Prevalence of Intestinal Protozoa among Saudi Patients with Chronic Renal Failure: A Case-Control Study.

Yousry A Hawash,Osama F Sharaf,El-Amir M Amir,Laila Sh Dorgham

doi:10.1155/2015/563478

Abstract

It has been hypothesized that chronic renal failure (CRF) predisposes patients to infection with intestinal protozoa. We tested this hypothesis with a matched case-control study to determine the prevalence of these protozoa and their diarrhea associated symptoms among 50 patients with CRF (cases) from Taif, western Saudi Arabia. Fifty diarrheal patients without CRF were recruited in the study as controls. Participants were interviewed by a structured questionnaire and stool samples were collected. Samples were thoroughly examined with microscopy and three coproantigens detection kits. Enteric protozoa were detected in 21 cases and 14 controls. Blastocystis spp. were the most predominant parasite (16% in cases versus 8% in controls), followed by Giardia duodenalis (10% in cases versus 12% in controls) and Cryptosporidium spp. (10% in cases versus 6% in controls). Cyclospora cayetanensis was identified in two cases, while Entamoeba histolytica was described in one case and one control. Intestinal parasitism was positively associated with the male gender, urban residence, and travel history. Clinical symptoms of nausea/vomiting and abdominal pain were significantly varied between the parasitized cases and controls (P value ≤ 0.05). Given the results, we recommend screening all diarrheal feces for intestinal protozoa in the study's population, particularly those with CRF.

Highlights

Enteric protozoa are a diverse group of unicellular microparasites inhabiting the intestinal tract of high vertebrate hosts including humans [1]
Fresh fecal specimens were examined for G. duodenalis with RIDA Quick Giardia (R-Biopharm, Darmstadt, Germany), Cryptosporidium spp. with RIDA Quick Cryptosporidium (R-Biopharm, Darmstadt, Germany), and for E. histolytica with E. histolytica II Test (TechLab, Blacksburg, Virginia, USA) commercial kits
In the study’s population, protozoan infections associated with diarrhea were common (35%)

Summary

Introduction

Enteric protozoa are a diverse group of unicellular microparasites inhabiting the intestinal tract of high vertebrate hosts including humans [1]. Diarrhea is relatively a frequent symptom for protozoan infections but asymptomatic colonization is common [1]. Attributing diarrhea to an exact parasite identified in a patient’s feces is not certain for all protozoa. While a number of intestinal protozoa such as Giardia duodenalis, Entamoeba histolytica, Cryptosporidium spp., Cyclospora cayetanensis, Cystoisospora belli, and Microsporidia spp. have been certainly recognized to cause diarrhea in humans [4], others like Entamoeba coli and Entamoeba dispar almost certainly have not [5]. Enteric protozoa like Blastocystis spp. and Dientamoeba fragilis have been recently identified in patients with diarrhea, but their causal role is still uncertain [6]. Regardless of the underlying protozoan parasite, diarrhea is usually mild and self-limited in healthy immunocompetent persons. Severe and protracted diarrhea has been reported in immunosuppressed patients [7]

Methods

Results

Conclusion