First case of human infection caused by Pasteurella gallinarum causing infective endocarditis in an adolescent 10 years after surgical correction for truncus arteriosus.

OBJECTIVE: To report the first case of human infection (infective endocarditis [IE]) caused by Pasteurella gallinarum and to review the literature regarding IE caused by the genus Pasteurella. SETTING: University hospital based. PATIENT: An adolescent boy who underwent successful correction for truncus arteriosus 10 years before the present illness. RESULTS: Persistent fever, pallor, and a palpable spleen suggested IE clinically. Echocardiography documented vegetation in the conduit that was used for surgical correction. Blood cultures grew P. gallinarum and confirmed its role as the causative organism for IE in the patient. CONCLUSION: This case illustrates that IE may develop in a child with congenital heart disease several years after surgical intervention using material that is foreign to the body (conduit), and that such a complication may involve unusual pathogens. These observations emphasize the need for careful long-term follow-up of children with congenital heart disease even after successful surgical correction.

A study on allergic asthma patients in the allergy clinic, KFHU, Al-Khobar.

A total of 68 patients' records visiting the Allergy Clinic of King Fahd Hospital of the University (KFHU) in Al-Khobar were reviewed. All patients were above the age of 15 years. Out of the 68 patients 37 were females while 30 were males. The record of one patient was missing and therefore, data could not be captured. IgE titres over 180 I.U. were detected in 32 patients out of 46 patients tested. Levels of Ig6, IgA + IgM were normal. Skin tests gave positive reactions to a variety of allergens mainly inhalants. These allergens are comparable to those occurring in other parts of the Kingdom. Family history of atopy was revealed in only less than 25% of patients.

Vaginal and cervical abnormalities associated with trichomonal infection.

Cytological changes were studied among 393 women, reporting to Samir Health Centre, Khartoum (Sudan), using Papanicolaou staining. Vaginal trichomoniasis was confirmed by wet-mounts and cultural methods. Non-specific inflammatory changes were prominent (17.4%). In 33.5% of parasitised patients, the cervix was found healthy. Cancer of the cervix was not detected in patients investigated.

Evaluation of the laboratory diagnosis of vaginal trichomoniasis in Khartoum.

A total of 403 vaginal discharge specimens were investigated for Trichomonas vaginalis using fresh wet-mounts, culture and Papanicolaou staining. By fresh wet-mounts, 58 specimens (14.4%) were found harbouring the parasite. On culture 67 isolates (16.7%) were identified. Both wet-mount and cultural procedures detected 18.3% positive isolates. Papanicolaou staining detected 40 positive cases (9.9%) from the patients investigated. Two culture media were tried in this study to isolate T. vaginalis, namely Lumsden's medium and Diamond's medium. Their efficacy was found to be 16.9% and 14.8%, respectively.

Vaginal trichomoniasis at a sexually transmitted disease clinic at Khartoum.

At a sexually transmitted disease clinic at Khartoum 613 Sudanese women presenting with vaginal discharge were investigated. Specimens were examined by microscopy and culture. Trichomonas vaginalis infestation was found in 123 patients (20.1%), predominantly in the age groups 16-19 years (27.1%) and 46-65 years (27%). Frequency of trichomonal vaginitis was highest (35.9%) among divorced women. Of the pregnant women investigated, 16.3% were found to harbour the parasite. There was no significant difference in the parity of parasitized and non-parasitized patients.

PIP: This investigation was carried out to evaluate the prevalence of vaginal trichomoniasis in relation to subjects' age, marital status, parity, pregnancy and the intensity of the discharge. The subjects were 613 Sudanese women presenting with vaginal discharge, investigated at a sexually transmitted disease clinic in Khartoum. On the day of examination, a full history was taken, and particular attention was paid to the duration and amount of any vaginal discharge, as well as to past antitrichomonal therapy. 123 (20.1%) of the patients examined were found infested with T. vaginalis. The duration of the vaginal discharge ranged from a few days to 10 years. The discharge in parasitized women was copious in 30 cases (24.2%), moderate in 42.3%, scanty in 26.9% and absent in 6.6% of the cases. In non-parasitized patients, the discharge was copious in 8.1% of cases. The frequency of vaginal trichomoniasis was 20.1% in all patients examined. Trichomonal infestation was predominant in the age groups 16-19 years (27.1%) and 46 years and above (27%), thus confirming reports that trichomonal infestation may occur during the period of greatest sexual activitiy, as well as at older ages. The highest frequency was among divorced women (35.9%), followed by widowed women (29.4%) and may be related to promiscuity and to variety of sexual contacts. 16.3% of the pregnant women investigated were found harboring the parasite; there was no significant difference in the parity of parasitized (81.6%) and non-parasitized patients (82.3%). Association of T. vaginalis with gonorrhea and candidiasis was significant, though this did not modify the symptoms and signs of trichomoniasis. The results suggest that there is no significant difference between whites and dark-skinned peoples.

Widespread IgE-mediated hypersensitivity in Northern Sudan to the chironomid Cladotanytarsus lewisi ('green nimitti').

Hypersensitivity to Chironomidae (non-biting midges) has been a problem in Northern Sudan since about 1927 and is probably due to the working of dams which have produced lake-like conditions on parts of the Blue and main Niles where breeding has evidently increased. Studies were undertaken to determine whether this hypersensitivity is mediated by IgE. Sixteen Sudanese, with bronchial asthma associated with exposure to the chironomid, Cladotanytarsus lewisi ('green nimitti'), were investigated. All patients gave a positive immediate-type skin reaction to an extract of the midge and the majority had markedly elevated concentrations of circulating IgE. Serum from all patients passively sensitized human lung fragments in vitro for the release of histamine and slow-reacting substance of anaphylaxis by the 'nimitti' antigen. This tissue-sensitizing activity could be removed by immunoabsorption with an anti-IgE. These results indicate that this widespread and important hypersensitivity in the Sudan is IgE-mediated and thus may potentially be treated by desensitization.

Studies on two methods for extraction of streptococcal T antigens.

The extraction of group A streptococcal antigens by group C phage-associated lysin has been confirmed. In addition to the T antigen the extract contained M-protein, group-specific polysaccharide and mucopeptide antigen which was difficult to remove. This method of extraction of the T antigen was compared with the trypsin method. The latter method was found to be of advantage in giving a pure specific antigen.

A serogroup A meningococcal polysaccharide vaccine: studies in the Sudan to combat cerebrospinal meningitis caused by Neisseria meningitidis group A.

Vaccination against cerebrospinal meningitis (CSM) has regained interest with the use of capsular polysaccharides (or polyosides) of the meningococcus as specific immunizing agents. These compounds proved to be effective in the USA against meningitis caused by Neisseria meningitidis serotype C. This study considers whether the polysaccharides of the serotype A meningococcus, which is prevalent in the African CSM belt, could be protective in epidemic conditions. Taking advantage of the usual seasonal peak of CSM cases, controlled field trials were undertaken in the Sudan early in 1973. 21 640 persons were vaccinated, half of them with a meningococcal polyoside A vaccine and the other half with tetanus toxoid as a placebo. In the former group there were no cases of meningitis, whereas in the latter 10 cases were reported, of which 7 were confirmed by laboratory tests. These studies indicate that the meningococcal polyoside A vaccine is efficient in epidemic conditions and could be used to control outbreaks of meningococcal meningitis.