مجله دانشکده پزشکی اصفهان
پیاپی 315 (هفته چهارم بهمن 1393)

Panton-Valentine leukocidin (PVL) is a Staphylococcus aureus gamma toxin. This toxin targets the outer membrane of polymorphnuclear cells, monocytes and macrophages. This toxin increases the cell membrane permeability that result degradation and necrosis of leukocytes. The aim of this study was to determine the frequency of PVL-positive Staphylococcus aureus and also, to determine antibiotic resistance of the isolates.

The total of 130 isolates were isolated and detected as Staphylococcus aureus during the period of 8 months in Alzahra Hospital, Isfahan, Iran. Then, polymerase chain reaction (PCR) method was used to detect PVL gene. The antibiotic susceptibility of all isolates to methicillin was determined using disk diffusion and agar screening methods.

Of 130 isolates, 61 (46.92%) were methicillin-resistant and 69 (53.08%) methicillin-susceptible Staphylococcus aureus isolates (MRSA and MSSA, respectively). We found that 23.08% of isolates (30/130) were positive for PVL; of them, 11 (36.33%) were of MRSA and 19 (63.67%) were of MSSA isolates.

Despite the existence of PVL genes in MRSA isolates, MSSA isolates can also play an important role in the dissemination of this gene. Since, PVL toxin producing strains of Staphylococcus aureus are of serious threat for health, rapid and accurate detection of gene is necessary. So, it seems that achieving a rapid and repeatable method for medical centers, will help the timely diagnosis and control of PVL-producing strains.

Tuberculosis (TB) has been remained as a major health problem. The most commonly used diagnostic tool for TB is a simple skin test. However, it has some disadvantages and it`s specificity can be compromised. Hence, detection of Mycobacterium tuberculosis specific antibodies in human sera has been considered as an important diagnostic test. In this study, humoral immune responses against recombinant CFP-10 protein of Mycobacterium tuberculosis in 51 patients with TB and 39 healthy subjects were evaluated using indirect enzyme-linked immunosorbent assay (ELISA). From 51 positive serum samples, 47 were positive and from 39 negative serum samples, 33 showed negative results. In this study, sensitivity and specificity of test were 92.15, 84.61 percent for dilution of 1:10 and 64.70 and 97.43 percent for dilution of 1:100, respectively. Accordingly, the estimated cut-off point was 0.351 and. 025 for dilutions of 1:10 and 1:100, respectively. Our data suggested that the levels of antibodies against CFP-10 antigens in patients with TB were significantly higher than those in healthy subjects. This study demonstrated that ELISA with the use of the CFP-10 recombinant antigens is simple and sensitive and can be used to analyze large numbers of samples for the serodiagnosis of TB.

Brucellosis is a zoonosis infectious disease and endemic in Iran. The certain diagnosis of disease is established on isolation of brucella from blood and other clinical samples. So, because of fastidious nature of this organism and problems in its isolation by conventional methods, and attending to the high prevalence of brucellosis in Kashan, Iran, the BACTEC9050 blood culture system was used in this survey for diagnosis of brucella bacteremia; advantages of this method has been discussed, too.

In this descriptive research, the blood samples of 206 patients suspected to brucellosis were studied in Brain-Heart Infusion (BHI) broth and BACTEC9050 blood culture system simultaneously.

In a period of 5 days, from 206 samples, totally 50 cases were positive; 32 cases were positive in both methods and 18 cases were positive only in BACTEC method. Continuing the incubation, 14 cases became positive but 4 cases were negative, even after 30 days of incubation. The average incubation period for specimens to become positive was 4 days.

The BACTEC automatic system reduced the examination process, and economized the time and the material. In cases that this system is not available for diagnosis of brucella, it is recommended to keep the final subcultures in 37°C for 1 month to get better diagnostic results.

Isfahan province is one of the common foci of the cutaneous leishmaniasis in Iran, particularly the wet or rural zoonotic cutaneous leishmaniasis (ZCL). Due to the lack of information about the epidemiology and prevalence of cutaneous leishmaniasis in Isfahan province, Iran, this study was designed. Data were collected from the recorded data of patients with leishmaniasis referred to Isfahan Province Health Care Center, Isfahan, Iran. The patients were diagnosed by direct microscopic examination of the samples. Data concerning demographic features, the number and location of lesions, duration of disease, area of residence, work location, the history of travel within the past two months, address, and telephone number of the patients was collected. The epidemiological status of leishmaniasis was determined from the recorded data. In total, data of 28315 patients with leishmaniasis during 2001 to 2011 were studied. Among them, 10809 (38.2%) patients were women and 17491 (61.8%) were men. The mean age of the patients was 22.40 ± 16.52 years (range: 1-100 years). The incidence of lesions was 12.1% in face, 12.3% in hands and legs, 4.5% in face and hands, 24.1% in legs, 32.3% in hands and 11.5% in the other parts of body. 12163 patients (43%) had one, 6330 (22.4%) had two, 503 (8.1%) had three, and 8008 (28.3%) had more than three lesions. Overall, 17883 patients (63.2%) lived in urban areas and 8241 (29.1%) in rural areas and most of the cases were seen among those who lived in cities and urban areas. Considering the high prevalence of cutaneous leishmaniasis in the Isfahan province, eliminating the leishmaniasis vector and its reservoirs in this endemic area seems to be necessary. During the years, it has been showed that leishmaniasis is endemic in Isfahan province; hence, a more extensive epidemiologic study is recommended.

Foot ulcer, with a prevalence of 15% in general population, is one of the main complications in patients with diabetes. So far, different therapeutic methods have been provided for the treatment of foot ulcers. When no response to the standard treatment methods is observed, other methods would be applied.Case Report: In this report, we introduce two men with type 2 diabetes mellitus and recalcitrant diabetic foot ulcer who were treated with topical 50% trichloroacetic acid solvent and autologous fibroblasts. The treatment resulted in complete healing of foot ulcers in both patients. Trichloroacetic acid and autologous fibroblast can be considered as therapeutic choice for recalcitrant diabetic foot ulcer.