سال:1398 | دوره: | شماره: |تعداد مقالات:15

Introduction: Chlamydia psittaci is an intracellular and zoonotic pathogen that is transmitted through contact with birds. This pathogen causes various clinical manifestations, including subclinical cases and fatal cases. On the other hand, the variety and low specifi city of many of the symptoms make diagnosis diffi cult while early detection of the disease causes a signifi cant reduction in mortality. Case Presentation: The patient was a 47-year-old man with a history of headache, fever, chills, dyspnea, and productive cough with a primary diagnosis of sinusitis, which was treated with co-amoxiclav. Due to the lack of recovery, the patient was hospitalized with the diagnosis of pneumonia and was treated with meropenem and levofl oxacin. After showing no improvement and fi nding out about the history of contact with a parrot, the treatment was changed to Doxycycline and Ceftriaxone, which led to the reduction of symptoms. Eventually, due to the patient’ s positive serological tests, the diagnosis of Chlamydia Pneumonia was established and the patient was discharged with oral doxycycline. Conclusions: As the fatality rate of psittacosis in absence of treatment is high, it is necessary to treat the patient immediately.

Objectives: Acinetobacter baumannii has emerged worldwide as a major nosocomial pathogen. The aim of this study was to evaluate the MLVA-8Orsay scheme suitability for clustering and diff erentiating A. baumannii strains isolated from two hospitals in Tehran. Methods: A panel of eight variable-number tandem-repeat (VNTR) markers was used for typing analysis (MLVA-8Orsay) of 89 carbapenem-resistant A. baumannii strains isolated from two hospitals in Tehran. Results: Abaum0845 (S-VNTR marker) was excluded from the MLVA scheme because of its great allelic diversity at this locus. The modifi ed MLVA-7 scheme provided excellent discriminatory power and detected 82 MLVA types among the 83 isolates. Additionally, the great diversity associated with MLVA markers did not permit to apply the previously proposed criteria for clustering the isolates. However, six MLVA complexes were defi ned assuming a 71% genetic similarity cut-off , corresponding to the existence of identically sized alleles for at least fi ve VNTR markers. The blaOXA-23-like gene (93. 2%) was the most prevalent gene in resistant isolates collected from the two hospitals. Conclusions: MLVA-7 discriminatory power was found to be excellent. This method was also appeared to be useful and reliable in epidemiological investigations of A. baumannii strains. MLVA-7 analysis revealed that carbapenemase-carrying A. baumannii isolates might be polyclonal and provided evidence for gene transfer among diff erent strains collected from the two hospitals. Overall, the study provided evidence supporting the use of MLVA-7 scheme as an alternative or complementary method for typing of A. baumannii isolates.

Dear Editor, In spite of the availability of a prophylactic vaccine for more than two decades, infection with hepatitis B virus (HBV) has remained a serious global public health problem. After the signifi cant advancements in the worldwide eradication of hepatitis C virus (HCV), it is believed that the eradication of hepatitis B is also possible (1). However, despite the several attempts toward the elimination of hepatitis B, no cure is available for chronic HBV (CHB) infection (2, 3).

Background: The increased prevalence of extended-spectrum -lactamases (ESBLs)-producing virulent strains possibly leads to serious outbreaks in hospitals. Objectives: The aims of the study were to detect ESBLs in Klebsiella pneumoniae isolated from patients in intensive care units (ICUs) of a hospital and to investigate their genetic relationships. Methods: A total number of 85 K. pneumoniae isolates were detected in the specimens of ICU patients in a tertiary hospital in the southwest of Tehran, Iran. Antibiotic susceptibility was determined by the disk diff usion method. The rmpA and wcaG virulence genes were detected by polymerase chain reaction (PCR). The ESBL-positive isolates were typed using multilocus variable-number tandem repeat analysis (MLVA) method. Results: Of the 85 K. pneumoniae isolates, 48 (56. 5%) produced ESBLs. There were statistically signifi cant diff erences in the prevalence of virulence genes based on ESBL production. The typing of the 48 ESBL-positive isolates showed a signifi cant genetic relatedness with the identifi cation of nine MLVA types. Conclusions: This study showed a relatively high prevalence of ESBL in K. pneumoniae isolated from ICU patients and a low diversity between these isolates. The selection of ESBL-producing clones was mainly responsible for the spread of K. pneumoniae in the ICUs.

Background: Leishmaniasis is a parasitic infection caused by the Leishmania spp. and transmitted via the bite of infected female Phlebotomine sand fl ies. Health education is one of the important approaches to increasing knowledge and awareness of the community about leishmaniasis health issues. Objectives: The aim of this study was to assess the eff ect of health education on knowledge, attitude and practice (KAP) of health volunteers about leishmaniasis in some areas endemic for cutaneous and visceral leishmaniasis. Methods: In this KAP study, 104 health workers (41 from East Azerbaijan, 41 from Khorasan Razavi and 21 from Ilam provinces) were participated in the study. For this purpose, a questionnaire containing 11 items on knowledge, 10 items on attitude and 13 items on practice was used before and after educational intervention. The results were analyzed by SPSS version 22 using Wilcoxon test, Kruskal-Wallis test, McNamar’ s test, and Fisher’ s exact test. Results: The results showed a signifi cant diff erence between pre and post-educational intervention scores. These results were reported for each province and for total subjects. KAP among the studied population was at a moderate level before the intervention, and it increased to high levels after the intervention; this diff erence was statistically signifi cant (P < 0. 01). After the intervention, there was a signifi cant diff erence between the provinces. After the intervention, the level of knowledge in Ilam was signifi cantly higher than Khorasan Razavi and Azerbaijan provinces (P < 0. 01). Attitude scores were signifi cantly lower in Khorasan Razavi Province compared to Ilam and East Azerbaijan provinces (P < 0. 01), and practice had improved more signifi cantly in Khorasan Razavi province compared to Ilam province (P < 0. 01). Conclusions: Health education can be considered as a simple and inexpensive approach to increasing KAP among health volunteers, and it can play an important role in the prevention of leishmaniasis.

Introduction: Myiasis can be defi ned as the infestation of living tissues of humans and animals by dipterous eggs or larval stages that can penetrate the skin and soft tissues. Case Presentation: The aim of the study was to report an uncommon case of insect infestation in human tissues, called myiasis. The patient was a 62-year-old woman, with the larval presence in the jaw, who suff ered from diabetes and anemia. She was originally from the rural areas of Khuzestan province, the southwest of Iran. She had a wound on her mandible with a foul-smelling mouth before preparing for coronary artery bypass grafting (CABG) surgery. Her mandible and mouth were infested by 50 live larvae after three days of CABG. The larvae were examined in the pathology and parasitology department of the laboratory and defi nitely identifi ed as Lucilia sericata. Conclusions: Myiasis can be a risk for elderly people, especially old patients. The primary control method is the prevention and repulsion of adult fl ies before they can cause any damage.

Background: Currently, qPCR has been used as a rapid diagnostic method for human leptospirosis. Previous studies have indicated that qPCR has high sensitivity in the early days of the illness. Objectives: The aim of this study was to evaluate qPCR as a diagnostic method for human leptospirosis in the National Institute of Hygiene, Rabat, Morocco. Methods: From 2004 to 2016, 67 sera related to 67 patients with clinical signs mimic to leptospirosis were sent to the laboratory of Bacteriology for routine diagnosis and confi rmation. SAT, ELISA IgM, ELISA IgG, and qPCR were used for the diagnosis. Results: High positivity was observed by SAT (88. 24%), ELISA IgM (58. 82%), and real-time PCR (17. 64%), in sequence. No negative results by serological tests had positive results by real-time PCR. Forty-six patients were males (68. 68%) and 21 were females (31. 34%). The high incidence observed was from Sidi Qacem (40%). Conclusions: SAT and ELISA IgM are useful for the diagnosis of human leptospirosis in Morocco and they can provide prompt and low-cost diagnosis, especially when resources are limited.

Background: Leishmania major (L. major) superoxide dismutase B1 (SODB1) is an important enzyme for parasite survival. Previous studies have shown that SODB1 is highly immunogenic and sera from patients infected with Leishmania react with recombinant SODB1 (rSODB1). Objectives: In the present study, the protective eff ect of immunization with recombinant SODB1 (rSODB1) against the infection with Leishmania major was evaluated in a mice model. Methods: Three groups of BALB/c mice received rSODB1 mixed with complete Freund’ s adjuvant (immunized group), adjuvant (control I) or PBS alone (control II). This protocol was repeated 15 days later. Three weeks after the second booster immunization, four mice from each group were sacrifi ced to measure in vitro cytokines production by splenocytes; remaining mice were challenged using meta-cyclic promastigotes. Eight weeks later, the infected mice were sacrifi ced, and their splenocytes were re-stimulated with rSODB1; then, cytokine levels were assayed by the enzyme linked immunosorbent assay (ELISA). Results: Immunization of mice with rSODB1 plus adjuvant elicited high level of IFN-, low level of IL-5 production, and a signifi cant increase in IL-10 level, as compared to controls. Post-challenge re-stimulation of splenocytes also showed a polarized TH1 response accompanied by higher levels of IL-10 in immunized mice with rSODB1 plus adjuvant compared to controls. Conclusions: Although immunization with recombinant SODB1 plus adjuvant induced a strong TH1 response, which was identifi ed by high-level IFN-y production, regarding the increase in footpad swelling and lesions size, it could be concluded that immunization with rSODB1 plus adjuvant was not able to provide protection against Leishmania infection in the presence of high level of IL-10 production.

Background: Accurate speciation of the clinical yeast isolates is essential to a targeted treatment. Objectives: The aim of this study was to identify and determine the frequency of uncommon and rare yeast species causing fungal infections that may be misidentifi ed. Methods: During a 10-month period, yeast isolates collected from patients referring to or hospitalized in some educational hospitals in Tehran, Iran, were included in this study. In addition to conventional methods such as direct microscopy and culture on CHROMagar Candida, molecular methods including PCR-RFLP and ITS-sequencing were used for the accurate identifi cation of the yeast strains. Results: Among 930 yeast isolates recovered from normally sterile and other clinical specimens, a total number of 27 strains were identifi ed as uncommon Candida species and three were identifi ed as rare non-Candida species yeasts. They included C. kefyr (n = 12), C. lusitaniae (n = 8), C. intermedia (n = 3), C. orthopsilosis, C. guilliermondii, and Trichosporon asahii (each n = 2), and Magnusiomyces capitatus (n = 1). Conclusions: The isolation of less common or rare yeast species, which can cause a variety of infections from superfi cial to systemic infections, is increasingly reported. Since this uncommon yeast species may exhibit low susceptibility to some antifungal agents, the use of reliable methods for accurate screening of these yeasts is necessary.

Background: Direct-acting antiviral agents (DAAs) have changed the treatment landscape of hepatitis C virus (HCV) infection. Sofosbuvir (SOF), as a DAA inhibiting HCV NS5B polymerase, has found a remarkable contribution to the treatment regimens of HCV genotype-2 (HCV-2) and-3 infections. Objectives: In this meta-analysis, we aimed to evaluate the effi cacy of the combination of SOF and Ribavirin (RBV) with or without pegylated-interferon (PegIFN) in the treatment of HCV-2 and-3 infections. Methods: In this meta-analysis, we searched electronic databases including PubMed, Scopus, ScienceDirect, and Web of Science using appropriate and relevant keywords. Based on the results of the heterogeneity test (chi-squared and I-squared), fi xed-or randomeff ects models were used to calculate the pooled sustained virological response (SVR) rates. Results: After removing duplicates and screening of 1408 articles, 16 studies were included in the quantitative synthesis. The pooled SVR rates calculated for the treatment of patients suff ering HCV-2 infection were 91. 2% (95% CI: 86. 6%-95. 8%) using the SOF + RBV regimen for 12 weeks and 92. 6% (95% CI: 87. 1%-98. 1%) using the SOF + RBV + PegIFN regimen for 12 weeks. The pooled SVR calculated for the treatment of patients suff ering HCV-3 infection was 53. 1% (95% CI: 41%-65. 1%) using the SOF + RBV regimen for 12 weeks, 81. 6% (95% CI: 74. 4%-88. 7%) using the SOF + RBV regimen for 24 weeks, and 93. 8% (95% CI: 86. 9%-100%) using the SOF + RBV + PegIFN regimen for 12 weeks. Conclusions: The combination of SOF and BV with or without PegIFN for 12 weeks is highly effi cacious (> 90%) for the treatment of patients with HCV-2 infection. However, for the treatment of patients with HCV-3 infection only would 12 weeks of SOF + PegIFN + RBV result in > 90% treatment success.

Background: The prevalence of wound infections associated with multidrug-resistant Staphylococcus aureus (S. aureus) strains among burns patients has tremendously increased. Recently, the role of integrons as a key system involved in spreading multi-drug resistance has been well documented. Objectives: To investigate the prevalence of integrons, antimicrobial resistance pattern, and S. aureus protein A (spa) typing of the mupirocin-resistant S. aureus (MRSA) strains obtained from a referral burns hospital in Tehran, Iran. Methods: This study was performed during January 2017 to April 2018 on 64 MRSA isolates gathered from burns patients. The isolates were examined for susceptibility to antimicrobial agents. The integrase-encoding gene was detected by conventional polymerase chain reaction (PCR). Integrase-positive strains were evaluated for the determination of integron classes by using PCR-restriction fragment length polymorphism assay, and genotyping was performed by spa typing. Results: Out of 64 MRSA strains, 24 (37. 5%) and 40 (62. 5%) isolates carried high-level and low-level resistance, respectively. The fi ndings revealed that the entire isolates were MRSA. They belonged to six diff erent spa types including t860 (40. 6%), t790 (21. 8%), t037 (17. 2%), t064 (17. 2%), t008 (1. 6%), and t631 (1. 6%). Class 1 and 2 integrons were found in 59. 4% and 17. 2% of the isolates, respectively, and 4 (6. 2%) isolates were observed to carry class 1 and 2 integrons simultaneously. Conclusions: Precise epidemiological monitoring of integrons is required to prevent mupirocin resistance dissemination in MRSA strains.

Background: This study aimed at evaluating the eff ect of the extract and essential oil of Zataria multifl ora on reducing phenotypes and genotypes of biofi lm formation in clinical isolates of Staphylococcus epidermidis. Methods: The ability to produce biofi lm was evaluated by microtiter plate (MtP) for phenotype and through the presence of icaADB and aap by PCR for genotype among the 153 clinical isolates of Staphylococcus epidermidis. The impact of ethanol extract and essential oil of Zataria multifl ora were measured on biofi lm formation in phenotypic evaluation based on MtP and on the expression of ica operon and aap by real time-PCR. Results: The results showed that 71. 2% of isolates were able to produce biofi lms. The PCR results showed that 52. 2% and 88. 9% of the isolates had icaABD and aap, respectively. In addition, the relative mRNA expression of icaA, icaD, and aap genes were signifi cantly reduced compared to the negative control after treating the Staphylococcus epidermidis RP62A with subMIC concentration of essential oil and extract (P < 0. 001). Conclusions: Given the signifi cant inhibitory eff ect of the extract and essential oil of Zataria multifl ora on biofi lm formation, it seems that these substances are good options for studies related to controlling biofi lm formation in Staphylococcus epidermidis.

Background: The extent of antibiotic resistance among Helicobacter pylori strains infl uences current clinical therapeutic regimens in each region. Objectives: This cross-sectional study aimed to determine the resistance property and minimum inhibitory concentration (MIC50-90) of Helicobacter pylori strains toward metronidazole, clarithromycin, and ciprofl oxacin in patients with distinct gastric histopathological changes in Tehran, Iran. Methods: This study was conducted on 170 patients suff ering from gastric complications in three hospitals in Tehran from October 2014 until March 2015. Two separate biopsy samples were collected from each patient and used for pathological and microbiological examinations. Antimicrobial susceptibility tests were performed by agar dilution method according to the CLSI guidelines. The MIC values and susceptibility to varying concentrations of metronidazole (4 to 64  g/mL), ciprofl oxacin (0. 5 to 16  g/mL), and clarithromycin (0. 25 to 16  g/mL) were determined based on EUCAST recommendations. Results: Our results indicated the infection with H. pylori in a frequency of 32% (55/170) among the study patients (female, 51% and male, 49%). Endoscopic fi ndings indicated that 42% of the patients suff ered from peptic ulcers, 33% from duodenal ulcers, and 25% with a non-ulcer disease. Pathological fi ndings indicated 58% of the patients had chronic gastritis, 33% had active chronic gastritis, and 9% suff ered from intestinal metaplasia. In terms of antibiotic susceptibility, nearly 76. 3%, 49%, and 45. 5% of the strains were resistant to metronidazole, clarithromycin, and ciprofl oxacin, respectively. The MIC values at which the growth of 50% and 90% of the strains was inhibited (MIC50-90) were 32-64  g/mL for metronidazole, 0. 5-16  g/mL for clarithromycin, and 2-16  g/mL for ciprofl oxacin. Conclusions: The overall resistance levels were relatively high among the study patients. Accordingly, the administration of other anti-Helicobacter drugs, as well as more appropriate therapeutic regimens based on laboratory results, is recommended in patients with a history of treatment failure.

Introduction: Rhinoscleroma and leprosy are two rare infectious granulomatous diseases that can involve the nasal cavity with similar pathophysiologies. It seems that this is the fi rst time that the coexistence of rhinoscleroma and leprosy has been reported in the English literature. Case Presentation: We present the case of a 65-year-old male presented with nasal purulent rhinorrhea, extensive crusts and a large septal perforation. Rhinoscleroma and leprosy were diagnosed histopathologically. Culture results confi rmed the diagnosis as well. Complete medical treatment was eff ective. Conclusions: This case report highlights the importance of possible coincidence of two rare granulomatous infectious diseases with similar pathophysiologies in a patient.

Background: Mucormycosis is a life-threatening infection due to the members of the Mucorales order with increasing incidence during the last decades. Rhizopus spp. are the most common causes of disease; however, this infection could be developed by various other species. Objectives: This study presented the clinical features and predisposing factors of several patients with mucormycosis along with the causative agents using sequence analysis. Methods: Clinical specimens of 25 cases with mucormycosis were included in this study. Direct examination and culture were performed for all specimens and then isolated fungi were identifi ed based on their morphology and sequence analysis of ribosomal DNA. Results: The patients were comprised of 17 (68%) females and 8 (32%) males with the mean age of 47. 16  17. 4 years. Rhino-cerebral mucormycosis was the most common clinical form (24 cases) followed by pulmonary mucormycosis (one case). Diabetes mellitus was the most common predisposing factor (n = 17, 68%). The culture was positive in 15 specimens and the isolated fungi were morphologically identifi ed as Rhizopus spp., subsequently, all of the isolates were identifi ed as Rhizopus oryzae at the species level using the molecular method. Conclusions: Diabetes and R. oryzae played the most important roles as the predisposing factor and etiologic agent of mucormycosis, respectively.