Multiple lung abscesses in a patient with kartagener's syndrome

Kartagener's syndrome is a rare genetic disorder, which is mostly inherited as an autosomal recessive trait. There are 4 genes with a proven pathogenetic role in Kartagener's syndrome. It results from ciliary dysfunction and is commonly characterized by sinusitis, male infertility, hydrocephalus, and situs inversus. Since Kartagener's syndrome causes deficiency or even stasis of the transport of secretions throughout the respiratory tract, it favors the growth of viruses and bacteria. As a result, patients have lifelong chronic and recurrent infections, typically suffering from bronchitis, pneumonia, hemoptysis, sinusitis, and infertility. We present a 27-year-old woman, a case of Kartagene's syndrome, with multiple pulmonary abscesses. Evaluation of sputum and tracheal secretions revealed Pseudomonas aeroginosa. Antibiotics were started and respiratory symptoms resolved and the patient was discharged in good general condition. As a conclusion, prompt and appropriate treatment of respiratory infections can minimize irreversible lung damage in such cases

BCG vaccination and active tuberculosis prevention: a three-year study

Six to eight million people are infected with tuberculosis [TB] annually throughout the world, out of which 2 to 3 million die. BCG vaccination and its efficacy are always used in tuberculosis control planning. There are different rates of BCG vaccination efficacy in the world from 0 to 80%. BCG vaccine has different efficacy in endemic and non-endemic areas. The prevalence of tuberculosis in Iran is high; therefore it was necessary to perform a study in this regard. This was a case-control descriptive study conducted from 2001- 2003. There were 50 cases of active pulmonary tuberculosis [according to WHO definitions], and 100 controls without tuberculosis admitted for other reasons. Vaccination was done in 10 [20%] people in the case group and 36 [36%] people in the control group [OR: 43%].Thus vaccine efficacy was calculated to be 57% in this study from the equation VE=1-OR [CI: 95% between 0.04-0.81]. Twenty percent of vaccinated people have been protected from active tuberculosis in this study. In this study vaccine efficacy was 57% [CI: 95% between 4-81%], and protection rate of vaccinated people against active tuberculosis was 20%. The effectiveness of BCG vaccine is not constant in all situations and old age and past history of contact with TB patients are confounding factors causing the low efficacy of the vaccine. While case control studies have limitations; thus, similar studies should be planned in different parts of our country for more accurate results

survey on 80 cases of botulism and its clinical presentations as a public health concern

Botulism is a toxin-induced paralytic illness characterized by cranial nerve palsies and descending flaccid paralysis. Borulinum 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 <24 hours after onset of symptoms

Outbreak of botulism type E associated with eating traditional soup in a family group, Loghman Hakim Hospital, Tehran, Iran

Botulism is a neuroparalytic illness caused by clostridium botulinium toxin that is usually transmitted as a foodborne disease. It is manifested by cranial nerve dysfunction and descending flaccid muscle paralysis. Patients: Eleven members of a family developed severe weakness, lethargy and other clinical manifestations compatible with botulism following the ingestion of traditional soup. Stool, gastric fluid and serum samples were submitted for toxicological evaluation with standard mouse bioassay, while, only one patient demonstrated type E toxin. All patients received 3 monovalent antitoxins A, B and E, whilst most of their symptoms improved within 12 hours, This study confirmed that prompt administration of antitoxin could prevent progression of the disease and may be a life-saving approach. Keywords: Botulism, Antitoxin, Outbreak

Antibiotic resistant patterns in MRSA isolates from patients admitted in ICU and infectious ward

Background: Methicillin- Resistant Staphylococcus Aureus [MRSA] has become one of the highest - ranking hospital acquired pathogens throughout the world, capable of causing a wide range of hospital infections. Staphylococcus aureus is a major nosocomial pathogen that causes a range of diseases, including endocarditis, osteomyelitis, pneumonia, toxic shock syndrome, food poisoning, carbuncles, and boils

Materials and Methods: One hundred S. aureus isolates recovered from patients in Loghman Hakim hospital were included in this study. Minimum inhibitory concentration [MIC] of strains for methicillin was determined by broth macrodilution method as recommended by NCCLS. Antibiotic susceptibility was tested by using the "disk diffusion technique on Mueller-Hinton Agar". Nineteen antibiotics were tested including Ampicillin, Penicillin, Cephalexin, Cefepime, Gentamicin, Doxycycline, Erythromycin, Chloramphenicol, Tetracycline, Nitrofurantoin, Kanamycin, Amikacine, Cefotaxime, Clindamycin, Cefazolin, Amoxicillin, Sulfamethoxazole-trimethoprim, Vancomycin, and Ciprofloxacin

Results: The MIC range for methicillin was from 1microg/ml to 1024microg/ml. Ninety percent of the isolated strains had methicillin MIC >/= 16microg/ml and were designated as resistant. Vancomycin and Chloramphenicol were the most effective antibiotics and only 7% and 14% of the isolates were resistant respectively. Forty-four percent hospital acquired MRSA strains were resistant to Co-trimoxazole. The high antibiotic resistance among MRSA strains could be originated due to widespread use of antibiotics

Conclusion: Out of 90 MRSA isolates characterized in this study, approximately half of them displayed resistance to one or more antimicrobial agents, including Penicillin, Cephalosporins, Tetracycline and aminoglycosides. These data are in accord with previous study suggesting use of these drugs was important in the emergence of antimicrobial resistance in MRSA. In addition, 66% of MRSA isolates were sensitive to Trimethoprim-Sulfamethoxazole [Co-Trimoxazole]. Since this drug combination is recommended for treating a range of human infections, S.aureus isolates should be monitored for further emergence of Co-Trimoxazole resistance