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

Kikuchi fujimoto disease in 21 year old man

Kikuchi Fujimoto disease also known as histiocytic necrotizing lymphadenitis is a benign disorder characterized histologically by necrotic foci surrounded by histiocytic aggregates, and with the absence of neutrophils. The patient was a 21 year old man with chills, fever and cervical lymphadenopathy. He had swelling and tenderness of cervical area. Multiple enlarged lymph nodes were palpable. Cervical lymph node excisional biopsy was performed. Microscopic examination showed reactive follicular hyperplasia with vast areas of necrosis without neutrophilic infiltration. No sign of malignancy was seen. Final diagnosis was Kikuchi Fujimoto necrotizing lymphadenitis. Kikuchi Fujimoto disease should be considered as one of the differential diagnoses in patients with prolonged fever and cervical lymphadenopathy. It should be differentiated from tuberculous lymphadenitis in regions where tuberculosis is prevalent

Tuberculin skin test among 1,424 healthy employees in Chaharmahal Province, Iran

Tuberculosis is still an important problem in developing countries. The tuberculin skin test [TST] is used for the identification of latent tuberculosis [TB] infection. This study aimed to evaluate the TST results of healthy employees of different departments in Chaharmahal province, Iran. This study was done on 1,424 healthy employees from 49 different departments in Chaharmahal Province. The tuberculin skin test was done with Purified Protein Derivative [PPD] solution. The induration was evaluated 48-72 hours later. Negative PPD test was observed in 346 subjects. A 5-10 mm induration was seen in 276, a 10-15 mm in 292, a 15-20 mm in 212, a 20-25 mm in 72, and a 25-30 mm induration was observed in 14 cases. A total of 212 subjects were absent when reading the induration. Tuberculin skin test can be used for the identification of TB infection. Prevalence of latent TB infection was low in our study. There were no significant differences in PPD test results between medical and non-medical departments

Mycobacterium tuberculosis and Cryptococcus neoformans co-infection meningitis in a young immuncompetent woman

Meningitis is a severe and potentially fatal form of tuberculosis. The diagnostic workup involves detection of acid-fast bacilli [AFB] in the cerebrospinal fluid [CSF] by microscopy or culture. However, the difficulty in detecting the organism poses a challenge in diagnosis. Cryptococcosis is an opportunistic fungal infection caused by cryptococcus neoformans. We presented central nervous system co-infection of tuberculosis and Cryptococcus neoformans which is extremely rare. The patient was a 35 year-old woman who was admitted in hospital due to fever, headache and changes of mental status. Physical examination revealed neck stiffness and positive Kernig's and Brudsinsky's signs. Cerebrospinal fluid analysis showed lymphocytic pleocytosis and culture of cerebrospinal fluid revealed mycobacterium tuberculosis and cryptococcus neoformans. Tuberculosis meningitis should be considered in patients with chronic meningitis especially in endemic areas. Cryptococcus neoformans meningitis may occur in immunocompromised and immuncompetent patients. Central nervous system co-infection with tuberculosis and Cryptococcus neoformans is possible

[Effect of infection on serum lipid level, a prospective study in Iran]

Serum lipid level may change due to acute febrile illness. This study was designed to evaluate serum lipid level changes in acute infectious diseases and emphasis on importance of serum lipid level measurement in infectious disease. This study also compares diagnostic value of serum lipids and acute phase reactant markers. This study was performed on 100 critically ill patients in 3 tertiary care hospitals in Tehran, Iran. 50 patients with infectious diseases were selected as case group and 50 patients without infectious diseases as control group. Serum level of total cholesterol [TC], high density lipoprotein [HDL], low density lipoprotein [LDL] and triglyceride [TG] were compared in case and control groups. Patients with critical illness and infection had lower level of HDL than patients with critical illness without infection. Mean and standard deviation of FIDL was 40 +/- 19 in case and 53 +/- 14 in control groups. HDL value as a guide to diagnosis infection is equal to erythrocyte sedimentation rate [ESR] and C- reactive protein [CRP]. Serum lipid level change in acute febrile illness. Serum level of high density lipoprotein decreases in infectious diseases and diagnostic value of high density lipoprotein is equal to erythroeyte sedimentation rate [ESR] and C- reactive protein [CRP] in our study

[Food fortifivation with calcium]

Calcium is an essential element for living cells and plays an important role in muscle contraction, neurotransmitter secretion and blood coagulation. It has been cleared that deficiency in daily calcium intake can increase the probability of osteoporosis, hypertension, colon cancer, post partum depression and premenstrual syndrome. Dairy products are the most important sources for calcium. Calcium requirement is increased during years of growing to reach peak bone mass. It is increased in puberty and also during years after menopause and elderly to prevent osteoporosis and resultant fractures. Nowadays, peoples in the society are consuming synthetic drinks increasingly while liquids like milk and yogurt have been replaced by this type of drinks. With attention to great consumption of this type of drinks, it seems that placing some foods which have been fortified by calcium in daily regimen, could supply daily calcium requirements. The aim of this review article is to insist on calcium importance and food fortification with calcium and also to describe methods of fortification

[Snakebite in Iran: diagnosis, treatment and prevention]

Due to different questions about how to handle snakebite and its mortality, snakebite management is an emergency and it is necessary to be discussed about. Snakes are divided to three categories including poisonous, semi-poisonous and non-poisonous. Poisonous snakes are divided to elapidae, viperidae, crotalidae and hydrophidae, each of them cause specific symptoms. Snakebite can cause local and systemic symptoms. Local symptoms include edema, tissue necrosis and bulla. Systemic symptoms include hemotoxicity, neurotoxicity, myotoxicity, nephrotoxicity and cardiotoxicity. In this article snakebite diagnosis, prevention and treatment like antivenom, antibiotic, tourniquet, suctioning, etc. has been discussed

Pneumonitis due to cytomegalovirus in an immunocompromised patient

Cytomegalovirus [CMV] pneumonia is one of the most important infections in immunocompromised host. Immunosuppressive therapy plays a major role in reactivation of CMV. The patient was a 56-year old lady, known case of chronic lymphocytic leukemia [CLL], had been taking prednisolone and chlorambucil, who presented with dyspnea and productive cough. After bronchoalveolar lavage [BAL], transbronchial lung biopsy [TBLB] and CT-guided biopsy, CMV pneumonia was diagnosed. CMV should be suspected as a cause of pneumonia in immunocompromised patient and diagnosis may require invasive procedures

Invasive aspergillosis of pituitary gland in an immunocompetent patient

Invasive aspergillosis is a major cause of morbidity and mortality in immunosuppressed patients. This infection is caused by Aspergillus, a hyaline mold, which is the etiologic agent for many different manifestations. A 63 year old diabetic housewife woman, living in northern Iran, presented with the history of right eye ptosis after a mild head trauma since about 3 weeks ago. She had positive history of intermittent headache several weeks before ptosis. On physical examination, the patient was afebrile and other vital signs were normal. Brain MRI showed a pituitary mass measuring about 4 cm. Pathological study showed hyphae in favor of aspergillosis. Amphotericin B was started and after 10 days changed to itraconazole. It is important to consider fungal infection as a differential diagnosis of cerebral lesions even in the immunocompetent hosts. The clinical presentation of cerebral aspergillosis is nonspecific and is characterized by focal neurologic signs, alteration in mental status and headache

Multiple lung abscesses in a patient with kartagener's syndrome

Kartagener's syndrome is a rare genetic disorder, which is mostly inherited as an autosomal recessive trait. There are 4 genes with a proven pathogenetic role in Kartagener's syndrome. It results from ciliary dysfunction and is commonly characterized by sinusitis, male infertility, hydrocephalus, and situs inversus. Since Kartagener's syndrome causes deficiency or even stasis of the transport of secretions throughout the respiratory tract, it favors the growth of viruses and bacteria. As a result, patients have lifelong chronic and recurrent infections, typically suffering from bronchitis, pneumonia, hemoptysis, sinusitis, and infertility. We present a 27-year-old woman, a case of Kartagene's syndrome, with multiple pulmonary abscesses. Evaluation of sputum and tracheal secretions revealed Pseudomonas aeroginosa. Antibiotics were started and respiratory symptoms resolved and the patient was discharged in good general condition. As a conclusion, prompt and appropriate treatment of respiratory infections can minimize irreversible lung damage in such cases