Title: Study of Cryptosporidiosis in Children with Hematological and Solid Malignancies Suffering From Diarrhea
Authors: Magdy Abd Elfattah Ramadan, Maha Yousef Kamal, Mona Mohamed Tolba, Ekram Abdelsalam Elfaramawy Mohamed
DOI: https://dx.doi.org/10.18535/jmscr/v5i7.46
Abstract
Introduction: Cancer is the second leading cause of death in children under 15 years of age. Childhood cancers (CC) include a variety of malignant tumors. Leukemia is constituted about 30 − 34% of all CC. Central nervous system (CNS) cancers are the second most frequent cancers, accounting for about 27% of CC. Lymphomas represent the next most common type of CC, averaging 15%.Patients with cancer suffer from an increased risk for common and opportunistic infections that result from intrinsic disease and anti-cancer therapy-induced immune deficiencies. Opportunistic enteric protozoan parasites such as Cryptosporidium spp and Microsporidia may cause severe diarrhoea, morbidity and even mortality among immunocompromised patients. Cryptosporidiosis has been reported in both immunocompetent and immunocompromised patients and it has three major clinical presentations, including; asymptomatic carriage, acute diarrhea, and persistent diarrhea.
Subjects: The study will be conducted on children aged 6 months - 16 years. It will include the following: 166 subjects, 83 immunocompromised children with diarrhea presenting to Alexandria University Children’s Hospital at Elshatby and 83 age matched control cases.
Methods: Collection of Stool samples, Stool examination by Modified Ziehl - Neelsen stain for the diagnosis of C. parvum and Copro-antigen detection test using Rida Screen cryptosporidium ELISA kit.
Results: Cryptosporidium infestation was significantly more frequent in studied patients suffering from malignancy as compared with control group.
Conclusion: children with cancer are more likely to suffer from severe gastrointestinal manifestations due to the disease itself or infectious and non-infectious complications of chemotherapeutic treatment. Cryptosporidium infection should be considered in cases of severe or prolonged watery diarrhea in children with cancer which necessitates appropriate management to decrease its complications.
Keywords: Cancer, opportunistic infections, Cryptosporidiosis, ELISA.
References
1. Ferlay J, Shin H-R, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008. Int J Cancer 2010;8(12):2893–2917.
2. Siegel R, Naishadham D, Jemal A. Cancer statistics. CA Cancer J Clin 2012;8(1):10–29.
3. Stefan DC, Jacobs P. Lymphoma: a pediatrician’s perspective. Transfus Apher Sci 2010;8(2):185–87.
4. Fayer R, Morgan U, Upton SJ. Epidemiology of Cryptosporidium: transmission, detection and identification. Int J Parasitol 2000;30(12–13):1305–22.
5. Chen XM, Keithly JS, Paya CV, LaRusso NF. Current concepts cryptosporidiosis. New Engl J Med 2002;346: 1723–31.
6. Brooks, Geo. F, Butel, Janet S, Morse, Stephen A. Jawetz, Melnick, &Adelberg’s Medical Microbiology . New York Lange Medical Books McGraw Hill 2004;23: 684–5
7. Ramirez NE, Ward LA, Sreevatsan S. A review of the biology and epidemiology of cryptosporidiosis in humans and animals. Microbes and Infection 2004; 6(8):773-85.
8. Rossignol JF, M. G, Ortega-Pierres, Ronald Faye. Drug treatment and novel drug targets against giardia and cryptosp-oridium. Giardia and Cryptosporidium From Molecules to Disease 2009;38: 463-82.
9. Ayalew D. Assessment of the association of Cryptosporidium parvum, Giardia lamblia and Entamoebahistolytica/dispar infection prevalence with drinking water source among children in Legedini, Adada and Legfbira, Dire-Dawa, Eastern Ethiopia. [Unpublished M.Sc. Thesis]: Department of Biology, Addis Ababa University 2006
10. MohammadiGhaleh Bin B, Falah S, Asgharzadeh M, et al. Prevalence of Cryptosporidium in children suffering from gastroenteritis in Ardabil hospitals. J Ardabil Univ Med Sci 2006;6(2):176-82.
11. Gatei W, Wamae CN, Mbae C, Waruru A, et al., Cryptosporidiosis prevalence, geno-type analysis and symptoms associated with infections in children in Kenya. Am J Trop Med Hyg 2006; 75 (1): 78-82.
12. Adamu, H. Opportunistic intestinal parasitic infections in pediatric patients with diarrhea in relation to some demographic features in Addis Ababa hospitals. Master thesis, Dept. Biology, Addis Ababa University2004; 68.
13. Mumtaz S, Ahmed J, Ali L. Frequency of cryptosporidium infection in children under five years of age having diarrhea in north west of Pakistan. Afr J Biotech 2010; 9 (8): 1230-35.
14. Al-Warid, Harith S., Ihsan M. Al-Saqur, and Souhaila H. Mahmood. "Occurrence of Cryptosporidium spp among People Live in North of Baghdad." Eur J Sci Res 2012; 78.4: 539-45.
15. Siwila J, Phiri IG, Vercruysse J, Goma F, Gabriel S, Claerebout E, Geurden T. Asymptomatic cryptosporidiosis in Zambian dairy farm workers and their household members. Trans R Soc Trop Med Hyg 2007;101(7):733–4.
16. Ferreira, M.S. Infections by protozoa in immunocompromised hosts. Memorias Instituto Oswaldo Cruz 2000; 95: 159-62.
17. Domenech, C, M. Rabodonirina, N. Bleyzac, M.P. Pages and Y. Bertrand. Cryptosporidiosis in children with acute lymphoblastic leukemia on maintenance chemotherapy. J Pediatr Hematol Oncol 2011; 33: 570-72.
18. Evering, T. and L.M. Weiss. The immu-nology of parasite infections in immune-compromised hosts. Parasite Immunol 2006; 28: 549-65.
19. Berenji, F., N. Zabolinejad, H. Kianifar, Z. Badeii, A. Banihashem and S. Hiradfar. Cryptosporidium infection in pediatric patients with lymphohema-topoietic malignancies. Iran J Pediatr 2007;3: 247-51.
20. Al-Megrin, W.A.I. Intestinal parasites infection among immunocompromised patients in Riyadh, Saudi Arabia. Pak J BiolSci 2010; 13: 390-94.
21. Smith, H.V and Corcoran, G.D . New drugs and treatment for cryptosporidiosis. Current Opinion in Infectious Disease 2004;17:557–64.
22. Mbanugo, J.I. and Agu, V.C. Prevalence of Crptosporidiumparvum infections in children, aged 0-15years, in Anambra State, Nigeria. Nig. J. Parasitol 2006; 26:15.
23. Arora DR, Arora B. Medical Parasitology. CBS Publishers India 2009;2:90-95.