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Burden of major diarrheagenic protozoan parasitic co-infection among amoebic dysentery cases from North East India: a case report



Intestinal diarrheagenic polyparasitic infections are among the major public health concerns in developing countries. Here we examined stool specimens by microscopy, DNA dot blot and polymerase chain reaction (PCR) to evaluate the co-infection of four principal protozoans among amoebic dysentery cases from Northeast Indian population. The multiplex PCR confirmed Entamoeba histolytica (8·1%), Entamoeba dispar (4·8%) and mixed infection of both the parasites (3·4%) in 68 of 356 stool specimens that were positive in microscopy and/or HMe probe based DNA dot blot screening. The prevailing parasite that co-exists with E. histolytica was Giardia duodenalis (34·1%), followed by Enterocytozoon bieneusi (22·0%), Cryptosporidium parvum (14·6%) and Cyclospora cayetanensis (7·3%, P = 0·017). Symptomatic participants (odds ratio (OR) = 4·07; 95% confidence interval (CI) = 1·06, 15·68; P = 0·041), monsoon season (OR = 7·47; 95% CI = 1·40, 39·84; P = 0·046) and participants with family history of parasitic infection (OR = 4·50; 95% CI = 1·16, 17·51; P = 0·030) have significant association with overall co-infection rate. According to molecular consensus, comprehensive microscopy yielded 3·4% (12/356) false-negative and 7·6% (27/356) false-positive outcome, suggesting an improved broad-spectrum PCR-based diagnostic is required to scale down the poor sensitivity and specificity as well as implementation of integrated control strategy.


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* Corresponding author. Department of Biotechnology, Assam University, Silchar 788011, India. E-mail:


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Alyousefi, N. A., Mahdy, M. A., Mahmud, R. and Lim, Y. A. (2011). Factors associated with high prevalence of intestinal protozoan infections among patients in Sana'a City, Yemen. PLoS ONE 6, e22044.
Daniel, W. W. (1999). Biostatistics: A Foundation for Analysis in the Health Science, 7th Edn. John Wiley & Sons, New York, USA.
Elwin, K., Chalmers, R. M., Roberts, R., Guy, E. C. and Casemore, D. P. (2001). Modification of a rapid method for the identification of gene-specific polymorphisms in Cryptosporidium parvum and its application to clinical and epidemiological investigations. Applied and Environmental Microbiology 67, 55815584.
Emile, N., Bosco, N. J. and Karine, B. (2013). Prevalence of intestinal parasitic infections and associated risk factors among Kigali Institute of Education students in Kigali, Rwanda. Tropical Biomedicine 30, 718726.
Feng, Y. and Xiao, L. (2011). Zoonotic potential and molecular epidemiology of Giardia species and giardiasis . Clinical Microbiology Reviews 24, 110140.
Fotedar, R., Stark, D., Beebe, N., Marriot, D., Ellis, J. and Harkness, J. (2007). PCR detection of Entamoeba histolytica, Entamoeba dispar and Entamoeba moshkovskii in stool samples from Sydney, Australia. Journal of Clinical Microbiology 45, 10351037.
Fotedar, R., Stark, D., Marriott, D., Ellis, J. and Harkness, J. (2008). Entamoeba moshkovskii infections in Sydney, Australia. European Journal Clinical Microbiology and Infectious Disease 27, 133137.
Gelaw, A., Anagaw, B., Nigussie, B., Silesh, B., Yirga, A., Alem, M., Endris, M. and Gelaw, B. (2013). Prevalence of intestinal parasitic infections and risk factors among schoolchildren at the University of Gondar Community School, Northwest Ethiopia: a cross-sectional study. BMC Public Health 13, 304.
Gibson, A. K., Raverty, S., Lambourn, D. M., Huggins, J., Magargal, S. L. and Grigg, M. E. (2011). Polyparasitism is associated with increased disease severity in Toxoplasma gondii-infected marine sentinel species. PLoS Neglected Tropical Diseases 5, e1142.
Goodgame, R. (2003). Emerging causes of traveler's diarrhea: Cryptosporidium, Cyclospora, Isospora, and Microsporidia . Current Infectious Disease Reports 5, 6673.
Hamzah, Z., Petmitr, S., Mungthin, M., Leelayoova, S. and Chavalitshewinkoon-Petmitr, P. (2006). Differential detection of Entamoeba histolytica, Entamoeba dispar and Entamoeba moshkovskii by a single-round PCR assay. Journal of Clinical Microbiology 44, 31963200.
Haque, R., Mondal, D., Kirkpatrick, B. D., Akther, S., Farr, B. M., Sack, R. B. and Petri, W. A. Jr. (2003). Epidemiologic and clinical characteristics of acute diarrhea with emphasis on Entamoeba histolytica infections in preschool children in an urban slum of Dhaka, Bangladesh. American Journal of Tropical Medicine and Hygiene 69, 398405.
Herbinger, K. H., Fleischmann, E., Weber, C., Perona, P., Loscher, T. and Bretzel, G. (2011). Epidemiological, clinical, and diagnostic data on intestinal infections with Entamoeba histolytica and Entamoeba dispar among returning travelers. Infection 39, 527535.
Liu, H., Shen, Y., Yin, J., Yuan, Z., Jiang, Y., Xu, Y., Pan, W., Hu, Y. and Cao, J. (2014). Prevalence and genetic characterization of Cryptosporidium, Enterocytozoon, Giardia and Cyclospora in diarrheal outpatients in China. BMC Infectious Diseases 14, 25.
Lopez, A. S., Bendik, J. M., Alliance, J. Y., Roberts, J. M., da Silva, A. J., Moura, I. N., Arrowood, M. J., Eberhard, M. L. and Herwaldt, B. L. (2003). Epidemiology of Cyclospora cayetanensis and other intestinal parasites in a community in Haiti. Journal of Clinical Microbiology 41, 20472054.
Mahbubani, M. H., Bej, A. K., Perlin, M. H., Schaefer, F. W. III, Jakubowski, W. and Atlas, R. M. (1992). Differentiation of Giardia duodenalis from other Giardia spp. by using polymerase chain reaction and gene probes. Journal of Clinical Microbiology 30, 7478.
Mirelman, D., Nuchamowitz, Y. and Stolarsky, T. (1997). Comparison of use of enzyme-linked immunosorbent assay-based kits and PCR amplification of rRNA genes for simultaneous detection of Entamoeba histolytica and E. dispar . Journal of Clinical Microbiology 35, 24052407.
Mirzaei, M. (2007). Prevalence of Cryptosporidium sp. infection in diarrheic and non-diarrheic humans in Iran. Korean Journal of Parasitology 45, 133137.
Nath, J., Banyal, N., Gautam, D. S., Ghosh, S. K., Singha, B. and Paul, J. (2014). Systematic detection and association of Entamoeba species in stool samples from selected sites in India. Epidemiology and Infection 4, 112.
Nguhiu, P. N., Kariuki, H. C., Magambo, J. K., Kimani, G., Mwatha, J. K., Muchiri, E., Dunne, D. W., Vennervald, B. J. and Mkoji, G. M. (2009). Intestinal polyparasitism in a rural Kenyan community. East African Medical Journal 86, 272278.
Ngui, R., Ishak, S., Chuen, C. S., Mahmud, R. and Lim, Y. A. L. (2011). Prevalence and risk factors of intestinal parasitism in rural and remote West Malaysia. PLoS Neglected Tropical Diseases 5, e974.
Ngui, R., Angal, L., Fakhrurrazi, S. A., Lian, Y. L., Ling, L. Y., Ibrahim, J. and Mahmud, R. (2012). Differentiating Entamoeba histolytica, Entamoeba dispar and Entamoeba moshkovskii using nested polymerase chain reaction (PCR) in rural communities in Malaysia. Parasites and Vectors 5, 187.
Noor Azian, M. Y., San, Y. M., Gan, C. C., Yusri, M. Y., Nurulsyamzawaty, Y., Zuhaizam, A. H., Maslawaty, M. N., Norparina, I. and Vythilingam, I. (2007). Prevalence of intestinal protozoa in an aborigine community in Pahang, Malaysia. Tropical Biomedicine 24, 5562.
Parija, S. C. and Khairnar, K. (2005). Entamoeba moshkovskii and Entamoeba dispar-associated infections in Pondicherry, India. Journal of Health, Population and Nutrition 23, 292295.
Pavie, J., Menotti, J., Porcher, R., Donay, J. L., Gallien, S., Sarfati, C., Derouin, F. and Molina, J. M. (2012). Prevalence of opportunistic intestinal parasitic infections among HIV-infected patients with low CD4 cells counts in France in the combination antiretroviral therapy era. International Journal of Infectious Diseases 16, e677e699.
Potters, L. and Van Esbroeck, M. (2010). Negative staining technique of Heine for the detection of Cryptosporidium spp: a fast and simple screening technique. Open Parasitology Journal 4, 14.
Pritt, B. S. and Clark, C. G. (2008). Amebiasis. Mayo Clinic Proceedings 83, 11541159.
Srivastva, S., Bhattacharya, S. and Paul, J. (2005). Species and strain-specific probes derived from repetitive DNA for distinguishing Entamoeba histolytica and Entamoeba dispar . Experimental Parasitology 110, 303308.
Tanyuksel, M. and Petri, W. A. Jr. (2003). Laboratory diagnosis of amebiasis. Clinical Microbiology Reviews 16, 713729.
Tengku, S. A. and Norhayati, M. (2011). Public health and clinical importance of amebiasis in Malaysia: a review. Tropical Biomedicine 28, 194222.
Verweij, J. J., Blange, R. A., Templeton, K., Schinkel, J., Brienen, E. A., van Rooyen, M. A., van Lieshout, L. and Polderman, A. M. (2004). Simultaneous detection of Entamoeba histolytica, Giardia lambia, and Cryptosporidium parvum in fecal samples by using multiplex real-time PCR. Journal of Clinical Microbiology 42, 12201223.
Wegayehu, T., Adamu, H. and Petros, B. (2013). Prevalence of Giardia duodenalis and Cryptosporidium species infections among children and cattle in North Shewa Zone, Ethiopia. BMC Infectious Diseases 13, 419.
WHO/PAHO/UNESCO Report (1997). A consultation with experts on amebiasis, Mexico City, Mexico 28–29 January. Epidemiological Bulletin 18, 1314.
World Health Organization (1998). Control of Tropical Diseases. WHO, Geneva, Switzerland.
World Health Organization (2002). Prevention and control of intestinal parasite infections. WHO Technical Report Series 749, Geneva, Switzerland.
Ximenez, C., Moran, P., Rojas, L., Valadez, A. and Gomez, A. (2009). Reassessment of the epidemiology of amebiasis: state of the art. Infection, Genetics and Evolution 9, 10231032.


Burden of major diarrheagenic protozoan parasitic co-infection among amoebic dysentery cases from North East India: a case report



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