Schistosomiasis of the spinal cord: report of 5 cases from Sudan

Schistosomiasis of the spinal cord is an uncommon but potentially curable form of schistosomiasis, if diagnosed and managed early. The spinal cord is more frequently affected in Schistosomo mansoni or S. hoemotobium infections. This paper describes the clinical manifestations, diagnosis and management of schistosomiasis of the spinal cord in 5 patients attending Shaab and Ibn Khuldoun Hospitals, Khartoum from 1997 to 2007. There were 4 males and 1 female aged 9-45 years. They presented with symptoms and signs due to cord compression at the lower thoracic and lumbar vertebrae. Imaging studies revealed intramedullary masses compressing the cord. Biopsy showed ova of 5. mansoni with surrounding inflammatory reaction. The cord showed demyelination nearthe ova and an associated inflammatory reaction. Patients responded well to surgical decompression and treatment with praziquantel and oral steroids

Gastrointestinal Basidiobolomycosis mimicking colon cancer in a Sudanese patient

Basidiobolomycosis is a rare disease caused by the fungus Basidiobolus ranarum. The incidence Rate of Gastrointestinal Basidiobolomycosis is approximately 1 in 45,333,334 or 0.00% in every 5 people in USA], member of the class Zygomycetes found worldwide [1].Basidiobolomycosis is usually a subcutaneous infection but rarely gastrointestinal1. This fungus is found mainly in the soil and on decaying vegetations2. It has been isolated from the banks of tropical rivers in West Africa, and has also been found in association with some insects2. The fungus is known to be present in the gastrointestinal tracts of reptiles, amphibians, and some bat species3. Definitive diagnosis requires culture and serological testing may be helpful. The fungal morphology and the Splendore-Hoeppli phenomenon are characteristic histological features. Basidiobolomycosis is treated with surgical resection and itracanzole 200mg BD for three months or Amphotericin B 5mg /kg iv/24 hrs4

Anti - glucose regulated protein 78 [GRP78] antibody responses in Alum/ALM plus BCG vaccinee, visceral leishmaniasis, and Post Kala- azar Dermal leishmaniasis patients

The Glucose Regulated Protein 78 [GRP78] of Leishmania donovani is considered to be one of the potential Leishmania vaccine candidates. Using Enzyme-Linked Immunosorbent Assay [ELISA], we measured IgG antibody responses to GRP78 in 39 healthy Sudanese volunteers vaccinated with Leishmania Alum/ALM + BCG vaccine, 29 patients with visceral leishmaniasis [VL], and 26 patients with post kala-azar dermal leishmaniasis [PKDL]. There was, no significant statistical difference in plasma levels of GRP78 antibodies in immunized and control group [P=0.37]. Furthermore, no significant statistical difference in the levels of GRP78 antibodies in the pre and post vaccination plasma samples [P=0.60]. Plasma IgG levels to GRP78 was significantly higher in visceral leishmaniasis and PKDL patients compared with control group [P=0.00]. This study concludes that Alum/ALM vaccine does not induce a Th2 type of immune response. It also demonstrated clearly that VL and PKDL are associated with elevation of anti-GRP 78 antibodies and that GRP78 ELISA can be used to confirm diagnosis of Leishmania infections based on the clinical presentation

Cell phenotypes, immunoglobulins and complement in lesions of eumycetoma caused by madurella mycetomatis

Mycetoma [maduromycosis] is a common health problem in Sudan. The causative organisms are either true fungi [eumycetoma] or actinomycetes [actinomycetoma]. The commonest eumycetoma in Sudan is caused by M mycetomatis. The cell phenotypes, immunoglobulins and complement in lesions of M mycetomatis were characterized by immunohistochemistry. In the HandE sections there were three types of inflammatory reactions. Type I reaction consisted of three zones: a neutrophil zone surrounding the grain, an intermediate zone of macrophages and giant cells and a peripheral zone consisting of lymphocytes and plasma cells. The neutrophils stained positively for CD15. The macrophages were positive for CD68. The majority of cells in the outermost zone were CD3 positive [T lymphocytes]; they were rimmed by CD20 positive cells [B lymphocytes]. In type II reaction there was no neutrophil zone, the grain being surrounded by macrophages and giant cells that stained positive for CD68. Type III reaction consisted of a discrete epithelioid granuloma without wellformed grains. IgG, IgM and C3 were found on the surface of the grain and the hyphae

Cutaneous leishmaniasis in Sudan: an update

Cutaneous leishmaniasis due to L.major is now endemic in many parts of the northern Sudan. In this up-date we discuss the clinical manifestations of cutaneous leishmaniasis, its diagnosis and treatment. The most common clinical forms are nodular, noduloulcerative and ulcerative lesions. Less common forms are sporotrichoid lesions, leishmanial dactylitis, leishmanial cheilitis, mycetoma- and residivans-like types. In a suspected case the diagnosis is made by demonstration of leishmania parasites in slit smears or biopsy, isolation of the parasite by culture in appropriate media and by the polymerase chain reaction [PCR] using specific primers. The majority of lesions heal spontaneously. Criteria for local or systemic treatment are given

Safety, immunogenicity and possible efficacy of immunochemotherapy of persistent post Kala-azaz dermal leishmaniasis

Post kala-azar dermal leishmaniasis [PKDL] is a common skin condition that follows successful treatment of visceral leishmaniasis [VL] in Sudanese patients. Lesions persist for years in 15% of patients and are viewed as reservoirs for the disease. Drug treatment is protracted, toxic and costly. Cure is strongly correlated with conversion in the leishmanin skin test. To determine safety, immunogenecity and possible efficacy of Alum-precipitated autoclaved L. major + BCG VL candidate vaccine combined with sodium stibogluconate [SSG] in patients with persistent PKDL. Following informed consent, the vaccine mixture was administered in a stepwise manner as follows: 5 patients received a single intradermal injection of 10 microg, 5 patients received a single dose of 100 microg and 2 patients received 4 doses of 100 microg at weekly intervals. Subsequently, the three groups of patients received means of 63.0 +/- 8.0, 53.0 +/- 5.0 and 40 days courses of SSG treatment respectively and were cured. Side effects were minimal and were confined to the vaccine injection site. Following completion of the safety study, eight patients were injected with 4-6 vaccine doses of 100 microg/dose at weekly intervals in combination with SSG. Patients were closely followed up in hospital, with minimal side effects and complete clearance of the skin rash in forty days. Alum/ALM + BCG vaccine mixture plus SSG was safe and was apparently effective in healing persistent PKDL lesions. SSG treatment duration could be shortened with the SSG/vaccine combination

Leprosy in an endemic focus in the Sudan

The objectives of this study were active case detection, provision of multidrug treatment in primary health care settings and evaluation of the accuracy of the clinical system of classification that was adopted by the Leprosy Control Program of Sudan. The whole population of two villages in a remote area in eastern Sudan were examined initially and then followed up for three years in this prospective study. Patients from the surrounding villages, who were self reporting were also included in the study. The study was conducted in a primary health care setting, which was the only available form of health care facility in the study area. Communal consent was obtained following explanation and discussion with the Sheikhs. The population of the two villages were interviewed and examined clinically with particular reference to skin lesions. Informed consents to participate in the study were obtained from individuals with skin lesions. Skin biopsies were taken under local anaesthesia and aseptic conditions from suspicious lesions. Multi-drug therapy regimen [MDT] was given to those with proven disease. Response was measured by improvement in skin lesions and sensations every six months. Compliance was around 90%. According to the clinical classification 68.4% and 31.6% of the patients were multi-bacillary and pauci-bacillary respectively. There was 100% agreement between the clinical classification and Ridley and Jopling classification where all Tuberculoid [TT] patients were correctly diagnosed as pauci-bacillary and borderline Lepromatous [BL] and Lepromatous [LL] patients were correctly diagnosed as multibacillary. Seventy BT patients were misclassified as multi-bacillary disease. The clinical classification is adequate for the diagnosis and treatment of leprosy patients in remote areas of eastern Sudan

unusual case of mucosal leishmaniasis with cutaneous dissemination in Sudan and its epidemiological significance

Sudan is endemic for visceral, cutaneous and mucosal leishmaniasis. The latter is the least common of the three forms of leishmaniasis. It is caused by L. donovani, the same parasite that causes visceral leishmaniasis [VL] in the country. Most of the cases were reported from VL endemic areas, the majority in adults. The disease may be primary in the oral and or the upper respiratory mucosa or may follow or accompany visceral leishmaniasis. This paper is a report of a case of mucosal leishmaniasis of the nose and lips. It is unusual in several aspects: the disease was acquired in a village where no cases of VL or mucosal leishmaniasis were recorded within living memory, before an outbreak in 1981 during which the patient was infected; the patient was infected at the age of five years and the disease remained active for 22 years causing physical deformity and psychological trauma to the patient

Blue nevus developing in a keratin cyst: a case report

A 35 years old patient reported with a ten years history of a cystic mass involving the skin and subcutaneous tissue over the shoulder. The cyst proved to be a keratin cyst with a blue nevus in its wall. This is an example of a group of lesions known as nevus with cyst, a term applied to different types of cysts that are closely associated anatomically with a melanocytic nevus

Post kala azar dermal leishmaniasis in Sudan

Post kala azar dermal leishmaniasis [PKDL] is a condition that develops after treatment of kala azar. We report on 42 patients with suspected PKDL, 40% of whom were children. Diagnosis was made though investigation of family history of kala azar, clinical examination and the use of laboratory investigations, such as skin smear, skin biopsy, bone marrow aspiration and the leishmanin skin test. Regarding the lesions, 24 patients [57%] had papular lesions, 10 [24%] had hypopigmented maculopapular lesions and 8 [19%] had nodular lesions. The lesions of PKDL may be confused with other dermatological diseases and therefore it is important that clinicians and pathologists collaborate in diagnosing such cases