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Original Article

Opportunistic Parasites among Immunosuppressed Children in Minia District, Egypt

Ekhlas H. Abdel-Hafeez1, Azza K. Ahmad1, Basma A. Ali2, Fadia A. Moslam3
The Korean Journal of Parasitology 2012;50(1):57-62.
Published online: March 6, 2012

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Corresponding author (ekhlas.abdelhafeez@med.miniauniv.edu.eg; ekhlash@yahoo.com)
• Received: July 29, 2011   • Revised: October 27, 2011   • Accepted: October 30, 2011

© 2012, Korean Society for Parasitology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Opportunistic Parasites among Immunosuppressed Children in Minia District, Egypt
Korean J Parasitol. 2012;50(1):57-62.   Published online March 6, 2012
DOI: https://doi.org/10.3347/kjp.2012.50.1.57
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Opportunistic Parasites among Immunosuppressed Children in Minia District, Egypt
Korean J Parasitol. 2012;50(1):57-62.   Published online March 6, 2012
DOI: https://doi.org/10.3347/kjp.2012.50.1.57
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Opportunistic Parasites among Immunosuppressed Children in Minia District, Egypt
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Fig. 1 Size, shape, and overall morphologic features of the protozoa identified using a modified acid-fast stain and also Giemsa stain (oil; ×1,000). (A) Cryptosporidium parvum oocysts, 4 to 6 µm in diameter, and round to irregular in shape. The oocysts are stained red with modified acid-fast stain and stained blue with Giemsa stain. (B) The oocysts of Cyclospora cayetanensis, 7.7 to 10.0 µm in diameter. The oocysts stained bright pink with modified acid-fast stain. (C) The oocysts of Blastocystis hominis, 6 to 8 µm in diameter, and round to irregular in shape. They have multiple vacuoles and dark thin peripheral layer of cytoplasm in multivacuolated form. The oocysts stained blue with Giemsa. (D) Isospora belli demonstrates the characteristic large, thick-walled immature oocyst containing the modified acid-fast sporoblast. The oocysts of I. belli, 20-33×10-19 µm. (E) Trophozoite of Giardia lamblia in oval or pear-shape, 9-21×5-15 µm. It has 4 flagella and 2 oval nuclei located anterior in a sucking disk. (F) Cyst of G. lamblia oval in shape, and measures 8 to 12 µm in length. The cytoplasm is retracted from the cyst wall and has 4 nuclei at 1 pole. (G) Trophozoite of Entamoeba histolytica in irregular shape, 15 to 40 µm in diameter. It has a nucleus with thin nuclear membrane, central karyosome, and fine peripheral chromatin regularly arranged on nuclear membrane. (H) Cyst of E. histolytica, binucleated, 10 to 20 µm in diameter.
Fig. 2 Size, shape, and overall morphologic features of the detected stages of the helminths (×400). (A) Egg of Taenia spp. It is rounded with thick-brown radially striated wall and contain mature embryo, 30 to 40 µm in diameter. (B) Egg of Hymenolepis nana. It is ovoid, translucent, mature, and characterized by the presence of polar filaments, 70-85×60-80 µm in diameter. (C) Egg of Ascaris lumbricoides. It is fertilized egg, Oval and brown. It has a coarse albuminous lamillated layer and is immature (contains 1 cell stage), 50-90 µm in diameter. (D) Egg of Enterobius vermicularis. It is translucent in color and D-shaped. It is mature (contain fully developed larva), and 140-150 µm in length. (E) Rhabditiform larvae of Strongyloides stercoralis; the first stage larva (L1). It has short buccal cavity, blunt tail end, and a large genital primordium, and its esophagus is rhabditiform, 0.3 mm long. (F) Adult male of Strongyloides stercoralis, 0.7 mm in length. It has rhabditifrom oesophagus. The posterior end is curved ventrally with 2 short (arrow).

Fig. 1

Fig. 2

Opportunistic Parasites among Immunosuppressed Children in Minia District, Egypt
Method of screening Number of positive samples (%) Number of negative samples (%) Total Wet saline direct smear 320 (71) 130 (29)a 450 Formol-ether concentration 18 (14) 112 (86) 130a Staining method 338 (100) - (0) 338 Protozoan parasites Immuno suppressed
Immuno competent
Total
No. (%) No. (%) No. (%) Cryptosporidium parvum 100 (60.2) 60 (42.2) 160 (51.9) Blastocystis hominis 20 (12.1) 10 (7.2) 30 (99.7) Isospora 15 (9.1) 9 (6.3) 24 (7.8) Cyclospora caytenensis 13 (7.8) 3 (2.1) 16 (5.2) Entamoeba histolytica 10 (6) 35 (24.6) 45 (14.6) Giardia lamblia 8 (4.8) 25 (17.6) 33 (10.7) Total 166 (100) 142 (100) 308 (100) Intestinal helminth Immuno suppressed
Immuno competent
Total
No. (%) No. (%) No. (%) Ascaris lumbricoides 3 (13.6) 1 (12.5) 4 (13.3) Taenia sp. 1 (4.5) 1 (12.5) 2 (6.7) Entrobious vermicularis 7 (31.8) 3 (37.5) 10 (33.3) Hymenolepis nana 8 (36.5) 3 (37.5) 11 (36.7) Strongyloides stercoralis 3 (13.6) 0 0 3 (10) Total 22 (100) 8 (100) 30 (100) Underlying cause (immunosuppression) No. of cases No. positive cases (%) Leukocytes (/mm3 of blood) Lymphocytes (% of leukocytes) CD4+ T-cell count (/mm3 of blood) Severe malnutrition 60 58 (96.7) 4,300-4,600 28-30 120-160 Chronic diseases 50 49 (98.0) 4,300-4,500 28-30 120-150 Receiving corticosteroids 65 60 (92.3) 4,000-4,300 24-26 80-100 Malignancies 25 21 (84.0) 3,600-4,000 20-24 70-90 Immunocompetent 250 150 (60.0) 9,500-10,400 35-40 400-450
Table 1. Positivity of opportunistic infections by different examination techniques

Negative cases by wet saline direct smears were subjected to formol-ether concentration.

Table 2. Percentage of protozoan infections between immunosuppressed and immunocompetent patients

χ2=17.5 (Df; 5); P=0.0007.

Table 3. Percentage of intestinal helminths between immunosuppressed and immunocompetent children

χ2=1.7 (Df; 4), P=0.7.

Table 4. Comparison between immunosuppressed and immunocompetent children with regard to the immune status

Table 1.

Table 2.

Table 3.

Table 4.

PHD : Parasites, Hosts and Diseases

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