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Amoebiasis; Hematology; Parasitic infection; Entamoeba

Introduction

Human infection with the protozoan intestinal parasite Entamoeba histolytica which causes Amoebiasis usually begins with ingestion of the dormant form of the organism [1]. Entamoeba histolytica spreads by the fecal-oral rout mainly in wares when water sanitation is poor [2]. Amoebiasis is a parasitic disease caused by Entamoeba histolytica (E. histolytica), an extracellular enteric protozoan. This infection mainly affects people from developing countries with limited hygiene conditions, where it is endemic. Infective cysts are transmitted by the fecal-oral route, excysting in the terminal ileum and producing invasive trophozoites (amoebae). E. histolytica mainly lives in the large intestine without causing symptoms; however, possibly as a result of so far unknown signals, the amoebae invade the mucosa and epithelium causing intestinal amoebiasis. E. histolytica possesses different mechanisms of pathogenicity for the adherence to the intestinal epithelium and for degrading extracellular matrix proteins, producing tissue lesions that progress to abscesses and a host acute inflammatory response. Much information has been obtained regarding the virulence factors, metabolism, mechanisms of pathogenicity, and the host immune response against this parasite; in addition, alternative treatments to metronidazole are continually emerging. An accessible and low-cost diagnostic method that can distinguish E. histolytica from the most nonpathogenic amoebae and an effective vaccine are necessary for protecting against amoebiasis. However, research about the disease and its prevention has been a challenge due to the relationship between E. histolytica and the host during the distinct stages of the disease is multifaceted. Intestinal parasites are endemic worldwide and have been described as constituting the greatest single worldwide cause of illness and disease. The effective prevention and control of intestinal parasitic infections requires identification of local risk factors, particularly among high-risk groups. Intestinal parasites are worms and other intestinal parasites, which infest human beings that populate the gastrointestinaltract. Children are more often infected with intestinal worms than adult. In humans, they are often spread by poor hygiene related to feces, contact with animals or poorly cooked food containing parasites. Intestinal parasitic infection affects 3.5 billion people in the world and mostly affecting the low socio-economic groups. The major groups of parasites can get into the intestine through the mouth and they move into the intestine where they can reproduce and cause disease. Health component depends upon socio-economic status, housing, hygiene i.e. Water supply, food hygiene, environmental hygiene and personal hygiene sanitation and education. A parasite is an organism, which feeds off and usually within a host body, such as our body or other living organism like plant and animals. They feed on the nutrient cells, blood and organs of the host. They reproduce by depositing thousands of eggs or simply by cells division within the host tissues and cells. Amoebiasis is a common infection of human gastrointestinal tract. It has been reported throughout India. The prevalence rate is about 15 percent ranging from 3.6 to 47.4 percent in different areas. Although it has worldwide distribution, it is a major problem in whole China, South East and West Asia, Latin America and Mexico. And it is estimated in 1997, 45 million people carried E. histolytica in their intestinal tract invasive amoebiasis. It is probable that invasive amoebiasis accounted for about 70000 deaths in the world [3]. Epidemiological studies on the prevalence of Entamoeba histolytica infection indicate that over 480 million people in the world harbor the parasite and every year about 10% of those infected show some short of clinical symptoms (dysentery, intestinal invasion) [4]. Entamoeba histolytica also causes extra intestinal diseases such as liver abbesses [5,6]. Amoebiasis is a disease of global importance caused by the eukaryotic parasite Entamoeba histolytica. It is the most common worldwide cause of mortality from protozoan after malaria, killing and estimated 40000-110000 people annually and causing 34-50 million cases of sever diseases. However, fever than 10% of those infected develop invasive amoebiasis.

Material and Methods

The Present study was carried out on human intestinal parasitic patients and few healthy subjects as control. A survey was carried out for human parasitic diseases. In the present study there were total numbers of 451 samples of stool collected for microscopic investigations. The Simple Smear in Saline and concentration methods was used to determine the stool samples. The persons having any cyst /ova / trophozoite / whole parasite were treated as parasitic positive patients. In this study hematological and biochemical effect of the gastrointestinal Entamoeba histolytica on human populations were observed. Blood samples were collected from intestinal parasitic positive patients and few healthy subjects as control from both populations for microscopic studies of samples. In the microscopic investigations hematological and biochemical investigations were examined for hematological findings (Hb, RBC, TLC, DLC, ESR, PCV, MCV, MCH and MCHC) and biochemical findings (Serum Total Protein, Serum Total Albumin, Serum Total Globulin, Serum Iron, Serum Binding Capacity, Serum Glucose and Serum Lipids) were applied during these studies. The t-Squared tests were performed.

Results and Discussion

Hematological findings

The mean level of Hemoglobin (Hb) in the patients of amoebiasis was observed as 10.4 ± 0.067* gm/dl. It was significantly higher as compared to control, Red Blood Cells (RBCs) 3.5 ± 0.031* million/ cumm. It was significantly higher than to control, Total Leucocytes Count (TLC) 8560 ± 45.73 mm3. It was lower than control. The mean level of erythrocyte sedimentation rate (ESR) was observed as 04 ± 0.709 mm in 1st hr. Packed cell volume (PCV) was 30.6 ± 0.245* percent. It was more significantly higher as compared to control, mean corpuscular volume (MCV) was observed as 87.4 ± 0.619* cubic micron and it was significantly higher as compared to control. The mean level corpuscular haemoglobin (MCH) was observed as 30 ± 0.213 picograms. Mean corpuscular concentration (MCHC) was 33.8 ± 0.178 percent. The mean level of differential counts (DLC) were observed in Polymorphs (P) 55 ± 1.58* percent it was more significant, in Lymphocytes (L) 33 ± 1.34 percent, in Eosinophils (E) 8.4 ± 0.70* percent was more significant, in Monocytes (M) 2.8 ± 0.375 percent and in Basophils (B) was observed as 0.4 ± 0.24 percent (Table 1 and Figures 1-3).

Table 1: Hematological findings in the patients of Amoebiasis
Values express as mean ± SE (n=5)
* Value significantly different from control.

Figure 1: Haematological studies showing the status of TLC in the patients of Amoebiasis.

Figure 2: Haematological studies showing the status of DLC in the patients of Amoebiasis.

Figure 3: Haematological studies showing the status of Hb, RBC, ESR, PCV, MCV, MCH and MCHC in the patients of Amoebiasis.

Biochemical findings

The mean level of Serum total protein (STP) was observed in the patients of amoebiasis as 6.5 ± 0.1 gm/dl, Serum albumin (S. A) was 3.7 ± 0.0865 gm/dl, Serum globulin (S. G) was observed as 2.8 ± 0.164 gm/ dl, Serum Iron (S I) mean level was 76.8 ± 1.160* μg/dl it was more than higher significant as compared to control, Serum iron binding capacity (SIBC) mean level was observed as 322 ± 3.48 μg/dl, and the mean level of serum of glucose (S G) was observed as 100.2 ± 2.60 mg/dl and the mean level of serum lipids was observed in the patients as 600.4 ± 6.40* mg/dl it was more significant as compared to control. It was decreased as compared to control group (Table 2, Figures 4 and 5).

Table 2: Biochemical findings in the patients of Amoebiasis
Values express as mean ± SE (n=5)
* Value significantly different from control.

Figure 4: Biochemical studies showing the status of STP, S. Albumin, S. Globulin in the patients of Amoebiasis.

Figure 5: Biochemical studies showing the status of STP, S. Albumin, S. Globulin in the patients of Amoebiasis.

It is revealed that the high prevalence of intestinal helminthes shown in the low socio-economic group. [7-14]. It is observed that the intestinal parasitic were found to be 45.5% on stool examination of 1022 children below 15 years of age resting in Udipur City. Amoebiasis topped the list (16.4%) followed by enterobius 10.8%, Giardia lamblia 9.5%, Entamoeba coli 2.8%, Hymenolopsisnana 2.7%, Trichuria trichuris 0.5% and Ancylostoma deudenale 0.3% [15]. The elevation in the count of eosinophils in the patients of amoebiasis and also described that intestinal amoebiasis shows moderate leukocytosis [16]. The relationship between socio-economic status and child mortality has been well documented [17-21]. Entamoeba histolytica is a protozoan that causes intestinal amoebiasis as well as extra intestinal manifestations. Although 90 percent of E. histolytica infections are asymptomatic, nearly 50 million people become symptomatic, with about 100,000 deaths yearly. Amebic infections are more prevalent in countries with lower socioeconomic conditions. Entamoeba histolytica is the third-leading cause of parasitic mortality globally [22] E. histolytica infection generally does not cause symptoms, but the parasite has potent pathogenic potential. The origins, benefits, and triggers of amoebic virulence are complex. Amoebic pathogenesis entails depletion of the host mucosal barrier, adherence to the colonic lumen, cytotoxicity, and invasion of the colonic epithelium. Parasite damage results in colitis and, in some cases, disseminated disease. Both host and parasite genotypes influence the development of disease, as do the regulatory responses they govern at the host-pathogen interface. Host environmental factors determine parasite transmission and shape the colonic microenvironment E. histolytica infects [23].

Conclusion

The present study is fulfilling the national needs and human health hazards which are the most urgent and serious problem to tackled at the present day conditions. This study provides the influence of unhygienic condition of the continuity of human intestinal parasitic infections in rural and urban population. The prevalence of gastrointestinal parasitic diseases in rural and urban population appears to be high due to poverty, low literacy status, standards of living, social norms, customs and open defection habits. The present study would also helpful in the designing antiparasitic agents in the terms of malnourished patients with single of concurrent infections.

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