LIPID PROFILE OF ENTERIC FEVER PATIENTS IN ENUGU IFEOMA  · Enteric fever or typhoid fever

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  • LIPID PROFILE OF ENTERIC FEVER PATIENTS IN ENUGU METROPOLIS

    BY

    IKEGWUONU IFEOMA CHINWE

    PG/MSC/02/31964

    DEPARTMENT OF MEDICAL LABORATORY

    SCIENCES UNIVERSITY OF NIGERIA, ENUGU CAMPUS

    THIS DISSERTATION IS SUBMITTED TO THE DEPARTMENT OF MEDICAL LABORATORY SCIENCES IN PARTIAL FULFILLMENT OF THE REQUIREMENTS

    FOR THE AWARD OF MASTER OF SCIENCE (MSC) DEGREE IN MEDICAL LABORATORY SCIENCES

    (CLINICAL CHEMISTRY)

    FEBUARY, 2009.

    1

  • CERTIFICATION

    This is to certify that this Dissertation titled LIPID PROFILE

    OF ENTERIC FEVER PATIENTS IN ENUGU METROPOLIS

    was carried out by Ikegwuonu Ifeoma Chinwe of Department

    of Medical Laboratory Sciences, University of Nigeria, Enugu

    Campus under my supervision.

    .. .

    ONYEANUSI J.C Date

    Supervisor

  • DEDICATION

    This work is dedicated to the memories of my late father,

    H.R.H. Igwe Sir G.O. Achufusi, to my husband Chief Hon.

    Ifenna P. Ikegwuonu and all my children Adanna, Tobenna,

    Chidera, Ifeoma, Ifechukwu and Kosisochukwu.

  • ACKNOWLEDGEMENT

    My first gratitude goes to God Almighty for the gift of

    life, wisdom and strength from the beginning of this work to

    its completion.

    I express my sincere gratitude to my supervisor J.C.

    Onyeanusi for his fatherly advice and relentless effort to see

    to the completion of this work.

    My special thanks goes to the Dean faculty of Health

    Sciences university of Nigeria Enugu Campus Prof. N.F.

    Onyemelukwe for her motherly advice and contributions to

    the success of this work. I also thank my lecturers I.S.I.

    Ogbu, Mr. Ureme, Mr. IG. Maduka and others for their

    criticism, advice and helping out with the analysis.

    This work would not have been possible without the

    special contributions of the Doctors and staff of M.O.P and

    G.O.P.D of both University of Nigeria Teaching Hospital and

    Parklane Specialist Hospital Enugu, who made their

    patients available for this project. I am also indebted to the

    Doctors and Medical. Lab. Scientists of Annunciation and

    Ntasi-Obi Ndi No-Na Afufu Hospitals for helping out with

    their patients.

    My most profound gratitude goes to my mum, children

    and finally my darling husband Chief Hon. Ifenna .P.

    Ikegwuonu whose love, support and caring helped me all

    through these years of struggling. May God bless you all in

    Jesus name Amen.

  • ABSTRACT

    Lipid profile of three hundred subjects (two hundred positively diagnosed of

    enteric fever and one hundred apparent healthy subjects) who were

    attending clinics in university of Nigeria Teaching Hospital (Ituku-Ozzalla,

    Parklane, Ntasi Obi-ndi-no-na-afufu and Annunciation, Hospitals Enugu

    were estimated. The enteric fever was investigated using slide and tube

    agglutination method and confirmed using enterocheck WB kit from Zephyr

    Biomedicals Verna, India. The serum cholesterol (TC), Triglycerides (TG) and

    High density Lipoprotein cholesterol (HDL-C) were assayed using enzymatic

    method while very low density lipoprotein cholesterol (VLDL-C) and low

    density lipoprotein (LDL-C) levels were estimated using Friedewald formula.

    The ages of all subjects were between twenty and forty years. The results

    showed no significant difference (P>0.05) in the mean values of TC, TG,

    HDL-C, VLDL-C and LDL-C for patients and controls. However, there was

    statistically significant difference (P

  • LIST OF TABLES

    TABLE TITLE PAGE

    2:1 Physical and chemical description of plasma

    lipoproteins in humans ..19

    2.2 Classification and properties of major human plasma

    apolipoproteins....22

    2.3 Physiological functions of the apolipoproteins in

    human

    plasma....26

    4.1 Lipid profile of enteric fever patients and of

    controls......62

    4.2 Lipid profile levels of male patients and age

    matched controls..

    .63

    4.3 Lipid profile of female patients and age-matched

    controls..

    64

    4.4 Lipid profile levels of patient (M & F) and age-

    matched controls (M&F) grouped according to age

    (in fives)65

    4.5 Correlation of parameters (TG, TC, HDL-C, LDL-

    C, VLDL-C) with age and tire O and H of

    patients...66

  • LIST OF FIGURES

    FIGURES TITLE

    PAGE

    4.1 Relationship between serum Triglycerides of patients and

    age.............6

    6i

    4.2 Relationship between serum total cholesterol of patients and

    age...6

    6ii

    4.3 Relationship between serum HDL Cholesterol of patients

    and

    age......66iii

    4.4 Relationship between serum LDL cholesterol of patients

    and

    age...66iv

    4.5 Relationship between serum VLDL Cholesterol of patients

    and

    age......66v

    4.6 Relationship between serum triglycerides of controls and

    age......6

    6vi

    4.7 Relation betweens serum HDL-cholesterol of controls and

    age..66

    vii

    4.8 Relationship between serum HDL cholesterol of

    controls and

    age.....66viii

    4.9 Relationship between serum LDL cholesterol of

    controls and age

    ........66ix

  • 4.10 Relationship between serum VLDL cholesterol of

    controls and age

    ..66x

    4.11 Relationship between lipids profile of patients and age groups

    (in

    five)66

    xi

    4.12 Relationship between lipids profile of controls and age

    groups (in

    five)....66xii

  • LIST OF ABBREVIATIONS

    Abbrev. Full Meaning

    HDL High Density Lipoprotein

    LDL Low Density Lipoprotein

    VLDL Very Low Density Lipoprotein

    TG Triglyceride

    TC Total serum Cholesterol

    FFA Fatty acids

    LCAT Lecithin Cholesterol Acyl Transferase

    IDL Intermediate Density Lipoprotein

    LP (a) Lipoprotein (a)

    Apo Apolipoprotein

    SD Standard Deviation

    Ig Immunoglobulin

    HTGL Hepatic Triglyceride Lipase

    LDL Lipoprotein Lipase

    CAD Coronary Artery Disease

    DNA Deoxyribonucleic Acid

    DM Diabetes Mellitus

    CETP Cholesteryl Ester Transfer Protein

    MP Malaria Parasite

    ML Milliliter

    MMOL/L Milimole Per Liter

    NS Not Significant

    SG Significant

    FH Familial Hypercholesterolemia

  • TABLE OF CONTENTS

    Approval pagei

    Dedicationii

    Acknowledgement....iii

    Abstractiv

    List of Tablesv

    List of Figures.vi

    List of Abbreviationsvii

    Table of Contents.viii

    CHAPTER ONE: INTRODUCTION

    1.1 Background of the study...1

    1.2 Aim and Objectives 5

    CHAPTER TWO: LITERATURE REVIEW

    2.1Pathphysiology of Enteric Fever..6

    2.2 Pathogenesis of Enteric Fever..6

    2.3 Lipid Chemistry....8

    2.4 Classification of Lipids...8

    2.5 Properties of Lipids.11

    2.6 Lipoproteins..13

    2.6.1 Functions of Lipoproteins.14

    2.6.2 Classification of Lipoproteins..15

    2.7 Apolipoproteins..20

    2.8 Factors Affecting Serum Lipid Levels............33

    2.9 Lipid Metabolism in Diseases..........36

  • 2.10 Lipid Metabolism in Enteric Fever44

    2.11 Normal Expected Lipids values.....45

    CHAPTER THREE: MATERIALS AND METHODS.

    3.1 Subjects...49

    3.2 Samples...49

    3.3 Methods for Enteric Fever Estimation..50

    3.4 Enteric fever Confirmatory Test..52

    3.5 Methods for Lipid Profile Estimation.54

    CHAPTER FOUR: RESULTS..59

    CHAPTER FIVE: DISCUSSION AND CONCLUSION.67

    REFERENCES..70

    APPENDIX 1..76

    APPENDIX 1189

    APPENDIX11191

  • CHAPTER ONE

    INTRODUCTION

    1.1 Background of the Study

    Enteric fever or typhoid fever is a major public health problem

    in the developing countries of the world with an estimated annual

    incidence of 540 per 100,000 (Katung, 2000). Typhoid fever is endemic

    in the economically disadvantaged countries in Africa like Nigeria,

    Asia and South and Central America (Philip 2000).

    Enteric fever is a severe bacterial infection which is used to

    describe two different but similar diseases known as typhoid fever and

    paratyphoid fever. Typhoid fever is caused by Salmonella typhi while

    paratyphoid fever is caused by Salmonella paratyphi A, Salmonella

    paratyphi B and Salmonella paratyphi C. Salmonella typhi must be

    ingested to cause disease. Transmission often occurs when a person

    in the carrier state does not wash hands thoroughly (or not at all) after

    defecation and serves food to others. This pathway is sometimes

    called the fecal-oral route of disease transmission. In countries where

    open sewage is accessible to flies, the insects land on the sewage, pick

    up the bacteria, and then contaminate food to be eaten by humane.

    After being swallowed, the S.typhi bacteria head down the digestive

    tract, where they are taken in by cells called mononuclear phagocytes.

    These phagocytes are cells of the immure system, whose job it is to

    engulf and kill invading bacteria and viruses. In the case of S.typhi,

    however the bacteria are able to survive ingestion by the phagocytes

  • and multiply within these cells. This period of time, during which