Archives of Clinical Infectious Diseases
Volume:12 Issue: 2, Apr 2017

Healthcare workers (HCW) such as medical, dental, nursing and midwifery workers are at high risk for occupational exposure to blood-borne pathogens such as hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV through sharp injuries of needlestick.
The current study aimed to evaluate the prevalence of needlestick injuries (NSIs) among healthcare workers in Milad hospital in Tehran, Iran, from 2007 to 2011 and investigate the related factors of needle sticking in the hospital in order to decrease the risk of infectious diseases transmission due to needlestick injury.
This retrospective cross-sectional study was performed among healthcare workers including nursing staff, physicians, gynecologist, laboratory staff, cleaners and garbage collectors in Milad hospital in Tehran, Iran, over a five-year period from 2007 to 2011. All of the NSIs data was obtained from infection control committee in Milad hospital. Questionnaire sheets were filled up and all of the information was rechecked one more time by experts. The information included demographic questions and NSI related questions. Vaccination for HBV and titer of hepatitis B surface antibody (anti-HBs) were recorded. The association between demographic and needlestick characteristics was tested through working shifts.
In the current study, 608 out of 3806 hospital staff including 209 (34.3%) male and 399 (65.7%) female had NSIs over a five-year period in Milad hospital. Most of the NSIs was observed in enrolled nurse, nursing sister and midwife groups 308 (50.7%) followed by servants 122 (20.1%) and the lowest was found in laboratory staff 14 (2.3%). Staff who worked in the internal medicine ward 95 (15.6%), emergency ward 72 (11.8%) and intensive care unit (ICU) 58 (9.5%) had experienced NSIs. There were uniform time patterns of NSIs by working shifts; therefore, the lowest number of the injuries occurred in the start of working shift (7:00 am, 01:00 pm and 07:00 pm) and increased along the time. Most of the NSIs occurred through taking blood and injection 182 (29.9%). Compared to NSI data by working shift, the greater number of the injuries occurred in the evening and night, but it was not statistically significant through needlestick characteristics (P value > 0.05).
Nurses are at the highest risk for NSIs and servants the second. Staff training, proper use of protective equipment, proper disposal of infectious waste and vaccination of all staff against HBV might be effective measures towards reduction of the number of NSIs.

Coagulase-negative Staphylococci (CoNS), especially Staphylococcus epidermidis, are considered as commensal bacteria of human skin and oral-nasal mucosa. Because of having many various virulence factors as well as the emergence of the multidrug-resistant (MDR) strains, this microorganism is regarded as a major cause of hospital-acquired bacteremia and invasive nosocomial infections.
Due to the significance of S. epidermidisassociated infections in different health care units, the aim of this study was to determine the molecular epidemiology of S. epidermidis in true infection-associated isolates.
In our cross sectional study, a total of 183 S. epidermidis strains was collected during 8 months. Only 40 strains, which were identified as “true” infection-associated strains, were assessed via antibiotic susceptibility testing and pulsed field gel electrophoresis (PFGE) typing. Finally, strains with specific assigned pulsotypes were also analyzed by multilocus sequence typing (MLST).
Specimens were most commonly obtained from the bloodstream, wound, and catheter. More than half (75%) of the tested strains were found to be resistant to cefoxitin and ciprofloxacin (60%), while 45% of strains showed resistance to tetracycline. Using PFGE, 3 clones (A, B and C) were identified. According to MLST, the frequency of ST2 and ST5 was more prominent than the other STs.
In accordance with the life cycle of S. epidermidis, molecular characterization of invasive isolates is essential for controlling the epidemic strains in health care units.

Fascioliasis is a neglected zoonotic disease with worldwide distribution. Phylogenetic analysis of Fasciola species is critical because of their different epidemiology.
The current study aimed at identifying Fasciola spp. based on spermatogenesis and phylogenetic analysis of mitochondrial (ND1) gene.
One hundred and fifty adults with fascioliasis were selected from the Eastern provinces of Iran, based on spermatogenetic ability, measurement criteria, and ITS (nuclear ribosomal DNA internal transcribed spacers) 1 gene restriction fragment length polymorphism (RFLP) pattern. Then, their genetic diversity indices and phylogenetic relationships were analyzed using mitochondrial DNA marker of Fasciola population spread in the East of Iran.
Aspermic F. gigantica was observed in the eastern part of Iran. Partial sequences of mtDNA showed new haplotypes in both species. Pairwise fixation index between different F. gigantica populations calculated from the nucleotide data set of ND1 gene were statistically significant and showed the genetic differences in pairwise population.
The results of the study showed that F. hepatica, lives in this region of Iran, had different genetic structures compared with the other Fasciola populations in the world. Fasciola gigantica present in the East of Iran had different genetic structures, compared with the other Fasciola population, based on genetic index.

Otomycosis is a globally distributed superficial infection of the auricle and external auditory canal. Its incidence differs in various geographical regions due to the different climatic conditions.
The aim of this study was to determine the incidence of otomycosis in Khorramabad, Lorestan province, western Iran, using mycological besides clinical criteria.
In this cross-sectional descriptive study, a total of 79 patients clinically suspected to otomycosis were recruited from April 2014 to April 2015. Specimens were collected using sterile swabs. All the specimens were subjected to direct examination using 10% KOH, and culture in Sabouraud dextrose agar containing chloramphenicol, malt-extract agar, and Czapek Dox agar. CHROMagar candida and carbohydrate assimilation profile in API 32 C were used for the identification of yeasts.
Among 79 patients, 15 (19%) were confirmed for otomycosis. The most common agent was Candida albicans (5, 33.33%), followed by Aspergillus flavus (4, 26.64%), Penicillium spp. (3, 19.98%), A. niger (2, 13.32%), and Alternaria spp. (1, 6.66%). Females were the dominant involved group (11, 73.33%) and itching was the most frequent clinical compliant in 100% of cases with otomycosis.
Regarding the dissimilarity in fungal spectrum in our study and other investigations and unspecificity of clinical signs and symptoms for otomycosis, mycological examination could be a beneficial measure for accurate diagnosis and treatment of otomycosis.

Some studies show that the gut microbiota is an essential risk factor in driving inflammatory bowel disease (IBD). There are some evidences regarding the involvement of Streptococcus spp. in the pathogenesis of IBD. In this study we compared proportions of Streptococcus spp. in feces of IBD patients and control volunteers.
The freshly prepared stool samples were collected from 29 patients with IBD and 29 healthy volunteers. Disease activity was measured by means of standard clinical indices. Total DNA was extracted from the stool samples and used for relative quantification of Streptococcus spp. based on the real-time PCR method in the patient’s and control’s groups.
Results showed a relative increase in abundance of Streptococcus spp. (0.0006 to 34.2 fold increase) and greater population diversity among IBD patients compared with the control group (mean ± standard deviation 2.94 ± 0.37 versus 1.07 ± 0.31). Patients with increased Streptococcus spp. levels represent a higher rate of neutrophil and lymphocyte infiltration than those with the lower levels; however, this increase was not statistically significant. Analysis of body mass index indicated a significant difference between IBD patients and healthy people (P value 0.02).
The determined correlation between increases in abundance of Streptococcus spp. and IBD suggests possible involvement of this bacterial genus in promotion or severity of the disease.

Toxoplasmosis, a worldwide parasitic infection, is considered as a transfusion-transmitted disease.
Due to ignorance about Toxoplasma infection in blood donors monitoring and its important role in provision of safe blood and blood products and also poor information about the seroprevalence of T. gondii infection in blood donors, this study was conducted to assess anti-Toxoplasma gondii antibodies and associated risk factors among blood donors in northwest of Iran.
In this cross- sectional study, 194 serum samples were collected from healthy blood donors who referred to Tabriz Blood transfusion organization (East Azerbaijan, Iran) during April and June 2014 and tested for anti-T. gondii IgM and IgG antibodies using chemiluminescence immunoassay. The questionnaire consisting of demographic and risk factors were filled for all the participants.
From 194 donors, 75 (38.66%) and 2 (1.03%) individuals were seropositive for anti-T. gondii IgG and IgM antibodies, respectively. In the present study, anti-T. gondii antibodies in first-time donors was significantly higher than those in regular blood donors (P Considering the medical importance of blood transfusion and high rate of anti- T. gondii antibodies in healthy blood donors, it seems that effective monitoring of infection is required to prevent transfusion- transmitted toxoplasmosis.

Methicillin resistance Staphylococcus aureus (MRSA) isolates have been recognized as one of the most important causes of infection in burn patients that have recently shown a frequent and rapid development of antibiotic resistance.
The present study described the distribution of different SCCmec types and antibiotic resistance pattern among MRSA strains isolated from burn patients in a referral burn center in Tehran, Iran.
During a 12-month study, 189 MRSA isolates were obtained from burn patients. Standard culture and biochemical tests were used for identification of MRSA isolates. The antibiotic susceptibility testing was performed using disc diffusion method and the presence of mecA, nucA, pvl, and tst encoding genes was determined using PCR method. In addition, the different SCCmec types were determined using multiplex PCR.
All the MRSA isolates were observed to be resistant to amoxicillin and penicillin and sensitive to linezolid, teicoplanin, and vancomycin. The rates of resistance to other antibiotics varied from 86.2% for amikacin to 17.5% for quinupristin-dalfopristin. MDR was observed in all the isolates. Six different antimicrobial resistance patterns were observed among our isolates. Based on the multiplex PCR assay, the two different SCCmec types were detected as 71.4% type III and 28.6% type IV. In total, 8.5% of isolates harbored pvl toxin encoding gene all of which belonging to SCCmec type IV. Furthermore, 33 isolates (17.5%) harbored tst encoding gene.
The results showed low diversity of SCCmec type among circulating MRSA in the burn center with relatively high prevalence of SCCmec III. These findings support the need for more studies to elucidate distribution of different SCCmec types among MRSA isolated from burn patients.

Vulvovaginal candidiasis is a widespread and frequent infection affecting up to 70% of healthy women, and some of them affected by recurring resistant forms of the disease. The main risk factors are hormone replacement therapy, diabetes mellitus, antibiotic usage, pregnancy, oral-contraceptives, and insufficient therapy. Candida albicans is the most etiologic agent of Candida vaginitis capable of colonizing on the mucous membrane of genitourinary tracts of healthy humans. The aim of the present study is to identify Candida species obtained from patients with vulvovaginitis by molecular techniques.
Between 2015 - 2016, 108 suspected patients were evaluated for vulvovaginal candidiasis. Suspected patients were divided into 3 groups and each group took only 1 antifungal agent including clotrimazole, miconazole, and nystatin, respectively. Direct microscopic examination, culture, and fragment size polymorphism (FSP) technique were used for identification of clinical isolates
Of the 108 patients, 59 (54.6%) had both positive culture and direct microscopic examination. The duration of disease was between 3 to 365 days. Candida albicans was the most prevalent Candida species isolated from patients (74.5%) followed by Candida glabrata (17%). The correlation between the kind of antifungal agents and recovery of patients was not statistically significant (P value = 0.056).
Resistance to various antifungal agents and emerging of non-albicans Candida species among clinical specimens are crucial affairs in the field of medical mycology. Since VVC is a prevalent and recurrent infection, controlling of predisposing factors, personal hygiene, and appropriate antifungal therapy are extremely recommended among vulnerable population.

Streptococcus pneumoniae is an important bacterial pathogen in children and older adults. It is associated with the highest case fatality rates in patients with pneumonia and meningitis.
In the present study, we determined the phenotypic and genotypic properties of a vancomycin nonsusceptible S. pneumoniae isolates from clinical specimens in Tehran, Iran.
Five pneumococcal isolates were included in the study from different clinical specimen in 2 hospitals in Tehran (Milad and Sina), Iran. Antimicrobial susceptibility tests of pneumococcal isolates were performed by the broth microdilution method according to CLSI guideline, and the presence of vanA gene was detected by PCR.
During the study period, 5 S. pneumoniae isolates resistance to vancomycin were identified. Vancomycin minimum inhibitory concentrations (MIC) ranged from 2 µg/mL to 16 µg/mL. All the isolates were resistant to cefotaxime and erythromycin. Moreover, only 1 isolate was susceptible to penicillin. PCR results showed that all isolates were negative for vanA gene.
Our results demonstrated that an alarming rate of vancomycin resistant pneumococci may result from the uncontrolled use of vancomycin and self-medication. Moreover, multiple drug resistant pneumococci were observed especially in cefotaxime and erythromycin, which may be a major health problem in Iranian patients.

Brucellosis is one of the most common worldwide zoonotic and still remains endemic in many developing countries including Iran. Splenic abscess is an extremely rare complication of brucellosis. Here we describe the first reported case of splenic abscess due to brucellosis from Iran.
In June 2014, a 17-year-old woman was admitted to the division of infectious diseases at the Imam Khomeini hospital, Ardabil University of Medical Science, Ardabil, Iran, with complaints of fever, nausea, sweating, headache, anorexia, and abdominal pain during the previous 2 months. Abdominal computed tomography (CT) revealed hypodense lesion within the spleen. Serum antibody tested positive at a dilution of 1:1280 by the Standard Tube Agglutination test (SAT), while blood culture yielded negative results. A diagnosis of splenic abscess due to brucellosis was made and started on streptomycin plus doxycycline and rifampin for 6 weeks. Two days after the initiation of the treatment, hemophagocytic syndrome occurred, which was controlled by oral prednisone. She was followed up in the outpatient department and was given further oral antibiotic treatment. After 2 months of treatment, CT results showed complete resolution of splenic abscess.
Splenic abscess due to brucellosis should be considered in differential diagnosis of patients who have complaints such as fever, sweating, and abdominal pain. The conservative approach of using antibiotics alone without surgical intervention can be successful in the treatment of splenic abscess due to brucellosis.

Osteomyelitis is a secondary complication in 1% to 3% of patients with pulmonary tuberculosis (TB). Definite diagnosis of TB-associated osteomyelitis is challenging for clinicians, as biopsies of deep osteoarticular tissues are necessary.
We present the case of a 50-year-old man, admitted to Imam Khomeini hospital, Tehran, Iran in March 2014. According to his self-report, he had a chronic ulcer on his left foot since September 2012. In physical examinations, there was a painful sinus tract orifice (2 × 2 cm) on the left medial malleolus. Magnetic resonance imaging (MRI) of the foot revealed osteomyelitis in the left ankle. Two biopsies were taken from the wound edge, and Mycobacterium tuberculosis was detected via polymerase chain reaction (PCR) assay.
Today, in the diagnosis of TB-associated osteomyelitis, it is a common practice to obtain 3 osteoarticular tissue biopsies for microbiological evaluation, PCR analysis, and histopathological assessment. We suspect that biopsies from the edge of the sinus tract orifice may help diagnose TB osteomyelitis.