Stressing a tired host: Cryptosporidium species and Helicobacter pylori infections in diabetes mellitus patients with gastrointestinal manifestations

Background: Cryptosporidium spp. and Helicobacter pylori are widespread gastrointestinal infections that appear to resist treatment in many cases. Cryptosporidiosis results in increased intestinal permeability while H. pylori causes atrophic changes in stomach, and both are opportunistic pathogens. The outcome of infection depends largely on the degree of the host immune status. Diabetes mellitus (DM) is a growing health problem in Egypt, with detrimental consequences that can affect the immune system, the gastrointestinal tract, and virtually all body systems, exposing diabetic patients to higher susceptibility to infections and intensified morbidity. Objective: The present study was designed to determine the burden of Cryptosporidium spp. and H. pylori among diabetic patients compared to non-diabetic patients attending Kasr Al Ainy hospitals. Subjects and Methods: Stool samples, demographic and clinical data were collected from 80 patients, 40 diabetics and 40 non-diabetics, with gastrointestinal manifestations. Microscopic stool examination and coproimmunoassays for the detection of Cryptosporidium spp. and H. pylori were performed for all samples. Results: Cryptosporidium spp. infection was detected in 15% of diabetics; with a frequency of 7.4% and 30.8% in patients with controlled DM and uncontrolled DM, respectively, and in 5% of non-diabetics. While H. pylori was equally detected at a rate of 60% in non-diabetic and diabetic patients (51.9% and 76.9% in patients with controlled DM and uncontrolled DM, respectively). Microscopic examination of stools revealed Blastocystis in 25% of diabetics (22.2% in controlled DM versus 30.7% in uncontrolled DM) and in 5% of non-diabetic patients. Co-infection with Cryptosporidium and H. pylori occurred in 10% of diabetic cases (3.7% in controlled DM versus 23.1% in uncontrolled DM), and in 5% of non-diabetic patients. Conclusion: Diabetic patients had a higher infection rate of Cryptosporidium as well as Blastocystis in comparison to non-diabetics. Screening for intestinal parasites is needed to control the infection and reduce morbidity in diabetics.