Archives of Clinical Infectious Diseases
Volume:4 Issue: 3, Jun 2009

Infective endocarditis is one of the most important complications of injection drug use, which is associated with significant mortality and morbidity. The aim of this study was to evaluate the influence of vegetation size and localization on outcome and in-hospital mortality of infective endocarditis.Patients and A total of 34 patients were admitted to a university hospital in a four-year period and analyzed prospectively. Injection drug users were defined as patients who had injected drugs intravenously within the past 3 months before admission. The diagnosis of infective endocarditis was made on the basis of modified Duke‘s criteria. Totally, 38 episodes of endocarditis in 34 patients were identified. Patients were all male with the mean (± standard deviation) age of 30.4±7.1 years. The affected valves were as follow: tricuspid valve in 26 cases (74.3%), mitral valve in 4 (11.4%), mitral and tricuspid valve in 4 (11.4%), and mitral and aortic valve in 1 (2.9%). The vegetation size was 10mm or less in 12 cases (34.29%), and more than 10mm in the remaining 23 cases (65.71%). Eight patients (21.1%) underwent surgery, however, unfortunately, nine (23.7%) died. Vegetations sized more than 10mm (

The annual risk of tuberculosis (TB) in Iran is about 0.5% with annual incidence rate of 23/100000 (16322 cases). Different factors have been postulated as TB predisposing factors. Several studies have linked smoking with pulmonary tuberculosis as the TB incidence in their adult men was 2.4 times higher than women. In Iran, however, this ratio is equal and somewhere the ratio in women is greater. We decided to carry out a case control study in order to evaluate the effect of cigarette smoking on pulmonary TB.Patients and A case-control study was achieved in health care centers of Mazandaran province (affiliated to Mazandaran University of Medical Sciences). Participants were men aged 15 years and older who were enrolled in health care centers with the diagnosis of active pulmonary tuberculosis. One hundred men (aged 15-85 years) with bacteriological TB (smear or culture positive) were selected as cases and 300 age-matched men without TB were selected randomly as controls. Information on smoking status, quality of tobacco smoked and duration of cigarette smoking and also the age at which smoking was first commenced were collected by a questionnaire. Smokers were 2.1 times more likely to develop pulmonary TB (OR=2.10, 95% confidence interval

Staphylococcus aureus is a major pathogen in hospital setting and in the community and causes a wide range of diseases. MRSA infection has recently become a serious problem in anti-microbial chemotherapy. The aim of the study was to detect and analyze the antibiotic diversity and isolation of methicillin resistance gene (mecA) of S. aureus isolated from Tehran hospitals as a rapid and reliable method.Patients and We studied 585 isolates of staphylococcus spp. recovered from patients at 3 clinical centers in Tehran from October 2005 to October 2006. Antibiotic susceptibility test of isolates was achieved with 13 antibiotics by disc diffusion. The MIC of methicillin was also performed by broth micro dilution assay. PCR was used for detection of mecA gene. Totally, 321 (54.7%) isolates were identified as S. aureus. 66, 65, 88, 88, 100, 41, 38, 41, 0, 40, 93, 20 and 64% of S. aureus isolates were resistant to kanamycin, cephotaxim, methicillin, oxacillin, ampicillin, erythromycin, clindamycin, sulphamethoxazole-trimethoprime, vancomycin, chloramphenicol, ciprofloxacin, gentamicin and tetracycline, respectively. All MRSA and 63% of intermediate isolates carried mecA gene. In contrary to other studies in Iran, the prevalence of methicillin resistance is rising up in Tehran and most of MRSA isolates were resistance to 5 antibiotics at least. Vancomycin, chloramphenicol, gentamicin and clindamycin are the most effective antibiotics. All MRSA isolates had mecA gene with different expression. Detection of mecA gene is a rapid and reliable method for identification of MRSA isolates.

Recently Cryptosporidium has gained much attention as a clinically human pathogen in immunocompromised cases and young children. This study investigated frequency and risk factors related to cryptosporidiosis in under 5–year old children.Patients and Stools were examined by ELISA method to detect Cryptosporidium surface antigen (CSA) using Remel Prospect Cryptosporidium (monoclonal) Microplate Assay. Stool samples were collected from children at admission and were kept at –70ºC until examination. Data were collected by a standard questionnaire and analysed in Epi info 2002 software. Of 171 children, 8(5%) were infected with Cryptosporidium. Most of the cases (6 cases) aged 2-12 months. Boys were more frequently infected than girls (p

Hepatitis C virus (HCV) is a major cause of chronic liver disease worldwide. The role of intra familial HCV transmission is still controversial. The aim of the present study is to determine intra familial transmission (sexual and non sexual contacts) of HCV in a group of Iranian population.Patients and In this historical cohort study, 270 first degree relatives of hepatitis C patients were enrolled as the exposed group and compared to 270 first degree relatives of normal subjects (with negative HCV) as the unexposed group. Antibodies to HCV were detected by commercially available fourth-generation enzyme immunoassay. Positive serum specimens were retested using a second generation recombinant immunoblot assay. Fisher''s exact test was used to detect association between the exposure and out come of the study. The mean age of exposed group was 27.1±19.8 years and 38.1% were male. The mean age of unexposed group was 29.4±16.7 years and 51.9% were male. Regarding gender, age, familial relation and condom use, there were not statistically significant differences between exposed and unexposed subjects. Only 2 HCV-infected subjects were detected in the unexposed group, both of whom were intravenous drug users. The frequency of positive HCV antibody among household contacts of two groups was not significantly different (NS). Our results revealed that house hold contact transmission of HCV is not a significant transmission route and sexual transmission does not seem to play a role in the intra familial spread of HCV infection.

Infections caused by Shigella are a major cause of diarrheal disease in the developing and developed countries. The present study was conducted to apply and evaluate arbitrarily primed PCR (AP-PCR) for investigation of genetic relatedness among the strains of Shigella sonnei isolated from cases of acute diarrhea in Tehran.Patients and Totally, 60 S. sonnei strains isolated from children hospitalized due to enteritis at five hospitals in Tehran during 2003 and two sporadic isolates recovered in 1984 were investigated. Molecular typing was performed by AP–PCR. Depending on the number and size of amplified DNA bands, the strains were clustered into AP–PCR profiles. All strains of S. sonnei were typeable with this approach. AP–PCR generated nine indistinguishable bands ranged from 0.35 to 2.5 kbp in all studied strains. Only a single AP-PCR pattern was observed among the S. sonnei strains recovered in 2003. Two sporadic isolates recovered in 1984 showed different AP-PCR patterns compared to recent clinical isolates. Results suggest that a very homogeneous AP-PCR cluster types might be responsible for shigellosis caused by S. sonnei in Tehran in 2003. Further molecular analysis conducted on a larger selection of isolates could confirm our findings

Diagnosis of pulmonary tuberculosis in patients with negative smear result or sputum culture and patients who are unable to produce sputum requires other tough techniques. This study compares the smear and culture results obtained by induced-sputum as a non invasive method with samples taken by bronchoalveolar lavage (BAL). Patients and A total of 82 patients subjected for bronchoscopy were enrolled. They had 3 negative sputum samples, or were unable to produce sputum. Induced-sputum specimens were taken from all patients before performing bronchoscopy. A total of 18 BAL culture samples were positive, among whom 16 had positive culture in induced-sputum sampling (kappa test: 0.92, p=0.0001). There was a significant relation between radiologic findings and smear and culture results. Induced-sputum is a non-invasive method when compared with BAL. It is a reassuring alternative of BAL which is a semi-invasive and expensive approach. If the radiologic findings are compatible with pulmonary TB, possibility of positive induced-sputum samples can be increased.

The effect of pyocyanine pigment, which was isolated and purified from Pseudomonas aeruginosa, on specific lymphocytes viability inside the body of white male Balb/c mice against the experimental secondary hydatidosis and the infectivity of protoscolices was studied in comparison with negative control mice groups, phosphate buffered saline (PBS) and positive control group (immunoferon). Four groups of male Balb/c mice were intraperitoneally (IP) inoculated with four purified concentrations of pyocyanine (25, 50, 75, 100mm/ml). Seven days later, they were given the same concentrations as a booster dose of the pigment, then 7 days later they were intraperitoneally infected with 2000 protoscoleces /mL (PBS) as a challenge dose. The fifth group was intraperitoneally inoculated with 1ml of sterile PBS and used as a negative control group, while the sixth group was intraperitoneally inoculated with 100µmg/ml immunoferon and received the challenge dose of 2000 protoscoleces/ml PBS and served as the positive control group. The concentrations of 50, 75 and 100mm/ml of this pigment had suppressive effect on these specific immune response cells. This effect was statistically significant (

Pneumonia in ventilated intensive care unit (ICU) patients is one of the most serious nosocomial infections with a frequently fatal outcome. Retrograde colonization of the oropharynx from the stomach by micro-aspiration of gastric fluid was shown to be associated with pneumonia. The purpose of the present study was to compare the frequency of ventilator-associated pneumonia (VAP) between two groups of ICU patients taking gastrointestinal bleeding prophylaxis including ranitidine or omeprazole.Patients and This double-blind randomized clinical trial was achieved on 129 subjects receiving at least 48 hours mechanical ventilation. They were assigned in 2 groups of ranitidine and omeprazole as the prophylactic regimen of stress-related gastrointestinal bleeding. In ranitidine group, 6 patients (9.7%) developed VAP compared to 8 subjects (13.1%) in the other group, however, chi square analysis failed to show a significant difference (P= 0.4). The incidence of VAP in ICU patients receiving either ranitidine or omeprazole did not differ significantly, however, further studies with greater sample size are required to draw a firm decision.

Kaposi sarcoma (KS) is an angioproliferative tumor that mainly involves mucocutaneous tissues, but extracutaneous spread to lymph nodes, GI tract, lungs, liver, pancreas, heart, and testes can occur in AIDS-associated KS. Patients with pulmonary KS may be symptomatic or present with an asymptomatic abnormality on chest radiography. Patient: A 28-year-old man presented with a one month history of rashes, cough, weakness and malaise. He has been an intravenous drug user since 5 years ago. The rashes were first noted in his face and then spread to his oral cavity and trunk. Skin biopsy was compatible with KS. Kaposi sarcoma of the tip of the nose has been introduced as a sentinel sign for Kaposi sarcoma of the lung. This case is a young man with mucocutaneous and pulmonary KS as a new HIV patient

Kikuchi-Fujimoto disease (KFD) is an enigmatic, benign and self-limited syndrome characterized by regional lymphadenopathy with tenderness, usually accompanied by mild fever and night sweats.Patient: A 17 years old girl admitted in infectious diseases ward with chief complaint of fever and cervical lymphadenopathy since one week ago. Her problems started with fever and pharyngitis. Three days later, she developed one cervical lymphadenopathy. Blood sample revealed a WBC count of 1700 cells/mm3, platelets count of 137000/mm3. IgG-anti EBV antibody (VCA) level was 98.7 (upper limit of normal 20) and IgM-anti EBV antibody level was 52.7 (upper limit of normal 40). In hospital course her leukopenia became worse and reached 700cells/mm3. After two weeks WBC count recovered, and reached 5100 cells/mm3. Lymph node biopsy was achieved and showed necrotizing lymphadenitis with histiocytic reaction consistent with Kikuchi disease. Kikuchi-Fujimoto disease must be considered in differential diagnosis of patients with acute severe neutropenia.