Evaluation of intestinal fungal and parasitic infection in iranian primary immunodeficiency patients.

BACKGROUND

Individuals with primary immunodeficiency disease (PID) often experience gastrointestinal (GI) disorders. This study investigated fungal and parasitic GI infections in Iranian patients with PID and evaluated the infectious etiology of diarrhea in these patients.

METHODS

Fifty-six stool specimens were obtained from patients with PID who were referred to the Immunology-Allergy Clinic at Rasoul Akram Hospital during the years 2023–2024. Sabouraud dextrose agar was used to culture the stool samples. After Gram-staining, the isolates were cultured on Candida chrome agar. Genomic DNA extraction was conducted, followed by PCR-RFLP analysis, and the isolates were subsequently sequenced. The samples were examined for intestinal parasitic infection using direct, concentration, and staining methods.

RESULTS

The results indicated that 22(39.3%) patients with diarrhea, including 14 with fungal and seven with parasitic infections and one mixed infection, were identified. In total, 14 out of 22 (63.6%) PID patients were positive for Candida spp, comprising eight (36.4%) C. albicans, four (18.2%) C. glabrata and two (9.1%) samples exhibiting mixed infections of C. albicans and C. glabrata using PCR-RFLP and sequencing. Among the 22 PID patients with GI symptoms, seven (31.8%) were infected with parasites, including three (13.6%) with Giardia lamblia and four (18.2%) with Blastocystis hominis and one (4.5%) mixed infection.

CONCLUSIONS

Candida may cause diarrhea in patients with primary immunodeficiency diseases (PIDs) who are undergoing treatment with certain antibiotics; however, additional research is required to assess the relationship between Candida and diarrhea. C. albicans emerged as the predominant isolate in patients with PID who exhibited intestinal Candida colonization. The intestinal protozoa identified were Giardia lamblia and Blastocystis hominis in PID patients.