Marrey E, 1Maklad SS, El-Zyaat TA, El-Naggar BM.
Pediatrics and 1Microbiology Departments Faculty of Medicine for Girls AL-Azhar University.
A portion of schistosomal patients with concomitant HCV infection progress to decompansated liver disease. Variability in outcome, morbidity and the immunoregulation of the doubly infected patients has not been satisfactory explained especially in children. This study was carried out to investigate a possible role of IL-10 in morbidity and disease progression in 26 chronically S. mansoni infected children and adolescents versus 12 patients with concomitant schistosomiasis and HCV infections. Sera obtained from patients with chronic S. mansoni infection were screened for the presence of anti-HCV antibodies using ELISA followed by polymerase chain reaction (PCR) to detect RNA and to identify patients with viremia. The expression of mRNA of IL-10 by peripheral blood mononuclear cells were tested using In Situ Hybridization technique. The results revealed that: 14.3% of schistosomal infected children were positive for anti-HCV antibodies and all had viremia. 66.7% of HCV positive schistosomal patients had organomegaly compared to 38.5% of HCV negative schistosomal patients. Clinically, abdominal distension and pallor were the most frequent signs in HCV positive children. All of HCV positive schistosomal patients had higher levels of expression of IL-10 mRNA compared with 38.5% of HCV negative patients (P<0.001), while none of controls were positive for IL-10. Significantly higher mean % of IL-10 expressing cells was detected in HCV positive (49.5+7.6) compared with HCV negative (20.8+4.3) and controls (11+0.9) (P<0.0001). Additionally, significantly higher expression was detected in HCV positive patients with organomegaly (P<0.01) than HCV negative with organomegaly. A highly significant positive correlation was detected between IL-10 expression and egg count / gm of stools in HCV positive schistosomal patients (P<0.001). In conclusion, HCV has an impact on the liver of schistosomal infected children and adolescents, and it is considered as a major factor contributing to the severity of liver disease. Elevated IL-10 expression in HCV positive schistosomal patients may have a role in the development of morbidity. Measuring of its level may be beneficial to identify those who will pass to a progressive disease.