Recurrent abdominal pain in children does toxocariasis play a role?

Recurrent abdominal pain [RAP] of unexplained etiology is a relatively common pediatric problem. It is often referred to as functional abdominal pain with only 5-10% of the affected children have organic causes for their pains. Toxocariasis, a helminthic zoonosis, causes a spectrum of diseases in man: two major syndromes; visceral larva migrans [VLM], Ocular larva migrans [OLM] and a third more common condition, covert toxocariasis in which positive toxocara serology [both anti-toxocara excretory-secretory IgG and IgE] are associated with a number of systemic and localized symptoms and signs; notably recurrent abdominal pain. It has been implicated as a cause of RAP which might be otherwise interpreted as an idiopathic. Aim of this study is to assess the role of toxocariasis as a causative agent of unexplained recurrent abdominal pain in our children based on clinical, serological and therapeutic criteria. One hundred fifty children suffering from RAP were included in our prospective study. After detailed history, thorough clinical examination and relevant investigations, patients were divided into two groups: the first with organic RAP and the second with unexplained RAP. Patients in the second group were subjected to complete blood count, eosinophilic count, urine and stool analysis, ELISA serotesting for anti-Toxocara excretory- secretory [TES] IgG and IgE and were followed-up for three months. Seropositive [IgG] patients were treated with Albendazole and re-tested for specific antibodies at the end of our study. Out of 150 children with RAP, 26.6% [40 patients] showed definite organic causes with intestinal parasites, particularly Giardia lamblia, represented the most common etiology. Among the remaining 73.4% [110 patients] who were addressed as unexplained RAP, 21.8% [24 patients] were anti [TES] IgG positive. Almost half of them [13 patients] were seropositive for anti [TES] IgE also [covert toxocariasis]. Unexplained RAP was the sole presentation in 61% [8/13] of them and high blood esinophils [>5% of TBL] was a common finding 77% [10/13]. Anti [TES] IgE was positive in 92% of chemoresponsive patients and was negative in all non-respenders. Post treatment mean of anti [TES] IgE showed significant decrease [P <0.05] when compared to pre-treatment level [45 +/- 9.8 Vsl90 +/- 13.3] while no difference can be proved regarding anti [TES] IgG [1.22 +/- 0.35 Vs 1.28 +/- 0.32]. Covert Toxocariasis may be a hidden cause of unexplained RAP in children and should be enlisted in its differential diagnosis particularly if associated with eosinophilia. ELISA quantitative assay of anti TES IgE, not only provide a specific diagnostic indicator for covert Toxocariasis but is a useful tool in monitoring drug therapy as well

Antineutrophil cytoplasmic antibodies types and titers inulcerative colitis patients. relationship with disease variables

Ulcerative colitis [UC] is a chronic, relapsing and tissue-destructive idiopathic inflammatory disease. Its etiology has not yet been fully elucidated. Autoimmune processes may play a role in the pathogenesis, since several types of autoantibodies, including antineutrophil cytoplasmic antibodies [ANCA] have been found in this disease. Although numerous studies have dealt with ANCA prevalence, antigenic specificities and clinical significance in UC, the relationship between ANCA types and titers with the disease variables remains controversial. This work aims to distinguish the fluorescence pattern of atypical ANCA [aANCA] from that of perinuclear ANCA [p-ANCA] in patients with UC. In addition, the study aims to elucidate the relation between ANCA type and titer in relation to disease variables [extent, activity, duration of the disease and response to treatment]. The study included 38 patients with UC, diagnosed by clinical, endoscopic and radiological examinations supported by histopathology. The patients were classified into 4 groups by using a clinical activity score during the study period, including group I [[active-quiescent] comprising 6 patients, group II [quiescent-active] including 10 patients, group ifi [active] comprising 4 patients and group IV [quiescent-] including 18 patients. Paired serum samples were collected from each patient for determination of ANCA type and titer by indirect immunofluorescence [HF]. In this work, 25 [65.8%] of 38 patients with UC had at least one sample included that was positive for ANCA by TIE. Twenty two [88%] of 25 positive ANCA samples were aANCA and 3 [12%] were p-ANCA. The presence of ANCA was not related to the clinical characteristics of patients in the four groups. Increasing ANCA titeos were detected in 6 patients. 2 in group I, I in group II and 3 in group IV, while decreasing ANCA titers were found in 10 patients: 2 in group 1, 3 in group 11 and 5 in group IV. No significant correlation was found between serum levels of ANCA or patterns of staining by [IF and different disease variables. In conclusion, a-ANCA were found at high prevalence in patients with UC. The a-ANCA represent a potentially valuable diagnostic seromarker for UC and should be differentiated from p-ANCA that are present primarily in patients with systemic vasculitides. Changes in ANCA titers in paired serum samples from UC patients were not correlated with the changes in disease variables. Further studies with antigen-specific tests are recommended to reveal whether UC activity or disease variablcs correlate with ANCA titers of any defined specificities