Publications by authors named "Alireza Emami Naeini"

17 Publications

  • Page 1 of 1

Prevalence of herpes simplex virus-1 in hospitalized adult patients with clinical diagnosis of meningoencephalitis using real-time polymerase chain reaction: A single-center, cross-sectional study.

J Res Med Sci 2019 31;24. Epub 2019 Jan 31.

Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Early diagnosis of herpes simplex virus-1 (HSV-1) meningoencephalitis is very important because antiviral therapy significantly decreases mortality and morbidity. Polymerase chain reaction (PCR) is a reliable method with high sensitivity and specificity in detection of HSV-1. The aim of this study is to determine the prevalence of HSV-1 in patients with diagnosis of meningoencephalitis using real-time PCR.

Materials And Methods: The cerebrospinal fluid samples were collected from 126 patients with clinical diagnosis of HSV-1 meningoencephalitis in Alzahra Referral Hospital in Isfahan, Iran. After deoxyribonucleic acid (DNA) extraction, real-time PCR was performed by fluorescence resonance energy transfer assay and participants underwent brain magnetic resonance imaging, as well.

Results: Among 126 patients, 68.3% were male and 31.7% were female. The mean age of the participants was 41.96 ± 22.36 years. Most of the participants were in the age group of 20-29 years. Three patients (2.4%) had positive and 123 patients (97.6%) had negative HSV-1 DNA test. Among three positive cases, two were in the age group of 20-29 years and one in the age group of ≥80 years. No HSV-2 DNA was detected.

Conclusion: According to the estimated prevalence of HSV-1 meningoencephalitis in the current study, it seems that the prevalence of HSV-1 meningoencephalitis is not too high in our community; therefore, initial empiric acyclovir therapy is frequently overused.
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http://dx.doi.org/10.4103/jrms.JRMS_370_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383335PMC
January 2019

Invasive Fungal Infection in Febrile Patients with Hematologic Malignancies Undergoing Chemotherapy in Iran.

Endocr Metab Immune Disord Drug Targets 2019 ;19(3):302-307

Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Patients with hematological malignancies undergoing cytotoxic chemotherapy are susceptible to develop invasive fungal infections particularly Aspergillus and Candida spp. Early detection of these infections is required to start immediate antifungal therapy and increase the survival of these patients.

Method: Our study included consecutive patients of any age with hematologic malignancies who were hospitalized to receive chemotherapy and suffer from persistent fever (rectal temperature >38.5°C) for more than 5 days despite receiving broad-spectrum antibiotics. A whole blood sample was taken and sent for blood culture. PCR was also conducted for Aspergillus and Candida species.

Results: One hundred and two patients were investigated according to the inclusion criteria. The most common hematologic malignancy was AML affecting 38 patients (37.2%). Six patients were diagnosed with invasive fungal infections (A. fumigatus n=3, C. albicans n=2, A. flavus n=1) by PCR (5.8%) while blood culture showed fungus only in 1 patient. Three more cases were known as probable IFI since they responded to antifungal therapy but the PCR result was negative for them. AML was the most prevalent malignancy in IFI patients (83.3%) and odds ratio for severing neutropenia was 21.5. Odds for each of the baseline characteristics of patients including gender, age>60, diabetes mellitus, previous IFI, history of using more than 3 antibiotics, antifungal prophylaxis, episodes of chemotherapy> 8 and chemotherapy regimen of daunarubicin+cytarabine were calculated.

Conclusion: We found that multiplex real-time PCR assay is more accurate than blood culture in detecting fungal species and the results are prepared sooner. Among all factors, the only type of cancer (AML) and severe neutropenia, were found to be risk factors for the development of fungal infections in all hematologic cancer patients and previous IFI was a risk factor only AML patients.
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http://dx.doi.org/10.2174/1871530319666190211163245DOI Listing
August 2019

Prevalence of Sexually Transmitted Infections and Their Risk Factors among Female Sex Workers in Isfahan, Iran: A Cross-Sectional Study.

J Int Assoc Provid AIDS Care 2017 Nov/Dec;16(6):608-614. Epub 2017 Oct 11.

1 Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Objectives: Female sex workers (FSWs) are at high risk of sexually transmitted infections (STIs) and form a core group to facilitate STI spreading. We aimed to estimate the prevalence of STIs among FSWs who attended Female Harm Reduction Center of Isfahan, Iran, and to determine the association between risky behaviors and STIs.

Study Design: In a cross-sectional study, 99 FSWs were recruited and interviewed about demographic characteristics and risky behaviors. A trained midwife examined FSWs for genital ulcer, abnormal vaginal discharge, and cervicitis. Urine and genital specimens were collected and real-time polymerase chain reaction was performed to diagnose Neisseria gonorrhoeae, human papilloma virus (HPV), and Trichomonas Vaginalis. Data were analyzed via χ test and logistic regression in StataCorp software (version 11) with 95% confidence interval.

Results: Totally, 84.9% of FSWs reported STI symptoms, while 12.1% of them were infected with N gonorrhoeae, HPV, or T vaginalis. Human papilloma virus and gonorrhea prevalence rates were 5.7% and 8% in FSWs with STI-associated symptoms. Sexually transmitted infections showed significant association with duration of prostitution (odds ratio [OR] = 1.009 [95% confidence interval [95% CI: 1.004-1.01]; OR = 1.01 [95% CI: 1.00-1.01]) and condom usage (OR = 0.11 [95% CI: 0.012-0.98]; OR = 0.04 [95% CI: 0.005-0.33]).

Conclusion: Due to the literature gap on the Iranian FSWs' sexual health and the intense stigma around this subject, in Iran, our results would be useful for developing an efficient intervention program. The prevalence of STIs in Isfahan FSWs can be controlled with programs such as consistent condom use and STI treatment. In addition, as just one-tenth of FSWs with an STI symptom were positive for an STI, symptomatic diagnosis of STIs might be insufficient.
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http://dx.doi.org/10.1177/2325957417732836DOI Listing
September 2018

Recurrent Vulvovaginal Candidiasis: Could It Be Related to Cell-Mediated Immunity Defect in Response to Candida Antigen?

Int J Fertil Steril 2017 Oct 27;11(3):134-141. Epub 2017 Aug 27.

Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address:

Background: Recurrent vulvovaginal candidiasis (RVVC) is a common cause of morbidity affecting millions of women worldwide. Patients with RVVC are thought to have an underlying immunologic defect. This study has been established to evaluate cell-mediated immunity defect in response to candida antigen in RVVC cases.

Materials And Methods: Our cross-sectional study was performed in 3 groups of RVVC patients (cases), healthy individuals (control I) and known cases of chronic mucocutaneous candidiasis (CMC) (control II). Patients who met the inclusion criteria of RVVC were selected consecutively and were allocated in the case group. Peripheral blood mononuclear cells were isolated and labeled with CFSE and proliferation rate was measured in exposure to candida antigen via flow cytometry.

Results: T lymphocyte proliferation in response to candida was significantly lower in RVVC cases (n=24) and CMC patients (n=7) compared to healthy individuals (n=20, <0.001), but no statistically significant difference was seen between cases and control II group (P>0.05). Family history of primary immunodeficiency diseases (PID) differed significantly among groups (P=0.01), RVVC patients has family history of PID more than control I (29.2 vs. 0%, P=0.008) but not statistically different from CMC patients (29.2 vs. 42.9%, P>0.05). Prevalence of atopy was greater in RVVC cases compared to healthy individuals (41.3 vs. 15%, P=0.054). Lymphoproliferative activity and vaginal symptoms were significantly different among RVVC cases with and without allergy (P=0.01, P=0.02).

Conclusion: Our findings revealed that T cells do not actively proliferate in response to Candida antigen in some RVVC cases. So it is concluded that patients with cell-mediated immunity defect are more susceptible to recurrent fungal infections of vulva and vagina. Nonetheless, some other cases of RVVC showed normal function of T cells. Further evaluations showed that these patients suffer from atopy. It is hypothesized that higher frequency of VVC in patients with history of atopy might be due to allergic response in mucocutaneous membranes rather than a functional impairment in immune system components.
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http://dx.doi.org/10.22074/ijfs.2017.4883DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5582140PMC
October 2017

Does working in hospital increases seroprevalence and carrier state against Bordetella pertussis?

Adv Biomed Res 2015 28;4:194. Epub 2015 Sep 28.

Department of Epidemiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Health care environments have been the setting for a number of pertussis outbreaks. Immunity after vaccination wanes overtime leading to a growing population of susceptible adolescents and adults. A number of pertussis outbreaks have occurred in hospitals resulting in transmission to health care workers (HCWs), and other patients. The aim of this study was to assess immunity status of a group of basic medical students and interns who worked in hospitals for about 4 years.

Materials And Methods: In a cross-sectional study, we measured the serum antibody titer of cases by enzyme-linked immunosorbent assay test. All 70 subjects have received pertussis vaccine in the routine childhood vaccination schedule. All cases were healthy and had no symptoms of any respiratory diseases. We also obtained a pharyngeal culture on Bordet-Gengou Agar for isolating Bordetella pertussis.

Results: The results of B. pertussis pharyngeal culture was positive for 5 (7.1%) cases and negative for 65 (92.9%). The IgM, IgA, and IgG serum antibody was positive in 1.4%, 7.1%, and 11.4% of cases, respectively. The mean age of cases had no significant effect on serum antibody titers (P = 0.23).

Conclusions: This study showed that majority of cases do not have protective serum antibody against B. pertussis. Working in hospitals does not affect seroprevalence and carrier state of B. pertussis. Immunization schedules that include no booster doses are at increased risk of pertussis. Due to the importance of the transmission in health care settings, vaccination of HCWs is a priority.
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http://dx.doi.org/10.4103/2277-9175.166155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617007PMC
November 2015

A female with positive serum nontreponemal tests.

J Res Med Sci 2015 Apr;20(4):422

Department of Infectious and Tropical Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4468463PMC
April 2015

Acute flaccid paralysis surveillance: A 6 years study, Isfahan, Iran.

Adv Biomed Res 2015 11;4:99. Epub 2015 May 11.

Department of Infectious Diseases Specialist, Health Care Center, Isfahan, Iran.

Background: Poliomyelitis is still an endemic disease in many areas of the world including Africa and South Asia. Iran is polio free since 2001. However, due to endemicity of polio in neighboring countries of Iran, the risk of polio importation and re-emergence of wild polio virus is high. Case definition through surveillance system is a well-defined method for maintenance of polio eradication in polio free countries.

Methods: In a cross-sectional survey from 2007 to 2013, we reviewed all the records of under 15 years old patients reported to Acute Flaccid Paralysis Committee (AFPC) in Isfahan province, Iran. All cases were visited by members of the AFPC. Three stool samples were collected from each reported case within 2 weeks of onset of paralysis and sent to National Polio Laboratory in Tehran, Iran, for poliovirus isolation. Data were analyzed by SSPS software (version 22). Student's t-test and Chi-square was used to compare variables. Statistical significance level was set at P < 0.05.

Results: In this 6-year period 85 cases were analyzed, 54 patients were male (63.5%) and 31 were female (36.5%). The mean age of patients was 5.7 ± 3.9 years. The most common cause of paralysis among these patients was Guillian-Barré syndrome (83.5%). We did not found any poliomyelitis caused by wild polio virus. Only one case of vaccine associated poliomyelitis was reported.

Conclusion: Since 1992, Iran has a routine and high percent coverage of polio vaccination program for infants (>94%), with six doses of oral polio vaccine (OPV). Accurate surveillance for poliomyelitis is essential for continuing eradication.
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http://dx.doi.org/10.4103/2277-9175.156670DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434443PMC
May 2015

Comparing the APACHE II score and IBM-10 score for predicting mortality in patients with ventilator-associated pneumonia.

Adv Biomed Res 2015 13;4:47. Epub 2015 Feb 13.

Department of Infectious and Tropical Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: VAP is defined as pneumonia in patients who use ventilators. The acute physiology and chronic health evaluation (APACHE II) scoring system was originally developed for predicting mortality in patients who were admitted to the intensive care unit. Due to the complexity, a simpler score called IBMP-10 was developed. We designed the study to confirm and further investigate these two methods.

Materials And Methods: This cross-sectional and analysis-descriptive study was done at the moment of VAP diagnosis on 60 patients in intensive care units. APACHE II and the IBMP-10 scores were calculated. ROC curves were generated to compare the new prediction rule with the APACHE II score. Results were reported as adjusted odds ratios with 95% confidence intervals (CIs). Analyses were performed using SPSS, version 20 and P values of 0.05 were considered to be statistically significant.

Results: APACHE II Score means (P < 0.001) and IBMP-10 score (P < 0.001) means had significant increase in Non-survivor patient than in patients who survived. APACHE II can be used as a good prediction measure for mortality rate. In IBMP-10 method, specificity and PPV were greater than APACHE II, but in mc-nemar test, there was no significant difference between the two methods (P = 0.55). Both prediction rules had high NPV. In our study, survivors' prediction value in APACHE II was 46.7%, and in IBMP-10, it was 46.7%.

Conclusion: IBMP-10, compared to APACHE II, has greater sensitivity, specificity, and AUC to predict mortality. So the consequence of the use of IBMP-10 was better than APACHE II.
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http://dx.doi.org/10.4103/2277-9175.151419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4358029PMC
March 2015

The prevalence of isolated hepatitis B core antibody and its related risk factors among male injected drug users in Isfahan prisons.

Adv Biomed Res 2015 30;4:17. Epub 2015 Jan 30.

Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The prevalence of isolated hepatitis B core antibody (anti-HBc) varies between 1% and 30% in different populations. Isolated anti-HBc-positive patients who suffer from occult hepatitis B virus (HBV) infection have the potential to transmit HBV infection. So isolated anti-HBc screening is a valuable tool to prevent HBV transmission. Considering the importance of isolated anti-HBc screening and high prevalence of HBV among injected drug users (IDU) prisoners, we designed this study to evaluate the isolated anti-HBc positivity among inmates with the history of IDU in our area.

Materials And Methods: We did this cross-sectional study from September 2009 to March 2010 among volunteer male IDU prisoners in Isfahan. Blood samples were taken from all of subjects and tested for HBV markers. Then a questionnaire containing socio-demographic, drug histories and high risk behaviors information was completed for all participants. Data analysis was done utilizing univariate analysis and multiple logistic regressions. A P < 0.05 was considered significant.

Results: Totally 970 male IDU prisoners (mean age 32.6 ± 8.1) were included in our study. The prevalence of isolated HBc Ab was 4.5%. Isolated anti-HBc significantly was related to tooth filling (OR: 2.62, CI: 1.20-7.14) and imprisonment (OR: 3.95, CI: 1.39-11.18). We couldn't find any relationship between isolated anti-HBc positivity and addiction duration, incarceration frequency, recent incarceration duration or number of injection per month.

Conclusion: For screening high risk groups in parallel with hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb) and other viral markers, maybe it is better to check HBcAb too, because isolated HBcAb-positive patients may have occult hepatitis B infection which could transfer the infection to others.
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http://dx.doi.org/10.4103/2277-9175.148675DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4333428PMC
February 2015

Immunocompromised patients: Review of the most common infections happened in 446 hospitalized patients.

J Res Med Sci 2014 Mar;19(Suppl 1):S71-3

Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Immunodeficiency is a heterogenous group of diseases affecting different components of the immune system. Patterns of infection, etiology and organ involvement are not similar in this risky population. This study was conducted to determine the prevalence of congenital and acquiring immunodeficiencies and also recognizing the most common infections and affected organs.

Materials And Methods: In a retrospective, cross-sectional survey, during 2006-2012, we reviewed all hospital records with any kind of immunodeficiency admitted in, all departments of university referral hospital, Isfahan, Iran.

Results: VARIOUS IMMUNODEFICIENCIES, SORTED BY PREVALENCE, WERE AS BELOW: Primary immunodeficiency diseases (PIDs) 122 (27.4%), lymphohematogenous malignancy (LHM) 105 (23.5%), solid cancer 56 (12.6%), human immunodeficiency virus/acquired immunodeficiency syndrome 64 (14.5%), non-cytotoxic immunosuppresion 94 (21%), and splenectomy 5 (1.2%). Common sources of infection were blood, lungs and buccal cavity.

Conclusion: The most frequent type of immunodeficiency was PIDs and LHM. Infection continues to be a major problem in all variety of immunodeficiency.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078380PMC
March 2014

Prevalence of transfusion transmitted virus infection in hemodialysis patients and injection drug users compared to healthy blood donors in isfahan, iran.

Gastroenterol Res Pract 2012 19;2012:671927. Epub 2012 Nov 19.

Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Introduction. The pathogenicity and transmission routes of Transfusion Transmitted Virus (TTV) remain unclear. The aim of this study was to determine the prevalence of TTV in hemodialysis patients, injecting drug users (IDUs), and healthy blood donors, in Isfahan, Iran. Method. In a case-control study, a total of 108 subjects were put into three groups namely Group I, 36 hemodialysis patients; Group II, 36 IDUs; and Group III, 36 healthy blood donors as the control group. A 5 ml blood sample was collected from each subject in an EDTA-containing tube. Samples were tested for TTV DNA by means of real-time polymerase chain reaction (PCR). Results. The mean age was 38.7 ± 14.7 years. Seventy-one subjects (66%) were male. Of the108 cases, 30 (27.8%) were TTV positive and 78 (72.2%) were TTV negative. The prevalence of TTV in IDUs [21 (58%)] was significantly higher than in the other groups [group I: 6 (17 %) and group III: 3 (8%)] (P < 0.0001). Conclusion. The prevalence of TTV in IDUs is significantly higher than in both hemodialysis patients and general population in Isfahan, Iran. It seems necessary to take serious measures to reduce the risk of TTV transmission to IDUs' close contacts and health care providers.
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http://dx.doi.org/10.1155/2012/671927DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3507261PMC
December 2012

Clinical features of novel 2009 influenza A (H1N1) infection in Isfahan, Iran.

J Res Med Sci 2011 Dec;16(12):1550-4

Associate Professor, Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: During August 2009, novel H1N1 influenza virus began causing illness in Isfahan. Since rates of hospitalization and mortality due to the disease have varied widely in different countries, we described the clinical, radiologic, and demographic features of H1N1 hospitalized patients in a hospital in Isfahan.

Methods: This cross-sectional study was conducted in Alzahra Hospital during September 2009 to February 2010. Totally, 216 patients with confirmed, probable, or suspected cases of 2009 influenza A (H1N1) were admitted.

Results: Most patients were women (50.5%). Mean age of patients was 26.6 ± 19.5 years. The most common complains on admission were respiratory symptoms (91.6%, n= 198), fever (88.4%, n = 191), myalgia (65.7%, n = 142). In addition, 120 patients (56%) had at least one underlying medical disorder. Thirty-six patients (16.7%) died. Mortality was higher in children under 5 years old (10/36, 10%) and female cases (63.9% of died patients). Predicting variables affecting mortality were intensive care unit (ICU) admission and procalcitonin (PCT) > 0.5. Antiviral treatment was prescribed for 200 (92.5%) of the 216 patients.

Conclusions: Based on the findings of the present study, novel H1N1 influenza is highly prevalent among the youth. Moreover, it causes a relatively high morbidity rate. Therefore, people need to be encouraged to have vaccination against 2009 H1N1. Early diagnosis and treatment is related to less admission and shorter duration of hospitalization.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3434895PMC
December 2011

Visceral leishmaniasis in a patient with cutaneous lesions, negative Leishman-Donovan bodies and immunological test: A case report.

J Res Med Sci 2011 Nov;16(11):1507-10

Associate Professor, Infectious Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

We report a case of visceral leishmaniasis (VL) in a patient from Shush in Iran with cutaneous lesions, negative for Leishman-Donovan bodies, enlarged spleen filled by leishmania protozoa and negative immunological test. The patient was a 26-year-old male, who attended hospital with fever and two deep purulent lesions on the distal part of his left leg. On physical examination, the patient had splenomegaly. Laboratory results were as follows: pancytopenia, positive C-reactive protein (CRP), elevated erythrocyte sedimentation rate (ESR) and lactate dehydrogenase (LDH) levels .The necessary treatment was administrated to the patient. Biopsy of lesion for Leishman-Donovan body was negative. In addition, indirect fluorescent antibody (IFA) screening for leishmaniasis was negative. Diagnostic splenectomy was performed which pathological exploration showed a bulk of leishmania protozoa in patient's spleen. Twenty days later, this patient expired.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3430071PMC
November 2011

Thoracic computerized tomographic (CT) findings in 2009 influenza A (H1N1) virus infection in Isfahan, Iran.

J Res Med Sci 2011 May;16(5):591-7

Isfahan Infectious Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Pandemic 2009 H1N1 influenza A virus arrived at Isfahan in August 2009. The virus is still circulating in the world. The abnormal thoracic computerized tomographic (CT) scan findings vary widely among the studies of 2009 H1N1 influenza. We evaluated the thoracic CT findings in patients with 2009 H1N1 virus infection to describe findings compared to previously reported findings, and to suggest patterns that may be suggestive for 2009 influenza A (H1N1) in an appropriate clinical setting.

Methods: Retrospectively, the archive of all patients with a diagnosis of 2009 H1N1 influenza A were reviewed, in Al-Zahra Hospital in Isfahan, central Iran, between September 23(rd) 2009 to February 20(th) 2010. Out of 216 patients with confirmed 2009 influenza A (H1N1) virus, 26 cases with abnormal CT were enrolled in the study. Radiologic findings were characterized by the type and pattern of opacities and zonal distribution.

Results: Patchy infiltration (34.6%), lobar consolidation (30.8%), and interstitial infiltration (26.9%) with airbronchogram (38.5%) were the predominant findings in our patients. Bilateral distribution was seen in 80.8% of the patients. Only one patient (3.8%) showed ground-glass opacity, predominant radiographic finding in the previous reports and severe acute respiratory syndrome (SARS).

Conclusions: The most common thoracic CT findings in pandemic H1N1 were patchy infiltration, lobar consolidation, and interstitial infiltration with airbronchogram and bilateral distribution. While these findings can be associated with other infections; they may be suggestive to 2009 influenza A (H1N1) in the appropriate clinical setting. Various radiographic patterns can be seen in thoracic CT scans of the influenza patients. Imaging findings are nonspecific.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3214369PMC
May 2011

HIV associated thrombocytopenia, misdiagnosed as thrombotic thrombocytopenic purpura: a case report.

Cases J 2009 Oct 29;2:175. Epub 2009 Oct 29.

Department of Infectious and Tropical Diseases, Isfahan University of Medical Sciences, Isfahan, Iran.

Introduction: Thrombocytopenia is one of the protean hematological manifestations of infection by human immunodeficiency virus. We present a case where diagnosis of human immunodeficiency virus infection was delayed because thrombocytopenia was the only presenting feature.

Case Presentation: A female presented with chief complaint of fever, productive coughs weight loss and nocturnal sweating; was detected to have thrombocytopenia on a complete blood count, performed five months ago. Her other clinical chemistry and hematological investigations were normal. She was previously diagnosed as having TTP, and had received 55 sessions of plasma exchange before presenting to us. At this time she was detected to be HIV positive, had CD4+ counts of 26/mm3, treated with antiretroviral drugs and Cotrimoxazol, and discharged asymptomatically.

Conclusion: HIV should be suspected in all cases of unexplained thrombocytopenia.
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http://dx.doi.org/10.1186/1757-1626-2-175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2783131PMC
October 2009

Rapidly evolving purpuric lesions to massive hemorrhagic bullae, with rapid improvement by Prednisolone: as a coetaneous manifestation of Systemic Lupus Erythematosus: a case report.

Cases J 2008 Aug 8;1(1):79. Epub 2008 Aug 8.

Assistant Professor, Department of Infectious and Tropical Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Systemic lupus Erythematosus is a chronic autodestructive disease, with loss of immune tolerance to nucleic acid and other cross reactive antigens. Despite of the numerous studies, the presence of some new manifestations indicates the greater proportion of unknown data.

Case Presentation: Our case, is a 26-year-old female, by the chief complaint of headache, vomiting, fever and arthralgia. Some hemorrhagic ulcers in her mouth with fulminant pethechia/purpura on her limbs and buttocks were prominent. On admission, she was in hypotensive state. By the clinical suspicion to meningococcal septicemia, lumbar puncture was performed, and antibiotic therapy was started. Cerebrospinal fluid was normal. Suddenly, on the 3rd day of admission, hemorrhagic bullae were evolved from those purpuric lesions. Leukocytosis, immune hemolytic anemia, thrombocytopenia and high antinuclear antibody/double stranded DNA level and hypocomplemania were present simultaneously. In skin biopsy, immune complex deposition in dermoepidermal junction was seen. The diagnosis of Systemic lupus Erythematosus was made. The patient responded well to corticosteroid therapy.

Conclusion: Coetaneous manifestations are very common in Systemic lupus Erythematosus, and help the physician making differential diagnoses and proper diagnosis. The rapidly evolving hemorrhagic bulla from primary purpuric lesions, with rapid response to Prednisolone, is a rare manifestation of Systemic lupus Erythematosus, which should be considered in such a disease setting.
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http://dx.doi.org/10.1186/1757-1626-1-79DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2526068PMC
August 2008

An unusual presentation of brucellosis, involving multiple organ systems, with low agglutinating titers: a case report.

J Med Case Rep 2007 Jul 21;1:53. Epub 2007 Jul 21.

Department of Infectious and Tropical Diseases, Alzahra University Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Brucellosis is a multi-system disease that may present with a broad spectrum of clinical manifestations. While hepatic involvement in brucellosis is not rare, it may rarely involve the kidney or display with cardiac manifestations. Central nervous system involvement in brucellosis sometimes can cause demyelinating syndromes. Here we present a case of brucella hepatitis, myocarditis, acute disseminated encephalomyelitis, and renal failure.

Case Presentation: A 26-year-old man presented with fever, ataxia, and dysarthria. He was a shepherd and gave a history of low grade fever, chilly sensation, cold sweating, loss of appetite, arthralgia and 10 Kg weight loss during the previous 3 months. He had a body temperature of 39 degrees C at the time of admission. On laboratory tests he had elevated level of liver enzymes, blood urea nitrogen, Creatinine, Creatine phosphokinase (MB), and moderate proteinuria. He also had abnormal echocardiography and brain MRI. Enzyme-linked immunosorbent assay for IgG and IgM was negative. Standard tube agglutination test (STAT) and 2-mercaptoethanol (2-ME) titers were 1:80 and 1:40 respectively. Finally he was diagnosed with brucellosis by positive blood culture and the polymerase chain reaction for Brucella mellitensis.

Conclusion: In endemic areas clinicians should consider brucellosis in any unusual presentation involving multiple organ systems, even if serology is inconclusive. In endemic areas low STAT and 2-ME titers should be considered as an indication of brucellosis and in these cases additional testing is recommended to rule out brucellosis.
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http://dx.doi.org/10.1186/1752-1947-1-53DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2072951PMC
July 2007