Day 3 :
University of California, San Francisco,USA
Keynote: The spectrum of human prion diseases
Michael D Geschwind is a Professor of Neurology at the UCSF Memory and Aging Center who specializes in the assessment, treatment and management of rapidly progressive dementias, including prion diseases such as Jakob-Creutzfeldt disease (JCD) and autoimmune encephalopathies, and other cognitive/movement disorder syndromes. He helped to establish a program for the assessment of rapidly progressive dementias at UCSF Medical Center, the first of its kind in the country. He helped to run the first US treatment trial for sporadic disease, at UCSF. He has also helped to establish and co-direct a clinic for patients with autoimmune
encephalopathy. He Co-directs the Huntington’s Disease Society of America Center of Excellence (HDSA COE) and Ataxia Clinic at the UCSF Memory and Aging Center. His research interests include rapidly progressive dementias, cognitive dysfunction in movement disorders, such as Huntington's disease, spinocerebellar ataxia, corticobasal degeneration (CBD), progressive supranuclear palsy (PSP) and other Parkinsonian dementias.
Statement of the Problem: Diagnosis of human prion diseases can be difficult as they can present similar to many other conditions, and many other conditions can clinically mimic prion disease. Correct diagnosis of prion disease is important in order to prevent accidental transmission of the prions, to prevent further unnecessary diagnostic testing and to provide a realistic prognosis to the patient and family.
Methodology & Theoretical Orientation: Our center has evaluated more than 2500 cases of rapidly progressive dementia (RPD), including more than 600 cases of prion disease through our clinical research program. Most patients undergo a comprehensive evaluation including clinical history, cognitive testing, CSF analysis, research brain MRI protocol and other testing. These data are analyzed to identify measures that might improve diagnostic accuracy of prion disease compared to other non-prion RPDs.
Findings: The clinical presentation, including presenting symptoms, duration of disease, and laboratory findings are quite varied in prion disease. Brain MRI with diffusion sequences showed high diagnostic accuracy for human prion disease.Unfortunately, radiologists in the USA often miss the radiological diagnosis of prion disease, despite the MRIs showing classic features. A relatively new CSF test called RT-QuIC shows high specificity, although not as good sensitivity, for prion diseasediagnosis.
Conclusion & Significance: Our ability to diagnosis prion disease has improved over the past few years to the point at which brain biopsies are rarely needed. Improved diagnosis will be important for future treatment trials and prevention of accidental transmission of these potentially infectious diseases.
Paris University, France
Eugénie Bergogne Bérézin has been nominated as a Professor of Clinical Microbiology and Infectious diseases:in: in her Clinical Microbiology department she developed several fields of Research with in her group, development of pharmacology of antibiotics, studies on diseasesand acinetobacter spp. She has been implicated in studies of Respiratory Tract antibiotic distribution in lungs and efficacy, essentially with nosocomial pathogens. She published high levels articles and contributed to several Books of high level in Infectious diseases. She participates in international conferences and gives lecture to students in Microbiology.
Appreciation of the importance of specific pathogens refers to their incidence in clinical infections as well as their pathogenicity, virulence and resistance to most antibiotics, even the most recent powerful drugs. The importance of Acinetobacter is related in addition to its particular behaviour in terms of versatility, diversity, evolution capabilities, evolving virulence factors. Acinetobacter spp are today considered as among the most dangerous nosocomial pathogens, predominantly isolated in ICUs, medical or surgical, and responsible for severe infections. Its nosocomial pathogenicity is largely attributed to the multidrug resistance phenotype, responsible for large outbreaks within intensive care units. A combination of resistance elements with intrinsic mechanisms has resulted in development of highly resistant subpopulation which survives to antibiotic challenge. Antibiotic resistance occurs through drug specific mutations and via non drug specific factors like efflux pump expression. A well known system is based upon acquisition of foreign genetic elements history of extension of resistance became well known by acquisition of plasmids, transposons, insertion sequences (high level resistance to specific antibiotics). The pathogenicity of Acinetobacter may vary between the multiple species and among them the occurrence of fulminant Acinetobacter pneumonia has attracted interest of research of virulence factors (ML Joly Guillou, 2005). Compared to other aerobic Gram negative organisms Acinetobacter spp can survive as important opportunistic pathogens, associated to its virulent factors and resistance to most antibiotics. Today after many years of International interest and annual inter-group meetings exchanging results of important research, Acinetobacter remains a formidable nosocomial pathogen.
Howard College of Medicine, USA
Harpal S Mangat, MD, is an Assistant Professor at Howard University College of Medicine. He submitted recommendations to his US senator that got incorporated into the 2010 Affordable Health Care Act. He has four issued US patents and additional patents have been filed. He is a Graduate of the Royal College of Surgeons, Ireland, trained at Trinity College Dublin, Oxford University and London University in Family Practice and Ophthalmology. In the US, he trained at University of South Florida and Mercy Hospital Philadelphia in Ophthalmology and Internal Medicine. He is the Transport Physician for difficult cases returning to United Arab Emirates. His clinical interests include innovative new technologies, neuroprotection, diabetes, sleep apnea, Lyme disease, especially its neurological manifestations, as well as long distance air transport of seriously ill patients.
Background: Lyme disease is caused by the bacterium Borrelia burgdorferi, transmitted to humans through the bite of infected blacklegged ticks. CD4/CD8 ratios in healthy adults vary across populations; in the US, a CD4/CD8 ratio ranging from 0.9 to 1.9 is considered to be normal in non-immunocompromised individuals. Lyme disease is diagnosed based on symptoms, physical findings (e.g. rash) and the possibility of exposure to infected ticks. Laboratory testing is helpful if used correctly and performed with validated methods. The US Center for Disease Control (CDC) diagnostic criteria requires the identification of five Western blot IgG bands for a positive diagnosis, although patients with less than five positive bands have been subsequently diagnosed with Lyme disease through urine PCR in Nanotrap testing.
Material & Methods: 183 patients at two medical centers were evaluated in Lyme endemic communities in Maryland, USA. Further investigation of 148 of these patients correlated their CD4/CD8 ratio with their Ig41 band, using one and two tail testing.
Results: The mean CD4/CD8 ratio in the 148 patients was 2.41 with a variance of 1.05 and a standard deviation of 1.025. Assuming a normal CD4/CD8 ratio of less than 2, with a 5% confidence interval, the p-value on both a one tailed and two tailed test was shown to be 0.00001. Two patients with an initial CD4/CD8 ratio of 2.7 and 2.8 who were IgG 41 positive were subsequently tested with the Nanotrap urine PCR and found to be positive for Lyme.
Conclusions: Increased CD4/CD8 ratio with a positive IgG 41 band appears to be a strong predictor of a subsequent diagnosis of Lyme disease despite current diagnostic guidelines. Further research should not only be directed towards investigating how Borrelia burgdorferi disrupts immune function, but also towards improving diagnostic guidelines in light of validated diagnostic methods.
- Immunology of Infections|Treatment for Infectious Diseases| Hepatitis|Antimicrobial | Antibiotic | Antibacterial Resistance | Global Trends in Emerging Infectious Diseases
Michael D Geschwind
University of California, San Francisco, USA
Harpal S. Mangat
Howard College of Medicine, USA
King Abdulaziz University, Saudi Arabia
Time : 12:20-12:45
Background: Obesity has been considered as one of the major modern global epidemics and a risk factor for both cardiovascular diseases (CVD) and diabetes. There is a rapid rise in the rate of overweight and obese people in the Kingdom of Saudi Arabia which has a tremendous impact on health and economic resources. Gut microbiota has lately been a major factor for many metabolic disorders and diseases, including obesity, diabetes, and CVD.
Objective: The aim of this research was to define those specific gut microbiota that are obesity-associated as determined based on mass index (BMI) among healthy Saudi females.
Methodology: 120 healthy females, below the age of 30, with different degrees of obesity were included in this study. All the participants had to fill out a questionnaire concerning their nutritional habits, health conditions and demographics. Their height, body weight, hip and waist circumference were measured and their BMI was determined accordingly. Stool samples were collected and genomic DNA was extracted from our study group. The DNA samples were sequenced using next generation sequencing (MiSeq), sequencing reads were trimmed, analyzed and filtered and assigned to taxonomic units.
Results: The results revealed the existence of different bacteriological groups including Firmicutes, Actinomyces odontolyticus, Escherichia coli and Ruminococcus obeum and others. Work is in progress to correlate the prevalence of those bacterial groups with BMI.
Conclusion/Recommendations: The data showed the presence of a variety of bacterial strains and microbiota populations among our study individuals. Bioinformatics data analysis will help to identify certain microbiota marker populations to be associated with different stages of obesity among the female Saudi population. Final goal is an early prediction of obesity and to target those patient groups to treat obesity.
Eisenhower Medical Center, USA
Time : 12:45-13:15
Introduction: Carbapenems are broad spectrum beta-lactam antimicrobials especially useful in infections involving multi-drug resistant bacteria and nosocomial infections. Seizures involving carbapenems are a rare occurrence overall and usually reported with imipenem use rather than ertapenem. Neurotoxicity associated with ertapenem use in a renal transplant patient has not been previously reported. We report a rare case of nonconvulsive status epilepticus associated with the use of ertapenem in a renal transplant patient.
Case Description: A 67 year old Lebanese woman with a history of living-related right renal transplant in 1993 presented with progressively worsening altered mental status for the past three days. She had a baseline creatinin of 2.5 mg/dL at the time and was on chronic immunosuppressive therapy. Patient was discharged three days prior from an outside hospital with a diagnosis of a complicated urinary tract infection (UTI) from ESBL-producing Escherichia coli bacteria which was sensitive to gentamicin, carbapenems and amikacin. She was sent home on a 14 day course of intravenous ertapenem therapy. She had completed 7 days of ertapenem therapy at the time of presentation. Patient was continued on her home UTI treatment regimen with 500gm IV ertapenem daily upon admission. Next day of her admission, patient had a witnessed generalized tonic-clonic seizure. On the 3rd day of admission (10th day of ertapenem administration), patient developed nonconvulsive status epilepticus. Ertapenem was at that point discontinued. She remained in status epilepticus for the next 4 days and was monitored with continuous electroencephalography (EEG) in the intensive care unit. She was treated with IV Dilantin, phenobarbital and versed. She responded well to the treatment. Seizure activity eventually diminished over the next 48 hours with intermittent left temporal lobe spikes initially until complete resolution. Patient returned to baseline mentation 9 days after admission and was subsequently discharged to acute rehabilitation.
Discussion: Seizures due to ertapenem use are rare with a reported incidence of 1.8%. Ertapenem is thought to induce seizures and cause encephalopathy by binding to GABA receptors in the central nervous system and lowering the seizure threshold. Ertapenem is predominantly eliminated via renal excretion. Patients with reduced renal clearance are therefore at an increased risk of experiencing adverse events with ertapenem use. Our case highlights that ertapenem use can cause significant neurotoxicity in renal transplant patients and in patients with renal insufficiency. Seizure activity due to ertapenem if not identified early can progress to status epilepticus. Despite renal dose-adjustment, ertapenem has potential to cause seizures especially in such patients. Care must be taken in administration of ertapenem in patients with renal insufficiency and it must be stopped immediately if any clinical signs of neurotoxicity do occur.
Conclusion: Ertapenem has the potential to cause significant neurotoxicity and can induce status epilepticus in patients with prolonged use. Patients with renal insufficiency are especially vulnerable even after renal dose adjustments.
Middlesex University, London, UK
Title: Apple cider vinegar (ACV®) displays potent antibiotic activity directly against Escherichia Coli and Candida albicans and within in vitro monocytes exposed to microbes by inhibiting inflammatory cytokine secretion
Time : 15:15-15:40
Darshna Yagnik is a Lecturer of Immunology and Biomedical Sciences at Middlesex University. Her research is based on human in vitro models of mononuclear cell differentiation and their role in inflammatory pathways and particularly the resolution phase of inflammation.
Introduction: Extraintestinal pathogenic Escherichia coli (E-coli) are the most frequent cause of blood borne, urinary tract and hospital acquired infections. Candida albicans infection can also pose a huge threat especially following transplantation and to immune compromised patients. Globally there has never been a more desperate time for novel anti-microbial agents to target microbes and multi drug resistance from bacterial or fungal associated infections.
Aim: The aim of this study was to investigate the potential anti-microbial effects of ACV®. We used microbial strains: E. coli strain 6571, C. albicans strain 90828 purchased from ATCC.
Methodology: We tested the effect of commercial ACV® directly on microbial cultures over a 24 hour period, measuring inhibition zones. We also looked at whether ACV® could have an anti-inflammatory effect in vitro. This was tested using human blood derived monocytes which were incubated with microbes and AVC®. The collected supernatants were analyzed for proinflammatory cytokine secretion by ELISA.
Results: When monocytes were cultured with both microbes they secreted TNFα and IL-1β. ACV® was able to significantly inhibit E-coli growth demonstrated by the results of direct co-culture with each of the microbial inoculums and ACV® in varying concentrations. The zone of inhibition with the addition of ACV® to each of the microbes varied dose dependently
ACV® concentration. For Candida albicans undiluted ACV® had the strongest effect, whereas on E-coli cultures, the most potent effect was visible at lower dilutions including 1/1000 dilution of the neat solution (p<0.05). When monocytes were cultured with both microbes they secreted inflammatory cytokines (TNFα, IL-1β) ACV® was effective in significantly inhibiting
inflammatory cytokine secretion in human peripheral blood monocytes cultured with E. coli and Candida albicans
Conclusion and significance: ACV® displayed potent anti-microbial and anti-inflammatory activity against E. coli and Candida albicans. We propose that ACV® could be potentially therapeutic in cases of antibiotic resistance and sepsis.
Ibidolapo Ijarotimi is a fellow of the West Africa College of Physicians with sub specialization in community health. She is also a resident of the joint CDC/ Nigeria Ministry of Health Field Epidemiology and Laboratory training program. In addition, she has a Master’s degree in Clinical Epidemiology. She has a background in health economics but has more interest in infectious disease epidemiology, Infection prevention and control in hospital settings and healthcare epidemiology. She has had trainings and trained others in Infection prevention and control in hospital settings and healthcare epidemiology.
Background: Hepatitis B is a global health problem which can cause lifelong infection, cirrhosis, liver cancer, liver failure, and death. According to WHO there is more than 350 million suffering from hepatitis B chronic infection worldwide. Sudan is a country with high HBV endemicity, according to CDC the prevalence of HBV chronic infection was reported to be( 5% to 6%)
in the general population , and 26% in the hospital outpatient. Hepatitis B is an important occupational hazard for health care personnel; however it can be prevented by the safe and effective vaccine with success rate of 95%. This study aimed to evaluate the hepatitis B vaccination coverage, barriers of complete vaccination, and immunization status after the vaccination among
nursing students in Khartoum locality, as a high risk group to percutaneous injuries
Methods: Cross sectional institutional based study conducted among nursing students in three nursing schools in Khartoum
locality with sample size of 261 using stratified random sampling. Data collection was carried out using pretested selfadministered
Results: 80% of respondents were females and 12% were males with mean age of 22 years. More than 80% knew that percutaneous injuries carry the risk of HBV transmission, about 23% of the participant suffered a needle stick injuries, however Only 41% of the students were fully vaccinated and only 10% of them checked the anti-HBs Ag titer after vaccination. The major reasons reported by the participants were being busy and unavailability of the vaccine in a nearby facility where they searched.
Conclusion & Recommendations: The vaccination rate was found to be low, the awareness of importance of hepatitis B vaccination should be raised, complete hepatitis B vaccination should be provided to all nursing students, and good response to the vaccine should be evaluated before starting clinical training.