埃及血液透析患者中与 CD4+ T 细胞计数相关的机会性寄生虫感染：一项对比研究。
Opportunistic parasitoses among Egyptian hemodialysis patients in relation to CD4+ T-cell counts: a comparative study.
机构信息
Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
Department of Microbiology and Immunology, Faculty of Pharmacy and Drug Manufacturing, Pharos University, Alexandria, Egypt.
出版信息
BMC Infect Dis. 2019 May 29;19(1):480. doi: 10.1186/s12879-019-4110-4.
BACKGROUND
Some reports are available on the prevalence of opportunistic parasitoses among hemodialysis (HD) patients, yet there is a paucity of data on the association of CD4+ T-cell counts with such infections. Therefore, this study aimed to determine the prevalence of intestinal parasites and Toxoplasma gondii in relation to CD4+ counts among HD patients in Alexandria, Egypt.
METHODS
A comparative cross-sectional study was conducted on 120 HD patients and 100 apparently healthy individuals between December 2014 and January 2016. Data and samples (stool and blood) were collected from the participants after obtaining their informed consent. Stool samples were examined for parasites after concentration and staining, EDTA-blood samples were used for CD4+ counting by flow cytometry, and sera were analyzed for anti-Toxoplasma IgM and IgG antibodies.
RESULTS
A significantly higher prevalence rate of intestinal parasitoses was found among HD patients compared to apparently healthy individuals (52.5% vs. 12.0%, respectively), with absence of helminths. Cryptosporidium species (32.5%), B. hominis(24.2%) and microsporidia (11.7%) were the most frequent parasites among HD patients, while B. hominis (13.0%), Cryptosporidium species (11.0%) and G. lamblia (4.0%) were the most frequent parasites among their counterparts. Statistically significant differences in parasite infection rates between patients and their counterparts were found for Cryptosporidium species, B. hominis and microsporidia. However, parasite species were not significantly associated with diarrhea. On the other hand, the overall T. gondii seroprevalence rate among HD patients was significantly higher than that among their counterparts (33.3% vs. 8%, respectively). HD patients with CD4+ counts < 200 cells/μl were twice more exposed to intestinal parasitoses compared to those with counts ≥200 cells/μl, but the difference was not statistically significant. However, low CD4+ counts were significantly associated with higher rates of Cryptosporidium species, microsporidia and T. gondii.
CONCLUSIONS
Intestinal parasitoses and T. gondii infection rates are significantly higher among Egyptian HD patients compared to apparently healthy individuals, with Cryptosporidium species, B. hominis, microsporidia and T. gondii being the most frequent parasites. CD4+ counts < 200 cells/μl are significantly associated with Cryptosporidium species, microsporidia and T. gondii among HD patients. Therefore, regular screening of HD patients for opportunistic parasites is recommended.
背景
已有一些关于血液透析（HD）患者机会性寄生虫病患病率的报告，但关于 CD4+T 细胞计数与这些感染之间的关系的数据却很少。因此，本研究旨在确定埃及亚历山大 HD 患者肠道寄生虫和弓形虫感染与 CD4+计数的关系。
方法
2014 年 12 月至 2016 年 1 月期间，对 120 名 HD 患者和 100 名健康对照者进行了一项比较性横断面研究。在获得知情同意后，收集参与者的数据和样本（粪便和血液）。粪便样本经浓缩和染色后检查寄生虫，EDTA 抗凝血样本采用流式细胞术检测 CD4+计数，血清分析抗弓形虫 IgM 和 IgG 抗体。
结果
与健康对照组相比，HD 患者肠道寄生虫病的患病率显著更高（分别为 52.5%和 12.0%），但无寄生虫感染。HD 患者中最常见的寄生虫为隐孢子虫（32.5%）、人芽囊原虫（24.2%）和微孢子虫（11.7%），而健康对照组中最常见的寄生虫为人芽囊原虫（13.0%）、隐孢子虫（11.0%）和蓝氏贾第鞭毛虫（4.0%）。HD 患者与健康对照组之间在隐孢子虫、人芽囊原虫和微孢子虫的寄生虫感染率方面存在显著差异。然而，寄生虫的种类与腹泻并无显著关联。另一方面，HD 患者的弓形虫总血清阳性率明显高于健康对照组（分别为 33.3%和 8%）。与 CD4+计数≥200 个细胞/μl 的患者相比，CD4+计数＜200 个细胞/μl 的 HD 患者更容易受到肠道寄生虫感染，但差异无统计学意义。然而，低 CD4+计数与较高的隐孢子虫、微孢子虫和弓形虫感染率显著相关。
结论
与健康对照组相比，埃及 HD 患者的肠道寄生虫病和弓形虫感染率显著更高，其中隐孢子虫、人芽囊原虫、微孢子虫和弓形虫是最常见的寄生虫。CD4+计数＜200 个细胞/μl 与 HD 患者中的隐孢子虫、微孢子虫和弓形虫显著相关。因此，建议对 HD 患者进行定期的机会性寄生虫筛查。
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