Detection of Five Parasites in Renal Transplantation Patients by Molecular Methods / Renal Transplantasyon Hastalarında Beş Parazitin Moleküler Yöntemler ile Tespiti
Objective: Intestinal parasitic infections are among the prominent public health concerns inpatients with suppressed immune function.Material and methods: Here we examined stool specimens by microscopy and polymerasechain reaction (PCR) to evaluate the infection of five principal protozoans (Cryptosporidiumspp., Giardia spp., Entamoeba histolytica, Blastocystis spp. and Dientamoeba spp.) among 90renal transplant recipient patients (RTP) in comparison with 90 healthy individuals (HI) fromTurkey.Results: The overall frequency of any parasites was 17.2% (31/180) with microscopy and51.7% (93/180) with PCR. Because of its high sensitivity, PCR was compared with microscopyin terms of the accuracy of detecting intestinal parasites, and the agreement was found to beinadequate (κ= 0.217; p<0.001). Multiparasitism (90.9%), Cryptosporidium spp. (84.6%) andGiardia spp. (74.1%) were the most frequent agents in RTP, respectively (p<0.001).Conclusions: This is the first study performed in Turkish reporting the prevalence of fiveintestinal parasites with PCR techniques among this group and seeks to provide a basis forfuture studies
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- 1. Alum A, Rubino JR, Ijaz MK. The global war
against intestinal parasites – should we use a holistic
approach? Int J Infect Dis 2010;14:732–8
- 2. Fletcher SM, Stark D, Harkness J, Ellis J. Enteric
protozoa in the developed world: a public health
perspective. Clin Microbiol Rev 2012;25:420–49.
- 3. Marcos LA, Gotuzzo E. Intestinal protozoan
infections in the immunocompromised host. Curr
Opin Infect Dis 2013;26:295–301.
- 4. Stensvold CR, Nielsen HV. Comparison of
microscopy and PCR for detection of intestinal
parasites in Danish patients supports an incentive
for molecular screening platforms. J Clin Microbiol
2012;50:540-1.
- 5. Akgül Ö, Kart Yaşar K, Sapmaz B, Kırkoyun
Uysal H, Yıldırmak T, Şimşek F, et al. Detection of
intestinal parasites with conventional and molecular
methods in follow-up HIV/AIDS cases. Mikrobiyol
Bul 2018;52:273-83.
- 6. IBM Corp. Released 2010 IBM SPSS Statistics
for Windows, Version 19.0. Armonk, NY: IBM
Corp 2010.
- 7. Uysal S, Tunalı V, Akdur Öztürk E, Ardeniz Ö,
Işıkgöz Taşbakan M, Pullukçu H, et al. Incidence
of Parasitic Diarrhea in Patients with Common
Variable Immune Deficiency. Turkiye Parazitol
Derg 2016;40:67-71.
- 8. Rasti S, Hassanzadeh M, Hooshyar H,
Momen-Heravi M, Mousavi SGA, Abdoli A.
Intestinal parasitic infections in different groups
of immunocompromised patients in Kashan and
Qom cities, central Iran. Scandinavian Journal of
Gastroenterology 2017;52:738-41.
- 9. Al-Qobati SA, Al-Maktari MT, Al-Zoa AM,
Derhim M. Intestinal parasitosis among Yemeni
patients with cancer, Sana’a, Yemen. J Egypt Soc
Parasitol 2012;42:727-34.
- 10. Ekberg H, Kyllonen L, Madsen S, Grave G,
Solbu D, Holdaas H. Clinicians underestimate
gastrointestinal symptoms and overestimate quality
of life in renal transplant recipients: a multinational
survey of nephrologists. Transplantation
2007;84:1052.
- 11. Bunnapradist S, Neri L, Wong W, Lentine KL,
Burroughs TE, Pinsky BW, et al. Incidence and risk
factors for diarrhea following kidney transplantation
and association with graft loss and mortality. Am J
Kidney Dis 2008;51:478.
- 12. Johnston BC, Shamseer L, da Costa BR,
Tsuyuki RT, Vohra S. Measurement issues in trials
of pediatric acute diarrheal diseases: a systematic
review. Pediatrics 2010;126:222–31.
- 13. Coste JF, Vuiblet V, Moustapha B, Bouin A,
Lavaud S, Toupance O, et al. Microbiological
diagnosis of severe diarrhea in kidney transplant
recipients by use of multiplex PCR assays. J Clin
Microbiol 2013;51:1841.
- 14. Bamias G, Boletis J, Argyropoulos T, Skalioti
C, Siakavellas SI, Delladetsima I, et al. Early
ileocolonoscopy with biopsy for the evaluation of
persistent post-transplantation diarrhea. World J
Gastroenterol 2010;16:3834.
- 15. Arslan H, Inci EK, Azap OK, Karakayali H,
Torgay A, Haberal M. Etiologic agents of diarrhea
in solid organ recipients. Transpl Infect Dis
2007;9:270.
- 16. Bandin F, Kwon T, Linas MD, Guigonis V,
Valentin A, Cassaing S, et al. Cryptosporidiosis in
paediatric renal transplantation. Pediatr Nephrol
2009;24:2245.
- 17. Raja K, Abbas Z, Hasan SM, Luck NH, Aziz
T, Mubarak M. Prevalence of cryptosporidiosis in
renal transplant recipients presenting with acute
diarrhea at a single center in Pakistan. J Nephrol
2014;3:127–31.
- 18. Udgiri N, Minz M, Kashyap R, Heer M, Gupta
CS, Mohandas K, et al. Intestinal cryptosporidiosis in
living related renal transplant recipients. Transplant
Proc 2004;36:2128–9.
- 19. Hunter PR, Nichols G. Epidemiology and
clinical features of Cryptosporidium infection in
immunocompromised patients. Clin Microbiol Rev
2002;15:145–54.
- 20. Valar C, Keitel E, Dal Prá RL, Gnatta D, Santos
AF, Bianco PD, et al. Parasitic infection in renal
transplant recipients.Transplant Proc 2007;39:460–2.
- 21. Ryan U, Paparini A, Oskam C. New technologies
for detection of enteric parasites. Trends Parasitol
2017;33:532–46.
- 22. McHardy IH, Wu M, Shimizu-Cohen R,
Couturier MR, Humpheries RM. Detection of
intestinal protozoa in the clinical laboratory. J Clin
Microbiol 2014;52:712–20.
- 23. Goka AK, Rolston DD, Mathan VI, Farthing
MJ. The relative merits of faecal and duodenal juice
microscopy in the diagnosis of giardiasis. Trans R
Soc Trop Med Hyg 1990;84:66–7.
- 24. Oberhuber G, Mesteri I, Kopf W, Müller H.
Demonstration of trophozoites of G. lamblia in ileal
mucosal biopsy specimens may reveal giardiasis in
patients with significantly inflamed parasite-free
duodenal mucosa. Am J Surg Pathol 2016;40:1280–
5.
- 25. Laude A, Valot S, Desoubeaux G, Argy N,
Nourrisson C, Pomares C, et al. Is real-time PCRbased diagnosis similar in performance to routine
parasitological examination for the identification
of Giardia intestinalis, Cryptosporidium parvum/
Cryptosporidium hominis and Entamoeba
histolytica from stool samples? Evaluation of a new
commercial multiplex PCR assay and literature
review. Clin Microbiol Infect 2016;22:190.e1-190.
e8.
- 26. Elsafi SH, Al-Maqati TN, Hussein MI, Adam
AA, Hassan MM, Al Zahrani EM. Comparison of
microscopy, rapid immunoassay, and molecular
techniques for the detection of Giardia lamblia
and Cryptosporidium parvum. Parasitol Res
2013;112:1641–6.