Iranian Journal of Infectious Diseases and Tropical Medicine
Year:2005 | Volume:10 | Issue:29|Papers Count:17

Background: The main aim of the treatment of chronic hepatitis B is to suppress HBV replication before irreversible liver damage occurs. In this study we evaluated the short-term efficacy and safety of alpha-2b interferon (Heberon Alpha R) on Iranian patients with chronic HBV infection.Methods: From 2002 to 2003, in a multicentric uncontrolled trial, 68 patients with chronic hepatitis B (HBeAg+: 32.4% & HBeAg-: 67.6%) treated with Heberon Alpha R in the mean dose of 31.32± (SD) 7.3 MU/Wand in mean duration of 5.32±.95 month. The biochemical response (BR) was defined as decrease in serum ALT level to within the normal range, virologic response (VR) as loss of serum HBV DNA on PCR and loss of HBeAg in patients who were initially HBeAg-positive, and BR+VR as complete response (CR). Result: During the treatment with Hebron did not report any serious or unexpected adverse reaction in treated patients. At the end of treatment, with per-protocol analysis, BR, VR, and CR were 58.8%, 47.5%, and 44.1 %, respectively. Complete response was significantly associated with pretreatment high serum ALT levels (P=. 002), high pathological liver grades (P=. 001), and a higher dose/week of INF-α (P=.001).Conclusion: In this study we showed an acceptable safety and efficacy for Hebron (a preparation of alpha-2b interferon) in the treatment of Iranian patients with chronic hepatitis B. These results should be supported by well-conducted randomized, controlled trials and evaluation of its long-term effects on chronic hepatitis B infection.

Background: Brucellosis is a zoonosis and multisystemic disease that is transmitted to human and is common in our area. This study was carried out to evaluate brucellosis in point of clinical, paraclinical and therapeutic study in children.Methods: This is a retrospective study of 44 patients who admitted in our center with diagnosis of brucellosis during 14 years period. The age range of patients was zero to 14 years.Results: Twenty nine of patients were male (65.9%). Consumption of unpasturized milk and dairy products was positive in 29 cases (65.9%). family history of brucellosis was positive in 20.4%. The most common clinical features were arthritis in (79.5%), fever (77.4%) anorexia (61.4%), sweating (52.3%), splenomegaly (43.2), hepatomegaly (34.1%) andymphadeopathy (13.6%). Respectively hematologic finding include: leucopenia (31.8%) anemia (56.8%), thrombocytopenia (9.1 %). Serum agglutination test (SAT) had done for all patients and seropositivity rate for brucellosis was positive was in 97.7%. Blood culture and bone marrow aspiration were positive in 30% and 50% of patients. Most of patients (68.1%) had been treated with combination of cotrimoxazole and rifampin, duration treat ment was 6 wks. Relapse was observed in 6 cases (13.6%).Conclusion: Fever and arthritis are two common clinical finding of brucellosis in current study. The SAT is a good method to detection of infected patient. Prevention should be relied education and control measures among human and animal population. Treatment must be long enough to achieve cure and avoid of relapse.

Background: The TT virus (TTV) is a recently discovered DNA virus, which was first identified in patients with non A to G hepatitis following blood transfusion. Transmission is generally via the parenteral route but recent data suggest that TTV can also be transmitted by the fecal-oral route.Methods: This cross-sectional study was conducted in March 2005. 324 Patients on maintenance hemodialysis at three different centers in the city of Tabriz were invited to participate. Demographic and clinical data were registered. Blood samples for virological and routine biochemical tests were drawn simultaneously. TTV DNA was detected using seminested polymerase chain reaction (PCR). All patients were previously tested for HBs Ag, anti- HCV and anti-HIV by EIA assay.Results: The overall seroprevalence of TTV was 9.3% ( 95% Cl: 6.1%-12.5%). The prevalence rate of HBV, HCV and HEV infection were 4.6% (95% Cl: 2.3%-6.9%) and 20.4% (95% Cl:16%-24.8%) and 7.4 % ( 95% Cl: 4.6%-10.6%), respectively. No relations were found between TTV infection and elevated levels of alanine aminotransferase (ALT). No significant association was found between anti-HEV positivity and age, sex, duration of hemodialysis, positivity for hepatitis B or C virus infection markers and history of transfusion.Conclusion: We observed low TTV prevalence; there was no association between TTV and blood borne infections (HBV, HCV, and HIV) in our HD patients. This is the first report concerning seroepidemiology of TTV infection in a large group of chronic HD individuals in Iran.

Backgrounds: Acute gastroenteritis have now been stablished as the major public health problem in children worlwide. Rotavirus is the most important etiological agent of dehydrating gastroenteritis among children in industrialized and developing countries, is also major cause of children malnutrition.Methods: Acollected of 1250 stool specimens from hospitalized children < 5 years old with acute gastroentritis in Tehran from January 2002 to April 2004 were analysed for Rotaviruses and characterized by antigenic (IDEIA, LA) and genomic (ds RNA PAGE) methods.Results: Group A Rotaviruses were detected in 28.4% of patients fecal specimens.The majority of Rotavirus infections (70%) were occurred in children< 2 years of age with peaks of infection in 6 to 12 months of age (p<0.005). Rotavirus diarrhea in males and females were 58.30% and 41.7% respectively (p>0.05). The highest of Rotavirus infections was in cool seasons with peaks of infection in the months of December, January and February (p<0.005). The study of clinical manifestations in Rotavirus gastroenteritis cases showed that most children had fever, vomiting and dehydration and breast feeding had a protective action against Rotavirus infection (p<0.005). In this study the molecular epidemiology of Rotavirus infection was investigated. Ten different RNA electrophoretic patterns, 7 of long and 3 short profiles were detected in the study area. A long RNA pattern classified as LA was the prevalent electrophoretype among all of the types, that occurred throughout the period studied and in 0-5 years old, but the short patterns occurred only in <24 months of age during the cool seasons. Rotavirus infection was shown to be an important agent of winter diarrhea disease in hospitalized young children in Tehran. Conclusion: The Results of this study in Tehran reinforces the need to immunizing of children by evaluated vaccine. The data demonstrate epidemiologic differences between Rotavirus long and short electrophoretypes incidence.

Background: Brucellosis is a zoonosis that is a systemic infection in which any organ or system of the body can be involved. Antimicrobial therapy relives symptoms and prevents complications. The aim of this study is comparation of two treatment regimens for relieves symptoms, rate of relapse, prevalence of complications.Methods: This study is a comparative randomized clinical trial Between 220 patients with brucellosis (Complications such as meningitis and endocarditic were excluded). First group were received Doxycyclin + Rifampin (OR group) and second group were received Doxycyclin + Rifampin + Amikacin (7 days) (ADR group).The patients were evaluated for percent of response to treatment, rate of relives symptoms and incidence of relapse.Results: In this study 203 cases have been response to treatment, that 106 cases with ADR group and 97 cases with OR were treated (P= 0.04). The appropriated response to treatment, time was shorted by ADR regimen (P=0.06). Relapse occurred in 9.3% in OR group but in 5.4% in ADR group. The complications of Drugs, were not different between two groups.Conclusion: The rate of response to treatment and successful in treating was higher in ADR group than OR groups, but the complications of Drugs was not different between Two groups, So ADR regimen is a good and effective combination in treatment of brucellosis.

Background: each year, approximately 2 million Muslims travel from all over the world to participate in Hajj. Despite of health facilities, which apply by physician committee of Saudi Arabia and other Muslim countries, over half of the pilgrims affected to respiratory diseases. In 1383, approximately 100000 Iranian pilgrims attended in Hajj pilgrimage that nearly 80% of them affected to respiratory infections. In this study, the role of viral agents investigated. Methods: Serum and throat washing samples have tested by hemagglutination inhibition and Immunofluorescence assays. Results of throat washing samples reveal that adenovirus and influenza viruses detected in 36.2% and 13.3%, respectively. Serologic results show that in 21.5% of second sera observed rise ≥ four-fold in antibody titer. In two cases RSV detected, but parainfluanza did not detected in none of samples.Result: These results show that adenovirus and influenza viruses were major causative agents of viral respiratory diseases among Iranian pilgrims. Nevertheless, the role of other agents and allergens should not ignore, because among more huge population of pilgrims, all of existing respiratory pathogens could be cause an epidemic.

Backgrounds: One of the occupational injuries in therapeutic centers due to injuries resulted from needle stick and contact with infective and blood borne pathogens from a patient that has an infection. Concerns about Special wards such as Operating Room, ICU and Emergency department causes which staffs exposure to Accidental exposure to blood caused by needle stick injuries Due to sharpened tools infected by blood. Because of no study in this matter in Mazandaran Province, penetrating stab wounds caused by a needle in staffs of teaching and non teaching hospitals of Mazandaran Province in 2003-2005, this research was done.Methods: ln a descriptive study, we investigated (352 persons) in special wards, 158 persons in teaching hospitals and 194 persons in non teaching hospitals as a sample respondents. This research was done by questionnaire (five demographic questions and 12 special questions pertaining to needle stick injury. The questionnaire provided by library reading and scientific articles and needs assessment of professionals and then was done in face to face among 20 staffs. In face to face communication with staffs and describing of the projects to them, accidents due to sharpened devices during to 3 past years was written in ready questionnaire and collected.Result: Results of a Research Project showed that 225 was (64%) male and 127 (36%) was female. 157 (%44.9) was in teaching hospitals and 194 (%55.1) was in non teaching hospitals. There was No statistically significant difference among male and female view point of accidents rate due to sharpened devices but there was statistically significant difference between teaching and non teaching hospitals (p</014). The results showered that %75.6 staffs experienced one time infective and blood borne pathogens from a patient that has an infection. The most common damager (%72.6) conducted due to syringes. Conclusion: Regarding to high rate of injuries in many staffs that working in special units and potential of pollutions transmission, it necessitates establishing educational programs and activating of infection control and planning committee for prevention of NSI and control of daily reports.

Background: Resistance to antimicrobial agent is a world-wide problem and there are some reports from different hospitals. Susceptibility and resistant pattern of microorganisms in any hospital is important for management and treatment of nosocomial infections. This study was designed to determine susceptibility and resistant pattern of microorganisms isolated in Loghman Hakim hospital.Methods: The research method was descriptive and its technique was observational. Results: 268 cultural specimen of admitted patients (90 female, 178 male) that 123 (39%) related to poisoning I.C.U (intensive care unit) and 39 (12%) related to general I.C.U were be studied. The most common culture- positive was from Poisoning ward and end tracheal tube samples. The most common microorganisms was Escherichia coli (E.coli) (60, 19%) and klebesilla (54, 17%) respectively. Maximum resistance of E.coli observed to Co-trimoxazol (71.6%), Ampicillin (84.3%), Cephazolin (83.7%) and Maximum resistance of klebesiella reported to Co-trimoxazol (72.6%), Ampicillin (96.1%), Cefazolin (76.7%). High resistance rate of microorganisms such as E.coli, klebsiella and Pseudomonas to antimicrobials such as Cotrimaoxazol, Aminoglicosides and first generation cephalosporin's and increasing of Oxacillin- Resistance Staphylococci coagulate negative may be resulted from over- use of these antimicrobial agents.Conclusion: Early beginning and inappropriate dosage of antimicrobial agents may be associated with an increased likelihood of the development of multiresistant bacteria. So it is highly recommended to prohibit unnecessary prescription of antibiotics.

Background: Antibiotics used for antimicrobial susceptibility testing is usually rewised yearly by the National Committee for Clinical Laboratory Standards (NCCLS).Emergence of drug resistance among local bacterial strains, and unsatisfaction of clinicians to the antimicrobial susceptibility test results are the main problems in the treatment of Infectious diseases. The purpose of this study was to select the more appropriate antimicrobial agents for antibiogram and also to satisfy practitioners and help them in choosing the best drug treatments.Methods: The study was carried out in shohada-e-Tajrish teaching hospital, Tehran, in 2004. A preliminary information about antimicrobial agents was obtained from the NCCLS guidelines and other standard references. Clinical experiences and recommendations of the hospital faculty members, experts from Infectious diseases research centers and also pharmacists in Tehran were collected. On the basis of the collected data, a new list of antimicrobial agents was prepared. Results: Antimicrobial agents recommended by the Hospital Practitioners are summarized. Then according to the NCCLS guidelines and recommendations of the clinicians, various antimicrobial agents were selected which are listed in four tables based on types of samples and bacterial isolates. Each of the tables consist of part "A" and part "B", in which part "A" is for primary and part "B" for secondary antibiogram. The hospital clinicians such as Professors of the Urology department of the hospital suggested that: 1) Ciprotloxacin and Nortloxacin may be used for primary antibiogram of the gram negative isolates, but Azithromycin and Nortloxacin for secondary antibiogram ; 2) Ceftazidime for the grame negative isolates from urinary and other tluid samples ; 3) Ceftriaxone may be included in primary antibiograms of gram negative organisms isolated from different fluid samples. Surgeons and Internists recommended Cefazolin and Coamoxyclav, respectively. However the clinicians did not recommend the use of chloramphenicol. Tazocin (Pipracillin + Tazobactam) was recommended by the Nephrologists for secondary antibiogram of gram negative isolates of upper urinary tract infections.Conclusions: Antimicrobial agents used for susceptibility testing were rewised by using international references and local clinical data which may help clinicians in choosing appropriate drug therapy for local resistant strains of different Infectious agents. It is recommended that this model of study may be carried out in different medical institutions and resultant proposed panels of drugs rewised yearly and then used as Iranian NCCLS guidelines.

Background: Individuals with diabetes mellitus (DM) exhibit greater frequency and severity of infection, so they are prone to several infections such as folliculate, furuncle, subcutaneous abscesses and diabetic foot ulcers. The most common responsible pathogen is staphylococcus aurous which has an endogenous source.Methods: We conducted a case control trial in which 120 samples of nasal swab from each group type I and type II (DM) patients and the control group were cultured and antibiograms were performed in positive cultures. Results: The results revealed 56.6% of nasopharyngeal carriers in type I and 50.8% in type II diabetic patients and 23.3% in control group. We found a significant difference between diabetic and control group (P<0.0001). Methicillin resistance in (DM) type I and II were seen in 57% and 61% of the cases respectively.Conclusion: The findings suggested the increased rate of staphylococcal colonization and methicillin resistant organisms in diabetic patients so recognition and treatment of these carriers are recommended.

Background: Iran is one of endemic countries for tuberculosis also, bronchogenic carcinoma is the most common cancer in the world and bronchogenic carcinoma can mimic or be masked by pulmonary tuberculosis. The aim of this study was to describe that these two diseases can progress coexisting.Methods: Study of patients whom have been admitted at three educational centers with diagnosis of pulmonary cancer from 20/03/95 to 19/05/99, and selecting patients that in whom pulmonary TB and bronchogenic carcinoma coexisted.Results: The findings of 354 patients with bronchogenic carcinoma include: Mean age of patients is 60/96 years, 261 (73/9%) males, 92 (26/1%) females, 11 (4%) patients had sputum smear and culture positive for TB, 5 (1/6%) had pulmonary TB in the past ( mean age of 16 patients with coexisting pulmonary TB and lung cancer was 61/34 years, 75% males and 25% females), 66/9% of patients were smokers ,the average delay in diagnosis was 6/75 months. In the patients with coexisting TB and lung cancer 5 (31/2%) had hilar adenopathy, 41/4% had classic radiologic pathern for TB in the apex of lung, and 37/9% had atypic padiologic pattern for TB. The most common cancer in the both groups was SCC (lung cancer & coexisting TB and cancer).Conclusion: Lung TB and lung cancer may coexist, we offer in any aged smoker patient with pulmonary TB especialy if there is atypic chest radiologic pathern to do cytologic or pathologic study to confirm lung cancer.