Kupffer cell count and plasma fibronectin level in hepatic schistosomiasis with and without virus hepatitis

The aim of this work was to study some kupffer cell receptors which influence their immunophagocytic capacity in relation to the levels of circulating immune complexes [CICs] and plasma fibronectin [PFN] in four groups of patients: early or late schistosomiasis and schistosomiasis associated with virus B or C infection as compared to a control group. Patients were diagnosed on clinical basis together with ultrasonography and various laboratory tests. Liver biopsies were obtained to confirm the diagnosis and provide Kupffer cells. After dispersion, total nucleated cells and liver macrophage counts were found to be elevated in early schistosomiasis compared to the other groups. The number and percent of Kupffer cells carrying Fc or complement receptors were significantly higher in early schistosomiasis as compared to all other groups, yet by referring to normal values as reported in the literature the percent carrying, receptors could be considered lower than normal. The CICs were higher in all groups than control. The levels were lower in early Schistosomiasis and highest in patients with mixed infection particularly in those with HBV. There was a negative correlation between CICs levels and the number and proportion of Kupffer cells carrying receptors. Plasma fibronectin [PFN] showed a significant increase in early schistosomiasis patients and a significant decrease in patients with schistosomiasis combined with virus hepatitis particularly HCV; compared to controls. Positive correlation was detected between PFN level and the number and percent of Kupffer cells carrying Fc and complement receptors. No correlation was found between PFN and CICs in all groups. It could be concluded that during early schistosomiasis, there is an increase in the immunophagocytic function of Kupffer cells. In chronic schistosomiasis a decreased activity was noted probably due to immunomodulation and fibrosis. In schistosomiasis associated with HBV or HCV, the function of Kupffer cells was markedly decreased. This is probably due to affection of the hepatocytes leading to lower FN level and increased CICs which may block the receptors. The marked lowering of PFN in schistosomiasis associated with HCV could be explained by the direct cytopathic effect of the virus

Value of certain parameters in differential diagnosis of ascites

Ascitis is not a disease by itself but it is a manifestation of diseases of various organs of the body. It is often a complication of schistosomal hepatic fibrosis, liver cirrhosis, congestive heart failure nephrotic syndrome, tuberculous peritonitis, disseminated carcinomatosis and/or nutritional diseases. In this study, albumin, cholesterol and lactate dehydrogenase [LDH] were estimated in serum and ascitic fluid in different types of ascitis. In tuberculous and malignant ascitis, ascitis albumin was markedly elevated and serum ascitic albumin gradient was less than 1.1 g/dl. On the other hand, serum cholesterol was significantly elevated in renal ascitis, while ascitic fluid cholesterol was significantly elevated in malignant ascitis. Ascitic LDH was significantly elevated in malignant ascitis, compared with other types. These parameters can be used as tools for diagnosis of different types of ascitis when the etiology is obscure