Printer Friendly

Microsporidiosis among children with malignant diseases in Basrah, Iraq.

Byline: Nadham K. Mahdi and Maysloon A. Al-Saadoon

ABSTRACT

Objective: To estimate the prevalence of microsporidiosis among children with malignant diseases.

Methodology: Stool samples were collected from 58 children (37 males and 21 females) with malignant diseases and 107 apparently healthy children (55 males and 52 females). Direct smear method was done for all stool samples to detect the intestinal parasites. Fecal smears were prepared and stained by Trichrome stain method for the recovery of Microsporidium spores. Results: The results showed that acute lymphocytic leukemia (ALL) was the most prevalent (55.2%) malignant disease among the studied patients. The highest rate of Microsporidium infection among the 12 types of malignant diseases was found in patients with Hodgkin and non-hodgkin lymphoma (83.3%). Prevalence of various species of intestinal parasites (including Microsporidium) was 48.3%. The highest rate of parasitic infections was observed in patients with ALL (34.4%). No Microsporidium spores were observed in stool samples of the control group. The clinical symptoms among patients included weight loss (77.6%), fever (29.3%) and diarrhea (27.6%).

Conclusion: Microsporidium and other intestinal parasites should be considered among the patients with malignant diseases in order to minimize their symptoms.

KEY WORDS: Malignant diseases, Microsporidiosis among children, Parasitic infections, Malignancies.

How to cite this article:

Mahdi NK, Al-Saadoon MA. Microsporidiosis among children with malignant diseases in Basrah, Iraq. Pak J Med Sci 2012;28(4):621-624

INTRODUCTION

Microsporidiosis is an emerging disease in immunocompetent hosts as well as immunocompromised patients.1,2 Microsporidiumspecies are protozoan parasites which cause sporadic cases characterized by symptoms such as diarrhea, cornea ulcer and myositis that are generally self limiting among immunocompetent individuals.3 Microsporidiosis has been reported in 2-70% of HIV infected patients with chronic diarrhea.4-6 The disease may spread from the gut to the upper respiratory tract and kidneys.7

Even the epidemiology of Microsporidium has been reported in Argentina, Australia, Brazil, Cana- da, Czech Republic, France, Germany, China, Italy, Japan, New Zealand, Spain, Seri Lanka, Switzer- land, Thailand, Uganda, USA, Zambia, Sweden, Batswana and Holland at various rates of infections among different groups of people8, but no previous studies have been found in the literature regarding the prevalence of this opportunistic parasite in Iraq. Therefore, the aim of this study was to estimate the prevalence of microsporidiosis among children with malignant diseases.

METHODOLOGY

Subjects: Forty eight patients with recently diagnosed malignancies according to a comprehensive diagnostic work up from typing of leukemia and staging for other malignancies who were admitted to Maternal and Child Hospital, Basrah, Iraq were included in this study. Their ages ranged from 8 months to 15 years with a mean age of 6.4 + 3.1 years. There were 37 males and 21 females. One hundred and seven apparently healthy children were involved in the study to serve as a control group. Their ages ranged from 9 months to 15 years with a mean of 7.1 + 3.3 years. There were 55 males and 52 females. This study was approved by the ethical committee of the College of Medicine, University of Basrah, Iraq.

Stool examination: Direct smear method was carried out for the stool samples which were collected from all patients and control group to identify the diagnostic stages of the parasites other than Microsporidium.9 Fecal smears were prepared and stained by Trichrome stain modified method for detetection of Microsporidium.2,10

Statistical Analysis: Chi-sequared (X2) test was used. Differences were recorded as significant whenever the probability (P) was less than 0.05.

RESULTS

The spores stained pink with distinct clear vacuole. The characteristic feature of microsporidial spores is presence of stained portions as dark bands (Fig.1). The results showed that acute lymphocytic leukemia (ALL) was the most prevalent (55.2%) malignant disease among the patients of age group between 4-8 years (Table-I). The highest rate of Microsporidium infection among the 12 types of malignant diseases was found in patients with Hodgkin and non-hodgkin lymphoma (83.3%) (Table II). However, the frequency of Microsporiium

Table-I: Types of malignant diseases among examined children in relation to age and sex.

Type of malignant cases###Age###Sex###Total

###less than 4###4-8###9-13###14-16###Male###Female###No.###%

Leukemia

1. ALL###11###15###5###1###19###13###32###55.2

2. AML###1###0###1###1###1###2###3###5.2

Lymphoma

1. HL###-###2###-###-###2###-###2###3.4

2. NHL###-###3###1###-###3###1###4###6.9

Neuroblastoma###2###3###-###-###3###2###5###8.6

Retinoblastoma###-###-###1###-###1###-###1###1.7

Rhabdomyosar-coma###-###-###-###1###1###-###1###1.7

Ewing's sarcoma###-###1###1###-###2###-###2###3.4

Wilm's tumor###-###1###-###-###1###-###1###1.7

Histiocytosis###-###1###-###-###1###-###1###1.7

Hepatoblastoma###1###-###-###-###-###1###1###1.7

Lmphoblastic lymphoma###-###4###1###-###3###2###5###8.6

Total###15###30###10###3###37###21###58###100

Table-II: Parasitic and Microsporidium infections among different types of malignant diseases in the examined children.

Malignant Disease###No.###Parasitic Micros poridium

###examined infections infection

###No.(%)###No.(%)

Leukemia

1. ALL###32###11 (34.4)###1 (3.1)

2. AML###3###2 (66.7)###0

Lymphoma

1.HL###2###2(100)###2(100)

2. NHL###4###4 (100)###3 (75.0)

Neuroblastoma###5###3 (60.0)###0

Retinoblastoma###1###1(100)###0

Rhabdomyosarcoma###1###0###0

Ewing's sarcoma###2###2 (100)###0

Wilm's tumor###1###1(100)###0

Histiocytosis###1###0###0

Hepatoblastoma###1###1 (100)###0

Lymphoblastic###5###2(40.0)###0

lymphoma

Total###58###28 (49.5)###6 (10.3)

Control group###107###13 (12.15)###0

X2 = 63.000; P less than 0.01. X2 = 8.34; P less than 0.01

infection was (3.1%) among ALL patients. The overall positivity of microsporiiosis in malignant patients was 6(10.3%) (Table-II).

Prevalence of various species of intestinal parasites (including Microsporidium) was 48.3%. The highest rate of parasitic infections was observed in patients with ALL (34.4%) (Table- II). Males in both patients and control groups have higher parasitic infections than females (Table-III). No Microsporidium spores have been observed in stools of the control group. The clinical symptoms among studied patients included weight loss (77.6%), fever (29.3%) and diarrhea (27.6%) (Table-IV).

DISCUSSION

Leukemia was the most common type of malignancy reported in this study. Males were more affected than females with no clear reason. Similar observations were recorded in different studies.11,12

Microsporidium was found in 10.3% in various types of malignancies. Most of these cases were reported in Hodgkin and non-hodgkin lymphoma rather than other types of malignancy. These results indicate that the patients with immune defects either by the disease itself or by cytotoxic drugs or both are at the risk of microsporidiosis.13 Accordingly, the prevalence of the parasites reported by several

Table-III: Distribution of parasitic infections among 58 patients according to sex.

Parasites###Patients Control

###Male Female Male Female

Single infection:###15###7###5###3

Giardia lamblia.###3###5###3###1

Blastocystis hominis.###3###1###2###2

Entamoeba histolytica.###5###1###-###-

Microsporidium###4###-###-###-

Mixed infection:###3###3###-###-

Microsporidium###1###-###-

and B.hominis.

Microsporidium###1###-###-###-

and G.lamblia

G.lamblia and

B.hominis..###2###2###-###-

infection was (3.1%) among ALL patients. The overall positivity of microsporiiosis in malignant patients was 6(10.3%) (Table-II).

Prevalence of various species of intestinal parasites (including Microsporidium) was 48.3%. The highest rate of parasitic infections was observed in patients with ALL (34.4%) (Table- II). Males in both patients and control groups have higher parasitic infections than females (Table-III). No Microsporidium spores have been observed in stools of the control group. The clinical symptoms among studied patients included weight loss (77.6%), fever (29.3%) and diarrhea (27.6%) (Table-IV).

DISCUSSION

Leukemia was the most common type of malignancy reported in this study. Males were more affected than females with no clear reason. Similar observations were recorded in different studies.11,12

Microsporidium was found in 10.3% in various types of malignancies. Most of these cases were reported in Hodgkin and non-hodgkin lymphoma rather than other types of malignancy. These results indicate that the patients with immune defects either by the disease itself or by cytotoxic drugs or both are at the risk of microsporidiosis.13 Accordingly, the prevalence of the parasites reported by several researchers among HIV-patients was at a range of 6.5% - 42% in different parts of the world.14-17 In general, the variation in the prevalence of parasitic including Microsporidium infection can be related to the characteristics of the regions worked on, the subject chosen, nutritional status, other infection and method used.

The results showed that weight loss, fever and diarrhea were important clinical symptoms among studied patients. A clear association between the presence of Microsporidium and diarrhea was established by many workers among HIV-infected patients.6,17-19

In conclusion, Microsporidium and other intestinal parasites should be considered among children with malignant diseases in order to minimize their suffering.

REFERENCES

1. Raynaud L, Delbac F, Broussolle V, Rabodonirina M, Veronique G, Wallon M, et al. Identification of Encephalitozoon intestinalis in travelers with chronic diarrhea by specific PCR amplification. J Clin Microbiol1998;36:37-40.

2. Deloul AM. Color Atlas of Parasitology. Vol 2. Format Utile, France, 1999: 34-63.

3. Karaman U, Daldal N, Atambay M, Colak C. The epidemiology of microsporidias in humans (Malatya sample). Turkish J Med Sci 2009;39(2):281-288.

4. Brasil P, de Lima DB, de Paiva DD, Lobo MS, Sodre FC, Silva SP, et al. Microsporidiosis in HIV-infected patients with chronic diarrhea in Rio De Janeiro, Brazil. Rev Inst Med Top S Paulo 2000;42:299-304.

5. Tumwine JK, Kekitinwa A, Nabukeera N, Akiyoshi DE, Buckholt MA, Tzipori S. Enterocytozoon bieneusi among children with diarrhea attending Mulago Hospital in Uganda. Am J Med Hyg 2002;67:299-303.

6. Centers of Diseases Control and prevention. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents. MMWR 2009;58(10):3-59.

7. Sancak B, Akyon Y. Microsporidia: General characteristics, infection and laboratory diagnosis. Micrbiol Bult 2005;39:513-522.

8. Weber R, Bryan RT, Schwartz DA, Owen RL. Human microsporidial infections. Clin Microbiol Rev 1994;7:426-431.

9. John DT, Petri WA. Markell and Voge's Medical Parasitology. 9th Ed. Saunders, Elsevier, St. Louis, Misssouri, 2006: 393-415.

10. Weber R, Bryan RT, Owen RL, Wilcox CM, Govelkin L, Visvesvara GS. Improved light microscopical detection of microsporidia spores in stools and duodenal aspirates. New Eng J Med 1992;3263:161-166.

11. Lee GR, Foerster J, Lukens J, Paraskevas F, Greer JP, Rodgers GM. Wintrobe's Clinical Haematology. 10th Ed. Philadelphia: Lippincott Williams and Wilkins, 1998: 2241-2271.

12. Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Nelson's Textbook of Pediatrics. 18th Ed. Philadelphia, London: WB Saunders Co, 2007: 594-599.

13. Rubin P, Williams JP. Clinical Oncology. 8th Ed. Philadelphia, London: WB Saunders Co, 2001: 32-46. 14. Bretagne S, Foulet F, Alkassoum W, Fleury-Feith J, Develoux M. Prevalence of Enterocytozoon bieneusi spores in the stool of AIDS patients and African children not infected by HIV. Bull Soci Pathol Exot 1993;86:351-357.

15. Field AS, Hing MC, Milliken ST, Marriott DJ. Microsporidia in the small intestine of HIV-infected patients. A new diagnostic technique and a new species. Med J Australia 1993;15:390-394.

16. Kumar SS, Ananthan S, Joyee AG. Detection of Enterocytozoon bieneusi (microsporidia) by polymerase chain reaction (PCR) using species-specific primer in stool samples of HIV patients. Indian J Med Res 2005;121:215-219.

17. Garcia LS, Shimizu RY, Bruckner DA. Detection of microsporidial spores in fecal specimens from patients diagnosed with cryptosporidiosis. J Clin Microbiol 1994;32:1739-1741.

18. Muller A, Bialek R, Kamper A, Fatkenheuer G, Salzberger B, Franzen C. Detection of microsporidia in travelers with diarrhea. J Clin Microbiol 2001;39:1630-1632.

19. Conteas CN, Berlin OG, Ash LR, Pruthi JS. Therapy for human gastrointestinal microsporidiosis. Am J Trop Med Hyg 2000;63(3-4):121-127.
COPYRIGHT 2012 Asianet-Pakistan
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2012 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Author:Mahdi, Nadham K.; Al-Saadoon, Maysloon A.
Publication:Pakistan Journal of Medical Sciences
Article Type:Report
Geographic Code:7IRAQ
Date:Sep 30, 2012
Words:1975
Previous Article:Comparison of corticosteroid injections, physiotherapy, and combination therapy in treatment of frozen shoulder.
Next Article:Limitations in thrombolytic therapy in acute ischemic stroke.
Topics:

Terms of use | Privacy policy | Copyright © 2019 Farlex, Inc. | Feedback | For webmasters