Invasive aspergillosis in liver transplant recipients, an infectious complication with low incidence but significant mortality

BACKGROUND

Infections, including invasive fungal infections (IFIs), are among the leading causes of mortality in liver transplant recipients during the first year post-transplantation.

AIM

To investigate the epidemiology, clinical manifestations, risk factors, treatment outcomes, and mortality rate of post-liver transplantation invasive aspergillosis (IA).

METHODS

In this case-control study, 22 patients with IA were identified by reviewing the archived and electronic medical records of 850 patients who received liver transplants at the Imam Khomeini Hospital complex in Tehran, Iran, between 2014 and 2019. The control group comprised 38 patients without IA infection matched for age and sex. The information obtained included the baseline characteristics of liver transplant patients, operative reports, post-transplantation characteristics of both groups and information about the fungal infection of the patient group.

RESULTS

The prevalence rate of IA among liver transplant recipients at Imam Khomeini Hospital was 2.7%. The risk factors of IA among studied patients included high serum creatinine levels before and post-transplant, renal replacement therapy, antithymocyte globulin induction therapy, post-transplant bile leakage, post-transplant hepatic artery thrombosis, repeated surgery within 30 d after the transplant, bacterial pneumonia before the aspergillosis diagnosis, receiving systemic antibiotics before the aspergillus infection, cytomegalovirus infection, and duration of post-transplant hospitalization in the intensive care unit. The most prevalent form of infection was invasive pulmonary aspergillosis, and the most common chest computed tomography scan findings were nodules, pleural effusion, and the halo sign. In the case group, prophylactic antifungal therapy was administered more frequently than in the control group. The antifungal therapy response rate at 12 wk was 63.7%. The 3- and 12- mo mortality rates of the patients with IA were 36.4% and 45.4%, respectively (compared with the mortality rate of the control group in 12 mo, which was zero).

CONCLUSION

In this study, the prevalence of IA among liver transplant recipients was relatively low. However, it was one of the leading causes of mortality following liver transplantation. Targeted antifungal therapy may be a factor in the low incidence of infections at our facility. Identifying the risk factors of IFIs, maintaining an elevated level of clinical suspicion, and initiating early antifungal treatment may significantly improve the prognosis and reduce the mortality rate of liver transplant recipients.

Transverse colon varices

Portal hypertension associated with liver cirrhosis usually leads to gastroesophageal varices; however, ectopic varices secondary to liver cirrhosis are not common, especially colonic varices which occur with a low frequency. We are going to discuss the case of a 75-year-old man with liver (HBV) cirrhosis who was admitted to the hospital with rectorrhagia. Colonoscopy revealed evidence of acute bleeding in tortuous colonic varices. The band ligation performed during the colonoscopy had failed to control the bleeding. The patient was referred to Taleghani Hospital in Tehran, and rectorrhagia was subsequently successfully controlled by BRTO technique (balloon-occluded retrograded transvenous obliteration).

Antibacterial effect of tramadol against Staphylococcus aureus and Pseudomonas aeruginosa: an in vivo study

Some important adverse effects of local and regional anaesthesia including injection-site infection, epidural abscess and meningitis, are usually caused by bacteria such as Staphylococcus aureus and Pseudomonas aeruginosa. These infections can even cause the patient's death in severe cases. In the present study, the antimicrobial activity of tramadol was investigated on S. aureus and P. aeruginosa in BALB/c-sensitive mice. This experimental multigroup research study evaluated the effect of two different concentrations of injectable tramadol (12.5 and 25 mg/mL) on local infections caused by S. aureus and P. aeruginosa in BALB/c mice within 24 and 48 hours. The results showed that tramadol injection in the specified doses did not have a significant impact on the diameter of lesions caused by local infections due to these organisms. However, the diameter of inflammation resulting from local infection with P. aeruginosa had statistically increased in the two doses after 48 hours (p 0.019). Subcutaneous injection of tramadol reduced the growth of S. aureus through enhancing phagocytes and tissue inflammation; however, it did not help eliminate P. aeruginosa, and at a dose of 25 mg/mL it also increased the growth and spread of the bacteria. It seems that the observed difference was due to the different characteristics of these two bacteria.

Evaluation of GeneXpert MTB/RIF for determination of rifampicin resistance among new tuberculosis cases in west and northwest Iran

Despite a Mycobacterium tuberculosis control programme and anti-tuberculosis drugs, drug-resistant tuberculosis (DR-TB) is one of the most serious public health issues worldwide. Rapid laboratory diagnosis of M. tuberculosis is needed for the diagnosis of multidrug-resistant (MDR) TB and to find the optimal treatment protocol. The purpose of this study was to detect resistance to rifampicin in new cases of TB using the GeneXpert MTB/RIF (M. tuberculosis/rifampicin) assay and the standard proportional method in west and northwest Iran. In this descriptive cross-sectional study, sputum samples were enrolled and screened for M. tuberculosis using Ziehl–Neelsen stain and mycobacterial culture. Samples from individuals with smear-positive TB were cultured on Lowenstein–Jensen medium; afterwards, the presence of resistance to rifampicin was examined by the GeneXpert MTB/RIF and standard proportional methods. A total of 400 new cases of suspected TB were collected, 162 (40.5%) of which were smear- and culture-positive for M. tuberculosis. The frequencies of rifampicin resistance in new smear-positive TB cases were 3.1% and 4.3% for GeneXpert and standard proportional method, respectively. Sensitivity and specificity of GeneXpert were 71% and 100%, respectively, compared with the proportional method. GeneXpert can be a quick and helpful method for the diagnosis of rifampicin-resistant TB in regions with high rates of DR-TB or MDR-TB. GeneXpert MTB-RIF assay must be used as an early diagnostic method whose results must be confirmed by the standard proportional method. The GeneXpert and proportional methods complement but do not replace each other.

Clonal evolution multi-drug resistant Acinetobacter baumannii by pulsed-field gel electrophoresis

BACKGROUND

Acinetobacter baumannii is usually multi-drug resistant (MDR), including third generation cephalosporins, amino glycosides and fluoroquinolone. Resistance to these antibiotics is mediated by multiple factors such as: lactamases, efflux pumps and other mechanisms of resistance. Pulsed-field gel electrophoresis (PFGE) was then used to investigate the genetic relationships among the MDR isolates.

AIM

The aim of this study was to determine MDR isolates and the existence of OXAs genes among MDR isolates of A. baumannii collected from Kermanshah hospitals in west of Iran.

MATERIALS AND METHODS

Forty-two MDR A. baumannii were collected from patients at Kermanshah hospitals. The isolates were identified by biochemical tests and API 20NE kit. The susceptibility to different antibiotics by disk diffusion method was determined. Polymerase chain reaction (PCR) was performed for detection of blaOXA-23-like , blaOXA-24-like , blaOXA-51-like and blaOXA-58-like betalactamase genes in isolates and clonal relatedness was done by PFGE (with the restriction enzyme ApaI) and patterns analyzed by Bionumeric software.

RESULTS

This study showed high resistant to ciprofloxacin, piperacillin, ceftazidime and also resistant to other anti-microbial agents and more spread blaOXA-23-like gene (93%) in MDR isolate. The PFGE method obtained six clones: A (10), B (9), C (5), D (4), E (11) and F (3) that clone E was outbreak and dominant in different wards of hospitals studied.

CONCLUSION

An isolate from the emergency ward of these hospitals had indistinguishable isolates PFGE profile and similar resistance profile to isolates from intensive care unit (ICU), suggesting likely transmission from ICU to emergency via patient or hospital staff contact.

Dioxins and furans releases in Iranian mineral industries

In this project, emissions of Poly-Chlorinated Dibenzo-p-Dioxins and Dibenzo-Furans (PCDD/Fs) were investigated and estimated for selected Iranian mining and ore processing industries, such as integrated iron & steel plant, primary production of aluminium and copper metal, and the production of cement. As a first step of this study the annual emission of PCDD/Fs was estimated at 120gTEQannum(-1) on the base of the UNEP standardised Toolkit for identification and quantification of dioxin and furan releases. Steel and cement were identified as major emission sources and earmarked for further scrutiny. For that reason, filter dust arising in these plants was sampled and analysed, as well as all raw materials employed. After extraction and clean-up according to standard methods, the resulting liquid samples were analysed and quantified by HRGC-HRMS. Complementary analyses using methods such as XRF, TGA/DTA were performed and the emission results statistically evaluated, in order to put PCDD/F emissions in perspective. It is concluded that the dioxins load of cement dust is unusually low, following the low carbon in raw materials, the use of natural gas as a fuel and the absence of waste incineration. Also the production of iron by direct reduction of ore is a low dioxins process; dioxin loads in dust are as usual - correlated with the presence of catalytic metals. Loss on ignition and chlorine are anti-correlated with the main earth elements and with sulphur oxides.