Background Major symptoms associated with blastocystosis include diarrhea, abdominal pain, fatigue, constipation, flatulence, urticaria, and skin rash. It may play a significant role in several chronic gastrointestinal illnesses such as irritable bowel syndrome (IBS). Objective The main objective was to identify Blastocystis spp. subtypes (STs) of clinical isolates obtained from three different groups of patients: IBS and non-IBS with and without gastrointestinal tract symptoms. The secondary objective was to evaluate the infectivity and pathogenicity of detected STs from each group in experimental rats. Patients and methods This study was designed as a case-control study. Stool samples were collected from patients attending Suez Canal University Hospitals. Only positive samples for Blastocystis spp. were included in the study and the three groups were identified (19 patients each). Blastocystis spp. STs were identified using seven pairs of primers (SB83, SB155, SB227, SB332, SB340, SB336, and SB337) to explore the relationship of different STs with different clinical presentations of each group. Detected STs, from each group, were then used to evaluate the infectivity and pathogenicity in experimentally infected rats monitored by parasitological and histopathological parameters. Results STs using seven different sequence-tagged site primers revealed 54 isolates with single infection and three isolates with mixed infection. ST3 was the most common one in the present sample of Egyptian population (56.1%) followed by ST1 (35.1%), then ST2 (3.5%), whereas 5.3% were mixed infection (ST1 and ST3). Conclusion Our results showed that the clinical outcome of blastocystosis is not likely associated with a specific ST, although some STs are predominant in other epidemiologic studies.

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Background Trichomoniasis is a sexually transmitted disease (STD) caused by the protozoan Trichomonas vaginalis. This infection is the most prevalent nonviral STD and may be symptomatic or asymptomatic. Accurate diagnosis is therefore necessary for specific treatment to facilitate control of infection and to prevent complication. Objectives The aim of the study was to evaluate different techniques for diagnosing trichomoniasis in symptomatic and asymptomatic patients. Patients and methods The present study included 85 nonpregnant female patients aged 18-50 years. According to the presence of symptoms related to vaginitis (discharge, itching, dysuria, dyspareunia, lower abdominal pain, and backache), patients were divided into two groups (symptomatic and asymptomatic). Vaginal samples were examined by wet mount, Giemsa stain, acridine orange stain (AO), and culture on modified diamond media in addition to PCR. Results The detection rate of T. vaginalis infection was 27.1, 28.2, 30.6, 35.3, and 57.1% using Giemsa stain, wet mount, AO, culture, and PCR, respectively. Giemsa stain, wet mount, and AO stain had a sensitivity of 76.7, 80, and 86.7%, respectively, when compared with culture. PCR detected all patients among the symptomatic and asymptomatic groups when compared with the culture method. The detection rate of T. vaginalis infection in symptomatic and asymptomatic patients by culture and PCR was 38.1 versus 51.8% and 27.3 versus 36.4%, respectively. The infection was commonest in the age range of 18-36 years. Conclusion The high sensitivity and specificity of PCR reported in this study offers a useful rapid screening tool and provides an excellent alternative for definitive laboratory diagnosis of T. vaginalis, particularly in asymptomatic patients, thus reducing spread and transmission of the infection as well as minimizing the complication sequels.

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Background Cestode tegument is the barrier that separates the parasite from the host, allowing it to develop and survive the hostile environment of the host. It is the only site for nutrient intake. Objective The present study was conducted to reveal the fine structural transformation of the tegument of Taenia pisiformis cysticerci (Cysticercus pisiformis) during development from egg to cysticercus stages. Materials and methods The present study records the development of C. pisiformis in experimentally infected domestic rabbits, with special emphasis on the ultrastructural variations within different stages of larval development using both scanning (SEM) and transmission (TEM) electron microscopes. Results Three to six days postinfection, the early developed scolex appeared as an invaginated thickening at the anterior end of the developed metacestode. The first development of the rostellar hooks and invagination canal was observed 1 week postinfection (PI), where the hooks appeared as minute conical bodies. Complete development of the invagination canal and hook crown was observed 2 weeks later, synchronizing with the onset of sucker differentiation. Fine structural transformation of the tegument included variations in the structure of microtriches (length, density, and shape); distal cytoplasm and parenchymal vesicles and inclusion bodies (size, shape, distribution, and electron density); and tegumental and parenchymal muscles (thickness, orientation, and distribution). Conclusion The tegument of different developmental stages of T. pisiformis cysticerci has the same basic pattern, with some variations in the subcellular structures, which supports the suggestion that T. pisiformis can be used as an experimental model in cysticerci research.

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Background Strongyloides stercoralis is an intestinal nematode that usually causes asymptomatic infection in immunocompetent individuals and reverts to life-threatening hyperinfection in immunocompromised individuals. Objective The aim of the study was to evaluate the effect of ivermectin (IVM) treatment on S. stercoralis larvae in-vitro cultured forms. In-vivo evaluation was performed by assessment of parasitological, histopathological, and ultrastructural changes in the lungs of mice with Strongyloides hyperinfection syndrome before and after treatment with IVM. Materials and methods S. stercoralis larvae were collected from agar plates cultures of positive stool samples from different areas in Menuofyia Governorate. The in-vitro study involved the examination of S. stercoralis larvae grown in agar plates (APC) after exposure for 2 h to IVM (15 μl/ml) by scanning electron microscope (SEM) and after 24 h for larval motility. In-vivo study involved 96 mice that were divided into four groups (24 mice in each). Group GI was immunosuppressed by dexamethasone and infected with S. stercoralis larvae; GII was immunosuppressed then infected and treated by IVM (0.5 mg/kg); GIII was infected with S. stercoralis larvae; and GIV was infected and treated by IVM. Fecal larval output was carried out on 1 ^st , 6 ^th , 11 ^th , and 13 ^th days postinfection (dpi); histopathological examination of the lung was conducted on 2 ^nd , 7 ^th , 12 ^th , and 14 ^th dpi; and lung ultrastructure study by transmission electron microscopy (TEM) was performed on 7 ^th and 14 ^th dpi. Results IVM caused severe destruction of S. stercoralis larvae detected by SEM after 2 h and resulted in their death after 24 h. In-vivo results recorded significant decrease in fecal larval output in the treated groups (GII and GIV) and in GIII in comparison with GI. The latter showed significant continuous increase in fecal larval output throughout the period of study. Histopathological and ultrastructural results showed marked pathological changes in GI that were still evident until the last day of the study. IVM induced mild improvement in lung tissues in GII in comparison with GIV. The latter showed obvious improvement with great preservation of lung tissue. In GIII, mild pathological effect of infection was still evident by the end of study. Conclusion Dexamethasone-immunosuppressed mice infected by S. stercoralis showed intestinal and pulmonary hyperinfection. IVM showed significant improvement of all parameters studied mainly in the immune group and was very effective on motility of S. stercoralis larvae in vitro.

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Background Giardia lamblia trophozoites colonize in the upper small intestine resulting in diarrhea and various clinical manifestations, including abdominal pain, anorexia, and signs of malabsorption. A decrease in the level of trace elements might occur because of this absorption deficiency resulting from giardiasis. Experimentally, the excretory secretory product of G. lamblia trophozoites increased the level of reactive oxygen species in mice enterocytes. The levels of bilirubin, uric acid, and albumin are often used as major nonenzymatic oxidative biomarkers. Objective This study was designed to determine the effect of therapy by metronidazole (MTZ) and artemether (ART) on trophozoite and cyst forms in experimentally Giardia spp.-infected hamsters and to reveal the changes in iron (Fe), manganese (Mn), copper (Cu), and chromium (Cr) serum levels pretreatment and post-treatment. Another objective was to evaluate the impact of this therapy on serum levels of bilirubin, uric acid, and albumin as nonenzymatic oxidative stress biomarkers. Materials and methods Hamsters were divided into four groups: the control group I included two subgroups, Ia (noninfected, nontreated) and Ib (infected, nontreated); group II (infected and treated with MTZ); group III (infected and treated with ART); and group IV (infected and treated with combined therapy of MTZ+ART). Hamsters of all four groups were killed 5 weeks postinfection (PI) - that is, 2 weeks after treatment - to evaluate drug efficacy. Stool samples and duodenal contents were examined to count the number of G. lamblia cysts and trophozoites, respectively. Blood samples were also collected to estimate trace elements (Fe, Mn, Cu, and Cr) as well as nonenzymatic oxidative stress biomarkers (bilirubin, uric acid, and albumin). Results There was a significant reduction in trophozoite and cyst counts following treatment with ART alone (88 and 82.5%, respectively) as compared with the infected control group Ib. Treatment with MTZ alone and in combination with ART also yielded a very high percentage of reduction in both trophozoites (94.2 and 98.3%, respectively) and cysts counts (93.9 and 95.5%, respectively). The trace elements in serum of infected controls (Ib) displayed nonsignificant decrease in Fe and significant decrease in Mn levels as compared with their levels in noninfected hamsters of group Ia. Cu levels increased in the infected group and were still increased after treatment with either MTZ or ART but decreased to normal with the combined therapy. Cr levels showed no significant change in all groups. Uric acid increased in infected controls as compared with normal controls. Treatment with MTZ or ART alone decreased uric acid levels lower than normal, and the combination of both drugs normalized its levels. Evaluation of serum bilirubin levels in the infected group and in those treated by MTZ and ART alone did not show any statistically significant differences compared with the normal noninfected group. Treatment with the combined therapy yielded even slightly lower insignificant level. Albumin level also did not differ significantly except in the combined regimen where it was lower than the normal range. Conclusion The effect of giardiasis on the changes in the level of trace elements and nonenzymatic oxidative stress biomarkers is relevant in this study. The combined therapy produced significant parasite eradication and normalized the studied parameters with the exception of Mn and albumin levels, which were adversely affected and remained lower than normal. Further studies are needed to evaluate these data in undernourished and chronically infected hamsters.

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Background Cryptosporidium and Cyclospora spp. are worldwide emerging parasites in both immunocompetent and immunocompromised individuals. Objective This study was designed to compare Cryptosporidium and Cyclospora spp. detected in fish with the corresponding species isolated from humans, morphologically and genetically. Detection of any similarity could be considered of potential epidemiological importance. Materials and methods Intestinal contents of 35 Tilapia zillii fish and 50 human stool samples were stained and examined to identify Cryptosporidium and Cyclospora oocysts. Thirty male Swiss albino mice were divided into the control group (I) and the experimental group (II), which was further subdivided into four equal subgroups (IIa, IIb, IIc, and IId), that were infected with fish and human Cryptosporidium and Cyclospora spp., respectively. Two weeks later, all mice were killed; parts of their small intestines were subjected to histopathological examination and processed for transmission electron microscopy (TEM). DNA was extracted from frozen oocysts present in human stool samples and fish intestinal samples, and amplification was performed using specific primers for Cryptosporidium parvum and Cyclospora cayetanensis. Results Cryptosporidium and Cyclospora spp. of both fish and humans detected in mice intestinal sections were morphologically similar by both light and electron microscope. However, failure of DNA amplification of oocysts of both parasites in fish intestinal samples, following application of the specific primers, indicates that fish species were not identical to human species. Conclusion It can be deduced that species identified in fish are apparently not infectious to humans.

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Infection by strongyloides stercoralis is currently recognized as a worldwide health problem, particularly in developing countries. Many cases of S. stercoralis infection may be over-looked if only diagnostic conventional methods are used. Additionally, the failure to detect larvae in a single stool sample does not necessarily indicate the absence of infection due to irregular output of the larvae. Thus, repeated examinations of feces using more sensitive parasitological methods are highly required to confi rm diagnosis. Although, strongyloidiasis is mostly an asymptomatic infection but it is important to detect latent S. stercoralis infection to avoid the possible complications which may occur after administration of immunosuppressive drugs especially for patients in endemic areas who are at risk. Up to date a specifi c and sensitive diagnostic test is lacking.

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