Nasosinus aspergillosis in Sudanese patients: clinical features, pathology, diagnosis, and treatment.

OBJECTIVE: The objective of this study was a prospective analysis of the clinical features, pathology, diagnosis, and treatment of patients treated between 1993 and 1996 for nasosinus aspergillosis in the Sudan. METHOD: Clinical examinations and laboratory tests for serologic, mycologic, and histologic analysis were conducted on all patients, as were radiologic and computerized tomographic studies when external swelling of any of the paranasal sinuses was evident. RESULTS: The age group 11 to 50 years were predominantly affected, with a peak in those aged 21 to 30 years. Females were affected more often than were males. The clinical features were mainly nasal polyposis, external swelling of the ethmoid sinus medial to the inner canthus, or maxillary cheek swelling and/or proptosis. In the paranasal sinuses, the ethmoids were the most frequently affected. Intracranial extension of the disease occurred in two patients. Serologic examinations and mycological cultures showed more incidence of positive results than did histopathology. Aspergillus flavus was grown in all the positive mycologic cultures except one, where Aspergillus niger was grown. The treatment was mainly surgical, supplemented by an antifungal drug (itraconazole). The incidence of recurrence was 9.3%, and it was noticed that the recurrence occurred in those patients who were not taking their medicines regularly. CONCLUSION: Nasosinus aspergillosis is a common disease in Sudan. Nasal polyposis is the commonest mode of clinical presentation. Serology and mycologic cultures are quite helpful in the diagnosis. Surgical and medical treatment are complementary of each other.

Foreign bodies in the tracheobronchial tree in Sudanese patients.

A prospective study of patients with foreign bodies in the tracheobronchial tree attending Khartoum North Teaching Hospital was carried out. The duration of the study was 3 years. The number of patients studied was 46. The majority were toddlers aged between 18 months and 2 years. There was no sex predominance. The most frequently encountered foreign bodies in the bronchi were ful sudani (peanut, Arachis hypogea), and tasaly seeds (water melon, Citrillus vulgaris). The foreign bodies were found more commonly in the right bronchus in 87% cases. Negative roentogenogram did not exclude presence of foreign bodies in the bronchi. Persistence of symptoms and signs were taken as the indication for the bronchoscopy. The mortality rate in this series was 4.3%.

Sudanese mucosal leishmaniasis: epidemiology, clinical features, diagnosis, immune responses and treatment.

The epidemiology, clinical features, pathology, immune responses, diagnosis and treatment of 14 patients with mucosal leishmaniasis in the Sudan are described. The condition occurred mainly in adult males, particularly in certain closely related tribes from the western Sudan. It affected the mucosa of the upper respiratory tract and/or the oral mucosa and sometimes followed treated kala azar. The parasites were sometimes confined to the mucosa, sometimes spread to the lymph nodes, and rarely infected the bone marrow and spleen. One of the 2 patients with both visceral and mucosal leishmaniasis differed from classical kala azar cases; his infection was longer lasting, he was leishmanin positive, and his peripheral mononuclear cells proliferated in response to leishmanial antigens. Mucosal leishmaniasis following treated kala azar is a similar phenomenon to post-kala azar dermal leishmaniasis and post-kala azar uveitis. Post-kala azar mucosal leishmaniasis can therefore be added to the other post-kala azar leishmanial infections. Using the polymerase chain reaction, Southern blot analysis with specific probes, and isoenzyme characterization, the causative parasite was identified as Leishmania donovani in 4 patients and as L. major in one. Unlike American mucocutaneous leishmaniasis, mucosal leishmaniasis in the Sudan was not preceded or accompanied by cutaneous lesions and the response to pentavalent antimony or ketoconazole was good.

Leishmaniasis of the nose caused by different species of Leishmania in the Sudan. Distinguishing features of the different clinical forms.

The nasal mucosa is affected in mucosal leishmaniasis and the skin of the nose, but not the mucosa, may be involved in cutaneous leishmaniasis (oriental sore) and in post kala-azar dermal leishmaniasis (PKDL). These clinical forms all occur in the Sudan and, particularly when advanced, may be confused with each other since mucosal leishmaniasis may extend to the skin of the upper lip and both cutaneous leishmaniasis and PKDL may spread to the anterior nares although they do not extend into the mucosa. Illustrative examples of the three conditions are described. Distinctive features of each form are given. The importance of making the correct diagnosis is stressed, since the different forms respond differently to anti-leishmanial drugs.

Chronic suppurative otitis media in Sudanese patients.

A retrospective study was carried out to show the pattern of chronic suppurative otitis media in Sudanese. Patients with chronic suppurative otitis media were 43% of all patients with ear problem. The majority of patients affected by the disease were between 11-30 years with even distribution. Males were affected more than females. The duration of symptoms varied between 0-20 years but most of the patients had the disease for over six years. Pseudomonas aeruginosa, pseudomonas pyocyaneous and B. Proteus were the commonest organism isolated in cultures. The predominant presenting symptoms were otorrhoea followed by deafness. The rate of complications was relatively high. The majority of patients were improved after conservative medical treatment, by repeated aural toilet and the use of the appropriate antibiotic.

The surgical treatment of secretory otitis media in children.

Two groups of children with secretory otitis media, 100 in each group, were followed after treatment. The first group was treated with adenoidectomy only, the second group was treated with adenoidectomy and bilateral myringotomies with insertion of grommets. The difference in results between the two treatments was found to be statistically not significant.