2^nd World Congress on Infectious Diseases August 24-25, 2016 Pennsylvania, Philadelphia, USA

Samer M Al-Hulu is an Assistant Professor of Microbiology. He has completed his PhD from College of Science, Babylon University. He has published more than 14 papers in microbiology field. He has trained at Ministry of Health at Laboratory of Babylon Maternity and Children Hospital. Presently, he is working at College of Food Science, Al-Qasim Green University.

Superbugs is the term which used for describing of multidrug-resistant organisms that evolved and developed resistance to at least one type of antimicrobial drug or antibiotic. MRSA, VRE, ESBLs are some examples on superbugs. The combating of superbugs can be achieved by proper hand washing and using of good hand hygiene. DNA Sequencing of superbugs playing an important role in combating of spread such as DNA sequencing from patient and compared with database for determining source of infection. Using of Nano-based therapy for combating of superbug such as using of nano metals and metallic oxides which having high activity against board spectrum antibiotic resistant bacteria such as AgNPs which having high activity against MRSA and silver resistant E. coli, also using of Nano-enabled antibiotics such as using drug delivery system and using of other methods such as cellulose nano crystals-porphyrin, CNTs and others. Other solution for combating of superbugs is prevent of antibiotic misuse and overuse which due to developing of resistant for antibiotics via one or more mechanisms of DNA alteration. Essential oil having a new weapon for combating of superbugs, oil is derived from variety of natural sources including plants or component of plants such as flowers, leaves and others, these oil having complex mixtures of chemicals which having antimicrobial activity. Phage therapy is plays an important role for fighting of drug-resistant pathogens.

Jamshaid Iqbal is a consultant at Mubarak Al-Kabir Teaching Hospital, Kuwait and he is the director at center for medical education and faculty of medicine at Kuwait University, Kuwait.

Background: Prostate cancer and benign prostatic hyperplasia (BPH) represents the most common urologic disease among the elderly males resulting in more than 2 million visits per year. BPH affects about one-quarter of men in their 50s. The pathogenesis of BPH is not yet completely understood however, the role of chronic inflammation is emerging as an important factor in BPH development and progression. Recently, the studies have found that T. vaginalis may be associated with asymptomatic infections in 50-75% of infected men. In this study we investigated the possibility of asymptomatic persistence of T. vaginalis in the prostate gland using benign hyperplastic prostate tissue as prostate condition other than clinical prostatitis.\r\n\r\nMaterials & Methods: We investigated the occurrence of T. vaginalis in prostate tissue of 75 men of >50 years of age suspected and treated for BPH by transurethral resection of the prostate at the Mubarak Al-Kabir Teaching Hospital, Kuwait. The presence of T. vaginalis infection in the prostate tissue was determined by PCR analysis of the DNA extracted from the tissue and Immunocytochemistry of the tissue sections of the prostate tissue. In addition, P16 antigen was also detected in the tissue sections. The antibodies to T. vaginalis were also determined in blood.\r\n\r\nResults: We detected T. vaginalis DNA in 18 of 75 (24%) and P16 antigen in 16/75 (21%) of BPH tissue samples, of which only 7 (39%) BPH tissues were positive by immunocytochemistry. In addition, three T. vaginalis DNA-negative prostate tissues were also positive immunochemistry. T. vaginalis-specific antibodies with predominantly IgG4 antibodies were detected in 23 (31%) cases.\r\n\r\nConclusion: Our preliminary study suggests a direct evidence of T. vaginalis in BPH tissues with no clinical signs of prostatitis. We hypothesize that chronic T. vaginalis infection of prostate tissue may lead to BPH in elderly people.

Andre Ricardo Araujo Da Silva has completed his PhD from FIOCRUZ-National Institute of Infectology, Brazil. He is an Associate Professor of Neonatology at Federal Fluminense University, Brazil, Coordinator of Scientific Program of Medicine Course and also leads the Laboratory of Teaching of Prevention and Control of Healthcare associated infections. He has published more than 15 papers in reputed journals and is a Member of International Federation of Infection Control.

Multidrug-resistance is a global concern. This is a major problem within intensive care units (ICU), where usually doctors have few options to treat healthcare associated infections (HAI). The aim of our work is to describe profile of Gram-negative resistance in cases of HAI occurred in a Pediatric Intensive Care Unit (PICU) of reference. We did a prospective study of all HAI reported in PICU of Prontobaby-Children’s Hospital, with focus in infections due to Gram-negative bacteria. We used National Healthcare Safety Network (NHSN) criteria to define HAI. Gram-negative resistance was defined according Magiorakis criteria. In seven-years of follow-up (from January 2009 to December 2015), we reported 224 HAI. 65 cases were due to Gram-negative and global rates of resistance reported were 47.7%. HAI rates ranges from 9.4 to 15.1 per 1000 patient-days in PICU, during the study. In five of seven years, Gram-negative resistance was higher than 50%. During this period only two HAI due to Enterobacteriaceae resistant to carbapenem were reported (0.9% of all HAI). The main agents founded are Enterobacteriaceae ESBL producers and P. aeruginosa resistant to carbapenem. In our casuistic, we found higher rates of Gram-negative bacterial resistance in cases of HAI. To avoid this problem, it is necessary to develop strategies to reduce incidence of HAI, even in critical ill children. Also, new treatment options are urgently needed.

Luis Del Carpio Orantes is a Medical Specialist in Internal Medicine and also an Internist in Mexican Social Security Institute. He is assigned to ICU Internist, D\'Maria Hospital and he is also an Expert Columnist for the Iberoamerican Society of Scientific Information with the theme of emerging viruses. He has published articles related to intensive care (negative pressure pulmonary edema and disseminated intravascular coagulation in the ICU) and epidemiology, regarding dengue, zika, chikungunya and influenza which can be referred in PubMed and other index. He is an Independent Researcher, projects a research on the treatment of dengue.

Objective: Casuistry of invasive candidiasis is reviewed on an intensive care unit, applying the candida score to assess their potential predictor of HIV infection.\r\n\r\nDesign: Retrospective, observational and descriptive study.\r\n\r\nMethods: The Candida score is applied retrospectively all identified cases of invasive candidiasis to evaluate its effect predictor of the disease; also the most common strains and their risk factors identified in this population are identified.\r\n\r\nResults: The casuistry of the intensive care unit were reviewed, which had 102 patients in the period 1 January to 31 December 2014, of which Candida infection in 14 patients (13.7%) was reported. Being the most affected female gender with 10 patients (71.4%), also the most affected age group was 81-90 years, followed by 71-80 years. The stay in the ICU, at the beginning of candidiasis averaged 8 days. Infection of an anatomical site was identified in 9 patients and in 5 patients in two anatomical sites with predominant involvement in the lungs (10 isolates), the urinary tract 2nd highest incidence (7 cases), it is noteworthy that no cases of candidemia and there was only one isolate in a central catheter, which was classified as catheter colonization; other cases invasive pulmonary candidiasis and urinary level (the latter probably bladder colonization, favored by use of urinary catheters) were considered. The most frequent isolates were Candida albicans (10 patients) followed by C. krusei (4 patients), C. tropicalis and Candida sp., in 3 patients, respectively. The score Candida was positive in 7 patients (50% score >2.5) but did not correlate with mortality as these patients, only 3 of them were fatal, C. albicans being the most deadly. In this casuistry 8 patients had a good outcome. The presence of a central venous catheter (14 patients), the long stay in the unit (12 patients) and the use of broad spectrum antimicrobials as prior (10 patients) were identified as predisposing factors. Risk factors being the bearer of chronic lung disease, sepsis and cardiovascular disease in 8 patients respectively were identified. Candidiasis appeared after a common course of broad spectrum antimicrobials (3rd generation cephalosporins basically) in 10 patients and only 4 had begun with an antimicrobial greater spectrum (carbapenem, glycopeptide or fluoroquinolone); once identified candidiasis, management began with triazolido (fluconazole in 9 cases and voriconazole in 1 case), meriting a second antifungal adjustment scheme with an echinocandin or voriconazole in 4 cases by persistent candidiasis. Of the 6 deaths, 4 had started operation with fluconazole and despite having given a second scheme with an echinocandin or voriconazole, the prognosis is not improved.\r\n\r\nConclusion: We conclude that the Candida score is a predictive indicator and signals to patients who are at risk for infection with Candida (score >2.5), but does not predict the mortality rate of each case. Risk factors and predisposing factors are similar to those reported in other series, only highlighting in this series, the presence of chronic lung disease, as correlational would explain the higher incidence of lung isolation level and in elderly patients. Also regarding the treatment employed, it is recommended that a positive Candida score, antifungal management spectrum starts, primarily an echinocandin or voriconazole, to try to improve the survival rate of these patients, who are often elderly patients, anergic, diseases chronic degenerative and high rate of morbidity and mortality and can be considered as neutropenic patients. In this series, chronic lung disease served as a major risk factor, which has not been previously reported, since in the literature to Aspergillus is mentioned as the leading pioneer in these patients which was not confirmed.

Luis Del Carpio Orantes is a Medical Specialist in Internal Medicine and also an Internist in Mexican Social Security Institute. He is assigned to ICU Internist, D\'Maria Hospital and he is also an Expert Columnist for the Iberoamerican Society of Scientific Information with the theme of emerging viruses. He has published articles related to intensive care (negative pressure pulmonary edema and disseminated intravascular coagulation in the ICU) and epidemiology, regarding dengue, zika, chikungunya and influenza which can be referred in PubMed and other index. He is an Independent Researcher, projects a research on the treatment of dengue.

Case Report: Male patient 36 years old with no history of importance except filing burn in your hands by electricity, admitted with symptoms 20 days of evolution characterized by fever, cough and yellowish expectoration, being treated with common antimicrobials previously, developed persistent fever so as right pleuritic pain, so entered, diagnosis protocol which only evinced leukocytosis of 13500/mm3 without respiratory, kidney or liver involvement starts. Smears are performed in series of 3 being negative, a first scan, which reports pneumonic process 70% with diffuse cavitary lesions in addition to air bronchograms (March 14), started treatment with imipenem and vancomycin is performed. The report cultivation expectoration was Staphylococcus epidermidis coagulase negative resistant to vancomycin handling adjusted with linezolid, a second tomography was performed which demonstrated increased cavitary, extended zones into the pleural cavity with multiple septums and fluid levels, so as destruction of lung parenchyma in middle and lower lobe of the right lung (March 20); by poor evolution of painting it was decided to send chest surgery but was managed conservatively, died after 5 days in the service management.\r\n\r\nConclusion: This case has clinical significance, since it illustrates the severity of necrotizing pneumonia, also aggressiveness with coagulase-negative germs, referred to as nosocomial pathogens emergency epidemiological displayed. The importance of pulmonary tomography for the diagnosis and therapeutic decisions also emphasized that in this case was fully indicated the surgical management, primodial mainstay of treatment of necrotizing pneumonia, combined with the antimicrobial medical treatment.

Tania M Kohal was graduated from the University of California Berkeley with Bachelor’s degrees in Molecular and Cellular Biology and Latin.

Introduction: Advances in pharmacological therapy have changed the narrative of individuals diagnosed with HIV, prolonging quality and length of life, however, prevention remains key in preventing transmission. Our project aims to assess how individuals obtain HIV information and testing services in the hope to better inform how resources for prevention can be effectively allocated.\r\n\r\nMethods: Our study involved designing a flyer to be placed in two clinics, Affirmations and American Indian Health Family Services (AIFHS) in a general information area and a testing area. The flyers contained different web addresses directing individuals to the same web module. This web module contained information about HIV and a survey querying prior testing, risk assessment and demographic factors. A link was provided from the web module to a website where testing resources were available. We designed a method of tracking web traffic to ascertain the initiative individuals were taking in seeking further information. A focus group was done to evaluate how individuals obtain HIV information for which a qualitative analysis was done.\r\n\r\nResults: Individuals do not readily engage in paper-media based information sources and are more likely to seek out web-based information on their own or respond to directed intervention by peers, physicians, etc.\r\n\r\nConclusion: Our study indicates that resources may be better directed towards web-based information sources and that a directed approach involving healthcare providers, peers, etc. is most effective in encouraging prevention-seeking behaviors.

Luis Del Carpio Orantes is a Medical Specialist in Internal Medicine and also an Internist in Mexican Social Security Institute. He is assigned as ICU Internist at D\'Maria Hospital and he is also an Expert Columnist for the Iberoamerican Society of Scientific Information. He has published articles related to intensive care (negative pressure pulmonary edema and disseminated intravascular coagulation in the ICU) and epidemiology, regarding dengue, zika, chikungunya and influenza.

Case: Woman 24 years old with no history of importance except being operated caesarean operation two months and a half without incident, resulting in macrosomia product. Enter a room trauma shock seizures witnessed at home and during transportation to the hospital, clouding, state initial shock, hypoglycemia, fever, with a history of non-specific prodrome 7 days prior characterized by fatigue and weakness, adding fever 72 hours previous and also presenting with behavioral disorders disorientation 24 hrs prior to admission, the previous night generalized purpuric dermatosis is added. Upon initial review apparently glasgow of 14, but disorientated and psychomotor agitation, presenting shock unresponsive to water resuscitation initial, feverish with suspected neuroinfection, so she underwent cranial tomography which is reported only discrete brain edema; passes intensive therapy for management of shock, after endotracheal intubation seizures and involvement of consciousness. Upon arrival even with persistent hypotension despite double scheme amines (dopamine, norepinephrine) and fluid resuscitation, also high ventilatory requirements with data from acute lung injury, in frank anuria and acute renal injury, severe metabolic acidemia that warrants management bicarbonate, hematologic data franca fails with disseminated intravascular coagulation and purpura generalized data. The antimicrobial management that had been initially with ceftriaxone-vancomycin, leaving vancomycin-meropenem also dose intravenous hydrocortisone (500 mg) is given for suspected acute adrenal insufficiency (manifested by shock, tendency to hypoglycemia, hyponatremia, hypokalemia) is set, is it gives renal support with loop diuretic infusion as well as bicarbonate infusion. He remains in the intensive care unit for 10 hrs, no response to management, a refractory shock, severe sepsis and multiple organ dysfunctions were considered. Since studied with neurological, metabolic and hematological disorders, kidney damage, lung damage, criteria for disseminated intravascular coagulation coupled with widespread purpura, Waterhouse-Friderich sensyndrome was considered, which was devastating for the patient. A 5-day incubation of blood cultures growth coagulase-negative staphylococci were reported, being sensitive to Vancomycin, definitive bacteriological diagnosis, staphylococcus haemolyticus. Negative serology for dengue and leptospirosis were reported, requested by endemic area meet such conditions. First case reported in adults Waterhouse-Friderichsen syndrome secondary to staphylococcus haemolyticus is concluded.

Gabriela Sanchez Petitto has completed her MD from the Universidad Central de Venezuela, School of Medicine. She is currently a Postgraduate student of Internal Medicine at the University of Texas Health Science Center at Houston. She has worked in several projects with hematological malignancies and in the upcoming future with antibiotic resistance projects.

A 67-year-old post-menopausal woman with advanced stage histiocytic sarcoma of the pelvis, presented with 4-day history of abdominal pain and fever. She had local tumor invasion to bladder and cervix requiring bilateral percutaneous nephrostomy tubes. She received chemotherapy and radiotherapy with partial tumor regression. On examination she had an enlarged suprapubic mass and foul-smelling vaginal discharge. A computed tomography (CT) scan demonstrated a large cervical mass occluding the cervical os, causing dilatation of the endometrial cavity, doubling its size compared to one month prior. The patient was started in broad spectrum antibiotics and a cervical catheterization was intended unsuccessfully. A CT guided percutaneous uterine drain was placed in her abdomen and purulent drainage grew Prevotella loescheii. Blood and urine cultures were negative. She was discharged under oral sulfamethoxazole/trimethoprim and metronidazole with clinical improvement. In the subsequent months she underwent chemotherapy and radiotherapy and required long-term percutaneous drainage. Pyometra is defined as the accumulation of pus in the uterine cavity and thought to be a result of interference with the natural drainage of the uterus. Symptoms are non-specific and easily misdiagnosed. Diagnosis can be made clinically by drainage of pus from the uterine cavity and with imaging. Treatment includes drainage along with antibiotics to cover microorganisms such as Lactobacillus iners, Prevotella spp., and Lactobacillus crispatus. Vague abdominal symptoms in a post-menopausal woman with pelvic malignancy should raise concern for pyometra and prompt treatment has to be instituted to prevent the development of the most catastrophic complication; uterine perforation.

Gabriela Sanchez Petitto has completed her MD from the Universidad Central de Venezuela, School of Medicine. She is currently a Postgraduate student of Internal Medicine at the University of Texas Health Science Center at Houston. She has worked in several projects with hematological malignancies and in the upcoming future with antibiotic resistance projects.

A 36-year-old woman with newly diagnosed nephrotic syndrome presented with a 10-day history of progressive vision loss. On ophthalmological exam, visual acuity was 20/800 in both eyes. The left eye showed grade 4 disc edema and both retina had vitreous and intraretinal hemorrhages. HIV serology was positive, CD4 count of 17/ul and viral load of 375000 copies/ml, newly diagnosed. CT head was normal. Cerebrospinal fluid analysis is unremarkable. Serum and CSF immunoglobulins against Toxoplasma spp., PCR for herpes simplex virus 1 and 2, varicella-zoster (VZV) and Cytomegalovirus (CMV) were negative. Empirical ganciclovir, trimethoprim-sulfamethoxazole and prednisolone were started. Vitreal fluid extracted by paracentesis was positive for toxoplasma antigen and negative for CMV and VZV in both eyes. The diagnosis of toxoplasma retinochoroiditis was confirmed. The patient continued a 6-week course of antibiotics with clinical improvement at 4 weeks. In immunocompromised patients is difficult to establish a diagnosis of ocular toxoplasmosis based upon the lesions’ appearance, since atypical lesions are common and obtaining reliable results for immunodiagnostic assays is more difficult. The best clue to diagnosis is recognition of the clinical presentation and the detection of the agent in ocular samples by molecular biology. Confirmation of diagnosis is higher for PCR of vitreous samples compared to aqueous humor; this due to the fact that, anatomically the vitreous humor is closest to the necrotic lesions, leading to a better sampling of the parasitic DNA. In summary, a positive PCR study for T. gondii became a dependable alternative to diagnose retinochoroiditis in an immunocompromised patient.

Sakly Mouna has completed her Medicine studies from El Manar University, Faculty of Medicine of Tunisia. She has submitted her Doctoral thesis in Medicine in 2002, completed Master of Advanced Studies in Economy Health and Hospital Management from the Faculty of Medicine of Tunisia in 2009, Master of Advanced Studies in Tobacco from the Faculty of Medicine of Tunisia in 2010 and Certification Green Belt Lean Manufacturing and Management L2M in 2016. She is the Coordinator of child health programs and primary health care quality program in Tunisia and she is also the Tunisian focal point on disability and deafness and a National Trainer in the counseling and HIV screening among pregnant women. She has published some papers in reputed journals. She is a Reviewer of Public Health Review, France since 2016 and a Teacher of the national maternal and newborn health program in the University Mohamed El Matri at Tunisia.

Introduction: the Influenza is an acute viral infection transmitted by air. It`s a highly contagious disease that can cause serious complications, especially among vulnerable people, it presents a major public health issue with a considerable socio-economic impact.\r\n\r\nPurpose: Review the epidemiological situation of influenza in Tunisia in The 2015-2016 season. Determine if the A (H1N1) virus has a particular virulence in Tunisia during the 2015-2016 season. Make recommendations to overcome challenges.\r\n\r\nMethods: This retrospective study is based on data issued by the National influenza surveillance unit; it relies on a descriptive analysis of influenza surveillance data provided by the network of sentinel sites and national influenza center (NIC).\r\n\r\nResults & Discussion: Influenza surveillance in Tunisia has been in established since 1999 with the creation of network sentinel sites, but it significantly developed on March 2014, by the enhancement of the national influenza surveillance system. In Tunisia, clinical, epidemiological and virological surveillance of influenza began in week 40/2015 (1st of October 2015) and ended in week 18/2016 (30th of April 2016). During the period of study: 96,240 cases ILI (Influenza-like illness) were collected from a total of 1,394,782 patients seen at sentinel ILI sites, representing 6.9% of total patients versus 7.7% during the 2014-2015 season. The epidemiological surveillance of influenza on the Tunisian territory showed that the influenza epidemic was spreading in the winter season 2015/2016 during fourteen weeks from the 25th of January 2016 (2016 / W4) to the 29th of April 2016 (2016/ W18) with an incidence rate of 10.3%. It started a little later than it did during the previous season and lasted relatively longer (14 weeks versus 8 weeks). During the 2014-2015 season, influenza reached its peak during the coldest weeks (S6 to S9) and there was an inverse trend of the monthly average temperature. This correlation has not been observed during this season having regard to the shift of the cold season. In fact, this flu season peaked during the week of 14 to 20 March 2016 (2016/S12), later than usual. These findings were also observed in Europe and in USA. All of the 24 governorates of Tunisia have been affected by the influenza and the incidence is higher in the most populated regions. Children 5 to 16 years are the most affected. Among the visits for influenza-like illness (ILI), 190 severe cases were hospitalized representing a comparable proportion to the previous season (0.19% vs 0.2%) and were mainly infected with A (H1N1) pmd09 virus (57% of cases). The average age for these severe cases was 46.5 years, with extreme ages varying between 6 months and 73 years. Their lethality was significantly higher than that observed during the previous season (20% vs 3%) and was H1N1 associated in 73.7% of cases. During Week 12, there was an increased circulation of influenza viruses in Tunisia and subsequently there were the highest number of deaths (10 deaths representing 26.3% of all influenza deaths). 37.1% of influenza deaths had no risk factors. The co-circulation of the three influenza viruses began in late January (W4) with a gradual increase in the circulation of the type A (H1N1) pmd09 virus. During the week W12, the type A (H1N1) pmd09 virus was more common than the type B. The seasonal distribution of three types of influenza viruses was: Virus A (H1N1) pmd09 (57.4%), Virus A (H3N2) (38.5%) and Virus B (3.5%). The positivity rate for influenza was 24.4% vs 28.4% during the previous season.\r\n\r\nConclusion: The 2015-2016 influenza epidemic started little later than the previous season, marked by the co-circulation of three influenza viruses and the predominance of the virulent type A (H1N1) pmd09 virus, the impact of the epidemic in terms of ILI consultations and hospitalizations was comparable to the previous season, but the lethality of severe cases was significantly higher. Viruses know no borders, control and fight against the influenza require a global vision of the dynamics of the disease in our country, as well as around the Mediterranean in order to better contain any unusual event.