Iranian Journal of Infectious Diseases and Tropical Medicine
Year:2007 | Volume:12 | Issue:37|Papers Count:20

Background and objective: Lamivudine (LAM) has been widely used as an effective antiviral agent for the treatment of patients with chronic hepatitis B (CHB) infection. However, the YMDD motif mutation of HBV polymerase resistant to LAM occurs frequently after long term therapy.Recent studies show that YMDD motif mutants occur as natural genome variability in patients with CHB who had not been treated with LAM before. In this study we aimed to determine the rate of the YMDD motif mutants in lamivudine-untreated CHB patients in Iran.Material and methods: A total of 77 CHB patients who had not been treated with LAM were included in study. Serum samples from patients were tested by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) for detection of wild-type YMDD motif mutants. All patients were also tested for liver enzymes, Hepatitis C virus antibody (anti-HCV), hepatitis Be Antigen (HBeAg) and hepatitis B e antibody (anti-HBe).Results: From 77 patients enrolled in study, 73% were male and 27% were female with mean age 27.4±9.3 years. Mean ALT and AST levels in them were 124.4±73.4 and 103.1±81 IU/L respectively. HBeAg and anti-HBe was positive in 40% and 60% of patients respectively. Anti- HCV was negative in all of them. The YMDD motif mutants were not detected in any of the patients in spite of liver enzymes levels and HBeAg or anti-HBe presence.Conclusion: Although natural occurrence of YMDD motif mutants in lamivudine-untreated patients with CHB had been reported, these mutants were not detected in Iranian lamivudineuntreated CHB patients.

Background and Objective: Cutaneous leismaniasis is one of the sisx important tropical diseases. In Iran, three species of Leishmaniahave been incriminated as the causative agents of human leishmaniasis - in order of epidemiological importance, Leishmania major, Leishmania tropica and Leishmania infantum. The objective of this research was to detect Leishmania species of mammals rather than previous reported from Iranian sandflies by using molecular tools.Material and methods: Using Nested PCR methods amplified two regions of the ribosomal RNA amplicon of Leishmania (ITS1-5.8S rRNA gene, and a micro satellite DNA region of ITS2), which were shown to be species-specific by DNA sequence or fragment size.Results: The PCR assays detected in Iranian sand flies not only Leishmania major but also for the first time L turanica and L. gerbilli sensu lato, two other parasites of the great gerbil. All three parasites were found in the northeast and centre of Iran, in two foci of rural Zoonotic Cutaneous Leishmaniasis (ZCL) caused by L. major. Fifty infections were detected in common sandfly species: at least seven geographically differentiated haplotypes of L. major in four-five species (Phlebotomus papatasi, P. caucasicus or the isomorphic P. mongolensis, P. sergenti and Sergentomyia sintoni); one strain of L. gerbilli s.l. in five-six species (the above plus P. ansarii); and one strain of L. turanica in one species (P.papatasi).Conclusion: Relative infection rates suggest that more than one of these sandflies might be the vectors of L. major (including P. papatasi, P. caucasicus and P. mongolensis) and L. gerbilli s.l. (including S. sintoni but excluding P. papatasi), but that only P. papatasi is likely to be the vector of L. turanica. This is further evidence for considering P. papatasi to play the key vectorial role in ZCL foci, given the importance of L. turanica for maintaining Leishmania infections in gerbils.

Background and objective: Cervical cancer is the second most common cancer after breast cancer among women worldwide. The association between certain Human Papillomavirus (HPV) and cervical malignancy is well documented, but the rate of HPV infection and HPV genotype distribution among Iranian women still are not well known.Material and methods: In this study 40 cervical tissue specimen with different degree of malignancy were obtained from women in Yazd province and the presence of HPV genotypes were analyzed.Results: HPV DNA was detected in 75% of specimens and DNA sequencing was revealed that the genotypes 16,18,33,45 and 73 were present. HPV 16 was the most frequently observed type (70%) followed by HPV 18(16.7%), HPV 45(6.7%), HPV 33(3.3%), and HPV 73(3.3%).Conclusion: HPV infection in Iran like the other parts of the world could be the most important risk factor for the development of cervical cancer and detection and determination of HPV genotypes in conjunction with the Pap smear might be a useful method for prevention and control of cervical cancers. In addition, determination of prevalent HPV genotypes in Iran could be utilized in production of suitable vaccines for the prevention and management of the cervical cancer.

Background and Objectives: Food borne infections are a significant public health problem. Intoxication due to toxin performed in the food is termed" food poisoning". Bacillus cereus is a major causative agent of food poisoning. The aim of this research was to investigate the food contamination caused by B. cereus on 500 samples including cream candies, grains, meat and different diary products.Material and methods: Three dilutions including 10-1, 10-2, and 10-3 of food samples were made then cultured on blood agar medium. Standard bacteriological methods were used for identification of bacterial isolates. Toxicity test was evaluated using cell culturing method.Results: Results showed that creamy candies were the most source of B. cereus (27%). The highest (15x104) and lowest (14x101) number of bacteria was associated to candies and sausage respectively.Conclusion: Different strains of B. cereus showed diverse ability of toxin production. The results obtained from current study indicated that Bacillus cereus is still an important causative agent of food contamination.

Background and objective: The objective of this study was collecting the documents of infectious, tropical and parasitic diseases published between 2001 till 2005 and creating the databank of infectious, tropical and parasitic diseases so that we could analyze the situation of the field of infectious diseases in order to set research priorities of infectious, tropical and parasitic diseases.Materials and Methods: First of all, the key words were specifed using ICD10 (International Classification of Diseases 10). Then the published articles on infectious, tropical and parasitic diseases were searched and retrieved in different databanks including PubMed, Scopus, Iranmedex, Iranmedline and Sid from 2001 till 2005. Moreover, presented articles in Congresses of Infectious Diseases and Tropical Medicine, approved research proposal of the university and internship and residency theses were collected. Finally, collected sources were classified based on their subjects.Results: The databank of infectious, tropical and parasitic diseases includes 510 (14.7%) articles in English, 798 (23%) articles in Persian, 2164 (62.3%) abstracts of articles presented in Congresses of Infectious Diseases and Tropical Medicine, 289 approved research proposal and 367 internship and residency theses of the university in previous five years (2001 till 2005). Totally, this databank includes 4128 documents.Conclusion: Collected documents present a general view of the total burden of infectious, tropical and parasitic diseases and its contribution in health, the burden of each disease among infectious, tropical and parasitic diseases, frequency of that disease, and complications, severity, trend and emergency of it in the country so that the persons who give scores to the research titles can devote suitable scores based on accurate and similar information without any bias.

Background and objective: Antibiotics are expensive drugs and critical in order to save the life of patients. Unnecessary usage of antibiotics causes treated failure and money lost for patients.The aim of this study was to determine the unused antibiotic and effects on treatment of patients and its problems come from antibiotic resistance bacteria.Material and methods: In this cross-sectional study which was carried-out in autumn 2004, the different antibiotic vials were collected from two different hospitals within 6 mounts one day a week. The amount of antibiotics in the 6 type of vials was measured. Moreover, the qualification level of injectors, the type of injections, the method of preparation, the volume of distill water as an solvent, the volume of antibiotics which remind in the vials and the time of injection after primary preparation were assessed. Furthermore, the results were analyzed using SPSS version 10.0.Results: From two hospitals 817 vials were collected within the period of times. The results of this study indicated that, firstly less than 4cc of distilled water was applied for solving of penicillin powders, secondly 4% of antibiotics powders remained unsolved in the vials and attached to the lateral top of vials. Thirdly in 37% of cases more them 1 ml of antibiotics solution were remained in the bottom of vials; fourthly, in 50% of cases more then 0.5 ml of solved antibiotics also remained at the bottom of vials. Finally, the situations were completely different when the vials were collected from orthopedic ward. In this ward only in 3% of cases 0.3 - 0.6 ml of antibiotic were remained.Conclusion: Antibiotics should be prescribed and taken sufficiently. Therefore if they are prescribed and taken in insufficient dosages, drug resistance and treatment failure will occur. Several factors have been found concerning inadequate doses of antibiotics. In this study, role of the personnel involved in injecting antibiotics has been considered one of the main factors of misusage of antibiotics and probably drug resistance. As results of this study show, in spite of the many education's and guidelines for prescribing manner of antibiotics are available, but occurrence of this problem is associated with treatment failure. Thus, for prevention of this problem in injection sections, following measures are recommended: usage of modem technology for makes the new vial and advanced education for Nurses and employing of personnel.

Background and objective: Frequency of Hepatitis G virus exposure in blood donors varies between 2.5% in Japan to 24.2% in Poland. Therefore there is a geographic difference in distribution of Hepatitis G virus (HGV) in the world. We aimed to determine the frequency of HGV exposure in Iranian blood donors.Material and methods: Blood samples from 478 Iranian volunteer blood donors were tested. Positive anti-E2 samples were tested for HGV RNA by RT PCR using primers derived from the NS5A region of the viral genome.Results: From 478 donors enrolled in our study, 5(1%) of them were positive for anti-E2. Co-infection of HGV with hepatitis B virus (HBV) was seen in 33.3% but we didn't find HGV and HCV co-infection in our subjects. HGV RNA wasn't observed in 5 anti-E2 positive subjects. We didn't find HGV viremia and antibody at the same time.Conclusion: Regarding to low frequency of HGV exposure in blood donors it doesn't seem that supervision and screening of blood donors will be necessary. We didn't observe co-infection of HGV with HCV in our subjects, supporting that although parenteral route is the most effective way, other routes such as sexual contact and intra familial contact may also play role in HGV transmission.  

Background and objective: To evaluate the conjunctival bacterial flora and its antibiotic resistance pattern in eyes of patients undergoing cataract surgery.Material and methods: From 2004 to 2005, 170 patients undergoing cataract surgery in the Ophthalmology department of Kermanshah University of medical sciences were prospectively evaluated. The patients with signs of ocular infection, external foreign body, use systemic or local antibiotic in past week were excluded. Conjunctival soap was obtained on the day of surgery before the application of topical anesthetic, antibiotic or povidone-iodine. Culture and antibiotic susceptibility tests were performed.RESULTS: Of the 170 patients 89 cases (52.4%) had positive cultures in of the eyes. In 79 eyes (88.8%) found coagulase-negative Staphylococcus. Staphylococ aureus was isolated from 7 eyes (7.9%), proteus from 2 eyes (2.2%), Citrobacter freundii from 1 eye (1.1%). Eighty two cases (95.3%) of isolated Staphylococcus were susceptible to Amikacin, 86 (100%) sensitive to ciprofloxacin and 42 (48.8%) sensitive to ceftazidim.CONCLUSION: This study showed that the bacterium most frequently found in the conjunctival flora of the patients undergoing cataract surgery was the CNS. Isolates of this bacterium had low susceptibility rates to caftazidim and vancomycin and high susceptibility to ciprofloxacin and amikacin.

Background and objective: There is a growing tendency to consume ready to eat chilled foods. Microbiological quality of these foods is considered by the health authority very important. Ready to eat chilled food such as potato salad implicated in food borne outbreaks. Food borne disease is mainly connected to poor manufacturing practices during production. A study was conducted to evaluate the microbiological quality of potato salad before and after implementation of Good Manufacturing Practice (GMP) and Good Hygienic Practice (GHP) in processing plant.Material and methods: Throughout the experiments, 146 samples were examined for total counts of aerobic bacteria (APC), counts of coliform organisms, counts of yeast and mould and for the presence of food borne pathogens (Salmonella, Staphylococcus aureus and Listeria monocytogene).Good manufacturing practice (GMP), personnel hygiene training, and appropriate cleaning and sanitation applied in potato salad processing plant. To evaluate effectiveness of application of GMP and GHP, 90 samples analyzed for the presence of food borne pathogens and indicator microorganisms after intervention.Results: Results of implementation of GMP and GHP indicated a lower incidence of studied microorganisms. All samples analyzed before intervention were free of Salmonella, but Staphylococcus aureus and Listeria monocytogenes isolated from 24% and 4% of samples respectively. The mean values for APC, coliform counts and yeast and mould counts were 9x103, 1.37x102 and 102 cfu/g respectively. All sumple collected after intervention were free of Salmonella, Listeria monocytogenes and Staphylococcus aureus. Mean values of APC decreased about 2.5 log cfu/g (up to 3x102 cfu/g). The mean values of coliform and yeast and mould counts were also decreased significantly to 3.3 and 0 cfu/g respectively.Conclusion: Implementation of GMP, training of personal hygiene, cleaning and sanitation procedures in addition to the rearrangement in the infrastructure of this establishment resulte a great improvement in potato salad microbial quality. Detection of food borne pathogem such as L. monocytogenes in ready to eat food is of great concern, as these products consume without further heat treatment. It is the duty of food regulatory organization to make sure of the safety of such a foods.

Background and objective: Enterococci are the second agent of UTI, the third agent of bacteremia and the second agent of hospital infections. In recent years, vancomycin has been considered as one of the most effective treatments for enterococcal infections. The rapid rise in the vancomycin-resistant entrococci (VRE) has also become a danger for public health. The use of wastewater for irrigation, in some cases, will increase the danger of rapid dissemination of the antibiotic resistant genes by enterococci. The aim of the present study was to determine different strains of enterococci in sewage treatment plants in Tehran, Iran, and their susceptibility to antibiotics.Material and methods: Samples collected four times from urban sewage treatment plant in Tehran between June 2005 and July 2006. Filtered samples were initially grown on mEnterococci medium containing 4mg/ml vancomycin. The isolates were identified by biochemical tests such as arabinose, argenine, growth at 45°C and NaCl 6.5%. All strains were then tested for their resistance against vancomycin, ampicillin, chloramphenicol, ciprofloxacin, erythromycin, tetracycline, streptomycin, amikacin and gentamycin and MIC were determined by microdilution broth test for vancomycm.Results: Of the 131 isolates resistance to 4 mg/ml vancomycin, 98 (75%) were identified as Enterococcus gallinarum, 24 (18%) as E. faecium and 9 (7%) as E. casseliflavus. There was a significant increase in the rate of resistance to all antibiotics (except chloramphenicol) among enterococci isolated during 2006 compared to 2005. Most of the samples were resistant to more than one antibiotic.Conclusion: The results showed that E.faecium and E. gallinarum were the most common species in the Tehran sewage treatment plant. E. casseliflavus showed the least prevalence. The results indicated that there was a significant increase in the rate of resistance to all antibiotics (except chloramphenicol) among enterococci isolated during 2006 compared to 2005. Our results may also suggest that the highly resistant glycopeptide E. gallinarum and E. casseliflavus in our study have captured plasmid containing resistant genes under natural conditions.

Background and objective: Tattooing is a risk factor for occurrence of viral infections. In order to determine the prevalence of viral infections in women who had a history of tattooing, this study was conducted.Material and methods: In this cross-sectional study, in a time period of 2 years from July 2004 to September 2006, a total of 63 women who had a history of tattooing were selected. They were the women, who fitted the selection criteria. These criteria included; having no history of vaccination against hepatitis B and no history of hepatitis, icterus, blood transfusion, blood let, surgery, injection drug use and no history of hepatitis in the husbands in married women. After recording the demographic data, blood sample was drawn from each case. Then sera were evaluated with ELISA method for HBsAg and anti-HBc (Kit Dia sorin bio-medica) and antibody against HCV and HIV. Positive samples for HCV and HIV were also confinned by western blot.Results: Among 63 cases with history of tattooing, 5 cases (7.9 %) were positive for HBsAg. Anti-HBc was seen in 33.3% of subjects. Two cases were positive for anti-HCV. HCV infection was confirmed by western blot in only one case. HIV test was positive in two cases. In recent group, one case had a history of immigration for one year to a neighbour country but this test did not confinn by western blot because she did not assist us for more evaluation.Conclusion: Although, the sample size was small, but upon present results, tattooing could be a potent risk factor for occurrence of infection.

Background and objectives: Dermatophytosis or tinea are the most common infectious diseases, that are cosmopolitan especially in tropical area. Among tinea, tinea capitis has a high endemic. It has been reported in different prevalence rate in Iran and all over the world. The aim of current research was to investigate disease severity and its distribution according to age, sex and detection the etiological agents.Material and methods: This investigation was carried out during 2003 - 2006 in fungal suspected patients who were referred to different diagnosis centers in Ahwaz city. Direct and culture examination were performed for all cases and etiological agents were diagnosed according to colony characterization, slide culture and supplementary tests for appropriate species.Results: Among 5312 fungal suspected cases, 1150 (21.6 %) had dermatophytosis infection and tinea capitis with 127(11%) cases were detected. Ectothrix infection with 88.19% was the most common type of tinea capitis followed by endothrix (9.45%) and favic type (2.36%). Trichophyton verrucosum with 71.65% was the most etiologic agent followed by Microsporum canis, Trichophyton rubrum, Trichophyton violaseum, Trichophyton schoenleini, and Trichophyton mentagrophytes. The disease was more common in male with 79.53% infection rate. Conclusion: Despite tinea capitis decreasing rate in comparison with last few years in our region, current study confirmed it existence in our area. Due to the high prevalence of zoophilic dermatophytes (71.65%) it seems that direct and especially indirect contacts play the most important role of disease distribution in the population area.

Background and objective: acute viral hepatitis is a form of inflammatory liver disease that destroys liver cells. Acute viral hepatitis is due to one of the 5 viruses: Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, and Hepatitis E. In the course of acute viral hepatitis, serum aminotransferases increases. Serum bilirubin level also increases that express sever liver malfunction. Objectives of present study are to assess probable connection between increase of liver enzyme level and degree of liver cell's necrosis and function in patients with viral hepatitis A, B, C. Materials and methods: in this study, 200 hepatitis A, B or C patients were selected, without any consideration to sex, ethics or age. Only patients with a history of hemolytic anemia, obstructive biliary disease or those with chronic hepatitis were excluded from this study. Every selected patients was first physically examined and the he/she was gone through a full laboratory tests of serum levels of aminotransferases (SGOT, SGPT), Alkalin phosphatase (Alk.P), LDH, Prothrombin time (PT), Billirubin (Bill) and WBC count.Results: In this survey, among 200 patients with viral hepatitis, hepatitis A; 21%, hepatitis B 57% and hepatitis C were 22%. Male to female ratio were 2.5/1. The dominant age groups of patients were 21-40 years old. The most increasing level of liver enzyme occurred in patients with hepatitis A. In these patients ALT and AST enzymes were in the range of 500-1500 IU. In the other hand, in hepatitis B patients the most increased level of total bilirubin were observed in the level of 20 mg/dl or more and prothrombin time in the level of 17 and upper.Conclusion: there was no connection between increased level of aminotransfrase and malfunction of liver. In spite of low increase of aminotransfrase in acute hepatitis B and C, the malfunction was more projected. In these cases, hepatitis cells in conjugating of bilirubin decreased. Production of coagulative system proteins is also decreased.

Background and objective: Nosocomial infection (NI) is one of the most important medical, social and economical problems creating factor, within developed and developing countries.Applying preventive measures and reducing the risk of infections in the obvious responsibility of nurses and nursing students (future nurses) in this concern the aim of this study is performed to compare the rate of knowledge of nursing student of midwifery and nursing department with nursing staff residing in Ham education of hospitals concerning NI control (2002).Material and methods: 116 Nursing students and staff Nurses were selected For descriptive analytical study by systemic sampling method. Data collected by questionnaires in two parts individual characteristics and questions about the awareness level is prepared.Results: The Findings showed that most staff personals (75.9%) and students (61.3%) had moderate knowledge about NI control and there was not significant relation. There was a significant difference between sex (staff and student) and knowledge level (p<0.001). There was a significant difference between knowledge rate average of student and staff (P<0.001).There was a significant difference between regular course student and part time (night) student (P<0.02), and vise versa for staff. There was a significant difference within Nursing student knowledge and year of study (P=000).There was a significant difference between nursing staff knowledge employed in different hospitals (P<0.01).Conclusion: Concerning importance of NI control and need to improve personal health it is advised for both students and staff need to be more instructed and continuous education.