الفهرس 
Chronic liver diseaseOnly 14 pages are availabe for public view
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Abstract
Infections are common in patients with chronic liver disease, especially those with cirrhosis. Patients with advanced liver disease, who develop bacterial infections, are at a substantially higher risk of death. As liver disease progresses, most immunizations lose their effectiveness.
The efficacy of immunization decreases with disease progression; for this reason, these patients should be immunized as soon as possible, so vaccinations programme is recommended, as well as selective vaccinations against influenza, pneumococci and viral hepatitis, depending on the underlying chronic disease.
However, there are few data about antibody responses to pneumococcal vaccine or the functional activities of these antibodies against pneumococci in cirrhotic patients.
This study was conducted on randomly chosen 20 patients with chronic liver disease recruiting to the Pediatric Hepatolgy clinic, Ain Shams University Hospital between Febreuary 2012 and June 2012, they were 9 (45%) males and 11(55%) females. Twenty healthy well matched regarding age and sex class were included as control group. Age in the study group ranged between 7 months and 17 years with mean±SD (7.535±5.245).
This study was conducted as case control study and all patients were subjected to full medical history with special stress on right hypochondrial pain, recurrent respiratory tract infection, itching, color of urine or stool and upper or lower GIT bleeding.
Clinical examination was one with special stress on anthropometric measures including patient’s weight and height and weight percentile and height percentile through plotting weight and height on the age- and gender-standard percentiles according to Egyptian growth charts. Liver and spleen size, ascites and signs of liver cell failure as jaundice, palmer erythema, lower limb edema or encephalopathy…etc.
Laboratory investigations including Liver function tests: Aspertate aminotransferase (AST), alanine aninotransferase (ALT), total and direct serum bilirubin, total protein and serum albumin using standerd laboratory tests, Coagulation profile: prothrombin time (PT) by standerd laboratory tests.
A seven valent pneumococcal conjugate vaccine (PCV7 vaccine), containing the 7 most common pneumococcal serotypes causing invasive infections in children (Prevnar (PCV7 - Conjugate)). It is available presentation of PCV7 is single-dose, pre-filled sterile syringes and contains no preservative for IM or deep SC injection. Seven valent Pneumococcal Ig G assay was done after 6 wks from vaccination.
Five patients (25%) had jaundice, 5 patients (25%) had abnormal urine or stool color, 1 (5%) had itching, 2 (10%) had bleeding history, 1 (5%) had right hypochondrial pain, 1 (5%) had tense ascites and 11 (55%) had cholestasis.
Thirteen patients (65%) had a history of recurrent respiratory tract infection. Five patients (38.5%) had recurrent tonsillitis, 8 (61.5%) had recurrent chest infection.
Hepatomegaly was detected in 18 pateints (90%) while spleenomegaly was detected in 13 (65%) of cases. According to Child classification (score); 4 patients (20%) were class A, 15 (75%) were class B and 1 (5%) was class C.
Pneumococcal IgG levels before vaccination ranged between 1.5 and 6.00 ng/l with mean±SD 3.175±1.185, while after vaccination ranged between 2.8 and 8.40 ng/l with mean±SD 5.526±1.452. There is a highly significant higher levels of IgG after vaccination (p=0.000) in the study group.
Pneumococcal IgG levels before vaccination ranged between 2.1 and 8.5 ng/l with mean±SD 4.241±1.421, while after vaccination ranged between 4.00 and 11.00 ng/l with mean±SD 6.330±1.828. There is a highly significant higher levels of Pneumococcal IgG after vaccination (p=0.000) in control group.
There was a highly significant difference as regard Pneumococcal IgG levels between cases and controls before vaccination. Significant lower Pneumococcal IgG levels before vaccination in the study group (p=0.014), while there is also lower Pneumococcal IgG levels after vaccination in the study group, but statistically non-significant (p=0.138).
In this study, there was significant positive correlation between age of the patient and Pneumococcal IgG level after vaccination. Meanwhile there was highly significant negative correlation between the frequency of recurrent infection and the Pneumococcal IgG either before or after vaccination.