الفهرس 
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Abstract
Diabetes mellitus is one of the diseases well known in Egypt; the prevalence of type II diabetic patients was recorded in 2013 as 20% of the population which is obviously a very high percentage. The disease is associated with several previously recorded pathological changes in the body as, decreased arterial perfusion, neuropathy, and suppressed immune response. Lymphocyte and polymorphonuclear leukocyte functions are altered. The most prominent alteration is in the phagocytic functions of polymorphonuclear leukocytes, leading to a body vulnerable to bacterial and candidal infections and other opportunistic micro-organisms. Therefore, the authors intended to assess the predisposition of the diabetic population in Sohag community to intestinal parasites by comparing their prevalence in diabetic and nondiabetic individuals.
In the present study, 100 stool samples were collected from patients who suffered from diabetes mellitus from the diabetes outpatient clinic in Sohag University Hospital and 100 stool samples from non diabetic apparently healthy control group from May to October 2013.
The collected samples were examined macroscopically, by direct smear and Kato thick smear methods. Part of each sample was also preserved in formalin 10% for further testing. Other concentration techniques used were; simple sedimentation, simple floatation, formol ether sedimentation tests. Also all samples were stained by modified Ziehl Neelsen stain for detection of oocycts of coccidia. Results were tabulated and statistically analyzed.
In the diabetic group, the age of patients ranged from 1 to70 years with the mean of 41.7 ± 20.3. Males constituted 56% of the whole patients (56 patients), while females were 44% of them (44 patients). Also 60% of patients were rural citizens (60 patients) and 40% of them were urban ones (40 patients). 25% (25 patients) of the patients with type I DM and 75% (75 patients) were type II. In type I patients, 60% of them were controlled (15 patients) and 40% were uncontrolled (10 patients). While in type II patients, 66.6% of them were controlled (50 patients) and 33.3% were uncontrolled (25 patients). The controlled group was 54 males and 46 females, age ranged from 1 to 70 years old.
The results revealed that the prevalence of intestinal parasitic infections was 25% of diabetic patients (25 cases) and 7% of control group (7cases). Diabetes mellitus affected the prevalence of intestinal parasitic infectionswith high significance (p value <0.001).
G. lamblia infection was detected in 22% of diabetic patients (22cases) and in5% of control group (5 cases). The infection was considered of a significant value (p value <0.001).
E. histolytica infectionwas found in 7% of diabetic patients (7cases) and in 3% in control group (3cases). The infection was statistically non significant (p value<0.3).
E. coli infectionwas found in 8% of diabetic patients (8cases) and in 3% in control group (3cases). The infection was statistically non significant (p value<0.2).
E. hartmanni infectionwas found in 3% of diabetic patients (3cases) and no case in control group (3cases). The infection was statistically non significant (p value<0.2).
D. fragilis infectionwas found in 1% of diabetic patients (1case) and no case was detectedin control group. The infection was statistically non significant (p value<0.3).
C. parvuminfection was found in 5% of diabetic patients (5cases) and no case was detected among control group. The infection was statistically non significant (p value<0.07).
Microsporidia was found in 3% of diabetic patients (3cases) and no case was detected among control group. The infection was statistically non significant (p value<0.2).
H. nana was detected in 5% of diabetic patients (5 cases) and in 3% of control group (3 cases). The infection was statistically non significant (p value<0.7).
Although, the prevalence of intestinal parasitic infections was 26.7% of male patients (15 cases) in comparison to 22.7% of the female patients (10 cases),gender was not a risk factor for intestinal parasites in diabetic patients (p value <0.8).
Also the prevalence of intestinal parasitic infections was 30% of diabetic patients in rural areas (18 cases) in comparison to 17.5% of thepatients diabetic in urban areas (7 cases) but residence was not a risk factor for intestinal parasites in diabetic patients(p value < 0.2).
Age was found to be significantly associated with the intestinal parasitic infections in diabetic patients (p value < 0.003) with the age group less than 10 years having the highest prevalence. Age distribution of intestinal parasites patients showed that 70% of patients less than 10 years, 50% of patients from 10 to 19 years, 20% of patients from 20 to 29 years, 16.6% of patients from 30 to 39 years, 15% of patients from 40 to 49 years, 26.08% of patients from 50 to 59 years and 5% of patients above 59 years. An unexplained prevelance leap of infection levels was noticed in the age group from 50 to 59 years.
Type of DM also affected the prevalence of intestinal parasitic infections with high significance (p value <0.001) as 52% of patients with type I diabetes (13 cases) and 16% of patients with type II diabetes (12 cases) were found to be infected.
Also control of the disease significantly (p value<0.007 in type I and p value< 0.01in type II) affected the prevalence of intestinal parasitic infections. Guided by the fact that 90% of uncontrolled type Ipatients (9 cases) and 26.6% of controlled type I patients with (4 cases) were infected. Mean while32% of patients with type II uncontrolled (8cases) and 8% of patients with type II controlled (4cases) were infected.
As regards the diagnostic procedures used, the number of intestinal parasites in the samples detected by formol ether sedimentation method was 68 parasites, 62parasites by simple sedimentation,53parasites by simple floatation, 47parasites by Kato thick smear and lastly 43parasites by direct smear. So, the best method for diagnosis of intestinal parasites in the present study was formol ether sedimentation technique.
The number of Cryptosporidiumand microsporidia detected by modified Ziehl-Neelsen stain was 8 parasites.
Conclusions:
At the ends of this study several significant relations were proved, including the relation of DM patients generally and acquiring intestinal parasites, type I, younger patients, and those not controlling their disease of type I and type II DM; are more liable to get infected, also they are more likely to be infected with Giardia lamblia. These proven relations lead us to an obligation for the patient, to advice him/her in the diabetes clinic they attend, to pay extra attention in their health behavior for cleanliness of themselves and the food they eat especially those young type I uncontrolled disease and they have to attend to the resort to the clinic as soon as any gastro-intestinal symptom occurs. A guidelines paper is suggested to be distributed among them advising them with the healthy way to protect them from the intestinal parasitic infections.
The present work unquestionably answered some targeted questions and raised few more. Some questions that need answers and are suggested by the authors as next points of research include:
• Immunological defects leading to the former results and whether local intestinal defense mechanisms are included, in what way? And how to treat the defect?
• Another point is the defect introduced by the lack of control in Types I and II DM that significantly increases the risk of intestinal parasitic infections.
• The effect of the intestinal parasitic infections on DM patients is also a point of interest.
• The notable leap of infection rate during the age between 50-59 years also raises a question that needs to be answered.
• The desired disappearance of many parasites previously well known to be endemic in the same locality (Sohag) and the rise of prevalence of othersneeds more investigations and co-operation with the public health researchers.