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Biomedical subjects

H S Ahmed

Publications and source records attributed to H S Ahmed.

8 recordsLinked to original sources
PubMed1996

Post-endemic acute bacterial meningitis in Sudanese children.

The study describes an 18-month surveillance of the epidemiological, clinical and microbiological features of childhood acute bacterial meningitis (ABM) seven months after the end of a major epidemic of Neisseria meningitidis (MC) in Khartoum. A total of 125 children, aged one month to 14 years, who were admitted with a provisional diagnosis of meningitis/meningoencephalitis to the Children's Emergency Hospital (CEH) in Khartoum, Sudan, were prospectively enrolled in the study. Bacterial meningitis was diagnosed by direct microscopy (DM), culture or a recently introduced ELISA assay (EIA-test) in 56 children. Haemophilus influenzae (HI) and MC were the commonest causative bacteria (each accounting for 38%) and were followed by Streptococcus pneumoniae (PNC, 23%). There was a relative decrease in the proportion of HI which was found to be the leading causative bacteria in a previous study done in the same hospital during endemic situations. This was accounted for by a relative excess of MC during the post-epidemic period. Molecular analysis of two MC strains revealed that clone III-I of serogroup A (that caused an intercontinental wave of MC disease between 1983 and 1990) was still prevalent. The case fatality rate was 28.6% which is higher than that reported in Sudan (18.6%) during endemic situations; but comparable to the mortality in other African countries. Of the prognostic factors on admission, low systolic blood pressure (< 70 mmHg), hyperpyrexia (temperature > 40 degrees C) and light to deep coma correlated significantly with a fatal outcome.

Acute Disease↗
PubMed1994

Viral pathogens and clinical manifestations associated with acute lower respiratory tract infections in children of the Sudan.

BACKGROUND: Incomplete knowledge regarding the viral agents causing respiratory infections in children living in developing countries impedes diagnosis and management of patients. OBJECTIVES: To assess the role of viral pathogens in Sudanese children presenting with acute lower respiratory tract infections (ALRI). STUDY DESIGN: The study population consisted of patients presenting with ALRI at the Children's Emergency Hospital in Khartoum during 2 periods (December 1987 to April 1988 and September 1990 to March 1991). Identification of viral infections was based an antigen detection by immunofluorescence and enzyme-linked immunosorbent assay (ELISA) on nasopharyngeal secretions and/or serology. RESULTS: After exclusion of children with measles, 102 and 111 children, respectively, were prospectively enrolled in the study during the 2 periods. Their ages ranged between one mouth and 14 years (mean 2.0 years). Radiologic pulmonary infiltrations were detected in 135 (66%) of the 206 patients who had chest radiographs, whereas 7 (3%) showed lobar pneumonia. The case fatality rate was 2.3%. Of 83 virus infections detected, 79 were in children < years and consisted mainly of respiratory syncytial virus (RSV, 28%), followed by parainfluenza (7%), adenovirus (5%) and influenza A (2%). Infiltrates on radiographs were significantly less often found in virus-infected cases than in ALRI-cases with negative virus tests. CONCLUSIONS: RSV predominantly infected young infants (</= 3 months) compared with those who were 5 years or older (28% and 13%, respectively). A tendency for respiratory viruses to be more prevalent was seen during the cooler months (January and February). There were no significant differences in clinical features between virus-positive cases and others. The panorama of viral infections proved to be the same as in other developing countries.

Journal Article↗
PubMed1991

Otitis media in Sudanese children: presentation and bacteriology.

Two hundred Sudanese children (105 males, 95 females) with otitis media (OM) were studied. Their age range was from 3 months to 15 years, with 41.5% being below 2 years of age. The presenting symptoms included ear discharge in 96% and pyrexia in 26.5% of patients. Ear ache and itching were reported in 22.5% and 7.0% respectively and impaired hearing in 7.0%. Bacterial pathogens were isolated from 115 (70.1%) of 164 cultures from children with chronic discharging ears. Organisms isolated in order of frequency were: Proteus species, Klebsiella with other coliforms, Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. Sixty of 84 (71.4%) cultures from children with acute OM grew pathogenic bacteria. Staphylococcus aureus and Klebsiella with other coliforms were the commonest pathogens. Proteus species and Pseudomonas aeruginosa were less frequent but beta-haemolytic Streptococcus, Streptococcus pneumoniae and Escherichia coli were the least common. Antibiotic sensitivity results show that the majority of isolates from children with discharging ears were sensitive to Gentamicin, followed by Co-trimoxazole and Streptomycin. The majority of organisms showed poor sensitivity to Ampicillin and Penicillin. The results of this study show that cotrimoxazole is the drug of choice for treating children with OM.

Adolescent↗
PubMed1990

Clinical features and complications of epidemic group A meningococcal disease in Sudanese children.

The clinical presentation and laboratory features in relation to short-term outcome in 118 prospectively studied Sudanese children who were admitted with meningococcal (MC) meningitis and/or septicaemia during the 1988 group A MC epidemic in Greater Khartoum are described. Their ages ranged from 25 days to 15 years (mean: 78 months) and 42% were less than 5 years old. The male:female ratio was 1.6:1. Forty (34%) came from one of the peri-urban shanty towns encircling Greater Khartoum. A history of MC immunization (A and C vaccine) was obtained in 22%, but only five children (4.8%) had the vaccine between 4 weeks and 1 year before their illness. The commonest symptoms on admission were vomiting, neck rigidity and diarrhoea. Convulsions were significantly more frequent in children under 5 years old (p = 0.0005). Fifty-six (47%) had evidence of malnutrition. In descending order, fever, neck stiffness and Kernig's sign were the most commonly observed signs, the latter two being significantly more often detected in children older than 1 year. Twenty-four patients 20%) had disturbed consciousness. The case fatality rate was 6.3% and this was significantly higher in those presenting with meningococcal septicaemia (p = 0.0006). Other significant associations with mortality were short duration (less than 1 day) of symptoms (p = 0.0006) and clinical shock detected on admission p = 0.003). Transient complications were infrequent and permanent neurological sequelae were confined to bilateral profound sensorineural hearing loss in three children (2.9%) and hemiplegia in two 1.9%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Features of a large epidemic of group A meningococcal meningitis in Khartoum, Sudan in 1988.

A large epidemic (February-August 1988) of group A sulphonamide resistant, clone III-1 meningococcal meningitis in Khartoum, Sudan is described. A total of 10,099 cases were admitted to treatment centers with 8,397 cases during March and April, corresponding to an annual incidence of 1,679/100,000 inhabitants during this period. The age profile showed a high morbidity in adults (31% of the cases greater than or equal to 20 years). The male dominance was marked especially in the adult cases with a proportion of 3.2:1. The epidemic started during the hot and dry season and declined when the clouds came, humidity rose, temperature fell and a mass vaccination campaign had been implemented together with other epidemic precautions. Vaccination with a combined group A/C polysaccharide vaccine had been given 4 weeks-1 year before hospitalization to 11% of the children, 80% of whom were greater than 18 months of age. The estimated case fatality rate was 6.3%. Since 47% of the cases came from periurban and rural areas, the actual mortality during the epidemic might have been higher when considering those who may have died before reaching any of the treatment centres. Fatal cases had a short history of acute illness and a septic condition. Septicaemia was rare and seen in only 3.7% of the cases, the rest had acute purulent meningitis. Hearing loss/impairment and hemiplegia was diagnosed in 2-3% of the cases. The epidemiology, based on detailed typing/subtyping and restriction enzyme patterns of meningococcal strains, was apparently associated with the Mecca outbreak in August 1987.

Adult↗
PubMed1989

Rapid diagnosis of bacterial meningitis by an enzyme immunoassay of cerebrospinal fluid.

A total of 250 cerebrospinal fluid (CSF) specimens were analyzed using a rapid enzyme immunoassay (Pharmacia Meningitis EIA-Test) (EIA) for the detection of antigens of Haemophilus influenzae type b, Neisseria meningitidis (serogroups A,B,C) and Streptococcus pneumoniae (25 selected types). The test is performed in less than 1 h and read by the naked eye. EIA and coagglutination (CoA) were compared with a constructed reference that comprised samples which were either positive by culture and/or on direct microscopy (DM), or in which there were positive results with both EIA and CoA for the bacteria covered by the assays. Using this reference for CSF samples assayed in a period between two meningococcal meningitis epidemics, the sensitivity was 0.86 for EIA and 0.69 for CoA, the specificity 0.95 (EIA) and 0.97 (CoA), the predictive value for a positive result 0.81 (EIA) and 0.87 (CoA) and, the predictive value for a negative result 0.96 (EIA) and 0.93 (CoA). Antibiotics had been given to 54% of the patients before admission. All of the 56 samples that were positive in any of the tests taken during an epidemic of group A meningococcal disease were detected by EIA; CoA was negative in 45% and culture/DM was negative in 32%. Sequential dilutions of two CSF samples from which H. influenzae type b had been isolated, showed the EIA to be 16-32 times more sensitive than CoA. With both technical feasibility and good sensitivity and specificity, the EIA seems to be useful and reliable for the rapid diagnosis of bacterial meningitis, especially in situations where pretreatment with antibiotics are likely.

Antigens, Bacterial↗