IRANIAN JOURNAL OF CLINICAL INFECTIOUS DISEASES
Year:2010 | Volume:5 | Issue:4|Papers Count:14

Only a small fraction of the estimated 500, 000 patients who have multidrug-resistant tuberculosis and 1.37 million patients who have co-infection with tuberculosis and the human immunodeficiency virus (HIV) worldwide each year have access to sufficiently sensitive case detection or drug-susceptibility testing.Diagnostic delay, aggravated by the disproportionate frequency of smear-negative disease in HIV-associated tuberculosis, is common.

Background: Neisseria meningitidis is a major cause of bacterial septicemia and meningitis. Currently, there are no vaccines to prevent disease caused by strains of N. meningitidis serogroup B, since cross-reactivity of the serogroup B capsule with human tissue has hampered efforts to develop a reliable vaccine. PilQ is an antigenically conserved outer membrane protein which is essential for meningococcal pilus expression at the cell surface.Materials and methods: In the current study, we selected a 1095bp fragment of C-terminal of secretin pilQ and evaluated the immunogenicity of this recombinant fragment. This fragment was amplified by PCR from genomic DNA isolated from N. meningitidis serogroup B and cloned into the pET-28a expression vector. PilQ406-770 was overexpressed with IPTG and then affinity-purified by Ni2+-Sepharose resin. The recombinant PilQ406-770 was reacted with rabbit anti- N.meningitidis polyclonal antibody in western-blot analysis. Mice were immunized subcutaneously with purified rPilQ 406-770 mixed with an equal volume of Freund's adjuvant and evaluated specific serum antibody responses.Results: Our results show pilQ 406-770 cloned in pET28a vector, while the cloning of pilQ 406-770 was confirmed by colony- PCR and enzymatic digestion. SDS-PAGE analysis showed that our constructed prokaryotic expression system pET28apilQ406- 770-BL21efficiently produces target recombinant protein with molecular weight of 43 kDa in the form of dissoluble inclusion body.Conclusion: Our results confirmed that a prokaryotic expression system for PilQ406-770 protein was successfully constructed.

Background: Novel H1N1 influenza virus is a unique type of an influenza virus which is built due to abrupt structural alterations. This virus created a pandemic disease. The manifestations and severity may be affected by environmental, cultural and economical condition.Patients and Methods: From October 2009 until December 2009, we had recruited 40 patients with H1N1 infection documented with RT-PCR. Their demographic features and presenting signs and symptoms as well as their associated laboratory data were recorded.Results: During the study period, 40 patients were studied with a mean age of 36.8±13.0 years of whom 21 were admitted to ICU. Totally, 37.5% of patients had risk factors. Pneumonia was the most frequent lung involvement. The most prominent radiographic findings were bilateral ground glass opacity and ARDS (25%). Cough and fever was the most prevalent presenting clinical symptoms. Unfortunately, 8 patients died. Independent risk factor of death was ICU admission and mechanical ventilation.Conclusion: Our findings were more or less the same as other centers, however, most of the studied subjects did not have an underlying risk factor. Except for pneumonia and ARDS, bilateral pulmonary thromboembolism were detected in patients all of whom discharged after complete recovery.

Background: To characterize and compare the epidemiological and microbiological aspects of community and healthcare-associated MRSA (CA-MRSA, and HA-MRSA) cases in Iran, this prospective cohort study was conducted from January to December 2008 in seven hospitals.Patients and methods: Staphylococci were isolated from 109 hospitalized patients. MRSA isolates were classified into HA-MRSA and CA-MRSA based on clinical features.Antibacterial susceptibility patterns of the isolates to eight antibiotics routinely used to treat infected patients were determined according to standard agar dilution methods.Staphylococcal Cassette Chromosome mec (SCCmec) type of isolates and their correlation with antimicrobial susceptibility patterns in CA and HC isolates were determined.Results: Of 109 isolates, 15 (13.7%) were community-associated and 94 (86.3%) were healthcare-associated MRSA.The most frequent SCCmec types in the studied hospitals were SCC mec type I (56.9%) and type II (22%). Relatively high resistance (>60%) of the MRSA to the seven tested antibiotics including: ciprofloxacin, trimethoprimsulfamethoxazole, clindamycin, rifampin, erythromycin, tetracycline and doxycycline were noticed.Conclusion: To our knowledge, this is the first time that the analysis of SCCmec type is carried out in Iran according to the clinical criteria. Difference in the prevalence of HC-MRSA and CA-MRSA based on the clinical and epidemiological features may indicate the need for revisiting the classification of MRSA. The high prevalence of multidrug resistant MRSA could be as a result of the excessive use of antibiotics in the hospitals. Therefore, periodical assessment of antibacterial susceptibility patterns of the MRSA strains is warranted.

Background: This study intends to evaluate the effect of health education program on healthy behavior and tinea capitis in Chabahar primary school-aged boys.Patients and methods: For this quasi-experimental (case–control) study, two primary schools were randomly selected in Chabahar, south-eastern of Iran. Initial data of 115 students were gathered using a well-prepared questionnaire, by means of a check list and a thorough clinical examination. Meanwhile, scalp and hair samples (direct slide exam and culture) were assessed. Subjects of the experimental (case) group had received necessary educations for one month after which both groups were evaluated 2 months later.Results: Totally, 20% and 18.3% of cases and controls were infected before conducting the educational program, respectively, however, following the education only 5.5% of cases were remained infected (p=0.008). Pre- and posteducation infection rate did not differ significantly.Conclusion: Our results showed that health education program had a positive effect on reduction of tinea capitis among prepubescent boys.

Background: To evaluate the manifestations and outcome of community acquired pneumonia in elderly population and compare it with other adults in two teaching hospitals.Patients and methods: A prospective study including all patients over 14 years of age admitted to our hospitals with community acquired pneumonia, was carried out over a period of 12 months. All adult patients and over 65 years old (elderly patients) diagnosed with pneumonia were examined and followed by two of the authors distinctly. Analysis was performed, using chi square, in order to find correlations between signs and symptoms of pneumonia and age.Results: Totally, 183 patients (103 elderly) were studied. The mean age of the participants (±SD) was 59±24 years. The main manifestations of pneumonia in elderly patients were as follow: tachypnea (64%), cough (62%), and fever (34%), respectively. Our results showed that the frequency of fever (p=0.04), chest pain (p=0.001), and pleuritic pain (p=0.001) decrease with aging, however, mental status changes (p=0.015), and CHF (p=0.02) increase with aging. Thirty one patients (17%) died, of whom 29 were over 65 years of age (p=0.001).Conclusion: The clinical presentations of pneumonia in the elderly population can be different from those in younger patients, therefore, it is important to be familiar with these differences to avoid unnecessary delays in prompt diagnosis.

Background: Hepatitis C virus (HCV) has emerged as the cause of the second major epidemic of viral infection after human immunodeficiency virus (HIV) within the past two decades, and co-infection of HIV and HCV represents a growing problem for the future. The purpose of this study was to investigate the prevalence of HCV antibodies (anti-HCV) in patients with HIV in Fars province.Patients and methods: A total of 101 HIV-1-positive individuals (89 males, 12 females) from Fars province (Counseling Behavioral Modification Center in Shiraz) were included in the study. They were distributed according to risk factors for HIV infection as follows: 35 (34.6%) IVDUs, 2 (2%) sexual high-risk behavior, 50 (49.5%) a combination of IVDUs and sexual behavior, 12 (12%) from HIV positive partners and 2 (2%) unknown. Detection of HCV antibodies was carried out by a third generation enzyme-linked immunosorbent assay.Results: Totally, 87 (84 males, 3 females) of 101 HIV-infected patients (86.1%) had antibodies to HCV. The prevalence of HCV antibodies was higher among the males (83.2%) than the females (3%). The prevalence of HCV antibodies was 94.4% in IVDUs, 96% in individuals with both IVDUs and sexual behavior risk factors and 25% in women who had HIV-positive partner. All unknown cases were positive for HCV and none of individuals who had sexual high-risk behavior were infected with HCV.Conclusion: The overall prevalence of HCV infection in HIV-positive individuals was 84.1%. The consistently high prevalence of HCV infection observed in HIV infected individuals supports the routine screening for HCV and continuous educational programs in these patients, especially among IVDUs in Iran.

Background: Helicobacter pylori (H. Pylori) bacteria colonize human stomach mucosa and may establish acute or chronic gastric inflammation. Cytotoxic-associated gene A (cag A) is associated with higher grades of gastric inflammation and carcinoma. In the present study we determine cag A seropositive strain in dyspeptic patients with H.pylori infection.Patients and methods: Six hundred adult dyspeptic patients examined for anti H. Pylori and anti-cag A antibodies by enzyme-linked immunoassay (ELISA) method. All cases resided in east Azarbijan in northwest of Iran and were enrolled in a 5-year period (2003-2008).Results: A total of 85.5% of dyspeptic patients were positive for H. pylori infection. Anti-cag A antibody was detected in 35.6% of patients with H. pylori infection.Conclusion: Screening of H. pylori infection by ELISA method revealed that the vast majority of (85.5%) dyspeptic patients are seropositive for H. pylori. Determining of photogenic strains of H. pylori by anti-cag A antibody could be diagnostic in severe gastric infections.

Background: Infections involving the cerebrum are true neurosurgical emergency that require rapid diagnosis and appropriate surgical and medical intervention to achieve good clinical outcome. Brain abscess is one of most common forms of intracranial pyogenic infections. Bacterial infections of the nervous system are often challenging for the treating physician.Patients and methods: In this study we evaluated 41 patients with brain abscess in Loghman hospital during 2002-2009. Demographic features, predisposing factors, clinical manifestations, laboratory data and managements were evaluated.Results: Totally, 53.6% of patients were 15-29, 26% were 30-49 and 17% were 50-70 years old. The most frequently encountered clinical manifestations were headache (92.6%) and nausea and vomiting (73.1%). Predisposing condition leading to brain abscess were sinusitis (9.2%), otitis (12%), CSF rhinorrhea (2.4%), mastoiditis (7.2%), neurosurgery (17%) and endocarditis (2.4%), and finally 20% had no risk factor. Mean duration of disease was 13 days. For 80% of patients surgical intervention was performed. Mortality rate was 12%. A total of 9.7% of patients admitted with diagnosis of brain abscess were finally diagnosed as acute demyelinating encephalomyelitis (ADEM).Conclusion: In spite of improvement in diagnosis and treatment of patients with cerebral abscess, mortality is still high.Factors related to patient underlying diseases and the delay in commencement of antibiotic treatment were associated with increased mortality.

Background: Herpes group of viruses give rise to vivid manifestations in the human body. Herpes zoster infection and reactivation results in characteristic vesiculo-bullous-ulcerative lesions of the face and the oral cavity. Herpes zoster induced alveolar bone necrosis is a rare manifestation and very few cases reports are available in the literature.Patient: A 60-year-old male patient presented with a complaint of an ulcer over the lower lip since a month. Based on the clinical features, a diagnosis of herpes zoster of mandibular division of right trigeminal nerve inducing alveolar necrosis with spontaneous exfoliation of teeth was proposed.Conclusion: Herpes zoster infection is a rather common viral infection. The manifestations of this infection can range from subtle to extensive lesions such as alveolar bone necrosis and exfoliation of teeth. When such widespread expression of the infection is noted the clinician should investigate to determine an underlying immunocompromised status.

Background: Varicella-zoster (VZV) is an exclusively human pathogen. The primary infection typically occurs during childhood and causes varicella. As other members of the herpes viruses’ family, VZV is noninfectious in its latent form but can reactivate at a later time to form intact virions in the involved sensory neurons. These virions then migrate to the skin through axons, spread from cell to cell, and penetrate the epidermis.Patient: A 72-year old woman with history of diabetes mellitus and hypertension hospitalized because of urinary retention, weakness and parestesia in right leg complicated with vesiculoulcerative lesions in sacral area with distribution to right buttock and vagina. Lumbar puncture confirmed inflammatory radiculopathy and showed aseptic meningitis. Treatment was commenced with acyclovir and prednisolone. Patient enjoyed healthy life thereafter.Conclusion: Motor weakness in non-cranial nerve is one of the zoster complications that known as zoster paresis. Weakness begins suddenly 2-3 weeks after rash and progress to extremities. In the present case nerve involvement was detected 3 weeks after rash.

Background: Breast tuberculosis is considered a rare clinical entity throughout the world. It has no defined clinical manifestation. Radiological imaging is not diagnostic also. Diagnosis is based on identification of typical histological features or cultures.Patient: A 48-year old woman was admitted because of a painful lump in her right breast. Her mammogram showed a lobulated mass, accompanied by swelling and retraction of the skin and nipple, suspected to be carcinoma. The diagnosis was made by histopathologic study and revealed to be tuberculosis. The tumor was excised and anti- tuberculosis drugs were commenced. Satisfactory out comes revealed during follow up.Conclusion: Breast tuberculosis is a rare form of extra-pulmonary tuberculosis which may presents with features of breast carcinoma. The basis of treatment is anti-tuberculosis antibiotic therapy, and conservative surgery for any residual masses or deformities.

Over the last 200 years, outbreaks and epidemics have occurred in many regions of the world (1). The epidemiology of invasive meningococcal epidemiology varies considerably geographically and in time and the risk to acquire meningococcal disease is influenced by living conditions and behaviour. Of the 12Neisseria meningitides serogroups which have been described, serogroups A, B, C; W-135 and Y are the most important cause for disease.

Meningococcal disease is a life-threatening illness that remains a serious public health issue in the Middle East countries, particularly in association with the Hajj and Umrah pilgrims, where outbreaks with international spread of disease occur periodically In this issue of the Iranian Journal of Clinical Infectious Diseases, Broker reviews the global epidemiology of Neisseria meningitidis serogroup distribution and discusses the advantages of tetravalent conjugate vaccines.