فهرست مطالب

Archives of Clinical Infectious Diseases - Volume:12 Issue:1, 2017
  • Volume:12 Issue:1, 2017
  • تاریخ انتشار: 1395/11/23
  • تعداد عناوین: 16
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  • Masoud Mardani * Page 1
  • Batool Sharifi Mood *, Masoud Mardani Page 2
    Context: Dengue fever (DF) is caused by an arbovirus, which transmitted to humans through the bite of an infected mosquito (Aedes species). Near 2.5 billion people are living in regions where the risk of transmission is high. Until the mid of 20th century, DF was restricted to special parts of tropical and subtropical regions. Dengue hemorrhagic fever (DHF) was first reported in the 1950s when two epidemics happened in the Philippines and Thailand. Now, with international travels and climate changes, its geographical distribution has been changed and increased..
    Evidence Acquisition: We searched medical databases (PubMed and Scopus) from March 1960 to Feb 2015. The key words for the review of literature were as follows: dengue, dengue fever, dengue hemorrhagic fever, epidemiology, transmission routes, clinical manifestation, treatment and prevention of dengue..
    Results
    Upon the results from literature search, the researchers found that human is the main reservoir for this virus. There are four serotypes of virus. Infection with one serotype cannot protect human against the other three serotypes. Dengue fever begins suddenly with an onset of an influenza-like syndrome and sometimes progresses to severe form of the disease. Treatment is supportive and includes diminishing the fever and balancing fluids and electrolytes. Real-time polymerase chain reaction assays, IgM and IgG-ELISA, and the NS1 ELISA-based antigen assay are available for diagnosis of DHF. There is no FDA-approved vaccine. Mosquito control is the main way for the prevention of dengue..
    Conclusions
    Dengue virus is not highly contagious and virus cannot be spread directly from person to person. Understanding the epidemiology, clinical manifestation, prompt diagnosis, suitable prevention routes such as mosquito control, and also coordinated effort in the community for disease control are important issues..
    Keywords: Dengue Fever, Dengue Hemorrhagic Fever, Diagnosis, Prevention, Treatment
  • Ebrahim Badparva, Behrouz Ezatpour *, Hossein Mahmoudvand, Masoud Behzadifar, Meysam Behzadifar, Farnaz Kheirandish Page 3
    Context: Blastocystis hominis is a unicellular protozoan found commonly in the intestinal tract of humans and many other animals with multiple subtypes, which tend to be specific to the host. We aimed to apply a meta-analysis for studies of protozoan pathogens in order to obtain a general overview of the prevalence and genotype analysis of Blastocystis spp. in Iran..
    Evidence Acquisition: International electronic databases such as PubMed, Scopus, ISI Web of Science, Ovid, Google scholar, and national databases including SID, Iranmedex and Magiran were searched from 2003 to 2015 for studies that reported the prevalence of B. hominis in Iran. We calculated prevalence estimates with 95% CIs and assessed heterogeneity between studies using the I2 statistic and the Cochran Q test..
    Results
    We included 40 eligible studies in this review. The pooled prevalence of Blastocystis hominis was 3% (95% CI: 3 - 3)..
    Conclusions
    Unlike the world, a ST5 subtype of human cases is common and the reservoir seems to be cattle. ST2 has been found in birds in Iran. Further studies are needed to confirm these important findings and to clarify the possible pathogenesis and reveal whether this is an exception or the rule..
    Keywords: Blastocystis hominis, Subtype, Epidemiology, Iran
  • Shahla Afshar Paiman, Morteza Izadi, Nematollah Jonaidi Jafari *, Reza Ranjbar, Hasan Mohtadi, Hamid Soheylipoor, Ali Akbar Esfahani, Reza Ajudani, Mohammad Hossein Khosravi Page 4
    Background
    Promoting varicella vaccination for military personnel and conscripts, as one of the susceptible and high-risk groups, is an important governmental approach in every society. The present study aimed to address the seroprevalence of this infection and its immunization level among Iranian military conscripts..
    Objectives
    This study was conducted to determine seroprevalence of varicella infection and its immunization level among Iranian military conscripts..
    Methods
    Four hundred and sixty-four conscripts, using cluster-stratified sampling, were selected from all military garrisons in Tehran. Seroprevalence of infection among each participant was determined by measuring varicella IgG antibody level via the enzyme-linked immunosorbent assay (ELISA)..
    Results
    The mean antibody titer among the participants was 109.66 ± 127.47; 86.9% of studied samples were seropositive. Place of residence could somewhat predict the seropositivity against varicella; seropositivity was significantly higher in participants, who lived in the capital city than those who lived in other regions (OR: 4.008, 95%CI: 0.947 - 16.953, P = 0.059). Age, education level, marital status and duration of military were not associated with seropositivity..
    Conclusions
    Susceptibility to varicella infection is considerably lower among military garrisons in Tehran and is mainly dependent on their place of residence. However, the current study could not provide a comprehensive picture of the immunological status of the varicella in Iran military garrisons, and we suggest further studies in more cities to aid with the design of immunization programs for these individuals..
    Keywords: Varicella, Seroprevalence, Military Personnel, Iran
  • Seyedeh Mahya Marashiyan, Fatemeh Moradian, Geita Saadatnia *, Majid Golkar Page 5
    Background
    Infections by the protozoan parasite Toxoplasma gondii (T. gondii) are widely prevalent in human and animals. SRS3 is a member of SRS antigen family (glycosylphosphatidylinositol-linked proteins), which is structurally related to the highly immunogenic surface antigen SAG1. The SAG family of proteins can cover the surface of T. gondii bradyzoites and tachyzoites..
    Objectives
    The aim of this study was to evaluate the recombinant SRS3 protein for diagnosis of toxoplasmosis by enzyme-linked immunosorbent assay..
    Methods
    Indirect immunoglobulin G (IgG) enzyme-linked immunosorbent assays (ELISAs) with recombinant SRS3 and SAG1 proteins of T. gondii were developed to evaluate the diagnosis of infection in pregnant women..
    Results
    The results showed that sensitivity and specificity were respectively 84.12% and 92% forý recombinant protein SRS3 and 92% and 96% for rSAG1..
    Conclusions
    Recombinant proteins SRS3 and rSAG1 are promising antigens in diagnostic assays for detection of specific antibodies against T. gondii..
    Keywords: Toxoplasma gondii, Recombinant Protein SRS3, Recombinant Protein SAG1, ELISA
  • Pantea Esfandiari, Jafar Amani *, Abbas Ali Imani Fouladi, Shahram Nazarian, Ali Mirhosseini, Ebrahim Moghimi Page 6
    Background
    Enterotoxigenic Escherichia coli (ETEC) is the most common agent, which causes diarrhea. ETEC is colonized along the cells and produces enterotoxins leading to diarrhea. Different detection methods have been utilized for detection of ETEC heat Labile Toxin (LT) toxins or respective genes. These methods have disadvantages such as high costs and labor time and limitations in handling many samples simultaneously..
    Objectives
    The aim of this study was detection of LT toxin genes in E. coli clinical strains by polymerase chain reaction-enzyme linked immunosorbent assay (PCR-ELISA)..
    Methods
    This experimental study was conducted on Iranian children communities from May to November 2014. Forty stool samples were obtained from laboratories and investigated for heat-labile toxin (LT). Specific primers were designed and the DIG -labeled PCR products were bounded to streptavidin-coated wells of a microtiter plate and detected by anti-DIG-peroxidase conjugate. An internal biotin-labeled probe was designed for LT gene and detected with streptavidin. Sensitivity and specificity of the PCR-ELISA method were determined using Enterobacteria strains..
    Results
    Overall, 7.5% of clinically isolated strains were detected as LT positive. The specificity of PCR-ELISA method was 100%. The detection limit of PCR-ELISA was 1.9 pg of genomic DNA..
    Conclusions
    Results showed that this method is fast and sensitive for diagnosing bacteria. Polymerase chain reaction-ELISA is a suitable substitute for all the above factors because it is a quite sensitive, specific and rapid way for detection of LT toxin gene from ETEC strains..
    Keywords: Enterotoxigenic Escherichia coli, Heat-Labile Enterotoxin, Diarrhea, PCR, ELISA
  • Mohammad Reza Arabestani *, Seyed Masoud Mousavi, Mona Nasaj Page 7
    Background
    Group B Streptococcus (GBS) is major cause of serious life threatening infections including sepsis, pneumonia and meningitis in neonates as well as in pregnant women. Capsular polysaccharide typing is significant and essential for epidemiological studies of GBS..
    Objectives
    The aim of the current study was to differentiate genotypes of GBS clinical isolates based on the polymerase chain reaction (PCR) to acquire information about distribution of GBS types in Hamedan, Iran..
    Methods
    In this experimental study we used sixty-two GBS clinical strains isolated from vaginal swabs (n = 16), urine cultures (n = 45) and blood culture (n = 1) of patients, who had referred to educational hospitals and private clinic centers during nine months from June 2013 to February 2014 in Hamedan, Iran, for genotyping using multiplex PCR assay..
    Results
    Among the 62 GBS isolates examined, all capsular types except for VI, VII and VIII were found. Types III and V were the most prevalent types with a sum of 46 isolates (74.2%). Type III was the predominant type with 35 (56.5%) isolates, followed by type V (11 isolates; 17.7%), type II (seven isolates; 11.3%), type Ia (five isolates; 8.1%) and Ib and IV with similar prevalence of two isolates (3.2%)..
    Conclusions
    The results of the current study demonstrated that type III is the predominant type in Hamedan, followed by types V, type II, type Ia, Ib and IV, respectively. Use of the molecular serotyping (MS) method such as PCR assay as an alternative to conventional serotyping (CS) method leads to accurate, sensitive, specific, and fast typing of GBS isolates..
    Keywords: S. agalactiae, Multiplex PCR, Genotyping, Capsule
  • Roohangiz Nashibi, Sara Afzalzadeh, Mohammad Javad Mohammadi, Ahmad Reza Yari, Farid Yousefi * Page 8
    Background
    Mucormycosis is an uncommon life-threatening fungal infection. The major risk factors of this infection include uncontrolled diabetes mellitus, prolonged steroid therapy, persistent neutropenia, hematological malignancies, autoimmune disorders, trauma, burns and surgical wounds..
    Objectives
    The current study aimed to determine the epidemiology and treatment outcome of mucormycosis in Khuzestan province, southwest of Iran..
    Methods
    This cross-sectional study was performed during a period of 10 years from April 2004 to March 2014 at Razi hospital in Ahvaz, southwest of Iran, during years 2004 to 2014. Demographic data, laboratory data, clinical features, antifungal treatment, the need for surgical debridement and the outcome were collected. Data were summarized using descriptive statistical methods and analyzed by SPSS version 15 software..
    Results
    The study included 20 patients with a biopsy-proven diagnosis of mucormycosis. Regarding the findings, the mean age was 51.4 ± 9.7 years. Eighty-five percent of patients had uncontrolled diabetes mellitus. Findings showed that all the cases received amphotericin B, but surgical debridement was performed on 10 patients (50%). Most prevalent season of mucormycosis was winter (40%)..
    Conclusions
    Prognosis of patients that underwent surgery and medical therapy was significantly better than medical therapy alone (90% vs. 50% patient’s survival)..
    Keywords: Mucormycosis, Epidemiology, Outcome
  • Maliheh Metanat, Batool Sharifi Mood, Masoud Salehi *, Alireza Ansari Moghaddam, Mohammad Rakhshani, Nahid Sepehri Rad Page 9
    Background
    Crimean-Congo hemorrhagic fever (CCHF) is an endemic disease in south eastern of Iran, especially in Sistan and Baluchestan province. CCHF is a potentially fatal disease. Many factors are suggested for the prediction of severity in this disease..
    Objectives
    In this study, the viral load in patients admitted to Boo-Ali hospital was determined and the association between viral load and disease severity was evaluated based on DIC severity score in patients with CCHF..
    Methods
    In this analytical cross-sectional study, we studied patients with confirmed CCHF who were admitted to Boo-Ali hospital, Zahedan, from September 2012 to March 2014. The patients were divided into two groups based on DIC severity score. Then, the viral load in the patients was measured by using RNA as a template for RT-PCR (QIAgene OneStep SYBR GREEN qRT-PCR smart mix) and finally, the two groups were compared. The results were analyzed using SPSS 20.0 (SPSS Inc.). To investigate the correlation between viral load and disease severity, and also to find the viral load differentiating mild cases from severe cases, ROC curve, Mann–Whitney U test, and Independent t-test were used..
    Results
    The total number of patients with confirmed CCHF under the subject of study was 37 (84% male and 16% female) in age range of 17 to 58 years (31.1 ± 12.2). The mean viral loads on the first and fifth days of admission were 1.3 × 106 and 3.7 × 105 copies/mL, respectively. After grouping patients based on DIC severity, the mean viral load on the first day of admission was 3.2 × 105 copies/mL in the mild CCHF group and 4.3 × 106 copies/m in the severe CCHF group. The viral load had a direct correlation with CCHF severity (P ≤ 0.001). Serum viral load that differentiated between mild and severe cases of CCHF was determined as 8.6 × 105 copies/mL with sensitivity of 100%, specificity of 92%, positive predictive value of 82%, and negative predictive value of 100%..
    Conclusions
    The viral load in patients who suffer from CCHF has a direct significant correlation with disease severity. Viral load above 8.6 × 105 copies/mL on the first day of admission is a predictor of severe CCHF..
    Keywords: Crimean-Congo Hemorrhagic Fever Virus, Disseminated Intravascular Coagulation, Real-Time Polymerase Chain Reaction
  • Davood Kalantar Neyestanaki, Maryam Koshesh, Zahra Hashemizadeh, Shahla Mansouri, Abbas Bahador, Mohammad Savari * Page 10
    Background
    Most urinary tract infections (UTIs) are caused by Escherichia coli (E. coli) species. Due to infections outbreaks of E. coli strains with multiple mechanisms of resistance to β-lactam antibiotics, the sensitivity of confirmatory tests to detect the extended spectrum β-lactamases (ESBLs) have decreased..
    Objectives
    The current study aimed to introduce a modified method to detect ESBLs in Gram-negative bacilli..
    Methods
    Totally, 86 clinical isolates of E. coli resistant to extended-spectrum cephalosporins were collected from patients with UTIs in Kerman, Iran. The susceptibility to antibiotics was determined by disk diffusion method. ESBLs producing isolates were identified by combination double disk synergy test (CDDST) and β-lactamase disk test. The β-lactamase genes including blaTEM, blaSHV, blaCTX-M, blaOXA-1 and blaPER were detected by polymerase chain reaction (PCR) method and sequenced..
    Results
    All of the isolates were multidrug-resistant (MDR). In the current study 88% and 97.6% of the isolates were considered as ESBLs producing by CDDST and β-lactamase disk test, respectively. At least 92% of the isolates were positive for one of the blaCTX-M, blaTEM, blaOXA-1 and blaSHV genes. The blaCTX-M, blaTEM, blaOXA-1 and blaSHV genes were detected in 74.4%, 61.6%, 14% and 2.3% of the isolates, respectively..
    Conclusions
    The β-lactamase disk test is appropriately sensitive to detect ESBLs in MDR isolates of E. coli..
    Keywords: Escherichia coli, Multidrug-Resistant, ?-lactamase
  • Mohsen Taheri, Mohammad Naderi *, Mohammad Hashemi, Marzieh Abiri, Maryam Sarabandi Page 11
    Background
    Interleukine-12 (IL-12) induced interferon-γ (IFN- γ) production and development of T cells into Th1 cells, which has a critical role in immunity to intracellular pathogens..
    Objectives
    The current study aimed to evaluate the possible association between IL12A rs568408, IL12B rs3212227 as well as IL-12 receptor (IL-12R) rs383483 polymorphisms and pulmonary tuberculosis (PTB)..
    Methods
    This case-control study was conducted on 174 confirmed PTB patients and 177 healthy subjects in a sample of southeast Iranian population. Genotyping was performed by the tetra amplification refractory mutation system- polymerase chain reaction (T-ARMS-PCR) method..
    Results
    The frequencies of GG, GA and AA genotypes of IL12A rs568408 variant in cases and controls were 58.9%, 38.5%, 1.7% and 61.6%, 37.3%, 1.1%, respectively. Regarding rs3212227 variant, the frequencies of AA, AC and CC genotypes in cases and controls were 47.1%, 54.4%, 7.5% and 50.8%, 43.5%, 5.7%, respectively. Concerning IL12R rs383483 polymorphism, the frequencies of AA, AG and GG in cases and controls were 39.1%, 31.4%, 29.5% and 40.2%, 25.3%, 34.5%, respectively. There was no significant difference in allele and genotype frequency of IL12A rs568408, IL12B rs3212227 and IL-12R rs383483 polymorphisms between patients with PTB and control groups (P > 0.05)..
    Conclusions
    The findings of the current study show that neither IL12A rs568408 and IL12B rs3212227 nor IL-12R rs383483 polymorphisms are associated with the risk of PTB in our population. Further studies with larger sample sizes and various ethnicities are needed to certify our findings..
    Keywords: IL-12, IL-12R, Polymorphism, Pulmonary Tuberculosis
  • Masoud Dadashi, Gita Eslami *, Ebrahim Faghihloo, Ali Pourmohammad, Jalil Hosseini, Robabeh Taheripanah, Zahra Arab Mazar Page 12
    Background
    Ovarian carcinoma is the most common malignancy in women and is a cancer with a 15% - 50% prevalence in the world. Human papilloma virus (HPV) is considered a factor in cervical and ovarian cancer (OCa) and is related to squamous cell carcinoma in the cervical region. The effect of fixed infection may cause chronic inflammation, in the cancer of ovaries it has received very rare attention, although a background of pelvic inflammatory disease (PID) in a case-control study is associated with a higher risk for ovarian carcinoma. HPV-16 is one type of HPV and the most common and important cause of cervical carcinoma in the developed world..
    Objectives
    The aim of this investigation was to evaluate the incidence of HPV-16 in patients with OCa who referred to Imam Hossein hospital of Shahid Beheshti University of Medical Sciences, Tehran, Iran..
    Methods
    In this case-control study that was conducted since May 2015 to October 2015 in Tehran, 140 samples were studied which were obtained from patients with OCa. After obtaining the samples from OCa tissue by a pathologist, for DNA extraction, samples were transferred to the laboratory of the university. DNA was extracted with Kit (intron biotechnology Co. Korea) according to the manufacturer’s instructions. To confirm the presence of HPV-16 in the samples of OCa, specific primers for the L1 gene of HPV were designed and standard PCR method was used for the detection of HPV. PCR product was sequenced to confirm the presence of HPV-16..
    Results
    Out of 140 samples of OCa, 70 (50%) samples were malignant cancer and 70 (50%) were benign cancer as the control group. Out of 70 malignant samples 25 (36.0%) were HPV-16 positive. 2.8% of the tissue samples of the control group were positive for HPV-16..
    Conclusions
    These results show a feasible role of HPV-16 in the carcinogenesis of OCa. According to these results, infection with HPV may play a relative role in the spread of OCa or it could comfort its development..
    Keywords: HPV, Ovarian Cancer, Malignancy, PCR
  • Mojtaba Kashfi, Ali Hashemi, Gita Eslami *, Mehrzad Sadredin Amin, Samira Tarashi, Elahe Taki Page 13
    Background
    The prevalence of resistance to aminoglycosides among P. aeruginosa isolates has increased all around the world. The resistance is caused through different mechanisms. One of these mechanisms is the use of enzymes such as phosphoryltransferases, acetyltransferases, and nucleotidyltransferases..
    Objectives
    The present study was conducted to determine the prevalence of Aph (3′)-Ib, Aph(6′)-VI, rmtA, aac (6′)-IIa, aadA, aadB, and armA genes among P. aeruginosa strains isolated from burn patients located in Tehran, Iran..
    Methods
    This descriptive study was performed on patients hospitalized at the Shahid Motahari burn hospital during August 2014 to July 2015. Antibiotic susceptibility tests were performed by disc diffusion and minimum inhibitory concentration methods. Aph (3′)-Ib, Aph (6′)-VI, rmtA, aac (6′)-IIa, aadA, aadB, and armA genes were detected by PCR..
    Results
    60 isolates were evaluated for antimicrobial susceptibility testing. The resistance of P. aeruginosa isolates to the tested antibiotics was as follows: 56 (94%) to ciprofloxacin, 57 (95%) to gentamicin, 57 (95%) to Imipenem, 57 (95%) to meropenem, 56 (94%) to doripenem, 49 (82%) to piperacillin-tazobactam, 58 (97.2%) to amikacin, 45 (75%) to ceftazidime, 59(98%) to Ticarcillin, 56 (93%) to Cefepime, 54 (90%) to piperacillin, 54 (90%) to Aztreonam, and 0 (0%) to colistin. Minimum inhibitory concentration (MIC) for amikacin and Gentamicin was determined according to the guidelines of CLSI. The highest resistance rate according to the MIC method was observed for Gentamicin and amikacin in 128 (40%) and 256 (92%) of the isolates, respectively. In this study, 94% of the isolates were multiple drug resistance (MDR). The prevalence of Aph (3′)-Ib, Aph (6′)-VI, rmtA, aac (6′)-IIa, aadA, aadB, and armA genes were 60%, 85%, 45%, 10%, 87.5%, and 55% according to the PCR, method respectively..
    Conclusions
    This study detected multiple drug resistance (MDR) in P. aeruginosa including aminoglycosides. Therefore, identification of drug resistance patterns in P. aeruginosa is of great importance in prevention and control of infections in burn patient centers..
    Keywords: P. aeruginosa, Multi Drug Resistance (MDR), Burn Patient, Aminoglycosides, Aminoglycoside-Modifying Enzymes
  • Roghayeh Norouzi *, Arman Manochehri Page 14
    Introduction
    Myiasis is a parasitic infestation of the animal or human body, caused by dipterous fly larvae feeding on the host’s necrotic or living tissues. Intestinal myiasis is usually an accidental phenomenon, which can be caused by the ingestion of fly larvae present in food or water..
    Case Presentation
    Herein, we present a case of accidental human intestinal myiasis, caused by Lucilia illustris larva in a 45-year-old rural woman, who was admitted to the hospital with specific abdominal pain and loose stool. The stool examination of the patient revealed L. illustris larva. Following the excretion of larva, the symptoms completely resolved within a few hours, and the patient remained asymptomatic several weeks later..
    Conclusions
    Intestinal myiasis in humans is probably an accidental myiasis, related to the ingestion of contaminated uncooked food or water containing fly larvae, especially in individuals with poor hygienic conditions. Nevertheless, this is the first reported case of intestinal myiasis due to L. illustris in Iran..
    Keywords: Intestinal Myiasis, Iran, Lucilia illustris
  • Iraj Sedighi, Shahla Nouri, Taravat Sadrosadat* Page 15
    Introduction
    Identification of the etiology of limping and gait disturbances in children necessitates accurate physical examination and history taking. Although serious conditions such as septic arthritis and Guillain-Barre syndrome are usually prioritized in the differential diagnosis of limping, benign disorders such as benign acute childhood myositis (BACM) should not be discarded..
    Case Presentation
    During the recent H1N1 influenza pandemic in the fall and winter of 2015 - 2016 in Hamadan, Iran, three school children presented to our clinic with limping and abnormal gait. Precise history taking, in addition to accurate physical examination and simple laboratory tests, confirmed the diagnosis of myositis. The patients were discharged soon after complete recovery..
    Conclusions
    Based on the findings, in case a child suffers from calf pain or gait disturbances during influenza outbreak, the possibility of BACM should be considered before performing laboratory tests, radiological examinations, or other investigations..
    Keywords: Limping, Children, Influenza, Myositis
  • Massoud Mardani, Narges Aslani, Mohsen Geramishoar, Sadegh Khodavaisy, Sahar Mohseni, Hamid Badali * Page 16
    Introduction
    Nocardia species are described as opportunistic pathogens that mainly cause pulmonary nocardiosis in immunocompromised individuals, particularly in patients with acquired immune deficiency syndrome (AIDS), intravenous drug abusers, strongly burned victims, the Cushing syndrome, the ones underlying transplantation, and prolonged use of corticosteroids..
    Case Presentation
    The current paper reported a case of disseminated nocardiosis in a 28-year-old Iranian male who had type 2 diabetes mellitus with prolonged use of corticosteroid for the last 5 years. He was admitted to the department of infectious diseases at Shahid Beheshti hospital, Tehran, Iran, following a complaint of pneumonia (chest pain) and presented a subcutaneous purple nodule on the left thigh without pain. Direct microscopic examination revealed numerous filamentous branching and rod-shaped bacilli. The tentative diagnosis of chronic inflammation with nocardiosis was made. In addition, tiny, chalky white and irregular colonies emitting an earthy odor appeared on blood and chocolate agar and were identified as Nocardia brasiliensis by sequencing of 16S rRNA gene as a valuable method to identify clinical isolates. Combination therapy was performed by entire surgical excisions and intravenous TMP-SMX (160/800 mg/bid; IV) and meropenem 1g/tid. The patient’s condition improved after 8 days and he was discharged..
    Conclusions
    Combination therapy with surgical excision has a synergistic effect and appears to be the best treatment for extended lesions. However, new potent antibacterial drugs may help to improve the management of such infections when there are sufficient data on their in vitro activity..
    Keywords: Disseminated Infection, Immunocompetent, Opportunistic Agent, Nocardia brasiliensis