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Abstract
Infection is still a major cause of death in patients with malignant blood diseases, especially acute leukemias. About 80% of the patients with acute leukemia develop infections during the course of their disease. As the anticancer treatment is taken; the host defenses are altered and the patient readily becomes infected even with non bacterial opportunistic agents like fungi, viruses and protozoa, while the incidence of helminthic infections was uncommon.
Defects in the immune system may be associated with different parasitic infections mainly protozoa such as Toxoplasma gondii, Cryptosporidium parvum, Isospora belli, Microsporidia, Cyclospora cayetanensis, Acanthameba and Trypanosoma and Strongyloides stercora lis as a helminthic infection.
The current study aimed to determine the frequency of some endo and ecto-parasites among children with ALL in relation to controls. The study was carried out in Alexandria University Children’s Hospital at EI-Shatby during one year. It is carried out on one hundred and seventeen children with ALL; they were aged from two to fourteen years. Same number of immunocompetent children was chosen as matched by age and sex to represent the control group, they included 25 children representing the siblings of leukemic cases, and the remaining 92 children were selected from the department of surgery in the same hospital.
Moreover, the study involved twenty four children attending the outpatient clinic for follow up; they terminated their chemotherapeutic course for ALL and were free from illness, all the children were subjected to the following:
1- An Interviewing questionnaire was designed to collect the data from the hospital’s reports and mothers of the target children. It included demographic data such as age, sex, residence, level of education and occupation of their parents, housing conditions regarding crowding index, source of water supply, and the presence of animals. Personal hygiene and habits included data about hand washing before eating and after defecation, washing of raw vegetables and fruits, nail trimming, playing at streets and eating food outdoors. Clinical data about general symptoms such as pain, fever, weakness, difficulty in breathing , difficulty in swallowing, loss of appetite, loss of weight , jaundice ,bleeding ,and bruising and, local GIT symptoms including, vomiting, colic and diarrhea.
2- Stool samples were collected and each sample was exposed to:
A portion of stool sample was used fresh in agar plate culture technique for detection of larvae of Strongyloides stercoralis. A second portion of fresh stool specimen was used to prepare thin smears which stained by Trichrome stain to detect intestinal protozoa and Quick-Hot Gram-Chromotrope stain to detect Microsporidia.Another portion of the stool specimen was preserved in 10% formalin and prepared later by formol ether concentration technique to diagnose intestinal helminth and Cryptosporidium parvum, Cyclospora cayetanensis and Isospora belli oocysts by using the modified Ziehl-Neelsen technique.
3- Urine samples were collected, and the samples were subjected to macroscopical and microscopical examination for detecting Schistosoma hematobium.