A global systematic review and meta-analysis on the babesiosis in dogs with special reference to Babesia canis

BACKGROUND

Canine babesiosis is a clinically significant tick-transmitted disease caused by several species of the intraerythrocytic protozoan parasite Babesia, which result in a wide range of clinical manifestations, from mild, transient infection to serious disease and even death.

OBJECTIVES

The current study aimed to estimate the global prevalence and associated risk factors of Babesia in dogs.

METHODS

Multiple databases (PubMed, Scopus, ProQuest, Web of Science and Google Scholar) were searched for relevant literature published from January 2000 up to December 2022. The statistical analyses were performed based on the R software (version 3.6) meta-package.

RESULTS

Out of 23,864 publications, 229 studies met the inclusion criteria. The pooled prevalence of canine babesiosis was 0.120 (95% CI; 0.097-0.146). The highest pooled prevalence was found in Europe (0.207, 95% CI; 0.097-0.344). Among several species, Babesia canis was the most prevalent parasite (0.216, 95% CI; 0.056-0.441). The highest pooled prevalence of Babesia in dogs was observed in the summer season (0.097, 95% CI; 0.040-0.174).

CONCLUSIONS

Regular screening and appropriate control strategies are recommended for the prevention of transmission of tick-borne disease transmission among dogs.

Trematode Cercariae from Lymnaea gedrosiana in the Caspian Sea Littoral in Iran: a one health concern

Introduction

Lymnaea gedrosiana snails are hosts to a variety of trematode cercaria of public and veterinary health importance. In Guilan Province, Iran, a region with a high level of fish and bird farming and wetlands important for migratory birds, little is known about the trematode cercaria from L. gedrosiana.

Methods

From April 2020 to October 2021, six freshwater sites in Guilan Province were sampled for Lymnaeidae snails three times per season (spring, summer, autumn and winter). Snails were exposed to light and heat to induce cercaria shedding and shredded cercaria were identified morphologically and molecularly.

Results

In total, 5,712 Lymnaeidae snails were collected of which 3,288 (57.6%) were identified to be L. gedrosiana with 54.3% containing trematode cercaria. Snail and cercaria recovery were highest in the spring and summer. Trematode cercaria identified included Telorchis assula, Hypoderaeum conoideum, Apharyngostrigea pipientis, Sanguinicola cf. inermis, Opisthioglyphe ranae, Diplostomum pseudospathaceum, and Australapatemon burti.

Discussion

The four trematodes D. pseudospathaceum, S. inermis, A. burti, and A. pipientis have not been previously reported in Iran; all four of these can infect migratory birds. The most common cercaria found, H. conoideum (18.3% of the snails) is of zoonotic importance. The third most common cercaria found, S. inermis (10.0% of the snails) is detrimental to fish production. Given the importance of the wetlands in the region for wildlife and migratory birds as well as the number of fish and bird farms in the area, efforts to control L. gedrosiana snails are needed to protect wildlife and human health. In addition, monitoring programs should be implemented to identify and prevent introductions of new trematode species.

The double-sided effects of Mycobacterium bovis bacillus Calmette-Guérin vaccine on helminthic infections – current data and future prospects

Bacillus Calmette-Guérin (BCG), a live attenuated strain derived from an isolate of Mycobacterium bovis, is one of the childhood vaccinations widely used against tuberculosis (TB). In addition to its effects on mycobacterial diseases, the information has shown the protection effect of BCG in helminthic diseases. In the current review, the role of BCG vaccine in non-specific protection helminthic infection is reviewed. In human alveolar echinococcosis (AE), treatment with BCG enhances host's innate immune response against the parasite via the number and activation of monocytes. In cysticercosis, despite the enhancement of Th1-biased immune responses by coadministration of rcC1 plus BCG-DNA, the level of induced protection did not increase compared to immunization with rcC1 antigen alone. Also, pretreatment of mice with live BCG vaccine induced a high level of protection against subsequent parasite infection with Taenia taeniaeformis. The reduction of the parasite burden in mice infected with Mesocestoides corti that received two doses of BCG post-infection demonstrated the therapeutic effect of BCG. The protective potential of the schistosomula/BCG vaccine against Schistosoma japonicum in sheep study showed a reduction in the number of adult worms and mean faecal egg counts post-challenge. In trichinellosis, BCG can induce hyperplasia of the reticuloendothelial system and activation of macrophages in mice. Therefore, these data revealed that BCG vaccination can exert non-specific protective effects for the prevention of diseases other than tuberculosis. Medicinal doses of BCG may be considered a new approach to the treatment of helminth infections.

Isolation and Identification of Free Living Amoeba from Patients and Contact Lens Users in Iran

Background:

Free-living amoebae (FLA) such as Acanthamoeba spp., are considered as opportunistic and pathogenic protozoans. Acanthamoeba granulomatous encephalitis (AGE) is a serious threat for immunodeficient patients and Acanthamoeba keratitis (AK) for contact lens users. We aimed to identify the presence of free living amoebae in nasal swabs of patients and contact lens users in Qazvin, Iran.

Methods:

During 2019, 251 nasal and oral swabs (including the pharynx and mouth) were collected from patients with diabetes, AIDS and those under periodic dialysis in Qazvin, Iran. In addition, 27 soft contact lenses were collected from the participants. Following DNA extraction, PCR and sequencing were conducted to identify the genotypes of the amoeba. Phylogenetic analysis of the identified sequences was performed using MEGA 7 software.

Results:

A strain of Acanthamoeba belonging to the T3 genotype was isolated from hemodialysis patients. Two specimens of Acanthamoeba with T3 genotype were isolated from keratitis patients.

Conclusion:

The clinicians should pay attention to the possible complication of this organism because this amoeba is potentially pathogenic for immunocompromised patients. Since the amoeba is present in environmental resources, the use of contact lenses should be accompanied by considering proper hygiene.

Parasites in surgically removed appendices as a neglected public health concern: a systematic review and meta-analysis

The role of various parasitic infections in the occurrence of appendicitis is illustrated through cases recorded all over the world. The purpose of the current study was to estimate the global prevalence of parasite infestation (other than E. vermicularis) in appendectomy specimens.In the setting of the PRISMA guidelines, multiple databases (Science Direct, Scopus, Web of Science, PubMed, and Google Scholar) were explored in articles published until 28 September 2020. Totally, 62 studies (106 datasets) with 77, 619 participants were included in the analysis.The pooled prevalence of parasites in appendectomy samples was as follows; 0.012% (95% CI; 0.004-0.025) for Ascaris lumbricoides, 0.004% (95% CI; 0.001-0.009) for Trichuris trichiura, 0.025% (95% CI; 0.007-0.052) for Schistosoma mansoni, 0.002% (95% CI; 0.001-0.005) for Taenia spp., 0.061% (95% CI; 0.020-0.122) for Entamoeba histolytica and 0.034% (95% CI; 0.018-0.056) for Giardia lamblia.Our results demonstrated that the risk of appendicitis may increase in the presence of helminth and protozoan infections. As such, the most cases of parasites in appendectomy specimens were reported in developing countries. Regular screening plans for diagnosis, treatment and prevention are needed for prevention of parasitic infection as well as parasitic associated appendicitis, especially in endemic regions of the world.

Finasteride in hospitalized adult males with COVID-19: A risk factor for severity of the disease or an adjunct treatment: A randomized controlled clinical trial

Background: There is controversy about the efficacy of 5-alpha-reductase inhibitors in COVID-19 patients. Some assumed that finasteride might be a risk factor for deterioration and others proposed it as a possible adjunct treatment for moderate to severe COVID-19 infection in the elderly.

Methods: We performed a randomized controlled clinical trial (registration ID IRCT20200505047318N1) on 80 hospitalized male patients aged ≥50 years diagnosed with COVID-19 pneumonia in a tertiary hospital in Qazvin (Iran) from April to July 2020. The patients were randomized into one of the 2 treatment groups using simple randomization. Treatment group patients underwent routine drug therapy and 5 mg finasteride once daily for 7 days. The primary endpoint was mortality rate and length of hospital stay (LOS), and secondary endpoints were peripheral capillary oxygen saturation, respiratory rate, and inflammatory markers changes. The study protocol was approved by the medical ethics committee of Qazvin University of Medical Sciences (registration ID IR.QUMS.REC.1399.080). Data were analyzed by statistical tests and SPSS version 25. Also, p<0.05 was considered to be statistically significant.

Results: We found a significant difference on O2 saturation among the 2 study groups on fifth day compared with the admission time (p= 0.018). The results did not show significant differences in mortality rate (2.5% vs 10%; p= 0.166) and LOS (p= 0.866) between patients in the finasteride and the control group.

Conclusion: A short course of finasteride administration partially improves O2 saturation but does not influence other outcomes in hospitalized male patients aged ≥50 years with COVID-19 pneumonia. Further research in a large scale with longer follow-up is required to help clarify the role of finasteride in this setting.

A Death Case Report in an Adult Woman With COVID-19 after Septoplasty

The mortality rate of Coronavirus Decease 2019 (COVID-19) is very high, but specific situations can increase the rate including severe hypoxemia, multiple organ injury, and thromboembolic events in various organs. Another factor is the stress caused after surgery that require general anesthesia. This study aims to report a case of death in an adult woman with COVID-19 infection who had underwent septoplasty and admitted to hospital after worsening of her general condition and treated when diagnosed with COVID-19. One day after admission, she was intubated due to progressive respiratory failure and deceased following bradycardia and cardiac arrest. It seems that the elective surgery should be avoided in patients infected with COVID-19 and should be postponed until complete recovery. Moreover, the possibility of this infection should be considered in all candidates for surgery with subtle respiratory symptoms.

Long-term immunogenicity of hepatitis B vaccine and impact of a booster dose on health care

Background: Accidental exposure to sharp instruments is an important problem for health care students. Thus, the aim of this study was to determine the rate of immunity in health care students 2 decades after national neonatal hepatitis B (HB) vaccination.

Methods: All junior students attending medicine, nursing and midwifery schools were screened for anti-HBs. One dose of hepatitis B vaccine was offered to all participants who did not have antibodies to HB surface antigen (anti-HBs) of > 10 IU/L; then, they were tested for anti-HBs after a month. The participants were classified into 3 groups: postboosting nonimmune, postboosting immune, and preboosting immune. Chi square test and ANOVA were used for data analysis.

Results: In the first step, 65.20% of participants did not show immunity, but after receiving a booster dose, only 6.0% remained nonimmune. The mean age of nonimmune students was significantly higher than that of students who had postboosting immune and preboosting immune status (p=0.001 and 0.002, respectively). Also, the mean injection time from last shot was higher in postboosting immune group compared to preboosting immune group (p<0.001). Also, prebooster anti-HBs level was significantly different among participants with suboptimal response and those who developed anamnestic response, indicating preserved immune memory (p=0.001).

Conclusion: High anamnestic response to HBV booster dose indicates sufficient immunity to HBV in the majority of health care students. However, identifying students who cannot respond to a booster dose of vaccine seems to be necessary at the beginning of health care courses.

Poverty as an independent risk factor for in-hospital mortality in community-acquired pneumonia: A study in a developing country population

BACKGROUND

Community-acquired pneumonia (CAP) is one of the most severe lower respiratory tract infections with a high in-hospital mortality. The aim of this study was to investigate the socioeconomic and medical risk factors affecting the prognosis of acute pneumonia. The results of this study can mention the value of socioeconomic backgrounds like poverty and illiteracy in clinical practice, even in a well-known biological phenomenon (eg acute pneumonia).

METHODS

In this cross-sectional study, all admitted patients to a tertiary teaching hospital with a diagnosis of community acquired pneumonia in a 12-month period were enrolled. Socioeconomic and demographic characteristics, underlying conditions, clinical manifestations and para-clinical test results at admission registered prospectively. A logistic regression model was conducted using in-hospital mortality as the dependent variable.

RESULTS

A total of 621 patients was included in this study. Among them, 47 patients (7.6%) died during the hospitalisation period. In multiple logistic regression analysis, pleural effusion, a higher CURB-65 score, hyponatremia, hyperglycaemia and poverty (being in the lower economic class) were identified as independent risk factors for in-hospital mortality in community-acquired pneumonia.

CONCLUSION

Numerous factors can influence the prognosis of CAP. In addition to the CURB-65 score and some other medical risk factors, socioeconomic backgrounds can also affect the early outcome in CAP. In this study, being in the lower economic class (as an indicator of poverty) is interpreted as an independent risk factor for a poor prognosis in CAP.

Metabolic syndrome as an independent risk factor of hypoxaemia in influenza A (H1N1) 2009 pandemic

A swine-origin influenza A (H1N1) emerged as a pandemic in 2009. We investigated the association between the overweight, metabolic syndrome and the severity of disease in the confirmed cases in Qazvin province, Iran. The study sample included all patients over 12 years old with confirmed influenza A (H1N1) in the province of Qazvin, Iran, in the 2009 pandemic, excluding pregnant women. To define overweight, sex and age-specific body mass index (BMI) cutoffs recommended by the International Obesity Task Force were used. Metabolic syndrome was defined by ATP III criteria. Multiple logistic regression analysis was performed to identify statistically independent predictors of hypoxaemia. Out of 55 confirmed cases, 28 (50.9%) were overweight and 24 (45.3%) were identified as having metabolic syndrome by ATP III criteria. Twenty four patients had hypoxaemia (arterial oxygen saturation below 90%) during the course of the disease. In multivariate logistic regression analysis, pulmonary co-morbidity (OR=9.54; 95% CI, 1.36 to 66.88; p= 0.023) and the metabolic syndrome (OR=18.66; 95% CI, 1.60 to 217.47; p= 0.019) were revealed to be independent risk factors for hypoxaemia in influenza A (H1N1) pdm09. The results of the present study reveal the role of the metabolic syndrome on the severity of influenza A (H1N1) pdm09 infection.

A local experience of treatment response in chronic hepatitis C infection

Hepatitis C virus infection is the major cause of liver cirrhosis. Antiviral treatment can achieve persistent viral clearance to prevent long-term complications of the disease. Despite the introduction of direct acting antivirals (DAAs) as effective therapy in recent years, the standard regimen consisting of interferon and ribavirin which are more accessible and inexpensive is still widely prescribed for the majority of worldwide hepatitis C patients in developing countries. The present study was conducted to demonstrate a local experience of treatment response (with combination therapy; interferon and ribavirin) and outcome in patients with chronic hepatitis C infection. In all, 107 patients from a referral centre for infectious diseases participated in the study from 2007 to 2012. They were evaluated for demographic characteristics, the disease, the presence of metabolic syndrome and its sub-scores, and lab characteristics. The resulting data were analysed with paired T-test, chi-square test, Fisher exact test and logistic regression, according to relevance. The virus eradication rate was 72.9% and 72% at the end of treatment and 6 months later, respectively. Of the patients with HCV chronic hepatitis, 27.96% had concomitant metabolic syndrome. There were statistically significant relationships between response to the treatment and the patient's age and gender, the genotype of the virus, presence of metabolic syndrome, waist circumference, BMI, viral load prior to the treatment and blood pressure (systolic and diastolic). Presence of metabolic syndrome (OR: 20.69, CI: 2.83-151.34, P=0.003) and the genotype of the virus (OR: 6.64, CI: (1.48-29.72), P=0.013) were independent risk factors of failure to achieve sustained virologic response in treatment of chronic hepatitis C with interferon and ribavirin in multivariate logistic regression analysis. According to the current study, HCV infection should be considered a metabolic disease, further to a viral infection. Metabolic factors may impact outcome of the antiviral therapy. Patients should be evaluated for metabolic factors prior to and during antiviral treatment.

Fatal Strongyloides hyper-infection in a patient with myasthenia gravis

PURPOSE

We report a fatal case of Strongyloides hyper-infection as the result of corticosteroid therapy of a patient with myasthenia gravis.

CASE PRESENTATION

Our patient was a farmer with a past history of living in an endemic area for Strongyloides stercoralis in Iran. Hyper-infection was diagnosed during the advanced-stage disease by demonstration of enormous number of larvae in the direct smears prepared from both the stool and tracheal secretions. Unfortunately, despite appropriate anti-parasite therapy, the patient died due to respiratory failure.

CONCLUSION

We recommend the provision of more awareness in high-risk people prior to immunosuppressive therapy, through screening for S. stercoralis, even in non-endemic regions.

The impact of pneumonia on hospital stay among patients hospitalized for acute stroke

OBJECTIVE

To determine the impact of pneumonia on length of hospital stay in cases of acute stroke.

METHODS

This was a retrospective cross-sectional study on 368 stroke patients admitted with a diagnosis of stroke at the Avicenna Hospital, Qazvin, Iran between January 2010 and March 2011. By reviewing the hospital patient records, the demographic characteristics, stroke characteristics, and complications of stroke in these patients were determined during their hospital stay. In surviving patients, the impact of each variable on length of hospital stay was calculated by logistic regression analysis and the Log-Rank test.

RESULTS

Patients with pneumonia during the post stroke period had an increased length of hospital stay (11.5+/-6.4 days), compared with other patients (7.2+/-4.1 days), (p=0.0005). Multiple logistic regression analysis showed a significant association between length of hospital stay and urinary tract infection (p=0.001), steroid consumption (p=0.028), index of stroke severity (p=0.039), pneumonia (p=0.042), and swallowing disorder (p=0.048).

CONCLUSION

Considering the impact of pneumonia on the length of hospital stay and its consequences, prophylactic activities, rapid diagnosis, and treatment of pneumonia may improve outcome and reduce costs in stroke patients.

Leprosy elimination campaign in Qazvin province, Islamic Republic of Iran (2006-07)

Multi-drug therapy (MDT) and Leprosy Elimination Campaigns (LEC) are the major strategies for eliminating leprosy. We report the results of a LEC conducted in 2006 in Qazvin. A total of 1987 individuals (1379 household contacts of 319 registered leprosy patients and 608 people from 3 endemic villages with a high prevalence of leprosy) were examined for detection of new cases of leprosy. All new cases were given MDT and were reviewed after a year. There were 256 suspected cases of leprosy, 13 of whom were confirmed as new cases (7 were classified as multibacillary leprosy). None had visible deformity nor was < 20 years old. All patients completed the recommended MDT course. The few cases detected suggest that in low prevalence areas, a long-term approach of integrated leprosy services and disability management may be more appropriate than LEC as a leprosy elimination strategy.

Erythema nodosum in the course of Crimean-Congo haemorrhagic fever

Crimean-Congo haemorrhagic fever is an emerging zoonosis with a wide geographic distribution and protean clinical manifestations. The main pathogenesis of this infection has not been elucidated. Erythema nodosum is an immunologically-mediated dermatologic disease and the most common form of panniculitis that has been associated with many infections and inflammatory disorders. We describe a case of Crimean-Congo haemorrhagic fever with severe bleeding diathesis and hepatic failure that was successfully treated with oral ribavirin. The patient presented with erythema nodosum in the course of disease. Crimean-Congo haemorrhagic fever and erythema nodosum have not been reported to occur together. We present the first reported case of erythema nodosum associated with this emerging viral infection. Furthermore, it may influence our opinion about pathogenesis and immunologic mechanisms of this disease.