Hematological Study of Infants Amoebiasis in Duhok City

Abstract

Out of 180 children, 60 (33.3%) have Amoebiasis infection as diagnosed by direct wet smear and Saturated Salt Solution (SSS). SSS method is more significant (P=0.001) in diagnosis of the disease. Number of children infected with Amoebiasis infection is higher in infants aged 1-6 months, but without any significant difference to ages 6-12 or 12-18 months. In contrast, infants aged 18-24 months are significantly differant (P=0.01) as the infection rate is 16.6%. Gender also is seen to be reduced in significance (P= 0.001) for females aged 18-24 months. Blood profile of the involved infants has shown a significant variation (P=0. 01) for all blood profile parameters (RBC (P=0.05), WBC (P=0.001), Lymphocytes (P=0.05), Granulated WBC (P=0.05), Hb (P=0.01) and Platelets counts (P=0.001). Many medicinal regimes are dependent in the treatment of Amoebiasis, Metronidazole (Flagyl) in significant variation (P=0.01), combination of Metronidazole and Bactrim

Full text

Baghdad Science Journal Vol.14(2)2017

DOI: http://dx.doi.org/10.21123/bsj.2017.14.2.0343
Hematological Study of Infants Amoebiasis in Duhok City
Assist. Prof. Dr. Saad Mohi Haider
Lecturer Saad Mohammed Shaheen Alsoufi
Duhok Technical Institute – Duhok Polytechnic University, Duhok, Iraq.
E-mail: saadmohi64@gmail.com, E-mail: Second author: saadalsufi@yahoo.com
Received 11/11/2015
Accepted 25/7/2016
This work is licensed under a Creative Commons Attribution 4.0 International License
Abstract: Out of 180 children, 60 (33.3%) have Amoebiasis infection as diagnosed by
direct wet smear and Saturated Salt Solution (SSS). SSS method is more significant
(P=0.001) in diagnosis of the disease. Number of children infected with Amoebiasis
infection is higher in infants aged 1-6 months, but without any significant difference
to ages 6-12 or 12-18 months. In contrast, infants aged 18-24 months are significantly
differant (P=0.01) as the infection rate is 16.6%. Gender also is seen to be reduced in
significance (P= 0.001) for females aged 18-24 months. Blood profile of the involved
infants has shown a significant variation (P=0. 01) for all blood profile parameters
(RBC (P=0.05), WBC (P=0.001), Lymphocytes (P=0.05), Granulated WBC (P=0.05),
Hb (P=0.01) and Platelets counts (P=0.001) Many medicinal regimes are dependent
in the treatment of Amoebiasis, Metronidazole (Flagyl) in significant variation
(P=0.01), combination of Metronidazole and Bactrim
Key words: Amoebiasis, Entamoeba histolytica, Infant, Children, Direct Smear,
Saturated Salt Solution, Blood Profile.
Introduction:
Amoebiasis is considered as a
worldwide distributed diarrheic disease
especially among children. Infection
commences soon after ingestion by
sensitive patients the infective stage of
the causative agent which is the cystic
form of Entamoeba histolytica
protozoan parasite via polluted water,
food and various other possible
mechanical vectors [1, 2, 3].
Entamoeba histolytica is the most
known agent causing Amoebiasis
among their genus. The parasite
colonizes in the mucosal layer Gastro
Intestinal Tract (GIT) with preferability
too, leading to lysis, corrosion and
bleeding [4]. Sometimes the parasite
distributes to other organs such as liver
and brain, causing a serious
consequences with bad sequels [5,6].
Other parts of the disease is related
with the zoonotic importance as it can
be transmitted from human to animal
and vice versa [7,8 ].
Pet dogs, rodents and domestic flies
are considered as biomechanical vectors
as well as reservoir hosts [9]. Cystic
form of the parasite is the resistant stage
to radical environment which plays an
Open Access

Baghdad Science Journal Vol.14(2)2017

important role in epidemiology of the
disease [10].
The disease isn’t studied in infant
children below 2 years old in Duhok city
of Kurdistan region. The following
study is designed to be concerned with
the distribution of the disease among
infants, blood profile, evaluation of
technical methods and the medical
approaches in treatment of the disease.
Materials and Methods:
Samples Collection:
A-Fecal samples (n=180 from March-
July) are collected from diarrheic infants
aged less than 2 years old randomly, sex
and addresses are considered, too.
Parasitological analysis is performed
within half an hour following samples
collection by two assessment diagnostic
techniques, namely direct wet smear and
Saturated Salt Solution (SSS).
Trophozoite and cystic forms are
investigated [11].
B- Blood samples (n=60) are collected
with aseptic condition. Venous blood in
about 3-5 ml is drawn from each reliable
infant. Heparinized tubes are used,
Coulter method is dependent [12], RBCs
(Red Blood Corpuscles), WBCs (White
Blood Cells), Lymphocytes, Granulated
WBC (GRA-WBC), Hb (Hemoglobin)
and Platelets counts are included.
c-Medical management approaches are
categorized according to authorized
physicians.
Statistical Analysis:
OpenEpi V.2.3 statistical program is
dependent for descriptive statistics
analysis and ANOVA application for the
obtained results.
Results and Discussion:
Out of 180 cases, only 60 are
considered as Ameobiasis among
various diarrheic children. The infection
rate reaches 33.3% at all (Tab. 1). This
rate of infection is adapted with
previous studies [13, 14]. In neighboring
countries the results (24.6-33%) are near
to the current one [15, 16]. Other results
in other countries differ (10-70%) as
they are concerned with surveys or
broad range of ages or other aims [17,
18, 19].
Generally, the chronological
approaches in combination with the
current research results is clarified that
there are no improvement recorded in
control and eradication of Amoebiasis.
This means that either there is a
decrease in the scientific knowledge or
negligence of this disease compared to
other diseases.
Table (1): Infants Ameobiasis
Diagnosis In Different Methods.
Number
of cases
Results
categories
Test
Positive
Negative
180
Ameobiatic
cases
N=60
(33.3%)
Direct
Smear
(DST)
20
40
Saturated
Salt
Solution
(SSS)
60***
0
Non
Ameobiatic
cases
N=120
(66.6%)
By Both
above
tests
0
120
***P=0.001
Table one shows that SSS techniques
are more reliable (P=0.001) in
comparison with direct wet smear
preparation. The significance of this
comparison is recorded in many
researches and tests [1, 2, 3, 20]. It is
worthy to provoke the use of SSS
method especially in developing and
unsophisticated places Both of direct
wet smear and SSS methods are
valuable for the diagnosis of Trophozoic
and cystic forms of the parasite, but
there are significant differences
(P=0.001) for trophozoites in direct wet
smear as well as for significance
(P=0.001) of cystic forms by SSS
method.
The above mentioned results are
familiar to previous (40%) studies
[4,9,10]. These findings show very
clearly that condition of examination

Baghdad Science Journal Vol.14(2)2017

achievement is very crucial in relation to
the accuracy of the test as well as for the
specificity and sensitivity of the test.
Direct fecal examination may be needed
to be duplicated or triplicated in
comparison with SSS method.
Table two shows that number of
infants who got infection is higher in the
age group 1-6 months but without any
significant difference to the age group 6-
12 or 12-18 months, in contrast to
children of the age 18-
Table (2): Infants Ages Infected With
Ameobiasis.
24 months who showed a significance
(P=0.01) of the infection rate of reduce
from 33.3% to 16.6%.
These results reflect the similarity of
situation of others [21] who found the
same findings but disagree to other
studies [13, 14, 16]. These controversies
might be related to individual variations
that could be related to epidemio-
geographical factors that affect
distribution of the disease.
The relationship of age to infection
rate is very obvious as it occupies to
below 6 months of age (33.3%) with
special attention to occurrence within
one month of age and that could explain
the increase risk factors around infants
in this age. This finding agrees with
Mondala et al. [22] and disagrees with
Ahmed [14].
Gender of children shows no
significance difference for male
infection rate at any age, but the
situation differs from females where the
infection rate is significant (P=0.001) to
be reduced to 3.3% from 20%.The
effects of gender upon infection rate of
infants Ameobiasis is never pointed
before, but it could be attributed to the
society tradition where the males are
very thusiastic in situation that makes
them at high risk of exposure to
Ameobiatic infection. This indication is
shown previously [7,13,14] in various
rates (10-25%).
Blood parameters of children (Tab.3)
shows a significant variation (P=0.001)
for all blood parameters in comparison
with normal values [Tab.3]. Values of
RBC counts and Hb. levels are shown to
be reduced (P=0.05 and P=0.01
respectively) in children suffering from
Ameobiasis. This is expected as
Entamoeba histolytica protozoan
parasite has the ability to invade the
epithelial tissue of GIT leading to minor
bleeding that lately could be developed
to clear obvious hemorrhage as it will be
diagnosed by blood blotches in the feces
or as observed free RBCs within
microscopic fields.
Table(3): Infants Ameobiatic Blood
Parameters.
These findings are absolutely agree
with many references that explain the
pathogenicity of amoebiatic causative
agent [4,13,22].
WBC (P=0.001), Lymphocytes
(P=0.01) and Granulated WBC (P=0.05)
are have a dramatic changes into rising
or reducing in advancing of amoebiatic

Baghdad Science Journal Vol.14(2)2017

infection, which stimulate the immune
system in all to respond suddenly as
acute reaction and that is very clear for
lymphocytes regulatory role and GRA
as they are the first immune cellular that
intersects with the parasitic infection.
This is adequate with many advanced
studies all over the world [4,11].
Platelets counts (PLT) decrease
significantly (P=0.001) and this is show
to be a de novo hematological response
which may be related to some of the
parasite metabolite to make blood
component available for parasite
viability.
Lately, Table 4 clarifies that many
tactics are dependent in treatment of
amoebiatic cases by the native
physicians, mostly depending upon
Metronidazole (Flagyl) in significant
variation (P=0.001), Tinidazole
(Fasigyn), combination of
Metronidazole and Bactrim antibiotic.
The above mentioned medications are
recommended by many medical
references [2, 6, 7, 11 ].
The major problem in medical
treatment of Amoebiasis seems to be a
lack of recommendation for necessity of
re-checking of patients after finishing
prescribed medicinal course. This
dilemma needs more attention as it may
be the only available method to judge
the efficacy of medicines in developing
countries, such as the current research
place.
Table (4): Treatment Regimes Of Infants
Ameobiatic Infection .
Treatment
regimes
Medicates
Number of
applicants
Regime 1
Metronidazole
(Flagyl)
40**
Regime 2
Tinidazole
(Fasigyn)
12
Regime 3
Metronidazole +
Bactrim
8
Totat
60
**P=0.01
Acknowledgement
Many thanks to Hevi Paediatric Hospital
in Duhok , especially to Head and Staff
members of Parasitology Lab.
References
[1] Pereira, V. V.; Conceição, A. D. S.;
Maximiano, L. H. S.; Belligoli, L. Q.
G.and Silva, E . S. D. 2014.
Laboratory diagnosis of amebiasis in
a sample of students from
southeastern Brazil and a comparison
of microscopy with enzyme-linked
immunosorbent assay for screening
of infections with Entamoeba sp.
Revista da Sociedade Brasileira de
Medicina Tropical .47(1):52-56.
[2] World Health Organization (WHO).
1997. Amoebiasis. Weekly
Epidemiological Record. 72:97-100.
[3] Huston, C.D. and Petri, W. A. 1999.
Amebiasis: Clinical implications of
the recognition of Entamoeba dispar.
Curr. Infect. Dis. 1:441-447.
[4] Chacin-Bonilla, L. 2013. Amebiasis:
aspectos clínicos, terapéuticos y de
diagnóstico de la infección. Rev Med
Chile. 141: 609-615.
[5] Ralston, K. S. and Petri, W.A. Jr.
2011. Tissue destruction and invasion
by Entamoeba histolytica. Trends
Parasitol. 27 (6):253-62.
[6] Bobbi, S.; Pritt, M. D. and Clark, G.
2008. Amebiasis. Mayo Clin Proc. 83
(10): 1154-60.
[7] Graczyk, T. K.; Knight, R. and
Tamang, L. 2005. Mechanical
transmission of Human protozoan
parasites by Insects. Clin. Microbiol.
Rev. 18(1): 128-132.
[8] Ghandour, A. M.; Zahid, N. Z.;
Banaja, A. A.; Kamal, K. B. and
Bouq, A. I. 1995. Zoonotic intestinal
parasites of hamadryas baboons,
Papio hamadryas, in the western and
northern regions of Saudi Arabia. J.
Trop. Med. Hyg., 98: 431-439
[9] Stanley, S. L. Jr. 2003. Amoebiasis.
Lancet. 361: 1025- 1034

Baghdad Science Journal Vol.14(2)2017

[10] Leber, A. L. and Novak, S. M.
2011. Intestinal and urogenital
Amebae, flagellates, and ciliates.In
Manual of Clinical Microbiology.
Volume 2. 10th ed. Edited by Murray,
P. R.; Baron, E. J.; Pfaller, M. A.;
Tenover, F. C. and Yolken, R. H.
Washington, DC: ASM Press. 1391–
1405
[11] Gockel-Blessing, E. A. 2013.
Clinical parasitology: A practical
approach .2ed Saunders, an imprint of
Elsevier Inc
[12] Sandhaus, L. M.; Osei, E. S.;
Agrawal, N. N.; Dillman, C. A. and
Meyerson, H. J. 2002. Platelet
counting by the Coulter LH 750,
Sysmex XE 2100, and ADVIA 120:a
comparative analysis using the
RBC/platelet ratio reference method.
Am J Clin. Pathol.118:235-241
[13] Al-Haboobi, Z. A.; Jasim, A. K. A.
and Al-Quraishi, M. A. 2013. The
pattern of leucocytes Parameters and
C - reactive protein findings of
G. lamblia and E. histolytica
Intestinal Infections in Children. Int.
J. Rec. Biotech. 1 (2): 5-14
[14] Ahmed, J. K. 2011. Prevalence of
intestinal of intestinal protozoal
infection among patients in Al-Dour
healthy centers .Al- Taqani. 24(7):64-
73.
[15] Heckendarn, F. N.; Goran, E. K.
and Flegar. 2000. I- Species specific
filed testing at Entamoeba spp. Iran
area at high endenicity. Trans. Roy.
Trop. Med. Hyg. 17(2): 212-216.
[16] Zaglool, D. A. M.; Khodari, Y. A.
W.; Khalid, Z. J. G.; Shaker, O. D.
H.; and Farooq, M. U. 2011.
Prevalence of Intestinal Parasites
among Patients of Al-Noor Specialist
Hospital, Makkah, Saudi Arabia.
Oman Medical Journal. 26 (3): 182-
185.
[17] Korpe, P. S.; Liu, Y.; Siddique, A.;
Kabir, M.; Ralston, K.; and Ma JZ.
2013. Breast milk parasite- specific
antibodies and protection from
Amebiasis and cryptosporidiosis in
Bangladeshi infants: A prospective
cohort study. Clin. Infect. Dis.
56:988–92
[18] Ali, I. K.; Clark, C. G. and Petri, Jr.
W. A. 2008. Molecular epidemiology
of Amoebiasis. Infect. Genet. Evol.
8: 698-707
[19] Blessman, J. Le Van. A. and
Tannich, E. 2006. Epidemiology and
treatment of Amoebiasis in Hue,
Vietnam. Arch Med Res. 37: 270-
272.
[20] Coelho1, W. M. D.; Gomes, J. F. G;
Falcão, A. X.; Santos, B. M. D;
Soares, A. F. T.; Suzuki, C. T. N.;
Amarante, A. F. T. D. and
Bresciani1, K. D. S. 2015.
Comparative study of five techniques
for the diagnosis of canine
gastrointestinal parasites. Braz. J.
Vet. Parasitol., Jaboticabal, . 24(2):
223-226, Apr.-Jun
[21] Rodriguez-Morales, A. J. 2012.
Current Topics in Tropical Medicine.
Tech. Janeza Trdine 9, 51000 Rijeka,
Croatia (Report).
[22] Mondala, D.; Petri, W. A.; Sackc,
R. B.; Kirkpatrickd, B. D. and
Haquea, R. R. 2006. Entamoeba
histolytica associated diarrheal illness
is negatively associated with the
growth of preschool children:
evidence from a prospective study.
Trans R Soc Trop Med Hyg .100
(11): 1032-1038.




Baghdad Science Journal Vol.14(2)2017


 

 


   
P= 0.001
-6-18-
-     P=0.01       
 P= 0.001 
P=0. 01P=0.05
   P=0.001     P=0.05    
P=0.05P=0.01
  P=0.001          
       P=0.01    


    

      


