Biomedical subjects
Publications and source records attributed to E S Mahgoub.
Thyroid function was assessed in seventy two patients with various types of mycetoma. There was no evidence of clinical or biochemical thyroid dysfunction in these patients. The symptoms encountered in some of the mycetoma patients mimic those of hypothyroidism should be attributed to other factors possibly mental depression and apathy.
Three cases of brain abscesses caused by Ramichloridium obovoideum are reported. Inspite of adequate antifungal chemotherapy and multiple surgical procedures, all the three patients died of the rupture of a recurrant abscess into the ventricles. Ramichloridium obovoideum was identified as the causative fungus of these brain abscesses. Clinical, histological and mycological features of these cases are described. To our knowledge this is the first time that this fungus is isolated from a brain abscess in Saudi Arabia. The possibility that this life threatening cerebral mycosis may be endemic in this part of the world is considered.
Levels of antibodies were determined by enzyme-linked immunosorbent assay (ELISA) in 13 patients with eumycetomas due to Madurella mycetomatis infections. Raised levels of specific IgM were observed in 12 patients, compared with normal human controls. By contrast, low levels of specific IgG were detected in some patients. Specific responses to separated protein antigens were investigated by immunoblotting. Of 10 patients' sera tested, IgM in 2 recognized up to 7 of the blotted antigens between 45 and 84 kDa. Gold-labelled protein A (which predominantly binds to IgG) indicated that sera from 2 patients reacted with at least 6 protein bands with relative molecular masses between 64 and 95. The demonstration of significant IgM levels by ELISA, but few antigenic bands in sera from the same patients by immunoblotting, may point to an antibody response against polysaccharide fungal antigens in mycetoma patients. The use of the ELISA to detect antibodies of different classes and the characterization of their antigenic specificities by immunoblotting may have both diagnostic and prognostic value.
A case of mycetoma of the mandibular region caused by Actinomadura madurae is presented. Diagnostic procedures and rationale for treatment are discussed. In tropical and subtropical areas where mycetoma is endemic it should be included in the differential diagnosis of tumours of the facio-maxillary region.
The differences in the fine structure and antigenic determinants of mycetoma fungi in the mycelial phase in vitro and in grains in vivo facilitate an interpretation of grain formation. Aggregates of hyphal elements with multiple and thickened walls was a feature of the fungi in vivo. Associated with hyphal wall material, numerous polysaccharide microfibrils were detected in grains of Madurella mycetomatis. These were not seen associated with hyphal elements in vitro and it is suggested that these structures may be concerned with the aggregation of fungal elements in the formation of grains. Antibodies directed against the fungi in vitro were shown, by indirect immunogold labelling, to bind at identical sites in fungal material grown in vitro as in mycetoma grains. However the grain matrix was not labelled, suggesting that part of the structure formed in vivo is composed of modified antigen or is host derived.
This study compares the in vitro ultrastructure of Streptomyces somaliensis with the grain formation seen in vivo. Cultured forms were cocco-bacillary with thick cell walls and septa. Individual cells stained with PAS.TCH and Alcian blue. Grains were largely composed of an electron-dense fibrillar matrix surrounding clear areas, some of which contained organisms. The ultrastructural appearances of the latter were not significantly different from those seen in vitro although the cell wall was less well defined and did not stain with Alcian blue, and there were more intracellular lipid droplets. Host cells surrounding the mass were incorporated into the structure of the grain, a process associated with cell death. The grains of S. somaliensis appear to be derived from both host and actinomycete elements. Compared to other mycetoma agents the mechanism of grain formation by this organism is distinctive.
Cranial mycetoma is not as rare as was believed. In the Sudan, the majority of cases are caused by S. somaliensis; no cases were found to be caused by Nocardia species. Cranial actinomycetoma proved to be potentially fatal and was the most difficult to treat. The best treatment results were achieved in cases of A. madurae infection.
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Eumycetoma is, at present, treated only by surgery which is amputation at times and mutilating excision at others. Surgical treatment is often followed by local, or rarely distant recurrence to regional lymph nodes and surrounding tissue. The results of the clinical trial with ketoconazole reported in this paper show that five of 13 patients were completely cured and four improved. It is worth noting that the daily dose for those cured was 400 or 300 mg while those who improved were on only 200 mg/day.
During a period of two years, 30 cases of brucellosis were positively diagnosed from a total of 209 patients who reported with prolonged fever for investigation. Diagnosis was made both by blood culture and serological tests. The latter included slide and tube agglutination in all cases and an enzyme linked immunosorbent assay (ELISA) in 16. 11 cases (36.7%) gave negative results by the slide-agglutination screening test used at the recommended single serum dilution of 1:80. This was due to the prozone phenomenon as they gave positive results upon further dilution in the tube agglutination test. 13 of the 16 tested by ELISA were positive for both IgM and IgG and three were positive for IgG only. Of the six cases that were positive by culture, five grew Brucella melitensis and one B. abortus.
During one year, 1452 specimens of faeces from patients with diarrhoea were investigated for Campylobacter jejuni. This organism was isolated from nine specimens only (0.6%). None was isolated from 160 control subjects who did not have diarrhoea. Though the number of isolates is small, diarrhoea due to C. jejuni was found to be more common in males; the ratio of males to females was 7:2. Out of the nine patients, only four were Saudis. This indicates that Campylobacter gastroenteritis exists in this part of the world. Its incidence was, however, much lower than gastroenteritis due to other bacterial pathogens which constituted 7%. The source of infection was possibly chickens, both live and dressed. Most of the latter are imported.
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Of 83 strains of Neisseria gonorrhoeae isolated in Riyadh, Saudi Arabia, between April 1979 and August 1980, 10 produced beta-lactamase and had minimum inhibitory concentrations (MICs) of penicillin between 1 and greater than or equal to 4 micrograms/ml. Of the 73 (88%) non-penicillinase-producing strains, 55% had diminished sensitivity to penicillin (MIC = 0.06 micrograms/ml) and 11 (15%) were highly resistant (MICs ranging from 0.5-2 micrograms/ml). This high incidence of resistance may be due to widespread abuse of antibiotics; it also confirms that two mechanisms of resistance to penicillin exist in this species.
Experiments with athymic nude mice "nu nu" strain showed grains of Madurella mycetomi as early as 9 days, and they were well developed by 21 days, after inoculation. Grains were similar to those of humans, in pigment production and tissue reaction.
Naturally occurring mycetomas were found in 3 goats. Two had mycetomas on their hind legs and the third on its left scapula. In 2 goats the causative agents were identified by culture, histopathology and serology as Actinomadura madurae. In the remaining goat diagnosis was based only on histopathology and the causative agent was considered to be A. pelletierii. Despite minor differences between goat and human strains of A. madurae, it would seem that goats could be useful experimental models.
Antibody levels in a small group of Sudanese patients with clinically diagnosed mycetoma, and control groups were measured by countercurrent immunoelectrophoresis (CIE) and enzyme linked immunosorbent assay (ELISA). Antigens were prepared from the following organisms: Streptomyces somaliensis, Actinomadura madurae, A. pelletieri, Nocardia brasiliensis and Madurella mycetomi. Positive reactions were obtained in clinical cases against the homologous antigens in both CIE and ELISA; all heterologous and control sera negative in CIE but produced some reaction particularly against N. brasiliensis and M. mycetomi antigens in ELISA.
Mycoses in the Sudan are still significant and, as well as mycetoma, there are a number of fungal diseases: paranasal aspergillus granuloma, which came into eminence in 1966; actinomycosis; subcutaneous phycomycosis; systemic phycomycosis; post-operative opportunistic infection of the eye with Trichosporon cutaneum and rhinosporidiosis. Mycetoma and paranasal aspergillus granuloma are discussed in detail.