Pseudomonas aeruginosa infection among cystic fibrosis and ICU patients in the referral Children Medical Hospital in Tehran, Iran

Introduction. Pseudomonas aeruginosa is one of the important causes of hospital-acquired infections in Intensive Care Unit (ICU) and considered as a major determinant of morbidity and mortality in patients affected by cystic fibrosis (CF). The aim of this study was to investigate clonal diversity among randomly picked P. aeruginosa isolates of CF and the other hospitalized patients in ICU. Methods. Cultivation, identification, and antimicrobial suscep- tibility testing of P. aeruginosa isolates were performed using standard techniques. The genetic similarity of the strains was investigated by amplification of the Enterobacterial Repetitive Intergenic Consensus-polymerase chain reaction (ERIC-PCR) sequence. Results and discussion. Among 49 isolates, sixteen were isolated from 11 patients affected by CF and 33 came from an epidemiologi- cal investigation of 25 P. aeruginosa infected patients of ICU. Five clusters were generated for all isolates analyzed through ERIC-PCR genotyping. Two major clusters (B and C) were discovered in P. aer- uginosa isolates of ICU and CF patients during the whole period of this study. Fifteen unique antibiogram patterns obtained from all iso- lates and multi-resistant P. aeruginosa (MRPA) were identified in 23 isolates (47%). MRPA isolates were detected in all clusters (except A) while pan-resistant isolates were recovered only in cluster C. The high prevalence of related or identical isolates in CF and non-CF patients can be due to transmission of particular domi- nant clones in ICU ward. Therefore, enhanced infection-control may become necessary to prevent further spread of clonal strains

Effect of early and current Helicobacter pylori infection on the risk of anaemia in 6.5-year-old Ethiopian children

Background: Epidemiological and clinical studies in high income countries have suggested that Helicobacter pylori (H. pylori) may cause anaemia, but evidence is lacking from low income countries.We examined associations between H. pylori infection in early childhood and anaemia at the age of 6.5 years in an Ethiopian birth cohort. Methods: In 2011/12, 856 children (85.1 % of the 1006 original singletons in a population-based birth cohort) were followed up at age six and half. An interviewer-led questionnaire administered to mothers provided information on demographic and lifestyle variables. Haemoglobin level and red cell indices were examined using an automated haematological analyzer (Cell Dyn 1800, Abbott, USA), and stool samples analyzed for H. pylori antigen. The independent effects of H. pylori infection (measured at age 3.5 and 6.5 years) on anaemia, haemoglobin level, and red cell indices (measured at age 6.5 years) were determined using multiple logistic and linear regression. Results: The prevalence of anemia was 34.8 % (257/739), and the mean (SD) haemoglobin concentration was 11.8 (1.1) gm/dl. Current H. pylori infection at age 6.5 years was positively, though not significantly related to prevalence of anaemia (adjusted OR, 95 % CI, 1.15; 0.69, 1.93, p = 0.59). Any H. pylori infection up to age 6.5 years was significantly associated with an increased risk of anaemia at age 6.5 (adjusted OR, 95 % CI, 1.68; 1.22, 2.32, p = 0.01). A significant reduction in haemoglobin concentration and red cell indices was also observed among children who had any H. pylori infection up to age 6.5 (Hb adjusted β = −0.19, 95 % CI, −0.35 to −0.03, p = 0.01; MCV adjusted β = −2.22, 95 % CI, −3.43 to −1.01, p = 0.01; MCH adjusted β = −0.63, 95 % CI, −1.15 to - 0.12, p = 0.01; and MCHC adjusted β = −0.67, 95 % CI, −1.21 to −0.14, p = 0.01), respectively. Conclusion: This study provides further evidence from a low income country that any H. pylori infection up to age 6.5 is associated with higher prevalence of anaemia, and reduction of haemoglobin level and red cell indices at age 6.5

The Prevalence and Antimicrobial Susceptibility of Bacterial Uropathogens Isolated from Pediatric Patients

"nBackground: Urinary tract infection (UTI) is considered as the most common bacterial infectious disease seen among the pediatric patients. The aim of this study was to investigate the prevalence and antimicrobial susceptibility of bacterial uropathogens isolated from the pediatric patients with urinary tract infections."nMethods: This descriptive study was conducted in Children Medial Center, Tehran, Iran from March 2006 to Feb 2007. Clean-catch midstream urine specimens were obtained from the patients and cultured on the appropriate bacteriological media. Bacterial isolates were identified by standard biochemical and serological tests. Antimicrobial susceptibility testing was performed according to CLSI guidelines."nResults: From 14199 urine specimens, 16.2% had positive results for bacterial cultures. Nine hundred twenty one strains were identified as Escherichia coli; 412 as Klebsiella spp., 285 as Coagulase negative Staphylocococci, 202 as Enterococcus spp., 158 as Pseudomonas spp., and 83 as Staphylococcus aureus. E. coli isolates showed high resistance to carbenicillin (68%), ampicillin (96%), trimethoprim-sulfomethoxazol (70%) and kanamycin (65%). More than 30% of isolates of Klebsiella spp., Pseudomonas spp. and Enterobacter spp. have shown high degree of resistance to commonly used antibiotics."nConclusion: Our findings reinforce the need for ongoing investigation to show trends in antibiotic resistance, which can help to prescribing of antibiotics in clinics

Hymenolepis Diminuta (Rodolphi, 1819) Infection in a Child from Iran

Hymenolepis diminuta is a cestode frequently found in rodents and humans. Species of flour moths of the genus Pyralis and beetles in the genus Tribolium are common intermediate hosts. Humans can be accidentally infected through the ingestion of the insects, including larvae in precooked cereals, dried fruits or other food items, and directly by ingesting the insects from the environment. This tapeworm, while infrequently encountered, has been reported from many parts of the world. In this paper we report the first case of infection with H.diminuta in Iran since 1972

Molekulare Integronanalyse und antimikrobielles Resistenzprofil von aus pädiatrischen Patienten mit Diarrhoe isolierten Shigella spp.

Introduction: Shigella spp. is a growing global health concern due to increasing multiple drug resistance, commonly resulting in therapeutic failure. Integrons are gene expression systems run by integrase genes. The aims of this study were detection of class I, II and III integrons and assessment of antimicrobial resistance in Shigella spp. isolated from acute pediatric diarrhea patients.Materials and methods: From January to December 2015, 16 Shigella spp. were isolated from 310 non-duplicative diarrheal stool samples in Children's Medical Center, Tehran, Iran. The isolates were analyzed for their antibiotic susceptibility using CLSI guidelines M100-S14. Multiplex PCR was used for amplification of I, II and III integron-associated integrase (intl ) genes.Results: Of 310 stool samples, 16 (5.2%) were positive for Shigella spp., in 7 of them S. sonnei and in 9 of them S. flexneri were identified. Results of the antimicrobial susceptibility test showed that 6.2%, 50%, 31.2%, 6.2%, 81.2%, 56.2% and 31.2% of the isolates were resistant to gentamicin, chloramphenicol, nalidixic acid, ciprofloxacin, tetracycline, ampicillin and trimethoprim-sulfamethoxazole, respectively. Multiplex PCR results revealed that 6.2% (1/16), 31.2% (5/16), 50% (8/16) of Shigella isolates carried intl I, intl II and both intl I/intl lI genes. No class 3 integrons were detected.Discussion: In this study, multidrug resistance was seen in Shigella isolates similar to that in isolates from other geographical areas. This is possible due to inappropriate use of antimicrobials. Furthermore, prevalence of multidrug resistance was significantly linked to the presence of integrin genes. Conclusion: A class 2 integron plays a role in presence of multidrug resistance in Shigella spp. It is vital to prevent the spread of antibiotic resistance through continuous monitoring.Hintergrund: Die Zunahme multiresistenter Shigella spp. ist ein globales Gesundheitsproblem wachsender Bedeutung. Integrons sind Genexpressionssysteme, die von Integrase-Genen gesteuert werden. Zielsetzung der Studie war die Detektion von Klasse 1, 2 und 3 Integrons und die Bestimmung der antimikrobiellen Resistenz von Shigella spp., die von pädiatrischen Patienten mit Diarrhoe isoliert wurden. Material und Methoden: Von Januar bis Dezember 2015 wurden 16 Shigella spp. aus 310 nicht-duplikativen Durchfall-Stuhlproben im Children's Medical Center, Tehran, gemäß Guideline des Clinical and Laboratory Standards Institute isoliert. Zur Amplifikation der I, II und III Integron-assoziierten Integrase(intl )-Gene wurde die Multiplex PCR eingesetzt.Ergebnisse: In 16 (5,2%) der 310 Stuhlproben wurden 7-mal S. sonnei und 9-mal S. flexneri isoliert. 6,2%, 50%, 31,2%, 6,2%, 81,2%, 56,2% bzw. 31,2% der Isolate waren resistent gegen Gentamicin, Chloramphenicol, Nalidixinsäure, Ciprofloxacin, Tetracycline, Ampicillin und Trimethoprim-Sulfamethoxazol. Mittels Multiplex PCR wurde nachgewiesen, dass 6,2% (1/16), 31,2% (5/16), 50% (8/16) der Shigella Isolate intl I, intl II bzw. beide Gene trugen. Klasse III Integrons wurden nicht detektiert.Diskussion: Bei Shigella -Isolaten wurde ähnlich zu anderen geographischen Regionen Multiresistenz nachgewiesen. Das wird begünstigt durch nicht Leitlinien gerechten Einsatz von Antibiotika. Die Prävalenz der Multiresistenz war signifikant mit dem Vorhandensein von Integrin-Genen assoziiert.Schlussfolgerung: Das Klasse 2 Integron ist von Bedeutung für die Multiresistenz von Shigella spp. Es ist wichtig, die Ausbreitung von Antibiotikaresistenzen durch kontinuierliche Überwachung zu verhindern

Phenotypic and genotypic determinants of mupirocin resistance among Staphylococcus aureus isolates recovered from clinical samples of children: an Iranian hospital-based study

Shima Mahmoudi,1 Setareh Mamishi,1,2 Mohsen Mohammadi,2 Maryam Banar,1 Mohammad Taghi Haghi Ashtiani,3 Masoumeh Mahzari,2 Abbas Bahador,4 Babak Pourakbari1 1Pediatric Infectious Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran; 2Department of Infectious Disease, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; 3Department of Pathology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; 4Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Backgrounds: The aim of this study was to evaluate both phenotypic and genotypic determinants of mupirocin resistance among methicillin-resistant Staphylococcus aureus (MRSA) and methicillin susceptible S. aureus (MSSA) strains recovered from different clinical samples of children who were admitted to the Children’s Medical Center (CMC) Hospital, Tehran, Iran. Materials and methods: A total of 120 clinical isolates of S. aureus were collected from the microbiology laboratory of CMC Hospital. Antimicrobial susceptibility of the isolates to different antimicrobial agents was determined by disk diffusion method. The methicillin resistance phenotype (MRSA) was identified using a 30 µg cefoxitin disk. The minimum inhibitory concentration (MIC) of mupirocin was determined by broth microdilution method. Strains with mupirocin MIC between 8 and 256 µg/mL were considered as low-level mupirocin resistant (LLMR), and strains with an MIC≥512 µg/mL were considered as high-level mupirocin resistant (HLMR). The presence of genes encoding HLMR (ie, mupA and mupB genes) was evaluated by PCR method. Results: Four out of 120 isolates (3%) had mupirocin MIC≥512 µg/mL and were HLMR; however, no LLMR isolate was detected. Fifty-two isolates (43%) were MRSA, and there were no differences in the distribution of mupirocin resistance among MRSA and MSSA isolates (P>0.05). The PCR method identified mupA gene in two out of four HLMR isolates, and mupB gene was not detected in any HLMR isolates. Conclusion: Because of discrepancies between the phenotypic and genotypic patterns of mupirocin resistance and due to the avoidance of false-negative results, it is better to determine the mupirocin resistance by both antibiotic susceptibility tests and PCR method. Considering the increasing need of mupirocin for the control of S. aureus infections, continuous checking of its susceptibility status is necessary. Keywords: methicillin-resistant Staphylococcus aureus, mupirocin, PCR, childre

The Study of Total IgE Reference Range in Healthy Adults in Tehran, Iran

"nBackground: IgE is an antibody class that regarded as an important factor in the pathogenesis of allergic diseases, asthma, im­mune responses to parasitic infection and it could be responsible for the late- phase allergic response. The objective of this study was to evaluate total IgE in healthy Iranian adults, establishment of reference range of total IgE and assess helpful­ness of this value in clinical diagnosis atopic and allergic diseases."nMethod: Three hundred sixty six healthy adults from blood transfusion volunteers (18 to 60 years) were selected in this study. A specific questionnaire (including demographic factors, smoking status and ...) was filled out for each person. Also, we evaluated effect of race and education on total IgE. These adults had no history of allergic disease. The total serum IgE level using a commercial enzyme immunoassay and CBC (Eosinophil count) was determined in them."nResults: Mean of age was 37.32± 10.93 yrs and 219 cases were males and 147 females. The geometric mean of total IgE was 20.84 IU/ml (2-373 IU/ml) (95% percentile= 250) (95% confidence interval=46.27-62.70). No differences was observed between mean of IgE log in males and females (P= NS) but mean of total IgE log in females is more than males."nConclusion: Normal range of serum total IgE obtained in this study could be helpful for diagnosis of IgE-dependent allergic dis­ease, as reference ranges in Iranian healthy adults

Atypical Yersinia virulence markers isolated from children with diarrhea

Background and Objective: Yersinia is a gram-negative bacillus that cause diarrhea through consumption of contaminated food and water.  This study was performed to identify the atypical Yersinia virulence markers isolated from children with diarrhea. Methods: This descriptive cross -sectional study was done on 384 fecal samples of 0- 14 years old children admitted at children medical center from August 2011 to August of 2012. Fecal samples, for the enrichment, after 21 days of incubation in alkaline buffer with pH=7.2 at 4degree C, on days 7, 14 and 21 samples were cultured on CIN agar and Mac agar and then confirm the differentiation atypical Yersinia from other typical Yersinia species from fermentation of different sugars. Isolates were tested for marker of virulence including calcium dependence, auto agglutination, Congo red uptake and binding of crystal violet. Results: Out of 384 stool samples, 4 (1.04%) were infected with Yersinia (Yersinia frederikseni, Yersinia kristensenii and Yersinia enterocolitica). Out of these three, only two samples in association was positive with virulence markers. Conclusion: Phenotypic markers can be used to study the properties of phenotypic strains of Yersinia