Close contact precautions could prevent an outbreak of Crimean-Congo hemorrhagic fever: a case series report from southern part of Tehran

Between the end of June and the middle of July 2011, an outbreak of CCHF occurred in southern part of Tehran, Iran. This study reports clinical, laboratory findings and outcome of six cases, who were all consanguine. Index case who was livestock-worker died with hemorrhagic manifestations; thereafter his pregnant wife, three brothers, mother-in-law and his pregnant sister-in-law were admitted and except for the latter, ribavirin was administered. The brother with close contact with body fluids and blood of index case, died with hemorrhage. Low platelet, high aminotransferases and elevated PT, PTT were detected in this case. Skin manifestations were present in five cases. Only in one case RT-PCR and IgM serology were reported as positive for CCHF virus by reference laboratory. In endemic areas, high index of suspicion should be kept in mind in successfully finding and treating cases in early phase of the disease

First Iranian imported case of dengue

Dengue fever, a mosquito-borne flavivirus infection, is endemic in Southeast Asia. Currently, incidences have been increasing among adults. There have been no published reports of dengue fever from Iran. Widespread connection between different countries may predispose them for acquisition of infection. The patient was a 58-year-old Iranian woman with acute unexplained high-grade fever for 4 days, associated with skin rash, after returning from Southeast Asia. CBC showed WBC = 1600/mm[3] and platelet count 99,000/mm[3]. The patient also had hematuria. ELISA immunoglobulin M [IgM] antibodies to dengue and serum RT-PCR for dengue virus was positive. The patient managed with conservative treatment and due to good general condition and improvement specific antiviral treatment was not started. She became afebrile at the 3[rd] day of hospitalization and discharged with good general condition on fourth day. She was afebrile after two weeks follow-up. Dengue fever has been increasing among adults. It should be suspected, when a patient presents with acute febrile illness and skin rashes returning from endemic region. Conservative treatment may be conducted in uncomplicated cases

[Crimean -Congo Hemorrhagic Fever]

Crimean-Congo Hemorrhagic Fever [CCHF] is an acute viral hemorrhagic disease which is transmitted to humans by the bite of the Hyalomma tick or by direct contact with blood of an infected animal or human. CCHF was first recognized in the Crimean peninsula in the mid-1940s, and the same virus was isolated from a patient in Democratic Republic of Congo, in 1956. Person-to-person transmission of CCHF virus occurs through direct exposure to blood or other secretions; in addition, nosocomial transmission is well-documented with case fatality rates ranging from 30 70%. Tick bite is one of the most important risk factors for CCHF acquisition and Hyalomma tick is its main reservoir in the nature, but many domestic animals including cattle, sheep, goats, hare, buffalo, and even ostrich can be infected by this virus. Disease in animals is subclinical and they are infected only for one week. During the viremia phase, direct exposure to blood or other secretions can infect human. Hyalomma ticks favor dry climates and arid-type vegetation, and are abundant in European countries bordering the Mediterranean Sea; numerous animals may act as CCHF virus hosts. In recent years, a number of cases have been reported from Africa, Eastern Europe and Asia. Healthcare workers are also at risk of infection through unprotected contact with infected blood and other body fluids. Incubation phase is about 3 to 4 days after tick bite and 3-14 days when the patient is exposed to infected blood and other body fluids. Typical CCHF progresses rapidly with high fever, malaise, severe headache, myalgia, and gastrointestinal symptoms like abdominal pain and nausea. CCHF is confirmed either by detection of specific immunoglobulin M antibodies or a four-fold increase of immunoglobulin G titers using enzyme-linked immunoassays, indirect immunofluorescent assays, or through RT-PCR. Supportive therapy is an essential part of the case management. Intensive monitoring of fluid volume and blood component replacement is recommended. Oral ribavirin is the therapy of choice in the clinical practice. If the patient meets the criteria for probable CCHF, treatment with ribavirin protocol needs to be started immediately. Interferon and Immunoglobulin have significant antiviral activity in vitro against CCHF. Recently, we face many cases of CCHF in several provinces of Iran. The aim of this article is to review clinical manifestations, treatment and prevention of this disease

Crimean-Congo hemorrhagic fever following consumption of uncooked liver: case series study

We have described four patients with Crimean- Congo hemorrhagic fever which acquired the illness following consumption of uncooked sheep liver. Three patients admitted to hospital nearly 36 hours after eating the liver with acute fever and with quick treatment they respond to therapy. Unfortunately, one patient who was referred late to hospital and treatment was after 5 days of the beginning of the first sign, died. Here in, we described four patients who consumed uncooked liver together in a party and apparently there were no other routes for transmission. Three of them were members of a family [one sister and two brothers] and the fourth was their friend who invited to their party

Performance of QuantiFERON-TB Gold test compared to tuberculin skin test in detecting talent tuberculosis infection in HUV-positive individuals in IRAN

There is limited data about the performance of QuantiFERON-TB Gold [QFT-G] test in detecting latent tuberculosis infection [LTBI] in our region. We intended to determine the performance of QFT-G compared to conventional tuberculin skin test [TST] in detecting LTBI in HIV-positive individuals in Iran. This study was conducted in a HIV clinic in Tehran, Iran in April 2007. A total of 50 consecutive HIV-positive patients, not currently affected with active tuberculosis [TB], were recruited; 43 [86%] were male. The mean age was 38 +/- 7.2 years [21-53]. All had history of Bacillus Calmetta Guerin [BCG] vaccination. A TST with purified protein derivative [PPD] and whole-blood interferon-gamma release assay [IGRA] in reaction, to ESAT-6 and CFP-10 antigens was performed and measured by enzyme-linked immune-sorbent assay [ELISA]. The agreement between TST and QFT=G results were analyzed using Kappa test. A total of 36 [72%] patients had negative TST. For QFT-G, 20 [40%] tested positive, 19 [38%] tested negative, and the results in 11 cases [22%] were indeterminate. A total of 14 [28%] patients had a CD4 count of < 200 .Of the 14, TST + group, 12 had QFT-G +, only one case TST +/QFT-G-, and QFT-G was indeterminate in one TST positive case. Of the 36 patients with negative TST test, 8 [22%] had positive GFT-G and 10 [28%] yielded indeterminate results. There was no association between a positive TST and receiving highly active anti-retroviral therapy [HAART] or CD4 counts was not significant [P=0.06]. Although TST results were not significantly different in patients with CD <200 vs. CD4>200 [P=0.095], association between QFT-G results and CD4 cutoff of 200 reached statistical significance [P= 0.027]. Agreement Kappa coefficient between TST and QFT-G was 0.54 [Kappa = 0.54, 95% CI = 38.4-69.6, P < 0.001]. Detecting LTBI in HIV-positive individuals showed moderate agreement between QFT-G and LTBI in our study. Interestingly, our findings revealed that nontuberculous mycobacteria and prior BCG vaccination have minimal influence on TST results in HIV patients in Iran

Comparison of community and healthcare-associated MRSA in Iran

To characterize and compare the epidemiological and microbiological aspects of community and healthcare-associated MRSA [CA-MRSA, and HA-MRSA] cases in Iran, this prospective cohort study was conducted from January to December 2008 in seven hospitals. Staphylococci were isolated from 109 hospitalized patients. MRSA isolates were classified into HA-MRSA and CA-MRSA based on clinical features. Antibacterial susceptibility patterns of the isolates to eight antibiotics routinely used to treat infected patients were determined according to standard agar dilution methods. Staphylococcal Cassette Chromosome mec [SCCmec] type of isolates and their correlation with antimicrobial susceptibility patterns in CA and HC isolates were determined. Of 109 isolates, 15[13.7%] were community-associated and 94 [86.3%] were healthcare-associated MRSA. The most frequent SCCmec types in the studied hospitals were SCC mec type I [56.9%] and type II [22%]. Relatively sulfamethoxazole, clindamycin, rifampin, erythromycin, tetracycline and doxycycline were noticed. To our knowledge, this is the first time that the analysis of SCCmec type is carried out in Iran according to the clinical criteria. Difference in the prevalence of HC-MRSA and CA-MRSA based on the clinical and epidemiological features may indicate the need for revisiting the classification of MRSA. The high prevalence of multi-drug resistant MRSA could be as a result of the excessive use of antibiotics in the hospitals. Therefore, periodical assessment of antibacterial susceptibility patterns of the MRSA strains is warranted

Research priority setting of Shaheed Beheshti medical university and tropical medicine research center in 2007

It is obvious that because of the lack of resources, we should devote our limited resources to priorities in order to reach an acceptable level of health. The objective of this study was research priority setting of infectious diseases using COHRED [Council on Health Research for Development] model. First of all, the stakeholders were identified and the situation of the field of infectious diseases was analyzed. Then, research areas and titles were specified using announcement, infectious diseases sources, [International Classification of Diseases 10] ICD10 and consensual qualitative techniques including brainstorming sessions, focal group discussion and Delphi. Finally, research priorities were specified by giving scores according to the criteria. Twenty-five research areas were obtained as priorities of infectious diseases and tropical medicine. These areas are HIV/AIDS, tuberculosis, drugs, infections in special hosts, avian flu, nosocomial infections, infections due to needle stick injury, malaria, viral hepatitis, viral hemorrhagic fevers, surgical- and burn- related infections, fever, central nervous system infections, effectiveness of vaccination, bloodstream infections, influenza, lower respiratory tract infections, gastrointestinal infections due to Entamoeba histolytica, bone and joint infections due to brucella, bioterrorism, brucellosis, hydatidosis, anthrax, botulism, and the role of migrants in the distribution of infectious diseases in Iran. Three subheadings including treatment, prevention and control and diagnosis methods got the most priorities, respectively. Although about half of the priorities are related to two subheadings including treatment and diagnosis methods, research priorities of prevention and control methods [22% of all priorities] indicate the importance of prevention for clinicians who gave scores to the titles