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Open Access Research

Prevalence, predictors and clinical significance of Blastocystis sp. in Sebha, Libya

Awatif M Abdulsalam1, Init Ithoi1*, Hesham M Al-Mekhlafi15*, Abdul Hafeez Khan2, Abdulhamid Ahmed3, Johari Surin1 and Joon Wah Mak4

Author Affiliations

1 Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia

2 Department of Parasitology, Faculty of Medicine, University of Sebha, Sebha, Libya

3 Department of Biology, Faculty of Natural and Applied Sciences, Umaru Musa Yar’adua University, Katsina, Katsina State, Nigeria

4 School of Postgraduate Studies and Research, International Medical University, Bukit Jalil, Kuala Lumpur, 57000, Malaysia

5 Department of Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen

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Parasites & Vectors 2013, 6:86  doi:10.1186/1756-3305-6-86

Published: 8 April 2013

Abstract

Background

Blastocystis sp. has a worldwide distribution and is often the most common human intestinal protozoan reported in children and adults in developing countries. The clinical relevance of Blastocystis sp. remains controversial. This study was undertaken to determine the prevalence of Blastocystis infection and its association with gastrointestinal symptoms among outpatients in Sebha city, Libya.

Methods

A total of 380 stool samples were collected from outpatients attending the Central Laboratory in Sebha, Libya for routine stool examination. The presence of Blastocystis sp. was screened comparing light microscopy of direct smears against in vitro cultivation. Demographic and socioeconomic information were collected with a standardized questionnaire.

Results

The overall prevalence of Blastocystis infection was 22.1%. The prevalence was significantly higher among patients aged ≥18 years compared to those aged < 18 years (29.4% vs 9.9%; x2 = 19.746; P < 0.001), and in males compared to females (26.4% vs 17.5%; x2 = 4.374; P = 0.036). Univariate analysis showed significant associations between Blastocystis infection and the occupational status (P = 0.017), family size (P = 0.023) and educational level (P = 0.042) of the participants. Multiple logistic regression analysis confirmed that the age of ≥ 18 years (OR = 5.7; 95% CI = 2.21; 9.86) and occupational status (OR = 2.2; 95% CI = 1.02, 4.70) as significant predictors of Blastocystis infection among this population. In those who had only Blastocystis infection but no other gastrointestinal parasitic infections, the prevalence of gastrointestinal symptoms was higher compared to those without Blastocystis infection (35.3% vs 13.2%; x2 = 25.8; P < 0.001). The most common symptoms among these patients were abdominal pain (76.4%), flatulence (41.1%) and diarrhoea (21.5%).

Conclusions

Blastocystis sp. is prevalent and associated with gastrointestinal symptoms among communities in Sebha city, Libya. Age and occupational status were the significant predictors of infection. However, more studies from different areas in Libya are needed in order to delineate the epidemiology and clinical significance of this infection.

Keywords:
Blastocystis; Gastrointestinal symptoms; Sebha; Libya