Genotypic analysis of E. coli strains isolated from patients with cystitis and pyelonephritis

Urinary tract infection is the most common health problem affecting millions of people each year, mainly caused by a large genetically heterogeneous group of Escherichia coli called uropathogenic E. coli. This study investigates the genotypic analysis of E. coli strains isolated from patients with cystitis and pyelonephritis. During 2008-2009, 90 E. coli strains were analyzed, consisting of 48 isolates causing pyelonephritis in children and 42 isolates causing cystitis. Having identified the strains by standard methods, they were subtyped by pulsed field gel electrophoresis [PFGE] and their corresponding patterns were compared using dendrogram. Sixty five PFGE profiles were obtained from the genome of E. coli strains by this genotyping method. Thirty six and thirty three patterns were obtained for pyelonephritis and cystitis, respectively. Most strains exhibited twelve and thirteen bands and the patterns with eight or nineteen bands had the lowest rate. Genome sizes of the strains were between 1610-4170 kbp. With due attention to these results, genetic patterns showed that the strains had different clonalities and it could be suggested in some cases that the strains causing pyelonephritis or cystitis have common patterns and different diseases could be explained by different gene factors

Susceptibility of clinical Candida species isolates to antifungal agents by E-test, Southern Iran: a five year study

The incidence of fungal infections in immunocompromised patients, especially by Candida species, has increased in recent years. This study was designed to identify Candida species and determine antifungal susceptibility patterns of 595 yeast strains isolated from various clinical specimens. Identification of the isolates were determined by the API 20 C AUX kit and antifungal susceptibilities of the species to fluconazole, amphotericin B, ketoconazole, itraconazole, voriconazole, and caspofungin were determined by the agar-based E-test method. Candida albicans [48%] was the most frequently isolated species, followed by Candida kruzei [16.1%], Candida glabrata [13.5%], Candida kefyr [7.4%], Candida parapsilosis [4.8%], Candida tropicalis [1.7%] and other species [8.5%]. Resistance varies depending on the species and the respective antifungal agents. Comparing the MIC90 for all the strains, the lower MIC90 was observed for caspofungin [0.5 microg/ml]. The MIC90 for all Candida species were 64 microg/ml for fluconazole, 0.75 microg/ml for amphotericin B, 4 microg/ml for ketoconazole, 4 microg/ml for itraconazole, and 2 microg/ml for voriconazole. Species definition and determination of antifungal susceptibility patterns are advised for the proper management and treatment of patients at risk for systemic candidiasis. Resistance to antifungal agents is an alarming sign for the emerging common nosocomial fungal infections

Susceptibility of Candida species isolated from immunocompromised patients to antifungal agents

This study was carried out from October 2003 to March 2007 to investigate susceptibility patterns to antifungals of Candida strains isolated from 410 immunocompromised patients in Shiraz, Islamic Republic of Iran. Patients were checked for systemic candidiasis. Fungal colonization was determined and clinical samples collected from those patients with clinical signs of infections were examined. The carbohydrate assimilation patterns of all 354 isolates were studied. Susceptibility of the isolates to antifungal agents was determined using the reference broth microdilution method. Candida Candida albicans was the species most often isolated. Voriconazole was highly active against all the isolates. Major resistance to itraconazole was observed in all Candida spp. Regular investigations into antifungal resistance in medical centres is highly recommended as this will result in more efficient management of invasive candidiasis in immunocompromised patients

Evaluation of cytomegalovirus infection after six months of liver transplantation in children in Shiraz, Southern Iran

Liver transplantation [LT] is a life-saving treatment for end-stage liver diseases [ESLD]. Cytomegalovirus [CMV] infection is one of the important causes of morbidity after LT. To evaluate the incidence of late-onset [after 6 months of LT] CMV infection in pediatric recipients. A retrospective analysis was conducted to evaluate 50 pediatric patients who underwent LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We retrospectively investigated episodes of CMV infection after 6 months of LT proven by CMV antigenemia test. Three recipients [6%] developed late-onset CMV infection. These patients finally responded to ganciclovir. CMV infection is one of the most common post-LT viral infections that usually occurs in the first six months of LT. Our study shows that the incidence of late-onset CMV infection is relatively low, but it still remains a significant problem. Therefore, monitoring and management is crucial for improving the survival of children

[Infestation of heartworm [Dirofilaria immitis] in a cat in Ahvaz city: a case report]

Heartworm disease is caused by Dirofilaria immitis in dogs and cats. Dirofilariasis is clinically considered very important, because of its severe and life threatening disease in case of even light infection. Cats are infected much less commonly, even in areas which present heavily infected dogs. After clinical examination blood samples were collected from 120 companion and stray adult cats in Ahvaz city. Dirofilaria microfilaria was detected by modified Knott method and its antigen detected by immunochromatography. One [2.5 years old], out of 120 [0.83%] of the studied cats was infected with Dirofilaria immitis microfilaria. Comparison male cat of domestic short hair [DSH] breed. This survey is the first report on isolation of Dirofilaria immitis in cats of Ahvaz city. It seems that carrier mosquitoes and their reservoirs present in this distinct: Therefore continuous challenge for eradication of stray cats and dogs, prophylactic treatment and accurate training to people should be done

Evaluation of serum agglutination test in the diagnosis of pediatric brucellosis

Brucellosis is a public health problem in many developing countries, including Iran. Diagnosis is based on history, clinical manifestations and positive serum agglutination test [SAT] or Wright test. The purpose of this study was to evaluate the diagnostic value of SAT in pediatric Brucellosis. In this prospective study, during 2 years, 52 patients with clinical features of Brucellosis were studied. Sera were obtained from all patients. Assuming that patients with active Brucellosis in our area have SAT >/= 1:80, all blood samples were tested by SAT and blood culture with BACTEC system. Of 52 patients with clinical presentation of brucellosis, in 26 patients, the diagnosis was confirmed according to positive blood culture and/or SAT [>/= 1:80]. Brucella spp were isolated in 10 patients [38.4%]. SAT was found positive in 25 samples [96.1%]. Blood culture and SAT both were negative in 26 cases and the final diagnosis of this group was a disease other than brucellosis. The sensitivity, specificity, positive and negative predictive value of the test were 90%, 62%, 36% and 96.2%, respectively. Wright test can be used as a reliable, convenient and cost - effective test in the diagnosis of pediatric brucellosis in our population

Primary splenic hodgkin's disease in a patient with chronic granulomatous disease, a case report

Here we report a 20-year-old male, a known case of chronic granulomatous disease [CGD], who presented with fever and splenomegaly. After splenectomy, primary splenic Hodgkin's disease was diagnosed. Immunohistochemistry confirmed the diagnosis [positive CD15 and CD30]. With chemotherapy, his fever was subsided and now after 6 months, he is doing well. Although primary immune deficiencies have been reported to show an increased tendency to develop malignancies, until now there has been no report of a patient with CGD and Hodgkin's disease

efficacy of hepatitis B vaccination among school age children in southern Iran

Primary prevention by vaccination to increase herd immunity remains the main thrust in the control of hepatitis B virus [HBV] infection and many countries such as Islamic Republic of Iran have incorporated HBV vaccination into their national expanded program of immunization. This study was performed to determine the vaccine efficacy of hepatitis B infection between vaccinated and non-vaccinated school-aged children. Three hundred and ninety four students aged 6 to 8 years who received the hepatitis vaccine in the infancy and 314 students aged 9 to 10 years who did not receive it in Sepidan, southern Iran were enrolled. We also determined the titer of anti HBs Ab in the vaccinated students. Two students [0.5%] were HBV infected [positive HBC Ab] and none were a chronic carrier. Two hundred and forty nine students [63.2%] had anti HBs titer greater than 10 IU/ml. One hundred and seventeen students [30%] had anti HBs titer between 1 and 10 IU/ml and only 28 children had anti HBs titer less than 1 IU/ml. Five [1.6%] were HBV infected [positive HBc Ab] and 2 [0.6%] were chronic carriers [positive HBs Ag]. The efficacy of the vaccine 6-8 years after vaccination was 67.9% [95 Cl 78-92]. Our results showed that similar to other studies, vaccination could not reduce the infection rate but had a significant effect on the reduction of chronic infection and carrier state, emphasizing on the role of vaccination in the control of HBV infection in an endemic region

Antibiotic-resistant bacteria in hospitalized patients with bloodstream infections: analysis of some associated factors

Blood infections are life-threatening if not detected and managed properly. This study investigates the correlation between fever and previous antibiotics therapy with differential time to positivrty [DTP] at admitted patients at Nemazee Hospital in Shiraz, southern Iran. From January 2005 to December 2006, 985 positive blood samples in Bactec bottles from the admitted patients at Nemazee Hospital were analyzed. Sensitivity patterns of the bacteria to a panel of antibiotics were determined by the disk diffusion method. S. epidermidis, S. aureus and Acinetobacter were the most prevalent isolates respectively. However, only 100 [20.7%] S. epidermidis samples were the true infections. The most susceptible Gram positive and negative bacteria were S. viridance, S. aureus, H. influenzae, and Brucella spp., respectively. Imipenem, amikacin and ciprofloxacin were the effective ones against Gram negative bacteria, while vancomycin, co-amoxiclav and chloramphenicol were effective against Gram positive ones. Cefuroxime and penicillin G were less effective antibiotics against both Gram negative and positive bacteria. As demonstrated, the combined prescription of vancomycin and imipenem seems to cover the majority of infective agents in the blood whenever an empirical therapy is to be initiated. Moreover, periodic surveillance of antibacterial susceptibility patterns is warranted

Seroepidemiology of varicella zoster virus infection among 1-70 year individuals in Iran

Varicella zoster virus [VZV] causes varicella and, later in the life of the infected person, can reactivate to cause Herpes zoster [HZ]. The objective of this study was the investigation of anti Varicella zoster virus IgG antibodies in infants and adults in Shiraz, southern Iran. A cross-sectional, age and population-based seroprevalence study was conducted in 2008 on 843 subjects, ages ranging from 1 to 70 years old. IgG antibodies against VZV were measured with a commercially available enzyme-linked immunosorbent assay [ELISA]. The seroprevalence of Varicella zoster antibodies increased with age, being 25.3% in 1-5 year age group, 43.1% in 6-10 year group, 73.5% in 11-15 year group and 86% in adult population. The majority of VZV infections occurred during childhood. The best policy to prevent the circulation of wild type VZV in the population and reduction of the rate of complicated cases is the immunization of 5 year old children and those younger. VZV vaccine should be incorporated in the conventional childhood vaccination plan in Iran

Prevalence of oropharyngeal colonization by Haemophilus influenzae type b in Iranian children

Healthy carriers of Haemophilus influenzae type b [Hib] play an important role in the spread of invasive disease. The aim of this study was to assess the need for Hib vaccination in Iranian children by estimating the prevalence of Hib oropharyngeal colonization among children in Tehran. Cultures were prepared from oropharyngeal swabs of 1000 children in 25 day-care centres in Tehran from October 2005 to March 2006. The prevalence of Hib carriers was 7.6%, similar to other developing countries prior to inoculation with the conjugate Hib vaccine. We recommend Hib vaccination be included in the Iranian national programme of immunization

[Polymerase chain reaction versus conventional laboratory methods in the diagnosis of fungal keratitis]

To compare the value of conventional laboratory methods and polymerase chain reaction [PCR] in the diagnosis of fungal keratitis. This cross sectional study was conducted at Khalili Hospital, Shiraz, Iran. Samples were taken from thirty-eight patients with findings suspicious for fungal keratitis. Corneal scrapings were used for Gram, Giemsa and KOH stains, culture and PCR analysis. Of 38 enrolled eyes, 25 eyes [68.5%] were judged to have fungal infection based on positive cultures, staining, PCR or response to antifungal treatment. PCR detected fungi DNA in 17 of 25 samples [68% sensitivity]. Staining [Gram, Giemsa and KOH] and culture yielded a positive result in 40% and 24% of samples respectively. Twenty one [84%] of 25 patients showed fungal elements in at least one laboratory work up and 4 patients were diagnosed as fungal keratitis only based on response to antifungal drugs. Compared to conventional laboratory methods, PCR based methods offer higher sensitivity and a faster diagnosis in fungal keratitis

[Risk Factors of nasal carriage of methicillin-resistant staphylococcus aureus and its antibiotic susceptibility pattern in Namazi hospital healthcare workers in Shiraz, Iran]

Methicillin-resistant Staphylococcus aureus [MRSA] is a major nosocomial pathogen worldwide. The aim of this study was to determine the risk factors of nasal carriage of MRSA and its antibiotic susceptibility pattern among healthcare workers at Namazi Hospital [Shiraz-Iran]. In a cross-sectional study from July to November 2006, nasal swabs were taken from 600 stratified randomly selected health care workers. The isolates were identified as S. aureus based on morphology, gram stains, catalase test, coauglase test and DNase Agar. To differentiate Methicillinsusceptible S. aureus [MSSA] and Methicillin Resistant S. aureus [MRSA], agar screen plate was used. All methicillin-resistant isolates were examined for mecA genes existence by PCR performance. The sensitivity patterns of S.aureus isolates were determined by disc diffusion and E-test method. Nasal screening identified 186 [31%] S. aureus carriers of whom, 154 ones [82.8%] were MSSA and 32 ones [17.2%] were MRSA. There was no significant association between related risk factors and gender, age, years of healthcare service and level of education. In the univariate analysis, a statistically significant difference was found only based on occupation [P=0.032] between carriers of MSSA and MRSA. In multivariate analysis [logistic regression], having nursing occupation [p=0.012, OR=3.6, 95%CI=1.3-9.7] was independently associated with MRSA carriage. All of the MRSA strains were sensitive to mupirocin. This study revealed that having nursing occupation is independently associated with MRSA carriage since all S.aureus isolates were susceptible to mupirocin, topical mupirocin could be used successfully to eradicate nasal staphylococcal colonization and carriers

Pseudomonas aeruginosa: burn infection, treatment and antibacterial resistance

Pseudomonas aeruginosa is an opportunistic pathogen causing severe, acute and chronic nosocomial infections in immunocompromised, catheterized or burn patients. Various types of virulent factors have been identified in P. aeruginosa, suggesting their contribution to the pathogenesis of the disease. The organism is generally resistant to numerous antimicrobial agents due to natural resistance in particular impermeability or mutations and acquisition of resistant determinants. Plasmid and integron have a crucial role in acquisition of mobile elements. Most treatment failures are related to inappropriate initial antibiotic therapy with insufficient coverage of multidrug resistant [MDR] pathogens, the rationale for using combinations of antibiotics to cover MDR gram-negatives. However, clinical data supporting this strategy are limited. In fact, systematic combination therapy may have contributed to the overuse of antibiotics and to the emergence of MDR microorganisms. Nevertheless, combination therapy is the best strategy to treat severe infections due to suspected MDR Pseudomonas. Optimally, therapeutic strategies should be sufficiently broad to cover relevant pathogens while minimizing the risk for emergence of antimicrobial resistance. Polymyxin E [colistin] and carbapenems are the most effective antibiotics against MDR isolates

Molecular identification and in-vitro susceptibility andida albicans and C. dubliniensis isolated from immunocompromised patients

Yeasts are increasingly implicated in serious systemic infections. The aim of this study was to identify Candida albicans and C. dubliniensis from isolates of immunocompromised patients and evaluate the in vitro antifungal activities of them against antifungal agents. One hundred and seventy eight C. albicans were isolated by routine methods from 403 immunocompromised patients. All isolated C. albicans were inoculated on CHRO Magar Candida medium. The carbohydrate assimilation patterns of all the isolates were studied, using the API 320 system. To identify C. albicans and C. dubliniensis, PCR was done by specific primers. The susceptibility test for the isolates was performed by a broth microdilution assay, according to the Clinical and Laboratory Standard Institute. Of 178 isolates C. albicans, six were C. dubliniensis with PCR assay, and 7% were resistant to amphotericin B, 4.6% to fluconazole, 7% to itraconazole, 1% to nystatin, 2.3% to voriconazole, and 7% to ketoconazole. Non of the C. dubliniensis isolates were resistant to the six anti-fungal agents. It would be convenient to carry out antifungal susceptibility studies in order to establish the in-vitro activities of antifungal agents against local isolates and also to detect shifts toward resistance as early as possible

Helicobacter pylori and extradigestive disorders in the past 10 years

While the association between Helicobacter pylori and other digestive conditions are still under the study, some authors have also investigated an expanding list of the studies on the role of H. pylori as a pathogenic determinant of some extraduodenal idiopathic diseases, such as cardiovascular, immunological, skin, liver, biliary tract, and various other disorders. Although it is still unclear how a localized infection may affect areas distant from the site of infection, it is supposed that H. pylori gastric infection may cause systemic illnesses through immunemediated mechanisms. This idea is based on the following points: [i] local inflammation can have systemic effects; [ii] gastric H. pylori infection is a chronic process that lasts for decades; [iii] persistent infection induces chronic inflammatory and immune responses that can cause lesions that are local or distant from the site of primary infection. In the past 10 years, an increasing number of studies concerning the association between H. pylori infection and extradigestive conditions have been reported. Most of these studies have documented the H. pylori infection by serology and Urease Breath Test [UBT], and rarely by PCR, and no one could isolate any H. pylori microorganism from samples, using culture method. Of course, the culture of this fastidious organism is extremely difficult; if not impossible. In this study, some of the recent papers are reviewed to find new scopes for the role of H. pylori in some kinds of extradigestive diseases

Meningococcal carrier rate before and after hajj pilgrimage: effect of single dose ciprofloxacin on carriage

We determined the carriage rate of Neisseria meningitidis before and after hajj pilgrimage among a group [1] of 674 randomly selected Iranian pilgrims, and the effect of 500 mg of ciprofloxacin given 24 hours before return on the reduction of meningococcal carriers among another group [2] of 123 randomly selected Iranian pilgrims. Throat specimens taken 1 hour before departure on the hajj and immediately on return were cultured. Carriage rates of N. meningitidis in group 1 were 5.2% before and 4.6% after pilgrimage [P = 0.65]; 3 new serogroups [Z, Z' and A] were identified on return. In group 2, the carriage rate decreased from 8.1% to zero before and after pilgrimage

Tick-borne relapsing fever, a neglected cause of fever in Fars province

Tick-borne relapsing fever is an endemic disease in some parts of Iran. Borellia persica, the most common cause of this disease in Iran, has a wide geographic distribution and is present in Alborz and Zagros mountain chains. Here we report a 16-year-old male patient who presented with two episodes of fever within 15 days. He had a history of few overnight stays in a cave of mountainous area in Fars province. Sites of tick bites were found on exposed areas of extremities. Spirochetes were detected in Wright-stained smears of the patient's peripheral blood. He was successfully treated with penicillin. To the best of our knowledge, there has been no reported case of tick-borne relapsing fever from Fars province in the literature during the last 28 years. Tick-borne relapsing fever should be considered in patients with recurrent fever and peripheral blood smear should be investigated for spirochetes. Further seroepidemiologic studies should be carried out to determine the prevalence of this disease in Fars province