Current status of intestinal parasitosis among patients attending teaching hospitals in Zagazig district, Northeastern Egypt

Abstract

Almost 80% of health problems in the developing world are due to malnutrition and infectious diseases, which are mainly parasitic. Updated records on the prevalence of parasitic infections and the potential risk factors are essential to enhancing control strategies. Therefore, this study was conducted to evaluate the current situation of intestinal parasitism among patients attending teaching hospitals in Zagazig district, Northeastern Egypt. The study involved five hundred cases. They were all subjected to faecal examination using direct smear measure and two commercial faecal concentrators: Mini-Parasep® solvent-free and Mini-FLOTAC procedures. Mini-FLOTAC was performed with two solutions (FS2: saturated sodium chloride and FS7: zinc sulphate). The overall prevalence of intestinal parasitic infections was 56%. Different species were identified, like Giardia lamblia (12.6%), Entamoeba histolytica/dispar (10%), Ascaris lumbricoides (8.8%) and Hymenolepis nana (8.6%). Data analyses revealed a significant association of intestinal parasitism with different socio-demographic features of the participants. Our results showed a better diagnostic performance of Mini-Parasep® in the overall recovery of intestinal parasites. It was more accurate than Mini-FLOTAC in diagnosing both helminths and protozoan infections. Mini-FLOTAC (FS2) exhibited a higher sensitivity than FS7 for helminth recovery (74.6% vs 53.4%), while FS7 was more sensitive for protozoan infections (50.6% vs 43.8%). Intestinal parasitosis remains a challenging health problem in Zagazig city, wherever reliable diagnostic approaches are limited. Thus, our study has proposed the value of the commercial concentrators (Mini-Parasep® and Mini-FLOTAC) as alternative techniques for diagnosing a large variety of parasite species in resource-constrained settings.

Keywords: Egypt; Mini-FLOTAC; Mini-Parasep®; Parasites; Prevalence.

Fig. 1

Prevalence of intestinal parasitic infections, by species, among 500 examined cases

Fig. 2

Distribution of intestinal parasitic infections during different seasons of study

Fig. 3

Positive detection rates of intestinal parasites determined by the commercial faecal parasite concentrators. Each bar of the chart represents the proportion of cases infected. MP®SF, Midi-Parasep®solvent-free concentrator; Mini-FLOTAC ZnSO4 (FS7); Mini-FLOTAC NaCl (FS2)

Fig. 4

Photomicrographs of different intestinal parasites recovered during the study. a Elongated E.coli dividing trophozoite with 4 nuclei seen in the plane of focus (black arrow) (iodine stain, × 400). b I. buetschlii cyst (black arrow) with a large glycogen vacuole (red arrow) (eosin stain, × 1000). c E. histolytica/dispar cysts (red arrows) (iodine stain, × 400). d E. coli trophozoite (black arrow) (eosin stain, × 400). e E. coli pre-cystic stage with one nucleus seen in the plane of focus (black arrow) (eosin stain, × 400). f Cryptosporidium oocysts (black arrows) (MZN stain, × 1000). g A. lumbricoides embryonated egg containing second stage larva (black arrow) (iodine stain, × 400). h H. heterophyes eggs (red arrows) (unstained smear, × 400). i E.vermicularis egg (red arrow) (unstained smear, × 400). a–c Recovered parasite species after concentration by Mini-Parasep®(SF). d–f Recovered parasite species after concentration by Mini-FLOTAC ZnSO4 (FS7). g, h Recovered parasite species after concentration by Mini-FLOTAC NaCl (FS2). i Recovered parasite in the unprocessed stool sample