Objective: A cross-sectional study was conducted to examine the Entamoeba species prevalence in a sample of people in Zakho city, Kurdistan Region, Iraq, and to compare the diagnostic accuracy of the microscopic, zinc sulfate flotation, and ELISA methods. The relationship between demographic and socioeconomic factors and infection was also evaluated.Methods: The number of stool samples, which were analyzed, was 615 (515 symptomatic patients and 100 asymptomatic participants) in September 2024-May 2025. Direct wet mount, zinc sulfate flotation and enzyme linked immunosorbent assay (ELISA) were used to test samples against E. histolytica-specific antigen. Structured questionnaires were used to obtain demographic data such as age, sex, education, income, family size and hygiene practices. Chi-squared tests were conducted as statistical analyses.Results: The zinc sulfate flotation method detected Entamoeba cysts and trophozoites in 24.22% of samples, significantly higher than the wet mount method (17.07%, P < 0.001). ELISA confirmed E. histolytica antigen in only 5.69% of cases, reflecting its greater specificity. Children aged 1–10 years showed the highest prevalence, while no significant difference was observed between genders. Infections were significantly associated with low income and low educational level (P < 0.05), but not with family size, water source, or fruit washing practices. The most common symptoms among infected patients were watery diarrhea (88.2%), fever (74.01%), and vomiting (68.5%).Conclusion: The floatation of zinc sulfate enhances the diagnostic sensitivity and ELISA confirms the specificity of E. histolytica. The interventions that need to be concentrated on include hygiene education, enhanced sanitation, and interventions with high-risk populations.

Urinary tract infections are one of the most frequently encountered bacterial infections globally and a significant issue in the public health burden because of high prevalence, recurrence, and the growing burden of antimicrobial resistance (AMR). Despite the fact that UTIs are more commonly diagnosed in females, infections in males are usually taken as complicated due to commonly associated with structural urinary tract abnormalities, catheterization, prostatic diseases, and old age. In Iraq, the region-specific information on the causative factors of male UTIs are scarce. The study took place during the period from January 2024 and December 2025 at a private medical lab in Duhok Province, Iraq. Male patients with clinical suspicion of UTIs had aseptic samples of midstream urine on MacConkey agar. Significant bacteriuria was defined as ≥10⁵ colony-forming units (CFU)/mL was used to identify bacteria and determine antimicrobial susceptibility and interpreting the results was based on the Clinical and Laboratory Standards Institute (CLSI) guidelines. One hundred and twenty-nine Gram-negative bacterial cultures were obtained. The most common uropathogen was Escherichia coli (47.3%), Klebsiella pneumoniae (24.0%) and Pseudomonas aeruginosa (13.9%). Proteus mirabilis (9.3%) and Acinetobacter baumannii (5.4%) were also less frequently isolated. These results indicate that Gram-negative bacteria especially E. coli are still the most common causal agents of UTIs in male patients in Duhok. A current local observation of uropathogens and their resistance phenotypes is needed to inform empirical treatment and enhance antimicrobial stewardship interventions.

Toxoplasmosis, caused by the protozoan parasite Toxoplasma gondii, affects immune response and haematological parameters. The study aimed to evaluate and compare haematological changes and distinct pro and anti-inflammatory cytokine profiles between anti-Toxoplasma seropositive and seronegative in post-abortive women. The enzyme-linked immunosorbent assay (ELISA) was performed to examine serum samples from 224 post-abortive women for anti-Toxoplasma immunoglobulin M (IgM) and G (IgG) antibodies. Besides serum cytokines such as Tumour Necrosis Factor α (TNF-α), interleukin 10, 12 (IL-10, IL-12), and Transforming Growth Factor ß1 (TGFß1) were evaluated. Also, the blood groups and haematological parameters were examined. The overall anti-Toxoplasma seropositivity was 25% (56/224), including 19.6% for IgG and 5.4% for IgM, with highly (p < 0.001) significant variations. Blood group type significantly affected IgG and IgM seropositivity rates (p = 0.003 and p = 0.004) individually. IgG seropositivity displayed significant differences in Granulocyte (GRA) p = 0.003, Haemoglobin (Hb) p = 0.009, Mean Platelet Volume (MPV) p = 0.004, and Red Blood Cell (RBC) p = 0.008, whilst IgM seropositivity displayed significant differences of Hb p = 0.019 plus RBC p < 0.001. Besides, IL-12 was significantly higher (p < 0.001) in comparison to controls. Toxoplasmosis was significantly associated with haematological changes and elevated IL-12 levels, highlighting the importance of regular immuno-haematological biomarker monitoring and toxoplasmosis screening to prevent adverse pregnancy outcomes.

Background: The study aimed to investigate the association between cytokine profiles and toxoplasmosis in newly married couples, with identifying the immunological markers to minimizing fertility complications through early detection and intervention. Methods: From May 2024 to February 2025, blood samples of 480 newlywed couples in Zakho City, Iraq, were evaluated for Anti-Toxoplasma G (IgG) and M (IgM) antibodies, as well as serum cytokines like Interleukin 12 (IL-12), Tumer Necrosis Factor α (TNF-α), Interleukin10 (IL-10), and Transforming Growth Factor ß1 (TGFß1), using ELISA. Additionally, C Reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR) were also estimated. Results: The overall seroprevalence of Anti-Toxoplasma antibodies were 25.8% (124/480), constituting 18.2% (88/480) for IgG, and 7.5% (36/480) for IgM, with highly significant difference (P< 0.001). Rates were higher in males, with age-related differences observed for both IgG and IgM. While statistically significant differences were reported for IgM alone relates to gender. Regarding cytokines, seropositive individuals showed significantly higher IL-10 and IL-12 levels than controls: IL-10 (IgG: 85.88±9.67 vs 37.88±5.06; IgM: 80.95±13.19 vs 51.72±6.19 pg/mL) and IL-12 (IgG: 22.43±3.05 vs 10.08±1.03; IgM: 29.25±5.46 vs 11.83±1.06 pg/mL). Besides, TNF-α elevated in the IgM+ group only. Conclusion: Elevated IL-10 and IL-12 levels in seropositive individuals suggest active immune modulation, while TNF-α dynamics point to stagespecific responses, higher in acute (IgM) infections. These immune patterns may influence reproductive health, underscoring the importance of early diagnosis and immune monitoring to reduce potential fertility complications, particularly in early marriage.

Objective: In this study, we compared the effectiveness of three detection methods: direct wet mount microscopy, zinc sulfate floatation, and enzyme-linked immunosorbent assay (ELISA) to detect Entamoeba. histolytica among inhabitants of Zakho city, Kurdistan Region of Iraq. Methods:The collection of faeces was carried out between September 2024 and May 2025 (615 samples, 515 symptomatic patients, and 100 asymptomatic patients). Direct wet mount microscopy, zinc sulfate flotation, and ELISA target E. histolytica-specific antigen were used to examine each specimen. Results:Wet mount revealed 105 positive results (17.07%), whereas zinc sulfate flotation was able to detect significant number of positive cases 149 of them (24.22%, p < 0.001). Only 35 cases (5.69%) were positive using E. histolytica-specific antigen detected by ELISA, which is more specific and can rule out deliberately nonpathogenic species that otherwise resemble pathogens morphologically, such as Entamoeba dispar and E. moshkovskii. The prevalence of infection was the highest in children between the ages of 1 to 10 years with the absence of any significant differentiation between the genders. Socioeconomic factors, in general, and low level of education and low income were found to be significantly associated with the infection rates. Conclusion: Wet mount microscopy is not very sensitive, and zinc sulfate flotation lacks specificity, although it improves sensitivity. ELISA gives valid validation of pathogenic E. histolytica. A combination of flotation and ELISA should be adopted to enhance better accuracy of diagnosis, prevent overtreatment and provide better and reliable epidemiological data in endemic settings.

TOXOPLASMA gondii is an opportunistic intracellular protozoan parasite which causes toxoplasmosis by using its surface proteins that evade the immune system of the host, leading to restricted immune signaling routes. This alteration has various influences on infected individuals, specifically pregnant women, which leads to repeated abortion. The aim of this study was to examine the correlation between systemic inflammatory biomarkers and abortion. Serum samples were collected from 224 aborted women and screened for anti-T. gondii immunoglobulin G and M (IgG, IgM) followed by quantification of Interleukin 12 (IL-12) and Tumor Necrosis Factor-alpha (TNF-α) levels using Enzyme Linked Immunosorbent Assay (ELISA) and some inflammatory tests such as C Reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR). The total seropositivity was 25%, which involved 19.6% IgG and 5.4% IgM antibodies with a highly significant (P<0.001) difference. Furthermore, significant differences (P<0.002) are only present regarding IgG test with the number of abortions. Besides, the ESR test showed significant differences (P=0.006, P<0.001) with anti-Toxoplasma IgG and IgM antibodies. While, for the CRP test, highly significant (<0.001) differences were observed for IgG Abs only. Moreover, higher mean concentrations of IL-12 and TNF-α were observed, which were (19.10±2.80, 7.92±0.45 pg/mL) and (99.13±17.62, 62.00±39.54 pg/mL), respectively, among seropositive patients in comparison to the control group, and the difference was statistically significant(P<0.001) for IL-12 only. The study concluded that T. gondii significantly boosted the cellular immune response. In addition, it highlights the importance of routine screening for anti-Toxoplasma antibodies prior to marriage, early immunological screening for pregnant females who are at high risk and raising public awareness about toxoplasmosis and its reproductive consequences through media campaigns and educational programs suggested

Pseudomonas aeruginosa is rod-shaped, an aerobic, gram-negative, and opportunistic bacterium that doesn't make spores. It can cause various infections in immunocompetent and immunocompromised individuals, including surgical sites, urinary tract, pneumonia, burns, soft tissues, and otitis externa. Furthermore, it possesses variable virulence factors enabling it to resist treatment with the most available antibiotics. The purpose of this chapter was to show how common Pseudomonas aeruginosa isolates are among patients and healthcare professionals, as well as how they resist different types of antibiotics. This chapter demonstrates significant health problems related to Pseudomonas aeruginosa and derives more attention to this bacterium. Since only limited antibiotics are effective against it, therefore, all isolates must be investigated by antimicrobial susceptibility testing to identify the effective ones. From the used antibiotics, only Colistin showed a bactericidal effect by inducing a mechanism involving hydroxyl radicals that cause cell death. The application of this test limits antibiotic use and prevents the patients from developing resistance, in addition, it aids in the managements of treatment strategies

Toxoplasma gondii is an opportunistic intracellular protozoan parasite which causes toxoplasmosis by using its surface proteins that evade the immune system of the host, leading to restricted immune signaling routes. This alteration has various influences on infected individuals, specifically pregnant women, which leads to repeated abortion. The aim of this study was to examine the correlation between systemic inflammatory biomarkers and abortion. Serum samples were collected from 224 aborted women and screened for anti-T. gondii immunoglobulin G and M (IgG, IgM) followed by quantification of Interleukin 12 (IL-12) and Tumor Necrosis Factor-alpha (TNF-α) levels using Enzyme Linked Immunosorbent Assay (ELISA) and some inflammatory tests such as C Reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR). The total seropositivity was 25%, which involved 19.6% IgG and 5.4% IgM antibodies with a highly significant (P<0.001) difference. Furthermore, significant differences (P<0.002) are only present regarding IgG test with the number of abortions. Besides, the ESR test showed significant differences (P=0.006, P<0.001) with anti-Toxoplasma IgG and IgM antibodies. While, for the CRP test, highly significant (<0.001) differences were observed for IgG Abs only. Moreover, higher mean concentrations of IL-12 and TNF-α were observed, which were (19.10±2.80, 7.92±0.45 pg/mL) and (99.13±17.62, 62.00±39.54 pg/mL), respectively, among seropositive patients in comparison to the control group, and the difference was statistically significant(P<0.001) for IL-12 only. The study concluded that T. gondii significantly boosted the cellular immune response. In addition, it highlights the importance of routine screening for anti-Toxoplasma antibodies prior to marriage, early immunological screening for pregnant females who are at high risk and raising public awareness about toxoplasmosis and its reproductive consequences through media campaigns and educational programs suggested.

The family Enterobacteriaceae is the leading cause of both hospital-and community-acquired urinary tract infections. The purpose of this study was to estimate the rate of infection with Enterobacteriaceae among outpatients suffering from UTIs at two majorhospitals in Zakho city. This study was conducted over the period of 5 months from the 1st of September 2021 till the end of January 2022,during this period a total of 454 midstream urine samples were collected from outpatients with UTIs of both genders and different ages (≤ one year to > 50 years). The isolated enterobacterial species were identified according to their biochemical characteristics using conventional standard methods. The result showed that 52.64% (239/454) of the tested urine samples wereinfected with species of Enterobacteriaceae. The most commonly detected species with their rates of infections were: Escherichia coli(69.46 %) and Klebsiella pneumoniae(27.20 %). In females, the overall rate of infection was higher over all ages than inmales (85.36% vs 14.64%) with the highest rate being among the ages ≤1-10 and >10-20 years,which was 91.67%. Married patients of both genders showed a slightly higher rate than single ones (53.62% vs 51.12%),and married women showed a higher rate than single ones (86.49% vs 83.52%). Urban residents had a higher infection rate than those living in camps and rural areas (53.85%, 48.48%, and 45.45%), respectively. This study concluded that members of Enterobacteriaceae are the major causative agents of UTIs,with E. coli being thepredominant isolated bacterial species. The rate of infection was higher in females, married patients and urban residents.

Abstract Background Helicobacter pylori infection affects over 50% of the global population. Individuals acquire this infection in early childhood that persists throughout life if not treated. The degree of the outbreak severity varied from one region to another, causing long-term clinical consequences such as gastritis, peptic ulcer disease, and cancer of the stomach. The primary objective of this investigation was to estimate the prevalence of Helicobacter pylori among the population in Duhok City via the implementation of non-invasive methods. Methods From January 2021 to December 2022, 2313 cases were studied using ELISA assays for immunoglobulins, IgG, IgM, and IgA, a stool antigen test (SAT), and a urea breath test (UBT) to identify Helicobacter pylori. Results Among 2313 patients of both genders, 61.7% (1427/2313) were females and 38.3% (886/2313) were males. The prevalence of H. pylori infection was 35.28% among them, with a high significant difference in infection rate in females than males (60.78% vs 39.22%), and among various ages with the highest being at ages of 31 to 40 years. The serological and the SAT tests are commonly used diagnostic tests that yield the most significant number of positive results. Furthermore, a notable correlation was observed between the prevalence of infection and age, especially for IgA and UBT where males exhibited higher significant levels than females; moreover, for UBT, highly significant variations were observed among ages also. Conclusions Over half of the performed tests detected H. pylori antibodies with the peak at 49.3% for the IgG test, indicating the body elicits an immune response against this bacterium. Both gender and age were linked to this infection. For more clarification of the prevalence of H. pylori, we recommend conducting more in-depth investigations.

Cryptosporidium (C.) parvum is the most prevalent species in the middle-east countries especially in Iraq and its zoonotic importance is not well documented. Hence, the current work included the study of the genetic profile of Cryptosporidium species from the fecal samples of infected cattle owners and cattle. Two hundred stool specimens were collected from cattle owners complaining of watery diarrhea and 100 fecal samples from diarrheic cattle in several rural areas of Zakho district. All stool specimens were analyzed microscopically using modified Ziehl Neelsen stain technique and genetically using traditional PCR approach targeting 18S rRNA, HSP70 and gp60 genes. The prevalence of Cryptosporidiosis in humans was 70% (140/200) and among infected cattle was 62% (62/100) by using modified Ziehl-Neelsen stain. On other hand, the molecular analysis (PCR) identified Cryptosporidiosis in 74.5% (149/200) among human samples and 65% (65/100) among cattle samples. The similarity in the analysis of Targeting genes presented that all isolates were identified as C. parvum which have 82–99.8 % similarity to other isolates from Iraq, China and USA. The phylogenetic analysis based on gp60 sequences of Cryptosporidium parvum revealed two subtypes belonging to family subtypes IIa (IIdA21G1 and IIdA19G1). This study confirms the prevalence of C. parvum among humans and cattle in this area. Furthermore, the C. parvum isolated from cattle are genetically identical to those found in humans.

Pseudomonas aeruginosa is the major cause of hospital acquired infections in immunocompetent and immunosuppressed individual such as, burn and surgical sites, UTIs, pneumonia, otitis externa, and soft tissues. Nowadays, the emergence of P. aeruginosa isolates that resist metallo-beta-lactamase antibiotics become a serious public health issue globally. The aims of the present investigation are to estimate the prevalence of P. aeruginosa isolates in inpatients, to determine their sensitivity and resistance to the prescribed antibiotics in this area and to identify some of the antibiotic resistant genes. The study was conducted from April 2021 to March 2022, and included 360 samples taken from inpatients admitted to three teaching hospitals (Azadi, Burin and Heevi) and the Vajeen private hospital in Duhok city. The overall prevalence of Pseudomonas aeruginosa was 30% (108/360). The highest rate in patient samples was 48.78% from sputum, followed by nearly equal rates of 38.78% and 38.3% from both of ears and burns, respectively and the lowest rate 19.34% from urine with highly significant (P<0.001) differences between these sources. The 16 S rDNA gene was amplified by PCR in all isolates, each of them produced a distinct band of 956 bps for this gene. The produced segments of 16S r DNA were sequenced, 4 sequences were deposited in GenBank under accession numbers: OP221013, OP221014, OP221015, OP221016 from sputum, ear, burn and wounds, respectively. In this study also, two antibiotic resistant genes were detected included blaOXA-10 and blaBEL1. The gene blaOXA-10 was present in100% of the isolates, while the genes blaBEL1 was detected in 95.83%. The sequence of blaOXA-10 gene was deposited in GenBank under accession number: OP251042. All isolates carried these genes were 100% resistant to β-lactam antibiotics in addition to Erythromycin and Trimethoprim/Sulfamethoxazole, furthermore about 34% of these genes were detected among ages >50 years.

Introduction: Acinetobacter baumannii (A. baumannii) is an opportunistic pathogenic bacterium mainly associated with hospital acquired infections and in immunocompromised individuals who stay in hospitals for a long time. In recent years, it has become increasingly resistant to many different types of antibiotics. The production of the metallo-beta-lactamase (MBL) enzyme is one of the primary causes of this resistance. This study aimed to detect the presence of MBL genes that belong to the verona integrin metallo-β-lactamase (bla-VIM) and imipenemase (bla-IMP) groups in the isolates of Acinetobacter baumannii from burn patients. Methodology: One hundred and seventeen (117) isolates of A. baumannii were obtained from patient specimens using traditional methods followed by using the VITEK 2 (BioMérieux, Les Pennes-Mirabeau, France) identification system. Metallo β-lactamases were detected in the imipenem-resistant strains by using imipenem disks on Muller-Hinton agar. The polymerase chain reaction (PCR) technique was utilized to examine 117 isolates for the detection of MBLs encoding genes such as bla-VIM, and bla-IMP. Results: Imipenem resistance was detected in 78.6% of the patients. The PCR assays of the isolates identified bla-VIM-1, bla-VIM-2, bla-IMP-1 and bla-IMP-2 genes at the rates of 17%, 40.1%, 29.9% and 4.2%, respectively. Conclusions: The findings suggest that the majority of A. baumannii isolates harbour one or more of the detected genes, signifying that the production of MBLs plays a pivotal role in resistance mechanisms.

Objective: Virulence factors are substances produced by pathogenic Pseudomonas aeruginosa that contribute significantly to the etiology of disease. Virulence genes encode these virulence factors on the Pseudomonas aeruginosa chromosome. Methods: Between July 2021 and June 2022, at the Burn and Plastic Surgery Hospital in Duhok city, Iraq, seventy-one isolates of Pseudomonas aeruginosa were isolated from infected burns. The lasB and toxA genes were identified using Polymerase Chain Reaction (PCR). Results: P. aeruginosa was isolated from 64.55% (71/110) of the specimens, with non-significantly higher rate from females than males (38.18% vs 26.36%), but the differences between various ages were significant (P < 0.04). About 38.18% of burns were due to flame and the highest rate (45.4%) of infected burns were second-degree burns. Furthermore, 76.06% (54/71) of the isolates were multidrug resistant. They demonstrated greater resistance to Piperacillin; the resistance was 98.59%. Of the isolates examined, 35 (64.81%) were positive for toxA and 27 (50%) were positive for lasB genes. Conclusion: Due to the limited number of effective medications against this bacterium that are currently available, testing for antimicrobial susceptibility must be performed on all isolates. By doing this, you can help manage the treatment plan and stop the emergence of resistance in burn units.

Infection of healthcare workers with methicillin resistant Staphylococcus aureus (HA-MRSA) occurs by direct contact with infected wounds, through hand contamination from asymptomatic people or medical devices. While Community-associated MRSA (CA-MRSA) infections arise in healthy non-hospitalized people or in those having medical procedure within the past year. The study was conducted from April 2021 to March 2022 to determine the rates of S. aureus and MRSA isolates, their antibiotic resistance and virulence factors among 712 specimens (308 out-patients and 404 healthcare workers) of Azadi and Bedari hospitals/ Duhok province. Staphylococcus aureus isolated at rates of 28.57% and 16.83%, among out-patients and healthcare workers, respectively. Male outpatients’, and patients with ages of >40-50 years showed higher isolate rate than healthcare worker (46.15% vs 35.38% and 85.71% vs 46.42 %) respectively. CA-MRSA showed higher resistance to beta lactam antibiotics, while HA-MRSA showed higher multidrug resistance. Males of both MRSA types (CA-MRSA and HA-MRSA) carried higher isolate rates than females (38.46% and 15.87%) respectively. The higher rates of CA-MRSA and HC-MRSA isolates were 64.29% and 22.54% at ages of >40-50 and >20-30 years, respectively. PCR analysis detected nuc and mecA genes in 100% of both MRSA types, also, the genes arcA lukS/F-pvl and lukE-lukD were detected at high rates (30.3%, 42.42% and 33.33%), respectively.

Methicillin-resistant Staphylococcus aureus (MRSA) is considered a serious public health problem. This study aimed to estimate the rate of MRSA among Staphylococcus aureus isolates of inpatients and to determine their susceptibility to antibiotics and some of the virulence genes. The study was conducted from April 2021 to March 2022 and involved specimens from 302 inpatients admitted to Azadi and Bedari teaching hospitals in Duhok province. Staphylococcus aureus was detected in 20.53% (62/302) of the examined specimens with the highest rate (37,50%) from surgical swabs. Antibiotics sensitivity tests showed that all isolates were resistant to penicillin G. Methicillin-resistant S. aureus was detected in 77.42% (48/62) of S. aureus isolates with a higher rate from skin swabs (85.71%). According to gender, a significantly (P<=0.005) higher rate of S. aureus and MRSA isolates was recorded in Males (21.52%). As regards age, ages > 40-50 years showed the highest rate of MRSA isolate (24.62%). Among MRSA, 77.08% (37/48) were multidrug resistant. Molecular analysis revealed the presence of nuc, mecA, pvl and eta genes at rates of 100%, 66.6%, 31.2% and 22.9%, respectively among the analyzed isolates.

Proteus mirabilis is the most common species among the genus Proteus that has been associated with various infections in humans. In this study, the prevalence of P. mirabilis among outpatients with UTIs, ear, burns, wounds, respiratory tract infections, and vaginitis who attended the major hospitals and clinics in Zakho city has been investigated. Four hundred specimens were collected from both genders at different ages (≤1 year to over 50 years), from July 2021 to January 2022. All specimens were analyzed according to conventional bacteriological methods for detecting the presence of P. mirabilis. Also, a molecular method was used using species-specific ureR primer to confirm the presence of P. mirabilis among the isolates. From all collected specimens, 23.75% (95/400) were identified as P. mirabilis with a higher rate in males than females (52.63% vs 47.37). Among both genders, the age group ≤ 1-10 years showed the highest rate of infection (61.90%). Married patients had a higher rate (27%) than unmarried ones (16.92%). In terms of residency, rural inhabitants had the highest rate (31.25%) among other inhabitants. Furthermore, infections during the months of the year were at their maximum rate during August (52.27%), while reduced to 11.67% in October. ureR primer gives a precise and specific detection of P. mirabilis. This study highlights that; P. mirabilis is one of the remarkable bacteria that cause various infections in humans through various risk factors like anatomical abnormalities, gender, age, and chronic diseases that facilitate its spreading in the community.

Pseudomonas aeruginosa is resistant to a wide range of extended spectrum-lactamases (ESBLs) antibiotics because it produces several kinds of ESBLs. The goal of the current investigation was to identify the bacteria that produce extended spectrum -lactamases and the genes that encode three different ESBLs, such as blaOXA-10, blaPER-1 and blaSHV genes in Pseudomonas aeruginosa isolated from burn patients. In this investigation, 71 Pseudomonas aeruginosa isolates were isolated from burn wounds in Burn and Plastic Surgery Hospital, Duhok City between July 2021 to June 2022. For the purpose of finding the blaOXA-10, blaPER-1, and blaSHV ESBL expressing genes, Polymerase Chain Reaction (PCR) was used. Among 71 Pseudomonas aeruginosa isolates, 26.36% (29/71) were isolated from males and 38.18% (42/71) from females, and 76.06% (54/71) of the isolates were multidrug resistant. They exhibited higher resistance against Piperacillin with resistance rates of 98.59%. Among the ESBLproducing isolates tested, blaOXA-10 was found in 59.26% (32), blaPER-1 was found in 44.44% (24), and blaSHV was found in 11.11% (6). All isolates must undergo antimicrobial susceptibility testing because only a few numbers of the available antibiotics are effective for the treatment of this bacterium. This will prevent the development of resistance in burn units and aids in the management of the treatment plan.

Abstract Objectives: Pseudomonas aeruginosa is opportunistic gram-negative bacillus and a major human pathogen belongs to family Pseudomonadaceae, it causes several nosocomial infections including pneumonia, urinary tract, surgical sites, otitis externa, and soft tissues. Methods: The study was conducted from April 2021 to January 2022 and involved the prevalence of Pseudomonas aeruginosa isolates and their susceptibility to different antimicrobial agents among patients and healthcare workers specimens in three hospitals of Duhok city. The collected specimens were examined and cultured on different media in the Advanced Microbiology Laboratory, Azadi teaching hospital. The isolated bacteria were identified according to their morphological and biochemical properties. Results: Out of 324 specimens, 29.32% (95/324) of the isolates were identified as Pseudomonas aeruginosa, isolated from 26.89% patients and 40% healthcare workers. Regarding isolate rates among specimens, the highest rate (48.78%) was from sputum, with a highly significant (P < 0.001) difference from other sources. Females had a non-significantly higher isolate rate than males (28.19% vs 25.22%), ages, > 50 years had the highest isolate rate (72.88%), while the lowest rate 6.25% was among ages > 10–20 years, with highly significant (P < 0.001) differences among them. Specimens from Heevi hospital showed a non-significantly higher isolate rate (28.57%) than other hospitals. Isolates highest susceptibility was to Colistin (88.7%)-followed by Imipenem (78.9%), while they were 98.6% resistant to ampicillin and 100% resistant to Amoxicillin, Erythromycin and Trimethoprim/Sulfamethoxazole. A high rate of extensively drug-resistant (19.72%) Pseudomonas aeruginosa isolates was documented among patients who attended these hospitals with the highest (31.25%) from wounds. Conclusion: These findings will be helpful to advise treatment with appropriate antibiotic strategy against multi- and extensively drugresistant P. aeruginosa to cope with the chances of evolving resistant pathogens.

Background: Acinetobacter baumannii (A. baumannii) is an opportunistic pathogenic bacterium mainly related with hospital acquired infections and in immunocompromised individual who stay for long time in hospitals. It has become increasingly resistant to many different types of antibiotics in recent years. The production of the metallo-beta-lactamase enzyme is one of the important causes of this resistance (MBLs). Methodology: This study aimed to detect the presence of metallo-beta-lactamase genes that belongs to the Verona Integrin Metallo- β-lactamase (bla-VIM) and the types of Imipenemase (bla-IMP) in the isolates of Acinetobacter baumannii from burn patients Methods: One hundred seventeen (117) isolates of A. baumannii were obtained from patient specimens using traditional methods followed by using VITEK 2 identification system. Metallo β-lactamases were detected in the imipenem-resistant strains that used imipenem disks on Muller-Hinton agar. The PCR technique was utilized to examine 117 isolates for the detection of MBLs encoding genes like as bla-VIM, and bla-IMP. Result: The rate of imipenem resistance was detected in 78.6% of the patients. The PCR assays of bla-VIM-1, bla-VIM-2, bla-IMP-1 and bla-IMP-2 genes were revealed at rates of 17%, 40.1%, 29.9% and 4.2%, respectively in these isolates.

Purpose: Brucellosis is a zoonotic disease that contributes to severe global health and economic issues. In this study, the Rose Bengal Test (RBT), a crucial diagnostic tool for brucellosis in Duhok city, was evaluated in order to offer updated epidemiological data on this disease. Patients and Methods: A total of 339 patients suffered from fever and seeking medical attention in the private medical health center in Duhok city, Iraq, were enrolled after taking ethical approval from committee at Faculty of Sciences, University of Zakho and a verbal consent from each enrolled patient for using his/her blood and data. The blood specimens were tested for Brucella spp. Antibodies using the RBT and blood cultures, followed by spp. determination. A questionnaire form was designed to detect the associated risk factors. Results: Prevalence of brucellosis was 12.6% among participants with a probable diagnosis and 10.3% among those with a confirmed diagnosis (positive blood culture). Most of the positive cases were between the ages of 20 to 40 years. A highly significant (P < 0.0001) association was found between brucellosis with both consuming raw milk and having contact with cattle. The most common species identified were Brucella melitensis (57.1%) and Brucella abortus (42.7%). Conclusion: Brucellosis is a significant cause of fever in the current study and can be detected using the RBT. Human brucellosis can be reduced by minimizing the chances of contact with cattle and consuming boiled or pasteurized milk.

Intestinal parasites and bacteria especially enteropathogenic Escherichia coli (EPEC) are important causative agents responsible for persistent diarrhea in infants and children worldwide due to their high occurrence in both the hospitals and community settings. However, sporadic outbreaks by these microorganisms occur globally. This study was conducted from August 2021 to January 2022, during which 500 diarrheic stool samples were collected from both genders and various ages (6 month to 12 years) from outpatient in Zakho hospital. In this study the total rate of infection was 64.2%(321/500), considerable number of samples were positive for more than one species of microorganisms, elevating the rate to 89%, with the highest rate (62%) being with bacteria among which E. coli was the dominant species (74.84%), while the rate with parasites was 27%, with E. histolytica being the dominant species (45.93%). Other recorded bacterial species with their rates are: Klebsiella (15.16%) Pseudomonas spp. and Shigella spp. at rates of 6.13% and 3.87%, respectively. While other parasites included: Cryptosporidium spp.(34.07%), Blastocystis spp.(13.33%), G. lamblia (5.93%) and H. nana (0.74%). Single infections were reported in 61.68%(198/321) of the positive cases with the highest rate (49.53%) of bacteria and only 12.15% with parasites. The dominant organisms in single infections were E. coli and the oocysts of Cryptosporidium spp. at rates of 81.13% and 61.54%, respectively. The mixed infections were documented in 38.32%(123/321). Among these, 67.48%(83/123) showed a combination between bacteria and parasites.

Intestinal parasites and bacteria especially enteropathogenic Escherichia coli (EPEC) are important causative agents responsible for persistent diarrhea in infants and children worldwide due to their high occurrence in both the hospitals and community settings. However, sporadic outbreaks by these microorganisms occur globally. This study was conducted from August 2021 to January 2022, during which 500 diarrheic stool samples were collected from both genders and various ages (6 month to 12 years) from outpatient in Zakho hospital. In this study the total rate of infection was 64.2%(321/500), considerable number of samples were positive for more than one species of microorganisms, elevating the rate to 89%, with the highest rate (62%) being with bacteria among which E. coli was the dominant species (74.84%), while the rate with parasites was 27%, with E. histolytica being the dominant species (45.93%). Other recorded bacterial species with their rates are: Klebsiella (15.16%) Pseudomonas spp. and Shigella spp. at rates of 6.13% and 3.87%, respectively. While other parasites included: Cryptosporidium spp.(34.07%), Blastocystis spp.(13.33%), G. lamblia (5.93%) and H. nana (0.74%). Single infections were reported in 61.68%(198/321) of the positive cases with the highest rate (49.53%) of bacteria and only 12.15% with parasites. The dominant organisms in single infections were E. coli and the oocysts of Cryptosporidium spp. at rates of 81.13% and 61.54%, respectively. The mixed infections were documented in 38.32%(123/321). Among these, 67.48%(83/123) showed a combination between bacteria and parasites.

Proteus mirabilis is one of the important causative agents of bacterial infections in humans. This study involved the prevalence of the virulence genes among P. mirabilis from urine, ear, sputum, burn, wound, and vagina specimens in Zakho city during the period of July 2021 until January 2022 and their susceptibility to different commonly used antimicrobial agents. Isolates were identified by traditional phenotypic and biochemical tests. Out of 400 cultures, 95 (23.75%) were P. mirabilis. The antibiotic susceptibility toward different antibiotics varied among the isolates. The results showed that ceftriaxone was the most potent antibiotic with a susceptibility rate of 90.28 %. The isolates were resistant to many screened antibiotics, with the highest rate of 88.42% to imipenem. Whereas, the resistant proportion was slightly lower toward other antibiotics at rates varied from 74.68 % and 77.89% for Ampicillin and Amoxicillin/clavulanic acid, respectively. Fifty-two P. mirabilis isolates were selected for PCR analysis, according to their multiple antimicrobial resistance to the used antibiotics. The selected samples were amplified for P. mirabilis identification by producing a single band of the ureR gene. The prevalence of the virulence genes (flaA, rsbA, zapA, and mrpA) among these isolates were 96.15%, 88.46%, 80.77%, and 69.23%, respectively. This study demonstrates that multidrug resistance P. mirabilis harbors multiple virulence genes.

The prevalence of ESBLs producing Enterobacteriaceae are increasing locally and globally. This study aimed to investigate the antibiotic susceptibility profile of Enterobacteriaceae causing urinary tract infection and to record the prevalence of ESBLs genes among enterobacterial isolates. A total of 454 urine specimens were collected from outpatients with UTIs from two major hospitals in Zakho city; The Zakho General hospital and Emergency hospital. The enterobacterial isolates were identified using the phenotypic and conventional biochemical tests. The antibiotic susceptibility of the isolated organisms was determined using the disk diffusion method, and ESBL production was detected by a double-disk synergy test. The suspected ESBL producers were further confirmed by the amplification of specific primers using PCR assay. Out of 454 specimens, 239 enterobacterial isolates were identified. The most common detected isolates and their rates were: Escherichia coli (65.20 %) and Klebsiella pneumoniae (25.49 %). Imipenem was the most effective antibiotic used while, amoxicillin and ampicillin were the most resistant. The highest level of ESBL production was determined in E. coli (66.3 %) followed by K. pneumoniae (30.43%). The predominant detected gene were both CTX-M and SHV equally followed by TEM. In conclusion, this study indicated that member of Enterobacteriaceae in particular E. coli and K. pneumoniae are the predominant species causing UTI. The isolated bacteria were resistant to most of used antibiotics except imipenem which was effective. These bacteria are becoming multidrug-resistant due to the absence of restriction in antibiotics uses, in addition to their abuse and overuse.

Klebsiella pneumoniae is a common cause of infections, particularly urinary tract infections (UTIs). Urine samples were taken from 800 patients with clinical indications of UTI who visited the inpatient and outpatient clinics from governorate hospitals and private clinics, namely, Azadi Teaching hospital, Duhok Emergency hospital, Heevi Pediatrics Teaching hospital and Vajeen Private hospital in Duhok city. Standard bacteriological methods were used to identify isolated colonies from urine samples cultured on bacterial media. A speciesspecific PCR assay was used to identify K. pneumoneae isolates at molecular level PCR assays and capsular type counting of the K1 and K2 genes were detected among 50 K. pneumoniae isolates. The furthermost predominant genes amongst all isolates were K1 gene (12%) followed by K2 gene (8%). This study emphasized on K. pneumoniae as sources of UTIs that displayed to harboring K1 and K2 genes. The goal of this work was to investigate the mucoviscosity of K. pneumoniae isolated from a urinary tract infection and to screen for certain virulence factor genes such as K1 and K2 genes.

This study involved the prevalence of uropathogenic Escherichia coli (UPEC) among outpatients of UTI attending three major hospitals in Zakho city. Four hundred urine samples were collected from patients of UTI of both sexes and different ages (≤ 1 year to over 50 years), during the period from July 2018 until January 2019. All urine samples were analyzed by conventional bacteriological method for the presence of Escherichia coli (E. coli), while molecular method was used for the presence of species-specific uidA gene in the isolated E. coli. Out of 400 samples, 141 (35.25%) were infected with UPEC from enrolled patients. The rate was higher in females than males (90.78% vs 9.22%), respectively. In both sexes, the age group 41-50 years in both sexes showed the highest rate (46.67%) of infection, and statistically this rate of infection was significant (p< 0.013) among both sexes and various age groups. Furthermore, in all ages, married patients showed slightly higher prevalence than un-married one (38% vs 32.5%), but this difference was statistically non-significant (p> 0.05%). The rate of UTI was higher among urban inhabitants (40.56%) than others. During the months of the year, the peak (90.48%) in both sexes was during December while the lowest rates (13.64%) was during January.

Background: Pseudomonas aeruginosa is common pathogen causing nosocomial infection. Acquired drug resistance and Metallo-β-lactamases (MBL) production have recently emerged as one of the most worrisome resistance mechanism that hydrolyze all beta-lactam antibiotics including penicillins, cephalosporins and carbapenems, with the exception of aztreonam. The aim was to find out the prevalence of multi drug resistant (MDR) and Metallo-β-lactamase (MBL) positive isolates of P. aeruginosa in wounds samples which are a serious concern. Methods: Pseudomonas aeruginosa strains were obtained by standard isolation and identification techniques from 307 wound samples of hospital. Strains were then subjected to susceptibility testing for anti-pseudomonas drugs as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Carbapenems resistant strains were selected for the detection of MBL enzyme production by disc potentiation test. Production of MBL was confirmed by enhancement of inhibition zone around imipenem and meropenem discs impregnated with EDTA, as compared to discs without EDTA. Results: Amongst the 71 isolates of P. aeruginosa, 62(87.3%) isolate were imipenem-sensitive, while 9(12.7%) isolates were found to be imipenem resistant and MBL producers. Very high resistance to antibiotics was recorded amongst MBL producers’ P. aeruginosa compared with non-MBL imipenem-sensitive strains. Conclusion: Study indicates that, surveillance for the detection of MBL is necessary. The rapid dissemination of MBL producers is worrisome and necessitates the implementation of proper and judicious selection of antibiotics especially carbapenem.

Uropathogenic Escherichia coli (UPEC) is one of the most causative agents which causing urinary tract infections (UTIs) in humans. This study involved the prevalence of the virulence genes among UPEC isolated from patients in various hospitals in Zakho city from July 2018 until January 2019 and their susceptibility to different commonly used antimicrobial agent against UPEC. The different culture media were used for the identification of Escherichia coli (E. coli). Out of 400 samples, 141 (35.25%) strains of UPEC were isolated from enrolled patients. The antibiotic susceptibility toward different antibiotics was varied among the isolates. Imipenem was the most potent antibiotic with a resistant rate of only 2.84%. While the isolates were resistant to most screened antibiotics, with the highest rate 96.45% to Amoxicillin/ clavulanic. The resistant rates decreased toward other antibiotics at rates varied from 93.62% for Amoxicillin to 43.97% for Norfloxacin. Fifty-seven isolates were selected for PCR analysis, according to the resistance of E.coli to various antibiotics. The selected samples were successfully amplified for E. coli identification by producing a single band of a target uidA gene. In this study, the virulence related genes were detected in only 35 (61.40%) isolates out of 57 isolates. The distribution of the virulence related genes that included; afa, sfa, hly, cnf and pai were 28.07%, 17.54%, 26.32%, 22.81% and 22.81%, respectively. The study highlight that multidrug resistance UPEC harbors multiple virulence genes circulating in this settin

Background and objective: Pseudomonas aeruginosa is very a well-documented nosocomial and opportunistic microorganism, a little challenge is being present with the identification of such pathogen. This study aimed to identify Pseudomonas on genus and species levels by conventional PCR and determine multi-drug resistant isolates.

Extended Spectrum Beta Lactamase-among Proteus mirabilis strains recorded high incidence leaving few therapeutic options of potential infections. The purpose of current study was to assess the prevalence of antibiotic resistance among Extended Spectrum Beta-Lactamases (ESBL) producing P. mirabilis, in addition to molecular characterization of the ESBL gene-types using PCR. All isolates were fully identified, checked for antibiotic susceptibility and ESBL production using double disk synergy phenotypic method. Positive ESBL-producing isolates were subjected to PCR assay using specific primers for detection of CTX-M, TEM, and SHV genes. The majority of the isolates exhibited absolute susceptibility (100%) to both meropenem and ertapenem and high susceptibility (95%) to imipenem, while co-resistance were expressed toward cefotaxime, ceftazidime, ceftriaxone and other non-lactam antibiotics. Out of 37 isolates, 21 (57%) were ESBL-producers and using a double-disc synergy test (DDST). Using molecular-based PCR, CTX-M (81%), TEM (57%) and SHV (24%) were determined among ESBL-positive. CTX-M was predominant and circulating among phenotypic multiple resistant strains. Moreover, the coexistence of CTX-M and TEM gene was a more frequent combination. The study highlighted the increasing levels of low antibiotic susceptibility among P. mirabilis harbored ESBL genes at Duhok city and also confirms that a high level of blaCTX-M-positive ESBL isolates is circulating in this area.

Enterococcus faecalis is one of the leading causes of many infections and mainly urinary tract infections. This pathogen developed high resistance to multiple antibiotics and it harbor many virulence factors genes. This study aimed to determine the antibiotic resistance patterns and screening for some virulence factor genes of E. faecalis isolated from urinary tract infection. Urine samples were collected from 788 outpatient’s clinic having clinical signs of UTI that visited Azadi Teaching Hospital in Duhok city. Urine samples were cultured on bacteriological media and isolated colonies identified using standard bacteriological methods. Antibiotic susceptibility was performed by Kirby Bauer test. All isolates were subjected to species-specific PCR assay for confirmatory identification followed by targeting virulence genes. Twenty five isolates of E. faecalis were detected and confirmed by species-specific PCR assay that expressed high antibiotic-resistance to many selected drugs except norfloxacin, penicillin and ampicillin. The most prevalent genes among all isolates were cpd genes followed by asa1, ace, esp, and gelE. Bearing of virulence genes combination were more frequent among multiple-antibiotic resistant strains. This study highlighted on E. faecalis as causes of UTI in Duhok city that showed multiple resistances to common antibiotics and harboring more than one virulence gene.

Twenty five isolates of Enterococcus faecalis have been previously identified and characterized were subjected to ERIC-PCR analysis in order to study the genetic relationship with regarding to their virulence profile. Nine virulence profiles were identified according to the presence/absence of five virulence factors; asa1, gelE, esp, cpd and ace. Most isolates (28%) were belonged to Virprofile1 asa1+, gelE+, esp+, cpd+, ace+ followed by Virprofile3 asa1+, gelE-, esp+, cpd+, ace+(20%), Virprofile4 asa1+, gelE+, esp-, cpd+, ace-accounting 16%, while virprofiles5 asa1+, gelE-, esp-, cpd+, ace+, virprofile6 asa1-, gelE+, esp+, cpd+, ace+ and virprofile8 asa1+, gelE-, esp+, cpd+, ace-representing 8%, virprofile2 asa1-, gelE-, esp-, cpd-, ace+, virprofile7 asa1+, gelE+, esp+, cpd+, ace-and virprofile9 asa1+, gelE+, esp-, cpd+, ace+ were 4%. ERIC-PCR analysis divided isolates into two main clusters named; cluster A accounting 28% which further classified into groups; 8% isolates were belonged to A1 and 20% were belonged to A2. Most isolates were belonged to cluster B accounting 72%. This cluster was involved two groups; six isolates (33.3%) were belonged to B1 while 66.6% of isolates were assigned as B2. However, no relationship was found between virulence profiles with phylogentic groups of the isolates.

Molecular characterization of ESBL-related bla genes including blaTEM, blaSHV, and blaCTX-M has been performed for Escherichia coli isolated from urine and collected from three cities in Kurdistan/region/Iraq (Erbil, Sulymani and Duhok). One hundred sixty nine isolates of E. coli have been identified and their production of ESBLs enzymes have been determined using phenotypic methods. All these isolates were successfully amplified producing a single band of the uidA locus in all strains with a molecular weight of about 670bp in order to confirm at molecular level that all these isolates were E. coli. One hundred sixty ESBL E. coli isolates out of 169 appeared to have one or more ESBLs genes accounting for 94.7%. CTX-M constituted the high prevalent type of ESBLs genes compared to the others represented by 94.1% of all isolates in all the three cities of Kurdistan region followed by TEM and SHV in a percentages of 43.8% and 2.5%, respectively. In Duhok, TEM showed the higher prevalence (60.8%) in comparison to the other two cities in percentages of 36.2% for Sulaimania while Erbil represented by 25%. Furthermore, it was clear that SHV type of ESBLs had the lower prevalence of all types and there were only four isolates out of 160 appeared to carry this type of gene representing 2.5%. The presence and/or absence of the three genes in all isolates were also investigated and it was shown that 86/160 isolates (53.75%) had the CTX-M gene only while the rest of genes were lacking. Moreover, 69/160 isolates had both CTXM and TEM. Interestingly, 3/160 harbored all three involved genes. The isolates characterized by the presence only TEM gene and those that had both CTX-M and SHV, shared the same percentage (0.6%). after taking sequencing of the PCR product of studied genes for 12 E coli isolates into consideration, it was obvious that all the PCR products of CTX-M were belonged to type CTXM-15; while TEM-1 type appeared predominant among all sequences PCR product for TEM gene.. Finally, from the three isolates which revealed positive PCR amplification for the SHV gene, two isolates showed 100% similarity to the SHV-12 genome type while the rest single isolate was similar (99%) to SHV11.

This study was purposed to sequence analysis of ESBLs genotype of K pneumoniae using partial sequence and Multilocus sequence typing (MLST). A total of 275 K. pneumoniae isolatesinvolved three general hospitals in Duhok, Erbil, and Sulymania, from September 2010 to June 2011. The Minimum Inhibitory Concentration (MIC) was measured by Phoenix system that confirmed 187 ESBL producing isolates followed by the Double Disk Synergy Test (DDST). Then, 12 isolates were selectedaccording to sample diversity, high resistancy to β-lactam and cephalosporins and harboring combination of three genes (TEM, SHV, and CTX-M). Partial sequence analysis of TEM; showed two different genotypes regarding blaTEM as 9 isolates (75%) from different samples (wound, sputum and blood) from three provinces harbor TEM-1 gene and 3 isolates (25%) only from urine in three provinces harbor TEM-198 gene. SHV analysis revealed characterization of selected isolates into six different genotypes. The common genotype was blaSHV-11 involved five isolates from sputum and blood in Erbil and Sulymania provinces, and wound in Duhok province. Only one genotype as all 12 isolates (100%) from different samples and different provinces was found harbored CTX-M-15 gene. Multilocus sequence typing (MLST) study performed using seven housekeeping genes (gapA, infB, mdh, pgi, phoE, rpoB and tonB). A total of 8 different sequence types (STs) were identified; ST11 was dominant sequence type, accounting 41.6%(5 isolates) and was harboring combination of TEM-1, SHV-11 and CTX-15 genes.

A total of 275 clinical isolates of Klebsiella pneumoniae were collected from three general hospitals in Duhok, Erbil, and Sulymania, during the period September 2010 to June 2011. The Minimum Inhibitory Concentration (MIC) of these isolates was measured using the Gram-negative susceptibility card (GNC) of Phoenix system. Only 187 ESBL producing K. pneumoniae isolates were detected by this system. These isolates were confirmed as 100% ESBLs producers by the Double Disk Synergy Test (DDST). All 187 K. pneumoniae isolates were 100% resistant to ampicillin, cefazolin, cefepime, ceftriaxone, cefotaxime, cefuroxime, ceftazidime, and aztreonam. These isolates showed different percentages of resistance 81.8%, 68.5%, 65.8%, 52.4%, 50.3%, 34.2%, 25.2%, and 12.3% towards, ampicillin/sulbactam, gentamicin, trimethoprime-sulfamethoxazole, ciprofloxacin, piperacillin-tazobactam, amikacin, amoxicillin-clavulanate, and levofloxacin respectively. Molecular characterization by PCR was employed using specific primers for three different ESBLs (TEM, SHV, and CTX-M). Results obtained revealed that SHV-type ESBLs were the most common ESBL occurring in 87% of the isolates with phenotypic evidence of ESBLs production. While those for TEM-type and CTX-M-type were 60% and 58% respectively.