Protozoan infections are under-recognized in Swedish patients with gastrointestinal symptoms
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ORIGINAL ARTICLE
Protozoan infections are under-recognized in Swedish patients with gastrointestinal symptoms Jessica Ögren 1,2
&
Olaf Dienus 1 & Jessica Beser 3 & Anna J. Henningsson 1 & Andreas Matussek 1,2,4
Received: 31 March 2020 / Accepted: 29 June 2020 # The Author(s) 2020
Abstract In acute gastroenteritis (GE), identification of the infectious agent is important for patient management and surveillance. The prevalence of GE caused by protozoa may be underestimated in Swedish patients. The purpose was to compare the prevalence of E. histolytica, Cryptosporidium spp., G. intestinalis, and C. cayetanensis in samples from patients where the clinician had requested testing for gastrointestinal parasites only (n = 758) to where testing for bacterial GE only (n = 803) or where both parasite and bacterial testing (n = 1259) was requested and a healthy control group (n = 197). This prospective cohort study was conducted in Region Jönköping County, Sweden (October 2018–March 2019). Fecal samples were analyzed with microscopy and real-time PCR. Cryptosporidium spp. was detected in 16 patients in the bacterial GE group and in 13 in the both bacterial and parasite group; no cases were detected in the group were only parasite infection was suspected. C. cayetanensis was detected in two patients in the bacterial GE group. One case of E. histolytica was detected in the bacterial group and one in the both bacterial and parasite group. G. intestinalis was detected in 14 patients in the parasite only group, 12 in the both parasite and bacterial group, three in the bacterial GE group, and one in the control group. Diarrhea caused by protozoa, especially Cryptosporidium was under–recognized by clinicians and is likely more common than hitherto estimated in Sweden. A more symptom-based diagnostic algorithm may increase detection and knowledge about protozoan infections. Keywords Gastroenteritis . Diagnostics . Entamoeba histolytica . Cryptosporidium . Cyclospora cayetanensis . Giardia intestinalis
Introduction In cases of acute gastroenteritis (GE), identification of the infectious agent can be of importance for patient management and for surveillance leading to early discovery of potential outbreaks that can be harmful for individuals and the community. The prevalence of the diarrhea-causing intestinal protozoa such * Jessica Ögren [email protected] 1
Clinical Microbiology, Region Jönköping County, Sweden and Department of Health, Medicine and Caring, Linköping University, Linköping, Sweden
2
Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
3
Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden
4
Division of Laboratory Medicine, Oslo University Hospital, Oslo, Norway
as Giardia intestinalis (G. intestinalis), Cryptosporidium spp, Cyclospora cayetanensis (C. cayetanensis), and Entamoeba histolytica (E. histolytica) in a low-risk country like Sweden is not well understood, and several factors like methodology, geographical setting,
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