World Congress on Infectious Diseases August 10-12, 2015 London, UK

Maria Fernanda Chiari graduated in biological sciences at Universidade Estadual do Norte do Paraná (2007) and became master in biotechnology at Universidade Federal de São Carlos in 2010. She is currently a fellow of CAPES doctoral program in biotechnology also from the Universidade Federal de São Carlos - UFSCar, working in the field of parasitology and immunology

Disseminated strongyloidiasis is rare among the population of immunocompetent, but very important in immunocompromised individuals, particularly those co-infected with HIV. This form of the disease is due to autoinfection capacity of Strongyloides stercoralis and characterized by the presence of larvae in multiple organs. The search for new compounds that have antiparasitic activity and less side effects is of great interest for the treatment of immunocompromised individuals. The search for new drugs has an important ally in medicine for centuries, the use of medicinal plants. And in our group we have shown beneficial effects of Mentha piperita L. in the treatment of experimental schistosomiasis. Thus, we evaluated the Menthol and menthone compound in the viability of in vitro parthenogenetic females Strongyloides venezuelensis. After 12 days of infection of rats (Wistar -1500 larvae per animal),15 cm of their small intestine were removed and the females were recovered. Two females per well containing 2 mL medium and compounds and Menthol and / or menthone (100 ug/ml, 50 ug/ml, 25 ug/ml and 12.5 ug/ml) in triplicate. We utilized Ivermectin (the same doses to compounds) to positive control and DMSO 99.9% to negative control. The tested compounds showed 100% efficiency for induction of in vitro female death, suggesting that these bio compounds have potential to be assessed for their effectiveness in reducing the parasitic load in vivo tests. And they can contribute to the search for new compounds in the control of parasitic diseases caused by nematodes

Nada Matougui is a second year PhD student in biology and health doctorate school at the University of Angers working under the supervision of the professor Patrick Saulnier. Her research is focused on the development of a Lipid-based Nanoformulation of Antimicrobial Peptides to Treat Bacterial Infectious Diseases. She is pharmacy graduate from the Medicine University of Algiers, followed by a Master degree in “Technologies Innovantes en Formulation” at University of Angers. She worked as an intern at the “MINT” laboratory on the development of a nanomedicine for glioblastoma therapy.

The rapid increase in drug-resistant infections presents an acute problem that continues to challenge the healthcare sector, generating interest in novel antimicrobial strategies. Antimicrobial peptides (AMPs) have a high potential as new therapeutics against infectious diseases as they are less prone to induce resistance due to their fast and non-specific mechanism of action. The new peptides included in the study are well-defined AMPs, established to have an antimicrobial effect and an acceptable safety profile. The aim of this work is to explore the potential of lipid nanocapsules (LNCs) for AMP delivery, and especially its ability to protect the peptide against degradation while at the same time maintain proper drug activity. The LNCs are described as an oily core composed of medium chain triglycerides, and surrounded by a surfactant shell made of lecithin and PEGylated surfactants. Their lipidic cores are not favorable as they stand to encapsulate hydrophilic molecules. To promote the peptide loading, the incorporation of the cationic peptides in the shell of the LNCs was envisaged. Two strategies are tested: adsorption of the AMPs on the surface of LNCs by incubation under magnetic stirring or incorporation of charged linkers to the formulation of LNCs. The incubation performed at different conditions shows a good association of the peptides to the surface of the LNCs. The minimal inhibitory concentrations (MIC) of the LNC-AMPs were determined for the sensitive strains. The results show a preservation of the antibacterial activity of the native peptide and in some cases a decrease of the MIC.

Anne Claire Groo studied Pharmacy at the University of Reims in France and then, formulation of colloidal systems at the University of Paris XI in France. She received her Ph.D. in Pharmaceutical Sciences from university of Angers, France, specialising in the nanocarrier optimization for oral delivery in 2013. Her main research interests during her thesis are the development and the evaluation of anticancer drug nanoparticles, for crossing the mucus layer and for improving oral bioavailability. She is a post-doctoral researcher and develops nanocarriers to encapsulated antimicrobial peptides to treat bacterial infection diseases.

Due to the increasing problem of resistance to traditional antibiotics, antimicrobial peptides (AMPs) have a huge potential as new therapeutics against infectious diseases as they are less prone to induce resistance due to their fast and non-specific mechanisms of action. The delivery strategies based on nanotechnology has the potential to improve the efficiency and stability of AMPs in clinical development. Moreover, nanocarriers were particularly promising for peptide delivery, controlled release strategies and technologies against proteolytic degradation of peptides. The Polymyxin B is a well-known antimicrobial peptide and was used as model peptide in our study. Lipid nanocapsules (LNCs) are a new generation of biomimetic nanocarriers and were used to deliver the peptide. The aim of the present study was to produce the LNCs with antibacterial activity. We have developed peptide-loaded reverse micelles and incorporated in LNCs by phase inversion process. In order to evaluate the antimicrobial activity, the minimum inhibitory concentration (MIC) was determined via a broth micro-dilution method. The activity of Polymyxin B solution and Polymyxin B-loaded LNCs were studied against the following bacterial Gram-negative strains: Pseudomonas aeruginosa (reference strains), Pseudomonas aeruginosa (clinical strains), Escherichia coli (reference strains), Acinetobacter baumannii AYE (reference strains). Polymyxin B was efficiency encapsulated in LNCs using reverse micelles and the antimicrobial activity was intact. The study shows that LNCs are an excellent candidate to deliver AMPs.

A Montagu is a PhD student at the University of Angers through a CIFRE thesis with Eydo pharma, dealing with essential oils encapsulation for the treatment of nosocomial infections under the direction of Pr. Marie-Laure Joly-Guillou and Pr. Patrick Saulnier. She studied biology at the University of Angers and she obtained master’s degree in biology whose the subject was the use of mesenchymal stem cells as vehicles for lipid nanocapsules for the treatment of glioma.

Acinetobacter baumannii is an important nosocomial pathogen, resistant to many commonly-used antibiotics. Considering the limited number of antibiotics in development, interesting strategies could lay on the use of natural resources especially essential oils (EOs). An interesting strategy underlined the antibacterial potential of EO components (carvacrol, cinnamaldehyde) loaded LNCs against A. baumannii. The aim of this study was to realize and characterize DiO-LNCs loaded with antibacterial actives. The antibacterial activity of these nano-carriers was evaluated in vitro against A. baumannii. Finally, we determine the interactions between bacteria and LNCs over time thanks to the fluorescence of DiO-LNCs and the properties of trypan blue in order to precise the physicochemical mechanisms occurring at the level of the biological membrane. The results underlined the attractiveness of the encapsulated actives compared to unloaded-LNCs. These results demonstrated the capacity of carvacrol-loaded-LNCs to interact and penetrate the bacterial membrane in comparison with cinnamaldehyde-LNCs and unloaded-LNCs. Moreover, the fluorescence of bacteria remained constant after contact with carvacrol-loaded-LNCs and cinnamaldehyde-LNCs whereas the fluorescence of the blank-LNCs decreased over time. This phenomenon could be explained by the release of these blank-LNCs by efflux pumps. Thereafter, modifications of carvacrol after substitution of hydroxyl functions by fatty acids (acetic acid, palmitic acid) demonstrated the crucial role of these latter for antibacterial activity. Finally, after contact with an efflux pump inhibitor CCCP (carbonylcyanide-3-chlorophenyl hydrazine), the results underlined a total synergistic effect for Car-LNCs showing that the CCCP is associated with action mechanism of carvacrol especially at the level of efflux pump mechanism.

Saif Musa is a member of Royal Free Hospital, London, UK

Introduction: National and international treatment guidelines endorse fidaxomicin (macrocylic antibiotic) for severe and recurrent Clostridium difficile infection (CDI). Reports of ‘real world’ practise are rare and inconsistent with clinical trials. We describe our inpatient CDI experience of fidaxomicin.

Method: Inpatients (aged >18) experiencing diarrhoea and positive C.difficile stool toxin enzyme immunoassay, prescribed fidaxomicin between September 2012-September 2014, were identified from Hospital databases. Medical records were retrieved. Public Health England criteria defined first/recurrent episodes, healthcare/community associated cases, severity and response.

Results: Fourteen patients, representing 11.6% of hospitalised CDI cases, received fidaxomicin. Notes were retrieved in 13/14 (92.9%) patients. Median age was 83 (IQR 81-87), most were female [11/13 (84.6%)], first episodes [9/13(69.2%)] and indeterminate or community associated [8/13 (61.5%)]. Ten ribotypes were isolated, 002 [3/13 (23.1%)] most frequent. None were ribotype 027. Most [10/13 (76.9%)] were non-severe CDI at fidaxomicin onset, median time to initiation 14 (IQR 4-25) days. One (7.7%) received fidaxomicin first line (recurrent CDI). Previous therapy included combined vancomycin and metronidazole, 7/13 (53.8%) cases, 4 (30.8%) vancomycin and one (7.7%) metronidazole alone. Two (15.4%) patients received rifampicin and one (7.7%) immunoglobulin. All patients were subject to multidisciplinary team (MDT) review. Ten (76.9%) responded; no relapses or CDI related readmissions were recorded within six months. Median time to symptom improvement was 4 (IQR 2-7) days. Overall in-hospital mortality was 7.7%.

Conclusion: Our ‘real life’ experience is favourable with no recurrences and readmissions. Further evaluation of fidaxomicin in clinical practise is required as is the MDT role in decision making.

Triantafyllou Argyro is a biopathologist at private hospital Hygeia since 2011 in the Hematology Department, 2years from 2008 till 2010 working in Blood Donation Lab in General Hospital Janneio, student in Master “International Medicine-Health Crisis Management”.

In Greece no case of rabies in animals has been recorded since 1987 and the last case of infection to humans has been recorded in 1970. Since 2012, 48 cases of rabies cases have been recorded in animals (40 foxes and 5 dogs) and more than 376 cases of people have been recorded who have been in contact with animals infected or possibly infected by rabies virus. In Europe 6000 animals die every year from rabies and 8-10 people per year, all in countries of the former Soviet Union. In Balkans because of the political and social disorders in recent years and the failure of the public health system to respond to new circumstances, there is a reemergence of rabies in foxes as well as in domestic cats, cattle and sheep. In Albania and Fyrom , the last decade there have been no cases in humans, while in Turkey 1-2 incidents are reported ,because they don’t take the appropriate treatment.(Table 1) .In Greece, a red fox in the area of Kozani was found positive for rabies virus ,on 19 October 2012.Since then, there have been 48 cases, mainly in north Greece.(table 2).The reappearance of the disease can be attributed to various causes, such as the presence of rabies in our neighboring countries , the movement of wild animals from these countries to Greece and the collapse of former Yugoslavia that resulted in ineffective control during and after the war. The lack of action by the State is another factor. From 2004, scientists pointed out the presence of rabies in neighboring countries and had proposed measures such as the airdrops of vaccines in baits, but had not been heard from the state, because it was considered unnecessary and costly. Airdrops of vaccines began the following year, in October of 2013,while they should have begun six months before, in March, which is the time of reproduction of foxes and likely to transmit rabies among them, so there was a delay of six months. This was done because the competition for the acquisition of the vaccines lasted several months, as there was a large participation of companies, but some did not meet the appropriate criteria. Necessary measures to limit the disease are: Continuous surveillance, reduction and vaccination of stray animals, vaccination of wild animals, passive and active surveillance, informing the public , collaboration between the authorities, medical doctors, veterinarians, Ministry of Rural Development and Food, Ministry of Health, KEELPNO, collaboration of Greece with neighboring countries.

Kocabas E is working as a Faculty of Medicine, Department of Pediatric Infectious Diseases, Cukurova University, Turkey.

Background and Aim: The spectrum of chronic hepatitis B (CHB) infection in children ranges from asymptomatic carriage with minimal disease, to cirrhosis and risk of hepatocellular carcinoma in adulthood. Identifying those who will benefit from treatment is a challenge. Untreated infection may lead to natural seroconversion and reduced risk of further disease. Interferon-based therapies have limited efficacy in childhood.

The aim of the present study was to evaluate naïve children with CHB infection and to compare the therapeutic efficacy of two different regimens in patients with CHB infection who had been followed-up in the Department of Pediatric Infectious Diseases of Cukurova University Faculty of Medicine.

Patients and Methods: In this retrospective study, 227 naive children with chronic hepatitis B (CHB) infection who had been followed-up at the out-patient pediatric infectious disease clinics of Balcali Hospital from 2008 January to 2013 December were evaluated. These 227 children’s demographic and clinical features; risk factors; biochemical, serological and virological feature were also evaluated.Of the total 227 pediatric patients who had CHB infection, while 70 ( 30.8% ) had spontanenous seroconversion, 157 (69.2%) did not have spontanenous seroconversion. Of the total 157 pediatric patients who had CHB infection, 49 ( 31.2% ) were treated with two different treatment modalities, 108 ( 68.8% ) had been followed-up with CHB infection.

Criteria for treatment of CHB infection included the presence of hepatitis B surface antigen (HBsAg) and elevated serum alanine amino transferase (ALT) for more than 6 months, along with distinctive necroinflammation in the liver.

A total of 49 children were prospectively allocated to two random treatment groups i.e. monotherapy and combination therapy. In the monotherapy groups; 25 patients in the first group (Group 1) received interferon-alpha (IFN-α) in a dose of 5 MU/m², subcutaneous injection, thrice/weekly alone for 6 months. In the combination groups; 24 patients in the second group (Group 2) received Lamuvidin (LAM) for 12 months (peroral, 4mg/kg per day dose, max.100 mg, daily) and IFN-α added to LAM for 6 months in a dose of 5 MU/m² (s.c., thrice/weekly ).
Complete response was defined as HBe/antiHBe seroconversion, clearence of HBV DNA and normalization of ALT at the end of therapy. The presence of ALT normalization and HBV DNA clearance, but not anti-HBe seroconversion, was accepted as a partial response. Sustained response at 6 months of follow up after completion of treatment was defined using the same parameters. The complete follow-up period continued 6 months from at the end of the therapy.
All tests were done in the Laboratories of the Balcali Hospital of Cukurova University, Faculty of Medicine. Serum ALT was evaluated by using standart methods ( upper limits of normal, 40 IU/L).
Viral markers were measured by using the macro ELISA method, (Cobas 601) Serum HBV DNA level was quantitatively asssesed with a commercial PCR assay (real-time PCR, Cobas Taqman 48) (cut-off value, 20-170.000.000 copies HBV DNA / ml). Statistical analysis was performed by SPSS software program (version 10.0). Comparisons between the groups were made with Mann-Whitney U test, Chi square test, Ficher’s Exact test, Kruskal-Wallis test. A two-tailed P value < 0.05 was considered significant.

Results: In this study 227 naive children with chronic hepatitis B (CHB) infection were evaluated retrospectively . Of the total 227 pediatric patients who have CHB infection, 70(30.8%) developed either spontaneous seroconversion or seroconversion during their eight year follow-up period. Of 157 patients who did not develop spontaneous seroconversion, 49 were treated with two different treatment modalities as they met the treatment criteria.
The average age of 227 patients who participated in the study was 173 months and the average diagnosis period was 35 months. 56% of the patients were identified during family screening. The existence of hepatitis B in the family was 85,9%, maternal hepatitis B was 60,4% and vertical transmission rate was 54,6%. 74% of the patients were asemptomatic. When the patients who had spontaneous seroconversion and those who had no spontaneous seroconversion are examined, it is seen that the average age (192 months) and diagnosis period (132 months) in the patients with spontenous seroconversion was statistically higher and longer than those without spontenous seroconversion (156 vs 109, respectively) (p<0.01). The rate of spontaneous seroconversion in males was statistically lower (p<0.01). Spontaneous seroconversion was statistically greater in the patients who had lower viral load and ALT value at the time of the diagnosis and who had IgG antibodies against hepatitis A virus (p<0.01, p<0.05 respectively). The patients with no spontaneous seroconversion had statistically higher familial and vertical contamination (p<0.05). A total of 49 patients with CHB infection were prospectively allocated to two random groups. Twenty-five patients in the monotherapy group (Group I) whereas 24 patients in the combination therapy group (Group II). Serum ALT value was higher in the patients in Group I than in those in Group II (p=0.06). While the patients who received IFN-α in Group I, were identified with 8% of Anti-HBs seroconversion, 36% of Anti-HBe seroconversion, those who received IFN-α + LAM in Group II had 8,3% of Anti-HBs seroconversion and 25% of Anti-HBe seroconversion. Twenty-nine (59,2%) patients who responded to treatment and 20 (40,8%) who did not respond to treatment is examined, it is seen that no statistically significant difference was found between the parameters under investigation in these groups. Anti-HBs seroconversion in the patients who responded to treatment and received IFN monotherapy occurred within nearly 37 month follow-up period whereas, the response period was found to be 21 months in the patients who received IFN+LAM. Anti-HBe seroconversion in the patients who received IFN monotherapy was observed in 26 month follow-up period while this period was found to be 33 months in the patients who received IFN+LAM.

Discussion: The findings of this study suggest that long follow-up period (an avareage of 10 years) for the patients who have been diagnosed with chronic hepatitis B and who do not meet the treatment criteria is essential in terms of spontenous seroconversion development. Hepatitis A vaccination in seronegative patients may induce spontaneous seroconversion. However, more detailed research studies are needed about this subject.
In this study, no statistically significant difference was found in terms of response to treatment between the two different treatment modalities given to the patients who met treatment criteria. The potential benefits of these two theuropatic regimens need to be futher investigated to confirm these results with larger number of patients.

Joon Seok Chae has completed his DVM, MS, PhD from Chonbuk National University and postdoctoral studies from Texas A&M University and University of California-Davis. He is the Professor of College of Veterinary Medicine, Seoul National University. He has published more than 160 papers in reputed journals and serving as an editorial board member of repute. His recent interesting research areas are tick-borne zoonotic pathogens (Anaplasma, Ehrlichia, Rickettsia, Bartonella, TBE and SFTS virus etc.) and equine stem cell therapy.

Human granulocytic anaplasmosis, an emerging infectious disease in the Republic of Korea (ROK), is caused by an obligate intracellular tick-borne bacterium of the family Anaplasmataceae. Anaplasma phagocytophilum has been found in a variety of animal species including wild deer, cats, dogs, gray squirrels, horses, and mice. The objective of the present study was to isolate and characterize the strains of A. phagocytophilum in black-striped field mice (Apodemus agrarius) and Korean water deer (Hydropotes inermis argyropus) in the ROK. Anaplasma infection based on the 16S rRNA genes were detected by conventional polymerase chain reaction (PCR) and species-specific nested PCR assays with DNA from Korean water deer (KWD) blood and black-striped field mice (BSFM) spleen. For isolation of A. phagocytophilum, BALB/c mice were used for propagation. White blood cells from 4-5 infected BALB/c mice were inoculated into 3×104 HL60 and THP-1 cell line, respectively. Eight KWD and 27 BSFM were captured. Seven (87.5%) blood samples of KWD and 12 (44.4%) spleens of BSFM were positive for A. phagocytophilum according to PCR. However, 7 white blood cell samples of KWD were not propagated in HL60 and THP-1 cell line. Twelve spleen suspensions of BSFM were pooled for inoculum, and 0.3 ml of spleen suspension was intraperitoneally inoculated into 20 BALB/c mice (5 in each group; total 4 groups). When tested for 10 days post-inoculation, inoculated mice were positive for A. phagocytophilum by PCR. Three of 4 groups were not propagated and 1of 4 groups was propagated in THP-1 cell line. A. phagocytophilum was observed in Wright-Giemsa stain preparations at 9 days after inoculation of cell cultures. Morulae were found on 70% of THP-1 cells at 12 days post-inoculation. Cultured A. phagocytophilum were confirmed by indirect immunofluorescence assay. PCR was performed using 16S rRNA, ankA, groEL, and msp2 gene primers were used to amplify the genes of A. phagocytophilum. All of the nucleotide sequences from cultured isolate were identical with A. phagocytophilum. We isolated the strain of A. phagocytophilum (AAIK isolate) in black-striped field mice (Apodemus agrarius) in the ROK. This strain may be expected to contribute to public health and veterinary medicine.

Sarimah A is a senior medical lecturer at Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia. She received Master of Community Medicine (Epidemiology and Biostatistics) from USM in 2004. She has experience in undergraduate and postgraduate teaching in epidemiology, biostatistics and research methodology. Her main research focuses on the time series modeling and forecasting on communicable particularly on tuberculosis and other diseases. Currently, she is also involved in research on domestic violence against women (DVAW).

Objective: To determine the factors influencing the cure outcome among patients with smear positive tuberculosis.

Methodology: A cross-sectional study was done to 3937 patients with smear positive tuberculosis from 2005 to 2012 in North-east Malaysia. Records of the patients were retrieved and data were collected on socio-demographic, clinical presentation and outcome of the patients. Cure outcome was determined based on Ministry of Health Malaysia for Practice Guidelines for the Control and Management of Tuberculosis of outcome analysis. Data were analysed with simple and multiple logistic regression using SPSS v 20.

Results: Out of 3937 patients, 69.5% were male, 24.9% were diabetes, 43.7% were smokers, 16.5% HIV positive, 68.9% have BCG scar and 13.7% have positive tuberculin test. The finding revealed that 2934 patients with sputum positive patients were cure (74.5%). Male, older age, positive HIV and single marital status were statistically significant reduced the cure outcome with (OR, 95% CI; p value) 0.526 (0.334, 0.830); 0.006, 0.976 (0.963, 0.988); ,0.001, 0.157 (0.097, 0.253); <0.001 and 0.578 (0.368, 0.909); 0.018 respectively. Positive tuberculin test was found significantly increased the cure rate with 2.03 (1.37, 3.01); <0.001. Conclusion:. Close monitoring and reinforcement of DOTS of specific target groups of male, older age, positive HIV, single marital status and negative tuberculin tests may increase the cure outcome among sputum positive smear tuberculosis.

Kabir K belongs to the Department of Social Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.

Background: HIV/AIDS is one of major world public health issue, which continues to get people’s lives while new cases are being infected each year. In 2013, 1.5 million people have died from HIV and 2.5 million new infections have happened. People with different demographic characteristics attend in blood donation, which creates an opportunity for estimation of HIV frequency and its risk factors. We studied data on HIV infection of blood donors from 2011-2014, to estimate frequency of HIV infection and some of its risk factors in Alborz province.

Materials and Methods: In a cross sectional design, data on all blood donors in Alborz province within 4 years from March 2011 to 2015 were studied. The blood transfusion organization registries used for data collection. During the study period, People donated 202814 times in Alborz province. After deleting duplicates (repeated), 109817 people entered the study. Data were described within 95% confidence interval and Chi square, Fisher exact test and logistic regression (backward Stepwise -Wald) used for comparisons and calculating adjusted odds ratios.

Findings: During the study period, 109817 people donated blood. The mean age of donors was 35.8(±9.94) years and most of them (93.7%) were males. During these 4 years, 15 donors confirmed for HIV infection. The rate of infection was 13.66 in 100,000 populations. Rate of HIV infection in women (43.33 in 100,000) and men (11.66 in 100,000) was different (P value<0.042). people who were graduated from high school or academic educations(7.91 in 100,000) had a lower rates than people less than high school graduation( p<0.022).
Adjusted odds ratios indicate that female gender (adjusted OR=3.73, p< 0.042) and education level less than high school graduation (adjusted OR=4.26, p< 0.009) increase the odds of HIV positivity in blood donors.

Conclusion: Rate of HIV infection in blood donors is low which reflects relatively lower rate of infection in our society and cause more blood transfusion safety. Higher HIV infection frequencies in female donors, needs more attention. We don’t know that this pattern can be seen in other regions of the country; but this may be a result of changing pattern of disease transmission from Injecting drug use to heterosexual sex activities. We recommend a wider national research based on available data from blood donation and/or designing studies to better estimate the frequency and its risk factors.

Keywords: HIV, AIDS, epidemiology, Risk factor, blood donors.

Woo Young Choi is a staff scientist in the Division of Arboviruses, National Institute of Health, Korea Centers for Disease Control & Prevention, Chungbuk, Republic of Korea.

Yellow fever virus (YFV) belongs to family Flaviviridae and is important mosquito-borne human pathogens. In this study, we describe the generation of monoclonal antibodies (mAbs) against envelope glycoprotein (E) of 17D Yellow fever vaccine virus for serologic diagnosis. After immunization of BALB/c mice with recombinant E protein, a total of 5 monoclonal antibodies were generated from the spleen of mice. Immunoglobulin types of antibodies were found to be 1 IgG2a/kappa, 2 IgG2b/kappa, and 2 IgG1/kappa. Indirect immunofluorescence assay revealed that all of the mAbs were reactive to YFV-infected cells. These data suggest that 5 monoclonal antibodies can be used for detection of YFV and have the potential for use in serodiagnosis.

Won Ja Lee is a Director, Division of Arboviruses National Institute of Health Korea Centers For Disease Control & Prevention, Chungbuk, Republic of Korea.

Severe fever with thrombocytopenia syndrome (SFTS) is a new emerging infectious disease in China, Japan, and South Korea. It is caused by SFTS virus (SFTSV), in the genus of Phlebovirus (family Bunyaviridae). The major clinical symptoms and laboratory parameters of SFTS are fever, thrombocytopenia, leukopenia, and elevated serum hepatic enzymes, and SFTS patients usually die due to multiple organ failure. In this study, we conducted the complete or draft genome sequencing of SFTSVs which were isolated from patients in South Korea during 2013. The single-stranded RNA genome comprised of three segments: L, M, and S. All coding sequences for five complete SFTSV sequences (L, M and S segment) and ten draft sequences (M and S) from Korean strains were nearly identical, with sequence similarities of 93.9%–100% for the S segment, 93.2%–99.8% for the M segment, and 96.2-97.6% for the L segment. These strains were compared to strains from two neighboring Asian countries, China and Japan. In phylogenetic analysis, the five Korean SFTSV sequences clustered with all of eight Japanese and three of 102 Chinese (KF374682, KJ597825, JQ670934) strains on the L segment. On the M segment, 12 of 15 Korean sequences grouped with all of eight Japanese and two of 106 Chinese (KF374684, KJ597824) isolates. All coding sequences will be studied further to determine the precise phylogenetic features and the transmission pattern.

Oya Bulut has completed her PhD from Selcuk University. She is working in Faculty of Veterinary, Selcuk University. She studied about Ebola viruses in Structural Biology Department of Biological Science, USA Purdue University. She has published papers and presentation about animal infectious diseases. She is interested about resistance genes against infectious diseases recently.

In this study nasal and conjunctival swab samples were obtained from 61 pet dogs with clinical signs of respiratory system. Swab samples (total 132) were passaged on Madin-Darby Canine Kidney (MDCK) cell cultures for three times. Cell culture supernatant obtained from last passage was tested for Canine Parainfluenza Virus Type 2 (CPIV-2) by Immunofluorescence (IF) test. Swab samples were inoculated onto MDCK cell cultures and subjected to three passages and no CPE was observed. All cell culture supernatants were analyzed by IF test but no positive results to be determined. Although all of the samples were determined as negative, dogs showing clinical signs of respiratory system should be examined for the presence of other respiratoric viral agents.

Kamil Uney (PhD, Assoc. Prof.) is currently working in Faculty of Veterinary Medicine, Selcuk University, Turkey, as teaching staff and principal investigator in Department of Pharmacology and Toxicology since 2003. He graduated from Selcuk University, Faculty of Veterinary Medicine (2001). He received Pharmacology and Toxicology degree from Selcuk University, Graduate School of Health Sciences (2007). His current research projects are studies including pharmacokinetics, therapeutic drug monitoring, the development and validation of method in drug analysis and producing of quality control sera. He has also studies in the drug metabolism, transporter proteins and the use of probe drugs in animals.

Ceftiofur is a broad spectrum third generation cephalosporin antibiotic developed especially for use in animals. The aim of present study is to determine the pharmacokinetics of ceftiofur and its metabolites after single intravenous (IV) and intramuscular (IM) injections at a dose of 2.2 mg/kg BW in rabbits. Six healthy, male, 7-9 months, 3.14±0.28 kg rabbits were used for the study. In pharmacokinetic study, the crossover design was performed. The withdrawal interval between the phases of the study was 15 days. Ceftiofur sodium was administered by IV bolus and IM injections at the dosage of 2.2 mg/kg BW to each rabbit. Plasma concentrations of desfuroylceftiofur were determined using the high-performance liquid chromatography. Plasma concentration–time curve of desfuroylceftiofur was best fitted to a two-compartment open model. Following IV injection, the major pharmacokinetic parameters (mean±SD) were distribution half-life (t1/2α) 0.34±0.07 h, elimination half-life (t1/2β) 2.75±0.59 h, volume of distribution at steady-state (Vdss) 260±71 mL/kg, area under the plasma concentration-time curve (AUC) 20.47±1.86 µg.h/mL, total body clearance (ClT) 108±10 mL.h/kg. After IM administration, the principal pharmacokinetic parameters (mean±SD) were absorption half-life 0.09±0.03 h, peak plasma concentration 9.94±1.35 µg/mL, time to peak concentration 0.25 h, t1/2α 0.31±0.16 h, t1/2β 2.84±0.68 h, AUC 20.11±2.49 µg.h/mL. The bioavailability after IM injection was 98±4.4%. Results indicated that ceftiofur was absorbed quickly and excellent bioavailability after IM administration. Single IV and IM injections of ceftiofur at a dose of 2.2 mg/kg may be effective to maintain the minimum inhibitory concentration (MIC) up to 12 h in rabbits against susceptible pathogens with MIC≤1 μg/ml.

Nermin Isik belongs to the Department of Parasitology, University of Selcuk, Turkey.

The aim of this study was to determination of role infection in neonatal calves in Central Anatolian, Turkey. A total 300 fecal samples were collected from diarrheic neonatal calves, aged between 0–90 days from Konya, Karaman, and Aksaray from January to April 2014. Fecal specimens from calves with clinically diarrheic symptoms were examined for the presence of Bovine Coronavirus, Bovine Rotavirus, Cryptosporidium sp., and E. coli by commercially available capture direct enzyme linked immunosorbent assay (ELISA) kit and Modified Ziehl Neelsen method (MZN). Calves were grouped according to their age as follows: 1-14, 15-29 and 30-90 days. Cryptosporidium sp. infection was detected in 52.8%, 58.8% and 39.2% by ELISA and 33.9%, 47%, 26.7% by MZN in the respective age groups. The seroprevalance of Rotavirus (12.5%, 40%, 12.5%), Coronavirus (2.5%, 0%, 3.5%) and E. coli (5%, 4.7%, 8.9%) infections were determined according to the age groups respectively. Cryptosporidium sp. was the most detected enteropathogen (52%) of calves and coronavirus was the least detected (2%). The detection rate of the mixed enfection was 9%. In conclusion, it must be evaluated by mix infections in calves with diarrhea. These results will provide an important contribution against the factors that cause diarrhea.

Keywords: Cryptosporidium sp., Bovine Coronavirus, Bovine Rotavirus, E.coli, calve, ELISA

Ozlem Derinbay Ekici belongs to the Department of Parasitology, Faculty of Veterinary Medicine, University of Selcuk, Turkey.

Bovine coccidiosis is a protozoan disease caused by various species of Eimeria and most signs of disease are chronic or subclinical. The aim of this study was to determine the prevalence of Eimeria spp. in calves in Konya, in Turkey. The study, conducted from January- February 2015, involved 240 faecal samples of calves in the age groups of <1 month, 1-3 months and >3 months in Konya city centre, in Turkey. In a retrospective study from these faecal samples of calves submitted to the University of Selcuk, Faculty of Veterinary Medicine, Laboratory of Parasitology were evaluated regarding the prevalence of Eimeria spp. Faecal samples were examined by Fulleborn saturated salt floatation technique. Eimeria oocysts were found in 8.33% of all samples. The positivity rates in each of the age groups were different. According to the age groups (<1 month, 1-3 months and >3 months), the Eimeria spp. were determined as 0.83, 22.73 and 7.41%, respectively. After examination of stool, detected oocysts were sporulated in 2.5% potassium dichromate at 22º C and species were identified as E. cylindrica, E. zuernii, E. ellipsoidalis, E. subspherica, E. bovis, E. auburnensis, E. canadensis, E. illinoisensis and E. brasiliensis in infected calves. In conclusion, the highest prevalence was observed in the age group of 1-3 months. The presence of Eimeria species in calves demonstrated for the first time in the Konya region in Turkey. Other etiologic agents should also be investigated in calves more seriously. Further molecular epidemiological studies should be performed in this community.

Shafi Alqahtani completed the bachelor degree in medicine at age of 24years from Prince Sattam bin Abdul Aziz university, Alkharj ,Saudi Arabia . He have under published more than 4 papers and more than 2 papers underprocess. Attended same conferance, Campaigns and workshop.

Background: Middle East respiratory syndrome coronavirus (MERS-CoV) that causes MERS disease was first identified in 2012 in Saudi Arabia. Since that cases have spread within the Kingdom and some cases were transmitted to other Middle Eastern countries, Europe and the United States. However, KSA remains the epicenter of this serious respiratory infection that is associated with high mortality rates. This accentuates the public health concerns because Saud Arabia receives millions of pilgrims from all over the world.

Aim: This study investigated the attitudes and degree of awareness about MERS-CoV among Saudis of different ages.

Patients and Methods: Structured anonymous closed ended dichometous questionnaires were distributed to a large population of Saudi men and women of different ages. The questionnaires included questions about modes of transmission of corona virus, clinical features, outcome of infection, the impact of infection on pilgrimage, methods of prevention, the governmental efforts to combat spread, the availability of information.

Results: Respondents were recruited for the study by random selection. Sixty-eight percent of respondents have good knowledge about the mode of transmission, 82% were aware about the seriousness of the infection, 51% responded positively to non availability of curative treatment or vaccine. 74% knew the modes of prevention and 93% believed that the government efforts were successful. Of the respondents, 41% considered MERS-CoV was a serious risk during Hajj or Umrah. Government media, the Saudi Ministry of health posters, radio and television, the social media was the main source of information among young adults and older participants.

Conclusion: The findings suggest that the level of awareness about MERS-Cov in among this Saud population is high and the level of perception reasonable. The governmental health education campaign is critical for increasing MERS-Cov infection awareness.

Muteb Aldawsari completed the bachelor degree in medicine from Prince Sattam bin Abdul Aziz university, KSA.

Background: Middle East Respiratory Syndrome (MERS-CoV) is caused by a novel betacoronavirus (MERS) which was first reported in Saudi Arabia in September 2012. It is caused by a corona virus called MERS-CoV. The disease resulted in severe respiratory illness and mortality rates ranging between 40-60%.

Aim of the Work: This systematic review analyses the clinical presentations of MERS-Cov infection in the Kingdom of Saudi Arabia.

Data sources and Study selection: We searched for all relevant English language publications with the terms “Middle East respiratory syndrome”, “MERS-CoV”, and “HCoV-EMC” individually and in combination with the terms epidemiology, transmission, clinical presentation, sequence. We searched MEDLINE, conference abstracts, Saudi Ministry of Health data, World Health Organization data and Centers of Disease Control data and statistics from 2012; references until 2015.

Data Extraction: Two reviewers extracted information on study design, population characteristics, clinical characteristics, disease outcomes and assessed risk of bias.

Data Synthesis: We included 139 studies published in Medline, 218 Saudi MOH, WHO and CDC notifications. As of 19 April, 2015, 979 cases of MERS-CoV(67% of men and 33% women) were reported in KSA. The mortality rate was 43.5% (427 patients). Five hundred eight patients were managed and resolved the infection. The majority of cases (72%) are above 40 years, 25% are 20-40 years old, and 3% are less than 20 years. Early cases were clustered in the Eastern region, however by mid-2013 cases emerged in central and Western Saudi Arabia. Intrfamilial spread, occupational transmission for health care workers, exposure to camels were the identified modes of transmission. In 82% of cases, flu like symptoms and fever were initially observed. Positive cases showed progressive rise in fever, cough, and shortness of breath. Pneumonia, respiratory failure that requires mechanical ventilation and support in an intensive‐care unit occurred in advanced cases. Gastrointestinal symptoms particularly diarrhoea, has been reported. Some patients developed renal failure and septic shock.

Conclusion: More studies are required to elucidate the modes of transmission of MERS Cov. Interpersonnal transmission is an important risk factor particularly in familial abd hospital settings. Severe upper respiratory infection is the prominent clinical presentation

Adelowotan AO belongs to the Department of Medical Microbiology, University of Pretoria, South Africa, Department of Microbiology, University of Lagos, Nigeria.

Introduction & Aim: African countries lack detailed and current surveillance information on circulating pathogenic S. aureus isolates because of limited resources. Preparedness to control outbreaks may therefore take longer. While Africa awaits uniform infectious diseases surveillance and reporting systems for the region, the sporadic contribution of research groups from the continent is noteworthy. Genotyping provides epidemiological data on circulating pathogens. Information on circulating S. aureus genotypes from western Nigeria is about eight years old. Previous sporadic S. aureus clones reported in Nigeria include sequence type (ST) 88, ST 5 and ST 8, a clone which is pandemic in Canada, several European countries and the United States. This study provides information on the circulating sequence types of selected S. aureus pulsotypes from western Nigeria.

Methods: Clinical S. aureus isolates were collected from a tertiary hospital in western Nigeria. Isolates were clustered into pulsotypes using pulsed field gel electrophoresis (PGFE). The sequence types as well as clonal complexes (CC) of selected pulsotypes were analysed using the multi locus sequence typing (MLST) method and the e BURST database respectively.

Results: The most prevalent clonal groups were the CC 15-ST 789 [31% (5/16) and CC 1-ST 8 [25% (4/16). Other circulating strains in the study were CC 1-ST 5, the Bengal Bay CC 1-ST 772, CC 9-ST 88 and CC 22-ST 152. The most prevalent clonal complex was CC 1 which includes ST 8, ST 5 and ST 772. Strains ST 772 and ST 789 have not been previously reported in western Nigeria.

Discussion & Conclusion: Pandemic and sporadic S. aureus strains belonging to ST 8, ST 88, ST 152 and ST 5 detected in this study, have been reported in previous studies in western Nigeria. The most prevalent ST 789 in this study has been previously reported in neighbouring Ghana while ST 772 is a transmitted strain reported in parts of the world including Saudi Arabia. Although patients history showed previous visits to these countries which may indicate possible source of transmission of these clones to Nigeria, further comparative genomic analysis will be required for confirmation.

Keywords: Staphylococcus aureus, PFGE, MLST, Nigeria

Himani B Pandya has completed her PhD. (medical microbiology) from Pramukh Swami Medical College, Karamsad, affliated to Sardar Patel University. She worked as a Lecturer and Head of department (MLT) for 11 years at Shree P.M. Patel college of Paramedical science and technology, Anand, Gujarat. She has guided 10 M.sc. MLT students for their dissertation work. She is presently working as a Tutor in S.B.K.S medical college, Gujarat in Microbiology Department. She has published 8 research papers in reputed national and international journal.

Distinct virulence factors of H. pylori have been described: the vacuolating cytotoxin (vacA), the cytotoxin associated gene (cagA), the induced by contact with epithelium factor Antigen (iceA gene) and the urease C gene (ureC). This cross sectional study aimed to investigate the prevalence of the vacA, cagA, iceA and ureC genotypes of H. pylori isolates. 71 biopsy samples were subjected to PCR, DNA isolation from biopsy was done by using “QIAamp DNA mini kit” from QIAGEN. Isolated genomic DNAs were processed for PCR. Out of the 71 biopsies screened, 22(31%) samples were positive for H.pylori by PCR. PCR results showed high proportion of cagA positive (23.94%) followed ure C genes (5.63%) and vac A (1.4%). Prevalence of cagA was higher in age group 21-40 yrs. (52.94%), followed by 41-60 yrs. (35.29%) and 61-80 yrs. (11.76%). prevalence of cagA was higher in females (10/17), compare to males (7/17), statistically significant (p value-0.042 < 0.05). Out of 17 cagA+ stains 9 were causing Gastritis (52.94%), 5 causing reflux esophagitis (29.41%) and 3 were causing duodenal ulcer (17.64%). We have 0% prevalence of iceA gene, conversely we had 3 peptic ulcer patients and all the three were cagA positive but iceA negative. We conclude that Prevalence of cagA genotype is higher in the Anand district compare to other genotypes. We also conclude that iceA genotype is not a useful marker of virulence in this population and that the progression from gastritis to peptic ulcer must require some other genes.

Ashraf O Abdellatif is a PhD student at Microbiology and Immunology department, Faculty of Pharmacy Cairo University and he has published 3 papers in reputed journals.

The plant Melaleuca alternifolia (Tea tree) has been used as topical antiseptic remedy for decades. The aim of this study was to investigate antimicrobial activity of tea tree oil (TTO), greenly synthesized silver and Sulphur nanoparticles (AgNPs and SNPs) against representative skin pathogens namely; Staphylococcus aureus, Methicillin resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa and Candida albicans. TTO was obtained by hydro distillation of plant leaves, while AgNPs and SNPs were prepared in leaves aqueous extract by using silver nitrate and Sodium Thiosulphate respectively. Thirty eight compounds were characterized by GC-MS analysis of TTO, among them Terpinen-4-ol , Limonene, γ-Terpinene, α-Terpinene, Cineol and α- Terpinolene. The result of the bioassay showed that oil possesses potent antimicrobial property especially against MRSA with inhibition zones ranging from 17 to 22 mm compared to standard kanamycin, Polymyxin and Nystatin with no activity against Pseudomonas aeruginosa. On the other hand AgNPs and SNPs were characterized by Transmission Electron Microscope (TEM). Both AgNPs and SNPs showed good activities against tested strains with zone of inhibition ranging from 13-16 mm. In conclusion, TTO, AgNPs and SNPs have been found to be effective against selected pathogen and this can provide a cheap broad active alternative to treat related skin infections. These activities prove the use of this plant in folk medicine as well as deserve much more work to develop a micro emulsion based transdermal delivery formulations of TTO and nanoparticles to synergize their antimicrobial abilities.

A Aslanyan managed to get into the University of Sheffield to do Medicine. After graduation in 2014 started working in Scunthorpe General Hospital as a Foundation Year 1 doctor. He already had rotations in Urology department (where he did the audit that he is going to present) and Gynaecology department. At the moment he is working in elderly medicine and stroke unit. He moved to Hull in August 2015 for his Foundation Year 2 where he is going to have rotations in Accident and Emergency, Psychiatry and Neurosurgery.

Introduction: The incidence of an allergic reaction to antibiotics is as high as 5-10% 1. Interestingly, a significant number of patients are under the impression that they are allergic to certain medications, but in fact, some of these cases are not true allergies but side effects. False drug allergy status can potentially compromise patients’ care and increase healthcare expenses.

Objective: This audit looks at
1) how well allergy status is recorded in medical and surgical wards at SGH
2) Are the appropriate red wristbands given?
3) What is the percentage of patients who are labelled as ‘allergic to certain medications’ have a true allergy?

Method: Data was collected from 99 random medical inpatients and 101 random surgical inpatients using our designed proforma. The proforma asked the following questions:
1) Does the patient claim to have allergy?
2) If yes - what reaction is it?
3) Is the allergy status recorded in clerking sheet and drug chart?
4) Is the allergic reaction recorded?
5) Are appropriate wristbands given to the patients?

Results: 30% of patients claimed that they have allergy. Only 89% and 97% of allergy status was recorded in clerking sheets and drug charts respectively. Out of the patients who had an allergy only 33.3% of allergic reactions was recorded. Only 40.3% of patients had true allergy (anaphylaxis; breathlessness; rash; swollen lips, face, etc.) and the rest had side effects which they thought are allergic reactions (e.g. stomach pain, muscle ache, sweating, diarrhoea and vomiting, etc.). Out of the patients who had an allergy 16.7% could not remember the allergic reaction and another 8.3% were not even aware that they had drug allergy even though it was mentioned in the notes. Overall 6% of patients did not have appropriate red wristbands on and another 6% of patients did not know that they have allergy.

Conclusion: According to the data only 1/3 of patients had the type of reaction recorded. Almost 35% of patients who were labelled as ‘allergic to certain drug’ had a false allergy. These data showed that it is very important to give appropriate wristbands to the patients with allergy because sometimes they do not remember/know that they have drug allergy. For optimal management of infectious diseases, the choice of most suitable antibiotic is essential. This audit aimed to highlight the importance of detailed record of allergy status and the potential implications in patients’ safety.

Kichan Lee is currently working in the Laboratory of Enteric and Respiratory Disease, Bacterial Disease division, Animal and Plant Quarantine Agency, Republic of Korea.

Clostridium tetani and Clostridium botulinum, respectively, produce botulinum neurotoxin (BoNT) and tetanus neurotoxin (TeTx), which is responsible for severe disease, botulism and tetanus. Several cattle botulism and tetanus occurred sporadically in Korea recently. Since these diseases could become a potential hazard to livestock industries, we investigated the distribution of C. tetani and C. botulinum in various samples of cattle farms in Korea. A total of 819 samples including cattle feces, stomach contents, hay and silages, soils, water trough were collected during 2012 to 2014, and incubated with anaerobic condition. The enrichment cultures were subjected to multiplex PCR developed in our laboratory for screening the presence of C. tetani and C. botulinum type B, C and D, and mouse neutralization test was also used for determination of the toxin type. Thirty six C. tetani were isolated from soils, 36 from feces, 24 from gastric contents, 7 from forage, and 11 from other sources. According to multiplex PCR, toxigenic strains were 99 (86%) of C. tetani isolates and non-toxigenic ones 15 (14%) of the isolates were non-toxigenic. Eight C. botulinum type B strains were isolated from forage and water trough, 1 C/D mosaic type from stomach contents and 18 type D from feces, stomach contents, water trough and forage. These studies demonstrated that C. tetani and C. botulinum were prevalent in cattle farms in Korea.

Zagala AF, MD, FPCP, recent graduate fellow from the Section of Pulmonary Medicine of the University of the Philippines-Philippines General Hospital. She had pre-medicine at De La Salle University-Taft, Manila (2000-2003) with BS Biology degree. She took her medicine at University of Santo Tomas- Faculty of Medicine and Surgery (2003-2007). She had internship at Chinese Gen-eral Hospital (2007-2008). Finished her residency in Internal Medicine at Makati Medical Center and went to University of the Philippines-Philippines General Hospital for Adult Pulmonology.

The problem of tuberculosis disease is global and the Philippines is 9th out of the 22 highest TB-burden countries in the world. Effects of the disease go beyond health, but also cause pronounced burden in the country’s economy. Aside from immediate loss of income for the infected household member, other family members are also affected in their efforts to provide care. Hence, it is estimated that some countries lose from four to seven percent of their GDP because of the disease. In our country, the individual economic losses is about 7.9 billion pesos (US$145 million) in lost wages from illness or disability and premature deaths. Definitely, care of people with TB is extremely important thus strategies to control TB are crucial to both confirmed and suspected individuals who harbour this disease. Various guidelines have been published in an effort to standardize the management of TB worldwide. Efforts have been made to encourage adherence of physicians to these guidelines. Thus, the World Health Organization (WHO) and the American Thoracic Society (ATS) published the first edition of the International Standards for Tuberculosis Care (ISTC) in 2006. Its purpose was to provide a widely accepted level of care that all practitioners should follow to in managing patients who have, are suspected of having, or are at increased risk of developing TB. The first version of the ISTC set 17 standards: six on TB diagnosis, nine on treatment, and two for the public health responsibilities that every health provider who care for persons afflicted with TB should adopt. At the time the first edition was published, a commitment was made to ensure that the ISTC became a living document that would be updated as new information emerged. Hence, in 2009 a second edition was made to encourage associated health professionals to endorse the standards and promote engagement of non-National Tuberculosis Program (NTP) care providers. This time, it incorporated 21 standards, which included revisions and expansion of some of the original standards and four completely new standards addressing co-morbid conditions, isoniazid preventive therapy in children and HIV-infected persons, and prevention of infection transmission in health care facilities. The consistent adoption of these new standards is perceived to enhance the care of TB persons and reduce morbidity and mortality of the disease worldwide.
Recent studies showed that in the 22 countries with the highest prevalence of TB including the Philippines, a mean of 62.6% of the total health expenditure is spent on private health professionals. Furthermore, 1/3 of all Filipinos with TB symptoms prefer to consult private physicians for treatment. And lots of these private practitioners (PPs) prefer to use management options other than TB DOTS, a treatment strategy which may have serious implications on the quality of TB care. With the activities and initiatives started in 2009 to reinforce the standards embodied in the ISTC since 2006, the investigators would like to describe the adherence of third year residents –in- training (Internal Medicine and Family Medicine from University of the Philippines, Philippine General Hospital, 2012-2013) to the ISTC 2009 guidelines. These trainees had been through multiple CMEs, round table discussions, and TB seminars during their training, hence it is the aim of this paper to determine if the efforts made since 2009 were translated into knowledge and actual practices of the physicians especially those who are in-training. These residents-in-training act as front liners in the delivery of primary health care services in the various points-of-care in hospitals and are probably expected to pursue private practices in the future.

Specific Objectives of this study are:
(1) to determine the proportion of physicians-in-training under Internal Medicine, and Family Medicine from the University of the Philippines- Philippine General Hospital from 2012 to 2013 adhering to International Standards for Tuberculosis Care (ISTC) 2009 based on: Standards 2,3 (Diagnosis); Standards 8, 10,13 (Treatment); Standard 14 (Addressing HIV Infection and other Co-morbidities); Standard 21 (Public Health and Prevention). These standards were selected based on the common practices and considered by investigators deemed important in tuberculosis care.
(2) To determine the most and the least adhered to standards among the said population.

Methodology: This study was done through review of randomly selected 59 outpatient records from January 2012 to December 2013 of TB patients seen by all third year residents from Internal Medicine and Family Medicine in UP-PGH. Outcome variables were the number of residents-in-training following the selected ISTC core standards: Standards for: Diagnosis (2,3); Treatment (8,10,13); HIV Infection and other Co-morbid Conditions (14); and Public Health and Prevention (21).

Results: Standards 2 (at least 2 sputum specimens), 17 (thorough assessment of co-morbidities), and 8 (use of 1st line treatment regimen) were noted with higher number of residents adhering with 88.1% (52/59), 76.3% (45/59) and 64.4% (38/59) respectively. Standard 14 (HIV testing among TB patients) was only documented in 15.2% (9/59) residents.

Conclusion: Standards 2, 17, and 8 were the most adhered ISTC guideline while standard 14 was least adhered to. Reinforcements are needed to provide updates to scale up TB management of residents-in-training based on international standard through regular continuing medical educations (CMEs) , forums and/or seminars and feedbacks. Mechanisms and infrastructures should be in place to facilitate adherence to the ISTC.