Molecular identification of Enterocytozoon bieneusi and Encephalitozoon spp. in immunodeficient patients in Ahvaz, Southwest of Iran

Microsporidia are often considered as an opportunistic infection in patients with impaired immune systems such as transplant recipients and patients with acquired immune deficiency syndrome (AIDS). Due to the increasing prevalence of parasitic infections and immunodeficiency diseases; the aim of the study is to evaluate molecular identification of Enterocytozoon bieneusi and Encephalitozoon spp. in immunodeficient patients in Ahvaz, southwest of Iran. At first, 310 stool samples were collected from patients with immunodeficiency. The specimens were stained by modified trichrome (weber) and were examined microscopically. The extracted DNA samples were evaluated by multiplex/nested PCR method. The products of multiplex/nested PCR were explored by RFLP method using the restriction enzyme of Mnl1. Of 310, 93 samples were suspected positive for microsporidia by the staining. Also, of 310, 88 samples were positive by the multiplex/nested-PCR test that 62 samples were positive for E. bieneusi as well as 26 were detected as Encephalitozoon species that including 3 E. cuniculi, 19 E. intestinalis and 4 E. hellem. Of 62 E. bieneusi, 45, 16 and 1 were detected as genotype D, M and WL11, respectively. Also, Of 3 E. cuniculi, 1 and 2 cases were identified as genotype I and II, respectively. All E. hellem samples were included genotype 1A. Our findings revealed a relatively high prevalence of microsporidia species in immunodeficient patients. The highest risk of this infection is at individuals with impaired immune systems that it can be life-threatening in people with immune system dysfunction. It is essential that the high-risk people should be receiving the information about the risk of direct contact with infected individuals and animal

Pathogen Identification in Suspected Cases of Pyogenic Spondylodiscitis

Pyogenic spinal infection continues to represent a worldwide problem. In approximately one-third of patients with pyogenic spondylodiscitis, the infectious agent is never identified. Of the cases that lead to organismal identification, bacteria are more commonly isolated from the spine rather than fungi and parasites. This study applied universal prokaryotic 16S rRNA PCR as a rapid diagnostic tool for the detection of bacterial agents in specimens from patients suspected of pyogenic spondylodiscitis. Gram and Ziehl-Neelsen staining were used as a preliminary screening measure for microbiologic evaluation of patient samples. PCR amplification targeting 16S rRNA gene was performed on DNA extracted from 57 cases including specimens from epidural abscesses, vertebral, and disc biopsies. Positive samples were directly sequenced. MRI findings demonstrated that disc destruction and inflammation were the major imaging features of suspected pyogenic spondylodiscitis cases, as 44 cases showed such features. The most common site of infection was the lumbar spine (66.7%), followed by thoracic spine (19%), the sacroiliac joint (9.5%), and lumbar-thoracic spine (4.8%) regions. A total of 21 samples amplified the 16S rRNA-PCR product. Sanger sequencing of the PCR products identified the following bacteriological agents: Mycobacterium tuberculosis (n = 9; 42.9%), Staphylococcus aureus (n = 6; 28.5%), Mycobacterium abscessus (n = 5; 23.8%), and Mycobacterium chelonae (n = 1; 4.8%). 36 samples displayed no visible 16S rRNA PCR signal, which suggested that non-bacterial infectious agents (e.g., fungi) or non-infectious processes (e.g., inflammatory, or neoplastic) may be responsible for some of these cases. The L3–L4 site (23.8%) was the most frequent site of infection. Single disc/vertebral infection were observed in 9 patients (42.85%), while 12 patients (57.15%) had 2 infected adjacent vertebrae. Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) inflammatory markers were noted in majority of the patients. In conclusion, microbiological methods and MRI findings are vital components for the proper diagnosis of pyogenic spondylodiscitis. Our findings suggest that molecular methods such as clinical application of 16S rRNA PCR and sequencing may be useful as adjunctive diagnostic tools for pyogenic spondylodiscitis. The rapid turnaround time of 16S rRNA PCR and sequencing submission and results can potentially decrease the time to diagnosis and improve the therapeutic management and outcome of these infections. Although S. aureus and M. tuberculosis were the most common causes of pyogenic spinal infections in this study, other infectious agents and non-infectious etiologies should be considered. Based on study results, we advise that antibiotic therapy should be initiated after a definitive etiological diagnosis

Comparing Seroprotective Levels of IgG Antibody Against Single and Two Shots of Measles-Rubella-Mumps (MMR) Vaccine in Children Aged 12 Months to 15 Years Old in Southern Iran, Ahvaz in 2018

Background and Objective: Despite inclusive measles and rubella vaccination programs, the epidemics are still present in some areas. The present study aimed to evaluate the efficacy of these two vaccines simultaneously by testing the levels of IgG antibodies in children aged 12 months to 15 years old in Southern Iran. Methods: This was a cross-sectional study on serum blood samples of 400 children aged 12 months to 15 years old in Ahvaz, Southern Iran in 2018. The children were divided into the following age groups: age group of 12 months to 17 months and 29 days who received a single dose of Measles, Rubella, Mumps (MMR) vaccine; age group of 18 months to 10 years old who received two doses of MMR vaccine at the ages of 12 months and 18 months; and age group of 11 to 15 years old who received two doses of MMR vaccine at the age of 12 months and 4-6 years old. In the assessments, the protective levels were defined as per the guidelines of the ELISA kit (VIRCELL Co., Spain) as follows: The serum IgG antibody levels above 11 IU/ml were defined as positive protective level, 9 to 11 IU/ml as an equivalent state, and the serum antibody level below 9 IU/ml as a negative state. Accordingly, the equivalent and negative cases were reported as negative and cases above 11 IU/ml were positive. Results: The male to female ratio was 1.02. Most of the patients (69%) were in the age group 18 months to 10 years old. In all age groups, the number of people with a high serum anti-rubella and anti-measles IgG antibody level was higher than the protective level. There was no significant difference between the mean serum anti-rubella and anti-measles IgG antibody level between the age groups (P= 0.515, P= 0.176, respectively). For rubella, 86.66% of females and 83.16% of males, and for measles, 86.36% of females and 83.66% of males were seropositive, and there was no significant difference by two sexes (P= 0.486 and P= 0.412, respectively). Conclusions: The frequency of seropositive anti-measles and anti-rubella vaccine was not significantly different between the subjects with a single dose and those with two doses of MMR vaccine. Further studies are needed to evaluate the adequacy of the MMR vaccine for Iranian children. Moreover, due to the lower average serum IgG antibody level measles and rubella in males, further investigation is needed to find out the causal relationship between the lack of appropriate response to vaccine injection and male gender

Comparing Seroprotective Levels of IgG Antibody Against Single and Two Shots of Measles-Rubella-Mumps (MMR) Vaccine in Children Aged 12 Months to 15 Years Old in Southern Iran, Ahvaz in 2018

Background and Objective: Despite inclusive measles and rubella vaccination programs, the epidemics are still present in some areas. The present study aimed to evaluate the efficacy of these two vaccines simultaneously by testing the levels of IgG antibodies in children aged 12 months to 15 years old in Southern Iran.Methods: This was a cross-sectional study on serum blood samples of 400 children aged 12 months to 15 years old in Ahvaz, Southern Iran in 2018. The children were divided into the following age groups: age group of 12 months to 17 months and 29 days who received a single dose of Measles, Rubella, Mumps (MMR) vaccine; age group of 18 months to 10 years old who received two doses of MMR vaccine at the ages of 12 months and 18 months; and age group of 11 to 15 years old who received two doses of MMR vaccine at the age of 12 months and 4-6 years old. In the assessments, the protective levels were defined as per the guidelines of the ELISA kit (VIRCELL Co., Spain) as follows: The serum IgG antibody levels above 11 IU/ml were defined as positive protective level, 9 to 11 IU/ml as an equivalent state, and the serum antibody level below 9 IU/ml as a negative state. Accordingly, the equivalent and negative cases were reported as negative and cases above 11 IU/ml were positive.Results: The male to female ratio was 1.02. Most of the patients (69%) were in the age group 18 months to 10 years old. In all age groups, the number of people with a high serum anti-rubella and anti-measles IgG antibody level was higher than the protective level. There was no significant difference between the mean serum anti-rubella and anti-measles IgG antibody level between the age groups (P= 0.515, P= 0.176, respectively). For rubella, 86.66% of females and 83.16% of males, and for measles, 86.36% of females and 83.66% of males were seropositive, and there was no significant difference by two sexes (P= 0.486 and P= 0.412, respectively).Conclusions: The frequency of seropositive anti-measles and anti-rubella vaccine was not significantly different between the subjects with a single dose and those with two doses of MMR vaccine. Further studies are needed to evaluate the adequacy of the MMR vaccine for Iranian children. Moreover, due to the lower average serum IgG antibody level measles and rubella in males, further investigation is needed to find out the causal relationship between the lack of appropriate response to vaccine injection and male gender

Chronic mycobacterial meningitis due to Mycobacterium chelonae: a case report

We report a case of chronic meningitis due to Mycobacterium chelonae. This organism is a rapidly growing Mycobacterium (RGM) and can be found worldwide in environmental sources such as soil, dust, and water. M. chelonae is an uncommon cause of meningitis; the majority of infections caused by this organism are localized cutaneous or soft tissue infections, and rarely lung infections. The organism is indistinguishable phenotypically, so we applied PCR based on the rpoB gene sequence followed by restriction fragment length polymorphism (RFLP) for molecular identification. The subsequent sequencing of RFLP products revealed 99.7% similarity with M. chelonae

Infection after open heart surgery in Golestan teaching hospital of Ahvaz, Iran

The present study surveyed demographic and infection data which were obtained after open heart surgery (OHS) through patient's admission in Golestan teaching hospital, Ahvaz metropolitan city of Iran, taking into account the confirmed location of the infection, microorganism and antibiotic susceptibility. The occurrence of infection among patients during 48 to 72 h after surgery and hospital admission is the definition of Nosocomial infections (NIs) (Salmanzadeh et al., 2015) [1]. All of them after OHS were chosen for this study. In this paper, type of catheter, fever, type of microorganism, antibiotic susceptibility, location of the infection and outcome (live or death) were studied (Juhl et al., 2017; Salsano et al., 2017) [2,3]. After the completion of the observations and recording patients' medical records, the coded data were fed into EXCELL. Data analysis was performed using SPSS 16. Keywords: Infection, Heart surgery, Hospital, Ira

An estimation of COPD cases and respiratory mortality related to Ground-Level Ozone in the metropolitan Ahvaz during 2011

Background & Aims of the Study :  Ground-Level Ozone (GLO) is the component of one of greatest concern that threatened human health in both developing as well as developed countries. The GLO mainly enters the body through the respiration and can cause decrements in pulmonary complications, eye burning, shortness of breath, coughing, failure of immune defense, decreases forced vital capacity, reduce lung function of the lungs and increase rate of mortality. Ahwaz with high emission air pollutants because of numerous industries is one of the metropolitan Iranian polluted. The aim of this study is evaluate to Chronic Obstructive Pulmonary Disease (COPD) and respiratory mortality related to GLO in the air of metropolitan Ahvaz during 2011. Materials & Methods: We used the generalized additive Air Q model for estimation of COPD and respiratory mortality attributed to GLO pollutant. Data of GLO were collected in four monitoring stations Ahvaz Department of Environment. Raw data processing by Excel software and at final step they were converted as input file to the Air Q model for estimate number of COPD Cases and respiratory mortality. Results: According to result this study, The Naderi and Havashenasi had the highest and the lowest GLO concentrations. The results of this study showed that cumulative cases of COPD and respiratory mortality which related to GLO were 34 and 30 persons, respectively. Also, Findings showed that approximately 11 % COPD and respiratory mortality happened when the GLO concentrations was more than 20 μg/m 3 . Conclusions: exposure to GLO pollution has stronger effects on human health in Ahvaz. Findings showed that there were a significant relationship between concentration of GLO and COPD and respiratory mortality. Therefore; the higher ozone pollutant value can depict mismanagement in urban air quality. &nbsp