Archives of Clinical Infectious Diseases
Volume:2 Issue: 2, Apr 2007

Staphylococcus aureus (SA) is frequently found on normal human skin and mucous membranes. Methicilline resistance S. aureus (MRSA) strains have spread in many hospital isolates world wide since 1970s. Hospital personnel tend to have higher colonization rates than the general population. Colonized residents and personnel are sources for dissemination of organism. For this cross sectional study, Mofid children’s hospital staff were evaluated for staphylococcal nasal colonization. Isolated staphylococci tested for methicilline sensitivity by MIC method and their antibiotic susceptibility was investigated for six antibiotics by Disk diffusion technique. Of 284 tested personnel, 56 (19.7%) revealed to have nasal colonization of whom 23 (8.1%) were methicilline resistant (MRSA). Working in the office (p

Aspergillus fumigatus (AF) is responsible for 90% of human infections. The lung is the predominate site of infection. It is able to colonize in respiratory tract of asymptomatic population and changed clinical features from noninvasive to invasive according to immuncomponent state of individuals. The aim of the present study was to determine the frequency of AF immunoglobulin (IgG) antibodies among chronic persistent asthmatic patients in Tehran. Chronic asthmatic patients, aged 15-60 years, were sequentially enrolled from out-patient respiratory clinics. The specific AF IgG antibodies, white blood cells count, peripheral eosinophil count, and immunoglobulin E antibodies were also measured. Totally, 497 chronic stable asthmatic patients were studied with the mean age of 45 years. Aspergillus IgG antibodies were detected in 285 subjects (57.3%). The mean (±standard deviation) serum IgE level was 257.22± 338.07IU/mL (ranged from 3.9 to 4333 IU/mL). Chest X -ray abnormalities were noted in 25 patients (

The annual Hajj pilgrimage to Mecca brings over two million people together in a small confined area. Respiratory involvement is the most common disease during this ceremony, and up to now no unique cause has been identified. The present study was conducted to determine the incidence and types of respiratory diseases and their associated etiologic agents. During this prospective study, seroconversion was assessed for bacteria, viruses and fungi on 170 Iranian pilgrims prior to departure and 2 weeks after convalescence and returning from the Hajj pilgrimage. Meanwhile, sputum specimens of 252 patients were cultured. The following viruses were detected: influenza type A and B (21.5%), adenovirus (36.2%), and RSV (1.9%). Among bacteria isolates, β-haemolytic Streptococcous (9.7%), Haemophilus species (9.1%), Gram negative bacilli (20.6%), Legionella pneumophila (6.3%), Mycoplasma pneumonia (0.8%), and Chlamydia (32%) were more common, however, no fungal seroconversion was noted. We suggest administration of Fluvaccin for high risk groups, adenoviral vaccine for volunteer pilgrims, erythromycin or azithromycine for empiric bacterial therapy, and Oseltamivir or Zanamivir for prophylaxis or treatment of influenza like illness.

Brucellosis is a common zoonotic infection that is endemic in many parts of the world. Neurological involvement is a rare entity, occurs in 2-5% of cases. Neurobrucellosis comprises a variety of complications, including meningitis, meningoencephalitis, myelitis and myelopaties, peripheral and cranial neuropathies, and psychiatric manifestations. The aim of the present study was to evaluate neurological manifestations and cerebrospinal fluid (CSF) findings in a group of Iranian patients with neurobrucellosis. During a 10-year period (1996-2005), medical records of 43 hospitalized patients with definite diagnosis of neurobrucellosis were studied. Inclusion criteria were a minimum titer of 1/160 for Wright and abnormal CSF findings. Age, gender, neurological manifestations, CSF analysis and its changes were investigated. Neurological manifestations include meningitis (64.9%), meningoencephalitis (11.6%), cranial nerve palsy (11.6%), brain abscess (2.4%), myelitis (2.4%) and psychiatric disorders (6.9%). Pleocytosis (100%), high protein (40%) and low glucose levels (40%) were noted in CSF analysis. Clinical manifestations and CSF abnormality of neurobrucellosis is similar to tuberculosis and neurobrucellosis must be kept in mind in approach of patients with acute or chronic lymphocytic meningitis with increased protein and low glucose level in CSF and risk factors of brucellosis.

Botulism is a toxin-induced paralytic illness characterized by cranial nerve palsies and descending flaccid paralysis. Botulinum toxin is regarded as the most lethal ever-known substance. The diagnosis in sporadic cases and even in small outbreaks is the main physicians’ challenge. The aim of this study was to assess clinical presentations of 80 cases of botulism referred to Loghman Hakim hospital in Tehran. A total of 80 botulism cases referred during a 10-year period (1996-2006) were included. The diagnosis of botulism was verified on epidemiological data and a clinical score of severity. Patients were assigned in 3 groups: mild, intermediate and severe. The study population included 40 males and 40 females with a mean age of 30.7±15.2 years (a range, 1-66 years). The suspected causative foods were cheese in 25 (31%), and sea-food in 20 (25%). The mean incubation period was 1.1±1.8 days (a range, 4 hours-10 days). Nausea and vomiting was noted as the first symptom in 17 cases. Diagnosis was confirmed in 47 patients (58.8%). The most common toxin subgroups were A (in 22 cases) and E (in 15 cases). All the patients were treated with antitoxin and recovered without sequel, however, 6 patients were admitted to intensive care unit (ICU) and required ventilatory support. Only one patient (1.3%) died. The mainstays of therapy are meticulous intensive care (including mechanical ventilation, when necessary) and promptly treatment with antitoxin. Antitoxin should be given early in the course of illness, ideally

Parapox virus is the causative agent of Orf disease which is basically seen in sheep and goats. It can be transferred to the human by direct contact with infected animals or indirect contact to infected meat or contaminated butchery instruments like knife. The skin lesions are usually found in fingers.Patients: Totally, 11 subjects from five families infected with Orf disease were surveyed. The diagnosis was verified on clinical manifestations and pathological changes. Local antiseptic (betadin) and tetracycline ointment were administered for all patients, however, 3 cases were treated with oral antibiotic. No disseminated signs or complications have been reported and patients cured in the third (6 cases) or forth week (5 cases). Little scars were noted in 3 cases after one month follow up. If there is a similar lesion in the members of a family, one should notice the background of epidemiological and clinical manifestations. Despite the rarity of Orf disease, its spread still exists in urban families, therefore, it is essential to wear gloves at the time of touching meat to prevent infection.

Pediculosis and scabies are infectious diseases that can spread easily in overcrowded places, like prisons. The aim of this study was to determine the prevalence of these diseases in Ghezel Hesar prison (a male prison). For this descriptive study, 1404 prisoners in Ghezel Hesar prison were included. The prisoners were evaluated clinically by two experienced dermatologists for scabies and pediculosis. Of 1404 prisoners, 31 (2.2%) were infested with Sarcoptes scabiei and 12 (0.9%) with body louse. There were no cases of head or crab lice. All of the subjects with scabies and 83% of Pediculosis corporis infestation had intense pruritus. There was a significant reverse association between the duration of imprisonment and these diseases. Pediculosis and scabies were more common among new prisoners (p

Brucellosis is a zoonotic disease involving several organs. Pulmonary involvement especially pleuritis is extremely rare.Patient: We report a 12-year old boy presented with a 3-week history of fever, chills, and profuse sweating, especially at night. He complained of fatigue, lack of appetite, weight loss, exertional dyspnea, nonproductive cough and mild pleuretic chest pain. Diagnosis of brucella pleuritis was verified by positive blood and pleural fluid culture and serology. Having completed a combined therapy (doxycycline/rifampin) for 3 months, no relapse occurred. Almost all radiological findings disappeared at the end of the therapy. Pulmonary involvement is a rare manifestation of brucellosis, however, it responds well to a combination therapy of rifampin and doxycycline.

Extrapulmonary tuberculosis is a complication of pulmonary tuberculosis that is disseminated through hematogenous or lymphatic system and may involve any organs. We present a case of primary tuberculosis of the penis that is a very rare presentation of tuberculosis.Patient: The patient was a 43-year-old man who had kidney transplantation. He admitted with painful ulceration on the glans of penis. Physical examination strongly suggested ulcer lesion that resemble to carcinoma or herpetic ulcer. He did not have any evidence of pulmonary tuberculosis. Having received empiric treatment against herpetic, bacterial and fungal infection, his condition did not improve and he was ordered biopsy of the lesion. Histopathologic studies and PCR revealed Mycobacterium tuberculosis, thus, anti-TB drugs were commenced. The ulcer was improved without any recurrence during a two-year follow up. In patients with kidney transplantation especially in countries endemic for Mycobacterium tuberculosis, chronic ulcer not responding to empiric therapy should be evaluated for Mycobacterium tuberculosis infection.