IRANIAN JOURNAL OF CLINICAL INFECTIOUS DISEASES
Year:2010 | Volume:5 | Issue:3|Papers Count:13

Standard antiretroviral therapy (ART) consists of the use of at least three antiretroviral (ARV) drugs to maximally suppress the HIV virus and stop the progression of HIV disease. Huge reductions have been seen in rates of death and suffering when use is made of a potent ARV regimen.

Background: Rhinocerebral zygomycosis is a rare, rapidly progressive and often fatal fungal infection occurring in several immunocompromised states. Prior investigators have reported an increasing incidence among Iranian population; therefore, we decided to present the clinical features and treatment outcome of a group of patients with rhinocerebral zygomycosis.Patients and methods: Medical records of all cases with the diagnosis of rhinocerebral zygomycosis attending Rasoule-Akram Hospital, Tehran, Iran, were retrospectively reviewed from 1997 to 2007. Age, gender, predisposing illness, surgical procedures, and treatment outcomes were reviewed.Results: Totally, 30 patients (17 males and 13 females) were reviewed with a mean age of 49.4±20.3 years. The lag time between onset of symptoms referable to zygomycosis and commencement of amphotericin B was 1 to 90 days with median of 10 days. An association between delayed treatment and mortality was found (p=0.01). Visual loss was observed in 53.3%. The ethmoid (86.6%) and maxillary sinuses (66.6%) were most commonly involved. Eighteen patients had underlying diabetes mellitus (60%). All patients received medical treatment, while 28 (93.3%) underwent surgical intervention. Twenty three patients (76.7%) had orbital involvement with a mortality rate of 43.5%. The overall mortality rate was 40% (12 cases). Patients with higher doses of amphotericin B and multiple surgical intervention had lower mortality rate (p=0.00 and p=0.01, respectively). Factors such as age, gender, predisposing diseases, orbital involvement, multi-sinus involvement, and white blood cell count had no impact on survival rate.Conclusion: Institution of aggressive surgical debridement of devitalized tissue and the timely initiation of systemic medical therapy is critical for good outcome.

Background: Fever, is a common sign during the course of HIV infection. The aim of this study was to describe the etiology and clinical characteristics of fever among HIV/AIDS patients in a teaching hospital in Iran.Patients and methods: In this existing data study, we retrospectively reviewed the charts of admitted HIV/AIDS patients with fever to Imam Khomeini hospital, from October 1995 to March 2005 to assess the causes of their fever.Results: Totally, 125 admissions were performed for 120 patients. The mean (±SD) age was 34.8±14.7 years. The final diagnosis of fever was determined in 65.6% of all admissions. Mostly (34.4%), the cause of fever remained undiagnosed. Pulmonary tuberculosis was the most commonly identified etiology of fever (33.6%), followed by opportunistic infections such as oral candidiasis, Pneumocystis jirovecii pneumonia and cerebral toxoplasmosis.Conclusion: Tuberculosis is the most common infection in Iranian HIV/AIDS patients and appropriate workup should be considered in all feverish HIV/AIDS patients.

Background: The endemicity and transmission intensity levels of malaria are related to genetic diversity of the parasites. Merozoite surface protein 3b (MSP3b) is an important marker for assessing the polymorphic nature of Plasmodium vivax while it is also a vaccine candidate against the parasite.Patients and methods: In this study we investigated the genetic structure of P. vivax population by sequence analysis of a polymorphic region of the P. vivax MSP3b gene in isolates from Iran. Blood samples were collected from 100 patients with clinical symptoms. DNA was extracted and the target gene was amplified by polymerase chain reaction (PCR).The sequences of 17 samples were used for sequence analysis using nucleotide Blast search and ClustalW multiple alignment. Phylogenetic tree was derived to describe the geographical branching and relationships.Results: A large number of nucleotide insertions and deletions were observed in the sequences of polymorphic region of PvMSP3b gene that were not specific in each biotype.Single nucleotide polymorphism (SNP) was found extensively in the sequences. The phylogenetic analysis did not show any significant geographical branching.Conclusion: The lack of any geographical branching and extensive polymorphism in MSP3b gene of P. vivax isolates suggests that more investigations are needed to find a more suitable gene in order to develop a vaccine.

Background: Urine tract infection (UTI) is the most prevalent bacterial infection and the second prevalent infection after viral flu among children. With respect to the importance of urine culturing, we decided to assess the effect of ablution the genital area on the result of urine culturing among 3-12 years old girls referring to Amir Kabir hospital, Arak, Iran.Patients and methods: This randomized clinical trial was achieved on 620 girls referring to our hospital. Children were randomly assigned in two groups, with and without ablution. In ablution group, the appropriate technique of genital area ablution with water and soap was trained as well as how to collect middle-urine sampling, however, the other group received recommendations on how to appropriately collect middle-urine sample.Results: Of 310 children of the ablution-trained group, UTI was reported in 11 (3.5%), contamination in 3 (1%) while 296 children were normal (95.3%). However, these figures were 14 (4.7%), 6 (2%) and 290 (93.3%) in the other group, respectively. Contamination rate did not differ significantly between the 2 groups (P=0.49).Conclusion: Genital area ablution is not associated with a significant decrease in rate of urine culture contamination, hence, it should not be routinely recommended for children.

Background: Acute sinusitis constitutes a significant portion of health service utilization globally both in- and outpatient as well as emergency department visits, with 83% resulting in a prescription for an antibiotic. This study compared the efficacy of a 5-day regimen of azithromycin (a macrolid antibiotic) with a 10-day regimen of coamoxiclav (combination of an amino penicillin with a beta lactamase inhibitor) for the treatment of acute sinusitis.Patients and methods: A total of 76 subjects with acute sinusitis were randomly assigned in two groups, azithromycin (n=40) and co-amoxiclav (n=36). One group received azithromycin, 500mg in the first day and 250mg for 4 days and the other group received co-amoxiclav 625mg, 3 times a day for 10 days. Patients were visited 4 times during the study (baseline, phone call, end of treatment, end of study) and regression/progression of their symptoms and their response to the treatment was evaluated.Results: There was no significant difference between the two groups' demographic and clinical presentations. Duration of regression of the symptoms in the azithromycin group was significantly shorter than the co-amoxiclav group (7.6 days versus 10.6, p=0.03). Clinical success rate at end of the study was 80% for azithromycin and 66.7% for co-amoxiclav (p=0.025). Clinical success rates among females in both groups seemed to be higher than males, but this difference was not statistically significant (p=0.13).Conclusion: Results revealed that azithromycin regimen is more efficient, has less side effects, and required shorter treatment period. Patients were able to tolerate the medications better with a higher compliance and less economic cost than co-amoxiclav regimen.

Background: Pseudomonas aeruginosa is the most significant bacteria capable of multiplying in water especially in recreational waters. This bacterium is also the most commonly bacterial pathogen in ear infections. Although the bacterium is infrequently found in the normal ear, but the users of swimming pools may be at risk of acquiring disease.Patients and methods: The bacteriological quality and health risk of the water of eleven public outdoor and indoor swimming pools in East and North-East of Tehran was assayed. Useful information was recorded at the time of sampling. Samples tested for aerobic colony count, coliforms, Escherichia coli and P. aeruginosa according to the standard method. Ear swabs were collected from 179 users with a history of ear problems during the previous two weeks. An adequate control group was chosen randomly from those who never used the investigated pools.Results: P. aeruginosa was isolated from 9 (81.8%) of the pools. P. aeruginosa was the only bacterium grew in 7 (63.6%) swimming pools, while in the other 2 (18.2%) swimming pools high rates of total bacterial count, total coliforms and fecal coliform counts were also found besidesP. aeruginosa. Meanwhile, P. aeruginosa was isolated from the ear swabs of 142 (79.3%) swimming pool users, as compared to 4% of the controls.Conclusion: Results revealed that otitis externa was strongly associated with swimming in pools, due to P. aeruginosa.Furthermore, contamination of the swimming pools withP. aeruginosa and often the chlorination process could not remove the pollution, especially when high numbers of people led to overuse of the pools, hence, more strict bathing water standards should be met in the public swimming pools in the city.

Background: Brucellosis is a major health problem worldwide, especially in developing countries. Following infection withbrucella, antibodies appear in the serum and its titer detection can help us to evaluate the course and epidemic status of the infection. The aim of this study was to determine the seroprevalence of anti-brucella antibody titer in rural population of Abhar.Patients and methods: In this descriptive study, 300 individuals were randomly selected for whom blood samples were screened to determine anti-brucella antibody titter, using standard tube agglutination (STA) and Coombs tests.Results: The seroprevalence of anti-brucella antibody titer was 1.25% for STA and 4.58% for Coombs test. Totally, 14 (5.83%) individuals had titers of 1/80 or higher in STA and/or Coombs tests.Conclusions: Our results emphasizes on the necessity of conducting comprehensive and scheduled program of seroprevalence survey, particularly in rural area, aimed at reducing brucella prevalence as well as to guide planning and resource allocation of decision makers for future interventions.

Background: Shigellosis is one of the major causes of morbidity in children with diarrhea in Iran.Integrons play an important role in the evolution and dissemination of multidrug resistance in gram-negative bacteria. The occurrence of integron’s among Shigella spp. is frequently reported throughout the world. The aim of this study was to assess the occurrence of class 2 integrons among the multidrug resistant S. sonnei isolated from Iranian children in 2005.Materials and methods: The study was conducted in two major pediatric hospitals in Tehran, Iran. Fecal specimens and rectal swab collected from patients were cultured and identified as Shigella by the conventional methods.Antimicrobial susceptibility test was performed according to the standard CLSI guideline. Multi-drug resistant isolates of S. sonnei were further examined for the presence of class 2 integron by PCR using specific primers. Amplicons were confirmed by restriction endonuclease analysis.Results: A total of 83 multi-drug resistant S. sonnei strains were isolated. Of these, 45 (54%) exhibited a class 2 integron of 2.1 kbp, and 34 (41%) a class 2 integron of 1.3 kbp. Class 2 integrons were not detected in four isolates.Conclusion: The results showed an increased occurrence of class 2 integron carrying S. sonnei isolated from children in Tehran in 2005.

Background: Surveying knowledge of nurses about HIV/AIDS can provide an evidence for designing appropriate educational program. This study aimed to investigate the knowledge of a sample of Iranian nurses about patients living with HIV/AIDS in Bandar Abbas, Iran.Materials and methods: In this cross sectional study, 150 nurses completed two questionnaires, one dealing with demographic data and the other inquiring knowledge of nurses about HIV/AIDS based on existing instruments developed by Eckstein in 1987.Results: The mean age of studied sample was 31.9±8.2 years. At the time of the study, 63.3% of the respondents had previously cared HIV-infected subjects. Most of the participants (99.3%) knew that drug abusers were at higher risk for HIV acquisition. Most of the participants (97.3%) also answered correctly that person with HIV could be asymptomatic but still infected. Finally, 29.3% thought that recapping used needles is a good way to prevent HIV infection. Those who had participated in educational program had higher overall scores of knowledge than non-participants (10.09±2.18 vs.9.66±2.32, p=0.002).Conclusion: Results revealed that those previously taken part in educational programs had good knowledge about HIV/AIDS.

Background: Spinal epidural abscess (SEA) is a rare disease, associated with high morbidity and mortality.Recently, incidence of the disease is increasing because of increased predisposing factors.Patients: Five cases with spinal epidural abscess admitted with neurologic deficits are reported here. Of these, one was an IV-drug abuser while in another case osteomyelitis resulted from tuberculosis. No source of infection was identified in other cases. All patients underwent urgent de compressive multilevel laminectomy followed by antibiotic therapy based on blood culture results. Finally, 3 patients could ambulate independently while the other two patients were left without improvement in neurologic status.Conclusion: SEA is a devastating condition if not diagnosed and treated promptly and effectively.Preoperative MR imaging provides a noninvasive, accurate means of diagnosis in this condition. Recent advances in the surgical treatment of SEA have resulted in the increased use of less-invasive surgical techniques, thereby decreasing the morbidity associated with surgery in both the short and long term.

The first effective treatment for tuberculosis (TB) was developed with the discovery of streptomycin (STM) by Waksman in 1943, however, immediately after its introduction many patients started showing resistance to this antibiotic. Basically, a single anti-TB drug should never be used in the treatment of active TB, and regimens that using more than one drug are recommended. In late 1960s, rifampicin (RMP) was introduced and with the use of combination therapy, there was a decline in drug-resistant and drug-susceptible TB.

Brucellosis is a disease with worldwide distribution. Despite its control in many countries, it remains endemic in Iran. A broad spectrum of clinical manifestations ranging from malaise to brain abscess is seen in brucellosis.In a retrospective study, we evaluated 140 patients with brucellosis admitted to Loghman hospital during a 6-year period. Hematologic and serologic characteristics and clinical manifestations were evaluated.