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Abstract
Summary Tuberculosis is a growing international health concern, it is the biggest killers among the infectious diseases in the world today, it is more prevent in developing countries, in which over 95 % of cases occur. It still remains a major challenge to global public health in the 21th century, especially with the steady increase in drug resistant TB particularly in developing countries. The key of controlling the spread of tuberculosis include proper case finding, rapid diagnosis of TB, prompt initiation of effective therapy and contact tracing to arrest further transmission. HCV is a major and growing global health problem affecting about 170-200 million people worldwide. The prevalence varies markedly from one geographic area to another in which Egypt has the highest worldwide prevalence. HCV infection is one of the main causes of chronic liver disease worldwide. The long-term hepatic impact of HCV infection is highly variable, from minimal changes to chronic hepatitis, extensive fibrosis, and cirrhosis with or without hepatocellular carcinoma (HCC). Coinfection with HCV can be found in several TB -infected patients. Therefore, the aim of the present study was the detection of HCV infection among TB patients. In the present study, serum samples from 106 patients with pulmonary tuberculosis. At the time of admission, none of the patients had associated diseases like human immunodeficiency virus infection.
Summary& Conclusion
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Moreover, serum samples from 45 patients with asymptomatic HCV infection. In addition to serum samples from 30 healthy individuals, were included as control group. The 27-kDa HCV-NS4 antigen was employed for screening of HCV infection in serum samples by applying Western blot and ELISA technique. The identification and verification of target HCV-NS4 antigen was based on using of a specific Mono-specific anti-HCV antibody. The target HCV-NS4 antigen was resolved by SDS-PAGE and stained with Coomassie blue. Western blot was used to identify the circulating 27-kDa HCV-NS4 in serum samples of patients infected TB, patients infected with other respiratory diseases, asymptomatic individuals and those healthy individuals. The following results were obtained: 1- 106 sputum samples collected from 106 patients of pulmonary tuberculosis were processed and subjected to Ziehl-Neelsen staining for detection of Mycobacterium tuberculosis. Out of 106 patients, 77.7% (76/106) were found positive by ZN and other 28.3% (30/106) were found negative by ZN. 2- HCV-NS4 antigen was detected in 72 of the total 106patients with pulmonary TB with detection rate (68.0 %). Moreover, HCV-NS4 antigen was detected in only 12 serum samples of 45 patients with asymptomatic HCV infection with detection rate (26.7%). While all of 30 controls individuals were negative for HCV-NS4 antigen with detection rate (0.0%) 3- HCV-NS4 antigen was detected in 56 of the 76 patients positive for Ziehl-Neelsen staining with detection rate (73.7%) and it was detected in 16 of the 30 patients negative for Ziehl-Neelsen staining with detection rate (53.3%). There was no significant difference (X2 = 4.0; p> 0.05) between patients positive for Ziehl-Neelsen staining and patients negative for Ziehl-Neelsen staining.
Summary& Conclusion
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4- There was extremely high significant difference (X2 = 25.4; p< 0.0001) among patients positive for Ziehl-Neelsen staining, patients negative for Ziehl-Neelsen staining and those asymptomatic patients. 5- The Level of HCV-NS4 antigen concentration (µg / mL) in those samples. The mean level ± slandered division (SD) of serum HCV-NS4 antigen was (74.2 ± 41.7 µg / mL) in total 106 patients with pulmonary TB. On the other hand, serum HCV-NS4 antigen was (42.6 ± 26.5 µg / mL) in asymptomatic HCV individuals. While, there was no antigen (0.0 ± 0.0 µg / mL) in serum samples from healthy individuals. There was extremely high significant difference (P < 0.0001) among three groups. Moreover, there was significant difference (P < 0.01) between patients with pulmonary TB and asymptomatic HCV individuals. On the light of the results obtained in the present study, it is noticeable that HCV-NS4 antigen was detected in 72 of the total 106 patients with pulmonary TB with detection rate (68.0 %). The high incidence HCV-NS4 antigen was detected in 56 of the 76 patients positive for Ziehl-Neelsen staining with detection rate (73.7%), alerts us about the risk of that possible HCV-TB coinfection, especially in high risk population with high prevalence of TB as in Egypt. HCV infection may be a potential explanation for the emergence and recurrence of TB infection among HCV-infected patients, due to its impact on the immune system, in addition to delay in TB diagnosis. In conclusion, the results of the present study revealed a new lethal coinfection of HCV and TB; each accelerates the course of the other.
Summary& Conclusion
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TB prevalence and recurrence in Egypt may be due to the high incidence of HCV throughout the country, in addition to poverty, overcrowding and lack of medical care. To cope with the challenge of HCV-TB coinfection, further research for TB diagnosis, detection of drug resistant strains of TB, as well as development of more effective therapeutic agents and vaccines are urgently needed especially in high risk population as Egypt where HCV is the leading pandemic.