title: Prevalence, predictors and clinical significance of Blastocystis sp. in Sebha, Libya.
abstract: BACKGROUND
  Blastocystis sp. has a worldwide distribution and is often the most common human intestinal protozoan reported in children and adults in developing countries. The clinical relevance of Blastocystis sp. remains controversial. This study was undertaken to determine the prevalence of Blastocystis infection and its association with gastrointestinal symptoms among outpatients in Sebha city, Libya.
  
  
  METHODS
  A total of 380 stool samples were collected from outpatients attending the Central Laboratory in Sebha, Libya for routine stool examination. The presence of Blastocystis sp. was screened comparing light microscopy of direct smears against in vitro cultivation. Demographic and socioeconomic information were collected with a standardized questionnaire.
  
  
  RESULTS
  The overall prevalence of Blastocystis infection was 22.1%. The prevalence was significantly higher among patients aged ≥18 years compared to those aged < 18 years (29.4% vs 9.9%; x² = 19.746; P < 0.001), and in males compared to females (26.4% vs 17.5%; x² = 4.374; P = 0.036). Univariate analysis showed significant associations between Blastocystis infection and the occupational status (P = 0.017), family size (P = 0.023) and educational level (P = 0.042) of the participants. Multiple logistic regression analysis confirmed that the age of ≥ 18 years (OR = 5.7; 95% CI = 2.21; 9.86) and occupational status (OR = 2.2; 95% CI = 1.02, 4.70) as significant predictors of Blastocystis infection among this population. In those who had only Blastocystis infection but no other gastrointestinal parasitic infections, the prevalence of gastrointestinal symptoms was higher compared to those without Blastocystis infection (35.3% vs 13.2%; x² = 25.8; P < 0.001). The most common symptoms among these patients were abdominal pain (76.4%), flatulence (41.1%) and diarrhoea (21.5%).
  
  
  CONCLUSIONS
  Blastocystis sp. is prevalent and associated with gastrointestinal symptoms among communities in Sebha city, Libya. Age and occupational status were the significant predictors of infection. However, more studies from different areas in Libya are needed in order to delineate the epidemiology and clinical significance of this infection.
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
authors.forename: Awatif M
authors.initials: AM
authors.lastname: Abdulsalam
authors.forename: Init
authors.initials: I
authors.lastname: Ithoi
authors.forename: Hesham M
authors.initials: HM
authors.lastname: Al-Mekhlafi
authors.forename: Abdul Hafeez
authors.initials: AH
authors.lastname: Khan
authors.forename: Abdulhamid
authors.initials: A
authors.lastname: Ahmed
authors.forename: Johari
authors.initials: J
authors.lastname: Surin
authors.forename: Joon Wah
authors.initials: JW
authors.lastname: Mak
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D016844:Blastocystis / Q000302:isolation & purification*; D016776:Blastocystis Infections / Q000453:epidemiology* / Q000469:parasitology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003710:Demography; D005243:Feces / Q000469:parasitology; D005260:Female; D006801:Humans; D007223:Infant; D008002:Libya / Q000453:epidemiology; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D016273:Occupational Exposure; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult