Background Some reports are available on the prevalence of opportunistic parasitoses among hemodialysis (HD) patients, yet there is a paucity of data on the association of CD4+ T-cell counts with such infections. Therefore, this study aimed to determine the prevalence of intestinal parasites and Toxoplasma gondii in relation to CD4+ counts among HD patients in Alexandria, Egypt. Methods A comparative cross-sectional study was conducted on 120 HD patients and 100 apparently healthy individuals between December 2014 and January 2016. Data and samples (stool and blood) were collected from the participants after obtaining their informed consent. Stool samples were examined for parasites after concentration and staining, EDTA-blood samples were used for CD4+ counting by flow cytometry, and sera were analyzed for anti- Toxoplasma IgM and IgG antibodies. Results A significantly higher prevalence rate of intestinal parasitoses was found among HD patients compared to apparently healthy individuals (52.5% vs. 12.0%, respectively), with absence of helminths. Cryptosporidium species (32.5%), B. hominis (24.2%) and microsporidia (11.7%) were the most frequent parasites among HD patients, while B. hominis (13.0%), Cryptosporidium species (11.0%) and G. lamblia (4.0%) were the most frequent parasites among their counterparts. Statistically significant differences in parasite infection rates between patients and their counterparts were found for Cryptosporidium species, B. hominis and microsporidia. However, parasite species were not significantly associated with diarrhea. On the other hand, the overall T. gondii seroprevalence rate among HD patients was significantly higher than that among their counterparts (33.3% vs. 8%, respectively). HD patients with CD4+ counts < 200 cells/μl were twice more exposed to intestinal parasitoses compared to those with counts ≥200 cells/μl, but the difference was not statistically significant. However, low CD4+ counts were significantly associated with higher rates of Cryptosporidium species, microsporidia and T. gondii . Conclusions Intestinal parasitoses and T. gondii infection rates are significantly higher among Egyptian HD patients compared to apparently healthy individuals, with Cryptosporidium species, B. hominis , microsporidia and T. gondii being the most frequent parasites. CD4+ counts < 200 cells/μl are significantly associated with Cryptosporidium species, microsporidia and T. gondii among HD patients. ...

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Background: Toxoplasmagondii is a ubiquitous protozoan parasite that is estimated to infect one-third of the world's human population. In the quest for a suitable diagnostic tool for detection of T. gondii antibodies, the rapid immunochromatographic test has been validated versus the enzyme linked immunosorbent assay (ELISA) technique for diagnosing toxoplasmosis among individuals with mental disabilities. Method: A cross-sectional study was carried out in Alexandria governorate, Egypt during the period from December 2015 to May 2016. Blood samples were collected from 188 mental disabled individuals. The first aliquot was tested by the rapid diagnostic test (RDT), the 2nd and 3rd aliquots were tested quantitatively for anti-T. gondiiIgG and IgM antibodies using ELISA test. Results: The seroprevalence of toxoplasmosis based on RDT was 26.6%, it significantly increased to 48.9% by using ELISA. The diagnostic parameters of RDT versus ELISA for IgG were: sensitivity 54.4%, specificity 100%, PPV 100%, NPV 69.6% with a diagnostic efficiency of 77.7%, while for IGM were: sensitivity 29.03%, specificity 100%, PPV 100%, NPV 87.7% and diagnostic efficiency 88.3%. Cohen's kappa coefficient was 0.549 and 0.406 for IgG and IgM respectively indicating good to moderate agreement between the two tests for detecting IgG and poor to fair agreement for IgM. Conclusion: Although RDT is inferior compared to ELISA, its speed, simplicity, low cost, high specificity and its good diagnostic efficiency in detecting IGG make it an important preliminary screening tool for diagnosing toxoplasmosis in remote endemic areas where facilities for ELISA are not available.

Introduction: Concomitant infections with pathogens are common, particularly when there are shared modes of infection or when one pathogen promotes the other. Residence among closed-type care institutions may pose an additional risk of such infections. Mentally challenged patients in rehabilitation centers constitute one of the special needs groups exposed to parasitic infections, including giardiasis. Several studies reported concomitant infection with G. lamblia and H. pylori worldwide and in Egypt; however, the co-existence of these two pathogens among mentally challenged individuals remains unexplored. The present study aimed to study the prevalence and association between G. lamblia and H. pylori among mentally challenged patients in rehabilitation centers in Alexandria, Egypt. Methodology: 200 individuals admitted to four mental rehabilitation centers in the period from June 2013 to January 2014, who guardians gave informed consent, were recruited. Stool samples were collected and subjected to trichrome stain for G. lamblia and to antigen detection for H. pylori. Results: The overall prevalence rates of G. lamblia and H. pylori were 8.5% and 24.0%, respectively. Monoinfection rates were 5.5% for G. lamblia and 21.0% for H. pylori, while concomitant infection with both species was detected in only 3.0% of cases. However, individuals who were H. pylori-positive were about two times more likely to be infected with G. lamblia than those who were H. pylori-negative (12.5% vs. 7.2%). Conclusions: Mentally challenged individuals in Alexandria harbouring H. pylori are about two times more likely to be exposed to G. lamblia. Large-scale studies are recommended to confirm this association.

Background: Waste water may contain pathogenic human and animal excreta-derived microorganisms that can cause infections. Municipal sewage workers are a relevant neglected high-risk population especially in the absence of effective protective equipment and lack of hygienic practices mainly washing hands. Objective: The present study aims to assess the hazards of infection with microorganisms among municipal sewage workers as a neglected population, besides those infections that maybe acquired via sources other than their occupational hazard. Subjects and Methods: A cross-sectional study was conducted on sewage workers from different sectors in Alexandria Governorate, Egypt. Collected stool samples were subjected to the following techniques; Kato-Katz, ether concentration, Jones' Media culture, modified Ziehl-Neelsen, and quick hot Gram-chromotrope staining. Stool samples were also tested for Helicobacter pylori antigen (H. pylori Ag). Serum was separated for detection of viral hepatitis C antibodies (HCV Ab), and HBV surface antigen (HBVs Ag). Results: Out of the 410 examined workers, 289 (70.5%) were infected; among them 111 (38.4%) had mixed infections. It was found that 56.8%, and 31.2% harbored intestinal parasitic infections (IPIs) and H. pylori, respectively; and 12.2% had hepatitis mainly HCV (9.8%). Protozoal infections amounted to 54.6%, and only 5.9% had helminthic infections. Blastocystis spp. was the most prevalent parasite (46.8%) followed by Cryptosporidium spp., Entamoeba histolytica/dispar and Microsporidium spp. (15.6%, 11.7%, and 7.8%, respectively). Almost equal percentages were recorded for single IPI and multiple infections (28.3%and 28,5% respectively). Significantly higher rates of IPIs and H. pylori were observed among workers who were in frequent contact with sewage. Also, IPIs were statistically higher among young workers (<40 years), while hepatitis was significantly more prevalent among those from rural areas. Conclusion: Although almost all the detected microbiological infectious hazards can affect sewage workers via sources other than their occupational hazard, our findings call for the importance of self-protection measures that should be in association with regular medical investigation and treatment. inTRoduCTion Water-borne diseases are associated with lack of safe sanitation practices [1]. Waste water treatment plant (WWTP) workers are obliged to work in harsh and dirty conditions as it is difficult to maintain good hygienic practices and very difficult to avoid accidental contact with sewage [2]. Hazards include chemicals that enter sewage treatment plants as industrial effluents, as well as pathogenic microorganisms found in sewage sludge. Waste water treatment (WWT) results in the generation of aerosols containing chemicals, microorganisms, and solvent vapors [3]. Related symptoms have been reported among sewage workers, including eye and nose irritation, lower airway and skin symptoms, headache, fatigue, and dizziness [4]. An increase in the risk of asthma as well as decreas...