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Use of multiplex real-time PCR for detection of common diarrhea causing protozoan parasites in Egypt

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Abstract

Diarrhea is an important cause of morbidity and mortality, worldwide. Giardia intestinalis, Cryptosporidium spp., and Entamoeba histolytica are the most common diarrhea-causing parasitic protozoa. Diagnosis of these parasites is usually performed by microscopy. However, microscopy lacks sensitivity and specificity. Replacing microscopy with more sensitive and specific nucleic acid based methods is hampered by the higher costs, in particular in developing countries. Multiplexing the detection of more than one parasite in a single test by real-time polymerase chain reaction (PCR) has been found to be very effective and would decrease the cost of the test. In the present study, stool samples collected from 396 Egyptian patients complaining of diarrhea along with 202 faecal samples from healthy controls were examined microscopically by direct smear method and after concentration using formol-ethyl acetate. Frozen portions of the same samples were tested by multiplex real-time for simultaneous detection of E. histolytica, G. intestinalis, and Cryptosporidium spp. The results indicate that among diarrheal patients in Egypt G. intestinalis is the most common protozoan parasite, with prevalence rates of 30.5 and 37.1 %, depending on the method used (microscopy vs. multiplex real-time PCR). Cryptosporidium spp. was detected in 1 % of the diarrheal patients by microscopy and in 3 % by real-time PCR. While E. histolytica/dispar was detected in 10.8 % by microscopy, less than one fifth of them (2 %) were found true positive for Entamoeba dispar by real-time PCR. E. histolytica DNA was not detected in any of the diarrheal patients. In comparison with multiplex real-time PCR, microscopy exhibited many false positive and negative cases with the three parasites giving sensitivities and specificities of 100 and 91 % for E. histolytica/dispar, 57.8 and 85.5 % for G. intestinalis, and 33.3 and 100 % for Cryptosporidium spp.

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Acknowledgments

This work was done for partial fulfillment of the MD in Medical Parasitology of John T. Nazeer. John T. Nazeer was financially supported by the Institute for Quality Assurance in Laboratory Medicine “INSTAND e.v.”, Dusseldorf, Germany.

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Authors and Affiliations

  1. Department of Parasitology, Faculty of Medicine, Ain Shams University, Abbassia, 11566, Cairo, Egypt

    John T. Nazeer, Khalifa El Sayed Khalifa, Mahmoud Mohamed El-Sibaei, Magda Youssef Abdel-Hamid & Ranya Ayman Samir Tawfik

  2. Department of Molecular Parasitology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany

    Heidrun von Thien & Egbert Tannich

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  1. John T. Nazeer
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  2. Khalifa El Sayed Khalifa
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Correspondence to Khalifa El Sayed Khalifa.

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Nazeer, J.T., El Sayed Khalifa, K., von Thien, H. et al. Use of multiplex real-time PCR for detection of common diarrhea causing protozoan parasites in Egypt. Parasitol Res 112, 595–601 (2013). https://doi.org/10.1007/s00436-012-3171-8

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