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INTRODUCTION: this study aimed to isolate P. aeruginosa and S. aureus, investigate the antimicrobial resistance of collected isolates, and investigate the distribution of exoU and mecA genes in P. aeruginosa and S. aureus isolates. METHODOLOGY: Out of 150 samples, 32 isolates were identified as P. aeruginosa, 48 isolates were identified as S. aureus. All isolates were checked for AST. Then, a PCR was applied to detect exoU and mecA genes in P. aeruginosa and S. aureus. RESULTS: 12.0% and 29.3% of the samples showed co-isolates and single isolates of studied pathogens, respectively. Regarding burn samples, S. aureus was the most prevalent pathogen (38.0%, 38/100) among males (41.8%, 23/55), followed by P. aeruginosa (27.0%, 27/100) among females (28.9%, 13/45). The highest burn infection rates of S. aureus (50.0%) and P. aeruginosa (32.7%) were recorded among age groups (≥ 50) and (18-49), respectively. Comparatively, wound samples were less infected with these pathogens. P. aeruginosa isolates usually exhibited high resistance to gentamicin, tobramycin, and netilmicin, whereas, imipenem showed low resistance at 46.87%. S. aureus isolates were susceptible to trimethoprim-sulphamethoxazole and rifampin. 56.25% of P. aeruginosa isolates were exoU positive and 37.5% of S. aureus isolates were mecA positive. Results of the cefoxitin inhibition zone with mecA gene amplification, 33.3% isolates were MRSA, 4.2% isolates were nmrMRSA, and 62.5% isolates were MSSA. Most of the resistant isolates of P. aeruginosa carried the exoU gene, 80% resistant isolates to imipenem were exoU positive. CONCLUSIONS: S. aureus was more predominant than P. aeruginosa in burns and wounds infections.

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Streptococcus is involved in mild and severe infections with a high level of antimicrobial resistance. This study aimed to investigate the prevalence and multi-drug resistance of Streptococcus spp isolates for three years (2016, 2017, and 2018). 1648 participants (246 males and 1402 females) were enrolled. Specimens were collected and transferred to the laboratory. All isolates were examined and identified according to standard methods. Susceptibility to antibiotics was evaluated utilizing the method of disk diffusion. Overall, Streptococcus spp were confirmed in 124 (7.52%) patients. The UTIs rate was significantly higher (76.6%) compared with other infections. The infected females were considerably higher than the infected males, 64.5% and 12.1% respectively. Higher percentages of Streptococcus spp were observed in 2017 (41.3%). The frequency of Streptococcus was higher in January compared with other months of the year. Streptococcus spp and S. pyogenes dominated over these months. The highest frequency of Streptococcus spp was found in age groups 16-20 and 21-25 (22/18.49%, and 26/21.85% respectively). Multi-drug resistance was found among 36 (81%) of Streptococcus pyogenes, 50% (5/10) of Streptococcus viridans and 75% of Streptococcus faecalis. The overall Streptococcus spp showed 90 (72.6%) multi-drug resistance. High resistance was recorded to different antibiotics, Ceftazidime (96.6%), Oxacillin (96.7%) and Cefixime (86.9%).  The incidence of Streptococcus spp was high during the three years of study with high resistance to the most available antibiotics. Susceptibility testing should be carried out and the empirical antibiotic treatment should be altered accordingly.

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INTRODUCTION: In 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the agent of Coronavirus Disease 2019 (COVID-19), spread all over the world. This global pandemic spread rapidly to more than 195 countries and caused over 200 million infections with a mortality rate of 2%. This study aimed to detect seropositivity against the SARS-CoV-2 virus among outpatients, symptomatic and asymptomatic individuals. METHODOLOGY: A total of 489 individuals of age 5-70 years (mean 38.0 ± 17 SD) were enrolled for a cross-sectional study. They were tested for presence of SARS-CoV-2 IgM/IgG antibodies in serum samples using Enzyme-linked Immunofluorescent Assay (ALFA). RESULTS: A higher seroprevalence was recorded for IgM among females (34.96%) than males (28.83%). In the case of IgG, and IgG + IgM, both males and females had similar values. A significant correlation was identified between seropositivity and age; higher seropositivity (IgG, IgM, and IgG + IgM) was recorded in age groups 51-60 and ≥ 61 years, relative to the younger age groups. No significant correlation was found between symptomatic and asymptomatic individuals. No significant correlation was detected between seropositivity and RT-PCR positive and negative cases. CONCLUSIONS: COVID-19 is spreading rapidly and there is a high percentage of asymptomatic carriers. The sensitivity of RT-PCR tests is not uniform and may not be able to detect all cases. On the other hand, serology can be used for large scale testing to detect the real extent to which the disease has spread.

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INTRODUCTION: Microbiome status is considered an important factor that contributes to obesity. Investigations have shown that the oral microbiome comprises a vast array of bacterial species that can influence human health. OBJECTIVE: To determine the association between the presence of the bacterial phyla Firmicutes and Bacteroidetes and the body mass index (BMI) status of normal, overweight and obese subjects in Duhok, Iraq. Additionally, to investigate the composition of oral Firmicutes and Bacteroidetes profiles for individuals with different BMI statuses. METHODS: A total of 155 saliva samples were collected from participants in Duhok, Iraq. Bacterial genomic DNA was then extracted from the collected saliva. The presence of Firmicutes and Bacteroidetes phyla was detected via polymerase chain reaction. RESULTS: Firmicutes and Bacteroidetes were detected in 63.2 and 37.4% of the population, respectively. Differences in the carriage rates of oral Firmicutes in overweight (78%) and obese individuals (83%) were statistically significant when compared to normal weight individuals (36%) (P<0.0001). The percentage rates of Bacteroidetes in obese individuals (26.4%) was statistically significant when compared to normal weight individuals (50.8%) (P=0.0078). The Firmicutes/ Bacteroidetes ratios (obese=3.1, overweight= 2.5 and normal weight=0.7) were higher with increasing BMI. CONCLUSION: This study provides evidence of the Firmicutes/Bacteroidetes ratio growing with increasing BMI. High rates of Firmicutes could serve a role in the development of obesity. Further studies are required to clarify the exact relationship between oral bacteria and obesity, which could lead to a promising therapeutic method for improving the physical health of humans.

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Background: The association between obesity and the oral microbiome has received great attention. Objective: This study aimed to determine the association of oral Staphylococcus aureus with different body mass index people. Material and Methods: A total of 155 saliva samples were collected. The individuals were grouped into three categories according to their BMI, normal weight, overweight and obese individuals. A loopful of saliva sample was cultured and incubated at 37°C for 24. Staphylococcus aureus isolates were diagnosed by colony characteristics, morphology, and biochemical tests. Results: The oral carriage rate of Staphylococcus aureus was 61.3% (65.1% females and 56.5% males). The Staphylococcus aureus rate was 68% in married and 60% in single people. The differences of oral carriage rates of Staphylococcus aureus in obese (73.6%) and overweight (85.4%) populations was statistically significant (p<0.0001) compared to the rate in normal weight group (34%). Among males, the highest oral carriage rate of Staphylococcus aureus was in overweight individuals (82.6%). Likewise, in females, the highest rate of salivary Staphylococcus aureus was among the overweight group (88.9%). Regarding marital status, in single people, the differences of Staphylococcus aureus in obese (p=0.0003) and overweight (p<0.0001) people was significantly compared to normal weight people. But, in married people, the differences in Staphylococcus aureus rates among all groups were statistically not significant (p=0.0935). Conclusion: Staphylococcus aureus was significantly related to overweight and obese individuals. The human oral Staphylococcus aureus may play a key role in the manifestation of obesity. The oral microbiota could provide a new target for improving the physical well being of humans.

Antecedentes: la asociación entre la obesidad y el microbioma oral ha recibido gran atención. Objetivo: Este estudio tuvo como objetivo determinar la asociación de Staphylococcus aureus oral en personas con diferentes índices de masa corporal. Material y Métodos: Se recolectaron un total de 155 muestras de saliva. Los individuos fueron agrupados en tres categorías según su indice de masa corporal: normopeso, sobrepeso y obesos. Se cultivó un asa de muestra de saliva y se incubó a 37°C durante 24 horas. Los aislamientos de Staphylococcus aureus se identificaron mediante las características de la colonia, la morfología y las pruebas bioquímicas. Resultados:La tasa de colonización oral por Staphylococcus aureus fue del 61,3% (65,1% mujeres y 56,5% hombres). La tasa de colonización por Staphylococcus aureus fue del 68% en casados y del 60% en solteros. Las diferencias de las tasas de portación oral de Staphylococcus aureus en las poblaciones obesas (73,6%) y con sobrepeso (85,4%) fueron estadísticamente significativas (p<0,0001) en comparación con la tasa en el grupo de peso normal (34.0%). Entre los hombres, la tasa más alta de portadores orales de Staphylococcus aureus fue en individuos con sobrepeso (82,6%). En las mujeres, la tasa más alta de Staphylococcus aureus salival se también se presentó en el grupo con sobrepeso (88,9 %). En cuantal estado civil, en solteros, las diferencias de Staphylococcus aureus en obesos (p=0,0003) y con sobrepeso (p<0,0001) fueron significativas compararadas con normopeso. Pero, en personas casadas, las diferencias en las tasas de Staphylococcus aureus entre todos los grupos no fueron estadísticamente significativas (p=0,0935). Conclusion: Staphylococcus aureus salival se relacionó significativamente en individuos con sobrepeso y obesidad. El Staphylococcus aureus oral humano puede jugar un papel clave en la manifestación de la obesidad. La microbiota oral podría proporcionar una nueva diana para mejorar el estado físico de los humanos

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Leishmaniasis is caused by protozoan parasites of the genus Leishmania and is a major health problem in various parts of the world. Cutaneous leishmaniasis (CL) occurs, among others, in unpredictable outbreaks after wars and disasters. After the last war in Iraq, the collapse of the health system led to the spread of infectious diseases, including CL. Between September 2016 and November 2017, all patients with confirmed CL having one or more skin lesion(s) were referred to a regional health center in Musol City within the Rabeea District. During this period, 1539 patients visited the clinic. A total of 190 patients were excluded from the study because of poor follow-up. The treatment success rate was 97.7% (1319/1349). Statistically significant associations were found between number of lesions and treatment failure (p = 0.0018; OR = 1.4430; CI = 1.1466-1.8161), number of doses and number of lesions (Pearson's correlation coefficient = 0.095; p = 0.001), and the lack of municipality services and number of doses used for the treatment (p = 0.008; OR = 1.0629; CI = 1.0158-1.1122). To conclude, the highest number of patients with CL in the city of Musol was recorded after the war in Iraq. The treatment success rate was high, which reflected the strict treatment and follow-up program. An urgent plan is needed to stop the spread of infection.

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OBJECTIVES: The aim of this study was to determine the prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) among healthcare workers (HCWs) compared with non-HCWs at Duhok city, Kurdistan Region, northern Iraq. METHODS: A total of 182 HCWs with different occupations and working in different hospital units as well as 198 non-HCWs were recruited. Nasal swab samples were collected and were inoculated on mannitol salt agar and incubated at 35°C for 48h. Isolates identified as S. aureus underwent antimicrobial sensitivity testing to oxacillin. MRSA isolates were selected and investigated for presence of the mecA gene. RESULTS: Among the HCWs, 41/182 (22.5%) were carriers of S. aureus compared with 37/198 (18.7%) non-HCWs (P=0.4). Amongst the S. aureus carriers, 25/41 strains (61.0%) isolated from HCWs were MRSA compared with 8/37 strains (21.6%) isolated from non-HCWs (P=0.039). The mean age of MRSA carriers was 35.6±6.7years compared with 30±5.8years for MRSA non-carriers (P=0.0177). The mean working years of MRSA carriers was significantly higher than that of MRSA non-carriers (7.8±5.5years vs. 3.9±5.3years; P=0.04). CONCLUSIONS: The prevalence of MRSA was very high amongst HCWs. Regular screening of carriers is required for prevention of nosocomial infections.

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BACKGROUND: The human papilloma virus (HPV) is considered as the major risk factor for the development of cervical cancer. This virus is of different genotypes and generally can be classified into high and low risk types. OBJECTIVE: To determine the rate of high risk HPV genotypes in women with vaginal discharge and lower abdominal pain in Kurdistan region, Iraq. MATERIALS AND METHODS: Cervical swabs were taken from 104 women. DNA was extracted and the polymerase chain reaction (PCR) technique was used to determine the presence of high risk genotypes. RESULTS: It was found that 13/104 (12.5%) of the samples were positive for high risk HPV genotypes. Amongst those who were positive, 4/13 (30.7%) were typed as genotype 16 and 7/13 (53.8%) showed mixed genotyping. On the other hand, genotypes 53 and 56 were found in only one sample each. CONCLUSIONS: High risk HPV genotypes are not uncommon and further community based study is needed to determine the prevalence of HPV and its genotypes and plan for prevention of infection.

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BACKGROUND AND OBJECTIVES: Helicobacter pylori is a Gram negative bacteria that causes peptic ulceration and gastric adenocarcinoma. H pylori virulence factors, such as cagA and dupA, are important to study in populations as they contribute to disease risk. This study aimed to look at the distribution of the cagA and dupA genes in H pylori strains isolated from patients suffering from gastroduodenal diseases in Kurdistan region, Iraq. DESIGN AND SETTINGS: A cross-sectional study conducted between June 2011 and January 2012. Biopsies were collected from the Endoscopy Department in Duhok and Sulaimania hospitals, Kurdistan region, northern Iraq. PATIENTS AND METHODS: Upper gastrointestinal (GI) endoscopy examination was performed and 4 gastric biopsies (2 from the antrum and 2 from the corpus) were obtained from 204 patients. H pylori positivity was examined by CLO test; then the association between disease status and virulence factors was assessed by polymerase chain reaction. RESULTS: 154 (75%) of our samples were found to be H pylori + by CLO test. Endoscopic diagnoses for those who were positive were as follows: peptic ulcer disease (PUD) including duodenal ulcer, 45; gastric ulcer, 23; and no ulcer (NPUD), 86. The overall prevalence rates of cagA and dupA were 72.7% and 18.8%, respectively. While a significant association between cagA and PUD was observed (P. ≤.017; OR=0.4; CI=0.18­0.85), no relationship between dupA and PUD could be seen. CONCLUSION: These data suggested that the presence of cagA may be a predictor of clinical outcome in Kurdistan region, northern Iraq.

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Neisseria meningitidis, Haemophilus influenzae and Streptococcus pneumoniae are major bacterial agents of meningitis. They each bind the 37/67-kDa laminin receptor (LamR) via the surface protein adhesins: meningococcal PilQ and PorA, H. influenzae OmpP2 and pneumococcal CbpA. We have previously reported that a surface-exposed loop of the R2 domain of CbpA mediates LamR-binding. Here we have identified the LamR-binding regions of PorA and OmpP2. Using truncated recombinant proteins we show that binding is dependent on amino acids 171-240 and 91-99 of PorA and OmpP2, respectively, which are predicted to localize to the fourth and second surface-exposed loops, respectively, of these proteins. Synthetic peptides corresponding to the loops bound LamR and could block LamR-binding to bacterial ligands in a dose dependant manner. Meningococci expressing PorA lacking the apex of loop 4 and H. influenzae expressing OmpP2 lacking the apex of loop 2 showed significantly reduced LamR binding. Since both loops are hyper-variable, our data may suggest a molecular basis for the range of LamR-binding capabilities previously reported among different meningococcal and H. influenzae strains.

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BACKGROUND AND STUDY AIM: Several genes of Helicobacter pylori, such as vacA, cagA, iceA and babA, have been reported to significantly increase the risk of gastrointestinal diseases. The aim of this study was to study the relationship between H. pylori virulence factors and clinical outcomes and identify the independent markers of peptic ulcer disease in Iraq. PATIENTS AND METHODS: DNA was extracted from specimens taken from 154 unselected H. Pylori positive Iraqi patients. Genotyping was performed by the polymerase chain reaction (PCR), using specific primers for cagA, vacA (s, m), iceA and babA2 genes. RESULTS: A total of 56 (82%) peptic ulcer disease (PUD) patients carried cagA+ strains, significantly more than the 56 (65%) non-ulcer disease (NUD) patients (p=0.017). The difference in the prevalence of babA2 positivity was significant between patients with NUD (33.7%) and PUD (58.8%) (p=0.002). In addition, babA2 was associated as an independent factor, with PUD (p=0.005; odds ratio (OR)=0.4; confidence interval (CI)=0.18-0.68) followed by cagA (p=0.05; OR=0.4; CI=0.18-0.85). Forty-five isolates (29%) were typed as 'triple positive' strains, and their presence was significantly associated with PUD (p=0.001). CONCLUSION: The cagA and babA2 genotypes might be considered as useful markers for PUD patients. However, iceA1 and iceA2 seem not to be good markers for the disease. The presence of H. pylori strains with triple-positive status is of high clinical relevance to H. pylori-associated diseases.

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