IRANIAN JOURNAL OF CLINICAL INFECTIOUS DISEASES
Year:2008 | Volume:3 | Issue:3|Papers Count:12

It is common sense that better noninvasive diagnostic methods are needed for the detection of invasive fungal diseases (IFDs). This is particularly true for immunocompromised patients in whom the performance of invasive medical procedures is not always feasible (1).The 1,3-b-D-glucan (BG) antigenemia is a method for the early diagnosis of invasive aspergillosis (IA) and candidiasis (IC) in neutropenic patients (2). Because of the morbidity and mortality of these infections, early antifungal therapy is critical. A noninvasive monitoring tool that detects both Aspergillus and Candida species is an attractive approach. A positive result of the screening test may trigger further investigations and preemptive antifungal therapy.

Background: Helicobacter pylori is known as an agent which may involve in the occurrence of peptic ulcer, gastric cancer and also other known and unknown diseases. Treatment of the infection with antibiotics eradicates the disease and prevents its pathologic effects. A noninvasive and inexpensive method for detection of the infection is needed. In this study the diagnostic values of serum and saliva anti H. pylori IgG was evaluated. Patients and methods: The saliva and blood samples were collected from 114 patients who underwent upper GI endoscopy and gastric biopsy. Tissue samples were examined by rapid urease test and microscopic study. Saliva and serum samples were tested by ELISA-based test for anti H. pylori IgG, using a commercial kit. Results: From 114 cases, 61 (53.5%) patients were positive for H. pylori in rapid urease test and microscopic study and 53 (46.5%) were negative in both tests. Rates of positive result for H. pylori in patients with and without peptic ulcer were almost similar. Mean values of anti H. pylori IgG in saliva and serum of H. pylori positive patients were higher than H. pylori negative patients. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of tests in saliva were 83.6%, 71.7%, 77.3%, 79.1%, 78.1% and in serum were 90.2%, 86.8%, 88.7%, 88.4% and 88.6% respectively.Conclusion: It was concluded that ELISA-based anti H. pylori IgG test in saliva could be used as an alternative diagnostic test in the absence of other invasive procedures.

Background: Brucellosis is a zoonotic disease with a very wide spectrum of clinical findings. Brucellosis is about 10 times more prevalent in patients with renal failure (dialysis patients) compared to population background. Precipitation of immunocomplexes produced by brucellosis is important in causing glomerulonephritis. Because the hallmark of glomerular diseases is abnormal protein loss in the urine we have decided to study proteinuria in brucellosis immunocomplex. The aim of this study was to evaluate probable relationship between brucellosis and glomerulonephritis. Patients and methods: This cross sectional study, performed on 200 patients with a history of the disease for about 1 year, diagnosed as having chronic brucellosis. The diagnosis was confirmed in 150 patients and by applying Brucella Standard Agglutination Test (SAT) and 2-mercaptoethanol test (2-ME). Titers of IgG/IgM and IgG/IgA in two groups of "with proteinuria" and "without proteinuria" was measured.Results: Both SAT and 2-ME tests test demonstrated that proteinuria increases with rising antibodies titers. In SAT, titer 1/160 was the most frequent, observed in 44% of the patients. In 2-ME test 1/40 titer was observed in 44% of the patients and was the most frequent.Conclusion: Our results clearly demonstrated that in both chronic and acute patients, proteinuria increases with rising IgG/IgA and IgM/IgG titers. Therefore brucellosis can cause nephropathy but chronic or untreated brucellosis is more important because it can permanently damage kidney.

Background: Leptospirosis is a widespread zoonosis in the world with more prevalence in tropical and subtropical regions. The disease is very common in flat area of Gilan, northern Iran, where the climate is humid and temperate and rice farming is main agricultural activity in rural areas.Patients and methods: We performed this study in 2004 by taking blood samples from 465 hospitalized patients who were suspected of leptospirosis based on their clinical presentation, to find positive cases and analysis their signs, symptoms, and epidemiological data, and also to determine the most common clinical features of the disease in the area. All sera were examined by microscopic agglutination test.Results: Renal failure was most common symptoms (4.5%). Icterhaemorrhagia had highest titers in 57.0% of patients.Conclusion: In Gilan province, some of the farmers get leptospirosis each year near the end of spring and summer at the time of rice harvesting. Better recognition of the disease and diagnosing it at proper time can improve the quality of life and health state of the farmers.

Background: Vancomycin-resistant Enterococci (VRE) are the most common nosocomial pathogen worldwide. Colonization with VRE can lead to serious infection, some of which e.g. VRE sepsis can be fatal. Because VRE are dangerous important pathogens, we aimed to determine the prevalence of VRE among patients admitted in infectious, ICU and surgery wards in a referral teaching hospital in Isfahan, Iran. Patients and methods: A total of 100 patients from infectious, ICU and surgery (post- operative patients) wards were selected by simple sampling method. Stool specimens were taken from the patients and cultured in VRE selective media (bile- esculin agar plate with 6 mg/ml of vancomycin) and gram positive cocci from black colonies were inoculated to the tryptase soya broth plus 6.5% NaCl and again gram positive cocci were inoculated to bile-esculin and finally MIC (minimal inhibitory concentration) evaluated by E-Test for detection of VRE. Results: Totally 58 out of 100 patients had positive cultures for enterococci. Among them 16 out of 58 were female (27.6%) and 42 (72.4%) were male. Of 58 positive cultures, 17 (29.3%) were highly resistant to vancomycin. There was significant relation between previous antibiotic therapy especially vancomycin and VRE in this study (P=0.02). Most of the patients (74.1%) with negative cultures for Enterococci had GI surgery. Most of culture positive patients (46%) were from infectious ward. There was no significant relation between VRE and sex, GI surgery and admission ward in this study.Conclusion: Results of this study suggest that previous antibiotic therapy especially vancomycin and B-lactam is a major risk factor for colonization with VRE. Prevalence of VRE in our study was high. This problem is very important in epidemiology of hospital infections. Considering the fact that there is no substitute agent for vancomycin in our country, it is necessary to determine guidelines regarding treatment with antibiotics specially vancomycin.

Background: Many viral infections are associated with significant maternal and fetal consequences if acquired during pregnancy. In this study we wanted to clarify or remind some of the failures of laboratory techniques or managements.Patients and methods: In this study 2049 serum samples in 4 years (2003-2006) were collected and examined with IgG and IgM ELISA techniques. These subjects were in the age range of 20-35 years. Subjects were referred to No 1 Lab of Specialized Clinics of Tabriz University of Medical Sciences.Results: Serum samples of 2049 females were analyzed, and 1814(%88.53) seropositive, 170 (8.29%) seronegative, 65 (3.17%) current infection were detected.Conclusion: Findings showed that there was not a suitable programmed management or a confirmed diagnostic technique in our scientific society for the prevention of some of the side effects of CMV infection in fetus of pregnant women. For these reasons we must review and prepare a new strategy for guiding our female population at least in university scientific centers.

Background: Urinary tract infections (UTIs) are one of the most frequent bacterial infections in children. Most commonly, members of Enterobacteriacea, particularly uropathogenic strains of E. coli and Enterobacter spp. are the primary causative organisms of UTIs in different parts of the world.Patients and methods: A total of 55 hospitals from 12 provinces in Iran participated in this study. 1696 children with UTI aged 0 to 5 years referred to these hospitals were included in this study. Urine cultures were carried out and the isolates were identified by gram staining and conventional biochemical methods. Antimicrobial susceptibility testing was performed by disk diffusion method according to the current National Committee for Clinical Laboratory Standards (NCCLS) guidelines.Results: In general 438 urine isolates were obtained. E. coli was the most frequently occurring pathogen (54.80%), followed by Klebsiella pneumoniae (16.0%), coagulase negative Staphylococci (11.2%), Enterobacter spp. (9.6%), Proteus spp. 1.4% and P. aeruginosa (1.4%). Resistance rates of E. coli isolates were 85.9% to co-trimoxazole, 80.0% to penicillin, 77.0% to ampicillin, 68.0% to chloramphenicol, 12.9% to ciprofloxacin, 12.9% to ceftriaxone, 12.9% to cephalotin, and 14.0% to amikacin. K. pneumoniae isolates were 18.5%, 20.0%, 24.0% and 29.0% resistant to cephalothin, ceftriaxone, amikacin and gentamicin respectively; however, penicillin (88.5%), co-trimoxazole (74.2%), and ampicillin (68.5%) were the least effective drugs.Conclusion: High prevalence of drug-resistant urinary tract pathogens, particularly to ampicillin and co-trimoxazole among Iranian children suggests cautious use of antibiotic therapy for the treatment. Finally, we suggest that empirical antibiotic selection should be based on knowledge of the local prevalence of bacterial organisms and antibiotic sensitivities rather than on universal guidelines.

Background: Growing antibiotic resistance demands the constant reassessment of antimicrobial efficacy, particularly in countries with wide antibiotic abuse. Knowledge of resistance trends is particularly important when prescribing antibiotics empirically, as is usually the case for urinary tract infections (UTIs) especially in children with terminal renal failure on continuous ambulatory peritoneal dialysis (CAPD) treatment. The aim of this study was to analyze the resistance of bacterial isolates to commonly used antibiotics in such patients. Patients and methods: In this study, bacterial isolates were evaluated from urine samples collected from pediatric patients (6 months to 17 years) on CAPD with acute UTIs in Tehran from March 2006 through September 2006. Sensitivity was measured by disc diffusion method using NCCLS protocol.Results: The most prevalent urinary pathogen was Escherichia coli from 27 cases (75%). In general, the lowest resistance rate of microorganisms was against amikacin (3.7%) and the highest resistance rate was against amoxicillin (70.4%).Conclusion: A comparison of these data with those of other countries showed that there was considerable geographic variation in bacterial patterns of sensitivity and resistance properties. Therefore, the selection of antibiotics for empiric therapy especially in children with terminal renal failure on continuous ambulatory peritoneal dialysis (CAPD) treatment should be based on the knowledge of the local conditions.

A 38 year old Iranian man presented with fever and nonproductive cough for 1 month. Patient developed non-pruritic rashes on hands, forearms (figure 1) and anterior aspect of legs a few days after his fever commencement. He didn’t have any history of allergy, previous lung disease, addiction, travel history or animal contact but had history of unpasteurized milk ingestion. The patient had received amoxicillin for 10 days without improvement before referring to the hospital.

Background: Invasive aspergillosis is a major cause of morbidity and mortality in immunosuppressed patients. This infection is caused by Aspergillus, a hyaline mold, which is the etiologic agent for many different manifestations. Patient: A 63 year old diabetic housewife woman, living in northern Iran, presented with the history of right eye ptosis after a mild head trauma since about 3 weeks ago. She had positive history of intermittent headache several weeks before ptosis. On physical examination, the patient was afebrile and other vital signs were normal. Brain MRI showed a pituitary mass measuring about 4 cm. Pathological study showed hyphae in favor of aspergillosis. Amphotericin B was started and after 10 days changed to itraconazole.Conclusion: It is important to consider fungal infection as a differential diagnosis of cerebral lesions even in the immunocompetent hosts. The clinical presentation of cerebral aspergillosis is nonspecific and is characterized by focal neurologic signs, alteration in mental status and headache.

Brucellosis is a worldwide health concern and still remains endemic in many developing countries including Iran, and hundreds of thousands of new cases of brucellosis are reported annually (1,2). The disease mainly affects animals and produces genitourinary infections that may lead to abortion (3). Transmission of Brucella from infected animals to human occurs either by occupational contact or by consumption of contaminated animal products especially milk, cream, butter, and fresh cheese (4,5).

Sarcoidosis is a multisystemic granulomatosis disease of unknown etiology that affects individuals worldwide; mostly involve patients between 20 to 40 years old (1,2). The respiratory system is the most commonly affected organ (approximately 90%). As many as 30-60% of the patients have no symptom at the  time of presentation but others commonly present with respiratory symptoms such as dyspnea and cough. One third may have constitutional symptoms including fever, weight loss, malaise and fatigue.