Cross-sectional study of parasitic causes of diarrhea in patients visiting a university hospital in Jeddah, Saudi Arabia


  • Haytham Ahmed Zakai Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, P.O. Box-80324, Jeddah-21589, Kingdom of Saudi Arabia.


Diarrhea, Intestinal parasites, Cardiovascular disorders, Ziehl-Neelsen stain


Diarrhea is considered a global health problem and a major mortality cause in children less than 5 years of age. Infectious diarrhea is usually associated with morbidity in the form of intestinal dysfunction and malnutrition. One of the major causes of diarrhea is intestinal parasitic infections. In this study, we investigate the parasitic causes of diarrhea in patients visiting King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia during 2014. A total of 627 stool samples was received during 2014 at the Parasitology lab for stool analysis. Samples were analyzed using the formalin-ethyl acetate concentration technique and a direct smear was performed for all diarrheic samples. A thick smear was prepared from all diarrheic specimens and permanently stained with a modified Ziehl-Neelsen staining procedure to look for the presence of Cryptosporidium. Four hundred and eighty (76.6%) specimens were negative for intestinal parasites and 88 (14%) non-diarrheic specimens were positive for intestinal parasites. Fifty-nine (9.4%) specimens were diarrheic and 30 of them had intestinal parasites. The most frequent parasites seen in diarrheic samples were Giardia lamblia (28.8%) and Entamoeba histolytica (10.2%). Cryptosporidium was found in only 2 (3.4%) diarrheic specimens. The Results of this work recommend the establishment of a high standard sewage system to provide a better quality of life.


Download data is not yet available.


[1]. Thillainayagam, A.V. (2003). Diarrhoea. Medicine, 31: 45-51.
[2]. Thapar, N. and Sanderson, I.R. (2004). Diarrhoea in children: an interface between developing and developed countries. Lancet, 363: 641-653.
[3]. Hamilton, A.C. and Auron, M. (2013). Diarrhea. Hospital Medicine Clinics, 2(2): e277-e246.
[4]. Tinuade, O., John, O., Saheed, O., Oyeku, O., Fidelis, N. and Olabisi, D. (2006). Parasitic etiology of childhood diarrhea. Indian Journal of Pediatrics, 73(12): 1081-1084.
[5]. Mukhopadhyay, C., Wilson, G., Pradhan, D. and Shivananda, P.G. (2007). Intestinal protozoal infestation profile in persistent diarrhea in children below age 5 years in western Nepal. Southeast Asian Journal of Tropical Medicine and Public Health, 38(1):13-19.
[6]. Platts-Mills, J.A., Liu, J. and Houpt, E.R. (2013). New concepts in diagnostics for infectious diarrhea. Mucosal Immunology, 6(5): 876-885.
[7]. Swierczewski, B.E., Odundo, E.A., Koech, M.C., Ndonye, J.N., Kirera, R.K., Odhiambo, C.P., Cheruiyot, E.K., Wu, M.T., Lee, J.E., Zhang, C., Oaks, E.V. (2013). Surveillance for enteric pathogens in a case-control study of acute diarrhea in Western Kenya. Transaction of the Royal Society of Tropical Medicine and Hygiene, 107: 83-90.
[8]. Fagundes-Neto, U. (2013). Persistent diarrhea: still a serious public health problem in developing countries. Current Gastroenterology Reports, 15 (9): 345, doi: 10.1007/s11894-013-0345-1.
[9]. AL-Kubaisy, W., AL-Talib, H., Al-khateeb, A. and Shanshal, M.M. (2014). Intestinal Parasitic Diarrhea among Children in Baghdad-Iraq. Tropical Biomedicine, 31(3): 499–506.
[10]. Dinesen, L. and Harbord, M. (2013). Acute diarrhea. Medicine, 41: 104-107.
[11]. Qadri, S.M. (1990). Infectious diarrhea: Managing a misery that is still worldwide. Postgraduate Medicine, 88(5): 169-175.
[12]. Klein, E.J., Boster, D.R., Stapp, J.R., Wells, J.G., Qin, X., Clausen, C.R., Swerdlow, D.L., Braden, C.R., Tarr, P.I. (2006). Diarrhea Etiology in a Children’s Hospital Emergency Department: A Prospective Cohort Study. Clinical Infectious Diseases, 43:807–813.
[13]. Kaiser, L. and Surawicz, C.M. (2012). Infectious causes of chronic diarrhea. Best Practice & Research Clinical Gastroenterology, 26: 563–571.
[14]. Rim, H.J., Chai, J.Y., Min, D.Y., Cho, S.Y., Eom, K.S., Hong, S.J., Sohn, W.M., Yong, T.S., Deodato, G., Standgaard, H., Phommasack, B., Yun, C.H., Hoang, E.H. (2003). Prevalence of intestinal parasite infections on a national scale among primary school children in Laos. Parasitology Research, 91: 267-272.
[15]. Mahdi, N.K. and Ali, N.H. (2004). Cryptosporidiosis and other intestinal parasitic infections in patients with chronic diarrhea. Saudi Medical Journal, 25(9): 1204-1207.
[16]. Dib, H.H., Lu, S.Q. and Wen, S.F. (2008). Prevalence of Giardia lamblia with or without diarrhea in South East, South East Asia and the Far East. Parasitology Research, 103: 239-251.
[17]. Haque, R., Mondal, D., Karim, A., Molla, I.H., Rahim, A., Faruque, A.S., Ahmad, N., Kirkpatrick, B.D., Houpt, E., Snider, C., Petri, W.A. Jr. (2009). Prospective Case-Control Study of the Association between Common Enteric Protozoal Parasites and Diarrhea in Bangladesh. Clinical Infectious Diseases, 48:1191–1197.
[18]. Mousa, K.M., Abdel-Tawab, A.H., Khalil, H.H. and El-Hussieny, N.A. (2010). Diarrhea due to parasites particularly Cryptosporidium parvum in great Cairo, Egypt. Journal of the Egyptian Society of Parasitology, 40(2): 439-450.
[19]. Shah, M., Tan, C.B., Rajan, D., Ahmed, S., Subramani, K., Rizvon, K. and Mustacchia, P. (2012). Blastocystis hominis and Endolimax nana Co-Infection Resulting in Chronic Diarrhea in an Immunocompetent Male. Case Reports in Gastroenterology, 6(2): 358-364.
[20]. Kurniawan, A., Dwintasari, S.W., Connelly, L., Nichols, R.A., Yunihastuti, E., Karyadi, T., Djauzi, S. (2013). Cryptosporidium species from human immunodeficiency-infected patients with chronic diarrhea in Jakarta, Indonesia. Annals of Epidemiology, 23 (11): 720-723.
[21]. Dash, M., Padhi, S., Panda, P. and Parida, B. (2013). Intestinal protozoans in adults with diarrhea. National American Journal of Medical Sciences, 5(12): 707-712.
[22]. Hegazi, M.A., Patel, T.A., El-Deek, B.S. (2013). Prevalence and characters of Entamoeba histolytica infection in Saudi infants and children admitted with diarrhea at 2 main hospitals at south Jeddah: a re-emerging serious infection with unusual presentation. The Brazilian Journal of Infectious Diseases, 17(1): 32-40
[23]. Hawash, Y., Dorgham, L. Sh., Al-Hazmi, A.S., Al-Ghamdi, M.S. (2014). Prevalence of Cryptosporidium-Associated Diarrhea in a High Altitude–Community of Saudi Arabia Detected by Conventional and Molecular Methods. Korean Journal of Parasitology, 52(5): 479-485.
[24]. Nazeer, J.T., El Sayed Khalifa, K., von Thien, H., El-Sibaei, M.M., Abdel-Hamid, M.Y., Tawfik, R.A., Tannich, E. (2013). Use of multiplex real-time PCR for detection of common diarrhea causing protozoan parasites in Egypt. Parasitology Research, 112:595–601.
[25]. Mukherjee, A.K., Chowdhury, P., Rajendran, K., Nozaki, T. and Ganguly, S. (2014). Association between Giardia duodenalis and coinfection with other diarrhea-causing pathogens in India. BioMed Research International, in press.
[26]. Cheesbrough, M. (1992). Medical laboratory manual for tropical countries. 2nd edition. Cambridge: ELBS with Tropical Health technology/Butterworth-Heinemann.
[27]. Casemore, D.P., Armstrong, M. and Sands, R.L. (1985). Laboratory diagnosis of cryptosporidiosis. Journal of Clinical Pathology, 38: 1337-1341.
[28]. Zakai, H.A. (2004). Intestinal parasitic infections among primary school children in Jeddah, Saudi Arabia. Journal of the Egyptian Society of Parasitology, 34(3): 783-790.
[29]. Zakai, H.A. and Barnawi, H.I. (2014). Prevalence of Cryptosporidium and Giardia lamblia in water samples from Jeddah and Makkah cities. Journal of Advanced Laboratory Research in Biology, 5(1): 12-17.
[30]. Norman, G., Pedley, S. and Takkouche, B. (2010). Effects of sewerage on diarrhoea and enteric infections: a systematic review and meta-analysis. Lancet Infectious Diseases, 10: 536–544.
[31]. Ben Ayed, L., Schijven, J., Alouini, Z., Jemli, M. and Sabbahi, S. (2009). Presence of parasitic protozoa and helminth in sewage and efficiency of sewage treatment in Tunisia. Parasitology Research, 105: 393-406.




How to Cite

Zakai, H. A. (2015). Cross-sectional study of parasitic causes of diarrhea in patients visiting a university hospital in Jeddah, Saudi Arabia. Journal of Advanced Laboratory Research in Biology, 6(2), 46–48. Retrieved from