الفهرس 
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Abstract
ESRD is an immunosuppressive condition that makes patients more prone to infections, including those caused by opportunistic protozoan parasites. Patients undergoing hemodialysis (HD) suffer from humoral and cell-mediated immune defects and have disturbances in acquired immune response to a variety of antigens.
ESRD leads to impaired cell-mediated immunity as a result of lymphopenia and dysfunction of cluster of differentiation 4 (CD4+) T cells. Moreover, uremia-associated pro-inflammatory conditions developed in ESRD patients can lead to irreversible premature aging of T-cell compartment that contributes to the cell-mediated defects and susceptibility to infectious agents. On the other hand, HD induces apoptosis of T cells, decreased phagocytic capacity of neutrophils and monocytes along with abnormal production of pro-inflammatory cytokines by monocytes because of their direct contact with artificial membranes in HD machines. In addition, frequent blood transfusions to patients with ESRD can lead to the development of antibodies against human leukocyte antigens, which can form immune complexes that interfere with cellular immune responses.
Opportunistic parasitic infections, including those with Cryptosporidium species, Cystoisospora belli, Cyclospora cayetanensis, Blastocystis hominis, Toxoplasma gondii and microsporidia, have been documented to cause serious complications or even death among immunocompromized patients, including those undergoing HD.
This cross-sectional study aimed to study the prevalence of common parasitic infections among the hemodialysis pediatric patients at Ain Shams University Pediatric Hemodialysis Unit (PUD).
To fulfill the aim of the current study 50 children with ESRD on regular hemodialysis and 20 apparently healthy age and sex matched children were included in this study during the period from June 2018 to December 2018. The mean age of our cases was 14.35 ± 4.44 years while the mean age of the controls was 8.52 ± 2.85 years. 46% of our cases were males while 55% of the controls were males. 88% of our cases were resident in urban areas while 75% of the controls were resident in urban areas.
All studied children were subjected to full history taking, general and abdominal examination and investigation (stool analysis and ELISA test for anti-Toxoplasma IgM and IgG).
*The current study revealed that:
• The overall prevalence rate of intestinal parasitoses among HD patients in the present study was a little bit higher than among their apparently healthy counterparts (70% vs. 60% respectively) but this was statistically insignificant.
• In the present study, HD children showed that Blastocystis hominis was the most prevalent (30%) and Cryptosporidium parvum the least one (10%).
• The overall T. gondii seroprevalence rate was approximately (22%) of HD patients in the present study. The anti-Toxoplasma IgM seroprevalence among HD patients was (2%).
• In the present study, among the controls Entameba histolytica and Giardia lamblia were the most prevalent but cryptosporidium parvum and B. hominis were not detected. Regarding T. gondii, the prevalence rate of anti-Toxoplasma IgG among control group was (15%) but the prevalence rate of anti-Toxoplasma IgM was (0%).
• In the present study, approximately half of HD patients had a significant increase of prevalence of diarrhea but not abdominal pain or vomiting when compared with the controls.
• In the present study when we compared between cases with positive parasitic infections and those negative for parasitic infections we found no a statistically significant association with diarrhea, vomiting or abdominal pain.
• In the present study organomegaly and exposure to animals had a significant prevalence in HD patients when compared to the controls.
• In the present study the comparison between patients positive for parasitic infections and those negative for parasitic infections showed no significant difference regarding the duration of HD, the total leucocytic count and eosiophilic count.
• Regarding symptomatolgy, abdominal pain was higher among children positive for B.hominis than those who negative for B.hominis but with no significant difference .On the other hand, No significant difference between children positive for Cryptosporidium parvum and those who negative for Cryptosporidium parvum regarding the prevalence of abdominal pain diarrhea.
• In the present study, when we compared between patients with reactive IgG for Toxplasma gondii and those with non reactive IgG for Toxoplasma gondii we found a significant increase of prevalence of organomegaly among patients with reactive Toxoplasma IgG. No significant difference regarding residency, animal exposure and lymphadenopathy between these two groups was found.
We can conclude that the results of this study revealed that opportunistic parasitic infections and related clinical symptoms in ESRD children undergoing hemodialysis were more frequent than in a matched control group. Considering that patients under hemodialysis are immunocompromised, parasitic infections may make their situation much more complicated.