ABSTRACT

Plants are an abundant source of biologically active compounds that have been shown to be effective antimicrobial agents. Many plants have traditionally been used to treat Mycobacterium infections. The goal of this research was to evaluate the effect of local medicinal plants on Mycobacterium tuberculosis isolates. The investigation was carried out on 130 pulmonary tuberculosis specimens from humans, obtained from Abo Anga and Al-Shaab hospitals. There were 103 infected males and 27 infected females, all of whom were between the ages of 20 and 30. The specimens were smeared, fixed, and stained directly with Ziehl-Neelsen. The acid-fast bacilli (AFB) were visible as red, straight, or slightly curved rods, singly or in small groups against a blue background.

The seven isolates were tested against extracts of Sudanese medicinal plants that had previously been shown to inhibit the growth of other microorganisms. The most active extracts were those of six plants particularly four extracts, belonging to two families that demonstrated activity against clinical isolates, and the minimum inhibitory concentrations were determined. Phytochemical screening was performed on the plants that demonstrated high anti-TB activity. It was concluded that specific tannins, saponins, and flavonoids play a significant role in anti-TB activity.

Key Words: Sudanese medicinal plants, Tuberculosis, Isolates, Phytochemical screening

Given that Mycobacterium tuberculosis is the cause of tuberculosis for more than 100 years and that efficient chemotherapy against the disease has been available for more than 50 years, it is a threat against humanity that this disease is still one of the world's most serious public health issues today [16]. TB treatment has been reshaped, and current therapy regimens are based on multidrug therapy, with 3-4 anti-tuberculosis drugs typically used. Even so, multidrug-resistant tubercle bacilli are becoming a problem for a variety of drugs, including isoniazid, ethambutol, rifampin, and streptomycin [17].

The drug resistance patterns of SM, RMP, EMP and INH were: (42.86%), (42.86%), (57.14%), (28.57%), respectively.

In the present study, the in vitro drug susceptibility testing showed that out of seven isolates, 1(14.29%) was fully sensitive to all the four drugs under investigation. However, 6 (85.71%) were resistant to one or more drugs. One (14.29%) isolate was resistant to a single drug, while 5 (71.43%) were multi-drug resistant (MDR), 4 (57.14%) were resistant to two drugs, and 1(14.29%) was resistant to three drugs. In another study, it was reported that primary and secondary drug resistance strains were 2.4% and 14.3%, respectively [18].

Drug-resistant tuberculosis is extremely difficult to treat, which necessitates the use of more and different medications over a longer period of time. Surgery is often required to remove areas of demolished lungs that are strongly infected with mycobacteria and are inaccessible to drugs [19]. Because mycobacteria are becoming increasingly resistant to traditional anti-tuberculosis drugs, there is an opportunity for new anti-tuberculosis agents. According to a recent WHO report, 2% of all tuberculosis cases worldwide are multi-drug resistant by description, meaning they are resistant to isoniazid + rifampicin (plus/minus other resistances). These cases can be cured in the United States and other high-resource countries, but at a high cost and with long courses of rather toxic medicines, posing a serious compliance dilemma [20]. It is critical to developing new anti-tuberculosis agents, preferably those that can be easily and cheaply manufactured from local sources. The use of antimicrobials derived from natural plants has a significant effect on human health care in developing countries.

Local healers have used herbal remedies in rural areas for centuries, and it has been developed in industrialized countries. Medicinal plant research has yielded a number of substances used in advanced medication to cure serious diseases [21]. In the situation of C. aculeatum, the root extract had the same effectivity as the seeds extract of C. hartmannianum, and both C. hartmannianum and C. aculeatum rank fifth in effectivity against the seven clinical isolates when compared to other plant extracts. In the case of C. glutinosum, the leaves extract had the lowest efficacy against clinical isolates when compared to all other extracts. C. aculeatum aerial part water decoction has anti-mycobacterial activity [22]. Martini et al. 2004 investigated the antibacterial activity of C. erythrophyllum and discovered that seven antibacterial flavonoids had antimicrobial activity against Gram-negative and -positive strains in another study [23].

In the case of C. hartmannianum, the leaves extract was more effective than the Plicosepalus acaciae extract against the seven clinical isolates, with a lower MIC comparable to C. hartmannianum seeds extract. C. hartmannianum leaves extract exhibited lower MIC in five clinical isolates out of seven samples, while C. hartmannianum seeds extract showed lower MIC in two clinical isolates. In the case of C. adenogonium, the leaves extract demonstrated lower MIC in one clinical isolate and moderate affectivity in the remaining six isolates. T. laxiflora leaves extracts exhibited moderate effectivity in five clinical isolates, higher effectivity in one, and lower effectivity in the last. The leaves extract of P.acaciae demonstrated high activity against six isolates in the current study. El- Shafeia et al. (2017)  analyzed P.acaciae for antibacterial activity and discovered that the plant contains a high concentration of flavonoids, tannins, and alkaloids [24].

El- Shafeia  et al. (2017) evaluated the antimicrobial activity of chloroform, methanol, and aqueous extracts of P. acaciae leaves and stem, and discovered that the leaf methanol extract exhibited the highest level of activity against a variety of Gram-positive and Gram-negative clinical isolates from Sudanese patients [24].

Except for C. adenogonium, all of these plant extracts contained anthraquinones. Except for the leaves of C. hartmannianum, none of them were found to contain alkaloids. Saponins, which have been linked to antibacterial activity in some plants, were found in all plant extracts except C. aculeatum. Tannins were abundant in T. laxiflora and P. acaciae. P. acaciae leaves, on the other hand, were high in sterols and triterpenes. All plant extracts contained flavonoids and coumarins, and four plant samples contained cyanogenic glycosides [25].

These chemical groups may vary even within the same plant species' morphological parts. At this point, it is impossible to say whether the activity of these samples was caused by one or more of these chemical groups, or by other groups of compounds that were not tested. Further research is required to identify the compounds responsible for the activity in each sample.

CONCLUSION

The most effective extracts (7) from six plants (7 parts) belonging to two families demonstrated activity against clinical isolates, particularly four extracts, and the minimum inhibitory concentrations were determined. Phytochemical screening was performed on the plants that demonstrated high anti-TB activity. It can be stated that specific tannins, saponins, and flavonoids play a significant role in the anti-TB activity.

Acknowledgments: This publication was supported by the Deanship of scientific research at Prince Sattam bin Abdulaziz University.

Conflict of interest: None

Financial support: None

Ethics statement: This study was approved by College of Pharmacy, University of Khartoum ethical board, and consent was also obtained from every participant in this study before the samples were obtained.

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