Hematology Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Egypt.
Hematology Department, Medical Research Institute, Alexandria University, Egypt.
Trop Biomed. 2021 Mar 1;38(1):50-56. doi: 10.47665/tb.38.1.009.
Several enteric protozoan species are linked to diarrhea in humans, with some causing debilitating illnesses, essentially in immunocompromised and neutropenic patients as in acute leukemias. The aim of this study was to detect intestinal protozoa in Egyptian neutropenic patients with acute leukemia. The study comprised two groups; 40 newly diagnosed neutropenic acute leukemia patients and 30 controls. Stool samples were collected from all participants and subjected to routine microscopic examination, special staining and detection of copro-antigen using rapid diagnostic test (RDT) RIDA®QUICK Entamoeba/ Giardia/ Cryptosporidium Combi. Cases were tested post-chemotherapy at the nadir of neutropenia (absolute neutrophil count ANC<= 0.5x10/L) and 19 cases were also tested initially prior to chemotherapy. Of examined patients, 15/40 (37%) were positive for Blastocystis hominis by wet mount, 10/40 (25%) had microsporidia using modified trichrome stain and only 2 cases (5%) of Cryptosporidium spp. by Ziehl-Neelsen stain. By RDT, 8/40 cases (20%) were positive compared to entirely negative controls. The positive cases included 4 patients with G. intestinalis 2 with Entamoeba and 2 with Cryptosporidium.19/40 cases were tested both pre- and post-chemotherapy. microsporidian spp. was diagnosed in 6/19 cases at the nadir of neutropenia compared to none of the cases pre-chemotherapy and the difference was statistically significant (p= 0.031*). Intestinal protozoa in acute leukemia patients post-chemotherapy are common especially B. hominis. Furthermore, RDT might be helpful for diagnosing intestinal protozoa in acute leukemia. Attention is highly required as intestinal protozoa infection can emerge after chemotherapy such as microsporidia.
几种肠原生动物物种与人类腹泻有关，其中一些会导致衰弱性疾病，主要发生在免疫功能低下和中性粒细胞减少的患者中，如急性白血病患者。本研究旨在检测埃及中性粒细胞减少症急性白血病患者的肠道原生动物。该研究包括两组；40 名新诊断的中性粒细胞减少症急性白血病患者和 30 名对照者。收集所有参与者的粪便样本，并进行常规显微镜检查、特殊染色和使用快速诊断测试（RDT）RIDA®QUICK 肠内阿米巴/贾第虫/隐孢子虫组合检测粪便抗原。在化疗后中性粒细胞减少症的最低点（绝对中性粒细胞计数 ANC<=0.5x10/L）对病例进行检测，并且在化疗前也对 19 例病例进行了初始检测。在检查的患者中，15/40（37%）通过湿片法对人芽囊原虫呈阳性，10/40（25%）使用改良三色染色法对微孢子虫呈阳性，只有 2 例（5%）对隐孢子虫属呈阳性。通过 RDT，40 例中有 8 例（20%）呈阳性，而对照组则完全呈阴性。阳性病例包括 4 例有肠道贾第虫、2 例有肠内阿米巴、2 例有隐孢子虫。19/40 例在化疗前后均进行了检测。与化疗前相比，中性粒细胞减少症最低点时诊断出 6/19 例微孢子虫属，而化疗前无病例，差异具有统计学意义（p=0.031*）。化疗后急性白血病患者的肠道原生动物很常见，尤其是人芽囊原虫。此外，RDT 可能有助于诊断急性白血病患者的肠道原生动物。由于化疗后可能会出现肠道原生动物感染，如微孢子虫，因此需要高度重视。
