Reactive arthritis induced by bacterial vaginosis: prevention with an effective treatment

We report a 42-year-old woman with reactive arthritis induced by bacterial vaginosis who presented with oligoarthritis with an additive form, arthralgia, and enthesitis. She hasn't had a history of diarrhea or dysuria or vaginal secretion, or sexually transmitted infections [STIs]. The laboratory tests were normal except for a high erythrocyte sedimentation rate [ESR]. Her pelvic examination revealed homogeneous white grey and malodorous vaginal discharge on the vaginal wall and Pap smear and Gram-stained smear of vaginal swab was consistent with bacterial vaginosis. She responded to metronidazole therapy and her six-month follow up hasn't shown recurrence of arthritis. As reactive arthritis [ReA] is a paradigm of a rheumatic disease in which the initiating infectious cause is known, so early use of antimicrobial drugs may prevent the development of musculoskeletal symptoms which are triggered by infections

Bacteriuria by extended-spectrum beta-lactamase-producing escherichia coli and klebsiella pneumoniae isolates in a governmental hospital in south of Tehran, Iran

Antibiotic resistant mutants producing extended-spectrum beta-lactamase [ESBL] have emerged among Escherichia coli and Klebsiella pneumoniae. This study was done to determine the frequency of ESBL-producing E coli and K pneumoniae species isolated from urine samples of our patients. A study was conducted on 164 urine isolates [124 E coli and 40 K pneumoniae] in the laboratory Loghman Hakim Hospital in Tehran, Iran, in 2007. Microbial sensitivity tests were done on Mueller-Hinton agar plates with disk diffusion method. Broad-spectrum resistance was defined as resistance to ampicillin or cephalothin; ESBL resistance, as resistance of these bacteria to one of ceftriaxone, ceftazidime, or ceftizoxime; and MDR-ESBL; as resistance to 3 of the following antibiotic groups: trimethoprim-sulfamethoxazole, aminoglycosides, fluoroquinolones, and nitrofurantoin. An ESBL resistance was detected in 52.5% of isolates with K pneumoniae and 45.2% of those with E coli. The MDR-ESBL pattern was detected in 26.8% of the isolates. These included 30.0% of the K pneumoniae and 25.8% of the E coli isolates. Broad-spectrum resistance was detected in all K pneumoniae isolates and 87.9% of 124 E coli isolates. Our study showed a high rate of ESBL resistant strain of E coli and K pneumoniae and the emergency of multiple drug resistance to these bacteria in our patients in Tehran, Iran

Source and response of antibody to hepatitis B vaccine in hemodialysis patients

All chronic hemodialysis patients for hepatitis B infection have to be tested and vaccinated against HBV infection routinely. A descriptive study was designed in 47 hemodialysis patients. After a blood sample was taken for serologic status, three doses [0, 1, 6 month] of hepatitis B vaccine were administered. Repeated titers were obtained one month after the last vaccination and analyzed by ELISA. 39 patients [83%] became immune with protective levels of HBs antibody. There was not a significant correlation between sex, age, smoking, underlying diseases, weight, duration of dialysis and positive HBs antibody after vaccination. Hmodialysis patients need follow-up testing

survey on 80 cases of botulism and its clinical presentations as a public health concern

Botulism is a toxin-induced paralytic illness characterized by cranial nerve palsies and descending flaccid paralysis. Borulinum toxin is regarded as the most lethal ever-known substance. The diagnosis in sporadic cases and even in small outbreaks is the main physicians' challenge. The aim of this study was to assess clinical presentations of 80 cases of botulism referred to Loghman Hakim hospital in Tehran. A total of 80 botulism cases referred during a 10-year period [1996-2006] were included. The diagnosis of botulism was verified on epidemiological data and a clinical score of severity. Patients were assigned in 3 groups: mild, intermediate and severe. The study population included 40 males and 40 females with a mean age of 30.7 +/- 15.2 years [a range, 1-66 years]. The suspected causative foods were cheese in 25 [31%], and sea-food in 20 [25%]. The mean incubation period was 1.1 +/- 1.8 days [a range, 4 hours-10 days]. Nausea and vomiting was noted as the first symptom in 17 cases. Diagnosis was confirmed in 47 patients [58.8%]. The most common toxin subgroups were A [in 22 cases] and E [in 15 cases]. All the patients were treated with antitoxin and recovered without sequel, however, 6 patients were admitted to intensive care unit [ICU] and required ventilatory support. Only one patient [1.3%] died. The mainstays of therapy are meticulous intensive care [including mechanical ventilation, when necessary] and promptly treatment with antitoxin. Antitoxin should be given early in the course of illness, ideally <24 hours after onset of symptoms

Tetanus antitoxin levels and cutaneous anergy in hemodialysis patients in two University Hospitals in Iran

The global incidence of tetanus is about I million cases annually. Tetanus antibody values decrease with age. Some patients with humoral immune deficiencies may not respond adequately to tetanus toxoid vaccination. The incidence of infectious disease is increased in patients with chronic renal failure. The purpose of this study was to determine tetanus antitoxin level and cutaneous anergy test in hemodiaksis patients. A cross sectional study was performed on 44 hemodialysis patients who had been on dialysis thrice a week for at least 2 months. Quantitation of tetanus-specific antibodies was achieved by ELISA technique. Then, for Manteaux test 0.1 ml of 1/10 saline diluted solution of tetanus and diphtheria toxoid was injected intradermally to the volar surface of the shunt-free arm. Induration was recorded 48 - 72h and 7 - 9 days after the injection. Twenty-eight [64%] patients had induration /= 0.1 IU/ml. There was no significant correlation between age, sex, duration of dialysis, frequencies of dialysis history of tetanus-diphtheria vaccination, and tetanus antitoxin levels. There was a significant difference between induration size of anergy test results recorded on two separate observations [48 - 72h and 7 - 9 days after the test] [p < 0.05]. Our results indicate that immunization history was not consistent with protective antibody level, so monitoring immunization status and administering the tetanus vaccine in hemodialysis patients are required. Keywords: Anergy test, Anti-tetanus antibody, Hemodialysis

Outbreak of botulism type E associated with eating traditional soup in a family group, Loghman Hakim Hospital, Tehran, Iran

Botulism is a neuroparalytic illness caused by clostridium botulinium toxin that is usually transmitted as a foodborne disease. It is manifested by cranial nerve dysfunction and descending flaccid muscle paralysis. Patients: Eleven members of a family developed severe weakness, lethargy and other clinical manifestations compatible with botulism following the ingestion of traditional soup. Stool, gastric fluid and serum samples were submitted for toxicological evaluation with standard mouse bioassay, while, only one patient demonstrated type E toxin. All patients received 3 monovalent antitoxins A, B and E, whilst most of their symptoms improved within 12 hours, This study confirmed that prompt administration of antitoxin could prevent progression of the disease and may be a life-saving approach. Keywords: Botulism, Antitoxin, Outbreak

Prevalence of Staphylococcus aureus carriage in patients on hemodialysis and the pattern of antibacterial resistance

Staphylococcus aureus is a virulent pathogen that is currently the most common cause of infection in hospitalized patients. These days, increment in antimicrobial resistance coupled with increasing prevalence of the agent as a nosocomial infection makes the situation even more complex. Patients on hemodialysis are at increased risk due to their immunocompromised state. The present study was designed to determine the prevalence of Staphylococcus aureus nasal carriage in a group of Iranian patients on hemodialysis. For this descriptive study, sterile-cotton-tripped swabs were rotated into anterior nares of 96 patients on hemodialysis, and then cultured on blood-agar medium. Having grown the colony, gram stain, catalase, manitol, DNAase and coagulase tests were all performed and the pattern of antibacterial sensitivity was determined. Of 96 patients on hemodialysis, 44 [45.8%] were nasal carrier of S. aureus. All isolated S. aureus were resistant to methicillin [MRSA], while 95% were resistant to cloxacillin, 6.81% to clindamycin, 6.81% to ciprofloxacin and 4.5% to rifampin; however, all microorganisms were sensitive to vancomycin. Patients on hemodialysis are at increased risk of S. aureus contamination, thus, screening these susceptible patients should be served as a health priority. Meanwhile, antibiogram should be ordered for all cases to optimize treatment options

Cutaneous anergy in patients reciveing long term hemodialysis

Hemodialysis patients are at risk of acquiring tuberculosis, which is most often due to reactivation of the infection. As a result, screening for tuberculosis is recommended in hemodialysis patients. In this study, the rate of response to cutaneous PPD along with tetanus and diphteria toxoid antigens have been evaluated to define in hemodialysis patients. This clinical trial was conducted on 67 chronic hemodialysis patients in Labbafi Nejad Hospital during March- May 2001. PPD, tetanus and diphtheria toxoid solutions, with 1/10 dilution were administered by Manteaux technique and the induration was evaluated 48-72 hours, 7 and 9 days after. Of 64 patients, 18.8% had positive PPD tests and 26.6% had negative anergy tests through the first evaluation. The degree of constancy in the results of PPD and anergy tests during the three-time evaluation period were 23.4% and 18.7%, respectively, and the degree of induration was increased or decreased among the rest. Hemodialysis patients are at the increased risk for acquiring tuberculosis. Thus, negative cutaneous PPD results should certainly be revised and evaluated using anergy tests and repetitive readings of the test results. Attention must be paid to the "Delayed Type Hypersensitivity" [DTH] phenomenon presenting for the first time in the analysis of cutaneous test results. Finally, it is recommended to reconsider the value of cutaneous PPD test and its method of analysis in hemodialysis patients