Archives of Clinical Infectious Diseases
Volume:1 Issue: 2, Apr 2006

With respect to the prevalence of tuberculosis in our country, BCG vaccination at birth seems to be an effective means of prevention. The present study was designed to evaluate the efficiency of BCG vaccination and factors influencing the tuberculin skin reaction. The inoculum of live BCG organisms in vaccinated infants was evaluated at birth and the correlation between the amount of CFU and PPD reaction was examined 3 months later. For this purpose, 854 newborn infants were included. PPD induration diameter was measured 72 hours after the tuberculin skin test. Results have revealed that most of the vaccine samples contained more than 3 million live organisms. Vaccines showing more than 3×106 live organisms were associated with positive tuberculin skin test in more 93% of cases as compared with 69% positive induration of vaccines with less than 3×106 live organisms. Breast-fed infants showed more positive reaction to tuberculin skin test. The number of live organisms in vaccines can play an important role in the size of tuberculin skin reaction.

Staphylococcus aureus is a virulent pathogen that is currently the most common cause of infection in hospitalized patients. These days, increment in antimicrobial resistance coupled with increasing prevalence of the agent as a nosocomial infection makes the situation even more complex. Patients on hemodialysis are at increased risk due to their immunocompromised state. The present study was designed to determine the prevalence of Staphylococcus aureus nasal carriage in a group of Iranian patients on hemodialysis. For this descriptive study, sterile-cotton-tripped swabs were rotated into anterior nares of 96 patients on hemodialysis, and then cultured on blood-agar medium. Having grown the colony, gram stain, catalase, manitol, DNAase and coagulase tests were all performed and the pattern of antibacterial sensitivity was determined. Of 96 patients on hemodialysis, 44 (45.8%) were nasal carrier of S. aureus. All isolated S. aureus were resistant to methicillin (MRSA), while 95% were resistant to cloxacillin, 6.81% to clindamycin, 6.81% to ciprofloxacin and 4.5% to rifampin; however, all microorganisms were sensitive to vancomycin. Patients on hemodialysis are at increased risk of S. aureus contamination, thus, screening these susceptible patients should be served as a health priority. Meanwhile, antibiogram should be ordered for all cases to optimize treatment options.

Intravenous drug use (IDU) is a frequent route of infection transmission, especially during the recent decades. Numerous studies have addressed the increasing frequency of IDU-associated infections such as hepatitis and AIDS. The present study was achieved to determine the prevalence of IDU-associated infections in 3 teaching hospitals in Iran. For this descriptive study, 3 teaching hospitals affiliated to Shaheed Beheshti University of Medical Sciences were considered and patients who had been admitted in infectious ward were included. Totally, 126 IDU patients were evaluated for duration of drug abuse, type of drug, site and frequency of injections, and clinical manifestations. The study population included 123 males and 3 females with a mean age of 37 years. They have averagely abused IV drugs for 5.8 years 3.3 times a day. Groin (44%) and upper extremity (forearm, arm or hand) (36%) were the most common sites of injection. Soft tissue and skin infection, respiratory infections and pulmonary TB, and viral hepatitis were the most common IDU-associated infections. Skin and soft tissues were the most common site of involvement among IDU patients. High frequency of pulmonary tuberculosis in IDU necessitates clinician’s attention; however, the association between TB and HIV was remarkable.

Brucellosis is a zoonotic disease that is endemic in Iran. Appropriate and rapid diagnosis has a vital role in public health improvement. Low isolation rate of the organism has reported frequently in various reports. The present study was conducted to determine the isolation rate of organism in culture from collected specimens of hospitalized patients who were not under antibiotic therapy. Meanwhile, comparing the direct inoculation to biphasic media with lysis method was also determined. Twenty-five hospitalized brucellosis patients diagnosed on the basis of clinical manifestations and positive serologic tests were included. Blood samples were provided and cultured either as direct inoculation into biphasic media or lysis method by washing with distilled water before culture on solid media. Brucella was isolated in 4 samples (16%). Further studies revealed all these four cases to be B. melitensis. Washing method did not differ in isolation rate with direct inoculation; however, Brucella was isolated in a shorter period in washing method. Higher isolation rate when compared with prior studies indicates an appropriate sampling time and technique, rapid inoculation to the media, and the lack of antibiotic therapy before sampling. Washing method has the preference of shorter isolation time to direct inoculation; however, it is faced with a higher risk of contamination.

Although recombinant hepatitis B vaccine is effective in a majority of population, a significant percent may do not response (up to 10%). Old age, obesity, heavy smoking and immunologic impairment have been associated with lower anti –HBs responses. In the present study, the efficacy of vaccine and effects of the abovementioned factors have been evaluated. Of 111 health care workers in Boo-Ali hospital, 72 participants completed primary vaccination series and antibody tittering. They received 20mg of recombinant HBV vaccine (Heberbiovac, Cuba) in standard schedule. Anti-HBs was determined by ELISA test (Diakey, South Korea) one month following the third dose. The lowest completion rate was reported among nursing staff and physicians (17%). Seroprotection (anti-HBs ≥10IU/L) was achieved in 86.1% of participants. Among seroprotected individuals, 52.8% were low-responders (anti-HBs titer of 10-99IU/L) and 33.3% were good responders (anti-HBs titer of >100IU/L). The independent predictors of responsiveness were age less than 40 (OR=3.5, 95%CI=1.8-14.6, p

Haemophilus influenza may cause severe infections in children and adults. The isolation and identification of Haemophilus spp. are not appropriately achieved in Iran, while numerous infections are ascribed to the different members of this genus. Lack of growth factors disks is our main shortage in this regard. We obtained haemin (X-factor) from human blood, and nicotinamidadenine di nucleotide (V factor) from yeast cells. The products were absorbed to the filter paper disks and a comparative analytical study was performed using prepared disks in comparison to commercial disks from Oxoid Company. Results revealed that the prepared disks were as useful, sensitive and potent as the Oxoid disks in isolation and identification of H. influenzae and H. parainfluenzae. We have prepared growth factor disks according to the original formulations. They could be commercially produced and uses in microbiological laboratories.

Hepatitis B virus (HBV) infection is a worldwide health concern. Alpha-interferon and lamivudine have been approved for HBV patients; however, their efficacy remains a matter of controversy. The present study compares these two antiviral regimens in a group of Iranian patients with chronic hepatitis B. It was a randomized controlled clinical trial. Totally, 32 newly diagnosed hepatitis B patients were assigned in 2 groups of lamivudine (100mg per day orally) and alpha-interferon 2a (9 million units every other days subcutaneously). Both groups were evaluated at weeks 0,1,2,4, and monthly after till the 6th month at Tehran Hepatitis Center. HBV DNA, HBeAg, anti-HBe, ALT activity, liver biopsy according to Knodell scoring system and drug side effects were determined, when appropriate. The mean age of the patients was 31.4 ±8.8 years. PCR studies revealed negative in 13 (81.3%) interferon- and 15 (93.8%) lamivudine-treated subjects after 6 months of therapy. Among 17 patients with ALT activity of less than 70IU/l prior to therapy, 9 (90%) interferon- and 7 (100%) lamivudine-treated patients were found to have negative PCR results following the therapy (p

Brucellosis is a relatively frequent disease in the Mediterranean and Middle East regions. We describe a young adult male presenting with a 6-month history of fever, headache, malaise, and mental dullness. CSF studies revealed lymphocytic pleocytosis with increased protein and low glucose. Serum and CSF analysis were strongly positive for brucella. He was prescribed ceftriaxone, doxycycline, rifampin, and co-trimoxazo1e, but two days later he developed quadriparesia with evidence of myelitis in cervical MRI for which he has received methyl prednisolone 500mg Iv for 5 days continued with prednisolone 50mg daily. His condition was improved significantly. This case is reported because of the importance of steroid therapy in brucellosis.