Diarrhea Due to Cryptosporidium Parvum in Immunocompromised and Immunocompetent Patients in Khartoum State

Objective: The objective of this study is to search for Cryptosporidium parvum in Sudanese immunocompromised and immunocompetent patients presenting with diarrhea. Methods: Two hundred and thirteen stool specimens were collected from different groups of patients presenting with diarrhea and healthy control (immunocompromised: 78; immunocompetent: 90; Control: 45). The immunocompromised group included 25 HIV positive patients; 27 tuberculosis patients; 11 patients with renal failure and 15 patients receiving immunosuppressive chemotherapy. Antigen ELISA was performed to detect the presence of the parasite in stool. Positive specimens were examined by the modified ZN stain to look for the oocyst of C.parvum. Result: Seventy one of the immunocompromised patients (91.0); twenty nine of immunocompetent patients (32.2) and ten of the control group (22.2) were found to be positive for C.parvum. A significant difference was noticed between the immunocompromised patients and the other groups (P0.05). Among the immunocompromised patients; the highest percentage of positive results (96.1) was in the HIV patients. The percentage of positive results within the tuberculosis; renal failure and immunosuppressive patients were 92.6; 83.3and 86.6respectively. Conclusion: The significant detection of C. parvum among the different groups of immunocompromised should raise the awareness of the clinicians towards this parasite as an important cause of diarrhea in such groups of patients

Isolation and Identification of E-Coli 0157:H7 amongst Sudanese Patients with Bloody Diarrhea and in Animals

E.coli 0157:H7 is present as a commensal in the intestine of animals and as a pathogen in human beings. It causes bloody diarrhoea due to the secretion of a verotoxin which may lead to lethal complications. Objective: This study is aimed at determining the presence of this organism in animals and patients. Methods: Rectal swabs were collected from 250 cows. Stool specimens were obtained from 200 patients presenting with macroscopically or microscopically bloody diarrhoea. All specimens were cultured on sorbitol MacConkey agar and incubated at 37oC overnight. Non-sorbitol fermenting colonies were identified by different biochemical and serological tests as E.coli 0157:H7. Antibiotic sensitivity was done for the isolates using ampicillin; cephalexin; ciprofloxacin; co-trimoxazole; gentamicin; and tetracycline. Results: Patients (n = 10; 5) with bloody diarrhoea were found to harbour E.coli 0157:H7 in their stools. All isolates (in humans) were resistant to ampicillin. Eight (80) were resistant to tetracycline and cephalexin; six (60) to co-trimoxazole; and four (40) to gentamicin. All isolates were sensitive to ciprofloxacin. Sixty percent of the human isolates were resistant to three antibiotics and 40to four antibiotics. Twenty of the cows (8) were found to be carriers of E.coli 0157:H7. All isolates (in animals) were resistant to ampicillin; five (25) to tetracycline and cephalexin and four (20) to co-trimoxazole. All animal isolates were sensitive to gentamicin and ciprofloxacin. Thirty five percent of the animal isolates were resistant to two antibiotics and 25to three antibiotics. Conclusion: The isolation of E.coli 0157:H7 from animals and patients should direct the attention of physicians and paediatricians to consider the possibility of infection and complications by this organism

Antibiotic Susceptibility and Plasmid Profiles of Shigella Species in Sudan

This study was carried out to determine the antibiotic susceptibility; plasmid profile and conjugative abilities of Shigella species isolated from different towns in Sudan during 2005-2007.Methods:Stool specimens were collected in Carry Blair transport medium from patients presenting with diarrhea from different sites in Sudan between the years 2005-2007.All specimens were inoculated on Mac Conkey's agar and Xylose Lysine Dioxycholate (XLD) (Mast group Ltd. Merseyside U.K.). Bacteria was isolated and subjected to different antibiotics to detect sensitivity and transference of resistance.Results:One hundred and fourteen Shigella isolates were included in the study.Eighty (70.1) were Shigella flexeneri representing the dominant isolate; followed by 20 (17.5) isolates of Shigella dysenteriae; 9 (7.9) Shigella sonnei and 5 (4.5) Shigella boydii.Most of the isolates showed resistance to streptomycin (70);tetracycline (52) and co-trimoxazole (43).They were highly sensitive to norfloxacin (97); nalidixic acid (95); gentamicin (89) and chloramphenicol (77).Multi-drug resistance to two or more antibiotics was apparent in most of the isolates (64; 56.1).Fifty nine of the resistant Shigella isolates were studied for their ability to transfer resistance to the donor E. coli K12 by conjugation.Of these;six were able to transfer resistance to streptomycin; tetracycline and co-trimoxazole.Extraction of the plasmid DNA from both donors and trans-conjugants showed a single type of plasmid with a molecular weight of 4.6 Kb.Conclusion The transfer of multi-drug resistant plasmids and the emergence of antibiotic Shigella and other bacterial species should raise the awareness and the seriousness of the uncontrolled (unsupervised) use of antibiotics in the medical practice

Prevalence of sexually transmitted diseases (STD) among women in a suburban Sudanese community.

338 women with age ranging from 15 to 69 years in a suburban Sudanese community were randomly selected and studied. Urine sample, high vaginal swabs and blood samples were investigated for bacterial vaginosis, candidiasis, trichomoniasis, gonorrhoea, HIV and syphilis. The sensitivity and specificity of some laboratory tests were evaluated. Bacterial vaginosis was found in 17.2% of the subjects, candidiasis in 10.1%, trichomoniasis in 7.7%, gonorrhoea in 1.2%, HIV in 1.2% and syphilis in 0.9% of the subjects. The sensitivity and specificity of amine test as a criterion for diagnosing bacterial vaginosis was 58.6% and 73.2%, respectively. The respective values of clue cells in wet preparation were 43.1% and 99.6%. The vaginal discharge in women with bacterial vaginosis lacked pus cells unless associated with concurrent infection.

Antimicrobial agent resistance in bacterial isolates from patients with diarrhea and urinary tract infection in the Sudan.

Antimicrobial sensitivity tests were performed on four-hundred and ninety-seven bacterial isolates from Sudanese patients with diarrhea or urinary tract infections. Shigella dysenteriae type I and enteropathogenic Escherichia coli showed high resistance rates (percentage of isolates showing antibiotic resistance) against the commonly-used antimicrobial agents: ampicillin, amoxicillin, chloramphenicol, tetracycline, cotrimoxazole, nalidixic acid, sulfonamide, and neomycin, and were completely sensitive to ciprofloxacin. Eighteen resistance patterns against nine antimicrobial agents tested were observed in enteric pathogens. Resistance to ampicillin, amoxicillin, tetracycline, cotrimoxazole, and sulfonamide was the most frequent pattern. The common urinary pathogens, E. coli, Klebsiella pneumoniae, and Proteus mirabilis showed high rates of resistance to ampicillin, amoxicillin, cotrimoxazole, tetracycline, sulfonamide, trimethoprim, streptomycin, and carbenicillin. We recommend that physicians seek updated knowledge of the common antibiotic-sensitivity patterns when starting empirical antibiotic therapy in Sudanese patients with diarrhea or urinary tract infection.

Water quality and public health in northern Sudan: a study of rural and peri-urban communities.

Access to adequate supplies of good quality drinking water continues to be limited among many rural and peri-urban communities in Africa, despite several decades of water improvement programmes. The present study investigated water quality at the source and point of consumption among rural and peri-urban communities in northern Sudan. Faecal coliform counts were determined by the membrane filtration technique and geometric mean counts compared in different seasons and among the different communities. Among nomadic pastoralists and riverine villages, both water sources and water stored for consumption had faecal coliform counts grossly in excess of WHO standards, with higher counts at the end of the rainy season. In the peri-urban community on the outskirts of Omdurman, while water quality from the distribution system had faecal coliform counts generally below 10 dl - 1, after storage, water was of considerably lower quality, with faecal coliform counts up to 1000 d1 - 1. The highest counts again occurred in the rainy season. Rates of diarrhoeal disease for Khartoum province were also greatest towards the end of the rainy season. The study has shown that poor quality water continues to be a major risk factor for public health in these communities.