الفهرس 
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Abstract
Diarrheal disease is the second leading cause of death in children under five years old and responsible for killing 1.5 million children annually. Generally, there are around two billion cases of diarrheal illness annually. Diarrhea is defined as the passage of at least three loose or liquid stools per day (or more frequent passage than is normal for the individual). Passing of loose, ”pasty” stools by breastfed babies is not diarrhea. Diarrhea is produced by different bacterial, viral, and parasitic pathogens. In developed countries, the major episodes of diarrhea are due to viral pathogens. In developing countries with poor sanitation and bad hygiene, viral, bacterial and parasitic pathogens are more predominant.
Parasitic infections are generally common worldwide. A wide variety of intestinal protozoa infect GIT of children. E. histolytica, G. lamblia, B. hominis and C. parvum are the most important diarrhea-causing protozoa worldwide.
Infection with E. histolytica occurs worldwide with a marked effect on worldwide general health. After malaria and schistosomiasis, amebiasis is observed as the third most common reason for death due to parasitic diseases, according to the WHO.
The clinical picture of amoebiasis is variable from asymptomatic symptoms to fulminant colitis and peritonitis to extra-intestinal amoebiasis such as an amoebic liver abscess. About only 10% of annual infected patients are symptomatic; 80 to 98% of them have symptoms associated with the intestinal mucosa and the remaining 2 to 20% develop extra-intestinal symptoms.
E. dispar, which is morphologically identical to E. histolytica is a separate non-pathogenic species, gave rise to about 90% of the 500 million new amoebic infections initially possible to happen every year.
Diagnosis of amoebiasis depends mainly on microscopic recognition of the various parasite stages in stool, duodenal fluid, or small intestine biopsy specimens. Other detection approaches as serology and immunodiagnosis or molecular diagnosis are available. Microscopic examination is the best commonly used technique for E. histolytica diagnosis in developing countries; however, microscopy lacks sensitivity but relatively cheap and suitable for resource-limited countries. Microscopic examination cannot differentiate between E. histolytica (pathological) from E. dispar (non- pathological) which has the same morphological features.
This study is a cross-sectional study done on 106 children attending the emergency department of Alexandria University Children’s Hospital with acute diarrhea with or without bloody stool aged from 1 year to 5 years of age, in the period from August 2017 to January 2018 for assessment of the prevalence and characteristics of parasitic infections as one of the causes of diarrhea in children and association between microscopic examination and antigen detection using ELISA in detection of E. histolytica infection in children with acute diarrhea.
All children were assessed by complete history taking and thorough physical examination and laboratory investigations.
Stool samples from all children were referred to MRI laboratory and other external labs. For microscopic stool analysis (wet mounts) by saline and Lugol’s iodine and modified MZN for ( cryptosporidium, cyclospora). ELISA test was done for all samples first for E. histolytica /dispar and positive results were further tested through ELISA test definite for E. histolytica antigen.
Statistical analysis of information accomplished from the present study revealed that parasitic infections were more common in older children with non-educated parents living in rural areas using tanks as water resources with no relation with a different sex. Parasitic infections in children can affect weight and L/H but did not affect HC and BMI. The possibility of parasitic infections in children who’s on exclusive breastfeeding and weaned at the age of six months was low. Parasitic infections can cause diarrhea with soft in consistency and short in duration but not complicated with dehydration. Also, parasitic infections commonly cause abdominal pain, but fever and vomiting were less common. Parasitic infections were considerably related to anemia and leukocytosis but not with thrombocytosis and increasing in CRP level. The occurrence of different intestinal protozoa detected by microscopic wet mount examination among the studied population was studied. B. hominis represented the highest percentage; 27 children (25.5%) followed by E. histolytica was seven children (6.6%), E. coli was six children (6.7%), D. fragilis four children (3.8%) and G.lambila and oxyuris each with only one child (0.9% each). Also as regarding combined infections, it was revealed that B.hominis, E. coli five children (4.7%), B.hominis, D. fragilis three children (2.8%) and B.hominis, Oxyuris only one child (0.9%). By using MZN stain, two children (1.88%) had c. parvum, only one child had cyclospora cayatenensis (0.94%). Comparing the results of the 106 children examined by MRI lab and other labs in diagnosis of E.histolytica/dispar, seven children (6.60%) had positive results of E.histolytica/dispar and 99 children (93.40%) had negative results by MRI lab,18 children (17%) had positive results of E.histolytica/dispar and 88 had (83.00%) had negative results by other labs. Comparing the results of the 106 children examined by ELISA for E.histolytica/dispar and ELISA specific for E.histolytica, three children (2.83%) had positive results and 103 children (97.17%) had negative results by using ELISA for E.histolytica/dispar. And only one child (0.94%) had positive result and 105 children (99.06%) had negative results by ELISA specific for E.histolytica.
Comparing the results of the 106 children examined by ELISA specific for E. histolytica with their results by microscopic examination, it revealed that only one child gave positive concordant results. By the study of the discordant results, six children were positive by microscopic examination and negative by ELISA specific for E. histolytica. Statistical analysis showed a Kappa index of 0.237 indicating fair agreement between both techniques in diagnosing E. histolytica infection.