Association of Rift Valley fever virus infection with miscarriage in Sudanese women: a cross-sectional study.

BACKGROUND: Rift Valley fever virus is an emerging mosquito-borne virus that causes infections in animals and human beings in Africa and the Arabian Peninsula. Outbreaks of Rift Valley fever lead to mass abortions in livestock, but such abortions have not been identified in human beings. Our aim was to investigate the cause of miscarriages in febrile pregnant women in an area endemic for Rift Valley fever. METHODS: Pregnant women with fever of unknown origin who attended the governmental hospital of Port Sudan, Sudan, between June 30, 2011, and Nov 17, 2012, were sampled at admission and included in this cross-sectional study. Medical records were retrieved and haematological tests were done on patient samples. Presence of viral RNA as well as antibodies against a variety of viruses were analysed. Any association of viral infections, symptoms, and laboratory parameters to pregnancy outcome was investigated using Pearson's χ2 test. FINDINGS: Of 130 pregnant women with febrile disease, 28 were infected with Rift Valley fever virus and 31 with chikungunya virus, with typical clinical and laboratory findings for the infection in question. 15 (54%) of 28 women with an acute Rift Valley fever virus infection had miscarriages compared with 12 (12%) of 102 women negative for Rift Valley fever virus (p<0·0001). In a multiple logistic regression analysis, adjusting for age, haemorrhagic disease, and chikungunya virus infection, an acute Rift Valley fever virus infection was an independent predictor of having a miscarriage (odds ratio 7·4, 95% CI 2·7-20·1; p<0·0001). INTERPRETATION: This study is the first to show an association between infection with Rift Valley fever virus and miscarriage in pregnant women. Further studies are warranted to investigate the possible mechanisms. Our findings have implications for implementation of preventive measures, and evidence-based information to the public in endemic countries should be strongly recommended during Rift Valley fever outbreaks. FUNDING: Schlumberger Faculty for the Future, CRDF Global (31141), the Swedish International Development Cooperation Agency, the County Council of Västerbotten, and the Faculty of Medicine, Umeå University.

Correlation of measles and dengue infection in Kassala, Eastern Sudan.

Using the clinical case definition adopted by the World Health Organization, a total of 275 suspected cases of measles were enrolled in this study during January-March 2012 in Kassala Teaching Hospital, Eastern Sudan. Various clinical manifestations (fever, headache, cough, coryza, conjunctivitis, skin rash, vomiting, diarrhoea, convulsion, and hemorrhagic manifestations) were reported among these patients. Blood was withdrawn from the first 64 (23.3%) patients. Two samples were hemolyzed and only 60 samples (21.8%) were investigated for measles and dengue IgM antibodies. Antibodies for measles, dengue, and co-infection were detected in the plasma of 12 (20%), seven (11.7%), and 10 (16.7%) samples, respectively. Although there was no significant difference in age, residence, occupation, and vaccination status among the different groups, a high proportion of male patients (P = 0.011), severe cases (P = 0.004), and death ((P = 0.001) were reported among co-infected cases.

Epidemiology of dengue infections in Kassala, Eastern Sudan.

Eighty-one (71.7%) out of 113 patients had confirmed dengue infection (using ELISA IgM serology) at Kassala, Eastern Sudan during the period of August through November 2010. According to the WHO criteria, dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS) were observed in 30.9, 58, and 11.1% of these patients, respectively. The mean age of these 81 patients was 25.5 years. Male:female ratio was 1.8:1. Various symptoms including fever (100%), headache (75.3%), vomiting (55.6%), nausea (53.1%), and backache (30.9%) were observed among these patients. Thrombocytopenia (<100/10(9) platelets/L), and leucopenia (WBC count <4,000 × 10(9) cells/L) and hemoconcentration (hematocrit >45) were reported in 86.4, 69.1, and 67.9% of the patients, respectively. High alanine aminotransferase (ALT, >65 U/L) and aspartate aminotransferase (AST >37 U/L) were seen in 9.9 and 14.8% of the patients, respectively. There were five (6.1%) deaths, three of them had DHF and the other two patients had DSS.

A nosocomial transmission of crimean-congo hemorrhagic fever to an attending physician in North Kordufan, Sudan.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF), a tick-borne disease caused by Crimean-Congo hemorrhagic fever virus (CCHFV), is a member of the genus Nairovirus in the family Bunyaviridae. Recently, CCHFV has been reported as an important emerging infectious viral pathogen in Sudan. Sporadic cases and multiple CCHF outbreaks, associated with nosocomial chain of transmission, have been reported in the Kordufan region of Sudan. AIMS: To confirm CCHF in an index patient and attending physician in North Kordufan region, Sudan, and to provide some information on virus genetic lineages. METHODS: Antibody captured ELISA, reverse transcription PCR, partial S segment sequences of the virus and subsequent phylogenetic analysis were used to confirm the CCHFV infection and to determine the virus genetic lineages. RESULTS: CCHF was confirmed by monitoring specific IgM antibody and by detection of the viral genome using RT-PCR. Treatment with oral ribavirin, replacement with fluid therapy, blood transfusion and administration of platelets concentrate resulted in rapid improvement of the health condition of the female physician. Phylogenetic analysis of the partial S segment sequences of the 2 CCHFV indicates that both strains are identical and belong to Group III virus lineage, which includes viruses from Africa including, Sudan, Mauritania, South Africa and Nigeria. CONCLUSION: Further epidemiologic studies including, CCHFV complete genome analysis and implementation of improved surveillance are urgently needed to better predict and respond to CCHF outbreaks in the Kordufan region, Sudan.

Multiple Crimean-Congo hemorrhagic fever virus strains are associated with disease outbreaks in Sudan, 2008-2009.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) activity has recently been detected in the Kordufan region of Sudan. Since 2008, several sporadic cases and nosocomial outbreaks associated with high case-fatality have been reported in villages and rural hospitals in the region. PRINCIPAL FINDINGS: In the present study, we describe a cluster of cases occurring in June 2009 in Dunkop village, Abyei District, South Kordufan, Sudan. Seven CCHF cases were involved in the outbreak; however, clinical specimens could be collected from only two patients, both of whom were confirmed as acute CCHF cases using CCHF-specific reverse transcriptase polymerase chain reaction (RT-PCR). Phylogenetic analysis of the complete S, M, and L segment sequences places the Abyei strain of CCHF virus in Group III, a virus group containing strains from various countries across Africa, including Sudan, South Africa, Mauritania, and Nigeria. The Abyei strain detected in 2009 is genetically distinct from the recently described 2008 Sudanese CCHF virus strains (Al-fulah 3 and 4), and the Abyei strain S and L segments closely match those of CCHF virus strain ArD39554 from Mauritania. CONCLUSIONS: The present investigation illustrates that multiple CCHF virus lineages are circulating in the Kordufan region of Sudan and are associated with recent outbreaks of the disease occurring during 2008-2009.

Maternal and perinatal outcomes of dengue in PortSudan, Eastern Sudan.

AIM: To investigate maternal and perinatal outcomes (maternal death, preterm delivery, low birth weight and perinatal mortality) of dengue at PortSudan and Elmawani hospitals in the eastern Sudan. METHOD: This was a retrospective Cohort study where medical files of women with dengue were reviewed. RESULTS: There were 10820 deliveries and 78 (0.7%) pregnant women with confirmed dengue IgM serology at the mean (SD) gestational age of 29.4(8.2) weeks. While the majority of these women had dengue fever (46, 58.9%), hemorrhagic fever and dengue shock syndrome were the presentations in 18 (23.0%) and 12, (15.3%) of these women, respectively. There were 17(21.7%) maternal deaths. Fourteen (17.9%) of these 78 women had preterm deliveries and 19 (24.3%) neonates were admitted to neonatal intensive care unit. Nineteen (24.3%) women gave birth to low birth weight babies. There were seven (8.9%) perinatal deaths. Eight (10.2%) patients delivered by caesarean section due to various obstetrical indications. CONCLUSION: Thus dengue has poor maternal and perinatal outcomes in this setting. Preventive measures against dengue should be employed in the region, and more research on dengue during pregnancy is needed.

Rift Valley Fever among febrile patients at New Halfa hospital, eastern Sudan.

BACKGROUND: Since the first isolation of the Rift Valley Fever virus (RVFV) in 1930s, there have been several epizootics outbreaks in the tropic mainly in Africa including Sudan. Recognition of cases and diagnosis of RVF are critical for management and control of the disease. AIMS: To investigate the seroprevalence and risk factors for seropositive to RVFV IgG among febrile patients. METHODS: All febrile patients presented to New Halfa hospital in eastern Sudan during September through November 2007 were investigated to identify the cause of their fever including malaria and RFV. RESULTS: Out of 290 feverish patients presented to the hospital, malaria was diagnosis in 94 individuals. Fevers of unknown origin were diagnosed in 149 patients. Seropositive to RVFV IgG was detected by enzyme-linked immunosorbent assay in 122 (81.8%) of the sera from these 149 patients with fever of unknown origin. While socio-demographic characteristics (age, Job, education and residency) were not associated with seropositive to RVFV IgG, male (OR = 2.8, 95% CI = 1.0-7.6; P = 0.04) were at three times higher risk for seropositive to RVFV IgG. CONCLUSION: There was a high seropositive to RVFV IgG in this setting, more research is needed perhaps using other methods like PCR and IGM.

Brief report: acute viral hepatitis and poor maternal and perinatal outcomes in pregnant Sudanese women.

Sixteen pregnant women presented at the three main hospitals in Khartoum province, Sudan during the period of March-September 2007 with features of acute viral hepatitis. Their mean (SD) gestational age was 28.0(6.7) weeks. The etiology of acute viral hepatitis was hepatitis B virus in five women (31.3%), hepatitis C virus in one woman (6.3%), hepatitis E virus in eight women (50%), and hepatitis non-A-to-E virus in two women (12.5%). There were four (25%) maternal deaths and three (18.7%) intrauterine fetal deaths. Three of these maternal deaths were due to hepatitis E virus and the fourth was due to hepatitis B virus.

Case report: Rift Valley Fever with vertical transmission in a pregnant Sudanese woman.

Rift Valley Fever (RVF) is a viral disease transmitted to humans by mosquito bite and contact with animals or their infected tissues. A 29-year old primigravidae presented in early labour with symptoms suggestive of RVF. She delivered baby of 3.2 kg with skin rash, palpable liver and spleen. The two samples from the mother and neonate were found to be positive for RVF-IgM. This report demonstrate that, RVF can be vertically transmitted.

Hepatitis B virus and hepatitis C virus in pregnant Sudanese women.

BACKGROUND: The epidemiology of viral hepatitis during pregnancy is essential for health planners and programme managers. While much data exist concerning viral hepatitis during pregnancy in many African countries, no proper published data are available in Sudan. AIM: The study aimed to investigate the sero-prevalence and the possible risk factors for hepatitis B virus (HBV) and hepatitis C virus (HCV) among antenatal care attendants in central Sudan. METHODS: During 3 months from March-June 2006, sera were collected from pregnant women at Umdurman Maternity Hospital in Sudan, and they were tested for markers of hepatitis B virus (HBVsAg) and HCV. RESULTS: HBVsAg was detected in 41 (5.6%) out 728 women, Anti-HCV was detected in 3 (0.6%) out of 423 women, all of them were not aware of their condition. Age, parity, gestational age, residence, history of blood transfusion, dental manipulations, tattooing and circumcision did not contribute significantly to increased HBVsAg sero-positivity. CONCLUSION: Thus 5.6% of pregnant women were positive for HBVsAg irrespective of their age, parity and socio-demographic characteristics. There was low prevalence of Anti-HCV.