refugee health and the risk of cutaneous leishmaniasis in europe

Abstracts / International Journal of Infectious Diseases 53S (2016) 4–163

19.205
Dengue virus nonstructural protein 1 induces
platelet activation and promotes platelet
aggregation
C.-H. Chao
Basic medical sciences of National Cheng Kung
University, Tainan/TW
Purpose: Dengue virus (DV) infection is currently regarded as
the most important mosquito-borne viral infection. The clinical
symptoms of dengue have a large spectrum from febrile illness to
severe syndromes accompanied with bleeding and shock. Thrombocytopenia and vascular leak are the two common features of
severe dengue. Recently, it was found that DV nonstructural protein
1 (NS1) which can be secreted into blood during DV infection, can
cause vascular leak. However, whether secreted NS1 is involved in
the pathogenesis of thrombocytopenia is still unclear. In this study,
we investigated whether NS1 could directly bind to platelet and
studied its effect on platelet activation.
Methods & Materials: Freshly isolated platelets were incubated with DV NS1 produced by Drosophila S2 cells. The binding
of NS1 on platelets was observed by immunofluorescent confocal
microscopy. The effects of NS1 binding on platelet activation were
measured by src phosphorylation, P-selectin expression, cytokine
secretion and platelet aggregation.
Results: We demonstrated that NS1 could co-localized with
TLR4 on platelets by confocal microscopy. In addition, binding of
NS1 to platelets induced Src-Y418 phosphorylation within 5 to
15 minutes, and this effect could be blocked by the presence of
certainly anti-NS1 monoclonal antibody. P-selectin expression and
macrophage migration inhibitory factor secretion were increased
in platelet after NS1 stimulation. In addition, NS1-activated platelet

have higher aggregation response in the presence of suboptimal
dose of ADP or thrombin stimulation.
Conclusion: Our results suggested that DV NS1 could directly
bind to platelets and induce platelet activation through src signal transduction, which may enhance platelet aggregation. These
results may explain part of the causes of thrombocytopenia and
re-emphasize the critical role of DV NS1 in dengue pathogenesis.
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Dengue transmission through human
movement in regular and seasonal patterns on
Koh Chang island in Thailand
C.Y. Hou a,∗ , P. Kittayapong b , J. Mumford a , L.R.
Carrasco c
a

Imperial College London, London/UK
Mahidol University, Bangkok/TH
c National University of Singapore, Singapore/SG
b

Purpose: Mosquitoes serve as vectors for many infectious diseases, of which a growing concern is dengue in Southeast Asia.
Control of vector-borne diseases is a substantial public cost and
personal mosquito control imposes a burden on many individual
households. Average annual national dengue incidence in Thailand
from 2000-2011 was 115 cases per 100,000 people, while on the
island of Koh Chang in the Trat province of Thailand the annual
incidence was on average 196 cases per 100,000 people over a
similar time period. Movement from mainland Thailand and from
nearby Cambodia may be driving the dengue dynamics at this local
scale. As a case study of a location with high tourism and seasonal

95

movement, this work aims to estimate the ranges of relevant
parameters that could impact local disease transmission in order
to understand disease dynamics influenced by human movement.
Methods & Materials: This study investigates non-seasonal
and seasonal human movement through networks of human and
mosquito populations in 6 residential communities in Koh Chang.
Using 2-patch and 3-patch metapopulation models, we estimate
the range of secondary cases, the basic reproductive ratio R0 , in
response to two parameters: the rate of movement between Koh
Chang and Cambodia and the rate of infection in Cambodia.
Results: We present results from multi-patch metapopulation
models that show how movement at local and regional scales may
impact R0 . We graph potential dengue cases resulting from ranges
of parameters estimating human movement and dengue incidence
to suggest what may lead to a local R0 ≥ 1 in Koh Chang.
Conclusion: The aim of this work is to model dynamics in disease risk and dispersal involving human movement, human disease
cases, and mosquitoes in a case study of Koh Chang, Thailand. An
understanding of human movement at the local and regional scale
may be helpful for disease management and preparation.
/>19.207
Refugee health and the risk of cutaneous
Leishmaniasis in Europe
A. Khamesipour a,∗ , B. Rath b
a

Tehran University of Medical Sciences, Center for
Research and Training in Skin Diseases and Leprosy,
Tehran/IR

b Vienna Vaccine Safety Initiative, Berlin/DE
Purpose: Leishmaniasis is a vector-borne neglected disease
caused by different species of intracellular Leishmania parasites
transmitted by sandfly species. The clinical manifestations of the
disease range from cutaneous leishmaniasis (CL), the most common form of the disease, to the potentially lethal forms of visceral
leishmaniasis. CL may be transmitted as a zoonotic disease caused
mostly by L. major in the Old World with small rodents serving as
the animal reservoir. Anthroponotic CL on the other hand, is caused
by L. tropica and transmitted through P. sergenti sandflies. In Syria,
CL is a well-known disease (“Aleppo boil”), but incidence rates had
decreased significantly prior to the civil war.
Methods & Materials: Risk assessments are based on World
Health Organization estimates that currently, a tenth of the world
population are at risk of leishmaniasis. The disease has been
reported from 98 countries on four continents leading to a loss in
disability-adjusted life years (DALYs) of about 2.4 million. Leishmaniasis is endemic to 14 of 22 EMRO/WHO countries, including
regions where the highest number of refugees to Europe originate,
including Syria, Iraq and Afghanistan, where L. tropica predominates.
Results: Although currently there is little information on the
prevalence of CL in Iraq and Syria, we found that >50,000 cases
have been reported in 2015 from the areas under Syrian government control, representing a dramatic increase in CL incidence in
the region. Refugees may be spreading L. tropica during migration, and cases have been observed in Lebanon, Turkey, Greece
and other parts of Europe. The vector, P. sergenti, is wide-spread in
the Mediterranean, including Cyprus, France, Greece, Italy, Malta,
Portugal and Spain. The authors present a needs-assessment for the
timely detection of leishmaniasis in Europe, along with an update
on the current state of diagnostics, therapy and vaccine development.


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Abstracts / International Journal of Infectious Diseases 53S (2016) 4–163

Conclusion: The possibility of transmission is high as long as
the vector is present. Permissive vectors, i.e those supporting the
development of most of Leishmania species, exist in many parts of
Europe. Physicians taking care of refugees and migrants in Europe
should be educated to identify cases early and to develop adequate
management and surveillance systems.
/>19.208
Three patients from Suriname with possibly
Zika virus associated Guillain-Barré syndrome
T. Langerak a,∗ , H. Yang b , J. Codrington c , H.
Alberga b , B. Jacobs d , C. Geurts van Kessel e , C.
Reusken f , M. Koopmans g , E. van Gorp h , S.
Vreden b
a

Erasmus Medical Centre, Viroscience, Rotterdam/NL
Academic Hospital Paramaribo, Neurology,
Paramaribo/SR
c Academic Hospital Paramaribo, Diagnostic
Laboratory, Paramaribo/SR
d Erasmus MC, Neurology&Immunology,
Rotterdam/NL
e Erasmus MC, Viroscience, Rotterdam/NL
f Erasmus Medical Center, Viroscience, Rotterdam/NL
g Erasmus Medical Centre, Rotterdam/NL
h Erasmus Medical Center, Rotterdam/NL
b

Purpose: Since the Zika virus (ZIKV) outbreak in South-America,
an increased incidence of microcephaly and the Guillain-Barré syndrome (GBS) is reported in several countries in South-America.
Here we present three patients with GBS during the ZIKV outbreak
in Suriname who were diagnosed in February and March 2016.
This case series shows the diagnostic challenge to prove the clinical
diagnosis of GBS in relation to ZIKV infection.
Methods & Materials: Plasma, serum and urine samples were
collected from the patients. RT-PCR for ZIKV was performed in the
urine and plasma. Presence of ZIKV antibodies in the serum was
tested with a ZIKV ELISA (Euroimmun, Lübeck, Germany) and a
virus neutralisation test. A multiplex serological protein microarray
using recombinant proteins was used for detection of Flaviviruses
and Chikungunya antibodies in the serum samples. ELISA was used
to detect IgM and IgG anti-ganglioside antibodies in the serum.
Results: The three patients had clinical signs and symptoms
of GBS, and the diagnosis was confirmed by the findings in cerebrospinal fluid and nerve conduction studies (NCS). The clinical
course of GBS in these patients was relatively mild and specific
treatment was not administered. The antiganglioside antibodies
were negative in all patients. One patient had a positive ZIKV
urine real-time PCR (RT-PCR) result. The other two patients had
a negative ZIKV urine RT-PCR but a positive virus neutralisation
test and presence of IgG antibodies against ZIKV in the serum.
Serological testing for recent infections with Campylobacter jejuni,
Cytomegalovirus and Epstein-Bar virus were negative.
Conclusion: To prove that a GBS case is triggered by ZIKV is difficult, especially after the viraemic period of ZIKV. However, taken
into account the increased GBS incidence that coincided with the
ZIKV outbreak in Suriname and the absence of most prevalent preceding infections of GBS in these patients, it is plausible that the
GBS in these patients is triggered by ZIKV infection in the recent
past.

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19.211
Malaria - a new re-merging disease in Albania
P. Pipero a , N. Como a , A. Harxhi a , E. Meta b , A.
Ndreu b , T. Kalo b , S. Bino c,∗ , M. Kokici d , T.
Myrseli e , D. Kraja a
a

Medical University of Tirana, Infectious Disease
Clinic, Tirana/AL
b University Hospital Centre, Infectious Disease
Clinic, Tirana/AL
c Institute of Public Health, Department of Infectious
Diseases, Tirana, ALBANIA/AL
d Medical University of Tirana, Clinical Laboratory,
Tirana/AL
e Public Health Institution, Infectious Disease,
Tirana/AL
Purpose: Albania was listed as an endemic area from the beginning of the 20th century. It was eradicated in 1967 and around 1994
the movement of people for work purposes and tourism to tropical areas,malaria reappeared again, already imported. The aim is to
note that malaria is re-emerging diseases in Albania.
Methods & Materials: We analyzed the etiological aspect, the
cause was determined on UHC laboratory and IPH, using method
the point of thin and thick blood. Epidemiological aspects-defined
the countries from which they came after the epidemiological
investigation. It was determined the age group and gender, season
and month of occurrence of malaria. Clinical aspect - the patients
were grouped according to clinical-biological data’s and preclinical
manifestations of different bodies taking into account the classification of cases according to the gravity and possible complications.
We included 27 cases of imported malaria in our country, the age

group 19-58 years old, during the period 2012 to 2016 on the infectious diseases service UHC.
Results: Based on etiological causes we found out 17 cases P
Falciparum, 1 case P Vivax, 6 cases P Oval, 3 mixes (P Oval and P falciparum). Epidemiological data: 1 case from Ghana, 1 from Greece,1
from Papua New Guinea,1from Cad, 2 from Nigeria,21 from Ecuatorial Guinea. All cases were male,19-30 years old 12 cases,31-40
years old 9, 41-50 years old 5, 51-58 years 1. Based on seasonality.
8 cases in the spring (april-may), summer 5, autumn 8(Octobernovember),in winter 6. Clinical classification:simple attacs 7, with
hematological, hepatic and renal alterations 16, cerebral malaria
4 cases where 1 was died. Clinical progress classification: primary
attacks 19, recrudesence 3, relapses 3, reinfections 2.
Conclusion: We identified 4 etiological factors, P.falciparum
62.9%, P. Vivax 3.70%, P. Oval 22.3% and mix causes 11.1% (P falciparum and P Oval). Distinguished in 6 different countries. Malaria was
present in all seasons. Exitus in 3.7%. Malaria already considered a
re-emerging disease in Albania. The presence of transmitting vectors not excludes the possibility of return to its native form, which
is in the attention of public health institute.
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