Investigation of ERG11 gene expression among fluconazole-resistant Candida albicans: first report from an Iranian referral paediatric hospital.

The multiplicity of mechanisms of resistance to azole antifungal agents has been described. As fluconazole-resistant clinical Candida albicans isolates that constitutively over-express ERG11 have been identified in previous studies, the aim of this study is to investigate this molecular mechanism involved in fluconazole resistance of C. albicans clinical isolates. Fluconazole susceptibility testing was carried out on clinical isolates of Candida spp. obtained from hospitalised children in an Iranian referral children's hospital. A polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) technique was used to differentiate Candida spp. The resistant C. albicans isolates were subjected to RT-qPCR using primers that identify ERG11 gene expression. Of the 142 Candida spp. isolates studied, C. albicans was the most predominant isolate, occurring in 68.3% (97/142) of the patients. According to the CLSI method, the majority of the C. albicans isolates (91.7%, 89/97), categorised as susceptible (minimum inhibitory concentration [MIC] ≤8 µg/mL), five isolates were considered resistant (MIC ≤64 µg/mL) and three had dose-dependent susceptibility (MIC = 8.16-32 µg/mL). The ERG11 gene in the five fluconazole-resistant C. albicans isolates was upregulated 4.15-5.84-fold relative to the ATCC 10231 control strain. In this study, the expression of ERG11 was upregulated in all the fluconazole-resistant C. albicans isolates. There are limited data on the antifungal susceptibility of Candida spp. as well as the molecular mechanism of azole resistance in Iran, especially for isolates causing infections in children. Therefore, the surveillance of antifungal resistance patterns and investigation of other mechanisms of azole resistance in all Candida spp. isolates is recommended.

Diagnostic accuracy of IL-2 for the diagnosis of latent tuberculosis: a systematic review and meta-analysis.

We conducted a systematic review and meta-analysis to evaluate the diagnostic potential of interleukin-2 (IL-2) as biomarkers for the diagnosis of latent tuberculosis. Related studies were identified through searches of PubMed, Embase, Web of Science, and complementary manual searches up to December 30, 2013. We used standard methods recommended for meta-analyses of diagnostic test evaluations. The analysis was based on a summary receiver operating characteristic (SROC) curve. Meta-regression analysis was used to assess the effects of some confounding factors on the results of the meta-analysis. The potential presence of publication bias was tested using the Deeks' funnel plots. The pooled estimates of IL-2 for latent tuberculosis infection (LTBI) diagnosis were as follows: sensitivity, 0.81 [95 % confidence interval (CI), 0.60 to 0.92]; specificity, 0.95 (95 % CI, 0.90 to 0.97); positive likelihood ratio (PLR), 15.2 (95 % CI, 8.1to 28.4); negative likelihood ratio (NLR), 0.20 (95 % CI, 0.09 to 0.47). We found that the SROC curve is positioned near the upper left corner of the curve and the area under the curve (AUC) was 0.96 (95 % CI, 0.94 to 0.98). In conclusion, according to the meta-analysis, IL-2 is a valid marker for the diagnosis of LTBI. When there is no definite gold standard for the diagnosis of LTBI, IL-2 release assay in addition to interferon-gamma release assays (IGRAs) can improve the ability of IGRAs to identify individuals with LTBI.

Candiduria in children: a first report from an Iranian referral pediatric hospital.

Candida spp. especially Candida albicans is considered as one of the most common cause of fungal infections. The aim of our study was to determine epidemiology of candiduria in children who were referred to an Iranian referral hospital. During May 2011 to February 2013, among 4813 urine culture positive, 209 candida spp. isolates (4.3%) was found. Forty-one percent of cadiduria infection was seen in patients between 1 month and 1 year, 24% in neonatant and 24% in patients 1 to 5 years. Cadiduria was mainly found in patients who had received more than 2 or 3 antibiotic during their hospitalization (37% and 24%, respectively). In our study, the highest frequency of cadiduria was seen in patients who had received more than 2 antibiotics and more than 3 antibiotics during their hospitalization; therefore, the strategic goals to optimize antimicrobial use including optimizing choice and duration of empiric therapy as well as monitoring and providing feedback regarding antibiotic resistance are recommended.

Diarrhoeagenic E. coli pathotypes in children with and without diarrhoea in an Iranian referral paediatrics centre.

Diarrhoeagenic Escherichia coli can be considered as the most important etiologic agents of diarrhoea in the Islamic Republic of Iran, particularly in children. This study determined the frequency of diarrhoeagenic E. coli isolates collected from children with acute diarrhoea (n = 50) and a control group (n = 50) at an Iranian referral paediatric centre during a 1-year period. Using multiplex PCR, diarrhoeagenic E. coli was identified in 90% ofthe case group and 20% of controls. Enterotoxigenic E coli was the most frequently identified pathotype in both groups (26% in cases; 10% in controls). Shiga toxin-producing E. coli was the second most isolated pathotype (17%), followed by enteroaggregative E. coli (12%). No enteroinvasive E. coli and enteropathogenic E. coli strains were recovered. More than 80% of isolates harboured the fimH gene. This high proportion of diarrhoeagenic E. coli and diversity of E. coli types highlights the need for enhanced surveillance of gastroenteritis agents in children in this country.

Staphylococcus aureus infections in children in an Iranian referral pediatric hospital.

INTRODUCTION: Staphylococcus aureus is associated with various infections ranging from skin and soft tissues such as surgical site infections and abscesses to lower respiratory tracts and bloodstream. The aim of this study was to evaluate underlying condition of patients with S. aureus infections in an Iranian referral pediatric Hospital. MATERIAL AND METHODS: Information was extracted retrospectively from the medical records of patients who were diagnosed with S. aureus infections. Data obtained about the study subjects included basic demographics, reason for admission, culture site, length of hospital stay, and methicillin susceptibility. RESULTS: The underlyning condition of of patients with S. aureus infection during November 2011 and March 2013 were included in the study. The most frequent diagnosis in patients with S. aureus infection was jaundice (12%), abscess (10%), cellulitis (10%), wound infection (8%), septic arthritis (7%) and sezeire (5%). Wound was the most common infection sites among all subjects 34/98 (35%) following by blood (20/98, 20%) as well as skin and soft tissue (19/98, 19%). The proportion of MRSA infections among all S. aureus isolates was 79% (77/98) during the study period. In addition, 58/74 (78%) met the definition of Hospital-Associated Methicillin-Resistant S. aureus (HA-MRSA) infections and the rest; 20/24 patients (83%), were classified as Community-Associated Methicillin-Resistant S. aureus (CA- MRSA). CONCLUSION: In our study, the high frequency of MRSA was found not only in HA S. aureus but also in CA S. aureus isolates; therefore, the strategic goals to optimize antimicrobial use including

Diarrhoeagenic E. coli pathotypes in children with and without diarrhoea in an Iranian referral paediatrics centre

Diarrhoeagenic Escherichia coli can be considered as the most important etiologic agents of diarrhoea in the Islamic Republic of Iran, particularly in children. This study determined the frequency of diarrhoeagenic E. coliisolates collected from children with acute diarrhoea [n= 50] and a control group [n= 50] at an Iranian referral paediatric centre during a 1-year period. Using multiplex PCR, diarrhoeagenic E. coli was identified in 90% of the case group and 20% of controls. Enterotoxigenic E. coli was the most frequently identified pathotype in both groups [26% in cases; 10% in controls]. Shiga toxin-producing E. coli was the second most isolated pathotype [17%], followed by enteroaggregative E. coli [12%]. No enteroinvasive E. coliand enteropathogenic E. colistrains were recovered. More than 80% of isolates harboured the fimHgene. This high proportion of diarrhoeagenic E. coli and diversity of E. coli types highlights the need for enhanced surveillance of gastroenteritis agents in children in this country

Seroepidemiology of Varicella Zoster Virus among children, adolescents and medical students in a referral children medical center, Tehran, Iran.

BACKGROUND AND OBJECTIVE: Varicella is a benign childhood infection with considerable complication in none immune adults. The aim of this study was to survey Varicella Zoster Virus (VZV) seroepidemiology in children, adolescents and medical students in Children Medical Center, Tehran, Iran. MATERIAL AND METHODS: In this cross sectional study, serum sample of children, adolescents 10 to 18 years old and medical students 18 to 25 years old were tested for VZV IgG with a commercial ELISA kit. RESULTS: A total of 412 individuals who were 10 to 25 years of age participated in this study. Overall 269 individuals (65.3%) were seropositive for VZV IgG. Seroprevalence of VZV antibody increased with age of participants, from 59% in 10-11years children to 80% in 20-21 years old young adult students, except in 22-23 and 24-25 years old, whom the frequency of positive results decreased interestingly to 41.7 and 52.8%, respectively. Prevalence of positive VZV antibody between two genders was not statistically different. CONCLUSION: On-going monitoring of the seroepidemilogy of VZV is necessary to assess trends of infection in the community. A considerable proportion of young medical students in this study were still susceptible to VZV and consequent complications.