O Wellington, O Chika, O Teslim, O Oladipo, F Adetayo, I Godswill
., gastroenteritis., protozoan intestinal parasitosis
O Wellington, O Chika, O Teslim, O Oladipo, F Adetayo, I Godswill. Cryptosporidium and other Intestinal Protozoans in Children with Diarrhoea in Lagos, Nigeria. The Internet Journal of Tropical Medicine. 2008 Volume 5 Number 2.
As reports of protozoan intestinal parasites in a mega city such as Lagos, Nigeria are scanty and not updated, this study reports the prevalence of intestinal parasites, especially
Diarrhea is a leading cause of morbidity and mortality among young children in low-income countries12 . It is also ranked among the largest numbers of reported notifiable disease in Nigeria 34.
There are various aetiological agents of diarrhoea in endemic areas and these include a wide variety of bacteria, viruses and parasites. The parasitic protozoans responsible for gastroenteritis include:
Watery diarrhea is a characteristic presentations of patients infected with any of the parasitic protozoans such as
Protozoan parasitic pathogens associated with diarrhea has been severally reported in pediatric and non-pediatric patients.45678 This study seeks to update available data and to highlight concurrent gastrointestinal infections involving
Materials And Methods
Study site and population: The study was carried out in Lagos, a mega city in Nigeria. Lagos State is the commercial capital of Nigeria and has an estimated population of approximately 20 million people. The study populations were children less than five years that presented with gastroenteritis in one of the major tertiary health facilities in Lagos. Diarrhea in this study was defined as passing three or more unformed stools within a 24 - hour period. Assent was obtained from the parents or guardian prior to collection of their stools. One hundred and five (105) stool samples were collected from 43 male and 62 female children for the laboratory work-up.
Stool collection and Examination: Fresh stool specimen were collected in clean, grease free universal bottles and examined fresh for vegetative form of parasite by direct microscopy. Macroscopic information of the stool samples namely: consistency, presence/absence of mucus and blood were recorded before processing the stool samples for microscopy. Essentially, fresh stools specimen from diarrheic patients were emulsified in normal saline and also in 5% lugol’s iodine preparation and observed microscopically. In addition, the modified formol-ether stool concentration technique was done for the detection of
Macroscopically, 52 (49.5%) of the stool examined were watery and had mucus; watery (33.3%); watery stool with blood and mucus (12.4%) and watery stool with blood (4.8%). Of the 62 female and 43 male children, 27.4% and 27.9% of them were infected respectively. Parasitic protozoan were detected more in watery stool with mucus, 12/52 (23.0%) compared with watery stool alone, 5 (14.3%). The overall prevalence of parasitic infection was 27.6%.
The highest infection was in the 4–5 age groups (34.9%) and the least was in 0–1 age group (22.7%). The occurrence of protozoan parasites in the children showed that all the age-groups were infected except the < 1 year old that was not infected with
The rate of mortality from diarrhea diseases in the developed countries has decreased, mainly because of better therapy and institution of interventions like good sanitary conditions, and health promotion .15 Nevertheless, acute diarrhea diseases continue to be one of the major causes of morbidity and mortality in the developing world such as Nigeria, where 197 in 1000 children under five die before their fifth birthday when compared with other statistical data from developed countries .16
The most important outcome of the present study is the identification of parasites associated with childhood diarrhea in Lagos, Nigeria. This study has shown a meso-endemic level of parasitic pathogens in pediatrics patients presenting with diarrhea. Belding 17 defined an area as mesoendemic when the parasite rate in infants and children (between 0 – 5 years) is between 10 –49 %. The fairly high incidence of these protozoa infection among the patients correlates with the results obtained by several workers5678910
However, mesoendemicity of an infection in an area indicates the unstable nature of the infection as this situation creates room for spontaneous epidemics of the infection.
The high prevalence of infection among age group (0–5 years) in this study is within the proportion of those reported by Gascon
However, we were unable to ascertain the immune status of the patients who enrolled for the study. The non-determination of the HIV status of our research participants is a limitation of this study as it would have proffered explanations on factors such as immunosuppression due to HIV/AIDs. Nevertheless,
This study therefore has provided current data on enteric parasitic protozoans in Lagos, Nigeria. Our reported prevalence is consistent with other studies in Africa181922 Surprisingly, no intestinal helminthes was found in the stool specimens examined. Another limitation of the study was the non inclusion of bacteriological work-up to assess the level and contribution of Bacteria to childhood diarrhea.
Our findings in the age group studied brings up the burden of disease in children less than 5 years of age and that the detection of
The contribution of the laboratory staff in the hospitals where the samples were collected is appreciated. Particularly, I thank Miss Tenny Egwuatu for her support during the period of sample collection.
Dr. Wellington Oyibo Tropical Diseases Research Laboratory Dept. of Medical Microbiology & Parasitology (rm 308) College of Medicine University of Lagos, Lagos, Nigeria E-mail: firstname.lastname@example.org Tel: 234-8035374004