IRANIAN JOURNAL OF CLINICAL INFECTIOUS DISEASES
Year:2009 | Volume:4 | Issue:1|Papers Count:12

Infections caused by resistant bacteria can strike anyone, the young and the old, the healthy and the chronically ill. Antibiotic resistance also is a serious problem for patients whose immune systems are compromised, such as people with HIV/AIDS and patients in critical care units. About 2 million people acquire bacterial infections in U.S. hospitals each year, and 90,000 die as a result. About 70 percent of those infections are resistant to at least one drug, according to the Centers for Disease Control and Prevention. The total cost of antimicrobial resistance to U.S. society is nearly $5 billion annually. Treating resistant pathogens often requires more expensive drugs and extended hospital stays. Staphylococcus aureus (staph) is a common cause of hospital infections that can spread to the heart, bones, lungs, and bloodstream with fatal results. In 2002, 57.1 percent (an estimated 102,000 cases) of the staph bacteria found in U.S. hospitals were methicillin-resistant (MRSA), according to CDC. Staph infections (even those that are not drug-resistant) can be deadly and costly (1,2).

Background: Brucellosis is an important cosmopolitan infection disease caused by organisms belonging to the genus Brucella. The cgt gene (cyclic b-1, 2 glucan transporter gene) is a virulent factor in Brucella genus. The present study was conducted with the aim of cloning and expression of Brucella cgt gene. Materials and methods: Brucella melitensis cgt gene was amplified from extracted chromosomal DNA by PCR, then PCR product was cloned into pTZ57R and subcloned into pGEMEX-1 expression vector, then expressed in JM109 E.coli strain. Recombinant protein was confirmed by western blot analysis using patient's serum. Results: The PCR product was cloned in pTZ57R plasmid via T/A cloning method. Recombinant plasmid was digested by BamHI and SacI restriction enzymes, the released band was purified and subcloned into pGEMEX-1 expression vector. Then, sample cells were lysed using lyses buffer and sonicated, then electrophoresed on SDS-PAGE. Protein bands were transferred on nitrocellulose membrane and reacted by patient's serum and detected by HRP conjugated anti human antibody.Conclusion: We cloned and expressed Brucella abortus cyclic b-1, 2-glucan transporter gene (cgt) which is an important agent in brucellosis. Using cgt gene mutant may be an effective way for inhibiting or decreasing the pathogenicity of bacteria.

Background: Due to danger of spillage of cyst materials during surgery, chemoprophylaxis is routinely recommended for cyctic echinococcosis. However, for prophylactic purposes the time for starting and the duration of administration of prophylactic drug regimen is not yet clear. The aim of the present study was to evaluate the chemoprophylactic efficacy of one month administration of albendazole or a combination of albendazole plus praziquantel against protoscoleces stage of Echinococcus granulosus when administered before inoculation with the protoscoleces. Patients and methods: Two days before infestation, 30 mice were assigned in three equal groups of control, albendazole and albendazole plus praziquantel. Control group received dimethylsulfoxide (DMSO). The drugs were suspended in DMSO and administered by gavage for one month (5 consecutive days and two days off every week) in doses of 50mg/kg/day albendazole or 50mg/kg/day albendazole plus 600mg/kg/day praziquantel. The mice were then infected by IP injection of 2000 protoscoleces. Then, three months after the last dose of drug, mice were sacrificed and the number of infected animals, the number, wet weight and cyst sizes were recorded.Results: The results showed that albendazole chemoprophylaxis reduced the number, weight and cyst sizes by 63.78%, 79.39% and 60.98%, respectively. The corresponding results for the combination of albendazole plus praziquantel were 91.70%, 90% and 80.3%, respectively. All the differences were statistically significant. Conclusion: Combination of albendazole and praziquantel is more effective than albendazole alone in controlling the development of secondary hydatidosis, when administered for a period of 4 weeks.

Background: The rapid emergence of antibiotic resistance, especially broad-spectrum antibiotics, resulted in the avid use of new potent antibiotics. Ceftriaxone and ceftazidime, two third-generation cephalosporin, are usually used to manage complicated and uncomplicated infections. The use of cefepime in resistant infections is increasing gradually, which put this potent antibiotic at risk of resistance.Patients and methods: During an 18-month period, a total of 220 gram-negative bacteria including Pseudomonas spp, Serratia spp, Acinetobacter spp, Proteus spp, E-coli and Klebsiella spp. have been isolated by standard microbiological methods from nosocomial surgical site, abscess, blood stream and urinary tract infections. MIC of antibiotics on isolated bacteria was determined by gradient concentration method.Results: Totally, 29.4%, 19.5% and 23.3% of isolated bacteria with MIC£8μg/ml were sensitive to cefepime, ceftriaxone and ceftazidime, respectively. High level resistance with MIC³256mg/ml to cefepime, ceftriaxone and ceftazidime was also observed in 47.1%, 70.8% and 62.5% of cases, respectively (p<0.05). High level resistance to cefepime were more commonly observed for pseudomonas (73.1%) and Klebsiella spp. (73.5%), respectively (p<0.05). Conclusion: According to CLSI criteria, 47.1% of isolated bacteria in this study showed high level of resistance (MIC³256mg/ml) to cefepime. Therefore application of cefepime, as a drug of choice, for gram-negative organisms is not reasonable. Our result demonstrated that this potent antibiotic should not be used as a choice for empiric antibiotic therapy, in the cases of nosocomial infections caused by gram-negative organisms.

Background: Influenza is a world-wide public health concern. It is one of the most important viral causes of acute respiratory illness, affecting all age groups, recurring several times during a lifetime. We assessed the antibody titers after vaccination against influenza among HIV-infected patients and health care workers (HCWs).Patients and methods: During this before-after study, the antibody responses were assessed in 60 HCW and 60 HIV infected patients vaccinated with split influenza vaccine (influvac® 2005/2006 Solvay’s influenza vaccines for the influenza season 2005/2006 in the northern hemisphere).Results: Although all participants had protective antibody levels against A(H1N1), A(H3N2), and B components of trivalent influenza vaccine (before vaccination), HIV-infected patients showed seroconversion against A(H1N1), A(H3N2), and B components in 75%, 45%, and 28.3% of cases, respectively. The corresponding values were 70%, 33.3%, and 53.3% among HCWs, respectively. There were no repots of any vaccine adverse reaction. Conclusion: A comparable rise in antibody titers against influenza antigens without any adverse reaction supports the previous recommendations for influenza vaccination. Such programs can effectively decrease the probability of influenza infection in both HCWs and HIV-infected patients who are not seriously immune compromised.

Background: Nosocomial infections are generally occurring 72 hours after admittance and are not present or incubating prior to admittance. The most common nosocomial infection is urinary tract infection (UTI). Scanty data are available regarding the nosocomial infections in Iranian teaching hospitals. The aim of the present study was to determine the frequency of symptomatic nosocomial UTI, identify the etiologic organisms, and determine their antimicrobial susceptibility pattern.Patients and methods: This cross sectional study was conducted on ICU patients of Firoozgar hospital affiliated to Iran University of Medical Sciences from September 2003 to September 2005. Antimicrobial susceptibility pattern was achieved by disk-agar diffusion and E. test methods.Results: Totally, 306 patients were admitted to ICU, of whom 28 (9.2%) suffered from symptomatic UTI. The most common isolated organism was Klebsiella (13 cases, 46%) followed by E.coli, Pseudomonas and Enterobacter spp. A high level of resistance was observed for third generation cephalosporins (Pseudomonas 100%, Klebsiella 92%, E.coli 71% and Enterobacter 25%), however, microorganisms were less resistant to imipenem and cefepime.Conclusion: Based on observed results, carbapenems and cefepime are the drugs of choice for empiric antibiotic therapy of nosocomial UTIs in Firoozgar hospital.

Background: Tubercle bacilli most often are transmitted from one person by the airborne route. The aim of the present study was to determine the frequency of latent tuberculosis infection and active pulmonary tuberculosis among patients with chronic psychiatric disorders in Hamedan.Patients and methods: In a cross sectional study, 215 patients with chronic psychiatric disorders were investigated for tuberculin skin test. Those with an induration of ³10 mm were introduced for further evaluation, including a chest-x-ray and examination of the sputum for acid-fast bacilli for those with radiographic abnormalities. Results: Of 215 patients, 62 (28.8%) had positive tuberculin skin test reaction. Age and duration of psychiatric disorders were significantly associated with test positivity. Of 62 tuberculin-positive patients, 25 (40.3%) had radiographic evidences of inactive pulmonary tuberculosis. None of them had positive sputum smear for tuberculosis.Conclusion: Chronic psychiatric patients are more susceptible to tuberculosis infection. Screening tests should be applied for these patients.

Background: Human papillomavirus (HPV) is associated with various benign and malignant lesions including genital condyloma and anogenital cancer. The presence of HPV-DNA was studied in archival biopsies of high- and intermediate-risk lesions for cervical carcinoma in women referred to Mirza hospital in Tehran. Patients and methods: Totally, 105 Iranian archived biopsies collected during February and November 2006. HPVDNA was isolated from the biopsies and detected by means of consensus polymerase chain reaction (PCR) detecting a broad spectrum of genital HPV types.Results: Totally, 26 samples (24.7%) were positive for oncogenic HPV-DNA. Risk of HPV infection was significantly higher in biopsies obtained from patients with confirmed squamous cell carcinoma (SCC) who started sexual activity more recently (£4 years ago) when compared with those who started earlier (³10 years ago). HPV-16 was more frequently detected in biopsies of younger women.Conclusion: HPV was more frequently detected in young women. Our data confirm the usefulness of this method for detection of HPV in archival biopsies.

Background: Hepatitis C virus (HCV) infection has been explained as a disease that sometimes present with rheumatic manifestations indistinguishable from rheumatoid arthritis. This study has been performed to evaluate the frequency of hepatitis C virus infection in a group of patients with rheumatoid arthritis.Patients and methods: In this study, during one year, serum samples collected from two hundred consecutive patients with rheumatoid arthritis in all affiliated hospitals of Shaheed Beheshti University, M.C., were examined for anti-HCV antibody and HCV-RNA by ELISA and RT-PCR method, respectively. Using a questionnaire, the frequency of HCV infection, age and sex distribution, duration of rheumatoid arthritis, associated immune mediated disorders and risk factors for hepatitis C virus infection were assessed.Results: A total of 200 patients (M/F=26/174) who were mainly aged 51-70 years were studied. The frequency of HCV was found to be 2% (95%CI: 0.6-7%). All of the infected persons have had a low risk occupation in terms of exposure to the virus and none of them had HCV risk factors. No associated immune mediated disorder was found in HCV infected patients.Conclusion: Our results did not support any contribution of HCV infection in the pathogenesis of rheumatoid arthritis. 

A 20 year-old Afghan man residing in southern provinces of Iran during the past few months, presented with periodic chills and fever since 3 months ago. Empirical therapy for malaria had been prescribed in spite of several negative smears for malaria. He was discharged with minimal improvement, however, headache and intermittent vomiting developed 2 months later. Fever continued and he was readmitted and evaluated for FUO (fever of unknown origin) and headache. Brain (without contrast) and sinus CT scan was normal. Abdominopelvic sonography and CT scan were normal. Chest x-ray was also normal. Complete blood count (CBC) revealed normocytic normochromic anemia, despite normal WBC and platelet count. ESR was 35mm/h. Biochemistry, liver function tests, and urine analysis and culture were all within normal limits.

INTRODUCTION: Hepatitis C is a global health problem worldwide affecting over 170-200 million people and the virus is distributed worldwide with prevalence varying between different countries from 0.2 up to 40% (1,2). Hepatitis C virus (HCV) is spread parenterally, either through intravenous drug use or, in lesser-developed countries, through transfusion of blood products and contamination during medical procedures. Despite a declining incidence of new infections, the burden of disease, both in terms of mortality and in terms of cost, is expected to increase over the next decade and HCV infection will be a potential cause of substantial morbidity and mortality in the future (1,2). Hepatitis B is a preventable infection by vaccination and the prevalence rate has been decreased in our community, however, hepatitis C is an emerging disease. Hepatitis C as the first cause of liver disease necessitates further liver transplantation (3-6)…

Further physical examination revealed neck stiffness and positive Brudzinski sign. Thus, lumbar puncture (LP) was performed. The result was: WBC =150/ml, lymphocyte= 65%, PMN=  35%, glucose=18mg/dl, protein=65mg/dl, concomitant blood sugar=90mg/dl. With possible diagnosis of chronic meningitis, evaluation was completed to rule out causes of chronic meningitis. CSF wright, VDRL, indian ink, cytology for malignant cell were negative. CSF TB-PCR was positive, even though, CSF smear was negative for AFB. Brain CT scan with contrast showed multiple ringed enhanced small masses in favor of tubercoluma (figure 1) and fundoscopy revealed choroidal tubercle.