Estimated of some Biochemical Parameter in Patients Infected with Entamoeba histolytica in Maysan/Amarah Province, Iraq

 

Nooraldeen Ali Jarullah, Dr. Shatha Khudairabbas Prof. Dr. Rajwa H. Essa

Department of Biology, College of Science, AL-Mustansiriyah University, Baghdad, Iraq

 

ABSTRACT:

The current study was carried out during the period from January 2017 to June 2017 in Maysan/ Amareh city for the detection of parasitic children infected with Entamoeba histolytica. One hundred child patients at the age’s group between 1-10 years old from both males and females with acute diarrhea clinically presented with bloody and mucoid diarrhea used to participate in the study. Samples collected from patient’s ( clinic paediatric in Shaheed Al - Sadr Teaching Hospital/Iraq, Al Zahrawi Surgical Hospitaland from the private laboratories City of Ammaraa ) and 25 persons as a healthy control. The results of biochemical parameters showed an elevated levels in liver the enzymes (GGT) and (LHD) was significantly higher than that observed in the non-patient (P<0.05).According to serum electrolytes , the serum level for, ionized calcium, and sodium were significantly lower for patients group (P<0.05). While for phosphorus and potassium there’s no significant difference between the patients group. The PH value for patients group (7.85) was significantly higher than non-patient (control group) (7.46).

 

 

 

I. INTRODUCTION:

The genus Entamoeba contains many species, of which Entamoeba histolytica is the only species definitely associated with pathological sequelae in humans (1). Entamoeba histolytica is a protozoan parasite that is considered as the causative agent of amebiasis and is considered a leading parasitic cause of human mortality (2). Intestinal parasites complains a major health problems in tropical and subtropical regions (3). The worldwide prevalence of amebiasis caused by the intestinal parasite Entamoeba histolytica, has an estimation of 50 million infected people and causing about 100,000 deaths per year (4).

 

The prevalence of infection is high in developing countries where transmission of E. histolytica by untreated drinking water and contaminated food is common (5). It was reported that children are the most infected persons (6). Clinical features of Entamoeba histolytica ranges from asymptomatic colonization of the large bowel to amoebic dysentery and invasive extra intestinal amebiasis, which is manifested to liver abscesses, Infection with the protozoan parasite Entamoeba histolytica caused a life threatening complication such as amoebic liver abscess (ALA) that cause inflammatory lesion of the liver (7). Additionally, significant association were reported high serum liver disease (8). In addition, Entamoeba histolytica considered to be responsible about mineral ions loss according to the presence of diarrhea because E. histolytica in patients (9). Acute diarrhea caused by intestinal amebiasis cause a loss of fluid and electrolytes which in relation cause dehydration

 

II. MATERIALS AND METHODS:

A- Studied groups:

The study carried out during the period from (from January 2017 to June 2017), the age of patients extended from (1-10) years, two studied groups were involved: - Suspected patients: Blood and stool samples were obtained from a total of 100 patients clinically with dysentery E .histolytic that had been examined and defined as suspected cases by specialized physician; the samples were collected from (collected from patient’s clinic paediatric in Shaheed Al - Sadr Teaching Hospital/Iraq, Al Zahrawi Surgical Hospitaland from the private laboratories) City of Ammaraa. Healthy Control: Blood and stool samples from a total 25 healthy control group involved from different places in Ammaraa; they were defined as healthy and no history of amoebic dysentery

 

B. Samples Collection:

Stool sample examination: Stool sample from each patient was collected in a clean, dry tight cover container and examined with a half an hour. The samples were examined for the presence of E. histolytica.

 

C. Macroscopic Examination:

It was performed by observing the consistency of stool, presence of blood, mucous and other substances.

 

D. Microscopic Examination:

For each stool sample, wet mount preparation slide was examined by one drop of normal saline and small amount of stool from different places of stool by using wooden stick, especially when blood or mucous were noticed, then mixed with normal saline and covered with cover slip, the slide was examined under the low (10x) and high power (40x) of microscope. [10].

 

E. Blood samples:

Five mL of Venus blood was obtained from each patient and collected in sterilized screw cap plastic tube, blood samples were left for 30 min. at room temperature, then centrifuge at 3000 rpm for five minute, then the serum for each sample was collected in Eppendorf tubes and stored in deep freeze at -20C° until the time for using. The current study included :

One hundred clinical patients of E. histolytica and (25) healthy control involved in the study. The levels of phosphorus and LDH was examined by spectrophotometric method according to [11]. The level of Serum elctrololyte was examined by electrolyte Analyzer method automated. The level of GGT was examined by Diemension system automated method. The level of vitamin B12 was examined by automatedcobas e411 analyzer.

 

III. STATISTICAL ANALYSIS:

The Statistical Package for Social Sciences software (SPSS, version 19, Chicago. Inc) was used for data processing and data analysis. Characteristics of subjects' variables were described using frequency distribution. A P-value of < 0.05 was considered the cut-off level for statistical significance. Analysis of Variance (ANOVA) was used to examine the impact of the variables of interest

 

IV. RESULTS:

Estimated level some biochemical parameters

Table (1) shows enzymatic lab tests according to group. GGT serum levels significantly associated with Entamoeba histolytica infection, For patient group it was (22.71±0.93) comparing to control group which was (18.72±0.97). The (LDH) serum levels patients group was significantly higher than that observed (209.91±9.1) comparing to control group which was (183.88±11.2). ((P<0.05).

 

The table below shows that there were significant different between patients and non-patients (Control group) except for phosphorus. The serum level for ionized calcium, and sodium and potassium levels (0.92±0.01mmol/L, 128.43±0.96 mmol/L and 3.29±0.07) significantly lower for patients group (P<0.05). While for phosphorus and potassium there’s no significant difference between the patients group (4.51±0.05 and the control group (4.67± 0.10) Moreover, the PH value for patients group (7.85) was significantly higher than non-patient (control group) (7.46).

 

Table (6): Enzymatic lab test values according to group (N= 125).

Lab test	Group		p-value
	Patient	(Control)
lactate dehydrogenase (LDH)	9.1±209.91	11.2±183.88	0.031*
Gamma-glutamyl transferase (GGT)	0.93±22.71	0.97±18.72	0.001*
PO4	0.05±4.51	0.10±4.67	0.231
iCa	0.01±0.92	0.02±1.16	0.000*
K+	3.29±0.07	4.05±0.11	0.000*
Na+	0.96±128.43	0.98±140.78	0.000*
PH	0.02±7.85	0.04±7.46	0.000*

Notes: All values are mean ± SE. Values determined with ANOVA (P<0.05) after adjustment for age and gender.*significant different.

 

 

 

DISCUSSION:

LDH serum levels of non-patient (control group) was significantly higher than that observed in the patients group.(12) reported that Lactate and lactate dehydrogenase (LDH) have been found to be elevated in sepsis, shock and hepatic injury.(13) recorded that Entamoeba histolytica infection induced LDH secretion in significant amount.

 

Our findings showed that GGT serum levels were significantly increased. It was reported that serum GGT associated with Entamoeba histolytica infection its activity attributed to hepatobiliary system considered as a diagnostic marker in patients with liver abscess.(14; 15). In agreement with our results.

 

Hypophosphatemia (low phosphorus) is also contributed to diarrhea. (16) reported that malabsorption and gastrointestinal losses with diarrhea induced phosphate deficiency, which is in contrast with our results that give a slightly decreased in phosphate level with no significant difference when compared with the control group. (17) agreed with our results and recorded no significant change in phosphate values in parasitic infection.

 

Our finding found that ionized calcium were significantly decreased in patients group compared with control group. This result also supported by (18) who demonstrated a significant reduction in Ca concentration according to parasite infection. (19)revealed that 48 hours after infection, ionized calcium levels were significantly decreased. (20) also found that levels of serum ionized calcium decreased in patients infected.

 

And results Potassium that there’s a significant decreased in the patient group compared with the control group for potassium level. Regarding the levels of potassium, (21) recorded no significant change in potassium with parasitic infection. While (22) agreement reported that hypokalemia was observed in patient with diarrhoea.

 

Our results revealed that the level of sodium was decreased significantly in the patient group and the control group in the sodium level (P<0.05). Fluid secretion during diarrhoea cause loss of water and salts like sodium and chloride. As agreement with our results (23) reported that excess intestinal losses due to diarrhoeal illness caused by parasites such like E. histolytica will cause dehydration and electrolyte imbalance.

 

Normal blood pH at 37°C is ranged between (7.2–7.6). Our results recorded a significantly higher pH value in the patient group (7.85) than non-patient (control group) (7.46). An explanation to this that in dehydration the fall in total body water, causes an increase in serum pH (24).And (17) investigated that mean pH of blood of animals infected with filariasis was slightly higher than those of healthy anima.

 

CONCLUSIONS:

According to the results the patients with E. histolytica infection elevated level GGT and LDH, where affected on liver tissue, also it effected on low level serum electrolyte and elevated PH.

 

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Received on 12.12.2017             Modified on 24.12.2017

Accepted on 20.01.2018           © RJPT All right reserved