Chronic recurrent multifocal osteomyelitis: a case report.

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare inflammatory bone disease. It is a diagnosis of exclusion based on the clinical, radiological and pathological criteria. The awareness of the corresponding feature can help avoid of unnecessary diagnostic procedures and prolonged antibiotic therapy. We present a case of 4.5 year old girl, diagnosed with CRMO who were followed for 6 months as a case of chronic bacterial osteomyelitis and received long course of antibiotic therapy.

Antigenic variations of human influenza virus in Shiraz, Iran.

PURPOSE: Influenza virus is a major cause of human respiratory infections and responsible for pandemics and regional outbreaks around the world. This investigation aims to determine the prevalent influenza genotypes during 2005-2007 outbreaks in Shiraz, the capital city of Fars province, southern Iran and compare the results obtained with those of previous study. MATERIALS AND METHOD: Of the 300 pharyngeal swabs collected from influenza patients, 26 were found to be positive by culture and hemagglutination (HA) assays. Typing and subtyping of the isolates carried out by using multiplex RT-PCR and phylogenetic analysis performed on isolated HA genes using neighbour-joining method. RESULT: Out of 26 positive isolates 12 and 14 were H1N1 and H3N2 respectively. The phylogenetic and amino acid sequence analyses of our H1N1 isolates showed 99-100% genetic resemblance to A/NewCaledonia/20/99 (H1N1) vaccine strain. Most of the Iranian H3N2 isolates varied form A/California/7/2004 vaccine strain in 20 amino acids of which positions 189,226 and 227 were located in antigenic sites of HA1 molecule. These substitutions were not observed in any of the H3N2 subtypes from the same region reported previously. CONCLUSION: The H3N2 subtype strains prevalent during the 2005/7 influenza outbreak in southern Iran demonstrated a drastic antigenic variation and differed from A/California/7/2004 vaccine strain. The H1N1 subtypes showed a notable resemblance to A/NewCaledonia/20/99 vaccine strain and therefore were predicted to be capable of conferring sufficient immunity against H1N1 subtypes.

Assessment of the consensus about tonsillectomy and/or adenoidectomy among pediatricians and otolaryngologists.

BACKGROUND: Several recent publications have shown that the current indications for tonsillectomy and/or adenoidectomy (T&A) in children vary considerably between and even within countries. The objective of our study is to present statistically valid information to surgeons and pediatricians, primary care physicians, and family physicians as key referral channels to the operation, whether there is consensus between pediatricians and otolaryngologists regarding the appropriateness of T&A. METHODS: Six academic pediatricians and six otolaryngologists participated in the study. After otolaryngologists visited 200 patients, the cases were referred to a pediatrician who also visited the patients independently on the same day pre-operatively. They ranked the appropriateness of T&A on a numerical Likert scale from 0 (never indicated) to 9 (always indicated) in a questionnaire. RESULTS: Overall, 200 (102 boys and 98 girls) children with a mean age of 6.1+/-5.6 were enrolled in this study. Otolaryngologists and Pediatricians had agreed about the history of tonsillitis attacks in the previous 6 months and previous year. The patients provided them with the same history. The agreement between otolaryngologists and pediatrician's views about T&A was poor. CONCLUSIONS: This study can serve as an initial warning in developing a national community-based working group to prepare a transparent local guideline regarding T&A indications. More attention should focused the role of pediatricians, primary care physicians, and family physicians for more follow up and determining which patients will eventually need T&A.

Epidemiology of tuberculosis among Afghan immigrants in Fars province, southern Islamic Republic of Iran.

Rates of tuberculosis are high among migrants from high-incidence countries. This study determined the epidemiology of tuberculosis among Afghan immigrants in Fars province, southern Islamic Republic of Iran. From April 2000 to April 2002, all records were examined for new tuberculosis patients of Afghan origin registered at Shiraz University of Medical Sciences. A total of 371 patients (208 males, 163 females) were found: 74.9% pulmonary and 25.1% extrapulmonary cases. Of the 278 new cases of pulmonary tuberculosis, 157 (56.5%) were sputum smear-positive and 121 (43.5%) were sputum smear-negative. The incidence of tuberculosis per 100 000 Afghan population in Fars province was estimated at 96.2, 88.2 and 63.5 in 2000, 2001 and 2002 respectively.

Epidemiology of tuberculosis among Afghan immigrants in Fars province, southern Islamic Republic of Iran

Rates of tuberculosis are high among migrants from high-incidence countries. This study determined the epidemiology of tuberculosis among Afghan immigrants in Fars province, southern Islamic Republic of Iran. From April 2000 to April 2002, all records were examined for new tuberculosis patients of Afghan origin registered at Shiraz University of Medical Sciences. A total of 371 patients [208 males, 163 females] were found: 74.9% pulmonary and 25.1% extrapulmonary cases. Of the 278 new cases of pulmonary tuberculosis, 157 [56.5%] were sputum smear-positive and 121 [43.5%] were sputum smear-negative. The incidence of tuberculosis per 100 000 Afghan population in Fars province was estimated at 96.2, 88.2 and 63.5 in 2000, 2001 and 2002 respectively

Evaluation of rK39 strip test for the diagnosis of visceral leishmaniasis in infants.

This study estimated the sensitivity and specificity of the rK39 strip test compared with the immunofluorescent antibody test and microscopy of bone marrow aspirate smears (the gold standard) in 47 children with suspected visceral leishmaniasis. A control group of children with other diagnoses (tuberculosis, toxoplasmosis, systemic lupus erythematosus, malaria or cutaneous leishmaniasis) were also tested to check false positive results. The sensitivity and specificity of the strip test were 82.4% and 100% and that of immunofluorescent antibody were 100% and 92.7%. The rK39 strip test is reliable where there is no access to laboratory facilities.

Evaluation of rK39 strip test for the diagnosis of visceral leishmaniasis in infants

This study estimated the sensitivity and specificity of the rK39 strip test compared with the immunofluorescent antibody test and microscopy of bone marrow aspirate smears [the gold standard] in 47 children with suspected visceral leishmaniasis. A control group of children with other diagnoses [tuberculosis, toxoplasmosis, systemic lupus erythematosus, malaria or cutaneous leishmaniasis] were also tested to check false positive results. The sensitivity and specificity of the strip test were 82.4% and 100% and that of immunofluorescent antibody were 100% and 92.7%. The rK39 strip test is reliable where there is no access to laboratory facilities

Prevalence of measles antibody in children of different ages in Shiraz, Islamic Republic of Iran.

An outbreak of measles due to secondary vaccine failure prompted this investigation into the prevalence of measles antibody in children. We studied 608 children in 7 different age groups: 6, 9, 14 and 18 months and 6, 10 and 15 years. Children in the 2 youngest groups received no vaccination; the rest were vaccinated at 9 months and 15 months. The 15-year-old age group received an additional vaccination. Transplacental measles antibody (Ab) decreased from 10.0% at 6 months to 0% at 9 months. Measles Ab was positive in 52.9% (14 months), 89.4% (18 months), 60.8% 96 years), 45.0% (10 years) and 96.8% (15 years). To increase Ab levels, a booster vaccination is recommended, administered either with the second DPT booster or at pre-high school age.

Prevalence of measles antibody in children of different ages in Shiraz, Islamic Republic of Iran

An outbreak of measles due to secondary vaccine failure prompted this investigation into the prevalence of measles antibody in children. We studied 608 children in 7 different age groups: 6, 9, 14 and 18 months and 6, 10 and 15 years. Children in the 2 youngest groups received no vaccination; the rest were vaccinated at 9 months and 15 months. The 15-year-old age group received an additional vaccination. Transplacental measles antibody [Ab] decreased from 10.0% at 6 months to 0% at 9 months. Measles Ab was positive in 52.9% [14 months], 89.4% [18 months], 60.8% 96 years], 45.0% [10 years] and 96.8% [15 years].To increase Ab levels, a booster vaccination is recommended, administered either with the second DPT booster or at pre-high school age

Prevalence of antibody to Brucella species in butchers, slaughterers and others.

Brucellosis is being reported with increasing frequency in the Islamic Republic of Iran. Serum antibodies in high-risk and general populations help to define cut-off levels and can be used as a simple and rapid diagnostic tests in infected areas. We performed the rose Bengal test (RBT), serum agglutination test (SAT) and 2-mercaptoethanol (2ME) titre determination on 415 healthy individuals including butchers, slaughterers and others. Positive results were found by RBT, SAT titre (1:80) and 2ME titre > or = 1:20 in slaughterers (10%, 20% and 6% respectively), butchers (6%, 4% and 1% respectively) and the general population (1%, 2% and < 1% respectively). A single SAT titre > or = 1:80 in the presence of 2ME titre > or = 1:20 can be diagnostic in this region.

Prevalence of antibody to Brucella species in butchers, slaughterers and others

Brucellosis is being reported with increasing frequency in the Islamic Republic of Iran. Serum antibodies in high-risk and general populations help to define cut-off levels and can be used as a simple and rapid diagnostic tests in infected areas. We performed the rose Bengal test [RBT], serum agglutination test [SAT] and 2-mercaptoethanol [2ME] titre determination on 415 healthy individuals including butchers, slaughterers and others. Positive results were found by RBT, SAT titre [1:80] and 2ME titre >/= 1:20 in slaughterers [10%, 20% and 6% respectively], butchers [6%, 4% and 1% respectively] and the general population [1%, 2% and < 1% respectively]. A single SAT titre >/= 1:80 in the presence of 2ME titre >/= 1:20 can be diagnostic in this region

IS6110-RFLP and spoligotyping of Mycobacterium tuberculosis isolates in Iran.

To evaluate and compare the usefulness of IS6110-restriction fragment length polymorphism (RFLP) and spoligotyping in the epidemiology of tuberculosis in Iran, Mycobacterium tuberculosis complex strains, isolated in 2 different areas of Iran, were subjected to RFLP and spoligotyping. The average number of IS6110 copies per strain was 11 and ranged from 5 to 18 among the M. tuberculosis strains. In total, among the 62 isolates, 56 different patterns were observed. 50 strains had unique RFLP patterns (89%) and 12 (11%) revealed patterns that were found among at least 1 other isolate. Spoligotyping of 97 isolates resulted in 42 different patterns, of which 72% were found in 15 clusters. 14 (29%) out of 48 investigated isolates were resistant to 1 or more antituberculosis drugs and 57% of the resistant isolates were isolated from Afghan immigrants. Ten percent of the isolates represented the Beijing genotype, including 4 of the 14 (36%) resistant strains. Three of these resistant Beijing strains were isolated from Afghan patients. IS6110-RFLP typing could be useful for studying the epidemiology of tuberculosis in Iran. IS6110 patterns were polymorphic and the average IS6110 copy number was high.

Active case-finding of communicable diseases in the south of the Islamic Republic of Iran.

In the Fars province of the Islamic Republic of Iran, we established the Communicable Diseases Committee which determined 24 priority infectious diseases for active reporting. The Committee chose laboratory criteria for diagnosis of the selected diseases, trained reporters and follow-up staff and invited cooperation from heads of private and government laboratories. Cases were identified by the reporting staff and patients were interviewed by the follow-up staff, who also requested patients to complete an epidemiological questionnaire. Results were returned to the district health care centres and to the Committee for data analysis. Case-findings in 16 out of the 24 selected diseases showed an increase of up to 30 times compared to passive case-finding. This was due more to the greater efficiency of the method than to cohort epidemics.

Childhood visceral leishmaniasis complicated by bacterial infections.

Bacterial superinfection is one of the major complications leading to death in patients with visceral leishmaniasis. We studied the frequency and type of bacterial infection in 54 patients admitted to hospital with visceral leishmaniasis. The patients were children who ranged in age from 3 1/2 months to 7 years. Bacterial infections were found in 22 (41%) of the patients. Bacteria were isolated in patients with pneumonia, septicaemia, otitis media, urinary tract infections and skin infections. Enterobacteriaceae were the most common bacterial agents isolated. In infants with visceral leishmaniasis, fatal bacterial infections can be accompanied by nonspecific signs and symptoms. Thus, it is important to initiate antibiotic treatment early.

Childhood visceral leishmaniasis complicated by bacterial infections

Bacterial superinfection is one of the major complications leading to death in patients with visceral leishmaniasis. We studied the frequency and type of bacterial infection in 54 patients admitted to hospital with visceral leishmaniasis. The patients were children who ranged in age from 3 1/2 months to 7 years. Bacterial infections were found in 22 [41%] of the patients. Bacteria were isolated in patients with pneumonia, septicaemia, otitis media, urinary tract infections and skin infections. Enterobacteriaceae were the most common bacterial agents isolated. In infants with visceral leishmaniasis, fatal bacterial infections can be accompanied by nonspecific signs and symptoms. Thus, it is important to initiate antibiotic treatment early