Sexually Transmitted Infections Among Hospitalized Patients With Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome (HIV/AIDS) in Zahedan, Southeastern Iran.

BACKGROUND: Studies show that nearly 40 million people are living with human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) around the world and since the beginning of the epidemic, about 35 million have died from AIDS. Heterosexual intercourse is the most common route for transmission of HIV infection (85%). People with a sexually transmitted infection (STI), such as syphilis, genital herpes, chancroid, or bacterial vaginosis, are more likely to obtain HIV infection during sex. On the other hand, a patient with HIV can acquire other infections such as hepatitis C virus (HCV) and hepatitis B virus (HBV) and also STIs. Co-infections and co-morbidities can affect the treatment route of patients with HIV/AIDs. Sometimes, physicians should treat these infections before treating the HIV infection. Therefore, it is important to identify co-infection or comorbidity in patients with HIV/AIDS. OBJECTIVES: This study was conducted in order to understand the prevalence of HIV/AIDS/STI co-infection. PATIENTS AND METHODS: In this cross-sectional study, we evaluated all HIV/AIDS patients who were admitted to the infectious wards of Boo-Ali hospital (Southeastern Iran) between March 2000 and January 2015. All HIV/AIDS patients were studied for sexually transmitted infections (STI) such as syphilis, gonorrhea, hepatitis B virus (HBV) and genital herpes. A questionnaire including data on age, sex, job, history of vaccination against HBV, hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), hepatitis B surface antigen (anti-HBs), HCV-Ab, venereal disease research laboratory (VDRL) test, fluorescent treponemal antibody absorption (FTA-Abs) test, and urine culture was designed. Data was analyzed by the Chi square test and P values of < 0.05 were considered significant. RESULTS: Among the 41 patients with HIV/AIDS (11 females and 30 males; with age range of 18 to 69 years) five cases (12.1%) had a positive test (1:8 or more) for VDRL. The FTA-Abs was positive for all patients who were positive for VDRL. Gonorrhea was found in seven patients (17%) and three cases had genital herpes in clinical examinations. All patients who had positive test results for these STIs were male. Eleven patients (26.8%) had HBV infection (three females and eight males). hepatitis C virus (HCV) was found in 13 cases (31%). Eighty percent of patients were unemployed. Seventy-eight percent of patients with HIV/STI were aged between 18 and 38 years. There was a significant difference between sex and becoming infected with HIV and also STI (P < 0.05). CONCLUSIONS: Patients with HIV/AIDS are more likely to acquire other STIs, because the same behaviors that increase the risk of becoming HIV infected can also increase the risk of acquiring STIs. Having a sore on the skin due to an STI can make the transmission of HIV to the sex partner more likely than people who don't have such sore in their genital area.

Lack of Association between miRNA-146a rs2910164 and miRNA-499 rs3746444 Gene Polymorphisms and Susceptibility to Pulmonary Tuberculosis.

Single-nucleotide polymorphisms (SNPs) in miRNAsmay alter its expression levels or processing and contribute to susceptibility to a wide range of diseases. Our study aimed to evaluate the possible association between miRNA-146a rs2910164 and miRNA-499 rs3746444 polymorphisms and susceptibility to pulmonary tuberculosis (PTB) in a sample of Iranian population. This case- control study was performed on 202 PTB patients and 204 healthy individuals. Genotyping was performed using tetra amplification refractory mutation system-polymerase chain reaction (T-ARMS-PCR). The results indicated that neither miRNA-499 rs3746444 nor miRNA-146a rs2910164 are associated with the risk of PTB in a sample of Iranian population. Larger studies with different ethnicities are required to validate our findings.

Molecular and serological findings in suspected patients with Crimean-Congo hemorrhagic fever virus in Iran.

Crimean-Congo hemorrhagic fever (CCHF) is an arthropod-borne disease of humans associated with a severe clinical picture, including hemorrhagic syndrome and a high mortality rate. CCHF virus is widely distributed throughout large areas of the world. To characterize the serological status in CCHF patients, paired clinical samples were collected from suspected CCHF patients and analyzed by microbiological and other laboratory analyses with the aim of: determining the presence of neutralizing antibodies against CCHF virus; investigating the cross-reactivity of these neutralizing antibodies against virus isolated from the same outbreak and against other available laboratory strain; and studying the relationship between the isolated virus with other virus by whole genome sequencing. Patients at Boo-Ali Hospital, Zahedan, Iran, with clinical symptoms ranging from mild to severe hemorrhagic fever were included in the study. Two serum samples were taken from each patient, the first as soon as the patient matched the criteria for CCHF notification and the second when the patient was discharged from hospital (2 weeks later). Commercial and in-house assays revealed a positive IgM signal in acute serum samples from six patients. A novel finding was that CCHF patients develop neutralizing antibodies soon after infection. Interestingly these antibodies were able to neutralize other CCHF virus strains too. The complete sequence of the Zahedan 2007 isolate, including the hitherto unknown first L-segment sequence, was identified using an original clinical sample from one patient with confirmed CCHF infection.

Macrophage migration inhibitory factor -173 G/C polymorphism is associated with an increased risk of pulmonary tuberculosis in Zahedan, Southeast Iran.

Macrophage migration inhibitory factor (MIF) has an important role in controlling infection. The aim of this study was to evaluate the possible association between MIF -173 G/C functional polymorphism and pulmonary tuberculosis (PTB) in an Iranian population from Zahedan Southeast Iran. This case-control study was done on 161 PTB and 142 healthy subjects. Genomic DNA was extracted from all participants by salting out method. The MIF -173 G/C variant was genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The finding showed that the MIF -173 G/C polymorphism increased the risk of PTB in codominant (OR=1.76, 95 % CI=1.05-2.95, p=0.038, GC vs GG) and dominant (OR=1.78, 95 % CI=1.09-2.91, p=0.027, GC+CC vs GG) tested inheritance models. Furthermore, the minor allele frequency (MAF) increased the risk of PTB in comparison with G allele (OR=1.63, 95 % CI=1.07-2.48, p=0.028). In conclusion, the present study provides evidence that -173 G/C polymorphism may increase the risk of PTB.

Pharyngeal carriage rate of Neisseria meningitidis before and after the Hajj pilgrimage, in Zahedan (southeastern Iran), 2012.

BACKGROUND/AIM: The annual Hajj pilgrimage to Mecca, which attracts more than 3 million Muslim pilgrims from around the world, has played a role in the global spread of meningococcal infection. We aimed to compare pharyngeal carriage of Neisseria meningitidis in Hajj pilgrims before departure and after returning to Iran, Zahedan. MATERIALS AND METHODS: This prospective and cross-sectional study was conducted among Hajj pilgrims in Zahedan (southeast Iran) in 2012. We studied all pilgrims who agreed to participate in this study and who met the inclusion criteria. Sampling was done by swabbing the posterior pharyngeal wall through the mouth with direct plating or keeping transport time to below 5 h. Specific culture, oxidase test, and carbohydrates tests were done on the positive samples. RESULTS: Among 422 pilgrims (42.2% male, 57.8% female; with age range 21-95 years), 6 (1.4%) were positive for N. meningitidis after the Hajj pilgrimage. Nobody was positive before departure. During the Hajj 58.5% of the participants received antibiotics. CONCLUSION: According to the results of our study, the prevalence of pharyngeal carriage of N. meningitidis in pilgrims after returning to Zahedan was low (1.4%). The quadrivalent meningococcal vaccine and antibiotic therapy were effective in reducing the number of carriers among pilgrims after travel.

Prevalence of crimean-congo hemorrhagic Fever among high risk human groups.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF), an acute viral infection, is a zoonotic disease which is transmitted to humans by infected ticks, direct contact with fresh meat or blood of infected animals (usually domestic livestock), or direct contact with the blood or secretions of an infected person. Livestock handlers, skin processors, veterinary staff, livestock market workers, and other personnel engaged in jobs requiring some contact with animals and/or animal products are at high risk for CCHF. Most reported cases of this disease in Iran belong to butchers and slaughterhouse workers. OBJECTIVES: We aimed to study the prevalence of CCHF in slaughterhouse workers and livestock handlers who were admitted to Boo-ali Hospital for treatment of CCHF. MATERIALS AND METHODS: We evaluated all patients' files with confirmed CCHF admitted to Boo-ali Hospital in Zahedan, in southeastern part of Iran, during 1999-2011. Then, we examined the prevalence of disease among the high risk groups. RESULTS: Out of 362 patients with CCHF (86% male, 14% female; with age range 12-78 years), 123 (34%) were slaughterhouse workers, 103 (28.5%) livestock handlers and farmers, 32 (9%) housewives, 7 (2%) students, 6 (1.9%) teachers, 4 (1.2%) military personnel, and other groups were workers with different employments. CONCLUSIONS: The present study showed that CCHF is highly prevalent in high risk occupational groups in Zahedan, Iran. Further surveillance, teaching and prevention programs are recommended.

Acute Q fever among febrile patients in Zahedan, southeastern Iran.

AIM: So far, few studies have been conducted on Q fever in Iran. The objective of this study was to determine the frequency of acute Q fever in febrile patients admitted to Boo-Ali Hospital in Zahedan (southeastern Iran). MATERIALS AND METHODS: In this study, 105 febrile patients suspected ofhaving brucellosis were examined using indirect immunofluorescent assay kit for the detection of Coxiella burnetii IgM and IgG phase antibodies in their serum. Serum with a phase II IgG titer of > or =256 and a phase II IgM titer of > or =50 was predictive for acute Q fever. Additionally, a 4-fold rise in antibody titers was considered diagnostic of Q fever. Results were analyzed using SPSS 17.0 for Windows. RESULTS: Among 105 patients (male: 52, female: 53), 35.2% (37/105) febrile patients had a positive serology test for acute Q fever. The prevalence of acute Q fever in women and men was 17/37 (45.9%) and 20/37 (54%), respectively. There was serological evidence of past infection in 36 (34.3%) patients. CONCLUSION: According to the results of our study, acute Q fever is highly prevalent in this province. Thus, it is necessary to pay attention to this disease to prevent its transmission in this region.

Efficacy of high-dose methylprednisolone in patients with Crimean-Congo haemorrhagic fever and severe thrombocytopenia.

Crimean-Congo haemorrhagic fever (CCHF) is an acute viral haemorrhagic disease that is now endemic in south eastern Iran. The most important factor associated with mortality is a platelet count of less than 50,000/mL. The purpose of this study is to compare treated cases with severe thrombocytopenia using ribavirin with high-dose methylprednisolone (HDMP) with patients receiving ribavirin without HDMP. A clinical trial was conducted for confirmed patients with CCHF and severe thrombocytopenia (platelet count less than 50,000/mL) admitted to Boo-Ali Hospital in Zahedan between January 2010 and October 2011. The intervention group was given oral ribavirin, supportive managements and HDMP and the controls were treated with ribavirin and supportive management. Following HDMP therapy in hospitalized patients with severe thrombocytopenia, the platelet count increased within 36 h and the leukocyte count within 48 h of the beginning of treatment. Fewer in the intervention group required a transfusion of blood products than in the controls (P < 0.001). No one in the intervention group died. It seems that high-dose methylprednisolone is effective in the treatment of patients with CCHF. The increased platelet count and reduction of blood product requirement for severe CCHF patients after receiving HDMP are promising results. Further investigation is necessary in order to determine the efficacy of corticosteroid and its effect on outcome.

Can serum ferritin level predict disease severity in patients with crimean-congo hemorrhagic Fever?

OBJECTIVE: Crimean-Congo hemorrhagic fever (CCHF) is an acute viral disease. Several factors have already been suggested to explain the pathogenesis as well as predict the disease severity. In our study we aim to investigate the role of serum ferritin level as a possible predicting factor of disease severity in these patients. MATERIALS AND METHODS: We evaluated all patients with laboratory confirmed diagnosis of CCHF who were admitted to Boo-Ali Hospital of Zahedan from May 2011 to June 2012. Confirmation of the disease determined using the presence of anti- CCHFV IgM in the serum by enzyme-linked immunosorbent assay (ELISA) or by polymerase chain reaction(PCR). After ethical approval, patients were categorized into two groups of mild and severe disease according to disseminated intravascular coagulation (DIC) severity using the scoring system of International Society on Thrombosis and Hemostasis (ISTH). Serum ferritin levels were evaluated and compared between these two groups. Receiver operating characteristic (ROC) curve analysis was performed to assess the optimal cutoff value of serum ferritin for predicting the disease severity. RESULTS: A total of 42 patients (36 men, 6 women, age range: 17-78 years) were included in this study, of whom 38% had Persian and 62% had Baloch ethnicity. According to DIC severity score, 54.7% of the patients had severe disease and 45.3% had mild disease. The area under the ROC curve was 0.896 and 95% CI was 0.801-0.991 (p<0.0001). A cut-off point of 1060 ng/dL, had a sensitivity of 78.9%, a specificity of 87%, a positive predictive value of 6% and a negative predictive value of 100%. Positive and negative likelihood ratios for this serum ferritin level were 6.05 and 0.24, respectively. CONCLUSION: Increased serum ferritin level has a significant positive correlation with disease severity in patients with CCHF and can evaluate the prognosis of these patients with a high sensitivity and specificity.

Diagnostic assays for Crimean-Congo hemorrhagic fever.

Crimean-Congo hemorrhagic fever (CCHF) is a highly contagious viral tick-borne disease with case-fatality rates as high as 50%. We describe a collaborative evaluation of the characteristics, performance, and on-site applicability of serologic and molecular assays for diagnosis of CCHF. We evaluated ELISA, immunofluorescence, quantitative reverse transcription PCR, and low-density macroarray assays for detection of CCHF virus using precharacterized archived patient serum samples. Compared with results of local, in-house methods, test sensitivities were 87.8%-93.9% for IgM serology, 80.4%-86.1% for IgG serology, and 79.6%-83.3% for genome detection. Specificity was excellent for all assays; molecular test results were influenced by patient country of origin. Our findings demonstrate that well-characterized, reliable tools are available for CCHF diagnosis and surveillance. The on-site use of such assays by health laboratories would greatly diminish the time, costs, and risks posed by the handling, packaging, and shipping of highly infectious biologic material.

Seroprevalence of hepatitis B surface antigen and anti hepatitis C antibody in zahedan city, iran: a population-based study.

BACKGROUND: There have been studies regarding the prevalence of hepatitis B surface antigen (HBsAg) and anti-hepatitis C antibody (HCVAb) in Iran. However, the majority of these have reported a variety of rates, depending on their study population, which limits the generalizability of their results to the general population. On the other hand, cultural diversity in the different provinces of Iran also necessitates the performing separate population-based studies in the various regions. OBJECTIVES: To evaluate the population-based prevalence of HBsAg and HCVAb and their correlates in Zahedan City, Iran. PATIENTS AND METHODS: Included in this study were 2587 individuals, using a random and cluster sampling approach. The participants were drawn from the Family Registry of the public health centers in Zahedan City, Iran, from 2008 to 2009. Following data collection from the interviews, subjects were assessed for seropositivity of HBsAg and HCVAb. We then calculated the prevalence of HBsAg and HCVAb, and evaluated these viral markers for an association with; age, sex and potential risk factors. RESULTS: Weighted seroprevalence of HBsAg and HCVAb was 2.5% (CI 95% : 1.9 to 3.3 %) and 0.5% (CI 95% : 0.27 to 0.9 %), respectively. Prevalence of HBsAg increased significantly with age (P value < 0.001), but this was not true for HCVAb (P value: 0.67). We observed no sex dominance in the prevalence of HBsAg (3.2% and 2.2% for males and females, respectively, P value: 0.15) or HCVAb (0.4% and 0.7% for males and females, respectively, P value: 0.27). In a multivariate regression analysis, every additional year in age resulted in a 2% increment in the odds of HBsAg seropositivity. HBsAg was also three times more prevalent among married, than single subjects (with a P value reaching toward significance: 0.065) in multivariate analysis. Prevalence of HCVAb did not differ with respect to any of the potential risk factors. CONCLUSIONS: This is the first population-based study on the prevalence of HCVAb and one of the few population based studies on HBsAg in Zahedan City. We detected lower prevalence rates of HBsAg and HCVAb than in previous studies conducted in Zahedan City. In addition to improvements in social awareness and general health elements, we think that the observed low prevalence rates have been achieved due to the efficiency of mass vaccination projects, implemented against HBV infection in Iran.

Association between tuberculosis and smoking.

BACKGROUND: The association between smoking and tuberculosis (TB), which has been proven in multiple studies with different study population ethnicity, has not yet received sufficient attention in terms of TB control. OBJECTIVES: The aim of the present study was to determine the association between TB and cigarette smoking in southeastern Iran, an endemic area for tuberculosis. PATIENTS AND METHODS: This prospective case-control study conducted at a University-Affiliated Hospital (Boo-Ali Hospital, Zahedan, and Southeastern Iran) from March 2007 to March 2012 enrolled 253 TB patients and 312 healthy controls. Factors including history of cigarette smoking, duration of smoking, number of cigarettes smoked per day, consumption of other drugs (parenteral and non-parenteral), and family history of tuberculosis and smoking, were evaluated in both cases and controls. Univarate and multivariate logistic regressions were performed to compare TB cases and controls. The odds ratio (OR) and 95% confidence intervals (CI) were also estimated. RESULTS: The results of the study revealed a significant difference between TB and control groups in relation to smoking (P < 0.0001). In multivariate logistic regression, cigarette smokers were 3.1 (95% CI: 1.4-10.3) times more frequent in TB patients compared with controls. Other factors that showed significant differences between TB patients and controls were the use of non-parenteral drugs (OR = 3.6, 95% CI: 2.2-21.4), family history of TB (OR = 6.6, 95% CI: 2.3-18.2), family history of smoking (OR = 2.8, 95% CI: 1.1-8.4), and smoking history of more than 10 years (OR = 1.6, 95% CI: 1.2-9.8). CONCLUSIONS: The present study evidenced the association between TB and smoking. It is therefore recommended to include interventions for smoking cessation in the current TB control practice.

Colorimetric nucleic acid testing assay for RNA virus detection based on circle-to-circle amplification of padlock probes.

We developed a molecular diagnostic method for detection of RNA virus based on padlock probes and colorimetric readout. The feasibility of our approach was demonstrated by using detection of Crimean-Congo hemorrhagic fever (CCHF) virus as a model. Compared with conventional PCR-based methods, our approach does not require advanced equipment, involves easier assay design, and has a sensitivity of 10(3) viral copies/ml. By using a cocktail of padlock probes, synthetic templates representing different viral strain variants could be detected. We analyzed 34 CCHF patient samples, and all patients were correctly diagnosed when the results were compared to those of the current real-time PCR method. This is the first time that highly specific padlock probes have been applied to detection of a highly variable target sequence typical of RNA viruses.

Current treatment of Crimean-Congo hemorrhagic fever in children.

Crimean-Congo hemorrhagic fever (CCHF) is a fatal viral hemorrhagic fever and is usually transmitted to humans by tick bite, or exposure to infected blood or tissues of infected livestock or humans. Although children can be infected with the CCHF virus, infection is unusual in the younger age group. Early diagnosis and treatment of CCHF infection is critical to the survival of patients and the control of the disease. In this article, we underline current therapeutic approaches to CCHF infection in children.

The outcome of patients with Crimean-Congo hemorrhagic fever in Zahedan, southeast of Iran: a comparative study.

BACKGROUND: Crimean-Congo hemorrhagic fever was rarely reported from Iran before 1999. In a recent outbreak, the disease has been reported from different provinces of Iran, especially from Sistan and Baluchestan. Ribavirin has been recommended by World Health Organization as a potential therapeutic modality for Crimean-Congo hemorrhagic fever. This study was conducted to determine the clinical outcome and the effect of ribavirin in two groups of patients with Crimean-Congo hemorrhagic fever who were treated at different times. METHODS: In this cross-sectional study, we evaluated patients with Crimean-Congo hemorrhagic fever who were admitted to Boo-Ali Hospital in Zahedan, a subtropical area in southeastern Iran, at the first three years after beginning of the last outbreak (1999 - 2003) and those who were admitted during 2005 - 2007. First, we found all patients with confirmed Crimean-Congo hemorrhagic fever infection who were treated with oral ribavirin. Then, they were evaluated for recovery and mortality rate. RESULTS: We evaluated 123 patients with confirmed Crimean-Congo hemorrhagic fever infection (91 patients treated between 1999 and 2003, and 32 patients between 2005 and 2007). Among the 91 patients, 73 (80%) survived, and 18 (20%) died of the disease. During 2005 - 2007, among the 32 patients who were treated within three days of onset of the disease, only one (3%) died of the disease. The recovery rate was higher among patients who were admitted during 2005 - 2007 than those hospitalized between 1999 and 2003 (97% vs. 80%). There was a significant (P=0.001) difference in the mortality rate between the two groups. CONCLUSION: Prompt treatment with oral ribavirin can increase the recovery rate in patients with Crimean-Congo hemorrhagic fever.

An old man with a mass in the retropharyngeal space.

In this article, we discuss clinical manifestations, laboratory results, and radiological findings in an old man with suppurative tender mass in the neck, accompanied by, fever, weight loss, malaise, fatigue, night sweat, cough, vomiting, and dysphagia. Pharyngeal exam revealed a huge retropharyngeal abscess.

Clinical and epidemiologic features of Crimean-Congo hemorrhagic fever among children and adolescents from southeastern Iran.

This study aimed to investigate the clinical and epidemiologic features of Crimean-Congo hemorrhagic fever among 34 children and adolescents (mean age, 13.3 +/- 4.6 years) from a highly endemic region. Clinical manifestations were similar to those in adults. The case-fatality ratio was 26.5% (9 of 34). Compared with adult patients, children and adolescents may be more vulnerable to severe and fatal Crimean-Congo hemorrhagic fever.

Hepatitis B and C virus infections in patients with hemophilia in Zahedan, southeast Iran.

OBJECTIVE: To determine the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in patients with hemophilia in Zahedan, Iran. METHODS: From March 2003 to January 2006, we evaluated 81 hemophiliac patients in Zahedan Hemophilia Center, southeast Iran, for hepatitis C virus antibody (HCV-Ab) and hepatitis B surface antigen (HBsAg), and evaluated the prevalence of HBV/HCV co-infection. RESULTS: The seroprevalence of HCV was 29.6%, and the HBsAg was positive in 4.9%. Four cases had HCV and HBV co-infection. All of the infected patients were unknowingly treated with contaminated plasma products before the middle of 1996. CONCLUSION: All hemophiliacs, especially patients who have been treated with unheated clotting factor concentrates, should be evaluated for HCV and HBV infections.

Spectrum of clinical disease in a series of hospitalized HIV-infected patients from southeast of Iran.

OBJECTIVE: To determine the pattern of opportunistic infections (OIs) and non-infectious opportunistic diseases in hospitalized HIV-infected patients in Zahedan, southeast of Iran. METHODS: We retrospectively reviewed the records of 52 HIV-infected patients (47 male, 5 female; age range, 21-54 years) who were admitted to Boo-Ali Hospital, Zahedan, Iran for evaluation and management of an HIV-related disorders from April 2000 to December 2005. RESULTS: Tuberculosis (TB) was the most common opportunistic infections (53.8%) followed by hepatitis C (11.5%), typhoid (9.6%), amebiasis (9.6%), candidal esophagitis (5.7%), acute bacterial pneumonia (3.8%), and cerebral toxoplasmosis (1.9 %). Most of the cases of TB were pulmonary (36.5%). Apart from other well-recognized OIs, 2 cases of HIV-associated lymphoma were encountered. Only 12 patients (23.07%) received antiretroviral therapy. Five patients (9.6%) died during hospital stay due to tuberculosis (4 cases) and typhoid (1 case). CONCLUSION: The findings show that opportunistic infections are common in HIV-infected patients in Zahedan, southeast of Iran. Tuberculosis remains the most common OIs and is the most common cause of death in these patients.