Journal of Parasitic Diseases

, Volume 42, Issue 4, pp 630–635 | Cite as

Cryptosporidium infection in chronic kidney disease patients undergoing hemodialysis in Egypt

  • Asmaa M. El-kadyEmail author
  • Yaser Fahmi
  • Mohammed Tolba
  • Abdel-Kader A. Hashim
  • Amal A. Hassan
Original Article


Patients with chronic renal failure are more susceptible to infections due to acquired immunodeficiency caused by uremia. Parasitic infections are one of the significant causes of morbidity and mortality in those patients, So we aimed to assess the prevalence of Cryptosporidium spp. and other protozoan infections in patients undergoing hemodialysis in Qena Governorate, Upper Egypt. The present study took place in Qena University Hospitals, Egypt. Participants were 150 Chronic Kidney Disease (CKD) patients undergoing hemodialysis, and 50 healthy individuals. After questionnaire, three consecutive stool samples from each participant were examined macroscopically and microscopically by different techniques for the presence of different stages of different protozoa. 66% of CKD patients and 26% of the control group were infected with intestinal protozoa. Cryptosporidium spp. were the protozoa with the highest prevalence in cases (40%) and control (6%) with statistical significance (P < 0.05). It was detected only in watery stool samples (P value < 0.05). Residence, age and gender were not significant variables in the prevalence of infection among patients with CKD. In Egypt, few studies had reported the prevalence of Cryptosporidiosis in chronic renal patients. Cryptosporidium infection should be suspected in all cases of prolonged watery diarrhea in CKD patients and stool samples should be examined using special stains as cold modified Ziehl–Neelsen staining for proper diagnosis of Cryptosporidium infections.


Cryptosporidium Hemodialysis Egypt 


Author’s contribution

AME and MMT conceived the idea. YF, AME and MMT collected and examined the samples. All authors contributed to the interpretation of the results, preparation of the manuscript and approval the final version of the manuscript.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.


  1. Abaza SM, Makhlouf LM, El-Shewy KA, El-Moamly AA (1995) Intestinal opportunistic parasites among different groups of Immunocompromised hosts. J Egypt Soc Parasitol 25:713–727PubMedGoogle Scholar
  2. Ali MS, Mahmoud LA, Abaza BE, Ramadan MA (2000) Intestinal spore-forming protozoa among patients suffering from chronic renal failure. J Egypt Soc Parasitol 30:93–100PubMedGoogle Scholar
  3. Ash LR, Orihel TC (1984) Atlas of human parasitology, 2nd edn. American Society of Clinical Pathologists Press, Chicago, pp 3–4Google Scholar
  4. Azami M (2007) Prevalence of cryptosporidium infection in cattle in Isfahan, Iran. J Eukaryot Microbiol 54:100–102CrossRefGoogle Scholar
  5. Azami M, Hejazi S (2010) Cryptosporidium and methods of diagnosis. Isfahan University of Medical Sciences Press, IsfahanGoogle 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 40:797–808PubMedGoogle Scholar
  7. Centers for Disease Control and Prevention (1982) Cryptosporidiosis: an assessment of chemotherapy of males with acquired immune deficiency syndrome (AIDS). MMWR Morb Mortal Wkly Rep 31:589–592Google Scholar
  8. Chonchol M (2006) Neutrophil dysfunction and infection risk in end-stage renal disease. Semin Dial 19:291–296CrossRefGoogle Scholar
  9. El-Nadi N, Taha A (2004) Intestinal parasites detected haemodialysis patients in Sohag University Hospitals. El-Minia Medical Bulletin. 15(2):233–240Google Scholar
  10. Garcia LS (2001) Diagnostic medical parasitology, 4th edn. p 723Google Scholar
  11. Gil F, Barros F, Maxlene J, Macedo Nazaré A, Júnior GE, Carmelino Redoan, Haendel Roseli Busatti, Gomes Maria A, Santos Joseph FG (2013) Prevalence of intestinal parasitism and associated symptomatology among hemodialysis patients. Revista do Instituto de Medicina Tropical de São Paulo 55(2):69–74CrossRefGoogle Scholar
  12. Glorieux G, Schepers E, Pletinck A, Dhondt A, Vanholder R (2013) Review of protein-bound toxins, possibility for blood purification therapy. Blood Purif 35(1):45–50PubMedGoogle Scholar
  13. Hawash YA, Dorgham L, El AMA, Sharaf OF (2015) Prevalence of intestinal protozoa among Saudi patients with chronic renal failure: a case-control study. J Trop Med. CrossRefPubMedPubMedCentralGoogle Scholar
  14. Hunter P, Nichols G (2002) Epidemiology and clinical features of cryptosporidium infection in immunocompromised patients. Clin Microbiol Rev 15:145–154CrossRefGoogle Scholar
  15. Karadag G, Tamer GS, Dervisoglu E (2013) Investigation of intestinal parasites in dialysis patients. Saudi Med J 34:714–718PubMedGoogle Scholar
  16. Kulik RA, Falavigna DLM, Nishi L, Araujo SM (2008) Blastocystis spp. and other intestinal parasites in hemodialysis patients. Braz J Infect Dis 12:338–341CrossRefGoogle Scholar
  17. Ma P, Soave R (1983) Three-step stool examination for cryptosporidiosis in 10 homosexual men with protracted watery diarrhea. J Infect Dis 147(5):824–828CrossRefGoogle Scholar
  18. Mehta P (2002) Laboratory diagnosis of cryptosporidiosis. J Postgrad Med 48(3):217PubMedGoogle Scholar
  19. Melvin DM, and Brooke MM (1982) Centrifugal sedimentation—ether method, pp 103–109. In: Laboratory procedures for the diagnosis of intestinal parasites. Health and human services publication no. 82-8282. U.S. Government Printing Office, Washington, D.CGoogle Scholar
  20. Mohaghegh MA, Jafari R, Ghomashlooyan M, Mirzaei F, Azami M, Falahati M et al (2015) Soil contamination with oocysts of Cryptosporidium spp in Isfahan, Central Iran. Int J Enteric Pathog 3:e29105Google Scholar
  21. Mohammadi-Manesh R, Hosseini-Safa A, Sharafi S et al (2014) Parasites and chronic renal failure. J Renal Inj Prev 3:87–90PubMedPubMedCentralGoogle Scholar
  22. Ocak S, Eskiocak A (2008) The evaluation of immune responses to hepatitis B vaccination in diabetic and non-diabetic haemodialysis patients and the use of tetanus toxoid. Nephrology 13:487–491CrossRefGoogle Scholar
  23. Omrani VFI, Fallahi SH, Rostami A, Siyadatpanah A, Barzgarpour G, Mehravar S, Memari F, Hajialiani F, Joneidi Z (2015) Prevalence of intestinal parasite infections and associated clinical symptoms among patients with end-stage renal disease undergoing hemodialysis. Infection 43(5):537–544CrossRefGoogle Scholar
  24. Seyrafian S, Pestehchian N, Kerdegari M, Yousefi HA, Bastani B (2006) Prevalence rate of cryptosporidium infection in hemodialysis patients in Iran. Hemodial Int 10:375–379CrossRefGoogle Scholar
  25. Tonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok M, McAlister F, Garg AX (2006) Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephrol 17:2034–2047CrossRefGoogle Scholar
  26. Turkcapar N, Kutlay S, Nergizoglu G, Atli T, Duman N (2002) Prevalence of cryptosporidium infection in hemodialysis patients. Nephron 90:344–346CrossRefGoogle Scholar
  27. Ungar BLP (2000) Cryptosporidium. In: Mandell GL, Bennet JE, Dolin R (eds) Principles and practice of infectious diseases, 5edn. Churchill Livingstone, Philadelphia, pp 2903–2912Google Scholar
  28. Zaytoun S, AbdElla OH, Ghweil AA, Hussien SM, Ayoub HA, Taha AM (2013) Prevalence of intestinal parasitosis among male youth in Qena Governorate (Upper Egypt), and its relation to socio-demographic characteristics and some morbidities. Life Sci J 10(3):658–663Google Scholar

Copyright information

© Indian Society for Parasitology 2018

Authors and Affiliations

  1. 1.Department of Medical Parasitology, Faculty of MedicineSouth Valley UniversityQenaEgypt
  2. 2.Department of Medical Parasitology, Faculty of MedicineAssiut UniversityAssiutEgypt
  3. 3.Department of Internal Medicine, Faculty of MedicineSouth Valley UniversityQenaEgypt
  4. 4.Department of Zoology, Faculty of ScienceDamanhour UniversityDamanhûrEgypt

Personalised recommendations