Medical Journal of Mashhad University of Medical Sciences
Year:2002 | Volume:45 | Issue:75|Papers Count:29

CD23, the low affinity receptor for IgE (FC E R 11), functions as a multifunctional regulator of immune system and IgE synthesis, in part, by producing an IgE binding factor (soluble CD23). To evaluate the serum levels of total IgE and soluble CD23 (sCD23) in atopic patients and to determine whether there is a correlation between these two markers.Forty-five adults atopic subjects (Allergic rhinitis 17, Allergic asthma 17 and atopic dermatitis 11) with positive skin prick test to common allergens and positive family history of atopy was entrolled in a case-control study. Serum levels of total IgE and sCD23 of these subjects were measured by ELISA method and compared with 25 healthy age - matched controls.Mean age and sex ratio were similar among study groups. Mean serum levels of sCD23 in atopic groups (5.12±3.9ng/ml) were significantly higher than control group (0.2ng/ml) (P<0.01). Mean total IgE level in atopic groups and control group were 388±204 IU/ml, 43±40 IU/ml respectively. Atopic subjects had significantly higher IgE level (P<0.01).SCD23 may be a good atopy prediction marker.

While head is exposed to x-rays for CT Scan some of the sensitive tissues such as thyroid and eye lenses are also exposed.In this study the resultant absorbed dose to these tissues have been measured by Thermolumincent Dosimeters (TLD), in patients admitted to the CT Scan ward, in Imam Reza Hospital in 1999.For this purpose TL pellets made from LiF: Mg, Ti were used The CT Scan machine used in this work was aGE CT 9800HL.The head scans investigated in this work were divided into five groups. Group one general head scans of patients over 16 years old. Group two head scans of patients below 16 years old, group three scans of patients eye orbit, group four scans of patients' sinus and group five scans of patients' sinus ear. Average eye lenses doses of patients examined in this study were: 3.22, 3.67, 22.2, 21.6 and 19.9 mGy for group one to five respectively.Average thyroid dose of patients included in this work were 0.78, 0.97, 0.52, 0.93 and 0.49 mGy respectively for group one to five.As absorbed dose in Eyes Lenses from the Thermolumincent Dosimetry in CT Scan of patients sinuses and eyes orbits and ears are higher than limit, it must be considered in use of CT Scan and other diagnostic radiographies.

The purpose of this study is to determine the incidence of different shunt complications and that if there is a significant statistical relationship between the complications and the origin of a shunt placement, the period of shunt insertion, CSF characteristics, symptoms and signs, preoperative and postoperative diagnoses and shunt type (low, medium, highpressure valve).This descriptive study covers 95 patients with hydrocephalus who had been treated with shunt therapy were studied over a 10 year period (from March 1991 to March 2001). They have all been admitted with shunt complication as the first diagnosis. We studied the sex, age, origin and period of shunt insertion, preoperative and postoperative diagnoses, CSF characteristics, symptoms and signs, shunt type (on the axiom of valve pressure).All the data were analyzed using SPSS 10.0 software and Chi_square, Kruskal_wallis, T_test and NPar as statistical tests.The results observed in-patients indicated that obstruction was the most common shunt complication (44.2%), the most common symptoms and sign were headache, nausea and/or emesis and DLOC respectively. The main mechanical causes for shunt failure were obstruction and disconnection.The CSF culture had a 50% sensitivity to suggest shunt infection. 66.6% with shunt malfunction as preoperative diagnosis had a definite diagnosis after the surgery. We could not find the relationship between shunt type and shunt complication.Most common complications of brain shunts were obstruction, infection and malfunction. In-patients with identified complications, longest period of use of shunt was seen in-patients with obstruction and peritonities. Headache, Nausea with or without womiting and consious were the most common signs and symptoms. Causes of disfunction in most cases were obstruction and separation. Kind of complication had relation with cause of shunt use but not with shunt type.

Congenital Erythropoietic Porphyria (CEP) is a rare autosomal recessive disorder of the porphyrin metabolism caused by the homozygous defect of uroporphyrinogen III cosynthase. We report two brother's aged 18 and 14 years with typical features of congenital erythropoietic porphyria in this article.They were born in Neishabour (Khorasan Province) and were admitted in Emam Reza Hospital dated 4.93 with clinical presentation such as skin lesions (Vesicular lesions on the exposed area of the body), reddish urine almost since birth mutilation and erythrodontia. The disease was first manifested in infancy and severe mutilating cutaneous photosensitivity eventually developed. The elder had anemia and splenomagaly was observed at the both patients.Laboratory findings indicated a large amount of porphyrins in urine analysis. The main histopathologic changes of CEP are dermal infiltrate with nonacantholytic subepidermal bullae. Histochemical examination showed deposition of PAS positive material in a perivascular distribution.

Iodine Deficiency Disorders (IDD) is a worldwide health problem. Many parts of the Islamic Republic of Iran had been known as areas of endemic goiter. IDD was accepted as a priority health problem in the country, and a National IDD council was formed in 1989.One of the main strategies of National council for IDD control was to provide at least 150µg of iodine per day to the entire population through making available iodized salt. This study was performed to evaluate the National IDD council program in 1996, in rural and urban areas of Khorasan province. 1400 schoolchildren, aged 8 to 10 year, including 50% girls and 50% boy, were selected through random sampling. Grading of goiter was performed according to WHO's classification. RIA and urinary iodine measured serum T3, T4 and TSH by digestion method. The mean of serum T4, T3 and TSH were: 10.0±2.0µg/dl, 162±122 ng/dl and 1.8µ2.0 µIu/ml, respectively. There was no difference between males and females and schoolchildren of rural or urban areas. Two people had serum T4 more than 12.5 µg/dl and seven people had TSH more than 5 µIu/ml. The mean urinary iodine was 25µg/dl in entire population, 90% had urinary iodine more than 10µg/dl. Only 4% had urinary iodine less than 5µg/dl. Total prevalence of goiter was 41% (46% in girls and 43% in boys). Based on the available data, seven years after generalized use of iodized salt and 2 years after more than 50% of population used iodized salt, urinary iodine of schoolchildren in Khorasan province showed sufficient intake of iodine. However, goiter is still endemic in Khorasan province.

Visceral Leishmaniasis (Kala-azar) is a zoonotic disease which is endemic in many part of Asia, Europe, Africa, south America and middle east area. Three species of Leishmania Genera (L. donovani, L. infantum and L. chagasi) are responsible for visceral leishmaniasis.The form of Kala-azar that is common in Iran is Mediteranian form and it is sporadic in Khorasan. In this study, the records of 104 patients hospitalized during 1982-1996 in Mashhad University Hospitals were investigated. More than 97% of patients were from Khorasan province and less than 3% were from the neighbour provinces. Most of the patients were from the northern part of Khorasan specially Shirvan, Bojnord and Mashhad.Most of the patients were male (62.5%) and more than 92% of them were under 10 years old. The common clinical signs were high fever, splenomegaly and paleness.Laboratory findings showed decrease of Hb and Hct. Leukopenia, with relative monocytosis, reticulocytosis, thrombocytopenia, increase of PT, PIT, ESR, and Gamaglobulin.Diagnosis was based on looking the Leishman body in bone marrow aspiration (97%) and liver biopsy (3%) and they were treated by Glucantime (i.m.) In all of them but prognosis was not good in few patients. It is concluded that visceral Leishmaniasis in Khorasan may have endemic foci, which needs more investigations.

Among different epileptic syndromes, infantile spasms (I.S.) or west syndrome is considered as the most malignant one, which causes irreparable brain damage in the child. Consequently the longer this type of epilepsy lasts, the more harmful results will follow.Knowing this fact, caretaker physician should consider controlling this type of epilepsy with the most important priority. The victims of I.S. are children younger than one year of age, only 5 percent of cases are reported in the age groups or above one year.Currently common treatments include drugs such as ACTH, prednisolone, valporic- Acid and benzodiazepines. In view of rapid appearance of seizure resistance to these medications and drug side effects particularly ACTH and prednisolone, usage of above mentioned pharmacologic agent it not problem. In a randomized control, double blind trial study we tried in pediatric neurology department at Mofid children's hospital, during 1377-79 (1998-2000) 60 children in the age group of 2-24 month who had I.S were admitted and treated with either Nitrazepam (NZP) or ACTH. In this experience, patients were divided randomly into two groups: group Nitrazepam (NZP) received NZP (0.5-1 mg/kg /24h) in three divided done taken with meals, in-group ACTH the patients took ACTH (40 D/daily) intramuscular single dose. At the end of second and fourth and sixth week of treatment, the patients were evaluated for complete control or reductions of seizure and drug side effects. The result of this study revealed that at the end of six weeks of treatment 63 percent of NZP treated had complete seizure control while group ACTH. Children who received ACTH, stop of seizure occurred in 30 percent of them, which shows more patients with NZP enjoyed full recovery of devastating (I.S.) relative reduction of seizure frequency was observed in 26 percent group Nitrazepam (NZP) and 53 percent Group ACTH (P<0.05). Reviewing patients EEG after six weeks of treatment showed complete normalization of tracing in NZP group 47 percent and in ACTH group 30 percent of them.Additionally this study vividly cleared the fact that NZP has less and negligible side effect compared to ACTH. Considering the better therapeutic effects, fewer side effects and lower cost of NZP in I.S patient's use of the drug choice is advised.

In order to investigate the frequency of gastrointestinal (GI) symptoms and their relation to dietary pattern in fasting in Ramadan, this cross-sectional study was carried out.The study involved 140 normal healthy volunteers who had no history of underlying disease or drug consumption. Routine clinical examination was normal. Finally 125 individuals completed the study. After 3 weeks of fasting these individuals filled out the prepared questionnaire concerning the quality and quantity of consumed food for four consecutive days in our samples 65 female and 60 male with a mean age of 27.6±11.9 years. Food consumption analysis indicated the mean daily caloric, carbohydrate, fat, protein and fiber intake as: 1160±390 kcal, 180±60, 28.5±13, 54.7±21 and 27.5±4 gram respectively. Except for protein, intake of these components was higher in men. According to the food type consumption in first mealtime (Sahar), cases were divided into 2 groups: group 1 (29 cases) had a light meal like an ordinary Iranian breakfast and group two (96 cases) consumed an imbalance protean diet. Composition of the second mealtime (Eftar) was similar in two groups. The mean daily food components intake was higher in group 2 than group 1 with a significant difference respectively as: calorie 1221 vs. 977 kcal (p<0.003), carbohydrate 187 vs., 156 (p<0.002), fat 30 vs. 21 (p<0.0006), protein 59 vs.41 (p<0.0007) and fiber 25 vs. 21 gram (p<0.02). Overall 73 cases (58.4%) developed GI complaints and female to male ratio was 1.7. Among the total frequency of symptoms, belching, bloating and plenitude feeling were the most frequent (19.4 %) while diarrhea (0.6%) was the least. The frequency of symptom in-group 1 was 55.2 % and in-group 2 was 59.4 % without a significant difference. Most of the upper GI symptoms such as dry mouth, sour mouth, pyrosis, nausea, retching, decreased appetite and early hunger sensation were correlated with some of dietary components, but other symptoms including mid and lower GI complaints, for example epigastric and periumblical pain, bloating, plenitude feeling, early satiety, diarrhea and constipation didnot show this relationship, that may be related to other factors. None of the subjects developed any acute GI complications or broke out their fasting and they didnot need medical management. So it is advisable to recommend fasting in healthy individuals in the presence of some minor digestive complaints.

Iron overload consequence of frequent transfusions is a serious life-threatening complication inpatient with major beta-thalassemia and major lifetime reducer and death in these patients.Desferal (Desferrioxamine) still is the most effective drug to increase the urinary excretion of Iron but there are not many papers about effective and helper drugs in Iron excretion in response to Desferal.In this study, the goal was to evaluate urinary iron excretion by ascorbic acid in Desferal users. We selected 50 patients (27 boy's and 23 girls, ranges ages between 2.5-17 years) with major beta thalassemia who suffered from iron overload and received Desferal by se infusion.Two randomly urine samples were obtained from each patient (one after using Desferal alone and the other after using oral vitamin e and Desferal).Mean urine iron after using vitamin e and Desferal (231.7+ 196.03mcg/dl) was significantly higher by 21.3% than Desferal alone (182.4+224.6mcg/dl), (P-value =0.000). Use of Vit. C increases the Iron urinary excretion in Deferal users in major beta thalassemic patient.

Vascular injuries of the upper extremity represent approximately 30%to 50% of all peripheral injuries. The majority of injuries are at the site of brachial artery, and return of function is often related to concomitant injury to peripheral nerves.This is a retrospective review of 109 patients who were admitted on for presumed upper extremity arterial trauma between 1981-1996. Preliminary physical examination and follow -up information obtained from medical record.There were 83 men and 19 women and average age were 28 years.The forearm arteries were most frequently involved, followed by axillary and subclavian artery. In addition to the arterial injuries 69% had another injuries, including 61 nerve injuries, and 13 venous injuries. The most frequent surgical option was primary anastomosis.Full function recovery was seen in 79 patients.Low mortality and moderately high morbidity is the rule of arterial upper extremity injuries. The magnitude of the concomitant neurologic injury is the major determinate of functional outcome in our patient population.

Cryptosporidiosis is one of the pathogenic parasites of human with different prevalence in each region of the world including our country.This is a self limited parasitic infection which may produce sever fatal disease in immuno deficient patients. Due to lack of information about the rate of human infections by this parasite in Kashan, a study was conducted to determine the rate of infection by this parasite in the children with diarrhea referred to central laboratory of Kashan during 1999-2000.A cross sectional descriptive study was performed on 240 stool samples taken by sampling from children suffering from intestinal discomforts. Formalin-ether concentration of fecal samples and warm Ziehl-Neelsen stain method was used and the smears were studied under light microscope.The highest rate of prevalence was found in rural areas and children over five years of age. The prevalence of infection in the hot seasons (that is spring and summer) of the year was also more than the cold seasons (that is autumn and winter). It was also observed that the prevalence of infection in those people who were in contact with cattles was more than others.Keeping in view the 3.75% prevalence of cryptosporidium infection among children under research, it is hereby recommended that the diagnostic centers pay more attention to this parasite particularly in those cases of diarrhea where no other pathogenic agent is found in stool.

Total Anomalous Pulmonary Venous Connection (TAPVC) is a rare life threatening congenital heart disease; Without surgical repair, the majority of patients die within the first year of life. We have evaluated an institutional experience with TAPVC.A retrospective analysis was carried out in 60 patients who 56 of them undergoing surgical correction over a 10 year period (1990-2000) at Shahid Rajaii Heart Hospital the group included 35 boys and 21 girls aged 45 days to 20 years (mean 4.8 years). Site of drainage was supracardiac 29.56 (52%), Cardiac 18.56 (32%), Infracardiac 5.56 (9%) and Mixed type in 4.56 (7%).The most common associated cardiac anomaly was ASD.Four of the patients died before surgery, early mortality after surgery was 30% (17.56), with one late noncardiac death. Sixty eight percent of the patients are currently well at a mean follow up of 4.4 years (range 2.4 mo.to 10 year). TAPVC is a rare life threatening congenital heart disease; prompt, accurate diagnosis and early surgical repair is life saving.

Diffuse lewy body disease is the second cause of dementia after Alzheimer's disease. It is characterized by a progressive dementia, fluctuation of cognitive deficits, frequent visual hallucination, delirium and hypersensitivity to neuroleptics and parkinsonian features.We report a 72 years woman patient in whom signs and symptoms consisted with neuroleptic malignant syndrome developed after 8 days of Resperidone therapy. Patient presented with fever, mental status changes rigidity and tremors. Her laboratory findings were significant for increased serum Cpk and Leukocytosis.Discontinuation of risperidone, in combination with a mild dopaminergic therapy and supportive care led to a complete recovery in one weak.

The purpose of this investigation was to compare the union rate of femoral and tibial shaft fractures with open and close locked intramedullary nail fixation.Between 1998- 2000, 65 injured patients with a total of 68 fractures of the shaft of the femur or tibia treated with static interlocking nail fixation were evaluated in a prospective review to compare their union rate data for analysis.The results of the analysis showed that the difference in union rate between open and close intramedullary locking nail fixation in femoral fractures was not significant. But in tibia fractures the difference was significant.We concluded that as there is no difference in union rate between open and close intramedullary nailing in femoral fractures (p>0.01), in most of our hospitals which there is not the equipments needed for close intramedullary nailing such as fluoroscopy and fracture table, we can use the easier and cheaper open technique without fearing of delayed union or nonunion. Therefore unavailability of expensive sets and tools for closed nailing should not make the surgeon to replace this good fixation device with a less desirable system. But in tibial fractures open technique had delayed union in compare with the close technique so we cannot replace it with the open technique (P<0.01). Fortunately because a major part of tibia bone is subcutaneous, close reduction of tibia is easy and there is no need for fracture table or fluoroscopy for reduction and interlocking nail fixation.

Complications of B.C.G. immunization are mostly benign. The most common one is adenitis (0.5- 5%) especially in axillary area (1,2). The cause of B.C.G. adenitis is unknown.Probably delayed hypersensitivity reaction playing the major role. This study was in two groups of infants with and without adenitis in post immunization period. This study was designed in order to determine the lymphocyte proliferating activity in two patient groups (with and without adenitis).Using both B.C.G. and some other mitogens including PHA and Con A (phytohemagglutinin and Concanavalin A). High lymphocyte proliferation was noticed in-groups who were tested with RC.G. +ConA or ConA alone (10).Results shown that lymphocyte in patient group (Adenitis group) highly stimulated with Con A, therefore C.M.I. (cell mediated immunity) activity most probably is the cause of BCG adenitis (8,19).

Minimally invasive direct coronary artery bypass (MIDCAB) is a new surgical procedure that revascularize the left anterior descending coronary artery (LAD) without the need for a median sternotomy or cardiopulmonary bypass (CPB). This operation is performed through a left anterior small thoracostomy (LAST).From December 1997 to December 2000, twenty two patients with isolated left anterior descending artery stenosis recognized by coronary angiography received left internal mammary artery grafting through a 4 cm, left anterior minithoracotomy, the mean age was 56 years (range, 25 to 76 years), 17 patients were men. LIMA is harvested under thoracoscopic guidance. This approach allows complete dissection of the LIMA from the subclavian artery to the fifth intercostal space. Coronary artery control is obtained with looping suture placed proximally to the site of the anastomosis. Anastomosis is then performed with 8/0 prolene on the beating heart, under direct vision without CPB.LIMA was used in all of cases. There were no operative complications and preoperative myocardial infarctions. Supraventricular and ventricular arrhythmias were never detected. Average operative time was 3 hours with shortened hospital stay.Minimally invasive direct coronary artery bypass grafting through a small anterior thoracostomy is a new promising technique that can be considered an alternative to myocardial revascularization. The procedure is safe and effective; these results are equivalent to conventional CABG. Then, the potential benefits of these approaches include: surgical invasiveness is limited, cardiopulmonary bypass risks and morbidities due to median sternotomy are avoided, blood loss is less and hospital stay is shorter, reduced costs and finally good cosmetic results on chest wall.

Hypernatremia is an important electrolytic disorder in children especially in neonate. We crossectionally studied Hypernatremia in neonate in Imam Reza medical center out patient NICU, during one year from March 1997 to March 1998.In this study the incidence of Hypernatremia was 6.01 %. The most important etiologies were increase water loss due to hyperthermia 43.13%, traditional drug use for hyperbilirubinemia, 15.89% and low breast milk intake due to infections 11.35% and asphyxia 11.35%, but increase sodium intake was etiologic factor for just 4.45% patients.This study showed that the incidence of hypernatremia is high and the etiologic factors are different from other ages and the mortality is lower than older ages.

Crimean - Congo Hemorrhagic Fever (CCHF) is an acute febrile illness, usually with mild to sever hemorrhagic main manifestation. Chumakov, Russian physician (in the end of World War II) described the clinical identification and viral etiology of disease.The syndrome was observed to the associated with transmission To. Human, by Ixodid ticks and was postulated to be a virus.Persons with CCHF develop a very high level of viremia, persisting 8-12 days, making the blood from CCHF patients quite infectious. Clinical picture of CCHF has three phases.In phase I the clinical magnification is non-specific with flu like syndrome, usually with bleeding through intestine, nasal, skin or other sites. In the second phase of disease, bradycardia or tachycardia (in sever bleeding) may be seen. Hypotension, hypovolomic shock and cardio- vascular failure are common signs of disease.Prolonged PT and PIT with thrombocytopenia with leucopenia are common lab findings.Blood transfusion and control of hypovolumia usually are life saving.Serum Elisa Essay and confirmative lab tests with control of bleeding tests are diagnostic assays in CCHF patients.

A 35 years old butcher (Mashhad Resident) was referred from a private clinic to infectious ward of Imam Reza Hospital.He had a fever, starting 5 days ago, with myalgia, headache, asthenia and two times vomiting and eventually abdominal discomfort, chillness and drowsyness were appeared.* He gave a history of epistaxis, hematuria, abdominal tenderness and diarrhea from 8days ago.In spite of lacking of signs and symptoms of ICP, he was stupored, and disoriented.He was hospitalized in another hospital.Lab tests in that hospital were: WBC= 4000, with 60% neutrophilia, CRP ++, ESR in first hour =45 cm, 8- 10 RBC in urine hpf, a moderate proteinuria, a high liver enzymopathy, OT=300, PT= 400, total bil. 1.2 mg/dl, chest X.Ray only congestion of lungs, PT and PTT normal, platelate =90000, Hep B, and Hep C tests were negative. For existence of purpura and petechial lesions and thrombocytopenia with diagnosis of ITP prednisolone was initiated. EKG and electrolyte in the third day were normal.The patient was discharged and from a private clinic was referred to the infectious ward.Blood culture, urine culture, gasometric and electrolyte detection, LFT, kidneys function, urine volume, coagulation tests, CBC (H1), EKG were performed and prednisolone discontinued.Purpura, petechia, on the chest and abdomen and epistaxis and rectorrhagia exist.In the second hospital day, fever was 38.2 with heartbeat about 50/min, blood pressure 95/60, two units blood were transfused and after that Ringer lactate was infused. Liver was palpated 3 cm under the border of ribs. Spleen was palpable, CBC, platelate count, PT, PTT, LFT, LDH, Ret.count, creatinine, blood sugar, Na, K, Ca, C3, C4, protein electerophoresis were requested and on the next day, laboratory reports were: WBC= 2900, with 50% neutrophylia, platelate =90000, PT=15 seconds, PTT=45 seconds, anti HCV, and HBS Ag= negative, blood culture negative, CBC with a shift to the left, Hg 9.5 gr/lit, MCV, MCH under the normal limit. Third generation of cephalosporine initiated, heart beat with sinusal rhytym and 50 beats/min.Febrile agglutination tests requested. The patient was alert, blood smears for malaria and borrelia were negative. Nose- bleeding and rectorrhagia continued. Whole blood transfused and platelate was requested. On the third hospital day in spite of discontinuing of bleeding the patient was ill with generalized myalgia. Blood pressure was 110/75, temperature 37.4, platelate count 110000, WBC= 4500, serum creatinine one milligram. On the forth hospital day, patient's situation was better, petechiae and purpura were fading, platelate count and coagulation factors were requested.On the 5th hospital day, injectable antibiotic switched to oral route and patient was discharged.

Ganglioneuroblastomas are malignant neoplasms that differentiate more than neuroblastomas but lower than ganglioneuromas. These occur more frequently in children commonly along the symphatic chain but rarely outside of it.Clinical and Radiologic findings can not differentiate these tumors from another benign and malignant tumors of the same site.Definite diagnosis is achieved by histopathologic examination.We report a rare case of ganglioneuroblastoma in a 16 years old girl associated clinically with growth and sexual retardation and microscopically with diffuse brown pigmentation.A brief literature review is also considered

Gonadoblastoma is a rare tumor, which occurs almost exclusively in-patients with some form of gonadal dysgenesia.In this article a patient is described with Gonadoblastoma but no dysgenesia in the pathology. The patient has normal anatomy and genital system function. He has 46-xy karyotype. It is interesting that he is fertile and has a normal offspring.This is a rare case that is phenotypically & genotypically normal.

A 2.5 year old girl was brought to emergency department of Imam Reza Hospital in Mashad University because of recurrent seizures.She was treated with anticonvulsant for long time. Initial evaluation ruled out metabolic or other causes of seizure and unconsciousness except for long QT interval in EKG tracing. After beginning propranolol these episodes were stopped.Early recognition of this syndrome is very important because of prognostic and therapeutic consequences. In this report a case of long QT syndrome with the diagnosis of Romano Ward Syndrome is presented.

Serologic tests for salmonella and brucella were negative. Peripheral blood morphology and liver enzymes were at normal level. Platelate 150000, PT 14.Regarding clinical feature and contact with sheep and regarding to nose-bleeding, intestinal hemorrhages, hematuria, dermal echimosis. The diagnosis was consistent with viral hemorrhagic fevers, fulminant hepatitis, leptospirosis, toxic salmonella infection, gram negative septic syndrome and…But regarding to initial septic syndrome, and profound cytopenia, continuous contact with blood of sheep and regarding to report of some cases of CCHF in Esfahan, Guilan and Tehran, serologic (Elisa) tests for CCHF was requested (Pasteur Institute, Tehran) and it was positive. Confirmative test for CCHF from Center of Arboviruses Researches in Senegal was positive. The patient's clinical situation after five days hospitalization was much better. IV antibiotic and other drugs were switched to oral route and he was discharged and asked him to comeback to outpatient clinic, for more evaluation.