Cryptosporidiosis in Egypt Prevalence Surveys: Year S Region Study Group % Notes Year S Region Study Group % Notes

Cryptosporidiosis in Egypt
Prevalence surveys
Year
Region Study Group % Notes
s
Year
s
13.6% of dairy cattle in four Nile

2013* Nile Delta cattle 13.6
River delta provinces 1
2015
Multiple
- cattle 9.7 9.7% of dairy cattle 2
locations
2016
2015
26% of diarrhea in children
- children 26
below age 12 months
2016
1989* Aswan children 9 9% of children with diarrhea 3
13.9% of malnourished children

with diarrhea, and 5.6% of
2001* Dakahlia children 13.9
controls in Mansoura, Dakahlia
Governorate 4
Delta 14% to 17% in the Nile Delta

2005* children 14-17
Region region 5
15% of children below age 60

2006* Fayoum children 15
months with diarrhea, 6
33.3% of immuno-compromised
2011* Tanta children 33.3
children 7
24% of children with acute

2011* Cairo children 24 lymphoblastic leukemia vs. 3%
of controls 8
60.2% of immunosuppressed
2012* Minia children 60.2
children in Minia District 9
2014* Cairo children 22.4 22.4% of children 10
11.63% of children with

2014* Qalubyia children 11.63
diarrhea 11
30.8% of symptomatic school

2015* children 30.8
children 12
20% of outpatient children ages

2015* Assiut children 20
1 to 6 years 13
2015
Multiple Survey of fecal samples from
- children 1.4
locations children ages <=8 years 14
2016
Survey of symptomatic
2015 Giza children 3.5
children 15
13.2% of children with diarrhea

2016* Cairo children 13.2
vs. 8% of a control group 16
6.1% of soil samples in Dakahlia

2005* Dakahlia environmental - soil 6.1
Governorate 17
0.2% of individuals in Behera

2000 Behera general population 0.2
Governorate
0% to 47% of immunocompetent
1985 general individuals with diarrhea
Multiple
- populationLiteratur 0-47 presenting to inpatient or
locations
2005 e Review outpatient clinics (literature
review) 18
2012
intellectual 23.5% of mentally-handicapped
- Alexandria 23.5
disability individuals in Alexandria 19
2013
2010* juice 61.29 61.29% of fresh fruit juices 20
1985 Alexandria military personnel 5 5% of diarrhea episodes among

Year
s
American military personnel in

Egypt 21
28.16- 59.3% of coins and 28.16% of

2010 Alexandria money
59.3 bank notes 22
14.3% of hospital outpatients in

2006* Mansoura patients 14.3
Mansoura 23
31.1% of patients with

2011* Cairo patients 31.1
diarrhea 24
7% of immunocompromised
2011* Cairo patients 7
patients 25
2012 6.7% of patients with

- Cairo patients 6.7 gastrointestinal symptoms, in
2013 Greater Cairo 26
19.5% of patients with

2015* Nile Delta patients 19.5
diarrhea 27
2015 21% of diarrheic

- Beni-Suef patients 21 immunocompetent patients
2016 (PCR) 28
Survey of patients with

2016* Zagazig patients 19.8
"gastrointestinal troubles" 29
5% of diabetics and 0% of
2015* Sohag patients - diabetes 5
controls 30
30% of patients with chronic

patients - liver
2014* Mansoura 30 liver disease vs. 14% of
disease
controls 31
Kafr El 1.29% of buffalo, 7.07% of

2014* ruminants 1.29-7.07
Sheikh cattle and 2.50% of sheep 32
2016* Aswan schoolchildren 1.7 33
New
2016* schoolchildren 0.09 34
Valley
2008 5.1% of stool specimens

- Cairo specimens - stool 5.1 (Cryptosporidium hominis and C.
2009 parvum) 35
5% of stool specimens tested for

2010 Alexandria specimens - stool 5
parasites 36
49.1% of diarrheic children ages

2012* Ismailia various 32.2-49.1 <10 years and 32.2% of
ruminants 37
9.33% of humans and 5.38% of

2013 Sharkia various 5.38-9.33
dogs 38
19% of humans, 10.2% of cattle

2014 Beni-Suef various 10.2-19
and 12.3% of buffaloes 39
49.1% of children with diarrhea

2014* Ismailia various 32.3-73.3 and 32.3% of cattle and buffalo,
and 73.3% of herds 40
34% of dogs and 35% of

2018* Sharkia various 34-35 children ages 2 to 12
(microscopy) 41
23.4% of municipality solid

2015* Alexandria waste collectors 23.4
waste workers in Alexandria 42
2007* Dakahlia water 3.1 3.1% of surface water samples 43
Giardia
lamblia and Cryptosporidiumwere
2012* Alexandria water 10
found in 10% of swimming pools
in Alexandria 44
2012* water buffalo 3.2 3.2% of water buffalo 45

* indicates publication year (not necessarily year of survey)
Seroprevalence surveys
Year Study
Region % Notes
s Group
Southern 35.9% of cattle in southern

2016* cattle 35.9
Region Egypt 46
* indicates publication year (not necessarily year of survey)
List of all refereReferences for Cryptosporidiosis in Egypt
1 Prevalence and characterization of Cryptosporidium spp. in dairy cattle in Nile River delta
provinces, Egypt. Close
Exp Parasitol 2013 Nov ;135(3):518-23.
Author(s):
Amer S, Zidan S, Adamu H, Ye J, Roellig D, Xiao L, Feng Y
Abstract:
Molecular characterizations of Cryptosporidium spp. in dairy cattle in industrialized nations have

mostly shown a dominance of Cryptosporidium parvum, especially its IIa subtypes in pre-weaned
calves. Few studies, however, have been conducted on the distribution of Cryptosporidium species
and C. parvum subtypes in various age groups of dairy cattle in developing countries. In this study,
we examined the prevalence and molecular characteristics of Cryptosporidium in dairy cattle in four
Nile River delta provinces in Egypt. Modified Ziehl-Neelsen acid-fast microscopy was used to screen
for Cryptosporidium oocysts in 1974 fecal specimens from animals of different ages on 12 farms.
Positive fecal specimens were identified from all studied farms with an overall prevalence of 13.6%.
By age group, the infection rates were 12.5% in pre-weaned calves, 10.4% in post-weaned calves,
22.1% in heifers, and 10.7% in adults. PCR-RFLP and DNA sequence analyses of microscopy-
positive fecal specimens revealed the presence of four major Cryptosporidium species. In pre-
weaned calves, C. parvum was most common (30/69 or 43.5%), but Cryptosporidium ryanae
(13/69 or 18.8%), Cryptosporidium bovis (7/69 or 10.2%), and Cryptosporidium andersoni (7/69
or 10.2%) were also present at much higher frequencies seen in most industrialized nations. Mixed
infections were seen in 12/69 (17.4%) of genotyped specimens. In contrast, C. andersoni was the
dominant species (193/195 or 99.0%) in post-weaned calves and older animals. Subtyping of C.
parvum based on sequence analysis of the 60kDa glycoprotein gene showed the presence of
subtypes IIdA20G1 in nine specimens, IIaA15G1R1 in 27 specimens, and a rare subtype
IIaA14G1R1r1b in one specimen. The common occurrence of non-C. parvum species and IId
subtypes in pre-weaned calves is a distinct feature of cryptosporidiosis transmission in dairy cattle
in Egypt. The finding of the same two dominant IIa and IId C. parvum subtypes recently found in
humans in Egypt suggests calves can be potential reservoirs of zoonotic cryptosporidiosis.
[Click here to see the PubMed abstract]
2 Age patterns of Cryptosporidium species and Giardia duodenalis in dairy calves in Egypt.
Close
Parasitol Int 2018 Jul 25;
Author(s):
Naguib D, El-Gohary AH, Mohamed AA, Roellig DM, Arafat N, Xiao L
Abstract:
Little is known of the occurrence and age patterns of species/genotypes and subtypes of
Cryptosporidium spp. and Giardia duodenalis in calves in Egypt. In this study, 248 fecal specimens
were collected from dairy calves aged 1 day to 6 months on eight farms in three provinces during
March 2015 to April 2016. Cryptosporidium spp. were detected and genotyped by using PCR-RFLP
analysis of the small subunit rRNA (SSU rRNA) gene, while G. duodenalis was detected and
genotyped by using PCR and sequence analyses of the triose phosphate isomerase (tpi), glutamate
dehydrogenase (gdh) and β-giardin (bg) genes. The overall infection rates of Cryptosporidium spp.
and G. duodenalis were 9.7 and 13.3%, respectively. The highest Cryptosporidium infection rate
(26.7%) was in calves of age ≤ 1 month while the highest G. duodenalis infection rate (44.4%) was
in calves of 2 months. Three Cryptosporidium spp. were identified, including C. parvum (n = 16), C.
bovis (n = 5) and C. ryanae (n = 3), with the former being almost exclusively found in calves of
≤3 months of age and the latter two being only found in calves of over 3 months. Subtyping of C.
parvum by PCR-sequence analysis of the 60 kDa glycoprotein gene identified subtypes IIaA15G1R1
(n = 15) and IIaA15G2R1 (n = 1). The G. duodenalis identified included both assemblages E (n = 32)
and A (n = 1), with the latter belonging to the anthroponotic subtype A2. These data provide new
insights into the genetic diversity and age patterns of Cryptosporidium spp. and G. duodenalis in
calves in Egypt.
3 Microbiologic and clinical study of acute diarrhea in children in Aswan, Egypt. Close
Scand J Infect Dis 1989 ;21(1):59-65.
Author(s):
Mikhail IA, Hyams KC, Podgore JK, Haberberger RL, Boghdadi AM, Mansour NS, Woody JN
Abstract:
Children with diarrhea presenting to a Government Rehydration Center in Aswan, Egypt, were
investigated to determine the etiology and clinical presentation of acute childhood diarrhea in
southern Egypt. Among 126 outpatients and 25 inpatients with diarrhea (mean age 18 months),
enterotoxigenic Escherichia coli (ETEC) (17% of cases), Cryptosporidium (9%), Salmonella spp.
(7%), Campylobacter jejuni/coli (7%), and Shigella spp. (5%) were the most common
enteropathogens identified during the high incidence season of July. Enteropathogens were isolated
as often from inpatients as outpatients, except for Salmonella spp. and Cryptosporidium, which
were recovered more often from inpatients. Salmonella-infected children, in particular, were more
ill, feverish, and dehydrated on presentation than other children, resulting in more frequent
hospitalization. Except for Salmonella-infected children, children with acute diarrhea usually
presented without severe dehydration, which may have been due to frequent initiation of oral
rehydration therapy (ORT) by mothers trained by local health care providers. A potential
environmental source of ETEC was identified in clay water storage containers commonly used in this
area.
4 Coccidiosis among malnourished children in Mansoura, Dakahlia Governorate, Egypt. Close
J Egypt Soc Parasitol 2001 Dec ;31(3):877-86.
Author(s):
Rizk H, Soliman M
Abstract:
Stool samples of 36 malnourished and 36 healthy control children were examined for oocysts of
Cryptosporidium parvum, Cyclospora cayetanensis, Isospora belli and Microsporidium. C. parvum
infection (single and mixed) was detected in 13.9% and 5.6% in malnourished and control children
respectively. C. cayetanensis oocysts were detected in 5.6% malnourished children and in 2.8% of
control group. I. belli oocysts were detected only in malnourished children 2.8%. On the other hand,
no Microsporidium oocysts were detected in both malnourished and control children.
5 Diarrhea associated with Cryptosporidium parvum among young children of the Nile River Delta in
Egypt. Close
J Trop Pediatr 2005 Jun ;51(3):154-9.
Author(s):
Abdel-Messih IA, Wierzba TF, Abu-Elyazeed R, Ibrahim AF, Ahmed SF, Kamal K, Sanders J, Frenck R
Abstract:
Over a 2-year period, the prevalence and clinical characteristics of Cryptosporidium-associated

diarrhea in the Nile River Delta of Egypt was studied. A stool sample was obtained from children
with diarrhea attending one of two study hospitals and of the 1275 children evaluated, 214 (17%)
were found to be infected with Cryptosporidium. Younger age was a risk factor for developing
Cryptosporidium-associated diarrhea. Children <12 months of age were 2.4 times more likely to be
infected with Cryptosporidium (p<0.01) and children 12 to 23 months were 1.9 (p<0.05) times
more likely to be infected with the organism as compared to older children. Breastfeeding had a
trend towards protection against Cryptosporidium-associated diarrhea (p=0.07). Clinical findings
associated with Cryptosporidium diarrhea included vomiting, persistent diarrhea and the need for
hospitalization. Our data suggest that Cryptosporidium is common in Egyptian children and may be
associated with severe diarrhea.
6 Enteric pathogens associated with diarrhea in children in Fayoum, Egypt. Close

Diagn Microbiol Infect Dis 2006 Sep ;56(1):1-5.
Author(s):
El-Mohamady H, Abdel-Messih IA, Youssef FG, Said M, Farag H, Shaheen HI, Rockabrand DM, Luby
SB, Hajjeh R, Sanders JW, Monteville MR, Klena JD, Frenck RW
Abstract:
In a cross-sectional study of children <60 months old from Fayoum, Egypt, presenting with
diarrhea, 46% (162/356) had detectable enteric pathogens. Bacterial pathogens were identified in
25% (89/356), whereas rotavirus and Cryptosporidium were detected in 21% (54/253) and 15%
(39/253), respectively. Cryptosporidium is an important pathogen in this region.
7 A preliminary study on the prevalence of parasitic infections in immunocompromised children.

Close
Author(s):
Antonios SN, Tolba OA, Othman AA, Saad MA
Abstract:
Parasitic infections might become life threatening in immuno-compromised children' The study
assessed the parasites' prevalence in different groups of immuno-compromised children. It was
conducted on 120 children of whom 90 were inpatients in Tanta University Pediatric Hospital and
were divided into 6 groups. GI: malignant diseases, GII: renal diseases, GIII: aggressive
corticosteroid therapy, GIV: malnourished, GV: diabetic & GVI: miscellaneous. GVII comprised
healthy children as control. Each child was subjected to history taking, clinical examination and
examination of 3 stool samples by direct wet smear and a concentration technique. Coproculture
and smear staining by a special stain, as well as examination of one blood sample for anti-
Toxoplasma antibodies were done. The diagnostic efficacy of an immuno-chromatographic test for
Giardia/ Cryptosporidium coproantigen was also assessed. The results revealed parasitic infections
in 62.2% of the children in the test groups. Cryptosporidium was the most prevalent (33.3%).
Cryptosporidium and Microsporidia were significantly prevalent in GI, Giardia was significantly high
in GII, and Strongyloides stercoralis was detected in GIII. Coproantigen detection test showed
100% sensitivity, 87.5% specificity and 95% accuracy for Giardia; and 13.3%, 100%, 35% for
Cryptosporidium respectively.
8 Cryptosporidium gastroenteritis in Egyptian children with acute lymphoblastic leukemia:

magnitude of the problem. Close
Infection 2012 Jun ;40(3):279-84.
Author(s):
Hassanein SM, Abd-El-Latif MM, Hassanin OM, Abd-El-Latif LM, Ramadan NI
Abstract:
Cryptosporidium infection should be considered in children with ALL presenting with prolonged or
severe watery diarrhea during chemotherapy, especially those treated with methotrexate and 6-
mercaptopurine. Since Cryptosporidium is not routinely tested for in stool examination, a MZN stain
is recommended.
9 Opportunistic parasites among immunosuppressed children in Minia District, Egypt. Close
Korean J Parasitol 2012 Mar ;50(1):57-62.
Author(s):
Abdel-Hafeez EH, Ahmad AK, Ali BA, Moslam FA
Abstract:
A total of 450 stool samples were collected from inpatient and outpatient clinics of Pediatric
Department, Minia University Hospital, Minia District, Egypt. Two groups of patients were studied,
including 200 immunosuppressed and 250 immunocompetent children. Stool samples were
subjected to wet saline and iodine mounts. A concentration technique (formol-ether sedimentation
method) was carried out for stool samples diagnosed negative by wet saline and iodine mounts.
Samples were stained by 2 different methods; acid fast stain (modified Ziehl-Neelsen stain) and
Giemsa stain. Total 188 cases (94%) were diagnosed positive for parasitic infections among
immunosuppressed children, whereas 150 cases (60%) were positive in immunocompetent children
(P<0.0001). The most common protozoan infection in immunosuppressed group was
Cryptosporidium parvum (60.2%), followed by Blastocystis hominis (12.1%), Isospora belli (9.7%),
and Cyclospora caytenensis (7.8%). On the other hand, Entamoeba histolytica (24.6%) and Giardia
lamblia (17.6%) were more common than other protozoans in immunocompetent children.
10 Molecular copro-prevalence of Cryptosporidium in Egyptian children and evaluation of three

diagnostic methods. Close
Indian Pediatr 2014 Sep ;51(9):727-9.
Author(s):
Fathy MM, Abdelrazek NM, Hassan FA, El-Badry AA
Abstract:
Cryptosporidium is a common cause of diarrhea in children in Egypt.
11 Predominance of Cryptosporidium parvum genotype among diarrheic children from Egypt as an

indicator for zoonotic transmission. Close
Acta Parasitol 2014 Mar ;60(1):26-34.
Author(s):
Eraky MA, El-Hamshary AM, Hamadto HH, Abdallah KF, Abdel-Hafed WM, Abdel-Had S
Abstract:
Cryptosporidium is a genus of zoonotic pathogens transmissible from a variety of animals to

humans and is a considerable public health concern. It is a significant cause of diarrheal disease in
developing and industrialized nations. Cryptosporidium parvum and Cryptosporidium hominis are
the main agents of cryptosporidiosis in humans. In this study we identified the genotypes of the
Cryptosporidium isolates from clinical samples from diarrheic children using polymerase chain
reaction (PCR) amplification and restriction fragment length polymorphism (RFLP) analyses of the
TRAP-C2 gene (Thrompodin Related Adhesive Protein). A total of 430 fecal specimens from 1 to 14
years children were collected from inpatient and outpatient clinics of Benha University, Educational
and Children Specialized Hospitals, Benha, Qalubyia, and were microscopically examined for
Cryptosporidium spp. All infected samples were also analyzed using nested PCR. A polymerase chain
reaction (PCR)-restriction fragment length polymorphism (RFLP) analysis of the (266-366 bp) of
TRAP-C2 gene was also used to detect and identify Cryptosporidium spp. in PCR- positive samples.
The results showed that 50 (11.63%) of the specimens were positive for Cryptosporidium spp.
Genomic amplification and restriction digestion of the PCR products by BstETI, Hae III for TRAP-C2
gene restriction enzymes revealed that 82% (41/50) had C. parvum, 12% (6/50) had C. hominis,
and three (3/50) samples (6%) had mixed infections. In conclusion, elevated prevalence of C.
parvum, suggesting animal-human (zoonotic) transmission and further investigations are required
to determine the subgenotypes of C. parvum to clarify the mode of transmission in order to improve
the control measures.
12 Cryptosporidium parvum infection among Egyptian school children. Close
J Egypt Soc Parasitol 2015 Apr ;45(1):125-31.
Author(s):
Shalaby NM, Shalaby NM
Abstract:
The present study determined cryptosporidiosis among 120 randomly chosen school children aged
4-16 years. Medical sheets were filled out on each child. The fresh stool samples were examined by
using Sheather's sugar flotation stained with modified Ziehl Neelsen stain. Blood samples were
examined by ELISA and IFA techniques. The results revealed that, the prevalence rate was 13.51%
with a peak among the age group (5-10) and. significant relation between males and females. There
was a significant relation between infection and low socio-economic level in rural area. Also, a
significant relation was obtained between the infection and the presence of animal contact. Watery
and loose diarrhea was more significant among infected children. Positive stool samples were
among 37 (30.8 %), while ELISA and IFA detected 30 (25%) and 33 (27.5%) respectively. The
validity test of ELISA declared sensitivity and specificity with 93.3% and 90% while IFA declared
90.9% and 91.1% respectively.
13 Effect of enteric parasitic infection on serum trace elements and nutritional status in upper
Egyptian children. Close
Trop Parasitol 2015 Jan-Jun;5(1):29-35.
Author(s):
Yones DA, Galal LA, Abdallah AM, Zaghlol KS
Abstract:
Coincident decrease in serum Zn level and an increase of serum Cu was more prominent among G.
lamblia and Cryptosporidium sp. patients. G. lamblia and Cryptosporidium sp. were found to be
more associated with nonstandard children nutritional status beside to an altered micronutrient
level.
14 Molecular characterization of Cryptosporidium spp. and Giardia duodenalis in children in Egypt.

Close
Parasit Vectors 2018 Jul 11;11(1):403.
Author(s):
Naguib D, El-Gohary AH, Roellig D, Mohamed AA, Arafat N, Wang Y, Feng Y, Xiao L
Abstract:
Data from this study are useful in our understanding of the genetic diversity of Cryptosporidium
spp. and G. duodenalis in Egypt and the potential importance of anthroponotic transmission in the
epidemiology of both pathogens.
15 Evaluation of primitive ground water supplies as a risk factor for the development of major
waterborne zoonosis in Egyptian children living in rural areas. Close
J Infect Public Health 2018 Mar - Apr;11(2):203-208.
Author(s):
Elfadaly HA, Hassanain NA, Hassanain MA, Barakat AM, Shaapan RM
Abstract:
The results confirm human biohazards through rural individual water supplies and reflect the need
for public health education regarding the correct use of drinking ground water only after effective
treatment through filtration and/or boiling.
16 COPRO-MOLECULAR CHARACTERIZATION OF CRYPTOSPORIDIUM SPP. AND GENOTYPES AMONG

EGYPTIAN CHILDREN. Close
J Egypt Soc Parasitol 2016 Aug ;46(2):375-386.
Author(s):
Abdelrazek NM, Al-Antably ASA, Fathy MM, El-Badry AA
Abstract:
Stool samples from 182 diarrhoeic (symptomatic) children and 100 apparently healthy
(asymptomatic) children, matched for age, from Aboul-Reesh Cairo University Pediatrics Hospital
were examined by ELISA and by nPCR (targeting COWP gene) for the detection of Cryptosporidium.
The demographic and environmental data of the diarrhoeic group was recorded. The PCR amplified
product of positive cases was then subjected to RFLP by digesting it with the restriction enzyme
RsaI. The obtained fragments were resolved by electrophoresis and the bands were visualized and
characterized versus a standard. ELISA results demonstrated a prevalence rate of 13.2% (24/182)
among diarrhoeic group, and 8% (8/100) among non-diarrheic group, with overall detection rate of
11.3% (32/282). Higher rates of detection were obtained by nested PCR assay among diarrhoeic
group 25.8% (47/182) and 16% (16/100) among non-diarrhoeic group with overall detection rate
of 22.3% (63/282). Considering nPCR as the reference method, ELISA had a sensitivity of 47.6%
and a specificity of 99.1%. RsaI digestion of nPCR product of COWP gene revealed the presence of 2
genotypes: genotype 1 with 4 bands (34, 106, 125 and 285) and genotype 2 in which 3 bands (34,
106 and 401). Among the 63 cases with cryptosporidiosis, 53 (88.3%) had genotype 1, and 7
(11.7%) had genotype 2. The higher prevalence of genotype 1 suggests a relatively greater risk of
human source of infection than zoonosis.
17 Geoparasites in rural Dakahlia Governorate, a preliminary based study for development of the
community-based intervention programs. Close
Author(s):
el-Beshbishi SN, Abdel-Magied AA, el-Nahas HA, Azab MS, el-Shazly AM, Morsy AT, Gamal-Edin MK,
el-Kadi MA
Abstract:
A prospective study was carried out to detect the rural prevalence and intensity of geoparasites in
Dakahlia Governorate, Egypt. A total of 1070 soil samples were collected; 571 (53.4%) were
infected with one or more parasites. Only 24% of samples were infected with one parasite, 16.4%
and 13% with two, and more than two parasites respectively, and the difference was statistically
significant. The geoparasites in a descending order of their prevalence were: E. histolytica cysts
(9.2%), Toxocara eggs (9.1%), Giardia cysts (7.9%), Cryptosporidium oocysts (6.1%),
Trichostrongylus eggs and larvae (5.6%), Isospora oocysts (4.3%), Acanathamoeba cysts (4.1%),
Naegleria cysts (3.6%), Dust mites (2.7%), H. diminuta eggs (2.7%), Strongyloides free living
adults, rhabditiform and filariform larvae (2.3%), H. nana eggs (1.7%), S. mansoni eggs (1.2%),
Ascaris eggs (0.6%), Ancylostoma larvae (0.5%), Taenia eggs (0.4%), Trichocephalus eggs (0.4%)
and F. gigantica eggs (0.2%). The prevalence of parasitic infections was significantly higher
(P<0.001) in fields (63.4%) than streets (47.7%) and indoor-yards samples (35.3%). The intensity
of infections was significantly higher (P< 0.001) in streets than fields and indoor-yards (18.1, 9.7 &
1 parasite/10 gm of soil respectively).
18 A review of cryptosporidiosis in Egypt. Close
Author(s):
Youssef FG, Adib I, Riddle MS, Schlett CD
Abstract:
Cryptosporidiosis, a parasitic zoonosis, while typically a short-term infection, has a global

distribution and can cause severe illness in children and other vulnerable populations. In order to
inform local and regional public health personnel and providers, the authors conducted a
comprehensive review of Cryptosporidium parvum (Cp) epidemiology in Egypt to establish what is
known, identify critical knowledge gaps, and develop a basis for future directions in mitigating the
burden associated with this illness among Egyptians and similar countries. A total of 61 published
studies between 1985 & 2006 were reviewed. Nineteen studies examined immunocompetent
individuals with diarrhea presenting to inpatient or outpatient clinics with a Cp prevalence ranging
from 0% - 47% (median 9%, IQR 3-15%). Identified risk factors, at risk populations, ecology,
environmental findings, as well as a quality assessment of the published literature are discussed.
The building blocks are in place to design studies aimed at defining the disease, societal burden and
evaluating public health interventions aimed at disrupting water and zoonotic transmission
modalities using the most current molecular techniques. Cp diarrhea is but one of the many causes
of diarrhea among Egyptians, but efforts to control this disease should also serve well to mitigate a
number of infectious causes of diarrhea and given the track record of previous work hopping to see
advances in the near future.
19 Intestinal parasitic infections among mentally handicapped individuals in Alexandria, Egypt.

Close
Ann Parasitol 2015 ;61(4):275-81.
Author(s):
Shehata AI, Hassanein F
Abstract:
This cross-sectional study was carried to determine the prevalence of intestinal parasitic infections
among mentally handicapped individuals in Alexandria, Egypt, in the period from December 2012 till
November 2013. The study was conducted on 200 institutionalized and non-institutionalized
mentally handicapped individuals. Fresh stool samples were subjected to different stains including;
trichrome for detecting intestinal protozoa, modified acid fast stain for intestinal coccidia and quick
hot gram chromotrope stain for Microsporidia. Also they were processed by Kato-Katz and formol
ethyl acetate techniques for intestinal helminths. Additionally, blood samples were collected for
measuring hemoglobin levels. Out of 200 mentally handicapped individuals, 87 (43.5%) were
infected. The infection rates were 44.6% and 42.6% for non-institutionalized and institutionalized
people, respectively. Regarding gender, 46.7% and 38.5% were reported for the males and females
respectively. The most common parasites detected were: Cryptosporidium sp. (23.5%),
microsporidia (15%), Giardia lamblia (8.5%), Dientamoeba fragilis (8%), Cyclospora cyatanensis
(7.5%), Blastocystis hominis (6.5%), Entamoeba histolytica (5.5%) and Entamoeba coli (2.5%).
Rates for Isospora belli and Enterobius vermicularis were estimated to be 1.5% for each, while
lower rate was reported for Iodamoeba butschlii (1.0%). Prevalence of infections among mentally
handicapped individuals are indications for several risk factors, including improper sanitary hygiene
and illiteracy about personal hygiene. Therefore, frequent investigations, health care and medical
intervention are needed.
20 Detection of some intestinal protozoa in commercial fresh juices. Close

Author(s):
Mossallam SF
Abstract:
Fresh fruit juices are popular, but not always safe. For assessing the likelihood of infection with
newly emerging intestinal protozoa, commercial fresh orange, lemon, sugar cane, strawberry, and
mango juices were screened by wet mounts, Weber's modified trichrome and modified Ziehl-
Neelsen stains. Protozoa viability was done by fluorescein-diacetate/propidium-iodide staining, and
infectivity was performed in Swiss albino mice. Results showed that 35.43% were contaminated
with one or more of Cryptosporidia, Microsporidia, and Cyclospora, as well as Giardia spp.
Strawberry was the most contaminated juice (54.28%), while orange was the slightest (22.86%).
Cryptosporidia was the highest contaminant (61.29%), and Cyclospora was the least (14.52%).
Microsporidia spp. was the most robust contaminant which retained its viability and infectivity in
juices in which it was detected. Moderately acidic strawberry and mango juices and alkaline sugar
cane juice pose a possible threat, due to harboring the highest viable and infectious protozoa.
Regarding highly acidic juices, viability and infectivity decreased in lemon, yet was not still risk
free. Orange juice was comparatively safe, as viability dramatically declined, while infectivity was
completely abolished. Hence consumers, especially high risk group, are placed at hazard of
contracting intestinal protozoa infections, especially through moderately acidic and alkaline juices.
21 Enteropathogens associated with diarrhea among military personnel during Operation Bright
Star 96, in Alexandria, Egypt. Close
Mil Med 1997 Jun ;162(6):396-400.
Author(s):
Oyofo BA, Peruski LF, Ismail TF, el-Etr SH, Churilla AM, Wasfy MO, Petruccelli BP, Gabriel ME
Abstract:
This study investigated the microbial causes of diarrheal disease among U.S. troops deployed near
Alexandria, Egypt, during October 1995. Bacterial causes associated with 19 cases of diarrhea
included: enterotoxigenic Escherichia coli (ETEC), 42% (21% heat-stable, 11% heat-labile, and
11% heat-stable/ heat-labile producers); enteropathogenic E. coli (5.3%); and enteroadherent E.
coli (42%). Four cases of diarrhea were associated with enteroaggregative E. coli based on probe
analysis for enteroaggregative heat-stable enterotoxin 1. Protozoan causes included; Entamoeba
histolytica (11%), E. hartmanni (5%), E. nana (5%), Blastocystis hominis (5%), Chilomastix
mesnili (11%), Dientamoeba fragilis (5%), Entamoeba coli (5%), and Cryptosporidium (5%).
Shigella, Aeromonas, Plesiomonas, Vibrio, Campylobacter, and Salmonella were not detected. Of the
eight ETEC cases, one was colonization factor antigen (CFA)/I only, one was both CFA/I and
CFA/III, three were CFA/II, two were CFA/IV, and two were CFA-negative. Antibiograms of the
ETEC and enteroadherent E. coli strains showed that all isolates were susceptible to norfloxacin,
ciprofloxacin, and nalidixic acid but resistant to ampicillin, tetracycline, chloramphenicol, and
sulfamethoxazole.
22 Currency as a potential environmental vehicle for transmitting parasites among food-related

workers in Alexandria, Egypt. Close
Trans R Soc Trop Med Hyg 2011 Sep ;105(9):519-24.
Author(s):
Hassan A, Farouk H, Hassanein F, Abdul-Ghani R
Abstract:
Transmission of parasites may occur indirectly via inanimate objects in the surrounding
environment. One of the objects most handled and exchanged by people are currency coins and
banknotes, which could be one of the most potential vehicles to transmit parasites, even between
countries. However, study of the potential contamination of currency in circulation with intestinal
parasites has not been given the interest it deserves and the present study is the first pilot study in
Alexandria, Egypt. It was revealed that 60.2% of 103 banknotes and 56.6% of 99 coins obtained
from food-related workers had been contaminated with one or more parasitic species. Protozoa
were the predominant parasites, with microsporidia and Cryptosporidium spp. being the most
prevalent. There was no statistically significant difference between currency types regarding
parasitological contamination, but there was a significant (P<0.001) association between the
physical condition of currency and its contamination. Moreover, the source of the currency was not
statistically associated with parasitological contamination. The denomination of coins was not
statistically associated with parasitological contamination, whilst that of banknotes was with the
lower denominations being more contaminated.

23 Intestinal parasites in Dakahlia governorate, with different techniques in diagnosing protozoa.
Close
Author(s):
El Shazly AM, Awad SE, Sultan DM, Sadek GS, Khalil HH, Morsy TA
Abstract:
A total of 3180 patients attending Mansoura University Hospitals' Clinics, were subjected to stool
examination by direct wet smear, formol-ether concentration, original formol-tween concentration,
modified formol-tween concentration, modified Sheather's sugar floatation, Potassium hydroxide
concentration and Gomori's Trichrome stain, and modified Kinyoun's acid-fast stain, and Ryan's
Trichrome blue stain for Microsporidia. The intestinal helminthes in a descending order of
abundance were: S. mansoni (5.3%), Fasciola sp. (4.8%), H. heterophyes (4.2%), Hymenolepis
nana (3.9%), Trichostrongylus sp. (2.6%), A. lumbricoides (1.8%), Strongyloides stercoralis
(1.5%), H. diminuta (1.4%), Taenia saginata (1.1%), E. vermicularis (by smear; 1.1 %), T. trichura
(0.7%) and lastly A. duodenale (0.1%). The intestinal protozoa in a descending order of abundance
were Blastocystis hominis (22.4%), Giardia lamblia (19.6%), Entamoeba histolytica/E.dispar
(19%), Iodamoeba butschlii (16%), Cryptosporidium parvum (14.3%), E. coli (9.7%), Isospora
hominis (7.7%), Endolimax nana (6.9%), E. hartmani (5.9%), Dientamoeba fragilis (5.1%),
Chilomastix mesnili (5.1%), Trichomonas hominis (4.2%), Cyclospora cayetanensis (4.2%),
Microsporidia spores (3.2%), Enteromonas hominis (1.9%) and Embadomonas intestinalis (1.3%).
The results were discussed.
24 Diarrhea due to parasites particularly Cryptosporidium parvum in great Cairo, Egypt. Close

Author(s):
Mousa KM, Abdel-Tawab AH, Khalil HH, El-Hussieny NA
Abstract:
A total of 110 stool samples from out and in-patients from different areas in Great Cairo suffering
from diarrhea were examined for parasitic causes. Stool samples were subjected to the direct wet
smear method and Sheather's sugar flotation and stained with Giemsa and/or modified Ziehl-
Neelsen. Also, stool samples were cultured on agar plates for strongyloidiasis. The overall parasitic
infection rate was 60.9% and non parasitic cause was 39.1%. The parasitic infection rate in a
descending order was 31.1% for Cryptosporidium parvurnm, 19.8% for Giardia lamblia, 9.9% for
Entamaeba histolytica and lastly 1.8% for Strongyloides stercoralis. The main clinical presentation
of diarrheic patients in a descending order was vomiting (31.3%), dehydration (29.86%),
abdominal pain (29.86%), flatulence (26.86%), anorexia (23.89%), tenesmus (17.9%) and lastly
fever (4.47%). The risk factors were living in rural areas, education level, contact with farm animals
and/ or pet animals. However, most of these risk factors although showed high percent, yet they
occurred in patients with other causes of diarrheas. Artificial breast feeding was not evaluated as
only 3 infants had C. parvum compared to non parasitic cause in 1 on the breast feeding.
25 Opportunistic parasitic infections among immunocompromised Egyptian patients. Close
Author(s):
Baiomy AM, Mohamed KA, Ghannam MA, Shahat SA, Al-Saadawy AS
Abstract:
The commonest opportunistic parasites causing morbidity and/or mortality in the immuno-
compromised subjects are mainly the gastro-intestinal ones. This study clarified the prevalence of
the opportunistic parasites among a group of immunocompromised patients selected from Al Azhar
University Hospitals. One hundred immunocompromised patients (GI) were divided into GIa: 40
malignancy patients. GIb: 30 with diabetes mellitus. GIc: 30 with chronic renal failure. GII: included
20 cross-matched healthy subjects as controls. Sheets were filled out on each subject including all
personal and medical history. Both groups were subjected to stool and blood examinations for
parasites. The results showed opportunistic parasites in 30% of patients and in 10% of healthy
controls. The highest group had parasitosis was patients suffering from malignancy (18%). The
patients suffering from chronic renal failure or from diabetes mellitus were equally affected (6%
each group). There was significant relation between malignant patients and diabetic or chronic
renal failure ones, but without significant relation between diabetic and chronic renal failure
patients. Giardia lamblia was the most common parasite found in the patients (10%) of which 5%
were among patients suffering from malignancy. Others were Cryptospotidium parvum (7%)
Cyclospora cayetanensis (3%) and Microsporidia species (2%). Mixed infection was detected in 2
cases that had C. parvum and Cyclospora. But, neither Isospora belli nor Strongyloides stercoralis
were detected. Also, ELISA showed antibodies against Toxoplasma gondii in sex patients but none
against Leishmania d. infantum.
26 Simultaneous detection of Entamoeba histolytica/dispar, Giardia duodenalis and cryptosporidia

by immunochromatographic assay in stool samples from patients living in the Greater Cairo Region,
Egypt. Close
World J Microbiol Biotechnol 2015 Aug ;31(8):1251-8.
Author(s):
Banisch DM, El-Badry A, Klinnert JV, Ignatius R, El-Dib N
Abstract:
Gastrointestinal infection due to intestinal parasites is an enormous health problem in developing

countries and its reliable diagnosis is demanding. Therefore, this study aimed at evaluating a
commercially available immunochromatographic assay (ICA) for the detection of cryptosporidia,
Giardia duodenalis, and Entamoeba histolytica/dispar for its usefulness in the Greater Cairo Region,
Egypt. Stool samples of 104 patients who presented between October 2012 and March 2013 with
gastrointestinal symptoms or for the exclusion of parasites at Kasr-Al-Ainy University Medical
School were examined by light microscopy of wet mounts and the triple ICA. Microscopy revealed in
20% of the patients [95% confidence interval (CI), 13.5-29.0%] parasites with Hymenolepis nana,
E. histolytica/dispar and Blastocystis hominis being the most frequent ones, but was not able to
detect G. duodenalis and cryptosporidia, whereas ICA was positive in 21% (95% CI, 14.3-30.0%)
and detected E. histolytica/dispar in 12.5% (95% CI, 7.3-20.4%), cryptosporidia in 6.7% (95% CI,
3.1-13.5%) and G. duodenalis in 15.4% (95% CI, 9.6-23.6%) of the patients. Detection of one or
more pathogens was associated with access to water retrieved from a well or pump (p = 0.01).
Patients between 20 and 29 years of age (p = 0.08) and patients with symptoms of 5 days or longer
(p = 0.07) tended to have a higher risk to be infected than patients of other age groups or with
shorter-lasting symptoms. In conclusion, the ICA was easy to perform and timesaving. Importantly,
it enabled the detection of cryptosporidia, which cannot be found microscopically in unstained
smears, demonstrated a higher sensitivity for the detection of G. duodenalis than microscopy, and
was more specific for distinguishing E. histolytica/dispar from apathogenic amoeba.

27 Molecular seasonal, age and gender distributions of Cryptosporidium in diarrhoeic Egyptians:
distinct endemicity. Close
Eur J Clin Microbiol Infect Dis 2015 Dec ;34(12):2447-53.
Author(s):
El-Badry AA, Al-Antably AS, Hassan MA, Hanafy NA, Abu-Sarea EY
Abstract:
Cryptosporidiosis is a worldwide gastrointestinal disease caused by the protozoan Cryptosporidium

parasite. It has a broad range of seasonal and age-related prevalence. We aimed to study the
molecular prevalence and seasonality of Cryptosporidium over a period of 1 year in a cohort of
Egyptian diarrhoeic patients. Stool samples were collected from 865 diarrhoeic patients attending
outpatient clinics of Cairo University hospitals, from all age groups over a 12-month period,
examined microscopically for faecal Cryptosporidium oocysts by the acid-fast staining method and
for copro-DNA detection using nested polymerase chain reaction (nPCR) assays. PCR-positive
samples were characterised molecularly by nPCR-restriction fragment length polymorphism (RFLP)
to determine Cryptosporidium genotypes. Cryptosporidium copro-DNA was detected in 19.5% of the
collected samples throughout the year, with a major peak in summer (August) and a small rise in
spring (April). Infection was mainly C. hominis (95.8%) followed by C. parvum (3.0%), affecting all
age groups, with predominance in the pre-school age group, and decrease with age. There were
statistically significant associations between the detection of Cryptosporidium and season,
diarrhoea, patient age and drinking water, while gender, contact with animals and presence of
mucus in stool showed no association. Cryptosporidium in diarrhoeic Egyptians was of distinct
endemicity, with the bi-model mostly influenced by population dynamics, with a clear high
prevalence in pre-school children and predominating anthroponotic (C. hominis) transmission
throughout the year. The obtained results highlight Cryptosporidium as a water contaminant and an
important cause of health problems in Egypt, necessitating further studies of the risk factors.
28 Detection of spp. in Diarrheic Immunocompetent Patients in Beni-Suef, Egypt: Insight into

Epidemiology and Diagnosis. Close
Korean J Parasitol 2018 Apr ;56(2):113-119.
Author(s):
Abdel Gawad SS, Ismail MAM, Imam NFA, Eassa AHA, Abu-Sarea EY
Abstract:
species is an important cause of gastrointestinal infections globally. This study aimed to shed light
on its role in diarrheic immunocompetent patients in Beni-Suef, Egypt and to compare three
diagnostic methods. Two hundred diarrheic patients, 37±16.8 year old, were enrolled. Stool
samples were examined by light microscopy, using modified Ziehl-Neelsen stain (MZN) for spp.
oocysts. Coproantigens were detected by sandwich ELISA. DNA molecular diagnosis was done by
nested PCR. PCR yielded the highest detection rates (21.0%), compared to ELISA (12.5%) and MZN
staining method (9.5%). The higher infection rates were in 20-40 year-old group, followed by 40-60
year-old. Association between epidemiologic factors was statistically not significant; positivity and
gender, clinical manifestations, residence, source or water, or contact with animals.
Cryptosporidiosis is an important enteric parasitic infection in Beni-Suef and PCR remains the gold
standard for diagnosis.
29 COMPARISON OF IMMUNOCHROMATOGRAPHIC TEST AND MICROSCOPY IN THE DETECTION OF

SOME ENTERIC PROTOZOA IN STOOL SAMPLES. Close
Author(s):
Atia MM, Elsettawy MA, Fathy GM, Salama MA, Metally Ashoush SEM
Abstract:
Infection with pathogenic intestinal protozoa. as Giardia lamblia,, Entamoeba histolytica and
Cryptosporidium parvum cause considerable gastrointestinal morbidity, malnutrition and mortality
worldwide, especially among young children in developing countries. The present study was carried
out on 71 cases (44 males & 27 females) chosen from Pediatric and Internal Medicine Inpatient and
Outpatient Clinics of Zagazig University Hospitals, complaining of different gastrointestinal troubles
with an age range of 6-60 years. Also, 20 apparently healthy individuals (11 males & 9 females)
cross matched were considered as a control negative group. All stool samples were examined by
direct wet smears, concentration techniques, staining of the smears using trichrome stain and
Modified Ziehl-Neelsen method. Copro-antigen detection in faecal sample was by using quick
immunochromatographic test. A total of 71 cases suffering from different GIT manifestations
showed G. lamblia (30.7%), Cryptosporidium parvum (19.8%), EntamoebahistolyticalE. dispar
(11%) and mixed infection of three protozoa (6.6%). However, by copro-antigen G. lamblia was
positive in (31.8%) of C. parvum in (20.9%); E. histolytica/E. dispar in (11%) of cases.
Immunochromatography/copro-antigen test recorded sensitivity and specificity of (100%) and
(96.6%) respectively in G. lamblia detection. For C. parvum, sensitivity was (100%) and specificity
was (97.1%) while for E. histolytica/E. dispar. sensitivity and specificity were (100%) for both.
Immunochromatographic assay proved to be simple, easy and useful in confirming absence or the
presence of intestinal protozoan infection in clinically suspected cases with negative stool
examination.
30 INTESTINAL PARASITES IN DIABETIC PATIENTS IN SOHAG UNIVERSITY HOSPITALS, EGYPT.

Close
Author(s):
Elnadi NA, Hassanien HA, Ahmad AM, Abd Ellah AK
Abstract:
Intestinal parasites usually create benign diseases, though they may induce complications with high
morbidity and mortality to the immunocompromised, including diabetic patients. The study detected
the prevalence of intestinal parasitic infections in diabetic patients, comparing to non-diabetic
controls and other parameters. A total of 100 fecal samples were collected from diabetic patients at
the outpatient clinic of Sohag University Hospitals and another 100 from cross matched controls.
The samples were examined macroscopically and microscopically by direct smear and different
concentration methods then stained by Modified Ziehl-Neelsen Acid fast stain. Glycated hemoglobin
(Hb Alc) was measured to detect DM controlled patients. The data were organized, tabulated, and
statistically analyzed. Intestinal parasites were found in 25 (25%) cases out of 100 patients in
diabetic group and 7(7%) cases out of 100 controls with high significance (P<0.001)). In the
diabetic group, Giardia lamblia was detected in 22 cases (22%) and 5 (5%) among controls,
Entamoeba histolytica in 7 cases (7%) and 3 (3%) among controls, Hymenolypis nana in 5 cases
(5%) and 3 (3%) among controls, Entamoeba coli in 8 patients (8%), Entamoeba hartmanni in 3
cases (3%), Dientamoeba fragilis in a case (1%), Cryptosporidium parvum in 5 cases (5%) and
microsporidia in 3 cases (3%). But, E. coli, E. hartmanni, D. fragilis and C. parvum nor microsporidia
were detected in controls. The rate of G. lamblia in DM patients compared to controls was high
significant (P<0.001). Hymenolepis nana was 5% (5 cases) in diabetic patients compared to 3% (3
cases) in controls. Residence and sex differences were not significant, while age, >10 years showed
the highest prevalence (P< 0.003), type I infection rate was significantly higher than type II
(P<0.001). DM control was also significantly affected the infection rates (P<0.007 in type I and P<
0.01 in type II).
31 Cryptosporidiosis in patients with diarrhea and chronic liver diseases. Close
J Infect Dev Ctries 2014 Dec 15;8(12):1584-90.
Author(s):
Mousa N, Abdel-Razik A, El-Nahas H, El-Shazly A, Abdelaziz M, Nabih M, Hamed M, Eissa M, Effat N,

Eldars W
Abstract:
Cryptosporidium is one of the important causes of diarrhea in patients with chronic liver diseases.
The infection significantly increased with the progression of chronic liver diseases. In patients with
advanced chronic liver diseases, Cryptosporidium infection may be a precipitating factor of hepatic
encephalopathy.
32 Prevalence and genotyping of Cryptosporidium spp. in farm animals in Egypt. Close
J Vet Med Sci 2014 Dec ;76(12):1569-75.
Author(s):
Mahfouz ME, Mira N, Amer S
Abstract:
In this study, we examined the prevalence and molecular characteristics of Cryptosporidium in
buffalo, dairy cattle and sheep in different farms at Kafr El Sheikh Province, Egypt. Rectal fecal
samples, including 466 samples from buffalo, 1697 from cattle and 120 from sheep, were collected
from different ages and screened by modified Ziehl-Neelsen acid-fast microscopy for detection of
Cryptosporidium oocysts. All studied farms were positives with an overall prevalence of 1.29% in
buffalo (4.17% in claves versus 0.48% in adults), 7.07% in cattle (6.90% in calves versus 10.20%
and 6.10% in heifers and adults, respectively) and 2.50% in sheep (4.40% in lambs versus 1.30%
in adults). PCR-RFLP analyses of small-subunit rRNA genes from positive specimens revealed the
occurrence of C. parvum and C. ryanae in buffalo; C. parvum, C. ryanae, C. bovis and C. andersoni in
cattle and only C. xiaoi in sheep. Genotypes distribution showed that C. ryanae was the dominant
species (60.0%) followed by C. parvum (40.0%) in buffalo calves. Meanwhile, in cattle calves, C.
parvum was the commonest species (74.23%) followed by C. ryanae (16.10%) and C. bovis
(9.70%). Subtyping of C. parvum based on sequence analysis of the polymorphic 60 kDa
glycoprotein gene locus showed the presence of subtypes IIdA20G1 and IIaA15G1R1 in both buffalo
and cattle calves, addressing the potential role of calves in zoonotic cryptosporidiosis in Egypt.
33 PARASITOLOGICAL STUDIES ON SOME INTESTINAL PARASITES IN PRIMARY SCHOOL CHILDREN

IN ASWAN GOVERNORATE, EGYPT. Close
Author(s):
Dyab AK, El-Salahy MM, Abdelmoneiem HM, Amin MM, Mohammed MF
Abstract:
This cross sectional study in Aswan Governorate determined the prevalence of intestinal parasites
and to identify the risk factors for infection in primary school children in this geographical area. The
results would facilitate evaluation of the endemic level of different intestinal parasites and the
determination of whether wiqespread or focal measures of parasite control are required. After
obtaining official permission from the school administration, information and consent forms were
given to the parents of all the schoolchildren. They were three-hundreds children aged between 6-
12 year were enrolled; a detailed questionnaire, complete clinical assessment complete as well as
stool analysis was done The study showed that the over-all infection was 31%, single parasitic
infection was 26% and mixed one was 5%.The commonest helminthic infection was E. vermicularis
6.6% followed by H. nana 3% Ascaris lumbricoidesl%. The commonest protozoa infection was E.
histolytica 8.3% followed by Giardia lamblia 3.7% and Cryptosporidium parvum 1.7%. Mixed
infection was E. vernficularis plus E. histolytica (23.4%), E vermicularis plus G. lamblia (17.6%), E.
vermicularis plus C. parvum (11.8%), E. histolytica plus H. nana (11.85%), A. -lumbricoides plus E.
histolytica (17.6%) and G. lamblia plus E. histolytica in (11.8%). Parasitic infection was more
prevalent in boys (53.8%) than girls (46.2%) and more prevalent in rural children (39.73%) than
urban ones (20.13%) among age ranged from 6 to 12 years (8.97±1.72).
34 THE PARASITIC PROFILE AMONG SCHOOL CHILDREN IN EI-WADI EL-GADDED GOVERNORATE,

EGYPT. Close
Author(s):
Bayoumy AMS, Ibrahim WLF, Abou El Nour BM, Said AAA
Abstract:
Parasitic infection is still a serious public health problem in the world, especially in developing
countries including Egypt. It represents a major cause of morbidity and mortality in childhood and
among high-risk groups-in most parts of the world. This study detected the prevalence of parasitic
infection among school children in-El-Wadi El-Gadded (the New Valley Governorate). A total of
randomly chosen 1615 students aged from 6-16 years, (771 males & 844 female) from 12 primary
schools and 12 preparatory schools related to four centers (El Dakhala, El Farfra, Paris and Platt)
from the New Valley. Governorate. Each child was subject to: A questionnaire sheet, Urine
examination through sedimentation methods, Stool examination using: Direct smear, Simple
sedimentation method and Modified Ziehl-Neelsen Stain, Blood samples were collected randomly
from 450 children and examined for Seropositivity of toxoplasmosis using (On-SiteToxolgG/IgM
Rapid Test- Cassette) and examination of hair & clothes for ectoparasites (lice). The overall
prevalence of parasites was (39.1%) among primary and preparatory school children. The
helminthes were E. vermicularis (15.2% & 17.1%); A. lumbricoides (1.3% & 1.9%) and then H.
nana (0.9% & 0.6%) and the protozoa were E. histolytica (14.1% & 13.2%), Giardia lamblia (3.8%
& 3.9%), and then Cryptosporidium parvum (0.09%) and seropositivity of toxoplasmosis was in
(3.0% & 2.7%) among primary and preparatory school children respectively. Mixed infection was in
(0.4%) among primary school children. Head lice infestaiion was more prevalent among primary
school children than preparatory school ones with a ratio (3.5% &0.2%) respectively, was nil
among males.

35 Detection of Cryptosporidium parvum and Cryptosporidium hominis in human patients in Cairo,
Egypt. Close
Parasitol Res 2012 Jan ;110(1):161-6.
Author(s):
Abd El Kader NM, Blanco MA, Ali-Tammam M, Abd El Ghaffar Ael R, Osman A, El Sheikh N, Rubio JM,
de Fuentes I
Abstract:
Cryptosporidium is a significant cause of diarrheal disease in developing and industrialized nations.

Cryptosporidium hominis and Cryptosporidium parvum are the main agents of cryptosporidiosis in
humans. In Egypt, very little is known about genetic structure of Cryptosporidium spp. Therefore,
this study was designed to examine samples from sporadic cases of cryptosporidiosis in Egyptians
in order to identify the species involved in infection as well as the transmission dynamics and
distribution of the parasite in the Great Cairo area. A total of 391 human faecal samples were
collected, between May 2008 and March 2009, from ten public hospitals in Great Cairo. Initial
screening by immunochromatographic detection kit "the Stick Crypto-Giardia; Operon" showed 23
possible positive cases. Twenty of them were confirmed by microscopic examination. PCR was
performed by amplification of the oocyst wall protein (COWP) gene where 18 out of 23 samples
were positive, one not detected by microscopy. Cryptosporidium genotyping was performed by RFLP
analysis of PCR products of the diagnosis PCR. Only 15 samples rendered a digestion pattern. The
genotyping distribution was nine cases showing C. hominis genotype, three showing C. parvum
genotype and three showing mixed infection by C. hominis and C. parvum. The data showed an
elevated prevalence of C. hominis (80.0%), the most anthroponotic species, suggesting a human-
human transmission. Furthermore, the presence of up to 40% of samples infected with C. parvum
shows that further investigations are required to determine the subgenotypes of C. parvum to
clarify the mode of transmission in order to improve the control measures.
36 Evaluation of enzyme immunoassay techniques for diagnosis of the most common intestinal
protozoa in fecal samples. Close
Int J Infect Dis 2011 Aug ;15(8):e541-4.
Author(s):
Gaafar MR
Abstract:
These results indicate that antigen detection by EIA has the potential to become a valuable tool,
capable of making stool diagnostics more effective.
37 Molecular epidemiology of Cryptosporidium in livestock animals and humans in the Ismailia

province of Egypt. Close
Vet Parasitol 2013 Mar 31;193(1-3):15-24.
Author(s):
Helmy YA, Krücken J, Nöckler K, von Samson-Himmelstjerna G, Zessin KH
Abstract:
The zoonotic potential of Cryptosporidium was studied in one of the most densely populated
provinces of Egypt regarding livestock and people. In a representative survey, faecal samples from
cattle, buffalo and stool samples from diarrhoeic children (<10 years) were investigated.
Parameters assumed to be related to cryptosporidiosis were recorded for animals and children.
Animal samples (804) were examined by the Copro-antigen RIDA(®)QUICK test, followed by PCRs
targeting the 18S rDNA and gp60 genes for antigen-positive and 10% randomly selected negative
samples. All 165 human samples were tested by both methods. The overall estimated prevalence of
Cryptosporidium in ruminants was 32.2%, without significant difference between animal species.
PCR identified 65.7% Cryptosporidium parvum, 11.8% Cryptosporidium ryanae, 4.1%
Cryptosporidium bovis, and combinations of C. parvum plus C. ryanae (11.2%), C. parvum plus C.
bovis (5.3%) and of C. parvum plus Cryptosporidium andersoni (1.8%), also without significant
differences in species occurrence between cattle and buffalos. The human Cryptosporidium spp.
prevalence was 49.1%, of which 60.5% were Cryptosporidium hominis, 38.2% C. parvum and 1.2%
C. parvum plus C. bovis. Analysis of gp60 variants allocated C. parvum found in animals to the
zoonotic subtype family IIa (18.9%, subtype IIaA15G1R1 only) and to IId (81.1%, mostly
IIdA20G1). In humans 50% were classified as subtype family IIa (IIaA15G1R1 and IIaA15G2R1)
and 50% were IIdA20G1. C. andersoni occurred only in cattle older than 1 year. In contrast, mono-
infections with one of the three single Cryptosporidium species and the three combinations with C.
parvum were more prevalent in cattle and buffaloes younger than 1 year, particularly in those
younger than 3 months, and were predominantly subtype family IId. In human samples no
Cryptosporidium were identified in children younger than 7 months. Neither place of residence nor
the source of drinking-water had measurable effects on prevalence. Remarkably, however, all
children with C. parvum subtype family IIa and 86% with subtype family IId had contact to
animals. High prevalence and identical genotypes of C. parvum in animals and humans indicate
zoonotic transmission due to contact with animals, involving IIdA20G1 as the most frequent
subtype.
38 Zoonotic enteric parasites transmitted from dogs in Egypt with special concern to Toxocara canis
infection. Close
Vet World 2015 Aug ;8(8):946-57.
Author(s):
Awadallah MA, Salem LM
Abstract:
Detection of enteric parasites in dogs and humans in Egypt substantiates the role posed by dogs in
transmitting zoonotic parasites to humans and knock an alarm for common sources of infection for
humans and dogs. Common sources may be infected fish or contaminated vegetables that are
consumed by dogs or humans or even infected rodents that may contaminate their feed. This pilot
study necessitate the need for similar studies and tracing such infection in fish, vegetables, rodent
that may be responsible for infecting humans and dogs in order to understand the epidemiology of
zoonotic parasitic infection transmitted from dogs to humans.
39 Epidemiology and public health significance of Cryptosporidium isolated from cattle, buffaloes,
and humans in Egypt. Close
Parasitol Res 2016 Jun ;115(6):2439-48.

Author(s):
Ibrahim MA, Abdel-Ghany AE, Abdel-Latef GK, Abdel-Aziz SA, Aboelhadid SM
Abstract:
The epidemiology and public health significance of Cryptosporidium species and genotypes were
investigated in Beni-Suef Governorate, Egypt. A total of 610 animal fecal samples (480 from cattle
and 130 from buffaloes) beside 290 stool samples from humans were collected in the period
between January and December 2014. Based on the microscopic examination, the overall estimated
prevalence of Cryptosporidium spp. in cattle, buffaloes, and humans was 10.2, 12.3, and 19 %,
respectively. The highest detection rates were in calves less than 2 months of age (17.1 %) and
diarrheic animals (13.0 %). Likewise in humans, the highest prevalence of Cryptosporidium was in
infants (31.3 %) and diarrheic individuals (21.1 %). The gender distribution in humans denoted
that Cryptosporidium was reported more frequently in males (21.7 %) than females (14.5 %).
Based on the molecular characterization of Cryptosporidium, Cryptosporidium oocyst wall protein
(COWP) and gp60 genes were successfully amplified in 36 out of 50 samples subjected to
genotyping. Restriction fragment length polymorphism (RFLP) analysis of the COWP fragments
revealed that Cryptosporidium parvum was the only species detected in cattle (12 isolates) and
buffaloes (4 isolates), while in humans, the detected species were Cryptosporidium hominis (15
isolates) and C. parvum (5 isolates). Sequence analysis of the gp60 gene identified the subtype
IIdA20G1 within C. parvum isolated from both animals and humans. The common occurrence of
zoonotic subtypes of C. parvum in cattle and buffaloes highlights the potential role of these animals
as significant reservoirs of infection to humans. Also, the presence of C. hominis and C. parvum in
humans indicates that both anthroponotic and zoonotic pathways are expected.
40 Frequencies and spatial distributions of Cryptosporidium in livestock animals and children in the
Ismailia province of Egypt. Close
Epidemiol Infect 2015 Apr ;143(6):1208-18.
Author(s):
Helmy YA, VON Samson-Himmelstjerna G, Nöckler K, Zessin KH
Abstract:
Faecal samples from 804 cattle and buffaloes and 165 diarrhoeal children of Ismailia province were
investigated by an immunochromatographic screening test and PCR to determine prevalences and
distributions of Cryptosporidium spp. Results were analysed statistically for clustering of animal and
human cases. Cryptosporidium herd prevalence was 73·3% and individual animal prevalence
32·3%. C. parvum was the dominant species in animals (65·7%). Young calves watered with canal
or underground water were at particular risk of infection. Detection rates were higher when calves
showed diarrhoea, fever and dehydration. Human Cryptosporidium prevalence was 49·1%. C.
hominis dominated in humans (60·5%), followed by C. parvum (38·3%). Living in villages, drinking
underground water and having contact with animals were risk factors. Cluster analysis revealed
differences in the distribution of infections between animals and humans and suggests different
transmission dynamics.
41 Molecular Screening and Genotyping of Cryptosporidium Species in Household Dogs and In-
Contact Children in Egypt: Risk Factor Analysis and Zoonotic Importance. Close
Vector Borne Zoonotic Dis 2018 Jun 12;
Author(s):
Gharieb RMA, Merwad AMA, Saleh AA, El-Ghany AMA
Abstract:
Cryptosporidiosis is a parasitic zoonosis implicated in severe diarrhoea in pets and humans. This
study aimed to determine the prevalence and genotypes of Cryptosporidium spp. in household dogs
and in-contact children, and the risk factors associated with infection in children in Sharkia
Province, Egypt. Fecal samples of 100 children (2-12 years old) and 50 dogs (3 months-1 year old)
were randomly collected from both rural (children: n = 85, dogs: n = 40) and urban (children: n = 15,
dogs: n = 10) households. Initial parasite detection was done by light microscopy, while, genotyping
was based on molecular diagnostic assays. The overall prevalence of Cryptosporidium spp. infection
in children was 35% using microscopy and 14% using nested polymerase chain reaction (PCR). In
dogs, it was 34% using microscopy and 24% using nested PCR. Cryptosporidium spp. from children
were identified as distinct genotypes, with the predominance of human genotype I
(Cryptosporidium hominis) over the zoonotic genotype II (Cryptosporidium parvum). Moreover,
only zoonotic genotype II (C. parvum) was identified in dog samples. The significant risk factors
associated with the prevalence of Cryptosporidium infection in children were the presence of
diarrheal episodes during time of survey, improper disposal of garbage, and dog feces and contact
with other livestock (p ≤ 0.05). This study concluded that the existence of C. parvum in children and
dogs residing the same households confirm the zoonotic transmission and its public health
significance. Also, the study recommended the necessity of hygienic disposal of dog feces and
preventing direct contact of dogs with other livestock.

42 Risk Factors Associated with Parasitic Infection Among Municipality Solid-Waste Workers in an
Egyptian Community. Close
J Parasitol 2016 04 ;102(2):214-21.
Author(s):
Eassa SM, El-Wahab EW, Lotfi SE, El Masry SA, Shatat HZ, Kotkat AM
Abstract:
Solid-waste management is associated with several health hazards, particularly parasitic infection.
The objective of the study was to determine the association between risk factors and the occurrence
of intestinal parasitic infections (potentially pathogenic) among municipal waste collectors in
Alexandria, Egypt. A cross-sectional survey was conducted in the main municipality company in
Alexandria. A total of 346 municipality solid-waste workers (MSWWs) was interviewed using an in-
depth questionnaire. The type of parasitic infections among waste handlers was determined using
formol-ether concentration and modified Ziehl-Neelsen technique. About half of the workers were
infected with parasites. The profile of parasitic infection revealed 12 parasitic species. These were
comprised of the following helminths: Schistosoma mansoni (13.3%), Enterobius vermicularis
(1.7%), Ascaris lumbricoides (1.4%), and Hymenolepis nana ova (0.6%). Among protozoa were
pathogenic Entamoeba histolytica (3.2%), Giardia intestinalis (2.9%), nonpathogenic protozoa such
as Entamoeba coli (1.7%), and potentially pathogenic or opportunistic ones as Cryptosporidium
(23.4%), Microsporidia (20.25%), Cyclospora (2.0%), Blastocystis hominis (1.7%), and
Cystoisospora belli (1.2%). About 1.4% of MSWWs have pediculosis and phthiriasis in their scalp
and eyelashes respectively. Risk factors for infection were associated with direct exposure to solid
fecal waste (odds ratio [OR] = 1.8, confidence interval [CI] = 1.1-3.0) and occupational activities
that allowed for direct exposure to solid fecal waste (OR = 2.3, CI = 1.4-4.0). Logistic regression
model has revealed that educational level and residence were the factors that contribute to parasitic
infection among MSWWs (P < 0.05). MSWWs are at high risk of acquiring parasitic infections. Data
of the present study highlighted the need for greater biomonitoring of MSWWs and the
improvement of environmental conditions and health care in such marginalized communities to
prevent parasitic infection and associated morbidities.
43 Protozoal pollution of surface water sources in Dakahlia Governorate, Egypt. Close

Author(s):
Elshazly AM, Elsheikha HM, Soltan DM, Mohammad KA, Morsy TA
Abstract:
Water samples were collected different water sources and different districts of Dakahlia G., from
September 2005 to August 2006, were investigated for pathogenic protozoa. Water specimens were
examined by concentration technique followed by modified Ziehl-Neelsen (MZN) and Truant
auramine-rhodamine (AR) stains for Giardia sp. cysts, Cryptosporidium sp. oocysts, and other
protozoa species. In the 1st survey, 94/480 (19.6%) water samples had protozoa. Prevalence rates
were in summer 38/120 (31.6%), autumn 27/ 120 (22.5%), spring 20/ 120 (16.6%) and lastly
winter 9/120 (7.5%). Protozoa were less common in treated potable water tanks 15/120 (12.5%),
followed by River Nile (Demiatta branch) 22/120 (18.3%) and sub-branch Bahr-El-Saghear 24/120
(20%). The highest prevalence was in water of the main local draining 33/120 (27.5%). In the 2nd
survey, 840 potable water samples from seven districts were examined. Prevalence in descending
order was C. parvum (3.1%), G. intestinalis (2.1%), E. histolytica (1%), Blastocystis homi-nis
(1%), Iodamoeba sp, (0.5%), Isospora belli (0.47%), E. coli (0.36%), Cyclospora cayetanensis
(0.24%), and Chilomastix mesnilli (0.12%). Data suggested that C. parvum and G. intestinalis were
the commonest disease-agent. The implementation of preventive measures to protect water system
from protozoa contamination was given.
44 Assessment of water quality of some swimming pools: a case study in Alexandria, Egypt.
Close
Environ Monit Assess 2012 Dec ;184(12):7395-406.
Author(s):
Abd El-Salam MM
Abstract:
In spite of the importance and popularity of swimming pools in summer, they have been identified
as posing some public health risks to users due to either chemical or microbiological contamination.
This study was carried out aiming at assessing the quality of water for some Alexandria's swimming
pools in order to determine its compliance with the Egyptian standards no. 418/1995. Five
swimming pools were selected randomly from different districts. Physical and chemical parameters,
as well as biological examination of a total of 30 samples, were carried out using standard analytical
methods. Water samples were collected from the studied swimming pools monthly over 6 months
and pool water monitoring was carried out during afternoon of the weekends when the pools were
most heavily used. The results indicated overall poor compliance with the standards. Compliance of
the pool water to the microbial parameters, residual chlorine, pH, and turbidity were 56.7% (17
samples), 20% (6 samples), 46.7% (14 samples), and 46.7% (14 samples), respectively. Statistical
analysis showed significant association between water contamination with microbial indicators and
physical-chemical aspects such as residual chlorine, temperature, turbidity, and load of swimmers.
Furthermore, Cryptosporidium oocysts and Giardia lamblia cysts has been found in 10% of samples.
It was concluded that there is a need to improve disinfection and cleaning procedures, with
consideration given to safety, and size of the pool in relation to bathing load. There is also a need to
monitor swimming pool water quality continuously, and to increase bather hygienic practices and
awareness of the risks as well as training of governmental inspectors.
45 Identity and public health potential of Cryptosporidium spp. in water buffalo calves in Egypt.
Close
Vet Parasitol 2013 Jan 16;191(1-2):123-7.
Author(s):
Amer S, Zidan S, Feng Y, Adamu H, Li N, Xiao L
Abstract:
Little is known about the diversity and public health significance of Cryptosporidium species in
water buffaloes. In this study, we examined the distribution of Cryptosporidium spp. in water
buffalo calves in Egypt. Rectal fecal specimens from 179 calves and 359 adults were screened
microscopically for Cryptosporidium oocysts using modified Ziehl-Neelsen stain. Cryptosporidium
spp. in 17 microscopy-positive specimens from calves were genotyped by DNA sequence analysis of
the small-subunit rRNA gene, and Cryptosporidium parvum was subtyped by sequence analysis of
the 60 kDa glycoprotein gene. Cryptosporidium ryanae was found in 10 specimens and C. parvum in
7 specimens, with the former belonging to the newly identified C. ryanae buffalo variant and the
latter belonging to the subtypes IIdA20G1 (in 5 specimens) and IIaA15G1R1 (in 2 specimens). The
prevailing occurrence of C. ryanae and the subtype family IId of C. parvum and the absence of C.
bovis and C. andersoni represent some features of Cryptosporidium transmission in water buffaloes
in Egypt.

46 Serological detection and epidemiology of Neospora caninum and Cryptosporidium parvum
antibodies in cattle in southern Egypt. Close
Acta Trop 2016 Oct ;162:206-11.
Author(s):
Fereig RM, AbouLaila MR, Mohamed SG, Mahmoud HY, Ali AO, Ali AF, Hilali M, Zaid A, Mohamed AE,
Nishikawa Y
Abstract:
Neospora caninum and Cryptosporidium parvum are intracellular protozoan parasites that are
distributed worldwide and of major economical concern in cattle industry. N. caninum can cause
abortion storms and high culling rates, whereas C. parvum has zoonotic implications and can cause
diarrhea in calves. There are currently no data on the prevalence of neosporosis and
cryptosporidiosis in humans or animals in southern Egypt. Prevalence of these two infections was
determined in a sample of cattle from two different areas in southern Egypt, Sohag and Qena, using
enzyme-linked immunosorbent assay. A total 301 cattle were sampled, of which 18.9% were
positive for N. caninum, 35.9% were positive for C. parvum and 10.0% were positive for both.
Geographical location and breeding system were considered as potential risk factors for C. parvum
infection. A higher prevalence of infection was identified on small scale farms, compared with
larger, intensive systems, with a prevalence of 50.2% compared with 37.8%, respectively. Animals
in Sohag had a significantly higher prevalence compared with Qena, with a seroprevalence of 46.1%
compared with 31.6%, respectively. In brief, marked seroprevalence recorded in this study
indicates a high incidence of N. caninum and C. parvum infections in cattle, and this necessitates the
application of more effective strategies for combating these types of infections on farms in Egypt.
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Cryptosporidiosis in Egypt

13.6% of dairy cattle in four Nile

1989* Aswan children 9 9% of children with diarrhea 3

13.9% of malnourished children

Delta 14% to 17% in the Nile Delta

15% of children below age 60

24% of children with acute

2014* Cairo children 22.4 22.4% of children 10

11.63% of children with

30.8% of symptomatic school

20% of outpatient children ages

13.2% of children with diarrhea

6.1% of soil samples in Dakahlia

0.2% of individuals in Behera

2010* juice 61.29 61.29% of fresh fruit juices 20

1985 Alexandria military personnel 5 5% of diarrhea episodes among

American military personnel in

28.16- 59.3% of coins and 28.16% of

14.3% of hospital outpatients in

31.1% of patients with

2012 6.7% of patients with

19.5% of patients with

2015 21% of diarrheic

Survey of patients with

30% of patients with chronic

Kafr El 1.29% of buffalo, 7.07% of

2016* Aswan schoolchildren 1.7 33

2008 5.1% of stool specimens

5% of stool specimens tested for

49.1% of diarrheic children ages

9.33% of humans and 5.38% of

19% of humans, 10.2% of cattle

49.1% of children with diarrhea

34% of dogs and 35% of

23.4% of municipality solid

2007* Dakahlia water 3.1 3.1% of surface water samples 43

2012* water buffalo 3.2 3.2% of water buffalo 45

Southern 35.9% of cattle in southern

List of all refereReferences for Cryptosporidiosis in Egypt

Exp Parasitol 2013 Nov ;135(3):518-23.

Amer S, Zidan S, Adamu H, Ye J, Roellig D, Xiao L, Feng Y

Molecular characterizations of Cryptosporidium spp. in dairy cattle in industrialized nations have

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Naguib D, El-Gohary AH, Mohamed AA, Roellig DM, Arafat N, Xiao L

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4 Coccidiosis among malnourished children in Mansoura, Dakahlia Governorate, Egypt. Close

J Egypt Soc Parasitol 2001 Dec ;31(3):877-86.

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J Trop Pediatr 2005 Jun ;51(3):154-9.

Over a 2-year period, the prevalence and clinical characteristics of Cryptosporidium-associated

[Click here to see the PubMed abstract]

6 Enteric pathogens associated with diarrhea in children in Fayoum, Egypt. Close

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7 A preliminary study on the prevalence of parasitic infections in immunocompromised children.

J Egypt Soc Parasitol 2010 Dec ;40(3):617-30.

Antonios SN, Tolba OA, Othman AA, Saad MA

8 Cryptosporidium gastroenteritis in Egyptian children with acute lymphoblastic leukemia:

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Hassanein SM, Abd-El-Latif MM, Hassanin OM, Abd-El-Latif LM, Ramadan NI

[Click here to see the PubMed abstract]

9 Opportunistic parasites among immunosuppressed children in Minia District, Egypt. Close

Korean J Parasitol 2012 Mar ;50(1):57-62.