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Archives of Clinical Infectious Diseases - Volume:12 Issue: 4, Oct 2017

Archives of Clinical Infectious Diseases
Volume:12 Issue: 4, Oct 2017

  • تاریخ انتشار: 1396/11/30
  • تعداد عناوین: 15
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  • Parisa Badiee *, Mehrzad Zare Page 2
  • Andrea Cortegiani *, Vincenzo Russotto, Pasquale Iozzo, Santi Maurio Raineri, Antonino Giarratano Page 3
    Invasive fungal infections (IFIs) are associated with high morbidity and mortality in intensive care units. Candida species are the most important fungal pathogens and among the most frequent causes of infection in critically ill patients. Studies have evaluated the correlation between the onset of antifungal treatment and survival. However, definitive diagnosis of IFI is time-consuming in clinical practice. Antifungal prophylaxis and preemptive or empirical treatments are among therapeutic strategies to prevent or treat early fungal infections in selected patients. Recently, new evidence from randomized controlled trials and systematic reviews has been published. Moreover, new clinical practice guidelines from international communities are available. The aim of this review was to present updated evidence on this topic.
    Keywords: Invasive Fungal Infection, Candida spp., Antifungal Treatment, Fungal Sepsis
  • Anahita Sanaei Dashti *, Abdollah Karimi, Babak Elyasi, Ahmad Reza Shamshiri, Seyed Abdolmajid Shoja, Maryam Shamshiri Page 4
    Background
    It seems that activation of the T helper 1 (Th 1) cell response, including production of Interleukin-12 (IL-12) and Interferon-gamma (IFN-γ), leads to the resolution of disease and the dominance of Th 2 cells, and related cytokines like IL-4 may reduce the process of Brucella eradication.
    Objectives
    The aim of this study was to evaluate the levels of serum cytokines, IL-12, INF-γ, Tumor Necrosis Factor alpha (TNF-α), and IL-4 in acute brucellosis and compare them with those in other febrile diseases.
    Methods
    This prospective cross-sectional study was done on 80 consecutive patients in Azerbaijan, Iran. The research defined 2 groups in the survey; (group 1) one group with brucellosis and the other group (group 2) without brucellosis; each consisting of 40 patients. All the patients had constitutional symptoms of fever, malaise, and anorexia. Serum agglutination and 2 ME (2 mercaptoethanol) tests were performed on the sera. Data were analyzed using the SPSS version 16 software.
    Results
    Serum TNF-α (group-1: 210.38 ± 168.35 and group-2: 19.53 ± 16.36), INF-γ (group-1: 64.72 ± 19.73 and group-2: 12.18 ± 5.37) and IL-12 (group-1: 283.10 ± 253.51 and group-2: 20.87 ± 12.58) levels were elevated significantly in brucellosis patients compared to the levels in other febrile patients (P value ≤ 0.001). The IL-4 level showed no significant difference between brucellosis and other febrile patient’s sera (P value = 0.870).
    Conclusions
    The current study showed that serum levels of Th 1 cytokines, including INF-γ and IL-12 levels are elevated significantly in systemic brucellosis patients. However, IL-4 levels, a Th 2 cytokine, had no significant difference between the 2 groups.
    Keywords: Cytokines, Interferon Gamma, Interleukin, 12, Tumor Necrosis Factor, alpha, Interleukin, 4, Brucellosis
  • Faith Mathai, Musa Otieno Ngayo *, Simon Muturi Karanja, Ahmed Kalebi, Raphael Lihana Page 5
    Background
    Hepatitis B Virus (HBV) viral load measurements is recommended for diagnosis and monitoring of patients on treatment for Chronic Hepatitis B (CHB). However, these diagnostic techniques are molecular-based and expensive and unavailable to majority of the Kenyan population. Quantitation of hepatitis B surface antigen (HBsAg) by automated chemiluminescent micro-particle immunoassay has been proposed as a surrogate marker.
    Objectives
    This study showed the correlation between HBsAg and HBV DNA levels among patients with CHB attending a referral Laboratory in Nairobi, Kenya.
    Methods
    One hundred and seventy-three (173) patients were enrolled while excluding Hepatitis C Virus (HCV) and Hepatitis D Virus (HDV) positive patients.
    Results
    The mean age of the study patients was 37.2 years, 112 (64.7%) were male, and 142 (82.1%) were hepatitis B e antigen (HBeAg) negative while 31/173 (17.9%) were HBeAg positive. The mean HBV DNA level was 2.89 log10 IU/mL and 41 (23.7%) had a baseline HBV DNA level of > 2000 IU/mL. By Mann-Whitney test, HBV DNA levels differed significantly between HBeAg positive and negative patients (P = 0.001), as did HBsAg titer (P = 0.032). Unfortunately, according to the Spearman test, there was a weak correlation between HBsAg and HBV DNA levels (P = 0.024 and r = 0.171).
    Conclusions
    Patients with HBeAg negative test results had lower levels of HBsAg and lower levels of HBV DNA. Serum quantitation of HBsAg may not replace serum HBV DNA levels among patients with CHB in Nairobi Kenya.
    Keywords: Correlation, Quantification HBsAg, HBV DNA, Chronic Hepatitis B, Nairobi, Kenya
  • Ensieh Lotfali, Ahmad Reza Shahverdi, Rasoul Mohammadi, Fatemeh Noorbakhsh, Ali Ghajari, Saham Ansari, Sassan Rezaie Page 6
    Background
    Resistance of pathogenic fungi to conventionally available antifungal agents has been increasing and has become a serious problem. On the other hand, nanoscience has emerged as a powerful tool capable of developing and designing new antimicrobial drugs.
    Objectives
    The aim of this study was to test minimum inhibitory concentrations (MICs) of silver (Ag-NPs) and selenium (Se-NPs) nanoparticles, both alone and in combination with antifungal agents fluconazole (FLU), itraconazole (ITR), and amphotericin B (AMB) on resistant C. parapsilosis strains.
    Methods
    Eight C. parapsilosis strains resistant to antifungal agents (FLU, ITR, AMB) and the standard strain of C. parapsilosis (ATCC 22019) as a control were used in this study. The standard protocol of antifungal susceptibility testing for yeast was performed by the broth micro-dilution method described in the clinical and laboratory standards institute (CLSI) guidelines, document M 27-S4.
    Results and
    Conclusions
    MICs of standard and resistant strains were different against nano compounds, both alone and in combination with antifungal drugs. The growth of yeast was inhibited by Ag-NPs at concentrations as low as 2 µg /mL (against FLCR1 and FLCR3) and 0.25 µg /mL (against ITRR2 and AMBR2). Antifungal activity testing of Se-NPs revealed that it can inhibit the growth of yeasts at concentrations as low as 4 µg /mL (against FLCR1 and FLCR3) and 0.5 mg/mL (against ITRR2, ITRR3 and AMBR1). The results demonstrated that Se-NPs had lower activity than Ag-NPs, but both (Se-NPs and Ag-NPs) had higher activity than common antifungal agents. Further in vitro and in vivo studies are required for this.
    Keywords: Nanoparticles, Fungal Drug Sensitivity Tests, Candida parapsilosis
  • Mohammad Reza Dayer *, Sara Taleb-Gassabi, Mohammad Saaid Dayer Page 7
    Background
    The severe acute respiratory syndrome (SARS) is a life threatening viral infection caused by a positive, single stranded RNA virus from the enveloped coronaviruse family. Associated with fever, cough, and respiratory complications, the illness causes more than 15% mortality worldwide. So far, there is no remedy for the illness except supportive treatments. However, the main viral proteinase has recently been regarded as a suitable target for drug design against SARS infection due to its vital role in polyproteins processing necessary for coronavirus reproduction.
    Objectives
    The present in silico study was designed to evaluate the effects of anti HIV-1 proteases inhibitors, approved for clinical applications by US FDA, on SARS proteinase inhibition.
    Methods
    In the present study, docking and molecular dynamic experiments were applied to examine the effect of inhibitors on coronavirus proteinase under physiological conditions of similar pH, temperature, and pressure in aqueous solution. Hex software version 5.1 and GROMACS 4.5.5 were used for docking analysis throughout this work.
    Results
    The calculated parameters such as RMSD, RMSF, MSD, dipole moment, diffusion coefficient, binding energy, and binding site similarity indicated effective binding of inhibitors to SARS proteinase resulting in their structural changes, which coincide with proteinase inhibition.
    Conclusions
    The inhibitory potency of HIV 1 protease inhibitors to cronovirus proteinase was as follows: LPV > RTV > APV > TPV > SQV. Lopinavir and Saquinavir were the most and the least powerful inhibitors of cronovirus proteinase, respectively.
    Keywords: Severe Acute Respiratory Syndrome, Anti HIV, 1 Protease Inhibitors, Lopinavir, Molecular Dynamic Simulation
  • Maryam Karimi, Reza Ghasemikhah, Hadi Mirahmadi, Adel Spotin, Soheila Rouhani, Seyyed Javad Seyyed Tabaei* Page 8
    Objectives
    Hydatidosis, as a cyclo-zoonotic indigenous disease, is marked by various strains and multiple infections around the world where different overlapping cycles of Echinococcus spp. are explicitly circulating among intermediate and definitive hosts. One of the current challenges in Echinococcus taxonomy is associated with the imprecise identification of dual infections in endemic regions. The aim of this study was to genotype Echinococcus strains, particularly those ignored during mixed infections, by employing phylogenetic analysis in order to determine the accurate status of the parasite in endemic areas.
    Methods
    60 isolates were collected from the liver and lungs of twenty humans, fifteen sheep, fifteen goat, and ten cattle during 2012 - 14 in Markazi province, Iran. Subsequently, the extraction of DNA was performed, followed by amplification and identification of the DNA through both PCR for internal transcribed spacer 1 (ITS1-rDNA) of ribosomal DNA and restriction fragment length polymorphism (RFLP) using two endonuclease ýenzymes: Rsa1 and HpaII. Then, the isolates were directly sequenced in order to accomplish the definite identification of strains/haplotypes. In addition, the mixed infections were analyzed by mixed sequences reader (MSR).
    Results
    The RFLP, phylogenetic analyses of ITS1-rDNA sequences and MSA finding based on analyzed chromatograms strongly revealed the sheep strain (n = 58) and two mixed infection G1 and G6 genotypes (n = 2). The five specific haplotypes that represent moderate diversity indices were identified. The haplotype diversity was estimated to be 0.522, with a nucleotide diversity of 0.02.
    Conclusions
    The G1 was reported to be the dominant strain in the central regions of Iran; however, the first dual discrimination of G1 and G6 genotypes in these regions showed that a sheep-camel/dog life cycle is circulating in central Iran. The current findings can facilitate the parasite taxonomic classification based on in silico analysis particularly about those that are neglected in dual infections. Additional studies are highly needed with a greater sample size and in various regions of Iran.
    Keywords: Mixed Sequences Reader, Mixed Infection, ITS1, rDNA, Central Iran, Echinococcus, In silico
  • Alisha Akya, Roya Chegene Lorestani *, Azam Elahi, Keyghobad Ghadiri Page 9
    Background
    Klebsiella pneumoniae causes a variety of infections including community acquired pneumonia and nosocomial infections.
    Objectives
    The aim of this study was to determine the plasmid-associated quinolone-resistance (PMQR) genes and mutations in quinolone-resistance determining region (QRDR) of topoisomerase genes in K. pneumoniae.
    Methods
    One hundred clinical K. pneumoniae isolates were collected from Kermanshah hospitals for this study. The minimum inhibitory concentrations (MIC) for levofloxacin and ciprofloxacin was determined by broth microdilution method. The presence of PMQR genes (qnrA, qnrB, qnrS, aac (6´)-Ib, and qepA) among isolates resistant to fluoroquinolones was detected by PCR. All PCR products for topoisomerase genes (gyrA, gyrB and parC) were sequenced and analyzed.
    Results
    Sequence analysis showed mutations in gyrA at codons 83 and 87 in 24 (85.7%) and 20 (71.4%) of isolates, respectively. For parC mutations were detected at codons 80 and 84 in 15 (53.6%) and 7 (25%) isolates, respectively. At the outside of QRDR in gyrA and gyrB, mutations were also observed. The mutation was not detected in the QRDR of gyrB. The qnrB, qnrS, and aac (6')-Ib-cr were found in 1 (3.6%), 11 (39.3%) and 25 (89.3%) of isolates, respectively. Howevr, the qnrA and qepA genes were not detected among isolates.
    Conclusions
    The resistance to fluoroquinolones is relatively high among K. pneumonia and mutations in QRDR of topoisomerase genes play an important role for this resistance. The plasmid-mediated genes also increase the level of resistance. The mutations outside the QRDR of topoisomerase genes also occur, but their exact role in resistance needs to be clarified.
    Keywords: Fluoroquinolones Resistance, QRDR Mutations, PMQR Determinants, Klebsiella pneumoniae
  • Nina Mendez-Dominguez *, Reinhard Janssen-Aguilar, Freddy Pacheco-Tucuch, Martin Inurreta-Diaz, Salvador Gomez-Carro Page 10
    Objectives
    In 2015, a total of 1607 chikungunya cases were confirmed in Yucatan, Mexico, where they all took place in the second half of the year, meaning a simultaneous occurrence of both chikungunya and dengue outbreaks. This coexistence of both outbreaks posed a challenge to differentiate clinical diagnosis. The current study aimed at identifying signs and symptoms to clinically discriminate chikungunya from dengue fever in ambulatory cases.
    Methods
    The results of a case series observational, descriptive, retrospective study of suspected ambulatory patients whose samples were referred to the laboratory for polymerase chain reaction (PCR)/serum analysis from August to December 2015 were provided.
    Results
    The study included 181 cases of which 152 were positive, finding that pruritus was a suggestive symptom of an acute infection caused by chikungunya virus (CHIKV). Polyarthralgia and pruritus were significantly associated with chikungunya confirmed cases, compared with discarded cases.
    Conclusions
    Polyarthralgia and pruritus are suggestive symptoms of an acute infection caused by CHIKV.
    Keywords: Chikungunya Virus Infection, Mexico, Diagnosis, Endemic
  • Seied Mohsen Emami, Pantea Mirmohamadi, Reza Jafarzadeh Esfehani Page 11
    Introduction
    Varicella infection is a vaccine-preventable infection, which can result in different complications. Necrotizing fasciitis (NF) as a skin and soft tissue infection is a rare complication of varicella infection in childhood. Early diagnosis and treatment of necrotizing fasciitis can save life. Surgical debridement along with appropriate antimicrobial treatment is very common. However, some patients cannot undergo surgeries and physicians should try other options.
    Case Presentation
    A 6-year-old male with a history of chicken pox infection was admitted due to abdominal pain and fever. On physical examination, abdominal tenderness and diffused erythema on the entire abdomen as well as crepitation was prominent. As acute abdomen was ruled out by abdominal sonography, the patient received antimicrobial treatment, which was ineffective. Meanwhile, his hemodynamic condition worsened and sign of scaly skin presented, antimicrobial regimen was changed and surgical consultation was ordered. Unfortunately, surgical debridement was impossible due to extensive tissue involvement. Intravenous immunoglobulin (IVIG) was initiated and patient was transferred to the intensive care unit (ICU). Within 72 hours of administering IVIG, skin erythema and abdominal pain decreased and on the 10th day of admission, the patient became afebrile and healthy. Antibiotics were discontinued on the 12th day and the patient was discharged in good conditions.
    Conclusions
    Although tissue debridement is the cornerstone to treat necrotizing tissue infection, in some cases patients might benefit from adjuvant treatments such as IVIG. Although this treatment cannot be generalized to every patient, it may be concluded that physicians can save surgical options and try IVIG under close clinical observation to avoid possible multiple surgical debridement.
    Keywords: Chicken Pox, Fasciitis, Necrotizing, Immunoglobulins, Intravenous, Debridement, Abdominal Pain
  • Majid Golestani Eraghi, Mihan Pourabdollah Toutkaboni, Behrooz Farzanegan, Majid Marjani, Seyed Mohammad Reza Hashemian, Payam Tabarsi * Page 12
    Introduction
    Gastrointestinal basidiobolomycosis (GIB) is an emerging fatal infection in healthy individuals with limited known signs and symptoms.
    Case Presentation
    A 42 years old labor man was admitted to the intensive care unit (ICU) of Masih Daneshvari hospital, Tehran, Iran, with chronic abdominal pain, a fever, and suspicion to post-operative abdominal infection. The patient had undergone an appendectomy as well as a colorectal surgery and a colostomy had been placed. The histopathological study of the colon was identical for gastrointestinal basidiobolomycosis. There was no eosinophilia in the peripheral blood sample. Patients’ treatment using itraconazole, voriconazole, and amphotericin B was not successful and unfortunately, he died because of septic shock.
    Conclusions
    GIB is an emerging and fatal fungal infection with non-specific presentation such as abdominal pain, mass, and fever in healthy individuals. Persistent leukocytosis with or without eosinophilia, resistant fever, and other signs and symptoms after surgical resection, patients job and residents are important clue and insert the basidiobolomycosis in list of differential diagnoses is most important factor to early diagnosis and treatment.
    Keywords: Basidiobolomycosis, Fungal Infection, Gastrointestinal Infection, Immunocompetent, Zygomycosis
  • Reza Nabie, Monireh Halimi, Adel Spotin * Page 13
    Introduction
    The orbital hydatidosis due to Echinococcus granulosus accounts for only less than 1% of all hydatid cysts. Here we report a case series of intraorbital hydatid cysts.
    Case Presentation
    This retrospective investigation included two pediatric patients (4 and 13-year-old boys) who were referred because of a progressive proptosis in northwest Iran. Orbital imaging disclosed cystic intraorbital lesions in the cases. Following clinical and surgical explorations, the histopathological evaluation re-confirmed definitely the infertile unilocular hydatid cysts.
    Conclusions
    Differential diagnoses of orbital hydatid cysts from cystic lesions should be explicitly noticed in endemic areas prior to surgery in order to avoid complications.
    Keywords: Unilocular Hydatid Cysts, Proptosis, Orbital Cyst
  • Mahdaneh Roshani, Hossein Goudarzi, Fattaneh Sabzehali, Soroor Erfanimanesh, Masoud Dadashi, Ali Hashemi* Page 14
    Background
    Bloodstream infection is one of the most life-threatening complications recognized as the frequent cause of treatment failure in children with acute lymphoblastic leukemia.
    Objectives
    In this study, we describe the isolation of an extended-spectrum β-lactamase (ESBL)-producing Escherichia coli.
    Methods
    Antimicrobial susceptibility tests were determined on the isolate by the Kirby-Bauer disk diffusion method. In addition, ESBL production of the isolate was examined using the Combination Disk Diffusion Test (CDDT). PCR was used to screen the presence of CTX-M-1, CTX-M-2, CTX-M-8, CTX-M-9, CTX-M-25, ISEcp1, IS26, and IS903 genes in this isolate.
    Results
    We found an ESBL-producing E. coli in a 1-month-old infant with a blood cancer that carried CTX-M-1 group enzymes.
    Conclusions
    Our finding emphasized the need for more precise screening methods to identify the causative infectious agents at early stages of infection to choose the appropriate treatment in these severely immunocompromised patients.
    Keywords: Bloodstream Infection, Extended, Spectrum β, Lactamase, Acute Lymphoblastic Leukemia, Escherichia coli
  • Kalenahalli Jagadish Kumar *, Halasahalli Chowdegowda Krishna Kumar, Chetak Kadabasal Basavaraja, Ravi Kumar Page 15
    Introduction
    Dengue infection has become a serious health problem. It is endemic in most countries of the South-East Asian region. In hyperendemic regions, DHF is more common in children less than 15 years of age. There have been increasing reports of DF and DHF with atypical manifestations (Expanded dengue syndrome). The spectrum of cardiac involvement varies from conduction rhythm disturbances to myocarditis causing hypotension.
    Case Presentation
    Arrhythmias are the first and early indicator of myocarditis. We report an 11-year-old girl who developed Junctional rhythm associated with dengue shock syndrome (DSS) from Mysore, India. Timely ECG will help the clinician detect cardiac involvement.
    Conclusions
    Even though cardiac involvement is rare in dengue fever, arrhythmias do occur. They are essential to diagnose, as they are the first signs of acute myocarditis. Arrhythmias with dengue shock may pose difficulties in the fluid management and use of inotropes. Simple ECG will help the clinician diagnose and monitor arrhythmias.
    Keywords: Dengue Shock Syndrome, Cardiac, ECG, Rhythm