Epidemiological survey of tularemia in Ilam Province, west of Iran

Background: Francisella tularensis is the causative agent of tularemia in humans and a large number of animal species. Considering recent evidence of the circulation of this bacterium in different parts of Iran, especially in the western provinces, the aim of current study was to determine the tularemia seroprevalence in the human population living in Ilam Province. Methods: In 2015, 360 serum samples were collected from five groups of people: ranchers (n = 112), farmers (n = 79), butchers and slaughterhouse workers (n = 61), Nature Conservation Officers (n = 34), and referents of medical diagnostic laboratories (n = 74). These samples were tested for the presence of anti- F. tularensis IgG antibodies using the ELISA method. Results: According to the ELISA manufacturer cutoffs, we found that 10 (2.78) and 9 (2.5) sera, respectively, were positive or borderline for F. tularensis IgG antibodies. The highest tularemia seroprevalence was observed among farmers (7.59). Conclusions: Our results strongly support the circulation of tularemia in Ilam Province. Because no human tularemia case has been reported so far in this province, we recommend specific education programs to increase knowledge of local health care professionals about this important zoonotic disease. © 2019 The Author(s)

Molecular survey of tularemia and plague in small mammals from Iran

Introduction: Plague and tularemia are zoonoses and their causative bacteria are circulating in certain regions of Iran. This study was conducted to investigate potential disease reservoirs amongst small wildlife species in different regions of Iran. Methods: Rodents, insectivores and hares from 17 different provinces of the country were collected in 2014 and 2015. Samples were taken from the spleens of the animals and Real-time PCR was applied to detect nucleic acid sequences that are specific to Francisella tularensis and Yersinia pestis, respectively. Results: Among 140 collected rodents, 25 distinct species were identified out of which five were the most common: Microtus paradoxus (21 out of 140 rodents), Apodemus witherbyi (12), Microtus irani (11), Mus musculus (11) and Microtus socialis (10). Seventeen insectivores were collected and identified as Crocidura suaveolens (82) and C. leucodon (18). Fifty-one hares were collected and identified as Lepus europaeus (57), Lepus tolai (14) and Lepus sp. (29). Three out of 140 explored rodents (1.91) were positive for F. tularensis, an A. witherbyi, a Mus musculus domesticus, and a Chionomys nivalis collected from Golestan, Khuzestan and Razavi Khorasan provinces, respectively. Two hares (3.92) were F. tularensis-positive, a L. europaeus from Khuzestan and a Lepus sp. from the Sistan and Baluchistan province. None of the tested animals were positive for Y. pestis. Conclusion: This is the first report of direct detection of F. tularensis in mammals of Iran and the first-time observation of the agent in a snow vole, C. nivalis worldwide. The results indicate that tularemia is more widespread in Iran than previously reported including the Northeast and Southwestern parts of the country. Future studies should address genetic characterization of F. tularensis positive DNA samples from Iran to achieve molecular subtyping and rule out assay cross-reactivity with near neighbor Francisella species. © 2018 Mostafavi, Ghasemi, Rohani, Molaeipoor, Esmaeili, Mohammadi, Mahmoudi, Aliabadian and Johansson

Prisoners co-infected with tuberculosis and HIV: a systematic review.

INTRODUCTION: Almost from the beginning of the HIV epidemic in 1981, an association with tuberculosis (TB) was recognized. This association between HIV and TB co-infection has been particularly evident amongst prisoners. However, despite this, few studies of TB in prisons have stratified results by HIV status. Given the high prevalence of HIV-positive persons and TB-infected persons in prisons and the documented risk of TB in those infected with HIV, it is of interest to determine how co-infection varies amongst prison populations worldwide. For this reason we have undertaken a systematic review of studies of co-infected prisoners to determine the incidence and/or prevalence of HIV/TB co-infection in prisons, as well as outcomes in this group, measured as treatment success or death. METHODS: A literature search was undertaken using the online databases PubMed, Embase, IBSS, Scopus, Web of Science, Global Health and CINAHL Plus. No restrictions were set on language or publication date for article retrieval, with articles included if indexed up to 18 October 2015. A total of 1975 non-duplicate papers were identified. For treatment and outcome data all eligible papers were appraised for inclusion; for incidence/prevalence estimates papers published prior to 2000 were excluded from full text review. After full text appraisal, 46 papers were selected for inclusion in the review, 41 for incidence/prevalence estimates and nine for outcomes data, with four papers providing evidence for both outcomes and prevalence/incidence. RESULTS: Very few studies estimated the incidence of TB in HIV positive prisoners, with most simply reporting prevalence of co-infection. Co-infection is rarely explicitly measured, with studies simply reporting HIV status in prisoners with TB, or a cross-sectional survey of TB prevalence amongst prisoners with HIV. Estimates of co-infection prevalence ranged from 2.4 to 73.1% and relative risks for one, given the other, ranged from 2.0 to 10.75, although some studies reported no significant association between HIV and TB. Few studies provided a comparison with the risk of co-infection in the general population. CONCLUSIONS: Prisoners infected with HIV are at high risk of developing TB. However, the magnitude of risk varies between different prisons and countries. There is little evidence on treatment outcomes in co-infected prisoners, and the existing evidence is conflicting in regards to HIV status influence on prisoner treatment outcomes.PROSPERO Number: CRD42016034068

Epidemiological survey of tularemia in Ilam Province, west of Iran

BackgroundFrancisella tularensis is the causative agent of tularemia in humans and a large number of animal species. Considering recent evidence of the circulation of this bacterium in different parts of Iran, especially in the western provinces, the aim of current study was to determine the tularemia seroprevalence in the human population living in Ilam Province.MethodsIn 2015, 360 serum samples were collected from five groups of people: ranchers (n=112), farmers (n=79), butchers and slaughterhouse workers (n=61), Nature Conservation Officers (n=34), and referents of medical diagnostic laboratories (n=74). These samples were tested for the presence of anti- F. tularensis IgG antibodies using the ELISA method.ResultsAccording to the ELISA manufacturer cutoffs, we found that 10 (2.78) and 9 (2.5) sera, respectively, were positive or borderline for F. tularensis IgG antibodies. The highest tularemia seroprevalence was observed among farmers (7.59).ConclusionsOur results strongly support the circulation of tularemia in Ilam Province. Because no human tularemia case has been reported so far in this province, we recommend specific education programs to increase knowledge of local health care professionals about this important zoonotic disease

Seroprevalence of Q fever among high-risk occupations in the Ilam province, the west of Iran

Background Q fever is a zoonotic disease of great public health importance in Iran. This disease is presented with high phase I antibody development in chronic and high phase II antibody in the acute form of illness. This study was conducted to evaluate the seroprevalence of Q fever among high-risk occupations in the Ilam province in Western Iran. Methods and findings In this cross-sectional study, 367 sera samples were collected from five groups comprised of animal husbandry workers, farmers, butchers, slaughterhouse workers, and park rangers. The collected sera were tested for IgG antibodies against Coxiella burnetii using ELISA. The seroprevalence of antibodies against C. burnetii in phase I and II was 24.38 and 26.37, respectively (i.e., 32.42 overall). Low educational level, living in rural areas, keeping sheep/goats, ages older than 50 years, and a history of arthropod bites positively correlated with increased risk of Q fever infection. Animal husbandry workers (45.13) were at higher risk of contracting Q fever compared with other occupations in the study (17.11). Conclusions High seroprevalence of C. burnetii among high-risk occupations is a serious challenge in the Ilam province. In addition, the high seroprevalence of endemic Q fever in rural and nomadic areas and a higher concentration of occupations who are directly engaged with livestock demonstrate the critical need for preventive medicine education and training in regards to mitigating risk for disease contraction in susceptible groups

Epidemiological investigation of pediatric tuberculosis in Tehran Province, 2006-2015

Background: On tuberculosis control standpoint, the treatment of children with TB is not considered a priority as they rarely transmit the disease and contribute little to the maintenance of the tuberculosis epidemic. Therefor this study conducted to describe pediatric TB cases, and to identify pattern of risk factors in non-endemic communities Materials and Methods: The present cross- sectional study conducted on 139 children under-five years of old with TB in Tehran province from March 2006 to March 2015. Data were extracted from TB registry system. Data were analyzed using Stata software version, 12. Results: Overall, records on 139 children with TB had been evaluated. Most of under-five TB cases were boys (58) and urban dwellers (88), roughly half of the sample (54) was diagnosed as extra- pulmonary TB, while most of them (66) had been reported through public health networks. Treatment success rate were nearly 85, and 11 of them had been deceased. There was a significant relationship between household contacts and type of TB (P < 0.05). Conclusion: We found that most of pediatric TB cases in central part of Iran were males, urban dwellers, and extra pulmonary type. Despite the fact that Afghans refugees make up a small percentage of the population of Tehran province but more than 25 of TB cases attributable to them. Given that Pediatric TB is a direct consequence of adult TB and is a good marker of current transmission in the community, therefore necessary health strategies should be taken to control TB in this high-risk group

Epidemiological investigation of pediatric tuberculosis in Tehran Province, 2006-2015

Background: On tuberculosis control standpoint, the treatment of children with TB is not considered a priority as they rarely transmit the disease and contribute little to the maintenance of the tuberculosis epidemic. Therefor this study conducted to describe pediatric TB cases, and to identify pattern of risk factors in non-endemic communities Materials and Methods: The present cross- sectional study conducted on 139 children under-five years of old with TB in Tehran province from March 2006 to March 2015. Data were extracted from TB registry system. Data were analyzed using Stata software version, 12. Results: Overall, records on 139 children with TB had been evaluated. Most of under-five TB cases were boys (58) and urban dwellers (88), roughly half of the sample (54) was diagnosed as extra- pulmonary TB, while most of them (66) had been reported through public health networks. Treatment success rate were nearly 85, and 11 of them had been deceased. There was a significant relationship between household contacts and type of TB (P < 0.05). Conclusion: We found that most of pediatric TB cases in central part of Iran were males, urban dwellers, and extra pulmonary type. Despite the fact that Afghans refugees make up a small percentage of the population of Tehran province but more than 25 of TB cases attributable to them. Given that Pediatric TB is a direct consequence of adult TB and is a good marker of current transmission in the community, therefore necessary health strategies should be taken to control TB in this high-risk group