الفهرس 
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Abstract
Influenza is a major health threat throughout the world, yet many countries lack even rudimentary influenza surveillance systems. Furthermore, influenza surveillance in developing countries often includes only major cities due to limited laboratory resources in outlying areas and poor infrastructure, e.g., lack of electrical power. Consequently, data are lacking about the types of influenza viruses that are circulating and the burden of influenza-related disease in the developing world increased cytokine production following influenza A H1N1 infection is considered to play an important role in viral pathogenesis and disease development.
Accordingly, the purpose of this study was to detect any relation between polymorphism of TNFα-308, IL6 and IL8 to occurrence and severity of infection of H1N1virus.
The nasopharyngeal swab and blood specimens were collected from 200 respiratory patients who were suspected to be infected with influenza virus (influenza –like- illness (ILI)). The nasopharyngeal Swabs were immediately kept at 4ºC in viral transport media (VTM). Then transported to the Molecular Biology Research Unit laboratories in Medical Ain Shams Research Institute (MASRI) as fast as possible for molecular examination by Real Time PCR (RT-PCR) according to CDC (2009) protocol to confirm or exclude infection by H1N1 influenza besides sub typing done for H1N1 positive cases. we chose randomly 50 patients positive for H1N1virus (group I)and50 patients negative for H1N1virus (influenza –like- illness (ILI)) (group II) were randomly selected. Detection of TNFα-308, IL6 and IL8 polymorphisms done by Real time-PCR amplification. Another 50 blood samples were collected from healthy individuals to be used as control cases (group III).
After testing 200 specimens for influenza viruses, found127 (63.5%) cases negative for H1N1 and73 (36.5%) were positive for H1N1 virus, out of these 73positive cases chose randomly only 50 samples analyze H1N1strain type in (group I), and found that 44 (88%) were influenza A virus, and 6 (12%) were influenza B virus. Among the influenza A virus found 28 (63.3%) were influenza A (H3N2) sub-type and 16 (36.2%) were influenza A sub-type (H1N1).
These results are in accordance with World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories in the United States.
The present results indicated that the TNFΑ-308−308 A allele and A/A genotype were associated with higher risk of infection by influenza A/H1N1, while the homozygous TNFα-308G/G genotype had a trend toward being associated with protection from infection. Found in group, a significant relation between TNFα-308genotypes and Diabetes, TB, HCV, Renal disease, Respiratory disease, CVD, Chest x-ray, Mortality and ICU Hospitalization and increase illness severity in patients carriers of TNFα-308AA homozygous genotype. And found no association between IL6 neither allelic nor genotype with infection, but we found increased risk of becoming infected with A/H1N1 virus associated with IL8A allele and AA homozygous genotype.
We found some disease conditions that might determine whether the patient would be infected and have a more aggressive disease. Among these conditions were diabetes, HCV, TB, renal disease and respiratory disease.
Finally found the eight mortality cases in our study were distributed as follow: one case from group II and seven cases from group I. and observed that died patients with a severe clinical course and up to ICU were more in H3N2 subtype of H1N1.