Saturday afternoon, 1 October 2016

The last ‘Meet the Infectious Disease Specialists™’ seminar of 2016 was held in the Lecture Theatre of the Gleneagles Hospital on 1st October 2016 afternoon. Before the start of the seminar, representatives from our sponsor, MSD gave an introduction on audience participation in the interactive seminar by using a website on their mobile phones and also pose questions to the speakers.

Dr Wong introduced the 4 scheduled speakers, and also announced to the 143 participants that there was a surprise guest speaker, Dr David Allen, the Courage Fund Visiting Professor. Dr Allen will present an interesting case of severe viral infection.

Dr Lui Hock Foong , Gastroenterologist at Gleneagles Hospital , was our first speaker. He gave a brief description of each Hepatitis virus from A to E including viral characteristics, host, incubation period, transmission, epidemiology, clinical features, severity, diagnostic testing, treatment and vaccination. Hepatitis A&E infection result from faeco-oral transmission and are largely self limiting illnesses. In contrast, Hepatitis B&C result from blood/body fluid borne transmission and may result in chronic infection. Delta Virus occurs in conjunction with Hepatitis B.

Pediatrician Dr Liew Woei Kang of Gleneagles Hospital discussed the various Enterovirus (EV) Infections in children including hand, foot and mouth disease(HFMD) , EV Meningitis, EV Encephalitis, Neonatal EV sepsis. He described the investigations, clinical management , prevention and control of each of these infections. In summary, Dr Liew emphasized that :

  • HFMD is usually a mild disease but complications can occur including meningitis, encephalitis, flaccid paralysis, hepatic necrosis, myocarditis and pneumonitis
  • EV PCR is the diagnostic method of choice for EV infection. It is rapid, sensitive.
  • Clinical management is mainly supportive
  • Hand Hygiene is the best prevention

Dr Shawn Vasoo, infectious disease physician from TTSH provided the current landscape for rapid viral diagnostics, especially in the outpatient setting. He covered the use of testing for arboviruses, blood borne-viruses (HIV, Hepatitis), respiratory tract infections and also the limitations of these tests. In summary, Dr Vasoo highlighted these points :

  • For Arboviruses – Dengue NS1/IgM/IgG tests are sensitive and accurate when used in combination. Rare false positive NS1 results occur. Zika serologic tests are difficult because of cross reactions and several kits are undergoing verification
  • HIV serology: Beware of the eclipse and window period. 4th/5th Generation tests combining antigen and antibody testing are more accurate. Repeat testing in 2-3 weeks or use HIV viral load in patients suspected to have seroconversion illness.
  • New rapid influenza tests (with desktop optical readers) may be helpful to guide therapy and reduce antimicrobial use

Dr Wong spoke about the various severe Viral Respiratory Tract Infections (RTI) in adults including pneumonia, MERS CoV , avian influenza and other emerging RTI. He concluded with the following:

  • Respiratory viruses are important cause of severe RTI
  • There is a greater appreciation of their role in pneumonia in children and adults
  • We live in a crowded and interconnected planet. Infections previously confined to one geographic location are now often globally relevant: examples are MERS-CoV in South Korea, Ebola in US
  • Emerging infections are expected to be the norm in future
  • Healthcare institutions have been linked to clusters and outbreaks of emerging infections, especially RTI

Dr Lam and Dr David Allen discussed interesting case presentations. Dr Lam went on to elaborate on Dengue and Zika virus infections. Dr Allen provided details on Herpesviridae Family viruses and discussed the severe complications of EBV infection.

We wish to thank our colleagues from Gleneagles Hospital and other fellow ID Physicians for making this seminar a successful one. We are also grateful to MSD for their support in organising this seminar.

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