فهرست مطالب

Archives of Clinical Infectious Diseases - Volume:13 Issue:2, 2018
  • Volume:13 Issue:2, 2018
  • تاریخ انتشار: 1397/03/30
  • تعداد عناوین: 12
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  • Fereshteh Rahimipour, Kiarash Ghazvini, Masoud Youssefi * Page 2
    Context: Staphylococcus aureus is one of the most important pathogens worldwide. The emergence of methicillin-resistant Staphylococcusaureus (MRSA) made vancomycin as the only therapeutic choice. Due to excessive use of vancomycin, decreased susceptibility and increased resistance against this antibiotic are reported worldwide. The current study aimed at investigating the emergence of vancomycin-resistant Staphylococcus aureus (VRSA) in different regions of the Middle-East.
    Evidence Acquisition: All reputable databases, such as Google Scholar and PubMed, were screened for articles and abstracts reporting VRSA in the Middle-East by the appropriate keywords. Reliable phenotypic and genotypic studies were included in the current review.
    Results
    Reviewing all articles/abstracts revealed more than 100 reports of VRSA isolates from the Middle-East. Most of the studies did not use the clinical and laboratory standards institute (CLSI) guidelines on VRSA identification. Until 2012, four VRSA strains were reported from Iran, 7 from Egypt, and 1 from Pakistan. From 2012 to 2016, seven VRSA isolates were added to the global statistics from the Middle-East; 1 from Iran and 6 from Egypt.
    Conclusions
    VRSA is a global health threat. According to the expanding reports on the emersion of VRSA, more attention should be paid to the proper prescription of this antibiotic as the only choice for S. aureus infections.
    Keywords: Vancomycin, Resistance, Staphylococcus aureus, Middle-East
  • Sara Nasirian, Sara Saadatmand, Hossein Goudarzi, Mehdi Goudarzi *, Hadi Azimi Page 3
    Background
    Staphylococcus aureus, as one of the most common causes of nosocomial infections, has widely spread to all parts of the world and is becoming a serious concern in public health.
    Objectives
    The present study aimed at evaluating the prevalence of adhesion and toxin gene profiles and their distribution among different agr types.
    Methods
    The current cross-sectional study was performed in Tehran, Iran, by analyzing 125 methicillin resistant Staphylococcus aureus (MRSA) strains isolated from hospitalized patients at the ICUs from March, 2016 to January, 2017. In vitro antibiotic susceptibility testing of isolates was assessed using the Kirby-Bauer disk diffusion method. The MRSA strains were genetically typed by agr typing and virulence and adhesion genes profile by conventional PCR.
    Results
    Antibiotic susceptibility testing showed that inducible macrolide-lincosamide-streptogramin B, constitutive macrolide-lincosamide-streptogramin B, and high-level mupirocin resistance phenotypes had a frequency of 18 (14.4%), 50 (56%), and 10 (31.3%), respectively. The predominant resistance profile among MDR-MRSA isolates included resistance profile to seven antibiotics (32%). A total of ten virulence genotypes were observed, from which genotype spa, clfA, clfB, fnbB, fnbA, ebp, and can / tst (36%, 45/125) comprised the majority followed by spa, clfA, clfB, and fnbB (24%, 30/125). Type I was the most prevalent agr type (52%), followed by type III (34.4%), type II (9.6%), I 5(5.3%), and IV (4%). All isolates carrying PVL-encoding genes and HLMUPR-MRSA strains corresponded exclusively to agr type I.
    Conclusions
    The current data demonstrated that virulence gene profiles among different agr types of MRSA isolates were divers. The present study suggests that molecular characterization of MRSA strains should periodically be studied.
    Keywords: MRSA, MDR, ICU, agr Typing
  • Hamid Reza Bitaraf, Faezeh Hamidi *, Vajiheh Zarrinpour, Mohsen Rahimi, Seyed Reza Shahrokhi, Aliyar Mirzapour Page 4
    Background
    Humans may be accidently infected by larva stage of Toxocara canis and Toxocara cati nematodes through consumption of contaminated vegetables and food by embryonated eggs and geophagia. They cause visceral, ocular, and neurological syndromes detected through serological methods. Parasitic contamination and infectious diseases are the main cause of eosinophilia.
    Objectives
    The current study aimed at investigating Toxocara canis seroprevalence in military personnel and their families with eosinophilia referred to a military hospital in Tehran, Iran, from 2015 to 2016.
    Methods
    In the current cross sectional study, 179 patients (military personnel and their families) referred to a military hospital with eosinophilia > 5% in a two-year period (2015 - 2016) were selected and after obtaining informed consent and filling out the questionnaires, anti-Toxocara canis IgG was detected in their sera using the enzyme-linked immunosorbent assay (ELISA) technique.
    Results
    Seroprevalence of Toxocara canis infection was 11.7%. Males were the most infected individuals. After statistical analysis, a significant relationship between the level of education (P = 0.01) and history of pet contact (P = 0.02), and anti-T. canis IgG was found; nevertheless, it had no relationship with age, gender, occupation, and place of residence (P > 0.05).
    Conclusions
    Prevalence of Toxocara antibody was relatively high, which can indicate susceptibility to Toxocara infection in military personnel due to military operations. Due to lack of clinical manifestations in some patients, survey of Toxocara infection in eosinophilia cases is recommended.
    Keywords: Toxocariasis, Military Personnel, Eosinophilia, Iran
  • Behnam Farhoudi, Amin Alipour, Saeed Ghodrati, Seyedahmad Seyedalinaghi *, Mehrangiz Zanganeh, Minoo Mohraz Page 5
    Background
    People with chronic illnesses such as HIV infection face many health status outcomes in the correctional settings. The current study aimed at investigating multiple determinants of HIV medication adherence among patients with HIV.
    Methods
    Focus group discussion (FGD) was conducted on inmates of Ghezel-hesar Prison in Karaj, Alborz province, Iran, to investigate the barriers and facilitators of adherence to antiretroviral therapy (ART) in January 2015. The purposive sampling method was employed to recruit seven male prisoners with HIV infection.
    Results
    Participants reported illegal drug use, poor education in HIV treatment, side-effects of antiretroviral drugs, treatment interruption, drug interferences, fear of hangover, poor diet, poor socioeconomic background, hopelessness, depression, not believing in the treatment, rejection and lack of social support, stigma, compulsory rest in the yard, lack of tendency toward visiting psychiatrists, lack of familial support, forgetfulness, and not receiving complementary drugs as the barriers to adherence to ART. In addition, the facilitators were physician-patient good relationship, physician’s compassion, counseling services for the patients, education of patients regarding HIV treatment necessities, peer education, informing patients about their CD4 levels, education of correctional staff to show courtesy in the treatment of patients, timely methadone therapy, and improved diet.
    Conclusions
    Providing welfare programs and education of inmates with HIV infection regarding the adherence to ART may play a prominent role in the treatment of such patients. Training correctional staff regarding the significance of HIV treatment and adherence to ART can also be effective in the treatment of prisoners with HIV infection.
    Keywords: HIV, Adherence, Barriers, Facilitators, Antiretroviral Treatment, Prison
  • Hamed Aghaei, Parivash Kordbacheh, Reza Kachuei, Shahram Mahmoudi, Setareh Agha Kuchak Afshari, Mahin Safara, Farideh Zaini * Page 6
    Background
    Members of the genus Fusarium are common soil saprophytes and important plant pathogens which also cause a wide spectrum of diseases ranging from onychomycosis to the life - threatening systemic infections. The antifungal susceptibility patterns of Fusarium isolates varies in different species.
    Objectives
    This study was undertaken to investigate the antifungal susceptibility pattern of environmental and clinical Fusarium isolates to conventionally - used azole antifungal drugs in Iran.
    Methods
    A total of 36 Fusarium isolates (16 clinical and 20 environmental) were included in this study. All environmental isolates were obtained from the culture collection of medical mycology laboratory of the School of Public Health at Tehran University of Medical Sciences, Tehran, Iran. Clinical isolates were obtained from patients with onychomycosis and were identified by PCR - sequencing of a fragment of translation elongation factor 1 alpha gene. All clinical and environmental isolates were tested for their in vitro susceptibility to itraconazole (ITC) and voriconazole (VRC) according to the CLSI M38 - A2 standard. Statistical analysis of data was performed using SPSS version 21.
    Results
    The majority of clinical isolates were identified as F. proliferatum (N = 6) followed by F. oxysporum (N = 4), F. solani (N = 3), F. verticillioides (N = 1), F. acutatum (N = 1), and F. thapsinum (N = 1). The lowest minimum inhibitory concentration (MIC) values of ITC was observed for environmental F. verticillioides isolates (N = 5, GM = 13.93 µg/mL). For VRC, the lowest MICs were recorded for environmental F. verticillioides isolates (N = 5, GM = 2.3 µg/mL), and the highest MICs were observed for clinical F. solani isolates (N = 3, GM = 10.08 µg/mL). ITC was inactive against all clinical and the majority of environmental Fusarium isolates (MICs ≥ 16 µg/mL). Significant differences were observed between MICs of ITC and VRC against environmental F. proliferatum and F. verticillioides isolates (P
    Conclusions
    The resistance pattern in Fusarium isolates is species specific and, therefore, identification at the species level is important for choosing the proper antifungal treatment.
    Keywords: Fusarium, Onychomycosis, Antifungal Agents, Iran
  • Nasrin Bahmani, Seyed Hamid Hashemi, Mohammad Reza Arabestani, Reza Mirnejad, Faramarz Masjedianjazi, Fariba Keramat, Mohammad Yousef Alikhani * Page 7
    Background
    Brucellosis is a zoonotic disease that causes major economic and public health problems. It is one of the most important diseases in humans and domestic animals. Hence, the exact identification of Brucella spp. is important for strategies of treatment and control. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) is one of the molecular techniques characterized by amplification of deoxyribonucleic acid (DNA) sequence and restriction enzyme digestion.
    Objectives
    This study aimed at identifying genetic polymorphisms of omp2a genes among 90 Brucella isolated from humans and animals, using the PCR-RFLP method.
    Methods
    Ninety Brucella spp. isolated from humans and animals in two different regions of Iran were used in this study. Biochemical tests and the Brucella omp2a (1100 bp) gene-PCR was used for identification of Brucella isolates. Polymerase Chain Reaction products were digested by restriction endonuclease enzyme pstI and gene sequencing analysis was carried out for molecular typing of Brucella strains. Therefore, genetic relatedness was revealed by a dendrogram.
    Results
    Analysis of the 90 Brucella strains by biochemical tests, PCR, and PCR-RFLP methods with PstI enzyme and omp2a sequencing showed four unique RFLP Profiles (P1-P4). Seventy-nine (87.8%) of the Brucella isolates belonged to B. melitensis strain 20236. From 30 animal isolates, nine (30%) belonged to B. melitensis biovare1 and two (6.6%) to B. abortus strain. According to the RFLP dendrogram, group 1 and 2 had higher genetic relatedness similarity.
    Conclusions
    The results showed B. melitensis strain 20236 was the predominant strain among human and animal Brucella isolates. Likewise, according to dendrogram results, the PCR-RFLP technique was not able to separate human and animal species of B. melitensis from B. abortus.
    Keywords: Omp2, Pst1, PCR, Brucella
  • Zahra Moazzen, Gita Eslami *, Ali Hashemi, Neda Yousefi Nojookambari Page 8
    Background
    One of the most important pathogens with increasing mortality rate in hospitalized patients is Acinetobacter baumannii.
    Objectives
    Therefore, this study aimed at detecting multidrug-resistance and the role of efflux pumps in Ciprofloxacin resistance of A. baumannii strains isolated from burn patients.
    Methods
    Eighty A. baumannii strains collected from 240 wound samples were isolated from burn patients hospitalized in the burn unit of Shahid Motahari hospital. Susceptibility to antibiotics was tested by disc diffusion and microdilution methods. Activity of the efflux pump system was assessed using the efflux pump inhibitor, Carbonyl Cyanide 3-Chlorophenylhydrazone (CCCP). Polymerase Chain Reaction (PCR) and sequencing were done for detecting the AdeABC genes.
    Results
    Overall, 100% of A. baumannii isolates were resistant to ceftriaxone, ceftazidime, cefepime, cefotaxime, meropenem, ciprofloxacin, co-trimoxazole, piperacilin, piperacillin/tazobactam and imipenem; 72 (90%) to amikacin, 72 (90%) to gentamicin, and 0 (0.0%) to colistin The high increase of the susceptibility to ciprofloxacine in the strains in the presence of the efflux pump inhibitor was remarkable. In 25% of isolates, CCCP decreased the minimum inhibitory concentrations (MIC) by 4 to 64 folds. In 80 (100%) of the isolates, adeb, adeA, and adeC genes were detected.
    Conclusions
    The results indicated the role of efflux pump in antibiotic resistance in A. baumannii isolates. Furthermore, A. baumannii strains could resist antibiotics by the efflux mechanism.
    Keywords: Antibiotic Resistance, Burn, Efflux Pump Inhibitor, CCCP, AdeABC
  • Bahram Naderi Nabi, Abbas Sedighinejad, Ahmad Reza Mirbolouk, Farnoush Farzi, Mohammad Haghighi, Zahra Atrkarroushan, Gelareh Biazar *, Amer Chohdary Page 9
    Background
    Treatment of chronic osteomyelitis is complex and includes long-term management with antibiotics and debridement. Inadequate blood supply, underlying diseases, and deep involvement of the infected area can cause classic treatments to fail and lead to serious complications, such as limb amputation. Recently, there has been increasing interest in the use of ozone therapy for infectious diseases.
    Objectives
    This study was designed to investigate the beneficial effects of ozone therapy on chronic osteomyelitis.
    Methods
    Sixty patients with chronic osteomyelitis were divided into two homogenized groups: ozone therapy and control. Ozone therapy at a concentration of 30 mg/mL was performed daily by ozone bagging, minor autohemotherapy, and ozone saline injection into the bone. Data were analyzed to determine recovery and erythrocyte sedimentation rates.
    Results
    The recovery rate was 73.33% in the control group versus 86.66% in the ozone group (P = 0.31). No significant difference was found between the groups regarding the recovery rate (P = 0.86). However, considering the erythrocyte sedimentation rate, the results were significantly superior in the ozone group (P = 0.0001).
    Conclusions
    These findings indicate that ozone therapy, as a promising complementary treatment, can be applied in chronic osteomyelitis management.
    Keywords: Ozone Therapy, Chronic Osteomyelitis, Vancomycin
  • Enayatollah Shadmand, Rasoul Baharlou, Mohammad Reza Shokouh, Seyed Dawood Mousavi Nasab, Abbas Ahmadi Vasmehjani, Kaveh Sadeghi *, Nayeb Ali Ahmadi Page 10
    Background
    Co - infection of hepatitis E virus (HEV) and hepatitis D virus (HDV) in human immunodeficiency virus (HIV) infected patients can develop and increase hepatic complications in the world, particularly in developing countries.
    Objectives
    The purpose of this study was to assess and compare the sero - virological prevalence of HEV and HDV in patients bearing HIV infection and HIV/HCV co - infection, as well as their relation to clinical and demographic data.
    Methods
    Cross - sectional study testing IgM/IgG anti - HEV and total antibodies HDV in serum samples belong to 73 HIV infected patients and co - infected HIV - HCV patients were evaluated. Demographic, lifestyle, and laboratory data such as CD4 counts and viral load were prospectively collected on each patient with the HIV infection.
    Results
    There were 26 HEV infected patients IgG positive, two HEV infected patients IgM positive, two HDV infected patients total antibodies positive, and only one HDV infected patient IgM among the 73 HIV infected patients. The prevalence of HDV positive IgG and total anti - HDV among co - infected patients were 2.2% and 2.2%. In addition 18 (69.2%) and 2.2% were positive for anti - HEV IgG and IgM, respectively. Furthermore, HIV viral load among HIV co - infected patients with HEV or HDV were shown higher compared to patients solely infected with only HIV. Also, the numbers of HEV or HDV positive were high in low levels of CD4.
    Conclusions
    According to the results, frequency of occurrence of hepatitis E was higher than hepatitis D in HIV infected patients. Severity of HIV infection and liver damage caused by HEV and HDV infections were in a direct relationship. Hence, HIV and HCV screening should be implemented in HIV - infected patients with liver damage.
    Keywords: HEV, HDV, Co - infection, HIV
  • Seyedahmad Seyedalinaghi, Behnam Farhoudi, Zeinab Najafi, Sirous Jafari, Mohammad Shahbazi Page 11
    Objectives
    We conducted this study to compare the tuberculosis (TB) incidence in an Iranian prison with the society in Iran.
    Methods
    In this present study, we investigated the incidence of TB among prisoners versus the society by an age range of 23 to 49 years. We used an active case finding (ACF) strategy as a screening method to find TB suspected prisoners in the Great Tehran Prison from October 2013 to May 2014.
    Results
    In the total of 5865 prisoners, only nine patients were diagnosed with TB while 2263 out of 4503516 individuals of the society had TB in this period of time. Statistical analyses showed that out of 100,000 people there were 153.5 patients detected in the prison and 5.02 patients in the society. Therefore, the incidence of TB in the prison was significantly more than the society (P
    Conclusions
    The incidence of TB in prisons is significantly more than society. Thus, TB management needs providing preventive measures such as intensifying case findings in prisons.
    Keywords: Tuberculosis, Prison, Society, Tehran, Iran
  • Narges Najafi, Alireza Davoudi *, Seyedeh Roshina Hassantabar, Ramin Haddadi Page 12
    Background
    Brucellosis is a zoonosis with diverse clinical manifestations. This study investigated the epidemiological, laboratory, and clinical features of brucellosis.
    Methods
    In a cross-sectional survey, we evaluated brucellosis patients who referred to Razi hospital, a referral center for infectious diseases in Mazandaran province (north of Iran), from 21 March 2009 to 20 March 2014. Factors such as age, sex, clinical signs, and laboratory findings were extracted from their medical records.
    Results
    219 patients with a mean age of 41.6 ± 16.9 years were enrolled including 86 women (39.27%) and 133 men (60.73%). 191 participants (87.2%) had used local dairy products. 174 (79.4%) were suffering from non-focal brucellosis and 45 patients (20.6%) from focal brucellosis. The rates of referral per season were 23.7, 33.8, 23.3, and 19.2 percent in the spring, summer, autumn, and winter, respectively (P = 0.006). In terms of job, 76 patients (34.7%) were in business/market-related jobs, 64 (29.2%) were homemakers, and 49 (22.4%) were in dairy jobs. The relationship between jobs and disease was significant (P = 0.003). The most common chief complaint of patients was fever and chills (31.1%).
    Conclusions
    Based on the findings, factors such as fever, chills, back pain, myalgia, anemia, and abnormal ESR were associated with brucellosis.
    Keywords: Brucellosis, Epidemiology, Clinical