Background:Patients who undergo cardiac surgery appear to be at increased risk for the development of Nosocomial infections (NIs). The development of antibiotic-resistant infections has been associated with significantly greater hospital mortality rates compared to similar infections caused by antibiotic-sensitive pathogens.Objectives:The purpose of this study is survey of Nis and antibiotic resistance patterns of causative bacteria among patients who underwent open heart surgery in the north of Iran during a 2-year period between September 2012 and September 2014.Methods:In this cross-sectional study we evaluated 187 patients that underwent open heart surgery with NIs. Demographic feature, clinical characteristics and risk factors of each infection were recorded. The antibiotic susceptibility test was performed using the Minimum inhibitory concentration (MIC) method according to the standard protocol of Clinical & Laboratory Standards Institute (CLSI). Detection of Extended-spectrum beta-lactamase (ESBL) producing bacteria was performed by the double-disk synergy (DDS) test; also Methicillin-resistant Staphylococcus (MRSA) strains were identified by MRSA Screen Agar. The collected data were analyzed using the SPSS software (ver. 16) and, descriptive statistics were used.Results:Out Of total of 2253 hospitalized patients who underwent open heart surgery, 187(5.05%) patients had NIs. 51.9% of the patients were female. The rates of surgical site infection (SSI), respiratory tract infection, endocarditis, Urinary tract infection (UTI), blood Infection and mediastinitis were 27.80, 25.66%, 17.64, 17.11% 8.55% and 3.20% respectively. E.coli and S.aureus were the most causative agents of NIs. The rate of ESBL-producing bacteria was 14.28- 71.42% among enterobacteriaceae and the rate of MRSA was 54.2% among S.aureus strains. All isolated Acinetobacter.spp were Multi-drug resistance (MDR).Conclusions:We showed that the rate of NIs among these high-risk patients was in the average level. But the emergence of MRSA and ESBL bacteria is increasing in our region.

The declining incidence of hepatitis A virus (HAV) infection in the IslamicRepublic of Iran may be reducing the population's natural immunity. This was the first systemized, population-based survey of the seroprevalence of HAV antibodies in urban and rural inhabitants of Sari, Mazandaran province. Serum from 1034 individuals aged 1-25 years in 2007 were tested for anti-HAV IgG antibody using a commercial enzyme immunoassay kit. The overall seroprevalence was 38.9%. The lowest prevalence (5.2%) was among the younger age group (1-5 years) from urban areas and the highest prevalence (82.0%) in the older age group (15-25 years) from rural areas. Seropositivity was significantly higher at higher age, among females and in rural areas. Sari is no longer classified as an area of high endemicity, and immunization against HAV may be needed in our population in the future. RÉSUMÉ La baisse de l'incidence de l'infection par le virus de l'hépatite A en République islamique d'Iran pourrait être en train d'affaiblir l'immunité naturelle de la population. Il s'agit de la première enquête systématique en population sur la séroprévalence des anticorps du virus de l'hépatite A chez les habitants des zones urbaines et rurales de Sari, dans la province de Mazandaran. Un échantillon de sérum prélevé chez 1034 personnes âgées d'un an à 25 ans en 2007 a été analysé à la recherche d'anticorps IgG du virus de l'hépatite A à l'aide d'une trousse commerciale pour épreuve immuno-enzymatique. La séroprévalence globale était de 38,9 %. La prévalence la plus faible (5,2 %) a été observée dans la tranche d'âge la plus jeune (1 à 5 ans) dans les zones urbaines et la prévalence la plus élevée (82,0 %) dans la tranche d'âge la plus âgée (15 à 25 ans) dans les zones rurales. La séropositivité était significativement plus élevée à un âge plus avancé, chez les femmes et dans les zones rurales. Sari n'est plus classée comme une zone à forte endémicité, et la vaccination contre le virus de l'hépatite A pourrait s'avérer nécessaire dans notre population à l'avenir.‫املتوسط‬ ‫لرشق‬ ‫الصحية‬ ‫املجلة‬ ‫عرش‬ ‫السابع‬ ‫املجلد‬ ‫العارش‬ ‫العدد‬ 755

Parapoxvirus infection in sheep and goats is usually referred to as contagious pustular dermatitis/ecthyma, or orf, and the corresponding human infection is referred to as orf. In humans, after a brief incubation period of 3 to 5 days, lesions begin as pruritic erythematous macules and then rise to form papules, often with a target appearance. Lesions become nodular or vesicular, and orf lesions often ulcerate after 14 to 21 days. Erythema multiforme and bullous pemphigoid have been associated with parapoxvirus infections and they are rare complications of orf disease. In this case report, we presented a 36-year-old woman with history of contact with sheep, developing a typical orf lesion that is complicated with erythema multiforme and bullous pemphigoid-like eruptions.

Cryptococcal meningitis is the most important opportunistic fungal infection with a high mortality in HIV-patients in less developed regions. Here, we report a case of cryptococcal meningitis in a 49-year-old HIV-positive female due to Cryptococcus neoformans (serotype A, mating-type alpha, genotype AFLP1/VNI) in Sari, Iran. In vitro antifungal susceptibility tests showed MICs of isavuconazole (0.016 μg ml(-1) ), voriconazole (0.031 μg ml(-1) ), posaconazole (0.031 μg ml(-1) ), itraconazole (0.063 μg ml(-1) ), amphotericin B (0.125 μg ml(-1) ) and fluconazole (8 μg ml(-1) ). Despite immediate antifungal therapy, the patient died 4 days later due to respiratory failure. Cryptococcal infections have been infrequently reported from Iran and therefore we analysed all published cases of cryptococcosis in Iran since the first reported case from 1969.

Background:Thrombocytopenia is associated with a bad prognosis in Leptospirosis.Objectives:We investigated the effect of corticosteroids to improve thrombocytopenia due to leptospirosis.Patients and Methods:In a clinical trial, all patients admitted with leptospirosis in Razi Hospital of Ghaemshahr, north of Iran were enrolled in a 2-year study. Totally, 56 patients with moderate to severe thrombocytopenia were randomized to control and treatment groups. The treatment group received corticosteroid (prednisolone 1 mg/kg/day for maximum one week) in addition to the standard antibiotic therapy.Results:There was no significant difference regarding age and gender between the two groups (P = 0.254, P = 0.789, respectively). The mean duration to improve thrombocytopenia was 4.41 ± 0.197 days in the treatment group and 5.72 ± 0.318 days in the control group, which was significantly different (P = 0.003). Duration of hospitalization in the treatment group was 5.24 ± 0.244 days and 6.23 ± 0.329 days in the control group, which was significantly different (P = 0.028). The two groups had no significant difference regarding mortality, intubation, level of platelet, duration of ICU admission and pulmonary, renal or hepatic involvement.Conclusions:Corticosteroid therapy decreased the length of hospitalization only in severe subgroup thrombocytopenia, but not in the moderate subgroup.

Background: Leptospirosis has a high mortality rate in north of Iran. Objectives: The current study aimed to assess the clinical and laboratory findings and their possible relationship with complications of leptospirosis. Patients and Methods: The current retrospective cross-sectional study, by reviewing hospital records, evaluated patients with leptospirosis hospitalized in Razi Hospital (the therapeutic center of infectious diseases in Qaemshahr city, in the North of Iran) from 2008 to 2012. The diagnosis was confirmed by increasing the antibody titer in immunofluorescence assay (IFA) or microscopic agglutination test (MAT). Results: Out of 634 patients, 61 subjects (9.62%) had significant complications including: acute renal failure, alveolar hemorrhage, ARDS, clotting disorders, pancreatitis, gastrointestinal bleeding and intracranial bleeding; Age, jaundice, renal and pulmonary involvement (oliguria and anuria), hypotension, leukocytosis, thrombocytopenia, hyponatremia, elevated bilirubin, alanine aminotransferase (ALT), Creatine phosphokinase (CPK), Lactate dehydrogenase (LDH) and erythrocyte sedimentation rate (ESR) increased the risk of leptospirosis complication. Conclusions: Renal involvement is one of the leading causes of death in such patients.

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