Document Type: Research Articles
Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran.
Departments of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Background: Intestinal parasitic infection in immunodeficient patients especially those with impaired cellular
immunity, like neoplasia, renal or heart transplant needs careful consideration. The objective of this study is to evaluate
the prevalence of intestinal parasites in different group of patients including cancer patients; organ transplants recipients,
and primary immunodeficiency patients. Methods: Stool samples from 190 patients including 80 patients with Primary
Immunodeficiency, 85 cancer patients and 25 organ transplant recipients were collected; a direct examination with
Phosphate buffered saline (PBS) and formalin ether concentration was performed. The DNA was extracted from
parasitologically confirmed patients and nested PCR and sequencing was performed and new obtained sequences of
Cryptosporidium parvum and Enterocytozoon bieneusi were compared with deposited ones. Results: In general, the
prevalence of parasites was 26/80 (32.5%) in primary immunodeficiency, 22/85(25.9%) in cancer group, and 7/25
(28%) in organ transplant. The prevalence of intestinal parasitic infections in primary immunodeficiency patients
were Blastocystis hominis 13 (16.2%), Giardia lamblia 10 (12.5%), Cryptosporidium 1(1.2%), Chilomastix mesnilii 1
(1.2%), Dientamoeba fragilis 1(1.2%). Of 25 organ transplants, 6 (24%) Cryptosporidium sp were found, all of which
were confirmed as Cryptosporidium parvum and one case of Microspora in a heart transplant recipient was confirmed
as Enterocytozoon bieneusi by PCR sequencing. The predominant intestinal parasitic infection in cancer patients was
19 (22.3%) Blastocystis hominis followed by two (2.3%) Giardia lamblia and one Dientamoeba fragilis 1 (1.1%).
Conclusion: The high rate of infection with Blastocystis hominis was found in cancer patients especially colorectal
cancer patients, so careful consideration should be given by physicians. Cryptosporidium sp was found to be the major
cause of parasitic intestinal infection in patients with organ transplant compared to primary immunodeficiency patients;
so transplant recipients undergoing immunosuppressive therapy should be considered as a risk group for acquiring
microsporidiosis and Cryptosporidium infection.