IRANIAN JOURNAL OF CLINICAL INFECTIOUS DISEASES
Year:2007 | Volume:2 | Issue:3|Papers Count:11

Sepsis affects millions of patients worldwide each year and results in the death of up to one-half of those afflicted, depending on age, severity of illness, the adequacy and timeliness of therapy, and a host of other factors. The cost is staggering and is estimated to be in the tens of billions of dollars in the USA alone. Beginning in 2003, the Surviving Sepsis Campaign made a commitment to reduce the mortality rate of sepsis by one-third by protocol-guided care.

Background: Although several studies have reported the poor mental health of patients with chronic viral hepatitis, few reports exists over the correlation of mental health and virus type. Current study was conducted to compare the severity of anxiety and depression in chronic hepatitis C, B and healthy subjects. Materials and methods: This case control study was conducted in Tehran Hepatitis Center (THC) in 2006. Group I (chronic hepatitis C, n=14), group II (chronic hepatitis B, n=65) and group III (healthy subjects, n=65) were matched for age, sex and educational level and were compared by means of the severity of anxiety and depression measured by Hospital Anxiety Depression Scale (HADS). The correlation between clinical or para-clinical findings of the patients with viral hepatitis and severity of anxiety and depression was also assessed.Results: Group I in comparison to other groups reported a higher anxiety (9.57±3.86 vs. 7.45±4.52 vs. 4.81±4.80, p=0.001) and depression (6.43±3.76 vs. 5.23±3.74 vs. 4.76±4.40, p=0.05). Anxiety and depression score were also both correlated with total serum bilirubin level, but were not correlated with other para-clinical findings. However the patients who had received interferon reported higher depressive symptoms but the difference did not reach statistically significant level.Conclusion: According to the higher severity of anxiety and depression in the case of chronic HCV infection in comparison to HBV infection or healthy subjects and the importance of mental health issues in viral hepatitis, we recommend a more close mental health observation in patients affected with HCV infection. Psychiatrist and psychologist visits and consultations can help in this approach.

Background: Acute infectious diarrhea is still one of the most important causes of death in childhood and malnutrition increases its morbidity and mortality. There is a strong correlation between the nutritional status of the child and the risk of subsequent diarrhea. Micronutrient deficiencies also increase the child’s susceptibility to diarrhea and vitamin A and zinc supplementation has been shown to reduce the incidence and hasten recovery from acute diarrhea episodes. Materials and methods: This study describes the association of nutritional deficiencies and other factors on the risk of subsequent diarrhea in children in Shahrekord, Iran. A cohort of 211 children less than 5 years old admitted with acute diarrhea to Hajar Hospital in Shahrekord, were followed for 14 weeks after hospital discharge. Results: Fifty-eight (27%) of these children developed a new diarrhea episode during the follow up period. Children who were vitamin A and zinc deficient at the time of admission, above 12 months of age, kept animals at home or had weight-for-age and weight-for-height z scores <-1 during the univariate analysis had a higher risk of experiencing subsequent diarrhea. Vitamin A and zinc deficiencies, keeping animals at home, diarrhea duration £ 4 days on enrolment and weight-for-age z score <-1 reminded as independent risk factors during multivariate analysis. The aggregation of these factors had a synergistic effect on the risk of subsequent diarrhea.Conclusion: Children with micronutrient deficiencies and in contact with animal had the highest risk of suffering subsequent diarrhea. Our findings support the current approach of providing multiple micronutrient supplements for the prevention of infection in order to reduce mortality in children.

Background: Measles is an acute highly infectious respiratory viral disease. It remains a leading cause of death among young children especially in developing country. Measles outbreaks occurred in Iran in recent years and soldiers and cadets have been vaccinated against it. This study was designed to evaluate primary and secondary failure of measles vaccine in cadets after mass measles vaccination.Materials and methods: For this cross-sectional study, one month after mass vaccination in 2003,all  vaccinated cadets were recruited. Eight hundred and sixty five cadets were evaluated in a simple random fashion. From each individual 5ml blood sample was obtained and checked in immunology laboratory of Baqiyatallah hospital. Antibody was checked by enzyme-linked immunosorbent assay (ELISA) for qualitative and quantitative measurement of IgG and IgM in accordance with Behring ELISA kit (Germany) instructions. Cut-off OD upper than 0.2 was considered positive and quantitative titer upper than 345 mIU/ml was considered protective.Results: All cadets were men with a mean age of 19.0±1.1 years. IgM anti-measles antibody was positive in 0.7%. Primary failure was positive in 1.8% of individuals. Anti measles IgG antibody was positive in 97.8% of cadets. History of childhood vaccination for measles was positive in 67.7% and past history of measles was positive in 23 cases (2.6%). Conclusion: Our results showed that secondary failure is more than 97%. Therefore, periodic studies should be performed to assess secondary failure rate in order to take preventive measures in time, of course, if its outbreaks are probable to happen.

Background: Post operative intraocular infection (endophthalmitis) is a rare but devastating complication. The present study aimed to determine the antibiotic susceptibility pattern of ocular surface bacterial flora isolated preoperatively from patients undergoing intraocular surgery.Materials and methods: In a prospective study, 269 patients scheduled for anterior segment surgeries, were enrolled, for whom lid and conjunctival cultures were obtained on the day of surgery before application of povidone – iodine or antibiotic drops. Bacterial isolates were identified and tested for antibiotics susceptibility using Kirby-Bauer discdiffusion technique.Results: Of 269 studied eyes, 127(47.2%) were male. In 101 (37.5%) cases bacterial growth was positive. Isolated bacteria in order of frequency were coagulase negative staphylococci (CNS) (90.0%), coagulase positive staphylococci (CPS) (4%), diphteroid (3%), gram negative bacillus (2%) and streptococci (1%). Totally, 95% of coagulase negative staphylococci were susceptible to vancomycin, amikacin and gentamicin. Less than 70% of isolated CNS were sensitive to ceftriaxon, tetracyelin, erythromycin, oxacillin, cotrimaxazole, and penicillin.Conclusion: Preoperative ocular surface isolates of CNS seems to be most sensitive to vancomycin, amikacin and gentamicin. Thus, preoperative application of these medications into ocular surface is suggested.

Background: The most prevalent complication of gallstone is chronic cholecystitis. The aim of the present study was to determine the responsible microorganisms in patients undertook cholecystectomy and determine their antibiotic resistance pattern.Materials and methods: Cholecystectomy was achieved in 100 patients. Collected samples transferred to laboratory in appropriate media, then cultured on selective media to isolate the possible causative bacteria. Antibiotic susceptibility tests were also performed by Kirby-Baur method with a colony in Muller-Hinton agar medium. Results: Totally, 63 samples showed bacterial growth, of which 11 revealed two species of bacteria. A total of 10 gram positive (enterococci and staphylococci) and 63 gram negative (E.coli, klebsiella, aerobacter, pseudomonas, proteus, citrobacter, providencia and acinetobacter) bacteria were isolated.Conclusion: Isolating bacteria and determining their susceptibility to different antibiotics may help physicians to manage cholecystitis and its associated complications.

Background: Diarrhea is the most common causes of mortality, accounting for 15-20% among children. It is caused by numerous microorganisms including, Shigella, Salmonella, enteropathogenic E. coli, and Yersinia enterocolitica. Yersinia enteroclitica is a gram-negative, facultatively anaerobic coccobacillus belonging to enterobacteriaceae. It causes numerous human diseases, mostly gastroenteritis.Materials and methods: A total of 800 diarrheal children aged less than 10 years entered this study. Suspected stool samples were cultured on both conventional enteric and cold-enriched media. Conventional enteric media included MacConkey agar, Cefsulodin-Irgasan-Novobiocin (CIN) agar, and Salmonella-Shigella Deoxycholate (2%) agar, while for cold-enriched media PBS (phosphate-buffered saline) (PH=7.2-7.8) was used. Other enteric pathogens including Salmonella, Shigella, and enteropathogenic E. coli were also isolated. Results: Of 800 suspected stool samples, 14 Yersinia enterocolitica were isolated (1.8%). Other enteric pathogens were as follow: 18 Shigella (2.3%), 32 enteropathogenic E. coli (4%), and 13 Salmonella (1.6%). Y. enterocolitica isolates were completely sensitive (100%) to gentamycin, kanamycin, ciprofloxacin, cefixim, cefataxim, and chloramphenicol, however, they were partially resistant to tetracycline (7.1%) and cotrimoxazole-nalidixic acid (14.3%). Yersinia enterocolitica isolates were completely resistant to ampicillin, penicillin, cephalotin, and erythromycin.Conclusion: Suspected diarrheal children should be checked for Yersinia enterocolitica using cold-enriched environment, while antibiogram studies are strongly recommended for positive isolates.

A healthy 35-year-old woman presented with a 2 months history of a cauliflower-like lesion on her right hand with no further lesions elsewhere. She declared that the disease began with one slightly elevated erythematous nodule with some exudates on its surface then grew slowly to form this vegetative plaque without any associated symptoms of itching or pain.

Background: Human immunodeficiency virus (HIV) infection in children causes a broad spectrum of diseases and varied clinical courses. Parotitis is one of the manifestations of paediatric HIV infection, occurs in 4-47% of children. Patient: We present a 4-year old boy with recurrent bilateral parotitis. He had been admitted twice with the diagnosis of iron deficiency anaemia and chronic hepatitis. During the last admission for recurrent parotitis, based on clinical and paraclinical findings, he was suspected to have HIV infection that was finally confirmed with laboratory tests. Conclusion: Despite low prevalence of HIV-infection among children, physicians should consider HIV infection in any pediatric patient who presents with unexplained signs and symptoms such as chronic or recurrent parotitis.

Background: Primary hydatidosis located in the thyroid is an infrequent finding; even in endemic regions, however, a few cases of secondary hydatid cyst of thyroid have been reported in literatures.Patient: A 17-year old female was admitted with history of a slow growing painless thyroid nodule for the last two years. Pre-operative investigations, including thyroid scanning and aspiration of the nodule, did not help in establishing the diagnosis that was later confirmed by histological examination. Histopathological examination of the specimen revealed a hydatid cyst with daughter cyst.Conclusion: In endemic areas such as Iran, any growing mass or tumor should arouse suspicion of hydatid disease.

Clostridium difficile is a Gram-positive sporeforming anaerobic bacillus, which is found in the stool flora of 25-80% of healthy infants but rarely in the stool of healthy adults and children over the age of 12 months…