Can Giardia Infection Impair the Diagnostic Level of Fecal Calprotectin in Patients with Inflammatory Bowel Disease? A Case Report
,
Abstract
Inflammatory bowel disease (IBD) is attributed to complex conditions of gastrointestinal tract that is frequently reported all over the world. Fecal calprotectin evaluation is described as a primary tool to screen IBD patients. There are reports showing the confounding role of some microbial agents in diagnostic levels of calprotectin. A 32-yr-old woman with symptoms like IBD/IBS (irritable bowel syndrome); admitted to IBD Clinic of Behbood Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Jan 2017 for evaluation of the level of fecal calprotectin. In spite of high level of calprotectin, trophozoite of Giardia intestinalis was observed in direct examination of stool sample. Microbial pathogens can lead to false elevation of fecal calprotectin and misdiagnosis of gastrointestinal patients suspected to IBD.
1. Feng Y, Xiao L. Zoonotic potential and molecular epidemiology of Giardia species and giardiasis. Clin Microbiol Rev. 2011; 24(1):110-40.
2. Esch KJ, Petersen CA. Transmission and epidemiology of zoonotic protozoal diseases of companion animals. Clin Microbiol Rev. 2013; 26(1):58-85.
3. Rayani M, Zasmy Unyah N, Hatam G. Molecular Identification of Giardia duodenalis Isolates from Fars Province, Iran. Iran J Parasitol. 2014;9(1):70-8.
4. Sarkari B, Hosseini G, Motazedian MH, Fararouei M, Moshfe A. Prevalence and risk factors of intestinal protozoan infections: a population-based study in rural areas of Boyer-Ahmad district, Southwestern Iran. BMC Infect Dis. 2016; 16(1):703.
5. Malekzadeh MM, Vahedi H, Gohari K et al. Emerging Epidemic of Inflammatory Bowel Disease in a Middle Income Country: A Nation-wide Study from Iran. Arch Iran Med. 2016; 19(1):2-15.
6. Safarpour AR, Hosseini SV, Mehrabani D. Epidemiology of inflammatory bowel diseases in iran and Asia; a mini review. Iran J Med Sci. 2013; 38(2 Suppl):140-9.
7. Hosseini SV, Jafari P, Taghavi SA et al. Fecal Calprotectin is an Accurate Tool and Correlated to Seo Index in Prediction of Relapse in Iranian Patients With Ulcerative Colitis. Iran Red Crescent Med J. 2015; 17(2):e22796.
8. Lee J. [Fecal Calprotectin in Inflammatory Bowel Disease]. Korean J Gastroenterol. 2016; 67(5):233-7. [Article in Korean]
9. Matowicka-Karna J. Markers of inflammation, activation of blood platelets and coagulation disorders in inflammatory bowel diseases. Postepy Hig Med Dosw (Online). 2016; 70:305-12.
10. Iborra M, Beltrán B, Nos P. Noninvasive Testing for Mucosal Inflammation in Inflammatory Bowel Disease. Gastrointest Endosc Clin N Am. 2016; 26(4):641-56.
11. Tibble JA, Sigthorsson G, Foster R et al. High prevalence of NSAID enteropathy as shown by a simple faecal test. Gut. 1999; 45(3):362-6.
12. Berni Canani R, Rapacciuolo L, Romano MT et al. Diagnostic value of faecal calprotectin in paediatric gastroenterology clinical practice. Dig Liver Dis. 2004; 36(7):467-70.
13. Chen CC, Huang JL, Chang CJ, Kong MS. Fecal calprotectin as a correlative marker in clinical severity of infectious diarrhea and usefulness in evaluating bacterial or viral pathogens in children. J Pediatr Gastroenterol Nutr. 2012; 55(5):541-7.
14. Duman M, Gencpinar P2, Biçmen M et al. Fecal calprotectin: can be used to distinguish between bacterial and viral gastroenteritis in children? Am J Emerg Med. 2015; 33(10):1436-9.
15. Johne B, Kronborg O, Tøn HI, Kristinsson J, Fuglerud P. A new fecal calprotectin test for colorectal neoplasia. Clinical results and comparison with previous method. Scand J Gastroenterol. 2001; 36(3):291-6.
16. Konikoff MR, Denson LA. Role of fecal calprotectin as a biomarker of intestinal inflammation in inflammatory bowel disease. Inflamm Bowel Dis. 2006; 12(6):524-34.
17. Bustinduy AL, Sousa-Figueiredo JC, Adriko M et al. Fecal occult blood and fecal calprotectin as point-of-care markers of intestinal morbidity in Ugandan children with Schistosoma mansoni infection. PLoS Negl Trop Dis. 2013; 7(11):e2542.
18. Munasinghe VS, Vella NG, Ellis JT, Windsor PA, Stark D. Cyst formation and faecal-oral transmission of Dientamoeba fragilis--the missing link in the life cycle of an emerging pathogen. Int J Parasitol. 2013; 43(11):879-83.
19. Kuzehkanani AB, Rezaei S, Babaei Z et al. Enteric protozoan parasites in rural areas of bandar-abbas, southern iran: comparison of past and present situation. Iran J Public Health. 2011;40(1):80-5.
20. Hatam-Nahavandi K, Mohebali M, Mahvi AH et al. Subtype analysis of Giardia duodenalis isolates from municipal and domestic raw wastewaters in Iran. Environ Sci Pollut Res Int. 2017; 24(14):12740-12747.
21. Zahedi MJ, Darvish Moghadam S, Hayat Bakhsh Abbasi M et al. The incidence rate of inflammatory bowel disease in an urban area of iran: a developing country. Middle East J Dig Dis. 2014;6(1):32-6.
22. Balaii H, Asadzadeh Aghdaei H1, Farnood A et al. Time trend analysis and demographic features of inflammatory bowel disease in Tehran. Gastroenterol Hepatol Bed Bench. 2015; 8(4):253-61.
23. Dhaliwal A, Zeino Z, Tomkins C et al. Utility of faecal calprotectin in inflammatory bowel disease (IBD): what cut-offs should we apply? Frontline Gastroenterol. 2015; 6(1):14-19.
24. Hanevik K, Hausken T, Morken MH et al. Persisting symptoms and duodenal inflammation related to Giardia duodenalis infection. J Infect. 2007; 55(6):524-30.
25. El-Gayar EK, Mokhtar AB, Hassan WA. Study of the pathogenic potential of Dientamoeba fragilis in experimentally infected mice. Parasite Epidemiol Control. 2016; 1(2):136-143.
2. Esch KJ, Petersen CA. Transmission and epidemiology of zoonotic protozoal diseases of companion animals. Clin Microbiol Rev. 2013; 26(1):58-85.
3. Rayani M, Zasmy Unyah N, Hatam G. Molecular Identification of Giardia duodenalis Isolates from Fars Province, Iran. Iran J Parasitol. 2014;9(1):70-8.
4. Sarkari B, Hosseini G, Motazedian MH, Fararouei M, Moshfe A. Prevalence and risk factors of intestinal protozoan infections: a population-based study in rural areas of Boyer-Ahmad district, Southwestern Iran. BMC Infect Dis. 2016; 16(1):703.
5. Malekzadeh MM, Vahedi H, Gohari K et al. Emerging Epidemic of Inflammatory Bowel Disease in a Middle Income Country: A Nation-wide Study from Iran. Arch Iran Med. 2016; 19(1):2-15.
6. Safarpour AR, Hosseini SV, Mehrabani D. Epidemiology of inflammatory bowel diseases in iran and Asia; a mini review. Iran J Med Sci. 2013; 38(2 Suppl):140-9.
7. Hosseini SV, Jafari P, Taghavi SA et al. Fecal Calprotectin is an Accurate Tool and Correlated to Seo Index in Prediction of Relapse in Iranian Patients With Ulcerative Colitis. Iran Red Crescent Med J. 2015; 17(2):e22796.
8. Lee J. [Fecal Calprotectin in Inflammatory Bowel Disease]. Korean J Gastroenterol. 2016; 67(5):233-7. [Article in Korean]
9. Matowicka-Karna J. Markers of inflammation, activation of blood platelets and coagulation disorders in inflammatory bowel diseases. Postepy Hig Med Dosw (Online). 2016; 70:305-12.
10. Iborra M, Beltrán B, Nos P. Noninvasive Testing for Mucosal Inflammation in Inflammatory Bowel Disease. Gastrointest Endosc Clin N Am. 2016; 26(4):641-56.
11. Tibble JA, Sigthorsson G, Foster R et al. High prevalence of NSAID enteropathy as shown by a simple faecal test. Gut. 1999; 45(3):362-6.
12. Berni Canani R, Rapacciuolo L, Romano MT et al. Diagnostic value of faecal calprotectin in paediatric gastroenterology clinical practice. Dig Liver Dis. 2004; 36(7):467-70.
13. Chen CC, Huang JL, Chang CJ, Kong MS. Fecal calprotectin as a correlative marker in clinical severity of infectious diarrhea and usefulness in evaluating bacterial or viral pathogens in children. J Pediatr Gastroenterol Nutr. 2012; 55(5):541-7.
14. Duman M, Gencpinar P2, Biçmen M et al. Fecal calprotectin: can be used to distinguish between bacterial and viral gastroenteritis in children? Am J Emerg Med. 2015; 33(10):1436-9.
15. Johne B, Kronborg O, Tøn HI, Kristinsson J, Fuglerud P. A new fecal calprotectin test for colorectal neoplasia. Clinical results and comparison with previous method. Scand J Gastroenterol. 2001; 36(3):291-6.
16. Konikoff MR, Denson LA. Role of fecal calprotectin as a biomarker of intestinal inflammation in inflammatory bowel disease. Inflamm Bowel Dis. 2006; 12(6):524-34.
17. Bustinduy AL, Sousa-Figueiredo JC, Adriko M et al. Fecal occult blood and fecal calprotectin as point-of-care markers of intestinal morbidity in Ugandan children with Schistosoma mansoni infection. PLoS Negl Trop Dis. 2013; 7(11):e2542.
18. Munasinghe VS, Vella NG, Ellis JT, Windsor PA, Stark D. Cyst formation and faecal-oral transmission of Dientamoeba fragilis--the missing link in the life cycle of an emerging pathogen. Int J Parasitol. 2013; 43(11):879-83.
19. Kuzehkanani AB, Rezaei S, Babaei Z et al. Enteric protozoan parasites in rural areas of bandar-abbas, southern iran: comparison of past and present situation. Iran J Public Health. 2011;40(1):80-5.
20. Hatam-Nahavandi K, Mohebali M, Mahvi AH et al. Subtype analysis of Giardia duodenalis isolates from municipal and domestic raw wastewaters in Iran. Environ Sci Pollut Res Int. 2017; 24(14):12740-12747.
21. Zahedi MJ, Darvish Moghadam S, Hayat Bakhsh Abbasi M et al. The incidence rate of inflammatory bowel disease in an urban area of iran: a developing country. Middle East J Dig Dis. 2014;6(1):32-6.
22. Balaii H, Asadzadeh Aghdaei H1, Farnood A et al. Time trend analysis and demographic features of inflammatory bowel disease in Tehran. Gastroenterol Hepatol Bed Bench. 2015; 8(4):253-61.
23. Dhaliwal A, Zeino Z, Tomkins C et al. Utility of faecal calprotectin in inflammatory bowel disease (IBD): what cut-offs should we apply? Frontline Gastroenterol. 2015; 6(1):14-19.
24. Hanevik K, Hausken T, Morken MH et al. Persisting symptoms and duodenal inflammation related to Giardia duodenalis infection. J Infect. 2007; 55(6):524-30.
25. El-Gayar EK, Mokhtar AB, Hassan WA. Study of the pathogenic potential of Dientamoeba fragilis in experimentally infected mice. Parasite Epidemiol Control. 2016; 1(2):136-143.
| Files | ||
| Issue | Vol 13 No 3 (2018) | |
| Section | Case Report(s) | |
| Keywords | ||
| Inflammatory bowel dis-eases Giardia intestinalis Fecal calprotectin test | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
MOHAMMAD ALI GOL S, MIRJALALI H, ASADZADEH AGHDAEI H, ZALI MR. Can Giardia Infection Impair the Diagnostic Level of Fecal Calprotectin in Patients with Inflammatory Bowel Disease? A Case Report. Iran J Parasitol. 2018;13(3):505-509.
