Pasteur Institute of Iran

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Pneumococcal endocarditis is an uncommon disease. Here, we describe a case of endocarditis caused by Streptococcus pneumoniae in a young man following a nose trauma. In traumas that involve the respiratory system and the mucous membrane, bacterial complications such as colonization and bacteremia and end-organ involvement should be considered by physicians.

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Ticks harbor many pathogenic, as well as endosymbiotic and non-pathogenic agents. They are host of a variety of as yet unidentified microbes that continue to be described. In the present study, a Brucella-like bacterium was detected in a Boophilus tick by PCR amplification of a partial fragment of 16S rRNA locus followed sequencing. Our results show that the members of the genus Boophilus may act as vectors of brucellosis in nature, but further studies are required to confirm the real role of ticks as vector or reservoirs of specific Brucella species.

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A 79-year-old male presented with an ulcerated lesion on the glans penis. Histopathological evaluation of the biopsy from the lesion revealed the presence of Leishmania amastigotes and confirmed the diagnosis of cutaneous leishmaniasis. The patient was treated with several sessions of cryotherapy; the lesion healed and left no scar.

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This study reports an Ophidascaris sp. infection in the gastrointestinal tract of a python snake found at a construction site in Labone, a suburb of Accra and the capital city of Ghana. Examination of the rectal contents of the snake by the zinc sulfate centrifugal floatation method revealed helminths eggs. Besides, examining various sections of the alimentary canal revealed adult worms of the genus Ophidascaris in the anterior half of the small intestine just below the stomach's pyloric sphincter. Also, milking one of the female worms onto a microscope slide and examining the exudate by microscopy following staining with Lugol's iodine dye revealed eggs. Our findings may alert the possibility of zoonotic transmission of the parasite from pythons to humans, especially in the suburban/rural areas where people consume snake meat.

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Coronavirus disease (COVID-19) pandemic has affected worldwide health care. Given the possibility for coronavirus to prompt oxidative stress, masked glucose-6-phosphate dehydrogenase deficiency (G6PD) deficiency in the presence of the COVID-19 viral infection may instigate hemolytic crisis and dangerous consequences in affected individuals. G6PD deficiency is an X-linked recessive disorder that affects some 400 million people worldwide, with a higher prevalence in Africa, the Mediterranean Region, and Asia. A dearth of studies and literature on available antivirals for managing COVID-19 patients with G6PD deficiency brings the healthcare workers to a conundrum. Here, we report an interesting symptomatic case of COVID-19 patient with G6PD deficiency, hypertension, and resolved hepatitis B. Antiviral therapy for COVID-19 positive patients with G6PD deficiency should be individualized by considering the risk and benefit of treatment involved, recommending a multidisciplinary team approach.

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Hematopoietic stem cell transplantation (HSCT) severely undermines the recipients' immune status and makes them prone to complications following viral infection. Here, we report a 3-year-old boy with mucopolysaccharidosis type VI who acquired SARS-CoV-2 infection after HSCT. The boy was diagnosed with SARS-CoV-2 during the post-transplant period (19 days after HSCT) when dealing with acute graft versus host disease (GVHD). He was successfully treated with remdesivir and tocilizumab and recovered. Well-timed treatment with tocilizumab might reduce the risk of invasive mechanical ventilation and death in patients with severe COVID-19 pneumonia in the early post HSCT period.

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Cytomegalovirus (CMV) is an endemic ubiquitous herpes virus transmitted through saliva, urine, genital secretions, mononuclear blood cells, and transplanted tissue. It is a common infection with mild symptoms or asymptomatic in the immunocompetent individuals but can be severe in the immunocompromised individuals, e.g., HIV-infected individuals, transplanted and cancer patients, and fetuses. CMV is the leading cause of congenital viral infection and the leading non-hereditary cause of sensorineural hearing loss and mental retardation in early childhood. Here, we describe the clinical and laboratory monitoring of four congenital CMV (cCMV) cases referred to Pediatric Belfort Establishment in Algiers in 2019, 2020, and 2021. All the patients had developed signs and symptoms of postnatal CMV infection with intrauterine growth retardation. The clinical manifestations differed; some presented cytopenia with or without hepatosplenomegaly and others a clinical and biological cholestasis syndrome. All our patients had intrauterine growth retardation. A CMV PCR of a urine sample was positive. Treatment for six weeks based on ganciclovir, with a relay by valganciclovir.

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In the SARS-CoV-2 pandemic, the seasonal viral respiratory infections had a minimum prevalence due to public health precautions to reduce the risk of getting Coronavirus Disease 19 (COVID-19). There have been reports of COVID-19 coinfection with influenza, respiratory syncytial virus (RSV), and seasonal coronaviruses during the pandemic. Here, we report a case in which the patient had sequential respiratory infections of human coronavirus HKU1 (HCoV-HKU1) and SARS-CoV-2 in a fully vaccinated, healthy person. It should be noted that other seasonal coronaviruses that could cause symptomatic RTIs might be misdiagnosed clinically with COVID-19. Hence, we highly recommend monitoring and follow-up of symptomatic patients with negative SARS-COV-2 RT-PCR results.
 

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Malaria is an imported disease in non-endemic regions of Iran. Imported malaria cases to Iran mostly come from illegal immigrants from neighboring eastern countries. The present study describes a case of imported malaria in a 14-month-old Afghan boy with prolonged fever, vomiting, and diarrhea. He was referred and hospitalized in Shahid Beheshti, Kashan, central Iran, in December 2021. He and his parents traveled and immigrated to Kashan, Iran, three weeks before hospitalization. After staining with Giemsa stain, a thin blood smear test showed Plasmodium vivax with the Schüffner's dots in red blood cells. The patient was treated with an antimalarial drug and discharged from the hospital with normal vital signs. Before arriving in Iran, all immigrants should receive a screening test or be checked for malaria symptoms.

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Precision tracking and monitoring viral genome mutations are critical during a viral pandemic such as COVID-19. As molecular assays for diagnosing numerous infectious agents are being developed, RT-PCR is still deployed as the gold standard for detecting SARS-CoV-2. Despite its proofreading capability, SARS-CoV-2, like other RNA viruses, adopts several changes in its genome. If these mutations, especially deletions, occur in the target areas of primers and probes, they will hinder molecular detection methods from identifying the given gene. The authors describe the cases in which, despite the lack of the N gene detection, the ORF1ab gene was discovered with a relatively low cycle of threshold (Ct). Following sequencing, changes were discovered in the annealing region of the forward and reverse primers and probes used in the SARS-CoV-2 detection kit. Among the most significant mutations is a large deletion of 15 nucleotides in the N gene, which has never been seen in prior variants. This highlights the importance of persistent monitoring of hypervariable regions in the SARS-CoV-2 genome through sequencing and updating the molecular detection kits during the COVID-19 pandemic.

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 While the COVID-19 pandemic affects millions, other infectious diseases might be overlooked. One of these crucial diseases is tuberculosis (TB), a highly infectious bacterial respiratory disease. According to WHO, TB is among the top 10 causes of death globally, with about one-quarter of the world's population infected. COVID-19 has emerged as a potential risk factor for TB in highly prevalent countries because of immunosuppression. This case report highlights a female patient who presented with swelling over the left supraclavicular region, which was very slow in progression. Following COVID-19 infection, a significant increase in swelling within a short time occurred, which was associated with easy fatigability, loss of appetite, generalized weakness, and significant weight loss. Based on investigations, a TB diagnosis was made. Few studies are available regarding the exacerbation of activated latent tuberculosis following COVID-19. Hence, this case report could help in screening and managing such cases.

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Introduction: Nocardiosis is a globally recognized opportunistic infection that predominantly affects immunocompromised individuals, leading to a diverse range of clinical manifestations, from cutaneous to severe systemic forms. The similarity of pulmonary nocardiosis symptoms to those of pulmonary tuberculosis often leads to misdiagnosis, presenting a significant diagnostic challenge for clinicians. We present an illustrative case of a 48-year-old male, newly diagnosed with HIV, who exhibited symptoms initially suggestive of pulmonary tuberculosis but was subsequently diagnosed with pulmonary nocardiosis. Methods: Bronchoalveolar lavage (BAL) fluid samples were obtained and subjected to microbiological culture, Gram staining, and modified acid-fast (Ziehl-Neelsen) staining for the identification of Nocardia species. Results: Gram staining of BAL fluid revealed thin, branched, beaded, filamentous, Gram-positive bacilli. Modified acid-fast staining identified branching acid-fast bacilli (1-2 organisms per high-power field (HPF)), consistent with Nocardia. Diagnosis of Nocardia is crucial as it necessitates targeted therapy, particularly in immunocompromised hosts. Nocardia was cultured after one week, highlighting its slow growth characteristic, which can delay diagnosis and treatment. The patient was commenced on trimethoprim-sulfamethoxazole (800/160 mg four times daily), showing significant clinical improvement within two weeks. After 12 months of treatment, there was complete resolution of symptoms, radiological improvement, and normalization of laboratory parameters, indicating successful treatment of pulmonary nocardiosis. Conclusion: Pulmonary nocardiosis must be considered in immunocompromised patients with persistent respiratory symptoms. Comprehensive imaging and bronchoscopy with BAL are pivotal for effective sample collection and accurate laboratory diagnosis. Modified Ziehl-Neelsen staining is critical for the definitive identification of Nocardia infection. Early and proactive screening in high-risk groups, such as HIV patients, cancer patients, or organ transplant recipients, is crucial for the prompt initiation of targeted therapy, typically with trimethoprim-sulfamethoxazole, to improve outcomes.