Ancylostoma duodenale infection: a study of serum immunoglobulin G4 response to the excretory secretory antigen of adult worm

The serum anti-Ancylostoma duodenale immunoglobulin [Is] G4 antibody response to fraction III of the partially purified excretory secretory antigen of adult worm [Ad III ESA] was studied. This work included 60 patients with A duodenale infection [GI], 40 patients with other parasitic infections [GII] and 30 apparently healthy parasite-free controls [GIII]. Level of serum specific IgG4 was measured by indirect enzyme linked immunosorbent assay and compared with serum specific IgG, IgG 1, 2 and 3 subclass antibodies. Patients of GI had gastrointestinal manifestations and symptoms suggestive of anaemia and by investigations they had anaemia in 31.7% and eosinophilia in 100%. Measuring the intensity of A. duodenale infection, quantified as fecal egg counts, in patients of GI revealed that 60%, 30% and 10% had light, moderate and heavy infections, respectively. The serum anti-Ad III ESA IgG and IgG 1-4 subclass antibodies were significantly elevated in patients of GI compared with GIII. Serum specific IgG4 was expressed in 100% of patients of GI at a significantly highly elevated level than IgG1, IgG2 and IgG3. Specific IgG1 was expressed in 88.3% of patients of GI at a significantly elevated level than IgG2 and IgG3 which were expressed in 31.7% and 38.3%, respectively, and elevated to a moderate extent. Serum specific IgG4 showed a 1.0, 1.1, 3.1 and 2.6-fold increase in detection rate of positive cases than IgG, IgG1, IgG2 and IgG3, respectively. The highest ability to differentiate between infected and healthy subjects was by serum specific IgG4 recording a discrimination coefficient of 9.4, while IgG, IgG1, IgG2 and IgG3 recorded 5.2, 6.3, 3.2 and 3.4,respectively. Serum specific IgG4 showed a significant positive correlation with the intensity of A. duodenale infection demonstrated by IgG and IgG3, respectively. Detection of serum anti-Ad III ESA IgG4 antibody recorded a 100% sensitivity that was significantly higher than IgG1, IgG2 and IgG3, but insignificantly different from IgG. Finally, serum specific IgG4 recorded a 100% specificity that was significantly higher than IgG, IgG2, IgG3 and IgG1. They showed cross-reactions with ascariasis, lymphatic filariasis and strongyloidiasis. The results were discussed

Study of the relation between Helicobacter pylori infection and gastric interleukin [8] in patients with chronic liver disease

Helicobacter pylori [H pylori] is a gram negative spirally shaped bacterium. It is known to be the most common important cause of gastritis, peptic ulcer, non ulcer dyspepsia and gastric carcinoma. The frequency and importance of gastric mucosal lesion in patients with chronic liver disease [CLD] have been increasingly recognized in recent years. IL-8 a potent leukocyte chemo-attractant cytokine produced by H-pylori. It promotes polymorphnuclear leucocytes [PMNs] and mononuclear cells [MNCs] accumulation in gastric mucosa.This work aimed to clarify the relation between H pylori and IL-8 production in various chronic liver disease [CLD] lesions. Eighty patients were included in this study, 50 with CLD and 30 dyspeptic patients without CLD. Gastric mucosal biopsies were examined histopathologically for H pylori, cellular infiltration and associated pathology, together with culture of H pylori and assessment of IL-8 level in gastric tissue supernatant. 30/50 [60%] CLD patients,10/15 [66.6%] patients with non gastric dyspepsia, and 14/15 [93.3%] patients with gastric dyspepsia were positive for H pylori. There was no relationship between the prevalence of H pylori and the aetiology of CLD. No significant difference was observed in CLD patients' group as regard to H pylori and Child grading, degree of varices, gastric or liver histopathology. Statistical difference in H pylori prevalence between patients with CLD and those with gastric dyspepsia was significant. IL-8 showed significant increase in H pylori positive vs H pylori negative patients. Positive correlation was found between H pylori density and tissue IL-8 and cellular infiltration. In conclusion the liver status does not play a role in the prevalence of H pylori infection, further studies to investigate the relation between virulent H pylori and IL-8 are needed