الفهرس 
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Abstract
Diarrhea is an important cause of morbidity and mortality worldwide.E. histolytica, G. lamblia, and C.parvum are the most frequent diarrhea-causing parasitic protozoa. Microscopy is the most commonly used method for the routine diagnosis of these parasites in developing countries, however, it lacks sensitivity and specificity. Laboratories in the developing world continue to rely on ova and parasite examination as the gold standard for detection of intestinal parasites as it is relatively inexpensive and appropriate for resource limited countries. However, accurate diagnosis of intestinal parasites is dependent mostly on the level of expertise of the microscopist, and therefore the sensitivity and the specificity of ova and parasite examination can vary from laboratory to laboratory.
The aim of the present work was to compare microscopical techniques with a commercially available copro-antigen assay to detect E. histolytica/dispar,G. lamblia and Cryptosporidium spp. infections in patients with diarrhea.
The current study was conducted on a total of 120 diarrheic patients attending the Parasitology Department laboratory in the Medical Research Institute and from different private laboratories in Alexandria, in the period from October 2014 to May 2015. The study patients were 61 males and 59 females, varying in age from 10 to 60 years. Seventy percent of them were from urban areas. All stool samples were collected and subjected to microscopic examination and copro-antigen detection using RIDA ®QUICK Entamoeba/Giardia/Cryptosporidium Combi immunochromatographic card test (ICT). Microscopic examination included wet mounts with saline, and iodine, as well as permanently stained with modified trichrome stain and Kinyoun acid fast stain.
All data were subjected to statistical analysis. Results of microscopic and immunologic detection of Entamoeba histolytica/dispar, Giardia and Cryptosporidium were compared.
The totalinfection rate was 34% (41of a total of 120), withdifferent intestinal parasitic infections as diagnosed after wet mounts.G. lamblia showed the highest percentage of infection (18.3%), with a statistically significant difference (p< 0.001) from infection with other parasites.The other parasites found were: B. hominis (8.3%), E. coli (6.7%), E. histolytica (4.2%), H. nana (2.5%), A. lumbricoides (1.7%) and S. mansoni (0.8%). Cryptosporidium parvum could not be detected by regular wet mount technique.
The highest infection rate was among subjects below 20 years (91.6%), which was statistically significantfrom all other groups(p<0.001*).The lowest infection rate was among individuals aged from 30-40 years in which only 12.1% were infected.
Regarding gender, 61 individuals were males, 36% of them were infected with intestinal parasites, while among 59 females, 32% had intestinal parasitic infections with no statistically significant difference between both groups (p >0.05).
A higher rate of parasitic infections was detected among those who reside inrural communities (70.2%)than those in urbanareas (18%) with a statistically significant difference between both groups (p < 0.05*).
The prevalence of different intestinal protozoa as detected by trichome stain showed thatG. lambliaacquired the highest percentage (16.7%) followed by B. hominis (11.7%), E. histolytica (5.8%), E. coli (6.7%) as well as Dientamoeba fragilis and Iodamoeba butschlii each with 2 cases (1.7%); which were not detected in wet mounts.
By modified ZN stain, out of 120 examined stool samples only one case had C. parvum infection (0.8%), while Isospora belli and C. cayetanensis were not detected.
Results detected by the immunochromatographic strip triple test (triple ICT)showed that G. lambliahad the highest percentage of infection 20 cases (16.7%) followed by E. histolytica 7 cases (5.8%), and the lowest was C. parvum with only one case detected (0.8%).
Comparison of the techniques used in the present study revealed that:
• Regarding E. histolytica/dispar, moderate agreement was found between wet mount and trichrome stain and between wet mount and ICT. Perfect agreement was found between trichrome stain and ICT.
• As for Giardia lamblia there was a strong agreement between wet mount stool examination and trichrome stain, three cases positive by wet mount were missed using trichrome stain, while one case diagnosed after trichrome stain was not detected by wet mount. There was also strong agreement between wet mount and ICT. A perfect agreement was found between trichrome stain and ICT.
• Considering C. parvum, perfect agreement was noted between MZN and ICT.
It was concluded that microscopic examination of wet mountsshould not beneglected, while ICT can replace the complex staining techniques for diagnosis of E. histolytica/dispar, G. lamblia and C. parvum.