Infectious Disorders - Drug Targets (Formerly Current Drug Targets - Infectious Disorders) - Volume 17, Issue 1, 2017

Background: Zika virus (ZIKV) is a deadly flavivirus that has spread from Africa to Asia and European countries. The virus is associated with other viruses in the same genus or family, transmitted by the same mosquito species with known history of fatality. A sudden increase in the rate of infection from ZIKV has made it a global health concern, which necessitates close symptom monitoring, enhancing treatment options, and vaccine production. Objectives: This paper reviewed current reports on birth defects associated with ZIKV, mode of transmission, body fluids containing the virus, diagnosis, possible preventive measures or treatments, and vaccine development. Methods: Google scholar was used as the major search engine for research and review articles, up to July, 2016. Search terms such as “ZIKV”, “ZIKV infection”, “ZIKV serotypes”, “treatment of ZIKV infection”, “co-infection with zika virus”, “flavivirus”, “microcephaly and zika”, “birth defects and Zika”, as well as “ZIKV vaccine” were used. Results: ZIKV has been detected in several body fluids such as saliva, semen, blood, and amniotic fluid. This reveals the possibility of sexual and mother to child transmission. The ability of the virus to cross the placental barrier and the blood brain barrier (BBB) has been associated with birth defects such as microcephaly, ocular defects, and Guillian Barre syndrome (GBS). Preventive measures can reduce the spread and risk of the infection. Available treatments only target symptoms while vaccines are still under development. Conclusion: Birth defects are associated with ZIKV infection in pregnant women; hence the need for development of standard treatments, employment of strict preventive measures and development of effective vaccines.

Background: The pattern of Mycobacterium tuberculosis susceptibility to first line drugs and multidrug resistance in Al-Madinah Al-Munawarah, a seasonally overcrowded are during Hajj and Omrah, is not well studied. Objective: This study aimed to investigate anti-tuberculosis drug resistance and its distribution among new cases in Al-Madinah Al-Monawarah. Methods: Study subjects included 622 patients with first time confirmed TB referred to the central tuberculosis laboratory in Al-Madinah between January 2012 and December 2014. Results: Out of the 622 isolates, 99 (15.9%) were Mycobacteria Other Than Tuberculosis (MOTTS) and 25 (4.0%), three of which (12%) were children under five years of age, revealed multidrug resistance (MDR). Monoresistance to isoniazid (H) was (1.8%), to rifampin (R) was (1.4%), to streptomycin (S) was (1.9 %) to ethambutol (E) was (1.1 %) and to pyrazinamide (Z) was (2.1%). Conclusion: Being among the new cases, multidrug resistant tuberculosis (MDR TB) is supposed to be caused by strains which are originally multidrug resistant. Neither nationality nor gender was found to be associated with MDR TB. Since 12% of MDR cases were among children, a probability of primary infection with MDR strains is to be considered. Moreover, mass gathering during Hajj and Omrah seasons does not seem to increase the burden of MDR in the region. However, further investigation is needed to molecularly characterize MDR isolates and their phylogenetics and geographical origin.

Chronic hepatitis B is a major global health issue, and has no known cure. Currently there are over 240 million people infected with the disease, and it leads to the death of over 686,000 people each year. A total of seven treatments which help to control the disease are currently available: interferon-based treatments (pegasys, and interferon alpha), and nucleoside and nucleotide analogs (Viread, Baraclude, Tyzeka, Hepsera, Epivir-HBV), but all require continuing treatment to maintain control of the disease. One of the definitions of a cure for hepatitis B virus (HBV) is the loss of hepatitis B surface antigen (HBsAg), the lipid envelope which surrounds the hepatitis B virus. The current interferon-based treatments, and nucleoside and nucleotide analogs give at most an approximately 10% rate of clearance of HBsAg. Other viral diseases such as HIV and hepatitis C have been most effectively treated with a combination of agents, and it is believed that the best opportunity for finding a cure for HBV will reside in a combination of therapies targeting different phases of the HBV lifecycle.A range of agents (small-molecules, natural products, macrocycles, and non-small molecules) have been described as having the ability to suppress the secretion of HBsAg (in vitro, as well as in vivo in animal models, pre-clinical models, and clinical trials), and this review will focus on an overview of the different agents, and different strategies being pursued to develop methods of inhibiting the secretion of HBsAg, with a view to the cure of HBV.

Background: Use of intra-articular antibiotics for the treatment of arthroplasty infections has gained some interest over the last few years. Objective: Some data exists on its use with bacterial arthroplasty infections. Method: We used intra-articular amphotericin B in an attempt to cure these joint infections and perform a one stage revision. Results: Two patients were treated with intra-articular amphotericin B for 6 weeks followed by suppressive fluconazole for 4 months. Intra-articular joint fluid was cultured during this process for re-growth of fungus. Conclusion: Both patients were treated successfully with the method with follow up showing no evidence of recurrence. IA administration of amphotericin B may be an alternative treatment in these patients.

Background: Echocardiography is a reliable means for the diagnosis of functional and valvular diseases of the heart in HIV positive and HIV negative patients. The current study was to evaluate echocardiographic abnormalities in HIV positive patients under an antiretroviral therapy (ART) program in Tehran, Imam Khomeini Hospital, Iran. Methods: This is a descriptive cross-sectional study, conducted among 231 HIV-1 positive patients under ART. All HIV positive patients including 150 men (65%) and 81 women (35%) (mean age of 41 years) were assessed by trans-thoracic echocardiography (TTE) in Imam Khomeini Hospital, over the period from 2013 to 2014. Results: The mean CD4 count was 408 cell/μl, and the average left ventricular ejection fraction (LVEF) was 59.5%. There was an inverse correlation between age and LVEF level. Nevirapine users showed a significantly higher LVEF than non-users. Left ventricular systolic dysfunction (LVSD) was diagnosed in 5.6% along with the increase in age, while left ventricular diastolic dysfunction (LVDD) was reported in 19.5% of patients associated with age and smoking. Here, the mean systolic pulmonary arterial pressure (SPAP) was only 20 mmHg and just four percent of the patients suffered pulmonary hypertension. Almost 44% had a heart valve disorder among which mitral valve prolapse is the most common problem. Pericardial effusion was not found in any patients. Conclusion: It seems that heart disorders with no suggestive symptoms in HIV positive patients, and mainly older adults who have traditional risk factors for heart diseases, should be seriously considered by health providers.

Background: Arthritis could be caused by different etiologies ranging from rheumatologic diseases to infectious conditions. Therefore, early diagnosis of etiology and treatment is important. The purpose of this study was to determine the the M. pneumonia in synovial fluid of children with arthritis by 2 methods (serology and qualitative PCR). Methods & Materials: This trial was carried out as a cross sectional study in pediatric and orthopedic ward of Rasoul-e Akram hospital in Tehran, Iran. Seventy three patients (39 boys and 34 girls) with mean age of 11± 3.9 y/o were selected by continuous sampling after synovial fluid aspiration. All samples were evaluated by direct smear, culture and latex tests. Septic arthritis was diagnosed in 18 patients (25.4%). PCR and serology tests for M. pneumonia (specific IgM and IgG) were performed in 50 cases with negative culture. The results were compared by Independent T test. Results: According to physical examination and culture 18 patients (25.4%) were diagnosed with septic arthritis, 50 patients with non-septic arthritis were studied. Seventeen patients (33.3%) were IgG positive and 2 patients (4%) were IgM positive. Only 2 patients (4%) showed weakly positive results on PCR which did not demonstrate any association with serology. Conclusion: Positive PCR in SF (4%) definitely indicates active infection and M. pneumonia induced arthiritis. Although positive SF-IgM (4%) suggests either a current or a very recent M. pneumonia infection but not for SF-IgG (previous infection). So, we can summate that PCR, though being the best and most accurate method to detect M. pneumonia infection arthritis, is not considered a practical one due to costs and availability issues. Hence it can be safely replaced by serology test (Specific IgM) in SF for diagnosis of M. pneumonia arthritis, which is available in most of the hospitals and is much more economical as compared to PCR.

Bacteremia is frequently caused by gram-positive organisms such as Staphylococcus aureus or β hemolytic streptococci. While there is adequate information for the diagnosis and management of these common bacteria, less information is available to address bacteremia that is caused by uncommon bacteria such as Citrobacter. Citrobacter species are gram-negative bacilli that have been noted to cause infections in immune compromised patients. The re-speciation of Citrobacter by its varied genetic composition has produced 11 distinct species. While C. braakii is part of the genome species 6 of the previous Citrobacter freundii complex, there is a lack of definitive research on the subject of Citrobacter bacteremia caused by lesser- known species. We report an unusual case of Citrobacter braakii bacteremia in a patient with multiple comorbidities that presented to the hospital with cellulitis and pleural effusion. Blood cultures grew Citrobacter braakii. Despite good response to antibiotic treatment, the patient’s infection proved to be persistent and he succumbed to the cirrhosis of the liver and subsequent renal failure. Multiple and fatal underlying disease processes seem to worsen the likelihood of recovery from unusual infections. We believe our case report can add to the limited data available for C. braakii.

Background: Neisseria are usually harmless inhabitants of otherwise asymptomatic persons’ upper respiratory mucosal surfaces. Method: It is, therefore, expected that a disturbance in the physiology leads to nongonococcal, non-meningococcal Neisseria becoming pathogenic. Result: We report the case of a diabetic man who initially presented with nonspecific symptoms and was later found to have cystitis caused by N. oralis. Conclusion: We also review the pertinent literature and discuss available evidence on pathophysiological mechanisms of infection with such commensal bacteria.

Methicillin resistant Staphylococcus aureus (MRSA) is responsible for a large number of antibiotic resistant infections worldwide. Understanding the epidemiology and identifying the molecular characteristics of MRSA is elemental in designing infection control plans to minimize the risks associated with these infections. The prevalence of MRSA varies between the different geographic regions. In Egypt, such knowledge is sparse, with a limited number of isolated studies reporting the infection rate of MRSA in select parts of the country. This work summarizes the few published reports that described MRSA prevalence and types in Egypt.