Serum levels of IL-10, TNF-alpha and neopterin in chronic hepatitis c virus infection and their relation to viral load

Hepatitis C virus [HCV] has been shown to be an etioligic agent responsible for chronic liver disease with eventual progress to cirrhosis in 20% of patients. While the immunologic mechanisms in chronic HCV infection have not been clearly defined, it is believed that cytokines are involved. In this study, the serum levels of IL-10 [by ELISA], TNF-alpha [by ELISA] and neopterin [by RIA] in patients with chronic hepatitis C [n = 40] were measured. They were compared with biochemical [ALT, AST, GGT] and viral [serum levels of HCV-RNA] indicators of infection. In addition, serum autoantibodies [anti-LKM, ANA, ASMA and APCA] were done by the indirect immunofluorescence technique. Also, twenty healthy subjects were enrolled as a control group. Serum levels of IL-10, TNF-alpha and neopterin were significantly increased in HCV infected patients versus normal control group [P<0.001]. There was significant positive correlation between serum level of IL-10 and serum level of HCV-RNA [P < 0.001]. There was also a significant negative correlation between serum level of TNF-alpha and both of serum level of HCV-RNA [P < 0.05] and IL-10 [P < 0.001]. ANA was detected in 7.5%, ASMA in 37.5% and APCA in 2.5% in these patients. In summary HCV patients have an altered immune reactivity that may play a role in the pathogenesis of chronic HCV. An activated T cell response is present in these patients as manifested by increased circulating cytokine levels and presence of serum autoantibodies. Proper understanding of the immune response in HCV patients should make it possible to design future treatment strategies for HCV infection

Intercellular adhesion molecule-1 [ICAM-1] in neonatal sepsis

Neonatal sepsis is a significant cause of morbidity and mortality in preterms. The signs of neonatal sepsis are clinically non-specific. ICAM-1 is one of the group of intercellular adhesion molecules. It has an important role in the early recognition of inflammation. So, this study was performed to find out any relation between neonatal sepsis and serum ICAM-1 for possible use as a diagnostic or prognostic parameter in such cases. This study comprised 28 neonate, admitted to the NICU of Maternity Hospital of Ain Shams University due to neonatal sepsis. They were 10 males and 18 females. Their ages ranged between 2-23 days. mean 7.57 +/- 5.54 days at the time of sampling. Their gestational ages ranged between 30-42 weeks, mean was 37.07 +/- 3.15 weeks. Fourteen were pretems [less than 37 weeks of gestation], 13 were fullterms [37-40 weeks of gestation] and one was post-term [42 weeks of gestation]. Their birth weights ranged between 1100-4115 g mean was 2795.1 +/- 820.39 g. Twenty-four were delivered by normal vaginal delivery, 3 by caesarian section and one by ventouse extraction. Eighteen cases were diagnosed as neonatal sepsis within the first week of life and 10 cases beyond the first week of life. Fifteen cases had risk factors predisposing to sepsis. Thirteen healthy normal neonates, age and sex matched were also included in this study, serving as control group. They were selected from neonates of normal deliveries accompanying their mothers during their follow up visits to maternity Hospital of Ain Shams University. They were 5 males and 8 females. Their ages ranged between 2-24 ways, mean 6.62 +/- 6.02 days at sampling time. Their gestational ages ranged between 37-40 weeks, mean was 39.2 +/- 12 weeks. Their birth weights ranged between 2600 - 4100 g, mean was 3338.5 +/- 524.1 g. Cases and control were subjected to medical history, clinical examination, complete blood count, quantitative C-reactive protein, blood culture and sensitivity test, estimation of serum ICAM-1 level by ELISA. As regards the group of cases, the clinical manifestations were, in descending order of frequency, lethargy, sluggish Moro's reflex, poor suckling, hypothermia, bleeding tendency, tachypnea, organomegaly, abdominal distension and fits. Haemoglobin% and RBCs count of cases were not significantly different from control [P>0.05]. Total leucocytic count of cases was highly significantly higher than control [P>0.01], 71,43% of cases had neutrophilia, 3.57% were neutropenic and 25% of cases had normal absolute neutrophil count, 85.71% of cases had bandaemia and 89.29% of cases were thrombocytopenic. Serum ICAM-1 was highly significantly higher in cases than control group, i.e., mean was 959.36 +/- 415.19 and 381.54 +/- 173.05 ng/ml respectively and P<0.001. It was significantly positively correlated with total leucocytic count among patient's group [r = 0.5655 and P<0.05]. Mean serum ICAM-1 of fullterms was 900.71 +/- 408.26 ng/ml, while for preterms, it was 1018.00 +/- 428.97, P>0.05 [non-significant]. As regards comparison to control, p was <0.001 for fullterms and p was <0.001 for preterms [both are highly significant]. Mean serum C-reactive protein [CRP] of cases was 39.86 +/- 49.45 mg/l and mean serum CRP of control was below 6 mg/l [P<0.01]. The serum CRP was not correlated with serum ICAM-1. The blood culture was positive in all cases, 14 klebsiella, 5 beta- Streptococci, 3 Staph aureus, 3 E. coli, 2 Staph. epidermidis and one Pseudomonas. No correlation was found between serum ICAM-1 and type of organism. Serum ICAM-1 is a very useful tool in diagnosis of neonatal sepsis in fullterms and preterms