ABSTRACT
Patients with bancroftian filariasis show a wide spectrum of clinical presentations often related to their immune responsiveness. The present study was designed to determine the role of host immune response and intensity of infection in the pathogenesis of bancroftian filariasis. In this study , 130 individuals seropositive for circulating filarial antigen [CFA] from endemic area for bancroftian filariasis with age ranged from 20- 60 years were subjected to, complete history taking , thorough clinical examination, midnight blood film and modified knott method for detection of microfilariae, then they were classified into the following groups. Group [I], 24 asymptomatic microfilaraemic patients, group [II] comprised 76 patients with chronic filariasis, all of them are amicrofilaraemic and group [III], 30 patients with symptomatic microfilaraemia presented with signs of acute filariasis. In addition to them 10 subjects from endemic area were included as endemic control group and 10 healthy subjects from non-filarial area were included as non-endemic control group. Circulating filarial antigen and anti-filarial specific IgG1 and IgG4 were quantitatively assessed by ELISA, Interleukin -2 [IL-2], interleukin - 4 [IL- 4] and tumor necrosis factor- alpha [TNF- alpha] were assessed in all groups by ELISA technique . The intensity of infection expressed in units of CFA/ml correlated positively with specific IgG1 and negatively with IgG4. Significant increase of CFA levels were encountered among group II and group III [2254.7 and 1985.8 respectively], than among group I and endemic control group [973.6 and 1349.2 respectively]. IL-2 significantly elevated in groups II and III in comparison to group I and endemic control. IL-4 was not significantly different among the three patients groups examined and TNF- alpha was significantly elevated in patients with acute filariasis [group III] only
Conclusion: as it is known that IgG1 is mainly controlled by cytokines Th1 response and IgG4 by Th2 response, the present study concluded that the antigen excess may have polarized Th0 response towards Th1 with consequent increase in its inflammatory cytokines that may have developed the recorded pathology
ABSTRACT
This study was carried out to evaluate the prevalence of fascioliasis, which is a relatively common, but usually underestimated problem in many rural areas in Egypt and to assess its role in causing biliary disorders using the recent technique of cystatin capture ELISA for immunodiagnosis of such cases.Between July 1999 and July 2001, 3218 individuals [2409 males and 809 females] with ages ranged from 6-70 years were selected by stratified random sampling from EI-Husseinya, Sharkeya Governorate, all these individuals were subjected to thorough history taking, clinical examination, stool examination using modified kato-thick smear method, serodiagnosis using cystatin capture ELISA technique. Patients with history suggestive of hepatobiliary disease were subjected to further radiological examination e.g abdominal ultrasonography, C, T abdomen and sometimes ERCP, also routine laboratory investigations were done for this group of patients e.g complete liver function tests and complete blood picture. The overall prevalence of fascioliasis among the present group of patients was 3.7%, the incidence was higher among adolescent [> 12 - 18 years] and adult [> 18 - 40 years] and much less in younger [6-12 years] and older [more than 40 years] age groups. Out of these fasciola positive patients only 10 patients [8.5%] suffered form biliary disorders as proved by abdominal ultrasonography and occasionally ERCP, these constituted about 3.4% of total number of patients who gave history suspecting biliary disorders [N=298]. The cystatin capture ELISA was used to detect anti-fasciola cystatin proteinase antibodies in sera of all fasciola copro positive group [118 patients] and also in a randomly selected group of copro negative patients [358 patients] with relevant or irrelevant signs and symptoms suggesting biliary affection. The ELISA capture test was positive in 110 out of 118 copro positive patients [93.2%] and it was negative in 352 out of 358 copro negative patients. This proved the highly specificity and sensitivity of this test in diagnosis of fascioliasis. The present community based study clarified the magnitude of fascioliasis as a health problem in rural area in Egypt and the significance of it as an aetiological agent of biliary disorders and the value of cystatin capture ELISA in picking up such cases