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Improving management of infectious diseases using nuclear techniques

From the IAEA Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section

Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS), tuberculosis (TB), and malaria are among the most common and significant infectious diseases worldwide. With two million people newly infected in 2014, HIV is still a major public health issue, causing a total of 36.9 million people living with HIV worldwide. Second to HIV, TB is the second greatest killer from a single infective organism, killing approximately 1.5 million people in 2013 followed by malaria, another major global killer, infecting 198 million people and taking the lives of 584 000 people in 2013.

Image shows the abnormal uptake of ubiquicidin in the chest clearly indicating location and extent of infection. (Photo: E. Estrada Lobato, IAEA)

Nuclear techniques through imaging and molecular laboratory tests help in the identification of infection and the management of drug resistance. Doctors commonly use imaging modalities such as X ray, ultra sound (US), or computed tomography (CT) to demonstrate the location of infection or inflammation in part of the body. Nuclear medicine techniques can have an important role in early diagnosis and localisation of infection. Single photon emission tomography (SPECT) scanners detect the radioactivity emitted by a tracer injected in the patient, which gathers at the site of infection. Positron emission tomography (PET) is also used for whole body imaging to locate the infection site. PET- CT can also be used for detection and localization of infections where conventional imaging modalities do not detect anything.

Image shows the abnormal uptake of ubiquicidin in the foot clearly indicating location and extent of infection. (Photo: E. Estrada Lobato, IAEA)

The benefit of using nuclear medicine for infection diagnostics has been proven in many Member States. The IAEA's support was highlighted at the final coordination meeting of a regional project including Cameroon, Democratic Republic of the Congo, Egypt, Ethiopia, Ghana, Morocco, Nigeria, Seychelles, Sudan, Tanzania, Tunisia and Zambia. The activities carried out by the IAEA helped participating laboratories in those countries build capacity to strengthen the routine utilisation of molecular techniques and establish links between counterparts working on drug resistance and immune response evaluation in HIV, TB and malaria. Various technical documents, including laboratory protocols, standard operating procedures and training materials produced for drug resistance detection and identification of immunological techniques were produced as a result of this invaluable cooperation. The achievements of the project included the establishment of three regional designated centres in Cameroon (malaria and TB), Kenya (malaria) and South Africa (TB).

A decade ago, the IAEA reached an important milestone in the management of infectious diseases by coordinating a research project to produce a new radiopharmaceutical to diagnose infections using nuclear medicine techniques. The result of this project was a compound called ubiquicidin (29-41) which has a very high sensitivity (95%) to detect any type of infection. In addition to being reliable, this compound is both safe and cheap. It has been used for the last 10 years in several Member States, and currently through a coordinated research project the IAEA is standardizing the use of this tracer in more countries for the benefit of a larger number of patients.