Archives of Clinical Infectious Diseases
Year:2018 | Volume:13 | Issue:5|Papers Count:17

Objectives: The current study aimed at finding the frequency of MRSA infections, contamination, and colonization in the teaching hospitals of Karaj city, Iran for the first time. Methods: The current cross sectional study was conducted in Karaj on three teaching hospitals from July 2013 to July 2014. Sample collection from personnel and surfaces was conducted twice and monthly, respectively, during the study period. Also, all Staphylococcus aureus species isolated from patients were included in the study. Antimicrobial susceptibility test was performed by the standard disk diffusion method. All isolates were subjected to mupA and mecA-specific polymerase chain reaction (PCR)to identify high-level mupirocin-resistant and MRSA isolates, respectively. Chi-square test was employed for data analysis. Results: The majority of S. aureus species were isolated from personnel and surfaces of the hospitals. One hundred sixty-eight S. aureus and 49 MRSA species were isolated from Karaj teaching hospitals. The main frequency of MRSA was isolated from intensive care unit (ICU) (75%) and high rate of resistance to rifampicin (53%) was observed in MRSA isolates. Although 10 S. aureus species were resistant to mupirocin by disk diffusion, no mupA gene was detected in the isolates. Conclusions: In conclusion, in comparison with the other studies from Iran, low frequency of MRSA was observed in the investigated hospitals. However high frequency (75%) of MRSA in ICU indicated that antibiotic policy is urgently needed to prevent the resistance development. Moreover, antibiotic susceptibility monitoring and regular screening surfaces and personnel of hospitals in terms of MRSA colonization, especially ICU, are indispensable.

Background: Cross-contamination between patients and the medical imaging device is a worldwide concern. In the current study, the ability of different molecular typing methods for differentiation of Clostridium difficile isolates from patientsand medical devices was compared to show their discriminatory power for molecular epidemiological purposes. Methods: A total of 23 C. difficile strains from fresh stool samples of patients subjected to colonoscopy, medical device, and environmental samples of a gastroenterology unit were used for molecular typing. Similarity of the strains was determined by the polymerase chain reaction (PCR) ribotyping, capillary gel electrophoresis based-ribotyping, and RAPD-PCR and ERIC-PCR methods. Phylogenetic analysis of the molecular patterns was done by the GelCompar II software and discriminatory power of the methods was measured using Simpson’ s index diversity. Results: RAPD-PCR and PCR-ribotyping methods showed the highest discrimination power for differentiation of the studied strains, while genotyping showed the lowest power. Similarity of C. difficile strains between the patients and medical equipment was detected for the strains presenting PCR-ribotypes B and CE-ribotype 150. Conclusions: Involvement of medical device for transmission of toxigenic strains of C. difficile was determined in this study. Although diversity of C. difficile strains was established in the studied hospital, a discrepancy was detected among these techniques for typing purposes. The results suggested the usage of a combination of two or more typing methods for detection of sources of cross-contamination in each hospital.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) has been considered as an important pathogen with a variety of virulence factors in communities and hospitals worldwide. Objectives: In this study, we focused on the detection of different virulence factors and enterotoxin genes of MRSA strains isolated from a referral hospital in Tehran, Iran. Moreover, the presence of different prophage types was studied. Methods: A total of 491 MRSA strains were isolated during three years from a referral hospital in Tehran. The staphylococcal enterotoxin (sea-seq) and pvl, hlb, sak, eta and tst genes were detected. A multiplex-polymerase chain reaction (PCR) assay was used for prophage typing of MRSA isolates. Results: Totally, 11 enterotoxin and 5 virulence factor genes were detected in MRSA strains. The sea, sek, seq, and hlb genes were present in all the MRSA and other enterotoxin genes. sel, seg, sem, sei, sen, seo, sec and sep were detected in 32. 8%, 20. 3%, 12. 6%, 8. 3%, 4. 1%, 2. 6%, 1. 6% and 0. 4% of the strains, respectively. A total of 93%, 81%, 15. 9% and 5. 7% of the strains harbored the sak, eta, tst and pvl genes, respectively. SGF, SGFa and SGFb proghage type genes were detected in 100% of the MRSA strains, and four different prophage patterns were identified among the strains. Conclusions: The presence of different prophage-encoded virulence factors among MRSA strains enable MRSA to produce a broad range of diseases, indicating MRSA strains as a potential threat to patients’ health.

Background: Toxoplasma gondii is an obligate intracellular parasite, which can be found in different cells of humans and animals and infect many tissues. The virulence of T. gondii strains is commonly detected, based on the outcomes of infection in mice. The present study was performed to determine the parasite distribution and tissue tropism of tachyzoites of T. gondii RH strain in an experimental mouse model of infection, using quantitative polymerase chain reaction (qPCR). Methods: In this experiment, male and female BALB/c mice were infected through intraperitoneal injection of 103 tachyzoites of T. gondii RH strain. The assessments were performed at 1, 2, 3, 4, and 5 days postinoculation (dpi), as well as the time of death; the mice were monitored 3 times a day. After the animals were sacrificed in each group, different tissues were collected from the heart, liver, lung, muscle, kidneys, genitals, spleen, brain, eyes, and blood and maintained at-20° C. Then, DNA samples were extracted using kits, and DNA copy number was measured via qPCR, targeting B1 gene. Results: The parasite was distributed in various tissues on the first day after infection and exhibited the ability to cross the bloodbrain barrier within the brain. Twenty-four hours after tachyzoite inoculation, the highest parasite load was observed in the liver tissues of both groups. Conclusions: Considering the blood flow to all tissues and transmission of parasite to other tissues, the highest parasite count was reported in the present study. These findings are invaluable for assessing the impact of new drugs on these parasites. There is also the possibility of sexual transmission, causing a significant parasite load in the genitals.

Background: Nowadays, nanocarriers are used for leishmaniasis treatment due to development of drug resistance and several side effects with conventional therapeutics. Objectives: In this studyweaimed to evaluate in vivo effects of four synthesized nanodrugs including amphotericin B-nanochitosan (AK), betulinic acid-nanochitosan (BK), amphotericin B-dendrimer (AD), and betulinic acid-dendrimer (BD) in the treatment of Leishmania major infection (L. major) in mice model by using pathological analyses to choose the most effective nanodrug in leishmaniasis. Methods: The four nanodrugs efficacy in the improvement of L. major lesion in a mice model was evaluated by using pathological analyses including measurement of organs size and parasite number. Additionally, the nanodrugs toxicity was evaluated by measurement of various blood factors. Results: The histopathological results of the present study showed that BK, at the dose of 20 mg/kg, and AK, at the dose of 10 mg/kg, were more effective in decreasing the parasite number in the kidney, liver, and spleen. Moreover, BK20 mg/kg and AK10 mg/kg decreased the organs size significantly while AD50 mg/kg and BD40 mg/kg were less effective. However, none of the four nanodrugs had increased the blood factors and they were not toxic. Conclusions: Overall, the pathologic findings of various mice organs treated with different formulations showed that AK10 mg/kg and BK20 mg/kg were more effective in recovery of L. major’ s pathological effects in comparison to AD50 mg/kg and BD40 mg/kg. Therefore, it seems that AK and BK, in this mentioned dosage, could be considered as a proper candidate for treatment of leishmaniasis.

Background: Hib conjugate vaccine has led to more than 90% decline in the prevalence of severe Hib diseases in countries with universal coverage vaccination program. After the addition of Hib vaccine to the national vaccination program with 3P (three doses of 2, 4, and 6 months) in IR Iran, we decided to study the vaccine efficacy after the last dose of vaccine in Iranian children in 2016. Methods: 500 blood samples were collected from one-year-old children who referred to the health care centers in Karaj. Demographic information was gathered by a questionnaire. Blood samples were sent to a laboratory for antibody titer determination by ELISA method. Results: 41. 2% of the children (95% CI: 36. 89-45. 51) had a titre of IgG against Hib (0. 15 to 1  g/mL) (short-term protection) and 57. 4% of the children had a titre of IgG against Hib (95% CI: 53. 07-61. 73) equal to or greater than 1  g/mL (long-term protection). Antibody GMT was 6. 92  g/mL (95% CI: 6. 76-7. 08). There was no significant correlation between the titer of H. influaenza antibody and demographic factors. Conclusions: In spite of the acceptable GMT titer, children who had antibody titer of < 1  g/mL comprised approximately 40% of the study population, showing the necessity of further investigation to assess the need for H. flu booster administration.

Background: Multidrug efflux pump is a ubiquitous mechanism of drug resistance in bacterial pathogens, such as Acinetobacter baumannii, which is mediated by integral membrane transport proteins. The purpose of the current study was to analyse the distribution of adeG and its role in resistance to ciprofloxacin in A. baumannii isolates from two hospitals of Tehran. Methods: Fifty-one isolates of A. baumannii were recovered from Shahid Motahari and Milad hospitals of Tehran, from July 2016 to March 2017. Identification of A. baumannii was confirmed by phenotypically and molecular methods. Antibiotic susceptibility testing was prepared by the Kirby-Bauer method. Resistance to ciprofloxacin was confirmed by determination of minimum inhibitory concentration (MIC). Efflux pumps inhibitor was used for phenotypic detection of active efflux pumps. Real-time polymerase chain reaction (PCR) was used to analyze adeG gene over expression. Results: Fifty-one isolates of A. baumannii were confirmed by phonotypical and molecular methods. Results of antibiotic susceptibility testing confirmed resistance to ciprofloxacin in all isolates. Results of conventional PCR showed that all of the isolates had the adeG gene. The MIC of ciprofloxacin was decreased by 4 to 32 folds or more in 88% of resistant isolates after adding the efflux pump inhibitor. Over expression of AdeG efflux pump gene was confirmed by real-time PCR in 34 strains. Conclusions: In conclusion, multidrug-resistant A. baumannii were prevalent in the studied isolates. Carbonyl cyanide3-chlorophenylhydrazone could reverse the susceptibility to ciprofloxacin in A. baumannii and was associated with overexpression of the adeG gene.

High mortality herpes simplex virus encephalitis (HSVE) presents with fever, headache, changes in personality, focal neurologic findings, and epileptic attacks. It causes common destruction in brain parenchyma with necrotic, inflammatory and hemorrhagic lesions, and neuron losses. Central nervous system vasculitis during HSV infection can develop strokes especially related to both hemorrhagic and ischemic reasons. Ramsay-Hunt syndrome (RHS) is characterized by the re-activation of the latent varicella zoster virus (VZV) in the geniculate ganglion of the facial nerve; it presents with peripheral facial nerve paralysis. Neurogenic pulmonary edema is the situation of respiratory failure occurring hours after the serious neurogenic incident without other reasons causing lung edema, which is developed by increase in sympathetic activity, and progressed by increase in alveolar and interstitial fluid. In the current study, a patient with developed neurologic pulmonary edema with ischemic stroke status as a result of cerebral hematoma and middle cerebral artery (MCA) ischemia following HSVE was followed up and a patient that developed anterior cerebral artery (ACA) and MCA territory infarction after RHS was mentioned.

Background: Rapid increase in nosocomial infections (NIs) due to antibiotic resistant organisms is a global issue, which causes significant morbidity in both patients and healthcare professionals ultimately leading to an extra cost on health care systems. Thus, studying NIs is a public health priority. Methods: The study was designed as a cross-sectional investigation between 2015-2017. Inpatient cases of selected hospitals with nosocomial infections were included. Demographics, source of infections, causative agents, and their antibiotic susceptibility through E-test method were collected. All data were analyzed using SPSS statistical software (version 19). Results: A total of 168 patients with NIs were identified. Of the patients, 100 (59. 5%) cases were male. The intensive care unit had the highest infection rate (N = 100 (59. 5%)) and bronchoalveolar lavage (BAL) (N = 58 (34. 5%)) and Acinetobacter (N = 76 (47. 5%)) were the most common source and organism of NI. Conclusions: Results of this studyshowedthe dangerously high nosocomial infection rates, which necessitates considering surveillance of antibiotic usage and restriction of using broad spectrum antibiotics in infections.

Background: Animal bite is an emerging public health problem. Annually, in different parts of the world, more than 15 million people are treated for animal bites. Each year, 140 cases of animal bites per 100, 000 population are estimated to occur in Iran, more than 85% of which are dog bites. Objectives: The aim of this study was to investigate the epidemiology of animal bites during years 2011 and 2013 in the East of Ahvaz county. Methods: This was a descriptive cross-sectional study performed on whole cases of animal bite registered at the health center of Eastern Ahvaz, Southwestern Iran. According to the current study, a “ bitten person” is bitten by an animal, and refers to the rabies prevention centers due to animal bites and fear of rabies. During a three-year period, through a questionnaire-based study, 2493 bitten individuals were enrolled in the research. In this respect, for all cases, demographic and epidemiological data, such as treatment, biting animals, age, gender, occupation, place of residence, month of the year, season and biting site on the body were recorded. Descriptive statistics, including frequency distribution and percentage were used to analyze the data. The analysis was performed using the SPSS version 18 software. Results: The highest number of bitten individuals were recorded during year 2012. Out of 2493 bitten individuals, 76. 6% were male and 23. 4% were female. Bites were most frequent among the age group of 21 to 30 years old. Most cases (24. 7%) were self-employed. in total, 65% of animal-bite incidents were in the city and 35% were in rural areas. The cases were mostly related to dog bites (78. 4%) and cat bites (17. 3%), respectively. Moreover, 100% of cases were vaccinated within the first 24 hours, 61. 4% had incomplete while 38. 6% had complete vaccination. Lower extremities were the most frequent bite site (46. 9%) followed by upper extremities (41. 6%), head and neck (5. 7%), and trunk (5. 8%). Animal bites were more common during spring (26. 7%) and autumn (25. 2%). Maximum number of incidents were reported during the month of April (9. 2%) and July (9%). Conclusions: Dogs were the most common animals causing this problem. Control of stray dog population by animal birth control and domestic animal vaccination is needed. Meanwhile, training people at risk can play an important role in reducing the incidence of animal bites and rabies.

Introduction: Brucella canis, a member of Brucella species, has been reported as a cause of human brucellosis in a few cases, and routine serologic tests do not identify this species. In spite the fact that Iran is an endemic area for brucellosis, there has not been any report of human brucellosis due to B. canis. Case Presentation: The patient was a 68-year-old female with complaints of fever, foul smelling urine, malaise, vomiting, and arthralgia. Considering significant leucocytosis and pyuria, positive urine culture antibiotic therapy was initiated for urosepsis. However, due to non-suitable response to antibiotic and negative serologic study for brucellosis, supplemental assessments, including bone marrow aspiration and biopsy (BMA&B), were performed to study malignancy, tuberculosis, and brucellosis. Brucella canis was isolated from BACTEC media and subsequently confirmed by polymerase chain reaction test. Conclusions: Considering the ineffectiveness of routine serologic study for diagnosis of B. canis in the presence of clinical presentations suggestive for brucellosis, blood or BM culture should be considered.

Context: Cotrimoxazole is one of the antibiotics commonly used to treat urinary tract infections. The widespread use of this drug has led to increased resistance to cotrimoxazole among urinary tract pathogens. This study aimed to investigate the cotrimoxazole resistance pattern of uropathogenic bacteria by a systematic review and meta-analysis method. Evidence Acquisition: Several databases including PubMed, Web of Science, Scopus, Google Scholar, Iran Medex, Magiran, IranDoc, MedLib, and SID were searched. From a total of 171 papers published from different regions of Iran from 1992 to May 2015, 67 were included in this study. To assess the quality of the study, the STROBE (strengthening the reporting of observational studies in epidemiology) checklist was employed. The I2 index was used to determine heterogeneity and a random effects model to analyze the data. Results: The results showed that the prevalence of urinary tract infection was several times higher in women than in men. The most common pathogens causing urinary tract infections were E. coli 64%, Klebsiella 12%, Staphylococcus 10%, and Enterobacter (6%). The prevalence of cotrimoxazole resistance was as follows: E. coli 62% (95%CI: 60-65), Klebsiella 54% (95% CI: 45-62), Staphylococcus 55% (95% CI: 47-63), and Enterobacter 52% (95% CI: 33-70). Cotrimoxazole resistance in different studies varied from 22% in Arak to 88% in Ahvaz. Conclusions: Gram-negative bacilli, particularly Escherichia coli, were the most common bacteria causing urinary tract infections. The majority of strains were resistant to cotrimoxazole. According to the findings, cotrimoxazole is not recommended as the firstline drug for the treatment of urinary tract infections in Iran.

Background: Cervical cancer is currently among the most important causes of cancer-related deaths in women. The development of cervical cancer is associated with high-risk human papillomavirus (HPV) infections and a series of epigenetic changes in host cell genome, such as histone acetylation. Furthermore, decreased E-cadherin level has been shown to play a critical role in cancer cell invasion and metastasis. Oxamflatin has been reported to have anti-cancer efficacy. Objectives: We aimed to study the effect of this drugoncervical cancer cell lines, HeLa cells, by assessing E-cadherin level as a marker of cancer invasion susceptibility. Methods: HeLa cells were treated with oxamflatin, and total RNA was obtained. Then, quantitative real-time polymerase chain reaction (PCR) was performed to evaluate E-cadherin expression level in cells treated with oxamflatin. Results: The findings of real-time PCR indicated that oxamflatin increased E-cadherin level in a time-and concentration-dependent manner. The level of E-cadherin significantly increased at the concentrations of 4mM(for 24 hours after treatment) and 2 and 4mM (for 48 hours after treatment) in comparison with corresponding control HeLa cells. Conclusions: The present study proposed that oxamflatin may have anti-migratory and anti-invasive potential against cervical cancer cells, which should be further evaluated in future studies.

Following natural disasters like earthquake property, trauma-related deaths and injuries, cause huge risk of infections, especially in vulnerable population such as pregnant women, people with untreated wounds, and newborns (1).When acute phase of emergency occurred, there are great needs of a temporary post disaster surveillance, early warning, and response (1). ...

Background: Enterococci form a part of the normal flora of the intestinal tract, the oral cavity, and the vagina; also, they can cause UTI, septicemia, intraabdominal abscesses, and nosocomial infections. High-level gentamicin resistance (HLGR) in enterococci is mediated by aminoglycoside modifying enzymes, which is mainly encoded by aac (6’ )-Ie-aph (2” )-Ia gene. Objectives: The present study aimed at investigating high-level gentamicin resistance in enterococci isolated from a pediatric hospital in Tabriz and detecting aac (6’ ) Ie-aph (2” ) Ia gene. Methods: In a descriptive and prospective study, a total of 100 enterococcal isolates were collected during September 2014 and June 2015 from a pediatric hospital in Tabriz, northwest of Iran. Bacterial identification and species determination were performed by standard biochemical tests. Antimicrobial susceptibility tests were performed by Kirby Bauer disc diffusion method. The frequency of aac (6’ )-Ie-aph (2” )-Ia gene in the isolates was determined by polymerase chain reaction. Results: Antibiotic susceptibility tests revealed that the highest resistance was against erythromycin (79%) and tetracycline (74%), whereas the highest susceptibility was observed against chloramphenicol (86%). Resistance to ampicillin, ciprofloxacin, and vancomycin were detected in 47%, 53%, and 42% of the isolates, respectively. In this study, 31 isolates (31%) were identified as HLGR from which 21 (67. 74%) had resistance gene of aac (6’ )-Ie-aph (2” )-Ia in their genome. The prevalence of resistance to other antibiotics and multi-drug resistance (MDR) was higher among the HLGR isolates compared to the non-HLGR isolates. Conclusions: High prevalence rates of MDR and HLGR enterococci are important problems associated with medical settings. The results of this study indicated that aac (6’ )-Ie-aph (2” )-Ia resistance gene is highly prevalent among gentamicin resistant isolates.

Background: Fever of unknown origin (FUO) remains a clinical challenge in both emergency and infectious diseases departments. Being clinically updated on probable etiologies helps physicians to narrow their diagnostic and treatment approach. Objectives: This study aimed to assess the causes of FUO in an academic setting in the recent 5 years to update the clinicians. Methods: In a cross-sectional study, the files all patients with the primary diagnosis of FUO were extracted and evaluated. The records were assessed with regard to patients& rsquo; age, gender, days of fever before admission, time of admission and discharge, clinical course of the disease, laboratory and other para-clinical findings were documented. The patients were then classified based on the etiology of the disease and the type of test utilized for the diagnosis. Median and frequencies were used for descriptive variables; chi-square test was performed for correlation analysis. Results: From March 2009 to April 2014, 101 patients were admitted and their files were recruited for the purpose of this study. The median age of our patient population was 39. Infections (23. 1%) and non-infectious inflammatory diseases (21. 1%) constituted the most common known causes of fever in our patient population. Invasive tests had been documented for 41. 1% while non-diagnostic in 20%. Non-invasive tests leading to final diagnoses were performed for 48. 4%. There was a significant association between the type of the utilized test for diagnosis and different etiologies of FUO (P = 0. 001). Conclusions: Similar to global trends, non-infectious inflammatory diseases comprised an increasing share of the causes of FUO. However, tuberculosis remains an important infectious cause thatmaypresent withFUOor simply be overlooked in primary patient visits. Updating a local database for the causes of FUO in hospitals at certain time intervals may facilitate the diagnostic approach.

This cross-sectional study was conducted on all registered smear-positive Tuberclosis (TB) patients during a time period of eight years (2005-2013); patients with records in the Hamadan provincial surveillance database were studied, in order to find secondary attack rate of TB. The contact investigation in 510 clusters resulted in secondary attack rate (SAR) of 18. 75 per 1000 (95% confidence interval: 1. 3-38. 7) children below the age of 15; SAR of 6. 7 per 1000 (95% confidence interval: 2. 1-11. 3) adults; and overall SAR of 8. 14 per 1000 contacts (95% confidence interval: 3. 4-12. 8). we concluded that age and household size had a significant impact on the transmission of TB to household contacts.