الفهرس 
TitleOnly 14 pages are availabe for public view
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Abstract
Blastocystis spp. is the most common eukaryotes reported to colonize humans, yet, remains an enigma on many levels. Despite having been described more than 100 years ago, the question of whether Blastocystis causes disease or is a commensal of the human gut still has no definitive answer. Moreover, its genetic diversity, host specificity and zoonotic potential remain very incomplete. Two types of reproduction have been described: asexual reproduction by binary fission, and sexual reproduction by autogamy to form primary cysts which are vacated in the faeces and communicated directly through faecal/oral contact, or by assimilation of contaminated water and food. B. hominis is a highly polymorphic organism with various morphological forms being reported in the literature including vacuolar, granular, amoeboid, cyst, avacuolar, and multivacuolar forms. The vacuolar form is the most common morphotype seen in in vitro cultures and stools.
Although several clinical and epidemiological studies of Blastocystis infection have been performed in Egypt, only few studies have addressed the relation between this intestinal parasite and the immunological status in children. In the present study, the percentage of Blastocystis hominis detected among haemodialysis patients and chronic kidney disease patients at El Shatby hospital was studied and analysed in relation to CD4, CD8 cell count and CD4/CD8 ratio. The relations between the rate of infection, its demographic, clinical and epidemiological data collected were also assessed.
The present study was conducted on 40 haemodialysis patients, 40 chronic kidney disease patients and 20 apparently healthy children free of renal disease randomly selected of children (1-14 years) from El Shatby hospital. A single stool sample collected from participating children for microscopic examination using iodine direct wet mount smear, formol-ethyl acetate concentration technique for the diagnosis of Blastocystis infection. Collected blood samples that were divided for two portions. The first part was for performing complete blood picture and renal function tests. The second part used for measuring CD4, CD8 count and CD4/CD8 ratio by flow cytometry.
Among the examined children, parasitological examination of B. hominis infections was 55% in haemodialysis patients, 62.5% in chronic kidney disease patients and 20% of control individuals. The infection rates of B. hominis were significantly different between the three studied groups. As regards CD4 cell count, it was found that 42.5% of HD patients, 17.5% of CKD patients and 0% of the control group had CD4 cell count less than 200 cell/μl. Most participants of the control group had CD4 cell count more than 500 cell/μl (75%).
By analysis of the association between demographic characteristics (age, gender, residence) and Blastocystis infection, no significant associations was observed. Also, no significant association was found between animal contacts and the source of drinking water as possible risk factors for infection acquisition. Concerning the clinical manifestations, no significant association was reported between the symptoms and infection. Similarly, no significant association was found between general laboratory data (CBC, urea and creatinine levels) and Blastocystis infection.
Summary, C onclusion and Recommendations
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In the present study, a significant association was found between Blastocystis infection and the immunological parameters in HD and CKD patients including CD4 cell counts and categories, CD8 cell counts, CD4/CD8 ratio and its categories. It was noted that Blastocystis was more commonly detected in patients with CD4 count less than 200. The infection rate of B. hominis was high among HD and CKD patients with CD4/CD8 ratio less than 1 (63.6% & 87.5 respectively).