6^th International Congress on Infectious Diseases February 25-26, 2019 Park Inn by Radisson Hotel Heathrow, London, U.K,

Tarek Ameen is currently working as an Assistant Professor of Internal Medicine, Gastroenterology and Hepatology unit in Mansoura University. He also works as Consultant in Department of Gastroenterology and Hepatology in King Fahd Hospital.

Objectives: Th is work was done to investigate the predictors of mortality in non-survivors due to MERS-coronavirus infection. Methods: Th is study was conducted on 45 patients with coronavirus infection who were admitted in King Fahd hospital, Al Madinah Al Munawwarah, Kingdom of Saudi Arabia during the period from October 2013 to June 2014. Th e studied patients were subjected to thorough medical history, clinical exam, complete laboratory investigations and nasal swabs and/or endotracheal secretion swabs for the intubated patients for detection of coronavirus by polymerase chain reaction (rRT-PCR). Treatment was carried out according to WHO guidelines and the outcomes were recorded by comparing the survivors with the non-survivors. Results: Th is study showed that most of the non-survivors were smokers, and presented with dyspnoea (88.9%), cough (83.3%), fever (94.4%) and bilateral radiological pulmonary infiltrates (83.3%). Twenty-seven patients (60%) out of the 45 studied patients, and 17 patients (94.5%) out of 18 non- survivors had at least one co-morbid condition. the duration of mechanical ventilation (MV), and the length of ICU and hospital stay were significantly prolonged in the non-survivors group compared to the survivors. Th ere was a statistically significant positive correlation between death and duration of illness before hospitalization, smoking severity, and presence of obesity, diabetes mellitus, end-stage renal diseases, and renal transplantations. Conclusions: Advanced age, smoking severity, bilateral radiological pulmonary infiltrates, and presence of associated comorbidities were risk predictors for mortality in hospitalized coronavirus-infected patients.

Sadaf Sabzevari is currently working as Assistant Professor at Vector-Borne Diseases Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran. He has his expertise in vector borne diseases and interested in Pathobiology.

Cutaneous leishmaniasis (CL), caused by several Leishmania species, is a complex disease with a wide spectrum of clinical features. Th is neglected vector-borne disease, is a major public health problem worldwide and one of the most common endemic diseases in Iran. According to the World Health Organization (WHO) reports, about 900,000 to 1.3 million new cases of leishmaniasis are reported per year; of these, approximately 0.7–1.2 million are cutaneous leishmaniasis. It is estimated that 20,000 new cases are reported annually in Iran, nevertheless, due to under-reporting, the actual number is almost higher. North Khorasan province in North Eastern Iran is one of the important focus of CL, and this study was performed to determine the main parasites, reservoir hosts and vectors of the disease in this district. Leishmania positive isolates from human cases in North Khorasan province (North East of Iran) were genotyped using PCR-RFLP analysis. Wild mammals were caught from gerbil burrows and the genus and species of the rodents were determined by external morphological characteristics. Leishmania parasites were detected to assess the infection of reservoir hosts through microscopically methods, PCR-RFLP and phylogenetic analysis. Sand flies were collected by sticky papers and identified to species level using light microscope and keys. PCR of kDNA, ITS1-rDNA, followed by RFLP were used for identification of DNA of Leishmania parasites within infected sand flies. Th e results of this study indicated that the parasite causing cutaneous leishmaniasis in this province is L. major. The results also revealed that Rhombomys opimus is considered as the main reservoir host of CL. Microscopic investigation on blood smear of the animals for amastigote parasites and PCR-RFLP revealed the presence of L. major in rodents. Two species of Phlebotomus papatasi and Phlebotomus salehi were found to be naturally infected with L. major. Moreover, mixed infection of L. turanica and L. major was observed in one specimen of P. papatasi. Characteristics of the collected Leishmania isolates from North Khorasan revealed that L. major is a predominant parasite of cutaneous leishmaniasis. Our study revealed that R. opimusis the most important reservoir host for maintenance of the parasite source in the area. According to the results, two vectors of cutaneous leishmaniasis were found to be active in studied area. P. papatasi and P. salehi are, like in several places, the probable vectors of cutaneous leishmaniasis in this focus of cutaneous leishmaniasis. We also found that the disease is endemic in Northern Khorasan Province.

Peighambari S M has completed his PhD at the University of Guelph, Canada in 1998. Currently, he is a Professor of avian diseases at the Faculty of Veterinary Medicine, University of Tehran. He has published more than 70 papers in domestic and international veterinary journals and has been serving as an editorial board member of three Iranian journals and the referee for many domestic and international journals.

Pseudomonas aeruginosa is one of the most important bacterial pathogens causing infections in humans and animals including pet birds. Pseudomonas aeruginosa fighting nature counteracts with antibiotics leading to the emergence of resistant bacteria. Th e genome of P. aeruginosa is capable of reading several efflux RND pumps which, from a clinical point of view, are very important in multidrug resistance. In this regard, the MexAB-OprM pump is considered as one of the most efficient RND pumps for P. aeruginosa. Th e purpose of this study is to determine the existence of MexAB-OprM pump genes and antibiotic resistance pattern of P. aeruginosa isolated from birds referred to the Pet Bird Clinic of the University of Tehran. During this study, multiplex PCR was used to detect the P. aeruginosa and MexAB-OprM pumps by using specific primers. Also using Kirby-Bauer agar disc diffusion method and according to the CLSI recommendation, the resistance pattern of the P. aeruginosa isolates was investigated against 20 antibacterial agents. Th e results showed the presence of MexA and OprM in all isolates of this study. However, MexB was not detected in any of isolates. Antibiotic resistance to neomycin, kanamycin, rifampicin, and vancomycin was 100% resistance to fluoroquinolones family such as ciprofloxacin, danofloxacin, norfloxacin, ofloxacin, and enrofloxacin was 0%, and nalidixic acid was 14.3%. Multidrug resistance was common among isolates. The findings of this study showed prevalence of P. aeruginosa among pet birds. Th ese findings are very important for public health.

Jyoti Gupta is pursing PhD from School of Biotechnology, Jawaharlal Nehru University. She is Senior Research Scholar in Department of Biotechnology. She has qualified National eligibility lectureship. She has presented her poster in many reputed national and international seminars and conferences.

Helicobacter pylori, most common etiologic agent colonizes the gastric mucosa of 50% world population and causes gastrointestinal diseases and gastric cancer. Mycobacterium tuberculosis causes tuberculosis in humans. One third of world population are infected with M. tuberculosis. Recent report shows that most of the death of TB was due to the latent asymptomatic M. tuberculosis infection. A seroprevalence of H. pylori is reported in many extragastrointestinal disorder and respiratory diseases and asthma is inversely associated. Th e infection prevent the development the asthma in mice model. However, all the studies are based on the case control. No study has focused to explore the underlying possible mechanism that modulate the pathogenesis of M. tuberculosis. To explore the innate immune mechanism murine macrophages RAW24.7 and alveolar macrophages were activated with H. pylori and then with M. tuberculosis and quantitative real time PCR have been performed to evaluate the polarization of macrophages. Results show that H. pylori suppressed proinflammatory markers (IL-1β, IL12and TNF-α) and upregulated anti-inflammatory and regulatory mediators IL10, DCSIGN, RELM and TGF-β and increased phagocytotic activity. Th us macrophages are modulated towards alternative macrophages that suppress the immune response against the M. tuberculosis and promote survival. Th e conclusion is that H. pylori infection tailored the immune response towards anti-inflammatory and regulatory type that promotes disease progression.

Tatiana Priputnevich PhD, is a Head of the Department of Microbiology, Clinical Pharmacology and Epidemiology, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov of Ministry of Healthcare of Russian Federation. Her special research and expertise is in clinical microbiology, genetic properties of opportunistic microorganisms, MALDI-TOF mass spectrometry.

Eggerthella lenta-associated sepsis is rarely reported, despite wide possibilities for identification of microorganisms. This case report highlights E. lenta severe endometritis complicated by abdominal sepsis in a young healthy woman. A woman aged 27 at 40 weeks of gestation was admitted to the center in labor. Th e pregnancy was complicated by bacterial vaginosis in the Ist trimester, and rotavirus infection which required inpatient care in the IInd trimester. Due to obstructed labor, caesarean section was performed. Rupture of membranes to delivery interval was 17 hours. Cefazolin was given preoperatively. Further antibacterial therapy with cefazolin was continued for the next 72 hours due to the patient’s history. 72 hours after the delivery the patient exhibited fever (37.5_), leukocytosis, neutrophilia and CRP rise. Microbiological analysis revealed the growth of three species of obligate anaerobes: Bacteroides thetaiotaomicron, Bacteroides uniformis and Eggertella lenta of 5-7 lg CFU/ml. All three isolates appeared sensitive to metronidazole, imipenem, amoxicillin clavulanic acid and resistant to cefotaxime. Eggertella lenta was sensitive to clindamycin, but B. thetaiotaomicron and B. uniformis were resistant to clindamycin; B. thetaiotaomicron was sensitive to moxifloxacin, but B. uniformis and E. lenta were not. E. lenta was sensitive to Vancomycin). MIC Linezolid for E. lenta and B. uniformis was 1 μg/mL and for B. thetaiotaomicron – 2 μg/mL. Th e patient was finally subscribed linezolid together with clindamycin. Th e patient’s clinical condition rapidly improved the fever and systemic inflammatory response signs resolved. Th e patient was discharged on the 21st day after delivery in satisfactory condition.

Geraldene Munsamy is a PhD candidate in Pharmaceutical Chemistry at the University of Kwa-Zulu Natal. She has completed her master’s degree in Medical Science at the University of Kwa-Zulu Natal. Her current research interests include malaria and is predominantly focused on exploring the structural and functional features of aspartic proteases, which play an essential role in malaria progression and the development of drug resistance. Her research includes the integration of molecular dynamic simulations coupled with other advanced bio-computational tools to explore the structural dynamics of these prominent aspartic proteases.

Plasmepsins, a family of aspartic proteases expressed by Plasmodium falciparum parasite, have been identified as key mediators in the onset of lethal malaria. Precedence has been placed on this family of enzymes due their essential role in the virulence of the parasite, thus highlighting their importance as novel drug targets. A previously published study by our group proposed a set of parameters used to define the flap motion of aspartic proteases. Th ese parameters were used in the study of Plm I–V and focused on the flap flexibility as well as structural dynamics. Recent studies have highlighted the essential role played by Plm IX and X in egress and invasion of the malarial parasite. Th is study aims to close the gap on the latter family, investigating the flap dynamics of Plms IX and X. Molecular dynamics simulations demonstrated an “open and close” mechanism at the region of the catalytic site. Further computation of the dihedral angles at the catalytic region revealed tractability at both the flap tip and flexible loop. Th is structural versatility enhances the interaction of variant ligand sizes, in comparison to other Plm family members. Th e results obtained from this study signify the essential role of structural flap dynamics and its resultant effect on the binding landscapes of Plm IX and X. We believe that this unique structural mechanism may be integrated in the design and development of effective anti-malarial drugs.

Robert S O’Neill is a final year Medical student from the University of Notre Dame, Sydney, Australia. He has a previous Science degree with a major in Immunobiology and has previously presented on topics associated with hepatopancreaticobiliary surgery.

Legionellosis is a clinical syndrome resulting from infection with the bacterium Legionella, with its incidence historically being difficult to quantify due to inconsistencies in case definitions, diagnostics and surveillance systems. Previously defined risk factors include immunosuppression, smoking, and age, with the latter being of importance due to the forecasted population shift in Australia to that of an aging population. Th is study aimed to describe the Legionellosis experience in Australia using publicly available data over a period from 1991-2018. Over the 27-year period there has been a 315% increase in Legionella notifications at a national level, however, the notification rate has remained relatively stable, peaking at 2.5 per 100,000 of the population. Analysis of national data demonstrated notification rates being greater in males, those aged 60-79 and in the autumn season, all of which were statistically significant (p<0.05). Analysis at a state level highlighted that in those over the age of 65, the mean notification rate of Legionella pneumophila was significantly greater that Legionella longbeachae. Th is study demonstrates the recent historical trends of legionellosis notification in Australia and further demonstrates that infection is more common in certain population groups, namely the male gender and those aged 60-79. Th is study also demonstrated that the season of autumn was associated with the highest notification rate during the period studied. Furthermore, in those over 65, the notification rate of L. pneumophila was significantly greater than L. longbeachae highlighting predominance in the elderly.

Sheila Moura Pone is a Pediatric Infectious Diseases Specialist at the National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF/FIOCRUZ) in Rio de Janeiro, Brazil. Her PhD research on dengue epidemics in children and her experience as Chief of the Pediatric Infectious Diseases ward were fundamental during the recent ZIKV outbreak in Rio. She is responsible for the outpatient and hospital care of children vertically exposed to ZIKV at IFF. She is also part of the Zika Task Force Group and she has published relevant papers on the subject, contributing to the knowledge of this new congenital infection.

During the Zika virus (ZIKV) epidemic in Rio de Janeiro (2015-2016), a prospective cohort study involving symptomatic pregnant women with PCR-confirmed ZIKV infection and their infants was established. A total of 94 children underwent brain imaging and assessment with the Bayley Scales of Infant and Toddler Development, third edition (Bayley-III) at 12-18 months of age. Transfontanelle cerebral ultrasonography was usually performed first, and further imaging was performed according to clinical discretion. Bayley-III was used to assess cognitive, language, and motor functions. Abnormal findings on neuroimaging were identified in 35 (37%) children, 10 (11%) had structural abnormalities, 5 (5%) had non-structural abnormalities, and 20 (21%) had abnormal results that were limited to a nonspecific T2-weighted hypersignal on MRI. No microcephaly was detected. Bayley-III scores above 85 (normal development) for all three domains were observed in 59 (63%) children; 24 (26%) had one or more Bayley-III scores between 85 and 71 (1 to 2 SD below the mean score); and 11 (12%) had one or more scores below 70 (2 SD below the mean score). Th is rate of severe neurodevelopmental delay (- 2SD) is higher than that reported in previous studies. Although a significant association was noted between normal results on brain imaging and higher Bayley-III scores, neuroimaging did not predict developmental delay in 2% of children and normal development in 16% of children. As the long-term evolution of ZIKV-exposed individuals is still unknown, cohort studies are important to improve the understanding of this new disease.

Onugbo Nnenna Kalu Okomba is currently a core medical trainee at the East Suffolk and North Essex NHS foundation trust, at the Ipswich Hospital, United Kingdom. She is also studying for a Master’s in Public Health at the University of Sheffield, United Kingdom. She has an interest in becoming an infectious disease specialist.

Introduction: Infective endocarditis is a deadly disease which needs to be recognized early to reduce the risk of mortality. There has been an increase in infective endocarditis incidence since the introduction of the European Society of Cardiology (ESC) guidelines in 2009,1,2,3 especially of streptococcal endocarditis. Infective Endocarditis prevalence has also increased in the UK since 2008 in both high risk and lower risk patients1,2,3 with high treatment costs as most patients spend long times in hospital, up to six weeks or more most of the times and sometimes even requiring intensive care and emergency surgery. Early recognition is important to reduce the resultant morbidity and mortality. Ipswich Hospital has also recently seen an increasing number of cases of infective endocarditis, it is important not to miss some cases. Method: Th e current prevalence, diagnosis and treatment practices in Ipswich Hospital between August 2017 and July 2018 were retrospectively reviewed. All the patients with a diagnosis of infective endocarditis within this time period were identified with the help of the coding department at Ipswich Hospital. Th ere were 21 patients found within the audit period, (1 child was excluded) the Modified Duke’s criteria and ESC guidelines 4, 5 were used to compare the diagnostic criteria used for diagnosis and compliance with Ipswich Hospital microbiology guidelines 6 was reviewed. A checklist for management of cases was developed. Results: A cardiology and microbiology input was sought in 100% of cases of infective endocarditis as recommended by the ESC guidelines, however 15% of patients got antibiotics prior to blood cultures. 14 patients (70%) had a definite diagnosis of infective endocarditis meeting the modified Duke’s criteria and ESC guidelines, 3 patients (15%) had correctly diagnosed presumed/possible infective endocarditis, 3 patients (15%) should have had a diagnosis of presumed endocarditis but did not. Only 13 patients (65%) had either a successful or attempted transoesophageal echocardiogram (TOE). Th ere was a 95% (19 patients) compliance with the Ipswich Hospital antibiotics guideline and a mortality rate of 15% (3 patients) in the sample studied. Conclusion: Not all guidance is being followed, there should be a high index of suspicion in high risk cases even those presenting without a fever, as well as emphasis on ensuring that blood cultures are done prior to commencing antibiotics for any infection. A checklist for management of cases of Infective endocarditis has been developed to improve patient care. A reaudit is planned in March 2019.