Evaluation of epidemiological and microbiological characteristics, clinical features, and outcomes of adult patients with infective endocarditis in Mashhad, Iran.

INTRODUCTION: Infective endocarditis (IE) is a serious problem with high morbidity and mortality. However, there is a paucity of data regarding its epidemiology in non-high-income settings. Here, we described the characteristics of patients with IE. METHODOLOGY: Between March 2012 to March 2020, all adults (≥ 16 years) with a diagnosis of IE who were admitted to a university hospital in Mashhad, Iran, were included in the study. RESULTS: We evaluated 46 cases of IE with a median age of 42 years (interquartile range 31 to 58.3 years), of whom 21 (46%) had a definite diagnosis. The presence of a prosthetic valve or intracardiac device was the leading predisposing factor (N = 14, 30%). The etiology of IE in 22 subjects (48%) remained unknown. Staphylococcus aureus (N = 12, 26%) was the most common causative pathogen. Echocardiography revealed the mitral valve as the most affected valve (N = 18, 39%). Intravenous drug users (IVDU) had a higher chance of right-sided IE, as compared to no IVDU patients (odds ratio: 35, 95% CI: 3.7 to 425.0). The most prevalent complications were lung infarction, acute heart failure, and neurologic involvement (N = 5, 11% for each), and 15 patients (33%) died because of IE. CONCLUSIONS: In our study, the median age of IE onset was relatively low. The most frequent predisposing factor was a prosthetic valve or intracardiac device. The proportion of negative blood cultures was unacceptably high. Thus, our findings emphasize promoting laboratory infrastructure, developing a national protocol for early initiation of appropriate treatment, and eliminating predisposing factors.

Q Fever Endocarditis in Northeast Iran.

This report presents a case of chronic Q fever endocarditis. A 60-year-old male farmer and rancher was admitted to the hospital with symptoms of weight loss, fever, severe sweating, weakness, and anorexia. PCR was negative for C. burnetii in the blood sample, but phase I and II IgG antibodies against C. burnetii were positive (1 : 16384 and 1 : 2048, respectively) by the indirect immunofluorescent assay (IFA). According to the adjusted Duke criteria, Q fever endocarditis was confirmed, and the patient was successfully treated with doxycycline and hydroxychloroquine.

Urine PCR evaluation to diagnose pulmonary tuberculosis.

BACKGROUND: Culture and specific staining (including Zeil-Nelson and fluorescent methods) are standard measures for the diagnosis of tuberculosis (TB). These methods are time-consuming and sometimes have a low level of accuracy. In addition, in some cases obtaining samples for smear and culture involves invasive procedures; while in other cases there is no suitable sample for evaluation. Therefore, there is a need for faster and more accurate diagnostic methods. OBJECTIVES: The current study investigated the diagnostic value of tuberculosis-polymerase chain reaction (TB-PCR) of urine in the diagnosis of pulmonary tuberculosis (PTB). PATIENTS AND METHODS: This case-control study included; 77 proven pulmonary tuberculosis cases (according to the national TB protocol), and 30 subjects who were completely healthy. The urine samples (50 mL) were mixed with 0.5 mL Ethylene diamine tetraacetic acid. DNA extraction and PCR testing were performed on all blood samples using SI 6110 primers. Mycobacterium tuberculosis was also cultivated in the sputum and urine samples of the patients. RESULTS: Results of the current study indicated that 48 (62.3%) patients out of 77 had a positive sputum culture. Urine cultures and acid-fast smears were negative. Urine PCR-TB was positive in 48.0% (37/77) of the patients. The specific TBPCR complex was positive in 56.2% (27/48) of the positive cultures and 34.4% (10/29) of the negative culture PTB patients. The control group had negative urine PCR (sensitivity 56.2% and specificity 100%). CONCLUSIONS: With regard to the ease of urine sample preparation and the 100% specificity the PCR method, performing urine PCR could be used as a diagnostic aid in PTB cases obtaining sputum samples is problematic.

Mathematical modeling of transmission dynamics and optimal control of vaccination and treatment for hepatitis B virus.

Hepatitis B virus (HBV) infection is a worldwide public health problem. In this paper, we study the dynamics of hepatitis B virus (HBV) infection which can be controlled by vaccination as well as treatment. Initially we consider constant controls for both vaccination and treatment. In the constant controls case, by determining the basic reproduction number, we study the existence and stability of the disease-free and endemic steady-state solutions of the model. Next, we take the controls as time and formulate the appropriate optimal control problem and obtain the optimal control strategy to minimize both the number of infectious humans and the associated costs. Finally at the end numerical simulation results show that optimal combination of vaccination and treatment is the most effective way to control hepatitis B virus infection.

Chronic cutaneus mucormycosis in an immunocompetent female.

INTRODUCTION: Cutaneous infection is an uncommon presentation of mucormycosis, usually seen after trauma, at the site of surgical drains or after occlusive dressings. The involved area is erythematous and painful, with varying degree of central necrosis. We report the case of chronic coetaneous infection of one year duration and without apparent necrosis in an immunocompetant patient. CASE PRESENTATION: A 32-year-old immunocompetent woman presented with a large unilateral firm infiltrative plaque resembling cancer lesions, disfiguring the eyelids, nose and lips. The punch biopsy and then surgical debridement was done and the diagnosis of cutaneous mucormycosis was confirmed on histologic examinations with granulomatous reaction and characteristic broad, nonseptate, pale-staining hyphae. CONCLUSIONS: Mucomycosis should be in differncial diagnosis of any chronic infiltrative lesions even without visible necrosis and normal immune status of the patient.

Frequency of caseous lymphadenitis (CLA) in sheep slaughtered in an abattoir in Tabriz: comparison of bacterial culture and pathological study.

From January to February 2008, 468 sheep carcasses (335 male and 133 female) in a Khosroshahr (suburb of Tabriz, East Azerbaijan province, Iran) abattoir were randomly selected for inspection. The aim of the study was to estimate the frequency of caseous lymphadenitis (CLA) in sheep and to compare the results of bacterial cultures and histopathology of suspected cases. The mean age of the population was 2.5 years. One hundred ninety-seven cases containing 153 (77.7%) males and 44 (22.3%) females had prominent enlargement of one of the lymph nodes (i.e., prescapular, prefemoral, inguinal, supramammary, or midiastinal); these were removed with the surrounding tissue for further evaluation. For confirmed diagnosis of CLA, samples were sent for microbiology and pathology analysis. Standard bacteriological culture methods for isolation of Corynebacterium pseudotuberculosis and tissue preparations for histopathological sections were performed. To evaluate the effect of age on the frequency of CLA, animals were categorized in four groups: under 1, 1-2, 2-3, and over 3 years of age. Based on the results, in 59 (12.60%) carcasses C. pseudotuberculosis was isolated, and in 94 (20.08%) of the cases histopathological studies revealed pathognomonic signs (lamellated exudates or onion ring) of CLA. The frequency of CLA based on bacteriological culture was 12.60% and on histopathological study 20.08%. In 37 (18.8%) of the carcasses, both bacteriological and histopathological studies confirmed CLA. The frequency of CLA following microscopic examination (20.08%) presented a more precise diagnosis compared to bacteriological culture (12.60%) and macroscopic evaluation of the lymph nodes (P < 0.05). Furthermore, there was a positive correlation rate between the bacteriological culture and histopathological study (r = 0.196, P = 0.006). The prescapular lymph node had the highest infection rate with 54 (1.70 ± 0.97) and supramammary lymph node had the lowest with two (0.07 ± 0.41) (P < 0.05). There was an increase in CLA detection with increasing age (P < 0.05), the mean age of animals with a positive CLA test were 2.92 years and in the oldest age group 31 (47%) cases had the highest infection.

Fuzzy modeling and control of HIV infection.

The present study proposes a fuzzy mathematical model of HIV infection consisting of a linear fuzzy differential equations (FDEs) system describing the ambiguous immune cells level and the viral load which are due to the intrinsic fuzziness of the immune system's strength in HIV-infected patients. The immune cells in question are considered CD4+ T-cells and cytotoxic T-lymphocytes (CTLs). The dynamic behavior of the immune cells level and the viral load within the three groups of patients with weak, moderate, and strong immune systems are analyzed and compared. Moreover, the approximate explicit solutions of the proposed model are derived using a fitting-based method. In particular, a fuzzy control function indicating the drug dosage is incorporated into the proposed model and a fuzzy optimal control problem (FOCP) minimizing both the viral load and the drug costs is constructed. An optimality condition is achieved as a fuzzy boundary value problem (FBVP). In addition, the optimal fuzzy control function is completely characterized and a numerical solution for the optimality system is computed.

Disseminated tuberculosis in a kidney transplant patient: Diagnostic significance of reversed circadian temperature rhythm.

Presently, clinicians often forget important aspects of fever patterns. This study presents the case of disseminated tuberculosis in a 64-year-old man whose chief complaint was morning fever. He was a kidney transplant patient and presented with productive cough, reverse fever pattern and a nodular pattern in chest radiograph. Clinicians should suspect disseminated tuberculosis in patients who present with reverse fever pattern, especially with compatible radiographic findings.

Isolated tricuspid valve endocarditis.

We present two non-HIV-infected patients with isolated native non-rheumatic tricuspid valve endocarditis who were not intravenous drug abusers. The patients presented with fever and chills. Plain radiography or high-resolution computed tomography of the chest revealed consolidation or infiltrate of the left parenchyma in both patients. Large vegetation located on the tricuspid leaflets was detected by transesophageal echocardiography. Staphylococcus aureus grew in two out of three blood cultures for one patient. Tricuspid valve endocarditis imitates illnesses with fever and pulmonary symptoms or signs of acute or chronic onset, and might be present even without abnormal chest X-rays or intravenous drug addiction.