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Introduction: Polymyositis is an idiopathic inflammatory myopathy that mainly manifests itself with muscle weakness. Patients with polymyositis have a higher risk of developing infections and malignancies. We report concurrent pulmonary and cerebral lesions in a polymyositis patient with many diagnostic challenges. Case Presentation: A 56-year-old woman complained of a productive cough and dyspnea from two weeks ago. Her symptoms gradually progressed until a sudden loss of consciousness occurred. She was a known case of polymyositis and was treated with oral prednisolone. Imaging revealed concurrent pulmonary and cerebral lesions. Initially, the patient underwent empirical therapy. However, the patient underwent a bronchoscopy because she did not respond to treatment. Specimens obtained from respiratory secretions revealed branched septate hyphae, and the culture was positive for Aspergillus fumigatus. She was diagnosed with invasive aspergillosis, so we replaced the therapy with voriconazole. After three months, the lung lesions improved, but the number and extent of cerebral lesions increased. Finally, after a stereotactic biopsy, the patient was diagnosed with astrocytoma and became a candidate for radiotherapy. Conclusions: Patients with polymyositis are prone to contracting opportunistic infections and malignancies. Both of them can mimic each other and present diagnostic challenges to physicians. Thus, they should think about them for early diagnosis and timely treatment.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) can cause serious infections not only in hospitals but also in the community. The present study was aimed to characterize drug resistance and virulence determinants of community-associated (CA) MRSA isolate compared with healthcare-associated (HA) MRSA. Materials and Methods: A total of 44 patients with HA-MRSA and 11 patients with CA-MRSA infection (median age, 72 years) were included. The clinical isolates of MRSA were subjected to molecular analysis of virulence genes and drug susceptibility testing. Results: Panton-Valentine leucocidin (PVL) exotoxin and toxic shock syndrome toxin (TSST) genes were disproportionately distributed between CA- and HA-isolates. PVL genes were more likely to be found among CA-isolates (36.4%) than HA-isolates (18.2). TSST genes were identified in only 2 CA-MRSA isolates tested (18.2%) compared with 9 HA-isolates (20.5%). Exfoliative toxin- b gene was negative in all isolates, however, one HA-isolate was positive for exfoliative toxin-a. mec-A gene was present in all clinical isolates. CA-isolates were more likely to be susceptible to trimethoprim-sulfamethoxazole and vancomycin compared with HA-isolates. Vancomycin-intermediate resistance was found in 2 HA-isolates. All clinical isolates were also resistant to clindamycin. Conclusions: CA- and HA- MRSA isolates are epidemiologically and microbiologically distinct. Thus, the strategies to prevent and treat these infections would be different. Patients with CA- and HA-MRSA infections should be treated effectively and receive follow-up evaluation to ensure the resolution of their infection. Surveillance studies should be conducted to determine the extent of CA- and HA-MRSA dissemination in Iran.

In late December 2019, a series of unexplained cases of pneumonia were reported in Wuhan, China. On January 12, 2020, the World Health Organization temporarily named the virus responsible for the emerging cases of pneumonia as the 2019 coronavirus. Acute respiratory distress syndrome (ARDS) due to Covid-19 has rapidly spread around the world, and while no specific treatment or vaccine has been reported, mortality rates remain high. One of the suggested treatments for cellular damage in the pathogenesis of ARDS caused by the coronavirus is the administration of high doses of intravenous vitamin C. Considering the paucity of literature on the therapeutic effects of high doses of intravenous vitamin C in patients with ARDS resulting from the coronavirus, this study was conducted to assess this therapeutic supplement in these patients.This study was performed as a single-center clinical trial in patients with a documented diagnosis of COVID-19 pneumonia. 54 eligible patients with moderate to severe COVID-19 symptoms, based on specific inclusion and exclusion criteria, were included in the investigation and randomly divided into two groups. The control group consisted of 26 patients who received standard treatment, whereas the treatment group was comprised of 18 patients administered intravenous vitamin C at a dose of 2 g every 6 hours for 5 days in addition to standard treatment. Demographic characteristics, underlying diseases, length of hospital stay, and mortality rates were reviewed and collected. Oxygen saturation, respiratory rates, serum C Reactive Protein (CRP) levels, lymphopenia and lung parenchymal involvement on CT were investigated at the time of admission and on the sixth day after hospitalization. Finally, all variables were analyzed with IBM SPSS Statistics 23 software and a significant statistical difference was defined for all variables, P0.05.Of these variables, the amount of oxygen saturation in the vitamin C group increased significantly from 86±5% on the first day of hospitalization to 90±3% on the sixth day of hospitalization (P value=0.02). Also, the respiratory rate in the vitamin C group decreased significantly from 27±3 on the first day of hospitalization to 24±3 on the sixth day of hospitalization (P value=0.03). Lung CT scans of patients in the two groups reported by two radiologists were also compared. Based on the report of the radiologists, the rate of lung involvement in the vitamin C group was significantly lower than in the control group at the end of treatment (P value=0.02).Due to the effectiveness of high doses of intravenous vitamin C on reducing lung involvement and improving clinical symptoms, further studies with a larger sample size are recommended to demonstrate the effects of this drug supplement.

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.

Aim: The present study seeks to provide insight into the management of patients with chronic kidney disease (CKD) infected with COVID-19.Material and methods: Patients with COVID-19 were included in the study if they met the inclusion criteria. 78 eligible patients were divided into four groups. After reviewing clinical charts, nursing records, laboratory findings, radiological reports and other medical records of CKD patients with COVID-19 confirmed infection, clinical presentation, laboratory data, radiology findings, and results were extracted from documented medical records using data collection forms. laboratory tests were performed again before discharge. Independent t-test, paired t-test, and chi-square were used to compare the clinical features of patients with COVID-19. A P< 0.05 was considered to indicate statistical significance. All the statistical analyses were performed by the SPSS. v 26.0.Results: Hypertension (72.5%), diabetes (63.8%), and Cardiovascular disease (38.2%) were the most common among patients, respectively. Among all participants, 40 (52.6%) patients died. The most common symptom was dyspnea (56.6%), followed by dry cough (38.7%). Comparison of blood, inflammatory, biochemical, and clinical indices between the four groups in patients show that LDH (P=0.022), AST (P=0.038), and ALT (P= 0.004) indices were significantly different between groups of patients. According to the results in Table 3, Unilateral ground-glass opacity (GGO) in the radiological findings of the Non-dialysis CKD group was significantly (P=0.50) higher than the other groups.Conclusion: It can be concluded that CKD is an important factor that can cause poor prognosis in COVID-19 patients.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) spread widely all around the world and has infected too many healthcare workers (HCWs) as the pioneers combating coronavirus disease 2019 (COVID-19). This study aims to evaluate the symptoms and outcome of medical staff from a tertiary hospital in Tehran, Iran.The diagnoses of 29 HCWs presenting COVID-19 symptoms were confirmed by molecular and imaging studies. Epidemiologic and disease-related data were collected via phone calls and filling a questionnaire and then analyzed descriptively.Eighteen (62.1%) of the affected HCWs were males. The mean age of them was 41.86 years with a lower average (38.27) for females than males. Nurses comprised 41.4% of our population. Only 2 (6.9%) patients were admitted to the respiratory care unit (RCU) (), marked as critical patients. The most presented symptoms were fever (79.3%) and dyspnea (79.3%). Overall, 55.2% of them had a longer exposure time (more than a week), which was more frequent in men than women.Fever was the most prevalent symptom among the study group. Even though the clinical features of COVID-19 among HCWs cannot be copiously determined by this study, it highlights the requirement for comparative studies to illustrate differences among HCWs and the general population. There might be an association between the duration of the exposure and the risk of the infection in men.

Objectives: The present study seeks to provide insight into managing patients with chronic kidney disease (CKD) infected with COVID-19.Methods: Patients with COVID-19 with CKD were included in the study. The eligible patients were divided into four groups: 1) patients who were not on dialysis, 2) patients on maintenance dialysis, 3) patients who underwent dialysis following COVID-19, 4) patients with a history of a kidney transplant. After reviewing clinical charts, nursing records, laboratory findings, radiological reports, and other medical records of CKD patients with COVID-19 confirmed infection, clinical presentation, laboratory data, radiology findings, and results were extracted from documented medical records. The epidemiological, clinical, laboratory and outcome characteristics of the subgroups were evaluated and compared.Results: Seventy-eight patients were included into the study. Hypertension (50 cases, 72.5%), diabetes (44 cases, 63.8%), and Cardiovascular disease (26 cases, 38.2%) were the most common risk factors in the studied patients. Among all participants, 40 (52.6%) patients died. The most common symptom was dyspnea (56.6%), followed by dry cough (38.7%). Comparison of blood, inflammatory, biochemical, and clinical indices among the patients' groups show that LDH (P=0.022), AST (P=0.038), and ALT (P= 0.004) indices were significantly different between groups of patients. According to the results in Table 3, Unilateral ground-glass opacity (GGO) in the radiological findings of the Non-dialysis CKD group was significantly (P=0.50) higher than the other groups.Conclusion: It can be concluded that CKD is one of the critical factors that can cause poor prognosis in COVID-19 patients. J Microbiol Infect Dis 2021; 11(3):152-158.

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.

Tuberculosis (TB) is a serious public health problem worldwide, particularly in developing countries. The most common presentation of TB is the pulmonary form; however, extrapulmonary manifestations are not uncommon, particularly in the immunocompromised patients. TB of the central nervous system is the most severe extrapulmonary presentation. We report a post-kidney transplant patient who had multiple ring-like lesions on contrast-enhanced magnetic resonance imaging (MRI). Based on the results of MRI and biopsy specimen, the patient was diagnosed with multiple intracranial tuberculomas. He was treated successfully with a standard quadruple therapy of rifampicin, isoniazid, ethambutol and pyrazinamide.

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.

Introduction: Nocardia cyriacigeorgica is a common environmental organism isolated from different clinical samples in Europe, Asia, and North America, predominantly from respiratory samples, but also from samples from several other sites. Case Presentation: In the current paper a disseminated Nocardia cyriacigeorgica infection in an immunocompromised patient was reported. The patient was admitted to the under study hospital with multiple cutaneous abscess such as lesion and paraspinal abscess developed to brain abscess. Conclusions: Nocardia cyriacigeorgica was isolated from a sample of skin lesion based on phenotypic properties and sequencing method. Limited cases of Nocardia cyriacigeorgica in Iran are reported.

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.

Introduction: Invasive mucormycosis is an opportunistic fungal infection in patients with predisposing factors. Case Presentation: We report a case of sino-orbito-cerebral mucormycosis in a diabetic patient successfully treated with combination of liposomal amphotericin B (L-AMB) and posaconazole. Conclusions: Clinicians should be alert of the clinical presentation of this fulminant fungal infection and notice that prompt diagnosis can be life-saving. Moreover, combination regimens may be considered as an option of treatment failure.

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: The aim of this study was to determine hepatitis B surface antigen (HBsAg) seroclearance rate among patients treated with lamivudine at a specialized tertiary care referral hospital in Tehran, Iran. METHODS: All patients on lamivudine (biovudin®) therapy at a dose of 100 mg/day, who showed seroclearnace between March 2001 and September 2011 were recruited. The main evaluation parameters were duration of HBsAg seroclearance and duration of HBsAg seroconversion. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were evaluated using standard methods. HBsAg seroclearance was defined as two consecutive negative serums HBsAg at least 6 months apart, whereas HBsAg seroconversion was defined as the disappearance of serum HBsAg and the presence of anti-HBs for >6 months. RESULTS: A total of 203 chronic HBV patients treated with lamivudine at a dose of 100 mg/day were included in the study. HBsAg seroclearance and seroconversion were observed in 11 patients after the initiation of the lamivudine therapy. Overall, in lamivudine responder patients, the mean time to HBsAg seroclearance was 26.90±10.93 months (range: 12-48 months). Furthermore, the responders showed seroconversion after a mean time of 26.90±11.08 months from the initiation of lamivudine therapy. When comparing the characteristics of those who have responded to lamivudine and those who have not responded, baseline HBV-DNA levels was significantly lower in responder than non responder patients (p

Background: New data indicates that vancomycin may be less effective against methicillin-resistant Staphylococcus aureus (MRSA) infections with minimum inhibition concentration (MIC) within a sensitive range. Objectives: The aim of this study was to determine the distribution of the vancomycin MIC between MRSA strains and observe the difference in mortality between patients, while the influence of changes in MIC on the efficacy of vancomycin was also examined. Patients and Methods: A routine date-based study was conducted on 41 MRSA isolates in a hospital in Tehran, Iran. The isolates were assessed for MIC by using the E-test method, and results were categorized into three groups: A (MIC < 1.5 μg/mL), B (1.5 ≤ MIC < 2 μg/mL) and C (MIC ≥ 2 μg/mL) MRSA. Results: Group A was the most common group, followed by groups C and B. Although there was no statistically significant difference between patients’ mortality with the MIC group, the mortality rate of group A was higher than C and B. Conclusions: Regarding Clinical and Laboratory Standards Institute (CLSI) definition for vancomycin susceptibility (MIC < 2 μg/mL), it seems that vancomycin may not be considered as the best antibiotic in order to treat heteroresistant vancomycin intermediate S. aureus (hVISA) and vancomycin sensitive S. aureus (VSSA) infections, and a new breakpoint for vancomycin and alternative antibiotics should be considered.

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.

Neutropenic patients are vulnerable to a wide spectrum of infectious agents. The aim of this study was to determine the current frequency of bacterial infections in patients with nosocomial fever and neutropenia.In a retrospective study, the neutropenic patients' specimens with nosocomial fever were cultured on blood and MacConkey agar plates and evaluated at microbiology laboratory. Ninety-five significant isolates as species level were recognized by bacteriological techniques.The most observed microorganism was Escherichia coli, followed by Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, Coagulase positive staphylococci and Coagulase negative staphylococci. One fungal infection was also observed. Overall, 67% of the organisms were gram negative, 29.8% gram positive, and 3.2% polymicrobial.The changing pattern of infectious agents in neutropenic patients overtime postulates the necessity of other studies to give the most up-to-date insight of the organisms to physicians.

Mucormycosis is an uncommon infection that afflicts severely immunocompromised patients and those with poorly controlled diabetes mellitus. In a r etrospective study we evaluated nine cases of mucormycosis in several tertiary care hospitals in Tehran, Iran during several years. Clinical manifestations, diagnosis including laboratory and radiologic study, management including surgical and medical inte rventions were evaluated.