Virulence genotyping of Escherichia coli isolates from diarrheic and urinary tract infections in relation to phylogeny in southeast of Iran

The purpose of this study was to determine the prevalence of virulence genes and phylogenetic groups/subgroups of Escherichia coli (E. coli) isolates from diarrheic and urinary tract infections (UTI) cases in Rigan area, southeast of Iran. One hundred thirty five E. coli were isolated from diarrheic (90 isolates) and urinary tract infections (45 isolates) samples. The confirmed isolates were examined to detect the phylogenetic group/subgroups and a selection of virulence genes including iucD, sfa/focDE, afaIBC, papEF, hly, cnfI and cdtI by PCR. The examined isolates belonged to four phylogenetic groups A (42.2%), B1 (14.1%), B2 (10.4%), and D (33.3%). Among 135 tested bacteria, 62.22% of diarrheic and 30.37% of UTI isolates had at least one of the virulence genes. In the diarrheic isolates iucD (47.77%) was the most prevalent gene. The other genes including sfa/focDE, afaIBC, papEF and cnfI/cdtI genes were detected in 15, 13, 11 and one diarrheic isolates respectively. None of the diarrheic isolates were positive for hly gene. Out of 45 UTI isolates 28.88% were positive for iucD, 13.33% for cnfI, 11.11% for afaIBC, 11.11% for papEF, 6.66% for sfa/focDE and 4.44% for cdtI genes. Several combination patterns of the virulence genes were detected in diarrheic and UTI isolates. In conclusion, the prevalence of virulence genes in diarrheic and UTI isolates differ according to phylogenetic groups, although B2 and D phylotypes have an accumulation of virulence associated genes.

A prospective cohort study of cutaneous leishmaniasis risk and opium addiction in south eastern Iran

Opium addiction and cutaneous leishmaniasis (CL) are endemic in different parts of Iran, particularly in Bam, where a massive earthquake occurred. This study was designed to compare the incidence rate and severity of CL cases among opium addicted and non-addicted individuals in south-eastern Iran. This study was carried out as a prospective cohort by active house-to-house visits of 1,481 habitants in Bam. CL cases were confirmed by smear and identification of Leishmania species was performed using nested-PCR. The data was analyzed by χ² and t-tests, using SPSS software and also Kaplan-Meier survival curve and long-rank test in Stata 11.2 and P<0.05 was considered as significant. A total of 904 individuals consisting of 226 opium addicted and 678 non-addicted individuals were followed-up for a period of seven years. The two cohorts were similar in terms of age, sex and place of residency. A similar pattern of incidence was observed among the two cohort groups. In contrast, the severity of CL in terms of the number, duration and the size of the lesions in opium addicted individuals was significantly (P<0.001) higher than non-opium addicted individuals. In conclusion, the present findings indicate that there is no relationship between the incidence of CL and opium addiction.

The emergence of anthroponotic cutaneous leishmaniasis following the earthquake in southern villages of bam district, southeastern iran, 2010

BACKGROUND

The objective of this study was to assess the epidemiological characteristics of a new emerging focus of cutaneous leishmaniasis (CL) in southern villages of Bam District, southeastern Iran, 2010.

METHODS

A house-to- house census survey of 5544 individuals were interviewed and physically examined for the presence of active lesions or scars. Diagnosis was confirmed by direct smears, cultures and identification by PCR. The data were entered into a computer and SPSS ver. 15.

RESULTS

Overall, 1.2% of the inhabitants were infected, 0.5% active and 0.7% scars and females were more significantly infected (1.7%) than males (0.8%), (P= 0.003). All age groups were equally affected. Most of the lesions were on the face and majority had single lesion. Most of the cases appeared from 2006 to 2008 during the CL epidemic in the city of Bam. PCR indicated L. tropica as the causative agent.

CONCLUSION

The presence of non-immune individuals along with suitable ecological conditions could induce a new emerging focus of ACL in villages.

Spatial distribution and molecular identification of leishmania species from endemic foci of South-eastern iran

BACKGROUND

Cutaneous leishmaniasis constitutes a major public health problem in many parts of the world including Iran. The primary objective of this study was to identify Leishmania species in endemic districts of Kerman Province, south-eastern Iran.

METHODS

This study was conducted by random sampling as cross- sectional descriptive between 2008 and 2010. Overall, 203 skin scraping smears were taken from the patients. Nested -PCR was performed to amplify variable minicircle fragments of Leishmania kDNA.

RESULTS

Bam was the most infected district (71.1%), followed by Kerman (14.7%), Jiroft (5.4%), Baft (2.7%), Sirjan (1.6%), Shahr-e Babak (1.5%) and others (3.0%). L. tropica was the most common species identified (194 cases, 95.6%), while L. major was found in only 9 cases (4.4%). Of 203 identified patients, all species in Bam (l07 cases), Kerman (32 cases), Jiroft (l6 cases) and Shahr-e- Babak (l1 cases) were detected as L. tropica, whereas infected subjects in Baft and Sirjan showed L. tropica or L. major. Characterization of Leishmania species resulted in generation of 750 bp and 560 bp fragments, corresponding to those of L. tropica and L. major, respectively.

CONCLUSION

L. tropica is the main species (95.6%) caused ACL in endemic areas of Kerman Province; however L. major is present in low level (4.4%).

Possible association between human blood types and opioid addiction

Drug addiction is a complex disorder that has been shown to have a genetic component like several other diseases. Finding any factor that is associated with higher risk of addiction tendency may influence the strategies of prevention and treatment of drug abuse and also provide an avenue of further research in genetics, immunology, and other related fields. This case-control study aimed at finding the frequency rate of ABO blood groups and Rhesus (Rh) factor among opioid dependents. Therefore, 249 opioid dependents referred to the Drug Quit center at Bam, Iran (case group) were compared with 360 blood donors referred to the Blood Transfusion Center (control group) in regard to the frequency of blood groups and Rh factor. The two groups were matched for demographic features. The odds ratio for AB blood group in addicts was 3.98 compared to non-addicts (p < .001) and the odds ratio of negative Rh in addicts compared to non-addicts was 4.27 (p < .001). According to the findings, in this population the frequency of negative Rh and AB blood group were significantly less than the predictive values. The relationship between opioid use and blood group type requires a cohort study eliminating all extraneous factors in order to be proved.

Cutaneous leishmaniasis in bam: a comparative evaluation of pre- and post-earthquake years (1999-2008)

BACKGROUND

The recent devastating earthquake of December 26 in Bam, 2003 created various risk factors; caused a sharp increase in incidence of anthroponotic cutaneous leishmaniasis (ACL) cases and reached to an epidemic proportion. The objective of this study was to evaluate the status of ACL cases five years before the earthquake compared to the cases occurred five years after the earthquake (1999-2008).

METHODS

Status of disease was assessed retrospectively for the five years before the earthquake and prospectively for the five years after the earthquake. Identification was confirmed by smear and polymerase chain reaction (PCR).

RESULTS

The mean annual incidence of ACL for the period from 1999 to 2003 was 1.9 per 1000 comparing to post earthquake period, which was 7.6 per 1000. Most of the infection was in individuals of <20 years, more frequently in females before the earthquake, whilst in contrast, there was a progressive rise in the number of cases, significantly in male individuals of >20 years (P< 0.0001) in post earthquake era. The anatomical distribution of lesions considerably changed during the two periods. Most of the cases were limited to three zones within the city prior to the earthquake, whereas it was spread throughout different zones after the earthquake. PCR indicated that the CL was due to Leishmania tropica in the city.

CONCLUSION

The results strongly suggest that in natural disasters such as earthquakes various precipitating factors in favor of disease will be created, which in turn provide a suitable condition for propagation of the vector and the transmission of the parasite.

Emergence of a new focus of anthroponotic cutaneous leishmaniasis due to Leishmania tropica in rural communities of Bam district after the earthquake, Iran

OBJECTIVES

To describe a new emerging focus of anthroponotic cutaneous leishmaniasis (ACL) due to Leishmania tropica in rural areas of Dehbakry county, south-eastern Iran, after the earthquake of 2003.

METHODS

House-to-house survey of 3884 inhabitants for active leishmaniasis lesions or scars. The diagnosis was confirmed by smears, cultures and identification of the parasite by polymerase chain reaction (PCR).

RESULTS

All age groups were affected, although patients ≤10 years of age showed the highest rate of infection (P = 0.0001). The overall prevalence rate was 5.3%; 6.3% in females and 4.3% in males. Of 204 cases, 1.8% had active sores and 3.5% had scars, with a significant difference between the sexes (P = 0.005). 47% of the lesions were on the face and 77.9% had one lesion. The incidence rose gradually 2004-2005, but grew exponentially 2006-2008. Electrophoresis of PCR products indicated that L. tropica was the causative agent.

CONCLUSIONS

The current emergence was unexpected in this rural locality, where no previous history of CL was recorded. According to our knowledge this is the first report of a gradually establishing new ACL focus in rural communities after the 2003 earthquake.

Leishmaniasis recidivans among school children in Bam, South-east Iran, 1994-2006

BACKGROUND

Leishmaniasis recidivans (LR) is a rare phenomenon in the world with high morbidity in children.

METHODS

Overall 22 838 school children were examined during 1994-2006. Diagnosis was performed by combination of methods as clinical appearance, direct smears, cultures, polymerase chain reaction (PCR) and histology.

RESULTS

Ninety-eight cases were diagnosed as LR with duration of lesions varying from 2 to 8 years and diameter of lesions 1-5 cm, yellowish-brown appearance with papules around or in the scar. Most of the lesions (95%) were on the face. No amastigote was found in direct smears. Identification of nine random isolates by PCR confirmed all species to be L. tropica. Tissue sections showed typical granulomatous reactions with various inflammatory cells but no visible amastigote was seen.

CONCLUSIONS

The presence of LR as an important cause of morbidity has future implications for treatment regimens and immunoprophylaxis.

Adverse impact of international NGOs during and after the Bam earthquake: health system's consumers' points of view

BACKGROUND

On December 26, 2003, an earthquake occurred in the city of Bam in Iran which completely destroyed the city. National and international responses to the calamity were quick and considerable and nongovernmental organizations (NGOs) from all over the world conducted extensive emergency assistance, fulfilling a crucial role during the emergency. The present study discusses some difficulties and problems which originated from the activities of international NGOs during their response to the Bam earthquake.

METHODS

A qualitative study using semistructured interview technique was conducted with nineteen public health and therapeutic affairs managers who were directly responsible for response and recovery in Bam. Analysis of the data was carried out by the framework analysis technique and supported by qualitative research software, the Atlas.ti.

RESULTS

The study found that although international NGOs did their best to help people in the region, they also had some adverse impacts on the community in the disaster affected areas. The problems originated from lack of knowledge of cultural issues, inefficient timing for the delivery of funds and services, uneven goods delivery, and poor communication with local people and authorities.

CONCLUSIONS

The study's findings could have implications for the international aid organizations including the United Nations (UN). Some activities such as roles and responsibilities of the NGOs; networking; and coordination and education of the NGOs could serve as the cornerstone for improvement of their efforts during disasters.

Epidemiological aspects of Pediculosis capitis and treatment evaluation in primary-school children in Iran

This study was undertaken to assess the prevalence of and epidemiological factors associated with, head lice infections in Iranian primary schools in 2006 and evaluate data on the therapeutic efficacy of lindane shampoo. A total of 40586 children (19774 boys (48.72%) and 20812 girls (51.28%)] from 198 Governmentprimary schools in Kerman, were screened for head lice between March and June 2006. The diagnosis of head lice infestation was confirmed by clinical inspection of scalp and hair for the presence of adult lice nymphal stage, or eggs (nit) by line-toothed head lice comb. All children infested with lice were treated with lindane shampoo (1% gamma benzene hexachloride). The overall prevalence of head lice infestation was 1.8%. The prevalence of infestation was significantly higher in girls (2.9%) than in boys (0.6%) (p = 0.000). The infestation rate was greater among pupils who were living in rural areas (4.6%) than in urban areas (1.5%). Of the 721 children with a positive examination result, 424 pupils (58.8%) were reported as having been infested with head lice in the previous 6 months. Mother's education level was a significant risk factor in this model (p < 0.05). At 2 weeks after the primary treatment, the success rates of treatment were 49%. Comprehensive survey in our work showed the better future of the disease and related factors. Education campaigns by health care officials, physicians and teachers are expected to be helpful for head lice control. It is essential that governments should be supported form cooperation between the school authorities and public health centers to successful control head lice infestation in primary school. Also there is an urgent need to identify safe, novel insecticides for proved efficacy.

Monitoring of insecticides resistance in main malaria vectors in a malarious area of Kahnooj district, Kerman province, southeastern Iran

BACKGROUND AND OBJECTIVES

Kahnooj district in south of Iran is an endemic area for malaria where Anopheles stephensi (Liston) is a main malaria vector and An. dthali (Patton) a secondary vector. According to the national strategy plan on monitoring of insecticides resistance, this study was performed on susceptibility and irritability levels of An. stephensi and An. dthali to different insecticides in the district.

METHODS

The susceptibility and irritability levels of field strains of An. stephensi and An. dthali at the adult and larval stages to discriminative dose of different imagicides was determined as recommended by WHO.

RESULTS

Using discriminative dose and WHO criteria it was found that An. stephensi is resistant to DDT and dieldrin with 36.1 +/- 2.3 and 62.2 +/- 1.95 mortality rates, respectively; but susceptible to other insecticides. An. dthali was found to susceptible to all tested insecticides. The larvae of An. stephensi, exhibited 100% mortality for temephos and malathion, but 44 +/- 4.32 for discriminative dose of fenitrothion. The results of irritability level for DDT and pyrethroids showed that permethrin had the most irritancy effect on An. stephensi and An. dthali. DDT and deltamethrin showed the least irritancy effect against An. stephensi with 0.42 +/- 0.08 and 0.77 +/- 0.12 take-offs/min/adult, respectively, however, lambdacyhalothrin had the least irritancy effect against An. dthali with 0.096 +/- 0.02 take-offs/min/ adult. The mean number of take-offs/min/adult with permethrin showed significant difference to DDT, lambdacyhalothrin, cyfluthrin and deltamethrin.

INTERPRETATION AND CONCLUSION

Pyrethroid insecticides are being used as indoor residual sprays in Iran. Based on our results, the main malaria vectors in the region are still susceptible to pyrethroid insecticides. Therefore, we propose the use of pyrethroids with low irritancy effect in rotation with carbamate insecticides in two interval seasonal peaks of malaria transmission. Biological control including larvivorous fishes, using of local made Bacillus thuringiensis and larvicides such as chlorpyrifos-methyl are the main larval control in the region. Result on larval test exhibited the susceptibility of main vectors to some larvicides, although the 100% mortality was not obtained using fenitrothion and this is postulated the use of this insecticide in agriculture pest control. Monitoring and evaluation of insecticides resistance in malaria vectors in the region could provide an essential clue for judicious use of insecticides.