Iranian Journal of Infectious Diseases and Tropical Medicine
Year:2007 | Volume:11 | Issue:35|Papers Count:23

Background and objective: Non-Melanoma skin cancer (NMSC) is the most common malignancy among Caucasians all around the world. Previous research on NMSC has led the scientists to Human Papillomaviruses (HPVs) as a viral cause. More than 100 types of HPV have been identified up to now and the role of certain types has been confirmed in carcinoma of cervix, but a similar role in skin cancer has not well established so far. The aim of this study was to determine the prevalence of different types of HPV in NMSC lesions in north of Iran. Material and methods: 136 NMSC and 139 non-cancerous paraffin embedded skin biopsies were collected from pathology labs from north part of Iran, where NMSC has the third position among other malignancies. PCR was performed using FAP59/68 primer set, which has high sensitivity for cutaneous and acceptable sensitivity for mucosal HPV types. Positive specimens were directly sequenced and compared with the reference sequences in GeneBank for genotype identification.Results: HPV-DNA was detected in 26.5% and 9.4% of NMSC and non-cancerous specimens, respectively. HPV types 4, 5 16, 18, 19, 20, 21, 23, 36, 48 and 56 were identified. A significant relationship was found between HPV16 and HPV18 (mucosal types) and NMSC (P=0.000, Odds Ratio=29.14, confidence Interval: 3.4-245.9), whereas a similar relationship was not found for cutaneous HPV types.Conclusion: Mucosal HPV types that are considered as "high-risk" in cervical cancer might play a significant role in development of NMSC.

Background and objective: OPV has been used in immunization programs in I.R. of Iran. Polio Eradication Initiative has been started in the country with National Immunization Day in 1994 and achieved for disruption of wild polio virus circulation since late 2000. However use of OPV is associated with some adverse events, including vaccine associated paralytic poliomyelitis, which is more common in immunodeficient cases. This is a case report of paralysis induced by Vaccine Derived Polio Virus in an immunodeficient patient.Case presentation: The patient was a case of severe combined immunodeficiency suffered lower limb paralysis due to VDPV-2 at 7 months old age. Unfortunately he died five months after detection by acute flaccid paralysis surveillance system at result of immunodeficiency and bulbo-cerebral poliomyelitis.Conclusion: Many developed countries use IPV while the most of developing countries have to use OPV for routine immunization programs. The potential for VDPV to circulate in populations with low immunity to poliovirus and appearance of chronic VDPV excretors have important implications for current and future strategies to eradicate polio worldwide.

Background and objective: Pseudomonas aeruginosa plays a prominent role in serious infections in burn patients. Quick acquisition of multi-drug resistance leads to the high morbidity and mortality especially in burn centers.Material and methods: Ten antibiotics which were widely administrated in our burn patients were selected. MICs for imipenem, mropenem, cefepime, ceftazidime, cafuparazone/sulbactam, ticarcillin/clavulanate, piperacillin/tazobactam, ciprofloxacin, tobramycin and amikacin to 70 strains of P. aeruginosa which were isolated from burn patients were determined by the E-test method (AB biodisk, Sweden). Extended-spectrum b-lactamase, group I inducible b-lactamases and metallo-b-lactamase activities were also determined.Results: Imipenem and meropenium were the most in vitro active antibacterial agents followed by ciprofloxacin (p<0.05) whereas, ticarcillin/clavulanate was the least active antibiotic. Almost all (98-100%) of the resistant isolates also showed cross-resistance to cefepime. The majority of imipenem and meropenem resistant isolates (85-100% & 76-100%) demonstrated cross-resistance to the rest of antibiotics. ESBLs were detected in only 3 (4.3%) isolates, whereas inducible b- lactamase was observed in 8 (11.4%) isolates. Metallo-b-lactamase was detected in none of the isolates.Conclusion: Almost all of the antibiotic resistant isolates also showed cross-resistance to the majority of penicillins and cephalosporins with or without b-lactamase inhibitors, from which ticarcillin/clavulanate demonstrated this phenomenon at the highest level.

Background and objective: Needle stick injury (NSI) is a risk in some occupations. With attention to high prevalence of viral hepatitis in general population in our country, NSI is able to transmit of this virus in society. Furthermore, because of straight exposure to rubbish, cleaner are more susceptible to this risk. The aim of this study was determination of prevalence of NSI and its risk factors in Tehran manipulators personnel.Materials and methods: This was a cross sectional study. 3127 subjects were selected from personnel of Tehan manipulator organization in 2005(1384). All subjects were assessed for demographic data, hepatitis risk factors and health history. Result: From all subjects, 15 persons (0.5%) had history of NSI. NSI was more prevalent in cleaners (16.2%) than non cleaners (0.2%) (P=0.001). Prevalence of NSI was higher in subjects who were less educated (P=0.030), with previous icter (P=0.01), self report of hepatitis (P=0.001), history of hepatitis in relatives (P=0.001) and history of liver diseases in relatives (P=0.004). There was no significant correlation between NSI and age (P=0.863), sex (P=0.980) and smoking history (P=0.356).Conclusion: Cleaners are at a higher risk of NSI (relative risk=81). This study showed that low education is a risk factor for NSI. Higher Previous history of icter, self report of previous hepatitis, history of hepatitis in relatives and history of liver diseases in family member may be causes of infection with viral hepatitis in these subjects that needs further study. On the basis of this study, more attention to put off sanitary rubbishes, education of persons at higher risk of exposure and screening programs seems to be necessary.

Background and objective: Acute bacterial sinusitis (ABS) is an acute infection of the paranasal sinuses and nose most commonly caused by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. In this study was compared the efficacy and safety of azithromycin (AZM) regimen, to the efficacy and safety of an amoxicillin-clavulanate (AMC) regimen.Material and methods: A total of 80 subjects (male 60%,female 40% ,mean age 32.7 years) 8 years of age or older with clinical diagnosis of ABS of sinuses upon entry into the study. Diagnosis was confirmed by the presence of either purulent nasal discharge or facial pain and/or pressure and/or tightness & X rays positive of sinuses. These patients were treated by azithromycin and coamoxiclave.Result: Clinical success rates were at the end of therapy (AZM-5, 37.5%; AMC, 72.5%). Subjects treated with AMC reported a higher incidence of treatment-related adverse events (17.5%) than AZM-5 (5%), P<0.001. Gastrointestinal discomfort was the most frequent treatment-related adverse effect.Conclusion: Result of this study demonstrated that AZM provides a better safety profile and better compliance than AMC for the treatment of ABS . Furture investigations of ABS treatment may require with longer duration or higher dose of AZM.

Background and objective: Previous vitamin D3 deficiency has effect on the induction and development of patients infected with M. tuberculosis to tuberculosis. Material and methods: In this case- control study, 45 patients with tuberculosis were selected. Forty five age, sex, and season-matched volunteers without past medical history of tuberculosis or chronic cough were selected. All patients and control groups were evaluated by measurement the level of vitamin D3 by RIA (radioimmunoassay) method. All results were analyzed by t-test and analyze & variance in spss11.1.RESULTS: The mean and SD of the level of vitamin D3 were (M=12.25, SD=9.98) and (M=24.68, SD=19.22) (P=0) among patients and control, respectively. Thirty nine (86.66%) patients and 26 (57.77%) controls had level of vitamin D3 below 20ng/ml. Twenty eight (62.22%) patients had tuberculosis in warm seasons. (Summer, P=0.007) & (fall, P=0.02) & (winter, P=0.08).CONCLUSION: There was significant association between previous vitamin D3 deficiency and tuberculosis. Also, tuberculosis was frequently occurred in warm seasons.

Background and objective: Haemophilia and thalassemia patients are at risk of acquiring hepatitis C virus infection. The rate of HCV infection and risk factors were evaluated among anti-HCV positive haemophilia and thalassemia patients in Isfahan.Material and Methods: Serum samples of 103 anti-HCY positive haemophiliacs and thalassemics were tested by nested RT-PCR.Results: 60% and 58% of anti-HCV positive haemophiliacs and thalassemics were HCV RNA positive respectively. Positivity for HCV RNA had no correlation with the type of disease (haemophilia or thalassemia) and the mean age of the patients. The rate of HCV infection in patients received blood or blood products from Isfahan province were 20% of those who frequently received blood or blood products from Isfahan or other provinces. In haemophiliacs, the rate of positive HCV RNA was significantly higher in male than in the females (p<0.03). A 2.6 folds increased frequency of HCV RNA was observed in patients treated by interferon and ribavirin for one year compared to patients treated for a period of 4 to 6 months.Conclusion: Our study reports a lower prevalence compared to western countries, where the widespread use of clotting factor concentrates began before the availability of inactivated products. Viral genotyping is necessary for effective treatment of infection and understanding the molecular epidemiology of HCV.

Background and objective: A wide range of skin problems can be seen in AIDS. Presence of the skin lesions in AIDS patients can be regarded as a good index for assessment of the immunologic and psycho logic status of the patients. This study deals with skin problems in HIV positive patients referring to HIVIAIDS counseling center in Sanandaj in 2005-2006. Material and Methods: This is a cross sectional descriptive- analytic study. The method of sampling was census and 74 HIV positive patients from HIV/AIDS counseling center and the city jail took part in our study. Dermatologic exam and diagnosis of the skin lesions were made by the dermatologists of the medical school of Kurdistan university.Results: 74 patients, 71 males and 3 females with the mean age of 34.47 (±7.7) years participated in our study. 68 (91.9%) patients had at least one dermatologic disease. The mean number of skin diseases was 2.46 (±1.79). The most abundant skin manifestations were absence of the nail lunula in 73 (9806%), gingivitis in 60 (82.4%), pallor of the nail bed in 38 (51.4%), purities in 30 (50.5%), photosensitivity in 26(3501), seborrheic dermatitis in 24 (3204%), oral candidiasis in 23 (31.1%) and folliculitis 22 (29.7%) patients. There was a significant relationship between age of the patients and the number of skin diseases. We noticed a decrease in diversity of skin diseases by increasing age (p<0.0001).Conclusion: According to the results of our study and other studies we conclude that the prevalence of skin problems in HIV positive patients is high. Several skin diseases are contagious and are important in view of public health care. Therefore we recommend regular skin examination in HIV positive patients.

Background and objectives: The objective was to investigate frequency of common nosocomial infections and the antimicrobial resistance among some of nosocomial gram negative bacilli isolated from patients admitted in Intencive Care Units in Sina and Imam Hospital in Tehrani Iran.Material and methods: From June 2004 to Decemeber 2005, 286 isolates of common gram negative bacilli (Klebsiella, Pseudomonas, Acinetobacter and E. coli) from 186 patients with nosocomial infections in Sina and Imam Hospitals were evaluated for the activity of imipenem, cefepime, ciprofloxacine, ceftriaxone and ceftazidime by E-Test methods. Results: The most common infections were: primary septicemia (34.6%), pneumonia (27.6%), and urinary tract infection (15.7%). The most fequent pathigens were Klebsiella spp (42 %), followed by pseudomonas (26%), Acinetobacted Spp. (19%), E Coli (13%). The most active antibiotic was Imipenem (85%). Studied microorganisms were 23% sensitive to Cefepime, 23% to Ciprofloxacin, 18% to Ceftazidime and 10% to Ceftrixone. The suseptibility rates of Klebsiella to Imipenem, Cefepime, Ciprofloxacin, Ceftazidime and Ceftrixone were 93, 21, 20, 10 and 5 percent; respectively. Likewise, these rates were 89, 22, 17, 25 and 25 percent for E. coli. Among Acinetobacter spp. susceptibility rate was 78% for imipenem and 18% for ceftazidime and cefepime and 22% for ciprofloxacin. Among Pseudomonas spp. the rate was 73% for imipenem and 32% for ciprofloxacin and 31% for cefepime and 27% for ceftazidime. Resistance to 3 drugs was 66%. Conclusion: The antibiotics resistance among gram negative bacilli has increased, so antibiotic policy is urgently needed in order to delay the resistanse development.

Objective and background: Tuberculosis (TB) is one of the most common infection diseases through the word. Diagnosis of TB in most cases is difficult and often needs Para clinical studies. Measuring immunoglobulin against A-60 antigens of TB microorganisms is one of these methods. This study's aim is analyzing of diagnostic value of serologic tests (lgA, IgM, IgG) against A-60 antigen in tuberculosis.Material and Methods: All of the cases with pulmonary and extra pulmonary tuberculosis were tested and IgM, IgA and IgG against A-60 antigen were measured. These immunoglobulin also were measured in control group without any disease. Cases group included 176 patients (124 patients with smear positive pulmonary TB and 52 patients with extra pulmonary TB). Control group Included 283 people without any obvious disease. Results: Sensitivity of IgM, IgG and IgA tests was 15%, 25%, 40% and their specificity was 100%, 75% and 90% receptivity. Positive predictive value (PPY) was 100%, 57% and 72% and negative predictive value (NPY) was 65%, 72% and 70% respectively. Combination of immunoglobulins increased sensitivity; the highest sensitivity was observed in combination of IgG and IgA.Conclusion: This study revealed that ELISA method in measuring Immunoglobulins is useful. Although its sensitivity is not high, but with combination of Immunoglubolins sensitivity is acceptable.

Background and objective: Pregnancy is an important period for both mother and fetus. Some infections such as CMV, Toxoplasmosis, and Hepatitis B&C can induce unwanted complication such as mortality, morbidity and fetal or congenital malformations. Screening programs before pregnancy have a great role in diminishing these problems.Materials and methods: In this retrospective study we studied all serologic results of patients attending to Avesina Infertility Clinic Lab during Mehr to Esfand 1383(2004-2005). Serologic results, age and sex of patient were analyzed by T and chi square tests. Results: 97.9% of women and 100% of men had CMV antibodies. The most CMV seroprevalence was seen in 14-19, 40-44 and 45-49 year old women. We found 2.7% CMV IgM positive results mostly in 35-39 year old women. In women 16.8% showed Toxo IgG positive mostly in 45-59 year old group and 2.4% showed Toxo IgM positive results mostly in 14-19 years old group. 21.1% of women and 26.8% of men had antibodies against Hepatitis B with most positively over 50 years old patients. There was a significant relation between age and HBsAb seropositivity. We found HBsAg seropositivity in 2.4% of women and 3.1% in men. There was a significant relation between age and HBsAg seropositivity. 0.4% of men were HCV Antibody positive but none of women.Conclusion: Based on the results it seems that screening women before pregnancy for CMV and Toxoplasmosis is highly valuable. Diagnosis and treatment of Toxoplasmosis during early stages of pregnancy is important in reducing prenatal transmission and its complications. Screening pregnant women for HBsAg is valuable because available prophylactic attempts can reduce prenatal transmission rate from 25-30% to 2-5% which is obviously considerable.So we recommended theses screening should be added to primary health care programs for pregnant women to reduce congenital infections and their adverse outcomes.

Background and Objectives: Vibrio parahaemolyticus is one of the important bacterial pathogens for human by contamination of different seafood. The aim of this research was to investigate the bacterial contamination of pool waters and various fishes caused by Vparahaemolyticus.Material and methods: One hundred-ten samples including 50 and 60 samples obtained from pool water and various fish species, respectively, were' studied for contamination by V. parahaemolyticus. Standard bacteriological methods were used for identification of bacterial isolates and antimicrobial resistance testing.Results: v. parahaemolyticus contamination was not detected in pool water samples however were detected in 3 fish samples. Antimicrobial susceptibility testing showed all of the isolated strains were susceptible to chloramphenicol, cephalothin and resistant to ampicillin, streptomycin, and nalidixic acid.Conclusion: The results obtained from current study indicated that V. parahaemolyticus is still an important causative agent offish contamination in the country.

Background and objective: Nosocomial infections as a serious health problem are responsible for the increased morbidity and mortality in the hospitals. The purpose of this study was to determine nosocomial infections among patients admited in Baqyiatallah hospital during one year of period.Material and methods: The study was conducted prospectively during a period of 12 months from March to February 2005 Baqyiatallah hospital in Tehran, Iran. All patients who were hospitalized with no signs and symptoms of infection before the first 48 hours of hospitalization and presenting signs and symptoms of infection after 48 hours of hospitalization, were included in this study.Results: The prevalence of nosocomial infection during this study period was 3.9%.The most nosocomial infections were belonged to intensive care unit (ICU). The most prevalent organism was Staphylococcus aureus (41%) followed by Pseudomonas auroginosa (20.7%). The most nosocomial microorganisms were isolated from samples obtained from lower respiratory tract (43.6%) and wounds (35.3%).Conclusion: Nosocomial infections rate in current study was lower than those reported by other researchers; however, the most prevalence of nosocomial infections were observed in ICU and among the patients with more than 50 years of ages. There is a need to develop of preventative the appropriate strategies in order to prevent the spread of nosocomial infections.

Background: Hepatitis G virus (HGV) is a blood-borne virus. Some data demonstrate an occupational risk of HGV infection in dialysis staff. The presence of HGV envelope protein E2 antibody (anti-E2) testifies past HGV contact. The aim of this study was to detection of HGV anti-E2 in dialysis staff.Methods: This study was undertaken in a dialysis unit in Tehran. In 27 dialysis staff, presence of HGV anti-E2 was detected by an ELISA assay and compared with 77 hemodialysis (HD) and 13 continuous ambulatory peritoneal dialysis (CAPD) patients. All of the subjects were also screened for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and hepatitis C antibody (anti-HCV).Results: HGV anti-E2 was not found in any of dialysis staff (0%). The frequency of HGV anti-E2 was 3.89% and 0% in HD and CAPD patients respectively .The Frequency of anti-HCV and anti-HBs in staff was 0% and 33.33% respectively.Conclusion: We didn't find HGV anti-E2 in dialysis staff in our study. So occupational risk for HGV exposure was minimal in our investigation.

Background and objective: Echerichia coli (E.coli) a coccobacillus from enterobacteriaceae family causes different diseases in human, and is the most common gram- negative bacterium, causing urinary tract infection. It can also produce bacteremia, gallbladder and billiary tract, gastrointestinal and wound infection. Although E.coli is known as an antibiotic- sensitive bacterium, it's resistance has been increased during past decade.Material and methods: This study was performed on 1042 positive cultures for E.coli at four laboratories: Shahid Rahnemoon hospital (Yazd), Afshar hospital (Yazd), Ziaie hospital (Ardakan) and central laboratory (Meibod). Data was collected by completing the questionnaires which then analyzed by SPSS software, using chi- square and extended fishers exact test.Results: In this study, sensitivity of E.coli was at the highest rate to ciprofloxacin (89%), ceftriaxone (86.6%) and chloramphenicol (76.1%), and the highest rate of resistance was to vancomycin (93.1 %) and ampicillin (65.2%). In this survey, the sensitivity rate of samples was different according to the geographic area and clinical isolates. Conclusion: Pattern of antibiotic resistance was different in different areas and clinical samples and this subject requires further studies in the future.

Background and objective: The first case of HIV recognized in twenty years ago in Iran and at this time 12500 of patients was reported. Update of knowledge, attitude and practice of nurses can help to prevent of HIV transmission to them. Aimed of this study was evaluation of these subjects and education effect to it in nurses. Material and methods: This is an observational cross-sectional study that conducted in 115 of nurses in baqyiatallah medical university hospitals with random sampling in available in Tehran in 2006.Knowledge, attitude, way the acquisition of information and the best way for education in the future for HIV were evaluated with questionnaire in four sections. Relation of Knowledge and attitude was evaluated with age, sex, married, literacy level and long time in service. Three group were evaluated, one; with classroom education in baqyiatallah hospital, two; education with especial paper in Najmieh hospital and three; without intervention in Jamaran hospital. Data was analysis in SPSS 13 program and T test and ANOVA was used and p<0.05 was significant. Results: In this study showed that 52.5% and 47.5% were women and men in respectively. The mean age was 34.4±6.4 SD years. The most common education level was licentiates' degree in 89.7%, history of in service was 9.7±4.7 years and 58.9% were married. This study determined that knowledge scale in 46.5%, attitude in 49% was weak and less. After education knowledge was increased in 61.4% in Najmieh, 28% in baqyiatallah and34.6% in Jamaran hospital. Attitude was increased in 47.4% in Najmieh, 59.4 in baqyiatallah and 42.3% in Jamaran hospital. Demographic information was not significant associated with level of knowledge and attitude except literacy level and knowledge about HIV and AIDS (p=0.01). Conclusion: this study showed that the main level of knowledge and attitude of nurses was not acceptable, but after education especially knowledge with paper, attitude with education in classroom was increased. Therefore update education and renewal of it was necessary and should be considered for nurses.