IRANIAN JOURNAL OF CLINICAL INFECTIOUS DISEASES
Year:2010 | Volume:5 | Issue:1|Papers Count:11

The increasing number of multi-antibacterial drug-resistant infections worldwide and the diminishing number of new antibacterial drugs in development with the potential to treat these infections represent one of the world's greatest health threats. The World Health Organization (WHO) has supported this premise, identifying antimicrobial resistance as one of the three greatest threats to human health.

Background: Gallstone disease is one of the most common gastrointestinal diseases requiring surgery with probable postoperative infection. The role of prophylactic antibiotics (AB) in prevention of infection is controversial. This study aimed to compare the manifestations, complications and outcomes of two groups of patients, those receiving prophylactic AB versus placebo, in order to determine whether antibiotic therapy is required.Patients and methods: In this double blind randomized clinical trial, we studied 130 patients with symptomatic cholelithiasis or polyps of gallbladder admitted in Shohada-e-Tajrish Hospital, Tehran, Iran for cholecystectomy between 2006 and 2008. Patients were randomly assigned in two subgroups: the first group received 1gr ceftriaxone during induction of anesthesia and the second group received 10mL of isotonic sodium chlorides solution as placebo. All patients were followed for 4 weeks after surgery.Results: The study population included 61 males and 69 females with the mean age of 49.3±9.6 and 51.8±9.9 years in treatment and placebo group, respectively. Of 130 bile culture results, 83 were negative. Escherichia coli, Klebsiella and Staphylococcus aureus were the most common cultured bacteria. There was no statistically significant difference in culture results between the patients received AB and placebo (NS). The surgical technique (open versus laparoscopic) did not influence the culture results.Conclusion: It can be concluded that prophylactic antibiotics do not have any preventive effect on wound infection in a double blind setting. According to our findings, routine antibiotic prophylaxis as recommended for biliary surgery (open or laparoscopic cholecystectomy) is now questionable.

Background: Congenital cytomegalovirus (CMV) infection affects nearly 1% of live births in the United States. Ten percent of these infants have symptoms at birth and another 10 to 15% develop hearing loss or developmental problems. The aim of this study was to compare CMV infection (IgM and IgG) rate in infants suspected for intrauterine infection with the control group.Patients and methods: A case-control study was performed in the Pediatrics Department of Hazrat Rasool Akram Hospital in Tehran. The study population included 74 suspected cases of intrauterine infection (mean age, 4.7±3.7 months) and 65 normal healthy controls (mean age, 5.3±3.1 months). We compared serum CMV antibodies (IgM, IgG) with ELISA kits.Results: Acute and previous immunity to CMV (IgM and IgG) was found in 41.9% (31/74) and 74% (54/74) of cases, respectively. These figures were 6.2% (4/65) and 95.4% (62/65) in controls, respectively. Acute infection (CMV-IgM) was more common among cases (p<0.0001), but previous immunity (CMV-IgG) was more prevalent among controls (p<0.001).Conclusion: We concluded that CMV is the most common cause of intrauterine infection in infants aged less than 6 months as compared to the healthy ones. We prefer, at least in our country, to consider seropositive (CMV-IgM) infants suspected of intrauterine infection (less than 6 months) as congenital form. To arrest the natural progression of congenital CMV, we recommend prolonged course of oral analogues of ganciclovir for children with symptomatic congenital CMV.

Background: Cigarettes smoking is a risk factor for tuberculosis (TB). Associations between smoking and TB disease have been reported, but there are few reports on the influence of smoking on the sputum smear and culture conversion time. This study surveyed the possible association between smoking and sputum smear conversion time among new smear-positive pulmonary tuberculosis patients.Patients and methods: Between May 2005 and December 2006, we evaluated smokers and non-smokers patients with pulmonary TB referred to Zahedan Tuberculosis Center (Southeastern Iran). Patients were not immunosuppressed or infected by human immunodeficiency virus (HIV). Drug resistant cases were also excluded.Results: A total of 200 TB patients, including 100 smokers, were evaluated. There was a significant delay in sputum smear conversion time between smokers and non-smokers 2 (53% vs. 10%, respectively, p<0.001) and 3 months following the treatment (19% vs. 2%, respectively, p<0.001). However, there was no significant difference in failure rate (a positive smear at the end of the 5th month of treatment) between two groups (95% vs. 97%).Conclusion: Our results revealed that smoking is significantly associated with a delay in sputum smear conversion time, hence, pulmonary TB cases must be strongly encouraged to cease smoking.

Background: Helicobacter pylori is a widely distributed gram negative bacterium that infects the human stomach and duodenum. Some antibiotic regimens are subjected to cure the infection but the cost of drugs, poor patient compliance and emerging of antibiotic-resistant strains are limiting the usefulness of these antibiotic therapies. Therefore, interest in a H. pylori vaccine is growing up rapidly.Materials and methods: We selected a fragment of B subunit of H. pylori urease enzyme consist of four important epitopes, involving in elevating host immune responses. This 1070bp fragment was amplified by PCR from genomic DNA isolated from H. pylori 22596 and then cloned into the pET28a expression vector. UreB229-561 was expressed and then affinity-purified by Ni2+-Sepharose resin. The recombinant UreB229-561 was reacted with the serum of H. pylori-infected human and rabbit anti-H. pylori polyclonal antibody in western-blot analysis.Results: Having transformed competent E.coli DH5a with ligation product of digested ureB fragment and pET28a, plasmid extraction from single colonies appeared in LB-agar plate after 18-24 h incubation at 37oC, using plasmid extraction kit (Bioneer, Korea). Applying both infected human serum and rabbit anti-H. pylori polyclonal antibody, brown strip corresponding to the location of the recombinant protein appeared on PVDF membrane after adding DAB solution, hence confirming the antigenicity of the protein. This recombinant fragment showed urease activity. Conclusion: Our findings confirmed that a prokaryotic expression system of rUreB229-561 was successfully constructed. The results of SDS-PAGE showed that our constructed prokaryotic expression system pET28a- ureB229-561 -BL21DE3 efficiently produces target recombinant protein in the form of dissoluble inclusion body. Therefore we can suggest that these epitopes can effectively be a vaccine candidate.

Background: Viral hepatitis is a systemic infection affecting the liver predominantly. Almost all cases of acute viral hepatitis are caused by one of five viral agents: HAV, HBV, HCV, HDV and HEV. The present study aimed to find out the frequency of various forms of viral hepatitis (HAV, HBV, and HCV), route of transmission, the history of vaccination against hepatitis B, and clinical findings in 252 hepatic patients referring to 2 teaching hospitals.Patients and methods: In this descriptive study, 252 patients with viral hepatitis hospitalized in two university hospitals were included. Based on medical files, the initial data and laboratory indices including HBS-Ag, HBS-Ab, anti- HBC Ab, anti-HCV Ab (ELISA generation II), anti-HAV Ab (IgG, Ig M), and anti-HIV Ab were gathered.Results: The mean age of patients (±standard deviation) was 40.3±16.3 years. Of 252 cases, 37 (14.5%) suffered from acute viral hepatitis, while 215 (85.5%) were chronically infected. Finally, the frequency of various forms of viral hepatitis was as follows: hepatitis A 5.2%, hepatitis B 54.8%, hepatitis C 34.9%, and hepatitis B and C co-infection 5.2%.Conclusion: With respect to the hazardous complications of hepatitis B and C and the reality that most of the patients are in their reproductive ages, suitable strategic planning for controlling and preventing the disease is of utmost importance.

Background: Nowadays the molecular methods widely use for rapid identification of Mycobacterium other than tuberculosis (MOTT). The Mycobacterium simiae isolates are cause of majority of human pulmonary diseases compared with other atypical mycobacteria. As sensitivity of primers and digestion patterns for diversified fragments is different, this survey evaluated the three various fragments using the PCR- restriction fragment length polymorphism analysis (PRA) for rapid diagnostic of M. simiae isolates. Patients and methods: Strains that were identified as M. simiae (17 isolates) by phenotypic (photochromogen and positive niacin) methods were selected for this study. The fragments of the 16S-23S rRNA gene spacer and hsp65 gene were amplified by PCR. Subsequently the amplicons were digested with three restriction enzyme namely AvaII, HphI and HpaII for a 644bp region of hsp65 DNAs, BstEII and HaeIII endonucleases for 439bp region of hsp65 gene (TB11 and TB12 fragment) and HaeIII digestion for 225bp region of 16S-23S rRNA gene spacer.Results: Of 962 culture positive specimens, 17(1.7%) were identified as M. simiae species; majority of them were multidrug-resistance (12; 70.5%). The overall detection rate by Tb11, Tb12 and SP primers were 82.3% whereas hsp65 primer was 100% (p>0.005). We also found out that the HpaII and HphI enzymes were more specific to distinguish M. simiae species than other restriction enzyme used in this study.Conclusion: The high discriminative power of hsp65 pattern particularly HpaII digestion, provide an exact and cost-effective method for rapid identification of M. simiae strains among registered pulmonary cases.

Background: Shigellosis as a global human health problem is more severe than other forms of gastroenteritis and causes over a million deaths in developing countries worldwide annually. Fatality due to shigellosis is usually due to dehydration and two-third of fatalities are seen among children. The aim of current study was to describe fatal cases of shigellosis due to infection with Shigella sonnei and S. flexneri.Patients and methods: We investigated the fatal cases of shigellosis among all children with acute diarrhea admitted to Children’s Medical Center, Tehran, Iran. Bacterial isolation and identification was achieved according to standard bacteriological methods. Antibiotic susceptibility tests, plasmid profiling and ribotyping were performed to investigate the clonal relationship among the isolates.Results: Among 1200 children with acute diarrhea, 140(12.7%) cases had shigellosis. Of these, three patients died. No signs of severe dehydration were observed among the fatal cases. The symptoms were not improved following antibiotic therapy and all three cases died after 24 h of hospitalization despite receiving intensive treatments. Stool cultures yielded S. flexneri and S. sonnei for one and two cases, respectively. The isolates were resistant to streptomycin, ampicillin, and sulfamethoxazole-trimethoprim. S. sonnei strains were further studied and showed a single pattern of antibiotic susceptibility and ribotyping.Conclusion: Mortality due to species other than S. dysenteriae is rare, however, in current study we found S. sonnei and S. flexneri as the cause of fatality among pediatric patients during the study.

Background: Infection is one of the most common causes of complication in burn patients. A severe burn injury is not only a life–threatening problem for the burned patients, but it also may have serious financial effects on the patient and society. Patients and methods: In a descriptive study, medical files of 6082 consecutive admissions for burn injury treated at Taleghani Burn Hospital over a five-year period were reviewed.Results: The mean age of patients was 22.4±16.9 years and overall male to female ratio was 1.25. Burns were more common during winter (33.6%) (p<0.001). Fire accident was the most common cause in all age groups (66.1%), except subjects aged less than 10 years. The percent of TBSA for burned patients ranged between 1% and 100% with a mean of 38.7±29.8%. There was a correlation between TBSA percentage and age (r=0.18%). The mean and median hospital stay was 14 and 9 days, respectively, with a range of 1-311 days. There was a significant association between fire accident and hospital stay (p<0.001). Of 6082 patients, 486 deaths were recorded (8%). E. coli in urine culture and Pseudomonas aeruginosa in blood and wound culture were the most predominant isolated bacteria.Conclusion: Preventive programs for reducing the risk of burns are needed. Furthermore, high percentage of TBSA and mortality and the presence of multi-drugs resistance bacteria are major concerns in our hospital.

Background: Health care workers (HCWs) are at high risk for acquisition of hepatitis B virus (HBV) infection due to occupational exposure to potentially infectious body fluids. This study was carried out to determine the prevalence of HBV markers and vaccination compliance among different categories of HCWs in Fars Province, Iran.Patients and methods: A total of 346 HCWs working at Gerash and Evaz hospitals, were included. Serological HBV markers were detected in serum samples of HCWs by ELISA method. Statistical analysis was performed to determine the significant difference.Results: The study population included 114 males and 232 females with their age ranged 20-59 years. Totally, 299 cases had received HBV vaccine. The overall prevalence of HBsAg, anti-HBs and anti-HBc among HCWs was 2.6%, 78.6% and 6.4%, respectively. The prevalence of HBsAg was higher in non-professional staff group (5%) but the anti-HBc rate was higher among aid-nurse group (12%). No significant difference was found for HBsAg and anti-HBc positivity between different variables including gender, age group and occupation. Significantly higher prevalence of compliance rate was observed among technician (96.8%) and nurses (88.4%) than non-professional staff (74.3%).Conclusion: Results revealed that HCWs are at higher risk for acquiring HBV infection than general population, thus, an intense program for education, vaccination and post vaccination assessment is mandatory.

Hepatitis B virus (HBV) infection is the main cause of chronic liver disease in Iran. The epidemiology of HBV infection in Iran has been changed during the last two decades and infantile vaccination with high coverage is the main cause for this change. The prevalence of hepatitis B surface antigen (HBsAg) in the country was reported between 2.5% and 7.2% in 1979. It was estimated that there were one million HBsAg positive carriers among 35 million Iranians at that time. In the 1980s, almost 3% of the Iranian population was affected, differing from 1.7% to 5% in different provinces.