World Journal of Microbiology and Biotechnology

, Volume 31, Issue 8, pp 1251–1258 | Cite as

Simultaneous detection of Entamoeba histolytica/dispar, Giardia duodenalis and cryptosporidia by immunochromatographic assay in stool samples from patients living in the Greater Cairo Region, Egypt

  • Dagmar M. Banisch
  • Ayman El-Badry
  • Jorge V. Klinnert
  • Ralf Ignatius
  • Nadia El-Dib
Original Paper


Gastrointestinal infection due to intestinal parasites is an enormous health problem in developing countries and its reliable diagnosis is demanding. Therefore, this study aimed at evaluating a commercially available immunochromatographic assay (ICA) for the detection of cryptosporidia, Giardia duodenalis, and Entamoeba histolytica/dispar for its usefulness in the Greater Cairo Region, Egypt. Stool samples of 104 patients who presented between October 2012 and March 2013 with gastrointestinal symptoms or for the exclusion of parasites at Kasr-Al-Ainy University Medical School were examined by light microscopy of wet mounts and the triple ICA. Microscopy revealed in 20 % of the patients [95 % confidence interval (CI), 13.5–29.0 %] parasites with Hymenolepis nana, E. histolytica/dispar and Blastocystis hominis being the most frequent ones, but was not able to detect G. duodenalis and cryptosporidia, whereas ICA was positive in 21 % (95 % CI, 14.3–30.0 %) and detected E. histolytica/dispar in 12.5 % (95 % CI, 7.3–20.4 %), cryptosporidia in 6.7 % (95 % CI, 3.1–13.5 %) and G. duodenalis in 15.4 % (95 % CI, 9.6–23.6 %) of the patients. Detection of one or more pathogens was associated with access to water retrieved from a well or pump (p = 0.01). Patients between 20 and 29 years of age (p = 0.08) and patients with symptoms of 5 days or longer (p = 0.07) tended to have a higher risk to be infected than patients of other age groups or with shorter-lasting symptoms. In conclusion, the ICA was easy to perform and timesaving. Importantly, it enabled the detection of cryptosporidia, which cannot be found microscopically in unstained smears, demonstrated a higher sensitivity for the detection of G. duodenalis than microscopy, and was more specific for distinguishing E. histolytica/dispar from apathogenic amoeba.


Entamoeba histolytica/dispar Giardia duodenalis Cryptosporidia Immunochromatographic assay Microscopy Greater Cairo Region Egypt 


  1. Abdel Hameed DM, Elwakil HS, Ahmed MA (2008) A single-step immunochromatographic lateral-flow assay for detection of Giardia lamblia and Cryptosporidium parvum antigens in human fecal samples. J Egypt Soc Parasitol 38:797–804Google Scholar
  2. Abdel-Hafeez EH, Ahmad AK, Ali BA, Moslam FA (2012) Opportunistic parasites among immunosuppressed children in Minia district, Egypt. Korean J Parasitol 50:57–62CrossRefGoogle Scholar
  3. Alyousefi NA, Mahdy MAK, Mahmud R, Lim YAL (2011) Factors associated with high prevalence of intestinal protozoan infections among patients in Sana’a city Yemen. PLoS One 6:1–7CrossRefGoogle Scholar
  4. Antonios SN, Tolba OA, Orthman AA, Saad MA (2010) A preliminary study on the prevalence of parasitic infections in immunocompromised children. J Egypt Soc Parasitol 40:617–630Google Scholar
  5. Badawy AA, Gneidy MR, Ghoniemy AE (2012) Acute diarrhea among military recruits. J Egypt Soc Parasitol 42:309–320CrossRefGoogle Scholar
  6. Baiomy AM, Mohamed KA, Ghannam MA, Shahat SA, Al-Saadawy AS (2010) Opportunistic parasitic infections among immunocompromised Egyptian patients. J Egypt Soc Parasitol 40:97–808Google Scholar
  7. Bhaskar S, Singh S, Sharma M (1996) A single-step immunochromatographic test for the detection of Entamoeba histolytica antigen in stool samples. J Immunol Methods 196:193–198CrossRefGoogle Scholar
  8. Costache CA, Calosi IA, Colosi HA (2009) Immunochromatography versus microscopy for the identification of Giardia lamblia and Cryptosporidium parvum in human feces. Scient Parasit 1–2:26–31Google Scholar
  9. Current WL, Garcia LS (1991) Cryptosporidiosis. Clin Microbiol Rev 4:325–358Google Scholar
  10. Curtale F, Nabil M, El Wakeel A, Shamy MY (1998) Anaemia and intestinal parasitic infections among school age children in Behera Governorate, Egypt. Behera Survey Team. J Trop Pediatr 44:323–328CrossRefGoogle Scholar
  11. Den Hartoq J, Rosenbaum L, Wood Z, Burt D Jr, Petri WA (2013) Diagnosis of multiple enteric protozoan infections by enzyme-linked immunosorbent assay in the Guatemalan highlands. Am J Trop Med Hyg 88:167–171CrossRefGoogle Scholar
  12. El-Hamshary EM, El-Sayed HF, Hussein EM, Rayan HZ, Soliman RH (2008) Comparison of polymerase chain reaction, immunochromatographic assay and staining techniques in diagnosis of Cryptosporidiosis. PUJ 1:77–86Google Scholar
  13. El-Helaly NA, Mona MA, Samar SA (2012) Detection of Cryptosporidium infection among children with diarrhoea. N Y Sci J 5:68–76Google Scholar
  14. El-Kadi MA, Ahmad OD, Shoukry NM (2006) Patients with gastrointestinal complaints due to enteric parasites, with reference to Entamoeba histolytica/dispar as detected by ELISA E. histolytica adhesion in stool. J Egypt Soc Parasitol 36:53–64Google Scholar
  15. El-Moamly AAR, El-Sweify MA (2012) ImmunoCard STAT! cartridge antigen detection assay compared to microplate enzyme immunoassay and modified Kinyoun’s acid-fast staining technique for detection of Cryptosporidium in fecal specimens. Parasitol Res 110:1037–1041CrossRefGoogle Scholar
  16. El-Mohammady H, Mansour A, Shaheen HI, Henien NH, Motawea MS, Rafaat I, Moustafa M, Adip-Messih I, Seben PJ, Young SYN et al (2012) Increase in the detection rate of viral and parasitic enteric pathogens among Egyptian children with acute diarrhoea. J Infect Dev Ctries 6:774–781Google Scholar
  17. El-Naggar SM, El-Bahy MM, Abd Elaziz J, El-Dardiry MA (2006) Detection of protozoal parasites in the stools of diarrhoeic patients using different techniques. J Egypt Soc Parasitol 36:7–22Google Scholar
  18. Elsafi SH, Al-Maqati TN, Hussein MI, Adam AA, Abu Hassan MM, Al Zahrani EM (2013) Comparison of microscopy, rapid immunoassay, and molecular techniques for the detection of Giardia lamblia and Cryptosporidium parvum. Parasitol Res 112:1641–1646CrossRefGoogle Scholar
  19. El-Sherbini GT, Abosdera MM (2013) Risk factors associated with intestinal parasitic infections among children. J Egypt Soc Parasitol 43:287–294CrossRefGoogle Scholar
  20. Fawzi M, El-Sahn AA, Ibrahim HF, Shehata AI (2004) Vegetable-transmitted parasites among inhabitants of El-Prince, Alexandria and its relation to housewives’ knowledge and practices. J Egypt Public Health Assoc 79:13–29Google Scholar
  21. Gaafar RM (2011) Evaluation of enzyme immunoassay techniques for diagnosis of the most common intestinal protozoa in fecal samples. Int J Infect Dis 15:541–544CrossRefGoogle Scholar
  22. Garcia LS, Garcia JP (2006) Detection of Giardia lamblia antigens in human fecal specimens by a solid-phase qualitative immunochromatographic assay. J Clin Microbiol 44:4587–4588CrossRefGoogle Scholar
  23. Goñi P, Martin B, Villacampa M, Garcia A, Seral C, Castillo FJ, Clavel A (2012) Evaluation of an immunochromatographic dip strip test for simultaneous detection of Cryptosporidium spp., Giardia duodenalis, and Entamoeba histolytica antigens in human faecal samples. Eur J Clin Microbiol Infect Dis 31:2077–2082CrossRefGoogle Scholar
  24. Hassanein SM, Abd-El-Latif MM, Hassanin OM, Abd-El-Latif LM, Ramadan NI (2012) Cryptosporidium gastroenteritis in Egyptian children with acute lymphoblastic leukemia: magnitude of the problem. Infection 40:279–284CrossRefGoogle Scholar
  25. Helmy YA, Krücken J, Nöckler K, von Samson-Himmelstjerna G, Zessin K-H (2014) Comparison between two commercially available serological tests and polymerase chain reaction in the diagnosis of Cryptosporidium in animals and diarrhoeic children. Parasitol Res 113:211–216CrossRefGoogle Scholar
  26. Ignatius R, Gahutu JB, Klotz C, Musemakweri A, Aebischer T, Mockenhaupt FP (2014) Detection of Giardia duodenalis assemblage A and B by immunochromatography in stoolsamples from Rwandan children. CMI 20:O783–O785Google Scholar
  27. Mahmud AM, Chappell C, Hossain MM, Habib M, Dupont HL (1995) Risk factors for development of first symptomatic Giardia infection among infants of birth cohort in rural Egypt. Am J Trop Med Hyg 53:84–88Google Scholar
  28. Pawlowski SW, Warren CA, Guerrant R (2009) Diagnosis and treatment of acute or persistent diarrhea. Gastroenterol 136:1874–1886CrossRefGoogle Scholar
  29. Sahagún J, Clavel A, Goñi P, Llorente MT, Castillo FJ, Capilla S, Arias A, Gómez-Lus R (2008) Correlation between the presence of symptoms and the Giardia duodenalis genotype. Eur J Clin Microbiol Infect Dis 27:81–83CrossRefGoogle Scholar
  30. Selim S, Nassef N, Sharaf S, Badra G, Abdel Atty D (2009) Copro-antigen detection versus direct methods for the diagnosis of Giardia lamblia in patients from the National Liver Institute. J Egypt Soc Parasitol 39:575–583Google Scholar
  31. Stark D, Al-Qassab E, Barratt JLN, Stanley K, Roberts T, Marriott D, Harkness J, Ellis JT (2010) Evaluation of multiplex tandem real-time PCR for detection of Cryptosporidium spp., Dientamoeba fragilis, Entamoeba histolytica, and Giardia intestinalis in clinical stool samples. J Clin Microbiol 49:257–262CrossRefGoogle Scholar
  32. Stauffer W, Abd-Alla M, Ravdin JI (2006) Prevalence and incidence of Entamoeba histolytica infection in South-Africa and Egypt. Arch Med Res 37:266–269CrossRefGoogle Scholar
  33. Taha HA, Soliman MI, Banjar SAN (2013) Intestinal parasitic infections among expatriate workers in Al-Madina Al-Munawarah, Kingdom of Saudi Arabia. Trop Biomed 30:78–88Google Scholar
  34. Youssef FG, Mikhail EM, Mansour NS (1989) Intestinal capillariasis in Egypt, a case report. Am J Trop Med Hyg 40:195–196Google Scholar
  35. Zaglool DA, Khodiari YA, Orthman RAM, Farooq MU (2011) Prevalence of intestinal parasites and bacteria among food handlers in a tertiary care hospital. Niger Med J 52:266–270CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Dagmar M. Banisch
    • 1
  • Ayman El-Badry
    • 2
  • Jorge V. Klinnert
    • 3
  • Ralf Ignatius
    • 4
  • Nadia El-Dib
    • 2
  1. 1.Institute of Tropical Medicine and International HealthCharité - Universitätsmedizin BerlinBerlinGermany
  2. 2.Medical Parasitology Department, Kasr Al-Ainy School of MedicineCairo UniversityCairoEgypt
  3. 3.German Embassy ClinicEmbassy of the Federal Republic of GermanyCairoEgypt
  4. 4.Institute of Microbiology and HygieneCharité - Universitätsmedizin BerlinBerlinGermany

Personalised recommendations