Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 3rd Annual Congress on Infectious Diseases San Francisco, California, USA.

Day 1 :

Keynote Forum

Michael Brady

Nationwide Children’s Hospital, USA

Keynote: Maternal immunizations: Protects mother, fetus and newborn infant

Time : 10:00-10:40

OMICS International Infectious Diseases 2017 International Conference Keynote Speaker Michael 	Brady photo
Biography:

Michael T Brady is an Emeritus Professor of Pediatrics at The Ohio State University. He is a Pediatric Infectious Diseases Clinician and Researcher. He is an Associate Editor of the 2015 and 2018 American Academy of Pediatrics Committee on Infectious Diseases Red Book. He has made presentations on Maternal Immunizations nationally and internationally

Abstract:

Many infectious diseases can adversely affect the health of pregnant women; adversely impact the fetus directly during gestation and cause infectious illnesses in newborn infants who are too young to receive benefit from available vaccines. Globally, 10-50% of still births are due to maternal/fetal infections; 600,000-800,000- neonatal deaths are due to infections. Maternal immunizations with vaccines targeting influenza, pertussis and tetanus have already provided improved maternal health during pregnancy, fewer adverse fatal fetal events and reduced illness in young infants. Infections in young infants frequently result in illness and the need for medical care; while some result in morbidity and even mortality. Some of these infections are due to vaccine-preventable conditions which are acquired at an age prior to completion of an effective vaccine series, e.g. influenza, meningococcal group B, pertussis. Other infections are caused by infections for which there is no currently available vaccine, e.g. group B streptococcus and respiratory syncytial virus (RSV). Utilizing vaccines more effectively during pregnancy could result in better health outcomes for the mother, her off-spring or both. Future candidates for maternal immunizations include: Group B streptococcus vaccine, respiratory syncytial virus vaccine, meningococcal group B vaccine, meningococcal conjugate vaccine (MenACWY) and pneumococcal conjugate vaccine. Considerations that will impact successful utilization of a maternal immunization strategy include: Vaccine safety during pregnancy: Mother and fetus, vaccine efficacy for mother, fetus and infant, increasing capacity and acceptance of vaccine administration by obstetric providers and cost.

Recent Publications

  1. Omer SB (2017) Maternal Immunization. NEJM 2017. 374: 1256-67.
  1. Edwards KN (2017) Ensuring vaccine safety in pregnant women. NEJM 2017. 376: 1280-1282.
  1. Kourtis A P, Read J S, Jamieson D J (2014) Pregnancy and Infection. N Engl J Med 2014. 370: 2211-2218.
  1. Munoz FM, Bond NH, Maccato M, et al. (2014) Safety and immunogenicity of tetanus diphtheria and a cellular pertussis (Tdap) immunization during pregnancy in mothers and infants: a randomized clinical trial. JAMA 2014. 311: 1760-1769.
  1. Tapia M D, Sow S O, Tamboura B, et al. (2016) Maternal immunization with trivalent inactivated influenza vaccine for prevention of influenza in infants in Mali: a prospective, active-controlled, observer-blind, randomised phase 4 trial. Lancet Infect Dis 2016. 16: 1026-1035.

Keynote Forum

Stef Stienstra

Dutch Armed Forces / Royal Dutch Navy, Netherlands

Keynote: Cooperation in public health to fight infectious diseases in developing countries is good for the global economy

Time : 10:40-11:20

OMICS International Infectious Diseases 2017 International Conference Keynote Speaker Stef Stienstra photo
Biography:

Stef Stienstra works internationally for several medical and biotech companies as Scientific Advisory Board Member and is also an active Reserve-Officer of the Royal Dutch Navy in his rank as Commander (OF4). For the Dutch Armed Forces, he is CBRNe Specialist with focus on (micro) biological and chemical threats and Medical- And Environmental Functional Specialist within the 1st CMI (Civil Military Interaction) Battalion of the Dutch Armed Forces. For Expertise France, he is now managing an EU CBRN CoE public health project in West Africa. In his civilian position, he is at this moment developing with MT-Derm in Berlin (Germany) a novel interdermal vaccination technology as well as a new therapy for cutaneous leishmaniasis for which he has won a Canadian Grand Challenge grant. With Hemanua in Dublin (Ireland), he has developed an innovative blood separation unit, which is also suitable to produce convalescent plasma for Ebola virus disease therapy. He has finished both his studies in Medicine and in Biochemistry in the Netherlands with a Doctorate and has extensive practical experience in cell biology, immuno-haematology, infectious diseases, biodefense and transfusion medicine.

Abstract:

Public health systems are not always prepared for outbreaks of infectious diseases. Although in the past several public health institutes, like the French ‘Institut Pasteur’ and the Dutch ‘Tropeninstituut‘, were prominent surveyors of infectious diseases, the investments in worldwide public health have decreased. Now more attention is given to curative healthcare compared to preventive healthcare. The recent Ebola Virus Disease outbreak in West Africa initiated a new wave of interest to invest in Worldwide Public Health to prevent outbreaks of highly contagious diseases. Zoonotic diseases are threatening as the population does not have natural nor artificial (from vaccination) immune response to new diseases like in the Ebola Virus Disease outbreak in 2014. The new strain of the Ebola Virus in West Africa was slightly less lethal, compared to other Ebola Virus strains, but the threat of spreading was far bigger as it had a longer incubation time. Most public health systems are not trained well enough to mitigate highly infectious and deadly disease outbreaks. NGO’s helping to fight the outbreak are often better trained in curative treatments and have less experience with biological (bioweapon) threats for which the military are trained for. The UNMEER mission was unique in this. It was a setting in which military and civilian actors cooperate in fighting a biological threat. Protection is essential for health workers. Smart systems have to be developed to prevent further spreading of the disease, but it is not only the biosafety, which has to be considered, but also the biosecurity, as misuse of extremely dangerous strains of microorganisms cannot be excluded. Several zoonotic infectious diseases, like anthrax, smallpox and haemorrhagic fevers are listed as potential bioweapons. Therefor both biosafety and biosecurity have to be implemented in all measures to fight outbreaks of highly infectious diseases.

Recent Publications:

  1. Moon S et al (2015) Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola. Lancet. 386: 2204-21.
  1. Kamradt-Scott A et al (2015) WHO must remain a strong global health leader post Ebola. Lancet. 385: 111.
  1. Kieny MP, Dovlo D (2015) Beyond Ebola: a new agenda for resilient health systems. Lancet 385: 92
  1. Cenciarelli O et al (2015) Viral bioterrorism: Learning the lesson of Ebola virus in West Africa 2013-2015. Virus Research 210: 318-326
  1. Abramowitz SA et al (2015) Social science intelligence in the global Ebola response. Lancet. 385: 330

 

Keynote Forum

Eugénie Bergogne-Bérézin

Paris University, Bichat Claude-Bernard- Hospital, France

Keynote: Digestive Tract Diseases and Infections.

Time : 11:40- 12:20

OMICS International Infectious Diseases 2017 International Conference Keynote Speaker Eugénie Bergogne-Bérézin photo
Biography:

Eugénie Bergogne-Bérézin is Professor of Clinical Microbiology at the University Paris 7. She is Doctor in Medicine (MD and PhD), specialized in Microbiology-Infectious Diseases. She has developed.several fields of Research: 1-Acinetobacter spp as a nosocomial pathogen (epidemiology, resistance, infections); 2-Pharmacology of antibiotics tissue and body fluid distribution Pharmacodynamics of Antibiotics -3 Intestinal microbial Ecology, jejunal flora, bacterial adhesion  to intestinal mucosa, impact of antibiotic therapy on intestinal flora. .She has published ~200 International Articles, 6 Medical Books, she contributed to Chapters in recent International Books of Infectious Diseases (Mosby), Pneumology (Respiratory Infection, James Pennington Ed, Raven Press), Antimicrobial Therapy (Victor Yu). She continues to work on Acinetobacter at an International level.

Abstract:

          Human digestive tract (DT) is one of the most vulnerable organs to microbial aggressions. A natural bacterial flora in the DT is a source of maturation of immune systems: Lactobacilli, Bifidobacterium lactis contribute to children growth. Normal adult intestinal flora includes Enterobacteriaceae, Escherichia coli, Proteus spp., and anaerobes, as contributors to digestive tract functions. In adults who suffered of recurrent gastric pain, the discovery of Helicobacter pylori, Gram negative micro-aerophilic, helix-shaped organism,  has been shown as responsible for gastric ulcer, Malt lymphoma, adeno-carcinoma: living in acidic areas, (upper digestive tract, 50% of elderly), treatment omeprazole+ clarithromycin has proven efficacy.  Lower intestinal tract can be invaded by species responsible for diarrhea, contagious, of variable severity: Shigella, Salmonella  spp, Vibrio cholerae: in countries with poor hygiene, cholera epidemics often occur. Yersinia enterocolitica, Y.pseudotuberculosis carried by pigs and contaminant to humans, determine sporadic acute gastro-enteritis, (contact with animals, contaminated food).  Intestinal infections should not be treated with antibiotics systematically, as in some cases they result in aggravation, emergence of Clostridium difficile. The presence in intestinal flora of Escherichia coli resistant to β-lactams is a threat for treatment failure. E.coli resistant to β-lactams and carriage of genes of resistance became international problems. In ICU patients, disorganized flora occurs whatever treatment used:  pathogenic MDR are often isolated. To re-establish equilibrium with a “normal “flora”, the development of “Fecal Microbiota  Transplant” becomes extensively used ( in pills or tablets). Another option has been successful using living organisms (“probiotics”) such as fungi (Saccharomyces spp., S.boulardii sp.) can  control ICU diarrhea.

  • Infectious Diseases | Immunology of Infections | Treatment for Infectious Diseases | Infectious Diseases Prevention, Control and CureVaccines and VaccinationNeuro Infectious Diseases
Location: Sanfrancisco
Speaker

Chair

Stef Stienstra

Royal Dutch Navy, Netherlands

Speaker

Co-Chair

Eugnie Bergogne-Brzin

Paris University, France

Session Introduction

Chandra Shekar pingili

Sacred Heart and Saint Joseph Hospitals, USA

Title: Neuro sarcoidosis masquerading as Neuroborreliosis (lymes)

Time : 12:20-12:45

Speaker
Biography:

Chandra Shekar Pingili is a Director, Division of infectious diseases, Sacred Heart and Saint Joseph Hospitals. Associate Professor of Medicine, University of Wisconsin Madison at Eau Claire, Wisconsin. Actively involved in teaching family medicine residency program and nursing staff. Director of Infectious Diseases at LE Phillips Rehab Center, Eau Claire and Chippewa Falls. Chief Infectious Disease adviser to the Clearwater Care Center, Eau Claire, WI. Chief Infectious Disease adviser to the Dove Health and Rehab Center, Chippewa Falls, WI. Director of Infectious Diseases at Indian Head Medical Center.

Abstract:

Background: Medical syndromes often overlap in clinical presentations. Often there is one or more than underlying etiology responsible for the patient’s Clinical presentation. We are reporting a patient who was admitted thrice with fevers and joint pains. Lymes IGG was positive. He was discharged home on doxycycline and prednisone suspecting gout. Second admission he was discharged to home on IV ceftriaxone. Patient however was re admitted twice within 3 weeks with cognitive impairment. Lymph node biopsy was positive for non caseating granulomas. Sarcoidosis was the final diagnosis.

Case Report: 74 year old white male was admitted with fever and multiple joint pains. Tmax was 100.5. WBC was 15 with normal CBC. LFTs were elevated. Rest of the labs was normal. Lymes IGG was positive. He underwent extensive rheumatologic and virological evaluation. Sonogram of the abdomen was negative. He responded to IV Ceftriaxone and was discharged home on Doxycycline for 3 weeks and Prednisone taper for a week .He was readmitted within 2 weeks with weakness and confusion. After ruling out multiple etiologies he was discharged home on IV Ceftriaxone suspecting Neuroborreliosis. But he was re admitted with worsening mentation in a week. This time he was diagnosed as case of neurosarcoidosis. He responded dramatically to IV steroids, methotrexate and one dose of infliximab. Patient continues to follow up with the clinic and is now at his base line with no recurrence.

Conclusion: He is one patient where an underlying disabling pathology was missed twice. He is a case of systemic and neurosarcoidosis masquerading as neuroborreliosis. Rarely is a clinical encounter so perplexing.

Nichola Ashby

RGN The University of Nottingham United kingdom

Title: Student Nurses, stigma and infectious diseases: A mixed methods study.

Time : 12:45-13:10

Speaker
Biography:

Dr Nichola Ashby is an Assistant Professor for the University of Nottingham, School of Health Sciences. As a nurse she is the lead within the school for Critical Care and Major Trauma. She undertook her PhD at the University of Birmingham and looked at stigma and iatrogenic disease, focusing on healthcare workers attitudes and values towards others within the profession. Further research undertaken is qualitative work on sepsis management, critical care, trauma coordinators doctoral journeys for women and pressure area care within critical care. Her research interests are the perceptions , values and attitudes of healthcare workers towards sepsis and infection. She works actively within national policy development for critical care and major trauma and is a clinical expert for the National Institute of clinical Excellence. Dr Ashby also is a steering group committee member for the Royal College of Nursing Critical Care and In flight Nursing.

Abstract:

Individuals or groups will form impressions of another based upon a series of traits, which may be relied upon when forming behaviour pattern towards others (Asch, 1946; Crocker and Major, 1989;  Pinel, 1999; Albon, 2002; Corrigan and Wassel, 2008). These traits will depict the reception individuals receive within healthcare and may depend upon learnt and inherited ‘perceived’ ideals affecting the working and personal relationships experienced by healthcare workers with a positive diagnosis o f infection, predisposing stigma responses to others (Asch, 1946)
A longitudinal exploratory study was undertaken over three years investigating the potential existence of stigmatising values from student nurses towards positively diagnosed healthcare workers with Pulmonary Tuberculosis (PTB), Human Immunodeficiency Virus (HIV), Methicillin-resistant Staphylococcus Aureus (MRSA), Hepatitis C and Diabetes type 2, was undertaken (Ashby, 2015). The mixed methods used to analyse data provided an interpretive exploration of the stigmatising attitudes and values of 482 student nurses undertaking an education programme.  Interpretation of the findings explored the participants views at course commencement, midpoint and completion considering variables of education (theoretical and clinical), personal and professional influences.    
Principle Component Analysis of the data provided components for three ANOVA’s and the within-subjects repeated measures showed little significance between disease groups. Further qualitative data was analysed to provide interpretation of these results demonstrating the presence of stigma. Therefore, the study recommends the implementation of a longitudinal education model for all healthcare workers, considering disease processes and influencing factors psychologically, socially and physically, which will provide opportunities to reduce the existence of stigmatisation for positively diagnosed healthcare workers.
 

Chris Whiteley

Department Biochemistry & Microbiology, Rhodes University, Grahamstown, SOUTH AFRICA

Title: In vivo; in vitro interaction of silver nanoparticles with leucine aminopeptidase from human and Plasmodium falciparum.

Time : 15:00-15:25

Speaker
Biography:

Abstract:

Statement of the Problem: There is increasing requirement for the development of new drug protocols against malaria, a fatal disease caused by the lethal parasite Plasmodium falciparum. Leucine aminopeptidase (PfLAP) of Plasmodium falciparum, is being pursued as a promising target for the discovery of novel antimalarials.. Methodology: PfLAP and HsLAP were expressed in Escherichia coli, and AgNPs (3-10 nm) characterized by ultra-violet spectroscopy and transmission electron microscopy. The effects of silver nanoparticles (AgNPs) against P. falciparum leucine amino-peptidase (PfLAP) and the human homolog (HsLAP) were compared. Findings: PfLAP indicated a Km of 694 µM towards leucine-p-nitroanilide and a Vmax of 57.9 μmol.ml-1.min-1 while HsLAP had a Km of 1.6 mM and Vmax of 119.6 μmol.ml-1.min-1. On interaction with AgNPs (670 nM) PfLAP was selectively inhibited (57.1 %; Ki = 610 nM) relative to HsLAP (10.8 %; Ki = 5.22 µM). The viability of P.  falciparum parasites was decreased when exposed to silver nanoparticles, with an IC50 value of 6.96 μM, compared to an IC50 value of 647.7 μM for human HeLa cells. Conclusion & Significance: Structural differences between the enzyme variants, particularly the orientation and distance of surface Met349 in PfLAP and Met306 in HsLAP to the zinc binding sites were significant and may allow for selective targeting of PfLAP by AgNPs.

Guozheng Wang

University of Liverpool, Liverpool UK

Title: Roles and mechanisms of DAMPs in sepsis

Time : 14:10-14:35

Speaker
Biography:

Guozheng Wang, a reader in University of Liverpool, UK, focuses on critical care medicine, particularly sepsis, using molecular and cellular approach, animal models and clinical investigation to understand the molecular mechanisms, develop diagnostic and therapeutic tools.

Abstract:

Statement of the Problem: The most common pathological change in critical illness is multiple organ failure, which often leads to death. However, the underlying mechanisms are not fully understood. Recently, the secondary hit by cell breakdown products causes great attention.
Methodology & Theoretical Orientation: Both septic animal models and patients with sepsis were investigated. Circulating histones released after cell death, the most abundant damage-associated molecular pattern (DAMPs), were detected and their association with organ injury markers was analyzed. Intervention with anti-histone reagents was carried out to confirm the cause-effect relationship.  
Findings: Circulating histones were dramatically elevated in both animal models and septic patients. Their levels were strongly associated with the severity of organ injury, particularly lung and cardiac injury. Using anti-histone scFv or non-anticoagulant heparin could significantly reduce organ injury as well as mortality rates. In addition, histones binding prothrombin initialized coagulation and significantly contribute to dysregulated coagulation leading to disseminated intravascular coagulation (DIC). Extracellular histones could interrupt integrity of cell membrane and cause calcium influx to damage cells, stimulate cytokine release and cause cardiac arrhythmia.   
Conclusion & Significance: DMAPs, particularly histones, play critical roles in sepsis, including inflammation, coagulation activation, and multiple organ injury. This lays a foundation for future anti-histone intervention to reduce the unacceptably high mortality rates of sepsis.
 

Hua Zhu

Rutgers New Jersey Medical School, USA

Title: Varicella-Zoster Virus Tissue Tropisms and Neuroattenuated Vaccine Development

Time : 14:35-15:00

Speaker
Biography:

Hua Zhu obtained Ph.D. degree from Columbia University and completed his postdoctoral studies from Princeton University. He has been working on herpesviruses for over 20 years. He started with studying human cytomegalovirus (HCMV) immediate-early gene function. He performed pioneer works on global cellular transcriptional responses to viral infection using differential display and gene chip technology. One important discovery from these studies is how HCMV infection activates large numbers of interferon-stimulated genes. Later, he applied the bacterial artificial chromosome (BAC) technology to study HCMV and varicella zoster virus (VZV) gene function,tropism and pathogenesis. He is one of the first to construct for HCMV and VZV BACs. He also used humanized mouse model and luciferase assay to study viral replication in vivo. He was first to discover VZV neurotropic factor which leads to a novel neuro-attenuated VZV vaccine candidate develop. He has published over 70 research articles, reviews and book chapters.

Abstract:

Varicella zoster virus (VZV) infection causes two distinct, but related diseases: varicella (chickenpox) following primary infection and zoster (shingles) after reactivation of latent VZV. VZV reactivationcauses serious neurological diseases such as, postherpetic neuralgia,myelitis, stroke and giant cell arteritis especially in the elderly. Thefactors involved in neuronal invasion and establishment of latency are still elusive. In our previous work, we employed a VZV BAC system in order to characterize a comprehensive library of VZV single ORF deletion mutants. We reported 18 ORFs to be fully dispensable in melanoma cells, which we postulated to encode elements responsible for specific tissue tropism. We now demonstrate that screening of these 18 dispensable gene mutants in differentiated neurons led to the identification of ORF7 as a neurotropic factor. This finding adds to our previous report that ORF7 is also a skin tropic factor. ORF7 is a virion component
localized to the Golgi compartment in infected cells, whose deletion causes loss of polykaryon formation in vitro and severely impairs viral spread in human nervous tissue ex vivo. Molecular mechanism of ORF7 in tissue tropism and pathogenesis are under investigation. Furthermore, ORF7 is required for VZV replication in xenografts of human skin and dorsal root ganglia in a SCID-hu mouse model. We showed that an ORF7 deletion virus is able to infect dendritic cells,which in turn can infect T cells. This unique set of characteristics lends an ORF7 deletion mutant the potential to become an excellent VZV vaccine candidate. This neuroattenuated vaccine would cause neither the primary chickenpox nor the secondary herpes zoster diseases. Finally, given that ORF7 is essential for VZV initial infection of neurons and replication therein, it may also be a critical trigger of reactivation from latency.
 

Speaker
Biography:

Hamoud Khalid Alshaya and Khalid Sukhail G Alshammari as a students of Medical College in the University of Hail.

Abstract:

Background: The oral cavity harbours a large number of bacterial species as normal flora existing as biofilm. Dental disease such as dental caries results when there is a shift in the balance of bacteria towards pathogenic species within these biofilms.

Objective: The objective of this study was to isolation, identification and characterization of oral bacterial species of patients with dental caries and caries-free healthy control subjects.

Materials & Methods: A standard bacteriological procedures were followed in the isolation of bacteria. The identification of bacteria was carried out using Matrix-Associated Laser Desorption Ionisation–Time of Flight–Mass Spectrometry (MALDI–TOF–MS) (Bruker MALDI Biotyper system). The characterization of bacteria involved in the determination of biofilm forming potential and assessment of synergistic antimicrobial action of manuka honey and gentamicin against the oral species.

Results: A total of 13 bacterial species were isolated from 35 orals samples (10 from patients with dental caries); of which 7 bacterial species have been isolated for the first time in Saudi Arabia. The Streptococcus spp. exhibited varied biofilm-forming potential and response to synergistic antimicrobial activity of manuka honey and gentamicin.

Conclusion: The isolation of 7 bacterial species for the first time from dental caries and caries-free subjects in Saudi Arabia warrants a larger prevalence study involving molecular and phenotypic tests to assess their role in health and disease in Saudi population.

Speaker
Biography:

Ting Li has her expertise in female genital tract infection diseases.

Abstract:

Statement of the Problem: Vulvovaginal candidiasis (VVC) is an opportunistic fungal infection predominantly caused by Candida albicans affecting a significant number of women of reproductive age. The Chinese medicine, the Baofukang suppository is widely used in the clinic for its antimicrobial activity and is therefore of great interest as a potential antifungal drug for the prevention of VVC.

Methodology & Theoretical Orientation: We evaluated the cytotoxic activity of the Baofukang suppository using the VK2/E6E7 vaginal epithelial cell (VEC) line. An ELISA analysis was made to evaluate three kinds of cytokines (Th1, Th2 and Th17 types) and non-B IgG in the supernatants. SEM was conducted to observe ultrastructural changes of VECs.

Findings: When treated with the Baofukang suppository, all of the immunocompetent cytokines and chemokines (e.g., IL-2, IL-4, IL-6, IL-8, and IL-17) by infected VK2/E6E7 cells was statistically up-regulated (P<0.05), except IL-4 (11.70±1.82 vs. 14.88±4.72, P=0.343) compared to the infected control cells. The secretion of non-B IgG also exhibited the same trend. Our scanning electron microscopy results revealed that C. albicans can invade VECs by both induced endocytosis and active penetration. The Baofukang suppository could effectively inhibit the adhesion, hyphal formation, and proliferation, as well as notably restore the vaginal epithelial cell morphology, viability, and enhance the local immune function of the VECs.

Conclusion & Significance: These preliminary results suggest promising antimicrobial properties of the Baofukang

suppository, which may be efficacious as an antifungal therapy candidate via up-regulating Th1 cellular immunity, the Th17-axis of the innate immune response, and the secretion of vaginal epithelial-derived IgG. These combined effects collectively restore the immune function of the infected VECs against Candida albicans in vitro.

Speaker
Biography:

V Kattel is the Faculty Member of Internal Medicine and Incharge of Tropical and Infectious Disease Unit at Referral Hospital and Medical School BPKIHS, Nepal. He has been involved in training more than 300 Nepalese Medical Doctors working at remote part of the country on infectious diseases of Nepal as a national expert. He has contributed for the development of national guidelines on outbreak potential infectious disease of Nepal, Management of Kala Azar in Nepal. His fields of interest are HIV/AIDS, acute undifferentiated fever and sepsis.

Abstract:

Statement of the Problem: HIV and Hepatitis C viral Infection (HCV) have same mode of transmission. A subset of HIV people on antiretroviral therapy (ART) achieves virological suppression but poor recovery of CD4 cell termed as immunological non-responders. It has been recommended to start HCV treatment in HIV coinfection if CD4 cells are more than 200/ml. Immunological non-responders could be a challenge to initiate HCV treatment especially in limited resources setting.

Case Description: A 24 years intravenous drug abuser male with HCV for last 3 years presented as HIV positive (CD4 - 186/ml) on July 2008. Despite ZDV/3TC/EFV for six months he did not achieve immunological recovery but his viral load was below 400copies/ml. On September 2009 he was presented with fever and constitutional symptoms for two weeks. On examination he was pale, icteric and had hepatospleenomegaly. Investigation revealed that pancytopenia, transaminitis, hepatospleenomegaly, sterile blood culture, normal chest X ray, sputum for acid fast bacilli and PCR for mycobacterium tuberculi negative, negative rK-39, malaria negative. He had CD4 of 156/ml, HIV viral load 72 copies/ml HCV RNA 15600copies/ml. Bone marrow aspiration revealed 3+ Leishmania Donovani (LD) bodies. ARV regimen was changed to TDF/3TC/EFV and tablet Miltefosine 50 mg twice a day for 28 days was initiated. He improved clinically and parasitologically. On April 2010 his second infection of Visceral Leishmaniasis (VL) was treated with injection amphoteracin B. On March 2011 and August 2012 he had third and fourth episode of VL infection and was treated with amphoteracin B plus miltefosine and liposomal amphoteracin B respectively. However the fourth episode was continued with secondary prophylaxis for six months with immunological recovery (CD4 756/ml). On April 2015 his HCV was treated with 12 weeks sofosbuvir and daclatasvir with rapid viral and sustained viral response.

Significance: Immunological non responders might be virtual phenomena.