Locally acquired lymphocytic choriomeningitis virus infections in South-East Queensland: an outbreak of a pathogen rarely described in Australia.

Lymphocytic choriomeningitis virus (LCMV) is a zoonotic virus that can cause clinically significant illnesses in humans. Although cases of LCMV infection are well described globally, and there is evidence that the virus is present in Australian rodent populations, there has been only one case of domestically acquired LCMV infection published previously. Here, we describe a cluster of LCMV infections in South-East Queensland identified in early 2021, and the diagnostic testing processes implemented. This identifies LCMV as an under-recognised human pathogen in Australia.

Comparison of the Pediatric Cochlear Implantation Using Round Window and Cochleostomy.

INTRODUCTION: Cochlear implantation (CI) is now regarded as a standard treatment for children with severe to profound sensor neural hearing loss. This study aimed to compare the efficacy of the round window approach (RWA) and standard cochleostomy approach (SCA) in the preservation of residual hearing after CI in pediatric patients. MATERIALS AND METHODS: This double-blind randomized controlled trial was conducted on 97 pediatric patients receiving CI with 12-month follow-up. The study population was divided into two groups according to the surgical approaches they received, including RWA and SCA. Consequently, the patients were evaluated based on the Categories of Auditory Performance scale (CAP) and Speech Intelligibility Rating (SIR) test 45-60 days and 3, 6, 9, and 12 months post-surgery. RESULTS: The CAP and SIR mean scores increased in both groups during the 12-month follow-up. This upward trend was significant in both groups (P<0.001). There was no significant difference between the two treatment groups in any of the follow-up stages regarding the CAP mean score. The mean SIR score (P=1.14±0.40) was significantly higher in the RWA group 3(P=0.001), 6(P=0.008), and 9(P=0.006) months after the surgery. However, there was no significant difference between the RWA and SCA groups, regarding 1-year SIR (P=0.258). CONCLUSION: The CI with either RWA or SCA could improve hearing and speech performance in pediatric patients. Although mid-term speech intelligibility was better for RWA, there was no significant difference in the 1-year outcome between these two methods.

First Report of Extended-Spectrum Betalactamase-Producing Klebsiella pneumoniae Among Fecal Carriage in Iran: High Diversity of Clonal Relatedness and Virulence Factor Profiles.

Increasing rate of silent intestinal carriers with extended-spectrum betalactamase (ESBL)-producing Klebsiella pneumonia (ESBL-KP) has given rise to a serious healthcare problem in clinical settings. Various epidemiological studies are being conducted to determine clonal relatedness among carriers. In this study, we investigated the intestinal carriage of ESBL-KP and clonal relatedness among ESBL-KP isolated from fecal carriage in Iran for the first time. A total of 120 rectal swabs (RSs) were collected including 61 from inpatients of intensive care unit and 59 from outpatients. ESBL-KP screening was performed using MacConkey agar supplemented with cefotaxime. PCR was done for detection of ESBL, carbapenemase, and virulence factor genes. Conjugation experiments and PCR-based replicon typing were performed. Clonal relatedness was investigated by multilocus sequence typing (MLST) and multiple locus variable number tandem repeat analysis (MLVA). Out of a total of 120 RSs, 18.3% (22/120) ESBL-KP were isolated. The rate of blaCTXM-15 was 81%. ompk35 was the most prevalent virulence gene detected in 86.3% of the isolates. In conjugation experiments, three out of five tested isolates had conjugative plasmids. The most prevalent plasmid types belonged to IncL/M, IncA/C, and Inc FII. The MLST analysis showed that the main sequence types (STs) identified among ESBL-KP isolates were ST147, ST15, and ST16. The isolates were characterized into 4 miniclusters and 11 singletons using MLVA. High heterogeneity among ESBL-KP isolates indicated that this bacterium could be colonized in different sites and easily transferred. Screening of carriers in hospitals and community could help in controlling of infection in the healthcare and community settings.

A Challenge between Central Nervous System Infection and Lead Toxicity: Opioid Case Reports from Iran.

Although lead pollution has long been known as a cause of poisoning, it has remained a challenge to reliably diagnose it due to its common symptoms in various diseases. In this article, we report two cases of acute loss of consciousness due to the ingestion of opium-contaminated with lead. The reported cases share patterns of symptoms similar to meningitis and encephalitis which are usual etiology for the loss of consciousness. Lead poisoning is not a usual etiology for loss of consciousness and is considered in cases of occupational or environmental exposure. These reported cases showed a pattern similar to meningitis and encephalitis, but due to the unusual manifestations during their admission and coexistence with gastrointestinal symptoms, we were led to consider poisoning as the cause of consciousness loss. Lead poisoning often goes unrecognized due to a low index of suspicion, but it may turn out to be fatal. Therefore, it should be considered in the differential diagnosis of any neurobehavioral deficits in substance abusers.

Vancomycin Minimum Inhibitory Concentration for Methicillin-Resistant Staphylococcus aureus Infections; Is There Difference in Mortality Between Patients?

BACKGROUND: New data indicates that vancomycin may be less effective against methicillin-resistant Staphylococcus aureus (MRSA) infections with minimum inhibition concentration (MIC) within a sensitive range. OBJECTIVES: The aim of this study was to determine the distribution of the vancomycin MIC between MRSA strains and observe the difference in mortality between patients, while the influence of changes in MIC on the efficacy of vancomycin was also examined. PATIENTS AND METHODS: A routine date-based study was conducted on 41 MRSA isolates in a hospital in Tehran, Iran. The isolates were assessed for MIC by using the E-test method, and results were categorized into three groups: A (MIC < 1.5 µg/mL), B (1.5 ≤ MIC < 2 µg/mL) and C (MIC ≥ 2 µg/mL) MRSA. RESULTS: Group A was the most common group, followed by groups C and B. Although there was no statistically significant difference between patients' mortality with the MIC group, the mortality rate of group A was higher than C and B. CONCLUSIONS: Regarding Clinical and Laboratory Standards Institute (CLSI) definition for vancomycin susceptibility (MIC < 2 µg/mL), it seems that vancomycin may not be considered as the best antibiotic in order to treat heteroresistant vancomycin intermediate S. aureus (hVISA) and vancomycin sensitive S. aureus (VSSA) infections, and a new breakpoint for vancomycin and alternative antibiotics should be considered.

Reactive arthritis induced by bacterial vaginosis: prevention with an effective treatment.

We report a 42-year-old woman with reactive arthritis induced by bacterial vaginosis who presented with oligoarthritis with an additive form, arthralgia, and enthesitis. She hasn't had a history of diarrhea or dysuria or vaginal secretion, or sexually transmitted infections (STIs). The laboratory tests were normal except for a high erythrocyte sedimentation rate (ESR). Her pelvic examination revealed homogeneous white grey and malodorous vaginal discharge on the vaginal wall and Pap smear and Gram-stained smear of vaginal swab was consistent with bacterial vaginosis. She responded to metronidazole therapy and her six-month follow up hasn't shown recurrence of arthritis. As reactive arthritis (ReA) is a paradigm of a rheumatic disease in which the initiating infectious cause is known, so early use of antimicrobial drugs may prevent the development of musculoskeletal symptoms which are triggered by infections.

Relationship between Age and Peripheral White Blood Cell Count in Patients with Sepsis.

OBJECTIVES: Total white blood cells (WBCs) decrease slightly in the elderly. In response to an acute infection, the number of WBCs increases and in sepsis, the increase is very dramatic. There are some reports about the effects of increased number of WBCs as a predisposing factor of bacteremia. An association between neutrophilia and eucopenia and increased mortality rate in the elderly has also been observed. We compared peripheral WBC counts in young and elderly patients with sepsis. METHODS: A case-control study was carried out on 130 admitted patients who were divided into two groups based on age, ≥ 65 years (case group) and < 65 years (control group). All patients were hospitalized with the diagnosis of sepsis in two teaching hospitals in Tehran, Iran, 2001-2006. RESULTS: Mean WBC counts at admission time were 17061.5 ± 14240.2 /µl in the case group and 13567.7 ± 9888.0 /ml in the control group. There were statistically significant associations between age and history of infection and history of hospitalization during the last month in the case group and also between age and source of infection (P < 0.05). CONCLUSIONS: The history of infection and the history of hospitalization during the last month with sepsis are important risk factors in elders.

Hospital acquired antibiotic-resistant acinetobacter baumannii infections in a 400-bed hospital in Tehran, Iran.

OBJECTIVES: Acinetobacter baumannii is an omnipresent pathogen known as a major agent in healthcare and nosocomoal-associated infections. Its ability to develop resistant pattern to the major and broad spectrum antibiotics is an important issue to be studied. METHODS: In this study, 101 strains of Acinetobacter baumannii were isolated from the hospitalized patients during July 2007 to June 2009 in one teaching hospital in the southern Tehran. The identification of Acinetobacter baumannii and resistant pattern was performed by using conventional bacteriological methods and Clinical Laboratory and Standards Institute (CLSI). RESULTS: Respiratory tract specimens were the most common place of Acinetobacter isolation. The organism was resistant to ceftazidime (96%), ceftizoxime (95%), ceftriaxone (93%), amikacin (58%), gentamicin (68%), co-terimoxazole (85%), and ciprofloxacin (85%). This pattern also pointed that imipenem had the lowest resistance rate (9%). CONCLUSIONS: Susceptibility rates of Acinetobacter baumannii isolates to third-generation cephalosporins, fluoroquinolones, amikacin, gentamicin, and trimethoprim/sulfamethoxazole (SXT) were very low and the rate of resistant Acinetobacter baumannii to imipenem was significant. It would be a good idea to consider surveillance of antibiotic usage and restriction of using broad spectrum antibiotics before development of resistance to these agents.

Country-to-country transfer of patients and the risk of multi-resistant bacterial infection.

Management of patients with a history of healthcare contact in multiple countries is now a reality for many clinicians. Leisure tourism, the burgeoning industry of medical tourism, military conflict, natural disasters, and changing patterns of human migration may all contribute to this emerging epidemiological trend. Such individuals may be both vectors and victims of healthcare-associated infection with multiresistant bacteria. Current literature describes intercountry transfer of multiresistant Acinetobacter spp and Klebsiella pneumoniae (including Klebsiella pneumoniae carbapenemase- and New Delhi metallo-ß-lactamase-producing strains), methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and hypervirulent Clostridium difficile. Introduction of such organisms to new locations has led to their dissemination within hospitals. Healthcare institutions should have sound infection prevention strategies to mitigate the risk of dissemination of multiresistant organisms from patients who have been admitted to hospitals in other countries. Clinicians may also need to individualize empiric prescribing patterns to reflect the risk of multiresistant organisms in these patients.

A six months follow-up on children less than 6 years old in contact with smear positive tuberculosis patients, varamin city, tehran, iran.

OBJECTIVES: Current international guidelines recommend 6-9 months of Isoniazid (INH) preventive chemotherapy to prevent the development of active tuberculosis in children exposed to smear positive tuberculosis (TB) patients. The aim of the present study was to evaluate the adherence to a six-month of supervised INH prophylaxis program and outcome in children with household exposure to an adult pulmonary tuberculosis index case in Varamin city, Tehran, Iran. METHODS: This cross sectional study was conducted among household contacts in Varamin city, between 1997- 1998. All children <6 years old with a household contact with an adult pulmonary tuberculosis index case were screened for tuberculosis and given supervised INH preventive chemotherapy once active tuberculosis was excluded as planned. Adherence and outcome were monitored. RESULTS: In total, 31 index cases and 128 household contact cases were identified; 23 (18%) children <6 years old experienced household exposure, who were fully evaluated. two children were treated for active tuberculosis and 15 (12%) children received preventive chemotherapy. All children completed 6 months of supervised INH prophylaxis with normal clinical examination in 3 and 6 months after beginning INH prophylaxis. No side effects (peripheral neuropathy or liver damage) were reported or observed within this study. CONCLUSIONS: Strategy of six months of supervised INH chemoprophylaxis is successful, particularly in children who are at a high risk to progress to disease following exposure.

Bacteriuria by extended-spectrum Beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: isolates in a governmental hospital in South of Tehran, Iran.

INTRODUCTION: Antibiotic resistant mutants producing extended-spectrum beta-lactamase (ESBL) have emerged among Escherichia coli and Klebsiella pneumoniae. This study was done to determine the frequency of ESBL-producing E coli and K pneumoniae species isolated from urine samples of our patients. MATERIALS AND METHODS: A study was conducted on 164 urine isolates (124 E coli and 40 K pneumoniae) in the laboratory Loghman Hakim Hospital in Tehran, Iran, in 2007. Microbial sensitivity tests were done on Mueller-Hinton agar plates with disk diffusion method. Broad-spectrum resistance was defined as resistance to ampicillin or cephalothin; ESBL resistance, as resistance of these bacteria to one of ceftriaxone, ceftazidime, or ceftizoxime; and MDR-ESBL; as resistance to 3 of the following antibiotic groups: trimethoprim-sulfamethoxazole, aminoglycosides, fluoroquinolones, and nitrofurantoin. RESULTS: An ESBL resistance was detected in 52.5% of isolates with K pneumoniae and 45.2% of those with E coli. The MDR-ESBL pattern was detected in 26.8% of the isolates. These included 30.0% of the K pneumoniae and 25.8% of the E coli isolates. Broad-spectrum resistance was detected in all K pneumoniae isolates and 87.9% of 124 E coli isolates. CONCLUSIONS: Our study showed a high rate of ESBL resistant strain of E coli and K pneumoniae and the emergency of multiple drug resistance to these bacteria in our patients in Tehran, Iran.

Measles and rubella vaccination of two million Iranians: complications in vaccinees aged 5-25 years.

In 2003 and 2004, 2,049,170 persons aged 5-25 y were vaccinated against measles and rubella in Tehran. Adverse events were actively monitored. A total of 688 adverse events was reported in 476 vaccine recipients with a female dominance (female to male ratio 2.2). Severe adverse events were noted in 13 cases: seizures within 48 h of vaccination (n = 9), encephalopathy (n = 2), flaccid paralysis (n = 1) and anaphylaxis (n = 1).