Archives of Clinical Infectious Diseases
Year:2013 | Volume:8 | Issue:4|Papers Count:10

Background: Urinary tract infection (UTI) is one of the most common types of infection which can occur in all age groups. The use of catheters is one of the most important underlying factors, especially when they are left in place for a long time. Objectives: This study aimed to investigate the effect of sterile catheter fixation on bacteriuria and urinary tract infections.Patients and Methods: The present research is a clinical trial study. The patients who had urinary catheters based on the existing indications in 2012, hospitalized in Imam Hussein (AS) Hospital, Tehran enrolled in the study. Patients were divided into two groups. The first group consisted of patients whom the catheters were installed by a medical intern in the emergency department. The second group consisted of patients whom the catheters were installed in the same department by two medical interns using a completely sterile method especially at fixation and lubrication steps. The information contained in the patients' check list including the background information, age, hospitalization days, history of urinary catheters, history of infection and results of urine culture and analysis.Results: A total of one hundred and eighty-eight individuals with the mean age of 39.1±19 years (age range between 18 - 77 years old) enrolled in this study. There was no significant difference in the number of hospitalization days between the two groups (P>0.05). The number of hospitalization days and incidence of infection were significantly correlated (P<0.05). The results showed a total OR of 1.5 indicating that the risk of infection is higher in the first group. Overall, the rate of urinary tract infection in this study was 16.4% while this rate was 19.1% and 13.8% in the first and second groups, respectively. The statistical tests showed significant difference between two groups in the incidence of urinary tract infection (P<0.05), and also positive urine cultures were reported for twelve patients in the first group and nine patients in the second group. Escherichia coli (E. coli) was the most common infective microorganism in both groups, which was observed in 66.6% of the first and 88.8% of the second groups. The frequency of Gram-negative bacteria was 10 cases (83.3%) in the first group and 8 cases (88.8%) in the second group.Conclusions: According to this study, employing the principles of sterile techniques during the catheterization and sterilization of instruments, as well as skills and experiments of individuals in this process, are the most important factors that can significantly reduce the number of infections after catheterization.

Background: More than 350 million people are chronic carriers of hepatitis B virus (HBV) and because of the high HBV-related morbidity and mortality, the global disease burden of HBV is substantial. In patients with HBeAg–negative chronic hepatitis B (CHB) with serum alanine aminotransferase (ALT) levels, 1-2×upper limit of normal (ULN) and HBV DNA load of 10000 to 100000 copies/mL, liver biopsy should be considered and treatment may be initiated if liver biopsy shows moderate/severe necro-inflammation or significant fibrosis. A dynamic balance between viral replication and host immune response is pivotal for the pathogenesis of liver disease in HBV infection. Due to immune response variability, there is thought to be a considerable difference in the histopathologic status of liver biopsy samples present in various populations.Objectives: Liver histopathology in asymptomatic patients with greater than 10000 DNA copies/mL despite negative Hbe Ag was studied to determine, the number of people that will benefit from a liver biopsy, and variables that will significantly be affected by viral load changes.Patients and Methods: Eighty-two symptomless hepatitis B patients, identified during screening tests, were entered into the study. All candidates were HBS Ag Positive, Hbe Ag negative, Hbe Ab positive, HDV Ab, HIV Ab 1, 2, and HCV Ab negative. In all cases HBV DNA virus load was greater than 10000 copies/mL (2000 U/mL). Liver biopsy was done after obtaining a written consent. Liver histopathology was reported based on the histological activity index (HAI).Results: Both HBV DNA load and serum ALT levels significantly correlated with the grade score. Both stage and grade significantly correlated with age. Stage score of liver specimens was significantly lower in women than men. Logistic regression analysis indicated that the baseline ALT and HBV DNA levels and age were independent predictors of the HAI score.Conclusions: In 10% of the patients, liver biopsy changed the treatment plan and treatment was started despite ALT levels being less than twice the normal level.

Tuberculosis (TB) is an airborne, globally common bacterial infection, easily spread by coughing, and can be fatal. It often lies dormant in the human body for many years; most of the 11 million infected people in the United States are not even aware of its existence. The only available vaccine has limited effectiveness and is not prescribed in most European and American countries. Today, the biggest risk for TB is not HIV/AIDS, which led to a surge in the late 1980s. The most challenging issues in this regard are multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) (1). Researchers followed up the South African patients with XDR-TB, who had been a part of an earlier study looking at early treatment outcomes in 2010. The study said that despite lengthy treatment with a median of eight anti-TB drugs, treatment outcomes were dismal: of 107 patients, only 17 were cured or completed the treatment after 24 months, and 12 had similar favorable outcomes five years after the treatment initiation. Forty nine patients died and in 25, the treatment was failed after 24 months of follow up. After 60 months, 79 patients died and in 11 the treatment was failed. Of the 45 patients released into the community, 19 did not achieve sputum culture conversion (2).

Background: Rapid detection of resistant strains of Helicobacter pylori in human clinical samples is of major importance in clinical settings. Inability of conventional clinical laboratory techniques in detection of these strains usually leads to failure of prescribed therapeutic regimens.Objectives: The aim of this study was designing a simple and rapid allele-specific PCR (AS-PCR) -based method for detection of more frequent gyrA mutations at Asn87Lys codon, responsible for emergence of fluoroquinolone resistance in H. pylori strains.Patients and Methods: All bacterial strains were obtained from clinical biopsy samples in our laboratory. Identification of the isolates was performed by the genus- and species-specific primers and allele-specific primers, designed to match with the site of the point mutations. Samples with positive results for the designed PCR method were sequenced to verify the existence of the target mutations.Results: Point mutations in the gyrA gene at Asn87Lys codon (AAT>AAA and AAC>AAG) were detected in all standard resistant strains as well as some of clinical isolates with previously determined resistance phenotypes for fluoroquinolones. Presence of the target mutations was successfully confirmed in all the control strains by the newly designed primers and sequencing.Conclusions: The designed AS-PCR was a good and reliable method for detection of AAT>AAA and AAC>AAG point mutations in H. pylori isolates.

Background: Bacteria are commonly isolated from gallstones. Presence of bacteria in gallstones might play a role in their formation. Objectives: We aimed to study different properties of isolates from gallstones and their relationship with the mechanism of gallstone formation.Patients and Methods: This study included 526 subjects. Gallstones and bile samples of the patients were cultured. Isolates were identified by different biochemical tests and examined for their b-glucuronidase activity, slime production and Urease activity. Biostatistical analyses were done to determine the relationship between the biliary bacterial factors and the types of gallstones. Role of Slime and urease activity in mechanism of gallstone formation were tested in vitro.Results: Overall, 94.77% of the gallstones were found to be infected, of which 85% of the cholesterol stones, 97% of pigmented stones and 100% of mixed stones showed the presence of bacterial isolates (P<0.0001). b-glucuronidase activity was associated with isolates from pigmented or mixed stones and completely absent in cholesterol gallstones (P=0.018). Urease activity was basically associated with cholesterol gallstones (P<0.0001) while slime (P<0.0001) activity was not specific for any single type of stone formation yet isolates of bile had a significant association with slime activity. In vitro analysis demonstrated that bacteria with urease activity are involved in CaCO3 precipitation and slime-producing isolates solidify the precipitated CaCO3. Conclusions: b-glucuronidase activity is mainly responsible for pigmented gallstone formation. Urease activity was predicted to be involved in nucleation and slime production during solidification of gallstones, as observed during in vitro studies. Hence, presence of these bacterial factors may enhance gallstone formation.

Background: One of the main components involving in the pathogenesis and prognosis of sepsis and septic shock is natriuretic peptide. Hemodynamic changes in sepsis or septic shock might explain increased plasma levels of these peptides circulations. Objectives: The present study aimed to assess the value of brain natriuretic peptide (BNP) in prediction of sepsis state and its related morbidity. We also attempted to determine the best cutoff point of BNP for diagnosis of sepsis state in those with critical illnesses, admitted to the hospital.Patients and Methods: In a cross-sectional study on critically ill patients referred to infections unit of Hazrat Rasoul Akram Hospital, the enrolled patients were assigned to one of the sepsis (n=30) and nonsepsis (n=30) groups, based on their results of blood culture and clinical manifestations. Plasma level of BNP was measured by immunoassay.Results: In-hospital mortality was only observed in one patient suffering from sepsis. Hospital length of stay (LOS) was significantly longer in the sepsis group compared with the nonsepsis one (17.47±10.10 days versus 7.93±2.92 days). The plasma BNP level, as a marker, was significantly higher in the sepsis group than the nonsepsis one (786.87±164.11 ng/mL versus 154.57±44.67 ng/mL, P=0.039). The BNP level was significantly correlated with some baseline variables including respiratory rate (beta=0.295, P=0.022) and ESR measurement (beta=0.296, P=0.022), but not with other characteristics. Through multivariable linear regression analysis, having other patients' variables information including demographics and hemodynamic parameters, the BNP level was significantly higher in the sepsis group compared with the nonsepsis one (odds ratio=1.008, P=0.046). According to the receiver operating characteristic (ROC) curve analysis, BNP measurement had an acceptable value for discriminating sepsis and nonsepsis states (c=0.734, 95% CI: 0.605-0.864, P=0.002). The optimal cutoff point of BNP for discriminating sepsis and nonsepsis states was 170 ng/mL, yielding a sensitivity of 66.7% and a specificity of 60.0%. Conclusions: Elevated BNP level was associated with a significantly increased risk of sepsis state in critically ill patients.

Introduction: Botulism is an acute form of poisoning resulted from ingestion of Clostridium botulinum toxin. Case Presentation: Here we present five cases of food-borne botulism poisoning from home produced cheese. Five patients from one family referred to our emergency unit with complaints of weakness and two had severe symptoms. In spite of the laboratory negative results antitoxin was administered and their symptoms improved. Discussion: Botulism poisoning can develop with any home-canned food and people must avoid consumption of such products.

Background: Genetic variation influences susceptibility/resistance to tuberculosis. CXCL10 is involved in T-cell migration and stimulation of natural killer cells in Mycobacterium tuberculosis infection. Objectives: We aimed to investigate the genetic polymorphisms in promoter of the CXCL10 gene in patients with pulmonary tuberculosis (PTB) and healthy controls, to clarify whether polymorphisms in the CXCL10 gene is associated with tuberculosis.Patients and Methods: This study was performed on 150 patients with PTB as well as 150 healthy subjects. Polymorphism of CXCL10 (-135 G/A) was determined using amplification refractory mutational system-polymerase chain reaction (ARMS-PCR).Results: There were significant differences in genotype and allele frequencies of the CXCL10 gene -135 G/A polymorphism between the groups. GA and AA genotypes were protective against tuberculosis in comparison with GG genotype (OR=0.19, 95% CI=0.10-0.36, P<0.001; and OR=0.12, 95% CI=0.04-0.43, P<0.001, respectively). Furthermore, A allele decreased the risk of PTB in comparison with G allele (OR= 0.55, 95% CI=0.39-0.77, P<0.001). Conclusions: Significant association was found between the CXCL10 -135 G/A promoter variant and host resistance to PTB in a sample of Iranian population.

Introduction: The classic “Mumps” is known as a viral parotitis caused by mumps virus belonging to the genus Rubulavirus in the Paramyxoviridae family. Case Presentation: We reviewed three patients diagnosed with aseptic meningitis due to acute non-mumps associated parotitis based on clinical and laboratory findings. While there are many similarities between the clinical characteristics of classic mumps and acute non-mumps associated parotitis, some significant differences exist. In addition, there are some important differences between mumps meningitis and aseptic meningitis due to non-mumps associated parotitis. If acute parotitis accompanies with clinical manifestations different from classic mumps and associated with aseptic meningitis in early stage of the disease with initially negative serological test for mumps, acute parotitis with aseptic meningitis caused by non-mumps virus should be considered and various serological tests should be performed to identify the causative virus. Discussion: PCR or enzyme linked immunosorbent assay (ELISA) on serum or cerebrospinal fluid would be the inevitable basis for accurate diagnosis in such cases.

Introduction: Tuberculosis (TB) is a disease with diverse clinical manifestations. It typically attacks the lungs (pulmonary); however, it may also affect other parts of the body (extrapulmonary) with or most commonly without lung involvement. Notable extrapulmonary infection sites include pleura, central nervous system, lymphatic system, genitourinary system, bones and joints, and abdomen.Abdominal TB is one of the most prevalent forms of extrapulmonary presentations of this variable disease. Given the patients with abdominal complaints especially in developing countries, where the disease is endemic, it should be kept in mind that abdominal TB has numerous differential diagnoses. Case Presentation: Our case is a 46 year-old female with left upper abdominal pain and mass sensation, with no associated signs or symptoms, but negative family history of TB and carcinoma. The patient underwent several diagnostic procedures so that the ultimate cause for her abdominal pain would be discovered among various existing differential diagnoses. Discussion: Peritoneal TB, although not very common, is still the important cause of not only abdominal symptoms but also female infertility. The need to pay more accurate attention to peritoneal TB in endemic areas, especially in young patients considered to have peritoneal carcinomatosis, seems very important.