Serum complement functions and opsonic activity in patients with bacteremia after elective injections sclerotherapy and band ligation for oeshageal varices

ABSTRACT

Acquired deficiencies of certain complement proteins and, or impaired opsonisation activity of serum have been implicated in the pathogenesis of increased susceptibility to infections of patients with cirrhosis. One handred patients with chronic liver disease complicated with oesophageal varices were included in this study. Eighty of them were randomized to receive either endoscopic injection sclerotherapy [EIS] [40 patients] or endoscopic band ligation [EBL] [40 patients] as elective therapy for their varices. The rest of the patienit 20 were endoscoped but their varices not injected nor ligated. The there groups were well matched as regards clinical, laboratory, ultrasonograhic data, endoscopic findings and Child-Puch classification. Twenty healthy patients- apart from dyspepsia, were exposed to upper GII endoscopy and used as control group. Aerobic and anaerobic blood cutluresd were done for all members before, 30 minutes, 4 hours and 24 hours after the procedures. Throat cultures and cultures of the bands, ethanolamine, injector needle, tip of the endoscope and waer supply were cultural immediately before the procedures, Serum concentration of C3 and C4 and haemolytic complement activity [classic and alternative pathways] of serum and serum opsonic activity were determined in all patients and control group. Aerobic blood cultures were positive in 8 [20%] patients of EIS group and 7 [17.5%] patients of EBL group with a no significant difference between them. Organisms isolated were streptococcus pneumonia and coagulase negative Stahyylococci. 30 minutes positive blood cultures turned negative at 4 hours cultures. Causative organisms were also isolated from the patients throat. All anaerobic cultures were negative. Throat swab, injector needle swab and endoscopic washing swab showed positive culture in 65%, 59.5%, 20%, 28.5% and 22.8% respectively, Other swab cultures from water supply, Scelerosant agent, and bands showed no bacterial growth. Serum C3 and C4 concentration and haemolytic complement activity were significantly reduced [P <0.05 and P0.01 respectively] in patients with bacteremia compared to non bacteremic patients serum opsonic activity showed insignificant difference between bacteremic and non baceremic patients. In conclusion, low serum C3 and C4 concentaration and decreased hemolytic complement functions are major risk factors for bacteremia after both procedures