Archives of Clinical Infectious Diseases
Volume:11 Issue: 3, Jul 2016

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..
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..
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..

Context: The association between 'Epstein-Barr' virus (EBV) and breast cancer risk still remains controversial. A Systemic Review (SR) published in 2012 reported that there might be a statistically significant association between EBV and risk of breast cancer. However, errors were found in the appraisal process of the concerned SR..
The aim of this report was to conduct an adaptive meta-analysis with additional extraction of relevant papers published up until September 2015..
Data Sources: The lists of references, cited articles and related articles provided by PubMed were made using the articles selected in the previous SR..
Study Selection: Among these articles, only case-control studies using Polymerase Chain Reaction (PCR) techniques to detect EBV DNA in tissues were selected..
Data Extraction: The summary odds ratio (SOR) and the 95% confidence interval (CI) were calculated though meta- analysis..
A total of 20 case-control studies were selected, and the total numbers of subjects in the case and control groups were 1947 and 1010, respectively. The findings of this meta-analysis revealed that EBV infection might increase the risk of breast cancer (SOR = 3.84, 95% CI: 2.24-6.58; I-squared = 62.2%). Sub-group analyses by region, sample type, and control tissue showed that a statistical significance of the risk was still secured..
The findings of the meta-epidemiological study support that EBV infection may increase the risk of breast cancer. Nested case-control studies are required in the future..

Clinical significance of Extended-Spectrum Beta-Lactamases (ESBLs) production in Enterobacter spp. has not well been established..
This study was conducted to investigate the prevalence of ESBLs produced by Enterobacter spp. in clinical isolates..
This descriptive cross-sectional study was performed during May 2010 to April 2012 in the city of Sanandaj, Kurdistan province, Iran. We did not include and directly contact the patient population, yet had access to two thousand patient specimens (urine, wound, respiratory tube, blood, cerebrospinal fluid and stool), which were collected from patients that had referred to various departments of two government hospitals of Toohid and Besat. As a result, 118 Enterobacter spp. isolates were identified and considered. The Clinical and laboratory standard institute (CLSI) Combined Disk Test (CDT) and polymerase chain reaction (PCR) were applied for detecting Enterobacter spp. Data were analyzed using the SPSS 11.5 software, Chi-square (x2) test and a Kappa coefficient (κ) (P Out of 118 Enterobacter spp. isolates, 31.36% were Enterobacter aerogenes (E. aerogenes), 20.34% Enterobacter agglomerans (E. agglomerans), 12.71% Enterobacter cloacae (E. cloacae), and 33.90% were other Enterobacter spp. All 118 (100%) Enterobacter isolates produced ESBLs. In the detection of ESBLs, CDT and PCR results were similar to each other and all 118 Enterobacter spp. were ESBLs producers (κ = 1)..
According to the results, most of the Enterobacter spp. produced ESBLs and were Cefotaxime-M (CTX-M) enzyme carriers. Guidelines and appropriate use of antibiotics are necessary to avoid the production of ESBLs..

Hepatitis B is still an issue after blood transfusion. A reason could be the window period of hepatitis B infection in blood donors. In countries such as Iran hepatitis B surface antigen enzyme-linked immunosorbent assay (ELISA) is the only test to detect the virus in blood donors. This procedure may miss the window period of hepatitis B infected donors..
The current study aimed to look for hepatitis B core antibody immunoglobulin M in blood samples of Iranian donors with a history of hepatitis B virus infection to detect window period infection..
Eighty serum samples with hepatitis B core antibody were collected from 1000 healthy blood donors, forty of them had been positive for hepatitis B virus DNA in authors’ previous study and were diagnosed as occult hepatitis B infection. All 80 samples were tested for hepatitis B core immunoglobulin M..
One thousand blood samples were collected from 64 (6.4%) female and 936 (93.6%) male subjects. None of the blood samples contained hepatitis B core immunoglobulin M. The study found no significant differences between male and female subjects in term of HBcAb positivity..
Hepatitis B core antibody immunoglobulin M positivity is different in healthy blood donors of different countries according to the prevalence of chronic hepatitis B and its vaccination. Based on the current study findings, all positive samples of hepatitis B core antibody in Iranian blood banks should be considered as candidates for occult hepatitis B not just the window period infected samples..

Staphylococcus epidermidis is well documented as an opportunistic pathogen causing biofilm in patients and healthy individuals..
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 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..
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..
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..

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..
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..
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..
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..
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..

Strongyloidiasis can vary from asymptomatic infection to life-threatening multisystem disease especially in immunocompromised patients. Although strongyloidiasis is a rare diagnosis in USA, transmission through immigrants and refugees obscured the geographical boundary. The clinical presentations vary widely depending on underlying comorbidities and immunosuppression..
Here we present a case of strongyloidiasis in hemodialysis patient requiring multiple admissions. Although the patient had high eosinophil count in previous admissions, eosinophil count was normal when the diagnosis was made..
Although strongyloidiasis is not endemic in USA, immigration obscured the geographical barrier of endemicity. The diagnosis can be difficult because of nonspecific symptoms and lack of sensitivity of microscopic diagnosis. Although eosinophilia is a common finding in patients with chronic strongyloidiasis, it is unreliable indicator of active infection, especially in immunosuppressed condition. Eosinophil count also may be falsely high in patients with hemodialysis. As Laboratory diagnosis is mainly based on microscopic identification of larvae in the stool, examination of multiple stool samples is warranted to increase the yield of diagnosis..

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..
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..
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..

Multiple sclerosis (MS) is a debilitating autoimmune and inflammatory disease of the central nervous system associated with both infectious and non-infectious underlying factors. Many recent studies suggest that infection with herpesviruses has a contributing role in the pathogenesis of MS..
The current case-control study aimed to evaluate the prevalence of herpes simplex virus (HSV) in peripheral blood mononuclear cells (PBMCs) of patients with MS compared to those of the healthy controls..
Patients and PBMC samples of 82 relapsing-remitting patients with MS (23 males, 59 females; mean age 36.9 ± 9.30 years) and 89 subjects in the healthy control group (34 males, 55 females; mean age 34.32 ± 10.56 years), from the North of Iran (2013 - 2014) were enrolled in a case-control study. The enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) were applied to investigate the frequency of HSV in the participants..
Totally, 63 (76.8%) patients with MS showed a history of HSV exposure by anti-HSV testing compared to 70 (78.7%) subjects in the healthy group (P value = 0.855). The HSV-DNA test was positive in 37 (45.1%) and 3 (3.4%) patients with MS and healthy subjects, respectively (P value Herpes simplex virus was present in more patients with MS than healthy cases. HSV may be directly or indirectly associated with MS development. Further comprehensive molecular studies are needed to confirm the etiopathologic association between HSV and MS disease..

Mycoplasmas (Mycoplasma spp. and Ureaplasma spp.) are sexually transmitted organisms found primarily in the human urogenital microbiota. These microorganisms are frequently associated with some diseases including non-gonococcal urethritis, vaginosis, pregnancy complications, prenatal infections, systemic infections and infertility..
The current study aimed to evaluate the prevalence of Mycoplasma hominis and Ureaplasma spp. in routine gynecological care..
Patients and A cross sectional study with simple random sampling was designed. A total of 6,810 patients with the age range of 11 to 80 years were evaluated, during a six-month period from January 2015 to June 2015 in Sao Paulo, Brazil. DNAs were extracted from cytological samples (ThinPrep™) to detect microorganisms by real-time polymerase chain reaction (qPCR)..
The high prevalence of M. hominis (n = 79), Ureaplasma spp. (n = 2,026) and the co-colonization of both (n = 199) with P In conclusion, the data showed that high rate of females harbor these microorganisms in the genital microbiota. This finding suggests the importance of routine gynecological tests, mainly in pregnant females, during the second and third trimesters, and in asymptomatic females under infertility clinical investigation. Furthermore, the application of molecular methods is suggested; since they provide a fast and accurate diagnosis of these microorganisms, but sensitivity of the tests should be considered in the clinical relevant concentration of microorganisms in the genital microbiota..

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..
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..
We recognized that the case was co-infected by CCHF and leptospirosis..

Crimean-Congo hemorrhagic fever (CCHF) is caused by a tick-borne virus in the family of Bunyaviridae. It is asymptomatic in infected animals, but it can cause severe hemorrhagic disease in human with mortality rate of 3% to 50%. Viral load and inflammatory cytokines have an important role in the pathogenesis of the disease..
The current study aimed to investigate the level of interleukin (IL)-6 in patients with CCHF and the relationship of its level with the severity of infection and clinical outcome of patients with CCHF..
Patients and This cross-sectional and prospective study evaluated all patients with confirmed CCHF admitted to Boo-Ali hospital in Zahedan, Southeast of Iran, from March 2012 to Jan 2015. The disease was confirmed by enzyme-linked immunosorbent assay (ELISA) IgM and IgG and /or real time polymerase chain reaction (RT-PCR). Also, a blood sample was drawn on the day of admission to test the level of IL-6 in the serum of patients. Then, the relationship between serum level of IL-6 with the severity of disease and clinical outcome in patients was evaluated. Data was analyzed by Mann-Whitney test and a P Among 50 patients with CCHF (38% female, 62% male with the age range of 18 - 63 years), the serum level of IL-6 was higher than normal (7 pg/mL) in 60% of the patients. According to the severity index disseminated intravascular coagulation score (DIC score), the mean serum level of cytokine in the mild and severe disease were 50.2 ± 79.4 and 127.3 ± 100.2, respectively. There was a significant difference between serum level of IL-6 and severity of disease (P = 0.003). There was no mortality in patients with low or normal serum levels of IL-6. But, in patients with a high serum level of IL-6, seven patients died..
Based on the obtained results, it was concluded that a diminished immune response caused by cytokines in acute phase response, can lead to dissemination of virus, severity of illness and increase of the mortality rate..

Toxoplasmosis is one of the most important diseases in humans and animals. Almost one-third of the human population around the world is infected with toxoplasmosis. The agent of this parasitic disease is a protozoan called Toxoplasma gondii (T. gondii) that causes encephalitis in people with suppressed immune systems and abortion, mental retardation and chorioretinitis in the fetus. Alzheimer’s disease (AD) is the most important neurodegenerative disease..
Due to the high prevalence of toxoplasmosis in Iran and evidence on its impact on neurodegenerative diseases, this study was performed to evaluate the T. gondii infection in patients with AD..
Patients and In this case-control study, after selection of alzheimer’s patients (APs) referred to Imam Reza psychiatric hospital of Khorramabad, west of Iran, and healthy controls (each group consisted of 87 individuals), using the convenience sampling method and under the supervision of a neurologist, blood samples were taken during July 2014 and January 2015. The collected samples were transferred to the research laboratory of parasitology under cold chain storage and then, the serum samples were separated by centrifugation and were frozen at -20°C until use. The T. gondii IgM and IgG specific antibodies were assessed in serum samples using commercial Enzyme Linked Immunosorbent Assay (ELISA) kits..
The overall prevalence of T. gondii infection in patients with AD and the control group, using ELISA assay, was obtained as 66.6% (58/87) and 56.32% (49/87), respectively (P = 0.99). In this study, there was no significant association between T. gondii infection and AD. On the other hand, no statistically significant difference was observed between the two groups in terms of infection with T. gondii (P = 0.99)..
Higher prevalence of T. gondii in patients with AD compared to controls showed the possible impact of this parasite in AD, which may exacerbate symptoms, and this requires special attention of specialists and patient families..

Meningitis is one of the most disturbing infectious diseases due to mortality, morbidity and its ability to cause epidemic..
The current study aimed to detect and remove explainable patterns of fever and neurological symptoms as suspected meningitis occurred in Hamadan province, West of Iran..
Monthly and daily data of suspected cases of meningitis of Iranian national surveillance system from 21st March 2010 to 20th March 2013 were used. explainable patterns of syndrome were identified using autocorrelation and partial autocorrelation functions, mean differences and nonparametric Mann-Kendall statistics. Besides moving average (MA) smoothing methods, Holt-Winters (HW) exponential smoothing and the Poisson regression model were used to remove such patterns..
The study findings indicated the presence of explainable patterns including day-of-the-week (DOW), weekend, holiday effects, seasonality and temporal trend in the syndromic data of fever and neurological symptoms. Overall, HW exponential and regression method had better performances to remove explainable patterns..
Addressing and removing explainable patterns of syndromic data on meningitis is necessary to timely and accurately detection of meningitis epidemics. It was concluded that decomposition methods had better performance compared to the model based ones..