No role of herpes simplex virus type 2 [HSV-2] infection on HIV progression in naive HIV patients

Background: Herpes simplex virus type 2 [HSV-2] is a common infection in human immunodeficiency virus [HIV] patients and may accelerate HIV progression by rising HIV viral load and decreasing CD4 count. However, the available data regarding the influence of HSV-2 seropositivity on HIV progression in HIV individuals are inconclusive. Therefore, we aimed to determine HSV-2 seroprevalence in naive HIV patients and normal controls and also investigate the relation of HIV viral load and CD4 count with HSV-2 seropositivity. Subsequently, we investigated the association of HSV-2 serostatus with changing in CD4 count and HIV viral load in our subjects, after one year follow-up

Methods: In this study, 116 naive HIV patients and 85 healthy controls from Tehran, Iran were enrolled. HSV-2 IgG antibody was detected by ELISA. CD4 count was determined by flowcytometry, and serum HIV RNA copy numbers were determined using real-time PCR

Results: The prevalence of HSV-2 IgG was 18.1% in naive HIV patients and 0% in the control group [P = 0.000]. HSV-2 seroconversion was observed in 2.43% of HIV patients after one year. There was no significant difference regarding HSV-2 serostatus with CD4 count and HIV RNA viral load in our study cohort at baseline and after one year

Conclusion: Our results revealed that the prevalence and incidence of HSV-2 infection are low in our HIV cases, and it is negligible in the control group. However, it seems that HIV/HSV2 co-infection has no role on HIV infection acceleration

Adverse reactions to Mycobacterium bovis bacille Calmette-Guerin vaccination against tuberculosis in Iranian children

PURPOSE: There are considerable variations in the number of adverse reaction reports related to vaccine from different countries. The aim of this study was to review the development of adverse reactions to bacille Calmette-Guerin (BCG) vaccination among hospitalized patients in an Iranian referral hospital. MATERIALS AND METHODS: We identified hospitalized patients with BCG complications in Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran during January 2007-April 2009. Data on demographics, clinical features, laboratory findings, personal history (including vaccination history), family history, and outcomes were retrieved from medical records. RESULTS: There were 46 cases with BCG complication during the 2 years period. All of the children received vaccination at birth. Twenty-eight patients (61%) were male. The mean age of the patients was 13.5 +/-11.3 months (range, 1 to 52 months; median, 10 months). The majority of children (57%) with BCG complication were less than 1 year old. Among hospitalized patients due to BCG complications, suppurative lymphadenitis was occurred in 28 children (61%) and lymphadenopathy was seen in 9 children (20%). Disseminated BCG was detected in 8 patients (17%) and only 1 child (2%) was presented with abscess. In 7% (n = 3) of children, the family history of BCG complications were positive. CONCLUSION: The most common side effect of the BCG vaccine in our study was suppurative lymphadenitis. Disseminated BCG infection in complications leading to hospitalization in our study was 17%. With regard to the difficulty in implementing such a guideline in settings where BCG is given to all newborns, registration of Iranian primary immunodeficiency disorders (PID) patients would be helpful to increase the awareness of medical community of Iran to investigate underlying disease. In addition, BCG vaccination should postpone in each newborn with a family history of PID until the definite condition has been ruled out.

Clinical features and laboratory findings of visceral leishmaniasis in children referred to children medical center hospital, Tehran, Iran during 2004-2011

Visceral leishmaniasis [VL] is one of the most important parasitic diseases endemic in northwestern and southern areas of Iran. The aim of the present study was to review the records of children hospitalized with VL in order to characterize the clinical features of children as well as laboratory finding in Children Medical Center Hospital, Tehran, Iran. The medical records of all children with a final diagnosis of VL were reviewed from 2004 to 2011. Demographic, clinical information, laboratory finding and treatment were considered. A total number of 34 children with confirmed VL through 2004-2011 were included in the study. The most prevalent sign and symptoms were fever [97.1%], pallor and weakness [97.1%], appetite loss [61.8%], splenomegaly [97.1%] and hepatomegaly [88.2%]. The most frequent laboratory abnormalities were hematological including anemia [97.1%], thrombocytopenia [91.2%] and leukopenia [67.6%]. Direct agglutination test [DAT] was performed in 23 cases and all of them showed anti-Leishmania antibodies with titers of >/= 1: 3200. In addition, 90% of patients had positive rK39 results. Identification of Ieishmania in the aspirates of the bone marrow was found in 83.3% of patients. Regional surveillance system in order to monitoring of leishmaniasis trends as well as detection of new emerging foci is recommended

Downregulation of calcineurin gene is associated with glucan-time[registered sign] resiatance in leishmania infantum

Pentavalent antimonials are the first line drugs for the treatment of leishmaniasis. Unresponsiveness of Leishmania spp. to antimonial drugs is a serious problem in some endemic areas. Investigations on molecular mechanisms involved in drug resistance are essential for monitoring and managing of the disease. Cal-cineurin is an essential protein phosphatase for number of signal transduction pathways in eukaryotic cells and it has a mediated role in apoptosis. This study aimed to determine of biomarker[s] in Glucantime[registered sign] resiatance strain of L. infan-tum. We used cDNA amplified fragment length polymorphism [cDNA-AFLP] and real time-RT PCR assays to compare gene expression profiles at the mRNA levels in resistant and susceptible L. infantum field isolates. The cDNA-AFLP results showed downlegulation of calcineurin in resis-tant isolate in comparison with susceptible one. Significant downregulation of cal-cineurin [0.42 fold] [P<0.05] was found in resistant isolate compared to susceptible one by Real time-RT PCR. This is the first report of calcineurin implication in Glucantime[registered sign] drug resistance of field [natural] isolate of L. infantum. Downregulation of calcineurin could protect parasites from antimonial-induced apoptosis

Generalized lymphadenopathy in infancy; a case report

Rosai-Dorfman disease [RDD] is a rare disease of histiocytic cells, a cause of benign cervical lymphadenopathy [LAP] and massive generalized lymph node enlargement in children and adults. There are also some reports on involvement of other human body organs with or without LAP. A 7-month-old infant with chief complaint of generalized massive LAP was referred to our center. RDD was diagnosed according to clinical manifestations and confirmed through histopathologic and immunoreactivity study on the obtained sample by cervical lymph node biopsy. RDD is not a malignant illness and lymph node enlargement most often decreases in its size happens without special treatment

Successful treatment of fungal osteomyelitis with voriconazole in a patient with chronic granulomatous disease

Chronic granulomatous disease [CGD] is an immunodeficiency affecting phagocytic leukocytes. Defective respiratory burst mechanism renders the affected patients to be susceptible to catalase positive microorganisms. With the great successes in antibacterial prophylaxis and therapy, fungal infections are a persistent problem. Invasive aspergillosis is the most important cause of mortality in CGD. We describe a nine-year-old boy with CGD who presented with aspergillus induced skull osteomyelitis. He was successfully treated with voriconazole after initial failure of amphotericin B therapy. Currently, newer triazoles are recommended as initial therapy for invasive aspergillosis in immunodeficiency states such as CGD

Evaluation of humoral immune function in patients with bronchiectasis

Bronchiectasis is a chronic debilitating condition characterized by abnormal dilated thickwalled bronchi. To investigate humoral immune function in bronchiectatic patients, this study was performed. Forty patients with established diagnosis of bronchiectasis, who were referred from two tertiary care pulmonology centers in Tehran, were investigated in this study. Immunoglobulin isotypes concentrations and IgG-subclasses were measured by nephelometry and enzymelinked immunosorbent assay [ELISA] methods, respectively. All patients received unconjugated pneumococcal vaccine, and blood samples were taken before and 21 days after vaccination. Specific antibodies against whole pneumococcal antigens were measured using the ELISA method. Fifteen [37.5%] out of 40 patients were diagnosed to have defects in antibody mediated immunity including 5 [12.5%] patients with immunoglobulin class deficiency [2 with common variable immunodeficiency and 3 with IgA deficiency], 3 [7.5%] with IgG subclass deficiency and 7 [17.5%] patients had Specific antibody deficiency [SAD] against polysaccharide antigen despite normal levels of serum immunoglobulins and IgG subclasses. Our study along with several other studies confirmed that all patients with bronchiectasis should undergo thorough immunological evaluation in order to identify the presence of the underlying immunologic defect. This evaluation should include serum immunoglobulins, IgG subclasses concentrations and also determination of serum antibodies against pneumococcal antigens. Early diagnosis and appropriate treatment will prevent the subsequent complications and improve quality of life of affected individuals

Intramedullary spinal cord abscess: report of two cases

Intramedullary spinal cord abscess is a treatable cause of paraparesis. It can rapidly lead to complete paralysis below the lesion. In this article two cases of spinal intramedullary abscess in pediatric age [3 and 4-year-old males] are presented. Incidence, clinical presentation, neurologic investigation and treatment are discussed. Although intramedullary spinal cord abscess is a rare disease, we should have knowledge of its existence because misjudgment and deferring adequate treatment may lead to an unfavorable outcome

Disseminated mycobacterium bovis infection after BCG vaccination

The Calmette-Guerin vaccine [BCG] is administered to all the newborns in Iran in order to prevent tuberculosis. Complications of this vaccine are uncommon. We report disseminated BCG disease in 17 patients less than 10 years old. This is a retrospective study of total of 17 cases who were admitted in Children Medical Center Hospital with systemic syndrome compatible with Mycobacterium disease with evidence of histopathologic demonstration of acid-fast bacilli during 1995-2004. Fourteen cases occurred in children younger than 1 year old. Nine patients were female. Ten of the 17 total cases were associated with an immune deficiency including severe combined immunodeficiency, chronic granulomatous disease and cell mediated immune defect. Response to therapy was ineffective and 10 of them [58.8%] died. Disseminated BCG disease is an uncommon but devastating complication of vaccination that should be considered in the appropriate clinical setting. Immune-compromised infants are at greatest risk and they respond poorly to standard therapies