Archives of Clinical Infectious Diseases
Volume:14 Issue: 6, Dec 2019

Toxocariasis is a zoonotic and telluric disease caused by the Toxocara species mostly in tropical areas. The relationship between toxocariasis and asthma has always been a subject of discussion.

This study evaluated the seroepidemiology of Toxocara among asthmatic children.

This cross-sectional study evaluated 150 children aged 3 - 12 years with asthma presentations, who were referred to Dr. Sheikh Hospital of Mashhad University of Medical Sciences from April 2017 to March 2018. Serum samples were tested for the presence of anti-Toxocara antibodies using Enzyme-linked Immunosorbent assay (ELISA). Positive sera were confirmed by the Western Blotting (WB) method.

Out of 150 asthmatic patients, Toxocara immunoglobulin G (IgG) antibody responses were observed in two (1.3%) patients by ELISA and one (0.6%) patient by both ELISA and WB. Moreover, none of the patients was detected as hypereosinophilia.

It seems there is no significant relationship between Toxocara infection and asthma in Northeastern Iran. These findings suggest the need for WB immunodiagnosis and ELISA using Toxocara antigens to improve human toxocariasis diagnosis in patients with asthma.

Candida albicans can cause oral, vaginal, and cutaneous infections, as well as systemic candidiasis. It has been recently documented that molecular factors play significant roles in the pathogenesis of Candida albicans in various anatomical sites of the host.

The present study was designed to answer the hypothesis of whether PLB1 and HWP1 mRNA expression patterns are related to the progression of infection in different anatomical sites of the body.

The experimental study was performed on 120 clinical isolates of C. albicans obtained from various sites of non-immune-compromised and immune-compromised patients. Initially, all samples were cultured on Sabouraud-dextrose agar and then CHROM agar Candida medium to isolate and obtain a pure colony of yeasts. Quantitative real-time PCR was carried out for the quantitative evaluation of HWP1 and PLB1 mRNA expression in all clinical samples. The frequency of the PLB1 and HWP1 genes among C. albicans strains isolated from four clinical sites was analyzed using Fisher’s exact test with a significance threshold of P < 0.05. Finally, data obtained from real-time PCR was interpreted using the comparative Ct method (∆∆Ct) by REST© software.

The HWP1 gene was detected at a higher frequency than the PLB1 gene in C. albicans strains. The HWP1 mRNA expression level of clinical samples was upregulated by 70, 83.3, 43.3, and 33.3% in four sites (oral, vaginal, BAL, and cutaneous sites), respectively. The PLB1 mRNA expression level of all samples was upregulated by 46.7, 53.3, 40, and 3.3% (P < 0.001) in four sites compared to the control group.

The PLB1 and HWP1 genes were expressed predominantly in mucosal (oral, vaginal, and BAL) specimens. This clearly shows that the expression pattern of these candidate genes depends on the organ localization. Furthermore, the presence of samples with no expression of HWP1 and PLB1 genes mRNA confirmed the recent hypothesis that there is a meaningful relationship between the higher expression level of candidate genes mRNA and the presence of infections in a specific site of the body. However, more studies are required on larger samples to characterize the exact molecular mechanism of candidate genes involved in the severity of symptoms, as well as their contribution to the site of infection.

Bacterial resistance is a worldwide phenomenon that can disrupt the treatment of many different infectious diseases. Identifying drug-resistant bacteria is very important in different aspects, such as choosing the appropriate antibiotics, accelerating treatment, reducing the costs of treatment, and preventing antibiotic resistance.

Therefore, the present study was aimed to investigate the prevalence of drug-resistant Gram-negative bacteria in a teaching hospital in Tehran, Iran.

In the present cross-sectional study, all clinical specimens that were obtained from patients admitted to the Imam Hossein Hospital for infections caused by Gram-negative bacteria during 2017 were included. The pattern of antibiotic resistance was determined by the disk diffusion test as recommended by the Clinical Laboratory and Standards Institute (CLSI) guideline.

The result of the culture for 295 patients under study was reported as positive for Gram-negative bacteria. The most frequent Gram-negative bacteria were Escherichia coli (31.2%), followed by Klebsiella spp (20.3%) and Pseudomonas spp (13.2). The most antibiotic resistance was observed against cephalexin, ceftriaxone, and cefotaxime.

Resistance in Gram-negative bacteria was relatively high in the current study. Establishment of better infection control policies and education of hospital staff, especially in the ICU are recommended for the prevention and control of drug-resistant pathogens in the health care settings.

One of the most serious complications of BCG immunization is disseminated BCG infection, which is suggested to occur in immunized children with underlying primary immunodeficiencies.

This study aimed to assess the clinical manifestations and underlying primary immunodeficiencies associated with disseminated BCG infection.

The study enrolled 47 patients suspected of disseminated BCG infection referring to Mofid Children Hospital and Masih Daneshvari Hospital for 12 years. The patients’ records were reviewed and patients were classified into three distinctive groups of definitive, probable, or possible disseminated BCG infection.

Twenty-five (53.2%) patients were male and twenty-two (46.8%) were female. The mean age at onset of clinical manifestations was 4.83 months. The first presentation of the disease occurred within one year of vaccination in 28 (60%) patients. Clinical manifestations included lymphadenopathies (61%), fever (38%), hepatosplenomegaly (36%), failure to thrive (23%), skin rash (14%), chronic cough (10%), ascites (6%), and clubbing (6%). The confirmed underlying primary immunodeficiency detected in these patients were Mendelian Susceptibility to Mycobacterial Disease (MSMD; 69.56%), Severe Combined Immunodeficiency (SCID; 26%) and Chronic Granulomatous Disease (CGD; 4.3%).

Disseminated BCG infection may be a devastating complication and an important preliminary manifestation of underlying primary immunodeficiency. Because of the wide spectrum of mortality and morbidity, as well as the socioeconomic burden on the health system, it is worth to take a careful medical history before BCG immunization particularly in families with a history of consanguineous marriage and death due to unknown etiology.

Spondylitis is an important osteoarticular manifestation of brucellosis that leads to serious complications.

We aimed to investigate various aspects of spondylitis in brucellosis patients in Kermanshah, a highly endemic area in the West of Iran.

This retrospective, single-center, cross-sectional study investigated 289 brucellosis patients among whom, 32 patients were confirmed to have brucellar spondylitis. The diagnosis of brucellosis was made by Wright or Coombs Wright tests (titers ≥ 1/80) or 2ME test (titer ≥ 1/40). Brucellar spondylitis was confirmed by vertebral MRI or whole-body bone scan. All analyses were done using SPSS 21 software. The chi-square or Fisher exact test was used for assessing associations. P values of < 0.05 were considered statistically significant.

Among 289 patients studied, 32 (11.07%) had spondylitis with a mean age of 53.44 ± 16.06 years. Unpasteurized dairy product consumption, rural residence, and livestock-related occupation were reported by 30 (93.7%), 22 (68.7%), and 28 (87.5%) patients, respectively. Back pain (100%) was the most common symptom while the temperature of ≥ 37.7 (50%) and vertebral column tenderness (50%) were the most observed signs. Brucellar spondylitis was statistically related to age > 40 years, admission duration > 10 days, and ESR > 40 mm/h but not to sex, fever, anemia, and Wright titer. The lumbar disc involvement was the most common involvement (90.6%) in brucellar spondylitis patients. Vertebral body involvement, abnormal marrow signal, and bone marrow edema were observed in all 31 patients diagnosed with MRI.

Brucellar spondylitis should be considered in patients with lower back pain and fever in endemic areas. Positive Wright serology, vertebral body involvement in MRI, and elevated ESR greatly favor the diagnosis of this complication.

Infection with Toxoplasma gondii (T. gondii) leads to activation of T-helper cells (Th-1 and Th-2) which are involved in the synthesis and release of different cytokines which may lead to endothelial dysfunction.

To evaluate the endothelial function in patients with acute toxoplasmosis.

This case-control study involved 31 patients with toxoplasmosis aged 19 - 47 years matched with 20 healthy subjects. Anti-T. gondii antibody (IgG, IgM, IgA) was determined by direct antigen-antibody reaction. Interleukin-6(IL-6), endothelin-1 (ET-1) and human malondialdehyde (MDA) serum levels were measured.

IgM, IgG and IgA levels were high in the infected patients compared with controls (P < 0.01). Furthermore, IL-6 serum level was high in the infected patients compared with controls (P < 0.01). In addition, ET-1 level was high in acute toxoplasmosis (7.29 ± 4.59 pg/mL) compared with controls (3.11 ± 1.69 pg/mL) (P < 0.01). In addition, MDA serum level was high (9.34 ± 4.17 nmol/mL) compared with controls (2.87 ± 1.13 nmol/mL), (P < 0.01). In acute toxoplasmosis IgM serum level was significantly correlated with IgG (r = 0.55, P = 0.001), IgA (r = 0.57, P = 0.0008), IL-6 (r = 0.45, P = 0.01), ET-1 (r = 0.51, P = 0.003) and MDA (r = 0.85, P = 0.0001).

Acute toxoplasmosis is associated with significant oxidative stress and pro-inflammatory changes which contribute to development of endothelial dysfunction.

The aim of our study was to investigate mechanisms of aminoglycoside resistance in extended-spectrum beta-lactamases (ESBL)-producing Klebsiella pneumoniae (K. pneumoniae) isolates from Iran. To this end, 154 clinical isolates of K. pneumoniae were collected from two hospitals in Ilam city, Iran. The Kirby-Bauer (agar diffusion) antibiotic testing method was used to determine the susceptibility pattern of the isolates against kanamycin, gentamicin, tobramycin, netilmicin and amikacin. Aminoglycoside acetyltransferases (aac(3)-IIa, aac(6’)-Ib, and aac(3)-Ia), 16SrRNA methylase genes (armA and rmtB) and ESBL genes (blaTEM, blaSHV, and blaCTX-M) were detected by PCR amplification. 59.1% (n = 91) of K. pneumoniae isolates were detected ESBL producers with the phenotypic test. Moreover, blaTEM, blaSHV and blaCTX-M were detected in 83.5% (n=76), 52.7% (n=48) and 26.4% (n=24) of the ESBL-producing isolates, respectively. Among 52 resistant or intermediate isolates against aminoglycosides, the aac(3)-IIa, aac(6’)-Ib and rmtB genes were detected in 55.8% (n = 29), 80.8% (n = 42) and 1.9% (n = 1) of the isolates, respectively; none of the isolates, however, had the aac(3)-Ia and armA genes. Therefore, the results showed the high prevalence of aminoglycosides resistance in the K. pneumoniae isolates. As observed, the acetyltransferase modifying enzymes (aac genes) played major roles in determining this resistance. However, the rate of 16srRNA methylase genes was extremely low in K. pneumoniae.

Liver diseases are still among the most important health problems worldwide. In order to make successful treatment, an accurate diagnosis is necessary.

In the forthcoming study, the level of menin protein expression and its relationship with early diagnosis of HBV-related HCC were studied in the liver tissue of Iranian patients.

The study consisted of 30 healthy control individuals (C) and 121 patients (40 patients with HBV only, 41 patients with HCC only, and 40 patients with HBV + HCC). The level of menin expression in the liver samples of all volunteers was evaluated by IHC and qRT-PCR.

Statistically, the level of menin expression was different between HBV-related HCC and HBV groups. There was a significant relationship between labeling index and immunohistochemical and molecular expressions of menin.

Results emphasized the significant relationship between menin expression and risk of HCC in patients with HBV. It was concluded that menin expressions could increase significantly in HBV-related HCC patients.

We reviewed the medical charts of 1,700 patients diagnosed with HIV who referred to a central HIV clinic in Tehran between 2004 and 2017. Participants who had a viral load of > 200 copies/mL after six months or more on antiretroviral therapy (ART) were grouped as virologic failure (VF). We assessed the demographic characteristics, diagnosis date, first ART regimen, and resistance to various ART drugs. Out of 1,700 patients, 72 (4.2%) had a treatment failure. Among those with treatment failure, 51.3% were on zidovudine + lamivudine + efavirenz, 13.9% were on tenofovir + lamivudine + lopinavir/ritonavir, and 12.5% were on tenofovir + emtricitabine + efavirenz. In patients with treatment failure, the highest resistance was to nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) combination (44.4%). In these patients, resistance to tenofovir (one of the NRTIs) was 29.1%. The highest treatment failure was observed among patients treated with nevirapine (NVP) and efavirenz (EFV)-based regimen. Our findings suggest that protease inhibitors should be considered as first-line drugs in ART regimens in VF patients in Iran.

Primary cutaneous tuberculosis (PCTB) is a relatively uncommon presentation, particularly in immunocompetent subjects and its diagnosis may be delayed, as it resembles many other skin infections.

The authors reported a case of PCTB in a 41-year-old Iranian female who presented with a 2 × 5 cm, erythematous swollen skin lesion over the dorsal aspect of the finger that had been diagnosed as a bacterial infection; after admission, the diagnosis of tuberculosis was also masked by a positive polymerase chain reaction for deep mycoses which resulted in a delay in treatment and several months of morbidity. The mycobacterial infection was confirmed by a positive culture for M. tuberculosis and the patient responded well to the anti-TB treatment.

A diagnosis of PCTB should be kept in mind in all patients who present with a chronic skin infection (especially nodular, ulcerated, and purulent lesions) with no response to initial antibacterial therapy.