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Abstract
Summary and conclusion
* The present work was a trial to find out the relationship between Cryptosporidium parvum infection and diarrhea in some immunocompetent and immunocompromised categories of patients.
* The obtained data were tabulated and statistically analysed then summarized in the following points:
1- Among Cryptosporidium infected cases, Males(61.85%) were more susceptible than Females (38.15%).
2- The patients with cryptosporidiosis +ve stool by MZN showed diarrhea and the stool is characterised by offensive odour in more than 80%, containing mucus in more than 80%, Watery in 66.7%.
3- Modified ZN stain showed positive results in more than 53.3% of studied diarrheic ( 53.3% in group II, 80% in goup III, 80% In group IV, 73.3% In group V, 80% In group VI, and 93.3% in group VII).and after exclusion of cases associated with other parasites result in cases with pure cryptosporidiosis are as follow ( 40% in group II, 53.3% in group III, 53.3% in group IV, 33.3% in group V, 46.7% in group VI and 66.7% in group VII).
4- The most common associated intestinal parasitic infestation were Entamoeba histolytica and Giardia lambalia.
5- By ELIZA test both Cryptosporidium IgG + IgM were Negative in groups I,III and V ; 6.7% In groups II, VI and VII; 13.3% in group IV.
6- Cryptosporidium IgM was Negative in groups I,III and V; 6.7% In groups II and VI; 13.3% in groups IV and VII.
7- Cryptosporidium IgG was 6.7% in groups I,III and V; 13.3% in groups II and VI; 26.7% in group IV and 33.3% in group VII.
8- After subdivision of cases associated with other parasites in stool from patients give positivity to ELIZA as a whole(IgM+IgG+(IgM+IgG)) the patients pure cryptosporidiosis by ELIZA are as follow( 20% in group II, 6.7% in group III, 26.7% in group IV, 6.7% in group V, 6.7% in group VI and 33.3% in group VII).
from the previous data , it can be concluded that :
1- Cryptosporidium Parvum must be taken in consideration as a cause of diarrhea.
2- the Male is more affected by Cryptosporidial infection than the Female.
3- There is no Age group more affected by cryptosporidial infection than the others in adult persons.
4- Modified Ziehl- Neelsen stain is the method of choice to diagnose the cryptosporidiosis because it is more rapid, more easy with least cost. also, because the usual methods of stool examination may fail to detect Cryptosporidial oocysts in light infection and requires multiple stool samples (due to intermittent and relatively short duration of oocysts excretion) and well experienced personnel to detect the oocysts in stained smears.
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5- Serological investigations like --- ELIZA is less useful in diagnosing of cryptosporidial infection. But it can be used in differentiation of acute from chronic cases, and it can detect acute cases on top of chronic, but it is more time consuming and highly costing .
6- The group of renal transplantation (taking chemotherapy and cortison) is more prone to cryptosporidial infection followed by group of Hepatoma then group of renal failure and least group affected by this parasite was group of liver cirrhosis.
7- The groups which show high incidence of cryptosporidiosis show also more incidence of other parasitic infection.
8- The patients with diarrhea , especially those who are immunocompromized, Modified ZN stain for stool testing is preferred over immunologic methods in diagnosis of cryptosporidium among these patients, in order to early diagnose the cause and proper managing diarrhea in such patients.
Finally, we recommended that :
All immunocompromised patients suffering from diarrhea should be tested for Cryptosporidium parvum, and Modified Ziehl Neelsen(MZN) stain is one of choice for their diagnosis.
An extended studies of Cryptosporidiosis in immunocompromised subjects including large number of young and more different non young age groups is needed with especial focus on cases with fetal diarrhea of non recognized causes.