Abstract
Background and study aim: Opportunistic parasitic infections have been documented to cause serious complications among immunocompromised patients, including those undergoing hemodialysis (HD). Therefore, this study aimed to determine the prevalence of common parasitic infections and associated morbidity among the HD pediatric patients at Ain Shams University Pediatric Hemodialysis Unit. Patients and Methods: A comparative cross-sectional study was conducted on 50 HD patients and 20 apparently healthy individuals from January 2018 to March 2019. Stool samples were examined for parasites using direct smear, formol ether concentration, and staining with modified Ziehl- Neelsen stain. The serological analysis for anti-Toxoplasma IgM and IgG and complete blood count was performed. The results were correlated with the history, physical, and demographic data of the study groups. Results: The overall prevalence rate of intestinal parasitoses among patients with HD was a little bit higher than the control group (70% versus 60%, respectively) but this was statistically insignificant. Blastocystis hominis (30%), Entamoeba histolytica (28%), and Giardia lamblia (20%) were the most frequent among children with HD, with a statistically significant difference in Blastocystis hominis infection rates between patients and their counterparts. Moreover, the overall Toxoplasma gondii seroprevalence rate among patients with HD was (22%) and the anti-Toxoplasma IgM was (2%). Conclusion: The overall rate of opportunistic parasitic infections and related clinical symptoms in children with HD was slightly more frequent than in the control group. So, stool examination for intestinal parasites and Toxoplasma gondii screening should be incorporated into routine clinical care for children with HD.
Highlights
The continuous progress in sanitation infrastructure, intestinal parasitic infection still be considered a problem at the community level, especially in poor countries
Out of our 50 cases, we found 17 patients who had CAKUT as a primary etiology of chronic kidney disease (CKD) e.g. renal dysplasia, posterior urethral valve, and vesicoureteral reflux, 12 patients had a history of chronic glomerulonephritis e.g. IgA nephropathy, chronic Henoch Schonlein purpura, and lupus nephritis, 4 patients with a history of congenital nephrotic syndrome, 5 patients with a history of hemolytic uremic syndrome (HUS), 4 patients who had steroidresistant nephrotic syndrome (SRNS), 2 cases of Joubert syndrome, 3 cases of primary hyperoxaluria and 3 cases of drug-induced chronic interstitial nephritis
Among 50 pediatric patients with HD, we could detect B. hominis infection in 15 patients (30%) with a significant statistical difference compared to the control group; p-value (0.004), C. parvum in 5 patients (10%), E. histolytica trophozoite in 14 patients (28%), G. lamblia cysts in 10 patients (20%), Enterobius vermicularis (E. vermicularis) in one patient (2%) and Vampirolepis nana (V. nana) in none of them (0%) with no significant statistical difference compared to the control group
Summary
The continuous progress in sanitation infrastructure, intestinal parasitic infection still be considered a problem at the community level, especially in poor countries. Patients on HD usually suffer from disturbed kidney functions with subsequent retention of uremic toxins in their blood. These toxins interfere with humoral and cellular immunity functions causing enhanced individual vulnerability to infections [3]. Parasitic infections are one of the significant causes of morbidity and mortality in patients with HD [5]. Opportunistic parasitic infections have been documented to cause serious complications among immunocompromised patients, including those undergoing hemodialysis (HD). This study aimed to determine the prevalence of common parasitic infections and associated morbidity among the HD pediatric patients at Ain. Shams University Pediatric Hemodialysis Unit
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