Archives of Clinical Infectious Diseases

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In Collaboration with Tropical Infectious Diseases Research Center, SBMU

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Archives of Clinical Infectious Diseases is a peer-reviewed multi-disciplinary medical publication, scheduled to appear quarterly serving as a means for scientific information exchange in the international medical forum. The journal particularly welcomes contributions relevant to the Middle-East region and publishes biomedical experiences and clinical investigations on prevalent infectious diseases in the region as well as analysis of factors that may modulate the incidence, course, and management of infectious diseases and pertinent medical problems in the Middle East.

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Comparable Antibacterial Effects of Silver and Iron Oxide Nanoparticles on Urinary Calculi Obtained After Percutaneous Nephrolithotomy
(Brieflands, 2024-06-30) Dariush Rabbani; Zeinab Piravar; Mehrdad Jafari Fesharaki; Amir Hossein Kashi; Mazyar Salimi
Background: In recent years, science and industry have focused on preparing nanoparticles (NPs). Due to the resistance of bacteria to antibiotics, there is an overwhelming need to find effective antimicrobials with fewer side effects. Objectives: The aim of this study was to synthesize silver and iron oxide NPs and investigate their antimicrobial effects on bacteria isolated from urinary stones. Methods: Cases of urolithiasis from 45 patients with staghorn stones, extracted through percutaneous nephrolithotomy (PCNL), were included in the study. Urinary stone cultures were performed, and the isolation and identification of bacteria were done using standard microbiological techniques. Silver and iron oxide NPs were synthesized, and the minimum bactericidal concentration (MBC) and minimum inhibitory concentration (MIC) were evaluated for the isolates. Results: Seventeen (60.7%) out of 28 positive cultured cases of the isolated bacteria were gram-negative, and 11 (39.3%) were gram-positive. The most abundant isolated bacterium was Escherichia coli, with 13 cases (46.4%). The antibacterial effects of silver and iron oxide NPs revealed that the maximum inhibitory zone for Ag NPs at 1000 ppm was 23 mm, and for Fe3O4 NPs, it was 18.5 mm. The MIC was 180 µg/mL for Ag and 250 µg/mL for Fe3O4. The MBC was 228 µg/mL for Ag and 300 µg/mL for Fe3O4. Conclusions: Nanoparticles exhibited antibacterial effects on the bacteria studied in a concentration-dependent manner. Ag NPs showed a more pronounced bactericidal effect than Fe3O4 NPs. As a result, these two NPs demonstrated effective antibacterial activity against both gram-positive and gram-negative bacteria.
Prevalence of Campylobacter Species, Helicobacter Pylori, Human Papillomavirus, and JC Polyomavirus in Patients with Colorectal Cancer in Iran
(Brieflands, 2024-06-30) Parisa Abedi Elkhichi; Ehsan Nazemolhosseini; Hossein Dabiri; Sama Rezasoltani; Abbas Yadegar; Mehdi Azizmohamad looha; Ali Mojtahedi; Mohammad Javad Nasiri
Background: Colorectal cancer (CRC) is a complex disease with diverse gene expression patterns, which can arise from common adenomas or serrated polyps. The role of intestinal microbiota in the development of CRC is still a subject of debate. Objectives: This study aimed to explore the prevalence of a selection of gastrointestinal microbiota in Iranian patients with CRC. Methods: A total of 86 biopsy specimens (17 samples from normal tissues and 69 samples from cancer tissues) were analyzed from normal controls and patients with CRC. The presence of Helicobacter pylori, Campylobacter species (including C. jejuni, C. coli, C. upsaliensis, C. bovis, and C. fetus), as well as human papillomavirus (HPV) and JC polyomavirus (JCV) in tissue specimens, was examined using PCR. Results: The prevalence of the targeted bacterial and viral agents in CRC patients exhibited significant variations compared to normal controls. Notably, there was a higher prevalence of the Helicobacter genus in patients with CRC compared to normal controls. Patients with CRC were found to be at an increased risk of Campylobacter infection, with various Campylobacter species identified. Additionally, HPV and JCV genomes were detected in cancer samples at a higher rate than in normal controls. Conclusions: Our findings demonstrated a higher prevalence of the Helicobacter genus, Campylobacter species, HPV, and JCV in patients with CRC compared to normal controls. However, further research is required to elucidate the potential role of these bacterial and viral agents in the development of CRC.
Antimicrobial Resistance as Global Emergency Action Plan
(Brieflands, 2024-06-30) Masoud Mardani
This article does not have an abstract.
Prevalence, Diversity, and Antimicrobial Susceptibility Profiles of Methicillin-Resistant Staphylococcus aureus Among Patients with Diabetic Foot Infections in a Referral Hospital in Tehran, Iran
(Brieflands, 2024-06-30) Fateh Rahimi; Sanaz Khashei; Mohammad Katouli
Background: The increasing incidence of methicillin-resistant Staphylococcus aureus (MRSA) poses a significant challenge in the treatment of diabetic foot infections (DFIs). Objectives: This study aimed to investigate the prevalence and diversity of clonal groups of MRSA strains isolated from patients with DFIs in a major referral hospital in Tehran. Methods: We determined the prevalence, diversity, and antibiotic susceptibility profiles of MRSA isolated from patients with DFIs attending a referral hospital in Tehran, Iran, during 2019 - 2020. Staphylococcal cassette chromosome mec (SCCmec) typing, ccr typing, PhP typing, and detection of the Panton-Valentine Leukocidin (pvl) gene were performed to explore the diversity of the strains. Antibiotic susceptibility profiles of the strains were determined using the disk diffusion method and broth microdilution assay. Results: Of the 238 S. aureus strains isolated, 73 were identified as MRSA. The highest antibiotic resistance was observed against ciprofloxacin (86%), followed by kanamycin and tobramycin (84%). Additionally, 49.3% of the strains exhibited high-level oxacillin resistance (MIC ≥ 256 µg/mL). SCCmec type III and type 3 ccr were detected in 86.3% of the strains, classifying them as hospital-acquired (HA)-MRSA. PhP typing revealed the presence of 8 common types (CTs) and 11 single types (STs), with CT2 comprising 41.1% of the strains. Conclusions: Our data suggest that MRSA strains isolated from DFIs in this region are diverse and resistant to clinically important antibiotics. Diabetic patients can serve as a reservoir for the dissemination of these bacteria between community and clinical environments.
Phenotypic and Molecular Characterization of Vancomycin and Linezolid Resistance in Clinical Isolates of Staphylococcus aureus
(Brieflands, 2024-06-30) Masoumeh Aslanimehr; Hajar kalhor; Adeleh Attar; Ameneh Barikani
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of healthcare-associated infections and poses a significant global challenge due to its high pathogenicity and rapid spread among patients. Vancomycin and linezolid are key antibiotics for treating staphylococcal MRSA infections. Objectives: This study aimed to investigate resistance to vancomycin and linezolid in clinical isolates of S. aureus. Methods: In this study, 270 S. aureus isolates were collected from patients admitted to hospitals in Tehran and Qazvin. Strain identification was performed using biochemical methods and femA gene amplification. Resistance to methicillin and vancomycin was determined using disk diffusion, minimum inhibitory concentration (MIC) determination, and E-test methods. Methicillin resistance was also assessed by detecting the presence of the mecA and mecC genes. Resistance to vancomycin and linezolid was evaluated by examining the presence of vanA, B, C, and cfr genes using PCR and sequencing. Results: Out of 270 S. aureus isolates, 152 (56.3%) were identified as MRSA, with 144 (94.7%) of these MRSA isolates containing the mecA gene. Two (0.7%) VRSA isolates were observed, and the vanA gene was detected in both. Additionally, four VISA (1.4%) isolates were identified, but the vanA gene was not detected in any of the VISA strains. None of the isolates contained the mecC, vanB, or vanC genes. Among the 10 (3.7%) linezolid-resistant isolates, none contained the cfr gene. Conclusions: The results of this study demonstrated a high prevalence of MRSA isolates, which can lead to treatment failure with beta-lactam antibiotics. The emergence and spread of VRSA and VISA isolates pose a serious concern for the healthcare system, particularly in the treatment of MRSA infections. Therefore, the findings emphasize the need for appropriate monitoring and control measures to prevent the emergence and transmission of MRSA and VRSA strains. Vancomycin and linezolid remain suitable drugs for treating these infections.
Exposing Vibriosis: A Scoping Review of the Literature Regarding Sequelae of Non-cholera Vibrio Infection
(Brieflands, 2024-06-30) Alexandra Armstrong; Sandra Hoffmann; Kylie Boyd; Erika Austhof; Caitlyn McFadden; Kenzie Schaefer; Kristen Pogreba-Brown
Vibriosis, non-cholera infection by marine bacteria of the genus Vibrio, is a relatively uncommon infection associated with high morbidity and mortality relative to other bacterial food and waterborne pathogens. The range and impact of these common marine organisms is likely to increase as global water temperatures rise in association with global warming. We have conducted a scoping review of available literature (2000 - 2020), including individual case studies, in order to provide the most current overview of reported sequelae and complications of this disease, including amputation, necrotizing fasciitis, organ failure, respiratory complications, and uncommon serious outcomes. Notably, we have found the available data indicate that route of exposure (contact with water, ingestion) may not be a reliably associated with disease presentation (soft tissue infection, gastroenteritis, sepsis) as has commonly been proposed. This information can be used to inform more accurate burden estimates for this disease, which have, to date, not included severe tissue sequelae including amputation as an outcome associated with foodborne exposure to non-cholera Vibrio. We have also identified knowledge gaps and priority research areas that may provide data allowing further refinement of cost and burden models.
Mycobacterium Tuberculosis Infection Presenting with Cutaneous Abscess and Osteomyelitis
(Brieflands, 2008-10-31) Kamal Esalatmanesh; Zahra Soleimani; Mohamad Soleimani
Background: Mycobacterium tuberculosis is a multi-systemic infection. A resurgence of cases of M. tuberculosis infection and extrapulmonary involvement has occurred in parallel with the HIV epidemic. Tuberculosis is rarely associated with cutaneous or osteoarticular infection. Patient: In this case report we described an unusual case of tuberculosis presenting with concurrent cutaneous abscess and osteomyelitis. The final diagnosis was confirmed by radiographic and cultural findings. Conclusion: Cutaneous tuberculosis should be included in the differential diagnosis of patients with cutaneous abscesses or musculoskeletal complaints, particularly in high risk populations such as immigrants from endemic regions and immunosuppressed patients.
Prevalence and Molecular Determination of Hepatitis C Infection in Khyber Pakhtunkhwa, Pakistan
(Brieflands, 2014-06-30) Muhammad Waqar; Asad Ullah Khan; Amjad Ali; Muhammad Wasim; Muhammad Idrees; Zobia Ismail; Agha Asad Noor; Noorul Akbar; Shaista Bano; Muhammad Arif Khan; Rahim Ullah Khan
Background: Hepatitis C virus (HCV) infection is the most significant source of chronic liver diseases in the globe. About 170 million individuals are infected by HCV worldwide. The reported prevalence of HCV in different areas of Khyber Pakhtunkhwa (KP) ranges from 4.1 to 36%. Objectives: The current study aimed to analyze the true prevalence of HCV infection in Khyber Pakhtunkhwa, Pakistan. Materials and Methods: Three hundred and ninety HCV enzyme-linked immunosorbent assay (ELISA) positive samples that belonged to the different regions of Khyber Pakhtunkhwa were sent to the Genome Centre for Molecular Based Diagnostics & Research (GCMBDR), Lahore, from January 2011 to March 2011, and were selected for the current study. Serological and biochemical data of these samples were provided by clinicians. Out of 390 samples, 40 were provided from Mardan, 65 from Dir (Lower), 185 from Swat and 100 from Malakand districts of Pakistan. Results: Out of 390 patients, 140 were found HCV RNA positive (by Polymerase Chain Reaction method) and 250 subjects were excluded from further analysis. Out of PCR positive subjects, 81 were male and 59 were female. All individuals were categorized in four age groups that is, 0 to 20, 21 to 40, 41 to 60 and above 60 years. HCV RNA was found in 16.67%, 37.5%, 35.51% and 36% of these groups, respectively. District wise HCV positivity rates were 36.2 % in Swat, 38.4% in Dir (L), 36% in Malakand and 30% in Mardan, respectively. Conclusions: It was found that among the studied areas, Dir district had the highest prevalence of HCV, the majorly of affected patients were among the age group of 21 to 40 , male patients were found more susceptible to this infection (P = 0.0103 < 0.05), and the possible reason can be the high exposure of males to the HCV infection risk factors. Furthermore the current study was unable to find the important risk factors responsible for the frequent prevalence of HCV infection in Khyber Pakhtunkhwa
The Association Between ABO-Rh Blood Groups and the Risk of COVID-19 Infection
(Brieflands, 2021-02-28) Abbas Sedighinejad; Hossein Khoshrang; Mohammad Haghighi; Ali Ashraf; Mostafa Saeedinia; Gelareh Biazar; Zahra Atrkarroushan; Mahdi Ajdadi
Background: Coronavirus disease 2019 (COVID-19) as an alarming attack broke out in China and spread rapidly worldwide. Objectives: Based on a theory indicating the correlation between some viral diseases and blood types, we investigated the relationship between blood groups and coronavirus infection risk in Guilan Province, Iran. Methods: Retrospectively, all the files of the admitted patients with suspected COVID-19, in peak conditions of the disease between March 1 and May 30, 2020, were reviewed using the Census method. The required data, including epidemiological and clinical information and outcomes, were obtained from electronic records. Results: A total of 249 cases were analyzed, of whom 109 were collected from governmental centers, and the rest were collected from private hospitals. The most common co-morbidity was diabetes with 71 (37.6%) cases and the main symptom at the admission time was dyspnea with 170 (24.5%) cases. Of the total patients, 155 (62.2%) were discharged, and the rest died. The most common blood group among our patients was O Rh-positive with 91 (36.5%) cases. No meaningful correlation was found between outcomes and blood groups in terms of ABO types (P = 0.89) or Rh factor (P = 0.456). The Rh-positive proportion was significantly higher in the COVID-19 cases than in the general population (P = 0.038). Conclusions: We found that the Rh-positive proportion was significantly higher in the COVID-19 cases than in the healthy individuals. However, no correlation was observed between the groups regarding ABO typing.
The Challenge of Tuberculosis Diagnosis and Management in the Era of the COVID-19 Pandemic and Diabetes Mellitus
(Brieflands, 2021-12-31) Alireza Esteghamati; Masoud Mardani
This article does not have an abstract.
Efficacy of Dexamethasone and Methylprednisolone in Hospitalization Outcomes of COVID-19 Patients: A Comparative Retrospective Study
(Brieflands, 2022-04-30) Mohammad Amin Abbasi; Amir Ziaee; Alireza Hejrati; Seyyed Alireza Hosseini; Lina Hejrati; Shahin Keshtkar Rajabi
Background: Control of the COVID-19 pandemic, its treatment, and prevention of mortality and morbidity have been the main focus of researchers over the past two years. Due to disagreement on the usefulness of different corticosteroids in the treatment of COVID-19, this work compared the efficacy of dexamethasone and methylprednisolone in the treatment outcomes of intensive critical care (ICU) patients. Methods: The present retrospective cohort study examined clinical records of 105 COVID-19 patients hospitalized in the ICUs of Firoozabadi Hospital in 2021. Clinical outcomes, including the length of hospital stay, the need for a ventilator, and mortality, were compared between patients who received either dexamethasone (DXM) or methylprednisolone (MP). Data were analyzed by SPSS V.20 software at P < 0.05 as statistical significance. Results: The mean ± SD ages of the patients in the DXM and MP groups were 58.82 ± 19.29 and 60.66 ± 14.17 years, respectively, without a statistically significant difference (P > 0.05). The mean duration of hospitalization was 8.14 ± 4.36 days in the DXM group and 6.80 ± 3.34 days in the MP group (P = 0.295). Also, 19 (33.3%) cases in the DXM group an, 19 (39.6%) in the MP group needed mechanical ventilation during hospitalization (P = 0.546). Finally, 30 (52.6%) patients in the DXM group and 27 (56.2%) in the MP group died. Conclusions: The findings indicated no significant difference in the mean duration of hospitalization, the need for a ventilator, and mortality in COVID-19 ICU patients treated with methylprednisolone or dexamethasone. There is a need to perform meta-analyses owing to conflicting results regarding the effects of different corticosteroids on the COVID-19 course.
Combined Evaluation of HSV Genome and Antibodies in Breast Cancer
(Brieflands, 2022-08-31) Zahra Tahmasebi Fard; Maryam Khayamzadeh; Zahra Mahdavi
Background: Breast cancer develops due to the combination of external and internal risk factors. Also, the role of viruses is considerable in developing breast cancer. Objectives: This study compared the frequency of herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) and the level of IgM and IgG antibodies against HSV between cancer patients and healthy individuals. Methods: Sixty women with breast cancer and 60 healthy women (40 with fibroadenoma and 20 in good health) were selected. Breast tissue and serum samples were taken from all the subjects to evaluate the HSV-1 and HSV-2 genome frequency using real-time PCR. Also, serum levels of IgM HSV and IgG HSV antibodies were assessed using the ELISA technique. Results: The HSV-1 genome was detected in six cancer specimens and in two fibroadenoma specimens (P = 0.143, OR: 3.22, CI95%: 0.623 - 16.66). Three cancer cases and one fibroadenoma case were positive for HSV-2 (P = 0.309, OR: 3.105, CI95%: 0.314 - 30.73). HSV IgM antibody was positive in three subjects in the control group and six in the case group (P = 0.298, OR: 2.11, CI95%: 0.503 - 8.87). Although the higher mean levels of antibodies were found in the case group (4.01 ± 5.91 U/mL) compared to the control group (2.95 ± 3.51 U/mL), there was no statistically significant difference between them (P = 0.179). The serum of all samples was positive for the HSV IgG antibody, and there was a statistically significant difference in its mean levels between the case (91.22 ± 13.58 U/mL) and control (81.58 ± 17.02 U/mL) groups (P = 0.008). Conclusions: The present study showed that HSV-1 and HSV-2 were not directly related to breast tissue carcinogenesis and may act as co-factors.
Therapeutic Effects of Nigella Sativa Linn (Black Cumin) on Candida albicans Vaginitis
(Brieflands, 2015-01-31) Farzaneh Adiban Fard; Shahnaz Tork Zahrani; Alireza Akbarzadeh Bagheban; Faraz Mojab
Background: Monilial Vaginitis is one of the most common gynecological problems among women all over the world causing 10 million consultations annually. Although the global prevalence of vaginitis is not clear, it has been reported that this infection becomes about twice more. The first cause of vaginitis in the Europe and the second cause in the United States are infections related to Candida albicans. Generally, the important cause of vaginitis is Candida albicans. Popular drugs regarding Candida albicans Vaginitis are topical ones such as Azoles. These drugs are known to cause severe adverse effects and high rate of relapse, in contrast some antifungal effects of Nigella Sativa L. without causing any adverse effect have been reported. Objectives: The aim of this study was to determine the effect of Nigella Sativa Linn capsule in the treatment of Candida albicans vaginitis. Patients and Methods: This study was a randomized clinical trial, triple-blind, placebo controlled study performed on 100 women in Iran. Gynecological and microbiological evaluations were performed before and after the treatment. There were not statistically significant difference in signs and symptoms of monilial vaginitis before the treatment (P ˃ 0.05). Nigella Sativa Linn capsule and clotrimazole vaginal cream for the study group and placebo capsule and clotrimazole vaginal cream for the control group were prescribed for seven days. Data was obtained by interview and observation and analyzed with Chi-square, t-test, Mann-Whitney, Fisher-exact-test and McNemar tests. Results: There was a statistically significant difference in vaginal itching, discharge, irritation, vulvovaginal redness and inflammation after the treatment between the two groups and much more in the study group (P ˂ 0.001). However, the culture and wet mount (with KOH) results showed much improvement in the study group after treatment. Conclusions: The use of Nigella sativa L. capsule with clotrimazole vaginal cream was found more effective than clotrimazole vaginal cream alone, in most common symptoms and signs of this vaginitis. Therefore, Nigella Sativa L. capsule is suggested for the treatment of Candida albicans Vaginitis.
Biofilm Producing Staphylococcus epidermidis Strains Isolated From Clinical Samples in Tehran, Iran
(Brieflands, 2016-07-01) Fateh Rahimi; Sharmin Karimi
Background: Staphylococcus epidermidis is well documented as an opportunistic pathogen causing biofilm in patients and healthy individuals. Objectives: The aim of this experimental study was to describe the antibiotic resistance patterns of biofilm producing S. epidermidis strains isolated from clinical samples in Tehran, Iran. Moreover, the role of different genes in biofilm formation was also described. Patients and Methods: A total of 250 S. epidermidis strains were isolated from patients in a private hospital of Tehran, Iran from February to December 2014. The biofilm formation of each strain was determined using combination of qualitative Congo-Red agar and quantitative microtiter plate assay, and presence of different genes involved in control and formation of biofilm was detected by the polymerase chain reaction (PCR). Susceptibility of S. epidermidis strains to 19 antibiotics was examined. Results: The results of the biofilm assay revealed that 82% of strains produced black colonies on Congo red agar plates and 68% were able to attach strongly to polystyrene microplates. One hundred percent, 88%, 84%, 64% and 60% of biofilm-producing strains were resistant to penicillin, cefoxitin, erythromycin, trimethoprim-sulfamethoxazole and kanamycin, respectively. On the other hand, none of the strains showed resistance to vancomycin, linezolid, quinupristin/dalfopristin. The icaA, icaD, aap and atlE genes were detected in all biofilm-producing strains and presence of IS256 transposon was limited to 84% of biofilm positive strains. Conclusions: The results of this study illustrated the high prevalence of antibiotic resistant biofilm-producing S. epidermidis strains in this hospital, which could be a reservoir for antibiotic resistance genes.
Immigration: a Potential Risk Factor for Intrafamilial Transmission of HIV Infection
(Brieflands, 2008-01-31) Batool Sharifi Mood; Malihe Metanat; Masoud Mardani; Bashir Pejman
Background: Injection drug users (IDUs) are at risk of HIV infection more than other groups. Also, immigration is a potent risk factor for HIV infection /AIDS. Saravan is a city in Southeast of Iran that men have to immigrate to other countries to work. Since, family deprivation is a risk factor for occurrence of infection in this group; we decided to define the prevalence of HIV infection in immigrant men and their families. Materials and methods: In this cross-sectional, descriptive study, in a time period of 5 months in 2005, in Saravan (Southeast of Iran), we evaluated the prevalence of HIV/AIDS in the families of the men with HIV infection/AIDS who had a history of immigration to other countries. Blood samples of the mothers and children were evaluated by ELISA method and in those who had a positive test, results were confirmed with a more specific assay (western blot). Results: Among 274 patients with HIV infection/AIDS (224 male and 50 female) in Sistan and Baluchestan Province in Southeast of Iran, 65 cases (41 male, 24 female) were from Saravan (a city in Sistan and Baluchestan). Out of 41 men with HIV/AIDS in Saravan, 21 cases had a history of immigration to neighboring countries. Forty- five percent of women (11 cases) who had infected immigrant husbands, showed a positive test and they were infected with HIV. Also, HIV test was positive in 3 children of families whom their fathers were infected immigrants. Fifty-one percent of men with HIV/AIDS had the history of immigration. Conclusion: Upon these results, immigration and family deprivation are potent risk factors for occurrence of infection
Antibiotic Susceptibility Pattern and Virulence Genes in Enterococcus spp. Isolated From Clinical Samples of Milad Hospital of Tehran, Iran
(Brieflands, 2016-07-31) Leila Arbabi; Mina Boustanshenas; Mohammad Rahbar; Parviz Owlia; Maryam Adabi; Samira Rasouli Koohi; Mastaneh Afshar; Sara Fathizadeh; Ali Majidpour; Mahshid Talebi-Taher
Background: Enterococcus spp. are part of the normal flora of humans and animals. The nosocomial pathogenicity of Enterococcus spp. has emerged in recent years and has caused great concern due to developing of resistance to many antimicrobial agents. Objectives: The current study aimed to determine the resistance pattern and the type of virulence genes in Enterococcus spp. isolated from Milad hospital of Tehran, Iran. Materials and Methods: The current observational study was conducted from Apr 2014 to Feb 2015 on a total of 149 Enterococcus species isolated from Milad hospital in Tehran, Iran. The antibiotic susceptibility pattern of the bacteria was determined by the disc diffusion method for eight antibiotics. Minimum inhibitory concentration (MIC) of vancomycin was also done using agar-dilution assay by clinical and laboratory standards institute (CLSI) recommendations. The sodA, esp, cyl, ace and gelE genes were detected by polymerase chain reaction (PCR) assay. Results: About 37.5%, 73%, 86.6%, 35.8%, 69%, 60.8%, 45% and 79% of the isolates were resistant to vancomycin, tetracycline, gentamicin, chloramphenicol, ciprofloxacin, penicillin, ampicillin and erythromycin, respectively. MIC on 38% of the isolates was ≥ 256 µg/mL. Although, the prevalence of vancomycin-resistant Enterococcus (VRE) strains belonged to two species, E. faecium showed high resistance to a broad range of antibiotics. In total, 94 isolates were positive for esp, and 59, 48 and 3 isolates were positive for ace, cylA and gelE, Respectively. Conclusions: The results of the current study designate the important role of medical samples as reservoirs of resistance inducing elements. Early detection of VRE with their virulence trait will help to prevent the spread of vancomycin resistant Enterococcus species. Supervision for antibiotic usage in hospitals, especially for last option antibiotics, can prevent the spread of resistant isolates and losing all treatment options in the future.
Co-infection of Leptospirosis and Crimean-Congo Hemorrhagic Fever
(Brieflands, 2016-07-01) Arash Seifi; Mahboubeh Hajiabdolbaghi; Esmaeil Mohammadnejad
Introduction: Infectious diseases are important factors affected human health over the years. At present, more than 450 diseases are known to be transmitted between animals and human. The Crimean-Congo hemorrhagic fever (CCHF) and leptospirosis are common zoonotic diseases causing fever and systemic illness. Clinical symptoms of CCHF and leptospirosis are often nonspecific; so, they may be mistaken with other infectious diseases. Case Presentation: This article presents a 56-year-old woman from Guilan Province, the north of Iran and the southern coast of the Caspian Sea, who admitted to the hospital with acute fever, severe headache, thrombocytopenia, anemia, epigastric pain, myalgia, nausea and vomiting. Conclusions: We recognized that the case was co-infected by CCHF and leptospirosis.
Invasive Pulmonary Aspergillosis in Patients with Non-Decompensated Liver Cirrhosis: A Case Report
(Brieflands, 2016-07-01) Roya Ghasemian; Anahita Nosrati; Mojtaba Nabili; Tahereh Shokohi
Introduction: Invasive pulmonary aspergillosis (IPA) is a fatal disease usually occurring in patients with neutropenia resulted from chemotherapy for malignancy. The other risk factors include consuming corticosteroids, organ transplant and advanced acquired immunodeficiency syndrome (AIDS). Recently, the incidence of IPA in immunocompetent patients without any history of organ transplant or malignancy has been increasing. Patients with advanced cirrhosis are one of the cases involved in this infection. Case Presentation: In this case study, we report invasive pulmonary aspergillosis in a 50-year-old patient (from Sari, Iran), who had gradual abdominal pain and ascites, cough and respiratory distress. Radiographic signs showed a round infiltration in the upper part of the right lung. Despite receiving 48-hour antibiotics therapy, the fever had not subsided. In CT-guided needle lung biopsy, septate and acutely angled hyphae (dichotomous) were seen. In CT-guided needle lung biopsy, septate and acutely angled hyphae (dichotomous) were seen. Direct examination of the sputum showed septate hyphae compatible with a filamentous fungus. According to morphological and molecular characterization, Aspergillus fumigatus was confirmed. Minimum inhibitory concentration (MIC) values of antifungal agents were determined based on the clinical and laboratory standard institute (CLSI) M38-A2. Treatment with intravenous amphotericin B was changed to oral voriconazole 200 mg, twice a day. The patient did not have any kind of residual lung lesion within the six-month follow-up and the cirrhosis was under control and she currently has no respiratory symptoms or signs. Conclusions: In patients with liver cirrhosis, when there is evidence of severe pulmonary disease without proper response to treatment, the possibility of invasive pulmonary fungal infection should be considered.
Magnesium Level in Patients With Adult T-Cell Leukemia: A Case Report
(Brieflands, 2016-07-01) Majid Khadem Rezaiyan; Farnaz Zahedi Avval; Zohreh Agheltar; Masoud Youssefi
Introduction: Adult T‐cell leukemia (ATL) is a rare neoplasm of post-thymic lymphocytes observed in only 3% - 4% of patients infected with human T-lymphotropic virus (HTLV-1). The exact mechanism by which HTLV-1 triggers ATL is still under investigation. HTLV‐I is endemic in specific regions of the world including Mashhad, Iran, where the present study was performed. Case Presentation: The current paper reports serum levels of calcium, magnesium and phosphorus as the main traced elements as well as parathormone (PTH) in five patients with ATL referred to Imam Reza hospital in Mashhad, Iran, in 2014. Conclusions: We observed upper limit values of the normal range for Mg in the ATL cases which may not be neglected from a clinical point of view. The other measurements did not show a remarkable difference with normal levels.
Changing Prevalence of Helicobacter Pylori in South of Iran
(Brieflands, 2010-04-30) Shohreh Farshad; Aziz Japoni; Abdolvahab Alborzi; Mohammad Zarenezhad; Reza Ranjbar
Background: The prevalence of Helicobacter pylori has declined rapidly in Asia. This has been shown in both seroprevalence-based and endoscopy-based studies. The present study was conducted to determine the prevalence of gastric infection caused by H. pylori in an Iranian population residing in south of Iran. Patients and Methods: A total of 522 patients (266 females and 256 males with the mean age of 44.313.0, range 18-83 years) underwent endoscopy in Shiraz, southern Iran. The diagnosis of H. pylori infection was established by rapid urease test, culture and gram staining and the gastric disease was confirmed by an expert pathologist. Results: From ulcerative (n=296) and non-ulcerative (n=226) patients, 156 (52.7%) and 94 (41.6%) H. pylori strains were isolated by culture, respectively. The prevalence of H. pylori infection was significantly higher in patients aged 21-30 and >50 years (66.66% and 62.12%, respectively). However, H. pylori was not detected in 22 patients aged Conclusion: The present study revealed a significant decline in the prevalence of H. pylori infection in the studied population. It seems that in parallel with better therapeutic approaches and elimination of bacteria, an improvement in the personal hygiene and living conditions of the Iranian population contribute to lower prevalence of H. pylori.

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