Infectious Disorders - Drug Targets (Formerly Current Drug Targets - Infectious Disorders) - Volume 20, Issue 6, 2020

The newly emerging infectious organisms, the global crisis in antibiotic resistance, and the threat of bioterrorism create an urgent need to discover novel antimicrobial agents. In order to develop novel antimicrobial agents, the mechanism of infectious disease must be better understood. DNA Gyrase is a bacterial enzyme that plays an important role in the replication of DNA and transcription process. It is not present in higher eukaryotes making it a perfect target for developing new antibacterial agents. This review describes the role of DNA gyrase inhibitors in preventing various diseases. In this review, we outline the synthesis and pharmacological action of various novel DNA gyrase inhibitors. DNA gyrase inhibitors were used to treat tuberculosis, bacterial, fungal infections and malaria. DNA gyrase inhibitors mainly act by preventing the supercoiling of DNA strands.

Objectives: A new national clinical guideline for the management of tuberculosis and HIV in Iranian prisons was released in 2011. The aim of this study was to compare HIV indicators in the case and control prisons after implementation of the new guideline. Methods: This report examines outcomes observed during the pilot phase of its implementation at a case prison from October 2013 to June 2014 compared to a control prison that had not yet implemented the guideline. The case prison included incarcerated individuals in the Great Tehran Prison. A prison in Alborz province was considered as a control group. Pearson’s Chi-squared, two-sample t-test, paired t-test and Kruskal-Wallis were used for the analysis. Results: The intervention significantly increased the total number of inmates tested for HIV and of diagnoses of HIV-positive inmates in the case prison compared to the control prison (P<0.001). Moreover, coverage of antiretroviral therapy was higher in the case prison compared to the control prison (P=0.015). Conclusion: We recommend the implementation of this guideline in all Iranian prisons.

Background: Considering the emergence of multidrug resistance (MDR) in prevalent human fungal pathogen, Candida albicans, there is parallel spurt in the development of novel strategies aimed to disrupt MDR. The cell envelope of C. albicans comprises a wealth of lipid moieties contributing towards long-term survival of pathogen that could be exploited as efficient antifungal target owing to the advancements made in mass spectrometry based lipidomics technology. Objective: This study aimed to utilize the lipidomics approach to unveil several lipid-associated changes in response to two natural anticandidal compounds perillyl alcohol (PA) and sesamol (Ses). Methods: Lipidomics is performed through ESI-MS, flippase activity by FACS, fluorescence spectrometric analysis is used to assess membrane fluidity. Results: Lipidomic analyses revealed that phosphatidylcholine (PtdCho) were decreased in the presence of Ses with considerable differences at specie level. Concurrently, we explored increased inward translocation (flip) of fluorophore labelled PtdCho across the plasma membrane attributed to enhanced PtdCho specific flippase activity. A considerable decrement in phosphatidylethanolamine (PtdEtn) leading to altered membrane fluidity was observed in response to PA and Ses. Additionally, we could detect alteration in the levels of phohatidylserine (PtdSer) and phosphatidylglycerol (PtdGro) along with decreased triacylglycerides (TAG). The differential expressions of various lipid biosynthetic pathway genes by RT-PCR corroborated with the lipidomics data. Furthermore, PA and Ses leads to potentiation of membrane targeting drugs (azole and polyene) and displayed additive effect. Conclusion: Our work offers the basis of further understanding the regulation of lipid homeostasis in C. abicans so that better therapeutic targets could be identified to combat MDR.

Background: The incidences of opportunistic bacterial infections have increased in the past two decades or is expected to increase in the near future. Despite the availability of various classes of antibiotics, bacterial infections are not handled properly. Methods: Thus, in the present study, we have repurposed atorvastatin against various types of bacterial strains by using in silico, in vitro, and in vivo studies. Furthermore, a preliminary safety study was conducted using MTT assay. Results: In silico study results have revealed that atorvastatin has good interaction with various targets of bacterial cell like that of the reference ligand. However, under in vitro conditions,it was found that atorvastatin was effective at higher concentrations (>128 μg/ml) against various bacterial strains. Thus, further, atorvastatin was tested in combination with standard antibiotics and has shown a synergistic effect. Conclusion: The MTT assay results have revealed non-cytotoxic activity of atorvastatin. In conclusion, atorvastatin in combination with standard drugs could be developed as an antibacterial agent.

Background and Aim: Dental caries is a communicable and the most prevalent infectious disease worldwide. Salivary oxidative stress and antioxidants may play a pivotal role in caries prevention, progression and pathogenesis. In this study, salivary superoxide dismutase, peroxidase, glutathione peroxidase, catalase and uric acid levels were evaluated in dental caries. Materials and Methods: One hundred male and female students in two groups (n=50) were subdivided into caries-active and caries-free (25) groups. Whole saliva samples were collected in the morning, and the salivary antioxidant levels were measured by a spectrophotometric assay. The data were analyzed using SPSS. Results: The caries-active group had higher peroxidase, uric acid, catalase and glutathione peroxidase levels, and lower superoxide dismutase level as compared to the caries-free group. The comparison between males and females showed lower peroxidase, catalase and uric acid levels and higher glutathione peroxidase levels in the female group. Conclusion: The caries-active group had altered salivary antioxidant levels. Therefore, it was concluded that salivary antioxidants have significant effects on oral and dental health.

Background: Obligate intracellular parasites of Leishmania genus belong to the family Trypanosomatidae and more than twenty species cause this neglected vector-borne infection throughout the globe. Objective: The current study was aimed to assess the antileishmanial activity of Amphotericin B (AmB) and AmB formulated into solid lipid nanoparticles (SLNs) in vitro and in vivo. Materials and Methods: In the present research, microemulsification and high shear homogenization methods were used to prepare SLNs. Leishmania major (L. major) promastigotes were cultured in RPMI 1640 and incubated for three time points of 24, 48 and 72 h at 25±1°C. Then, the MTT colorimetric assay was employed for obtaining 50% inhibitory concentration (IC50). Finally, the efficacy of AmB and AmB-SLN was evaluated for the treatment of experimental cutaneous leishmaniasis (CL) in BALB/c mice. Results: The average diameter sizes of prepared AmB-SLN were <180 nm and monodisperse preparations with polydispersity index 0.21±0.29. The antileishmanial activity of AmB and AmBSLN revealed a dose and time-dependent manner in vitro. The IC50 values of AmB (38.18±1.33, 25.06±2.00, and 13.87±0.61 μg/ml) and AmB-SLN (0.40±0.02, 0.26±0.02, and 0.14±0.01 μg/ml) were estimated after 24, 48 and 72 hours, respectively. In all BALB/c treatment groups, the diameter of lesions was significantly smaller than the control group. Conclusion: AmB-SLN was significantly more potent than AmB in vitro and in vivo. The discovery of new effective drugs based on nanocarriers, such as SLN, is practical and opens a new window for the treatment of CL.

Background: Enterococcal infections comprise a wide range of diseases with increasing importance due to the growing frequency of health-care-associated infections and the increasing incidence of antimicrobial resistance. Vancomycin-resistant Enterococcus (VRE) is an emerging drug-resistant organism responsible for increasing numbers of nosocomial infections in both adults and children. Few data are available on the epidemiology and impact of VRE infections in Iranians. In the present study, attempts were made to evaluate the prevalence and molecular characterization of VRE isolates from patients referred to several hospitals in Iran. Materials and Methods: Eight hundred and fourteen enterococcal clinical isolates from different patients were selected for this cross-sectional study during June 2018 and February 2019. Antimicrobial susceptibility testing was performed by standard methods according to the Clinical Laboratories Standards Institute (CLSI) guidelines. The vanA and vanB genes in VRE isolates were amplified by PCR. Results: Our findings indicated that 20.7% of the isolates were collected from hospitalized patients in the ICU. Among all the isolates, 254 (30%) were identified as VRE strains. All of the VRE isolates were sensitive to linezolid. Moreover, only 39.9% of the VRE isolates harbored the vanA gene, while none of them carried the vanB gene. Conclusion: The present study reports the highest range of VRE infections in Iran. The constant surveillance and monitoring of VRE strains are recommended to limit the occurrence and spread of VRE clones within and among hospitals and community settings.

Objectives: Giardiasis is one of the human parasitic diseases by a flagellate protozoan named Giardia lamblia. This parasite is one of the most common organisms causing diarrhea in humans and a common gastrointestinal parasite in vertebrates. The purpose of this investigation was to determine the molecular epidemiology of Giardia lamblia (G. lamblia) by PCR-RFLP method in the Mazandaran Province and to investigate the possible relationship between parasite genotype and clinical symptoms.

Methods: In this study, 50 stool samples were collected from human cases of G. lamblia. referred to health centers in Sari, Babol, Nowshahr cities. The samples were examined by formalin-ether concentration procedure. DNA extraction was carried out on samples containing adequate Giardia cysts, and then PCR-RFLP was done on glutamate dehydrogenase (gdh) marker.

Results: In these patients, the most common signs were abdominal pain (42.9%), and diarrhea (47.6%); and least marked common sign was malaise (4.7%). Of all 21 isolates, 9 samples (42.8%) were found as genotype mixed AII and BIII, 6 samples (28.6%) belonged to genotype BIII and 6 (28.6%) were of genotype AII. Additionally, there was a significant correlation between AII genotype and clinical symptoms (P <0.05). According to the statistical tests, there was a significant relationship between abdominal pain and the intensity of infection (P<0.05).

Conclusion: However, genotype AII and mixed AII and BIII genotypes were more common, respectively. The relatively high prevalence of mixed infection of these genotypes indicated the potential of zoonotic source of giardiasis among patients in Mazandaran Province.

Background & Aims: Hepatitis B is a potentially life-threatening liver infection and it is a major global health problem. Over the past decade, numerous studies have reported that patients with CLD, especially HCV-positive and HBV-positive patients, have decreased 25(OH) D levels. The current study was designed to assess the serum levels of vitamin D [25(OH) D3] in chronic hepatitis B patients, before and during treatment with antiviral therapy. Methods: It was a prospective study in which 80 subjects were enrolled between December 2017 and June 2018. A total of 50 treatment-naïve chronic HBV patients and 30 healthy subjects were recruited. The studied cases received treatment in the form of Lamivudine 100 mg tablet, once daily. Full routine laboratory investigations, HBV DNA measurement by real-time PCR were conducted once before initiation of antiviral treatment and again at least 6 months later. Serum vitamin D level [25(OH)D3 was assessed twice, once before initiation of antiviral treatment and again at least 6 months later. This was done for all the patients enrolled in the study. Results: The studied cases showed a significantly low mean serum Vitamin D level when assessed before treatment (21.6 ± 5.8 ng/ml), compared to the level after 6 ms of treatment (31.1 ± 7.3 ng/ml) which was comparable to that of the control group (33.4 ± 5 ng/ml). Conclusion: The present study highlights the impact of antiviral therapy on vitamin D deficiency in CHB patients, where effective therapy improves vitamin D levels. Meanwhile, it is recommended to study the impact of vitamin D replacement and correction on the disease progression or regression.

Background: Antiretroviral medications have improved the survival and life quality of people living with HIV and turned HIV into a chronic controllable disease. However, the success of HIV treatment depends on many factors; patient adherence is one the most important indicators. In this study, we explored the potential barriers to an effective adherence antiretroviral therapy (ART) among the HIV-positive prisoners of Ghezel-Hesar prison, Iran. Methods: To explore and identify the barriers toward ART adherence, a focus group discussion was held with six prisoners eligible for ART but rejected to be treated or did not retain on ART. The prisoners were recruited through purposive sampling method. All the words, behaviors and even body languages were precisely recorded and analyzed to reach the final results. Results: The most reported obstacles toward ART adherence were the lack of trust in the effectiveness of medications and drug complications. Other reasons were inadequate nutrition, lack of amenities, social stigma, lack of economic and psychological support, misbehavior of prison staff and inadequate methadone prescription for those with opium addiction. Conclusion: Due to the results and the fact that adequate Methadone prescription for opium addiction, improving life quality and receiving emotional and medical support from staff could improve adherence to HIV medication in prisoners,comprehensive education of prisoners about their health condition along with staff education may improve the life condition of HIV infected prisoners and may cause dramatic improvement in ART adherence and prisoners health.

Background: The current study was aimed to assess the prevalence of intestinal parasitic infections (IPIs) in persons who were referred to selected hospitals of Abadan and Khorramshahr cities, in the southwest of Iran.

Materials and Methods: In this descriptive cross-sectional study, 43200 and 28821 stool specimens were gathered from Abadan and Khorramshahr cities, respectively, during four consecutive years (2014-2017).

Results: A decreasing trend was seen in the prevalence rate of IPIs in Abadan and Khorramshahr cities. The overall prevalence of IPIs was estimated to be 5.82% and 6.11% in Abadan and Khorramshahr cities, respectively. In Abadan city, the proportion of IPIs in male persons with 56% was higher than females 44%, while in Khorramshahr city, more prevalence was observed in females (54% vs. 46%). Moreover, according to the season, the highest prevalence was recorded in Spring (30.4%) and Summer (31.1%) in Abadan and Khorramshahr cities, respectively. We found Giardia lamblia, as the most frequent parasite in studied individuals of both cities (Abadan: 2.92%; 1261/43200 and Khorramshahr: 3.15%; 908/28821). Other parasites were as follows: Entamoeba histolytica/dispar, E. coli, E. hartmanni, Blastocystis hominis, Hymenolepis nana, Enterobius vermicularis, Strongyloides stercoralis, and Taenia spp.

Conclusion: This was the first study on the prevalence of IPIs in Abadan and Khorramshahr cities, southwest of Iran. Intestinal parasites are still the main public health concern in these regions. Health education, improving sanitary conditions, screening and treatment of infected people, particularly in rural and semi-urban areas can be helpful.

Background: The overexpression of the efflux transporter genes is one of the important mechanisms of resistance in fungal pathogens such as Candida and Aspergillus species. Objective: Here, the expression alterations of drug efflux transporter genes were evaluated in non- Cyp51A voriconazole-resistant Aspergillus fumigatus isolates. Methods: Six A. fumigatus isolates including four voriconazole-resistant isolates with and without azole-resistance-related mutations in addition to two susceptible A. fumigatus isolates were selected from 300 previously characterized A. fumigatus clinical and environmental isolates, received during 2013-2015. In order to extract RNA, the minimum inhibitory concentrations (MICs) for the isolates were determined according to the broth microdilution protocol regarding the Clinical and Laboratory Standards Institute document M38-A2 (CLSI, 2008). Alteration in the expression of AfuMDR1, AfuMDR2, AfuMDR3, AfuMDR4, Cyp51A, and atrF was studied using the real-time polymerase chain reaction assay. Results: Based on REST® output, significant overexpression of atrF, AfuMDR1, AfuMDR3, and AfuMDR4/Cyp51A, atrF, AfuMDR2, AfuMDR4 genes was observed in the isolates without azoleresistance- related mutations, respectively. No significant overexpression was seen in the isolates with T34/L98H except for the AfuMDR3 and AfuMDR4(P< 0.05). Conclusion: Our results support the hypothesis that efflux pump transporters can contribute to voriconazole resistance in A. fumigatus.

Objective: This study assessed the anti-pathogenic potential of culture supernatants from three probiotic strains viz. Lactobacillus plantarum, Bifidobacterium bifidum, and Enterococcus faecium against five different gram-positive and gram-negative pathogenic bacteria. Methods: The effect of probiotic culture supernatants on growth and production of quorum sensing (QS)-regulated pigments was assessed through broth dilution assay. In vivo anti-infective efficacy of these supernatants was evaluated by challenging the model nematode host Caenorhabditis elegans with pathogenic bacteria pre-treated with probiotic culture supernatants, and worm survival was monitored over a period of 8 days. Results: All the probiotic culture supernatants (at 5-10 %v/v) exhibited bactericidal activity against four of the test pathogens (including three multi-drug resistant gram-negative bacteria) and they (at ≥ 1%v/v) could also modulate QS in pathogenic bacteria. Pre-treatment with culture supernatants from all the three probiotic strains were able to attenuate virulence of four of the test pathogens towards C. elegans. Worms challenged with supernatant-pre-treated pathogens recorded 75-100% better survival than those challenged with pathogens receiving no such pretreatment. Virulence-attenuating effect of the culture supernatants was also carried forward to daughter populations of the supernatant-treated parent pathogens. Lactic acid seemed to contribute notably towards anti-virulence activity of the culture supernatants, but acidic pH did not seem to be important for such activity. Conclusion: Culture supernatants of probiotic strains used in this study can be said to possess appreciable virulence-attenuating potential. Further investigation for characterization of these supernatants and identification of the bioactive constituents is warranted. Elucidation of the molecular basis associated with the anti-pathogenic potential of these supernatants may lead to the identification of novel targets in pathogenic bacterial populations.

Background & Objectives: Prevalence of hepatitis B virus in patients with rheumatic diseases has been reported differently among studies. The loss of immune control in these patients may result in the reactivation of HBV replication within hepatocytes. Considering the lifelong use of multiple anti-rheumatic drugs, screening for HBV is recommended before starting immunosuppressive or immunomodulatory therapy. The aim of this study was to select the best and simplest test for screening of HBV in rheumatic patients. Methods: This study was carried out in 102 patients with different rheumatic diseases. Screening to all patients for hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) antibodies and human immune deficiency virus antibodies (HIV) was done. HBV core antibodies and real time PCR to detect HBV DNA were done. Results: The mean age of the patients was 37.18 ± 12.37 years, 3.9% of them were males and 96.1% were females. HBsAg had 100% Sensitivity, 100% Specificity, 100% PPV, 100% NPV and 99.0% accuracy. While, anti-HBc had 100% Sensitivity, 78% Specificity, 8% PPV, 100% NPV and 78% accuracy in the screening of HBV. Conclusions: HBs Ag was found to be superior to antiHBc for screening for HBV infection in rheumatic patients.

Background: Salmonella typhimurium is a rod-shaped bacteria with a Gram-negative genus, belonging to the Enterobacteriaceae family of microbes, which invades the intestinal lumen of Human. Salmonella typhimurium is a root source, accounting for gastroenteritis in humans as well as in other mammals. Gastroenteritisis associated with Salmonella Typhimurium interacts with the contaminated food and water and spreads to nearby people in the area. Small intestine is attacked by Salmonella, which then enter into the bloodstream momentarily, and are responsible for millions of mortalities and morbidities around the globe. Salmonella typhimurium toxins cause gastrointestiritis due to inflammation in the stomach and intestine in infants and young children. It accounts for millions of deaths with a higher incidence rate in developing countries. Methods: In the current research, subtractive proteome mining has been done to recognize putative drug targets. The proteome was analyzed through blast in order to exclude homologous proteins. Bacterial essential proteins were predicted and the participation of the essential genes in the metabolic pathways has been analyzed. Results: 36 essential genes and 15 unique pathways have been identified as potential drug targets among the total of 1934 proteins. The location of proteins is determined as an outer membrane. 3 proteins out of 36 essential proteins are recognized as putative drug targets. Conclusion: In the future, virtual screening for the evaluation of novel clinical compounds for the identified proteins will be effective and valuable for Salmonella Typhimurium infection in Homo sapiens.

Background: Tuberculosis is one of the transmitted diseases that has been claimed as one of the most serious health problems worldwide resulting in death, as reported in WHO in Global Tuberculosis Report 2014 . It has been predicted that 9 million people suffer from tuberculosis disease and 1.5 - 2 million deaths occur by this disease. Objective: The aim of this research is to know the species of plant used as anti-hematemesis medicine that has the activity of antituberculosis and antituberculosis-MDR and then investigate the phytochemistry characteristics of the compound from every parts of the plant extract that show the activity of antituberculosis and antituberculosis-MDR which is indicated by the value of Minimum Inhibitory Concentration (MIC) of the extracts. Methods: The extraction method used in this research was the maceration method. The antituberculosis activity test was investigated using MODS and LJ media methods. The isolation of the active compound was carried out using Bioassay Guided Fractionation and then the compound characteristics were identified using spectroscopy data. Results: The results showed that extracts from Talas (Collocasia esculenta tuber) and Kariango (Acorus calamus rhizome) plants were active against M. tuberculosis. The FTIR spectroscopy data showed that three isolates obtained from Talas plants contained aliphatic OH and C-O and CH groups. The MIC values of kariango and Talas extracts using the MODS method were 45 mg/ml and 40 mg/ml, respectively. Conclusion: Talas (Collocasia esculenta) tuber and Kariango rhizome ethanolic extract have a potency for antituberculosis and anti-MDR tuberculosis drugs.

Background: Tenualosa ilisha (ilish, hilsa, hilsa herring, or hilsa shad) is a species of migratory fish in the herring family (Clupeidae), and is considered as a popular food fish in the southwest of Iran. Objective: Due to the high consumption of T. ilisha fish in Khuzestan province (especially in Abadan and Khorramshahr cities) and lack of any reports about the intestinal trematode of this fish; the current study was aimed to investigate the trematode parasites of T. ilisha. Methods: For this purpose, a total of 50 T. ilisha fishes were collected from the Karun River during Feb-Mar 2017. The fishes were transferred to the Department of Medical Parasitology of Tarbiat Modares University and dissected to obtain the intestine. The intestines were extensively searched for the presence of trematode and after parasites recovering, they were preserved in 70% alcohol. Moreover, the helminths were stained by acetic carmine. The parasites were identified with the aid of reliable sources. Results: Forty-one out of 50 (82%) fishes were found to be positive for trematode. The recovered trematode belonged to Faustula keksooni. Conclusion: The present study showed a high burden of infection in T. ilisha. It should be noted that we reported F. keksooni for the first time in Iran.

Background: Klebsiella pneumoniae is a common cause of hospital-acquired infections, including urinary tract infection (UTI). Biofilm formation makes the K. pneumoniae infection more complicated and carrying extended-spectrum beta-lactamases (ESBLs) genes, it limits antibiotic choices for treatment. Lactobacillus strains are known as natural protective barriers against UTIs. Objectives: This is a small in-vitro study aimed to determine the effect of probiotic Lactobacillus strains and some types of their metabolites on the growth and biofilm of UTI isolates and reference strain of Klebsiella pneumoniae. Methods: The efficacy of Lactobacillus supernatants and antibiotics in the prevention and elimination of K. pneumoniae biofilms was determined using a quantitative adherence assay. A rapid colorimetric microplate bioassay was applied for the detection of survived bacterial cells after treatment with antibacterial agents. Biofilm phenotypes were studied by scanning electron microscopy (SEM). Results: The results showed that seven out of eight ESBL producing uropathogenic K. pneumoniae isolates in this study were able to produce biofilm. Lactobacillus supernatants at 1:1 to 1:16 dilutions, had more than 95% biofilm-inhibitory and biofilm-killing properties on a strong biofilm producer isolate. Supra-MIC levels of antibiotics had a much lower anti-biofilm effect than Lactobacillus supernatant and left considerable alive biofilm cells. Conclusions: Although antibiotic resistance increases in biofilm forms of Klebsiella pneumoniae, Lactobacillus supernatants have strong antibiofilm efficacy even in lower concentrations of MIC. Biofilm formation decreases considerably in the presence of Lactobacillus supernatants. Hydrogen peroxide is an effective product against growth and biofilm formation of Klebsiella pneumoniae.

Background: Although a majority of patients with cutaneous leishmaniasis (CL) are healed with Glucantime chemotherapy, the increased drug resistance rate following its application is a concern. In this study, Naja naja oxiana crude venom of cobra snakes was used for the first time as an assembled combination of bioactive pharmaceutical components on Leishmania major (L. major) standard strain. Objective: To evaluate the efficacy of the Naja naja oxiana crude venom of Iranian cobra snakes on Leishmania major standard strain in vitro. Methods: Five concentrations (1.25, 2.5, 5, 10 and 20 μg/mL) of venom were added to Leishmania major cultures at 24, 48 and 72 h. The viability of the parasites and venom toxicity were assessed by MTT test. The apoptosis was determined by flow cytometry, while IC50 was determined by counting parasites compared to that of glucantime. Each test was conducted in triplicate. Results: After the exposure of the venom for 72 h, IC50 value was 0.36 μg/mL and 14.12 μg/mL for promastigotes and amastigotes, respectively. MTT valuation clarified 1.01% promastigotes viability. Furthermore, the results indicated that the venom of Naja naja oxiana induced early and late apoptosis in parasites. Conclusions: The venom of Naja naja oxiana revealed remarkable anti-leishmanial effects as a novel anti-parasitic alternative. Thus, the bioactive and effective fractions of this venom may be considered as anti-leishmanial candidates in future studies.

Background: Helicobacter pylori is a slow-growing micro-aerophilic gram-negative organism found in the stomach and duodenum. It is also associated with a number of stomach-duodenal diseases. Material and Methods: There are invasive and non-invasive methods to detect Helicobacter pylori infections. In a 13-months period, 101 patients with clinical signs of infection confirmed by biopsy and Rapid Urease test as well as a culture were included in this study. Results: There were significant correlations between breath urease test, anti-Helicobacter pylori serum IgG and IgA as well as fecal Helicobacter pylori Ag with the gold-standard method, (P=0.001) Moreover, there was a significant correlation between Monocytosis (P= 0.05) and goldstandard method. Conclusion: Based on studies conducted on patients with Helicobacter pylori infection, noninvasive diagnostics methods can be useful in the diagnosis of Helicobacter infections rather than evaluating anti-Helicobacter pylori serum IgM and also increased blood monocytes could be a reliable confirmation for detection. Furthermore, Monocytosis must be considered as a Helicobacter pylori infection at the first step in an area with a high infected percentage.

Cytomegalovirus retinitis is a rare complication in kidney transplant patients with only one other reported incidence. A 70-year-old female with a previous history of kidney transplant began experiencing a decreased vision of her right eye and was diagnosed with CMV retinitis and started on ganciclovir treatment. After completing the treatment, the patient has had no signs of recurrence or any other complaints. There is only one other published case report of CMV retinitis in a kidney transplant patient, therefore appropriate treatment and predictability of recurrence are unknown.

Background: Non-tuberculous mycobacterial (NTM) infections have been drawing interest recently because of their rising incidence not only in immunocompromised but also in immunocompetent individuals. These are underdiagnosed in India, due to the lack of awareness and a low index of suspicion. In regions endemic for tuberculosis (TB) such as India, presumptive anti-tubercular treatment (ATT) is often prescribed. Non-response of NTM to the treatment may be wrongly ascribed to multidrug-resistant tuberculosis. This emphasizes the need to correctly identify them before initiating therapy. Case Study: We describe the case of a young, healthy female patient who developed cervical lymphadenitis and was given presumptive ATT. Microbiological examination of aspirate revealed M. fortuitum. This not only rectified the course of treatment resulting in complete cure, but also spared the patient from significant side effects of ATT. This case is an awakening call for clinicians to avoid presumptive ATT.

Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis (WG), is a multisystem autoimmune disease of unknown etiology often misdiagnosed as pneumonia. The hallmark features include necrotizing granulomatous inflammation and pauci-immune vasculitis in small and medium-sized blood vessels. We described a 15-year-old female with a history of six months of acne-like facial and peri-auricular lesions. She had received conventional treatment for acne (antibiotics + topical corticosteroid) with no response. She also had a history of chronic coughs, which always diagnosed and treated as sinusitis. In addition, she had a history of frequent dysuria, which always diagnosed and treated as a urinary tract infection. Given the history, with suspicion of a multi-systemic disease such as vasculitis; we performed some diagnostic laboratory and radiologic tests in order to rule out the possible etiologies. The results were positive for cytoplasmic anti-neutrophil cytoplasmic antibody (C-ANCA). The urine analysis suggested the involvement of kidney micro-vasculature. In addition, two nodular lesions with the cystic pattern were observed in the CT scan of the lungs. However, the skin and nasal biopsies revealed no evidence of chronic necrotizing vasculitis or granulomatous lesion. Nonetheless, treatment was initiated with a strong suspicion of GPA. Following the treatment, the patient's symptoms completely disappeared, and the diagnosis of GPA was confirmed.