Diagnosis of Cutaneous Leishmaniasis using Microscopic Detection and Molecular-based PCR Assay Techniques

: 2.028_INF Diagnosis of Cutaneous Leishmaniasis using Microscopic Detection and Molecular-based PCR Assay Techniques Y. Wang, R. Armijos, M. Weigel, A.O. Balogun, T. Sorocco, W. Cevallos, X. Sanchez, E. Puebla, R. Rodriguez; Indiana University, Bloomington, Indiana, USA, Universidad Central del Ecuador, Quito, Ecuador Background: Molecular identification of Leishmania species using Polymerase Chain Reaction (PCR) has been studied as a more sensitive approach compared to parasitological and microscopic methods. However, in many Cutaneous Leishmaniasis (CL) -endemic areas in low and middle income countries, there is little to no infrastructure to conduct PCR assays on the site. PCR-based molecular diagnosis aids in CL treatment and follow-up due to its higher sensitivity and specificity. Methods: Our sample consisted of 16 subjects with suspected cases of CL in North West Ecuador. We used the tissue smear which is the gold standard diagnostic method as well as two molecular-based PCR-assay methods cytochrome B (cyt B) PCR and the Internal Transcribed Spacer 1 (ITS1) PCR and compared results. Tissue smears were obtained from patients and examined under the microscope on site. Also, tissue samples were obtained using FTA cards and transported to a laboratory for DNA extraction and PCR assay. Findings: Identification using microscopic tissue smear yielded a sensitivity of 56.25% compared to Cyt B PCR (87.5%) and ITS1 PCR (93.75%). An additional benefit of the molecular methods was the ability to identify the exact species of Leishmania following sequencing of the PCR product. Interpretation: Our results suggest that molecular techniques are indeed more sensitive than the use of microscopic smears. The FTA cards proved effective at retaining the integrity of the samples during transportation to the laboratory and could also be used more often in addition with PCR for Leishmaniasis diagnosis. Source of Funding: Indiana University Bloomington. Abstract #: 2.030_INF: 2.030_INF Patterns and Perceptions of Self-Prescribed Antibiotic Use in

Background: Many HIV testing services campaigns for young people are designed by experts with limited input from young people. Hackathons are events in which a diverse community of individuals collaborates over several days, typically developing a new technology. We adapted the concept of a hackathon to focus on developing a community-based HIV testing campaign for young men who have sex with men (MSM).
Methods: We implemented a crowdsourcing designathon focused on creating an HIV test promotion campaign for young men who have sex with men (MSM). The intensive 72-hour crowdsourcing designathon contest brought together eight multi-sectoral teams with expertise in public health, design, advocacy, and communications. The incentive to participate was having the finalist campaign implemented among young MSM in eight Chinese cities.
Findings: A total of 53 individuals applied to participate and 40 were selected to join the designathon. Among the 40 participants, 30/40 (75%) were 30 years or younger, 16 (40%) were young students. Campaign themes developed by the teams were compelling and feasible. Two teams were commended as exceptional, forming the basis for an eight-city HIV testing campaign to be evaluated using a stepped wedge randomized controlled trial (ClinicalTrials.gov NCT02796963). Major themes included HIV self-testing and using social media to promote HIV testing. Six images from the crowdsourcing designathon were included in the final implemented campaign.
Interpretation: Crowdsourcing designathons may be useful for creating more engaging and effective health campaigns for youth, including young MSM. This method increased youth ownership of the HIV testing campaign. Background: Molecular identification of Leishmania species using Polymerase Chain Reaction (PCR) has been studied as a more sensitive approach compared to parasitological and microscopic methods. However, in many Cutaneous Leishmaniasis (CL) -endemic areas in low and middle income countries, there is little to no infrastructure to conduct PCR assays on the site. PCR-based molecular diagnosis aids in CL treatment and follow-up due to its higher sensitivity and specificity.

Source of
Methods: Our sample consisted of 16 subjects with suspected cases of CL in North West Ecuador. We used the tissue smear which is the gold standard diagnostic method as well as two molecular-based PCR-assay methods -cytochrome B (cyt B) PCR and the Internal Transcribed Spacer 1 (ITS1) PCR and compared results. Tissue smears were obtained from patients and examined under the microscope on site. Also, tissue samples were obtained using FTA cards and transported to a laboratory for DNA extraction and PCR assay.
Findings: Identification using microscopic tissue smear yielded a sensitivity of 56.25% compared to Cyt B PCR (87.5%) and ITS1 PCR (93.75%). An additional benefit of the molecular methods was the ability to identify the exact species of Leishmania following sequencing of the PCR product.
Interpretation: Our results suggest that molecular techniques are indeed more sensitive than the use of microscopic smears. The FTA cards proved effective at retaining the integrity of the samples during transportation to the laboratory and could also be used more often in addition with PCR for Leishmaniasis diagnosis.

Source of Funding: Indiana University Bloomington.
Abstract #: 2.030_INF

Patterns and Perceptions of Self-Prescribed Antibiotic Use in Guayaquil, Ecuador
O. Hall 1 , L. Malter 1 , E. van der Linden 2 , J. Weinstein 1 ; 1 New York University School of Medicine, New York, USA, 2 Fundación Sonrisa Naranja, Guayaquil, Ecuador Background: The rising incidence of antibiotic-resistant disease is partially attributable to the extensive use and misuse of antibiotics. Ecuador has the second highest rate of per-capita antibiotic consumption in Latin America. The purpose of this study is to identify factors that contribute to self-prescribed antibiotic use in a lowincome neighborhood of Guayaquil, Ecuador's largest city, where antibiotics are frequently available over-the-counter.
Methods: Qualitative, oral interviews were conducted with local residents who had seen a physician in the last two years (group A, 101 subjects) and those who had not for two years or more (group B, 100 subjects). Subjects were recruited at a local medical clinic and a nearby food market.
Findings: Although 71% of subjects overall report that they believe antibiotics could be dangerous for them, 74% have self-medicated with antibiotics in their lifetime, and 43% have taken antibiotics in the last month. 73% of subjects report taking just one or two antibiotic pills when they self-medicate. There were no differences between groups for these findings, but subjects in group A were more than twice as likely to have spoken with a physician before starting antibiotics the last time they took them (56% vs. 25% p<0.001), and more than three times as likely to complete a full course of antibiotics that had been prescribed by a physician (41% vs. 13% p<0.001). Overall, 78% of subjects who had children under the age of 18 reported self-medicating with antibiotics, but 85% said Infectious Diseases Old and New e Implications for Global Health J a n u a r y eF e b r u a r y 2 0 1 7 : 1 5 6 -1 6 9