ABSTRACT
Objective: To investigate the prevalence of non-tuberculosis mycobacteria (NTM) among the samples deposited from the National Tuberculosis Reference Laboratory of Iran between 2011 and 2018. Methods: The study evaluated the prevalence of NTM among specimens from patients with pulmonary tuberculosis symptoms (n=15 771) deposited at the National Tuberculosis Reference Laboratory of Iran from 2011 to 2018. Detection of Mycobacterium (M.) tuberculosis was based on presence of a 190-bp amplicon from IS6110 insertion sequence using Tb1 and Tb2 primers, and amplicon-negative specimens were tested for NTM and M. tuberculosis (refractory to IS6110 amplification) using restriction fragment length polymorphism PCR of hsp65 amplicon fragment. Results: A total of 7 307 (46.33%) M. tuberculosis and 658 (4.17%) NTM specimens were found, the latter mainly comprising M. abscessus (10.18%), M. avium (2.28%), M. chelonae (8.97%), M. intracellulare (10.49%), M. kansasii (4.71%), and M. simiae (56.08%). Conclusions: As treatment for NTM differs from that for M. tuberculosis, accurate detection of Mycobacterium sp. is of public health significance.
ABSTRACT
Respiratory failure is a serious complication of H1N1 influenza that, if not properly managed, can cause death. When mechanical ventilation is not effective, the only way to save the patient's life is extracorporeal membrane oxygenation [ECMO]. A prolonged type of cardiopulmonary bypass, ECMO is a high-cost management modality compared to other conventional types and its maintenance requires skilled personnel. Such staff usually comprises the members of open-heart surgical teams. Herein, we describe a patient with H1N1 influenza and severe respiratory failure not improved by mechanical ventilation who was admitted to Masih Daneshvari Medical Center in March 2015. She was placed on ECMO, from which she was successfully weaned 9 days later. The patient was discharged from the hospital after 52 days. Follow-up till 11 months after discharge revealed completely active life with no problem. There should be a close collaboration among infectious disease specialists, cardiac anesthetists, cardiac surgeons, and intensivists for the correct timing of ECMO placement, subsequent weaning, and care of the patient. This team work was the key to our success story. This is the first patient to survive H1N1 with the use of ECMO in Iran
ABSTRACT
Background: Lung abscess is a rare and jeopardizing disease particularly in children. Early diagnosis of the disease can prevent further complications. Delay in diagnosis not only increases the mortality, but also can lead to severe complications along with the need for surgical intervention. Hence, we decided to evaluate the clinical and para-clinical features of our cases to estimate the magnitude of the problem
Materials and Methods: Data was obtained based on a retrospective study from 1992 to 2004, during a 12-year period in our centre. All the children who were admitted in NRITLD with lung abscess were enrolled in the study. Data was collected and analysed considering their age, gender, underlying disease, and aspiration history
Results: A total of 17 children were identified including 12 boys and 5 girls. 12[70%] children were under 10 years of age. Nine had a history of interstitial lung disease while 12 children had history of aspiration. The most common complaints were cough [94%], fever [82%], and sputum [82%]. Leukocytosis was observed in 76.5% of the cases while 70% showed shift to the left in their blood analysis. 60% of the cases were diagnosed only by CT-scan without any other evaluation. Gram positive organisms [Streptococcus pneumonia 11.6% and Staphylococcus aureus 5.8%] were the most prevalent organisms involved in our cases
Conclusion: According to this study, lung abscess is more prevalent in boys. The most common symptoms are cough, fever, and sputum. Furthermore, we suggest CT scan for diagnosing the disease because of its valuable role in detecting lung abscess in early stages
ABSTRACT
Background: HIV is the most common risk factor for reactivation of latent TB and is associated with increased rate of progression of infection to disease. Radiological presentation of TB is variable in both HIV [-] and HIV [+] patients but is more in the latter. In this study we describe and analyze radiological presentation of TB/HIV patients in Massih Daneshvari hospital in IRAN
Materials and Methods: We registered the demographic, clinical and laboratory information of TB/HIV patients in Massih Daneshvari hospital between 2002-2003. Inclusion criteria were standard serologic test for HIV [Two positive Elisa test and one positive westernblot test] and proof of TB with clinical and mycobacteriologic or pathologic criteria. Chest x-ray was reported by pulmonary imaging specialist and was divided to two category: Typical [fibrocavitary infiltration in posteroapical segment of upper lobes] and atypical [opacity in middle and lower lobe, hilar and mediastinal adenopathy, pleural effusion, diffuse nodular opacity and normal X-ray]. Findings were analyzed using SPSS version 10.5
Results: 15 patients, 13 men [86.7%] and 2 women were included. Mean [ +/- SD] of CD4 count was 229.15 +/- 199.45. 53.3% of patients had adenopathy, 26.7% had pleural effusion. Only one patient had cavitary disease. Radiographic pattern was typical in one [6.7%] and atypical in 93.3% of patients. In regard to severity of radiological presentation, mild; moderate and severe pattern was seen in 40%, 26.7% and 33.3% respectively. There was no correlation between severity of radiological presentation and death [p=0.8] and severity of radiological presentation and CD4 count [p=0.53]
Conclusion: In this study, it was shown that in spite of some other studies, radiological presentation had not direct correlation with CD4 count; thus, in HIV+ patient, we must consider TB in all atypical radiological presentation regardless of CD4 count
ABSTRACT
Background: Increased rates of multidrug-resistant tuberculosis [MDR-TB] have been reported from developing countries. We evaluated the incidence of drug resistance in children in order to determine the magnitude of the problem, in our region
Objective: To determine the resistance pattern of Mycobacterium tuberculosis to four anti-tuberculosis drugs in childhood pulmonary tuberculosis at National Research Institute of Tuberculosis and Lung Disease [NRITLD] which is a referral centre in Tehran. Treatment of the patients was based on the DOTS strategy according to the WHO protocols since 1989
Materials and Methods: Retrospective analysis of all cases of pulmonary tuberculosis with positive M. tuberculosis culture who had referred to paediatrics ward from January 1999 to August 2004. M. tuberculosis sensitivity testing was performed by the Lowenstein-Jensen medium for isoniazid [INH], rifampicin [RMP], streptomycin [SM], and ethambutol [EMB]
Results: Among 350 children [0-15years] with confirmed tuberculosis, 7 children had resistance to at least one of the four anti-TB drugs. Out of the 7 patients, 6 were Afghan refugees and one patient was Iranian. Among those 85.7% had resistance to RMP, 71.4% to INH, 57.1% to SM, and 28.6% to EMB .In addition, 28.5% of patients had resistance to all four drugs [RMP, INH, SM, EMB], 14.2% to INH, RMP, SM, 28.5% to INH, RMP and 14.2% had resistance to each of SM and RMP. In this study 2% of children with TB had resistance out of which primary resistance was detected in 57.1%. Secondary resistance was found in 42.9% of cases who had previous history of anti-TB therapy
Conclusion: According to 2% prevalence of drug resistance in children and high resistance to RMP in our study, more aggressive interventions should be considered. Further management and supervision in DOTS implementation is highly recommended to prevent transmission of resistant tuberculosis