الفهرس 
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Abstract
Schistosoma mansoni infection is a parasitic infection causing severe morbidity and mortality in several regions of the developing world,including Egypt. It is characterized by a strong T-helper type 2 (Th2)cell-associated immune response, but in H. pylori infection, it is associated with interferon-gamma (IFN-gamma) increase and induction of Th1 immune response. Few data were available about the immune response of cases infected with combined H. pylori and schistosomiasis.Thus, the investigation of the cytokine pattern in patients coinfected with both H. pylori and Schistosoma mansoni was rationale of the presentstudy.The objective of the present study was to evaluate changes in cytokinelevels in patients with S. mansoni and H. pylori concurrent infection.The present study included 96 individuals of different age groups ranging from 18-65 years. They were subdivided into S. mansoni infected group,H. pylori infected group, S. mansoni and H. pylori concurrent infection group and the apparently healthy control group.All the examined groups were subjected to full history taking, thorough clinical and laboratory investigations.Diagnosis of schistosomiasis was done by stool examination by different techniques, IHAT and rectal snip. H. pylori infection was diagnosed by ELISA test for IgG in patient’s sera. Then levels of IL-4 and IFN-γ were measured in all studied groups.The study revealed that infection rate of both S. mansoni and H. pyloriwas higher in rural areas.Regarding different methods for diagnosing schistosomiasis including stool analysis, rectal snip, Kato thick smear and IHAT, results revealed& conclusion that all cases were positive by IHA test, followed by rectal snip 35.4%(17 cases), and lastly stool analysis using Kato thick smear and concentration methods 20.8% (10 cases).The results showed that the patients infected with H. pylori had significantly higher serum levels of IFN-gamma compared to controls,combined coinfection or schistosomiasis alone groups (P < 0.001).On the other hand, serum levels of IL-4 were significantly higher in patients with schistosomiasis compared to controls and H. pylori infected patients (P < 0.001).
Schistosomiasis appears to induce a Th2 cytokine profile, with increase in serum levels of IL-4, even in the presence H. pylori coinfection. In conclusion, schistosomiasis may downregulate the stimulatory effect of H. pylori on Th1 cytokines.The impact of concomitant S. mansoni infection on H. pylori induced gastritis was studied in patients infected exclusively with H. pylori and coinfected groups. The results revealed that severe gastritis was significantly more common in the patients infected exclusively with H.pylori.It is therefore concluded from the present study that concurrent helminthic infection (schistosomiasis) may modify the inflammatory response to gastric H. pylori infection manifested by the reduction of cellular proliferation activity, and the increase in Th 1 production. Concurrent S. mansoni infection may have a protective effect against the possible progression of H. pylori-induced gastritis towards gastric carcinoma.