Is There a Predisposition to Intestinal Parasitosis in Diabetic Patients?

doi:10.2337/diacare.24.8.1503-a

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Letters: Observations
Letter

Is There a Predisposition to Intestinal Parasitosis in Diabetic Patients?

Yasar Nazligul, MD¹, Tevfik Sabuncu, MD² and Hatice Ozbilge, MD³

¹ Department of Internal Medicine, the
² Department of Endocrinology and Metabolism, and the
³ Department of Clinical Microbiology and Parasitology, University of Harran, Faculty of Medicine, Research Hospital, Sanliurfa, Turkey

Although intestinal parasites usually create benign diseases,sometimes they may cause complications with high mortality andmorbidity (1,2). It is known that diabetic patients are moresusceptible to bacterial infections. Decreased arterial perfusion,neuropathy, and suppressed immune response in diabetes aggravatethe frequency and severity of infectious diseases (3). Lymphocyteand polymorphonuclear leukocyte functions are altered (4). Themost prominent alteration is the phagocytic functions of polymorphonuclearleukocytes (5,6). It has also been reported that candidal infectionsoccur more frequently in diabetic patients than in nondiabeticcontrol subjects (7,8). Is a similar kind of predispositionpresent against parasitic infections, particularly against theintestinal parasites in diabetic patients? There is no adequatestudy about this subject. Therefore, we assessed whether thereis a predisposition against intestinal parasites in the diabeticpopulation by comparing their prevalence in diabetic and nondiabeticindividuals living in the Sanliurfa province, which lies insoutheast Anatolia. Here, intestinal parasites are very commonbecause of the hot climate, agricultural usage of sewage, andinadequate purified drinking water.

A total of 200 diabetic (16 type 1 and 184 type 2) and 1,024nondiabetic individuals who were consecutively recruited toendocrinology and internal medicine outpatient clinics wereincluded in the present study. The diabetic group comprised72 male and 128 female patients (mean age 45.2 years, range15–79). Of the 200 diabetic patients, 26 were on insulintherapy, 106 were on oral antidiabetic agents, 21 were on dietalone, and 47 were not on therapy. The nondiabetic group comprised344 male and 680 female patients (mean age 40.0 years, range15–74). Fresh stool samples were examined macroscopically,followed by microscopic examination by native, lugol, and flotationmethods under 10x and 40x magnification. The differences betweenthe categorical variables under consideration were analyzedby ${chi}$ ² test. P < 0.05 was considered statistically significant.

Intestinal parasitosis was diagnosed in 94 of 200 patients (47%)in the diabetic group (61 women and 33 men). The distributionof the parasites found was: 57.5% Ascaris lumbricoides, 14.2%Trichuris trichura, 13.3% Entamoeba histolytica, 11.7% Giardiaintestinalis, and 3.3% tenias (T. saginata or Hymenolepis nana).In 15 patients, two or more kinds of parasites were found. Therewere no statistically significant differences with regard toincidences of intestinal parasites between male and female patients(45.8 and 47.6%, respectively) and between therapy groups. Inthe control subject group, 380 of 680 women (55.9%) and 184of 344 men (53.4%) had intestinal parasites, and 72 people hadmore than one kind of parasite. The prevalence of the parasitesdid not show significant differences between sex parasites.Ascaris lumbricoides was the most common intestinal parasitein both groups (P < 0.05). Intestinal parasite prevalencein the diabetic group was found to be significantly lower thanin the control subject group (47 vs. 55%, P < 0.05).

It has been reported that certain medications and diabetes affectimmune mechanisms in AIDS-infected patients. The patient’simmune status is relevant in determining which parasitic infectionsneed to be considered. In patients infected with HIV, specificprotozoan diseases may develop opportunistically (9). Patientswith hypogammaglobulinemia or cystic fibrosis may develop refractorygiardiasis. In patients developing symptoms of enterocolitiswhile receiving glucocorticoids, the possibility of an exacerbationof unsuspected strongyloidiasis or amebic colitis should beconsidered (10). Although several defects in the immune systemhave been reported in diabetic patients (3,4), there are insufficientdata in the literature about concordance of diabetes and intestinalparasitic diseases. In a study by Abaza et al. (11), the frequencyof opportunistic intestinal parasites was explored in four groupswith immunocomprimised hosts and was found in 31.7% of patientsunder corticosteroid therapy, in 28.8% of patients sufferingrenal failure, in 25.7% of patients with malign neoplasm, andin 8% of diabetic patients. In our study, no significant predispositionto intestinal parasitosis was observed in diabetic patients.Moreover, diabetic patients had less intestinal parasites comparedwith the general population in our endemic region. Because ofsimilar frequencies of parasites in all groups, the lower prevalenceof intestinal parasitic disease in diabetic patients did notdepend on the antidiabetic agents used (i.e., insulin, oralantidiabetic agents, diet alone, or no treatment). This lowfrequency of parasites in diabetic patients may be a resultof the fact that, because of their illness, they undergo physicalexaminations and laboratory tests more frequently than the generalpopulation in our region. The greater number of physician visitsincurred by diabetic patients may cause this lower frequencyof parasitosis.

FOOTNOTES

Address correspondence to Dr. Tevfik Sabuncu, Bahcelievler,Cengiz Topel Cad., Rahmet Apt. D:10, Sanliurfa 63100, Turkey.E-mail: sabuncut{at}ixir.com.

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