Prevalence of occult hepatitis C virus in patients with HCV-antibody positivity and serum HCV RNA negativity

Introduction and aim: chronic hepatitis C infection [CHC] is a global health-care problem with an increasing burden year-by-year, particularly in Egypt. Even with the advent of high sensitive techniques, a subset of patients with positive HCV-Ab and negative HCV-viremia remain challenging. Therefore, we herein tried to determine the prevalence of occult HCV infection in peripherd blood mononuclear cells [PBMCs] of Patients presented with positive serologic test for anti-HCV-Ab and negative serum HCV-RNA-PCR [spontaneously cleared-patients] and also, we followed up those patients

Patients and Methods: between March 2010 to March 2015, a prospective study was designed to include all consecutive patients with HCV-Ab positivity and HCV-RNA negativity who attended to Assiut unit for treatment of viral hepatitis; sector of national committee for contrbl of viral hepatitis. A total of 25 patients were recruited. Spontaneous clearance of serum HCV infection was approved by [HCV-Ab positive using two 3rd generation ELISA tests and serum HCV RNA negative in three consecutive occasion each six months apart]. Follow up serum HCV RNA for patients with Occult 1 HCV Infection every 6 months. The RNA extraction step was performed by a protocol modified from, that of the QIAamp viral RNA kits [Qiagen, courtaboeuf, France]. Blood samples for separation of I PBMCs were collected from all patients. PBMCs were obtained using Ficoll-Hypaque density gradient of EDTA anticoagulated blood according to the manufacturer's instructions [Lymphoflot, Biotest,Dreleich, Germany]. Detection of HCV viral load was performed by kit supplied by applied Biosystem [HCV RT-PCR Kit lot No.]

Results: a total of 25 [21 males, mean age 36.2 +/- 9.1] patients who cleared HCV spontaneously [HCV- Ab positive and serum HCV RNA negative]. The genomic HCV RNA was detected in PBMCs from 3 [12%] of 25 patients. Follow up for those three patients with occult HCV infection were done for 18 months by measuring serum HCV RNA by using highly sensitive real-time Polymerase Chain Reaction [RT-PCR] every 6 months, only single patient became overt HCV with low level of viremia

Conclusion: occult HCV infection was detected in a considerable prevalence in patients in whom apparent clearance of HCV-viral load occurred that entails corporations of HCV-viral assay in PBMCs into the diagnostic algorithm

Clinico-laboratory study on children with auto-immune hepatitis in upper Egypt

Auto-immune hepatitis [AIH] in children is a rare chronic progressive liver disorder. It is characterized serologically by high aminotransferase levels, elevated immunoglobulin G [IgG] and the presence of autoantibodies. AIH is divided into two types according to the autoantibody profile. This study aims to assess frequency, clinical manifestations, biochemical features and outcome of AIH in children attending Assuit University Hospitals in Upper Egypt with acute icteric hepatitis and seronegative viral markers [anti-hepatitis A virus [HAV] IgM, HbsAg, anti-hepatitis C virus [anti-HCV] Ab]. The study includes 34 children with AIH, diagnosed on the basis of the International Scoring Criteria of Auto-immune Hepatitis, recruited from Assuit University Hospitals, during the period from January 2005 to December 2009. All patients received prednisolone 2 mg kg[-1] day[-1]. Follow-up was done for 1 year. Among 34 children diagnosed as AIH, 24 were females [70.5%] and 10 were males [29.5%]. Jaundice represented the most consistent finding in all patients. According to the autoantibody profile, 25 children were classified as type 1 and nine children were classified as type 2. Corticosteroid therapy was started. Complete remission was observed in 67.6% of patients and partial remission in 17.6%. There was no significant statistical difference in clinical and biochemical features of AIH in patients regarding the response to treatment. Mild side effects of steroid therapy were encountered in 48.2% of patients. After complete withdrawal of corticosteroids, six patients [20.7%] developed relapse. AIH type 1 was the main form of AIH in children referred to Assiut University Hospitals. Girls were more affected than boys. AIH type 1 exhibited a more active, ongoing immunologic process. Steroid alone can be used successfully in most cases. Children with AIH type 2 had a higher frequency of relapse after corticosteroid withdrawal. Further studies on a larger number of cases and long-term follow-up are recommended

suggested algorithm for using serum biomarkers for the diagnosis of liver fibrosis in chronic hepatitis C infection

Hepatitis C virus infection [HCV] is endemic in Egypt. Liver biopsy is the gold standard for diagnosis and staging of fibrosis in chronic hepatitis C patients. However, it is invasive, associated with sampling error and poses potential complications. A non-invasive alternative is needed. This assessed the accuracy of certain biochemical markers and ultaronography in predicting the stage of fibrosis in chronic hepatitis C patients. Sixty five patients with chronic HCV were enrolled. Ultrasonographic examination, complete blood count and liver function tests were done. Serum levels of hyaluronic acid [HA] and YKL-40 [a 40-kDa glycoprotein produced by stellate cells] were determined. Liver biopsy was done. Fibrosis was correlated with biochemical markers and ultrasonographic findings. Histopathological examination showed that 39 patients [60%] had F1, nine [14%] had F2, 17 [26%] had F3 and none had F0 or F4 scores. A value of alanine aminotransferase [ALT] index <0.38, HA <9.7 ng - ml[-1] or portal vein [PV] cross-sectional area <25.8 mm[2] excluded significant fibroses [>/= F2]. A value of aspartate aminotransferase [AST] + ALT<39.5 or ratio of AST index to the platelet count [APRI] <0.235 or HA x 100 per platelet [Plt] < 9.534 excluded the presence of advanced fibrosis with 100% negative predictive value [NPV]. Using these values, advanced fibrosis could be excluded in 72% of our patients. An APRI value of >/= 1.1 can diagnose advanced fibrosis with 100% positive predictive value [PPV] in 10%of our patients. Hence, only 18% of our patients in whom liver biopsy was recommended were not classified by these parameters. YKL-40 did not help in the diagnosis of advanced fibrosis. Applying a simple algorithm based on ALT, AST, platelet count, PV cross-sectional area, in addition to HA level may eliminate the need for liver biopsies in more than 80% of chronic HCV patients

Adult community acquired pneumonia in Assiut University Hospital

Community-acquired pneumonia [CAP] is a common infectious disease that is associated with significant morbidity and mortality in both developing and developed countries. Due to the delayed results of many diagnostic tests, the antibiotic treatment for CAP empirically relies on epidemiologic data regarding the causative pathogens in a particular geographic area. Most studies showed that Streptococcus pneumonia remains the primary cause of CAP. The incidence of other microbial pathogens varies both seasonally and geographically. The present study was designed to evaluate the bacteriological profile of CAP in Assiut, Egypt. One hundred and one adult patients; with community acquired pneumonia were admitted to Assiut University Hospital from March 2002 to October 2003 were enrolled in this study. In all the patients sputum culture, Bronchoalveolar Lavage [BAL] and Protective Specimen Brush [PSB] cultures as well as serological studies for the detection of specific 1gM antibodies for Legionella, Mycoplasma pneumoniae, Chiamydia pneumoniae, coxiella, influenza A virus, influenza B virus, Para influenza virus and Respiratory syncytial virus by indirect immunofluorescence technique were done. Causative organisms were identified in 95 patients [94%], in 6 patients we could not detect organisms by different techniques. The most frequent identified organisms in Sputum were S. pneumoniae [45%], Coagulase Negative Staphylococcus [CoN staph] [30.9%] and Staph. aureus [16.9%]. In BAL S. pneumoniae [23.7%], Staph aureus [18.6%] and CoN staph [16.9%] and in PSB S. pneumoniae [36.8%], Staph aureus [14.4%]and Klebsiella pneumoniae [9.2%]. For atypical microrganism and viral infection the most common pathogen were Legionella Spp. [35.7%], Mycoplasma pneumoniae [21.4%], Chlamydia Pneumoniae in [14.2%] and Influenza A [14.3%]. PSB and BAL cultures are more specific and useful for detection of the underlying pathogen than sputum examination. Strept. pneumonia is the most common implicated pathogen in CAP, followed by atypical pathogens. Serological examination must be done for detection of atypical pathogens as they represent about 25% of CAP cases. There is significant impact of age, smoking and co-morbidity on the severity of CAP. Malnutrition is considered an important risk factor for the development of CAP