Prevalence of Intestinal Parasites in Cancer Therapy Recipients with Concurrent Diarrhea

Aims: Patients receiving intensive cancer therapeutic regimens are subjected to increasing risk for developing infections including intestinal parasites. Changes in epidemiology of parasitic infections are important in those patients as some parasites may lead to prolonged and severe life threatening diarrhea. So, the purpose of the present study was to investigate the prevalence of intestinal parasites in those patients.

Study Design: This is an observational cross-sectional study.

Place and Duration of Study: Hospitalized patients in the Oncology and Radiotherapy Department, Mansoura University Hospital (MUH), Dakahlia governorate, Egypt, from December 2012 to March 2014.

Methodology: A total of 145 patients with haematological malignancy presenting with diarrhea while currently in the course of cancer therapy were recruited. Fresh stool samples were examined by saline, iodine mounts and after concentration with formol-ether sedimentation method. Staining of smears was performed with Trichrome, modified Trichrome, and modified Ziehl-Neelsen acid fast stains. Stool culture of fresh samples using both Harada Mori filter paper strip culture and modified agar plate was used for detection of Strongyloides or hookworm larvae.

Results: Intestinal parasites were detected in 124 of 145 (85.5%) subjects. Giardia lamblia was the most frequent parasite (36.6%), followed by Cryptosporidium parvum (30.3%), then Entamoeba histolytica(27.6%). Only Cryptosporidium parvum and Entamoeba histolytica were the parasites significantly present as mixed infections with other parasites (p= 0.006, 0.019 respectively). Persistent diarrhea was mostly associated with parasitic infections.

Conclusion: The study highlighted the importance of regular laboratory screening for intestinal parasites in patients receiving cancer therapy. Persistent diarrhea should raise high suspicion for parasitic infections in this particularly susceptible group.