IRANIAN JOURNAL OF CLINICAL INFECTIOUS DISEASES
Year:2006 | Volume:1 | Issue:1|Papers Count:10

The outbreak of SARS in 2003 showed that even a disease with a relatively small health impact can have a major economic effect. Globally, SARS is believed to have infected around 8000 people, killing 800 (1). The Asian Development Bank estimated that the economic impact of SARS was around $18 billion in East Asia, around 0.6% of gross domestic product (2)….

Background: Increased levels of non-organ-specific autoantibodies are frequently seen in patients suffering from chronic hepatitis C (CHC); however, the etiology and its effects on the course of the disease and response to therapy are largely undetermined. Particularly, it seems of utmost importance to define whether this increase is solely an insignificant coincidence or a major finding which have an impact on the course of the disease. Materials and methods: Fifty-two patients with CHC (case group) and 52 aged- and sex-matched IBS patients (controls) were enrolled. The sera of all subjects were checked for non-organ-specific autoantibodies, including antinuclear antibody (ANA), anti-smooth muscle antibody (ASMA), anti-mitochondrial antibody (AMA), and antiliver/ kidney microsomal antibody (ALKM). All cases underwent a liver biopsy and treated with a 12-month course of combination therapy with interferon and ribavirin.Results: The mean age of cases and controls was 32.8±12.7 and 31.6±14.1 years, respectively. The overall frequency of non-organ-specific antibodies was significantly higher in anti-HCV positive patients in comparison with controls (36.5% vs 7.7%, p<0.001). Seropositivity of ANA and ASMA was significantly higher in patients with CHC than in controls (11.5% vs. 1.9%, p<0.05 and 13.5% vs. 1.9%, p<0.027, respectively). There was no significant relationship between seropositivity of different autoantibodies and patients’ age and sex, duration of disease and serum aminotransferases levels. Nor this seropositivity had significant relationship with grade and stage of the liver disease and response to treatment, while serum globulin level was significantly higher in ANA positive patients. Conclusion: Seroprevalence of ANA and ASMA seems to be higher in patients with CHC but its impact on the severity of disease and response to therapy is the subject for further investigations.

Background: Hepatitis B vaccination of the newborn prevents prenatal transmission of hepatitis B virus. American Academy of Pediatrics (AAP) recommends that preterm infants weighing less than 2000 grams at birth who born to HBS-Ag negative mothers should receive their first dose of hepatitis B vaccine as early as one month of age. The aim of the present study was to assess and compare the immune response of preterm and term infants to hepatitis B vaccine. Materials and methods: Forty-eight preterm and 49 term neonates were enrolled for this case-control study. The vaccine was administered at birth, 1.5 and 9 months of age. Antibodies against hepatitis B surface antigen (Anti–HBS) were measured in all infants at 15 months of age.Results: The study population included 24 boys and 24 girls with the mean birth weight of 1595.7±388.3 g. The mean gestational age of preterm infants was 32.4±2.1 weeks. Immune response to HB vaccine was protective and similar in both preterm and term infants (85.4 vs. 85.7%, NS). There was no significant association between the type of response and the infant's birth weight or sex. However, there were significant associations between antibody titer and use of mechanical ventilation and sepsis (p<0.01 for both). Conclusion: Preterm and term infants have similar and effective response to hepatitis B vaccine when given immediately after birth.

Background: Due to repeated cholera outbreaks in Iran and neighboring countries, the present study was performed to determine the prevalence of phenotypes of Ogawa and Inaba serotypes of Vibrio cholera 01 and classic Vibrio cholera 01 biotypes.Materials and methods: Scanning and transmission electron microscopy (SEM and TEM) were applied on 4 species, of Ogawa and Inaba serotypes and two classic serotypes of Vibrio cholera 01. Results: Membrane diameter of Eltor was wider as compared to classic biotype. Number of ribosomes, protein synthesis, length and number of flagella were quite more in comparison with classic biotype. Conclusion: According to our findings, genome of classic biotype is more compact.

Background: Crimean-Congo hemorrhagic fever (CCHF) is an arboviral zoonotic infection with several reported cases in Iran. The present study was conducted with the aim of establishing effective ways to reduce exposure to the infectious agent and to organize appropriate policies for importing animals.Materials and methods: For this cross sectional study, 372 local and 372 imported sheep were randomly selected and the presence of CCHF-related IgG antibody and tick on their body were investigated.Results: Totally, 286 (76.9%) of local and 223 (57.8%) of imported sheep were seropositive, however, their difference did not reach a statistical significant level. Ticks were found on the body surface of 115 (31%) local sheep, but imported sheep lacked any tick on their body.Conclusion: Our results revealed the endemic spreading of CCHF in sheep in Isfahan province. Further studies in other parts of Iran may pave the way for better understanding of the CCHF epidemiology in Iran.

Background: Fungal infections of the paranasal sinuses in the immunocompetent patients are being recognized with increasing frequency. Infections are assigned in invasive and noninvasive forms.Materials and methods: In a retrospective study, a total 39 patients with suspected fungal sinusitis were studied for causative fungal agents between 1994 and 2001. Diagnosis was confirmed by demonstration of fungi in direct preparations and culture techniques. Samples were biopsy specimens taken from the sinuses or exudates from deep sinus tracts.Results: Paranasal sinuses mycoses were proven in 18 patients, including 12 men and 6 women, their age ranging from 17 to 58 years. The most frequently isolated organisms were Aspergillus spp. and Candida spp. Paranasal sinuses infections by Cladosporium trichoides (bantianum) and Pseudallescheria boydii are reported for the first time in Iran from Pasteur Institute.Conclusion: In our series, Aspergillus flavus has been isolated more frequently than other agents.

Background: The global incidence of tetanus is about 1 million cases annually. Tetanus antibody values decrease with age. Some patients with humoral immune deficiencies may not respond adequately to tetanus toxoid vaccination. The incidence of infectious disease is increased in patients with chronic renal failure. The purpose of this study was to determine tetanus antitoxin level and cutaneous anergy test in hemodialysis patients.Materials and methods: A cross sectional study was performed on 44 hemodialysis patients who had been on dialysis thrice a week for at least 2 months. Quantitation of tetanus-specific antibodies was achieved by ELISA technique. Then, for Manteaux test 0.1ml of 1/10 saline diluted solution of tetanus and diphtheria toxoid was injected intradermally to the volar surface of the shunt-free arm. Induration was recorded 48-72h and 7-9 days after the injection.Results: Twenty-eight (64%) patients had induration £5mm in 48-72h, classified as non-responsive, whereas 16 (36%) had induration ³5mm that was classified as positive test (NS). There was no significant correlation between age, sex, duration of dialysis, frequencies of dialysis , history of tetanus-diphtheria vaccination and cutaneous anergy test. Of 44 patients, 34(77.3%) had antibody level of <0.01 IU/ml, 8 (18.2%) between 0.01-0.1 IU/ml and 2 (4.5%) had an antibody level of ³0. 1 IU/ml. There was no significant correlation between age, sex, duration of dialysis, frequencies of dialysis, history of tetanus-diphtheria vaccination, and tetanus antitoxin levels. There was a significant difference between induration size of anergy test results recorded on two separate observations (48-72h and 7-9 days after the test) (p<0.05).Conclusion: Our results indicate that immunization history was not consistent with protective antibody level, so monitoring immunization status and administering the tetanus vaccine in hemodialysis patients are required.  

Background: Tuberculosis is an endemic disease in Iran which may occur more frequently among hemodialysis patients. We have evaluated tuberculin skin test (TST) in hemodialysis patients in a university hospital in 2003-2004. Materials and methods: Sixty-seven hemodialyis patients were enrolled for tuberculin skin tests. Indurations were measured 48-72 hours after the injection and then on the 7th day. Those with indurations less than 5mm in TST1 were introduced for TST2.Results: Of 67 patients, 18(26.9%) had indurations of less than 5mm in TST1 and were introduce for TST2 among whom 7 (39%) had an induration measured less than 5mm. Of 18 cases, 11 (61%) were revealed to have booster effect that represent a ratio of 16% of all studied hemodialysis patients in our study. Conclusion: It seems that the second TST is a better indicator of infectivity in hemodialysis patients, especially for patients who require repeated or annual estimation for M. tuberculosis infection.

A 40 years old woman residing in a rural area, referred with chief complaint of fever and generalized body pain since 4 months ago which was aggravated during the recent month. She had history of intermittent fever, mostly at nights. She had not traveled. On admission, she was depressed and pale in appearance with stable vital signs. On physical examination, spleen was palpable 5 cm below costal margins and spanned about 15 cm in midclavicular line. She had no adenopathy or rash….

Background: Botulism is a neuroparalytic illness caused by clostridium botulinium toxin that is usually transmitted as a foodborne disease. It is manifested by cranial nerve dysfunction and descending flaccid muscle paralysis. Patients: Eleven members of a family developed severe weakness, lethargy and other clinical manifestations compatible with botulism following the ingestion of traditional soup. Stool, gastric fluid and serum samples were submitted for toxicological evaluation with standard mouse bioassay, while, only one patient demonstrated type E toxin. All patients received 3 monovalent antitoxins A, B and E, whilst most of their symptoms improved within 12 hours. Conclusion: This study confirmed that prompt administration of antitoxin could prevent progressionof the disease and  may be a life-saving approach.