Hepatitis c virus among different social classes at El-Minia governorate; intra familial spread and psychosocial effects

The aim of the study was to evaluate the intra- familial spread of hepatitis C virus among different social classes and the psychosocial effects in patients with hepatitis C. Fifty patients with chronic hepatitis C were studied. They were classified into A, B and C classes according to their social levels based on the educational degrees, the jobs and the monthly income. All patients answered a questionnaire, which was specifically designed to evaluate the psychosocial effects of HCV infection. This questionnaire included the post infection mode of dealing with the family contacts, friends and colleagues, feelings, behavioral changes, personality changes, and psychosomatic disorders. On the other hand, the family contacts of the patients were subjected to anti HCV antibodies to evaluate the intra-familial spread and positive cases were subjected to HCV RNA [PCR] to reflect the existing viremia. The results showed that there was a significant increased incidence of HCV among the lower social classes. The intra-familial spread of HCV was evaluated among the family members of the 50 patients of the study. The overall positive anti HCV ratio was 8.42 [16/190] and all such positive familial contacts were tested for PCR to reflect the existing viremia. The total number of the positive spouses was 12 cases [24.5%] [five husbands and seven wives] of the total cases. The incidence of the positivity of spouses was significantly increased with the duration of marriage. The total number of sons was 75 of whom three were positive for HCV antibodies by ELISA, one of them showed a negative PCR. On the other hand, the total number of daughters was 66 of whom only one was infected with no significant difference between sons and daughters. Also, there were negative psychosocial effects on the patients reflected by the prevalent psychosomatic disorders

Correlation between intensity of infection and hepatic histopathological lesions in bilharzial patients

Liver biopsy examination of 106 patients showed 47 with pure bilharzial liver, 16 with chronic persistent hepatitis, 19 with chronic persistent hepatitis associated with bilharzial liver, 14 with chronic active hepatitis and 10 with chronic active bilharzial liver. There was significant correlation between intensity of infection and bilharzial affection of the liver

Combined effect of hepatic schistosomiasis and chronic hepatitis on the liver of bilharzial patients

Among 127 bilharzial patients [52 with bilharzial liver, 22 with chronic persistent hepatitis, 20 with chronic persistent hepatitis and bilharzial liver, 23 with chronic active hepatitis and 10 with chronic active and bilharzial liver] were studied. The combined effect of bilharziasis and chronic hepatitis participates in the derangement of liver histology in bilharzial patients

Immunoglobulins in bilharzial patients with and without chronic hepatitis

The mean values of IgG and IgA were significantly higher in bilharzial patients than in the non-bilharzial ones. The mean IgG level in patients with S. mansoni was significantly higher than that in patients with negative stool, while the reverse was true as regards IgA. Among the bilharzial patients the mean values of IgG, IgM and IgA were significantly higher in CAH and CAH. bilharziasis than in patients with pure bilharziasis, CPH and CPH with bilharziasis. It might be concluded that the altered immune response produced by schistosomiasis, the frequent exposure to the hepatitis B virus and the bilharzial hepatitis lesions, all may pave the way for development of severe diseases, e.g. chronic active hepatitis and liver cirrhosis

Hepatic schistosomiasis and chronic active hepatitis

As part of an investigation of the possible role of autoimmune mechanisms in the development of chronic active hepatitis [CAH] in schistosomiasis, sera from 25 patients [group I] with hepatic schistosomiasis without histological features of CAH and 5 patients [group II] with CAH and intestinal mansoniasis, but without discernible hepatic infection, were examined for the presence of the liver membrane antibody [LMA] that is reportedly associated with the autoimmune variant of CAH. All patients were HBsAg-negative. Circulating LMA was found in 17 [68%] [group I] and 3 [60%] [group II] patients. Low titer of various organ-non-specific autoantibodies were found in about a third of all patients, but these did not correlate with the presence of LMA. There was also no correlation between LMA and antibodies to the hepatitis B core antigen [anti-HBc], found in the sera of 67% of the patients, indicating that occult or recent past hepatitis B virus infection was not a factor in LMA production. Long-term follow-up of the group I patients should reveal whether current LMA-positivity is related to eventual development of CAH in hepatic schistosomiasis

Dot-Elisa in diagnosis of schistosomiasis

1 ul of S. mansoni egg antigen was dotted directly on the nitrocellulose paper sheet acting as the adsorbent surface [9 dots/paper]. The sera of 25 Egyptian patients and 15 healthy persons [2 ul of each] were dotted over the antigen dots, then 2 ml of each of the blocking, washing, HRP-conjugated IgG and DAB adding procedures were added over the nitrocellulose paper in the Petri dish at room temperature. An intact brown circle [by naked-eye] indicated a positive in Dot-ELISA. There is an insignificant dot color intensities in different clinical stages of S. mansoni infected Egyptian, whereas a direct relation was obtained between egg count and color intensity of the dots. The test had 100% sensitivity and 86% specificity, thus it appears to be useful for both laboratory and field studies

HBSAg antigenaemia in bilharzial patients

The frequency of HBSAg in bilharzial patients [7%] was significantly higher than that in non-bilharzial ones [2-5%]. The presence of insulted liver by bilharzial, non-bilharzial [CPH and CAH] or both [CPH with bilharzia and CAH with bilharzia] lesions have no role in changing the incidence of HBSAg in sera of bilharzial patients

Immunodiffusion, countercurrent immunoelectrophoresis and elisa for detection of circulating schistosomal antigens and antibodies

Circulating schistosomal antigens and antibodies were determined in 34 patients and 26 control using ouchterlony immunodiffusion [I.D.], double countercurrent immunoelectrophoresis [D.C.I.E.] and ELISA methods. The adult S. mansoni antigen was used for detection of antibodies, and rabbit antischistosomal [S. mansoni] adult antiserum was used for detection of schistosomal antigens. The results showed that ELISA technique was the most sensitive, but no difference in the specificity of the three methods. It was concluded that ELISA technique had the highest diagnostic efficacy for detection of both circulating antibodies and antigens when compared to D.C.I.E. and I.D

Mansoniasis: clinical manifestations versus the intensity of infection

Some workers confirmed the relation between the infection level with mansoniasis and the manifestation of the disease while other investigators disproved this relation. To assess this situation a group of patients suffering from mansoniasis was classified according to egg count into four groups and the clinical manifestations were studied accordingly. It was concluded that there is a significant correlation between the intensity of infection and bleeding per rectum but no correlation between the egg count and haematemesis, abdominal pain and size of liver and spleen

value of skin test for diagnosis of immediate and delayed hypersensitivity in schistosomiasis

In this work the role of immediate and delayed reaction in schistosomiasis using the intradermal test was studied. The patients tested were 78, those who had intestinal bilharziasis were 40 and those with urinary bilharziasis were 38. Skin biopsies were taken from 40 patients showing induration between 3-8 hours, some of these biopsies showed arthus reaction. There was definite relation between the delayed reaction in schistosomiasis and tuberculin test. There was also correlation between the delayed reaction and age of the patient. The immediate reaction is important for confirmation of diagnosis of schistosmiasis while the delayed reaction is of limited value in this respect

Duodenoscopy in the tropics

Fiberoptic endoscopy was carried out in 520 patients with dyspepsia, the duodenum was examined in all these patients. The lesions found were as follows: duodentis in 226 [43.46%], duodenal ulcer in 154 [29.6%], duodenal diverticulum in 3 [0.57%], and duodenal polyp in one case [0.19%]. Aspiration of duodenal content through gastroduodenoscope was carried out in 20 cases of duodenitis; the trophozoite of Giardia lamblia was seen in one case, and the larvae of Strongtyloides stercoralis was seen in another case. The comments site of duodenal ulcer was on the anterior wall 82/154 [53.2%], the least was on the inferior wall 16/154 [10.4%]. The most common site for bleeding duodenal was on the anterior wall 35/53 [66%]

Effect of oxamniquine and praziquantel on cell mediated immunity in intestinal bilharziasis

Fifty-three cases with pure active intestine hepatic S. mansoni infection were studied. Cell mediated immunity was evaluated by intradermal skin test [immediate, Arthus and delayed] using adult schistosomal antigen, PPD and Candida antigen before and 15 days after treatment with either oxaminiquine or praziquantel therapy. The relation between intensity of infection by egg count and schistosomal intradermal tests was also studied. The results were discussed