الفهرس 
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Abstract
Diabetes mellitus is one of the most frequent metabolic diseases worldwide especially among obese and carbohydrate-rich food consumers. DM results in immune-suppression through various ways causing increase in susceptibility to various infections including bacterial, viral, fungal and opportunistic helminthic and protozoan infections.
Intestinal parasites are one of the most widespread causes of human infections worldwide. Although parasitic infections usually create benign diseases, some of them gained increased attention as important opportunistic pathogens in immunosupressed patients where they can cause severe manifestations.
The present study was done to detect common intestinal parasitic infections in patients with DM in comparison with non–diabetic individuals as a control group and to estimate the risk factors involved in the acquisition of intestinal parasitic infection.
This study was conducted on 200 individuals attending the Outpatient Clinics and Internal Departments of Beni-Suef University Hospital. The studied population was divided into two groups (100 diabetic patients and 100 healthy non-diabetic individuals as controls). A structural questionnaire sheet was used to collect the subjects’ socio-demographic characteristics and their clinical and laboratory data.
Fresh stool specimens were collected from the study groups. Each stool sample from the two groups was subjected to direct wet smear examination, formol-etheyl acetate concentration technique, permanent staining using modified Ziehl Neelsen stain for detection of acid fast protozoa and modified trichrome stain ”Ryan Blue modification” for detection of Microsporidia spores and culture on nutrient agar plates for detection of Strongyloides stercoralis or hookworm larvae.
The prevalence of intestinal parasites was higher in diabetic patients (44%) than in the control group (32%) but this difference was non-significant (P-value=0.08). The most prevalent parasite was B. hominis. It was detected in (25%) of the studied population followed by Cryptosporidium spp. (8.5%), G. lamblia (8%), H. nana (3%), Microsporidia spp. (2.5%), E. histolytica/dispar (2%) and the least prevalent parasite was C. philippinensis (1.5%). Strongyloides stercoralis, C. cayetanensis and I. belli were detected neither in cases nor in controls.
No statistical significance was detected in any of the intestinal parasites between diabetic cases and controls except for Microsporidia spp. Single parasitic infection was detected in 68.4% of cases, while mixed parasitic infections was detected in 31.6% of cases nearly equal in both diabetic and control group.
As regard association of different risk factors of acquiring intestinal parasites in diabetic patients by univariate analysis, intestinal parasitic infections were more prevalent in patients aged ≥ 41 years old (61.4%) with significant statistical value (P-value=0.016). Also, intestinal parasites were higher in females diabetics (63.6%) than males (36.4%) but this difference was statistically insignificant (P-value=0.632). Results showed significantly more parasitic infection in diabetic patients inhabiting rural areas (77.3%) than urban ones (22.7%) (P-value=0.035). While, level of education, occupation, source of water supply and sewage system were not significantly associated with intestinal parasitic infections (P-value=0.407, 0.099, 0.285, 0.592, respectively).
While, multivariate analysis of different risk factors of acquiring intestinal parasites among diabetic group showed that the residence affects intestinal parasites acquisition in diabetic patients (P-value=0.04). Rural residence increases the risk of infection compared to urban residence when all other risk factors are constant.
Among diabetic patients, intestinal parasites were higher in uncontrolled patients (77.3%) than controlled ones (22.7%) with statistically significant value (P-value=0.014). Also, the presence of complications was significantly associated with the prevalence of intestinal parasitic infections (P-value=0.043) where intestinal parasites were higher in complicated cases (79.5%) than uncomplicated ones (20.5%). However, the prevalence of intestinal parasites was higher in patients treated with oral hypoglycemic than in patients treated with insulin, yet this difference was statistically insignificant (P-value=0.66).
As regard gastrointestinal manifestations presented in the diabetic patients, intestinal parasites were highly associated with diarrhea and flatulence (P-value<0.001 and =0.042, respectively).
So, patients with DM are at higher risk of infection with intestinal parasites than normal population. Also, B. hominis is an important parasitic infection which can cause gastrointestinal symptoms.