High prevalence of HCV coinfection in HIV-infected individuals in Shiraz, Islamic Republic of Iran

We carried out a cross-sectional survey in Shiraz to determine the prevalence of hepatitis C virus [HCV] in 1 444 individuals infected with human immunodeficiency virus [HIV]. We also determined the risk factors for this coinfection. Demographic and behavioural data were obtained using a standard questionnaire. The prevalence of HIV–HCV coinfection was 78.4% [95% CI: 76.3–80.5]. Intravenous drug use [OR = 7.2; 95% CI: 4.9–10.6], imprisonment [OR = 6.9; 95% CI: 4.6–10.4], tattooing in prison [OR = 2.61; 95% CI: 1.4–4.8], tattooing out of prison [OR = 2.0; 95% CI: 1.3–3.1] and age [OR = 1.02 with increasing each year of life; 95% CI: 1.0–1.04] were significantly associated with HCV–HIV coinfection. Prevalence of HCV–HIV coinfection is high in Shiraz. Intravenous drug use and imprisonment are the main risk factors for this coinfection. Therefore, serious implementation of HIV and HCV testing, education, prevention, care and treatment programmes and evaluation of harm reduction programmes in prisons are very important.

Evaluation of prophylactic antibiotic administration at the surgical ward of a major referral hospital, Islamic Republic of Iran

We evaluated the appropriateness of antibiotic prophylaxis administered before surgery at a major referral hospital in Shiraz, against the American Society of Hospital Pharmacists [ASHP] guidelines. Data on surgical procedure, choice of antibiotic and administration were gathered for all surgeries performed on hospitalized patients during 15 days in March 2010, Of 155 patients included in the analysis, 98% received prophylactic antibiotic before surgery; according to ASHP guidelines, prophylaxis was needed in only 106 [68.4%]. Of these 106, only 8 patients received the correct antibiotic regimen. The commonest regimens administered were cefazolin + gentamicin [47.6%], cefazolin [20.5%] and cefuroxime [8.5%]. Antibiotic prophylaxis was continued in 83% of cases, while this was necessary in only 37%. In only 1 surgical procedure were all evaluated parameters correct

Seroprevalence of hepatitis C virus in the families of the patients with hepatitis C infection in Shahre-Kord, Iran

Chronic hepatitis C is a major health concern around the world. Although transmission of hepatitis C virus [HCV] infection through parenteral exposure is well documented, sexual transmission of HCV is still debated. Therefore, we evaluated the prevalence of HCV infection within the families of the patients infected with HCV in a central city of Iran, Shahre-kord. We examined eighty patients with chronic HCV-associated liver disease and their 230 first degree families in a cross-sectional descriptive serological study. Their serum samples were tested for anti-HCV antibody, using ELISA and Immunobloting. A questionnaire including risk factors for HCV infection specially drugs addiction, sexual behaviors, and duration of partnership was filled in by the cases. About 2.17% of the household contacts were seropositive. Of them, 8.7% spouses and 20% sisters had anti-HCV antibody. The risk of HCV transmission between monogamous sex partners is higher than that of in other family members, depending on the duration of exposure especially sexual exposure. Infection rate in other family members of HCV-infected persons and community members is the same

Association between PPD and quanti FERON gold TB test in TB infection and disease among HIV-individuals in southern Iran

Tuberculosis is one of the most common diseases among HIV-infected patients. A person with a positive tuberculin skin test [TST] acquiring HIV infection has a 3-13% annual risk of developing active tuberculosis. The diagnosis of TB in HIV infected patients may be difficult. QuantiFERON-TB Gold [QFT-G] test is a novel method as an aid for diagnosis of Mycobacterium tuberculosis infection. We evaluated the association between TST and QFT-G test in latent TB infection [LTBI] and TB in HIV-infected patients. One hundred and seventy six HIV-infected subjects from Shiraz Consultation and Behavioral Modification Center [SCBMC] entered our study. The individuals were screened for TST, using 5TU purified protein derivative [PPD]. Also, blood sample was provided for QFT, measuring INF-gamma response to M. tuberculosis antigen. Of 176 participants, 98.3% returned for evaluation of TST results. Among them, 63% and 37% were negative and positive for TST, respectively. All the participants returned for QFT-G sampling. Of them, 64.8% and 27.8% were respectively negative and positive for the test and 7.4% showed undetermined results. The agreement between PPD and QFT-G in their negative results was 39.9% and 8.1% in their positive results and the overall agreement was 50%. Disagreement of TST-/QFT[+] was noticed in 19.7% of the subjects and TST[+]/QFT- disagreement in 24.9%. CD4[+] count <100 mm[3] was seen in 5.9%, >/= 100 and < 200 mm[3] in 17.1% and CD4[+] T cell count >/= 200 mm[3] in 76.9% of subjects. As the agreement rate between QFT-G and TST in HIV-infected patients was fair, a strategy of simultaneous TST and QFT-G testing would maximize the potential for LTBI diagnosis in HIV-infected subjects

prevalence of M. tuberculosis infection and disease in HIV positive individuals in Shiraz, Southern Iran

The emergence of HIV infection and its close association with TB poses an even greater challenge to the health systems and when co-infection is present, it is the most potent risk factor for progression of the disease to an active TB. This study was performed to determine the HIV-seropositive individuals with Mycobacterial infection referring to Center for Counseling and Behavioral Modification in Shiraz, southern Iran. From January 2004 to December 2006, 459 HIV-positive individuals who referred to Center for Counseling and Behavioral Modification in Shiraz, Southern Iran were enrolled. HIV antibody tests included ELISA and western blot tests, and the tests used for M. tuberculosis infection were PPD skin test, chest x-ray, Ziehl-Neelsen technique, culture in Lowenstein-Jensen medium and pathological examination. 28.5% of HIV-positive individuals had a positive PPD skin test, among whom 89.3% showed a latent tuberculosis infection and 10.7% active tuberculosis. 7.9% of HIV positive patients had active tuberculosis including pulmonary [75.8%] and extrapulmonary types [24.2%]. Among the latter cases, 62.5% had TB lymphadenitis, 25% pericarditis and 12.5% TB pleuritis. 40% of those with pulmonary tuberculosis and 50% with exptrapulmonary TB had a positive PPD skin test. As tuberculosis is a common opportunistic infection in HIV-positive patients in Iran with a higher prevalence of extrapulmonary type and the complex clinical presentation of disease, HIV-positive patients should be regularly screened for tuberculosis. Early recognition of latent tuberculosis infection and adequate chemoprophylaxis seem to be essential too

prevalence of Pediculus capitis among school children in Fars province, southern Iran

Pediculus capitis or head louse infestation affects millions of children worldwide, especially those in the 5-11 years age group. This study aimed to determine the prevalence of head pediculosis among school children in urban and rural areas of Fars Province, southern Iran. All school children of age 6-11 yr from both genders in all urban and rural areas of the province were screened for head louse infestation by examination of their hair and scalps. Parents of all infested children were also examined. The study was repeated in different seasons in the same areas. Moreover, infested children were treated with 5% permethrin shampoo and re-examined one week later for any relapse. The general prevalence of head louse infestation in primary school students was 0.49% in autumn, 0.37% in winter and 0.20% in spring. In the mentioned seasons, the prevalence of P. capitis was higher among females and in rural areas [P=0.001]. Although treatment with permethrin shampoo failed in females, it was successful in all infected males from both regions in autumn and spring and in males from urban areas in winter. Head louse infestation is uncommon among Fars Province school children in rural and urban areas and should not be considered a public health priority. However, due to the higher prevalence of pediculosis in low socioeconomic group and rural area in our region, it seems that health promotion, particularly early detection and effective management strategies should target this group in the province

12-years surveillance of poliomyelitis and acute flaccid paralysis in Fars Province, Southern Iran

Following the widespread use of poliovirus vaccine in the mid-1950s, the incidence of poliomyelitis declined rapidly in many industrialized countries. The aim of this study was to determine the surveillance of poliomyelitis and acute flaccid paralysis [AFP] in Fars Province, southern Iran to detect poliovirus wherever it may circulate. From 1995 to 2006, in a cross-sectional study, all patients over 15 years of age with flaccid paralysis in Fars Province of Iran were enrolled. The surveillance medical officers visited every AFP case, took clinical histories, and performed clinical examinations. Two stool samples were collected from each reported case within 14 days of the onset of paralysis and sent to WHO-accredited laboratories for poliovirus isolation and intra-typic differentiation. AFP cases from which stool sample of wild poliovirus was isolated were classified as confirmed poliomyelitis. Those AFP cases whose cultures for poliovirus were negative were referred to an expert panel. Whenever possible, nerve conduction velocity tests, electromyography, and other diagnostic modalities such as brain and vertebral MRI were performed along with a detailed neurological examination at least three weeks after the onset of paralysis. The non-polio AFP rate was 227 [mean: 18.91 per year]. Only one case of poliomyelitis was reported in the first year of surveillance. Other 226 cases had non-polio AFP. The most common cause of paralysis among these patients was Guillain-Barre syndrome [66%]. The non-polio AFP rate is almost in agreement with the estimated incidence of AFP in the population aged 0-15 years worldwide. Routine coverage with three doses of OPV with supplementary immunization activities has reportedly reached over 95% of all target children. The existing system must be closely monitored and actively supported to maintain and constantly improve performance

Toxoplasmosis in HIV/AIDS patients in Shiraz, southern Iran

Toxoplasma gondii is an intracellular protozoan parasite, and causes zoonotic infection. Human latent toxoplasmosis occurs in about half the world's population though most cases are asymptomatic. Toxoplasma encephalitis [TE] has become one of the more frequent opportunistic infection in HIV infected patients. This retrospective and descriptive study was carried out at the Referral Behavioral Counseling and Modification Center in Shiraz, Iran. We were able to review the medical records of 208 HIV infected patients. They were examined and their records were screened via the standardized data collection sheet for demographic characteristics. Diagnoses of TE based on the presence of at least two of the following findings: a history of neurological symptoms, neurological signs, suggestive CT, clinical and radiological response to antitoxoplasmosis medication. The seroprevalence of toxoplasmosis among 208 HIV/AIDS patients was [18.2%] [38 patients] while 4 [10.4%] and 34 [89.6%] subjects showed Toxoplasma seropositivity with and without TE respectively. The majority of these patients were in the 25-34 age group, male, unemployed, single and residence in Shiraz, southern Iran. Toxoplasmosis is a silent disease, which poses many diagnostic and therapeutic challenges. Based on findings of this study, we support a screening program of Toxoplasma infection. Primary chemoprophylaxis should be routinely given to all HIV infected with Toxoplasma seropositive status. Also HIV infected individuals with Toxoplasma seronegative status may be advised about preventive behavioral practice

Should we consider another booster dose of measles vaccine?

To date, 36 years has passed since the beginning of measles vaccination; the disease is still circulating around the world, threatening lives of human beings especially in developing countries. In recent years, we have confronted measles in previously vaccinated adults from all over the country. To find out if there is a need for changing our routine measles vaccination schedule. In a cross-sectional study, 241 medical students [127 males and 114 females] were randomly selected. We measured the titer of antibody against measles in their blood using ELISA. Ninety-eight [40.7%] out of 241 had positive, 39 [16.2%] borderline, and 104 [43.1%] negative antibody titers. In this study, only 40.7% of the previously vaccinated students had positive antibody titers, while the rest remained susceptible to contract wild measles virus