Archives of Clinical Infectious Diseases
Volume:13 Issue: 1, Jan 2018

Brucella is an intracellular gram-negative bacterium that can infect many kinds of mammals like humans, sheep, cattle, etc. Brucellosis is a contagious occupational disease caused by Brucella spp. that affects individuals who have close contact with infected animals. The clinical features of Brucellosis are not disease-specific and almost every organ can be affected. This zoonotic disease is a great health concern and economically important in many countries, such as Iran. The aim of this study was to detect Brucella spp. in pasteurized and non-pasteurized dairy products.
In this study, 208 samples, including goat, sheep, and cow raw and pasteurized milk as well as pasteurized and non-pasteurized cheese, were collected in Tehran province. The DNA was extracted, and then the real-time PCR was used for detection of the Brucella spp. gene.
The prevalence of Brucella spp. contamination in the dairy products was: 45.5% in goat`s raw milk, 39.1% in non-pasteurized cheese, 27.3% in sheep`s raw milk, 26.3% in cow`s raw milk, 25% in pasteurized cheese, and 14.7% in pasteurized milk.
Rapid and exact detection of pathogens in dairy products is the most significant factor to prevent foodborne diseases. In addition, the real-time PCR assay is sensitive and specific enough to detect a low number of Brucella spp. in dairy products.

Hydatid cyst disease is a well-known parasitic disease globally. It develops in humans after ingestion of Echinococcus granulosus eggs. In order to better prevent and control hydatid cyst disease, it is crucial to identify the epidemiologic aspects of this parasitic infection.
The current study aimed to evaluate the epidemiology and features of this disease in a livestock-raising area in Khuzestan, southwest of Iran.
The present study was a descriptive-analytical study conducted in 360 patients from different areas of Khuzestan Province, southwest of Iran, with a diagnosis of hydatid cyst disease, during a period of 15 years between 2000 and 2015. Data were gathered by reviewing the patient’s records. Demographic data, laboratory findings, clinical features, the need for surgical debridement, and the outcome were collected. Data were summarized and analyzed using descriptive and analytical statistical methods, respectively.
The findings showed that 158 males (43.9%) and 202 females (56.1%) were recorded. The mean age of the patients was 37.36 ± 15.2 years. The results of the study showed that most patients were in the over-50-year-old age group (103 (28.6%)), and the less-than-10-year-old age group had the lowest number (19 (5.3%)). Most of the cysts were detected in the liver (234 (65%)). There was no statistically significant association between sex, residing area, and animal contact and the number of the cysts (P = 0.12, 0.36, and 0.95, respectively); however, a significant association was found between sex and the body organ involved (P = 0.007), so that liver involvement was mostly detected in females (79.9%), while involvement of the lung was mostly found in males (66.4%). No statistically significant association was found between age and the number of the cysts or the body organ involvement (P = 0.35 and 0.61, respectively).
Our study showed that hydatid cyst disease could be surprisingly common in apparently low-risk populations, such as those living in urban areas or without direct contact with dogs and farm animals. Therefore, identification of the populations most at risk and educating the community about the most common modes of acquisition could be helpful in the control and prevention of this disease.

Klebsiella pneumoniae has the potential to disseminate at speed among the hospital environment, hence included as a major nosocomial pathogen cause of severe infections. This work mainly focused on finding out the prevalence of different classed of integrons in colistin-resistant Klebsiella pneumoniae and to analyze the efficacy of colistin-meropenem in combination.
For this cross-sectional study, random non-biased sampling technique was followed and non-repetitive, Klebsiella pneumoniae clinical isolates were collected (Jan 2015 - Jan 2016) from 2 diagnostic centers located at Chennai and Trichy in Tamil Nadu, India. Isolates were identified as Klebsiella pneumoniae using the VITEK identification system. All the 24 isolates collected were studied for resistance using disk diffusion and minimal inhibitory concentration (MIC). Integrons (class 1, 2, 3) and mcr-1/2 genes were screened for all the isolates. Synergism for colistin-meropenem was tested using checkerboard, time-kill, and modified time-kill analysis.
Klebsiella pneumoniae isolates (n = 24) that were resistant to colistin were studied, and MIC50, as well as MIC90 values for colistin, were 64 µg/mL and 16 µg/mL, respectively. Whereas the gene mcr-1/2 was absent in all the isolates tested. Our results revealed the prevalence of class 1 integron among 10/24 isolates (41.6%) and its integron gene cassette in 60% of the isolates with a pattern of variable regions ranging between 700 bp to 2000 bp. The combination of colistin-meropenem implies that by the checkerboard method 86% (21/24) of the isolates, by time-kill analysis 76% (16/21), and by modified time-kill analysis 94% (15/16) of the colistin-resistant isolates showed synergism.
This study reveals that the prevalence of integrons might have an impact in spreading colistin resistant Klebsiella pneumoniae among hospital environment, which is a major threat for clinicians. The combination of colistin with meropenem had bactericidal effect against colistin- resistant Klebsiella pneumoniae.

In recent decades Procalcitonin (PCT) has been introduced to help physicians differentiate sepsis from SIRS. Its routine use in such specific settings as ICU, on the other hand, is very polemical owing to the variable results.
In this prospective observational study, we examined the accuracy of PCT levels in differentiating septic from SIRS in critically ill patients admitted to the general ICUs of two hospitals in Tabriz, Iran from September 2014 to May 2016. Further appraised was the effect of illness severity and organ failure on PCT value. We tried to answer this question that why there is controversial and wide range of findings pertaining to PCT in critical care settings.
One hundred and thirty two SIRS (Systemic Inflammatory Response Syndrome) positive critically ill patients admitted to the ICU were enrolled in the present research. Patients were divided based on their positive cultures into infectious and SIRS positive groups, in both of which, PCT was measured, severity of illness and organ failure were recorded, and the PCT sensitivity and specificity for the detection of sepsis and its relationship with disease severity and mortality were evaluated.
The optimal cut-off point for the PCT, determined 0.25μg/L with a sensitivity and specificity of 73 % and 39 %, respectively. PCT level was not able to significantly diagnose septic patients from SIRS positive ones and was significantly correlated with Cr and BUN concentrations.
These findings indicate that PCT may not differentiate between sepsis and SIRS in a heterogeneous population of critically ill patients admitted to the ICU; PCT measurements, nonetheless, can probably conduce to predicting the outcome of patients.

The HP0242 plays an important role in physiology of H. pylori in acidic condition.
The aim of this study was cloning and expression of immunogenicity of HP0242 gene of H. pylori.
The whole sequence of the hypothetical gene was amplified with specific primers. The DNA sequence (716 bp) was cloned into E. coli TOP10F by utilizing PEGFP-C1 and PTZ vectors. The protein product in CHO cells was elucidated with the SDS-PAGE technique. Western blot analysis showed that HP0242 expressed by recombinant E. coli had favorable immune-reactivity. Western blot was conducted to assess the immune-reactivity.
Presence of hypothetical gene in the expression PEGFP-C1 vector was confirmed with digestion by sacII and smaI. Finally, the expression of the hypothetical protein in CHO cells was confirmed by SDS-PAGE and thus, can be considered as a DNA vaccine candidate for H. pylori. Western blot analysis showed that HP0242 expressed by recombinant E. coli had a favorable immune-reactivity.
The expressed HP0242 gene showed the possibility that it can be used as a candidate DNA vaccine for H. pylori in the future research.

Helicobacter pylori (H. pylori) is one the most infectious microorganism of human disease found in half of the world’s population. Despite intense investigations into the spread of rosacea, the precise etiology remains unclear. There are theories, which suggest H. pylori as a predisposing factor for the occurrence. This study aimed at determining the prevalence of H. pylori in patients with rosacea.
This analytical-descriptive study was conducted on patients with rosacea disease attending Tabriz University of Medical Sciences Dermatology Clinics from October 2011 to January 2011. Patients, who were 18- to 65-year-olds with confirmed rosacea diagnosis, were included in the study. All patients were referred to a dermatologist and the severity of rosacea was categorized in 3 grades of mild, moderate and severe. Then H. pylori infection was investigated using H. pylori stool antigen. P values of less than 0.05 were considered statistically significant.
Out of 63 patients with rosacea, 35 patients (55.55%) were male and 28 patients (44.44%) were female. Based on the rosacea categorization, 11 (17.46%), 32 (50.79%), and 20 (31.74%) patients had respectively severe, moderate, and mild rosacea. There was no statistical significant difference regarding age and gender between different severities (P = 0.39). Forty patients (63.4%) out of all 63 were positive for H. pylori on stool antigen examination. There was no statistically significant association between H. pylori infection and gender (P = 0.87) or age (P = 0.62). There was a statistically significant difference between patients with H. pylori negative and positive test results considering severity (P = 0.013).
In conclusion, although no association between rosacea and H. pylori infection was seen, there was a significant association between H. pylori infection and cases of severe rosacea.

Acinetobacter baumannii is an opportunistic multidrug-resistant pathogen associated with nosocomial infections in critically ill patients. Antibiotic resistance genes are often encoded by class 1 and 2 integrons and located on plasmids that can facilitate their horizontal transfer among bacteria.
The aim of this research was to study the correlation between plasmid carriage and presence of class 1 and 2 integrons in nosocomial isolates of A. baumannii.
Fifty isolates collected between October 2014 and March 2015 from Imam Hussein hospital in Tehran were examined. Bacterial identification was carried out by biochemical identification as well as detection of the blaOXA-51 gene among the isolates. Susceptibility to 18 antibiotics was determined by disc diffusion method. Class 1 and 2 integrons were detected in total DNA extracts as well as in isolated plasmids using specific primers and PCR.
All isolates were extremely drug-resistant (XDR). Integron carriage was observed in 32 isolates (64%). Seventeen isolates (34%) carried plasmids with molecular sizes of > 20 kbp. Among them, six (35.4%) carried class 1, three (17.6%) harbored class 2, four (23.5%) had both integron classes, and four isolates (23.5%) carried no integrons. Of the plasmid negative isolates, 14 (42.4%) had no integron, 10 (30.3%) carried integron 2, five (15.2%) harbored integron 1 and interestingly, four (12.1%) carried both integron classes.
No correlation was found between antibiotic resistance profiles and integron carriage. Class 1 integron was significantly associated with plasmid carriage showing its role in the dissemination of drug resistance in A. baumannii. No association was observed between class 2 integrons and plasmid carriage suggesting their chromosomal location.

Antibiotic therapy should be done based on resistance characteristics of Helicobacter pylori strains to commonly prescribed antibiotics in areas with higher resistance rates.
This study examined antibacterial activity of nitazoxanide and doxycycline against clinical H. pylori isolates showing different metronidazole resistance levels.
A total of 122 patients, who underwent endoscopy were enrolled in this study from 3 hospitals of Tehran, during November 2014 to July 2015. Helicobacter pylori isolates were obtained from gastric biopsies of the patients after culture in specific culture medium and characterization by both biochemical and molecular methods. Antimicrobial susceptibility to metronidazole was detected using the agar dilution method and minimum inhibitory concentrations of nitazoxanide and doxycycline were determined for metronidazole resistant strains.
From a total of 122 gastric biopsy specimens, 55 H. pylori strains were recovered (45%). Thirty-three of these strains (60.0%) were resistance to metronidazole. MIC50 and MIC90 values for metronidazole were 32 and 64 µg/mL, respectively. MIC50 and MIC90 values for doxycycline and nitazoxanide were measured as 4 and ≥8 µg/mL, and 8 and ≥32 µg/mL, respectively.
Dominance of high level metronidazole resistance H. pylori strains among the studied patients questioned its usefulness for first-line therapy in Iran. Nitazoxanide and doxycycline showed superior activity against H. pylori strains in comparison to metronidazole, which should be considered for alternative therapies.

Crimean-Congo hemorrhagic fever (CCHF) is caused by a tick-borne virus in the family of Bunyaviridae. A hard tick, in the genus of Hyalomma, is a reservoir and also a vector for CCHF virus. Infection in humans usually occurs by infected tick bite or through contact with infected animal tissues and blood. CCHF can also transmit from one infected person to another through contact with infectious blood or body fluids. Human-to human transmission is also reported as a nosocomial infection.
Here, we presented 5 patients from a family with Crimean-Congo hemorrhagic fever, who got the illness at the same time when they cut the frozen meat together. Fortunately, all patients referred to hospital soon and received treatment during 24 to 72 hours after the first sign or symptom was presented.
Frozen meat can transmit CCHFV to humans, which can be due to high viral load or a virus with high virulence in the infected animal tissues.

Invasive Trichosporon species have been documented mostly in neutropenic patients with underlying hematological malignancies with high mortality, and in critically ill patients exposed to multiple invasive medical procedures. This fungus has been recognized as the second or third most common agent of yeast fungemia.
This study reports on invasive infection with Trichosporon asahii in a non-neutropenic patient with Tuberculous meningitis, who was a known case of diabetes mellitus type II.
Although fungemia due to Trichosporon species is an opportunistic pathogen in granulocytopenic patients, there is a steady increase in the number of such cases in non-neutropenic and non-hematological malignant patients. Thus, clinicians as well as microbiologists should be aware of such infections in critically ill patients as early diagnosis and timely management with appropriate antifungal drugs could decrease morbidity and mortality rate.