University of Khartoum

Potential Immunological Markers of Genital Chlamydial trachomatis Infection among Patients with Confirmed Ectopic Pregnancy in Khartoum state

Potential Immunological Markers of Genital Chlamydial trachomatis Infection among Patients with Confirmed Ectopic Pregnancy in Khartoum state

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Title: Potential Immunological Markers of Genital Chlamydial trachomatis Infection among Patients with Confirmed Ectopic Pregnancy in Khartoum state
Author: Mansor, Amna Elmahi Mohammed Osman
Abstract: Background: Ectopic pregnancy is a gynaecological emergency that may result in significant morbidity and mortality. The links between chlamydia trachomatis infection and pelvic inflammatory diseases, and ectopic pregnancy have been established. Immunological markers to be utilized as rapid, remote setting-adapted screening tests are needed to detect early ectopic pregnancy. The objectives of this study were to characterize serum immunological markers of ectopic pregnancy (IgG and IgA), to set up a quantitative cut-off value of the suitable marker for early detection of ectopic pregnancy and to determine if there is any association between the identified marker and the molecular diagnosis of chlamydia trachomatis. Materials and Methods: This was a case-control study of 45 women with ectopic pregnancy (cases) and 90 women with normal pregnancy in their first trimester (controls). Both cases and controls had syndromic diagnosis of pelvic inflammatory disease. They were recruited from obstetrics and gynaecology hospitals at Khartoum State after they have signed a written consent. The demographics of cases and controls were collected using a pre-tested questionnaire. Serum samples were collected from both cases and controls in sterile plain containers. Tissue samples from the fallopian tubes of ectopic pregnancy were collected in 50 ml sterile falcon tubesin phosphate buffer saline (PBS) as well as endocervical and peritoneal swabs for DNA extraction. Specific serum levels of IgG and IgA to C. trachomatis were determined using ELISA technique. C. trachomatis DNA was typed by polymerase chain reaction (PCR) and sequenced for OMP1 gene for confirmation of PCR results. Data were analyzed using SPSS package, version 20. A p value of less than 0.05 was considered statistically significant. Results: The mean age for cases and controls was 30.2 ± 6.5 and 27.0 ± 5.6 years respectively. The mean gestational age for the cases and controls was 5.0 ± 1.1 and 7.0 ± 2.3 weeks respectively. The controls are of moderate socio-economic class (86.7%, 78/90) compared with the cases who are poor (55.6%, 25/45). The mean level of serum IgA was significantly higher in cases compared with controls p<0.001, whereas the mean level of serum IgG was comparable p = 0.78. The frequency of C. trachomatis confirmed DNA in fallopian tube tissue in cases was 44.2% (19/43), whereas 33.3% (14/42) from cervical swabs and 7.5% (3/40) from peritoneum swabs.The IgA mean level was significantly associated with the presence of C. trachomatis DNA p = 0.04. Interestingly recessive operating curve (ROC) showed that C. trachomatis ELISA for IgA has defined a cut-off value of 0.5C. trachomatis IgA index with a sensitivity of 74.40% and specificity of 60.8%. Conclusion: Unlike serum IgG level, serum IgA is an immunological marker of ectopic pregnancy due to C. Trachomatis since it differentiates between ectopic pregnancy and non-ectopic pregnancy. C. trachomatis DNA is abundant in ectopic tissue compared with the endocervix. IgA-based remote setting-adapted dipstick test can be developed and used for routine antenatal care for early detection of ectopic pregnancy due to C. trachomatis at a primary health care level in Sudan. It can also be of value when the sonogram fails to locate it.
Description: 179page
URI: http://khartoumspace.uofk.edu/123456789/26669


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