Search

Infection is a significant cause of morbidity and mortality in patients with chronic kidney disease, especially who were under dialysis due to their depressed immunity. Toxoplasma gondii is a ubiquitous parasite that causes severe manifestations in immunocompromised patients. This case-control study was conducted to the immunodiagnosis and molecular validation of T. gondii infection among patients with end-stage renal disease undergoing haemodialysis. The study population consisted of 260 haemodialysis patients and 259 healthy controls referred to the main dialysis centres of Tehran, Iran during 2016. Anti-T. gondii immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies were assessed using enzyme-linked immunosorbent assay. As well, the T. gondii genomic DNA in whole blood samples of IgM-positive patients and healthy controls was evaluated using GRA6-polymerase chain reaction (PCR) and SAG1-loop-mediated isothermal amplification (LAMP) assays. The anti-T. gondii IgG and IgM antibodies were detected in 175 (67.3%) and 18 (7%) of haemodialysis patients and 122 (47%) and 4 (1.5%) of controls, respectively. Two of the 18 blood samples from IgM-positive patients and none of the IgM-positive control subjects were positive by GRA6-PCR. Whereas, nine and two blood samples of IgM-positive patients and controls were positive for Toxoplasma DNA by a SAG1-LAMP technique respectively. The seropositivity of the Toxoplasma IgM antibody was significantly different between haemodialysis patients and healthy controls which was confirmed by PCR and LAMP. The higher prevalence of T. gondii infection in haemodialysis patients compared with the controls proposes that these patients can be a group at risk for toxoplasmosis and screening for toxoplasmosis before dialysis is necessary for the patients.

Background: Rapid increase in nosocomial infections (NIs) due to antibiotic resistant organisms is a global issue, which causes significant morbidity in both patients and healthcare professionals ultimately leading to an extra cost on health care systems. Thus, studying NIs is a public health priority. Methods: The study was designed as a cross-sectional investigation between 2015 - 2017. Inpatient cases of selected hospitals with nosocomial infections were included. Demographics, source of infections, causative agents, and their antibiotic susceptibility through E-test method were collected. All data were analyzed using SPSS statistical software (version 19). Results: A total of 168 patients with NIs were identified. Of the patients, 100 (59.5%) cases were male. The intensive care unit had the highest infection rate (N = 100 (59.5%)) and bronchoalveolar lavage (BAL) (N = 58 (34.5%)) and Acinetobacter (N = 76 (47.5%)) were the most common source and organism of NI. Conclusions: Results of this study showed the dangerously high nosocomial infection rates, which necessitates considering surveillance of antibiotic usage and restriction of using broad spectrum antibiotics in infections.

Free-living amoebae (FLA) of the genus Acanthamoeba are opportunistic pathogenic agents able to cause life-threatening infections in immunosuppressed patients. Chronic kidney disease impairs adaptive and innate immunity. Thus, patients with chronic kidney disease are prone to opportunistic infections by potentially pathogenic FLA. Therefore, in the present study, the investigation of Acanthamoeba genotypes isolated from the oral cavity of hemodialysis patients of reference hospitals in Iran was aimed, using both morphology and molecular (sequence-based analysis) tools. Furthermore, classification of the strains at the genotype level was performed on the basis of differences in the diagnostic fraction 3 (DF3) region of the 18S rRNA gene. The pathogenic potential of the isolated amoebae was also determined using thermotolerance and osmotolerance assays. Out of the 187 oral cavity samples investigated, nine (4.8%) were positive for FLA. DNA sequencing of the ASA.A1 region of the 18S rRNA gene revealed that the isolated strains belonged to the Acanthamoeba T1 and T4 genotypes. Genotype T1 was isolated for the first time from a patient in Iran. Interestingly, the T1 strain (AN2 strain) exhibits a high pathogenic potential in tolerance assays. The pathogenicity assay revealed that five strains were able to grow at high temperatures (37-40 °C) and high osmolarity (0.5 and 1 M D-mannitol) conditions; thus, they were considered as potentially pathogenic strains. Moreover, two of the patients were positive for Vermamoeba genus. The present study is the first report of genotype T1 isolation in Iran and the first to identify the occurrence of Acanthamoeba and Vermamoeba genera in patients undergoing hemodialysis worldwide. Monitoring hemodialysis and renal failure patients should be a priority for possible control of Acanthamoeba and other FLA-related diseases.

Background Nosocomial infections are one of the health problems of modern societies, which are rising with unusual organisms. Acintobacter, which is the main cause of nosocomial infections such as pneumonia and nosocomial pneumonia, is caused by mechanical ventilation. Acinetobacter species are becoming resistant to antibiotics. One the most important agent of nosocomial infections with high mortality is infections by Acinetobacter baumannii which is Gram- negative opportunistic Coccobacilli. Treatment in these infections is difficult and sometimes impossible, due to multidrug resistance in strains isolated from nosocomial infections. Objectives The aim of the current study was to evaluate antibiotic resistance in A. baumannii isolates Khatam-Al-Anbia Hospital, Tehran, Iran. Methods In this cross-sectional study 100 of Acintobacter baumannii were isolated from hospitalized patients during 2013-2015 in Khatam-Al-Anbia hospital in Tehran. In this study samples of A. baumannii isolated from trachea, blood, urine, sputum and wound samples of patients bedridden in Intensive care unit (ICU) wards. Antimicrobial susceptibility and minimum inhibitory concentration (MIC) were determined by E-test methods. We used descriptive statistics to analyze the data by using SPSS 21 software. Results A total of 100 A. baumannii were isolated from clinical samples. The organism was resistant to rifampicin (46%), gentamicin (67%), meropenem (100%), piperacilin (98%), colistin (0%), and ceftazidin (96%). Conclusions The antibiotic resistance against most of the antibiotics especially meropenem is very high in this study. Moreover, colistin was most effective antibiotic to be used in A. baumannii infections. Colistin is the best choices for treatment of Acinetobacter.

Background: Over the past decade, Enterococci have been shown to be an important cause of nosocomial and community-acquired infections. Inappropriate use of antibiotics led to changes in the pattern of antibiotic resistances in Enterococcus species. Unfortunately, no study has been performed in Iran in recent years regarding the antimicrobial resistance of Enterococci using the E-test method as a base. We must gain sufficient knowledge about the regional antibiotic resistances related to Enterococcus so that we can monitor the prevalence and antimicrobial resistance of Enterococcus by administering appropriate treatments. Objectives: The objective of this study was to evaluate the antimicrobial susceptibility among Enterococcus species by the E-test method at Khatam-ol-Anbia hospital during 2013 - 2014. Patients and Methods: This descriptive cross-sectional study was carried out during 2013 - 2014. All clinical samples were collected from the intensive care unit (ICU) and general wards of Khatam-ol-Anbia hospital. All Enterococcus species were detected via biochemical testing. Antimicrobial susceptibility and minimum inhibitory concentration (MIC) were determined via disk diffusion and the E-test method. We used descriptive statistics to analyze the data. Results: A total of 53 Enterococci were isolated from clinical samples of blood, urine, wounds, sputum, and cerebrospinal fluid (CSF) over a two-year period from the ICU and general wards. The isolated Enterococcus species were 77.35% E. faecalis, 18.86% E. faecium, and 3.77% other species. Species evaluated by E-test were resistant to imipenem, ampicillin, co-trimoxazole, gentamicin, rifampicin, vancomycin, linezolid, and teicoplanin; 54%, 68%, 100%, 93.8%, 60.4%, 39.6%, 0%, and 29.2%, respectively. Among the strains of enterococci, 90.9% of E. faecium and 20% of E. faecalis species were resistant to vancomycin. Conclusions: According to these findings, antibiotic-resistance patterns have changed, and vancomycin resistance, especially among E. faecium, is rising because of nosocomial infections. Consequently, it has become a serious subject for patients admitted into a hospital.

Introduction: Toxoplasmosis is caused by infection with the obligate intracellular parasite Toxoplasma gondii. Toxoplasmosis is generally a late complication of HIV infection and usually occurs in patients with CD4+ T-cell counts below 200 cells/iL. Case Presentation: A case of cerebral toxoplasmosis is reported in a healthy 39-year-old woman who was admitted to hospital with the complaint of a headache. Gadolinium-enhanced brain magnetic resonance imaging (MRI) showed an irregular, ring enhancing, hyperintense lesion in the right temporoparietal lobe. Toxoplasma serology revealed raised IgG antibody levels. Based on the MRI features, biopsy, and serology, a diagnosis of cerebral toxoplasmosis was made. Conclusions: Cerebral toxoplasmosis can occur outside the setting of advanced HIV immunodeficiency or drug-induced immunosuppression. This highlights the fact that it should be considered in the differential diagnosis of opportunistic infections in HIV-negative patients.

Introduction: Malaria is the most important parasitic infection, which is now spread all over the globe. Malaria infections with more than two species, especially Plasmodium falciparum and P. vivax, are common, but infections with P. malariae and P. falciparum are rare. Case Presentation: A 33-year-old man presented with fever and chills for three days, pancytopenia, and abnormal liver function tests, Peripheral blood smear revealed P. falciparum and P. malariae. After artemisinin-based combination therapy, all of his symptoms subsided. Discussion: Mixed malaria infection is not uncommon, and it needs to be diagnosed and treated effectively in order to control the disease. Travel consultations should be given for all travelers before their trip to endemic countries.

Background: Resistance in enteric Gram-negative bacteria is of a great concern and concise local data are lacking. Objectives: To determine prevalence and antimicrobial susceptibility pattern of Extended Spectrum Beta-Lactamase (ESBL) and non-ESBL producing enteric Gram-negative bacteria. Materials and Methods: In a descriptive study in Tehran, patients' samples have been obtained and were inoculated on blood and MacConkey agar plates at microbiology laboratory hospital, and a total of 292 Gram-negative species were isolated at Microbiology Laboratory from patients' specimens. Susceptibility pattern was determined by disk diffusion method based on Kirby-Bauer method on Mueller-Hinton agar plate. SPSS 16 software (descriptive analysis, Chi-square) was used for statistical analysis of this study. Results: Escherichia coli was the most common organism [189 (64.7%)], followed by Acinetobacter baumannii [40 (13.7%)], Pseudomonas aeruginosa [32 (11%)], Klebsiella pneumoniae [26 (8.9%)], Proteus mirabilis [4 (1.4%)], and Serratia marcescense [1 (0.3%)]. 122 (41.8%) of isolates were classified as ESBL - producers. E. coli accounted for most of the ESBL-producer bacteria, followed by K. pneumoniae. 170 (58.2%) of isolates were non-ESBL producers. All of the ESBL producer isolates were sensitive to imipenem, piperacillin-tazobactam and colistin whereas resistance to these antibiotics in the non-ESBL group was seen. The rate of resistance to nitrofurantoin in ESBL group was lower than of that in non-ESBL group. The majority of the ESBL isolates of resistant to trimethoprim-sulfamethoxazole, ciprofloxacin, the third generation cephalosprins (ceftriaxone, cefixime, and cefotaxime), gentamicin and amikacin, were sensitive to nitrofurantoin. Conclusion: Although all ESBL producer Gram-negative bacteria were sensitive to imipenem, piperacillin-tazobactam, and colistin, non-ESBL isolates showed resistant pattern. Interestingly, notable percent of mentioned resistant isolates were sensitive to nitrofurantoin.

Actinomycosis is an infectious disease caused by a gram-positive anaerobic or microaerophilic Actinomyces species that causes both chronic suppurative and granulomatous inflammation. The following study reports a 48-year-old Iranian woman presenting with a spontaneous discharging sinus on the hard palate for 8months. The patient has no past medical history of note. Laboratory findings were unremarkable. The diagnosis was based on history and clinical evidence of the lesion confirmed by histopathological examination. The patient was treated with a regimen of oral ampicillin 500mg four times a day. She had a marked response to the treatment after 4weeks, and it was planned to continue the treatment for at least 6months with regular follow-up. To the best of the researchers’ knowledge, this is the first report of actinomycotic sinus tract of the hard palate in Iran.