شيوع عوامل انگلي و قارچي روده در بيماران همودياليزي شهر اصفهان

The Prevalence of Intestinal Parasitic and Fungal Agents in Hemodialysis Patients in Isfahan

بيماران مبتلا به نارسايي مزمن كليه و تحت همودياليز، به واسطه ي اختلال در عملكرد لكوسيت ها و كاهش تعداد آن ها، اختلال در پاسخ هاي ايمنولوژيك مانند فاگوسيتوز و كموتاكسي و نيز اختلال در عملكرد كمپلمان دچار ضعف سيستم ايمني بوده، مستعد ابتلا به عفونت هاي فرصت طلب مي باشند. در زمينه ي شيوع عفونت هاي انگلي و قارچي روده در بيماران تحت همودياليز مطالعات محدودي وجود دارد و با همين هدف، اين بررسي انجام شد. روش ها: 330 نمونه ي مدفوع از بيماران مبتلا به نارسايي مزمن كليه كه تحت همودياليز بودند، جمع آوري شد. پس از ثبت مشخصات بيماران در پرسش نامه، بر روي هر نمونه ي جمع آوري شده آزمايشات مستقيم، تغليظ، رنگ آميزي وكشت با روش هاي آزمايشگاهي ويژه انجام گرفت. نتيجه گيري: نظر به اين كه ميزان شيوع عفونت هاي انگلي و قارچي روده در بيماران تحت همودياليز از درصد به نسبت بالايي برخوردار است، به پزشكان و متخصصان نفرولوژي پيشنهاد مي شود كه قبل از تجويز داروهاي مختلف، بيمار را از نظر عفونت هاي انگلي و قارچي روده مورد آزمايش كلينيكي قرار دهند. همچنين توصيه مي شود كه آزمايش مدفوع از نظر بررسي ميكروسكوپي و كشت جزء آزمايشات بيماران مبتلا به نارسايي مزمن كليه كه قرار است تحت پيوند كليه قرار گيرند، در نظر گرفته شود تا در صورت وجود عوامل عفوني، بيماران به سرعت تحت مراقبت و درمان قرار گيرند.

Background: Patients with chronic renal failure and hemodialysis impaired their immunological responses such as phagocytosis and chemotaxi and also, complement dysfunction due to leukocyte dysfunction and reduced number. Therfor they are susceptible to opportunistic infections. The studies on intestinal parasitic and fungal infections in patients with hemodialysis are few. This study was done to investigate the frequency of parasitic and fungal infections in these patients. Methods: This study was a cross-sectional study. 330 stool samples from hemodialysis patients with chronic renal failure were collected. After recording the patient profile in questionnaire, different tests was performed with specific laboratory methods. Finding: The prevalence of intestinal parasites and fungi in hemodialysis patients were 23.9 and 36.1%, respectively. Endolymax Nana (6.4 %) and Geotricum Candidom (10.9 %) were the most common fungi and parasite in hemodialysis patients. The highest rate of intestinal parasites and fungi were reported in the age groups of 65-51 years (29.7 %) and older than 65 years (60.3 %). Between age and prevalence of intestinal parasites and fungi was significant relationship (P = 0.002 and P = 0.004, respectively). There was no significant relationship between gender and the prevalence of intestinal parasitic infections (P = 0.184), while the relation of incidence of fungal infections and gender was significant (P = 0.028). There was significant relationship between the prevalence of intestinal parasitic and fungal infections and the duration of dialysis and health status (P < 0.05) but with Location subjects no significant relationship was found (P > 0.05). The most common digestive symptom was constipation and then, abdominal bloating was reported. Conclusion: Considering that the prevalence of intestinal parasitic and fungal infections in patients undergoing hemodialysis is high, it is recommended to evaluate hemodialysis patients for intestinal parasitic and fungal infections before drug prescription. Furthermore, the microscopic examination of stool culture and component tests of patients with chronic renal failure undergoing kidney transplantation should be considered.