فهرست مطالب

Archives of Clinical Infectious Diseases - Volume:13 Issue: 5, 2018
  • Volume:13 Issue: 5, 2018
  • تاریخ انتشار: 1397/08/12
  • تعداد عناوین: 17
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  • Aslan Bijari, Masoumeh Hallaj Zade, Shiva Hatami, Enayat Kalantar, Mohammad Noori Sepehr, Kourosh Kabir, Ehsan Zahmatkesh, Mohammmad Hassan Naseri, Davood Darban Sarokhalil * Page 1
    Objectives
    The current study aimed at finding the frequency of MRSA infections, contamination, and colonization in the teaching hospitals of Karaj city, Iran for the first time.
    Methods
    The current cross sectional study was conducted in Karaj on three teaching hospitals from July 2013 to July 2014. Sample collection from personnel and surfaces was conducted twice and monthly, respectively, during the study period. Also, all Staphylococcus aureus species isolated from patients were included in the study. Antimicrobial susceptibility test was performed by the standard disk diffusion method. All isolates were subjected to mupA and mecA-specific polymerase chain reaction (PCR)to identify high-level mupirocin-resistant and MRSA isolates, respectively. Chi-square test was employed for data analysis.
    Results
    The majority of S. aureus species were isolated from personnel and surfaces of the hospitals. One hundred sixty-eight S. aureus and 49 MRSA species were isolated from Karaj teaching hospitals. The main frequency of MRSA was isolated from intensive care unit (ICU) (75%) and high rate of resistance to rifampicin (53%) was observed in MRSA isolates. Although 10 S. aureus species were resistant to mupirocin by disk diffusion, no mupA gene was detected in the isolates.
    Conclusions
    In conclusion, in comparison with the other studies from Iran, low frequency of MRSA was observed in the investigated hospitals. However high frequency (75%) of MRSA in ICU indicated that antibiotic policy is urgently needed to prevent the resistance development. Moreover, antibiotic susceptibility monitoring and regular screening surfaces and personnel of hospitals in terms of MRSA colonization, especially ICU, are indispensable.
    Keywords: Methicillin-Resistant Staphylococcus aureus, MRSA, Intensive Care Unit, ICU, Iran
  • Hamid Kassiri *, Atefe Ebrahimi , Masoud Lotfi Page 2
    Background
    Animal bite is an emerging public health problem. Annually, in different parts of the world, more than 15 million people are treated for animal bites. Each year, 140 cases of animal bites per 100,000 population are estimated to occur in Iran, more than 85% of which are dog bites.
    Objectives
    The aim of this study was to investigate the epidemiology of animal bites during years 2011 and 2013 in the East of Ahvaz county.
    Methods
    This was a descriptive cross-sectional study performed on whole cases of animal bite registered at the health center of Eastern Ahvaz, Southwestern Iran. According to the current study, a “bitten person” is bitten by an animal, and refers to the rabies prevention centers due to animal bites and fear of rabies. During a three-year period, through a questionnaire-based study, 2493 bitten individuals were enrolled in the research. In this respect, for all cases, demographic and epidemiological data, such as treatment, biting animals, age, gender, occupation, place of residence, month of the year, season and biting site on the body were recorded. Descriptive statistics, including frequency distribution and percentage were used to analyze the data. The analysis was performed using the SPSS version 18 software.
    Results
    The highest number of bitten individuals were recorded during year 2012. Out of 2493 bitten individuals, 76.6% were male and 23.4% were female. Bites were most frequent among the age group of 21 to 30 years old. Most cases (24.7%) were self-employed. in total, 65% of animal-bite incidents were in the city and 35% were in rural areas. The cases were mostly related to dog bites (78.4%) and cat bites (17.3%), respectively. Moreover, 100% of cases were vaccinated within the first 24 hours, 61.4% had incomplete while 38.6% had complete vaccination. Lower extremities were the most frequent bite site (46.9%) followed by upper extremities (41.6%), head and neck (5.7%), and trunk (5.8%). Animal bites were more common during spring (26.7%) and autumn (25.2%). Maximum number of incidents were reported during the month of April (9.2%) and July (9%).
    Conclusions
    Dogs were the most common animals causing this problem. Control of stray dog population by animal birth control and domestic animal vaccination is needed. Meanwhile, training people at risk can play an important role in reducing the incidence of animal bites and rabies.
    Keywords: Animals, Bites, Epidemiology, Prevalence, Rabies, Iran
  • Mohammad Mahdi Majzoobi, Hamid Reza Ghasemi Basir, Mohammad Reza Arabestani, Surur Akbari *, Haleh Nazeri Page 3
    Introduction
    Brucella canis, a member of Brucella species, has been reported as a cause of human brucellosis in a few cases, and routine serologic tests do not identify this species. In spite the fact that Iran is an endemic area for brucellosis, there has not been any report of human brucellosis due to B. canis.
    Case Presentation
    The patient was a 68-year-old female with complaints of fever, foul smelling urine, malaise, vomiting, and arthralgia. Considering significant leucocytosis and pyuria, positive urine culture antibiotic therapy was initiated for urosepsis. However, due to non-suitable response to antibiotic and negative serologic study for brucellosis, supplemental assessments, including bone marrow aspiration and biopsy (BMA&B), were performed to study malignancy, tuberculosis, and brucellosis. Brucella canis was isolated from BACTEC media and subsequently confirmed by polymerase chain reaction test.
    Conclusions
    Considering the ineffectiveness of routine serologic study for diagnosis of B. canis in the presence of clinical presentations suggestive for brucellosis, blood or BM culture should be considered.
    Keywords: Brucellosis, Brucella canis, Iran
  • Reza Arjmand , Mehri Gholami , Fariba Shirvani*, Omid Safari , Mostafa Qorbani , Mohammad Javad Gharavi Page 4
    Background
    Hib conjugate vaccine has led to more than 90% decline in the prevalence of severe Hib diseases in countries with universal coverage vaccination program. After the addition of Hib vaccine to the national vaccination program with 3P (three doses of 2, 4, and 6 months) in IR Iran, we decided to study the vaccine efficacy after the last dose of vaccine in Iranian children in 2016.
    Methods
    500 blood samples were collected from one-year-old children who referred to the health care centers in Karaj. Demographic information was gathered by a questionnaire. Blood samples were sent to a laboratory for antibody titer determination by ELISA method.
    Results
    41.2% of the children (95% CI: 36.89 - 45.51) had a titre of IgG against Hib (0.15 to 1 µg/mL) (short-term protection) and 57.4% of the children had a titre of IgG against Hib (95% CI: 53.07 - 61.73) equal to or greater than 1 µg/mL (long-term protection). Antibody GMT was 6.92 µg/mL (95% CI: 6.76 - 7.08). There was no significant correlation between the titer of H. influaenza antibody and demographic factors.
    Conclusions
    In spite of the acceptable GMT titer, children who had antibody titer of < 1 µg/mL comprised approximately 40% of the study population, showing the necessity of further investigation to assess the need for H.flu booster administration.
    Keywords: Serologic Response, Haemophilus influenzae Type B, Child
  • Tahereh Zadeh Mehrizi , Nariman Mosaffa , Mostafa Haji Molla Hoseini&amplrm, , Ali Khamesipour , Mehdi Shafiee Ardestani , Amitis Ramezani * Page 5
    Background
    Nowadays, nanocarriers are used for leishmaniasis treatment due to development of drug resistance and several side effects with conventional therapeutics.
    Objectives
    In this study we aimed to evaluate in vivo effects of four synthesized nanodrugs including amphotericin B-nanochitosan (AK), betulinic acid-nanochitosan (BK), amphotericin B-dendrimer (AD), and betulinic acid-dendrimer (BD) in the treatment of Leishmania major infection (L. major) in mice model by using pathological analyses to choose the most effective nanodrug in leishmaniasis.
    Methods
    The four nanodrugs efficacy in the improvement of L. major lesion in a mice model was evaluated by using pathological analyses including measurement of organs size and parasite number. Additionally, the nanodrugs toxicity was evaluated by measurement of various blood factors.
    Results
    The histopathological results of the present study showed that BK, at the dose of 20 mg/kg, and AK, at the dose of 10 mg/kg, were more effective in decreasing the parasite number in the kidney, liver, and spleen. Moreover, BK20 mg/kg and AK10 mg/kg decreased the organs size significantly while AD50 mg/kg and BD40 mg/kg were less effective. However, none of the four nanodrugs had increased the blood factors and they were not toxic.
    Conclusions
    Overall, the pathologic findings of various mice organs treated with different formulations showed that AK10 mg/kg and BK20 mg/kg were more effective in recovery of L. major’s pathological effects in comparison to AD50 mg/kg and BD40 mg/kg. Therefore, it seems that AK and BK, in this mentioned dosage, could be considered as a proper candidate for treatment of leishmaniasis.
    Keywords: Histopathology, L. major, Nanochitosan, Nanodendrimer, Amphotericin B, Betulinic Acid
  • Sule Aydin Turkogu*, Elif Sultan Bolac , Emine Dagistan , Ergun Sevil Page 6
    High mortality herpes simplex virus encephalitis (HSVE) presents with fever, headache, changes in personality, focal neurologic findings, and epileptic attacks. It causes common destruction in brain parenchyma with necrotic, inflammatory and hemorrhagic lesions, and neuron losses. Central nervous system vasculitis during HSV infection can develop strokes especially related to both hemorrhagic and ischemic reasons. Ramsay-Hunt syndrome (RHS) is characterized by the re-activation of the latent varicella zoster virus (VZV) in the geniculate ganglion of the facial nerve; it presents with peripheral facial nerve paralysis. Neurogenic pulmonary edema is the situation of respiratory failure occurring hours after the serious neurogenic incident without other reasons causing lung edema, which is developed by increase in sympathetic activity, and progressed by increase in alveolar and interstitial fluid. In the current study, a patient with developed neurologic pulmonary edema with ischemic stroke status as a result of cerebral hematoma and middle cerebral artery (MCA) ischemia following HSVE was followed up and a patient that developed anterior cerebral artery (ACA) and MCA territory infarction after RHS was mentioned.
    Keywords: Herpes Simplex Virus Encephalitis, Ramsay-Hunt Syndrome, Stroke, Brain Hemorrhage, Neurogenic Pulmonary Edema
  • Sirus Jafari , Aida Fatollahzadeh , Fereshte Ghiasvand , Arash Seifi * Page 7
    Background
    Fever of unknown origin (FUO) remains a clinical challenge in both emergency and infectious diseases departments. Being clinically updated on probable etiologies helps physicians to narrow their diagnostic and treatment approach.
    Objectives
    This study aimed to assess the causes of FUO in an academic setting in the recent 5 years to update the clinicians.
    Methods
    In a cross-sectional study, the files all patients with the primary diagnosis of FUO were extracted and evaluated. The records were assessed with regard to patients & rsquo; age, gender, days of fever before admission, time of admission and discharge, clinical course of the disease, laboratory and other para-clinical findings were documented. The patients were then classified based on the etiology of the disease and the type of test utilized for the diagnosis. Median and frequencies were used for descriptive variables; chi-square test was performed for correlation analysis.
    Results
    From March 2009 to April 2014, 101 patients were admitted and their files were recruited for the purpose of this study. The median age of our patient population was 39. Infections (23.1%) and non-infectious inflammatory diseases (21.1%) constituted the most common known causes of fever in our patient population. Invasive tests had been documented for 41.1% while non-diagnostic in 20%. Non-invasive tests leading to final diagnoses were performed for 48.4%. There was a significant association between the type of the utilized test for diagnosis and different etiologies of FUO (P = 0.001).
    Conclusions
    Similar to global trends, non-infectious inflammatory diseases comprised an increasing share of the causes of FUO. However, tuberculosis remains an important infectious cause that may present with FUO or simply be overlooked in primary patient visits. Updating a local database for the causes of FUO in hospitals at certain time intervals may facilitate the diagnostic approach.
    Keywords: Fever of Unknown Origin, Infection, Etiology
  • Fateh Rahimi *, Leili Shokoohizadeh Page 8
    Background
    Methicillin-resistant Staphylococcus aureus (MRSA) has been considered as an important pathogen with a variety of virulence factors in communities and hospitals worldwide.
    Objectives
    In this study, we focused on the detection of different virulence factors and enterotoxin genes of MRSA strains isolated from a referral hospital in Tehran, Iran. Moreover, the presence of different prophage types was studied.
    Methods
    A total of 491 MRSA strains were isolated during three years from a referral hospital in Tehran. The staphylococcal enterotoxin (sea-seq) and pvl, hlb, sak, eta and tst genes were detected. A multiplex-polymerase chain reaction (PCR) assay was used for prophage typing of MRSA isolates.
    Results
    Totally, 11 enterotoxin and 5 virulence factor genes were detected in MRSA strains. The sea, sek, seq, and hlb genes were present in all the MRSA and other enterotoxin genes. sel, seg, sem, sei, sen, seo, sec and sep were detected in 32.8%, 20.3%, 12.6%, 8.3%, 4.1%, 2.6%, 1.6% and 0.4% of the strains, respectively. A total of 93%, 81%, 15.9% and 5.7% of the strains harbored the sak, eta, tst and pvl genes, respectively. SGF, SGFa and SGFb proghage type genes were detected in 100% of the MRSA strains, and four different prophage patterns were identified among the strains.
    Conclusions
    The presence of different prophage-encoded virulence factors among MRSA strains enable MRSA to produce a broad range of diseases, indicating MRSA strains as a potential threat to patients’ health.
    Keywords: Methicillin-Resistant Staphylococcus aureus, Virulence Factors, Prophage Typing, Enterotoxins
  • Masoumeh Azimirad , Masoud Alebouyeh*, Marjan Rashidan , Mohammad Mehdi Aslani , Mohammad Reza Zali Page 9
    Background
    Cross-contamination between patients and the medical imaging device is a worldwide concern. In the current study, the ability of different molecular typing methods for differentiation of Clostridium difficile isolates from patients and medical devices was compared to show their discriminatory power for molecular epidemiological purposes.
    Methods
    A total of 23 C. difficile strains from fresh stool samples of patients subjected to colonoscopy, medical device, and environmental samples of a gastroenterology unit were used for molecular typing. Similarity of the strains was determined by the polymerase chain reaction (PCR) ribotyping, capillary gel electrophoresis based-ribotyping, and RAPD-PCR and ERIC-PCR methods. Phylogenetic analysis of the molecular patterns was done by the GelCompar II software and discriminatory power of the methods was measured using Simpson’s index diversity.
    Results
    RAPD-PCR and PCR-ribotyping methods showed the highest discrimination power for differentiation of the studied strains, while genotyping showed the lowest power. Similarity of C. difficile strains between the patients and medical equipment was detected for the strains presenting PCR-ribotypes B and CE-ribotype 150.
    Conclusions
    Involvement of medical device for transmission of toxigenic strains of C. difficile was determined in this study. Although diversity of C. difficile strains was established in the studied hospital, a discrepancy was detected among these techniques for typing purposes. The results suggested the usage of a combination of two or more typing methods for detection of sources of cross-contamination in each hospital.
    Keywords: Genotyping, Ribotyping, Random Amplified Polymorphic DNA Technique, Clostridium difficile, Cross-Contamination
  • Ebrahim Faghihloo* , Mojdeh Hakemi Vala , Gita Eslami , Hossein Goudarzi Page 10
    Background
    Cervical cancer is currently among the most important causes of cancer-related deaths in women. The development of cervical cancer is associated with high-risk human papillomavirus (HPV) infections and a series of epigenetic changes in host cell genome, such as histone acetylation. Furthermore, decreased E-cadherin level has been shown to play a critical role in cancer cell invasion and metastasis. Oxamflatin has been reported to have anti-cancer efficacy.
    Objectives
    We aimed to study the effect of this drug on cervical cancer cell lines, HeLa cells, by assessing E-cadherin level as a marker of cancer invasion susceptibility.
    Methods
    HeLa cells were treated with oxamflatin, and total RNA was obtained. Then, quantitative real-time polymerase chain reaction (PCR) was performed to evaluate E-cadherin expression level in cells treated with oxamflatin.
    Results
    The findings of real-time PCR indicated that oxamflatin increased E-cadherin level in a time- and concentration-dependent manner. The level of E-cadherin significantly increased at the concentrations of 4 mM (for 24 hours after treatment) and 2 and 4 mM (for 48 hours after treatment) in comparison with corresponding control HeLa cells.
    Conclusions
    The present study proposed that oxamflatin may have anti-migratory and anti-invasive potential against cervical cancer cells, which should be further evaluated in future studies.
    Keywords: Cervical Cancer, HPV, Oxamflatin, E-cadherin, HeLa Cells
  • Mostafa Rezaei, Tavirani, Sobhan Ghafourian, Fatemeh Sayehmiri, Reza Pakzad, Saeid Safiri, Iraj Pakzad * Page 11
    Context
    Cotrimoxazole is one of the antibiotics commonly used to treat urinary tract infections. The widespread use of this drug has led to increased resistance to cotrimoxazole among urinary tract pathogens. This study aimed to investigate the cotrimoxazole resistance pattern of uropathogenic bacteria by a systematic review and meta-analysis method.
    Evidence Acquisition: Several databases including PubMed, Web of Science, Scopus, Google Scholar, Iran Medex, Magiran, IranDoc, MedLib, and SID were searched. From a total of 171 papers published from different regions of Iran from 1992 to May 2015, 67 were included in this study. To assess the quality of the study, the STROBE (strengthening the reporting of observational studies in epidemiology) checklist was employed. The I2 index was used to determine heterogeneity and a random effects model to analyze the data.
    Results
    The results showed that the prevalence of urinary tract infection was several times higher in women than in men. The most common pathogens causing urinary tract infections were E. coli 64%, Klebsiella 12%, Staphylococcus 10%, and Enterobacter (6%). The prevalence of cotrimoxazole resistance was as follows: E. coli 62% (95%CI: 60 - 65), Klebsiella 54% (95% CI: 45 - 62), Staphylococcus 55% (95% CI: 47 - 63), and Enterobacter 52% (95% CI: 33 - 70). Cotrimoxazole resistance in different studies varied from 22% in Arak to 88% in Ahvaz.
    Conclusions
    Gram-negative bacilli, particularly Escherichia coli, were the most common bacteria causing urinary tract infections. The majority of strains were resistant to cotrimoxazole. According to the findings, cotrimoxazole is not recommended as the first-line drug for the treatment of urinary tract infections in Iran.
    Keywords: Urinary Tract Infections; Gram-Negative Bacteria; Gram-Positive Bacteria; Cotrimoxazole, Antimicrobial Resistance; Meta-Analysis
    Keywords: UrinaryTractInfections, Gram-NegativeBacteria, Gram-PositiveBacteria, Cotrimoxazole, AntimicrobialResistance, Meta-Analysis
  • Masoud Mardani * Page 12
    Following natural disasters like earthquake property, trauma-related deaths and injuries, cause huge risk of infections, especially in vulnerable population such as pregnant women, people with untreated wounds, and newborns (1). When acute phase of emergency occurred, there are great needs of a temporary post disaster surveillance, early warning, and response (1). During evacuation and clean up there are increased risk of wounds such as puncture to skin, scrubs, laceration, and other skin injuries. The cleanup worker, volunteers, and resident are in direct touch with flood water and human or animal waste; therefore, for as much as exposure to soil can cause tetanus, workers and resident should be up to date with tetanus vaccination (2). The Aceh earthquake and tsunami in 2004 killed 12700 people and caused 500000 injuries in Indonesia. In addition, the Yogyakarta earthquake caused 5700 deaths and 3700 injuries in 2006. In both earthquakes, in rescue and evacuation, most of patients had been wounded and injured, which lead to dilation and case severity due to poor access to health care, low vaccination coverage, and lack of awareness of tetanus (3). Tetanus, also known as lockjaw, is a toxin mediated infection that is not communicable, fatal, and severe requiring emergency action. Tetanus is caused by an infection with the bacterium Clostridium tetani, which is commonly found in soil, saliva, dust, and manure. Any break such as cut or puncture in the skin is the way of penetration of bacteria and cause of diseases, which is characterized by muscle spasms particularly in people who are not vaccinated completely. In fact, most of the tetanus cases are among people who never received tetanus vaccination or have not completed their childhood vaccination program (4, 5). If the tetanus occurs, emergency treatment should be done as soon as possible, and tetanus immune globulin (TIG) should also be given, medication to control muscle spasm, wound care, tetanus toxin booster, and antibiotics are recommended (6). History of damage or clear gateway of passage might be needed. The average of incubation period is about 10 days, which ranges from 3 to 21 days. General health of patient, age, the amount of present toxin, and degree of prior immunity are responsible for clinical course of generalized tetanus. The generalized tetanus death rates is about 10% to 20% even with modern intensive care support (6). Patient immune status and type of wound are important tetanus disease risk factors. Wounds that contaminated with dirt, feces, soil, saliva, as well as puncture wounds, crushing wounds, and burn tissues are at higher risk of tetanus. Proliferation of C. tetani is possible in prone environments such as necrotic and gangrenous wounds, avulsion fractures, burn, and frostbite. Therefore, every wound should be disinfect and cleaned up by removing dirt, foreign material, and debris (6). As CDC currently recommended a primary series with an age-appropriate tetanus, toxoid-containing vaccine (DTaP, Tdap, or Td) should be prescribed in any unvaccinated person with any type of wound. Primary series of vaccine should be completed in patients who have an unknown or uncertain history of receiving prior dose of tetanus toxoid containing vaccine (7). Another dose of tetanus toxoid containing vaccine is not needed in patients with simple and clean wounds and who received the last dose of tetanus toxoid containing vaccine in last three years. If the last dose of tetanus toxoid containing vaccine is from less than five years ago and they have a contaminated wound, they are considered protected against bacteria and there is no need for another dose of vaccine. Otherwise, in both situations a booster dose should be administered (7). Unfortunately, temporary immunity is provided by TIG and can only contribute to removing unbound tetanus toxin and cannot neutralize toxin, which is bound to be nerve ending. Prophylactic dose of TIG should be administered in patients who are not vaccinated or have less than a three dose vaccine. In order to do prophylactic prevention, 250 IU TIG should be administered intramuscularly. People with HIV and contaminated wounds, regardless of their CD4 count, immune status, and history of tetanus immunization, should receive TIG. The wound should be checked in order to observe the sign of infection, however, antibiotic therapy is not recommended and in the case of detection, infection treatment should be done promptly (7). The organism is rarely recovered from the afflicted site of infections, due to the fact that there is no available laboratory test to confirm tetanus; clinical symptoms is the only way of diagnosis. In a patient with recent a history of open and contaminated wound and spasm of muscles, tetanus should be suspected particularly in incompletely vaccinated or unvaccinated cases. Although rigidity is sometimes confined to the region of injury, abdominal rigidity is a common first sign suggestive of tetanus in older children and adults (8). Therefore, vaccination coverage and awareness, wound care treatment, establishment regular surveillance system besides disaster management, and support program can successfully prevent tetanus outbreak after disaster (8). In Iran, during half of the past century, the national extended immunization program is given for free to every person who was born. The vaccination coverage of tetanus in the first decades of life is estimated at about 98%, however, unfortunately, most of the vaccinated children do not receive a booster dose due to the lack of adult vaccination program, which lead to reducing protective antibody level. Furthermore experience of tetanus prophylaxis in soldiers during 8 years of war between Iran and Iraq show that excellent management of tetanus prophylaxis could lead to not increasing incidence of tetanus cases. Special attention to the prevention of tetanus should be paid due to the fact that from a geographical point of view, Iran is located in an earthquake zone region and there have recently been periodic earthquakes.
    Keywords: Tetanus, Earthquake, Management
  • Sina Sekandarpour, Mahdi Mohammadi, Jalal Zaman, Ramin Saravani, Mohammad Mousavi , Hadi Mirahmadi* Page 13
    Background
    Toxoplasma gondii is an obligate intracellular parasite, which can be found in different cells of humans and animals and infect many tissues. The virulence of T. gondii strains is commonly detected, based on the outcomes of infection in mice. The present study was performed to determine the parasite distribution and tissue tropism of tachyzoites of T. gondii RH strain in an experimental mouse model of infection, using quantitative polymerase chain reaction (qPCR).
    Methods
    In this experiment, male and female BALB/c mice were infected through intraperitoneal injection of 103 tachyzoites of T. gondii RH strain. The assessments were performed at 1, 2, 3, 4, and 5 days postinoculation (dpi), as well as the time of death; the mice were monitored 3 times a day. After the animals were sacrificed in each group, different tissues were collected from the heart, liver, lung, muscle, kidneys, genitals, spleen, brain, eyes, and blood and maintained at -20°C. Then, DNA samples were extracted using kits, and DNA copy number was measured via qPCR, targeting B1 gene.
    Results
    The parasite was distributed in various tissues on the first day after infection and exhibited the ability to cross the blood-brain barrier within the brain. Twenty-four hours after tachyzoite inoculation, the highest parasite load was observed in the liver tissues of both groups.
    Conclusions
    Considering the blood flow to all tissues and transmission of parasite to other tissues, the highest parasite count was reported in the present study. These findings are invaluable for assessing the impact of new drugs on these parasites. There is also the possibility of sexual transmission, causing a significant parasite load in the genitals.
    Keywords: Real-Time PCR, In Vivo, Parasite Burdens, Toxoplasma gondii
  • Parisa Mobasseri, Leila Azimi, Mitra Salehi, Farzaneh Hosseini, Fatemeh Fallah * Page 14
    Background
    Multidrug efflux pump is a ubiquitous mechanism of drug resistance in bacterial pathogens, such as Acinetobacter baumannii, which is mediated by integral membrane transport proteins. The purpose of the current study was to analyse the distribution of adeG and its role in resistance to ciprofloxacin in A. baumannii isolates from two hospitals of Tehran.
    Methods
    Fifty-one isolates of A. baumannii were recovered from Shahid Motahari and Milad hospitals of Tehran, from July 2016 to March 2017. Identification of A. baumannii was confirmed by phenotypically and molecular methods. Antibiotic susceptibility testing was prepared by the Kirby-Bauer method. Resistance to ciprofloxacin was confirmed by determination of minimum inhibitory concentration (MIC). Efflux pumps inhibitor was used for phenotypic detection of active efflux pumps. Real-time polymerase chain reaction (PCR) was used to analyze adeG gene over expression.
    Results
    Fifty-one isolates of A. baumannii were confirmed by phonotypical and molecular methods. Results of antibiotic susceptibility testing confirmed resistance to ciprofloxacin in all isolates. Results of conventional PCR showed that all of the isolates had the adeG gene. The MIC of ciprofloxacin was decreased by 4 to 32 folds or more in 88% of resistant isolates after adding the efflux pump inhibitor. Over expression of AdeG efflux pump gene was confirmed by real-time PCR in 34 strains.
    Conclusions
    In conclusion, multidrug-resistant A. baumannii were prevalent in the studied isolates. Carbonyl cyanide3-chlorophenylhydrazone could reverse the susceptibility to ciprofloxacin in A. baumannii and was associated with overexpression of the adeG gene.
    Keywords: Multidrug Efflux Pump Genes, Real-Time Polymerase Chain Reaction, Acinetobacter baumannii, adeG Gene
  • Saman Dorodgar, Hossein Hatami, Zahra Arab, Mazar , Davood Yadegarynia* Page 15
    Background
    Rapid increase in nosocomial infections (NIs) due to antibiotic resistant organisms is a global issue, which causes significant morbidity in both patients and healthcare professionals ultimately leading to an extra cost on health care systems. Thus, studying NIs is a public health priority.
    Methods
    The study was designed as a cross-sectional investigation between 2015 - 2017. Inpatient cases of selected hospitals with nosocomial infections were included. Demographics, source of infections, causative agents, and their antibiotic susceptibility through E-test method were collected. All data were analyzed using SPSS statistical software (version 19).
    Results
    A total of 168 patients with NIs were identified. Of the patients, 100 (59.5%) cases were male. The intensive care unit had the highest infection rate (N = 100 (59.5%)) and bronchoalveolar lavage (BAL) (N = 58 (34.5%)) and Acinetobacter (N = 76 (47.5%)) were the most common source and organism of NI.
    Conclusions
    Results of this study showed the dangerously high nosocomial infection rates, which necessitates considering surveillance of antibiotic usage and restriction of using broad spectrum antibiotics in infections.
    Keywords: Nosocomial Infection, Bacterial Agent, Resistance, Susceptibility
  • Salman Khazaei, Ali Zahiri, Abdollah Mohamadian, Hafshejani, Hamid Salehiniya , Shahrzad Nematollahi* Page 16
    This cross-sectional study was conducted on all registered smear-positive Tuberclosis (TB) patients during a time period of eight years (2005 - 2013); patients with records in the Hamadan provincial surveillance database were studied, in order to find secondary attack rate of TB. The contact investigation in 510 clusters resulted in secondary attack rate (SAR) of 18.75 per 1000 (95% confidence interval: 1.3 - 38.7) children below the age of 15; SAR of 6.7 per 1000 (95% confidence interval: 2.1 - 11.3) adults; and overall SAR of 8.14 per 1000 contacts (95% confidence interval: 3.4 - 12.8). we concluded that age and household size had a significant impact on the transmission of TB to household contacts.
    Keywords: Household Contacts, Tuberculosis, Hamden Province
  • Mahsa Choukhachian, Mohammad Ahangarzadeh Rezaee, Javid Sadeghi , Mohammad Reza Nahaei* Page 17
    Background
    Enterococci form a part of the normal flora of the intestinal tract, the oral cavity, and the vagina; also, they can cause UTI, septicemia, intraabdominal abscesses, and nosocomial infections. High-level gentamicin resistance (HLGR) in enterococci is mediated by aminoglycoside modifying enzymes, which is mainly encoded by aac (6’)-Ie-aph (2”)-Ia gene.
    Objectives
    The present study aimed at investigating high-level gentamicin resistance in enterococci isolated from a pediatric hospital in Tabriz and detecting aac (6’) Ie-aph (2”) Ia gene.
    Methods
    In a descriptive and prospective study, a total of 100 enterococcal isolates were collected during September 2014 and June 2015 from a pediatric hospital in Tabriz, northwest of Iran. Bacterial identification and species determination were performed by standard biochemical tests. Antimicrobial susceptibility tests were performed by Kirby Bauer disc diffusion method. The frequency of aac (6’)-Ie-aph (2”)-Ia gene in the isolates was determined by polymerase chain reaction.
    Results
    Antibiotic susceptibility tests revealed that the highest resistance was against erythromycin (79%) and tetracycline (74%), whereas the highest susceptibility was observed against chloramphenicol (86%). Resistance to ampicillin, ciprofloxacin, and vancomycin were detected in 47%, 53%, and 42% of the isolates, respectively. In this study, 31 isolates (31%) were identified as HLGR from which 21 (67.74%) had resistance gene of aac (6’)-Ie-aph (2”)-Ia in their genome. The prevalence of resistance to other antibiotics and multi-drug resistance (MDR) was higher among the HLGR isolates compared to the non-HLGR isolates.
    Conclusions
    High prevalence rates of MDR and HLGR enterococci are important problems associated with medical settings. The results of this study indicated that aac (6’)-Ie-aph (2”)-Ia resistance gene is highly prevalent among gentamicin resistant isolates.
    Keywords: Enterococcus, Gentamicin, Antibiotic Resistance, Iran