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Objective: Bacterial gastroenteritis is a significant public health concern, capable of causing severe infections. Among the various pathogens involved, those belonging to the Enterobacteriaceae family are the most frequently isolated and associated with gastrointestinal disorders. This study aimed to investigate the prevalence of common diarrheagenic Enterobacteriaceae in Iran over the past two decades, from 2000 to 2023. Methods: A comprehensive systematic search was conducted across multiple databases, including EMBASE, HINARI, MEDLINE, PubMed, Google Scholar, and the Cochrane Library. The focus was on observational published studies reporting the prevalence of diarrheagenic Enterobacteriaceae in Iran during 2000 and 2023. The criteria did not restrict patient demographics such as age, gender, health conditions, or occupation. This meta-analysis employed a 95% confidence interval (CI) for analysis. Evidence of heterogeneity was determined using an I² value greater than 50%. To explore potential sources of heterogeneity, subgroup analysis and meta-regression analysis were performed. Statistical analyses were executed using R version 4.3.2 along with the meta package. A p-value less than 0.05 was considered statistically significant. Results: Out of 3,701 papers reviewed, 56 studies met the inclusion criteria and were analyzed. The overall pooled prevalence of diarrheagenic Enterobacteriaceae species from 2000 to 2023 was 14.0% (95% CI: 0.11–0.17). Subgroup analysis revealed Shigella spp. had the highest prevalence at 18.0% (95% CI: 0.13–0.24; I²=99%), followed by diarrheagenic Escherichia coli at 11.0% (95% CI: 0.09–0.15; I²=97%), Salmonella spp. at 9.0% (95% CI: 0.05–0.17; I²=99%), and Yersinia spp. at 2.0% (95% CI: 0.00-0.10; I²=94%). Prevalence trends showed Shigella spp. increasing from 4% (95% CI: 0.03–0.08) in 2000–2004 to 36% (95% CI: 0.20–0.55) in 2021–2023. Diarrheagenic E. coli (DEC) showed no clear pattern, ranging from 5% (95% CI: 0.01–0.24) to 17% (95% CI: 0.07–0.36). Salmonella spp. exhibited more significant fluctuations, rising from 6% (95% CI) in both 2000–2004 and 2005–2008 periods to 20% (95% CI: 0.03–0.66) in 2009–2012 and 30% (95% CI: 0.11–0.60) in 2017–2020. Yersinia spp. was only determined in 2000–2004 with a pool prevalence of 12% (95% CI: 0.00-0.91). Sub-species analysis revealed Shigella sonnei was the most prevalent species among Shigella spp. in Iran, accounting for 42% of cases (95% CI: 0.33–0.52). Regarding DEC species, Enteroaggregative E. coli (EAEC) and Enterotpathogenic E. coli (EPEC) had the highest rate at 15% (95% CI). Furthermore, a pool prevalence of 2% (95% CI: 0.00-0.89) was reported for Yersinia enterocolitica among diarrheagenic Enterobacteriaceae in Iran. Conclusion: This meta-analysis provides valuable insights into the prevalence of diarrheagenic Enterobacteriaceae in Iran over the past two decades. The findings highlight the significant impact of these pathogens on public health, with Shigella spp. showing the highest prevalence and increasing trends. Further research should investigate the factors contributing to the prevalence of diarrheagenic Enterobacteriaceae, including genetic diversity of diarrheagenic Enterobacteriaceae isolates, molecular mechanisms underlying the virulence of these pathogens, or antibiotic resistance patterns. [ABSTRACT FROM AUTHOR]

Coexisting pulmonary aspergillosis and tuberculosis in a post-COVID-19 patient is rare. Here, we are going to report a case of combined pulmonary aspergillosis and tuberculosis in a 51-year-old female who was previously diagnosed with COVID-19 pneumonia. The patient was treated with voriconazole and anti-tuberculosis agents. [ABSTRACT FROM AUTHOR]

Cytomegalovirus (CMV) infection is not common in immunocompetent patient. This study is a case report of a 60-year-old man with no evidence of immunocompromised history, who died from CMV-associated encephalitis. The patient presented with a 5-month headache whose pattern and severity changed in the past few days, coffee ground vomiting, and three times seizure. The condition caused his level of consciousness to decrease, he didn’t respond to the primary empirical treatment, and the primary paraclinical work up had no specific findings. Magnetic resonance imaging (MRI) showed normal pressure hydrocephalus, and cerebrospinal fluid (CSF) analysis had aseptic pattern, blood culture was negative, and CSF culture was negative too. After that multiplex polymerase chain reaction (PCR) was done on the CSF, which was positive for CMV. Foscarnet therapy was initiated for the patient, but it was too late, and the patient did not respond to these treatments. Finally, the patient died. It is too important to diagnose these conditions and initiate therapy as soon as possible. [ABSTRACT FROM AUTHOR]

Legionella pneumophila is a thin, aerobic, Gram-negative, pathogenic bacillus and the leading cause of Legionnaires’ disease (LD) in human, especially those with high risk conditions including immune system disorders or chronic lung diseases. The mortality rate of LD has been reported to be 60% or higher in inappropriately treated cases. Investigating the prevalence of L. pneumophila and identifying contaminated sources in hospital settings are essential steps that should be taken to control the disease and evaluate the efficacy of interventional strategies. Currently, the culture method is considered as the “gold standard” for detection of L. pneumophila and LD diagnosis. In this case report of severe LD in Iran, we studied a 60-year-old male patient with underlying chronic obstructive pulmonary disease (COPD). We also presented the clinical and pathophysiological features of LD as well as its diagnostic and therapeutic methods. The importance of early diagnosis of L. pneumophila infection in patients with COPD is also highlighted. [ABSTRACT FROM AUTHOR]

Introduction: Vibrio cholerae, the causative agent of cholera, has attracted a great deal of attention as one of the major causes of morbidity and mortality worldwide, especially in developing countries. In most laboratories, biochemical assays are primarily performed for possible detection of these strains, which are then followed by a PCR (polymerase chain reaction) test to verify their identity. This study aimed to optimize dot blot technique in order to detect Vibrio cholerae bacteria for V. cholera as an easy-to-use and beneficial method. Methods: A dot blot hybridization test was developed in this study to identify V. cholerae isolates as well as to assess the sensitivity and specificity of this test compared whit biochemical and PCR tests which are routinely performed for V. cholerae screening and detection in clinical specimens. Results: Herein, the dot blot hybridization test was optimized to detect V. cholerae. A combination of three biochemical assays and PCR test confirmed the results of dot blot hybridization test. This test was able to identify V. cholerae strains with a high sensitivity and specificity of 100%. Using the newly developed method, a set of 26 collected V. cholerae isolates from clinical samples were accurately identified. Conclusion: This study optimized dot blot technique as a simple and useful assay that could be employed in V. cholerae monitoring programs and strategies to effectively detect V. cholerae strains in surface water and fecal specimens. [ABSTRACT FROM AUTHOR]

Background and Objectives: The selection of alternative treatment options with antibiotic combinations may be used for successful managing of multidrug-resistant Acinetobacter baumannii. The aim of this study was to determine the synergistic effects of ampicillin-sulbactam combined with either levofloxacin or tigecycline against MDR A. baumannii. Materials and Methods: A total 124 of A.baumannii isolates collected from clinical samples of hospitalized patients which assessed for antibiotic susceptibility using disk diffusion method. E-test was used on 10 MDR A. baumannii isolates to determine the minimum inhibitory concentration (MIC) of ampicillin-sulbactam, levofloxacin and tigecycline. Any synergistic effects were evaluated at their own MIC using E-test assay at 37°C for 24 hours. Synergy was defined as a fractional inhibitory concentration index (FICI) of ≤0.5. Results: Levofloxacin plus ampicillin-sulbactam combination was found to have synergistic effects (FIC index: ≤0.5) in 90% of the isolates, but there was no synergistic effect for ampicillin-sulbactam/tigecycline and tigecycline/ levofloxacin combination. The antagonist effect in 50% of isolates (FIC index: >2) showed in combination of levofloxacin/tigecycline. Conclusion: The emergence of multidrug A. baumannii isolates requires evaluating by combination therapy. The combination of levofloxacin plus a bactericidal antibiotic such as ampicillin-sulbactam is recommended. Results should be confirmed by clinical studies. [ABSTRACT FROM AUTHOR]

Acinetobacter baumannii (A. baumannii) is an important nosocomial pathogen in healthcare institutions. β-Lactamase-mediated resistance is the most common mechanism for carbapenem resistance in A. baumannii. The aim of this study was to determine the antibiotic resistance pattern, to detect OXA encoding genes, class A, blaPER-1, and to detect the presence of ISAba1. A total of 124 A. baumannii isolates were collected from hospitalized patients in a teaching hospital in Kashan, Iran. The susceptibility of isolates to different antibiotics was determined by disk-diffusion method. PCR was used to detect blaPER-1, blaOXA-23, blaOXA-24, blaOXA-51, blaOXA-58, and ISAba1 genes. All isolates were resistant to ceftazidime, ceftriaxone, and cefotaxime. All of the isolates revealed susceptibility to polymyxin B and colistin. Ninety-six percent of the isolates were extensive drug resistance (XDR), 5.6% extended spectrum beta-lactamase (ESBL), and 54.8% metallo-beta-lactamase (MBL). All isolates were positive for blaOXA-51 and ISAba1. blaOXA-23,  blaOXA-24, and blaOXA-58 were found in 79.8%, 25%, and 3.2%, respectively. The frequency rate of blaPER-1 gene was 52.4%. Multidrug resistant A. baumannii isolates are increasing in our setting and extensively limit therapeutic options. The high rate presence of class D carbapenemase-encoding genes, mainly blaOXA-23 carbapenemases, is worrying and alarming as an emerging threat in our hospital. [ABSTRACT FROM AUTHOR]