[Antibiotic resistance pattern of Vibrio cholerae strains isolated from the stool of cholerae patients in Kashan during 1998-2009]

Cholera is an acute diarrhoeal disease that can cause severe dehydration and death within the hours of its onset. Considering the importance of the disease, this study was carried out to assess the antibiotic resistance pattern of Vibrio cholerae [V. cholerae] strains isolated from the stool of cholerae patients in Kashan during 1998-2009. This cross-sectional study was carried out on stool specimens obtained from acute diarrhea cases referred to health care centers in Kashan. The samples were identified according to the guidelines established by the National Committee for Clinical Laboratory Standards [NCCLS] and then the biotype and serotype of V. cholerae isolates were identified using the enzymatic method. Finally, antibiotic sensitivity testing was performed using the Kirby-Bauer disk diffusion method. Resistance to all antibiotics except erythromycin was seen in all isolates of V. cholerae [58 isolates]. The highest antibiotic resistance rate was seen for ampicillin [31%] and the lowest ones for doxycycline, ciprofloxacin and tetracycline [7.1%], respectively. Moreover, among different V. cholerae serotypes, the lowest and highest levels of antibiotic resistance were seen for Inaba and Ogawa serotypes, respectively. There was no significant difference in resistance pattern between the different age and gender groups. According to the results of this study, an increased antibiotic resistance in V. cholerae has been observed which can result in the emergence of multidrug resistance and therapeutic complications

[Epidemiological survey of confirmed influenza A [H1N1] in Kashan, Aran and Bidgol cities during 2009-10]

The first outbreak of Influenza A [H1N1], the first pandemic influenza in the present century, in Iran was in Kashan in July 2009. This study was carried out to describe the stages of spread and also the outcome of influenza A [H1N1] in terms of incidence and death in Kashan, Aran and Bidgol cities during 2009-10. In this case series-study of confirmed influenza A [H1N1], clinical and demographic data of all confirmed cases were recorded using SPSS software and were analyzed by Mann-Whitney test. The total number of confirmed cases [mean and median of age were 29.8 +/- 18.7 and 26 years, respectively] was 86 with a male/female ratio of 1:1. Among the 7 cases who died [mortality rate: 8.1%] the mean age for death was 46.9 +/- 27.9 years, though greater than that of the recovered cases [30.01 +/- 18.1 years], but non-significant statistically. Beginning of new educational year for schools was identified as the most important factor in spread of the disease. Considering the mortality rate and other related variables, no significant difference was seen between Kashan, Aran and Bidgol cities compared to other countries. However, comparing the present findings with the findings of other domestic medical universities can disclose the reasons for disparities. Moreover, a 10 week time interval between the first outbreak and the peak for pandemy highlights the presence of an efficient surveillance system for disease control

[Cutaneous tuberculosis presented by chest wall fistula formation]

Tuberculosis is one of the world's most debilitating diseases and it is at the top of six most prevalent and dangerous infectious diseases recognized by World Health Organization. Although one out of every three people in the world is affected by Mycobacterium tuberculosis, cutaneous infection is a relatively uncommon event. Here, we report a rare form of cutaneous tuberculosis presented by multiple fistulas over the anterior chest wall. This is a 50 year old insulin-dependent diabetic man from Afghanistan who was presented with a history of multiple skin lesions over his anterior chest wall for 3 months duration. At first, there was a single non-painful, small popular lesion, which became fistulized and developed purulent discharge, later. The patient was suspected as a case of cutaneous tuberculosis according to his nationality and prolonged history of unresponsiveness to outpatient antimicrobial treatment. This diagnosis approved based on skin biopsy result as it revealed multiple granulomas consisted of giant Langhans cells and the detection of numerous acid fast bacilli in the Ziehl-Neelsen staining of the skin secretions. Six weeks after treatment with anti-tuberculosis drugs, the signs of improvement were appeared and 6 months later there was no active fistula any more. Cutaneous tuberculosis may present itself in uncommon forms such as fistula. It might be seen anywhere including chest wall. Therefore, this impression should be considered in patients with prolonged skin lesions and featured by fistula formation