ABSTRACT
PURPOSE: Cryptosporidium species is considered to be an important cause of significant morbidity in immunocompromised individuals. A prospective case-control study of sporadic diarrhea due to Cryptosporidium infection was conducted on children with acute lymphoblastic leukemia (ALL). METHODS: Forty children with ALL on maintenance chemotherapy according to the Berlin-Frankfurt-Munster (BFM-90) protocol and 45 sex- and age-matched controls were studied. The ALL group included 25 patients with acute diarrhea and 15 without diarrhea, and the control group included 30 children with acute diarrhea and 15 without. Collected stool specimens were examined using modified Ziehl-Neelsen (MZN) and modified trichrome stains. Serum Cryptosporidium Parvum immunoglobulin G (IgG) antibodies were detected by enzyme-linked immunosorbent assay. RESULTS: Cryptosporidium oocysts, pathogenic Gram-negative organisms, Giardia lamblia, and Entamoeba histolytica were identified in the stool samples (fecal specimens) of six (24%), eight (32%), four (16%), and two (8%), respectively, of the 25 patients with ALL and actute diarrhea and in one (3%), two (6.5%), six (20%), and five (16.5%), respectively, of the 30 control patients with diarrhea. Serum IgG antibodies were positive in four of the six ALL patients and in one of the control group patients with Cryptosporidium diarrhea who tested positive for oocysts in the stool. Diarrhea duration and severity were greater in ALL patients with stool-positive Cryptosporidium oocysts than in those with non-Cryptosporidium-positive diarrhea (p < 0.000). CONCLUSIONS: Cryptosporidium infection should be considered in children with ALL presenting with prolonged or severe watery diarrhea during chemotherapy, especially those treated with methotrexate and 6-mercaptopurine. Since Cryptosporidium is not routinely tested for in stool examination, a MZN stain is recommended.
Subject(s)
Cryptosporidiosis/parasitology , Cryptosporidium parvum/isolation & purification , Gastroenteritis/parasitology , Mercaptopurine/therapeutic use , Methotrexate/therapeutic use , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/immunology , Adolescent , Case-Control Studies , Child , Child, Preschool , Cryptosporidiosis/immunology , Diarrhea/immunology , Diarrhea/parasitology , Egypt , Entamoeba histolytica/isolation & purification , Feces/microbiology , Feces/parasitology , Female , Gastroenteritis/immunology , Giardia lamblia/isolation & purification , Gram-Negative Bacteria/isolation & purification , Humans , Immunocompromised Host , Immunosuppressive Agents/therapeutic use , Infant , Maintenance Chemotherapy/adverse effects , Male , Precursor Cell Lymphoblastic Leukemia-Lymphoma/parasitology , Prospective StudiesABSTRACT
Blastocystis hominis is a common intestinal parasite, with a prevalence in developing countries of up to 50%. The aim of this study was to investigate the association of this parasite with urticaria by determining the genotypic isotypes in the Egyptian population. In total, 54 patients with urticaria and 50 controls were enrolled in the study. Stool samples were examined and assessed by PCR. The parasite was detected in a significantly higher number (P < 0.001) of the patient group than the control group. There was no significant difference between the patients with acute and those with chronic urticaria (P = 0.2). The amoeboid form was found in 60.6% of Blastocystis-positive patients with urticaria, but in none of the healthy controls. Subtype 3 was the only isolate found in both the patient and control groups. We recommend treatment for Blastocystis-positive patients with urticaria in developing countries. The prevalence is much lower (around 10%) in developed countries, where treatment should only be considered in the absence of other possible causes of urticaria.
