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Objective: To determine the potential effect of environment variables on cutaneous leishmaniasis occurrence using time-series models and compare the predictive ability of seasonal autoregressive integrated moving average (SARIMA) models and Markov switching model (MSM). Methods: This descriptive study employed yearly and monthly data of 49 364 parasitologically-confirmed cases of cutaneous leishmaniasis in Isfahan province, located in the center of Iran from January 2000 to December 2019. The data were provided by the leishmaniasis national surveillance system, the meteorological organization of Isfahan province, and Iranian Space Agency for vegetation information. The SARIMA and MSM models were implemented to examine the environmental factors of cutaneous leishmaniasis epidemics. Results: The minimum relative humidity, maximum relative humidity, minimum wind speed, and maximum wind speed were significantly associated with cutaneous leishmaniasis epidemics in different lags (P<0.05). Comparing SARIMA and MSM, Akaikes information criterion (AIC), and mean absolute percentage error (MAPE) in MSM were much smaller than SARIMA models (MSM: AIC=0.95, MAPE=3.5%; SARIMA: AIC=158.93, MAPE:11.45%). Conclusions: SARIMA and MSM can be a useful tool for predicting cutaneous leishmaniasis in Isfahan province. Since cutaneous leishmaniasis falls into one of two states of epidemic and non-epidemic, the use of MSM (dynamic) is recommended, which can provide more information compared to models that use a single distribution for all observations (Box-Jenkins SARIMA model).

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Objective: To investigate the antimicrobial resistance patterns and prevalence of integrons in Shigella species isolated from children with diarrhea in southwest Iran. Methods: In this study, 1 530 stool samples were collected from children under 15 years with diarrhea referred to teaching hospitals in Ahvaz and Abadan, southwest Iran. Shigella spp. were identified by standard biochemical tests and PCR. The antibiotic resistance pattern of all Shigella isolates was determined by the disk diffusion method and minimum inhibitory concentration (MIC) by E-test. Results: Of 1 530 stool samples, 91 (5.9%, 91/1 530) were positive for Shigella spp. the most common Shigella isolates were Shigella flexneri 47 (51.6%, 47/1 530). Antibiotic susceptibility tests showed that the highest antibiotic resistance was related to trimethoprim-sulfamethoxazole (87.9%, 80/91) and ampicillin (86.8%, 79/91). Multiplex PCR results revealed that 56% and 86.9% of Shigella isolates carried integron class I and integron class II genes, respectively. None of the isolates included the integron class III gene. Conclusions: The high prevalence of multi-drug resistance in Shigella isolates in our area increases the concerns about dissemination of the antibiotic-resistant isolates in this bacterium.

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Mosquitoes belonging to the genus Aedes pose a significant threat to human health on a global scenario due to their role in transmission of dengue, chikungunya, zika, and yellow fever. In absence of specific medications and vaccines against these diseases, disease prevention relies on vector control. However, in today's world, vector control is facing major challenges due to the onset of insecticide resistance in mosquitoes. There are four main mechanisms of insecticide resistance, namely, behavioral resistance, reduced penetration/cuticular resistance, metabolic detoxification, and target site resistance; however, the latter two mechanisms have been studied widely in Aedes mosquitoes. Insecticide resistance in Aedes mosquitoes is widespread throughout the world. This review compiles the degree of insecticide resistance/susceptibility prevailing among different field populations of Aedes mosquitoes worldwide. In addition, the review has detailed the mechanisms providing the resistance phenomenon observed in nature in Aedes mosquitoes.

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Rationale: Candida auris is a potential emerging pathogen among Candida and causes serious health threats globally. Patient concerns: We reported a case of vulvovaginal candidiasis caused by Candida auris. A 26-year-old female presented with complaints of vaginal discharge, itching and low back pain. Diagnosis: High vaginal swab culture yielded Candida. The strain was confirmed as Candida auris by amplification and sequencing the internal transcribed spacer region. Antifungal susceptibility testing revealed that the isolate was resistant to fluconazole, amphotericin B and clotrimazole and susceptible to ketoconazole and nystatin. The isolate also exhibited biofilm forming ability. Interventions: Her symptoms did not subside with initial management with fluconazole and clotrimazole. Later, she was started on ketoconazole therapy. The patient responded well to ketoconazole. Outcome and lessons: To the best of our knowledge, this is the first report about the presence of a drug resistant biofilm forming Candida auris strain isolated from a vaginal swab sample from Chennai area. Biofilm forming ability might contribute to its drug resistance. Nucleic acid analysis helps in rapid and accurate identification of such rare species.

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Objective: To carry out the genetic characterization and evolutionary analysis of three avian orthoavulavirus 1 (AOAV-1) isolates from poultry workers with respiratory symptoms. Methods: Using Illumina MiSeq, whole-genome sequencing was carried out to assess the evolutionary dynamics of three AOAV-1 isolates. A phylogenetic and comparative analysis of all coding genes was done using bioinformatics tools. Results: Phylogenetic analysis and genetic distance estimation suggested a close relationship among human- and avian-originated velogenic strains of genotype XIII, sub-genotype XIII.2.1. Several substitutions in the significant structural and biological motifs were exclusively identified in the human-originated strains. Conclusions: To our knowledge, this is the first report of a velogenic AOAV-1 isolate from natural infection of the human upper respiratory tract. Our findings highlight the evolution and zoonotic potential of velogenic AOAV-1 in a disease endemic setting.

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Objective: To detect Dientamoeba (D.) fragilis and Enterocytozoon (E.) bieneusi and to assess their genetic characteristics in stool samples submitted for routine examination in a clinical laboratory in Southeastern Brazil. Methods: In this survey, 348 stool samples from female and male individuals with age ranging from 0 to ≥55 years were analyzed by PCR amplifying and sequencing based on the small subunit ribosomal RNA (SSU rRNA) gene of D. fragilis and the internal transcribed spacer of E. bieneusi. Results: D. fragilis and E. bieneusi isolates were observed in 2.29% (8/348) and 4.59% (16/348) of the samples, respectively. These parasites were detected in stool samples from individuals of both genders, including young children under nine until adults over 55 years old. No statistically significant differences were found. All D. fragilis isolates were classified as genotype 1 and E. bieneusi isolates included genotypes D (n=15) and A (n=1). Conclusions: The findings provide relevant findings on occurrence and genetic diversity of D. fragilis and E. bieneusi, pointing to the need for the diagnosis of these parasites in routine examinations in clinical laboratories. In addition to sensitive diagnostic methods, it is mandatory that these parasites be considered relevant for physicians and laboratory staff.

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