Detection of cryptosporidium in immunosuppressed patients.

BACKGROUND: Cryptosporidium is an important cause of diarrhoeal disease in children and immunosuppressed persons. It is an opportunistic pathogen. A study was done to determine the frequency of Cryptosporidium in immunosuppressed persons. METHODS: Fecal samples were collected from Jinnah Postgraduate Medical Centre Karachi during July to December 2003 and they consisted of three categories of patients which included cancer patients (10) diabetics (20) and patients on dialysis (20). Direct microscopy in saline and iodine was done to detect parasites. Detection of Cryptosporidium from fecal samples was done by Kinyoun method. Bacteriological study was also done to determine any bacterial pathogens. RESULTS: Out of 50 fecal samples Cryptosporidium was found in 20 (40%) of cases. Among the different groups Cryptosporidium was found in 80% of cancer patients, 25% diabetics and 35% dialysis patients. Distribution of Cryptosporidium according to gender indicated more cases in males (87%) among cancer patients and 40% among dialyzed patients while diabetic patients showed similar distribution. Among the different age groups male patients were found to be between 40-49 years group for all categories of patients while more positive cases were detected in females in 30-39 years age group. Direct microscopy did not indicate any ova or parasite and bacteriological study indicated Salmonella and Shigella spp. in stool samples. CONCLUSION: This study provides indication of the possibility of Cryptosporodisis in immunosuppressed patient and further comprehensive study is required to clearly establish the relationship of opportunistic infections in immunosuppressed patients.

Diagnostic efficacy of stool antigen test (HPSA), CLO test and serology for the detection of Helicobacter pylori infection.

BACKGROUND: The diagnosis of Helicobacter pylori infection was initially being made through invasive methods but now non invasive methods have been developed to make the diagnosis easier. The present study was done to evaluate the diagnostic efficacy of a two non invasive tests i.e. Helicobacter pylori Stool antigen test (HpSA) and Helicobacter pylori IgG serology with an invasive method i.e. Campylobacter like organism (CLO) gel test. METHODS: The study was conducted in the gastroenterology unit of Pakistan Medical Research Council Research Centre Karachi. Adult patients with gastroduodenal disease were selected for study and their medical history was recorded. Endoscopy was done on all patients and the antral biopsy sample was tested for H. pylori using CLO test. Serology (IgG) was done elsewhere using ELISA and titers of over 50 units were recorded as positive. HpSA was done to determine the presence of H. pylori antigen in stool. RESULTS: Out of 43 patients 34 (79%) were males and 9 (21%) females. The main presenting symptom was epigastric pain in 74% cases. Although H. pylori IgG antibody titers of over 50 were taken as positive but for this study titres of over 100 were taken as significant for comparison with other tests. CLO test was positive in 26 (60.5%) cases, H. Pylori antibody titers of over 100 IU were present in 33 (76.7%) cases and HpSA in 21 (48.8%). Using CLO test as the gold standard the sensitivity of serology was 81% and that of HpSA 65% with a 29% and 76% specificity respectively. CONCLUSION: In our setting CLO test is still the best diagnostic test for H. Pylori detection. Both non invasive tests i.e. serology and stool HpSA are less sensitive than CLO but amongst each other both are equally sensitive.

Efficacy of albendazole in giardiasis.

Albendazole and metronidazole were compared in 68 patients diagnosed positive for giardiasis. Albendazole 1200 mg, one dose was given to 24 patients, albendazole 400 mg twice a day for 3 days was given to 23 patients, and metronidazole 400 mg 3 times a day for 5 days to 21 patients. Response to therapy was monitored by clinical examination and analysis of fresh faecal samples on days 0, 3, 7 and 10. Response to the single dose of albendazole was 55%, to the divided dose of albendazole 70%, and to metronidazole 84%. The results show that albendazole, originally recommended for helminthic infection, can also be used in patients with mixed protozoal infection or for infections resistant to metronidazole.

Efficacy of albendazole in giardiasis

Albendazole and metronidazole were compared in 68 patients diagnosed positive for giardiasis. Albendazole 1200 mg, one dose was given to 24 patients, albendazole 400 mg twice a day for 3 days was given to 23 patients, and metronidazole 400 mg 3 times a day for 5 days to 21 patients. Response to therapy was monitored by clinical examination and analysis of fresh faecal samples on days 0, 3, 7 and 10. Response to the single dose of albendazole was 55%, to the divided dose of albendazole 70%, and to metronidazole 84%. The results show that albendazole, originally recommended for helminthic infection, can also be used in patients with mixed protozoal infection or for infections resistant to metronidazole

Role of cytokines in giardiasis.

OBJECTIVES: The purpose of this study was to determine the relationship of inteleukins with G. lamblia infection. METHODS: Serum interleukins were estimated in 42 patients suffering from giardiasis and 42 apparently healthy controls. Tumor Necrosis Factor (TNF) was also studied in 14 patients and 14 controls. Interleukins (IL-2, IL-4, IL-10) and TNF alpha were determined by ELISA. RESULTS: IL-4 was present in 14 (33.3%) patients (mean value 220 pg/ml) and 8 (19%) controls (mean value 93 pg/ml). IL-10 was present in 5 (12%) patients (mean value 57 pg/ml) and 6 (14%) controls (mean value 79 pg/ml). IL-2 was present in one patient only but absent in controls. TNF alpha was not detected in patients but was present in 2 (14.2%) controls (mean value 75 pg/ml). CONCLUSION: Results indicate that IL-4 being an inflammatory regulator appears to have some relationship with giardiasis, while TNF alpha was not detected in patients probably because G. lamblia is a non invasive parasite.

Efficacy of a combined diloxanide furoate-metronidazole preparation in the treatment of amoebiasis and giardiasis.

A combined formulation of diloxanide furoate and metronidazole was used to treat amoebiasis and giardiasis (cysts and vegetative forms) in 54 patients. Of these 34 patients had amoebiasis, 19 had giardiasis and one had mixed infection. Each patient took one tablet (containing 500 mg diloxanide furoate and 400 mg metronidazole), three times daily for 5 days, and the response to therapy was checked by clinical examination and by examination of fresh stools on days 3, 5 and 10. Abdominal pain was completely relieved in 91% and 84% of patients with amoebiasis and giardiasis, respectively, while parasitic clearance was 100% in both groups. Tolerance to the drug was adequate.

Significantly increased IgG2 subclass antibody levels to Blastocystis hominis in patients with irritable bowel syndrome.

Blastocystis hominis is a common intestinal parasite of humans in the tropics whose pathogenic role is in dispute. Its presence has been reported in a variety of intestinal disorders resembling irritable bowel syndrome (IBS) such as diarrhea, anorexia, and flatulence. We have therefore investigated a possible link between IBS and blastocystosis by determining IgG antibody levels to B. hominis in patients with IBS. Levels of IgG antibodies were significantly elevated in patients with IBS compared with asymptomatic controls (P < 0.0001, by Student's t-test) in both B. hominis stool culture-positive and stool culture-negative IBS patients. When IgG antibodies were divided into their respective subclasses, only IgG2 levels were significantly increased in IBS patients compared with asymptomatic controls, indicating that the predominant response in these patients may be directed to carbohydrate antigens. The diagnostic usefulness of this test in IBS patients remains to be established because these data are only suggestive of a possible link between B. hominis and IBS. However, we hope that this antibody test will help in elucidating the controversy that surrounds the role of B. hominis as a pathogen at present.