الفهرس 
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Abstract
Schistosomiasis is a chronic disease with an ancient roots in Egypt, it is reported to be endemic in 77 countries in tropical and subtropical regions leading to infection of about 250 million individuals worldwide. Co-infection with viral hepatitis is very common since the regions with a high prevalence of schistosomiasis usually have a high endemicity of chronic viral hepatitis as well.
Egypt has the highest prevalence of recorded hepatitis C virus worldwide, which was attributed to extensive iatrogenic transmission during the era of PAT mass-treatment campaigns. Increasing age and history of parenteral anti-Schistosomal therapy (PAT) were common risk factor of HCV infection.
No recognized risk factors can be identified in 10-40% of hepatitis C virus (HCV)-infected patients suggesting that the modes of transmission involved could be underestimated or unidentified. Invasive diagnostic procedures, such as endoscopy, have been considered as a potential HCV transmission route.
Endoscopy is a vital part of medical diagnostic processes. The rapid increase in the application of digestive endoscopy has brought about the re-use of endoscopes in different patients within a short period of time in many endoscopy centers. Transmission of microorganisms by gastrointestinal endoscopy is reported. The majority of these cases predated the adoption of guidelines established in 1988 which stressed the importance of adequate manual cleaning before disinfection. Several cases of patient-to-patient HCV transmission have been related to inadequate cleaning and disinfection of GI endoscopes and accessories and to the use of contaminated anesthetic vials or syringes.
The present work was conducted to study the role of upper endoscopy in transmission of hepatitis C virus among schistosoma patients.
The study subjects were recruited on 86 patients from Endoscopy unit, Surgery Department of Medical Research Institute, University of Alexandria and Endoscopy unit of Alexandria Fever Hospital, they were classified into 2 groups: Schistosomal patients and Non- Schistosomal controls. The target sample included 24.42 % females and 75.58 % males with a mean age of 52.49 years old. Most of individuals (61.63 %) were from El Behera, 32.55% from Alexandria and 5.81% from Kafr el sheikh.
In the current study; 61.63 % of them had an old schistosomiasis infections, 29.07% of them were treated by injection, 16.27% by tablets, 15.12% by both tablet and injection and 1 person did not have any treatment. All patient were asked about HCV risk factors in the last 3 months before endoscopy and 13.95% of them were susceptible to HCV risk factors such as blood transfusion, intravenous drug use, piercing, tattooing, acupuncture, visiting dentists and suspicion of nosocomial transmission. 40.7% of the target sample were treated before from an old HCV infection more than 2 years ago and retested for SVR.
Patients had different reasons to apply endoscopy; 62.79% of them were subjected to endoscopy due to follow up of old varices, 26.74% were due to undefined gastric complaints, 6.98% was to diagnose a GIT disease and other rare causes such as chronic diarrhea, blood vomiting and esophageal reflux.
Summary
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Results of endoscopy were recorded for all the current study individuals; the most common endoscopy finding was hypertensive gastropathy (45.51%) followed by gastritis (20.93%), obliterated esophageal varices (13.95 %), gastrodeudenitis (9.3%), 8.14% for band ligation therapy, esophagitis & deudonitis, 6.98% for EBL for residual esophageal varices, 5.81% for sliding hiatal hernia , 4.65% for esophageal varices I, 3.49% esophageal varices III & duodenal ulcer, 2.33% for pyloric ulcer, positive H. pylori and gastric ulcer and finally 1.16% for weak OGJ, duodenal polypectomy, fundic ulcer, colitis and GERD class B. Both endoscopy units follow the standard procedure of cleaning and sterilization of the endoscope, in MRI endoscopy unit they used a manual cleaning and sterilization procedures while in Alexandria fever hospital endoscopy unit used manual cleaning procedure and an automated machine for and sterilization of the endoscope.
Stool analysis was done using two techniques; Sedimentation technique; 87.21% were negative, two cases of both B.hominis and E.histolytica cyst were detected (2.33%) and eight S. mansoni cases (9.3%). As per Kato/Katz technique; 90.7% of the samples were negative and eight S. mansoni cases were detected in patients group (9.3%) with a perfect agreement between the two techniques.
Bilharzia antibody was measured by IHAT, control group represented the negative results of the total sample (46.51% was negative and 3.49 % was 1/80) while all positive results were from the patient group as the following; 27.91% was of titre 1/160, 8.14% was of titre 1/320, 4.65% was of titre 1/640, 5.81% was of titre 1/1280 and 3.49% was of titre 1/2560. HCV antibody was detected using ELISA technique which revealed that 48.84 % of each patients, controls and the total sample were negative and 46.51, 34.88 & 40.7% of patients controls and the total sample were positives for HCV respectively, while there were 3 borderline cases (3.49%); 1 from patients and 2 from controls plus 6 weak positive cases (6.98%); 1 from patients and 5 from controls. Both border line and weak positive cases were reexamined using automated cobas system, kappa test gave fair agreement between the two techniques (kappa = 0.380). All positive and weak positive cases were confirmed using real time PCR, the total repeated cases were 44 cases, all of these cases were negative for HCV by PCR. Thirty three cases out of the total positive cases were treated from an old HCV infection, so their HCV antibody is normally to be still positive and the remained 11 cases were confirmed negative by PCR, agreement between ELISA and PCR results was in 75 % of the total sample while 25% were positive HCV Ab and confirmed negative by PCR. For follow up; only 10.47% of patients came after 1 month, the majority came after longer period up to 3 months, HCV PCR results after endoscopy were negative of all participants which suggests that with appropriate cleaning and sterilization procedures of endoscopy, risk of HCV transmission is eliminated. 48.6 % of old treated HCV cases had an old injection treatment of schistosomiasis which prove the role of old schistosomiasis parenteral treatment in HCV spreading. However state of schistosomiasis infection doesn‘t seem to increase the risk of HCV transmission during endoscopy.