Hajarzadeh R

Kia Eb

Maryam Niyyati

Niyyati M

Rezaeian M

Zahabion F

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   Pak J Med Sci   2009   Vol. 25   No. 1      www.pjms.com.pk   87
Original Article
A SURVEY ON INTESTINAL PARASITIC
INFECTIONS IN PATIENTS REFERRED
TO A HOSPITAL IN TEHRAN
Niyyati M1, Rezaeian M2, Zahabion F3, Hajarzadeh R4, Kia EB5
ABSTRACT
Objectives: To determine the prevalence of parasitic infections in people referred to Kashani
Hospital Tehran during Summar season in 2005.
Methodology: Fecal samples were examined by direct examination, formalin-ether
concentration and staining with Ziehl-Neelsen. To identify Strongyloides stercoralis samples were
cultured on the nutrient agar medium.
Results: In a total of 205 cases examined 29.75% were found infected with at least one parasite.
The rates was as follows: Blastocystis hominis 20.9%, Giardia lamblia 5.36%, Iodamoeba butschelii
0.48%, Dientamoeba fragilis 0.48%, Trichomonas hominis 0.48%, Endolimax nana 0.97%,
Enterobius vermicularis 0.48% and Taenia 0.48%
Conclusion: Results included the significance of Giardia infection in children along with
symptoms. 76.74% of patients with Blastocystis infection have presented with intestinal
symptoms. More research is encouraged to identify the relationship of B. hominis and the
symptoms.
KEY WORD: Intestinal parasite, Giardiasis.
Pak J Med Sci   January - March 2009   Vol. 25   No. 1    87-90
How to cite this article:
Niyyati M, Rezaeian M, Zahabion F, Hajarzadeh R, Kia EB. A survey on intestinal parasitic
infections in patients referred to a Hospital in Tehran. Pak J Med Sci 2009;25(1):87-90.
1. Niyyati M, PhD,
Student of Parasitology,
2. Rezaeian M,
Professor of Parasitology,
3. Zahabion F,
Master Science of Parasitology,
4. Hajarzadeh R,
Master Science of Parasitology,
Kashani Hospital, Iran.
5. Kia EB,
Associated Professor of Parasitology
1-3,5: Department Parasitology and Mycology,
School of Public Health,
Tehran University of Medical Sciences, Tehran – Iran.
Correspondence
Maryam Niyyati
maryamniyati@yahoo.com
   * Received for Publication: December 13, 2007
   * Revision Received: December 17, 2007
   * Revision Accepted: November 16, 2008
INTRODUCTION
Parasites are one of the important casual
agents of gastrointestinal disorders such as
diarrhea, loss of weight, abdominal pain, nau-
sea, vomiting, lack of appetite, abdominal dis-
tention and also sometime mentally related dis-
orders.1 These infections are still a hygienic
problem particularly in developing countries
as well as tropical and sub tropical zones.2
Several factors such as poor hygienic envi-
ronment, poor socioeconomic statues, climate
and overcrowding of people are the major
causes of increasing incidence of parasitic
infections. Differentiation of parasitic agents
is an important step for initiation of tailored
treatment and prevention of these infections.
88  Pak J Med Sci   2009   Vol. 25   No. 1      www.pjms.com.pk
Niyyati M et al.
Therefore, proper hygienic conditions in the
society and diagnosis are important priorities.
Epidemiological surveys carried out in differ-
ent countries have shown that in summer time
the rate of parasitic infestation increases be-
cause of high temperature and more usage of
public water sources which are usually unsafe
in places with poor sanitary condition. So sur-
veys on such infections are necessary for any
control strategy. Hence research priorities in
developing countries include to study status of
intestinal infections.
The aim of this study was to determine the
rate of parasitic infections in people referred
to Kashani Hospital, Tehran, Iran during sum-
mer 2005 in order to help the health authori-
ties for planning prevention and control
program for such infections.
METHODOLOGY
The fecal samples of 205 patients who were
referred to Kashani Hospital, Tehran, Iran
during the summer 2005 were collected for
parasitological examinations. For every patient
a questionnaire was filled including informa-
tion about age, sex, presence of intestinal
symptoms and presenting complaints of the
patients. These samples were transferred to the
Parasitology laboratory, School of Public
Health, Tehran University of Medical
Sciences.
Direct microscopy was performed1 for
detecting parasites ova, protozoal cysts, tro-
phozoite form of protozoa, specially the mo-
tile trophozoites. In the next step, in order to
concentrate the sample, formalin-ether concen-
tration technique was applied according to
Garcia protocol.1 In addition staining with
Ziehl-Neelsen was prepared for coccidial
identification.1
To identify Strongyloides stercoralis, 4gr of
stool was put on the surface of nutrient agar
plate and sealed with parafilm for prevention
of contamination. 48 hour later and for 7 con-
secutive days the plates were scrutinized for
larva or adult form of nematodes.
RESULTS
Overall 205 stool samples were examined,
including 95 (46.34%) male and 110 (53.65%)
female. Of these, 43 (20.97%) were children less
then 12 years old and 162 (79.02%) adults.
A total of 155 individuals had intestinal
symptoms.
According to the results, 61 (29.75%) of the
205 subjects were infected at least with one spe-
cies of intestinal parasites. The rate of infec-
tion with each parasite has been presented in
Table-I. Accordingly, the most prevalent para-
site was Blastocystis hominis (20.97%). Among
43 people infected with this parasite including
8 children and 35 adults, overall 33 patients
(76.74%) had intestinal symptoms (Table-II)
especially abdominal pain and diarrhea.
The second-most prevalent parasite was
Giardia lambila all 11 cases occurred in children
under 12 years old and all also presented with
intestinal disorders.
DISCUSSION
In this study 29.75% of study subjects were
infected with intestinal parasites. There was
no statistical significant correlation between the
infectivity with intestinal parasites either with
gender or age.
Table-I: Rate of infection with each intestinal
parasite in 205 patients referred to Kashani
Hospital in Tehran,  Iran during summer 2005
Parasite Subjects No   %
B. hominis 43 20.97
G. lamblia 11 5.36
I. butschelii 1 0.48
D. fragilis 1 0.48
T. hominis 1 0.48
E. nana 2 0.97
E. vermicularis 1 0.48
Taenia 1 0.48
Total 61 100
   Pak J Med Sci   2009   Vol. 25   No. 1      www.pjms.com.pk   89
Intestinal parasitic infections
Protozoal infections were found to be much
higher than helminthes infestations. This is in
agreement with several studies carried out in
different parts of Iran which showed that in
recent year’s the prevalence of intestinal
helminthes had undergone remarkable de-
crease compared to previous decades.2-6 Indeed
both helminthes and protozoan parasites were
much prevalent as stated by Rezaeian (1986)
who found 53.8% infectivity with intestinal
parasites (18.3% helminthes & 45% protozoan
parasites) in people referred to the school of
Public Health, Tehran Medical University
during 1980 – 1983.7
In the current study all cases of Giardiasis
were found in children. This is in agreement
with other studies1,2 emphasizing the higher
prevalence of this parasite in children and its
association with intestinal disorders in this age
group.
Also B.hominis was found as the most preva-
lent parasite. In the study of Yazici et al(2007)
among 58 food workers in Aydin hospitals of
Turkey similar results were obtained.8 How-
ever, in contrast to the present study Shahbazi
et al reported only 1.6% infectivity with B.
hominis among 755 people from rural areas of
saveh, Markazi Province, Iran.5 This contra-
diction is probably due to the sample groups
which were selected from a community
population in the Shahbazi et al (2006) study,5
while in the present study it was from those
referred to the hospital, most showing clinical
symptoms.
In the current study, among infected people
with B. hominis, 33 individuals (76.74%)
showed clinical symptoms. In the study of
Shazly et al (2005) in 23 patients with clinical
symptoms B. hominis was the only causative
agent.9 In addition, Dogan et al (1998) dem-
onstrated that all 88 patients with B. hominis
had clinical symptoms such as abdominal pain
and lack of appetite.10 Therefore, although the
pathogencity of B. hominis is still controver-
sial.1,11 The findings of our study support the
role of this pathogen as causative agent of in-
testinal clinical symptoms in infected people.
Further studies with larger groups, especially
in infected patients without any other infec-
tious agents will improve our knowledge about
correlation of the infectivity with B. hominis and
accompanying clinical symptoms.
ACKNOWLEDGMENTS
We would like to appreciate Shohreh Farnia
and Fatemeh Tarigi for their kind cooperation.
This study was funded by School of Public
Health, Tehran University of Medical Sciences,
Iran.
REFERENCES
1. Garcia LSH. Diagnostic Medical Parasitology, fourth
edition, ASM Press, 2004.
2. Gharavi MJ, Eslami N. An investigation on the preva-
lence of intestinal parasitic disease between the stu-
dents of Tehran schools. Iran Social Security Med J
2002;4-10.
3. Banai F. Prevalence’s of intestinal parasities in
Ghazvin Province, Iran. Thesis for MSPH Degree in
Medican Parasitology. 2002, School of Public Health,
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south-west of Khuzestan Province, South-west, Iran.
Thesis for MSPH Degree in Medical Parasitology. 2007.
School of Public Health, Tehran University of
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5. Shahbazi AE. Prevalence of intestinal parasites in ru-
ral area of Saveh, Markazi Province. Thesis for MSPH
Degree in Medical Parasitology. 2006, School of Pub-
lic Health, Tehran University of Medical Sciences.
Table-II: Association of intestinal clinical symptoms in 43 patients
infected with Blastocystis hominis
No   %
B.hominis with symptoms 33 76.74
B.hominis without symptoms 10 23.25
Total 43 100
90   Pak J Med Sci   2009   Vol. 25   No. 1      www.pjms.com.pk
Niyyati M et al.
6. Akhavan P. Survey of intestinal parasitic infections
in primary suburbs schools of Tehran (Zone 1) and
effectiveness of zanjabil in treatment of Giardiasis
infected person. Thesis for MSPH Degree in Medical
Parasitology. 2002, School of Public Health, Tehran
University of Medical Sciences.
7. Rezaeian M. Intestinal parasitic survey in Tehran dur-
ing 1980 – 1983. Iranian J Public Health 1986;14:1-4,101.
8. Yazici V, Siriken F, Ertabaklar H, Ertug S. Investiga-
tion of intestinal parasites in food workers in hospi-
tals in Aydin, Turkey. Turkiye Parazitol Derg
2007;31(2):136-8.
9. El-Shazly AM, Abdel-Magied AAM, El-Beshbishi SN,
El-Nahas HA, Fouad MA, Monib MS. Blastocystis
hominis among symptomatic and asymptomatic indi-
viduals in Talkha Center, Dakahlia Governorate,
Egypt. J Egypt Soc Parasitol 2005;35(2):653-66.
10. Dogan N. Prevalence of Blastocystis hominis in Bozan
region. Turkiye Parazitol Derg 1998;22(3):247-50.
11. Kaya S, Cetin ES, Aridogan BC, Arikan S, Demirci M.
Pathogenicity of Blastocystis hominis, A clinical
reevaluation. Turkiye Parazitol Derg
2007;31(3):184-7.
WHO IS ELIGIBLE FOR AUTHORSHIP
The menace of Gift Authorship is spreading fast and the biomedical journal
editors have to take some effective measures to check this menace. As such,
effective January 1st 2009, Pakistan Journal of Medical Sciences as a policy has
decided to ask all authors to include a paragraph in the manuscript enumerat-
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A SURVEY ON INTESTINAL PARASITIC INFECTIONS IN PATIENTS REFERRED TO A HOSPITAL IN TEHRAN

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A SURVEY ON INTESTINAL PARASITIC INFECTIONS IN PATIENTS REFERRED TO A HOSPITAL IN TEHRAN

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