role of typhoid carrier state in the aetiopathology of hepatobiliary carcinoma in Egypt

ABSTRACT

The relationship between typhoid infection, typhoid carrier state and hepatobiliary cancer was pointed out worldwide, in New York, Norway, California and in Egypt. In Egypt, typhoid is an endemic problem. This work included 100 patients with hepatobiliary carcinoma [60 with hepatocellular carcinoma, 35 with cholangiocarcinoma, 5 with cancer gall-bladder]. 100 healthy individuals were also studied as a control group [selected to match the diseased group]. Screening for typhoid carrier state was done by bacteriological stool cultures for patients with hepatocellular carcinoma and bile cultures for patients with cholangiocarcinoma and gallbladder cancer. Serological Vi [Virulence] antibodies detection was done for all cases including the healthy matched control group [which was the only method of detection]. The overall percentage of typhoid carrier state among 100 patients with hepatobiliary cancer was 13%. In the first group of patients [60 patients with hepatocellular carcinoma], 5 cases were positive [only 1 of them was +ve for HBsAg] [8.4%], while in the second group [40 patients with cholangiocarcinoma and cancer gall- bladder] there were 8 +ves [20%]. In the control group, there was only one +ve case among 100 healthy individuals, detected by serological examination. The explanation of such association/complication was correlated to obstruction and stasis. It is attributed to prolonged and repeated use of chloramphenicol which got an immunosuppressive action. Eradicating typhoid carriers, probably by using a 3-day course of ceftriaxone [proved superior to a 14-day oral therapy with chloramphenicol] can be considered as a step in omitting a precancerous lesion in the hepatobiliary tree which is on the rise among Egyptians