utility of the interferon gamma-inducible protein-10 [IP-10] level in bronchoalveolar lavage and blood in the diagnosis of tuberculosis

Introduction: Control of TB depends on early detection and treatment of active cases

Aim of the work: Investigating the utility, sensitivity and specificity of interferon gamma inducible protein IP-10 in both blood and bronchoalveolar lavage [BAL] in the diagnosis of TB infection in clinically suspected patients

Methods: Thirty patients with clinical and/or radiological suspicion of pulmonary tuberculosis and negative sputum smear for AFB with Z-N stain were included in the study. BAL and blood samples were sent for the estimation of the level of interferon gamma inducible protein IP-10

Results: IP-10 levels in both blood and BAL were significantly higher in TB patients [P = 0.005 and 0.007 respectively]. Sensitivity of IP-10 in blood was 100% and specificity was 60%. Positive predictive value was 56%, negative predictive value was 100% and accuracy was 73%. Sensitivity of IP-10 in BAL was 100% and specificity was 35%. Positive predictive value was 44%, negative predictive value was 100% and accuracy was 57%. Sensitivity of IP-10 in blood and BAL were similar [100%] and both were more sensitive than tuberculin skin test [TST] [sensitivity 67%]. Detection of IP-10 in blood [specificity = 60%] was more specific than its detection in BAL [specificity = 35%]. On the other hand, specificity of detection of IP-10 in blood [60%] was comparable to the tuberculin test [specificity = 62%]

Conclusion: Interferon gamma inducible protein IP-10 may help in detecting M. tuberculosis infection and monitoring disease activity and efficacy of therapy

Epithelial-mesenchymal interaction in rhino-bronchial remodeling

The clinical phase and outcome of allergic diseases is related to the degree of bronchial and nasal remodeling. The present study aimed at assessing some features of both upper and lower airway remodeling in allergic patients as well as the role of epidermal growth factor and its receptor [EGFR] and transforming growth factor fi [TGF-fi] in this process.Twenty patients with mild persistent asthma according to G1NA guidelines and mild persistent allergic rhinitis [ARIA] were included in the present study. Fibreoptic bronchoscopy was done during stable disease. Forceps biopsy was taken from a segmental bronchus and from the nasal turbinates. The biopsies taken were stained by haematoxylin and eosin [H and E] for histopathologic evaluation and immunohistochemical detection of EGFR and TGF-ft was done.Abnormalities in nasal epithelium [ulceration, atypia, and basement membrane thickening] were detected in 50% of asthmatic patients and abnormalities in bronchial epithelium were detected in 40% of them. EGFR was expressed in all abnormal nasal and bronchial epithelium specimens. TGF-f$ was expressed in 90% of abnormal nasal epithelium and all abnormal bronchial epithelium. Both factors were expressed only in hypertrophied nasal and bronchial mucus glands and some inflammatory cells. They were positively correlated with both nasal and bronchial basement membrane thickness.Remodeling occurs even in mild allergic patients. Epithelial-mesenchymal interaction through EGFR and TGF-/3 release plays a major role in this process

Spontaneous bacterial empyema in cirrhotic patients: complements 3 and 4, opsonic power and C-reactive protein as pathogenic mechanisms and diagnostic tools

Hepatic hydrothorax occurs in approximately 5-12% of patients with cirrhosis and portal hypertension and may be complicated by spontaneous bacterial empyema [SBE]. Pathogenic mechanisms of SBE still need to be investigated. The present work assesses the role of complement components [C3, C4], opsonizing power and C-reactive protein in the pathogenesis of SBE in cirrhotic patients. Twenty five cirrhotic patients with hepatic hydrothorax were randomly selected and 10 patients with hydrothorax secondary to heart failure were included as controls in the study. Pleural fluid [PF] and serum samples were analyzed for: total protein [TP], albumin, lactic dehydrogenase [LDH], glucose, polymorph nuclear leukocytic count [PMNL], complement components [C3, C4], opsonic activity [on the basis of log-kill] and high sensitive C-reactive protein [CRP]. SBE was diagnosed when pleural fluid PMNL was > 250 cells/mm[3] with a positive culture or >500 cells/ mm[3] with a negative culture after exclusion of pulmonary infections. Thirteen patients [52%] [Group I] were diagnosed as SBE and 12 patients [48%] had no SBE [Group II]. There was no significant difference between patients and controls [GIII] as regards age, gender, serum proteins, serum C3, serum WBC and effusion CRP. Levels of serum albumin, total pleural effusion proteins, PT% and opsonic activity of groups I and II were significantly lower than in GIII with no significant difference between groups I and II. Levels of serum bilirubin and C4 of groups I and II were significantly higher than group III with no significant difference between groups I and II. Level of pleural effusion C3 in group I was significantly lower than in groups II and III and level of C3 in group II was significantly lower than in group III. Level of pleural effusion C4 in group I was significantly lower than group III, but there was no significant difference between groups I and II. In hepatic patients, 7 patients [28%] belonged to Child's class B and 18 [72%] to class C. Spontaneous bacterial empyema was detected in 56% of hepatic patients with Child's class C and in 43% of Child's class B. There was no significant difference between hepatic patients with and without SBE with regard to Child-Pugh's score. In patients with SBE, levels of C3 and C4 were significantly less in pleural fluid than in serum but there was no significant difference with regard to opsonic activity. Local complement defects [especially C3] and opsonic activity in cirrhotic patients predispose to SBE. Serum CRP increases, but effusion CRP level should be reassessed as a cheap diagnostic tool