Archives of Clinical Infectious Diseases
Volume:11 Issue: 4, Oct 2016

Context: The wild polio virus is disrupted in all countries in the world, except Afghanistan and Pakistan, the two neighboring countries of Iran. Because of illegal migrations and some geographical, socioeconomic and managerial problems, Iran is exposed to reemerging of the disease. The current study aimed to assess the condition of the disease in Iran and propose preventive measures..
Evidence Acquisition: Authors extracted and evaluated 33 relevant articles among 189 polio related abstracts. The key words were: polio, poliomyelitis, polio eradication, oral polio vaccine (OPV), inactivated polio vaccine (IPV), acute flaccid paralysis (AFP), vaccination derived paralysis (VDP) and Iran. PubMed was used as an international site and IranMedex as a national motor search to assess the subject..
Since 2001, Iran is recognized as a polio free country by world health organization (WHO). Afghanistan and Pakistan, the two neighboring countries of Iran, are still infected with wild poliovirus. About 2.5 million Afghan refugees live in Iran and they communicate with their compatriots. Iran and its neighbors are different regarding vaccination coverage rates, rate of access to safe drinking water, political, security and cultural issues, health system and managerial indicators..
Health managers in Iran should continuously monitor the coverage of vaccination with at least three doses of OPV in the level of over 95%, monitor the health of the Helmand River water which comes from Afghanistan to Iran, vaccinate the immigrants and replace bivalent vaccine (bOPV) with trivalent (tOPV) vaccine..

Hydatidosis is an infectious disease resulting from the development of the larval form of the parasite Echinococcus granulosus in humans. The invasion of the chest wall by echinococcosis is rarely described..
The current study reported all cases of chest wall hydatidosis treated in the department of cardiothoracic surgery from January 1990 to December 2011..
The mean age of the patients was 41.3 ± 16.8 years. Males and females were equally affected. The cysts mostly were located at ribs (13 cases) and ribs with vertebrae (10 cases). The chest wall muscles, the sub-cutaneous tissue and the sternum were involved in four, three and two cases, respectively. A costal resection was performed in 13 cases (one to three ribs; mean, 1.5 ribs) and a costovertebral resection was performed in 10 cases (transverse process three, vertebral body four and both three). The other surgical procedures were partial resection of the sternum (two cases) and cystectomy with resection of parietal soft tissue (nine cases). The outcome was favorable for 29 patients. A recurrence was observed in two patients who presented costovertebral and sternal involvements..
The chest wall localization of the hydatid cyst is rare. In the costovertebral involvements, this parasitic disease behaves locally as a bone malignancy. The treatment is surgical and the resection should be large and radical to avoid recurrences..

Enterococci are a natural part of the genito-intestinal and gastrointestinal normal flora in humans and are widely distributed in the environment and are one of the most important causes of nosocomial infections..
The aim of this study was to identify Enterococcus spp. from vaginal samples of pregnant women and measure their antibiotic resistance patterns..
This descriptive study was performed on 602 strains. Vaginal swabs were cultured for Enterococcus spp. from pregnant women at 35 - 37 weeks of pregnancy in Kerman city, Iran, during April 2013 to March 2014 or in labor samples transported to the laboratory using Amies transport medium. Swabs were cultivated in Todd Hewitt broth medium and subsequently plated on blood agar plates containing gentamicin and nalidixic acid. Antimicrobial susceptibility testing was performed for enterococci by disk diffusion and minimum inhibitory concentrations (MIC)..
Vaginal colonization of Enterococcus genus was 8.14%. Parameters of age, parity, history of abortion, history of ruptured membranes, vaginal discharge and other vaginal signs (itching and so on) had no influence on vaginal colonization of Enterococcus spp. The predominant species were respectively E. faecalis 89.8%, E. faecium 6.1% and other Enterococcus spp. 4.1%. All samples were susceptible to gentamicin and amoxicillin and MIC for gentamicin and amoxicillin was 2 to 8 μg mL-1 and 0.5 to 8 μg mL-1, respectively. Resistance to ciprofloxacin was 6.4%, while its MIC range was 8 to 16 μg mL-1..
In this study none of the isolates were resistant to vancomycin, while 20% of isolates with MIC of 4 μg mL-1 had intermediate reaction to it. Other demographic parameters had not correlation with vaginal colonization of enterococci..

Methicillin-resistant Staphylococcus aureus (MRSA) strains are known as one of the most common causes of infection in humans and animals can produce a variety of virulence factors such as enterotoxins. Staphylococcal food poisoning is one of the most common food-borne diseases in the world..
The current experimental study aimed to isolate and determine the clonality of MRSA strains isolated from chicken meat samples, and describe the presence of different prophage types, enterotoxin genes and also the expression of Staphylococcus cassette chromosome mec (SCCmec) gene types..
During six months in 2014, a total of 36 chicken meat samples were collected from Isfahan local markets and analyzed to screen MRSA strains. All isolates were typed using high resolution automated Phene plate (PhP) system and tested for the presence of different enterotoxin genes. Different staphylococcal cassette chromosome mec (SCCmec) and prophage types were determined..
All 116 isolated MRSA strains were discriminated into seven PhP types consisting of seven common types (CTs) and were positive for mecA gene. All isolates harbored SCCmec type III and SGF, SGFa and SGFb prophage types. Genes encoding enterotoxins SEA, SEK and SEQ were detected in all MRSA isolates..
These findings illustrated the presence and persistence of clonal groups of MRSA strains, in chicken meat in Isfahan, Iran, that serve as reservoirs to disseminate bacteriophage encoded enterotoxin and virulence agents..

Health-care workers (HCWs) are considered as high-risk groups of acquiring hepatitis B infection due to their occupational exposure. Hepatitis B vaccination is the best protective method..
The current study aimed to evaluate the coverage and long-term immunity in HCWs and the impact of the occupational health department to improve the performance of a vaccination program..
This retrospective descriptive study was conducted in two academic hospitals of Tehran, Iran, in the occupational health department from October 2012 to September 2013..
Of 665 subjects, 620 (93%) received complete series of hepatitis B vaccine; anti-HBs level was adequate in 94.4% of vaccinated HCWs. The rate of non-responders after revaccination was below 1%. Nurses were significantly more likely to have protective anti-HBs levels than other groups (odds ratio = 2.1; 95% CI: 1.05 - 4.19).There was no significant association between demographic characteristics and immunity responses. The time between vaccination and the time of anti-HBs level ranged from 0 to 23 years. It was found that anti-HBs did not decline over the time..
The hepatitis B vaccination coverage was more than many studies in other countries. It seems that the vaccination program of the current study had sufficient efficacy for medical surveillance of HCWs in the academic hospitals under study. The essential point for success at a vaccination program was good performance of occupational health department..

The occurrence of invasive Candida infections has increased during the past two decades as a result of increasing in the number of immunocompromised patients..
In this study (cross sectional design), during six months, the prevalence patterns of Candida species isolated from sterile body sites of patients admitted to the general hospital of Milad Intensive Care Units (ICUs) in Tehran (Iran), were determined..
Candidal isolates were obtained from 50 patients admitted to Milad ICUs from April to September 2013. Identification of the isolates was performed using morphological and Polymerase Chain Reaction assay. For identification of Candida at the species level, degenerated and specific primers based on the genomic sequences of DNA topoisomerase II of Candida species were used and their specificities tested by PCR-based identifications..
A total of 67 Candida isolates were obtained from 50 patients. Out of 67 Candida isolates, 47.8% were C. glabrata, 28.3% were C. albicans, 7.5% were C. tropicalis, 7.5% were C. guilliermondii, 3% were C. krusei and 4.4% were C. dubliniensis. The main patient group affected by candidal infections was aged 50 to 70 years. Overall, 11.7% of patients had cancer while other diseases such as diabetes were less reported. The mean time of stay at the ICU before identification was 25.3 days (ranging from 2 to 120 days)..
Increase in the prevalence of non-C. albicans species in the recent years has become a problematic event amongst clinicians caring for ICU patients. Candida glabrata is the most common species isolated from ICU patients in comparison with other species in this study. These findings emphasized on the significance of organizing treatable prevention programs..

Human Immunodeficiency Virus (HIV)-1 infection is one of the most important infectious diseases in Iran, and common isolates belong to the new CRF35_AD subtypes. The Gp120 protein, which is located on the surface of the HIV envelope, plays a role in entrance into host cells and immune responses. As there isn’t any clear analysis of the envelope protein of Iranian isolates regarding potential variations, structural and immunological properties, in the current study we attempted to research in this area..
The present study was designed to demonstrate the immunoinformatics of gp120 of human immunodeficiency virus Type 1 subtype CRF35_AD, isolated from Iranian patients..
In this analytical perspective bioinformatics study, the steps were as follows; data collection and sequence classification (303 sequences), finding the mutational/conserved regions, evaluation of N-linked glycosylation sites, prediction of tertiary structures, model validation, and prediction of conformational and linear B-cell epitopes..
High degrees of sequence variation in the CRF35_AD subtype and also more than 10 variation sites in gp120 protein segments were identified. The total N-linked glycosylation sites for selected complete env sequences in NX [ST] pattern and the NXS and NXT combination count revealed that most of the glycosylation sites were conserved. Tertiary structure was obtained by homology modeling, and the Ramachandran plot assessment showed model validity. Finally, mapped consensus discontinuous immunogenic regions (epitopes) were AA25-65, AA337-365 and AA443-505..
The obtained results provide a background for understanding CRF35_AD molecular characteristics, as well as design and development of effective HIV-1 vaccines and immunotherapeutic regimens against CRF35_AD subtype..

Invasive fungal sinusitis (IFS) is a potentially deadly infection especially in patients with immunocompromising conditions..
The current study aimed to evaluate the clinical manifestations, outcomes and factors that may affect survival of patients with IFS..
A cross sectional descriptive study was performed on hospitalized patients admitted to Taleghani hospital affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran, from October 2012 to October 2013. The clinical data of 24 patients with IFS were reviewed. All patients had hematologic malignancies, and received broad spectrum chemotherapy. Demographic data, clinical characteristics, presented symptoms and signs, underlying diseases and outcomes of the patients were studied..
The age range of patients was 15 - 60 years. The IFS was proven, probable and possible in 25%, 66.7% and 8.3% of the cases, respectively. Serum galactomannan antigen was positive in 41.6% of the cases; 15 out of 24 cases with IFS had received antifungal chemoprophylaxis before diagnosis, 54% fluconazole and 8.3% itraconazole. Aspergillus flavus (33%), Aspergillus fumigatus (20.8%), Aspergillus niger (16.7%) and Mucor spp. (16.7%) were responsible for incidence of IFS; 54% of IFS cases occurred in summer and 91.6% of occurred during hospital construction; a risk factor in 91.6% of the cases..
Current study revealed that A. flavus was the most common isolated pathogen. Moreover, A. fumigatus was the second common isolated pathogen in patients with IFS. Additionally, the hospital construction was an important environmental risk factor for acquisition of infection in patients with hematological malignancy. The most common season for IFS incidence was summer. Additionally, the common causes of death in patients with IFS were primary disease and also resistance to chemotherapy (37.5%)..

A large number of epidemiological evidence in humans and experimental studies in rodents have hypothesized that Toxoplasma gondii is a potentially relevant etiological factor in some mood disorders..
The aim of this study was to investigate whether latent toxoplasmosis has any role in mood disorders such as schizophrenia and bipolar disease in Western Iran..
Patients and A total of 170 patients including 85 schizophrenia and 85 bipolar patients referred to the only psychiatric hospital in Lorestan province in Khorramabd city, Western Iran, and 170 healthy volunteers were screened for IgG and IgM anti-T. gondii antibodies by the Enzyme Linked Immunosorbent Assay (ELISA). Structured questionnaires were used to obtain information on risk factors for T. gondii infection..
Out of the 170 psychiatric patients, 103 (63.5%) patients were seropositive for IgG antibody and 14 (8.2%) were seropositive for IgM antibody. Of the 85 bipolar patients, 54 (63.5%) and 6 (7%) were found positive for anti-T. gondii IgG and IgM antibodies, respectively; whereas among 85 schizophrenia patients, 49 (57.6%) and 8 (9.4%) samples were found positive for anti- T. gondii IgG and IgM antibodies, respectively. From 170 healthy volunteers, 73 (42.9%) tested seropositive for anti-T. gondii antibodies; 65 (38.2%) tested seropositive for IgG antibody and 8 (4.7%) tested seropositive for IgM antibody. There was a significant difference in T. gondii IgG positivity between the psychiatric patients and control groups (P = 0.009). Several risk factors, which were significantly related to T. gondii seropositivity in psychiatric patients are being in contact with cats (P = 0.004), eating unwashed raw vegetables (P We concluded that psychiatric patients in general and schizophrenia and bipolar cases in particular had a significantly higher relative frequency of T. gondii infection than healthy individuals of Lorestan Province, Western Iran..

Candida spp. are members of a genus, including closely related fungal species that cause a variety of infections..
The aim of this study was the isolation of various Candida species from vulvovaginitis and urethra of patients in Neyshabur, Northeast Iran from 2013 to 2015..
This descriptive-analytical and cross-sectional study was performed to identify Candida spp. causing vulvovaginitis and Urinary Tract Infection (UTI) at a referral laboratory in Neyshabur district, Khorasan Razavi Province. A total of 451 vaginal and midstream urine samples were collected. Ten micro-liters of each specimen was cultured on CHROM agar plates and then incubated at 37°C for 24 to 48 hours, aerobically. Candida species were identified based on colony morphology, germ tube production and micro-morphology on corn meal agar including 1% Tween 80..
The mean age of the patients was 34.7 ± 16.3. Candida albicans was the predominant species isolated. Moreover, age groups of 21 to 30 and 0 to 1 years were the most and the least infected individuals. Moreover, Candida spp. were significantly more common in females compared to males (P value 103..
In this study, C. albicans was the most common species isolated from patients with vulvovaginitis and UTI, and significantly more common amongst females compared to males. The prevalence of candida spp. had significantly declined from 2013 to 2015. Moreover, the candida spp. counts were mostly higher than 103cfu/mL..

Demographic transition and increasing elderly population in Iran can be associated with age related disorders such as dementia. Recently, Helicobacter pylori infection was considered as a risk factor for cognitive impairment..
This study aimed to examine this relationship between H. pylori infection and cognitive impairment in Iranian elderly..
This cross-sectional study was performed on elderly subjects initially enrolled in the Amirkola health and ageing project. Demographic information was collected using a questionnaire and all participants filled the mini-mental state examination (MMSE) questionnaire. The maximum MMSE score is 30 points. Scores of 25 to 30 out of 30 are considered normal 21 to 24 as mild, 10 to 20 as moderate and 20 ur/mL was considered positive..
The study was performed on 1514 individuals with an average age of 69.3 ± 7.4 years. Overall, 836 (55.2 %) of the participants were male. Furthermore, 68.7% of the participants had normal MMSE score and 75.7% were seropositive for H. pylori. The risk of cognitive disorder in H. pylori positive patients (29.8%) was lower than H. pylori positive patients (35.9%) (RR = 0.81, CI95% = 0.67 - 0.97). No significant correlation was detected between H. pylori antibody level and MMSE score (r = 0.039, P = 0.129)..
In our population of elderly individuals in northern Iran, H. pylori infection was not associated with cognitive impairment in this large population..

Nosocomial Staphylococcus aureus is known as an important clinical pathogen in health care, hospital, and community settings. One of the serious threats associated with clinical isolates of Staphylococcus aureus is multi-drug resistance associated with integrons..
The objective of the present study was to investigate antimicrobial susceptibility patterns, frequency of class 1 and 2 integrons, and associated gene cassettes in different spa types of Staphylococcus aureus isolated from intensive care units (ICUs)..
During a five-month descriptive cross-sectional study, 80 Staphylococcus aureus strains isolated from hospitalized patients in ICU wards in five hospitals of Tehran, Iran were investigated. Staphylococcus aureus isolates were submitted to susceptibility testing and Polymerase Chain Reaction (PCR) to detect mecA gene, class 1 and 2 integrons, and associated gene cassettes. All the isolates were genotyped by staphylococcal protein A (spa) typing..
The overall prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) was found to be 86.2%. All the isolates were susceptible to vancomycin, teicoplanin and linezolid and resistant to penicillin and ampicillin. All the 80 Staphylococcus aureus isolates were observed to be multi-drug resistant. Class 1 and 2 integrons were commonly found in 56.3% and 18.7% of the isolates, respectively. Six different gene cassettes were detected in class 1 integron (aadA2, aadB, blaoxa, aacA4, cmlA6, and catB) and three were found in class 2 (dfrA1, aadA1, and sat2). Gene cassette arrays aadA, aadB, blaoxa, and aacA were common in the two integron classes of Staphylococcus aureus isolates. Five different spa types of t790, t030, t969, t7580 and t1425 were identified among our isolates where spa type t790 was the most predominant spa type among integron-bearing Staphylococcus aureus strains..
The present study reports on a high rate of multi-drug resistance, the predominance of the frequency of class 1 integron, and the emergence of spa type t790 among Iranian Staphylococcus aureus strains. The results revealed that the dissemination of multi-drug resistance among Staphylococcus aureus isolates may be associated with the presence of integrons. Therefore, continuous surveillance to monitor integrons and the associated gene cassettes among nosocomial pathogens, especially Staphylococcus aureus, is essential..

Pseudomonas aeruginosa and Acinetobacter baumannii are the common causes of nosocomial infections especially among patients with burn injuries..
The current study aimed to determine the frequency of blaIMP, blaVIM, blaDIM, blaAIM, blaGIM and blaNDM genes among P. aeruginosa and A. baumannii strains isolated from patients with burn injuries hospitalized in Shahid Motahari hospital, Tehran, Iran..
The current cross-sectional study evaluated a total of 309 nonduplicate isolates of P. aeruginosa and 189 isolates of A. baumannii collected from different clinical samples of patients with burn injuries in Shahid Motahari hospital in Tehran, Iran, from 2012 to 2015. Antibiotic susceptibility tests were conducted by Kirby-Bauer disc diffusion and broth microdilution methods according to the clinical and laboratory standards institute (CLSI) guidelines. The frequency of metallo-beta-lactamase (MBL) producers was evaluated by the combination disk diffusion test (CDDT). The blaIMP, blaVIM, blaDIM, blaAIM, blaGIM and blaNDM genes were detected by polymerase chain reaction (PCR) and sequencing techniques..
The most effective agent against the studied isolates was colistin. By CDDT, it was found that among 278 imipenem resistant P. aeruginosa strains, 178(64.02%) were MBL producers. The blaIMP-1 and blaVIM-1 genes were detected in 30(16.8%) and 52(29.2%) of P. aeruginosa isolates, respectively. Result of 187 imipenem resistance A. baumannii strains showed that 85(45.4%) were MBL producers. The blaOXA-51, blaIMP-1 and blaVIM-1 genes were detected in 187(100%), 10(5.3%) and 34(18.18%) of A. baumannii isolates, respectively..
The high prevalence of MBLs-producing P. aeruginosa and A. baumannii strains in the study were one of the major concerns..

In the last decade, there has been an accelerated increase in the number of cardiovascular implantable electronic device (CIED) implantations. Similarly, CIED infections have risen significantly with a three-fold augmentation for pacemaker infections and a six-fold augmentation for implantable cardioverter defibrillator (ICD) infections. The complications of CIED infections may be critical, and related infections are associated with heightened risk of mortality. Most patients, who experience symptoms related to CIED infections present either a generator-pocket site inflammation or unspecific symptoms in relation to positive blood cultures or fever of unknown origin. The diagnosis is mainly supported by evidence of cardiac or CIED involvement by transesophageal echocardiography (TEE)..
In this report, we describe a case of a CIED infection in a 49-year-old female, admitted in 2013 to a hospital in Copenhagen, Denmark, with persistent Staphylococcus epidermidis bacteremia without any clinical signs of generator-pocket infection and several negative TEE studies..
The diagnosis of CIED infection was established with Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) scan revealing clear evidence of infection localized to the vascular ICD lead and generator-pocket..

Miliary Tuberculosis (TB) is a rare and lethal form of TB and needs urgent detection and treatment. Miliary TB due to drug-resistant strains of Mycobacterium tuberculosis is even more difficult to manage. We present clinical and bacteriologic findings of a rare case of miliary multi-drug resistant tuberculosis (MDR-TB)..
Our case was a young female patient with in vitro fertilization (IVF) pregnancy, who had radiological diagnosis of miliary TB and had not responded to antituberculous therapy with four drugs. Second line antituberculous drugs were started empirically and definite diagnosis of MDR-TB was obtained by culture and drug susceptibility test of biopsy specimens..
Although very rare, MDR miliary TB can be seen in immunocompetent subjects. We, thereby, emphasize that early recognition and initiation of treatment are associated with a significant improvement in outcomes. Tuberculosis remains a serious worldwide health problem associated with high morbidity and mortality..