Association Between Giardia Genotype and Oxidative Stress Biomarkers Among Giardia-Infected Children: A Case-Control Study.

PURPOSE: Giardia duodenalis is the most common worldwide intestinal protozoal infection. The implication of free radicals in organ injury occurs through oxidative stress. Infections as Giardia may act as a triggering or promoting factor for oxidative stress, particularly in children with compromised immunity. Besides, the effect of Giardia genotype on oxidative stress status is yet to be explored. Therefore, we sought to compare the oxidative stress status between Giardia positive cases (case group) and Giardia negative cases (control group), and to explore the association between Giardia genotype and the level of oxidative stress markers in Giardia-infected children, especially those receiving immunosuppressive therapy. METHODS: Pediatric patients attending Mansoura University Children Hospital in the period from April 2015 to October 2016 were enrolled. Both case (n = 50) and control (n = 50) groups were further subdivided into immunosuppressive therapy recipients (ITR) and non-immunosuppressive therapy recipients (NITR). Genotyping of Giardia from positive stool samples by PCR was carried out, and oxidative stress markers were measured from venous blood samples. RESULTS: Giardia positive cases had higher levels of Malondialdehyde (MDA) and lower levels of total antioxidant capacity (TAC). MDA highest level was associated with mixed genotypes A and B, while the highest TAC level was associated with Giardia genotype A in both ITR and NITR cases. CONCLUSION: Elevated oxidative stress biomarkers in pediatric patients infected with specific Giardia genotypes should receive considerable attention, because if prompt treatment is not conducted, oxidative damage may occur in patients with giardiasis, especially those receiving immunosuppressive therapy.

Toxoplasma gondii infection among chronic hepatitis C patients: a case-control study.

OBJECTIVE: To determine the detection rate of anti-Toxoplasma gondii (T. gondii) IgG and IgM in chronic HCV patients attending the Department of Tropical Medicine Mansoura University hospital in Egypt. METHODS: This study included 120 adult chronic HCV patients, 81 decompensate cirrhosis (late-stage) and 39 chronic HCV non cirrhotic patients (early-stage) and 40 healthy blood donors as controls. Serum samples were examined for anti-Toxoplasma IgM and anti-Toxoplasma IgG antibodies by ELISA. Real-time RT-polymerase chain reaction assay was done for quantitation of hepatitis C virus. RESULTS: Anti-T. gondii IgG antibodies were detected in 75 (92.6%) of 81 late-stage cirrhotic patients, 30 (76.9%) of the 39 chronic HCV non cirrhotic patients (early-stage) and in 6 (15%) of 40 controls with statistically significant difference (P<0.001). Anti-T. gondii IgM antibodies were found in 11 (13.6%) in late stage patients, 5 (12.8%) in early stage and in 3 (7.5%) of controls with no statistical significant difference (P=0.610). There was no correlation between stage of fibrosis and IgM or IgG antibodies positivity in our studied groups (P=0.526). High IgG levels significantly correlated with high viral load (P=0.026). CONCLUSIONS: Our findings suggest that the serious opportunistic T. gondii infection represent a potential significant risk for chronic HCV patients. So, toxoplasmosis should be considered in their investigations and follow-up.

Giardia diagnostic methods in human fecal samples: a comparative study.

Several methods were tried for Giardia detection in stool. This study aimed to compare between the results of ordinary microscopy, direct immunofluorescence assay (DIF), and flow cytometry (FC) for the detection of Giardia cyst in human stool samples. The study included 84 children recruited from outpatient clinics of Mansoura University Children Hospital. Fecal samples were processed and examined for Giardia cysts using conventional microscopy, DIF, and FC. Among 84 fecal samples, 40 (47.6%) were diagnosed as Giardia-positive by saline wet mount, while DIF and FC detected 52 (61.9%), and 38 (45%) Giardia-positive cases, respectively. When compared with DIF as a gold standard method, ordinary microscopy had 76.9% sensitivity and 100% specificity while the FC had a sensitivity of 73.1% and 100% specificity, with statistically significant differences between DIF and the other two methods (P < 0.05). DIF was able to detect as few as 500 cysts/g of concentrated stool, yielding a threshold higher than ordinary microscopy (1,800 cyst/g) even after concentration. It is concluded that direct microscopic examination is reliable in Giardia diagnosis as a first choice test. DIF is an excellent technique in clinically suspected cases after negative microscopy. FC was found to be less sensitive to obtain accurate organisms' count but it could be an effective alternative method for the detection of Giardia cysts, especially for large-scale epidemiological studies or extensive surveillance programs as it has the beneficial attribute of speed and do not depend on an experienced microscope viewer. However, DIF remains the gold standard while FC still requires significant technical improvements before it can compete with DIF for Giardia diagnosis.

Diagnostic criteria for house dust mites sensitized allergic patients.

House dust mites (HDM) contain a large number of components that react with IgE in individuals with allergies and induced sensi-tization and allergic diseases. The work aimed to correlate between clinical manifestations of HDM allergic patients and skin prick test (SPT) grading, and to clarify some markers denoting allergic disorders caused by HDM exposure. Thirty allergic patients with positive SPT reaction to HDM were selected, grading of disease severity according to SPT and clinical presentations. The results revealed bronchial asthma (40%), atopic dermatitis (26.7%), rhinitis (20%) and conjuncttivitis (13.3%). Serum ELISA-IgE showed mean level of 398.41 +/- 84.73, 369.87 +/- 86.76, 332.16 +/- 65.57 and 300.25 +/- 79.39 IU/ml respecttively, with highly statistically significant difference between cases and controls (p < 0.001). Eosinophila showed highly significant difference between atopic dermatitis cases and controls (p < or = 0.001).

Comparative study between immunohistochemical grading and giardia genotyping among symptomatic and asymptomatic humans.

In the last years, multiple studies indicated the potential effectiveness of the polymerase chain reaction (PCR) for detection of Giardia in pathological specimens. By using the difference at the triose phosphate isomerase (tpi) gene locus, we investigated the genotype groups of Giardia lamblia isolated directly from fecal specimens collected from humans living in Dakahlia Governorate, Egypt. Immunohistochemical staining for detection of Giardia local antigenic and cellular immune-determinants focusing on CD4 and CD8 T-lymphocytes was also applied. The sensitivity of the ABC (avidine-biotin-peroxidase complex) immunoperoxidase technique for detection of the antigen was 97.3% and the specificity was 100%. Our study clearly demonstrated a highly significant difference between patients and controls as regards the grade of CD4 and CD8 lymphocyte infiltration (p < 0.001 for each correlation) but no significant difference was found between Giardia symptomatic and asymptomatic patients. Using the PCR technique, 89.3% sensitivity, 100% specificity and diagnostic accuracy of 92% were reached. Nevertheless, there was statistically insignificant difference between symptomatic and asymptomatic groups regarding the prevalence of different Giardia genotypes and the prevalence of CD4 and CD8 lymphocyte infiltration grading in different Giardia genotypes.

The reflection of control programs of parasitic diseases upon gastrointestinal helminthiasis in Dakahlia Governorate, Egypt.

The study area included Mansoura city as an urban area and Gogar village as a rural area. One thousand individuals were randomly selected from each area. Different methods of stool examination, perianal swab and urine examination of all participants revealed that the incidence in Mansoura city was in a descending order Heterophyes heterophyes 6.4%; Enterobius vermicularis 3.9%; Hymenienolepis nana 2.2%; Schistosoma mansoni 0.5%; Trichostrongylus colubriftormis; Strongyloides stercoralis and Fasciola sp. were recorded as 0.2% of each. Taenia saginata, Ascaris lumbricoides and Trichocephalus trichiuris were recorded as 0.1% of each. Neither Ancylostoma duodenale nor Hymenolepis dimninuta was recorded. In Gogar, the parasitic infection was H. hetephyes 4.5%; E. vermicularis 4.1%: H. nana 3.3%; S. mansoni 1.6%; T. colubriformis 0.9%; S. stercoralis 0.5%. Fasciola sp. 0.4%; T. saginata, A. lumbricoides, H. diminuta, A. duodenale and T. trichiuris were recorded as 0.1% of each. None S. haematobiumn was detected in both areas. So, the infection rates of H. heterophyes, E. vermicularis, H. nana S. mansoni, Fasciola sp., T. colubriformis and S. stercoralis were relatively high the rural than in urban area. This was not surprising since the socioeconomic, hygienic conditions and medical services were relative high in the city than in the village. No doubt, the identifications of parasitosis pave the way for feasible treatment and control measures.

Present situation of house dust mites in Dakahlia Governorate, Egypt.

House dust mites are common inhalant allergens, which can precipitate atopic disease episodes. The present study revealed presence of four mites. These are Dermatophagoides farinae, D. pteronyssinus, Acheles gracilis and Ornithonyssus bacoti. Population densities of different live adult mites were investigated in different house habitats. In urban houses, pyroglyphid mites were the predominant in bedrooms and D. farinae was the most abundant. A. gracilis was more abundant in living rooms followed by D. farinae then D. pteronyssinus. A. gracilis was the most prevalent in kitchens. While in rural houses, O. bacoti was the most abundant species followed by pyroglyphid mites. Since Dermatophagoides species and A. gracilis were present in numbers high enough to allow their ecological consideration, their seasonal abundance in urban bed-rooms was investigated and revealed that both D. farinae and D. pteronyssinus have two peaks of abundance, one slightly higher in spring and the second in autumn. A. gracilis has two peaks but the higher occurred in autumn and the second in spring.

Some molecular aspects in schistosomiasis mansoni and toxoplasmosis.

The IL-2 and IL-4 cytokines production represent cellular Th1 & Th2 immune responses respectively were associated with chronic schistosomiasis mansoni (stages 1-4) and chronic toxoplasmosis gondii. In the hepatosplenic schistosomiasis, the level of IL-2 and disease stage increased in parallel (P<0.05, <0.01, <0.01 & <0.001 in stages 1, 2, 3 & 4 respectively), whereas, IL-4 was highly significantly increased in stage 1 than control (P<0.001), then decreased to lower levels. The mean concentrations of IL-2 & IL-4 in patients with T. gondii were higher compared to control being more marked in IL-2 (P<0.001) versus IL-4 (P< 0.01). The data indicated that there are patterns of cytokine expression characteristic of type 1 & type 2 responses in vivo, with the ultimate goal of being able to manipulate the response to minimize inflammation and fibrosis for clinical benefit.

Geoparasites in rural Dakahlia Governorate, a preliminary based study for development of the community-based intervention programs.

A prospective study was carried out to detect the rural prevalence and intensity of geoparasites in Dakahlia Governorate, Egypt. A total of 1070 soil samples were collected; 571 (53.4%) were infected with one or more parasites. Only 24% of samples were infected with one parasite, 16.4% and 13% with two, and more than two parasites respectively, and the difference was statistically significant. The geoparasites in a descending order of their prevalence were: E. histolytica cysts (9.2%), Toxocara eggs (9.1%), Giardia cysts (7.9%), Cryptosporidium oocysts (6.1%), Trichostrongylus eggs and larvae (5.6%), Isospora oocysts (4.3%), Acanathamoeba cysts (4.1%), Naegleria cysts (3.6%), Dust mites (2.7%), H. diminuta eggs (2.7%), Strongyloides free living adults, rhabditiform and filariform larvae (2.3%), H. nana eggs (1.7%), S. mansoni eggs (1.2%), Ascaris eggs (0.6%), Ancylostoma larvae (0.5%), Taenia eggs (0.4%), Trichocephalus eggs (0.4%) and F. gigantica eggs (0.2%). The prevalence of parasitic infections was significantly higher (P<0.001) in fields (63.4%) than streets (47.7%) and indoor-yards samples (35.3%). The intensity of infections was significantly higher (P< 0.001) in streets than fields and indoor-yards (18.1, 9.7 & 1 parasite/10 gm of soil respectively).

Human fascioliasis and anaemia in Dakahlia Governorate, Egypt.

Fasciola infection (fascioliasis) appeared to be endemic in Egypt. Stool samples of fourty eight patients were coprologically diagnosed. According to Fasciola egg counting per gram stool, the severity of infection was divided into light infection in 60.5%, moderate in 27.1% and severe infection in 12.5%. No significant correlation was detected between severity of infection and patients' sex. Complete blood picture, reticylocytic count, serum iron, immunological assays as anti-nuclear, anti-smooth muscle antibody, anti-mitochondrial anti-body, anti-DNA tests and rheumatoid factor and occult blood in stool were investigated. Normocytic normochromic anaemia was detected in 62.5% of the fascioliasis patients, microcytic hypochromic anaemia in 31.3% and macrocytic one in 6.3%. Highly significant negative correlation (R = -0.68) was detected between haemoglobin concentration and egg count per gram faeces. Human fascioliasis was associated with normocytic normochromic anaemia and to a lesser extent microcytic hypochromic anemia.

Blastocystis hominis among symptomatic and asymptomatic individuals in Talkha Center, Dakahlia Governorate, Egypt.

Blastocystis hominis is now getting acceptance as an agent of human intestinal disease. B. hominis in stool samples of symptomatic and asymptomatic individuals was evaluated as a possible cause of gastro-intestinal troubles. B. hominis was found in 106 (10.1%) out of 1050 individuals examined from six villages and one city in Talkha Center, Dakahlia Governorate. The highest infection rate was in Manshayt El-Badawy village (25.47%), whereas Talkha City showed the lowest rate (4.73%). Age group 10-20 years had higher infection (13.3%). In twenty-three symptomatic patients, B. hominis represented the only causative parasitic agent. The most common symptoms were diarrhoea (30.4%), abdominal pain (26.1%), flatulence (21.7%). vomiting (13.1%) and fatigue (8.7%). High concentrations of B. hominis were found in symptomatic patients than in asymptomatic ones with statistical significant difference (8.2 cells/100 x field versus 3.8 respectively). The mean number of B. hominis was significantly high in patients complaining of diarrhoea and abdominal pain.

Cholestasis in human fascioliasis in Dakahlia Governorate, Egypt.

This study was conducted to assess cholestasis in human fascioliasis. Twenty five patients, passing Fasciola eggs, were compared to twenty age- and sex-matched healthy controls. All were subjected to thorough clinical examination, stool analysis, complete blood picture, liver function tests (AST, ALT, SAP, GGT and total serum bilirubin). Autoimmune and viral hepatitis (HCV & HBV) were excluded. All cases were subjected to radiological examinations (chest x-ray and abdominal ultrasonography). The study revealed significant elevation of liver enzymes in the patients compared to the controls (p < 0.001). Calcular and non-calcular cholecystitis were common findings among patients (32% and 24% respectively). Ascites (4%) and dilated intra-hepatic biliary radicals (32%) were encountered; pleural effusion was detected by chest x-ray in 20% of cases. So, fascioliasis should be considered in the diagnosis of cholestasis in Fasciola endemic areas.

Serological diagnosis of Trichinella spiralis in experimentally infected mice.

ELISA and IFA tests were used to detect IgG levels in sera of experimentally infected mice with Trichinella spiralis, during a period of 12 weeks post infection. A crude saline extract of muscle larvae was used for application of ELISA technique, while the intact T. spiralis muscle larvae were used as an antigen for IFAT. In both tests, T. spiralis IgG antibodies could be detected one week post infection in sera of all infected mice. ELISA test showed a sensitivity of 100% during the whole period of the experiment, while its specificity was 93.3%. Meanwhile, IFA test revealed a sensitivity of 100% and a specificity of 85%.

Laparoscopic excision of prostatic hydatid cyst: case report and review of literature.

It is rare for hydatid disease to be encountered primarily in the urogenital system or retroperitoneum. Moreover, prostatic involvement is extremely rare. We present a case report of prostatic hydatid cyst that was treated with laparoscopic excision. We reviewed diagnosis and management of hydatid disease of the urogenital tract.