title: Prevalence and Risk Factors for Intestinal Protozoan Infections with Cryptosporidium, Giardia, Blastocystis and Dientamoeba among Schoolchildren in Tripoli, Lebanon.
abstract: BACKGROUND
  Intestinal protozoan infections are confirmed as major causes of diarrhea, particularly in children, and represent a significant, but often neglected, threat to public health. No recent data were available in Lebanon concerning the molecular epidemiology of protozoan infections in children, a vulnerable population at high risk of infection.
  
  
  RESULTS
  In order to improve our understanding of the epidemiology of intestinal pathogenic protozoa, a cross-sectional study was conducted in a general pediatric population including both symptomatic and asymptomatic subjects. After obtaining informed consent from the parents or legal guardians, stool samples were collected in January 2013 from 249 children in 2 schools in Tripoli, Lebanon. Information obtained from a standard questionnaire included demographic characteristics, current symptoms, socioeconomic status, source of drinking water, and personal hygiene habits. After fecal examination by both microscopy and molecular tools, the overall prevalence of parasitic infections was recorded as 85%. Blastocystis spp. presented the highest infection rate (63%), followed by Dientamoeba fragilis (60.6%), Giardia duodenalis (28.5%) and Cryptosporidium spp. (10.4%). PCR was also performed to identify species and genotypes of Cryptosporidium, subtypes of Blastocystis, and assemblages of Giardia. Statistical analysis using a logistic regression model showed that contact with family members presenting gastrointestinal disorders was the primary risk factor for transmission of these protozoa.
  
  
  CONCLUSIONS
  This is the first study performed in Lebanon reporting the prevalence and the clinical and molecular epidemiological data associated with intestinal protozoan infections among schoolchildren in Tripoli. A high prevalence of protozoan parasites was found, with Blastocystis spp. being the most predominant protozoans. Although only 50% of children reported digestive symptoms, asymptomatic infection was observed, and these children may act as unidentified carriers. This survey provides necessary information for designing prevention and control strategies to reduce the burden of these protozoan infections, especially in children.
authors.affiliation: Institut Pasteur de Lille, Centre d’Infection et d’Immunitè de Lille (CIIL), UMR CNRS 8204, Inserm U1019, Université de Lille, Biologie et Diversitè des Pathogènes Eucaryotes Emergents (BDPEE), Lille, France.|Centre AZM pour la recherche en biotechnologies et ses applications, Universitè Libanaise, Laboratoire de Microbiologie Santè et Environnement (LMSE), Tripoli, Lebanon.|Faculté de Santé Publique, Université Libanaise, Beirut, Lebanon.
authors.forename: Marwan
authors.initials: M
authors.lastname: Osman
authors.affiliation: Institute Pasteur de Lille, Centre d'Infection et d'Immunitè de Lille (CIIL), UMR CNRS 8204, Inserm U1019, Université de Lille, Biologie et Diversitè des Pathogènes Eucaryotes Emergents (BDPEE), Lille, France.|Centre AZM pour la recherche en biotechnologies et ses applications, Universitè Libanaise, Laboratoire de Microbiologie Santè et Environnement (LMSE), Tripoli, Lebanon.|Faculté de Santé Publique, Université Libanaise, Beirut, Lebanon.
authors.forename: Dima
authors.initials: D
authors.lastname: El Safadi
authors.affiliation: Institute Pasteur de Lille, Centre d'Infection et d'Immunitè de Lille (CIIL), UMR CNRS 8204, Inserm U1019, Université de Lille, Biologie et Diversitè des Pathogènes Eucaryotes Emergents (BDPEE), Lille, France.
authors.forename: Amandine
authors.initials: A
authors.lastname: Cian
authors.affiliation: Institute Pasteur de Lille, Centre d'Infection et d'Immunitè de Lille (CIIL), UMR CNRS 8204, Inserm U1019, Université de Lille, Biologie et Diversitè des Pathogènes Eucaryotes Emergents (BDPEE), Lille, France.|Facultè Libre des Sciences et Technologies de Lille, Universitè Catholique de Lille, Universitè de Lille, Laboratoire Ecologie et Biodiversitè, Lille, France.
authors.forename: Sadia
authors.initials: S
authors.lastname: Benamrouz
authors.affiliation: Clermont Université, Université Blaise Pascal-Université d'Auvergne-CNRS, UMR 6023 Laboratoire Microorganismes: Génome et Environnement, Clermont-Ferrand, France.|Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Gabriel-Montpied, Clermont-Ferrand, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Nourrisson
authors.affiliation: Clermont Université, Université Blaise Pascal-Université d'Auvergne-CNRS, UMR 6023 Laboratoire Microorganismes: Génome et Environnement, Clermont-Ferrand, France.|Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Gabriel-Montpied, Clermont-Ferrand, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Poirier
authors.affiliation: CHU Clermont-Ferrand, Unité de Biostatistiques, Direction de la Recherche Clinique, Clermont-Ferrand, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.affiliation: EA 3800, Université de Rouen & Centre Hospitalier Universitaire Charles Nicolle, Rouen, France.
authors.forename: Romy
authors.initials: R
authors.lastname: Razakandrainibe
authors.affiliation: Institute Pasteur de Lille, Unité de Sécurité Microbiologique, Lille, France.
authors.forename: Anthony
authors.initials: A
authors.lastname: Pinon
authors.affiliation: CHU Clermont-Ferrand, Unité de Biostatistiques, Direction de la Recherche Clinique, Clermont-Ferrand, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Lambert
authors.affiliation: Clermont Université, Université Blaise Pascal-Université d'Auvergne-CNRS, UMR 6023 Laboratoire Microorganismes: Génome et Environnement, Clermont-Ferrand, France.
authors.forename: Ivan
authors.initials: I
authors.lastname: Wawrzyniak
authors.affiliation: Centre AZM pour la recherche en biotechnologies et ses applications, Universitè Libanaise, Laboratoire de Microbiologie Santè et Environnement (LMSE), Tripoli, Lebanon.|Faculté de Santé Publique, Université Libanaise, Beirut, Lebanon.
authors.forename: Fouad
authors.initials: F
authors.lastname: Dabboussi
authors.affiliation: Clermont Université, Université Blaise Pascal-Université d'Auvergne-CNRS, UMR 6023 Laboratoire Microorganismes: Génome et Environnement, Clermont-Ferrand, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Delbac
authors.affiliation: EA 3800, Université de Rouen & Centre Hospitalier Universitaire Charles Nicolle, Rouen, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Favennec
authors.affiliation: Centre AZM pour la recherche en biotechnologies et ses applications, Universitè Libanaise, Laboratoire de Microbiologie Santè et Environnement (LMSE), Tripoli, Lebanon.|Faculté de Santé Publique, Université Libanaise, Beirut, Lebanon.
authors.forename: Monzer
authors.initials: M
authors.lastname: Hamze
authors.affiliation: Institute Pasteur de Lille, Centre d'Infection et d'Immunitè de Lille (CIIL), UMR CNRS 8204, Inserm U1019, Université de Lille, Biologie et Diversitè des Pathogènes Eucaryotes Emergents (BDPEE), Lille, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Viscogliosi
authors.affiliation: Institute Pasteur de Lille, Centre d'Infection et d'Immunitè de Lille (CIIL), UMR CNRS 8204, Inserm U1019, Université de Lille, Biologie et Diversitè des Pathogènes Eucaryotes Emergents (BDPEE), Lille, France.|Département de la Recherche Médicale, Groupement des Hôpitaux de l'Institut Catholique de Lille, Faculté de Médecine et Maïeutique, Université Catholique de Lille, France.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Certad
mesh_terms: D000293:Adolescent; D000818:Animals; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005243:Feces / Q000469:parasitology*; D005260:Female; D006801:Humans; D007411:Intestinal Diseases, Parasitic / Q000453:epidemiology*; D007861:Lebanon / Q000453:epidemiology; D008297:Male; D008969:Molecular Sequence Data; D010271:Parasites / Q000145:classification* / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D015995:Prevalence; D011528:Protozoan Infections / Q000453:epidemiology*; D012307:Risk Factors; D012574:Schools; D017422:Sequence Analysis, DNA; D011795:Surveys and Questionnaires