ICCAID 2008

ALMATY, KAZAKHSTAN

THE SECOND INTERNATIONAL

CONGRESS OF
CENTRAL ASIA
INFECTIOUS DISEASES
MARCH 27 - MARCH 31, 2008

PROGRAM
AND
ABSTRACT BOOK

www.iccaid.org
Contacts
Scientific Secretary
Salih Hoso¤lu, MD
Dicle University Hospital
Dept.of Infectious Diseases
21280, Diyarbakir, TURKEY
Tel : +90 248 84 73
Mobile : +90 536 240 53 25
hosoglu@hotmail.com

Congress Organizations Secretary

Mine AKTURK TUTER
ACP Congress & Organizations INC
Valikonagi Cad. Samsun Apt. No:57/3
34365 Nisantasi, Istanbul, TURKEY
Tel : +90 212 219 99 39
Fax : +90 212 232 09 76
mine@acporganizasyon.com
www.acporganizasyon.com
 - CONTENTS -
Page

Welcome 4
Committees 5
Congress Registration and Information 6
Program at a Glance 7
Scientific Program 8
Presentations of Invited Speakers 14........63
Oral Presentations 64........78
Poster Presentations 79.......164
Authors index 164.....168
Keywords index 169.....172
 The Second International Congress of Central Asia Infectious Diseases

After the collapse of former Soviet Union, the incidences of infectious diseases have dramatically increased in the
Central Asian States. Along with economic and political problems, ineffective new healthcare systems and programs in
these countries contributed to the rise of such endemic diseases. The first International Congress of Central Asia
Infectious Diseases (ICCAID) was held in Bishkek, Kyrgyzstan from October 30 through November 2, 2006. It was a
very successful event in terms of the collaboration and exchange of experience and expertise among scientists from
different nations participating in the conference. The meeting was a great chance to experience central Asian
hospitality and to be exposed to the latest front line clinical and genomic-based research. As all researchers in the
infectious diseases area have a common goal of understanding and fighting the relentless spread of infectious diseases,
we hope that such meetings, exchanges and collaborations will help the developing regions of the world succeed in its
fight against infectious diseases.

In order to continue the effort that began in Bishkek in 2006, the second ICCAID has been scheduled between 27 and
30 March 2008 in Almaty-Kazakhstan. Our expectation is a high-level scientific congress with participation from
around the world.

Congress Presidents

Professor Talgat Muminov, M.D. Professor Hakan Leblebicioglu, M. D.

The President of Kazakh National Medical The President of Society of Black Sea Clinical
University, Almaty-Kazakhstan Microbiology and Infectious Diseases,
Samsun-Turkey

4
 COMMITEES

Congress Organizing Committee Local Kazakh Organizing Committee :

Dr. Raushan Issayeva, Almaty – Kazakhstan Dr. Raushan Kabykenova
Dr. Murat Gunaydin, Samsun - Turkey Dr. Gulnar Alshinbaeva
Dr. Salih Hosoglu, Diyarbakir - Turkey Dr. Kenes Ospanov
Dr. Amangul Duisenova, Almaty - Kazakhstan Dr. Saule Doskozhaeva
Dr. Elmira Alibi, Almaty – Kazakhstan Dr. Amirbek Karabekov
Dr. Saken Amirejev
Dr. Galia Kuttykuzhanova
International Scientific Board : Dr. Bahyt Ramazanova
Dr. Ravilya Yegemberdieva
Yasmin Abdul Malik-Malaysia Dr. Lyazzat Yeralieva
Gulnara Alshimbaeva-Kazakhstan Dr. Anar Daniarova
Turan Aslan-Turkey Dr. Meiramgul Gabasova
Peter C. Appelbaum-USA Dr. Olzhas Utepbergenov
Ismail Balik-Turkey
Baurzhan Bayserkin-Kazakhstan
Nedim Cakir-Turkey The Scientific Secretary
Mehmet Doganay-Turkey
Riza Durmaz-Turkey Salih Hosoglu, MD,
Amangul Duisenova-Kazakhstan Dicle University Hospital,
Inge Gyssens-The Nederlands Dept. of Infectious Diseases
Bulent Gurler-Turkey 21280, Diyarbakir, Turkey
Murat Gunaydin-Turkey Phone: +90 412 2488473 Mobile: +90 532
Salih Hosoglu-Turkey 5401248
Ronald N. Jones-USA (Iowa City) e-mail : hosoglu@hotmail.com
David Kelvin-Ontario, Canada
Roman Kozlov-Russian Federation (Smolensk)
The Organisation Secretary
Ainura Kutmanova-Kyrgyz Republic
Adnan al Lahham-Jordan Mine Akturk
Hakan Leblebicioglu-Turkey Project Coordinator
Mark Lobe-Canada (Ontario) ACP Congress & Organization
Ziad Memish-S. Arabia Address : Valikonagi Cad. Samsun Apt. No:57 Kat:3
Dominique L. Monnet-Denmark 34365 Nisantasi - Istanbul / Turkey
Kurt Naber-Germany Phone : +90 212 219 99 39
Necati Ormeci-Turkey Fax : +90 212 232 09 76
Hasan Ozkan-Turkey e-mail : mine@acporganizasyon.com
Recep Ozturk-Turkey
Gian Maria Rossolini-Italy
Victor Rosenthal-Argentina
Ahmet Sanic, Baku, Azerbaijan
Salvatore Rubino-Italy
Paul Tulkens-Belgium
Sercan Ulusoy-Turkey
Serhat Unal-Turkey
Gaye Usluer-Turkey
Haluk Vahaboglu-Turkey
Aysegul Yagci-Turkey
John Wain-UK
Afia Zafar-Pakistan

5
CONGRESS REGISTRATION AND INFORMATION
Registration
Speakers should submit their presentations (on CD) to the technical staff in
The registration desks and the secretariat are located at the entrance of the the presentation preview room at least one hour before their meeting.
congress center the secretariat is the in the charge of registration, hotel Computers and slide projectors will be available for reviewing of the pre-
booking and social events. sentations.
CDs for on screen presentations should be like wise marked clearly and
The opening hours are: submitted to the technical preview room staff for transfer on to the com-
26 March 08:30 - 18:30 puter system.
27 March 08:30 - 18:30
28 March 08:30 - 18:30
29 March 08:30 - 18:30 Oral Presentation Guideline:

Please note that the registration desk will be available to accept payment
in the USD and the EURO.
Congress badges
Your personal badge is your entrance ticket to all sessions and exhibitions.
Please remember to wear your badges at all the times in the congress
venue.
Program and abstract book
A copy of program and abstract book are included in your congress bag.
All presentations and slides should be in English.
Talks are scheduled at 5 minutes in Poster Presentation Part 1 and 10 min-
utes in Poster Presentation Part 2. The end of session, a 2-3 minutes ques-
tion period will be available.
An LCD projector and computer will be provided in each of the scientific
sessions (no other presentation media will be accepted) to project
PowerPoint Presentations
Note: Avoid computer problems by bringing your presentation on a USB.
All sessions will be held in the conference rooms located on the Hall
Almaty at the Congress Venue

Certificate of attendance Poster Sessions

A certificate of attendance will be given to the participants on request Poster board assignment: Your poster board number will be available on
please go to the registration desk the web site (in the abstracts), please be sure to check www.iccaid.org to
locate your assigned poster board number for placing your poster pres-
Language entation.

English is the official language of ICCAID 2008.

English- Russian simultaneous translation will be available in all halls. The poster board is 70 cm. wide x 100 cm tall. In general, posters are dis-
played from 10:00 a.m. to 4:30 p.m. Your poster MUST remain on dis-
Lost and found play throughout the day on your scheduled day. You are scheduled to be
available at your poster for one hour, beginning at 12.30 to 13.30. Show
For lost and found personal belongings, please contact the Congress this letter to Security at the Poster Confirmation desk, to access the poster
Secretariat area between 8:30 a.m. – and 18:30 p.m. Posters must be removed by
18:00. Please check bags, convention materials, poster tubes, etc. in the
Lunch box and Coffees Poster Storage area.

You will find coupons for Lunch boxes for each day. You may get your
launch boxes using these coupons for 3 days of congress the coffee bar
will be open for the participants during the coffee breaks.
Disclaimer
The organizer committee ACP Organization Co. and KNMU accept no
liability for injuries/losses of what ever nature incurred by participiants
and /or accompanying persons, or for loss or damage to their luggage
and /or personal belongings.
Note: All posters are to be presented in English.
Title is to be printed at the top of the poster. (BOLD CAPITAL letters, Font:
Times New Roman, Size: # 100).
Name(s) of author(s), institution(s), city and country of author(s) should be
stated clearly, directly below the title. Provide the surname(s) of the
author(s) followed by initials.
Print the name of the presenting author in bold.

Posters are to be mounted at eye level.

Scientific information
All posters will be discussed in the specific session ‘Poster Discussion’. All
Speaker presentations the representative authors should be ready at that meeting. The best three
posters will be chosen and declared in the end of session.
All chairs and co- chairs should be in their designed room a few minutes
prior the start of the sessions.
The co-chairs should ensure that all speaker adhere
allocated time for their presentations. A presentation preparing room will
be available during the following times:

26 March 08:30 - 18:30

27 March 08:30 - 18:30
28 March 08:30 - 18:30
29 March 08:30 - 18:30

6
 27 March 2008 28 March 2008 29 March 2008
26 March 2008
Hours
Precongress Day
Hall Astana Hall Almaty Hall Astana Hall Almaty Hall Astana

09.00-18.00 Registration Registration

Registration
09.00-9.30 The burden of
Round Table:
antimicrobial
Current problems in
resistance on clinical Laboratory diagnosis of tuberculosis
Opening Ceremony Chronic Viral
09.30-10.30 management of
Collaboration for Infectious Diseases Hepatitis
infections

10.30-11.00 COFFEE BREAK COFFEE BREAK COFFEE BREAK

Intestinal Infections
The Resistance in Developing
11.00-12.30 Sterilization and Improving
Problem among Countries
Disinfection antimicrobial use in Current approach to the Viral Hepatitis
Nosocomial
developing countries

7
Registration Pathogens
A new approach to
12.30-13.00 ESGAP Course Treatment of Hydatid Cyst

Specific Meeting: Mathematic and Medicine New laboratory equipment for science and industry
13.00-14.00 LUNCH
LUNCH LUNCH

Emerging Important
Emerging Zoonotic Oral Nosocomial Infections and Infection
14.00-16.00 Zoonotic Parasitic Diseases
Infections Presentations-1 Control
Infections in Asia

16.00-16.30 COFFEE BREAK COFFEE BREAK COFFEE BREAK

Current Problems Important Zoonotic

16.30-17.30 Poster Discussion
New Vaccinology in Sexually Community Acquired infections in Asia
Strategies Transmitted Infections
Diseases
17.30-18.30 Oral Presentations-2 Closing Ceremony
SCIENTIFIC PROGRAM

27 MARCH 2008

HALL ASTANA

09:00 - 18:00 Registration

09:30-10:00 OPENING CEREMONY

10:00-10:30 Lecture: Synopsis The Congress

Chairs:
N. Cakir, Izmir,Turkey
M. Favorov, CDC, USA

The mission of the ICCAID for collaboration

among developing countries
S. Hosoglu, Diyarbakir,Turkey
Using of standards and algorithmic measures
for infectious diseases
S. Amireev, Almaty, Kazakhstan

10:30 - 11:00 COFFEE BREAK

11:00 - 13:00 The Resistance Problem among Nosocomial Sterilization and Disinfection (Arranged by
Pathogens Turkish DAS Society)
Chairs: Chairs:
K. G. Naber, Straubing, Germany B. Gurler, Istanbul, Turkey
B. Karalnik, Almaty, Kazakhstan S. Esen, Samsun, Turkey

MRSA, VISA, VRSA, hVISA Main principles in sterilization at hospitals

P. Appelbaum, Hershey, USA W. Renders, Belgium
The rising resistance among Acinetobacter and The disinfection policy at hospital settings:
Pseudomonas Which? Where? When? How?
H. Vahaboglu, Kocaeli, Turkey D. Esel, Kayseri, Turkey
Epidemiology of C-MRSA Hand Hygiene
S. Harbarth, Geneva, Switzerland (ESGAP) M. Gunaydin, Samsun, Turkey
Standards and performance indicators to con- The technology and validation of steam sterili-
trol hospital infection and antimicrobial resist- zation
ance H. Winkelmann, Hamburg, Germany
B. Cookson, London, UK (ESGAP) The problems of disinfection procedures at
Discussion hospitals settings
O. Hasenova, Almaty,Kazakhstan
13.00-13.30 Specific Meeting: Mathematic and Medicine Discussion
Mathematical modeling and simulation in
medical sciences
Alemdar Hasanoglu, Kocaeli-Turkey

8
27 MARCH 2008
HALL ASTANA
13:00 - 14:00 LUNCH
14:00 - 16:00 Emerging Viral Diseases (Arranged by ISC)
Chairs:
A. Dmitrovsky Almaty, Kazakhstan
M.A. Tasyaran, Ankara, Turkey
Migratory H5N1 Bird Flu: A Prelude to a
Pandemic?
V. Chow, Kent Ridge, Singapore
Avian Flu in Kazakhstan
Y. Zheteyeva, Almaty, Kazakhstan
West Nile Virus Infection: Flight from East to
West and Vaccine Development
K. Morita, Nagasaki, Japan
Immunomodulators in treatment of viral infec-
tions
S.N. Eduardo, Madrid, Spain
Discussion
16:00 - 16:30 COFFEE BREAK
16:30- 18:30 New Vaccinology Strategies
Chairs:
M.F. Gurkan, Diyarbakir, Turkey
R.S. Idrissova, Almaty, Kazakhstan
Hepatitis A vaccination: Turkish experience
M. Bakir, Istanbul, Turkey
Universal immunization against Hepatitis A in
Minsk, Belarus: four-year results
O. Lyabis, Moscow, Russia
Control of Typhoid Fever in endemic countries:
Vi vaccines are a viable solution
A. Rasuli, Lyon, France
Pneumococcal vaccination of elderly and risk
groups
C. Vlasich, Vienna, Austria
The problems of vaccination in adults
B. Karalnik, Almaty, Kazakhstan Discussion
9
HALL ALMATY
Important Parasitic Diseases in Asia
Chairs:
T.Aslan, Istanbul, Turkey
G. Alshinbaeva, Astana, Kazakhstan
Helmintosis in Kazakhstan
G. Alshinbaeva, Astana, Kazakhstan
Leishmaniasis
S. Ozensoy,Izmir, Turkey
Toxoplasmosis
M. Hokelek, Samsun, Turkey
Echinococcosis and other helmintic diseases
N. Altintas- Izmir, Turkey
Molecular diagnosis in parasitic infections
Y. Guruz, Izmir, Turkey
Current Problems in Sexually Transmitted
Diseases
Chairs:
M. Hasanova, Almaty, Kazakhstan
M. Doganay, Kayseri, Turkey
The problems of control of STDs in developing
countries
I. Hakk› Bahar, Izmir, Turkey
The epidemiology of HIV/AIDS infection in the
Republic of Kazakhstan
S. Doskozhaeva, Almaty, Kazakhstan
The HIV problem as an STD in the world
N.P. Petrova, Almaty, Kazakhstan
The importance of microflora of urogenital tract
in infections
B.A. Ramazanova, Almaty, Kazakhstan
28 MARCH 2008

HALL ASTANA HALL ALMATY

09:00 - 10:30 The burden of antimicrobial resistance on clini- Round Table: Current problems in Chronic Viral
cal management of infections Hepatitis
(Arranged by ESCMID) Chairs:
N. Ormeci, Ankara, Turkey
Chair: K. Kurmanova, Almaty, Kazakhstan
G. Cornaglia, Verona, Italy
Antimicrobial resistance and respiratory tract Contributors:
infections H. Leblebicioglu, G. Kuttykuzhanova, G.
J. Garau, Barcelona, Spain Kurmanova, R. Ozaras
Beta-lactamases and infections sustained by
Gram-negative bacteria
G.M. Rossolini, Siena, Italy
The impact of resistance on the
immunocompromised host
M. Akova, Ankara, Turkey

10:30-11:00 COFFEE BREAK

11:00-13:00 Improving antimicrobial use in developing

countries
Chairs:
B. Cookson, London, UK
Z. Memish, Riyad, S. Arabia
The global rising of antibiotic resistance
T. Aslan, Istanbul, Turkey
How to perform surveillance of antimicrobial
resistance and antibiotic consumption in
developing countries
M. A. Borg, Msida, Malta
The preventive policies for antibacterial
resistance in developing countries
I. C. Gyssens, Rotterdam, the Netherlands
(ESGAP)
Effect of governmental policies on the antimi-
crobial use
G. S. Guven, Ankara, Turkey
Discussion
Intestinal Infections in Developing Countries
Chairs:
B. Ramazanova, Almaty, Kazakhstan
H. Ozkan, Ankara, Turkey
Salmonella typhi: a new superbug
J. Wain, Welcome Trust, UK
Salmonella drug resistances: a recurrent prob-
lem
S. Rubino, Sassari, Italy
The clinical and epidemiological manifestations
of typhoid fever in Kazakhstan
A. M. Dmitrovsky, Almaty, Kazakhstan
Epidemiology of cholera in 21st Century
P. Cappuccinelli, Sassari, Italy
Discussion
...............................................................
12:30-13:00

Specific Meeting: Treatment of Herpes

Infections
Chairs:
R. Ozaras, Istanbul, Turkey
H. Vahaboglu, Kocaeli, Turkey
The approach to therapy of Herpesvirus
infections
N. B. Serebryanaya, Saint Petersburg, Russia

10
28 MARCH 2008

HALL ASTANA HALL ALMATY

13:00-14:00 LUNCH

14:00-16:00 Emerging Zoonotic Infections (Arranged with Oral Presentations-Part 1

ISC) Chairs:
Chairs: R. Begaydarova, Kazakhstan
A. Duisenova, Almaty, Kazakhstan T. Aslan, Istanbul, Turkey
A. Sanic, Baku, Azerbaijan H. Bodur, Ankara, Turkey

Anthrax in 21st Century

M. Doganay, Kayseri, Turkey
Anthrax in Kazakhstan
G. Utepbergenova, Shimkent, Almaty,
Kazakhstan
The epidemiology and clinic of brucellosis in
endemic region
A. Duisenova, Almaty, Kazakhstan
The molecular diagnosis of brucellosis
S. Mizanbayeva, Almaty, Kazakhstan
Brucellosis –Successful control strategies
Z. Memish, Riyadh, S. Arabia
Discussion

16:00-16:30 COFFEE BREAK

16:30-18:30 Community Acquired Infections: Drug Important Zoonotic infections in Asia

Resistance and Treatment Chairs:
Chairs:
S. Ulusoy, Izmir, Turkey The epidemiology of Hemorrhagic Fever in
I. C. Gyssens, Rotterdam, the Netherlands Kazakhstan
R. Yegemberdieva, Almaty, Kazakhstan
Epidemiology of drug-resistance in S. pneu- The treatment of Crimean-Congo Hemorrhagic
moniae Fever
P. Appelbaum, Hershey, USA H. Leblebicioglu, Samsun, Turkey
Epidemiology of drug-resistance in H. influen- Leptospirosis in developing countries: is it the
zae and N. meningitidis tip of an iceberg?
B. Bozdogan, Aydin, Turkey N. Cakir, Izmir, Turkey
The epidemiology of bacterial meningitis in ...............................................................
Kazakhstan
17:30-18:30
L. Deryabina, Almaty, Kazakhstan
Oral Presentations-Part 2
The current treatment of community acquired
Chairs:
pneumonia
S. Demirci, Ankara, Turkey
G. Usluer, Eskisehir, Turkey
S. Oncu, Aydin, Turkey
Discussion
11
29 MARCH

HALL ASTANA

09:00-10:30 Laboratory diagnosis of tuberculosis

Chairs:
T. Muminov, Almaty, Kazakhstan
M.F. Gurkan, Diyarbakir, Turkey

Molecular tests for diagnosis of tuberculosis

R. Durmaz, Malatya, Turkey
Tuberculin skin test and interferon assays for diagnosis of tuberculosis
A. Yagci, Istanbul, Turkey
Multi-drug-resistant tuberculosis in Kazakhstan: epidemiology and new
approaches to laboratory diagnostics
T. Muminov, Almaty, Kazakhstan
Molecular-epidemiological analysis of Mycobacterium tuberculosis
strains circulating in Kazakhstan
B. T. Zhakipbayeva, Almaty, Kazakhstan
Discussion

10:30-11:00 COFFEE BREAK

11:00-13:00 Current approach to the Viral Hepatitis

(Arranged by Turkish Viral Prevention Hepatitis Society)
Chairs:
I. Balik, Ankara, Turkey
K. Kurmanova, Almaty, Kazakhstan

The current treatment of hepatitis B

N. Ormeci, Ankara, Turkey
The current treatment of hepatitis D
F. Tabak, Istanbul, Turkey
The current treatment of hepatitis C
R. Ozaras, ‹stanbul, Turkey
The treatment of childhood chronic virus hepatitis B and C
G. G. Kuttykuzhanova, Almaty, Kazakhstan
The treatment of Hepatic encephalopathy
N. Gubergrits, Donetsk, Ukraine
Discussion

13:00-14:00 Specific Meeting:

Chairs:
M.A. Cevik, Ankara, Turkey
D. Esel, Kayseri, Turkey
What is new laboratory equipment for science an industry?
J. Wiegand, Hamburg, Germany

LUNCH
12
29 MARCH

HALL ASTANA

Nosocomial Infections and Infection Control

14:00-16:00
Chairs:
A. Kotova, Almaty, Kazakhstan
H. Leblebicioglu, Samsun, Turkey

Challenges in infection prevention and control

in developing countries
M. A. Borg, Msida, Malta
Impact of microbiological research in system of
the Infection Control in Kazakhstan
A. Kotova, Almaty, Kazakhstan
Nosocomial urinary tract infection - what can
we improve?
K. G. Naber, Straubing, Germany
Use of molecular typing methods in infection
control
P. Jayaratne, Hamilton, ON, Canada
Discussion

16:00-16:30 COFFEE BREAK

16:30 - 17:30 Poster Discussion

Chairs:
A. Yagci, Istanbul, Turkey
Z. Odabasi, Istanbul, Turkey
Z. Karaev, Baku, Azerbaijan

17:30-18:30 CLOSING CEREMONY

13
 PRESENTATIONS OF INVITED SPEAKERS
L-1
THE MISSION OF THE ICCAID FOR
COLLABORATION AMONG DEVELOPOING
COUNTRIES
Salih Hosoglu, M.D.
Dicle University Hospital, Department of Infectious Diseases and
Clinical Microbiology, Diyarbakir-Turkey
Infectious diseases have been considered as specific impor-
tance during the humankind history. Mainly in developing
countries infectious diseases are responsible an important
part of deaths. Emerging infectious diseases (EIDs) have
been described as the infectious diseases whose rates of
incidence have increased within the previous two decades
or those with the potential of rate increases in the near
future. EIDs are relatively new diseases such as SARS and
HIV/AIDS, whereas re-emerging infectious diseases are
those whose incidence has increased after a period of con-
trol (e.g. cholera, tuberculosis, West Nile virus. Different
risks impacts on the epidemiology of infectious diseases in
the world. These contributing factors alone or in combina-
tion may activate the emerging/re-emerging infections. The
challenge of EIDs exceeds national boundaries by increas-
ing international trade and travel.
In most of Asia and Eastern Europe, especially in Former
Soviet Countries, international collaboration on scientific
research and combating infectious diseases are not satis-
factory. Eurasian Society of Infectious Diseases (ESID) (the
former Blacksea Society of Clinical Microbiology and
Infectious Diseases=BSCMID) started to scientific collabora-
tion among Eurasian Countries. This initiative aims to close
relation among former Soviet Union Countries and other
regional countries in Eurasia. There are many opportunities
on the collaboration topics.
One of the collaboration attempts started as international
scientific meeting in Central Asia. In that area, the
researchers have many limitations to participate into inter-
national scientific meetings. This scientific congress aimed
to introduce local researchers and foreigner attendants
from other parts of the world. The first congress was held
in Bishkek, Kyrgyzstan from October 30 through
November 2, 2006. It was a very successful event in terms
of the collaboration and exchange of experience and
expertise among scientists from different nations participat-
ing in the conference. Atmosphere of the meeting was a
great chance to meet scientists from different countries and
14
exchange experiences. As all researchers in the infectious
diseases area have a common goal of understanding and
fighting the relentless spread of infectious diseases, we
hope that such meetings, exchanges and collaborations will
help the developing regions of the world succeed in its fight
against infectious diseases.
In our point of view, strengthen collaborative research and
capacity building projects in low-income countries are key
factors for combating infectious diseases. We would like to
expose the scientist exchange programs promote collabo-
rative research between developed and developing coun-
tries. I would like to announce the opportunities from Turkey
about to joining the researches in Turkey for foreigners. The
Scientific & Technological Research Council of Turkey
(TUBITAK) (http://www.tubitak.gov.tr) supports coopera-
tion with regional and international institutions. TUBITAK
supports many foreigner researchers to come and complete
their researches in Turkey also. ESID aimed to support
researchers from Eurasian researchers for further collabo-
rative studies.
Keywords : Infectious diseases, collaboration, international,
Eurasia, Central Asia, ICCAID
L-2
USING OF STANDARDS OF INFECTIOUS
DISEASES IN MEDICAL PRACTICE
S. Amirejev, T.Muminov
Almaty, Kazakhstan
Standardization of services provided on the occa-
sion of infectious conditions in Kazakhstan is a public
health priority direction. Given this we were the first to have
devised standard case definitions and algorithms of inter-
ventions for the primary health level specialists covering
115 infectious and parasitic conditions. Methodological
basis include CDC (USA) recommendations. Criteria for
standard case definition are: presence of specific for the
given nosologic form of clinical manifestations, epidemio-
logic signs and positive result of one/or several specific
laboratory tests.
A disease case was considered to be a list of
objective, standardized and balanced criteria, based on
which a health worker may make a decision regarding the
presence of the given condition in a specific patient.
Standard case definition included the following gra-
dations: assumption of a case, probable case and confirmed
case.
Algorithms of activities devised by us stipulate stage-wise
activities in line with the aforementioned gradations of case
definition. At this peculiarities of epidemiologic process of
each nosologic form or a group of infections are taken into
account.
When applying standard case definition unified
epidemiological surveillance system and simplicity of its
implementation are ensured; diagnostic reliability is
achieved; stability of the system of registration and case
recording and comparability of data pertaining to morbid-
ity on different territories; hence, there is a possibility of
timely introduction of related corrections and adequate
managerial decision-making.
Two volumes of practical Guidelines have been
published - «Standards and algorithms of interventions
related to infectious diseases». Practical health care spe-
cialists of all levels are provided with this Guidelines, train-
ing have been initiated as to the use of standard case def-
initions and algorithms of interventions in case emergence
of infectious diseases.
Keywords: Standardization, algorithms, Methodological, nosologic,
epidemiological
L-3
MRSA, VISA, VRSA, hVISA
P. Appelbaum Hershey, USA
ß-Lactamase production in Staphylococcus aureus strains,
especially those acquired in the hospital, is the rule.
Although these strains are normally susceptible to isoxa-
zolylpenicillins such as nafcillin, methicillin-resistant
S.aureus strains are increasingly encountered in hospital
practice. These strains are not only resistant to all ß-lactams
but are almost always resistant to quinolones, macrolides,
cotrimoxazole, and other agents. Although most MRSA
strains in the past were hospital-acquired, a serious trend
towards life-threatening infections caused by toxin-produc-
ing community-acquired (CA) MRSA has developed.
Although these strains are still quite drug-susceptible, it is
expected that the resistotype of these community strains
will, sooner rather than later, resemble that seen in nosoco-
mial strains. Although glycopeptide therapy is effective for
infections caused by MRSA strains, recent years has seen
the appearance of strains which are both intermediately
and fully resistant to glycopeptides such as vancomycin and
teicoplanin. Glycopeptide non-susceptibility has developed
amongst coagulase-negative staphylococci (especially
15
S.haemolyticus), and resistance occurs in these strains very
frequently, maybe even more frequently than in S.aureus.
Detection of the hVISA, VISA and VRSA phenotype is cur-
rently unstandardized. It seems very clear that hVISA and
VISA strains occur much more commonly than is currently
reported due to the above difficulties and are definitely
pathogenic, some causing serious systemic and fatal infec-
tions. Bacteremia and endocarditis due to these van-
comycin non-susceptible (VISA) strains is of particular con-
cern as daptomycin does not seem to be universally active
against these strains Most hospital acquired MRSA strains
are resistant to all clinically available quinolones. Although
most community-acquired MRSA strains are still quinolone
susceptible, this situation will surely change sooner rather
than later and community MRSA strains will acquire the
hospital MRSA resistance phenotype. Drugs active against
drug-resistant MRSA include quinupristin/dalfopristin,
daptomycin, telavancin, linezolid, tigecycline, dalba-
vancin, oritavancin, ceftobiprole and ceftaroline but an
ideal bactericidal agent against systemic infections such as
bacteremia, endocarditis and osteomyelitis caused by van-
comycin-nonsusceptible MRSA is not yet approved or on
the market. Current vancomycin breakpoints recommended
by CLSI are reasonable but the recommended microdilution
MIC technique does not accurately identify VISA nor does
it identify hVISA strains. Neither disk diffusion nor automat-
ed methodology is of use in this regard. It is postulated that
screening with a BHI plate containing 3 μ/ml vancomycin
incubated for 48 h, with >1 colony screened as presump-
tively hVISA, VISA or VRSA, and confirmation of VISA or
VRSA status by the overnight Etest and of hVISA by a 48 h
“macro Etest” using a 2 McFarland inoculum and a double-
sided vancomycin-teicoplanin Etest strip, will help solve
routine identification of these strains in the clinical microbi-
ology laboratory. It seems clear that the incidence of gly-
copeptide non-susceptible MRSA will increase in the future
and spread within the community.
L-4
THE RISING RESISTANCE AMONG
ACINETOBACTER AND PSEUDOMONAS
H. Vahaboglu,
Kocaeli University Hospital, Kocaeli, Turkey
Remarkable changes occurred in the epidemiology of
causative organisms of nosocomial infections during last
decades. P. aeruginosa and more recently Acinetobacter
emerged in intensive care units often with a multi-drug
resistant phenotype. These opportunistic pathogens are
able to grant resistance to antibiotics by the use of intrinsic
strategies such as odification of target sequences or alter-
ation of the expression of porin and efflux mechanisms.
However, the acquisition of resistance genes on mobile
genetic elements remains as the principle mechanism.
Ambler class A ESBLs, VEB-1 and PER 1 were found to be
widespread among P. aeruginosa and Acinetobacter in
various countries conferring resistance to expanded-spec-
trum beta-lactam antibiotics. ESBLs from TEM and SHV
families have rarely been reported among these species.
Metallo enzymes from molecular Class B, IMP-type and
VIM-type disseminated rapidly further limiting the treatment
options by conferring resistance to carbapenems. Even
more important is the co-existence of an ESBL and a metal-
lo-enzyme giving rise to MDR resistant phenotype. Finally,
OXA-type enzymes with a wide range of activity on antibi-
otics especially from Acinetobacter deserve mentioning. P.
aeruginosa and Acinetobacter are significant nosocomial
pathogens in intensive care units and deserves attention.
L-5
EPIDEMIOLOGY OF C-MRSA
Stephan Harbarth
Methicillin-resistant Staphylococcus aureus
(MRSA) is an emerging community pathogen. It was first
reported in the early 1990’s among closed communities of
aborigines in Western Australia. Outbreaks of community
associated MRSA (CA-MRSA) infections in healthy children
and in adults have been described worldwide. In Europe
PVL-producing CA-MRSA was first reported in the late
1990s. The prevalence of CA-MRSA carriage in Central
Asia remains largely unknown, since few systematic studies
have assessed the epidemiology of CA-MRSA in this
region.
While academic centers and other large hospitals
were once thought the sole province of antibiotic resistance
in S. aureus, community outbreaks of MRSA are now
occurring in those who lack the traditional risk factors for
carriage of antibiotic resistant strains. CA-MRSA infections
tend to occur in younger persons that hospital acquired
MRSA (HA-MRSA). Although outpatients with a history of
intravenous drug use, endocarditis, nursing home residen-
cy, immigration or recent hospitalization appear to carry
heightened risk for MRSA carriage, a significant minority
16
of patients admitted with MRSA carriage do not have such
identifiable risk factors.
CA-MRSA causes sporadic cases of skin and soft
tissues infections although cases of necrotising pneumonia
and fasciitis have been reported. CA-MRSA infection has
been associated with virulent strains producing Panton-
Valentine leukocidin (PVL) and a variety of other exotoxins.
It shows resistance to methicillin, which is encoded by the
mecA gene, mostly found on the type IV staphylococcal
cassette chromosome (SCC). The emergence of these
strains does not seem to be limited to the community and
may also be emerging in the hospital environment.
It is essential to differentiate healthcare-associated
MRSA infections occurring in the community among
patients at risk of HA-MRSA (having a previous history of
hospital admission, for example) and true CA-MRSA infec-
tions due to strains, which are present in the community
only. The possibility that these community strains will dis-
seminate further within the hospital population is of great
concern.
Chambers has recently estimated that MRSA
prevalence in the community would reach 25% within the
next decade, with double such rates in hospitals. Thus, bet-
ter assessment of trends in the epidemiology of CA-MRSA
and risk profiling of patients at high risk of CA-MRSA infec-
tions should be performed, in order to impact public health
policies, help prevent transmission of these strains in the
community and facilitate patient care protocols (e.g. choice
of empiric antibiotic therapy in soft tissue infections).
Standards and performance indicators to control hospital
infection and antimicrobial resistance
L-6
STANDARDS AND PERFORMANCE
INDICATORS (SPIS) FOR HOSPITAL INFECTION
CONTROL AND ANTIMICROBIAL
STEWARDSHIP IN EUROPE
Barry Cookson,
Laboratory of Healthcare Associated Infection, Centre for
Infections, HPA, London, UK
METHODS: A questionnaire survey was performed in all
MS to explore the current situation. A steering group
informed the project group as to the design of national and
local SPIs, which were then to be explored in detail, as well
as practicality and level of detail. We used the results of
several EU consensus meetings and DG SANCO docu-
ments on HCAI/AMR that had been explored with MS's
departments of health.
RESULTS: 28 (88%) of the 33 MS replied. Analyses showed
that 72% had a national HCAI, and 62% an AMR, pro-
gramme. National laws were in place (55%/32%).
Reductions in HCAI/AMR were targets for approximately
two-thirds of programmes, but much variation in responsi-
bilities (9 explored) and topics covered (9 explored). The
same was true for PIs (7 explored), e.g. only 5 considered
hand hygiene. Training was considered in only 43% for
HCAI and 71% for AMR. HCAI surveillance (78 %: 59 %
compulsory, 41 % recommended) and AMR (95 %: 55 %,
45 %). The results clearly indicated a wide variation and
the need for a consensus. National and local SPIs were
developed: five groups with 51 SPIs. 28 MS responded: an
average of 83% agreed with these, 12% agreed with alter-
ation, 2% were neutral and 3% disagreed. There were 138
statements of underlying principles relating to these SPIs
(82% agreed; 6% with alterations, 5% neutral, 3% dis-
agreed. 89% thought the tools were practical, 57% thought
the level of detail was about right but 39% thought it was
too much.
Keywords: hospital, infection, antimicrobials, stewardship, standards,
indicators
L-7
MAIN PRINCIPLES IN STERILIZATION AT HOS-
PITALS
Wim Renders, Lanquais-Belgium
‘Sterilization’ cannot isolate itself from the laws which also
govern other economic sectors. One of the most important
of these is that innovation has to lead to growth and
progress. Standing still can be equated with moving back-
wards in an ever developing environment.
Knowledge and research are in our society the stepping
stones to progress and innovation. Research has demon-
strated that the drive in an organisation to learn is amongst
others influenced by external contacts.
The annual WFHSS congress provides a perfect opportuni-
ty to do something about this. Moreover, the Forum also
makes available a lot of information on its website. It is,
however, essential that information is transformed into
knowledge, that this knowledge is disseminated and made
part and parcel of daily practice in the sterilization depart-
ments of hospitals. The latter should be the “core” business
of any national society. It indeed occupies a key position in
17
the promotion of a good, national sterilization practice. It
is obvious that DAS, in this area, can function as a role
model for countries in which there is not yet a sterilization
society.
The practice in the hospital itself should be based on the
definition of sterility and the circumstances in which it is
applicable. To make compromises in this area is not at all
acceptable because this will sooner or later be to the detri-
ment of the patient.
The question which remains is what is the best method to
sterilize the medical devices?
Some principles which should be taken into account are the
following ones:
1. Sterility is the result of an encompassing process.
Centralization of the activities is therefore a conditio sine
qua non to be able to deliver a good, reproducible end
product.
2. By strictly separating areas in the CSSD cross contami-
nation can be prevented.
3. The application of the CEN and ISO norms makes it pos-
sible to demonstrate conformity to the precautionary prin-
ciple, which stipulates that one should not harm a third
party. The use and implementation of norms moreover
increases the self-confidence in the sterilization depart-
ment.
Furthermore an overview of a CSSD is provided with spe-
cial attention to a number of critical care points in the dif-
ferent areas.
The conclusion is that the sterilization should be dealt with
on the basis of principles. If the conditions are not yet per-
fect a step by step strategy will be the best guarantee to get
closer to the ultimate goal: the provision of a good medical
device.
L-8
THE DISINFECTION POLICY AT HOSPITAL SET-
TINGS: WHICH? WHERE? WHEN? HOW?
Dr. Duygu Eflel
Department of Microbiology, Erciyes University Faculty of
Medicine, Kayseri-TURKIYE
The increasing use of complicated medical equipment,
presence of potentially hazardous blood-borne infections
such as hepatitis B, hepatitis C, and human immunodefi-
ciency virus, and proof of microorganisms living on inani-
mated surfaces for months, have increased the need for
well-defined decontamination procedures. That is why;
every hospital should have a well-defined disinfection and
sterilization policies in order to protect patients from hospi-
tal infections. The need for appropriate disinfection proce-
dures is highlighted by the multitude of outbreaks resulting
from improperly decontaminated patient-care items. In
order to produce and implement a disinfection policy in the
hospital, those steps are required:
1. Organization and coordination
a. Defining the team responsible for the policy
b. Investigation and assessment of current
methods for disinfection
c. Selection of the best model for producing policy
d. Choosing the best format and best disinfectants
by testing
2. Implementation of the policy
3. Staff training
4. Updates for the policy
A disinfectant policy should provide detailed information
on the reason for disinfection, all types of disinfectants,
especially of the selected ones for the hospital and on pro-
cedures for their use. Policies should consist of: the purpos-
es for which disinfectants are used; eliminating their use
when sterilization rather than disinfection is the object,
where single-use equipment is economical. Although many
hospitals have a policy for disinfection, implementation is
often not successful. In order to prove efficient implementa-
tion a short guide to use should be provided for the med-
ical staff.
Over 30 years ago Spaulding devised a rational approach
to disinfection and sterilization of patient-care items or
equipment. This classification scheme is so clear and logi-
cal that it has been retained, refined, and successfully used
by infection control professionals and other when deciding
disinfection policy in the hospital. Spaulding divided the
medical instruments and items into three categories based
on the degree of risk of infection involved in the use of the
items. Three categories he described were critical, semicrit-
ical and noncritical.
Crtitical Items: Critical items are so called because of the
high risk of infection if such an item is contaminated with
any microorganism, including bacterial spores. Thus iti is
critical that enter sterile tissue or the vascular system be
18
sterile, because any microbial contamination could result
disease transmission. This category includes surgical instru-
ments, cardiac and urinary catheters, implants, ultrasound
probes used in sterile body cavities. Most of the items in this
category should be purchased as sterile or be sterilized by
steam sterilization if possible. If heat sensitive, the objects
may be treated with ETO, hydrogen peroxide gas plasma
or by liquid chemical sterilants if other methods are unsuit-
able.
Semicritical Items: Semicritical items are those that come in
contact with mucous membranes or nonintact skin.
Respiratory therapy and anesthesia equipment, some
endoscopes, laryngoscope blades, esophageal manometry
probes, rectal manometry catheters, and diaphragm fitting
rings are included in this category. These medical devices
should be free of all organisms, although small numbers of
bacterial spores may be present. Reprocessing semicritical
items involves meticulous cleaning followed preferably by
high-level disinfection using chemical disinfectants.
Noncritical Items: Nonocritical items those that come in
contact with intact skin but not mucous membranes.
Examples of noncritical items are bedpans, blood pressure
cuffs, crutches, bed rails, linens, some food utensils, bed-
side tables, patient furniture, and floors. Reprocessing of
noncritical items involves cleaning and/or low level disin-
fection.
Risk assessment is not only important for instrument disin-
fection but also surface disinfection. Critical areas such as
operating rooms, bone-marrow transplantation units, cen-
tral sterile supply departments, and intensive care units
should be disinfected regularly using low or medium level
disinfectant, but noncritical areas of the hospital such as
manager rooms should be cleaned only with a detergent.
The disinfectant should preferably be bactericidal and its
spectrum should include all the common non-sporing
pathogens, including tubercle bacilli. Viricidal activity is
also a requirement for routine disinfection. Surface disin-
fectants should be rapid in action and have prolonged
activity. High protein based materials absorb and neutral-
ize some chemical disinfectants. Presence of organic mat-
ter and other compounds such as soaps may neutralize
some disinfectants. Interactions between disinfectant and
surface and the compounds on the surface should be con-
sidered and evaluated before choosing disinfectant. Toxic
effects for human and also for environment and corrosive
effects on the instruments and surfaces of disinfectant
should be minimal. It is important to understand the mode
of action in order to select the appropriate disinfectant. It is
also important to choose the proper concentration, suffi-
cient exposure time and appropriate temperature, and
quantity of disinfectant that is best suited to each situation.
Cost should be acceptable and supplies assured. Excessive
costs are mostly due to unnecessary use, incorrect concen-
trations or inappropriate disinfectants being used.
In conclusion, disinfection has a role in reducing risks for
hospital infections but if the disinfection policy is illogical
and ineffective, the staffs are not trained enough, and the
policy is not updated regularly, disinfectants mean nothing
other than spending money in vain for the hospitals.
References
1. Fraise AP. Decontamination of the environment and
medical equipment in hospitals. Fraise AP, Lambert PA,
Maillard JY (eds). In: Russell, Hugo, Ayliffe’s Principles
and Practice of Disinfection, Preservation and
Sterilization, 4th edition. Blacwell Publishing, USA, 2004.
pp: 563-585.
2. Coates D, Hutchinson DN. How to produce a hospital
disinfection policy. J Hosp Infect 1994; 26: 57-68.
3. Rutala W. The benefits of surface disinfection. Am J
Infect Cont 2004; 32: 226-231.
4. Rutala WA, Weber DJ. Disinfection and sterilization in
health care facilities: What clinicians need to know. Clin
Infect Dis 2004; 39: 702-709.
5. Boyce JM. Environmental contamination makes an
important contribution to hospital infection. J Hosp Infect
2007; 65 (suppl 2): 50-54.
6. Dettenkofer M, Block C. Hospital disinfection-efficacy
and safety issues. Curr Opin Infect Dis 2005; 18: 320-
325.
L-9
HAND HYGIENE
Prof. Murat Gunaydin, MD
Ondokuz Mayis University Medical School, Department of
Clinical Microbiology, Samsun, Turkey
Introduction
Healthcare-associated infection incidence is around 7 to
10% worldwide, and treatment costs of these infections are
noticeably high. Especially in the tertiary-care hospitals
with high numbers of inpatients, hospital infection inci-
dence can be above 10%, and associated with increased
length-of-stay, besides necessitating additional therapeutic
interventions causing higher costs. Hospital infections are
also associated with resistance development in microor-
19
ganisms.
Contaminated hands of health care workers (HCWs) act as
reservoir in 20 to 40% of the cases of transmission and dis-
semination of highly virulent and multidrug-resistant
microorganisms between the patients in hospital settings.
At least half of the connected problems are preventable
with the application of a simple procedure of hand clean-
ing. In general, studies show that although one third of the
hospital infections are related to preventable causes, only 6
to 9% is being prevented.
History
In 1846, Ignaz Semmelweis observed that women whose
babies were delivered by students and physicians in the
First Clinic at the General Hospital of Vienna consistently
had a higher mortality rate when compared to those whose
babies were delivered by midwives in the Second Clinic.
He postulated that the puerperal fever was caused by
“cadaverous particles” transmitted from the autopsy suite to
the obstetrics ward with the hands of students and physi-
cians. When upon the insistence of Semmelweis, students
and physicians clean their hands with a chlorine solution
between each patient in the clinic, the maternal mortality
rate in the First Clinic subsequently dropped dramatically
and remained low for years. This intervention by
Semmelweis provided the first evidence showing that clean-
ing heavily contaminated hands with an antiseptic agent
between patient contacts can reduce the healthcare-
acquired transmission of contagious diseases more effec-
tively than handwashing with plain soap and water.
Formal written guidelines on handwashing practices in hos-
pitals were published by the Centers for Disease Control
(CDC) in 1975 and 1985. The recommendations in these
guidelines were hand washing with non-antimicrobial soap
between patient contacts, and washing with antimicrobial
soap before and after performing invasive procedures. In
1988 and 1995, new guidelines for hand washing and
hand antisepsis were published by the Association for
Professionals in Infection Control (APIC). Although the rec-
ommendations in these guidelines were similar to those list-
ed in the CDC guidelines, alcohol-based hand cleaning is
also discussed. In 1996, Healthcare Infection Control
Practices Advisory Committee (HICPAC) recommended the
use of either an antimicrobial soap or a waterless antisep-
tic agent for cleansing hands upon leaving the rooms of
patients with multi-drug resistant pathogens such as van-
comycin-resistant enterococci (VRE) and methicillin-resist-
ant Staphylococcus aureus (MRSA).
Recently, the CDC/HICPAC guideline has been issued in
2002 that defined the alcohol-based hand rubbing as the
standard of care for hand hygiene practices in health-care
settings.
Normal Bacterial Flora on Hands
Human skin is the largest organ of the body with an area
of approximately 1,5 square meters. Normal human skin
inhabits aerobic organisms in differing numbers on the dif-
ferent sites. The total number of bacteria on the hands of
HCW is between 3.9x104 and 4.6x106 .
The microflora recovered from the hands could be divided
into two categories, namely transient or resident. The resi-
dent flora consists of microorganisms that are under the
superficial cells of the stratum corneum, and can also reside
on the surface of the skin. The dominant species, particular-
ly among HCWs, is Staphylococcus epidermidis. Other res-
ident bacteria in the microflora are; S. hominis, other coag-
ulase-negative staphylococci (CNS) and coryneform bacte-
ria. Resident flora has two important protective functions:
microbial antagonism and the competition for nutrients in
the ecosystem. Resident microorganisms are attached to
deeper layers of the skin, and are more resistant to
removal. In general, resident microflora is less likely to be
associated with infections, but may cause infections in ster-
ile body cavities.
Transient flora, which colonizes the superficial layers of the
skin, can be more easily removed by routine hand wash-
ing. They are frequently acquired by HCWs during direct
contact with patients or contaminated environmental sur-
faces adjacent to the patient, and are the organisms most
often associated with health care-associated infections
(HCAIs).
Preparations used for hand hygiene
Water Use
The main aim of handwashing is the cleaning of dirt and
organic material, and removal of transient microorgan-
isms. Water as a solvent for a large number of organic and
inorganic substances is generally called the universal sol-
vent. Although water is a good solvent, it cannot directly
remove dirt such as proteins, oily and fatty materials. To
20
improve the dissolving capacity of water for fat and oil,
and for the other chemical substances, it should be used
together with a soap or a detergent. Soaps and detergents
loosen dirty material, and disperse them into the water. As
water is the main source of waterborne diseases, the pres-
ence of contaminants should be sought in order to control
contamination. In fact, drinking-water is open to contami-
nation by any kind of microorganism such as viruses, bac-
teria, helminths and pathogenic protozoa. One of the
routes of transmission of organisms (e.g. Legionella,
Pseudomonas, Stenotrophomonas, Mycobacterium) is the
hospital water systems. If HCWs have been using contami-
nated water to wash their hands, obviously there would be
a possibility to transmit the contaminants to the patients
through their hands.
The physical, chemical and bacteriological characteristics
of water should comply with the regulations of the local
authority. Chlorine is the most practical disinfectant to use.
As an alternative, monochloramine, chlorine dioxide,
ozone or ultraviolet irradiation can also be used in water
treatment process.
There are other important factors for hand hygiene such as
the temperature of the water to be used, using towel, etc.
According to recent investigations, water temperature does
not, however, seem to be as critical for handwashing.
Apparently, contact time and friction are more important
aspects than temperature. In addition, hand drying is an
essential step in hand cleansing and should be done, oth-
erwise wet hands provide better conditions for the transmis-
sion of microorganisms. Ideally, drying of hands should be
done by using individual paper towels. When towels are
used, it is important to pat the skin, rather than to rub it, to
avoid cracking. Skin excoriation may lead the bacteria to
colonize the skin and possible spread to bloodstream.
Plain (non-antimicrobial) soap
Soaps are composed of detergent products that contain
esterified sodium and fatty acids or potassium hydroxide.
Plain soaps show minimal antimicrobial activity. Although
handwashing with plain soap can remove loosely adherent
transient flora, it is ineffective to remove pathogens from
the hands of HCWs. On the contrary, handwashing with
plain soap can result in a paradoxical increase in bacteri-
al counts on the skin due to induction of considerable skin
irritation and dryness.
Alcohols
Alcohol antiseptics contain either ethanol, isopropanol or
n-propanol, or a combination of two of these products.
Studies of alcohols have evaluated either individual alco-
hols in varying concentrations, combinations of two alco-
hols, or alcohol solutions containing small amounts of
hexachlorophene, quaternary ammonium compounds,
povidone-iodine, triclosan or chlorhexidine gluconate.
Alcohols cause denaturation of proteins and inhibit
microorganisms. Alcohol solutions should contain 60–80%
alcohol which are most effective, with higher concentra-
tions being less potent. This paradox results from the fact
that proteins are not denatured easily in the absence of
water. Alcohol concentrations in antiseptic handrubs are
often expressed as a percentage by volume. Alcohols have
excellent in vitro germicidal activity against Gram-positive
and Gram-negative vegetative bacteria (including mul-
tidrug-resistant pathogens such as MRSA and VRE), M.
tuberculosis, and a variety of fungi. However, they have
virtually no activity against bacterial spores or protozoan
oocysts, and very poor activity against some nonenveloped
(non-lipophilic) viruses. Some enveloped (lipophilic) viruses
(e.g. HIV, Herpes) are susceptible to alcohols when tested
in vitro.
Alcohols reduce bacteria in artificially contaminated hands
at an average of 3.5 log10 after a 30-second
application,and 4.0–5.0 log10 after a 1-minute applica-
tion. Alcohols are rapidly germicidal when applied to the
skin, but have no substantial persistent (residual) activity.
Addition of chlorhexidine, quaternary ammonium com-
pounds, octenidine or triclosan to alcohol-based formula-
tions can result in persistent activity. A synergistic combina-
tion of a humectant (octoxyglycerine) and preservatives
results in prolonged activity against transient pathogens.
The efficacy of alcohol-based hand hygiene products is
affected by a number of factors, including the type of alco-
hol used, the concentration of alcohol, the contact time, the
volume of alcohol used, and whether the hands are wet
when the alcohol is applied.
Chlorhexidine
Chlorhexidine gluconate is a cationic bisbiguanide.
Chlorhexidine base is barely soluble in water, but the diglu-
conate form is water-soluble. Chlorhexidine affects bacter-
ial cytoplasmic membranes. Chlorhexidine’s antimicrobial
activity is slow, and has a significant residual activity. It has
21
good activity against Gram-positive bacteria, although
somewhat less activity against Gram-negative bacteria and
fungi, and minimal activity against mycobacteria.
Chlorhexidine is not sporicidal. It has in vitro activity
against enveloped viruses such as HIV, but significantly less
activity against non-enveloped viruses such as rotavirus,
adenovirus and enteroviruses.
Chloroxylenol
Chloroxylenol, also known as para-chloro-meta-xylenol
(PCMX), is a halogen-substituted phenolic compound that
has been used widely as a preservative in cosmetics and
other products, and as an active agent in antimicrobial
soaps. Chloroxylenol affects bacterial enzymes and alters
cell walls. It has good in vitro activity against Gram-posi-
tive organisms and fair activity against Gram-negative
bacteria, mycobacteria and some viruses. Chloroxylenol is
not as rapidly active as chlorhexidine gluconate or
iodophors, and its residual activity is less manifest than that
observed with chlorhexidine gluconate. Chloroxylenol is
absorbed through the skin and generally well tolerated.
Hexachlorophene
Hexachlorophene is a bisphenol composed of two pheno-
lic groups and three chlorine moieties. In the past, 3%
hexachlorophene was widely used for hygienic handwash-
ing, as surgical scrubs, and for routine bathing of infants in
hospital nurseries. Hexachlorophene inactivates bacterial
essential enzyme systems. Hexachlorophene is bacteriosta-
tic, with good activity against S. aureus, and relatively
weak activity against Gram-negative bacteria, fungi and
mycobacteria. Hexachlorophene has residual activity for
several hours after use and gradually reduces bacterial
counts on hands after multiple uses (cumulative effect). In
1972, the FDA warned that hexachlorophene should no
longer be used routinely for bathing infants.
Hexachlorohene has been banned worldwide because of
its high rates of dermal absorption and subsequent toxic
effects.
Lodine and iodophors
Application of iodine causes irritation and changes the
color of the skin. When a microorganism exposed to
iodine, iodine molecules penetrate the cell wall and effect
chemistry of the protein synthesis and causes alteration of
cell membranes. Iodophors have largely replaced iodine as
the active ingredient in antiseptics. Iodophors contain ele-
mental iodine, iodide or triiodide with a high molecular
weight polymer carrier, which is called complexing agent.
A widely used polymer in the iodophors is polyvinyl
pyrrolidone (povidone). Iodophors may also contain alco-
hol and nonionic detergents. Factors such as pH, tempera-
ture exposure time, and the presence of free iodine and
other organic compounds such as alcohols and detergents
affect the activity of the iodophors. The amount of free
iodine in the iodophors affects the level of the antimicrobial
activity.
Iodophors have shown bactericidal activity against Gram-
positive, Gram-negative and some spore-forming bacteria
(clostridia, Bacillus spp.) and are active against mycobac-
teria, viruses and fungi. However, in concentrations used in
antiseptics, iodophors are not usually sporicidal. In the
presence of organic substances such as blood or sputum,
the in vivo antimicrobial activity of iodophors is significant-
ly reduced. Generally, iodophor preparations used for
hand hygiene contain 7.5–10% povidone-iodine.
Quaternary ammonium compounds
Quaternary ammonium compounds are ammonium salts in
which four alkyl groups attached directly to nitrogen atom.
One of the several types of these salts that are widely used
as antiseptics is alkyl benzalkonium chlorides. Some other
alternative compounds are benzethonium chloride, cetrim-
ide, and cetylpyridium chloride. It is believed that antimi-
crobial activity of this type of compounds causes leakage of
low molecular weight cytoplasmic constituents after adsorp-
tion to the cytoplasmic membrane.
Although they are microbicidal against some organisms at
high concentrations, quaternary ammonium compounds
are primarily bacteriostatic and fungistatic. They are more
active against Gram-positive bacteria than against Gram-
negative bacilli. Quaternary ammonium compounds have
relatively weak activity against mycobacteria and fungi,
and have greater activity against lipophilic viruses. Since
quaternary ammonium compounds have a positive charge,
their antimicrobial activity is adversely affected by the pres-
ence of active ingredients such as organic material, and
they are not compatible with anionic detergents.
Some new handwashing products containing benzalkoni-
um chloride or benzethonium chloride are available for use
by HCWs. A recent clinical study performed among surgi-
cal ICU HCWs found that cleaning hands with antimicro-
bial wipes containing a quaternary ammonium compound
22
was about as effective as plain soap and water handwash-
ing.
Triclosan
Triclosan is an organic molecule having chemical name
2,4,4’–trichloro-2’-hydroxydiphenyl ether. It has been
added to soaps for use in handwashing. Amounts varying
from 0.2% to 2% have antimicrobial activity.
Triclosan penetrates bacterial cells and disrupts cytoplasmic
membrane and synthesis of RNA, fatty acids, and proteins.
Triclosan’s activity against Gram-positive organisms
(including MRSA) is greater than against Gram-negative
bacilli, particularly P. aeruginosa. The agent possesses rea-
sonable activity against mycobacterial and Candida spp.,
but has little activity against filamentous fungi. Triclosan
(0.1%) reduces bacterial counts on hands by 2.8 log10
after a 1-minute hygienic handwash.
Further evaluation of this agent by the FDA is under way.
Like chlorhexidine, triclosan has persistent activity on the
skin. Its activity in hand-care products is affected by pH, the
presence of surfactants or humectants, and the ionic nature
of the particular formulation.
Activity of antiseptic agents against spore-forming
bacteria
Compounds including alcohols, chlorhexidine, hexa-
chlorophene, iodophors, chloroxylenol, triclosan used in
antiseptic handwash or antiseptic handrub preparations is
not reliably sporicidal against Clostridium spp. or Bacillus
spp.
Washing contaminated hands with non-antimicrobial or
antimicrobial soap and water may help physically remove
spores. HCWs should be encouraged to wear gloves when
caring for patients with C. difficile-associated diarrhea.
After disposing gloves, hands should be washed with a
non-antimicrobial or antimicrobial soap and water, or
cleansed with an alcohol-based handrub.
During outbreaks of C. difficile-related infections, it may be
preferable to wash hands with a non-antimicrobial or
antimicrobial soap and water after glove removal.
Similarly, a recent study demonstrated that HCWs with sus-
pected or documented exposure to B. anthracis-contami-
nated items should wash their hands with a non-antimicro-
bial or antimicrobial soap and water.
Hand Hygiene principles*
Indications for handwashing and hand antisepsis
A. Wash hands with soap and water when visibly dirty or
contaminated with proteinaceous material, or visibly soiled
with blood or other body fluids, or if exposure to potential
spore-forming organisms is strongly suspected or proven
or after using the restroom.
B. Preferably use an alcohol-based handrub for routine
hand antisepsis in all other clinical situations described in
items C(a) to C(f) listed below, if hands are not visibly
soiled. Alternatively, wash hands with soap and water.
C.Perform hand hygiene:
a. Before and after having direct contact with patients.
b. After removing gloves.
c. Before handling an invasive device for patient care,
regardless of whether or not gloves are used (urinary
catheter, peripheral vascular catheter, or other invasive
devices).
d. After contact with body fluids or excretions, mucous
membranes, non-intact skin, or wound dressings.
e. If moving from a contaminated body site to a clean
body site during patient care.
f. After contact with inanimate objects (including medical
equipment) in the immediate vicinity of the patient.
D. Wash hands with either plain or antimicrobial soap and
water or rub hands with an alcohol-based formulation
before handling medication or preparing food.
E. When alcohol-based handrub is already used, do not
use antimicrobial soap concomitantly.
Hand hygiene technique
A. Apply a palmful of the product and cover all surfaces of
the hands. Rub hands until hands are dry (The handrub-
bing technique is illustrated in figure I).
B. When washing hands with soap and water, wet hands
with water and apply the amount of product necessary to
cover all surfaces. Vigorously perform rotational handrub-
bing on both hand palms and backs, interlace and inter-
lock fingers to cover all surfaces. Rinse hands with water
and dry thoroughly with a single-use towel. Use running
23
and clean water whenever possible. Use towel to turn off
tap/faucet (The handwashing technique is illustrated in fig-
ure II).
C. Make sure hands are dry. Use a method that does not
recontaminate hands. Make sure towels are not used mul-
tiple times or by multiple people. Avoid using hot water, as
repeated exposure to hot water may increase the risk of
dermatitis.
D. Liquid, bar, leaf or powdered forms of plain soap are
acceptable when washing hands with a non-antimicrobial
soap and water. When bar soap is used, small bars of
soap in racks that facilitate drainage should be used.
Recommendations for surgical hand preparation
A. If hands are visibly soiled, wash hands with plain soap
before surgical hand preparation. Remove debris from
underneath fingernails using a nail cleaner, preferably
under running water.
B. Sinks should be designed to reduce the risk of splashes.
C. Remove rings, wrist-watch, and bracelets before begin-
ning the surgical hand preparation. Artificial nails are pro-
hibited.
D. Surgical hand antisepsis should be performed using
either an antimicrobial soap or an alcohol-based handrub,
preferably with a product ensuring sustained activity,
before donning sterile gloves.
E. If quality of water is not assured in the operating theatre,
surgical hand antisepsis using an alcohol-based handrub is
recommended before donning sterile gloves when perform-
ing surgical procedures.
F. When performing surgical hand antisepsis using an
antimicrobial soap, scrub hands and forearms for the
length of time recommended by the manufacturer, 2 to 5
minutes. Long scrub times (e.g. 10 minutes) are not neces-
sary.
G. When using an alcohol-based surgical handrub product
with sustained activity, follow the manufacturer’s instruc-
tions. Apply the product on dry hands only. Do not com-
bine surgical hand scrub and surgical handrub with alco-
hol-based products sequentially.

H. When using an alcohol-based product, use sufficient
product to keep hands and forearms wet with the handrub
throughout the procedure.
I. After application of the alcohol-based product as recom-
mended, allow hands and forearms to dry thoroughly
before donning sterile gloves.
Selection and handling of hand hygiene agents
A. Provide HCWs with efficacious hand hygiene products
that have low irritancy potential.
B. To maximize acceptance of hand hygiene products by
HCWs, solicit their input regarding the feel, fragrance, and
skin tolerance of any products under consideration. In
some settings, cost may be a primary factor.
C. When selecting hand hygiene products:
• Determine any known interaction between prod-
ucts used to clean hands, skin care products, and the types
of gloves used in the institution.
• Solicit information from manufacturers about the
risk of contamination.
• Ensure that dispensers are accessible at the point
of care.
• Ensure that dispensers function adequately and
reliably and deliver an appropriate volume of the product.
• Ensure that the dispenser system for alcohol-
based formulations is approved for flammable materials.
• Solicit information from manufacturers regard-
ing any effect that hand lotions, creams, or alcohol-based
handrubs may have on the effects of antimicrobial soaps
being used in the institution.
D. Do not add soap to a partially empty soap dispenser. If
soap dispensers are reused, follow recommended proce-
dures for cleansing.
Skin care
A. Include information regarding hand-care practices
designed to reduce the risk of irritant contact dermatitis and
other skin damage in education programmes for HCWs.
B. Provide alternative hand hygiene products for HCWs
with allergies or adverse reactions to standard products
used in the health-care setting.
C. When needed to minimize the occurence of irritant con-
24
tact dermatitis associated with hand antisepsis or hand-
washing, provide HCWs with hand lotions or creams.
Use of gloves
A. The use of gloves does not replace the need for hand
cleansing by either handrubbing or handwashing.
B. Wear gloves when it can be reasonably anticipated that
contact with blood or other potentially infectious materials,
mucous membranes, or non-intact skin will occur.
C. Remove gloves after caring for a patient. Do not wear
the same pair of gloves for the care of more than one
patient.
D. When wearing gloves, change or remove gloves during
patient care if moving from a contaminated body site to a
clean body site within the same patient. Change or remove
gloves after touching a contaminated site and before touch-
ing a clean site or the environment.
E. Avoid the reuse of gloves. If gloves are reused, imple-
ment an adequate reprocessing method to ensure glove
integrity and microbiological decontamination.
Other aspects of hand hygiene
A. Do not wear artificial fingernails or extenders when hav-
ing direct contact with patients.
B. Keep natural nails short (tips less than 0.5 cm long)
C. No recommendation on wearing rings in healthcare set-
tings. But several studies have shown that skin underneath
rings is more heavily colonized than comparable areas of
skin on fingers without rings.
HCW Educational and Motivational Programs
A. Educate staff regarding the types of patient care activi-
ties that can result in hand contamination and the advent-
ages/disadvantages of various methods used to clean their
hands.
B. Monitor HCWs adherence with recommended hand
hygiene practices and provide personnel with information
regarding their performance.
C. Encourage patients and their families to remind HCWs
to decontaminate their hands.
*Recomondations from WHO guidelines on hand hygiene in health
Care (advanced draft, 2006)
References:
1. Boyce JM. It is Time for action: Improving Hand Hygiene
in Hospital. Ann Intern Med. 1999; 19;130(2):153-55
2. Boyce JM et al. Guideline for hand hygiene in health-
care settings. Recommendations of the Healthcare Infection
Control Practices Advisory Committee and the
HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.
Society for Healthcare Epidemiology of
America/Associationfor Professionals in Infection
Control/Infectious Diseases Society of America. Morbidity
and Mortality Weekly Report, 2002, 51(RR-16):1-45
3. de Vries JH., van drop WT and Braeveld PW. A ran-
domize trial of alchol 70 % versus alcoholic iodine 2 % in
skin disinfection before insetion of peripheral infusion
cathaters. J.Hosp.‹nfect. 1997;36(4):317-20
4. Esen S. Hand hygiene and antiseptics. In: Gunaydin M.,
Sunbul M. Eds. 3th National Sterilization and Disinfection
Congress Book. Ankara, SIMAD press, (2-4 october 2003,
Samsun). p:120-130
(http://www.das.org.tr/tr/dosya/kongre/kong2003/09.
htm) (tr)
5. Gunaydin M, Hand Hygiene an disinfectans., 2001,
(http://das.org.tr/muratomu/elhijyeni.htm) (tr)
6. Kampf G, Jarosch R, Ruden H. Limited effectiveness of
chlorhexidine based hand disinfectants against methicillin-
resistant Staphylococcu S aureus (MRSA). J Hosp
Infect.1998;38:297-303
7. K›l›c D. Decreasing of patient to patient tranmission. In:
Gunaydin M., Sanic A, Gürler B. Eds. 4th National
Sterilization and Disinfection Congress Book. Ankara,
DAS press, (20-24 April 2005, Samsun). p:479-492
(http://www.das.org.tr/tr/dosya/kongre/kong2005/44-
05.pdf ) (tr)
8. Koksal F. Hand Hygiene. In: Gunaydin M, Esen S, Sanic
A, Leblebicioglu H. Eds.Sterilization Disinfection and
Hospital Infection. Istanbul, SIMAD pres, p:211-223,
http://www.das.org.tr/tr/dosya/kongre/kong2002/023
.pdf ) (tr)
9. Larson E. APIC Guidelines Committee. APIC guideline
for handwashing and hand antisepsis in health care set-
tings. Am J Infect Control. 1995;23:251-269
10. Pittet D. MD, MS Improving Compliance With Hand
Hygiene in Hospitals Infect Control Hosp Epidemiol.
2000;21:381-386
11. Pittet D et al. Revolutionising hand hygiene in health-
care settings: guidelines revisited. Lancet Infectious
Diseases, 2003, 3:269-270
12. Ritchie K et al. The provision of alcohol based products
to improve compliance with hand hygiene. In: Health
25
Technology Assessment - Report: NHS Quality
Improvement Scotland, 2005. (http://www.nhshealthqual-
ity.org/nhsqis/files/21487%20NHSQIS%20HTA%20Repo
rt%207_1.pdf)
13. Rotter ML.,Koller W.Surgical hand disinfection :effect
of sequential use of two chlorhexidine preparat›on.
J.Hosp.‹nfect.1990;16(2):161-6
14. Rotter ML, Simpson RA, Koller W. Surgical hand disin-
fection with alcohols at various concentrations: parallel
experiments using the new proposed European standards
method.Infect Control Hosp Epidemiol. 1998;19(10):778-
781.
15. Rotter M. Hand washing and hand disinfection. In:
Mayhall CG, ed. Hospital Epidemiology and Infection
Control. Philadelphia, PA: Lippincott Williams &
Wilkins.1999;1339-1355.
16. Sesso R.,Barbosa D.,Leme IL.(et.al).Staphylococcus
aureus prophylaxis in hemodialisis patients using central
venous catheter: effect of mupirocin
ointment.J.Am.Soc.Nephrol.1998;9(6):1085-92.
17. Sattar SA, Abebe M, Bueti AJ et al.. Activity of an alco-
hol-based hand gel against human adeno-, rhino-, and
rotaviruses using the fingerpad method. Infect Control Hosp
Epidemiol. 2000;21(8):516-519.
18. Tietjen L et al. Infection prevention guidelines for
healthcare facilities with limited resources: (Hand Hygine).
Baltimore, MD, JHPIEGO, 2003.
(http://www.reproline.jhu.edu/english/4morerh/4ip/IP_
manual/03_HandHygiene.pdf )
19. Thompson B.L,, MD, MSPH; Dwyer D.M, MD;. Ussery,
X.T MD.(et.al) Handwashing and Glove Use in a Long-
Term-Care Facility. Infect Control Hosp
Epidemiol.1997;18:97-103.
20. Voss,A., MD; Widmer A.F, MD, MS No Time for
Handwashing! .Handwashing Versus Alcoholic Rub: Can
We Afford 100% Compliance? Infect Control Hosp
Epidemiol.1997;18:205-208..
21. WHO Guidelines on hand hygiene in health Care
(advanced draft), April 2006,
(http://www.who.int/patientsafety/events/05/HH_en.pdf
#search=%22WHO%20guidelines%20on%20hand%20hy
giene%20in%20health%20Care%20(advanced%20draft)%
20%22 )
Figure I: Hand hygiene technique with alcohol based formulation*

A- Apply a palmfull of the product in B- Rub hands palm to palm C- Palm to palm with fingers interlaced D--Left palm over right dorsum with
a cupped hand and cover all surfaces interlaced fingers and vice versa

E- Rotational rubbing backwards and F- Back of fingers to opposing palms G- Rotational rubbing of right thumb H- Once dry, your hands are safe
forwards with clasped fingers of right with fingers interlocked clasped in left palm and vice versa
hand in left palm and vice versa

*Duration of entire procedure 20-30 seconds

Adapted from WHO guidelines on hand hygiene in health Care (advanced draft) / modified
according to EN1500

Figure II: Handwashing technique with soap and water*

A- Wet hands with water B- Apply enough soap to cover C- Rub hands palm to palm D-Palm to palm with fingers interlaced
all surfaces

E- Left palm over right dorsum with F- Rotational rubbing of right thumb G- Backs of fingers to opposing palms H- Rotational rubbing backwards and
interlaced fingers and vice versa clasped in left palm and vice versa with fingers interlocked forwards with clasped fingers of right
hand in left palm and vice versa

I- Rinse hands with water J- Dry thoroughly with single use towel K- Use towel to turn off fauce/tap, L- And your hands are safe
without touching waste container
throw out the towel

*Duration of entire procedure 40-60 seconds

Adapted from WHO guidelines on hand hygiene in health Care (advanced draft) / modified according
to EN1500

26
L-10
PROCESS TECHNOLOGY AND VAL‹DAT‹ON
OF STEAM STERILIZATION IN LABORA
TOR‹ES
H. Winkelmann,
Hamburg, Germany
Historically, not many efforts were done by the industry for
the optimization of laboratory steam sterilizers to carry out
safe, accurate, reproducible and validateable sterilization
processes. This presentation covers the main issues con-
cerning the sterilization of liquid media, laboratory waste
and hollow items. It addresses the issues relevant to the
safety of autoclaves with respect to avoiding injuries due to
the explosion of glass vessels and delayed boiling during
media sterilization. A validation method is described for
examining the physical parameters and the biological effi-
ciency of a steam sterilization process for laboratory waste
and hollow items. Furthermore, the technical configuration
of such optimized laboratory steam sterilizers is discussed,
taking the different physical characteristics of the items to
be sterilized into account, to enable safe, accurate, repro-
ducible and validateable steam sterilization processes to be
carried out.
L-11
MIGRATORY H5N1 BIRD FLU:
A PRELUDE TO A PANDEMIC?
Chow Vincent T.
Department of Microbiology and Infectious Diseases Programme,
National University of Singapore, Kent Ridge, Singapore 117597
Since 1997, highly virulent H5N1 avian influenza A virus-
es have caused sporadic outbreaks in poultry and in
humans with unusually high mortality rates. Aquatic birds
are the natural reservoirs of H5N1 viruses which have
migrated from Asia to Europe and Africa. Genetic analy-
ses suggest that H5N1 viruses are reassortants derived
from other bird flu strains. Most human infections are
caused by direct viral transmission from infected chickens,
and there is no evidence of efficient human-to-human
transmission. However, if the current H5N1 strains mutate
and acquire the ability to spread easily among humans,
they may trigger a severe pandemic. Influenza pandemic
preparedness plans include biosecurity, stockpiling anti-
viral drugs, and rapid development of pandemic flu vac-
27
cines. “Pre-pandemic” vaccines have been tested in
advance of the possible mutation of H5N1 into a lethal
pandemic version. Such candidate vaccines are safe, well-
tolerated, and stimulate immune responses potent enough
to neutralize H5N1 strains. It is unclear whether vaccines
now being developed would be effective against an emer-
gent pandemic strain. Fatal outcome in patients with severe
influenza pneumonitis may be attributed to acute respirato-
ry distress syndrome, sepsis syndrome, and/or multiorgan
failure. Influenza viruses that caused previous pandemics
were avian-related viruses that acquired the ability to prop-
agate in the human lung. We have developed an animal
model to document the cellular and molecular changes that
occur during the adaptation of the human influenza virus
A/Aichi/2/68 (H3N2) in the lungs of BALB/c mice. This
model is a useful strategy for studying cross-species adapt-
ability of influenza A virus.
Keywords: H5N1, avian influenza, pandemic, preparedness, vaccines, pneu-
monitis, mouse model, pathogenesis
L-12
WEST N‹LE VIRUS INFECTION:
FLIGHT FROM EAST TO WEST AND VACCINE
DEVELOPMENT
Kouichi Morita
Department of Virology, Institute of Tropical Medicine, Nagasaki
University
The West Nile fever is a tropical mosquito-borne virus that
has caused epidemics sporadically in Africa, the Middle
East, and parts of West Asia. In the United States of
America (U.S.A.), a West Nile Virus (WNV) outbreak was
first reported in New York City in 1999, and after which,
swept across the continental United States. It has since con-
tinued to steadily spread further, penetrating other parts of
the Pan-American continent and Caribbean islands caus-
ing a serious public health problem across North America.
While, the Japanese Encephalitis Virus (JEV) is the main
cause of mosquito-borne viral encephalitis in Asia.
Recently, phylogenetic analysis of the virus clearly demon-
strated that the virus strains harbored in Southeast Asia
were often introduced to parts of the East Asian region such
as the Korean Peninsula and Japan proper. It has been
strongly suggested that there is a “highway” that transports
JEV over large distances, most probably by migrating
birds. At present, there are no signs that the WNV has
affected Japan or other parts of East Asia. However, if the
virus does reach the Asia-Pacific Region, the spread could
be attributable to the JEV “highway”. Hence, vaccine
development of WNV needs to be accelerated if we are to
effectively manage the threat that poses Asian countries.
In view of this, we have experimentally produced 1) an
inactivated vaccine candidate using purified virion; and 2)
a live vaccine candidate produced by genetic engineering.
The inactivated WN fever vaccine candidate was produced
from the NY99-35262-11 WNV strain. It was developed
using a tissue culture technique recently established for the
production of a new JE vaccine. In animal experiments it
achieved 100% protection against wild-type WNV chal-
lenge. On the other hand, our live attenuated WN fever
vaccine candidate is a chimeric Japanese
encephalitis/West Nile virus constructed from cDNA tem-
plates encoding the envelope protein (E) of WN-NY99
virus. The West Nile (WN) portion is inserted into a back-
bone composed of an attenuated JE virus strain, ML-17.
The ML-17/WN chimeric virus multiplied well in both
mammalian cell cultures (LLC-MK2, BHK-21 and Vero), as
well as in mosquito cell culture, (C6/36). The chimera virus
produced intermediate sized plaques compared with its
parental viruses. Mice immunized with the chimera virus at
a minimum dose of 1 x 105 FFU through the intraperitoneal
(i.p.) route, were protected against WN-NY99 virus chal-
lenge at a dose of 100 x LD50, administered through the
same route. Also, mice immunized with the chimera virus
were partially protected against JE virus challenge. Thus,
both inactivated and live WN fever vaccine candidates
appear useful for the control of WNV infection and present
us with a potential tool for the control of WN fever out-
breaks.
Keywords: West Nile, infection, vaccine, epidemiology
L-13
LEISHMANIASIS
S. Ozensoy,Izmir-Turkey
Ege University Medical School department of Parasitology,
Bornova, ‹zmir
e-mail: seray.ozensoy.toz@ege.edu.tr
Leishmaniasis, a complex of diseases with important clini-
cal and epidemiological diversity as: visceral leishmaniasis
(VL) which is fatal when untreated, mucocutaneous (MCL),
diffuse cutaneous leishmaniasis (DCL) due to a deficient cel-
lular-mediated immune response and cutaneous leishmani-
asis (CL). Anthroponotic VL foci can be origin of frequent
and deathly epidemics. Leishmaniasis burden remains
28
important: 88 countries, 350 million people at risk,
500,000 VL and 1–1.5 million CL new cases annually. It is
concentrated on few countries with clear geographic prior-
ities. It is still an important health problem due to not only
environmental risk factors (massive migrations, urbaniza-
tion, deforestation, new irrigation schemes) but also to indi-
vidual risk factors (HIV, malnutrition, genetic, etc). It is
caused by Leishmania parasites and spread by the bite of
the female sand flies. Members of the subgenus Leishmania
exist in both Old World and New World, whereas those of
the subgenus Viannia are limited to South America. 20
Leishmania species are pathogenic for humans and 30
sand fly species are proven vectors. In Asia continent,
according to VL: Bangladesh, India, Nepal and according
to CL: Afghanistan belong to the group of countries where
the majority (90%) of cases occur.
In Asia continent, leishmaniasis distribution in the countries
on the Silk Road like Kazakhstan, Azerbaijan,
Turkmenistan, Kyrghyzstan, Tadjikistan, China, Turkey and
other countries like Pakistan, Afghanistan, Sri Lanka,
Nepal, India and Bangladesh will be discussed.
VL is endemic in Azerbaijan, Armenia, Georgia,
Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and
Uzbekistan. Before the independency, sporadic VL foci are
encountered mainly in the natural foci including valleys and
foothills. The reservoir suggested as Vulpes vulpes and
dogs and the probable vector as Phlebotomus turanicus. In
Kazakhstan VL cases are encountered in the thickets of the
Syr-Darya flood lands in Kzyl-Orda province, where the
reservoir are Canis aureus L. and Vulpes corsac, and the
vector is P. smirnovi. Isolates were identified as Leishmania
infantum by zymodem analyses from VL patients and dogs
in Turkmen SSR. The spread of VL and P.turanicus distribu-
tion was overlapped. Since 1980, cases have been diag-
nosed from East Azerbaijan, mostly, from Meshkin-Shahr.
The majority (86%) of VL cases were found among children
up to 4 years. VL focus in the Ordubad District of the
Nakhichevan ASSR has become active for the last years
and isolates were identified as L. infantum. Phlebotominae
species were found as P. major, P. kandelakii, P. halepen-
sis, P. balcanicus, P. papatasi, P. sergentii, P. caucasicus,
P. alexandri, Sergentomyia dentate and S. palestinensis.
Authors suggest the disease as Mediterranean VL
Laroussius and Adlerius subspecies are the probable vec-
tors in the focus.
An outbreak of CL was documented in the Geokchai District
of Azerbaijan in 1980’s mainly in rural areas and the iso-
late was identified as L.donovani sensu lato. Five
Phlebotominae species (P. kandelakii, P. tobbi, P. transcau-
casicus, P. brevis, P. alexandri) out of 9 were reviewed as
L. infantum vectors. CL isolates in Ashkhabad city were
identified as L.tropica. The entomological studies demon-
strated specific L. tropica vector-P. sergenti. In the hyperen-
demic foci of Turkmenistan, Leishmania isolates from great
gerbils, P. papatasi, and patients in the Tedzhen oasis were
similar to those in Uzbekistan and Kazakhstan. L. turanica
a non-pathogenic species for human prevailed among
great gerbils in winter, spring, and early summer. Great
gerbil infection rate by L. major up to 100% appeared dur-
ing August-September. Therefore, most isolates were clone
mixtures of L. major and L. turanica. P. papatasi was the
only vector in the Tedzhen oasis with the strong evidence of
transmission both L. major and L. turanica. Zoonotic CL is
constantly notified in the valley-delta and the spread of CL
coincides with the distribution of P. papatasi. Strains of
great gerbils in Turkmenistan, Uzbekistan, Kazakhstan,
and Mongolia were examined by PCR fingerprint and L.
turanica strains were showed a high genetic intraspecific
heterogeneity showing 3 groups geographically as
Mongolia, Kazakhstan and Turkmenistan-Uzbekistan. No
intraspecific polymorphism was found among L. major and
L. gerbilli strains. Totally, 78 cases of a rural CL registered
in the Tadjik SSR over a 10-year period.
Mediterranean type, L. infantum is the principal agent of
VL throughout China. L. infantum is also responsible for CL
in Karamay, Xinjiang. L. turanica and L. gerbilli are the
parasites of great gerbils. rK39 antigen has been used with
high specificity and sensitivity for human and canine VL. VL
epidemics observed in 3 foci (hills, plains and desert) with
different characteristics. In hilly regions, dogs are the main
reservoir. The sequences of the SSU rDNA variable regions
of isolates from hilly foci were identical with the isolate from
plain focus and L.infantum; there was also 100% identity
between the isolate from desert and India. The plain focus
(Shandong, Jiangsu) in China shows similarity with India.
Sichuan and Gansu Provinces are part of the hill type VL
epidemic. The vectors are P.chinensis in hilly and plains
regions and P.major in desert. PCR products of VL patients
were sequenced and two products were revealed 100%
identity and showed more similarity to L. donovani Indian
strain than Africa and South America L. donovani strains.
However, VL isolates appear to be different from India L.
donovani by zymodemes and RFLP. Sequences were not
identical to the reference L. donovani from India or L. infan-
tum from Tunisia. Primary and secondary structures of
Xinjiang CL isolate were different from L. infantum and L.
29
tropica.
In Turkey, human VL and CanL caused by L. infantum
MON-1 are endemic along the Aegean and
Mediterranean coasts and occur sporadically in other
regions. CL is still highly endemic in the south and south-
east regions. There is also a new CL focus in Aegean region
of Turkey. IFAT and rK39 dipstick assay for human and
dog sera were used as sero-diagnostic tools showing high
sensitivity and specificity. The PCR assays specific to kine-
toplastic and miniexon regions of Leishmania were used
successfully for diagnosis. L.tropica and L.infantum were
identified as etiological agents of CL. The PCR-RFLP specif-
ic for internal transcribed spacer (ITS) region of ssuRNA
gene of Leishmania was revealed different genotypes of
L.tropica in different CL sites in Turkey. There are 20
Phlebotomus species in Turkey and 9 of them are proven
vectors in Old World.
VL has been a major public health problem in the state of
Bihar, India and also in the neighbouring states of West
Bengal and Uttar Pradesh and in low-lying regions of
neighbouring countries Nepal and Bangladesh. Nearly
100.000 people are estimated to become infected with VL
annually while approximately 147 million people in the
area are at risk. Post kala azar dermal leishmaniasis
(PKDL) can follow recovery from VL infection, and PKDL
patients may act as a reservoirs. Leishmaniasis/HIV co-
infection is on the rise. Man is the only reservoir host of VL
and P. argentipes the only vector in this endemic region of
South-East Asia. VL is endemic in the eastern states of
India.
In India, autocutaneous cases of CL are confined to the dry
northwestern half of the Indo-Gangetic plain, including dry
areas bordering Pakistan from Amritsar to Gujarat. To the
east, cases have been reported from as far as Delhi and
Varanasi. Sporadic cases were revealed in Fazilka
(Punjab) and Rajasthan (Sriganganagar district) and L.
tropica was identified as causative agent. Autocutaneous
CL patients were revealed in Kasargod district in the
Western Ghats region of South India. In Kerala, the cases
of CL have been reported from Malappuram and
Trivandrum.
CL is growing epidemically in Pakistan and Afghanistan. P.
papatasi, P. sergenti and P. salehi are the sand fly species
reported from Pakistan. The wet type of the disease is more
common in Baluchistan and interior regions of Sindh
province, while dry type is more prevalent in Punjab
province. Wet type lesions were only seen in patients who
had a history of stay in or visit to, Baluchistan or Sindh
province. VL is gradually spreading southwards in the
country. Children below 5 years are mainly affected. Bone
marrow examination is the most reliable and simple
method of diagnosis. A high index of suspicion must he
kept in mind for all febrile cases coming from Hazara divi-
sion, Northern areas, Azad Kashmir.
CL is an emerging disease in Sri Lanka. Patients were from
5 of the 7 agroclimatic zones in Sri Lanka and CL isolates
were identified as L.donovani by DNA sequencing and
microsatellite analyses and found to be closely related to
Indian VL isolates. The VL vector P. argentipes is widely dis-
tributed throughout the Indian sub-continent and S.E. Asia.
Locally acquired VL was reported in Sri Lanka in 2007.
L-14
TOXOPLASMOSIS
Murat Hokelek
Ondokuz May›s University, Department of Microbiology and Clinical
Microbiology
Samsun, Turkey
INTRODUCTION
Toxoplasma gondii is an obligate intracellular protozoon
that produces a wide range of clinical syndromes in
humans, various mammals and bird species. T. gondii has
been found from locations throughout the world.
T. gondii infects a large population of the world but uncom-
monly causes clinically significant disease. However, cer-
tain individuals are at high risk for severe or fatal disease
due to this protozoon. Populations at risk include fetuses,
newborns, and immunodeficient patients. Congenital toxo-
plasmosis is usually a subclinical infection. Among immun-
odeficient patients, toxoplasmosis most often occurs in
those with defects of T-cell–mediated immunity, for instance
those with organ transplants, malignancies, or HIV infec-
tions.
The organism of toxoplasmosis has two different life cycles.
The sexual cycle occurs only among cats, the definitive
host. The asexual cycle involves humans and other mam-
mals and various species of birds. It consists of two forms,
known as tachyzoites or trophozoites and bradyzoites.
Tachyzoites are the rapidly dividing form observed in the
acute phase of infection. Bradyzoites are the slowly grow-
ing form observed in tissue cysts. The sexual cycle begins in
the gastrointestinal tract of the cat. During a primary infec-
tion, the cat can excrete millions of oocysts daily for 1-3
weeks.
T. gondii oocysts, tachyzoites, and bradyzoites can cause
30
infection in humans. Infection can occur by ingestion of
oocysts following the handling of contaminated soil or cat
bedding material or the intake of contaminated water or
food sources (eg, unwashed garden vegetables).
Transmission of tachyzoites to the fetus can occur via the
placenta following primary congenital infection.
EPIDEMIOLOGY
In many populations, such as those in France and El
Salvador, the seropositivity prevalence rate is as high as
75% by the fourth decade of life. Approximately 50% of the
adult population is infected in Germany. Women of child-
bearing age in much of Western Europe, Africa, and South
and Central America have seroprevalence rates of greater
than 50%. In HIV-infected individuals, the seropositivity
rate is approximately 50-78% in various areas of Western
Europe and Africa. Toxoplasmic encephalitis (TE) is the
AIDS-defining diagnosis in 16% of AIDS patients. In
France, 37% of AIDS patients have evidence of TE after
autopsy. The prevalence rate in different provinces ranged
from 0.3-11.8% in China.
PATHOGENESIS, CLINICAL SIGNS AND SYMPTOMS
When the organism is ingested, sporozoites are released
from oocysts or bradyzoites are released from tissue cysts,
and the organisms enter gastrointestinal cells. The sporo-
zoites multiply, rupture cells, and infect contiguous cells.
They are transported via the lymphatics and disseminated
hematogenously throughout the tissues.
Tachyzoites proliferate, producing necrotic foci surrounded
by a cellular reaction. With the development of a normal
immune response, tachyzoites disappear from tissues. In
immunodeficient patients and in some apparently immuno-
logically healthy individuals, the acute infection progresses
and may cause potentially lethal consequences such as
pneumonitis, myocarditis, or necrotizing encephalitis.
Tissue cysts form as early as 7 days after infection and
remain for the lifespan of the host. They produce little or no
inflammatory response but cause severe disease in
immunocompromised patients or chorioretinitis in congeni-
tally infected older children.
When a mother acquires the infection during pregnancy,
the parasite may be disseminated hematogenously to the
placenta. If the mother gets the infection in the first trimester
and the infection is not treated, approximately 17% of
fetuses are infected, and disease in the infant is usually
severe. If the mother acquires infection in the third trimester
and the infection is not treated, approximately 65% of
fetuses are infected, and involvement is mild or inapparent
at birth. These different rates of transmission are most like-
ly related to placental blood flow, the virulence and amount
of T. gondii acquired, and the immunologic status of the
mother to restrict parasitemia.
Only 10-20% of cases of toxoplasmosis in adults and chil-
dren are symptomatic. Patients have cervical lym-
phadenopathy with discrete, usually nontender, nodes that
are smaller than 3 cm in diameter. Fever, malaise, night
sweats, and myalgias are reported. Retroperitoneal and
mesenteric lymphadenopathy with abdominal pain may
occur. Chorioretinitis is reported.
Brain involvement is the most common manifestation, with
or without focal CNS lesions in AIDS patients. Clinical find-
ings are altered mental state, seizures, weakness, cranial
nerve disturbances, sensory abnormalities, cerebellar
signs, meningismus, movement disorders, and neuropsy-
chiatric manifestations. The characteristic presentation is
usually a subacute onset with focal neurologic abnormali-
ties in 58-89% of those patients. However, in 15-25% of
cases, the clinical presentation may be more abrupt, with
seizures or cerebral hemorrhage. Most commonly, hemi-
paresis, speech abnormality, or both are the major initial
manifestation. The diffuse TE form may manifest acutely
and can be rapidly fatal; generalized cerebral dysfunction
without focal signs is the most common manifestation, and
CT scan findings are within normal limits or reveal cerebral
atrophy. Pneumonitis due to toxoplasmosis is being
increasingly recognized in AIDS patients who are not
receiving appropriate anti-HIV drugs or primary prophy-
laxis for toxoplasmosis. Toxoplasmic chorioretinitis is
observed relatively infrequently in AIDS patients; it com-
monly manifests with ocular pain and loss of visual acuity.
Congenital toxoplasmosis is most severe when maternal
infection occurs early in pregnancy. Approximately 67% of
patients have no signs or symptoms of infection.
Chorioretinitis occurs in 15% of patients. Intracranial calci-
fications develop in 10%. Cerebrospinal fluid (CSF) pleocy-
tosis and elevated protein values are present in 20% of
patients. Patients have anemia, thrombocytopenia, and
jaundice at birth. Microcephaly is reported. Affected sur-
vivors may have mental retardation, seizures, visual
defects, spasticity, or other severe neurologic sequelae.
Chorioretinitis develops in patients with ocular toxoplasmo-
sis. They have a yellowish, white, elevated cotton patch
31
with indistinct margins. The lesions may occur in small clus-
ters. Congenital disease is usually bilateral. Acquired dis-
ease is usually unilateral. Symptoms include blurred vision,
scotoma, pain, and photophobia.
DIAGNOSIS
The Sabin-Feldman dye test is a sensitive and specific neu-
tralization test. It measures IgG antibody and is the stan-
dard reference test for toxoplasmosis. The indirect fluores-
cent antibody test measures the same antibodies as the dye
test. Titers parallel dye test titers.
Detection of T. gondii antigen in blood or body fluids by
enzyme-linked immunosorbent assay (ELISA) technique
indicates acute infection. The results from a double-sand-
wich IgM ELISA are more sensitive and specific than the
results from other IgM tests. The results of the IgG avidity
test may help discriminate those with acute infection from
those with chronic infections better than alternative assays,
such as assays that measure IgM antibodies. As is true for
IgM antibody tests, the avidity test is most useful when per-
formed early in gestation because a long-term pattern
occurring late in pregnancy does not exclude the possibili-
ty that the acute infection may have occurred during the
first months of gestation.
Isolation of T. gondii from amniotic fluid is diagnostic of
congenital infection by mice inoculation. PCR on body flu-
ids, including CSF, amniotic fluid, BAL fluid, and blood,
may be useful in the diagnosis.
In most immunodeficient patients with TE, CT scans show
multiple bilateral cerebral lesions. MRI has superior sensi-
tivity to CT scan, and images often demonstrate a single or
multiple lesions or more extensive disease not apparent on
CT scan images.
TREATMENT
Currently, recommended drugs against T. gondii act pri-
marily against the trophozoite form; thus, they do not erad-
icate the bradyzoite form. Most effective available thera-
peutic combination is pyrimethamine plus sulfadiazine or
trisulfapyrimidines. These agents are active against tachy-
zoites and are synergistic when used in combination.
Leucovorin should be administered concomitantly to avoid
bone marrow suppression.
Careful attention to dosing regimen is necessary because
differs depending on patient variables (eg, immune status,
pregnancy). Pyrimethamine may be used with sulfon-
amides, quinine, and other antimalarials and with other
antibiotics.
PREVENTION
Preventing the infection is especially important for patients
who are seronegative and immunocompromised and for
women who are pregnant. These persons should avoid eat-
ing raw meat, unpasteurized milk, and uncooked eggs,
wash hands after touching raw meat and after gardening
or other contact with soil and wash fruits and vegetables.
Avoiding contact with cat feces is very important. To
attempt to prevent congenital toxoplasmosis, routine sero-
logic screening of pregnant women has been performed in
order to identify fetuses at risk of becoming infected. If pos-
sible, recipients who are seronegative should receive trans-
planted organs from donors who are seronegative.
References
1. Beaman MH: Toxoplasmosis. In: Rakel RE, Bope ET,
eds. Conn's Current Therapy. 53rd ed. Philadelphia, Pa:
WB Saunders; 2001: 156-62.
2. Boyer KM: Diagnostic testing for congenital toxoplas-
mosis. Pediatr Infect Dis J 2001 Jan; 20(1): 59-60
3. Chen XG, Wu K, Lun ZR: Toxoplasmosis researches in
China. Chin Med J (Engl) 2005 Jun 20; 118(12): 1015-
21
4. Cold CJ, Sell TL, Reed KD: Diagnosis -- disseminated
toxoplasmosis. Clin Med Res 2005 Aug; 3(3): 186
5. Hill DE, Chirukandoth S, Dubey JP: Biology and epi-
demiology of Toxoplasma gondii in man and animals.
Anim Health Res Rev 2005 Jun; 6(1): 41-61
6. Jones JL, Kruszon-Moran D, Wilson M, et al:
Toxoplasma gondii infection in the United States: sero-
prevalence and risk factors. Am J Epidemiol 2001; 154:
357-65
7. Kravetz JD, Federman DG: Toxoplasmosis in pregnan-
cy. Am J Med 2005 Mar; 118(3): 212-6
8.Lappalainen M, Hedman K: Serodiagnosis of toxoplas-
mosis. The impact of measurement of IgG avidity. Ann Ist
Super Sanita 2004; 40(1): 81-8
9.Luder CG, Bohne W, Soldati D: Toxoplasmosis: a per-
sisting challenge . Trends Parasitol 2001; 17: 460-3
10.Montoya JG, Remington JS: Toxoplasma gondii. In:
Mandell GL, Bennett JE, Dolin R, eds. Principles and
Practice of Infectious Diseases. 6th ed. Philadelphia, Pa:
Churchill Livingstone; 2005: 3170-93.
11.Montoya JG, Rosso F: Diagnosis and management of
toxoplasmosis. Clin Perinatol 2005 Sep; 32(3): 705-26].
12.Montoya JG, Liesenfeld O: Toxoplasmosis. Lancet 2004
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Jun 12; 363(9425): 1965-76
13.Peyron F, Wallon M: Options for the pharmacotherapy
of toxoplasmosis during pregnancy . Expert Opin
Pharmacother 2001; 2: 1269-74
14.Pinon JM, Dumon H, Chemla C, et al: Strategy for diag-
nosis of congenital toxoplasmosis: evaluation of methods
comparing mothers and newborns and standard methods
for postnatal detection of immunoglobulin G, M, and A
antibodies . J Clin Microbiol 2001; 39: 2267-71
15. Remington JS, Thulliez P, Montoya JG: Recent develop-
ments for diagnosis of toxoplasmosis. J Clin Microbiol
2004 Mar; 42(3): 941-5
16. Rothova A: Ocular manifestations of toxoplasmosis.
Curr Opin Ophthalmol 2003 Dec; 14(6): 384-8
17. Schwartzman JD: Toxoplasmosis. Curr Infect Dis Rep
2001; 3: 85-89
18. Switaj K, Master A, Skrzypczak M: Recent trends in
molecular diagnostics for Toxoplasma gondii infections.
Clin Microbiol Infect 2005 Mar; 11(3): 170-6
19. Tierney,Jr LM, McPhee SJ, Papadakis MA, eds:
Toxoplasmosis. In: Current Medical Diagnosis & Treatment.
40th ed. New York, NY: McGraw-Hill; 2001: 1444-7.
20. Trikha I, Wig N: Management of toxoplasmosis in
AIDS. Indian J Med Sci 2001; 55: 87-98
L-15
ECHINOCOCCOSIS AND OTHER HELMINTHIC
DISEASES IN AS‹A AND TURKEY
Prof. Dr. Nazmiye Alt›ntafl
Ege University, School of Medicine, Department of Parasitology,
Bornova-Izmir, Turkey
Echinococcosis is a chronic disease of humans which has a
serious prognosis and is caused by metacestodes of the
genus Echinococcus which include E.granulosus, E.multiloc-
ularis, E.vogeli or E.oligarthrus species. Infections by larval
stages of tapeworms of this genus are zoonotic infections of
major public health and economic importance throughout
of the world especially occurring in humans cystic
echinococcosis (CE) is caused by metacestod of E.granulo-
sus and alveolar echinococcosis (AE) is caused by metaces-
tod of E.multilocularis are of special importance due to their
wide geographic distribution. E.granulosus is the most
widespread of the species with high endemicity in southern
part of former Soviet Union; southern Asia, including
Afghanistan, Pakistan, Nepal, Bhutan, Bangladesh, India
and Sri Lanka; in the south-western Caucasus region
(Georgia, Armenia and Azerbaijan; in the South:
Kazakhstan, Turkmenistan, Tajikistan, Uzbekistan,
Kyrgyzstan), also Mongolia and the Republic’s of China.
Sporadic cases of human CE, either imported or locally
acquired, have been reported from various countries,
including Laos, Thailand, Vietnam, Malaysia, Indonesia,
the Philippines, Kores, Japan and Taipei China. Two forms
of echinococcosis occur in Turkey, i.e. E.granulosus and
E.multilocularis. According to Ministry of Health records,
52.124 patients had operations to treat or confirm CE in
the period 1990-2005 which corresponds to 3257 patients
per year. The estimated surgical case rate of CE is 0.87-6.6
per 100.000 in Turkey and according to some of the
authors, estimated incidence rate is between 0.8-
2.0/100.000 or %0.3-%0.087. The prevalence of E. gran-
ulosus infection in dogs in Turkey is between 0.32 and 40%
and varies widely with geographical location. The reported
prevalence of CE in domestic animals in Turkey has ranged
from 11.2 to 50.7% and has varied widely with geograph-
ical location. AE is not as widespread as CE but is an
emerging zoonosis in the country. Since the first human
case, reported in 1939, there have been more than 200
reported cases o AE over the last 20 years.
There are many helminths which caused serious illness in
human in Asia and Turkey but we will mention here espe-
cially have more importance for Asian countries.
Foodborne trematodiasis is an emerging public health
problem, particularly in Southeast Asia and the Western
Pacific region. Currently, 601.0, 293.8, 91.1, and 79.8
million people are at risk for infection with Clonorchis
sinensis, Paragonimus spp., Fasciola spp., and
Opisthorchis spp., respectively. The endemic area of
Clonorchiasis is limited to China, Malaysia, Republic of
Korea, Singapore, Taiwan, Viet Nam. The most important
endemic areas of Paragonimiosis are East and Southeast
Asia, China, Japan, the Philippines, Republic of Korea,
Thailand, Taiwan, the maritime provinces of the former
USSR, and there are also isolated foci in India and Viet
Nam. Human Fascioliasis caused by F.hepatica has been
found mainly in areas where sheep and cattle are raised
and where humans consume raw freshwater plants, includ-
ing Europe, the Middle East and Asia (Iran). In Thailand,
the prevalence of F. gigantica in cattle and buffalo vary
considerably, ranging from 0 to 85%. Only 12 human
cases of fascioliasis gigantica and fascioliasis hepatica
have been recognized in the northeastern and northern
provinces. Only five cases of human fascioliasis have been
reported in Korea. On the other hand, large numbers of
33
cases of human fascioliasis caused by F. gigantica have
been reported in Viet Nam (500 since 1978, mostly from
the central provinces) and in northern Iran where 10,000
cases were diagnosed in 1999. The prevalence of
Fasciolopsiasis caused by F.gigantica in children ranges
from 57% in mainland China to 25% in Taiwan and from
50% in Bangladesh and 60% in India to 10% in Thailand.
In Turkey, only human Fascioliasis caused by F.hepatica
has been found among these trematodiosis.
Some of the emerging or ubiquitous parasites, including
Taenia and Trichinella, present enormous risks to global
food production and consumer health. Taeniasis saginata
is a food-borne zoonosis in man caused by Cysticercus
bovis and is distributed worldwide. T.saginata approxi-
mately 10 times more prevalent than T.solium. In Iran, the
prevalence of C. bovis in cattle ranged from 7.7 to 10.7%.
In India, only 1.5% of humans have T.saginata, while tae-
niasis saginata was widespread throughout China with
prevalence ranging from 2 to 70%. In Indonesia, the preva-
lence of C. bovis varied from 0.3 to 2.4%, and in endemic
foci in the Philippines, 10.3% of people have T.saginata.
Infection rate among aborigines in the mountainous areas
of Taiwan was 10–20%. T.solium is much more common in
developing countries and the non-islamic countries of
Southeast Asia. Cysticercosis (neurocycticercosis) caused
by T.solium have been recorded in Nepal, Viet Nam,
Indonesia, India and China. Because of eating habit in
Turkey, raw meat balls were made with minced beef meat,
tomato paste and hot spices, taeniasis saginata was wide-
spread throughout Turkey especially in East and South
Anatolia. According to local studies have been done, the
prevalence of T.saginata varies from 0.08 to 19.5 %
among preliminary school children in different cities.
Major outbreaks of the Trichinellosis have been reported
primarily in China and Thailand which are highly endemic
areas for this parasite. Economic losses due to Trichinella
infection are not negligible in China, where there have
been more than 500 outbreaks of human trichinellosis,
affecting more than 20,000 people and causing more than
200 deaths. In Thailand, over the past 27 years, 120 out-
breaks were reported involving nearly 6700 patients and
97 deaths. Japan has had fewer outbreaks and some spo-
radic cases have been attributed to imported infection.
Trichinellosis has also been documented in domestic ani-
mals and/or humans in Cambodia, Indonesia (Bali and
Sumatra), Lao PDR, Malaysia, Myanmar, Thailand, and
New Zealand, and in wildlife of Tasmania. In Islamic coun-
tries, very few outbreaks of trichinellosis have been seen for
the religious belief to not to eat pork. In Turkey, raw meat
balls were made with minced beef meat, tomato paste and
hot spices but when the producer added pork to beef meet,
a large outbreak of trichinellosis occurred in Izmir in
January 2004. Larvae from both meat balls and human
biopsy have been identified as Trichinella britovi by PCR.
619 of 1165 persons were fit with the criteria of trichinel-
losis of the International Commission on Trichinellosis. 356
were confirmed by serology of these 619 cases and the
other 263 cases can be considered as probable infections.
The age of patients ranged from 3 to 70 years.
Anisakiasis, Capillariasis, Gnathostomiasis and intestinal
helminthic diseases are also important helminthic diseases
in Asia.
L-16
MOLECULAR DIAGNOSIS OF PARASITIC
DISEASES
A. Yüksel Gürüz, Professor
Ege University Medical Faculty Detp. of Parasitology, Head
of the Molecular Parasitology Lab, Bornova-Izmir, Türkiye
Some parasites are members of macroenviroment, which
are easy to diagnose. But some lifetreathning parasites are
so minute that it may not be easy to trace them even with a
microscope. Therefore serology is widely used. Serology
generaly captures the shadow of the organism. It generaly
shows the past and sometimes present time to mass the
ideas of science persons. We only beleiev in what we see.
For this reason, we, parasitologists, always respect micro-
scopic examination results. But some ocations, it is time
consuming and needs expert eyes. This effort resembles the
work of police detectives, catching the criminal by the fin-
gerprints. But there is a better way, you may name this
action “finding Cinderella by the shoe”, all you need is to
express a DNA sequence that carries all characteristics of
the target organism, than let the hunt begin. Molecular
diagnosis, for sure is highly sensitive and specific if per-
formed in optimum conditions. It also enables physicians to
follow the efficacy of the treatment additional to its value in
immunosupressed patient groups when compared to serol-
ogy. In our molecular Parasitology Lab (MolParLab) we
assess Nested and Real-Time PCR at the same time to
increase the specificty and sensivity even in case of muta-
tions. Molecular diagnosis, especially in toxoplasmosis,
sometimes is a must in organ transplant patients, risky ges-
tations and AIDS patients. Performing 2 different PCR meth-
34
ods gave us a chance to follow up the efficacy of the treat-
ment, additional to early warning in reactivated or sero-
converted patients.
Keywords: Parasitic diseases, molecular, diagnosis, DNA sequence
L-17
HEPATITIS A VACCINATION:
TURKISH EXPERIENCE.
Mustafa Bakir, MD
Department of Paediatric Infectious Diseases, Marmara University
Medical School, Istanbul, Turkey.
Randomised, observer-blind clinical trial conducted in
Turkey evaluated the immunogenicity, safety and inter-
changeability of three paediatric inactivated hepatitis A
vaccines in 424 seronegative children between 1 and 15
years of age. Methods: Potential subjects were screened for
anti-hepatitis A virus (HAV) antibodies prior to receiving a
first dose of Avaxim 80, Havrix 720 or Vaqta 25, followed
by a second dose of either the same vaccine or Avaxim 6
months later. Anti-HAV antibody concentrations were
measured 2 weeks after the first injection, at 24 weeks
(before the second dose) and at 28 weeks for the evalua-
tion of the immune response. Results: Nearly 80% of the
children between 1 and 5 years of age and half of those
between the ages of 6 and 10 in the population from which
the subjects were recruited were seronegative for HAV anti-
bodies. Two weeks after the first dose, 98.2% of all subjects
had anti-HAV antibody concentrations equal to or higher
than 20 mIU/mL, believed to be seroprotective, and all
subjects were seroprotected before and after the second
dose. Anti-HAV geometric mean concentrations (GMCs) 2
weeks after the first dose and before the second were sim-
ilar in children who received Avaxim and Vaqta (P = 0.2),
but both were higher than Havrix (P < 0.01). There were no
significant differences in the anti-HAV GMCs between the
study groups that received two doses of the same vaccine
compared with two doses of different vaccines. There were
no significant differences in the frequency of any local or
systemic adverse events among the study groups following
either of the two doses. Conclusion: All three vaccines are
safe and highly immunogenic in healthy children aged 1 to
15 years. Avaxim 80 may also be given as the second dose
when Havrix 720 or Vaqta 25 are given as the first dose.
The pattern of seroprevalence seen here is similar to that
reported in a number of recent evaluations in Turkey, and
are supportive of the routine hepatitis A vaccination of
young children.
Keywords: Hepatitis A, vaccination, childhood, Turkey, Turkish
experience
L-18
FOUR-YEAR RESULTS OF UNIVERSAL
Effect of universal hepatitis A vaccination of 6-year old
IMMUNIZATION AGAINST HEPATITIS A IN
children
Minsk City, Belarus
Fisenko E. G.1, Germanovich F. A.1, Volosar L. A.1,
Ushakevich I. G.2, Baburchik L. P.2, Gaidukevich T. M.2,
Lyabis O. I.3, Rasuli A. M.4
1
Minsk Center of Hygiene and Epidemiology, Minsk,
Belarus Republic
2
Minsk Municipality Health Department, Minsk, Belarus
Republic
3
Medical Affairs, Sanofi Pasteur, Moscow, Russia
Herd immunity: decrease in incidence rate in all age
4
Medical Affairs, Sanofi Pasteur, Lyon, France
groups (number of cases per 10,000 age-population)

Hepatitis A is a reportable disease in Belarus. Universal

hepatitis A vaccination of children 6 years of age in Minsk
City in began 2003. This analysis was conducted to evalu-
ate the short-term impact of the program. Hepatitis A inci-
dence data from 1954 to 2006 was evaluated. Vaccination
effectiveness was estimated by comparing the incidence of
reported hepatitis A cases after 4 years of immunization
(2006) with the incidence when the vaccination program
started (2003). The vaccines used were Avaxim 160™or
Avaxim 80™ (95%) and Havrix 720™ (5%). From 2003
through 2006, hepatitis A incidence in vaccinated children
Hepatitis A Incidence in Vaccinated and Non-vaccinated
<14 years of age was 20-fold lower than the incidence in
Children 1-17 years of age from 2003 through 2006
unvaccinated children (0.3 cases/10,000 versus
5.98/10,000, odds ratio=0.05, 95% CI 0.012-0.202), for Index per
Number HA cases
10,000
a vaccination effectiveness of 95%. The decreased inci-
dence in all age groups in 2006 (by 12 times in pre-school Vaccinated 65,171 2 0.31
children 1-5 years of age, 13 times in children of 10-14
years old, and 4-6 times among adults), including those Non-vaccinated 210,900 131 6.21
without high coverage by vaccination, can be explained by
Keywords: Hepatitis A, universal vaccination, effectiveness
a herd effect. Routine vaccination also resulted in a shift of
the age pattern of hepatitis A morbidity. The proportion of
cases in children under 14 years of age decreased from
L-19
33-41% in 2000-2002 to 7% in 2005-2006. We conclude CONTROL OF TYPHOID FEVER IN ENDEMIC
that introduction of universal hepatitis A vaccination in COUNTRIES: VI VACCINES ARE A VIABLE
Minsk resulted in sharply reduced incidence in both vacci- SOLUTION
nated and unvaccinated children. Virus circulation might
be further decreased by beginning vaccination at a
Dutta Anil, Rasuli Anvar
younger age. Medical Affairs, Sanofi Pasteur, Lyon, France

Typhoid fever imposes a serious healthcare burden, with up

to 22,000,000 cases and over 200,000 deaths reported
annually. It affects world’s most impoverished communities,
particularly in Asia. Despite treatment with antibiotics,
around 10% of cases develop complications. Mortality rate

35
 can be as high as 30% without treatment. The effective
treatment of typhoid fever with antibiotics is increasingly L-20
being limited by the worldwide spread of drug resistance.
PNEUMOCOCCAL DISEASE PREVENTION WITH
As humans form the only reservoir for S. typhi, controlling
THE 23-VALENT POLYSACCHARIDE VACCINE
typhoid fever is realistic. Typhoid fever vaccines are avail-
able, effective, well-tolerated, and recommended by the
Vlasich Clemens
WHO for prevention and outbreak control. There are three
Sanofi Pasteur, Vienna, Austria
ways of using vaccines to control disease: a) Mass vaccina-
tion of populations affected by typhoid fever outbreaks; b)
Pneumococcal disease is a major public health problem
Routine, preventive vaccination to reduce S. typhi transmis-
worldwide, although the exact burden of disease is often
sion rates; c) Sporadic preventive vaccination of individu-
not known because of the difficulty to diagnose certain
als, or specific groups, who are known to be at high risk of
pneumococcal infections and because of different surveil-
exposure to S. typhi.
lance systems. Mainly young children, older adults,
Vi vaccine is based on the Vi polysaccharide of S. typhi. A
immunocompromised patients and those with certain
single, intramuscular dose is effective in about 70% of indi-
chronic diseases suffer severe infections caused by S. pneu-
viduals, and revaccination is recommended at 3 years after
moniae. The highest mortality rates have been shown in
the first dose. In a clinical trial, Typhim Vi® (sanofi pasteur,
elderly people. Moreover, the costs of treating pneumococ-
France) in one week produced antibody titres above the
cal infections represent a substantial economic burden on
postulated threshold for seroprotection, and continued to
society.
increase thereafter.
A 23-valent pneumococcal polysaccharide vaccine
Thus, typhoid Vi vaccines provide an excellent means for
(PPV23) for persons above 2 years of age is available since
controlling typhoid fever now, while other control pro-
the 1980s. It covers about 90% of the serotypes involved in
grammes (sanitation, new-generation vaccines) are devel-
invasive pneumococcal infections and most antibiotic resist-
oped. Vi vaccines can be used in existing vaccination pro-
ant strains. The vaccine has been shown to be very well tol-
grammes, at the same time as other vaccines.
erated, and its effectiveness to protect against invasive dis-
Immunogenicity of Typhoid Vi polysaccharide vaccine
ease has been widely documented among various risk
groups including older adults. From a societal point of
100 view, pneumococcal vaccination has been proven to be
very cost-effective.
80 Worldwide recommendations for the use of pneumococcal
polysaccharide vaccine will be reviewed. Some countries
Seroprotection rate (%)

60 provide public reimbursement through national or social

health insurance, other countries rely on private financing
40
mechanisms.
In Scotland and in Catalonia, a region in the Northeast of
20
Spain, pneumococcal vaccination is provided for free to all
persons over 65 years. In both cases the effectiveness of
0
Day 0 Day14 Day28 1year 2year 3year such a programme has been well documented.
In Russia PPV 23 is used since 1998 and its effectiveness
Typhim VI* Subjest were adminstired Vi vaccine was shown in various risk groups, e.g. in patients with
Threshold for seroprotection 1pg/mL
Overbosh D. J. Trav. Med. 2005; 12.319-326 Reproduced with COPD.
Keywords: Pneumococcal disease, vaccination, pneumococcal poly-
permission from Blackwell Publishing
saccharide vaccine
Keywords: Typhoid fever, vaccination, Vi polysaccharide vaccine

36
L-21
PROBLEMS OF VACCINATION: EVOLUTION OF
PRINCIPLES, INDUSTRIAL TECHNOLOGIES AND
VACCINATION QUALITY
B.V.Karalnik
The scientific approaches to vaccination began from work-
ing out of live vaccines containing the less virulent natural
or specially attenuated pathogen strains. Then non-live vac-
cines were appeared, the principles of industrial technolo-
gies of which develop permanently. It is advisability to clas-
sify non-live vaccines taking in account the principles of
active substances production and applying auxiliary ingre-
dients to increase immunogenicity of the latter. At the
beginning all-cellular and all-virion killed vaccines, then –
lysate (containing the sum components of pathogen), later
– the protective antigens segregated from cells or viruses
(polysaccharides, proteins, in case of virus vaccines the
term “subunit” was adopted), recombinant (prepared by
genetic engineering methods), peptide (synthetic protective
peptides of pathogen). Development of principles and tech-
nologies is defined by two cardinal goals – guaranteeing
of specific immunogenicity and safety including manufac-
ture safety (personnel security, protection in extremal cases,
protection from bioterrorism), safety for vaccinated persons
and for population of corresponding species – man and
animals. Manufacture perfection also foresees guarantee of
rapid manufacturing of vaccines (for example – transfer-
ring manufacturing of influenza vaccines from virus cultiva-
tion on chicken embrions to cultivation on cell cultures in
bioreactors). Guaranty of necessary degree of immuno-
genicity is provided by application of active protective anti-
gens and by using different adjuvants, immunostimulators
too. Such auxiliary substances can be added to protective
antigen, serve to it as sorbent, be conjugated with it and
etc. In some cases immunogenicity of one specific antigen
can be increased by its combination (conjugation or sorp-
tion) with other specific antigen. The level of protection
from infections and vaccination safety depends also from
use of regulated schemes elaborated by account of ratio of
infection risk and the risk of non-forsseeing effects of vacci-
nation. Elaboration of principles of vaccine preparation
and manufacture technologies and schemes of vaccination
is going on permanently.
37
L-22
THE PROBLEMS IN CONTROLLING SEXUALLY
TRANSMITTED DISEASES IN DEVELOPING
COUNTRIES
Ismail Hakki BAHAR Izmir, Turkey
Sex is a normal and healthy part of our lives.
The primary role of the living creatures is to reproduce and
to maintain their generations. Even in animal kingdom this
sacred role has been very important and the conjunction of
the ovum and the sperm seen as a grace which turned all
this into a matter of pleasure and formed up the concept of
sexuality.
However, this issue of pleasure can turn human lives into a
hell. This usually happens when a disease passed from one
partner to another. Despite the developments in diagnostic
technologies and the improvements in medical industry
these diseases that are defined as Sexually Transmitted
Diseases (STDs) are turning to be a bigger and bigger
problem for humanity. Only in 1980’s the disease factors
that were followed in this group by CDC were 5 and yet
these factors are over 50 now-a-days.
These diseases are problematic even in developed coun-
tries but especially in underdeveloped and developing
countries the diseases are causing serious problems and
affecting that country’s socio-economical and cultural lives.
In this section the reasons why STDs are not being able to
prevent and some occasions that engender will be ana-
lyzed under the stated headlines:
• Socio-Economical-Cultural issue,
• The age of sexual maturation to be earlier than before,
•The changes in the understanding of sexual freedom,
•The changes in the understanding of morality,
•Media,
• The increase in the allowance of sexual chooses,
• Search for new pleasure- different pleasure applications,
• Internal or external wars,
• Economical distress,
• Emigrations,
• Prostitution,
• Tourism,
• The increase in transportation opportunities,
• Long distance transportation,
• The applications in health area,
• Defects in notices for the facts and defects in registration
• Lack of education in the community
• Family planning ( wrong decision, trust ),
 o Doctors that don’t see enough facts
o Exaggerated trust in the medicines and over
use of drugs
L-23
THE EPIDEMIOLOGY OF HIV/AIDS INFECTION
IN THE REPUBLIC OF KAZAKHSTAN
Saule T. Doskozhayeva Almaty-Kazakhstan
The level and structure of the HIV disease in the Republic
demonstrates that the epidemy has entered its concentrated
phase. By the end of 2006 the parameter of prevalence
amounted to 49,0 per 100 000 of population. The rate
sexual and intrahospital transmission in 2006 (19,5% and
4,2% accordingly) and new cases of HIV-infection among
young women (24,6%) has increased. Clinical displays of
HIV-infection in the concentrated stage of epidemic process
are characterized by the fact that majority of patients are
being revealed in the 1st clinical stage (53 %). The lower
percentage of revealing at II clinical stage (25 %) is main
tained with symptoms of superior respiratory diseases (75
%), mycotic lesions of skin and mucous layers (22-23 %)
and a combination of 2 and more secondary infections at
77 % of patients. Patients are being revealed at late stages
(22 %) symptoms of III clinical stage with symptoms of can-
did infections (71 %), losses of weight for more than 10 %
of body weight (29 %), tuberculosis (20 %); at the IV clini-
cal stage - tuberculosis (40 %), sarcoma Caposhy (40%),
candid infections (20 %), HIV-cachexia (10 %) and a com-
bination of 2-3 and more secondary infections. The condi-
tions in 80 % in III stage and in 86 % in IV stage has
increased.
To the HIV-infection patients to appoint AARVT in accor-
dance with «The report on providing help and treatment for
HIV-infection and AIDS». The combined (active) antiretro-
viral therapy of HIV patients is effective: the virological effi-
ciency amounts to 94 %, immunological - 81 % and clini-
cal - 95 % and should be introduced everywhere. At the
organization antiretroviral therapy of HIV/AIDS patients to
begin with interaction with the patient in order to develop
the adherence to treatment and to have a stable infrastruc-
ture of public health services, laboratory base, the medical
personnel, continuous deliveries of antiretroviral drugs. For
conducting the ÄÄRVT to apply the CDC Classification
(1993).
38
L-24
THE MICROFLORA OF UROGENITAL TRACT:
DISBACTERIOSISIS, INFECTIONS, TREATMENT
Ramazanova B.A., Urazbayeva D.Ch., Shalekenov B.U.
There is still vagueness about meaning of intestinal dysbac-
teriosisis in occurring of bacteriuria. The developing of
intestinal dysbacteriosis in infections of urethral tract is not
researched enough.
The bacteriological estimation of intestinal microflora was
done among 50 patients with acute and chronic
pyelonephritis.
Investigation of intestinal microflora showed that dysbioti-
cal breaches were revealed at all patients. The breach of
intestinal normocenosis was characterized by decreasing
Bifidobacterium and Lactobacillus spp, the presence of
atypical E.coli, Staphylococcus spp. The dysbiotical
breaches at chronic pyelonephritis were characterized by
annexation of Klebsiella, Candida.
L-25
BETA -LACTAMASES AND INFECTIONS
SUSTAINED BY GRAM-NEGAT‹VE BACER‹A
Gian Maria Rossolini
University of Siena Medical School & Siena University Hospital,
Siena, Italy
Beta-lactamase production is the most important mecha-
nism of acquired resistance to beta-lactam antibiotics
among major gram-negative pathogens, including mem-
bers of the family Enterobacteriaceae, Pseudomonas
aeruginosa, Acinetobacter baumannii and other Gram-
negative nonfementers (GNNFs). Currently, the beta-lacta-
mases of major clinical concern are the extended-spectrum
beta-lactamases (ESBLs) and the AmpC-type beta-lacta-
mases (CBLs) which can confer resistance to expanded-
spectrum cephalosporins, and the carbapenemases which
can confer resistance to carbapenems.
The ESBLs are now widespread in Enterobacteriaceae
worldwide (mostly in Klebsiella pneumoniae and
Escherichia coli, but also in Proteus mirabilis and other
enterics), while they remain overall less common in
GNNFs. The epidemiology of ESBLs has recently under-
gone important changes, with a massive spread of CTX-M-
type enzymes (that in some areas are now more prevalent
than the original TEM-type and SHV-type ESBLs) especially
in E. coli, and with a significant dissemination also outside
the hospital setting. The CBLs are emerging in
Enterobacteriaceae, although their prevalence remains
overall lower than that of ESBLs. The carbapenemases are
found both in GNNFs and in Enterobacteriaceae, and
include the metallo-beta-lactamases (MBLs) and the serine
carbapenemases of molecular classes A and D. The MBLs
are more common in GNNFs, while the class A and D ser-
ine carbapenemases are currently spreading in
Enterobacteriaceae or Acinetobacter, respectively.
The dissemination of these powerful beta-lactamases poses
a number of challenges for the Clinical Microbiology
Laboratory (in terms of detection and reporting issues) and
for the Infectious Diseases Clinician (in terms of treatment
and infection control practices). The scope of this presenta-
tion will be to highlight the current epidemiology of beta-
lactamase-mediated resistance in Gram-negative
pathogens, and to briefly discuss over the most relevant
diagnostic and clinical issues related to these resistance
determinants.
Keywords: Gram negative bacteria, beta-lactameses, AmpC, ESBL
L-26
THE IMPACT OF RESISTANCE ON THE
IMMUNOCOMPROMISED HOST
Murat Akova
Hacettepe University School of Medicine, Section of
Infectious Diseases, Ankara, Turkey
Several recent reports have indicated that not only a shift in
the etiology of infections and resistance patterns in patients
with cancer, but also important differences between
regions and countries. Viridans streptococcal bacteremias
are common among those patients being second only to the
coagulase-negative staphylococci. However, in certain cen-
tres in Europe Gram-negative bacilli have once again
become the predominant infecting pathogens. The prob-
lems associated with emerging resistance have been wide-
ly documented in the literature. In some institutions methi-
cillin-resistance among coagulase-negative staphylococci
has reached very high proportions, and in others the inci-
dence of extended-spectrum beta-lactamase producing
Gram-negative bacilli has risen markedly. These shifts in
antimicrobial susceptibility are important in guiding the
choice of agents for patients with severe immunosuppres-
sion and neutropenia. Antibiotic use and prophylaxis have
both been associated with changes in susceptibility, and
prescribing habits may influence emerging resistance. In
this context, the choice of empirical antibiotic therapy and
39
the use of prophylaxis should be driven by a sound under-
standing of local circumstances.
Initiating empirical broad-spectrum antibacterial therapy
has long been the standart practice for febrile neutropenic
cancer patients. However, during the last decade it has
become evident that patients with febrile neutropenia do
not constitute a homogenous group. The risk factors for
developing infection and other major complications vary
widely in different subsets of patients with cancer.
Therefore, a valuable risk assessment of every febrile neu-
tropenic patient is essential in order to define a tailored
therapeutic approach. Those patients with hematological
malignancies and severe and prolonged neutropenia will
fall into the cathegory of “high-risk”, while others who were
treated with less intensive chemotherapies and who were
expected to have a short duration (e.g. less than 7-10 days)
of neutropenia and fewer complications during the course
of neutropenia will be categorized in the ‘low-risk’ group.
Recently published “The Multinational Association for
Supportive Care in Cancer (MASCC)” risk index has been
shown to be a valuable tool for identifiying low-risk
patients among adult febrile neutropenic cancer patient
population. Patients with solid tumors who were treated
with conventional chemotherapy and with minimal or no
comorbidities (such as mucositis, cellulitis, anorectal infec-
tion, pneumonia) will usually be placed into the cathegory
of “low-risk”. On the other hand, more intensive
chemotherapies have been increasingly used in solid tumor
patients and some of them will also undergo an autologous
hematopoietic stem cell transplantation (AHSCT). This
approach will obviously increase the expected duration of
neutropenia, the incidence of other comorbidities (e.g.
mucositis), and may also affect the hemodynamic and clin-
ical stability of the patient.
Once the patient is stratified in one of the risk groups, there
are several options for empirical treatment. Nevertheless,
many other factors need to be considered regarding to spe-
cific antimicrobial regimen. Among these are local epi-
demiological pattern of the infecting microorganisms and
their antimicrobial resistance pattern. Recent published
data indicate that low-risk patients who are able to swal-
low can successfully be treated with oral antibiotics. The
most frequent used regimen for this indication is a combi-
nation of a quinolone derivative (e.g. ciprofloxacin) and
amoxicillin/clavulanate. Newer quinolones with enhanced
activity against gram-positive pathogens (e.g. moxi-
floxacin, gatifloxacin) have been currently under evalua-
tion for a monotherapy option. This type of therapy is
applicable for both inpatient and outpatient settings.
Stringent criteria need to be applied for selecting patients
who will be treated in an outpatient program which also
requires a strong committment from both patient and
healthcare team’s side. Another option is to admit the
patient to the hospital and treat with parenteral antibiotics
until defervescence, and then swich to oral therapy. This
provides a viable alternative for patients receiving more
intensive chemotherapies for treating cancer with or with-
out AHSCT. Upon switch to an oral regimen the patient
could be discharged if his/her clinical condition is permis-
sive.
For the initial parenteral therapy, monotherapy with vari-
ous beta-lactam antibiotics has been extensively studied
comparing with different beta-lactam plus aminoglycoside
combinations. The data indicate that monotherapy with a
broad-spectrum cephalosporin (e.g. ceftazidime, cefepime)
or beta-lactam/beta-lactamase inhibitor combination (e.g.
piperacillin/tazobactam) or a carbapanem (i.e. imipenem
or meropenem) is as effective as a beta-lactam plus amino-
glycoside combination for initial empirical regimen.
Specific concerns for ceftazidime use exist since this drug
has been held responsible for increased incidence of
extended-spectrum beta-lactamase producing klebsiella
infections in some institutions. Recently published meta-
analyses caused concern about cefepime which was found
to cause increased mortality in patients due to unexplained
reasons. Parenteral quinolones has been less studied for
this indication and the data are inconclusive. Therefore
quinolones can not be recommended as the initial par-
enteral agent.
Glycopeptides should not be incorporated into the initial
empirical regimen, until a documented gram-positive bac-
terial infection is observed. Recent data indicate that
empirical addition of these agents is also unnecessary in
those patients without defervescence after 60-72 hours of
empirical broad-spectrum antibacterial therapy. Actually,
glycopeptide use should strongly be discouraged unless the
patient has a documented gram-positive bacterial infection
or has strong predisposing factors to acquire such infec-
tions (e.g. clinically documented vascular catheter infection,
colonization with methicillin resistant staphylococci or peni-
cillin resistant pneumococci).
In summary, local resistance patterns of infecting
pathogens in immunosuppressed patients are of extreme
importance since this patient population usually requires to
be treated empirically. Therefore, a cost –effective
approach would a regimen that is tailored for local epi-
40
demiological factors.
Keywords: Immunocompromised, neutropenia, antibiotic, canser
patients, MASCC
References
1) Akova M. Emerging problem pathogens: A review of
resistance patterns over time.
Int J Infect Dis. 2006;10 Suppl 2:S3-8.
2) Cometta A, Kern WV, De Bock R, et al and International
Antimicrobial Therapy Group of the European
Organization for Research Treatment of Cancer.
Vancomycin versus placebo for treating persistent fever in
patients with neutropenic cancer receiving piperacillin-
tazobactam monotherapy. Clin Infect Dis. 2003;37:382-9.
3) Kern WV, Cometta A, De Bock R, et al. Oral versus
intravenous empirical antimicrobial therapy for fever in
patients with granulocytopenia who are receiving cancer
chemotherapy. International Antimicrobial Therapy
Cooperative Group of the European Organization for
Research and Treatment of Cancer. N Engl J Med.
1999;341:312-8.
4) Klastersky J, Paesmans M, Rubenstein EB, et al. The
Multinational Association for Supportive Care in Cancer
risk index: a multinational scoring system for identifying
low-risk febrile neutropenic patients. J Clin Oncol
2000;18:3038-51.
5) Viscoli C, Castagnola E. Treatment of febrile neutrope-
nia: what is new? Curr Opin Infect Dis. 2002;15:377-82.
6) Yahav D, Paul M, Fraser A, Sarid N, Leibovici L. Efficacy
and safety of cefepime: a systematic review and meta-
analysis. Lancet Infect Dis. 2007 May;7(5):338-48.
L-27
HOW TO PERFORM SURVEILLANCE OF
ANTIMICROBIAL RESISTANCE AND
ANTIBIOTIC CONCUMPTION IN DEVELOPING
COUNTRIES
Dr. Michael A. Borg
Chair: International Federation of Infection Control,
Director of Infection Control, Mater Dei Hospital, Malta
e-mail: michael.a.borg@theIFIC.org & www.theIFIC.org
Surveillance of both antimicrobial resistance and consump-
tion have been identified as an essential initiative in order
to achieve proper antibiotic stewardship and therefore
improve the use of antimicrobials, particularly in health
care settings, and minimize the pressure for the establish-
ment and dissemination of multiresistant organisms. This is
now supported by several studies. However most of this
research has been undertaken in developed countries.
Much less data has originated from countries with limited
resources. Nevertheless the data that is available suggests
that resistance in these regions of the world is as much, if
not more, relevant than in their higher resource counter-
parts. In addition the impact of resistance is often higher
particularly in developing countries where hospitals may
face problems with consistent availability of second and
third line antibiotics that are critical for the treatment of
serious infections cause by multiresistant organisms.
Effective surveillance initiatives are, as result, critical in
developing countries in order to address these concerns.
There are numerous guideline publications and protocols to
follow in order to perform antimicrobial resistance and
consumption surveillance and, in most instances, these
methods are usually well applicable even to a low resource
environment. It is however important to factor in possible
challenges and obstacles that tend to be present more fre-
quently in lower resource countries. These include inade-
quate resources of trained personnel and information tech-
nology systems, as well as difficulty in identification and
utilisation of sources of data. In addition any surveillance
initiative would be not worthwhile undertaking unless the
information gathered is fed back to the users to serve as a
tool for practice improvement. Developing countries offer
additional social and cultural and social that frequently
impact on the potential for change that this feedback can
provide.
The presentation will delineated these particular chal-
lenges, as they predominate and impact in situations of lim-
ited resources and discuss potential methods of adapting
established systems already tested successfully for the sur-
veillance of antibiotic resistance and consumption in order
to achieve the desired end result.
L-28
THE PREVENTIVE POLICIES FOR ANTIBACTERI-
AL RESISTANCE IN DEVELOPING COUNTRIES
Inge C. Gyssens MD PhD
Department of Internal Medicine, Nijmegen University Centre for
Infectious Diseases (NUCI), Radboud University Medical Centre, Geert
Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands
Antimicrobial resistance is a worldwide threat for high -
income and developing countries alike. Individual patients
acquire infections by micro-organisms against which no
41
effective antibiotic is available. Antimicrobial use, both in
humans and in the veterinary sector, is the major factor
driving resistance. Poor hygienic practices increase the
spread of resistant micro-organisms in hospitals. A multi-
disciplinary approach is needed to curb increasing antimi-
crobial resistance. To develop and sustain preventive poli-
cies, close collaboration between the relevant professional
groups is needed. Relevant professionals are clinicians and
microbiologists, pharmacists/ pharmacologists, infectious
diseases physicians, but also epidemiologists, infection
control - and veterinary specialists.
Governments should prioritize this major issue.
The WHO and EU recommendations on Antimicrobial
resistance control can be used as a starting point. Basic
requirements for preventive policies are a health insurance
system adapted to the economic situation of the country, a
well functioning national regulatory agency for evaluation
and registration of (antimicrobial) drugs and a reliable
distribution system of (antimicrobial) drugs from the WHO
essential drug list to the community. An Intersectoral Co-
ordination mechanism (ICM) in the field of antimicrobial
resistance is essential for structure and authority. The
Ministry of Health should appoint the members of the ICM
proposed by the relevant professional groups and give
them a mandate.
One of the first tasks of the ICM is the setup/coordination
of a national surveillance system for microbial resistance
and antimicrobial drugs. Linking resistance to use should
identify targets for action. Quality-of-use audits, preferably
in a research setting, both in hospitals and in the commu-
nity, expose the problems. Methodological tools that were
developed for Western hospitals can be adapted to low
resources settings. Tailored intervention strategies should
then be developed. Successful intervention strategies are
recently reviewed by a Cochrane group.
A second step is the development of an evidence based
guideline program on diagnosis and therapy of Infectious
Diseases. Last but not least, training programs for good
Antibiotic stewardship should be established. Academy
should make their scientists available for research in this
topic and for education.
Examples of national initiatives on preventive policies for
antimicrobial resistance are the government-funded Dutch
national Working Party on Antibiotic Policy (SWAB) and
on Infection Prevention (WIP). They develop national guide-
line programmes on antimicrobial treatment and hospital
hygiene, respectively. Examples of national surveillance
reports are DANMAP (DK) and NethMap (NL). The
ESCMID Study Group for Antibiotic Policies (ESGAP) is an
example of a European Scientific study group that, support-
ed by their professional Society, invests in postgraduate
educational activities. An example of collaboration
between developing and developed countries is the
Antimicrobial resistance in Indonesia: prevalence and
prevention (AMRIN) study, that has been conducted
between 2000 and 2004 within a Scientific co-operation
Netherlands – Indonesia (SPIN) program, funded by the
Royal Netherlands Academy for Arts and Sciences. AMRIN
identified major issues in hospital management of infec-
tious diseases and infection control and studied the out-
come of interventions in the setting of this rapidly develop-
ing country. More recently, SWAB has provided expertise
for a project in Eastern Europe that is financed by the
Netherlands Ministry of Foreign affairs through the EVD
agency MPAP programme. Experts assist the Croatian
Ministry of Health in initiating an Intersectoral Coordination
Mechanism (ICM), ISKRA, for control of antimicrobial
resistance. Major activities are the set up of an automated
laboratory surveillance network and a programme of evi-
dence based guidelines on infectious diseases.
Worldwide, new antimicrobial drugs are developed by the
pharmaceutical industry. The need for financial returns for
their effort is driving markets, which leads to overuse if
commercial pressure is not counterbalanced by a strong
scientific and professional community, supported by
national policy makers. Therefore, worldwide, efforts
should be made to reconcile interests of the producers and
policy makers, the public and the medical community, to
maximally conserve the potential of the available and
affordable antimicrobial drugs and stimulate the research
on new antimicrobial drugs.
References
1. Dutch Working Party on Antibiotic Policies,
www.swab.nl tab: are you a foreign visitor?
2. Dutch Working Party on Infection Prevention,
www.wip.nl
3. ESCMID study group on Antibiotic Policies (ESGAP),
www.escmid.org/sites/index_f.aspx?par=2.5
4. I.C. Gyssens. International guidelines for Infectious
Diseases: a practical guide.
Neth J Med 2005;63:291-299 (free access to full text)
5. J.M. Prins, B.J. Kullberg, I.C. Gyssens. The SWAB
42
guidelines revisited. Neth J Med 2005;63:288-290 (free
access to full text)
6. Davey P, Brown E, Hartman G, Ramsay C, Wiffen P,
Fenelon L et al. Interventions to improve antibiotic pre-
scribing practices for hospital inpatients. The Cochrane
Database of Systematic Reviews (Issue 4):1-92, 2005
7. Antimicrobial Resistance Surveillance in Human Health
- MATRA project Croatia: the ISKRA Website
http://iskra.bfm.hr/
L-29
EFFECT OF GOVERNMENTAL POLICIES ON
ANTIMICROBIAL USE: EXAMPLES OF
DIFFERENT POLICIES
Gulay Sain Guven,
Hacettepe University Hospital, Ankara, Turkey
Increasing antibiotic resistance has become a major con-
cern throughout the world. As few, and in certain cases no
antibiotics are available to deal with some critical infec-
tions, the World Health Organization has been regarding
antibiotic resistance as a major threat to global public
health (1). Consequently, strategies to improve antibiotic
use have gained greater attention in recent years.
Certain antibiotic guidelines have been developed and
there are a number of associated interventions which have
been shown to be effective in ensuring better antibiotic use.
Australia, for example, has formed a national drug policy
by employing those guidelines. Moreover, certain activities
to improve rational drug use have been supported by allo-
cating government funding (2). A crucial objective of
Australia’s National Medicines Policy is Quality Use of
Medicines (QUM) which defines the required approach
and principles in order to ensure QUM in Australia.
Developing and implementing the National Strategy for
QUM, is under the responsibility of the government, the rel-
evant agencies and committees. Similarly, they coordinate
relevant government programs, and are in charge of inves-
tigating and developing suitable structures, funding mech-
anisms, legislation and environments that support QUM.
Significant rate of success has been achieved in initiatives
promoting QUM, supported by other initiatives carried out
as a part of the National Medicines Policy. Consequently,
better use of antibiotics has been observed. A significant
outcome of this has been improved health outcomes, with
declines in hospitalisations as well as in deaths associated
with the adverse effects of these medicines.
Another example is China. The Chinese Ministry of Health
issued "Principles of Clinical Antimicrobial Use Guidelines"
in 2004. The manual was designed to standardize physi-
cians' use of antibiotics and as a result, provide better
treatment of bacterial infections in Chinese hospitals.
Likewise, a new Korean government policy announced in
July 2000 prohibited doctors from dispensing and pharma-
cists from prescribing drugs by law. Before the above men-
tioned policy came into effect, all doctors based in offices
could dispense drugs, which were then reimbursed by the
national health insurance system at pre-established prices
for each particular drug. This system made it possible for
physicians to profit on mark-up over drug purchase costs.
Implementation of the policy removed the physicians’ prof-
it incentives as they could not dispense drugs any more. The
policy was expected to change prescribing patterns of doc-
tors. It was also regarded as an experiment to evaluate the
effects of a policy prohibiting medication dispensing by
physicians in the same population. Antibiotics were used at
a rate of 33.2 defined daily doses (DDD)/1000 inhabi-
tants/day in 1997 in Korea, which was significantly high-
er than the average observed in OECD countries of 21.3
DDD/1000 inhabitants/day (3). Moreover, a substantial
proportion of antibiotic use in Korea has been reported to
be inappropriate or unnecessary (4). Excessive use of
antibiotics is widely regarded to be a major contributor to
ever-increasing antibiotic resistance worldwide.
Significantly higher resistance rates can be observed in
Korea, with 86% of Streptococcus pneumoniae isolates
resistant to penicillin, compared with rates of 46% and 34%
in Singapore and the US, respectively (5). Park S et al. ana-
lyzed the incidence of episodes which were prescribed an
antibiotic as well as the number of different antibiotics pre-
scribed for patients who were diagnosed with viral and
bacterial illness episodes, both before and after the policy
(5). The nationally representative sample had a total of
50,999 episodes (18,656 viral and 7,758 bacterial pre-
policy, 16,736 viral and 7,849 bacterial post-policy) from
a total of 1,372 primary care clinics. Generalized estimat-
ing equations were employed to investigate alterations in
antibiotic prescribing patterns after the policy came into
effect; and multiple linear regression was used to establish
provider factors associated with reductions in inappropri-
ate antibiotic prescribing for viral illness. After the dispens-
ing restriction policy started to be implemented, a signifi-
cant drop was observed in the number of patients with viral
illness who were prescribed antibiotics (from 80.8 to
72.8%, relative risk (RR) = 0.89, [95% confidence interval:
0.86, 0.91], p< 0.001). However, the decline for patients
43
with bacterial illness was not as significant (from 91.6 to
89.7%, RR=0.98, [0.97, 0.99], p= 0.017). On the other
hand, reductions established in antibiotic prescribing were
significantly larger (RR= 0.90, [0.87, 0.93], p<0.001) for
patients diagnosed with viral illness (5). Similarly, the num-
ber of different antibiotics prescribed per episode was also
observed to have decreased significantly after the policy.
The dispensing restriction had a reducing impact on pre-
scription of non-antibiotic drugs as well, with no difference
by diagnosis. Younger age and practice location in an
urban area were established to be the provider factors
associated with the decline in inappropriate antibiotic pre-
scribing. As a result of the policy which prohibited physi-
cians from dispensing drugs generally reduced prescribing,
both of antibiotics and other drugs. Furthermore, it selec-
tively decreased inappropriate antibiotic prescribing for
viral cases.
Antimicrobials have a total share of 24% of all drug expen-
diture in Turkey according to the figures in 2002. A new
policy to limit antimicrobial prescription was put into effect
by the Turkish government in 2003 with the aim of decreas-
ing the cost. As stated in the new policy, the primary
responsibility for antimicrobials prescription lies with infec-
tious diseases specialists. In a study carried out by Hosoglu
S et al., antimicrobial usage at hospitals before and after
the implementation of the new restriction policy was inves-
tigated comparatively (6). The data for two separate peri-
ods in 2003 were collected from pre-established depart-
ments at 15 hospitals throughout Turkey. The first set of
data was collected a few days prior to the new policy in
May 2003, while the second set of data came from the
period 6 months after that. Antimicrobial usage was calcu-
lated as DDDs per 100 patient days consistent with
ATC–DDD index. The alteration in antimicrobial consump-
tion was established by comparing mean DDD values
before and after the implementation of the new policy.
Before the policy came into effect, the mean antimicrobial
use density was 71.56 DDD/100 patients-day at the hos-
pitals taking part in the study. Six months following the
implementation, the mean antimicrobial use density
dropped to 52.64 DDD/100 patients-day. A 26.4%
decrease was observed in antimicrobial usage between the
two periods (P<0.025). The study revealed that the imple-
mentation of the restriction policy led to a significant
decline in antimicrobial prescription.
Are The Policies Enough?
• Despite ongoing improvements, problems with medica-
tion use remain significant in Australia, as estimates sug-
gest 80,000 hospital admissions annually are associated
with medication-related problems. Moreover, many senior L-30
citizens are still at significant risk of medication misadven-
SALMONELLA TYPHI: A NEW SUPERBUG
ture, as well as of emerging and increasing antibiotic resist-
John Wain
ance. Therefore, it would be safe to assume that we still
Welcome Trust Sanger Institute
have a considerable amount of ground to cover.
• Although there was a sharp drop in the number of
Antibiotic resistance in Salmonella Typhi and Paratyphi A
different antibiotics prescribed per episode after the policy
to; chloramphenicol, co-trimoxazole, ampicillin (MDR) and
in Korea, no significant differences were noted in these
recently fluoroquinolones, threatens effective management
reductions between viral and bacterial illness. Furthermore,
of individual patients. Resistance is now at a level in the
despite significant improvements, prescription of inappro-
bacterial population to render these first choice drugs inef-
priate antibiotics and other drugs were established to be
fective for blind therapy of enteric fever in many regions of
high even after the policy came into effect. Prohibiting doc-
the world.
tors from dispensing medicines does remove a potential
Plasmid borne MDR has spread via IncH plasmids which
financial incentive but providing a restriction policy is not
appear to have evolved to a stable partnership with S.
enough in itself to alter prescribing patterns which may
Typhi and have recently also spread to S. Paratyphi A.
have been calcified over time due to various factors.
Even when the treatment of typhoid fever switched to the
Research has revealed that approximately 50% of all pri-
fluoroquinolones, which is not encoded on IncH plasmids,
mary physicians in Korea are of the opinion that antibiotics
these plasmids remained in the bacterial population. This
are beneficial in management of common cold in children
may be because these plasmids confer on Salmonella, as
(5).
well as resistance, an enhanced survival ability inside
Keywords: Antimicrobial use, policy, intervention, goventmental
macrophages and that an H-NS-like protein is responsible
policy
for reducing the disturbance of bacterial global regulatory
References
networks after plasmid acquisition. Using sequencing of
1. World Health Organisation: Antimicrobial resistance:
core genes, to detect genetic drift, and long range PCR, to
the facts. In WHO: Essential Drugs Monitor No. 28&29
detect genetic rearrangements we have analysed plasmids
edition. Geneava ;2000, p:8-9.
from a global collection of S. Typhi. One IncH plasmid type
2. Commonwealth of Australia: The National Strategy for
has spread globally and replaced previous, less fit, versions
Quality Use of Medicines. Edited by: Australia C.
of this widespread IncH plasmid. Competition between
Canberra, the Department of Communications, Information
plasmids could be driving the host S. typhi to increased lev-
Technology and the Arts; 2002.
els of virulence.
3. Lee EK, Bae JM, Park KH et al. Drug Use Evaluation.
The emergence of fluoroquinolone resistance in S. Typhi
Seoul,Korea: Korea Institute for Health and Social Affairs.
was first described in the early 1990’s with the realisation
2000.
that single amino acid changes in DNA gyrase led to resist-
4. Park S, Moon OR. Patterns of antibiotics utilization in
ance to the quinolone; nalidixic acid, and that this was
some respiratory diseases in clinics. Journal of Korean
associated with reduced susceptibility, and poor clinical
Society of Quality Assurance in Health Care 1998.5:
response, to the fluoroquinolones. Reduced susceptibility to
58–75.
fluoroquinolones is now well established in S. Typhi popu-
5. Park S, et al. Health Policy Plan 2005 Sep;20(5):302-9.
lations and has recently become epidemic in S. Paratyphi
Epub 2005 Jul 6.
A from China and India. In Pondicherry, India the first
6. Hosoglu S, Esen S, Ozturk R, Altindis M, Ertek M,
known isolate of fluoroquinolone resistant S. Paratyphi A
Kaygusuz S, et al. Eur J Clin Pharmacol 2005 61:
was shown to harbour three mutations in the topoiso-
727–731.
merase genes and by engineering these mutations into a
susceptible S. Typhi we have shown that these mutations
alone can encode full fluoroquinolone resistance. We
believe however that the accumulation of three mutations is
a rare genetic event because of a lack of selection after the
second mutation. Fully fluoroquinolone resistant S. Typhi,

44
associated with a 50Kb IncN, plasmid however have
emerged and spread in India and so the fitness cost has
been ameliorated. We are investigating the impact of the
IncN plasmid on the bacterial host fitness. Partially resistant
S. Paratyphi A are also spreading in New Delhi and is
caused by a combination of target site mutation and
enhanced efflux. This is of particular concern as enhanced
efflux in the Salmonella has been associated an increased
ability to colonise the gut in animal models.
Therefore it seems that antibiotic resistant enteric fever
Salmonella ; S. Typhi and S. Paratyphi A, are evolving
under the elective pressure of chemotherapy to become
more pathogenic for humans.
L-31
SALMONELLA:
DRUG RESISTANCE –A RECURRENT PROBLEM
1 1 1
Salvatore Rubino , Bianca Paglietti , Manuela Murgia ,
2 2 3
Amber Farooqui , Shahana Urooj Kazmi , Rajni Gaind
1
Department of Biomedical Sciences, University of Sassari,
Sassari, Italy
2
Immunology and Infectious Disease Research Laboratory,
Department of Microbiology, University of Karachi,
Pakistan
3
VMMC and Associated Safdarjung Hospital, New
Delhi,India
Salmonella are among the most common bacterial food
borne pathogens worldwide. According to the World
Health Organization (WHO) Global Salm- Surv, S. enteri-
tidis, S.Typhimurium and S.Typhi were ranked among the
15 most common human serotypes in all the six regions of
the world for the period 2000-2002. The highly adapted S.
enterica Typhi causes typhoid fever only in humans, where-
as other serotypes, namely Nontyphoid Salmonella
serotypes (NTS) can cause a wide spectrum of diseases in
humans and animals. Last 2 decades has seen expanding
antibiotic resistance in both typhoidal and NTS.
One of the most significant trends in NTS resistance is the
increasing resistance to multiple antibiotics. The resistance
rates vary with different serotypes and antibiotics. S.enter-
ica serotype Enteritidis, one of the most prevalent serotypes
is relatively more susceptible than S.Typhimurium.
Surveillance data demonstrate an obvious increase in over-
all antimicrobial resistance amongst NTS from 20%–30% in
45
the early 1990s to as high as 70% in 2000. Similarly with
emergence of MDR in typhoidal Salmonellae, extended
spectrum cephalosporins and fluoroquinolone has been the
drug of choice for management of MDR salmonella
serotypes.
The current concerns are reports of emerging resistance to
both cephalosporin’s and fluoroquinolones. Resistance to
former is mainly due to production of extended spectrum ‚
lactamases (ESBL) and is mediated through plasmids. In
contrast fluoroquinolone resistance is due to chromosomal
mutations in topoisomerase genes. A single mutation in
gyrA confers resistance to nalidixic acid –the prototypic
quinolone and only low level resistance to fluoroquinolone
and is associated with clinical failure. High level fluoro-
quinolone resistance results from two or more mutations in
gyrA and parC.
Transferable resistance due to qnr plasmid also confers low
level fluoroquinolone resistance and has been reported in
NTS but not in S.Typhi or Paratyphi A. Another mechanism
of fluoroquinolone resistance in Salmonella is the recent-
ly reported AcrAB-TolC efflux system and its regulatory
genes marRAB and sox RS Both target gene mutation and
efflux pumping are important mechanism in triggering high
level fluoroquinolone resistance and confer resistance to
multiple antibiotics and bile leading to increased patho-
genicity .
Amongst the typhoidal Salmonella though there have been
decrease in plasmid mediated MDR from 80-15% in the
last decade, however the current resistance rates are still
high for use of primary drugs for management. Situation is
further complicated by high rates of low level fluoro-
quinolone resistance in endemic areas. Further in New
Delhi 12% of the S.Typhi have high level fluoroquinolone
resistance, resulting from mutation in target genes. In con-
trast S. Partyphi A resistance to fluoroquinoloes is a combi-
nation of target genes and efflux pumps. Recent report of
resistance to 3rd generation cephalosporin from Nepal due
to ESBL producing S. Paratyphoid A has further limited
treatment options for salmonella causing enteric fever.
Low level resistance Fluoroquinolone resistance is also
emerging in NTS with a 5 fold increase in US and UK from
1999, but high level resistance is uncommon. However the
emergence of MDR and high level resistance in S. cholera-
suis is worrisome in Taiwan. Resistance to 3rd generation
cephalosporin has emerged in NTS with rates of 0.4%,
1.5% and 16% in Europe Taiwan and South Africa respec-
tively. In a recent study from India, S.Typhimurium isolates
producing ESBL, management was further complicated by
associated MDR and low level fluoroquinolone resistance
due to qnr plasmid resulting in use of reserve and expen-
sive antibiotics like carbepenems for management for com-
munity acquired infections.
Recent studies have also revealed that some virulence plas-
mids after combination with resistance plasmid form hybrid
plasmid which confers advantage to virulent strain the
advantage of survival in n unfavorable drug environment.
Expanding antibiotic resistance to fluoroquinolones and
cephalosporins has lead to a situation of therapeutic dilem-
ma. This calls for more deliberate use of antibiotics in
humans and animals. Continued surveillance of antibiotic
resistance and appropriate screening tests for ESBL and
low level fluoroquinolone resistance are essential prevent
treatment failures.
Increasing rate of antibiotic resistance among Salmonella
leaves the disease untreated and urges development of new
antimicrobial agents and/or their combinations.
An alternative or complement antibiotic could be searched
in natural products. The potential effect of plant extract (i.e.
green tea) against S.Typhi MDR strains we will describe.
Keywords: Salmonella, antibiotic resistance, S. typhi, Nontyphoid
Salmonella serotypes (NTS)
L-32
CLINICAL AND EPIDEMIOLOGICAL
MANIFESTATIONS OF TYPHOID FEVER IN
KAZAKHSTAN
Dmitrovsky Andrey Mikhaylovich, Rayushkin Boris
Vasilyevich, Uteulin Marat Nurumbayevich
Kazak National Medical University
Typhoid fever morbidity decreasing braked in Kazakhstan.
There is sporadic incidence, where it’s impossible detect
source of infection. Investigation goal was describe spo-
radic (STF) and epidemic (ETF) Typhoid fever morbidity epi-
demiological and clinical manifestations. Typhoid fever
morbidity 10 years analysis in Southern Kazakhstan show
following data.
Infant (including 15 years) where ill with ETF (31,7%) more
often, than STF (13,3%; P<0,05), including 17 years, –
accordingly 53,7 N 20,0% (P<0,05); as well as infant
younger 7 years, – accordingly 9,7% N 0 (P<0,05).
The unemployed where ill with ETF and STF more often
(accordingly – 41,0 N 30,0%), but really they where
engaged in commerce in markets and streets. So they are
the main Typhoid fever «reservoir». Second risk group is all
46
ages pupils (accordingly – 39,0 N 20,0%, with the teachers
– 42,7 N 26,7%; N<0,05).
7,1% patients with TTF where catering workers (they didn’t
ill with STF). It is an important part in epidemiologic
process.
Peoples, which had contact with patients (medicals) or their
materials (laundry workers or disinfectors) where ill with
STF more often (10,0%; they didn’t ill with ETF); pensioners
where ill with STF more often, too (accordingly – 13,1 N
1,2%; N<0,05).
Patients with ETF were more typical clinically: characteristic
tongue (89%), intestine symptoms (wind – 78%, Padalka
symptom – 68%, constipation – 51%), and more intensive
bacteremia (splenomegaly – 23%).
STF was atypical –gastroenteritis-like acute begining, –nau-
sea, vomiting (66%), abdominal pain (61%), diarrhea
(40%), hyperhidrosis (68%), chills (62%), tachycardia
(33%).
Keywords: Typhoid fever, incidence, epidemiology, clinical mani-
festations
L-33
EPIDEMIOLOGY OF CHOLERA IN THE 21ST
CENTURY
Piero Cappuccinelli
Department of Biomedical Sciences, Division of Clinical and Experimental
Microbiology, University of Sassari, Sardinia, Italy
Cholera is still a diffuse disease with million of cases per
year, although its real burden is difficult to estimate, and
still retain an extraordinary impact on human psychology
and behaviour. Cholera Vibrio has established endemic
spots and natural reservoirs in different areas of the globe
from which outbreaks erupt and diffuse. During the last
decades new opportunity were added to the more tradi-
tional ways of diffusion, due to the globalization of goods
exchange and the explosion of travelling, thus giving raise
to a new dimension of the epidemiology of the disease. In
addition, recent advances in molecular techniques and the
availability of genome sequencing has brought new impact
on the knowledge of Vibrio cholerae biology and its inter-
actions with the environment and human host, that are rel-
evant for deeper knowledge of its epidemiology.
This overview will take into consideration up to date
advances in the field particularly significant for the under-
standing of Vibrio cholerae behaviour and cholera epi-
demiology.
Keywords: Cholera, Epidemiology, Vibrio cholerae
 by popularity of anthrax. The highest level of the anthrax is
L-34 Rebublic Tajikistan, where the level of this illness is 5-5,5.
In Kirgiztan 0,5-1,8, in Kazakhstan – 0,1-0,4 among
ANTHRAX IN 21ST CENTURY
1000 of population. The lowest level of morbiting is in
M. Doganay
Uzbekiston.
Department of Infectious Diseases, Erciyes University, Kayseri, Turkey
Today in Kazakhstan are regisrated 1770 stationarily-
unfortunane of anthrax settlements and epidemic centers.
Currently, human anthrax is seen most commonly in agri-
Considerable quantity of these centers are in East-
cultural regions of the world where anthrax in animals is
Kazakhstan -668, South- Kazakhstan -556 (32,8%) from
prevalent, in which countries of Middle East, in Africa,
all stationaraly unfortunate of anthrax centers in
Central Asia, South America and Haiti. Human cases may
Kazakhstan as a whole, Kostanai region – 356. The lowest
occur in an agricultural or an industrial environment. The
concentration are in Atyrau and Mangistau regions -7. 34
infection is an occupational hazard of workers who process
morbid events were registrated in 2002 in Kazakhstan
hides, hair, bone and bone products, and wool and of vet-
region – 33 of which were is South- Kazakhstan. It com-
erinarians and agricultural workers who handle infected
posed 99% from all morbidity in South- Kazakhstan.
animals. The main route of transmission is contact with or
Anthrax was found in whole Kazakhstan in 2001 – 17
inhalation of Bacillus anthracis spores. Today anthrax has
patients, in 2002 – 2, in 2006 – 9.
a great importance in the world after the “anthrax letter”
The farming animals such as cattle 32-37% small animals
events in 2001. The idea of using B.anthracis as a bioter-
(45-55%), horses – 5%, pigs – 4%, camels – 1% and other
rorism agent or biological weapon has been realized.
animals – 6% are the sourses of anthrax for people in KR.
Research programs are conducted for both offensive and
The main transfer ways of this disease are cutting, the con-
defensive purposes in many nations.
tact with meat, cooking, contact with soil.
The Ministry of Health recorded 6430 human anthrax
cases between 1990 and 2005 in Turkey. Thirty-four
The first form is skin form, which is characterized by pain-
reports were appeared in international journals from
less anthrax, flat with a thick black crust. The second is sep-
Turkey between 1990-2007 on human anthrax, included
tic form, whick has been developed in – 3,6% of patients,
totally 926 cases but 426 cases could be reviewed. Of
other 6% of patients were operated. Since 1948-2006,
these, 96.9 % were cutaneous anthrax, 1.9 % gastrointesti-
among 465 sick people 5 patients diet – 1%: 2 with intes-
nal anthrax and 1.2 % anthrax meningitis. Ninety five per-
tine form, 3 – with second-septic form. The letal results were
cent of cases had a history of contact with contaminated
in Otyrar – 3, Ordabasy – 1 and Shymkent – 1.
materials. All human origin isolates were sensitive to peni-
cillin and not produce beta-lactamase. Majority of patients
The epidemiological inspedtorate problems are in the
(88.7 %) had received penicillin G. Total mortality was 2.8
absence of using the standard transactions in determina-
%.
tion of cases, predominances of the epidemiological survel-
A good veterinary service in endemic and hyperendemic
lance for the the treatnsent and nursing, the absence of
areas may control infection in agricultural areas.
Keywords: Anthrax, Bacillus anthracis, bioterrorism, epidemiology, algoritm introduction in the lab.diagnosis.
clinical form, treatment
The problem of diagnosis is in the laboratory decryption
L-35 (37,3% Since 1996) and the absence of the application
contemporary methods of the diagnosis (IEA – immune –
ANTHRAX IN KAZAKHSTAN
enzyme analysis, PCR – polymerase – chain reaction).
G.A.Utepbergenova
Chair of Infections diseases South-Kazakhstan State Medical Academy,
The problem of treatment concludes that, present Pec.SES
Shymkent, Republic Kazakhstan
of KR anthrax strains high sensative to doxycicline, chlo-
ramphenole, cyclophloraxicine, cetriaxone – 100%, 50%
One of the most dangerous infections among zoonoses of
strains sensible to pencillin and streptomycin, 25% strains
bacterial environment is anthrax. Patogen is Bac.anthracis,
low sensitive to take into account while treting the patients.
wich can be reserved in the from of spore in soil about 100
45,6% heavy form of anthrax demands prescription of
years. Central Asiatic region belongs to the endemic zone

47
specifical immunetherapy, 1/3 patients of antrax turns for
medical aids to sorcerer on to devote attention to selftreat-
ment, using red-hot iron, ware, baked onion, cigarets
urinethevapy. 6% patients conducted surgical intevference.
L-36
THE CLINIC AND EPIDEMIOLOGY OF
BRUCELLOSIS IN ENDEMIC REGION
A. Duisenova
Kazakh National Medical University, Almaty, Kazakstan
The modern clinic and epidemiology of brucellosis was
investigated. Hyper epizootic on brucellosis with progress-
ing development of morbility among the people, including
children, makes Kazakhstan as hyperendemic region of
this zoonosis and determines the presense and repeated
microinfection, superinfection because of direct contacts
with source of infections.
Number of acute brusellosis is growing each single year.
According to the City’s Clinical Infectious Hospital in
Almaty in 2001-2005 y there were 759 patients with
brusellosis and 259 of them had acute form which is 34.1
%. The correlation acute form to chronic is 1:3, but last
years it was 1:11-1:19 (Kurmanova K.B., 1990). We can
see growing frequency of acute form. In comparison with
the clinic of brucellosis in 70-80 y. now increase the fre-
quency of acute brucellosis with heavy current (from 20.4%
to 32.1%) with metastatic and infectio-allergic nidi (from
26% to 48%) leads to increasing of the share of secondary-
chronic brucellosis (67.7%) in decompensative form
(78.8%). There are increasing the frequency of pathology
of central nervous system (meningitis, meningoencephalitis,
myelitis, and neuritis), cardiovascular system (myocarditis,
endocarditis, myocardiodystrophia), urogenital system
(orchitis), locomotor system (polyarthritis, sacroileits,
spondylitis, periostitis) and so on.
Last years it is observed the increasing of frequency of the
alimentary way of infection (52%), when traditional contact
way of infection was only 48%. The alimentary way of
infection is realised in 85% cases by using dairy produce
and in 15% cases meat products. This fact depends on
migration of Brucella melitensis to large horned cattle.
City people are infected by alimentary way beside contact
way (79.1±4.3% against 48.2±5.5%), rural populations
vice versa by contact way (51.8±5.5% against
20.9±4.3%). Thus among patients with acute brusellosis
city population is between 48.1% and 79.1%, that tell us
changing episodic seat from village to city with expansion
48
of contacts with source of infection.
The oppression of immune response was established in
patients with acute brucellosis which described by decrease
of CD3+ and CD4+ lymphocytes, low specific antybody
biosynthesis with the increase of specific sensibilization (by
results of LMIR and skin allergic test). The decrease of CD3+
and CD4+ lymphocytes in chronic brucellosis was more
expressed than in acute; the CD16+ cells contents changes
were different in chronic brucellosis: lower or same to con-
trol group in one way; increased in another way. The
expressed decreasing of T-lymphocytes, T-helpers and T-
cytotoxic cell’s counts was estimated in group with lowering
CD16+ cells contents.
In common the features of immune reactivity suppression
during immune response to brucellosis infectious process
was more expressed at patients infected by alimentary way
in comparison with patients infected by contact way, espe-
cially at subacute brucellosis. There was estimated that at
acute period of brucellosis the clinical features depends on
the path of infection: at alimentary way of infection there
was more expressed fever and polyarthroneuromialagia,
leukopenia; arthritis, lymphocytosis and acceleration of
ESR meet than at a contact way of infection less often.
The character of changes at lymphocytes’ population struc-
ture and functional condition of neutrophile phagocytes at
brucellosis depends on ways of infection - alimentary or
contact.
At the patients with acute brucellosis at alimentary way of
infection the contents of T-killers and the parameters of
induced by brucellosis antigen NBT test has appeared
below, than at contact way of infection.
L-37
EPIDEMIOLOGY OF DRUG-RESISTANCE IN
HAEMOPHILUS INFLUENZAE AND NEISSERIA
MENINGITIDIS
Bülent Bozdogan
Adnan Menderes Universitesi, Aydin, Turkey
bbozdogan@adu.edu.tr
Haemophilus influenzae, and Neisseria meningitidis are
the most common bacterial pathogens causing community-
acquired meningitis, the third most important pathogen
being Streptococcus pneumoniae. Vaccination against type
b H. influenzae diminished the rates of meningitis due to H.
influenzae in developed countries however in developing
countries H. influenzae is still one of the most important
agent. Other than meningitis H. influenzae is the important
causative agent of otitis media, sinusitis, and respiratory vey programs are necessary to obtain data to know the
tract infections. state of resistance and to guide the appropriate treatment.
Antimicrobial resistance is increasing among invasive H.
influenzae strains. Beta laktam resistance is usually due to L-38
presence of beta lactamases encoded by blaTEM and less-
EPIDEMIOLOGY AND CLINICAL
er degree blaROB genes. Even though a decrease is
MANIFESTATION OF BACTERIAL MENINGITIS
observed in the rates of beta lactamase positive ampicillin
resistant strains recently in the USA and France, beta lacta- IN ALMATY.
mase negative ampicillin resistant H. influenzae rates are
increasing in certain regions of the world. Resistance in Lidiya Vladimirovna Deryabina
City infectious diseases hospital
these strains is due to changes in penicillin binding protein
Almaty Institute of Advance Medical Education
3 (PBP3) as a result of mutation in ftsI gene. BLNAR strains
are also decreased susceptibility to amoxicillin-clavulanic
Purpose of research: To study epidemiology and clinical
acid and certain cephalosporins. This mechanism is the
manifestation of bacterial meningitis.
most common beta lactam resistance mechanism in Japan.
Although rare strains that have combination of both mech-
Methods and materials: Case histories of 50 patients hos-
anisms PBP3 mutation and presence of beta lactamase are
pitalized to the city infections diseases hospital in Almaty.
emerging. Macrolides are considered to be active against
H. influenzae strains although an active efflux mechanism
Results: Incidence of bacterial meningitis has a tendency to
is present in these bacteria. Combination of efflux mecha-
increase among young adults. Clinical manifestation of
nism with mutation in 23S rRNA or ribosomal proteins L4
meningitis with different etiology is similar. Purulent spinal
and L22 confers high level macrolides and ketolide resist-
fluid is more often seen in bacterial meningitis cases.
ance in H. influenzae strains. Resistance to tetracycline,
Serous spinal fluid is typical for cases of tuberculosis
chloramphenicol and trimethoprim-sulfamethoxazole is
meningitis.
usually due to presence of tet(B) gene, -cat gene and muta-
• Etiological identification of meningitis is inade-
tions in DHFR, respectively. France is one of the countries
quate. Only 30% of patients with meningitis are released
with high level ampicillin resistance rates with 36% of resist-
from the hospital with the confirmed bacteriological diag-
ance and 49.6 % of the resistant strains are BLNAR, 35%
nosis.
are BLP and 15.4% are BLPACR. A worldwide survey with
• It is important to improve not only bacteriologi-
participation of 26 countries reported beta lactamase pos-
cal but also serological diagnostics procedures and to
itivity rate among H. influenzae as 16.9% and the USA
establish PCR testing for various meningitis.
with the highest (29.6%) prevalence.
• Etiological identification of bacteriological
Penicillin nonsusceptibility is due to alterations in PBP2
meningitis is important for the early and rational therapy
encoded by penA gene in N. meningitidis. Clonal spread
of meningitis with antibiotics.
of an intermediate resistant strain was shown in Italy.
Mosaic structure of penA gene is also used for molecular
typing of N. meningitidis strains. Resistance with presence L-39
of a beta lactamase is very rare among N. meningitides TREATMENT OF COMMUNITY-ACQUIRED
and in that case level of resistance is very high. An interna- PNEUMONIA
tional multi-center study has shown that the prevalence of Gaye Usluer, M.D.
penicillin resistance is 15% and in countries like France University of Eskisehir Osmangazi, School of Medicine,
attains 33%. Serogroups W135 and C are more associat- Department of Infectious Diseases and Clinical Microbiology,
ed with penicillin resistance. Tetracyclin and chlorampheni- Eskisehir, TURKEY
col resistance is usually due to presence of an efflux mech- Community-acquired pneumonia (CAP) is defined as pneu-
anism (tetB) and chloramphenicol acetyltransferase (catP), monia not acquired in a hospital or a long-term care facil-
respectively. Presence of mef and/or erm genes is the ity. It has an incidence of 3 to 5 cases per 1,000 persons,
cause of macrolide resistance in N. meningitidis. and a mortality of 5 to 15% in hospitalized patients. Initial
Antimicrobial resistance in H. influenzae and N. meningi- antibiotic treatment is key for the resolution of infection and
tidis is growing public health problem and continuous sur- for prognosis, with higher mortality if the treatment is inap-

49
propriate. The difficulty in selecting the appropriate antibi-
otics arises because CAP can be caused by multiple organ-
isms, which cannot be identified on clinical and radi-
ographic findings, and the conventional microbiological
methods have limited sensitivity and specificity. Usually the
antibiotic treatment is chosen empirically at the time of
diagnosis.
Treatment
Initial treatment of CAP is based on physical examination
findings, laboratory results,
and patient characteristics (e.g., age, chronic illnesses, his-
tory of smoking, history of the illness). The primary goals of
pharmacotherapy for patients with CAP include eradicat-
ing the causative pathogens, resolving the clinical signs
and symptoms, minimizing hospitalization, and preventing
reinfection. The majority of patients with CAP are treated
empirically based on the most common pathogen(s) associ-
ated with the condition.
The new guidelines support the use of the Pneumonia
Severity Index (PSI) as a scoring system to determine which
patients require hospital admission. They also support the
use of CURB-65 (Confusion, Urea > 7 mmol/L, Respiratory
rate ? 30/min, systolic blood pressure ≤ 90 mm Hg, and
diastolic blood pressure ? 60 mm Hg, and age 65 years or
older). When calculating the 30-day mortality rate, if the
CURB-65 score is greater or equal to 3, the site of care
should be the intensive care unit (ICU). If the score is 2,
admission to a hospital is sufficient. Outpatient manage-
ment is warranted when the CURB-65 score is 0 or 1.
For outpatients, the preferred treatment regimen is a
macrolide (clarithromycin or azithromycin if H influenza is
suspected), doxycycline, or a fluoroquinolone antibiotic
(specifically levofloxacin, moxifloxacin, or gatifloxacin). In
these patients, an alternate treatment regimen would be
amoxicillin and clavulanate potassium combination and a
second-generation cephalosporin (eg, cefuroxime axetil,
cefpodoxime, or cefprozil), but these agents are not active
against atypical pathogens. For the treatment of patients
hospitalized, the IDSA prefers a combination of a beta-lac-
tam plus a macrolide antibiotic or monotherapy with a flu-
oroquinolone antibiotic. Patients who require hospitaliza-
tion in the ICU should always be treated with combination
therapy. This therapy should be with either a beta-lactam
plus a macrolide or with a beta- lactam plus a fluoro-
quinolone antibiotic. The goal of combination therapy in
ICU patients is to provide optimal coverage for the two
most commonly identified causes of lethal pneumonia— S
pneumoniae and Legionella species. The IDSA prefers the
following beta-lactams and beta-lactam–beta-lactamase
50
inhibitor combinations: cefotaxime, ceftriaxone, ampicillin
and sulbactam combination, or piperacillin and tazobac-
tam combination. For patients with hypersensitivity to beta-
lactams, clindamycin and fluoroquinolone antibiotics are
recommended. For patients with structural lung disease
such as bronchiectasis or cystic fibrosis, the IDSA recom-
mends antimicrobial agents with coverage for
Pseudomonas species.
Duration of treatment has been shortened to a minimum of
5 days, providing patients are afebrile for 48 to 72 hours
and have no more than 1 sign of clinical instability.
Extended duration is warranted if initial therapy is not
effective, if there are complications due to extrapulmonary
infection such as meningitis or endocarditis, or if bac-
teremia is present, especially S aureus, S pneumoniae, or P
aeruginosa.
Keywords: community acquired pneumonia, treatment, antimicro-
bials
References
1. Andrews J, Nadjm B, Gant V, Shetty N.
Communityacquired pneumonia. Curr Opin Pulm Med
2003;9: 175-80.
2. File TM. Community-acquired pneumonia. Lancet
2003;362:1991-2001.
3. Fine MJ, Pratt HM, Obrosky DS, Lave JR, McIntosh LJ,
Singer DE, et al. Relation between length of hospital stay
and costs of care for patients with communityacquired
pneumonia. Am J Med 2000; 109:378-85.
4. Gagnon L. IDSA/ATS to Release New Guidelines on
CAP Diagnosis and Treatment. 2006 (Toronto)
5. Mandell LA, Marrie TJ, Grossman RF, Chow AW,
Hyland RH, for the Canadian Community-Acquired
Pneumonia Working Group. Canadian guidelines for the
initial
management of community-acquired pneumonia: an evi-
dence-based update by the Canadian Infectious Diseases
Society and the Canadian Thoracic Society. Clin Infect Dis
2000;31: 383-421.
6. Niederman MS, Mandell LA, Anzueto A, Bass JB,
Broughton WA, Campbell GD, et al. American Thoracic
Society. Guidelines for the management of adults with
community-acquired pneumonia. Diagnosis, assessment of
severity, antimicrobial therapy, and prevention. Am J
Respir Crit Care Med 2001;163:1730–54.
8. Purvin B. Shah, DO, MS; James C. Giudice, DO;
Russell Griesback, Jr, DO; The Newer Guidelines for the
Management of Community-Acquired Pneumonia.
2004;104 (12): 521-526
L-40
THE EPIDEMIOLOGY OF HAEMORRHAGIC
FEVERS IN KAZAKHSTAN
R.A. Yegemberdiyeva, A.M. Dmitrovskiy, K.S. Ospanov.,
S.V. Kazakov, K.K. Kiraubayev, A.M. Mirzabekov
Almaty, Kazakhstan
e-mail: regemberdieva@rambler.ru
The goal of the following report is to characterize epidem-
ic display of haemorrhagic fevers (CCHF – HFRS) on the
territory of the widespread area of Kazakhstan.
Since 1948 Crimean-Congo haemorrhagic fever (CCHF)
has been officially registered in Kazakhstan. The active nat-
ural centres are located in Zhambyl, Kyzylorda, and South
– Kazakhstan areas. 486 infected people were revealed in
the Republic of Kazakhstan between 1982 – 2006 years.
Disease is usually characterized with sporadic cases. The
rate of the disease on 100 people is estimated from 0.02
to 0.07. There were picks of the number of infected people
in several years. The biggest number of CCHF cases was in
Zambyl area, where 266 cases (54.7%) have been official-
ly registered, South-Kazakhstan area – 108 cases (22.2%),
Kyzylorda area – 106 cases (21.8%).
Hyalomma asiaticum, Hyalomma anatolicum, Hyalomma
detrium, Dermacenter marginatus - ticks, which are the
main keepers and transformers of CCHF disease in that
areas. During the period between 1982 and 2006 it was
fixed 7.9% of death rate in Zambyl area, 21.7% - in South-
Kazakhstan area, 11.4% - in Kyzylorda area.
People of 21 – 50 ages, men (73.3%), cattle breeders
(70%) represent the main part of infected patients. Getting
the blood of infected ticks on human skin is the mechanism
of being infected through transmission way, which was
observed in the half of total cases.
In the recent years the borders active widespread areas of
CCHF have been expanded. The disease was registered in
the areas where the illness has not been observed tens
years ago (Sariagash, Turkistan area of South-Kazakhstan
region). As the result of ticks brought from the wild nature,
areas the local population of ticks, which are able to exist
by themselves and maintain the area CCHF, occurred and
took their roots in a settlement.
In Kazakhstan haemorrhagic fever with renal syndrome
disease (HFRS) is registered only in West- Kazakhstan
region, but other areas are not exception as well.
In Kazakhstan haemorrhagic fever with renal syndrome
51
disease (HFRS) was firstly registered in 2000 year. The nat-
ural centre of HFRS was discovered in Western-
Kazakhstan. The high rate of infected by antigen of han-
tavirus was found among rodents. It was totally registered
136 people infected by HFRS during 2000 – 2006 period
of time. In 2005 there was the maximum number of infect-
ed people – 85 cases (63%). The diagnosis was laborator-
ial approved in 123 cases (90%). People of 16 – 49 ages
(90%) were the most frequent patients. The disease com-
monly had been registered in fall and the beginning of win-
ter times.
An increasing number of mouse-type rodents are the main
cause of disease spread. People were infected in the areas
where they were busy with the preparation of hay, fire
wood, fishing, gathering of mushrooms, even getting infect-
ed though dirty food and water. Except of that, people
were infected though the dust, while they were loading a
hay, grain.
L-41
TREATMENT OF CRIMEAN-CONGO
HEMORRHAGIC FEVER
Prof. Hakan Leblebicioglu
Department of Infectious Diseases and Clinical Microbiology
Ondokuz Mayis University Medical School
Samsun, Turkey
Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne
viral disease mainly transmitted to humans by the bite of
infected arthropod. The virus has a wide geographic distri-
bution in many regions of Africa, the Middle East and
Eastern Europe. CCHF is a severe disease. Its clinical man-
ifestations include headache, fever, weakness, myalgia,
anorexia, nausea, vomiting. CCHF may progress to a hem-
orrhagic fever stage. Petechiae, ecchymosis, mucous mem-
brane and conjunctival hemorrhage epistaxis, hemoptysis,
uterine hemorrhage, hematemesis, and melena may occur.
At this time there is neither specific treatment nor human
vaccines for CCHF. Intensive supportive care is necessary
for most cases of CCHF. Constant monitoring of the
patient's fluid and electrolyte balance is essential. Careful
attention should be paid to oxygenation and hemodynam-
ic support, and appropriate treatment of secondary infec-
tions.
Bleeding, usually the consequence of thrombocytopenia,
generally responds to platelet administration. Prophylactic
platelet transfusion is performed when platelets fall to <
10,000/ÌL. Fresh frozen plasma (FFP) is indicated for
patients with documented coagulation factor deficiencies
and active bleeding demonstrated by prolongation of pro-
thrombin or partial thromboplastin times (>1.5 times nor-
mal) or an international normalized ratio (INR) (>1.6).
There is no specific antiviral drug for treatment of CCHF.
Ribavirin exhibited antiviral activity against CCHF virus in-
vitro and in-vivo mice model. Ribavirin is increasingly
being used off label in the treatment of CCHF. Even though,
no randomized controlled trials have compared ribavirin
with placebo. According to observational studies, there
were conflicting results regarding the efficacy of ribavirin.
Mardani et al compared the mortality rate between patients
being treated with oral ribavirin and historical controls in
Iran and found that mortality is lover in treatment group
than who did not receive ribavirin (30.2% vs 45.8.%.).
However in the studies done by Ergonul and Ozkurt, fatal-
ity rates, were not significantly different between the treat-
ment group and controls. Because of the potential for selec-
tion biases such as severity and stage of the disease, differ-
ent wait times before the onset of diagnosis and/or treat-
ment, the results of observational studies should be inter-
preted cautiously. In conclusion there is a still debate for
using ribavirin in this setting, until the time that clear results
are obtained in well controlled studies.
References
1. Bakir M, Ugurlu M, Dokuzoguz B, Bodur H, Tasyaran M,
Vahaboglu H, Turkish CCHF Study Group. Crimean-Congo
haemorrhagic fever outbreak in Middle Anatolia: a multi-
centre study of clinical features and outcome measures. J
Med Microbiol 2005;54:385-389.
2. Cevik MA, Erbay A, Bodur H, Gulderen E, Bafltug A,
Kubar A, Akinci E. Clinical and laboratory features of
Crimean-Congo hemorrhagic fever: predictors of fatality.
Int J Infect Dis. 2007 Dec 4. (Epub ahead of print)
3. Ergonul O. Treatment of Crimean-Congo hemorrhagic
fever. Antiviral Res. 2007 Dec 3. (Epub ahead of print)
4. Ergonul O, Celikbas A, Baykam N, Eren S, Dokuzoguz
B. Analysis of risk factors among patients with Crimean-
Congo haemorrhagic fever virus infection: severity criteria
revisited. Clin Microbiol Infect 2006;12:551-554.
5. Mardani M, Jahromi MK, Naieni KH, Zeinali M, The
efficacy of oral ribavirin in the treatment of Crimean-Congo
hemorrhagic fever in Iran. Clin Infect Dis 2003;36:1613-
1618.
6. Ozkurt, Z, Kiki I, Erol S, Erdem F, Yilmaz N, Parlak M,
Gundogdu M, Tasyaran MA. Crimean-Congo hemorrhag-
52
ic fever in eastern Turkey: clinical features, risk factors and
efficacy of ribavirin therapy. J Infect 2006;52:207-215.
7. Vorou R, Pierroutsakos IN, Maltezou HC. Crimean-
Congo hemorrhagic fever. Curr Opin Infect Dis
2007;20:495-500.
L-42
LEPTOSPIROSIS IN DEVELOPING COUNTRIES:
IS IT THE TIP OF AN ICEBERG?
Nedim Cakir
Dokuz eylul University faculty of medicine, Department of infectious dis-
eases
Inciralt› ‹zmir, Turkey
Leptospirosis is one of the most leading zoonotic diseases
in both developing and industrialized countries. The main
characteristics of the disease are: occurred mostly in warm
and humid (tropical and sub-tropical) climatic conditions,
may present in wide variety of symptoms, has higher mor-
tality rates and laboratory diagnostic considerations are
still problematic. These protean symptomatic characteristics
of leptospirosis causes overlooked and underreported in
many areas of the World, and remains unresolved epi-
demiologic enigmas. This manuscript will discuss global
epidemiologic considerations of leptospirosis.
Leptospirois is zoonotic infectious disease caused by genus
Leptospira. These members of bacteria were classified into
two species, L. interrogans, containing all pathogenic
strains, and L. biflexa is taking part of saprophytic strains
isolated from the unanimated environment. L. biflexa is dif-
ferentiated from L. interrogans by their some physiologic
characters like growth at 13°C or the presence of 8-aza-
guanine (225 Ìg/ml). Routine conventional direct light
microscopy may not help the diagnosis because of its
shape and size.
Pathogenic strains are transmitted to humans with either
direct or indirect contact with infected rodents’s urine.
Indirect transmissions are mainly occurred in rainy seasons
by contamination of soil and flood by infected animal’s
urine in the part of humid countries of the World.
Leptospirosis is considered as an occupational disease in
agriculture workers, sewage workers, animal handlers, for-
est workers, hunters and butchers. Moreover epidemics are
occurred in flood hits especially during rainy seasons. The
other major indicators of epidemic are amount and char-
acteristics of rodent fauna in flooded areas.
Because of all conditions above stated, leptospirosis can
detect in tropical countries in endemic character.
In medical literature some countries publish annual lep-
tospiral incidence while some cannot. Figure 1 shows the
ten highest incidence counties in the World. But this is pos-
sibly incidental, because some regional data reported from
other countries show higher than known. Figure II shows
 regions and their incidence rates higher than known top ten informational correspondence. These countries are outlined
countries. Some of the countries which they have proper in Table.
seasonal characteristics for endemicty have no nationwide
ANNUAL INCIDENCE OF LEPTOSPIROSIS IN TOP TEN COUNTRIES

SEYCHELLES

TRINIDAD AND TOBAGO

BARBADOS

JAMAICA

COSTA RICA

SRI LANKA

THAILAND

EL SALVADOR

NEW ZEALAND

URUGUAY

COUNTRIES 0 50 100 150 200 250 300 350 400 450 500
ANNUAL INCIDENCE (PER MILLION POP.)
FIGURE I: Annual incidence of leptospirosis in top ten Countries
(Addopted from: Pappas G, et al., The globalization of leptospirosis: worldwide incidence trends, Int J Infect Dis (2007), TABLE I: COUNTIRES
doi:10.1016/j.ijid.2007.09.011) POSS‹BLY ENDEM‹C BUT
NO COUNTRYWIDE
REGIONAL ANNUAL LEPTOSPIRAL INCIDENCE IN SELECTAD COUINTRIES DATA AVAILABLE

KALATURA - SRILANKA
India
MATARA - SRILANKA
Malaysia
KEGALE - SRILANKA Bangladesh
MATALE - SRILANKA Viet Nam
SUR‹N - THAILAND Laos
POLLONARUWA - SRILANKA Nepal
LAMPANG - THAILAND Cambodia
KALASIN - THAILAND
Indonesia
KHON KAEN - THAILAND
Myanmar
China
N QUEENSLAND-
Iran
ROI ET - THAILAND
Suriname
GUADELOUPE-FRANCE
Haiti
LOEI-THAILAND
Peru
ANDAMAN ISLAND-INDIA

PROVINCE-AREA 0 50 100 150 200 250 300 350 400 450 500 550

INCIDENCE (PER MILLION POPULAT‹ON)

FIGURE II: Highest annual incidence of leptospirosis in selected regions
(Addopted from: Pappas G, et al., The globalization of leptospirosis: worldwide incidence trends, Int J Infect Dis (2007),
doi:10.1016/j.ijid.2007.09.011)

53
L-43 tries having high TB incidence. The sensitivity of this test
was found to be 97.7% for smear- and culture positive
MOLECULAR TESTS FOR DIAGNOSIS OF
samples, 48.8% for smear- negative and culture- positive
TUBERCULOSIS
samples, and the specificity was 99% (8). Beside commer-
R›za DURMAZ
cial diagnostic tests, many laboratories have try to develop
Department of Clinical Microbiology, Faculty of Medicine, Inonu
and optimize in-house polymerase chain reaction (PCR)
University, Malatya, Turkey
tests for determine mycobacterium nucleic acid in clinical
specimens. However, the sensitivity and specificity of in-
Accurate and rapid diagnostic tests for tuberculosis (TB) are
house PCR assays are more variable and inconsistent than
very critical issues for global TB control (1). Conventional
commercial tests. A meta-analysis of the 84 studies showed
diagnostic tests including smear microscopy, culture, tuber-
that the sensitivity of in house-PCR tests ranged from 9.4%
culin-skin testing and chest radiography have some limita-
to 100%, and specificity ranged from 5.6% to 100% (9).
tions, such as low sensitive, time-consuming, and difficult to
These results indicated that the molecular test results must
applied in field conditions (2). For these reasons
be carefully interpreted. Since many factor such as quality
researchers and many companies have focused on devel-
and type of the specimens, storage and transportation con-
oped new diagnostic tools that might be more rapid, accu-
ditions, and used extraction, amplification, and result
rate and convenient for TB diagnosis. Molecular diagnostic
observation techniques, and laboratory conditions may
tests have been applied for rapid detection of M. tubercu-
influence the results of molecular diagnostic tests (7).
losis complex in clinical specimens, identification of
Because of their poor sensitivities on ectrapulmonary TB,
mycobacterial strains at species level, detection of drug
NATs cannot be used reliably to rule out TB meningitis or
resistance, and molecular epidemiology of tuberculosis.
other extrapulmonary TB. Since they have high specificity,
Rapid diagnosis of TB in clinical specimens
it is suggested that NATs can be the first-line test for ruling
Nucleic acid amplification tests (NATs) designed to ampli-
in TB meningitis, but they need to be combined with the
fy M. tuberculosis complex specific gene have been widely
result of other tests to rule out TB (10). All these results
used as rapid diagnostic tests. The results of the published
showed that a negative NAT cannot role out the diagnosis
data indicate that the specificity of these tests is very high,
of TB and also a positive NAT cannot prove tuberculosis
but sensitivity is much lower and highly variable depending
alone. Molecular diagnostic tests should not be performed
on type of clinical specimens and the results of microscopy.
if microscopy is negative and if clinical suspicion is low.
The highest sensitivity is obtained in smear-positive speci-
These tests can be useful to confirm that a smear positivity
mens, however, it is low in extrapulmonary tuberculosis
is due to M. tuberculosis. But it is indicated that this
and smear-negative pulmonary diseases (3-7). Sensitivities
approach is not necessary in high-burden countries where
of two commercial kits, the AMPLICOR M. tuberculosis
TB treatment is mainly based on smear positivity (2).
assay and Amplified M. tuberculosis Direct (AMTD2)
Moreover, since NATs cannot distinguish viable bacilli
assay, in respiratory specimens ranged from 83% to 98%,
from dead bacilli, they should not be done in patients who
from 90% to 100%, and from 50% to 96% for overall,
are being anti-tuberculois treatment (6,11).
smear-positive, and smear-negative specimens, respective-
Identification of mycobacteria by molecular methods
ly. When extrapulmonary specimens or mixtures of respi-
Identification of mycobacteria by conventional methods
ratory and extrapulmonary specimens were considered,
such as growth characteristics, the niacin acumulation,
sensitivities of the AMPLICOR M. tuberculosis assay ranged
nitrate reduction, catalase activity, etc. needs growth of
from 27.3% to 85%, from 87.5% to 100% and from 17.2%
bacteria and takes time. More rapid identification methods,
and 70.8% for overall, smear-positive and smear-negative
such as sequencing a portion of mycobacterial 16SrDNA,
specimens, respectively (3). In a recent review, the mean
nucleic acid probes, DNA strip assays, and PCR amplifi-
sensitivity of the commercial molecular diagnostic tests had
cation-restriction analysis, have been developed to identify
been noted as 96-98% and 71-96% for smear- positive
mycobacterial species from cultered isolates and some of
specimens, respectively. These values were 57-76% and
them can also be used in clinical specimens. Beside rapid
97-99% for smear- negative specimens, respectively (7). A
results of the molecular tests, they help to find new
new commercial molecular diagnostic test, a loop-mediat-
mycobacterial spesies. These tests are rapid and provide
ed isothermal amplification (LAMP), was developed and its
very useful data to menengment of TB, especial in HIV
efficacy was evaluated with a study performed on the coun-

54
infected. However they have some limitations: some needs
sophisticated instruments, many of them cannot distihushe
M. tuberculosis from the other species in the complex, other
can differentiate only a limited number of species, and all
these tests are more expencive than conventional methods
(5, 7).
Rapid detection of drug resistance
The results of anti-tuberculosis drug susceptibility testing
have very critical importance for appropriate therapotic
decisions. Increasing multy-drug resistant M. tuberculosis
and new emergence of extremely drug resistant M. tuber-
culosis strains have forced to use new tests which can give
results as soon as possible. Culter based methods are gold
standart, however, they need approximately 2-4 weeks.
Developments in molecular biology have provide very use-
ful data about the genetic basis of resistance to antituber-
culosis drugs including rifampicin (rpoB gene), isoniazid
(katG gene), isoniazid and ethionamid (inhA gene), pyrasi-
namide (pncA gene), ethambutol (embB gene), and strep-
tomycin (rrs and rpsL genes). In paralel to these improve-
ments many molecular methods, such as DNA sequencing,
heteroduplex analysis, molecular beacons, and multiplex
allel specific PCR have been developed to detect mutations
in gene related to the drug resistance of M. tuberculosis
strains (5,6,12,13). Most of the molecular studies have
largely focused on rifampicin (RIF) and isoniazid (INH)
which are two major antituberculosis drugs and resitance
to those indicates multidrug resistant M. tuberculosis (12-
14). Acceptable accuracy and very rapid results were
obtained by molecular test used for RIF and INH resistance.
In a meta-analaysis, the sensitivity of a probe-assay test for
detection of the mutations on rpoB gene ranged from 95%
to 100% when cultured M. tuberculosis was used (15).
Sensitivity for INH is lower (88%), because of multiplicty of
mutations that may lead to resistance (16).
Application of molecular typing methods in tuberculosis
Molecular typing methods used to determine clonal and
pylogenetical relationship of M. tuberculosis strains pro-
vide very useful data about epidemiology of tuberculosis in
any population, in country, among countries and over the
world. The rate of the strains harboring the same finger-
printing profiles refelects transmission degree in study pop-
ulation and from these one can estimate efficay of the
tuberculosis control program in this setting (17-20).
Furthermore, molecular typing of M. tuberculosis strains
can be used for identification of laboratory cross-contami-
nation, distinction between reactivation and re-infection,
and following distribution of a specific strain (Beijing/W,
55
LAM7-TUR, MDR-TB, etc) (17, 21-24). This has been
achieved using a variety of methods such as IS6110 restric-
tion fragment length polymorphism (IS6110-RFLP), spoligo-
typing, mycobacterial interspersed repetitive units (MIRUs),
pTBN12 fingerprinting, arbitrarily primed polymerase
chain reaction, etc. (19,25). IS6110-RFLP based on the
genetic variation in the number of insertion element IS6110
is considered a “gold standard” M. tuberculosis genotyp-
ing (26,27). However it is time-consuming and difficulties
on interpretation of results restrict the wide-spread use of
this technique. In addition, it has a limited discriminatory
power for strains having less than 6 copies of IS6110 (low-
copy-number strains) (26). Spoligotyping, which identifies
repetitive genetic elements in the direct repeated sequence
(DR) is very useful for phylogenetic analysis of M. tubercu-
losis isolates (21,22). More recently, MIRU typing was opti-
mized as an alternative to IS6110-RFLP both for TB molec-
ular epidemiology and for analysis of the population struc-
ture of the M. tuberculosis isolates, especially with IS6110
low-copy strains (23,26,28,29).
Conclusion: Developments of the molecular technology
have provided important advances on laboratory diagno-
sis, identification of species and resistant strains of
mycobacteria and also molecular epidemiology of tubercu-
losis. However, none of these tests has not replaced the
conventional procedures. They can still serve as a comple-
mentary tools for tuberculosis control.
References
1. WHO. Global tuberculosis control: Surveillance,
Planning, Financing. WHO Report 2006, Geneva.
2. Pai M, Kalanti S, Dheda K. New tools and emerging
technologies for the diagnosis of tuberculosis: Part II.
Active tuberculosis and drug resistance. Expert Rev Mol
Diagn. 2006;6(3):423-432.
3. Piersimoni C, Scaudio C. Relevance of commercial
amplification methods for detection of Mycobacterium
tuberculosis complex in clinical samples. J Clin Micobiol.
2003;41:5355-5365.
4. Johansen IS, Lundgren B, Tabak F, Petrini B, Hosoglu
S, Saltoglu N, Thomsen VO. Improved sensitivity of nucle-
ic acid amplification for rapid diagnosis of tuberculous
meningitis. J Clin Microbiol. 2004:42:3036-3040.
5. Cheng VC, Yew WW, Yuen KY. Molecular diagnostics
in tuberculosis. Eur J Clin Microbiol Infect Dis.
2005;24(11):711-720.
6. Nahid P, Pai M, Hopewell PC. Advances in the diag-
nosis and treatment of tuberculosis. Proc Am Thorac Soc.
2006;3:103-110.
7. Cho S-N. Current issues on molecular and immunologi-
cal diagnosis of tuberculosis. Yonsei Medical Journal
2007;48:347-359.
8. Boehme CC, Nabeta P, Henostroza G, Raqib R, Rahim
Z, Gerhardt M, et al. Operational feasibility of using
loop-mediated isothermal amplification for diagnosis of
pulmonary tuberculosis in microscopy centers of develop-
ing countries. J Clin Microbiol 2007;45:1936-40.
9. Flores LL, Pai M, Colford Jr JM, Riley LW. In-house
nucleic acid amplification tests for the detection of
Mycobacterium tuberculosis in sputum specimens: meta-
analysis and meta-regression. BMC Microbiology 2005,
5:55.
10. Dinnes J, Deeks J, Kunst H, Gibson A, Cummins E,
Waugh N, Drobniewski F, Lalvani A. A systematic review
of rapid diagnostic tests for the detection of tuberculosis
infection. Health Technol Assess. 2007;11(3):1-196
11. Pai M. The accuracy and reliability of nucleic acid
amplification tests in the diagnosis of tuberculosis. Natl
Med J India 2004;17(5):233-236.
12. Su W-J. Recent advances in the molecular diagnosis
of tuberculosis J Microbiol Immunol Infect 2002;35:209-
214.
13. Yang Z, Durmaz R, Yang D, Günal S, Zhang L,
Foxmen B, Sanic A, Marss CF. Simultaneous detection of
isoniazid, rifampin, and ethambutole resistance of
Mycobacterium tuberculosis by a single multiplex allele-
specific PCR assay. Diagn Microbiol Infect Dis.
2005;53(3):201-208.
14. Aktas E, Durmaz R, Yang D, Yang Z. Molecular char-
acterization of isoniazid and rifampin resistance of
Mycobacterium tuberculosis clinical isolates from Malatya,
Turkey. Microb Drug Resist. 2005;11(2):94-99.
15. Morgan M, Kalantri S, Flores L, Pai M. A commercial
line probe assay for rapid detection of rifampicin resist-
ance in Mycobacterium tuberculosis: a systemic review
and meta-analysis. BMC Infect Dis 2005;5:62.
16. Palomino JC. Newer diagnostics for tuberculosis and
multi-drug resistant tuberculosis.
Curr Opin Pulm Med. 2006;12(3):172-178.
17. Achonu C, Jamieson F, Behr MA, Lillebaek T, Khan K,
Gardam M. Evidence for local transmission and reactiva-
tion of tuberculosis in the Toronto Somali community.
Scand. J. Infect. Dis. 2006; 38:778-781.
18. Durmaz R, Gunal S, Yang Z, Ozerol IH, Cave MD.
Molecular epidemiology of tuberculosis in Turkey. Clin
Microbiol Infect 2003; 9:873-877.
56
19. Durmaz R, Ozerol IH, Durmaz B, et al. Primary drug
resistance and molecular epidemiology of Mycobacterium
tuberculosis isolates from patients in a population with high
tuberculosis incidence in Turkey. Microbial Drug Resistance
2003;9:361-366.
20. Godfrey-Faussett P, Sonnenberg P, Shearer SC et al.
Tuberculosis control and molecular epidemiology in a
South African gold-mining community. Lancet
2000;356:1066-1071.
21. Filliol I, Driscoll JR, Van Soolingen D, Kreiswirth BN,
Kremer K, Valetudie G, et al. Global distribution of
Mycobacterium tuberculosis spoligotypes. Emerg. Infect.
Dis. 2002; 8:1347-1349.
22. Filliol I, Driscoll JR, Van Soolingen D, Kreiswirth BN,
Kremer K, Valetudie G, et al. Snapshot of Moving and
Expanding Clones of Mycobacterium tuberculosis and
Their Global Distribution Assessed by Spoligotyping in an
International Study. J. Clin. Microbiol. 2003; 41:1963-
1970.
23. Mathema B, Kurepina NE, Bifani PJ, Kreiswrith BN.
Molecular epidemiology of tuberculosis: current insights.
Clin. Microbiol. Rev. 2006;19(4):658-685.
24. Zozio T, Allix C, Gunal S, Saribas Z, Alp A, Durmaz
R, et al.. Genotyping of Mycobacterium tuberculosis clini-
cal isolates in two cities of Turkey: description of a new
family of genotypes that is phylogeographically specific for
Asia Minor. B.M.C. Microbiol. 2005; 5:44.
25. Kanduma E, McHugh TD, Gillespie SH. Molecular
methods for Mycobacterium tuberculosis strain typing: a
users guide. J. Appl. Microbiol.2003; 94:781-791.
26. Gopaul KK, Brown TJ, Gibson AL, Yates MD,
Drobniewski FA. Progression toward an improved DNA
amplification-based typing technique in the study of
Mycobacterium tuberculosis epidemiology. J. Clin.
Microbiol. 2006; 44:2492-2498.
27. van Embden JD, Cave MD, Crawford JT, Dale JW,
Eisenach KD, Gicquel B, et al. Strain identification of
Mycobacterium tuberculosis by DNA fingerprinting: recom-
mendations for a standardized methodology. J. Clin.
Microbiol. 1993;31:406-409.
28. Oelemann MC, Diel R, Vatin V, Haas W, Rusch-
Gerdes S, Locht C, et al. Assesment of an optimised
Mycobacterial interspersed repetitive unit-variable number
of tandem repeat typing system combined with spoligotyp-
ing for population-based molecular epidemiology studies
of tuberculosis. J. Clin. Microbiol. 2007;45 (3):691-697.
29. Supply P, Allix C, Lesjean S, Cardoso-Oelemann M,
Rusch-Gerdes S, Willery E, et al. Proposal for standardiza-
tion of optimized mycobacterial interspersed repetitive unit-
variable-number tandem repeat typing of Mycobacterium
tuberculosis. J. Clin. Microbiol.2006; 44:4498-4510.
L-44
TUBERCULIN SKIN TEST SKIN TEST AND INTER-
FERON ASSAYS FOF DIAGNOSIS OF
TUBERCULOSIS
Aysegul Yagci, MD, Professor of Clinical Microbiology
One third of the world population is infected with tubercu-
losis (TB), and 7.5 million new cases and 2.5 million TB
deaths occurred each year. One in four preventable adult
deaths worldwide was attributable to TB [1]. The Mantoux
tuberculin skin test (TST) is the standard method of deter-
mining whether a person is infected with Mycobacterium
tuberculosis. Reliable administration and reading of the TST
requires standardization of procedures, training, supervi-
sion, and practice. The TST is performed by injecting 0.1
ml(5-tuberculin unit) of tuberculin purified protein deriva-
tive (PPD) intradermally into the inner surface of the fore-
arm and reaction should be read between 48 and 72 hours
after administration. The reaction should be measured in
millimeters of the induration (palpable, raised, hardened
area or swelling). but not the erythema . The reaction to
intracutaneously injected tuberculin is the classic example
of a delayed (cellular) hypersensitivity reaction. T cells sen-
sitized by prior infection are recruited to the skin site where
they release lymphokines.These lymphokines induce
induration through local vasodilatation, edema, fibrin dep-
osition, and recruitment of other inflammatory cells to the
area .Interpretation of TST reaction is given in Table 1
[2].Since sensitivity of TST is low (in persons who have cuta-
neous anergy,recent TB infection, very old TB infection ,very
young age, recent live-virus vaccination, overwhelming TB
disease, some viral illnesses (e.g., measles and chicken
pox); or incorrect method of TST administration, incorrect
interpretation of reaction the test is false negative ) it can
not be used to eliminate the possibility of active tuberculo-
sis. False-positive reactions may occur in persons infected
with nontuberculosis mycobacteria, previous BCG vaccina-
tion, incorrect method of TST administration, incorrect inter-
pretation of reaction, incorrect bottle of antigen used.
Positive and negative predictive values are dependent on
the prevelance of infection with M. tuberculosis. In popula-
tions where BCG vaccination or other mycobacterial expo-
sure is low the specificity of test is 99%. In countries with
low prevalence of infection screening of groups is not rec-
57
ommended due to high rate of false positivity. In contrast,
in high prevalence countries a positive test is highly likely
to indicate tuberculosis infection. T-cell interferon-gamma
release assays (TIGRAs) have been developed as an alter-
native immunodiagnostic approach to the TST for detecting
M. tuberculosis infection. TIGRAs are based on the ex-vivo
detection of interferon-gamma released from presensitized
M. tuberculosis-specific T cells in response to two immun-
odominant secreted proteins: early secretory antigen tar-
get-6 (ESAT-6) and culture filtrate protein 10 (CFP-10).
Those antigens are encoded within the region of difference
1 of the M. tuberculosis genome, and they are more specif-
ic for M. tuberculosis than PPD because they are not shared
with BCG strains or common non-tuberculous mycobacte-
ria. The two commercially available tests are the T SPOT-
TB assay (Oxford Immunotec Ltd, Abingdon, UK), an
enzyme-linked immunosorbent spot or ELISPOT test that
uses peripheral blood mononuclear cells, and the
QuantiFERON-TB Gold, an enzyme-linked immunosorbent
assay (ELISA) that uses whole blood (Cellestis, Carnegie,
Australia) .The QuantiFERON-TB Gold involves the use of
more specific antigens and has replaced the first genera-
tion QuantiFERON-TB. A variant of the ELISA-IGRA called
"QuantiFERON-TB Gold in tube" uses blood-collection
tubes (which are precoated with control and test antigens)
as incubation vessels, thus minimizing blood handling and
simplifying the blood stimulation step QuantiFERON-TB
Gold is the only test of its class licensed by the Food and
Drug Administration for use in the United States and a
guideline about its usage was published by CDC [3]. .
Although not FDA approved, ELISPOT test is currently CE
marked for use in Europe, and licensed for use in Canada.
Comparison of QUANTIFERON and TST tests is given in
Table 2 [4]. There is body of literature suggesting TIGRA
assays have higher specificity than tuberculin test, better
correlation with surrogate markers of exposure to M. tuber-
culosis in low- incidence settings, and less cross reactivity
causing by BCG vaccination; hovewer several unresolved
and unexplained issues remain [5]. An expert group was
assembled in Geneva, Switzerland (March, 2006), by the
Stop TB Working Group on New Diagnostics. The meeting
was co-organised by the Foundation for Innovative New
Diagnosis (FIND) and WHO. The group was charged with
reviewing the research evidence supporting the use of inter-
feron-Á release assays, their clinical use and limitations,
and directions for future research, with a specific focus on
resource-limited settings. A summary of those issues are
given in Table 3. Major limiting factor of widespread use
of TIGRA assasys is their high costs especially in low
income countries [6]. US Centers for Disease Control and
Prevention now recommends that the QuantiFERON-TB
Gold assay may be used in place of the tuberculin skin test
for all indications, including contact investigations, evalua-
tion of immigrants, and serial testing of health-care work-
ers [7]. Meanwhile, The UK National Institute for Health
and Clinical Excellence (NICE) tuberculosis guidelines rec-
ommend a hybrid, two-step approach for latent tuberculo-
sis infection diagnosis, which includes initial screening with
tuberculin skin test, and subsequent interferon-Á release
assay testing, if available, of those who are tuberculin skin
test positive (or in whom tuberculin skin test may be unreli-
able) to confirm tuberculin skin test results [8]

An induration of 5 or more An induration of 10 or more millimeters is An induration of 15 or more millimeters is

millimeters is considered positive in
- HIV-infected persons
- A recent contact of a person with TB dis-
ease
- Persons with fibrotic changes on chest
radiograph consistent with prior TB
- Patients with organ transplants
- Persons who are immunosuppressed for
other reasons (e.g., taking the equivalent of
>15 mg/day of prednisone for 1 month or
longer, taking TNF-? antagonists)
considered positive in considered positive in any person, including
- Recent immigrants (< 5 years) from high- persons with no known risk factors for TB.
prevalence countries However, targeted skin testing programs
-Injection drug users should only be conducted among high-risk
- Residents and employees of high-risk con- groups.
gregate settings
- Mycobacteriology laboratory personnel
- Persons with clinical conditions that place
them at high risk
- Children < 4 years of age
- Infants, children, and adolescents exposed
to adults in high-risk categories

Table 2. Comparison of QuantiFERON-TB Gold and Tuberculin Skin Testing

QuantiFERON-TB Gold TST

Laboratory measurement of interferon-gamma Intradermal injection of purified protein deriv-

How is the test performed? in whole blood ative and measurement of resulting induration
What does the test measure? In vitro release of interferon gamma after In vivo type intradermal hypersensitivity after
exposure to specific M. injection of a mixture of mycobacterial
tuberculosis antigens antigens (not only M. tuberculosis)
Ability to detect tuberculous infection Yes Yes
Ability to distinguish latent and active tuber- No No
culosis
False positive results Yes, but less frequently than with the TST. Yes. False-positive results may occur after
False-positive results may occur with exposure exposure to nontubercular mycobacteria or
to selected nontubercular mycobacteria, but after BCG vaccination.
not after BCG vaccination.
False negative results Possible among immunosuppressed Possible among immunosuppressed individu-
individuals als
Effect of BCG vaccination None May give a false-positive result after BCG
vaccination
Need for patient to return for second visit No Yes, for reading of the skin reaction
Required infrastructure Yes. Special equipment required in the No special infrastructure required. Easy to
laboratory perform even in unsophisticated facilities
Subjectivity in reporting results No Yes, it may vary depending on training of
individual
Cost More expensive Less expensive
Time to obtain result At least 24 hours, but longer if run in batches At least 48 hours
Boosting an anamnestic response with succes- No Yes
sive tests

58
TST, tuberculin skin test; BCG, Bacillus Calmette-Guérin.
Table 3. Future points to be resolved
1. Biological issues
• discordance between the tuberculin skin test and
interferon-Á release assays
• selection of appropriate cut-off points in different
populations
• correlation between bacterial burden and T-cell
responses
• what extent a positive interferon-Á release assay
result suggests previous (remote) infection (either cleared or
still persistent) versus recent infection.
2. Test performance in high-risk populations and poorly
studied groups
• the accuracy and reliability in children, immuno-
suppressed patients
3. Risk prediction
• the ability to identify latently infected individuals
who are most likely to progress active disease and benefit
from preventive therapy ? the ability to exclude
presence of active disease
4. Test reproducibility and serial testing ? the ability to
use periodic screening
• the ability to follow efficacy of treatment 5.
Epidemiological and field applications
• more studies are needed in geographically
diverse, high incidence settings
6. Health system, operational and economic research
7. the major limiting factor is their high cost and the need
for laboratory infrastructure and trained personnel
References
1. Dye C. Global epidemiology of tuberculosis. Lancet
2006; 367: 938–40.
2. Tsicopoulos, A., Q. Hamid, V. Varney, S. Ying, R.
Moqbel, S. R. Durham, and A. B. Kay. Preferential messen-
ger RNA expression of Th1-type cells (IFN-gamma+, IL-2+)
in classical delayed-type (tuberculin) hypersensitivity reac-
tions in human skin. J. Immunol 1992; 148: 2058-2061
3. Mazurek GH, Jereb J, Lobue P, Iademarco MF,
Metchock B, Vernon A. Guidelines for using the
QuantiFERON-TB Gold test for detecting Mycobacterium
tuberculosis infection, United States. MMWR Morb Mortal
Wkly Rep 2005; 54: 49–55
4. Madagaria M, Jalali J, Swindells S. Clinical utility of
interfeorn gamma assay in the diagnosis of tuberculosis. J
Am Board Fam Med 2007; 20 (6): 540- 574
59
5. Pai M, Dhea K, Cunnigham J, Scano F, O’Brien R. Tcell
assys for the diagnosis of latent tuberculosis infection: mov-
ing research agenda forward. Lancet Infect Dis 2007; 7:
428- 438.
6. Oxlade O, Schawartzman K, Menzies D. Interfereon-
gamma release assays and Tb screening in high- income
countries: a cost effectiveness analysis. Int J Tuberc Lung Dis
2007; 11: 11-26.
7. American Thoracic Society and CDC. Diagnostic stan-
dards and classification of tuberculosis in adults and chil-
dren. Am J Respir Crit Care Med 2000; 161.
8. NICE, Clinical guideline 33. Tuberculosis: clinical diag-
nosis and management of tuberculosis, and measures for
its prevention and control, National Institute for Health and
Clinical Excellence, London (2006)
L-45
MULTIDRUG-RESISTANT TUBERCULOSIS IN
KAZAKHSTAN : EPIDEMIOLOGY AND NEW
APPROACHES TO LABORATORY DIAGNOSTICS
T. A. Muminov
Kazakh Medical National Academy, Almaty, Kazakhstan
The rate of multidrug-resistant tuberculosis (MDR-TB) in
Kazakhstan during 2000-2006 and annual incidence rate
of this form of TB are presented. Factors which determined
the epidemiological situation on MDR-TB and control meas-
ures are considered. The review of modern rapid laborato-
ry diagnostics of MDR, including molecular-biological
methods, is presented. Mutations conferring resistance on
rifampicin and isoniazid of M. tuberculosis strains isolated
in Kazakhstan are described.
L-46
MOLECULAR-EPIDEMIOLOGICAL ANALYSIS OF
MYCOBACTERIUM TUBERCULOSIS STRAINS
CIRCULATING IN KAZAKHSTAN
B. T. Zhakipbayeva Almaty, Kazakhstan
More than two hundred randomly selected Mycobacterium
tuberculosis strains from patients with pulmonary tubercu-
losis in five regions of Kazakhstan, including patients in
prisons, were studied by different genotyping methods
(IS6110 RFLP, spoligotyping and VNTR-typing by five
accurate repeat tandems of ETR A, B, C, D and E). The
clonal structure of studied population was analyzed. The
most widespread genetic types were detected. The general
parameters describing the epidemic process (percentage of
clustered isolates, the transmission activity factor) and risk
factors for acquiring infection by strains of dominant geno-
types were estimated. The relationship between genotype
and drug resistance patterns of the isolate, disease's fea-
tures and patient's epidemiological characteristics were
analyzed.
Keywords: Mycobacterium tuberculosis, epidemic process
L-47
CURRENT TREATMENT OF CHRONIC HEPATITIS
B INFECTION.
Prof. Dr. Necati Örmeci
Ankara University School of Medicine. Department of Gastroenterology,
Ankara, Turkey
Today, more than 350 million people are infected with
hepatitis B virus. Carriers of HBV are at increased risk of
developing cirrhosis, hepatic decompensation and hepato-
cellular carcinoma (HCC). It is mandatory to treat the
patients with chronic hepatitis B virus (HBV) infection. The
aims of the treatment are as follows: a-to interrupt tne
necroinflammation b-to decrease HBV-DNA levels c-to
decrease the complications of the disease d-to normalize
ALT. The patients who have chronic liver disease due to
hepatitis B virus or HBV-DNA levels are higher than 104
copy/ml in HBe Ag negative or 105 copy /ml in HBe pos-
itive cases are needed to treat. Interferons (classical or
pegilated), lamivudine, adefovir, entecavir and tenofovir
are licensed for the treatment of chronic HBV infection.
Before the treatment,It must be pay attention HBV-DNA lev-
els, ALT levels, histopathological findings, genotype of
virus, age and sex of the patients.
PegIFN should be preferred in the following patient groups;
a-younger than 60 years of age and otherwise healthy. b-
baseline HBV DNA ≤109 copies/mL, c-baseline ALT > 2-
3 x ULN , d-HBV genotype A or B, d-Absence of
cirrhosis.However, nucleos(t)ide analogue can be used in
the following patients with a-adult of any age, b-baseline
HBV DNA ?2 x 108 IU/mL , c-baseline ALT >5 x ULN, d-
any HBV genotype, e-cirrhosis with or without decompen-
sation, f-HBsAg(+) chemotherapy patient.
Combination therapy should be kept for thethe patients
with resistant to treatment.
L-48
THE CURRENT TREATMENT OF HEPATITIS C
Resat OZARAS, MD,
Ass. Professor, Istanbul University, Cerrahpasa Medical School Infectious
60
Diseases Department
Hepatitis C virus (HCV) associates acute and chronic liver
injury, cirrhosis, and hepatocellular carcinoma, and infects
an estimated 170 to 350 million people worldwide (1).
After the identification of the virus in 1989, substantial
advances occured over the last years in the fields of diag-
nosis, treatment, and prevention. After recognising the role
of transmission via infected blood, routine screening for
anti-HCV decreased the transmission by this route signifi-
cantly. Molecular methods improved detection and quanti-
tation of the virus and thus led to easy recognition of the
virus and monitoring the response to the treatment. Current
Therapeutic Options: Currently, pegylated IFN-alpha plus
ribavirin combination seems to be the most effective thera-
py. Interferon: IFN-·, shows its antiviral effect by two mech-
anisms: (2) (i) induction of a non-virus-specific antiviral
state in infected cells, directly inhibiting viral replication
and (ii) immunomodulatory effects that enhance the host’s
specific antiviral immune responses. Ribavirin: Ribavirin, a
synthetic guanosine analogue, when used alone, depresses
viral replication mildly in nearly half of the cases (3).
However when combined with IFN-·, it inhibits viral repli-
cation more effectively (4). Dose and duration of the drugs
are determined according to the genotype and body
weight (Table 1). The aim of treatment: The eradication of
virus and prevention of complications. This aim can be rep-
resented by sustained virological response (Negative HCV-
RNA 6 months after the completion of therapy). Early viro-
logical response and early discontinuation of therapy:
Response to Peg-IFN-· and ribavirin combination can be
predicted in months 3 and 6: In patients infected with geno-
type 1, if the therapy does not lead to a reduction >2 logs
(100 times) in 3 months, it can be discontinued, since such
a patient has a likelihood of sustained virological response
of 0-3% (32,33). If there is stil a measurable viral load
despite this reduction and if another HCV-RNA study in
month 6 remains positive, the therapy can be discontinued.
(5). For genotypes 2 and 3, the duration of therapy is 6
months without monitoring viral load. The factors associ-
ate unfavorable response to therapy are genotypes other
than 2/3, high viral load, Africo-American race, high
fibrosis score, hepatosteatosis, alcohol consumption, and
advanced age (6-8). Contraindications to therapy include
active psychiatric disorder, solid organ transplantation,
autoimmune hepatitis, untreated hypothyroidism, underly-
ing severe disorders (severe hypertension, cardiac failure,
severe coronary artery disease, severe chronic pulmonary
obstructive disorder), hypersensitivity to the drugs, preg-
nancy, and lactation (9). In decompanseted cirrhotics,
except the period before liver transplantation, IFN-· and
ribavirin combination should not be used (10). Teratogenic
effect of ribavirinin should be considered. Side effects of
therapy: Most frequently seen side effects are fatigue,
headache, fever, myalgia, insomnia, alopecia, arthralgia,
skin rash, depression, and reaction at the injection site
(5,6). Paracethamol or ibuprofen before the injection may
relieve some of these side effects. Since IFN-· supresses
bone marrow and ribavirin may lead to hemolysis, hema-
tological side effects may limit the use of the drugs (11).
Hemoglobin level should be >10 gr/dl and below this level,
ribavirin dose should be decreased. When anemia is
severe (<8.5 gr/dl) ribavirin therapy should be interrupted
(11). Peg-IFN-· should be interrupted when neutrophil
count <500/mm3 and platelet count <50.000/mm3
(38,41). The studies did not result in an effective vaccine.
Since the current therapies can not provide a solution in
nearly half of the patients, new options are needed.
References:
1. Feld JJ, Liang TJ. HCV persitence: cure is still a four let-
ter word. Hepatology 2005;41:23-5.
2. Sen GC, Ronsohoff RM. Interferon-induced antiviral
actions and their regulation. Adv Virus res 1993;42:57-
102
3. Pawlotsky JM, Dahari H, Neumann AU, et al. Antiviral
action of ribavirin in chronic hepatitis C. Gastroenterology
2004;126:703-14.
4. Dixit NM, Layden-Almer JE, Layden TJ, Perelson AS.
Modelling how ribavirin improves interferon response rates
in hepatitis C virus infection. Nature 2004; 432:922-4.
5. Perlman BL. Hepatitis C Update. Am J Med 2004;
117:344-52.
6. Fried MW, Shiffman ML, Reddy KR, et al. Peginterferon
alfa-2a plus ribavirin for chronic hepatitis C virus infection.
N Engl J Med. 2002; 347:975-82.
7. Heatcote J, Main J. Treatment of hepatitis C. J Viral
Hepatitis 2005;12:223-35.
8. Schalm SW, Weiland O, Hansen BE, et al. Interferon-
ribavirin for chronic hepatitis C with and without cirrhosis:
analysis of individual patient data of six controlled trials.
Eurohep Study Group for Viral Hepatitis. Gastroenterology
1999;117:408-13.
9. Kim AI, Saab S. Treatment of hepatitis C. Am J Med
2005; 118:808-15.
10. Forns X, Garcia-Retortillo M, Serrano T, et al. Antiviral
therapy of patients with decompensated cirrhosis to prevent
recurrence of hepatitis C after liver transplantation. J
Hepatol 2003;39:389-96.
11. Russo MW, Fried MW. Side effects of therapy for
61
chronic hepatitis C. Gastroenterology 2003; 124:1711-9.
L-49
THE TREATMENT OF CHILDHOOD CHRONIC
VIRUS HEPATITIS B AND C
G. Kuttykuzhanova
Purpose: Evaluate the efficiency of Pegintron in Children
with CVHG and C. Children at the age of 4 to 18 years
with the diagnosis: Chronic Virus Hepatitis B and C were
under the observation. The activity of the process was from
the minimal to the high. They got anti-virus therapy with
Pegintron + Rebetol (for Hepatitis C) in combination with or
without Lamivudin for Hepatitis B. The early virologic
response (HCV with the negative PCR method), i.e. after 4
weeks of treatment, was noted in 20% of the treated
patients; lowering of HCV concentration was observed in
60% and no changes – in 20 % of the treated patients,
depending on the genotype of the virus. Complete virolog-
ic response was received in 78% of children after 24 weeks
of treatment, stable one – in 71% 6 months after the end of
the treatment. The results less efficient were received during
treatment of children with chronic virus hepatitis B. The
early virologic response was received 12 weeks after the
start of the treatment, the full virologic response was
observed only in 45% of the treated patients 24 weeks after
the start of the treatment.
L-50
CHALLENGES IN INFECTION PREVENTION
AND CONTROL IN DEVELOPING COUNTRIES
M. A. Borg, Msida, Malta
The prevention and control of infections within health care
settings remains a major challenge for all health profes-
sionals. Health care associated (or nosocomial) infections
have been shown to pose a significant burden of mortality
and morbidity throughout the world. In addition, they
absorb a substantial portion of every hospital’s financial
budget in the management and treatment of infections,
many of which are preventable. Infection control principles
are very much the same throughout the world and focus
primarily on the reduction or elimination of the transmis-
sion of micro organisms from a source to a host, either a
patient or a healthcare professional. Achieving this goal is
also fundamentally identical irrespective of whether the
health care entity is found within a developed or a devel-
oping country.
However developing countries, mainly as a result of limited
resources, often face additional problems in achieving sat-
isfactory levels of infection control. These are usually multi
factorial and particularly include lack of trained personnel
to spearhead infection control programmes. In addition,
deficiencies within the environment may predispose to
overcrowding, low rates of hand hygiene due to inade-
quate facilities as well as difficulties in isolating patients
colonised or infected by multi resistant organisms such as
MRSA. In addition, infection control professionals in devel-
oping countries often face major socio-cultural challenges
in order to affect the change necessary to implement effec-
tive infection prevention. Nevertheless, success stories do
occur and serve as a useful template for others. These often
find their basis in improved education and better network-
ing, which has been shown to be extremely effective in
increasing dissemination of knowledge and awareness.
The session will attempt to define the current epidemiology
and drivers of healthcare associated infections in develop-
ing regions of the globe, using MRSA as a model, focusing
on the results of the ARMed study as a template. It will iden-
tify the challenges and initiatives adopted by infection con-
trol practitioners in the various countries and regions to
address the challenge of HAI within the resources available
to them and discuss the world-wide efforts of the
International Federation of Infection Control (IFIC) to mini-
mize the risk of HAI through development of a network of
infection control organizations as well as indicate possibil-
ities for delegates to participate in these initiatives.
Keywords: Infection control, developing countries, healthcare relat-
ed infections
L-51
IMPACT OF MICROBIOLOGICAL RESEARCH IN
SYSTEM OF THE INFECTION CONTROL IN
KAZAKHSTAN
Kotova A.L, Shakenova Z. E.
Microbiological investigation implemented in the medical
facilities helps to effectively find sources, transmission
routes and factors of the infection. It can also help to see
dynamics of etiological agent accumulation and elimina-
tion, which allows specifying the level of environmental
safety or danger. It also allows implementation of retro-
spective analysis for optimization of treatment and preven-
tive activities.
Keywords: Microbiological investigation
L-52
NOSOCOMIAL URINARY TRACT
INFECTIONS – WHAT CAN WE IMPROVE?
Kurt G. Naber
Technical University of Munich, Munich, Germany
Urinary tract infections (UTI) are responsible for 40-60% of
all nosocomial infections. Thus, nosocomially-aquired uri-
nary tract infections (NAUTI) have a great impact on clini-
cal medicine. Increased age of patients and multimorbidity
renders hospitalised patients susceptible for infection.
NAUTI are almost exclusively complicated UTI and consist of
a very heterogeneous group with a common feature of com-
plicating factors such as:
anatomical, structural or functional alterations in the urinary
tract, which have urodynamic impact (i.e. stents, instrumen-
tation, kidney stones, tumours, neurologic disorders);
impairment of renal function by renal, pre-or postrenal
nephropathies (i.e. analgesics, renal insufficiency, heart
insufficiency) accompanying diseases which deteriorate the
immune system (i.e. diabetes mellitus, liver insufficiency,
62
immunosuppression, AIDS, hypothermia)
The bacterial spectrum shows a large variety with often mul-
tiresistant strains.
Diagnosis should encompass symptoms, findings, clinical
investigation, microbiological investigation of urine, blood
cultures, clinical chemistry, sonographic and if need endo-
scopic and radiological investigations, as well as an evalu-
ation of organ functions. The CDC recommendations for the
diagnosis of NAUTI should be followed for surveillance.
There UTIs are divided into symptomatic and asymptomatic
infections. In two internet-based one-day-prevalence studies
on NAUTI performed in 2003 and 2004 in Europe and
Asia the data of 6033 hospitalised urological patients in
194 different urology departments were screened (1,2).
Detailed reports on 727 patients with NAUTI were provid-
ed. The prevalence of NAUTI was 11% in the combined
analysis. The largest group was asymptomatic bacteriuria
(29%) followed by cystitis (26%), pyelonephritis (21%), and
urosepsis (12%). The most commonly reported pathogen
was Escherichia coli (31%), followed by species of
Pseudomonas (13%), Enterococcus (10%), Klebsiella (10%),
Enterobacter (6%) and Proteus (6%). Candida spp. and
Pseudomonas spp. occurred significantly more frequently as
causative agents in urosepsis than in other types of infec-
tions. The resistance of E. coli, Klebsiella and Proteus spp.
was below 45% for the most commonly used antibiotics.
Enterococcus spp. and Pseudomonas spp. however, had
resistance rates above 70% to most antibiotics. A total of
56% of the hospitalized urological patients were receiving
antimicrobial therapy on the study day; 46% for prophylax-
is, 26% for microbiologically proven UTI, 21% for only clin-
ically suspected UTI and 7% for other infections. The most
commonly used antibiotics were fluoroquinolones (35%),
cephalosporins (27%), penicillins (16%), aminoglycosides
(15%), and co-trimoxazole (9%).There were significant dif-
ferences between regions and types of hospitals.
Approximately 80% of nosocomial UTI are associated to uri-
nary catheters and another 5 to 10% arise after instrumen-
tation. A special feature of the catheter-associated UTI is the
biofilminfection. However, a biofilmin fection is not limited
to urinary catheters or stents, but can also be associated
with urolithiasis, scar- or necrotic tissue, and obstructive.
Bacteria in biofilm in copious amounts are integrated in
anorganic or organic material and are by far more resistant
than their floating counterparts. Mere chemotherapy nor-
mally cannot eradicate the pathogens. Therefore, the infec-
tious biofilm must be removed (replacement of catheter,
removal of kidney stones).
Urosepsis is almost exclusively due to complicated/nosoco-
mial UTIs and comprises approximately 25% of all sepsis
cases, whereby obstructed uropathy of the upper or lower
urinary tract is the main underlying condition. The optimal
management of urosepsis comprises four major aspects: 1.
Control of the complicating factor; 2. Optimal pharmaco-
dynamic exposure to antimicrobials both in plasma and in
the urinary tract; 3. Supportive, early goal directed thera-
py; 4. Specific sepsis therapy. The rapid identification and
control of the septic focus in the urinary tract, the adequate
initial antibiotic therapy and the early adequate tissue oxy-
genation is critical in the successful management of a
patient with severe urosepsis. To achieve this goal an opti-
mal interdisciplinary approach encompassing emergency
unit, urological specialties and intensive-care medicine is
required.
References:
1. T.E. Bjerklund Johansen, M. Cek, K.G. Naber, L.
Stratchounski, M.V. Svenden, P. Tenke: Hospital acquired uri-
nary tract infections in urology departments: pathogens, sus-
ceptibility and use of antibiotics. Data from PEP and PEAP-
studies. Int J Antimicr Agents 28 S: S91-S107 (2006)
2. T.E. Bjerklund Johansen, M. Cek, K. Naber, L.
Stratchounski, M.V. Svendsen, P. Tenke, on behalf of the PEP
and PEAP study investigators, the board of the European
Society of Infections in Urology. Prevalence of hospital-
acquired urinary tract infections in urology departments.
European Urology 51:1100-1112 (2007)
Corresponding Address:
Prof. Dr. Dr. h.c. Kurt G. Naber
Karl-Bicklederstr. 44c
D-94315 Straubing Germany
Tel:+49-9421-33369
kurt@nabers.de
L-53
USE OF MOLECULAR TYPING METHODS IN
INFECTION CONTROL
Padman Jayaratne
Rapid emergence and ever increasing hospital-acquired
infections (HAI) with decrease susceptibility to antimicrobial
drugs and the high morbidity, mortality and costs associated
with these infections has driven us to find more effective and
efficient approaches to aid in the diagnosis and epidemiolog-
ic analysis of HAI to control them. Microbiological element is
an essential part of infection control which complements clin-
ical infection surveillance during an epidemic investigation by
comparing bacterial isolates to determine whether they are
distinct or indistinguishable from each other. Knowledge of
pathogen distribution and relatedness is essential to determin-
ing the epidemiology of infections and helping in the design
of effective pathogen control measures. During the past two
decades there have been many molecular typing methods
with a higher degree of discriminatory power, reproducibility
and typeability than conventional phenotypic typing methods
has developed to identify the most accurate genotypic relat-
edness among pathogens responsible for infections.
Molecular methods can be very effective in source tracking
and determining the spread of pathogens which would allow
infection control team to act promptly to take necessary
action. This will lead to improved patient health and econom-
ic benefits through the reduction of infections. A few molecu-
lar typing methods are based on the molecular heterogeneity
of expressed proteins such as essential metabolic enzymes
whereas many other methods are based on the nucleic acid
heterogeneity. The nucleic acid-based methods could be
broadly categorized into four main groups. (1) Plasmid DNA
analysis, (2) Restriction fragment length polymorphism-based
methods (RFLP), (3) PCR amplification-based methods, and
(4) DNA sequence-based methods. An overview and a com-
parison of these different nucleic-acid based molecular typing
methods with special reference to the techniques, limitations,
advantages, and disadvantages of each method will be pre-
63
sented. Since molecular typing methods are expensive when
evaluating and selecting a typing method to use in study of
HAIs one should first have the objective and the need to use
a molecular epidemiologic approach clearly defined. The
investigator also should have knowledge on the genotypic
characteristics and genetic heterogeneity of the pathogen
under investigation. Finally, the selection criteria for finding a
suitable molecular typing method in an investigation and the
interpretation of results will also be discussed.
L-54
EPIDEMIOLOGY OF DRUG-RESISTANCE IN
S.PNEUMONIAE
P. Appelbaum, Hershey, USA
Since their first description more than 35 years ago, strains
of Streptococcus pneumoniae resistant to ß-lactams and
other classes of drugs (macrolides, trimethoprim-sul-
famethoxazole, tetracyclines, chloramphenicol) have
increased greatly and are now encountered, to a greater or
lesser degree, all over the world. Apart from Hong Kong
and some countries in Central and Eastern Europe,
quinolone resistance in pneumococci is still rare. Although
introduction of a pediatric conjugate vaccine has greatly
reduced systemic infections (bacteremia, meningitis)
caused by the usually encountered clones of drug-resistant
S.pneumoniae, this dramatic decrease has not been found
in community-acquired respiratory tract infections (includ-
ing pneumonia, sinusitis, otitis media, and acute exacerba-
tions of chronic bronchitis). Indeed, a pan-resistant non-
vaccine type 19A pneumococcal clone resistant to all
antibacterials approved for pediatric use by the FDA has
recently been described in babies with severe otitis media,
and seems to be spreading all over the world. The latter
clone can only be treated at the moment by levofloxacin,
moxifloxacin and gemifloxacin (compassionate use only).
With the exception of this clone, pneumococcal communi-
ty-acquired respiratory tract infections that do not require
hospitalization may conveniently be treated by oral amox-
icillin/clavulanate, especially the preparation with the
higher dose of amoxicillin. The three quinolones described
above may also be used in adults, especially in cases
where patients require hospitalization, such as older
patients with acute exacerbations of chronic bronchitis.
Because a significant percentage of drug-resistant pneumo-
cocci are also non-susceptible to macrolides, these drugs
should probably be restricted to cases of pneumonia in
which Chlamydophilia pneumoniae, Mycoplasma pneumo-
niae, and Legionella pneumophilia are suspected. The inci-
dence of drug-resistant pneumococci in countries near
Central Asia such as the entire Middle East is very high and
there is a pressing need for pneumococcal susceptibility
surveys throughout all the countries in Central Asia so that
directed therapy may be provided.
Keywords: Epidemiology, drug-resistance, S. pneumoniae,
community-acquired
Oral Presentations: Part I
28 March 2008 14:00- 16:00
Hall Almaty
O-01
The Changing Epidemiology of MRSA isolated in Kuwait
hospitals
Udo Edet E, Al-sweih Noura, Mathew Bindu, Noronha
Bobby, Kuwait University, Kuwait
O-02
Biofilm and Antibiotic Resistance in Diabetic Foot Infections
Aziz Mubashar, Baqai Rakhshanda, Karachi, Pakistan
O-03
Characterization of Pseudomonas aeruginosa isolated
from clinical and environmental samples in Minia, Egypt:
Prevalence, antibiogram, and resistance mechanisms
Fadl Gamal, El-domany Ramadan, Zaki Sahar, Ashour
Hossam M, Cairo, Egypt
O-04
Influenza polymerase subunits compatibility between
human H1 and H5 viruses
Li Olive Tin Wai, Poon Leo Lit Man
Hong Kong, China
O-05
Needle Prick Injuries in King Fahd General Hospital-
Jeddah, Saudi Arabia: A Nine Year Survey
Halwani Muhammad Abdul Rahman, Khayyat Inass Abdul
Rahman, Jeddah, Saudi Arabia
O-06
Genomic signatures of food-associated Enterococci
Bolotin Alexander, Barbe Valerie, Botina Svetlana,
Quinquis Benoit, Tanganurat Winee, Couloux Arnaud,
Weissenbach Jean, Ehrlich S. Dusko, Jouy en Josas,
France, Evry, France, Moscow, Russia, Bangkok, Thailande
O-07
Identification of integrons and drug resistance genes in
clinical isolates of extraintestinal Escherichia coli
Haque Abdul, Bashir Saira, Mohsin Mashkoor, Ali Aamir,
Haque Asma, Sarwar Yasra, Tariq Ayesha, Faisalabad,
Pakistan
64
O-08
Current and symptoms of pneumococcus and hemophillus
meningitis among children. The results of the cure of bacte-
rial meningitis by Interleukin-2
Yeraliyeva Lyazzat Tasbulatovna, Almaty, Kazakhstan
O-09
The survey of common bacterial contamination in bottled
mineral water in Iran (2006)
Mardani Masoud, Gachkar Latif, Simin Najar Pyrayeh, Ali
Asgari, Bahareh Haji Khani, Reza Amiri, Tehran, Iran
O-10
In-Vitro Growth Inhibitory Properties of Natural Plant
Products against MDR Mycobacterium tuberculosis Strains
Kazmi Shahana Urooj, Bibi Nazia, Ali Shaiq, Ahmed
Vaqaruddin, Fahim Rashida, Sadique Ashraf, Ifzal
Rehana, Karachi, Pakistan
O-11
The Study of Antioxidant and Antimicrobial Activities of the
Rosmarinus Officinals Extracts
Ebadi Abdol Ghaffar, Jouybar, Iran
O-12
A Study on Association of H. pylori infection in Coronary
Heart Disease
Khan Dr Zaheer-ullah, Sherwani Sikandar Khan, Kazmi
Shahana Urooj, Karachi, Pakistan
O-13
The Therapy Óf Parasitic Mix-Invasions
Sergey Kozlov, St-Petersburg, Russia
O14
The effect of hospitalization of patients with pulmonary
tuberculosis during the intensive treatment phase on sec-
ondary family transmission—Dushanbe, Tajikistan,
December 2003-May 2006
Davlyatov Firuz S, Almaty, Kazakhstan
O-15
Alterations of the immune system after blood transfusions
and prognosis in patients affected bay colorectal cancer:
our assessment follow-up five years after surgery
Buda Francesco, Udine, Italy
O-16
Vaccination strategies against toxoplasmosis: past and
future
Doskaya Mert, Caner Ayse, Degirmenci Aysu, Guruz
Yuksel, Izmir, Turkey
O-17
Salmonellas of rare groups - ecology, virulence and persist-
ence factors
Tabayeva Aliya, Almaty, Kazakhstan
O-18
The HIV-infection and Virus Hepatitis
Sergaliyeva Aliya, Alshinbayeva Gulnara, Astana,
Kazakhstan
O-19
Characteristics of Micro Flora of Duodenal Contain at the
Patients with Chronic Opisthorchiasis
Batyrkhan Ainur, Alshinbayeva Gulnara, Imanbayeva
Gulsara
Department of Infectious Diseases, Kazakh State Medical
Academy, Astana, Kazakhstan
O-20
Results of recombinant interleukin-1‚ treatment in patients
with chronic brucellosis
Zhankin Alimkhan, Kurmanova Gaukhar, Kurmanova
Kuliash, Kurmanova Almagul
O-21
The comparative clinical laboratory estimate of the
efficiency of the treatment for the candidasis vaginitises
S. Nurusheva, L. Almenova, Almaty, Kazakhstan
O-22
Tuberculosis in the penitentiary facilities
Rakisheva Anara, Zhandauletova Zhanar, Karaganda,
Kazakhstan
O23
Diagnosing contamination and determining effective fac-
tors on contraction of trichomonas vaginalis and gonorrhea
in female prisoners at Evin Jail Tehran, 2004
Mosaviani Zinat, Behbahani Mohammad, Afshar Parviz,
Vartanoosian Jacqueline, Tehran, Iran
O-24
The Role of Non-Governmental Organizations in
HIV/AIDS Fighting: Giresun AIDS Society Example
Torun M, Ozdemir I, Giresun, Turkey
O-25
Avian flu H5N1 vaccine
Katlinsky A.V., Korovkin S.A., Melnikov S.J., Mironov
A.N., Krasilnikov I.V., Moscow, Russia
65
O-26
New class of vaccines based on virus-like nanoparticles:
Strategy perspectives.
Katlinsky AV, Semchenko AV, KorovkinSA, Melnikov SJ,
Krasilnikov I.V., Moscow, Russia
Oral Presentations: Part II
28 March 2008: 17.30-18.30
Hall Almaty
O-27
Quality of Doctors's approach to the diagnosis and treat-
ment of tuberculosis in Turkey
Tanrikulu Cetin, Palanci Yilmaz, Eren Dagli Canan,
Gurdal Yilmaz, Karaca Mehmet, Sahin Levent, Kars,
Kahramanmaras, Trabzon, Kutahya, Turkey
O-28
Non cardiac complications of Infective Endocarditis in
Turkey
Alan Sait, Akil Ata, Kara Ali Fuad, Bilik Zihni, Kaya Ilyas,
Diyarbakir, Turkey
O-29
The role of disinfection measures in preventive mainte-
nance of nosocomial infections in hospitals
Khassenova Oral Abyzovna, Almaty, Kazakhstan
O30
Immunization problems of the hard-to-reach population’s
elements of the Republic of Kazakhstan and their settle-
ments
Kuatbaeva Ainagul Muhanovna, Ospanov Kenes
Sarsengalievich, Boshugulov Beibut, Almaty, Kazakhstan
O-31
Mutations of hepatitis C virus 1b NS5A PKR binding
region (PKRbd) before and after interferon-· treatment
Komissarov Andrey, Buzitskaya Janna, Pisareva Maria,
Esaulenko Elena, Grudinin Mikhail, Kiselev Oleg
Saint-Petersburg, Russia
O-32
Rapid diagnosis and anti fungal susceptibility testing of
clinically important Candida species
Javaid Sayyada Ghufrana, Kazmi Shahana Urooj,
Karachi, Pakistan
O-33
Diagnosing contamination and determining effective fac-
tors on contraction of trichomonas vaginalis and gonor-
rhea in female prisoners at Evin Jail Tehran, 2004
Mosaviani Zinat, Behbahani Mohammad, Afshar Parviz,
Vartanoosian Jacqueline, Tehran, Iran
O-34
Yersinios in Kazakhstan
Z. Suleimenova, Almaty, Kazakhstan
 ORAL PRESENTATIONS
Oral Presentations: Part I
O-01
The Changing Epidemiology of MRSA isolates in Kuwait
hospitals
Udo Edet E, Al-Sweih Noura, Mathew Bindu, Noronha
Bobby
Department of Microbiology, Faculty of Medicine,
Kuwait University, Kuwait.
Methicillin-resistant Staphylococcus aureus is an important
pathogen causing infections in healthcare facilities and in
the community. The aim of this study was to determine
changes in antibiotic resistance and clonal patterns of
MRSA isolated in Kuwait hospitals over time. Results of
antibiotic susceptibility testing and pulsed-field gel elec-
trophoresis (PFGE) were used to determine the clonal types.
A total of 1,312 MRSA isolates were obtained from 14
hospitals during three surveillance periods in 1999 (258
isolates), 2002 (466 isolates) and 2005 (588 isolates).
Twelve MRSA clones, designated PFGE types 1-12, were
identified during the surveillance periods. The types 1, 3, 4,
5, 6 and 8 clones were multiresistant to gentamicin,
kanamycin, streptomycin, erythromycin, clindamycin, tetra-
cycline, trimethoprim, ciprofloxacin and fusidic acid where-
as the other clones were non multiresistant. While type 1
clone was the most common clone in most of the hospitals,
the other clones were less widely distributed. Although the
type 1 clone declined from 78.7% of MRSA isolates in
1999 to 44.7% in 2005, the types 2 and 3 clones showed
increasing trends. The type 2 clone increased from 5.8% in
1999 to 10.3% in 2005 and the type 3 clone increased
from 3.9% in 1999 to 28% in 2005. The prevalence of non
multiresistant strains, consisting of the epidemic MRSA-15
clone and community-associated MRSA, increased from
5.2% in 2001 to 21.6% in 2005. This study has defined the
major MRSA clones and their changing epidemiology in
Kuwait hospital.
Keywords: Antibiotic resistance, MRSA, molecular typing, PFGE
O-02
Biofilm and antibiotic resistance in diabetic foot infections
Aziz Mubashar, Baqai Rakhshanda
University of Karachi, Karachi, Pakistan
Foot infections are one of major complications of Diabetes
mellitus Biofilms are complex communities of surface
attached microorganisms and exist in all settings where
bacteria are present in hydrated environment. The objec-
tive of study was to identify pathogens causing foot infec-
66
tion and their antibiotic sensitivity pattern. Biofilm produc-
tion and factors contributing towards non healing ulcers
was also determined. 100 pus samples from patients with
diabetic foot infection along with clinical history were col-
leted from different hospitals of Karachi. Specimens were
cultured on selective media, identified by standard bio-
chemical tests and Quick test strip (QTS.) Antimicrobial sus-
ceptibility testing was done by Disc diffusion method.
Biofilm were determined by simple flow tube and its opti-
mal density measured by quantitative Spectrophotometer
assay and ELISA. Biofilm structure was analyzed by scan-
ning electron microscopy. Results indicated that 85% were
males15% were females in the age group between 40 to
60 years and duration of diabetes was greater than 10
years. Some had toe or below knee amputations. Major
isolates were Staphylococcus aureus 30%, Streptococci
28%, Pseudomonas spp.27%, Proteus mirabilis 18%,
Klebsiella spp, 15%, Enterococcus faecalis 10%, E. coli 8%,
and anaerobes 3%. Antibiotic sensitivity pattern indicated
multi drug resistant strains 40% of isolates were having
property of biofilm formation and resistance to different
antibiotics. As immune system is defective in diabetic
patients, limb threatening infections were polymicrobial
and multi drug resistant organisms were isolated having the
property of biofilm production.
Keywords: Diabetic foot infection, Antibiotic resistance, Biofilm
O-03
Characterization of Pseudomonas aeruginosa isolated
from clinical and environmental samples in Minia, Egypt:
Prevalence, antibiogram, and resistance mechanisms
Fadl Gamal1, El-domany Ramadan2, Zaki Sahar3,
Ashour Hossam M4
1
Department of Microbiology and Immunology, Faculty of
Pharmacy, Minia University, Cairo, Egypt
2
Department of Microbiology and Immunology, Faculty of
Pharmacy, Helwan University, Cairo, Egypt
3
Department of Environmental Biotechnology, Genetic
Engineering and Biotechnology Research Institute,
Mubarak City for Scientific Research and Technology
Applications, Alexandria, Egypt
4
Department of Microbiology and Immunology, Faculty of
Pharmacy, Cairo University, Cairo, Egypt
Objectives: To assess the prevalence, levels of antimicrobial
susceptibility and resistance mechanisms of Pseudomonas.
Methods: A total of 445 clinical isolates and 200 environ-
mental isolates were collected from three hospitals in
Minia, Egypt. The minimum inhibitory concentrations for
different antibiotics were determined using the agar dilu-
tion method. The isolates were tested for ‚-lactamase pro-
duction and for the presence of efflux pumps. Results: Out
of the 445 clinical specimens, 107 Pseudomonas strains
(24 %) and 81 P. aeruginosa strains were isolated (18.2
%). Out of the 200 environmental specimens, 57
Pseudomonas strains (28.5 %) and 39 P. aeruginosa
strains were isolated (19.5%). Amikacin was the most
active drug against P. aeruginosa followed by meropenem,
cefepime, and fluoroquinolone. P. aeruginosa was highly
resistant to all other antibiotics tested. The environmental
isolates of P. aeruginosa exhibited higher antibiotic resist-
ance than clinical isolates. Mechanisms of resistance used
by P. aeruginosa included ‚-lactamase production and mul-
tiple drug resistance efflux pumps. Our results showed that
29 (36%) of the clinical P. aeruginosa isolates and 37
(95%) of the environmental P. aeruginosa isolates were ‚-
lactamase producers. In addition, P. aeruginosa isolates
effectively used an efflux-mediated mechanism of resist-
ance against ciprofloxacin and meropenem, but not gen-
tamicin or cefotaxime. Conclusion: This study covered the
prevalence of P. aeruginosa, and its susceptibility patterns
to different antibiotics. The presence of antibiotic resistant
P. aeruginosa isolates could be attributed to ‚-lactamase
production and the use of multiple drug resistance efflux
pumps.
Keywords: Nosocomial infections, Antibiotics, Beta-lactamase,
Efflux pumps
O-04
Influenza polymerase subunits compatibility between
human H1 and H5 viruses
Li Olive Tin Wai, Poon Leo Lit Man
The University of Hong Kong, Hong Kong
Influenza A virus belongs to the Orthomyxoviridae family
and remains to be medically important throughout cen-
turies. The last two pandemic strains, H2N2 in 1957 and
H3N2 in 1968 possessed also a polymerase subunit from
their avian counterparts. Whereas the properties of the
viral trimeric polymerase complex formed by polymerase
basic 2 (PB2), polymerase basic 1 (PB1), and polymerase
acid (PA) were suggested to play part in adaptation and
virulence of H5N1 in mammalian species. Better under-
standings on the compatibility between influenza poly-
merase subunits from different stains would therefore be
extremely important for influenza pandemic preparedness.
Recombinant viruses with single polymerase genes
swapped up between H1 and a H5 strain were generated
by a plasmid-based reverse genetics system. All studied
polymerase recombinants were viable however with a
diverse phenotype and growth kinetics. The luciferase-
reporter based polymerase transcriptional activity analyses
and primer extension studies revealed that polymerase con-
stellations associated with their functions. Furthermore,
67
investigation on the virulence of these mutants in small ani-
mal is currently undergoing. Results from this study
revealed that the compatibility between avian and human
viral polymerase subunits could be complex. This studied
model might allow elucidating the prerequisites for the
reassortment of polymerase genes from different strains.
Further efforts will be made to identify the cause of this
alternated function, which might help to identify the
requirements for an avian influenza polymerase in achiev-
ing an effective function in mammalian species, which may
help to predict the possibility of an avian H5N1 viral poly-
merase to fully adapt in humans.
Keywords: Influenza, Polymerase, PB2, PB1, H5N1
O-05
Needle Prick Injuries in King Fahd General Hospital-
Jeddah, Saudi Arabia: A Nine Year Survey
Halwani Muhammad Abdul Rahman, Khayyat Inass Abdul
Rahman
King Fahd Hospital, Infection Control Department, Jeddah,
Saudi Arabia
Introduction: Accidental needle prick injuries sustained by
healthcare workers are regarded as occupational hazards
in healthcare settings. AIM: To study the epidemiology of
needle prick injuries in an 800-bed Saudi hospital and
identify possible contributing factors. Method/Approach:
A retrospective study was undertaken on all needle prick
and sharp injuries reported by the hospital workers
between 1998-2007. Outcome: During the 9-year period,
112 healthcare workers reported incidents of needle prick
or sharp injuries. Of these, 50% were staff nurses, 21%
house keepers, and 14.20% were doctors. Circumstances
associated with the injuries included 34% accidents, 22%
during handling medical waste bags, and 12% because of
recapping. Most of the injuries took place during morning
duties (60%) compared to the evening (20.5%) or night
duties (12%). Only 50% of the reported injuries had a
known serology source; 55% of these 56 known serology
sources had positive HCV results, 20% HBsAg and 9% HIV.
Post exposure follow-up showed zero seroconversion.
Discussion: The study revealed that there is underreporting
and poor hospital staff knowledge in the safe disposal of
medical wastes. RECOMMENDATIONS: There is an urgent
need to raise awareness and train hospital staff regarding
the safe disposal of medical wastes.
Keywords: needle prick injuries, retrospective study
O-06
Genomic signatures of food-associated Enterococci
Bolotin Alexander1, Barbe Valerie2, Botina Svetlana3,
Quinquis Benoit1, Tanganurat Winee4, Couloux Arnaud2,
Weissenbach Jean2, Ehrlich S. Dusko1
1
Genetique Microbienne, INRA, Jouy en Josas, France
2
CNS, Evry, France
3
GNIIgenetika, Moscow, Russia
4
Kasetsart University, Bangkok, Thailande
Enterococci (Group D streptococci by Lancefild serological
classification) are widely spread in the nature and show a
large spectrum of interactions with the host. They are com-
mensal occupants of the intestinal tract of humans and ani-
mals, are used in preparation of certain types of cheese
and sausage, but also are recognized as casual agents in
many food born and life-threatening nosocomial infections.
This group is under intensive survey since identification of
Vancomycin Resistant Enterococci (VRE) as one of most
important nosocomial pathogens of the 1990’s, including
comprehensive genetic approaches as MLST
(www.mlst.net) and genome sequencing. Following the first
genome sequencing of E. faecalis [Paulsen et al, 2003]
genomes of other clinical isolates of two E. faecalis and
three E.faecium strains are now being sequenced
(www.genomesonline.org). E. faecium, an ubiquitous colo-
nizer of humans and animals, has evolved in the last 15
years from an avirulent commensal to the third most fre-
quently isolated nosocomial pathogen among intensive
care unit patients in the United States. Strain E. lactis
CK1114 was isolated from cheese of “Brynza” type in
Stavropol region of Russia [Botina & Sukhododolets,
2006]. It has lactic acid bacteria metabolic profile and bet-
ter adaptation than other isolates of E. faecium group to
food-related environment. Its chromosome is 2.68 Mb long.
This strain had been selected for genome sequencing and
comparative genome analysis with other Enterococci to
identify genetic determinants related to the constraints of
the environmental niches and inhabitants.
Keywords: Enterococcus genomics
O-07
Identification of integrons and drug resistance genes in
clinical isolates of extraintestinal Escherichia coli
Haque Abdul, Bashir Saira, Mohsin Mashkoor, Ali Aamir,
Haque Asma, Sarwar Yasra, Tariq Ayesha
Health Biotechnology Division, National Institute for
Biotechnology and Genetic Engineering (NIBGE),
Faisalabad, Pakistan
The extraintestinal strains of Escherichia coli are distinct
68
from commensal and intestinal pathogenic strains by virtue
of their functionally unique virulence factors and multiple
drug resistance. Twenty six local isolates of extra intestinal
E. coli were studied for drug resistance genes and inte-
grons. All isolates were resistant to at least two drugs. Four
isolates showed resistance to all seven drugs used. All the
isolates were resistant to ampicillin. For other drugs, 20
(77%), 7 (27%), 10 (38%), 17 (65%) and 21(81%) resistant
isolates were observed for tetracycline, chloramphenicol,
ciprofloxacin, sulfonamide and streptomycin respectively.
Chloramphenicol was the antibiotic against which least
resistance was observed. The respective targeted drug
resistance related genes were tem ß lactamase, tet B, cat P,
gyr A, sul II, and aadA 1. The results of disc diffusion test
and relevant gene detection by PCR were generally similar.
When association of these drug resistance genes with inte-
grons was evaluated, it was found that amplified PCR prod-
uct of a uniform size specific for Class 1 integron was pres-
ent in 17 (65%) isolates. Further studies indicated the pres-
ence of tem ß lactamase gene in DNA extracted from these
amplicons in 5 isolates and that of tet B gene in 2 isolates.
No other drug resistance gene in our study was found to be
associated with these integrons. Class II integron was
detected in only one isolate and all isolates were negative
for Class III integrons.
Keywords: Extraintestinal E.coli, drug resistance genes, integrons
O-08
Current and symptoms of pneumococcus and hemophillus
meningitis among children:
The results of the cure of bacterial meningitis by
Interleukin-2
Yeraliyeva Lyazzat Tasbulatovna
Kazakh National Medical University, Almaty, Kazakhstan
The purpose of this work was the study of epidemiologic
and clinical peculiarities of meningites produced by
Streptococcus pneumoniae and Haemophilus influenzae in
children of the city of Almaty and substantiation of use of
Roncoleukin in the complex treatment of acute bacterial
meningites of staphylococcal, pneumococcal, and hemo-
philic etiology. The data of observation of the children
admitted to the Children’s Infectious Clinic of the city of
Almaty with the diagnosis of purulent meningitis for the
period from 2001 till 2005 were analyzed. Prevalence of
pneumococcal meningites in the structure of bacterial
meningites of non-meningococcal nature and change of the
specter of antibacterial sensitivity of pneumococcus was
revealed. High sensitivity of pneumococcus to Ceftriaxon –
56.4%, Ceftazidin – 40%, Cefurozim – 35% was noted,
residual impairments in the psycho-neurological status of
different degree are observed in more than 1/3 of children
after the disease. Hemophilic meningitis prevails in children Keywords: Bottled mineral water, bacteria, contamination, com-
at the age from 1 to 6 months and from 5 to 7 years; sea- mensals
sonal fluctuation is expressed – in one half of the cases chil-
dren were admitted in the summer time, gradual onset of O-10
the disease with increase of symptoms within 48-60 hours In-Vitro Growth Inhibitory Properties of Natural Plant
dominated, the principal unfavorable prognostics of Hib Products against MDR Mycobacterium tuberculosis Strains
meningites were development of ventriculitis and cerebral
edema. Increase of Hib strains resistant to penicillin antibi- Kazmi Shahana Urooj1, Bibi Nazia1, Ali Shaiq2, Ahmed
otics, aminoglycosides, and levomicytin was discovered. Vaqaruddin2, Fahim Rashida4, Sadique Ashraf3, Ifzal
Expressed immuno- and indirect detoxicating effect of Rehana4
Roncoleukin in the form of acceleration of liquor sanitation,
1
Immunology and Infectious Disease Research Laboratory,
shortening of infusion and antibacterial therapy, decreased Department of Microbiology -University of Karachi,
time of inpatient treatment. Karachi, Pakistan
Keywords: Bacterial meningitis, Streptococcus
2
HEJ Research Institute of Chemistry, University of Karachi,
Karachi, Pakistan
pneumoniae, Haemophilus influenzae, Roncoleukin.
3Ojha Institute of Chest Disease, Karachi, Pakistan
4
Department of Chemistry, University of Karachi, Karachi,
O-09
Pakistan
The survey of common bacterial contamination in bottled
mineral water in Iran (2006)
The plant-based traditional medicines play an essential role
in primary health care in the third world countries. TB –a
Mardani Masoud, Gachkar Latif, Simin Najar Pyrayeh, Ali
disease caused by M. tuberculosis, is the leading cause of
Asgari, Bahareh Haji Khani, Reza Amiri
death in Pakistan and other countries of the world. The
Department of Infectious Diseases, Shaheed beheshti
alarming increase of multi-drug-resistant (MDR-TB) TB
Medical University, Tehran Iran
cases calls for renewed efforts to develop new anti-TB
drugs. In this study, clinical strains of Mycobacterium tuber-
Background: Bottled mineral water, generally considered
culosis were screened against the 1st line anti-TB drugs by
more pure than tap water in developing countries. To deter-
resistant ratio method. All isolates were also screened
mine the risk of common bacterial contamination of com-
against twenty crude organic plant extracts, their fractions
mercial bottled mineral water in Iran, we conducted this
and pure compounds by absolute concentration method.
study in 2006. Material and Method: The design of the
Out of 120 isolates tested, 79 (66%) were completely sus-
research is descriptive study. 68 samples (35 brand named
ceptible to all 4 first line anti-TB drugs and the remaining
company) of bottled mineral water was collected from dif-
isolates were resistant to either single or multiple drugs.
ferent province of Iran. Initially 200 ml of bottled water was
Among them, 13% were found to be resistant to isoniazid
filtered with 0.45 micrometer pore (Sartorius).The filter was
alone followed by 3% to rifampicin, less than 3% to strep-
divided by sterile pence and scissor to multiple pieces, sus-
tomycin and none of the isolates was found to be resistant
pension in nutrient broth and centrifuged. The culture was
to ethambutol alone while multi- drug resistance was
made by use of different selective media. The bacterial con-
observed in 13% of all tested isolates. Majority of the plant
tamination were detected after incubation in 42ºc, 35ºc
extracts exhibited activity for MDR and non-MDR- TB
and 25ºc for 24 h, 48h and 7 days. Results: Out of 68
strains at 2.5 and 5 mg/ml, whereas the MICs of the frac-
samples of bottled mineral water (35 brands), 41 samples
tions and pure compounds obtained from different plants,
(60%) showed evidence of contamination with common
inhibited the growth at a much lower concentration. The
bacterial, including 15 samples (36%) Gram-positive spore
bioactive anti-TB components isolated from S. recemosa
forming bacilli, 20 samples (49%) Gram-positive non spore
and P. armeniaca (a commonly used fruit) can serve as an
forming bacilli (diphteroids) and 6 samples (15%) Gram-
alternative source for developing new Anti-TB antibiotics
positive cocci. The marker organisms, i.e. the classic fecal
provided they prove to be effective and non-toxic in animal
contamination indicators were not detected in any of the
studies and clinical trials.
samples. Conclusion: This finding indicated that the use of
Keywords: Antimycobacterial activity, Medicinal Plants, Multi-
bottled mineral water in immunocompotent persons is safe,
drug Resistant M. tuberculosis
but the use of this bottled mineral water in immunocompro-
mised patients should be done with meticulous precaution.
Some of bacteria were known human commensals suggest-
ing contamination of waters prior to bottling. It is recom-
mended that bottling, packaging and distribution of this
water should be done more surveillance.

69
O-11
The Study of Antioxidant and Antimicrobial Activities of
the Rosmarinus Officinals Extracts
Ebadi Abdol Ghaffar
Department of Biological Sciences and Medicinal plants,
Islamic Azad University, Jouybar Branch, Jouybar, Iran
Tannins and essential oils are potent antimicrobial and
antioxidant agents, with positive effects on human health.
Rosmarinus officinals L. (Labiatae Family) is one of the less
studied plants in Iran for above properties. The whole and
fresh parts of Rosemary samples collected in Mazandaran
Province in the north of Iran, except root parts,were extract-
ed with EtOH and an aqueous suspension of the obtained
EtOH extract was partitioned successively with CHCl3,
EtOAc and n-BuOH, leaving a residual water extract. All
obtained extracts were evaluated for their antioxidant and
antimicrobial properties. The antioxidant potential was
evaluated using following in vitro METHODS: FRAP (ferric
reducing antioxidant power) assay, and scavenging of 2,2-
diphenyl-1-picrylhydrazyl (DPPH) radical. Antimicrobial
activity was estimated using a microdilution technique
against food-borne, mycotoxin producers and human
pathogenic bacteria and micromycetes. The following bac-
teria were tested: Salmonella typhimurium, Escherichia
coli, Bacillus subtilis, Staphylococcus epidermidis,
Staphylococcus aureus, as well as micromycetes:
Aspergillus niger, Aspergillus ochraceus, Aspergillus
flavus, Penicillium ochrochloron, Penicillium funiculosum,
Trichoderma viride, Fusarium tricinctum and Alternaria
alternata. Results showed that all extracts possessed con-
centration-dependent antioxidant activity. In biological
assays, Rosmarinus officinals extracts showed antimicro-
bial activity comparable with standard antibiotics.
Keywords: Rosmarinus officinals, Antioxidant activity, FRAP,
DPPH, Antimicrobial activity
O-12
A Study on Association of H. pylori infection in
Coronary Heart Disease
Khan Zaheer-ullah1, Sherwani Sikandar Khan2, Kazmi
Shahana Urooj2
1
Bolan Medical College, Quett, Balochistan
2
Immunology and Infectious Disease Research Laboratory,
Karachi, Pakistan
Recent studies suggest that inflammatory diseases like H.
pylori associated chronic gastritis may have a significant
role in the pathogenesis of coronary heart disease. This
study was designed to determine an association of H.
pylori mediated chronic gastro intestinal disease with the
70
onset of Coronary Heart Disease (CHD) in Pakistan. Blood
samples (152) of normal individuals and patients with
coronary heart disease with Gastro- Intestinal Pathology
(GIP) were processed for detection of H. pylori specific Ig
G antibody titer by ELISA and other hematological param-
eters. Selected samples were categorized into A, B and C
group respectively. Group A included patients with the his-
tory of CHD and GIP, B included patients having a history
of CHD with GIP and diabetes and the remaining 50 blood
samples from normal individuals were included in group
C(control).In group A, 56 out of 76 patients (73.6%) were
found to posses high titers of anti H. pylori antibodies, in
group B, 22 out of36 (61%) patients had raised levels of
specific antibodies and in control group C, 22 out of 50
samples (44%) were positive for HP specific antibody. High
titers of H.pylori specific Ig G in our CHD/GIT patients as
compared to control group and diabetic/non-diabetic CHD
patients group strongly suggests its significant role in the
pathology of coronary heart disease. Changes in lipid pro-
file including slight lowering of HDL and raised fibrinogen
levels and ESR/TLC in H. pylori positive patients as com-
pared to HP negative individuals also suggested a possible
role of infection as risk factors for cardiovascular disease.
Keywords: Coronary heart disease, H. pylori, Ig G antibody
O-13
The Therapy of Parasitic Mix-Invasions
Kozlov Sergey S.
Department Parazitology and Tropical Diseases, Military
Medical Academy, St-Petersburg, Russia
Such mix-invasions as toxocarosis + giardiasis, ascaridosis
+ giardiasis, giardiasis + intestinal trichomoniasis and oth-
ers are often registered among children which have not
good sanitarian-hygienic habits. That is why it is necessary
to fulfill the complete parasitological examination of such
patients in order to make an accurate diagnosis and chose
the drugs for adequate therapy. The most effective therapy
of visceral toxocarosis and giardiasis included using of 10
Ïg/kg of Albendazole twice per day during 14 days. Such
a course excluded the use of other drugs. Giardia intesti-
nalis eradication was detected in 100% of patients after the
course of therapy. The efficacy of toxocarosis therapy was
appreciated according to elimination of clinical symptoms,
normalization of rentgenologic (X-rays) examination
results, decreasing of the eosinophile level and specific
antibody titers in pair serums. In 6 months the full recovery
was detected in 83,4% of cases. 16,6% of patients needed
the second course of etiotropic therapy.The therapy of 11
patients with ascaridosis-and-giardiasis mix-invasion
included using of 10 Ïg/kg of albendazole twice per day
during 7 days. Three-time parasitological examination
after the course of therapy allowed to detect 100% recov-
ery of patients. The therapy of patients with giardiasis-and-
intestinal trichomoniasis mix-invasion with albendazole
caused the development of severe diarrhea. Parasitological
examination after the course of therapy allowed detecting
significant quantity of Pentatrichomonas hominis and full
eradication of Giardia intestinalis. Perhaps, albendazole is
most effective against Giardia intestinalis, but ineffective
against other Flagellata, ex. Pentatrichomonas hominis.
Using of metronidazole has good clinical result in such
cases.
Keywords: parasitic diseases, toxocarosis, giardiasis, ascaridosis,
mix-invasions, treatment
O-14
The effect of hospitalization of patients with
pulmonary tuberculosis during the intensive treatment
phase on secondary family
transmission-Dushanbe, Tajikistan,
December 2003-May 2006
Davlyatov Firuz S
Applied Epidemiology Training Program, CDC/Central
Asian Regional Program, Kazakhstan
Background: In 2002, Tajikistan implemented the tubercu-
losis DOTs strategy in several districts. Although hospital-
ization is not normally required, it is still offered to pul-
monary tuberculosis (PTB) patients during the 2-month
intensive treatment phase under the assumption that it
reduces secondary family transmission. To evaluate this
assumption, we conducted a retrospective cohort study in
Dushanbe in 2006. Methods: Families, whose index PTB
patient (IP) was >17 years of age and diagnosed during
December 2003-May 2006, were investigated. IP were
ascertained in the Tuberculosis Registry. Exposed families
were that who’s IP was treated at home; in unexposed fam-
ilies, IP received hospital treatment. Secondary family cases
were those diagnosed 2-18 months after the IP’s date of
disease onset. Information on the IP’s and the families was
obtained through interviews and reviewing medical
records. Logistic regression was used to compare the odds
of an exposed family having a secondary patient to that of
an unexposed family. Results: 431 exposed families (1,608
individuals) and 179 unexposed families (723 individuals)
were enrolled. 7% (30) of exposed families and 6.7% (12)
of unexposed families had secondary cases. After adjust-
ment for the confounding effect of other factors, there was
no evidence that exposed families were more likely to have
a secondary tuberculosis patient than unexposed families
(OR=1.3; 95%CI=0.6-2.7). Conclusion: This study does not
support the assumption that hospitalization of PTB patients
reduces secondary family transmission. Therefore, our rec-
71
ommendations to health officials will be that hospitalization
may be offered to those who need it on clinical and epi-
demiological grounds.
Keywords: hospitalization, pulmonary tuberculosis, secondary
family transmission, Tajikistan
O-15
Alterations of the immune system after blood transfusions
and prognosis in patients affected by colorectal cancer: our
assessment follow-up five years after surgery
Buda Francesco
Internal Medicine, Medical Oncology, City of Udine
Hospital, Udine, Italy
Background: Several retrospective analyses showed a sig-
nificant correlation between blood transfusion (BT) and
unfavorable evolution after surgery of patients affected by
colon-rectal cancer. Other reports, however, have not con-
firmed that blood transfusion worsen the prognosis of neo-
plastic disease. Numerous alterations of the immune system
after BT have been demonstrated: several data suggest that
blood can contain substances able to cause immunosup-
pression.
Methods and Results: This study evaluated if:the survival
time of transfused cancer patients is significantly shorter
than that of un transfused ones; the association between BT
and unfavorable prognosis of cancer is significant; the
observed phenomenon is not caused by other prognostic
factors.52 pts (27M+25F, mean age 65 years) affected by
colorectal cancer(32out of them perioperatively transfused)
were examined before surgery and followed up for five
years after surgery to evaluate the influence of some prog-
nostic factors(age, staging of neoplasm, Hb concentration,
red cell number, duration of surgery and transfused blood
components)on patients survival. As expected, we observed
a significantly lower red cell number and Hb concentration
in transfused patients as compared to un transfused ones.
We observed also that, even though not statistically signif-
icant in transfused patients the tumor stage was more
advanced and the duration of surgery was longer. The sur-
vival time of transfused patients at five years after surgery
was little than that those non-transfused. Conclusion: In our
experience, the analysis of these results suggests that the
shorter survival of transfused cancer patients can be attrib-
uted to their worse clinical condition.
Keywords: Alterations of the immune system, blood transfusion,
prognosis cancer patients
O-16
Vaccination strategies against toxoplasmosis: past and
future
Doskaya Mert, Caner Ayse, Degirmenci Aysu, Guruz
Yuksel
Department of Parasitology, Ege University Medical
School, Izmir, Turkey
Toxoplasma gondii is one of the most successful protozoan
parasites infecting all warm-blooded animals, including
humans and causes serious clinical presentations. There
are no 100 % effective drugs to treat all clinical presenta-
tions. Available drugs have many side effects. The develop-
ment of a vaccine, which can prevent the consequences of
acute infection, is therefore an attractive alternative. After
classification in category B bioterrorism agents as a food
and water safety threat, the demand for a protective vac-
cine has increased. Vaccination studies against toxoplas-
mosis have increased after 1990s. Accumulated results in
animal models show that a protective vaccine candidate
must elicit Th1 immune response, IFN-Á production, CD 8+
T cells response against toxoplasmosis. Vaccination strate-
gies against toxoplasmosis mainly used DNA vaccine, puri-
fied recombinant proteins, T. gondii strains. A vaccine
using live attenuated S48 strain, developed for veterinary
purposes was unsuitable for human due to its short shelf life
and possibility of reversion to a pathogenic strain.
Currently, SAG1, SAG2, SAG3, SRS1, GRA1, GRA4,
GRA7, ROP2, MIC3, HSP30, HSP70 genes and proteins
have been used as vaccine candidate antigens and showed
partial, full, or occasionally no protection in animals
because vaccine candidate antigens were almost always
selected randomly and targeted to induce protective immu-
nity against the tachyzoite form of the parasite which
invades the host cell abruptly and immediately embeds
itself in a protective parasitophorous vacuole in the host cell
which keeps away the host immune response. Thus, the
present study first time evaluates an anti-sporozoite vaccine
candidate’s immunogenicity.
Keywords: Toxoplasma gondii, vaccination, anti-sporozoit vac-
cine candidate
O-17
Salmonellas of rare groups - ecology, virulence and per -
sistence factors
Tabayeva Aliya
Kazakh National Medical University, Almaty-Kazakhstan
The analysis of etiologic structures of salmonellosis in
Kazakhstan for last 15 years is carried out. The landscape
of the salmonellas from objects of an environment is stud-
72
ied. Zones of the limited, incidental distribution and a zone
of constant circulation of salmonellas of rare groups are
defined. 500 strains of salmonellas of rare groups various
ecotopic origins was investigated on presence of virulence
and persistence factors. All strains had adhesiveness.
Presence of plasmid of virulence defined on ability of bac-
teria to bind a crystal violet. Capable to bind crystal violet
were 10, 4±1,4 %. Plasmida contains bacteria met among
strains from an environment (16.3±2.6 %), in comparison
with strains from carriages (5.6±1.7 %) and from patients
(7.1±2.4 %) is more often. Intensity of endocellular repro-
duction of the salmonellas from an environment, in 3 times
exceeded that at the germs from people (ê<0.001).
Dermonekrotic activity had 60.9±61%, mainly strains from
an environment. Haemolytic activity had 28.0±2.0 %,
mainly clinical isolates. Synthesis of lysocim activity pos-
sessed 13.4±2.3 %, antilysocim activity – 96.8 ± 1.3 %.
RNA depolymeric ability found out at 34.6±2.1%, DNA -
at 4.8±1.0 % (ê ‹0.001). Share RNA activity strains among
the cultures from an environment, made 22.6 ± 2.9 %, from
people – 40.5-47.3%. Poly resistant strains was 63.2 ± 2.2
%, germs from people were allocated in 1.7-1.9 times more
often. Correlation between these factors was more
expressed at salmonellas from an environment and car-
riages.
Keywords: Salmonellas, ecology, virulence factors, persistence
factors
O-18
The HIV-infection and Virus Hepatitis
Sergaliyeva Aliya, Alshinbayeva Gulnara
Department of Infectious Diseases, Kazakh State Medical
Academy, Astana, Kazakhstan
A frequency of a multi-infection of B and C hepatitis and
the HIV-infection in structure of the infectious pathology has
been increased during last years that is a reflection of the
general transfer way. Significant part of HIV-infected
patients has markers of B and C hepatitis. Since hepatitis of
HIV-infected patients proceed basically in the form of the
chronic infection, they have extremely poor clinical exhibit-
ing. As a rule, complaints to depression of appetite, delica-
cy, periodic pains in the right hypochondrium are pre-
vailed. It is noted that patients have the hepatomegalia up
to 1.5-2.0-3.0 cm, with the moderate density, some
patients have joint pains. Such patients have more
expressed inflammatory and fibrotic processes in the liver
tissue, hyperactivity of the indicator enzymes of ALT and
AST, increased alkaline phosphatase, at the same time the
parameters of the general bilirubin are within normal lim-
its that is the cholestasia syndrome is not marked. The CD4-
cells level decreases less than 100 in 1 mcl, level of HIV
RNA increases more than 1000000 spears in 1 ml (PCR
method), and there are clinical signs of the immunodefi-
ciency. Thus, if a patient with the HIV-infection and chron-
ic hepatitis has clinical exhibiting or essential depression in
the CD4-cells number, clinicians face ‡ selection problem
of the optimal antiretroviral therapy plan and its combina-
tion with the chronic hepatitis treatment. Thus the combined
therapy should comprise reception of continuous long and
maximal suppression of a virus replication.
Keywords: HIV-infection, hepatitis, clinic
O-19
Characteristics of Microflora of Duodenal Content at the
Patients with Chronic Opisthorchiasis
Batyrkhan Ainur, Alshinbayeva Gulnara, Imanbayeva
Gulsara
Department of Infectious Diseases, Kazakh State Medical
Academy, Astana, Kazakhstan
Background: Despite of the majority of researches describ-
ing clinical picture of chronic opisthorchiasis, there is no
observations of qualified and quantitative structure of
microflora of duodenal content. It embarrasses the appro-
priate and adequate administration of antibacterial
drugs.The aim of this research is duodenal contain of
patients with chronic opisthorchisis exponents study.
Material and Method: 94 patients with diagnosis of chron-
ic opisthorchiasis was made on the base of clinical, epi-
demiological, laboratory results with performing
coproovoscopy by ephir-formal method and duodenal con-
tent investigation. Results: The following changes of duode-
nal content of the patients with chronic opisthorchisis were
received: in A portion - 55%, in B and C (55.5%) leucocytes
were revealed in a great number which indicates on chron-
ic inflammation of duodenum and inflammatory process in
bile excretory tract. Opisthorchial eggs were revealed in
every portions of bile. During biological investigation of
bile it was revealed 29% of cases Streptococcus faecalis;
Candida-20%; Streptococcus epidermiditis-16%.
Conclusion: The discovery at 79% of patients chronic
opisthorchisis pathogenic and conditional pathogenic
microflora from duodenal content manifests of presence in
high percentage the cases of disbacteriosis and slow
inflammatory process in bile excretory tract. In this connec-
tion we recommend to all the patients with chronic
opisthorchisis to carry out bacteriological investigation of
duodenal content at the preparation to dehelminthation
with the following administration of anti mycosietic drugs
and antibiotics of cephalosporines.
Keywords: Opisthorchisis, clinic
73
O-20
Results of recombinant interleukin-1‚ treatment in patients
with chronic brucellosis
Zhankin Alimkhan1, Kurmanova Gaukhar1, Kurmanova
Kuliash2, Kurmanova Almagul3
1
Kazakh National Medical University, Kazakhstan
2
Almaty State Doctors’ Postgraduate Institute, Kazakhstan
3
Republican Research Centre of Obstetrics, Gynecology
and Perinatology, Kazakhstan
The purpose of research was to study the recombinant
interleukin-1‚ (Betaleukin) efficiency in the treatment of the
patients with chronic brucellosis. The chronic brucellosis
patients (n=45) with resistant course of disease and severe
local disturbances. Betaleukin injected in a dose of 500 ng
per day subcutaneously ?5 on a background of ethiotropic
therapy with ciprofloxacine (1000 mg per day during 20-
30 days). At 44 of patients at once after a treatment course
the test of antigen binding lymphocytes’ (ABL) determina-
tion became negative. On the opposite, the patients with
negative or doubtful results of reaction of agglutination
(RA) had substantial growth of the contents of specific anti-
bodies. In 3-5 month after treatment in all patients the com-
plete normalization of blood parameters was observed
(lymphocytosis has disappeared, erythrocytes sedimenta-
tion rate was normalized). The relative contents of the lym-
phocyte’s basic populations (CD3 +, CD4 +, CD8 + CD16
+, CD56 +, CD95 +, CD25 +) did not differ from the same
of the healthy persons. The negative result of ABL test kept
during 1-2 years of supervision (supervision proceeds). At
3 patients the relapse of arthralgia was observed, but at
negative results of ABL and serological tests. The relapse
was observed at 3 patients through 6, 10, 12 months
accordingly. The efficiency of immunotherapy with
Betaleukin at the patients with severe course of chronic bru-
cellosis has been 93, 3 % (authentically concerning control
group - traditional therapy - P < 0.001).
Keywords: Brucellosis, interleukine-1, lymphocyte's profile
O-21
The comparative clinical laboratory estimate of the efficien-
cy of the treatment for the candidiasis vaginitises
S. Nurusheva, L. Almenova
Almaty, Kazakhstan
The frequency candidasis vaginitises was becoming almost
twice the size during last 10 years and forming now 30-45
% in the structure among pathology of the of the sexual
organ ground floor. There is the uniform ecological system
of the micro-/macro organism interaction at the mucous
membrane level of sexual tract in a basis of infectious dis-
eases pathogenesis. The vaginal microflora in norm is
characterized by great amount of the Lactobacillus which
provides an adequate level of local immune gearing. The
study of local immunity and inclusion the eubiotics in com-
plex therapy for candidasis vaginitises are making more
effective the clinical laboratory recovery.
O-22
Tuberculosis in the penitentiary facilities
Rakisheva Anara, Zhandauletova Zhanar
Karaganda State Medical Academy, Karaganda,
Kazakhstan
The systematic implementation of integrated TB activities
during the 5 years have resulted to decreasing TB morbid-
ity in 3,3 times and mortality in 2,3 times. It was happened
due to implementation in the penitentiary facilities the inter-
national standards of TB diagnosis and treatment, human-
ization of penitentiary system, decreasing the number of
inmates, improving the living conditions of prisoners, train-
ings for medical staff, which are increasing their qualifica-
tion, timely detection of TB patients by providing double
prophylactic fluorography and detection the smear positive
patients by smear microscopy examination, also isolation
of TB patients to specialized colonies. However in spite of
the achieved results for TB control in the penitentiary system
there are lot of unsolved problems: lack of medical equip-
ment and apparatuses, interruption of TB treatment which
is related with conducting investigative actions. Complete
TB service continuity has not been developed between pen-
itentiary system and civil health care sector in connection
with that about 30% of TB patients after release from pris-
ons are not continuing TB treatment thereby they remain as
“reservoir” of TB infection. There is the unsolved urgent
problem of separate isolation and treatment of TB chronics
cases. The high turnover of medical staff in the prison facil-
ities has existed, the nosocomial TB transmission and mor-
bidity among prison medical and non-medical staff has
occurred. All these questions should be solved which could
be achieved through mutual collaboration of all services
and departments, providing additional funding, medical
and social support for inmates.
Keywords: penitentiary system, tuberculosis
O-23
Diagnosing contamination and determining effective fac -
tors on contraction of Trichomonas vaginalis and Neisseria
gonorrhea in female prisoners at Evin Jail Tehran, 2004
Mosaviani Zinat, Behbahani Mohammad, Afshar Parviz,
Vartanoosian Jacqueline Nursing and Midwifery Faculty of
Shahid Beheshti University, Iran
74
Purpose: With respect to the importance of STDs, this
descriptive study was conducted to diagnose contamination
and determine effective factors on contraction of
Trichomonas vaginalis and Neisseria gonorrhea in female
prisoners at Evin Jail. Material and Method: One hundred
and fifty one subjects with at least one record of marriage
were selected. Data collection tools included a question-
naire, a checklist, and laboratory equipment including
microscope, incubator, autoclave, culture media, and digi-
tal scale. Content validity was used to validate the question-
naire and checklist. The equipment was calibrated and set
by medical engineers of Armin Teb Co. Sample from vagi-
nal secretions were taken to diagnose the microorganisms.
To observe Trichomonas vaginalis , slides were prepared
for gonorrhea; then the samples were cultured and put in
slides with appropriate staining. Results: Mean age of the
subjects was 32.08 and their mean age of marriage was
16.9. 31.1% were illiterate, 70.9% were housewife, and
29.1% were employed. 26.5% were contaminated by
Trichomonas vaginalis but no gonorrhea infection was
detected. Factors such as husband"s job, itching, burning,
and redness of vulva vaginal secretions and its foul smell;
vaginal redness and frequency had a significant relation
with contamination rate of Trichomonas vaginalis.
Discussion and Conclusion: The results showed that those
who did not apply health principles were susceptible to
contamination and contraction of the disorders. In spite of
having medical facilities, the contamination rate of the sub-
jects was relatively high. It can be concluded that the neces-
sity of obligatory medical examination, management, and
follow-up in this population has a critical importance.
Keywords: Trichomonas vaginalis, Gonorrhea, Jail
O-24
The Role of Non-Governmental Organizations in
HIV/AIDS Fighting: Giresun AIDS Society Example
Torun M, Ozdemir I
Giresun General Hospital, Giresun, Turkey
After collapse Soviet Union, Sarp Gate, the border gate
between Turkey and Georgia, has been opened in 1990.
After 1990, risky sexual behaviors increased in the
Blacksea Region of Turkey. In that period, sexually trans-
mitted diseases (STD) incidence, especially HIV/AIDS
cases, started to increase. In 1994, Giresun AIDS Society
has been founded. The Society started an educational cam-
paign to take precautions against this danger. A common,
effective and volunteer educational program has been
developed and took into the community. The educational
method was interactive. At the same time, collaboration
has been developed among governmental and other
NGOs against STDs. During the education period, STD
problem became limited in Giresun Province.
Keywords: NGOs, HIV transmission, education, community health

O-25
Avian flu H5N1 vaccine
Katlinsky A.V., Korovkin S.A., Melnikov S.J., Mironov
A.N., Krasilnikov I.V.
Microgen State Scientific Industrial Company, Moscow,
Russia
A sudden break of the influenza on the vast territory of
South East and Central Asia, the Europe, Africa and the
Near East caused by the H5N1 avian flu virus has become
a true global emergency. According to the World Health
Organization (WHO) data as of the end of 2007 330 lab-
oratory-confirmed H5N1 infections in humans were regis-
tered in different countries all over the world and 60% of
the cases ended with a lethal outcome. WHO experts antic-
ipate that the next pandemic may come soon and will be
associated with a high death toll. To create an effective
H5N1 avian influenza vaccine and thus prevent a bird flu
pandemic is “top-of-the-list” task of a day at this respect. In
2005-2006 MICROGEN State Company developed sever-
al avian influenza vaccines of different types. The pandem-
ic vaccine candidates in question were created with the
help of clinical trial evaluations made by other foreign
research teams that had been discussed at WHO meetings.
The company’s experience in influenza vaccine manufac-
turing had been considered as well. Phase I clinical trials
showed that the most rate of seroprotection and the 4-fold
seroconversion in both HI and VN is reached in the volun-
teers administrated with an inactivated subunit H5N1 avian
flu vaccine candidate adjuvanted with aluminum hydroxide
(content of HA - 15 μg and Al(OH)3 - 0,5 mg per a dose,
the strain NIBRG – 14 (A/Vietnam/1194/2004). Phase II
clinical trials proved the vaccine candidate to be an effec-
tive, safe and well tolerable formulation.
Keywords: Avian flu, H5N1 vaccine, Pandemic
O-26
New class of vaccines based on virus-like
nanoparticles: Strategy perspectives.
Katlinsky AV, Semchenko AV, KorovkinSA, Melnikov SJ,
Krasilnikov IV
Microgen State Scientific Industrial Company, Moscow,
Russia
Mictogen State Scientific Industrial Company develops and
puts into production new immunobiological preparations
taking advantage of modern technologies. Some nanotech-
nologies are among them. A virosome based vaccine strat-
egy is considered to be a highly promising approach for
antiviral vaccine development. A new generation inactivat-
ed influenza vaccine Grifor® is the first home-produced
vaccine based on virus-like nanoparticles. The public health
problem of population immunization against influenza
75
which is still acute in Russia gave rise to this development.
Vaccine Grifor® is formulated from protective surface and
internal influenza virus antigens, highly purified, which
form nanostructures sized from 90 nm to 189 nm.
Preclinical and clinical trials were performed to compare
safety, reactogenicity and immunogenicity of Grifor® and
Vaxigrip®, France. The studies proved there was difference
in neither safety nor reactogenicity of the vaccines. No sta-
tistically significant differences were found in immuno-
genicity regards to 35 μg and 45 μg dose of Grifor® vac-
cine compared to Vaxigrip® (45 μg HA). Immunogenicity
of Grifor® vaccine dosages meets CPMP EMEA criteria.
Thus, experimental clinical evidences have been obtained
that prove advantages of the vaccines based on virus-like
nanoparticles compared to traditional subunit and split
vaccines.
Keywords: a virosome vaccine, virus-like particles
Oral Presentations: Part II
O-2 7
Quality of Doctors's approach to the diagnosis
and treatment of tuberculosis in Turkey
Tanrikulu Cetin1, Palanci Yilmaz2, Eren Dagli Canan3,
Gurdal Yilmaz4, Karaca Mehmet5, Sahin Levent6
1
Department of Chest Diseases, Faculty of Medicine
University of Kafkas, Kars, 2Department of Public Health
Faculty of Medicine University of Kafkas, Kars,
3
Department of Chest Diseases Faculty of Medicine
University of Sutcu Imam, Kahramanmaras,
4
Department of Infectious Diseases Faculty of Medicine
University of Blacksea Technical University, Trabzon,
5
Department of Gynecology and Obstetrics of Medicine
University of Kafkas, Kars,
6
Department of Anesthesiology Health College, University
of Dumlup›nar, Kutahya Turkey.
Inappropriate anti-tuberculosis (TB) treatment particularly
at the beginning of the disease is an important cause of
drug resistance. Survey was performed to evaluate doctor’s
approach to the diagnosis and treatment of TB. This study
was performed in at least two cities of seven geographical
regions of Turkey. The doctors were asked to fill a question-
naire including their specialization, affiliation, experience
in TB diagnosis and treatment, etc. There were a total of
1,326 doctors mean age was 32.41 ± 6.59 years.
Statistical analyses indicated that doctors who had signifi-
cantly higher TB knowledge were those who were chest
specialists, who worked at a third stage institution, who
diagnosed TB previously, who had shorter carrier, and who
had bacteriological laboratory facilities in their institution.
Consequently, lack of knowledge on TB concerning WHO
guidelines was common. We think that detailed education
programs performed by specialists on TB control are essen-
tial for most of them.
Keywords: Tuberculosis, doctors, knowledge, diagnosis
O-2 8
Non cardiac complications of Infective
Endocarditis in Turkey
Alan Sait, Akil Ata, Kara Ali Fuad, Bilik Zihni, Kaya Ilyas
Dicle university school of medicine department of
cardiology
The aim of this study was a systematic review of the litera-
ture related to infective endocarditis associated non cardiac
complications in Turkey. Material and Method:
International databases were searched to find the pub-
lished series between February 2003 and January 2008.
Results: Data for 82 patients with the diagnosis of infective
endocarditis from 19 articles have been retrieved. Infective
endocarditis is uncommon condition, with a high degree of
morbidity and mortality. The majority of the reason under-
lying cardiac pathology was Rheumatic valvular disease in
Turkey. The majority of non cardiac complications were
systemic arterial embolism 30 of the patients, in generally,
emboli were occurred with fungi, S. aureus, followed by
neurological complications occurred 23 of patients
(ischemic cerebral infarction is the most frequent patholog-
ic lesion), Mycotic aneurysms are reported 18 of patients
by septic embolization that developed as complications of
staphylococcal endocarditis and by direct fungal invasion.
Acute renal insufficiency occurred in 8 of patients which
caries a poor prognosis, other rare complications were
reported, nephrotic syndrome, Facet Joint Arthritis by
Group B Streptococcal enfection, rectal carc›noma and its
neurological complications by Streptococcus bov›s endo-
carditis, sudden unilateral loss of vision, ruptured abdomi-
nal aortic aneurysm, peroneal neuropathy due to a
popliteal aneurysm, cerebral pyogenic ventriculitis.
Conclusions: systemic arterial embolism remain common
noncardiac complications in Turkey, followed by neurolog-
ic complications, Mycotic aneurysms, acute renal insuffi-
ciency
Keywords: Infective endocarditis, Complications, meta-analyses,
Turkey
O-2 9
The role of disinfection measures in preventive
maintenance of nosocomial infections in hospi-
tals
Khassenova Oral Abyzovna
Republican Sanitary Epidemiological Station, Kazakhstan
In the prevention of occurrence, distribution and liquida-
tions of infectious illnesses the important meaning has real-
ization of system of sanitary and epidemical measures, one
of which parts is the not specific preventive maintenance.
76
The leading place in these measures is disinfection. One of
conditions of effective preventive maintenance of nosoco-
mial infections is the qualitative realization of disinfection
measures dependent on an adequate choice of disinfection
means, which would answer to requirements on safety for
man and environment. In practice of a medical network of
republic has used the super modern foreign devices, equip-
ment, endoscopes and other optical devices are applied
which require high technologies of disinfection and sterili-
zation. For this purpose the application of disinfectants reg-
istered in Republic of Kazakhstan is authorized according
to the methodical instructions. One of priority directions in
republic within many years was work on expansion of cen-
tralized sterilization of branches in hospitals. Now as a
whole on republic is developed more than 790 centralized
sterilization branches. For achievement of the purposes in
struggle with nosocomial infections the medical personnel
should precisely own algorithms of disinfection and sterili-
zation in view of application of modern highly effective dis-
infectants and antiseptics.
Keywords: Disinfection, Sterilization, Nosocomial infections
O- 30
Immunization problems of the hard-to-reach population’s
elements of the Republic of Kazakhstan and their settle -
ments
Kuatbaeva Ainagul Muhanovna, Ospanov Kenes
Sarsengalievich, Boshugulov Beibut
Republican Sanitary Epidemiological Station, Kazakhstan
Particularity of the problem of the infectious diseases con-
cludes in the global distribution all over the world. The most
countries including the Republic of Kazakhstan recognize
the new understanding of the infectious diseases danger.
The conception of the World Health Organization “Health
for everybody in XXI century” includes one of the primary
goals – reduction of mortality and liquidation of some
infectious diseases. There was defined one of seven long-
term priorities “Health, education and welfare of the
Kazakhstan’s citizens” in the Message of the President of
the Republic of Kazakhstan Nursultan Nazarbaev to the
population. Prosperity, security and improvement of the
welfare of the Kazakhstan’s citizens”. For the last years the
most of our countrymen return to the historical motherland
from the neighboring countries, particularly from Iraq,
Turkey, China, Mongolia etc. Moreover, the population
residing in self-buildings and holiday cottages in the coun-
try are also considered as the hard-to-reach populations
elements relative to the organization and conducting of the
preventive vaccinations. With the purpose of avoiding of
the infections distribution and complication of the epidemi-
ological situation in the country the work for the identifica-
tion and accounting of the permanent migrated “oralmans”
and migrants (refugees) is made together the migratory
service in the regions of the country. Traveling vaccination
teams organize more than 15 000 set-offs every year to the
distant population centers in frames of the vaccinations cal-
endar. There is the work with ill-being families, with per-
sons without the permanent place of residence; there are
also the homesteads rounds.
Keywords: infection, the hard-to-reach population’s elements
O-31
Mutations of hepatitis C virus 1b NS5A PKR binding region
(PKRbd) before and after interferon-· treatment
Komissarov Andrey1, Buzitskaya Janna1, Pisareva Maria1,
Esaulenko Elena2, Grudinin Mikhail1, Kiselev Oleg1
1
Laboratory of Molecular Virology and Genetic
Engineering, Research Institute of Influenza, Saint-
Petersburg, Russia
2
Department of Chronic Viral Hepatites, Research Institute
of Influenza, Saint-Petersburg, Russia
Hepatitis C virus is an enveloped (+) ssRNA virus belong-
ing to Flaviviridae family. The most intensively studied HCV
protein is NS5A. There is a binding site for protein kinase
R (PKRbd) in NS5A. It can be involved in IFN resistance
development. PKRbd including ISDR (interferon-sensitivity
determining region)[aa 2209-2248] is a putative IFN
resistance determinant in NS5A sequence which can be
used for clinical outcome prediction. Resistance determi-
nants identification is based on correlation between the
number of non synonymous mutations and sustained viro-
logical response (SVR). There are three ISDR types: wild
type (no mutations), intermediate type (1-3 mutations) and
mutant type (3-11 mutations). Detection of virus bearing
mutant type ISDR before treatment is concerned to be a
good SVR predictor. Direct sequencing of the HCV1b
NS5A gene region coding PKRbd (ISDR) from blood of 15
non-responder and 1 responder patients before and after
interferon treatment was performed. Obtained sequences
were aligned with PKRbd sequence of Japanese isolate
HCV-J (D90208) and Russian strain 274933RU
(AF176573) (Fig. 1). Alignment revealed that all sequences
were closer to 274933RU than to HCV-J. Mutant type ISDR
sequences were detected neither in non-responders nor in
sustained responders. ISDR from sustained responder
before treatment belongs to intermediate type. We have
identified 8 diverse non synonymous mutations (K2212R,
T2217A, H2218C, H2218R, H2218N, R2234K, E2236D
and N2248S) in PKRbd. No correlation between these
mutations and clinical outcome has been found. ISDR
sequences from non-responder patients do not change sig-
nificantly during treatment, but several sequences convert
77
from wild to intermediate type (#3, #10).
Keywords: Hepatitis C virus, HCV1b, NS5A, PKRbd, interferon-·
resistance, chronic viral hepatitis, clinical outcome
Fig. 1. Amino acid sequence alignment of the NS5A PKRbd
region from patients 1-16 together with published HCV-J
AND 274933RU sequences
#1-7, 9-16 – non-responder patients, #8 – sustained
responder patient,w0 – before treatment, w48 – at the end
of treatment (48th week), w72 – six month after treatment
(72th week). Amino acid substitutions are highlighted.
O-3 2
Rapid diagnosis and anti fungal susceptibility testing of
clinically important Candida species
Javaid Sayyada Ghufrana1, Kazmi Shahana Urooj2
1
Department of microbiology, jinnah university for women,
Karachi, Pakistan
2
Department of microbiology, university of Karachi,
Karachi, Pakistan
Candidiasis is a growing problem among large immuno-
compromised population. That’s why rapid identification of
pathogenic yeast and detection of poly fungal specimens in
the laboratory is mandatory. Chromagar is a newly intro-
duced growth media for the detection and identification of
pathogenic microorganisms by color of colonies. In this
ongoing study, conducted during Jan' 2004 - Feb' 2007,
350 isolates from various clinical specimens were investi-
gated in order to determine the selective isolation and iden-
tification of different species of Candida on Chromagar
and routinely used Saburaoud’s agar and Potato dextrose
agar. Out of 350 isolates 25% were found C. albicans,
35% were C. tropicalis, 3% were C. kruzii, and 37% were
others. To confirm this identification Gram’s staining, ure-
ase production, and Germ tube formation were done fol-
lowed by characterization using API-20C strips®
(Biomerioux). These isolates were than subjected to antimi-
crobial susceptibility testing using conventional disk diffu-
sion method and latest E-test strip method against flucona-
zole, itraconazole, posaconazole, amphotericion B, and
ketoconazole (AB- biodisk, USA®). Up till now four steps
of the designed methodology have been completed, and
for this purpose we have worked with 350 clinical isolates
of Candida species. Now, extracted DNA from the isolat-
ed strains of Candida species are ready for PCR and kary-
otyping, which will be followed by determination of gene
related virulence factors and resistance factors. Use of ani-
mal mouse model to determine the gene associated viru-
lence and resistance factors is also included in future
aspects of the study.
Keywords: Candida, Immunocompromised, antifungal suscepti-
bility
O-3 3
Diagnosing contamination and determining effective fac -
tors on contraction of Trichomonas vaginalis and Neisseria
gonorrhea in female prisoners at Evin Jail Tehran, 2004
Mosaviani Zinat, Behbahani Mohammad, Afshar Parviz,
Vartanoosian Jacqueline Nursing and Midwifery Faculty of
Shahid Beheshti University, Iran
Purpose: With respect to the importance of STDs, this
descriptive study was conducted to diagnose contamination
and determine effective factors on contraction of
Trichomonas vaginalis and Neisseria gonorrhea in female
prisoners at Evin Jail. Material and Method: One hundred
and fifty one subjects with at least one record of marriage
were selected. Data collection tools included a question-
naire, a checklist, and laboratory equipment including
microscope, incubator, autoclave, culture media, and digi-
tal scale. Content validity was used to validate the question-
naire and checklist. The equipment was calibrated and set
by medical engineers of Armin Teb Co. Sample from vagi-
nal secretions were taken to diagnose the microorganisms.
To observe Trichomonas vaginalis , slides were prepared
for gonorrhea; then the samples were cultured and put in
slides with appropriate staining. Results: Mean age of the
subjects was 32.08 and their mean age of marriage was
16.9. 31.1% were illiterate, 70.9% were housewife, and
29.1% were employed. 26.5% were contaminated by
Trichomonas vaginalis but no gonorrhea infection was
detected. Factors such as husband"s job, itching, burning,
and redness of vulva vaginal secretions and its foul smell;
vaginal redness and frequency had a significant relation
with contamination rate of Trichomonas vaginalis.
Discussion and Conclusion: The results showed that those
who did not apply health principles were susceptible to
contamination and contraction of the disorders. In spite of
having medical facilities, the contamination rate of the sub-
78
jects was relatively high. It can be concluded that the neces-
sity of obligatory medical examination, management, and
follow-up in this population has a critical importance.
Keywords: Trichomonas vaginalis, Gonorrhea, Jail
O-3 4
Yersinios in Kazakhstan
Z. Suleimenova, Almaty, Kazakhstan
Yersinious in the Republic of Kazakhstan are being regis-
tered from 80-s of 20-th century.
To present day Y. enterocolitica takes the first place, Y.
pseudotuberculosis comes forth in single instance from
2000s Y. kristensenii is determined. More than 70% of fall-
en ill are teenagers (15-19) and people of 20-30 years old.
Falling sick increased the frequency in warm seasons of the
year.
Leading way of becoming infected is alimentary (till 70%).
More than, two times less the number of falling sick, deter-
mined by contact with radents.
The leading clinical form of disease is primary - general-
ized. Increased the number of primary - centralized form:
gastroenteric in 5 times, acute respiratory more than in 2
times, angina in 10 times. Slightly decreased the number of
hepatic form, often was met pneumonic. Taken results were
conditioned by the improvement of bacteriological and
serological diagnostics of yersinious.
Clinics of illness, during more than 20 years don’t suffer
essential modifications. Beginning of the disease is acute,
with high temperature of the body. Fever was accompanied
by symptom of intoxication of central nervous system:
expressed weakness, indispotion, headache with vomiting,
giddiness. Defeat of vegetative nervous system is character-
ized with repeated shivering, arthralgia, myalgia, body
pain.
At the same time advanced characteristic to yersinious
polyorganity of defeat: inflammation of nasal respiratory
tract in the form of pains and tickling in a throat, dehumid-
ified cough and rhinitis. Changes of gastrointestinal tract
were shown by symptom of gastroenteritis: diarea up to
five times a day, pain at epigastry, or at all stomach, nau-
sea, decline in appetite up to anorexia.
Signs of defeat of parenchyma of the liver were icteric of
skin and mucous, pains in right subcostal. The fifth part of
sicks from the first day of illness had skin rash.
In the heat of disease symptoms neatly formed into defeats
of organs which allowed to mark out one or another clini-
cal form of disease.
At the close of the 90-s and from 2000-s of 21-th century
by the clinical picture they begin to divide primary - gener-
alized and acute feverish. The last was characterized by
slight flow and absence of polyorganity of defeat.
POSTER PRESENTATIONS

P18
27 March 2008; 09.00-18.00 Polymerase chain reaction and adapted enzyme linked immunosorbent
assay for diagnosis of camel brucellosis
TUBERCULOSIS AND BRUCELLOSIS Aldubaib Musaad Ahmad, Hashad Mahmoud A
Cairo University
P1 P19
Depression rate among tuberculosis patients in Sanandaj and environs in A case of neurobrucellosis
2007 Tekin R, Ustun C, Geyik MF, Ayaz C, Celen MK
Vahedi MS, Ardalan M, Zabihi S Diyarbakir, Turkey
Sanandaj, Iran P20
P2 An unusual case of brucellar spondylodiscitis involving the cervical spine
Condition of the tuberculosis sick rate in Karaganda region Nas K, Bukte Y, Ustun C, Geyik MF, Cevik R, Batmaz I
Begaydarova R Khasanovna, Konstantinidi M Lefiterievich, Starikov J Diyarbakir, Turkey
Grigorievich, Konstantinidi T Anatolievna, Esimov K Nurgazinovich P21
Karaganda, Kazakhstan An unusual presentation of brucellosis complicated by septic throm-
P3 bophlebitis and urinary tract infection: a case report
Extrapulmonary Tuberculosis with Multiple Localizations in A Chronic Yildirim M, Ozdemir D, Guclu E, Demirli K
Renal Failure Patient Duzce, Turkey
Kelefl M, Topal N, Uyanik H, Uyanik A, Cetinkaya R, Bilen Y, Kantarci R, P22
Tanas K Renal involvement in brucellosis: Case report
Erzurum, Turkey Ucmak H, Sayarlioglu H, Dogan E, Balakan O, Kadiroglu AK, Sayarlioglu
P4 M
Intermittent tuberculosis treatment in patients undergoing long-term dialy- Kahramanmaras, Turkey
sis P23
Sayarlioglu H, Erkoc R, Dogan E, Soyoral Y, Kara P, Esen R Brucella endocarditis: A Case Report
Kahramanmaras and Van, Turkey Alan S
P5 Diyarbakir Turkey
Tuberculous epididymitis: A case report P24
Yildirim M, Guclu El, Tekin A, Yildirim Ü, Gunal O Modified Rose Bengal Test for Diagnosis of Human Brucellosis
Duzce, Turkey Grushina T Appolonovna
P6 Almaty, Kazakhstan
Estimation of a Disease burden from Tuberculosis in Kazakhstan P25
Iskakova F Arkenovna, Muminov T Ashirovich, Favorov M Olegovich, The Diagnosis of Brucellosis Using a Nested PCR Method
Almaty, Kazakhstan and Georgia, USA Ceken S, Kaygusuz S, Kilic D, Agalar C
P7 Kirikkale, Turkey
Experimental substantiation of laboratory diagnostics of tuberculosis P26
applying the method of revealing antigen binding lymphocytes of tuber- Eearly Resposnse to Medical Treatment in a case of Brucellar
culin specificity Spondylodiscitis with Medullary Compression
Karalnik BV, Denisova TG, Plazun AA, Nurshin KA Nas K, Tasdemir N, Kemaloglu MS, Bukte Y, Gur A, Bozkurt M
Almaty, Kazakhstan Diyarbakir, Turkey
P8
Tuberculosis in the penitentiary facilities ANTIMICROBIALS
Rakisheva Sadvakasovna A, Rakisheva A, Zhandauletova Zh T
Almaty, Kazakhstan P27
P9 Bacteraemic and Non-Bacteraemic Brucellosis: Clinical and Laboratory
VNTR-Genoyping of Mycobacterium tuberculosis strains isolated from Observations
patients of family infections foci Kadanali A, Ozden K, Altoparlak Ulku, Erturk Ayse, Parlak M
Dauletbakova AM, Zhakipbayeva BT, Beisembayeva Sh A, Erzurum, Turkey
Degemerzanova NK P28
Almaty, Kazakhstan Antimicrobial effects of two herbal extracts on the two oral streptococci
P10 Vahabi Surena
Ronkoleukin implementation for comprehensive treatment of patients with Tehran, Iran
osteo-articular TB P29
Ospanov S, Alenova A, Alenova S, Baisalmakov A, Baisalmakov Zh., The incidence and antimicrobial susceptibility of bacterial
Iglikova Sh. enteropathogens isolated from patients admitted to Kashani Hospital of
Almaty, Kazakhstan Iran
P11 Moghtadai K Elham
Differential diagnosis of disseminated pulmonary tuberculosis Shahrekord, Iran
Ulan M, B. Kumisbaeva, A. Rahisheva P30
Almaty, Kazakhstan Determine the inducible resistance phenotype in methicillin resistance
P12 Staphylococcus aureus and coagulase negative staphylococci isolated
Change in trace elements in blood related to liver dysfunction in patients from patients in Imam Reza hospital
with pulmonary tuberculosis and alcohol and drug abuse Naderinasab M, Yousefi F, Farshadzadeh Z
Botagoz K, Ulan M Mashhad, Iran
Almaty, Kazakhstan P31
P13 Changing pattern of antibiotic resistance among urinary tract infection
Differential diagnosis of pulmonary tuberculosis and sarcoidosis isolates
Aisha R, Kumisbayeva B, Makulbayeva U Hasan Najm Ul, Abbas Tanveer, Naqvi Syed A Baqar
Almaty, Kazakhstan Karachi, Pakistan
P14 P32
The role of detoxication in the treatment of MDR-TB form Microbial spectrum and antibiotic susceptibility profile of gram-positive
Arimbayeva A, Kanlibayeva L, Abdukarimov K, Bocharov S, aerobic bacteria isolated from cancer patients
Musdubayeva B, Beissebayeva S Ashour Hossam M, El-sharif A
Almaty, Kazakhstan Cairo, Egypt
P15 P33
Serum Copper, Zinc, Magnesium and Selenium Levels in Patients with Sensitivity of clinical strains of Salmonella enteritidis and Salmonella
Pulmonary Tuberculosis typhimurium to antimicrobial preparations at children in Karaganda
Ustun C, Geyik MF, Tegin Ibrahim, Begaydarova R Khasanovna, Abilkasimov Z Erdinbayevich,
Diyarbakir and Siirt, Turkey Alshynbekova G Kanagatovna, Devdariani K Georgiyevna, Tulegenova
P16 G Kydyrbayevna
Polymorphism of gene SLC11A1 (NRAMP1) at patients with a pulmonary Karaganda, Kazakhstan
tuberculosis P34
Shopayeva Gulzhan A, Filipenko Maksim L, Voronina Elena N, Evaluation of risk factors for Nosocomial multidrug resistant Pseudomonas
Beisembayeva Sholpan A, Muminov Talgat A aeruginosa infections
Almaty, Kazakhstan and Novosibirsk, Russia Ustun C, Hosoglu S, Geyik MF, Ayaz C, Celen MK
P17 Diyarbakir, Turkey
Pressing questions of tuberculosis at children and teenagers P35
Rakisheva A, Serikbaeva K, Kasenova L Antibiotic susceptibility patterns and Molecular analysis of clinical isolates
Almaty Kazakhstan of Staphylococcus aureus in Tehran, Iran

79
Pourmand MR, Bagherzadeh YS Integron associated resistance genes among MDR P. aeruginosa isolated
Tehran, Iran from clinic
specimens
Budak Fatma, Kasap Murat, Kolayli Fetiye, Karadenizli Aynur,
P36 Vahaboglu Haluk
Investigation of Antibiotic Resistance Rates in Gram- Negative Bacteria Kocaeli, Turkiye
Isolated from 28 March 2008; 09.00- 18.00
Nosocomial Infections
Ustun C, Geyik MF, Hosoglu S, Ayaz C, Celen MK GENITOURINARY INFECTIONS
Diyarbakir, Turkey
P37 P53
Ceftazidime, amikacin, ciprosoxacin, meropenem, imipenem resistance Knowledge of hairdressers toward HIV infection in north of Iran
rates and MIC values among nosocomial Pseudomonas aeruginosa spp Panahandeh Z, Doostdar S Mehrnaz,
Ustun C, Hosoglu S, Geyik MF, Ayaz C, Celen MK Rasht, Iran
Diyarbakir, Turkey P54
P38 Acute bacterial prostatitis in Korea: clinical outcome, including symptoms,
Investigation of antibiotic resistance rates among Staphylococcus spp. iso- management, microbiology and course of disease
lated from nosocomial infections in Dicle University Hospital Han Chang Hee, Kim Chul Sung, Shim Bong Suk, Lee Sang Don, Lee Sang
Ustun C, Geyik MF, Celen MK, Hosoglu S, Ayaz C Eun, Cho Won Yeol, Cho Yong-hyun
Diyarbakir, Turkey Seoul, Kwangju and Busan, South Korea
P39 P55
Antibiotic Sensitivity Ratios of Pathogen Microorganisms Isolated from Microbial study of intra uterine contraceptive device users in Hamadan
Pulmonary Disease in Intensive Care Unit city, Iran
Uzun K, Teke T, Maden E, Yavuz Z, Korkmaz C Shobeiri F, Soltani F, Nazari M
Konya, Turkey Hamadan, Iran.
P40 P56
Comparative Study of Antimicrobial Activities of Aloe Vera extracts and Protective effects of cranberries on infectioninduced oxidative renal dam-
antibiotics against isolates from skin infections age in a rabbit model of vesico-ureteric resux
Bashir A, Jehan N, Sherwani S Khan, Mujahid T Yasmin Han Chang Hee, Kim Chul Sung, Shim Bong Suk, Lee Sang Don, Cho
Karachi, Pakistan Won Yeol, Lee Sang Eun, Cho Yonghyun
P41 Seoul, Kwangju and Busan, South Korea
Prevalence of class 1 integrons and antibacterial resistance in indigenous P57
E. coli strains in antibiotic treated and naïve infants Estimation of diagnostic importance of parameters of ultrasound before
Sepp Epp, Shchepetova Jelena, Kõljalg Siiri, Truusalu Kai, Lõivukene labors at women with scar on a uterus after previous cesarean section
Krista, Naaber Paul, Voor Tiia, Mikelsaar Marika Doschanova A Mzhaverovna, Mireyeva A
Tartu, Estonia Almaty-Kazakhstan
P42 P58
Antibiotic sensitivity of Listeria monocytogenes, determined in Almaty Application of the immunocorrection therapy in treatment of mixed infec-
Zubova NV, Dmitrovsky AM tions transmitted by sexual contact in high risk groups
Almaty, Kazakhstan Niyazalieva M, Adambekov D, Aldjambaeva I
P43 Bishkek, Kyrgyz Republic
Using Roncoleicin to treat children’s’ obstructive bronchitis P59
Jojua Y, Kasymbekova R, Efimova O, Asmetova G, Dusembaeva R A case of anicteric leptospirosis complicated by interstitial nephritis
Almaty, Kazakhstan Yildirim M, Ozdemir D, Demirli Ke, Guclu E
P44 Duzce, Turkey
Antibiotic resistance of microorganisms isolated from urinary tract infec- P60
tions in a large clinic in Almaty Kazakh National Medical University Modern aspects of optimization of complex therapy at men with inflam-
Urazbayeva D Chimbulatovna, Kotova A Leonovna, Ramazanova B matory diseases of urogenital canal, caused by herpetic infection
Amanulovna Vyskubov D
Almaty, Kazakhstan Almaty, Kazakhstan
P45 P61
Microbiological efficiency of antimicrobial therapy in patients with urinary The present stage of the HIV/AIDS-infection, and the development of ren-
infection dering medical aids to patients in the Republic of Kazakhstan
Mustafina K Kamalovna, Urazbayeva D Chimbulatovna, Orazbayeva G Doskozhayeva S
Nurgazievna, Sadikov A Maratovich Almaty, Kazakhstan
Almaty, Kazakhstan P62
P46 HIV infection in South Kazakhstan
Antimicrobial agents without medical prescription Albaeva GM, Utepbergenova GA, Sagynbaeva BA, Otarbaeva AP
Farinati Alicia Esther, Fernández María Isabel, Ortiz Corina, Davolos Shymkent, Kazakhstan.
Ignacio, Perez Cortizo Gonzalo, Rodríguez S Victoria, López Santiago, P63
Morguillo Pablo, Campana Victoria Condition of immune system of HIV-infected children
Buenos Aires, Argentina Kozachenko NV, Godunova MI,
P47 Karaganda, Kazakhstan
Nosocomial Candida albicans meningitis treated successfully with P64
voriconazole after failure with amphotericin B deoxycholate (AMBD) and Pyelonephritis of pregnant women and risk for complication of
amphotericin b lipid complex (ABLC) pregnancy
Sipahi OR, Bardak S, Ruksen M, Arda B, Yurtseven T, Metin D, Ulusoy S G Zhatkanbayeva
Izmir, Turkey Almaty, Kazakhstan
P48 P65
Linezolid in the treatment of methicillin-resistant staphylococci (MRS) relat- The comparative clinical and laboratory estimation of the treatment effi-
ed nosocomial meningitis: Report of ten cases ciency for Candida vaginitis
Sipahi OR, Arda B, Turhan T, Pullukcu H, Bardak S, Ruksen M, Aydemir Nurusheva S, Almenova L
St, Dalbasti T, Yurtseven T, Zileli M, Ulusoy S Almaty, Kazakhstan
Izmir, Turkey P66
P49 Serum Copper, Zinc and Magnesium Levels in Patients with Pelvic
Antibacterial resistance in microbiologically confirmed nosocomial bac- Inflammatory Disease
teremia (MCNB) related Acinetobacter baumannii strains in a tertiary care Ustun C, Hancer FN, Tegin I, Geyik MF
educational hospital in Turkey Diyarbakir and Siirt, Turkey
Pulllukcu Husnu, Aydemir Sohret, Sipahi OR, Tasbakan Meltem, Cilli P67
Feriha, Ulusoy S, Tunger Alper Studying of epidemic process of a HIV-infection by means of correlation
Izmir, Turkey and spectral analysis
P50 Saparbekov M
Successful treatment of multi-drug resistant Acinetobacter baumannii Almaty, Kazakhstan
meningitis with sistemic and intrathecal colistin P68
Cinar G, Memikoglu KO, Goktekin S, Cokca F, Unlu MA The sexually transmitted diseases in penitentiary establishments
Ankara, Turkey Eshimov A, Saparbekov M, Nurusheva S
P51 Almaty, Kazakhstan
Antibiotic prescribing habits of physicians in a primary health-care center P69
Oncu Selcen, Oncu Serkan Level of antenatal medical aid and childbirth support in Kazakhstan
Aydin, Turkey Katarbayev A
P52 Almaty, Kazakhstan

80
PARASITIC DISEASES VIRAL HEPATITIS

P70 P87
Cutaneous Leishmaniasis: topical treatment with Peganum harmala extract A case of Hydatid cyst with multiple organ involvement
in laboratory animals Ustun C, Tekin R, Avci A, Hancer FN, Geyik MF
Mirzaei M Diyarbakir, Turkey
Kerman, Iran
P71
Identification of anisakid larvae from Epinephelus tauvina (Greasy
grouper) in Persian Gulf P88
Radfar M Hossein, Eslami A Biologically active admixture "Baur" in complex treatment of viral hepati-
Kerman, and Tehran, Iran tis A
P72 Begaydarova R Khasanovna, Zhunusov ES, Efimova O Nikolayevna,
Effect of wild rue extract on Leishmania tropica promastigotes Konstantinidi T Anatolievna, Zolotareva Oxana Anatolievna
Mirzaei M Karaganda, Kazakhstan
Kerman, Iran P89
P73 The effect of antiviral therapy in children with chronic virus hepatitis B and
Modern condition of the sick rate and detectability parameters of C
helminthiases in Karaganda region Kuttykuzhanova G
Begaydarova R Khasanovna, Baymukanova K Shymbulatovna, Almaty, Kazakhstan
Alshynbekova G Kanagatovna, Diusembaeva A Ermukhanovna, Efimova P90
O Nikolayevna Spontaneous seroconversion of hepatitis B surface antigen in a patient
Karaganda, Kazakhstan with liver cirrhosis
P74 Goral V, Ozturk ID, Bereketoglu N
Clinical-laboratory diagnostics and treatment of lambliasis at children Diyarbakir, Turkey
Begaydarova R Khasanovna, Nasakayeva G Ermekbayevna, Starikov J P91
Grigorievich, Konstantinidi T Anatolievna The effect of HCV infection on the immune status in hemodialysis patients
Karaganda, Kazakhstan Sayarlioglu H, Erkoc R, Dogan E, Soyoral Y, Oner AF
P75 Kahramanmaras and Van, Turkey
The use of Modified Ziehl-Neelsen method for detection of P92
Cryptosporidium spp prevalence in companion dogs in Kerman City (Iran) Comparative evaluation of four hepatitis B vaccines available in Karachi,
Mirzaei Mohammad Pakistan: reactogenecity and immunogenecity
Kerman, Iran Hakim S Tabassum, Kazmi S Urooj
P76 Karachi, Pakistan
A Case of Cerebral Hydatic Cysts with Cardiac Origin: Case Report and P93
Review of the Literature The comparative characteristics of antiviral therapy of chronic viral hepa-
Kader Cigdem, Memikoglu Osman, Polat Cegergun, Birengel Serhat, titis C
Balik Ismail, Kader Cigdem, Memikoglu Osman, Birengel Serhat, Balik Kosherova B, Baltynova R, Antonina K, Zhantakbayeva B, Arinova B,
Ismail Nechayev A
Ankara, Turkey Karaganda, Kazakhstan
P77 P94
A case of unusual wound infestation: Human Myiasis Effect of Initial Renal Replacement Type on Hepatitis C Frequency in
Ustun C, Avci Alper, Geyik MF Peritoneal Dialysis Patients
Diyarbakir, Turkey Keles M, Cetinkaya R, Uyanik H, Uyanik A, Akbas EM, Bilen Y, Eroglu F,
P78 Ferah H
Sensitivity of Trichomonas vaginalis To Different Antiprotozoal Drugs Erzurum, Turkey
Kozlov Sergey S, Zakharkiv Yury F, Streltsova Kira G P95
St-Petersburg, Russia Recombinant Interleukin-1 and Interleukin-2 in treatment of chronic B and
P79 C viral hepatitis: 5-year's experience
Preliminary analysis of the molecular phylogenetics of Toxocara canis Kurmanova G, Kurmanova A, Sadykova S
(Nematoda: Ascaridoidea) using nuclear ribosomal second internal tran- Almaty, Kazakhstan
scribed spacer sequences Rodriguez-morales Alfonso J, Barbella-aponte P96
Rosa A Seroprevalence of hepatitis B, hepatitis C, and human immunodeficiency
Caracas, Venezuela and Valencia, Spain virus in children, who admitted to pediatric surgery polyclinic
P80 Basugay E, Deveci U, Ustun C
Toxic effect of amitriptyline-an antidepressant drug on Drosophila Mardin, Elazig and Diyarbakir, Turkey
melanogaster P97
Nazari Mansour, Hepatitis C Virus Infection and Chronic Obstructive Pulmonary Disease
Hamadan, Iran Erol S, Saglam Leyla, Ozbek Ahmet, Kadanali A, Parlak M
P81 Erzurum, Turkey
The treatment of ascariasis
Kosherova B, Baltinova R, Syzdykov M, Khairova U, Knaus A, HEMORRHAGIC FEVERS
Donenbaeva S
Karaganda, Kazakhstan P98
P82 A Case of Nosocomial Crimean-Congo Hemorrhagic Fever with Good
About the role of carnivores of Canidae family in distribution of Prognosis
helminthozoonoses pathogens Gurbuz Yunus, Sencan I, Ozturk Baris
Abdybekova A Makenovna, Shapiyeva Z Zhakanovna, Karamendin K Ankara, Turkey
Karaevich P99
Almaty, Kazakhstan Interleukin (IL)–1, IL-6, IL-10 and Tumor Necrosis Factor– a level in Patients
P83 with Crimean-Congo hemorrhagic fever
The clinical-epidemiological description of echinococcosis in Almaty and Kadanali A, Erol S, Ertek M, Kiziltunc A, Karaca C, Ozden K, Parlak M
region of Almaty Ankara and Erzurum, Turkey
Yermukhanova N, Yermukhanova G, Ksyetaeva G, Alimbetova K, P100
Faizullin M The clinical characteristics of haemorrhagic fevers in Kazakhstan
Almaty, Kazakhstan Yegemberdiyeva R
P84 Almaty, Kazakhstan
The tropical diseases on the terms in the Republic of Kazakhstan P101
Yermukhanova N, Yermukhanova G, Ksyetaeva G, Daniyarova A, Crimean-Congo haemorrhagic fever virus infection in eastern Turkey
Seidullaeva L Kadanali A, Ozden K, Erol S, Parlak M
Almaty, Kazakhstan Erzurum, Turkey
P85 P102
Visceral leishmaniasis that mimics multiple myeloma: A case report CrimeN-Congo hemorrhagic fevers in The Republic of Kazakhstan
Memikoglu KO, Yanmaz E, Bayraktar N, Balik I Kyraubayev K.
Ankara, Turkey Almaty, Kazakhstan,

P86 CASE REPORTS

Scrotal Filariasis: A Case Report from the South of Turkey
Calik Basaran N, Ascioglu S, Taylan Ozkan A, Sain Guven G P103
Ankara, Turkey A case of nasal ecthyma gangrenosum

81
Tekin R, Ustun C, Hancer FN, Urakci Z, Geyik MF intestinal dysbacteriosis at children
Diyarbakir, Turkey Begaydarova R Khasanovna, Alshynbekova G Kanagatovna,
P104 Kuzgibekova A Bulatovna, Bobreshova I Vladimirovna, Baltynova R
Amphotericin B Associated Convulsion: A Case Report Zaydanovna
Tekin R, Ustun C, Avci Alper, Hancer FN, Geyik MF Karaganda, Kazakhstan
Diyarbakir, Turkey P122
P105 The analysis of clinical features of the dysentery caused by Shigella
A Case of Meningitis duo to Bacillus anthracis sexneri and Shigella sonnei
Geyik MF, Ustun C, Celen MK, Hosoglu S, Ayaz C Karalnik B Volfovich, Omarova M Nurgalievna, Sadikova A Maralovna,
Diyarbakir, Turkey Karabekov A Gamaubaevich, Duisenova A Kuandikovna
P106 Karaganda, Kazakhstan
A native aortic valve endocarditis caused by Staphylococcus aureus asso-
ciated with pemphigus vulgaris due to long-time immune suppressive P123
treatment and prolonged hospital stay Differential diagnosis in acute intestinal infections and acute surgical dis-
Kayrak M, Ulgen MS, Yazici M, Bacaksiz A, Gok H eases
Konya, Turkey Sadikova A Maralovna
P107 Karaganda, Kazakhstan
Endocarditis of mitral annuloplasty ring due to coagulase-negative P124
staphylococci The investigation of faecal fungal sora in inpatients and healthy volunteers
Kayrak M, Ulgen MS, Bacaksiz A, Altunkeser B, Kaya Z, Narin C Oksuz S, Yildirim M, Sahin I, Sencan I
Konya, Turkey Duzce and Ankara, Turkey
P108 P125
Brain abscess due to Haemophilus aphrophilus: A rare case Faecal fungal sora in healthy schoolchildren
Tutuncu E, Sencan I, Altay FA Oksuz S, Yildirim M, Sahin I
Ankara, Turkey Duzce, Turkey
P109 P126
A case of anthrax sepsis with haemoconcentration, hypotension, and Application of tagansorbent upon acute enteric infections
hyponatremia due to cutaneous anthrax Zhampeisova BM
Dokmetas I, Engin A, Elaldi N, Bakir M, Bakici Z, Sencan M Almaty, Kazakhstan
Sivas, Turkey P127
P110 Gene expression Patterns of Salmonella Using Bioinformatics Techniques
Toxic Epidermal Necrolysis (Lyell’s syndrome) in twins and tools
Niyazalieva M.S., Adambekov D. A., Ashiraliev M. E., Sabodaha M. A., Parmar Komal C, Parmar C.
Kudoyarov B. D. Vadodara, India
Bishkek, Kyrgyz Republic P128
P111 Main pathologies that accompany cholestasis caused by intestinal infec-
Pulmonary valve endocarditis due to Chlamydia trachomatis tion of infants.
Aygul N, Altunkeser BB, Aygul MU, Ulgen MS Dosbayeva ZhT
Konya, Turkey Almaty, Kazakhstan
P112 P129
Bacterial meningitis accompanied to thalidomide therapy in two cases of Clinical-Epidemiological Parameters of some viral-bacterial infections in
multiple myeloma the Karaganda region
Pasa S, Altintas A, Cil T, Ustun C, Ayyildiz O, Muftuoglu E Begaydarova RKh
Diyarbakir, Turkey Karaganda, Kazakhstan
P113 P130
Pulmonary emboli associated with Sinus Venosus Trombosis and lung Effectivity of laser scanning beam therapy in patients with functional dys-
abscess: A case report pepsia associated with Helicobacter pylori
Eren Dagli C, Koksal N, Ucmak H, Gelen Mt, Atilla N, Koksal D Myrzabayeva N Abdullayevna
Kahramanmaras, Turkey Almaty Kazakhstan
P114 P131
Disseminated yersiniosis in a patient admitted to Shymkent Hospital Condition of some airborne infections sick rate in Karaganda region
Utepbergenova GA, Kassimova TV, Didenko TV, Berdikulova MM Begaydarova R Khasanovna, Starikov J Grigorievich, Diusembaeva A
Shymkent, Kazakhstan Ermukhanovna, Efimova O Nikolayevna, Zolotareva O Anatolievna
P115 Karaganda, Kazakhstan
Ecthyma Contagiosum (Orf): Report of a Human Case with Multiple P132
Lesions from Turkey The incidence of bacterial pathogens in children with lower respiratory
Sasmaz S, Uzel M, Sener S, Ucmak H tract infections
Kahramanmaras, Turkey Ziyade N, Aksu B, Yagci A
‹stanbul, Turkey
28 March 2008; 09.00- 18.00 P133
The Microbial Pathogens Isolated from Patients with Bloodstream Infection
P116 Behzadi P, Behzadi E, Yazdanbod H, Aghapour R, Akbari C M, Salehian
Atypical Salmonellosis: A Case of Sacroiliitis O Djaafar
Ulug M, Celen MK, Geyik MF, Hosoglu S, Ayaz C Tehran, Iran
Diyarbakir, Turkey P134
P117 Blood smear microscopy in diagnosis of bacteremia and fungemia
Recurrent prosthetic valve endocarditis caused by Kargaltseva N Michailovna
Staphylococcus warnerii Saint-Petersburg, Russia.
Arslan F, Kara AR, Saltoglu N, Mete B, Velet S, Ozaras R, Tabak F, P135
Ozturk R, Mert A Prospective evaluation of Stenotrophomonas maltophilia bacteremia:
Istanbul, Turkey review of 36 cases.
P118 Pullukcu H, Sipahi OR, Tasbakan M, Calik S, Cilli F, Yamazhan T, Ulusoy
Nocardiosis in an Immunocompromised Patient: From Treatment to S
Diagnosis When Your “Hands and Feet Are Tied Up” with Izmir, Turkey
Thrombocytopenia P136
Aydin K, Tezcan ME, Durusu Tanriover M, Sain Guven G, Uzun O Serum Copper, Zinc, Magnesium and Selenium Levels in Patients with
Ankara, Turkey Sepsis
P119 Geyik MF, Ustun C, Tegin Ibrahim,
Atypical Site Of ‹nfection For Escherichia Coli: Soft Tissue Diyarbakir and Siirt, Turkey
Pepedil F, Calik Basaran N, Ascioglu S, Sain Guven G P137
Ankara, Turkey Comparison of catheter care practices and catheter infection rates a
Turkish and Dutch Intensive Care Units: A prospective study
EPIDEMIOLOGY Alp E, Loefsen F, Yucel S, Doganay M, Voss A
Kayseri, Turkey and Nijmegen, the Netherlands
P120 P138
Condition of the acute intestinal infections sick rate in Karaganda region Device Related Health Care Infections in non Intensive Care Unit Patients
Begaydarova R Khasanovna, Alshynbekova G Kanagatovna, Ustun C, Geyik MF, Hosoglu S, Ayaz C, Celen MK
Abilkasimov Z Diyarbakir, Turkey
Karaganda, Kazakhstan P139
P121 Device related health care infections in neurology intensive care unit
Use of admixture “NAN sour-milk” with bifid bacteria in treatment of Ustun C, Hosoglu S, Geyik MF, Aluclu Mehmet Ufuk

82
Diyarbakir, Turkey P159
P140 Up-to-day peculiarities of course of meningoencephalitis and CNS
Clinical and microbiological characteristics of nosocomial infections Abdukarimov K, Arimbaeva A, Abdrasulov R, Bocharov R, Musdubayeva
caused by Sphingomonas paucimobilis B, Kanlibayeva L
Sirmatel Fatma, Elham Behzadi, Oguz Karabay Almaty, Kazakhstan
Bolu, Turkiye P160
P141 Diagnostic and prognostic significance of cardiospecific ferments of
Nasal carriage of meticillin-resistant Staphylococcus aureus among hospi- infants with internal wombing cytomegalovirus infection
tal personel in a Turkish hospital Onalbaeyeva BZ
Yildirim M, Ozdemir D, Guclu E, Cakir S, Erdogan S Almaty, Kazakhstan
P142 P161
Evaluation of nosocomial infection surveillance in general surgery unit Prognostic significance of neurospecific enolaza, and cytokins in children
between 1997 and 2006 with internal wombing cytomegalovirus infection
Geyik MF, Ustun C, Celen MK, Tekin R, Aldemir M, Girgin S, Hosoglu S, Bozhbanbayeva NS
Ayaz C Almaty, Kazakhstan
Diyarbakir, Turkey P162
P143 The diphtheria in the Republic of Kazakhstan
Surveillance of Nosocomial Infections in a Medical Faculty Hospital, 2006 Daniyarova A
Kadanali A, Ozden K, Beyhun E, Altoparlak U, Erol S, Ozkurt Z, Aktas Almaty, Kazakhstan
AE, Parlak M P163
Erzurum, Turkey Insuence of collective anti-diphtheria immunity on epidemical process
P144 Daniyarova A, Amireev S, Nazhmedenova A
Nosocomial Infections in A Turkish University Hospital In 2007 Almaty, Kazakhstan
Demirdal T, Demirturk N, Sara N, Uyar S P164
Afyonkarahisar, Turkey Some microbiological questions of the wound infections
P145 Niyazalieva M, Adambekov D, Sabodaha M, Mustafina F, Kenenbaeva R
Evaluation of surveillance and control program on the nosocomial infec- Bishkek, Kyrgyzstan
tions: a ten-year experience P165
Geyik MF, Hosoglu S, Ayaz C, Celen MK, Ustun C Treatment of pyoinflammatory diseases of soft tissues at patients with drug
Diyarbakir, Turkey addiction
P146 Kapanova G, Seksenbaev B, Esergeneva R
Molecular Typing of Pseudomonas aeruginosa Strains Isolated from Almaty, Kazakhstan
Intensive Care Units in a Teaching Hospital, Turkey. P166
Otlu B, Durmaz R, Gursoy N, Caliskan A, Ersoy Y An economic evaluation of diabetic foot ulcers: results of a retrospective
Malatya, Turkiye study on 97 patients
P147 Gundes S, Aksoy S, Vahaboglu H
Molecular Epidemiological Analysis of Serratia marcescens Outbreak in a Izmit, Turkey
Neonatal Intensive Care Unit by Pulsed Field Gel Electrophoresis, RAPD- P167
PCR and Plasmid Typing Methods. The correlation between microsora types and immune reaction in patients
Arslan U, Kirdar S, Yuksekkaya S, Tuncer I, Bozdogan B with pyo-septic diseases
Aydin, Turkey Isayev H Bilaloglu
P148 Baku, Azebaijan
Evaluation of the Phoenix system for identifying of clinical isolates; P168
Comparative study with the Microscan system Associated Factors of Histopathologically Confirmed Prostatitis in Patients
Altindis M, Gulamber C, Kalayci R,Demirdal T, Cetinkaya Z, Ciftci Ihsan Ceylan K, Gonulalan H, Akdeniz H, Karahocagil M, Tanik S, Erkoc R
H, Aktepe OC Van, Turkey
Afyonkarahisar, Turkey P169
P149 Epidemiological efficiency of Insuenza vaccination in population of
Prevalence of Typhoid Fever in Kathmandu Valley and its Rapid Diagnosis Republic of Kazakhstan
by Detection of IgM Antibodies, Using Commercial Kit Kuatbaeva A Muhanovna, Utegenova E Seitbekovna, Ospanov K
Ghimire J Prasad, Upadhyay R Ratna Sarsengalievich, Baimbetova A
Bhaktapur and Kathmandu, Nepal Kazakhstan
P150 P170
Features of listeriosis clinical current at children Peculiarities of insuenza infection at children the first year during inter-epi-
Begaydarova R Khasanovna, Asenova L Khasenovna demic period
Karaganda, Kazakhstan Ksyetaeva G, Naumova N, Usmanov M, Litosh E, Kaymoldanova N,
P151 Sydykova K
Dynamical and clinic-epidemiologic characteristics of Listeria infection Almaty, Kazakhstan
Slavko Y Alekseevna P171
Almaty, Kazakhstan Prevalence of Mycoplasma (MH) and Ureaplasma (UU) in infertile cases
P152 and pretreatment and posttreatment changes in semen parameters in cul-
Hydrophobia in Southern Kazakhstan ture positive cases
Utepbergenova GA, Nyshanov NS, Tanibergenova AJ, Nurmasheva AA, Ceylan K, Abdullah Yildiz, Hayrettin Akdeniz, Karahocagil M, Tanik S,
Sarypbekova LL, Zhumadullaev NK Erkoc R
Shymkent, Kazakhstan Van, Turkey
P153 P172
Clinical features of botulism in Kazakhstan Development of recombinant vaccines
Utepbergenov Olzhas, Duisenova A, Dmitrovskiy Andrey, Utaganova Krasilnikov IV
Tamara Moscow, Russia
Almaty, Kazakhstan P173
P154 Measles, execution of operation of MAKAKAR, vaccination
Epidemiological characteristics of botulism in Kazakhstan. Gabasova M
Utepbergenov O, Dmitrovskiy A, Duisenova A, Tutaeva Y Almaty, Kazakhstan
Almaty, Kazakhstan P174
P155 Stages of measles elimination and decrease of rubella morbidity in
The role of non-polio enteroviruses causing acute saccid paralysis in Iran Republic of Kazakhstan (organization of Public Health)
in 2003 Nazhmedenova A, Amireyev S, Moldagasimova G, Gabasova M
Abbasian F, Tabatabaii H, Sarijloo S, Kargar M, Mokhtari T, Nategh R Karaganda, Kazakhstan
Tehran and Tanekaban, Iran P175
P156 Siderophore Production of Methicillin Resistant Staphylococcus aureus
Meningitis due to Streptococcus pneumoniae and Haemophilus insuen- (MRSA) and Enteropathogens.
zae: epidemiological and clinical features and efficacy of interleukin-2 Ahmed A, Shahana UK, Yasir R
treatment Karachi, Pakistan
Yeraliyeva Ly Tasbulatovna P176
Almaty, Kazakhstan Implementation of safe microbiological policy for assessment of dairy
P157 industry associated bacteria
Early age children’s meningococcal infections characteristics Bezirtzoglou E, Kourkoutas Y, Stefanis C, Vavias S, Plessas S, Voidarou
Aspetova N, Kasimbecova R, Katarbaev, Karabaeva AK, Ahmetjanova Z C, Alexopoulos A
Almaty, Kazakhstan Democritus and Athens, Greece
P158
The etiology of bacterial meningitis in children
Yeraliyeva L
Kazakh National Medical University, Kazakhstan
83
P1 1
Chair of children infectious diseases, Karaganda State
Depression rate among tuberculosis patients in Medical Academy, Karaganda, Kazakhstan

Sanandaj and environs in 2007

2
Department of State sanitary-epidemiological supervision,
1 Karaganda, Kazakhstan
Vahedi Mohammad Saleh , Ardalan Marlin2, Zabihi
Salah2,1Anesthesia, 2Nursing,
Purpose of the research: to determine condition of tubercu-
Kurdistan University Of Medical Science, Sanandaj, Iran
losis sick rate in Karaganda region.
Materials of the research: We carried out analysis of
INTRODUCTION: Although tuberculosis was controllable in
detectability and sick rate of tuberculosis.
the past it is reappeared mainly because of reasons such as
Results and conclusions: Among 1.340.000 person (in
AIDS/HIV, poverty, misuse of drugs and alcohol consump-
cities – 1.000.000, in districts – 340.000 person) of
tion. If patient becomes disappointed, he will lose his ten-
Karaganda region tuberculosis sick rate in 2007 was
dency toward continuing regular and in time treatment.
121.3 cases for 100000 of population against 124.2 in
Therefore investigation of depression rate among Tb
2006. In Karaganda region in 2007 there has been
patients is very important.
revealed 1625 cases of active tuberculosis (children -
METHODS: Tuberculosis patients (n:79) were selected from
109(6.7%), teenagers - 65(4.0%)). Bacillar form at adults
health centers of Sanandaj and environs in 2007.
has been found out in 510(35.1%) cases, against 6(3.4%)
Accessible patients received a questionnaire by referring
cases at children and teenagers. That fact is guarded, that
researcher to the samples home and non- accessible
people at able-bodied age are sick of tuberculosis.
patients were interviewed by telephone.
Detectability of tuberculosis in cities was much higher –
RESULTS: Majority of samples were female (63.3%). Mean
1,234(75.9%), rather than in districts - 391(24.1%). The
age was 55.5± 18.68 mean age, weight 51.89 ± 14.57
greatest sick rate was revealed in Karaganda, Temirtau,
and 73.4% were resident of Sanandaj, 1.3% were prison-
Zhezkazgan. Among the townspeople tuberculosis of respi-
ers, 15.2%% were followed in Velayatefaghih clinic, 57%
ration organs was fixed at 1190(96.9%), tuberculosis of
have pulmonary tuberculosis, 91.1% were new cases,
bones - 9(0.7%) cases, other localizations - 28(2.4%)
46.8% have depression score lower than 10 and 25.3%
cases. At countrymen tuberculosis of respiration organs has
mild depression,19% average depression, 8.9% severe
made 379(96.9%) cases, tubercular meningitis - 1(0.3%),
depression. Chi-square test showed a statistically important
tuberculosis of bones - 1(0.3%), tuberculosis of other viscer-
relationship between gender and depression (p< 0.0001),
al lesions - 9(2.4%) cases. Speaking about timeliness of
place of life (p< 0.0001), being in prison (p< 0. 001),
tuberculosis diagnosing it’s possible to note that advanced
related clinic (p< 0.0001), type of Tb (p< 0.0001) and new
forms among urban population made 19(1.5%), among
cases (p< 0.0001). T-test also showed a statistically impor-
peasants - 8(2.0%) cases. Carrying out comparative analy-
tant relationship between age, weight and depression (P<
sis of death rate from tuberculosis in 2007-2006, it is
0.0001). X Ç and t- test also showed a meaningful relation-
pleasant to note some tendency to its decreasing. In 2006
ship between incidence depression rates with all demo-
the parameter made 23.3 for 100000 of population, in
graphic characteristics.
2007 – 22.1 (decreasing on 5.2%).
CONCLUSION: In addition to regular and complete treat- Keywords: tuberculosis, detectability, sick rate
ment of Tb patients, we should prevent patients from
becoming depressed in order to complete the treatment. P3
Keywords: Depression, tuberculosis
Extrapulmonary Tuberculosis with Multiple
P2 Localizations in A Chronic Renal Failure Patient
Kelefl Mustafa1, Topal Nurhan2, Uyan›k Hamidullah3,
Condition of the tuberculosis sick rate in
Uyan›k Abdullah1, Çetinkaya Ramazan1, Bilen Yusuf2,
Karaganda region
Kantarc› Ragibe2, Tanas Kadriye2
Begaydarova Rosa Khasanovna , Konstantinidi Mark
1
1
Departments of Nephrology, 2Departments of Internal
Lefiterievich , Starikov Juri Grigorievich , Konstantinidi
2 1
Medicine, 3Departments of Microbiology, Ataturk
Tatiana Anatolievna , Esimov Khamit Nurgazinovich
1 2
University, Erzurum, Turkey

84
Tuberculosis is still an important health problem. The inci-
dence in chronic renal failure (CRF) in tuberculosis patients
was 10 times higher than that in the general population.
Here, we presented uncommon extrapulmonary tuberculo-
sis localizations in a CRF patient. A 36-year-old male
patient with CRF was on maintenance hemodialysis for 8
years. He presented to our outpatient clinic with complaints
of dull backache, fatigue and dull pain in both legs. A right
axillar lymphadenopathy (1x1.5 cm in size) was found in
his physical examination. His laboratory results, except ESR
(110 mm/h), ferritin (2000 ng/ml) and CRP (12.4 mg/dl),
were comparatively unrecognizable with CRF cases. His
PPD test was negative. Chest X-ray was normal.
Histopathological examination of bone marrow and lymph
node biopsies showed granulomatous lesions containing
Langhans type giant cells and caseification. MRI of vertebra
showed diffuse lymphadenopaties located bilaterally on
femur head, bilaterally around L1 and L2 vertebral bodies
and also abscess formation around the right psoas muscle.
Lumbar vertebral bodies were also affected.
Antituberculosis therapy (isoniazid, rifampycine, ethambu-
tol and pyrazinamide) was started. The complaints start to
diminish in the third month of therapy. In such cases, early
diagnosis and treatment is an important factor to diminish
the mortality and morbidity.
Keywords: Chronic Renal Failure, Extrapulmonary Tuberculosis
P4
Intermittent tuberculosis treatment in patients
undergoing long-term dialysis
Sayarlioglu Hayriye1, Erkoc Reha2, Dogan Ekrem1,
Soyoral Yasemin2, Kara Pinar3, Esen Ramazan3
1
Department of Nephrology, Sutcu Imam University,
Kahramanmaras, Turkey
2
Department of Nephrology, Yuzuncu Yil University, Van,
Turkey
3
Department of Internal Medicine, Yuzuncu Yil University,
Van, Turkey
INTRODUCTION: Tuberculosis (TB) is a significant problem
in view of diagnosis and therapy in patients on haemodial-
ysis (HD) and peritoneal dialysis (PD). There is an increased
risk of TB in patients with chronic renal failure. We carried
out a retrospective study by examining our cases diag-
nosed with tuberculosis in patients on HD and PD.
METHODS: We evaluated 52 patients undergoing HD and
80 PD treatments in the course of a 3 year period. Ten
85
patients (5 male, 5 female; mean age 47.5 13.8, 34-65),
received intermittent tuberculosis treatment. Primary dis-
eases of the patients were as follows; diabetes 3, SLE 1,
chronic glomerulonephritis 3, unknown etiology 3. Of
cases 1 urinary, 5 miliary, 2lymphadenitis, 2 peritoneal
tuberculosis were detected. All cases were started on
rifampisin 600 mg, INH 300 mg, etambutol 20 mg/kg,
morfazinamid 40 mg/kg thrice a week.
RESULTS: Two patients died in the first and sixth months of
the treatment for diseases unrelated to tuberculosis. Other
patients tolerated the treatment well. Lymphadenopathy of
patients was smaller at the end of the treatment. Three mil-
iary tuberculosis cases presented with acute respiratory
failure attacks and these attacks were no longer seen after
the first month of the treatment. Urinary tuberculosis bacilli
disappeared in the second month of the treatment. Value of
CRP decreased significantly (149 39.7 ve 14.4 12.9,
p<0.05). Patients had no adverse effects except mild eme-
sis and vomiting.
CONCLUSIONS: Intermittent tuberculosis treatment in
patients undergoing long-term dialysis is effective and safe.
Drugs are well tolerated.
Keywords: Haemodialysis, peritoneal dialysis, tuberculosis, inter-
mittent tuberculosis treatment
P5
Tuberculous epididymitis: a case report
Yildirim Mustafa1, Guclu Ertugrul1, Tekin Ali2, Yildirim
Ümran3, Gunal Omer4
1
Department of Clinical Microbiology and Infectious
Diseases, Duzce University Faculty of Medicine, Duzce,
Turkey
2
Department of Urology, Duzce University, Faculty of
Medicine, Duzce, Turkey
3
Department of Pathology, Duzce University, Faculty of
Medicine, Duzce, Turkey
4
Department of General Surgery, Duzce University Faculty
of Medicine, Duzce, Turkey
Tuberculous infection of the scrotum is rare and occurs in
approximately 7% of patients with tuberculosis. We report
a 71-year-old man who was admitted with the chief com-
plaints of unilateral scrotal swelling and pain, fever, cough,
and sputum. Scrotal ultrasonography demonstrated hydro-
cele containing anechoic septations and an increase in
dimension and vascularity of left epididymis (epididymi-
tis?). Rose Bengal test was negative. Blood and urine cul-
tures were yielded negative. Non-homogen infiltrations
were showed on chest X-ray. Piperacillin-tazobactam treat-
ment was administered for 13.5 g/day. Vancomycin (2
g/day) was added to piperacillin-tazobactam treatment at
the sixth day of treatment. However, any recovery for fever,
and scrotal swelling and pain were not determined. The
antibiotics were stopped at the tenth day of treatment. In
second ultrasonography, minimal heterogenity in left epi-
didymis, bilateral cutaneous and subcutaneous tisue thick-
ening and edema, hidrocele containing anechoic septa-
tions in left scrotum and 28x19 mm inhomogeneous mass
imaging in the inferior of left testis was detected. Then, rad-
ical orchiectomy was performed. Pathological examination
of the orchiectomy specimen demonstrated chronic granu-
lomatous inflammation with caseous necrosis in epididymis
(tbc epididymitis?). Mycobacterium tuberculosis was detect-
ed by using polymerase chain reaction in orchiectomy
specimens. Sputum and urine specimens were negative for
acid-fast stains. However, Mycobacterium tuberculosis was
growth in sputum culture. Starting antituberculosis therapy
was planned for patient. In conclusion, the diagnosis of
tuberculous epididymitis should be considered in patients
who present with scrotal swelling, failure to respond to con-
ventional antibiotics, clinical evidence of tuberculosis else-
where in the body.
Keywords: Tuberculosis, epididymitis
P6
Estimation of a Disease burden from
Tuberculosis in Kazakhstan
Iskakova Farida Arkenovna1, Muminov Talgat Ashirovich1,
Favorov Michael Olegovich2
1
Kazakh National Medical University, Kazakhstan
2
Centers for Disease Control and Prevention (USA)
The different diseases, especially TB, cause significant bur-
den to people’s health. Data organization of the burden
estimated for assumption and improvement of Public
Health.
GOAL: estimation of the burden from TB in Kazakhstan by
definition of years of potential life lost due to mortality
(YPLL). This method developed by CDC (USA) and recom-
mended by WHO.
METHODS: Analyses of 3860 TB death causes by defini-
tion of YPLL in cohorts (children, able-boded and highest
age citizens) in 2000.
Result. The most burdens under an assessment of YPLL for
86
people in general were made Trauma and accidents (561
198 years), heart and vascular diseases (299660 years)
and lung diseases (160224 years) TB occupied the fifth
place (85170 years). Lung diseases (106 481 years), trau-
ma and accidents (78380 years) and infection diseases
(36046 years) were the most reasons of death among chil-
dren. TB was on the 10th place. Trauma and accidents
(412 333 years), heart and vascular diseases (70085
years) were predominant reasons among adults 15-44
years by YPLL. TB was on the third place. Heart and vascu-
lar diseases (163 198 years), trauma and accidents (70
085 years) and cancers (63 198 years) were the main rea-
sons of death among adults 45 years and older by YPLL. TB
was on the 6th place.
Conclusion. TB is the largest burden for society and Public
Health in Kazakhstan from an untimely death especially
among able-boded citizens.
Keywords: TB, years of potential life lost due to mortality (YPLL),
children, able-boded and higher ages citizens
P7
Experimental substantiation of laboratory diag -
nostics of tuberculosis applying the method of
revealing antigen binding lymphocytes of tuber -
culin specificity
B.V.Karalnik, T.G.Denisova, A.A.Plazun, K.A.Nurshin
Almaty, Kazakhstan
Appearance in the blood in perceptible number of lympho-
cytes which bind specific antigen (ABL) can be applied in
immunologic diagnostics. It was demonstrated in many
bacterial, fungal and virus infections. In experiments of
Mycobacterium tuberculosis and Mycobacterium bovis
infection and rabbits treating with DOTS scheme it was
investigated the possibility of diagnostics and evaluation of
efficiency of tuberculosis treating by this method with
applying of elaborated immunologic reagents of human
and bovine PPD specificity. The ABL were revealed in 7 –
119 days after pathogen inoculation. After that ABL were
not revealed in the blood. In cases of treating rabbits (treat-
ment began after 7 days upon inoculation of
Mycobacteria) ABL disappeared in 45 days after infecting.
Microbiologic and morphologic investigation in different
periods after infecting showed that bacterial number and
affecting of rabbit organs in the dynamics of infectious
process are increased at the beginning and reduced at the
end of experiment. The reduction is developed more inten-
sively at treating as the length of revealing ABL too. The
residual bacteria number in organs reserved in the back-
ground of histological detection well formed granuloma
even after ABL disappearing. It may reflect termination of
the contact of mycobacteria isolated in granulomas with
immunocytes. The received results substantiated the possi-
bility of applying ABL method to diagnostics and control the
effectiveness of tuberculosis treatment.
Keywords: Tuberculosis, lymphocytes, diagnosis
P8
Tuberculosis in the penitentiary facilities
Anar Rakisheva Sadvakasovna, Rakisheva A.,
Zhandauletova Zh. T.
Kazakh National Medical Univetsity, Almaty, Kazakhstan
In the last years significant changes have been occurred in
the penitentiary system of the country. In spite of the com-
plex epidemiological TB situation in the penitentiary system
of the Republic of Kazakhstan the systematic implementa-
tion of integrated TB activities during the 5 years have
resulted an increase in TB morbidity in 3,3 times and mor-
tality in 2,3 times. It was happened due to implementation
in the penitentiary facilities the international standards of
TB diagnosis and treatment, humanization of penitentiary
system, decreasing the number of inmates, improving the
living conditions of prisoners, timely detection of TB patients
by providing prophylactic double fluorography and detec-
tion the smear positive patients by microscopic examina-
tion, also isolation of TB patients to specialized areas.
However in spite of the achieved results for TB control there
are lot of unsolved problems: lack of medical equipment,
interruption of TB treatment which is related with conduct-
ing investigative actions. Complete TB service continuity has
not been developed between penitentiary system and civil
health care sector in connection with that about 30% of TB
patients after release from prisons are not continuing TB
treatment thereby they remain as “reservoir” of TB infec-
tion. There is the unsolved urgent problem of separate iso-
lation and treatment of TB chronic cases. All these questions
should be solved which could be achieved through mutual
collaboration of all services and departments, providing
additional funding, medical and social support for inmates.
Keywords: tuberculosis, penitentiary, country-wide
87
P9
VNTR-Genoyping of Mycobacterium tuberculo -
sis Strains Isolated from Patients of Family
Infections Foci
Dauletbakova A.M., Zhakipbayeva B.T., Beisembayeva
Sh.A., Degemerzanova N.K.
Kazakh National Medical University, Almaty, Kazakhstan
The necessary parts of struggle against tuberculosis spread-
ing are early diagnostics and effective treatment in con-
junction with contacts revealing. The important role in it
should belong to the epidemiological researches directed
on identification of strains, circulating in the epidemic foci.
The successful decision of similar problems is possible only
on the basis of the complex analysis of the data received by
means of epidemiological research, traditional phenotypic
(definition of drug susceptibility profiles, phage typing) and
the newest genotypic methods of strains marking.
Materials and methods. Comparison of the genetic struc-
ture of 28 Mycobacterium tuberculosis strains, isolated
from suspected sources of infection and from the diseased
contact persons from 11 family foci of tuberculosis in
Atyrau region, by VNTR- typing method with use of 5 loci
– ETRA, B, C, D, E (R. Frothingham et al., 1998) for the
period 2005-2007yy.
Results. Among analyzed isolates group five different geno-
types were found. The most often defined genotype is
42435 — 17 of 28 (60±9,2 %), which were revealed at 8
from 10 suspected sources (80±12,6 %) and at 9 diseased
contact persons from 17 (52±12,0 %) analyzed. Genotype
22232 was found out at 2 suspected sources, and at 4 dis-
eased contacts. Genotypes 32332, 42434, 42432 are
revealed at 4 contacts and one source. The isolates of M.
tuberculosis at seven foci from suspected sources of infec-
tion and from diseased contacts have identical genotypes:
at six foci it was genotype 42435, at one foci - genotype
22232. At four foci, where genotypes of mycobacteria
were different, the additional epidemiological research has
allowed to establish presence of other possible sources of
infection.
Conclusions: Molecular analysis of M. tuberculosis strains
by VNTR-typing has shown, that in 63,6 % of family foci of
tuberculosis at suspected sources and at diseased their
contacts had identical genotypes of mycobacteria that
specifies on mainly the exogenous mechanism of distribu-
tion of a tubercular infection in the family centers of infec-
tion.
Keywords : Tuberculosis, VNTR
P10
Ronkoleukin implementation for comprehensive
treatment of patients with osteo-articular TB
Serik Ospanov, A. Alenova, S. Alenova, A. Baisalmakov,
Zh. Baisalmakov, Sh. Iglikova
National Center for TB Problem, Almaty, Kazakhstan
Up-to-day objective of phthisiatria is the study and stimula-
tion of the immune system of patients with osteo-arthricular
TB (OA Tb) needed to increase therapy effectiveness. Since
2006 clinical and immunological effectiveness of
immunomodulator ronkoleukin for patients with bone-and-
joint TB was investigated. Examination and comprehensive
treatment with ronkoleukin was conducted for 44 patients
with OA Tb. Among 44 patients to be studied 24 (54.5%)
were men, 20 (45.5%) women. In 37 (84%) TB spondilytis,
in 7 (16.0%) TB of great joints of low extremities was pres-
ent. Adolescents up to 14 years old constituted 14 people,
adults did 35. Majority of patients had advanced and com-
plicated OA Tb: in 24 (54.5%) fistulas functioning, in 19
(43.2%) concomitant pulmonary TB, in 9 (20.4%) MDR- TB
patients. Ronkoleukin was administrated 1 or 1, 5 month
later after anti-TB therapy administration: intravenously in
a dose of 250 000 IU for children and 500 000 IU for
adults with interval of 48 hours, three procedures. Clinical
and immunological investigation of patients was conducted
before IL-2 administration, one week later and one month
later after including cytokinotherapy. Analysis of clinical
effectiveness of ronkoleukin implementation: clinical posi-
tive dynamics, appetite and self-feeling improved, intoxica-
tion symptoms decreased. In 16 patients content evacua-
tion from fistulas diminished. In 9 cases normalization of
ESR and body temperature was observed. In 8 patients with
concomitant pulmonary TB X-ray fixed improvement. 1.5
month later in experimental group reliable increase in titer
of anti-TB antibodies in ELISA, content of gamma-interfer-
ron, interleukin-2, CD4 took place.
Keywords: osteoarthricular tuberculosis, ronkeleukin, MDR
88
P11
Differential diagnosis of disseminated pul-
monary tuberculosis
Ulan M, B. Kumisbaeva, A. Rahisheva
Kazakh National Medical University, Kazakhstan
Differential diagnosis of disseminated pulmonary tubercu-
losis (DPTB) is a complicated task. Significant difficulties
arise if trying to recognize the disseminated and diffuse
processes in lungs due not only to the variety, but similari-
ty of clinical and roentgenological signs of these diseases.
We studied the informative methods in diagnostics of dis-
seminated processes in lungs. 201 patients aged from 18
to 70 years were observed. Men were 110 (54.7%),
women 91 (45.3%). After scrupulous comprehensive exam-
ination DPTB was diagnosed in 178 (88.6%) cases, other
diagnosis was stated in 23 (11.4%): in 5 (21.7%) carcino-
matosis, 3 (13.0%) idipatic fibrosing alveolitis, 1 case
(4.3%) dissemination of unclear etiology, 1 (8.7%) lung
adenomatosis, in one case (4.3%) adenocarcinoma, 1
(4.3%) central lung cancer, 2 (8.7%) cystous hypoplasy, 3
(13.0%) Beck’ sarcoidosis, 2 (8.7%) chronic bronchitis, 1
(4.3%) squamous cell carcinoma, 1(4.3%) chorionepithe-
lioma and 1 case bilateral focal pneumonia were con-
firmed. Thus, our investigation allows concluding that veri-
fication of disseminated lung processes needs to implement
the comprehensive clinical, roentgenological, instrumental
and cytological methods of investigation.
Keywords: tuberculosis, pulmonary, differential, diagnosis
P12
Change in trace elements in blood related to
liver dysfunction in patients with pulmonary
tuberculosis and alcohol and drug abuse
Botagoz K, Ulan M
Kazakh National Medical University, Kazakhstan
57 patients with fibrocavernous pulmonary TB were exam-
ined, 38 out of them with alcohol and drugs addiction con-
stituted the main group, 19 persons without this did the
control group. Trace elements (cuprum, ferrum, man-
ganum, zinc, nickel) were determined through emission
spectrum analysis method. Abnormalities of liver functions
was found out in 29 (76.3%) in the main group and in 3
(15.7%) of control. At this, moderate liver enlargement up
to 2-4 cm under costal arch being solid and painful when
palpitation was marked in 21 (56.2%) patients of the main
group. All of them complained about nausea, decrease in
appetite, heaviness and pains in the right hypochondrium.
Among patients of main group increasing in transaminas-
es activity: ALT up to 2.09±0.89 mmol/L and AsT up to
1.27±0.09 mmol/L and increasing the indicators in thymol
test up to 7.11±0.72 U were observed, while normal in the
control. Increase in bilirubin content up to 25.73±1.89 in
the main group and up to 1.32±0.86 in the control was
determined. In main group cuprum content up to
143.15±5.2 mkg/% (norm 101.6±3.7) increased, ferrum
significantly decreased to 71.4±5.6 mkg% (norm
97.4±5.18), zinc constitute 205.92±9.89 (norm
253.1±9.09), nickel 2.67±0.08 mkg% (norm 3.38±0.11)
and manganum decreased to 4.30±0.70 mkg% (norm
4.88±0.16). While in the control group cuprum content
constituted 131.6± 4.0 mkg%, ferrum 117.6±9.9. Thus,
because of impact of intoxication due to TB, alcohol and
drugs, abnormalities in the biochemical parameters related
to liver which is a depot organ of trace elements due to
which the disbalance emerges in the blood.
Keywords: Tuberculosis, liver functions
P13
Differential diagnosis of pulmonary tuberculosis
and sarcoidosis
Aisha R, Kumisbayeva B, Makulbayeva U
Kazakh National Medical University, Kazakhstan
Target was to investigate the differential diagnostic ways in
pulmonary TB and sarcoidosis. 26 patients that were
76.9% woman were investigated. Mean age of women was
43,6 and 32.4 for man. Urban inhabitants constituted
88.5% and 81.0% of European nationalities. Disease was
asymptomatic in 4 patients (15.4%) who were diagnosed
during preventive examination. Among them one patient
was referred to the National Center for TB Problems RK
(NCPT) with suspicion to have sarcoidosis, 3 others were
send to oncology clinics. 22 patients had to address for
medical care: 20 of them with chest complains (84.6%) and
2 with extrapulmonary ones. In 8 (42.3%) out of them pri-
marily was supposed an oncologic diagnosis, 2 (9%) were
referred to NCPT with diagnosis of disseminated pul-
89
monary TB. Other 9 patients (48.7%) were treated unsuc-
cessfully from bronchitis, pneumonia, and alveolitis.
Examinations revealed sarcoidosis or granulomatosis.
Sarcoidosis was excluded in 2 cases: in 1 case lym-
phogranulematosis and in other one bronchomegaly were
found out. Sarcoidosis of intrathoracic lymph nodes was
notified in 54.2%, others had lung injury. In 8 (33.3%)
cases diagnosis was stated without invasive examination
methods on a base of clinical and roentgenological data
thanks to typical symptomatic complex. Average in-patient
stay was 68.5 bed/days. Taking into account absence of
pathognomonic clinical and cytological signs of sarcoido-
sis which could differ it from tuberculosis it is necessary to
improve the diagnostics of this disease through active
implementation of instrumental methods that will shorten
the terms of diagnostics and save patients from non-ade-
quate treatment during months.
Keywords: Tuberculosis, sarcoidosis, diagnosis
P14
The role of detoxication in the treatment of
MDR-TB form
Ainur Arimbayeva, L. Kanlibayeva, K. Abdukarimov, S.
Bocharov, B. Musdubayeva, S. Beissebayeva
National Center for TB Problem, Kazakhstan
Usually insufficient effectivity of treatment of MDR-TB forms
is due to the side effects to anti-TB drugs. Target of our
study was to decrease the drugs complications caused by
anti-TB drugs of the second line. Significant role for this
belongs to the medical plasmatheresis. Different blood
indices were analyzed in 17 patients with MDR-TB which
were examined by us, 8 out of them with fibrocavernous TB
(FTB), while 9 with infiltrative TB (ITB). Five out of 8 patients
with FTB had the allergic dermatitis with skin rash and itch.
After plasmatheresis course conducted their self-feeling
improved due to eosinophilia decrease or disappearance
and clinical status improvement. Yet, drug intolerance in
one case was expressed in term of the toxic hepatitis (skin
yellowness, liver extension, nausea, vomiting) while two
patients complained having somnolence or insomnia that
disappeared after plasmatheresis. In the group with ITB 6
patients had the allergic dermatitis, 2 had the arthralgia
and one had the toxic hepatitis. Plasmatheresis course com-
pleted all the patients had the clinical improvement, nor-
malization of blood indices, and itcingh, rash, nausea or
vomiting disappeared. Thus, plasmatheresis against the
background of anti-TB therapy with anti-TB drugs of the
second line leads to attenuate or disappear the clinical
manifestations, normalize the biochemical blood indices
due to the drug-induced complications.
Keywords: MDR- TB, treatment
P15
Serum Copper, Zinc, Magnesium and Selenium
Levels in Patients with Pulmonary Tuberculosis
Ustun Cemal1, Geyik Mehmet Faruk1, Tegin Ibrahim2
1
Dicle University Medical Faculty, Depertment of Clinic
Microbiology and Infection diseases, Diyarbakir, TURKEY
2
Siirt University Department of Chemistry, Faculty of
Science and Art, Siirt, TURKEY
OBJECTIVE: The aim of this study is to compare the serum
Copper (Cu), Zinc (Zn), Magnesium (Mg) and Selenium
(Se) levels of patients with pulmonary tuberculosis and
healthy individuals.
MATERIAL-METHODS: In this study, 50 patients with pul-
monary tuberculosis, and 90 healthy individuals in the con-
trol group were included. From totally 140 individuals, 5
ml of venous blood was taken after fasting 10 hours at
night. Serum samples were decomposed by centrifugeting
at 5200 turn for 10 minutes. Serum samples were diluted
with deionised water. Cu, Zn, Mg and Se levels were meas-
ured in all serum samples by using Unicam 929 Atomic
Absorption Spectrophotometer. All data entry and analysis
were performed using SPSS 10.0 for Windows Version
program.
RESULTS: The average age of 50 patients with pulmonary
tuberculosis was 45.2 ±18.9 years, of whom 34 were
males (68%), 16 were females (32%). The average age of
90 healthy individuals was 29.3 ±8.8 years, of whom 45
were males (50%), 45 were females (50%). Serum Cu, Zn,
Mg and Se levels of patients with pulmonary tuberculosis
and control group was shown in table. A statistically signif-
icant increase at serum Cu, Mg and Se levels and no sig-
nificant decrease in Zn levels of patient with pulmonary
tuberculosis were detected, when compared with the con-
trol group
CONCLUSION: The current evidence suggests that, Cu, Mg
and Se levels may be helpful as indicator in the course of
pulmonary tuberculosis
Keywords: Pulmonary tuberculosis, serum trace elements
90
P16
Polymorphism of gene SLC11A1 (NRAMP1) at
patients with a pulmonary tuberculosis
Shopayeva Gulzhan A.1, Filipenko Maksim L.2, Voronina
Elena N.2, Beisembayeva Sholpan A.1, Muminov Talgat
A.1
1
Kazakh National Medical University after
S.D.Asfendiyarov, Almaty, Kazakhstan
2
Institute of Chemical Biology and Fundamental Medicine,
Novosibirsk, Russia
Now sufficient attention is paid to studying of polymorphic
variants of the genes contributing to development of vari-
ous multifactorial diseases. The tuberculosis concerns to
number of such diseases. Approximately 30 % of the pop-
ulation in the world are infected with M.tuberculosis, annu-
ally register 8-12 million new cases of infection with the
active form of tuberculosis. However clinical attributes of
disease arise only at 5-10 % infected by mycobacteria peo-
ple. Most likely, genetic factors underlie ability of macroor-
ganism to resist infection (Frodsham, Hill, 2004). Among
genes - candidates of tuberculosis studying SLC11A1 (ear-
lier NRAMP1) is of interest. Protein coded by it belongs to
family of conveyors of cations of metals and express in
phagocytes. Polymorphism of gene is actively studied in
different populations for association with tuberculosis.
Results of these researches are inconsistent. We’ve carried
out research on studying polymorphism SLC11A1 at 68
patients with pulmonary tuberculosis in comparison with 98
healthy individuals. The nonconservative nucleotide
replacement changing 543 codon Asp->Asn (D543N) has
been analyzed. By results of our researches allele N poly-
morphic locus of SLC11A1-D543N authentically more
often meets in group of the control (Odds_ratio=0.246, C.I.
= [0.099-0.607], chi2=10.55, p=0.00116), that is it has
proved as the protective factor at disease by tuberculosis.
However on the literary data the opposite situation when
allele N mainly meets at patients with a tuberculosis is more
often is observed. Probably, it is connected to different eth-
nic accessory of researched groups. The given researches
proceed among the population of Kazakhstan.
Keywords: tuberculosis, genetic polymorphism, gene SLC11A1
P17
Pressing questions of tuberculosis at children
and teenagers
Rakisheva Anara, Serikbaeva Kamila, Kasenova Laura
Kazakn National
Medical University, Almaty Kazakhstan
In Kazakhstan the incidence of tuberculosis remains high,
in connection with presence of the significant tank of an
infection among the population, increase in cases of infec-
tion with multiresistant Mycobacterium tuberculosis,
decrease in the general susceptibility of an organism. In a
modern social - epidemiological situation the problem of
tuberculosis among children and teenagers not only has not
lost the value, but also has become aggravated. The high
level of disease of children (31, 7 on 100 thousand) and
teenagers (128, 4 on 100 thousand) is caused as a high
parameter of disease of adults with excretion of mycobac-
teries, and deterioration of social conditions of the life,
harmful habits of teenagers, distribution of other illnesses.
Now change of structure of clinical forms aside their
weightings, increase in number widespread and progress-
ing forms of tuberculosis is marked. Guards growth among
children and teenagers of a tuberculosis with plural medic-
inal stability which reason is infection with multiresistant
strains of mycobacteries of a tuberculosis, mainly in the
family center. The multiresistant tuberculosis is character-
ized widespread process and heavy current, presence of
complications. Duly diagnostics of a tuberculosis with plu-
ral medicinal stability, early and adequate therapy by
preparations of reserve lines yield positive results. Among
pressing questions modern of phthisiopediatrics priority
there is a preventive maintenance, early revealing, diag-
nostics of initial forms of tuberculosis, increase of efficiency
of treatment of children and teenagers with various forms
of tuberculosis.
Keywords: tuberculosis, epidemiological situation
91
P18
Polymerase chain reaction and adapted enzyme
linked immunosorbent assay for diagnosis of
camel brucellosis
Aldubaib Musaad Ahmad1, Hashad Mahmoud A2
1
Department of Veterinary Medicine, College of
Aqriculture and Veterinary medicine, Qassim University
2
Microbiology Department, College of Veterinary
Medicine, Cairo University
In the present study, polymerase chain reaction was carried
out on 10 brucella isolates recovered from female camels
affected with brucellosis in the central region of Saudi
Arabia. Brucella abortus as well as Brucella melitensis spe-
cific primers were employed for the assay. All isolates were
identified as B. melitensis. This was in agreement with the
results of the traditional bacteriological identification.
Moreover, antibodies against camel IgG was raised in rab-
bits and purified with polystyrene affinity chromatography.
The purified anti-camel IgG was conjugated with horserad-
ish peroxidase (HRPO) using the sodium periodate method.
The anticamel-HRPO conjugate prepared in this study was
tested in an indirect ELISA adapted in the same study on
camel sera positive and negative for brucellosis as indicat-
ed by the Rose Bengal plate test. The conjugate was found
efficient and was able to elucidate positive and negative
samples at a dilution of 1/40.
Keywords: PCR, Brucella, ELISA, Saudi Arabia
P19
A case of neurobrucellosis
Tekin Recep, Ustun Cemal, Geyik Mehmet Faruk, Ayaz
Celal, Celen Mustafa Kemal
Department of Clinical Microbiology and ‹nfectious
Diseases, Faculty of Medicine, Dicle University,
Diyarbakir, Turkey
OBJECT‹VE: A case of neurobrucellosis was reported.
CASE: An 80 years old man, admitting to our clinics with
fever, headache, nausea and vomiting was hospitalized.
He was complaining from a 10-day headache, nausea-
vomiting, a fever rising with chilling subsequently decreas-
ing via sweating. On physical examination, body temper-
ature was 38.4°C, blood pressure was 110/70 mmHg,
pulse was 94/min; neck stiffness and brudzenski sign were
positive; while other systems’ examinations were assessed
as normal. Laboratory investigations showed a WBC count
of 7600/mm3(PMNL 45%), ESR of 45 mm/hr, CRP of 21
mg/dl, ALT of 74 U/l AST of 102 U/l. Cerebrospinal fluid
(CSF) was obtained by lumbar puncture. CSF findings
were: high pressure, pandy (+), WBC count 260/mm3
(lymphocyte 80%), protein 134 gr/dl, glucose 52 gr/dl
(concurrent blood glucose was 75 mg/dl), clor 111 mEq/L.
Rose bengal test, performed with serum and CSF, was
reported as positive. Wright agglutination test was positive
as well. Blood, urine, CSF cultures were obtained.
Considering brucella meningitis, the patient was begun on
ceftriaxone 4 mg/day, doxicillin 200 mg/day and
rifampicin 600 mg/day empirically. Brucella species grew
on CSF and blood cultures. On the sixth day of treatment,
his fever declined with an improvement in his general sta-
tus. Receiving a 20-day triple antibiotic treatment, ceftriax-
one was changed with TMP-SMX and his medication was
completed in six months. CSF was analysed as normal at
the end of the treatment.
RESULTS: Routine Rose-bengal examination of CSF is a
simple and convenient method in the diagnosis of neuro-
brucellosis in brucella-endemic regions.
Keywords: Neurobrucellosis, meningitis
P20
An unusual case of brucellar spondylodiscitis
involving the cervical spine
Nas Kemal1, Bukte Yasar2, Ustun Cemal3, Geyik Mehmet
Faruk , Cevik Remzi , Batmaz ‹brahim
3 1 1 Keziban
1
Departments of Physical Medicine and Rehabilitation,
School of Medicine, Dicle University; Diyarbakir, TURKEY,
2
Department of Radiology, School of Medicine, Dicle
University; Diyarbakir, TURKEY, 3Department of Infectious
Diseases and Clinical Microbiology, School of Medicine,
Dicle University; Diyarbakir, TURKEY
OBJECTIVE: An unusual case of brucellar spondylodiscitis,
involving the cervical spine, was reported.
CASE: A 71-year-old man presented with a 3-month histo-
ry of acute neck pain associated with decreased range of
motion, fever, chills, sweating, especially at night. He com-
plained of fatigue, weight loss, pain increased with neck
movements and paresthesia of upper extremities for the
past 3 months. On physical examination, his temperature
92
was 37.8oC; pulse, 80/min; respiration, 22/min; and
blood pressure, 110/70mmHg. We observed painful per-
cussion of the cervical spine and passive mobilization of the
neck, decreased range of motion, and cervical paraverte-
bral tenderness, but no abnormalities or sphincter distur-
bance were seen on neurological examination. Laboratory
investigations showed a WBC count of 4700/mm3(PMNL
47%), ESR of 25 mm/hr. Serum agglutination test for bru-
cella was positive at 1/320. Magnetic resonance imaging
(MRI) of the cervical spine revealed spondylodiscitis
involvement of the C3-C4 disc and the adjacent C3 and C4
vertebral bodies. Owing to the presence of such chronic
symptoms in a patient from an endemic area, the diagno-
sis of brucellosis was considered. He was treated with
rifampin (600mg/day orally) and doxycycline
(200mg/day). The patient’s condition improved at 2 weeks
after initiation of therapy. The therapy was stopped after 3
months; he was very healthy, and no relapse was seen after
6 months following therapy.
RESULTS: Cervical involvement due to spinal brucellosis is
quite rare. In endemic regions, MRI should be performed in
cases with fever, neck and low back pain considering the
spinal involvement of brucellosis.
Keywords: Brucellosis, Spondylodiscitis, MRI
P21
An unusual presentation of brucellosis complicat -
ed by septic thrombophlebitis and urinary tract
infection: a case report
Y›ld›r›m Mustafa, Ozdemir Davut, Guclu Ertugrul, Demirli
Department of Clinical Microbiology and Infectious
Diseases, University of Duzce
Brucellosis is a multisystem disease that may present with a
broad spectrum of clinical manifestations and its complica-
tions can affect almost all organs and systems with varying
incidence. We present a case of brucellosis complicated by
septic thrombophlebitis, urinary tract infection, and renal
failure. A 72-years-old female was admitted to the hospital
with complaints of left flank pain, fever, dysuria, lomber
pain, and skin rashes. Meticillin-sensitive Staphylococcus
aureus was yielded at the first and second set of blood cul-
tures. Cefazolin (6gr/day) and gentamycin (160mg/day)
treatment was administered. There was not found infective
endocarditic signs in echocardiography. Rose Bengal test
was positive. Standard tube agglutination test was found
positive at 1/160 titer and 1/320 titer in the second week.
At the seventh day of treatment, fever of patient was nor-
mal and gentamicin therapy was stopped. Brucella mel-
litensis was yielded at the third set of blood culture. Lower
extremity Doppler ultrasonographic examination revealed
a hypo echoic thrombus within the right saphenous magna
vein that occluding it and making partial occlusion within
the right main femoral artery. Acute renal failure was con-
sidered by Nephrology department and hemodialyse was
decided because of increase in creatinine level.
Unfortunately, cardiopulmonary arrest was developed dur-
ing inserting central venous catheter. In conclusion, this
case suggests that, in endemic areas of the world, clinicians
should consider brucellosis in any unusual presentation
involving multiple organ systems. Its diagnosis requires
microbiological confirmation by means of isolation from
blood culture or demonstration of the presence of specific
antibodies by serological tests.
Keywords: Brucellosis, septic thrombophlebitis,
urinary tract infection
P22
Renal involvement in brucellosis: Case report
Ucmak Hasan , Sayarlioglu Hayriye , Dogan Ekrem ,
1 2 2
Balakan Ozan3, Kadiroglu Ali Kemal2, Sayarlioglu
Mehmet 3
1
Department of Infectious Disease, Sutcu Imam University,
Kahramanmaras, Turkey
2
Department of Nephrology, Sutcu Imam University,
Kahramanmaras, Turkey
3
Department of Internal Medicine, Sutcu Imam University,
Kahramanmaras, Turkey
Brucellosis is a systemic disease that can involve almost any
organ system. Interstitial nephritis, pyelonephritis, exuda-
tive pyelonephritis and IgA nephropathy accompanying
brucellosis have been reported. In this paper, we present a
case of brucellosis with renal involvement.
CASE: A 16-year-old girl was admitted with complaints of
dark urine, fever, and weakness. Her physical examination
was normal except fever. The diagnosis of brucellosis was
made 5 months ago in another hospital using agglutination
test for Brucella (a titer of 1/160) and then appropriate
therapy (rifampicin and trimethoprim-sulfamethoxazole)
was initiated. Since the complaints started again, the
93
patient was referred to our hospital. Laboratory findings
were as follows: urea:43 mg/dl, creatinine:1.8 mg/dl,
AST:26 U/L, ALT: 45 U/L, albumin 2.7 g/dl, normal elec-
trolyte levels, CRP:124 mg/dl, ESR: 114 mm/h, hemoglo-
bin: 10,2 g/dl, leukocyte: 6180, and thrombocyte:
335000 /mm3. Urine analysis revealed hematuria (ery-
throcyte 722), pyuria (leukocyte 43), proteinuria (150
mg/dl). Brucella spot test was positive. Brucellacapt
(immunocapture-agglutination) test was used for the detec-
tion of total antibodies and revealed 1/5120 titers. Urinary
ultrasonography was done and obstructive uropathy, SLE
and chronic renal failure were excluded. Urine culture was
negative. She received antimicrobial treatment (oral doxy-
cyclin 200 mg and rifampin 600 mg per day). Creatinine,
urea and urinary findings of this case recovered after 6
weeks of therapy, and brucellacapt test revealed 1/640
titers. These findings led us consider the diagnosis as tubu-
lointerstitial nephritis due to brucella.
In endemic areas for brucellosis, this infection should be
considered in the differential diagnosis of acute renal fail-
ure.
Keywords: Brucella, renal involvement, tubulointerstitial nephritis
P23
Brucella endocarditis A Case Report
Alan Sait
Dicle University Hospital, Department of cardiology,
Diyarbakir Turkey
One of the complications of brucellosis is infective endo-
carditis which carries a high mortality rate if undiagnosed.
After Brucella specific treatment, patient show dramatic
clinical improvement. Brucella endocarditis has a low
occurrence rate in cases of brucellosis and has been
endemic in regions surrounding Turkey. No data is avail-
able about Brucella endocarditis prevalence in Turkey.
Brucella endocarditis causes destructive valvular lesions.
The aortic valve is the most common affected site, We pres-
ent a case of Brucella endocarditis with mitral root
abscess,A male patient, aged 45 years,he had intermittent
fever with chills and rigors,cardiac discomfort.On physical
examination,he had a fever of 38.° C,her blood pressure
was 145/85 mmHg, heart rate 115/min,respiratory rate
26/min. Laboratory test 9.6 mg/dl haemoglobin and ele-
vated erythrocyte sedimentation rate 56mm/hour.echocar-
diography showed vegetations 47 x 35 mm on anterior
mitral leaflet, Serial blood samples were taken for hemocul-
ture and vancomycin, gentamicin and rifampin were initi-
ated empirically.Since her fever did not resolve on the 7th
day of the treatment a diagnostic operation was planned
but on the 11th day of treatment Brucella melitensis was
grown from blood cultures.Antibiotic therapy was then
shifted to doxycycline (200mg/day) and rifampin (600
mg/day) the fever and chills disappeared and her haemo-
dynamic state stabilized on the 5th day. Emergency pros-
thetic valve replacement was planned.Finally Brucella
endocarditis is a very serious and potentially lethal compli-
cation of brucellosis.After diagnosis of Brucella endocardi-
tis of either native valve or prosthetic valve, antibiotic ther-
apy must be started immediately and surgical intervention
should be performed as soon as possible.
Keywords: Brucellosis, endocarditis
P24
Modified Rose Bengal Test for Diagnosis of
Human Brucellosis
Grushina Tamara Appolonovna
Department of zoonotic diseases, M. Aikimbaev's Kazakh
Scientific Center for Quarantine and Zoonotic Diseases,
Almaty, Kazakhstan
The combination of various serological tests is mandatory
for a definite diagnosis to avoid false negative results
.Huddleson agglutination reaction (HR) is quite widely
used. However, it can produce non-specific results. A more
specific, but less sensitive method is Rose Bengal Test
(RBT).The modified RBT (MRBT) with filter paper was
designed by us. Technique: 6 drops of stained antigen
were put on paper strips. A serum drop was put on top of
each antigen drop. Positive serum and normal rabbit serum
were used as controls. The strips were lowered vertically
into physiological solution. Visual check was carried out in
5 minutes. Positive result: the antigen spot had clearly seen
outline, and color column was not more than 2 cm.
Negative result: the spot outline was not seen, and column
was 5-7cm. Serum samples of patients (n: 234) were test-
ed for brucella antibodies using HR, SAT, PHAR, RBT and
MRBT. Healthy people (n: 137) with negative test results
were used as control. The number of positive results was
highest with HR (168, 71.8±2.9) and MRBT (160,
68.4±3.0). SAT positive results (146, 62.4±3.1) were com-
parable with the PHAR (146, 62.4±3.1), lower than that of
HR and MRBT, but higher than RBT (130, 55.6±3.2). Thus,
94
MRBT is comparable with HR We believe that this test is
easy to perform, and can be used under any circum-
stances.
Keywords: Human brucellosis, serological diagnostics,
Rose Bengal Test
P25
THE DIAGNOSIS OF BRUCELLOSIS USING A
NESTED PCR METHOD
Sabahat Çeken, Sedat Kaygusuz, Dilek K›l›ç, Canan
A¤alar.
University of K›r›kkale Faculty of Medicine, Department of
Infectious Diseases and Clinical Microbiology, K›r›kkale,
TURKEY.
Brucellosis is still a public health problem in our country.
Polymerase chain reaction (PCR) is a good alternative in
rapid diagnosis of brucellosis. The aim of this study was to
use PCR method in diagnosis of brucellosis and compare its
efficiency and cost with conventional methods. The study
included 35 patients who referred to University of Kirikkale
Faculty of Medicine, department of Infectious Diseases and
Clinical Microbiology with clinical findings of brucellosis
(Group-1) and 20 healthy volunteers (Group-2). Sera for
serology (standard agglutination tests-SAT, Coombs test)
and whole blood samples for PCR were collected from each
subject in both groups and two blood cultures were done
for all patients in Group-1. The primers that amplify a 223-
base pair fragment from the conserved region of the gene
which encodes a membrane protein of 31 kDa of Brucella
abortus was used for the assay. DNA was extracted from
peripheral mononuclear cells obtained from the blood sam-
ples and nested PCR assay was used to detect Brucella
DNA. SAT titers of patients in Grup-1 were ? 1/160 except
one patient that was 1/80. Blood cultures were of 16
patients were positive. The SAT titers of Group-2 were neg-
ative. Thirty-four (97%) of the patients in Group-1 had pos-
itive nested PCR results. None of the 20 volunteers in
Group-2 were positive. Specificity of this PCR method was
100%. These results suggest that nested PCR has high sen-
sitivity and specificity in diagnosis of brucellosis. The cost of
PCR methos is approximately same when compared with
SAT and blood cultures. Therefore it may be used in rapid
diagnosis of brucellosis.
Keywords: Brucellosis, PCR, serology
P26
EARLY RESPONSE TO MEDICAL TREATMENT
IN A CASE OF BRUCELLAR
SPONDYLOD‹SC‹T‹S WITH MEDULLARY
COMPRESSION
Kemal NAS1, Nebahat TAfiDEM‹R2, Mustafa Serdar
KEMALO⁄LU3, Yaflar BUKTE4, Ali GÜR1 , Mehtap
BOZKURT1
1
Department of Physical Medicine and Rehabilitation,
2
Neurology, 3Neurosurgery, 4Radiology
We have presented a patient with brucellar spondylodisci-
tis who developed paraparezi secondary to spinal cord
compression, and responded well to the medical treatment
A 55 year-old male farmer presented with a 7-day history
headache, urinary retention, weakness in his lower extrem-
ities and a 3-month history of back pain. Blood Brucella
Wright antibody titer was 1/160 and Rose Bengal test was
positive.
Our case did not need a surgical intervention and gave a
good response to medical treatment and rehabilitation.
Thus, we suggest that in cases with brucella spondylitis,
medical treatment should be considered at first, even in
cases with spinal cord compression due to prevertebral
abscess.
Keywords: Brucellar spondylodiscitis, medical treatment,
medullar compression, rehabilitation
P27
Bacteraemic and Non-Bacteraemic Brucellosis:
Clinical and Laboratory Observations
Kadanal› Ayten1, Ozden Kemalettin1, Altoparlak Ulku2,
Erturk Ayse1, Parlak Mehmet1
1
Dept. of Infectious Diseases, Atatürk University, Erzurum,
Turkey
2
Dept. of Microbiol. and Clinical Microbiol., Atatürk
University ,Erzurum, Turkey
OBJECTIVE: Although Brucella bacteraemia is common in
adults living in endemic areas, reports on brucella bacter-
aemia are scarce. The aim of this study was to evaluate the
epidemiological, clinical, serological and prognostic fea-
95
tures of bacteraemic brucellosis versus non-bacteraemic
brucellosis.
METHOD: Retrospective case series of 123 patients with
brucellosis admitted to a hospital providing tertiary level
medical care in eastern Turkey. While 60 patients had pos-
itive culture results for Brucella spp, the results of 63
patients for Brucella spp. were negative. RESULTS: The
mean age of non-bacteraemic patients was significantly
greater than that of bacteraemic patients (41.9 versus
34.0, P=0.007). Duration to the onset of symptoms was 6.1
weeks in culture positive and 16.8 weeks in culture nega-
tive cases (P=0.002). Number of patients with fever was
significantly higher in bacteraemic patients (P=0.002).
Arthralgia was more often the symptom in non-bacter-
aemic patients (P<0.05). Significant elevation of AST
(P<0.01) and ALT (P<0.05) levels and leukopenia (P<0.05)
were detected in bacteraemic patients. Commonly used
antimicrobial regimens were consisted of doxycycline plus
streptomycin or doxycycline plus rifampicin given for 6
weeks. Most common way of transmission (61.8 %) was
ingestion of milk products from diseased animals. CON-
CLUSION: Compared to nonbacteraemic brucellosis, bac-
teraemic brucellosis was diagnosed during its earlier stage
and in younger patients. Such clinical and laboratory fea-
tures as fever, chills, elevation of AST, ALT levels and
leukopenia might differ in these two groups of patients with
brucellosis.
Keywords: Brucella, bacteraemia, diagnosis
P28
Antimicrobial effects of two herbal extracts on
the two oral streptococci
Vahabi Surena
Department of Periodontics, Dental Faculty, Shahid
Beheshty University of Medical Sciences, Tehran, Iran
OBJECTIVES: Gingivitis is the most prevalent disease of
gum and the Streptococci are the most prevalent bacteria
which involve in gingivitis. The aim of this study was to
compare the effects of two herbal plants: Malva Sylvesteris
and Salvadora Persica, on S. salivarius and S. sanguis.
METHODS: Phenol coefficient of aqueous-alcoholic root
extract of M. sylvesteris and S. persica which had been
taken with succilate method was defined through its impact
on Pseudomonas aeruginosa. Both diluted extracts,
chlorhexidine mouthwash, betadine and phenol were came
together in blood agar culture media with S. salivarius and
S. sanguis in dilution degree of 5% Mc Farland (1.5 ?10
cfu/ml) and an average diameter for 14 halos of no
growth in each case was measured using caliper. Data was
analyzed using ANOVA with an alpha error level less than
0.05.
RESULTS: Average diameter of halo of no growth of S. san-
guis showed no significant difference between S. persica
extract and chlorhexidine (P=0.00). Average diameter of
halo of no growth created by M. sylvesteris was more than
both mouthwashes but less than chlorhexidine and beta-
dine and had significant difference with the other three
materials (P=0.00). There were no differences between
mean diameter of halo of no growth of S. salivarius for M.
sylvesteris and S. persica (P= 0.00) and had significant dif-
ferences with each of the three materials (P= 0.00).
CONCLUSIONS: Regarding to high antimicrobial effects of
aqueous- alcoholic extracts of these herbs, we recommend
more studies to demonstrate practical approaches of using
herbal materials in medicine.
Keywords: streptococci, Malva sylvesteris, Salvadora persica,
Chlorhexidine
P29
The incidence and antimicrobial susceptibility of
bacterial enteropathogens isolated from patients
admitted to Kashani Hospital of Iran
Moghtadai Khorasgani Elham
Department of Pathology, Islamic Azad
University,Shahrekord, Iran
BACKGROUND: Antimicrobial resistance in enteric bacte-
ria is increasing worldwide. Little data available on epi-
demiology and antimicrobial susceptibility pattern of
enteric pathogens in Shahrekord city of Iran.
METHOD: A 2 year prospective surveillance study was per-
formed on bacterial pathogens isolated from stool speci-
mens from community acquired gastroenteritis submitted to
Kashani Hospital in Shahrekord. The organisms were iden-
tified using conventional laboratory methods. Antimicrobial
susceptibility tests for Salmonella spp and Shigella spp
were performed.
RESULTS: There were 275 cases of bacterial gastroenteri-
tis. Salmonella spp accounted for 42.1%, Shigella spp
33.1%, Campylobacter spp 24%. Resistance to
ciprofloxacin was uncommon in Salmonella spp (1.8%)
and not detected in Shigella spp. However ciprofloxacine
resistance was high in campylobacter (50%).
96
Cotrimoxazole resistance was high in shigella spp with a
highest rate in S.sonnei (92%). In Salmonella spp cotrimox-
azole resistance was 6.3%. Erythromycine resistance in
Campylobacter was uncommon. The patterns of infection
and resistance rate were similar for adult and children.
CONCLUSION: The patterns of infection and antimicrobial
resistance in bacterial enteric pathogens in Iran have fea-
tures in common with both the developing and developed
world. Cotrimoxazole should not be used as empirical ther-
apy for dysentery. Quinolones should be used with caution
as empirical therapy for gastroenteritis because of the high
incidence of ciprofloxacin resistance in campylobacter.
Erythromycin remains the agent of choice for campylobac-
ter infection.
Keywords: hospital,resistance
P30
Determine the inducible resistance phenotype in
methicillin resistance Staphylococcus aureus and
coagulase negative staphylococci isolated from
patients in Imam Reza hospital
Naderinasab Mahboobeh, Yousefi Frough, Farshadzadeh
Zahra
Microbiology Lab. Imam Reza Hospital and research
microbiology laboratory of Buali center, Medical School,
Mashhad Iran
INTRODUCTION: Macrolide, lincosamide and strep-
togramin B (MLSB) are antimicrobial agents widely used in
treatment of staphylococcal infection. Clindamycin is a fre-
quent choice for some staphylococcal infection, particular-
ly skin and soft tissue infections. Erythromycin is a
macrolide and clindamycin is a lincosamide that- present
two distinct classes of antimicrobial agents which inhibit
protein synthesis by binding to the 50S ribosomal subunits
of bacterial cells. Inducible resistance to clindamycin is not
diagnosed using conventional antibiogram and most physi-
cians when observing the resistance to erythromycin refuse
to prescribe clindamycin whereas all strains resistant to
erythromycin are not resistant to clindamycin and by per-
forming inducible test determining the usage of clin-
damycin in the treatment. The aim of this study was to
determine the inducible resistance phenotypes to clin-
damycin in methicillin resistance Staphylococcus aureus
and coagulase negative staphylococci.
MATERIAL-METHODS: The inducible test was performed
by disk diffusion method, placing an erythromycin disk
adjacent to a clindamycin disk on Muller Hinton agar plate.
If the isolates are resistant to erythromycin and this resist-
ance are induced to clindamycin an inhibition zone shaped
like the letter D is produced.
RESULT: Inducible resistance was detected in 128 methi-
cillin resistantant Staphylococcus aureus and coagulase
negative staphylococci isolates. . From witch 6 isolates
were D and 1 D+.
CONCLUSION: Inducible resistance test can identify iso-
lates resistant to erythromycin that induce resistance to clin-
damycin and we generate a correct report on the sensitivi-
ty of this antibiotic.
Keywords: test, erythromycin, clindamycin, Staphylococcus
aureus, coagulase negative staphylococci
P31
Changing pattern of antibiotic resistance among
urinary tract infection isolates
Hasan Najm Ul1, Abbas Tanveer1, Naqvi Syed A. Baqar2
1
Department of Microbiology University of Karachi,
Karachi, Pakistan
2
Department of Pharmaceutics, Faculty of Pharmacy,
University of Karachi, Karachi, Pakistan
PURPOSE OF STUDY: The study is based under the aim to
investigate the prevalence and susceptibility pattern of
pathogens causing urinary tract infections (UTIs) to antibi-
otics commonly used in routine medication.
Over a period of 10 months 100 urine sample isolates
were collected for the determination of their susceptibility to
chosen antibiotics, from patients, through different health
laboratories in urban area of Karachi. All Gram-negative
rods and Enterococci recognized urinary tract pathogens
were identified by their morphological and biochemical
characteristics and the susceptibility to seven antibiotics
was determined. Pathogens were found as, Escherichia
coli, Pseudomonas, Klebsiella, Enterobacter, and
Staphylococci. Antimicrobial sensitivity testing of all iso-
lates was performed on Diagnostic Sensitivity Test plates by
Kerby Bauer method. The antibiotics were
Amoxicillin/Clavulanic acid, Cefixime, Chloramphenicol,
Gentamicin, Imipenem, and Ofloxacin.
RESULTS AND CONCLUSIONS: Our results indicate that E.
coli and Pseudomonas are the most common organisms
97
causing UTI in this community. Other organisms involved
are Pseudomonas aeruginosa, Enterobacter species,
Staphylococcus, and Klebsiella species. In E. coli, more
than half of the isolates were resistant to one or more of the
all antimicrobial drugs investigated. Resistance was most
common to Amoxicillin/Clavulanic acid and Ofloxacin,
Cefixime, followed by Gentamicin. Organisms resistant to
various antimicrobial agents such as gentamicin,
Ofloxacin, are increasing. Pattern of antibiotic susceptibili-
ty to first line antibiotics is changing. Antimicrobial suscep-
tibility testing of all isolates is crucial for the treatment of
UTI.
Keywords: UTI, Antibiotics, Kerby Bauer method,
P32
Microbial spectrum and antibiotic susceptibility
profile of gram-positive aerobic bacteria isolat -
ed from cancer patients
Ashour Hossam M1, El-sharif Amany2
1
Department of Microbiology and Immunology, Faculty of
Pharmacy, Cairo University, Cairo, Egypt
2
Department of Microbiology and Immunology, Faculty of
Pharmacy, Al-Azhar University, Cairo, Egypt
Cancer patients are particularly susceptible to nosocomial
infections because of their compromised immune system,
and because of the nature of the treatment practices they
experience. Recently, a shift of the microbial spectrum of
cancer patients from gram-negative to gram-positive has
been demonstrated. This study examined microbial spec-
trum of gram-positive bacteria in various infection sites in
patients with hematologic malignancies (mainly leukemia)
or solid tumors. There is scanty literature covering antimi-
crobial resistance of nosocomial bacterial isolates from
cancer patients in Egypt. Thus, the antimicrobial resistance
patterns of pathogens accounting for the majority of gram-
positive infections in cancer patients were studied. Most of
the gram-positive isolates from UTI (100%), RTI (89.7%)
and BSI (65.5%) were obtained from leukemic patients. All
gram-positive isolates from Skin infections (SI) were isolat-
ed from solid-tumor patients. In both leukemic and solid-
tumor patients, gram-positive bacteria causing nosocomial
BSI were mainly CNS and S aureus, while gram-positive
bacteria causing nosocomial RTI were mainly ·-hemolytic
streptococci and CNS. Gram-positive bacteria were not
isolated from GITI. S aureus, CNS, and ·-hemolytic
Streptococci demonstrated methicillin resistance (81.5%,
92.3%, and 90% resistance respectively). S aureus and
CNS were susceptible to Linezolid (15.4% and 0% resist-
ance respectively), and Vancomycin (15.5% and 11%
resistance respectively). This is the first study to report the
emergence of Vancomycin-resistant and Linezolid-resistant
S aureus in Egypt. Newer generation quinolones
(Moxifloxacin, Gatifloxacin) were more active than older
quinolones (Ciprofloxacin, and Ofloxacin) against S
aureus and CNS suggesting the usage of newer generation
quinolones in the prophylaxis of cancer patients.
Keywords: Leukemia, Solid-tumor, Vancomycin, Linezolid,
Antibiotic resistance, Staphylococcus, Streptococcus
P33
Sensitivity of clinical strains of Salmonella enteri-
tidis and Salmonella typhimurium to antimicro-
bial preparations at children in Karaganda
Begaydarova Rosa Khasanovna, Abilkasimov Zulfikar
Erdinbayevich, Alshynbekova Gulsharbat Kanagatovna,
Devdariani Khatuna Georgiyevna, Tulegenova
Gulbagdan Kydyrbayevna
Chair of children infectious diseases, Karaganda State
Medical Academy, Karaganda, Kazakhstan
Purpose of the research: monitoring of antimicrobial sus-
ceptibility patterns of clinical isolates .
Materials and methods : It was carried out comparative
research of sensitivity of clinical isolates of S.enteritidis
(n=22) and S.typhimurium (n=24), allocated from children
in 2006, to antimicrobial preparations. Definition of sensi-
tivity to antimicrobial preparations was carried out by the
method of disks and method of serial dilutions on Müller-
Hinton’s medium. Allocation of cultures was carried out
with use of medium Salmonella differential agar (HiMedia).
Definition of sensitivity to antimicrobial preparations and
interpreting of results was carried out according to direc-
tions of NCLS (2004).
Results and conclusions: At the comparative estimation of
sensitivity to antimicrobial preparations we have revealed
essential differences in two compared groups. The domi-
nating mass of strains S.enteritidis was characterized by
high sensitivity to the majority of antimicrobial prepara-
tions. A share of sensitivity of these strains to II-IV genera-
tion cephalosporins were 88.5% (MIC90 for Ceftriaxon has
made 4 MCg/ml). Sensitivity to carbapenems was marked
in all cases of observation. An estimation of sensitivity to
98
clinically significant aminoglycosides also has revealed
high percent of sensitivity to Gentamycin and Isepamycin
(89.9%). Sensitivity to fluoroquinolones has made 94.7%
(MIC90 for Ciprofloxacine has made 0.094 mcg/ml). At
the estimation of S.typhimurium sensitivity to antimicrobials
the high percent of resistant strains was revealed. So,
86.4% of the strains were hyperproducers of expanded
spectrum beta-lactamases (ESBL), that was accompanied
by the resistance to all beta-lactams excluding Immipenem
and Meropenem. Sensitivity to Ciprofloxacine was
observed in 95.2% of cases (MIC90=2 mcg/ml).
Keywords: Salmonella enteritidis, Salmonella typhimurium,
antimicrobial preparations, sensitivity
P34
Evaluation of risk factors for Nosocomial multi-
drug resistant Pseudomonas aeruginosa infec -
tions
Ustun Cemal, Hosoglu Salih, Geyik Mehmet Faruk, Ayaz
Celal, Celen Mustafa Kemal
Dicle University Medical Hospital, Infection Diseases and
Clinical Microbiology Department, Diyarbakir, TURKEY
AIM: In this study, the risk factors of multi-drug resistance
Pseudomonas aeruginosa (MDR-Pa) infections were evalu-
ated.
METHOD: A prospective case-control study was done for
evaluation of risk factors of MDR-Pa infections at Dicle
University Hospital. The case group was formed from
patients with a nosocomial MDR-Pa infection. Two different
control groups were structured. The following patients from
each case were entered into the control group. The first
control group(C-1) was consisted of the patients with non-
MDR-Pa infections. The second control group(C-2) was
consisted of the patients with non-MDR gram negative bac-
terial infections. The susceptibility of P. aeruginosa strains
were confirmed using ‘disc diffusion test’ (Oxoid). The pos-
sible risk factors for MDR-Pa acquisition were analyzed
with univariate and multivariate logistic regression tests.
RESULTS: The mean age was 29.8 ±27.2-years for the
cases, 29.2 ±25.9-years for C-1 and 46.6 ±24.8-years for
C-2. The ratio of men was 59% in the cases, 69% in the C-
1 and 61% in C-2. In the multivariate analyses comparing
C-1 group the following variables were found: Use of car-
bapenem (p<0.011), long time hospitalization(p<0.006),
number of invasive procedure>=3(p<0.018), Chronic care
patients(p<0.027), number of risk factor>=7(p<0.009),
Previous surgical intervention(p<0.001) and Total parenter-
al nutrition(p<0.016). In the multivariate analyses compar-
ing C–2 group the following variables were found: Use of
carbapenem (p<0.022), long time hospitalization
(p<0.041), number of invasive procedure>=3(p<0.002),
Chronic care patients (p<0.018), Burn (p<0.001),
Pneumonia (p<0.012) and Sepsis (p<0.005)
CONCLUSION: The patients with MDR-Pa should be fol-
lowed carefully if the followings are available: long time
hospitalization, multiple invasive procedures, antimicrobial
drug use and multiple co-morbidities.
Keywords: multi-drug resistant Pseudomonas aeruginosa, noso-
com›al infections
P35
Antibiotic susceptibility patterns and Molecular
analysis of clinical isolates of Staphylococcus
aureus in Tehran, Iran
Pourmand Mohammad Reza, Bagherzadeh Yazdchi Sahar
Department of Pathobiology, Tehran University of Medical
Sciences, Iran
Nosocomial infections caused by Staphylococcus aureus
especially Methicillin- Resistant Staphylococcus aureus
(MRSA) belong to the most important multiresistant
pathogens worldwide. Therefore, genotypic surveillance of
these strains in patients with staphylococcal infections is
crucial in control of nosocomial infections.
In this survey, 55 isolates of Staphylococcus aureus were
collected from Tehran University hospitals. Antibiotic sus-
ceptibility patterns of the all isolates were determined to the
12 antibiotics by the standard disk-diffusion method.
According to the genome sequence of the standard strains
of S. aureus, COL and 8325/4, two pairs of primers were
designed for coa, and spa genes.
Twenty nine isolates (52.7 %) were resistant to methicillin
and oxacillin. All the isolates were susceptible to van-
comycin, and chloramphenicol. Fifty one isolates (92.7 %)
were sensitive to rifampin. Five patterns (C1-C5 ) of coa
gene were detected with C1 being the most prevalent; 41
(74.54 %). Four (7.27 %), 2 (3.63 %), 2 (3.63 %), and 6
(10.9 %) isolates displayed patterns C2, C3, C4, and
C5,respectively. The results for spa gene were as follows;
pattern S1; 41 (74.54 %),S2; 6 (10.9 %), S3; 4 (7.27 %),
S4;1 (1.81 %), S5; 1 (1.81 %), and S6; 2 (3.63 %). Three
coa gene RFLP patterns (A to C) were observed: Pattern A
99
was most common (63.41 %), followed by pattern
B (31.7 %) and C (4.87 %).
The coa and spa genes PCR-products assay is useful as
molecular marker for a quick, preliminary study of MRSA
and MSSA outbreaks.
Keywords: MRSA, PCR-RFLP, coa, spa
P36
Investigation of Antibiotic Resistance Rates in
Gram- Negative Bacteria Isolated from
Nosocomial Infections
Ustun Cemal, Geyik Mehmet Faruk, Hosoglu Salih, Ayaz
Celal, Celen Mustafa Kemal
Dicle University Faculty of Medicine, Department of
Clinical Microbiology and Infectious Diseases, Diyarbakir,
TURKEY
AIM: The antibiotic resistance rates of gram-negative bac-
teria isolated from nosocomial infections in a nine-year-
period between the years 1997–2005 in Dicle University
Hospital were evaluated.
METHOD: Nosocomial infections have been prospectively
investigated with active surveillance between the years of
1997-2005 in Dicle University Hospital. Antibiotic suscep-
tibility testing in isolates was performed with Sceptor
Microdilution technique. Antibiogram datas were ana-
lyzed.
RESULTS: We followed up 207,366 hospitalized patients
during this period. Two thousand eight hundred and seven-
teen nosocomial infection episodes developed in 2530 of
the hospitalized patients. Gram-negative bacteria were iso-
lated in 1341of nosocomial infections. The Gram-negative
microorganisms were isolated; 463 Escherichia coli
(34.5%), 267 Pseudomonas spp. (19.9%), 194 Klebsiella
spp. (14.5%), 186 Enterobacter spp. (13.9%), 78
Acinetobacter spp. (5.8%) and 153 others (11.4%).
Antibiotic resistance rates (%) of Gram-negative bacteria
were demonstrated in the table.
CONCLUSION: The high level of antibiotic resistance
among Gram-negative bacteria responsible for nosocomi-
al infection results in excessive carbapenem consumption.
Increasing resistance rates for carbapenem among gram-
negative bacteria constitude an important forthcoming
problem.
Keywords: Antibiotic resistance, Gram-negative bacteria,
Nosocomial infection
P37
Ceftazidime, amikacin, ciprofloxacin, meropen-
em, imipenem resistance rates and MIC values
among nosocomial Pseudomonas aeruginosa
spp
Ustun Cemal, Hosoglu Salih, Geyik Mehmet Faruk, Ayaz
Celal, Celen Mustafa Kemal
Department of Infectious Diseases and Clinical
Microbiology, Faculty of Medicine, Dicle University,
Diyarbak›r, Turkey
AIM: Ceftazidime, amikacin, ciprofloxacin, meropenem,
imipenem resistance rates and MIC values among
Pseudomonas aeruginosa spp., isolated from nosocomial
infections were investigated at Dicle University hospital
(DUH).
METHOD: Antibiotic susceptibility tests of pathogenic
microorganisms isolated from nosocomial infections in the
year 2006 at DUH, were performed with Sceptor
Microdilution technique and BD Phoenix 100 System.
Antibiogram datas of P. aeruginosa spp. were analyzed.
RESULTS: P. aeruginosa spp. was isolated from 70 patients
with nosocomial infections. Mean age of the patients, rang-
ing from 1 to 75 years old, was 28.8 ± 26.2 years. Of the
patients 44 (63%) were male, while 26 (37%) were female.
P. aeruginosa was the most frequent isolated microorgan-
ism in burn wound infections in Burn Unit (43%).
Ceftazidime, amikacin, ciprofloxacin, meropenem, imipen-
em resistance rates and MIC values among P. aeruginosa
spp. were established on the table.
CONCLUS‹ON: Multiple antibiotic resistandes among P.
aeruginosa spp. in DUH constitute an important forthcom-
ing problem.
Keywords: Antibiotic resistance, P. aeruginosa
P38
Investigation of antibiotic resistance rates among
Staphylococcus spp. isolated from nosocomial
infections in Dicle University Hospital
Ustun Cemal, Geyik Mehmet Faruk, Celen Mustafa Kemal,
Hosoglu Salih, Ayaz Celal
Department of Infectious Diseases and Clinical
100
Microbiology, Dicle University Faculty of Medicine,
Diyarbak›r, Turkey
AIM: The antibiotic resistance rates of gram-positive bacte-
ria isolated from nosocomial infections in a nine-year-peri-
od between the years 1997 and 2005 in Dicle University
Hospital were analyzed.
METHOD: Nosocomial infections in Dicle University
Hospital between the years 1997 and 2005 have been
prospectively investigated with active surveillance.
Antibiotic susceptibility testing of isolates was performed by
Sceptor Microdilution technique.
RESULTS: We followed up 207,366 hospitalized patients
during this period. 2817 nosocomial infection episodes
developed in 2530 of the hospitalized patients. 1897 bac-
teria were isolated totally in nosocomial infections; among
these, 556 were Staphylococcus spp. 279 (50.2%) of
staphylococci were Stafilococcus aureus, while 277
(49.8%) were coagulase negative staphylococci (CNS).
Antibiotic resistance rates of staphylococcus spp. were
demonstrated on the table.
CONCLUSION: Antibiotic resistance in staphylococci spp.
duo to nosocomial infections have became an important
health problem in Dicle University Hospital.
Keywords: Antibiotic resistance, staphylococci spp., nosocomial
infections.
P39
Antibiotic Sensitivity Ratios of Pathogen
Microorganisms Isolated from Pulmonary
Disease in Intensive Care Unit
Uzun K, Teke T, Maden E, Yavuz Z, Korkmaz C
Selcuk University, Meram Medical Faculty, Pulmonary
Disease Department, Konya
Intensive care units(ICU) have high risk for hospital
acquired pneumonia(HAP) and 25% of HAP developes in
ICU. Delay in effective infection therapy causes increased
morbidity and mortality. National and international guide-
lines are important factors in antibiotic therapy. To know
the local antibiotic resistance profile for appropriate and
sufficient antibiotic usage is important for selection of
empirical antimicrobial therapy.
In this study the aims were to determine the pathogens
causing HAP in our ICU, to evaluate the antibiotic sensitiv-
ity ratios and to form our local data in the light of these
results.
MATERIALS and METHODS: In this study, we retrospective-
ly evaluated the data of cases who were followed in our
hospital’s ICU connected to mechanical ventilation (MV)
and stayed in ICU more than 48 hours, between February
2005 and February 2007. The culture and antimicrobial
sensitivity test results of mini BAL and bronchial lavage
samples, obtained by deep tracheal aspiration(DTA), of
patients in 48 hours of admission to ICU and 48 hours after
(3. and 4. day) connection to MV were recorded.
FINDINGS: We detected growth in 93 of bronchial lavage
cultures. The most commonly isolated microorganism in
bronchial lavage cultures was pseudomonas (46.2%), and
acinetobacter (28.0%). Piperasilin-tazobaktam (85%) was
the agent that pseudomonas was most sensitive in vitro.
DISCUSSION In conclusion distrubition of pathogens and
resistance patterns detected in each setting is very impor-
tant. For effective and appropriate empirical antibiotic ther-
apy, antibiotic usage principles should be formed by eval-
uating the local data and guidelines together.
Keywords: empirical antimicrobial therapy, intensive care unit,
local antibiotic resistance profile
P40
Comparative Study of Antimicrobial Activities of
Aloe Vera extracts and antibiotics against
isolates from skin infections
Bashir Miss Asma, Jehan Mrs Nayer, Sherwani Sikandar
Khan, Mujahid Talat Yasmin
Department of Microbiology, University of Karachi,
Karachi, Pakistan
Plants are of relevance to dermatology for both their ben-
eficial and adverse effects on skin and skin disorders.
One of the medicinal plants, Aloe Vera (Aloe barbadensis
Miller) is reputed to have medicinal properties. For cen-
turies, it has been used for an array of ailments such as
mild fever, wounds and burns, gastrointestinal disorders,
diabetes, sexual vitality and fertility problems to cancer,
immune modulation, AIDS and including various skin dis-
eases. In this study antibacterial activity of leaf and gel
extracts of Aloe Vera was tested against gram positive
and gram negative skin infections isolates. For this pur-
pose, hundred and fifteen bacterial strains were isolated
from skin wounds, burns and acne patients from various
hospitals of Karachi, a cosmopolitan and heavily populat-
101
ed city of Pakistan, and the strains were identified by con-
ventional methods. Among the total isolates, 90% of the
organisms were gram positive while the remaining 10%
were gram negative. The gel extracts of Aloe Vera
showed antibacterial activity against both gram positive
and gram negative isolates while the leaf extracts showed
no such activity. In parallel, five standard antibiotics were
also tested against the isolated strains. The data showed
promising results in case of Aloe Vera compared to five
broad-spectrum antibiotics. Additionally, the study also
demonstrated that the skin infectious isolates were resist-
ant against broad-spectrum antibiotics.
Keywords: Aloe vera, antimicrobial, plant extracts
P41
Prevalence of class 1 integrons and antibacterial
resistance in indigenous E. coli strains in antibi-
otic treated and naïve infants
Sepp Epp, Shchepetova Jelena, Kõljalg Siiri, Truusalu Kai,
Lõivukene Krista, Naaber Paul, Voor Tiia, Mikelsaar
Marika
Department of Microbiology, University of Tartu, Tartu,
Estonia
Introduction. E. coli belongs to indigenous intestinal
microflora yet causing several intestinal and extraintestinal
infections. However, there are few data if antibiotic treat-
ment is associated with the prevalence of class I integrons
and antibiotic resistance pattern of indigenous E. coli in
infants.
Objective. Comparison the occurrence of int1 gene and its
associations with MIC values in indigenous E. coli strains in
antibiotic naïve and treated infants.
Material. A total of 57 indigenous E. coli strains were iso-
lated from stool: 30 from 10 antibiotic naïve infants (age 3-
12 months) and 27 from 9 children treated with antibiotics
(age 1 week-12 months). The MIC values were measured
by E-test. Int1 was detected by PCR with the primers IntI-F
and IntI-R.
Results. The prevalence of int1 gene in E. coli strains in
these groups was similar (16/30 versus 17/27). However,
the MIC values were lower to sulfamethoxazole (MIC50/90
512/512 versus 512/512; p=0.048), cefuroxim (2/4 ver-
sus 6/256; p<0.001), cefotaxim (0.064/3versus 0.125/8;
p=0.013), gentamicin (0.38/3 versus 1.5/8; p=0.003)
and ciprofloxacin (0.012/1versus 0.023/2; p=0.002) in
E. coli strains isolated from antibiotic naïve infants.
Conclusions. We found high prevalence of Class 1 integron
positive E. coli strains in the intestinal tract of infants.
Antibiotic treatment does not influence the ratio of integron
positive/negative strains of indigenous E. coli. However,
intestinal E. coli strains of antibiotic treated children had
significantly higher MIC values to several antibiotics. Thus
development of resistance in intestinal E. coli strains in
infants did not depend on the presence of integrons.
Keywords: E. coli, antmicrobial resistance, integrons
P42
Antibiotic sensitivity of Listeria monocytogenes,
determined in Almaty
Zubova N.V., Dmitrovsky A.M
Stepanov V.M. of Kazakh National Medical University,
Almaty, Kazakhstan
Listeria monocytogenes, is an agent which causes a circling
disease; to treat which some antibacterial drug are pre-
scribed. Circling disease stocks, determined in Almaty have
some differences and varies from those specified in medical
reference books by Russian and Europian authors. As for
Safdar A., Armstrong D. (J Ciin. Microbiol. 2003; 41:483-
5) information high sensitivity of stock was observed to to
penicillin 97,6%, ampicillin 90,7%, tetracycline 96,9%,
gentamicin 98,0%. Ampicillin and gentamicin combination
was acknowledged as a standard for treating circling dis-
ease.
The aim of our work is a sensitivity analysis of 347 clinical
stocks of Listeria monocytogenes, determined from different
substrates of patients for the last years. The results shows as
following: high activity is determined in cephalosporin type
drugs of the second and the third generation, namely cef-
triaxone 64,1%, Cifloks – 62,7%. The third place holds
nitrofuran type drugs, namely: Furagin – 53,4%, nitrofu-
rantoin and furasolidone – 53,2%. Rifampicin sensitivity
equaled to 52,2%, for ampicillin – 22,9%, for lincomycin –
8,5% for Abactal – 3,3%, for amoxicillin – 3,2%. Stock
resistance was determined to penicillin and doxycycline
(98,2%). In three cases 100% resistance to all antibacterial
drugs was detected. From 1997 to 1999 antibacterial
drugs sensitivity to 137 stocks was observed as following:
amoxicillin -60%, gentamicin – 64%, torhinol -34,4%,
ampicillin – 25,5%, in 4 cases there was discovered sensi-
102
tivity to lincomycin.
As a conclusion to above mentioned results, it is obvious
that Listeria monocytogenes stocks falls into groups accord-
ing to antibiotic sensitivity. Also there observed a stocks’
resistance increase.
Keywords: Antibiotic sensitivity, Listeria monocytogenes, Almaty
P43
Using Roncoleicin to treat children’s’ obstructive
bronchitis
Yelena Jojua1, Roza Kasymbekova1, Olga Efimova1,
Guzel Asmetova2, Roza Dusembaeva2
1
Kazakh National Medical University, Almaty, Kazakhstan
2
Children's infections diseases clinical Hospital,
Kazakhstan
Our goal is to prove the effectiveness of Roncoleicin to treat
children with obstructive bronchitis. 19 children, aged three
months to four years, all of whom were diagnosed with
acute respiratory viral infections with obstructive bronchitis
complications and respiratory problems of the 1st and 2nd
kind, were under observation. The sick children were divid-
ed into two groups. The children in the first group (there
were eight of them) received traditional treatment (antibi-
otics, expectorant, and other bronchial medications). The
second group of children (eleven of them) received inhala-
tions Roncoleicin with a dose of 250 000 units throughout
the course of 3-4 days. In the first group, the respiratory
pain and breathing problems stopped approximately on
the fifth day after hospitalization, and in the second group
it stopped during the fourth day. The body temperature of
the first group was normalized on approximately the fourth
day after being sick, and in the second: on the third day
after hospitalization. The obstructive symptoms of the first
group stopped in the first groups after seven days of being
sick, and in the second- after six days. This proved that an
inhalation of 250 thousand units of Roncoleicin during the
course of 3-4 days will help with the treatment of children
with obstructive bronchitis.
Keywords: children’s’ obstructive bronchitis, treatment,
Roncoleicin
P44
Antibiotic resistance of microorganisms isolated
from urinary tract infections in a large clinic in
Almaty Kazakh National Medical University
Urazbayeva Dinara Chimbulatovna1, Kotova Albina
Leonovna2, Ramazanova Bahit Amanulovna2
Kazakh National Medical University,
Department of Microbiology, Almaty
Many types of microbes among the conditional-pathogen-
ic group have high congenital resistance against medical
products or get resistance easily. So determining correct
therapy requires sensitivity results of isolated pathogens.
Researches included 475 clinical isolates
(Enterobacteriaceae - 118, Staphylococcus spp - 236,
Enterococcus spp - 64, Pseudomonas spp - 57), obtained
from patients with acute and chronic pyelonephritises.
Sensitivity of Enterobacteriaceae was defined by the disc
diffusion method for 30 antibacterial preparations,
Staphylococcus - for 25 preparations, Enterococcus - for
22 preparations, P. aeruginosa - for 21 preparatus. The
performed local epidemiological analysis of antibiotic
resistance of acute and chronic pyelonephritises causative
agent has shown their high polyresistency to the majority of
antibiotics (82,8-98,2%). At acute development of disease
the percent of stable Enterobacteriaceae has made
48,2±3,7%, Staphylococcus – 60,7±3,6 %, P. aeruginosa
– 85,7±2,6 % (p<=0,01). At chronic pyelonephritis the
number of stable Enterobacteriaceae and Staphylococcus
cultures increased. The highest percent of sensitive cultures
at pyelonephritises was found among Enterobacteriaceae –
43, 4±3,7 % and 33,4±1,7 % (p<=0,01). The lowest per-
cent of sensitive cultures was noted among P. aeruginosa
isolates (14,3±2,6 % and 12,6±1,2 % accordingly). It was
established, that among cultures of Staphylococcus methi-
cillin resistant isolates were found out. Methicillin resistance
of the tested cultures has made 16,3±4,1 %.
Keywords: Antibiotic resistance, urological stains
P45
Microbiological efficiency of antimicrobial thera-
py in patients with urinary infection
Mustafina Kamilya Kamalovna1, Urazbayeva Dinara
Chimbulatovna2, Orazbayeva Gulsanat Nurgazievna3,
Sadikov Askar Maratovich3
Almaty, Kazakhstan
The main task of treatment in patients with a pyelonephritis
is liquidation or reduction of microbial and inflammatory
process in renal tissues.Treatment efficiency with lev-
ofloxacine has been estimated at 94 pyelonephritis
patients. The preparation in a dose of 500 mg was applied
of once a day during 5 - 10 days. Bacteriological urine test
was made before treatment, on the 3-rd day, at the end of
the therapy course. Prior of treatment 140 cultures of
microorganisms has been singled out. Mono-infection has
been found in 49 of patients. Microbiological efficiency of
treatment with levofloxacine has been high. Full elimitation
of pathogen has been obtained in 75,5±4,4 % of cases. In
all patients progressive decrease in degree of bacteriuria
has been noted – the decrease in microbic intensity urine
semination in some orders has been noted. Bacteriuria was
observed at 26,6±4,6 % of patients only on the 3rd to 5th
day of the therapy. Antibacterial therapy was inefficient
and the same pathogen was singled out after treatment at
9,6±3,0% of patients, at acute process this state was at
2,2±2,2% of patients, and at chronic - at 16,7±5,4% of
patients ( <=0,001). One pathogen replacement to anoth-
er or joining of the other microorganism took place in our
researches. This was observed at 11 patients (11,7± 3,3
%). Thus, high microbiological efficiency was demonstrated
at application of levofloxacine for therapy of patients with
pyelonephritises.
Keywords: Microbiological efficiency, antimicrobial therapy, uri-
nary infection
P46
Antimicrobial agents without medical
prescription
Farinati Alicia Esther, Fernández María Isabel, Ortiz
Corina, Davolos Ignacio, Perez Cortizo Gonzalo,
Rodríguez Stoup Victoria, López Santiago, Morguillo
Pablo, Campana Victoria
103
Department of Microbiology, Salvador University, Buenos P47
Aires, Argentina Nosocomial Candida albicans meningitis treat -
ed successfully with voriconazole after failure
BACKGROUND: The self-treatment with antimicrobial
with amphotericin B deoxycholate (AMBD) and
agents (AM) and their sale without medical prescription
can be an important problem. AIM: To determine the amphotericin b lipid complex (ABLC)
behaviour of pharmacists regarding the sale of AM to
patients who describe different infectious symptoms. Sipahi O¤uz Reflat1, Bardak Selin1, Ruksen Mete2, Arda
METHODS: In a cross-sectional observational study, the Bilgin1, Yurtseven Taskin2, Metin Dilek3, Ulusoy Sercan1
simulated patients (SP) completed a data card with phar-
macists’ response. We studied 1074 adult SP (ADU) and
1
Department of Infectious Diseases and Clinical
571 pediatric SP (PED). The infections in ADU were respi- Microbiology, Ege University Faculty of Medicine, Izmir,
ratory (RTI) and urogenital tract infections (UGT): phrangi- Turkey
tis (PH), sinusitis (SI), otitis media (OM) and bronchitis (BR);
2
Department of Neurosurgery, Ege University Faculty of
uretritis (UR), vaginal discharge (VD), frequency urgency Medicine, Izmir, Turkey
and dysuria syndrome (DS), genital ulcers (GU) and geni-
3
Department of Microbiology and Clinical Microbiology,
tal herpes (GH), respectively. In PED were selected PH, ani- Ege University Faculty of Medicine, Izmir, Turkey
mal bites (AB) in children (CH); fever and diarrhea (FD)
and nasal purulent secretion (PS) in suckling babies (SB). OBJECTIVE: To present a case of C. albicans meningitis
Results. The most recommended AM was amoxicillin treated with voriconazole after failure with AMBD and
187/295 (63,4%) in RTI; fluoroquinolones (FQ) to 70/77 ABLC. Case presentation: Thirty-three year old male, who
(91%) in DS, aminoglycosides (AG) 18/41 (44%) in GU had pituitary adenoma, had undergone two consequent
and metronidazole (MZ) 43/80 (54%) in VD.A prescrip- transsphenoidal hypophysectomies. Ten days after the dis-
tion was asked to 5.6% ADU and to 2.8% of the PED charge from the hospital, patient readmitted to the hospital
patients. CONCLUSIONS: The recommendation of AM with complaints of headache, nausea and vomitting. CSF
without medical prescription in adults is generalized: pre- analysis revealed a WBC of 300/mm3. Intravenous
scription of FQ to sexually active women without consider- cefepime (1g 3x2) and vancomycin (500mg 4x1) was
ing a possible pregnancy, MZ as the most recommended started empirically (Meropenem was temporarily unavail-
AM in VD and the AG in GU. It might be necessary to able in the market.). Lumbar drainage was performed.
teach people the correct use of AM as well as to train phar- Since there was no bacterial growth on CSF cultures and
macists to suggest that patients with possible infections there was no clinical improvement despite five days of
should visit the physician and to know the rules of preven- treatment, therapy was switched to ceftazidime and linezol-
tion of common infections. id combination. Repeated CSF culture (On the 5th day of
Keywords: antibiotic prescribing, respiratory infection, antibiotic cefepime+linezolid) yielded C. albicans. AMBD
utilization, urogenital infections (1.2mg/kg) was added to the treatment. On the fifth day
patient developed nephrotoxicity and AMBD was switched
AM prescription and visit to physicians
to ABLC (6,2mg/kg). The MICs of the strain determined by
Simulated patients AM Visit p
ETEST ((AB BIODISK, Solna, Sweden, Performed according
n n to CLSI criteria) was as follows: AMBD:4 mg/l, flucona-
Groups
(%) (%)
zole:2 mg/l, itracanazol: 8mg/l, voriconazol:0,06mg/l
295 643
ADU n=1074 RTI n=494 and caspofungin: 0.25mg/l. On the fourth day of the ABLC
(59.7) (59.9)
treatment, he still had fever; there were >1000 leuko-
307 <
UGT n=580 cytes/mm3 in CSF and culture of the CSF still yielded
(52.9) 0.0001
C.albicans. ABLC was switched to intravenous voricona-
PED 21 444
SB n=279 zole (400 mgx2). CSF cultures became sterile on the third
n=571 (7.5) (77.7)
day. His clinical status improved and the treatment has
101
CH n=292 been continued for six weeks.
(34.6)
Abbreviations in the text

104
CONCLUSION: Voriconazole may be used at least as a
salvage therapy option in the management of C. albicans
meningitis.
Keywords: yeast, hospital acquired meningitis, postneurosurgical
meningitis, healthcare associated meningitis, azoles
P48
Linezolid in the treatment of methicillin-resistant
staphylococci (MRS) related nosocomial meningi - ed meningitis at least as a salvage therapy option.
tis: Report of ten cases
Sipahi O¤uz Reflat1, Arda Bilgin1, Turhan Tuncer2,
Pullukcu Husnu1, Bardak Selin1, Ruksen Mete2, Aydemir
Sohret3, Dalbasti Tayfun2, Yurtseven Taskin2, Zileli
Mehmet2, Ulusoy Sercan1
1
Department of Infectious Diseases and Clinical
Microbiology, Ege University Faculty of Medicine, Izmir,
Turkey
2
Department of Neurosurgery, Ege University Faculty of
Medicine, Izmir, Turkey
3
Department of Microbiology and Clinical Microbiology,
Ege University Faculty of Medicine, Izmir, Turkey
OBJECTIVES: This report aimed to present ten cases of MRS
meningitis trated with linezolid.
METHODS: All adult (aged>18) patients with culture
proven methicillin resistant
staphylococcal meningitis (MRSA or MRCNS) treated with
linezolid between January 2006 and 15 November 2006
th
in our setting (A tertiary care general teaching hospital with
an active neurosurgery ward with 78 beds, 16 of which are
in intensive care unit) were included in the study.
Demographic, clinical and laboratory data, predisposing
factors, as well as information on response to treatment
and outcome were obtained from each patient's hospital
records. A definite diagnosis of meningitis was based on
the isolation of the bacteria in at least one CSF culture.
Typical CSF findings included a leucocytosis with a pre-
dominance of polymorphonuclear cells and classic clinical
manifestations of meningitis.
RESULTS: There were a total of ten patients (8 MRCNS, 1
MRSA, 1 MRCNS+ MRSA, aged 45.5+-14.2, 7 males, 3
females.) As clinical findings; seven had fever, four had
disturbances in consciousness, three neck stiffness and six
nausea/vomitting.
Laboratory data, underlying conditions, treatment regi-
mens, morbidity and results of the patients are shown in
105
table. All patients had hospital-acquired meningitis and
had undergone neurosurgery. Six of nine cases with
MRCNS meningitis and all two patients with MRSA menin-
gitis were treated successfully. There was no staphylococcal
meningitis related mortality. There was no haematological,
nephro- or hepato-toxicity.
CONCLUSIONS: Our experience with linezolid suggets
that it can be an alternative for the treatment of MRS relat-
Keywords: hospital acquired meningitis, shunt infection,
postsurgical meningitis
P49
Antibacterial resistance in microbiologically con -
firmed nosocomial bacteremia (MCNB) related
Acinetobacter baumannii strains in a tertiary
care educational hospital in Turkey
Pulllukçu Hüsnü1, Aydemir Sohret2, Sipahi O¤uz Reflat1, Tasbakan
Meltem1, Cilli Feriha2, Ulusoy Sercan1, Tunger Alper2
1
Department of Infectious Diseases and Clinical Microbiology,
Ege University Faculty of Medicine, Izmir, Turkey
2
Department of Microbiology and Clinical Microbiology, Ege
University Faculty of Medicine, Izmir, Turkey
OBJECTIVES: This study aimed to evaluate the resistance patterns
of MCNB related A.baumannii strains between 2000-2006.
METHOD: Setting was a 1788 bedded tertiary care educational
hospital 77 of which
are in intensive care units. Resistance patterns of A.baumannii
strains isolated
from hospital wide MCNB patients between 2000 and 2006 were
evaluated retrospectively. Any patient in whom A.baumannii was
isolated in at least one set of blood cultures (Sent to the bacteriol-
ogy laboratory 72 h after hospital admission) was considered to
have MCNB. Data of antibacterial resistance and hospital admis-
sion dates were extracted from hospital patient record database.
Double or more isolates during each episode were counted as one
episode. Resistance patterns in the 2000-2002 and 2004-2006
periods were compared by Chi-square test. 2003 data were
excluded to see the probable effect of governmental antibiotic
restriction policy, which was started in March 2003. Blood cul-
tures were performed on Bact/Alert (bioMerieux, Durham, NC).
Bacterial identifications were performed by automated API
(bioMerieux, Durham, NC). Antibacterial susceptibility tests for
antibiotics shown in tables (all discs Oxoid, England) were per-
formed by Kirby Bauer disc diffusion method following the recom-
mendations of NCCLS/CLSI. Mueller Hinton agar (Oxoid,
England) was used for all susceptibility tests. Zone sizes were
interpreted as described by NCCLS/CLSI. sensitive drugs or an unrecognized outbreak of a multidrug resist-
RESULTS: Results are shown in Table 1 and 2. ant strain seem to have effected the situation.
CONCLUSION: Resistance rates seem to decrease in the 2004- Keywords: nosocomial bacteremia, blood stream infection, hospi-
2005 periods but by 2006 the relative inadequacy of available tal acquired bacteremia,healthcare associated bacteremia

P50
Successful treatment of multi-drug resistant INTRODUCTION: Antibiotics have a limited ability to pen-

Acinetobacter baumannii meningitis with sistemic etrate cerebrospinal fluid(CSF). Because of that in patients
with menengitis the treatment of multi-drug resistant
and intrathecal colistin
Acinetobacter baumannii infections is a serious therapeutic
problem. Mortality rate of menengitis due to Acinetobacter
Ç›nar Güle1, Memikoglu Kemal Osman1, Göktekin Serap1,
spp. is about 20.27%.
Çokca Fügen1, Ünlü Mehmet A¤ahan2
CASE: A 27-year-old female who had a traffic accident,
had a surgery of external lumbal drainage because of otor-
1
Department of Clinical Microbiology and Infectious dis-
rhoea on 7th day and 13th day. But on day 14 the patient
eases, Ankara University Faculty of Medicine, Ibn-i Sina
presented fever (>38`C), headache and somnolance.CSF
Hospital, Ankara, Turkey
showed pleocytosis (1980 cells/μl; with pmnl, dominance
2
Department of Nerochirurgica, Ankara University Faculty
(100%), a protein level of 347 mg/dl and a glucose level
of Medicine, Ibn-i Sina Hospital, Ankara, Turkey

106
of 1 mg/dl (blood glucose level was 106).Vancomycin (1
g q12h) and meropenem (1 g q8h) were began. Multi-drug
resistant A. baumannii was isolated from the CSF. Both
meropenem and vancomycin were stopped and the treat-
ment changed to colistin intravenous (2 MU q8h) and
intrathecal (50000 U q2d). The CSF was sterile on day 12
of treatment. Treatment was maintained for 21 days and
the patient was discharged.
DISCUSSION: High use rates of broad-spectrum antibiotics
have been corraleted with the emergence of resistance in
Acinetobacter strains. In multidrug-resistant A. baumannii
infections alternative therapies such as colistin are being
increasingly employed. And also intrathecal colistin has
been used with good results. Among the patients who
receive intravenous and intrathecal therapies, cure seems
to be more frequent.
CONCLUSION: Combination systemic and intrathecal
therapy of colistin may have a potentially effect on cases of
meningitis caused by multi-drug resistant A. baumannii.
Keywords: multi-drug resistant A.baumannii, intravenous and
intratechal colistin
P51
Antibiotic prescribing habits of physicians in a
primary health-care center
Oncu Selcen1, Oncu Serkan2
1
Department of Microbiology, Institute of Health Sciences,
Adnan Menderes University, Aydin, Turkey2Department of
Infectious Diseases and Clinical Microbiology, Adnan
Menderes University Medical Faculty, Aydin, Turkey
Antibiotic resistance is a serious problem in communities
because of the limited number of antibiotics that may be
used efficiently against microorganisms. The most common
reason in developing antibiotic resistance is the unneces-
sary usage of these agents. The aim of this study was to
detect the prescribing habits of the primary physician’s in
common infectious diseases. Between the dates of January
2005 – May 2005, all of the prescribed antibiotics in a pri-
mary health care center in Aydin were retrospectively
analysed. Infectious disease was diagnosed in a total num-
ber of 4902 (29.6 %) patients. Upper respiratory tract
infection (URTI) (71.7%) was the most common diagnosis
followed by lower respiratory tract infection (LRTI) (14%),
urinary tract infection (UTI) (9.6%) and the others. In high
percentage (79%) of the patients an antibiotic was pre-
107
scribed. Clarithromycin (16.9%) was the most commonly
prescribed antibiotic followed by ampicillin-sulbactam
(12.6%) and amoxicillin-clavulanate (11.6%). Ampicillin-
sulbactam (15.3%), clarithromycin (48.3%), ciprofloxacin
(42.5%), azithromycin (34.9%) and co-trimaxazole
(50.5%) were the most prescribed antibiotics in URTI, LRTI,
UTI, skin-soft tissue infections and gastrointestinal infec-
tions, respectively. Unnecessary and mis-usage of the
antibiotics is still a common problem among primary
healthy care physicians. More efficient postgraduate edu-
cation programs should be performed for the physicians to
improve their prescribing habits.
Keywords: Antibiotic, primary health-care, prescription
P52
Integron associated resistance genes among
MDR P. aeruginosa isolated from clinic
specimens
Budak Fatma1, Kasap Murat2, Kolayl› Fetiye1, Karadenizli
Aynur1, Vahabo¤lu Haluk3
1
Kocaeli University Medical School, Department of
Microbiology and Clinical Microbiology,Kocaeli,Türkiye
2
Kocaeli University Medical School, Department of Medical
Biology,Kocaeli,Türkiye
3
Kocaeli University Medical School, Department of ‹nfec-
tious Diseases, Kocaeli,Türkiye
Introduction
Pseudomonas aeruginosa is a significant pathogen leading
to severe infections in hospitals. In this study, we aimed to
characterize common beta-lactamase genes and the role of
integrons in beta-lactam antibiotic resistance among mul-
tiresistant P. aeruginosa strains isolated from intensive care
units in Turkey.
Material and Methods
A total of 67 P. aeruginosa that were isolated from six
University hospitals located in various regions of Turkey
was included in this study. Among these, 14 isolates of four
different locations were resistant to all the tested beta-lac-
tams and aminoglycosides. These 14 isolates were studied
further to characterize the beta-lactamases and integrons.
MICs, PCR screening, IEF, outer membrane isolation and
analysis, cloning and sequence analysis were performed
according to published protocols.
Results PCR screening for common beta-lactamases detect-
ed PER-1 and OXA-10 among selected MDR P. aeruginosa
. All the strains were positive with Class I integrase PCR but
only two isolates gave PCR product with 5' - 3' Class I inte-
gron PCR. The sequence analysis of these integrons
revealed the existence of 6'-N-acetyltyransferase (aac(6)-
Ib), streptomycin 3''-adenyl transferase (aadA2) cassettes
(GeneBank acces. # EF368053). However, shotgun cloning
from one isolate and PCR screening with related primers
revealed the existence Class I integron associated blaOXA-
2 gene cassette in eight isolates. Interestingly OXA-2 posi-
tive isolates were of those PER-1 positive isolates.
Conclusion
This study showed that PER-1 is still widespread among
MDR P. aeruginosa in Turkish hospitals and Class I inte-
gron associated OXA-2 accompanies as another extended
spectrum Beta-lactamase.
Keywords: Pseudomonas aeruginosa, beta lactamase, integro

108
P53
Knowledge of hairdressers toward HIV infection
in north of Iran
Panahandeh Zahra, Doostdar Sanaye Mehrnaz,
Department of Community Medicine, Guilan Medical
University, Rasht, Iran
OBJECTIVES: In Iran, training classes about communicable
diseases have been done by local health centers for differ-
ent occupational groups in recent years. We designed this
study to determine hairdressers’ knowledge about HIV
infection in Rasht, centre of Guilan province in north of
Iran.
MATERIALS-METHODS: In a cross- sectional study between
January to June 2006, 456 hairdressers who were working
in Rasht completed a self- administered questionnaire
about routes of transmission and prevention of HIV infec-
tion. The questions were designed according to the stan-
dard questionnaire of WHO about AIDS in population
studies. It contained two parts, demographic and knowl-
edge questions. Level of knowledge was classified to weak,
moderate and good according to the knowledge scores.
Data analysis was done by SPSS ver.11.5. We used chi-
square test for detection of any statistical relation between
variables. P-value<0.05 was considered significant.
RESULTS: In this study about 23% of women had good,
76% moderate and 1% weak information about HIV infec-
tion. The most common source of their knowledge was TV
and then health training classes. The subjects who partici-
pated in health training classes had higher information
about HIV infection than others (p<0.05).
CONCLUSION: Knowledge level of most participant in our
study was intermediate. It seems that education about HIV
infection by local health centers has had positive effect in
increasing their knowledge.
Keywords: Knowledge, Hairdressers, HIV, Iran
P54
Acute bacterial prostatitis in Korea: clinical out -
come, including symptoms, management, micro -
biology and course of disease
Han Chang Hee1, Kim Chul Sung2, Shim Bong Suk3, Lee
Sang Don4, Lee Sang Eun5, Cho Won Yeol6,
Cho Yong-hyun1
1
Department of Urology, College of Medicine, The
Catholic University of Korea, Seoul, South Korea
2
Department of Urology, College of Medicine, Chosun
University, Kwangju, South Korea
3
Department of Urology, College of Medicine, Ewha
Womans University, Seoul, South Korea
4
Department of Urology, College of Medicine, Pusan
National University, Busan, South Korea
5
Department of Urology, College of Medicine, Seoul
National University, Seoul, South Korea
6
Department of Urology, College of Medicine, Dong-A
University, Busan, South Korea
The Korean Association of Urogenital Tract Infection and
109
Inflammation (KAUTII) conducted a multicentre, retrospec-
tive analysis of acute bacterial prostatitis (ABP) to document
clinical features, management, microbiology and the
course of disease. The clinical records of 473 cases com-
patible with a confirmed diagnosis of ABP from 16 urolog-
ical centres between 2001 and 2005 were reviewed.
Susceptibility of the organisms causing ABP, including
Escherichia coli, to ciprofloxacin was shown to be very low,
fuelling debate as to the efficacy of ciprofloxacin against
uropathogens in Korea. When subcategorised according
to history of prior manipulation of the lower urinary tract,
there were distinct differences between ABP patients with or
without a history of prior manipulation with regard to over-
all clinical and microbiological features. The difference in
the distribution of pathogens between the two groups as
well as the difference in susceptibility between E. coli and
other pathogens should influence empirical antibiotic treat-
ment. In the group with a history of prior manipulation of
the lower urinary tract, ciprofloxacin or cephalosporins
alone are an inadequate choice and the combination of
cephalosporins and amikacin is recommended for empiri-
cal therapy.
Keywords: Acute bacterial prostatitis, Microbiology, Susceptibility
P55
Microbial study of intra uterine contraceptive
device users ?in Hamadan city, Iran
Shobeiri Fatemeh-1, Soltani Farzaneh-1, Nazari Mansour-2
1
Dept. of Obstetrics, School of Nursing & Obstetrics,
Hamadan University of Medical Sciences, Hamadan –
Iran.
2
Dept. of Parasitology, School of Medicine, Hamadan
University of Medical Sciences, Hamadan – Iran.
The practice of birth control can be traced back to ancient
societies. Today voluntary prevention of pregnancy is wide-
ly accepted. The intrauterine device (IUD) is a highly effec-
tive means of birth control for a well-selected group of
women. Vaginitis is the most common gynecologic problem
for which women seek treatment. The purpose of study was
to microbial study of intra uterine contraceptive device
users ?in referent to medical and health centers in
Hamadan city, Iran.
A descriptive and analytic study involving 100 women vis-
iting family planning clinic for follow up were enrolled in
the study. Each subject underwent detail history, demo-
graphic characteristics, vaginal discharge was subjected to
wet mount examination, gram staining and for culture.
Data were collected through interviews with women in the
clinics in the health centers. Data processing and statistical
analysis were performed using SPSS 10.0.
The results revealed that majority of IUD users (57%) had
positive clinical signs. There was statistically significant dif-
ferences between clinical signs and contraception methods
(P= 0/00). The prevalence of Trichomoniasis, Bacterial
vaginosis, Candidiasis and E. coli was determined (5, 12,
7 and 12%) in IUD users, respectively.
Bacterial vaginosis, trichomoniasis and candidiasis were
the most common genital infection. Women using IUD
requires a regular follow-up, clinical examination and
counseling.
Keywords: Intrauterine Devices, Contraception Methods, Vaginitis Table 1. Experimental groups

P56 Group Procedures

Protective effects of cranberries on infection- Control (N=4) Sham op.
induced oxidative renal damage in a rabbit Sterile (N=8) VUR+sterile urine
model of vesico-ureteric reflux E. coli (N=8) VUR+infected urine
Cranberry (N=8) VUR+infected urine+cranberry
Han Chang Hee1, Kim Chul Sung2, Shim Bong Suk3, Lee
Sang Don4, Cho Won Yeol5, Lee Sang Eun6, Cho Yong- Melatonin (N=8) VUR+infected urine+melatonin
hyun1
Table 2. Renal tissue malondialdehyde
1
Department of Urology, College of Medicine, The
Catholic University of Korea, Seoul, South Korea Group Mean MDA±SD (μM/gm)
2
Department of Urology, College of Medicine, Chosu
I 3.01±1.41
University, Kwangju, South Korea
3
Department of Urology, College of Medicine, Ewha II 3.92±1.25
University, Seoul, South Korea III 5.12±1.54*
4
Department of Urology, College of Medicine, Pusan
IV 3.47±1.34
National University, Busan, South Korea
5
Department of Urology, College of Medicine, Dong-A V 2.69±0.97
University, Busan, South Korea *: p<0.05 compared with group I, IV, V
6
Department of Urology, College of Medicine, Seoul
National University, Seoul, South Korea
P57
PURPOSE: We evaluated the protective effects of cranber-
Estimation of diagnostic importance of parame -
ry on infection-induced oxidative renal damage in rabbits
with experimental vesico-ureteric reflux (VUR). ters of ultrasound before labors at women with
MATERIALS-METHODS: A total of 36 New Zealand male
rabbits were divided into 5 groups (Table 1). VUR was cre-
scar on a uterus after previous cesarean section
ated by incising the roof of the left intravesical ureter and
confirmed at 2 weeks after operation. Infection was Doschanova Aigerim Mzhaverovna, Mireyeva Alla
induced by intravesical instillation of 2 ml of E. coli suspen-
Chair of Obstetrics and gynecology, Kazakh National
sion (105 E. coli in 1 ml). Cranberry powder (1 g/kg/day)
was supplied with feed during the experimental period. Medical University, Almaty-Kazakhstan
Melatonin was injected into the peritoneal cavity immedi-
ately after operation and every week. 3 weeks after oper- AIM: estimation of diagnostic importance of parameters of
ation the rabbits were sacrificed and the kidneys were
obtained. Oxidative renal damage was evaluated by ultrasound at presence of scar in bottom segment of a
measuring malondialdehyde in the renal tissue. uterus for 10 - 12 days up to calendar term of labors.
RESULTS: The kidneys from E. coli group showed apparent Facility: Chair of obstetrics and gynecology, Kazakh
periglomerular mononuclear cell infiltration, tubular dilata-
National Medical University.
tion and atrophy, and interstitial fibrosis. The kidneys from
sterile, cranberry and melatonin group showed mild Materials: Pregnant women(n: 392) with scar on a uterus
mononuclear cell infiltration without interstitial fibrosis. The are surveyed: with functionally consistent scar(n: 207),
level of malondialdehyde in E. coli group was significantly functionally inconsistent scar (n: 185).
higher than that in control, cranberry and melatonin group
(p<0.05). The malondialdehyde level in cranberry and METHODS: ultrasound research with definition of cervix
melatonin group did not differ significantly from that in length, thickness of a wall and front-back size (FBS) of bot-
sterile group (Table 2). tom segment of a uterus was carried out.
CONCLUSION: This study demonstrates that cranberry has
RESULTS: it was found that inconsistent scar of a uterus was
an anti-inflammatory effect by anti-oxidative function and
may prevent infection-induced oxidative renal damage. characterized by large length of cervix (41,87±0,49 mm),
Thus, clinically cranberry may be used for a beneficial low values of thickness of a wall (2,69±0,05 mm) and FBS
adjuvant treatment to prevent renal damage due to of bottom segment (76,86±0,40 mm) of a uterus. At con-
pyelonephritis in children with VUR.
Keywords: vesico-ureteric reflux, oxygen free-radical, cranberry, sistent scar - low parameters of cervix length (36,83±0,54
kidney, damage mm), high numerical parameters of thickness of a wall
(3,46±0,05 mm) and FBS of bottom segment (82,44±0,28
mm) of a uterus. 167 women are admitted to vaginal birth.

110
From them have given birth to 76 %, were operated on
obstetrics indications to 24 %.
CONCLUSION: for forecasting vaginal birth application of
the above-stated parameters determining a functional con-
sistency of a uterus is necessary.
Keywords: obstetrics, ultrasound, cesarean section, scar of a
uterus, vaginal birth
P58
Application of the immunocorrection therapy in
treatment of mixed infections transmitted by sex-
ual contact in high risk groups
Niyazalieva Mira1, Adambekov Dokturbek2, Aldjambaeva
Irina3
1
Kyrgyz State Medical Academy, Department of
Microbiology, Virology and Immunology
2
Medical Center "Nauchdiamed"
3
Medical Center "Nauchmedlight", Kyrgyz Republic,
Bishkek
OBJECTIVES: The aim of research is to study the degree of
persistence of the chlamydial and mycoplasmal infections
under the application of ethiotropic treatment with the use
of immunocorrection and syndromic treatment. Within the
framework of our study, totally 30 female intravenous drug
users and 30 female sex workers with mixt Chlamydia-
mycoplasmal infection were observed and treated by
ethiotropic therapy with immunocorrection. At the same
time, according to clinical protocols of the Ministry of
Health of Kyrgyz Republic, there was separate group (of
same number of individuals and from the same group cat-
egory and infection) that were treated by syndromic thera-
py. Detection of the infectious agents has been done by
enzyme immunoassay (EIA), polymerase chain reaction
(PCR), direct immunofluorescence tests and culture media.
Immunologic indexes have been studied by using mono-
clonal antibodies of “MedBioSpectr” by immunofluores-
cence method.
RESULTS: The study showed that among the individuals of
high risk group there is high level of those who are infect-
ed by chlamydial and mycoplasmal infections. In patients
of high risk group, immunologic results have shown pres-
ence of suppression of the phagocytic activity blood leuco-
cytes, antibody- and cell-mediated immune responses. It
means that the facts of immunity decreasing are strongly
marked among group of intravenous drug users. In spite of
the conducted syndromic treatment, the level of persistency
111
of chlamydial and mycoplasmal pathogens still remains
very high.
CONCLUSION: Under the immunocorrection application,
the degree of persistency is completely different from the
patients infected by mixed Chlamydia-mycoplasmal infec-
tions who got only syndromic treatment
Keywords: immunocorrection, high risk groups, empiric and syn-
dromic treatment
P59
A case of anicteric leptospirosis complicated by
interstitial nephritis
Yildirim Mustafa, Ozdemir Davut, Demirli Keziban, Guclu
Ertugrul
Department of Clinical Microbiology and Infectious
Diseases, University of Duzce, Duzce, Turkey
Leptospirosis is a widespread zoonotic disease caused by
spirochetes. We present a case of anicteric leptospirosis
complicated by interstitial nephritis. A 39-year-old male
patient was admitted because of high fever (39.5°C) asso-
ciated with diffuse myalgias. The patient is a forestry
farmer living in a rural area for twenty years. The blood
biochemical tests results were as follows: WBC: 3.6?109/L,
urea: 32 mg/dL, creatinine:1.00 mg/dL, AST:79 IU/L,
ALT:32 IU/L, total bilirubin:0.3 mg/dL (direct 0.1),
LDH:1223 IU/L, ALP:66 IU/L. Urinalysis revealed specific
gravity of 1.020, pH 6.0, protein 500 mg/dL, 10 red
blood cells/mL, and 25 white blood cells/mL. Two sets of
blood cultures and one set of urine, and stool cultures were
negative for bacterial growth. Widal and Wright tests were
negative. Abdominal ultrasonography showed mild
hepatosplenomegaly. Ceftriaxone was empirically started.
On the 4th day of therapy, patient's temperature was nor-
mal. The microscopic agglutination test (MAT) was positive
in a dilution of 1:200 for leptospirosis. The patient was dis-
charged after 10 days of hospitalization, in a very good
health. In outpatient clinic control, after one week from dis-
charge, BUN (50.46 mg/dL), urea (108 mg/dL), and cre-
atinin (2.35 mg/dL) values were found high. In renal ultra-
sonography, bilateral renal parenchym was hyperechoic
(grade 1). Interstitial nephritis due to leptospirosis was
thought by Nephrology Department and called for control.
In conclusion, this case report suggests that interstitial
nephritis may be a complication of leptospirosis. Because
of this, in our conviction the patients who have leptospiro-
sis must be taken to close control for renal insufficiency.
Keywords: leptospirosis, interstitial nephritis
P60
Modern aspects of optimization of complex
therapy at men with inflammatory diseases of
urogenital canal, caused by herpetic infection
Vyskubov Denis
Department of Urology, Postgraduate Medical Institute,
Almaty, Kazakhstan
The given work takes up the most problematic questions of
modern therapy of genital herpes. Difficulties of this prob-
lem are connected to lifelong persistance of Herpes virus in
host tissues and absence of the preparations that able to
eradicate the agent. The importance antiviral agents,
immunocorrectional medical products capable consider-
ably to increase results of therapy that is connected with
etiopathogenetic aspects. 42 patients were researched in
the given work, and they were under observation within
three months, with chronic forms of recurrent genital herpes
of external genitals, and also chronic uretroprostatitis of
virus etiology. Researches have shown that carrying out of
complex therapy with use of immunomodulating prepara-
tions, possessing combined action, have shown excellent
clinical efficacy, and also positive changes of the immune
status of patients.
Keywords: genital herpes, urogenital canal, immunomodulating
preparations
P61
The present stage of the HIV/AIDS-infection,
and the development of rendering medical aids
to patients in the Republic of Kazakhstan
Doskozhayeva Saule
Department of Infectious and Tropical Diseases, Kazakh
National Medical University, Almaty, Kazakhstan
The research issues. To analyze the dynamic of HIV-infec-
tion, to study the structure of clinical displays of HIV/AIDS
at a stage of concentration in the Republic of Kazakhstan,
to study the specifications of clinics and conditions of
immune system of injection drug addicts (IDA) HIV-infected
patients, to estimate the efficiency of the modern (active)
antiretroviral therapies of HIV-infected , to develop a esti-
mating system of HIV-infection and the formula of medi-
112
cines in the Republic of Kazakhstan with the consideration
of the stage of the disease.
The results of research. The level and structure of the HIV
disease in the Republic demonstrates that the epidemi has
entered its concentrated phase. By the end of 2006 the
parameter of prevalence amounted to 49, 0 per 100 000
of population. The rate sexual and intrahospital transmis-
sion in 2006 (19, 5% and 4,2% respectively) and new
cases of HIV-infection among young women (24,6%) has
increased. The combined (active) antiretroviral therapy of
HIV patients is effective: the virological efficiency amounts
to 94 %, immunological - 81 % and clinical - 95 % and
should be introduced everywhere. With the purpose of
early revealing of HIV/AIDS, the patients with recurring
and combined infections (herpetical, mycotic, bacterial,
etc.) should be tested for HIV-infection. All HIV infected
patients should be examined for active tuberculosis. The
appointment of AARVT to the HIV patients should be done
in accordance to «The report on providing help and treat-
ment for HIV-infection and AIDS».
Keywords: The HIV/AIDS-infection
P62
HIV infection in South Kazakhstan
Albaeva G.M, Utepbergenova G.A, Sagynbaeva B.A,
Otarbaeva A.P.
Infectious Disesases Department of South Kazakhstan
Medical Academy
Shymkent City, Republic of Kazakhstan.
HIV infection covered the whole continents. In South
Kazakhstan 1143 HIV people was registered, died 126,
and also AIDS people -33, infected children 153. The
growth of first revealed incidents of HIV infection is 47,66
% in 2007 year. Nowadays all regions of South
Kazakhstan are affected by epidemic. The highest number
of HIV infected people is found within Shymkent -700, in
Sayram region – 101, in Tolebi region- 71. There are 846
men (74% ) and 297 women (26% ) among HIV infected
people. The most number of HIV infected young people
from 20-29 , 5 %. There is an acute growth of HIV infect-
ed one year –old children – 69 in 2006, above 10 months
-89 in 2007, children from two till five year -13 and 46
accordingly. About 105 10-aged children were infected by
blood transfusion . This procedure was held to every child
from 2 to 24 times. The burst of disease was because of
excessive an insecure using of blood and its preparations,
misuse of technical safety of medical interventions and
usage of multiuse instruments. HIV infection takes 1-rst
place in using intravenous narcotics-58,7%, by sexual rela-
tion-16,12%, within hospital -8,39%, hem transfusions-
0,17%, during pregnancy from mother to fetus – 1,84%,
undetermined ways-14,78%. Spreading among vulnerable
groups (injection drug users and commercial sex women) is
19,2 in South Kazakhstan. The number of HIV infected
people increased two times for the last 3 years owing to the
foreigners, who live in the territory of the district. And so
HIV infection and AIDS are the most important problems of
the humanity. There is still no vaccine against the virus.
HIV/AIDS are not the only physicians’ problem, scientists’
of many specialty, statesmen’, economists’, lawyers’, social
workers’ too.
Keywords: HIV, epidemiology
P63
Condition of immune system of HIV-infected
children
Kozachenko N.V., Godunova M.I.,
Scientific Research Center
Karaganda State Medical Academy, Kazakhstan
Research goal: Characteristics of immunologic parameters
of HIV-infected children of Shymkent.
Materials and methods: In February, 2006 we have exam-
ined 131 residents of Shymkent, 53 of them were HIV-
infected children. Lymphocyte immunophenotyping was
done using monoclonal antibodies CD 3, CD 4, CD 8, CD
20, CD 56 by streptavidin-biotin method (Lebedev K.A. et
al., 2000). The enhanced blood of all the examined per-
sons analysis allowed to determine the level of morphode-
generative changes of blood cells. We have also analyzed
the adhesive and phagocytic activity of peripheral blood
neutrophils by the method of Lebedev K.A. (1996).
Results: We have analyzed the functional condition of the
immune system in HIV-infected children. At the moment of
examination the clinical signs of immune insufficiency were
revealed in all children. The prevailing and more expressed
clinical sign was the infection syndrome. As a rule, all the
children had a high frequency of severe and chronic bac-
terial, viral, and fungal diseases. The analysis of the
immune status of HIV-infected children did not reveal any
expressed damages of the immune system. The average
113
count of CD3 lymphocytes (%) was 45.81±5.24, CD4 –
39.4±6.32, CD8 – 17.3±4.76, CD20 – 12.7±6.12, CD56
– 39.6±9.35. However the hematologic analysis revealed
the moderate leukocytosis due to lymphocytosis. The other
finding was the decrease of hemoglobin – up to
100.81±12.32 g/l. There was a high percentage of mor-
phodegenerative changes of blood cells of both the leuko-
cytic and erythrocytic layers.
Conclusion: The carried analysis revealed the immune
stress of HIV-infected children, confirmed by the clinical
and laboratory investigations. These results were used to
develop the recommendations to correct the health status of
the given cohort of children.
Keywords: HIV, immunologic parameters
P64
Pyelonephritis of pregnant women and risk for
complication of pregnancy
Goulmira Zhatkanbayeva
Kazakh Medical University, Almaty, The Republic of
Kazakhstan
The aim of the current research was to study specific
moments of process for gestoz disease among women with
pyelonephritis in comparison of of labour and cure tactic.
Material and methods of research. Analysis of pregnancy
movement, labour and period of early adaptation among
217 patients with pyelonephritis and newborns were car-
ried out. The gestoz type of pyelonephritis was identified
for 92 (42,4%) patients. Chronic pyelonephritis with
2,3±0,7 year duration of disease with often repetition was
identified for 101 (46,5%) patients. Un-symptomatic bac-
teriuria was identified in 24 (11,1%) of patients. Kanefron
preparation (Bionorika AG/Germany) have been used for
treatment among patients of main women group: within 2-
7 week since 20-th week of pregnancy in standard dozen
– by 2 3 times in a day. Control group was presented by
30 pregnant women, whom received traditional antibiotic
treatment. The patients of main and control groups were
with same ages, parity of pregnancy duration and labour,
level of extra-generative pathology, obstetric-gynecologic
case history. Common sustainability, ultrasonic picture,
data of bacteriological research have got a duration of
treatment for patients. The control of treatment effectiveness
was estimated after finish a course of treatment among two
studying groups.
Results and discussion. The increasing of pathology for the
majority of pregnant women with chronic pyelonephritis
86 (85,6%) was identified within 8-12 and 18-27 weeks of
pregnancy. The gestoz pyelonephritis for majority of preg-
nant women 65 (70,6%) developed first time at the 21-22
weeks and reliable often (p<0,05) for first time pregnant
women of old age. At the structure of complication for
pregnancy development among patients with pyelonephri-
tis were identified: hypochomic anaemia (52,6%), late
gestoz (43,6%), threat for broken pregnancy (41,6%) with
recurrence in each second case, candidose kolpit (33,4%),
chronic placenta failure (31,8%). The majority of bacterio-
logical study of urine 141 (64,9%) showed mixinfection
Escherichia coli, Klebsiella pneumonia, Enterobakter acro-
denes. Untimely eruption of near-foetus water (49,3%),
anomalous to deliver a baby (20,3%) and pathology of
placenta period (10,5%) were dominated among complica-
tion of labour for patients with pielonephrit. In order to be
alive a new baby was implemented operational deliver a
baby in 14,5% cases in comparison of total for relative evi-
dences. The 219 babies were born and majority of them –
212 (96,8%) was born in time with estimation 7-8 mark by
Apgar scale. It was 7 cases (3,2%) of untimely labour with
34-35 weeks for total period of pregnancy among preg-
nant women with pyelonephritis First level hypotrophy was
diagnosed among 33 (15,1%) new born babies. The
hypoxy middle and light levels was diagnosed among 42
(19,2%) new born babies.
Conclusion. 1. Specific gravity of gestoz pyelonephritis
consists (42,4%) was diagnosed first time for period 21-22
weeks. 2. Intensification of chronic pyelonephritis was
diagnosed among 46,5% patients. Peaks of increasing in
the frequency of intensification of chronic pyelonephritis
were 8-12, 18-27 weeks of pregnancy. 3. The hypochom-
ic anaemia (52,6%), late gestoz (43,6%), threat for broken
pregnancy (41,6%), chronic placenta failure (31,8%) were
dominated at the structure of complication for pregnancy
process among of patients with pyelonephritis 4. The com-
plication of labour process has been characterized untime-
ly eruption of near-foetus water, anomalous to deliver a
baby and pathology of placenta period among patients
with pyelonephritis 5. The treatment under using Kanefron
preparation (since 20-th week of pregnancy by mono-ther-
apy or complex prophylactic actions) has a positive effec-
tiveness for development of pregnancy and substantiated
patho-genetic treatment of gestoz pyelonephritis.
Keywords: Pyelonephritis, pregnancy
114
P65
The comparative clinical and laboratory estima-
tion of the treatment efficiency for Candida
vaginitis
S. Nurusheva, L.Almenova
Almaty, Kazakhstan
The frequency of Candida vaginitis has increased twice
during the last 10 years and forming now 30-45 % in the
structure among pathology of the of the sexual organ
ground floor. There is uniform ecological system of the
micro-/macro organisms interaction at the mucous mem-
brane level of sexual tract in a basis of infectious diseases
pathogenesis. The vaginal microflora in norm is character-
ized by great amount of the Lactobacillus which provides
an adequate level of local immune gearing. The study of
local immunity and inclusion the eubiotics in complex ther-
apy for Candida vaginitis are making more effective the
clinical laboratory recovery.
Keywords: Candida, vaginitis, treatment
P66
Serum Copper, Zinc and Magnesium Levels in
Patients with Pelvic Inflammatory Disease
Ustun Cemal1, Hancer Fatma Nur2, Tegin Ibrahim3, Geyik
Mehmet Faruk1
1
Dicle University Medical Faculty, Depertment of Clinical
Microbiology and Infectious Diseases, Diyarbakir,
TURKEY
2
Dicle University Medical Faculty, Depertment of
Obstetrics and Gynecology, Diyarbakir, TURKEY
3
Siirt University Faculty of Science and Art, Depertment of
Chemistry, Siirt, TURKEY
OBJECTIVE: The aim of this study is to compare serum
Copper (Cu), Zinc (Zn), and Magnesium (Mg) levels of
patients diagnosed as Pelvic Inflammatory Disease (PID),
with healthy women.
MATERIAL-METHODS: Forty-one patients with PID, and 45
healthy voluntary women as the control group were includ-
ed in this study. Five ml venous blood samples were
obtained from each of 86 women after fasting 10 hours at
night. Serum samples were decomposed by centrifugeting
at 5200 turn for 10 minutes. Subsequently, these samples
were diluted with deionised water. Cu, Zn and Mg levels
were measured in all serum samples by using Unicam 929
Atomic Absorption Spectrophotometer. All data entry and
analysis were performed using SPSS 10.0 for Windows
version program.
RESULTS: The average age of 41 patients with PID was
31.2 ±10.2 years, meanwhile average age of 45 healthy
women was 30.3 ±10.3 years. Serum Cu, Zn and Mg lev-
els of patients with PID and healthy voluntary women were
shown in table. A statistically significant increase at serum
Cu (p=0.002) and Zn (p=0.0001) levels were detected,
while there was no significance in Mg (p=0.367) levels of
patient with PID when compared with the control group.
CONCLUSION: The current evidence suggests that serum
Cu and Zn levels may be beneficial as an indicator in the
course of PID
Keywords: Pelvic inflammatory disease, serum trace elements
P67
Studying of epidemic process of a HIV-infection
by means of correlation and spectral analysis
Saparbekov Marat
Almaty, Kazakhstan
The purpose of the research is studying epidemic process
by means of the correlation and spectral analysis. As a
material for the analysis have served disease of a HIV-
infection across Kazakhstan and of Temirtau in incidence
parameters on 100 thousand populations. More exact rep-
resentation about internal structure of processes and can be
received their interrelations by means of the spectral analy-
sis. The idea of the spectral analysis consists in representa-
tion of time numbers in the form of the sum of harmonious
fluctuations. Results of research have shown existence of
cyclic in the studied time numbers. The spectrum of the
basic frequencies which depend on a system and expres-
siveness of recurrence of this or that period in an investigat-
ed number of supervision is received. We shall note, that
as a result of the analysis those epidemic rises and reces-
sions of disease of a HIV-infection which have no natural
recurrence and by that elimination of incoherent fluctua-
tions has been reached have been excluded.The periods of
the order of 2nd years have been revealed. I attract atten-
tion detection in the period of development of a HIV-infec-
tion characteristic, practically unequivocal on the expres-
115
siveness of harmonious components. It testified to stability
the basic parameters of cyclic until investigated process is
kept. We believe, that cyclic at a HIV-infection, possibly, is
consequence of influence of a complex of socially-biologi-
cal conditions on epidemic process. Thus priorities substan-
tially belong to social factors.
Keywords: Epidemic process, HIV-infection
P68
The sexually transmitted diseases in penitentiary
establishments
Eshimov Askar1, Saparbekov Marat2, Nurusheva Saule3
Almaty, Kazakhstan
The purpose of the research is determining the risk factors
in STD among prisoners of Almaty city. Material for study-
ing was data of sociological researches of prisoners In total
347 men, 269 women have been interrogated. Research
was done by means of the special anonymous question-
naire. Results of research have shown that 79,6% majori-
ty(79.6) had a low educational level and enough experi-
ence of an active sexual life before condemnation, thus
only have specified 31,4%, that at presence of casual com-
munications use condoms. It is noted, that 3,8% use nar-
cotics constantly, 27,7% occasionally. On a question
«where in your opinion, higher probability of infection with
venereal illnesses», 60, 0% of respondents have noted, that
on freedom. However 17, 1% interrogated have specified
an opportunity infected STD and in places of imprisonment
that it is necessary to consider at the organization and car-
rying out of preventive actions in penitentiary establish-
ments. Researches have shown their high awareness con-
cerning a HIV-infection. Studying a question of interest in
reception of the information about STD, we have estab-
lished, that condemned show the big interest to this prob-
lem. As a result of research it has been revealed, that there
are the certain preconditions providing an opportunity of
distribution STD in penitentiary establishments. We believe,
that the received data on behavioral characteristics con-
demned a level of their awareness concerning STD and
HIV/AIDS enable to develop programs on the primary pre-
ventive maintenance STD, the prisoners adapted for every-
one type.
Keywords: sexual transmitted diseases
P69 has pharmacologically active compounds including several
Level of antenatal medical aid and childbirth alkaloids with antiprotozoal properties, which are found
especially in the seeds and the roots. In this research, topi-
support in Kazakhstan
cal treatment with Peganum harmala extract -containing
ointment was studied in BALB/c mice had cutaneous leish-
Katarbayev Amir
maniasis caused by Leishmania major. Female BALB/c
Almaty, Kazakhstan
mice, 8 to 12 weeks old, were experimentally infected by
Leishmania major. Forty BALB/c mice which showed
The objective of the paper was to study within the frame-
lesions of cutaneous leishmaniasis were chosen and ran-
work of medical-demographic researches in Kazakhstan
domly divided in 2 groups, A and B. Group A was treated
how to render first medical aid to most socially vulnerable
with 20% Peganum harmala extract -containing ointment
population groups in the republic. Within that program for
and Group B was kept untreated as the control. Topical
research purposes of that population group were inter-
treatment twice daily for 10 days caused total elimination
viewed 4800 females aged between 15-49 and examined
of the parasites and healing of the lesion in all treated mice
1354 children under 5. The research results show that 76%
in group A.
of childbirth cases within 5 years preceding the interview,
Keywords: BALB/c mice, cutaneous leishmaniasis, topical treat-
the women were provided antenatal aid by doctors. The
ment, Leishmania major, Peganum harmala extract
percentage of women who got medical aid was higher in
Almaty city (89%), as compared with other regions. The
P71
percentage of mothers who did not get antenatal aid was
Identification of anisakid larvae from
rather high in Central and Eastern regions (17% and 13%
Epinephelus tauvina (Greasy grouper) in Persian
respectively). According to the data of our research most of
Gulf
women (84%) visited female medical consultation service
center by the third month of their pregnancy. The research
Radfar Mohammad Hossein1, Eslami Ali2
results provide data that 98% of all childbirths were held in 1
Department of Parasitology, Shahid Bahonar University,
the medical institutions and out of them 89% - in maternity
Kerman, Iran
homes, 9% - in state-run hospitals. Only in 2% of cases 2
Department of Parasitology, Tehran University, Tehran,
childbirths were held not in the medical institutions (in the
Iran
homes of respondents). Thus, according to our research
data in Kazakhstan the medical aid level by the services of
Anisakis is a helmintic parasite of fish and shellfish that can
antenatal aid and childbirth support are still at high level.
induce in humans, after consumption, an immunoallergic
But it should be noted that the percentage of women who
response with multiorganic affectation, especially cuta-
did not get antenatal aid was high in central and Eastern
neous (urticaria and angioedema), gastrointestinal and
regions.
anaphylactic symptoms. The 384 fish of Epinephelus
Keywords: reproductive age, abortion, pregnancy pathologies
tauvina (Greasy grouper) caught from Khoozestan water in
Persian Gulf were dissected and examined for anisakid lar-
P70
vae and adults in visceral organs, abdominal cavity, and
Cutaneous Leishmaniasis: topical treatment with
muscles. The anisakid larvae (third-stage) were found in
Peganum harmala extract in laboratory animals
abdominal cavity, and muscles of the Epinephelus tauvina
(Greasy grouper) that studied. No adult–stage of anisakis
Mirzaei Mohammad
was found in any of the 384 fish that studied. The anisakid
Department of Pathobiology, School of Veterinary
larvae were found throughout of year. High prevalence in
Medicine, Shahid Bahonar University of Kerman, Kerman,
autumn (17/2%) and low prevalence in summer (2/1%)
Iran
and with a yearly average (10/6%). The mean intensity of
larvae per fish was 2.4, Minimum and maximum intensity
Cutaneous leishmaniasis (CL), an endemic disease in many
was 1 – 98 larvae respectively.
parts of the world whisch continues to present serious ther-
Keywords: Anisakis, Epinephelus tauvina, zoonosis
apeutic problems. The disease, although usually self limit-
ing, can cause considerable morbidity and may result in
severe disfigurement. Peganum harmala, or Syrian Rue,

116
P72 Medical Academy, Karaganda, Kazakhstan
Effect of wild rue extract on Leishmania tropica 2
Department of State sanitary-epidemiological supervision,

promastigotes Karaganda, Kazakhstan

Purpose: to reveal condition of the helminthiases sick rate

Mirzaei Mohammad
in Karaganda region.
Department of Pathobiology, School of Veterinary
Material and Methods: We have analysed patient’s cards
Medicine, Shahid Bahonar University of Kerman, Kerman,
of children and adults with helminthiases.
Iran
Results and conclusions: Annually at the Karaganda region
from 6 up to 8 thousand patients with various parasitic dis-
Parasites of the genus Leishmania are transmitted by sand-
eases are recorded. The parameter of helminthiases sick
flies that ingest the parasite in the amastigote stage resi-
rate for 100000 of population changes from 559 in 2004
dent within macrophages, then inoculate the promastigote
up to 473 in 2006.
stage into other hosts. Peganum harmala, or wild rue, has
On the average 94% of the revealed cases of enterobiosis
pharmacologically active compounds including several
fell at children till 14 years, and the sick rate of city chil-
alkaloids with antiprotozoal properties, which are found
dren has made 80.4%, rural – 19.6%. The analysis of an
especially in the seeds and the roots. In this research,
epidemiological situation for ascariasis has shown that
Leishmania tropica were cultured in vitro, then by using a
among the registered patients the share of the townspeople
MTT assay, the biological activity of wild rue extract on L.
made 85% and only 15% were peasants. First of all it is
tropica promastigotes were assessed. Wild rue extract
explained by the use of badly washed vegetables and fruit,
solutions for biological testing were prepared in PBS at
use of not composted excrements as fertilizer; besides this
5000-20000 μg/mL. All experiments were repeated at
parameter indirectly testifies to unsatisfactory diagnostics
least three times in duplicate. For wild rue extract, the con-
of parasitic diseases in rural districts. The high ascariasis
centration-response curve was plotted from which IC50
sick rate with tendency to increase causes vigilance. In
values were determined. Wild rue extract inhibited the
2004 there were registered 1278 cases of ascariasis, and
growth of promastigote forms of L.tropica in vitro after 72
in 2006 - already 2238 cases. Increase of the sick rate has
h of incubation and had an IC50 of 1801.15 ± 29.32
made 20%. The highest parameters of sick rate were
μg/mL. Statistical analysis of the results (optical density
revealed in Karaganda, Shakhtinsk, Saran, Bukhar-Zhyrau
and inhibitory percent) of the different concentrations of
and Aktogay districts. Anamnestic research has revealed
wild rue extract showed with concentration increasing of
periodically appearing dermal manifestations at all
wild rue extract, significantly the optical density decreased
patients (as urticaria, atopic dermatitis, dryness and scal-
and inhibitory percent increased and the different concen-
ing of the skin, etc.). It’s typical that all phenomena of skin
trations resulted in different optical densities or inhibitory
lesion completely disappear after "exile" of ascarides.
percents (P<0.05) so that, Wild rue extract is effective
Keywords: helminthiases, sick rate, enterobiosis,ascariasis
against L. tropica in vitro.
Keywords: In vitro, Leishmania tropica, wild rue extract, MTT
P74
assay
Clinical-laboratory diagnostics and treatment of
P73 lambliasis at children
Modern condition of the sick rate and
detectability parameters of helminthiases in Begaydarova Rosa Khasanovna1, Nasakayeva Gulmira
Ermekbayevna1, Starikov Juri Grigorievich1, Konstantinidi
Karaganda region
Tatiana Anatolievna1
1
Chair of children infectious diseases, Karaganda State
Begaydarova Rosa Khasanovna1, Baymukanova
Medical Academy, Karaganda, Kazakhstan
Kalamkash Shymbulatovna2, Alshynbekova Gulsharbat 2
Regional infectious diseases hospital, Karaganda,
Kanagatovna1, Diusembaeva Ainash Ermukhanovna1,
Kazakhstan
Efimova Oxana Nikolayevna1
1
Chair of children infectious diseases, Karaganda State

117
Purpose of the research: analysis of clinical-laboratory
manifestations and problems of treatment of lambliasis at
children.
Materials of the research: Ninety nine children aged 1-16
years, 51(51.5%) - girls, 48(48.5%) – boys were diag-
nosed as lambliasis with the help of clinical and scatologi-
cal methods. Additionally all patients were carried out
ultrasonic research by the device “Shimadzu-350”. Patients
were divided into 3 groups: 1. Tiberal, 2. Metronidazolum,
3. Furazolidonum were used respectively. The preparations
were prescribed in age dosages within 5-7 days.
Results and conclusions: At ultrasonic research revaled an
insignificant enlargement of the size, diffuse changes and
increased echogeneity of pancreas were marked at
5(5.05%) patients. Hypokinetic form of dyskinesia was
revealed more often at children (more senior than 10 years
- 32(32.3%)) with long current of disease, hyperkinetic
function was at 27(27.3%) children in the age from 7 till 10
years. After the termination of treatment course at repeat-
ed inspection in 1st group lamblia cysts were found out in
16.6%, in 2nd group - at 34.3% and in 3 - at 47.05% of
children. From the received data it is visible that the most
effective antilambliasis preparation is Tiberal and the least
effective is Furazolidonum. After carrying out second
course by the alternative antilambliasis preparations in 1st
group 100% sanitation was achieved, in 2 and 3 groups it
was about 85%.
Keywords: lambliasis, children, Tiberal
P75
The use of Modified Ziehl-Neelsen method for
detection of Cryptosporidium spp prevalence in
companion dogs in Kerman city (Iran)
Mirzaei Mohammad
Department of Pathobiology, School of Veterinary
Medicine, Shahid Bahonar University of Kerman, Kerman,
Iran
This study was carried out to determine the prevalence of
Cryptosporidium spp infection in companion dogs in
Kerman (Iran) during April 2006 to March 2007. Faecal
samples were collected from 350 companion dogs of
Kerman city. The presence of Cryptosporidium oocysts
were detected by means of the Formalin-ether sedimenta-
tion method followed by modified Ziehl-Neelsen staining.
Finally prepared smears were studied by light microscope.
118
The recognition of Cryptosporidium oocysts was done in
accordance with their morphological properties. The analy-
sis of data and consequences has been done with spss soft-
ware and chi-square test. Cryptosporidium oocysts were
identified in 1.1% (4/350) of the samples. The results of the
staining indicated that Ziehl-Neelsen is a suitable method
for showing Cryptosporidium oocysts in which they will be
recognized in a circular to oval shape and in a red colour
with a green background. Faeces were classified according
to the consistency as diarrheic (34/350) and non-diarrhe-
ic (316/350). Diarrhea was recorded in 2 of the positive
samples (5.9%). Cryptosporidial prevalence was signifi-
cantly higher in diarrhoeic (5.9%) versus non-diarrheic
(0.6%) dogs (p<0.05). The highest rate of infection was in
autumn (3.8%) but this difference was not statistically sig-
nificant (P>0.05). Statistically there was no significant cor-
relation between age, sex and breed of dogs with infection
rate (P>0.05). This study besides confirmation dog's role in
human cryptosporidiosis infection, points to the importance
of routine fecal examination in dogs with persistent diar-
rhea.
Keywords: Cryptosporidium, Ziehl-Neelsen, dog, prevalence,
diarrhea
P76
A Case of Cerebral Hydatic Cysts with Cardiac
Origin: Case Report and Review of the
Literature
Kader Cigdem1, Memikoglu Osman1, Polat Cegergun2,
Birengel Serhat1, Balik Ismail1
1
Kader Cigdem, Memikoglu Osman, Birengel Serhat,
Balik Ismail, Department of Infectious Diseases and
Clinical Microbiology, School of Medicine, Ankara
University, Ibni Sina Hospital, Ankara, Turkey
2
Polat Cegergun, Department of Cardiology, School of
Medicine, Ankara University, Ibni Sina Hospital, Ankara,
Turkey
BACKGROUND: Echinococcal disease remains a problem
within some endemic areas. The hydatidosis is an endemic
illness in east regions of the Turkey. Echinococcal cysts usu-
ally involve the liver and lungs, but any other organ can
potentially be involved. The preferential localization of cyst
hydatic is the liver (48%), the lung (36%) and in 6% of cases
it is localized in unaccustomed sites such as the brain.
Intracerebral localization is relatively rare, its impact is 1 to
5% of all cases of hydatidose. Cardiac hydatid cysts are
rare and represent less than 2% of all hydatid cases.
Cardiac hydatid cysts rarely involve the interventricular
septum. Here we present a case of 52 years old male
patient with a diagnosis of hydatidosis located in the heart,
brain and lung.
METHODS: This report is a case study of a medical prob-
lem in disseminated involvement of hydatid disease.
Various treatment modalities are reviewed.
RESULTS: The patient was from Mus in Turkey. He had
undergone albendazole therapy and three operations of
cranial and cardiac hydatid cysts in 2003-2004. He con-
tinued to have cardiac problems and was referred to our
institution. Echocardiography revealed that he had con-
strictive pericarditis. The patient refused surgery and alben-
dazole 400 mg/day was begun and his treatment is still
going on.
CONCLUSION: Medical treatment in hydatid disease
might be recommended when the disease is extensive; the
surgery is contraindicated or refused by the patient.
Keywords: Hydatic Cysts, Echinococcal disease, Hydatidosis.
P77
A case of unusual wound infestation: Human
Myiasis
Ustun Cemal , Avc› Alper , Geyik Mehmet Faruk
1 2 1 medical academy, St-Petersburg, Russia
1
Dicle University Medical Faculty, Infectious Disease and
Clinical Microbiology Department, Diyarbakir, TURKEY
2
Dicle University Medical Faculty, Thoracic Surgery
Department, Diyarbakir, TURKEY
OBJECTIVE: An unusual wound infestation case was pre-
sented.
CASE: A 71 years old male, falling from his car into the
sewage in a traffic accident, was hospitalized in Thoracic
Surgery Clinics with the diagnoses of pneumothorax. He
was learned to fall into sewage system a week ago and his
head was injured. His medical condition was middle, body
temperature of 36,6oC, blood pressure of 110/60mmHg,
pulse of 112/min, respiratory rate of 30/min. On physical
examination; a malodorous, necrotic, sutured wounds
approximately 6x8cm in diameter and covered by crust,
was observed on the left and right occiputoparietal area of
his scalp. Besides, chest x-ray revealed contusion signs on
the left. Laboratory investigations showed a WBC
3500/mm3(70% PMNL), Hct 32%, Hb 10.9, Plt
145000/mm3, glucose 156mg/dl, urea 33mg/dl, crea-
tinin 0.8mg/dl, sodium 128mmol/l, potassium 2.4mmol/l;
119
while blood gas results were PCO2 39mmHg, PO2
42mmHg, SO2 80%, PH 7.46. Oxygen supply, fluid
replacement therapy and empirical sulbactam/ampicillin
dosed at 4gr/day were begun. His medical condition was
improved. However, on the fourth day of hospitalization,
the scalp wound opened, and several white round worms
approximately 1-2cm in diameter erupted from the lesion.
Urgently consulting to the Parasitology and Plastic-
Reconstructive surgery department, the wounds were
depredated with antiseptics and isotonic solution. Human
Myiasis was detected after parasitological examinations.
RESULTS: Myiasis is frequently manifested on animals.
Nevertheless, it is occasionally seen on humans. In this
case, myiasis is considered to be developed due to inap-
propriate care of the wound contaminated with sewage
excrement.
Keywords: Human myiasis, wound infestation.
P78
Sensitivity Of Trichomonas vaginalis To Different
Antiprotozoal Drugs
Kozlov Sergey S.1, Zakharkiv Yury F.2, Streltsova Kira G.2
1
Department of parasitology & tropical diseases, Military
2
Department of biology, Military medical academy, St-
Petersburg, Russia
The urogenital trichomoniasis mortality-rate in Russia has
the highest level among sexually transmitted diseases (from
261 to 343 among 100000 of population). Such a level
nowadays depends on wide spread of Trichomonas vagi-
nalis strains resistant to the different antiprotozoals espe-
cially if the strain has been isolated from the patients with
chronical urogenital trichomoniasis. That is why we studied
the sensitivity of 234 T. vaginalis strains from the patients
with chronical form of urogenital trichomoniasis using a
cultivation method to following antiprotozoal drugs:
metronidazole, tinidazole, nimorazole, ornidazole and
tenonitrazole (5-nitroimidazole group), chloroquine and
nifuratel.
We considered the strain to be resistant to the antiproto-
zoal drug if concentration of T. vaginalis cells in 96 hours
after passage was 50% and more comparing with control
test. The results of our research are presented in table 1.
According to results of our study ornidasol and tenonitra-
zole are the most effective drugs against T.vaginalis. Thus
the widespread T.vaginalis resistant strains among the
patients with chronical forms of urogenital trichomoniasis ITS2 alleles are monophyletic, as well T.malaysiensis with
provides the necessity of estimation of such strains sensitiv- T.vitulorum (Figure). As expected also, we observed a high
ity to the different antiprotozoal drugs in order to work out nucleotide diversity (p=0.705825; Tajima test=0.461359)
the optimal schemes of rational etiotropic therapy. between the studied species. CONCLUSIONS: The nuclear
Keywords: Trichomonas vaginalis, strains, sensibility, antiproto- ITS rDNA sequence has been extensively used to define
zoal drug, urogenital trichomoniasis genetic markers for different species of nematodes and the
Sensitivity Of Trichomonas vaginalis To Different aims of this study were to use the ITS2 to investigate the lev-
Antiprotozoal Drugs els of genetic variation within Toxocara and generate a first
phylogenetic tree (Figure). If there are normal levels of gene
Antiprotozoal drug Sensitive strains % Resistant strains %
flow between populations (or species), these populations
Tenonitrazole 89,3 10,7
are likely to be similar in their overall genetic characteris-
Metronidazole 76,8 23,2 tics, and genes for important characteristics are likely to
Tinidazole 83,9 16,1 spread easily. ITS2 of other Toxocara species should be
included in further analysis (eg. T.genettae, T.lyncis, T.vin-
Ornidazole 91,0 9,0
centi, among others), to better define the evolutionary rela-
Nimorazole 82,6 17,4 tionships and phylogeny of the genus Toxocara.
Nifuratel 79,3 20,7 Keywords: Toxocara, bioinformatics, phylogenetics, ITS2

Chloroquine 75,9 24,1 P80

Toxic effect of amitriptyline-an antidepressant
P79 drug on Drosophila melanogaster
Preliminary analysis of the molecular phyloge -
netics of Toxocara canis (Nematoda: Nazari Mansour,

Ascaridoidea) using nuclear ribosomal second Department of Medical Parasitology, School of Medicine,
Hamadan University of Medical Sciences, Hamadan, Iran
internal transcribed spacer sequences
OBJECTIVE: The fruit fly Drosophila melanogaster is one of
Rodriguez-morales Alfonso J1, Barbella-aponte Rosa A2
the most intensively studied organisms in biology and
1
Immunoparasitology Section, Tropical Medicine Institute,
serves as a model system for investigations of many devel-
Universidad Central de Venezuela, Caracas, Venezuela
opmental and cellular processes common to higher eukary-
2
Pathology Service, Consorci Hospital General Universitari
otes, including man.
Valencia, Valencia, Spain
The objective of this study is to evaluate the genotoxic effect
of amitriptyline on D. melanogaster and to make sugges-
OBJECTIVES: Toxocariasis is a zoonotic disease caused by
tions if any for its use.
Toxocara canis and T.cati. Many biological and molecular
MATERIAL-METHODS: The pure strain of Drosophila
aspects are still lack of knowledge and research about
melanogaster (Oregon K) was used for experiments. The
these pathogens. There are no studies describing the phy-
pure culture was maintained under the laboratory condi-
logenetics of Toxocara using any molecular marker. METH-
tion at a temperature 24±2º C. Standard food medium
ODS: For these reasons, nuclear internal transcribed spac-
(wheat cream agar medium) was used for maintenance of
er 2(ITS2)rDNA sequences were used for the first molecu-
Drosophila flies in the laboratory. Eggs of the same age
lar phylogenetic analysis and tree of five Toxocara species.
collected by procedure of Delcour. LC50 of amitriptyline for
ITS2-rDNA sequences were already available from
the larval feeding method was estimated (0.21%) then, sub
GenBank (accession numbers AB110034,AB110033,
lethal concentrations of 0.05, 0.1, 0.2 and 0.3% of
EU189085,AM231609 and AB027152), corresponding
amitriptyline were selected.
to T.canis, T.cati, T.vitulorum, T.malaysiensis and T.tanuki.
RESULTS: Mean viability was reduced in different concen-
Phylogenetic analysis was made after aligned these
trations of amitriptyline. There is no significant difference in
sequences using GeneDoc 2.7, using the method of
sex ratio of D. melanogaster treated with amitriptyline.
Maximum Parsimony and the bootstrap test for phylogeny
Increase in concentration not only there was delay in emer-
with MEGA 4. RESULTS: As expected, T.canis and T.cati

120
gence but also reduction in the number of flies emerged.
Amitriptyline in all concentrations employed prolong the
developmental time even in the lowest concentration tested.
CONCLUSION: Amitriptyline has effect on viability, eclo-
sion and developmental time but not on sex ratio of
Drosophila melanogaster.
Keywords: Amitriptyline, Antidepressant drugs, Drosophila
melanogaster, Toxicology
P81
The treatment of ascariasis
Kosherova Bahit1, Baltinova Rosa2, Syzdykov Marat3,
Khairova Ulmeken4, Knaus Anna5, Donenbaeva Saule6
Karaganda State Medical Acedemy
Karaganda, Kazakhstan
The aim: to analyse of the effectiveness of ascariasis
therapy
Methods: The analysis of the effectiveness of the anti-
helminthic therapy in the ambulatory conditions was done
in 132 ambulatory cases. The patients were separated in 3
groups: I – 36 patients given Levamizol (150 mg) accord-
ing to the scheme (the whole course dose – 900 mg); II –
45 patients given Mebendazole 200 mg a day, during 3
days; III – 51 patients given Karbendacim 10 mg/kg a day
in 3 motions, during 3 days. The basic complaints were the
weakness in 89 patients, the undue fatigue in 67 patients,
the allergic eruption in 43 patients, the stomach ache in 23
persons, the nausea in 34 patients. There were Ascarides
ova in the feces of all patients. Eosinophilia was detected in
the total blood count. The comparative analysis showed
that after the therapy for a week, the microscopy became
negative. Weekly repeated analysis revealed that
Ascarides ovum had been picked out in 68% and in 72 %
accordingly. The patients in the first group felt better, the
positive laboratory dynamics was observed among them.
But the patients in the second and third groups the weak-
ness, the undue fatigue, the periodic eruption and ache in
stomach sustained. Thus, the comparative analysis of the
treatment of ascariasis illustrates the effectiveness of
Levamozol.
Keywords: ascariasis, levamizol
121
P82
About the role of carnivores of Canidae family
in distribution of helminthozoonoses pathogens
Abdybekova Aida Makenovna1, Shapiyeva Zhanna
Zhakanovna2, Karamendin Kubey Karaevich3
1
Republican sanitary- epidemiological station, Almaty,
Kazakhstan
2
Research veterinary institute, Almaty, Kazakhstan
3
Institute of microbiology and virology, Almaty,
Kazakhstan
Carnivores of Kazakhstan are widely infected with
helminthes presented the great epidemic danger, such as
A. multilocularis, E. granulosus, T.spiralis, T. canis. At
necropsy of waif dogs in 40, 59±4, 89 % of cases 10
helminthes species were found. E.granulosus always para-
sitized with the highest infection intensity - 436,4 -
6146,64. In 86 soil samples from agrocenoses 30, 2%
infectious agents are revealed. In research of unidentified
faeces of dogs in Almaty, in 35, 1 % various helminthes
species eggs are registered (Taenia sp. -10,8 %, T. canis –
11,7 %). The epidemiological situation helminthoses is
intense. It is annually registered more than 1000 cases of
echinococcosis, the index of prevalence has grown more
than 2,3 times for last 10 years (1997 - 2,5 per 100.000
of population, 2007 - 5,66). In 2007 the epidemiological
situation on trichinellosis, caused by 2,4 times growth of
prevalence (2006 - 12 cases, 2007 – 29), has worthened.
As a source of infection in 37 % of cases, the meat of wild
boar and wolf, in 63 % of cases - waif dogs has served.
The special attention should be paid to a problem of toxo-
carosis, shown in people with expressed allergies, and
other serious violation of health. 21 cases of toxocarosis
are registered in 2006, in 2007 – 14 cases. Now diagnos-
tics of Toxocarosis is not adjusted properly in
Kazakhstan.High infectiousness of carnivores with zoonot-
ic infections leads to their wide distribution in environment.
The complex research of these diseases among people and
animals has actual importance.
Keywords: carnivores, helminthes, helminthozoonoses, epidemi-
ological situation
P83
The clinical-epidemiological description of
echinococcosis in Almaty and region of Almaty
Yermukhanova Nurzhamal1, Yermukhanova Gulnaz1,
Ksyetaeva Gulzakira1, Alimbetova Kulyash2, Faizullin
Mukhametkali2
1
Kazakh National Medical University named by
Asfendiyarov S.D, . Kazakhstan
2
Sity Student's Polyclinic, Kazakhstan
The echinococcosis is a serious parasitic disease, which is
characterized by the destructive lesions of liver, lungs and
other organs; allergization of the organism and serious
complications, which is accompanied by frequently invalid-
ity and mortality. As from 1985 registered slow yearly
growth index of the disease echinococcosis. Morbidity of
echinococcosis in Republic has risen by 30%, registrated
lethal termination in East – Kazakh and Kostanaisk regions.
We observed 61 patients, 13 of them were the students of
the institute of higher education of Almaty and 48 of them
were the people of countryside. They were located in –
patient treatment at clinics in Almaty and region of Almaty.
Patients age from 17 untill 72 years. The continuation of the
disease was from 2 months until 4 years. The diagnosis has
been established on clinical – laboratory, instrumental (CT-
scan, US) methods of investigations. Practically, all patients
had weakness, loss of appetite, weight loss, abdominal
pains, and heaviness in hypochondria. In five (8%)
patients, jaundice has been noticed and sparingly expres-
sive symptoms of intoxication that demands exception of
viral hepatitis. Observation has showed the advantages of
CT-scan in revealing of the cyst, than ultrasound (four con-
ditions of echinococcosis cysts was not acknowledged. By
this way, our observation reveals about the tendency of the
growth of the illness echinococcosis, not connected with
profession region, residence and age factors. Difficulty in
diagnosis, absent of reliable chemotherapy, relapse of
echinococcosis cyst increases the value of prophylactic
measures.
Keywords: echinococcosis, CT-scan, US, a parasitic disease
P84
The tropical diseases on the terms in the Republic
of Kazakhstan
Yermukhanova Nurzhamal, Yermukhanova Gulnaz,
Ksyetaeva Gulzakira, Daniyarova Anar, Seidullaeva Liza
Kazakh National Medical University named by
Asfendiyarov S.D, Kazakhstan
The diseases of tropical countries are original area of the
medicine and it has separated in special discipline. A
122
spreading of the tropical diseases connected with tropical
climate and had natural-endemically nature. The tropical
diseases are important today, because:1. Migration of
population 2. Importation of sea foods, exotic fruits, fish
foods 3. Change of ecosystem, which is result in reproduc-
tion of insect – carriers 4. Natural disasters in neighboring
states, contributory in removal of natural vessels of infec-
tions and invasions to territory of our country.
5. Absence of medical – preventive inspectorate. Migration
of population to Kazakhstan means the return of migrants
from countries of distant and near abroad, such as China,
Afghanistan, Pakistan, Iran, Turkey, Tajikistan, Uzbekistan,
Turkmenistan, etc. As well as, it includes military men of
Kazbat are located in Iraq; foreign students, tourists, which
are constitute a threat of bring of infection diseases in our
country. The tropical diseases are transmitted by transmis-
sive–percutaneous way that complicated of preventive
health care. The importation seafoods also can be a factor
of transmission diseases. On territory of Kazakhstan
because of ecosystem’s changes - it is a waterlogged
places, rise air temperature and air moisture, etc – began
to register an insect-carriers of diseases such as a malaria,
leishmaniasis, filariasis, miasis, and mycosis.The absence
at doctors of practical skills of tropical pathology is present
difficulties in timely diagnostics. On extension, courses of
general practitioners and of particular specialists (cardiol-
ogist, neurologist, and ophthalmologist) must widely cov-
ered questions of tropical pathology consideration of mul-
tiple organ affection.
Keywords: the tropical diseases in Kazakhstan
P85
Visceral leishmaniasis that mimics multiple
myeloma: a case report
Memiko¤lu Kemal Osman, Yanmaz Evrim, Bayraktar
Nesil, Bal›k Ismail
1
Department of Clinical Microbiology and Infectious dis-
eases, Ankara University Faculty of Medicine, Ibn-i Sina
Hospital, Ankara, Turkey
Visceral leishmaniasis is a protozoal infection which car-
ried by sandflies of the genus phelobotomus and wild
canids can be reservoirs. It may mimic or lead to several
types of hematological disorders including pancytopenia.
Fever, massive splenomegaly, hepatomegaly, leukopenia,
hipergamaglobunemia and weight loss are the common
signs.
CASE: A 54 years old male presented with fever, weak-
ness, night sweats. Blood counts showed pansitopenia and
biopsy of bone marrow aspirate had increased plasma cell
ratio, %13. His illness was diagnosed as multiple myeloma
with increased Ig G, low chian immunoglobulin, lambda
and cappa, by serum immunfixation test. He treated with
two courses of VAD chemotherapy but he did not respond
to the treatment. They researched bone marrow puncture
second time and found amastigotes forms of Leischmania
donovani. Finally he was admitted to our clinic and was
treated with 20 mg/kg/day Na stibogluconate
(Pentostam). On the fourth day of the therapy acute pan-
creatitis and acute renal failure had developed and Na sti-
bogluconate therapy was stopped. He receiwed 3
mg/kg/day liposomal amphotherisin B every other day
(alternative day) in renal dose for ten days.At the end of the
therapy there were no amastigote forms in bone marrow
puncture, he discharged with complete cure.
CONCLUSION: Visceral leishmaniasis should be thought
in differential diagnosis of patients who have fever, pansi-
topenia, weakness, massive splenomegaly and have not
response to therapy. Liposomal amphoterisin B is the alter-
native choice for the treatment of patients who are suffer-
ing from Visceral leischmaniasis and do not tolorate Na sti-
bogluconate.
Keywords: Visceral leishmaniasis,multiple myeloma
P86
Scrotal Filariasis: A Case Report From The South
of Turkey
Calik Basaran Nursel , Ascioglu Sibel , Taylan Özkan
1 1
Aysegul2, Sain Guven Gulay3
1
Hacettepe University Internal Medicine Department
Section of Infectious Disease
2
Refik Saydam Hifsizsihha Center, Parasitology Unit
3
Hacettepe University Internal Medicine Department,
Section of General Internal Medicine Unit
INTRODUCTION: Filariasis is a disease of arthropod born
nematodes residing in deep tissues and lymphatic system.
Filarial nematodes are endemic in tropical countries but not
common in Turkey.
CASE: A 52 year-old man living in Southern Turkey was
admitted to hospital with sudden scrotal swelling and pain,
He had no fever or genital ulcer. He complained of chills,
night sweatings and inguinal pain at the time of swelling.
123
He was diagnosed as scrotal abscess, given antibiotic treat-
ment but it didn’t work. On admission to our hospital the
scrotum was extremely edematous, hyperemic, warm and
skin over scrotum was thickenend. Complete blood cell
count was normal. Ultrasonographic examination of scro-
tum showed hydrocele but no abscess. When the history
was detailed, he remembered a painful fly bite while sitting
at a river side in the South region of Turkey. After the sus-
pected history and physical examination, the patient was
diagnosed as filariasis. Nocturnal venous blood sampling
was done for thin and thick blood smear and serologic test.
Microfilaria were detected on the blood smears.
Dietilcarbamezin and albendazole was given for the treat-
ment.
CONCLUSION: Filariasis is the leading cause of debilitat-
ing disease in the world and endemic in Africa and South
Asia threatening millions of people. But as we see here,
physicians can come across to it in a non-endemic region.
This infrequent infection is important because of difficulty in
diagnose and uncertainy in treatment. Even more crucial is
to find the source and provide vector control for public
health.
Keywords: filariasis, scrotum, lymphatic
P87
A case of Hydatid cyst with multiple organ
involvement
Ustun Cemal1, Tekin Recep1, Avci Alper2, Hancer Fatma
Nur3, Geyik Mehmet Faruk1
1
Dicle University Faculty of Medicine, Department of
Infectious Diseases and Clinical Microbiology, Diyarbakir,
TURKEY
2
Dicle University Faculty of Medicine, Department of
Thoracic Surgery, Diyarbakir, TURKEY
3
Dicle University Faculty of Medicine, Department of
Obstetrics and Gynecology, Diyarbakir, TURKEY
OBJECTIVE: A hydatid cyst case, presented with multiple
organ involvement, is reported.
CASE: A 56 years old woman hospitalized in the thoracic
surgery clinics with a 3 month history of cough, chest pain
and shortness of breath. On physical examination,
decreased breath sounds on left lung by auscultation and
tenderness by abdominal palpation were detected. Her
chest XR revealed a well circumscribed solid mass located
at the middle aspect of left upper lobe of lung. Blood inves-
tigations showed a WBC count of 7800/mm3, ESR of 37
mm/hr, CRP of 12 mg/dl. Echinococus granulosus IgG
was found to be positive with the titer of 1/160 on serolog-
ical test performed with IFA. Abdominal and thoracic com-
puted tomography showed a 7x4 cm lobulated cystic lesion
with inner calcifications at the hilus of left lung, multiple
well circumscribed cystic lesions in liver and a 13x12 cm
cystic lesion lying from upper pole of left kidney to beneath
the neighborhood of psoas muscle. Preparing for surgery,
the patient was begun on albendazole dosed at 800
mg/day. The cysts, confirmed to be hydatid cyst by histo-
logical examination, were totally respected from the lung
and kidney. The patient, receiving medication for six
months, were found to be completely cured at the end of
the period.
CONCLUSION: Hydatid cysts commonly affect the liver
and lung. Kidney involvement is rare. Surgical intervention,
as well as medical treatment, should be performed in large
cysts with multiple organ involvement.
Keywords: Hydatid cyst
P88
Biologically active admixture "Baur" in complex
treatment of viral hepatitis A
Begaydarova Rosa Khasanovna, Zhunusov E. S., Efimova
Oxana Nikolayevna, Konstantinidi Tatiana Anatolievna,
Zolotareva Oxana Anatolievna
Chair of children infectious diseases, Karaganda State
Medical Academy, Karaganda, Kazakhstan
Purpose of the research: to reveal clinical efficiency of bio-
logically active admixture "Baur".
Materials of the research: 94 patients with viral hepatitis A
in the age from 3 till 47 years, hospitalized to infectious
department, were subject to examination. Clinical and lab-
oratory results of treatment were estimated. Groups of com-
parison were made by the patients received basic therapy.
Results and conclusions: Biologically active admixture
"Baur" was used in complex treatment of 94 patients with
the viral hepatitis A, course 7-10 days. After the carried out
treatment the general condition of the patients has
improved, signs of intoxication in 1.5-2.3 times and dys-
peptic manifestations in 2.5 times has decreased.
Laboratory parameters also had primary improvement in
patients receiving "Baur". In the basic group activity of
serum enzymes (alaninaminotransferase, aspartatamino-
transferase) after treatment has made 128.0±12.35 and
78.3±9.8 nmole/s.l. Accordingly, whereas in control
group these parameters were equaled 286.0±22.41 and
124
132.0±15.34. Level of the total and direct bilirubin after
treatment in the basic group has decreased to 22.2±8.2
and 6.2±2.4 mcmole/l, in control group was equaled
43.12±12.7 and 27.2±12.4 mcmole/l accordingly.
Antipyrogenic, detoxic and hepatoprotective action of
"Baur" is caused by intensifying of bile moving in intrahep-
atic and extrahepatic biliary ducts under its influence,
decrease of concentration of bile acids in bile and blood
bilirubin. Thus, "Baur" can be successfully used for treat-
ment of VHA. For therapy of VHA seven-day course of
"Baur" application is sufficient. Good acceptability and
absence of adverse effects allow recommending "Baur" for
wide use in infectious practice.
Keywords: viral hepatitis, bilogically active admixture, treatment
P89
The effect of antiviral therapy in children with
chronic virus hepatitis B and C
Kuttykuzhanova Galiya S.D.
Asfendiyarov Kazakh National Medical University
PURPOSE: Evaluate the efficiency of Pegintron in children
aged 4 to 18 years with chronic viral hepatitis C and B. The
activity of the process was from the minimal to the high.
They got anti-virus therapy with Pegintron + Rebetol (for
Hepatitis C) in combination with or without Lamivudin for
Hepatitis B. The early virologic response (HCV with the
negative PCR method), i.e. after 4 weeks of treatment, was
noted in 20% of the treated patients; lowering of HCV con-
centration was observed in 60% and no changes – in 20 %
of the treated patients, depending on the genotype of the
virus.
Complete virologic response was achieved in 78% of chil-
dren after 24 weeks of treatment, stable one – in 71% 6
months after the end of the treatment. The results less effi-
cient were received during treatment of children with
chronic virus hepatitis B. The early virologic response was
received 12 weeks after the start of the treatment, the full
virologic response was observed only in 45% of the treated
patients 24 weeks after the start of the treatment.
Keywords: Chronic Virus Hepatitis B, Hepatitis C, anti-virus ther-
apy, Pegintron
P90
Spontaneous seroconversion of hepatitis B sur - INTRODUCTION: The high risk of bacterial and viral infec-

face antigen in a patient with liver cirrhosis tions in ESRD patients are related to an acquired immunod-
eficiency. We have investigated immune responses in
chronic renal disease patients with HCV infection.
Goral Vedat1, Ozturk Ikram Durç2, Bereketoglu Nuh2
MATERIAL-METHOD: We studied 30 HCV negative
1
Department of Gastroenterology, Dicle University School
patients and 25 HCV positive with ESRD on chronic HD
of Medicine, Diyarbakir,Turkey
and 21 healthy subjects. Patient group included 34 female
2
Department of Internal Medicine, Dicle University School
and 21 male with mean age of 46, 5±16, 1 (18–77) year.
of Medicine, Diyarbakir,Turkey
The mean time on HD was 3,5 ± 2,9 (1–15) years. Healthy
controls were 11 female and 10 male with mean age
Hepatitis B surface antigen (HBsAg) seroclearance is a rare
40,5±13,3 (18–61) years. For all patients and healthy vol-
event that occurs in 0.1% to 2% of patients with chronic
unteers’ serum urea, creatinine, anti HCV antibody, anti
hepatitis B per year. Patients with HBsAg seroclearance
HBs antibody IgG, IgM, and IgA was measured.
have improvement of liver biochemistry and hepatic
Lymphocytes were analyzed. CD4, CD8, CD19, CD16–56
necroinflammation. The viral load gradually decreases with
lymphocytes were measured. Kt/V values were calculated.
time, although some patients still have detectable intrahep-
RESULTS: Lymphocyte and lymphocyte subgroups values of
atic hepatitis B virus DNA, mainly in the form of covalently
hemodialyzed patients were significantly lower than healty
closed circular DNA. There is no reduction of the risk of cir-
persons [1439.546±546 (HCV-), 1353±313 (HCV+),
rhosis-related complications and hepatocellular carcinoma
2555±663 (healty persons) p< 0.001]. IgG, IgM and ALT
if HBsAg seroclearance occurs at an older age when cir-
levels of HCV positive hemodialysis patients were signifi-
rhosis has already been established. But, spontaneous
cantly higher compared with HCV negative hemodialysis
seroconversion of hepatitis B surface antigen in a patient
patients (14,5±5,1 g/dl vs 11,8±3,1 g/dl p=0.03,
with liver cirrhosis is very few.
1,3±0,7 g/dl vs 0,9±0,4 g/dl, p=0.02, 29±23 U/L vs
CASE: 57 years old male had admitted to the university
15±9 U/L p=0.005 respectively). There was no difference
hospital for liver transplantation. He had HBV history in the
for CD4/CD8 ratios.
last 5 years. But at the admission to the department,
In conclusion, IgG and IgM levels of HCV + hemodialysis
HBsAg, HBeAg, anti-HBeAg and HBV DNA tests were neg-
patients were higher than negatives, no other difference
ative. He had Child C liver cirrhosis. He was sent to anoth-
was observed between groups, the clinical importance of
er center for liver transplantation. He had not used any
this difference could not be interpreted; further large scale
antiviral drugs (lamuvidine, adefovir, entecavir) for treat-
studies are needed to determine the effect of HCV on
ment of chronic HBV infection at the past. This case report
immune functions in HD patients.
is very interesting. According to the literature, there is no
Keywords: HCV, hemodialysis, immunity
enough information about spontaneous seroconversion of
hepatitis B surface antigen in a patient with liver cirrhosis.
P92
Keywords: Liver Cirrhosis, Spontaneous HBV seroconversion
Comparative evaluation of four hepatitis B vac -
P91 cines available in Karachi, Pakistan: reacto -
The effect of HCV infection on the immune status genecity and immunogenecity
in hemodialysis patients Hakim Shazia Tabassum1, Kazmi Shahana Urooj2
1
Department of microbiology, Jinnah University for women,

Sayarlioglu Hayriye1, Erkoc Reha2, Dogan Ekrem1, Karachi, Pakistan

Soyoral Yasemin2, Oner Ahmet Faik3

2
Department of microbiology, University of Karachi,
1
Department of Nephrology, Sutcu Imam University, Karachi, Pakistan

Kahramanmaras, Turkey
2
Department of Nephrology, Yuzuncu Yil University, Van, Main objective of this study was to evaluate the effective-

Turkey ness of hepatitis B vaccines commonly available in the

3
Department of Hematology, Yuzuncu Yil University, Van, Pakistan’s market, in apparently healthy young female vol-

Turkey unteers in Karachi.

125
Today most of the world’s people recognize the importance
of vaccination and more than 80% of the world children
are now immunized against diseases covered by EPI.
Approximately 100 countries, consistent with World Health
Organization policy, have added HB vaccination to their
routine childhood immunization programs.
A total of 243 apparently young healthy female students of
two Universities of the city were included in this study per-
formed during March 2002 to October 2006, after receiv-
ing written informed consent. Four recombinant yeast
derived HB vaccine were used as test regimens i.e. Euvax-
B (LG Chemicals Ltd., Korea), Heptis-B (Boryang, Korea),
Amvax-B (Amson, Pakistan) and Engerix-B (GS & K,
Belgium). Participants were injected with the vaccine of
their own choice. Anti-HBV antibody titers were recorded
using EILSA (IMX-Abbott).
Among these four candidate vaccines Engerix-B came up
with the least adverse effects, Euvax-B and Heptis-B showed
moderate level of side effects, while Amvax-B showed max-
imum level of side effects. Although, none of these vaccines
showed very sever type of adverse effects like demylination
or central nervous system disorders during last 05 years
period, except soreness, indurations, swelling, redness,
mild pain, granuloma formation, and mild fever at the time
of injection or just after injecting the vaccine, which was
recovered within couple of hours.
Keywords: Sero protection, Mass Immunization, HBV,
Reactogenecity, Immunogenecity
P93
The comparative characteristics of antiviral
therapy of chronic viral hepatitis C
Kosherova Bahit1, Baltynova Rosa2, Kim Antonina3,
Zhantakbayeva Botagoz4, Arinova Balzhan5, Nechayev
Andrey6
Kanaganra State Medical Academy
Karaganda, Kazakhstan
The aim: to study of clinical and laboratory effectiveness of
combined antiviral therapy in patients with chronic hepati-
tis C.
The clinical and laboratory researches took place in 42
patients at the age of 17 – 50 years. The patients had been
separated in 3 groups: I group – 21 patients given
Pegasis+Ribaverin; II group – 16 persons given
Ropheron+Ribaverin; III group – 5 patients given
126
Pegintron+Ribaverin. The genotype 1b was diagnosed in
18 patients, 2a in 2 patients and 3a in 22 patients. All the
patients had a viral load. The comparative estimation of the
therapy showed that in patients with genotype 2a and 3a
who were given Pegasis+Ribaverin and
Pegintron+Ribaverin ,the clinical and laboratory dynamics
were marked characterized by the cupping of intoxication
syndrome, dyspepsia, the lowering of liver size and the
absence of viremia in 91% of patients. The transaminases
were 2, 7 times higher than in normal and the keeping of
viremia was in 1 patient. The clinical and laboratory
indices were without positive dynamics in 16% of patients
with genotype 1b, taken Ropheron+Ribaverin. Thus, the
most effective treatment of chronic viral hepatitis C is the
combined antiviral therapy with Pegasis+Ribaverin and
Pegintron+Ribaverin, promoting the stable clinical and lab-
oratory remission.
Keywords: hepatitis C, Pegasis, Ribaverin, Pegintron
P94
Effect of Initial Renal Replacement Type on Hepatitis C
Frequency in Peritoneal Dialysis Patients
Kelefl Mustafa1, Çetinkaya Ramazan1, Uyan›k
Hamidullah2, Uyan›k Abdullah1, Akbafl Emin Murat3, Bilen
Yusuf3, Ero¤lu Fatma1, Ferah Hüsniye1
1
Departments of Nephrology, Ataturk University, Erzurum,
Turkey
2
Departments of Microbiology, Ataturk University,
Erzurum, Turkey
3
Departments of Internal Medicine, Ataturk University,
Erzurum, Turkey
BACKGROUND: Dialysis patients have a high risk for
Hepatitis C virus (HCV) infection. Anti-HCV (+) frequency in
peritoneal dialysis (PD) patients is 3.9 % in our country.
HCV infection leads to liver failure and becomes an obsta-
cle for renal transplantation candidates. In this study, we
aimed to retrospectively investigate the effect(s) of initial
renal replacement therapy (RRT) in HCV infection frequen-
cy. METHODS: 341 (177 females, 164 males) PD patients
(age range: 16-70 years) followed in our nephrology unit
were included in study. All patients were checked for Anti-
HCV with ELISA. PD patients were divided into two groups
according to initial type of therapy (HD vs PD).
RESULTS: Frequency of Anti-HCV positivity was found as
4.6 % in PD patients. 211 patients initiated to RRT with
hemodialysis and rest 130 with PD. Number of Anti-HCV-
positive patients in PD group was only one whereas it was
18 in hemodialysis (HD) group. Anti-HCV positivity was
significantly lower in PD group than in HD group (p<0.05).
CONCLUSIONS: In PD patients, Anti-HCV positivity is less
if patient initiates to RRT with PD. It is assumed that initial
PD is preferable in terms of HCV infection risk especially in
patients in whom renal transplantation is planned.
Keywords: Hepatitis C virus, hemodialysis, peritoneal dialysis.
P95
Recombinant Interleukin-1 and Interleukin-2 in
treatment of chronic B and C viral hepatitis: 5-
year's experience
Kurmanova Gaukhar , Kurmanova Almagul , Sadykova
1 2
Sholpan1
1
Kazakh National Medical University, Kazakhstan
2
Almaty State Doctors’ Postgraduate Institute, Kazakhstan
The purpose of research - comparison of clinical and
immunological efficiency of recombinant interleukin-1‚ (rIL-
1) and interleukin-2+·-interferon (IL-2+ ·INF) in treatment of
patients with chronic B and C viral hepatitis. Treatment with
rIL-1‚ in monotherapy (5-8 ng„/kg, per day s/c ?10) at
91,6 % of the patients with a HCV-infection had positive
result in suppression of virus replication at once after treat-
ment with preservation of effect during 24 months. As a
result of the rIL-1 therapy of patients with chronic viral hep-
atitis B the relapse of replication within 1 year after the
treatment was found out in three patients. Stable virologi-
cal response was observed only at 57, 2 % at the patients
with HBV monoinfection during supervision till 18-24
months. Recombinant IL-2 (500000 åÖ 1 time per 3 day
s/c) in a combination with - ·-interferon (3 mln åÖ 1 time
in 3 days, subcutaneosly) the patients received within 2-4
months depending on terms of PCR negativation. The effi-
ciency of such course was 78,6 % in the patients with HCV
infection (proof virological response), and 86,7 % in the
patients HBV–infection. At positive results at both treatment
regimens in the HBV and HCV infection patients in terms
corresponding to early virological response to anti-virus
therapy the same changes in lymphocyte’s population pro-
file were observed. But the treatment with rIL-2 and ·-inter-
feron combination the duration of the treatment course was
2 months at 2/3 patients, and 3-4 months - at 1/3 ones.
The duration of IL-1 treatment was only 20 days.
Keywords: HCV, HBV infection, interleukine-1, interleukine-2
127
P96
Seroprevalence of hepatitis B, hepatitis C, and
human immunodeficiency virus in children, who
admitted to pediatric surgery polyclinic
Basugay Erol1, Deveci Ugur2, Ustun Cemal3
1
Mardin State Hospital, Department of Pediatric Surgery,
Mardin, TURKEY
2
Sarahatun Obstetric and Gynecology Hospital,
Department of Pediatrics, Elazig, TURKEY
3
Dicle University Medical Faculty, Department of Infectious
Disease and Clinical Microbiology, Diyarbakir, TURKEY
OBJECTIVE: We aimed to determine the seroprevalence of
hepatitis B, hepatitis C and human immunodeficiency virus
(HIV) in patients aged between 0-16 years who admitted to
Mardin State Hospital Pediatric Surgery Polyclinic in South
Eastern Anatolia of Turkey.
METHODS: Between January-December 2007, 307 chil-
dren referred to pediatric surgery polyclinics, HBSAg,
antiHBs, anti-HIV and anti-HCV seropositivity was evaluat-
ed with ELISA technique.
RESULTS: Of the cases, 251 (81.7%) were male, 56
(18.3%) were female. Mean age of cases was 5.22 ±3.73
years. Five patients (1.3%) were HBsAg positive, 166
patients (54%) were AntiHBs positive and, the others
(44.7%) were seronegative. There were no anti-HIV and
anti-HCV positive cases. A hundred and sixty-one of cases
(52%) were immunized for hepatitis B.
CONCLUSIONS: Hepatitis B virus carriage was detected to
be 1.3 % in this study. In Turkey, Hepatitis B prevalence
may vary according to other studies and it is 4-10%. This
difference may be originated from regional differences.
Keywords: Hepatitis B, hepatitis C, HIV, Seroprevalance,
Children.
P97
Hepatitis C Virus Infection and Chronic
Obstructive Pulmonary Disease
Erol Serpil1, Sa¤lam Leyla2, Ozbek Ahmet3, Kadanali
Ayten1, Parlak Mehmet1
1
Department of Infectious Diseases, Ataturk University,
Erzurum, Turkey
2
Department of Chest Diseases, Ataturk University,
Erzurum, Turkey
3
Department of Microbiology and Clinical Microbiology,
Ataturk University, Erzurum, Turkey
BACKGROUND: Hepatitis C virus (HCV) infection is some-
times associated with extrahepatic diseases. Otherwise,
several reports have suggested an important role for latent
viral infections in the etiology and progression of chronic
obstructive pulmonary disease (COPD). In this study, we
aimed the frequency of HCV infection in patients with
COPD, and pulmonary disease in patients with HCV infec-
tion.
METHOD: Anti-HCV antibodies were evaluated by ELISA
method. HCV-RNA was evaluated in the anti-HCV positive
patients by real time polymerase chain reaction (PCR). HCV
infection was considered in case of both anti-HCV and
HCV-RNA positivity. The prevalence of anti-HCV antibody
in COPD group compared with the 2 previous studies
investigate the prevalence of anti-HCV antibody in healthy
population in our region.
RESULTS: The study included 108 patients with COPD, and
68 patients with HCV infection. Thirteen patients with
COPD had anti-HCV antibodies(12.0 %), and nine of them
were HCV-RNA positive by PCR assay. Eventually, the
prevalence of HCV infection in this group was 8.3%. On
the other hand, the prevalence of COPD in patients with
HCV infection was 17.6%. In addition, 14.7% of the
patients had asthma. In two previous studies in our region,
the prevalences of anti- HCV antibodies in healthy popula-
tion were 1.2% and 2%. Compared to these rates, the
prevalence of anti-HCV antibody was higher in patients
with COPD ( p: 0.000)
CONCLUSION: Patients with COPD constitute a risk group
for HCV infection, and COPD may be an extrahepatic dis-
ease associated with HCV infection.
Keywords: Hepatitis C virus, COPD, pulmonary disease
P98
A Case of Nosocomial Crimean-Congo
Hemorrhagic Fever with Good Prognosis
Gurbuz Yunus, Sencan Irfan, Ozturk Bar›s
D›skap› Y›ld›r›m Beyaz›t Training Hospital
Crimean-Congo hemorrhagic fever (CCHF) is caused by a
tick-borne virus (Nairovirus) in the family Bunyaviridae.
Since 2002, the disease has been diagnosed throughtout
Turkey, especially Central Anatolia and Black Sea regions.
Transmission to humans occurs through contact with infect-
ed animal blood or ticks. It may also occur as nosocomial
128
infection. Nosocomial infections have usually more severe
prognosis. Below, we report a case of nosocomial CCHF
diagnosed with mild prognosis at our hospital. Thirty eight
year-old woman (S.C.) admitted to our clinic with high
fever and dysuria at 2006. Urinary tract infection caused
by Klebsiella was diagnosed and appropriate antibiotic
according to antibiogram was given. After three days of
hospitalisation, pancytopenia was occurred and this
patient was diagnosed as CCHF with positive EL‹SA and
PCR test. We reexamined the patient and learned that she
had beaten by a tick and she had removed it seven days
before hospitalisation. The patient immediately isolated
from other patients. The second patient (A.Y.) sharing same
room for five days with S.C. had been hospitalisated for
treatment of brain abscess and she had never come into
contact with a tick and lived in an endemic region. Having
contacted first patient (S.C.) for five day in same room, she
developed CCHF proved by laboratory diagnose with pos-
itive EL‹SA and PCR test. This patient (A.Y.) has been
accepted nosocomial infection. Both patients had good
prognosis.
Keywords: Crimean-Congo hemorrhagic fever, Nosocomial,
good prognosis
P99
Interleukin (IL)–1, IL-6, IL-10 and Tumor Necrosis
Factor– a level in Patients with Crimean-Congo
hemorrhagic fever
Kadanal› Ayten1, Erol Serpil1, Ertek Mustafa2, K›z›ltunç
Ahmet3, Karaca Cezmi1, Özden Kemalettin1,
Parlak Mehmet1
1
Department of Infectious Disease, Ataturk University,
Erzurum, Turkey
2
Refik Saydam National Hygiene Center, S›hhiye,
Ankara – Turkey
3
Department of Biochemistry, Ataturk University, Erzurum,
Turkey
BACKGROUND: The pathogenesis of CCHF is poorly
understood and results in an approximately 30% fatality
rate. As in other viral hemorrhagic fevers, cytokines may
play a key role in the pathogenesis and outcome of the dis-
ease.
OBJECTIVE: To evaluate serum levels of IL–1, IL- 6, IL- 10
and TNF– a levels in serum samples obtained from labora-
tory confirmed patients with CCHF.
METHOD: PCR positive 30 cases, PCR negative and serol-
ogy positive 27 cases and 27 control cases were included
in this study. Serum levels of IL–1, IL- 6, IL- 10 and TNF– a
were measured during the illness.
RESULTS: Statistically significant difference between patient
and control goups was obtained only for IL- 6. IL- 6, TNF–
a, IL- 10 was elevated in 36 patients, 18 patients and 16
patients respectively, and in none of the control cases. IL–1
was elevated in 48 patients and all of controls.
CONCLUSION: We found that TNF– a was associated with
severe form of CCHF, while statistically significant differ-
ences between patient and control goups was obtained for
IL- 6 levels. Proinflammatory cytokins may play a major
role in the pathogenesis of CCHF
Keywords: Crimean-Congo hemorrhagic fever, IL–1, IL -6, IL- 10,
Tumor Necrosis Factor– a
P100
The clinical characteristics of haemorrhagic
fevers in Kazakhstan
Yegemberdiyeva Ravilya
Kazakhstan National Medical University, Kazakhstan
It was conducted an evaluation of 36 cases of Crimean-
Congo haemorrhagic fever (CCHF). The disease had a
medium-hard overcoming in 64%, in 33% - the hard over-
coming. The main symptom of CCHF is fever (100%). The
average continues of fever is 5.8 days. Patients with CCHF
had the following symptoms: rigor (44%), head ache
(86%), weakness (100%), arthralgia (61%), myalgia (36%),
and waist ache (47%). The patients were complaining on
nausea (58 %), vomiting (42 %), a pain in a stomach (39
%), and diarrhea (36%). Haemorrhagic syndrome is recog-
nised according to nose bleeding (28%), gum bleeding
(25%), gastroenteric bleeding (14%), kidney bleeding (8%),
uterus bleeding (1 case), the haemorrhagic spots (53%),
bleeding spots on the places of injection (14%). In 86% of
cases the illness was ended up with the recover, in 14%
with the deaths. A haemorrhagic fever with renal syndrome
disease was analyzed among 50 people. In 8% of cases –
a light form of disease, in 48% - medium-hard, in 44% - a
hard from. A fever faze begins from a high body tempera-
ture accompanied with the head ache, waist ache (78%),
stomach ache (74%), nausea, vomiting, weakness (100 %).
The haemorrhagic syndrome developed in 25% of cases
and recognised according to bleeding in injection spots, in
conjunctiva (12%), in a mucous membrane of the firm and
soft mouth (4 %), petechial eruption (10%), nose bleeding
129
(16%). Acute renal insufficiency was developed in 30% of
cases, disseminated interavascular coagulation – syndrome
in 8% of cases.
Keywords: Crimean-Congo haemorrhagic fever, a haemorrhag-
ic fever with renal syndrome, a haemorrhagic syndrome
P101
Crimean-Congo haemorrhagic fever virus
infection in eastern Turkey
Kadanal› Ayten, Ozden Kemalettin, Erol Serpil,
Parlak Mehmet
Dept. of Infectious Diseases, Atatürk University, Erzurum,
Turkey
OBJECTIVES: In this study we described the epidemiologi-
cal, clinical, laboratory findings, risk factors, outcome fea-
tures and efficiacy of ribavirin therapy for CCHF patients
admitted to tertiary care hospitals in Eastern Turkey
between 2004-2006. METHODS: Definitive diagnosis was
based on the detection of CCHF virus-specific IgM by ELISA
and/or of genomic segments of the CCHF virus by RT-PCR.
Related data were collected pospectively.
RESULTS: Sixty-three patients were enrolled in the study.
Twenty-two (50.8 %) of the patients were female, and 31 of
them (49.2 %) were male. The mean age of the patients
was 46±16.9 years. Fifty-nine (93.6 %) patients were
involved farming/handling livestock. Anti-CCHFV IgM was
positive 52 patients, and Real time polymerase chain reac-
tion (RT-PCR) was positive 13 patients. The overall case
fatality rate was 4.8 %. The mean duration to the onset of
symptoms was 4.7±2.5 days and diifferences between sur-
viving and died patients were not statistically significant
(P=0.27). Weakness, confusion, bleeding from multiple
sites and presence of petechia/ecchymosis were more
often in the patients who died (p=0.02, p=0.05, P<0.001).
Significant elevation of LDH levels (p=0.004), PTT
(p=0.02), PT (p=0.04) and trombocitopenia (p=0.01) were
detected in the patients who died.Thirty two patients 50.8%
had a tick-bite history before the onset of fever. In this
series, the disease occurred from April to august (most fre-
quent in July-2005, June -2006). Oral ribavirin was pre-
scribed to 46 (73%) patients.
CONCLUSIONS: General supportive treatment was the
most essential for these patients.
Keywords: Crimean-Congo haemorrhagic fever virus, diagnosis,
ribavarin, risk-factors
P102
CrimeN-Congo hemorrhagic fevers in The
Republic OF Kazakhstan
Kyraubayev K.
Republican Sanitary Epidemiologic Station-Kazakhstan,
Almaty
In the territory of the Republic the natural centers of
Crimea-Congo Haemorrhagic fevers (CCHF) are located in
6 out of 14 administrative territories due to the presence of
carriers CCHF - ticks Hyalomma asiaticum, Hyalomma
anatolicum, Hyalomma plumbeum.
The most epidemiological danger is represented by the
activity of tick Hyalomma asiaticum which are naturally
populated in the South-Kazakhstan, Zhambyl and
Kyzylorda regions. Human disease cases in these regions
are registered annually.
In the Republic within the last 20 years (1987-2007) the
most cases of disease are registered in Zhambyl (258
cases), fatal cases of disease - 12,9 cases in a year has
made 6,01 %, and; in the South-Kazakhstan area accord-
ingly 120 - 21,7 % - 6,0 cases; in Kyzylorda areas accord-
ingly 102 - 11,4 % - 5,1 cases in a year. During these
years in the Republic of Kazakhstan there were 483 CCFG
cases registered. The frequency and seasonal prevalence of
diseases is traced. Frequency makes 4-6 years.
The reasons of activation of the natural centers were
change of a climate, desertification of territories owing to
economic influence of the humans which have resulted in
activation of a carrier of virus CCGF. In these conditions
duly performance of desincective and deratization works is
the important part of preventive maintenance.
Besides change of patterns of ownership, occurrence coun-
try and farms have demanded the new approach to per-
formance of preventive works in natural centers CCGF
since have stopped centralized allocation of financial
assets from the Ministry of Agriculture on carrying out
desincective and deratization works. It has led to deteriora-
tion of carrying out works against pincersgs of agricultural
animals and to creation of a sanitary-protective zone
around of unsuccessful settlements.
For the decision of these questions with Decisions territori-
al majors have obliged managing agricultural subjects, pri-
vate owners of cattle to allocate financial assets for carry-
ing out works against pincers of cattle. Departments of
Gossanepidnadzor of territory financed means for creation
of a sanitary-protective zone around of unsuccessful settle-
ments on CCGF. Only in 2007 in natural centers CCGF for
carrying out desincective and deratization works there
130
were more than 20.2 million tenge allocated. Pincers bar-
rier processing has been lead on the area 29494600
square meters. In 116 unsuccessful settlements 6172 court
yard by the area 2750158 square meters also are in addi-
tion processed.
Zoology-parazitology brigades collect 23900 copies of
ticks, is removed from animals of 7790 copies of ticks. Ticks
have been found out in 100 % of cases in all examined ani-
mals. The extracted material has been investigated by lab-
oratories of departments of highly danger infections by
application IFA of diagnostics. In 420-ÚË copies of ticks
positive results on CCGF are found out.
Introduction of new forms of carrying out of preventive
works promoted decrease in desease CCGF for last years
(2003-2007) from 0.18 up to 0.11 on 100 thousand pop-
ulations.
Conclusion: Efficiency of preventive measures against
Crimea-Congo hemorrhagic fevers is connected with close
interaction with local authorities and financial support in
order to perform preventive measures against pincers and
creation of a sanitary-protective zone
P103
A case of nasal ecthyma gangrenosum
Tekin Recep1, Ustun Cemal1, Hancer Fatma Nur2, Urakc›
Zuhat3, Geyik Mehmet Faruk1
1
Dicle University Faculty of Medicine, Department of
Infectious Diseases and Clinical Microbiology, Diyarbakir,
TURKEY
2
Dicle University Faculty of Medicine, Department of
Obstetrics and Gynecology, Diyarbakir, TURKEY
3
Dicle University Faculty of Medicine, Department of
Internal Medicine, Diyarbakir, Turkey
OBJECTIVE: A rare case of nasal ecthyma gangrenosum,
secondary to Pseudomonas aeruginosa bacteremia, in a
patient with acute myelogenous leukaemia is reported.
CASE: A 58 years old woman hospitalized in hematology
clinics was evaluated for high-grade fever and deteriora-
tion of general medical condition. Complaining about
necrotic lesion on her nose and fever, on her physical
examination, the body temperature was 39.2°C, the blood
pressure was 130/70 mmHg, the pulse rate was 108 beats
per minute, the respiratory rate was 22 beats per minute,
there were bilateral post auricular lymphadenopathy while
other system examinations were assessed as normal.
Necrotic areas originating from dorsum nasi lying towards
the nasal openings were observed. Blood investigations
showed a WBC count of 131.000/mm3, ESR of 36 mm/hr
and CRP of 365 mg/dl. Urine, blood and lesion swab cul-
tures were performed. Meropenem 3 gr/day and amikacin
1.5 gr/day was begun on as the empirical treatment. P.
aeruginosa was isolated from both blood and lesion swab
cultures, with the same resistance pattern. The patient,
decompansating gradually, passed away on the fifth day
of treatment.
RESULTS: Ecthyma gangrenosum is a coetaneous infection
most commonly associated with a P. aeruginosa bac-
teremia. Perineum, buttocks and extremities are the fre-
quent sites of manifestations. Nevertheless, nasal involve-
ment is rarely seen, as presented in this case.
Keywords: Ecthyma gangrenosum, P. aeruginoza.
P104
Amphotericin B Associated Convulsion: A Case
Report
Tekin Recep1, Ustun Cemal1, Avc› Alper2, Hancer Fatma
Nur , Geyik Mehmet Faruk
3 1
1
Department of Infectious Diseases and Clinical
Microbiology, Faculty of Medicine, Dicle University,
Diyarbakir, Turkey Department of Thoracic Surgery,
2 anthracis is reported in Turkey. CASE: A 17 years old
Faculty of Medicine, Dicle University, Diyarbakir,
Turkey Department of Obstetrics and Gynecology, Faculty
3 high grade fever and poor consciousness to emergency
of Medicine, Dicle University, Diyarbakir, Turkey
OBJECTIVE: Convulsion induced by liposomal ampho-
tericin-B (LAB) in a candidal empyema case is established.
CASE: A 55 years old woman hospitalized in the thoracic
surgery clinic with one week history of fever, cough and
shortness of breath. On physical examination, the body
temperature was 38.7°C, blood pressure 130/80mmHg,
cardiac pulse rate 94/minute and respiratory rate
20/minute. Decreased breath sounds on left lung were
detected by auscultation, while other system examinations
were assessed as normal. Blood investigations showed an
ESR 57mm/hr, WBC 3800/mm3, CRP 8.1mg/dl. Thoracic
computed tomography revealed a 5x7cm empyema in left
pleural cavity. Blood, urine and pleural fluid cultures were
performed, with the application of thoracic tube drainage.
Candida spp. was detected on the gram staining and cul-
ture of the pleural fluid. The patient was began on LAB
dosed at 200mg/day on the 6th day of treatment fever was
improved considerably, however, on the 14th day she sud-
denly developed a generalized tonic-clonic seizure attack.
131
Consultation was made with neurology department; she
was begun on anticonvulsant therapy. Subsequent cranial
magnetic resonance imaging and electroencephalography
results were reported as normal. Regarding the results of
the tests when other potential causes of seizure were ruled
out, amphotericin-B seems to be the probable cause of the
seizures. No convulsive attack was observed in subsequent
follow-up after the cessation of LAB.
RESULTS: One of the rare side effects of LAB is seizure.
Ruling out other causes of seizure, adverse drug effect
should be considered in a patient treated with ampho-
tericin-B.
Keywords: Amphotericin-B, convulsion, tonic-clonic seizure.
P105
A Case of Meningitis duo to Bacillus anthracis
Geyik Mehmet Faruk, Ustun Cemal, Celen Mustafa Kemal,
Hosoglu Salih, Ayaz Celal
Dicle University Medical Faculty, Infectious Disease and
Clinical Microbiology Depertment, Diyarbakir, TURKEY
OBJECTIVE: The case of meningitis duo to Bacillus
male-farmer was admitted with severe headache, vomiting,
room. He was interned to Clinical Microbiology and
Infectious Disease department. His complains had begun
two days ago and there was animal died in area, where he
was living for two weeks. There were 38.5oC fever,
hypotension (90/60 mmHg), poor consciousness and
meningeal irritation sign in the physical examination. In the
laboratory examination, his WBC 15400/mm3 (91% neu-
trophyl), platelet 19500/mm3, sedimentation 42 mm/h,
CRP 98.4 mg/l, glucose 185mg/dl, sodium 129 mmol/l
and clor 99 mmol/l were found. The other biochemical lab-
oratory parameters were found as normally. Seftriaxon 2
gr intravenous was performed as empirically. The lumber
puncture was made immediately. Cerebrospinal fluid (CSF)
was projectile and with high pressure. In the CSF laborato-
ry examination, WBC higher than 10,000/mm3 (90% neu-
trophyl), pandy +++, protein 80 mg/dl, glucose 55 mg/dl
(blood glucose 144 mg/dl) were found. Large Gram-posi-
tive bacilli were seen in the CSF smear. Antibiotic treatment
was changed with meropenem 6 gr/day plus vancomisin 2
gr/day. B. anthracis was isolated from cultures of CSF and
blood. Unfortunately patient died after two days hospital-
ized in.
RESULTS: Meningitis duo to B. anthracis is extremely rare.
The physicians should consider anthrax meningitis if there
is a history of contact with infected animals. CSF Gram
strain may be helpful to physicians in first diagnosis.
Keywords: Bacillus anthracis, meningitis.
P106
A native aortic valve endocarditis caused by
Staphylococcus aureus associated with pemphi -
gus vulgaris due to long-time immune suppres -
sive treatment and prolonged hospital stay
Kayrak Mehmet, Ulgen Mehmet S, Yaz›c› Mehmet,
Bacaks›z Ahmet, Gok Hasan
Department of Cardiology, Selcuk University Medical
Faculty, KONYA/TURKEY
Infective endocarditis (IE), a microbial infection of the endo-
cardial surface of the heart, most commonly involves heart
valves and causes valvular insufficiency. Especially hospi-
talized immune suppressive patients such as pemphigus
vulgaris with nosocomial infections, significant percentage
of patients
Pemphigus vulgaris is a potentially life-threatening, autoim-
mune bullous disease of the skin and mucous membranes.
In this case we presented S.aerus endocarditis in a patient
with pemphigus vulgaris taking immunosuppressive treat-
ment.
A 62 year old man was admitted to our hospital because
of bullous lesions presenting at scalp at first and than
spreading to the thorax. Skin biopsy revealed pemphigus
vulgaris and than prednisolon (120 mg/day) and azoth-
iopirin (150 mg/day) were started. After 3 mounts the
patient was admitted recurrent febrile. I‹n physical exami-
nation new severe diastolic murmur was heard. A transtho-
racic echocardiography demonstrated severe aortic regur-
gitation and vegetation on the right coronary cuspis of
aotric valve (figure-1).WBC was increased to 15.200/μl
and ESR increased to 61 m/h. Penicillin resistant
Staphylococcus aureus was isolated from consecutive three
blood cultures (there were 10 minutes among three cul-
tures). Vancomycin and gentamycin therapies were started
and continued for 6 weeks. After antimicrobial treatment
the patient referred to aortic valve replacement because of
persistent of vegetation and left ventricle dilatation due
severe aortic regurtation.
In conclusion; we should remind that infective endocarditis
132
(especially S. Aureus) in patient who has been given sys-
temic steroid therapy for dermatologic disorders and being
signs of systemic infection.
Keywords: endocarditis, pemphigus vulgaris, immune suppres-
sive treatment
P107
Endocarditis of mitral annuloplasty ring due to
coagulase-negative staphylococci
Kayrak Mehmet, Ulgen Mehmet S, Bacaks›z Ahmet,
Altunkeser Bulent, Kaya Ziynettin, Narin Cuneyt
Department of Cardiology, Selcuk University Meram
School of Medicine Hospital
Endocarditis after mitral valve repair is very rare but seri-
ous complication causing valve replacement. In this paper
we present a case of infective endocarditis involving the
annuloplasty ring and treated by valve replacement. A 68
years old woman was referred to our clinic for evaluation
of palpitation and shortness of breath. The patient had a
history of rheumatic valvulitis, and four months ago she
had undergone mitral valvuloplasty. At physical examina-
tion, she was afebrile, blood pressure was 120/80 mmHg
and pulse rate was 130 beats per min. She has grade II/IV
mitral regurgitation murmur. The ECG showed atrial fibril-
lation. Transthoracic echocardiography showed multiple
masses (the largest one measuring 1.3?1.0cm) stalked to
the artificial mitral ring with a mild central mitral regurgita-
tion. Blood examinations were as follows; C reactive pro-
tein: 107.7mg/l, ESR: 5mm/h, WBC count: 14.7K/μl and
polymorphonuclear neutrophils 13.0 K//μl (88.4%). A
combination of ceftriaxone sodium (1g i.v., 2 times a day)
and gentamicin sulfate (60mg i.v., three times a day) were
given to her empirically. One of the blood cultures yielded
coagulase negative staphylococci. After four days of antibi-
otic therapy, inflammation markers regressed but the
patient referred for cardiac surgery because of excessive
embolic risk due to high mobility of masses. It was seen
multiple vegetations surrounding annuloplasty ring at the
operation. The entire valve and annuloplasty ring were
removed and an artificial valve was inserted. In conclusion
endocarditis of annuloplasty ring after mitral valve repair is
very rare but is one of the most serious complications caus-
ing valve replacement
Keywords: Mitral valve repair, ring annuloplasty, infective endo-
carditis
P108
Brain abscess due to Haemophilus aphrophilus: Anthrax is still a common infectious disease in many devel-

a rare case oping countries where animal rearing is conducted with

traditional techniques. It has been taken attention recently
in developed countries due to bioterrorist attacks. The agent
Tütüncü Ediz, Sencan Irfan, Altay Fatma Aybala
is a Gram positive rod-shape bacterium called Bacillus
D›skap› Y›ld›r›m Beyaz›t Training Hospital
anthracis. Humans become accidentally infected through
contact with infected animals or their products. Direct expo-
H. aphrophilus is a member of the normal oral cavity flora
sure to infected animals or animal products through skin
and can often be found in dental plaque or gingival scrap-
exposure, ingestion of undercooked meat, or inhalation of
ings. It is reported to be the aetiological agent of infections
spore-containing particles may be the cause of transmis-
such as endocarditis, soft tissue infections including neck
sion to humans. There are three clinical forms of the dis-
and head infections, bone and joint infections, bacteremia,
eases: cutaneous anthrax, gastrointestinal anthrax, and
meningitis and brain abscess. Here we present a case of H.
inhalational anthrax. In human, anthrax presented as cuta-
aphrophilus brain abscess probably associated with a den-
neous form in 95% of the cases. There are three forms of
tal infection in a previously healthy young man. 28 year
cutaneous anthrax: mild cutaneous, severe cutaneous and
old male patient was admitted to emergency service
toxemic shock type. Septicaemia is rarely seen in patients
because of headache for about 10 days, vomiting and
with cutaneous anthrax, but if it occurs the mortality rate is
right side weakness for a few days. Hemiparesis was noted
high. In this case report, we present a patient with a histo-
on neurological examination. CT scan showed a hipodence
ry of suspicious insect bite. The lesion appeared on the
lesion in the left temporoparietal area and MRI revealed the
front of his neck on left side, and was diagnosed as cellüli-
same lesion with the differential diagnosis of abscess and
tis. During the course of the diseases sepsis was developed
intracranial mass. The patient was operated and abscess
with haemoconcentration, hypotension, and hyponatremia.
was totaly removed with its capsule. Abscess material was
In blood culture, Bacillus anthracis was isolated. The patient
cultured and antibiotic therapy was started with ceftriaxone
was intubated due to dyspnea caused by tracheal compres-
and metronidazole.
sion. Supportive treatment with antibiotics and corticos-
The aspirate grew gram negative, catalase and oxidase
teroids was given. After two weeks, the patient was recov-
negative cocci on culture, later identified as Haemophilus
ered without any sequela.
aphrophilus. The patient was screened for possible sources
Keywords: anthrax, sepsis, haemoconcentration, hypotension,
of the infection and root infection of the primary molar
hyponatremia
tooth was detected on dental examination. He was treated
with antibiotics for 3 weeks after the surgery and recovered
P110
completely. It should be kept in mind that serious clinical
conditions such as brain abscess could be a complication
Toxic Epidermal Necrolysis (Lyell’s syndrome) in
of dental infections with oral commensals. twins
Keywords: H. aphrophilus, oral cavity, flora, brain abscess
Niyazalieva M.S.1, Adambekov D. A.1, Ashiraliev M. E.2,
P109 Sabodaha M. A.1, Kudoyarov B. D.2
A case of anthrax sepsis with haemoconcentra - 1
Kyrgyz State Medical Academy, Bishkek, Kyrgyz

tion, hypotension, and hyponatremia due to Republic

2
National Center on Protection of Maternity & Childhood,
cutaneous anthrax
Bishkek, Kyrgyz Republic

Dokmetas Ilyas1, Engin Aynur1, Elald› Nazif1, Bak›r

Toxic Epidermal Necrolysis (TEN), also known as Lyell’s
Mehmet1, Bak›c› Zahir2, Sencan Mehmet3
syndrome is a life-threatening dermatological condition
1
Departments of Infectious Diseases and Clinical
that is frequently induced by a reaction to medications. It is
Microbiology, Sivas, Turkey
characterized by the detachment of the top layer of skin
2
Departments of Clinical Microbiology, Sivas, Turkey
from lower layers of the skin all over the body. The inci-
3
Departments of Haematology, Sivas, Turkey
dence of this disease is between 0.4 and 1,2 cases per

133
year.
CASE: Two babies three month of age have been treated
with sulfonamide due to respiratory infection they have got
disorders on mucous membranes and skin. The affection
first started from their eyes, mouth and genitals; later the
process began on skin of different parts of the body.
Children have been treated at their local hospital but with-
out positive result. On 10 of December 2007 they were
admitted in Allergy department of National Center on pro-
tection of Maternity and Childhood, with severe intoxica-
tion and multiforme erythema. The diagnosis was made
clinically. Fever, mucous membranes and skin lesions (red
rash in different parts of the body, peeling of epidermis in
some parts, on some lesions pyogenic-inflammatory infec-
tion), itching of affected sites, anxiety, whining.Treatment:
diet, clemastine intramuscular injection once a day, hyox-
isone ointment (application), zinc oxide ointment (applica-
tion) on the affected sites. Outcome: patients discharged
from hospital with recovery, the symptoms of disease
almost disappeared. . However children should be
observed by local Medical Office for some times. Although
it is a rare disease it should be kept in mind.
Keywords: Toxic Epidermal Necrolysis (TEN), Lyell’s syndrome
P111
Pulmonary valve endocarditis due to Chlamydia
trachomatis
Aygul Nazif, Altunkeser Bulent Behlul, Aygul Meryem
Ulku, Ulgen Mehmet Siddik
Selcuk University, Meram Faculty of Medicine, Cardiology
Department, Turkey
An 18 year-old female patient was admitted to the cardiol-
ogy clinic with a 1-week history of palpitation, shortness of
breath, and fewer. The temperature, the heart rate and the
blood pressure were as follows: 39 °C, 96 beats/ min and
90/60 mm Hg. On cardiac examination, P2 component of
the second heart sound was accentuated and a 3/6
midsystolic murmur was auscultated on pulmonary regions.
The respiratory sound was not audible on basal region of
right lung. Electrocardiography revealed sinus rhythm,
incomplete right bundle branch block, P pulmonale, right
ventricular hypertrophy. On admission at hospital, leuko-
cytes were 30.5 K/uL, C-reactive-protein was 120.6 mg/L
and sedimentation-rate was 64 mm/h. Transthorasic-
echocardiography showed, concentric hypertrophy of right
ventricle, thickening of pulmonary valve, and decreased
134
valve opening and normal left–right ventricular systolic
function. Color-Doppler showed mid-degree pulmonary
regurgitation and CW-Doppler revealed a maximum sys-
tolic 50 mmHg pressure gradient at pulmonary valve. A
vegetation 7x7 in mm diameter was detected on pulmonic
valve.
Chlamydia trachomatis-IgM and salmonellaTH, PBO, TO
be positive in blood sample and infective endocarditis (IE)
was suspected. Intravenous imipenem and vancomicin
treatment were given for 45 days. After treatment, clinical
and laboratory signs were improved and transesophageal-
echocardiography showed no vegetation on pulmonary
valve. Isolated endocarditis of the pulmonary valve is a rare
finding and Chlamydia trachomatis is one of the rarest cul-
prit microorganisms in the etiology of IE. In this patient,
imipenem and vancomicin treatment has been very effec-
tive. Therefore, in the etiology of IE Chlamydia trachomatis
should be suspected.
Keywords: infective endocarditis, Chlamydia trachomatis, pul-
monary valve
P112
Bacterial meningitis accompanied to thalidomide
therapy in two cases of multiple myeloma
Pasa Semir1, Altintas Abdullah1, C›l Timucin2, Ustun
Cemal3, Ayy›ld›z Orhan1, Muftuoglu Ekrem1
1
Dicle University Medical Faculty Department of
Hematology, TURKEY
2
Dicle University Medical Faculty Department of
Oncology, TURKEY
3
Dicle University Medical Faculty Depatment of Infectious
Diseases and Clinical Microbiology, TURKEY
Background and aim: Morbidity and mortality in multiple
myeloma is often attributed to life-threatening infections. A
defect in humoral immunity has been proposed for the pre-
disposition to bacterial infections. Most of the infections are
of bacterial origin, and the most serious infectious are sep-
ticemia, meningitis, or pneumonia. Thalidomide is a drug
with pleitropic effects. The immunomodulatory effects of
thalidomide are at least in part mediated through its abili-
ty to down-regulate the pathogenic over-production of
tumor necrosis-alpha (TNF-alpha). TNF-alpha is one of the
cytokine which plays a central role in the regulation of the
host immune and inflammatory response to infection. In the
central nervous system, TNF-alpha is involved in induction
of a fever response, and triggers the release of other
cytokines, and may also influence transport of compounds
into the brain by opening the blood-brain barrier, leads to
cerebrospinal fluid leukocytosis, increased protein influx,
and lactate accumulation. Thalidomide has been shown to
down-regulate the production of TNF-alpha. On the other
hand, knowledge of the effects of thalidomide on granulo-
cyte functions is limited. Thalidomide attenuated neutrophil
adhesion and chemotaxis. Herein, we present two cases of
S. pneumoniae bacterial meningitis, developed soon after
starting of thalidomide treatment, and discuss the effect of
thaidomide on immune system.
CONCLUSION: Although, it is not clearly known if thalido-
mide caused to development of bacterial infections and
meningitis, and its pathogenetic mechanisms, physicians
should be alert for signs and symptoms of meningitis in
patients with multiple myeloma who treated with thalido-
mide, especially at the neutropenic states.
Keywords: Bacterial meningitis, thalidomide, multiple myeloma.
P113
Pulmonary emboli associated with Sinus
Venosus Trombosis and lung abscess: A case
report
Eren Dagli Canan1, Koksal Nurhan1, Ucmak Hasan2,
Gelen Mehmet1, Atilla Nurhan1, Koksal Deniz3
1
Chest diseases department, Kahramanmaras Sutcu Imam
University, Kahramanmaras, Turkey
2
Infectious diseases department, Kahramanmaras Sutcu
Imam University, Kahramanmaras, Turkey
3
Neurology department, Kahramanmaras Sutcu Imam
University, Kahramanmaras, Turkey
We describe a case of pulmonary embolus associated with
intracranial venous sinus thrombosis and lung abscess. 25
year old man presented with symptoms of syncope, cough,
headache and hemoptysis.On exam, he was cooperated,
had a fever of 37 C, Pulse 88/min and TA 120/80 mmHg.
Physical examination of the lungs revealed crackles in the
right lower and middle lobes. Cranial MR and venography
showed trombus in the right transvers sinus and superior
sagittal sinus and parenchymal haemorragic changes in
the right frontal and parietal lobes. Computed
Tomographic Pulmonary Angiography showed embolic
trombus in the right pulmonary truncus. Thorax CT showed
pleural effusion of 3 cm thickness in the right pleura, con-
solidation and cavitary lesion in the right lower lobe.
Anticoagulant treatment with Warfarin 10 mg was started.
135
Antibiotherapy was started with Tienam 500 mg.The
patient was young and no signs of lower extremity deep
venous trombosis were neither detected nor other major
risk factors for pulmonary emboli. Genetic predisposition
was examined and we found protrombin G2021A muta-
tion and anticardiolipin AK positivity. The patient was hos-
pitalised for antibiotheraphy and anticoagulation for 3
months and was discharged on Warfarin 5 mg daily
planned for the whole life period. Pulmonary emboli as a
complication of cerebral venous sinus thrombosis with
genetic predisposition and lung abscess in a young patient
are rare and should be kept in mind.
Keywords: lung ascess, pulmonary emboli
P114
Disseminated yersiniosis in a patient admitted to
Shymkent Hospital
Utepbergenova G.A., Kassimova T.V., Didenko T.V.,
Berdikulova M.M.
SKUMA faculty of infectious illnesses: the manager of
faculty d.M.S.
The 14 year old patient was admitted to UIH on December
21, 2007 with the findings of high fever, eruptions on the
body, weakness and headache. From anamnesis: was ill 5
days back, from high temperature, headache, vomit are
sharp, be sick in a stomach, frustration of a chair. For the
second day of a fever the rash with blue by a shade on the
person and limb (for a type of "hood", "socks") has
appeared. The patient lives in the private (individual)
house, there are sheds, where the vegetables and fruit are
kept. In family one was ill. To hospitalize in reanimation
branch UIH in a condition infection-toxic of a shock: tem-
perature of 38-39 degrees, dullard, is sleepy. A hell -
90\70mm. On a neck, limbs, flexion surfaces of large
joints it is marked large the rash with lamellate peeling
spotty&populous. Skin covers red – blue colours, limfo-
knotes are not increased. The liver acts on 1.5 cm from
under edges costal of an arch, spleen is not increased. It is
marked oedemas on bottom limbs, light oedemas of the
person. The patient is examined together with toxicologist,
neuropathology, nephropathologist twice. In reanimation
the intensive therapy was spent: dezintocsication prepara-
tions, inhibitor protioleze, antibacterial therapy
(penicillin,levomicitin).
From the laboratory data: the general analysis of blood -
red corpuscle 4,4x10\liter, HB-110g\liter, leucocytes -
18,9x10\liter, CO3-4mm\hour; the general(common)
analysis wet fiber 0,066g\liter, leucocytes up to 10 in a
field of sight. Physical examination: Hepatamegalia, on the
part of kidneys without the special pathology; urea –
18mm\liter, bilirubin 30.0-20.0 at normal
meanings(importance) ALT, that is, the attributes toxic
nephrite, toxic hepatite are revealed. RPGA with iersinioze
diagnostics is positive in a credit 1:200. As a result of treat-
ment to 12 days is translated in branch, where was on
treatment up to 8.01.0. Patient was discharged from hos-
pital with recovery.
Keyword: Yersinosis, diagnosis, treatment
P115
Ecthyma Contagiosum (Orf): Report of a Human
Case with Multiple Lesions from Turkey
Sasmaz Sezai1, Uzel Murat2, Sener Serpil1, Ucmak
Hasan3
1
Department of Dermatology, Kahramanmaras Sutcu
Imam University, Kahramanmaras, Turkey
2
Department of Orthopaedic Surgery, Kahramanmaras
Sutcu Imam University, Kahramanmaras, Turkey
3
Department of Infectious Diseases and Clinical
Microbiology, Kahramanmaras Sutcu Imam University,
Kahramanmaras, Turkey
Orf is caused by a Parapox virus. It is a zoonosis usually
transmitted to humans from affected sheep or goats
through direct contact or contaminated fomites. The clinical
picture is usually characterized by a solitary lesion that
develops on the dorsal side of the fingers or hands. This
condition produces little or no systemic complaints and the
lesions usually regress spontaneously without scar forma-
tion within 6 weeks. The correct diagnosis is usually based
on a clinically typical skin lesion and by patient’s history
Usually only a single lesion is present but we report a case
with four lesions on their fingers acquired by contact with
two sheep and three goats. Our patient is 34 old-men with
a 10-day history of mildly painful lesions on tip and the
dorsa of fingers of the hands. The lesions consisted of a
raised granulomatous mass with a violaceous center, a
white middle ring, and a red periphery. Regional lym-
phadenopathy was present. No pathology was found in
systemic examination. With the characteristic lesion after
history of contact with sheep and goats, orf was diagnosed.
The veterinary control of the animal health, preventive
136
measures and controlled slaughtering of animal by profes-
sional workers are very important to prevent human orf,
especially during the Feast of Sacrifice in Muslim Countries.
Every year, an outbreak of orf is observed in Turkey, occur-
ring 2 or 3 weeks after the Feast of Sacrifice. As a matter
of fact, our case applied to our clinic in the period follow-
ing the Feast
Keywords: Ecthyma Contagiosum, Orf, Parapox virus, multiple
lesions, Turkey, Feast of Sacrifice
P116
Atypical Salmonellosis: A Case of Sacroiliitis
Ulug M1, Celen MKl2, Geyik Mehmet Faruk2,
Hosoglu Salih2, Ayaz Celal2
1
Department of Clinic Microbiology And Infectious
Diseases, Midyat State Hospital, Mardin, Turkey
2
Department of Clinic Microbiology And Infectious
Diseases, Dicle University Hospital, Diyarbakir, Turkey
INTRODUCTION: Salmonella infections present in multiple
ways: gastroenteritis most commonly; enteric fever; bacter-
imia with or without endovasculer infections such as aorti-
tis and endocarditis; and focal metastatic infections like
sacroiliitis, osteomyelitis and abscess formation. Although
septic arthritis due to Salmonellae is reported in large num-
bers, Salmonella typhi as its causative agent is rare.
CASE: A previously healty 22-year-old woman was admit-
ted to the University of Dicle Hospital, Diyarbakir, Turkey
with complaints of pain, inability to walk and bear weight
on the right hip. There had been no trauma to the back nor
any previous serious illness. She gave a week history of
severe low back pain radiating to the left leg. Laboratory
findings included a total leucocyte count of 8580/mm3,
ESR was 86 mm/h with a CRP measuring 117 mg/dl. The
Widal test showed titers of 1/320 for TO. The sacroiliac
joints, pelvis, lumbosacral spine, and hip joints were radi-
ologically normal. However, an abnormal signal in the left
sacroiliac joint and abscess formation were found at right
on MRI .
The patient was initially treated with Cefazolin 3 g/day
with no improvement. After 3 days, the blood culture grew
Salmonella typhi that was suspectible to all tested antibi-
otics. Therapy was changed to oral Ciprofloxacin 500 mg
twice daily.
CONCLUSION: Acute suppurative arthritis or osteomyelitis
is usually due to Staphylococcus auerus. Salmonella infec-
tion of the sacroiliac joint is an uncommon cause of an
uncommon joint infection. This case is being reported to
high light the unusual presentation of Salmonella typhi.
Keywords: Salmonella typhi, sacroiliitis
P117
Recurrent prosthetic valve endocarditis caused
by Staphylococcus warnerii
Arslan Ferhat , Kara Ali R›tvan , Salto¤lu Nefle , Mete
1 1 1
Bilgül1, Velet Selvinaz2, Özaras Reflat1, Tabak Fehmi1,
Öztürk Recep1, Mert Ali1
1
Department of Infectious Diseases and Clinical
Microbiology, Istanbul University, Istanbul, Turkey
2
Department of Internal medicine, Isatnbul University,
Istanbul, Turkey
Although coagulase-negative staphylococci (CNS) are fre-
quent causes of prosthetic valve endocarditis, identification
at species level is usually overlooked by many clinicians.
Here, we report a case of prosthetic valve endocarditis
caused by Staphylococcus warnerii in a 34-year old
woman who had aortic valve replacement surgery one
year ago. She presented with fever and on physical exam-
ination, diastolic murmur (2/6) at aortic area was heard.
Further questioning revealed that she was treated for S.
warnerii endocarditis with ceftriaxone and gentamicin for
four weeks about three months ago. She had procedures
such as silicon mammoplasty and dental extraction nine
months and four months prior to presentation, respectively.
We initiated empirical infective endocarditis treatment with
ampicillin and gentamicin. Transthoracic and trans-
esophageal echocardiograms revealed vegetation (15 mm
x 4 mm in size) on the prosthetic valve with moderate
valvular insufficiency. Methicillin-sensitive CNS (subse-
quently identified as S. warnerii) was isolated from two sets
of blood cultures. On seventh day of the same treatment,
she developed right hemiparesis and aphasia. Computed
tomography analysis showed a hypodense lesion in the left
frontotemporal area and cerebral angiography revealed
an aneurysm at the bifurcation of the middle cerebral
artery. The aneurysm was successfully obliterated by a neu-
rosurgical intervention and hemorrhagic lesion eventually
resolved. The antibiotic treatment was continued for a total
of eight weeks. She survived with minimal sequelae. Our
experience with this case suggests that the concise identifi-
cation of the microorganism causing endocarditis and
administration of effective antibiotics for appropriate dura-
tion are important factors for treatment success.
Keywords: Endocarditis, Staphylococcus warnerii
137
P118
Nocardiosis In An Immunocompromised Patient:
From Treatment To Diagnosis When Your
“Hands And Feet Are Tied Up” With
Thrombocytopenia
Aydin Kadriye1, Tezcan Mehmet Engin1, Durusu Tanriöver
Mine2, Sain Güven Gülay2, Uzun Ömrüm3
1
Hacettepe University, Department of Internal Medicine
2
Hacettepe University, Department of Internal Medicine,
Section of General Internal Medicine
3
University, Department of Internal Medicine, Section of
Infectious Diseases
OBJECTIVE: Nocardia species are gram-positive, aerobic
bacteria having predilection for central nervous system.
Nocardiosis is typically regarded as an opportunistic infec-
tion but concomitant cerebral and pulmonary nocardiosis is
rarely encountered on chronic corticosteroid therapy.
CASE: A 29 year-old-man was admitted to our hospital
with right-sided weakness and general malaise. He was
diagnosed to have idiopathic thrombocytopenic purpura 6
months ago and he was on high dose corticosteroid thera-
py. On the third month of his treatment he had fever and
productive cough. Afterwards he complained of headache.
A modified acid-fast stain of the sputum demonstrated
weak acid-fast staining. Aerobe and tuberculosis cultures
were negative. A magnetic resonance imaging of the brain
revealed a 29x23 mm nodular lesion with regular margins
and a peripherally limited diffusion on at the thalamic
region. Contrast enhanced computerized tomography scan
of the lung revealed a 14 mm nodule at the right apex.
Surgical intervention was impossible due to deep thrombo-
cytopenia. No significant progress was achieved with sul-
bactam ampicillin therapy. Due to the imaging findings,
long term corticosteroid use and lack of response to sulbac-
tam ampicillin therapy, the suspected diagnosis was nocar-
diosis and high dose trimethoprim/sulfametaxozole thera-
py was initiated. After 9 months, the lesion in the brain was
reduced from 30 mm to 8 mm, the lesion in the lung total-
ly disappeared.
CONCLUSION: Clinical suspicion is one of the main steps
of diagnosis in nocardiosis. Nocardiosis should be always
kept in mind when cerebral and pulmoner lesions are
found in a patient on chronic corticosteroid therapy.
Keywords: nocardiosis, opportunistic infection, corticosteroid
therapy
P119
Atypical Site Of ‹nfection For Escherichia Coli:
Soft Tissue
Pepedil Funda1, Çal›k Baflaran Nursel2, Sibel Aflç›o¤lu2,
Sain Güven Gülay 3
1
Hacettepe University, Department of Internal Medicine
2
Hacettepe University, Department of Internal Medicine,
Section of Infectious Diseases
3
Hacettepe University, Department of Internal Medicine,
Section of General Internal Medicine
INTRODUCTION: Escherichia coli is a facultatively anaer-
obic gram-negative bacilli. It is one of the most frequent
causes of many common bacterial infections, including
cholecystitis, cholangitis, urinary tract infection (UTI) and
bacteremia. However, it is rarely isolated from soft tissue
abscesses.
CASE: A 63-year-old diabetic woman was admitted to the
hospital with the complaint of painful swelling on her left
leg, right shoulder and left wrist for 2 months. Vital signs
were as follows: body temperature: 38.7ºC, pulse:
86/minute, blood pressure: 130/70 mmHg. She had
leukocytosis, anemia of chronic disease, elevated serum C-
reactive protein and sedimentation rate. Other laboratory
tests including urea, creatinine, electrolytes, glucose, liver
transaminases were within normal ranges. HbA 1c was 6.6
%. Ultrasonography showed abscesses within the muscle
tissue in the swollen extremities. E. coli was isolated from
the drained abscess material. Urine culture also yielded
same strain of E. coli. There was only one blood culture
which was taken after antibiotic therapy and that yielded
no growth. Transesophageal echocardiography didn’t
show evidence of infective endocarditis. Immunoglobulin E
level was normal. Thoraco-abdominal computed tomogra-
phy revealed no other sources of infection. She recovered
within 3 months after drainage and antibiotherapy.
CONCLUSION: This is a report of diabetic patient with
multiple soft tissue abscesses caused by E. coli. Since dia-
betes mellitus may impair the function of leukocytes and
complement systems, diabetic patients are more prone to
infections. This fact may be the cause of atypical site of
infection with this common microorganism following UTI
and possible bacteremia.
Keywords: Escherichia coli, abscess, soft tissue
138
P120
Condition of the acute intestinal infections sick
rate in Karaganda region
Begaydarova Rosa Khasanovna, Alshynbekova
Gulsharbat Kanagatovna, Abilkasimov Zulfikar
Erdinbayevich, Devdariani Khatuna Georgievna,
Tulegenova Gulbagdan Kydyrbayevna
Chair of children infectious diseases, Karaganda State
medical academy, Karaganda, Kazakhstan
Purpose of the research: to determine condition of the acute
intestinal infections sick rate in Karaganda region.
Materials of the research: We have analyzed 1820 case
reports of patients with acute intestinal infections, including
acute dysentery, salmonellosis, esherichiosis and intestinal
infections caused by conditional-pathogenic bacteria.
Results and conclusions: In etiological structure leading
place is occupied with dysentery (41%), 2nd place - esheri-
chiosis (12%), third place - salmonellosis (10%). By territo-
rial distribution the greatest dysentery sick rate was in
Karaganda, Temirtau both in 2005 and 2006, the least –
in Shakhtinsk, Balkhash, Zhezkazgan. It is possible to note
with satisfaction that in the region it’s marked decreasing of
dysentery sick rate on 17.5%, including in Karaganda - on
34.8%. Analyzing specific and sample structure of
Shigellas it is possible to ascertain that in 2005 Shigella
Sonnei prevailed, in 2006 championship belongs to
Shigella flexneri. In Flexneri’s dysentery clinical picture col-
itic and intoxication syndromes acted on the parity bases.
At Sonnei’s dysentery gastroenterocolitic syndrome domi-
nated, intoxication syndrome was expressed insignificant-
ly. Among the acute intestinal infections salmonellosis takes
the important place, differing by expressiveness of intoxica-
tion, duration of current, younger age contingent. In 2006
S.Ânteritidis made 72.8% of densities, against 24.1% of S.
typhimurium. Densities of esherichioses among conditional-
pathogenic bacteria changed from 5-6% up to 50-60% in
different years. Sick rate by the intestinal infections caused
by conditional-pathogenic bacteria was marked incompa-
rably less often than sick rate by shigelloses and salmonel-
loses. In most cases they were caused by Proteus,
Citrobacter, Enterobacter, Klebsiella and Morganella.
Keywords: acute intestinal infections, sick rate, dysentery, esheri-
chiosis, salmonellosis
P121
Use of admixture “NAN sour-milk” with bifid
bacteria in treatment of intestinal dysbacteriosis
at children
Begaydarova Rosa Khasanovna1, Alshynbekova
Gulsharbat Kanagatovna1, Kuzgibekova Alma Bulatovna1,
Bobreshova Irina Vladimirovna1, Baltynova Rauza
Zaydanovna2
1
Chair of children infectious diseases, Karaganda State
medical academy, Kazakhstan
2
Regional infectious diseases hospital, Karaganda,
Kazakhstan
Purpose of the research: to estimate efficiency of the admix-
ture “NAN sour-milk” with bifid bacteria at treatment of
children with intestinal dysbacteriosis.
Materials of the research. We have analysed case reports
of 96 children in the age from 1 till 12 months, which
arrived to Regional infectious diseases hospital of
Karaganda with diagnosis «acute intestinal infection».
Results and conclusion
Results of the intestinal microflora research have been
appreciated according to I.N.Blohina’s classification
(1981). Dysbacteriosis correction was carried out in two
groups: 1st - children with ß degree dysbacteriosis
(32,3%), 2nd - children with II degree dysbacteriosis
(67,7%). Taking into account, that children were artificially
fed and received various adapted admixtures, transition to
“NAN sour-milk” feed was carried out gradually during 3-
4 days, replacing 1-2 feedings a day. Positive clinical effect
was marked by 2nd day of treatment and characterized by
improvement of emotional tone and appetite, positive
changes of stool (chyme-like consistency, without patholog-
ical admixtures, 1-2 times a day). Expanded microbiologi-
cal examination of feces has shown 100% positive changes
of parameters at all observable children. Eubiosis has been
revealed in 95,5% of patients with ß degree dysbacteriosis,
and in 42,9% of patients with ßß degree dysbacteriosis.
Received results have shown an opportunity of alimentary
correction of ß degree dysbacteriosis (compensated form)
by application of “NAN sour-milk” with bifid bacteria,
which is a high-grade substitute of female milk. At ßß
degree dysbacteriosis (subcompensated form) positive
effect was marked at 41,2(63,3%) sick children, that
demands additional application of pro- or prebiotics.
Keywords: children, dysbacteriosis
139
P122
The analysis of clinical features of the dysentery
caused by Shigella flexneri and Shigella sonnei
Karalnik Boris Volfovich1, Omarova Mariam
Nurgalievna2, Sadikova Ainur Maralovna3, Karabekov
Amir Gamaubaevich4, Duisenova Avankul Kuandikovna5
Karaganda State Medical Academy,
Karaganda, Kazakhstan
The purpose - to study the influence of Shigella flexneri and
Shigella sonnei species on clinical characteristics of dysen-
tery. The clinical, bacteriological, instrumental and statisti-
cal methods were used. The analysis of 364 patients
(flexneri and sonnei dysentery) for the period of 2004-
2006 was carried out. A number of features on age distri-
bution of patients, the terms of hospitalization, disease
gravity, frequency of atypical dysentery and dysentery
without clear clinical symptoms, presence of accompanying
gastroenteric diseases (AGED), and intensity of inflamma-
tory changes in large intestines and frequency of protract-
ed current was revealed. Features of age distribution of
patients and terms of their hospitalization, probably, are
connected with peculiarities of epidemic processes of
flexneri and sonnei dysentery. The correlation between
shigella species AGED influenced inflammatory changes
severity in large intestines .The most heavy, catarrhal-ulcer-
ic changes were found in flexner patients without AGED.
Accordingly the most slight, catarrhal changes were more
rarely found in such patients. But the shigella species influ-
ence in patients without AGED wasn’t found. Discovered
features define perspectivity of the individualized treatment
schemes of depending on a Shigella species, and, accord-
ingly, expediency of perfection of laboratory methods and
preparation for the early and express dysentery diagnos-
tics.
Keywords: Shigella Flexneri, Shigella Sonnei, clinical features
P123
Differential diagnosis in acute intestinal infec -
tions and acute surgical diseases
Sadikova Ainur Maralovna
Karaganda State Medical Academy,
Karaganda, Kazakhstan
In practice of infectionists and surgeons often there are
diagnostic situations, requiring differential diagnosis
between acute intestinal infections (AII) and acute surgical
diseases (ASD). Differential diagnosis of AII remains very
difficult, especially on the prehospital stage, in connection
with similarity of clinical displays. So from data of
Shuvalovoj E.P. (1985) In 40% cases of patients, delivered
in infectious disease department with a diagnosis of «acute
dysentery» acute surgical diseases were exposed, such as
a thrombosis of mesenterial vessels, acute appendicitis.
Diagnostic errors are assumed not only on the prehospital
stage the doctors of other specialities but also by infectious
diseases specialist in receiving rest and in the first days of
hospitalization in separations. So, for 2005 from the sepa-
ration of intestinal infections in surgical separations 27 is
translated patients (1.7% from a number hospitalized); for
2006 31 patients (1,8%). It should be noted that 21 patient,
accepted in infectious diseases unit with the diagnosis of
AII, consulted surgeons, in connection with suspicion on
ASD. The diagnosis of ASD was here eliminated. Patients
with AID at presence of testimonies must be examined sur-
geons, if necessary – in a dynamics. Doctors must have
perfect knowledge on differentiation of AID and ASD
regardless of their speciality.
Keywords: Differencial diagnostics, acute intestinal infections,
acute surgical diseases
P124
The investigation of faecal fungal flora in inpa-
tients and healthy volunteers
Oksuz Sukru1, Yildirim Mustafa2, Sahin Idris3, Sencan Irfan4
1
Department of Microbiology and Clinical Microbiology,
Duzce Atatürk State Hospital, Duzce, Turkey
2
Department of Clinical Microbiology and Infectious
Diseases, University of Duzce, Faculty of Medicine, Duzce,
Turkey
3
Department of Microbiology and Clinical Microbiology,
University of Duzce, Faculty of Medicine, Duzce, Turkey
4
Department of Clinical Microbiology and Infectious
Diseases Yildirim Beyazit Training and Research Hospital,
Ankara, Turkey
Candida species, predominantly Candida albicans strains,
are part of the normal flora of gastrointestinal tract, but
they are also responsible for superficial and systemic infec-
tions. The objective of this study is to evaluate faecal fungal
140
flora in inpatients and healthy volunteers. Our study popu-
lation encompassed 67 inpatients and 96 volunteers.
Candida species were identified by the germ-tube test,
CHROMAgar Candida (CHROMAgar Company, Paris,
France), and by API-20C identification kits (Bio-Merieux-
Vitek, France). Among inpatients, fungi were recovered
from 25 subjects (37.3%); the majority (88%) had a single
species. Types of species were C.albicans (n=19; 67.9%),
non-albicans Candida species (n=8; 28.6%) which includ-
ed C.glabrata (n=2), C.tropicalis (n=1), C.krusei (n=1),
C.parapsilosis (n=1), C.kefyr (n=1), C.zeylanoides (n=1)
and C.lipolytica (n=1), and yeast other than Candida (n=1;
3.6%). No moulds were recovered. Fungal isolates were
detected in 15 volunteers (15.6%). Among individuals with
fungi the majority (n=12; 80%) had a single species and
the remainder had two species. Species detected were
C.albicans (n=8; 44.4%), non-albicans Candida species (9
isolates from 8 individuals; 50%), and yeasts other than
Candida (n=1; 5.6%). Comparing healthy adult volunteers
with inpatients showed that inpatients had a higher preva-
lence of fungi. The difference reached statistical signifi-
cance (P=0.002). Inpatients had more frequent Candida
albicans. Non-albicans Candida species were more preva-
lent in volunteers. But differences did not reach statistical
significance (P>0.05). In conclusion, this study delineates
the faecal fungal flora in volunteers and inpatients. Most
subjects harbour a single species. Inpatients had higher
prevalence of yeast with Candida albicans in the majority.
Keywords: Faecal fungal flora, inpatients, healthy volunteers
P125
Faecal fungal flora in healthy schoolchildren
Oksuz Sukru1, Yildirim Mustafa2, Sahin Idris3
1
Department of Microbiology and Clinical Microbiology,
Duzce Atatürk State Hospital, Duzce, Turkey
2
Department of Clinical Microbiology and Infectious
Diseases, University of Duzce, Faculty of Medicine, Duzce,
Turkey
3
Department of Microbiology and Clinical Microbiology,
University of Duzce, Faculty of Medicine, Duzce, Turkey
Candida species are normal commensals of humans and
are commonly found on skin, throughout the entire gas-
trointestinal tract. The purpose of this study was to investi-
gate the fecal fungal flora of healthy schoolchildren. The
present study was conducted at a Primary School in Duzce
by Duzce University and 484 healthy schoolchildren (257
female, 227 male, range; 6-14 years) were included. Stool
samples were instantly spread out on a Saboraud agar,
Candida species were identified by the germ-tube test,
CHROMAgar Candida (CHROMAgar Company, Paris,
France), and by API-20C identification kits (Bio-Merieux-
Vitek, France). Fungal isolates were detected in 96 healthy
schoolchildren (18.8%); all of them had a single species.
Types of species were C.albicans (n=61; 63.5%), non-albi-
cans Candida species (n=31; 32.3%) which included
C.glabrata (n=9; 9.4%), C.tropicalis (n=6; 6.3%), C.zey-
lanoides (n=4; 4.2%), C.krusei (n=3; 3.1%), C.kefyr (n=3;
3.1%), C.parapsilosis (n=2; 2.1%), C.lusitaniae (n=2;
2.1%), C.guilliermondii (n=1; 1.0%), and C.sphaerica
(n=1; 1.0%), and yeast other than Candida (Trichosporon
sp.) (n=3; 3.1%), and moulds (n=1; 1.0%). Comparing
male children (15.5%) with female children (23.6%)
showed that female children had a higher prevalence of
fungi. The difference reached statistical significance
(P=0.025). There was not statistical significance between
gender and the rates of C.albicans and non-albicans
Candida species (P>0.05). The relation of ages with the
prevelance and the type of Candida species did not reach
statistical significance (P>0.05). In conclusion, this study
provides a thorough analysis of the faecal fungal flora in
healthy schoolchildren and Candida albicans considerably
outnumbered the remaining fungal species in the isolates.
Keywords: Faecal fungal flora, healthy children
P126
Application of tagansorbent upon acute enteric
infections
B.M. Zhampeisova
ASPATI, Almaty, Kazakhstan
The problem of acute enteric infections (AEI) still remains
the issue of the day. More than one million cases of AEI are
being registered annually in the republics of CIS including
Kazakhstan. The leading therapeutic principle of infectious
pathology – a priority etiotropic treatment – is not fully
implemented in contemporary therapy of acute enteric
diarrheic infections. Application of antibiotics must be
strictly restricted and differentiated.
143 patients in the age of 17 through 69 (35 ±11.1) have
been examined with the purpose of study of taganbsorbent
influence on the flow of acute enteric infections (AEI).
53.8% of them were men and 46.2% - women. After initial
water content restoration in organism 63 patients received
141
1 g of T 3 times a day during 2-5 days before taking anti-
bacterial medication or in monotherapy, 40 – smekta (S)
through the same pattern and 40- base therapy. Intake of
entersorbents was ceased after 24 hours after normaliza-
tion of stool (1-2 formed [solid] stool or absence of stool
within 24 hours).
AEI diagnosis was confirmed by exposure of exciter
and/or specific antibodies in increasing titers in DHAR or
antigens of exciters in stool in DHAIR. Upon prescription of
T maximal duration of diarrhea with salmonellosis was 6
days, minimal – 1 day, in case of dysentery diarrhea was
stopped within 2-7 days, in case of FTI – in first days. They
have basic clinical manifestation of disease: diarrhea, nor-
malization of stool, stomack pain, rumbling, abdominal
distension, large intestine spasm, and weakness went in
reliable early terms comparing to the patients of a screen-
ing group.
Upon intake of T vomiting, abdominal distension, tenesmus
would regress reliably earlier than upon taking S. T did not
influence toxically on essential organs: bilirubin level, ALT,
AST, thymol (turbidity) test, rest [nonprotein] nitrogen, urea
and blood whole [crude] protein remained to be normal.
Upon control bacterial inoculation exciters were absent in
stool of all patients involved in examination.
Keywords: Enteric infections, treatment
P127
Gene expression Patterns of Salmonella Using
Bioinformatics Techniques and tools
Parmar Komal C, Parmar C.
Computer dept., Pragna Study anad Research Cener,
Vadodara, India
Salmonella species are food borne pathogens causing gas-
tro- intestinal infection and illness. About 70% of all diar-
rhea cases are found among children under the age of 5
and diarrheal diseases cause the death of three millions.
Severity of Salmonella infection is likely to increase due to
HIV epidemics in developing and under developed coun-
tries. Monitoring and controlling its epidemic diffusion of
such diseases are important. To prevent such diseases,
bioinformatic tools and techniques are novel, safe, and
time saving in microbiological and clinical research per-
taining clues of growth and measures. My theme of this
paper reveals the intelligent classification of data set using
salmonella enterica strain. The hybridization of array with
two labelled with different fluroes for the parallel analysis
remains the choice in the present work contains the gene
expression patterns by measuring the mRNA level in nor-
mal and pathological cells. The cDNA may be generated
with manually depositing small fragments of genes of inter-
est from known location on the glass surface. The output of
depositions are groups of cDNA are amplified PCR. cDNA
probes hybridized to array and washed off. The array
could be scanned to determine how much each probe is
bound to each spot. The probes are tagged with fluoresce
a reporter molecules with detectable light stimulated by a
laser. Each spot of array is scanned by microscope with
computerized scanner. Various soft wares are used to con-
vert them into numerical data.
Keywords: Salmonella Gene Expression, cDNA of Salmonella,
microarray techniques in Microbial clinicals
P128
Main pathologies that accompany cholestasis
caused by intestinal infection of infants.
Zh. T.Dosbayeva
Almaty State Institute of Medical Perfection of the Republic
of Kazakhstan, Almaty city.
We examined 200 infants with cholestasis syndrome with
prolonged conjunctival jaundice and found diffuse changes
of liver parenchyma in 100 % of cases, at the same time
dyskenesia of bile removing tracks (DBRT) was observed in
27% of infants; the second place is taken by the functional
and structural dysfunctions of central nervous system (CNS-
97,5%) - perynatal encaphylopathia (PEP), hypertenzia-
hydrocefal syndrome (HHS), periventicular brain swelling
(PBBD) and ventricular hemorrhage (VH), that were
observed in infants; stomach intestinal diseases (28,5%) –
belly swelling, belching, dysbacteriosis of stomach; anemia
and other dysfunctions of blood and heart system were
found in 20% of cases; kidneys pathology that was charac-
terized by broadening of cup-pelvis system (CPS) in 11% of
cases. I.e, in our researches of the infants with cholestasis
syndrome revealed that first come liver dysfunctions, then-
of central nervous system, third- stomach system, and in
descending order- heart and blood system and breathing
organs and kidneys. Other pathologies were found in sin-
gular cases therefore, logical connection with intestinal
infection is difficult to observe.
Keywords: Cholestasis, infants
142
P129
Clinical-Epidemiological Parameters of some
viral-bacterial infections in the karaganda
region
R.Kh.Begaydarova,
Children Infectious Diseases, Karaganda State Medical
Academy, Karaganda, Kazakhstan
It was carried out clinical -epidemiological analysis of
1820 case reports of children and adults sick of the acute
intestinal infections (acute dysentery, salmonellosis, esheri-
chiosis, conditional-pathogenic intestinal infections) as well
as measles, rubella, parotitis, helminthiases in the
Karaganda region. In etiological structure of the acute
intestinal infections leading place is occupied with a dysen-
tery (41%), 2nd place belongs to esherichiosis (12%) and
the third place - to salmonellosis (10%). By territorial dis-
tribution the greatest sick rate of dysentery was in
Karaganda, Temirtau both in 2005 and in 2006, and the
least – in Shakhtinsk, Balkhash and Zhezkazgan. It is pos-
sible to note with satisfaction that in the region there is
marked decreasing of the dysentery sick rate on 17.5%,
including by Karaganda city - on 34.8%. Analyzing spe-
cific and sample structure of Shigellas it is possible to ascer-
tain that if in 2005 Shigella Sonnei prevailed, in 2006
championship belongs already to Shigella Flexneri. In the
clinical picture of Flexneri’s dysentery colitic and intoxica-
tion syndromes acted on the parity bases. At Sonnei’s
dysentery gastroenterocolitic syndrome dominated, and the
intoxication syndrome was expressed insignificantly.
Salmonellosis infection in group of acute intestinal infec-
tions takes the important place, differing by expressiveness
of the intoxication, duration of current and younger age
contingent. If the last years Salmonella typhimurium domi-
nated, in 2006 Salmonella Ânteritidis has made 72.8% of
densities, against 24.1% of Salmonella typhimurium.
In different years densities of esherichioses in group of con-
ditional-pathogenic bacteria changed from 5-6% up to 50-
60%, thus Esherichia serovars é124, é20 and é151 were
dominating serovars. Sick rate by the intestinal infections
caused by conditional-pathogenic bacteria was marked
incomparably less often than the sick rate by shigelloses
and salmonelloses. In most cases such intestinal infections
were caused by Proteus, Citrobacter, Enterobacter,
Klebsiella and Morganella. Analyzing features of measles
current at adults in comparison with children, we have
revealed a series of distinctive attributes such as longer cur-
rent and the greater percent of viral-bacterial complications
on the part of respiration organs. It was marked increasing
of densities of adults with parotitis infection, at which
severe forms with involving of nervous system and genitals
to the pathological process prevailed. The most wide-
spread kinds of helminthiases are enterobiosis, ascariasis,
opisthorchosis. That fact is guarded that there is a high ten-
dency to increase of the sick rate by ascariasis and occur-
rence of helminthes unusual for human, namely – toxocari-
asis.
Keywords: Children, intestinal infections,measles
P130
Effectivity of laser scanning beam therapy in
patients with functional dyspepsia associated
with Helicobacter pylori
Myrzabayeva Neilya Abdullayevna
Clinic pharmacology physiotherapy department. Kazakh
National Medical University named after
S.D.Asfandiyarov, Almaty Kazakhstan
The purpose of research was studying efficiency and safe-
ty of therapy by laser beam at patients with functional dys-
pepsia. 58 male and female patients were under our super-
vision. The diagnosis was established after exclusion of
possible organic pathology by proper physical emamina-
tion. Effectivity of the treatment was visible in 3-4 weeks
after ending of eradication therapy All the patients were
divided into 2 groups general and control Patients of the
general group were subscribed eradication therapy and
treatment by laser (license 27007 of June 15, 2007)
Patients of the control group received only eradication ther-
apy. Observed groups of patients were represented and
confronted according to their sex age clinical biochemical
morphological parameters. Medical supervision of patients
showed that patients of the general group treated with laser
have positive results quicker than control group The most
essential influence of therapy marked on reduction of pain
syndrome Dyspeptic syndrome was eliminated by the end
of treating course without undue side-effects. There was no
change in clinic-biochemical analyses of the blood after
treatment .Under the influence of treatment, increasedf PH
of the stomach in antral part of body was reduced. The
results of the treatment testify about clinical effectivity of
laser therapy and successful eradication of Helicobacter
pylori among the patients with functional dyspepsia
Keywords: functional dyspepsia, Helicobacter pylori, laser scan-
ning beam
143
P131
Condition of some airborne infections sick rate
in Karaganda region
Begaydarova Rosa Khasanovna, Starikov Juri
Grigorievich, Diusembaeva Ainash Ermukhanovna,
Efimova Oxana Nikolayevna, Zolotareva Oxana
Anatolievna
Chair of children infectious diseases, Karaganda State
Medical Academy, Karaganda, Kazakhstan
Purpose of the research: to define a condition of some air-
borne infections sick rate in Karaganda region.
Materials of the research: It has been studied clinical cur-
rent of measles in 360 patients (outbreak in 2004-2005),
of rubella in 144 patients during the outbreak of 2002-
2003.
Results and conclusions: Belsky–Filatov’s spots were not a
visiting card of measles at the most part of adults.
Bloodshot loosened mucosas of the cheeks were marked in
all children and adults. This attribute was constant and
expressed both in catarrhal and in the period of eruption,
that allows to put it to a rank of basic signs and to take into
account in diagnostics and differential diagnostics. We
have revealed current of measles in adults has a series of
distinctive attributes in comparison with children. Longer
current, big percent of complications in adult patients with
measles testify to decreasing and even complete disappear-
ance of vaccinal immunity, that dictates necessity of carry-
ing out of serologic control and revaccination. High densi-
ty of complications in adults is argued factor at prescribing
of antibacterials for prophylaxis of complications. Problem
of rubella remains actually. At the majority of patients
rubella began acutely, with the period of eruption. In some
children and in 17% of adults the eruption was accompa-
nied by the mild itch. The rash at overwhelming number of
patients was of spherical form, light pink color, not plenti-
ful. Rather constant attribute at 83.6% of children and at
92.7% of adults was posterocervical and occipital
polyadenitis.
Keywords: airborne infections, sick rate, measles, rubella
P132 2
Microbiology Department, Islamic Azad University,
The incidence of bacterial pathogens in children Science and Research Campus, Tehran – Iran

with lower respiratory tract infections

3
Technical Supervisory, Central Laboratory, Dr. Shariati
Hospital, Tehran – Iran
4
Microbiology Laboratory, Dr. Shariati Hospital, Tehran –
Ziyade Nihan, Aksu Burak, Yagci Ayflegül
Iran
Marmara University, Faculty of Medicine, Department of
Microbiology
Bloodstream infection is potentially life-threatening. It is of
interest that the epidemiology of nosocomial bloodstream
In this study, sputum samples were homogenized with
pathogens has changed dramatically during the last 15
physiological serum, vortexed, centrifuged, and incubated
years. The most important aim in this retrospective project
for 15 minutes after adding N- acetyl- L –cysteine. Washed
was to detect microbial pathogens from blood in patients
samples were diluted 1:10 and counting plates were incu-
who referred to the Central Laboratory of Dr. Shariati
bated after inoculation. Positivity threshold was >106 cfu
Hospital in Tehran, IRAN during 1 year. The data were col-
/ml and bacteria were identified by using standard proce-
lected by the questionnaires. Finally, the statistical method
dures. Antimicrobial resistance was determined by agar
of Chi Square was done by SPSS software version 15. The
diffusion and/or E-test following CLSI approved standards.
results indicate that there are 22 different microbial
Serial isolates of Haemophilus influenzae strains were
pathogens which are isolated from the patients. But, the fre-
genotyped by arbitrarily primed-polymerase chain reac-
quency of isolates shows that the most important microbial
tion (AP-PCR) by using primers AP2 and ERIC 1+ERIC 2.
agent of infection is Staphylococcus epidermidis. The oth-
We analyzed 154 sputum samples from 116 patients (63
ers respectively are: Acinetobacter spp., Escherichia coli,
boys, mean age 10,7± 3.5). Eighty percent of the patients
Staphylococcus aures, Klebsiella pneumoniae,
were outpatients, mainly from pediatric chest diseases
Pseudomonas aeruginosa .In this investigation, 56.6% of
(59%). Forty percent of the samples (55.3%) were not
patients were men and the left 43.4% were women. In con-
acceptable using the number of epithelial cells as rejection
clusion, there is significant relation between the blood
criteria. Bacterial pathogens were detected in 45.5% of the
infection and the male gender (P<0.05).
samples. The most commonly isolated pathogen was
Keywords: Bloodstream infection, Microbiology, Infectious
Haemophilus influenzae (70%), followed by Streptococcus
Diseases
pneumoniae (11%) and Pseudomonas aeruginosa (6%).
Beta lactamase positivity was 14, 3% among H. influenzae
P134
strains and only one in 49 of them were serotype b. AP-
PCR analysis of 18 serial isolates from 8 patients revealed
Blood smear microscopy in diagnosis of bac-
that same genotype was persistent in 6 patients (4 months teremia and fungemia
apart for the longest). Also, two of H. influenzae strains
from twin patients gave identical pattern. Intermediate Kargaltseva Natalia Michailovna
penicillin resistance was detected among 27.2% of pneu- Department of laboratory diagnosis, Kirov military medical
mococci whereas there was no high level resistance. academy, Saint-Petersburg, Russia.
Keywords: Lower respiratory tract infection, quantitative culture,
children The microscopic examination of any pathologic specimen is
the first step in diagnosis of acute inflammatory conditions.
P133 The microscopy of peripheral blood smear is a method of
The Microbial Pathogens Isolated from Patients early diagnosis which is based on the demonstration of

with Bloodstream Infection microorganisms in the stained preparations. The agent

identification is based on morphological and stained fea-
tures of microorganism. From the buffy-coat of anticoagu-
Behzadi Payam1, Behzadi Elham2, Yazdanbod Hodjjat3,
lated blood of 1313 samples from 853 inpatients and 269
Aghapour Roghiyyeh4, Akbari Cheshmeh Mahboubeh4,
smears from 269 outpatients were smeared and stained
Salehian Omran Djaafar4
with Gram. Simultaneously blood cultures were also made.
Microbiology Department, Islamic Azad University,
1

The smears of 64.7% inpatients and 98.5% outpatients

Shahriyar-Shahre Qods Branch, Tehran – Iran

144
were positive. The blood cultures were positive in 35.9%
and 55.4%, respectively. The morphology of the discovered
and isolated microorganisms was compared and found to
be similar in 75.2%. The most frequently discovered and
isolated microorganisms were gram-positive cocci
(36.4%). The fungal blood cultures were positive in 1.2%,
but the yeast cells were seen in up to 22.2%. These data
illustrate the diagnostic role of the buffy-coat microscopy.
Diagnostic microscopy is of great importance in the early
diagnosis of bacteremia and fungemia. The discovered
microorganisms become early indicators for treatment in
these patients.
Keywords: Bacteremia, fungemia, smears, blood.
P135
Prospective evaluation of Stenotrophomonas mal-
tophilia bacteremia: review of 36 cases.
Pullukçu Hüsnü1, Sipahi O¤uz Reflat1, Taflbakan Meltem1,
Çal›k fiebnem1, Çilli Feriha2, Yamazhan Tansu1, Ulusoy
Sercan1
1
Department of Infectious Diseases and Clinical
Microbiology, Ege University Faculty of Medicine, Izmir,
Turkey
2
Department of Microbiology and Clinical Microbiology,
Ege University Faculty of Medicine, Izmir, Turkey
OBJECTIVES: This study aimed to analyse the clinical and
microbiologic data of patients in whom SM was isolated
from blood cultures
METHODS: Clinical and microbiologic data of patients in
whom SM was isolated from blood cultures performed on
Bact-Alert (Bio Merioux) between January 2005-April
2007 were collected prospectively. Antibacterial suscepti-
bility tests were performed by ETEST following the recom-
mendations of CLSI. Patients who did not have any clinical
complication or deterioriation despite lack of treatment for
SM were considered to have transient bacteremia.
RESULTS: There were a total of 36 bacteremia episodes in
36 patients (27 males, 9
females, aged 47.05± 18.5, min:15, max:76). Seven
episodes were considered to have transient bacteremia.
Mean duration of hospitalization of 36 cases was
23.7±23.2 days. All patients had central venous catheters,
83.3% had indwelling urinary catheters, 88.9% had a his-
tory of extended-spectrum antibiotic consumption, 86.1%
were in intensive care units, 75% were on mechanical ven-
145
tilation, 66.7% had previous Gram negative, 50% had pre-
vious Gram positive bacterial nosocomial infection, 33.3%
had malignity, 16.7%had diabetes mellitus. 33.3% had a
history of surgery. Of 29 cases in whom bacteremia was
not considered to be transient 22 had received adequate
treatment for SM. Seven patients in whom the culture results
were late or ignored and two patients who received treat-
ment for SM died. Resistance rates of the infecting strains
for amikacin, ceftazidime, ciprofloxacin, doxycycline and
trimethoprime/sulfomethaxasole was 92%, 47%, 27%, 5%,
0%, respectively. CONCLUSION: SM is associated with
significant resistance to commonly used antibiotics, mor-
bidity and mortality.
Keywords: blood stream infection, hospital-acquired infection,
healthcare associated infection
P136
Serum Copper, Zinc, Magnesium and Selenium
Levels in Patients with Sepsis
Geyik Mehmet Faruk1, Ustun Cemal1, Tegin Ibrahim2
1
Dicle University Medical Faculty, Depertment of Clinic
Microbiology and Infection diseases, Diyarbakir, TURKEY
2
Siirt University Depertment of Chemistry, Faculty of
Science and Art, Siirt, TURKEY
OBJECTIVE: The aim of this study is to compare the serum
Copper (Cu), Zinc (Zn), Magnesium (Mg) and Selenium
(Se) levels of patients with sepsis and healthy individuals.
MATERIAL-METHODS: In this study, 50 patients with sep-
sis, and 90 healthy individuals in the control group were
included. From totally 140 individuals, 5 ml of venous
blood was taken at morning. Serum samples were decom-
posed by centrifugeting at 5200 turn for 10 minutes. Serum
samples were diluted with deionised water. Cu, Zn, Mg
and Se levels were measured in all serum samples by using
Unicam 929 Atomic Absorption Spectrophotometer. All
data entry and analysis were performed using SPSS 10.0
for Windows Version program.
RESULTS: The average age of 50 patients with sepsis was
52.7 ±18 years, of whom 24 were males (48 %), 26 were
females (52%). The average age of 90 healthy individuals
was 29.3 ±8.8 years, of whom 45 were males (50%), 45
were females (50%). Serum Cu, Zn, Mg and Se levels of
patients with sepsis and control group was shown in table.
A statistically significant increase at serum Cu, Mg and Se
levels and no significant increase in Zn levels of patient with
sepsis were detected, when compared with the control
group
CONCLUSION: The current evidence suggests that, Cu, Mg
and Se levels may be helpful as indicator in the course of
sepsis
Keywords: Sepsis, serum trace elements
P137
Comparison of catheter care practices and
catheter infection rates a Turkish and Dutch
Intensive Care Units: A prospective study
these interventions but, as shown in the present study, will
not achieve persistent behavioural changes, unless they are
repeatedly applied.
Keywords: catheter related infection, infection control, hand
hygiene
P138
Device Related Health Care Infections in non
Intensive Care Unit Patients

Ustun Cemal, Geyik Mehmet Faruk, Hosoglu Salih, Ayaz

Alp Emine1, Loefflen Frans2, Yucel Sansel1, Doganay
Celal, Celen Mustafa Kemal
Mehmet1, Voss Andreas3
Dicle University Faculty of Medicine, Department of Clinical
1
Department of Infectious Disease, Faculty of Medicine,
Microbiology and Infectious Diseases, Diyarbakir, TURKEY
Erciyes University, Kayseri,Turkey
2
Department of Medical Microbiology, Radboud
AIM: In this study, invasive device utilization and rates
University Medical Centre, Nijmegen, The Netherlands
(DRIs) were examined in non intensive care unit patients at
3
Department of Medical Microbiology, Radboud
Dicle University Hospital (DUH), in 2006.
University Medical Centre, and Department of Medical
METHOD: DUH is a tertiary care hospital with 1150 beds.
Microbiology and Infectious Diseases, Canisius-
DRIs and invasive device utilization days have been
Wilhelmina Hospital, Nijmegen, the Netherlands
prospectively investigated with active surveillance by a res-
ident and academic staff in the 2006 year at DUH. Invasive
OBJECTIVES: The aim of this study was to compare catheter
device usage rate = invasive procedure day/hospitalized
care practices before and after an educational intervention
patient day, DRIs rate = invasive device related
in a Turkish and a Dutch ICU.
infection/invasive device day x 1000 formulas were used
Material and Methods: The study was prospectively con-
in calculations. Centers for Diseases Control and Prevention
ducted in ICUs of a Turkish and Dutch university hospital
(CDC) criteria were used to define the patients.
and consisted of three periods: pre-interventional period,
RESULTS: Forty-two thousand eight hundred and forty-three
interventional period (feedback, educational programme)
patients were hospitalized in DUH in 2006. During this
and re-observations of the nurses, one and six month(s)
period, 602 nosocomial infections developed in 545
after the intervention.
patients. All around the hospital were established 166
RESULTS: While both settings employed bed-side alcoholic
DRIs. Of the DRIs 64 (39%) were detected in non intensive
rubs, skin antisepsis and dressing practices differed
between the two hospitals. The overall compliance with care unit patients. forty-three of these were urinar tract
hand disinfection prior to the intervention were significant- infections, 12 were central venous catheter infections, while
ly different between the two ICUs (65% versus 18% in the 9 were mechanical ventilator related pneumonia. Invasive
Dutch and Turkish ICU, respectively). In both settings, the procedure day, device utilization day and DRI rates of
interventions lead to an immediate increase of hand nosocomial infections in patients with urinary catheter, cen-
hygiene compliance. However six month after the interven- tral venous catheter and mechanical ventilator were
tion, compliance dropped in the Turkish ICU, whereas it demonstrated in the table.
further increased in the Dutch setting. Comparably, hub CONCLUSION: Nosocomial infections are seen in an
disinfection rates were lower in the Turkish ICU before and increasing pattern owing to the increase in invasive proce-
after the intervention. Probably as a result of the lower com- dures and invasive device utilization. DRIs, encountered in
pliance with catheter-care practises, CRIs-rates were two- intensive care unit and non intensive care unit patients, can
time higher among Turkish ICU patients. be compared within themselves as well as with other hospi-
CONCLUSIONS: CR-BSI can be significantly reduced by tals.
applying multifaceted interventions that help to ensure Keywords: Device related health care infections, non intensive
adherence with simple, evidence-based infection control care unit patients.
measures. Educational programs and feedback are part of

146
P139
Device related health care infections in neurology
intensive care unit
Ustun Cemal1, Hosoglu Salih1, Geyik Mehmet Faruk1,
Aluclu Mehmet Ufuk2
1
Dicle University, Faculty of Medicine, Department of
Infectious Diseases and Clinical Microbiology, Diyarbakir,
Turkey2Dicle University, Faculty of Medicine, Department
of Neurology, Diyarbakir, Turkey
OBJECTIVE: The invasive device utilization ratios and
device related health care infection rates were analyzed in
the 2006 year at neurology intensive care unit.
METHODS: Device related health care infections, in the
neurology intensive care unit, were followed up by a resi-
dent and an academic staff with active surveillance
prospectively. In the calculations, invasive device utilization
ratio = invasive procedure-day /patient hospitalization-
day, device related health care infection rate = invasive
device related infection/invasive device procedure day x
1000 formulas were used. Centers for Diseases Control
and Prevention (CDC) ciritaria were used to define the
patiens.
RESULTS: Neurology intensive care unit has eight beds,
where 237 patients were hospitalized, in 2006. Forty-four
devices related health care infection were detected in 39
patients. Of the patients with device related health care
infection were 23 male (59%) and 16 female (41%). Of
device related health care infections were 22 urinary tract
infections, 13 catheter related bacteremia and nine pneu-
monia. Device related health care infections for urinary
catheter, central venous catheter and mechanical ventilator
were detected as 8.8, 18.2 and 26.8 respectively (Table).
CONCLUSION: Intensive care units are areas of high risk
for health care infections, associated with the invasive med-
ical procedures frequently performed; and areas where
patients in bad general condition were hospitalized in. A
close monitorization of the patients hospitalized in the
intensive care units, in terms of device related health care
infections, will improve the morbidity and mortality.
Keywords: Device related health care infections, health care
infections, intensive care unit infections, neurology intensive care
unit
Table. Device related health care infections
(DRHI) rate, device utilization rate and invasive procedure day
147
P140
Clinical and microbiological characteristics of
nosocomial infections caused by Sphingomonas
paucimobilis
Sirmatel Fatma1, 2Elham Behzadi, 3Oguz Karabay,
Abant Izzet Baysal University, Bolu, Turkiye
Sphingomonas paucimobilis (S. paucimobilis) is an aerobic
gram-negative bacillus that causes a variety of infections in
healthy as well as immunocompromised individuals. Four
isolates of S. paucimobilis, obtained from patients with
nosocomial infections at Abant Izzet Baysal hospital, in
Bolu, TURKEY from April to September 2007. Two of the
patients had wound infections, one with vaginal infection
and the last one had a blood infection. The S. paucimobilis
isolates were identified according to biochemical profiles
established with use of the API 32A system and susceptibil-
ity testing on bacterial isolates was performed against dif-
ferent antibiotics such as amicasin and trimethoprim. The
present study shows that S. paucimobilis should be consid-
ered as an important nosocomial infections in humans,
especially in immunocompromised hosts.
Keywords: Sphingomonas paucimobilis, immunocompromised
individuals, nosocomial infections
P141
Nasal carriage of meticillin-resistant
Staphylococcus aureus among hospital person -
nel in a Turkish hospital
Yildirim Mustafa, Ozdemir Davut, Guclu Ertugrul, Cakir
Selma, Erdogan Selvi
Department of Clinical Microbiology and Infectious
Diseases, University of Duzce, Duzce, Turkey
Nasal carriage of Staphylococcus aureus is a major risk
factor for the development of both community-acquired
and nosocomial infections. The aim of this study is to deter-
mine the prevalence of meticillin-resistant Staphylococcus
aureus (MRSA) among hospital personnel. Seventy (41
female, 29 male) hospital personnel from various clinics
were included. A total of 70 nasal swabs were obtained
and cultured for the carriage of S.aureus. Twenty-five
(35.7%) S.aureus strains were identi-
fied based on their growth charac-
teristics on mannitol-salt agar, cata-
lase and tube coagulase and DNA
hydrolysis. Among the 25 S.aureus isolates, 56% were
MRSA strains and the carriage rate of MRSA in the popu-
lation was 20%. The physicians was more colonized by
S.aureus (56%) than nurses (21.2%) and auxiliary staff
(33.3%) (P=0.023). Of the 25 doctors, 8 (32%) had nasal
MRSA carriage. The rates of MRSA strains isolated from
nurses and auxiliary staff were as 15.2% (n=5) and 8.3%
(n=1), respectively. There was no any significant difference
between the three groups (physicians, nurses and auxiliary
staff) according to the rates of MRSA carriage (P>0.05). A
variable proportion of MRSA strains expressed resistance
to the antibiotics: 35.7% to mupirocin, 21.4% to fusidic
acid, 42.9% to gentamicin, 64.3% to erythromycin, 21.4%
to levofloxacin, 35.7% to rifampin, and 28.6% to tetracy-
cline. No isolate was resistant to vancomycin and linezolid.
In conclusion, the prevalence of MRSA carriage among
hospital personel is high; these personnel constitute an
infectious risk for the hospitalized patients. Accordingly,
education of hospital personnel and active intervention
against the spread of MRSA are needed.
Keywords: MRSA, nasal carriage, hospital personel
P142
Evaluation of nosocomial infection surveillance in
general surgery unit between 1997-2006
Geyik Mehmet Faruk , Ustun Cemal , Celen Mustafa
1 1
Kemal1, Tekin Recep1, Aldemir Mustafa2, Girgin Sadullah3,
Hosoglu Salih1, Ayaz Celal1
1
Department of Clinical Microbiology and Infectious
Diseases, Dicle University, Diyarbakir, Turkey
2
Department of Emergency Medicine, Dicle University,
Diyarbakir, Turkey
3
Department of General Surgery, Dicle University,
Diyarbakir, Turkey
BACKGROUND: The aim of this study was to assess data
on the epidemiology of nosocomial infections (NIs) occur-
ring in the general surgery unit and to use them for inter-
nal quality organization.
MATER‹AL AND METHODS : This study was performed
between January 1997 and December 2006. The surveil-
lance method was active, prospectively, laboratory and
patient based. Active surveillance for NIs was performed
by infection control team, using the criteria proposed by the
Centers for Diseases Control and Prevention (CDC) and
National Nosocomial Infections Surveillance System (NNIS)
methodology.
148
RESULTS: During the ten-year follow up period, 305 NI
episodes were detected in 290 patients out of 149,987
inpatients. The overall incidence rates (NI/100) and inci-
dence densities (NI/1000 days of stay) of NIs were 2.0%
(range 0.7-2.9/1000) and 2.3/1,000 patients-days
(range 1.0-3.8/1000), respectively. The most common NIs
by primary site were surgical site infections, urinary tract
infections, pneumonia, catheter related bloodstream infec-
tions, catheter related local infections, bloodstream infec-
tion and sepsis. The most prevalent microorganisms were
Escherichia coli (36.8%), Staphylococcus aureus (17.7%)
and Pseudomonas aeruginosa (10.5%). Meticillin resist-
ance among S. aureus isolates was 76% and all were sen-
sitive to vancomycin. Meropenem and amikacin were the
most effective agents against gram-negative bacteria.
CONCLUSIONS: Data from surveillance activities must be
decisively evaluated, regularly with cooperation between
infection control team, infectious disease clinic, and gener-
al surgery unit. So that variation and trends of NIs can be
detected.
Keywords: nosocomial infections, general surgery unit, surveil-
lance, surgical site infections, antibiotic susceptibility
P143
Surveillance of Nosocomial Infections in a
Medical Faculty Hospital, 2006
Kadanal› Ayten1, Özden Kemalettin1, Beyhun Ercüment2,
Altoparlak Ülkü3, Erol Serpil1, Özkurt Zülal1, Aktafl A. Esin3,
Parlak Mehmet1
1
Department of Infectious Disease, Atatürk University
Medical School, Erzurum, Turkey
2
Department of Public Health, Atatürk University Medical
School, Erzurum, Turkey
3
Department of Microbiolog and Clinical Microbiology,
Atatürk University Medical School, Erzurum, Turkey
OBJECTIVE: Ataturk University Research Hospital, a 1200-
bed tertiary hospital is the largest teaching hospital of east-
ern Turkey. The aim of the study was to determine the
prevalence of nosocomial infections among patients in our
hospital; the most frequently reported infections, causative
agents and their antimicrobial susceptibility.
METHOD: The study was performed prospectively on
43,118 patients, hospitalised at Ataturk University
Hospital. An infection disease specialist and infection con-
trol nurse analysed the patients by active surveillance
method based on laboratory and patient data. The diagno-
sis of nosocomial infections was established according to
the “Centers for Disease Control and Prevention (CDC)” cri-
teria.
RESULTS: The rate of nosocomial infections was 1.4 %.
There was decreasing NI prevalance during the last 3 years
(p<0.001) (table1). The most frequent NI was bacteremia
with a rate of 28.9%, followed by surgical site infections
(18 %). The highest infection rates were detected in inten-
sive care unit (53 %).The most frequently isolated Gram
negative microorganisms were Escherichia
Pseudomonas aeruginosa, and Enterobacter spp. The most
susceptible antibiotics of Gram negative strains were
imipenem, meropenem, amikacin, netilmicin.
CONCLUSION: Hospitals infection transmission risks are
present in all hospital settings. However, certain hospital
settings and patient populations have unique conditions
that predispose patients to infection and merit special men-
tion. Education to medical personnel and enforcement of
infection control practices are all needed to reduce NI.
Keywords: Surveillance, Nosocomial Infections, Prevalence
Table 1. Nosocomial infections during the last three years
Year Patient (N) Patient with NI (N)
2004 37 402 933
2005 39 054 714
2006 43 118 627
X test used. P<0.001
2
P144
Nosocomial Infections In A Turkish University
Hospital In 2007
Demirdal Tuna1, Demirturk Nese1, Sara Nurhak2, Uyar
Serpil2
1
Department of Infectious Diseases and Clinical
Microbiology, Kocatepe University, Afyonkarahisar,
Turkey
2
Infection Control Committe, Kocatepe University,
Afyonkarahisar, Turkey
OBJECTIVE: Nosocomial infections (NIs) are a significant
clinical and economical burden worldwide. More recently,
NIs has been shown to be a significant economical burden
in developing countries. We aimed to detect the hospital
infection rates, dispersion according to departments, infec-
tion localization and causal agents in a tertiary-care uni-
versity hospital in Turkey.
METHODS: In this study, hospital infections observed by
Infection Control Committe of Kocatepe University School of
Medicine between January 2006 and January 2007.
Nosocomial infections were identified using the Centers for
Disease Control and Prevention National Nosocomial
Infections Surveillance System (NNIS) definitions.
RESULTS: We evaluated 14,063 patients in 2007. There
were 445 episodes (3.1%) of NIs in 261 patients (1.8%).
coli, The most common nosocomial infection sites were lower
respiratory system [32.2%, the most common isolated
microorganism was MRSA (18.9%)], bloodstream [26.3%,
the most common isolated microorganism was
MRSA(16.2%)], urinary tract [17.9%, the most common
isolated microorganism was E.coli(37.9%)] and surgical
sites [16.2%, the most common isolated microorganism
was MRSA(16.6%)]. Highest rates of hospital infections
were observed in anesthesia and reanimation intensive
care unit (21.2%), internal medicine intensive care unit
(14.9%), and internal medicine clinics (10.2%), and gener-
CUSSION: This study showed
al surgery clinics (9.5%). DISC
the need for more effective infection control interventions in
intensive care units in our hospital.
Keywords: nosocomial infection, intensive care unit, infec-
tion control committe
P145
Evaluation of surveillance and control program
on the nosocomial infections: a ten-year experi -
ence
Geyik Mehmet Faruk, Hosoglu Salih, Ayaz Celal, Celen
Mustafa Kemal, Ustun Cemal
Dicle University Medical Faculty, Department of Clinical
Microbiology and Infectious Diseases, Diyarbakir,
TURKEY
OBJECTIVE: The main objective was to recognize the eval-
uation of surveillance and control program on the nosoco-
mial infections (NIs) in a university hospital. METHODS: A
prevalence study was performed prospectively, at the DUH
(1050-bed) from 1997 to 2006. NIs were searched among
250209 inpatients. NIs were defined according to CDC criteria.
RESULTS: During ten year follow up period, 3382 NI episodes
were detected in 3075 patients out of 250209 inpatients. The
overall incidence rates (NI/100) and incidence densities
(NI/1000 days of stay) of NIs were 1.4% (range 0.8-2.5/1000)
and 1.7/1000 patients-days (range 0.7-2.5/1000), respective-
ly. NIs were seen frequently in ICU (20.1 episodes per 1000
149
bed-days), burn unit (14.5 episodes per 1000 bed-days), and RESULTS: All patients had at least one invasive application.
neurology (3.7 episodes per 1000 bed-days). The most common Thirty-tree patients (53.2%) had nasogastric feeding tube,
NIs according to the primary sites were urinary tract infection 18 (28%) had percutaneous endosmotically gastrostomy, 8
(24%), bloodstream infection (22%), pneumonia (13%) and sur-
(12.9%) had intravenous nutrition. The most effective
gical site infection (13%). The most prevalent microorganisms
antibiotic was amikacin with a resistance rate of 3%, fol-
were Escherichia coli (26%), Pseudomonas aeruginosa (15%),
lowing by norfloxacin (5%) and sulbactam-cefoperazone
coagulase-negative staphylococci (14%) and Staphylococcus
aureus (13%). Amikacin and meropenem were the most effective (7%). Ceftriaxone and mezlocillin were the worst effective
agents against Gram-negative bacteria. Meticillin resistance antibiotics with resistance rates of >50%. PFGE typing
among S. aureus (MRSA) isolates was 67% and all were sensi- yielded 37 different PFGE patterns. Eleven of these patterns
tive to vancomycin. were indistinguishable including 36 strains (grouping rate
CONCLUSION: This study represent that the rate of NIs reduced 58%). A total of 43 strains (70%) were clonally related.
with appropriate interventions. Surveillance and constant moni- CONCLUSIONS: High clonal relationship among the
toring are effective along with educating the staff about infection
strains indicates failure of control measure in our hospital.
control practices.
More strike control measure must be applied for control this
Keywords: Nosocomial infections, surveillance
nosocomial pathogen.
Keywords: Genotyping, Intensive care unit, Molecular typing, P.
P146
aeruginosa
Molecular Typing of Pseudomonas aeruginosa
The results of antimicrobial susceptibility testing.
Strains Isolated from Intensive Care Units in a
Teaching Hospital, Turkey. Sulb
AK ATM FEB CROCAZ CIP GM IMP MEM PIP TZP TOP NOR act/ MEZ NET CAR
CFP
Otlu Bar›fl1, Durmaz R›za1, Gürsoy Nafia1, Çal›flkan
Ahmet1, Ersoy Yasemin2 S
83 56 70 19 82 85 67 81 73 80 82 80 93 93 40 76 89
(%)
1
Department of Clinical Microbiology, Molecular
Microbiology Section, Inonu University Faculty of
R
Medicine, 44069 Malatya, Turkey. 3 34 23 64 13 11 31 17 22 17 16 20 7 5 52 22 11
(%)
2
Department of Infectious Disease and Clinical Microbiology,
Inonu University Faculty of Medicine, 44069 Malatya, IR
8 10 7 17 5 3 2 2 5 3 2 0 0 2 9 2 0
(%)
Turkiye.

OBJECTIVES: The aims of this study were to determine
antimicrobial drug resistance and clonal relatedness of
the 62 P. aeruginosa strains isolated from different clinical
specimens of the 55 patients hospitalized in intensive care
units (ICUs) in a one year period.
S: Sensitive, R: Resistance, IR: intermediate resistance
AK:amikacin, ATM:aztreonam, FEP:cefepime, CRO:ceftriaxone, CAZ:cef-
tazidime, CIP:ciprofloxacin, GM:gentamicin, IMP:imipenem, MEM:meropen-
em, PIP:piperacillin, TZP:piperacillin tazobactam, TOB:tobramycin,
NOR:norfloxacin, Sulbact-CFP:sulbactam cephaperazon, MEZ:mezlocillin,
NET:netilmycin, CAR:carbenicillin

MATERIALS-METHODS: A total of 62 P. aeruginosa strains

were isolated from tracheal aspirates (33), urine (13),
blood (12), and wound (4) specimens. Of the 62 strains,
42 (67.7%) were isolated from the patients in anesthesia-
reanimation-ICUs, 13 from surgical-ICUs, 4 from medical-
ICUs, and 3 from pediatric-ICUs. The standardized disk-
diffusion method was used to determine resistance of the
strains to imipenem, meropenem, ceftazidime, aztreonam,
amikacin, gentamicin, mezlocillin, cefepime, tobramycin,
ceftriaxone, piperacillin, piperacillin-tazobactam, nor-
floxacin, sulbactam-cephaperazon, netilmycin, carbeni-
cillin and ciprofloxacin. Molecular typing of the strains was
done by pulsed-field gel electrophoresis (PFGE).

150
P147 Keywords: Molecular epidemiology, parenteral nutrition, outbreak,

Molecular Epidemiological Analysis of Serratia Serratia marcescens

marcescens Outbreak in a Neonatal Intensive

P148
Care Unit by Pulsed Field Gel Electrophoresis,
Evaluation of the Phoenix system for identifying
RAPD-PCR and Plasmid Typing Methods.
of clinical isolates; Comparative study with the

Arslan Ugur1, Kirdar Sevin2, Yuksekkaya Serife1, Tuncer

Microscan system
Inci1, Bozdo¤an Bülent3
Altindis Mustafa1, Gulamber Cihangir1, Kalayc› Raike1,
1
Department of Clinical Microbiology, Selcuk University Demirdal Tuna2, Cetinkaya Zafer1, Ciftci Ihsan Hakki1,

Meram Faculty of Education’s Research and Practice Aktepe Orhan Cem1

Hospital, Konya, Turkey2Mikrobiyoloji ve Klinik

1
Afyon Kocatepe University School of medicine Dept of

Mikrobiyoloji AD, Tip Fakultesi, Adnan Menderes Microbiology

Universitesi, Ayd›n, Turkey3ADU BILTEM Epidemiyoloji

2
Afyon Kocatepe University School of medicine Dept of

Birimi, Aydin, Turkey Infection Disease, Afyonkarahisar

Introduction. Serratia marcescens is a well-known cause of In this study the abilities of two commercial systems to iden-

nosocomial infections and outbreaks, especially in neonatal tify Enterobacteriaceae isolates have been evaluated. The

intensive care unit (NICU). This study aimed to investigate an Phoenix system (BD Diagnostic Systems) was compared with

outbreak caused by Serratia marcescens in NICU by three the MicroScan WalkAway system for accuracy of identifica-

different molecular epidemiologic methods. tion results. The 144 Enterobacteriaceae isolates were

Materials and Methods. The outbreak occured 10-12 included in this study and these isolates were processed

December 2005. Blood cultures of 7 babies with sepsis were using Neg Combo 20 Microscan panels, and NMIC/ID-5

positive for S. marcescens. All isolates had the same antibi- BD Phoenix panels. The distribution of Enterobacteriaceae

otic susceptibility patterns. Extensive environmental sam- isolates by the Phoenix system were; 126 E.coli, 13

plings including parenteral nutrition (PNs) were performed Klebsiella pneumoniae, 1 Klebsiella oxytoca, 1 Serratia

and S. marcescens strains were isolated from PNs. Clonal marcescens, 1 Morganella morganii, 2 Citrobacter freundii

relations were tested by PFGE, Eric RAPD-PCR and plasmid and by the MicroScan WalkAway system were; 127 E.coli,

DNA typing. 13 Klebsiella pneumoniae, 1 Serratia marcescens, 1

Results. Seven S. marcescens were isolated from newborns Morganella morganii, 2 Citrobacter freundii. The overall

who received PN. Three S. marcescens were isolated from rate of agreement between the two systems for species level

PNs. DNA analysis by PFGE revealed a unique restriction identification and the genus level agreement was 99.2 %

profile for 3 isolates from in-use PNs and 7 isolates from and 100 % for E.coli; 100 % and 92.3 % for Klebsiella pneu-

babies. Plasmid were extracted from all S. marcescens iso- moniae, respectively. The rates were 100 % for Serratia

lates and restricted by Hind3. All strains had identical pro- marcescens, Morganella morganii and Citrobacter freundii.

files. RAPD-PCR using Eric2 primer gave the same profile. Arbitration of the 1 Klebsiella pneumoniae, 1 E. coli and 1

Conclusion. An outbreak due to PN contaminated with S Klebsiella oxytoca disagreements resolved in agreement

marcescens occurred in NICU in Konya. By using PFGE typ- with the Phoenix identification. Our results show that the

ing, plasmid analysis and RAPD-PCR we confirmed that the Phoenix system is a rapid and reliable system for identifica-

outbreak was caused by a single strain of S. marcescens. tion of Enterobacteriaceae isolates.

Keywords: Phoenix BD, Microscan system, identification
Contamination may occur during PN preparation and stor-
age. Drastic measures should be taken during preparation
of PN (laminar flow, aseptic techniques) and health care
workers, doctors, nurses, and hospital staff should be
trained for hospital infections and contaminations.
Preparation of PN under hygienic conditions does lead to
decrease both morbidity and high cost.

151
P149 Purpose of the research: to study clinical current of listerio-
Prevalence of Typhoid Fever in Kathmandu sis at children.
Materials of the research: Under observation there were 25
Valley and its Rapid Diagnosis by Detection of
children with listeriosis in the acute period of disease. From
IgM Antibodies, Using Commercial Kit
observed patients children with the diagnosis “listeriosis,
eye-glandular form” (mono-infection) have made 40%, “lis-
Ghimire Jhabindra Prasad1, Upadhyay Ram Ratna2
teriosis in combination with acute bronchitis and interstitial
1
SAARC TB & HIV/AIDS Center, Thimi, Bhaktapur, Nepal
pneumonia” - 40%, “listeriosis in combination with
2
Nepal Medical College, Jorpati, Kathmandu Nepal
cytomegalovirus infection” - 20% (mixt-infection).
Results and conclusions: All patients were carried out stan-
BACKGROUND: Aim of this study was to find out effective-
dard analysises of blood, urine, biochemical researches,
ness of commercial testing kit for Salmonella typhi IgM in
bacteriological and tool research. By results of the
early diagnosis of enteric fever.
researches we have obtained the following data: 1) There
METHODS: A total 81 patient, 34 females and 47 males
have been revealed listeriosis risk groups, where children
and age group between 5 to 78 years, during 25 July
have come: living in countryside; born from mothers with
2006 to 30 December 2006 were subjected to study. All
burdened obstetric anamnesis; with the mixed virus-bacte-
samples were tested for S. typhi IgM (Enterocheck-WB test-
rial infection. 2) There have been described features of clin-
ing kit), total WBC count, hemoglobin and alanine amino-
ical symptomatology at children: long fever (on the average
transferage (ALT) and subjected to culture for salmonella.
8-10 days), hepatosplenomegaly, repeated spontaneous
RESULTS: Among all suspected typhoid fever cases, the dis-
vomiting, catarrhal manifestations and lesion of respiration
ease was confirmed bacteriologically in 11 (13.6%), where
organs (bronchitis, pneumonia), puffiness and moderate
as 20 (24.7%) were considered to have typhoid fever on
hyperemia of the eyelids, narrowness of eye-slits. The phe-
clinical backgrounds and rise or fall in the titer of salmonel-
nomena of catarrhal-granulomatosal conjunctivitis with
la antigens through Widal test. The Enterocheck-WB
hemorrhages were marked, thus the partial atrophy of an
showed its diagnostic specificity and sensitivity 57% and 71
optic disk was marked. There has been fixed also that liste-
%, respectively which were lower than those of Widal test
riosis at children proceeds with lesion of gastrointestinal
(70% and 95%, respectively), but combined culture and S.
path (coloenteritis). 3) RDHA with listeriosis diagnosticum
typhi IgM assay
at the surveyed patients was 1:100; in 10 days 4) . Multiple
(sensitivity 96% and specificity 98 %) were superior to com-
increase of antibody titers was marked (1:400). 4) In gen-
bined culture and Widal test ( sensitivity 87% and specifici-
eral blood analysis there are marked leukocytosis, lympho-
ty 95 %).
cytosis, monocytosis, accelerated ESR. 5) By results of our
CONCLUSION: The major advantages of the dipstick
researches the most effective as starting therapy is par-
assay are; easy to use, not require special equipment or
enteral administration of Ampicillinum and Gentamycin in
training, and uses stabilized components. It therefore, has
age dosages.
a potential high degree of acceptability for patients with
Keywords: listeriosis, clinical current, children
suspected typhoid fever but cultures are negative or in
areas where culturing facilities are not available. P151
Keywords: Salmonella typhi, immunochromatography, culture,
Dynamical and clinic-epidemiologic characteris -
Widal test
tics of Listeria infection
P150
Features of listeriosis clinical current at children Slavko Yelena Alekseevna

Begaydarova Rosa Khasanovna1, Asenova Lazzat

Kazakh National Medical Universty,
Khasenovna2
Almaty, Kazakhstan
1
Chair of children infectious diseases, Karaganda State
Medical Academy, Karaganda, Kazakhstan
Inthe last year the incidence of Listeria infections increased
2
Faculty of postdegree education and continuous profes-
in Kazakhstan. Alongside with quantitative increase of the
sional improvement, Karaganda, Kazakhstan
incidence of circling disease, there is a shift in severity and

152
types of this infection. This depends on resistance change
of microorganism and types of Listeria penetration into the
human body. The purpose of this work is the analysis of
changes in clinical aspect and epidemiological factors
determination of a spread of a Listeria infection. It was
determined that for the last years there was a shift in forms
and severity of circling disease. There is an increase in
severe form infection and specific weight of secondary
nidal forms, namely meningeal-encephalitis form, more
often without preliminary initial stage of nidal form and
speed of infectional generalization. It is worth to mention
that the genital circling disease increase and circling dis-
ease increase among pregnant women is obviously
depends on increase of people with genital pathobiology-
cal inspected for circling disease. Widely spread way of
infection transmission is still alimentary one, among trans-
mission factors are: salads from vegetables, meat and
dairy products.
Keywords: Listeria infection in Kazakhstan clinical aspect and
epidemiological factors of Listeria infection.
P152
Hydrophobia in Southern Kazakhstan
Utepbergenova G.A., Nyshanov N.S., Tanibergenova
A.J., Nurmasheva A.A., Sarypbekova L.L., Zhumadullaev
N.K.
South-Kazakhstan State Medical Academy, Shymkent,
Management of State Epidemiology Control in S.K.R.
The modern situation on furiousness in the territory of
Southern Kazakhstan is defined as epizootic natural cen-
ters of illnesses among the dogs. In the South-Kazakhstan
were registered 8 causes of furiousness among the people
in 2007. In comparison with the last year the quantity of
sick people were increased in five cases. The general quan-
tity is 8 sick people among them, 7- from regions, 1- sick
man from Shymkent City, there’s 1 woman, 7 men, 5 chil-
dren and 3 adults. Four cases of history with the diagnosis:
furiousness were analyzed who were under the treatment in
the infectious hospital .3 of them villagers, 1 – urban.
Gender classification: There are 3-men, woman-1, chil-
dren-1, adults -3. Age classification: 14 age old – 1, 16
age old -1, 40-50 age old age -2. Social classification:
schoolboy -1, teacher -1, workers and unemployment -1.
The epidemiological analysis shows that the disease has
153
been caused from the bite, of unknown vagrant dogs -1,
cat-1. Nobody addressed for inoculations. The rise of dis-
ease was registered very often in autumn and winter. The
patients were bitten by dogs in January, and May. One
patient was bitten by unknown dog during the hunt, anoth-
er was bitten by a cat in the camp, other two patients were
bitten by the dogs on the way home. There was – 1 bite into
the ear, 1 - into the upper extremity, and 2- into the lower
extremity. The incubation period has been lasted 2-6
months. Patients were in the hospital about 10 days. In the
stage harbingers of illness was taken -1 patient, in the
stage of exciting -1 patient , in the stage of paralysis -2
patients . So the course of furiousness in 2007 among peo-
ple were dogs (about 92.4%). The 59% of them were wild
street dogs. Most of the patients were men (about 7 cases).
There were 3 cases among children. All these facts proved
the fact of people’s periodic contact with animals. The vet-
erinaries service checked about 23% street dogs and 5 of
them had furiousness The main measures of fighting
against furiousness are: immunization, liquidation of neg-
lected animals, increasing of sanitary literacy of the popu-
lation in the concrete region. Also, it is necessary to involve
medical workers for these problem, in order to everyone
who had received damage from animals must be examined
by a doctor and given a necessary antirabic inoculations.
Keywords: Hydrophobia, dogs, rabies
P153
Clinical features of botulism in Kazakhstan
Utepbergenov Olzhas, Duisenova Amangul, Dmitrovskiy
Andrey, Utaganova Tamara
Department of infectious and tropical diseases, KazNMU,
Almaty, Kazakhstan
In connection with widely occurrence of Clostridium botu-
linum in the environment and popularity of taking home-
made preserved products, the problem of botulism remains
actual. Total number of patients who received the treatment
in Clinical Infectious Hospital of Almaty city, was 6303
patients in 2004, 7101 patients in 2005, and 6891
patients in 2006; number of patients with botulism was 3
(0,05%), 13 (0,2%) and 9 (0,1%) respectively. It is noted
that there was a tendency to spreading the disease
amongst young people. So, if people upwards 50 years
were 66, 6% in 2004, 53, 9% in 2005, in 2006 were pre-
vailed patients aged under 30 years – 66, 7%. Clinical
diagnosis of botulism (detection of early symptoms of dis-
ease as sensation of “the net before eyes”, diplopia, nosal-
ity, difficulty of reading the text) was determined on 1-3
day at 17 patients (68%), on 4-5 day – at 6 (24%), on 6-
10 day at 2 (8%). Laboratory verification of diagnosis
remains low and late (on 7-10 day of hospitalization) in
connection with absence of express methods of diagnostics.
Verification with use the bacteriological and biological
methods were in 2004-33,3%, in 2005 – 53,9%, 2006 –
44,4%, on average – 43,9%. Mainly the disease was taken
its grave course – from 77% (2005) to 100% (2004,2006).
As a result of this the high indices of lethality were noted –
from 11, 1% (2006) to 33, 3% (2004). The most frequent
causes of death were acute respiratory failure and
myocarditis.
Keywords: botulism, Clinical Infectious Hospital of Almaty city,
Laboratory verification
P154
Epidemiological characteristics of botulism in
Kazakhstan.
Utepbergenov Olzhas, Dmitrovskiy Andrey, Duisenova
Amangul, Tutaeva Yevgeniya
Department of infectious and tropical diseases, KazNMU,
Almaty, Kazakhstan
In connection with high lethality (from 77,7% to 100%),
imperfection of diagnostic methods, low effeciency of treat-
ment, prophylaxis of the disease is taking on paramount
significance. Research’s aim was to study the frequency of
epidemiological factors of botulism’s development in
Kazakhstan. Collection of epidemiological anamnesis at
patients revealed taking pickled cucumbers - 40%, pickled
mushrooms – 12 %, pickled vegetable salads – 48%. At
that patients denyed taking meat and fish products of
home-made smocking and pickled products of factory pro-
duction. Thus the important role in botulism’s epidemiology
is playing taking the home-made preserving products by
population. It is noted the inclination to infection by botu-
lism in social groups with low income: unemployed people
– 6 (24%), pensioners – 10 (40%), labourers – 5 (20%) stu-
dents – 2 (8%), non-manual workers – 2 (8%).
Keywords: high lethality, low effeciency of treatment
154
P155
The role of non-polio enteroviruses causing
acute flaccid paralysis in Iran in 2003
Abbasian Firouz1, Tabatabaii Hamideh2, Sarijloo Sajede2,
Kargar Mohammad3, Mokhtari Talat2, Nategh
Rakhshande2
1
Tonekabin Azad University,Iran
2
Tehran University, Tehran Iran
3
Jahrom Azad University,Tanekaban, Iran
Acute flaccid paralysis (AFP) is a weakness of any organ of
body that peaks after 4-5 days of infection. In etiology of
AFP polioviruses are more important than others. At cur-
rently, poliovirus has been eradicated in most countries
and we must analyze the role of non-polio agents in this
disease. In this work, stool specimens of AFP patients diag-
nosed in 2003 were inoculated to five cell lines. We inoc-
ulated two specimens from any of 460 cases younger than
15 years. Ultimately, we isolated 34 different species and
serotypes of enteroviruses. Upon this result, 7.1% of all
cases were positive for cell culture. Positivity rate did not
influence by gender. Most of these viruses isolated from
children younger than 5 years and positivity rate declines
by age. Echoviruses (12 cases) and polioviruses (12 cases)
have been isolated more than others. We showed a mean-
ingful difference between RP (remained paralysis) positive
and RP negative cases. Upon this result, we showed non-
polio enteroviruses can cause RP. Isolation rate did not
change according to vaccine type. Then we showed OPV
vaccines used in Iran, have enough safety. The difference
in isolation of Coxsacie virus between RP positive and RP
negative is not meaningful. We demonstrate echoviruses
can cause AFP in children younger than 5 years, because
the difference in isolation of Echoviruses between RP posi-
tive and RP negative patient is meaningful.
Keywords: Acute Flaccid Paralysis, Cell line, Nonpolio
Entroviruses, Iran.
P156
Meningitis due to Streptococcus pneumoniae
and Haemophilus influenzae: epidemiological
and clinical features and efficacy of interleukin-
2 treatment
Yeraliyeva Lyazzat Tasbulatovna S.D.
Asfendiyarov Kazakh National Medical University,
The purpose of this work was the study of epidemiologic
and clinical peculiarities of meningitis produced by
Streptococcus pneumoniae and Haemophilus influenzae in
children of the city of Almaty and substantiation of use of
Roncoleukin in the complex treatment of acute bacterial
meningitis of staphylococcal, pneumococcal, and hemo-
philic etiology. The data of observation of the children
admitted to the Children’s Infectious Clinic of the city of
Almaty with the diagnosis of purulent meningitis for the
period from 2001 till 2005 were analyzed. Prevalence of
pneumococcal meningitis in the structure of bacterial
meningitis of non-meningococcal nature and change of the
spectrum of antibacterial sensitivity of pneumococcus was
revealed. High sensitivity of pneumococcus to Ceftriaxon –
56.4%, Ceftazidin – 40%, Cefurozim – 35% was noted,
residual impairments in the psycho-neurological status of
different degree are observed in more than 1/3 of children
after the disease. Hemophilic meningitis prevails in children
at the age from 1 to 6 months and from 5 to 7 years; sea-
sonal fluctuation is expressed – in one half of the cases chil-
dren were admitted in the summer time, gradual onset of
the disease with increase of symptoms within 48-60 hours
dominated, the principal unfavorable prognostics of Hib
meningitis were development of ventriculitis and cerebral
edema. Increase of Hib strains resistant to penicillin antibi-
otics, aminoglycosides, and levomicytin was discovered.
Expressed immuno- and indirect detoxicating effects of
Roncoleukin were acceleration of liquor sanitation, shorten-
ing of infusion and antibacterial therapy, decreased time of
inpatient treatment.
Keywords: bacterial meningitis, Streptococcus pneumoniae,
Haemophilus influenzae, Roncoleukin.
P157
Early age children’s meningococcal infections
characteristics
Nina Aspetova , Roza Kasimbecova , Adil Katarbaev , K.
1 1 1
155
Karabaeva2, Z. Ahmetjanova2
1
Kazakh National Medical University, Kazakhstan
2
Children's infections diseases clinical Hospital,
Kazakhstan
We observed the children brom the beginning of the first
months of the life till three years. Meningococcemia devel-
oped at 11% cases. Meningitis at 45%, mixt form of illness
at 48% cases. It was hart form of illness at 72% of sick chil-
dren. Only 37% of sick children were hospitalized at first
48 hours from the beginning of the illness. Typical forms of
meningococcal infection were developed at grown ups.
These cases were not difficult to diagnostic. Most of the sick
children were hospitalized at the first 48 hours, and nega-
tive results were registrated rarely. During the first years of
the children’s life clinical picture was significantly different
from the illness’s clinics of the other children’s period of life.
So in many cases the illnesses begin from the sub febrile
temperature and not always have meningial syndrome.
However the illness was hard. Often we watch mental
desiarthes, convulsions and local neurological sympto-
matics that might be connected with morphologically and
functionally not matured brain. Watching the children after
the disease we found maximal hard after effects in such
group of children epeleption, late physical development. So
children at their first 1, 5 year old ages, who catch
meningococcal infection, have non-typical symptoms of ill-
ness in many cases, which were characterized by the infec-
tion shock and mental dysfunction development. It should
be taken into account in doing patogenetical therapy.
Keywords: meningococcal infections, age children’s characteris-
tics
P158
The etiology of bacterial meningitis in children
Yeraliyeva Lyazzat
Kazakh National Medical University, Kazakhstan
The aim of the research: to determine the main causative
agents of bacterial meningitis in children in Almaty during
the period from 1992 to 2004. Purulent bacterial meningi-
tis is a severe infectious disease and it remains as an urgent
problem in many countries of the world. Menix vasculosa
of the brain base and the superior part of spinal cord are
involved in inflammatory process of purulent meningitis.
Localization of inflammatory focus, characteristic clinical
manifestations of the disease and generalization of the
process affecting various body organs and tissues indicate
the necessity to determine the etiology of the disease as
quick as possible and to make a prompt decision about
administration of adequate antibacterial therapy which is
often unequal for different kinds of purulent meningitis with
different etiology. From 1992 to 2004 there were 972
cases of purulent bacterial meningitis which were studied.
Neisseria meningitidis caused 45.6% of cases of meningi-
tis; Streptococcus pneumoniae – 12.3%; Haemophilus
influenzae type “b”– 9.6%, Staphylococcus aureus – 4.5%;
other causative agents – 0.3%.The etiology of meningitis in
27.7% of cases failed to be found. Other causative agents
were represented by individual cases of Pseudomonas
aeruginosa, Escherichia coli, Listeria monocytogenes.
During the last years of the period side by side with appro-
priate variations of sickness rate of meningococcal menin-
gitis it was noticed the increasing the number of Hib-menin-
gitis cases from 5.2% to 22.8% as well as the number of
pneumococcal meningitis cases. The highest point of pro-
portion of pneumococcal meningitis cases was recorded in
2004 – 42. 2%.
Keywords: Purulent bacterial meningitis, etiological structure,
meningococcal infection.
P159
Up-to-day peculiarities of course of meningoen -
cephalitis and CNS
Khashim Abdukarimov, A. Arimbaeva, R. Abdrasulov, R.
Bocharov, B. Musdubayeva, L. Kanlibayeva
National Center for TB Problem, Kazakhstan
Up-to-day percentage of atypical forms of TB meningitis
and CNS increased and age compound of patients as well
that made difficult their diagnostics. Target of our study was
to determine the peculiarities of course of TB menigoen-
cephalitis and CNS. 14 men and 23 women, out of them 6
children up to 14 years old. Due to the fact that these forms
are the secondary TB disease, pulmonary TB was diag-
nosed among 25 patients, other TB locations in 12 cases.
All the patients were referred in non-TB primary care insti-
tutions because of missed diagnostics of different infectious
diseases or acute disturbances of brain blood circulation.
By 10th day TB meningoencephalitis and CNS was diag-
nosed in 6 cases (16.0%) out of 37, by one month in 7
156
(19.0%) and after one month from the beginning of disease
development in 12 (32%) cases. In 12 (12.0%) TB menin-
goencephalitis and CNS was diagnosed against the back-
ground of the specific anti-TB chemotherapy. Among of 37
patients investigated 24 (64.9%) died, one of them was a
child up to one year old, 1 (4%) up to 14 years old, 10
(41%) from 15 to 28 years old, 5 (20%) from 29 to 40
years old, 7 (29%) from 50 years or older. Patients cured
from TB meningoencephalitis and CNS with residual
changes in the central nervous system continued to be treat-
ed at the neurological unit.As a conclusion, up to day TB
meningoencephalitis and CNS is manifested by later case-
finding and higher lethality.
Keywords: tuberculosis, meningitis
P160
Diagnostic and prognostic significance of car -
diospecific ferments of infants with internal
wombing cytomegalovirus infection
BZ.Onalbaeyeva
Kazakh National Medical University named
S.D.Asfendiyarov of the Republic of Kazakhstan, Almaty
The paper objective is to work out new diagnostic criteria,
evaluation of the seriousness and prognosis of the infection
process, including the seriousness and prognosis of heart
damage among the infants (0-3 months old) by internal
wombing cytomegalovirus infection (CMIWI) based on the
reseaaches of the cardio specific enzymes contents (KFK, a-
GBDG, KFK-MB, LDG, AsAT, AlAT) in blood serum. Under
observation were 35 infants with verified in IFA and PCR
internal wombing CMIWI. The control group was made of
30 healthy infants with negative results of IFA and PCR for
IWI. The researches proved that irrespective the index of
avidity of anti-bodies the infected group had verifiably
high indicators (p<0,05) of ferments as compared with the
control group. It should be noted that the patients with
heavy pathology (bicameral pneumonia of breathing insuf-
ficiency, heart damage with heart-vessel system insufficien-
cy, with pronounced hyperbiliribinemia, heavy damage of
central nervous system), concentration of ferments Íin blood
serum exceeded the norm 10-20 times. In particular was
high level of LDG, KFK and MF of KFK faction. Moreover,
the patients had hypoproteinemia, hypoalbuminemia, clear
decrease of a-amilaza and increased level of urine acid. In
defining the ferments concentration in dynamics (a month
later) most of infants (83%) had normalized indicators.
Only 17% of infants with heart pathology (cardit, VPS) had
the contents of heart faction äFä and ·-GBDG at high level.
Also was found verified increase of äFä-MB and LDG
(p<0,05) with increasing indicators while the patients grew
more and more serious. 100% of infants that went through
perinathal hypoksia, and in the mid of transitory sharp
infection disease had secondary cardiopatia as result of
post-hypksia syndrome of desadaptation SSS. The bio-
chemical analysis showed hypertransaminazemia, increase
of LDG, a- GBDG and KFK-MV. When the infection
process decreased the ferments got the normal level. Long
preservation of the indicators at high levels was registered
in the patients with heart disease.Thus, definition of car-
dioferments in infants with CMIWI can be additional crite-
ria of infection process seriousness and the heart damage.
Keywords: Cytomegalovirus, heart, diagnosis
P161
Prognostic significance of neurospecific enolaza,
and cytokins in children with internal wombing
cytomegalovirus infection
N.S. BOZHBANBAYEVA
Scientific Center of Pediatria and Infant Surgery
Almaty, Kazakhstan
The objective of the paper is to work out new diagnostic cri-
teria, evaluation of infection seriousness, including the
severity of the damage of central nervous system among
infants (0-3 months old) by the internal wombing
cytomegalovirus infection (CNSIWCMI) on the basis of
researches of neurospecific siolaza contents (NSS), cytokins
- FNé – · and Á-IF in blood serum. Under observation 35
infants verified with IFA and PCR as having internal womb-
ing infection. Due to index of anti-bodies avidity infants
were divided into 2 groups: I group – 13 (37%) of patients
with active (sharp) CMVI (with low avidity index of anti-
bodies); II group – 22 (63%) of patients with chronic CMVI
(with high index of anti bodies avidity). The control group
was made of 30 healthy infants with negative results of IFA
and PCR for IWI. During the researches of the neurospe-
cific enolaza concentration, anti-infectional cytokins -FNO
– a and Y-IF in the blood serum of infants in neonatal peri-
od and in dynamics through 2-3 weeks ‚ was found that in
group I were verifiably high (p<0,05) data of NSE and
cytokins as compared with group II. Relatively high con-
157
centration of NSE and cytokins in the blood serum of
patients with low avidity anti bodies testifies of more seri-
ous infection of the central nervous system, that revealed
itself through frequent syndrome of hyper arousal ( <0,05)
and retardation of psychomotor development ( <0,05).
Dynamic indication of HSE contents and prytokins showed
retardation of their decrease in blood serum in group I and
group II, that resulted from deceleration of reparation
processes in central nervous system. At the same time high
indicators of HSE and cytokins and their decelerated
decrease in were found not only in patients with damaged
central nervous system, but among children with attending
pathology of both groups: pneumonia, carditis, jaundice
syndrome, intestine syndrome, thus reflecting the serious-
ness of infection process. Thus, all infants with low avidity
anti-bodies were found high indicators of NSE and cytokins
and their decelerated decrease testifies the active infection.
Complex definition of NSE and cytokins - FNO – a and Y-
ø in blood serum in dynamics combining clinical -instru-
mental data of infants can serve as additional criteria for of
how seriously central nervous system was damaged, active
infection process and as the criteria of the nearest and far
prognosis.
Keywords: Cytomegalovirus, infants, enolase
P162
The diphtheria in the Republic of Kazakhstan.
Daniyarova Anara
Kazakh National Medical University, Department of
Epidemiology,
Almaty, Kazakhstan
Impossibility of liquidation of the diphtheria, activation of
epidemic process of given infection take a perfection of
preventive and antiepidemic measures, which must be ade-
quate to change the epidemic situations. Only realization
of the effective epidemiological inspector at the diphtheria
can take success in management of epidemic process.
Infections with respiratory way of transmission of the
pathogen are controlled successfully by specific preventive,
which is able to make an implanted long and expressed
immunity. Epidemical inspector for diphtheria consists of
line of simple interfacing components taking into account
behavior of agent. Under with modern scientific presenta-
tions and practical possibilities the purpose of epidemiolog-
ical inspector realizes in the next points: 1. Prevention of
organization of focus bulk diseases and lethal terminations.
2. Prevention of organization of the bacteria carrying. 3. P164
Stabilization of morbidity on sporadic level. 4. To improve Some microbiological questions of the wound
and adapt existent standards of definition case, algorithms infections
of measure in diphtherial infection and bacteria carrying of
the given infection. 5. The level of tension of postvaccinal
Niyazalieva Mira, Adambekov Dokturbek, Sabodaha
immunity. Epidemical inspector for diphtherial infection is
Marina, Mustafina Firusa, Kenenbaeva Roza
epidemiological investigation of tendencies of epidemic
Kyrgyz State Medical Academy, Department of
process, including peculiarities of the diseases spreading,
Microbiology, Virology and Immunology
clinical forms and lethal terminations of illness, as well as
factors, which determine a nature of manifestation and dif-
OBJECTIVES: The aim of research is to study the etiologic
fusion of agent and ENT-pathology, quality and effective-
structure of the pyogenic-inflammatory diseases and sus-
ness of preventive and antiepidemic measures.
ceptibility testing of isolated cultures and to evaluate the
Keywords: diphtheria, liquidation, Epidemical inspector,epidemic
process antibiotic susceptibility.
METHODS: 160 patients with the wound diseases were
P163 observed. They underwent a cure in surgery department of
Influence of collective anti-diphtheria immunity National Hospital in Bishkek during 2007. The pathogens

on epidemical process were isolated in pure culture and identified by convention-

al procedures and antibiotic susceptibility test was done by
disc diffusion technique according to Sidorenko S.V.,
Daniyarova Anara1, Amireev Saken2, Nazhmedenova
Kolupaev V.E.
Aigul3
RESULTS: In most of the cases (93%) a single pathogen was
isolated and among them Gram-positive microorganisms
Kazakh National Medical University, Department of
(85%) were dominated. They were represented by
Epidemiology,
Staphylococcus spp. in 6.1% and Streptococcus spp. in
Almaty, Kazakhstan
20.7%. In cases of mixt-infections Staphylococcus spp. and
Streptococcus spp. were obtained in combination with
Periodicity in development of epidemic process of diphthe-
another Gram-positive and Gram-negative microbes.
ria, which is characteristic for this infection, also is kept in
Among Gram-negative bacteria Klebsiella spp. 4%, Hafnia
conditions of mass immunization. Rise of disease is caused
alvei 3.4%, Pseudomonas aeruginosa 2.7% were frequent-
by accumulation of non immune persons, change of a dom-
ly obtained. Antimicrobial resistance patterns of Gram-
inating biovariant among circulating stems of the activator,
positive microorganisms were as followed: Staphylococcus
absence of bacterial immunity to which promotes greater
spp. were highly susceptible to Riphampin( 85.7-93%) and
infectious of the population, and also strengthening of
Gentamicin(75-100%) and were resistant to Oxacillin
migratory processes in the country. In the article there is a
(51.6-80%); 80% of S. aureus were MRSA and 20% of
population analysis of antitoxic antidiphtheria immunity in
MSSA. Streptococcus spp.: were highly susceptible to
epidemiological processes against diphtheria under
Ofloxacin(80%) and resistant to Azitromycin (83.3-100%),
Almaty adult population. There is a high level of immunity
Penicillin (82-90%) and Ampicillin (55-70).
in between students after the revaccination against diphthe-
CONCLUSION: For effective treatment of the wound infec-
ria. Antibodies to diphtheritic and tetanic anatoxins
tions susceptibility of microorganisms should be monitored
revealed by micromethod in RPGA with stable erythrocytes
constantly and in every concrete case to conduct qualitative
diagnosticum, which produced by "Biomed" named after
identification of the isolated microorganisms including their
I.I.Mechnikova. Activity of diphtheritic diagnosticum with
antibiotic resistance.
standard anti-diphtheria serum made up 1:3200-1:12800.
Keywords: wound infection, pyogenic-inflammatory diseases,
Credits of antibodies 1:40 and above are considered as
antibiotics
protective. Activity of tetanic erythrocytes diagnosticum
with standard anti-diphtheria serum made 1:1280-
1:5120. Credits of antibodies 1:20 and above are consid-
ered as protective.
Keywords: epidemic process, diphtheria

158
 P165 Summary
Treatment of pyoinflammatory diseases of soft
tissues at patients with drug addiction Objective: To evaluate the antibiotic cost of treating foot
ulcers in diabetic patients.
Methods: A retrospective pharmaco economic study was
Kapanova Gulnara1, Seksenbaev Bahitjan2, Esergeneva
carried out through using direct costs of antibiotics from the
Riza1
evaluation of diabetic foot patients hospitalized in Kocaeli
1
Department of General Surgery, Kazakh National
University Hospital during 2005-2006. For each patient, a
Medical University, Almaty, Kazakhstan
form included laboratory and clinical profile with length of
2
Department of treathment&prevention, Ministry of Health
hospital stay, antibiotic (s) used and prognosis were com-
pleted.
Doctors who work in surgical hospitals meet with the prob-
Results: Ninety-seven patients (58.8% males), with a mean
lem of narcotism in increasing frequency, as the majority of
age 51.8 and 11 years of average duration of diabetes,
drug addict patients use injectable drugs. We studied
were included in the study. Average day of hospitalization
patients with pyoinflammatory diseases of various localiza-
was 27.2 days, average antibiotic cost of a patient was
tions at the basic clinics of our faculty. Localization of the
6239 euro. Daily antibiotic cost was found as 319.6 euro
infection in drug addicts is various. It is connected with
per patient. In 81 patients (89%) antibiotics started on day
development of neklostredial anaerobic infection in a
of admission. Average day of antibiotic use was 19.5
wound. In this connection, we used immobilized enzymes
days. Combination therapy was the first-line choice in
in complex treatment, included in the composition of poly-
79 % of cases. Beta lactam-‚ lactamases were the most pre-
mers of various structure and nature(imozimaza), which do
ferred drug group.
not have antimitotic and cytotoxic activities, are not soaked
Conclusion: Antibiotic costs of our diabetic foot patients
up in blood and do not change its coagulant activity.
were found six times higher than European countries. Since
We’ve surveyed 95 patients. All patients with pyoinflam-
antibiotic usage represented only 10% of total costs, the
matory diseases have been operated. According to local-
economic burden behind the diabetic foot population can
ization, the phlegmon of hip became evident at 49(51.5%).
easily be estimated. Since the antibiotic cost of a diabetic
At 6 (6.3 %) the purulent process was localized in the field
foot patient was closely related with the grade of the lesion,
of perineum closer to pararectal areas, at 27. (28.4%)– a
treatment should be focused on primary prevention of dia-
phlegmon of forearm was diagnosed, and at 9 (9.4%)
betes-related complications.
patients - a phlegmon of hand, at 4 (4.4%)- a sepsis was
Keywords: Diabetic foot ulcer, antibiotic cost
diagnosed. Imoziama was used locally everyday as appli-
cation. A gross impression of wound, a character of sepa-
P167
rated in the wound and also terms of wound healing were
considered. Activation of regeneration processes was
The correlation between microflora types and
observed. Clarification of wound surfaces from the devital- immune reaction in patients with pyo-septic
ized tissues, infected grumes, fibrin pellicle have been diseases
occurred faster for 3-5 days, than in control group.
Keywords: pyoinflammatory diseases, soft tissues, drug-addict Isayev Hidayet Bilaloglu
patients, imozimaza M.A.Topchubashov Scientific Center of Surgery
Baku, Azebaijan
P166
An economic evaluation of diabetic foot ulcers: Everyone knows that biologically active substances in
results of a retrospective study on 97 patients microbic cells vary from flora types. Therefore, the immune
reaction of the organism varies in the above flora resulting
Gündefl S, Aksoy S, Vahaboglu H in purulent disease. 41 patients underwent the study of the
types of mocroorganisms and immune reaction of the orga-
Infectious Diseases Department, Kocaeli University, ‹zmit, nizm. Of these patients, 31 had local pyo-inflammatory
Turkey diseases, 10-sepsis. The findings showed that compensa-
tory and lysosomic activity did not relate to microflora type

159
( p<0,01). Serium bactericidal values of purulent patients
showed significant changes varying from microflora
type.Bactericidal action (BA) wos significantly reduced (
17,55 ±3,28%), p<0,01 for soft tissue purulent processes
where staphylococci (SP) were the major pathogene, while
the BA values did not differ from those of normal subjects
of the same age in Gram-negative fl;ora (GNF). The BA
values showed sharp reduction 2,22±6,14 % in sepsis;
3,81±24,24% in GNF; 0,74±12,42% in polymicrobic (PM)
sepsis. The amounts of T-lympocytes for local infections
showed significant reduction (0,945±0,085 in Spinfection;
0,648±0,088 x 10 in PM infection). The amounts B-lym-
phocytes were reduced and reached 0,204±0,05.109/l in
GNFand it was even less 0,66±0,088.109/l in PM.
Among immunoglobullins (lg) M-fraction showed a moder-
ate reduction ( 0,96±0,25g/l, p<0,01) in SP sepsis; the
values were much more low than those of normal subjects
in local infection. The lgG levels were higt and reached
21,54±0,8 in SP infection; 19,5±1,02 g/l, (p<0,001) in
PM infection. At the same time in sepsis the lgG values for
both infections were reduced that indicated the reduced
protective functions of the organism. Thus, based on the
data obtained, we may conclude that the immune reaction
of patients with pyo-inflammatory diseases from microflora
type resulting in the inflammatory process.
Keywords: Microflora, immune reaction, bacterial infections
P 168
Associated Factors of Histopathologically
Confirmed Prostatitis in Patients
Kadir Ceylan1, Hasan Gönülalan1, Hayrettin Akdeniz2,
Mustafa Karahocagil2, Serhat Tanik1’ Reha Erkoc3
1- Yuzuncu Yil University, Faculty of Medicine,
Department of Urology
2- Yuzuncu Yil University, Faculty of Medicine,
Department of Infectious and Diseases
and Clinical Microbiology
3- Yuzuncu Yil University, Faculty of Medicine,
Department of Nephrology
e-mail: Drceylan26@yahoo.com
Aim: We investigated the correlation of histopathologically
confirmed prostatitis with age, prostate volume, blood bio-
chemistry, total PSA and free PSA levels, catheterization
time and growth of especially E. coli in urine culture in
160
patientswho underwent open prostatectomy or TUR-P due
to BPH.
Methods: 56 patients were included in our study, 27 of
them were catheterized and 29 were non-catheterized.
Serum PSA levels were calculated by Active IRMA kit.
Histopathology of prostatic tissue, frequency of urinary
infection, prevalent organisms and their susceptibility were
analyzed for the patients of clinically diagnosed with pro-
statitis and BPH.
Results: The mean age of the patients was 679±7.02 (55-
83), 21 (37.5%) underwent TURP and 35 (62.5%) open
prostatectomy. On histopathological examination, 32
patients (57.1%) had prostatitis and 24 (42.9) only BPH. In
urine culture of totally 29 cases (51.7%) grew a pathogen.
In urine culture of 21 cases (65.6%) of 32 cases with pro-
statitis and in 8 cases (33.3%) of 24 BPH cases grew a
pathogen. When statistically compared, the difference was
statistically significant. In 22 (75.8%) of 29 cases grew E.
coli, being 18 from prostatitis cases. In conclusion, we
found no correlation between the presence of prostatitis
and age, prostate volume, urea, creatinine, tPSA, fPSA,
and fPSA/tPSA ratio.
Coclusions: The relationship between long term catheteri-
zation and histopathologically confirmed prostatitis was
significant. The most prevalent microorganism in patients
with prostatitis was E. coli and the high resistance rates to
quinolones and ceftriaxone drew our attention, but fortu-
nately SXT susceptibility has been found favorable.
Keywords: prostatitis, catheterization, antimicrobial resist-
ance, correlation factors
P169
Epidemiological efficiency of Influenza vaccina-
tion in population of Republic of Kazakhstan
Kuatbaeva Ainagul Muhanovna, Utegenova Elmira
Seitbekovna, Ospanov Kenes Sarsengalievich,
Baimbetova Asel
Republican Sanitary and Epidemiological Station,
Kazakhstan
During the last 5 years the incidence of acute respiratory
virus diseases (ARVD) and influenza in population remain
stable with non-significant tendency to reduction. There is
registered 1- 1, 5 million of ARVD and flu cases in RK
annually. Children younger than 14 years of age consists
75% of cases whereas adults older than 60 years were 10-
20%. In spite of officially registered 30 Influenza cases
there was determined circulation of B strains. As is known
influenza vaccination in children and adults has significant
influence on the reduction of epidemiology process and
decreases disease incidence and death rate among vacci-
nated population. In RK there are three registered influen-
za vaccines: Influvac, Vaxigripp, and Fluarix. From the
beginning of epidemic season there were 594, 580 vacci-
nated persons that composes 3, 8% of country population.
In such case amount of vaccinated persons is 82% higher
in comparison with the last season data. (327213 person –
2,1%). Post vaccine exacerbations in vaccinated persons
were not elicited.
Keywords: influenza, vaccination, efficiency.
P170
Peculiarities of influenza infection at children the
first year during inter-epidemic period
tacts with people having influenza (19% - in control group).
It is necessary to note that in spite of absence of severe dis-
orders in the debut of disease, 76% of patients had compli-
cations in the form of obstructive bronchitis, pneumonia.
Thus, the results obtained enable us to assume that children
living the first year having background diseases are vulner-
able to influenza virus persistence.
Keywords: influenza, influenza viruses persistence, MIFA (enzme
immunodetection on membranous sorbent)
P 171
Prevalence of Mycoplasma (MH) and
Ureaplasma (UU) in infertile cases and pretreat-
ment and posttreatment changes in semen
parameters in culture positive cases
Kadir Ceylan1, Abdullah Yildiz1, Hayrettin Akdeniz2,
Mustafa Karahocagil2, Serhat Tanik1’ Reha Erkoc3

Ksyetaeva Gulzakira1, Naumova Natalya1, Usmanov

1- Yuzuncu Yil University, Faculty of Medicine,
Muhammed2, Litosh Ella2, Kaymoldanova Nurgul2,
Department of Urology
Sydykova Klara2
2- Yuzuncu Yil University, Faculty of Medicine,
1
Department of chidren's diseases of KazNMU, Almaty,
Department of Infectious and Diseases
Kazakhstan
and Clinical Microbiology
2
Children Municipal Clinical Infectional Hospital, Almaty,
3- Yuzuncu Yil University, Faculty of Medicine,
Kazakhstan
Department of Nephrology
e-mail: Drceylan26@yahoo.com
As result of extensive spreading of influenza viruses,
influenza antibodies and specifically oriented lymphoid
Aim: To investigate the frequency of MH and UU in semens
cells transferred from mother to child through placenta and
of men who referred to our clinic for infertility. We investi-
through milk are revealed at newborns. The purpose of the
gated the effects of these pathogens on semen parameters
research is to reveal persistence of influenza viruses during
after treatment and whether there is an improvement in fer-
inter-epidemic period in organism of children living the first
tility states of these individuals.
year. We examined 47 children at the age of up to 1 year,
Methods: 106 men attending our clinic were enrolled in the
who were admitted to CMCH during inter-epidemic period
study. The cases were divided into three groups: First com-
with acute respiratory viral infection, obstructive bronchitis
prised of 41 cases having an infertility problem, and sec-
and pneumonia. Control group consisted of 50 children liv-
ond 33 cases having complaints of prostatism. The third
ing the 1st year who had influenza during epidemic peri-
comprising of 32 cases served as a control group.
od. Indication and identification of influenza viruses were
Mycoplasma IST2 kit was used for isolation, cantitative
conducted by MIFA method and detergent-test. Influenza
measurement and antibiotic susceptibility of MH and UU.
viruses were revealed at 57,6% of children admitted to hos-
Results: UU was isolated in 17 cases in the infertile group
pital during inter-epidemic period. Combination of sub-
(41.5%) and MH in 3 cases in this group UU was isolated
types of A virus or combination of A and B types of virus-
in 15 cases in the prostatitis group (45.5%) and MH in 3
es were observed in 91,5% of cases. Most often children
cases (9.1%) in this group. In culture positive cases, post-
were taken to the hospital on the 4-6th day of illness (in
treatment sperm motility in the infertile group was 250% in
control group – on the 2-3rd day). 2-3 months before this
13 cases (65%), vs 5 cases (25%) in pretreatment period.
illness 23% of patients had acute respiratory viral infection.
The difference was also significant. After treatment, con-
41, 2% of children, according to parents, didn't have con-

161
ception occurred in spouses of 4 of 20 culture positive
cases in the infertile group which was interpreted as treat-
ment had a significant effect on fertility.
Conclusion, UU is frequently isolated from semen samples
of infertile cases and may
adversely affect sperm motility, but the contribution of
antibiotic treatment to fertility could not be exactly evaluat-
ed due to a small number of our study group.
Keywords: Mycoplasma, Ureaplasma, infertility, culture
P172
Development of recombinant vaccines
Igor V. Krasilnikov
Microgen State Scientific
Industrial Company, Moscow, Russia
Keywords: recombinant vaccines, gene engineering, cell enzy-
mology
Infectious diseases have been an ever-present threat to
mankind. The invention of prophylactic vaccines has saved
hundreds of millions lives but the problem of infectious dis-
eases is still acute. On the one hand, by now vaccines
against tens of bacterial and virus originators are created,
on the other, mass vaccination has revealed the two main
problems for a biotechnological producer:
- for some virus the cell systems in which these
viruses can grow are not found
(Hepatitis B and C virus);
- lack of substrates in which a virus grows does not
allow to produce the necessary number of
vaccines.
The second one is especially acute in terms of a predicted
influenza pandemic coming soon.
The methods of gene engineering and cell enzymology
used for recombinant vaccine creation allows to solve these
production problems.
One of the first recombinant vaccines was a live attenuat-
ed influenza vaccine prepared by reassortation. The
“infection” cloning technology has been used to design
some attenuated vaccines. The vaccine against Hepatitis B
is a true victory of gene engineering. Recombinant protein
became the base of the effective HB vaccine used world-
widely for 20 years.
Nowadays researchers are working hard on a therapeutic
vaccine against HB. Some American companies have
162
launched the production of therapeutic vaccines against
melanoma, colorectal cancer, leucosis and other tumors.
The research work on formulating the vaccines against
rheumatoid arthritis, multiple sclerosis, myasthenia and
allergic diseases have been started as well.
Keywors: Recombinant vaccines, hepatitis, influenzae
P173
Measles, execution of operation of MAKAKAR,
vaccination
Gabasova Mira
Department of Epidemiology, Kazakh National Medical
University, Almaty, Kazakhstan
In 9th coordinality conference “Operation MAKAKAR”
{29-31.08.2006 Stambul, Turkey}took part the group of
repreants of MZ RK. In Kazakhstan in 2005 with financial
support of primery MZ RK was National Company of
immunization {NIK} against rubella and measles, when it
were 1.5 mil men. Then there continued rutin and irase
immunization of decreated group. Epidemic situation fop
NIK was hard- for 2004 year had disias measles – 2204,
and in 2005 year – 16118 men. After Immunization
Company the number of measles had decreased to 109 in
2006 year and 13 situations in 2007 year. During the
analysis in 2006 year more illness noted in Mangistau,
south Kazakhstan and city of Almaty, between 1-20-39
age. Determination of vaccination against measles show
that 25.6% were not vaccinated, 37.6% lack vaccination of
data. Selection of serological research immunity popula-
tion against measles of 14th region and 2th big cities or
republic in 2006 year shows that from 12983 inspectors
seronegatives are 7.6%. Analysis of these group shows that
there were children from Tajikistan, Uzbekistan, and
Chechen republic. In that case NIK of 2005 year brought
to elimination of measles in 2007 year, all the 13 morbid
event were registered between not vaccinated migrate pop-
ulation
Keywords: measles, execution of operationm, vaccination,sero-
logical research
P174
Stages of measles elimination and decrease of
rubella morbidity in Republic of Kazakhstan
(organization of Public Health)
Nazhmedenova Aigul1, Amireyev Saken2,
Moldagasimova Gulmira3, Gabasova Malika4
Karaganda State Medical Academy,
Karaganda, Kazakhstan
The aim of the study was to evaluate the efficiency of
National immunization company (NIC) against measles
and rubella, performed from the 21st February to 5th
March, 2005.
Materials and methods of the study. We carried out a ret-
rospective epidemiological analysis (REA) of measles and
rubella morbidity for 1980 – 2004 with determining the
tendencies of epidemic process for many years. There were
studied the periods of vaccine prophylaxis against measles
and its efficiency. We used an operative epidemiological
analysis (OEA) for studying features of epidemic process at
these infections in 2004 – 2005. There was conducted a
great work in realization of IME among population. Results
and discussion A retrospective epidemiological analysis of
measles disease dynamics for 1980 – 2004 has deter-
mined 2 periods due to intensity of epidemic process: with
high morbidity for 1980 – 1990 and low morbidity for
1991 – 2004. These manifestations of epidemic process
are associated with the quality of vaccine prophylaxis
against measles in Republic and with percent of population
vaccination. From 1965 there was being introduced a vac-
cine from “Leningrad - 16” strain made in Russian institute
of epidemiology and microbiology named after Paster.In
our country up to now, unfortunately, there wasn’t a
planned vaccine prophylaxis of population against rubella.
The analysis of measles and rubella morbidity among
Republic population for 20 years has determined a marked
tendency to decrease of rubella.
Keywords: rubella, morbidity
163
P175
Siderophore Production of Methicillin Resistant
Staphylococcus aureus (MRSA) and
Enteropathogens.
Ahmed Ayaz , Shahana U Kazmi, Yasir Raza
Immunology and Infectious diseases research Laboratory,
University of Karachi, PAKISTAN
Siderophores are the low molecular weight iron chelater
proteins. This helps microorganism to survive under hypo-
ferremic condition. It also helps in the pathogenicity of
microorganisms. Siderophore can be classified into three
class’s catecholate, hydroxamate and mixed ligands. Most
of the microorganism produces siderophores like ente-
rochelin, enterobactin by Escherichia coli and other
enteropathogens spp. Pseudobactin by Pseudomonas spp.
Mycobactin by mycobacterium spp. In this study we deter-
mine the production of siderophore in iron deficient media,
the antibiotic susceptibility pattern; antimicrobial activity of
the organometallic compounds which gives positive results
against mycobacterium spp.; the combined effect of the
siderophores and organometallic compounds. MRSA
which are only susceptible to vancomycin are also sensitive
to organometallic used in the study having MIC in the
range of 15.625-125μL, especially K99 Having MIC in the
range of 15.625-62.5 μL. All the strains of MRSA and
other enteropathogens produce siderophores when tested
in Chrome Azurol S (CAS) Assay. These microorganisms
show the reduction of growth in iron deficient medium as
compared to normal medium which shows the importance
of iron for the growth and production of siderophores.
When the combination of siderophores and organometal-
lic compounds are given there is a great reduction of MICs
of both used alone and synergism observed. All the organ-
isms used are positive for siderophore production and
these organometallic compounds can be used as an alter-
native for the treatment of MRSA. Siderophore can also be
used as drug delivery systems for the antibiotics that which
microorganisms produces resistance due to change surface
structures.
Keywords: MRSA, Siderophore, CAS Agar, Organometallic
Compounds
P176 ard compromising public health. Bacterial estimation was
Implementation of safe microbiological policy for based on guidelines given by the Health Protection Agency

assessment of dairy industry associated bacteria back in 2004. Our media were incubated aerobically and
anaerobically for 48h at 37°C. The identification of the
anaerobic bacteria was carried out according to Bergey's
Bezirtzoglou Eugenia1, Kourkoutas Yiannis2, Stefanis
manual. Microscopic examination of Gram-stained cells,
Christos1, Vavias Stavros1, Plessas Stavros1, Voidarou
catalase, oxidase and biochemical tests were performed,
Chrissa1, Alexopoulos Athanasios1
when necessary to identify. Beneficial lactic acid bacteria
1
Democritus University of Thrace, Department of Food
(3.14-106 cfu/g) were present in all yoghurts associated
Science and Technology, Laboratory of Microbiology,
undoubtly to the starter culture. Moreover,
Biotechnology and Hygiene
Enterobacteriaceae (up to 6.4-104 cfu/g), Enterococcus
2
Democritus University of Thrace, Department of
sp. (up to 7.12-106 cfu/g ), Staphylococcus sp. (up to 23
Molecular Biology & Genetics
cfu/g), moulds and yeasts (2.9-106 cfu/g ) were exhibited
depending to the self life of the product. To protect con-
Efficient control of contaminants and residues in foodstuffs
sumers from microbiological risks in food products,
is an essential contribution to the maintenance of a high
Community legislation sets out numerous hygienic meas-
level of consumer protection. Foodstuffs of animal and
ures. Systematically monitoring and surveillance of the
plant origin may present intrinsic hazards, due to microbi-
microbiological quality of selected ecosystems by imple-
ological contamination. On the present research work our
mentation of a public education campaign must be done,
aim was to investigate the microbial flora of some dairy
in order to preserve food quality, optimizing sewage treat-
products, such as yoghurts and evaluating about their via-
ment and safeguard the public health.
bility in the production chain as an emerging disease haz-
Keywords: Food quality, Dairy products, Microbiological anlysis

164
 INDEX

AUTHORS INDEX
LECTURE

A H R

Akova M. 39 Hand Hygiene Ramazanova B.A 38

Alshinbaeva G. Hokelek Murat 30 Rasuli A.M. 35
Prof. Dr. Alt›ntafl Nazmiye 32 Hoso¤lu S. 14 Rayushkin Boris Vasilyevich 46
An›l Dutta 35 Hasenova O. Rossolini G.M. 38
Anvar Rasuli H. Vahaboglu 15 Rubino Salvatore 45
Aslan T. H.Winkelmann 27
A. Al-Lahham S
J
B Shakenova Z.E. 62
Jayaretne Padman 63 Stephan Harbarth 16
Baburchik L.P. 35 S. Amirejev 14
Bahar Ismail Hakki 37 Saule T. 38
Bakir M. 34 K
Barry Cookson, 16 T
Bozdo¤an B. 48 Karalnik B.V. 37
Borg M.A. 40, 61 Kauchi Marita 27 T.Muminov 14
Kazakov S.V. 51
C Kazmi S.U. 45
Kiraubayev K.K. 51 U
Cak›r Nedim 52 Kotova A.L, 62
Cappuccinelli Piero 46 Kurt G. Naber 62 Ushakevich I.G. 35
Chaw Wincent 27 Kuttykuzhanova G. 61 Usluer G. 49
.Utepbergenova A. 47
D L Uteulin Marat Nurumbayevich 46

Do¤anay M. 47 Prof. Leblebicioglu Hakan 51 V

Doskozhayeva Saule T Lidiya V.D. 49
Dmitrovsky Andrey Lyabis O. 35 Vlasich Clemens 36
Mikhaylovich 46, 51 Volosar L.A. 35
Duisenova A. 48 M
Durmaz R›za 54 W
Mirzabekov A.M. 51
E Muminov T.A. 59 Wain John 44
Murgia Manuela 45 Wim Renders 17
Eduardo S.N.
Eflel Duygu 17 O Y

F Prof. Dr. Örmeci Necati 60 Ya¤c› Ayflegül 57

Ospanov K.S. 51 Yegemberdiyeva R.A. 51
Farooqui Amber 45 Ozaras Reflat 60
Fisenko E.G. 35 Ozensoy S. 28 Z

G Zhakipbayeva B.T. 59
P
Gaidukevich T.M. 35
Gaind Rajni 45 Pagluetti Bianca 45
Garau J. P. Appelbaum 15
Gubergrits N.
Günayd›n M. 19
Guruz Y. 34
Guven G.S. 42
Gyssens I. 41

165
 ORAL PRESENTATION

A H
Afshar Parviz 74,77 Halwani Muhammad Abdul Rahman 67 R
Ahmed Vaqaruddin 69 Haque Abdul 68 Rakisheva Anara, 74
Akil Ata 75 Reza Amiri, 69
Ali Aamir 68 I
Ali Asgari, 69 Ifzal Rehana, 69
Alan Sait 75 Imanbayeva Gulsara 73 S
Alshinbayeva Gulnara 72, 73 Sadique Ashraf, 69
Ali Shaiq 69 J Sahin Levent, 75
Al-sweih Noura, 66 Sarwar Yasra, 68
Javaid Sayyada Ghufrana, 77
Ashour Hossam M 66 Simin Najar Pyrayeh, 69
Aziz Mubashar 66 Sergaliyeva Aliya, 72
K
S. Nurusheva, 73
Kara Ali Fuad, 75
Sherwani Sikandar Khan, 70
Karaca Mehmet, 75
B
Kaya Ilyas, 75
Baqai Rakhshanda 66
Kazmi Shahana Urooj, 69
Bahareh Haji Khani 69 T
70 77
Barbe Valerie 68 Tabayeva Aliya, 72
Khan Dr Zaheer-ullah, 70
Bashir Saira, 68 Tanganurat Winee, 68
Khassenova Oral Abyzovna, 75
Batyrkhan Ainur 73 Tanrikulu Cetin, 75
Khayyat Inass Abdul Rahman, 67
Behbahani Mohammad, 74,77
Kiselev Oleg 76
Bibi Nazia, 69 Tariq Ayesha, 68
Komissarov Andrey, 76
Bilik Zihni 75 Torun M, 74
Kozlov Sergey 70
Bolotin Alexander, 68
Kuatbaeva Ainagul Muhanovna, 76
Botina Svetlana, 68 U
Kurmanova Almagul 73
Buda Francesco 71
Kurmanova Gaukhar, 73 Udo Edet E. 66
Buzitskaya Janna, 76
Kurmanova Kuliash 73

C W
Caner Ayse, 72 L Weissenbach Jean, 68
Couloux Arnaud, 68
Li Olive Tin Wai, 67
L. Almenova 73
D Y
Davlyatov Firuz S, 71
Yeraliyeva Lyazzat Tasbulatovna, 68
Degirmenci Aysu, 72 M
Doskaya Mert, 72
Mardani Masoud, 69 Z
Mathew Bindu 66 Zhandauletova Zhanar, 74
E Mohsin Mashkoor, 68 Zaki Sahar … 66
Ebadi Abdol Ghaffar, 70 Mosaviani Zinat, 74, 77 Z. Suleimenova 78
El-domany Ramadan, … 66
Eren Dagli Canan, 75 N
Esaulenko Elena, 76
Noronha Bobby 66,

O
F
Ospanov Kenes Sarsengalievich, 76
Fadl Gamal, 66
Fahim Rashida, 69
P
Poon Leo Lit Man 67
G
Palanci Yilmaz, 75
Gachkar Latif 69
Pisareva Maria, 76
Grudinin Mikhail 76
Gurdal Yilmaz 75
Q
Guruz Yuksel 72
Quinquis Benoit, 68

166
POSTER PRESENTATION
A D K

Abbas Tanveer 97 Dalbasti Tayfun 105 Kadanali Ayten 95,128,129

Abdybekova Aida Makenovna 121 Dauletbakova A.M., 87 Kader CigdeM 118
Degemerzanova N.K. 87
Abdukarimov, K. 89 Kadiroglu Ali Kemal 93
Demirli Keziban 92,111
Abilkasimov Zulfikar 98 Kanlibayeva, K. 89
Denisova T.G. 86
Adambekov Dokturbek 111 Davolos Ignacio 103 Kantara Ragibe 84
Ainur Arimbayeva, 89 Devdariani Khatuna Kara P›nar 85
Aisha R, 89 Georgiyevna 98 Karadenizli Aynur 107
Akbafl Emin Murat 126 Deveci Ugur 127 Karalnik B.V. 86,139
Aldjambaeva Irina 111 Dilek K›l›ç 94 Karamendin Kubey Karaevich 121
Alshynbekova Gulsharbat 98,117 Diusembaeva Ainash E. 117 Kargaltseva Natalia
Alan Sait 93 Dmitrovsky A.M 102 Michailovna 144
Dokmetas Ilyas 133
Albaeva G.M, 112 Kasap Murat 107
Doschanova Aigerim M. 110
Aldubaib Musaad Ahmad, 91 Kasenova Laura 91
Doostdar Sanaye Mehrnaz 109
Ali Gür 95 Doskozhayeva Suale 112 Katarbayev Amir 116
Altoparlak Ulku 95 Do¤an Ekrem 85,93,125 Kayrak Mehmet, 132
Altunkeser Bulent Behlul 134 Kazmi Shahana Urooj 125
Anar Rakisheva Sadvakasovna 87 Kelefl Mustafa 84,126
Arda Bilgin 104,105 E Kemal Nas 95
Ardalan Marlin2 84 Khairova Ulmeken 121
Ascioglu Sibel 123 Eren Dagli Canan 135 Kim Antonina 126
Erkoç Reha 85,125
Ashour Hossam M. 97 Kim Chul Sung 109,110
Erol Serpil 127,128,129
Avc› Alper 119 Knaus Anna 121
Erturk Ayse 95
Ayaz Celal 91,98 Esen Ramazan 85 Kolayl› Fetiye 107
99,100 Eshimov Aksar 115 Korkmaz Celalettin 100
136 Esimov Khamit Nurgazinovich 84 Kosherova Bahit 121,126
Aydemir Sohret 105 El-sharif Amany 97 Kozachenko N.V., 113
Aydin Kadriye 137 Kumisbayeva B, 89
Aygul Nazif, 134 Kurmanova Almagul 127
A. Alenova, 88 Kurmanova Gaukhar 127
F Konstantinidi Mark L. 84
A. Baisalmakov, 88
A. Rahisheva 88 Konstantinidi Tatiana
Farinati Alicia Esther, 103
Farshadzadeh Zahra 96 Anatolievna 84,117
Favorov Michael Olegovich 86 Kotova Albina 103
B Fernández María Isabel 103 Kõljalg Siiri 101
Filipenko Maksim 90 Kozlov Sergey S. 119
Bagherzadeh Yazdchi Sahar 99 Kuttykuzhanova Galiya S.D. 124
Balakan Ozan 93 Kyraubayev K. 130
Balik Ismail 118,122
G L
Baltinova Rosa 121
Bardak Selin 104,105 Geyik Mehmet FaruK
Bashir Miss Asma, 101 90,91,92 Lee Sang Don 109,110
Basugay Erol 127 98,99,100 Lee Sang Eun
Batmaz ‹brahim 92 114,119,123 López Santiago, 103
Baymukanova 130,131,136 Lõivukene Krista, 101
Kalamkash Shymbulatovna 117 145,146,147
Begaydarova Rosa Khasanovna, 148,147
98,117 Godunova M.I., 113 M
Goral Vedat 125
138,139
Goulmira Zhatkanbayeva 113
Beisembayeva Sholpan A. 90 Maden Emin, 100
Göktekin Serap 106
Bereketoglu Nuh 125 Guclu Ertugrul 85,92,111 Makulbayeva U 89
Birengel Serhat 118 Grushina Tamara Mehtap Bozkurt 95
Bocharov S. 89 Appolonovna 94 Memikoglu Kemal Osman 106,118,122
Botagoz K. 88 Gulbagdan Kydyrbayevna 98 Metin Dilek 104
Begaydarova Rosa Khasanovna Günal Ömer 85 Mikelsaar Marika 101
84,124,143 Gurbuz Yunus, 128 Mireyeva Alla 110
Beisembayeva Sh.A., 87 Guzel Asmetova 102 Mirzaei Mohammad 116,117,118
Bilen Yusuf 84 Muminov Talgat Ashirovich 86,90
H
Budak Fatma 107 Moghtadai Khorasgani Elham 96
Bukte Yaflar 92 Hakim Shazia Tabassum 125 Morguillo Pablo, 103
Han Chang Hee 109,110 Mujahid Talat Yasmin 101
C Hancer Fatma Nur 114,123,130,131 Musdubayeva B., 89
Hasan Najm 97 Mustafa Kemal 91
Calik Basaran Nursel 123 Hashad Mahmoud A 91 Mustafina Kamilya K. 103
Campana Victoria 103 Hoso¤lu Salih 99,131,136 Mustafa S.Kemalo¤lu 95
Canan A¤alar 94 147,148,149
Celen Mustafa K. 98,99,100
I
Çetinkaya Ramazan 84,126
Cevik Remzi 92 Iskakova Farida Arkenovna 86
Cho Won Yeol 109,110
Cho Yong-hyun 109, 110
Cilli Feriha 105 J
Ç›nar Güle 106
Çokca Fügen 106 Jehan Mrs Nayer, 101 167
 N R U

Naaber Paul, 101 Radfar Mohammad Hossein 116 Ucmak Hasan 93

Naderinasab Mahboobeh, 96 Rakisheva A., 87,91 Ulan M.B. 88
Naqvi Syed A. 97 Ramazanova Bahit A. 103 Ulgen Mehmet S, 132
Nas Kemal 92 Rodriguez-morales Alfonso J. 120 Ulug M1, Celen 136
Nazari Mansour 109,120 Rodríguez Stoup Victoria, 103 Ulusoy Sercan 104,105
Nebahat Tafldemir 95 Roza Dusembaeva 102 Ünlü Mehmet Agahan 106
Niyazalieva Mira 111, 133 Roza Kasymbekova 102 Urazbayeva Dinara C. 103
Nurshin K.A. 86 Ruksen Mete 104,104 Ustun CemaL 90,
Nurusheva Suale 115 91,92,98,99
S 100,114,119
123,127,130
O Sabahat Çeken, 94 131,134,145
Sadikov Askar M. 103 146,147,148
Oksuz Sukru 140 Sadikova Ainur Maralovna 139 149
Olga Efimova 102 Sagynbaeva B.A, 112 Utepbergenova G.A, 112, 135
Oncu Selcen 107 Sain Guven Gulay 123,138 Uyan›k Abdullah 84,126
Oncu Serkan 107 Saparbekov Marat 115 Uyan›k Hamidullah 84,126
Orazbayeva Gulsanat N. 103 Sasmaz Sezai 136 Uzun Kürsat, 100
Ortiz Corina, 103 Sayarlioglu Hayriye 85,93,125
Otarbaeva A.P. 112 Sayarlioglu Mehmet 93
Özaras Reflat 137 Sedat Kaygusuz, 94 V
Ozdemir Davut 92,111 Sencan Irfan, 128,133
Ozden Kemalettin 95,128,129 Sepp Epp, 101 Vahabi Surena 95
Ozturk Ikram Durç 125 Serik Ospanov, 88 Vahabo?lu Haluk 107
Serikbaeva Kamila, 91 Vahedi Mohammad Saleh 84
P Shchepetova Jelena, 101 Voor Tiia, 101
Sherwani Sikandar 101 Voronina Elena N 90
Panahandeh Zahra, 109 Shim Bong Suk 109,110 Vyskubov Denis 112
Parlak Mehmet 95,129 Shobeiri Fatemeh 109
Parmar Komal C, 141 Shopayeva Gulzhan A. 90 Y
Parmar C. 141 Shapiyeva Zhanna 121
Pepedil Funda 138 Sipahi O¤uz Reflat 104, 105 Yanmaz Evrim 122
Perez Cortizo Gonzalo 103 S. Beissebayeva 89 Yaflar Bukte 95
Plazun A.A… 86 Soltani Farzaneh 109 Yavuz Zuhal, 100
Polat Cegergun 118 Soyoral Yasemin 85 Yelena Jojua 102
Pourmand Mohammad Reza, 99 Starikov Juri Grigorievich 84,117 Yegemberdiyeva Ravilya 129
Pullukcu Husnu 1,105 Streltsova Kira G. 119 Yermukhanova Nurzhamal 121,122
S. Alenova, 88 Yildirim Mustafa 85, 92,111
Sh. Iglikova 88 Y›ld›r›m Ümran 85
S. Nurusheva, 114 Yousefi Frough, 96
Yurtseven Taflk›n 104,105

T W

Tanas Kadriye 84
Tasbakan Meltem 105
Taylan Özkan 123 Z
Tegin Ibrahim 90,114
Teke Turgut, 100 Zabihi Salah 84
Tekin Alp 85 Zakharkiv Yury F. 119
Tekin Recep 91,123 Zhakipbayeva B.T. 87
130,131 Zhandauletova Zh. T. 87
Truusalu Kai, 101 Zhantakbayeva Botagoz 126
Topal Nurhan 84 Zileli Mehmet 105
Tunger Alper 105 Zubova N.V., 102
Turhan Tuncer 105 Zh. Baisalmakov, 88
Tütüncü Ediz, 133

168
KEYWORDS INDEX
A haemorrhagic fever with renal syndrome 129 Botulism 154
A haemorrhagic syndrome 129 Brain abscess 133
A parasitic disease 122 Brucella 91,
A.baumannii, intravenous and intratechal colistin 107 93, 95
Able-boded and higher ages citizens 86 Brucellar spondylodiscitis 95
Abortion 116 Brucellosis 73,92
Abscess 138 93, 94
Acute bacterial prostatitis 109 Candida 77,114
Acute Flaccid Paralysis 154 Canser patients 40
Acute intestinal infections 138, 140 Carnivores 121
Acute surgical diseases 140 CAS Agar 163
Aeruginosa 150 Catheterization 160
Age children’s characteristics 155 cCatheter related infection 146
Airborne infections 143 cDNA of Salmonella 14
Algorithms 15 Cell line 154
Almaty 102 Central Asia, 14
Aloe vera 101 Cesarean section 111
Alterations of the immune system 71 Childhood, 34
Amitriptyline 121 Children 86,118
AmpC 39 127,139
Amphotericin-B 131 143,144
Anisakis 116 152
Anthrax 47,133 Children’s’ obstructive bronchitis 102
Antibiotic 40, 104 Chlamydia trachomatis 134
107 Chlorhexidine 96
Antibiotic cost 159 Cholera, 46
Antibiotic prescribing 104 Cholestasis 142
Antibiotic resistance 46,66,98 Chronic Renal Failure, 85
99,100,103 Chronic viral hepatitis 76
Antibiotic sensitivity 102 Chronic Virus Hepatitis B, 124
Antibiotic susceptibility 148 Clindamycin 97
Antibiotics 67,97,158 Clinic 73
Antidepressant drugs 121 Clinical current 152
Antifungal susceptibility 77 Clinical features 139
Antimicrobial 101 Clinical form 47
Antimicrobial activity 70 Clinical Infectious Hospital of Almaty city 154
Antimicrobial preparations 98 Clinical manifestations 46
Antimicrobial resistance 160 Clinical outcome 76
Antimicrobial therapy 103 Coa 99
Antimicrobial use 44 Coagulase negative staphylococci 97
Antimicrobials 17,50 Collaboration 14
Antimycobacterial activity 69 Commensals 69
Antioxidant activity 70 Community acquired pneumonia 50
Antiprotozoal drug 120 Complications 75
Anti-sporozoit vaccine candidate 72 Contamination 69
Anti-virus therapy 124 Contraception Methods 110
Antmicrobial resistance 102 Convulsion 131
Ascariasis 117,121 COPD 128
Ascaridosis 71 Coronary heart disease 70
Avian influenza 27 Correlation factors 160
Azoles 105 Corticosteroid Therapy 137
Bacillus anthracis 47,132 Country-wide 87
Bacteraemia 95 Cranberry 110
Bacteremia 145 Crimean-Congo haemorrhagic fever virus 129
Bacteria 69 Crimean-Congo hemorrhagic fever 128, 129
Bacterial infections 160 Cryptosporidium 118
Bacterial meningitis 69,135, 155 CT-scan, 122
BALB/c mice 116 Culture 152,162
Beta-lactamase 67 Cutaneous leishmaniasis 116
Beta-lactameses 39 Cytomegalovirus 157
Bilogically active admixture 124 Dairy products 164
Biofilm 66 Damage 110
Bioinformatics 120 Depression 84
Bioterrorism 47 Detectability 84
Blood 145 Developing countries, 62
Blood stream infection 106,144, Device related health care infections 146,147
145 Diabetic foot infection 66
Blood transfusion 71 Diabetic foot ulcer 159
Bottled mineral water 69

169
Diagnosis 34,75 H. Pylori 70
87, 88 H5N1 27,67
89,95 Haemoconcentration 133
129,136 Haemodialysis 85
157 Haemophilus influenzae 69,155
Diarrhea 118 Hairdressers 109
Differencial diagnostics 140 Hand Hygiene 146
Differential 88 HBV 126
Diphtheria 158 HBV infection 127
Disinfection, 76 HCV 125,127
DNA sequence 34 HCV1b 75
Doctors 75 Health care infections 147
Dog 118 Healthcare associated bacteremia 106
Dogs 153 Healthcare associated infection 145
DPPH 70 Healthcare associated meningitis 105
Drosophilamelanogaster 121 Healthcare related infections 62
Drug resistance genes 68 Healthy children 141
Drug-addict patients 159 Healthy volunteers 140
Dysbacteriosis 139 Heart 157
Dysentery 138 Helicobacter pylori 143
E. coli 102 Helminthes 121
Echinococcal disease 119 Helminthiases 117
Echinococcosis 122 Helminthozoonoses 121
Ecology 72 Hemodialysis 125,127
Ecthyma Contagiosum 136 Hepatitis 162
Ecthyma gangrenosum 131 Hepatitis 73
Efficiency 161 Hepatitis A 34
Efflux pumps 67 Hepatitis B 127
ELISA 91 Hepatitis C 124,126,127
Empiric and syndromic Treatment 111 Hepatitis C virus 75, 127, 128
Empirical antimicrobial therapy 101 HIV 109,113,127
Endocarditis 94,132 HIV-infection 73,115
137 High lethality 154
Enolase 157 High risk groups 111
Enteric infections 141 Hospital 17,96
Enterobiosis 117 Hospital acquired bacteremia 106
Enterococcus genomics 68 Hospital acquired meningitis 105
Epidemic process 60,115 Hospital personel 148
158 Hospital-acquired infection 145
Epidemical inspector 158 Human brucellosis 94
Epidemiological 15 Human myiasis 119
Epidemiological factors of Listeria infection. 153 Hydatid Cyst 119,124
Epidemiological situation 91,121 Hydatidosis 119
Epidemiology 28,46 Hydrophobia 153
47,113 Hyponatremia 133
Epididymitis 86 Hypotension 133
Epinephelus tauvina 116 ICCAID 14
Erythromycin 97 Identification 151
ESBL 39 Ig G antibody 70
Escherichia coli, 138 IL- 10 129
Esherichiosis 138 IL -6 129
Etiological structure 156 IL–1 129
Eurasia 14 Immune reaction 160
Execution of operationm 162 Immune suppressive Treatment 132
Extraintestinal E.coli 68 Immunity 125
Extrapulmonary Tuberculosis 85 Immunochromatography 152
Factors 72 Immunocompromised 40,77
Faecal fungal flora 140,141 Immunocompromised individuals 147
Feast of Sacrifice 136 Immunocorrection 111
Filariasis 123 Immunogenecity 126
Flora 133 Immunomodulating Preparations 112
Food quality 164 Imozimaza 159
FRAP 70 In vitro 117
Functional dyspepsia 143 Incidence 46
Fungemia 145 Infants 142,157
Gene SLC11A1 90 Infection 17,28
General surgery unit 148 Infection 76
Genetic polymorphism 90 Infection control 62,146
Genital herpes 112 Infection control committe 149
Genotyping 150 InfectiousDiseases 14,144
Giardiasis 71 Infective endocarditis 75,132,134
Gonorrhea 74,78 Infertility 162
Good prognosis 128 Influenza 67,161
Goventmental 44 Influenza viruses persistence 161
Gram-negative bacteria 39, 99 Influenzae 162
H. Aphrophilus 133 Inpatients 140
170
Integrons 68,102 MRI 92
Intensive care unit 101,149 MRSA 66, 99
150 148, 163
Intensive care unit infections 147 MTT Assay 117
Interferon 75 Multi-drug resistant 99,107
Interleukine-1 127 Multidrug Resistant M. Tuberculosis 69
Interleukine-1 73 Multiple lesions 136
Interleukine-2 127 Multiple myeloma 123,135
Intermittent tuberculosis treatment 85 Mycobacterium tuberculosis 60
International 14 Mycoplasma 162
Interstitial nephritis 111 Nasal carriage 148
Intervention 44 Needle prick injuries 67
Intestinal infections 143 Neurobrucellosis 92
Intrauterine Devices 110 Neurology intensive care unit 147
Iran 109,154 Neutropenia 40
ITS2 120 Nocardiosis 137
‹ndicators 17 Non intensive care unit patients. 146
Jail 74, 78 Nonpolio Entroviruses 154
Kerby Bauer method 97 Nosocomial bacteremia 106
Kidney 110 Nosocomial Infections 67,76,99
Knowledge 75,109 100,147,148
Laboratory verification 154 149,150
Lambliasis 118 Nosocomial infection 99
Laser scanning Beam 143 Nosocomial 128
Leishmania major 116 Nosologic 15
Leishmania tropica 117 NS5A, 75
Leptospirosis 111 Obstetrics 111
Leukemia 98 Opisthorchisis 73
Levamizol 121 Opportunistic infection 137
Linezolid 98 Oral cavity, 133
Liquidation 158 Orf, 136
Listeria infection in Kazakhstan clinical aspect and Organometallic Compounds 163
Listeria monocytogenes 102 Osteoarthricular tuberculosis 88
Listeriosis 152 Outbreak 151
Liver Cirrhosis 125 Oxygen free-radical 110
Liver functions 89 P. Aeruginosa 100
Local antibiotic resistance profile 101 P. aeruginoza 131
Low effeciency of treatment 154 Pandemic 27
Lower respiratory tract infection 144 Parapox virus 136
Lung ascess 135 Parasitic diseases 34, 71
Lyell’s syndrome 134 Parenteral nutrition 151
Lymphatic 123 Pathogenesis 27
Lymphocytes 87 PB1, 67
Lymphocyte's profile 73 PB2, 67
Malva sylvesteris 96 PCR 91
MASCC 40 PCR, 94
Mass Immunization 126 PCR-RFLP 99
MDR 88 Peganum harmala extract 116
MDR- TB 90 Pegasis 126
Measles 143,162 Pegintron 124,126
Medical treatment 95 Pelvic inflammatory disease 115
Medicinal Plants 69 Pemphigus vulgaris 132
Medullar compression 95 Penitentiary 87
Meningitis 92,132 Penitentiary system 74
156 Peritoneal dialysis 85,127
Meningococcal infection 156 Persistence 72
Meningococcal infections 155 PFGE 66
Meta-analyses, 75 Phoenix BD 151
Methodological 15 Phylogenetics 120
MIFA PKRbd 75
(enzme immunodetection on membranous sorbent) 161 Plant extracts 101
Microarray techniques in Microbial clinicals 14 Pneumonitis 27
Microbiological anlysis 164 Policy 44
Microbiological efficiency 103 Polymerase 67
Microbiological investigation 62 Postneurosurgical meningitis 105
Microbiology 109,144 Postsurgical meningitis 105
Microflora 160 Pregnancy 114
Microscan system 151 Pregnancy pathologies 116
Mitral valve repair 132 Preparedness 27
Mix-invasions 71 Prescription 107
Molecular 34 Prevalence 118,149
Molecular epidemiology 151 Primary health-care 107
Molecular typing 66 Prognosis cancer patients 71
Morbidity 163 Prostatitis 160
Mouse model 27 Pseudomonas aeruginosa 99
171
 Pulmonary 88 Sterilization 76
Pulmonary disease 128 Stewardship 17
Pulmonary emboli 135 Strains 120
Pulmonary tuberculosis 90 Streptococci 96
Pulmonary Valve 134 Streptococcus 98
Purulent bacterial meningitis 156 Streptococcus pneumoniae 69,155
Pyelonephritis 114 Surgical site infections 148
Pyogenic-inflammatory diseases 158 Surveillance 148,149,150
Pyoinflammatory diseases 159 Susceptibility 109
Quantitative culture 144 TB 86
Rabies 153 Test 97
Reactogenecity 126 Thalidomide 135
Recombinant vaccines 162 The hard-to-reach population’s elements 76
Rehabilitation 95 The HIV/AIDS-infection 112
Renal involvement 93 The tropical diseases in Kazakhstan 122
Reproductive age 116 Tiberal 118
Research 162 Tonic-clonic seizure 131
Resistance 76,96 Topical treatment 116
Respiratory infection 104 Toxic Epidermal Necrolysis (TEN) 134
Retrospective study 67 Toxicology 121
Ribavarin 126,129 Toxocara 120
Ring annuloplasty 132 Toxocarosis 71
Risk-factors 129 Toxoplasma gondii 72
Roncoleicin 102 Treatment 36,47,50
Roncoleukin 69,155 71,90,102,
Ronkeleukin 88 114,124,141
Rose Bengal Test 94 Trichomonas vaginalis 74,78,120
Rosmarinus officinals 70 Tuberculosis 74,75,84
Rubella 143,163 85, 86, 87
S. typhi, Nontyphoid Salmonella serotypes 88,89,90
(NTS) 46 91,156
Sacroiliitis 137 Tubulointerstitial nephritis 93
Salmonella 46 Tumor Necrosis Factor– a 129
Salmonella enteritidis 98 Turkey 34,75,136
Salmonella Gene Expression 14 Turkish Experience 34
Salmonella typhi 137,152 Typhoid fever 36,46
Salmonella typhimurium 98 Ultrasound 111
Salmonellas 138 Ureaplasma 162
Salvadora persica 96 Urinary Infection 103
Sarcoidosis 89 Urinary tract infection 93
Saudi Arabia 91 Urogenital canal 112
Scar of a uterus 111 Urogenital infections 104
Scrotum 123 Urogenital trichomoniasis 120
Sensibility 120 Urological stains 103
Sensitivity 98 US 122
Sepsis 133,146 UTI 97
Septic thrombophlebitis 93 Utilization 104
Sero protection 126 Vaccination 34,36,72
Serological 162 161,162
Serological diagnostics 94 Vaccine 28
Serology 94 Vaccines 27
Seroprevalance 127 Vaginal birth 111
Serratia marcescens 151 Vaginitis 110,114
Serum trace elements 90,115, 146 Vancomycin 98
Sexual transmitted diseases 115 Veast 105
Shigella Flexneri 139 Vesico-ureteric reflux 110
Shigella Sonnei 139 Vi polysaccharide vaccine 36
Shunt infection 105 Vibrio cholerae 46
Sick rate 84,117 Viral hepatitis 124
138,143 Virulence factors 72
Siderophore 163 Visceral leishmaniasis 123
Smears, 145 VNTR 87
Soft tissue 138 West Nile 28
Soft tissues 159 Widal test 152
Solid-tumor 98 Wild rue extract 117
Spa 99 Wound infection 158
Sphingomonas paucimobilis 147 Wound infestation 119
Spondylodiscitis 92 Years of potential life lost due to mortality
Spontaneous HBV seroconversion 125 (YPLL) 86
Standardization 15 Yersinosis 136
Standards 17 Ziehl-Neelsen 118
Staphylococci spp. 100 Zoonosis 116
Staphylococcus 98
Staphylococcus aureus 97
Staphylococcus warnerii 137
172