99 research outputs found
Serological and Molecular Diagnosis of Visceral Leishmaniasis (VL) and Malaria in VL Suspects in Gedarif State, Eastern Sudan
No full textVisceral leishmaniasis (VL) and malaria are two major health problems
in Sudan. Demonstration of parasites in clinical samples remains the mainstay for the
diagnosis of VL and malaria; however, parasitological methods are either invasive or
insensitive. Thus, diagnosis of both diseases with non-microscopic, simple, rapid,
reliable, and accurate methods are needed. Worldwide malaria parasites were detected
in VL patients but none of such cases have been reported from Sudan.
This study was conducted to evaluate the performance of the rk39 rapid test (DiaMed-
IT LEISH), and PCR on blood spotted on filter paper for the diagnosis of VL in
patients presenting with clinical features suggestive of VL, and to diagnose malaria in
those cases using OptiMAL-IT and PCR tests. Another aim of the study was to
determine the prevalence of malaria in VL confirmed cases
Liver and Renal Profiles in Kala-azar, HIV and Kala-azar patients co-infected with HIV in Gedarif and Sinnar States. Sudan.
No full textBackground: Visceral Leishmaniasis (VL) presents a major health problem
in several states in Sudan. VL/HIV co-infection is an emerging health
problem which has been reported to be associated with renal and liver
dysfunction.
Design: A descriptive study and cross sectional studies also were performed.
Setting: The study was conducted at Tabarak-Allah Rural Hospital Gedarif
state and Al- Azaza Centre, Sinnar State.
Objectives:
General objective: To study the prevalence of VL/HIV co-infection in the
Sudan
Specific objective: To determine the liver and renal profiles in VL, HIV and
VL/HIV co-infected patients.
Material and methods: A total of 99 VL parasitologicaly confirmed cases
in Tabarak-Allah Rural Hospital (Gedarif state, Eastern Sudan) and Al-
Azaza Centre (Sinnar State) and. There were 57(57.6%) males and
42(42.4%) females, their ages ranged from 2-75 years (mean of ages was 16
years),30 HIV seropositive individuals from Al Gadarif Teaching Hospital
were studied, 23 (76.7%) of them were males, and 7 (23.3%) were females.
Their age ranged between 30 and 54 years (mean of age was 40 years). All
serum samples from VL samples were analyzed for renal and liver profiles
using chemistry analyzer and were also screened for HIV by third generation
ELISA kits. The 30 HIV seropositive samples were analyzed for liver and
renal profiles and for CD4 cell count by flowcytometry.
Results: Of the 99 VL confirmed cases jaundice was detected in Nine
(9.1%), elevated AST activity in 85(85.9%), elevated ALT in 19(19.2%),
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elevated ALP in 55(556%) , low albumin level in 78(78.8%),
hyperprotienamia in 40 (40.4%), azotamia in 7 (7.3%), hypocalcaemia in 48
(48.5%), hyponatraemia in 89(899%), hypokalamia in 29(29.3%) and
hyperkalaemia in 11(11.1%). Two (2.4%) patients had renal failure.
Seven (7.1%) of the 99 confirmed VL patients were HIV co-infected. One
(14.3%) of those 7 HIV/ VL co-infected cases had elevated ALT, 7(100%)
had elevated AST, 6(85.7%) had elevated ALP activity, 2(28.6%) had
hyperprotienamia, 5(71.4%) had hypoalbuminaemia, 3(42.9%) had
hypocalcaemia, 7(100%) had hyponatraemia, 2(28.6%) had hypokalamia
and 1(14.3%) had hyperkalaemia.
Of the 30 HIV seropositive individuals, 3(10%) were jaundiced,12(40%)
had elevated ALT,11(36.7%) had elevated AST , 11(36.7%) had elevated
ALP, 6(20%) had hyperprotiemaemia,3(10%) had hyperprotienamia,
19(63.3%) had hypoalbuminaemia, 3(10%) had Azotamia, 16(60%) had
hyponatraemia, 2(6.7%) had hyperkalaemia, 10(33.3%) had hypokalamia,
13(43.3%) had hyperuricaemia , 1(3.3%) had hypouricaemia ,16(53.3%)
had hypocalcaemia and one (3.3%) had renal failure.
The comparison of liver profile between confirmed VL and VL/coinfected
cases showed significant differences in in ALT , ALP ,AST ,
T.Protien and Albumin Levels ( P.Value < 0.05) but there was no
significant difference in T.Bilirubin and D.Bilirubin levels ( P.Value >
0.05). In the renal profile creatinine and sodium levels, were also
significantly different between the two groups (P.Value < 0.05). However,
there was no significant difference in urea, calcium and potassium levels
(P.value > 0.05).
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Conclusion and Recommendation: In view of the results of the present
study it is concluded that VL and VL/HIV co-infection can be associated
with impairment in renal and liver functions; .The prevalence of VL /HIV
co-infection is increasing in Sudan. Accordingly, it can be recommended
that renal and liver profiles should be determined before treatment in all VL
cases that show clinical features of renal or liver dysfunction. Urine analysis
is recommended to be a routine test in VL as an indicator for any
abnormality in renal function. Due to the limited number of VL/HIV coinfected
cases in the present study further studies involving larger sample
size are required
Retratação: “Anticorpos antipeptídeos citrulinados e o fator reumatoide em pacientes sudaneses com infecção Leishmania donovani”
No full textRESUMOO trabalho intitulado Ahlin E, Elshafei A, Nur M, El Safi SH, Johan R, Elghazali G, Anticorpos antipeptídeos citrulinados e o fator reumatoide em pacientes sudaneses com infecção Leishmania donovani. Rev Bras Reumatol. 2011 Dez; 51(6):579‐86 Inglês, Português. PubMed PMID: 22124592 foi retratado
Haematological findings in Kala‐azar, HIV, and Kalaazar co‐infected patients including T.lymphocytes differential count by both flowcytometry and double immunocytochemistry
No full textA descriptive study was conducted in two kalazar centers in Tabarak-Allah
(Gedarif state) and El- Azaza (Singa state), Eastern Sudan.
160 VL patients out of 520 suspected VL cases were included. Diagnoses
was made by direct microscopy using lymph node and/or B.M aspirates and
confirmed serologicaly using DAT and/or Katex. There were 96(60%)
males, 64(40%) females; mean of patient's ages was 14 years.
Full blood count were done for all VL patients. Anemia was found in all,
(mean of Hb: 8.5 g/dl), 80(50%) o them had a normocytic normochromic
anemia, 16(10%) with microcytic hypochromic, 57(35.4%) with dimorphic
anemia, and sickle cells anemia was found in 7 (4.6%) patients. 152 (95%)
patients had a platelet count of < 140X103/ μl, 128(80%) patients with
TWBCs < 3X 103/μl. The differential WBCs count was a follows:
lymphocytes were > 40% in 112(70%) patients, neutrophils were < 45% in
89(55%) patients, and ESR was > 45 mm/h in 50/50 patients (100%). WBCs
morphology was normal in 110(69%) patients, shift to left was found in
40(25%) patients, and shift to right was found in 6(10%) patients. Prominent
Target cells were found in 54(34%) patients and nucleated RBCs in 24(15%)
patients.
The differential T cells count was done for 5 patients. CD4 T cells were <
250 / μl in all 5 patients. The mean of CD4 was 210 / μl, the mean of CD8
was 490 / μl, and CD4/CD8 ratio was 1/2.3.
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All parasitologicaly and serologicaly confirmed VL patients were screened
for HIV, 6 (3.5%) patients were co-infected, all of them were males, mean of
patients ages was 25 years.
Full blood counts were done for these patients. All patients were anemic
(mean of Hb: 8.0 g/dl), 3(60%) patients with normocytic normochromic,
2(40%) patients with microcytic hypochromic anemia. Platelets were <
140X103, and TWBCs were < 3X 103/μl in all patients. The differential
WBCs count was a follows: lymphocytes were > 40%, neutrophils were <
45%, and ESR > 45 mm/h were found in all patients.
Also differential T cells count were done, CD4 T. cells were < 200/ μl in all
patients, mean of CD4 was 180 / μl, mean of CD8 was 340 / μl, and
CD4/CD8 ration was 1/1.9.
A cross sectional study was done to determine the hematological parameters
and T cell subsets count in 30 known seropositive HIV individual, during
ART at VCT Centre (Om durman Teaching Hospital), Khartoum state.
Anemia was found in 15(50%)patients (mean of Hb: 11g/dl), 12(80%)
patients with normocytic normochromic, 3(20%) patients with microcytic
hypochromic anemia. 4(13.3%) patients had platelets < 140X103, 5(16.7%)
patients with TWBCs < 3X 103/μl, 10(33.3%) patients with TWBCs > 6X
103/μl. The differential WBCs count; lymphocytes were > 40% in 9(30%)
patients, neutrophils were < 45% in 7(23.3%) patients, neutrophils were >
70% in 3(10%) patients.
In differential T cells count, CD4 T. cells were < 200/ μl in 20(66.6%)
patients, mean of CD4 was 255 / μl, mean of CD8 was 530 / μl, and
CD4/CD8 ration was 1/2.1.
We concluded that normocytic normochromic anemia, leucopenia,
thrombocytopenia were the common hematological changes in VL and
VL/HIV co-infected patients. Relative lymphocytosis and neutropenia were
less common. In HIV seropositive individuals anemia were noted in have of
patients. Luecocytosis, lymphocytosis, Eosinophilia and monocytosis were
noted in third of patients.
The differential T cells count indicated that, the cellular immunity was
depressed among the VL, HIV, and VL / HIV co-infected patients; with
decreased in CD4 number and reversed CD4/CD8 ratio.
Comparison between Flowcytometry & double immunoenzymatic for CD4
counts were done for five HIV seropositive individual. Results indicated that
there is a significant variation between the two methods (P <0.05).
Sensitivity and specificity of double immunoenzymatic staining method
were 100%
Evaluation of Fluorescence Microcopy and Indirect ELISA in the Diagnosis of Pulmonary Tuberculosis in Khartoum State
No full textTuberculosis remains a major health problem in the Sudan and a
leading cause of morbidity and mortality . Early diagnosis and correct
treatment are the mainstay for the control of the disease.
The present study aimed to evaluate fluorescence microscopy
(FM) in the detection of M.tuberculosis in sputum and to compare the
results to light microscopy using ZN stained smear and culture in
addition to a serological method (ELISA using 38kd antigen). Another
aim of the study was to determine the sensitivity and specificity of ELISA
and to compare the results with those obtained by direct microscopy
(light, and fluorescent).
A descriptive study was carried out in 233 patients with
clinical features suggestive of TB (fever, chronic cough, mucopurulent
sputum, loss of weight, night sweat, and haemoptysis), who reported to
Abou-Anja Chest Hospital (Omdurman) between the period from June
2002 up to October 2003, were included. Sputum samples were
collected from all the patients and studied by bacteriological methods
including FM, ZN and culture. In addition, a venous blood sample (5ml
) was obtained from each patient ; serum was separated and tested with
ELISA for the detection of IgG antibodies against 38kd antigen .Blood
samples were also collected from healthy controls at the Blood Bank ,
Khartoum Teaching Hospital.
81(35%)cases were positive by ZN method ,while the FM method
detected 93(40 %) positive cases. The culture technique showed 75(32
%) positive cases; in 69 (92%) of those cases the growth of
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M.tuberculosis was confirmed by growing the organism on TCH media.
In the other 6 (8%) culture positive samples, growth similar to M.bovis
and M.africanum was observed but more investigations were needed to
determine the species.
As compared to culture and ZN the FM showed a sensitivity
of 80.6% and 75.3%, respectively. Statistical analysis showed that FM
was more sensitive than ZN and culture (P= 0.0001).
The ELlSA was positive in 103 (44.2%) of the studied cases. The
sensitivity of the test - as compared to ZN, FM, and culture -was 48.5%,
49.5% and 42.7, respectively . The ELISA was less sensitive than ZN
staining method (P=0.0001), FM (P=0.01) culture (P=0.003). The
specificity of ELISA was 82% as compared to apparently health controls.
However, in 53 of the ELISA positive cases who were negative by ZN,
the culture was positive in 8 cases. In addition , the culture was positive
in 5 of the 52 cases, who were ELISA positive but FM negative.
In view of the results obtained in the present study it can be
concluded that FM is more sensitive than ZN staining method and culture
in the detection of M.tuberculosis in sputum samples for the diagnosis of
PTB . Accordingly the FM is recommended to be included in the routine
diagnosis of PTB in ZN stained smear negative cases. In spite of the low
sensitivity of ELISA the test can still be useful in the diagnosis of TB in
some cases in whom bacteriological diagnosis can not be confirmed.
The test may also be helpful in the diagnosis of the disease in patients
in whom sputum sample cannot be obtained
Retraction: “Anti-citrullinated peptide antibodies and rheumatoid factor in Sudanese patients with Leishmania donovani infection”
No full textAbstractThe paper entitled Ahlin E, Elshafei A, Nur M, El Safi SH, Johan R, Elghazali G. Anti-citrullinated peptide antibodies and rheumatoid factor in Sudanese patients with Leishmania donovani infection. Rev Bras Reumatol. 2011 Dec;51(6):579-86. English, Portuguese. PubMed PMID: 22124592 has been retracted
Evaluation and Development of Simplified and Rapid Molecular Tests for Diagnosis and Species Identification of the Genus Leishmania
No full textBackground: Recent innovations in molecular diagnosis such as nucleic acid sequencebased
amplification (NASBA) and polymerase chain reaction (PCR) products have
opened perspectives for robust and rapid point-of-care molecular tests as a real alternative
for parasitological and serological diagnosis in leishmaniasis together with the potential
of differentiating species and subspecies in one test. The objectives of this study are to
determine the leishmania species of isolates from eastern Sudan, to evaluate the
repeatability and reproducibility of NASBA and PCR followed with
oligochromatography (OC) for the detection of Leishmania in a ring trial multicenter
study and to evaluate the performance of both tests in phase II study using clinical
leishmaniasis samples from Sudan and Kenya as well as to develop ribosomal DNA
internal transcribed spacer 1(rDNA-ITS1) species-specific PCRs that discriminate
between old world leishmania species. Methods: The rDNA-ITS1 and Leishmania
Cysteine proteinase B species-specific PCRs were used for typing of 22 leishmania
isolates .In addition 34 samples were tested blindly by both NASBA-OC and PCR-OC in
the ring trial and a laboratory based evaluation of both tests was also performed using
Sudanese (247) and Kenyan(182) leishmaniasis samples.Furthermore,four speciesspecific
(PCRs) amplifying ITS1 were developed to discriminate L. aethiopica, L.
tropica, L. major, and the L. donovani complex; these PCRs use the same cycling
conditions, and include an internal amplification control. Principal Findings: All the
leishmania isolates belong to donovani sub-species within the donovani complex.
NASBA-OC and PCR-OC tests showed high repeatability and reproducibility in the ring
trial study. In phase II study using Sudanese samples, the PCR-OC (OligoC-TesT) as
well as the NASBA-OC showed a sensitivity of 96.8% (95% CI: 83.8%–99.4%) on
lymph node aspirates and of 96.2% (95% CI: 89.4%–98.7%) on blood from the
confirmed VL cases. The sensitivity on bone marrow was 96.9% (95% CI: 89.3%–
99.1%) and 95.3% (95% CI: 87.1%–98.4%) for the OligoC-TesT and NASBA-OC,
respectively. All confirmed CL and PKDL cases were positive with both tests. The
specificity on the healthy endemic controls was 90% (95% CI: 78.6%–95.7%) for the
OligoC-TesT and 100% (95% CI: 92.9%–100.0%) for the NASBA-OC test. On the
suspected VL cases, we observed a positive OligoC-TesT and NASBA-OC result in
37.1% (95% CI: 23.2%–53.7%) and 34.3% (95% CI: 20.8%–50.9%) on lymph, in 72.7%
(95% CI: 55.8%–84.9%) and 63.6% (95% CI: 46.6%–77.8%) on bone marrow and in
76.9% (95% CI: 49.7%–91.8%) and 69.2% (95% CI: 42.4%–87.3%) on blood. Seven out
of 8 CL suspected cases were positive with both tests. The specificity on the healthy
endemic controls was 90% (95% CI: 78.6%–95.7%) for the OligoC-TesT and 100%
(95% CI: 92.9%–100.0%) for the NASBA-OC test. On Kenyan samples, the Leishmania
OligoC-TesT showed a sensitivity of 96.4% (95% [CI]: 90–98.8%) and a specificity of
88.8% (95% CI: 81–93.6%), while the sensitivity and specificity of the NASBA-OC were
79.8% (95% CI: 67–87%) and 100% (95% CI: 96.3–100%), respectively. The species
specific PCRs can amplify up to 0.1 pg of Leishmania DNA, while being 100% specific
for species identification on an extensive panel of geographically representative strains
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and isolates; they could also be used for leishmania species identification in clinical
specimens. Conclusions: The entire 22 leishmania isolates lie within the donovani
complex in the rDNA-ITS1 phylogeny with almost identical sequence, and they are all of
L.donovani sub-species. NASBA-OC and PCR-OC showed high sensitivity on lymph,
blood and tissue scrapings for diagnosis of VL, CL and PKDL in Sudan and Kenya, but
the specificity for clinical VL was significantly higher with NASBA-OC. The ITS1
species specific PCRs presents the first step towards a standardized typing assay for Old
World Leishmania species. Recommendations: Further characterization with ITS1 of
leishmania isolates from different parts of the Sudan is needed in order to have a
comprehensive picture of the distribution of the species causing leishmaniasis in Sudan,
The Leishmania OligoC-TesT and NASBA-OC can be used as powerful diagnostic tests
in disease surveillance programmes and in monitoring intervention studies. Phase 11
evaluation of the rDNA species specific PCR using an extended set of clinical samples
from leishmaniasis patients with different clinical presentation is recommended
IINCIIDENCE OF COELIIAC DIISEASE IIN HIIGH RIISK SUDANESE CHIILDREN IIN KHARTOUM STATE
No full textThis is a prospective hospital-based study which aimed to determine the incidence of celiac disease among Sudanese children with feateatures suggestive of the disease , to study socio-demographic and clinical features of celiac patients and to correlate between the serological markers titres and the degree of villous atrophy.
Inclusion criteria were children aged nine month-18years, with two of the following:chronic diarrhea,growth retardation, refractory iron or folate deficiency anaemia, family history of diagnosed celiac disease.Eighty children 46 males and 34 females were enrolled this study.
Study tools included: questionnaire, physical examination, anthropometric measurements, laboratory tests, serology for celiac disease using anti-gliadin anti-bodies test(IgA and IgG classes) and endomysium anti-body test and duodenal biopsy.
The result revealed that 18 children (22.5%) confirmed CD (with at least two positive markers of CD and duodenal biopsy confirmatory to CD). 26 children (32.5%) were propable CD ( with at least one marker positive and no confirmatory biopsy). 36 children (45.0%) were non-coeliacs ( with negative AgA test both IgA and IgG classes).
There were no statistical significant difference between the three groups regarding socio-demographic and clinical features.
The mean age of onset of symptoms of celiac patients was six years and ten years at the time of diagnosis. Male to female ratio was 1:1.3.Celiac
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children were predominantly from middle socioeconomic class, from from tribal origins from northern and central Sudan. 22.2% of them had delayed motor development, half presented with diarrhea while the other half presented with other symptoms. The commonest presenting symptoms were poor appetite, abdominal distension, vomiting and abdominal pain.
Most celiac children presented with severe wasting , 65.4% had weight per height below 3rd centile.The commonest clinical signs were pallor, signs of iron deficiency anaemia, muscle wasting and abdominal distension.
Haemoglobin level was low in the majority of celiac children 17(94.4%) had haemoglobin level 5-12 mg/dl. 12 celiac children (66.7%) had iron deficiency anaemia, the remaining had combined iron and folate deficiency anaemia.
The degree of villous atrophy did not correlate with the duration, severity of diarrhea or severity of anaemia. There was no correlation between the serological titres and the degree of villous atrophy.
AGA-IgG was found more sensitive but less specific,AGA-IgA was less sensitive but more specific while EMA test was highly specific.
It was recommended that high risk children should be screened for CD. Prevalence of CD in the community should be determined by further studies by using serological tests for the initial screening
The Validity of Latex Agglutination Test as Screening Test for Diagnosis of Toxoplasmosis in HIV Infected Individuals
No full textThis study was carried out to assess the validity of the latex agglutination (LAT) as a quick
screening technique against ELISA test in the diagnosis of toxoplasmosis in HIV infected
individuals. A total number of 72 of HIV/AIDS patients and 72 control sera were collected from
Voluntary Counseling and Testing Center (VCT) and Blood Bank of Sudan Heart Center
respectively. The HIV infected patients (males and females) were ELISA screened and confirmed by
Western Blot. Anti-Toxoplasma antibodies (IgG and IgM) were detected in all individuals by LAT
and ELISA. Estimation of CD4+ cells count in patients was carried out.
As for the control group serum samples were tested for HIV, VDRL and HBsAg by the blood bank
and were negative for HIV, VDRL and HBsAg. The results showed that Anti-Toxoplasma antibodies
detected by latex agglutination test in HIV positive and HIV negative individuals were detected in
43% (31/72) and 38.8%(28/72) respectively. There was no significant difference between the two
groups (x2=0.611, p-value > 0.05). However, the rates of anti-Toxoplasma antibodies detected by
ELISA in the same groups were; 30.6% (22/72) in HIV positive patients and 18 % (13/72) in HIV
negative individuals. There was significant difference between HIV positive and HIV negative
individuals(x2=0.001, p-value<0.05). Moreover, the prevalence rate of IgG anti-Toxoplasma
antibodies in HIV positive group was 27.8% (20/72) and in HIV negative group was 8.3%(6/72).
Further, the prevalence rates of IgM anti-Toxoplasma antibodies in HIV positive and control
individuals were; 5.6% (4/72) and 9.7% (7/72) respectively. It was concluded that the prevalence
rate of IgG anti-Toxoplasma antibodies was higher in HIV positive than control individuals and that
the prevalence of anti-Toxoplasma antibodies was higher in HIV infected individuals than in the
general population. While the prevalence rate of IgM anti-Toxoplasma antibodies was higher in
control in HIV positive individuals.
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The prevalence rate of anti-Toxoplasma antibodies depending on HIV infection revealed significant
difference. Further, comparison between LAT and ELISA test showed significant difference with
ELISA being more sensitive than the LAT. Therefore, it was concluded that both tests were useful in
the diagnosis of latent toxoplasmosis and that LAT is a simple and reliable test to be used for quick
screening. However, since it yields some false positive results, the LAT should be confirmed by
ELISA test which is considered to be a more specific test
The Challenges of Conducting Clinical Research on Neglected Tropical Diseases in Remote Endemic Areas in Sudan.
No full textThe Challenges of Conducting Clinical Research on Neglected Tropical Diseases in Remote Endemic Areas in Sudan</p
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