Hypoalbuminemia as a predictor of diarrhea caused by blastocystis hominis

Blastocystis hominis is an intestinal protozoan found worldwide, particularly in developing countries, that may cause gastrointestinal symptoms, including diarrhea. We conducted a hospital-based study to identify clinical factors predictive of diarrhea caused by B. hominis. We studied patients with positive stool samples for B. hominis by formalin ethyl acetate concentration technique at Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand between 2003 and 2010. Patients were divided into diarrhea and non-diarrhea groups. Diarrhea patients were categorized if the diarrhea was associated with B. hominis only. In total, 81 patients with isolated B. hominis infection were studied. Of those, 17 patients (21%) had diarrhea associated with B. hominis infection. Eight variables were included in the final model predicting diarrhea caused by B. hominis on multiple logistic regression analysis. Only serum albumin level was significantly associated with diarrhea cases in this study with an adjusted OR of 0.162 and a 95% CI of 0.027- 0.957. Hypoalbuminemia is associated with diarrhea associated with blastocystosis.

Household environmental conditions are associated with enteropathy and impaired growth in rural Bangladesh

We assessed the relationship of fecal environmental contamination and environmental enteropathy. We compared markers of environmental enteropathy, parasite burden, and growth in 119 Bangladeshi children (≤ 48 months of age) across rural Bangladesh living in different levels of household environmental cleanliness defined by objective indicators of water quality and sanitary and hand-washing infrastructure. Adjusted for potential confounding characteristics, children from clean households had 0.54 SDs (95% confidence interval [CI] = 0.06, 1.01) higher height-for-age z scores (HAZs), 0.32 SDs (95% CI = -0.72, 0.08) lower lactulose:mannitol (L:M) ratios in urine, and 0.24 SDs (95% CI = -0.63, 0.16) lower immunoglobulin G endotoxin core antibody (IgG EndoCAb) titers than children from contaminated households. After adjusting for age and sex, a 1-unit increase in the ln L:M was associated with a 0.33 SDs decrease in HAZ (95% CI = -0.62, -0.05). These results are consistent with the hypothesis that environmental contamination causes growth faltering mediated through environmental enteropathy.

[Recurrent diarrhea due to Cystoisopora belli in HIV/AIDS patients receiving HAART]

The Cystoisospora belli, before denominated as Isospora belli, is the etiologic agent of cystoisosoporiasis, an opportunistic infection affecting immunocompromised patients, characterized by chronic diarrhea and weight loss. The incidence of chronic diarrhea for this agent, in HIV patients, has decreased considerably. This thanks to the advent of highly active antiretroviral therapy (HAART), which has improved the patient's immune response and decrease viral load. We present six cases of cystoisosoporiasis recurrent and refractory to treatment in HIV patients, who was being treated with with trimethoprim / sulfamethoxazole (TMP / SMX) orally as a prophylaxis. Five of these patients passed away due to the infection, despite of the fact that they had a good response to HAART (adequate increase in CD4 and viral load undetectable) and they had been treated with second line drugs.

[Enteropathogens responsible for gastrointestinal disorders in HIV patients]

Gastrointestinal disorders or GID are debilitating conditions common in individuals infected by the human immunodeficiency virus (HIV), capable of leading to death. Numerous etiological agents and pathophysiological mechanisms have been involved in this status. Although the use of highly active antiretroviral therapy (HAART) in many countries has greatly reduced the prevalence of gastrointestinal infections, enteric pathogens such as bacteria, parasites, fungi and viruses may still act as opportunist agents in these patients. Cytomegalovirus, adenovirus, calicivirus, astrovirus, rotavirus, enterovirus, picobirnavirus and some more recently described, like bocavirus and Aichi virus, have been detected in HIV patients. However, except for cytomegalovirus, which is an established etiological agent of GID in these patients, the role of the other viruses remains unclear. Several species of Cryptosporidium, microsporidia, Salmonella, atipical mycobacteria and Campylobacter jejuni, have also been recognized as important causes of GID in HIV patients. The progressive incorporation of increasingly sensitive immunological and molecular assays for antigen, antibody and pathogens detection from faeces, has improved the diagnosis of diarrhea and contributed to clarify the etiological significance of some microorganisms in immunocompetent patients. In Venezuela, some information is available about the prevalence of enteric pathogens in immunocompromised patients infected with HIV. The identification of the etiologic agent responsible for this condition may be useful for the management and treatment of these patients, for whom viral enteritis is a disease, which reduces their quality of life and causes a high public health spending.

Strongyloidiasis in a nonagenarian who previously worked in conservancy services

We report a case of strongyloidiasis in a patient born in Hong Kong and was possibly infected via her prior occupation in conservancy services. She presented with chronic diarrhoea, anorexia, and extensive scratch marks over the lower extremities. Further assessment yielded eosinophilia, intermittent dyspepsia, and an episode of unexplained Clostridium perfringens bacteraemia. She was treated with a course of albendazole. Subsequently, the eosinophilia and diarrhoea subsided.

Is there a need for improved Cryptosporidium diagnostics in Swedish calves?

Cryptosporidium parvum is a common pathogen in preweaned calves but in Sweden Cryptosporidium bovis, which is considered apathogenic, is the most common species in this age group and it has been identified in diarrhoeal samples, indicating that it could be a cause of diarrhoea. In routine diagnostic procedures, infection is determined by microscopy, which is not sufficient to differentiate these species. We investigated whether routine Cryptosporidium diagnostic procedures need improvement to include species determination. The relation of Cryptosporidium spp. and subtype with the clinical picture and other pathogens was also investigated. A total of 782 diarrhoeal calf samples were analysed and Cryptosporidium infection was diagnosed in 198 samples. Cryptosporidium parvum was identified in 178, C. bovis in six and mixed C. bovis/C. parvum in seven samples. Twenty-seven C. parvum subtypes were identified, of which 16 were newly described. Except for three herds, only one subtype per herd was identified. Cryptosporidium parvum-positive calves were younger than C. bovis-positive calves and most C. parvum infections were seen at 1-3 weeks of age. Oocyst counts were higher in C. parvum samples. Yellow faecal colour was associated with C. parvum infection. Watery faeces had no greater association with C. parvum infection, but C. parvum subtype family IIa was more common than subtype family IId in watery faecal samples. No other pathogens were detected in the six C. bovis-infected calves, indicating a pathogenic potential. Our results show that species determination does not need to be included in routine Cryptosporidium diagnostic procedures in order to estimate the clinical relevance of infection in diarrhoeal calves. The maximum age when analysis for clinical cryptosporidiosis is performed can be lowered to 6 weeks of age. However, the indicated pathogenic potential of C. bovis warrants further attention.

Prevalence and characters of Entamoeba histolytica infection in Saudi infants and children admitted with diarrhea at 2 main hospitals at South Jeddah: a re-emerging serious infection with unusual presentation

In this study, Entamoeba histolytica had high prevalence and unusual presentation by affecting high proportion of infants under 1 year; severe clinical manifestations, and laboratory findings that were known to be usually encountered in invasive amebiasis as significant leukocytosis for age, neutrophilic leukocytosis for age, and positive C-reactive protein were found among more than 50% of admitted Saudi infants and children with E. histolytica infection in our locality. E. histolytica can be a re-emerging serious infection when it finds favorable environmental conditions and host factors which are mainly attributed to inadequate breastfeeding in this study. This may occur in any other area of the world with the same risk factors, so we must be ready to tackle it with effective and more powerful preventive measures.

[Peculiarities of the distribution of Cryptosporidia (Coccidia: Cryptosporydiidae) in monkeys in an apery]

A total of 520 monkeys belonging to 6 species (Macaca mullata, M. fascicularis, M. nemestrina, Cercopithecus aethiops, Papio anubis, and P. hamadrias) were investigated. Total frequency of occurrence of the protozoan Cryptosporidium in the Adler apery constituted 13.8%. The majority of parasites were found in animals with intestinal disorders such as diarrhea. The lowest frequency of cryptosporidias occurrence was revealed in clinically healthy monkeys. Among sick monkeys, the invasion was most common in infants under one year of age. Cryptosporidiosis is rarely found just as it is, and, as a rule, it accompanied by other parasitogenic and bacterial infections.

Effect of immunosuppression on the course of cryptosporidiosis experimentally

This study evaluated the effect of immunosuppression on experimental cryptosporidiosis, by parasitological and histopathological studies at different days post infection (p.i). A total of one hundred five clean laboratory bred male Wister rats were divided into four groups: normal control group (GI), infected group (GII), immunosuppressed control group (GIII) and immunosuppressed infected group (GIV). The infection was done by inoculation orally with 10(5) Cryptosporidium oocysts in 0.1 ml PBS. The immunosuppression was done by administration of cytotoxic drug (Endoxan) intraperitoneal in a dose of 5 mg/kg/d for 4 weeks. The results showed that in GII, most of animals attained its activities without apparent clinical symptoms except some of them had diarrhea while in GIV, all had diarrhea, loss of appetite, weakness, lethargy and hair loss. The death rate was (10%) in GII while in GIV was 51.4%. The infection rate among GII was 95% and GIV was 100%. The infection intensity was higher in GIV than in GIII and the greatest number of excreted oocysts was observed on day 15th post-infection (PI) in GIV and on day 11th PI in GII. The histopathological changes in the ileum were more advanced in GIV.

A systematic review and meta-analysis of the association between Giardia lamblia and endemic pediatric diarrhea in developing countries

We performed a systematic literature review and meta-analysis examining the association between diarrhea in young children in nonindustrialized settings and Giardia lamblia infection. Eligible were case/control and longitudinal studies that defined the outcome as acute or persistent (>14 days) diarrhea, adjusted for confounders and lasting for at least 1 year. Data on G. lamblia detection (mainly in stools) from diarrhea patients and controls without diarrhea were abstracted. Random effects model meta-analysis obtained pooled odds ratios (ORs) and 95% confidence intervals (CIs). Twelve nonindustrialized-setting acute pediatric diarrhea studies met the meta-analysis inclusion criteria. Random-effects model meta-analysis of combined results (9774 acute diarrhea cases and 8766 controls) yielded a pooled OR of 0.60 (95% CI, .38-.94; P = .03), indicating that G. lamblia was not associated with acute diarrhea. However, limited data suggest that initial Giardia infections in early infancy may be positively associated with diarrhea. Meta-analysis of 5 persistent diarrhea studies showed a pooled OR of 3.18 (95% CI, 1.50-6.76; P < .001), positively linking Giardia with that syndrome. The well-powered Global Enteric Multicenter Study (GEMS) is prospectively addressing the association between G. lamblia infection and diarrhea in children in developing countries.

Molecular characterization of Cryptosporidium spp. in pre-weaned kids in a dairy goat farm in western France

A longitudinal study was undertaken to characterize the course of Cryptosporidium infection in a dairy goat farm located in western France. Two cohorts of twenty-five and fifteen animals, respectively, were sampled once a week from birth to weaning. Each individual fecal sample was screened using direct immunofluorescence (IFT) and if found positive, the Cryptosporidium species was identified using PCR analysis. Seventeen (68% [95% CI: 44-91]) animals were positive at least once during the first study and 14 (93% [95% CI: 80-100]) during the second, after IFT examination. In the first study, the age at first excretion was 17 days and the peak of excretion (mean arithmetic excretion: 22,700 oocysts per gram (opg) of feces) was recorded when kids were between 22 and 28 days old. For the second study, the age at first excretion was 10 days and the peak of excretion (mean arithmetic excretion: 3.4 × 10(6)opg) was recorded in animals aged between 10 and 14 days. Clinical signs were observed only in animals of the second cohort. DNA sequence analysis at the 18S ribosomal RNA locus was successful for 9 of the 27 IFT-positive samples in the first cohort and for 10 of the 34 positive isolates in the second cohort. All isolates were identified as Cryptosporidium xiaoi except one which was identified as Cryptosporidium parvum. Our results confirm that goat kids are hosts for C. parvum and C. xiaoi and that infection by C. xiaoi may be associated with mild clinical signs.

Outbreak of cryptosporidiosis associated with a man-made chlorinated lake--Tarrant County, Texas, 2008

In July 2008, clusters of laboratory-confirmed cryptosporidiosis cases and reports of gastrointestinal illness in persons who visited a lake were reported to Tarrant County Public Health. In response, epidemiologic, laboratory, and environmental health investigations were initiated. A matched case-control study determined that swallowing the lake water was associated with illness (adjusted odds ratio = 16.3; 95% confidence interval: 2.5-infinity). The environmental health investigation narrowed down the potential sources of contamination. Laboratory testing detected Cryptosporidium hominis in case-patient stool specimens and Cryptosporidium species in lake water. It was only through the joint effort that epidemiologic, laboratory, and environmental health investigators could determine that >1 human diarrheal fecal incidents in the lake likely led to contamination of the water. This same collaborative effort will be needed to develop and maintain an effective national Model Aquatic Health Code.

Serious diarrhea with weight loss caused by Capillaria philippinensis acquired in China: a case report

BACKGROUND

Diarrhea caused by Capillaria philippinensis (C. philippinensis) has not been reported in any areas with the exception of Taiwan province in China. We herein report the misdiagnosis and subsequent management of a patient with diarrhea caused by C. philippinensis.

CASE PRESENTATION

A 33-year-old woman from the outskirts of Danzhou city, Hainan province, China, had an 11-month history of chronic diarrhea with abdominal pain, edema, hypoalbuminemia, and severe weight loss. The patient was misdiagnosed at an outpatient clinic and one hospital. She was finally correctly diagnosed with C. philippinensis by stool examination. The patient was given a 30-days course of albendazole (400 mg/day) and had an uneventful and stable recovery.

CONCLUSION

Doctors cannot lose sight of patients' dietary histories, must query stool examination results, and need to expand their knowledge of certain nonlocal and global diseases, especially those described in new case reports. Some diagnostic examinations must be performed repeatedly. Hainan province may be the epidemic focus of C. philippinensis.

[Blastocystis hominis in symptomatic celiac patients]

INTRODUCTION

Celiac disease (EC) not diagnosed or treated affect histological, immunological and nutritional status of patients who suffer it. These changes allow infection by parasites that cause no symptoms in immunocompetent patients, such as Blastocystis hominis (Bh). OBJETIVE. To analyze the presence of Bh in symptomatic celiac patients and describe the clinical, histological, immune and nutritional status in these patients. MATERIAL AND METHOD An observational descriptive cross sectional study was performed. Thirty symptomatic celiac patients (18 women, mean age 41 years old, range 19-68 years), assisted at the Institute of Gastroenterology of Cuba from January to December 2009, entered the study.

RESULTS

Diarrhea and chronic anemia were the most commonly reported clinical manifestations (22 and 4 patients, respectively). The analysis of more than five Bh per field was more frequent in the group ofpatients studied (63.3%), with statistically significant difference in patients with vilous atrophy and low weight (P < 0.03) compared to cases with less than five Bh per feld. No significant differences were found when the immune status of patients was analyzed. CONCLUSIONS. In symptomatic celiac patients with subtotal-total villous atrophy and low weight the finding of more than five Bh perfield should be considered as opportunistic.

Symptomatic chronic strongyloidiasis in children following treatment for solid organ malignancies: case reports and literature review

Strongyloidiasis is an infection caused by the intestinal nematode Strongyloides stercoralis. Infected healthy individuals are usually asymptomatic, however it is potentially fatal in immunocompromised hosts due to its capacity to cause an overwhelming hyperinfection. Strongyloidiasis could be missed during routine screening because of low and intermittent larval output in stool and variable manifestations of the symptoms. We present two cases of strongyloidiasis occurring in children with solid organ malignancies suspected to have the infection based on their clinical conditions and treatment history for cancer. Both patients were diagnosed by molecular and serological tests and were successfully treated. Thus, strongyloidiasis in patients undergoing intensive treatment for malignancies should be suspected, properly investigated and treated accordingly.

Failure to eradicate Isospora belli diarrhoea despite immune reconstitution in adults with HIV--a case series

Isospora belli causes diarrhoea in patients with AIDS. Most respond to targeted therapy and recommendations are that secondary prophylaxis can be stopped following immune reconstitution with ART. We report eight cases of chronic isosporiasis that persisted despite standard antimicrobial therapy, secondary prophylaxis, and good immunological and virological response to ART. Median CD4 nadir was 175.5 cells/mm(3) and median highest CD4 while symptomatic was 373 cells/mm(3). Overall 34% of stool samples and 63% of duodenal biopsy specimens were positive for oocytes. Four patients died, two remain symptomatic and two recovered. Possible explanations for persistence of symptoms include host factors such as antigen specific immune deficiency or generalised reduction in gut immunity. Parasite factors may include accumulating resistance to co-trimoxazole. Research is required to determine the optimum dose and duration of co-trimoxazole therapy and whether dual therapy may be necessary. Mortality was high and pending more data we recommend extended treatment with high-dose co-trimoxazole in similar cases.

Strongyloidiasis: a diagnosis more common than we think

Strongyloides stercoralis is endemic to many tropical regions; however, there is limited knowledge concerning the clinical implication of this helminth, particularly in urban medical centers. We report a case series of strongyloidiasis in our urban medical center in New York City. Patients over the age of 18 years who were examined in our institution from January 1998 to May 2011 were identified by electronic medical record search using International Classification of Diseases, 9th Revision codes. We identified 22 cases of S. stercoralis. Eleven patients were men and 11 were women, with the average age at diagnosis being 62.4 years. Fourteen patients emigrated from the Caribbean, one from Nepal, five were blacks born in the USA, and two did not have their birthplace documented. The main presenting complaints were diarrhea (9/22), abdominal pain (6/22), vomiting (7/22), and weight loss (8/22). Seventeen patients demonstrated eosinophilia. Four patients were positive for human T-lymphotropic virus-1 antibodies, and three patients were infected with HIV. Diagnosis was made with stool examination (19/22), bronchoalveolar lavage (1/22), gastric biopsy (1/22), and duodenal biopsy (3/22). Among six patients who had upper endoscopy performed, the findings commonly included gastritis and gastric and duodenal ulcers. After treatment, 12/22 showed resolution of symptoms. Although a diagnostic approach tends to start with stool collections, consideration of upper endoscopy with biopsy in symptomatic patients is advisable. The absence of eosinophilia should not deter the clinician from seeking a diagnosis. Although often not done, ascertaining HIV and human T-lymphotropic virus-1 status should be part of the work-up.

[High perinatal mortality associated with triple anthelmintic resistance in a German sheep flock]

High perinatal mortality, low milk yields and occasional ewe deaths were investigated in a Dorper sheep flock in Southern Germany. Parasitic gastroenteritis due to Trichostrongylus spp. associated with severe weight loss despite regular anthelmintic treatments of the flock was identified as the underlying cause. A faecal egg count reduction (FECR) test revealed zero reduction after treatment with ivermectin or albendazole, respectively, and a FECR of 57.9% following treatment with levamisole. These results indicate a lack of, or considerably reduced efficacy of substances from all three classical groups of anthelmintics and demonstrate that triple anthelmintic resistance is also present in Germany. The introduction of resistant worm populations with imported livestock, excessive use of anthelmintic drugs and under-dosing of goats have possibly led to the problem in the flock described. Veterinary advice on anthelmintic treatments and responsible parasite control programmes are therefore crucial in small ruminant flocks.

Quantification of diarrhea risk related to wastewater contact in Thailand

Wastewater reuse contributes to closing the nutrient recycling loop as a sustainable way of managing water resources. Bangkok has over a thousand man-made drainage and irrigation canals for such purposes. Its use for agricultural and recreational purposes has a long tradition in rural and peri-urban areas. However, the continuation of these practices is increasingly questioned since potential health risks are an issue if such practices are not appropriately managed. The microbial and chemical quality of canal water has considerably deteriorated over the last decade, mainly because of discharged, untreated domestic and industrial wastewater. It is important to understand the health risks of wastewater reuse and identify risky behaviors from the most highly exposed actors promote the safe use of wastewater. This study assessed diarrhea infection risks caused by the use of and contact with wastewater in Klong Luang municipality, a peri-urban setting in Northern Bangkok, using quantitative microbial risk assessment. Wastewater samples were collected from canals, sewers at household level, and vegetables grown in the canals for consumption. Samples were also collected from irrigation water from the agricultural fields. Two protozoa, Giardia lamblia and Entamoeba histolytica, were quantified and analyzed by real-time PCR, exposure assessment was conducted, and finally, the risk of infection due to contact with wastewater in different scenarios was calculated. The results showed that canal water and vegetables were heavily contaminated with G. lamblia and E. histolytica. Infection risk was high in tested scenarios and largely exceeded the acceptable risk given by WHO guidelines.

[Endemic cryptosporidiosis--underdiagnosed disease in Finland]

Acute diarrhea caused by Cryptosporidium-protozoan is rarely diagnosed in Finland. The infection is usually self-limited and does not require antimicrobial treatment. Cryptosporidiosis, like other intestinal parasite infections, is mostly associated with travelling, but may also cause large waterborne epidemics. Contact with infected calves may be a source of cryptosporidiosis also in Finland. Cryptosporidiosis should be considered in patients suffering from severe or long-lasting watery diarrhea. We describe three cases of cryptosporidiosis, originating from infected calves. These cases show that verification of the etiology of human cryptosporidiosis associated with calves may be difficult and demands collaboration of clinicians, laboratories and veterinarians.

[Intestinal parasite infections]

Symptoms in a diarrhea patient are most commonly due to a virus or a bacterium, but they may also be caused by a parasite. A long incubation period is typical of intestinal parasite infections, and in addition to diarrhea they cause prolonged symptoms such as abdominal pain and nausea. Parasitic cyst forms are secreted with feces and are highly tolerant against various environmental conditions. The infections are caught via fecally contaminated food or drink. The diagnosis is based on a formalin-fixed fecal parasitic specimen, leading to further investigations when necessary.

CRYPTOSPORIDIOSIS AND ITS GENOTYPES AMONG CHILDREN ATTENDING MOI TEACHING AND REFERRAL HOSPITAL IN ELDORET, KENYA

OBJECTIVES

To determine the prevalence of cryptosporidiosis and the associated factors, and characterise the Cryptosporidium isolates from children aged five years and less with diarrhoea.

DESIGN

A prospective cross-sectional study.

SETTING

This was a health facility and laboratory based study. Screening for Cryptosporidium oocysts was done at the Microbiology laboratory, School of Medicine, Moi University, Eldoret and genotyping and sub-genotyping at the Kenya Medical Research Institute, Nairobi, Kenya.

SUBJECTS

Children aged five years and less seen at the outpatient clinic and those admitted in the pediatric wards at MTRH were recruited into the study upon obtaining assent and written consent from the parents or guardians.

RESULTS

The prevalence of cryptosporidiosis was 9.8% (N = 317). A duration of diarrhoea of more than two weeks was associated with cryptosporidiosis (OR = 1.8301) compared to those with diarrhoea for less than one week. There were no sex related differences in the cryptosporidiosis prevalence (P = 0.9752). Waste disposal, water sources and treatment, and livestock in homesteads were not associated with cryptosporidiosis. About 82% of the isolates were C. hominis and 18% were C. parvum. There were 6 subtypes of C. hominis and 4 subtypes of C. parvum in circulation.

CONCLUSION

The prevalence of cryptosporidiosis is comparable to other regions of the worldwith C. hominis being the most common followed by C. parvum. Human-to-human transmission is the mainmode of spread of cryptosporidiosis. All the Cryptosporidium isolates were from children residing in peri-urban and rural areas.

Species identification of trichomonads and associated coinfections in dogs with diarrhea and suspected trichomonosis

Trichomonads have been infrequently reported in the feces of dogs where their pathogenicity remains uncertain. It is currently unknown whether Tritrichomonas foetus or Pentatrichomonas hominis is identified more commonly in dogs with trichomonosis or how often these infections are accompanied by concurrent enteric infectious agents. The objective of this study was to determine the identity of trichomonads present in a series of 38 unsolicited canine diarrheic fecal samples submitted for T. foetus diagnostic polymerase chain reaction (PCR) testing between 2007 and 2010. We also examined each fecal sample for an association of trichomonosis with concurrent infection using a convenient real-time PCR panel for nine gastrointestinal pathogens. P. hominis, T. foetus, or both were identified by PCR in feces of 17, 1, and 1 dogs respectively. Feces from the remaining 19 dogs were PCR negative for T. foetus, P. hominis and using broader-spectrum Trichomonadida primers. The total number and specific identities of concurrent enteropathogens identified did not differ between fecal samples from dogs that were or were not identified by PCR as infected with trichomonads. These results suggest that P. hominis infection is more frequently identified than T. foetus infection in diarrheic dogs with trichomonosis and that concurrent enteropathogen infection is common in this population.

Study of nonoutbreak giardiasis: novel findings and implications for research

BACKGROUND

The burden of nonoutbreak-related Giardia infections in the US is poorly understood, with little information on its impact on people's lives and on unusual manifestations of infection. This study was designed with the objectives of better defining the impact of infection, examining the occurrence of extraintestinal manifestations, and determining risk factors for delayed treatment of infection.

METHODS

Foodborne Diseases Active Surveillance Network surveillance was used to identify persons with nonoutbreak-related, laboratory-confirmed Giardia infection. People were enrolled into the Risk Factor arm and the Delayed Enrollment arm. Detailed questionnaires collected information on clinical manifestations, impact on activities of daily living, health care utilization, and treatment.

RESULTS

The study enrolled 290 people. Multivariate predictors of delayed study enrollment, a surrogate for delayed diagnosis of Giardia, included intermittent diarrheal symptoms, delayed time to first health care visit, and income. Decreased ability to participate in one's activities of daily living was reported by 210 (72.4%) participants. Appropriate therapeutic agent for Giardia was received by 237 (81.7%) by the time of study enrollment. Extraintestinal manifestations of Giardia were reported by 72 (33.8%) persons who enrolled in the Risk Factor arm.

CONCLUSIONS

The presence of intermittent diarrhea contributes to delayed health-seeking behavior and to delayed diagnosis of Giardia. More study is needed to determine if this symptom can help distinguish Giardia from other causes of infectious diarrhea. The occurrence of extraintestinal manifestations of Giardia infection does not appear to be rare, and merits further study.

[Protozoal antigen positivity in diarrheal patients admitted to emergency service: a point prevalence study]

Intestinal parasites are the important etiological agents of water and food related diarrhea cases which are frequently seen during summer/early autumn seasons in developing countries. This point prevalence study was aimed to determine the protozoal antigen positivity rate in diarrhea cases admitted to the emergency service in one single day. A total of 198 diarrheal patients (90 male, 108 female; age range: 1-82 years, mean age: 29 years) who were admitted to the emergency service of Ankara Training and Research Hospital were included in the study. Macroscopic and direct microscopic examinations were performed for the stool samples of patients, and the samples which yielded pathological microscopic findings (e.g. presence of leukocytes, erythrocytes, and trophozoits) were investigated in terms of Entamoeba histolytica adhesin antigen, Giardia intestinalis cyst antigen and Cryptosporidium oocyst antigen by commercial ELISA kits (Techlab, USA). Macroscopic examination of the stool samples revealed that 60 (30%) of them had blood and mucous, 137 (69%) were watery and one sample had normal appearance. Pathologic results were obtained for 96 (48.5%) of the samples by microscopic examination: 36 (37.5%) revealed erythrocytes, 90 (93.7%) had leukocytes and 3 (1.5%) had G.intestinalis trophozoites. Since Shigella spp. were cultured in two of these 96 samples, these two cases were omitted from the study and 94 samples were investigated by ELISA assays. G.intestinalis was detected in 13 (13.8%) and E.histolytica in 2 (2.1%) samples while Cryptosporidium antigen was not detected in any of the samples by the ELISA assays. It was concluded that ELISA antigen assays were rapid and cost-effective methods for the determination of the causative agent in cases of diarrhea.

[Detection of Cryptosporidium infection among HIV/AIDS patients with chronic diarrhea in Beijing, Henan and Xinjiang of China]

OBJECTIVE

To investigate the Cryptosporidium infection and its epidemiological characteristics in HIV/AIDS patients with chronic diarrhea.

METHODS

Stool samples collected from HIV/AIDS confirmed patients with chronic diarrhea who lived in Beijing, Henan and Xinjiang. Samples were concentrated by Formalin-Ethyl Acetate Sedimentation technique and stained by modified acid-fast stain (AFS) for the identification of oocysts by microscopy. CD4(+)T cells count was performed by Flow Cytometry.

RESULTS

The overall infection rate of Cryptosporidium in AIDS patients was 12.6% (32/253). The infection rates of oocysts in the area of Beijing, Henan and Xinjiang were 5.97% (4/67), 16.1% (24/149) and 10.8% (4/37) respectively. The infection rate of oocysts in the urban areas was 6.5% (7/104) while in the countryside it was 16.8% (25/149) and the difference was significantly different. However, there were no any differences discovered between the infection rates on patient's gender or on infection occurred in different seasons. The infectious rates of oocyst in patients on different stages of the disease were also significantly different (P < 0.01).

CONCLUSION

AIDS patients infected by Cryptosporidium were not rarely seen in northern China. The rate of infection was not associated with patient's gender but was associated with patient's living environments. Patients living in the countryside, with lower lever of CD4(+)T cells counts and at the middle/late stage of the disease, Cryptosporidium infection appeared to be high.

Detection of faecal Cryptosporidium parvum antigen in diarrheic Holstein dairy cows

Over a one-year period, based on a random cluster sampling design, 661 faecal samples from natural cases of diarrheic calves were taken in Fars province of Iran. The samples were taken from the 267 diarrheic calves of high and 394 diarrheic calves of average producing Holstein dairy cows. Faecal samples were collected directly from the rectum. Herd selection was based on geographical location and density of cattle in the region. Samples were collected based on 5 percent of herd population in 4 geographical regions: North, West, East and South of Fars province. The herds were stratified into small, medium and large size. Laboratory investigation consisted of a direct identification test for antigen of Cryptosporidium parvum. All herds had HPDC and APDC Cryptosporidium-infected diarrheic calves in their population. Diarrheic Cryptosporidium infected HPDC calves in southern region of Fars province were at much lower risk (P<0.05) than APDC calves. The rate of Cryptosporidium infection in diarrheic APDC calves in southern region of Fars province was highest when compared to other geographical locations. When considering the effect of age, diarrheic Cryptosporidium affected APDC Holstein calves of younger dams (>2 to 3years) showed a higher rate of infection when compared to diarrheic HPDC Cryptosporidium infected ones. There were no differences among the occurrence of Cryptosporidium infection in diarrheic HPDC and APDC calves of different herd size groups.

[Two diarrhea cases caused by Cyclospora cayetanensis]

Cyclospora cayetanensis is an intestinal protozoon that has emerged as an important cause of endemic or epidemic diarrheal disease in children and adults worldwide. Cases of cyclosporiasis have been frequently missed, since it is difficult to detect the parasite in fecal sample, despite an increasing amount of data regarding this parasite. In this case report two patients admitted to hospital with complaints of diarrhea and abdominal pain, were presented. Blood and urine biochemistry of both of the patients were within the normal limits and no pathogenic bacteria were grown in their stool samples. Occult blood in stool were negative in both cases. Both of the cases had normal serum immunoglobulin levels and had negative viral hepatitis, HIV and autoimmune markers. Direct microscopic examination and modified acid-fast staining of the stool samples revealed C.cayetanensis oocysts. Clinical response and eradication of the parasite were achieved with two weeks trimethoprim/sulphamethoxazole (2 x 160/240 mg) therapy. Since both cases applied in July 2009, an epidemiological investigation was initiated, however, no relation was determined. Although Cyclospora infections are assumed to be endemic in our country, the sporadic case reports might be attributed to the lack of relevant information about the parasite by the clinicians, lack of appropriate laboratory diagnosis and specialized personel for parasitic examination. Thus, screening studies performed with appropriate diagnostic methods for Cyclospora, might provide more informative epidemiological data related to this infection in Turkey.

[Cyclospora cayetanensis - the rare causal agent of diarrhoeal diseases]

Cyclospora cayetanensis a casual agent of diarrhoeal diseases, was detected in 6 out of 3 097 patients between February 2009 and March 2010 using standard parasitological methods. Five cases were imported from the endemic countries. One patient was the first case with no travel history in the Czech Republic.

First description of naturally acquired Tritrichomonas foetus infection in a Persian cattery in Spain

Tritrichomonas foetus has been identified as the causative agent of feline intestinal trichomonosis, characterized by clinical signs of chronic large bowel diarrhoea. This disease has been reported in cats from the USA, Europe and Australia. However, its epidemiology is still unclear. The aim of the present study was to describe T. foetus infection in a Persian cattery in Spain. T. foetus infection was sequentially diagnosed in 20 cats by direct faecal smear examined under the microscope, specific culture (In Pouch TF medium) and PCR. A standard coprological sedimentation method was also performed in order to screen for other intestinal parasites in all the cats included. In addition, sera were tested for IgG antibodies against Leishmania infantum, Toxoplasma gondii, and for the detection of feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV). Five out of 20 cats were positive for T. foetus (25%), two of them by microscopy, culture and PCR and three by culture and PCR. No association was found between T. foetus infection and age or sex. L. infantum and T. gondii seroprevalence rates were 15% and 10%, respectively. The prevalence of FeLV p27 antigen and of FIV antibodies in the study population was zero. Cystoisospora spp. oocysts were detected in one cat. These preliminary results show that the transmission of T. foetus infection in cluster conditions may occur between asymptomatic cats and young or immunocompromised animals.

Modified acid fast staining: a better diagnostic tool in chronic diarrhoea due to cryptosporidiosis

BACKGROUND

Cryptosporidium parvum is an emerging pathogen responsible for chronic diarrhoea in children and immuno-compromised individuals, especially AIDS patients. Currently, there is no effective therapeutic strategy for treating cryptosporidiosis, therefore control and supportive treatment of cryptosporidiosis depends upon rapid and accurate diagnosis of this infection.

METHODOLOGY

A descriptive study was conducted in the Pathology Department of Khyber Medical College and Pathology Laboratory of Khyber Teaching Hospital over a period of one year March 2007-April 2008. A total of 200 stool samples were tested for the presence of C. parvm oocysts from children < 5 years age suffering from diarrhoea for > 5 days. Total and differential leukocyte count was determined to assess immune status of the patients. Modified Ziehl-Neelsen (Z-N) staining, a rapid, sensitive and easy test, was used successfully for the detection of C. parvum oocysts in stool specimen.

RESULTS

Cryptosporidium oocysts were found in 18 (9.0%) samples. Out of 18 positive cases, 13 (72.2%) children had lymphopenia hence their immune status was impaired. Infection was common in children between 1-24 months of age. Mean duration of diarrhoea was 11 months. Most of C. parvum infected children were consumers of well water (77.8%).

CONCLUSION

Cryptosporidiosis, although a self-limiting disease, rarely investigated routinely, can become chronic and life threatening in immuno-compromised individuals. Majority of affected patients are immune-compromised. Modified Z-N is a sensitive and rapid method which can explore the gravity of this infection even further if used routinely and may control morbidity and mortality associated with this infection.

[Cyclospora cayetanensis: biology, environmental distribution and transfer]

Cyclospora cayetanensis is an apicomplexan protozoan that has emerged as an important pathogen causing endemic or epidemic diarrheal disease worldwide. In industrialized countries, the parasite has been recognized as the causative agent of several outbreaks of diarrheal illness mostly associated with produce imported from endemic areas. In developing countries, human cyclosporosis is widely distributed. Infection rates from 0% to 41.6% have been described in the general population. However, the epidemiology, biology, and ecology of C. cayetanensis are not fully understood. The life cycle is not completely characterized, although it appears to require a single human host to be accomplished. The role of animals as natural reservoirs of the parasite remains to be determined. Little information is available concerning the environmental distribution and vehicles of transmission of C. cayetanensis. Contaminated water, foods or soil can be vehicles of spread of the parasite. The significant uncertainties that remain in the knowledge of C. cayetanensis highlight the need for continuing research in several areas, including its basic biology and environmental distribution.

In a trial of the use of miltefosine to treat HIV-related cryptosporidiosis in Zambian adults, extreme metabolic disturbances contribute to high mortality

There is still no effective treatment for cryptosporidiosis even though the disease has a significant impact on HIV-infected adults and children. Following evidence of the drug's promising efficacy in vitro, a phase-1-phase-2 study of miltefosine (given at 2.5 mg/kg for 14 days, with the dose capped at 100 mg/day) was recently initiated among Zambian adults with HIV-related cryptosporidiosis. Seven patients were recruited before the trial was terminated prematurely because of lack of efficacy and the development of severe adverse events. The latter may have been entirely drug-related or the result of extreme metabolic abnormalities already present in the patients enrolled in the trial. In future trials of miltefosine, attention will have to be paid to the possibility of metabolic abnormalities in the subjects investigated.

Entamoeba histolytica/Entamoeba dispar infection in chronic hemodialysis patients

To determine the prevalence of Entamoeba histolytica/E. dispar (Eh/Ed) in chronic hemodialysis (HD) patients, we collected 330 samples of feces from 110 patients, and nine individuals were found to be positive for Eh/Ed. We compared the infected patients with a group of 14 uninfected HD patients. Both groups were analyzed for their signs, symptoms and socio-economic characteristics using questionnaires. Blood tests were also performed in both the groups. Although both groups did not differ statistically with respect to their signs, symptoms and socio-economic conditions, there was a trend toward a greater number of individuals with diarrhea in the Eh/Ed infected group. In conclusion, we suggest that a parasitological examination of the patient's stool to detect the Eh/Ed complex should be included with the routine tests so that those patients with a positive fecal test could be initiated on appropriate anti-Eh/Ed therapy.

[Parasitic and bacterial etiologies of diarrhea among people living with HIV hospitalized in Fann hospital (Senegal)]

Diarrhea is the most common opportunistic infection in AIDS. We conducted at the Fann National University Hospital in Dakar, a study of all patients living with HIV, hospitalized in the the Clinical service of Infectious Diseases from 1 January 2003 to December 31, 2006, with diarrhea and having received an bacteriological and / or a parasitological examination of stools. The aim of this study was to identify the various pathogens isolated in the laboratory and responsible for those diarrhea. In total, 351 patients were collected, their average age was 39.93 years and the extreme ages 15 and 72 years. HIV1 serological profile was found in 90.77% of patients; 34.42% of patients received a dosage of CD4 count, among them 21.09% had a rate <200/mm3. Fifteen stool cultures were positive with the following breakdown: - Shigella (10 strains): 7 strains of Shigella flexneri, 2 of Shigella sp, one of Shigella sonnei; antibiotics most active on the Shigella strains were third generation cephalosporins and quinolones. - Salmonella (5 strains) with Salmonella Typhimurium and Salmonella Enteritidis, strains sensitive to an association of amoxicillin + clavulanic acid, to cephalosporins and to ciprofloxacin. 289 patients received a parasitological examination of the stools (KOP) and the positive number of KOP was 90 a 30,14% rate. The parasites most frequently found were: Cryptosporidium parvum, representing 10.38% of positive KOP, Isospora belli 6.23%, and Entamoeba coli 5.19%. These parasites were found predominantly in patients infected with HIV1 (61 cases/90). Cases of cobacterial and parasitic co-infections were also found. Diarrhea is one of the leading causes of death among people living with HIV. The etiologies of diarrhea, multiple, are yet to be identified and this should go through an improvement of the technical capacity and quality of our laboratories.

Hospitalization of Cuban children for giardiasis: a retrospective study in a paediatric hospital in Havana

The medical records of the 185 children who, in 2007, were admitted to the Academic Paediatric Hospital 'Centro Habana', in the Cuban capital of Havana, because of giardiasis were analysed retrospectively. A standardized form was used to collect data on the socio-demographic characteristics, clinical features, laboratory diagnosis, treatment and length of stay of each child. Information on the 15 children who had incomplete medical records was excluded from the data analysis. Of the remaining 170 children, 85 (50·0%) were aged 1-4 years, 97 (57·1%) were male, and 106 (62·4%), 92 (54·1%) and 69 (40·6%) had presented with diarrhoea, vomiting, and/or abdominal pain, respectively. Most (91·2%) of the cases had been diagnosed by the microscopical examination of a duodenal aspirate, and the drugs that had been most used frequently were quinacrine and tinidazole, which had been given to 72 (42·4%) and 62 (36·5%) of the cases, respectively. The mean length of hospital stay was 4·9 days. Such information on the clinical characteristics of giardiasis among children living in an endemic area may be valuable to paediatricians and public-health officials who wish to screen for the disease.

Environmental and demographic risk factors associated with the prevalence of Cryptosporidium infection in the Alice rural settlements of the Eastern Cape Province of South Africa: a pilot study

We undertook this study to identify the risk factors and prevalence of Cryptosporidium spp. in HIV-positive and HIV-negative diarrhea patients in the Alice rural settlement in the Eastern Cape Province of South Africa. A total of 180 stool specimens (35 HIV-positive diarrhea, 125 HIV-negative diarrhea patients, and 20 apparently healthy subjects) were screened for cryptosporidiosis using an ELISA-based approach. Sociodemographic information, water supply, and animal contact were recorded for diarrhea-positive patients. The data were analyzed using Pearson's chi2-test and Fisher's exact test. Cryptosporidium antigen was detected in 122 of 180 specimens (overall prevalence=67.8%). In HIV-positive diarrhea patients, the age groups 31-43 years (mean age 36.5 years) and 70-82 years (mean age 75.8 years) had a higher prevalence (100%) of the antigen than age groups 18-30 years (mean age 23.2 years) and 83-95 years (mean age 88.8 years) (50.0%). In HIV-negative diarrhea patients, the prevalence was highest (87.5%) at ages 18-30 years (mean age 23.2 years) and lowest (35.7%) at ages 83-95 years (mean age 88.8 years). Cryptosporidium antigenemia was slightly higher in females (78.2%, mean age 46.7 years) than in males (71.1%, mean age 42.6 years), but the difference was not significant (p>0.05). No apparently healthy control subject was infected with Cryptosporidium. HIV-negative patients had a significantly higher prevalence of antigen than HIV-positive patients, with farm animals considered a possible risk factor. In HIV-positive diarrhea patients, the prevalence peak was detected in more low income patients (85.7%) than in high income patients (32%). The high infection rate of specific groups was associated with exposure to a contaminated water supply. The results indicate that Cryptosporidium infection is highly prevalent in adult fecal specimens from the Nkonkobe Municipality, an indication of active infection that is likely to emerge as a major human pathogen in this locality owing to socioeconomic changes that favor transmission.

Molecular characterization of Cryptosporidium spp. in pre-weaned dairy calves in the Czech Republic: absence of C. ryanae and management-associated distribution of C. andersoni, C. bovis and C. parvum subtypes

A total of 750 faecal samples of dairy calves at up to 2 months of age kept in various housing systems were screened for Cryptosporidium spp. infection using the aniline-carbol-methyl violet staining method. DNA was extracted from Cryptosporidium positive samples and from 150 randomly selected microscopically negative samples. Nested PCR was performed to amplify the partial SSU rRNA gene of Cryptosporidium that was subsequently digested by SspI, VspI and MboII restriction enzymes to determine the present Cryptosporidium species and genotype. In addition, the samples characterized as Cryptosporidium parvum were subsequently analyzed at the GP60 gene to determine the distribution of zoonotic subtypes. Sequence analyses and RFLP identified C. parvum in 137, Cryptosporidium andersoni in 21 and Cryptosporidium bovis in 3 samples. Neither mixed infections nor Cryptosporidium ryanae was detected. Sequencing of the GP60 gene from C. parvum-positive samples revealed all five subtypes of family IIa (A15G2R1, A16G1R1, A22G1R1, A18G1R1, and A15G1R1). The obvious management-associated distribution of Cryptosporidium spp. was demonstrated. Direct contact with adult animals was found to be a risky factor for C. andersoni and C. bovis infection. IIaA15G2R1 and IIaA16G1R1 were detected as major subtypes, whereas only the IIaA16G1R1 subtype was found in animals kept in boxes. Three of the five detected subtypes were previously associated with human cryptosporidiosis, and moreover, the IIaA15G1R1 subtype, previously reported in humans only, was detected in calves for the first time.

Strongyloidiasis: prevalence, risk factors, clinical and laboratory features among diarrhea patients in Ibadan Nigeria

Strongyloidiasis is a parasitic infection caused by Strongyloides stercoralis. The infection is usually mild or asymptomatic in normal immunocompetent individuals, but could be very severe or even fatal due to hyper infection in individuals who are immunosuppressed. This study aimed at determining the prevalence, risk factors and features of strongyloidiasis among diarrhea patients in Ibadan. This is a descriptive cross-sectional study of diarrhea patients from a teaching hospital, three major government hospitals and one mission hospital in Ibadan. Self administered questionnaire, clinical assessment and laboratory investigations were used to confirm health status and presence of S. stercoralis. Diagnosis was made by microscopic examination of stool in saline preparation and formol-ether concentration. One thousand and ninety patients, (562 (51.6%) males and 528 (48.4%) females) consisting 380 (34.9%) children and 710 (65.1%) adults who had diarrhea were studied. The prevalence rate for the parasite among diarrhea patients was 3.0%. While the risk factor for infection remains contact with contaminated soil, malnutrition, steroid therapy, HIV/AIDS, lymphomas, tuberculosis, and chronic renal failure. Others are maleness, institutionalism and alcoholism. Predominant clinical presentations are abdominal pain, chronic diarrhea, and bloating and weight loss, Strongyloides stercoralis should be considered in diarrhea patients who are either malnourished or immunosuppressed.

Hexamita infection associated with diarrhoea and stunting in native turkey poults

Hexamita sp. was identified in 8 cases of sixty (13.3%) stunted diarrhoeic 1- 12- week old native turkey poults. Large numbers of the flagellated parasites were found within the dilated crypts of Lieberkuhn of ileum and jejunum. In TEM studies on the parasagittal section of the parasite, elongated flagellated binuclear parasite was found. The morphological characteristics of the seen protozoan are similar with those described for Hexamita meleagridis. The parasite could be considered as an intestinal pathogenic protozoan parasite, causing stunting and diarrhoea in turkeys in Iran.

Probiotics for treating acute infectious diarrhoea

BACKGROUND

Probiotics may offer a safe intervention in acute infectious diarrhoea to reduce the duration and severity of the illness.

OBJECTIVES

To assess the effects of probiotics in proven or presumed acute infectious diarrhoea.

SEARCH STRATEGY

We searched the Cochrane Infectious Diseases Group's trials register (July 2010), the Cochrane Controlled Trials Register (The Cochrane Library Issue 2, 2010), MEDLINE (1966 to July 2010), EMBASE (1988 to July 2010), and reference lists from studies and reviews. We also contacted organizations and individuals working in the field, and pharmaceutical companies manufacturing probiotic agents.

SELECTION CRITERIA

Randomized and quasi-randomized controlled trials comparing a specified probiotic agent with a placebo or no probiotic in people with acute diarrhoea that is proven or presumed to be caused by an infectious agent.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed the methodological quality of the trial and extracted data. Primary outcomes were the mean duration of diarrhoea, stool frequency on day 2 after intervention and ongoing diarrhoea on day 4. A random-effects model was used.

MAIN RESULTS

Sixty-three studies met the inclusion criteria with a total of 8014 participants. Of these, 56 trials recruited infants and young children. The trials varied in the definition used for acute diarrhoea and the end of the diarrhoeal illness, as well as in the risk of bias. The trials were undertaken in a wide range of different settings and also varied greatly in organisms tested, dosage, and participants' characteristics. No adverse events were attributed to the probiotic intervention.Probiotics reduced the duration of diarrhoea, although the size of the effect varied considerably between studies.The average of the effect was significant for mean duration of diarrhoea (mean difference 24.76 hours; 95% confidence interval 15.9 to 33.6 hours; n=4555, trials=35) diarrhoea lasting ≥4 days (risk ratio 0.41; 0.32 to 0.53; n=2853, trials=29) and stool frequency on day 2 (mean difference 0.80; 0.45 to 1.14; n=2751, trials=20).The differences in effect size between studies was not explained by study quality, probiotic strain, the number of different strains, the viability of the organisms, dosage of organisms, the causes of diarrhoea, or the severity of the diarrhoea, or whether the studies were done in developed or developing countries.

AUTHORS' CONCLUSIONS

Used alongside rehydration therapy, probiotics appear to be safe and have clear beneficial effects in shortening the duration and reducing stool frequency in acute infectious diarrhoea. However, more research is needed to guide the use of particular probiotic regimens in specific patient groups.

Molecular characterization of viruses associated with gastrointestinal infection in HIV-positive patients

BACKGROUND

Diarrhea is a major cause of morbidity and mortality among HIV-infected patients worldwide.

OBJECTIVE

We sought to determine the frequency of viral gastrointestinal infections among Brazilian HIV-infected patients with diarrhea.

METHODS

A collection of 90 fecal specimens from HIV-infected individuals with diarrhea, previously tested for the presence of bacteria and parasite was analyzed by polymerase chain reaction and sequence analysis for the presence of enteric viruses such as astrovirus, norovirus, rotavirus groups A, B and C, adenovirus, herpes simplex virus, Epstein-Barr virus, cytomegalovirus, and human bocavirus.

RESULTS

Twenty patients (22.2%; n = 90) were infected with parasites (11 single infections and nine coinfected with virus). Enteropathogenic bacteria were not found. Virus infections were detected in 28.9% (26/90) of the specimens. Cytomegalovirus was the most common virus detected (24.4%; 22/90). Coinfections with viruses and/or parasite were observed in 10 (11.1%) samples.

CONCLUSION

Gastrointestinal virus infections were more frequent than parasitic or bacterial infections in this patient population.

Diffuse small bowel thickening in AIDS patient--a case report

BACKGROUND

Diarrhea is common in HIV/AIDS patients, caused by both classic enteric pathogens and different opportunistic agents. Infection with these different pathogens may lead to similar radiological findings, thus causing diagnostic confusion.

CASE PRESENTATION

A 30-yr-old female with AIDS presented with chronic diarrhea of 4 months duration. She had diffuse small bowel thickening present on CT scan of her abdomen, with stool examination showing no parasites. She was erroneously diagnosed as abdominal tuberculosis and given antituberculosis drugs with which she showed no improvement. Repeat stool examination later at a specialized laboratory revealed Cryptosporidium parvum infection.The patient was given an extended course of nitazoxanide treatment, as her stool examination was positive for Cryptosporidium parvum even after 2 weeks of drug consumption. Parasite clearance was documented after 10 weeks of treatment. Interestingly, the bowel thickening reversed with parasitological clearance.

CONCLUSIONS

Cryptosporidium parvum may lead to small bowel thickening in AIDS patients. This small bowel thickening may reverse following parasitological clearance.

Diarrhea due to parasites particularly Cryptosporidium parvum in great Cairo, Egypt

A total of 110 stool samples from out and in-patients from different areas in Great Cairo suffering from diarrhea were examined for parasitic causes. Stool samples were subjected to the direct wet smear method and Sheather's sugar flotation and stained with Giemsa and/or modified Ziehl-Neelsen. Also, stool samples were cultured on agar plates for strongyloidiasis. The overall parasitic infection rate was 60.9% and non parasitic cause was 39.1%. The parasitic infection rate in a descending order was 31.1% for Cryptosporidium parvurnm, 19.8% for Giardia lamblia, 9.9% for Entamaeba histolytica and lastly 1.8% for Strongyloides stercoralis. The main clinical presentation of diarrheic patients in a descending order was vomiting (31.3%), dehydration (29.86%), abdominal pain (29.86%), flatulence (26.86%), anorexia (23.89%), tenesmus (17.9%) and lastly fever (4.47%). The risk factors were living in rural areas, education level, contact with farm animals and/ or pet animals. However, most of these risk factors although showed high percent, yet they occurred in patients with other causes of diarrheas. Artificial breast feeding was not evaluated as only 3 infants had C. parvum compared to non parasitic cause in 1 on the breast feeding.

Gastrointestinal helminthiasis presenting with acute diarrhoea and constipation: report of two cases with a second pathology

Gastrointestinal helminthiasis in developing countries contributes to malnutrition and anemia. Diagnosis and treatment of helminthiasis, especially with low worm load is an unmet public health need in such settings. The infection may sometimes become manifest when a second pathology leads to purgation of the gastrointestinal tract. Two cases of helminthiasis are presented in which the infections only became amenable to diagnosis due to acute diarrhoea caused by giardiasis and lactulose administration. In the first case, acute giardiasis revealed Ascaris lumbricoides infestation, and in the second case primary helminthiasis (strongyloidiasis) was revealed by lactulose, and also led to Vibrio cholera bacteremia. These cases highlight the need to diagnose helminth infestations especially with low worm burdens by means of public health surveillance programmes. These cases highlight the need to diagnose helminth infestations especially with low worm burdens by means of public health surveillance programmes.