Detection of circulatory E. granulosus-derived cell-free DNA in the plasma and urine of human cystic echinococcosis using an in-house PCR: a potential promising diagnostic biomarker.

BACKGROUND: The diagnostic tool for identifying cystic echinococcosis (CE) patients at an early stage is currently lacking. However, circulatory cell-free DNA (cfDNA) has shown potential as a biomarker for parasitic infections and could be used for diagnosing CE. RESEARCH DESIGN AND METHODS: The plasma and urine samples were collected from 39 patients with confirmed CE through imaging and histopathological techniques. All plasma samples were tested for anti-echinococcal antibodies using a commercial ELISA test. Total plasma and urine cfDNA were extracted and an in-house PCR assay was developed to detect E. granulosus specific cfDNA in the samples of CE patients. RESULTS: Out of the 39 patients, 30 tested positive for E. granulosus using serology, with a sensitivity of 76.9%. Moreover, the detection rates for the cfDNA were 79.5% in plasma samples and 58.97% in urine samples using the 80 bp COX1 gene. The plasma-based PCR and serology test showed the highest agreement (Kappa = 0.53). CONCLUSIONS: Plasma-based PCR has been found to be a reliable diagnostic tool for identifying CE patients at different cyst stages. It offers validity, speed, and sufficient sensitivity, making it an alternative to serology in diagnosing CE in endemic areas.

Status of human cystic echinococcosis based on hospital records in Mazandaran Province: A first registry-based evidence.

Background: Human cystic echinococcosis, as an emerging neglected parasitic disease, is caused by tapeworms of the genus Echinococcus spp. Because of the medical and economic importance, this study aims to review the epidemiology and clinical features of hydatidosis in patients admitted to medical and surgical wards in three referral teaching hospitals over 15 years in Mazandaran Province, northern Iran. Methods: Data were collected from hospital records that were accessible via the hospital information system (HIS) between 2005 and 2019 (15 years).The demographic information (age, sex, living area, and occupation), dog contact, number of the cysts, types of organs involved, and history of disease recurrence were assessed. Results: One hundred twenty-one patients with human cystic echinococcosis (CE) were involved in the study, from whom 58 patients (47.93%) were male and 63 (52.07%) were female. The majority of patients were rural residents (64.46%) and also housewife (28.10%). Based on the results, only about 16.53% of the patients had history of close contacts with dogs. The liver was the organ involved in the most cases of CE. There were statistically significant differences between residence, occupation, history of close contacts with dogs, type of organs involved, number of cysts and history of disease recurrence (P < 0.05). Conclusions: Our data provides valuable registry-based information about CE in an endemic region. The data highlights that most patients lived in rural areas and were housewives. Additionally, they had a low rate of disease recurrence but a high rate of close contact with dogs. Moreover, further monitoring on registry-based program and strengthening the HIS in the provincial hospitals in the studied area are required.

Credible Serological Evidence of Latent Toxoplasma Infection Among Women with Primary Infertility: A Ten-Year Registry-Based Study.

BACKGROUND: Some evidence reveled that chronic infection with Toxoplasma gondii (T. gondii) has recently been associated with infertility in human and experimental model. This baseline study aimed to investigate serological evidence of Toxoplasma infection among infertile women who admitted to the in vitro fertilization (IVF) clinic at Imam Khomeini Hospital, Mazandaran province, Sari, northern Iran. SUBJECTS AND METHODS: In this retrospective (descriptive-analytical) study, all infertile women referred to the IVF clinic during 2010-2019 (10 years), constitute the study population. All data including demographic and some related characteristics were collected into a questionnaire and registered at the Iranian National Registry Center for Toxoplasmosis (INRCT) at the Mazandaran University of Medical Sciences, northern Iran. The existence of anti-Toxoplasma antibodies (IgG and IgM) was explored using a commercially available enzyme-linked immune sorbent assay (ELISA) kit (PishtazTeb, Iran), based on the manufacturer's protocol. RESULTS: Of 520 infertile women, anti-T. gondii IgG, IgM and both IgG and IgM antibodies were detected among 342/520 (65.77%), 1/520 (0.19) and 4/520 (0.77) infertile women, respectively. Primary and secondary infertility was detected in 74.56% and 25.44% of IgG seropositive infertile women, respectively. Also, most of the IgG seropositive subjects had no history of abortion, polycystic ovary syndrome (PCO), fibroma, contraceptive use and varicocele in spouse as primary cause of infertility. Furthermore, serum levels of prolactin and antimullerian (AMH) hormones were normal in 81.29 and 80.12% of infertile women with anti- T. gondii IgG, respectively. There was also a statistically significant difference between the seroprevalence of Toxoplasma infection and these variables associated to primary infertility (P < 0.05). CONCLUSION: According to the high prevalence (about two thirds) of chronic T. gondii infection among infertile women, particularly those with a history of abortion and primary infertility, it can be concluded that latent Toxoplasma infection pose a risk to infertile woman in the study area. Therefore, we advise that screening and treatment of Toxoplasma infection among infertile women must be favorably considered.

High Occurrence of Emerged Lophomonas Infection among Patients Suspected of Having Pulmonary Tuberculosis: In-House PCR-Based Evidence.

Objectives: Lophomonas infection is a respiratory disease in humans that is associated with symptoms of cough, sputum, dyspnea, and sometimes hemoptysis, which shows the importance of differentiating this disease from tuberculosis and asthma. Methods: This study was performed on 216 participants suspected of having tuberculosis who had symptoms of fever, chronic cough, or sputum and were referred to tuberculosis laboratories in three cities in Golestan Province, northeastern Iran, during 2019-2020. A sputum sample was taken from the suspected patients. DNA was extracted from the frozen samples, and an in-house polymerase chain reaction was performed to detect the Lophomonas DNA. Results: Out of 216 subjects, 47 (21.75%) were infected with Lophomonas spp. Moreover, 9 patients (4.2%) were infected with tuberculosis. Also, 2 patients had a comorbidity of tuberculosis and Lophomonas infection (P=0.63). There was no significant difference in the comparison of symptoms and the rate of Lophomonas infection (P=0.84), but in the comparison of the set of symptoms of cough, sputum, and fever with those of cough and sputum, cough with fever, sputum with fever, and the rate of Lophomonas infection, there was a significant difference (P=0.012). Conclusions: Lophomonas infection was relatively high in patients suspected of having tuberculosis and due to the similar clinical symptoms of Lophomonas infection and tuberculosis; it is recommended that the sputum samples of subjects suspected of having tuberculosis be examined for this parasite in order to make a correct diagnosis and the patients receive timely treatment and the appropriate medication.

Two decades of echinococcosis/hydatidosis research: Bibliometric analysis based on the web of science core collection databases (2000-2019).

Echinococcus granulosus sensu lato and Echinococcus multilocularis are responsible for serious health and economic implications for humans and animals. This study was designed to conduct a bibliometric analysis of global research on echinococcosis/hydatidosis included in the Web of Science Core Collection databases from 2000 to 2019. A total of 7066 relevant articles between 2000 and 2019 were identified. Most articles were published in 2015 (502 articles), 2017 (492 articles) and 2018 (493 articles), with the Veterinary Parasitology journal publishing the largest number of articles (237). Researchers from Xinjiang Medical University, China authored the most articles (388) in the field. Authors Craig, P.S. and Deplazes, P. were the most active in publishing143 and 126 hydatid cyst research papers, respectively. The most echinococcosis/hydatidosis publications originated from Turkey, China and Iran, with 1210, 708 and 531 articles, respectively. The highest levels of research collaboration were evident between China- England, China-France, England-France, China-Australia, and China-Japan. Also, the top researchers in this field had relatively extensive collaborations with each other. Our bibliometric analysis provides a picture of the scientific research into the echinococcosis/hydatidosis field. Further multi-national collaborative research efforts in this field should show promising progress in the future.

Suicide attempt using zinc phosphide rodenticide: A case report and literature review.

The patients with a history of intentional or unintentional consumption of rodenticide compounds, especially ZnP, it is necessary to assess ABG and abdominal radiography.

Acute pancreatitis due to methanol toxicity during the COVID-19 pandemic.

Acute methanol poisoning may be associated with a variety of symptoms, such as abdominal pain, blurred vision, loss of consciousness, and acute pancreatitis. We present a 37-year-old man with acute pancreatitis due to methanol poisoning during the COVID-19 pandemic.

Toxoplasma gondii infection in patients with rheumatoid arthritis and systemic lupus erythematous diseases: serological and molecular evidence.

This study aimed to determine Toxoplasma gondii infection in rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) patients in Mazandaran Province, north of Iran. During April 2019 to February 2020, 305 patients with RA (N=272) and SLE (N=33) diseases are included in this cross-sectional study. The baseline data of patients were collected into a questionnaire. Also, blood sample was taken from each patient in tubes containing k2-EDTA as anticoagulant for serological and molecular analyses. The presence of specific IgG antibody against T. gondii in plasma was explored using ELISA method. DNA was extracted and conventional-PCR method was done using RE primers on buffy coat samples. Anti-Toxoplasma IgG were detected among 105/272 RA (38.6%) and 11/33 (33%) SLE patients (P=0.55). IgG seropositivity was more common in females (95.70%) than in males (4.30%) and in 51-60 years old patients (37.10%) in rural populations (62.07%). Also, seropositivity was higher in patients who kept cats (93.95%). Keeping cats and patient's age were two studied risk factors which had significant relations with T. gondii seropositivity in patients (P<0.05). Overall, T. gondii DNA was found in 60 of 305 (19.7%) of enrolled patients, whether serology positive or negative (P<0.0001). Given the RA and SLE patients can be considered as a risk group for toxoplasmosis, in addition to the serological test, PCR based techniques is recommended for early and accurate detection of recent T. gondii infection.

Occurrence of hypoglycemia in patients with benzodiazepines poisoning: A cross-sectional study.

BACKGROUND: Benzodiazepine (BZD) poisoning is a common medical condition often accompanied by respiratory arrest, aspiration pneumonitis, and may rarely result in death. Although it is not studied well, hypoglycemia is a real and life-threatening condition that may occur in BZD poisoning. Thus, the present study was shown to determine the prevalence of hypoglycemia among patients with BZD poisoning compared to toxicity with other drugs. PATIENTS AND METHODS: In this study, patients with drug-induced poisoning referred to Vasei hospital, Sabzevar, eastern Iran, were registered and their blood glucose levels at presentation were collected during 2019. RESULTS: Overall, 300 poisoned patients were evaluated (17% with BZD poisoning). The prevalence of hypoglycemia was significantly higher in patients with BZD poisoning (11.8% vs. 2.8%, p = 0.004), especially in males (P = 0.016), aged >30 years old (p = 0.006). However, the prevalence of hypoglycemia was higher in patients with GCS<10 (p = 0.005) and in patients referred later than 1 h to a medical center (p = 0.015). CONCLUSION: Results were show that hypoglycemia is a frequent complication of BZD poisoning and should be considered in the initial evaluation of patients referred to the emergency department with this medical condition.

Global status of neglected human Linguatula infection: a systematic review of published case reports.

Human linguatulosis is a rare but highly specialized pentastomid parasitic infection all around the world. The disease is caused by worm-like parasites which share some morphologic features of arthropods and annelids. The life cycle of Linguatula spp. is provided as an example of pentastomid biology. The adult forms of Linguatula spp. are found in the nasal passages and frontal sinuses of dogs and other canids, domestic animals, and humans. Infestation may occur in the viscera, where immature forms develop in the liver, spleen, lungs, eyes, and other organs, or in the nasopharyngeal area. This review includes previous studies on the genus Linguatula in Iran and other countries from 1940 to 2019. Considering a few reports of human infestation, a comprehensive search was performed on both English and Persian databases for publications reporting human cases all around the world. Finally, 30 papers of 62 human cases were included in this study. The mean age of the patients was 25.8 years (varied from 8 to 79 years). Altogether, 41 (66.1%) and 21 (33.9%) of the patients were female and male respectively. The maximum cases (n = 25) were from Sudan. Nasopharynx was the most frequently involved organ in human cases. Our findings offer that physicians should consider the Linguatula infection in patients with complaints like unexpected dysphagia, with coughing, sneezing, and vomiting, after consuming raw/undercooked contaminated ruminant's viscera.

Mild-to-severe poisoning due to Conium maculatum as toxic herb: A case series.

Conium maculatum toxicity may occur by mistakenly or intentionally eating this plant. Due to muscarinic or nicotinic symptoms associated with this plant toxicity, supportive care and treatment with atropine are urgently important.

Fulminant hepatorenal syndrome due to Acetaminophen toxicity: A case report.

HRS is a rare and poor prognosis complication of chronic acetaminophen toxicity, which presents by progressive decline in renal function secondary to liver failure.

Methanol poisoning as a new world challenge: A review.

BACKGROUND: Methanol poisoning (MP) occurs often via ingestion, inhalation, or dermal exposure to formulations containing methanol in base. Clinical manifestations of MP include gastrointestinal symptoms, central nervous system (CNS) suppression, and decompensated metabolic acidosis occurred with blurred vision and early or late blindness. OBJECTIVE: This study reviewed the clinical manifestations, laboratory and radiology findings, and treatment approaches in MP. DISCUSSION: Methanol is usually rapidly absorbed after ingestion and metabolized by alcohol dehydrogenase (ADH), then distributed to the body water to reach a volume distribution approximately equal to 0.77 L/kg. It is also eliminated from the body as unchanged parent compounds. Clinical manifestations of MP alone initiate within 0.5-4 h after ingestion and include gastrointestinal symptoms and CNS suppression. After a latent period of 6-24 h, depending on the absorbed dose, decompensated metabolic acidosis occurs with blurred vision and early or late blindness. Blurred vision with normal consciousness is a strong suspicious sign of an MP. The mortality and severity of intoxication are well associated with the severity of CNS depression, hyperglycemia, and metabolic acidosis, but not with serum methanol concentration. After initial resuscitation, the most important therapeutic action for patients with known or suspected MP is correction of acidosis, inhibition of ADH, and hemodialysis. CONCLUSION: Since MP is associated with high morbidity and mortality, it should be considered seriously and instantly managed. Delay in treatment may cause complications, permanent damage, and even death.

Morphological and Molecular Identification of Emerged Lophomonas blattarum Infection in Mazandaran Province, Northern Iran: First Registry-Based Study.

BACKGROUND: In the last decade, several cases of bronchopulmonary lophomoniasis (BPL) have been recorded. Little information is available about epidemiological aspects on Lophomonas infection among BPL patients. The present study was aimed to investigate the prevalence of Lophomonas spp. infection in patients who were referred to the Iranian National Registry Center for Lophomoniasis (INRCL), using morphological and molecular tests. SUBJECTS AND METHODS: We examined patients enrolled in the INRCL from 2017 to 2019 at the Mazandaran University of Medical Sciences, northern Iran. All bronchoalveolar lavage fluid (BALF) and two nasal discharges of the patients were examined by both microscopic and small-subunit ribosomal RNA (SSU rRNA) PCR methods. To confirm the species of Lophomonas, two positive samples were sequenced. RESULTS: In this study, 321 specimens (including 319 BALF and 2 nasal discharges) were microscopically examined. Lophomonas spp. was found in 45(14%) (n = 44 BAL; n = 1 nasal discharge). The mean age of infected patients was 54.9 ± 17.1 years. The following morphological characteristics were observed in both fresh and Papanicolaou-stained smears to identify Lophomonas spp. All microscopically positive specimens were confirmed with genus-specific PCR technique. The obtained sequences were deposited in Gen Bank under the accession numbers (MN243135-36). The BLAST analysis of our two sequences with the only available sequence in the Gen Bank of the Thailand strain of L. blattarum, showed identity of 99-100% and 98.51%, respectively. CONCLUSION: To the best of our knowledge, this is the first registry-based study regarding lophomoniasis worldwide. According to our study, the conventional PCR test is an available and reliable tool for confirming the Lophomonas parasite in clinical samples. Moreover, the results confirmed that L. blattarum is circulating at least in our region.

Alkaline phosphatase and score of HRCT as indicators for predicting the severity of COVID-19.

BACKGROUND: The clinical symptoms, blood laboratory data, O2 saturation and high-resolution computed tomography (HRCT) findings are critical factors in diagnosis of COVID-19 infection. METHODS: In this study, 105 hospitalized patients suspected of having COVID-19 were evaluated. Finally, the laboratory and HRCT and related factors data of 83 confirmed cases by HRCT and RT-PCR were analyzed. To compare the median of quantitative variables in the two groups, the Mann-Whitney U test was used. Also, to determine the factors associated with the positiveness of the HRCT result, a univariate logistic model was fitted. Moreover, receiver operating characteristic (ROC) curves were constructed to test the ability of the final model to predict the positiveness of HRCT result. RESULTS: 61.40% of the patients had a comorbidity disease. 89.20% had fever, 92.00% cough, 91.40% dyspnea. Abnormal CRP was seen in 77.80% of the patients, followed by 66.70% lymphopenia, and 60.30% neutrophilia. Also, ALP (abnormal vs. normal) and score of HRCT assessment variables had a significant effect on the positiveness of HRCT findings. 87.95% had abnormal HRCT with 41% bilateral multi lobar patchy ground glass opacity (GGO). Moreover, there was a statistically significant association between the level of O2 saturation and HRCT results. CONCLUSION: Our findings showed that male patients with middle age and comorbidity disease were more susceptible to the COVID-19 infection. Additionally, clinical features, blood laboratory findings, O2 saturation and HRCT findings are critical factors in the prognosis of COVID-19 infection.

Massive cutaneous complications due to snakebite: A case report and literature review.

Wound infections due to snake bites such as cellulitis and necrotizing fasciitis, although not common, are seen in snake bites and if left untreated can cause serious complications.

First Evidence for Colonizing of Acanthamoeba T4 Genotype in Urinary Tracts of Patients with Recurrent Urinary Tract Infections.

BACKGROUND: Limited evidence about the presence of Acanthamoeba spp. in urine specimens collected from urinary catheters of the patients in the intensive care units persuaded our study. No evidence has been found about colonizing of Acanthamoeba spp., in urinary tracts of patients with recurrent urinary tract infections (UTIs) yet. METHODS: In this study, 50 urine samples were collected from patients presenting with recurrent UTI. The type of bacteria causing UTI was determined by using bacteriological tests. To cultivate Acanthamoeba spp., in a sterile condition, 10 mL of urine was centrifuged and the sediment was cultivated on non-nutrient agar. Genotypes were determined by sequencing the DF3 region of the 18S rRNA gene. RESULTS: The bacteriological test findings on the urine samples of the UTI patients (n = 30) demonstrated that those were found to be positive for Escherichia coli (n = 17), Staphylococcus aureus (n = 6), Pseudomonas aeruginosa (n = 4) and Klebsiella spp. (n = 3) respectively. Moreover, a total of 50 urine samples was examined; 6 (6/50; 12%) and 11 (11/50; 22%) were positive by using culture and the PCR test for Acanthamoeba spp., respectively. Sequencing analysis showed all isolates were T4 genotype. CONCLUSIONS: Our data showed that the high relative prevalence of Acanthamoeba T4 genotype spp., in the urine of recurrent UTI patients. As well as, providing the first evidence for colonizing of the Acanthamoeba in the urinary tracts of patients with recurrent UTIs. These findings, warrant further investigation among those patients to fully appraise the role of Acanthamoeba spp., as possible latent carriers for resistant bacteria and biofilm formation in the future.

Co-morbidity of Covid-19 and Stenotrophomonas maltophilia in a Patient with Hodgkin's Lymphoma History from North of Iran.

INTRODUCTION: Immunocompromised patients, especially those hospitalized, are at a higher risk for infection with opportunistic pathogens such as Stenotrophomonas maltophilia (S. maltophilia) which is a multidrug-resistant gram-negative bacillus and can cause a challenge in the management of patients with concomitant COVID-19 and S. maltophilia pneumonia. CASE PRESENTATION: A 71-year-old man with Hodgkin's lymphoma presented with severe respiratory symptoms of COVID-19 was intubated upon admission and the initial standard treatment for COVID-19 was started for him. The patient subsequently developed superimposed bacterial pneumonia with S. maltophilia. According to that, the patient's intubation tube was removed and a tracheostomy was performed for him. Also, antibiotic treatment was replaced with Colistin and Co-trimoxazole drugs. Finally, after 31 days of hospitalization in the ICU and the appropriate drug treatment, he was discharged with reduced symptoms and partial recovery. CONCLUSION: It should be noted that the occurrence of co-infection with multidrug-resistant pathogens such as S. maltophilia requires proper management to select appropriate treatment methods and drugs, so that in addition to proper effectiveness, it does not lead to side effects and complications associated with COVID-19 disease.

Comparative evaluation of amniotic fluid as an alternative to fetal bovine serum in the maintenance of Leishmania major and Toxoplasma gondii.

This study aimed to evaluate the efficacy of amniotic fluid (AF) as an alternative to fetal bovine serum (FBS) in the maintenance of Leishmania major promastigotes and Toxoplasma gondii tachyzoites. AF was collected by an obstetrician using sterile syringes during a cesarean section. The culture medium was supplemented with 5 different concentrations of FBS or AF including 2, 5, 10, 20, and 30%. These concentrations were used to maintain both mentioned parasites. L. major was maintained at temperatures 4 and 24 °C and examined once a week for 4 weeks, while T. gondii was maintained at temperatures 4, 24, and 37 °C and examined at hours 24, 48, 72, and 96. For L. major, at both 4 and 24 °C, we observed no significant difference between FBS and AF on day 7. However, on days 14, 21, and 28, the difference between FBS and AF was significant at both temperatures. For T. gondii, no significant difference was observed between FBS and AF at hour 24 and all temperatures. However, this difference was significant at hours 48, 72, and 96 and all temperatures. According to our results, although FBS had a greater efficacy than AF in the growth of L. major and the survival of T. gondii, the number of promastigotes increased over time in AF-containing medium and the number of tachyzoites reduced slowly with a mild slop. Therefore, AF can be a potential alternative to FBS.

A Bibliometric Analysis of Global Research on Lophomonas Spp. in Scopus (1933-2019).

BACKGROUND: This study was designed to analyze the global research on Lophomonas spp. using bibliometric techniques. METHODS: A bibliometric research was carried out using the Scopus database. The analysis unit was the research articles conducted on Lophomonas spp. RESULTS: A total of 56 articles on Lophomonas spp. were indexed in the Scopus throughout 1933-2019 (87 years) with the following information: (A) The first article was published in 1933; (B) 21 different countries contributed in studies related to Lophomonas spp.; (C) China ranked first with 16 publications about Lophomonas spp.; and (D) "Brugerolle, G" and "Beams, H.W." from France and the US participated in 4 articles respectively, as the highest number of publications in the Lophomonas spp. network. DISCUSSION: After 87 years, Lophomonas still remains unknown for many researchers and physicians around the world. Further studies with high quality and international collaboration are urgently needed to determine different epidemiological aspects and the real burden of the mysterious parasite worldwide.