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Intestinal spore-forming protozoa among patients suffering from chronic renal failure
M S Ali1, L A Mahmoud, B E Abaza
1Department of Parasitology, Faculties of Medicine, Zagazig, Egypt.
Abstract:
Cryptosporidium parvum, Isospora belli, Cyclospora cayetanensis and Microsporidia are four intestinal spore-forming protozoa that cause diarrhoea in immuno-competent individuals and immuno-suppressed patients. Fresh stool samples were obtained from 120 patients suffering from CRF and attending the Dialysis Unit of Zagazig University Hospital. Also, stool samples were obtained from 40 immuno-competent individuals complaining of diarrhoea (control group). The stool samples were examined by direct smear and formol-ether concentration methods then stained by Giemsa, Modified Ziehl Neelsen (MZN) and Aniline carbol methyl violet stains. The four intestinal spore-forming protozoa were detected in 40/120 (33.3%) of patients with CRF and in 2/40 (5.0%) of the control group with a statistically highly significant difference (P < 0.001). C. parvum, Microsporidia, C. cayetanensis and I. belli were detected in 18/120 (15%), 10/120 (8.3%), 9/120 (7.5%) and 3/120 (2.5%), respectively. The four protozoa were found as mixed infections with other pathogens or as single infections confirming their role alone as a cause of diarrhoea. MZN stain was the most efficient simple, and not expensive.
Insights
Patients with chronic renal failure (CRF) have a higher risk of intestinal protozoa infections, including Cryptosporidium parvum and Microsporidia. The Modified Ziehl Neelsen (MZN) stain is an effective diagnostic tool.
Area of Science:
- Medical Parasitology
- Infectious Diseases
- Nephrology
Background:
- Intestinal spore-forming protozoa like Cryptosporidium parvum, Isospora belli, Cyclospora cayetanensis, and Microsporidia cause diarrhea in immunocompetent and immunosuppressed individuals.
- Chronic renal failure (CRF) patients may be more susceptible to opportunistic infections.
Purpose of the Study:
- To investigate the prevalence of four intestinal spore-forming protozoa in CRF patients undergoing dialysis.
- To compare the infection rates between CRF patients and a healthy control group.
- To evaluate the efficacy of different staining methods for protozoa detection.
Main Methods:
- Stool samples from 120 CRF patients and 40 controls were analyzed.
- Direct smear, formol-ether concentration, Giemsa, Modified Ziehl Neelsen (MZN), and Aniline carbol methyl violet stains were employed.
- Statistical analysis was performed to compare groups.
Main Results:
- A significantly higher prevalence of these protozoa was found in CRF patients (33.3%) compared to controls (5.0%) (P < 0.001).
- Cryptosporidium parvum (15%), Microsporidia (8.3%), Cyclospora cayetanensis (7.5%), and Isospora belli (2.5%) were identified in CRF patients.
- Mixed and single infections were observed, confirming their etiological role in diarrhea.
- The MZN stain demonstrated high efficiency, simplicity, and cost-effectiveness.
Conclusions:
- CRF patients exhibit a significantly increased risk of intestinal spore-forming protozoa infections.
- These protozoa are important causes of diarrhea in CRF patients, necessitating appropriate diagnostic approaches.
- The Modified Ziehl Neelsen (MZN) stain is recommended for its efficiency and affordability in diagnosing these infections.