Antimicrobial susceptibility and distribution of TEM and CTX-M genes among ESBL-producing klebsiella pneumoniae and pseudomonas aeruginosa causing urinary tract infections

Extended spectrum beta lactamases [ESBLs] have been observed in nearly all the species of family Enterobacteriaceae. The enzymes are plasmid mediated and are derived from broad-spectrum beta lactamase TEM and CTX- M by a limited number of mutations. This study was undertaken to characterize ESBL producers among Klebsiella pneumoniae and Pseudomonas aeruginosa by PCR, which were initially screened by phenotypic method. A cross-sectional study was performed to evaluate 180 strains [30 K. pneumoniae and 150 P. aeruginosa] isolated from urine culture of hospitalized patients [Amir Al-Momenin Hospital, Zabol, south-eastern Iran] suffered from urinary tract infections during a period of six months. The prevalence of ESBL producing K. pneumoniae and P. aeruginosa was evaluated by disk diffusion test and polymerase chain reaction [PCR] by detecting TEM and CTX-M gene. The results of the study revealed that the prevalence of ESBL producing P. aeruginosa and K. pneumoniae by disk diffusion test was 13.3% for P. aeruginosa and 66.6% for K. pneumoniae. Seventy five percent and 65% of K. pneumoniae harboured the gene TEM and CTX-M, respectively. Forty five percent of P. aeruginosa isolates harboured the gene TEM but none of them demonstrated the gene CTX-M using PCR method. ESBL producing P. aeruginosa and K. pneumoniae isolates showed a high prevalence in this study. Therefore it seems that continuous surveillance is essential to monitor the ESBLs producing microorganisms in hospitals and community

Hepatitis in patients with crimean -congo hemorrhagic fever

Crimean-Congo hemorrhagic fever [CCHF] is a viral disease and causing approximately 30% fatality rate. Recent studies have been reported that hepatitis in CCHF patients is with high mortality. The aim of this study was to determine the prevalence of hepatitis in the CCHF cases and also detect the mortality rate among patients with hepatitis. The present study was conducted in patients with CCHF who were hospitalized in Boo-Ali hospital in Zahedan between Oct 2009 to Feb 2012. Liver function tests including aminotransferase enzymes and prothrombin time and mortality rate were evaluated. Among 53 patients with CCHF, hepatitis was seen in 19 patients [45%]. Nine patients died [21%]. All dead patients had a serum aminotransaminase level >/=10 times the upper normal limit. Our study showed that hepatitis is prevalent in CCHF patients and a serum aminotransaminase level >/=5 times the upper normal limit [UNL] is a risk factor for severe disease and high mortality

Pustulotic arthro-osteitis [sonozaki syndrome]

Sonozaki syndrome or pustulotic arthro-osteitis is a relatively rare chronic illness which belongs to the group of seronegative arthritis. Sonozaki syndrome includes arthro-osteitis and symmetrically localised palmoplantar pustulosis. The disease is characteristically non-erosive and transient and does not lead to contracture deformities. Early recognition of the disease can prevent misdiagnosis. Hereby, we describe a 51-year old woman with palmar pustulosis and involvement of the left sternoclavicular joint and peripheral oligoarthritis

case of fascioliasis from south-east of Iran

Fascioliasis is a zoonotic infection caused by Fasciola hepatica. Human is accidentally infected by ingesting contaminated drinking water or plants in endemic area [mainly North of Iran]. The disease is usually reported from the sheep raising area of our country. We report a case of human fascioliasis in south-eastern Iran with dry climate without any history of travel to endemic regions

Cranial nerve palsy as a factor to differentiate tuberculous meningitis from acute bacterial meningitis

Tuberculous meningitis [TBM] and acute bacterial meningitis [ABM] cause substantial mortality and morbidity in both children and adults. Identification of poor prognostic factors at patient's admission could prepare physicians for more aggressive monitoring of patients with meningitis. The objective of this study was to determine the predictive value of neurological features to differentiate ABM and TBM. A retrospective study was conducted between patients affected with ABM or TBM admitted to three teaching hospitals during the last 14 years in Zahedan the central city of Sistan and Balouchestan province [Iran]. The neurological features include seizure, level of consciousness, stroke, focal neurologic deficit and cranial nerve palsy at the time of admission. Mean age for patients with TBM and ABM were 41 +/- 22.4 and 24 +/- 18.5 years respectively. In univariate analysis, all measured variables revealed significant difference between ABM and TBM patients except for seizure episodes. Multivariate logistic regression analysis showed positive predictive effect of cranial nerve palsy [AOR=1.980, CI 95%: 1.161-3.376] on the diagnosis of TBM. In our study cranial nerve palsies was the most important neurological predictor factor to differentiate TBM from ABM

Infective causes of stroke in tropical regions

Vascular diseases of the brain are the second reason of the death and the first cause of morbidity and disability worldwide. In tropical areas stroke has some particular features related to the nature of torrid zones. There are some special causes of the stroke, mainly infectious, although some of them are non-infectious. The most important etiologies are malaria, tuberculosis, cysticercosis, syphilis, and Chagas' disease. The mean age of the patients with stroke in tropical areas seems to be less than that in developed countries, and the disease is more prevalent in younger adults. Prevention and/or treatment of the classic risk factors as well as factors related to tropical zones are the mainstays of controlling the disease. It has to be mentioned that lack of human as well as financial resources makes it difficult to control and treat the disease properly. Herein, the etiologies and risk factors of the cerebrovascular diseases in tropical regions will be reviewed

Clinical and laboratory diagnosis of the patients with sputum smear-negative pulmonary tuberculosis

The objective of this study is to describe the proportion of patients with chronic cough and negative smear microscopy appropriately diagnosed as tuberculosis [TB] and to identify clinical features that could be used in developing a diagnostic scoring system for smear-negative patients. Records of patients with chronic cough and > 3 negative sputum smears for acid fast bacilli who attended a reference University hospital in south-eastern Iran and screened by culture were retrospectively reviewed. We compared confirmed smear-negative pulmonary TB [PTB; culture-positive] and unconfirmed smear-negative patients [culture-negative] to describe the appropriateness of treatment and their characteristics. Features independently predictive of smear-negative PTB [SNPTB] were entered into a logistic regression to create a diagnostic rule. This study enrolled 350 patients, of which 52 [14.8%] were culture-positive and 298 [85.2%] culture-negative. Of these, 38 out of 52 [sensitivity 73%] confirmed SNPTB were diagnosed as TB and 283 out of 298 [specificity 95%] unconfirmed sputum-negative patients were diagnosed as non-PTB. Variables associated with confirmed SNPTB were the presence of night sweats, family history of TB, typical chest radiography, erythrocyte sedimentation rate > 45 mm and white blood cell count < 11000/mL. The score constructed with these variables had a sensitivity of 94% and specificity of 74% with an area under the curve of 0.90. The clinical differences between SNPTB and control patients could be used to develop a clinical scoring system to identify patients with SNPTB

Osseous hydatid disease

A 48-year-old man referred with pain and swelling at the upper and middle third of left tibia with a history of previous osseous hydatid disease three years ago. Despite surgical procedure which was performed in this case, recurrence was observed and repeated exploration with wide resection and oral medical therapy were recommended. Bone hydatid cyst is an uncommon disease with difficult response to treatment. Hydatid disease should be included in the differential diagnosis of cystic lesions of bone in endemic regions

Spectrum of clinical disease in a series of hospitalized HIV-infected patients from southeast of Iran

To determine the pattern of opportunistic infections [OIs] and non-infectious opportunistic diseases in hospitalized HIV-infected patients in Zahedan, southeast of Iran. We retrospectively reviewed the records of 52 HIV-infected patients [47 male, 5 female; age range, 21-54 years] who were admitted to Boo-Ali Hospital, Zahedan, Iran for evaluation and management of an HIV-related disorders from April 2000 to December 2005. Tuberculosis [TB] was the most common opportunistic infections [53.8%] followed by hepatitis C [11.5%], typhoid [9.6%], amebiasis [9.6%], candidal esophagitis [5.7%], acute bacterial pneumonia [3.8%], and cerebral toxoplasmosis [1.9%]. Most of the cases of TB were pulmonary [36.5%]. Apart from other well-recognized OIs, 2 cases of HIV-associated lymphoma were encountered. Only 12 patients [23.07%] received antiretroviral therapy. Five patients [9.6%] died during hospital stay due to tuberculosis [4 cases] and typhoid [1 case]. The findings show that opportunistic infections are common in HIV-infected patients in Zahedan, southeast of Iran. Tuberculosis remains the most common OIs and is the most common cause of death in these patients

Recurrent non-typhoidal salmonella bacteremia in a patient with interleukin -12p40 deficiency

The South eastern region of Iran is an endemic area for salmonellosis. Sometimes bacteremia due to nontyphoidal salmonella occurs but certain patients are at increased risk for recurrent bacteremia. The risk of invasive salmonellosis and recurrent bacteremia is increased in the patients with immunosuppression, especially impaired cell-mediated immunity, lymphoproliferative diseases and in patients with IL-12 deficiency. In recent years, a series of inherited disorders of IL-12-IFN-gamma axis have been described that predispose affected individuals to disseminated disease caused by environmental mycobacteria and non-typhoidal salmonella. We report here the first such patient originating from and living in Iran. The patient was a 26-year-old man, suffering from IL-12p40 deficiency and presented with recurrent episodes of systemic salmonellosis. This report indicates that there are patients with inherited defects of the IL-12-IFN-gamma circuit in Iran. We recommended to consider this group of disorders in all patients with recurrent non-typhoidal salmonella bacteremia, wherever they are found

Prevalence of hepatitis B surface antigen in pregnant women in Zahedan, Iran

Introduction: hepatitis B virus is one of the most common chronic infections in the world. Over half of the world population has been exposed to this virus. It is estimated that 3% of Iranian population are - chronic carriers

Objective: to determine the seroprevalence of hepatitis B infection in pregnant women in Zahedan, Iran

Method: in this cross-sectional study in a period of one month in Zahedan, total cases of 200 pregnant women were enrolled in our study. Sera obtained from these pregnant women were evaluated for HBsAg by ELISA method

Result: our data showed that 6.5% of the pregnant women had a positive test for HBsAg

Conclusion: it seems that hepatitis B infection is highly endemic at least in pregnant women in Zahedan. On the basis of these epidemiologic data, screening of all pregnant women is necessary