Abstract
BACKGROUND: Chronic/persistent diarrhea due to parasites is emerging. However, majority of the studies document the causes of acute diarrhea. This cross-sectional study was undertaken to determine the occurrence of intestinal parasites in persistent/chronic diarrhea. MATERIALS AND METHODS: A single diarrheal stool sample from adults with diarrhea >2 weeks were collected for wet mount examination. Patients with prior intake of antiparasitic agents, with cytomegalovirus (CMV), fungal, and bacterial causes of diarrhea, and those with multiple comorbidities were excluded. Modified acid-fast staining was performed for oocysts. Polymerase chain reaction (PCR) for CMV was performed to exclude CMV diarrhea. PCR for Giardia lamblia, Ancylostoma duodenale, Ascaris, Cryptosporidium spp., Strongyloides stercoralis, and Entamoeba spp. was performed through multiplex and nested multiplex protocols, respectively. Results were statistically analyzed using Chi-square and analysis of variance. RESULTS: A total of 204 cases of chronic/persistent diarrhea, 115 (56.4%) males and 89 (43.6%) females with a mean age of 38.93 ± 16.0 years were studied. Majority (134, 65.7%) had diarrhea with inflammatory bowel disease (IBD) (P = 0.001). Cysts of Entamoeba spp. (Entamoeba histolytica) in 8 (3.9%) and 12 (5.8%) while cysts of G. lamblia were detected in 8 (3.9%) and 10 (4.9%) through microscopy and PCR, respectively. The detection of parasites was significantly higher with PCR (P = 0.0001). None of the samples showed the presence of helminths. CONCLUSIONS: The study revealed 10.7% (E. histolytica, 5.8% and G. lamblia, 4.9%) occurrence of parasitic infections in adults with persistent/chronic diarrhea. It was significantly associated with IBD. The combination of both methods can increase the accuracy of detection.