الفهرس 
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Abstract
Schistosomiasis is one of chronic liver diseases which reported to be the most common disease among Egyptian patients. According to the estimation of WHO, schistosomiasis affects over 200 million people throughout the world and is responsible for 800,000 deaths per year and considered as second in importance only to malaria.
Helicobacter pylori is a gram negative, non-spore forming spiral bacterium which colonizes the human stomach and is prevalent worldwide. It has been associated with peptic ulcer disease, gastric adenocarcinoma and it is considered as a major global health issue in both developed and developing countries.
Studies of co- infection have focused largely on immune-mediated mechanisms, primarily due to the known immunomodulatory effects of helminths which can alter the response to other antigens. Some studies have shown that helminth infection may be protective against H. pylori infection and that infected patients may have a less severe form of the disease.
The present work aimed to investigate antibody response to H. pylori and to assess biochemical and hematological parameters in patients infected with H. pylori and S. mansoni single or combined.
One hundred subjects were enrolled in the present study. They were selected from the local health units in Abou homos area, El-Behira governorate.
The study samples were divided into four groups:
group 1: Included twenty five cases infected with H. pylori (Active cases).
group 2: Included twenty five cases infected with S. mansoni (Active cases).
group 3: Included twenty five cases co-infected with H. pylori and S. mansoni.
group 4: Included twenty five apparently healthy subjects free from any parasitic infection as control.
Each individual was subjected to the following:
1- Interviewing questionnaire: completed through an interview. It included socio-demographic and personal data, Housing conditions and clinical manifestations.
2- Laboratory studies:
a- Stool examination for detection of S. mansoni eggs using simple sedimentation and Kato katz techniques and to detect H. pylori copro-antigen using ELIZA technique.
b- Blood sample was collected to perform the following :
- Complete blood picture, estimation of total protein, albumin, globulin and ferritin
- Serological testes to detect serum concentration of H. pylori IgG and IgA antibodies by using ELISA.
These methods revealed the following results:
1- The median age was high in group3 followed by control group. Then group 2 and group1 respectively. The difference was statistically insignificant
2- In all the studied groups the percentage of males exceeded that of females where male percentages constituted 56% of gp1, 76% of gp2, 52% of gp3 and 60% of gp4. The difference was not statistically significant (P > 0.05).
3- All patients of gp1 and gp2 were working in the farms compared to 16% and 40% of gp3 and gp4 respectively. The difference was statistically significant ( P<0.001).
4- Most of the participants had a low crowding index. Higher percentages of low crowding index level were observed in Gp1, Gp2 and Gp3. Lower percentage was observed in the control group. Also the median crowding index was more or less equal in the four studied groups. The differences were statistically insignificant.
5- Abdominal pain was the most common symptom in all patient groups followed by diarrhea, vomiting and fatigue. Blood in stool was recorded only in three patients (two patients in Gp1 and one patient in Gp2). None of the patients had dyspepsia.
6- The GMEC was higher in group2 than in group1. The majority of patients in Gp1 (96%) and all patients in Gp2 had low egg count (1-99 EPG). Moderate intensity of infection (100- 399) was recorded in one patient in Gp1.
7- H. pylori IgG median level was 17.81 U/ml in group 1 while in Gp2 and G3 the levels were (44.55 U/ml and 44.89 U/ml respectively) and the lowest level was observed in Gp4, it was 9.18 U/ml. Statistically significant differences were observed between Gp1 and Gp2, between Gp1and Gp3 and between Gp2and Gp3. Also statistically significant differences were observed between each group and the control.
8- The IgA antibody index was relatively low in Gp1 and Gp4. Higher IgA antibody index values were recorded in Gp2 and Gp3. There were statistically significant differences between each group and the controls as well as between each two patient groups.
9- The mean value of Hb level, RBCs count RBCs indices were more or less equal in the four studied groups with non-significant difference. There were no statistically significant differences between all groups regarding HCT, MCV, MCH and MCHC.
10- The median Platelet count was nearly similar in Gp2 and Gp3 (18.8×104 and 18.5×104respectively). High platelet count was observed in control group (26×104) compared to Gp1 (21.3×104). Statistically significant differences were observed between Gp1 and Gp2, Gp1 and Gp3 also between each group and control group.
11- There were no statistically significant differences between the studied groups regarding total WBCs count. As regards differential count, mean neutrophil percentage was significantly lower in Gp2 (56.66 ±3.35) compared to the control group (59.82± 6.14). Gp3 showed significantly higher mean neutrophil percentage (60.72± 4.74) compared to the control group. There were no statistically significant differences between the studied groups regarding lymphocytes and monocytes mean percentages. As regards, eosinophils percent the mean eosinophils percent was significantly higher in group 1 and group2 compared to group 3 and control group.
12- No statistically significant differences were observed between the studied groups regarding total protein and albumin levels (p=0.419 and p=0.505 respectively) while statistical significant difference was observed between studied groups regarding globulin level (p<0.05). The mean globulin level was significantly higher in Gp2 compared to control group.
13- Median serum ferritin level was high in Gp3 (48), followed by Gp4 (37.69) then Gp2 and Gp1 (31and 28 respectively). No statistical significant differences were observed between the studied groups (p=0.252).