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Cryptosporidium gastroenteritis in Egyptian children with acute lymphoblastic leukemia: magnitude of the problem

  • Clinical and Epidemiological Study
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Abstract

Purpose

Cryptosporidium species is considered to be an important cause of significant morbidity in immunocompromised individuals. A prospective case–control study of sporadic diarrhea due to Cryptosporidium infection was conducted on children with acute lymphoblastic leukemia (ALL).

Methods

Forty children with ALL on maintenance chemotherapy according to the Berlin–Frankfurt–Munster (BFM-90) protocol and 45 sex- and age-matched controls were studied. The ALL group included 25 patients with acute diarrhea and 15 without diarrhea, and the control group included 30 children with acute diarrhea and 15 without. Collected stool specimens were examined using modified Ziehl–Neelsen (MZN) and modified trichrome stains. Serum Cryptosporidium Parvum immunoglobulin G (IgG) antibodies were detected by enzyme-linked immunosorbent assay.

Results

Cryptosporidium oocysts, pathogenic Gram-negative organisms, Giardia lamblia, and Entamoeba histolytica were identified in the stool samples (fecal specimens) of six (24%), eight (32%), four (16%), and two (8%), respectively, of the 25 patients with ALL and actute diarrhea and in one (3%), two (6.5%), six (20%), and five (16.5%), respectively, of the 30 control patients with diarrhea. Serum IgG antibodies were positive in four of the six ALL patients and in one of the control group patients with Cryptosporidium diarrhea who tested positive for oocysts in the stool. Diarrhea duration and severity were greater in ALL patients with stool-positive Cryptosporidium oocysts than in those with non-Cryptosporidium-positive diarrhea (p < 0.000).

Conclusions

Cryptosporidium infection should be considered in children with ALL presenting with prolonged or severe watery diarrhea during chemotherapy, especially those treated with methotrexate and 6-mercaptopurine. Since Cryptosporidium is not routinely tested for in stool examination, a MZN stain is recommended.

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Acknowledgments

The authors thank all of the patients who participated in our study. We are grateful to Professor El-Rifai, Wael, Professor of Surgery and Cancer Biology, for his help in revising the manuscript.

Conflict of interest

None.

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Authors and Affiliations

  1. Pediatrics, Faculty of Medicine, Ain Shams University, P.B. 11381, Abbassia Square, Cairo, Egypt

    S. M. A. Hassanein

  2. Department of Research and Applications of Supplementary Medicine, National Research Center, Cairo, Egypt

    M. M. S. Abd-El-Latif

  3. Clinical Pathology, Molecular Department of Medical Research Center, Ain Shams University Hospitals Abbassia, Cairo, Egypt

    O. M. Hassanin

  4. Medical Biochemistry Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

    L. M. S. Abd-El-Latif

  5. Parasitology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

    N. I. Ramadan

Authors
  1. S. M. A. Hassanein
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  2. M. M. S. Abd-El-Latif
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  3. O. M. Hassanin
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  4. L. M. S. Abd-El-Latif
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Correspondence to S. M. A. Hassanein.

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Hassanein, S.M.A., Abd-El-Latif, M.M.S., Hassanin, O.M. et al. Cryptosporidium gastroenteritis in Egyptian children with acute lymphoblastic leukemia: magnitude of the problem. Infection 40, 279–284 (2012). https://doi.org/10.1007/s15010-011-0230-5

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  • DOI: https://doi.org/10.1007/s15010-011-0230-5

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