Development of a combined CMV-UL97 C592F and CMV-UL54 T503I resistance mutation during ganciclovir treatment in a kidney transplant recipient In CMV high-risk kidney transplant recipients (KTR), recommended antiviral human cytomegalovirus (CMV) treatment can lead to nephrotoxicity and antiviral resistance. In this case report, we report the development of a combined CMV-UL97 C592F and CMV UL54 T503I resistance mutation in a high-risk KTR most probably linked to the previous treatment with valganciclovir (valGCV) and ganciclovir (GCV). Routine CMV screening, in addition with testing of CMV immunity and applied stewardship programs for ganciclovir might have been helpful in preventing the development of these mutations in this patient.

Swine flu a seasonal pandemic, symptoms, diagnostics and prevention H1N1 often is cause of annual epidemics in world particularly during winters and is a seasonal pandemic that has been a cause of many deaths. The display of various strains of H1N1 always creates confrontation to public health and the scientific communities. The key behind the repeated epidemics is the transformation of the viruses to escape the immunity that is induced by former infection or vaccination. The pandemic was declared, by the WHO, as officially over in August 2010. The H1N1 virus has become a regular flu virus which occurs seasonally, and causes outbreaks in many areas of the world. This mini review discusses risk of this disease with pandemic potential globally, transmission, diagnostics and preventive measures to be taken by people and health institutes. A present it calls for alertness of the health systems worldwide and a need for active correlation between public and health institutes.

Influenza A virus and related secondary bacterial infections Influenza infection is considered to be a serious respiratory disease in human. Annually, epidemics or even pandemics give rise to the frequent antigenetic variations of virus surface receptors, throughout the world. Bacterial infections followed by influenza are the biggest medical concerns associated with elevated mortality rates. These high morbidity and mortality rates, have become a priority in terms of health. Likewise, economic aspects of the issue have special importance also. In the present study, several articles have been investigated with regards to main key words including influenza A, secondary bacterial infections and pandemics. Then, attempts have been made to summarize the information in concise figures (was graphically visualized) and tables in addition to main literature. Until this date, a number of influenza pandemics have taken place with varying morbidity and mortality rates because of secondary bacterial infections followed by influenza. However, the 1918 pandemic had the highest death rate recorded. According to investigative studies, Streptococcus pneumoniae and Staphylococcus aureus are the most common isolated bacteria in patients with secondary infections. Other bacteria, such as Haemophilus influenza, Streptococcus pyogenes, and to a lesser degree Legionella spp., are involved in these infections as well. Currently, it is known that various protease enzymes intensify the influenza virus infectivity. Another important aspect of influenza occurs in the Hajj pilgrimage season and many vaccines have been made to deal with its consequences. These vaccines decrement the mortality rate, however, some have minor side effects.

Investigating the presence of qacA/B and mecA genes in Staphylococcus aureus strains isolated from metro stations in Tehran city of Iran Objective: Staphylococcus aureus is responsible for a wide range of infections by invasion and toxin production in humans. The aim of this study was to investigate the presence of S. aureus at the surface environment of metro stations and the carriage of methicillin and quaternary ammonium compound (QAC) resistance genes. Materials and methods: Sampling was carried out in Tehran Metro from 2016 to 2017. One hundred samples were collected from metro wagons. The antibiotic susceptibility test was done with the disk diffusion test using cefoxitin, cefotaxime, cotrimoxazole, methicillin, and oxacillin antibiotics. Sensitivity to Deconex AF was measured by Broth dilution test. PCR technique was used to investigate the presence of mecA and qacA/B genes using specific primers. Results: Of the 40 samples isolated from the metro environment, resistance to cefoxitin was 2.5% (MRSA). The highest resistance rate was against amoxicillin (50%) and the lowest rate was against vancomycin and linezolid (0%). Also, 30% of the samples contained the qacA/B gene and 42.5% contained the mecA gene and 27.5% contained both genes. Forty percent of isolates had a minimum inhibitory concentration of 2.5 mg/ml and 40% had a MIC of 25 mg/ml. Conclusion: In this study, there was a close relationship between resistance to methicillin and resistance to QACs in S. aureus isolated from metro stations. It has also been shown that these isolates carry antibiotic resistance genes and are resistant to most common antibiotics used to eradicate these bacteria, such as third-generation cephalosporins, methicillin, and oxacillin, which are considered as serious warning to society.

Genotyping and diversity of virulence genes among Shigella sonnei isolated from children with diarrhoea Shigella sonnei, which has historically prevailed in industrialized countries, is currently undergoing an unprecedented expansion throughout the developing world. The harshness of shigellosis relies on certain virulence factors produced by the pathogen. Available information regarding virulence genes and epidemiological relatedness of S. sonnei strains in Iran is relatively scarce. In this study, 3540 stool specimens were obtained from children with diarrhoea in Tehran, Iran, from September 2016 through January 2018. PCR assays were performed to evaluate the presence of virulence genes among S. sonnei strains. The genetic relatedness of these strains was also assessed by multiple-locus variable number tandem repeat (VNTR) analysis (MLVA). A total of 50 S. sonnei strains were obtained, all of which harboured ipaH, sigA, and virA, whereas ial, invE, and sen were positive in 70% (n = 35), 62% (n = 31), and 54% (n = 27) of the strains, respectively. None of the S. sonnei strains carried set1A, set1B, and sat. The most frequent virulence profile was VP1 (positive for ipaH, ial, invE, sen, sigA, and virA), which was observed in 16 (32%) strains. Using MLVA, 12 genotypes were identified. According to the minimum spanning tree (MST) analysis, S. sonnei strains were grouped into three clonal complexes. CC1, which consisted of 44 (88%) isolates, was the largest clonal complex identified. No association was observed between virulence profiles and genotypes. Overall, it was shown that S. sonnei strains were virulent and clonally related. Furthermore, MLVA can be used as a helpful method for epidemiological investigations.

The immunomodulatory and antiallergic effects of human colonized probiotics The rate of allergy is increasing particularly among infants due to several factors reaching up to 30%. Several materials components have been implicated in the development and excessive activation of the immune system, acting as irritants and allergic agents. In several studies, in Mediterranean inhabitants with a specific diet, the prevalence of allergies in children was low, whereas dietary supplements in the Western and Mediterranean countries had a different role in the regulation of immune responses and in the reduction of allergic reactions. Probiotics have been associated with reduction of allergic reactions mostly by positive effect on T helper cells, regulatory T cells (Tregs), B cells and dendritic cells. Furthermore, probiotics existing in the human intestine can modulate the immune response and allergic reactions through downregulation of Th2-related responses (IgE, IL-4 and IL-5). They mostly exert anti-inflammatory and immunomodulatory properties by modulation of immune system components via hindering of various signaling pathways such as the NF-κB pathway, probably associated with changes in mitogen-activated protein kinases and pattern recognition receptors pathways. These microorganisms have also potential to inhibit the bacterial lipopolysaccharide attachment to the CD14 receptor, hence reducing the overall activation of NF-κB and proinflammatory cytokines production. Bifidobacterium and Lactobacillus species act through increase in proinflammatory (Th1) cytokines (INF-γ, IL-12, IL-13, TNF-α and also IL-4 and IL-10), dendritic cells, CD4+FoxP3+ T cells, GATA-3 and intestinal barrier maturation, whereas decrease the Th2-mediated cytokines, IgA, IgE, IgG1, IL-4, IL-5 and IL-6, IL-13, airway reactivity, pulmonary eosinophilia. Furthermore, Clostridium butyricum could act by improvement of anaphylaxis symptoms and increase of sIgA and CD4+ CD25+FoxP3Treg cells. In this review, we assessed the recent evidence that confirms the role of probiotics compounds as an important factor in the safety of homeostasis and the development of allergic reactions through a complex set of metabolites and the immune cells. The employment and application of probiotics combined with immunotherapy approaches can be possibly effective in reducing allergic reactions and related therapeutic costs.

Photodynamic therapy of infection in burn patients Burns are one of the very ordinary and destructive forms of trauma. Patients with significant thermal injury require urgent specialized care for minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. Photodynamic therapy (PDT) was discovered over 100 years ago by observing the killing of microorganisms when harmless dyes and visible light were combined in vitro. Since then it has primarily been developed as a treatment for cancer, ophthalmologic disorders and in dermatology. Multidrug-resistant Acinetobacter baumannii infections and Pseudomonas aeruginosa is considered one of the most important pathogens that represent life-threatening risk in nosocomial environments, mainly in patients with severe burns. Antimicrobial PDT is an effective and useful method to kill bacteria. The advantages of PDT include the rapid effect on bacteria and the lack of drug resistance to this system. The disadvantages of this method can be noted loses antimicrobial activity when the light source turns off and less than perfect selectivity for microbial cells over host tissue. Available data from different studies retrieve from PubMed, Scopus and Google scholar databases on antimicrobial affects of PDT. Based on existing research, PDT is one of the effective methods for the treatment of burn infections with fewer side effects and no sign of resistance.

Systematic review and meta-analysis of the prevalence and mortality of metallo-beta-lactamases in Iranian patients infected with metallo-beta-lactamase-producing Pseudomonas aeruginosa Background and adjective: Pseudomonas aeruginosa is associated with morality and healthcare associated infections. P. aeruginosa producing metallo-beta-lactamase (MBL) genes causing more problems especially in patients with underlying immunosuppressive background. The aim of this study is a systematic review and meta-analysis of the prevalence of MBLs in P. aeruginosa in Iranian patients. Search method: All available national and international databanks (PubMed, Science Direct and pages web address) were searched to find published studies from 2006 to March 2018. Quality of studies was assessed by STROBE. Because of the significant heterogeneity, random effects model was used to combine the results. Statistical analysis was performed by STATA (software version 13, Stanford, California, USA) (confidence interval; 95%, P < 0.05). Findings: Final analyze was done on 51 articles relevant with 7548 sample size. Current study indicates that most of the P. aeruginosa isolated from wound. Pooled prevalence belonged to genes blaVIM-1 3%, blaVIM-2 2%, blaIMP-1 5% and blaIMP-2 3% in infected patients. Overall prevalence of another MBLs is replaced in Table 1. The overall prevalence of the MBL genes in all regions of Iran were 16% (95% confidence interval, 0.15–0.17). Moreover, the mortality rate in MBL producing P. aeruginosa infected patients, was 6% in three studies. Conclusion: The blaVIM-1, blaIMP, blaIMP-1 and blaIMP-2 genes are more prevalent in Iranian patients. Therefore, it is essential to set a national surveillance program for preventing of antibiotic resistance in Iranian patient.

New Books related to Medical Microbiology No abstract available