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Galactomannan Enzyme Immunoassay (GM-EIA) is proved to be a cornerstone in the diagnosis of COVID-19-associated pulmonary aspergillosis (CAPA), its use is limited in middle and low-income countries, where the application of simple and rapid test, including Galactomannan Lateral Flow Assay (GM-LFA), is highly appreciated. Despite such merits, limited studies directly compared GM-LFA with GM-EIA. Herein we compared the diagnostic features of GM-LFA, GM-EIA and bronchoalveolar lavage (BAL) culture for CAPA diagnosis in Iran, a developing country.Diagnostic performances of GM-LFA and GM-EIA in BAL (GM indexes ≥1) and serum (GM indexes0.5), i.e. sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) and areas under the curve (AUC), were evaluated using BAL (n = 105) and serum (n = 101) samples from mechanically ventilated COVID-19 patients in intensive care units. Patients were classified based on the presence of host factors, radiological findings and mycological evidences according to 2020 ECMM/ISHAM consensus criteria for CAPA diagnosis.The Aspergillus GM-LFA for serum and BAL samples showed a sensitivity of 56.3% and 60.6%, specificity of 94.2% and 88.9%, PPV of 81.8% and 71.4%, NPV of 82.3% and 83.1%, when compared with BAL culture, respectively. GM-EIA showed sensitivities of 46.9% and 54.5%, specificities of 100% and 91.7%, PPVs of 100% and 75%, NPVs of 80.2% and 81.5% for serum and BAL samples, respectively.Our study found GM-LFA as a reliable simple and rapid diagnostic tool, which could circumvent the shortcomings of culture and GM-EIA and be pivotal in timely initiation of antifungal treatment.

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Objectives Invasive pulmonary aspergillosis is a well-known complication in COVID-19 patients. A reliable and early diagnosis is essential for the early initiation of antifungal therapy. On the other hand, conventional Bronchoalveolar lavage (BAL) culture may lack the specificity of differentiating between colonization and infection. Here, we aimed a comparative analysis of Galactomannan Lateral Flow Assay (GM-LFA), Galactomannan Enzyme Immunoassay (GM-EIA), and BAL culture for diagnosis of COVID-19-associated pulmonary aspergillosis (CAPA). Methods BAL (n = 105) and serum samples (n = 101) from COVID-19 patients who were mechanically ventilated for ≥4 days in intensive care units (ICUs) were evaluated by GM-LFA and GM-EIA. All BAL samples were cultured on Sabouraud-Chloramphenicol dextrose Agar. Diagnostic performance of GM-LFA and GM-EIA in BAL (GM indexes ≥1) and serum (GM indexes >0.5) were evaluated and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) and Roc curve compared with BAL culture calculated. Results The Aspergillus GM-LFA for serum and BAL samples showed a sensitivity of 46.9% and 54.5%, specificity of 100% and 91.7%, PPV of 100% and 75%, and NPV of 80.2% and 81.5%, when compared with BAL culture, respectively. GM-EIA showed sensitivities of 56.3% and 60.6%, specificities of 94.2% and 88.9%, PPVs of 81.8% and 71.4%, and NPVs of 82.3% and 83.1% for serum and BAL samples, respectively. Conclusion According to our results BAL GM detection using both EIA and LFA may be a promising approach for early diagnosis of CAPA and differentiating between colonization and invasive infection.

Background: In the last decade, several cases of cutaneous leishmaniasis (CL) have been recorded by the provincial health center of Mazandaran Province, northern Iran. However, there is no documented report of autochthonous CL in the province yet. Case Presentation: The patient, a 59-year-old female, known case of diabetes mellitus, lived in therural area of Kiasar district (in theeastern part of the Mazandaran) with 5 skin lesions suspected of having vasculitis, without ahistory of traveling to the endemic areas of CL,was admitted to Imam Khomeini teaching hospital, Sari. To rule out CL, fine needle aspiration(FNA)procedure was used aseptically for the patient. Laboratory investigations showed Leishman bodies (amastigotes) by direct smear preparation, and species identification confirmed Leishmania major (L. major) by polymerase chain reaction (PCR)molecular method. Accordingly, this is the first documented report of autochthonous CL in Mazandaran Province. Conclusion: Overall, due to the abundance of probable rodent reservoir hosts and confirmation of infectionof sandflies (Phlebotomus papatasi) withL. major in the Kiasar district, where our patient was livingthere, it seems that CL emerged in the eastern part of the province. Therefore, further studies on rodents and sandflies fauna in terms of emerging leishmanial infection in the area is recommended.

Background: Toxoplasmosis is a worldwide infection caused by the Toxoplasma gondii, an obligate intracellular protozoan. Approximately one-third of the world’s population is chronically infected by T. gondii. This study was conducted to determinate the anti-T. gondii antibodies (IgG and IgM) in the rural population of Qaemshahr, northern Iran in 2019. Material and methods: Sera of 350 individuals referred to the laboratories of the rural health centers in Qaemshahr city northern Iran were collected from February to April 2019 and were assessed for anti-T. gondii (IgG and IgM) antibodies using the ELISA kits (Pishtazteb, Iran). The results were analyzed using the Chi-Square test. Results: Totally, 296 (84.57%, 95% CI: 80.07-88.2 %) out of 350 sera were positive for anti-T.gondii IgG antibody. There was a significant correlation between the age group (p =0.000), soil contact (p=0.000), job and positive anti-T. gondii IgG antibody. No samples were positive for anti-T.gondii IgM antibody. No significant association was observed between the seroprevalence of T.gondii with the gender, contact with the cat and other animals, ingestion of the undercooked meat, non-chlorinated water, undercooked egg and raw milk and vegetables. Conclusions: Results of the study showed that the prevalence of toxoplasmosis was much higher among the rural individuals in the Qaemshahr city northern Iran than those previously reported from other areas of Iran. Thus, the efforts should be focused on public health education to reduce the chance of toxoplasmosis transmission especially in the high-risk groups in this region.

Rhino-orbito-cerebral mucormycosis (ROCM) is a progressive and life-threatening disease that is caused by a fungal infection. Every uncontrolled diabetic patient with a skin lesion on their head and neck, sinusitis symptoms, headache, and orbital edema should be evaluated for mucormycosis.

Background Limited studies have been conducted on patients with renal function recovery regarding severe leptospirosis. The purpose of this study is to evaluate the effectiveness of N-acetylcysteine (NAC) in accelerating the reduction of serum creatinine in patients with leptospirosis. Patients and methods This is a clinical trial study involving 64 patients with leptospirosis, with microscopic agglutination tests used to confirm the diagnosis of acute kidney injury. NAC was given to patients with a glomerular filtration rate of less than 60 ml/min at 1200 mg every 12 h, and it lasted for 48 h. Next, 32 patients were measured and the relationship between the length of hospitalization, age, and sex was also examined. Additionally, the two groups of case and control were compared in terms of the rate of decrease in serum creatinine level in three different time periods. The Shapro-Wilk test was used to investigate the distribution of data. Results No significant differences were observed in the decrease in serum creatinine level on the first, third, and seventh days of hospitalization and also in the use of NAC between the case and control groups (P = 0.255). In addition, the use of NAC had no significant effect on reducing the length of hospitalization (P = 0.067). Conclusion Recovery of acute kidney injury following leptospirosis and drugs that accelerate the healing process in these patients require further studies with greater sample size and longer follow-up time., Highlights • Evaluation of the effectiveness of N-acetylcysteine in patients with leptospirosis. • The use of N-acetylcysteine has been effective in patients with renal failure following leptospirosis. • Recovery of AKI following leptospirosis that accelerate the healing process in these patients require further studies with greater sample size and longer follow-up time.

Background: Recent studies from multiple countries have shown a high prevalence of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) among severely ill patients. Despite providing valuable insight into the clinical management of CAPA, large-scale prospective studies are limited. Here, we report on one of the largest multicenter epidemiological studies to explore the clinical features and prevalence of COVID-19-associated pulmonary mold infections (CAPMIs) among mechanically ventilated patients.Methods: Bronchoalveolar lavage (BAL) and serum samples were collected for culture, galactomannan (GM), and β-D-glucan (BDG) testing. Patients were classified as probable CAPMI based on the presence of host factors, radiological findings, and mycological criteria.Results: During the study period, 302 COVID-19 patients were admitted to intensive care units (ICUs), among whom 105 were mechanically ventilated for ≥4 days. Probable CAPMI was observed among 38% of patients (40/105), among whom BAL culture of 29 patients turned positive for molds, while galactomannan testing on BAL (GM index ≥1) and serum (GM index >0.5) samples were positive for 60% (24/40) and 37.5% (15/39) of patients, respectively. Aspergillus (22/29; 75.8%) and Fusarium (6/29; 20.6%) constituted 96.5% of the molds isolated. Diaporthe foeniculina was isolated from a COVID-19 patient. None of the patients who presented with CAPMI were treated with antifungal drugs.Conclusion: Despite being prevalent, the absence of appropriate antifungal treatment highlights that CAPMI is a neglected complication among mechanically ventilated COVID-19 patients admitted to ICUs. CAPMI can be caused by species other than Aspergillus.

Wound infections due to snake bites such as cellulitis and necrotizing fasciitis, although not common, are seen in snake bites and if left untreated can cause serious complications.

Background The aim of this clinical trial was to evaluate the effects of febuxostat (FBX) in comparison with hydroxychloroquine (HCQ) on clinical symptoms, laboratory tests and chest CT findings in outpatients with moderate symptoms of COVID-19 infection. Methods We conducted a clinical trial involving adult outpatients with the moderate respiratory illness following COVID-19 infection. Patients were randomly assigned to receive either FBX or HCQ for 5 days. The measured variables were needs to hospitalisation, clinical and laboratory data including fever, cough, breathing rate, C-Reactive Protein level, lymphocytes count at onset of admission and was well as at 5 days of treatments. In addition, CT findings were evaluated on admission and 14 days after initiation of treatment. Results Sixty subjects were enrolled in the study with a 1 to 1 ratio in FBX and HCQ groups. On admission, fever (66.7%), cough (87%), tachypnoea (44.4%), dyspnoea (35%), elevated CRP value (94.4%) and lung involvement according to chest CT (100%) were documented in enrolled patients with insignificant difference between FBX and HCQ groups. Fever, cough and tachypnoea were significantly mitigated in both groups after five days of treatments without any significant differences between groups. The mean percentages of lung involvement were significantly reduced to 7.3% and 8% after 14 days of treatment with FBX and HCQ, respectively. In adult outpatients with moderate COVID-19 infection, the effectiveness of FBX and HCQ was not different in terms of resolution of clinical manifestations, laboratory tests and lung CT findings. Conclusion This trial suggests that FBX is as an alternative treatment to HCQ for COVID-19 infection and may be considered in patients with a contraindication or precaution to HCQ.

BACKGROUND: In December 2019, coronavirus (CoV) disease 2019 (COVID-19) was detected in Wuhan, China, which is known as severe acute respiratory syndrome CoV 2 (Severe acute respiratory syndrome [SARS]-CoV-2). AIM: This study attempted a narrative review of the researches about COVID-19 in children. METHODS: We searched all articles between 2000 and April 2020 in PubMed, Scopus, and ScienceDirect related to COVID-19 in children, using the following terms: “COVID-19,” “coronavirus,” “SARS-CoV-2” in combination with “pediatrics,” or “children.” RESULTS: The most common method of transmitting the disease to children was through close contact with family members through respiratory droplets. Coinfection is common in pediatric with COVID-19 infection. One of the most important transmission routes is oral feces. The severity of the disease was mild or asymptomatic in most children. The most common clinical symptoms were fever and cough, and gastrointestinal symptoms were more common in children than in adults. Infants and preschoolers had more severe clinical symptoms than older children. The most common radiographic findings from the lungs were bilateral ground-glass opacity. Increased procalcitonin and lactate dehydrogenase should be considered in children. The use of intravenous immunoglobulin, lopinavir/ritonavir, and oseltamivir, along with oxygen therapy, had the greatest effect on improving children’s conditions. CONCLUSIONS: The most important way to prevent this disease in children is to follow the health tips of family members. Although the number of children with the disease is low, children are vulnerable to infection. Antiviral medications along with the use of muscle relaxants and oxygen therapy have a great impact on children’s condition.

Empyema necessitans (EN) is a kind of empyema that diffuses to extrapleural space and can involve chest pain. Tuberculosis (TB) is the most common cause of EN. This disease can be found in both immunocompromised and immunocompetent individuals but is usually seen in the immunocompromised individuals. Because of long duration and ambiguous symptoms of the disease, diagnosis can be hard. The disease can be treated both medically and surgically. Missing the disease can lead to undesirable effects on patient’s condition and health care setting. This problem can be seen in endemic area in which controlling of TB is hard. Report of the disease in local health care center for desirable treatment and health maintenance is necessary. We explained a rare case of pulmonary TB in a patient that was healthy in other fields and just showed the minimum systemic symptoms. The patient came with a mass in lower part of back of chest cage, with a mild pain. The imaging survey showed EN. Smear and Ziehl-Neelsen stains from subcutaneous aspiration were positive for TB. This case showed importance of clinical view and awareness of this silent but serious disease in endemic area especially for TB.

An estimated 185 million people worldwide are infected with hepatitis C virus (HCV). Combination therapy with pegylated interferon-α (peg IFN) and ribavirin is the first line of treatment against the psychiatric side effects, including mood disorders, anxiety and irritability. In the present study, all of the studies electronically published between 2000 and 2016 were retrieved using databases including Scopus, PubMed, Institute for Scientific Information, Science Direct and Google Scholar. All of the articles were independently evaluated by two reviewers and the results were compared, followed by removal of duplicate, irrelevant and re-published studies after reviewing. The studies were assessed based on the heterogeneity of their results using the Cochrane test and I2 analysis. All groups included neuropsychiatric side effects, fatigue was reported at the highest rate in 60.41% [95% confidence interval (CI)=39.18-81.64%] and insomnia was reported at a lower rate in 16.28% of cases (95% CI=6.59-25.98%). In conclusion, the present meta-analysis indicated that treatment with peg IFN + ribavirin or interferon only is associated with a wide range of neuropsychiatric side effects, including fatigue, mood disorders, anxiety, irritability, emotional ability and agitation.

Context: Cervical and genital infections are responsible for the more common sexually transmitted cancers among women aged 14 - 55 years. There are more than 100 HPV types which cause 60% - 70% (high risk types: 16, 18) and 90% (low risk types: 6, 11) cervical cancers. This study aimed to evaluate the efficacy of L1 protein vaccines against cervical and vaginal cancer.Evidence Acquisition: Different databases (including Scopus, Google scholar, PubMed, Cochrane, and Science Direct) were searched using relevant keywords such as Gardasil, Cervarix, and cervical cancer. After restricting the search strategy and excluding duplicates, the remained articles were screened by investigating their titles, abstracts, and full texts. Cochrane Q-test and I-squared index were used to detect the heterogeneity among the results, and fixed effect model was applied to estimate the pooled risk ratio.Results By combining the results of 10 primary articles, the efficacy of monovalent (HPV16), bivalent (HPV 16, 18), and quadrivalent (HPV16,11,6,8) vaccines was estimated between 86% and 100%.Conclusions The results of this meta-analysis showed that Gardasil and Cervarix vaccines are highly effective against cervical cancer. According to the point that approximately 50% of cervical cancers and human carcinogenicity are related to HPV-16 infection, the bivalent HPV vaccine might have protective effects against HPV-16 CIN2-3 lesion and cervical cancer.