Archives of Clinical Infectious Diseases
Volume:14 Issue: 3, Jun 2019

Acute viral respiratory diseases are among the most prevalent diseases in humans. Viral respiratory infections are the main reasons for hospitalization and death in developing countries. The aim of this study is to determine the prevalence and clinical symptoms of the respiratory viruses including influenza viruses A and B, respiratory syncytial virus type A and B (RSV-A and RSV-B), human parainfluenza virus type 1 to 4 (HPIV-1-4) among patients with Influenza-like illness (ILI) in Zahedan City, Southeastern Iran from October 2015 to March 2016. Clinical and epidemiological data from patients who presented to outpatient clinics with ILI from October 2015 to March 2016 in Zahedan were collected. A total of 240 throat swabs were tested for Influenza virus by RT-PCR, and then those with negative results were tested for RSV-A, RSV-B, and HPIV type 1 - 4 using Multiplex-PCR. Among 240 patients, 115 (47.9%) were male and 125 (52.1%) were female. Influenza A virus was detected in 196 (81.7%) patients, out of them 157 (65.4%) had H1N1 subtype and the remaining patients had H3N2 subtype. Influenza B virus was observed in 9 (3.8%) patients. Respiratory syncytial virus type A and B, and human parainfluenza virus type 1 to 4 were not detected in this study. The highest rate of influenza A infection was in the age range of 16 - 45 years old and for influenza B was in the age group of more than 46 years. The most common clinical manifestations in both influenzas A and B were fever, cough, and myalgia. Over half of the patients with influenza B had dyspnea compared to 30% of ILI patients with influenza A virus infection. The results of the study revealed the highest rate of Influenza A infection with H1N1 subtype among patients presented to the outpatient clinics with the clinical manifestations of influenza-like illness. This study suggests continuing surveillance, infection control, and annual vaccination for Influenza.

Despite the clinical importance of ventilator-associated pneumonia (VAP) as the most common nosocomial infection in ICU, there are few studies in Iran evaluating the bacterial causative agents involving VAP. The aim of the present study was to determine the prevalence of bacterial agents of VAP, and to evaluate the presence of S. pneumoniae in VAP- confirmed ICU patients by real-time PCR. In this cross-sectional study, during March 2016 to March 2017, 50 tracheal aspirates were collected from VAP-confirmed ICU admitted patients in Tehran. The number of epithelial cells and white blood cells (WBC) were determined by direct microscopy. Bacterial identification from VAP samples was done by routine biochemical tests and culturing on differential media. DNA was extracted from samples, and based on lytA gene amplification, a quantitative real-time PCR was performed for S. pneumoniae detection and quantification. In culture, a pure bacterium was isolated from 40 out of 50 samples (80%), with Klebsiella pneumoniae (26%) and Acinetobacter ssp. (18%) being the most common isolates, respectively; however, all cultures were negative for S. pneumoniae. By real-time PCR, two samples (4%) were positive for S. pneumoniae with 4×104 and 1.6×105 CFU/mL bacterial load. These two samples contained 10 and 12 WBC/lpf, respectively. Although with only a with few clinical samples, this is the first study reporting pneumococcal VAP in Iran. Furthermore, in regards to the importance of VAP in ICU patients, more studies to optimize cultural method and evaluate applicable diagnostic molecular methods could be appreciated.

Pathogenicity O island 122 (OI-122) associated with the severity of Enteropathogenic Escherichia coli (EPEC) disease. The aim of this study was the characterization of OI-122 in Iranian EPEC isolates. The distribution patterns of OI-122 were investigated in 42 EPEC strains by detection of OI-122 genes and serogrouping, multi locus VNTR (MLVA) typing, and phylogenetic grouping. The complete OI-122 was identified in 18.75% of tEPEC and in 3.8% of aEPEC strains, an incomplete OI-122 with various combinations of genes was found in 75% of tEPEC and 30.76% of strains aEPEC, and OI-122 genes were absent in 6.25% of tEPEC and 65.3% of aEPEC strains. nleB (52.4%) was the most frequently detected, and the prevalence of pagC, efa1/lifA, and sen genes were 19%, 16.7%, and 14.3%, respectively. The most common phylogenetic group among tEPEC and aEPEC strains were B1 (68.75% and 80.76%, respectively). The common serogroups among EPEC isolates were O128, O111, O55, O127, and O44, and 45.2% of the isolates were untypeable. Forty-one MLVA types among 42 EPEC strains were classified into 7 clonal complexes. The diverse distribution of OI-122 genes among MLVA clonal groups provides evidence for dynamic evolution regarding the OI-122 pathogenicity island in tEPEC and aEPEC strains. The results also indicate that the acquisition of OI-122 gene contents occurs in a modular manner.

Enterococci are recognized as a cause of nosocomial infections and a major public health problem. The reliable identification to the species level of enterococci should be considered. The study aimed to develop a LAMP assay for the rapid and accurate detection of Enterococcus faecalis and E. faecium. In total, 57 enterococcal isolates from UTI patients were identified using conventional microbiological methods. Two sets of specific primers were designed for E. faecalis and E. faecium targeting the mtlf and efmC genes, respectively. The LAMP assays were conducted using specific primers, dNTPs, MgSO4, Bst DNA polymerase, and templates. The results of phenotypic testing indicated that of the 57 enterococcal isolates, 49 (85.9%) were identified as E. faecalis and eight (14.1%) as E. faecium. The optimal reaction temperatures in the LAMP assays were 60 and 61ºC for the detection of E. faecalis and E. faecium, respectively. All the 57 enterococcal isolates were identified as E. faecalis by the LAMP assay. The present study highlights the importance of the LAMP assay as a rapid and confirmatory tool for the identification of clinical Enterococcus spp.

The high-risk types of human papillomavirus (HPV) have been identified as one of the main causes of genital cancers over the recent years, therefore their accurate diagnosis plays an important role in controlling cancer and maintaining the community health. Since a primary diagnosis of this virus is not possible through serologic methods and cell culture, the present study has been conducted with the aim to identify and determine the frequency of oncogenic types of HPV from paraffin block samples using PCR. In this cross-sectional study, which was carried out in 2017, a total amount of 97 genital samples coated in paraffin were collected from precancerous and cancerous lesions. Their DNA was extracted using special kits, and PCR and post PCR techniques were applied using specific primers. 58 samples (59.8%) showed positive results in terms of the presence of HPV DNA, which indicated a high frequency for HPV. Moreover, 56.9% of HPV genotypes were classified under high-risk and 43.1% under low-risk categories, out of which HPV-16 (22.2%), HPV-11 (19%) and HPV-6 (12.7%) had the highest frequencies, respectively. The results of this study show that HPV could be considered as the main factor responsible for the changes in genital tissues is men and women, which have the potential to develop cancer. Furthermore, the involvement of various types of this virus in creating simultaneous and multiple infections further emphasizes the significance of screening and constant control of this virus.

Chronic hepatitis B is a major public health problem, especially, in developing countries. T helper 17 (th17) cells produce cytokines that have been shown to mediate host defensive mechanisms in various infections, but their role in HBV infection has not been well characterized. The aim of this study is to determine the level of interleukin 17 (IL-17) in patients with chronic hepatitis B infection and assess the relationship between different titers of viremia with serum IL-17 and liver enzyme levels. Patients with chronic hepatitis B virus infection (HBV) who were referred to Hepatitis Clinic at Boo-Ali Hospital, Zahedan, Iran, were divided into three major groups according to their viral load and subsequently IL-17 and serum alanine aminotransferase (ALT) levels were measured. The data analysis was examined by Kruskal-Wallis and Mann-Whitney tests. In this cross-sectional study, 143 untreated patients with chronic hepatitis B infection were divided into three main groups. Seventy-four patients with HBV DNA less than 2000 IU/mL; 53 patients with HBV DNA between 2000 - 107 IU/mL and 16 patients with HBV DNA more than 107 IU/mL. The mean of serum IL-17 levels in these three groups was 30.66, 26.87 and 24.42 pg/mL, respectively. There was no significant difference between different levels of HBV DNA with the serum level of IL-17 and ALT (P > 0.05). Although IL-17 may contribute to disease progression and liver injury in chronic HBV infected patients, the association between serum levels of IL-17 with viral load was not detected in this study.

The aim of this study was to evaluate the etiologic agents of a hand, foot, and mouth disease (HFMD) outbreak in Ahvaz, Southwest Iran and their evolutionary analysis by phylogenetic construction and Simplot analysis. We collected 16 serum samples in an outbreak of HFMD in Ahvaz in October 2013. RNA was extracted from the samples and subjected to reverse transcription polymerase chain reaction for detection of Enterovirus group A and B. Positive cases were sequenced and subjected to phylogenetic and Simplot analysis for detecting the signs of recombination. Of the 16 specimens, nine (56.25%) were PCR-positive with the universal primers for the Enterovirus 5’UTR region. Coxsackievirus A6 was detected as a predominant agent of HFMD with two cases of Echovirus 6 and Echovirus 30. In the case of Echovirus 6, the signs of recombination in the 5’UTR region were observed based on phylogenetic and Simplot analysis. Coxsackievirus A6 is the main agent of HFMD in Ahvaz. The evidence of recombination in this isolate of Echovirus 6 in this study emphasizes common hygiene practices and sanitation to prevent the circulation of this isolate in community and the advent of new strains.

Ecthyma gangrenosum is a skin lesion presenting invasive infection in the skin, which is commonly caused by Pseudomonas. Pathogenesis is mostly attributed to the microbial invasion in cutaneous tissues caused by the microorganism. One of the important, but rare causes of Ecthyma gangrenosum after Pseudomonas is Escherichia coli. A 45-year-old woman known as a case with acute myeloid leukemia who went into remission due to chemotherapy. After chemotherapy, she was febrile and septic. A physical examination revealed an erythematous round lesion (3 × 3 cm) that had developed on the posterior aspect of the right thigh with central bolus necrosis. E. coli was detected based on both blood cultures. Ecthyma gangrenosum is mostly seen in patients with severe immunodeficiency such as aplastic anemia, hematologic malignancies, especially patients with leukemia after chemotherapy and also in HIV patients. So far, in 11 patients reported in the literature, at least 8 cases are reported lesions on the lower limb, which is the most probable anatomic area for E. coli-induced Ecthyma gangrenosum. The E. coli-induced Ecthyma gangrenosum is a rare infectious lesion that is particularly seen in patients with a malignancy history, and lower extremity lesions should be considered.

Staphylococcus epidermidis as a typical opportunist pathogen is responsible for major nosocomial infections, and has a substantial impact on human life and health. Studies have shown that its main virulence factor is the ability to form biofilms on polymeric surfaces to which it adheres and colonize. The biofilms protect microorganisms such as Staphylococcus epidermidis against the action of antibiotics administered for the treatment of infections and against the patient’s immune system. In the current study, 50 isolates of S. epidermidis were characterized and subjected to biofilm detection by the microtiter plate (MTP), Congo red agar (CRA), and PCR methods. Antibiotic resistance was assessed by the disk diffusion method. The clinical source of S. epidermidis was as follows: blood (n = 20, 40%), urine (n = 4, 8%), wound (n = 8, 16%), catheter (n = 10, 20%), and pus (n = 8, 16%). The current study showed that all the isolates were susceptible to nitrofurantoin, vancomycin, and Synercid and all were resistant to penicillin. Moreover, 68% of the isolates were biofilm-positive by CRA and 76% by MTP methods. Finally, 72% of the isolates showed icaA genes. The pathogenic determinants of S. epidermidis are very complex, multifactorial, and dependent on numerous genetic and environmental factors. Other genes that may contribute to pathogenicity are also involved in biofilm formation in S. epidermidis that need to be studied in more accurate molecular assays.

Influenza causes high mortality rate among pregnant women, while morbidity and mortality cases of this disease and its side effects among pregnant women can be simply prevented by vaccination and reducing risk factors such as cardiovascular diseases, diabetes, hypertension, etc.

Hence, this study was conducted to investigate the risk factors and mortality rate of seasonal influenza among pregnant women referring to healthcare centers in Iran during 2015 - 2016.

This case-control study was conducted to examine the odds ratio of seasonal influenza among pregnant women with seasonal influenza who had referred to all healthcare centers in Iran with severe respiratory disease symptoms during 2015-2016. The statistical population consisted of 2,080 pregnant women of whom, 24 dead women constituted the case group and 100 randomly selected living women constituted the control group. A researcher-made checklist was used for data collection. The collected data were analyzed using the statistical test of the odds ratio with SPSS-22 software.

Mean (standard deviation) of age was 31 (2.3) and 34 (3.8) in living and dead pregnant women, respectively. The most frequent type of conflicting influenza virus was H1N1 in both case and control groups (83% and 71%, respectively). There was a significant difference between case and control groups in the risk factors including diabetes (P = 0.003), blood pressure (P = 0.001), obesity (P = 0.026), cardiovascular diseases (P = 0.001), renal diseases (P = 0.013), and respiratory diseases (P = 0.012). Among these risk factors, the highest odds ratio (OR) was related to cardiovascular diseases (OR = 24), blood pressure (OR = 16.3), and diabetes (OR = 12.9), in sequence. Oseltamivir prescribed to all patients in the control group and 92% of patients in the case group. Seven patients in the control group and none in the case group had a history of influenza vaccination.

It is necessary to take steps and underpin training programs to reduce the risk factors of seasonal influenza among pregnant women based on the national vaccination guidelines.