ABSTRACT
Background: Hepatitis E virus [HEV] infection is enterically transmitted and usually present as acute self limiting infection. However, in cirrhotic patients, it is usually problematic being a possible trigger of decompensation with high mortality rates
Objectives: To determine the seroprevalence of HEV IgG and risk factors of HEV exposure in cirrhotic patients. Also, to determine the role of acute HEV infection as a possible trigger of acute-on-chronic liver failure [ACLF] in cirrhotic Egyptian patients in East Delta and to compare different clinical, laboratory and ultrasonographic features between acute HEV positive and negative ACLF patients
Methods: Two groups of cirrhotic patients were enrolled; group [1] included 216 patients with compensated cirrhosis and group [2] included 67 cirrhotic patients presenting with ACLF. For group [1] patients; HEV seroprevalence was determined by testing for anti-HEV IgG by ELISA, while acute HEV infection was detected in group [2] patients by testing for anti-HEV IgM and HEV RNA by ELISA and RT-PCR respectively. For ACLF cases, full history, clinical, laboratory and ultrasonographic findings were recorded
Results: The seroprevalence of anti-HEV IgG was 39.4 % in cirrhotic patients and well water use was the only significant predictor affecting HEV seropositivity. Acute HEV infection was detected in 13.4% [9/67] of cirrhotic patients with ACLF. It came third among the identified triggering factors of ACLF following bacterial infections [22.4%] and variceal bleeding [14.9%]. Acute HEV positive ACLF patients showed significantly higher levels of liver enzymes than acute HEV negative cases
Conclusion: In our locality, securing a safe water supply seems to be the most important HEV preventive measure. Meanwhile, clinicians should consider testing for acute HEV infection in cirrhotic patients developing ACLF, particularly those showing marked liver enzyme elevation
ABSTRACT
This study aimed to detect Gram negative bacilli by different microbiological methods and to detect the endotoxin by The Limulus Amebocyte Lysate [LAL] assay in water and dialysate of haemodialysis unit in Zagazig University Hospitals. Two hundred eighty one water samples, 50 concentrate and 100 dialyste samples were collected. All tested samples were cultured on four media using membrane filtration technique, M- Endo at 37 degree C for 24 hours [selective for total coliform], M- FC medium at 45 degreeC for 48 hours [selective for faecal coliform], Reasoner's 2 agar [R2A] at 22 degreeC for 7 days [for isolation of heterotrophs] and Cetermide medium at 37 degree C for 24 hours [selective for Pseudomonas auroginosa].Forty samples were tested for endotoxin by gel clot method LAL assay along with bacterial count on R2A medium. Fifty dilaysate samples were tested for free short segments of DNA .The same samples were directly tested by PCR for the presence of Gram negative bacilli 16S t RNA universal gene. No water samples showed coliform or faecal coliform growth while concentrate and dialysate samples showed 12% and10 % coliform growth and 6% and 5% faecal coliform growth respectively. 9.7 % of all tested samples showed growth of Pseudomonas aurginosa. On R2A 28.9% of all tested samples showed growth. Forty percent of treated water, 60% of treated water after distribution and 70 % dialyste samples had endotoxin level > 0.25 EU/ml. 82% of dialysate samples showed short DNA fragment with molecular weight below 100 bp.62% of samples showed positive results for the presence 16S t RNA gene with bands that lie in the area between 123-246 bp .The quality of water and fluids used in the heamodialysis unit under study necessitates revision of to elevate the quality of haemodialysis service with better outcome for patients