Fungal Aeroallergen Sensitization Patterns among Airway-Allergic Patients in Zagazig, Egypt.

BACKGROUND: Airway allergies such as asthma and allergic rhinitis, as well as their comorbidities, are increasing worldwide, causing significant socioeconomic health burdens to societies. It is estimated that between 3% and 10% of the population is allergic to fungi. The type of fungal sensitization varies from one geographical region to another. The present study aimed to identify the common fungal aeroallergen sensitization patterns among airway-allergic patients residing in the Zagazig locality, Egypt, in order to obtain a better understanding of fungal allergy, in addition to improving the awareness and management strategies for those patients. METHODS: The present cross-sectional study included 200 allergic rhinitis and asthma patients. Sensitization to fungal aeroallergens was evaluated by skin prick testing and in vitro measurement of total and specific immunoglobulin E. RESULTS: As determined by a skin prick test, 58% of the patients studied were allergic to mixed molds. Alternaria alternata was the predominant fungal aeroallergen among the studied patients (72.2%), which was followed by Aspergillus fumigatus (53.45%), Penicillium notatum (52.6%), Candida albicans (34.5%), and Aspergillus niger (25%). CONCLUSION: Mixed mold sensitization ranked fourth among the most frequent aeroallergens in airway-allergic patients, and Alternaria alternata was the most frequently encountered fungal aeroallergen in the Zagazig locality.

Interleukin 10 -1082 G/A Gene Polymorphism and Susceptibility to Bronchial Asthma in Children: A Single-Center Study.

Interleukin-10 (IL-10) is the key regulator of immune responses preventing the undesirable exaggerated ones. Genetic variation in the promoter region of IL-10 may influence its serum level and contribute to susceptibility to bronchial asthma in children. This is a case-control study including 100 patients and 100 healthy control children who had undergone skin prick test, estimation of total IgE and serum level of IL-10 by enzyme-linked immunosorbent assay, and polymerase chain reaction-restriction fragment length polymorphism for IL-10 gene polymorphism. A significant association between IL-10 polymorphism and susceptibility to pediatric asthma was found. AA genotype represented (66%) of the patient group compared to (6%) only of the control group, while AG genotype was detected in 20% of patients and 4% of control. In contrast, wild genotype GG was found in 14% of patients and 90% of control with a highly statistically significant difference among both groups (P < 0.001). The serum level of IL-10 was significantly elevated in the GG genotype in comparison to other genotypes (P < 0.001), and it was negatively correlated with the severity of asthma among the studied pediatric asthmatic group (P < 0.001). In conclusion, IL-10 polymorphism may play an important role in the development of bronchial asthma in children.

Role of circulating microRNA-132 in allergic bronchopulmonary aspergillosis: A case-control study.

Allergic bronchopulmonary aspergillosis (ABPA) is an allergic respiratory disease. In the current study, we aimed to evaluate the roles of miRNA-21 and miRNA132 as biomarkers in the diagnosis of ABPA. A total of 30 controls, 30 allergic asthmatic patients, 30 severe asthma with fungal sensitization (SAFS) patients, and 30 ABPA patients were included. Real-time polymerase chain reaction was used to quantify the level of miRNAs expression. The expression level of miRNA-21 was significantly higher in allergic asthmatic, SAFS, and ABPA patients in comparison with controls (p < 0.001). However, no significant difference was detected in the expression level of miRNA-21 among the different patient groups (p > 0.05). The ABPA patients had significantly higher levels of miRNA-132 expression compared to controls, allergic asthmatic patients, and SAFS patients (p < 0.001), but there was a non-significant difference between controls and allergic asthmatic patients (p = 0.09). At a cut-off of 1.52, the sensitivity of miRNA-132 expression was 93.3% and the specificity was 100% different ABPA from healthy controls. At a cut-off of 6.5, miRNA-132 expression was found to reliably differentiate between ABPA and SAFS, with a sensitivity of 86.7% and a specificity of 80%. In ABPA patients, miRNA-132 expression positively correlation with the levels of serum IL-5 (r = 0.91, p < 0.001). miRNA-132 has a role in ABPA detection and distinguishing ABPA from allergic asthma and SAFS. These preliminary data from case-control study need further studies to confirm its finding.

Serum Procalcitonin as A Diagnostic and Prognostic Marker for Bacterial Community - Acquired Pneumonia.

For community acquired pneumonia (CAP), the discrimination between typical and atypical bacterial causes could influence antibiotic choice and outcome of patients. Objective of this study was to evaluate the utility of serum procalcitonin (PCT) level as a diagnostic and prognostic marker for CAP. Typical bacteria were isolated and identified by conventional methods. An indirect immunoflourescence assay was used to diagnose atypical bacteria. Serum level of PCT was measured by ELISA and clinical outcome was evaluated. Out of 240 enrolled CAP patients, 95 (39.6%) had bacterial etiology (30.8 % typical bacterial pneumonia and 8.8% atypical pneumonia). Ninety five bacterial CAP patients were divided into 3 groups; group 1 (mortality, 20.1%), group 2 (complications, 52.6 %) and group 3 (discharge, 26.3 %). Group 1 patients had the highest PCT level in serum compared to other groups with a statistically significant difference (P < 0.001). A statistically significant higher serum level of PCT was detected in typical than atypical pneumonia (P < 0.001). In conclusion, serum PCT level may serve as a diagnostic and prognostic marker in CAP.

Evolving relationship between respiratory functions & impairment in sleep and cognition in patients with multiple sclerosis.

BACKGROUND: The most apparent source of disability in patients with multiple sclerosis (MS) is the physical and mental impact. The pathophysiological mechanisms of cognitive dysfunction are multifactorial although hypoventilation secondary to respiratory dysfunction may contribute to cognitive decline. METHODS: This study was conducted on 146 MS patients with baseline clinical assessments including the Epworth sleepiness scale (ESS) and physical disability was assessed using the Expanded Disability Status Scale (EDSS). Cognitive testing was performed utilizing the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and the Perceived Deficits Questionnaire (PDQ). Respiratory functions were assessed by spirometry and the respiratory muscle functional assessment was done by maximal mouth pressure measurement. RESULTS: The respiratory muscle function test had a significant negative correlation with the score of ESS and PDQ scale and a significant positive correlation with the BICAMS scale score (p < 0.001). The ESS and PDQ scores were significantly negatively correlated with forced expiratory volume in the first second (FEV1)/ forced vital capacity (FVC) (p = 0.03, 0.02), FVC supine (p = 0.03, 0.01), FVC upright- FVC supine (ΔFVC) (p < 0.001, <0.001) FEV1 (p < 0.001) and FVC (L) (p < 0.001), respectively. While the BICAMS showed a significant positive correlation with spirometry results except FVC upright. ESS scores were significantly correlated with the BICAMS and PDQ scale score (p < 0.001). CONCLUSION: Among MS patients, impaired respiratory functions are significantly associated with sleep disturbance and cognitive impairment. Thus the spirometry and respiratory muscle strength assessment are necessary from the early phase of MS.

Serum Level of CD48 and Its Expression on Blood Leukocytes in Persistent Asthmatic Patients.

CD48 is a surface receptor (mCD48) expressed on most hematopoietic cells, as well as in a soluble form (sCD48). It seems to play a major role in asthma through the interactions of mast cells with eosinophils via its ligand CD244. Hence, this study was done to evaluate the role of CD48, in its membrane and soluble forms, as a novel biomarker in asthma with various degrees of severity. One hundred participants were enrolled in this study and divided into 4 equal groups matched in age and sex; mild asthma, moderate asthma, severe asthma and apparently healthy controls. All were investigated for blood leukocytes mCD48 expression using flow cytometry and sCD48 in serum using ELISA. Our results revealed that the sCD48 was significantly elevated in patients with mild asthma compared with the controls (P<0.001) while significantly decreased in severe asthma than mild asthma (P<0.001) and moderate asthma (P=0.002) patient groups. Expression of mCD48 on eosinophils in moderate asthma group was significantly elevated compared with the control and the mild asthmatic groups (P<0.001). However, it was significantly decreased in severe asthma compared with moderate and mild asthma (P<0.001 and P=0.03, respectively). While it was significantly upregulated in severe asthmatic group compared to controls, patients with mild and moderate asthma on T-cell, B cells, Monocytes and NK cells (P<0.001 for all). In conclusion, CD48 may play a role in asthma and its level varies with severity of the disease being a useful marker in mild asthma.

Predictive role of IL-17A/IL-10 ratio in persistent asthmatic patients on vitamin D supplement.

Asthma is an airway inflammatory disorder. Vitamin (Vit) D is a potent immuno-modulator. It suppresses Interleukin (IL)-17 and induces IL-10. This study aims to investigate the role of IL-17A and IL-10 in predicting asthma control in case of Vit D supplementation. Seventy-nine patients enrolled in this study (42 patients received Vit D supplement and 37 patients did not receive the supplement). The enrolled patients were assessed at the beginning of this study and after 3 months. At the end of the study, there was a significant improvement in pulmonary function parameters in the Vit D supplemented group when compared to both the baseline values and the non-supplemented group. There was a significant decrease in serum IL-17A levels and a significant increase in serum IL-10 levels in comparison with the baseline values (p < 0.0001). The highest correlation of FEV1% improvement percentage was associated with the baseline IL-17A/IL-10 ratio (r = 0.65; p < 0.0001). The IL-17A/IL-10 ratio at a cutoff ≥ 2.66 had a sensitivity of 72.2% and a specificity of 83.3%. The IL-17A/IL-10 ratio had an adjusted odds ratio = 4.66 (p = 0.04). Vit D supplementation reduces the serum IL-17A levels and elevates the serum IL-10 levels in persistent asthmatic patients. So, Vitamin D can be used as an adjunct therapy side by side with the conventional asthma therapy. The IL-17A/IL-10 ratio seems to be a possible predictive biomarker for asthma improvement in patients depending on Vit D supplementation.

Diagnostic and prognostic roles of peripheral blood Toll-like receptor-4 and stanniocalcin-1 genes expression in acute lung injury.

Acute lung injury (ALI) is an acute inflammatory disorder. Toll-like receptor-4 (TLR-4) and Stanniocalcin -1 (STC-1) had roles in lung endothelial protection. This study aims to assess TLR-4 and SCT-1 genes expressions in peripheral blood of ALI patients. Total RNA was extracted from peripheral blood of 48 subjects (20 healthy controls, 28 ALI patients) and expressions of genes were assessed by real-Time qRT-PCR. The expression levels of TLR-4 and SCT-1 genes were significantly lower in ALI patients compared to controls (P < 0.0001). After 10 days, the expression levels of TLR-4 and SCT-1 were increased compared to their baseline levels (p = 0.012 and 0.024, respectively). SCT-1 has 92.9% sensitivity and 100% specificity in ALI detection. SCT-1 gene expression was negatively correlated with severity score (r= -0.54, p = 0.003). The mortality pattern was higher in ALI patients with lower TLR-4 gene expression (p = 0.014). In conclusion, the peripheral blood expressions of TLR-4 and STC-1 genes were decreased in ALI patients. Both genes expressions were increased with patients' recovery. SCT-1 had higher sensitivity and specificity in ALI diagnosis. The peripheral blood expressions of SCT-1 and TLR-4 genes seem to be diagnostic and prognostic markers in ALI.