Clinical and therapeutic aspects of typhoid fever in Upper Egypt

This study included 160 patients [97 males and 63 females, their ages ranged from 3 to 45 years with a mean of 14.66 +/- 7.62 SD] suspected clinically to be typhoid or paratyphoid fevers. They were classified into two groups: Group I, included 93 patients who were blood culture-positive for salmonella and group II, included 67 patients who were culture-negative for salmonella. The criteria of inclusion included patients presenting with fever five days or more with apparent toxemia, headache, coated tongue and with or without splenomegaly. The patients were subjected to full clinical history, general examination, abdominal examination, routine investigations [abdominal ultrasonography, chest X-ray, ECG, urinalysis and stool analysis, complete blood picture, liver function tests and kidney function tests] as well as investigations for the diagnosis of enteric fever, Widal and modified Widal tests to all patients. Serum chloramphenicol level was estimated in 43 patients in group I and in 29 patients in group II and no statistical significant difference was found in the mean level between the two groups. Concerning therapy in the two groups, the response to chloramphenicol was significantly higher in group II in comparison with group I. On the other hand, the resistance to chloramphenicol was significantly higher in group I compared with group II. The responses to antibiotics other than chloramphenicol were similar in the two groups

Evaluation of the levels of circulating carbohydrate antigen and anti-SWAP antibodies in patients with active Schistosoma haematobium infection and its relation to morbidity changes

The immune responses of schistosomiasis and its relation to morbidity changes is important to understand the pathogenesis of this disease. The aim of this study is to evaluate the levels of circulating antigen and anti-SWAP antibodies and its relation to morbidity changes in patients with active Schistosoma haemtobium infection. An antigen enzyme-linked immunosorbent assay [ELISA] employing monoclonal [mAb] 128C3/ 3/21 was used to detect circulating parasite-derived antigen in the sera of 35 of actively infected schistosoma haematobium patients [31 males and 4 females, 5 to 25 years of age] seen in the out patient clinic of Assiut University Hospital. AntiSWAP [soluble adultworm antigen preparation] immunoglobulins IgG1. IgG4 and IgE were performed for 25 of them. Patients were treated with praziquantel [PZQ] and re-evaluated after 1, 3, and 6 months. Changes in morbidity were evaluated using ultrasonographic grading of urinary bladder lesions. It was found that all patients had significantly high levels of circulating antigens in their sera i. e. above the cut-off value. The antigen level fell significantly in the follow cup visits [p<0.001]. Although the mean antigen level was still significantly reduced [p<0.001] at 6 months visit, 16 patients had high mean antigen level and 9 had rising levels of antigenaemia, reflecting reinfection in 6 patients and persistence of infection in the others. On the other hand, all patients had positive ELISA reaction for IgG1 and IgG4, while 5 patients had negative reaction for IgE through the different visits before and after treatment. The decrease in the mean levels of IgG1 and IgG4 were statistically significant only after 6 months of treatment, but the mean levels of IgE showed significant drop at 3 and 6 months of treatment. A significant correlation was found between the circulating antigen and the anti SWAP IgE during the active infection, but no significant correlation was found between the antigen level and IgG1 and IgG4. There was a significant correlation between the level of circulating carbohydrate antigens and morbidity changes of the urinary bladder. On the other hand there was no significant correlation between the anti-SWAP antibodies and morbidity changes. We conclude that ELISA assay for detection of circulating carbohydrate antigen of S.haematobium is valuable and sensitive in diagnosis of active infection, measurement of intensity of infection and detection of reinfection as well as evaluation of the efficacy of treatment. Its level correlates with anti-SWAP IgE during active infection. In addition it correlates significantly with

frequency of gallbladder stones in patients with liver cirrhosis and schistosomal hepatic fibrosis in upper Egypt

This work was designed in order to study the frequency of gallbladder stones in patients with liver cirrhosis and schistosomal hepatic fibrosis using ultrasonographic examination. The relative frequency of gallbladder stones was significantly higher in patients [12.8%] than controls [6.8%] [P < 0.01]. The frequency was significantly higher in females than in males in both groups [P < 0.01]. Eight [10%] out of 80 patients with schistosomal hepatic fibrosis and 33 [7.3%] out of 240 patients with post hepatitic cirrhosis had gallbladder stones, however, the difference was not significant. The frequency of gallbladder stones increased with the advancement of the disease, as it was significantly higher in patients with Child's C liver cirrhosis than in patients with either Child's A or B. Out of the 41 cases who had gallbladder stones 33 [80.5%] were discovered accidently and they had no history that can suggest gallbladder stone; one patient [2.4%] had history of right hypochondrial pain, 4 [9.8%] had acute calcular cholecystitis and 3 patients [7.3%] were diagnosed to have calcular obstructive jaundice. It was concluded that the pathology itself rather than it's etiology that lies behind the increased frequency of gallbladder stones in chronic liver diseases