Archives of Clinical Infectious Diseases
Volume:13 Issue: 6, Dec 2018

Multi-drug resistant (MDR) strains of staphylococci are usually difficult to treat. Vancomycin has had a time-honored niche in treating MDR Staphylococcus strains; however, during recent years, many clinical failures have been reported worldwide. Since 2014, new semisynthetic lipoglycopeptides antibiotics have been introduced to combat methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-intermediate Staphylococcus aureus (VISA), vancomycin-resistant Staphylococcus aureus (VRSA), and vancomycin-resistant enterococci (VRE). They include dalbavancin, oritavancin, and telavancin. These semisynthetic lipoglycopeptides have a considerable efficacy against MDR Staphylococcus strains. Due to the presence of a lipid side chain, the half-life is prolonged and enables them to anchor the cell membrane of a pathogen. Lipoglycopeptides display a greater potency and more consistent activity against all species of staphylococci than vancomycin. Among them, oritavancin is active against MRSA, VISA, and VRSA. However, dalbavancin and telavancin have activities against MRSA and VISA. Dalbavancin is used once weekly, telavancin is used daily, and oritavancin is usually administered one dose per treatment. Compared to vancomycin, these semisynthetic lipoglycopeptides have longer half-lives with a lower minimum inhibitory concentration (MIC) and fast bactericidal activities. In addition, lipoglycopeptides have concentration-dependent effects in vivo and in vitro. In the present paper, we review the structure, mechanism of action, microbiology, indications, safety, and important interactions of dalbavancin, oritavancin, and telavancin

One of the most common infections in women, especially during the reproductive age, is vulvovaginal candidiasis, which can cause physical and psychological distress for patients. According to different reports, Candida albicans is the main etiological agent of this infection. However, non-Candida albicans species have arisen recently. Therefore, it seems that in VVC, the pattern of Candida species, have changed. In the current study, the researchers determined the frequency of different species of Candida in the Iranian female population. Five hundred and fifty-nine patients suspected of VVC, participated in this study. Wet swabs were used for collecting the samples. Vaginal swabs were examined microscopically and treated for fungal culture. Candida species identification was done by polymerase chain reaction (PCR)-Sequencing with universal fungal primers (ITS1 and ITS4). Out of 559 patients, 46 (8.2%) samples were positive for VVC. The age group of 30 to 39 years old with 20 (44.7%) patients had the highest frequency. Itching concomitant with abnormal discharge and vaginal irritation (59.6%) were the most prevalent symptoms in the patients. The most frequent identified species of Candida were Candida albicans (67.7%), Candida glabrata (25.8%), and Candida kefyr (3.2%), respectively. In addition, only one (2.1%) case showed recurrent vulvovaginal candidiasis (RVVC). The results of the present study demonstrated that in patients with VVC, Candida albicans species are more frequent than other candida species. In order to achieve appropriate treatment, clinical and laboratory findings must be considered together.

Ventilator associated pneumonia is one of the most important nosocomial infections with often poor outcomes and heavy economic burdens on health care systems.

Several studies have been done for evaluating the effect of different types of stress related mucosal disease (SRMD) prophylaxis on nosocomial pneumonia, as among factors participating in its establishment, gastrointestinal tract is believed to play an important role especially in ventilator-associated pneumonia.

In this cross-sectional study, 150 patients who were admitted to intensive care unit (ICU) and developed documented culture positive VAP, were evaluated for the study inclusion criteria. The patients with clinical pulmonary infection score (CPIS) ≥ 6 were included and some others with conditions affecting comparability excluded. The patients with Acute Physiology and chronic health evaluation II (APACHEII) scores between 10 and 24, within the first 24 hours of ICU stay, were included. Finally, 100 patients who fulfilled all criteria were evaluated for the responsible organisms and type of SRMD prophylaxis they had received. The patients included were either on intravenous pantoprazole (49 patients) or intravenous ranitidine (51 patients). The goal of this study was to evaluate the organisms, which have been isolated from the sputum of ICU patients with ventilator-associated pneumonia, according to their SRMD prophylaxis regimen.

There were 59 men (59%) and 41 women (41%) ranging from 19 to 82 years old. The mean ages were not significantly different between the two groups (P = 0.586). APACHEII score was ranging between 15 and 21 with the mean of 17.57 in pantoprazole and 16.80 in ranitidine group (P = 0.006), there was a statistical but not clinical difference. With P-value of 0.001, there was significant difference in ICU stay days. The mean mortality rates were 18.4% and 1.8% for pantoprazole and ranitidine group, respectively. The difference was statistically significant (P < 0.001). Multi-drug resistant pathogens were significantly higher in the pantoprazole group (0.001). The organisms, which have been obtained from each group were different. Acinetobacter and Pseudomonas aeruginosa were highly cultivated in the pantoprazole group, while Staphylococcus aureus and Proteus were more in patients who had received ranitidine.

It can be suggested that each bacterium has a unique propensity to grow in specific gastric pH and other systemic changes made by various agents used for SRMD prophylaxis. More studies are needed to evaluate large number of patients receiving SRMD prophylaxis, with perspective of VAP incidence, the responsible organisms, hospital and ICU stay days, and mortality rate in order to prevent poor outcomes caused by specific organisms.

Exposure to hepatitis B virus (HBV) or human immunodeficiency virus (HIV) infection is common among hepatitis C virus (HCV)-infected Intra venous drug users (IVDUs); however there exist only a few data about frequency and risk factors of HCV, occult HBV infection (OBI) and HIV among IVDUs.

This study aimed to investigate the prevalence and associated risk factors for OBI and HIV infections among Iranian HCV infected IVDUs.

Serum samples were screened for the presence of hepatitis C virus antibody (HCVAb), hepatitis B core antibody (HBcAb), hepatitis B surface antigen (HBsAg), and human immunodeficiency virus antibody/antigen (HIVAb/Ag) using enzyme linked immunosorbent assay (ELISA). For detection of OBI, presence of HBV DNA among HBcAb positive/HBsAg negative subjects was determined using nested polymerase chain reaction (PCR).

Among all subjects, 94 cases (53.5%) were positive for HCVAb from which 7% and 23.4% were positive for HCV/OBI and HCV/HIV co-infections, respectively. A significant association existed between HCVAb with type of drug, sharing syringes and needles and a history of imprisonment. In the case of HCV/OBI co-infections, the only significant correlation was between sharing a syringe and occult hepatitis B infection. Also no significant association existed between risk factors and HCV/HIV co-infections.

the present data documented an alarming prevalence of HCV and HIV as well as co-infections among IVDUs, which emphasizes the requirement for expansion of public health interventions for this at-risk population. Despite previously high prevalence reported for HCV/HBV/HIV triple infections among IVDUs, low prevalence of triple HCV/OBI/HIV infections was obtained. The reason for this difference may be related to the effect of HCV on HBV expression in case of OBI which had been suggested previously.

Velvet ants (Mutillid wasps) are among the venomous and stinging insects, which their existence has been reported from different areas of Iran. Since no study has been done so far in Iran in regards to their sting, their clinical complications and their sting are studied for the first time in Kashan. In this descriptive cross- sectional study that was performed during 2014 - 2015, 49 individuals stung by velvet ants in the residential areas in Kashan were assessed. Identification of the sting agent was according to the morphologic specifications of the collected samples of the insect in the houses of the injured. Sting complications in the individuals were studied according to the clinical manifestation and the time of the sting, which was from June to September. In this study, the sting agent was identified as velvet ants, Dentilla genus. Most sting cases were in the age group of 11 - 20 years with 30.5% and the lowest belonged to the age groups of 31 - 40 and 41 - 50 years. The first sign of the sting was a severe and sharp pain. The highest percentage of redness in the individuals was 47% in the first day, and the lowest belonged to four or five days after the sting with 2%. Intense itching was one of the main symptoms of velvet ant stings. In the final stages of pain and itching, hemolysis and bruise signs were observed as brown spots. Velvet ant stings have not been reported so far from Kashan. Due to the high cases of stinging in the women carpet weaving workshops, their sitting rooms, and bed rooms, it can be concluded that this arthropod is a domestic pest. Therefore, control and prevention of its potential damages must be programmed accordingly.

Given the prevalence of high-risk behaviors among various sections of a society, prostitution is considered one of the most important current problems.

The present study was conducted to determine the awareness of known women with high-risk sexual status about sexually transmitted infections (STIs) and their individual-social predictors in Kermanshah, Iran, in 2015.

This cross-sectional study was done on 173 prostitutes. All eligible female prostitutes who had records at the Department of Welfare, the health centers, and the drug rehabilitation centers were selected by convenience sampling. Street prostitutes were also selected by snowball sampling method. Socio-demographic and knowledge questionnaires were used to collect data. The data were analyzed by using an independent t test, one-way ANOVA test, and multivariate linear regression model.

The mean (SD) score of knowledge was 62.1 (18.2) within the acquirable score range of zero to 100. According to the multivariate linear regression model, variables including duration of staying at this job, education level, husband’s education, father's job, number of children, age at the first sexual activity, and the ways of supplying condoms were knowledge predictors while adjusting other variables.

Educational planning should include all age groups from all social and economic classes. Identifying and focusing on the variables of knowledge can improve the knowledge of women about STIs

Coagulase-negative Staphylococcus epidermidis is the most prevalent member of the human skin normal biota that plays an important role as a common cause of catheter and prosthetic device-related infections from, for example, indwelling catheters.

This study aimed to characterize the clonality of biofilm-producing methicillin-resistant S. epidermidis (MRSE) strains isolated from catheterized patients with urinary tract infection at a referral hospital in Tehran, Iran.

Between 2014 and 2016, a total of 56 methicillin-resistant S. epidermidis (MRSE) strains were recovered from catheterized patients. The MRSE isolates were tested for biofilm formation and different genes involved in this process were detected. Clonal dissemination of MRSE isolates was determined using the combination of pulsed-field gel electrophoresis (PFGE) and SCCmec typing.

Out of the 56 MRSE strains, 50 (89%) formed biofilm and were positive for icaA and icaD genes, and 73% (n = 41) harbored IS256. The PFGE patterns revealed a total of 32 different pulsotypes consisting of 16 single types (STs), 16 common types (CTs), and 2 SCCmec types (III and IV) were detected. Moreover, all STs carried SCCmec type IV and classified as community-acquired strains. Four CTs were common among biofilm and non-biofilm producing strains.

The presence of icaA and icaD genes with a high prevalence of IS256 element in clonal groups of MRSE strains suggests that ica, IS256, and biofilm forming ability occur simultaneously in specific S. epidermidis clones and spread preferentially in hospitals and community

  Chlamydia trachomatis, Mycoplasma genitalium, and Ureaplasma urealyticum are genital infectious agents that can be sexually transmitted. They are involved in many infections both in women and men and can also be the cause of abortion in women. This study aimed to determine the prevalence of the aforementioned bacteria in pregnant women and those with abortion in Kerman, southeast of Iran. Totally, 200 vaginal specimens were taken from pregnant women (n = 76) and those with abortion (n = 124) and were investigated for chlamydial and mycoplasmal infections using polymerase chain reaction (PCR) assay. From December 2015 to December 2016, 200 women were enrolled in this study. Demographic and behavioral information were gathered for statistical analysis. The prevalence of bacteria was determined in the vaginal samples by PCR. All the studied bacteria were more frequently isolated from women with abortion, that is, 34.6% versus 15.7% for U. urealyticum, 20.9% versus 17.1% for M. genitalium, and 15.3% versus 10.5% for C. trachomatis. However, only for U. urealyticum the difference was significant (P = 0.0006). Again, occurrence of co-infection was mostly detected in women with abortion, and co-infection of U. urealyticum and M. genitalium was significantly higher (P ≤ 0.03). Also, follow-up studies indicated the importance of U. urealyticum in adverse outcomes of pregnancy in this region. Thus, special attention should be paid to this infection during pregnancy. The present study showed a significantly high prevalence of U. urealyticum in women with abortion separately and also in combination with M. genitalium. Diagnostic tests are recommended to detect these bacteria in high-risk women

Drug resistance is emerging as one of the greatest challenges in the development of effective treatment for HIV infection. The importance of clinical studies in this field stems from the world wide growing of treatment drug-resistant mutations.

This study was performed to determine the HIV subtype and the resistance mutations to the protease inhibitors in both untreated HIV patients and patients under treatment with protease inhibitors (PIs) in Iran.

The study was conducted on two groups of participants. The first group consisted of 25 HIV patients who did not receive any antiretroviral treatment. The second group included 25 HIV patients who have being treated with a combination of protease inhibitors. After genome extraction, a nested polymerase chain reaction was performed to amplify the protease gene. Upon confirmation using electrophoresis, the amplicons or PCR products were sequenced and analyzed to determine the drug resistance mutations as well as the viral subtypes.

No mutations were found in the first group; however, 32% of the samples in the second group had PI related drug-resistance mutations. The major mutations were V82A and M46I, which were seen in 12% of the samples, while the minor mutation F53L was seen in 16% of the samples. The subtype analysis showed that 94% of the samples were subtype CRF35_AD, and 6% were of defined as subtype A.

The present study reports updates on the mutations related to protease resistance in Iranian HIV patients receiving treatment. Our data, as well as existing reports, support the need for the optimization of treatment to prevent emergence of resistant viruses and a search for new antiretroviral drug candidates for HIV patients.

The term hepatobiliary tuberculosis refers to the rare and localized form of hepatic tuberculosis as a distinct clinical entity, with signs and symptoms related to the hepatobiliary tract. We aimed to report a case of the primary biliary tuberculosis with subsequent pulmonary presentation.

A 28-year-old woman was admitted to our hospital due to recurrent abdominal pain, low-grade fever, and icterus and with a temperature of 38.2°C. According to magnetic resonance cholangiopancreatography (MRCP) with bile duct dilatation, IgG4, and high eosinophil with impression of autoimmune cholangiopathy, corticosteroid was administered. A few weeks later, she was hospitalized again because of fever and leukocytosis and the creation of multiple lymph nodes in the neck and abdomen. Biopsy of cervical lymph node was performed, which was not diagnostic. Smear, culture, and polymerase chain reaction (PCR) to detect tuberculosis were negative. According to eosinophilia and hypointense masses with the possibility of parasitic causes (Fasciola hepatica) triclabendazole was started. The symptoms briefly improved and she had little weight gain, but four months later she was hospitalized with pulmonary symptoms. Culture and sputum smear were positive for acid-fast bacilli.

Hepatobiliary tuberculosis has delayed presentations with nonspecific manifestations. In our patient, despite that clinical presentations matched those of hepatobilliary tuberculosis, multiple biopsies from the abdominal and prepheral lymph nodes could not verify it. Therefore, diagnosis was made with delay, and finally, pulmonary presentation and positive smear for acid-fast bacilli confirmed tuberculosis

The caspase recruitment domain containing protein 9 (CARD9) deficiency is a primary immunodeficiency disorder that affects the innate immune system, resulting in increased susceptibility to fungal infections. We describe progressive disseminated phaeohyphomycosis due to a melanized fungus in a 26-year-old healthy female with inherited CARD9 deficiency to highlight the clinical presentation of this disorder.

The diagnosis of disseminated phaeohyphomycosis due to melanized fungi was made on the basis of clinical and histopathological findings. CARD9 gene was sequenced and a homozygous c.883C>T mutation in exon 6 at codon 295 was found, resulting in a mutation at position 295, Q295X.

There are more cases of fungal infection associated with CARD9 deficiency in Iran compared to other Asian countries. Although consanguineous marriage is common in the Middle East, severe fungal infections related to CARD9 deficiency were only reported from Iran and Turkey. The higher incidence in comparison to other Middle Eastern countries may be associated with rapid population growth, large family size, and the availability of diagnostic facilities. Although Iranian patients with Q295X mutation are susceptible to candidiasis and dermatophytosis, our patient is the first report of phaeohyphomycosis related to Q295 mutation.

 

Hydatid cysts of bones may develop in any part of the body, however, they are usually found in the liver and lungs. The primary localization of the cysts in bone is not common.

In this paper, we report the case of a 58-year-old man who was admitted complaining of leg pain. He had undergone hydatid cyst surgery several times over the past years.

The patient had surgical removal of the hydatid cyst along with chemotherapy before and after surgery. The patient did not report any problem in a two-year follow-up after his last surgery

Meningitis is commonly caused by a viral, bacterial, fungal, or parasitic infection that involves the cerebrospinal fluid (CSF) and leads to inflammation of the protective membranes covering the brain and spinal cord. Among bacterial pathogens responsible for meningitis, Streptococcus pneumoniae is notorious for causing more than 50% of all cases of bacterial meningitis. Neisseria meningitis is also a major cause of bacterial meningitis. Here, we report a rare case of a 13-month-old infant with cardiac dysfunction associated with meningitis caused by co-infection with Streptococcus pneumoniae and Neisseria meningitides. Cardiac dysfunction is a condition where the heart pumping becomes less effective and the heart cannot pump sufficient blood to meet the body's needs. Bacteria were isolated by culture and detected by polymerase chain reaction (PCR) on CSF. The patient was treated with vancomycin, ceftriaxone, and rifampin followed by three months of follow-up without any clinical symptoms. This raises the possibility of finding other cases of mixed neonatal meningitis in the future since the incidence of meningitis is currently increasing in the region

Our purpose in this case report is to pay attention to an unusual presentation of HPV infection. A 27-year-old-male patient with the complaint of dysuria, hematuria, and urethral lesion was presented to the clinic. The first diagnosis was papillary urethral cancer based on the pathology report. We considered another expert's opinion from a pathologist point of view due to the report of a rare cancer for this young patient. The slides review showed no dysplastic change and confirmed condylomata acuminata. Primary urethral condyloma acuminata is rare and health care professionals should consider a thorough medical history, especially high-risk sexual behaviors of patients. Considering the risk of anogenital cancers, the type of HPV virus should also be determined in the patients.

The hepatitis C virus (HCV) and hepatitis B virus (HBV) infections are significant concerns in patients with inherited disorders of hemoglobin (IDH). This study aimed to assess the prevalence of HCV and HBV infections in a large cohort of patients with IDH in Sistan and Baluchistan province, Iran. In this retrospective study, 2391 patients with IDH in Sistan and Baluchistan were enrolled. The anti-HCV antibody (HCV Ab) and hepatitis B surface antigen (HBsAg) were assessed using ELISA. A total of 2387 patients with a mean age of 12.7 years were included in the final analysis. Most of the patients were residents of Zahedan city (28.1%) and suffered beta-thalassemia major (99.2%). The prevalence of HCV Ab was 5.87% (95% CI = 5.0% - 6.89%) and HBsAg was detected in 0.29% (95%CI = 0.14% - 0.6%) of the patients. The prevalence of HCV Ab was associated with the age of patients, and there was a great difference in the prevalence of HCV Ab between patients with IDH who born before and after 1996 (17.2% vs. 5.1%; P < 0.05). Among 101 patients with positive results for HCV Ab who were tested for HCV RNA, 53 (52.5%; 95% CI = 42.8% - 61.9%) had HCV RNA in their serum samples. Moreover, 40 patients had results for HCV genotyping including 29 (72.5%) HCV genotype 3 and 11 (27.5%) HCV genotype 1. Hepatitis C had a high seroprevalence of 5.87% in patients with IDH in Sistan and Baluchistan while hepatitis B had a low seroprevalence of 0.29% that is unusual in a region with > 3% prevalence of hepatitis B in the general population.

Food poisoning is a common infectious disease and Shigella is at the top of causative pathogens. All species of Shigella cause an acute bacterial disease involving the large and distal small intestine that presents with diarrhea, vomiting, and abdominal pain. To interpret clinical and paraclinical characteristics of patients in the food poisoning outbreak by Shigella boydii in Kerman-Iran. On October 2015, 241 residents of the Anduhjerd town of Kerman, Iran, came to clinics and hospitals with a complaint of food poising. Meanwhile, 118 people referred to Afzalipoor Hospital - a referral center. Among them, 21 patients were admitted due to fever, dysentery, old age, or bad general condition. We assessed and reported clinical and paraclinical characteristics of all these 21 hospitalized patients. The mean age of patients was 38.1 years old while 71.4% of them were women. In the history of all patients, the use of cooked wheat groats, as a votive food from the neighborhood inhabited, was detected, which was a long time period between cooking and consumption while food was not kept in the refrigerator. The time period between food consumption and onset of symptoms varied from eight to 13 hours and the most common symptoms were diarrhea (90.4%), vomiting (85.7%), and abdominal pain (80.9%). Five patients (19%) had bloody diarrhea, although 71.4% of stool exams were positive for WBC and RBC, and 23.8% of stool cultures were positive with Shigella boydii. In the course of hospitalization, 5 other patients (19%) developed dysentery and eight of them (38%) developed labial herpes. All patients received rehydration and antibiotic therapy, and were discharged with no complication. This is the first outbreak of Shigella boydii in Iran that occured in a votive food distribution. Votive food is a very common convention in Iran; therefore, there must be more notices about cooking and keeping food until the consumption to prevent such events.

Hydatid disease is an infection caused by the larval form of Echinococous granulosus and is endemic in animal husbandry communities. Hydatid disease of the breast is rare and occurs in less than 1% of the cases. In this paper, we presented a known case of hepatic hydatidosis readmitted due to hydatid cyst of the breast. A 38-year-old woman, a known case of neglected hepatic hydatidosis since eight years ago, presented to our hospital with new onset of abdominal pain. Computed tomography (CT) scan revealed signs of hydatid cysts in the liver, spleen, and both breasts. Laparotomy with complete resection of the hydatid cysts in the right lobe of the liver was performed along with cholecystectomy due to the closeness of the cysts to the gallbladder and severe adhesions. The patient also underwent splenectomy and cystectomy of the breasts. Histopathologic report of the resected cysts from the breasts, liver, and spleen confirmed the diagnosis of hydatidosis. The patient was discharged with albendazole (10 mg/kg daily for three weeks) and was advised to come back to the clinic for follow-up evaluations. Although breast hydatidosis is rare, it should be considered as a differential diagnosis of breast lumps presenting in endemic areas and among immigrants from endemic areas.