The etiology of acute hepatitis in adults in Egypt.

The causes of acute hepatitis were prospectively studied in 141 patients admitted to Embaba Fever Hospital, Cairo, Egypt in 1983. Serologic diagnosis showed: hepatitis A (0.7%), hepatitis B (46.8%), dual infections with A and B (1.4%), acute hepatitis in HBsAg carriers (14.2%), drug induced hepatitis (5.7%), and hepatitis non-A non-B (NANB) (31.2%). Among hepatitis B patients tested for the following seromarkers, 40% had HBeAg, 8% anti-delta antibody, and 6 simultaneous presence of HBsAg and anti-HBs; in convalescence, a 9% HBsAg carrier rate was found. Clinical, epidemiological, and biochemical findings did not distinguish one cause of hepatitis from another. For 32% of NANB patients parenteral injection was a likely source of infection.

The etiology of acute hepatitis in hospitalized children in Cairo Egypt.

Seromarkers for hepatitis A, B and D were used to determine the cause of acute hepatitis in 94 children (age 2 to 14 years) prospectively studied when they were admitted to Embaba Fever Hospital in Cairo, Egypt, between January and April 1983. The diagnoses were: hepatitis A (4%), hepatitis B (33%), acute hepatitis in HBsAg carriers (10%), dual infections with A and B (2%), and hepatitis non-A, non-B (NANB) (50%). Past hepatitis A was diagnosed in 96%. Among acute hepatitis B infections, 17% (5 of 29 tested) had anti-delta antibody; of HBsAg positive persons, 15% (6 of 40) were HBeAg positive. Two patients had simultaneous presence of HBsAg and antiHBs. For differential diagnosis, clinical, epidemiological, and biochemical findings were evaluated but did not distinguish hepatitis B from NANB hepatitis. Males predominated for HBV infections. No risk factors were found for 58% of HBV and 70% of NANB infections; of the remaining patients, 42% percent of HBV and 30% of NANB infections were associated with injections or surgery but none with transfusion or known contact with hepatitis cases.

Effect of praziquantel on certain immune responses of schistosomal Egyptian patients. I. Changes of specific immunoglobulins.

Specific antischistosomal IgG, IgM, and IgE were estimated by ELISA in 117 rural school students before specific treatment with praziquantel monthly for 3-4 months thereafter. IgG and IgM were estimated as percentage of bound antibodies. IgE was estimated by avidin-biotin ELISA (AB-ELISA) as IU/ml using a panel of known IgE standards. Soluble surface Schistosoma mansoni adult worm antigen was used for all estimates. Total IgE was estimated in a smaller group by an ELISA kit. The percentage of specific IgE was calculated. A group of endemic controls (22 students) and non-endemic controls (17 cases) were included. Statistical analysis of results showed the specific immunoglobulins to be significantly reduced 2 months after treatment of the schistosomal cases. These reduced levels, however, were still significantly higher than those of controls. The presence of early hepatosplenomegaly and the co-existence of other parasites had no significant influence on the results. No correlation could be established between the levels of specific antischistosomal IgG, M and E and the intensity of infection. The significance of these results is discussed.

Effect of praziquantel on certain immune responses of schistosomal Egyptian patients. II. Cell-mediated lymphoproliferative response.

The lymphoproliferative blastogenic responses to mitogens, PHA and Con A, and to schistosome-derived antigens. S. mansoni worm and egg, were tested in 35 schistosomal patients and 10 healthy controls. Of the former group, 18 patients had intestinal mansoniasis and 17 had mansoniasis with hepatosplenomegaly. The test was repeated 2 weeks and 1 and 2 months after treatment with praziquantel. The delayed intradermal test for schistosomiasis was performed on 25 of the schistosomal patients and was repeated 1 month after treatment. Statistical analysis of results of lymphoproliferative blastogenic responses showed no significant differences between the control and the two schistosomal groups in response to mitogens. The group with intestinal mansoniasis responded significantly to both schistosomal antigens, compared to the control and hepatosplenic groups. Their proliferative responses showed a significant rise 2 weeks after treatment, then a gradual drop at 1 and 2 month intervals. The hepatosplenic group responded significantly to worm antigen before treatment; their proliferative responses to both schistosomal antigens showed a significant rise 2 weeks after treatment and remained raised thereafter. No relationship was established between either of the two schistosomal groups for age, intensity of infection or positive delayed intradermal reaction.

Subcutaneous implantation of the spleen as a new technique for experimental induction of hepatic Schistosoma mansoni egg granulomas.

Schistosoma mansoni egg granulomas were induced in the livers of mice by injecting eggs into spleens which had been surgically exposed with their vascular beds intact. Subsequent return of the spleens to a subcutaneous site allows repeated injections of eggs into the liver if necessary.

Prevalence of Entamoeba histolytica in patients with schistosomal colonic polyposis.

Two hundred and fifty-seven Egyptian patients were classified into three groups: patients with schistosomal colonic polyposis, those with simple schistosomiasis without polyposis, and a non-schistosomal group. A diagnosis of schistosomiasis was made by clinical history and examination plus three fresh stool examinations or a rectal biopsy. The presence of schistosomal colonic polyps was established by sigmoidoscopy and biopsy of polyps. Stool examinations were made on all individuals, using the merthiolate-iodine-formaldehyde technique to detect Entamoeba histolytica. We found the prevalence of amebiasis in the group with schistosomal colonic polyposis (37%) to be significantly higher than that in the non-schistosomal group (11%) and in the schistosomal group without polyposis (15%). The difference in prevalence of amebiasis between the simple schistosomal and non-schistosomal groups was not significant.

Prevalence of HBs-Ag in schistosomiasis. (A) general aspects.

Nine hundred and sixteen schistosomal patient together with 97 non-schistosomal controls were examined for the presence of HBs-Ag and anti-HBs in their sera by counter-immunoelectrophoresis (CIEP). The results are reported and statistically analysed. HBs-Ag, anti-HBs and the exposure rate were found significantly higher in schistosomal patients than in controls. The frequency of HBs-Ag was not significantly different in the active and inactive schistosomal groups, while the anti-HBs was significantly higher in the inactive group. S. mansoni-infected cases showed significantly higher frequency of HBs-Ag and anti-HBs than cases with S. haematobium. The prevalence of HBs-Ag was highest between 20-39 years of age in the schistosomal group, while the anti-HBs was maximum at the age of 30-39 years. There were no sex differences in the prevalence of HBs-Ag and anti-HBs in both schistosomal and control groups. However, a significantly higher frequency of anti-HBs was found between male patients and male controls. The same was true for females. Patients with history of parenteral anti-bilharzial treatment and blood transfusions were accompanied with significantly higher percentage of HBs-Ag and anti-HBs. The importance and significance of the results are discussed.

Prevalence of HBs-Ag in schistosomiasis: B-frequency in various stages of schistosomiasis.

The study included 916 schistosomal patients and 97 controls. The prevalence of HBs-Ag and anti-HBs was significantly higher in the bilharzial patients compared to controls. Their frequency was higher in the ascitic than the hepatosplenic group, and the difference between each and the simple group was highly significant. Cases with current jaundice showed highly significant frequency of both HBs-Ag and anti-HBs compared to those with no history or manifest jaundice at the time of study. In addition, cases with raised bilirubin, SGPT and SGOT showed significantly higher frequency of HBs-Ag and anti-HBs compared to cases having normal levels. On the other hand, the frequency was not affected by the level of serum alkaline phosphatases. As regards liver pathology, cases with mixed pathologic picture showed significantly higher frequency of both HBs-Ag an anti-HBs compared with those having pure schistosomal lesions.

Delayed hypersensitivity to specific antigen and hetrologous PPD antigen in patients infected with Schistosoma mansoni and/or Schistosoma haematobium.

181 cases with schistosomiasis were skin tested with S. mansoni antigen and tuberculin (PPD) after complete clinical and parasitological examination. Their results were compared to a control group of 89 non bilharzial cases. The positivity of tuberculin reaction was found to be less frequent in schistosomiasis (37.5%) when compared to non schisto. controls (55.0%). This low reactivity was more manifest in the advanced stages of the disease. The delayed skin reaction with S. mansoni antigen was seen in 52.4% of schisto. cases while non of the control showed any positivity. There are more delayed skin test positives with the advance of the disease.

Preliminary investigation of bilharzial patients for the presence of Australia antigen using latex agglutination test.

THE AUSTRALIA antigen was studied by the use of a reversed passive latex agglutination test in the sera of 250 cases, mostly bilharzial. The results were analysed in relation to age, clinical presentation, bilharzial infestation, antibilharzial treatment, jaundice and serum bilirubin. It was found that, the test was significantly more positive in hepatosplenic cases, in those with past history of bilharziasis, in those with jaundice and in those with higher serum bilirubin level. While no significant difference was found in relation to age, and to history of antibilharzial treatment.

Preliminary studies on the anti-schistosomal effect of Ammi majus L.

AMMI MAJUS L., a plant belonging to the family Umbellifereae was found to possess a certain antischistosomal effect in mice infected with S. mansoni. This was proved by applying two techniques, the worm burden and the Oogram change. Bergapten, a pure furocoumarin naturally present in Ammi majus was found to have certain schistosomicidal effect.

A preliminary report on the materno-foetal immunological changes in schistosomiasis. I. Immunoglobulin changes.

Twenty five simple bilharzial pregnant females together with eight control non-bilharzial gravid women were included in this study. Quantitation of immunoglobulins G and M was performed on both maternal and cord blood sera. The transmission of IgG through the placenta was suggested by the trend for positive correlation between foetal and maternal IgG levels. Maternal IgG was significantly higher in the active bilharzial group compared with the non-active group. Foetal IgM was significantly higher in the active bilharzial group compared with the control non-bilharzial cases.

A preliminary report on materno-foetal immunological changes in schistosomiasis. II. Circulating antigens and antibodies.

Twenty five pregnant simple bilharzial patients together with 8 non-bilharzial pregnant women and 14 bilharzial non-pregnant females were included in this study. Circulating bilharzial antigens were tested in all groups by the IHA technique. Both IHA and COP were used for detection of bilharzial antibodies in the same groups. Bilharzial antigenaemia was higher in pregnant bilharzial women than in non-pregnant ones. The bilharzial antibodies were detectable in a smaller percentage of bilharzial pregnant women than in non-pregnant ones. Also, the IHA antibody titers and COP grades were lower in the former than in the latter; a total picture suggestive of depressed humoral immune response in pregnant bilharzial women. The passage of circulating bilharzial antigens and antibodies through the placenta to the foetus is demonstrated.

Serological diagnosis of schistosomiasis. 1 Demonstration and significance of bilharzial antigenaemia.

Circulating bilharzial antigens were demonstrated in 39% out of 87 bilharzial patients via the IHA and CF techniques using hyperimmune rabbit anti - S.mansoni worm serum. Correlation between the percentage of positive cases and the age, duration of infection, clinical presentation, type of bilharzial infection, chemotherapeutic effect and the intradermal test (I.D.T.) were made. The percentage of positive cases was found to increase with age and with the duration of infection. More positivity was encountered in hepatosplenomegalic and in S.mansoni-infected cases. Most of the I.D positive cases were also IHA positive, but still some I.D. negative cases were IHA positive. Specific chemotherapy resulted in rise in the number of IHA positive cases which was followed by gradual fall in teh next six months until they became negative. On the other hand, using the CF technique, all cases turned negative after treatment with no phase of augmentation. However, antigenaemia reappeared in few cases. These cases relapsed later. Comparing the results of IHA and CF indicates that each test may be detecting a different group of antigens.

The effect of the antibilharzial compound (Bilharcid) on Schistosoma mansoni in vitro and in vivo.

The effect of Piperazine diantimonyl tartrate (Bilharcid) as compared with that of tartar emetic on Schistosoma mansoni has been studied. In vitro experiments on living worms in tyrode/serum cultures have proved that Bilharcid 5-10 gamma/ml has the same antibilharzial activity as tartar emetic in 5-10 gamma/ml. In vivo experiments on Schistosoma mansoni infected mice have proved also that Bilharcid has more or less the same effect as that of tartar emetic. In this study, the worm burden load and the oogram techniques were used as the criteria for antibilharzial assessment.

Preliminary report on some clinical and biochemical observations in patients treated with Bilharcid.

Tartar emetic (potassium antimony tartrate) has been used since a long time as the drug of choice for the treatment of Bilharziasis in Egypt. This drug, though effective, has severe side effects. A newly synthesized trivalent antimony preparation (piperazine di-antimonyl tratrate) Bilharcid, has proved in animal experiments to be less toxic, more effective, and having little side effects. The drug was tried in various schemes on various age groups of patients infected with S. haematobium. Control cases were treated with tartar emetic. Urine analysis was done for the detection of living or dead ova before and after treatment. E.C.G., alkaline phosphatase, serum transaminase, lactic dehydrogenase, and urea tests were done before and after treatment. Follow up studies were recorded for three months after treatment. Results are presented in the full text.