Prevalence and Clinical Nature of Brucellosis among Egyptian Patients with Liver Cirrhosis

Abstract

Prevalence and Clinical Nature of Brucellosis among Egyptian Patients with Liver Cirrhosis Liver cirrhosis is a diffuse hepatic process characterised by fibrosis and the conversion of normal liver architecture into abnormal nodules.Around 80-90% of the liver parenchyma needs to be destroyed before there are clinical signs of liver failure.The main causes of cirrhosis are hepatites C virus hepatites B virus,alcohol abuse and non -alcoholic steatohepatites(Tsochatzi et al 2014).The world Health Organization (WHO) has found that Egypt has highest prevalence of HCV in the world on 2015. Liver cirrhosis patients is presented with fatigue ,anorexia ,malaise and weight loss while in advanced decompensated patients the presentations may include odema,ascites, spontaneous bacterial peritonites, hepatosplenomegaly. The portal hypertension is a major complication which can lead to esophageal varices as well as kidney hypoperfusion and low rate of clotting factors synthesis. The severity of the disease can be assessed by childpauch score and modified end stage liver disease. Cirrhosis -associated immune dysfunction syndrome (CAIDS) leads to many types of infections due to reducing of chemotaxis,bacterial phagocytosis and bacterial killing making the immune system less able to clear cytokines,bacteria and endotoxins from the circulation.Because of cirrhosis associated immune dysfunction syndrome ,brucellosis is one of the infection that may occur in cirrhotic patients.Brucellae are aerobic gram negative coccobacilli with multiple species like B.abortus,B.melitensis,B.suis and B. canis.Brucellae transmitted mainly by ingestion of unpasteurizsd milk or raw meat with high prevalence in those contact with animals . Brucellosis presented mainly with fever ,rigor ,hepatospleenomegally and arthralgia mostly with low back pain affecting sacrroiliac joint while the most of the patients suffer from anorexia,malaise,asthenia and weight loss. In our study ,we are searching about the prevalence and clinical nature of brucellosis in Egyptian patients with liver cirrhosis.100 cirrhotic patients attended out patiens clinic or admitted to inpatients Gastroenterology and Hepatology Unit of Ain Shams University hospital were enrolled in this study.Each patient subjected to full history and clinical examination stessing on signs and symptoms 0f brucellosis and liver cirrhosis and labratory investigation with ultra sound and plain x-ray. Blood samples was collected from each cirrhotic patient with fever sending for complement fixation test and blood culture by lysis concentration method.