Intestinal parasitic infections and associated risk factors in diabetic patients: a case-control study

Diabetes mellitus (DM) is a metabolic disease that puts the individual at immune-suppression state. The present study aims to detect the burden of intestinal parasites and associated risk factors among diabetic patients in a case-control study. Stool samples from 100 diabetic patients, and 100 non-diabetic controls attending Beni-Suef University Hospital were collected and processed by direct smear examination, concentration technique, permanent staining by modified Ziehl-Neelsen and modified trichrome stains, and culture on nutrient agar plates. The overall prevalence of intestinal parasites was 38%; higher in diabetic patients (44%) than control group (32%) with non-statistical significance. The most predominant intestinal parasites detected among diabetics were Blastocystis hominis (29%), followed by Cryptosporidium sp. (12%), Giardia lamblia (7%), Microsporidia sp. (5%), Entamoeba histolytica/dispar, Hymenolepis nana, and Capillaria philippinensis (each representing 2%). No statistical difference was detected between both groups in all parasites except for Microsporidia sp. (P = 0.008). In diabetic patients; age ≥ 41 years, living in rural areas, and patients having uncontrolled and complicated DM were significantly associated with intestinal parasitosis by univariate analysis (P = 0.016, 0.035, 0.014, 0.043) respectively. By multivariate analysis, age and rural residence were the only statistically significant risk factors (OR = 6.192, and 2.614) respectively. Intestinal parasites were highly associated with diarrhea (P < 0.001), and flatulence (P = 0.042) in the diabetic patients. Diabetic patients should be screened routinely for intestinal parasites, especially the opportunistic ones, and treated for their overall well-being.

Toxoplasma gondii in cancer patients receiving chemotherapy: seroprevalence and interferon gamma level

Toxoplasma gondii is an opportunistic parasite causing life-threatening diseases in immune-compromised patients. The purpose of the study is to determine the seroprevalence of Toxoplasma gondii in chemotherapy receiving cancer patients in relation to different types of malignancies, and to estimate the level of interferon gamma in Toxoplasma seropositive and seronegative cancer patients and healthy controls. Anti-Toxoplasma IgG and IgM antibodies, and interferon gamma were analyzed in 120 cancer patients receiving chemotherapy (60 having hematological malignancies and 60 with solid organ tumors) and 60 healthy controls using ELISA method. Toxoplasma (IgG and IgM) were determined in (66.7% and 9.2%) of the cancer group compared to (33.3% and 6.7%) of the control group with statistical significance only in IgG seropositivity (p < 0.001, OR = 4). Patients with hematological malignancies had higher IgG seropositivity than solid organ tumors (40% vs 26.7%). The difference between the groups was statistically significant (p = 0.002, OR = 3.5). Median level of interferon gamma was in the same range between cancer patients and control group. However, it was highly elevated in Toxoplasma seropositive (76 pg/ml) than seronegative (44.5 pg/ml) cases with statistical significance (p < 0.001). T. gondii infection remains a major threat to cancer patients and still needs proper screening, diagnosis and treatment.

Human intestinal myiasis caused by Clogmia albipunctata larvae (Diptera: Psychodidae): First report in Egypt

This is the first case report in Egypt and Middle East region of human intestinal myiasis caused by Clogmia albipunctata larvae. A 36-year-old male patient presented to the Outpatient Clinic of Internal Medicine in Beni-Suef University Hospital complaining of abdominal pain, bloating, and diarrhea intermittent with constipation. Patient's stool sample was referred to the Department of Medical Parasitology for examination of passed larvae and treatment prescription. Examination of larvae by light and scanning electron microscopy confirmed the morphological identification of fourth instar larvae of C. albipunctata. Human intestinal myiasis is an unusual cause of gastrointestinal manifestations.

Case Report of Human Urinary Myiasis Caused by Clogmia albipunctata (Diptera: Psychodidae) with Morphological Description of Larva and Pupa

BACKGROUND

Urinary myiasis is a form of myiasis caused mainly by larvae of Fannia scalaris, Musca, Sarcophaga, Lucilia, Wohlfahrtia, Calliphora, and rarely by Eristalis and Clogmia albipunctata.

METHODS

This report presents a case of female patient complaining of dysuria and frequency of micturition associated with intermittent passage of small, motile, dark-colored worm-like organisms in urine. She was a married housewife aged 24 years old referred from the Tropical Outpatient Clinic of Beni-Suef University Hospital, Egypt. The patient was subjected to a full questionnaire sheet and investigations such as CBC, stool and urine analysis and urinary ultrasonography. Collected larvae and pupae from urine samples were examined macroscopically and microscopically.

RESULTS

The examined larvae and pupae belonged to C. albipunctata. Ivermectin was prescribed to the patient with complaint withdrawal and complete disappearance of the larvae from urine.

CONCLUSION

This study reports the first case of urinary myiasis caused by C. albipunctata in Beni-Suef Governorate, the second in Egypt and third case worldwide. The study throws some light on the medical importance and management of urinary myiasis.