Relationship Between Schistosomiasis and Hepatitis C

Relationship Between Schistosomiasis and Hepatitis CSchistosomiasis is a inveterate parasitic disease in tropical and is associated with a variety of clinical syndromes that may lead to severe morbidity (Bahgat et al., 2010). Due to control program everywhere the last decade, a decline in the prevalence of human schistosomiasis in Egypt has been report (Barakat et al., 1998 Bahgat et al., 2010) however, the disease is still endemic in many foci (El-Sahn et al., 2002 Bahgat et al., 2010). The car park used method in the diagnostic of schistosomiasis is stool examination, using the Kato-Katz method (Carvalho et al., 2011) However, this method presents limitation for the catching of positive individuals, when the intensity of transmittal is hapless it is less effective in determining the prevalence in low endemic areas (Feldmeier and Poggensee 1993 Kongs et al., 2001 Carvalho et al., 2011). And a relatively time consuming nature of this method in application for epidemiological a ssess custodyt and clinical use (Van Etten et al., 1994 Hamilton et al., 1998 Corachan , 2002 Van Dam et al., 2004). And it is difficult to detect ova in rectal biopsy specimens in chronic infections collect to the earnest fibrosis present around the pelt (Attallah et al., 1999).Several schistosome serodiagnostic assays designed for the detection of specific anti-schistosome (antibodies) (Doenhoff et al., 1989 Maddison, 1987 Attallah et al., 1999). Prepatent and early infections may not ease up stimulated a detectable antibody response and Positive tests do not necessarily denote an restless (living) infection. Antibody tests are also prone to cross reactions with former(a) infections (Strrouk, 2001).HCV is a serious humans health problem affecting 170 million carriers worldwide. It is a leading cause of chronic hepatitis (Thong et al., 2014). In Egypt, the older generations have a higher HCV prevalence than younger ones. Geographically, areas near the Nile River continue to exhibit very high rates of infection (Sievert et al., 2011). Chronic HCV infection may cause liver cirrhosis and (HCC) all over the course of two or more decades (lee et al., 2008), and is the primary cause for liver transplantation worldwide (Thong et al., 2014), There is no vaccine available for prevention of HCV infection collectible to high degree of strain variation (Ashfaq et al., 2011). A previous adopt by Albeldawi et al (2010) report that the patients with risk factors for HCV infection and abnormal liver enzyme trains, HCV infection is probable but not certain.In the present study 275 blood serum samples were tested for anti-HCV antibodies and 205/275 only contain anti-HCV antibodies with percent (74.5%) and the remaining 70 samples (25.5 %) were negative for anti-HCV antibodies. Anti-HCV antibodies alone(predicate) cannot discriminate patients who are infectious from those who have resolved the infection. The active infection confirmed by observe HCV-NS4 antigen i n serum samples using ELISA match to Attallah et al., (2012) in which sensitivity and specificity of this method to detect HCV-NS4 antigen were high (90 and 96%, respectively), HCV-NS4 antigen was detected in 205( positive for anti-HCV antibodies) against 32 healthy (negative control) by using ELISA with detection rate 85.0% for CHC patient positive for anti-HCV antibodies, and 0.0% detection rate for healthy control, this mean that 174/205 only has Anti-HCV and HCV-NS4 (HCV patient) , on that point was extremely statistically world-shattering mingled with (pGhany et al (2009) reported that aggrandizement value differs by age, race, and gender, and by body mass index, it has been suggested that the upper limit of normal (ULN) for natural elevation should, in fact, be 30 IU/L for men and 19 IU/L for women, but many laboratories continue to set the ULN of ALT at about 40 IU/L. In the present study, 174 HCV have high increase in transaminase enzyme as ALT, AST, and at that place was extremely statistically crucial amid (pAs is customary the transaminase enzymes are biomarker of liver health. Elevated serum levels of ALT during chronic hepatitis C are associated with an increased risk of liver fibrosis progression (Hui et al., 2003 Maasoumy and Wedemeyer, 2012) lower progression rates of fibrosis were reported in patients with normal ALT levels (Mathurin et al., 1998 Maasoumy and Wedemeyer, 2012) However, there are reports of marked fibrosis (5%-30%) and even cirrhosis (1.3%) in persons with normal ALT values (Ghany et al., 2009).Normal ranges of ALP were 40-129 U/L for males and 35-104 U/L for females, ALP is expansive in a variety of diseases as bone disease, bile duct obstructed and liver disease (Bodlaj et al., 2010), and in current study ALP was elevated in CHC patient and there was statistically significant between (p0.05) platelets in CHC patients and negative control, Furthermore, T. Bilirubin was elevated in CHC patient and there was statistical ly significant between (p0.05) between INR-prothrombin time in CHC patient and control.A Previous study by Attallah et al (1999) reported that genus Schistosoma circulating antigens were used for the detection of active infection. And the detection of Schistosoma antigens was initially based on the use crude soluble egg antigens (SEA) and soluble adult worms protein (SWAP) (Dunne et al., 1984). And another study reported that the circulating antigens could be released from the schistosome surface or gut to the blood circulation of infected host and consequently excreted in urine (Deelder et al., 1994 Attallah et al., 1998). Several investigators have isolated and characterized many of the schistosomiasis antigens in different developmental stages of the parasite that have a potential application in immuno diagnosis (Attallah et al., 1999). And more than coke schistosome antigens have been identified (Siddiqui et al., 2011).In The present study we aimed to detect the 63-KDa circula ting antigen of Schistosoma parasites in serum samples by SDS-PAGE, immunoblotting, and ELISA technique, The antigenic stub was identified by western blotting technique by using specific Mab an intense sharp band was appeared in serum samples of infected patients with S. mansoni at 63-kDa, and no reaction with healthy sample. Consistent with these findings previously study by Attallah et al (1999) also identified a 63-kDa antigen in different extracts of Schistosoma mansoni cercariae, adult worms, and eggs and in the urine of S.mansoni-infected individuals by specific monoclonal antibody in urine patient sample.ELISA is a serological test useful for epidemiological studies, due to its high sensitivity for the diagnosis, depending on the S.mansoni antigen used in the test (Sorgho et al., 2002 Ishida et al., 2003 Alarcn de Noya et al., 2007Luo et al., 2009 Carvalho et al.,2011), and the possibility for automating the process (Carvalho et al.,2011), previous study Attallah et al (1999 )used the Fast Dot-ELISA as a diagnostic tool for the detection of 63-kD circulating antigen and sensitivity of this assay was 92% among proven S. mansoni-infected individual, the specificity was 84%, PPV = 94%, and NPV = 81%.In the current study, the cutoff of 63-KDa of Schistosoma antigen was calculated, and the cutoff level = 0.33, mouse monoclonal antibody specific to S. mansoni was used as a probe in ELISA to detect 63-kDa S. mansoni antigen in serum samples from CHC patients, the 63-kDa S. mansoni antigen was detected in 118 out of total 174 chronic hepatitis C patients with detection rate (67.8%) All of the 32 controls were negative for 63-kDa S. mansoni antigen with detection rate (0.0 %) and there was extremely statistically significant between (PS.mansoni antigen in CHC patient and control.In the present study we determined the relation between 63-KDa S. mansoni antigen and laboratory parameters in the 118 serum samples from CHC patients determined, and serum ALT levels te nded to increase as the level of 63-KDa antigen increased and there was extremely statistically significant between 63-KDa and ALT, serum AST levels tended to increase as the level of 63-KDa antigen increased and there was extremely statistically significant between 63- KDa and AST.Furthermore, there was negative correlativity between serum albumin and 63-KDa antigen, but there was extremely statistically significant between 63-KDa and serum albumin, serum ALP levels tended to increase as the level of 63-KDa antigen increased but this was not statistically significant, total bilirubin levels tended to increase as the level of 63-KDa antigen increased but this was not statistically significant, there was negative correlation between PLTs count and 63-KDa antigen and this was not statistically significant, INR-prothrombin time levels tended to increase as the level of 63-KDa antigen increased but this was not statistically significant.Both HCV and schistosomiasis are highly endemic i n Egypt and coinfection is frequently encountered (Abdel-Rahman et al., 2013). The prevalence of HCV/S.mansoni joining ranged from 0.8 to 50.0% among the studies, with the highest ranges in Egypt (10 to 50%) (Van- Lume et al., 2013). A previous study by Blenton et al (2002) mentioned that Coinfections might influence disease expression. HCV has been implicated in some studies as a factor influencing the rigourousness of schistosomiasis (Mohamed et al., 1998 Blenton et al., 2002). And, in turn, an influence of schistosomiasis on HCV severity has been suggested (Kamal et al., 2000 (Blenton et al., 2002). Another study suggests that Schistosomiasis weaken anti- HCV immune responses and worsen liver disease (Kamal et al., 2000 Kamal et al., 2001 Osada and Kanazawa, 2011).It is proper to notice that another study by Abdel-Rahman et al (2013) reported that HCV/schistosomiasis coinfected patients have more rapid progression of hepatic fibrosis than those with HCV mono-infection encounte red, the effect of such coinfection on hepatic and response to therapy remain unclear.In light of the previous by Bahgat et al (2010) real time PCR findings from, soluble egg antigen (SEA) should be considered as a potential stimulatory factor for HCV RNA that may have influenced the early detection of HCV RNA as SEA can stimulate viral replication. The higher morbidity that is observed in patients coinfected with schistosomiasis and HCV is related, at least in part, to direct stimulation of viral replication by SEA. Another study by Vanlume et al (2013) reported that when schistosomiasis and hepatitis C association is established, the clinical course develops into severe hepatocellular damage. Viral persistence and hepatic cirrhosis can develop faster than in mono-infected people.The association between schistosomiasis and hepatitis C has been studied by many investigators due to its important but, the object of current study was undertaken to determine a correlation between HCV an d schistosomiasis infection in relation to evaluation of HCV-NS4 in CHC patient only and S.mansoni/HCV co-infection , from our finding r = 0.407, this means that, there was positive association was observed between 63 KD-a S. mansoni antigen and HCV-NS4 antigen, and there was extremely statistically significant between (p S. mansoni antigen and HCV-NS4 antigen, it is of interest that our study is the first to focus on the relation between 63-KDa S. mansoni antigen and HCV-NS4 antigen.In present study, we made comparison between investigated blood markers in CHC patient co-infected and HCV only, from our finding there was increase in activities of ALT, AST in CHC patients co-infected than HCV only, On the other hand, there was decrease in serum albumin level, platelets count for CHC patients co-infected compared with non-infected with S. mansoni group and there was extremely statistically significant between (pS.mansoni/HCV) co-infected and non-infected with S. mansoni (HCV only), bu t this was not statistically significant between ALT in CHC patients (S.mansoni/HCV) co-infected and non-infected with S. mansoni (HCV only).The transaminase enzymes are indicator of liver fibrosis, this may be that co-infection accelerate tissue damage and liver fibrosis, there was no statistically significant between ALP in CHC patients (S.mansoni/HCV) co-infected and non-infected with S. mansoni (HCV only), this was no statistically significant between bilirubin in CHC patients (S.mansoni/HCV) co-infected and non-infected with S. mansoni (HCV only), there was no statistically significant between Albumin in CHC patients (S.mansoni/HCV) co-infected and non-infected with S. mansoni (HCV only), there was no statistically significant between PLTs count in CHC patients (S.mansoni/HCV) co-infected and non-infected with S. mansoni (HCV only). In the previous study by reported that S.mansoniinfection is known to induce hepatocellular injury, which in turn, leads to the release of enzymes from the injured hepatic cells into the blood circulation (Dkhil,2014). In current study, showed that an increase in the level of HCV-NS4 antigen in patient with S.mansoni/HCV than level of HCV-NS4 antigen inpatient with HCV only.In conclusion, the 63-KDa was the antigenic component of S.mansoni, our study showed increased activity in transaminase enzyme and decreased activity in Albumin and PLTs in S.mansoni/HCV coinfection than HCV only, and 63-KDa antigen S.mansoni has a positive correlation with HCV-NS4 antigen