review of epidemiology, diagnosis and management of brucellosis for general physicians working in the Iranian health network

Although rare in industrialized countries, brucellosis continues to be a major public health problem in developing countries such as Iran. General physicians [GP] as well as health care workers [HCW] are concerned about brucellosis both as a public health problem as well as an occupational hazard. The aim of this article is to review the information about the epidemiology, immunopathogenesis, diagnosis and occupational risks associated with the prevention and treatment of brucellosis. Information obtained from previous investigations on brucellosis has yielded better knowledge about this illness. This information enables GPs to provide improved health services including preventive consultations, early diagnosis and treatment to attending people or patients at health care units.

Drug induced hepatitis among Iranian patients suffering from tuberculosis

To identify the risk factors of anti TB drug induced hepatitis [ATDH] among the atients with tuberculosis. In a retrospective study, medical records of 3960 notified tuberculosis cases over the five year period [2004-2008] in Khuzestan province Health Center, south west of Iran, were reviewed and ATDH data were analyzed. Inclusion criteria were documented TB, diagnosed based on National Tuberculosis Program [NTP]. Data of ATDH and non ATDH were analyzed in SPSS 16 system and by chi square and exact fisher tests. One hundred ninety eight cases including 65[32.8%] female and 133[67.2%] male with mean age of 43.2 year and SD of 9.5 were registered as ATDH during treatment and follow up period. Differences between HIV infection and intravenous drug injection in ATDH cases and non ATDH patients was statistically significant [[p=0.0001, OR: 14.2], [p=0.0001, OR: 7.5] and [p=0.0001, OR: 11.3] respectively]. Among previously established risk factors for ATDH, HCV infection, IVDU and HIV infection had the most importance

[Evaluation of tuberculosis management and its failures: a health system research in Khuzestan]

Successful control of tuberculosis [TB] is achieved by a good management of TB control program based on Directly Observed Treatment Short course [DOTS]. The aim of this study was to evaluate anti TB activities at the mid levels of TB management. In a descriptive study which was conducted in Khuzestan province from Sept 2000 to Sept 2002 anti TB activities in Khuzestan Health Centre was studied. Managing indexes such as manpower, laboratory equipments, drug provisions, budget and anti TB activity indexes such as case finding rate, cure rate and treatment failure rate were analyzed. DOTS coverage was 61.7%. Duration of time between onset of symptoms and diagnosis of TB was more than 3 months in about 30% of patients. TB incidence rate was 21.3 per 100000 population and case finding rate was 41.6%. Cure rate, treatment failure and death rate due to TB were 94.2%, 3.1% and 2.6% respectively. 37.7% of primary health care worker [called Behvarzes] and 17% of general physicians were unaware of DOTS. Approved budget was 25% of required budget. Job satisfactory rate in Behvarzes and physicians was 80% and 20% respectively. Sixteen percent of the health centers suffered from at least one major anti TB drug. TB management, at the mid levels, suffers from weakness in personal education, drug provisions and financial supporting. More than half of the patients remain undiagnosed. The treatment failure rate and mortality rate was relatively high. Irregular treatment increases the risk of multi drug resistant TB

evidence against the effect of chronic cytomegalovirus infection in unstable angina pectoris

Recent reports have suggested that cytomegalovirus [CMV] infection may contribute to risk of cardiovascular disease. However, relationship between CMV infection and unstable angina [UA] is controversial and studies about this subject in Iran and even region are lacking. The aim of this study was to determine whether unstable angina is related to seropositivity to chronic cytomegalovirus infection. We measured serum CMV IgG levels in a case control study participants in CCU in Razi Hospital, Ahvaz, Iran, from 2004 to 2005. Blood samples were drawn during study period from 96 patients [mean age 56 years] with UA according to American Heart Association Criteria and from 96 participants free of cardiovascular disease [mean age 58 years] and stored at -20 Degree C. Blood samples of patients were undertaken for investigating the specific anti CMV-IgG by ELISA method. Data were analyzed in SPSS 11.5 by using chi square test, odds ratios [OR] with 95% confidence intervals [CI]. Ninety three percent of patients with unstable angina and 96.7% in the control group presented a positive anti CMV-IgG. Odds ratio was 0.52 with 95% CI: 0.10 to 2.42. There was no significant correlation between CMV-IgG positivity and unstable angina [P>0.05]. There was also no differences in CMV-IgG positivity in clinical groups of UA [P>0.05]. The relationship between seropositivity of CMV-IgG and unstable angina has been restituted by the results of this study. However, further population based cohort studies for relationship between CMV infection and coronary artery disease must be conducted

Latent tuberculosis infection in individuals with human immunodeficiency virus infection: comparison of tuberculin skin test to the anti TB-IgM antibodies

To determine Latent Tuberculosis Infection [LTBI] prevalence and compare TST results to the anti TB-IgM anti bodies [ATIA] for the diagnosis of LTBI in HIV infected individuals. Sixty two randomized sampled HIV infected subjects from an addict treatment center in Ahvaz southwest Iran underwent TST, using 5 TU of purified protein derivative, and measuring ATIA. Data were analyzed in SPSS [version 16, USA]. Of 62 participants, 34 [54.8%] had positive result for TST, whereas 6 [9.7%] had positive ATIA. Overall concordance between TST and ATIA was 45.2% [Kappa= 0.37, p = 0.32]. In subjects with positive test results by either TST or ATIA, only 4.8% had positive test results by both tests. Discordant results were found in 54.8% of subjects. Positive results for both tests in subjects categorized in two groups [above and below 200 CD4-cell/mm3] had no significant difference [P>0.05]. LTBI prevalence among HIV infected individuals in studied area is higher than other parts of the world. TST is a useful test for LTBI diagnosis and prefer to ATIA. Concordance between TST and ATIA is low

Infective endocarditis among hospitalized intravenous drug user patients in the south west of Iran

To determine the frequency of Infective Endocarditis [IE], clinical, echocardiographic and microbiological status at a teaching hospital in Ahvaz, South West Iran. Medical records of 323 Intravenous Drug User [IDU] inpatients from 2001 to 2006 were reviewed, out of which 33 cases that fulfilled the Duke criteria for diagnosis were included in the present study. The patients' characteristics, clinical findings, microbiological findings, echocardigraphic and comorbidities data were extracted. Data of patients with IE and without IE were compared in SPSS using t-test and chi square test. Patients with IE were 32 male and one female cases with a mean age of 26.2 years. Non IE patients were 288 male and two female cases with mean age of 37.8 years. Nineteen of our patients were HIV positive. There was statistically significant difference between HIV-positive and HIV-negative patients. Weight loss and fever were the commonest clinical findings. Staphylococcus aureus was the most common organism [24.2%] followed by coagolase negative staphylococcus [15.1%], most of them were methiciline resistant. Tricuspid valve was involved in 33.3% of cases. Frequency of Infective Endocarditis [IE] among Intravenous Drug User [IDU] is higher than reported in earlier studies. HIV infection increases the risk of IE. Methicilin resistant Staphylococcus aureus is the commonest organism. Tricuspid is the commonest involved cardiac valve

Predictors of bacterial meningitis in adult patients of South West Iran

To study the clinical and lab parameters in adult patients with suspected or confirmed bacterial meningitis [BM] to find out the usefull predictors. This was a retrospective study conducted in Razi hospital, a training center affiliated to Ahvaz Joundishapoor University of Medical Sciences in Iran. All patients with meningitis aged 18 years or more between 2003 and 2007, with CSF pleocytosis and who had not received antibiotic treatment before lumbar puncture were reviewed. Among 312 patients with CSF pleocytosis, two hundred fifteen [68.9%] had BM and ninety seven [31.1%] had aseptic meningitis [ASM]. The mean age for patients with BM was 34.7 +/- 17.7 years and for ASM was 32.2 +/- 15.5 years [P=0.22, NS]. Sixty percent of the cases of BM and 61.2% of the cases of ASM occurred in men [P=0.70, NS]. We identified the following predictors of BM: CSF-WBC count>100 per micro liter, CSF-glucose level<40 mg/dl, CSF-protein level>80 mg/dl. Sensitivity, specificity, PPV, NPV of these predictors, and LR for BM are 86.5%,52.6%,80.2%, 63.7% and 104.1 for CSF-WBC count and 72.1%, 83.5%, 90.6%,57.4% and 164.2% for CSF glucose, and 49.7%, 91.8%, 93.4%,45.2% and 104.5% for CSF protein. The CSF WBC count should not be used alone to rule out bacterial meningitis. When it is combined with other factors such as CSF glucose and protein it helps in decision making in patients suffering from bacterial meningitis

Study of urethritis among subjects regardless to religious rites

Sexually transmitted diseases [STD] in young population of Iran and the frequency of sexual behaviors is a major public health problem in the country. The aim of this study was to study urethritis [the most common STD in Khuzestan] among subjects regardless of religious [Islamic] rites. In this prospective study conducted from 2005 to 2007 in Amirkabir Hospital in Ahvaz, 1199 adult men with symptomatic urethritis were studied. One thousand and forty six subjects declared that they respect religious rites [Group-I] and 153 subjects declared that they were not much concerned about religious rites and they were included in Group-II. Urethritis was diagnosed based on clinical and laboratory examinations. Subjects were placed in two groups and compared. Extracted data from questionnaires were analyzed in SPSS 13 software using chi-square and exact Fisher tests. Of total 1199 subjects, 44 patients were diagnosed having urethritis, among them gonococcal urethritis was detected in 16[36.5%] and Chlamydia in 28[63.7%]. Mean age of the patients was 28.2 +/- 9.4 years with the range of 18-47 years. Incidence of urethritis in Group-I was 2% [21/1046] and in Group-II 15.03% [23/153]. Frequency of Men having sex with men [MSM], extramarital contact, HIV seropositivity, Injecting drug use [IDU], and imprisonment among Group-I and Group-II was [1.2%, 1.4%, 0.8%, 0.6%, 0.8%] and [8.2%, 8.2%, 4.6%, 3.6%, 12.4%] respectively. Subjects who are not concerned about religious rites have high frequency of unsafe sexual contact like homosexuality, extramarital contact. HIV infection and IDU as compared to those who respects religious rites

Seroprevalence of Legionella pneumophila in admitted patients with pneumonia in training hospitals, Ahvaz, Iran

To determine the seroprevalence of Legionella pneumophila [LP] in patients with pneumonia. During a 12-month study period, from December 2007 and November 2008 121 randomized selected patients admitted to the three training hospitals of Jundishapoor University of Medical Science in Ahvaz [a city southwest Iran] with pneumonia were investigated to determine the serprevalence of LP. The diagnosis of LP infection was based on positive serology. Sera were tested for L. pneumophila IgG and IgM by using Elisa kit [Vircell, Spain]. All analyses were done using the SPSS, version 16 statistical package. Of a total of 121 serum samples tested, 21 [17.3%] were positive for LP- IgG, IgM. Fifty percent of pneumonia patients in ICU were seropositive. Age, gender and area of residency did not significantly [p >0.05] affect the seroprevalence of LP. Overall, the prevalence of LP seropositivity was not significantly [p >0.05] affected by co-morbidities except diabetes melitus. Smoking and receiving antibiotic was observed in 86% and 100% seropositve patients. Legionella pneumophila is a prevalent infectious agent in the region of study and should be considered as potential invader patients with pneumonia especially in diabetic, smoker and ICU patients

C-reactive protein, rheumatoid factor and circulatory immune complex as markers for monitoring treatment of infective endocarditis

To evaluate the diagnostic usefulness of serum C-reactive protein [CRP], rheumatoid factor [RF] and circulatory immune complex [CIC] determinations in monitoring the outcome of infective endocarditis [IE]. In this prospective analytic descriptive study CRP, RF and CIC were measured on admission and 4 weeks after initiation of standard antibiotic regimen in 30 hospitalized patients with IE in an educational hospital between 2006 and 2007 in Ahvaz a city south west Iran. Duke criteria were used for diagnosis of IE. CRP and RF were examined using quantitative neflometry [Binding site kit, UK] and CIC was detected by semi quantitative immune diffusion [Baharafshan SIRD kit, Iran]. Data were evaluated using statistical analyses in SPSS [version 12, USA] software for windows. The fall in serum C-reactive protein or RF was significant [P=<0.05] when a patient had a full recovery, but no such behavior was observed in CIC [P>0.05]. Only two of the 30 patients, who had elevated CRP, RF and CIC week four failed to response and one needed cardiac surgery. The C-reactive protein proved to be a good tool for monitoring the treatment of IE. Also RF proved useful in the assessment of patients with IE, but the value of CIC was negligible

Ten years survey of animal bites in Khuzestan

Animal bites and stings are among the most common injuries in Iran and worldwide. The aim of this study was to determine the incidence and characteristics of the injuries caused by animal in the population of Khuzestan admitted in educational hospital emergency departments. In this retrospective study medical records of 894 admitted patients with animal bite or sting were studied. Data including epidemiological aspects, clinical findings and outcomes of treatment were analyzed in SPSS 11.5 by using descriptive statistics and chi-square test. Out of total 894 patients 61.9% were male, median age of male and female was 24.4 years and 26.2 years respectively. Dog, scorpion, mouse and snake were the most common animal species with the frequency of 69%, 12.6%, 8.8% and 4.4% respectively. Feet [58.05%] and hands [30.65%] were the most common body part affected, followed by face and other parts. One hundred Twenty seven patients had infectious complications, among them soft tissue infection 94[74.05%], sepsis 28[22.04%] and endocarditis 5[3.91%]. Thirty five case [3.91%] died of animal bites and stings, among them 28[80%] due to scorpion sting, 4[11.4%] related to dog and 3[8.6%] from snake bite. No rabid case was observed in these patients. Animal bite is a major public health problem in Khuzestan with a high frequency, significantly high percentage of hospitalization and considerable mortality

Association between cigarette smoking and pulmonary tuberculosis

To determine the association between cigarette smoking and pulmonary tuberculosis. In this retrospective study which was carried out in Razi hospital, in Ahvaz a city southwest Iran, medical charts of patients with tuberculosis between 2005 and 2007 were reviewed. Sixty one patients aged 15-96 years with documented pulmonary tuberculosis [smear positive] were selected as cases and 122 age and sex matched persons without tuberculosis[patients hospitalized in surgery and orthopedic wards] were selected randomly as controls. Data on smoking status, quantity of cigarette smoked, and duration of smoking was collected from medical charts. The data in the two groups were statistically compared with SPSS version 16. The chi square test was used to compare the frequency of cigarette smoking in two groups. Ninety-five percent confidence intervals were calculated when appropriate. Differences with a P value of <0.05 were considered significant. Of total 61 case, 42 [68.9%] were smoker, while, of total 122 controls 22[18%] were smoker. The estimated odds ratio [OR] of the relation between smoking and tuberculosis was 10.1 [[95% confidence interval [CI] 4.3 to 23.5], P<0.001]. The mean of pocket -year of smoked cigarette [20/pocket] in cases and controls were 15.9 +/- 13.7 and 13.5 +/- 9.1, respectively [P=0.5]. This study showed that pulmonary tuberculosis is associated to cigarette smoking. The association is not dose-dependent. Smoking may be a risk factor for TB acquisition

Chlamydia pneumoniae seropositivity associated with atherothrombotic cerebrovascular infarction?

Several studies suggested that Chlamydia pneumoniae [CP] infection may be a risk factor for cerebrovascular disease. Since these studies have reported controversial results, we performed this study to identify whether Cp-immunoglobulin was associated with atherothrombotic cerebrovascular infarction [ACI] in Iranian patients. Forty-five patients admitted with ACI, and 45 control without ACI were enrolled in this case-control study. Using an enzyme-linked immunosorbed assay kit [ELISA], the presence of CP-immunoglobulin [CP-IgG] in studied patient's sera was determined. The seroprevalence of CP-IgG was 35[77.7%] in the ACI group [mean age = 73.3 years] and 29[64.4%] in the control group [mean age = 70.1 years] [P > 0.05]. There was no difference in sex, age, hypertension, smoking, hyperlipidemia, diabetes and obesity between cases and control groups [P > 0.05]. No association was observed between CP seropositivity and ACI [OR: 1.95 [95% CI, 0.081-2.03], P = 0.16]. Our finding suggests that there is no association between ACI and positive CP-IgG in Iranian patients

Frequency of HLA-B27 antigen in iranian patients with brucellosisand it's relationship with osteoarticular complication

To determine frequency of HLA-B27 in brucellosis patients and to investigate a possible association between osteoarticular bruceltosis and HLA-B27 antigen. Sixty patients with serotogicatly confirmed brucettosis and 100 healthy controls were screened for HLA-B27 by using standard microlymphocytotoxicity method. Osteoarticular involvement was suggested by clinical presentation and confirmed by nuclear scan. Patients were placed in two groups and compared, patients with osteoarticular involvement [OAP group] and without osteoarticular involvement [OAN group]. All data were analyzed by SPSS [versionl 11.5, USA] and using Fisher's exact X2 test. Out of total 60 patients with brucellosis 38 [63.3%] were male. Mean age of the patients were 36.2 +/- 12.3 with the range of 18-65 years. HLA-B27 test was positive in 11 patients [18.33%] with brucellosis, whereas in control group HLA-B27 positivity was 7% [p<0.05].The prevalence of HLA-B27 in OAP and OAN groups was 33.33% and 8.33%, respectively [p<0.05]. The prevalence of HLA-B27 in our bruceltosis patients is higher than normal population and there is a significant association between HLA-B27 and bruceltar osteoarthritis in the region of study

Epidemiology of animal bites and stings in Khuzestan, Iran, 1997-2006

To determine the incidence and characteristics of the injuries caused by animals among the population of Khuzestan region, Iran admitted to teaching hospital emergency departments. Retrospective study. Place and duration of study: From 1997 to 2006 in teaching hospitals in Ahvaz, Iran. Methodology: The medical records of 894 patients admitted to hospital with animal bites or stings were studied. Data including epidemiological aspects, clinical findings and outcomes of treatment were analyzed using descriptive statistics and the x[2] test. Of 894 patients 62.0% were male, and the median age of males and females was 24.4 years and 26.2 years, respectively. Dogs, scorpions, mice and snakes were the most commonly involved animal species, causing injuries with a frequency of 69%, 12.5%, 8.8% and 4.4%, respectively. Feet [58.1%] and hands [30.6%] were the most commonly affected body parts, followed by the face and other parts. Infectious complications were seen in 127 patients, among them 94 soft tissue infections [74.1%], 28 cases of sepsis [22.0%] and five of endocarditis [3.9%]. Thirty-five cases [3.9%] died following animal bites and stings, among them 28 [80%] due to scorpion stings, four [11.4%] related to dogs and three [8.6%] from snake bites. No cases of rabies were observed in these patients. Animal bite is a major public health problem in Khuzestan, with a high frequency, a high percentage of hospitalization and considerable mortality

Relative frequency of infections among hospitalized injecting drug user-HIV positive patients in Razi hospital, Ahvaz, SW Iran [2001-2003]

Frequency of infections in Injecting Drug Users [IDU] varies in different areas according to socioeconomic and geographic situation as well as Human Immunodeficiency Virus [HIV] infection rate. The present study was performed to determine the frequency of infections in IDU-HIV positive patients. Forty known cases of HIV infected [by positive ELISA and western blot tests] were investigated for various infections in Razi hospital in Ahvaz, South West of Iran during 2001-2003. Medical charts including age, duration of addiction, imprisonment, site of infection, signs and symptoms, laboratory findings, imaging result and echocardiography report were prepared. Data were analyzed in SPSS software by using descriptive statistical methods. Forty IDU-HIV positive male patients with a mean age of 25 +/- 6.3 years were included in this study. More than 50% of patients had a history of imprisonment. Bacterial infection diagnosed in 40% and viral infection in 100%. Three patients died due to mixed infection and AIDS. The obtained rate of infections in IDU-HIV positive in Ahvaz was very higher than expected. Rapid diagnosis of above mentioned infections, appropriate management and treatment can prevent or postpone progressing of AIDS

case report of septic sacroilitis due to Staphylococus aureus

Sacroilitis is an inflammatory disease, which is often caused by Brucella species [mainly by Brucella melitensis, and B. abortus], Mycobaterium tuberculosis or inflammatory diseases such as ankylosing spondilitis. It is rarely associated with Staphylococcal infections. In this report, a case of a 24-year-old sailor with a history of low back pain is presented who was initially suspected to suffer from ankylosing spondilitis or brucellosis. Further evaluation of this case revealed septic sacroilitis due to Staphylococcus aureus and was successfully treated with vancomycin

Relationship between the serologic status of Helicobacter pylori with the presence of unstable angina

To determine whether unstable angina is co-related to seropositivity to chronic Helicobacter pylori [HP] infection. It is a case control, descriptive study conducted at CCU in Razi Hospital in Ahwaz a city southwest Iran, from 2004 to 2005.We measured serum HP- IgG levels of participants in CCU in a hospital. Blood samples were drawn during study period from 96 patients [mean age 56 years] with Unstable Angina [UA] according to American Heart Association criteria and from 96 participants free of cardiovascular disease [mean age 58 years] and stored at "20°C. Serology results were studied in relation to UA. Using chi squared test, odds ratios [OR] and 95% confidence intervals [CI] were calculated, adjusting for age, gender, and established risk factors. Seventy nine [82.3%] of patients with unstable angina and 55[61.1%] in the control group presented a positive anti HP-IgG. Odds ratio was 3 with 95% CI: 1.9 to 4.3. There was significant relation between HP-IgG positivity and unstable angina [P<0.001].There was no sex and age significant difference in HP-IgG positivity in patients and controls [P>0.05]. Our study revealed relationship between seropositivity of HP-IgG and unstable angina

causes of death among patients with tuberculosis in Khuzestan, Iran

To assess the cause of death in tuberculosis patients. It is a retrospective descriptive study conducted in Khuzestan province in the south west of Iran, from 2002 to March 2006. Medical records of tuberculosis patients over the 5-year period were reviewed and death data were analyzed. Inclusion criteria were documented TB, diagnosed based on National Tuberculosis Program [NTP], extracted data were analyzed in SPSS11.5 system and by descriptive statistics. One hundred and twenty five deaths [3.15%] with mean age of 48.96 +/- 10.03 years were detected. The frequency rate for cigarette smoking, diabetes, chronic renal failure, MDR-TB, imprisonment, HIV infection and injection drug usage were 31.2%,16%, 6.4%,6.4%,22.4%,13.6% and 22.4%, respectively. Eighty four deaths [67.2%] were directly attributed to tuberculosis, among them overwhelming TB disease, haemoptysia, and MDR-TB accounted as the cause of death in 77.4%, 13.1%, 9.5% and 6.4% respectively. Forty one [32.8%] deaths were due to other medical problems, which included AIDS, cardiovascular diseases, bacterial super infection and cancers i.e. 21.9%, 19.5%, 17.1% and 12.2% respectively. This study showed that overwhelming TB disease, haemoptysis, cardiovascular diseases, bacterial super infection and cancers are the main cause of death. Smoking, imprisonment, injection drug usage and diabetes are frequent risk factors for TB mortality

Frequency of anti toxocara antibodies in school children with chronic cough and eosinophilia in Ahwaz, Iran

To determine the seroprevalence of Toxocara in children having chronic cough. It is a cross sectional study conducted at Ahwaz a city southwest Iran, from Sep 2006 to Dec 2006. Analyses were based on 115 children [randomized cluster sampling] with chronic cough [cough with duration of 2 weeks or more]. Laboratory exams; CBC, eosinophils absolute count and tests for intestinal parasites were performed. Eosinophils <500/mm3 were considered as eosinophilia. IgG anti-toxocara antibodies test was carried out by ELISA method for eosinophitic child. Out of total 115 children 29 [25.2] were eosinophilic, among them 10 [34.48%] hypereosinophilic and 40 [34.78%] had intestinal parasites. Frequency of Toxocara-IgG in chronic cough, eosinophilic and hypereosinophilic was 13.9%, 55.2% and 80% respectively. Chronic cough associated eosinophilia among children in Ahwaz may be contributing to Toxocara infection