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Diagnosing and Treating Infectious Diseases with Nuclear Techniques

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Aldo Malavasi, Deputy Director General and Head of the Department of Nuclear Sciences and Applications and May Abdel-Wahab, Director of the IAEA Division of Human Health, opening the event held on the margins of the 62nd IAEA General Conference. (Photo: Y. Yustantiana/IAEA)

Every year, 13 million people die from infectious diseases such as tuberculosis, malaria and HIV/AIDS around the world. The overwhelming majority of these deaths occur in developing countries and early detection is key to mitigate the spread of infection and the outbreak of epidemics. During an event held on the margins of the 62nd IAEA General Conference today, experts reviewed the role of nuclear medicine in the diagnosis of infectious diseases and the ways in which the IAEA can support Member States in building capacities to diagnose these diseases. The event also covered the role of stable isotope techniques in understanding the link between nutrition and infectious diseases.

“Infectious diseases that had been decreasing in incidence are re-emerging as a significant threat world-wide, especially in view of resistance to treatment. In addition, inadequate nutrition can also render the population more susceptible to certain infections” said May Abdel-Wahab, Director of the IAEA’s Division of Human Health. “Nuclear techniques can be used to improve accuracy and provide solutions to these diagnostic challenges.”

Increased resistance to antibiotics, a rise in international travel and growing populations in urban areas are creating new challenges to the management of infectious diseases. Since these diseases are no longer considered to be endemic, many countries do not have the radiopharmaceuticals necessary to accurately diagnose infections early.

Developments such as the emergence of drug-resistant tuberculosis, the reappearance of tuberculosis in countries which generally consider the disease to be under control, as well as the fact that it is spreading in some of Asia’s crowded metropolises, require international cooperation in addressing these public health concerns, panellists agreed.

The experts pointed out that when using conventional screening methods, some infections may not be discernible in their earlier stages and may even be mistaken for other diseases, including different cancers. Nuclear technologies enable detection before the appearance of symptoms in individuals, increasing the chances of physicians to control the spread of disease. “Molecular imaging has a unique role in detecting changes related to infection. The IAEA supports Member States in the proper use of imaging and radiopharmaceuticals to diagnose and monitor infections and response to prescribed treatments,” Abdel-Wahab said.  

Radionuclide imaging is becoming a more important diagnostic tool for physicians, said Helmut Sinzinger, Professor at the Sigmund Freud University in Vienna. “This is thanks to more accurate visualizations of infection sites.” Sinzinger also highlighted the importance of choosing the appropriate radiopharmaceuticals for diagnosing different diseases.

The side event on infectious diseases highlighted the role of nuclear medicine in diagnosis and treatment. (Photo: Y. Yustantiana/IAEA)

In-vivo nuclear imaging methods are used in the diagnosis and follow-up of different diseases, such as infections of the bone, fevers of unknown origin and infected blood vessel bypasses, while in-vitro techniques help identify other infections and verify drug resistance, said Juliano Cerci, President of the Brazilian Society of Nuclear Medicine. “Both in-vivo imaging and in-vitro methods are part of the nuclear medicine toolkit to diagnose infectious diseases,” he said.

Hadj Slimane Cherif, Head of Oman’s Peaceful Nuclear Technology Office spoke about the re-appearance of malaria in Oman. “We went from a time when malaria was completely eliminated in the country, to when it has been imported,” he said. One of the greatest challenges in diagnosing the disease is the number of infected individuals who do not show symptoms, he added. “Nuclear medicine is able to detect malaria infections not detected through routing screenings.”

Proper nutrition

Speakers also highlighted the importance of meeting nutritional requirements of people worldwide as malnutrition increases vulnerability to infections. These infections in turn further contribute to malnutrition. For example, HIV/AIDS and tuberculosis are associated with anaemia.

In this context, panellists emphasized that nutritional interventions should always be part of prevention and therapy, since infections generally intensify nutritional requirements. Stable isotope techniques are increasingly used by nutrition and health professionals to determine and monitor such interventions.

Stable isotope techniques allow for accurate assessment of body composition, thereby enabling the tracking of metabolic changes associated with infection and response to nutrition therapy. The non-invasive nature of stable isotopes furthermore means they can be used on everyone, including young children and babies, said Victor Owino, a nutritionist at the IAEA.

Boitumelo Stokie Motswagole, Principal Nutritional Officer at the National Food Technology Research Centre in Botswana, described a study on growth and nutritional status of children in Botswana, comparing results between children in a high malaria risk area and a low malaria risk area. “Anameia rates were greater in the malaria prone area, at 47%, compared to 19% in the low risk area.” In managing anaemia, there needs to be “more attention on infections rather than focusing only on iron supplementation,” she said.

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