL. CD4 count was 228
cells/mm^3. Highly Active Antiretroviral Therapy (HAART) was started.

Discussion: Eczema herpeticum is an unusual superinfection caused by herpes simplex virus. It usually
affects patients with atopic dermatitis, but it has also been described to affect patients with Hailey-
Hailey disease, pemphigus, mycosis fungoides, and Sezary syndrome. The most commonly compromised
regions include the face, neck, and thorax. EH is characterized by painful, vesicles, pustules, ulcers and
umbilicated papules. Risk factors include younger age, nonwhite ethnicity and psoriasis. Disruption of the
epithelial barrier and immunosuppression allow a widespread infection. Around 10% of EH patients have
eye involvement. Herpes keratitis is the leading infectious causes of corneal ulcers and blindness in the
world. Primary infection occurs after inoculation of mucosal or skin surface. Clinical manifestations include
conjunctivitis, chemosis, blurry vision, reduced corneal sensation and corneal ulcers. Herpes keratitis can
be clinically diagnosed, although PCR and viral culture may be performed for diagnostic confirmation.
Treatment with antivirals reduces viral replication, severity of the lesions and prevents complications.

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Conclusion: Eczema herpeticum is a severe infection of the skin that affects persons with underlying skin
disorders. It may be life-threatening, particularly in immunocompromised patients. Herpetic keratitis is
a potentially blinding disease caused by HSV. Both conditions should be considered in HIV patients. Early
antiviral treatment is of paramount importance to prevent associated morbidity and mortality.

Audience Take Away Notes

• To identify an unusual dermatologic finding in HIV patients
• To recognize a life-threatening complication of atopic dermatitis
• To be aware of the association between eczema herpeticum and herpes simplex keratitis

Photo of the patient

Biography

Dr. Vivas studied Medicine at Icesi University, Cali and graduated as MD in 2020. He joined the research group of Dr.
Tobon MD, PhD at Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional (CIRAT). He has
published 9 research articles in SCI(E) with over 55 citations. He currently works as a physician in the emergency
department in Armenia, Colombia.

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Infection 2024

Amy Hesketh1*, Yannick Charretier1, Jean Marc Monneuse1,

Hayat Hage1, Celie Da Silva1, Francesco Olmo2, Thomas Ribette1,
Fanny Escudie3, Martin Taylor2, Gilles Courtemanche4, Derry
Mercer4, Adrien Saliou1, Eric Chatelain3, John Kelly2, Josephine Abi
Ghanem1
OMICS Unit, Bioaster, 40 Avenue Tony Garnier 69007 Lyon – France
1

Department of Infection Biology, London School of Hygiene and Tropical

2

Medicine, Keppel Street, London WC1E 7HT, United Kingdom

3
Drugs for Neglected Diseases initiative (DNDi), 15 Chemin Camille Vidart, 1202 Geneva, Switzerland
4
Antimicrobial Program, Bioaster, 40 Avenue Tony Garnier 69007 Lyon – France

Multi-omics workflow for the identification of discriminant markers

associated with trypanosoma cruzi populations
Introduction: Trypanosoma cruzi (T. cruzi) is a protozoan parasite that causes Chagas disease. This
zoonotic disease is transmitted to human by blood-sucking triatomine bugs. According to WHO, Chagas
disease is affecting 30 000 new cases and is causing 13 000 deaths per year mainly in Mexico, Central
and South America. The life cycle of T. cruzi implies a differentiation of non-infective to infective forms
within the triatomine gastrointestinal tract and an intracellular progression of T. cruzi infection in human.
After surviving the acute stage, patients progress in a large part to an asymptomatic chronic infection. In
around 30-40% of the cases, they can progress towards further complications such as cardiomyopathy
and gastrointestinal tract mega syndrome. Currently, knowledge limitations of the mechanistic processes
associated with the persistence of T. cruzi compromise the development of improved treatments for
Chagas disease.

To improve the understanding of Chagas disease, two populations (replicating epimastigotes and replicating
amastigotes) have been isolated. An integrated proteome and transcriptome profiling method has been
performed to identify discriminant markers/pathways associated with the stage of infection.

Material & Methods: Intracellular amastigotes can be isolated by repeated passage of infected host cells
through a syringe needle. This is a rapid procedure but with safety issues. Fluorescently tagged amastigotes
can be further sorted using an Aria BD cell sorter. This technique achieves a higher purity with a lower
yield and can be time-consuming. Cells were inactivated with a nonionic detergent (Cell Disruption Buffer,
PARIS kit - Thermo) and frozen until preparation. Samples were then divided in two for parallel proteomic
and transcriptomic analysis.

Results: A clear separation of amastigote and epimastigote populations was observed for both the
transcriptome and the proteome profiles. An additional separation of the amastigote populations was
observed for both techniques. This separation could be explained by the difference of infection stages
between the replicates (optimization of the isolation procedure). A higher number of down regulated
genes and proteins was observed in amastigotes compared to epimastigotes. An off/on pattern of protein
expression was observed mainly in amastigotes (590 proteins were absent in amastigotes and present in
epimastigotes).

Conclusion: A robust method was developed to explore the transcriptomic and proteomic profiles of diverse
parasite populations from a single sample. The observed distinction in transcriptomic and proteomic
profiles of amastigotes and epimastigotes might be explained by their intracellular or extracellular states,
respectively. Identification of differentially expressed genes and proteins between populations will further
allow to select discriminant markers/pathways. The ability to sort different amastigote sub-populations,
will be of interest to isolate “dormant/quiescent” parasites that may have a role in treatment failure. Low
input and/or single-cell approaches are needed to deeply investigate these relevant populations.
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Infection 2024

Audience Take Away Notes

• We propose a full workflow to isolate and analyze different populations of Trypanosoma cruzi
• The initial steps of the workflow are common to the proteomic and transcriptomic analysis limiting the
number of samples and cells required for this multi-OMICS analysis
• This integrated proteome and transcriptome profiling method will bring insight in the mechanisms
involved in T. cruzi differentiation and treatment resistance
Biography

Dr. Amy Hesketh studied Biology with a special focus on Genetics at the Clermont Auvergne University, France
and graduated as MS in 2017. She then joined the research group of Dr. Olivier Mathieu at the Institute of Genetic,
Reproduction and Development (iGReD). She received her PhD degree in 2021 at the same institution. She obtained the
position of Research Fellow at the BIOASTER institute and is now Team Leader of the Genomics and Transcriptomics
team.

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Infection 2024

Christodoulou. A*, Xanthopoulou A. M, Kallinikidis. T

Internal Medicine Clinic, Serres General Hospital, Serres, Greece

A case of late onset prosthetic valve endocarditis with cerebral thrombo-

embolic episodes and aseptic meningitis

T his case report describes a 57-year-old man with a history of Coronary Artery Bypass Grafting (CABG)
and mitral valve replacement who presented with fever, rigors, and focal neurological symptoms.
The patient was diagnosed with late-onset Prosthetic Valve Endocarditis (PVE) complicated by cerebral
thromboembolic episodes and aseptic meningitis. In this presentation, attendees will be guided through
a detailed exploration of late-onset Prosthetic Valve Endocarditis (PVE) utilizing a captivating case study
as the focal point. The discussion will unravel the intricate nuances of this challenging clinical entity,
encompassing diagnostic dilemmas, therapeutic approaches, and clinical ramifications. By dissecting the
complexities of late-onset PVE, participants will gain invaluable insights into its pathophysiology, clinical
manifestations, and management strategies, equipping them with essential knowledge to navigate this
intricate terrain effectively.

The presentation commences by elucidating the clinical presentation of late-onset PVE, emphasizing
its protean nature and the diagnostic challenges it poses. Through the analysis of the presented case,
attendees will develop a comprehensive understanding of the varied clinical manifestations of late-onset
PVE, ranging from fever and rigors to focal neurological deficits. This exploration serves to underscore the
importance of maintaining a high index of suspicion for infective endocarditis in patients with prosthetic
valves, particularly in the context of atypical presentations.

Subsequently, the discussion delves into the diagnostic workup of late-onset PVE, elucidating the role of
various investigative modalities in establishing a definitive diagnosis. Attendees will gain insight into the
limitations of conventional diagnostic techniques, such as transthoracic echocardiography, and the pivotal
role of transesophageal echocardiography in confirming the presence of vegetations on prosthetic valves.

Moreover, the presentation navigates through the therapeutic landscape of late-onset PVE, addressing the
complexities of antibiotic therapy and the potential role of surgical intervention. Attendees will be guided
through the rationale behind antibiotic selection, including considerations for antimicrobial coverage
and duration of therapy. Furthermore, the discussion will explore the indications and timing of surgical
intervention in late-onset PVE, highlighting the importance of a multidisciplinary approach in optimizing
patient outcomes.

Audience Take Away Notes

• Enhanced understanding of the clinical manifestations and diagnostic considerations of late-onset
PVE
• Insight into the optimal management strategies, including antibiotic selection and the role of surgical
intervention
• Appreciation of the importance of timely recognition and treatment of embolic complications to
improve patient outcomes

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Infection 2024

• Recognition of the diagnostic limitations of transthoracic echocardiography and the utility of

transesophageal echocardiography in confirming the diagnosis
• Application to Audience
o Attendees will be equipped with the knowledge and skills necessary to recognize and manage late-
onset PVE effectively in their clinical practice
o This presentation serves as a valuable resource for faculty seeking to expand their research or
teaching in the field of infectious diseases and cardiology
o The insights provided offer practical solutions for clinicians and designers, streamlining diagnostic
and therapeutic decision-making processes
o Improved accuracy in diagnosis and treatment planning will lead to better patient care and
outcomes, ultimately enhancing the efficiency and effectiveness of healthcare delivery
Biography

Dr. Christodoulou studied in Aristotle University Medical School in Thessaloniki and graduated in 2019. He then
worked as a rural service doctor in Naxos General Hospital for one year. Then he worked in Larnaca General Hospital,
in the Internal Medicine Clinic, as a junior doctor for 4 months. He is currently working as a resident doctor of Internal
Medicine in Serres General Hospital in the 3rd year of his residency. He has participated in the ECIM 2024 with one
poster presentation and in the 15th Panhellenic Infectious Diseases Conference with three poster presentations.

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Infection 2024

Andrew Kimera1*, Joan Mutyoba2, Lynn Atuyambe2, Nelson

Mukiiza3, Andrew Basenero3
1
College of Health Sciences, Makerere University College of Health Sciences,
Kampala, Uganda
2
School of Public Health, Makerere University College of Health Sciences,
Kampala, Uganda and Research Department, Joint Clinical Research Centre,
Kampala, Uganda
3
Rinecynth Advisory, Kampala, Uganda

Hepatitis B vaccination uptake and associated factors among

communities targeted for mass vaccination in Gulu, Uganda
Background: Hepatitis B Virus (HBV) is associated with several acute and long-term complications and
vaccination is the cornerstone of prevention. A recent outbreak in Gulu, Uganda, one of the districts
covered by a mass vaccination campaign, suggests low uptake of HBV vaccination.

Objective: To determine uptake and completion of HBV vaccination and associated factors among residents
of Gulu, Uganda.

Methods: This was a cross-sectional study among residents of Gulu in Northern Uganda; Gulu city
representing urban Gulu and Gulu District representing rural Gulu. A total of 434 adults (>18 years) that
had been residents of this area for at least 5 years at the time of study were recruited. A pretested study
questionnaire was used to obtain data for socio-demographics, perceptions, and knowledge on HBV
vaccination as well as measure uptake and completion. Additionally, 10 key informant interviews were
conducted. The uptake, completion and factors associated to HBV vaccination were determined. Thematic
analysis was used for qualitative data.

Results: The median age of participants was 33 (IQR: 26-44) years; 246/434 (56.7%) were females. Out of
434 respondents, 182 (41.9%), 141 (32.5%), 87 (20%) had ever received at least one dose, at least 2 doses and
all the 3 doses of the vaccine. 47.8% of those vaccinated completed. Factors related to: Non-uptake were
not being aware of the vaccination campaign, myths about the vaccine, inaccessibility of the vaccine and
fear; Incompletion: lack of awareness of need to complete, poor access to vaccination points or sites and
myths; and for uptake of hepatitis B vaccine were being female, Adj. PR: 1.33 (1.09 – 1.61), urban residence,
Adj. PR: 1.49 (1.19-1.88), low perceived risk Adj. PR: 1.58 (1.31-1.91), perceived lack of safety of Vaccine-Adj.
PR: 2.83 (1.27-6.32) and awareness about the mass vaccination campaign, Adj. PR: 2.36 (1.52-3.67). Factors
associated with completion of the hepatitis B vaccination schedule were urban residence, Adj. PR: 2.67
(1.58-4.49) and low perceived risk PR: 2.94 (1.98-4.37). Health facility factors that influenced uptake and
completion were: inadequate mobilization and low sensitization; stock outs; inadequate facilitation for
health workers; VHTs Distance from facility; health worker knowledge gaps; poor attitude towards none
routine vaccination by some health workers; mistrust of the government; myths and fear of side effects.

Conclusion: The uptake and completion of Hepatitis B vaccine were low in Gulu (41.9%, 20%). Sex, residence,
perceived risk to Hepatitis B, perceived safety of the vaccine and awareness of the mass vaccination
campaign independently influenced the uptake of the vaccination. Whereas, residence and perceived risk
to Hepatitis B with completion. The government therefore should invest in creating awareness to the
health workers and masses and also bring vaccination services closer to the community by empowering
the community health workers.

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Infection 2024

Audience Take Away Notes

• The uptake rates of the Hepatitis B vaccine in highly endemic communities of Sub-Saharan Africa
• The unique factors that affect the Uptake and completion of the vaccination series during Mass
vaccination campaigns to inform on key strategies for intervention
• Possible further research areas in for vaccine uptake to improve on the level of protection
• Success pointers of vaccination in the highly endemic Sub-Saharan Africa as a step in reducing the
Global burden of Hepatitis B infecetion
Biography

Dr. Kimera Andrew is currently a finalist Paediatrics resident at the College of Health Science, Makerere University;
Uganda with special interest in Infectious disease prevention through vaccination. He holds a Masters of Public health
from Makerere and studied Hepatitis B vaccine uptake following mass vaccination in highly endemic regions of Uganda.
He also has experience in Hospital Management and underwent a short training in management studies at the Uganda
Management Institute, Uganda. His passionate about child health, disease prevention and policy analysis. He is also a
dedicated Husband and father of 2 back working with C-Care IMC now 8 years.

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Infection 2024

Andrew Kimera1*, Joseph Rujumba2, Victor Musiime2, Cynthia

Kuteesa3
1
Department of Pediatrics, School of Medicine, Makerere University College of
Health Sciences, Kampala, Uganda
2
Department of Pediatrics, School of Medicine, Makerere University College
of Health Sciences, Kampala, Uganda and Research Department, Joint Clinical
Research Centre, Kampala, Uganda.
3
Rinecynth Advisory, Kampala, Uganda

Immune response to Hepatitis B vaccination among children under 5 in a

highly endemic country in Sub-Saharan Africa: Uganda
Background: Hepatitis B virus vaccination plays a crucial role in preventing Hepatitis B infection, particularly
in high-risk groups such as children under-five, who have a 60-90% higher chance of seroconversion. As
per the World Health Organization (WHO), about 5–10% of infants may not respond effectively to the
vaccination, leaving them vulnerable to Hepatitis B virus and its complications. The paucity of data on the
Immune response to hepatitis B Virus vaccination among children raises the question of how protected
our children in Uganda are against Hepatitis B.

Objective: To determine the immune response to Hepatitis B vaccination and associated factors among
children under five attending the outpatient care at Mulago Assessment Centre Pediatrics clinic.

Methods: This was a cross-sectional study among children (1 to < 5) years attending MAC Paediatrics
clinic at Mulago National Referral Hospital who met the eligibility criteria in the month of February, 2023.
All children 1-5 whose caregivers gave consent were enrolled and a pretested study questionnaire was
administered by trained research assistants. Blood samples taken for analysis; Hepatitis B core antibody
screening and anti HBs Ag titres by Electrochemiluminescence using the Cobas 6000. Descriptive analysis
using proportions was used to determine the immune response as good or Poor response. Logistic
regression analysis was done to determine factors that were independently associated with the different
categories of immune response.

Results: Total of 301 children under 5 years, majority aged 2 years (29.6%). All were negative for the Hepatitis
B core antibody. The immune response from 2 IU/ml to 1000 IU/ml with median titres of 86.2 IU/ml (IQR:
14.5, 239.4). 77.4% (233/301) (95% CI: 72.3% - 81.8%) had a good response and 58.4% (136/233) (95% CI:
51.9% - 64.6%) very good responders. Younger age and caregiver HIV status being negative were found to
be independently associated with a good immune response.

Conclusion: Children at MAC Paediatrics clinic had a protective level of antibodies to HBV vaccine at 77%
which is still less than the expected 95% by WHO. Younger age and negative parental HIV status were
independently associated with good response. Emphasis should be made on birth dose, booster to at risk
groups and periodic studies to monitor the response in children.

Audience Take Away Notes

• Information on the immune response to the vaccines being used against the Hepatitis B virus especially
in Sub Saharan Africa that is highly endemic
• The possible key issues that affect the response to vaccination against Hepatitis B that could be used
for targeted interventions
• Possible further research areas in the Immunological response to Hepatitis B vaccination among
children

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• Global strategies in place to eliminate Hepatitis B and how they are being implemented especially in
Africa
• Success pointers of vaccination in the highly endemic Sub-Saharan Africa as a step in reducing the
Global burden
Biography

Dr. Kimera Andrew is currently a finalist Paediatrics resident at the College of Health Science, Makerere University;
Uganda with special interest in Infectious disease prevention through vaccination. He holds a Masters of Public health
from Makerere and studied Hepatitis B vaccine uptake following mass vaccination in highly endemic regions of Uganda.
He also has experience in Hospital Management and underwent a short training in management studies at the Uganda
Management Institute, Uganda. His passionate about child health, disease prevention and policy analysis. He is also a
dedicated Husband and father of 2 back working with C-Care IMC now 8 years.

202
Infection 2024

Ashin Mehta*, BS; Timothy Yung, MD; Whitt Davis, DO; Jennifer
Choi, DO; Sanjay Singh, MD
Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI,
United States

PD-associated peritonitis: A case first for aquamicrobium

A 56-year-old male with end-stage renal disease undergoing home peritoneal dialysis presented
with abdominal pain, nausea, and altered mental status. White blood cell count was 12.3 10e3/uL,
urinalysis was positive for 2+ blood, and peritoneal fluid contained a total nucleated cell count of 1840
with 98% neutrophils. The patient was empirically treated with intravenous piperacillin-tazobactam and
vancomycin, and a 2% mupirocin ointment was applied around his peritoneal catheter site. Following this
treatment, he showed significant symptomatic improvement. On hospital day three, the patient’s fungal
culture and Methicillin-resistant Staphylococcus aureus came back negative, but his aerobic/anaerobic
culture was positive for Aquamicrobium lusatiense. Aquamicrobium is an aerobic gram-negative rod
which until recently had only been isolated from wastewater and contaminated soil. In 2021, two cases of
Aquamicrobium infection in humans were reported. Both resulted in endophthalmitis following cataract
surgery. To our knowledge, this was the third case of Aquamicrobium infection in a human and the first
example of this agent causing peritonitis. Following identification of the infectious agent, the patient was
transitioned to intraperitoneal vancomycin and cefepime. Two days into the new treatment course, the
patient’s peritoneal fluid demonstrated a total nucleated cell count of 5 with a 40% neutrophil composition.
The patient was discharged home after a seven-day inpatient stay with instructions to continue cefepime
1g via intraperitoneal injection for three weeks. On the day of discharge, his white blood cell count was 4.4
10e3/uL.

Audience Take Away Notes

• This presentation provides insight on the treatment of a bacterial infection which currently has only
three known cases in humans
• Due to its rarity, no guidelines on medically managing Aquamicrobium exists. The two previously
reported cases with this infection failed conservative treatment and had to be surgically managed.
This presentation serves as a guide for clinicians if they encounter a patient with an Aquamicrobium
infection
• This presentation will provide clinicians with awareness to consider Aquamicrobium in a patient who
has a culture positive for gram negative rods but negative for common infectious agents
Biography

Ashin Mehta studied Human Biology at the University of Southern California, United States and graduated as BS in
2015. He then joined the research group of Dr. Thomas Anderson at Stanford University where he investigated the
efficacy of focused ultrasound to inhibit nerve conduction and reduce post-operative pain. Following this, he began
medical school at the Medical College of Wisconsin and will receive his MD in 2025.

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Infection 2024

Aiki Raji C. O*, Ahmed S. O Olojede, O. A. Fagbohun

Department of Veterinary Microbiology, University of Ibadan, Nigeria

Molecular detection and charcterization of protoparvoviruses in bats

and lion in Ibadan, Nigeria

P rotoparvoviruses are a diverse genus of small, non-enveloped, single stranded DNA viruses in the
Parvovirinae subfamily of the virus family Parvoviridae. Three of the fifteen member species of this
genus have been associated with human infections, while some others infect domesticated animals.
Parvoviruses are ubiquitous in nature and they possess a diverse host range. Mammalian parvoviruses
are potential zoonotic agents, especially if they make incursions with the right mutations into the human
ecosystem. As such, there is the need to constantly monitor the parvoviruses circulating in mammals in
order to further elucidate the viral diversity, evolution and host-virus interactions. Bats are known to
harbor a diverse array of viruses, including several that are highly pathogenic in humans.

Fecal samples were collected from eleven Fruit Bats (Eidolon helvum) and one lion at the Zoological Garden,
University of Ibadan, Nigeria. DNA were extracted from the samples using the QiagenTM DNA extraction
Kit. A 350 bp portion of the VP2 gene was amplified in order to detect the presence and determine the
species of protoparvovirus present. The amplicons were purified and sequenced. The sequences obtained
were analysed.

Five of the twelve samples were positive, with the expected band size of 350 bp, four of these were from
bats while the only sample from a lion was also positive, the nucleotide sequence analysis confirmed the
presence of canine parvovirus in all the samples, with some nucleotide mutations noted. Multiple sequence
alignment revealed mutations at positions G4A, A18T, G36A and G 207A in the bat samples while the lion
sample showed mutations at positions G4A, A18T and G207A.

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Infection 2024

David Mejia, Ph.D

Universidad Peruana Cayetano Heredia, Peru

Current situation of Cystic Echinococcosis in Peru

T he Cystic Echinococcosis in Peru, is an important problem in public health and in the economy, causing
great economic losses both in livestock production and in the recovery of the health of the affected
human population (Naquira C., 2010). Human Cystic Echinococcosis has a worldwide distribution, occurring
in many parts of South America, including Peru, Argentina, Bolivia, Uruguay, Chile and the southern part of
Brazil (Cucher et al., 2016; Pavletic et al., 2017). In Peru, E. granulosus sensu stricto (G1 genotype) was mainly
identified in all animal hosts, while, the E. canadensis (G7 genotype) was only identified in cysts from pigs
and alpacas. This is the first report of E. granulosus sensu stricto and E. canadensis in llamas and alpacas,
respectively (Sanchez et al., 2022).

In my country, the accumulative incidence rates fluctuate between 39 and 79 cases per 100,000 inhabitants.
However, since 1980, hydatidosis has not been treated by the state and is one of the neglected diseases
(Moro et al., 1997; Perez et al., 2007; Rafael et al., 2008; Irabedra & Salvatella, 2010). In studies carried out
on animals in the department of Junín, an 87% prevalence is reported in sheep and between 32 and 79%
in dogs, these being the highest reported prevalences in South America (Cardona, 2013; Carmena, 2013). A
study in the andean region of Peru with echographic examination and X ray test, the overall prevalence of
human cystic echinococcosis was 5.5% (52/949) and the 95% confidence interval varied from 4.1 to 7.1%
(Chumbe et al., 2007).

The prevalence of human echinococcosis in this endemic area of Peru is one of the highest in Latin America,
due to the close interaction with dogs, as they shepherd the flocks, plus poor sanitation and hygiene
conditions in the area (Chumbe et al., 2007). A study in the Tacna Region of Peru found a 4.96% prevalence
of echinococcosis in bovine species for the period 2001-2010, the prevalence for sheep was 91% for the
period 2001-2010; and the human prevalence rate in the Tacna Region is 10 x 100 000 habitants for the
period 2001-2010 (Velasco et al., 2010). High prevalence in Peru and even more so in the central Andean
region: Cerro de Pasco, Junín, Huancavelica (Guerra et al., 2015). Currently progress is very slow to deal
with this zoonosis, personally I’m in charge of educating or giving talks to the inhabitants of the endemic
areas or towns of Peru. Also, I’m working (my doctoral thesis) on the generation of Alpaca antibodies for
the serological diagnosis of this disease.

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Appendix: 1

Lachaqui, Canta – Peru, 4000 msnm. December 31, 2020.

Huancavelica, Peru 4500 msnm July 2022.

Biography

David Mejia PhD (c) Veterinarian PhD candidate, Student of the Doctoral Program in Sciences (Biochemistry and
Molecular Biology) at the “Cayetano Heredia” Peruvian University. He then joined the research group of Molecular
Biotechnology (at the same university). He received his Master degree in 2020 at the San Marcos University (Peru)
working in the Genetics and Molecular Biology Laboratory (2016-2018). He has published 1 article and participated in
National and International Conferences.

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David Kent Stiles*, PhD; Ashish Bhandari, MS; Harish Shankaran,

PhD; Helen Wei, PhD; Shane Rowley, PhD; Gaurang Patel, MD;
Brian Lu, MD
Recursion Pharmaceuticals, Inc., Salt Lake City, UT, United States

REC-3964, a first-in-class molecule for the prevention of recurrent

clostridioides difficile infection

R EC-3964 is an oral, novel, diazepinedione-class chemical entity identified from Recursion’s high-
content phenotypic imaging platform. REC-3964 inhibits toxins associated with Clostridioides Difficile
Infection (CDI).

In a disease-relevant hamster model of acute CDI, REC-3964 extended survival in a dose-dependent

manner. In this same model, REC-3964 significantly extended survival compared to bezlotoxumab.
Monotherapy was safe and well tolerated when administered as single doses up to 1200 mg and multiple
doses up to 900 mg in a healthy volunteer, single- and multiple-ascending dose study (n=90). Exposures
(AUC) increased approximately dose-proportionally across dose ranges tested, and half-life ranged from
approximately 7–10 hours. All Treatment-Emergent Adverse Events (TEAEs) were mild in severity with no
serious adverse events, deaths, or TEAEs leading to discontinuation. No clinically relevant effects on vital
signs, ECG parameters (including QTcF), or other laboratory parameters were observed in the study.

Planned study REC-3964-201 will evaluate recurrent CDI (rCDI) reduction with REC-3964 after initial
clinical resolution. Based on preclinical data indicating a dose-dependent treatment effect, two doses of
REC-3964 are being explored.

Overall, these data demonstrate that REC-3964 is a safe and well-tolerated, orally bioavailable, small
molecule Clostridioides difficile toxin inhibitor with potential to prevent rCDI in high-risk patients.

Audience Takeaway Notes

• Clostridioides Difficile Infection (CDI) is a leading cause of diarrhea in people treated with antibiotics,
and those with extended stays in healthcare settings are at especially high risk. CDI is recurrent in
>20% of patients and can lead to severe colitis, sepsis, organ failure, and death
• C. difficile toxins inactivate Rho GTPase inside cells of the gut lumen, which induces apoptosis and
barrier dysfunction, driving CDI pathophysiology
• Current standard of care for CDI is vancomycin or fidaxomicin with added intravenous bezlotoxumab
for high-risk patients
• Recursion’s approach to drug development identified REC-3964, a small molecule that blocks C. difficile
toxin enzymatic activity without affecting the host enzyme, preventing toxin-mediated damage. REC-
3964 rescued barrier activity and extended survival in CDI animal models

• This first-in-human study showed that REC-3964 administered orally had favorable pharmacokinetic
and safety profiles across doses in healthy volunteers and is suitable for evaluation in the planned
phase 2 study in patients with CDI

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Biography

David Stiles has been working as a clinical pharmacologist and pharmacometrician in the pharmaceutical and drug
delivery industry for 18 years. Previous employers include Medtronic, Pfizer, Vertex, and Vigil Neuroscience working
in clinical areas such as neurology, pain management, cystic fibrosis, and rare disease. He is currently a clinical
pharmacologist employed at Recursion, supporting clinical and nonclinical drug development. He has a PhD in Systems
Engineering with a focus on biomedical applications from Oakland University.

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Dr. Dorarca Lynch*, Dr. Rhea O’ Regan, Prof. Catherine Fleming

Infectious Diseases Department, Galway University Hospital, Galway, Ireland

HAV-ing a Moment
Clinical case: We present a case of a 32-year-old Indian gentleman admitted to a tertiary hospital in the
West of Ireland Hospital with a weeklong history of fevers and right upper quadrant pain complicated
by the development of clinical jaundice. His past medical history was significant for previously treated
Malaria. 3 weeks prior to presentation to our hospital, he travelled from Southern India, spending time in
Mumbai before relocating to Ireland. In Mumbai he noted being bitten by numerous mosquitos as well as
consuming street food including fresh watermelon.

Initial work up demonstrated thrombocytopenia of 124 x109L (150-400x109L), haemoglobin of 15g/dL (13.0-
17.0g/dL) and Bilirubin of 95g/dL (1-21g/dL). Liver function tests were grossly deranged with ALT of 2000
u/L (0-40u/L) and INR of 1.3.

Patient was investigated extensively for Fever in Returning traveller work up. Multiple malaria blood
films returned negative and blood cultures remained sterile. HIV, Hepatitis B, C and E were not detected.
Leptospirosis, Chikungunya and Dengue serology returned negative. Hepatitis A IgM subsequently returned
positive with HAV IgG negative.

Ultrasonography of his abdomen showed a thickened oedematous appearing gallbladder wall consistent
with acute acalculous cholecystitis.

The patient clinically and biochemically improved with supportive therapy.

Background: Hepatitis A is the leading cause of hepatitis worldwide. It is an RNA virus which is spread
by direct contact with persons who have been infected or by ingesting contaminated water or food, with
an incubation period of 14 to 28 days. It occurs sporadically and in epidemics worldwide with a tendency
for cyclic recurrence. The virus is endemic in low-income countries where sanitary conditions are poor.
Interestingly improved living conditions in certain countries has reduced the incidence of Hepatitis A
infection, however, this can lead to more severe disease in susceptible adults who have not acquired
immunity in childhood. The changing epidemiology of Hepatitis A sees a higher proportion of symptomatic
cases as the average age of infection increases. Mandatory vaccination for high-risk groups is being called
for in certain parts of India following outbreaks of Hepatitis A earlier this year.

Acute acalculous cholecystitis is inflammation of the gallbladder without evidence of gallstones. This is a
very rare complication of Hepatitis A. The pathophysiology of acalculous cholecystitis during acute viral
hepatitis remains unclear.

Audience Take Away Notes

• Highlighting the importance of globalization and the changing epidemiology of Hepatitis A as well as
the changing spectrum of imported illnesses seen in tourists and migrants presenting to hospitals and
community-based practices throughout Ireland
• The role of vaccination in high-risk areas as a preventative measure

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• The importance of a thorough travel history and epidemiological risk factors when presented with a
patient with a fever returning from travel
• Acalculous cholecystitis is a very rare complication of acute viral Hepatitis A
Biography

Dr. Dorarca Lynch graduated with a first-class honours’ degree in medicine from University of Galway, Ireland in
2019. She has been working in general medicine since graduation in Ireland and Australia, with a specific interest in
Infectious Diseases. She is a member of the Royal College of Physicians of Ireland since completing her examinations
in 2023. She is currently completing the Basic Medical Specialty training in the West of Ireland. She plans to pursue a
career in Infectious Diseases in Ireland commencing higher specialist training in the coming years.

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Edeline Anne L. Dondonilla, RND, MD1*; Grace Malayan, MD,

FPPS, FPAPP2; Ma. Lucila M. Perez, MD, MSc, FPPS3
1
Ospital ng Makati, Metro Manila, Philippines
2
Consultant, Pediatric Pulmonology Ospital ng Makati, Metro Manila, Philippines
3
Supervising investigator, Ospital ng Makati, Metro Manila, Philippines

Five year profile and outcomes of pediatric patients diagnosed with

tuberculosis at a Tertiary Hospital in Makati, Philippines (2016-2020)
Background: The Philippines ranks fourth worldwide in tuberculosis incidence and is considered as a high-
burden country of tuberculosis in the world. Differences in the pathophysiology and clinical presentation
of TB in children make diagnosis more challenging than in adults.

Objectives: This study aims to provide a socio-demographic profile and treatment outcomes of admitted
patients and managed as cases of Pulmonary and Extra-Pulmonary Tuberculosis at Ospital ng Makati
Department of Pediatrics from January 2016 to December 2020.

Design: Descriptive.

Methodology: 127 children aged 18 years old and below who were diagnosed with tuberculosis (Pulmonary
and Extrapulmonary Tuberculosis) and admitted at Ospital ng Makati Department of Pediatrics from
January 2016 to December 2020 were included in the study.

Results: From the 127 patients included in this study, 91 (71.65%) have Pulmonary TB (PTB) while the
remaining 36 (28.35%) have Extrapulmonary TB (EPTB). In general, there are more male patients who
contacted Tuberculosis. In most of the age groups, male PTB patients shows more symptoms than female
PTB patients. Symptoms are more prominent in ages 1 – 3 years. Aged 14-18 years old presented with the
most cases. And TB Meningitis was the most common EPTB.

Conclusion/Recommendations: This study highlights the importance the synergistic use of thorough
history taking, physical examination, clinical presentation and laboratory findings in diagnosing
tuberculosis, and the importance of timely identification of TB cases which may consequently be used in
further improving outcomes to achieve the eventual eradication of Tuberculosis.

Keywords: Tuberculosis, Pulmonary Tuberculosis, Extra-Pulmonary Tuberculosis, Clinical Profile,

Descriptive.

Audience Take Away Notes

• Tuberculosis, being an endemic disease in the Philippines still heavily burdens the population,
particularly the pediatric population. In this new era of technology and globalization, the progression,
disease burden and societal impact of tuberculosis will not only effect 3rd world countries, but can
also impact other regions, and even globally. The study aimed to present the profile and outcomes
from a five-year period (2016-2020). During which, in 2020, the COVID-19 Pandemic has started, which
heavily influenced the health-seeking behaviors of patients, and thus, also impacting the results of
this study. It can also give the audiences an overview of the disease burden, and how this affects the
pediatric population who are very vulnerable in contracting tuberculosis. Tuberculosis in the young is
not just a specific age group problem, but is also reflective of the disease containment in all ages which
can give light to future projects and researches for better implementation in early recognition of the

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disease and improvement on compliance with treatments. Knowledge on the profile and outcomes will
also aid in further investigation of the impact of COVID-19 and other emerging infectious diseases in
the management and outcomes of Tuberculosis. This in turn can help not just the medical community
but also policy makers in future projects on the road to eradication of tuberculosis not just in the
Philippines but the whole world
Biography

Dr. Edeline Dondonilla studied BS Nutrition and Dietetics as her undergraduate degree at University of the Philippines
– Los Banos and completed her degree of Doctor of Medicine in University of the Perpetual Help DALTA-Jonelta in
2016. She underwent her Medical Internship training at Victoriano Luna Medical Center in 2017. She underwent and
completed her training specializing in Pediatrics in 2021 in Ospital ng Makati – a tertiary local government hospital in
the Philippines.

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Eduardo Ferracioli Oda1*, Tatiana Tanaka1, Michele Soares Gomes

Gouvea2, Joao Renato Pinho2, Veronica Coelho3, Carlos Eduardo
Hirata1, Joyce Hisae Yamamoto1
1
Clinica of talmologica (LIM 33), Hospital das Clinicas HCFMUSP
2
Lab. Gastroenterologia Clinica e Experimental (LIM 07), Instituto de Medicina
Tropical
3
Laboratorio de Imunologia, Instituto do Coracao, Faculdade de Medicina,
Universidade de Sao Paulo

Low-volume direct multiplex PCR for etiological diagnosis of infectious

uveitis
Purpose: To describe the pathogens detected in intraocular fluid of individuals with active uveitis using a
low-volume direct multiplex PCR.

Methods: Eighty-six individuals with active uveitis were included in this study between July, 21 and
November, 23. All participants had at least (2+) cells in Anterior Chamber (AC) or vitreous haze. Samples
were obtained by AC paracentesis (81 samples) or pars plana vitrectomy (5 samples). We also included
23 control samples, being aqueous humor from cataract surgery (21 samples) and vitreous humor from
epiretinal membrane surgery (2 samples). Twenty µl of the sample was analysed through a qualitative
direct multiplex real-time Polymerase Chain Reaction (PCR) assay, developed by Japanese researchers for
uveitis diagnosis purpose. It detects Herpes Simplex Virus (HSV) 1 and 2; Varicella-Zoster Virus (VZV),
Cytomegalovirus (CMV), Epstein-Barr Virus (EBV), Human Herpes Virus 6 (HHV6), Human T-Lymphotropic
Virus (HTLV), Treponema pallidum and Toxoplasma gondii. This multiplex PCR was validated mainly in
Japan. This study was approved by Institution Ethics Committee (CAAE 91413918.5.0000.0068) and all
participants signed the informed consent form.

Results: The clinical characteristics of the uveitis were as follows. Anatomic classification were mainly
anterior (39 patients; 45.3%) and posterior (37 patients; 43%). The onset/course of the uveitis: first acute
episode in 32 patients (37.2%), recurrent in 28 patients (32.5%) or chronic in 29 patients (33.7%). Overall
positivity was 23.5% (20/86 samples); among acute uveitis, it was 28.8% (17/59 samples) and, among
infectious uveitis (diagnosis before intraocular fluid analysis), it was 35.1% (20/57 samples). Herpes virus
was detected in 10 samples (50%). The agent detected and final diagnosis based on clinical and PCR results
were: EBV in three samples (VZV PCR+ acute retinal necrosis and coinfection with EBV; PCR- toxoplasmosis
but EBV+ in two cases); CMV (CMV associated anterior uveitis in two cases) and HHV6 (HHV6 associated
anterior uveitis in two cases) in two samples, each; VZV (VZV associated acute retinal necrosis), HSV2
(HSV2 associated acute retinal necrosis) and HSV1 (HSV1 associated acute retinal necrosis) in one sample
each. Toxoplasma gondii was detected in 9 samples (45%) and all cases had retinochoroiditis. HTLV and T.
pallidum were detected in one sample each and both cases had diffuse uveitis. The strip PCR changed the
etiological diagnosis in five cases (5.8%; 3 cases of herpetic uveitis to toxoplasmosis, one case of syphilis
to toxoplasmosis and one case of toxoplasmosis to herpetic uveitis). Detailed results are shown in Tables
1 and 2.

Conclusion: For uveitis etiological diagnosis, direct strip PCR was able to demonstrate the infectious agent
in almost one fourth of our sample, using just a small sample volume, remaining material for further analysis
of this valuable low-volume sample. The multiple pathogens selected encompass the most important
infectious uveitis etiologies. Further, even though most patients were under use of topical and/or systemic
therapy, we could not observe interference of treatment in PCR positivity.

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Table 1. Clinical data of participants with uveitis (n=86)

Infectious Uveitis (IU)

NIU
(n=29) Overall Herpetic Toxoplasmosis O t h e r
(n=57) (n=24) (n=25) (n=8)

Age, median 50 53 54.5 47 44.5

(range), years (19 - 82) (20 - 77) (22 - 74) (20 - 74) (26 - 77)

Gender, F/M 22/7 22/35 11/13 7/18 4/4

(%) (75.8/24.2) (38.6/61.4) (45.8/54.2) (28/72) (50/50)

Strip PCR 0 20 7* 11 * 2
positivity, n (0) (35.1) (29.2) (44) (25)
(%)

One sample were positive for VZV and EBV, two cases with final diagnosis of toxoplasmosis were positive
for EBV.

Table 2. Clinical characteristics of participants with herpetic or toxoplasmosis uveitis according to

Direct Strip multiplex PCR result

Herpetic uveitis Toxoplasmosis uveitis

Anterior uveitis Posterior uveitis

PCR + PCR - P PCR + PCR - P PCR + PCR - P

(n=5) (n=15) (n=2) (n=2) (n=9) (n=16)

Anterior 2 2 >0.999§ 3 3 >0.999§ 2 3 0.297§

chamber / (2 - 3) (2 - 3) (3 - 3) (2 - 4) (2 - 3) (2 - 4)
vitreous cells
0.767§ 0.333§ 22.5
Duration of 63 43.5 31.5 75.5 39 0.054§
(3 -
active uveitis (9 - 115) (2 - (27 - 36) (67 - (9 -
339)
in days 204) 84) 258)
>0.999† - 8
No 2 8 0 0 1 0.087†
(50)
treatment*, n (40) (53.3) (0) (0) (11.1)
(%)
0.072† - 9
Antiviral or 2 2 1 2 3 0.411†
(56.2)
antibiotic (40) (13.3) (50) (100) (33.3)
systemic
treatment, n
(%)
Results are represented as median and range, * no topical or systemic treatment, ** EBV positive cases
were not included in this table, §Mann-Whitney test, †Fisher’s exact test.

Audience Take Away Notes

• The importance to analyse intraocular fluid in the diagnosis of uveitis
• Methods that propose to test to multiple pathogens, in low-volume sample and is rapid should be
pursued
• In our study, this direct Strip PCR demonstrated to be a useful tool for diagnosing the etiology of
infectious uveitis

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• The use of only a small volume (20µl) and with no extraction step make this method easy to perform
and allow the ophthalmologist to use the remaining sample for other analysis (as microbiological
culture or flow cytometry)
• Overall positivity was 23.5%; considering only infectious uveitis it was 35.1%; anterior chamber or
vitreous cell count (SUN) and treatment did not interfere in PCR positivity
Biography

Dr. Eduardo Ferracioli Oda studied in the University of Sao Paulo Medical School and there received his medical
degree in 2015. He completed his Ophthalmology residency in the same institution in 2019 after focusing his studies
in Uveitis. During his fellowship in Uveitis, Dr. Ferracioli-Oda started his PhD protocol about ocular fluids analysis
through multiple tests (as PCR, cytokines profile and metagenomics).

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Elinam Adzo Agbobli

Department of Animal Biology, University Of Ghana, Accra, Ghana

Assessment of tick diversity and potential pathogen transmission in two

ecological niches: Implications for zoonotic disease surveillance

T icks play a significant role in disease transmission, rivaling mosquitoes in importance, yet knowledge
gaps persist regarding ticks of public health importance. Their remarkable diversity stems from
complex life cycles and interactions with hosts, leading to their ubiquity across diverse animal species.
This study aimed to assess tick diversity in the Ghanaian Shai Hills Resource Reserve and surrounding
communities. Tick specimens were collected from various hosts, including wild animals like Struthio
camelus, Python regius, and Equus quagga, and domestic animals like Bos taurus, Canis lupus familiaris,
Felis catus, and Ovis aries. Amblyomma variegatum emerged as the predominant tick species on domestic
hosts outside the reserve, while Rhipicephalus evertsi prevailed among ticks from captive wild animals
within the reserve. Amblyomma variegatum, particularly prevalent on Bos taurus, which freely moves and
forages in the reserve’s buffer zones, was observed across both study sites. Given its association with
zoonotic diseases like Crimean-Congo hemorrhagic fever and African tick-bite fever, the presence of
Amblyomma variegatum underscores the risk of pathogen transmission. Molecular analysis targeting the
cox-1 gene confirmed tick species identification. The findings emphasize the importance of surveillance
and management strategies to mitigate the public health risks posed by ticks and the pathogens they carry,
urging further investigation into the specific pathogens transmitted by these vectors.

Keywords: Ticks, Amblyomma Variegatum, Resource Reserve, Rhipicepahlus Evertsi, Bos Taurus.

Audience Take Away Notes

• Identification of High-Risk Tick Species: By identifying Amblyomma variegatum as the predominant
tick species, particularly prevalent on domestic hosts such as Bos taurus, the audience will recognize
the importance of this species in disease transmission. This information can guide targeted surveillance
efforts and help prioritize control measures to mitigate disease spread
• Recognition of Zoonotic Disease Risks: The study highlights the association of Amblyomma variegatum
with various zoonotic pathogens, including Crimean-Congo hemorrhagic fever and African tick-bite
fever. This awareness can alert public health professionals and veterinarians to the potential risks of
tick-borne diseases and inform preventive measures to protect both human and animal populations
• Potential for Further Research and Education: The findings provide a foundation for future studies
on tick ecology, disease epidemiology, and wildlife management strategies. Other faculty members
could use this research to expand their teaching and research agendas, contributing to a broader
understanding of tick-borne diseases and ecosystem health
• Solutions for Disease Control: By identifying high-risk tick species and associated pathogens, the study
offers practical solutions for disease control and management. Findings from the study can inform the
development of targeted interventions, such as vector control measures and vaccination strategies, to
reduce the burden of tick-borne diseases on human and animal populations

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• Public Health Awareness: Improved knowledge of tick diversity and disease risks enhances public
health preparedness and response capabilities. Health professionals can use this information to
educate communities about tick-borne diseases, implement early detection and surveillance systems,
and develop effective disease prevention and control strategies
Biography

Miss Elinam Adzo Agbobli, a researcher in Biological Sciences, completed her post-baccalaureate studies at the
University of Ghana. Joining the Noguchi Memorial Institute for Medical Research, she contributes to the Gyan
laboratory's work on 'Blood-Brain Barrier, Cerebral Malaria, and Exosome Study'. Passionate about scientific inquiry,
she focuses on biomedical research, particularly infectious diseases. Miss Agbobli has presented her findings through
multiple oral and poster presentations, showcasing her dedication to advancing scientific knowledge. Her commitment
to addressing health challenges highlights her potential as a future leader in the scientific community.

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Laelson Rochelle Milanes Sousa1, Renata Karina Reis1, Milton

Jorge De Carvalho Filho2, Hemilio Fernandes Campos Coelho3, Ana
Cristina De Oliveira E. Silva3, Elucir Gir1*
1
University of Sao Paulo, Ribeirao Preto College of Nursing/General and
Specialized Nursing Department, Ribeirao Preto, Sao Paulo, Brazil
2
UNINOVE, Sao Bernardo do Campo, Sao Paulo, Brazil
3
Federal University of Paraiba, Joao Pessoa, Paraiba, Brazil

Prevalence of physical and/or mental health symptoms for four weeks or

more due to COVID-19 among Brazilian nurses
Introduction: Long COVID comprises a complex, multidimensional, progressive and impactful syndrome
characterized by the persistence of residual symptoms after the initial COVID-19 infection, without an
alternative diagnosis or associated condition.

Objective: To identify the prevalence of physical and/or mental health symptoms for four weeks or more
due to COVID-19 and associated variables among Brazilian nurses.

Method: A cross-sectional study was carried out using an online survey with 3,697 nurses from all regions
of Brazil, which included capitals and the interior of the country. Data were collected through an adaptation
of the respondent-driven sampling method to the virtual environment. The prevalence of physical and/or
mental health symptoms for four weeks or more due to COVID-19 among Brazilian nurses was identified
through the variable: “Have you had any physical and/or mental health symptoms persist for 4 weeks or
more due to COVID-19?” (YES NO)". The statistical association was verified using Pearson Chi-Square.

Results: 3,697 nurses participated in the study, 3,081 (83.3%) female, 1,791 (48.4%) white, 1,946 (52.6%) had
been diagnosed with COVID-19 only once and 381 (10.3%) had been diagnosed confirmed with COVID-19
three times. The main symptoms were: respiratory 785 (21.2%); circulatory 743 (20.1%); fatigue 2,018 (54.6%)
and cognition 1,836 (49.7%). The prevalence of physical and/or mental health symptoms for four weeks or
more due to COVID-19 among Brazilian nurses was 61.6% (2,279). The following variables had a statistically
significant association with the persistence of physical and/or mental health symptoms for four weeks
or more due to COVID-19 among Brazilian nurses: number of times of confirmed diagnoses (p<0.001);
incomplete vaccination schedule (p<0.001); presence of chronic disease (p<0.001) and sex (p<0.001).

Conclusion: It is concluded that conditions prior to diagnosis and incomplete vaccination schedule were
related to the persistence of physical and/or mental health symptoms for four weeks or more due to
COVID-19 among Brazilian nurses.

Descritores: Nurses, COVID-19, SARS-CoV-2, Post-Acute COVID-19 Syndrome.

Audience Take Away Notes

• Identification of the prevalence of physical and/or mental health symptoms for four weeks or more
due to COVID-19 and associated variables among Brazilian nurses
• Variables associated with the prevalence of physical and/or mental health symptoms for four weeks or
more due to COVID-19 among Brazilian nurses
Biography

Dr. Elucir Gir studied nursing in at the University of Sao Paulo, Ribeirao Preto College of Nursing. Full professor
since 2004 (PhD, MNSc.RN) with the General and Specialized Nursing Department, Graduate Program in Fundamental
Nursing. Vice Dean of University of Sao Paulo, Ribeirao Preto College of Nursing, Coordinator of NAIDST and RENAIDST.
She has published more than 280 research articles in journals.

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Laelson Rochelle Milanes Sousa1, Andressa Silva Torres dos

Santos1, Milton Jorge De Carvalho Filho2, Hemilio Fernandes
Campos Coelho3, Ana Cristina De Oliveira E Silva3, Elucir Gir1*
1
University of Sao Paulo, Ribeirao Preto College of Nursing/General and
Specialized Nursing Department, Ribeirao Preto, Sao Paulo, Brazil
2
UNINOVE, Sao Bernardo do Campo, Sao Paulo, Brazil
3
Federal University of Paraiba, Joao Pessoa, Paraiba, Brazil

Prevalence of COVID-19 diagnosis among Brazilian nurses after complete

vaccination schedule
Introduction: Facing the COVID-19 pandemic caused damage to the physical health of nurses, especially
those who worked on the so-called front line, as they were exposed to constant risks of contamination,
exhaustive workload and difficulties in the availability of inputs, such as equipment Personal Protection
(PPE).

Objective: To identify the prevalence of COVID-19 diagnosis among Brazilian nurses after a complete
vaccination schedule.

Method: A cross-sectional study was carried out using an online survey with 4,780 nurses from all
regions of Brazil, which included capitals and the interior of the country. Data were collected through
an adaptation of the respondent-driven sampling method to the virtual environment. The prevalence of
COVID-19 diagnosis among Brazilian nurses after a complete vaccination schedule was identified using the
variable: “Have you had a confirmed diagnosis of COVID-19 after a complete vaccination schedule? (YES/
NO)". The statistical association was verified using Pearson Chi-Square.

Results: 4,780 nurses participated in the study, 3,968 (83.0%) were female, 275 (5.8%) provided assistance
to indigenous populations, 290 (6.1%) provided assistance to riverside populations, 289 (6.0%) provided
assistance to quilombola populations, 1,065 (22.3%) did not receive quality PPE, 632 (13.2%) did not receive
sufficient PPE for use. The prevalence of COVID-19 diagnosis after a complete vaccination schedule was
39.5% (1,887 nurses). The following variables had a statistically significant association with the diagnosis of
COVID-19 after a complete vaccination schedule: provided assistance to riverside populations (p=0.041);
provided assistance to quilombola populations (p=0.046) and sex (p<0.001).

Conclusion: It is concluded that, despite the availability of vaccines and nurses' adherence to vaccination,
complementary actions for prevention are necessary, such as standard precautionary measures and
considering the type of assistance provided.

Audience Take Away Notes

• Identification of the prevalence of COVID-19 diagnosis after a complete vaccination schedule
• Variables associated with the diagnosis
• Prevention recommendations to improve the physical health of nurses
Biography

Dr. Elucir Gir studied nursing in at the University of Sao Paulo, Ribeirao Preto College of Nursing. Full professor
since 2004 (PhD, MNSc.RN) with the General and Specialized Nursing Department, Graduate Program in Fundamental
Nursing. Vice Dean of University of Sao Paulo, Ribeirao Preto College of Nursing, Coordinator of NAIDST and RENAIDST.
She has published more than 280 research articles in journals.

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Infection 2024

Eric Brownhill*, MD, PhD; Michael Rosenberg, MD, PhD; Kenneth

Rivlin, MD, PhD
Department of Pediatrics, Jacobi Medical Center, Bronx, New York, United States

Treatment of Iron-deficiency anemia reduces pneumonia- and

bacteremia-associated hospitalizations
Introduction: The safety profile of oral iron supplementation is well established and generally benign, but
many practitioners limit iron supplementation in patients hospitalized for infectious causes, even in the
presence of Iron-Deficiency Anemia (IDA). Nearly all human pathogens require iron, and must obtain it
from the host, so administering iron during an infection is feared to exacerbate the infection. However, IDA
itself is associated with worse outcomes in many infections, so iron stores must be balanced for optimal
outcomes.

Objective: In this study, we examine the relationship between IDA, iron supplementation, and infection in
hospitalized patients.

Methods: Inpatient admission data for pediatric patients from multiple institutions, from 2020 to 2023 were
retrospectively analyzed for infectious diagnoses on or during admission, IDA (defined by the intersection
of abnormal HgB, abnormal MCV, and abnormal RDW) and prescribed iron supplements. Of 91,029 total
hospital admissions, 7344 patients had IDA, of whom 1994 were prescribed iron. 3249 patients were
prescribed iron with no IDA by these criteria. Chi-squared analysis was performed on infection category:
bacteremia, urinary tract infection (UTI), pneumonia, and meningitis, to find a correlation between IDA
and infection, or iron supplementation and proportion of hospitalized patients with each infection.

Results: IDA correlated significantly with all infections analyzed. Iron supplementation in patients with
no IDA correlated with increased likelihood of bacteremia and meningitis, but not UTI, and correlated
inversely with pneumonia. In patients with IDA, iron supplementation correlated with decreased likelihood
of pneumonia and bacteremia, but had no effect on meningitis or UTI.

Discussion/Conclusion: Our data describe the effects of anemia and iron in various infections. IDA
correlates with an increased likelihood of all infections analyzed, on or during hospitalization, and iron
supplementation increases proportions of certain infections only in patients without IDA. For patients
with IDA, iron supplementation appears to be, at worst, benign in terms of risk of infection. However, iron
supplementation actually decreases pneumonia at or during admission, regardless of IDA status. The lung
is a unique immune organ, in which alveolar macrophages play a key role in homeostasis and infection
control, and these macrophages require iron for multiple antimicrobial pathways. Thus, based on these
data, and supported by an understanding of lung immunity, providing iron to iron-deficient patients is
critical to support immune function, particularly to combat pneumonia.

Audience Take Away Notes

• Pediatric hospitalists and Infectious Disease specialists may refine their recommendations for
treatment of iron deficiency anemia in the setting of serious bacterial infections
• Academic faculty may improve their teaching regarding risks and benefits of iron supplementation
with regard to risk of infection

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• Research clinicians may use this information as a basis for future studies to examine the relationship
between iron and specific pathogens
Biography

Dr. Brownhill studied Molecular and Cellular Biology at the Johns Hopkins University and graduated with MS in 2011.
He then attended Boston University School of Medicine, where he completed his combined MD and PhD degrees in
2022, working in the laboratory of Dr. Igor Kramnik at the National Emerging Infectious Disease Laboratories (NEIDL)
in Boston, MA, USA. He is currently completing his residency training in Pediatrics at Jacobi Medical Center in New
York, USA, after which he intends to pursue a fellowship in Pediatric Infectious Diseases.

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Infection 2024

Veronika Nemethova1, Petra Babiakova1, Michal Selc2,3,

Kristina Jakic2, Lucia Uhelska1, Boglarka Teglasova1, Alexandra
Poturnayova4, Lubos Drgona5, Andrea Babelova2,3, Filip Razga1*
1
Selecta Biotech SE, Bratislava, Slovak Republic
2
Department of Nanobiology, Cancer Research Institute, Biomedical Research
Center, Slovak Academy of Sciences, Bratislava, Slovak Republic
3
Centre for Advanced Materials Application, Slovak Academy of Sciences,
Bratislava, Slovak Republic

4
Institute of Molecular Physiology and Genetics, Centre of Biosciences, Slovak Academy of Sciences,
Bratislava, Slovak Republic
5
Department of Oncohematology, Comenius University and National Cancer Institute, Bratislava, Slovak
Republic

Effective reduction of SARS-COV-2 RNA levels in transfected lung cells

using a tailor-made therapeutic oligonucleotide

M ore than four years after the outbreak of the COVID-19 pandemic, the SARS-CoV-2 virus is still causing
lasting damage around the world, impacting the health and lives of many. Preventive measures, such
as widespread administration of vaccines, is playing a role in reducing the severity of cases. For those who
require treatment, clinicians can try to treat the disease and its symptoms with existing drugs. However,
an effective therapy specifically targeted against SARS-CoV-2 is still lacking.

Here, we report the antiviral potential of a tailor-made oligonucleotide-based inhibitor targeting SARS-
CoV-2, called ASC1R, which showed spontaneous cellular uptake and a remarkable >94% efficacy in reducing
RdRp RNA levels in transfected lung cell lines following a single application.

The therapeutic potential of the structurally unique ASC1R could translate into substantial clinical benefits
for patients with COVID-19, while the versatility of the platform could be exploited in the development of
analogue antivirals for other viral diseases. The findings could help meet the global challenge of developing
new and safe treatment modalities.

This work was supported by the Slovak Research and Development Agency under Contracts No. PP-
COVID-20-0007 and APVV-21-0220.

Audience Take Away Notes

• Therapeutic oligonucleotides represent a promising pharmaceutical perspective for the treatment of
many pathological conditions, including those of viral origin
• ASC1R showed spontaneous cellular uptake reaching 30 million molecules per cell without cytotoxicity
• ASC1R reduced RdRp RNA levels in transfected human lung cells with a remarkable efficiency of >94%
after a single application
Biography

Dr. Razga has more than 20 years of professional experience in oncology with a focus on biotechnology within the last
decade. He is trained in Physical and Biomolecular chemistry and has a primary research interest in RNA structure and
function. He is currently leveraging his expertise in the development of new therapeutic modalities using the antisense
platform to develop quality healthcare products that have the potential to redefine treatment outcomes. He is the
author of more than 60 scientific papers and developed several proprietary technologies aiming at precise diagnosis
and personalized therapeutic approaches.

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Infection 2024

Fiona Murphy, M.B, B.Ch, B.A.O1*, Jack McHugh, M.B, B.Ch, B.A.O2,
Ryan Khodadadi, M.D2, Omar Abu Saleh, M.D2
Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States
1

Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo

2

Clinic, Rochester, Minnesota, United States

Rare fungal infection in chronic lymphocytic leukemia: Scopulariopsis as

a clinical challenge

A 59-year-old male with a history of relapsed refractory Chronic Lymphocytic Leukemia and associated
hypogammaglobulinemia presented to our medical service with neutropenic fever, a skin lesion, and
progressive pulmonary infiltrates.

He had been evaluated for cough and neutropenic fever 7 weeks prior and was treated for Aspergillus
and had interval improvement. He was receiving chemotherapy with Rituximab, Etoposide Phosphate,
Vincristine Sulfate, Cyclophosphamide, and doxorubicin (R-EPOCH), in addition to ibrutinib. Antimicrobial
prophylaxis regimen included voriconazole, trimethoprim-sulfamethoxazole, and acyclovir. Computed
Tomography (CT) of the chest demonstrated bilateral multifocal areas of consolidation and nodularity
(Figure 1).

Pertinent work-up included negative bacterial and fungal cultures from blood and a Bronchoalveolar
Lavage (BAL) specimen, negative serum and BAL Aspergillus antigen, negative pneumocystis polymerase
chain reaction and cryptococcal antigen from BAL, negative serological testing for endemic fungi, and a
serum (1,3)-β-D-glucan of 124 pg/mL (reference range < 60 pg/mL). After five days of broad-spectrum
antimicrobial therapy there was no clinical or radiographic improvement. The patient was started on
liposomal amphotericin B and transitioned to posaconazole after initial improvement. CT chest two weeks
into treatment demonstrated improving infiltrates. Treatment was switched to caspofungin given concern
for possible a possible interaction between chemotherapy and posaconazole. He remained profoundly
neutropenic during this time-period.

On arrival to our institution, examination was notable for fever (temperature 38.2C), crackles in the right-
lung base, and a new papular lesion on the right parietal scalp (Figure 2). CT Chest demonstrated new
bilateral nodules and ground glass opacities. A diagnosis of disseminated Scopulariopsis sp. infection was
confirmed via matrix-assisted light desorption ionization-time of flight mass spectrometry. The patient
was escalated to combination therapy with liposomal amphotericin B and caspofungin. Terbinafine was
subsequently added. In managing Scopulariopsis infections, clinicians face numerous challenges due to
the rarity of the condition and its propensity for affecting immunocompromised individuals. Effective
management requires a multi-faceted approach, beginning with a high index of suspicion for fungal
infections, especially in patients with hematologic malignancies, solid organ transplants, or those receiving.

Repeat bacterial and fungal blood and sputum cultures were negative. Serum (1,3)-β-D-glucan was 71 pg/
mL, and serum aspergillus antigen remained undetectable. Bronchoalveolar lavage (BAL) was performed,
and after three days of incubation there was growth of a filamentous fungus on fungal cultures (Figure 3).
Subsequent fungal cultures obtained from a biopsy of the papular lesion grew the same organism.

In managing Scopulariopsis infections, clinicians face numerous challenges due to the rarity of the condition
and its propensity for affecting immunocompromised individuals. Effective management requires a multi-
faceted approach, beginning with a high index of suspicion for fungal infections, especially in patients with

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hematologic malignancies, solid organ transplants, or those receiving immunosuppressive therapies. Early
diagnosis is crucial, relying on a combination of clinical suspicion, imaging studies, and microbiological
testing, including fungal cultures and microscopy to identify characteristic features such as dark brown
colonies and septate hyphae.

Figure 1: Computed tomography of the chest with bilateral consolidation

Figure 2: Red papule, right parietal scalp

Figure 3a: Fungal culture

Figure 3b: Microscopy of fungal cultures with lactophenol blue staining

Audience Take Away Notes

• This case challenges the reader to identity the etiology of an invasive mold infection involving the
lungs and skin. While rare, infections with Scopulariopsis sp. are increasing
• When considering the differential diagnosis for an IMI in an immunocompromised host, an
understanding of the prevalence of various fungal species is paramount

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Infection 2024

• Characteristic features of Scopulariopsis sp. include dual lung and skin involvement, rapid growth of
flat dark brown colonies on fungal cultures, and the presence of septate hyphae with characteristic
conidiogenous cells (annellides) observed on microscopy
Biography

Dr. Murphy studied Medicine at University College Cork Ireland graduating in 2019. She completed a post graduate
Master’s in Clinical Research. She is completing her residency training in the Mayo Clinic Rochester Minnesota in the
United States. She is returning to Ireland in 2024 to commence Infectious Diseases specialty training. Her interests
include bone and joint infections and opportunistic pathogens.

225
Infection 2024

Franciela Golden*, DO, MS; Nadine Elhage, DO; Trent Davis, MD;
Kelley Devoe, DO; Aleksandra Murawska Baptista, MD; Abhinav
Singla, MD
Mayo Clinic Jacksonville, United States

Native aortic valve endocarditis secondary to streptococcus gordonii: A

rare presentation

S treptococcus Gordonii (SG) is an alpha hemolytic gram-positive streptococcus bacterium most

commonly present in the oral cavity and gastrointestinal tract. Despite an increase in the incidence
of Infective Endocarditis, SG cases reported on a native aortic valve are relatively uncommon. Previous
cases of SG have been associated with spondylodiskitis, intraabdominal infection, and oral procedures.
We present a case of a 79-year-old male with a native aortic valve SG endocarditis that was admitted for
AKI, diarrhea, and dehydration, found have SG bacteremia with endocarditis, 1.7cm vegetation on native
aortic valve and subsequent multiple septic emboli on brain MRI. The patient was successfully treated with
IV antibiotics and required aortic valve replacement at following hospitalization. The most likely source
of the bacteremia was a trigger point injection to the lumbar spine which was consist with MRI lumbar
spine findings of spinal abscess. However, other possible sources include oral procedure and colonoscopy
with polypectomy within 8 weeks of the hospitalization. This case illustrates the importance of thorough
history taking and consideration for echocardiogram to rule out endocarditis if SG bacteremia is present,
in addition to close monitoring and outpatient follow up post diagnosis. Considering an increasing number
of procedures involving the oral cavity, spine and abdominal area, and we hope that this case will bring
awareness in the diagnosis of SG endocarditis.

Audience Take Away Notes

• The audience will be able to understand the clinical significance of ordering echocardiogram for
patients diagnosed with Streptococcus Gordonii bacteremia and its related complications such as
valvular vegetation and septic emboli. Multiple sources of SG endocarditis are addressed, and this
should prompt audience to expand differential diagnosis based on this case presentation
Biography

Dr. Franciela Golden studied Health Science at Merrimack College and graduated in 2017. She completed a Master of
Health and Wellness Management in 2018 followed by Medical School Graduation from The Idaho College of Osteopathic
Medicine in 2023. She is currently a first year Family Medicine Resident at Mayo Clinic Florida. Aleksandra Murawska
Baptista, MD FHM is a consultant in department of Hospital Internal Medicine in Mayo Clinic Florida. She graduated
Family Medicine Residency Program in Alabama after which she graduated Fellowship Program in Hospital Medicine
in Geisinger Hospital in Pennsylvania. Before she became Mayo Clinic Faculty she was working as a Hospitalist and
Instructor of Medicine at Brigham and Women’s Hospital in Boston and Harvard Medical School. She is an assistant
professor and associate program director for Hospital Internal Medicine Fellowship Program. She is involved in
multiple leadership projects including being a President of North Florida Chapter for Society of Hospital Medicine. She
is passionate about education and innovation. She is involved in developing curriculum projects for medical students
as well as residents. She also is a Mayo Alix School of Medicine Faculty and Society Affair Representative for Association
of American Medical Colleges. She is involved in multiple quality improvements projects as well as international
collaboration with other hospitals and universities.

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Infection 2024

Rumeysa Soycan, Hatice Turk Dagi*, Duygu Findik

Department of Medical Microbiology, Selcuk University, Konya, Turkiye

Colonization and infection in admitted patients with vancomycin-

resistant Enterococcus in a tertiary hospital

E nterococci are gram-positive, facultative anareobic bacteria that are usually found in gastrointestinal
tract of humans, animals and environmental sources. Enterococci can lead to severe hospital-acquired
infections and are difficult to treat due to their high level of antibiotic resistance. Vancomycin-Resistant
Enterococci (VRE), are strains that developed resistance to vancomycin which is used against gram-positive
bacterial infections. VRE are one of the most common nosocomial pathogens that cause colonisation and
infection both in hospitalized patients.

We aim to better understand whether the patient is only carrier or infected with VRE by conducting a
retrospective study including admitted patients between 2019 and 2024 at Selcuk University Hospital.

1467 rectal swab samples were inoculated onto chromogenic VRE agar and incubated at 37°C. After bacterial
growth, identification was performed using the Vitek-2 automated system. The disc diffusion method was
used to determine antibiotic susceptibility according to EUCAST guidelines.

Out of 157 rectal swab culture-positive patients, 97 patients (61.7%) were only colonized and 60 patients
(38.2%) were infected by VRE. 30 patients (19.1%) had cystitis, 18 patients (11.4%) had blood-stream
infection, three patients (1.8%) had meningitidis yet one of them was shunt-associated, two patients (1.2%)
had catheter infection, two patients (1.2%) had wound infection, one patient (0.6%) had both cystitis and
blood-stream infection, one patient (0.6%) had both cystitis and peritonitis, one patient (0.6%) had both
cystitis and catheter infection; one patient (0.6%) had both blood-stream infection and pleuritis, one
patient (0.6%) had tissue infection.

In conclusion, we observed a high rate of infection in VRE carriers. The highest percentage of patients had
cystitis however life-threatning infections such as blood-stream and meningitis are also observed. Since
VRE easily spread among admitted patients, comply with the rules of isolation plays a key role in protecting
non-colonized patients. Determining the source is crucial for preventing transmission of VRE by especially
the hands of medical staff or devices within the hospital.

Audience Take Away Notes

• The high rate of infection developed in VRE carriers
• Life-threatning infections such as blood-stream and meningitis also observed
• Isolation of colonized patients plays a key role in protecting non-colonized patients
Biography

Prof. Dr. Hatice Turk Dagi graduated as MD in 1999 from Selcuk University/Faculty of Medicine, Turkiye. She received
specialization in Medical Microbiology degree in 2009 at the same institution. She worked in Batman State Hospital
between 2009-2011. Since 2012 has worked in Selcuk University/Faculty of Medicine. She received her Prof. Dr. degree
in 2021. She received her PhD degree in Immunology in 2023 at the same institution.

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Infection 2024

Ihtisham Ul Haq1,2*, William Gustavo Lima3, Katarzyna

Krukiewicz2, Rafael Pinto Vieira1,4, Maria Elena de Lima1,3,5
1
Programa de Pos-graduacao em Inovacao Tecnologica, Universidade Federal de
Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
2
Department of Physical Chemistry and Technology of Polymers, Silesian
University of Technology, M. Strzody 9, 44-100 Gliwice, Poland
3
Programa de Pos-Graduacao Stricto Sensu em Medicina e Biomedicina,
Faculdade de Saude Santa Casa de Belo Horizonte, Belo Horizonte/MG, Brasil

4
Departamento de Bioquimica e Imunologia, Universidade Federal de Minas Gerais, 31270-901 Belo
Horizonte, MG, Brazil
5
Programa de Pos Graduacao em Medicina e Biomedicina da Faculdade Santa Casa de Belo Horizonte,
Belo Horizonte 30150-240, MG, Brazil

Antimicrobial activity of peptides derived from lycosa erythrognatha

spider venom against quinolone-resistant Uropathogenic Escherichia
Coli (UPECS)

U ropathogenic Escherichia Coli (UPECs) is the leading pathogen involved in urinary tract infection.
Although quinolones are widely used in these cases, the resistance of UPECs to this class has been
growing significantly, challenging the effectiveness of antibacterial therapy. Thus, the development of novel
antimicrobials agents for the treatment of quinolone-resistant UPECs infections is imperative. Herein,
arthropod toxin stand out as a promising source of new bioactive compounds against superbugs such as
quinolone-resistant UPECs, especially Antimicrobial Peptides (AMPs).

Objectives: To study the antibacterial effect of synthetic peptides derived from a natural compound present
in the venom of the spider Lycosa erythrognatha against clinical isolates of quinolone-resistant UPECs.

Methodology: Ten clinical isolates of UPECs were included. The bacteria were identified by biochemical-
physiological assay. Antimicrobial resistance profile and the Extended Spectrum Beta-Lactamase (ESBL)
production was determined. Next, the antibacterial effect of the peptides was studied by determining the
Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC). In silico study
was performed to determine the mode of action of the peptide against the E. coli adhesins PapG and FimH
via ClusPro webserver.

Results: Five compounds were tested, but LyeTx I mnΔK (16 amino acid residues; 1871.32 Da) showed the best
activity. The MIC and MBC of this compound was of 2 µM and 8 µM, respectively, to all included isolates.
All the isolates were resistant to nalidixic acid, ofloxacin, norfloxacin ciprofloxacin and levofloxacin. In
addition, five isolates were ESBL-positive. Peptide showed binding with both of the adhesins, PapG and
FimH, that help E. coli in binding to kidney and bladder cells, respectively. Conclusion: The LyeTx I mnΔK
peptide is a potential prototype to development of new antimicrobial agents against quinolone-resistant
uropathogenic Escherichia coli.

Financial support: CAPES, INCT-TeraNano, CNPq, FAPEMIG.

Keywords: E. Coli, Urinary Infection, Drug Resistance, Antimicrobial Peptides, Drug Development.

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Infection 2024

Audience Take Away Notes

• Audience can see the antibiotic resistance profile of quinolone-resistant uropathogenic Escherichia
coli (UPECs)
• Audience can avoid taking the antibiotics which are not effective against quinolone-resistant
uropathogenic Escherichia coli (UPECs)
• The antimicrobial peptides can be used for the treatment of several other pathogenic bacteria and
fungi
• After some clinical trials we will be able to formulate a new peptide based antibiotic
• It will help in desiging the treatment strategies for quinolone-resistant uropathogenic Escherichia coli
(UPECs) infections
• Antimicrobial peptides have captivated the interest of researchers worldwide due to their broad-
spectrum antifungal capabilities and the low likelihood of inducing drug resistance. There has been
a gradual yet notable advancement in the development of peptides, attributed to their minimal
cytotoxicity and hemolytic activity, positioning them as ideal candidates for enriching the arsenal
of antibiotic drug classes. On a laboratory scale, peptides have demonstrated significant therapeutic
potential in vivo studies
Biography

Mr. Ihtisham Ul Haq is pursuing Joint PhD at Universidade Federal de Minas Gerais, Belo Horizonte, Brazil and Silesian
University of Technology, Gliwice, Poland. He is working under the supervision of Prof Maria Elena de Lima and
Prof katarzyna Krukiewicz. His main research interests are antimicrobials and antimicrobials peptides. He has 22
publications including 7 book chapters 4 research papers and 11 review papers.

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Infection 2024

Joo Hee Walzlein*, Andreas Kurth, Susann Kummer

Centre for Biological Threats and Special Pathogens, Robert Koch-Institute,
Berlin, Germany

Stability and disinfection studies for risk group 4 pathogens: Improving

biosafety measures for laboratories and patient management

O ur project highlights the critical need for scientific data in assessing the risks posed by emerging and
re- emerging viruses, both during endemic and pandemic outbreaks. It emphasizes the importance of
validated decontamination procedures and infection control measures with the aim to minimise person-
to-person transmission, as well as transmission through environmental contamination.

There is a general lack of evidence-based scientific data guiding the implementation of infection control
measures, particularly in handling infectious patient samples and contaminated materials. This issue
extends to the need of improving biosafety measures in high-containment laboratories.

To address this lack of data, this study follows a three-fold approach:

Validation of Sampling Techniques: This involves validating defined sampling techniques to ensure
reproducible results for swabs on various surfaces, thereby facilitating accurate assessment of
environmental contamination.

Determining Persistence of Infectivity: These studies aim to determine the persistence of infectious
particles derived from risk-group 4 pathogens in different (body) fluids and on various relevant surfaces
across various environmental conditions. These data are crucial for understanding the longevity of viral
presence and transmission potential in field, hospital and laboratory environments.

Validation of Disinfection and Decontamination Procedures: Different commercially available and

commonly used disinfectants are tested for their ability to reduce viral load under various conditions
including concentration, temperature and exposure time.

Ultimately, the results from these studies are meant to be used for providing improved evidence for
infection control measures in hospital environments, thereby enhancing safety for both patients and
healthcare workers. Especially in areas, in which high-risk viruses are endemic, this is of utmost importance
in order to prevent disease spreading. In addition, the data are intended to be used for formulating and
adjusting validated safety measures in high-containment laboratories. Finally, by filling knowledge gaps
and optimising validating protocols, this study aims to contribute to a general pandemic preparedness,
therefore minimising the risks of global infectious disease spreading.

Audience Take Away Notes

• Especially doctors and healthcare workers in areas in which high-risk viruses are endemic, will
benefit from guidelines based on newly obtained scientific data regarding virus stability and effective
disinfection regimes
• The data obtained from these studies will also help to improve biosafety measures in hospital
environments as well as in laboratory settings
• The results can further be used in order to correctly set up experiments, for which virus stability and
specific decontamination procedures are crucial

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Infection 2024

Biography

Dr. Joo Hee Walzlein studied Biology at the Eberhard-Karls-University in Tubingen, Germany and graduated in 2003.
She then joined the group of Prof. Kettenmann at the Max-Delbruck Center in Berlin, Germany and received her PhD
in Medical Neurosciences in 2007. After several postdoctoral positions at King`s College/University College London
(London, UK) in the field of prion research, she obtained a position as a research fellow at the Robert Koch-Institute
in Berlin and is now working with high-risk viruses.

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Infection 2024

Joo Hee Walzlein1*, Karla A. Schwenke1, Joy Orezimena Mejedo1,2,

Jenny Ospina Garcia1,2, Sebastian Reusch2, Christian Klotz2, Marc
A. Schneider3,4, Susann Kummer1
1
Centre for Biological Threats and Special Pathogens (BSL-4 laboratory), Robert
Koch-Institute, Berlin, Germany
2
Unit “Mycotic and parasitic agents and mycobacteria”, Robert Koch-Institute,
Berlin, Germany
3
Translational Research Unit, Thoraxklinik at Heidelberg University, Heidelberg,
Germany
4
Translational Lung Research Centre Heidelberg (TRLC), German Centre for Lung
Research (DZL)

Establishment of a human lung organoid method platform for infectious

disease modelling
Background: In recent years, organoids have advanced to prominent and versatile tools in 3R research,
representing valuable alternatives for animal models and physiologically relevant human disease models at
the same time. As the federal Public Health Institute, the RKI aims to establish an in-house multi-species,
multi-organ organoid platform. The objective is a broad methodology in order to strengthen the Institute`s
pandemic preparedness plans for novel and re-emerging pathogens, which often have to be handled in a
BSL4 laboratory. So far, in our group, bronchial and nasal lung organoids have been generated from adult
stem cells derived from various primary and commercial cells. Characterisation on mRNA and protein level
showed that, with small variances, all organoids consist of a physiologically applicable cell composition.

Methodology: Single-cell RNA sequencing (scRNA sec) should be applied to investigate complex questions
like e.g. viral cell tropism, host cell response etc. Less generalized questions regarding differential gene
expression during a viral infection can be tackled with the Nanostring method. In order to study inter-
organ viral dissemination, as well as inter-species transmission of pathogens, the relatively new multi-
organ-chip technology is currently being established. Classic antiviral tests are also included in our method
range. Once conditions will be established, these tests will be applied to the multi-organ-chip format,
which allows physiologically more relevant tests. Finally, using a fluorescent labelled virus, 4D image data
have been generated and with the help of deep learning, will be used for modelling viral replication kinetics.

Results: Quality control scRNA sec runs yielded a good cell viability, sufficing for future runs. Differential
gene expression following infection of lung organoids with the BSL4 pathogens EBOV, MARV, NiV and LASV
has been studied by a Nanostring host-response panel and is currently being analysed. Preliminary infection
of organoids on organ chips with VACV-GFP have been performed and successful inter-organ transmission
could be observed. Furthermore, the anti-viral effect of the two clinically licensed drugs itraconazole and
fluoxetine has been tested in EBOV-infected organoids. Results are currently being analysed. Lastly, the
successfully generated 4D data is currently being processed by our AI department.

Audience Take Away Notes

• On completion of this study a fully characterized novel model system will be available for infectious
disease research
• The data will be published open access and freely accessible for the scientific community
• Establishment and optimization of the different methods will facilitate their application in other areas
of organoid research
• All methods will be established for application in a high-containment laboratory, which will make
tedious and time-consuming adjustments for other research groups working in the same environment
dispensable

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Infection 2024

Biography

Dr. Joo-Hee Walzlein studied Biology at the Eberhard-Karls-University in Tubingen, Germany and graduated in 2003.
She then joined the group of Prof. Kettenmann at the Max-Delbruck Center in Berlin, Germany and received her PhD
in Medical Neurosciences in 2007. After several postdoctoral positions at King`s College/University College London
(London, UK) in the field of prion research, she obtained a position as a research fellow at the Robert Koch-Institute
in Berlin and is now working with high-risk viruses.

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Infection 2024

Julia Nowak1*, Jacque Ssanyu2, Flavia Namiiro3, Nicola Mountford4,

Avery Parducci4, Kieran Walshe5, Peter Waiswa2, Sean Doyle1
1
Department of Biology, Maynooth University, Maynooth, Ireland
2
Makerere University School of Public Health, Kampala, Uganda
3
Mulago National Referral Hospital, Kampala, Uganda
4
School of Business, Maynooth University, Maynooth, Ireland
5
Accuplex Diagnostics Ltd., Maynooth, Ireland

Diagnosis of neonatal sepsis using a rapid lateral flow test to detect

serum Amyloid A.

S epsis is a serious medical condition, and newborns in Low- and Middle-Income Countries (LMICs) are
particularly vulnerable. Uganda has one of the highest rates of neonatal sepsis deaths in the world at 17
neonatal deaths per day. Such high mortality rates are largely due to the absence of suitable biomarkers and
diagnostic systems to enable early diagnosis. However, Serum Amyloid A (SAA) is emerging as a potential
standalone biomarker for the diagnosis of neonatal sepsis. SAA can be detected by laboratory-based tests
but these are often unavailable in LMICs.

To address these issues, in an ethically-approved study we deployed a competitive, lateral flow test
(NeoSep-SAATM; Accuplex Diagnostics Limited, Ireland) to semi-quantitatively detect SAA in whole blood
at patient-side in a LMIC. Our study assessed the performance of NeoSep-SAATM for neonatal sepsis
detection. NeoSep-SAATM showed a sensitivity and specificity of 92 % and 73 % with PPV and NPV of
0.78 and 0.90, respectively (n= 714) individuals; 95% CI). NeoSep-SAATM significantly out-performed the
currently-available gold-standard biomarker, C-Reactive Protein, for neonatal sepsis detection (P < 0.0001,
95% CI). This study demonstrates NeoSep-SAATM can successfully detect sepsis and potentially enable a
rapid decision to initiate antibiotic therapy to improve neonatal mortality incidence.
Biography

Julia Nowak studied Biological and Biomedical Sciences at Maynooth University, Ireland and graduated in 2022. She
then joined the Science Foundation Ireland- funded research group led by Prof. Sean Doyle at Maynooth University
collaborating with Makerere University in Kampala, Uganda working on the NeoSepsis Project. Together, the research
group won a prize of 1 million Euro as part of a competitive project scheme funded by Science Foundation Ireland.
The NeoSepsis team is working on delivering a SAA-detecting lateral flow test to Ugandan healthcare systems to aid
in neonatal sepsis diagnosis.

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Infection 2024

Kathleen Maguire1*, Elizabeth Hastie2, Ahmed Shabaik3, Anne

Cowell2
1
Internal Medicine, UCSD, San Diego, CA, United States
2
Infectious Disease Department, UCSD, San Diego, CA, United States
3
Pathology Department, UCSD, San Diego, CA, United States

Peritoneal coccidioidomycosis presenting as treatment resistant

tuberculosis

W e present a case of peritoneal coccidioidomycosis in an immunocompetent female patient initially

diagnosed with tuberculosis at an outside hospital who presented with suspected RIPE therapy
failure. She presented with a history of recurrent ascites, headaches, and shortness of breath. She underwent
bronchoscopy, paracentesis, and lumbar puncture, which respectively revealed hilar lymph node aspirate,
peritoneal fluid, and cerebrospinal fluid, all positive for Coccidioides and negative for Tuberculosis.
Extrapulmonary or disseminated coccidioidomycosis occurs only in approximately 1% of patients and
typically involves the skin, bone, or meninges. This case underscores the importance of reconsidering the
diagnosis in patients who have seemingly failed RIPE therapy in regions where Coccidioides is endemic.
Accurate diagnosis and appropriate antifungal therapy led to inpatient treatment with amphotericin B and
plan for indefinite fluconazole and outpatient ID follow up after discharge. Unfortunately, the patient was
lost to follow up. Overall, this case contributes to existing literature by highlighting diagnostic challenges
and the importance of broadening the differential in endemic regions when treatment is not leading to
symptom resolution.

Audience Take Away Notes

• Recognize diagnostic challenges in cases of disseminated fungal infections, especially in areas where
multiple fungi are endemic
• Review immune markers thought to play a role in coccidioidomycosis susceptibility and pregnancy as
an immunocompromising state
• Discuss treatment of coccidiomycosis and important labs to monitor
Biography

Dr. Maguire received her M.S. in Biology at University of California, San Diego in 2016. She received her M.D. in 2021 at
the same institution. She continued her training in Internal Medicine at UCSD and will complete her residency training
in June 2024.

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Infection 2024

Khalid Al Balushi1*, Zaaima AL Jabri2

1
Senior medical student, College of Medicine and Health Sciences, Sultan Qaboos
University, Muscat, AL-Khoudh, Oman
2
Assistant professor, Department of microbiology and Immunology, College of
Medicine and Health Sciences, Sultan Qaboos University, Muscat, AL-Khoudh,
Oman

Prevalence of co-infections among hospitalized patients with COVID-19

at a Tertiary-Care Hospital, Muscat, Oman: A retrospective study
Objectives and Rationale: This study aims to investigate the prevalence, demographics, and risks of co-
infections among hospitalized patients at Sultan Qaboos University Hospital (SQUH); a tertiary-care
hospital in Muscat, Oman.

Aim: This study aims to identify the most common etiologies of co-infections and the associated pathogens
in coronavirus disease 2019 (COVID-19) patients admitted to Sultan Qaboos University hospital (SQUH). In
addition, it aims to assess the risk factors and the empirical antimicrobial therapy prescribed during their
admission.

Methods: A 2-year retrospective cohort study that included a total of 2000 adult patients admitted with
moderate to severe COVID-19 and associated with the presence of co-infection at SQUH from January
2020 to December 2021. All the clinical and demographic data were provided by the electronic medical
record. The data were analyzed using the Statistical Package for Social Science Software Version 23 (SPSS).

Results: Out of the 150 co-infected COVID-19 patients, Respiratory pathogens predominated. Bacterial
etiologies were the most common; including Klebsiella pneumonia (19%) which was the leading pathogen to
cause bacterial co-infections, followed by Pseudomonas aeruginosa (14%) and MRSA (11%). Fungal etiologies
were also common and were mostly caused by candida species. Viruses affected 9% of COVID patients and
were mostly caused by Rhinovirus, followed by Adenovirus. There is an association between co-infections
and the prevalence of older age groups (>50), and ventilation usage (all types of ventilation). More than two-
third of the patients were males. The most common empirical antibiotic used was ceftriaxone, followed by
Azithromycin and meropenem.

Conclusion: The most common co-infection associated with COVID are bacterial, followed by fungal and,
to a lesser extent, viral co-infection. This could help direct the treatment and management of COVID-19 by
improving modifiable risk factors that can predispose to these co-infections. Co-infections are common
and severe, particularly in ventilated patients who require special attention.

Keywords: Co-infections, COVID-19, Ventilation, Comorbidities, Antibiotics, Management.

Audience Take Away Notes

• Audience will learn through understanding how antibiotics should be used cautiously in such situation,
as bacteria is no the only onanism that co-occurs with COVID-19
• As doctors, they will use the antibiotics cautiously in such infections
• Having an idea about what specific organism might be causing the co-infection with COVID-19
• By involving large centers, this research has the potential to be expanded for further understanding

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Infection 2024

Biography

Khalid Al Balushi is a senior medical student at Sultan Qaboos (SQU) University, he graduated high school from
Huntington high school in the US and is now working with Dr. Zaeema from the microbiology department on Infectious
diseases researches. He already published a Narrative review about a Immunotherapeutic drug called Tebentafusp that
is used in Uveal melanoma, currently is involved in researches about Infectious diseases at SQU.

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Infection 2024

Kristine Mae D. Barredo, MD, MPH

Department of Pediatrics, Zamboanga City Medical Center, Zamboanga City,
Zamboanga del Sur, Philippines

Epidemiological and clinical features of COVID-19 among the pediatric

patients admitted in the Zamboanga City Medical Center and other
facilities handling Covid patients
Introduction: Defining the epidemiological and clinical features of COVID in pediatric patients can aid in
the control of spread and improve the curative rate.

Objectives: This study determined the epidemiological and clinical characteristics of COVID confirmed
children admitted at Zamboanga City Medical Center and other facilities handling COVID-19 patients.

Methodology: This is a descriptive study among RT-PCR confirmed COVID-19 children, less than 18 years,
who were admitted at ZCMC and other facilities handling COVID patients from March 2020 to September
2021. The outcome included the incidence and survival rates. The variables studied included demographic
data, clinical status, clinical symptoms, complications, treatment done, and clinical outcome. Data entry
was performed and was analyzed using counts or frequencies and percentages.

Results: A total of 2,025 patients were admitted to hospitals (n=141, 7%) and quarantine facilities (n=1884,
93%) within Zamboanga City. 72 out of the 141 respondents were admitted to Zamboanga City Medical
Center, the apex tertiary hospital in the region. The mean age of the respondents was 9.94±5.78 years old.

Six hundred seventy-six (33.3%) were considered as direct contacts of index cases. Two hundred ninety-
nine (14.76%) were symptomatic, with fever (66.1%) as the most common symptom. One hundred forty-
one (6.9%) were admitted to hospitals, while the remaining 1,844 (91.05%) were admitted to quarantine
facilities. Most patients (44.7%) were classified with moderate COVID. However, there were 23 (1.13%)
deaths reported. Majority (66.7%) did not necessitate oxygen support. Nevertheless, 67.7% received IV
antibiotics – most commonly Ceftriaxone (49, 52.17%) and Gentamycin (21, 22.34%).

Conclusion and Recommendation: While COVID-19 infection in the pediatric age group was generally mild
with low mortality rates, infections in this age group should not be overlooked. With the emergence of
more virulent variants and with many unvaccinated, the pediatric population continuous to be a vulnerable
group that requires special attention.

Audience Take Away Notes

• Many may consider COVID-19 now as a thing of the past. However, the threat continues as more
virulent variants are emerging. With this presentation, the audience will have an additional insight on
the epidemiological features and clinical presentation of COVID- 19 in children. They will also learn
how these children were treated, and their outcome, despite being in a province of a third world
country
• Though COVID-19 infection is generally mild in the children population, it should always be
considered as a diagnosis as its clinical presentation is vast and erratic. In addition, having data on

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Infection 2024

the epidemiological and clinical features of COVID-19 can help administrations/offices assessing the
health of the community and amending their policies on the control of spread and treatment of this
infection
• COVID-19 is a relatively new disease; and with the emerging virulent variants and its varying
presentations, further research on the treatment, management, and its complications will be of great
help in combating and controlling this disease. In addition, with the advent of COVID vaccination in
children, further studies may also compare the disease course between the vaccinated and unvaccinated
children
• This does not provide a practical solution to a problem that could simplify or make a designer’s job
more efficient
• This study can be used as a benchmark for similar studies
Biography

Dr. Kristine Mae D. Barredo is a graduate of Doctor of Medicine at the Ateneo de Zamboanga University, Philippines
in 2016. The year after, she received her Masters in Public Health at the same institution. Thereafter, she went into
her pediatric residency training at Zamboanga City Medical Center and graduated last April 2023. She is currently
working at the same institution as a junior consultant, and as a part-time instructor at her alma mater, the Ateneo de
Zamboanga University.

239
Infection 2024

Lauren Panny*, Ashley Piper, Christina Gardner, Crystal Burke

Division of Virology, US Army Medical Research Institute of Infectious Diseases,
Frederick, MD, United States

Improved techniques for validation of inactivated virus and RNA of

positive sense RNA viruses for containment research

A lphaviruses, such as Eastern Equine Encephalitis Virus (EEEV), are genetically encoded by a single
positive sense RNA genome. Following glycoprotein-assisted entry into the cells, fusion with the
endosomal membrane, and capsid release, translation of the non-structural proteins is rapidly initiated
by the host cell ribosome. With initiation of viral replication being driven by the host cell, functional
alphavirus RNA that successfully enters a permissive host cell can result in production of progeny virions.
This presents a challenge when there is a desire to remove samples from containment spaces as proof of
viral RNA inactivation is required in addition to inactivation of infectious virus. Many laboratories validate
inactivation of alphavirus RNA by merely adding the viral RNA to a media overlay on cells. However, this
methodology does not provide entry of the RNA into cells where replication occurs, therefore, it does
not validate that the RNA is inactivated rather that the RNA is not entering into cells. Alphaviruses are
responsible for numerous severe human diseases that can cause neurological complications (new world
alphaviruses) or debilitating arthritis (old world alphaviruses). Therefore, it is essential from both a
biodefense and public health perspective to validate that viral RNA present in samples removed from the
containment environment is inactivated and unable to produce infectious virions. The research proposed
in this abstract aims to demonstrate these points using methods that ensure viral RNA enters into cells
during a series of experiments aimed at validating inactivation of EEEV RNA by chemical means.

Audience Take Away Notes

• The audience will learn how to best validate the inactivation of RNA from positive sense RNA viruses.
This knowledge will help better mediate the removal of potentially infectious genomic material from
laboratory facilities. This knowledge will help scientists ensure the safety and mediation of infectious
viral pathogens
Biography

Dr. Panny received her B.S. in General Biology in 2015 while researching in Dr. David Donze’s genetics laboratory. She
then worked at clinical research organizations performing biopharmaceutical testing for 2 years. Dr. Panny received
her PhD degree and graduate certificate in public health at Virginia Polytechnical Institute in 2023 while researching
Venezuelan equine encephalitis virus under Dr. Kylene Kehn-Hall. Currently, Dr. Panny is working as a postdoctoral
fellow funded by the National Research Council. Her research is performed at the US Army Medical Research Institute
of Infectious Disease where she works with numerous viral pathogens under the mentorship of Dr. Crystal Burke.

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Infection 2024

L. Gounder1,2*, M Pillay1,2, S Manyana1, S Govender1, A Khan1,2, K

Francois1,2, P. Moodley1,2, N. Msomi1,2, K. Govender2, R Parboosing2,3,
K Naidoo4, B Chimukangara2,4,5
1
Department of Virology, National Health Laboratory Service, Inkosi Albert
Luthuli Central Hospital, Durban, South Africa
2
School of Laboratory Medicine and Medical Science, University of KwaZulu-
Natal, Durban, South Africa

3
School of Pathology, University of Witwatersrand & National Health Laboratory Service, Johannesburg,
South Africa
4
Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
5
Critical Care Medicine Department, NIH Clinical Center, Bethesda, Maryland, United States

Assessing HIV-1 drug resistance in patients with virological failure amid

the rollout of dolutegravir in hyperendemic Kwazulu-Natal, South Africa
Background: HIV Drug Resistance (HIVDR) remains a major threat to achieving sustainable viral suppression
in patients on Antiretroviral Therapy (ART). In South Africa, since its rollout in December 2019, Dolutegravir
(DTG) has been the preferred ART backbone.

Methods: We curated HIVDR genotypic data obtained from the National Health Laboratory Service (NHLS)
for ART-experienced patients with virological failure (i.e., consecutive viral loads ≥1,000 copies/mL)
receiving HIV care at public-sector healthcare facilities in KwaZulu-Natal (KZN), South Africa. We estimated
the levels of HIVDR from genotypes collected between January 2020 and June 2022, and assessed temporal
trends in HIVDR across 11 districts of KZN following DTG-rollout in South Africa.

Results: Of the 2,380 genotypes curated, 2,049 (86.1% CI 84.6–87.5) had HIVDR mutations, with most
resistance mutations occurring among adult females aged >19 years, (p=0.01). Protease inhibitor (PI)-
specific mutations were present in one-third of genotypes, including 671 (28.2%) with additional resistance
to nucleoside, and non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations. Only 39 genotypes
had integrase resistance data, 9 (23.1%) of which had intermediate to high levels of resistance to DTG.
Overall, compared with densely populated peri-urban and urban districts, rural districts had fewer HIVDR
genotypes (369/2380, 15.5%) but more HIVDR (86.4% CI 82.5–89.8).

Conclusions: Six out of seven genotypes from patients with virologic failure had HIVDR mutations despite
DTG-rollout, with persistent NNRTI resistance. Thus, while the introduction of DTG is expected to alleviate
the HIVDR burden, a sub-population of people may not fully benefit from DTG-use due to multi-drug
resistance, at which point PI-based ART may be warranted. There were higher proportions of HIVDR in
rural districts and among adult women, highlighting regions and individuals needing priority HIV care.
Overall, these findings urge the strengthening of HIV services in public healthcare systems to ensure
sustainable DTG-use in first-line and subsequent ART regimens.

Audience Take Away Notes

• Our research highlights the importance of monitoring trends in HIV drug resistance, especially during
programmatic changes in drug regimens. Such information is crucial in evaluating the success of HIV
treatment programmes, considering that expanded access to antiretroviral therapy has been suggested
as a strategy to eliminate HIV in South Africa
• Mapping the proportions of resistant patients at public-sector healthcare facilities in a hyperendemic

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Infection 2024

province in South Africa, provides a basis for targeted spatial health systems strengthening, particularly
in rural areas
• We describe HIV-1 drug resistance mutations to integrase strand transfer inhibitors, thus adding to
the growing body of knowledge on dolutegravir-related resistance. This knowledge is valuable to
scientists, clinicians, pharmacists and policymakers for planning interventions and optimizing service
delivery in sub-Saharan Africa
Biography

Dr. Lilishia Gounder is a South African clinical virologist and an emerging researcher whose interests include HIV
drug resistance, geospatial analysis, and data science. She is currently in her 3rd year of PhD training, which focuses
on monitoring and analysing HIV drug resistance in the province of KwaZulu-Natal, South Africa, the epicentre of the
HIV pandemic.

242
Infection 2024

Dr. Luis F. Vargas Garcia1*, Dr. Angelina Espino Barros Palau2, Dr.
Marcos Ibarra Flores3
1
Department of Neuro-Infectious Diseases, Hospital Christus Muguerza Alta
Especialidad/Monterrey, Nuevo Leon, Mexico
2
Department or Neuro-Ophthalmology, Hospital Zambrano Hellion, San Pedro,
Nuevo Leon, Mexico
3
Department or Cardiology, Hospital Zambrano Hellion, San Pedro, Nuevo Leon,
Mexico

Diseminated lyme disease: A rare presentation of bilateral optic neuritis

and sinus bradycardia without any conduction defects

L yme disease (Lyme borreliosis) is a multisystem zoonotic disease caused by the spirochete Borrelia
burgdorferi. Individuals without treatment may progress to a disseminated stage having cardiac,
neurological or another systemic manifestations. We present a rare case of a 40-year-old white woman
from Monterrey, Mexico without medical history. She presented to the emergency department with
progressive onset of bilateral vision loss, headache and tingling/numbness of her bilateral lower and upper
extremities. She also reported episodes of sudden loss of consciousness for 8 weeks. In the emergency
room, sinus bradycardia without evident metabolic alterations is detected and dilated fundus exam
demonstrated bilateral optic head edema, hyperemia, and optic nerve elevation. After extensive workup
and ruling out other neurological and cardiac alterations, she was diagnosed with Lyme Disease with
elevated serum IgM antibodies of 30.55 UR/mL (reference 0.00- 22), and the Western blot was positive
for serum IgM Lyme antibodies but negative for IgG antibodies. More specifically, 2 bands (P21 IgM and
P25[Osp C] IgM) were positive in addition to the positive Western blot, which fulfilled the Centers for
Disease Control and Prevention (CDC) recommendation for a positive Lyme test. Due to the persistence of
symptoms a lumbar puncture was performed, and showed normal opening pressure; glucose and protein
levels were within normal limits but there was mild Cerebrospinal Fluid (CSF) pleocytosis with lymphocyte
predominance. She was treated with doxycycline for 2 weeks. She was discharged home in stable condition
with outpatient neuro- ophthalmology and cardiology follow-up.

Audience Take Away Notes

• Increase awareness to include Lyme disease in the differential diagnosis of optic neuritis
• This research could be used among clinicians to expand their research or teaching about zoonotic
infections and their diverse clinical manifestations
• Learning about this case could simplify or make a clinician job more efficient by speeding the diagnosis
of Lyme disease and prevent complications
Biography

Dr. Vargas studied Medicine at the Universidad de Monterrey, Mexico and graduated in 2010. He then joined the
Internal Medicine Residency at the Hospital Christus Muguerza Alta Especialidad in Mexico and graduated in 2014.
After 2 years he received his degree as Infectious Diseases M.D in Guadalajara, Mexico and in 2017, after one year of
medical fellowship he obtained the degree of Neuro-infectiologist by the Universidad Autonoma de Mexico, one the
most prestigious Universities in the country. He has published case reports as well as original researches in the field
of Infections of the CNS in local and international journals.

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Infection 2024

Dr. Maria Aguilar Amaya*, Kenneth Rocko Cook

Southwest Interdisciplinary Research Center, Arizona State University, Phoenix,
Arizona, United States

Advancing sexual health education: A methodological triangulation in the

development and impact of the DISH-AZ academic detailing program

D uring this poster presentation, the presenter will discuss the development of the Academic Detailing
(AD) DISH-AZ (Detailing for Improved Sexual Health in Arizona) program and will explain the
methodological triangulation approach that is being used in Arizona. By employing a methodological
triangulation approach consisting of academics, a provider/healthcare staff, and public health experts,
the DISH-AZ program offers invaluable benefits for enhancing the quality and effectiveness of academic
detailing to connect, educate, and support better health outcomes for LGBTQ+ patients and people living
with HIV (PLWH), while also providing a more comprehensive understanding of healthcare topics. This
approach not only increases the credibility of the information presented but also allows for tailored
educational strategies that address the diverse needs and preferences of the target audience. Furthermore,
methodological triangulation enables the cross-validation of key messages and recommendations,
reinforcing their validity and relevance. Ultimately, this collaborative and multidisciplinary approach
fosters innovation, promotes evidence-based practice, and contributes to improved healthcare delivery
and patient outcomes.

The presenter will also discuss the methodology used for whole clinic assessment and pathways for AD
sessions in order to meet the needs of the entire clinic. DISH-AZ uses AD strategies to address the gaps in
knowledge and methods to assist healthcare staff to improve equity in patient care, especially for LGBTQ+
patients and PLWH, through comprehensive clinic-wide connection, education, and support. DISH-AZ
is an AD program launched in 2021 by Arizona State University (ASU) in collaboration with the Arizona
Department of Health Services (ADHS). Targeting health care staff caring for individuals living with and
at risk for HIV, DISH-AZ emphasizes a holistic approach to improve care and patient outcomes using AD
sessions to promote evidence-based and status neutral practices. In 2023, 250 sessions were held with 144
providers in Arizona and Nevada and 18 group presentations had 500+ attendees. The strategy involves
developing programs and education with a status-neutral and pleasure-based biomedical approach,
addressing outreach methods, protocols, and clinical practices. Lastly, while the focus of the program has
been on status neutral approaches and practices, Pre-Exposure Prophylaxis (PrEP) and non- occupational
Post Exposure Prophylaxis (nPep) to prevent HIV transmission, Rapid Start implementation for rapid
initiation of antiretroviral therapy for persons diagnosed with HIV, hepatitis C treatment, and drug user
health, since then, the program has expanded to include other topics such as mpox, gender-expansive care,
and syphilis. The DISH-AZ Academic Detailers have expertise from each of the focus topics as well as lived
experiences, which has proven to be impactful when establishing credibility with physicians and clinical
staff. The lived experiences of our Academic Detailers enrich the educational exchange between detailers
and physicians and their staff, leading to more meaningful discussions, enhanced learning outcomes and
ultimately, improved patient care.

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Infection 2024

Audience Take Away Notes

• The development and methodology of the DISH-AZ (Detailing for Improved Sexual Health in Arizona)
academic detailing program, including the utilization of methodological triangulation involving
academics, providers/healthcare staff, and public health experts

• The benefits of employing a methodological triangulation approach to academic detailing, such as

enhancing the quality and effectiveness of educational interventions for LGBTQ+ and people living
with HIV (PLWH) and providing a more comprehensive understanding of healthcare topics

• The significance of tailored educational strategies that address the diverse needs and preferences
of the target audience, resulting from the collaborative efforts of academics, physicians, and public
health experts

• The impact of the DISH-AZ program on healthcare delivery and patient outcomes, demonstrated
through the number of sessions conducted, the range of topics covered and the expertise and lived
experiences of the academic detailers involved in the program
Biography

Dr. Maria Aguilar-Amaya is Director of the Office of Evaluation and Partner Contracts and at Arizona State University,
Southwest Interdisciplinary Research Center (SIRC). She is Faculty Associate in the School of Social Work. Her current
research focuses on health equity using community-based participatory research. Previous research focused on
substance use/abuse and recidivism. She is a bilingual and bicultural researcher; a citizen of Mexico and the USA with
ancestral roots from Apache and Tarasco tribes in Mexico. She received her MA (2005) and doctorate degree (2013)
from the University of Phoenix (AZ, USA) in Organizational Management and Leadership.

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Infection 2024

Jacqueline de Aguiar Barros1,3, Fabiana Granja2,3, Daniel da Silva

e Silva2, Arthur Camurca Cito4, Cassio Peterka5, Maria de Fatima
Ferreira da Cruz6,7*
1
Nucleo de Controle da Malaria/Departamento de Vigilancia Epidemiologica
2
Coordenacao Geral de Vigilância em Saude/SESAU- RR, Roraima, Brazil
3
Centro de Estudos da Biodiversidade, Universidade Federal de Roraima (UFRR),
Roraima, Brazil

4
Programa de Pos-Graduacao em Biodiversidade e Biotecnologia da Rede BIONORTE (PPG-BIONORTE),
Roraima, Brazil. Nucleo de Apoio a Pesquisa em Roraima (NAPRR) do Instituto Nacional de Pesquisas da
Amazonia (INPA), Roraima, Brazil
5
Secretaria de Vigilancia em Saude e Ambiente, Ministerio da Saude, Brasília, Brazil. Coordenacao de
Eliminacao de Malaria
6
Laboratorio de Pesquisas em Malária/Malaria Research Laboratory, Instituto Oswaldo Cruz, Fundacao
Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil, Centro de Pesquisa, Diagnostico e Treinamento em Malaria
(CPD-Mal)
7
Reference Center for Malaria in the Extra-Amazonian Region of the Brazilian Ministry of Health, Fiocruz,
Rio de Janeiro, Brazil

A snapshot of a representative Brazilian state of illegal mining in

indigenous areas during the era of malaria elimination

M alaria is a public health problem and the cases diagnosed in the capital of Roraima have the potential to
characterize the burden of the disease in the state. This study aimed to describe the epidemiological,
clinical and laboratory aspects of malaria cases diagnosed in Boa Vista. For this purpose, a descriptive,
cross-sectional study was carried out in two health units in the city, with individuals diagnosed with
malaria and who agreed to respond to the questionnaire. Of the total of 206 participants, 96.1% (198)
reported gold mining activity, characterized as men, mixed race and young. Of the group of miners, 66.2%
(131) came from other states of Brazil or other countries. The mines were mainly located in the Yanomami
Indigenous Territory in Roraima. P. vivax infection occurred in 74.3% (153) of participants. In the miner’s
group, there were reports of hospitalizations for severe malaria, reports of previous episodes of malaria
and delays in treatment after the onset of symptoms. Although 73.2% (145) of miners reported knowing
how malaria was transmitted, only 54% (107) took precautions with mosquito nets or repellents. The use
of Artecom® and chloroquine was reported by miners as a way of relieving symptoms before returning
to work, which highlights the importance of molecular surveillance of antimalarial resistance. Miners are
considered a vulnerable population and impact to perpetuate malaria in Roraima. Therefore, access to
diagnosis and treatment in gold mining areas and integrated surveillance of this population's mobility
routes are important strategies to achieve the goal of eliminating malaria in the state.

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Infection 2024

Michele de Leon Jauregui1*, MD; Melanie Rosado2*, MD; Lauren

Lajos3, MD
1
Department of Pediatrics and Department of Psychiatry, University of Utah, Salt
Lake City, Utah, United States
2
Department of Pediatrics and Department of Internal Medicine, University of
Utah, Salt Lake City, Utah, United States
3
Department of Pediatrics and Department of Pediatric Infectious Disease,
University of Utah, Salt Lake City, United States

Use of intravenous immunoglobulin in neonatal enteroviral sepsis

A 4-day-old term infant with a low EOS risk score originally presented to the ED with six hours of lethargy
and poor feeding. Initial work-up was demonstrated acute liver failure (PT/INR 18.5, ALT>90, AST>300),
hypoglycemia, hyperferritinemia (ferritin >44,000), severe thrombocytopenia, and hypoxia concerning for
enteroviral sepsis. Her hospitalization was complicated by hyperinsulinemia, hypoxic respiratory failure,
severe pulmonary hypertension, and decreased systolic biventricular function (concerning for myocarditis).
The patient required mechanical ventilation as well as vasoactive support with epinephrine and milrinone.

Management of her severe enteroviral sepsis was primarily supportive; however, the patient was initially
treated with 2 g IVIG. Existing literature demonstrates some level of evidence in favor of using IVIG for
the treatment of severe enterovirus infection. Despite her complications, the patient showed remarkable
improvement after treatment with IVIG. At time of discharge, she was tolerating enteral feeds and was
weaned off both heart failure therapies and sildenafil. Her echocardiogram showed mildly diminished
systolic function and mild mitral valve regurgitation.

This case presentation will further contribute to the literature addressing the utility IVIG use in neonates
with enterovirus infection. We aim to complete a comprehensive literature review and identify the most
recent evidence and consensus on guidelines about the use of IVIG in the fetus and neonate.

Audience Take Away Notes

• This case expands on the current limited evidence about the utility of IVIG in neonatal enteroviral
sepsis
• This case reviews a broad spectrum of clinical syndromes associated with enterovirus
• The literature review aims to provide the most recent evidence and consensus on guidelines about the
use of IVIG in infants
Biography

Dr. Michele de Leon Jauregui graduated in 2011 from the University of Utah with degrees in Chemistry and Psychology.
She earned her Doctor of Medicine at Rush University. She is currently a third year Triple Board Resident (pediatrics,
psychiatry, and child psychiatry) at the University of Utah. She has presented at multiple conferences and published in
both psychiatric and pediatric journals.

Dr. Melanie Rosado graduated in 2012 from the University of Michigan with a degree in Psychology. She completed
her Doctor of Medicine at Rush University. She is currently a second year Internal Medicine and Pediatrics resident at
the University of Utah. Her current interests include heart failure, cardiogenic shock, clinical reasoning, and intensive
care. Dr. Rosado has presented at the Society of General Internal Medicine and has published in the journal, Pediatrics.

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Infection 2024

Nikki Kasal1*, BA; Samantha Devlin2, MS; Amy K. Johnson3, PhD,

MSW; Alicia Dawdani2, BS; Ososese E. Enaholo3, MPH; Geoffroy
Liegeon2, MD, PhD; Maria Pyra4, MPH, PhD; Lisa R. Hirschhorn4,
MD, MPH; Sadia Haider5, MD, MPH; Kelly Ducheny6, PsyD, DrPh;
Jodi Simon7, MS; Jessica Ridgway2, MD, MS
The University of Chicago Pritzker School of Medicine, Chicago, IL, United
1

States

2
Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago,
Chicago, IL, United States
3
The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie
Children’s Hospital of Chicago, Chicago, IL, United States
4
Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago,
IL, United States
5
Division of Family Planning, Rush University, Chicago, IL, United States
6
Howard Brown Health, Chicago, IL, United States
7
AllianceChicago, Chicago, IL, United States

Designing a Pre-Exposure Prophylaxis (PrEP) training for providers to

increase PrEP awareness and prescription for black cisgender women
Background: Awareness and uptake of HIV Pre-Exposure Prophylaxis (PrEP) remains low among Black/
African American cisgender women at risk for HIV acquisition. Primary care appointments present
a valuable opportunity for introducing PrEP to clients; however, Primary Care Providers (PCPs) report
minimal comfort level and low familiarity with PrEP. Ensuring PCPs are properly trained on PrEP is crucial
as increased PrEP knowledge is associated with higher rates of PrEP prescription and future intent to
prescribe. We conducted focus groups with medical providers at Community Health Centers (CHCs) across
the Southern and Midwestern United States to identify themes informing the content, design, and delivery
of a PrEP provider education aiming to increase PrEP utilization among Black women.

Methods: Focus group discussions occurred with providers at three healthcare organizations in the
Midwest and South from August 2022 to February 2023. Providers were asked for input on content and
design of provider education regarding PrEP and feedback on preliminary visuals and case scenarios.
Transcripts underwent rapid qualitative content analysis using the Stanford Lightning Report Method via
Dedoose software. Emergent themes were identified and presented under the domains of the Consolidated
Framework for Implementation Research (CFIR).

Results: 10 providers (n=10) completed four focus groups. Themes emerged related to the individual
characteristics of providers (limited PrEP knowledge, low comfort initiating PrEP discussions), the
outer setting of client needs (perceptions of provider bias in identifying women who are at risk for HIV,
varying levels of HIV risk self-perception), and attributes of the inner setting (need for support from the
implementing center). Key opportunities were identified to maximize the benefit of training material,
design, and delivery (i.e., developing specific case scenarios to enhance providers’ cultural competency
with Black women and their overall knowledge regarding PrEP).

Conclusion: A comprehensive PrEP training for providers should feature a combination of didactic material
and interactive role-plays to equip providers with knowledge relevant to PrEP prescription for women
while building their comfort initiating PrEP discussions with clients. Centers should implement effective
and sustainable initiatives to support providers in prescribing PrEP following training completion, such as
sharing updated PrEP guidelines and creating quick reference guides.

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Infection 2024

Audience Take Away Notes

• Our findings contribute to existing literature indicating comfort discussing sexual health and PrEP as
a key training need among primary care providers in the United States. In particular, our research is
valuable for primary care providers looking to gain self-efficacy with discussing and prescribing PrEP,
particularly for cisgender women, as this work will contribute to our research team’s development
of a comprehensive PrEP educational training consisting of a combination of didactic and interactive
material. We believe this training will play a role in bridging inequities in PrEP distribution in the United
States by increasing provider PrEP knowledge and confidence and, subsequently, PrEP awareness and
uptake among Black cisgender women
Biography

Nikki Kasal received her Bachelor of Arts in Biological Sciences from the University of Chicago in 2021. She currently
attends the University of Chicago Pritzker School of Medicine and will receive her MD in 2026.Dr. Melanie Rosado
graduated in 2012 from the University of Michigan with a degree in Psychology. She completed her Doctor of Medicine
at Rush University. She is currently a second year Internal Medicine and Pediatrics resident at the University of Utah.
Her current interests include heart failure, cardiogenic shock, clinical reasoning, and intensive care. Dr. Rosado has
presented at the Society of General Internal Medicine and has published in the journal, Pediatrics.

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Infection 2024

Antonio Antela1, Pere Domingo Pedrol2*, Francisco Mariano Jover

Diaz3, Javier Martinez Sanz4
1
Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
2
Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, Spain
3
Hospital Clinico Universitario de San Juan, Alicante, Spain
4
Hospital Ramon y Cajal, Madrid, Spain

Does switching from triple (or quadruple)-drug regimen to double-drug

regimen with oral INSTIs reduce Drug-Related Adverse Events (DRAES)
and toxicity in virologically suppressed people with HIV? Satisfaction
study
Background: Triple- or quadruple Drug Regimens (3 or 4DR) remain the gold standard for HIV treatment.
However, there is currently a trend towards a reduction in the number of drugs from 3 or 4DR to Double-
Drug Regimens (2DR) based on Integrase Strand Transfer Inhibitors (INSTIs). Switching to 2DR is not based
on increased efficacy, as studies suggest non-inferiority of 2DR, but aims to reduce adverse events and
long-term toxicity associated with prolonged exposure to current antiretroviral drugs. However, to date,
neither clinical trials nor real-world data have confirmed this hypothesis.

This study aims to describe the proportion of DRAEs reported in phase III and IV studies in virologically
suppressed people with HIV (PWH) on 3 or 4DR and those who have switched from 3 or 4DR to 2DR with
second-generation oral INSTIs at ≥ 48 weeks.

Methods: A systematic literature review was conducted, searching the main databases (PubMed,
ClinicalTrials.gov, EU Clinical Trials Register, Cochrane, and Embase) from March 2014 to March 2024 and
the main conferences from March 2022 to March 2024. We included phase III clinical trials and phase
IV studies evaluating the switch from 3DR or 4DR to 2DR based on oral second-generation INSTIs in
virologically suppressed PWH, with ≥ 48 weeks of follow-up.

Results: Nine publications met the inclusion criteria. Eight publications corresponded to three phase III
clinical trials (TANGO, SALSA and SWORD) at different follow-up periods and one to a phase IV study
(DOLAM), with a 48-week follow-up.

The percentage of DRAEs and DRAEs leading to discontinuation increased in patients who switched to 2DR
([6-20%] and [2-4%], respectively) compared to those who remained in 3DR or 4DR ([0-6%] and [0-1%])
at 48 weeks in all studies analyzed (Figure 1). A similar trend was observed with longer follow-up times.
Differences observed in laboratory parameters when switching from 3DR or 4DR to 2DR were not clinically
relevant.

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Conclusions: Therapy simplification from 3DR or 4DR to 2DR with oral second-generation INSTIs in
virologically suppressed PWH at ≥ 48 week did not enhance the safety and tolerability profile compared
with 3DR or 4DR continuation, according to data reported in phase III clinical trials and phase IV studies.

Financial support: Gilead Sciences

Audience Take Away Notes

• The audience will gain a comprehensive understanding of the safety and tolerability profile of switching
from complex (3- or 4-drug regimens) to a reduced double therapy using oral second-generation
INSTIs in virologically suppressed patients with HIV
• This knowledge will help clinicians in making informed decisions regarding treatment strategies for
virologically suppressed patients
• This systematic review serves as a resource for other researchers and clinicians in the field of HIV
treatment. It provides a basis for further research on optimizing treatment regimens and understanding
patient outcomes
• These findings may contribute to refining treatment guidelines and protocols, leading to more effective
and safer management strategies for HIV patients globally
• Yes, this study shown that the reduction in number of drugs from double to triple (or quadruple)
regimens did not enhance the safety and tolerability profile, contrary to prevailing belief
• Other benefits
o This SLR summarizes all currently available evidence related to switching therapy from triple (or
quadruple) drug regimen to dual drug regimen with oral INSTIs, which helps clinicians keep up to
date with the latest research
Biography

Dr. Pere Domingo Pedrol is an Internal Medicine specialist who graduated from the University of Barcelona. He is
currently the Director of the HIV/AIDS Program at the Infectious Diseases Unit of Hospital de la Santa Creu i Sant Pau
in Barcelona. Dr. Domingo has authored more than 800 scientific papers and 100 book chapters and has spoken at over
600 conferences. He reviews for more than 60 journals or serves on editorial boards. His research mainly focuses on
antiretroviral therapy and its complications, and he collaborates with the Spanish and European Medicines Agencies.

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Infection 2024

Preslava M. Hristova¹*, Alexandra S. Alexandrova2, Teodora

Bulgaranova1, Stefan Trifonov3, Hristina Y. Hitkova1, Biser K.
Borisov4
¹Department of Microbiology and Virology, Medical University, Pleven, Bulgaria
2
Department of Medical Microbiology, Medical University of Sofia, Bulgaria
3
Department of Anatomy, Histology, Cytology and Biology, Medical University,
Pleven, Bulgaria
4
Department of Nephrology and Dialysis, Medical University Pleven, Bulgaria

Catheter-related atlantibacter hermannii sepsis in a hemodialysis

patient
Background: Atlantibacter hermannii, previously known as Escherichia hermannii is a rare causative agent of
human infections. Several reports testify that the most frequently infected patients are immunosuppressed,
especially those undergoing hemodialysis.

Materials and Methods: A 34-year-old man with an end-stage renal disease complained of chills, fever
and general fatigue at the end of a regular hemodialysis session. The blood cultures were performed using
BD BACTECTM Plus Aerobic/F and BD BACTECTM Plus Anaerobic/F bottles incubated in BACTEC 9120
Blood Culture System. Semiquantitative (roll-plate) culture of a segment from the replaced catheter tip
was performed. The bacterial isolate was identified using Vitek 2 Compact. Verification of the automated
identification was performed using 16S sequencing. The antimicrobial susceptibility test was performed by
using ATS-N222 card on a Vitek 2 compact and minimum inhibitory concentrations were reported by the
system automatically.

Results: Physical examination demonstrated that the patient was febrile (39.2℃) with a normal pulse rate
(80/min) and arterial pressure (140/80 mm/Hg). The laboratory tests were as follow: white blood cells 7.2
x 109/l with 89% neutrophils, C-reactive protein 145 mg/l, hemoglobin 89.0 g/l, erythrocytes 2.7 x 1012/l,
hematocrit 0.28 l/l platelets 184 x 109/l and creatinine clearance < 5 mL/min. The echocardiographic
examination showed a vegetation located on the dialysis catheter in the right atrium. Empirical therapy
was initiated with intravenous gentamicin and after the isolation of the agent, the treatment was continued
with intravenous imipenem/cilastatin. The blood cultures and the tip of the replaced catheter were positive
for A. hermannii. The 16S sequence product was used to query the NCBI bacterial database and revealed
99.75% identity to that of A. hermannii strain CIP 103176 16S ribosomal RNA in the NCBI GenBank database.
The antimicrobial susceptibility results revealed resistance to aminopenicillins and susceptibility to all
other tested antimicrobials.

Conclusions: To our knowledge, this is the first report of catheter-related vegetation with echocardiographic
confirmation and the successful eradication of A. hermannii infection in a patient undergoing hemodialysis
with imipenem/cilastatin.

Key word: Hemodialysis, Atlantibacter Hermannii, Catheter-Related Bloodstream Infection.

Audience Take Away Notes

• The audience will learn more about the role of an unusual bacterial human pathogen called Atlantibacter
hermanii. The number of presented clinical cases associated with this bacterium is still limited. At
the same time, A. hermanii is involved in the pathogenesis of quite serious infections. The audience
will have a chance to study more about the methods in the bacterial diagnostic process, e.g. clinical,
echocardiographic, microbiological, genetic methods and to understand more about antimicrobial
susceptibility of A. hermanii

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Infection 2024

• Our work will help the audience in their job in the accurate clinical and microbiological diagnosis of
catheter-related A. hermanii sepsis and also in the treatment of the current bacteria
• This research could be used to expand the researches or teaching of other faculty
• This provides a particular solution in the treatment of catheter-related A. hermanii sepsis in patient
undergoing hemodialysis, using a successful antibiotic combination with imipenem/cilastatin
• It will improve the accuracy of a design and also will provide new information to assist in a design
problem
• Other benefits
o First report of catheter-related vegetation with echocardiographic confirmation
o First report of a successful eradication of A. hermannii infection with imipenem/cilastatin
Biography

Dr. Preslava Hristova studied Medicine at the Medical University-Pleven, Bulgaria and graduated as MD in 2015. She
then joined the Department of Microbiology and Virology, Medical University-Pleven as an Assistant professor and
also join the Microbiology laboratory at UMHAT “Dr. G. Stranski”, Pleven. In 2020 she has become specialist in Medical
Microbiology. She defended her PhD thesis in 2023 at Medical University-Sofia. In February 2024 she became a Senior
Assistant professor in the Department of Microbiology and Virology, Medical University-Pleven. She has published
more than 10 research articles in SCI(E) journals. Her scientific interests are associate with antimicrobial resistance,
vancomycin-resistant enterococci, unusual pathogens and gut microbiota.

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Infection 2024

Juat S. Abigail Kristine1, MD, MBA; Yu Quennie Bien Bien C1*, MD;
Y. Cheng Jasmine Clarisse1 MD; T. Ang Dean Kyle1, MD; Tolentino,
Kurt Bryan2, MD; V. Santos Suzanne3, MD
1
Department of Internal Medicine, St. Luke’s Medical Center - Global, Taguig City,
Metro Manila NCR, Philippines
2
Department of Endocrinology, St. Luke’s Medical Center - Global, Taguig City,
Metro Manila NCR, Philippines
3
Department of Infectious Diseases, St. Luke’s Medical Center - Global, Taguig
City, Metro Manila NCR, Philippines

Kluyvera cryocrescens central line associated bacteremia in a

hemodialysis patient: A case report and review of literature

K luyvera sp., an opportunistic Gram-negative bacillus found in clinical specimens such as sputum, urine,
bile, peritoneal fluid, and blood, rarely causes significant infections. This case report manages a rare
Kluyvera cryocrescens bacteremia in a female patient with chronic kidney disease due to IgA Nephropathy
undergoing hemodialysis, highlighting the critical recognition of rare pathogens in patients with complex
medical histories.

A 29-year-old female with end-stage kidney disease from IgA Nephropathy, polycystic ovary syndrome,
and hypertension presented with weakness, lightheadedness, and generalized tremors three days post-
hemodialysis. Despite the lack of fever or hemodynamic instability, symptoms such as weakness, malaise,
pleuritic chest pain, and pain at the IJ catheter site suggested a systemic infection. Blood cultures from
peripheral and central lines were obtained. Empiric therapy with Piperacillin-tazobactam was initiated.
The isolates were identified as Kluyvera cryocrescens, sensitive to the administered antibiotics, which
were therefore continued. The IJ catheter was temporarily removed and later re-inserted at a different
site. After clinical improvement, IV antibiotics were switched to oral Ciprofloxacin, resulting in symptom
resolution and the patient's stable discharge.

Kluyvera cryocrescens poses a risk for opportunistic infections in immunocompromised individuals. Though
this infection may be uncommon, documented cases reveal a spectrum of clinical presentations, such as
peritonitis, cholecystitis, wound infections, and complications related to indwelling devices. Our literature
review, supported by findings from the present case, highlights bacteremia in the context of indwelling
catheters as a notable risk factor. Empirical therapy, guided by the organism's susceptibility profile,
typically include extended-spectrum cephalosporins, carbapenems, fluoroquinolones, and tetracyclines.
Furthermore, this case emphasizes the importance of vigilance for infectious risks associated with
hemodialysis and indwelling catheters, advocating for a cautious approach in similar patient populations.

Audience Take Away Notes

• Our case will detail the antibiotic sensitivity profile of the rare pathogen Kluyvera cryocrescens, to
choose the most appropriate initial therapy, potentially leading to better patient outcomes
• This presentation will illustrate the clinical variability and potential outcomes of Kluyvera cryocrescens
infections through a review of case reports in adult humans
• The discussion will highlight the implications of underlying conditions and indwelling devices in
infection risk, particularly in hemodialysis patients
• The detailed case comparison can serve as a starting point for further research into the pathogenesis,
treatment, and prevention of Kluyvera cryocrescens infections, as well as antibiotic resistance patterns
• Educators can utilize these tables as teaching tools to demonstrate the complexity of treating infections
with variable antibiotic susceptibilities and the importance of considering individual patient histories
and comorbidities

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Infection 2024

Biography

Dr. Quennie studied Doctor of Medicine at University of the East Ramon Magsaysay Medical Center, Philippines and
graduated as MD in 2020. She then joined the Internal Medicine residency program at St. Luke's Medical Center,
Taguig City Philippines and is currently on her 3rd year the program.

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Infection 2024

Amna Ahli, MD; Reem al Saadi*, MD; Ady Assaf, MD

Internal Medicine Department, Medical Subspecialities institute, Cleveland clinic
Abu Dhabi, Abu Dhabi, United Arabs Emirates

Disseminated Echinococcus infection with Cardiopulmonary

involvement

O ur presentation is about a challenging case of a 28-year-old male, previously healthy and a

nonsmoker, from India and working as a security guard. He was referred to our facility for evaluation
of disseminated Echinococcus infection affecting the lung and heart, presenting with hemoptysis,
melena, unintentional weight loss, and cardiopulmonary symptoms. Diagnostic findings included positive
Echinococcus and Strongyloides antibodies, imaging revealing lung and cardiac masses, and pathology
confirming Echinococcus infection. Treatment involved a combination of albendazole and praziquantel
therapy, followed by successful surgical resection of cardiac and pulmonary lesions.
Audience Take Away Notes
• The clinical manifestations and diagnostic challenges of disseminated Echinococcus infection with
cardiopulmonary involvement
• The importance of a multidisciplinary approach involving medical, surgical, and pathology teams in
managing complex parasitic infections
• The role of imaging modalities, serological tests, and pathological analysis in establishing a definitive
diagnosis and guiding treatment decisions
• The efficacy of combined medical and surgical interventions in achieving favorable outcomes and
preventing disease recurrence
• The significance of long-term pharmacological therapy with albendazole in preventing relapse and
ensuring patient recovery
• Enhancing diagnostic acumen in identifying rare infectious diseases, particularly those with atypical
presentations
• Implementing a comprehensive treatment strategy involving pharmacotherapy and surgical
intervention for complex parasitic infections
• Improving patient care through interdisciplinary collaboration and tailored management plans
• Expanding research endeavors in tropical medicine and parasitology to explore innovative diagnostic
modalities and therapeutic interventions
• Providing practical solutions for clinicians encountering similar cases, thereby optimizing patient
outcomes and reducing morbidity associated with neglected tropical diseases
• In summary, our presentation offers valuable insights into the diagnosis, management, and treatment
outcomes of disseminated Echinococcus infection with cardiopulmonary involvement, equipping
healthcare professionals with the knowledge and tools necessary to address similar clinical challenges
effectively

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Infection 2024

Reem Alblooshi, MD
Cleveland Clinic Abu Dhabi, United Arab Emirates

When dengue disguises itself: Uncommon presentation resembling

hemophagocytic lymphohistiocytosis in a young adult

W e describe a case of a 24-year-old male who presented with fever associated with flu-like symptoms
that progressed to skin involvement with a diffuse erythematous and painful rash necessitating
inpatient admission for further management. His physical examination was notable for widespread
maculopapular rash of the trunk, upper and lower extremities as well as splenomegaly. Extensive
investigations were remarkable for elevated liver function tests, ferritin, lactate dehydrogenase, and a
peripheral smear revealing ovalocytes with reactive lymphocytes. Brucella antibodies but dengue and
cytomegalovirus antibodies were still pending during his inpatient stay. Other autoimmune and infectious
investigations and imaging were negative. Multidisciplinary discussions between Rheumatology,
Dermatology, and Haematology resulted in primary differentials of hemophagocytic lymphohistiocytosis
(HLH), drug eruption rash, and viral illness. He was started on methylprednisolone 80 mg, followed by a
gradual taper in light of the differentials. A bone marrow biopsy was scheduled but patient’s family declined
and he was discharged home. Upon follow-up two weeks post-discharge, the patient received a diagnosis
of dengue fever based on the identification of elevated IgM and IgG levels in the initial laboratory tests
conducted during the inpatient admission.
Biography

Reem Alblooshi, MD is an Internal Medicine Doctor who graduated from Internal Medicine Residency program at
Cleveland Clinic Abu Dhabi institution. She qualified from RAK Medical Health Science University. She then completed
her internship at Cleveland Clinic Abu Dhabi. She joined the same center for Internal Medicine residency program.
She worked as a junior internal medicine resident then senior resident. Dr. Alblooshi`s academic career includes a
number of publications in peer reviewed journals. She was an active member of the medical education community. She
is a member of American college of physician for internal medicine. She navigated the rigorous training, showcasing
exceptional diagnostic acumen and empathy. Her journey is marked by tireless nights, hands-on experience, and a
commitment to staying at the forefront of medical advancements.

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Infection 2024

Marcela Antonini1, Mario Vianna Vettore2, Anita Ogard Repal2,

Daniel de Macedo Rocha1, Karyanna Alves de Alencar Rocha1,
Henrique Ciabotti Elias1, Ana Luiza Carsoni Alves de Almeida1,
Marina Andreoli Trigo1, Julia Freitas Gomes1, Felipe Barufaldi3,
Rodrigo Carvalho Santana3, Elucir Gir1, Bruno Spire4, Renata
Karina Reis1*
University of Sao Paulo, Ribeirao Preto College of Nursing/General and
1

Specialized Nursing Department, Ribeirao Preto, Sao Paulo, Brazil

2
University of Agder/Department of Health and Nursing Sciences, Kristiansand, Vest-Agder, Norway
3
University of Sao Paulo, Ribeirao Preto Medical School/Department of Internal Medicine, Sao Paulo,
Brazil
4
Aix-Marseille Universite, Marseille, France

Patterns of chlamydia trachomatis and neisseria gonorrhoeae in

different anatomical sites among Pre-Exposure Prophylaxis (PrPE) users
in Brazil
Introduction: The presence of an untreated STI significantly increases the chance of acquiring HIV. In
Brazil, CT/NG testing among PrEP users is insufficient and syndromic treatment is a priority in clinical
practice. Multi-site testing for CT/NG improves screening of asymptomatic cases and timely treatment.
So, it’s essential for HIV prevention.

Objective: This study aimed to test the importance of multisite testing for better screening of these
pathogens and to test the presence of symptoms as an indicator for CT/NG infection.

Methods: This is a cross-sectional study carried out in four public infectious diseases clinics in the city of
Ribeirao Preto, São Paulo, Brazil between January 2022 and March 2023. All participants had an anal swab
and a first-pass or mid-stream urine collected for Chlamydia Trachomatis (CT) and Neisseria Gonorrhoeae
(NG) analysis by Polymerase Chain Reaction (PCR). Data about sociodemographic, sexual behavioural and
clinical aspects were collected. Pathway analysis was used to examine the direct and indirect relationships
between variables according to the theoretical model.

Results: We screened 171 PrEP users which had two samples collected (urine and anal swab), resulting
in 342 samples. Comparing the anatomic sites, the urine samples showed lower sensitivity for CT and
NG than anal samples. Gonorrhoea was directly linked to lower age (β= -0.161, p=0.001). Time of PrEP
use was directly associated with CT infection (β=0.202; p=0.042) and inversely associated with dysuria (β=
-0.121, p=0.009). Lower occurrence of yellow-green secretion was linked to the detection of CT (β= -0.089,
p=0.005) and NG (β= -0.048, p=0.002) infections. Foul-smelling discharge was directly associated with CT
(β= 0.275, p=0.004) and NG (β= 0.295, p= 0.037) infection.

Conclusion: The symptoms are a bad indicator of CT and NG infection, and the screening must be done in
multiple sites since most of the positive results would be missed if only urines were tested. In the case of
testing only one anatomical site, specifically the urethra, the CT/NG incidence and prevalence would be
underestimated. Multisite testing improves detection rates of CT/NG, and PrEP follow-up benefits people
offering STI testing.

Descriptors: Chlamydia trachomatis; Neisseria gonorrhoeae; Sexually Transmitted Infections; Prevalence;

Pre-Exposure Prophylaxis; HIV prevention.

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Infection 2024

Our findings call the attention of health authorities supporting their decisions over public health policies
focused on offering CT/NG testing. Our study is about the prevalence of CT/NG by multi-site testing in
PrEP users and about the symptoms as a bad indicator of CT/NG infections. This will help the audience
understand that multisite testing improves the chance of detecting pathogens. Further, our evidence
contributes to the discussion about reducing syndromic diagnosis. Finally, it contributes to the discussion
that PrEP benefits their users because it makes it easier to access STI testing, early diagnosis and quick
treatment.
Biography

Dr. Renata Karina Reis. Nurse. Master and PhD in at the University of Sao Paulo, Ribeirao Preto College of Nursing.
Post-Doctorate at Aix-Marseille Universite, France (2017). Associate Professor at the University of Sao Paulo at EERP
since 2018 (PhD, MNSc. RN) with the General and Specialized Nursing Department, Graduate Program in Fundamental
Nursing. Coordinator of NAIDST and RENAIDST research group. She has published more than 137 research articles
about HIV/aids and sexually transmitted infections.

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Infection 2024

Larissa Gerin1, Marcela Antonini2, Andrey Oeiras Pedroso2, Elucir

Gir2, Renata Karina Reis2*
Ribeirao Preto City Hall, Ribeirao Preto, Sao Paulo, Brazil
1

2
University of Sao Paulo, Ribeirao Preto College of Nursing/General and
Specialized Nursing Department, Ribeirao Preto, Sao Paulo, Brazil

Predictors of vaccination rates in people living with HIV/AIDS followed

at a specialty care clinic Ribeirao Preto, Sao Paulo, Brazil
Introduction: Vaccine hesitancy was considered by the World Health Organization as one of the 10 threats
to global public health in 2019. In Brazil, the National Immunization Program offers the population vaccines
free of charge through the Unified Health System. However, people living with the human immunodeficiency
virus (PLHIV) may have a worse prognosis for diseases prevented by vaccination and therefore have a
special indication for vaccination.

Objective: This study aimed to explore patient-specific predictors that influenced vaccination rates in
people living with HIV/AIDS (PLWHA).

Methods: This single-center retrospective cohort review of all cases of PLWHA reported in Notifiable
Diseases Information System (SINAN) for HIV/AIDS from the Ribeirão Preto, São Paulo, Brazil to explore
patient-specific predictors that influenced vaccination rates in PLWH. The data were collected from the
SINAN, which consolidates the registration of notifiable diseases and conditions nationwide. Information
regarding the CD4 T-cell count and viral load was collected from the Laboratory Test Control System
(SISCEL), while vaccination coverage indicators were obtained from the Computerized Outpatient Care
System (Hygia-RP System), specifically from records related to immunization actions. Information about
vaccine registration was accessed from the National Immunization Program Information System (SI-PNI
Web) and VaciVida System. Univariate and multivariate logistic regression analyses expressed as crude
odds ratios (cORs) and adjusted odds ratios (aORs), each with 95% confdence intervals (95% CI), were
performed to compare the proportional diferences of factors associated with vaccine coverage.

Results: Our sample included data 645 people living with HIV/AIDS aged 14 to 72 years old and the mean
age of the individuals was 32.1 years (SD+/- 11.1). Individuals aged 13 to 19 years had a better vaccination
rate (12.8%, p=0.005), and none of those aged 50 years or older had completed the vaccination schedule.
Receiving the last vaccine doses at the Specialized Assistance Service (SAE) was associated with completing
the vaccination schedule compared to receiving vaccines at Basic Health Units (p=0.009), as well as
demonstrating good adherence to antiretroviral therapy (p=0.003). Individuals vaccinated at SAE 4 had
a higher rate of being adequately vaccinated; however, there was no association of this variable with the
appropriate vaccination schedule (p=0.078). Considering the nine vaccines evaluated, individuals aged 40
years or older were 87.0% (aOR: 0.13, 95%CI: 0.02 – 0.72; p=0.020) less likely to be adequately vaccinated
compared to individuals aged 10 to 19 years. With regard to the health facility where the last doses of
the vaccine were received, individuals vaccinated in other health units were 10 times more likely to be
adequately vaccinated compared to those who received their last vaccine doses at the SAE (aOR: 10.44,
95%CI: 1.35 – 80.83; p=0.025).

Conclusion: The decision to vaccinate is individual, and as such, it is necessary for vaccines to be available
in healthcare services where the person receives follow-up care and easily accessible to the population,
along with having trained healthcare professionals. Therefore, multifactorial health interventions are

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Infection 2024

needed to address factors influencing vaccine coverage among PLHIV to improve vaccination rates.

Key Words: Vaccines. HIV. Acquired Immunodeficiency Syndrome. Vaccination. Vaccination Coverage.

Audience Take Away Notes

• Our study addresses various factors that may be related to confidence in the safety and efficacy of
immunobiologicals, both for those who will receive them and for those who will indicate or administer
vaccines. Vaccine coverage in adult individuals is unknown, with few studies conducted to assess
vaccination rates in this population and in groups more vulnerable to vaccine-preventable diseases
that have special vaccination schedules. This study definitively contributes to understanding the low
vaccine coverage in PLHIV. It is hoped that by addressing various factors, ranging from issues related
to services to those related to individuals themselves, it will be possible to achieve vaccine coverage
not only in PLHIV but also in the entire population
Biography

Dr. Renata Karina Reis. Nurse. Master and PhD in at the University of São Paulo, Ribeirão Preto College of Nursing.
Post-Doctorate at Aix-Marseille Université, France (2017). Associate Professor at the University of São Paulo at EERP
since 2018 (PhD, MNSc. RN) with the General and Specialized Nursing Department, Graduate Program in Fundamental
Nursing. Coordinator of NAIDST and RENAIDST research group. She has published more than 137 research articles
about HIV/aids and sexually transmitted infections.

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Infection 2024

Lic. Rigoberto Fimia Duarte1*, Ph.D, Lic. Ricardo Oses Rodriguez2,

MSc, Prof. Paul Robert Vogt3, MD
1
Department of Hygiene and Epidemiology, Faculty of Health Technology and
Nursing (FHTN), University of Medical Sciences of Villa Clara (UMS-VC), Cuba
2
Forecast Department, Meteorological Center of Villa Clara, Cuba
3
President of EurAsia Heart Foundation, Suiza

Objective regressive regression methodology in terms of infectious

entities and more

T he methodology of Regressive Objective Regression (ROR) is based on a combination of Dummy

variables with ARIMA modeling, where only two Dummy variables are created, and the trend of the
series is obtained. It requires few cases to be used, and also allows the use of exogenous variables, with the
possibility of modeling and forecasting in the long, medium and short term, depending on the exogenous
variable. This methodology has a wide and proven range of applicability in the field of biomedical sciences,
ranging from: a) the ROR methodology applied to the control of culicid larval populations (larval densities,
both general (DLG) and specific (DLE) (mosquitoes of the genus Anopheles), as well as for the mosquito
species Aedes aegypti and Ae. albopictus, involved in the transmission of the arboviral entities Dengue,
Yellow Fever, Chikungunya and Zika), b) The ROR methodology and its impact on fluvial and terrestrial
malacofauna of veterinary medical interest, c) The ROR methodology and its application in transmissible
infectious entities (mainly in transmissible infectious entities, both of viral and parasitic etiology, such as
HIV, Leptospirosis, Cholera, Dengue, Chikungunya, Yellow Fever and Zika, and the case of Malaria, as the
main parasitic entity), d) ROR methodology applied to Acute Respiratory Infections and Bronchial Asthma
Crisis, up to e) ROR methodology and its application in the COVID-19 pandemic (the modeling of SARS-
CoV-2, virus causing COVID-19 through the methodology of the Regressive Objective Regression (ROR),
both in Santa Clara municipality and Villa Clara province and for Cuba, which made it possible to make
short, medium and long term forecasts according to COVID-19. On the other hand, with this methodology,
it was possible to make forecasts of deaths and new cases weeks in advance, as well as forecasts for deaths,
critical, severe, confirmed and new cases of COVID-19; In addition to the application of this methodology
to vaccination against COVID-19 in Cuba, and the comparison of the ROR methodology as a linear model
with the non-linear Weibull model for COVID-19), and the possibility of forecasting extreme meteorological
disturbances (earthquakes, cold fronts, cyclones and hurricanes), as well as seismic events (earthquakes).
Evidently, the ROR Modeling and Prediction methodology is novel, since it allows modeling an immense
set of natural, biological, biomedical and social processes and phenomena with great simplicity and
economy of resources. By working with exogenous variables, it allows the modeling and prediction of
events, phenomena and processes over time, both in the short, medium and long term. Undoubtedly, it also
constitutes a contribution to the science of modeling and forecasting variables to know the future, as well
as the impact that different variables contribute to an event or phenomenon, and because it is universal, it
can be applied anywhere in the Universe.

Audience Take Away Notes

• On a novel methodology, Objective Regressive Regression (ORR), and its multiple possibilities of
application in the field of biomedical sciences, and in the forecasting of extreme weather disturbances
(earthquakes, cold fronts, cyclones and hurricanes), as well as seismological events (earthquakes)
• It can be used to know the future, as well as the impact that different variables contribute to an event
or phenomenon, and because it is universal, it can be applied anywhere in the Universe

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• As it requires few cases to be used, it enables the use of exogenous variables, with the possibility of
modeling and forecasting in the long, medium and short term, depending on the exogenous variable.
This methodology has a wide and proven range of applicability in the field of biomedical sciences
• Yes, this research that other faculty could use to expand their research or teaching
• Of Course this provide a practical solution to a problem that could simplify or make a designer’s job
more efficient
• Yes, it improve the accuracy of a design, or provide new information to assist in a design problem
• Other benefits.
o This methodology has a wide and proven range of applicability in the field of biomedical sciences,
ranging from: a) ROR methodology applied to the control of culicid larval populations (the
mosquito species Aedes aegypti and Ae. albopictus, involved in the transmission of the arboviral
entities Dengue, Yellow Fever, Chikungunya and Zika), b) ROR methodology and its incidence in
fluvial and terrestrial malacofauna with veterinary medical interest, c) ROR methodology and its
application in transmissible infectious entities (mainly in transmissible infectious entities, both
viral and parasitic etiology), d) ROR methodology applied to Acute Respiratory Infections and
Bronchial Asthma Crisis, e) ROR methodology and its application in the COVID-19 pandemic and
f) The possibility of forecasting extreme meteorological disturbances (earthquakes, cold fronts,
cyclones and hurricanes), as well as seismic events (earthquakes)
Biography

Rigoberto Fimia Duarte was born in 1966 in the current province of Sancti Spiritus, Cuba. He was Graduated in 1989
in Biology Science. Currently works at the University of Medical Sciences of Villa Clara (UCM-VC), Cuba. He has to his
credit, 579 scientific results/publications, of which, he is the author of 398 scientific articles in specialized journals of
recognized prestige and impact, as well as 31 books.

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Infection 2024

Silvia Giono Cerezo2*, Julia Moreno M1,2,

Maria Dolores Alcantar Curiel1*
1
Laboratorio de Infectologia, Microbiologia e
Inmunologia Clinica, Unidad de Investigacion en
Medicina Experimental, Facultad de Medicina,
Universidad Nacional Autonoma de México, Ciudad de
México 06720, Mexico
2
Laboratorio de Bacteriologia Medica, Posgrado en
Ciencias Quimicobiologicas, Escuela Nacional de
Ciencias Biologicas, Instituto Politecnico Nacional,
Ciudad de México 11350, Mexico

Acinetobacter baumannii blaOXA-143-like and blaOXA-72 with global

international clone (IC) 2 and the Latin America endemic Ic5 exhibiting
strong biofilm formation in a Mexican Hospital

A cinetobacter baumannii is an opportunistic pathogen responsible for Healthcare- Associated

Infections (HAIs) and outbreaks. Antimicrobial resistance mechanisms and virulence factors allow it to
survive and spread in the hospital environment. However, the molecular mechanisms of these traits and
their association with international clones are frequently unknown in low- and middle-income countries.
Here, we analyze the phenotype and genotype of seventy-six HAIs and outbreak-causing A. baumannii
isolates from a Mexican hospital over ten years, with special attention to the carbapenem resistome and
biofilm formation. The isolates belonged to the global International Clone (IC) 2 and the Latin America
endemic IC5 and were predominantly extensively Drug-Resistant (XDR). Oxacillinases were identified as
a common source of carbapenem resistance. We noted the presence of the blaOXA-143-like family (not
previously described in Mexico), the blaOXA-72 and the blaOXA-398 found in both ICs. A low prevalence of
efflux pump overexpression activity associated with carbapenem resistance was observed. Finally, strong
biofilm formation was found, and significant biofilm-related genes were identified, including bfmRS, csuA/
BABCDE, pgaABCD and ompA. This study provides a comprehensive profile of the carbapenem resistome
of A. baumannii isolates belonging to the same pulse type, along with their significant biofilm formation
capacity. Furthermore, it contributes to a better understanding of their role in the recurrence of infection
and the endemicity of these isolates in a Mexican hospital.
Biography

Dr. Silvia Giono Cerezo PHD National School of Biological Sciences Instituto Politecnico Nacional- IPN Chemist
Bacteriologist Parasitologist Doctor of Science Member of the National Academy of Medicine Member of the Mexican
Association of Infectious Diseases Collegiate Member of the Postgraduate Studies Professor of Medical Bacteriology
and Host-Parasite Relationship Theory and laboratory also Problems of Medical Bacteriology Tutor, Director Advisor
of Bachelor's, Master's and Doctorate students Lines of research: Diagnostic Medical Microbiology and Antimicrobial
Resistance of the ESKAPE group diagnosis and analysis of the genome of Helicobacter pylori MLST of Stenotrophomonas
spp several publications.

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Infection 2024

Simona Yoffe Deri

Sheba Medical Center, Israel

Early versus late onset necrotizing enterocolitis in very low birth infants
in the neonatal intensive care unit
Background: Necrotizing Enterocolitis (NEC), one of the most severe emergencies in neonates, is a
multifactorial disease with diverse risk factors.

Objectives: To compare between the clinical and laboratory characteristics of premature infants diagnosed
with Early-Onset NEC (EO-NEC) and those with Late-Onset NEC (LO-NEC).

Patients and Methods: Enrolled infants were identified from prospective local data collected for the Israel
National Very Low Birth Weight (VLBW, <1500 grams) infant database and from the local electronic patient
files data base for the period 1996-2017.

Results: Overall, 95 VLBW infants (61, 64.21% EO-NEC and 34, 35.87% LO-NEC) were enrolled. EO-NEC
infants had higher rate of IVH grade 3 and 4 (26.2% vs 2.9%, p=0.005). LO-NEC infants had a higher
incidence of previous bloodstream infections (35.3% vs 8.2%, p=0.002) compared with EO-NEC. EO-NEC
infants were more likely to undergo surgery (49.2% vs 26.5%, p=0.031), less likely to receive postnatal
steroids (8.2% vs 20.6%, p=0.109) and had a higher risk of death (59% vs 41%, p=0.095) than LO-NEC. In
multivariable analysis models surgical intervention was associated with EO-NEC (OR: 4.627, p=0.013) as
well as PDA and positive blood culture prior to the NEC episode.

Conclusions: Our data support the hypothesis that EO-NEC has significant different clinical and
microbiological attributes compared with LO-NEC.

Key Words: Prematurity, Mortality, Bacterial Sepsis.

Biography

Simona Yoffe Deri is from Sheba Hospital, Israel.

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Infection 2024

Simona Yoffe Deri

Sheba Medical Center, Israel

The presentation of rhabdomyolysis in influenza B patients – A case

series

I nfluenza B-associated rhabdomyolysis is relatively rare. Herein, we describe a retrospective case-series

of five children hospitalized in a single institution for rhabdomyolysis from PCR-confirmed Influenza
B. Viral sequencing revealed a novel deletion of one amino acid in the viral hemagglutinin, potentially
explaining the unusual cluster of cases. Altogether, this work expands current knowledge on Influenza
B-associated rhabdomyolysis in children.
Biography

Simona Yoffe Deri is from Sheba Hospital, Israel.

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Infection 2024

Sneha Thatipelli1*, Megan Grabill2, Kayla Harrell3, Nia Bhadra

Heintz4, Sara Solomon5, Shimrit Keddem6, Florence Momplaisir7
1
Division of Infectious Disease, University of Pennsylvania, Philadelphia, PA,
United States
2
Department of Family Medicine and Community Health, University of
Pennsylvania, Philadelphia, PA, United States

3
Division of Infectious Disease, University of Pennsylvania Summer Program in Infectious Diseases
Research and Penn Center for AIDS Research Scholar, Philadelphia, PA, United States
4
Department of OBGYN and Division of Addiction Medicine, University of Pennsylvania, Philadelphia, PA,
United States
5
Implementation Science Consultant, Penn Center for AIDS Research, Philadelphia, PA, United States
6
VA Center for Health Equity Research & Promotion, Department of Family Medicine & Community
Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
7
The Penn Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA,
United States

Perspectives of OBGYN clinicians on integrating PrEP in routine

women’s health care: A qualitative analysis
Background: Human Immunodeficiency Virus (HIV) continues to be a major public health problem in the
United States. Pre-Exposure Prophylaxis (PrEP) is highly effective in preventing HIV, but uptake remains
low, especially among women. Furthermore, HIV prevention in pregnant individuals provides protection
for both the mother and fetus. Research demonstrates OBGYN providers play an important role in HIV
prevention care, but OBGYN perspectives around this have not been surveyed.

Methods: We conducted qualitative interviews with OBGYN providers, medical directors, and PrEP
navigators in 2 academic OBGYN clinics in Philadelphia to understand facilitators and barriers for PrEP
uptake among cisgender women.

Results: We completed 16 interviews: 12 physicians, 2 PrEP navigators, and 2 Advanced Practice Providers.
Participants were mostly female (88%). The most common barriers identified included 1) decreased risk
perception (provider for the individual or the individual for themselves) 2) Provider inexperience with
PrEP Provider discomfort with prescribing and monitoring individuals on PrEP 4) Lack of a streamlined
workflow for PrEP 5) Time and personnel limitations and 6) HIV stigma. Facilitators included 1) a strong
desire to provide HIV preventative care services 2) an interdisciplinary care team including pharmacists,
PrEP navigators, and social workers and 3) Having an infectious diseases expert liaison. Participants
suggested education, improvements in workflow, and utilizing the electronic medical record (EMR) for HIV
screening and PrEP care.

Conclusions: Understanding barriers and facilitators can help guide implementation of PrEP strategies in
the OBGYN setting. Our study demonstrates OBGYN providers view HIV prevention within their scope of
practice, however there are key clinic infrastructure and personnel limitations to provide this care. We
highlight interdisciplinary teams as a facilitator for this work. Participant feedback suggests care can be
improved through a multifactorial intervention including PrEP education, utilizing the EMR for prompts
for screening and monitoring, team-based care, and a clear workflow.

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Infection 2024

Audience Take Away Notes

• Use qualitative interviews to identify key facilitators and barriers for HIV Prevention care among
OBGYN providers in an urban healthcare setting
• Use the consolidated framework for implementation research (CFIR) to categorize barriers and
facilitators into CFIR domains
• Link barriers and facilitators to implementation strategies in different CFIR domains to improve overall
PrEP uptake
• Identify multi-level barriers and facilitators to PrEP uptake in the prenatal care setting
• Describe strategies to improve conversations about the benefits of using PrEP for HIV prevention in
pregnancy
• PrEP care can be integrated in routine prenatal care
Biography

Sneha Thatipelli, MD is an infectious disease physician at the University of Pennsylvania. Dr. Thatipelli’s clinical
interests include general infectious disease with an emphasis on the HIV care continuum. She hopes to work towards
improving the health of safety net populations with an interest in combatting health disparities.

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Infection 2024

Veronika Nemethova1*, Petra Babiakova1, Michal Selc2,3,

Kristina Jakic2, Lucia Uhelska1, Boglarka Teglasova1, Alexandra
Poturnayova4, Lubos Drgona5, Andrea Babelova2,3, Filip Razga1
1
Selecta Biotech SE, Bratislava, Slovak Republic
2
Department of Nanobiology, Cancer Research Institute, Biomedical Research
Center, Slovak Academy of Sciences, Bratislava, Slovak Republic
3
Centre for Advanced Materials Application, Slovak Academy of Sciences,
Bratislava, Slovak Republic

4
Institute of Molecular Physiology and Genetics, Centre of Biosciences, Slovak Academy of Sciences,
Bratislava, Slovak Republic
5
Department of Oncohematology, Comenius University and National Cancer Institute, Bratislava, Slovak
Republic

An unconventional therapeutic oligonucleotide effectively reduces

SARS-CoV-2 RNA levels in preclinical animal studies

S ince the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2019, the
number of confirmed cases worldwide exceeded 770 million in 222 countries by March 2024, with more
than 7 million confirmed deaths, according to the statistics from the World Health Organization. In addition
to quarantine measures, preventive measures, immunization of the population with vaccines, prophylaxis,
symptomatic treatment, or secondary-use medications have become the main tools of prevention and
therapeutic intervention against the virus.

Therapeutic oligonucleotides have attracted great interest due to their potency and potential to change
the therapeutic landscape of many pathological conditions, including those of viral origin. Targeting the
conserved SARS-CoV-2 RNA sequences essential for viral replication offers a rational approach to inhibiting
viral infection and thereby halting disease progression.

Following the successful in vitro validation of a tailor-made therapeutic oligonucleotide with an

unconventional structural design, called ASC1R, which was shown to be remarkably effective in transfected
cell lines, we report here the results of subsequent preclinical animal studies of this active pharmaceutical
substance. ASC1R has demonstrated excellent tolerability without any observed behavioural changes or
mortality in acute and subacute toxicology studies in C57BL/6 mice, even at doses exceeding 100 times the
therapeutically effective concentration. Functional studies showed effective reduction of target RdRp RNA
levels in the liver of transfected mice by 95.1 (median (N=9), Q25-Q75=77.7-97.5) and 98.1% (median (N=9),
Q25-Q75=94.1-98.8) after single application of ASC1R at doses of 1 and 10 mg/kg, respectively.

The therapeutic potential of ASC1R could translate into substantial clinical benefits for patients with
COVID-19. Furthermore, in the context of infectious diseases, our results provide implications for the
research and development of analogous antivirals for other diseases of viral origin. The findings could help
meet the global challenge of developing new and safe treatment modalities.

This work was supported by the Slovak Research and Development Agency under Contracts No. PP-
COVID-20-0007 and APVV-21-0220.

Audience Take Away Notes

• Oligonucleotide-based antisense strategies represent the most powerful approach to blocking target
RNAs
• Therapeutic oligonucleotides have attracted much interest due to their potency and potential to
change the therapeutic landscape of many pathological conditions, including those of viral origin

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Infection 2024

• ASC1R has demonstrated excellent tolerability in preclinical acute and subacute toxicology studies
• ASC1R reduced RdRp RNA levels with a remarkable efficiency of >98% after a single dose
Biography

Dr. Nemethova holds an honors degree in Molecular biology and genetics, and Macromolecular chemistry, and has
>15 years of professional background in clinically oriented research. After gaining extensive experience working as
a specialist at the Center of Molecular Biology and Gene Therapy (CZ), she later became a leader for early-stage
validation of therapeutic oligonucleotides at the Slovak Academy of Sciences. As Head of the Therapeutics department
at Selecta Biotech SE, she currently coordinates the development and preclinical studies of therapeutic leads for
multiple diseases. She has published more than 20 research papers and is the author of several granted patents.

270
Infection 2024

Yen Chin Liu1,2,3*, Chih Ching Wu1,2,3,4, Chun Ju Chang1,2,3, Shin Ru

Shih1,2,3,5,6, Rei Lin Kuo1,2,3
1
Research Center for Emerging Viral Infection, Chang Gung University, Taoyuan,
Taiwan
2
Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung
University, Taoyuan, Taiwan

3
Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan
4
Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital,
Taoyuan, Taiwan
5
Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
6
Research Center for Chinese Herbal Medicine, Research Center for Food and Cosmetic Safety, and
Graduate Institute of Health Industry Technology, College of Human Ecology, Chang Gung University of
Science and Technology, Taoyuan, Taiwan

SARS-CoV-2 omicron nucleocapsid effectively suppresses interferon beta

expression via interaction with host HSPA4

S evere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can dysregulate host antiviral responses,
including interferon production, to facilitate viral replication and spread via interacting with their hosts;
however, the impact of the SARS-CoV-2 Omicron nucleocapsid protein on the innate immune response
remains unclear. In this study, FLAG-tagged nucleocapsids of SARS-CoV-2 were first overexpressed in
HEK293T cells, after which anti-FLAG immunoprecipitation and Western blotting assays were performed.
Nucleocapsid-associated protein complexes in human cells were identified using co-immunoprecipitation
and were combined with in-gel digestion and ultra-high-pressure liquid chromatography coupled to
tandem mass spectrometry. We discovered that the nucleocapsid of SARS-CoV-2 could specifically
interact with cellular Heat Shock Protein Family A member 4 (HSPA4) in the cytoplasm. The nucleocapsid
of the SARS-CoV-2 Omicron variant exhibited a heightened interaction with HSPA4 compared to other
variants. Downregulation of HSPA4 expression in A549-ACE2-TMPRSS2 cells decreased the innate immune
responses and significantly increased the viral titers, suggesting that HSPA4 was an antiviral regulator in
the SARS-CoV-2 life cycle. We further demonstrated that the nucleocapsid inhibited the phosphorylated-
interferon regulatory factor 3 protein, interferon beta mRNA, and interferon-stimulated genes; however,
HSPA4 overexpression could recover them. Moreover, HSPA4 is involved in the upregulation of innate
antiviral immunity. Our data suggests a novel mechanism by which the SARS-CoV-2 nucleocapsid hijacks
cellular HSPA4 to suppress the host innate immune response and facilitate viral replication.

Audience Take Away Notes

• The cellular innate immune response of SARS-CoV-2 infection
• The cellular and viral protein-protein interaction
• The variants of SARS-CoV-2 Nucelocapsid proteins
Biography

Dr. Yen Chin Liu received her PhD degree in 2014 from Graduate Institute of Biomedical Sciences, Chang Gung
University, Taiwan. The findings reveal a novel mechanism of viruses attacking hosts whereby picornaviral polymerase
(3Dpol) enters the nucleus and targets the central pre-mRNA processing factor 8 (Prp8) to block pre-mRNA splicing
and mRNA synthesis. This work has been published in PLoS Pathogens. Dr. Liu worked as post-doctoral fellow from
2014 to 2019 in Department of Microbiology, the University of Hong Kong. She identified a novel virus host interaction
mediated by XRN1 in influenza virus infection. This work has been accepted by mBio.

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