Background: Treatment failure and relapse is a major problem in the treatment and control of brucellosis. The present study directed to determine risk factors for failure of treatment and relapse in patients treated for brucellosis.

Materials and Methods: This study was a descriptive - analytic and prospective study and were conducted in 72 patients with acute brucellosis.Patients were followed up during treatment and for six months after completion of therapy, and patients with treatment failure or relapse were analyzed. All data analyzed using SPSS software and P-value of less than 0.05 was considered significant.

Results: The mean value of age in patients was 40.2 ± 16.5 years. Treatment failures was 6.9% and the relapse at the end of the ninth month was 12.5% that recurrence of symptoms were associated with increased titers of serological tests and 80.6 percent had successful treatment. In this study gender of male (P = 0.026), occupational exposure (P = 0.005), delayed treatment in less than two weeks (P = 0.016), hepatosplenomegaly (P = 0.003), thrombocytopenia (P = 0.023), CRP &ge +2 (P = 0.017) and Wright &ge 1/320 and 2-ME &ge 1.160 at the end of the sixth week of treatment (P = 0.004 and P = 0.010) were risk factors of treatment failure and relapse in brucellosis.

Conclusion: The diagnosis and treatment of relapse and treatment failure in acute brucellosis is not clear, therefore, the prediction of relapse may be useful in preventing recurrence and treatment of patients.

Background: The emergence of antibiotic resistance, particularly resistance to methicillin in Staphylococcus aureus has made the treatment process more difficult. Therefore, producing of an effective vaccine seems to be necessary to prevent infections with methicillin-resistant Staphylococcus aureus (MRSA). In this study, a mixture of naloxone and alum has been used to improve the efficacy of a vaccine against MRSA.

Materials and Methods: MRSA 834 strain was grown on TSB medium and the grown cells were harvested and killed by sonication and were used as a vaccine model. Balb/c mice were divided into six groups and the vaccines were either injected alone, with naloxone, alum, or a mixture of naloxone - alum and control group received naloxone and PBS buffer. Total IgG antibody level was measured by ELISA method and finally, the challenge test of this bacterium was performed and the mice were examined regarding the degree of bacteria growth in their kidneys.

Results: The serum level of Total IgG antibody in the mixture of naloxone – alum with MRSA group was shown to be significantly increased (p<0.05). Furthermore, the lowest bacterial load was observed in this group.

Conclusion: It seems that a mixture of naloxone and alum as an adjuvant with the killed methicillin-resistant Staphylococcus aureus enhances the humoral immunity leading to a high level of protection against MRSA infections. Therefore, this seems to be a good option for improving the performance of this vaccine.

Background: Fungal spores are present in large amounts in the nature which may cause diseases in the susceptible individuals. Fungal rhinosinusitis has been increased during recent decades. This study aims to investigate fungal rhinosinusitis in the patients with chronic needing endoscopic sinus surgery aims and to determine the sensitivity of the isolates to rhin sinusitis antifungal agents.

Materials and Methods: In cross sectional study, specimens were obtained in sterile plates containing normal saline. from the suspected cases of chronic rhinosinusitis who had undergone endoscopic sinus surgery. Microscopic experiments and Cultures were done in Sabouraud Dextrose Agar medium. Minimum inhibitory concentration (MIC) of the growth of fungi for seven antifungal agents against the isolates was determined using E-Test.

Results: In total, specimens from 102 immunocompetent patients were examined. Nine positive specimens were presented, consisting of 3 for Aspergillus fumigatus, 3 for Penicillium, 2 for Aspergillus flavus and 1 for Alternaria. The mean age of the patients was 38 years, with 59 males and 43 females. The isolates were most sensitive to the voriconazole and amphotericin B.

Conclusion: Since the prevalence of fungal rhinosinusitis is low, unfortunately, the clinicians are not attentive enough to the condition, and they initiate antifungal therapy if the patients are not responsive to antibiotics. Early diagnosis and suitable treatment can help more efficient management of patients.

Background: Brucellosis is a highly contagious zoonotic disease between humans and animals known for high frequency of relapsing and ability to cause chronic infection. The function of immune system plays an important role in induction of chronic diseases. However, the role of immune system response is not completely studied. Therefore, this study designed to investigate the cytokine profile of the patients suffering from chronic and acute brucellosis.

 Materials and Methods: This descriptive- analytical study was performed on 22 patients with acute brucellosis (mean age 38±17), 21 patients with chronic brucellosis (mean age 43±10) and 21 healthy people (mean age 26±4) with the same age and sex as patients. The serum IFN-&gamma, IL-17, IL-5 and TGF- &beta levels were measured using ELISA method.

 Results: The mean IFN-&gamma serum level in acute and chronic brucellosis patients group was significantly higher than control group (p=0.045). The mean IL-17 serum level in acute brucellosis patients was significant decreased once compared with control group and in chronic patients was significantly decreased when compared with control group (p=0.024). In addition, the mean IL-5 and TGF-&beta serum levels of acute brucellosis patients group were significantly decreased as compared to chronic patients (p=0.001).

 Conclusion: The results of current study indicate that cytokine profile of chronic brucellosis patients is more related to Th2 immune response. Hence, Th2 immune response inhibition would be an appropriate way to treat and prevent disease to become chronic.

Background: Hydatid disease is a zoonotic infestation by a tapeworm of the genus of Echinococcus that characterized by cystic lesions in the liver and lungs but rarely in other parts of the body.

Case: Known case of chronic Lymphocytic leukemia was a 56-years old man with several hydatid cysts of liver and lungs that was hospitalized because of ascites and abdominal pain. The patient received albendazol and surgical operation with diagnosis of peritonitis and complicated hydatid cyst in lungs and liver and Peritoneum. Patient expired with DIC and sepsis.

Conclusion: This case report provides evidence that complicated hydatid cysts in immunocopromised patients have a bad prognosis and can not be safely treated by medication and surgery.

Background: Pathogenic Pseudomonas aeruginosa strains produce a polar flagellum that required for motility, adhesion, invasion and secretion of virulence factors. The aim of this study was to evaluate the effect of prevention and treatment with anti-recombinant type B flagellin antibody in a burned mouse model.

Materials and Methods: One hundred twenty six mice were divided into 16 groups injected with different regimen of anti-recombinant type B flagellin antibody. Infections were caused by sub-dermal injection of P. aeruginosa PAO1 and PAK strains at the burn site. Groups were monitored for mortality for one week. Additionally, functional activity of this antibody was assessed by motility inhibition and opsonophagocytosis assays.

Results:  Immunotherapy with rabbit antisera substantially increased (85.71%) survival rate of mice challenged with a homologous strain PAO1 compared with the control PBS. The mortality rate in mice infected by the heterologous strain PAK was only 28.57%. This antibody increased phagocytosis killing of the homologous strain but it only had a slight effect on the heterologous strain.

Conclusion:  Passive immunotherapy protected burned mice challenged with the homologous strain but showed lower efficacy against the heterologous strain.

  Background: The physiological role of apelin, an adipokine secreted by adipose tissue , in insulin resistance and type 2 diabetes has been identified . The aim of this study was to determine t he correlation of plasma level s of apelin-13 with insulin resistance index (HOMA-IR) and plasma leptin of diabetic male rats after 8-week aerobic exercise .

  Materials and Methods: Peresent study was an experimental study with animal model. Twenty eight diabetic male Wistar rats were divided into 3 groups: Non-diabetic (n=9), control diabetic (n=9) and trained diabetic (n=10). Type 2 diabetes was induced by intraperitoneal injection of nicotinamide and streptozotocin. The trained diabetic rat ran 8-week on treadmill progressively. After the training period, plasma levels of glucose, insulin, leptin and apelin-13 were measured and HOMA-IR was calculated. One-way analysis of variance (ANOVA) and Pearson’s correlation were used for analyzing data. p<0.05 was considered to be statistically significant.

  Results: A significant decrease in plasma levels of glucose, insulin and leptin and HOMA-IR in trained diabetic vs control diabetic rats, a significant increase in plasma levels of apelin in trained diabetic vs non-diabetic and control diabetic rats and a significant negative correlation of plasma levels of apelin with HOMA-IR and plasma leptin in trained diabetic rats was observed.

  Conclusion: In present study, 8-week aerobic training by improvement of insulin sensitivity (decrease of HOMA-IR and plasma leptin) increased plasma levels of apelin-13 in diabetic male rats.

  Background: Colonization with MRSA is no longer limited to hospitalized patients or persons with predisposing risk factors and at present there are several strains of community-acquired MRSA (CA-MRSA). The purpose of this study is to determine etA and etB genes in isolated Staphylococcus aureus strains of clinical samples from teaching hospital in Shahrekord in 2014.

  Materials and Methods: In this descriptive study, 220 clinical samples were collected from teaching hospitals in Shahrekord. The microbiologic characteristics of isolates were determined using microbiologyic standard methods. The MRSA detection was carried out on oxacillin agar medium. The detection of virulence genes etA and etB was used by PCR. Inducible resistance to clindamycin was tested by "D-test".

  Results: In 220 isolates, 110 detected as S. aureus and 13 as MRSA. Inducible clindamycin resistance was seen in 4 (3.5%) of the isolates. The frequency of genes etA, etB in studied strains was 7.6 and 15.3, respectively. Also, Inducible resistance to clindamycin was seen in four isolates(2%).

Conclusion: The results of this study confirme the presence of community- acquired strains in Shahrekord. The results of this study indicate the presence of genes etA and etB in the strains studied, transforming into the strains of Staphylococcus aureus resistant to methicillin obtained from hospital, the development and transfering these strains in the community.

  Background: In spite of designing and applying an effective vaccine against Hepatitis B virus (HBV), chronic infection with this virus is still one of the most important health problems worldwide. Host genetic background including single nucleotide polymorphisms play a significant role in chronicity or clearance of the infection. The final product of programmed cell death 1 gene (PDCD1) is expressed frequently on T-cells and in chronic viral infections, prevent the virus-specific T-cell response against the virus. In this study, the association of a single nucleotide polymorphism (+7146A/G) in intron 4 of PD1 gene with chronic hepatitis B infection in Iranian population has been assessed.

  Materials and Methods: 212 chronic HBV patients and 208 healthy controls were analyzed in this case-control study. Genomic DNA of the studied individuals was extracted and after performing polymerase chain reaction (PCR), polymorphism of +7146 was determined via RFLP method.

  Results: Frequencies of GG, GA and AA genotypes on position 7146 of the intron 4 of PD1 gene were 77.4%, 20.7% and 1.9% in patient group and 80.8%, 15.4% and 3.8% in control group, respectively. After statistical analysis, No significant difference was observed between patient and control groups (p=0.198).

  Conclusion: Genotype frequencies in the studied population are in accordance with the results of previous studies. Results of the present study suggest that there is not any association between A/G single nucleotide polymorphism in intron 4 of PD1 gene and susceptibility to chronic hepatitis B in Iranian population.

Background: Staphylococcus aureus is one of the important pathogens can cause infections in hospitals specially in intensive care units (ICU). It seems that nasal carriage is important risk factor for developing l infection at ICU units. This study was designed to investigate the frequency of S. aureus nasal carriage and its virulence in patients admitted to ICU units in Vali-Asr hospital at Arak university of medical sciences.

Materials and Methods: In this cross-sectional study, nasal swab samples were obtained from all the patients hospitalized in ICU unit of Vali-Asr hospital from July-December 2014 at admission. After identification, methicillin resistance and the frequency of pvl and acme genes determined by PCR. Demographic data were collected using questionnaire and were analysed using SPSS 20 software.

Results: Out of 390 patients, 81(20.8%) and 31(12.9) patients had been colonized with MSSA and MRSA, respectively. The result of culture was negative for 278 patients (71.3%). 77.4% of MRSA and 54.3% of MSSA isolates were positive for acme gene. Also, 11.11% of and 6.45% of MSSA MRSA isolates were positive for pvl gene.

Conclusion: The application of medical supportive devices like cv line, ventilator, history of surgery operation and antibiotic use significantly was associated with S. aureus nasal carriage. High prevalence of S.aureus shows that these bacteria settled in the hospital. Hence, infection control measures must be performed to reduce the risk of hospital infection.

Background: Hepatitis B virus (HBV) is a member of hepadenaviridae family, which is infectious for humans and a few animal species. Successful clearance and elimination of infection from the body or development of HBV infection to chronic disease depend on the host genetic background in immune system genes. Interleukin-12 (IL12) and also Interleukin-12 Receptor B1 (IL 12 RB1) are the key factors in the spontaneous clearance of viral infections, especially HBV. The aim of the present research is to investigate the association between Interleukin-12 receptor B1 gene polymorphism (rs11575934 A/G) and susceptibility to chronic Hepatitis B virus infection.

Materials and Methods: In this case-control study, genomic DNA of 150 chronic HBV infected patients and 150 healthy controls were extracted from peripheral blood cells. Single nucleotide polymorphism (rs11575934 A/G) was genotyped using polymerase chain reaction/restriction fragment length polymorphism (PCR-RFLP).

Results: The frequency of GG, AG, AA genotypes was 6.7%, 40.7%, and 52.7% in chronic patients and 12.7%, 41.3%, and 46% in control group, respectively. No statistically significant difference between case and control groups has been observed (p=0.176).

Conclusion: In the present study, no significant correlation between rs11575934 A/G single nucleotide polymorphism of the IL12RB1 gene and susceptibility to chronic hepatitis B virus infection has been observed. According to the study, this polymorphism does not affect the susceptibility to chronic HBV infection.

Background: Brucellosis is one of the most important diseases among humans and animals. Clinical management of brucellosis due to an increased rate of treatment failure and recurrence is extremely worrying. The aim of this study was to determine the antimicrobial susceptibility pattern of the brucella isolates.

Materials and Methods: From April to September 2014 a total of 30 brucella isolates that were cultured on brucella agar has been studied. The species identification was carried out and to determine the effect of antibiotics on bacteria antibiogram testing was performed by disk diffusion.

Results: In this study, 30 brucella strains were isolated from cultured specimens and antibiogram testing was performed. All microbial positive specimens were sequenced by PCR. All isolates were Brucella melitensis. According to the tests, suceptibility to tetracycline, minocycline, gentamicin, tigecyclin was 100%, to doxycycline 93.3%, co-amoxiclave 66.7%, rifampin 44.7%, streptomycin 86.7%, ciprofloxacin 80%, cotrimoxazole 76.7% and ceftriaxone 73.3%.

Conclusion: This study shows that the predominant strain in our patients was Brucella melitensis. Also, due to high levels of resistance to rifampin to use the other effective drugs like gentamicin, streptomycin, ciprofloxacin or cotrimoxazole in combination with doxycycline or tetracycline.

Background: Brucella is an intracellular bacterium that causes chronic infection in humans and domestic animals. The underlying mechanisms that cause prolonged illness are complex and not fully understood. Immune responses may have an important role in the chronicity of infection. Here, we evaluated the lymphocyte proliferation responses in patients with chronic and acute brucellosis.

Materials and Methods: This descriptive - analytical study was performed on 22 patients with acute brucellosis, 21 patients with chronic brucellosis and 21 healthy people with the similar age, sex and genetic background as control group. Peripheral lymphocytes were isolated using Ficoll and the cellular proliferation was quantified in presence of antigen and phytohemaglutinin-A by MTT method.

Results: The brucella antigen-specific stimulation index in patients with chronic brucellosis was significantly lower than the acute brucellosis patients (p=0.001). Also, stimulating the lymphocytes with phytohemaglutinin-A has shown that proliferative response in patients with chronic brucellosis was lower than the other groups (p=0.04).

Conclusion: The results indicated that chronic brucellosis inhibits lymphocyte proliferation. This inhibition of lymphocyte proliferation may be due to the induction of anergy.

Background: The efflux pumps are one of the main mechanisms of resistance to antibiotics in E. coli and K. pneumoniae strains. The aim of this study is to study the association between genes coding efflux pumps AcrAB and Qep A and ciprofloxacin resistance among E. coli and K. pneumoniae clinical strains

Materials and Methods: This study was done on 100 strains of E. coli isolated from Taleghani and Labbafinejad Hospitals and 100 strains of K. pneumoniae isolated from Taleghani and Mofid Children Hospitals. Antimicrobial susceptibility tests were performed by disk diffusion method based on CLSI guidelines. Identification of genes encoding efflux pumps Acr AB and Qep A was done by PCR technique.

Results: In this study, fosfomycin and imipenem had the best effect against E. coli clinical isolates and fosfomycin and tigecycline had the best effect against K. pneumoniae clinical isolates. PCR assay demonstrated that the prevalence of AcrA, AcrB and QepA genes among E. coli isolates were 92%, 84% and 0%, respectively and among K. pneumoniae isolates were 94%, 87% and 4%, respectively.

Conclusion: The prevalence of genes encoding efflux pumps in E. coli and K. pneumoniae clinical strains, which causes resistance to fluoroquinolones, is cause for concern. Therefore, controlling infection and preventing the spread of drug-resistant bacteria needs to manage medication carefully and identify resistant isolates.

Background: Biofilm formation is one of the pathogenicity factors of Staphylococcus aureus that can help the bacteria to stick to the other surface and also increase antibiotic resistance pattern. This study aimed to investigate the phenotypic and genotypic indices for formating biofilm in Staphylococcus aureus isolates isolated from infectous samples.

Materials and Methods: 250 Staphylococcus aureus strains isolated from hospital infections were selected. Antibiotic resistance pattern was determined by using disk diffusion method. The ability of biofilm formation was investigated by molecular and phenotypic method.

Results: In this study, 73.5% of isolates were able to bind strongly, 5.33% had the ability of medium connection and 15.4% had the ability of weak connection in biofilm production. The frequency of icaC and icaB genes were 67.3% and 63.2%, respectively. 92.2% of biofilm producing isolates have mecA gene.

Conclusion: The spread of antibiotic resistance in isolates especially isolates that produce biofilm will create serious problems in the hospital therapeutic wards.

Abstract

Background: Probiotics are known as a factor for prevention of infectious diseases such as urinary tract infection(UTI). The present study aimed to investigate the positive effects of probiotics on urinery truct infection of cateterized intensive care unit patients.

Materials and Methods: In a triple blind clinical trial, 125 cateterized intensive care unit patients were randomly selected and divided into two groups, Treatment group (n = 63) was well matched with placebo group (n = 62) for age and sex and duration of admission .Case group received one lactocare capsule for 10 days and control group with a same method received placebo for 10 days. In both groups urine analysis and urine culture were measured with a same method at the first day and then twentieth day and finally data were analysed with t-test.

Results: The incidence of urinary tract infection between treatment and control group (respectively 17.4% and 22.5%) had no statistically significant difference (p=0.672). But, in terms of sex, incidence of urinary tract infections in women compared to men with the same condition was significantly different(p=0.002). In treatment group with long term cathetrization, urinary tract infections significantly were significantly different(p=0.041).

Conclusion: Administration of lactocare capsule has no statistically significant impact on the incidence of urinery truct infection of cateterized intensive care unit patients. In comparsion of cateterized men and women receiving probiotics, the reduction of urinary tract infection in women was more than in men. Probiotics had preventive effects on long term catheterization.

Background: Parvovirus 4 (PARV4) was first discovered in 2005, in a hepatitis B virus–infected injecting drug user (IDU). To date, the best evidence about PARV4 transmission is parenteral roots and comes from IDU individuals. It seems that the prevalence of the virus in the normal population is very low. In this study, we investigated the prevalence of PARV4 virus among patients with chronic HCV infection compared with healthy controls and related risk factors among these groups.

Materials and Methods: A total of 206 patients, including 103 patients with chronic HCV infection and 103 healthy controls, were studied by use of nested-PCR and also real-time PCR techniques.

Results: AST enzyme levels with a mean of 40.45+34.84 and 18.58+5.9 in patients and healthy group respectively and the amount of enzyme ALT among patients with a mean of 40.45+35.75 and 21.50+11.35 in patients and healthy group respectively, were reported. Finally, after screening all DNA samples from patients and controls, we discovered that none of these people are infected with the PARV4 virus.

Conclusion: This study is the first to investigate the occurrence of PARV4 among HCV patients in Iran. The results show that, the virus is not important in Iranian population, even in patients with blood born infections such as HCV and further studies in other areas and various groups are required.