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Background: Herpes simplex clinical manifestations are in the form of vesicular eruptions on erythemateus base. The virus can remain latent within sensory nerve ganglions following the initial infection and be reactivated in some cases such as intracranial surgery, dental surgery, stress and excitements. Systemic or disseminated infection occurs in immune-deficient patients and sometimes in healthy individuals. In Previous studies, in most of the disseminated infection cases, visceral organs involvement has been mostly observed while skin involvement has been reported just in one case. Thus, our patient was the second case with herpes simplex disseminated skin infection. Case: The patient was a 38 year-old man who underwent craniotomy surgery due to epidural hematoma following car accident and head trauma. Almost 10 days after the surgery, the patient developed disseminated vesicular eruptions in erythemathous base which initially appeared in the face, head, and then in body and extremities. Fever was detected 5 days before the development of eruptions. Other than anemia and leucocytosis, there were no other notable points in the systemic examination and lab tests. For patient skin biopsy was taken with an impression of herpes simplex, mulocum contagiosum and a lower probability for bullouse diseases. In the skin biopsy, intra-epidermal vesicles and extensive epidermal necrosis with multinucleated giant cells and intra-nuclear objects were observed. A plethora of neutrophilic cells inside the vesicles and inflammatory cell infiltration in the underlying debris were seen. Based on the pathology report, infection with herpes simplex hominis was confirmed. Conclusion: Disseminated skin infection with herpes simplex can be observed even in healthy people with no background.

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Background Vancomycin resistant enterococcus (VRE) is the third major cause of nosocomial infections in hospitals after staphylococcus and E. coli. The aim of this study was to evaluate resistance pattern of VRE to the antibiotics recommended by CLSI. Materials and Methods: In this clinical trial, 833 enterococci, obtained from urine, wound, blood, and stool, were selectively collected from hospitals in Tehran. After verification of the VRE isolates through the use of 30µg vancomycin disc and agar dilution, VREs were isolated, and their inhibiting concentrations were determined. The sensitivity of these enterococci to antibiotics was assessed at CLSI’s M100 standard. Results: Of the 833 isolated enterococci, 4% had a high level of resistance to vancomycin, and 38.5% had a low level of resistance to vancomycin. Of the VREs, 8.5%, 85%, 50%, 42%, 94%, 30%, 70%, 24%, 6%, and 97% were resistant to vancomycin, ampicilin, erythromycin, tetracycline, rifampin, chloramphenicol, gentamicin, synercid, linozolid and penicillin, respectively. All these VRE isolates were sensitive to nitrofurantoin. Conclusion: In this study, all VRE isolates were sensitive to nitroforantoin, and this antibiotic, as a drug of choice for urinary tract infections, can also be recommended in the treatment of resistant enterococci.

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Background: Brucellosis, a zoonotic disease with worldwide spread, is a common disease in Iran and is endemic in Markazi Province. Brucella osteomyelitis, on the other hand, is a rare disease. Here we reported a case of brucella osteomyelitis of the tibia following trauma. Case: The patient was a 22 year old man referring with chronic draining tibia ulcer. He had a history of trauma of the tibia, dating back to 3 years ago, for which local prosthesis had been prescribed. Later on, the prosthesis had been removed due to infection. Staining of the tissue samples indicated the presence of gram-negative coccobacill and brucella growth in the culture of excretions. Conclusion: This case was reported because of rare presentation of brucella and the educational implications of the patient with respect to the possibility of brucella development in chronic ulcers or prosthesis. Although uncommon, brucellosis should be regarded as a potential cause of osteomyelitis in patients with a record of physical contact with animals.

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Background: Helicobacter pylori iceA gene has been reported to be a genetic marker for the development of peptic ulcer in western populations. The aim of this study was to investigate the prevalence of iceA genotypes and their relationship with peptic ulcer in Iran. Materials and Methods: This observational study was carried out on 75 patients. Biopsy specimens were evaluated for the presence of Helicobacter pylori through rapid urease test. GlmM gene and iceA1 and iceA2 genotypes allelic verification and variation culture were determined via PCR. Results: In this study, iceA1 and iceA2 alleles were identified in peptic ulcer disease (PUD) patients. IceA1 genotype (64%) was more prevalent than iceA2 (21.3%). IceA1 strains were more observable in patients with PUD. No significant relationships were seen between iceA genotypes and the clinical outcomes following infection (p= 0.71). Conclusion: This study revealed a significant two-tailed correlation between iceA genotypes and PUD occurrence. The results indicate that iceA1 gene can be used as a reliable marker in predicting the clinical outcomes of Helicobacter pylori infection. Therefore, further in-vitro and in-vivo investigations are needed for reaching general consensus in this regard.

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Background: Candida species are among the most important factors in development of fungal infection in human beings and animals. Noticing the daily increase of drug resistance, attempts should be made for providing anti-fungal and anti-microbial drugs. Hence, this study was conducted to investigate the in-vitro effects of Scrophularia deserti ethanolic extract and amphotricin B on Candida albicans. Materials and Methods: In an experimental trial, anti-Candida effects of Scrophularia deserti ethanolic extract and amphotricin B on Candida albicans were evaluated using serial dilution method. Data analysis was done using SPSS, through paired and independent t-tests. Results: Minimum inhibition capacity (MIC) of Scrophularia deserti extract on Candida albicans in the first and second trials were OD600=1.56(59%) and OD600=1.68(59%), respectively, whereas this value for amphotricin B was 59%. The difference between minimum growth inhibition capacity of Scrophularia deserti and amphotricin B was not significant. Conclusion: The findings of this study indicated that ethanolic extract of Scrophularia deserti has anti-fungal properties comparable to amphotricin B.

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Background: Based on the severity and prognostic condition of respective cancers caused by them, papilloma viruses are classified into high, medium, and low risk groups using E6 and E7 viral proteins. Nowadays, different methods of modeling in clinical medicine are used for diagnosis of diseases and evaluation of their molecular characteristics. Among the new methods of modeling, fuzzy systems are of particular importance in various fields of science. The aim of this study was to use a new intelligent Adaptive Nero Fuzzy Inference System (ANFIS) for predicting human papilloma virus oncogenicity based on a number of biochemical properties of E7 protein. Materials and Methods: In this study, using ANFIS model, a new model was developed for predicting oncogenicity of papilloma virus isolated from patients. The process of training and testing was performed using a set of available published filed data and several statistical and graphical criteria. Accordingly, through provision of needed biochemical and biophysical data on E7 gens from the existing data, this model was developed. The results of this model were, then, validated by the authentic published data. Results: Based on the results, the developed model is capable of predicting papilloma virus oncogenicity efficiently. R2 and RMSE values in training stage were 0.99 and 101.18, respectively. In the testing stage, however, they stood at 0.94 and 173.8, respectively. Conclusion: Based on the findings, the use of ANFIS model significantly improves the accuracy of estimating virus oncogenicity phenomenon. The methodology presented in this study is a new approach in estimating viral oncogenicity and can successfully be combined with other mathematical models for model updating in real conditions.

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Background: TTV is the first human circoviridae that was isolated from Japanese patients with unknown hepatitis in 1997. Since then, several studies have been done on different aspects of TTV pathogenesis. The aim of this study is to determine the prevalence of TTV in patients with chronic hepatitis using two different primer sets. Materials and Methods: In this descriptive study, blood samples from 240 patients with chronic hepatitis C at Professor Alborzi Clinical Microbiology Research Center were assessed in terms of the presence of TTV DNA in plasma through the nested polymerase chain reaction using two primer sets. Results: Of the 240 patients, TTV-DNA was detected in 220 (92%) patients with chronic hepatitis C using 5΄-UTR primer and in 12 (5%) patients using N22 primer. According to the demographic data, there was not a significant difference between male female patients in prevalence of TTV infection. Conclusion: The prevalence of TTV DNA in plasma samples from patients with chronic HCV by using 5΄-UTR primer was high and it was congruent with studies done in other countries however, N22 primer showed a lower prevalence of viral DNA in the samples. Overall, there was not a significant correlation between sex and the presence of viral DNA in patients. Controversial or high prevalence of this virus in HCV infected people necessitate further studies for determining the relationship between HCV and TTV infection.

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Background: Existence of extended spectrum B-lactamase (ESBL) genes plays an important role in spreading B-lactam antibiotic resistance in the producing strains of these enzymes. The resistance of gram-negative bacteria, such as Pseudomonas aeruginosa, to different antimicrobial agents, especially B-lactam and carbapenem, has increasingly been reported. This study was conducted to determine the prevalence of TEM-1 beta-lactamases in Pseudomonas aeruginosa isolates through Duplex PCR. Materials and Methods: In this descriptive-analytic study, 175 Pseudomonas aeruginosa isolates collected from burn patients were subjected to bacteriological tests. The samples were cultured and identified according to standard methods. Then the frequency of ESBL producing strains was determined via the combined disk method. Using boiling method, DNA was extracted and examined for the existence of TEM-1 gene by Duplex PCR. Results: Out of the 175 Pseudomonas aeruginosa isolates, 66 (37.7%) were ESBL positive, 15.15% of which were positive for TEM-1 B-lactamases resistance gene. Conclusion: Noticing the increasing rate of the ESBLs producing strains, using the appropriate treatment protocol based on the antibiogram pattern of the strains is highly recommended.

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Background: Mycobacterium marinum is an atypical mycobacterium that causes a type of skin infection known as fish tank granuloma affecting people who are exposed to aquatic environments and manifests with erythematous, papulonodular or plaque-like lesions of the extremities. Case: A 15 year-old woman working in a tropical aquarium in Khomein referred with a non-tender nodule on the dorsum of fourth finger of left hand for 4 months. There were no specific findings in physical examination. Routine laboratory tests were normal. Skin biopsy was obtained which revealed suppurative granulomas, but staining of PAS and Ziel-Nelson were negative. The patient was treated with doxycycline 100 mg P.O. BID for 2 months with complete improvement of the lesions. Conclusion: In patients with a history of work in aquatic environments who manifest erythematous, papulonodular, or plaque-like lesions of the extremities should be checked in terms of fish tank granuloma and infection with mycobacterium marinum and skin biopsy and culture should be done for lesions.

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Background: Polymerase chain reaction is the most common technique in the field of molecular biology that use for amplification of a specific nucleic acid sequence. Degenerate primers have ability to amplify related but distinct sequences. The aim of current study was to use, two sets of degenerate primers in combination with Hemi Nested PCR for detection V3-Loop sequence of envelope gene from wide spectrum of Human Immunodeficiency Virus (HIV) subtypes. Material and Methods: In this experimental study we designed and optimized, a degenerate primer pair in combination with Hemi Nested PCR, to detect HIV-1 V3 loop from Envelop gene that has wide variations among genotypes. The developed assay was used to check, 40 HIV infected, 10 negative controls as well as 5 samples from each HCV, HBV, HGV, and TTV were analyzed using developed method. Results: after optimization, 35 out of 40 positive controls were positive using our test. None of the negative human and viral control samples showed specific band. Also, in positive samples, non-specific bands were not detected. Conclusion: In this study moreover than standard PCR, we used two degenerate primers that could detect specific region of genome. In fact, first round of PCR product act as a template for second round inner primers and can produce smaller sequence with high sensitivity due to degeneracy. Based on the current investigation, the developed assay had advantages including product confirmation and hence more sensitivity.

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Background: HIV-1 and HCV are two of the most important blood-borne infectious agents. Hence, reliable, precise, and sensitive detection of these viruses in infected patients and donated blood units is highly important. Noticing the limitations of serological assays in detection of these infectious agents, this study was to use fast and sensitive molecular assays like real-time PCR. Materials and Methods: In this trial, a home-brewed SYBR green-based multiplex real time PCR, on the basis of melting curve analysis, was developed for the single or simultaneous detection of HCV and HIV-1 infections in plasma samples. Data were analyzed using SPSS software version 16. Results: The results obtained from different reactions on several clinical samples showed that the analytical sensitivities of the developed assay for HIV-1 and HCV were 200 and 100 copies/ml, respectively. It was also shown that the primers designed for each virus had no interaction with each other and other interfering agents. Conclusion: Noticing the good level of sensitivity and specificity, easy handling, relatively low cost, and rapid analysis of samples, this method can be a useful and rapid approach for simple and effective detection of HCV and HIV-1 in plasma samples.

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Background: Influenza is an acute respiratory disease caused by influenza virus. Influenza epidemics are reported every year and worldwide pandemics occur with varying frequencies. The majority of mortalities are due to underlying diseases and complications associated with influenza. In this study, we evaluated ten fatal cases caused by the established type A influenza (H1N1) infection in the 2009-2010 pandemic. Materials and Methods: This mortality survey was compiled by a review of the deceased patients’ files. The assessed variables were demographic data, underlying diseases, secondary infections, delayed commencement of therapy, and non-medication. Collected data were analyzed by measures of central tendency and dispersion using SPSS software. Results: In the ten deaths due to the established H1N1 virus, the median of age was 30 years and 90% of the cases had underlying diseases. Ninety percent of the deaths occurred during October and November and the rest took place in December and February. Conclusion: The main cause of death was the delayed commencement of antiviral treatment. This emphasizes the importance of timely treatment in high risk patients. In flu pandemics, physicians should swiftly start specific therapy in at-risk groups to reduce the mortality rates.

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Background: Brucellosis is an endemic disease in Iran and its treatment is a medical problem. This study was performed to observe the influence of the administration of corticosteroid on symptomatology of subjects with acute, subacute, and chronic brucellosis. Materials and Methods: In this randomized controlled trial, 48 patients with brucellosis were randomly assigned to two groups. The first group (N=30) received the standard regimen plus dexamethasone (4 mg t.d.s for 5 days) and the second group (N=17) received only the standard regimen. The results of corticosteroid administration were evaluated according to such factors as clinical status of the patient, duration of hospital stay, duration of illness, pain score, and use of analgesics. The results were analyzed by Chi-square test, Fisher’s exact test, independent sample t-test, and Mann-Whitney test. Results: No significant differences were seen in the mean of hospital stay, duration of illness, and use of oral and injectable analgesics between the two groups (P<0.05). Also, there was not a significant difference in mean pain score reduction between groups 1 and 2 (P<0.05). Conclusion: Noticing the findings of this study, corticosteroid does not seem to alter the clinical course of brucellosis significantly. Nevertheless, further controlled clinical trials with larger sample sizes are recommended

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Human Brucellosis is an infectious disease caused by Brucella bacteria. An average of 150 cases of brucellosis among 330 million people is reported in the USA each year. This bacterium is small, gram-negative rods that grow in phagocytes. They primarily cause diseases among different animals and humans become infected when is in contact with animals or their products. Brucella can cause various symptoms in humans which is similar to human influenza. Brucellosis is diagnosed in a laboratory by finding Brucella organisms in samples of blood or bone marrow or to detect antibodies against the bacteria in two blood samples, collected 2 weeks apart. Depending on severity of illness, recovery may take as long as several months. There is no vaccine available for human except live vaccines and that should be consulted to a health care provider. DNA findings for Brucella species in the index patients focused our attention on revealed human cancers. Also, granalomatous inflammation of testes and medulloblastomas has been linked to chronic Brucellosis infection which could be similar to Helicobacter pylori that is associated with gastric tumor formation. More scientific investigation is needed to properly address the connection of Brucella with other human malignancies.

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Background: Brucellosis is an endemic infectious disease in Iran. The neurological involvement of the central nervous system in brucellosis patients is about 3 to 5 %. Case: The case was a 25-year old Afghan man with weakness and arthralgia for one year as well as terrible headache, vertigo, vomiting, cough, sputum, and disequilibrium. Brain CT-Scan indicated communicating hydrocephalus in four ventricles. Since hydrocephalus was idiopathic and noticing the prevalence of tuberculosis among Afghan immigrants that can also cause hydrocephalus, ventriculo-peritoneal shunt was inserted for the patient. Pressure in CSF increased and had a turbid appearance. Glucose value of CSF decreased (35 mg/dl), whereas protein value increased (724 mg/dl). Leukocyte count was 10 mm3 with 80% neutrophils and 20% lymphocytes. The presence of brucella species in CSF culture confirmed that subacute meningitis had caused hydrocephalus due to delay in diagnosis and treatment. The patient was treated for brucellosis and discharged after 10 days with oral medications. Conclusion: Noticing this case and other studies, it is recommended that patients with neurological symptoms, such as hydrocephalus, be evaluated for neuro-brucellosis in endemic areas for brucellosis.

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Background: Brucellosis is one of the zoonotic diseases that has always been considered a health problem in Iran. Since this disease is endemic in Arak and Markazi Province, this study was done to investigate its epidemiology during 2001-2010. Materials and Methods: In this epidemiological study, data on patients with brucellosis were obtained from the medical records in Arak Health Center during 2001-2010. The collected data were analyzed by SPSS software version 16. Results: During this period, 3880 new cases were reported. The mean incidence rate of brucellosis was 60 per 100000 people during 2001-2010. The greatest incidence was in 2004 (111.5 per 100000 people), whereas the lowest incidence was in 2006 (40.5 per 100000 people). Overall, 72% of the patients lived in villages, and 60% of them were male. The majority of the patients were in the second decade of their lives (10-19 years old). The majority of the patients had Wright test titer=1:320 and 2ME titer=1:80 in serology titration. Conclusion: Arak is one of the regions with high incidence of brucellosis. In this region, the patients are mostly male, live in villages, and age 10-19.