ABSTRACT
The cag pathogenicity island [cagPAI] is one of the major virulence determinants of Helicobacter pylori [H. pylori]. Acquiring virulent strains of H. pylori is associated with increased risk for the development of gastric ulcers or cancer. The aim of this study was to determine H. pylori cagPAI genes pattern among dyspeptic Egyptian patients and its correlation with the varying degrees of the associated chronic gastritis. Histopathological examination, urease test and polymerase chain reaction [PCR] assay were performed for gastric antral biopsies obtained from 106 dyspeptic patients undergoing upper endoscopy. DNA extracts from H. pylori positive cases were analyzed for the presence of cagPAI genes cagA, cagE, cagM, tnpA, tnpB and cagT by using PCR assay. Apparently normal gastric mucosa was seen on endoscopy in 30.2% of dyspeptic patients while gastritis was diagnosed in 69.8% with significant difference [p<0.05]. H.pylori was detected in 71.7% of dyspeptic patients. A strong association was observed between H. pylori infection and gastritis patients [p<0.01]. The positivity rate of any of the cagPAI genes were 65.8% of H. pylori positive cases. Analysis of the entire cagPAI genes revealed that both cagA and cagE were the most predominant genes [30.2% , 18.4% respectively]. cagT and tnpB genes were not detected in all H. pylori positive gastric biopsies. The presence of the entire cagPAI genes was more substantiated in gastritis patients than in those with apparently normal mucosa [p<0.05]. The presence of cagA1/2, cagA3/4, cagM and cagE genes were significantly associated with moderate degree of gastritis [p<0.02], while tnpA gene was mostly detected in marked degree of gastritis [p<0.02]. In conclusion, it can be admitted that infection with virulent strain carrying cag PAI genes may be an indication of the risk of progression of gastric mucosal damage in chronic gastritis patients. In such country as Egypt where there is a high prevalence of H. pylori infection, cagPAI genotyping is important for prediction of the clinical outcome in H. pylori related gastritis aiming at eradication of infection before the progression to severe gastroduodenal diseases
ABSTRACT
Increased expression of inducible nitric oxide synthase [iNOS] has been observed in patients with chronic inflammatory diseases of the gastrointestinal tract leading to sustained production of nitric oxide [NO] which may induce DNA damage. Since Helicobacter pylori [H. pylori] infection produces a state of chronic immunostimmulation in the gastric epithelium and a causal relationship between H. pylori CagA+ strains infection and gastric cancer has been suggested, therefore, our aim was to evaluate the significance of iNOS expression in gastric lesions induced by H. pylori CagA+ strains with correlation to the encountered endoscopic and pathological diagnoses. Eighty four dyspeptic patients underwent endoscopic examination. Four antral gastric biopsies were obtained for detection of H. pylori by histopathological assessment [Giemsa staining], urease test and gene expression of H. pylori using PCR assay. Immunohistochemical staining for iNOS expression and quantitative detection of anti-CagA antibodies were performed. It was found that H. pylori infection was detected in 64.3%, CagA seropositivity in 54.8% and iNOS expression in 61.9%. Anti-CagA antibodies seropositivity and iNOS immunoexpression were significantly related to H. pylori infection. The positive rates of iNOS immunostaining increased with the lesion progression from chronic superficial gastritis to chronic atrophic gastritis to intestinal metaplasia [45.2%, 87.5% and 92.8% respectively]. Positive immunostaining rates of iNOS correlated significantly with H.pylori Cag A seropositivity with respect to both endoscopic and pathologic diagnoses. In conclusion, CagA+ H. pylori strains are associated with enhanced immunoexpression of iNOS in H. pylori-related gastric diseases, therefore they might contribute as risk cofactors that conduces to gastric carcinogenesis. Given the high prevalence of H. pylori gastric diseases and frequent performance level of endoscopic gastric examinations among Egyptian patients, prompt identification of gastric infections caused by H. pylori harboring Cag A virulence factor is necessary for the early eradication of infection before the development of pre-neoplastic lesions
ABSTRACT
In this study anti-enterobacterial common [ECA] was determined in 60 patients with endemic hepatosplenomegaly, 43 with enterica and 82 apparently control group. It was found that the ECA was significantly increased [P less than 0.001] in chronic active hepatitis, while the schistosomal affection of the liver showed no increased difference either between the control or the enteric group inspite of the presence of the collateral circulation. It is concluded that the degree of damage of the Kupffer cells is responsible for the cases of bacteraemia rather than the degree of collateral circulation
Subject(s)
Enterobacteriaceae/immunology , Antibodies, BacterialABSTRACT
This study was performed on 50 patients clinically diagnosed as enterica. Only 35 of them proved to have enterica. 20 out of the 35 showed disturbed liver function tests [LFT] and 5 out of 15 of those with negative blood culture and low agglutinin titre also had disturbed LFT. HBsAg was detected only in 6 patients with disturbed LFT, denoting a carrier state or incubated virus hepatitis while the remaining patients with disturbed LFT were negative for HBsAg indicating that enterica may change the pattern of LFT and be misdiagnosed as virus hepatitis