Archives of Clinical Infectious Diseases
Volume:6 Issue: 4, Oct 2011

The nature of changes in the lipid profile caused by an acute infection is controversial. In this study we compared concentrations of plasma lipids in 70 septic and non-septic patients in ICU and studied the prognostic impact of cholesterol, LDL-C, HDL-C and triglyceride. From March 2009 to February 2010, all patients consecutively admitted to the Intensive Care Units of Rasoul Akram University Hospital, Tehran, Iran, were studied. Each person was examined for signs and symptoms of infection during hospital stay. Patients were classified as suffering from sepsis or not at the first 24 hours of admission. Descriptive results of continuous variables were expressed as mean (±SD). The associations between factors were analyzed by t-test and between factors and prognosis by χ2 test when appropriate The study population included 28 males and 42 females with mean (± standard deviation) age of years 73.6 ± 15.7 that 29 of them were in sepsis group and 41 of them in non-sepsis group. There wasn’t any relationship between sex and mortality (p= 0.34), although by increasing age mortality leveled out (r=-0.58, p= 0.04).The concentrations of total cholesterol (89.3 ± 33.6 vs 100.7 ± 25.3 mg/dl), HDL (20 ± 5.6 vs 30.2 ±8.7 mg/dl), and LDL (61.5 ± 18.7 vs 70.6 ± 14.5 mg/dl) showed significantly lower values in septic group but no difference could be find in triglyceride level (177.7 ± 28.7 vs 182.8± 45.9 mg/dl). In septic group the initial and second levels of cholesterol were considerably higher in patients who died than those who survived (101.6 ± 37.5 versus 69.4 ± 8.3 and 103.2 ± 23.4 versus 79.4 ± 47 respectively, p=0.00). In ICU setting, measurement of cholesterol values has been shown to improve risk prediction, and inclusion of lipid values in clinical risk assessment scores of critically ill patients has been advocated. Further understanding of the alterations in lipid metabolism may have therapeutic implications in treatment of sepsis.

Vibrio cholerae causes potentially lethal disease, cholera, through the elaboration of the intestinal secretion of cholera toxin. The cholera enterotoxin (CT) has been considered as the major virulence factor of V. cholerae. This microorganism also produces other putative toxins such as Zonula Occludens toxin (Zot) and Accessory cholera enterotoxin (Ace). Zot has the ability to reversibly alter intestinal epithelial tight junctions, allowing the passage of macromolecules through the mucosal barrier. The Zot toxin alters ion transport and causes fluid accumulation in ligated rabbit ileal loops which results in mild diarrhea. In this study, gene coding for the Zot toxin was amplified from V. cholera isolate 62013. The PCR product containing the Zot gene was cloned in pET28a expression vector. The recombinant Zot gene was transformed into E. coli (DH5 α) and then retransformed into E. coli Tuner for expression. Expression of recombinant protein induced by isopropythio-β-D-galctoside (IPTG) at different concentration and was examined by SDS-PAGE and Western blotting. Rabbit ileal loops experiment was conducted. Cloning of Zot was confirmed by colony-PCR and enzymatic digestion. The recombinant Zot with molecular weights of 45KDa and 22kDa was expressed and reacted with rabbit anti-Vibrio cholerae polyclonal antibody in western-blot analysis. Zot protein significantly causes fluid accumulation in ligated rabbit ileal loops test. Our findings indicated that a prokaryotic expression system for Zot protein was successfully constructed. This expression system can be useful as a tool for production of Zot protein for vaccine purposes.

Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care units (ICUs), leading to increase in mortality and length of ICU and hospital stay as well as duration of mechanical ventilation and hospital charges. The present study was conducted to investigate the effect of combination strategy on early VAP. In a controlled clinical trial, 117 patients undergoing mechanical ventilation were evaluated in ICU in two groups comprising control (n=71) and intervention (n=46); the former received the ward's routine care, and the latter received planned nursing care protocols. Incidence of pneumonia was investigated using clinical pulmonary infection score system (CPIS) and Mini-BAL method. The incidence of early VAP was 19.6% and 40.8% in the intervention and the control groups respectively (P <0.001). The early VAP rate was 22.8 and 14.41 per 1000 ventilator days in control and the intervention groups respectively. Length of ICU (P <0.02) and hospital (P<0.001) stay and also duration of mechanical ventilation (P<0.001) showed significant reduction in the intervention group compared to the controls. Precise implementation of planned and evidence-based nursing care is effective in reducing incidence, duration and hospital stay associated with early VAP.

Recent studies demonstrated an increased pattern of drug resistance in uropathogenic Escherechia coli (E. coli) which is considered as the most common cause of urinary tract infections (UTIs). Present investigation was undertaken to evaluate antibiotic resistance pattern of E. coli causing UTIs obtained from urine samples and their relationship with integron class1. Apart from that, special emphasis was given on mediated and transferable antibiotic resistance in E. coli as well as the mobilized integrons that contribute to dissemination of antibiotic resistance. Methods and Materials: Susceptibility of isolates to 12 antibiotics was tested by the Kirby -Bauser disk diffusion method. The sensitivity was monitored by zone of inhibition according to the clinical and laboratory standard institute (CLSI) guidelines. Plasmid DNA from E. coli strains was tested for class 1 integron by PCR. Rate of resistance to the 12 antibiotics is as follows: Ampicillin (89.4%), Cefotaxim (31%), Ciprofloxacin (22.4%), Aztreonam (21.7%), Ceftazidim (21.1%), Ceftriaxon (20.5%), Co-trimoxazole (19.9%), Gentamicin (15.5%), Amikacin (7.5%), Cefepim (11.8%), Nitrofurantoin (6.2) and Imipenem (1.9%). Existence of integron was confirmed in 41.9% of isolates. Significant association was evaluated by PCR between resistance to Gentamicin, Amikacin, Gentamicin, Amikacin, Cefotaxim, Ceftazidim, Ceftriaxon, Aztreonam, Ciprofloxacin and Co-trimoxazole with the existence of class 1 integrons. Imipenem could be used as the initial therapy for E. coli in UTIs. Similar studies are essential to determine appropriate guidelines for empirical therapy which vary by location.

Helicobacter pylori is associated with the chronic gastritis, peptic ulcer, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Moreover, antibiotic therapies do not protect against potential re-infection while have risk for development of drug resistance. Therefore, vaccine-mediated protection against H. pylori became an attractive clinical interest. H. pylori urease plays an important role in survival and pathogenesis of the infection. In this study the UreB122 (aa143-264) gene cloned in pET expression vector and the recombinant protein (rUreB122) was over expressed in Escherichia coli (E. coli). Patients and Genomic DNA of the standard H. pylori strain 26695 was isolated as the template and UreB122 gene was amplified by PCR. Prokaryote expression vector pET32a was inserted with UreB122 gene (pET32a- UreB122). The recombinant plasmid was used to transform competent E. coli DH5α, and positive clones were selected. Then the recombinant plasmid was used to transform E. coli BL21DE3 for expression of recombinant protein UreB122. The expression of recombinant protein was induced by isopropythio-β-D-galctoside (IPTG) at different concentration and examined by SDS-PAGE. Western blot assay was used to determine immunoreactivity of rUreB122 by anti His-Tag antibodies against recombinant UreB122. In comparison with the reported corresponding sequences, the nucleotide sequence homology of UreB122 gene was 99.9%. UreB122 fusion protein was able to react with the anti His-Tag antibody. A prokaryotic expression system with high efficiency of H. pylori UreB122 gene was successfully established and UreB122 fusion protein showed satisfactory immunoreactivity. These results indicate that production of specific recombinant protein is an alternative and potentially more expeditious strategy for development of H. pylori vaccine.

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal-recessive disorder. Recurrent osteomyelitis is also a rare, severe and fatal finding in this disorder. We report a 4-year-old boy brought to Namazi Hospital with a pus draining fistula on his right foot. He was the first son of an Iranian consanguineous parent. He had a history of episodic hyperpyrexia since neonatal period, absence of sweating except emotional tear, insensitiveness to injections and trauma, multiple burn and fractures in both extremities, corneal ulceration in 3rd month of his life, hyperactivity, frequent constipation with rectal prolaps, oral scar on his lips and tongue because of self biting, multiple scars on palms and hands and several hospitalization history for debridement of necrotic tissue and bone due to recurrent osteomyelitis of right calcaneous bone. Electromyography of the extremities and nerve conduction velocity confirmed nociceptive fiber pathology compatible with CIPA which is the first diagnostic hypothesis when assessing a child with CIPA and undiagnosed infection. CIPA is an untreatable illness, however the early diagnosis, cooperation and education of the parents will help us control its most severe and fatal complications.

Global spread of blaNDM-1 genes among multidrug resistant bacterial pathogens is a threat for human that affects all patients throughout the world. Therefore, 2011 was named as Antibacterial Resistance year. Carbapenems are last–line antibiotics for treatment of nosocomial infections. Resistance to this group of antibiotics is because of producing metallo-β-lactamase especially NDM-1. Different sorts of plasmids in different sizes carry blaNDM-1 gene. In addition to NDM-1, plasmids have the other resistance genes like extended spectrum β-lactamase (ESBL), cephalosporinases, carbapenemases, macrolides as well as rifampin and fluoroquinolones resistance genes. These plasmids can be transferred from bacteria to bacteria, from man to man and even country to country. There is still no vaccine to prevent from infections produced by bacteria which have carbapenemases. So, it is necessary to inspect phenotyping and genotyping NDM-1 resistant pattern worldwide.

There are many published international recommendations and guidelines for the management of Invasive Fungal Infections (IFIs). It is very important to develop Iranian recommendations to implement those guidelines in a daily routine practice in Iran considering the local specifications. This was the objective of this meeting, which was held on November 3rd, 2011 in Tehran. 17 Iranian scientific leaders met and reviewed all the available published International Guidelines for management of IFIs in different groups of patients. This was followed by an open discussion to develop local recommendations for appropriate implementation of International Guidelines using the available treatments in Iran. This review shows the outcome of this meeting. We believe that, putting these recommendations into practice may lead to better results of the management of cases with IFIs.