A newly emerged cutaneous leishmaniasis focus in central Iran

SummaryObjectivesThis study was performed to evaluate the epidemiological status of cutaneous leishmaniasis (CL) in the most important endemic foci of Qom Province, central Iran. The city of Qom is the largest center for Shi’a scholarship in the world and is a significant pilgrimage destination.MethodsDuring 2006–2011, all suspected CL patients with skin lesion(s) referred to regional health centers of Ghomrood and Ghanavat regions, and all actively detected cases, were examined clinically and parasitologically for CL. Patient information was recorded and patients were categorized based on the number and size of the lesions. Odds ratios (OR) of different risk factors were calculated.ResultsA total of 849 (59.2% male, 40.8% female) confirmed cases of CL were enrolled; the average incidence rate of the disease was 14.9 per 100000 people. During the study period 2006–2011, the trend in CL incidence showed no sudden variations in the areas studied, except for an outbreak of CL in 2009. Leishmania major was identified as the causative agent based on internal transcribed spacer 1 (ITS1) ribosomal DNA PCR analysis. During the study period, the age distribution of CL cases was relatively stable, with the majority (50%) of patients aged 1–25 years. Most cases (n = 468; 55.1%) had a single lesion and 82 (9.6%) patients had four or more lesions (range 1–29). The risk of developing multiple lesions was significantly increased in patients with seasonal jobs (summer workers) (p = 0.023; OR 1.516) and significantly decreased in patients who were affected in winter (p = 0.010; OR 0.398). The risk of developing large-sized lesions (>1cm) was significantly increased in patients in the age groups >25 years (p = 0.001–0.015; OR 2.5–3.5) and decreased in patients with seasonal jobs (summer workers) (p = 0.005; OR 0.570).ConclusionsThe present data show the importance of CL as a health problem in suburban areas of Qom Province. In order to identify other epidemiological aspects of leishmaniasis in this area, studies on vectors and reservoirs are recommended. Since leishmaniasis caused by L. major is typically zoonotic, control measures should focus on rodents as the main reservoirs and Phlebotomus papatasi as the main vector. Awareness should be raised in the high-risk populations comprising people with diabetes, young adults (<25 years old), and those who work outdoors during the summer

The Prevalence of Sharp Object Injuries and Consequences in the Hospital Staff of the Qom Province

سابقه و هدف: آسيب‌هاي ناشي از ابزار برنده به‌عنوان يکي از خطرات مشاغل بهداشتي- درماني شناخته مي‌شود که پيشگيري از آن‌ها در دستورالعمل‌هاي ايمني مشاغل آورده شده است. اين مطالعه با هدف بررسي همه‌گيري‌شناسي آسيب‌هاي ناشي از ابزار برنده و پيامدهاي حاصل از آن‌ها در کارکنان بيمارستان‌هاي استان قم انجام‌ شد. روش بررسي: اين تحقيق به شکل توصيفي- تحليلي گذشته‌نگر بر روي پرونده‌هاي سه سال اخير کارکنان انجام شد. تجزيه و تحليل آماري داده ‌هاي اين مطالعه به‌وسيله‌ي نرم‌افزار SPSS انجام شد و براي مقايسه گروه‌ها از آزمون‌هاي آماري کاي مربع (k2) و تي تست (T-test) و آزمون دقيق فيشر (Fisher Exact test) استفاده شد. لازم به ذکر است به تمامي بيماران اين اطمينان داده شد که اطلاعات محرمانه باقي خواهد ماند و در صورت انتشار، اسامي افراد ذکر نخواهد شد. يافته‌ها: مجموعاً 100 نفر(59 زن و 41 مرد) از کارکنان بهداشتي درماني بيمارستان‌هاي موردمطالعه که سابقه ثبت صدمات ناشي از اجسام برنده را در پرونده داشتند وارد مطالعه شدند. ميانگين سني افراد آسيب‌ديده 4/6±42 سال و فراواني افراد بالاتر از 30 سال بيش از افراد کمتر از 30 سال بود (05/P&lt;0). بيشترين درصد آسيب‌ها مربوط به پرستاران (و پيراپزشکان) با 47% و کمترين ميزان مربوط به پزشکان با 15% موارد بود (05/P&lt;0) که اغلب در نوبت شب (57%) و بخش‌هاي جراحي (21%) ، اورژانس و &nbsp;تزريقات (20%) رخ داد. سرسوزن سرنگ (51%) و سوزن بخيه (42%) با اختلاف معني‌دار عامل بيشترين آسيب بودند . 28% از افراد منبع HBs Ag مثبت داشتند گرچه در پايش افراد آسيب‌ديده هيچ‌کدام از آزمايش‌ها مثبت نشدند. نتيجه‌گيري: ازآنجايي‌که وقوع جراحات با اجسام برنده به‌ويژه در نوبت شب ممکن است در انتقال عفونت‌هاي منتقله از خون نظير ويروس هپاتيت نقش داشته باشد؛ ضروري است اين آسيب‌ها يکي از مخاطرات مهم شغلي به‌ويژه براي کارکنان مراکز بهداشتي-درماني محسوب شده و به‌طور کامل موارد اين اتفاقات مراقبت شوند. How to cite this article: Nateghi Rostami M, Darzi F. The Prevalence of Sharp Object Injuries and Consequences in the Hospital Staff of the Qom Province. J Saf Promot Inj Prev. 2020; 8(2):58-64.&nbsp;Background and Objectives: Sharp injuries are known as one of the hazards of Health Care workers. This study was designed to determine the epidemiology of sharp injuries of&nbsp; staffs in the&nbsp; Qom province. Materials and Methods: This is a descriptive-analytical and retrospective study which is done on the sharp injuries patients files in the last three years in Qom province. Statistical analysis of data was performed by using SPSS software (Ver. 22).k2, t-test and Fisher’s exact tests were used to compare groups. Result: Totally 100 subjects (59 female and 49 men) who had a history of injuries accident were included from Qom provinces’ hospitals. The mean age of the subjects was 42±6.4 years and the frequency of those over 30 years was significantly higher than other age groups (P&lt;0.05). The highest percentage of injuries was related to nurses and paramedics with 47% and the lowest rate to physicians (15%) (P&lt;0.05); most of them were working at nights (57%) in surgery (21%) and emergency (20%) units. Syringe (51%) and suture (42%) needles were responsible for most of the injuries (P&lt;0.05). Most of subjects were negative for viral infections tests, but 28% of them were HBs Ag positive. Other laboratory tests were also negative for the affected subjects. Conclusion: As sharp injuries especially in the night shifts might have a role in the transfer of blood burn infections including Hepatitis viruses, it is necessary to recognize sharp injuries as a major occupational hazard, especially for health care staff, and accidents should be included in surveillance programs. How to cite this article: Nateghi Rostami M, Darzi F. The Prevalence of Sharp Object Injuries and Consequences in the Hospital Staff of the Qom Province. J Saf Promot Inj Prev. 2020; 8(2):58-64.&nbsp

Co-infection of Phlebotomus papatasi (Diptera: Psychodidae) gut bacteria with Leishmania major exacerbates the pathological responses of BALB/c mice

Clinical features and severity of the leishmaniasis is extremely intricate and depend on several factors, especially sand fly-derived products. Bacteria in the sand fly’s gut are a perpetual companion of Leishmania parasites. However, consequences of the concomitance of these bacteria and Leishmania parasite outside the midgut environment have not been investigated in the infection process. Herein, a needle infection model was designed to mimic transmission by sand flies, to examine differences in the onset and progression of L. major infection initiated by inoculation with “low” or “high” doses of Enterobacter cloacae and Bacillus subtilis bacteria. The results showed an alteration in the local expression of pro- and anti-inflammatory cytokines in mice receiving different inoculations of bacteria. Simultaneous injection of two bacteria with Leishmania parasites in the low-dose group caused greater thickness of ear pinna and enhanced tissue chronic inflammatory cells, as well as resulted in multifold increase in the expression of IL-4 and IL-1β and a decrease in the iNOS expression, without changing the L. major burden. Despite advances in scientific breakthroughs, scant survey has investigated the interaction between micro and macro levels of organization of leishmaniasis that ranges from the cellular to macro ecosystem levels, giving rise to the spread and persistence of the disease in a region. Our findings provide new insight into using the potential of the vector-derived microbiota in modulating the vertebrate immune system for the benefit of the host or recommend the use of appropriate antibiotics along with antileishmanial medicines

CD8+ T Cells as a Source of IFN-γ Production in Human Cutaneous Leishmaniasis

Cutaneous leishmaniasis (CL) is usually a self-healing skin lesion caused by different species of Leishmania parasite. Resistance and susceptibility of mice to Leishmania major infection is associated with two types of CD4+ T lymphocytes development: Th1 type response with production of cytokine IFN-γ is associated with resistance, whereas Th2 type response with production of cytokines IL-4 and IL-5 is associated with susceptibility. A clear Th1/Th2 dichotomy similar to murine model is not defined in human leishmaniasis and we need as much information as possible to define marker(s) of protection. We purified CD4+/CD8+ T cells, stimulated them with Leishmania antigens and analysed gene and protein expression of Th1/Th2 cytokines in volunteers with a history of self-healing CL who are presumed to be protected against further Leishmania infection. We have seen significant upregulation of IFN-γ gene expression and high IFN-γ production in the Leishmania stimulated CD4+ T cells and CD8+ T cells. We concluded that both antigen-specific IFN-γ producing CD4+ Th1 cells and IFN-γ producing CD8+ T cells contribute to the long term protection in individuals with a history of CL. This proves the importance of CD8+ T cells as a source of IFN-γ in Th1-like immune responses

First report of OXA-143-lactamase producing Acinetobacter baumannii inQom

Objective(s):Antibiotic resistance in Acinetobacter baumannii and outbreaks caused by this organism have been reported from several areas of the world. The present study aimed at determining the antibiotic susceptibility profiles and the distribution of OXA-type beta-lactamases among Iranian Acinetobacter baumannii isolates from Qom of Iran. Materials and Methods: For this study, 108 non-duplicate A. baumannii isolates were obtained from clinical specimens in four teaching hospitals in Qom in the central of Iran. The antimicrobial susceptibility of isolates was tested by standard disk diffusion and prevalence of bla OXA genes was investigated by PCR method. Results: Among 97 carbapenem non-susceptible isolates of A. baumannii, 90.72% (88 isolates) isolates showed extensive drug resistance to multiple antibiotics. Among carbapenem resistant isolates, 100% carried blaOXA-51-like, 82.47% carried blaOXA-23-like, 55.67% carried blaOXA-58-like, 22.68% carried blaOXA-40-like and 14.43% had blaOXA-143-like resistance genes. Conclusion: This study demonstrated high genetic diversity of OXA genes among isolates of A. baumannii in Qom, Iran

Memory T cells: promising biomarkers for evaluating protection and vaccine efficacy against leishmaniasis

Understanding the immune response to Leishmania infection and identifying biomarkers that correlate with protection are crucial for developing effective vaccines. One intriguing aspect of Leishmania infection is the persistence of parasites, even after apparent lesion healing. Various host cells, including dendritic cells, fibroblasts, and Langerhans cells, may serve as safe sites for latent infection. Memory T cells, especially tissue-resident memory T cells (TRM), play a crucial role in concomitant immunity against cutaneous Leishmania infections. These TRM cells are long-lasting and can protect against reinfection in the absence of persistent parasites. CD4+ TRM cells, in particular, have been implicated in protection against Leishmania infections. These cells are characterized by their ability to reside in the skin and rapidly respond to secondary infections by producing cytokines such as IFN-γ, which activates macrophages to kill parasites. The induction of CD4+ TRM cells has shown promise in experimental immunization, leading to protection against Leishmania challenge infections. Identifying biomarkers of protection is a critical step in vaccine development and CD4+ TRM cells hold potential as biomarkers, as their presence and functions may correlate with protection. While recent studies have shown that Leishmania-specific memory CD4+ T-cell subsets are present in individuals with a history of cutaneous leishmaniasis, further studies are needed to characterize CD4+ TRM cell populations. Overall, this review highlights the importance of memory T cells, particularly skin-resident CD4+ TRM cells, as promising targets for developing effective vaccines against leishmaniasis and as biomarkers of immune protection to assess the efficacy of candidate vaccines against human leishmaniasis

Comparison of clinical performance of antigen basedenzyme immunoassay (EIA) and major outer membrane protein (MOMP)-PCR for detection of genital Chlamydia trachomatis infection

Background: Chlamydia trachomatis is the most common sexually transmitted bacterial pathogen worldwide. Early detection and treatment of C.trachomatis genital infection prevent serious reproductive complications. Objective: Performances of enzyme immunoassay (EIA) and major outer membrane protein (MOMP)-polymerase chain reaction (PCR) for diagnosis of genital C.trachomatis infection in women were compared. Materials and Methods: In this cross sectional study a total of 518 women volunteers were included (33.67±8.3 yrs) who had been referred to Gynecology clinics of Qom province, Iran, were included. Endocervical swab specimens were collected to detect lipopolysaccharide (LPS) antigen in EIA and to amplify MOMP gene of C.trachomatis in PCR. Results were confirmed using ompI nested-PCR. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated for performance of the tests. Odds ratios were determined using binary logistic regression analysis. Results: In total, 37 (7.14%) cases were positive by EIA and/or MOMP-PCR. All discrepant results were confirmed by nested-PCR. Sensitivity, specificity, PPV and NPV values of EIA were 59.46%, 100%, 100% and 96.98%, and those of MOMPPCR were 97.30%, 100%, 100%, 99.79%, respectively. Reproductive complications including 2.7% ectopic pregnancy, 5.4% stillbirth, 5.4% infertility, and 10.8% PROM were recorded. The risk of developing chlamydiosis was increased 4.8-fold in volunteers with cervicitis (p<0.05; OR 4.80; 95% CI 1.25-18.48). Conclusion: C.trachomatis infection should be regarded in women of reproductive ages especially those with cervicitis. Primary screening of women by using the low cost antigen-EIA is recommended; however, due to the low sensitivity of Ag-EIA, verification of the negative results by a DNA amplification method is needed