Efficacy of plasmapheresis in neutropenic patients suffering from cytokine storm because of severe COVID-19 infection

Background@#With the emergence of the coronavirus disease 2019 (COVID-19) and inability of healthcare systems to control the disease, various therapeutic theories with controversial responses have been proposed. Plasmapheresis was administered as a medication.However, the knowledge of its efficacy and indications is inadequate. This study evaluated the use of plasmapheresis in critically ill patients with cancer. @*Methods@#This randomized clinical trial was conducted on 86 patients with malignancies, including a control group (N=41) and an intervention group (N=45) with severe COVID-19 during 2020-21. Both groups were treated with routine medications for COVID-19 management according to national guidelines, and plasmapheresis was applied to the intervention group. C-reactive protein (CRP), D-dimer, ferritin, lactate dehydrogenase, hemoglobin, and white blood cell, polymorphonuclear, lymphocyte, and platelet levels were measured at admission and at the end of plasmapheresis. Other variables included neutrophil recovery, intensive care unit admission, intubation requirements, length of hospital stay, and hospitalization outcomes. @*Results@#CRP (P ＜0.001), D-dimer (P ＜0.001), ferritin (P =0.039), and hemoglobin (P =0.006) levels were significantly different between the groups after the intervention. Neutrophil recovery was remarkably higher in the case than in the control group (P ＜0.001). However, plasmapheresis did not affect the length of hospital stay (P =0.076), which could have significantly increased survival rates (P ＜0.001). @*Conclusion@#Based on the study findings, plasmapheresis led to a significant improvement in laboratory markers and survival rate in patients with severe COVID-19. These findings reinforce the value of plasmapheresis in cancer patients as a critical population suffering from neutropenia and insufficient immune responses.

Antibacterial resistance patterns of Acinetobacter baumannii complex: The results of Isfahan Antimicrobial Resistance Surveillance-1 Program

Objective: To determine the antibiotic resistance patterns of the Acinetobacter (A.) baumannii complex isolates that cause the confirmed infection. Methods: The present descriptive study was performed from March 2016 to March 2018 in three referral hospitals in Isfahan, Iran. All A. baumannii complex strains isolated from different clinical samples were identified by conventional phenotypic methods and antibiotic susceptibility pattern was detected. After the clinical investigation, contaminated samples were excluded and the source (hospital/community) and site of the infection were determined. Data on antibiotic susceptibility testing were extracted from WHONET software and analysis was done with SPSS. Results: From 254 patients who had confirmed A. baumannii complex infection, 158 (62.20%) cases were male, 27 (10.63%) were less than 20 years old, 172 (67.72%) had healthcare-Associated infections and 96 (37.79%) were admitted in intensive care units. The most frequent infection was bloodstream infections (111, 43.70%). Our results showed that most of the isolates were resistant to most of the antibiotics (more than 75.00%) and a lower rate of non-susceptibility was observed against minocycline (20, 44.44%) and colistin (0%). The rate of multidrug-resistant isolates was 88.97%. There was no significant difference between resistance of A. baumannii complex isolates according to age. However, the resistance to amikacin and minocycline and the rate of multidrug resistance (MDR) were significantly different between males and females. In patients with healthcare associated infection (HAI), MDR isolates were significantly different regarding admission in ICU ward. Resistance to levofloxacin and ciprofloxacin were lower in isolates from patients with bloodstream infections in comparison to other diagnoses. Conclusions: In our study, a high level of antibiotic resistance was detected in both community-Acquired and healthcare-Associated A. baumannii complex infections. Appropriate antibiotic prescription in a clinical setting is an essential need for the control and prevention of A. baumannii resistant infections.

CD107a expression and IFN-gamma production as markers for evaluation of cytotoxic CD3+ CD8+ T cell response to CMV antigen in women with recurrent spontaneous abortion

Some evidence has shown a relationship between primary human cytomegalovirus [CMV] infection and pregnancy loss. The impact of CMV infection reactivation during pregnancy on adverse pregnancy outcomes is not completely understood. It is proposed that altered immune response, and therefore, recurrence or reactivation of latent CMV infection may relate to recurrent spontaneous abortion [RSA]; however, few data are available in this regard. To find out about any cell mediated defect and reactivation of latent CMV infection in women with RPL, cellular immunity to the virus has been evaluated by specific cytotoxic T lymphocyte [CTL] response to CMV. In a case control study, CTL CD107a expression and intercellular IFN-gamma production in response to CMV pp65 antigen and staphylococcus enterotoxin B [SEB] in women with RSA were assessed by flow cytometric analysis. Forty-four cases with history of recurrent pregnancy and forty-four controls with history of successful pregnancies were included. The FACSCaliber flow cytometer were used for analysis. No significant difference was observed between CD107a expression and IFN-gamma production in response to CMV PP65 antigen in RPL patients and control group. However, the cytotoxic response to SEB antigen in patients with RPL was significantly lower than control group [p=0.042]. The results of this study show that impaired CD107a expression and IFN-gamma production as CTL response to CMV does not appear to be a major contributing and immune incompetence factor in patients with RPL, but cytotoxic T cell response defect to other antigens requires to be assessed further in these patients

Efficacy of double dose recombinant hepatitis b vaccination in chronic hepatitis c patients, compared to standard dose vaccination

Hepatitis B virus [HBV] vaccination is a well-known, safe and effective way for protection against HBV infection; however, non-responders remain susceptible to infection with HBV. This is so important in patients with any kind of chronic liver disease, especially chronic hepatitis C virus [HCV] patients in whom acute HBV infection may lead to decompensation of liver disease. Some of the studies have shown that immunogenicity of HBV vaccination is decreased in these patients. The aim of this study was to evaluate the efficacy and safety of double dose vaccination of HBV in these patients, compared with standard dose vaccination in similar patients and healthy adults. A total of64 patients with chronic HCV infection were randomized into 2 groups of 32. Group A received standard dose HBV vaccine, at 0, 1, 6 months, whereas group B received double dose HBV vaccine. Group C consisted of 32 healthy adults who also received standard dose vaccination. At 1 month after the end of vaccination, Hepatitis B surface antibody [HBsAb] titer was checked in all participants and the results were compared. There was no significant difference in age or sex among three groups. The response rate in groups B and C was 100% [all had HBsAb titer >10 mIU/mL], while in group A, 4 patients [12.5%] were non-responders [HBsAb titer < 10 mIU/mL]. The difference in response rate was statistically significant between Group A and the other two groups [P< 0.05]. The efficacy of standard dose HBV vaccination in patients with chronic HCV infection was suboptimal. Using double dose vaccination in these patients was an effective way to increase the antibody response

Immunoglobulin a nephropathy and malaria falciparum infection; a rare association

Glomerular involvement occurs as a rare form of renal manifestation in Plasmodium falciparum malaria. Here, we report a rare case of falciparum malaria-associated IgA nephropathy. A 28-year-old man was admitted because of fever and abdominal pain. Ultrasound and computed tomography [CT] showed right kidney pyonenphrosis. Despite placing a nephrostomy tube, fever continued. Repeated CT was in favor of focal pyelonephritis. In addition, peripheral blood smear suggested malaria. Anti-malarial drugs were initiated and right nephrectomy was performed. One year after recovery from malaria, a persistent rise in serum creatinine was detected. A left kidney biopsy showed mesangial proliferation and dominant IgA deposits in immunofluorescence study while C[1q] was not deposited. The impression was IgA nephropathy with M[1]E[0]S[0]T[0] of Oxford classification. The patient was prescribed a combination of low dose prednisolone and angiotensin converting enzyme inhibitor. Six months after treatment serum creatinine decreased from 1.6 mg/dL to 1.3mg/dL and urine abnormalities were disappeared. Our findings suggest that malaria infection might be associated with IgA nephropathy

Hepatitis D virus infection in Isfahan, central Iran: prevalence and risk factors among chronic HBV infection cases

Hepatitis D virus [HDV] is dependent on hepatitis B virus [HBV] infection. Acute infection with HDV can occur simultaneously with acute HBV infection of be superimposed onto a chronic HBV infection. This study aimed to identify cases of HCV and determine its prevalence in patients with chronic HBV infection for the first time study in Isfahan, central Iran. In a cross-sectional study in 2009, 346 who had been diagnosed for at least 6 months with chronic HBV were enrolled consecutively. Anti-HDV was measured by ELISA in the serum of these patients. The study included 245 males [70.8%] and 101 [29.2%] females with a mean age of 39 +/- 12.4 years. Anti-HDV was present in 8 [3.5%] HBe antibody-positive patients [p= 0.36] and in 2 [2.3%] HBe antigen-positive cases [p = 0.68]. No association was found between hepatitis D and probable risk factors. This study demonstrates that the prevalence of HDV infection is higher in patients who are positive for HBeAb compared those who are HBeAg-positive. Therefore, most HDV antibody-positive cases in Isfahan are HBV/HDV superinfections but not coinfections

Hepatitis B virus surface antigen variants clustered within immune epitopes in chronic hepatitis B carriers from hormozgan province, south of Iran

The aim of this study was to characterize the hepatitis B virus surface protein genotypes and sequence variations among hepatitis B virus surface antigen [HBsAg] positive chronic patients in Hormozgan province, south of Iran. A total of 8 patients enrolled in this study. The surface gene was amplified and directly sequenced. Genotypes and nucleotide/ amino acid substitutions were identified compared to the sequences obtained from the database. All strains belonged to genotype D. Overall 77 "mutations" occurred at 45 nucleotide positions, of them, 44 [57.14%] were silent [no amino acid altering] and 33 [42.86%] were missense [amino acid changing]. A number of 24 [80%] out of 30 amino acid changes occurred in different epitopes within surface protein, of which, 9 [30%] in B cell epitopes in 7 residues [2 occurred in "a" determinant region]; 8 [42.1%] in T helper epitopes in 7 residues and 7 [10%] in 4 residues inside CTL epitopes. Hepatitis B virus genome containing mutated immune epitopes no longer could be recognized by specific T-cells of the host immune surveillance and did not enhance anti-HBs production. This could led to the progression of chronicity B virus infection

Central nervous system aspergillosis in an immunocompetent patient

A 12-year-old girl was admitted to the Emergency Department with seizures and headache for 2 months. A CT scan and MRI showed a mass in the right frontal lobe with obvious mass effect. Surgery was carried out, and the resultant pathology was found to be aspergillosis. This study reports aspergillosis in an immunocompetent host following recurrent fungal otitis media. Although this condition is rare, it should be considered in patients with a history of fungal infections

Molecular identification and conventional susceptibility testing of iranian clinical mycobacterium fortuitum isolates

Rapidly growing mycobacteria [RGM] are capable of producing diseases in humans. Since mycobacteria vary in their susceptibility, precise identification is critical for adoption of correct drug therapy. The main aim of this study was molecular identification and evaluation of antimicrobial susceptibility pattern of Iranian clinically isolated Myocbacterium fortuitum. A total of 72 presumptively identified isolates of clinical atypical mycobacteria collected by Isfahan Research Center for Infectious Diseases and Tropical Medicine during 2006-2008 were included in the current study. A combination of conventional and molecular tests was applied to identify the isolates. Molecular methods including genus and group specific PCR and PCR-Restriction Algorithm [PRA] based on hsp65 gene were applied to achieve exact identification of mycobacterial strains. Antimicrobial susceptibility testing on M. fortidtum isolates was performed by in-house prepared broth microdilution test. Out of 72 collected atypical mycobacteria isolates, we identified 25 strains of M. fortuitum. All strains had the specific molecular markers of mycobacterial identity and similar species specific PRA pattern of the international type strain of M fortuitum. Drug susceptibility testing showed that the M. fortidtum isolates are sensitive to amikacin, sulfamethoxazole and ciprofloxacin [100%], imipenem [92%], clarithromycin [76%], cefoxitin [56%] and doxycycline [16%]. Molecular identification of atypical mycobacteria based on PRA is a reliable and rapid approach which can identify mycobacterial strains to the species level. Our study showed that M. fortuitum plays a significant role in pulmonary and extrapulmonary infection in patients and should be given proper considerations when clinical samples are processed

[Efficacy of integration methods in the control of cutaneous Leishmaniasis in Imamzadeh Agha Ali Abbas in Natanz in Isfahan in 1996-98]

Background: Humans, rodents and sandflies have role in transmitted cycle of cutaneous leishmaniasis. To control the disease, promoting the environment, killing the rodent and poisoning the vectors are recommended, individually all over the world. Since, there is no effective vaccine against this disease, the integration of methods is considerable

Objective: To evaluate the efficacy of integration method in the control of cutaneous leishmaniasis

Patients and Methods: This study was an interventional study, which after knowing the ecosystem around the Imamzadeh Agha Ali Abbas in Natanz in Isfahan, perform the plat covering within a radius of 100m, entrances correction, pool and garbage storage removal and sweepings for the rodents within a radius of 2kms around the Imamzadeh and poisoning the vectors have been done

Results: The incidence of disease was 3.7% in 1996 [Before intervention], which was decreased to 1/17 in 1996 and to 1/12 a year later

Conclusion: Integration method consisting of environment improvement, rodents removal and poisoning as well as training high risk people is recommended to control cutaneous leishmaniasis

Prevalence of vancomycin resistant enterococci colonization in gastrointestinal tract of hospitalized patients

Vancomycin-resistant Enterococci [VRE] are the most common nosocomial pathogen worldwide. Colonization with VRE can lead to serious infection, some of which e.g. VRE sepsis can be fatal. Because VRE are dangerous important pathogens, we aimed to determine the prevalence of VRE among patients admitted in infectious, ICU and surgery wards in a referral teaching hospital in Isfahan, Iran. A total of 100 patients from infectious, ICU and surgery [post- operative patients] wards were selected by simple sampling method. Stool specimens were taken from the patients and cultured in VRE selective media [bile- esculin agar plate with 6 micro g/ml of vancomycin] and gram positive cocci from black colonies were inoculated to the tryptase soya broth plus 6.5% NaCl and again gram positive cocci were inoculated to bile-esculin and finally MIC [minimal inhibitory concentration] evaluated by E-Test for detection of VRE. Totally 58 out of 100 patients had positive cultures for enterococci. Among them 16 out of 58 were female [27.6%] and 42 [72.4%] were male. Of 58 positive cultures, 17 [29.3%] were highly resistant to vancomycin. There was significant relation between previous antibiotic therapy especially vancomycin and VRE in this study [P=0.02]. Most of the patients [74.1%] with negative cultures for Enterococci had GI surgery. Most of culture positive patients [46%] were from infectious ward. There was no significant relation between VRE and sex, GI surgery and admission ward in this study. Results of this study suggest that previous antibiotic therapy especially vancomycin and B-lactam is a major risk factor for colonization with VRE. Prevalence of VRE in our study was high. This problem is very important in epidemiology of hospital infections. Considering the feet that there is no substitute agent for vancomycin in our country, it is necessary to determine guidelines regarding treatment with antibiotics specially vancomycin

Seroepidemiology of Crimean-Congo hemorrhagic fever in the local and imported sheep in Isfahan province, Iran, 2002

Crimean-Congo hemorrhagic fever [CCHF] is an arboviral zoonotic infection with several reported cases in Iran. The present study was conducted with the aim of establishing effective ways to reduce exposure to the infectious agent and to organize appropriate policies for importing animals. Materials and methods: For this cross sectional study, 372 local and 372 imported sheep were randomly selected and the presence of CCHF-related 1gG antibody and tick on their body were investigated. Totally, 286 [76.9%] of local and 223 [57.8%] of imported sheep were seropositive, however, their difference did not reach a statistical significant level. Ticks were found on the body surface of 115 [31%] local sheep, but imported sheep lacked any tick on their body. Our results revealed the endemic spreading of CCHF in sheep in Isfahan province. Further studies in other parts of Iran may pave the way for better understanding of the CCHF epidemiology in Iran. Keywords: Crimean-Congo hemorrhagic fever, sheep, Iran