5th International congress on Infectious Diseases March 1-2, 2018 Berlin, Germany

Lee Jun Jun has completed her Medical Training at Tapei Medical University and Resident Training at Kaohsiung Chung Gung Memorial Hospital.

We collected 540 patients with adult bacterial meningitis (ABM) from 1986-2015, of whom 167 were ≥65 years. Of these 167 elderly patients, 82 had post-neurosurgical infections and 85 had spontaneous infections. The 82 elderly ABM patients with post-neurosurgical infections included 48 men and 34 women with a median age of 71 years (range: 65-84 years). The major clinical presentations were fever (80.5%), altered consciousness (50.0%), hydrocephalus (43.9%), seizure (24.4%) and septic shock (15.9%). Of the implicated pathogens, staphylococcal species (spp.) were the most common (31.7%), followed by Acinetobacter spp. (12.2%), Enterobacter spp. (7.3%), Pseudomonas spp. (7.3%), Enterococcus faecalis (7.3%) and Escherichia coli (6.1%). The implicated staphylococcal spp. had a high rate of non-susceptibility to methicillin (84.6%), and the implicated Acinetobacter spp. and Enterobacter spp. had non-susceptible rates to ceftazidime of 60% and 50%, respectively. The mortality rate was 28.1%, and septic shock was the most significant prognostic factor. As the conclusion, elderly patients accounted for 30.9% of all cases of ABM, of whom 49.1% had post-neurosurgical ABM. The clinical characteristics of the elderly patients with post-neurosurgical ABM were non-specific, and cerebrospinal fluid studies were needed to confirm the diagnosis. The mortality rate of this group of patients was high, and septic shock was an important prognostic factor. The clinical and laboratory features and therapeutic outcomes were different between the elderly patients with post-neurosurgical and spontaneous ABM.

Hsieh Yuan Kuei has completed his Medical Training at Taipei Medical University and Resident Training as Neurosurgeon at Chi Mei Hospital. He got his Master degree at Taipei Medical University.

Adult patients with spontaneous spondylodiscitis usually present in elderly population with diabetes mellitus or systemic infection. This 29 years old women, previously healthy, reported chronic low back pain with acute exacerbation in five days prior to her visit. The severe pain radiated to right leg and made her disability in walking. There was no fever, no travel history, no contact history, and no wound. Neurologic examination revealed right L4/5 dermatome paresthesia and her muscle power was full over four extremities. The lab data showed leukocytosis and elevated C reactive protein level. The dynamic plain film of lumbar spine showed L4/5 spondylolisthesis. The Magnetic Resonance Imaging of lumbar spine showed mild L4/5 degenerative spondylolisthesis and diffuse posterior herniated disc, with right lateral ruptured sequestrum compromising L4 foramino-outlet nerve root. She was admitted to general ward and she received laminectomy and facetectomy then. During operation, purulent material was collected. The lumbar spine specimen and blood culture both identified methicillin-resistant Staphylococcus aureus. She received vancomycin then. Trace back her history, she worked as a nurse and denied any Intravenous drug abuse. The survey for HIV and autoimmune disease were also negative finding. There was no evidence of infective endocarditis by transthoracic echocardiography. The clinical presentation in this case was atypical in two aspects. First, the relative young age was not fit in bimodal distribution in spondylodiscitis; second, she did not have any related comorbities.

Vineet Jain is an Associate Professor at Hamdard Medical College, New Delhi, India. He has an experience of eight years post MD. His special interest has always been towards Infectious Diseases. He believes that all infectious disease if diagnosed in time and managed appropriately can lead to a drop in mortality. So lot of my research work is focused on understanding various aspects of infections.

Background: Liver abscess has shown a major change in demographics, etiology, diagnosis, and treatment over the past 100 years. The modern diagnostics like ultrasound and computed tomography to locate and drain the abscess have reduced the mortality to 2-12%. However, due to the complications of liver abscess especially the amebic ones the morbidity is still high.This study aims to study the correlation of various LFT parameters with abscess volume for early detection of high risk patients and early treatment thus reducing morbidity. Methods: The study was conducted over a period of six months on 50 patients of liver abscess. History and physical examination was done. All patients were subjected to complete hemogram, liver function test, coagulation profile (PT/INR) and USG abdomen. The data was recorded and compiled in excel sheets and analyzed using correlation coefficient (R) method. Results: The mean age of the patients was 41.2 years with male preponderance. Amoebic liver abscess (88%) was predominant over pyogenic liver abscess (12%). Alcoholism (48%), smoking (42%) and diabetes mellitus (18%) are main predisposing factors in case of liver abscess. Hepatomegaly was found in 88% cases. Elevated ALP, low albumin, increased PT INR points to the diagnosis of liver abscess. Complications seen were pleural effusion (10%) and ascites (4%). On analysis, liver abscess size is significantly positively correlated with INR, ALP, liver enzymes, and negatively correlated with serum albumin level. Conclusions: Liver abscess size was found to be positively correlated with INR and alkaline phosphatase (ALP), liver enzymes (SGOT, SGPT) and negatively correlated with serum albumin levels. There was no correlation of abscess size and bilirubin levels. Hence, LFT can be used to estimate the liver abscess size and predict the severity and prognosis of patient.

Soraya J Kaewpitoon has completed her MD at Khon Kaen University in Thailand and FCFPT at Royal College of Family Physicians of Thailand. She is the Vice Dean in Research Affair, and Head of Parasitic Disease Research Center, Institute of Medicine, Suranaree University of Technology, Thailand. She has published more than 60 papers in reputed journals and has been serving as an Editorial Board Member of repute.

Liver fluke is an endemic in Southeast Asia particularly in Thailand, Lao People’s Democratic Republic, and Cambodia. The infection is associated to cholangiocarcinoma; bile duct cancer. Prevention and control is required to decrease the liver fluke incident. Here, we described the liver fluke prevention and control program (LFPCP) through Inter- and Transdisciplinary University (ITU). LFPCP was constructed among the rural communities in northeast Thailand during November 2016 and July 2017. ITU was integrated in LFPCP; briefly, ITU is comprised the partnership, scholarship, mutual benefit, and social impact. ITU is established by teachers and student (medical, nursing, public health, engineering, and business computer) from Suranaree University of Technology, Vongchavalitkul University, and Nakhon Ratchasima Rajabhat University, local government officers, and villagers, to solve the health problem in the rural community particularly liver fluke disease and cholangiocarcinoma. Quantitative and qualitative data were collected by questionnaires, group and individual feedback, consequently. Of 120 participants were included. Participants (89%) had a high level of satisfaction regarding LFPCP particularly in the steps of sharing ideas, decision making, and planning step. They could improve their knowledge, attitude and their practice regarding liver fluke prevention and control. LFPCP is an integrative activity that improves knowledge, attitude, skill, and practice for students and villagers. Therefore, LFPCP toward ITU is highly potential mutual benefit among university, students, teachers, and communities.

Gladys Makuta completed her MSc in International Health and Management and BA in Health Sciences and Social Services. She is currently a PhD student in the Division of Population Medicine at Cardiff University, United Kingdom, working on the balloon study. She has strong research interest in infection detection, prevention and management in a global health context. She has significant experience in commercial and non-commercial clinical research and teaching gained from both developed and resource limited areas, prior to her current role.

Background: Pneumonia is a leading cause of death in children. Approximately 75% of patients with acute respiratory tract infections (ARTI) receive antibiotics despite most of these infections having viral origin. Early diagnosis and appropriate treatment is essential. There is no point-of-care (POC) test, available to diagnose bacterial pneumonia. This study aims to investigate the feasibility of developing a POC device that will measure bacterial load in breath from children with pneumonia and empyema. The purpose is to find a diagnostic POC test capable of isolating bacterial pneumonia. Methods: This study is designed to show that a POC breath test can detect the difference in bacterial load (through assay of lipopolysaccharide (LPS) and peptidoglycan) in exhaled breath of children with pneumonia/empyema and those without a chest infection (controls). It comprises of development of a breath sampler, laboratory and clinical testing. Three prototypes of the breath sampler were produced in phases with refinement. Each prototype underwent laboratory testing using a known concentration of endotoxin which was nebulized thorough the prototype incorporating a sampling surface (SS). Subsequently, a sample of endotoxin impinged on the SS was extracted and tested using limulus amebocyte lysate (LAL) assay. Clinical testing involves collecting breath samples from 48 children between 5 to 15 years with pneumonia/empyema and well matched controls. Semi-structured qualitative interviews will be conducted with participants, parents and clinicians to examine the acceptability of the test. Results: A breath sampler, suitable for clinical testing has been developed. Results from laboratory testing show that it is possible to detect nebulized endotoxins (comparable to levels detectable in breath) using the LAL assay. Discussion & Conclusion: The study will demonstrate the potential of using a POC test to identify children with pneumonia or empyema who may benefit from antibiotics.

Arash Heidari is a fourth year Medical Student of Medical School of Tehran University of Medical Sciences, Tehran, Iran.

Nosocomial infections are a serious problem in health care centers and dramatically increase the morbidity and mortality of patients and pose costs on patients and health care. One of the most common causes of these infections is medical and therapeutically interventions, therefore, the role of doctors and medical students in the prevention of nosocomial infections is of particular importance. This study was carried out to assess medical students’ knowledge and practice of nosocomial infection in hospitals affiliated to Tehran Medical Science Universities (Tehran, Iran and Shahid Beheshti Medical Science Universities). In this descriptive study, 150 medical students (externship period) were selected randomly from three universities. Data were collected by self-reported questionnaire including questions on awareness of nosocomial infection and prevention, demographic characteristics and practice. Data was analyzed by SPSS software using descriptive and analytical statistical methods and Pearson correlation. Results showed that the mean scores of knowledge and practice were 58.22±13.66 (moderate) and 48.41±5.62 (poor) respectively. Results showed that there was no statistically significant relationship between medical students’ knowledge and their practice (p=0.10).There was a significant relationship between knowledge and academic year (P=0.01) and practice and clinical unit (P=0.04). There was no significant difference between knowledge level with age, sex, marital status, history of needle steak, history of hospitalization and relative’s hospitalization (p>0.05). The results showed that although the level of knowledge of medical students regarding to prevention of nosocomial infections is moderate but their practice is poor, therefore the practical training of students should be emphasized more than before.

Manijeh Nourian has completed his PhD in Nursing at University of Social Welfare and Rehabilitation Sciences and he is Scientific Member and Director of Pediatric & NICU Nursing department, Nursing & Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Septicemia is one of the major causes of infant mortality. Premature infants are more at risk of septicemia due to the lack of development of the defense system, the acquisition of aggressive care and long hospitalization time. The application of therapeutic touch in neonatal intensive care unit is expanding to implement developmental and holistic care. The aim of this study was to determine the effect of healing touch (HT) on death rate and physiological criteria in neonates with septicemia. This is a randomized clinical trial, in which 50 premature infants with septicemia admitted to NICUs of hospitals affiliated with Shahid Beheshti University of Medical Sciences of Iran were selected through convenience sampling and assigned randomly in two groups. In the HT group, the procedure was conducted twice a day (morning and evening) for 15 minutes over 10 days. The physiologic variables (O2 saturation, respiration rate, heart rate) were recorded 10 minutes prior to HT, during 15 minutes of HT (7th minute) and 10 minutes after HT. The number of deaths was recorded in both groups. Data were analyzed with SPSS 21 using repeated measurements analysis. The death rate in the HT group was significantly lower than the control group during intervention (P=0.001). The mean heart rate in HT group in evening record was lower compared to control group, but statistically was not significant (P=0.07). There was statistically significant difference in the respiratory rate of the neonates in morning and evening record between the groups (P=0.009, P=0.005)). Results showed significant difference in the mean of O2 saturation in morning record in the HT group was higher than control group (P=0.006). Repeated measurements test showed that the trend of changes in all physiological criteria were not significantly different during the intervention period (p>0.05). The death rate in the HT group was significantly lower than the control group and healing touch may have a positive effect on reducing respiration rate, and could be effective in increasing O2 saturation in premature infants with septicemia.

Catherine Hsu is final-year medical students at the University of Cambridge with an interest in infectious disease medicine and global health. They undertook their elective at the Oxford University Clinical Research Unit (OUCRU) in Vietnam, under the guidance of Dr Louise Thwaites (senior clinical research fellow and member of the Emerging Infections group at OUCRU). Catherine completed a BA researching the oncogenic potential of human herpesvirus-8 and has also presented her work on neglected tropical diseases at a national level. Su Ling completed her BA in neuroscience and is particularly interested in neurological infections.

Tetanus remains a dangerous problem in many low to middle-income countries, despite the availability of an effective vaccine. Death usually arises from autonomic dysfunction and spasm-related respiratory failure. Heavy sedation with benzodiazepines therefore forms the cornerstone of treatment. However, this necessitates mechanical ventilation, often unavailable where tetanus burden is highest, and may explain why tetanus mortality has remained >40% in the last 50 years. Magnesium sulphate has been suggested as a promising therapeutic alternative, but only one inconclusive meta-analysis has been published on its use in tetanus. We therefore performed an up-to-date systematic literature review of all primary studies examining the effects of magnesium sulphate on mortality, length of stay, spasm and autonomic control and potential toxicity in tetanus patients. Two independent reviewers carried out a set search on PubMed and Web of Knowledge. Identified texts underwent abstract and full text review, with further review of relevant reference lists. Data was then extracted for comparison. No study showed a mortality benefit. However, magnesium was demonstrated to significantly shorten duration of hospital stay, reduce muscle spasms, lower maximum systolic blood pressure and heart rate, and reduce the need for additional drugs such as benzodiazepines and inotropes. Magnesium at therapeutic serum levels was not associated with any clinically significant side effect, though disagreement exists as to whether magnesium causes hypoventilation. Magnesium appears both safe and effective in managing tetanus. Future work should establish regimens preserving respiratory muscle function, to allow widespread use of magnesium in units without access to ventilatory support.

Jack Vojak is medical student pursuing his final year in medical school at University of Liverpool. He completed his MSc at Liverpool School of Tropical Medicine where he studied biology and control of parasites and disease vectors. During his time at the school, he undertook research into the host pathogen relationship between the infectious bacterial pathogen Streptococcus pneumoniae and the human nasopharynx.

Morbidity and mortality caused by Streptococcus pneumoniae is a global issue affecting all age groups from every walk of life. Disproportionately high levels of pneumococcal disease are associated with abnormalities of nasopharyngeal mucus production. Additionally, an association between viral co-infection and increased pneumococcal pathogenicity has been observed. Pneumococcal disease requires the bacterial colonisation of the human nasopharynx; without which colonisation and disease cannot occur. Despite this, colonisation does not inevitably result in disease. In order to understand why this may be, it is essential to understand the roles of immune factors at the epithelial barrier with regards to colonisation and how this progresses to invasive disease. Using an experimental human pneumococcal carriage model, colonisation in the nasopharynx of human volunteers was studied to elucidate the dynamic relationship between pneumococcus and the immune responses present at the epithelial barrier. To achieve this, quantification of MUC5AC, a key glycoprotein found in the mucus of the nasopharynx, was performed. This was done in the presence of attenuated viral co-infection in participants who were carriage positive or negative for pneumococcus. Additionally, the direct killing effect of secretory mucus was measured on pneumococcal colonies. Finally, we assessed the impact of secretory mucus on pneumococcal adherence to a living population of cells. We found there no killing effect of mucus on pneumococcus (p=0.20) and instead found the mucus to significantly increase bacterial replication. Secretory mucus was also found to possess barrier properties. These properties significantly reduced the proportion of pneumococcus in an environment from adhering to a living cell layer (P<0.001). Finally, our study indicated no relationship between raised MUC5AC levels and pneumococcal carriage with attenuated viral co-infection (P>0.05). Mucins role in pneumococcal colonisation is not yet well characterized. The study concluded that further investigation into the effect of mucus will be vital in fully understanding the immunological processes at play. Only then therapies can better target invasivepneumococcal disease and reduce the impact of this globally significant pathogen.

Trisha Patel is the Infectious Diseases/Critical Care Pharmacist at Cancer Treatment Centers of America (CTCA). She completed her Pharmacy Residency with a specialty in critical care at University of Alabama Hospital in Birmingham (UAB). After working at UAB for four years as the Medical ICU Pharmacist, she moved to Philadelphia to work at CTCA. Since acquiring this position, she has assisted Dr. Mashiul Chowdhury in managing all patients on antibiotics as well as to lead their Antimicrobial Stewardship Program.

Clostridium difficile is not only the most common organism to cause hospital acquired infections in the US but the incidence in cancer patients is increasing significantly. Their risk factors for acquiring Clostridium difficile infections (CDI) are prolonged hospitalization, chemotherapy, and changes in bowel environment. However, the most common risk is frequent exposure to antibiotics. The centers for disease control and prevention showed the risk of CDI among those exposed to highrisk antibiotics was three times higher compared to persons with low-risk or no antibiotic exposure. This emphasizes the crucial role of ASPs which have created a positive impact on CDI rates in several studies. At a private oncology hospital, ASP and infection control use several strategies to retain low rates of CDI. ASP reviews all patients on antibiotics daily to identify opportunities to optimize therapy. Prospective audit and feedback is then provided to clinicians on any necessary interventions. Educational in-services are also performed for nurses and the medical staff on a regular basis. Additionally, infection control enforces strict hand hygiene for which compliance has consistently been greater than 98%. Due to oncology patients having a higher incidence of baseline diarrhea, a three-component C. difficile test is used at this institution to reduce false positive results. The glutamate dehydrogenase (GDH) antigen and enzyme immunoassay tests for toxins A and B are obtained on all samples. If there is discordance between the tests, then only is a polymerase chain reaction (PCR) test performed. With these combined efforts, there were 0 incidences of CDI over a period of 10 months in 2017 and no more than one incidence per month since January of 2016. However, both incidences in August and September 2017 were false positive results. Therefore, without any clinical infections, the institution had 0 incidences of CDI for one year (table 1).

Satesh Bidaisee is a Professor of Public Health and Preventive Medicine and Assistant Dean for Graduate Studies at St. George’s University. He is a graduate of the University of the West Indies, Faculty of Medical Sciences, St. Augustine, Trinidad, St. George’s University, School of Medicine, School of Graduate Studies and the University of Sheffield, UK. As a research investigator, Prof. Bidaisee supports community based participatory research and service activities in the fields of Emerging Infectious Diseases, Zoonoses, Food Safety and Security and One Health One Medicine. His research projects include Human Behavior, Climate Change and Viral Infections, Zoonoses and One Health and Vector Borne Disease outbreak investigation. Prof. Bidaisee is board certified by the U.S. National Board of Public Health Examiners, and holds Fellowships to the Royal Society of Public Health (FRSPH), Royal Society of Tropical Medicine and Hygiene (FRSTMH), International Society on Infectious Diseases and the Society of Biology.

Vector-borne diseases (VBDs) remain a prominent threat to human health, and research in this field has increased dramatically in recent decades. This study examines the published literature on VBDs and public health over a 25-year time period (1986-2010) and identifies important trends, hypothesizes their underlying factors, and makes predictions for future trends. Not only does this provide a historical snapshot for future researchers, but by identifying where significant focuses and neglects have been thus far, it can potentially influence future research decisions such as the allocation of funding and resources. A systematic literature review was conducted from May-June 2017 using Web of Science and Google Scholar. A random sampling method was used to review publications for inclusion. Each publication was classified into a sub-theme based on its main purpose and further into 1 of 6 overarching themes. The prevalence (proportion of times a theme appeared) over the entire study period and rates for individual years were calculated and plotted appropriately. A total of 632 publications were reviewed, the majority being peer-reviewed journal articles. A sharp increase in total publications was observed over the study period. Vector Pathogen Characteristics + Epidemiology was the most prevalent theme overall (28%) followed by Biotechnology Advancements (21%). Environmental Factors/Human Impact exhibited a strong positive trend overall (R = 0.53) due to an increasing number of publications on climate change. Many important trends were identified and discussed. Some of the most important include associations between an increase in the popularity of climate change and the dramatic increase in Lyme disease incidence in the U.S. (both in the 1980’s) with subsequent increases in publications. Moreover, the much higher prevalence of themes on vector behavior and control/prevention methods compared to clinical management of diseases shows that population-level approaches to preventionremain the dominant focus in combating VBDs.

Nuryuziliana Dolmat (Yuzi) is currently working as Obstetrician and Gynecologist at Tawau General Hospital, Tawau Sabah. She completed her Masters of Obstetrics & Gynaecology from the University of Malaya. She worked at Sabah Women and Children Hospital as a Specialist and then promoted as Head of Department in Obstetric Department in Tawau General Hospital. She had involved with many teaching session for post graduate student in O&G.

Group A streptococcus (GAS)-induced toxic shock syndrome (TSS) in pregnancy is rare, but its clinical course is fulminant. Mortality of GAS-induced toxic-shock syndrome is high as 50%. Here, we report two obstetrics cases from South-East Coast of Sabah, Malaysia. The first case was 23 year old lady presented with preterm labour at 24 weeks. She was in severe septic shock at presentation that requires three inotropes support. Her condition deteriorate very fast despite broad spectrum antibiotic and metronidazole, she succumbed within 24 hours from admission. Post mortem was done for her showed tissue culture from multiple organs grew GAS. While in other case, 23 year old lady at 34 weeks initially presented with shortness of breath with elevated blood pressure which been treated as acute pulmonary oedema secondary to severe pre-eclampsia. Her chest X-ray also suggestive of pneumonia was treated with ceftriaxone and azithromycin. An emergency lower segment caesarean section was done as her condition was worsening, severe metabolic acidosis requiring haemodialysis, difficulty in maintaining ventilation and needing inotropes to support her blood pressure. Post operatively, she was monitored in intensive care unit and antibiotics were changed to C-Penicillin and Clindamycin as her blood culture grew GAS which was sensitive to both. She had good recovery period after completion of antibiotics for 10 days and discharged well home. Unfortunately, both baby for these two women did not survive. The clinical manifestation is varied thus it is challenging in making diagnosis and subsequently delivering early management.

Fikreslasie Samuel is currently working as expert in public health, Ethiopian Public Health Institute, Ethiopia

Background: Soil-transmitted helminths (STHs) are widespread in underdeveloped countries. In Ethiopia, the prevalence and distribution of helminth infection varies by different exposing risk factors. We therefore investigated the prevalence of and risk factors of STHs infection in school children living in Ambo town, west Shoa Ethiopia. Methods: In 2014/15, among 375 school children planned to be included in this study, only 321 school children were recruited in the study. Data onto school children from different schools were collected, including stool samples for qualitative STHs analysis. Questionnaire data on various demographic, housing and lifestyle variables were also available. Results: Prevalence of any STHs infection was 12.6%. The respective prevalence of major soil-transmitted helminths is Ascaris (7.8%), hookworm (2.8%) and Trichuris (2.2%). This study result shows STHs prevalence varies regards to age, sex, latrine use, family size and nail trimming. Conclusion: The results of the present study indicated that the percentage of positive finding for STHs in Ambo area is low. Besides, large family size, not nail trimming and unavailability of improved latrine were identified as predisposing factor for STHs infections. All school children enrolled and not enrolled in this study should be treated twice a year until the prevalence falls below the level of public health importance.

Han Naung Tun is a Physician in Internal medicine, Tropical Medicine and Cardiology, has been working at Pun Hlaing Siloam Hospital. He got MBBS from University of Medicine (2), Yangon. He is also an International Active Member of American Academy of Family Medicine and Australia College of Tropical Medicine and Professional Member of European Society of Cardiology and Working Groups. He has him expertise in Tropical Medicine and Cardiology in both clinical and Research. He has been still working in new Treatment outcomes and Molecular Topical Medicine research join with University of Medicine, Yangon and Zurich University.

This abstract is to review the demographic results, complication and treatment outcomes of CMV eye program. A retrospective review of patients’ register based on our under-care patients at HIV clinic and the period of treatment was started from March 2016 to December 2017. 914 patients whose CD4 is less than 100 were eligible for the study. Mean age was 30.37 +/- 10.7 year. Among those patients with active CMV lesion, 50% of them were already on any kind of first line ART (NNRTI and NRTI) but 38.9% of the newly diagnosed patients with HIV infection were also co-infected with active CMV lesion. Only 5.6% of the patients were already on second line ART (with PI) or another special regimen of ART. On one month after the treatment according to our WHO CMV protocol, 73.3% of the lesions became improved with appropriate treatment and 26.7% of the lesions became inactive. Here, 16.7% of the patients did not reach to one month. On three months, 53.8% of the lesions became inactive and 23.1% of the lesions become improved well on the treatment but another 23.1% of the patients suffered again with relapsed. The reason of relapse was not due to inefficiency of the treatment but mainly due to loss of follow up for weeks or months. Here also 27.8% of the patients did not reach to three months. On six months, 60% of the lesions became inactive and 40% of the lesions improved well. There was low incidence of complications (5 cases in 914). The cause of death was due to occurrence of new OIs who were also loss to follow up. The cause of death is not totally associated with side effect of injection (Ganciclovir) and oral (Valganciclovir). The study showed that even low CD4 (<100) with CMV retinitis was effectively cured with very low side effect and achieved better outcome with least of adverse reaction.