Intestinal protozoan infections among egyptian neutropenic patients with acute leukemia

Abstract

Several enteri c protozoan speci es are l i nked to di arrhea i n humans, wi th some causi ng debilitating illnesses, essentially in immunocompromised and neutropenic patients as in acute l eukemi as. The ai m of thi s study was to detect i ntesti nal protozoa i n Egypti an neutropeni c pati ents wi th acute l eukemi a. The study compri sed two groups; 40 newl y di agnosed neutropeni c acute l eukemi a pati ents and 30 control s. Stool sampl es were collected from all participants and subjected to routine microscopic examination, special stai ni ng and detecti on of copro-anti gen usi ng rapi d di agnosti c test (RDT) RIDA® QUICK Entamoeba/ Giardia/ Cryptosporidium Combi. Cases were tested post-chemotherapy at the nadir of neutropenia (absolute neutrophil count ANC< 0.5x109 /L) and 19 cases were also tested initially prior to chemotherapy. Of examined patients, 15/40 (37%) were positive for Blastocystis hominis by wet mount, 10/40 (25%) had microsporidia using modified trichrome stain and only 2 cases (5%) of Cryptosporidium spp. by Ziehl-Neelsen stain. By RDT, 8/40 cases (20%) were positive compared to entirely negative controls. The positive cases included 4 patients with G. intestinalis 2 with Entamoeba and 2 with Cryptosporidium.19/40 cases were tested both pre-and post-chemotherapy. microsporidian spp. was diagnosed in 6/19 cases at the nadi r of neutropeni a compared to none of the cases pre-chemotherapy and the difference was statistically significant (p= 0.031*). Intestinal protozoa in acute leukemia patients post-chemotherapy are common especially B. hominis. Furthermore, RDT might be helpful for diagnosing intestinal protozoa in acute leukemia. Attention is highly required as intestinal protozoa infection can emerge after chemotherapy such as microsporidia.