Pattern of thyroid diseases in central Sudan: Nuclear medicine perspective

Thyroid scintigraphy using Tc-99m pertechnetate is a frequently performed procedure in routine nuclear medicine practice in addition to thyroid hormonal assay by radioimmunoassay (RIA). There is no clear description of thyroid diseases pattern in Sudan using nuclear medicine as a diagnostic tool. The aim of this retrospective study is to determine the pattern of thyroid diseases using the nuclear medicine facilities in our institute during a period (2001-2003). Methods: All patients referred to the department of nuclear medicine for thyroid scan from January 2001 to December 2003 were included in this study and the thyroid function test when available. Data were analyzed by SPSS software. Results: A total of 2070 patients were referred to the department and only 1605 (77.5%) have thyroid function test results available for scan reporting. Female to male ratio is 9:1. The mean age is 34 ±13.36 (1-86 years old). The most common pattern is simple multinodular goiter 784 (37.8%) and the second is solitary thyroid nodule 506 (24.4%), followed by simple diffuse goiter 415 (20%). From a total of 1605 thyroid function test results, 1377 patients (85.8%) were euthyroid, 168 (10.5%) were having hyperthyroidism while only 60 (3.7%) were having hypothyroidism. Conclusion: The vast majority of patients in this study were young females with simple goiter and normal radionuclide uptake. No more information gained particularly when the patient is known clinically and biochemically to have a simple goiter. A solitary cold nodule is also common.Keywords: Thyroid scan, goiter, cold nodule, iodine deficiency, thyroid disease

Occult Hepatitis B Virus in Gezira State Sudan

Background: Occult hepatitis B infection (OBI) is simply defined as serologically undetectable hepatitis B surface antigen (HBsAg-ve), despite the presence of circulating HBV DNA.Objective: The aim of this study was to determine the prevalence of occult HBV among Screened HBsAg subjects in Gezira State, Sudan.Materials and Methods: A total of 176 subjects including cancer patients, hospital based controls and health care workers were screened for HBsAg by ELISA, and their DNA was extracted by using polymerase chain reaction.Results: 49/176 (27.8%) were positive for occult HBV as follows: cancer patients had 31/81 (38.2%) cases, while 18.9% were reported among hospital based controls. 11.2%, 2.2% were positive for both HBsAg and DNA respectively. Ten out of the 50 (20%) healthcare workers, who were negative for HBsAg, were found to be positive for HBV DNA, while one out of the 19, who were positive for HBsAg, was found to be positive for HBV DNA. Occult HBV among this study groups showed an approximately equal distribution among males and females 18.2% and 20.5 %, respectively.Conclusion: This study concluded that the prevalence of OBI among healthcare workers, hospital based controls and cancer patients, is remarkably increasing compared with the prevalence of the disease. More molecular epidemiological studies are needed to delineate a link between OBI and cancer. Proper HBV screening should be carried out to avoid occult hepatitis B infection transmission.Keywords: Hepatitis B virus, Gezira State, cancer, healthcare workers, Suda

Detection of pathogens of acute febrile illness using polymerase chain reaction from dried blood spots

Quantitative polymerase chain reaction (qPCR) of dried blood spots (DBS) for pathogen detection is a potentially convenient method for infectious disease diagnosis. This study tested 115 DBS samples paired with whole blood specimens of children and adolescent from Burkina Faso, Sudan, and Madagascar by qPCR for a wide range of pathogens, including protozoans, helminths, fungi, bacteria, and viruses. Plasmodium spp. was consistently detected from DBS but yielded a mean cycle threshold (Ct) 5.7 +/- 1.6 higher than that from whole blood samples. A DBS qPCR Ct cutoff of 27 yielded 94.1% sensitivity and 95.1% specificity against the whole blood qPCR cutoff of 21 that has been previously suggested for malaria diagnosis. For other pathogens investigated, DBS testing yielded a sensitivity of only 8.5% but a specificity of 98.6% compared with whole blood qPCR. In sum, direct PCR of DBS had reasonable performance for Plasmodium but requires further investigation for the other pathogens assessed in this study

Pathogens that cause acute febrile illness among children and adolescents in Burkina Faso, Madagascar and Sudan

BACKGROUND: The etiology and optimal clinical management of acute febrile illness (AFI) is poorly understood. METHODS: Blood samples taken from study participants with acute fever (>/=37.5 degrees C) or a history of fever and recruited into the previous Typhoid-Fever-Surveillance-in-Africa (TSAP) study were evaluated using a polymerase chain reaction (PCR)-based TaqMan-Array Card designed to detect a panel of bacterial, viral and parasitic pathogens. Clinical metadata were also assessed. RESULTS: A total of 615 blood samples available for analysis originated from Burkina Faso (n=53), Madagascar (n=364) and Sudan (n=198) and were taken from participants ranging from 0-19 years of age. Most individuals [86.4% (531/615)] presenting at healthcare facilities were outpatient adolescents (11-19 years-old). Leading clinical diagnoses were respiratory tract infections [45.9% (282/615)], malaria [27.3% (168/615)], and gastrointestinal tract infections [10.7% (66/615)]. Through the TaqMan-Array Card, at least one pathogen was detected in 62% (33/53), 24% (86/364), and 60% (118/198) of specimens, from Burkina Faso, Madagascar and Sudan, respectively. The leading identified pathogen overall was Plasmodium spp., accounting for 47% (25/53), 2.2% (8/364) and 45% (90/198) of AFI at respective sites. In Madagascar, dengue virus was the most prevalent pathogen (10.2%). Overall, 69% (357/516) of patients with clinical diagnoses of malaria, respiratory, or gastrointestinal infections were prescribed a WHO-guideline-recommended empiric antibiotic,whereas only 45% (106/237) of patients with pathogens detected were treated with an antibiotic exerting likely activity. CONCLUSIONS: A PCR-approach for identifying multiple bacterial, viral and parasitic pathogens in whole blood unveiled a diversity of previously undetected pathogens in AFI cases and carries implications for the appropriate management of this common syndrome

Mass drug administration non-recipients

BACKGROUND: Repeated mass drug administration (MDA) with preventive chemotherapies is the mainstay of morbidity control for schistosomiasis and soil-transmitted helminths, yet the World Health Organization recently reported that less than one-third of individuals who required preventive chemotherapies received treatment. METHODS: Coverage of community-directed treatment with praziquantel (PZQ) and albendazole (ALB) was analyzed in 17 villages of Mayuge District, Uganda. National drug registers, household questionnaires, and parasitological surveys were collected to track 935 individuals before and after MDA. Multilevel logistic regressions, including household and village effects, were specified with a comprehensive set of socioeconomic and parasitological variables. The factors predicting who did not receive PZQ and ALB from community medicine distributors were identified. RESULTS: Drug receipt was correlated among members within a household, and nonrecipients of PZQ or ALB were profiled by household-level socioeconomic factors. Individuals were less likely to receive either PZQ or ALB if they had a Muslim household head or low home quality, belonged to the minority tribe, or had settled for more years in their village. Untreated individuals were also more likely to belong to households that did not purify drinking water, had no home latrine, and had no members who were part of the village government. CONCLUSIONS: The findings demonstrate how to locate and target individuals who are not treated in MDA. Infection risk factors were not informative. In particular, age, gender, and occupation were unable to identify non-recipients, although World Health Organization guidelines rely on these factors. Individuals of low socioeconomic status, minority religions, and minority tribes can be targeted to expand MDA coverage.This work was supported by the Vice Chancellor’s Fund of the University of Cambridge, the Schistosomiasis Control Initiative, the Wellcome Trust (Programme grant 083931/Z/07/Z to D.W.D), and the Netherlands Organization for Scientific Research (N.W.O. grant 452-04-333 to E.B.).This is the final version of the article. It first appeared from Oxford University Press via http://dx.doi.org/10.1093/cid/civ82

The phylogeography and incidence of multi-drug resistant typhoid fever in sub-Saharan Africa.

There is paucity of data regarding the geographical distribution, incidence, and phylogenetics of multi-drug resistant (MDR) Salmonella Typhi in sub-Saharan Africa. Here we present a phylogenetic reconstruction of whole genome sequenced 249 contemporaneous S. Typhi isolated between 2008-2015 in 11 sub-Saharan African countries, in context of the 2,057 global S. Typhi genomic framework. Despite the broad genetic diversity, the majority of organisms (225/249; 90%) belong to only three genotypes, 4.3.1 (H58) (99/249; 40%), 3.1.1 (97/249; 39%), and 2.3.2 (29/249; 12%). Genotypes 4.3.1 and 3.1.1 are confined within East and West Africa, respectively. MDR phenotype is found in over 50% of organisms restricted within these dominant genotypes. High incidences of MDR S. Typhi are calculated in locations with a high burden of typhoid, specifically in children aged <15 years. Antimicrobial stewardship, MDR surveillance, and the introduction of typhoid conjugate vaccines will be critical for the control of MDR typhoid in Africa

Association of toll-like receptor 2 polymorphisms with susceptibility to pulmonary tuberculosis in Sudanese

Background: Mycobacterium tuberculosis (MT) is a leading cause of death worldwide, and the incidence of the tuberculosis) has been escalating due to the convergence of multidrug-resistant strains and HIV infection epidemics. Genetic and nongenetic factors of both the bacterium and the host have impact on the host response to MT. Toll-like receptors (TLRs) play an important role in the innate immune response to pathogens. It has been proved that viable Mycobacterium bacilli contain distinct ligands that activate cells via TLR2. Aim: This study was conducted to test the association of TLR2 gene polymorphisms with susceptibility to pulmonary tuberculosis in Sudanese. Subjects and methods: A case-control study of 207 Sudanese patients with pulmonary tuberculosis and 395 healthy controls was used. Three tag single nucleotide polymorphisms (SNPs) in TLR2 gene and its 3-Kb flanking regions on chromosome 4 were selected. The tag approach was set to r2 > 0.8 and minor allele frequency (MAF) > 0.2. Genotyping was performed by polymerase chain reaction followed by restriction fragment length polymorphism method. Results: Genotypes of the 3 SNPs (rs1816702, rs3804099, and rs7656411) were estimated and compared. The stepwise regression procedure demonstrated that elimination of rs1816702 and rs3804099 from the model did not have any significant effect (p = .0685, .7300 respectively), while rs7656411 was significantly associated with tuberculosis susceptibility (p = .0372). TLR2 rs7656411 TG and GG genotypes frequencies were higher in pulmonary tuberculosis patients (OR = 1.74, 95% CI = 1.09–2.78, and OR = 2.24, 95% CI = 1.37–3.68 respectively). The haplotype TCG of TLR2 SNPs was also associated with TB susceptibility (p = .0004). Conclusion: Our study suggests that allele G of rs765641 on TLR2 gene might influence susceptibility to pulmonary tuberculosis in Sudanese. Keywords: Toll-like receptor 2, Pulmonary tuberculosis, Polymorphism

Common polymorphisms in TLR4 gene associated with susceptibility to pulmonary tuberculosis in the sudanese

Author name used in this publication: Leung, K.H.Author name used in this publication: Yip, S.P.2012-2013 > Academic research: refereed > Publication in refereed journalAccepted ManuscriptPublishe

Article type: Original Article

This is the Pre-Published Version. 2 ABSTRACT SETTING: Host genetic risk factors influence the susceptibility to tuberculosis (TB). There is ample evidence supporting the involvement of toll-like receptor 4 (TLR4) in mycobacterial infection. OBJECTIVE: To study the relationship between the TLR4 gene and TB susceptibility in Sudanese. DESIGN: A case-control study was conducted by recruiting 207 patients with pulmonary TB and 395 healthy controls. Ten tag single nucleotide polymorphisms (SNPs) of the TLR4 gene were genotyped using restriction digestion or hybridization assays, and analyzed. RESULTS: The genotypes were in Hardy-Weinberg equilibrium. With Mantel-Haenszel tests controlled for gender, four SNPs showed significant differences between cases and controls even after correction of multiple comparisons by Bonferroni procedure. The Mantel-Haenszel estimates of allelic odds ratios for the high-risk alleles were 1.67 for rs1927911 (P=0.0001), 1.85 for rs5030725 (P=0.0008), 2.14 for rs7869402 (P=1.87e-07), and 2.31 for rs1927906 (P=1.23e-10). Haplotype analysis showed that rs1927911 and rs5030725 were in one haplotype block, and rs7869402 and rs1927906 were in another haplotype block. Conditional haplotype analysis suggests the presence of one causal variant downstream of a recombination hotspot at the 3&apos; region of the TLR4 gene. CONCLUSION: This is the first study to show that common TLR4 polymorphisms are associated with TB susceptibility in a Sudanese population. (Abstract: 203 words)