Hala Ahmed El-Nahas

Impact of basic lymphedema management and antifilarial treatment on acute dermatolymphangioadenitis episodes and filarial antigenaemia

Background: A major factor in the progression of lymphedema is acute dermatolymphangioadenitis (ADLA). Aims To study ADLA episodes and antigenaemia in patients with different grades of filarial lymphedema at pre- and two years post-treatment. Setting and Design: A prospectively conducted study from May 2008 through May 2010. Patients and Methods: Forty five patients complaining of limb swelling with present or past history of limb redness suggestive of ADLA attacks were included. Patients were clinically examined for lymphedema grading, detection of potential entry points and diagnosis of microfilaraemia. Wuchereria bancrofti antigen titer was estimated by “Trop-Ag W. Bancrofti” ELISA kit. Basic lymphedema management and treatment with antifilarial drugs were applied. Statistical Analysis Mann–Whitney test and Chi-square test were used. Results: The number of ADLA attacks in the pretreatment period, ranged from one to three per year. Mean duration of the attacks was 3.87±0.79 days. Entry points were detected in 82% of cases. The study revealed statistical significance between extension and grade of lymphedema and number of ADLA attacks per year (P=0.018 and 0.022, respectively). Microfilaraemia was detected in four cases and positive filarial antigenaemia were detected in 29 patients (64.4). The number of ADLA attacks per year significantly decreased from the pre-treatment period (mean: 2.05±0.560) to be 1.23±0.706 after one year and 0.89±0.575 after two years post treatment. There was a significant decrease in the mean antigen titer one year and two years after treatment. Conclusion: Basic lymphedema management is effective for controlling ADLA attacks in areas where lymphatic filariasis is endemic.

Toxoplasma gondii infection among chronic hepatitis C patients: a case-control study.

OBJECTIVE To determine the detection rate of anti-Toxoplasma gondii (T. gondii) IgG and IgM in chronic HCV patients attending the Department of Tropical Medicine Mansoura University hospital in Egypt. METHODS This study included 120 adult chronic HCV patients, 81 decompensate cirrhosis (late-stage) and 39 chronic HCV non cirrhotic patients (early-stage) and 40 healthy blood donors as controls. Serum samples were examined for anti-Toxoplasma IgM and anti-Toxoplasma IgG antibodies by ELISA. Real-time RT-polymerase chain reaction assay was done for quantitation of hepatitis C virus. RESULTS Anti-T. gondii IgG antibodies were detected in 75 (92.6%) of 81 late-stage cirrhotic patients, 30 (76.9%) of the 39 chronic HCV non cirrhotic patients (early-stage) and in 6 (15%) of 40 controls with statistically significant difference (P<0.001). Anti-T. gondii IgM antibodies were found in 11 (13.6%) in late stage patients, 5 (12.8%) in early stage and in 3 (7.5%) of controls with no statistical significant difference (P=0.610). There was no correlation between stage of fibrosis and IgM or IgG antibodies positivity in our studied groups (P=0.526). High IgG levels significantly correlated with high viral load (P=0.026). CONCLUSIONS Our findings suggest that the serious opportunistic T. gondii infection represent a potential significant risk for chronic HCV patients. So, toxoplasmosis should be considered in their investigations and follow-up.