Tropical Medicine Research Center Research Articles

Treatment of Patients with Community-Acquired Pneumonia: Official Practice Guideline of the Infectious Diseases and Tropical Medicine Research Center Advisory Committee

Context: Community-acquired pneumonia (CAP) refers to pneumonia attained outside the hospital or less than 48 hours before admission, which is a significant cause of mortality and morbidity, especially in major comorbidities and older age. Several microorganisms contribute to developing CAP, primarily Streptococcus pneumonia, Haemophilus influenza, Moraxella catarrhalis, and atypical pathogens, e.g., Mycoplasma pneumonia. The incidence of these microorganisms depends on outpatient or inpatient settings. Administering appropriate treatment among available antibiotics is a critical issue affecting patient survival. Methods: With a multidisciplinary panel expert, this document offers evidence-based recommendations for managing CAP in Iran. Results: The document evaluated the availability of antimicrobial agents and local antibiotic resistance patterns based on 94 relevant published studies from Google Scholar, Scopus, PubMed, Scientific Information Database (SID), Iran Medex, Iran doc, Mag Iran, PubMed, and expert opinions. Conclusions: The panel addressed two main parts of rational recommendations for managing outpatients or hospitalized patients with CAP.

Keynote Message - Dr. Anthony S. Fauci

Warm greetings to you all. My name is Dr. Tony Fauci, and I am the Director of the National Institute of Allergy and Infectious (NIAID) at the U.S. National Institutes of Health and Chief Medical Adviser to President Joe Biden. I sincerely appreciate being asked to help open the National Academy of Science and Technology, Philippines’ 43rd Annual Scientific Meeting with its focus on learning from the past to inform the future. Among the most important lessons we have learned from the COVID-19 pandemic is that sustained biomedical research is essential to global well-being, as manifested by the successful development of highly effective vaccines against SARS-CoV-2. We also have seen that an effective response to emerging infectious diseases requires international scientific cooperation. Keeping in mind the theme of this meeting, I would like to briefly highlight the value and importance of research cooperation between the United States and the Philippines while expressing my hope that this cooperation will continue and thrive in the coming years. The institute I lead, NIAID, has supported US and Filipino scientists working together for more than 30 years. As we now fight SARS-CoV-2, HIV, and other viral diseases together, our efforts continue to grow when scientific importance and public health value. Over the years, much productive NIAID supported collaborative research in the Philippines has focused on HIV and tuberculosis co-infections. Talented Filipino scientists from your outstanding institutions have participated in multiple AIDS clinical research networks that have advanced the global understanding of HIV prevention, treatment, and care particularly while addressing TB as a comorbidity in resource challenge settings. Participation of the Philippines in these multi-country networks has helped ensure that your scientists are among the core of key contributors advancing biomedical discoveries that have made AIDS a preventable chronic disease rather than an acute one with a high degree of mortality. In addition to participation in HIV/AIDS research, Filipino scientists have helped lead the way in studies of tuberculosis particularly multidrug-resistant TB (MDR TB). The work in the Regional Prospective Observational Research in Tuberculosis (RePORT) network has been especially important and promising. With continuing support from the Department of Science and Technology (DOST), the Philippines is sure to make significant contributions to the global fight against TB. Philippine institutions also have played an important in other infectious diseases research. For example, Filipino scientists continue to lead research on dengue (another flaviviruses), malaria, and schistosomiasis building on prior NIAID support for Filipino studies on these pathogens. For many years the Research Institute for Tropical Medicine (RITM) received NIAID funding as a tropical medicine research center of excellence. Hopefully, this institution and others will continue to receive Philippine government support so that they will remain competitive for both funding and talent. Given this track record, I also can foresee great value in the Philippines expanding its scientific leadership role in the Asia-Pacific region. In this regard, we are pleased to partner with the Department of Science and Technology through the e-ASIA Joint Research Program (e-ASIA JRP). In the future, this program–which supports collaborative research involving US and Filipino scientists–has the potential of adding real value to our overall research efforts, as long as it is adequately supported by all the participating agencies. In closing, I want to emphasize the importance of sustained local support for scientists and scientific institutions in the Philippines and elsewhere. This support is necessary foundation to attract funding from outside the country. It is also an essential element for economic vitality and growth. In addition, as we have seen with COVID-19, science–particularly biomedical research–is fundamentally important to pandemic preparedness and effective outbreak responses that save lives and stabilize societies. Fortunately, the Philippines has long recognized the value of science. Just four (4) months ago, we saw this again when NIAID and DOST jointly sponsored a special COVID-19 workshop focused on research findings and scientists in this region. With the success of that workshop, we look forward to convening the 2022 emerging infectious diseases of the Pacific Rim Conference which DOST has offered to co-host along with NIH and Japan’s AMED. Thank you again for a long-standing scientific partnership and for the continuing commitment of the Philippines to the global research enterprise. Through decades of collaboration, we have learned from each other and share the tradition of excellence in science and technology particularly in biomedical research. I am confident that our future collaborations will continue to contribute to scientific discovery through basic and clinical research and the training of the talented new scientists. I wish you every success with your 43rd Annual Scientific Conference and with the implementation of its results.

Left ventricular systolic dysfunction predicted by artificial intelligence using the electrocardiogram in Chagas disease patients-The SaMi-Trop cohort.

BackgroundLeft ventricular systolic dysfunction (LVSD) in Chagas disease (ChD) is relatively common and its treatment using low-cost drugs can improve symptoms and reduce mortality. Recently, an artificial intelligence (AI)-enabled ECG algorithm showed excellent accuracy to detect LVSD in a general population, but its accuracy in ChD has not been tested.ObjectiveTo analyze the ability of AI to recognize LVSD in patients with ChD, defined as a left ventricular ejection fraction determined by the Echocardiogram ≤ 40%.Methodology/principal findingsThis is a cross-sectional study of ECG obtained from a large cohort of patients with ChD named São Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) Study. The digital ECGs of the participants were submitted to the analysis of the trained machine to detect LVSD. The diagnostic performance of the AI-enabled ECG to detect LVSD was tested using an echocardiogram as the gold standard to detect LVSD, defined as an ejection fraction <40%. The model was enriched with NT-proBNP plasma levels, male sex, and QRS ≥ 120ms.Among the 1,304 participants of this study, 67% were women, median age of 60; there were 93 (7.1%) individuals with LVSD. Most patients had major ECG abnormalities (59.5%). The AI algorithm identified LVSD among ChD patients with an odds ratio of 63.3 (95% CI 32.3–128.9), a sensitivity of 73%, a specificity of 83%, an overall accuracy of 83%, and a negative predictive value of 97%; the AUC was 0.839. The model adjusted for the male sex and QRS ≥ 120ms improved the AUC to 0.859. The model adjusted for the male sex and elevated NT-proBNP had a higher accuracy of 0.89 and an AUC of 0.874.ConclusionThe AI analysis of the ECG of Chagas disease patients can be transformed into a powerful tool for the recognition of LVSD.

Disease Severity in Cancer Patients Infected With SARS-COV-2: An Ambiguous Issue.

To the Editor: Patients with cancer are considered more susceptible to SARS-CoV-2 infection. One of the serious complications of COVID-19 is hyperactivation of the immune system, which induces an uncontrolled production of cytokines that poses a high mortality. Although a weakened immune system may be harmful in the initial phase of COVID-19, the phase that the immune response is necessary to inhibit viral replication, in immunocompromised patients, an attenuated inflammatory response may not be associated with development of severe COVID-19 and also cytokine storm, due to suppression of some pathway of cellular or humeral responses1; hence, immunosuppression might have a beneficial effect on the cytokine release storm phase of COVID-19 in these groups of patients. On the other hand, several immunosuppressive drugs and chemotherapeutic agents used in these patients that have direct inhibitory effects on SARS-CoV-2 replication in vitro or induce potentially increased vulnerability to this virus are known.2 With the onset of the coronavirus pandemic, studies on the relationship between viral load and disease severity have been performed. It is unknown whether viral load really affects the disease severity or not. Some studies showed that viral load has important prognostic implications and could therefore help identify patients who are at highest risk for adverse outcomes. In addition, it was shown that, compared with patients with mild disease, those with severe disease showed higher viral load and a later shedding peak.3,4 On the other hand, it has been shown that viral load based on cycle threshold values seem to be different in solid tumors versus hematologic malignancies in patients undergoing chemotherapy. One study showed that patients with hematologic malignancies had higher viral loads than did patients with solid tumors or patients without cancer. This finding may be from the underlying immunodeficiencies and therapies administered that confer a decreased ability to inhibit the proliferation of a virus without a statistically significant increase in mortality among patients with hematologic malignancies versus patients with solid tumors or patients without cancer.5 In another study, Ju et al6 reported 2 cancer patients, 1 with critical type and 1 asymptomatic carrier, who were undergoing or just completed chemotherapy treatment, respectively, with favorable outcomes after being infected with COVID-19. The authors reported a low viral load level in both patients despite receiving chemotherapy. Whether cancer itself is an independent risk factor for severe COVID-19 remains to be clarified. What seems to be important is not a single factor, but the host immune system, viral load, immunosuppressive drugs' effects on virus replication and phase of disease, and chemotherapy may play a role that determines the severity of the disease. More studies are needed to clarify this association. Masoud Mardani, MDAtousa Hakamifard, MD Infectious Diseases and Tropical Medicine Research Center Shahid Beheshti University of Medical Sciences Tehran, Iran [email protected]

Methodology and Early Results of the First Surveillance Program on Prevention and Control of Antimicrobial Resistance in Isfahan, Iran: The IAS-I Study.

Background:Isfahan Antibiotic Resistance Surveillance System-1 has been instituted in Isfahan, Iran to construct a project for surveillance of clinically significant bacteria, and to help raise a logic regional stewardship program for prevention and control of disseminating-resistant organisms.Methods:During March 2016 to March 2018, an antibiotic resistance surveillance system was designed and implemented by Isfahan Infectious Diseases and Tropical Medicine Research Center. The surveillance program was implemented in three general hospitals in Isfahan. In addition to the routine microbiology data, clinical data (differentiation between true infections and contamination, healthcare-associated infections (HCAI) and community-acquired infections (CAI), as well as determination of the infection site) were obtained and analyzed by WHONET software.Results:During a 2-year period, from 7056 samples that revealed growth of bacteria, 3632 (51.5%) isolates were detected as contamination and 3424 (48.5%) true bacterial isolates were identified. Of these, about 32% of isolates were recognized as HCAI. Totally, the most recognized infections were urinary tract infection, bloodstream infection and skin and soft tissue infections. In patients with HCAIs, 70% of isolates were gram negative and in patients with CAIs 73% isolates were gram negative bacteria.Conclusions:The strength of the project is gathering enough clinical information in addition to microbiologic data, which would increase application of the results for empiric treatment and prevention of the infectious diseases in clinical settings.

Correction to: Lack of relationship between PTEN 32-bp and TP53 16-bp Ins/Del polymorphisms and chronic hepatitis B virus infection.

[This corrects the article DOI: 10.1007/s13337-017-0391-7.].

Hepatitis A Virus Infection

Children and Adolescents Health Research Center, Aliebn-E-Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, IR Iran Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran Corresponding author: Batool Sharifi-Mood, Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran. Tel: +98-5433228101, Fax: +98-5433236722, E-mail: batoolsharifimood@yahoo.com

Application of Immunocytochemistry on Oral Smears: A Noninvasive Method for Early Detection of Cellular and Molecular Changes in High-Risk Populations

Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran Department of Histology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, IR Iran Corresponding author: Bita Moudi, Department of Histology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, IR Iran. Tel/Fax: +98-5433295794, E-mail: bita.moodi@yahoo.com

Seasonal Influenza and Prevention

Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran Corresponding author: Batool Sharifi Mood, Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran. Tel: +98-5413228101-2, Fax: +98-5413236722, E-mail: batoolsharifimood@yahoo.com

Zika Virus Infection

Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran School of Medicine, Mashhad Univesrsity of Medical Sciences, Mashhad, IR Iran Corresponding author: Batool Sharifi-Mood, Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran. Tel: +98-54332281012, Fax: +98-5433236722, E-mail: batoolsharifimood@yahoo.com

Longitudinal study of patients with chronic Chagas cardiomyopathy in Brazil (SaMi-Trop project): a cohort profile

PurposeWe have established a prospective cohort of 1959 patients with chronic Chagas cardiomyopathy to evaluate if a clinical prediction rule based on ECG, brain natriuretic peptide (BNP) levels, and other...

Trophoblast Giant Cells, the Prime Suspects of Deficient Placentation Associated With Pregnancy Complications

Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran Department of Histology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, IR Iran Corresponding author: Nadia Sheibak, Nadia Sheibak, Department of Histology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, IR Iran. Tel: +98-5433295794, Fax: +98-5433295794. E-mail: nadia1989sh@yahoo.com

The Impact of Statin on Influenza Vaccine Efficacy in the Elderly and Patients With Acute Respiratory Illness

Copyright © 2016, Infectious Diseases and Tropical Medicine Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited. Statins are a class of drugs used to lower cholesterol levels by inhibiting the enzyme HMG-CoA reeducates. Considering the association between elevated cholesterol levels and the risk of cardiovascular diseases and because of studies show that statins can lower this risk, it is given to a large number of adults (1). In fact, it is estimated that more than one billion people worldwide take statins (2). Although the primary goal of statin therapy was to lower cholesterol levels, it was recognized that this drug class had other effects, including suppression of T-cell activation and immunomodulatory and anti-inflammatory effects (3, 4). Many patients who routinely take statins are the elderly who are at higher risk for the complications of influenza (5). Statins are beneficial for cardiovascular diseases due to their lipid-lowering effect (6). They also exhibit anti-inflammatory and immunomodulatory properties, which not only contribute to their impact on cardiovascular disease, but can also affect the clinical course of a variety of infectious processes, including sepsis, bacteremia, communityacquired pneumonia and laboratory-confirmed influenza. Furthermore, statins affect vaccine responsiveness in individuals, and their widespread use could influence overall vaccine effectiveness (VE) in a population (7-11). Based on a study, the immunosuppressive effect of statins on the vaccine immune response was most dramatic in individuals receiving synthetic statins. These effects were observed in both the adjuvanted and nonadjuvanted vaccine groups in the clinical trial. These results, if confirmed, could have implications both for future clinical trial designs, as well as vaccine use recommendations for the elderly (12). Also in another study, statin therapy was associated with reduced influenza VE against medically attended acute respiratory illness (MAARI). Many cases of MAARI are not caused by influenza; studies on the impact of statins on influenza VE against laboratory-confirmed influenza are needed (13). Researchers observed that statin users had a significantly reduced to immune response to vaccination compared to those not taking statins, as measured by the level of antibodies to the flu vaccine strains in the patients’ blood three weeks after vaccination. The effect was most dramatic in patients on synthetic statins, rather than naturally derived statins (14). Apparently, statins interfere with the response to influenza vaccine and lower the immune response, and it seems to also result in a lower effectiveness of influenza vaccines. If confirmed, the findings could support the preferential use of high-dose flu vaccine or vaccines containing adjuvants to boost immune response in the elderly, in an attempt to counteract the apparent effect (15, 16). Researchers in a study observed that vaccine effectiveness, to prevent serious respiratory illness, was lower among the patients taking statins compared to the ones not on statins, particularly when flu was widespread in the region. The findings have potential implications for guidelines regarding statin use in older adults around the vaccination time, but additional studies, including researches examining laboratory-confirmed cases of flu, are needed to provide more guidance (12, 13). In conclusion the results of these studies should be viewed as hypothesis-generating and should prompt further investigations on whether statins reduce inactivated influenza vaccine immunogenicity and, if so, the mechanisms by which immune responses and associated vaccine effectiveness are adversely affected.

Postoperative Meningitis: The Necessity of Establishing a National Comprehensive Program

1Skull Base Research Center, Loghman Hakim Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran 2Infectious Diseases and Tropical Medicine Research Center, Loghman Hakim Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran 3Anesthesiology Research Center, Loghman Hakim Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

Seroprevalence of Hepatitis B and C Virus Infection Among Barbers in Isfahan Province, Iran

1Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran 2Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran 3School of Medicine, Isfahan University of Medical Sciences, Isfahan, IR Iran 4Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran 5Department of Gastroenterology, Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran *Corresponding author: Behrooz Ataei, Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran. Tel: +98-3113359359, E-mail: ataei@med.mui.ac.ir

Comment on: “Mass Gatherings and Infectious Diseases Epidemiology and Surveillance”

Copyright © 2015, Infectious Diseases and Tropical Medicine Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

Is Hepatitis E a Vaccine Preventable Diseases?

Copyright © 2015, Infectious Diseases and Tropical Medicine Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited. Hepatitis E virus (HEV) is a positive-sense single-stranded RNA icosahedral virus with a 7.5 kilobase genome, which has 5 genotypes (1 to 5) (1, 2). HEV genotypes 1 and 2 are the most common causes of waterborne infections that mainly occur in resource-limited countries (3). The other pattern of transmission is from animals and humans (zoonotic transmission), caused by HEV genotype 3 or 4 and occurs widely in both resource-limited and developed countries (3). HEV infection can occur either in large epidemics in endemic regions and some parts of the Middle East or in sporadic forms in developed or developing countries (3, 4). HEV infection is a self-limited and clinical illness, similar to other forms of viral hepatitis except in pregnant women in whom the illness is particularly severe with a mortality rate of up to 25% (3, 4). Recently, Zhang et al. reported the long-term efficacy of hepatitis E vaccine as 86.8%, which is new and hopefully promising (5). Although hepatitis E is known to be a problem among people living in crowded and unsanitary conditions such as camps for refugees and internally displaced people, regarding the absence of precise data, the disease and its mortality are serious problems, which make it difficult to define the clinical and public health applications of hepatitis E vaccination (6). For example, in Bangladesh, a study in which standardized interviews were conducted with family members and caregivers to assess the cause of maternal deaths revealed that one in five deaths was related to jaundice; although the published data suggested that about half of those deaths could be related to hepatitis E (7). If the efficacy of HEV vaccine is determined to be pan-genotypic, several public health questions must be answered, including who and when should be vaccinated, as well as the cost-effectiveness of the vaccination as a prevention tool (8). Additional data regarding the safety, immunogenicity, and efficacy of the hepatitis E vaccine in pregnant women, patients with chronic liver disease, and other vulnerable groups are needed too (8). Before adding hepatitis E vaccination to the childhood vaccination schedule, safety and efficacy data, including its interaction with other vaccines (simultaneously) are needed in children less than 16 years of age. Also, field trial studies must be conducted to establish an effective vaccination series (9). Although studies of the vaccine suggest that 2 doses may effectively prevent hepatitis E, a well-designed evaluation of the effectiveness of fewer doses with shorter dosing schedules is required (9). The World Health Organization’s Strategic Advisory Group of Experts (SAGE) on immunization recently cited the need for additional data regarding the incidence of HEV infection and disease and the safety and efficacy of the vaccine before recommending routine hepatitis E vaccination in countries where hepatitis E is highly endemic (10). Hepatitis E vaccine could become a powerful tool in the prevention and control of HEV transmission and disease. Most immediately, it can have a role in curbing outbreaks of hepatitis E in humanitarian crises. The benefits of broad adoption of hepatitis E vaccine can be far-reaching, if studies reveal that vaccination protects against all HEV genotypes and is safe and effective when used in people at high risk for hepatitis E-related illness and death, including pregnant women (5). In Iran, pigs and other animals have a minor role in HEV infection (11), so other measures such as preparing sanitary water for agriculture, especially vegetables, avoiding contamination of water pipelines with sources of infection, improving public awareness to preserve the hygiene of water, and enhancing epidemiological knowledge regarding HEV infection seem highly important for better application of HEV vaccine prevention program.

Malaria in Children

Copyright © 2015, Infectious Diseases and Tropical Medicine Research Center; Published by DOCS. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited. Dear editor,

HIV/AIDS Good News and Bad News

Copyright © 2014, Infectious Diseases and Tropical Medicine Research Center; Published by Kowsar. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited. Thirty years into the HIV epidemic, it is time of celebration for successes in dealing with HIV combination antiretroviral therapy (cART), effective prevention of mother to child transmission (PMTCT), treatment as prevention, and effective opportunistic infections prophylaxis, which has been resulted increasing life expectancy of persons living with HIV (1). Moreover with the tools we have to prevent (pre exposure prophylaxis, condoms, circumcision) and treat HIV, certain groups have experienced declines in HIV incidence (2). Now days, most experts agree that HIV infection is no longer a death sentence. Instead, it is a chronic, long-term disease (1). Before 1995, a newly infected person faced the near-certainty of dying with AIDS. Today a newly infected person can look forward to 24 years and potentially much more! of living with HIV (3). Very few pregnant women with HIV/AIDS pass on the disease to their unborn children. Without HIV treatment, one in four pregnant women with HIV or AIDS transmits the virus to their babies (4). The CDC reports that in 1992, 885 children developed AIDS; in 2005, that number decreased to 57 children a 93 percent decline (5). Although the HIV good news is an honor, yet some of the obstacles threats eradication and struggle of this disease. Despite many treatment and prevention successes to combat the HIV epidemic, people are still dying from AIDS. In 2006, HIV was the third leading cause of death for black men and women 35 to 44 years old and the fourth leading cause of death for Latino men and women of the same age (6). From the start of the HIV epidemic through 2007, more than 576,000 people in the United States have died from AIDS (5). For instance, the incidence of HIV among youth and young adults between 12 and 24 years of age has increased over the past five years, while other populations have experienced a decline in their rates of infection (5). The increase is probably related to a combination of increased testing, lack of awareness of HIV status, continued high-risk behaviors, and some disinhibition regarding the potential risks and implications of an HIV diagnosis (7). It is estimated that 50% of persons with HIV acquired the infection during their adolescent or youth years, presenting to care later (7). Men having sex with men (MSM) make up only 2 percent of the United States population, but they accounted for 61 percent of all new HIV infections in 2009. Men who have sex with other men report higher rates of condom use and HIV testing than other groups, but they still have the highest rates of infection (8). Overall, there is plenty of reason to celebrate the achievements of the last 33 years of success, and plenty of hope for the future. Also there is optimism around the possibility of a genuine cure for HIV being developed within the next few decades. Also, the launch of a new strategy to develop a cure, involving scientists, policy makers, funders and people living with HIV seems highly vital.

Dalbavancin, Oritavancin and Tedizolid are Safe and Effective for Skin Infection Treatment

Copyright © 2014, Infectious Diseases and Tropical Medicine Research Center; Published by Kowsar Corp. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Acute bacterial skin and skin structure infections are among the most common reasons for hospitalization of adults (1). These infections are most often caused by Staphylococcus aureus and streptococci (2). Methicillin-resistant S. aureus (MRSA) account for many of these infections and present a particular treatment challenge because current therapies are limited by toxicity, resistance, or the lack of an oral formulation (3). Patients with skin or skin structure infections have three new antibiotic options, which have similar efficacy and safety profiles as vancomycin. Glycopeptides, such as vancomycin are the most available agents with in vitro and in vivo activity against gram-positive infection. Dalbavancin (Durata Therapeutics) is a lipoglycopeptide antibiotic agent with in vitro and in vivo activity against gram-positive pathogens and a minimal inhibitory concentration (MIC) of this agent is required to inhibit the growth of 90% of the isolates (MIC90) (4). Oritavancin, a synthetic analog of vancomycin that also has activity against gram-positive bacteria. In a double-blind, placebo-controlled study, oritavancin and IV vancomycin were compared for the treatment of patients with acute bacterial skin and skin structure infection (SOLO I); patients were randomly assigned to receive either a single-dose intravenous oritavancin or intravenous vancomycin twice daily and treatment was successful for 82.3% of the oritavancin group and 78.9% of the vancomycin group (5). Tedizolid is a novel oxazolidinone antibacterial drug designed to provide enhanced activity against gram-positive pathogens. The efficacy and safety of intravenous and oral tedizolid for treatment of patients with acute bacterial skin and skinstructure infections has been established by some studies. Intravenous to oral once-daily tedizolid 200 mg for 6 days is non-inferior to twice-daily linezolid 600 mg for 10 days for treatment of patients with acute bacterial skin and skin-structure infections. Tedizolid could become a useful option for the treatment of acute bacterial skin and skin-structure infections in the hospital and outpatient settings (6). Studies have shown that the efficacy of dalbavancin administered once weekly, Oritavancin single dose and tedizolid 200 mg daily for 6 days are not inferior to that of a conventional twice daily antibiotic regimen with vancomycin or other glycopeptides and the early primary end point of cessation of the spread of infection and the absence of fever showed a consistent treatment effect regarding a reduction in the area of infection (4-6). Patients treated with dalbavancin had fewer adverse events than those treated with vancomycin and linezolid. However, further evaluation and monitoring is necessary as more patients are exposed to these agents; according to preliminary data, the adverse-effect profile of oritavancin and dalbavancin of these lipoglycopeptides is generally similar to that of drugs currently used to treat severe gram-positive infections (7). In the recent years, despite of suitable treatments in terms of cost befit and availability for gram-positive infections in Iran, it seems that the old treatment of gram-positive infection such as vancomycin is still prescribed by Iranian physicians. Studies comparing new and old treatments can lead Iranian physicians to optimal choice for treatment of gram-positive infections.