Alteration of Serum Lipid Profiles among Amoebasis and Giardiasis Confirmed Patients at North West Ethiopia

doi:10.21203/rs.3.rs-4292224/v1

Background: Amoebiasis and giardiasis, common intestinal infections caused by Entamoeba histolytica and Giardia lamblia parasite. These agents are dependent of host-derived lipids for their membrane biogenesis and potentially alter host serum lipid profiles, might results in cardiovascular complications. Yet, limited studies have investigated the association between the infections and lipid profiles in Ethiopia.

Methods: A cross-sectional study was conducted from July 10 to August 252023. A total of 180 study participants were recruited using a convenient sampling technique. Socio-demographic and clinical data were collected using structured questionnaires via face-to face interviews and reviewing medical records, respectively. Approximately 5 grams of stool samples were collected and examined under a light microscope. Three milliliters of blood were collected from the case and control groups. The blood samples were then centrifuged to separate the serum from the whole blood. Subsequently, the lipid profiles were analyzed using a Coulter chemistry analyzer. The data were entered into epidata version (4.6), and exported into SPSS (25) for analysis. The lipid profile parameters of case were assessed and compared with healthy control groups using one way ANOVA. A P-value < 0.05 was considered as statistically significant.

Result: The study showed that E. histolytica/dispar-infected patients had significantly lower mean serum total cholesterol (120.21 ± 40.11), HDL (33.73 ± 13.36), and LDL (74.63 ± 32.93) levels compared to healthy groups. Additionally, the median interquartile range of triglyceride value decreased in E. histolytica/dispar infected patients (P ≤ 0.05). Likewise, patients infected with G. lamblia had lower mean serum total cholesterol (123.46 ± 48.18), HDL (34.30 ± 14.30), and LDL (73.57 ± 42.65) levels compared to healthy groups. Also, the median interquartile range of triglyceride value was lower in Giardia-infected patients (P≤0.05).

Conclusion: This study confirmed that E. histolytica/dispar and G. lamblia has significantly altered blood lipid levels in infected patients. Requires routine lipid panel analysis for these cohorts.

Lipid profiles

Alteration

Gardiaisis

Amoebasis

Sanja

Northwest Ethiopia

According to Global Burden of Diseases(GBD) report, intestinal protozoan parasite (IPPS), remains the third leading causes of human death worldwide (1, 2). This infections pose significant public health problems mainly under-resourced countries with poor water and food sanitations practice (3). Amebiasis and Giardiasis are the two most common food-borne protozoan infections of upper and lower gastro-intestinal tract(GIT) (4, 5). These are caused by the Entamoeba histolytica/dispar (E. histolytica/ dispar),and Giardia lamblia (G. lamblia) protozoan parasites respectively (6, 7). Both pathogen are characterized by bi-morephic life forms, cyst ( infective/ non-feeding), and trophozoite, (pathogenic/ feeding) stages (8, 9). A diseases formation of these parasite is related with effect of trophozoite attachment to upper portion of small intestine, and their protolytic enzymes (cysteine proteases and glycosidases) (10, 11). This increases rate of enterocyte apoptosis, loss of barrier function, leading to lymphocyte-mediated microvillus shortening and reduction of absorptive surface area, ultimately are responsible for mal-digestion and malabsorption of nutrients (12-14). In acute clinical stages, are almost clinically overlapping that characterized by fever, watery diarrhea and other intestinal disorders (6, 15). Although, majority of gardiasis and amoebiasis are self resolving, yet in some case both result in chronic infection. Thus, the infected populations is might end-up with deficiency of vital caloric source (carbohydrate, protein), normal hemoglobin level, and lipid soluble vitamins (K, A, D, E) (15, 16). Moreover, several experimental finding indicates that both parasites are unable to synthesize their own lipids and cholesterol de novo, due to lack mitochondria, Golgi complexes, and other organelles typical of higher eukaryotes (17). Thus, trophozoite of both parasite species has been suggested to change lipid host transporters lets luminal fat buildup by impairing fat absorptions to circulatory systems (18-21). Besides, the trophozoite stage scavenges host lipids/ fate molecules via endocytic and non-endocytic pathways for the neutrition, survival mechanism, energy production, and membrane biosynthesis (12, 19). This direct to lipid metabolic abnormalities(hypolipidemia) which is characterized by change in blood total cholesterols (TC), triglycerides (TG), low levels of high-density lipoprotein cholesterol (HDL) and high levels of low-density lipoprotein cholesterol (LDL) levels (22). As result, individuals infected with both parasites might end-up with development of majorly cardiovascular diseases, atherosclerosis, stroke (23), and rarely infertility, rickets, osteoporosis, diabetes, Alzheimer’s, and inflammatory bowel disease (24, 25). Even if the chronic infection of both parasite are suggested to cause cardio and non -cardiovascular complications, the scholars research attention is still limited in this area. Moreover, existing studies regarding effect of giardiasis, and amoebiasis in the lipid panels (TC,TG, HDL, LDL) of infected patients reveals controversial results (16, 26). Yet, despite the high magnitude of giardiasisand amoebasisin Ethiopia (27, 28), there is no published evidence that investigated relationship between serum lipid profile and G. lamblia or E. histolytica infection and our study amide to fill this information gapes. The study finding in alteration of lipid profile would be helpful for the management E. histolytica or G. lamblia infectionassociated metabolic syndromes. It might create a better insights/awareness for policymakers and health organizations to plan prevention and intervention measures as well as to prepare improved health care service guidelines. Therefore, the current study amid to assess the alteration of serum lipid profile among amoebasisandgiardiasis stool microscopy confirmed patients using result of healthy controls as comparison standards at northwest Ethiopia.

Study design, period and setting

An institutional based cross-sectional study was conducted at Sanja Primary Hospital (SPH) from July 10 to August 25; 2023.This hospital locates 65km away from central Gondar zone town and 792 km from capital city of Ethiopia, Addis Ababa. The area has altitude, annual rainfall and temperature of 1900 m to 2200 m above sea level, 800 to 1800 mm and 25°C to 42°C respectively. Moreover, the study setting has one Public River and stream serving as source of water for bathing, cloth washing and recreational activities(29). Besides, local dwellers have a bad basic hygiene practice including open defecation along waterways and improper waste disposal which can be key sources of common intestinal parasites. A magnitude of both Amoebiasis and Giardiasis were reported to reach 21.6% and 9.2% respectively (27) in the study area. Hospital provides diagnostic and treatment service for the inpatient and outpatient town and surrounding inhabitants. Trophozoit and cyst stage detection in stool wet mount by microscopy is the routine methods for diagnosis of Amoebasis and Giardiasis patients in the study setting. Yet, the hospital didn’t have advanced laboratory test service, requires patients transfer and sample shipment to referral hospitals in the regions.

Source of population and Eligibility criteria

All E. histolytica/dispar or G. lamblia microscopy confirmed patients who attended at SPH during data collection period and full fill the inclusion criteria were source population for this study. All participants above six months age confirmed with both protozoan infections and who have not been taking anti-protozoan drugs (Metronidazole /Tinidazole) within the last 14 days were included in the study. Besides, apparently healthy volunteer individuals of patient’s caregivers, and hospital staffs without recent history of both infections, taking any of anti-protozoan drugs, and double slide stool wet mount negative were included as control group. Whereas all study participants with a known history of hypertension, renal failure, liver disease, cancer, diabetes mellitus, pregnancy, patients co-infected with malaria, human immune virus (HIV) ,viral hepatitis(B,C) were excluded from this study. Exclusion was made physical examination and clinical observation by expert clinician, patient medical chart review and diagnostic laboratory test results in the setting. Moreover, obese patients were excluded from the study using their body mass index calculated values.

Sample size determination and sampling technique

Because of cost feasibility issue for lipid profile analysis, we have forced to use rules of thumb for sample size determinations that have been recommended by van Voorhies and Morgan. According to this rules , 30 participants per group are required to recognize real differences, which could achieve an estimated 80% power (30). However, to maximize the power of the study, the number of study participants was increased to two-fold for each groups. Thus, a total of 180 study participants (60 patients infected with G. lamblia: 60 patients infected with E. histolytica/dispar and 60 healthy control participants were recruited using convenient sampling techniques.

Operational definition

Serum lipid profiles: includes HDL, LDL, TG and TC.

WHO categorical of obesity based on the BMI of weight-for-height: underweight (<18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obesity (≥30 kg/m2) (31).

Data collection and laboratory methods

Socio-demographic and lifestyle related data were collected using a structured questionnaire by two expert nurses and Laboratory a technologist under supervision of principal investigators. Clinical data associated with history of chronic disease (kidney, liver, hypertension, diabetes mellitus and cancers, and other acute symptoms of diarrhea, abdominal pain, vomiting, Amoebic dysentery or blood/mucus in stools, loss of appetite data were obtained from physician/ experienced nurse communication and face-to-face patient’s interviews. Co-infection status of study participants with HIV, hepatitis B and C virus, malaria, other intestinal parasite, and pregnancy status was confirmed by laboratory test by experienced professionals.

Biometric Measurement

A portable stadiometer and digital electronic scale were used to measure height and weight of study participants respectively. Both devices were able to measure precision levels nearest to 0.1 cm and 0.1 kg separately. All study participants were weighed without extra layers of clothing, shoes, and any items in their pockets. Then BMI was computed by weight in (kg) dividing by height in meter squared (m²) to screen the body fat ratio as WHO guidelines) (31).

Laboratory stool sample collection and examinations

Following comprehensive instruction for study participants on how to collect stool sample and the goal of the study, about 5gm of stool specimen was collected from both case and comparison groups using labeled clean, dry, and leak proof plastic cup containers. Standard double slide saline wet mount smears were performed from fresh samples up on arrival of laboratory sections in study site for convenient detection and identification of motile/labile E. histolytica/dispar and G. lamblia trophozoit stages. Initial microscopic examination was done by researchers and were confirmed by site Laboratory experts using 10x and 40x power within 30 minutes to one hour. In microscope trophozoit stage both species were identified using species dependent characteristic motility.

Blood sample collection, serum separations and shipment procedures

Among eligible participants who provide their consents, and following standard operating procedure, a 3 mL of fasting (12-14 hours) antecubital veinus whole blood was collected into a serum separator plane tubes. Collected blood was allowed to clot for 10–20 minutes at room temperature and immediately separated by spun for 5 minutes at 2200–2500 RPM. Separated serum was kept at –20˚C until analysis. Due to lack of automated chemistry analyzer machine for lipid profile analysis in the study area, we had transported serum sample under safe triple-packing cold chains system to Tibebe Ghion Specialized and referral hospital clinical chemistry laboratory units, located at Bahir-Dar, capital city of Amhara regions. Similar step were done for age and sex matched health controls.

Lipid profile analysis

Prior to actual patient’s sample analysis we had run internal quality control (IQC) using two level (normal and pathologic reagents. The control result was in the acceptable ranges. Lipid profiles test (Total cholesterol, HDL cholesterol, LDL cholesterol and TG) were determined using standard cholesterol LDL precipitating reagent kit at specific wave length with photoelectric colorimetric principles using Beckman Coulter DXC 700 AU machine. Serum lipid profiles analysis of healthy control was done in similar protocols and analyzer machines. Up on the incubation time analyzer displayed specific test result and were carefully printed. All of these tests were completed according to the manufacturer's guidelines.

Sample Quality Controls

We strictly followed SOPS in all steps of pre-analytical, analytical, and post-analytical phases for the study. Briefly, we had performed normal and pathological QC reagents prior to proceeding actual patient and healthy control sample analysis as for the manufacturer’s instruction. Beside, QC results were interpreted according to West- Gard rules(32).

Data quality control

An English version of data collection tool developed and translated to the local languages, and then re-translated back to English for gathering data related to independent variables. Half day, training was given for data collectors to assure reliability and validity of data to be collected by principal investigators .Collected data were daily, reviewed, checked and monitored to ensure the accuracy, relevance, completeness and consistency as well as presence of clerical errors.

Data management and Statistical analysis

All data were code, entered to Epi-Data (version 4.6) software and exported to Statistical Package for Social Science (SPSS, version 25) for final analysis. The kolomogrove smirove test were used to check normality continuous data and found to normally distributed (TC, LDL and HDL) (P>0.05). Descriptive statistics, of percentile, mean and standard deviation for dependent and independent variables were used. The mean difference in Lipid profiles (TC, LDL and HDL) between groups of E. histolytica infected patient, G. lamblia infected patient and healthy control groups were computed by using one way ANOVA test with the 95% confidence intervals (CIs). Moreover, Kruskal-Wallis test was used to determine mean differences between non-normally distributed continuous variables between groups. A P< 0.05 with 95% CI was set as statistically significant for each dependent variable and the results were presented in the form of text and tables.

Ethical Consideration

We obtained Ethical Clearance from School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar (Protocol number: SBMLS/517). Official permission letter was obtained from the Sanja hospital administrations. Informed consent/assent was obtained from each study participants and confidentiality was kept. Amoeba and Garadia confirmed patients were received treatment service care by hospital and a healthy volunteer with unusual finding was linked to responsible bodies in the setting for appropriate care. The reliability of study methodological issues were carefully validated by institutional ethical review committee, and laboratory procedure including lipid profiles test was performed in accordance with manufacture and international guidelines to assure production of all inclusive and conclusive test result.

Socio-demographic characteristics of study participants

In this study, a total of 180 study participants (60 E. histolytica infected patients, 60 G. lamblia infected patients, and 60 healthy controls) were involved. Majority of the participants in each group were males. Among E. histolytica infected patients, 34 were males while 26 were females. The sex distributions were 104 (57.8%) males and 76 (42.2%) females in the three groups. The mean ages (SD) were 17.22±10.84 in E. histolytica infected patient, 14.07±11.02 in G. lamblia infected patient and 19.40 ±7.28 in healthy control group (Table1).

Table 1: Socio-demographic and behavioral characteristics of study participants at Sanja Primary Hospital from July, to August 2023 (N = 180).

Variable	Category	*E. histolytica* group n(%)	*G.lamblia* group n(%)	HC group n(%)
Sex	Male	34 (56.7%)	36 (60.0%)	34(56.7%)
Sex	Female	26 (43.3%)	24 (40.0%)	26(43.3%)
Age	<11	19 (31.7%)	30 (50.0%)	9 (15.0%
	12-19	22 (36.7%)	14 (23.3%)	19 (31.7%)
	20-34	15 (25.0%)	13 (21.7%)	32 (53.3%)
	>35	4 (6.7%)	3 (5.0%)	0 (0.0%)
BMI (Kg/m²	Mean ±SD)	20.097± 2.05	19.54 ± 2.00	20.09 ± 2.07

Clinical characteristics of E. histolytica and G. lamblia infected patient participants

Clinical data from E. histolytica and G. lamblia infected patients, such as signs and symptoms of E. histolytica and G. lamblia infection, were collected from the patient‘s medical chart. From the total of 120 E. histolytica and G. lamblia-infected study participants, 42 (35.0%) had diarrhea, 72 (60.0%) had fever, 36 (3.00%) had vomiting, 47 (39.2%) had abdominal pain, and 34 (28.3%) had weight loss. Moreover, 43 (35.8%) and 29 (24.2%) had loss of appetite and amoebic dysentery or blood/mucus in stools, respectively (Table 2 ).

Table 2: Clinical characteristics of E. histolytica and G. lamblia infected patients at sanja primary hospital from July to August 2023 (N = 120)

Clinical characteristics		Category	E. histolytica infected patients (N=60) n (%)	G. lamblia infected patients (N=60) n (%)
Sign and symptoms of E. histolytica and G. lamblia infected patients	Diarrhea	Yes	2 (3.3)	40 (66.7)
	Diarrhea	No	58 (96.7)	20 (33.3)
	Fever	Yes	34 (56.7)	38 (63.3)
	Fever	No	26 (43.3)	22 ( 36.7)
	Vomiting	Yes	17 (28.3)	19 (31.7)
	Vomiting	No	43 (71.7)	41 (68.8)
	Abdominal pain	Yes	31 (51.7)	16 (26.7)
	Abdominal pain	No	29 (48.3)	44 (73.3)
	weight loss	Yes	16 (26.7)	18 (30.0)
	weight loss	No	44 (73.3)	42 (70.0)

Notes: N, number; %, percentage

Lipid profiles among E. histolytica infected, G. lamblia infected and healthy control of the study participant

Since the data were normally distributed across the groups, we used a one-way ANOVA test followed by a Post-hoc H Bonferroni pairwise comparison test to compare the mean differences of lipid profiles across study groups. In one-way ANOVA analysis, the mean ± SD of TC, LDL, and HDL levels were 120.21 ± 40.11, 74.63 ± 32.93, and 33.73 ± 13.36 among E. histolytica-infected patients, and 123.46 ± 48.18, 73.57 ± 42.65, and 34.30 ± 14.30 among G. lamblia-infected patients, respectively. The results revealed that the mean concentrations of TC, LDL and HDL in the blood were significantly decreased in E. histolytica and G. lamblia infected patients compared to the control group(Table 3a).However, the means difference of all lipid profile parameters between patients infected with E. histolytica and G. lamblia infections have no statistically significant (P ≥ 0.05)(Table 3a)

Table 3a: Comparison of Lipid profiles among E. histolytica, G. lamblia infected patients and healthy controls at the Sanja Primary Hospital, July to August 2023 (N = 180)

Parameters		E. histolytica infected	G. lamblia infected
Parameters		Mean ± SD (mg/dl)	Mean ± SD (mg/dl)
TC	Patients	120.21 ± 40. 11	123.46 ± 48.18
	Health control	148.03 ± 59.36	148.03 ± 59.36
	p-value	0.008	0.023
LDL	Patients	74.63 ± 32.93	73.57 ± 42.65
	Health control	91.32 ± 33.46	91.32 ± 33.46
	p-value	0.041	0.026
HDL	Patients	33.73 ± 13.36	34.30 ± 14.30
	Health control	43.70 ± 10.77	43.70 ± 10.77
	p-value	0.001	0.001

Note: TC: Total Cholesterol, LDL: Low Density Lipoprotein, HDL: High Density Lipoprotein, mg/dl: milligram per deciliter, SD: Standard Deviation.

The data related to TG was not normally distributed across the groups. As a result, non-parametric tests (Kruskal Wallis test followed by dunn-Bonferroni pairwise comparison test) were used to compare the median differences between study groups. TG level was lower in E. histolytica and G. lamblia infected patients when compared control group. In Kruskal-Wallis analysis, the median (IQR) of TG level was 89.05 (72), 98.00 (74) and 121 (97) among E. histolytica infected patient, Giardia infected patient, and healthy control, respectively. TG level were significantly higher in control group p = 0.05. There was no statistically significant difference of median (IQR) between patients infected with E. histolytica and G. lamblia infections (P ≥ 0.05). (Table 3b)

Table 3b: Comparison of TG level among E. histolytica, G. lamblia infected patients and healthy controls at the Sanja Primary Hospital, July to August 2023 (N = 180)

Parameters		E. histolytica infected	G. lamblia infected
Parameters		Median (IQR) (mg/dl)	Median (IQR) (mg/dl)
TG	Patients	95.26 (51.29)	102.90 (52.14)
	Health control	126.82(61.19)	126.82 (61.19)
	p-value	0.005	0.014

Abbreviation: TG: Triaglycerol, IQR: interquartile range, mg/dl: milligram per deciliter, *=significant at p-value ˂0.05

Infections with E. histolytica and G. lamblia are two major public health issues in Ethiopia. Epidemiological study in Ethiopia have reported a high prevalence of both infections(28), but there were limited published reports on the relationship between lipid profile levels among E. histolytica and G. lamblia infected patient, particularly in Northwestern Ethiopia. The current study aimed to compare the lipid profile levels (TC, HDL, LDL, and TAG) among E. histolytica, G. lamblia-infected patients, and healthy controls. Lipid and lipoprotein abnormalities are commonly reported in physiologic and non-physiologic conditions (33, 34).The changes that occur during inflammation and infection are part of the innate immune response and therefore are likely play an important role in protecting the host (33, 35, 36). In the current study, serum total cholesterol level was found significantly decrease in E. histolytica infected patient group compared to healthy control group (120.21 ± 40. 11 mg/dl vs 148.03 ± 59.36 mg/dl) (p = 0.008). The finding is in agreement with a study done in Iraq(37, 38) and India (18) that showed a significant decrease in serum TC in E. histolytica patient. These changes might be due to E histolytica unable to synthesize its own cholesterol de novo; it must scavenge from the host intestine in order to carry out the biosynthesis of internal and plasma membranes as well as other function(19, 39).Additionally, cholesterols play a role in the pathogenesis of E. histolytica, in accordance with studies that demonstrate E. histolytica becomes more virulent in the presence of cholesterol (40).However, our finding contradicts previous studies conducted in Iraq(25). These variations may be due to genetic and lifestyle factors that raise cholesterol levels in the blood (41). The findings of the present study showed that the mean difference for cholesterol-rich lipoprotein levels, such as LDL and HDL, was significantly decreased in patients with E. histolytica compared to healthy controls (74.63 ± 32.93 vs. 91.32 ± 33.46 mg/dl) and [33.73 ± 13.36 vs. 91.32 ± 33.46 mg/dl], respectively. Similarly, the median (IQR) of TAG decreased significantly in patients with E. histolytica compared to healthy controls. Our finding is consistent with previous studies conducted in Iraq (18, 38), and India (18). These changes might be due to the fact that E. histolytica reduces cholesterol absorption in the intestine (18).This reduction in intestinal cholesterol absorption is increasing sterol loss and significantly reducing LDL levels; it also induces a compensatory increase in cholesterol synthesis by the liver (42).

In the current study, the mean difference of serum TC, level was found significantly decreased in G. lamblia infected patients compared to healthy control group[123.46± 48.18 mg/dl Vs 148.03± 59.36 mg/dl] by a mean difference of 24.56 mg/dl [95% CI; 5.01, 44.11].This result is in agreement with previous studies conducted in Iraq (38, 43-45)and Iran (26). This may be due to cholesterol is required for Giardia membrane biogenesis, as Giardia is unable to synthesize cholesterol/lipid de novo, which it obtains from the milieu of the upper small intestine (19). In addition, cholesterol starvation initiates encystations. This indicates that cholesterol has a role in pathogenesis as it helps the parasite to remain in trophozoite stage(34).On the other hand, an increase in the TC level was observed in studies conducted in Iraq (46) and Sudan (47). The reason for the disagreement could probably be the increase in total cholesterol, depending on factors such as duration of infection, geographic locations (e.g., urban vs. rural or endemic vs. non-endemic), and BMI (48).

The current study demonstrated that serum LDL, in Giardia infected patient significantly decreased compared with control group [73.57 ± 42.65 mg/dl Vs 91.32 ± 33.468 mg/dl] by a mean difference of 17.75 mg/dl[95% CI; 3.889, 31.611]. Similar results were reported in the previous studies done in Iraq (38, 45) and Iran (26). This may be due to an immunologic mechanism since Giardia infection triggers the release of cytokines such as interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α), which alter lipid metabolism (49). Elevated levels of IL-6 and TNF-α in parasitic infection may induce stimulation of the LDL receptor (LDLR), resulting in enhanced LDL receptor activity (50). This may result in lower plasma LDL levels since Giardia needs cholesterol from the host and internalizes it by LDLR -mediated endocytosis (51). The finding of this study is on the contrary with a study done in Iraq (46) and Sudan (47), which reported a higher mean level of LDL in the Giardia-infected group. These variations in cholesterol levels may be influenced more by nutrition, genetics and lifestyle (41).The findings of the present study showed that the median (IQR) of serum TG levels decreased in Giardia-infected patients compared to the healthy control group [102.90 ± 52.14 mg/dl Vs 126.82 ± 61.19 mg/dl], respectively. The findings of this study are in line with the studies conducted in Iraq (45) and Iran (26)that reported a decrease in serum TG levels in giardia-infected patients.

In the current study, the mean serum HDL level was found significantly decrease in patients infected with G. lamblia compared to the control group [34.30 ± 14.32 mg/dl Vs 43.70 ± 10.72 mg/dl] by a mean difference of 9.4 mg/dl [95% CI; 4.81, 13.98]. This finding is consistent with a previous study conducted in Iraq (38), Khartoum-Sudan (47), that found a significant decrease in serum HDL level in G. lamblia infected patients. This may be due to a defect in the bile gland caused by blockage of the bile ducts by G. lamblia and thus leads to fat loss, which is a complication of Giardia infection, which leads to foul-smelling stools accompanied by undigested fats. Another possible mechanism for reducing serum HDL levels is Giardia-induced cytokinesis, such as TNF-α, which induces the expression of LDL receptors, which is secondary to a decrease in cellular cholesterol content caused by TNF-α stimulated lipid secretion (52). On the other hand, a significant difference was not observed in studies conducted in Iraq (45) and Iran (26).

In the present study, E. histolytica/dispar and G. lamblia infected patient has low levels of total cholesterol, LDL and TG, therefore these parasites use host cholesterol in order to carry out the biosynthesis of internal and plasma membranes as well as other function. The HDL levels are below the normal range in E. histolytica and G. lamblia-infected patients, which can indicate an increase in the risk of heart disease, including premature coronary artery disease, heart attack, and stroke.We would like to recommend future researchers conduct large-scale studies that include advanced laboratory methods with an adequate sampling of patients to assess the accurate implications of all test parameters of Giardia and Amoeba infections. We recommend future studies include molecular and immunological methods with a longitudinal cohort of patients. Limitations in this study, the sample size was relatively small, especially compared with large-scale population studies abroad.

Acknowledgement

We are thankful for Sanja Health center staff, study participants for their invaluable contribution for the study. Our warmest gratitude also goes to Department of Medical parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health science, University of Gondar for all the unreserved service delivery for us.

Author contributions

MS: Conceptualization and design of the study, TE: Study protocol development, Supervision of data collection, MT: formal analysis and Data interpretation, writing original draft Manuscript, YM: Methodology, Review, FM and AAA: editing of manuscript, MW and DW: data collections and data curation, AA, AM, NC: Idea conceptions, AYM, DMB and BBT: Manuscript Writing. All authors read and approved the final manuscript.

Data Availability and Materials

Original data that used for analysis are available and applicable up on the request corresponding authors by Journal

Computing Interest

The author(s) declare no competing interests.

Funding

Author has not received any specific funds

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No competing interests reported.

Alteration of Serum Lipid Profiles among Amoebasis and Giardiasis Confirmed Patients at North West Ethiopia

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Abstract

Introduction

Methods and Materials