Approach to anemia in hospitalized patients with infectious diseases; is it appropriate?

Anemia of chronic diseases [ACD] is a common problem in patients with infectious diseases and can influence the quality of life and patients› survival. Despite the clinical importance of ACD, data are still lacking regarding this problem in the infectious diseases. This study aimed to evaluate the prevalence, related factors, outcome and approaches to anemia in the infectious diseases ward. This retrospective study was performed to review the medical records of patients admitted to the infectious diseases department of Imam Khomeini hospital during a two-year period between 2009 and 2011. A standard protocol was developed to evaluate anemia. Patients' demographic data approaches to manage anemia and routine laboratory tests were recorded and compared with the protocol. Totally, 1,120 medical records were reviewed. ACD was recognized in 705 patients [63%]. Only 5.1% of diagnostic and 8.7% of treatment approaches was based on the protocol. The majority of patients [89.4%] were received inappropriate treatment regarding. Mortality rate of patients with ACD was 3.4%. Moreover, a significant correlation between anemia and mortality was detected [r = 0.131; p = 0.026]. A statistically significant correlation was also identified between patients' Hgb and ESR, CRP, reasons of admission, number of medications, and underlying diseases. In conclusion, results of this study suggested that ACD is a common problem in infectious diseases patients and significantly associated with patients' mortality. Moreover, the majority of studied patients were not received an appropriate diagnostic and treatment approach which arises more concerns regarding the management of ACD in infectious diseases setting

Frequncy and etiology of lymphadenopathy in Iranian HIV/AIDS patients

<p><b>OBJECTIVE</b>To estimate and outline the frequency and etiology of lymphadenopathy in HIV/AIDS patients.</p><p><b>METHODS</b>This study was conducted on 178 consecutive HIV/AIDS patient files for etiologies (categorized into three sub-groups: definite, probable and possible) and associated factors of local and generalized lymphadenopathy.</p><p><b>RESULTS</b>Seventy-two (40.45%) patients including 63 male patients (87.5%) developed lymphadenopathy. HIV in lymphadenopathy(+) patients was most commonly transmitted intravenously (n=49). Generalized and localized lymphadenopathy respectively occurred in 27 (37.50%) and 45 (62.50%) patients, mainly in the cervical region (28.9% for local and 63% for generalized lymphadenopathy). The most common causes of lymphadenopathy were tuberculosis (n=24, 33.3%) and lymphoma (n=12, 16.6%). The frequency of lymphadenopathy was non-significantly higher in patients with AIDS (CD4 count <200 cell/µL) vs. HIV(+) patients (CD4 count >200 cell/µL).</p><p><b>CONCLUSIONS</b>Lymphadenopathy in HIV/AIDS patients may reflect a serious condition, most likely tuberculosis and lymphoma. Since patients might underestimate lymphadenopathy, physicians would rather list these entities for diagnosis.</p>

[Intralipid efficacy in decreasing Amphotericin B associated nephrotoxicity]

Background: Amphotericin B Deoxycholate [ABD] has been the best therapeutic agent for treatment of most systemic fungal infections. However, untoward adverse effects like nephrotoxicity may limit its appropriate therapeutic use. We studied administration of fat emulsion early after infusion of ABD to evaluate its effects on ABD-associated nephrotoxicity

Methods: This study was a randomized clinical trial. Patients with fungal infections admitted in Amir-Alam and Imam-Khomeini University Hospitals, Tehran, Iran, entered the study during 1390- 1391. The patients were randomized to intervention and control groups. In both groups, patients received 1mg/kg/day ABD in dextrose 5%. In intervention arm, the patients additionally received intralipid 10% daily that was started as soon as possible within one hour after infusion of ABD. ABD-associated nephrotoxicity [a minimum 50% increase in baseline serum creatinine to a minimum of 2mg/dl], daily serum creatinine changes during first two weeks of treatment and some other relevant indices of renal function were compared between groups. ABD-related hypokalemia was also compared as an additional target

Results: Thirty one patients entered the study. ABD-associated nephrotoxicity and values of other relevant indices of renal function were not different between intervention and control groups [P>0.05]. Daily changes in serum creatinine level within first two weeks of treatment in both groups were not also statistically different [P=0.62]. Furthermore, ABD-related hypokalemia was not significantly different between groups [P=0.47]

Conclusion: Administration of intralipid 10% early after infusion of ABD in dextrose 5% does not have any effect in decreasing ABD-associated nephrotoxicity. Moreover, it does not have any significant effect on ABD-related hypokalemia

Multiple brain abscesses due to nocardia in an immunocompetent patient

Nocardia cerebral abscesses are rare intracranial lesions. They account for only 1% to 2% of all brain abscesses. They are important in immunocompromised patients, but rarely occur in immunocompetent hosts. Here, we present a case of multiple primary brain abscesses with Nocardia in an immunocompetent patient, who was treated successfully with oral antibiotic therapy

Antibody responses to trivalent influenza vaccine in Iranian adults infected with human immunodeficiency virus

The serious influenza-associated complications among immunodeficient individuals such as those who are infected with human immunodeficiency virus [HIV], highlights the importance of influenza vaccination in these people. Therefore, the current study aimed to investigate the antibody responses to influenza vaccine in this group. Two hundred subjects were recruited, during autumn 2010 and 2011, to receive, trivalent inactivated influenza vaccine consisting of A [H1N1], A [H3N2], and B strains. Hemagglutination inhibition assay was used to measure the antibody titer against all strains of the vaccine prior and one month post vaccination. Seroconversion rate for A [H1N1], A [H3N2], and B were found to be 58.5%, 67% and 64.5%, respectively. No correlation was found between antibody titer and demographics factors such as age and gender; however, we found a significant correlation between antibody titer and CD4 cell count. Checking the local and systemic reactions after vaccination, the pain on the injection site and myalgia were the most common local and systemic reactions with 20% and 6.5%, respectively. As vaccination with influenza mount considerable antibody responses in HIV-infected patients, annul influenza vaccination seems to be rational in order to prevent or reduce the severe clinical complications induced by influenza virus

Changes in 4-year antimicrobial resistance pattern of gram-positive bacteria at the main referral teaching hospital, Tehran, Iran

Infectious diseases are one of the most common causes of morbidity and mortality and the spread of resistant microorganisms is playing a significant role in this regard. The purpose of this study was to assess the trend in antimicrobial resistance of gram-positive bacteria at the main referral teaching hospital in Tehran during a 4-year period. All patients' biological isolates such as blood, urine, wound drainage, synovial fluid, sputum, and cerebrospinal fluid sent to the central laboratory of the hospital from 2007 to 2010 for identification and subsequently, antimicrobial susceptibility testing by Kirby-Bauer disc diffusion method were considered. All isolates [100%] of S. aureus were sensitive to vancomycin and linezolid and resistant to amoxicillin. The rate of S. aureus resistance to oxacillin increased from 60.78% in 2007 to 72% in 2010. All isolates of Streptococci in 2007 and 2008 were sensitive to vancomycin; while, 3.33% and 4.76% of Streptococci isolates were reported to be vancomycin-resistant in 2009 and 2010, respectively. Enterococci isolated from the entire specimens were identified to be sensitive to teicoplanin and linezolid and resistant to cloxacillin and oxacillin. The rates of Enterococci sensitivity to vancomycin were 90.91%, 81.25%, 86.67%, and 93.3% in 2007, 2008, 2009, and 2010, respectively. Changes of antibiotics sensitivity against g positive pathogens were significant during four years in this study. To minimize the spread of resistant gram positive pathogens, periodic and regular surveillance of antimicrobial resistance pattern is highly recommended.

Brucella infection in HIV infected patients

The purpose of this study was to assess the possible correlation between Brucella and HIV infections. Iran is a country where HIV infection is expanding and Brucellosis is prevalent. In the present study. 184 HIV infected patients were assigned and for all of them HIV infection was confirmed by western blot test. In order to identify the prevalence rate of Brucella infection and systemic brucellosis in these subjects, sera samples were obtained and Brucella specific serological tests were performed to reveal antibody titers. Detailed history was taken and physical examination was carried out for all of patients. 11 [6%] subjects had high titers but only 3 of them were symptomatic. Most of these subjects were injection drug user [IDU] men and one was a rural woman. Considering both prevalence rates of Brucella infection [3%] and symptomatic brucellosis [0.1%] in Iran, our HIV positive patients show higher rates of Brucella infection and systemic brucellosis. Preserved cellular immunity of participants and retention of granulocytes activity may explain this poor association; whereas other explanations such as immunological state difference and non-overlapping geographical distribution of the 2 pathogens have been mentioned by various authors