Osong Public Health and Research Perspectives

Volume 5(6); December 2014

Editorial

Out of Africa, Into Global Health Security Agenda: Hae-Wol Cho, Chaeshin Chu; Osong Public Health Res Perspect. 2014;5(6):313-314. Published online December 31, 2014; DOI: https://doi.org/10.1016/j.phrp.2014.11.004

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Annals of Global Health.2019;[Epub] CrossRef
Assessing National Public Health Law to Prevent Infectious Disease Outbreaks: Immunization Law as a Basis for Global Health Security
Tsion Berhane Ghedamu, Benjamin Mason Meier
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The West Africa Disaster Preparedness Initiative: Strengthening National Capacities for All-Hazards Disaster Preparedness
Melinda J. Morton Hamer, Paul L. Reed, Jane D. Greulich, Gabor D. Kelen, Nicole A. Bradstreet, Charles W. Beadling
Disaster Medicine and Public Health Preparedness.2017; 11(4): 431. CrossRef
Two Epidemics and Global Health Security Agenda
Hae-Wol Cho, Chaeshin Chu
Osong Public Health and Research Perspectives.2015; 6(6): S1. CrossRef

Original Articles

Optimal Implementation of Intervention to Control the Self-harm Epidemic: Byul Nim Kim, M.A. Masud, Yongkuk Kim; Osong Public Health Res Perspect. 2014;5(6):315-323. Published online December 31, 2014; DOI: https://doi.org/10.1016/j.phrp.2014.10.001

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Abstract PDF

Objectives
Deliberate self-harm (DSH) of a young person has been a matter of growing concern to parents and policymakers. Prevention and early eradication are the main interventional techniques among which prevention through reducing peer pressure has a major role in reducing the DSH epidemic. Our aim is to develop an optimal control strategy for minimizing the DSH epidemic and to assess the efficacy of the controls.
Methods
We considered a deterministic compartmental model of the DSH epidemic and two interventional techniques as the control measures. Pontryagin's Maximum Principle was used to mathematically derive the optimal controls. We also simulated the model using the forward-backward sweep method.
Results
Simulation results showed that the controls needed to be used simultaneously to reduce DSH successfully. An optimal control strategy should be adopted, depending on implementation costs for the controls.
Conclusion
The long-term success of the optimum control depends on the implementation cost. If the cost is very high, the control could be used for a short term, even though it fails in the long run. The control strategy, most importantly, should be implemented as early as possible to attack a comparatively fewer number of addicted individuals.

Citations

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A review of the use of optimal control in social models
D. M. G. Comissiong, J. Sooknanan
International Journal of Dynamics and Control.2018; 6(4): 1841. CrossRef
Adolescent self‐harm and risk factors
Jixiang Zhang, Jianwei Song, Jing Wang
Asia-Pacific Psychiatry.2016; 8(4): 287. CrossRef
Optimal Intervention Strategies for the Spread of Obesity
Chunyoung Oh, Masud M A
Journal of Applied Mathematics.2015; 2015: 1. CrossRef

Predicting 5-Year Survival Status of Patients with Breast Cancer based on Supervised Wavelet Method: Maryam Farhadian, Hossein Mahjub, Jalal Poorolajal, Abbas Moghimbeigi, Muharram Mansoorizadeh; Osong Public Health Res Perspect. 2014;5(6):324-332. Published online December 31, 2014; DOI: https://doi.org/10.1016/j.phrp.2014.09.002

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Abstract PDF

Objectives
Classification of breast cancer patients into different risk classes is very important in clinical applications. It is estimated that the advent of high-dimensional gene expression data could improve patient classification. In this study, a new method for transforming the high-dimensional gene expression data in a low-dimensional space based on wavelet transform (WT) is presented.
Methods
The proposed method was applied to three publicly available microarray data sets. After dimensionality reduction using supervised wavelet, a predictive support vector machine (SVM) model was built upon the reduced dimensional space. In addition, the proposed method was compared with the supervised principal component analysis (PCA).
Results
The performance of supervised wavelet and supervised PCA based on selected genes were better than the signature genes identified in the other studies. Furthermore, the supervised wavelet method generally performed better than the supervised PCA for predicting the 5-year survival status of patients with breast cancer based on microarray data. In addition, the proposed method had a relatively acceptable performance compared with the other studies.
Conclusion
The results suggest the possibility of developing a new tool using wavelets for the dimension reduction of microarray data sets in the classification framework.

Citations

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Shiva Borzouei, Hossein Mahjub, NegarAsaad Sajadi, Maryam Farhadian
Journal of Family Medicine and Primary Care.2020; 9(3): 1470. CrossRef
Thyroid disorder diagnosis based on Mamdani fuzzy inference system classifier
Negar Asaad Sajadi, Hossein Mahjub, Shiva Borzouei, Maryam Farhadian
Koomesh Journal.2020; 22(1): 107. CrossRef
Diagnosis of hypothyroidism using a fuzzy rule-based expert system
Negar Asaad Sajadi, Shiva Borzouei, Hossein Mahjub, Maryam Farhadian
Clinical Epidemiology and Global Health.2019; 7(4): 519. CrossRef
WaveICA: A novel algorithm to remove batch effects for large-scale untargeted metabolomics data based on wavelet analysis
Kui Deng, Fan Zhang, Qilong Tan, Yue Huang, Wei Song, Zhiwei Rong, Zheng-Jiang Zhu, Kang Li, Zhenzi Li
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Characterization of Plasmid-Mediated AmpC and Carbapenemases among Iranain Nosocomial Isolates of Klebsiella pneumoniae Using Phenotyping and Genotyping Methods: Alireza Japoni-Nejad, Ehsanollah Ghaznavi-Rad, Alex van Belkum; Osong Public Health Res Perspect. 2014;5(6):333-338. Published online December 31, 2014; DOI: https://doi.org/10.1016/j.phrp.2014.09.003

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Abstract PDF

Objectives
Plasmid-mediated AmpC β-lactamases (PMABLs) and carbapenemases are emerging groups of antimicrobial-resistance determinants. The aims of the study were to evaluate the occurrence of PMABLs and carbapenemases in clinical isolates of Klebsiella pneumoniae and compare the test performance of various phenotypic methods for detection of these enzymes in Iran.
Methods
A total of 100 K. pneumoniae isolates were collected from clinical specimens obtained in Valiasr Hospital. AmpC production in all isolates was determined using the AmpC disk test, the cephamycin Hodge test, the AmpC Etest, and the boronic acid combined-disk test. In addition, carbapenemase production was determined using the modified Hodge test, the EDTA disk synergy test, and the boronic acid combined-disk test. The performances of various phenotypic methods were evaluated by the comparison of their results with polymerase chain reaction (PCR) method as the gold standard.
Results
Of the 100 isolates, 19 (19%) were demonstrated to harbor the PMABL-resistance gene by the multiplex PCR method. The PCR result indicated the presence of carbapenemase genes in 12 isolates. The performance of various phenotypic tests carried out for detection of carbapenemase-producing isolates varied widely, ranging in sensitivity from 30% to 100% and in specificity from 90.8% to 100%.
Conclusion
This is the first report of MOX-type AmpC β-lactamase and bla_GES in K. pneumoniae in Iran. A comparison of the phenotypic methods showed that a combination of cefoxitin plus boronic acid is optimal for detecting plasmid-mediated AmpC enzymes in K. pneumoniae, whereas the implementation of molecular methods is often complex, requires specially trained personnel, and is associated with higher costs.

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The Global and Regional Prevalence of Hospital-Acquired Carbapenem-Resistant Klebsiella pneumoniae Infection: A Systematic Review and Meta-analysis
Xing-chen Lin, Chang-li Li, Shao-yang Zhang, Xiao-feng Yang, Meng Jiang
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High frequency of NDM-1 and OXA-48 carbapenemase genes among Klebsiella pneumoniae isolates in central Iran
Elnaz Abbasi, Ehsanollah Ghaznavi-Rad
BMC Microbiology.2023;[Epub] CrossRef
Detection of ESBL and AmpC producing Klebsiella pneumoniae ST11 and ST147 from urinary tract infections in Iran
Shaghayegh Shahkolahi, Pegah Shakibnia, Shahla Shahbazi, Samira Sabzi, Farzad Badmasti, Mohammad Reza Asadi Karam, Mehri Habibi
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Plasmid-mediated AmpC β-Lactamase Gene Analysis in Klebsiella Pneumoniae Clinical Isolates
Nabi Jomehzadeh, Khadijeh Ahmadi, Hasti Shaabaninejad, Gholamali Eslami
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Roya Ghanavati, Hossein Kazemian, Parisa Asadollahi , Hamid Heidari, Gholamreza Irajian, Fatemeh Navab-Moghadam, Shabnam Razavi
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Farnaz Hajikarim, Mohammad Mehdi Soltan Dallal, Mohammad Reza Pourmand, Milad Abdi
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Prevalence and Mechanisms of Carbapenem Resistance in Klebsiella pneumoniae and Escherichia coli: A Systematic Review and Meta-Analysis of Cross-Sectional Studies from Iran
Mohammad Javad Nasiri, Mehdi Mirsaeidi, Seyyed Mohammad Javad Mousavi, Mania Arshadi, Fatemeh Fardsanei, Behnaz Deihim, Sara Davoudabadi, Samin Zamani, Bahareh Hajikhani, Hossein Goudarzi, Mehdi Goudarzi, Zahra Sadat Seghatoleslami, Hossein Dabiri, Payam
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Shaymaa H. Abdel-Rhman, Grzegorz Woźniakowski
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Mubin Kazi, Kanchan Ajbani, Jeffrey A. Tornheim, Anjali Shetty, Camilla Rodrigues
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Maryam Ghane, Laleh Babaeekhou, Mahdi Jafar Shanjani
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Antimicrobial Agents and Chemotherapy.2016; 60(7): 4237. CrossRef
Molecular characterization of extended-spectrum β-lactamase, plasmid-mediated AmpC cephalosporinase and carbapenemase genes among Enterobacteriaceae isolates in five medical centres of East and West Azerbaijan, Iran
Mohammad Reza Sadeghi, Reza Ghotaslou, Mohammad Taghi Akhi, Mohammad Asgharzadeh, Alka Hasani
Journal of Medical Microbiology .2016; 65(11): 1322. CrossRef
High Prevalence of AmpC β-Lactamases in Clinical Isolates of Escherichia coli in Ilam, Iran
Abbas Maleki, Afra Khosravi, Sobhan Ghafourian, Iraj Pakzad, Shiva Hosseini, Rashid Ramazanzadeh, Nourkhoda Sadeghifard
Osong Public Health and Research Perspectives.2015; 6(3): 201. CrossRef

Dentofacial and Cranial Changes in Down Syndrome: Deepika Shukla, Deepika Bablani, Aman Chowdhry, Raveena Thapar, Puneet Gupta, Shashwat Mishra; Osong Public Health Res Perspect. 2014;5(6):339-344. Published online December 31, 2014; DOI: https://doi.org/10.1016/j.phrp.2014.09.004

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Abstract PDF

Objectives
This study aimed to determine the prevalence of certain oral characteristics usually associated with Down syndrome and to determine the oral health status of these patients.
Methods
The cross-sectional study was conducted among patients attending a special education program at Faculty of Dentistry, Jamia Millia Islamia, Delhi, India. The study design consisted of closed-ended questions on demographic characteristics (age, sex, and education and income of parents), dietary habits, and oral hygiene habits. Clinical examination included assessment of oral hygiene according to Simplified Oral Hygiene Index (OHI-S), dental caries according to decayed, missing, and filled teeth (DMFT) index, periodontal status according to the Community Periodontal Index of Treatment Needs (CPITN), and malocclusion according to Angles classification of malocclusion. Examinations were carried out using a using a CPI probe and a mouth mirror in accordance with World Health Organization criteria and methods. Craniometric measurements, including maximum head length and head breadth were measured for each participant using Martin spreading calipers centered on standard anthropological methods.
Results
The majority of the patients were males (n = 63; 82%) with age ranging from 6–40 years. The Intelligence Quotient (IQ) score of the patients indicated that 31% had moderate mental disability and 52% had mild mental disability. 22% exhibited hearing and speech problems.12% had missing teeth and 15% had retained deciduous teeth in adult population. The overall prevalence of dental caries in the study population was 78%. DMFT, CPITN and OHI scores of the study group were 3.8 ± 2.52, 2.10 ± 1.14 and 1.92 ± 0.63 respectively. The vast majority of patients required treatment (90%), primarily of scaling, root planing, and oral hygiene education. 16% of patients reported CPITN scores of 4 (deep pockets) requiring complex periodontal care. The prevalence of malocclusion was 97% predominantly of Class III malocclusions. Further 14% presented with fractured anterior teeth primarily central incisor. The percentage means of cephalic index was 84.6% in the study population. The brachycephalic and hyperbrachycephalic type of head shape was dominant in the Down syndrome individuals (90%).
Conclusion
The most common dentofacial anomaly seen in these individuals was fissured tongue followed by macroglossia.

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Aging-related Changes in Mouse Serum Glycerophospholipid Profiles: Seungwoo Kim, Hyo-Soon Cheon, Jae-Chun Song, Sang-Moon Yun, Sang Ick Park, Jae-Pil Jeon; Osong Public Health Res Perspect. 2014;5(6):345-350. Published online December 31, 2014; DOI: https://doi.org/10.1016/j.phrp.2014.10.002

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Abstract PDF

Objectives
Metabolic dysfunction is a common hallmark of the aging process and aging-related pathogenesis. Blood metabolites have been used as biomarkers for many diseases, including cancers, complex chronic diseases, and neurodegenerative diseases.
Methods
In order to identify aging-related biomarkers from blood metabolites, we investigated the specific metabolite profiles of mouse sera from 4-month-old and 21-month-old mice by using a combined flow injection analysis–tandem mass spectrometry and liquid chromatography–tandem mass spectrometry.
Results
Among the 156 metabolites detected, serum levels of nine individual metabolites were found to vary with aging. Specifically, lysophosphatidylcholine (LPC) acyl (a) C24:0 levels in aged mice were decreased compared to that in young mice, whereas phosphatidylcholine (PC) acyl-alkyl (ae) C38:4, PC ae C40:4, and PC ae C42:1 levels were increased. Three classes of metabolites (amino acids, LPCs, and PCs) differed in intraclass correlation patterns of the individual metabolites between sera from young and aged mice. Additionally, the ratio of LPC a C24:0 to PC ae C38:4 was decreased in the aged mice, whereas the ratio of PC ae C40:4 to LPC a C24:0 was increased, supporting the aging-related metabolic changes of glycerophospholipids.
Conclusion
The ratios of the individual metabolites PC and LPC could serve as potential biomarkers for aging and aging-related diseases.

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Rapid DNA Extraction from Dried Blood Spots on Filter Paper: Potential Applications in Biobanking: Eun-Hye Choi, Sang Kwang Lee, Chunhwa Ihm, Young-Hak Sohn; Osong Public Health Res Perspect. 2014;5(6):351-357. Published online December 31, 2014; DOI: https://doi.org/10.1016/j.phrp.2014.09.005

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Abstract PDF

Objectives
Dried blood spot (DBS) technology is a microsampling alternative to traditional plasma or serum sampling for pharmaco- or toxicokinetic evaluation. DBS technology has been applied to diagnostic screening in drug discovery, nonclinical, and clinical settings. We have developed an improved elution protocol involving boiling of blood spots dried on Whatman filter paper.
Methods
The purpose of this study was to compare the quality, purity, and quantity of DNA isolated from frozen blood samples and DBSs. We optimized a method for extraction and estimation of DNA from blood spots dried on filter paper (3-mm FTA card). A single DBS containing 40 μL blood was used.
Results
DNA was efficiently extracted in phosphate-buffered saline (PBS) or Tris-EDTA (TE) buffer by incubation at 37°C overnight. DNA was stable in DBSs that were stored at room temperature or frozen. The housekeeping genes GAPDH and beta-actin were used as positive standards for polymerase chain reaction (PCR) validation of general diagnostic screening.
Conclusion
Our simple and convenient DBS storage and extraction methods are suitable for diagnostic screening by using very small volumes of blood collected on filter paper, and can be used in biobanks for blood sample storage.

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Antihematotoxic Role of Bunium persicum Seed Differential Extracts in Animal Model: Reactive Oxygen Species Might Be a Contributor: Tahir Ali, Kamran Saeed, Muhammad Abdullah, Iram Murtaza; Osong Public Health Res Perspect. 2014;5(6):358-363. Published online December 31, 2014; DOI: https://doi.org/10.1016/j.phrp.2014.11.005

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Abstract PDF

Objectives
Humans have been using plants as natural medicines since prehistoric times. Bunium persicum is a rich source of oils with different biological activities such as antioxidative and antimicrobial activities. The aim of this study is to evaluate the antihematotoxic and antioxidative effects of the differential extracts of B. persicum against leukemic blood induced hematotoxicity in an animal model.
Methods
This study was performed on animals, which were divided into several groups: normal control, disease control, and groups that were administered with differential extracts of plants. We measured the concentration of free radical [reactive oxygen species (ROS)] and hematological parameters as blast cells from the tibia and femur in different groups.
Results
The ROS level and blast cells count were higher in disease control groups than in groups treated with varying amounts of B. persicum extract and the normal group. Moreover, there was an imbalance in hematological parameters in untreated and treated groups with a correlation between free radicals and plant extract administration.
Conclusion
These findings may indicate a possible link between free radicals and hematotoxicity and blast cells, while depicting a potential therapeutic role for B. persicum against ROS-induced hematotoxicity.

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Diversity of Rotavirus Strain Circulated in Gwangju, Republic of Korea: Min Ji Kim, Hye Sook Jeong, Seon Gyeong Kim, Se Mi Lee, Sun Hee Kim, Hye-Young Kee, Eun-hye Jo, Hye-jung Park, Dong-Ryong Ha, Eun Sun Kim, Kye-Won Seo, Jae Keun Chung; Osong Public Health Res Perspect. 2014;5(6):364-369. Published online December 31, 2014; DOI: https://doi.org/10.1016/j.phrp.2014.10.004

4,318 View
25 Download
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Abstract PDF

Objectives
The introduction of new rotavirus vaccines into the public sphere makes it necessary to maintain constant surveillance and to heighten public awareness of the appearance of new rotavirus strains. We describe the molecular epidemiology of circulating rotavirus strains after vaccine introduction.
Methods
We collected a total of 1070 stool samples from children with gastroenteritis from January 2013 to June 2013. The antigenic prevalence of rotavirus group A was distinguished using enzyme immunoassay. The G and P genotypes of enzyme immunoassay-positive samples were determined with reverse transcription-polymerase chain reaction and nucleotide sequencing analysis.
Results
Of the 1070 samples collected, 277 (25.9%) tested positive for rotaviruses by enzyme-linked immunoabsorbent assay. The most prevalent circulating genotype G was G1 (51.3%), followed by G2 (34.7%) and G9 (10.8%). The predominant type of genotype P was P[8] (66.1%), followed by P[4] (31.4%). In this study, nine genotypes were found. G1P[8] was the most prevalent (51.8%), followed by G2P[4] (30.5%), G9P[8] (9.9%), and G2P[8] (4.0%). Several unusual combinations (G1P[4], G3P[9], G3P[8], G4P[6], and G9P[4]) were also identified.
Conclusion
Molecular epidemiological knowledge of rotaviruses is critical for the development of effective preventive measures, including vaccines. These data will help us monitor the effectiveness of current rotavirus vaccines.

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Rotavirus infection among hospitalized children under five years of age with acute watery diarrhea in Sri Lanka
Paba Palihawadana, Gagandeep Kang, Janakan Navaratnasingam, Geethani Galagoda, Janaki Abeynayake, Madhava Gunasekera, Shilanthi Seneviratne
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Infection, Genetics and Evolution.2018; 65: 357. CrossRef
Post-marketing safety surveillance conducted in Korea (2008–2013) following the introduction of the rotavirus vaccine, RIX4414 (Rotarix™)
Son Moon Shin, Chun Soo Kim, Naveen Karkada, Aixue Liu, Girish Jayadeva, Htay Htay Han
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Composition of Metabolic Syndrome Among Korean Adults in a Lifestyle Modification Intervention: Nan-He Yoon, Seunghyun Yoo, Hyekyeong Kim; Osong Public Health Res Perspect. 2014;5(6):370-377. Published online December 31, 2014; DOI: https://doi.org/10.1016/j.phrp.2014.10.005

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29 Download
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Abstract PDF

Objectives
The aim of this study was to examine the composition of metabolic syndrome (MetS) components among middle-aged and older Koreans.
Methods
A total of 263 participants (age 40 + years) in a lifestyle modification intervention program who met the MetS definition of National Cholesterol Education Program (NCEP) – Adult Treatment Panel (ATP) III criteria were included in the study. The frequent patterns and clustering of MetS components were investigated. Clustering of changes in individual components, through a lifestyle modification intervention, was also identified. All characteristics were stratified by and compared between sexes.
Results
Approximately 80% of the participants had three of five MetS risk factors at baseline. The prevalence of each risk differed by sex. MetS composition patterns that do not include low high-density lipoprotein (HDL) cholesterol were more noticeable in men because of the low prevalence of low HDL cholesterol. In women, with higher prevalence of low HDL cholesterol, more patterns that include low HDL cholesterol were observed. The most common combination was “elevated blood pressure + abdominal obesity + impaired fasting glucose” in both sexes. Clustering of MetS risks was also found with most of the frequent combinations of MetS components. Through the lifestyle intervention, the greatest change was observed in HDL cholesterol among men and blood pressure among women. Triglycerides and HDL cholesterol were likely to be improved with blood pressure in men and abdominal obesity in women.
Conclusion
Differences in the prevalent patterns of MetS compositions were observed prior to and after the intervention, along with during-intervention changes. It is recommended that intervention strategies and guidelines for MetS management consider the MetS composition patterns for effectiveness.

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Osong Public Health and Research Perspectives.2015; 6(4): 224. CrossRef

Brief Reports

Ebola Hemorrhagic Fever and the Current State of Vaccine Development: Joo Eun Hong, Kee-Jong Hong, Woo Young Choi, Won-Ja Lee, Yeon Hwa Choi, Chung-Hyeon Jeong, Kwang-il Cho; Osong Public Health Res Perspect. 2014;5(6):378-382. Published online December 31, 2014; DOI: https://doi.org/10.1016/j.phrp.2014.09.006

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Abstract PDF

Current Ebola virus outbreak in West Africa already reached the total number of 1,323 including 729 deaths by July 31st. the fatality is around 55% in the southeastern area of Guinea, Sierra Leone, Liberia, and Nigeria. The number of patients with Ebola Hemorrhagic Fever (EHF) was continuously increasing even though the any effective therapeutics or vaccines has not been developed yet. The Ebola virus in Guinea showed 98% homology with Zaire Ebola Virus.Study of the pathogenesis of Ebola virus infection and assess of the various candidates of vaccine have been tried for a long time, especially in United States and some European countries. Even though the attenuated live vaccine and DNA vaccine containing Ebola viral genes were tested and showed efficacy in chimpanzees, those candidates still need clinical tests requiring much longer time than the preclinical development to be approved for the practical treatment.It can be expected to eradicate Ebola virus by a safe and efficient vaccine development similar to the case of smallpox virus which was extinguished from the world by the variola vaccine.

Citations

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Recent developments and strategies of Ebola virus vaccines
Ashish Ranjan Sharma, Yeon-Hee Lee, Sudarshini Nath, Sang-Soo Lee
Current Opinion in Pharmacology.2021; 60: 46. CrossRef
Predictive Effects of Novelty Measured by Temporal Embeddings on the Growth of Scientific Literature
Jiangen He, Chaomei Chen
Frontiers in Research Metrics and Analytics.2018;[Epub] CrossRef
Social network analysis and modeling of cellphone-based syndromic surveillance data for Ebola in Sierra Leone
Jia B. Kangbai
Asian Pacific Journal of Tropical Medicine.2016; 9(9): 851. CrossRef
El desarrollo de nuevas vacunas
Fernando González-Romo, Juan J. Picazo
Enfermedades Infecciosas y Microbiología Clínica.2015; 33(8): 557. CrossRef
Out of Africa, Into Global Health Security Agenda
Hae-Wol Cho, Chaeshin Chu
Osong Public Health and Research Perspectives.2014; 5(6): 313. CrossRef

Acute Human Cytomegalovirus Infection with Bleeding in Iran: Behzad Pourhossein, Farhad Yaghmaei, Saber Esmaeili, Omid Banafshi, Shahla Afrasiabian, Mohammad Reza Shirzadi, Mark Schleiss, Ehsan Mostafavi; Osong Public Health Res Perspect. 2014;5(6):383-386. Published online December 31, 2014; DOI: https://doi.org/10.1016/j.phrp.2014.10.003

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Abstract PDF: In December 2011, a 42-year-old male farmer was admitted to a hospital in Sanandaj (Western Iran) with fever and anemia in order to check whether he suffered from some infectious diseases. During the first 3 days after admission, the patient gradually developed progressive oliguria, fever, abdominal pain in the right upper quadrant, leukocytosis with toxic granulation, petechiae and ecchymosis, oral bleeding, and vomiting. The sonographic findings revealed splenomegaly and an increase in the thickness of the gall bladder wall. In order to manage the patient and taking into consideration the most probable differential diagnoses, diagnostic tests were performed on two blood samples collected from him, and real-time polymerase chain reaction for human cytomegalovirus was positive.

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