Cutaneous anthrax associated with facial palsy:A case report

Rationale:Anthrax is a zoonotic disease caused by spores of Gram-positive Bacillus anthracis,commonly affects mammals and in rare cases birds.Human infection occurs accidentally through direct or indirect exposure to animal or their products.Patient concerns:A 63-year-old man was referred to our hospital with flu-like symptoms and severe swelling and redness on the face,the roof of the mouth,and nostrils.He had a history of direct contact with a slaughtered mutton two days ago.He declared controlled diabetes,hypertension,hypertriglyceridemia,and heart failure.Lungs were normal in lung high resolution CT,but multiple lymphadenopathies were seen in the mediastinum.Bilateral axillary lymphadenopathy with a maximum sad of 23 mm and pleural effusion on the right side was observed.CT scan of the nose and sinuses showed an increased density of polyps in the left maxillary sinus.Slides were prepared from the patient's lesions and examined under a light microscope.Bacillus shape with Streptococcus bacteria was seen.Diagnosis:Anthrax co-infection with herpes systemic virus and Streptococcus pyogenes.Interventions:Multidrug therapy started with appropriate antibiotics.Outcomes:The symptoms of the patient gradually disappeared.The patient was discharged without any complications.Lessons:Cutaneous anthrax in endemic areas in patients with skin presentations and a history of contact with infected animals or products should be considered a differential diagnosis.This is more important in mixed infections where the main cause of the problem may be hidden.

Fatal case of human rabies infection: A case report

Rationale:Rabies,as an acute viral disease of the mammal’s central nervous system(CNS),with a high mortality rate,is transmitted to humans through the bite of a rabid animals,especially canine and feline.Patient concerns:An Afghan man,aged 50 years was bitten by a fox in a farm around the Qom-Tehran road,Central Iran in 2018.The patient visited the doctor after the bite,however the period between incidence and hospital visit was not established and no indication was given whether the bite site injury was thoroughly washed.The patient was neither referred to the health center for vaccination(post-exposure prophylaxis)nor an effective therapeutic measures was applied.Forty-five days post-exposure,the patient presented with symptoms such as headache,fever,tingling and burning sensation and was referred to the Centers for Disease Control and Prevention(CDC)unit of Qom Provincial Health Center.Diagnosis:Rabies infection.Interventions:Forty-five days after the animal bite,in CDC of Qom Health Center,he received rabies post-exposure prophylaxis treatment and was referred to an infectious diseases physician.Based on the history of animal bites,the patient was classified as probable case of rabies.The clinical symptoms of rabies appeared in patient after hospitalization.Outcomes:Ultimately the patient died in hospital 4 days after hospitalization(50 days after the occurrence of animal bite).After referring the patient to the CDC,the patient’s saliva(0.5-1 mL)was sampled three times every 3-6 hours and tested by PCR.Human rabies was confirmed by Department of Virology in the Pasteur Institute of Iran.Lessons:Physicians and clinicians have responsibilities to be critical in observations and take prompt actions in case of animal bites,as rabies usually develops within 7 to 14 days,and delayed intervention after the onset of symptoms,vaccine and serum injections cannot lead to the survival of the patient.

Incidence of Enterobius vermicularis in acute appendicitis: A systematic review and meta-analysis

Objective: To evaluate the incidence of Enterobius vermicularis (E. vermicularis) in appendectomies in Iran from 1993 to 2018 . Methods: Data were systematically collected on the electronic databases including PubMed, GoogleScholar, ScienceDirect, Scopus, Web of Science, Magiran, Irandoc (Bareket), IranMedex, and Scientific Information Database in English or Persian. Six articles including 29694 cases of appendicitis with 258 positive cases of infection withE. vermicularis were eligible to enter into this systematic review and meta-analysis. Results: The overall prevalence of E. vermicularis in appendicitis in Iran was 1% (95%CI=0.00-0.02) with the highest rate of 3% (95%CI=0.02-0.03) and lowest rate of 0% (95%CI=0.00-0.01). Conclusions: Prevalence of E. vermicularis infectionin appendicitis in Iran is low and has no statistically significant correlation with age and gender.

Distribution and ecological aspects of sand flies(Diptera:Psychodidae) species in Northeastern Iran

Objective:To determine both the distribution and the ecological characteristics of sand flies in Golestan Province,northeast of Iran in 2016.Methods:In this study,34 villages were selected based on their geographical conditions.Sticky paper traps were used for collecting the sand flies.Sampling was carried out in each of villages from May to November.In each village,60 traps for indoors and 60 for outdoors were monthly installed.The species of all collected sand flies were determined using approved morphological keys.Pearson coefficient correlation was used to find the relationship between the number of collected Phlebotomus papatasi from different villages and incidence rate of zoonotic cutaneous leishmaniasis as well as the number of positive cases of the disease.The altitude of the studied villages was extracted from digital elevation model of the area using GIS and vegetation cover density index of the province was extracted from Modis satellite imagery and distribution map of sand flies drown up.Results:Overall,5 428 sand flies were collected and identified,belonging to 18 species.Phlebotomus wenyoni was reported for the first time from the area in this study.The frequency of sand flies in the villages located in northeast of the Golestan province(the plateau area,lower altitude,arid and semi-arid climates,and lower vegetation cover density),were more than other villages in this province.There was a significant correlation between the number of collected Phlebotomus papatasi and incidence rate of the zoonotic cutaneous leishmaniasis cases in different villages(r=0.837,P=0.019) as well as the number of positive cases of the disease(r=0.688,P<0.001).Conclusions:In the northeaster areas of Golestan Province which is known as the endemic foci of zoonotic cutaneous leishmaniasis,the abundance of sand flies were more and the conditions for their growth and development were more appropriate.

Tick-borne pathogens in Iran:A meta-analysis

Objective:Different studies have been performed on the prevalence of tick-borne pathogens in different areas of Iran;however,as far as our knowledge,there is no regional meta-analysis available for consideration and estimation of tick species infected with different pathogens in Iran.Methods:In this review,among different databases,a total of 95 publications were included,and the infection of different tick species to different tick-borne pathogens was determined;furthermore,presence of pathogens(with 95%confidence intervals)in tick vectors was calculated separately for each province,using Comprehensive Meta-Analysis version 2(Biostat,USA).Results:Totally,among all 95 studies,5673 out of 33521 investigated ticks were positive according to different detection methods.Overall estimated presence of pathogens in tick vectors in Iran was 8.6%(95%CI 7.0%-10.6%,P<0.001).Of all 46 species of ticks in 10 genera in Iran,28 species in 9 genera,including Alveonasus,Argas,Boophilus,Dermacentor,Haemaphysalis,Hyalomma,Ixodes,Ornithodoros,and Rhipicephalus were infected with at least 20 pathogens in 10 genera including Aegyptianella,Anaplasma,Babesia,Borrelia,Brucella,Orthonairovirus[CrimeanCongo hemorrhagic fever virus(CCHFV)],Coxiella,Ehrlichia,Rickettsia and Theileria in 26 provinces of Iran.The presence of pathogens in ticks collected in western Iran was more than other regions.Hyalomma anatolicum(20.35%),Rhipicephalus sanguineus(15.00%),and Rhipicephalus bursa(14.08%)were the most prevalent infected ticks for different pathogens.In addition,most literatures were related to CCHFV and Theileria/Babesia spp.Conclusions:Public health and veterinary professionals should be aware of diagnosing possible diseases or outbreaks in vertebrates.

A review of Acanthamoeba keratitis in the Middle East and Iran

Acanthamoeba keratitis, a vision-threatening disease, is caused by a free-living amoeba of genus Acanthamoeba. Amoeba is widely distributed all around the world. Several cases of Acanthamoeba keratitis have been reported from the Middle East and Iran as well. The infection is mainly caused by inappropriate use of contact lens;therefore, it is more common among lens wearers. The number of reported cases worldwide is increasing annually due to the increasing number of contact lens wearers for medical or cosmetic reasons. It is known that early diagnosis and treatment can reduce consequent damages, while the delay in these processes will deteriorate the vision. Nowadays contact lens wearing, surgery and use of corticosteroids are known to predispose to Acanthamoeba keratitis, and it was also believed that trauma was the main cause. Increasing public knowledge about Acanthamoeba infection, inquiring the history of patients, clinical signs and laboratory findings can be helpful to early diagnosis and better treatment. Regardless of the increasing knowledge of diagnosis and treatment, this disease is still a challenge. Considering the long curative time, and insufficient efficacy of available treatments, it seems that the prevention is more important than the treatment. This review aimed to explain Acanthamoeba keratitis in the Middle East and Iran from the aspects of epidemiology, diagnosis, and therapeutic treatment.

Chest CT features in COVID-19 patients:A systematic review and meta-analysis

Objective:To derive the pooled estimate of chest computed tomography(CT)findings in coronavirus disease 2019(COVID-19)patients.Methods:A comprehensive systematic search was conducted according to the PRISMA checklist from January 2020 to September 2020 in electronic databases including PubMed,Google Scholar,and Scopus based on search terms in title and texts.Original descriptive studies with epidemiological parameters of interest were included into the systematic review and meta-analysis.Results:Totally 54 articles comprised of 4879 patients with a mean age of 49.05 years were eligible for this study.The pooled prevalence for abnormal CT images was 86.0%.Pooled prevalence for ground-glass opacity was 68.0%,71.0%for bilateral abnormalities,47.0%for mixed ground-glass opacity and consolidation and 29.0%for consolidation.In addition,64.0%of lesions were peripheral,and 12.0%were central while 28.0%were both central and peripheral.Furthermore,61.0%of lower lungs were involved,and 7.0%and 5.0%of the cases presented with pleural effusion and pericardial effusion,respectively.Besides,11%of the cases showed lymphadenopathy,and 37%had air broncho gram sign.The pooled prevalence of other chest CT findings ranged from 8.0%to 65.0%.Conclusions:Chest CT can be used as predictive tools for the detection of COVID-19 disease along with clinical manifestations and the RT-PCR method.