Comparative study on different recent diagnostic and therapeutic regimens in acute typhoid fever.

Forty five positive blood culture acute typhoid cases were studied during a 2 years period (1997-1999) in Abbassia Fever hospital, Cairo, Egypt. Their ages ranged between 4-23 (12 +/- 2.5) years. Male: Female ratio was 1:1. Three of the 4 classical signs namely: toxic look (84%), bronchitic chest (47%), tumid tympanitic abdomen (84%) and just palpable receding spleen (69%) were found in almost all cases and offer a good bed side clinical diagnostic test. Blood picture revealed anaemia, within normal white blood count and thrombocytopenia. Liver function tests showed within normal total serum bilirubin, two or more folds increase of ALT and within normal serum alkaline phosphatase. Comparing the 3 tests, namely significant Widal titre (56%), modified Widal test (89%) and bright spleen (78%), it was found that modified Widal test is the most sensitive serological test. Ultrasonographic finding of bright spleen is an easy, safe, noninvasive and sensitive technique which is relatively cheap. Each of the 3 drugs in our study namely chloramphenicol, quinolones and ceftriaxone resulted in improvement of general condition, drop of fever, increase in haemoglobin, white blood count and platelet count. Also, there was a significant improvement of liver function tests by either of the 3 drugs. Ceftriaxone is the best drug from the clinical and laboratory points of view followed by quinolones in multidrug resistant (MDR) acute typhoid cases. Chloramphenicol is still the drug of choice in chloramphenicol sensitive salmonellae.

Evaluation of specific immunoglobulin G avidity enzyme linked immunosorbent assay (IgG avidity ELISA) in diagnosis of early and chronic Schistosomiasis mansoni.

This work was performed to study variations of Schistosoma specific immunoglobulins between early and chronic schistosomiasis mansoni in both children and adults. A modified enzyme linked immunosorbent assay (ELISA), based on dissociation of antigen antibody complexes with 8 mol/L urea (8 M urea) solution, was used to measure levels of low avidity immunoglobulin G antibodies (IgG Abs) against Schistosoma mansoni soluble egg antigen (SEA). The study included eighty (80) patients with active mansonian schistosomiasis. They were classified according to age, history, clinical symptomatology and examination and direct parasitological methods of diagnosis into early and chronically infected children and adults. Sera of all patients were subjected to: ELISA measuring Schistosoma specific IgM and IgG., immunoglobulin G (IgG) avidity ELISA and indirect haemagglutination test (IHA). Schistosoma specific IgG avidity ELISA detected higher levels of both urea IgG inhibition percentage and low avidity IgG Abs in early cases of schistosomiasis than chronic ones in both children and adults. Levels of urea IgG inhibition percentage were higher in children than adults. Schistosoma specific IgM/IgG ratio was more than one (> 1) in early cases in both children and adults and less than one (< 1) in chronic cases in children and 70% of adults. IHA titres were statistically higher in chronic cases than early ones in children only. So, it can be concluded that IgG avidity ELISA is a valuable method that helps to differentiate early from chronic schistosomiasis mansoni infection in both children and adults.

Screening tests for diagnosis of cervical lymphadenopathy presenting as prolonged fever.

During a two years period, 16 cases having cervical lymphadenopathy presenting as prolonged fever were studied in Abbassia fever hospital, Cairo, Egypt. Patients were subjected to careful history, thorough clinical examination, complete blood picture, tuberculin test, chest x-ray, Monospot test, indirect fluorescent antibody test for toxoplasmosis, detection of cytomegalovirus antibodies and lymph node biopsy with histopathological examination. Ten within normal subjects were taken as controls. The patients were grouped on histopathological basis into 5 groups: (1) One (6%) of the cases was non-specific lymphadenitis diagnosed by clinical examination of the scalp and leucocytosis with polymorphonuclear predominance. (2) Reactive lymphadenitis included 6 (38%) of the cases. Infectious mononucleosis cases were diagnosed by clinical triad of fever, pharyngitis and cervical lymphadenopathy, relative lymphocytosis, monocytosis and positive monospot test. Cytomegalovirus case was diagnosed by lymphocytosis, monocytosis and negative monospot test. Toxoplasmosis cases were diagnosed by monocytosis, negative tuberculin test and positive indirect fluorescent antibody test. (3) Granulomatous lymphadenitis comprised 6 (3%) of the cases. Tuberculous cases were diagnosed by high ESR and highly positive tuberculin test. Sarcoidosis cases were diagnosed by negative tuberculin test and presence of hilar lymphadenopathy. (4) Non-Hodgkin lymphoma case (6%) was diagnosed by clinical deterioration and total lymph node biopsy. 15) Systemic infections were diagnosed by clinical examination, blood culture for salmonellae and brucellae, Widal and Brucella agglutination tests. It is concluded from this study that screening tests are important aids in the diagnosis of cases of cervical lymphadenopathy presenting by prolonged fever especially if lymph node biopsy and histopathological examination are not available or contraindicated. Tub

Circulating intercellular adhesion molecule-1 in endemic chronic liver diseases.

Soluble intercellular adhesion molecule-1(ICAM-1) is probably released from a variety of cells, including leukocytes and endothelial cells at sites of inflammation or in the circulation, and serum levels may therefore be used to give an indication of immune activation and inflammatory processes. In the present study, an ELISA was used to measure serum ICAM-1 levels in forty patients with endemic chronic liver diseases and these were correlated with histological changes in the liver and with liver functions. Serum ICAM-1 levels were significantly higher in patients with chronic active liver diseases than in normal subjects and correlated positively with the grade of histological activity. Furthermore, serum levels of ICAM-1 were substantially greater in patients with cirrhosis than in those without cirrhosis. There was also a significant positive correlation between serum levels of ICAM-1 and serum alanine aminotransferase activities. It is concluded that, in chronic liver disease, intercellular adhesion molecule-1 serum concentration seems to represent hepatocellular damage. The authors suggest that serum ICAM-1 may prove worthy in the investigation, diagnosis and therapeutic monitoring of various inflammatory conditions of the liver.

Parasitic infections presenting as prolonged fevers.

Over two successive years, out of 187 cases of fevers of undetermined origin (FUO) admitted to Abbassia and Embaba Fever Hospitals, 30 (16%) cases proved to be of parasitic origin. Ten within normal subjects were taken as controls. Complete blood picture, repeated stool examination, rectal snip by transparency technique, ELISA for specific IgM antibodies for S. mansoni, indirect haemagglutination test for S. mansoni, Fasciola, hydatid, amoebic liver abscess and toxoplasmosis, indirect fluorescent antibody test for toxoplasmosis and abdominal ultrasonography were performed whenever indicated. Cases comprised 8 (26%) acute S. mansoni, 7 (24%) acute fascioliasis, 3 (10%) hydatid cyst, 8 (26%) amoebic liver abscess, 2 (7%) toxoplasmoisis and 2 (7%) malaria cases. The clinical picture of acute S. mansoni and acute fascioliasis were similar in the form of prolonged fever, diarrhea, hepatomegaly and leucocytosis with high eosinophilia. Serology (ELISA and IHAT) was essential in differentiating them. Abdominal ultrasonography is an easy, sensitive, cheap, non-invasive technique aiding in the diagnosis of amoebic liver abscess, liver hydatid cysts and fascioliasis but again serology was essential in differenting them. Toxoplasmic lymphadenitis mimic the clinical picture of infectious mononucleosis. Serology (monospot test, IHAT, IFAT) clinched the diagnosis. Malaria cases presented atypically by gastrointestinal manifestations and hepatic affection. Diagnosis was by positive blood smears.

Histochemical studies on rectal mucosa in active intestinal schistosomiasis.

Thirty patients suffering from active intestinal S. mansoni infection, were classified into 3 groups. The first group: 13 cases with early active intestinal schistosomiasis without hepatosplenomegaly. The second group: 11 cases with hepatosplenomegaly and the third group: 6 cases with splenomegaly and ascites. Also 10 normal individuals were included as a normal control group. Histopathological examination of rectal mucosa showed hyperaemia with extravasation of blood in early cases and granulomatous lesions in the second group with hepatosplenomegaly. The structural changes were severe in the late ascitic group. In this group the rectal mucosal glands showed distorted irregular tubular branching in addition to the granulomatous and the fibrous reactions. Histochemical studies including periodic acid schiff, alkaline phosphatase and acetyl cholinestrase reactions were done. Using the periodic acid shiff stain, the goblet cells showed strong reaction for neutral mucin in cases of group I (early cases) and group II (late hepatosplenomegalic cases). In group III (late ascitic cases) the goblet cells were faintly stained. A notable difference was observed between the lightly and heavily infected patients of this group. No alkaline phosphatase reactivity could be identified in rectal crypts of patients and controls. Alkaline phosphatase reactivity was sharply localised in S. mansoni egg shell. There was obvious decrease in the acetyl cholinesterase stained nerve fibres in the rectal mucosa of all studied patients. The decrease was more in chronic and heavily infected cases rather than in the acute and lightly infected ones.