Archives of Clinical Infectious Diseases
Year:2014 | Volume:9 | Issue:1|Papers Count:8

Background: Pertussis is a highly communicable, vaccine-preventable respiratory disease; which may circulate even in populations with high vaccination coverage. Although frequent, but it is often underestimated as a cause of prolonged cough illness in both children and adults. Without boosting, the protection of the childhood vaccination would be minimal after 10 years. The need for adult booster vaccination depends on the national epidemiology.Objectives: The aim of this study was to evaluate the seroepidemiological incidence of Pertussis in fresh college students in four majors.Patients and Methods: In a cross sectional multicenter study, blood samples were obtained from 1617 junior students of four universities.None had receivedPertussis booster vaccine in the preceding 10 years. Serum immunoglobulin G (IgG) antibody for Pertussis toxin antigen was measured. Some social and demographic determinants including age, sex and number of family members were recorded.Results: The mean age of participants was 19.64±2.1 years; positive anti Pertussis toxin IgG levels (by cut point of 94 U/mL) was detected in 31.6%. Positivity rate was associated with sex but not with age or residential area.Conclusions: Pertussis continues to challenge medical and public health professionals. Recent reports of increases in the prevalence and incidence may be because of the limited time of protection of childhood vaccination. Our study can serve as one of the scarce populationbased reports from developing countries. A universal cut point should be determined for diagnosis of seropositivity, and a booster of a cellular vaccine is recommended in adolescence.

Tuberculosis (TB) remains a major global health problem, with 8.6 million cases and 1.3 million deaths in 2012.The emergence of multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) is an increasing global health problem. MDR-TB is widespread, with an estimated 450000 cases and 170000 deaths in 2012, and XDR-TB was reported in 92 countries in 2012. Current TB drugs were developed over 40 years ago. However, curing TB requires long treatment duration and many TB drugs. Moreover, treatment of drug-resistant TB is difficult because less potent and more toxic drugs, as well as longer treatment duration are required. The lack of effective treatment could be one of the causes of low treatment success. For example, in 2010, only 48% of MDR-TB patients were successfully treated.

Background: Brucellosis as a zoonotic infectious disease is endemic in Iran and due to the variation in clinical and laboratory findings, its diagnosis is often delayed.Objectives: The aim of this study was to determine clinical and laboratory aspects of the disease in Khuzestan.Patients and Methods: Medical records of 81 admitted patients with a diagnosis of brucellosis were reviewed. The study took place at Razi Hospital, a teaching hospital where infectious patients of Khuzestan are refereed. Clinical and laboratory findings of patients were reviewed. Diagnosis of brucellosis was made by measuring Brucella antibodies in the presence of clinical findings suggestive of brucellosis.Wright and mercapto-ethanol (2 ME) with titers more than 1.80 were considered positive.Results: The most common symptoms of the disease in this study were fever (85.2%), joint pain (72.9%), chills (42%) and sweating (37%). The most common signs in this study were arthritis (9.9%), tachycardia (6.2%) and tenderness in the lumbar spine (4.9%). Furthermore, the most common laboratory findings were normal white blood count (WBC) (94.82%), anemia (75.3%) and elevated erythrocyte sedimentation rate (ESR) (75.3%).Conclusions: In the studied region, when dealing with patients complaining of fever, chills, sweating and joint pain associated with normal WBC count and anemia, brucellosis should be placed on top of the differential diagnosis list and patients should be examined for Brucella serological evaluation.

Introduction: Spontaneous bladder rupture is a rare manifestation of hyporeflexic bladder due to HAM/TSP (human T-cell lymphotropic virus type 1 (HTLV1) associated myelopathy/tropical spastic paraparesis).Case Presentation: We report a case of spontaneous bladder rupture in a 62-year-old woman with a HTLV1 infection. Discussion: Bladder over-distention and spontaneous bladder rupture, although very rare in HAM/TSP, should be considered in a differential diagnosis of bladder rupture, especially in patients with a history of HTLV1.

Introduction: Malaria is the most important parasitic infection, which is now spread all over the globe. Malaria infections with more than two species, especially Plasmodium falciparum and P. vivax, are common, but infections with P. malariae and P. falciparum are rare. Case Presentation: A 33-year-old man presented with fever and chills for three days, pancytopenia, and abnormal liver function tests, Peripheral blood smear revealed P. falciparum and P. malariae. After artemisinin-based combination therapy, all of his symptoms subsided. Discussion: Mixed malaria infection is not uncommon, and it needs to be diagnosed and treated effectively in order to control the disease.Travel consultations should be given for all travelers before their trip to endemic countries.

Context: Crimean-Congo hemorrhagic fever (CCHF) is a fatal viral disease which has 30% to 80% mortality rate. In endemic areas, livestock handlers, skin processors, veterinary staff, livestock market employees, farmers, and health care staff are at risk. Diagnosis is made based on clinical manifestations, epidemiologic factors, and laboratory tests. Here, we reviewed the epidemiology, clinical manifestation, diagnosis, treatment, and the prophylaxis of CCHF.Evidence Acquisition: We searched electronic databases (PubMed and Scopus) from January 1980 to May 2014. Key words including CCHF, epidemiology, clinical manifestation, treatment, and prevention routes were searched.Results: CCHF is widely distributed in different countries worldwide and is also endemic in our country, Iran. Treatment is mainly supportive; however, if the patient is suspected to have CCHF, ribavirin therapy is needed immediately. High dose methylprednisolone, interferon, and intraveonus immunoglobulin (IVIG) are other treatment protocols. Postexposure prophylaxis should be considered potentially in people who were exposed to CCHF virus, such as those who have mucous membrane contact or percutaneous injuries in contact with body secretions or blood of infected animal or patients with CCHF.Conclusions: CCHF is a fatal viral disease. Therefore, preexposure and postexposure prophylaxis should be potentially considered to decrease the rate of infection.

Introduction: Crimean-Congo hemorrhagic fever (CCHF) is a viral hemorrhagic fever caused by infection with a tick-borne virus from the family of Bunyaviridae. This viral hemorrhagic fever is found throughout Central Asia, Southern Europe, Africa and the Middle East.Transmission to humans occurs through contact with infected animals or tick bite. The first human cases of infectious hemorrhagic fever in Iran were reported from the western part of the country. Since June 1999, endemic areas for CCHF have substantially increased in several provinces of Iran especially in the southeast of Iran with a high fatality rate (30%) in the initial years.Case Presentation: Hereby, we present a patient with hypertension, which to our opinion might have been secondary to CCHF virus infection.Discussion: Our report is the first report of a very rare presentation of CCHF.

Background: Escherichia coli is the most important as well as the most common bacteria causing urinary tract infections (UTIs) and its resistance to common antibiotics is increasing. Extended-spectrum beta-lactamase (ESBL) producerE. coli strains can resist against the third-generation and fourth-generation cephalosporins.Objectives: This study aimed to evaluate the resistance profile of E. coli isolated from patients with UTIs referred to Imam Khomeini and Baqiyatallah Hospitals, Tehran, Iran, through phenotypic and molecular methods.Materials and Methods: During 2010-2011, 180 urine samples of patients with UTIs from Imam Khomeini and Baqiyatallah Hospitals were collected. Based on the standard bacteriologic tests, E. coli isolates were identified. Resistance to common antibiotics was tested by the Kirby-Bauer method and reconfirmed by determining minimum inhibitory concentration (MIC) through microdilution method. Further phenotypic double-disk synergy test (DDST) was performed to screen the ESBL producer strains. Resistance genes related to ESBL andqnrA were evaluated by Polymerase chain Reaction (PCR).Results: A total of 100 E. coli strains were examined by antibiogram and the rates of resistance to the tested antibiotics were as follows: 100% to penicillin and amoxicillin, 77% to amoxicillin-clavulanic acid, 72% to ceftazidime, 69% to cefotaxime, 47% to cefoxitin, 46% to ceftriaxone, 43% to cephalexin, 27% to aztreonam, 53% to nalidixic acid, 51% to ciprofloxacin, and 2% to imipenem. The MIC to ciprofloxacin, cefazolin, and ceftriaxone were ≥ 0.249, ≥ 0.508, and ≥ 0.044, respectively. Moreover, 20% of E. coli isolates were ESBL-producing isolates by DDST. The frequency ofbla CTX-M, bla TEM, bla SHV, and qnrA genes was 87%, 82%, 65%, and 39%, respectively. Conclusions: Considering the high prevalence of ESBL genes (bla CTX-M, 87%; and bla TEM, 82%), fluoroquinolones may be used as an alternative drug in treatment, although resistance to this family is increasing as well. As a result, this increasing trend should be prevented using appropriate guidelines for prescription.