PREVALENCE OF CRYPTOSPORIDIUM INFECTION AMONG EGYPTIAN HEMODIALYSIS PATIENTS AFTER APPLYING ANALYTICAL ACCURACY OF THREE KNOWN DIAGNOSTIC TECHNIQUES
Marwa A. Elmallawany¹, Samar S. Attia¹, Asmaa M. Abdelhameed²,³,Reham K. Nahnoush¹
1Medical Parasitology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
2Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
3Internal Medicine Department, Armed Forces College of Medicine (AFCM), Cairo, Egypt
Chronic kidney disease patients undergoing hemodialysis (CKDH) are known to be immune suppressed due to uremia with more susceptibility to infections including parasitic infections that increase morbidity and mortality among CKDH. A cross-sectional study was conducted to determine the prevalence of Cryptosporidium among Egyptian hemodialysis patients (n=160), compared with apparently healthy participants (n=80). Aiming to enhance diagnosis and hence precisely verifying the prevalence of Cryptosporidium infection in this study, 3 diagnostic techniques were applied; traditional microscopic examination of modified Ziehl-Neelsen (MZN) stained smears, immunological method using sandwich ELISA and molecular diagnosis using nPCR. Applying extended reference standard, the diagnosis of cryptosporidiosis was confirmed in 61 cases, 58 cases (36.3%) belonging to Hemodialysis patients group and 3 cases (3.8%) belonging to control group with statistically significant difference (P <0.05). Age, rural residency and contact with domestic animals were detected as statistically significant variables among hemodialysis patients. Diabetes and hypertension were associated as well with cryptosporidiosis among CKDH. Results of this study showed that CKDH patients should be thoroughly investigated in case of suggestive clinical manifestations of cryptosporidiosis even in negative MZN - stained smears. As missed diagnosis of cryptosporidiosis in CKDH could result in serious morbidity sequences and even mortality.