Diagnosis and genetic susceptibility of pulmonary tuberculosis in children

This study consisted of 3 closely related parts; the first part included 70 children with pulmonary tuberculosis [TB], aged 2 - 10 years and 20 healthy children as controls. All were subjected to thorough history taking, clinical examination, chest x-ray and tuberculin test. Blood samples were taken to perform glutaraldehyde test and for detection of IgG antibodies against mycobacterium TB by ELISA technique using antigen A60. The sensitivity of glutaraldehyde test was 87.1% and its specificity was 90% with high significance, while the sensitivity of ELISA test was 48.6% and its specificity was 90%. In the second part of the study, sputum samples from 57 children recently diagnosed as having pulmonary tuberculosis, were processed for microscopic examination of smears after staining for acid fast bacilli, culture on Lowenstein-Jensen medium and nested polymerase chain reaction [PCR]. Patients included in this part were divided into 3 groups. In a group of 20 children not-receiving antituberculous therapy yet, the results of smear examination and PCR were identical in 75% of cases. In 10% of cases culture was most sensitive, but in 25% of patients nested PCR was positive even when smear and culture were negative. In a group of 20 children receiving antituberculous therapy for less than six months, PCR positive results were obtained even when both smear and culture were negative. In a group of 17 children receiving antituberculous therapy for more than six months, positive PCR results were detected up to the 7[th] month of therapy. The third part of the study included the HLA [A, B, C loci] phenotyping in 25 cases out of 70 studied in the first-part, and 92 controls. The results showed higher frequency of the following HLA antigens among cases of pulmonary TB than the controls: A25[10], A26[10], AW66, B35, BW55, CW3, CW4 and CW5, and associated with increased relative risk [RR] above one and the etiologic factor for CW4 antigen was 0.408. On the other hand HLA- B5+ B18+ B35, B12, B27 were significantly higher among the controls than the cases. We concluded that glutaraldehyde test can be used as simple, rapid, inexpensive, not tedious test and was positive in cases of TB with malnutrition. Concerning ELISA test, it can be used as rapid serodiagnostic test which is reliable and relatively inexpensive technique for diagnosis of active pulmonary TB in children. Application of nested PCR assay could be used as a follow-up tool in monitoring of pulmonary tuberculosis in children. Regarding HLA antigens the results showed high frequency of the previously mentioned HLA antigens with pulmonary TB, which may indicate, increased susceptibility to pulmonary TB infection. On the other hand, high frequency of other mentioned HLA antigens among controls may indicate a protective effect of these antigens. Anyhow further studies are still needed to be done and on a wide scale to prove the association of HLA antigens and tuberculosis

Cytokines and zinc levels in serum and cerebrospinal fluid of children with febrile seizures and encephalitis

The present study was proposed in an attempt to understand the role of serum and cerebrospinal fluid [CSF] levels of proinflammatory cytokines [TNF-alpha, IL-1beta and IL-6] and zinc in children with febrile convulsions and cases with encephalitis in comparison with normal ranges. Fifty patients were enrolled in the study, 15 with febrile convulsions, 15 patients with acute encephalitis and a control group of 20 patients with febrile illness but no convulsions. Serum and CSF levels of TNF-alpha, IL1-Beta and IL-6 were significantly higher in cases with encephalitis than in cases with febrile convulsions and control. There were no significant differences between cases with febrile convulsions and controls. On comparing cases with febrile convulsions and cases with encephalitis, serum and CSF levels of pro-inflammatory cytokines were significantly higher in cases with encephalitis. It was also found that children with febrile convulsions had decreased serum and CSF levels of zinc much less than in both cases with encephalitis and control groups. The correlation between serum and CSF levels of pro-inflammatory cytokines was significantly positive for cases with febrile convulsions and encephalitis, while there was no correlation between serum and CSF zinc levels in both groups

Plasma glutathione reductase, total antioxidants and neuropeptide Y among children with bronchial asthma

Though bronchial asthma is a common chronic disorder in children, its pathogenesis is far from being simple. The diagnosis of bronchial asthma is mainly based on clinical picture and laboratory diagnosis. Measurement of plasma concentration of antioxidants like glutathione [GSH] reductase is considered a new diagnostic procedure for bronchial asthma and may play a role in preventing bronchial asthma. Neuropeptide Y [NP-Y], a pro-inflammatory mediator, has a wide distribution and physiological effects on the lung and small bronchioles suggest that it may be involved in the exacerbation of asthma. The aim of the study was to evaluate the role of GSH reductase, total antioxidants and NP-Y in the diagnosis of bronchial asthma in children. This study consisted of two closely related parts. The first part included 30 patients with asthma and 20 healthy children as controls. The plasma samples were assayed for GSH reductase activity and total antioxidants concentrations. GSH reductase activity was significantly lower in patients than in control group [P <0.001], however, total antioxidants showed no significant difference between both groups [P >0.05]. There were no significant differences in GSH reductase or total antioxidants concentrations between patients with respiratory infections and those without. Patients treated with bronchodilators and steroids had a significant lower level of GSH reductase concentration as compared with those treated with bronchodilators only, however, the difference in total antioxidants concentration between both groups was statistically insignificant. In the second part of the study, plasma samples were obtained from 30 patients attending the emergency ward with exacerbations of asthma and from 20 healthy controls. All samples were assessed for NP-Y before and after treatment. The mean plasma level of NP-Y was higher in patients [10.02 +/- 4.6 ng/ml] than in controls [0.13 +/- 0.05 ng/ml], p <0.001. There was no significant difference between the level of NP-Y before and after treatment. No relation was observed between the severity of asthma and plasma level of NP-Y since hospitalized patients had almost the same results of NP-Y as other patients with mild or moderate asthma and left the hospital within the same day. In conclusion, GSH reductase could help as a laboratory marker in the diagnosis and prognosis of bronchial asthma in children On the other hand, plasma NP-Y could be a useful diagnostic tool but can not be employed as a predictor of responsiveness to therapy