Immunoparasitological Study in Bilharzial Patients With or without Hepatitis C Virus in El-Beheira Governorate

Hepatitis C virus infection and schistosomiasis are common in Egypt. Coinfection is not uncommon. Little and quite controversial data are known about biochemical profile in these patients. This study was designed to study IL-2 production as a marker of lymphocyte activity in patients suffering from schistosomiasis with or without hepatitis C virus infection. This work enrolled 513 patients (239 females and 274 males) of Damanhour Teaching Hospital. Study sample included 120 subjects to form 4 groups: gp I (30 normal subjects as control), gp II (30 patients +ve for S. mansoni only), gp III (30 patients seopositive for HCV only), and gp IV (30 patients with mixed S. mansoni and HCV infection). The intensity of schistosomiasis was estimated by Kato-Katz technique. ELISA was used to detect anti HCV, HBs Ag and to estimate interleukin 2 (IL 2) in serum of selected groups. Indirect haemagglutination test was used to detect schistosomiasis among pure HCV. Complete blood picture and liver function tests were also done. Out of 513 samples examined, 89 (17.3%) were +ve for Schistosoma mansoni and 7 (1.4%) +ve for Schistosoma heamatobium. The overall prevalence rate among males was almost double that among females (21.9% versus 12.1%). The risk of HCV infection increased 7 times with the presence of S. mansoni infection. Focusing on the risk factors for S. mansoni infection it was found that gender, water contact, low education, and low socioeconomic status were the most important factors affecting prevalence of S. mansoni infection which in turn increased the risk of HCV infection. In the selected studied groups the results of heamatological and biochemical parameters showed significant decrease in group IV (schistosomiasis + HCV) than that of normal controls, schistosomal, and HCV patients groups. On the other hand, there were an increase in serum bilirubin and aminotransferase enzymes in the group of mixed infections. It has been shown that, in patients with mixed infections, IL2 level was lower than that of the other 3 groups. In conclusion S. mansoni was the predominating species in the present study. History of water contact, low education, and low socioeconomic status were the most important determinant factors of schistosomiasis. The risk of HCV infection increased with the presence of schistosomiasis. INTRODUCTION Schistosomiasis is still endemic in 74 tropical and subtropical countries. It ranks second behind malaria in terms of socio-economic and public health importance. Despite control efforts in a number of countries, still an 691 Bull High Inst Public Health Vol.37 No.3 [2007] estimated 200 million people are infected and about 600 million are at risk. (1) WHO reported that 120 million are symptomatic and 20 million have severe consequences of the infection. (2) In Egypt, the total number of infected individuals with schistosomiasis are in the range of 5-6 million which means that Egypt is one of the most highly endemic areas in the world(3). The prevalence of S. mansoni ranged between 17.5% to 42.9% among both sexes aged 5-50 years in ElBehira Governorate. (4,5) Hepatitis C virus infection is a global health problem. WHO estimates that 3% of the world’s population has been infected with HCV and that more than 170 million persons are chronic carriers. (6) Recently, HCV infection was concluded to be the main cause of chronic liver diseases in Egypt, where this infection is largely associated with schistosomiasis which has been claimed to be an important risk factor for HCV infection(7). However, The immunologic aspects of this pattern of coninfection have never been reported because of the absence of small animal model that can support both infections(8). A cytokine (IL2), is one of the peptide mediators which up and down regulate immunologic, inflammatory, and reparative host responses to injury. (9) Thelper lymphocytes are separated into Thelper 1 (Th1) and T-helper 2 (Th2) cells depending on their cytokine secretion pattern. Th1 cytokines; (interferon γ (IFN-γ), IL2, and tumour necrosis factor) promote cellular immune responses. Th2 cytokines (IL-4, IL-5, IL-6, and IL-10) regulate the humoral immune responses. Cytokines produced by each subset inhibit the production and activities of the opposing subset.