Opportunistic parasites among immunosuppressed children in Minia District, Egypt

Updates on the worldwide burden of amoebiasis: A case series and literature review

BACKGROUND

Amoebiasis is an intestinal and tissue parasitic infection caused by the protozoan Entamoeba histolytica. Despite significant medical importance and worldwide dispersion, little is known about the epidemiology and distinct geographical distribution of various clinical forms of amoebiasis in the world. In this study, we present an amoebiasis case series referred to Avicenne Hospital (Bobigny, France) from 2010 to 2022 followed by an overview of the released literature to explore diverse clinico-pathology of amoebiasis and to update the actual epidemiological situation of this parasitosis worldwide.

METHODS

The referred patients underwent a combination of clinical and parasitological examinations and imaging. The study was followed by an overview of released literature performed based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline.

RESULTS

A total of 15 patients with amoebiasis were diagnosed with an average age of 48.5 years old at the occurrence time of infection. Men (78%) were the most affected patients. Most of the cases were reported following a trip to endemic regions, such as Mali, India, Nepal, Algeria, Cameroon or Congo. All of the processed patients exhibited a hepatic amoebiasis. Amoebic abscess was observed in all cases with an average size of 6.3 cm. Of these patients, seven cases (46.7%) benefited from drainage following a risk of rupture or superinfection of the abscess. A compilation of findings extracted from 390 scientific publications via seven major medical databases, allowed us to update the main epidemiological and clinical events that has led to the current worldwide expansion of amoebiasis. We presented a clinical and epidemiological overview of the amoebiasis accompanied with a worldwide illustrative map displaying the current distribution of known amoebiasis foci in each geographical ecozone of Asia, Europe, Africa, Americas, and Australia.

CONCLUSIONS

Although Metropolitan France is not known as an endemic region of amoebiasis, amoebic liver abscess was the most frequent clinical form observed among our 15 patients processed. Most of infected patients had a history of travel to or lived-in endemic areas before arriving in France.

Cryptosporidiosis is predominantly an urban, anthroponotic infectious disease among Zambian children

BACKGROUND

Cryptosporidium species are leading causes of diarrhoea in children and immunocompromised individuals. This study aimed to characterise Cryptosporidium species from children in rural and urban settings of Zambia.

METHODS

Stool samples collected from 490 children aged <5 y with diarrhoea were assessed for Cryptosporidium oocysts microscopically. A structured questionnaire was used to collect demographic and socioeconomic characteristics. Positive samples were subjected to PCR and gp60 sequence analysis.

RESULTS

The overall prevalence was 10% (50/490, 95% CI 7.8 to 13.2) with a peak in March, the late rainy season. Children who came from households where boiling water was not practised (OR=2.5, 95% CI 1.29 to 5.17; p=0.007) or who had experienced recurrent episodes of diarrhoea (OR=9.31, 95% CI 3.02 to 28.73; p=0.001) were more likely to have Cryptosporidium infection. Genotyping of 16 positive samples (14 from urban and 2 from rural sources) revealed Cryptosporidium hominis (14/16) and Cryptosporidium parvum (2/16). The Cryptosporidium hominis subtypes identified were Ia, Ib and Ie with subtype families IeAIIG3 (1), IbA9G3R2 (2), IaA31R3 (3), IbA9G3 (5), IaA27R3 (1), IaA30R3 (1) and Ia (1). Subtypes IbA9G3 and Ia were identified in children from a rural area. Cryptosporidium parvum subtypes were IIcA5G3R2 (1) and IIcA5G3a (1).

CONCLUSIONS

All isolates successfully genotyped were C. hominis or anthroponotic C. parvum, suggesting that anthroponotic transmission dominates in Lusaka and the surrounding countryside.

Clinical and Laboratory Diagnosis of Cryptosporidiosis among Children with Acute Gastroenteritis at a Tertiary Hospital, Cairo, Egypt

BACKGROUND

Most studies on gastroenteritis have focused on viral and bacterial infections, while gastroenteritis where intestinal protozoan parasites may have played a role has not been well studied. This study was therefore, designed to assess the frequency and several potential risk factors for Cryptosporidium infection among children suffering from acute gastroenteritis and presented to a tertiary hospital in Cairo, Egypt. Effectiveness of modified Ziehl-Neelsen (MZN) and nested polymerase chain reaction (nPCR) for Cryptosporidium detection were evaluated as well.

METHODS

A cross-sectional study was performed during the period from July 2018 to December 2018, where 100 human diarrheic stool samples were collected from children aged 3 months up to 12 years old presented to Ain Shams University Pediatrics Hospital, Cairo, Egypt with acute gastroenteritis. Demographic and clinical data were obtained from the participants. Initial parasite screening was done using the MZN staining method, and microscopically examined for Cryptosporidium infection, while genotyping was based on molecular diagnostic assays using nPCR and sequencing for selected samples.

RESULTS

The overall frequency of Cryptosporidium infection was 5% using light microscopy, while 19% of samples were positive by nPCR. Cryptosporidium hominis was the only detected genotype. Clinical picture among cases were not significant in comparison to patients with other causes of gastroenteritis.

CONCLUSION

Cryptosporidium infection is more common below 5 years of age; however, clinical data are not enough for suspicion of infection. Nucleic acid-based methods are more sensitive and specific despite the high cost in developing countries. However, real estimation of Cryptosporidium disease burden is of an outmost importance to achieve prevention and detection of the Cryptosporidium species genetic diversity. Lay summaryCryptosporidium is a protozoan, which causes gastroenteritis in humans. It is most common below 5 years of age; however, diarrhea and vomiting characteristics are not different from other causes of gastroenteritis. General diagnostic methods are inadequate for detection of these infections. Nested polymerase chain reaction (nPCR) and sequencing are accurate methods for pathogen detection and species verification. Our study included 100 Egyptian children with acute gastroenteritis. The overall frequency of Cryptosporidium infection was 5% using light microscopy, while 19% of samples were positive by nPCR. The clinical picture of the children presenting with this disease was not significantly different from those presenting with gastroenteritis due to other causes. This emphasizes the importance of proper diagnosis to know the true burden of the disease.

A Complementary Herbal Product for Controlling Giardiasis

Giardiasis is an intestinal protozoal disease caused by Giardia lamblia. The disease became a global health issue due to development of resistance to commonly used drugs. Since many plant-derived products have been used to treat many parasitic infestations, we aimed to assess the therapeutic utility of Artemisia annua (A. annua) for giardiasis. We showed that NO production was significantly reduced whereas serum levels of IL-6, IFN-γ, and TNF-α were elevated in infected hamsters compared to uninfected ones. Additionally, infection resulted in increased numbers of intraepithelial lymphocytes and reduced villi heights, goblet cell numbers, and muscularis externa thickness. We also showed that inducible NO synthase (iNOS) and caspase-3 were elevated in the intestine of infected animals. However, treatment with A. annua significantly reduced the intestinal trophozoite counts and IEL numbers, serum IL-6, IFN-γ, and TNF-α, while increasing NO and restoring villi heights, GC numbers, and ME thickness. Moreover, A. annua treatment resulted in lower levels of caspase-3, which indicates a protective effect from apoptotic cell death. Interestingly, A. annua therapeutic effects are comparable to metronidazole. In conclusion, our results show that A. annua extract is effective in alleviating infection-induced intestinal inflammation and pathological effects, which implies its potential therapeutic utility in controlling giardiasis.

Diversity, geographical distribution, and prevalence of Entamoeba spp. in Brazil: a systematic review and meta-analysis

The genus Entamoeba includes a variety of widely distributed species adapted to live in the digestive tracts of humans and a large variety of animals of different classes. The objective of this study was to investigate the prevalence, distribution, and molecular epidemiology of Entamoeba spp. in different classes of hosts in Brazil. Studies that analyzed hosts from several classes, including humans and domestic, wild, or captive animals, were considered. The pooled prevalence of Entamoeba spp. was calculated using the random-effects model. A total of 166 studies on humans and 16 on animals were included. The prevalence of Entamoeba spp. in the Brazilian population was 22% (95% CI: 21–24). The state with the highest prevalence was Paraiba with 72%, followed by Federal District with 53%, and Rondonia with 50%. In immunocompromized patients, the prevalence was 18%, and cancer (36%) was the most prevalent cause of immunosuppression. The prevalence of Entamoeba spp. in animal hosts was 12% (95% CI: 7–17). Captive wild animals and domestic farm animals showed the highest prevalence, with 16% and 15%, respectively. The species found more often were E. coli (86.5%), E. dispar (7.9%), and E. histolytica (3.1%). In conclusion, a high prevalence (22%) of Entamoeba spp. was found in the Brazilian population, with a prevalence of up to 50% mainly in the northern, northeastern, and central-western regions. The pathogenic species E. histolytica is distributed in most Brazilian regions, with significant prevalence percentages. Among animals, unidentified Entamoeba species were most prevalent in mammals.

Prevalence of Intestinal Parasitic Infection and Associated Factors Among HAART Initiated Children Attending at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

BACKGROUND

Human immunodeficiency virus (HIV) and intestinal parasites co-infections are the most common causes of clinical illness and death, especially for children living in resource constrained setting. Therefore, the aim of this study was to determine the prevalence and associated factors of intestinal parasites among highly active anti-retroviral therapy (HAART) initiated children.

METHODS

Cross-sectional study was conducted among 255 HAART initiated HIV-infected children at the University of Gondar Comprehensive Specialized Hospital from January to April 2020. Socio-demographic characteristics were collected using a structured questionnaire via a face-to-face interview. Clinical data of the children were collected by reviewing the medical records. Venous blood was collected for complete blood counts, viral load determination, and blood film examination. Flotation concentration technique was done in addition to direct wet mount for parasitological examination. Bi-variable and multi-variable logistic regression analysis were used to check the presence of significant association, and P-value<0.05 was considered as statistically significant.

RESULTS

The overall prevalence of intestinal parasite infection (IPI) among the study participants was 22.4% (95% CI=17-28%). The presence of opportunistic infection (AOR=2.09 95% CI=1.81-5.43), no eating under-cooked animal products (AOR=0.38 95% CI=0.16-0.94), male sex (AOR=0.45 95% CI=0.22-0.90), viral load rate >1,000 copies/mL (AOR=1.80 95% CI=1.67-4.19), and cytopenia (AOR=2.71 95% CI=1.59-12.25) showed significant association with the prevalence of IPI.

CONCLUSION

Entamoeba histolytica and Ascaris lumbricoides were the most prevalent intestinal parasites among HAART initiated children. Among HAART initiated children, IPI were associated with gender, cytopenia, viral load, undercooked animal products, and the presence of opportunistic infections. Therefore, health education, prompt treatment, and regular deworming should be implemented to alleviate the burden of intestinal parasites in HIV-infected children.

Strongyloides stercoralis and other intestinal parasites in patients receiving immunosuppressive drugs in northern Iran: a closer look at risk factors

OBJECTIVES

The objective of this study was to evaluate the prevalence of Strongyloides stercoralis and other intestinal parasites in patients receiving immunosuppressive drugs in northern Iran and to investigate related risk factors.

METHODS

This cross-sectional study was conducted among 494 patients receiving immunosuppressive drugs, including cancer patients undergoing chemotherapy (n=188) and those treated with prolonged corticosteroid administration (n=306). All fresh fecal samples were examined using the direct wet-mount, formalin ethyl acetate concentration, and agar plate culture techniques.

RESULTS

In total, 16.8% of patients were positive for at least 1 intestinal parasite; the helminthic and protozoan infection rates were 5.1% and 12.3%, respectively. The infection rate was significantly higher in corticosteroid-treated individuals (19.6%) than cancer patients (12.2%) (p<0.05). The prevalence rate of S. stercoralis among patients receiving chemotherapy and those treated with corticosteroids were 4.3% and 5.2%, respectively. The prevalence rate of S. stercoralis infection was significantly higher in older patients (p<0.05).

CONCLUSIONS

Strongyloidiasis is one of the most common parasites among patients receiving immunosuppressive drugs in northern Iran. Early diagnosis and proper treatment of these patients are necessary to minimize the complications of severe strongyloidiasis.

The Prevalence of Blastocystis Infection in Pediatric Patients with Malignancy: A Single-Center Study in Ahvaz, Iran

Background: Blastocystis spp. is known as one of the few intestinal parasites, prevalent in more than 5% and 30 - 60% of the population in industrialized and developing countries, respectively. In this respect, immunocompromised individuals, such as patients undergoing chemotherapy or those with malignancies, are at risk of the clinical symptoms of Blastocystis infection; however, the given condition is often self-limiting in healthy individuals. Objectives: The current study aimed at evaluating the prevalence of Blastocystis infection in children with malignancies receiving chemo drugs. Methods: The current descriptive, cross-sectional study was conducted on 52 stool specimens collected from patients with cancer admitted to the Oncology Ward of Shahid Baqaei 2 Hospital, Ahvaz, Iran, for six months. A standardized questionnaire was filled out for all cases. Each specimen was also prepared using direct smear, the Lugol iodine staining, and the formalin-ether condensation method. Results: Blastocystis spp. was detected in 21.1% of the cases among them, 11.5% demonstrated gastrointestinal symptoms; therefore, a significant relationship was observed between Blastocystis infection and gastrointestinal symptoms. Conclusion: Patients undergoing chemotherapy should be screened for opportunistic parasitic infections such as Blastocystis to avoid potentially life-threatening outcomes. Besides, further studies are required to identify the subtypes of Blastocystis.

Worldwide prevalence of emerging parasite Blastocystis in immunocompromised patients: A systematic review and meta-analysis

BACKGROUND

Blastocystis is one of the most common pathogens of the human intestine, caused by an emerging parasite, which can lead to severe symptoms and even death in immunocompromised patients. We aimed to determine the global prevalence of Blastocystosis infection in people with immunodeficiency. A systematic literature search was conducted on Web of Science, Scopus, Google scholar, Science Direct and MEDLINE databases to select all observational studies reporting the prevalence of Blastocystosis infection in Worldwide, based on different diagnostic methods in immunocompromised patients of any age and published from inception to February 2019. Pooled estimates and 95% confidence intervals (95% CIs) were calculated using random effects models and in addition, the I² statistic was calculated. The geographic distribution of studies was evaluated and the diagnosis of Blastocystis was compared by various techniques. Electronic databases were reviewed for Blastocystosis infection in HIV/AIDS, cancer and other immunocompromised patients, and meta-analyses were conducted to calculate the overall estimated prevalence. Total68 eligible studies were included. The estimated pooled prevalence rate of Blastocystosis infection in immunocompromised patients was overall 10% (95% CI, 7-13%; I² 96.04%) (P < 0.001), of whom 21% [18-25] were in Australia, 12% [4-24] in America, 11% [6-17] in Europe and 10% [5-15], 7% [3-13] in Asia and Africa, respectively. It was calculated that the estimated pooled prevalence rate of Blastocystosis infection in immunocompromised patients was overall 10% and the prevalence estimates ranged from 0.44 to 72.39. Also, overall the prevalence of parasites co-infection in immunocompromised patients was detected as 0.024%. Our finding showed that immunocompromised people show a high prevalence of Blastocystosis infection compared to the control population. Adequate information on the prevalence rate is still missing from many countries. However, current information underscore that Blastocystis should not be neglected.

Intestinal Parasites Infections among HIV Infected Children Under Antiretrovirals Treatment in Yaounde, Cameroon

BACKGROUND

Intestinal parasitic infections are among the most common communicable diseases worldwide, particularly in developing countries. Human immunodeficiency virus (HIV) causes dysregulation of the immune system through the depletion of CD4+ T lymphocytes which gives rise to opportunistic infections.

METHODOLOGY

A cross-sectional study was conducted from January to October 2018. Stool and blood samples were collected from participants aged 1 to 19. Stool samples were analyzed for intestinal parasites. Blood samples were analyzed for HIV and CD4 + T cell counts.

RESULTS

Out of 214 children enrolled, 119 (55.6%) were HIV infected and 95 (44.4%) were HIV non-infected. All infected children were on antiretroviral treatment (ART). The prevalence of intestinal parasites was 20.2% in HIV infected and 15.8% in non-infected children. Among the 119 HIV infected children, 33 (27.7%) of them had a CD4+ T cell count less than 500 cells/mm3, and amongst them 5.9% had CD4+ T cell count less than 200 cells/mm3. Among HIV infected children, Cryptosporidium spp. was frequently detected, 7/119 (5.9%), followed by Giardia lamblia 5/119 (4.2%) then Blastocystis hominis 3/119 (2.5%) and Entamoeba coli 3/119 (2.5%). Participants on ART and prophylactic co-trimoxazole for >10 years had little or no parasite infestation.

CONCLUSIONS

Although ART treatment in combination with prophylactic co-trimoxazole reduces the risk of parasitic infection, 20.2% of HIV infected children harbored intestinal parasites including Cryptosporidium spp. Stool analysis may be routinely carried out in order to treat detected cases of opportunistic parasites and such improve more on the life quality of HIV infected children.

Frequency and Molecular Identification of Cryptosporidium Species among Immunocompromised Patients Referred to Hospitals, Central Iran, 2015-16

BACKGROUND

The purpose of this study was to determine the prevalence and genotype of Cryptosporidium spp. in different groups of immunocompromised patients admitted to the referral hospitals in center of Iran during 2015-2016.

METHODS

This cross-sectional study was conducted on 346 immunocompromised patients (HIV⁺/AIDS, Lymphoma, Leukemia and organ transplants) in referred hospitals from central parts of Iran including Isfahan, Markazi, Yazd and Chaharmahale Bakhtiari provinces. Stool samples were analyzed for Cryptosporidium species, modified Ziehl-Neelsen staining techniques followed by the semi-nested PCR and DNA sequencing methods.

RESULTS

The total rate of Cryptosporidium spp. was 3.46% (12/346) in the patients, however, the prevalence of the parasite, was 4.6% (4/87) in HIV⁺/AIDS patients, 3.6% (6/168) in patients with blood malignancy and 2.1% (2/91) in organ transplant recipients. The SSU rRNA gene of Cryptosporidium spp. in all microscopic-positive samples was effectively amplified by the semi-nested PCR and DNA sequences, exposed the existence of two Cryptosporidium species, including C. hominis 91.6% (11/12) and C. parvum 8.3% (1/12).

CONCLUSION

The predominance of C. hominis in the present study may be certifies the importance of anthroponotic transmission of cryptosporidiosis in center of Iran.

Intestinal Protozoan Parasitic Infections in Immunocompromised Child Patients with Diarrhea

Intestinal protozoan parasites are common causes of infectious diarrhea in children receiving anticancer therapy or undergoing transplantation. Additionally, immunosuppression therapy in such patients may exacerbate the symptoms related to these parasitic infections. The aim of this study was to evaluate the prevalence and diagnostic importance of parasitic protozoan infections in children treated for malignancies or undergoing transplantation, and to highlight the control of intestinal parasitic infections for immunosuppressed patients at a hospital in İzmir, Turkey. In total, 82 stool samples from 62 patients were analyzed by microscopic examination and polymerase chain reaction (PCR) for the presence of coccidian parasites. Our results showed that Cryptosporidium, Cyclospora, and Cystoisospora were present in 22.5% (14/62), 9.6% (6/62), and 3.2% (2/62) of the cases using either method, respectively. The prevalence of these coccidian parasites identified with both methods was 35.4% (20/62). Other intestinal parasites (Blastocystis, Giardia, and Entamoeba coli) were detected in 10 patients. PCR analysis showed the presence of all coccidian parasites in the same stool sample for one patient. Finally, both PCR and microscopic examination of the stools revealed that there is a higher prevalence of Cryptosporidium, Cyclospora, and Cystoisospora in immunocompromised children. These examinations allowed an early start of appropriate antibiotic treatments and led to an increased percentage of correctly treated patients.

Cystoisospora belli infections in humans: the past 100 years

Cystoisospora belli is a coccidian parasite of humans, with a direct fecal-oral transmission cycle. It is globally distributed, but mainly found in tropical and subtropical areas. Many cases of C. belli infections have been reported in patients with HIV, and in patients undergoing immunosuppressive therapy for organ transplants or those treated for tumours worldwide. Unsporulated or partially sporulated oocysts of C. belli are excreted in feces. When sporulated oocysts in contaminated water or food are ingested, asexual and sexual stages of C. belli are confined to the epithelium of intestines, bile ducts and gallbladder. Monozoic tissue cysts are present in extra-intestinal organs (lamina propria of the small and large intestine, lymph nodes, spleen, and liver) of immunosuppressed humans. However, a paratenic host has not been demonstrated. Cystoisospora belli infections can be persistent, lasting for months, and relapses are common; the mechanism of relapse is unknown. Recently, the endogenous stages of C. belli were re-examined and attention was drawn to cases of misidentification of non-protozoal structures in the gallbladder of patients as C. belli. Here, we review all aspects of the biology of C. belli, including morphology, endogenous stages, prevalence, epidemiology, symptoms, diagnosis and control.

Cyclospora cayetanensis and Cyclosporiasis: An Update

Cyclospora cayetanensis is a coccidian parasite of humans, with a direct fecal-oral transmission cycle. It is globally distributed and an important cause of foodborne outbreaks of enteric disease in many developed countries, mostly associated with the consumption of contaminated fresh produce. Because oocysts are excreted unsporulated and need to sporulate in the environment, direct person-to-person transmission is unlikely. Infection by C. cayetanensis is remarkably seasonal worldwide, although it varies by geographical regions. Most susceptible populations are children, foreigners, and immunocompromised patients in endemic countries, while in industrialized countries, C. cayetanensis affects people of any age. The risk of infection in developed countries is associated with travel to endemic areas and the domestic consumption of contaminated food, mainly fresh produce imported from endemic regions. Water and soil contaminated with fecal matter may act as a vehicle of transmission for C. cayetanensis infection. The disease is self-limiting in most immunocompetent patients, but it may present as a severe, protracted or chronic diarrhea in some cases, and may colonize extra-intestinal organs in immunocompromised patients. Trimetoprim-sulfamethoxazole is the antibiotic of choice for the treatment of cyclosporiasis, but relapses may occur. Further research is needed to understand many unknown epidemiological aspects of this parasitic disease. Here, we summarize the biology, epidemiology, outbreaks, clinical symptoms, diagnosis, treatment, control and prevention of C. cayetanensis; additionally, we outline future research needs for this parasite.

Mitochondrial genome sequence variation as a useful marker for assessing genetic heterogeneity among Cyclospora cayetanensis isolates and source-tracking

Background

Cyclospora cayetanensis is an important enteric pathogen, causing diarrhea and food-borne cyclosporiasis outbreaks. For effective outbreak identification and investigation, it is essential to rapidly assess the genetic heterogeneity of C. cayetanensis specimens from cluster cases and identify the likely occurrence of outbreaks.

Methods

In this study, we developed a quantitative PCR (qPCR) targeting the polymorphic link region between copies of the mitochondrial genome of C. cayetanensis, and evaluated the genetic heterogeneity among 36 specimens from six countries using melt curve, gel electrophoresis, and sequence analyses of the qPCR products.

Results

All specimens were amplified successfully in the qPCR and produced melt peaks with different Tm values in the melt curve analysis. In gel electrophoresis of the qPCR products, the specimens yielded bands of variable sizes. Nine genotypes were identified by DNA sequencing of the qPCR products. Geographical segregation of genotypes was observed among specimens analyzed, which could be useful in geographical source-tracking.

Conclusions

The length and nucleotide sequence variations in the mitochondrial genome marker allow rapid assessment of the genetic heterogeneity among C. cayetanensis specimens by melt curve, gel electrophoresis, or DNA sequence analysis of qPCR products. The sequence data generated could be helpful in the initial source-tracking of the pathogen.

Molecular characterization of Cryptosporidium spp. and Giardia duodenalis in children in Egypt

BACKGROUND

The transmission of Cryptosporidium spp. and Giardia duodenalis into humans varies according to species/genotypes of the pathogens. Although infections with both parasites are recorded in Egypt, few data are available on the distribution of Cryptosporidium species and G. duodenalis genotypes. The present study assessed the occurrence and genetic diversity of Cryptosporidium spp. and G. duodenalis in Egyptian children.

METHODS

In the present study, 585 fecal specimens were collected from children eight years old and younger in three provinces (El-Dakahlia, El-Gharbia and Damietta) during March 2015 to April 2016. PCR-RFLP analysis of the small subunit rRNA gene and sequence analysis of the 60 kDa glycoprotein gene were used to detect and subtype Cryptosporidium spp., respectively, whereas PCR and sequence analyses of the triose phosphate isomerase, glutamate dehydrogenase and β-giardin genes were used to detect and genotype Giardia duodenalis.

RESULTS

The overall infection rates of Cryptosporidium spp. and G. duodenalis were 1.4% and 11.3%, respectively. The Cryptosporidium species identified included C. hominis and C. parvum, each with three subtype families. The C. hominis subtypes were IbA6G3 (n = 2), IdA17 (n = 1), IdA24 (n = 1) and IfA14G1R5 (n = 1), while C. parvum subtypes were IIdA20G1 (n = 1), IIaA15G2R1 (n = 1), and IIcA5G3a (n = 1). The G. duodenalis identified included both assemblages A (n = 31) and B (n = 34). All G. duodenalis assemblage A belonged to the anthroponotic sub-assemblage AII, while a high genetic heterogeneity was seen within assemblage B.

CONCLUSIONS

Data from this study are useful in our understanding of the genetic diversity of Cryptosporidium spp. and G. duodenalis in Egypt and the potential importance of anthroponotic transmission in the epidemiology of both pathogens.

Simultaneous Molecular Detection of Cryptosporidium and Cyclospora from Raw Vegetables in Korea

Cryptosporidium and Cyclospora are well-known coccidian protozoa that can cause waterborne and foodborne diarrheal illnesses. There have been a few reports regarding contamination in different vegetables with Cryptosporidium, but no data are available regarding the sources of Cyclospora infections in Korea. In the present study, we collected 6 kinds of vegetables (perilla leaves, winter-grown cabbages, chives, sprouts, blueberries, and cherry tomatoes) from July 2014 to June 2015, and investigated contamination by these 2 protozoa using multiplex quantitative real-time PCR. Among 404 vegetables, Cryptosporidium and Cyclospora were detected in 31 (7.7%) and 5 (1.2%) samples, respectively. In addition, Cryptosporidium was isolated from all 6 kinds of vegetables, whereas Cyclospora was detected in 4 kinds of vegetables (except perilla leaves and chives). Cryptosporidium (17.8%) and Cyclospora (2.9%) had the highest detection rates in chives and winter-grown cabbages, respectively. Cryptosporidium was detected all year long; however, Cyclospora was detected only from October to January. In 2 samples (sprout and blueberry), both Cryptosporidium and Cyclospora were detected. Further investigations using TaqI restriction enzyme fragmentation and nested PCR confirmed Cryptosporidium parvum and Cyclospora cayetanensis, respectively. In conclusion, we detected C. cayetanensis in vegetables for the first time in Korea. This suggests that screening should be employed to prevent these protozoal infections in Korea.

Molecular Analysis of the Enteric Protozoa Associated with Acute Diarrhea in Hospitalized Children

Pediatric diarrhea is a common cause of death among children under 5 years of age. In the current study, we investigated the frequency of intestinal parasites among 580 pediatric patients with chronic diarrhea. Parasitic protozoa (all species combined) were detected by molecular tools in 22.9% of the children and the most common parasite was Cryptosporidium spp. (15.1%). Blastocystis hominis was detected in 4.7%, Dientamoeba fragilis in 4%, Giardia duodenalis in 1.7%, and Entamoeba histolytica in 0.17%. Protozoan infections were observed among all regional groups, but prevalence was highest among Qatari subjects and during the winter season. Typing of Cryptosporidium spp. revealed a predominance of Cryptosporidium parvum in 92% of cases with mostly the IIdA20G1 subtype. Subtypes IIdA19G2, IIdA18G2, IIdA18G1, IIdA17G1, IIdA16G1, and IIdA14G1 were also detected. For Cryptosporidium hominis, IbA10G2 and IbA9G3 subtypes were identified. This study provides supplementary information for implementing prevention and control strategies to reduce the burden of these pediatric protozoan infections. Further analyses are required to better understand the local epidemiology and transmission of Cryptosporidium spp. in Qatar.

A Comprehensive Review of Common Bacterial, Parasitic and Viral Zoonoses at the Human-Animal Interface in Egypt

Egypt has a unique geographical location connecting the three old-world continents Africa, Asia and Europe. It is the country with the highest population density in the Middle East, Northern Africa and the Mediterranean basin. This review summarizes the prevalence, reservoirs, sources of human infection and control regimes of common bacterial, parasitic and viral zoonoses in animals and humans in Egypt. There is a gap of knowledge conerning the epidemiology of zoonotic diseases at the human-animal interface in different localities in Egypt. Some zoonotic agents are “exotic” for Egypt (e.g., MERS-CoV and Crimean-Congo hemorrhagic fever virus), others are endemic (e.g., Brucellosis, Schistosomiasis and Avian influenza). Transboundary transmission of emerging pathogens from and to Egypt occurred via different routes, mainly importation/exportation of apparently healthy animals or migratory birds. Control of the infectious agents and multidrug resistant bacteria in the veterinary sector is on the frontline for infection control in humans. The implementation of control programs significantly decreased the prevalence of some zoonoses, such as schistosomiasis and fascioliasis, in some localities within the country. Sustainable awareness, education and training targeting groups at high risk (veterinarians, farmers, abattoir workers, nurses, etc.) are important to lessen the burden of zoonotic diseases among Egyptians. There is an urgent need for collaborative surveillance and intervention plans for the control of these diseases in Egypt.

Coccidian intestinal parasites among immunocompetent children presenting with diarrhea: Are we missing them?

BACKGROUND

Diarrhoea is an important cause of both morbidity and mortality among children in India. Coccidian parasitic infections are an important cause of diarrhea in immunocompromised patients, but their investigations are rarely sought by the treating physicians in seemingly immunocompetent children. This study was aimed to find the incidence rate of coccidian parasites in all children presented with diarrhoea, irrespective of their immune status.

MATERIALS AND METHODS

Between December 2015 and May 2016, all fecal samples from children aged between 0 and 15 years presenting with diarrhoea, irrespective of their immune status, were examined using conventional wet mount and modified acid-fast staining. At the end of the study, records of their clinical history and immune status including HIV positivity were evaluated. Findings of wet-mount and modified acid-fast stained smear microscopy were analyzed in relation with clinical details.

RESULTS

During the study, samples from 200 children (single sample) with diarrhea were processed. Their mean age was 5.7 ± 3.3 years (range 4-168 months). Seventeen out of 200 (8.5%) samples were positive for acid-fast coccidian parasites. Eight (4%) samples were found to be positive for Cryptosporidium hominis, while 5 (2.5%) were positive for Cyclospora cayetonensis and 4 (2%) samples for Isospora belli oocysts. Half (50%) of the children who were tested positive for Cryptosporidium and Cyclospora were found to be otherwise immunocompetent. However, all four cases of Isosporiasis were immunocompromised patients.

CONCLUSION

We highlight the high incidence of coccidian parasites among immunocompetent children with diarrhea. The clinicians need to be aware that coccidian parasites are a potential cause of childhood diarrhea even in immunocompetent children.

Risk Factors Associated with Parasitic Infection Among Municipality Solid-Waste Workers in an Egyptian Community

Solid-waste management is associated with several health hazards, particularly parasitic infection. The objective of the study was to determine the association between risk factors and the occurrence of intestinal parasitic infections (potentially pathogenic) among municipal waste collectors in Alexandria, Egypt. A cross-sectional survey was conducted in the main municipality company in Alexandria. A total of 346 municipality solid-waste workers (MSWWs) was interviewed using an in-depth questionnaire. The type of parasitic infections among waste handlers was determined using formol-ether concentration and modified Ziehl-Neelsen technique. About half of the workers were infected with parasites. The profile of parasitic infection revealed 12 parasitic species. These were comprised of the following helminths: Schistosoma mansoni (13.3%), Enterobius vermicularis (1.7%), Ascaris lumbricoides (1.4%), and Hymenolepis nana ova (0.6%). Among protozoa were pathogenic Entamoeba histolytica (3.2%), Giardia intestinalis (2.9%), nonpathogenic protozoa such as Entamoeba coli (1.7%), and potentially pathogenic or opportunistic ones as Cryptosporidium (23.4%), Microsporidia (20.25%), Cyclospora (2.0%), Blastocystis hominis (1.7%), and Cystoisospora belli (1.2%). About 1.4% of MSWWs have pediculosis and phthiriasis in their scalp and eyelashes respectively. Risk factors for infection were associated with direct exposure to solid fecal waste (odds ratio [OR] = 1.8, confidence interval [CI] = 1.1-3.0) and occupational activities that allowed for direct exposure to solid fecal waste (OR = 2.3, CI = 1.4-4.0). Logistic regression model has revealed that educational level and residence were the factors that contribute to parasitic infection among MSWWs (P < 0.05). MSWWs are at high risk of acquiring parasitic infections. Data of the present study highlighted the need for greater biomonitoring of MSWWs and the improvement of environmental conditions and health care in such marginalized communities to prevent parasitic infection and associated morbidities.

Zoonotic enteric parasites transmitted from dogs in Egypt with special concern to Toxocara canis infection

AIM

This work aimed to study the role played by dogs in transmitting zoonotic enteric parasites to humans in Egypt and to analyze the risk factors associated with the occurrence of such infection in dogs. Serodiagnosis of anti-Toxocara immunoglobulin G (IgG) antibodies among human beings as well as analyzing risk factors predispose to Toxocara canis infection in human beings are another objectives of this study.

MATERIALS AND METHODS

From June to December 2013, a total of 130 fecal samples from 4 dog populations (Military, nomadic and domiciled dogs from rural and high standard districts) and 150 stool samples of 6 occupational groups were examined for the presence of enteric parasitic infection. Moreover, 150 serum samples were collected from humans from whom stool samples were collected and examined for the presence of anti-T. canis antibodies.

RESULTS

Enteric parasites were detected in 30% of fecal samples from 4 dog populations in Egypt. High infectivity had been reported in nomadic dogs (63.33%) (Crude odds ratios [COR]=67.36, 95% confidence interval [CI]=8.09-560.8, p<0.000), followed by domiciled dogs from rural areas (40%) (COR=26, 95% CI=3.14-215.54, p=0.003), domiciled dogs from high standard areas (23.33%) (COR=11.87, 95% CI=1.37-102.69, p=0.025) and military dogs (2.5%). Twelve species of enteric parasites were identified, Ancylostomatidae (6.15%), T. canis and Cryptosporidium spp. (5.38%, each), Heterophyes spp. (3.85%), Toxocara leonina and Blastocystis spp. (3.07%), Taenidae eggs (2.31%), Hymenolepis diminuta (1.54%) and Entamoeba canis, Cyclospora cayetanensis, and Paragonimus spp. (0.77%, each). Univariate logestic regression revealed significant association of age (COR=4.73, 95% CI=2.13-10.53, p<0.000), gender (COR=2.63, 95% CI=1.22-5.68, p<0.014), housing system (COR=5.10, 95% CI=2.04-12.75), p<0.000) with enteric parasitic infection in dogs. However, breeds (COR=6.91, 95% CI=0.88-54.52, p=0.067) and type of feeding (COR ranged from 3.5 to 7.62, p>0.05) did not seem to have a significant association among the examined dogs. Enteric parasitic infection was reported in 31/150 human stools (20.67%). Students were the most affected groups (37.14%), followed by nomadic people (24%), house wives (20%), house guarders and military workers (12%, each), and employees (10%). The identified parasites were Cryptosporidium spp. (9.33%), Ascaris lumbercoides (3.33%), Heterophyes spp. and Ancylostoma spp. (2.66%, each) and Paragonimus spp. and Hymenolepis nana (1.33%, each). Toxocara IgG antibodies were detected in 36/150 (24%) serum samples investigated. Toxocara IgG antibodies were more prevalent in males (26.66%) than females (20%). Seroprevalence was highest (17/35, 48.57%) in 7-15 years old (COR=6.93, 95% CI=1.75-27.43, p=0.006). Seroprevalence values for T. canis antibodies were higher in those; raising dogs (29.85%), eating raw vegetables (25.21%) and not washing hands before meals (25.45%). T. canis antibodies were detected in 25% of those contacted with soil compared to 30% of those did not. Students were mostly affected (34.29%), followed by nomadic people (32%), house guarders (28%), housewives (20%), military workers (13%), and employees (10%).

CONCLUSION

Detection of enteric parasites in dogs and humans in Egypt substantiates the role posed by dogs in transmitting zoonotic parasites to humans and knock an alarm for common sources of infection for humans and dogs. Common sources may be infected fish or contaminated vegetables that are consumed by dogs or humans or even infected rodents that may contaminate their feed. This pilot study necessitate the need for similar studies and tracing such infection in fish, vegetables, rodent that may be responsible for infecting humans and dogs in order to understand the epidemiology of zoonotic parasitic infection transmitted from dogs to humans.

Simultaneous detection of Entamoeba histolytica/dispar, Giardia duodenalis and cryptosporidia by immunochromatographic assay in stool samples from patients living in the Greater Cairo Region, Egypt

Gastrointestinal infection due to intestinal parasites is an enormous health problem in developing countries and its reliable diagnosis is demanding. Therefore, this study aimed at evaluating a commercially available immunochromatographic assay (ICA) for the detection of cryptosporidia, Giardia duodenalis, and Entamoeba histolytica/dispar for its usefulness in the Greater Cairo Region, Egypt. Stool samples of 104 patients who presented between October 2012 and March 2013 with gastrointestinal symptoms or for the exclusion of parasites at Kasr-Al-Ainy University Medical School were examined by light microscopy of wet mounts and the triple ICA. Microscopy revealed in 20% of the patients [95% confidence interval (CI), 13.5-29.0%] parasites with Hymenolepis nana, E. histolytica/dispar and Blastocystis hominis being the most frequent ones, but was not able to detect G. duodenalis and cryptosporidia, whereas ICA was positive in 21% (95% CI, 14.3-30.0%) and detected E. histolytica/dispar in 12.5% (95% CI, 7.3-20.4%), cryptosporidia in 6.7% (95% CI, 3.1-13.5%) and G. duodenalis in 15.4% (95% CI, 9.6-23.6%) of the patients. Detection of one or more pathogens was associated with access to water retrieved from a well or pump (p = 0.01). Patients between 20 and 29 years of age (p = 0.08) and patients with symptoms of 5 days or longer (p = 0.07) tended to have a higher risk to be infected than patients of other age groups or with shorter-lasting symptoms. In conclusion, the ICA was easy to perform and timesaving. Importantly, it enabled the detection of cryptosporidia, which cannot be found microscopically in unstained smears, demonstrated a higher sensitivity for the detection of G. duodenalis than microscopy, and was more specific for distinguishing E. histolytica/dispar from apathogenic amoeba.

Giardia duodenalis assemblages in Egyptian children with diarrhea

Giardia duodenalis is considered the most common cause of parasitic diarrhea worldwide. Genetic studies revealed that at least eight assemblages (A-H) exist. Of these assemblages, A and B are found primarily in human beings and occasionally in animals. The association between clinical symptoms and G. duodenalis assemblages is controversial. The aim of the present study was to determine the assemblages of G. duodenalis prevalent among Egyptian children with diarrhea. Therefore, 96 positive stool samples for Giardia by light microscopy were subjected to multilocus genotyping targeting the triose phosphate isomerase (tpi), β-giardin (bg), and glutamate dehydrogenase (gdh) genes. Amplified polymerase chain reaction (PCR) products were then purified, sequenced, and aligned with reference strains to determine the assemblages of the Giardia isolates. Out of the 96 microscopically positive stool samples for Giardia, 77 (80 %) were successfully amplified and sequenced at least at one locus. Of these, 21 (27.3 %) were shown to be assemblage A, 54 (70.1 %) assemblage B, while discordant sequence typing results were observed in 2 (2.6 %) samples. AII was the predominant subassemblage of assemblage A, while it was generally difficult to further classify assemblage B. It was concluded that infection with assemblage B was more common than that with assemblage A. No associations between epidemiological information and assemblage were detected, except with age. Although infections with assemblage B were more frequently associated with abdominal pain and acute diarrhea than with assemblage A, the difference was not statistically significant.

Human fascioliasis: a re-emerging disease in upper Egypt

In recent years, the number of humans infected with Fasciola has risen rapidly. Diagnosis is based mainly on detection of eggs in stool analysis. The rate of infection in Egypt is unknown. In this retrospective study, we describe 23 cases of hepatic fascioliasis, and only 2 of these cases showed eggs in stools. The symptoms of infection, such as pyrexia of unknown origin, epigastric pain, and abdominal distension, were suggestive. Imaging techniques, including abdominal ultrasonography and computed tomography, were very helpful in detecting hepatic changes. An indirect hemagglutination assay proved to be of value for diagnosis. Treatment using a 2-day triclabendazole regimen cured the infection and signs of hepatic involvement disappeared. Combining both imaging techniques and laboratory tests is essential for diagnosis of fascioliasis in the early stage.

Location and pathogenic potential of Blastocystis in the porcine intestine

Blastocystis is an ubiquitous, enteric protozoan of humans and many other species. Human infection has been associated with gastrointestinal disease such as irritable bowel syndrome, however, this remains unproven. A relevant animal model is needed to investigate the pathogenesis/pathogenicity of Blastocystis. We concluded previously that pigs are likely natural hosts of Blastocystis with a potentially zoonotic, host-adapted subtype (ST), ST5, and may make suitable animal models. In this study, we aimed to characterise the host-agent interaction of Blastocystis and the pig, including localising Blastocystis in porcine intestine using microscopy, PCR and histopathological examination of tissues. Intestines from pigs in three different management systems, i.e., a commercial piggery, a small family farm and a research herd (where the animals were immunosuppressed) were examined. This design was used to determine if environment or immune status influences intestinal colonisation of Blastocystis as immunocompromised individuals may potentially be more susceptible to blastocystosis and development of associated clinical signs. Intestines from all 28 pigs were positive for Blastocystis with all pigs harbouring ST5. In addition, the farm pigs had mixed infections with STs 1 and/or 3. Blastocystis organisms/DNA were predominantly found in the large intestine but were also detected in the small intestine of the immunosuppressed and some of the farm pigs, suggesting that immunosuppression and/or husbandry factors may influence Blastocystis colonisation of the small intestine. No obvious pathology was observed in the histological sections. Blastocystis was present as vacuolar/granular forms and these were found within luminal material or in close proximity to epithelial cells, with no evidence of attachment or invasion. These results concur with most human studies, in which Blastocystis is predominantly found in the large intestine in the absence of significant organic pathology. Our findings also support the use of pigs as animal models and may have implications for blastocystosis diagnosis/treatment.

Review of parasitic zoonoses in egypt

This review presents a comprehensive picture of the zoonotic parasitic diseases in Egypt, with particular reference to their relative prevalence among humans, animal reservoirs of infection, and sources of human infection. A review of the available literature indicates that many parasitic zoonoses are endemic in Egypt. Intestinal infections of parasitic zoonoses are widespread and are the leading cause of diarrhea, particularly among children and residents of rural areas. Some parasitic zoonoses are confined to specific geographic areas in Egypt, such as cutaneous leishmaniasis and zoonotic babesiosis in the Sinai. Other areas have a past history of a certain parasitic zoonoses, such as visceral leishmaniasis in the El-Agamy area in Alexandria. As a result of the implementation of control programs, a marked decrease in the prevalence of other zoonoses, such as schistosomiasis and fascioliasis has been observed. Animal reservoirs of parasitic zoonoses have been identified in Egypt, especially in rodents, stray dogs and cats, as well as vectors, typically mosquitoes and ticks, which constitute potential risks for disease transmission. Prevention and control programs against sources and reservoirs of zoonoses should be planned by public health and veterinary officers based on reliable information from systematic surveillance.

Molecular epidemiology of Cryptosporidium in livestock animals and humans in the Ismailia province of Egypt

The zoonotic potential of Cryptosporidium was studied in one of the most densely populated provinces of Egypt regarding livestock and people. In a representative survey, faecal samples from cattle, buffalo and stool samples from diarrhoeic children (<10 years) were investigated. Parameters assumed to be related to cryptosporidiosis were recorded for animals and children. Animal samples (804) were examined by the Copro-antigen RIDA(®)QUICK test, followed by PCRs targeting the 18S rDNA and gp60 genes for antigen-positive and 10% randomly selected negative samples. All 165 human samples were tested by both methods. The overall estimated prevalence of Cryptosporidium in ruminants was 32.2%, without significant difference between animal species. PCR identified 65.7% Cryptosporidium parvum, 11.8% Cryptosporidium ryanae, 4.1% Cryptosporidium bovis, and combinations of C. parvum plus C. ryanae (11.2%), C. parvum plus C. bovis (5.3%) and of C. parvum plus Cryptosporidium andersoni (1.8%), also without significant differences in species occurrence between cattle and buffalos. The human Cryptosporidium spp. prevalence was 49.1%, of which 60.5% were Cryptosporidium hominis, 38.2% C. parvum and 1.2% C. parvum plus C. bovis. Analysis of gp60 variants allocated C. parvum found in animals to the zoonotic subtype family IIa (18.9%, subtype IIaA15G1R1 only) and to IId (81.1%, mostly IIdA20G1). In humans 50% were classified as subtype family IIa (IIaA15G1R1 and IIaA15G2R1) and 50% were IIdA20G1. C. andersoni occurred only in cattle older than 1 year. In contrast, mono-infections with one of the three single Cryptosporidium species and the three combinations with C. parvum were more prevalent in cattle and buffaloes younger than 1 year, particularly in those younger than 3 months, and were predominantly subtype family IId. In human samples no Cryptosporidium were identified in children younger than 7 months. Neither place of residence nor the source of drinking-water had measurable effects on prevalence. Remarkably, however, all children with C. parvum subtype family IIa and 86% with subtype family IId had contact to animals. High prevalence and identical genotypes of C. parvum in animals and humans indicate zoonotic transmission due to contact with animals, involving IIdA20G1 as the most frequent subtype.

Use of multiplex real-time PCR for detection of common diarrhea causing protozoan parasites in Egypt

Diarrhea is an important cause of morbidity and mortality, worldwide. Giardia intestinalis, Cryptosporidium spp., and Entamoeba histolytica are the most common diarrhea-causing parasitic protozoa. Diagnosis of these parasites is usually performed by microscopy. However, microscopy lacks sensitivity and specificity. Replacing microscopy with more sensitive and specific nucleic acid based methods is hampered by the higher costs, in particular in developing countries. Multiplexing the detection of more than one parasite in a single test by real-time polymerase chain reaction (PCR) has been found to be very effective and would decrease the cost of the test. In the present study, stool samples collected from 396 Egyptian patients complaining of diarrhea along with 202 faecal samples from healthy controls were examined microscopically by direct smear method and after concentration using formol-ethyl acetate. Frozen portions of the same samples were tested by multiplex real-time for simultaneous detection of E. histolytica, G. intestinalis, and Cryptosporidium spp. The results indicate that among diarrheal patients in Egypt G. intestinalis is the most common protozoan parasite, with prevalence rates of 30.5 and 37.1 %, depending on the method used (microscopy vs. multiplex real-time PCR). Cryptosporidium spp. was detected in 1 % of the diarrheal patients by microscopy and in 3 % by real-time PCR. While E. histolytica/dispar was detected in 10.8 % by microscopy, less than one fifth of them (2 %) were found true positive for Entamoeba dispar by real-time PCR. E. histolytica DNA was not detected in any of the diarrheal patients. In comparison with multiplex real-time PCR, microscopy exhibited many false positive and negative cases with the three parasites giving sensitivities and specificities of 100 and 91 % for E. histolytica/dispar, 57.8 and 85.5 % for G. intestinalis, and 33.3 and 100 % for Cryptosporidium spp.