التعبير الجيني لبعض العوامل المناعية وتحديد مستوياتها في مرضى الالتهاب الرئوي المكتسب من المجتمع

Gene Expression and Level Determination of Some Immunological Factors in Patients with Community -Acquired Pneumonia

Summary
Pneumonia is considered a disease that affects the lower respiratory system and occurs as a result of lung infection with bacteria, viruses, parasites, and fungi. It causes serious diseases and complications ,and one of these complications is sepsis, which is a life-threatening organ dysfunction caused by a desregulated host response to infection. It is considered a major cause of morbidity and mortality worldwide, as it affects about 49 million people and causes the death of about 11 million people around the world annually, and as a result of the increase in the number of cases of sepsis as a result of community-acquired pneumonia. It is necessary to find rapid diagnostic methods such as Complete Blood Count(C.B.C.), some of Immunological Factors , and some of Immune Related – Genes for reducing morbidity and mortality.
In this study (120) participants were collected at Imam Al-Sadiq Hospital in Babylon Governorate and Imam Al-Hussein Medical City in Kerbala Governorate from December 2022 to June 2023 and divided into three groups (60) patients with community-acquired pneumonia, (20) patients with sepsis due to community-acquired pneumonia and (40) people as a control groups. They were diagnosed by specialized doctors based on some non-culture methods such as clinical methods (signs , symptoms) and tomographic methods(X-ray or/and Computed Tomography scan).
Average of age groups of participants were (54.9, 72.5 and 51.4 years) for three participants groups (community-acquired pneumonia, sepsis due to community-acquired pneumonia and healthy groups) respectively, and the age range was between 23 to 95 years. Nonetheless, The participants in this study were 30 male and 30 female for the community-acquired pneumonia group, with 7 male and 13 female in the sepsis due to the community-acquired pneumonia group, while there were 18 male and 22 female for the healthy group. The results of the study indicate that the incidence increased significantly with increasing age, while Sex did not showed any significant in the three groups.
There was no growth in the blood cultures of patients with sepsis due to CAP due to number of samples was low, previous treatment with antibiotics, not used more one bottle at different times, and anaerobic cultivation methods were not used. In contrast the results of sputum culture showed that the bacterial isolates that causes of the infection were belong to the Gram-positive bacteria with 45 isolates and percentage (56.25%) and It was sensitive to Meropenem, Rifampin , and Cefipime. Streptococcus pneumonia was the most common of isolated of Gram Posative bacteria. and the number of Gram-negative bacteria was 35 isolates with percnteage(43.75%) and It was sensitive to Cefipim, Amikacin and Meropenem and the results showed that Hemophilus influenzae was the most common type Gram negatine bacteria.
The results of the Procalcitonin showed a highly significant difference (P. Value < 0.000) between the patients and the control groups. The CBC results between the patients and the control groups revealed significant differences (P. Value < 0.000) in White Blood Cells, Granulocytes , Granulocytes %, and the ratio of Neutrophils to Lymphocytes , while plateletes lymphocytes ratio between the patients and control groups were highly significant difference at P. Value < 0.007.
The results of the concentrations of Toll Like Receptor 2(TLR2), Toll Like Receptor 4(TLR4), Chemokine(C-X-C motif) ligand 3(CXCL3) and Chemokine(C-C motif) ligand 7(CCL7) in the serum were determined by the ELIZA test. The results showed a highly significant difference in the concentration of TLR2 and CXCL3 between the patient group and the control group at a value of (P. Value < 0.000), while the results did not show a significant difference in the concentration of TLR4 and CCL7 at a value of P. Value < (0.585 and 0.673) respectively.
The results of gene expression levels (Fold Chang) of immune-related genes (TLR2F,TLR4F, Cluster Differentiation 81 (CD81F), and Human Leukocyte Antigen (HLA – DMAF) showed there was a significant difference in the level of gene expression for the genes (TLR2F, TLR4F, and CD81F) between the patient group and the control group at P. Value < (0.000), while the results in found the level of gene expression in the group of CAP patients was more than sepsis due to CAP, while the results level of gene expression for the HLA-DMAF gene did not appear significantly different (P. Value < 0.056).
Finally, early detection of causative agents is one of the most essential aspects since , it allows for rapid treatment and reduces mortality rates that may evolve during the time of infection. Even though blood culture represents the gold standard and most used diagnostic method for detecting sepsis , this method is insufficiently sensitive. There are more specific medical laboratory criteria that can be used for early diagnosis of sepsis, especially when the blood culture fails to detect the etiologic agent of sepsis despite the presence of clinical symptoms.