6^th International Conference on Tropical Medicine and Infectious Diseases January 28-29, 2019 Barcelona, Spain

Chair

Marie St Rose

Norfolk State University, USA

Co-Chair

Jens M Warnecke

Scientific Communication Manager Infectious Diseases at EUROIMMUN AG, Germany

Session Introduction

Boulenouar Mesraoua

Weill Cornell Medical College, Qatar

Title: Clinical presentation and epidemiology of neurocysticercosis in Qatar and the region

Biography:

Dr Boulenouar Mesraoua is consultant neurologist at Hamad General Hospital and also associate Prof .clinical neurology at weill Cornell Medical College, Qatar. After a medical graduation from the university of Oran in Algeria, he moved to Belgium, the city of liege, for a residency in Internal Medicine and Neurology; after getting the Belgian Board of Neurology, he went to the National Hospital for Nervous Diseases, Queen Square, London, UK, for a fellowship in clinical neurophysiology, under Prof. Willison, he had also further training in Epilepsy and Continuous EEG Monitoring in the Neurophysiology department of Zurich, Switzerland, under Prof. HG Wieser.

Abstract:

Neurocysticercosis (NCC) is the parasitic infection of the central nervous system by the larval stage of the tapeworm Taenia solium, through fecal oral infestation. It is endemic to many developing countries, with high prevalence noted in Latin America, sub-Saharan Africa, and South East Asia. Pigs are the intermediate hosts for this parasite; therefore historically the disease was non-existent in Muslim countries where raising or consuming pork is unlikely. However, clinical experience from the neurology service at Hamad Medical Corporation (HMC) ,Doha, Qatar identifi es NCC as a common reason for neurological consultation. The resurgence of this disease in Qatar and other countries in the Arabian Peninsula is related most likely to immigration from endemic countries. Th e present study describes the clinical presentation of NCC as well as its epidemiology aspects in Qatar and the region and the financial burden of NCC on the society overall.

Rubeena N. Shaffi

Cork University Hospital, Ireland

Title: Tuberculosis and its management; challenges in ophthalmology

Biography:

Dr Rubeena Nazil Shaffi have been working as a medical ophthalmologist at the department of Ophthalmology Cork University hospital since Nov 2015. She did her fellowship in Ophthalmology from College of Physicians and surgeons Pakistan in 2006. As a medical ophthalmologist she have come across a number of patients with Toxoplasmosis, Chlamydia, Neisseria Gonorrhoeae, Syphilis, HIV, Tuberculosis a few to name.Thus she always in a liaison with the Infectious diseases department which is of utmost importance for effective management of their patients with ocular symptoms.

Abstract:

Purpose: To highlight the diversity of clinical presentation of ocular tuberculosis in a non-endemic setting and discuss an effective approach towards its diagnosis and management. Also to emphasize on close monitoring of patients as anti-tuberculous treatment itself can further complicate and prolong the course of the disease due to its ocular and extraocular complications.

Method: Descriptive Case Series

Results: Three cases of varied presentation of ocular tuberculosis and one case of extrapulmonary TB associated with ocular complications due to treatment were diagnosed over a period of eight months at Dept. of Ophthalmology, CUH, Cork. Presentations included recurrent blephroconjunctivitis with chlazion, recurrent granulomatous anterior and posterior uveitis, choroidal tuberculoma, recurrent vitreous haemorrhage and pan uveitis. All patients had normal X-ray chest and negative Tuberculin Skin test (Monteux). Diagnoses were presumptive and assisted with positive Interferon Gamma Release Assay

(IGRA); Quantiferon. Complications associated with treatment of tuberculosis included optic neuritis, ocular cranial nerve palsy and extra ocular complications including worsening liver functions.

Conclusion: A high ind ex of suspicion helps diagnosis of ocular TB in areas of low-prevalence of the disease. It forms part of diff erential diagnosis of chronic, recurrent blephroconjunctivits and uveitis especially in at-risk patients. Anti-tuberculous treatment seems highly effective, yet close monitoring is important to pinch up treatment related complications early on, a

prompt referral to the related medical specialities can lead to favourable outcome without prolonging course of the disease.

Ana Poveda

Central University of Ecuador, South America

Title: Characterization of new therapeutic drugs against leishmaniasis

Biography:

Ana Poveda is a doctor in molecular biology at Universitat de València, España and Post-doc at Institut de Génétique Humaine-CNRS, Francia. She is a Researcher in fields of chromatin, histone modification, DNA replication and evaluation of active molecules in S. cerevisiae and Lleishmania and spp. Professor at Universidad Central del Ecuador (Centro Internacional de zoonosis, Facultad de Ciencias Químicas). IP of DNA replication & Genome instability (DR&GI) at Centro Internacional de Zoonosis. She is an autor of 14 publications.

Abstract:

Leishmaniasis is a largely neglected infection caused by Leishmania spp. parasites. Th e first-line treatment, antimonate meglumine, has a large number of adverse effects, high costs and is developing resistance. New alternatives are mandatory. Here we show the results obtained with synthetic compounds (bis(spiropyrazolone)cyclopropanes, Schiff bases) and well knownold antibiotics used against bacteria1. These compounds were chosen because many evidences indicate that bis(spiropyrazolone)cyclopropanes and Schiff bases have biological properties. The antibiotic selected was the fl uoroquinolones(FQ), a drug largely used against bacteria2. FQ are a good candidate since sequence alignments shows a good conservation of topoisomerases type II, the molecular target. To determine the leishmanicidal eff ect of drugs, a fluorescence method was optimized to determine MIC and IC50 in cultures of L. mexicana and L. braziliensis promastigotes3. In order to determine the toxicity and presence of DNA damage, bioassays with yeast were implemented (drop test using yeast mutants and comet assay). However, many compounds has a limited solubility. This limitation could be solved loading it into liposomal systems such as the transferosomes, ultradeformable nanovesicles4. Transferosomes were characterized in terms of size, polydispersity index, zeta potential, entrapment percentage, dissolution profile and physical stability. These nanovehicles enhanced the leishmanicidal activity compared with enrofloxacin in solution, around 15 times. So the nanoencapsulation could be an  interesting approach to develop a topic formulation to treat cutaneous leishmaniasis.Our results indicate that two Schiff bases,one bis(spiropyrazolone)spirocyclopropane and one FQ, are potential candidates for alternative treatment of leishmaniasis. Next eff orts are oriented to assay these drugs in murine models.

Karl Philipp Puchner

German Leprosy and TB Relief Association, Germany

Title: Eliminating leprosy: A marathon rather than a sprint?

Biography:

Karl Philipp Puchner is a physician specialized in internal medicine and has a master’s degree in “International health” from the Institute of Tropical Medicine and International Health in Berlin. Since 2015, he is working as a medical advisor for the German Leprosy and Tb Relief Association (GLRA) and since August 2017 as a medical coordinator of Médecins du Monde, Greece. During his career, he has acquired experience and skills, among others, in the fields of internal medicine, tropical medicine -particularly NTDs and TB - public health, refugee and migrant health as well as epidemiological research.

Abstract:

Statement of the Problem: After introduction of the groundbreaking Multi-Drug Therapy (MDT) in the early 1980s, WHO pushed for the elimination of leprosy by 2000. However, despite intensive efforts over 3 decades and undisputable progress, elimination of leprosy as a public health problem (PHP) at global level is still beyond reach. In this paper we review the epidemiological dynamics of leprosy, the control strategies applied in the past as well as their evolution and adjustment to the new state of evidence. Furthermore, inherent challenges and remaining obstacles in the undertaking of leprosy as a PHP are analyzed. Finally, taking the gradual shift towards integrative health policies and practices into account, we reflect on the

meaningfulness and timeliness of the set elimination targets for leprosy and other Neglected Tropical Diseases (NTDs).

Methodoly: Critical review of articles both on related operational research and basic science, opinion papers and epidemiological data on leprosy and other NTDs.

Findings: While trends in detection of new cases exhibit a plateau in the last decade, there is evidence of ongoing leprosy transmission in endemic settings. MDT has made enormous progress possible, yet seems to be insufficient for achieving the final push. Other recent innovations, though contributing further to the control of leprosy, are unlikely to lead alone or combined to elimination, as lack of basic biomedical tools and critical knowledge gaps remain. Emerging evidence about animal reservoirs, regional re-emergence and MDT resistance complicate further the feasibility of near-term elimination of leprosy. Universal health coverage and integrative medicine undoubtedly strengthen NTDs control ultimately, yet may jeopardize near-term disease specifi c elimination milestones.

Conclusions: Despite undeniable progress, near-term achievement of leprosy elimination as a PHP remains unlikely. In face of the pursuit of horizontal approaches in global health, meaningfulness of individual NTDs elimination targets might need critical reevaluation.

Kleriene Souza

Federal University of Mato Grosso, Brazil

Title: Surgical management of lung hydatidosis a monocentricexperience: At habib bourghiba university hospital, Sfax-Tunisia

Biography:

Kleriene Souza is a medicine student of 4Th year in Federal University of Mato Grosso in Brazil, did an exchange in March 2018 in CHU HABIB BOURGHIBA, TUNISIA with Doctor Chaari when this research has been developed. Doctor Zied Chaari : MD, thoracic surgeon in the Department of thoracic and cardiovascular surgery in Habib Bourguiba University Hospital (Sfax – Tunisia) since 2016. Worked as intern in thoracic surgery in Abderrahmen Mami University Hospital (Department of Thoracic Surgery) and in Avicenne Hospital in Paris – France in 2014 and 2015. Activity in thoracic surgery, lung disease, diaphragm disease, mediastinal tumors, lung cancer, VATS and mini invasive thoracic surgery. Thoracic Oncology Diploma obtained in Paris – France in 2015.

Abstract:

Hydatidosis is a parasitic disease caused by the larval form of the Taenia Echinococcus granulosus in human which is considered as the accidental intermediate host. Hydatidosis is widely seen in the Mediterranean region, South America, Australia and New Zealand. Th e liver is the most common location followed by the lung in adults.We report a monocentric experience of the surgical management of lung hydatidosis in a total period of 6 years from January 2012 to December 2017 in the department of thoracic and cardiovascular surgery in the university hospital Habib Bourguiba in Sfax, Tunisia.

Results: A total of 80 patients had surgery for lung hydatidosis with a 42,5 years average (minimum: 7 and maximum:78) and a SEX RATIO female/male = 1,16:1. In 67 cases (83,75%) were pulmonary hydatid cysts in only one lung, and the cyst was bilateral in 3 cases (5%). Th e cyst was multiple in 3 cases (3,25%). The mean location was the right lung (46.7%). Otherwise, the cyst was developed in the pleura in 3 cases (3,75%), in the mediastinum in 1 case. Cystectomy was performed in all patients. Surgery was completed by closure of bronchial fi stula in 52 cases (65%). Anatomical resection (lobectomy) was necessary only in 2 cases (2,5%). The evolution was simple in 70 cases (87,5%) and complicated in 10 cases with a total morbidity rate of 12,5%. The main complications were: fever, pneumonia, hemothorax, empyema and atelectasis. The peri operative mortalility was about 2,5%.Conservative surgical procedure (cystectomy) is the treatment of choice of lung hydatidosis specially the uncomplicated ones. This simple procedure is safe, reliable and successful. However anatomical resections should only be carried out in selected patients with specific indications.

Asmae Zarrouk

Abdelmalek Essaadi University, Morocco

Title: Mapping the potential risk of human visceral leishmaniasis in Morocco

Biography:

Asmae Zarrouk is Ph.D. in Biology at the Faculty of Sciences of Tetouan in Morocco: Specialization Ecology and Epidemiology. She have an article "Ecological and epidemiological status of species of Phlebotomus perniciosus complex (Diptera: Psychodidae, Phlebotominae) in Morocco" (ZARROUK et al., 2015). She participated by oral communication "Seasonal Fluctuations of Sandfly Populations (Diptera: Psychodidae) in Endemic and Non-endemic Areas of VL, Northern Morocco" at the 9th International Francophone Conference of Entomology ( CIFE) in Montpellier. 2-6 July 2018 and a posted communication "Epidemiology of visceral leishmaniasis in northern Morocco". Workshop Molecular Biology of Leishmania in Trieste, Italy.22 - 24 October 2018.

Abstract:

Visceral leishmaniasis is the most fatal forms of leishmaniasis. It is potentially lethal if left untreated. Leishmania infantum is the etiological agent of HVL in the Mediterranean regions including Morocco. Its main transmission mode is by the bite of infected phlebotomine sand fly insects which are the only proven vectors of this protozoan with dogs being considered the major reservoir of the parasite for humans and other mammalian hosts. In Morocco, human visceral leishmaniasis (HVL) represents an important problem for public health mainly in northern areas but recently, more autochthonous and imported cases were reported in central and southern Morocco, areas traditionally considered to be free from L. infantum. Our objective is to determine the potential distribution of L. infantum and its incriminated vectors in Morocco and estimate their ecological niche using the ecological niche modeling. Our results identified the districts at HVL risk and they are divided into three categories based on their possible exposure to VL risks. Areas with high risk where conditions suitable across the whole district and areas with moderate disease risk where suitable conditions is limited only to small belt in the western side of district, and others with low disease risk where conditions were unsuitable.

Ahmed Sherif Attia

Cairo University, Egypt

Title: Development of a novel rapid assay for the detection of Enterobacter cloacae using conjugated gold nano-particles

Biography:

Ahmed Sherif Attia, works as a Professor of microbiology and immunology, Faculty of Pharmacy, Cairo University. He obtained his PhD in molecular microbiology from the University of Texas Southwestern Medical, USA working on the molecular aspects of the microbial resistance to the complement system. He is working as a postdoctoral fellow at Vanderbilt University, USA, he identified new microbial therapeutic targets and novel host antimicrobial mechanisms using cutting edge technologies. His current

research focuses on; i) identifying novel microbial therapeutics, ii) development of new vaccines and biotechnological products, and iii) studying the relationship between microbial infections and therapeutic clinical outcomes in non-infectious diseases. His work is highly recognized both on the national and international stage by being awarded many prestigious awards.

Abstract:

Enterobacter cloacae is a Gram-negative bacterium that contributes to a wide range of nosocomial infections all over the world. It causes blood stream infections in both adults and infants, including neonates. Th e mortality associated with such infections have reached alarming rates, up to 60% in some instances. The emergence of strains that are highly-resistant to multiple antibiotics adds more complexity to situation. In this work, we are developing a rapid assay for the detection of E. cloacae using conjugated gold nano-particles. Bioinformatics analyses of E. cloacae proteome identifi ed two peptides that are unique to E. cloacae. Th ey are highly conserved among E. cloacae strains that are sequenced in Genbank. In addition, they showed almost

no similarities to peptides in other members of the Enterobacteriaceae family nor other species within the Enterobacter genus.The two peptides were chemically-synthesised, and their identity and purity were verifi ed, then they were used individually to  immunize BALB/C mice to produce specifi c anti-sera. Gold nano particles (GNPs) were produced with the citrate reduction

method and their size was verifi ed using electron microscopy. Antibodies were purifi ed and then conjugated to the GNPs. The developed GNPs were then used to detect E. cloacae in solution through microscopic examination, spectrophotometrically, and visual inspection. The developed GNPs detected E. cloacae with both high sensitivity and specificity. More importantly the time taken for getting the results was less than 1 hour as compared to the 48 hours required for traditional methods and with much less cost than the nucleic acids-based methods. The developed assay provides a sensitive, rapid, and low-cost tool forn detection of E. cloacae and would contribute in reducing the harms caused by this pathogen through prompt accurate diagnosis.

Session Introduction

Apeksha Agarwal

University of Texas Health Science Center, USA

Title: Fatal fulminant murine typhus (MT) presenting with status epilepticus and multiorgan failure: A case report

Biography:

Apeksha Agarwal is a third year anatomic and clinical pathology resident at University of Texas Health Science Center at San Antonio, Texas, USA.

Abstract:

Background: MT is a flea-borne infection caused by Rickettsia typhi presenting with fever, headache, rash, chills, malaise, myalgias and anorexia. Of the 3,048 probable and confi rmed MT cases in Texas (1985-2015), 11 were fatal.

Methodology: A 46-year-old Caucasian man with history of alcohol abuse and cranioplasty at 12 years of age, but no recent significant travel history or exposure to fleas, ticks, rodents, cats or dogs, presented with hypotension, tachycardia, convulsions and hypoxemia. Physical examination revealed central cyanosis, horizontal nystagmus, rhythmic jerking of extremities, and coarse breath sounds. An EEG showed nonconvulsive status epilepticus. Serologic studies for MT and Rocky Mountain spotted fever were both positive. Despite fluid resuscitation and antimicrobials for septic shock and suspected meningoencephalitis, he developed multiorgan dysfunction and succumbed 6 days post-admission.

Results: At autopsy, external findings included a petechial rash on both legs, gangrenous toe tips, multiple cutaneous ecchymoses, and scleral hemorrhages. Gross examination of internal organs revealed hemorrhagic pneumonia, cerebral edema, and mild cerebellar tonsillar herniation. Microscopic findings included multifocal small-vessel thromboses in the lungs, skin and kidneys, along with cutaneous vasculitis and scattered perivascular mononuclear cell infi ltrates in the brain. Liver, adrenal glands, kidneys, and watershed areas of the cerebrum showed hypoxic ischemic necrosis.

Discussion: There are few published reports of morphologic findings in fatal cases of MT. Three case reports have described myocarditis, and one described diff use alveolar damage, encephalitis and renal failure. In our case, the patient had a rapid course leading to death within 6 days of hospitalization, and showed autopsy evidence of cutaneous and cerebral vasculitis, and disseminated intravascular coagulation. CNS involvement is unusual in MT and was undoubtedly the cause of patient’s intractable status epilepticus.