Archives of Clinical Infectious Diseases
Volume:12 Issue: 3, Jul 2017

Currently, a dengue vaccine has been approved in some countries. The problem with this new vaccine is whether the public could accept and be willing to purchase.
This study aimed to provide solid data regarding factors associated with acceptance and willingness to pay for dengue vaccine.
A systematic review with a meta-analysis was conducted on September-October 2016 for previous studies. Literatures from PubMed and Embase were searched for eligible publications (cut-off date for updates: September 10, 2016). The combined odds ratios (ORs) and 95% confidence intervals (95% CIs) were assessed using random or fixed effect model. Narrative review was used to analyze the data when they were not qualified for meta-analysis.
There were several factors associated with acceptance of dengue vaccine including attitude toward vaccination, preventive measures against dengue, attitude towards dengue, knowledge on dengue, socioeconomic level, and dengue experience. However, our meta-analysis revealed that only attitude towards vaccination (OR95%CI = 0.313 [0.137 - 0.713], P = 0.006) and socioeconomic level (OR95%CI = 0.576 [0.385 - 0.862], P = 0.007) had significant associations with dengue vaccine acceptance. Studies also revealed that preventive measures against dengue, attitude towards dengue, knowledge on dengue fever, knowledge on dengue viruses, socioeconomic levels, dengue experience, and vaccine price were associated with willingness to pay. However, none of those data was qualified for meta-analysis.
Meta-analysis reveals that good attitude towards vaccination and higher socioeconomic levels are associated with better acceptance of dengue vaccine.

The significant role of vitamin D in bacterial infections through induction of cathelicidin, as an antimicrobial protein, has been clearly addressed in the literature. Previous studies have demonstrated that women taking vitamin D supplements are more likely to produce cathelicidin, compared to the controls. Vitamin D could play a protective role against asymptomatic bacteriuria and urinary tract infections.
The aim of this study was to evaluate the association between serum vitamin D level and asymptomatic bacteriuria in pre- and postmenopausal women.
This case-control study was performed during 6 years (2011 - 2016) in Tehran, Iran. A total of 65 pre- and postmenopausal women with asymptomatic bacteriuria were enrolled in the study. The serum level of vitamin D was measured in cases with asymptomatic bacteriuria and compared with 65 age-matched women with no asymptomatic bacteriuria (control group).
The serum level of 25-hydroxyvitamin D was significantly lower in patients with asymptomatic bacteriuria, compared to women without asymptomatic bacteriuria.
Our results demonstrated that serum vitamin D level was significantly associated with asymptomatic bacteriuria in both pre- and postmenopausal women. These results underscore the importance of understanding the nonskeletal function of vitamin D, particularly its immunomodulatory effects on the prevention of infectious diseases. However, further prospective studies with a larger sample size are required to substantiate the available evidence.

Cases of dengue are on the rise and India experienced its worst epidemic during 2015. There was almost a 2 times rise in the number of cases. This study was done to understand the varied presentation and manifestation of dengue at a tertiary care centre of Haryana, India.
This was an observational cross sectional study undertaken at PGIMS Rohtak, Haryana, India. One hundred and one patients aged ≥ 14 years, who had positive test results for dengue, as NS1/IgM, were included in the study. Clinical presentations, haematological, and biochemical markers were studied and analyzed.
Out of 101 patients, 63.3% were males. Overall, 95% had fever followed by headache (62.3%), rash (53.4%), retrorbital pain (43.5%), and abdomenal pain (43.5%). Furthermore, 31.8% of patients had bleeding manifestation, of which the commonest was petechiae (12.8%) followed by malena (7.9%) and bleeding gum (6.9%). All patients had raised liver enzymes. Platelet count of Dengue could have varied presentations ranging from a simple febrile illness to fatal multiorgan failure. It is crucial to understand the features, which predict the progress of dengue fever (DF) to dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). Considering that the treatment of dengue is relatively simple, early institution of appropriate therapy with close monitoring of vital signs and laboratory parameters could help prevent morbidity and mortality related to dengue.

Blood transfusion is used to treat patients with beta-thalassemia major. Blood transfusion is associated with risk of infection, especially hepatitis C virus (HCV).
The aim of this study was to determine the prevalence of anti-HCV antibodies in patients with beta-thalassemia major in Kurdistan, Iran.
In this cross sectional study, serum samples were collected from 106 out of 129 registered patients with beta-thalassemia major, referred to hospitals in Kurdistan province, Iran in 2015. The sera were kept at -20°C until analysis. Antibodies to HCV (IgG and IgM) were determined using enzyme-linked immunosorbent assay (ELISA); ELISA-positive samples were verified by the recombinant immunoblot assay (RIBA).
The prevalence of anti-HCV antibodies was 5.66% (4 males, 2 females), based on the ELISA assay. Four (3.77%) ELISA-positive patients were confirmed by RIBA assay (2 males, 2 females), while the results of 2 (1.88%) men were indeterminate. HCV antibodies showed a significant correlation with the patient’s age (P = 0.001) and duration of receiving blood transfusions (P = 0.003). However, there was no significant association between HCV antibodies and gender (P = 0.428).
The prevalence of HCV in patients with beta-thalassemia major was lower in Kurdistan, compared to other provinces of Iran. Although screening programs for blood donors in blood transfusion centers can be effective, it is recommended to use nucleic acid tests for screening blood donors.

Infection with HBV is a major public health problem. Determining the risk factors of such an infection is of great importance for a preventive public health plan.
This study was conducted to determine the clinical presentations of patients with HBV, to assess the knowledge of patients about the mode of transmission of the infection, and to estimate the prevalence of risk factors associated with HBV infection.
A cross-sectional study was performed among patients with HBV attending hepatitis unit in Azadi teaching hospital, Duhok city, Iraq. A total of 423 patients were recruited in the study over the period of January 2013 to December 2015. Data collection was performed by a face-to-face interview using a questionnaire sheet for the collection of personal information, data regarding the knowledge about mode of transmission of HBV, and data about risky behaviors.
Results and 287/423 (68%) of the recruited subjects were males, 141/423 (33%) were from the central area in Duhok, and 216/423 (51%) were married. Additionally, 375/423 (88.7%) of the patients were asymptomatic. 383/423 (90.5%) of the recruited subjects claimed that they do not know the risk factors of HBV transmission. 85/423 (20.1%) of the recruited subjects gave a history of previous surgical operation and 73/423 (17.2%) of the patients gave a history of dental surgery.
Our study has given an insight into the most common risk factors associated with HBV infection. Furthermore, it has shown a lack in knowledge regarding HBV. A comprehensive population based program is needed to combat the spread of infection and early detection of HBV infection especially in rural and remote areas.

Medical foods could be vehicles of pathogenic microbes for vulnerable people in the hospitals. Hospital kitchen is considered as the main source of this cross-contamination.
The current study aimed at investigating the frequency of bacterial species and their antimicrobial resistance patterns in foods, food handlers, and utensils compared with those of the clinical isolates in a hospital kitchen in Tehran, Iran.
This cross sectional study was performed in a hospital in Tehran, Iran from April 2011 to January 2013. Accordingly, simple random sampling of raw and cooked food materials, swab samples of cooking utensils, and hands and noses of food staff were done. Clinical samples were collected from blood, urine, wound, and respiratory aspirates of patients with hospital acquired infections. Bacterial isolates were identified according to biochemical standard identification schema. Antimicrobial susceptibility of the strains was determined by disk diffusion method according to the CLSI (the clinical and laboratory standards institute) guidelines. Molecular diversity of indicator bacterial isolates of Staphylococcus aureus and Escherichia coli in the kitchen and those of the isolated ones from intensive care unit were also investigated by molecular typing method. The occurrence of cross-contamination was hypothesized based on the results of phylogenetic investigation and resistance biotyping.
Out of the 200 kitchen samples, S. aureus, E. coli, Acinetobacter spp., Pseudomonas spp., and Enterococcus spp. were isolated in frequencies of 15.5%, 8%, 2.5%, 0.5%, and 0.5%, respectively. Prevalence of multidrug resistant-methicillin resistant strains of S. aureus (MDR-MRSA) in the samples of the hospital kitchen vs the intensive care unit (ICU) was 18.7% (6/32), compared with 91.6% (22/24), respectively. Among the kitchen E. coli isolates, MDR pattern was detected in a frequency of 52.9%; the highest frequency was detected among the isolates of utensils. Although the results of the phylogenetic and resistance biotyping analyses did not confirm significant relationship between the isolates of the ICU and hospital kitchen, this similarity was confirmed among the strains isolated from the foods, food handlers, and utensils. In this regard, food staff and utensils were considered as the main sources of cross-contamination for S. aureus and E. coli, respectively.
Weak health conditions of food workers and inadequate cooking to eliminate the contaminants during food processing were postulated as the main risk factors for transmission of these bacteria, through medical foods. into hospital.

Existence of cytotoxin associated gene A (cagA) is considered as a marker for detection of an oncogenic Helicobacter pylori strain. Expression of cagA in the strains with incomplete delivery system (partial CagPAI) could convert them to less virulent strains. This study was aimed to analyze expression of cagA in H. pylori strains presenting diverse cagPAI and its effect on histopathological changes of the gastric tissue.
Clinical strains of H. pylori and related histopathological data were obtained to examine the presence of 12 cagPAI segments by PCR. Expression of cagA was analyzed by RT-PCR as well as Immunoblotting on RNA and protein extracts of the cagPAI-positive strains, respectively. In situe expression of CagA-positive strains was determined in a gastric epithelial cell line.
Intact cagPAI was detected among 33% (4/12) of H. pylori strains. Out of 7 diverse cagPAI genotypes in these strains, expression of cagA was confirmed in 2 strains with complete cagPAI at both RNA and protein levels. Occurrence of intestinal metaplasia and severe active gastritis were mainly detected in the strains with complete cagPAI genotype. No association was detected between EPIYA types of the strains and expression of cagA.
These results collectively showed high diversity of cagA and cagPAI among the H. pylori strains. These diversities may provide some reasons to explain distinct disease severity caused by different H. pylori strains in the gastric tissue.

According to WHO, brucellosis is one of the 7 neglected zoonotic diseases and a major challenging issue for public health.
The aim of this study was to investigate the psychometric properties of the PRECEDE model-based scales for brucellosis prevention (PRECEDE-MSBP).
In this cross-sectional study conducted in 2015, stratified random sampling was employed to recruit 420 rural residents in Ahar county, Iran. A comprehensive literature review was conducted to develop the initial draft of PRECEDE-MSBP. Face, content, and construct validity and reliability were determined.
Applying Exploratory Factor Analysis, the optimal solution including 37 items and 7 factors for Educational and Ecological diagnosis, 5 items and 2 factors for Environmental diagnosis, and 9 items and 3 factors for Behavioral diagnosis were emerged, which accounted for 60.43%, 56.51%, and 53.75% of the total variances, respectively. Appropriate validity, reliability, functionality, and simplicity were demonstrated for PRECEDE-MSBP.
Researchers and health care providers interested in brucellosis prevention may apply the PRECEDE-MSBP inventory as a suitable instrument to provide the best information while conducting brucellosis prevention need assessments for their interventional efforts. However, further studies applying this instrument are needed in order to compare the different aspects of PRECEDE-MSBP in different communities.

People with Chagas disease are at a higher risk of death due to cardiac arrest (CA). Considering that Chagas disease remains a serious health problem in Latin America, studies in this regard are still needed. The aim of this study was to present 2 patients with Chagas that developed CA and were treated at the emergency department of a reference hospital in Brazil (Sao Paulo city). Case one: Male (73 years old and Caucasian) with a history of systemic arterial hypertension, diabetes mellitus, liver cirrhosis, and Chagas disease associated with megacolon and megaesophagus. After cardiac collapse and 30 minutes of cardiopulmonary resuscitation (CPR), unfortunately the patient died. Case two: A female patient (64 years old and Caucasian), with a history of systemic arterial hypertension, obesity, and Chagas disease. After 23 days of hospitalization, pharmacological therapy, and implantation of a cardioverter defibrillator, the patient was discharged. People with Chagas disease are at a higher risk of CA. The researchers believe that a prompt and efficient treatment (advanced life support) allied with educational programs on CA recognition targeted at health professionals and caregivers (basic life support knowledge) could improve the prognoses of these patients.

Despite being an extremely common disease worldwide, especially in the temperate areas, hydatid disease continues to startle by varying presentations. The current study presented a case of primary hydatid in the subcutaneous region of face of a young patient accurately diagnosed preoperatively by the characteristic of imaging findings on ultrasonography (USG) and comouted tomography (CT) and confirmed on surgery. Although it was a rare site of presentation, the radiological features were essentially the same as elsewhere in the body and could help to make correct decision to manage the patient.