Cryptococcal meningitis relapse in an immunocompetent patient

Cryptococcal meningitis is a common opportunistic infection in patients with underlying immunosuppressive state specially AIDS patients. However, it could be seen in immunocompetent patients mostly in tropical areas. There are scanty reports of such infection in healthy patients of non-tropical areas. We report an immunocompetent 43 years old Iranian man who was in excellent health status until 3 weeks before hospitalization when he developed headache. He experienced a 5-week delay in diagnosis of cryptococcal meningitis which led to his blindness of right eye despite treatment. We believed that the nonspecific clinical and laboratory finding of the present case and also the rarity of disease in our area especially in immunocompetent patients made his diagnosis confounding

Frequency of nasal carriage of staphylococcus aureus and its antimicrobial resistance pattern in patients on hemodialysis

Staphylococcus aureus is currently the most common cause of infection in hospitalized patients. Patients on hemodialysis are at increased risk due to their immunocompromised state. The present study was designed to determine the frequency of S aureus nasal carriage in patients on hemodialysis. This study was undertaken in 2 dialysis centers to establish the frequency of S aureus nasal carriage at teaching hospitals of Mazandaran University of Medical Sciences, in the north of Iran. Standardized nose swabs were rotated into the anterior nares of the patients, and the samples were cultured on a blood-agar medium. Having grown the colony, gram stain, catalase, manitol, DNAase, and coagulase tests were all performed. Pattern of antibacterial sensitivity was determined by using the disc diffusion method. Also, agar dilution method was used to determine minimal inhibitory concentration of oxacillin and vancomycin. Of 84 patients on hemodialysis, 31 [36.9%] were nasal carriers of S aureus, of whom 23 [74.2%] were resistant to methicillin. Of the methicillin-resistant S aureus isolates, 3 [13.0%] were resistant to vancomycin and 7 [56.5%] had reduced susceptibility to vancomycin in agar dilution method. Resistance frequencies to clindamycin, ciprofloxacin, and trimethoprim-sulfamethoxsazole were 12.9%, 9.7%, and 19.3%, respectively. However, all microorganisms were sensitive to rifampicin. Patients on hemodialysis are at an increased risk of S aureus infections; thus, screening of these susceptible patients should be considered as a health priority. Meanwhile, microbial sensitivity tests should be ordered for all cases in order to optimize treatment options

Association between cigarette smoking and pulmonary tuberculosis in men: a case-control study in Mazandaran, Iran

The annual risk of tuberculosis [TB] in Iran is about 0.5% with annual incidence rate of 23/100000 [16322 cases]. Different factors have been postulated as TB predisposing factors. Several studies have linked smoking with pulmonary tuberculosis as the TB incidence in their adult men was 2.4 times higher than women. In Iran, however, this ratio is equal and somewhere the ratio in women is greater. We decided to carry out a case control study in order to evaluate the effect of cigarette smoking on pulmonary TB. A case-control was achieved in health care centers of Mazandaran province [affiliated to Mazandaran University of Medical Sciences]. Participants were men Aged 15 years and older who were enrolled in health care centers with the diagnosis of active pulmonary tuberculosis. One hundred men [aged 15-85 years] with bacteriological TB [smear or culture positive] were selected as cases and 300 age-matched men without TB were selected randomly as controls. Information on smoking status, quality of tobacco smoked and duration of cigarette smoking and also the age at which smoking was first commenced were collected by a questionnaire. Smokers were 2.1 times more likely to develop pulmonary TB [OR=2.10, 95% confidence interval [CI]:1.33-2.33, p<0.04]. The age adjusted odds ratio was 1.804 [95% CI;1.66-2.5, p<0.05]. Quantity of cigarette smoking and duration of smoking had positive association with pulmonary TB. The Ors for mild [1-10 cigarette/ day], moderate [11-20/day] and heavy [>20/day] smoking were 1.68, 2.46, and 2.56, respectively [p<0.05]. The Ors for duration of smoking with <10 years, 11-20 years and >20 years of smoking were 0.91, 2.48, and 2.9, respectively [p<0.001]. We conclude that smoking may increase the risk of pulmonary TB in men. Further studies should be conducted to investigate this association and to establish whether smoking strategies contribute to tuberculosis control

Animal bites and rabies in northern Iran; 2001-2005

Animal bites are potentially harmful for people. The prophylaxis approach is effective and safe, however, it is expensive and sometimes may be used without clear indication. Prophylaxis programs depend on local epidemiology. The aim of this study was to survey the animal bites and rabies epidemiology in northern Iran. We performed a descriptive study on all animal bites and rabies in the Mazandaran Province during 2001 to 2005. Initial data including age, sex, site of bite, incidence, type of animal, geographical distribution, number of vaccinations and death by rabies were gathered and analyzed by SPSS soft ware. Annual frequency of animal bites was between 3,174 and 4,670 in the Mazandaran Province. One hundred sixty bites per 100,000 persons occur annually, with a cost of approximately US $0.5 million in health care expenditures and loss of income. Twenty thousand animal bites occurred during the year of 2001 to 2005. Behshar, with 302.88 cases per 100,000 persons was the most prevalent city. We found that the majority of bites are from dogs [84.87%], especially stray dogs. Men are frequently bitten by dogs [79.62%], while adolescence is the most frequent victims of dog bites, especially in rural areas. Dog bites resulted in 2 deaths, both of which had bites on their faces. Exposure to dogs, especially stray dogs in Mazandaran Province, reported the majority of cases of human bites and post-exposure prophylaxis

[Clinical Manifestations and usual and unusual CXR manifestation of smear positive pulumonary tuberculosis; in Sari, Qaemshahr and Neka]

Clinical and radiological manifestations of Pulumonary tuberculosis are well known. However, it appears there is an increasing rate of unusual radiological patterns in immuno-competent adults, with smear positive pulmonary tuberculosis [based on our experience]. The aim of this study was to analyze chest X-ray [CXR] findings and clinical patterns among immuno-competent men and women with smear positive pulmonary tuberculosis [TB] in Sari, Qaemshahr and Neka, during March 2006 to March of 2007. All new cases of pulmonary TB diagnosed during 12 months in 3 districts in Northern Iran, [Mazandaran Province] were included in a cross-sectional study. Inclusion criteria's were: positive smear of sputum and absence of any immuno-suppressive state. 65 cases fulfilled the inclusion criteria. Descriptive methods were used for data analysis. The common presenting symptoms were: coughing at 83%, hemoptysis at 24.6%, night sweating at 55%, anorexia at 60%, weight loss at 73.8%, and fever at 60%. Usual radiological patterns was found in 70.8% of patients [upper lobe lesion with or without the remaining part] and incidence of an unusual radiographic pattern was 29.2%[middle and lower lob infiltration without upper lob lesion, milliary pattern, hilar lymphadenopathy and normal CXR]. This study showed that TB with atypical radiographic manifestations is more common than reported previously. These varieties of radiologic manifestations can mimic other disease entities. Therefore, recognition and understanding of radiologic manifestations and complication of tuberculosis are important to facilitate a diagnosis