Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000-2018.

BACKGROUND: Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15-59 years across SSA. METHODS: We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units. RESULTS: We found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group. CONCLUSIONS: As the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA.

Herd-level contamination of Neospora caninum, Toxoplasma gondii and Brucella in milk of Iranian dairy farms.

The bulk milk examination is a reliable screening tool for monitoring the quality of milk in the farms. The infection to Neospora caninum, Toxoplasma gondii and Brucella sp. Was evaluated in bulk milk samples of dairy farms in Hamedan province, West part of Iran. All the dairy farms (n = 149) were examined for N. caninum, T. gondii and Brucella infections using milk ring test (MRT), microbiology, serology (Enzyme-linked Immunosorbent Assay), and molecular techniques. Based on molecular methods, Brucella-infection was negative in all farms; while, 55 %, 5.4 % and 2.7 % of samples were positive for N. caninum, T. gondii and mix infection, respectively. The highest Neospora-infection was detected in the farms with history of abortion in fall and winter. There was significant association between Neospora-infection and the presence of dogs and rodents in the farms, herd size, and age of the animals. Also, a significant association was seen between Toxoplasma-infection and the presence of cats and rodents in the farms, as well as age of the animals. Average total bacterial count (TBC) was calculated 1.14 × 106±1.1 × 106. The highest TBC was in the farms from Central locations of studied area (5.7 × 106±2.24 × 106), farms with more than 120 animals (7.9 × 106±2.8 × 106), and farms with ≥50-months age (1.74 × 106±6.3 × 105) in spring and summer (6.9 × 106±3.7 × 106). The number of somatic cells was estimated between 1 × 104 and 2 × 106 (Average = 4.2 × 105±3.39 × 105). The current study was a comprehensive evaluation of Neospora, Toxoplasma and Brucella infections in milk samples of Iranian dairy farms for the first time. Neospora-infection is responsible for economic losses in the region. Health education and milk pasteurization are so helpful for inhibiting the milk borne diseases. To reduce the risk factors, predict and design the appropriate schemes like redundant of heterogeneous animals are recommended.

Efficacy of chitosan-based chewing gum on reducing salivary S. mutans counts and salivary pH: a randomised clinical trial.

OBJECTIVE: To determine chitosan-based chewing gum role on reducing salivary S. mutans counts and salivary pH. MATERIALS AND METHODS: The present double-blind randomised clinical trial with the trial registration number of IRCT20190724044319N1 was conducted on 36 dental students. The volunteers were, randomly, divided into two groups (n = 18) including: G1: intervention group (chitosan chewing gum) and G2: control group (placebo chewing gum). Each participant was given eight pieces of the chewing gum, and was asked to chew each gum piece for 5 min and this was repeated for eight times. Their Saliva was collected before and after chewing gums and the number of S. mutans colonies and salivary pH were determined. Data were analysed using SPSS (ver.21) and independent student t test. p Value less than .05 was set as significant. RESULTS: There was significant difference between two groups for the number of salivary S. mutans colonies (3.31*105  in the intervention group compared to 13.94*105 in the Control group) (p < .001). The salivary pH evaluation showed that salivary pH mean value in intervention group was not significant in compared with control group (p = .17). However, the chitosan chewing gum led to an increase in salivary pH by 0.17, which was statistically significant (p = .01). CONCLUSION: Results of this study showed that chitosan chewing gum has a positive effect on the reduction of numbers of salivary S. mutans colonies but had no considerable effect on the increase of salivary pH.

Prevalence of main quinolones and carbapenems resistance genes in clinical and veterinary Escherichia coli strains.

Background and Objectives: Antibiotics-resistant Escherichia coli strains are considered one of the most important causes of human and animal infections worldwide. The aim of current study was to detect common resistance (carbapenems and quinolones) genes by PCR. Materials and Methods: A total of 100 E. coli strains isolated from human urinary tract infection and 20 isolated strains of aborted sheep embryos were collected. PCR was performed using specific primers to detect the resistance genes. Results: Overall, among the quinolones resistance genes, qnrS resistance gene had the highest frequency (48%) and among carbapenem resistance genes, imp resistance gene had the highest frequency (45%). The frequency of resistance genes, IMP (28.45%), KPC (9.5%), VIM (9.15%), NDM (7.20%) were observed in clinical and veterinary strains, respectively. According to the results, 38.6% of E. coli strains had at least one from five genes of resistance to quinolones. The lowest frequency of resistance gene was related to qnrA, which was observed in only 29 (24.2%) strains. Conclusion: Monitoring of carbapenem and quinolone resistance in pathogenic E. coli to humans and animals has an important value in revising treatment guidelines and the national public health, and plays an important role in preventing the spread of resistant strains.

Brucellosis in livestock: First study on seroepidemiology, risk factors, and preventive strategies to manage the disease in Famenin, Iran.

Background and Aim: Brucellosis is an infectious disease in humans and livestock. The disease is endemic in many regions of Iran, for example, Hamedan Province. Knowledge of infection rate and associated risk factors is essential to control and prevent the disease. The study aimed to estimate the prevalence of brucellosis and associated risk factors in cattle, sheep, and goats in Famenin, Hamedan Province, West of Iran. Materials and Methods: Blood samples of 1758 animals (1470 sheep, 190 goats, and 98 cattle) were obtained in different rural regions of Famenin. The samples were evaluated to detect of Brucella-antibodies using rose Bengal plate test (RBPT), Wright standard tube agglutination test (SAT), and 2-Mercapto-Ethanol (2-ME) techniques. The risk factors associated with brucellosis such as age, gender, history of vaccination against brucellosis, and abortion history in animals were evaluated. In the sampling process, the critical gaps related to the distribution of brucellosis in the herds and regions are identified for designing the strategies to prevent and control the disease. Results: About 6.88% and 89.31% of animals had a history of abortion and vaccination against brucellosis, respectively. Most of the animals were female (92.49%) and in the range of 2-3 age old (39.8%). The antibodies to the Brucella-infection in animals were 2.73% with RBPT and 1.30% with SAT and 2-ME. The prevalence of brucellosis was detected 1.3% among individual animals and 11% among herds. This rate was 1.43% for sheep and 1.05% for goats, with no significant statistical difference. No seropositive case was detected in cattle samples using RBPT, STAT, and 2-ME. The highest rate of brucellosis (6.25%) was detected in Emamzadeh-Pirnahan region (22.2% goats and 5.6% sheep). In sheep, most cases of the disease were in 3-4 age-old group (1.92%), animals without a history of abortion (1.58%), and without a history of vaccination against brucellosis (2.80%). Furthermore, 5.94% of males and 1.11% of females were detected positive for brucellosis (p < 0.001). The chance of brucellosis in rams was 5.6 folds higher than in others (odds ratio = 5.64). Brucellosis in goats was detected 2.94% and 1.89% in the age groups <1 and 2-3 year-old. Furthermore, 1.22% of females and 1.34% of animals without a history of abortion were positive. Brucellosis was found in 0.61% of vaccinated and 3.85% of non-vaccinated goats. Except for gender in sheep, no significant statistical correlation (p > 0.05) was observed between prevalence of brucellosis and risk factors. In farmers, low level of information about the transmission and also control and preventive methods of the disease was dominant. Consumption of traditional and unpasteurized dairy products is also very common in the studied regions. Conclusion: This is a comprehensive evaluation of animal brucellosis parallel to humans' cohort study in the Famenin region for the first time. Although the rate of brucellosis in animals is low in the region, explaining the risk factors to farmers, mass vaccination, regular screening of animals, and culling the positive animals are very important for controlling and reducing the disease in the region.

Serological and molecular investigation of human brucellosis in participants of Famenin brucellosis cohort study, Hamadan, Iran.

BACKGROUND AND OBJECTIVES: Brucella is an intracellular pathogen that causes brucellosis in humans and animals. This study aimed to assess the results of brucellosis seroprevalence among participants of the Famenin brucellosis cohort with molecular investigation technique and determine Brucella-approved species. MATERIALS AND METHODS: Following the first phase of the Famenin brucellosis cohort in 2016 which investigated the seroprevalence of brucellosis among 2367 participants in Famenin city, a total of 575 people including all seropositive and some seronegative people were examined again by wright serological tests in 2019. The PCR assay was accomplished on all cases that have wright titers ≥ 1/20 for tracing Brucella DNA using BCSP31 target gene and IS711 locus. RESULTS: Out of 575 studied cases, 145 people had wright titers ≥ 1/20. The PCR reactions of these 145 blood samples were positive in 63/145 (43.44%) tested samples using primers (B4/B5) for Brucella genus detection. In the second PCR assay using specific-primers for Brucella abortus and Brucella melitensis, 18/63 (28.57%) of the samples were diagnosed as B. abortus, and 18/63 (28.57%) were diagnosed as B. melitensis. CONCLUSION: In this study, using the selected specific genes for the diagnosis of Brucella in the genus and species levels, the PCR technique was evaluated as a promising method for the rapid and safe detection of brucellosis besides the serological test for more accurate detection of brucellosis especially in cases that are not definitive.

Establishment of brucellosis relapse and complications registry: a study protocol.

Brucellosis is an endemic bacterial zoonotic disease in developing countries; that is a serious public health problem in Iran. Brucellosis is a life-threatening multi-system disease in human with different clinical manifestations, complications and relapse. The incidence of brucellosis in Hamadan province, west of Iran is high. In addition, there is few reliable and population-based studies regarding relapse and complications of brucellosis in developing countries, therefore establishment of the registry system in areas with adequate occurrence of cases is needed to better understand the predictors of brucellosis relapse and complications and management of the disease. Detecting occurrence of relapse and complications over time and by geographical area provide information for further investigations and identification of health system deficiencies in the management of patients.

Antibiotic resistance pattern and phylogenetic groups of the uropathogenic Escherichia coli isolates from urinary tract infections in Hamedan, west of Iran.

BACKGROUND AND OBJECTIVES: Escherichia coli is the most common causative agent of urinary tract infections (UTIs) in 90-80% of patients in all age groups. Phylogenetic groups of these bacteria are variable and the most known groups are A, B1, B2 and D. The present study aimed to evaluate the phylogenetic groups of E. coli samples obtained from UTIs and their relation with antibiotic resistance patterns of isolates. MATERIALS AND METHODS: In this study 113 E. coli isolates were isolated from distinct patients with UTIs referred to Hamadan hospitals. After biochemical and molecular identification of the isolates, typing and phylogenetic grouping of E. coli strains were performed using multiplex PCR targeting chu, yjaA and TSPE4.C2 genes. The anti-microbial susceptibility of the isolates to amikacin, ampicillin, trimethoprim-sulfamethoxazole, amoxicillin/clavulanic acid, ciprofloxacin, cefotaxime, imipenem, aztreonam, gentamicin, meropenem, nitrofurantoin, nalidixic acid and cefazolin was determined using disk diffusion method. RESULTS: Of 113 isolates, 50 (44.2%), 35 (31%), 23 (20.4%) and 5 (4.4%) of samples belonged to group B2, group D, group A and group B1 phylogenetic groups respectively. All isolates were susceptible to meropenem, imipenem (100%), followed by amikacin (99.1%). The highest resistance rates were observed against ampicillin (74.3%) and nalidixic acid (70.8%). Correlation between phylogenetic groups and antibiotic susceptibilities was significant only with co-amoxiclav (P = 0.006), which had the highest resistance in phylogenetic group A. CONCLUSION: Prevalence of different phylogroup and resistance associated with them in E. coli samples could be variable in each region. Therefore, investigating of these items in E. coli infections, could be more helpful in selecting the appropriate antibiotic treatment and epidemiological studies.

Seroprevalence of Brucellosis among General Population in Famenin City, Western Iran in 2016: The Famenin Brucellosis Cohort Study.

BACKGROUND: Brucellosis is endemic in Iran with a higher level of endemicity in western areas, including the Hamadan province. This study aims to define the seroprevalence of brucellosis and it,s risk factors in general the population of Famenin, Hamadan province, in western Iran. METHODS: This survey was conducted on 2367 participants in Famenin and its villages from September to November 2016. After receiving written consent from subjects, demographic information was obtained through questionnaires and 10cc blood samples were taken from the participants. Blood samples were sent to the Core facility of Hamadan University of Medical Sciences and were tested using Wright and 2ME kits (Pasteur Institute, Iran) for serological detection of brucellosis. The seroprevalence of brucellosis was reported as percentage with 95% confidence interval (CI). RESULTS: Totally, 2367 individuals with the mean age (SD) of 34.6 (20.9) (range: 2 to 95) years were enrolled. Of these, 1060 (44.8%) were men and 1610 (68.0%) lived in rural areas. The seroprevalence of brucellosis according to the Wright titer (equal to or greater than 1:80) was 6.6% (95% CI: 5.62%, 7.66%). The corresponding prevalence based on 2ME titers (equal to or greater than 1:40) in subjects with positive Wright test was 37.2% (95% CI: 29.5%, 44.84%). We saw a significant association between the incidence of brucellosis and occupation (P < 0.001) and type of contact with livestock (P = 0.009) as two important risk factors. CONCLUSION: The seroprevalence of brucellosis in Famenin population was considerable. Contact with livestock, animal husbandry, farming and history of brucellosis were risk factors for brucellosis infection.

Molecular identification and genotyping of Acinetobacter baumannii isolated from burn patients by PCR and ERIC-PCR.

BACKGROUND: Acinetobacter baumannii is one of the most important agents of hospital infections. Rapid and accurate identification and genotyping of A. baumannii is very important, especially in burn hospitals in order to prevent the spread of related nosocomial infections and to further epidemiological studies. MATERIAL AND METHODS: For two months, 82 A. baumannii isolates were collected from burn wound swabs of patients in a major burn hospital in Tehran. A. baumannii isolates were identified by conventional microbiological test and polymerase chain reaction (PCR) using the primers of blaOXA-51 gene, while the genetic linkage of A. baumannii isolates was investigated by enterobacterial repetitive intragenic consensus (ERIC)-PCR technique. Similarity, a cut-off of ⩾ 95% was considered for classifying the genotypes. RESULTS: The molecular test (PCR) confirmed 97.56% of phenotypic results for the detection of A. baumannii isolates. ERIC-PCR results revealed 14 different ERIC patterns (ERIC-types) including 11 common types and three unique types. CONCLUSION: Our findings show that we can simply and quickly detect A. baumannii isolates by PCR using blaOXA genes and genetic diversity by ERIC-PCR, respectively. These rapid and simple techniques for the routine screening and identification of clinical A. baumannii isolates could be useful with epidemic potential.

Cohort profile: Famenin Brucellosis Cohort Study.

BACKGROUND: To achieve preventive and controlling activities of Brucellosis, we aimed this study as the first prospective cohort survey on brucellosis in Iran. This cohort in different phases from 2016 until 2020 going to investigate about brucella infection in selected population of Famenin, a city located in Hamadan province, west of Iran. STUDY DESIGN: A prospective cohort study. METHODS: At the first phase of study, Famenin inhabitants including urban and rural people were studied during September to December in 2016. All identified household's people referred to specified health centers and clinically visited. Blood sampling was done, then these subjects were joined and the follow-up was initiated. At the next step, taken blood samples were examined using Wright kits and 2ME test for diagnosis the seroprevalence of brucellosis. Participants will be followed up for next years to examine clinical profiles of brucellosis and complete investigation about the main risk factors to reach strategies to control and reduce human and animal brucellosis. RESULTS: In the first phase, according to statistical analysis, 3363 persons including 47clusters were enrolled and considered for future studies. All participants were interviewed and demographic questioners were successfully completed. Finally, 2367 blood samples were entered in serology analysis. The seroprevalence of brucellosis based on serologic titers of Wright and 2ME test was 6.59% (95% CI: 5.62%: 7.66%) and 3.46 %( 95% CI: 2.72%: 4.20%) respectively. CONCLUSION: In the first phase, an extensive range of data and information were collected as the basic data for following phases of the cohort.

Seroprevalence of Brucellosis in Human Immunodeficiency Virus Infected Patients in Hamadan, Iran.

OBJECTIVES: Brucellosis is a systemic disease with a wide spectrum of clinical manifestations. This study aimed to determine the seroprevalence of brucellosis in human immunodeficiency virus (HIV) infected patients in Hamadan Province in the west of Iran. METHODS: A total of 157 HIV-infected patients were screened through standard serological tests, including Wright's test, Coombs' Wright test, and 2-mercaptoethanol Brucella agglutination test (2ME test), blood cultures in Castaneda media, and CD4 counting. Data were analyzed using Stata version 11. RESULTS: Wright and Coombs' Wright tests were carried out, and only 5 (3.2%) patients had positive serological results. However, all patients had negative 2ME results, and blood cultures were negative for Brucella spp. Moreover, patients with positive serology and a mean CD4 count of 355.8 ± 203.11 cells/µL had no clinical manifestations of brucellosis, and, and the other patients had a mean CD4 count of 335.55 ± 261.71 cells/µL. CONCLUSION: Results of this study showed that HIV infection is not a predisposing factor of acquiring brucellosis.

Role of efflux pump inhibitor in decreasing antibiotic cross-resistance of Pseudomonas aeruginosa in a burn hospital in Iran.

INTRODUCTION: Multidrug resistance in Pseudomonas aeruginosa may be due to efflux pump overexpression. This study phenotypically examined the role of efflux pump inhibitors in decreasing antibiotic cross-resistance between beta-lactams, fluoroquinolones, and aminoglycosides in P. aeruginosa isolates from burn patients in Iran. METHODOLOGY: A total of 91 phenotypically and genotypically confirmed P. aeruginosa samples were studied. Multidrug cross-resistance was determined using the disk diffusion method and minimum inhibitory concentration (MIC) test. The contribution of efflux pumps was determined by investigating MIC reduction assay to markers of beta-lactams, fluoroquinolones, and aminoglycosides in the absence and presence of an efflux pump inhibitor. All the isolates were also tested by polymerase chain reaction for the presence of mexA, mexC, and mexE efflux genes. RESULTS: Of the isolates, 81 (89%) and 83 (91.2%) were multidrug resistant according to the disk diffusion and MIC method, respectively. Cross-resistance was observed in 67 (73.6%) and 68 (74.7%) of isolates according to the disk diffusion and MIC method, respectively. In the presence of the efflux pump inhibitor, twofold or higher MIC reduction to imipenem, cefepime, ciprofloxacin, and gentamicin was observed in 59, 65, 55, and 60 isolates, respectively. Except for two isolates that were negative for mexC, all isolates were positive for mexA, mexC, and mexE genes simultaneously. CONCLUSION: Efflux pumps could cause different levels of resistance based on their expression in clinical isolates. Early detection of different efflux pumps in P. aeruginosa could allow the use of other antibiotics and efflux pump inhibitors in combination with antibiotic therapy.

Spread of Efflux Pump Overexpressing-Mediated Fluoroquinolone Resistance and Multidrug Resistance in Pseudomonas aeruginosa by using an Efflux Pump Inhibitor.

BACKGROUND: Fluoroquinolone resistance in Pseudomonas aeruginosa may be due to efflux pump overexpression and/or target mutations. We designed this study to investigate the efflux pump mediated fluoroquinolone resistance and check the increasing effectiveness of fluoroquinolones in combination with an efflux pumps inhibitor among P. aeruginosa isolates from burn wounds infections. MATERIALS AND METHODS: A total of 154 consecutive strains of P. aeruginosa were recovered from separate patients hospitalized in a burn hospital, Tehran, Iran. The isolates first were studied by disk diffusion antibiogram for 11 antibiotics and then minimum inhibitory concentration (MIC) experiments were performed to detect synergy between ciprofloxacin and the efflux pump inhibitor, carbonyl cyanide-m-chlorophenyl hydrazone (CCCP). Then to elucidate the inducing of multi drug resistance due to different efflux pumps activation in Fluoroquinolone resistant isolates, synergy experiments were also performed in random ciprofloxacin resistant isolates which have overexpressed efflux pumps phenotypically, using CCCP and selected antibiotics as markers for Beta-lactams and Aminoglycosides. The isolates were also tested by polymerase chain reaction (PCR) for the presence of the MexA, MexC and MexE, which encode the efflux pumps MexAB-OprM, MexCD-OprJ and MexEF-OprN. RESULTS: Most of the isolates were resistant to 3 or more antibiotics tested. More than half of the ciprofloxacin resistant isolates exhibited synergy between ciprofloxacin and CCCP, indicating the efflux pump activity contributed to the ciprofloxacin resistance. Also increased susceptibility of random ciprofloxacin resistant isolates of P. aeruginosa to other selected antibiotics, in presence of CCCP, implied multidrug extrusion by different active efflux pump in fluoroquinolones resistant strains. All of Ciprofloxacin resistant isolates were positive for MexA, MexC and MexE genes simultaneously. CONCLUSION: In this burn hospital, where multidrug resistant P. aeruginosa isolates were prevalent, ciprofloxacin resistance and multidrug resistance due to the overexpression of fluoroquinolones mediated efflux pumps has also now emerged. Early recognition of this resistance mechanism should allow the use of alternative antibiotics and use an efflux pumps inhibitor in combination with antibiotic therapy.

Distribution of class I integron and sulfamethoxazole trimethoprim constin in Vibrio cholerae isolated from patients in Iran.

The occurrence of drug-resistant Vibrio cholerae is being reported with increasing frequency worldwide. Spread of resistant strains has been attributed, in part, to class I integrons and sulfamethoxazole trimethoprim-constin (SXT-C). Sixty clinical V. cholerae isolates were isolated from four different provinces in Iran, which were subjected to antibiotic susceptibility testing, polymerase chain reaction amplification of class I integron and SXT-C, and sequencing of the amplified fragments. Ribotyping technique was used to assess the clonality of the isolates. The highest and the least levels of antibiotic resistance were seen to SXT, streptomycin, and chloramphenicol (95%, 95%, and 92%, respectively) and doxycycline, gentamicin, and oxytetracycline (0%, 3%, and 3%, respectively). The results showed that out of the total of 60 isolates, only 1 contained class I integron, which harbored streptomycin resistance gene cassette (aadA2). This isolate showed ribotype pattern similar to the other strains (lacking class I integron) obtained in the same year (2006). On the contrary, the SXT-C was found in 95% of the isolates. These isolates showed three different but related ribotype patterns. Overall, the results of this study showed insignificant contribution of class I integron in antibiotic resistance of our V. cholerae isolates. On the other hand, V. cholerae resistance to SXT, streptomycin, and chloramphenicol could be, in part, due to wide distribution of SXT-C among the isolates. In addition, the ribotype data suggest that the clinical V. cholerae population from 2004 to 2006 were homogeneous.