Infection of tendon sheaths, joints, bursae, soft tissue, and tendon rapture by brucella: A case report.

Key Clinical Message: Arthritis is one of the main presentations of chronic brucellosis, but bursitis and tendon rupture are also caused by brucellosis. Therefore, brucellosis should be considered in the differential diagnosis of arthritis, bursitis, and tendon rupture by physicians. In addition, early diagnosis and treatment are very important in the prevention of disability. Abstract: Brucellosis is a zoonotic disease common in the Middle East. Manifestations of acute disease are fever, sweating, myalgia, and arthralgia. However, bone joint involvement occurs in 10%-85% of patients, and sacroiliac involvement occurs in up to 80% and vertebral joint involvement in up to 54%. A 57-year-old woman was admitted to the hospital of Islamic Azad University on February 26, 2021, with a history of one-month pain and limited movement of the right shoulder joint with fever for surgery of the shoulder ligament. The standard agglutination titer (Wright) for brucellosis at first was 1/640 and then increased. MRI of the shoulder showed a supraspinatus tendon and anterosuperior labral of the glenoid labrum tear. Although the patient was a candidate for shoulder joint ligament surgery, with a diagnosis of brucellosis, the treatment of brucellosis was prescribed, symptoms disappeared with anti-brucellosis antibiotic therapy without surgery, and the patient recovered. Supraspinatus tendon and antero superior labral of glenoid labrum tear of the shoulder joint in brucellosis is generally very rare. Failure or delay in the treatment of brucellosis can cause ligament rupture or joint disability. Sometimes, there are no symptoms except osteoarticular manifestations in brucellosis; therefore, brucellosis should be one of the differential diagnoses in osteoarticular diseases.

Correction to: Intestinal Microbiota Composition in Iranian Diabetic, Pre-diabetic and Healthy Individuals.

[This corrects the article DOI: 10.1007/s40200-020-00625-x.].

Association of acute hepatitis B and acute myopathy: a case report.

BACKGROUND: Hepatitis B virus infection is a global public health problem. Although hepatitis B virus primarily affects hepatocytes, it sometimes develops disease manifestations outside the liver, such as myopathy, which is commonly caused by chronic hepatitis B. CASE PRESENTATION: This case report describes a 57-year-old Iranian woman admitted to the hospital with jaundice, fever, body itching, abdominal pain, progressive muscle weakness, icteric sclera, right upper quadrant pain, and decreased muscle force. Examination on the first day of admission revealed that the patient was negative for hepatitis D antibody, positive for hepatitis B core (IgM) antibody, positive for hepatitis B surface antigen, and negative for hepatitis B e antibody but positive for hepatitis B e antigen. Moreover, she showed high levels of hepatitis B virus DNA viral load, creatine kinase, lactate dehydrogenase, serum glutamic-oxaloacetic transaminase, serum glutamic-pyruvic transaminase, total bilirubin, direct bilirubin, and alkaline phosphatase, and electromyography/nerve conduction velocity showed acute myopathic process. CONCLUSIONS: Interestingly, myopathy symptoms improved after improving hepatitis symptoms and decreasing hepatitis B viral load, suggesting a close association between hepatitis B infection and myopathy.

Assessment of fecal Akkermansia muciniphila in patients with osteoporosis and osteopenia: a pilot study.

OBJECTIVES: Osteoporosis is characterized by slow deterioration in bone mass and disruption of its structure, leading to an increased risk of bone fractures. Gut microbiota plays an important role in the transport and absorption of nutrients needed for bone health. Akkermansia muciniphila is one of the gut microbiota members that its beneficial role in prevention of metabolic disorder was suggested. The aim of the current pilot study was the assessment of fecal A. muciniphila in patients with osteoporosis and osteopenia. METHODS: A total of 36 subjects including eight with osteoporosis (three men and five women), eight with osteopenia (two men and six women), and 20 normal controls (six men and 14 women) were selected. Microbial genome was extracted from fresh stool samples. The bacterial load was determined by quantitative real-time PCR using 16S rRNA specific primers. RESULTS: The participants' mean age in the osteoporosis, osteopenia and control groups were 61.71, 45 and 45.05 years, respectively. The majority of osteoporosis patients were post-menopause women, while in osteopenia group was pre-menopause. There were significant differences in terms of age, T-score, Z-score, and menopause among groups (P value < 0.05). The presence of A. muciniphila was higher in the healthy group compared to osteopenia group; however, these differences were not statistically significant. CONCLUSIONS: In conclusion, however, there was no statistically significant difference between the study groups; it seems that the load of A. muciniphila may be related to bone health. Further in vivo and in vitro studies are needed to investigate the immunological and biochemical pathways.

Blood microbiota composition in Iranian pre-diabetic and type 2 diabetic patients.

BACKGROUND: Type 2 diabetes as the most prevalent metabolic disorder, is one of the major causes of morbidity and mortality worldwide. Recent studies suggest that body microbiota may play a role in developing metabolic disorders including type 2 diabetes. The objective of the present study was to investigate the blood microbiota composition in Iranian pre-diabetic and type 2 diabetic patients compared to healthy individuals. METHODS: Blood samples were taken after 12-h fasting from 90 participants, 30 healthy individuals, 30 type 2 diabetes patients and 30 pre-diabetic participants. The buffy coat layer separated by centrifugation at 800 and DNA was extracted using a column-based method. Composition and load of blood microbiota was evaluated by real-time PCR method using genus specific 16S rRNA primers. RESULTS: The load of Akkermansia, and Faecalibacterium was higher in normal volunteers compared to pre-diabetic and type 2 diabetes group (p< 0.05).The load of Bifidobacterium was higher in normal volunteers compared to type 2 diabetes patients (p= 0.02). In contrast, the load of Lactobacillus and Escherichia coli was higher in pre-diabetics and type 2 diabetes patients compared to normal volunteers (p< 0.05).The load of Bacteroides fragilis was not statistically different between studied groups but it was higher in males compared to female group (p= 0.04). the load of other bacteria was not significantly different between male and female participants. CONCLUSION: There is difference between microbiota composition in white blood cells of pre-diabetic and type 2 diabetes patients compared to healthy people. Determination of blood microbiota pattern may have a role in diagnosis and preventive of type 2 diabetes in a certain population. For more clarification about correlation between blood microbiota and type 2 diabetes, larger studies with more participants in different ethnical populations is suggested.

Main gut bacterial composition differs between patients with type 1 and type 2 diabetes and non-diabetic adults.

BACKGROUND: Regarding the role of gut microbial dysbiosis in hyperglycemia, we aimed to compare the main gut bacterial composition among type 1 and type 2 diabetic patients and healthy non-diabetic adults. METHODS: A total of 110 adult subjects (49 patients diagnosed with type 2 diabetes, 21 patients diagnosed with type 1 diabetes and 40 healthy persons) were included in this case-control study. The intestinal microbiota composition was investigated by quantitative real-time polymerase chain reaction (qPCR) method targeting bacterial 16S rRNA gene. Comparison between three groups was done using one-way analysis of variance. RESULTS: The participants' mean age in the type 1 diabetes, type 2 diabetes and control groups was 35.4, 57.2 and 38.0 years, respectively. Higher level of Escherichia, Prevotella and Lactobacillus was observed in both type 1 and type 2 diabetic patients compared with the healthy group (P ˂0.001). In contrast, bacterial load of Bifidobacterium, Roseburia and Bacteroides was higher in healthy control group (P < 0.05). Faecalibacterium was significantly lower in type 1 diabetic patients compared with the other two groups (P ˂0.001). No significant difference was found in Akkermansia level among three groups. CONCLUSIONS: Gut microbial alterations have been observed among patients suffering from type 1 and type 2 diabetes mellitus and healthy control adults. Butyrate producing genera including Roseburia and Faecalibacterium decreased while Escherichia, Prevotella and Lactobacillus increased in diabetic patients compared to healthy subjects. Modulating approaches of gut microbiota composition could be helpful in diabetes management.

Intestinal Microbiota Composition in Iranian Diabetic, Pre-diabetic and Healthy Individuals.

BACKGROUND: Type 2 diabetes, as the most prevalent metabolic disorder, is one of the leading causes of death worldwide. Recent studies showed a significant association between intestinal microbiota and type 2 diabetes. These studies have shared evidences that alteration in the composition of intestinal microbiota can disrupt the balance of the host homeostasis and lead to metabolic disorders such as type 2 diabetes. In the present study, we compared the intestinal microbiota composition in three groups of type 2 diabetes patients, pre-diabetic patients and healthy individuals of Iranian population. METHODS: After obtaining informed consent, stool samples were collected from 90 individuals of three studied groups. The DNA was extracted using column-based method. Intestinal microbiota composition was evaluated by quantitative real-time PCR using specific bacterial 16S rRNA primers. The difference of bacterial load was compared between three groups. RESULTS: The prevalence of Akkermansia muciniphila and Bifidobacteria species in healthy group was higher than type 2 diabetes group (P Value 0.006 and 0.001, respectively). In contrast, the load of Lactobacillus (P Value 0.044), Escherichia coli (P Value 0.005), and Bacteroides fragilis (P Value 0.017) in type 2 diabetes group, and the frequency of E. coli (P Value 0.001) and Bacteroides fragilis (P Value 0.004) in pre-diabetic group was significantly higher than healthy group. Moreover, the frequency of Faecalibacterium prausnitzii in healthy group was significantly higher compared to two other groups (P Value 0.005). CONCLUSION: There is a correlation between intestinal microbiota composition and type 2 diabetes. Determination and restoration of this microbiota composition pattern may have a possible role in prevention and control of type 2 diabetes in a certain population.

Impact of hepatitis B virus and hepatitis C virus infection on sperm parameters of infertile men.

BACKGROUND: Viral hepatitis is one of the health problems which have the effects on the health issues. It seems that hepatitis B virus (HBV) and hepatitis C virus (HCV) infection have negative impacts on the semen quality and male infertility rate. OBJECTIVE: In this study, we aimed to evaluate the effects of HBV and HCV on sperm quality among Iranian infertile men referred to Royan Institute Reproductive Biomedicine Research Center between 2003 and 2014. MATERIALS AND METHODS: This retrospective case-control study included 112 HBV positive infertile men and 47 HCV positive infertile men as case group and 112 HBV negative and HCV negative matched infertile men as a control group. All semen analysis and viral parameters assessment was performed in the central laboratory with the same method and instruments. RESULTS: Sperm count among infertile men with HBV and HCV infection was significantly lower than control group [the mean of the total sperm count 100.95░±â–‘118.59, 118.22░±â–‘141.18, 166.27░±â–‘151.25 (p░<░0.001)]. Sperm motility was significantly decreased in HBV and HCV positive men in comparison to the control group [30.97░±â–‘25.88, 31.09░±â–‘28.72, 40.87░±â–‘23.37, respectively (p░<░0.007)]. The percentage of normal sperm morphology was significantly higher in control group in comparison to HBV and HCV infected group [the mean of the normal semen morphology 3.23░±â–‘3.27, 3.70░±â–‘3.83, 4.51░±â–‘3.15 p░<░0.015]. Although there is a significant decline in liquefaction time in the case group but the viscosity, semen volume, and PH of semen samples were similar in the both case and control groups. CONCLUSION: Our results suggest that HBV and HCV infection are associated with poor sperm quality.

The prevalence of HBV, HCV and HIV infections among Iranian infertile couples referring to Royan institute infertility clinic: A cross-sectional study.

BACKGROUND: The role of the screening protocol for viral hepatitis and human immuunodeficiency virus (HIV) infections among infertile couples were seldom investigated. OBJECTIVE: The present study was performed to assess the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV infections among infertile couples referring to infertility clinic of Royan Institute. MATERIALS AND METHODS: This analytical cross-sectional study was performed on 21673 infertile couples referring to infertility clinic of Royan Institute between 2009 and 2014. Serological findings for viral hepatitis B, C and HIV infection were gathered herewith demographic data of the study participants through the study checklist. Ultimately, 302 couples who had at least one positive result in their serological tests were included in the statistical analysis. RESULTS: The HBV and HCV infections prevalence among study participants were 0.57% and 0.148% respectively; only two cases had HIV infection. HBV and HCV infections prevalence had significant association with the gender of participants, but there was no significant relationship between these infections and infertility types. CONCLUSION: Viral hepatitis infections screening among infertile couples undergoing assisted reproductive techniques needs more attention.

Urine-Based Nested PCR for the Diagnosis of Mycobacterium tuberculosis: A Comparative Study Between HIV-Positive and HIV-Negative Patients.

BACKGROUND: While tuberculosis (TB) can be diagnosed by microscopy and culture, the sensitivity of Ziehl-Neelsen staining is variable and culture results require 4 - 8 weeks to be determined. Polymerase chain reaction (PCR) and its modifications, including nested PCR, might be promising methods for the rapid diagnosis of TB. OBJECTIVES: This study aimed to evaluate the performance of nested PCR on urine samples of human immunodeficiency virus (HIV)-positive and -negative patients with different manifestations of clinical TB. METHODS: In a prospective study, three early-morning urine samples from 100 patients with pulmonary TB (PTB) or extrapulmonary TB (EPTB) were evaluated using a molecular target with insertion element IS6110, specific to the Mycobacterium tuberculosis genome, and nested PCR was performed. The results were analyzed with SPSS version 22. RESULTS: A total of 100 patients, including 74 (74%) with PTB and 26 (26%) with EPTB, were enrolled. Positive smears were seen in 38 patients (38%). Lymph nodes were the most commonly involved organ in 14 of the 26 (53.8%) EPTB patients (13.5%). Seven (23.1%) of the EPTB patients were HIV-positive. Urine PCR was positive in only 28 patients (28%). Seven HIV-positive patients with PTB showed positive urine PCR results. Moreover, PCR results were positive in only one of the seven HIV-positive subjects with EPTB. Positive PCR results were found in 20 of the 73 HIV-negative patients (27.4%) and in 8 of the 27 HIV-positive patients (29.6%). Therefore, there was no significant difference between the HIV-negative and HIV-positive patients for urine PCR (sensitivity 29.6%, specificity 72.6%; positive and negative predictive values 28% and 72%, respectively; P = 0.138). CONCLUSIONS: Nested PCR showed the same sensitivity in HIV-positive and HIV-negative patients. It can be applied as a rapid technique for the diagnosis of TB.

Primary hydatid cyst of the axillary region: a case report.

Introduction. Hydatid disease is a disease caused by the cestode Echinococcus. Echinococcus granulosus is the most common Echinococcus species affecting human. It may affect any organ and tissue in the body, most in the liver and lung. Disease is endemic in some regions of the world, and is common in Iran. Primary hydatid cyst of the axillary region is an unusual and rare localization of hydatid disease. So far, only sixteen cases have been published in the all medical literature. Case Report. Herein, we present a 33-year-old woman because of a mass in the axillary region of four months duration. Axillary ultrasonography showed a thick wall cystic lesion. No abnormality was found in mammographic examination of either breast, or in abdominal ultrasonography and chest X-ray. The mass was excised for pathological examination that showed a typical laminated membrane of hydatid cyst. Postoperative IgG- ELISA serology in this case was negative. Based on pathology an axillary hydatid cyst was diagnosed. Conclusion. Hydatid cyst should be considered in endemic areas in patients presenting with a soft tissue mass in the axillary region.

Pyomyoma in a premenopausal woman with fever of unknown origin.

BACKGROUND: Pyomyoma (suppurative leiomyoma) is a rare disease that is a serious complication. Most cases have occurred in pregnant or postmenopausal women. CASE: A perimenopausal woman presented with fever and shoulder pain. She had no predisposing factors or history of leiomyoma. Ultrasonographic as well as abdominal and pelvic computed tomography scans showed an enlarged uterus with two large masses. Internal heterogeneous echogenicity was noted in the lower segment and body of the uterus. The elevated temperature continued despite a 3-day antibiotic course of clindamycin, ceftriaxone, and gentamicin. With a clinical impression of infected leiomyoma, she underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Pathological findings showed a leiomyoma with abscess formation. The patient responded well to surgery. CONCLUSION: Pyomyoma may be difficult to diagnose, especially in women with a nonspecific clinical presentation. Delayed diagnosis may result in serious complications, and surgery and broad spectrum antibiotics are indicated.

Seropositivity for Listeria monocytogenes in women with spontaneous abortion: a case-control study in Iran.

OBJECTIVE: There are many studies supporting the role of certain asymptomatic infections such as Listeria monocytogenes (L. monocytogenes) in spontaneous abortion. In some cases, latent listeriosis may complicate the pregnancy, and serologic tests can, therefore, be used to detect the disease. This study was designed to assess the relationship between seropositivity for L. monocytogenes and spontaneous abortion. MATERIALS AND METHODS: A total of 250 women with previous spontaneous abortion and a control group of 200 women with normal full-term deliveries entered the study as case and control groups, respectively. Demographic characteristics were recorded for each subject, and serum samples were obtained from all participants. All serum samples were examined using the indirect immunofluorescence antibody test for L. monocytogenes antibody. Data was analyzed using Chi-squared and t tests. RESULTS: The average age of participants was 25.6 +/- 7.6 years in cases and 25.3 +/- 6.5 years in controls. Eighty-nine (35.6%) of the cases with abortion and 35 (17.5%) of the control group were positive for L. monocytogenes antibody (p = 0.001). No relationship was observed between the number of pregnancies and infection with L. monocytogenes (p = 0.4), or between the number of previous abortions and L. monocytogenes seropositivity (p = 0.2). CONCLUSION: We suggest monitoring L. monocytogenes seroprevalence in pregnant women at high risk of threatened abortion, and further microbiological assessment of symptomatic women for detection of L. monocytogenes and insidious infection.

The effect of combination therapy with albendazole and praziquantel on hydatid cyst treatment.

The standard therapy of hydatid cyst is surgery but, in nonoperable patients and multiple organ involvement, medical therapy may be more useful. The efficacy of drugs especially in short-term treatment of hydatid cyst is unknown. This study was carried out to evaluate the effect of combination therapy with albendazole and praziquantel in the treatment of hydatid diseases. In a nonrandomized quasi-experimental study, nine patients with multiple hydatid cysts were treated with albendazole (400 mg/twice a day) and praziquantel (40 mg/kg per day) twice a week for 4 weeks. This regimen was repeated for three courses with a 2-week interval between each one. The average follow-up period after treatment was 18 months. Response to treatment was assessed through the observation of the symptoms and radiologic findings (computed axial tomography scan, sonography, X-ray). Symptoms disappeared in seven (77.8%) patients and improved partially in two (22.2%) patients. Radiological assessment showed significant improvement in five (55.6%) and partial improvement in four (44.4%) patients. Combination therapy with albendazole and praziquantel is effective in the treatment of hydatid cyst and can be used as an alternative to surgery in disseminated and nonoperable cases.