Association of hepatitis C virus with liver cirrhosis and hepatocellular carcinoma compared with hepatitis B virus in Egyptian patients

Hepatocellular carcinoma [HCC] is an aggressive malignancy and carries a poor prognosis. Documentation of the wide geographical variation in its incidence has led to clear identification of several risk factors. These include hepatitis B virus [HBV] and hepatitis C virus [HCV] infections in endemic areas. The present study investigated the association of HBV with HCV and cirrhosis, the latter is regarded as a premalignant lesion and underlies most cases with HCC. Serum samples from 94 patients with HCC [n = 25] and cirrhosis [n = 69] were tested for hepatitis C virus antibody [anti-HCV], hepatitis B surface antigen [HBsAg], hepatitis B core antibody [anti-HBc] and serum alphafetoprotein [APP]. Of the 94 patients, 71 [75.5%] had anti-HCV, 6 [6.4%] were positive to HBsAg, while 64 [68.1%] were positive to anti-HBc. These viral markers were more prevalent among HCC patients, 19 [76.0%] had hepatitis C antibody, 3 [12.0%] were positive to HBsAg and 22 [88.0%] were positive to anti-HBc compared with 52 [75.4%], 3 [4.3%] and 42 [60.9%], respectively in patients with cirrhosis. Regarding serum AFP measurement, 14 [56%] of patients with carcinoma and 35 [50.7%] of patients with cirrhosis demonstrated levels above 7 ng/ml. In patients with cirrhosis, elevated serum AFP and presence of anti-HCV in serum were significantly associated. In conclusion, this study shows that viral hepatitis is strongly associated with the development of cirrhosis and HCC in Egyptian patients. Hepatitis C virus seems to play a predominant role compared with hepatitis B virus

Evaluation of the need for RIBA confirmation of second generation ELISA HCV antibody results

Samples were collected in Egypt from professional and voluntary blood donors, pregnant women and transfused children, and tested by second generation Abbott ELISA for antibodies to hepatitis C virus [HCV]. A total of 331 sera with sample optical density [O.D.] /cut-off O.D. [S/CO] ratios greater than 1.0 [positive samples] were tested by RIBA-2 and the results compared. Overall, 75% of samples that were positive by ELISA were also positive by RIBA-2. Samples with high S/CO ratios were positive on RIBA-2 more frequently than samples with low S/CO ratios for samples with a high S/CO ratio [greater than 3], 231 of 260 [89%] were positive with RIBA-2, whereas 5 out of 44 [11%] samples with a low S/CO ratio [less than 2] were positive. Indeterminate RlBA-2 results were more often associated with a S/CO ratio of less than 3 than with a S/CO ratio of greater than 3. From this study conducted in Egypt, a setting with a high seroprevalence of HCV infections, the second generation ELISA can reliably be used to detect anti-HCV antibodies without the need for confirmation by more expensive tests

Antibodies to certain arboviruses in humans from a flooded village in Egypt

A study was carried out on 180 sera collected from inhabitants of a seepage flooded village [Begiram] in a. Nile Delta governorate in Egypt. The aim of the study was to monitor the prevalence of certain arboviruses; some of them are known to be endemic in Egypt. Sera were screened by ELISA except for, the HTN by IF, and the results indicated that NE and SFS exhibited the highest prevalence 45.5% followed by SFN [21%]. These 3 viruses are known to be endemic in Egypt. The high prevalence of W.N. and S.F.S viruses in Begiram village in comparison to lower rates detected in sera from nearby Sharkqiya governorate collected almost at the same time may reflect the adverse effect of the environmental change in the flooded village. RNF virus which caused a major epidemic in Egypt in 1977 and continued to be circulating until 1980, its antibodies were detected only in those above 20 years of age with a prevalence rate of 5%. Antibodies against two tick borne viruses viz QRF and CCHF were also detected with low prevalence rate 2.75% and 1.1% respectively; also antibodies to the rodent-borne HTN virus were detected with prevalence rate 1.1%. Antibodies to mosquito borne SIN and BAT viruses were not detected in the tested sera

Hepatitis C and B viruses and their association with hepatocellular carcinoma in Egypt

Hepatitis C and B viruses are associated with hepatocellular carcinoma in Europe, Asia and Southern Africa. A study of hepatitis C and hepatitis B virus infection was carried out on 70 patients with HCC, from the National Cancer Institute, Cairo University. Sera from patients were tested for anti-HCV and HBsAg markers. Twenty patients [30%] were anti HCV positive alone, 15 [21.4%] were HBsAg positive alone, 28 [40%] were positive for both anti-HCV and HBsAg and the remaining 6 patients [8.6%] were negative for the two markers. The total positivity for anti-HCV and for HB5Ag in these patients was 70% and 61.4% respectively. The comparable figures in a recent study on 90 blood donors from Egypt were 24.4% for anti-HCV and 4.4% for HBsAg. These data suggest a possible link between HCV and HBV infection and the development of hepatocellular carcinoma in Egypt, as has been found elsewhere in the world

Non-A, non-B viral hepatitis in Egypt

A study was carried out on 200 patients of ages 20-40 years suffering from acute viral hepatitis. Sera were tested for markers of hepatitis B [HBsAg, and IgM anti-HBc] and hepatitis A [IgM-anti-HAV] by the ELISA technique. Sera negative for the markers of both viruses: Hepatitis A [HAV] and Hepatitis B [HBV] were subsequently tested for IGM Heterophil antibodies against Epstein-Barr virus [EBV] by the Monospot slide test to diagnose acute infectious mononucleosis and tested for anti-CMV [IgM] by ELISA technique for the diagnosis of acute Cytomegalovirus [CMV] infection. Non-A, non-B hepatitis [NANB] was diagnosed by exclusion. The results of the study showed that 133 [66.5%] patients had evidence of HBV infection, while only 9 [4.5%] were diagnosed as HAV infection. EBV and CMV were the possible etiological agents of acute viral hepatitis in [3.5%] and [1%] respectively. Accordingly the Non-A, non-B hepatitis in this study amounts to [24.5%] of the acute viral hepatitis

Delta virus infection in Egypt

The present study was carried out on 124 serum samples of acute hepatitis B, 51 with chronic HBV infection, and 41 chronic HBsAg carriers. Sera were tested by ELISA for HBV markers and anti-delta [anti-HDV]. Delta infection [anti-HDV] in acute HB was found to be 16.9% [21 out of 124], 23.5% in chronic HB cases [12 out of 51], and 21.9% among chronic HBsAg carriers [9 out of 41]. Out of the twelve delta positive in chronic HB patients, ten [83%] were suffering from CAH [chronic active hepatitis] denoting a possible role of delta infection in deteriorating the course of the disease. A competitive inhibition of HBV replication by coexistent delta infection was demonstrated in the present study. This was reflected on anti-HBc IgM in the acute cases and on HBeAg in chronic HB cases. Anti-HBc IgM was 71.42% [15 out of 21] in delta positive acute HB patients versus 92.23% [95 out of 103] in delta negative acute HB patients. On the other hand, HBeAg percentage was 8.33% [1 out of 12] and 46.15% [18 out of 39] in delta and non-delta chronic HB patients respectively. The difference in both anti-HBc IgM and HBeAg as regards delta positive and negative patients was found to be statistically significant. Out of the twelve chronic HB cases with delta infection, four cases were negative for HBsAg [33.33%]. This observation might be attributed to the clearance effect of hepatitis D virus [HDV] on HBsAg [Ischimura et al., 1988] or due to suppressing effect resulting in low undetectable HBsAg level in serum, [Sherlock, 1989]. From the present study it may be concluded that delta infection is endemic in Egypt [its incidence ranged from 16.94% in acute HB to 23.53% in chronic HB infection], delta infection possibly also worsens the outcome of chronic HB patients. Delta infection may exert a competitive inhibitory effect on HBV replication

Antibody level after measles vaccination

The present study was designed to estimate the level of measles IgG antibody in infants early after vaccination and in preschool children to determine their immune status. Three groups were studied: Group I, unvaccinated infants, Group II, recently vaccinated infants and Group III vaccinated preschool children. Measles IgG antibody was measured using the ELIZA technique. The study showed that 90% [18/20] of the unvaccinated Group I infants were seronegative and only 10% were seropositive for measles IgG antibody representing most probably persisting maternal antibodies. Fifty percent [15/30] of recently vaccinated Group II infants were seropositive. A statistically significant higher antibody level was observed in Group II infants in comparison to those of Group I. The majority of seropositive infants of Group II [10/15 = 66.7%] showed high antibody level representing successful vaccination. Seropositives represented 77.4% [24/31] of Group III preschool children and the majority of them 75% [18/24] showed high antibody level which was significantly higher than the comparable in Group II infants, most probably due to subclinical infection in addition to successful vaccination. Fifty percent [15/30] of Group II infants and 22.6% [7/31] of Group III children were seronegative, more likely due to failure of initial vaccination

Arboviruses infecting humans and lower animals in Egypt: a review of thirty years of research

The 31 arboviruses reported from Egypt between 1950 and 1980, reviewed in a historical perspective reflect the continuing close scientific collaboration between Egyptian and American scientists during this period. Eleven of these arboviruses were first isolated in Egypt though all are now known elsewhere in Africa and/or in Eurasia. Eight of the 31 have been demonstrated or are believed to be transmitted by mosquitoes, 16 by ticks, and three by Phlebotomus sandflies; the vectors of four are unknown. An additional virus [Tettnang] isolated from Hyalomma ticks is now considered to be probably not an arbovirus. The public health significance of arboviruses in Egypt can be categorized as: [1] proven to cause epidemics [Rift Valley fever]; [2] capable of causing epidemics or severe outbreaks [Crimean-Congo hemorrhagic fever]; [3] endemic in children; hazardous to non-immune resident adults and visitors [West Nile, Naples and Sicilian phlebotomus fevers]; [4] causing sporadic illness in Egypt and/or elsewhere but public health significance unstudied [Sindbis, Quaranfil, Kemerovo, Thogoto, Dugbe, Bhanja, Wanowrie]; and [5] unknown [others]. Dengue was probably common in Egypt before 1950 but disappeared when Aedes aegypti was eradicated after the advent of DDT. Other arboviruses identified in seroepidemiological surveys of human blood samples in Egypt are Ntaya, Saint Floris, Gabek Forest, Arumowat, Karimabad, Tahyna, and Qalyub. Six arboviruses were isolated in Egypt during the fall migration of Eurasian birds from Eurasia to Africa [Kemerovo, Matariya, Burg el Arab, Bahig, Matruh, Thimiri], and one during the spring migration of birds from Africa to Eurasia [Abu Mina].The arthropods chiefly associated with these arboviruses are mosquito Culex pipiens [and/or other Culex spp. or other genera] [West Nile, Ntaya, Dengue, Arumowat, Rift Valley fever, Tahyna], the sandfly Phlebotomus papatasi [Naples and Sicilian phlebotomus fevers, Karimabad], argasid ticks Argas spp. [Chenuda, Abu Mina, Abu Hammad, Nyamanini, Quaranfil] and Ornithodoros erraticus [Qalyub], and ixodid ticks Hyalomma spp. and other ixodid genera [Wad Medani, Bahig, Thogoto, Dugbe, Crimean-Congo hemorrhagic fever, Dhori, Wanowrie]. The virus-arthropod-vertebrate interrelationships of these agents, and their biological and epidemiological dynamics, need considerable study for developing a satisfactorily integrated base of scientific, biomedical, and clinical knowledge to apply to public health problems in Egypt. Rift Valley fever [RVF] virus exploded in an epidemic in the Nile Valley and the southeastern sector of the Nile Delta during the summer of 1977. After a wintertime decline in morbidity, other cases occurred in 1978. The virus is postulated to have been introduced by viremic camels from the Sudan, where RVF virus has circulated actively since at least 1973. Antibodies against the virus were detected in about one-third of the examined camels entering Egypt from the Sudan in 1977 and 1978. Before 1977, RVF virus had been absent north of the Sahara. In 1978, the presence of a few seropositive persons and animals in Sinai, near the Suez Canal area, raised an alerm that RVF virus might spread beyond Africa [at the end of 1980, there was no evidence for presence of the virus elsewhere in North Africa or the Near East]. Economic losses were heavy from death and abortion among sheep, cattle, buffaloes, and other domestic animals in the Nile Valley and Delta in 1977 and 1978. Unknown thousands of humans suffered from, the dengue-like illness in both years; two human cases were virologically confirmed in 1980 but none in 1979; Three RVF strains were isolated from domestic animals in 1979; the morbidity and mortality rates for domestic animals in 1979 and 1980 are unknown. The disease course of most human RVF was [acute febrile] Other patients exhibited ocular complications or encephalitic [some fatal] or hemorrhagic disease courses [the last often associated with schistosomal hepatosplenomegaly and fatal]. Analysis of RNA species extracted from Egyptian and tropical African strains of RVF virus by individual and composite oligonucleotide fingerprints showed Egyptian strains [isolated in 1977 and 1978 from a human and from a cow in Lower and Upper Egypt] to be distinguishable from the others. Culex pipiens, which breeds in tremendous numbers throughout the RVF-infected areas of Egypt and feeds on both humans and domestic animals here, is demonstrated experimentally to have a high vector capacity for transmitting RVF virus. Few unblooded infected C. pipiens were found in nature but the presence of RVF virus in numerous blooded specimens suggests the usefulness of these data as an indicator of virus prevalence. Contact with infected meat, blood, and animal products, and inhalation of infected droplets, are undoubtedly also epidemiologically significant routes of RVF virus transmission from domestic animals to humans in Egypt. Rodents and other wild animals have little or no role in RVF virus circulation. Virus isolates from nasopharyngeal washings, throat swabs, and feces present the possibility of human to human transfer of the agent. Hematophagous insects such as fleas and bedbugs infesting intensely viremic patients should be considered as potential mechanical vectors of RVF virus among members of the patients households and visitors. The results of a recent [1980] seroepidemiological study [CF test] of 361 sera from rodents [Rattus rattus, B. norvegicus, Arvicanthis niloticus] in Alexandria, Suez, and Cairo Governorates, tested for antibodies to 11 tickborne viruses, are presented in an Appendix 1. Among the more interesting results are the high overall prevalence rate [19.9%] of antibodies against Matariya virus in the samples and of antibodies against most of the viruses in samples from R. norvegicus, especially from Alexandria. The overall rate [12.5%] of antibodies against Wad Medani virus is also notable. Overall rates between 7.7% and 4.4% were recorded for Dhori, Wanowrie, Thogoto, Dugbe, Crimean-Congo hemorrhagic fever, Karimabad, and Quaranfil viruses. Overall rates between 3.0% and 1.1% were recorded for antibodies against Abu Hammad, Abu Mina, and Bhanja viruses