Mucosa-Associated Escherichia coli in Colorectal Cancer Patients and Control Subjects: Variations in the Prevalence and Attributing Features.

Accumulating evidence indicates that specific strains of mucosa-associated Escherichia coli (E. coli) can influence the development of colorectal carcinoma. This study aimed to investigate the prevalence and characterization of mucosa-associated E. coli obtained from the colorectal cancer (CRC) patients and control group. At two referral university-affiliated hospitals in northwest Iran, 100 patients, 50 with CRC and 50 without, were studied over the course of a year. Fresh biopsy specimens were used to identify mucosa-associated E. coli isolates after dithiothreitol mucolysis. To classify the E. coli strains, ten colonies per sample were typed using enterobacterial repetitive intergenic consensus-based PCR (ERIC-PCR). The strains were classified into phylogroups using the quadruplex PCR method. The PCR method was used to examine for the presence of cyclomodulin, bfp, stx1, stx2, and eae-encoding genes. The strains were tested for biofilm formation using the microtiter plate assay. CRC patients had more mucosa-associated E. coli than the control group (p < 0.05). Enteropathogenic Escherichia coli (EPEC) was also found in 23% of CRC strains and 7.1% of control strains (p < 0.05). Phylogroup A was predominant in control group specimens, while E. coli isolates from CRC patients belonged most frequently to phylogroups D and B2. Furthermore, the frequency of cyclomodulin-encoding genes in the CRC patients was significantly higher than the control group. Around 36.9% of E. coli strains from CRC samples were able to form biofilms, compared to 16.6% E. coli strains from the control group (p < 0.05). Noticeably, cyclomodulin-positive strains were more likely to form biofilm in comparison to cyclomodulin-negative strains (p < 0.05). In conclusion, mucosa-associated E. coli especially cyclomodulin-positive isolates from B2 and D phylogroups possessing biofilm-producing capacity colonize the gut mucosa of CRC patients.

Screening of congenital CMV infection in saliva of neonates by PCR: report of a pilot screening study in Iran.

BACKGROUND: Cytomegalovirus (CMV) is a leading cause of congenital infection in neonates. Most infants with congenital CMV infection are asymptomatic at birth and not diagnosed on routine clinical examination. To identify these at-risk infants early in life, polymerase chain reaction (PCR) assays are done to screen large populations of newborn infants. OBJECTIVE: We carried out a pilot study to estimate the prevalence of CMV in saliva from newborns by DNA PCR assay. METHODS: This study was performed from January 2012 to March 2012 at a maternity hospital in the south of Tehran. All newborns aged between 1 to 14 days born at this hospital were enrolled. Saliva specimens from newborns were collected by swabbing the inside of the baby's mouth and stored at -70 degrees C until PCR processing for virus detection. RESULTS: Six-hundred and twenty infants between 1 to 14 days of age were enrolled during the study period of two months. The PCR assay was positive for CMV in 2 newborns [0.3%]. Both of these infants were asymptomatic for congenital CMV at birth and also when followed up at three months and six months of age. CONCLUSIONS: Our findings reveal that because of a low yield of positive results, screening for congenital CMV infection would not be cost-effective in Iranian neonates.

Clinical symptoms, laboratory, and microbial patterns of suspected neonatal sepsis cases in a children's referral hospital in northwestern Iran.

Sepsis is the systemic response to infection manifested as hyperthermia or hypothermia, tachycardia, tachypnea, and shock. This condition represents a major life-threatening factor in all age groups, particularly in neonatal period. The present study aimed to examine the results of blood, cerebrospinal fluid (CSF), and urine culture tests in suspected neonatal sepsis cases in northwestern Iran.This descriptive-analytical study was conducted on suspected neonatal sepsis cases hospitalized in Tabriz Children's Hospital. All subjects underwent complete blood count with white blood differential, C-reactive protein, blood culture and, if deemed necessary, CSF and urine culture tests and analyses. Laboratory findings in positive culture cases were scored based on the hematological scoring system (HSS) for the diagnosis of neonatal sepsis. The data were then collected, entered into SPSS v18 and analyzed.Among 838 suspected neonatal sepsis cases, 102 (12.17%) neonates with positive cultures were examined; 59.8% of whom were male with a mean age of 9.9 days, gestational age of 36.91 weeks, and mean weight of 2.966 kg. 76.47% of neonates with positive culture were term, 69.6% had normal birth weights, 68.6% were diagnoses with late-onset sepsis, 65.68% had positive blood culture, 38.23% had positive urine culture with no positive CSF culture case. Poor feeding (39.21%) and lethargy (35.29%) were the most common clinical symptoms and previous history of hospital stay (40.19%) and surgery (21.56%) the most common risk factors for neonatal sepsis development. Results revealed that 50 (49.01%) neonates achieved HSS scores equal or greater than 2 (HSS ≥2), and that the mean HSS score in deceased positive blood culture neonates was significantly higher than that of survived ones (2.21 vs 1.37). In this study, coagulase-negative staphylococcus and Staphylococcus aureus represented the most common bacteria isolated from blood with 37.31% and 12.43%, respectively. Fungi (38.5%) and Klebsiella (28.20%) were the most common microorganic urine isolates.The results suggested that only a small percentage of suspected neonatal sepsis cases had positive blood and/or urine cultures (12.17%) and that coagulase-negative staphylococcus (CoNS) and S aureus were highly prevalent in positive blood cultures, whereas fungi and Klebsiella were the most common microorganisms found in positive urine cultures.

Pediatric visceral leishmaniasis in northwest of Iran.

Leishmaniasis is one of the major health problems in Iran. Although the incidence of visceral leishmaniasis (VL) is reported almost everywhere, the northwestern Iran is one of the major endemic regions.To do this study, clinical, laboratory as well as disease characteristics of children admitted to Children Cure and Health Hospital, Tabriz University of Medical Sciences, were examined as the reference hospital for the treatment of VL in northwestern Iran.In this study, 156 children hospitalized in a pediatric hospital from 2000 to 2015 for VL were included. Gender, age, anemia, thrombocytopenia, increase in the erythrocyte sedimentation rate (ESR), alanine transaminase (SGPT), and aspartate transaminase (SGOT), major clinical manifestations such as fever, splenomegaly, hepatomegaly, treatment type, and the disease were studied.Among 156 patients examined in this study, 88 (56.41%) and 68 (43.59%) participants were male and female, respectively. The minimum and maximum ages of the infection were 4.5 months and 6 years, respectively. The mean age of the infected children was 17.94 months. Fever (94.24%) and splenomegaly (86.53%) were the most common symptoms of this disease among children. In addition, 49 (31.41%), 64 (41.02%), 18 (11.53%), 33 (21.15%), and 40 (25.64%) participants had leukopenia, hemoglobin count below 8, ESR above 100, ESR above 60, and platelets below 100,000, respectively. Moreover, 39 (25%) and 17 (10.89%) patients had high aspartate transaminase (AST) and alanine transaminase (ALT). Also, 96.2% of the participants responded to the treatment with glucantime. The rate of mortality in this study was 3.2%.Clinically, almost all children had fever and splenomegaly at the onset of the disease. In addition, hepatic involvement was observed in all cases of mortality, cases with a lack of initial response, and those in need of auxiliary medication. Hepatic involvement appears to be related to the prognosis of the disease. In our study, bone marrow aspiration (BMA) and positive direct antiglobulin test (DAT) were observed in 66.67% and more than 90% of the patients, respectively.Children with VL in northwestern Iran responded well to glucantime. In case of resistance, amphotericin B was a good alternative. Early diagnosis is essential in reducing mortality rate.

Surveillance of Antibiotic Consumption Point Prevalence Survey 2014: Antimicrobial Prescribing in Pediatrics Wards of 16 Iranian Hospitals.

BACKGROUND: Antibiotics are among the most commonly prescribed drugs in pediatrics. Due to lack of uniformity in pediatric antimicrobial prescribing and the emergence of antibiotic resistance, appropriate drug utilization studies have been found to be crucial to evaluate whether these drugs are properly used. METHODS: Data were collected between January 2014 and February 2014 in 16 Iranian pediatric hospitals using a standardized method. The point prevalence survey included all inpatient beds. RESULTS: Of 858 children, 571 (66.6%) received one or more antimicrobials. The indications were therapeutic in 60.6%. The parenteral route was used in 92.5% of therapeutic indications. Ceftriaxone was the most prescribed antimicrobials for therapeutic indications (32.4%) and combination-therapy was the most type of therapy in pediatric intelligent care unit (PICU). CONCLUSION: According to results of this study, antibiotics' prescribing in pediatrics wards of Iranian hospitals is empirical. Therefore, for quality improvement of antimicrobial use in children continuous audit process and antibiotic prescriptions require further investigation.

Etiology and Antimicrobial Susceptibility Pattern of Pathogenic Bacteria in Children Subjected to UTI: A Referral Hospital-Based Study in Northwest of Iran.

Urinary tract infection (UTI) is 1 of the most common bacterial diseases in children with a considerable resistance to antimicrobials. This 5 years prospective study was carried out to determine the frequency of isolation and antimicrobial resistance patterns of uropathogens among children subjected to urine culture at Tabriz Children Educational-Health Care Center, in the northwest of Iran. Organisms were isolated using standard culture techniques. Frequency of UTI among children examined by urine culture was 3.6%. The isolated bacteria were Escherichia coli (71.4%), followed by Klebsiella spp. (9.6%), Enterococcus spp. (6.4%), Pseudomonas aeruginosa (4.2%), Serratia spp. (4.2%), and Enterobacter spp. (4.2%). E coli resistance levels were 11% for nitrofurantoin, 15% for ciprofloxacin, 25% for nalidixic acid, and 30% to 75% for amikacin, gentamicin, ceftriaxone, ceftizoxime, cefotaxime, and co-trimoxazole. Among the tested antibiotics, ciprofloxacin, showed the highest activity (100%) against Klebsiella and P aeruginosa isolates followed by amikacin, nalidixic acid, and gentamicin. Overall, the highly active antibiotic against Gram-negative and Gram-positive organisms was amikacin and then ciprofloxacin. On the other hand, the empirical initial therapy with co-trimoxazole and third-generation cephalosporins would be inadequate for more cases of UTI in the study area. Moreover, susceptibility testing should be carried out on all clinical isolates, and the empirical antibiotic treatment changed accordingly.

Etiology and antimicrobial resistance patterns of acute bacterial meningitis in children: a 10-year referral hospital-based study in northwest iran.

BACKGROUND: Bacterial meningitis is still considered as one of the most dangerous infectious diseases, which causes numerous complications and high mortality if not diagnosed and treated timely. OBJECTIVES: This study was performed to determine antimicrobial resistance patterns of bacterial pathogens isolated from acute bacterial meningitis at Tabriz Children Educational-Health Care Center in Iran. PATIENTS AND METHODS: In a retrospective study (from 2003 through 2013), all patients with bacterial meningitis were identified by cerebrospinal fluids with positive results in culture (107 cases). Patients' necessary data was recorded in a questionnaire. Furthermore, the results of simultaneous blood culture were also examined. Ultimately, antimicrobial susceptibility of isolates was determined using the disc diffusion method. RESULTS: One hundred and seven patients with bacterial meningitis were identified by cerebrospinal fluids with positive results in culture. All of patients (100%) had fever (male/female = 1.27/1). The most prevalent pathogens isolated from CSF culture were Streptococcus pneumoniae (34.5%), Haemophilus influenzae type b (23.36%), Neisseria meningitidis (6.54%), Serratia spp. (6.54%), and Klebsiella pneumoniae (5.6%), respectively. Moreover, the patients' blood culture had positive results in 36.44% of cases with H. influenzae type b (20.65%) and S. pneumoniae (6.54%) as the main bacteria isolated from blood. Meningitis occurred mostly in children under two years (P = 0.001). According to antimicrobial susceptibility test, a relatively high resistance was reported against some conventional cephalosporins and other antibiotics. CONCLUSIONS: S. pneumoniae and H. influenzae type b were the main pathogens of bacterial meningitis in children in the area under study. Most species had relatively high resistance to conventional antibiotics as compared to the past.

Association of Brucella meningoencephalitis with cerebrospinal fluid shunt in a child: a case report.

OBJECTIVE: Brucellosis is an endemic zoonosis in Iran. It is a systemic infection that can involve any organs or systems of the body and have variable presentations. Ventriculoperitoneal (VP) shunt infections due to brucellosis have been rarely reported in the literatures. This is the history of a four years old boy who developed Brucella meningoencephalitis at the age of 42 months, whilst he had a VP shunt in situ for hydrocephalus treatment. Also, he presented brucellosis as acute abdomen. This patient was treated with trimethoprim-sulfamethoxazole, gentamicin and rifampicin. The shunt was extracted and all clinical and laboratory test abnormalities subsided through this management. We propose that in a patient with Brucella meningoencephalitis, the cerebrospinal fluid shunt system can be extracted and treatment with appropriate combination of antibiotics could be successful. Moreover, it shows that brucellosis should be considered in the differential diagnosis for acute abdomen and ascites in endemic regions.

Detection of serum antibodies against measles, mumps and rubella after primary measles, mumps and rubella (MMR) vaccination in children.

BACKGROUND: In Iran, the measles, mumps and rubella vaccine (MMR) is administered in a two-dose protocol where the first dose is scheduled at 12 months of age. This study aims to determine the efficacy of the MMR vaccine by testing IgM and IgG antibody levels 4 - 7 weeks after primary vaccination. METHODS: A single group cohort study was performed on healthy children, 12 - 15 months of age, who were vaccinated at health centers affiliated with Shahid Beheshti University of Medical Sciences in Tehran, from January to April 2009. Children with negative vaccination and/or clinical history for measles, mumps or rubella were administered the first dose of the MMR live attenuated vaccine. IgG and IgM antibodies were checked by enzyme linked immunoassay (ELISA) in serum samples 4 - 7 weeks after vaccination. A child was considered seropositive if antibody levels were higher than the assay cut-off level set by the ELISA kit. RESULTS: Samples from 240 children were checked for antibodies against measles and rubella. Measles serum IgM level was positive in 71.7% of samples and IgG in 75.8%. The rubella serum IgM level was positive in 71.7% of children and IgG in 73.8%. From 190 blood samples that were checked for mumps antibodies, serum IgM was positive in 68.9% and IgG in 95.3%. No significant relationship was found between seropositivity and age or gender. CONCLUSION: IgG and IgM antibody levels were below the assay cut-off levels against measles and rubella in approximately one-fourth of the children following primary MMR vaccination. A second dose was necessary to raise the level of protection against measles and rubella.

Nasopharyngeal carrier rate of Streptococcus pneumoniae in children: serotype distribution and antimicrobial resistance.

BACKGROUND: This study aimed to define the nasopharyngeal carrier rates, serotype distribution, and antimicrobial resistance patterns of Streptococcus pneumoniae in healthy children less than ten years-old in Tehran. METHODS: This was a cross-sectional study conducted from November 2008 until January 2009. Nasopharyngeal specimens were collected by trained investigators from 1300 healthy children recruited from 20 randomly selected day care centers and 50 elementary schools in Tehran and inoculated into blood agar. Positive cultures that grew alpha-hemolytic colonies were gram-stained and serotypes of the isolates identified by the Quellung reaction. All isolated pneumococci were tested for sensitivity to different antibiotics by the disc diffusion method. RESULTS: The carrier rate for Streptococcus pneumoniae was 44.1%. Serotypes 19, 6, 14, 17, 20, 23, and 21 were most common, found in decreasing order from 11.9% to 6.1%. Only 38.56% of isolates belonged to strains covered by the heptavalent pneumococcal vaccine. Most (69.4%) were resistant to one or more antimicrobial agents: tetracycline (69.85%), clarithromycin (57.2%), azithromycin (54.9%), co-trimoxazole (11.8%), penicillin (9.2%), and vancomycin (1.5%). All isolates were sensitive to rifampin and meropenem. CONCLUSION: This study has revealed the nasopharyngeal carrier rate, serotype distribution and antibiotic sensitivities of Streptococcus pneumoniae strains in children from Tehran. Our findings may have implications on the type and efficacy of pneumococcal conjugate vaccines that should be used for prevention of pneumococcal invasive disease in Iranian children.