Iranian Journal of Infectious Diseases and Tropical Medicine
Year:2006 | Volume:11 | Issue:32|Papers Count:14

Background: Lipodystrophy syndrome is a rather widespread problem between adult HIV infected cases on HAART. Peripheral fat reduction and central fat accumulation, along with metabolic abnormalities such as an increase in LDL serum level and triglyceride, and a decrease in HDL serum level are some of the manifestations of this syndrome. Yet, there is still no valid and accurate diagnostic way to diagnose it. This paper tries to measure the frequency of this complication through clinical and laboratory criteria.Materials and methods: This is a descriptive, cross-sectional study, which examines 18 HIV positive cases on HAART to determine lipodystrophy complication and its severity. To diagnose the abnormalities we used two different approaches: Clinical examination and scoring through laboratory parameters such as (Anion, CD4, HDL, LDL, Triglyceride, Lactate, and gap), age, gender, and HIV infection duration and waist/hip ratio. In both approaches the patients were given some scores. If in self-evaluation or clinical examination the case was given moderate to severe score he was considered with lipodystrophy complication.Results: %27.8 (5 cases) of the cases had lipodystrophy syndrome (at least in one approach). The ways of infection transmission are unsafe sex (%60), injecting drugs (%20), and surgery (%20). The average of CD4 count in cases with lipodystrophy was 616.4mm3; in cases without lipodystrophy the CD4 count level was 610.5mm3. The mean of HIV infection duration in cases with lipodystrophy was 57.8 months and the mean duration of HAART was 35.6 months. In %15 of cases with lipodystrophy, blood cholesterol and LDL level were higher than normal, and in %20 of cases blood HDL level was lower than normal range. Blood triglyceride level and FBS had a normal range in all the cases.Conclusion: The frequency of lipodystrophy in the cases was %27.8 which seems to be higher than a multi-central study which predicted the lipodystrophy to be %20. There was no significant difference between HIV infection duration mean and cases both with and without lipodystrophy though. There was also no significant difference between blood triglyceride level, total cholesterol, HDL and LDL in both groups with and without lipodystrophy syndrome.

Background: Hepatitis B virus (HBY) infection remains a major issue among dialysis patients. Patients on hemodialysis (HD) elicit a weaker response to HBY vaccine. We aimed to determine, rate of successful immunization in HD patients and factors which could affect response to HBY vaccination. Material and methods: HBY vaccination was offered to 61 patients that were HBY antigen and antibody negative and vaccine series was given as 40 microgram, at 0, I, 2 and 6 months and antibody responses detected 1-2 months after completion of vaccination. We checked some lab test include C3, C4, Triglyserid, cholesterol... and HLA I, II.Results: A protective level of Anti-HBs antibody (>10IU/L) was developed in 86.9% after completion of vaccination .We found significant correlation between C3, C4, Fasting blood sugar, CRP, Parathyroid hormone, cholesterol and mean anti-HBs titer level and response to vaccine (p<0.0001) but we didn't find any significant relation between the other parameters. We checked HLA class I, II antigens in our vaccinees. We detected DR53, DQ3, CW4, B5, Al at significant higher frequency in high responder compared to nonresponder groups (p<0.05).Conclusion: This study showed response to HBY vaccine is affected in multifactorially model.

Background: The incidence of infectious diseases is increased in patients with chronic renal failure. Tetanus antibody values are under the protective level in the elderly people, chronic haemodialysis patients, renal transplant recipients, and chronic renal failure. Most hemodialysis patients will develop an adequate anti-tetanus antibody titer following administration of a single dose of tetanus vaccine. The aim of this study was to assess the immunity against tetanus in hemodialysis patients and to examine the immune response to a single dose of tetanus toxoid vaccine. Material and methods: A clinical trial study (before-after) was designed in 54 hemodialysis patients who had been on dialysis for at least 3 months, three times a week. We described the experiment to the patients and received their consent. After a blood sample for anti-tetanus antibody titer, single dose of tetanus toxoid vaccine was administered. Repeat titers were obtained 8 week after the vaccination and analyzed by ELISA assay. Antibody levels equal to or greater than 0.1 IU/ml were considered protective.Results: 53 patients (98%) had inadequate antibody (0<0.1 IU/ml). After vaccination, 51 of 53 (96%) became immune with adequate antibody (> 0.1 IU/ml). There was a significant differences between titers of circulating antibodies were obtained before and after injection Td with Wilcoxon signed rank test (P<0.0001). Conclusion: This study showed the efficacy and safety of vaccination against tetanus in hemodialysis patients. 4% of patients had inadequate antibody after Td vaccination, therefore, hemodialysis patients will need revaccination much earlier, and tetanus toxoid antibody levels should be checked, if a patient is injured and potentially requires vaccination.

Background: Blood Exchange transfusion (BET) via umbilical vein has an important role in treatment of neonatal hyperbilirubinemia and prevention of kernicterus. The aim of this study was to determination of the incidence of bacterimia and septicemia following BET.Material and Methods: This descriptive- analytic and cross sectional study was conducted from December 2001 up to February 2004 in Amirkola children hospital (Babol-Iran). The criteria of BET was in full term healthy and neonates with body weight ≤2000 gr with serum total bilirubin level ≤20 mg/dl and in neonates with body weight lower than 2000 gr with serum total bilirubin level of more than one percent of body weight per gr. Umbilical vein catherization was done by catheter of Vygon standard set of BET made in France. First 5ml of blood drown from catheter (before BET) and last 5ml of blood drown from catheter (after BET) were cultured on KFG media (made in Iran). Every positive blood cuture was follow up by another culture. Data were collected and analyzed by SPSS software. Results: Of all 1726 hyper bilirubinemic neonates 314 neonates needs BET (18.6%).85.7% need one BET and rest more than one BET.At the first BET 628 (before and after BET) blood specimen were cultured that bacteria grown on 11.8% of total specimen and 18.6 neonates. Bacteria were grown on 13.3% before and 9.8% after BET specimen; there is no significant difference (p= 0.213).From 74 blood specimen before and after BET on 37 neonates for 2nd BET, bacteria were grown on 28.3% total specimen in comparison to 1st BET (11.8) difference was significant (p<0.0001) In the 37 neonates on 2nd ET bacteria were grown on 45.95% neonates in comparison to 1st BET difference was significant (p<0.0001). In all follow up culture only 4.77% (15 from 314 neonates) were blood culture positive with symptom of clinical sepsis.Coagolase positive staphylococcus 52.38%, Coagolase negative staphylococcus 19.04%, Ecoli 11.9% and rest 16.68% were enterobacter, pseudomonas, diphteroid and gram-positive cocci Were grown on culture media.Conclusion: Regarding to high rate of transient bacteremia following BET, only 4.77% of hyperbilirubinemic neonates need treatment after BET due to nasocomial sepsis.

Background: In the beginning 21st century tuberculosis is yet a global emergency. The main reason for this problem is emerging multi drug resistant Mycobacterium tuberculosis (MDR-TB). The strategy DOTS was offered to prevent MDR-TB but after 10 years it is yet a serious problem. We conducted this study for treating smear positive pulmonary tuberculosis who are at high risk to have MDR-TB such as progressing disease, large or multiple cavities, HIV positive patients, history of prisoning, and closed contact with known case of MDR-TB.Material and methods: This study is a comparative clinical trial study. Patients who took part in this study were divided in two groups. The first consists 25 patients and were treated by DOTS regimen. 10 patients in the other group were treated by our offered regimen. Duration for treatment and follow up was 18 months and 2years. Fisher exact test and spss 11.5 were used to compare results. Results: Conversion rate in sputum examination (positive to negative) at the end of 2, 5 ,9 and 18th, month in DOTS regimen were consequently 40%, 60% and 80%, but in our offered regimen were 70%, %90%, and 90% .There was no significant difference in effectiveness of treatment between two anti TB regimen (p=0.12). There was no difference in drug side effects between two groups. Conclusions: This study showed that although conversion rate of sputum in patients who were treated with our offered regimen was higher (90% versus 60%) and faster (after 5 months in contrast 9 months of treatment) than was DOTS, but statistically difference between this 2 regimens is not significant ,so we recommend further clinical trials to achive better results.

Background: HBV is estimated to have infected 350, millions people world wide and can induce a spectrum of acute and chronic liver diseases. Replication of virus and progress of diseases is dependant on presence of specific markers in blood. These markers include ALT levels, presence or absence of HBe antigen and degree of viremia i.e. HBV-DNA level in blood. It had been reported that there is a direct correlation between HBe Ag and ALT level. Our aim is study of this correlation till if it found correct HBe - antigen is taken as an alternate for determination of chronicity in chronic hepatitis B patients when we don't have PCR.Material and methods: In this retrospective study, 120 patients who were found to be HBs Ag positive were evalvated by testing HBs Ag, HBe Ab and ALT. If ALT was  abnormal (X≥2 Normal) that patient was tested for HBV - DNA. Patients were divided into two groups: Group A (HBe Ag positive) and Group B (HBe Ab positive).The Correlation between HBe Ag and ALT was evaluated. we evaluated this correlation a bout HBV - DNA positive patients also. Age was a demographic factor in this study. The data were analyzed by spss version 11.5, t-test and K2.Results: out of 120 patients, 78.3% were male. The mean age of the sample population was 32.5 years (Range 6-67). HBe - Ag was positive in 19 cases (15.8%) patients with Hbe - Ag positive were younger and their mean ALT was also higher. HBe - Ag+ patients have ALT=74. 32±23.23 and HBe - Ab+ patients have ALT= 30.42±8.69. (P=0.007 raised ALT and AST are likely to be positive for HBV-DNA. The combination of routine serology and biochemical tests may be considered as an alternative to HBV - DNA in evaluating the chronic HBV infection.

Background: The group of Enteroviruses is one of the human important pathogens of picornaviridae family, that according to pathogenictiy classified to: Poliovirus, Coxsackieviruses A and B, Echoviruses and new Enteroviruses. These viruses can enter in blood circulation system and create systemic infection after replication in gastrointestinal or respiratory tract. The aim of this research is direct assessment of concentrated sewage specimen with use of Integrated Cell-Culture- PCR method for considering Enteroviruses in sewage system of Tehran.Materials and methods: In this study, 63 sewage samples were obtained from the 6 main sewage disposal systems in Tehran with Two-phase concentration method has been assessed. Then all of specimens inoculated to sensitive cell culture, RD and Hep-2 and after 24 hours incubation in 36˚C with use of Pan E.V primers, and then with use of Pan P.V primers and Sabin primers, RT-PCR test on the cell culture specimens accomplished. Results: Out of 63 sewage specimen, from 41 specimen (65.07%) Enterovirus are isolated .Then, we detected poliovirus by specific RT-PCR with 9.52% frequency. Conclusion: The sensitivity of this method for detection of Enteroviruses less than 0.01 TCID50 had been assessed. That this matter is the reason of acceptibility and sensitivity of this method for detection Enteroviruses from sewage specimens.

Background: Syphilis, a chronic systemic infection caused by Treponema pallidum. Nearly all cases of syphilis are acquired by sexual contact with infectious lesions. Less common mode of transmission includes nonsexual personal contact and infection in utero or following blood transfusions. Routine serologic screening for syphilis is recommended for all pregnant women in Iran.Material and Methods: The results of rapid plasma regain (RPR) test were compiled for1484 pregnant women tested between 2004 and 2005 in Yazd. Any RPR reactivity observed in serum was considered positive and confirmed by a FTA-ABS test (Fluorescent treponemal antibody-absorbed). Results: The mean age of the pregnant women in this study was 22 years. In pregnant women who underwent screening for syphilis, there were no positive tests. Conclusion: The prevalence of syphilis is extremely low in three studies in the antenatal care population in Iran. This calls for a nation-wide survey to assess the need for continuation of antenatal syphilis screening with regards to its potential benefits and cost effectiveness in the Iran.

Background and objectives: Improvement quality of life and health status are from most important factors for therapeutic acceptance by TB patients. Hence, this study has been conducted to determine of quality of life and associated variables in TB patients. Materials and methods: In this cross sectional study participants were selected from TB clinic and wards of Masih Daneshvary hospital in Tehran by convenience sampling. Demographic characteristics questionnaire and Iranian version of short form health survey (SF-36) scale were used to data collection. The data were analyzed with descriptive and inferential statistic tests at SPSS software, windows version. Results: 189 TB patients were participated in this study. Upon to result, 54.5 % of subjects were male, 45.5% female and average age was 41.79±17.64 years. The range of quality of life scores in different domains was variants from 16.85 (±32.58) for role limitations due to physical problems to 59.18 (±22.55) for social functioning. There were significant correlations between age and income level with quality of life different dimensions. Also there were significant differences between quality of life different dimensions scores and variables of level of education, job status, cigar smoking and living place. The statistical tests didn't reveal significant correlations between other variables and health-related quality of life different dimensions scores.Conclusion: The results of this study revealed that quality of life of TB patients is decreased at disease and treatment period. Mostly role limitations due to physical problems and vitality dimensions of quality of life are influenced by TB. There fore, considering of these dimensions and associated variables are important to improvement quality of life of TB patients.

Background: Tuberculosis is an health important problem in developing countries and Iran. It constitutes the main infectious cause of death worldwide. An estimated the most common manifestation is pulmonary infection but extra-pulmonary tuberculosis accounts for up to one third of all cases. Children show a higher predisposition to the development of extra-pulmonary tuberculosis. The impact of extra-pulmonary tuberculosis is greatest among infants and young children who tend to develop more severe extra-pulmonary disease, especially meningitis, and miliary tuberculosis. This study was conducted in order to determine the prevalence of tuberculosis meningitis in children in Zahedan.Materials and methods: In this Existing data study all patients aged less than 18 years who were treated for active tuberculosis during 10 years between Feb 1994 to 2003 were identified. Then children with tuberculosis meningitis determined. Results: Of the 398 patients with tuberculosis, 123 cases (31%) had extra pulmonary TB. Out of patients with extra pulmonary TB, 86% were Iranian and 14% were Afghan patients. Tuberculosis lymphadenitis was the commonest form (44.7%) and pricarditis was less than other forms (2.4%). Among the patients with extrapulmonary TB, 9.2% (12 cases) had treated for tuberculous meningitis, that 7 cases (58%) were male. The mean age at presentation was 4.1 years, with 4 patients (33%) younger than 10 years. Our epidemiologic data showed that7 (58%) of the patients had a family history of TB, and all patients had a Mantoux skin test result of >10 mm of induration. Radiographic studies demonstrated abnormal chest findings in 6 patients (50%) (hilar adenopathy, infiltrates, miliary pattern, and pleural effusions, and 8 (66%) cases with hydrocephalus 3 cases, parenchymal disease (1 case), basilar meningitis (2 cases) and 2 patients with tuberculomas. Only 2 of children had a positive PCR for mycobacterium tuberculosis in cerebrospinal fluid, and Mycobacterium tuberculosis was not isolated in any patients three cases had complication including hemiparesis, seizure and facial paralysis. All the patients were treated with Isoniazid, rifampin, and streptomycin or pyrazinamide for 9 months.Conclusions: As a conclusion, in the endemic areas when a patient has an lymphocyter meningitis with an sub acute or chronic period, the physicians must have TB meningitis in mind too.

Background: Enterovirus 70 (EV70) and Coxsackievirus A24 variant (CA24v) are the etiologic agents of acute hemorrhagic conjunctivitis (AHC). The two viruses were isolated in early 1970s in Japan and Singapore, respectively. EV70 was responsible for two pandemics and several outbreaks worldwide affecting millions of people. CA24v has been responsible for several outbreaks of AHC especially in the Southeast Asian countries. Despite reports from Mediterranean region and Middle East there are no records of EV70 or CA24v infections in Iran. We conducted a serologic study to obtain such information.Material and Methods: Blood samples were collected from 66 donors in Tehran, Iran. Serum was separated under sterile conditions, stored below -20°C until shipped on dry ice to the Enterovirus Research Centre, Mumbai, India. LLC-MK2 and HeLa cell lines were used for testing samples for antibodies against EV70 and CA24v, respectively. Virus neutralization test was carried out in microtitre plates using serial two-fold dilutions of serum and 100TCID50 of the viruses. The highest serum dilution that neutralized the virus infectivity completely was taken as the titer of antibody in the serum.Results: 68% (44/66) sera showed presence of neutralizing antibodies against EV70. Individuals in all age groups showed presence of EV70 antibodies the youngest donor was 4 years old. There was no difference in proportion of anti-EV70 antibody positive samples among men and women. Interestingly, antibodies against CA24v were absent in all the 65 serum samples tested.Conclusions: Iranian population has been exposed to EV70 infections during recent years but not to CA24v. A systematic study of disease burden due to viral AHC in Iran is warranted.