Yıl: 2021 Cilt: 45 Sayı: 1 Sayfa Aralığı: 62 - 67 Metin Dili: İngilizce DOI: 10.4274/tpd.galenos.2020.6819 İndeks Tarihi: 16-01-2022

Investigation of Intestinal Protozoon Prevalence in Immunocompromised Patients at a University Hospital

Öz:
Objective: Immunocompromised patients are at a greater risk of developing intestinal parasite infections. In this study, we examined the presence of Enterocytozoon bieneusi, Encaphalitozoon intestinalis and other intestinal protozoa in stool samples of immunosuppressed patients. Methods: A total of 100 stool samples were obtained from patients receiving chemotherapy because of solid organ tumour with haematological malignancies and those receiving immunosuppressive treatment because of rheumatic diseases, organ transplant patients and patients receiving treatment for HIV-related infections. Stool samples were examined by using the native-lugol method in which the stool concentration, modified Kinyoun acid-fast and trichrome staining methods and parasite presence were analysed. The stool samples were also examined for the presence of Enterocytozoon bieneusi and Encephalitozoon intestinalis using an indirect fluorescent antibody method. Results: Intestinal parasites were detected in 12% of all patients. The distribution of intestinal parasites in patients were 7% Blastocystis spp., 2% Blastocystis spp. + Dientamoeba fragilis, 1% Blastocystis spp. + Entamoeba coli, 1% Blastocystis spp. + Giardia intestinalis and 1% G. intestinalis. Microsporidia spp. were detected in 4% of all patients by the IFAT method and in 8% of all patients by calcoflour staining method. Conclusion: In our study, the most prevalent parasite detected in the immunosuppressed patients was Blastocystis spp. The pathogenesis of Blastocystis spp. remains to be controversial, and their role in immunocompromised patients continues to remain unknown. Although these rates detected in our study are similar to the prevalence in the normal population, it is important to study these microorganisms in immunocompromised patients in terms of the associated decreasing morbidity and mortality rates.
Anahtar Kelime:

Bir Üniversite Hastanesinde İmmünsüpresif Hastalardaki İntestinal Protozoon Prevalansının Araştırılması

Öz:
Amaç: Bağışıklık sistemi baskılanmış hastalar, fırsatçı bağırsak parazit enfeksiyonları bakımından risk altındadır. Bu çalışmada, bağışıklık sistemi baskılanmış hastaların dışkı örneklerinde Enterocytozoon bieneusi ve Encephalitozoon intestinalis ile diğer bağırsak protozoonlarının varlığının incelenmesi amaçlanmıştır. Yöntemler: Solid organ tümörü nedeniyle kemoterapi alan ya da hematolojik malignitesi olan, romatolojik hastalıklar nedeniyle immünsüpresif tedavi gören, organ nakli yapılan ve HIV enfeksiyonu nedeniyle tedavi almakta olan toplam 100 hastadan dışkı örnekleri alınmıştır. Dışkı örnekleri nativ-lugol yöntemi, dışkı konsantrasyon, modifiye Kinyoun asit-fast ve trikrom boyama yöntemleriyle incelenerek protozoon varlığı araştırılmıştır. Dışkı örnekleri, indirekt floresan antikor yöntemi kullanılarak Enterocytozoon bieneusi ve Encephalitozoon intestinalis varlığı açısından da incelenmiştir. Bulgular: Hastaların %12’sinde, bir ya da daha fazla sayıda intestinal protozoon saptanmıştır. İntestinal protozoonların dağılımı ise %7 Blastocystis spp., %2 Blastocystis spp. + Dientamoeba fragilis, %1 Blastocystis spp. + Entamoeba coli, %1 Blastocystis spp. + Giardia intestinalis ve %1 G. intestinalis şeklindedir. Microsporidia spp. IFA yöntemi ile %4, kalkoflor boyama ile %8 oranında saptanmıştır. Sonuç: Çalışmamızda, immünsüpresif hastalarda en fazla saptanan intestinal protozoon Blastocystis spp.’dir. Blastocystis türlerinin patojenitesi halen tartışmalı olup, immünsüpresif hastalardaki rolü tam olarak bilinmemektedir. Çalışmamızda bulunan bu oranlar normal toplumdaki prevalanslarla benzer olmakla birlikte; bağışıklık sistemi baskılanmış hastalarda bu mikroorganizmaların araştırılması, morbidite ve mortalitenin azaltılması açısından önem taşımaktadır.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Stark D, Barratt JL, van Hal S, Marriott D, Harkness J, Ellis JT. Clinical significance of enteric protozoa in the immunosuppressed human population. Clin Microbiol Rev 2009; 22: 634-50.
  • 2. Marcos LA, Gotuzzo E. Intestinal protozoan infections in the immunocompromised host. Curr Opin Infect Dis 2013; 26: 295-301.
  • 3. Vanathy K, Parija SC, Mandal J, Hamide A, Krishnamurthy S. Cryptosporidiosis: A mini review. Trop Parasitol 2017; 7: 72-80.
  • 4. Custodio H. Protozoan Parasites. Pediatr Rev 2016; 37: 59-69.
  • 5. Mahmoudi MR, Ongerth JE, Karanis P. Cryptosporidium and cryptosporidiosis: The Asian perspective. Int J Hyg Environ Health 2017; 220: 1098-109.
  • 6. Ortega YR, Sanchez R. Update on Cyclospora cayetanensis, a food-borne and waterborne parasite. Clin Microbiol Rev 2010; 23: 218-34.
  • 7. Herwaldt BL. Cyclospora cayetanensis: a review, focusing on the outbreaks of cyclosporiasis in the 1990s. Clin Infect Dis 2000; 31: 1040-57.
  • 8. Siddiqui ZA. An overview of parasitic infections of the gastro-intestinal tract in developed countries affecting immunocompromised individuals. J Parasit Dis 2017; 41: 621-6.
  • 9. Han B, Weiss LM. Microsporidia: Obligate Intracellular Pathogens Within the Fungal Kingdom. Microbiol Spectr 2017; 5: 10.1128
  • 10. Field AS, Milner DA Jr. Intestinal microsporidiosis. Clin Lab Med 2015; 35: 445-59.
  • 11. Ghoshal U, Khanduja S, Pant P, Prasad KN, Dhole TN, Sharma RK, et al. Intestinal microsporidiosis in renal transplant recipients: Prevalence, predictors of occurrence and genetic characterization. Indian J Med Microbiol 2015; 33: 357-63.
  • 12. Zeeshan M, Zafar A, Saeed Z, Irfan S, Sobani ZA, Shakoor S, et al. Use of ‘‘Parasep filter fecal concentrator tubes’’ for the detection of intestinal parasites in stool samples under routine conditions. Indian J Pathol Microbiol 2011; 54: 121-3.
  • 13. Turgay N. Özel boyama yöntemleri. Korkmaz M, Ok ÜZ (Ed.). Parazitolojide Laboratuvar. Türkiye Parazitoloji Derneği. 2011: s.37-40.
  • 14. Kır B, Kaçmaz G, Karaman Ü, Direkel Ş, Akdemir C, Baldemir A, Güçlüer Ildır N. Comparison of The Modified Trichrome Stain Method With Wheatley’s Trichrome Stain Methods (article in Turkish). Klinik Tıp Aile Hekimliği Dergisi 2018; 10: 15-8.
  • 15. Aydın M, Adıyaman G, Kaya T, Kuştimur S, Doğruman AL F. Comparison of Conventional and Commercial Trichrome Staining Methods for Detecting Protozoan in Stool Samples (article in Turkish). Kafkas Univ Vet Fak Derg 2012; 18: 155-9.
  • 16. Ghoshal U, Khanduja S, Pant P, Ghoshal UC. Evaluation of Immunoflourescence antibody assay for the detection of Enterocytozoon bieneusi and Encephalitozoon intestinalis. Parasitol Res 2016; 115: 3709-13.
  • 17. Dropulic LK, Lederman HM. Overview of Infections in the Immunocompromised Host. Microbiol Spectr 2016; 4.
  • 18. Bednarska M, Jankowska I, Pawelas A, Piwczyńska K, Bajer A, WolskaKuśnierz B, et al. Prevalence of Cryptosporidium, Blastocystis, and other opportunistic infections in patients with primary and acquired immunodeficiency. Parasitol Res 2018; 117: 2869-79.
  • 19. Rasti S, Hassanzadeh M, Hooshyar H, Momen-Heravi M, Mousavi SGA, Abdoli A. Intestinal parasitic infections in different groups of immunocompromised patients in Kashan and Qom cities, central Iran. Scand J Gastroenterol 2017; 52: 738-41.
  • 20. Paboriboune P, Phoumindr N, Borel E, Sourinphoumy K, Phaxayaseng S, Luangkhot E, et al. Intestinal parasitic infections in HIV-infected patients, Lao People’s Democratic Republic. PLoS One 2014; 9: 91452.
  • 21. Zorbozan O, Quliyeva G, Tunalı V, Özbilgin A, Turgay N, Gökengin AD. Intestinal Protozoa in Hiv-Infected Patients: A Retrospective Analysis. Turkiye Parazitol Derg 2018; 42: 187-90.
  • 22. Reust CE. Evaluation of primary immunodeficiency disease in children. Am Fam Physician 2013; 87: 773-8.
  • 23. Uysal S, Tunalı V, Akdur Öztürk E, Ardeniz Ö, Işıkgöz Taşbakan M, Pullukçu H, et al. Incidence of Parasitic Diarrhea in Patients with Common Variable Immune Deficiency. Turkiye Parazitol Derg 2016; 40: 67-71.
  • 24. Salehi Sangani G, Mirjalali H, Farnia S, Rezaeian M. Prevalence of Intestinal Coccidial Infections among Different Groups of Immunocompromised Patients. Iran J Parasitol 2016; 11: 332-8.
  • 25. Assis DC, Resende DV, Cabrine-Santos M, Correia D, Oliveira-Silva MB. Prevalence and genetic characterization of Cryptosporidium spp. and Cystoisospora belli in HIV-infected patients. Rev Inst Med Trop Sao Paulo 2013; 55: S0036-46652013000300149.
  • 26. Hijjawi N, Zahedi A, Kazaleh M, Ryan U. Prevalence of Cryptosporidium species and subtypes in paediatric oncology and non-oncology patients with diarrhoea in Jordan. Infect Genet Evol 2017; 55: 127-30.
  • 27. Taş Cengiz Z, Yılmaz H, Çiçek M, Beyhan YE, Dülger AC. Cystoisospora sp. Infection Determined in Immunosuppressed and Immunocompetent Children: Three Cases Report. Turkiye Parazitol Derg 2016; 40: 107-9.
  • 28. Rosman Z, Shoenfeld Y, Zandman-Goddard G. Biologic therapy for autoimmune diseases: an update. BMC Med 2013; 11: 88.
  • 29. Braz AS, de Andrade CA, da Mota LM, Lima CM. Recomendações da Sociedade Brasileira de Reumatologia sobre diagnóstico e tratamento das parasitoses intestinais em pacientes com doenças reumáticas autoimunes [Recommendations from the Brazilian Society of Rheumatology on the diagnosis and treatment of intestinal parasitic infections in patients with autoimmune rheumatic disorders]. Rev Bras Reumatol 2015; 55: 368-80.
  • 30. Ramsay DB, Long SE, Ali MA, Entwisle C, Orenstein JM, Rossi C, et al. Isolated gastric cryptosporidiosis in an immunocompetent patient. Dig Dis Sci 2007; 52: 1364-6.
  • 31. Chiuchetta FA. Cryptosporidiosis in a patient with ankylosing spondylitis treated with adalimumab. Rev Bras Reumatol 2010; 50: 328-32.
  • 32. Jimenez-Balderas FJ, Camargo-Coronel A, Gargia-Jaimes J, ZonanaNacach A, Alcantara-Anguianoi I, Carrillo-Becerril L, et al. A study on parasites in Mexican rheumatic disease patients. J Egypt Soc Parasitol 2012; 42: 271-80.
  • 33. Wawrzyniak I, Poirier P, Viscogliosi E, Dionigia M, Texier C, Delbac F, et al. Blastocystis, an unrecognized parasite: an overview of pathogenesis and diagnosis. Ther Adv Infect Dis 2013; 1: 167-78.
  • 34. Zhang W, Ren G, Zhao W, Yang Z, Shen Y, Sun Y, et al. Genotyping of Enterocytozoon bieneusi and Subtyping of Blastocystis in Cancer Patients: Relationship to Diarrhea and Assessment of Zoonotic Transmission. Front Microbiol 2017; 8: 1835.
  • 35. Nooshadokht M, Sharifi I, Mohammadi MA, Pirestani M, Afgar A, Mahootchi A et al. Intestinal microsporidiosis in Iran: infection in immune-compromised and immunocompetent patients. Curr Med Mycol 2017; 3: 30-6.
  • 36. Tavalla M, Mardani-Kateki M, Abdizadeh R, Nashibi R, Rafie A, Khademvatan S. Molecular identification of Enterocytozoon bieneusi and Encephalitozoon spp. in immunodeficient patients in Ahvaz, Southwest of Iran. Acta Trop 2017; 172: 107-12.
  • 37. Aikawa NE, Twardowsky Ade O, Carvalho JF, Silva CA, Silva IL, Ribeiro AC, et al. Intestinal microsporidiosis: a hidden risk in rheumatic disease patients undergoing anti-tumor necrosis factor therapy combined with disease-modifying anti-rheumatic drugs? Clinics (Sao Paulo) 2011; 66: 1171-5.
  • 38. Hamamcı B, Çetinkaya Ü, Berk V, Kaynar L, Kuk S, Yazar S. Kemoterapi alan kanserli hastalarda Encephalitozoon intestinalis ve Enterocytozoon bieneusi prevalansı [Prevalence of Encephalitozoon intestinalis and Enterocytozoon bieneusi in cancer patients under chemotherapy]. Mikrobiyol Bul 2015; 49: 105-13.
  • 39. Mirjalali H, Mirhendi H, Meamar AR, Mohebali M, Askari Z, Mirsamadi ES, et al. Genotyping and molecular analysis of Enterocytozoon bieneusi isolated from immunocompromised patients in Iran. Infect Genet Evol 2015; 36: 244-9.
APA Demirel F, Inkaya A, AKSOY S, Abbasoglu O, Ertenli I, Büyükaşık Y, Arikan-Akdagli S, AKYON YILMAZ Y, Ergüven S (2021). Investigation of Intestinal Protozoon Prevalence in Immunocompromised Patients at a University Hospital. , 62 - 67. 10.4274/tpd.galenos.2020.6819
Chicago Demirel Filiz,Inkaya Ahmet Cagkan,AKSOY SERCAN,Abbasoglu Osman,Ertenli Ihsan,Büyükaşık Yahya,Arikan-Akdagli Sevtap,AKYON YILMAZ YAKUT,Ergüven Sibel Investigation of Intestinal Protozoon Prevalence in Immunocompromised Patients at a University Hospital. (2021): 62 - 67. 10.4274/tpd.galenos.2020.6819
MLA Demirel Filiz,Inkaya Ahmet Cagkan,AKSOY SERCAN,Abbasoglu Osman,Ertenli Ihsan,Büyükaşık Yahya,Arikan-Akdagli Sevtap,AKYON YILMAZ YAKUT,Ergüven Sibel Investigation of Intestinal Protozoon Prevalence in Immunocompromised Patients at a University Hospital. , 2021, ss.62 - 67. 10.4274/tpd.galenos.2020.6819
AMA Demirel F,Inkaya A,AKSOY S,Abbasoglu O,Ertenli I,Büyükaşık Y,Arikan-Akdagli S,AKYON YILMAZ Y,Ergüven S Investigation of Intestinal Protozoon Prevalence in Immunocompromised Patients at a University Hospital. . 2021; 62 - 67. 10.4274/tpd.galenos.2020.6819
Vancouver Demirel F,Inkaya A,AKSOY S,Abbasoglu O,Ertenli I,Büyükaşık Y,Arikan-Akdagli S,AKYON YILMAZ Y,Ergüven S Investigation of Intestinal Protozoon Prevalence in Immunocompromised Patients at a University Hospital. . 2021; 62 - 67. 10.4274/tpd.galenos.2020.6819
IEEE Demirel F,Inkaya A,AKSOY S,Abbasoglu O,Ertenli I,Büyükaşık Y,Arikan-Akdagli S,AKYON YILMAZ Y,Ergüven S "Investigation of Intestinal Protozoon Prevalence in Immunocompromised Patients at a University Hospital." , ss.62 - 67, 2021. 10.4274/tpd.galenos.2020.6819
ISNAD Demirel, Filiz vd. "Investigation of Intestinal Protozoon Prevalence in Immunocompromised Patients at a University Hospital". (2021), 62-67. https://doi.org/10.4274/tpd.galenos.2020.6819
APA Demirel F, Inkaya A, AKSOY S, Abbasoglu O, Ertenli I, Büyükaşık Y, Arikan-Akdagli S, AKYON YILMAZ Y, Ergüven S (2021). Investigation of Intestinal Protozoon Prevalence in Immunocompromised Patients at a University Hospital. Türkiye Parazitoloji Dergisi, 45(1), 62 - 67. 10.4274/tpd.galenos.2020.6819
Chicago Demirel Filiz,Inkaya Ahmet Cagkan,AKSOY SERCAN,Abbasoglu Osman,Ertenli Ihsan,Büyükaşık Yahya,Arikan-Akdagli Sevtap,AKYON YILMAZ YAKUT,Ergüven Sibel Investigation of Intestinal Protozoon Prevalence in Immunocompromised Patients at a University Hospital. Türkiye Parazitoloji Dergisi 45, no.1 (2021): 62 - 67. 10.4274/tpd.galenos.2020.6819
MLA Demirel Filiz,Inkaya Ahmet Cagkan,AKSOY SERCAN,Abbasoglu Osman,Ertenli Ihsan,Büyükaşık Yahya,Arikan-Akdagli Sevtap,AKYON YILMAZ YAKUT,Ergüven Sibel Investigation of Intestinal Protozoon Prevalence in Immunocompromised Patients at a University Hospital. Türkiye Parazitoloji Dergisi, vol.45, no.1, 2021, ss.62 - 67. 10.4274/tpd.galenos.2020.6819
AMA Demirel F,Inkaya A,AKSOY S,Abbasoglu O,Ertenli I,Büyükaşık Y,Arikan-Akdagli S,AKYON YILMAZ Y,Ergüven S Investigation of Intestinal Protozoon Prevalence in Immunocompromised Patients at a University Hospital. Türkiye Parazitoloji Dergisi. 2021; 45(1): 62 - 67. 10.4274/tpd.galenos.2020.6819
Vancouver Demirel F,Inkaya A,AKSOY S,Abbasoglu O,Ertenli I,Büyükaşık Y,Arikan-Akdagli S,AKYON YILMAZ Y,Ergüven S Investigation of Intestinal Protozoon Prevalence in Immunocompromised Patients at a University Hospital. Türkiye Parazitoloji Dergisi. 2021; 45(1): 62 - 67. 10.4274/tpd.galenos.2020.6819
IEEE Demirel F,Inkaya A,AKSOY S,Abbasoglu O,Ertenli I,Büyükaşık Y,Arikan-Akdagli S,AKYON YILMAZ Y,Ergüven S "Investigation of Intestinal Protozoon Prevalence in Immunocompromised Patients at a University Hospital." Türkiye Parazitoloji Dergisi, 45, ss.62 - 67, 2021. 10.4274/tpd.galenos.2020.6819
ISNAD Demirel, Filiz vd. "Investigation of Intestinal Protozoon Prevalence in Immunocompromised Patients at a University Hospital". Türkiye Parazitoloji Dergisi 45/1 (2021), 62-67. https://doi.org/10.4274/tpd.galenos.2020.6819