IRANIAN JOURNAL OF CLINICAL INFECTIOUS DISEASES
Year:2006 | Volume:1 | Issue:4|Papers Count:11

The frequency of invasive, opportunistic mycoses has increased significantly over the past 2 decades (1-3)….

Background: Trichomonas vaginalis infection is the most prevalent sexually transmitted disease in the world. It causes vaginitis, urethritis and preterm birth. It has been associated with nongonococcal urethritis in men. In this study, a polymerase chain reaction (PCR) targeting the beta-tubulin genes of T. vaginalis was developed for the detection of the organism in both vaginal swab and urine specimens from infected patients.Materials and methods: Random urine samples were collected from 30 patients (23 females and 7 males) tested positive for T. vaginalis by wet preparation and the Inpouch T. vaginalis culture system. Two vaginal swabs were collected by each woman, first before insertion of the speculum and then after the insertion of the speculum. A previously published T.vaginalis specific primer set, (BTUB 9/2), BTUB 9 (5’ CAT TGA TAA CGA AGC TCT TTA CGA T 3’) and BTUB2 (5’ GCA TGT TGT GCC GGA CAT AAC CAT 3') recognizing a 112-bp target within the b- tubulin gene of the T. vaginalis organism was used for this purpose. Results: The positive result was reported 28.6% in male urine and 39.1% in female urine samples, first swab 65.2% and second swab 78.3% by wet preparation diagnosis. By the culture test, the male urine samples recorded 42.9% positive, female urine 69.6% while the first swab recorded 86.9% positive and the second swab 91.3% positive. All negative cases by culture in urine and vaginal samples were tested by PCR, which resulted as 2 cases positive in male urine samples and 5 cases were positive in female urine samples, but one case only gave positive with PCR in first swab of vaginal samples and 2 cases of second swab became positive by PCR. No statistical differences were observed in incidences among patients.Conclusion: On conclusion the PCR assay was even more sensitive than wet preparation and culture and afforded the practical advantages of providing results.

Background: Most therapeutic interventions in acute phase of viral hepatitis B patients are conservative. Prostaglandins have absorbed many scientists' attention for improving these patients condition, therefore, the present study was designed to evaluate misoprostol (PGE1 Analogue) effect on acute phase of viral hepatitis B.Materials and methods: A randomized matched controlled clinical trial was performed on two equal groups each included fifteen male acute phase hepatitis B patients who were anti HBC IgM and HBs Ag positive, hepatitis C negative and their total bilirubin level was more than 10 mg/dl. The experimental group received 800μg misoprostole (200mg × 4 times a day) while the control group received placebo for 14 days. Their bilirubin and serum transaminases concentrations as well as PT and PTT were checked before and after the therapy and compared by chi square and tstudent tests using SPSS software. Results: At the end of the treatment phase, serum bilirubin, SGPT and PTT were significantly lower in the experimental group. After three weeks follow up, only SGOT was not significantly lower in experimental group. At the end of the 4th and the 5th week after treatment initiation, serum bilirubin, SGPT, alkaline phosphatase and PTT were significantly lower in experimental group.Conclusion: These results confirm that misoprostol improves hepatitis B patients' condition and reduces their serum bilirubin, SGPT, alkaline phosphatase and PTT.

Background: Necrotizing fasciitis is an uncommon severe infection involving the subcutaneous soft tissue, particularly the superficial and often the deep fascia. Early diagnosis is of utmost importance since the disease progress rapidly. The present study was conducted to determine clinical, laboratory and therapeutic aspects of necrotizing fasciitis in a group of Iranian patients referred to a referral center in Tehran between 1999 and 2003. Materials and methods: For this descriptive study, all patients with the diagnosis of necrotizing fasciitis referred to Imam Khomeini hospital during a 4-year period (1999-2003) were enrolled. The diagnosis of necrotizing fasciitis was verified according to the clinical, radiologic, and direct inspection of a surgeon. Results: Totally, 34 patients referred during the studied period with the mean age of 43.7±28.3 years and male to female ratio of 19:15. Tachycardia (41.2%) and tachypenia (44.1%) were the most common presenting signs. Lower limb was the most frequent site of involvement (70.5%). Totally, 64 operations were performed (2.14 operation/ patient). Conclusion: Necrotizing fasciitis should be ruled out in any patient presented with pain, flu-like symptoms, swelling, blisters, and necrotizing appearance skin, especially if it is associated with diabetes mellitus, injecting drug abuse or recent trauma. Prompt diagnosis, suitable antibiotic use, and extensive operation could significantly reduce mortality.

Background: Current guidelines suggest that the PPD Mantoux tuberculin test should be read after 48 or 72 hours. We have compared the measurements at these time points. Materials and methods: A 5-tuberculin unit (TU) PPD Mantoux test was administered to 100 subjects (91% with Bacillus Calmette- Guerin scars). Induration was measured 48 and 72 hours following the injection. Results: The measurements made at 72nd hour were significantly higher than those made at 48th hour (median: 8.9 vs 4.5mm, p=0.01). In those subjects with indurations at either or both time points (n=74), the readings taken at 72nd hour were on average 2.1mm (95% confidence interval: 0.3-3.1mm) larger than those at 48th hour. Using an induration of >15mm diameter to define a positive result, there were more positive test results at 72nd hour (24) compared to 48th hour (20).Conclusion: We concluded that, in adults, the size of the 5-TU Mantoux reaction is significantly larger at 72nd hour, thus, in clinical practice, tuberculin tests should be read at this time point since negative tests at 48th hour may be false negative.

Background: Scorpions are widely distributed in Iran. Kashan city has a suitable climate for these creatures (especially Butidae species). The preset study was designed to determine the epidemiological picture of scorpions in Kashan. Materials and methods: In this descriptive study, medical files of all patients bitten with scorpion during 1991-2002 were reviewed.Results: Totally, 367 cases were bitten during the studied period, of whom 67% were male and 33% were female with a mean age of 23.1±15.1 years. Children aged <9 years were the most commonly affected group (36.5%), while lower limbs were the most commonly bitten site (64.3%). Most of the patients suffered from inflammation and pain, and unfortunately, 7 cases of death due to scorpion bite were reported.Conclusion: Scorpion sting-associated illness was quite common in Kashan during the study period, therefore, preventive tools and suitable educational programs, especially at schools, are required to alleviate the probable problems.

Background: During the past decades the prevalence of tuberculosis (TB) has declined and its prognosis has changed dramatically due to chemotherapy; however, cases of tuberculous pericarditis are still reported worldwide. Materials and methods: The study population included 19 men and 11women aged 12-76 years admitted to the hospital for acute pericardial disease. The diagnosis of tuberculous pericarditis was verified based on the adenosin deaminase activity (ADA), culture on Lowenstein-Jensen media, Ziehl Neelsen staining, biopsy of pericardial tissue and evaluation of tuberculin test.Results: Of 30 patients, 13 (43.3%) had tuberculous pericarditis. All of whom had clinical TB manifestations. The culture of pericardial fluid in 6 patients (46%), staining in 3 (23%), and the culture of pericardial tissue in 6 patients (46%) were positive. The caseating granuloma w identified in 46% of cases. Ten case (77%) had positive PPD reaction. All tuberculous pericarditis patients had ADA level of >45U/l.Conclusion: Results have revealed that measurement of ADA level may prove a good screening test for early diagnosis of tuberculous pericarditis.

A healthy 42–year Old Iranian man who was a butcher presented with a 3 days history of a large bullous lesion on his right thumb. (Figure 1). He had a history of cutting his hand during meat slicing about 10 days ago. On physical examination there was a large 4×5 cm diameter bulla adjacent to a 2×2 cm targetoid nodule....

Background: Tuberculous brain abscess is an extremely rare manifestation of tuberculous involvement of the central nervous system. In countries such as India where tuberculosis is fairly common, few cases of tuberculous brain abscess have been reported.Patient: The patient was an 8-year old boy presented with the diagnosis of cystic fibrosis and a history of tonic and clonic convulsions since 2 years ago with normal brain CT scan. Two months ago he became febrile and complained of severe headache that often awakened him up. Diagnosis of intracranial abscess was made clinically and the patient received ceftriaxon, amikacin and clindamycine; however, 2 weeks of treatment failed to show improvement. During craniotomy multiple cystic lesions and a mass of 9×3×8cm in frontoparietal area was found. After operation the patient developed severe hepatitis with elevated enzymes and bilirubin level due to anesthesia and anti- tuberculous treatment.  Drugs were discontinued but fever persisted and he started a downhill course. While hepatitis was going to resolve, restarting antituberculous drugs flared up hepatitis and 3 days later he expired because of hepatic failure. Conclusion: Meningitis is an entity of tuberculous infection in subjects living in countries of high burden tuberculosis, thus, it should be kept in mind for suspicious subjects.

Background: Crimean-Congo haemorrhagic fever (CCHF) is a worldwide distributed lethal disease. Miscellaneous complications have been reported, however, compartment syndrome is a very rare complication.Patients: We report two cases of compartment syndrome of the left and right upper limbs following haemorrhage due to Crimean-Congo haemorrhagic fever.Conclusion: These cases suggest that CCHF should be included in the differential diagnosis of patients with compartment syndrome. Patients are at risk of developing compartment syndromes especially in the forearm. We emphasize the importance of clinical signs in the early diagnosis of this potentially serious complication of viral hemorrhagic fevers.

Infection remains a common complication in patients with hematologic malignancies, and despite significant advances in antimicrobial therapy and supportive care, is still associated with substantial morbidity and some mortality. The epidemiology of bacterial infection continues to change and is impacted upon by several factors, including the nature of the underlying immunological deficit(s), the nature of antineoplastic therapy, the use of chemoprophylaxis, the use of central venous catheters and other medical devices, and some local epidemiological factors. Constant surveillance and monitoring is necessary in order to detect epidemiological changes in a timely manner, and develop prevention/treatment strategies that take these epidemiologic changes into account. This review will focus on bacteria that are emerging as significant pathogens and are likely to cause therapeutic challenges in the near future, and the need for antimicrobial stewardship.