Seroprevalence of HBV and HCV Among Diabetes Mellitus Patients Attending University of Gondar Hospital, Northwest Ethiopia.

BACKGROUND: Hepatitis B and hepatitis C viruses are common infections and main causative agents of chronic liver diseases, cirrhosis, and hepatocellular carcinoma. The liver is the major site of hormone and glucose metabolism which have deep interconnection with diabetes. Hepatitis-B and hepatitis-C virus infection and diabetes are prevalent diseases worldwide associated with increased morbidity and mortality. High prevalence of DM, HCV, and HBV showed that there is a higher chance of coexisting in an individual. Therefore, our study tried to assess the coexistence of hepatitis viruses and diabetes mellitus among DM patients at the University of Gondar comprehensive specialized hospital. METHODS: The hospital-based, cross-sectional study was conducted from November 01 to December 30, 2019 to as-sess the prevalence and associated factors of HBV and HCV among diabetes patients attending at University of Gondar referral hospital. Sociodemographic data was collected using a semi-structured questionnaire. Four milliliters of blood were collected using an anticoagulant free test tube for measurement of biochemical parameters and detection of hepatitis viruses. HBsAg and anti-HCV antibody detection was performed using One Step Cassette Style HBsAg Rapid Test and EUGENE® anti-HCV rapid test, respectively. Binary and multivariable logistic regression models were used to evaluate associated risk factors for the outcome variable. A p-value of < 0.05 was considered statistically significant. RESULTS: A total of 288 diabetes patients were included in this study and the prevalence of HBV and HCV was 7 (2.43%) and 18 (6.25%), respectively. Hepatitis B virus showed similar prevalence for type 1 and type 2 diabetes at 2.6% and 2.3%, respectively, but HCV showed a wide variation with 17.5% and 4.3% prevalence, respectively, for both diabetes types. In a multivariable logistic regression model compared with younger age (≤ 24 years), older age ≥ 65 years (AOR: 19.545, 95% CI: 2.577 - 22.827) age groups and poor glycemic control (AOR: 18.84, 95% CI: 17.83 - 20.39) showed significant association with HBV. CONCLUSIONS: A considerably large number of diabetes patients tested positive for anti-HCV antibody as a marker of Hepatitis C virus infection. None of the variables showed significant association with active Hepatitis B virus infection whereas older ages (≥ 65 years) and diabetes patients with poor glycemic control showed significant association with anti-HCV antibody positivity.

Helminth species dependent effects on Th1 and Th17 cytokines in active tuberculosis patients and healthy community controls.

Despite that the impact of different helminth species is not well explored, the current dogma states that helminths affect the Th1/Th2 balance which in turn affects the risk of tuberculosis (TB) reactivation and severity of disease. We investigated the influence of helminth species on cytokine profiles including IL-17A in TB patients and healthy community controls (CCs). In total, 104 newly diagnosed pulmonary TB patients and 70 HIV negative and QuantiFERON negative CCs in Gondar, Ethiopia were included following helminth screening by stool microscopy. Plasma samples and ex vivo stimulation of peripheral blood mononuclear cells (PBMCs) with purified protein derivative (PPD) and Staphylococcus enterotoxin B (SEB) was used to determine cytokine profiles by cytometric bead array. In CCs, Ascaris lumbricoides or Schistosoma mansoni infections were associated with an impaired Th1-type response (IFN-gamma, IL-6 and TNF-alpha) in PBMCs mainly with SEB stimulations, whereas in TB patients only hookworm infection showed a similar pattern. Among CCs, the IL-17A response in PBMCs stimulated with SEB was higher only for S. mansoni, whereas in TB patients, the elevated systemic IL-17A plasma level was significantly suppressed in hookworm infected TB patients compared to patients without helminth coinfection. Following treatment of TB and helminth infection there was a general decrease in ex vivio IL-10 and TNF-alpha production in unstimulated, PPD or SEB stimulated PBMCs that was the most pronounced and significant in TB patients infected with S. mansoni, whereas the follow-up levels of IFN-gamma and IL-17A was significantly increased only in TB patients without helminth coinfection from PBMCs stimulated mainly with SEB. In summary, in addition to confirming helminth specific effects on the Th1/Th2 response before and after TB treatment, our novel finding is that IL-17A was impaired in helminth infected TB patients especially for hookworm, indicating a helminth species-specific immunoregulatory effect on IL-17A which needs to be further investigated.

Helminth species specific expansion and increased TNF-alpha production of non-classical monocytes during active tuberculosis.

Both Mycobacterium tuberculosis infection and helminths may affect innate immune mechanisms such as differential effects on monocytes towards the non-classical and intermediate subsets that favor bacterial persistence. Our aim, was to investigate helminth species specific effects on the frequency and functional activity of monocyte subsets in patients with active tuberculosis and healthy subjects. HIV-negative patients with active pulmonary tuberculosis (PTB) and community controls (CCs) in Gondar, Ethiopia were screened for helminth infection by stool microscopy. Flow cytometric analysis of peripheral blood mononuclear cells (PBMCs) and ex vivo stimulation with purified protein derivative (PPD) and helminth antigens were used to characterize the distribution of monocyte subsets and their function. A total of 74 PTB patients and 57 CCs with and without helminth infection were included. Non-classical monocytes were increased in PTB patients with Ascaris and hookworm infection but not in Schistosoma-infected patients. Ascaris had the strongest effect in increasing the frequency of non-classical monocytes in both PTB patients and CCs, whereas PTB without helminth infection did not affect the frequency of monocyte subsets. There was a helminth specific increase in the frequency of TNF-α producing non-classical monocytes in hookworm infected PTB patients, both with and without PPD-stimulation. Low-to-intermediate TB disease severity associated with increased frequency of non-classical monocytes only for helminth-positive PTB patients, and the frequency of TNF-α producing monocytes were significantly higher in intermediate and non-classical monocytes of helminth positive PTB patients with an intermediate disease score. Helminth infection affected the frequency of monocyte subsets and function both in TB patients and controls which was helminth species dependent in TB patients. The clinical role of this potential immunomodulatory effect needs further study and may affect the response and protection to tuberculosis in areas where helminth infections are endemic.