Infectious Disorders - Drug Targets (Formerly Current Drug Targets - Infectious Disorders) - Volume 21, Issue 3, 2021

Many infectious diseases have yet to be conquered by modern medicine. This is generally attributed to both a failure of the immune system and the lack of an effective anti-microbial pharmaceutical. Infections can be regarded as a competitive process between the microbe and the host for cellular energy-generated resources. Cells obtain energy not only from the metabolism of food but also from the alternative cellular energy (ACE) pathway. This pathway utilizes an environmental force termed as KELEA (kinetic energy limiting electrostatic attraction), which provides an added kinetic/chemical energy to the body’s fluids. The ACE pathway can be enhanced through the use of KELEA activated water, which is currently available under different names from several sources. Enhancing the body’s ACE pathway, including the use of a wearable waterceutical ™, provides a novel means of potentially increasing the body’s resistance against all infectious diseases.

Enterovirus D68 (EV-D68) is a single-stranded positive-sense RNA virus, and it is one of the family members of Picornaviridae. Except for EV-D68, the entire family Picornaviridae has been illustrated in literature. EV-D68 was first discovered and isolated in California, USA, in 1962. EV-D68 has resulted in respiratory disorders’ outbreaks among children worldwide, and it has been detected in cases of various neurological diseases such as acute flaccid myelitis (AFM). A recent study documented a higher number of EV-D68 cases associated with AFM in Europe in 2016 compared to the 2014 outbreak. EV-D68 is mainly diagnosed by quantitative PCR, and there is an affirmative strategy for EV-D68 detection by using pan-EV PCR on the untranslated region and/or the VP1 or VP2, followed by sequencing of the PCR products. Serological tests are limited due to cross-reactivity of the antigens between the different serotypes. Many antiviral drugs for EV-D68 have been evaluated and showed promising results. In our review, we discuss the current knowledge about EV-D68 and its role in the development of AFM.

Human skin is considered as the first line of defense and barrier against the majority of infections caused through the skin that affect humans. Healthy skin promotes a healthy body that can be achieved with the usage of modern, allopathic and natural remedies. Major skin ailments affecting humans are skin cancers, eczema, herpes infection, fungal infection, anti-aging, itching, insect bites, pemphigus vulgaris, trauma, psoriasis, athlete’s foot infections, rashes, skin pigmentation, acne, major and minor wound infections that are slowly becoming a burden on health care. Skin infections can be treated from sources that originate from animals and plants. In spite of advancements in science and technology, the emergence of natural herbal remedies for managing skin disorders has become a pivotal and essential contributor in treating skin infections due to increased demand for herbals and their lower price, and continuous adverse effects of modern medicines. In the recent era, herbal extracts and their phytomedicines have made a vital contribution to human health care. Herbal products nowadays are considered as a single line of treatment for many diseases like Cancers, Diabetes, Cardiovascular and Brain disorders, thereby creating awareness regarding purity, efficacy and safety of herbal medicines for health care management. Many therapeutically active natural herbal resources like Aloe, Neem, Liquorice, Tulsi, Amla, Papaya, Ginger and Eucalyptus are potent and safe in the treatment of dermatological infections. This review article summarizes the significance of herbal plants for protecting, treating and minimizing skin infections through the utility of herbal pharmaceuticals like creams, decocted extracts, poultice, paste and lotions that aid in the treatment of skin infections and diseases at a relatively lower cost with lesser side effects as compared to modern and allopathic medicines.

Some fungal species of the genera Aspergillus, Penicillium, and Fusarium secretes toxic metabolites known as mycotoxins, have become a global concern that is toxic to different species of animals and humans. Biological mycotoxins detoxification has been studied by researchers around the world as a new strategy for mycotoxin removal. Bacteria, fungi, yeast, molds, and protozoa are the main living organisms appropriate for the mycotoxin detoxification. Enzymatic and degradation sorptions are the main mechanisms involved in microbiological detoxification of mycotoxins. Regardless of the method used, proper management tools that consist of before-harvest prevention and after-harvest detoxification are required. Here, in this review, we focus on the microbiological detoxification and mechanisms involved in the decontamination of mycotoxins.

The 2019 coronavirus pandemic (COVID-19) continues to expand worldwide. Although the number of cases and the death rate among children and adolescents are reported to be low compared to adults, limited data have been reported. We urgently need to find the treatment and vaccine to stop the epidemic. Vaccine development is in progress, but any approved and effective vaccine for COVID-19 will take at least 12 to 18 months. The World Health Organization (WHO), the Center for Disease Control and Prevention (CDC), and the Food and Agriculture Organization (FAO) have issued instructions and strategies for controlling COVID-19 outbreak to the general public, physicians, travelers and injured patients to follow so that the transmission to a healthy population can be prevented. In this review, we summarize demographic data, clinical characteristics, complications and outcomes and finally prevention and control strategies for this serious pandemic.

Background: Curcumin (CUR) is a bright yellow chemical and it is used as an additive in foods. Recently CUR and its associated bioactive compounds have received much attention in the literature review. The aim of this systematic review is to overview the antileishmanial properties of CUR and its mechanism; perhaps the results of this study will be used for therapeutic and preventive purposes. Methods: Following the PRISMA guidelines, international databases were systematically searched for studies published until September 2019. Articles related to the subject were selected and included in this systematic review. Results: A total of 15 articles met our eligibility criteria. Then, the effect of CUR and its associated bioactive compounds on Leishmania species was evaluated. In most studies, CUR/derivatives were tested on L. major and in vitro condition. Most investigations were conducted on the promastigote rather than the more relevant intracellular amastigote stage. Our results showed that CUR overcomes the inhibitory effect of nitric oxide (NO) on Leishmania parasites. Conclusion: This review indicated that CUR derivatives, instead of CUR alone showed a high potential to serve as an effective herbal drug against leishmaniasis. Moreover, we concluded that the antileishmanial activity of CUR/bioactive compounds is mostly due to increased oxidative stress and apoptosis.

Background: Dermatophytosis is a globally distributed fungal infection. Treatment failure and relapse is common in this disease. Silver nanoparticles are known for their promising antimicrobial activity. The aim of this study was to determine the antifungal activity of these nanoparticles against common dermatophyte species. Methods: A set of 30 molecularly identified dermatophytes including Trichophyton interdigitale (n=10), Trichophyton rubrum (n=10), and Epidermophyton floccosum (n=10) were used in this study. Green synthesized silver nanoparticles using chicory (Cichorium intybus) were tested for their antifungal activity in comparison to fluconazole, itraconazole and terbinafine. Interspecies differences in minimum inhibitory concentrations of antifungal drugs and silver nanoparticles were tested using Kruskal–Wallis test in SPSS software version 21. Results: The highest minimum inhibitory concentrations (MICs) among antifungal drugs were observed for fluconazole [range: 4–64 μg/mL, geometric mean (GM) =17.959 μg/mL], followed by itraconazole (range: 0.008–0.5, GM= 0.066) and terbinafine (range: 0.004–0.25 μg/mL, GM=0.027 μg/mL). Silver nanoparticles showed potent antifungal activity against all dermatophyte isolates with MICs (range: 0.25–32 μg/mL, GM=4.812 μg/mL) higher than those of itraconazole and terbinafine, but lower than fluconazole. MIC values of silver nanoparticles demonstrated significant differences between species (P=0.044), with E. floccosum having the highest MICs (GM=9.849 μg/mL) compared to T. interdigitale (GM=3.732 μg/mL) and T. rubrum (GM=3.031 μg/mL). Conclusion: Silver nanoparticles demonstrated promising anti-dermatophyte activity against the studied dermatophytes. Due to their wide-spectrum activity against other fungal and bacterial pathogens, they could be a potential choice, at least in the case of cutaneous and superficial infections.

Introduction: The infections caused by Toxocara spp. are considered as one of the most important zoonotic diseases in the world, especially in developing countries. Human toxocariasis, particularly in children, is acquired by playing in public parks. Hence, the aim of the current study was to detect Toxocara spp. in the soils of public parks of the city of Ahvaz, southwest of Iran, using the PCR and loop-mediated isothermal amplification (LAMP) methods. Methods: In this descriptive cross-sectional study, 260 soil samples were randomly collected from the different public parks of the city of Ahvaz. After performing zinc sulfate (ZnSO4) flotation technique, the DNA samples were extracted from the isolated Toxocara spp. eggs. Lastly, the extracted DNA was used for PCR and LAMP-based molecular detection. Results: Out of 260 specimens, 57 (21.9%) samples were found positive for Toxocara spp., using the PCR method, out of that 38 (14.6%) samples were positive for T. canis and 19 (7.3%) samples were positive for T. cati. Also, out of 260 specimens, 81 (31.1%) cases were positive for Toxocara species, using the LAMP method, among them 51 (19.6%) samples were found positive for T. canis and 30 (11.5%) samples were positive for T. cati. Kappa (Κ) coefficient between PCR and LAMP showed a strong agreement (0.766, P-value=0.002). Conclusion: The obtained data showed a relatively high outbreak of Toxocara spp. in the public parks’ soils of the city, using the PCR and LAMP methods. Since the parasite can cause human toxocariasis, particularly in children; thus, the health authorities of the city of Ahvaz and other similar cities, especially in developing countries, must pay more attention to the hygiene of the public parks’ soils.

Background: Tinea pedis is one of the most common skin infections of interdigital toe webspace as well as feet skin and may affect the nail or the hand. It is caused by dermophytes fungi especially Trichophyton species. Direct contact with a contaminated environment or animal is the main mode of transmission. Tinea pedis is more frequent among adults than children and more among those with the previous infection with the disease, diabetes mellites, abnormally increased sweating, and the disease is common among individuals who wear unventilated (occlusive) footwear. Tinea pedis is 2-4 times more common in men than females. Aim of the study: To study the epidemiological characteristics and risk factors of tinea pedis disease. Methods: Descriptive study was conducted on patients attending the dermatology outpatient clinic in Tikrit Teaching Hospital, Tikrit, Iraq. The study was done during the period from 1st November 2018-10th June 2019. The sample included 680 persons. The cases were diagnosed clinically and by a direct microscope. The demographic information of patients was obtained according to certain questionnaire design. The study was done to reveal the epidemiology of tenia pedis disease among affected patients. Results: The frequency of tinea pedis cases among the study sample was 7% (48/ 680). It has been observed that there was no significant association as a result of the difference in gender, body weight, positive family history, history, presence of fungal skin disease, and presence of nail trauma. On the contrary, a significant association was observed as a result of the presence of the young age group, diabetes mellitus, and history of wearing occlusive shoes. Conclusion: The frequency of tinea pedis disease among the study sample was 7%. There was a significant association between age group and the presence of diabetes mellitus disease and wearing occlusive shoes.

Objective: Pro- inflammatory cytokines including Interleukin (IL)-18 have been shown to be involved in the clearance of Hepatitis C virus (HCV) infection. However, changes in the balance of pro- and anti-inflammatory cytokines production during the immune response, can elicit a variety of liver damages. Therefore, it is of interest to study IL-18 serum levels in hepatitis patients and its correlation with HCV infection. Methods: Twenty-nine newly diagnosed HCV+ patients with no history of antiviral therapy, and 17 healthy controls, were enrolled in our study. Biochemical markers of liver disease were evaluated by biochemistry assay kits. Serum concentrations of IL-18 were determined with the ELISA method before and after treatment with pangenotypic direct-acting antivirals (DAAs) treatment. Results: Our results showed statistically significant difference in serum levels of IL-18 in HCV+ patients (692.261 ± 48.76) compared to healthy controls (520.00 ± 44.73) (P=0.021). However, there was no significant difference in IL-18 serum levels between the treated group compared to untreated patients (P=0.74). No significant correlations were detected between the level of IL-18 and liver enzyme levels. Conclusion: According to our study, IL-18 might be a disease marker associated with HCV infection; however, this conclusion requires further investigation.

Background: HIV can interrupt the normal development of bone marrow cell lines. Bone marrow aspiration/biopsy (BMA/B) has been described as a diagnostic tool in AIDS patients with fever of unknown origin (FUO). In this review, we aimed to study patients with AIDS who had undergone a BMA/B to investigate FUO and describe the pathologies diagnosed in the biopsy. Methods: Thirty-four BMA/B samples were collected from AIDS patients admitted for work-up of FUO to the infectious disease ward of a tertiary referral HIV center in Tehran, Iran, between September 2014 and September 2015. Data including age, sex, duration of disease, CD4 cell counts, hepatitis B (HBV) and C (HCV) coinfection, the primary presentation of AIDS, and the treatment history were retrieved and analyzed. Patients underwent BMA/B. An expert pathologist reviewed the BMA/B specimens. Results: The mean age of the patients was 37.5 years (range, 26-56), and 27 (79%) were men. Twenty-seven (79%) patients contracted HIV from injection drug use, and 7 (21%) via sexual transmission. Only 3 (9%) of the BMA/B examinations were normal. Hypocellular bone marrow was diagnosed in 22 (65%) patients. Other pathologies included granulomas in 6 (18%), hematologic malignancies in 2 (6%), and leishmaniasis Aspergillosis, each in 1 (3%) patient. Six (17%) of the specimens were found to have tuberculosis infections. Conclusion: Hypocellular bone marrow was the most common pathology on BMA/B examinations, followed by the presence of granulomas. Tuberculosis, Aspergillosis, and Leishmaniasis the opportunistic infections diagnosed on BMA/B specimens. Our results support BMA/B as an appropriate diagnostic tool for early diagnosis of opportunistic infections and malignancies in AIDS. BMA/B is indispensable in the armament of diagnostic tools of the physicians managing AIDS patients.

Background: Laghman province, in the east of Afghanistan, is one of the most malaria endemic regions with prominence of Plasmodium vivax and Plasmodium falciparum. So far, no study has been conducted to investigate the extent of mixed infections in this area. Objective: In this study, we aimed to evaluate the prevalence of mixed infections of malaria in Laghman province by using a new and highly sensitive molecular method (real-time polymerase chain reaction high resolution melting analysis) and compare its results with microscopically confirmed cases of malaria. Methods: In general, 347 infected individuals have been referred to Khalwati laboratory that is located in the center of Laghman province from May to November of 2018. Microscopic analysis was performed on prepared thick and thin blood films under 00 lens with oil immersion. The real- time-PCR-HRM assay was performed using an ABI 7500 Fast Real-time PCR system. Results: In a microscopic examination, out of 347 patients referred to the Center, 267 (76.94%) cases were detected to be Plasmodium vivax, 79 (22.76%) Plasmodium falciparum and 1 (0.28%) case of mixed of two species. However, by using Real-time PCR-HRM technique, 249 (71.75%) were detected Plasmodium vivax, 79 (22.76%) were Plasmodium falciparum and 19 (5.47%) were mixed of two species. Conclusion: Our result indicated that the Real-time PCR-HRM method is more accurate and more reliable than microscopic method in the diagnosis of malaria mixed infections.

Background: Considering the emergence of multidrug resistance (MDR) in prevalent human fungal pathogen, Candida albicans, there is a parallel spurt in the development of novel strategies aimed to disrupt MDR. Compounds from natural resources could be exploited as efficient antifungal drugs owing to their structural diversity, cost effectiveness and negligible side effects. Objective: The present study elucidates the antifungal mechanisms of Vanillin (Van), a natural food flavoring agent against Candida albicans. Methods: Antifungal activities were assessed by broth microdilution and spot assays. Membrane and cell wall perturbations were studied by PI uptake, electron microscopy, plasma membrane H+ extrusion activity and estimation of ergosterol and chitin contents. Mitochondrial functioning was studied by growth on non-fermentable carbon sources, rhodamine B labeling and using retrograde signaling mutants. Gene expressions were validated by semi-quantitative RT-PCR. Results: We observed that the antifungal activity of Van was not only limited to clinical isolates of C. albicans but also against non-albicans species of Candida. Mechanistic insights revealed the effect of Van on cell surface integrity as evident from hypersensitivity against membrane perturbing agent SDS, depleted ergosterol levels, transmission electron micrographs and diminished plasma membrane H+ extrusion activity. In addition, spot assays with cell wall perturbing agents, scanning electron micrographs, delayed sedimentation rate and lower chitin content further substantiate cell wall damage by Van. Furthermore, Van treated cells underwent mitochondrial dysfunctioning via impaired retrograde signaling leading to abrogated iron homeostasis and DNA damage. All the perturbed phenotypes were also validated by RT-PCR depicting differential regulation of genes (NPC2, KRE62, FTR2 and CSM3) in response to Van. Conclusion: Together, our results suggested that Van is promising antifungal agent that may be advocated for further investigation in therapeutic strategies to treat Candida infections.

Background: In recent years, great progress has been made in reducing the high level of malaria suffering worldwide. There is a great need to evaluate drug resistance reversers and consider new medicines against malaria. There are many approaches to the development of antimalarial drugs. Specific concerns must be taken into account in these approaches, in particular the requirement for inexpensive and simple new therapies and the need to limit drug discovery expenses. Important ongoing efforts are the optimisation of treatment with available medications, including the use of combination therapy, the production of analogs of known agents and the identification of natural products, the use of compounds originally developed against other diseases, the assessment of overcoming drug resistance and the consideration of new therapeutic targets. Liver and spleen are the important organs which are directly associated with malarial complications. Aim: An analysis of the Activity of Adenosine Triphosphatase, Aryl Hyrocarbon Hydroxylase Enzymes and Malondialdehyde in spleen Explant Culture. Objective: To determine in vitro effectof Chlorquine and Picroliv on Plasmodium Berghei induced alterations in the Activity of Adenosine Triphosphatase, Aryl Hyrocarbon Hydroxylase Enzymes and Malondialdehyde in spleen Explant Culture. Materials and Methods: 1-Histological preparation of spleen explants for paraplast embedding. 2- Biochemicalstudies (Enzymes (Atpase, ALP) and the level of protein, Malondialdehyde (MDA). Results: Splenomegalyis isone of the three main diagnostic parameters of malaria infection besides fever and anaemia. Many enzymes present in the liver and spleen may also be altered or liberated under different pathological conditions. Enzymes (ATPase, ALP) and the level of protein, Malondialdehyde (MDA) content was found to increase in the liver and spleen explants during malarial infection. In the liver and spleen derived from parasitized CQ treated animals, the activity of all the above enzymes (ATPase, ALP) and the level of protein & MDA of liver/spleen reversed towards the normal for all the 4 or 3 days of incubations. Picroliv efficacy decreased with the increment of parasitaemia and at 60% parasitaemia. Conclusion: Alkalinephosphatase (ALP) was found to increase with increasing parasitaemia. After the addition of Picroliv to the medium, a decrement in the activity was observed up to day 4 of culture. A similar positive effect of Picroliv was observed on the ATPase and ALP activity of spleen explants. DNA and protein contents also increased in the parasitized liver cultured in the presence of picroliv. On the contrary, in the spleen explants DNA, protein and MDA content were found to decrease after Picroliv supplementation to the culture medium.

Background: Dental caries is the most common and one of the prevalent diseases in the world. Streptococcus mutans is one of the major oral pathogens that cause dental caries by forming a biofilm on dental tissues, degrading dental enamel and consequent cavitation in the tissue. In vitro selection of drug targets is a laborious and expensive process and therefore, computational methods are preferable for target identification at the initial stage. Objective: The present research aims to find new drug targets in S. mutans by using subtractive proteomics analysis, which implements various bioinformatics tools and databases. Methods: The proteome of S. mutans UA159 was mined for novel drug targets using computational tools and databases such as: CD-HIT, BLASTP, DEG, KAAS and CELL2GO. Results: Out of 1953 proteins of S. mutans UA159, proteins that are redundant, homologous to human and non-essential to the pathogen were eliminated. Around 178 proteins already available in drug target repositories were also eliminated. Possible functions and subcellular localization of 32 uncharacterized proteins were predicted. Substantially, 13 proteins were identified as novel drug targets in S. mutans UA159 that can be targeted by various drugs against dental caries. Conclusion: This study will effectuate the development of novel therapeutic agents against dental caries and other Streptococcal infections.

Background: Soil-transmitted parasites (STPs) are significant intestinal parasites that infect humans and animals and impose considerable burdens on human society and animal husbandry industries. Therefore, the present study aimed to determine the prevalence of parasitic elements of soil samples collected from the north of Iran. Methods: A total of 256 soil samples were collected from public parks, public places, vegetable gardens, sand heaps, and shadow areas near houses in the north of Iran and examined using the sucrose flotation method. Results: Out of 256 examined samples, 131 (51.2%) showed parasitic contamination, including larvae (43%), oocysts (14.1%), and different eggs (6.6%). According to the results, the most and least common parasites observed in the samples were larvae (43%), as well as Toxascaris leonina, and Trichuris trichiura (0.4%), respectively. Moreover, the most and least contaminated locations were sand heaps (62.5%) and shadow areas near houses (45.6%), respectively. Regarding cities, Behshahr (68.3%) and Sari (67.5%) had the highest contaminated soil samples, whereas Chalus (37.5%) showed the lowest contamination. On the other hand, rural samples showed more contamination compared to urban areas (P< 0.05). Conclusion: The findings of the present study indicate that the overall prevalence of STPs in examined areas and highly contaminated soil samples can be considered as a potential source of human contamination particularly tourists with STPs.

Background: Nocardia species are important cause of infections in humans but are underreported due to missed diagnosis as well as misdiagnosis. Majority of the literature on these infections consists of case reports or series with few articles describing high number of cases. Objective: To study the epidemiology of Nocardia infections in a tertiary care center. Materials and Methods: This retrospective observational study was done in a tertiary care centre of North India over a period of 10 years (2007-2016). The detection of Nocardia spp. from clinical specimens was done by conventional methods viz. direct microscopy (Gram’s stain, modified Ziehl -Neelsen stain [1%], KOH examination) and culture. Results: A total of 25 cases of nocardiosis were diagnosed during the study period. The mean age of the patients was 50.9 years (range 30-72 years) with a male:female ratio of 3:2. The site of disease in these patients included pulmonary (n=18), cutaneous (n=4), perinephric abscess (n=1), ocular (n=1) and bone (n=1). Risk factors associated were underlying lung disease (n=11), smoking (n=7), diabetes (n=5) and steroid therapy (n=4) in pulmonary nocardiosis, iatrogenic (n=1) and leprosy (n=1) in cutaneous nocardiosis, diabetes in perinephric abscess and cataract surgery in ocular nocardiosis. Culture was positive in 12/25 (48%) patients for Nocardia spp. Direct microscopy was positive in 22 patients. We wish to highlight that meticulous observation of KOH wet mount examination helped in clinching the diagnosis of Nocardiosis in 3 cases which were earlier missed by other methods. Conclusion: Good communication with the clinician alongside a meticulous effort in the laboratory is essential for appropriate diagnosis and management of these cases.

Background: Studies have shown that selenium is an essential component of glutathione as an important antioxidant to reduce oxidative stress and inhibit intracellular parasites’ growth. In contrast, calcium in the cytosol of such parasites plays a key role in the entry of the parasite into the host cell and its primary motility. Aims and Objectives: The present study was designed to evaluate and compare glutathione peroxidase bioactivity effects post administration of selenium and calcium in BALB/c mice infected by Toxoplasma gondii. Methods: Sixty BALB/c mice susceptible to T. gondii were randomly divided into twelve groups of case and control groups. There were six control groups including two positive controls infected only with the parasites either 10⁴ or 5×10⁴, non-infected and untreated groups. Treated controls received only calcium, selenium, or both respectively. Case groups were infected with 10⁴ or 5×10⁴ parasites. While each set of three case groups separately received minerals alone or together. Mice were orally fed with 200 μg selenium, 50 μg calcium or their combination for 7 days. Mice were infected by parasite’s tachyzoites. Sera of mice were kept and the peritoneal macrophages were isolated for counting tachyzoites during infection. Results: The results showed that selenium unlike calcium was significantly effective in reducing Toxoplasma tachyzoites compared to control groups. Moreover, glutathione peroxidase [GPX] activity was elevated in mice treated with selenium and vice versa decreased in mice treated with calcium. Conclusion: Administration of selenium unlike calcium reduced Toxoplasma tachyzoites proliferation by elevating bioactivity of selenium-dependent detoxification enzyme, GPX.

Background: Methicillin-resistant staphylococcus capitis (MRSC) NRCS-A clone (Multi- resistant and vancomycin-non susceptible) has been recently described as an emerging cause of nosocomial bacteremia, especially in neonatal intensive-care units (NICUs). Objective: The objective of this study was to evaluate the antibiotic and antiseptic resistance patterns, biofilm-producing ability and the prevalence of SCCmec and ACME types among MRSC isolates as well as to check the possible presence of NRCS-A clone at Tehran’s Children's Medical Center, Iran. Methods: A total of 256 coagulase-negative Staphylococcal isolates were collected, of which 10 S. capitis isolates were obtained and tested for susceptibility against 13 antimicrobial and 3 antiseptic agents, as well as biofilm production. The presence of 15 distinct resistance genes, staphylococcal cassette chromosome mec (SCCmec), and arginine catabolic mobile elements (ACMEs) were tracked. Results: Seven out of 10 S. capitis isolates were MRSC (MIC90 van=8μg/mL) and resistant to trimethoprim/sulfamethoxazole, produced biofilm, (3 as strong biofilm producers) and carried ACME types I and II. Despite the identification of mec and ccr complexes in some isolates, all the SCCmec cassettes were untypeable (UT). Conclusion: According to the studied features, only one isolate belonged to the NRSC-A clone. The results indicate that MRSC with high antibiotic resistance and unknown SCCmec might become a serious problem in the future for the treatment of patients, particularly children.

Background: In the last decade, several cases of cutaneous leishmaniasis (CL) have been recorded by the provincial health center of Mazandaran Province, northern Iran. However, there is no documented report of autochthonous CL in the province yet. Case Presentation: The patient, a 59-year-old female, known case of diabetes mellitus, lived in therural area of Kiasar district (in theeastern part of the Mazandaran) with 5 skin lesions suspected of having vasculitis, without ahistory of traveling to the endemic areas of CL,was admitted to Imam Khomeini teaching hospital, Sari. To rule out CL, fine needle aspiration(FNA)procedure was used aseptically for the patient. Laboratory investigations showed Leishman bodies (amastigotes) by direct smear preparation, and species identification confirmed Leishmania major (L. major) by polymerase chain reaction (PCR)molecular method. Accordingly, this is the first documented report of autochthonous CL in Mazandaran Province. Conclusion: Overall, due to the abundance of probable rodent reservoir hosts and confirmation of infectionof sandflies (Phlebotomus papatasi) withL. major in the Kiasar district, where our patient was livingthere, it seems that CL emerged in the eastern part of the province. Therefore, further studies on rodents and sandflies fauna in terms of emerging leishmanial infection in the area is recommended.

Background: Recently, COVID-19 infection has become a public health concern. On March 12th, 2020, the World Health Organization (WHO) announced it as a global pandemic. Early diagnosis of atypical cases of COVID-19 infection is critical in reducing the transmission and controlling the present pandemic. In the present report, we described a patient with the chief complaints of dyspnea and dry cough referred to the oncology center at Imam Khomeini Hospital, Tehran, with the differential diagnosis of lung cancer who was diagnosed and treated for COVID-19 infection in follow up. Case Presentation: A 59-year-old patient complained of fever, dry cough, and dyspnea from two weeks ago. The patient had been referred to this center with the differential diagnosis of lung cancer due to the massive pleural effusion in the initial chest CT scan. Dyspnea was the patient’s main complaint at the time of admission in this center and the oxygen saturation was 84%. In the new chest CT scan, similar findings were observed. Due to the severe respiratory distress, a chest tube was placed in the chest cavity to remove the pleural effusion fluid on day one. The patient’s felt relieved immediately after the procedure; however, the oxygen saturation did not rise above 85% despite the oxygen therapy. The cytology of pleural fluid was negative for malignant cells. On day 2, the lymphopenia and high level of CRP suggested the COVID-19 infection. Therefore, a control chest CT scan was conducted and the test for COVID-19 was performed. The CT report indicated the clear pattern of COVID-19’s lung involvement in the absence of pleural effusion. Thus, the treatment for COVID-19 was immediately initiated. On day 4, the test reported positive for COVID-19. Conclusion: Currently, it is important to bear in mind the COVID-19 infection in evaluating patients with respiratory symptoms. This report indicated how misleading the presentation of a chest CT scan could be in clinical judgment. Therefore, we recommend ruling out the COVID-19 infection in all the patients with any pattern of lung involvement to avoid missing the potential cases of this vicious infection.