فهرست مطالب

Archives of Clinical Infectious Diseases
Volume:11 Issue: 1, Jan 2016

  • تاریخ انتشار: 1394/12/15
  • تعداد عناوین: 9
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  • Davood Yadegarynia, Sara Rahmati Roodsari, Zahra Arab, Mazar* Page 1
    Background
    Over the past decade, Enterococci have been shown to be an important cause of nosocomial and community-acquired infections. Inappropriate use of antibiotics led to changes in the pattern of antibiotic resistances in Enterococcus species. Unfortunately, no study has been performed in Iran in recent years regarding the antimicrobial resistance of Enterococci using the E-test method as a base. We must gain sufficient knowledge about the regional antibiotic resistances related to Enterococcus so that we can monitor the prevalence and antimicrobial resistance of Enterococcus by administering appropriate treatments.
    Objectives
    The objective of this study was to evaluate the antimicrobial susceptibility among Enterococcus species by the E-test method at Khatam-ol-Anbia hospital during 2013 - 2014.Patients and
    Methods
    This descriptive cross-sectional study was carried out during 2013 - 2014. All clinical samples were collected from the intensive care unit (ICU) and general wards of Khatam-ol-Anbia hospital. All Enterococcus species were detected via biochemical testing. Antimicrobial susceptibility and minimum inhibitory concentration (MIC) were determined via disk diffusion and the E-test method. We used descriptive statistics to analyze the data.
    Results
    A total of 53 Enterococci were isolated from clinical samples of blood, urine, wounds, sputum, and cerebrospinal fluid (CSF) over a two-year period from the ICU and general wards. The isolated Enterococcus species were 77.35% E. faecalis, 18.86% E. faecium, and 3.77% other species. Species evaluated by E-test were resistant to imipenem, ampicillin, co-trimoxazole, gentamicin, rifampicin, vancomycin, linezolid, and teicoplanin; 54%, 68%, 100%, 93.8%, 60.4%, 39.6%, 0%, and 29.2%, respectively. Among the strains of enterococci, 90.9% of E. faecium and 20% of E. faecalis species were resistant to vancomycin.
    Conclusions
    According to these findings, antibiotic-resistance patterns have changed, and vancomycin resistance, especially among E. faecium, is rising because of nosocomial infections. Consequently, it has become a serious subject for patients admitted into a hospital.
    Keywords: Microbial Sensitivity Tests, E, test, Enterococcus
  • Marcelo Corti* Page 2
    Context: Strongyloides stercoralis is a nematode parasite, which is endemic in tropical and subtropical regions. Infection usually remains asymptomatic, but in immunocompromised hosts, hyperinfection syndrome (HS) and disseminated disease (DD) can occur and can be related to a high mortality rate.Evidence Acquisition: An exhaustive bibliographic research was performed in the main biomedical databases, including PubMed, Scopus, Index Copernicus, DOAJ, EBSCO, Iranmedex, Scielo, and Google Scholar. Articles written in English, Spanish, and Portuguese were considered. Narrative and systematical reviews, case-control studies, observational studies, and remarkable case reports (due to atypical presentation) were included in the revision. Duplicated articles, abstracts only, and grey literature were not considered for revision. A narrative review of the included article was done. The databases were searched to identify review articles, original manuscripts, and case reports about strongyloidiasis in immunocompromised patients. Terms used in the search were the following: Strongyloides stercoralis, hyperinfection syndrome, immunosuppressed patients, AIDS, HIV, HTLV-1, transplant recipients, corticosteroid therapy, immunosuppressive drugs, síndrome de hiperinfestación, pacientes inmunocomprometidos, SIDA, VIH, receptors de trasplantes, tratamiento con corticoides, e inmunosupresores.
    Results
    S. stercoralis is an intestinal nematode that can survive in asymptomatic form in its human host for decades after the initial infection. However, this geohelmintic parasite can lead to a disseminated and fulminant hyperinfection syndrome in severely immunocompromised patients, or patients with HIV or HTLV-1 retroviral infections, especially those treated with high doses of corticosteroid therapy.
    Conclusions
    Clinical features of strongyloidiasis are nonspecific, and a high index of suspicion is necessary for early diagnosis and to improve the poor prognosis of patients with hyperinfection syndrome due to S. stercoralis.
    Keywords: Strongyloides stercoralis, Nematode Infection Treatment, Epidemiology, Diagnosis, Hosts, Immunocompromised
  • Yosef Taher, Ghasemi, Iraj Nikokar*, Ahmad Reza Yazdanbakhsh, Hadi Sedigh Ebrahim, Saraie, Robabe Vakili Sadeghi, Abdolhalim Rajabi Page 3
    Background
    Certain social determinants may influence host susceptibility to tuberculosis (TB) infections, and increase the risk of developing the disease.
    Objectives
    The present study aimed to evaluate the effects of several host and environmental factors on the risk of TB in northern Iranian households.Patients and
    Methods
    This case-control study was conducted for one year between 2010 and 2011 in the Guilan province in Iran. Eighty-seven confirmed TB positive cases, based on convenience sampling, were included in this study. A patient positive for TB was confirmed by a positive sputum smear, chest X-ray, and clinical manifestations as diagnosed by a physician. The data were collected using observational methods, and were analyzed by SPSS software.
    Results
    The average mean age of the TB cases was 51 ± 22 years old, and 40.2% (35/87) of the TB cases were male and 59.8% (52/87) were female. The majority of TB cases were from rural areas (71.3%, 62/87), while 28.7% (25/87) were from urban areas. Significant differences (P < 0.001) were observed between the geographical conditions and distribution of the disease. The room density of the individuals was significantly different (2.9 ± 1.2 vs. 2.2 ± 1.9, P < 0.002) among the TB cases and control group, respectively. A statistical difference was observed between the groups in terms of the building materials (P < 0.05), while significantly inadequate UV irradiation was seen in the houses of the TB patients, compared to the control group (82.8% vs. 14.9%, P < 0.001). The hygiene of the houses seemed to be a significant risk factor (P < 0.001) for TB infection.
    Conclusions
    The results suggest that in the studied region several host and environmental factors were associated with higher risks of TB infection.
    Keywords: Tuberculosis, Risk Factors, Social Medicine, Case, Control Studies
  • Fateh Rahimi*, Sharmin Karimi Page 4
    Background
    Methicillin-resistant Staphylococcus aureus (MRSA) has been known as one of the most important nosocomial pathogens that able to produce a variety of virulence factors.
    Objectives
    In this study, we aimed to describe the prevalence, presence of different virulence factors, staphylococcal cassette chromosome mec (SCCmec) and prophage typing of MRSA strains isolated from a referral hospital in Tehran, Iran.
    Materials And Methods
    A total of 279 S. aureus strains were collected from a referral hospital in Tehran during August to December of 2013. All isolates were confirmed using species specific primers and were tested for susceptibility to oxacillin and cefoxitin disks by the recommendations of clinical and laboratory standards institute (CLSI). The staphylococcal enterotoxin (sea-seq) and pvl, hlb and sak genes were detected and typed using prophage typing and SCCmec typing methods.
    Results
    Out of the 279 S. aureus isolates, 91 (32.6%) strains were confirmed as MRSA. Totally, 6 enterotoxin and 2 virulence factor genes were detected in MRSA strains. The sea, sek, seq and hlb genes were present in all MRSA and sak, seg, sei and sel were detected in 85%, 35%, 23% and 44% of the strains. Only SCCmec type III and type 3 ccr and 2 different prophage patterns were identified among the strains.
    Conclusions
    Our results show the presence of clonal groups of enterotoxin-producing MRSA strains in this hospital in Tehran. The presence of bacteriophage encoded virulence factors and resistance to oxacillin enable bacteria to produce a broad spectrum range of diseases.
    Keywords: Enterotoxins, Prophages, Bacterial Typing Techniques, Methicillin, Resistant Staphylococcus aureus
  • Gita Eslami, Ali Hashemi, Mohammad Mahdi Karimi Yazdi, Mozhgan Esmaeili Benvidi*, Parvaneh Khiabani Rad, Sadegh Lotfolah Moradi, Fatemeh Fallah, Masoud Dadashi Page 5
    Background
    Carbapenem resistance due to acquired metallo-beta-lactamases (MBLs) is considered to be more serious than other resistance mechanisms.
    Objectives
    The aim of this study was to examine the effects of the methanolic extracts of Zataria multiflora, Ziziphus, Chamomile and Myrtus communis leaves on IMP-type MBL- producing Pseudomonas aeruginosa strains.
    Materials And Methods
    This cross-sectional descriptive study was conducted on burn patients hospitalized in Shahid Motahari Hospital, Tehran, Iran, during 2012 - 2013. Antibiotics and extracts susceptibility tests were performed using the disc diffusion and broth micro dilution methods. The metallo-beta-lactamase detection was performed by combination disk diffusion test. The bla (VIM) and bla (IMP) genes were detected by polymerase chain reaction (PCR) and sequencing methods.
    Results
    Eighty-three out of 96 samples were imipenem-resistant P. aeruginosa strains. Among 83 imipenem-resistant P. aeruginosa strains, 48 (57.9%) were MBL producers. Polymerase chain reaction and sequencing methods proved that these isolates were positive for blaIMP-1 genes, whereas none were positive for bla (VIM) genes. The minimum inhibitory concentration (MIC) for imipenem was 128 (µg/mL) for all strains. The MIC and minimum bactericidal concentration (MBC) of M. communis were 6.25 and 12.5 (mg/mL) for all isolates, respectively; the MIC and MBC of Z. multiflora were somehow the same. Methanolic extract of Chamomile showed to have a beneficial effect on this strain, while the Ziziphus leaves methanolic extract showed no significant effect on these isolates.
    Conclusions
    The results of this study reveal that the M. communis extract and methanolic extract of Chamomile have a high antibacterial effect on regular and IMP-producing P. aeruginosa strains; so, these extracts can be suitable alternatives for less-effective antibiotics, which are commonly used.
    Keywords: Metallo, β lactamases, Methanolic Extract, P. aeruginosa
  • Masoud Mardani, Davood Yadegarynia *, Shabnam Tehrani Page 6
    Introduction
    Invasive mucormycosis is an opportunistic fungal infection in patients with predisposing factors.
    Case Presentation
    We report a case of sino-orbito-cerebral mucormycosis in a diabetic patient successfully treated with combination of liposomal amphotericin B (L-AMB) and posaconazole.
    Conclusions
    Clinicians should be alert of the clinical presentation of this fulminant fungal infection and notice that prompt diagnosis can be life-saving. Moreover, combination regimens may be considered as an option of treatment failure.
    Keywords: Mucormycosis, Diabetes Mellitus, Liposomal Amphotericin B, Posaconazole
  • Zahra Arab, Mazar, Mohammad Hossein Zamanian*, Davood Yadegarynia Page 7
    Introduction
    Toxoplasmosis is caused by infection with the obligate intracellular parasite Toxoplasma gondii. Toxoplasmosis is generally a late complication of HIV infection and usually occurs in patients with CD4+ T-cell counts below 200 cells/µL.
    Case Presentation
    A case of cerebral toxoplasmosis is reported in a healthy 39-year-old woman who was admitted to hospital with the complaint of a headache. Gadolinium-enhanced brain magnetic resonance imaging (MRI) showed an irregular, ring enhancing, hyperintense lesion in the right temporoparietal lobe. Toxoplasma serology revealed raised IgG antibody levels. Based on the MRI features, biopsy, and serology, a diagnosis of cerebral toxoplasmosis was made.
    Conclusions
    Cerebral toxoplasmosis can occur outside the setting of advanced HIV immunodeficiency or drug-induced immunosuppression. This highlights the fact that it should be considered in the differential diagnosis of opportunistic infections in HIV-negative patients.
    Keywords: Cerebral Toxoplasmosis, Non, HIV Patient, Headache
  • Ali Karimi, Reza Imani, Rastabi, Masoumeh Moezzi, Mohammad, Taghi Moradi* Page 8
    Background
    Recently, the epidemiology of hepatitis A virus (HAV) infection has been changing sue to lifestyle-related variations. To our knowledge, there are no published data about the seroepidemiology of this infection in Shahrekord, central Iran, by which decisions on the commissioning of a vaccination program could be made.
    Objectives
    This study aimed to assess the seroprevalence of HAV immunoglobulin G (IgG) antibody at the Shahrekord Center of Chaharmahal and Bakhtiari province, southwest Iran.Patients and
    Methods
    In this cross-sectional study, using the multistage cluster sampling method, a total of 501 serum samples from the same number of individuals over 15 years in both urban and rural areas of Shahrekord, during 2013 were tested for HAV IgG antibody using enzyme-linked immunosorbent assay (ELISA). The data were analyzed using the Pearson chi-square test. Logistic regression was also used to calculate odds ratios (ORs) with 95% confidence intervals (CIs).
    Results
    It was found that 455 out of 501 (90.8%) serum samples, including those of 211 (42.1%) men and 290 (57.9%) women, were positive for HAV IgG antibody. Education level, age, marital status, and ethnicity were associated with HAV seropositivity in the studied individuals (P < 0.05).
    Conclusions
    The HAV seroprevalence of 90.8% in the studied region may be representative of a highly endemic region of HAV that does not require a vaccination program to be commissioned.
    Keywords: Hepatitis A virus_Seroprevalence_Antibodies_Iran_Epidemiology