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Coccidian Intestinal Parasites Shamsan et al. Universal Journal of Pharmaceutical Research Available online on 15.9.2019 at http://ujpr.org Universal Journal of Pharmaceutical Research An International Peer Reviewed Journal Open access to Pharmaceutical research This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial Share Alike 4.0 License which permits unrestricted non commercial use, provided the original work is properly cited Volume 4, Issue 4, 2019 RESEARCH ARTICLE COCCIDIAN INTESTINAL PARASITES AMONG CHILDREN IN AL-TORBAH CITY IN YEMEN: IN COUNTRY WITH HIGH INCIDENCE OF MALNUTRITION 1 2 3 4 Emad Najeeb Ali Shamsan , CAO De-ping , Hassan A. Al-Shamahy , Manal Mutaher Ali Al- Hajj , JIANG Bo-fan5, Zhang Yaogang6 1Immunology and Parasitology, Faculty of Medicine, Qinghai University, China. 2Medical Microbiology, Faculty of Medicine, Qinghai University, China. 3Medical Microbiology and Clinical Immunology, Faculty of Medicine and Health Sciences, Sana’a University, Yemen. 4Biology Department, Faculty of Sciences, Sana'a University, Republic of Yemen. 5Pathogen Biology, Faculty of Medicine, Qinghai University, China. 6Pathogen Biology, Faculty of Medicine, Qinghai University, China. ABSTRACT Objective: Diarrhoea is an important cause of malnutrition, morbidity and mortality among children in Yemen. Coccidian parasitic infections are an important cause of diarrhea in children particularly malnutrition and immune-compromised patients, but their investigations are rarely required by the treating physicians in apparently immunocompetent children. This study was aimed to find the prevalence of intestinal coccidian parasites in country with high incidence rate of malnutrition. Methods: Between May 2016 and October 2016, 228 faecal samples from 228 selected school children in Al Turbah city, Taiz governorate, Yemen, aged between 6 and 15 years were examined using wet-mount preparations and formal concentration method then films stained by modified acid-fast staining. Also data of children were collected including demographic data, and sources of water. Findings of positive intestinal coccidian parasites were analyzed in relation with demographic data, and sources of water. Results: The prevalence of Cryptosporidium species, Cyclospora species and Isospora belli were 75.9%, 45.6% and 1.75% respectively. There was significant association between positive of Cryptosporidium species and females (OR=2.1 times, P=0.01), and spring water source (OR=4 times, P=0.04), while there was no significant association between positive of Cryptosporidium species and others factors studied. Also there was no significant association between positive of Cyclospora species and Isospora belli and children sex, age groups, or different sources of water. Conclusion: In conclusion the study highlights the high prevalence of coccidian parasites among immunocompetent school children in Yemen. The clinicians in Yemen need to be aware that coccidian parasites are a potential cause of childhood diarrhea even in immunocompetent children. Keywords: Children, Coccidian, Cryptosporidium, Cyclospora, Isospora, Yemen. Article Info: Received 13 August 2019; Revised 23 August; Accepted 7 September, Available online 15 September 2019 Cite this article- Shamsan ENA, De-ping CAO, Al-Shamahy HA, Al-Hajj MMA, Bo-fan J, Yaogang Z. Coccidian intestinal parasites among children in Al-Torbah city in Yemen: in country with high incidence of malnutrition. Universal Journal of Pharmaceutical Research 2019; 4(4): 25-29. DOI: https://doi.org/10.22270/ujpr.v4i4.301 Address for Correspondence: Prof. Hassan A. Al-Shamahy, Faculty of Medicine and Heath Sciences, Sana'a University, P.O. Box 775 Sana'a, Yemen. Phone: +967-770299847, E-mail: [email protected]. INTRODUCTION system1,2,3. Cryptosporidium and Isospora have been Coccidian is a primary microscopic parasite that infects identified as important and widespread causes of the intestinal system of most human and animal diarrheal disease in both immunocompromised organisms. These organisms are one of the main individuals and those with immunodeficiency causes concerns of doctors, especially with increasing the rate such as acute malnutrition as well as people who move of HIV. Coccidian parasites (Cryptosporidium spp., from a clean environment to a contaminated Isospora belli, and Cyclospora spp.) are the most environment such as tourists so it has been described as common intestinal parasites in immunocompromised traveler disease4,5. Acute or chronic diarrhea patients that can usually lead to fatal acute diarrhea syndromes caused by these parasites are usually while causing moderate and limited gastrointestinal accompanied by weight loss, dehydration, abdominal disorders in individuals with a natural immune pain and malabsorption syndrome in ISSN: 2456-8058 25 CODEN (USA): UJPRA3 Shamsan et al. Universal Journal of Pharmaceutical Research immunocompromised patients6. Chronic diarrhea in lack of sewage, poverty, etc., have been reported to be malnourished children can also increase the incidence associated with coccidian gastrointestinal infections9. of these parasites and mortality in these patients6. Table 4: The prevalence rate of Cyclospora species Coccidiosis diarrhea has been observed with fluid loss in different sex and age of tested children. of 25l/day in infected patients, which can last for Characters Positive OR 95%C χ2 P weeks in immunocompromised patients7. Cyclospora Table 1: The prevalence of coccidian intestinal spp parasites among 228 children in Al-Torbah city in No % Yemen. Sex Coccidian parasites Number % Male n=109 56 51.4 1.5 0.9- 2.7 0.09 Cryptosporidium species 173 75.9 2.6 Cyclospora species 104 45.6 Female 48 40.3 0.6 0.3- 2.7 0.09 Isospora belli 4 1.75 n=119 1.0 Age groups 6-10 years 44 47.8 1.16 0.6- 0.3 0.58 Isospora belli is one of the opportunistic coccidian + n=92 1.9 parasites that affects HIV /AIDS patients, especially in 11-15 years 60 44.1 0.8 0.5- 0.3 0.58 developing countries of Africa, Asia, and Latin n=136 1.4 America with low levels of hygiene. Table 2: The prevalence rate of Cryptosporidium In Yemen, the prevalence of coccidian parasites has species in different sex and age of tested children. not been studied, not among immunocompromised Characters Positive OR 95%CI χ2 P patients as well as children with diarrhea or Cryp spp malnutrition in which the malnutrition rate among No % children in Yemen raised due to the Saudi-Emirati Sex aggression against Yemen10. Male 75 68.8 0.4 0.22- 5.7 0.01 Table 5: The association between Cyclospora n=109 0.8 Female 98 83.3 2.1 1.1-3.9 5.7 0.01 infections and income and water sources for tested n=119 children. 2 Age groups Characters Positive OR 95%CI χ P 6-10 years 72 78.2 1.2 0.6-2.3 0.47 0.48 Cyclospora n=92 No % 11-15 years 101 74.3 0.8 0.4-1.5 0.47 0.48 Income n=136 Low n=83 42 50.6 1.37 0.79-2.3 1.3 0.25 Moderate 62 42.8 0.7 0.4-1.25 1.3 0.25 It is always considered as a neglected parasite and there n=145 is lack of enough investigation, particularly in Water sources Wells n=7 3 42.8 0.8 0.19-4 0.02 0.88 immunocompromised patients, so the previous factors 8 Subterranean 53 46.9 1.1 0.65-1.8 0.15 0.69 lead to underestimate this infection . water n=113 Table 3: The association between Cryptosporidium Rain n=41 16 39 0.72 0.3-1.4 0.87 0.34 species infections and income and water sources for Springs 11 44 0.9 0.4-2.1 0.02 0.86 tested children. n=25 Characters Positive OR 95%CI χ2 P Treatment 1 14.3 0.19 0.02-1.6 2.8 0.09 Cryp spp water n=7 No % wells+ 9 60 1.7 0.6-5.1 1.17 0.29 Income subterranean Low n=83 63 75.9 1.0 0.5-1.8 0.0 0.99 water n=15 Moderate 110 75.8 0.99 0.5-1.8 0.0 0.99 rain+ 11 55 1.5 0.6-38 0.7 0.37 n=145 subterranean Water sources water n=20 Wells n=7 6 85.7 1.9 0.2- 0.3 0.53 16.4 Therefore, it may not be out of context to suggest that Subterranean 87 77 1.1 0.6-2 0.15 0.69 identification of these so-called opportunistic water n=113 pathogens should be an essential part of investigations Rain n=41 33 80.5 1.3 0.5-32 0.5 0.44 for childhood diarrhea, particularly with the rise of Springs 23 92 4 1.0-17 4 0.04 malnutrition rate among children in Yemen which n=25 affect the immune status of the children. With this aim, Treatment 5 71.4 0.78 0.14- 0.07 0.77 water n=7 4.1 this study was conducted to find the prevalence of wells+ 9 60 0.4 0.1-1.3 2.2 0.13 intestinal coccidian parasites among children in subterranean country with high incidence of malnutrition and water n=15 determine some risk factors associated with this rain+ 10 50 0.27 0.1-0.7 8 0.004 infection in Al Turbah city, Taiz governorate, Yemen. subterranean water n=20 SUBJECTS AND METHODS Various risk factors for coccidian parasites such as use The study conducted in the Faculty of Sciences, Taiz of contaminated drinking water, exposure to animals, University, Taiz city, Yemen. Between May 2016 and ISSN: 2456-8058 26 CODEN (USA): UJPRA3 Shamsan et al. Universal Journal of Pharmaceutical Research October 2016, 228 fecal samples from 228 selected than that reported in general population of developing school children in Al Turbah city, Taiz governorate, and developed countries in which the rate of aged between 6 and 15 years were examined.
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