INTESTINAL SPOREFORMING PROTOZOA AMONG PATIENTS SUFFERING FROM CHRONIC RENAL FAILURE

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INTESTINAL SPORE-FORMING PROTOZOA AMONG PATIENTS
SUFFERING FROM CHRONIC RENAL FAILURE
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INTRODUCTION
Cryptosporidium parvum, Isospora belli,
Cyclospora cayetanensis and Microsporidia are
important pathogens. In healthy individuals they
cause mild to moderate self-limited diarrhoea
but in immunosuppressed patients they cause
severe intestinal injury and prolonged
diarrhoea.
They are transmitted either directly from person
to person, or through contaminated water or food
by infectious agent called a spore or oocyst.
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AIM OF THE WORK
The aim of this work is to identify these spore
forming Protozoa as a cause of chronic
diarrhoea in patients suffering from chronic
renal failure, hopefully to choose a better
diagnostic method.
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PATIENTS AND METHODS
Fresh stool samples were obtained from 120
patients (75 males and 45 female)
suffering from chronic renal failure who
were regularly undergoing haemodialysis for more
than 3 years in the Dialysis Unit of Zagazig
University Hospital.
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Their ages ranged from 40-60 years. All patients
were complaining of gastrointestinal troubles
mainly chronic diarrhoea. Also, stool samples
were obtained from 40 immunocompetent individuals
with the same age group without any history of
renal or debilitating diseases but complaining of
diarrhoea (control group).
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Stool samples were put in 5 formalin and
processed by formal-ether concentration. The
sediments were examined as follows
(1) Direct saline smear and iodine stained smears
as a routine examination.
(2) Permanent staining by (a) Giemsa stain, (b)
Modified Ziehl Nelseen stain (MZN) and (c)
Aniline carbol methyl violet stain.
(3) Measurement of oocysts by ocular micrometer
calibrated against a stage micrometer slide.
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RESULTS
The four protozoa were detected in stool
specimens of 40/120 (33.3) of immunosuppressed
patients with CRF and 2/40 (5.0) of
immunocompetent with a highly significant
difference (Plt0.001) (table 1)
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TABLE (1) Intestinal protozoa in chronic
diarrhoeic stools of immunosuppressed patients
with CRF and immunocompetent control group.
Highly significant
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TABLE (2)Evaluation of different stains used in
the diagnosis of the four intestinal
spore-forming protozoa.
- Unstained
Somewhat fair Good stain
Excellent stain
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In the present work, the four protozoa were found
as mixed infections with other pathogens or as
single infection confirming their role alone as a
cause of diarrhoea. In the present study, MZN
stain was found to be more efficient than Giemsa
and Aniline stains. It clearly detected the four
protozoa, and being a simple, rapid and not
expensive.
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CONCLUSION
It is concluded that, patients with CRF
undergoing haemodialysis and suffering from
chronic diarrhoea should be screened for
spore-forming protozoa. These protozoa should be
looked for during investigations of
immunosuppressed patients whatever the cause.
Modified Ziehl Nelseen stain should be routinely
performed in all examined smears of stool of the
diarrhoeic patients, to diagnose these protozoa.