IRANIAN JOURNAL OF CLINICAL INFECTIOUS DISEASES
Year:2010 | Volume:5 | Issue:2|Papers Count:12

Meningococcal disease is a global health problem. The World Health Organization estimates that there are 1.2 million cases of invasive meningococcal disease and 135,000 related deaths annually. Although the disease occurs sporadically in industrialized countries, the major disease burden is in the non-industrialized countries. A recent epidemic in Nigeria resulted in 4164 cases and 171 deaths in 1 week alone.

Background: The prevalence of Helicobacter pylori has declined rapidly in Asia. This has been shown in both seroprevalence-based and endoscopy-based studies. The present study was conducted to determine the prevalence of gastric infection caused by H. pylori in an Iranian population residing in south of Iran.Patients and methods: A total of 522 patients (266 females and 256 males with the mean age of 44.3±13.0, range 18-83 years) underwent endoscopy in Shiraz, southern Iran. The diagnosis of H. pylori infection was established by rapid urease test, culture and gram staining and the gastric disease was confirmed by an expert pathologist.Results: From ulcerative (n=296) and non-ulcerative (n=226) patients, 156 (52.7%) and 94 (41.6%) H. pylori strains were isolated by culture, respectively. The prevalence of H. pylori infection was significantly higher in patients aged 21- 30 and >50 years (66.66% and 62.12%, respectively). However, H. pylori was not detected in 22 patients aged <20 years.Conclusion: The present study revealed a significant decline in the prevalence of H. pylori infection in the studied population. It seems that in parallel with better therapeutic approaches and elimination of bacteria, an improvement in the personal hygiene and living conditions of the Iranian population contribute to lower prevalence of H. pylori.

Background: Urinary tract infections (UTIs) are among the most commonly bacterial infections in clinical practice. Almost half of all women experience at least one urinary tract infection in their lifetime. This study compared efficacy and safety of 3-day and 7-day ciprofloxacin regimen for the treatment of uncomplicated urinary tract infection in women.Patients and methods: A total of 76 patients were randomly assigned to two treatment groups. One group received ciprofloxacin, 250 mg twice a day for 3 days (n=39) and the other group received ciprofloxacin 250 mg twice a day for 7 days (n=37). Subjects were visited and assessed three times during the study period (baseline, end of treatment, and test for cure). Clinical and bacteriological responses to the treatment were compared between the two groups.Results: There was no significant difference between the two groups in terms of age distribution and clinical signs/symptoms during the baseline visit. There was no significant difference between clinical or bacteriological responses between the two groups. Three-day regimen of ciprofloxacin showed high microbiological eradication rate for E. coli (66.7%) which was similar to the eradication rate observed for 7-day regimen (64.8%). No statistically significant difference was found in adverse effects between the groups, except for nausea (p=0.041).Conclusion: A 3-day ciprofloxacin regimen appeared to be safe and effective for the treatment of UTI in women. Therefore, shorter therapy duration with ciprofloxacin can potentially improve patient compliance and decrease costs.

Background: Urinary tract infection (UTI) is a major health concern worldwide. The present study was aimed to compare drug resistance to ceftriaxone and cefazolin in adult patients with acute pyelonephritis.Patients and methods: For this clinical trial, patients with fever plus either dysuria, frequency, flank pain or flank tenderness were enrolled. Having performed urinalysis (U/A), urine culture (U/C) and antibiogram, they were randomly assigned in two groups: ceftriaxone 1gr twice a day or cefazolin 1gr trice a day. Three days later, urine was re-evaluated and patients were categorized as clinical and microbiological responders. Chi-square test and Fisher’s exact tests were used, when appropriate. Statistical significance was defined as p<0.05.Results: Study population included 59 females and 27 males. Escherichia coli were the most frequent isolated pathogen (86.0%). Dysuria, flank pain and flank tenderness was more frequent among non-E. Coli-infected than E. coli-infected subjects, however, the difference was solely significant for flank tenderness (p=0.008). Clinical response was observed in 86.1%, 11.6%, and 2.3% of patients 3, 4, and 5 days following the therapy, respectively, however, there was no significant difference between ceftriaxone and cefazolin group. Totally, 93% of patients became culture negative. Rate of microbiological response did not differ significantly between groups.Conclusion: The results demonstrated that clinical and microbiological responses of patients with acute pyelonephritis are not always compatible. Meanwhile, first and third generation cephalosporins have similar efficacy for treatment of uncomplicated patients.

Background: Surgical site infections (SSIs) are the most common nosocomial infections in surgical patients. Depending on the source of a traumatic wound, particular pathogens are expected to be present while their prevalence varies in different conditions. This study focused on determination of microorganisms in traumatic wound infection and the frequency of Staphylococcus aureus and other organisms in SSIs.Patients and methods: A total of 116 patients were studied among whom 86 patients (18 females and 68 males) underwent microbiological assessment for non-surgical wound infections and 30 patients (all were males) had SSIs. Specimens were cultured on blood agar, MacConkey agar, and chocolate agar while direct examination and gram staining were also achieved for each sample.Results: Staphylococcus aureus (20.9%) was the most commonly isolated organism among non-surgical traumatic wound infections, however, Proteus mirabilis, Salmonella Arizona and streptococcus group A were less commonly isolated (1.1% each). Similarly, S. aureus (40%) was the most prevalent isolated organism in SSIs while enterobacter Spp was found only in 4 cases (13.3%).Conclusion: Our results revealed that S. aureus is the most commonly isolated organism in non-surgical traumatic wound infections and SSIs, therefore, appropriate therapeutic approach and applying efficient preventive modalities are of utmost importance.

Background: Herpes simplex virus type 1 and type 2 (HSV-1 and HSV-2) are common infectious agents worldwide. Data on prevalence of HSV-1 and HSV-2 infections are limited in Asia, especially in Iran. Our study aimed on determination of seroepidemiology of HSV-1 and HSV-2 infections in asymptomatic healthy students of Islamic Azad University of Kazeroun, Fars province, southwest of Iran.Patients and methods: The study population included 360 students with a mean age of 22.2 years. Demographic data were gathered by a well-designed questionnaire. For serological studies, 5 ml of blood sample was collected and centrifuged. Enzyme linked immunosorbent assay (ELISA) was used to determine immunoglobulin G (IgG) antibody titer to the HSV-1 and HSV-2.Results: Totally, HSV-1 and HSV-2 IgG antibody were positive in 285 (79.2%) and 84 (23.3%) subjects, respectively. The seroprevalence of HSV-2 was higher among females (29.0%) compared with males (17.5%) (p<0.05), however, there was no significant correlation between gender and HSV-1 seroprevalence.Conclusion: Results confirm a high prevalence of HSV infection. Our findings were in agreement with prior studies in which HSV-2 infection was more prevalent among female subjects. The high prevalence of HSV infection underlines the need for focusing on preventive efforts and education among the population.

Background: Helicobacter pylori multiplies and causes infection in human gastric mucosal layer. New approaches have focused on using specific treatments, such as immunotherapy, to limit this infection. Urease, as one of the most important virulent and antigenic factors of the bacterium, is a suitable target for this purpose.Patients and methods: In order to prepare recombinant proteins, the synthetic genes for total ureC protein (UreCt) and its N (ureCn) and C (ureCc) terminal fragments were ligated into pET28a. The recombinant proteins were expressed in E. coli BL21(DE3). White leghorn hens were injected with the purified recombinant proteins. IgY recovered from egg yolk, using PEG precipitation. Finally, urease neutralizing ability of the antibodies was evaluated by urease activity assay in presence of the purified IgY.Results: SDS-PAGE analysis revealed a good expression and purification of the recombinant proteins. Indirect ELISA observation demonstrated high antibody titer in sera and egg yolks and high ability of IgY Anti-UreCt and IgY Anti- UreCc antibodies in recognition of urease subunit C. Anti-UreCT and Anti-UreCc IgYs were more potential H.pylori urease inhibitors than Anti-UreCn.Conclusion: While all three UreC fragments induce prophylactic responses. UreCt and UreCc possess almost equal responses. Anti-UreCc IgY has advantage of smaller size and is preferred for its activity and easier protein recovery and purification process. These features emphasize on importance of simpler, easier and cost effective antibody production.

Background: Micronutrients such as zinc (Zn) and copper (Cu) have a modulatory effect on immune system. Altered serum concentrations of these nutrients have been described in patients with specific disease conditions. The aim of this study was to evaluate serum Zn and Cu level alterations in patients with brucellosis in comparison with healthy individuals.Patients and methods: Serum Zn and Cu level of 43 patients with brucellosis (34 men and 9 women) were compared with 43 matched healthy controls. Serum micronutrient concentrations were measured by automatic absorptive spectrophotometry.Results: Mean serum Cu concentration was significantly higher in subjects with brucellosis when compared with agematched healthy controls (p<0.05). Mean serum Zn level was decreased in female patients compared with controls (p<0.05), however, there was no significant difference between male patients and controls.Conclusion: Serum Zn and Cu concentrations may alter in patients with brucellosis during the period of infection. Further studies are needed to determine whether these micronutrients have an effect on disease severity and outcome. Measuring serum Cu level may be suggested as a complementary screening tool for brucellosis.

Background: Strongyloides stercoralis is prevalent in tropical and subtropical regions worldwide. This parasite is the only nematode with the ability to multiply in its host's body via autoinfection transmission. Larvae detection in feces is difficult partly because of low egg production and also irregular larvae excretion in feces. Serologic tests (ELISA, IFA) are also diagnostic, however Strongyloides stercoralis antigens are not available as a diagnostic tool. In the present study, we analyzed filariform larva (L3) proteins of Strongyloides stercoralis by the immunoblot technique.Materials and methods: Stool samples were examined by direct smear, formalin-ether and agar plate method to identify infected patients. Sera were also obtained and stored at -20oС. Infective larvae were then obtained by agar plate culture, which was incubated for 6-7days at 25oC, then frozen at -70oC. Finally, larvae were suspended at a concentration level of 12000 in 250ml PBS, containing protease inhibitors and then were sonicated. Protein level was measured by Bradford method. Proteins of Strongyloides stercoralis filariform larvae were separated by SDS-PAGE, blotted onto nitrocellulose paper. Western blot analysis of these antigens was achieved using infected human sera (0.1, 0.01, 0.001 dilution) with strongyloidiasis, toxocariasis, hydatidosis, amebiasis and normal human serum as control.Results: Four immunodominant proteins (23, 28, 30, 41 kDa) were recognized with strongyloidiasis sera in 0.1 diluted serum. None of the proteins reacted to normal human and amebiasis serum, but some showed reaction with serum of hydatidosis and toxocariasis. Having increased the level of serum dilution, only 41 kDa protein was recognized by strongyloidiasis sera. Other serums did not represent any reaction to the parasite’s proteins. Therefore, the 41 kDa protein presents as the most important immunodominant protein in this study.Conclusion: The identification of immunodominant proteins adapted to the physiological and genetic conditions of he host is an appropriate diagnostic approach, which could be associated with improved sensitivity and specificity of serologic tests.

Background: Optimal use of the clinical examination aids physicians in identifying patients at risk for meningitis. The low specificity of the meningeal signs may be due to the presence of cervical arthritis and spondylosis. One of the most sensitive maneuvers in the diagnosis of meningitis is jolt accentuation of headache.Patients and methods: A descriptive research was performed on suspected acute meningitis patients. The patients were evaluated for presence of meningeal signs before lumbar puncture. Sensitivity, specificity, positive and negative predictive values, likelihood-ratio-positive (LR+), and likelihood-ratio-negative (LR-) were determined. A p-value of <0.05 was considered to be statistically significant.Results: Totally, 14 patients were evaluated. Neck stiffness, Kernig, Brudzinski and jolt accentuation sign were positive in 78.6%, 14.3%, 14.3%, and 64.3% of patients, respectively. The prevalence, sensitivity, specificity, PPV, NPV, LR+, and LR- of neck stiffness in comparison with pleocytosis was 50%, 100%, 57%, 70%, 100%, 2.33, and 0, respectively. The prevalence, sensitivity, specificity, PPV, NPV, LR+, and LR- of jolt accentuation sign in comparison with neck stiffness was 78.5%, 82%, 60%, 100%, 60%, 0, and 0.18, respectively, however, when jolt accentuation sign was compared with pleocytosis these parameters were 50%, 100%, 71.5%, 78%, 100%, 1, and 0, respectively.Conclusion: When evaluating suspected cases of meningitis with limitations for neck stiffness examination, we can alternatively evaluate jolt accentuation sign. The LR- of 0.18 for jolt accentuation sign when compared with neck stiffness revealed that jolt accentuation sign is an appropriate maneuvers in the diagnosis of meningitis.

A 55-year old male patient underwent open cholecystectomy and choledocholithotomy with Ttube drainage for cholelithiasis and choledocholithiasis with obstructive jaundice.Postoperative period was uneventful and serum bilirubin level was falling gradually. T-tube drainage was reduced to 50-100 ml bile per day.On 10th postoperative day, T-tube cholangiography was done, showing a linear filling defect in common bile duct (figure 1). Magnetic resonance cholangiography was performed, which confirmed the shadow in common bile duct (figure 2).

Clostridium botulinum causes severe food poisoning from botulinum neurotoxin (BoNT) production in the food (1, 2). This toxin acts as a neuromuscular blocking agent, which causes paralysis (botulism) by preventing the release of neurotransmitter from motor neurons. Botulism can present as other illnesses, and apparently unlikely foods can harbor botulinum toxin. The objective of this study was to confirm the diagnosis and determine the cause and extent of an outbreak of botulism associated with traditional vegetable pickle.