The hidden impact of different Blastocystis genotypes on C-3 and IgE serum levels: a matter of debate in asthmatic Egyptian children

  • Enas A. El SaftawyEmail author
  • Noha M. Amin
  • Dina H. Hamed
  • Aly Elkazazz
  • Sherihan Adel
Original Article


Blastocystis hominis is highly prevalent with respiratory allergies among Egyptian children. Yet, little is known about the possible immunological relationship. Aims of this study were to measure complement-3 (C-3), total and specific IgE to intestinal allergens in patients’ serum regarding the identified B. hominis genotypes. In a cross-sectional study, three hundred children (150 asthmatics and 150 non asthmatics) participated in the study from both sexes, mean age 7.5 ± SD (3–4) years after a questionnaire administration. PCR-based genotyping of B. hominis selective in vitro cultivation was performed. C-3, total and specific IgE were all measured in patients’ serum utilizing ELISA. Blastocystosis was detected in 100 out of 300 children, 65 (43.3%) out of 150 asthmatics and 35 (23.3%) out of 150 non-asthmatics. Vacuolar forms were the most prevalent in both direct wet mount and stool cultures. Forty (61.5%) out 65 asthmatics and 5 (14.2%) out of 35 non-asthmatics were ≥ 5 organisms/HPF. Sex and irritable bowel disease were statistically insignificant (p value < 0.05). Urticaria was coincided in 15.4% of asthmatics and 8.6% of non-asthmatics. Of 100 cases of blastocystosis, eighty-four were genotype-3 and sixteen were genotype-4. Out of these, 55 cases of genotype-3 and 6 cases of genotype-4 were asthmatics. Positive C-3 serum levels were in 46 (54.81%) of genotype-3 and 2 (12.5%) of genotype-4. High total IgE levels in 30 (35.7%) out of 84 cases of genotype-3 and 4 (25%) out of 16 cases of genotype-4. Positive specific IgE was in 25 (29.8%) of genotype-3 and 3 (18.75%) of genotype-4. Genotype-3 was of higher infection intensity (p value = 0.0001). In conclusion, B. hominis possess a hidden allergy triggering impact that can be obscured by simultaneous high (total and specific) IgE levels towards specific common intestinal allergens. Blastocystosis induces allergy by increasing C-3 serum levels in a genotype-dependent manner being higher in genotype-3. Virulence of genotype-3 seems to stand beyond increased parasite intensity and wide absorption of intestinal allergens that indirectly elevate IgE serum levels.


Blastocystis hominis Allergies Genotype-3 Genotype-4 C-3 IgE 



The authors thank the whole pediatrician team at chest clinics located in the Outpatient’s Department of Abou El-Reesh Teaching Pediatrics Hospital, Cairo University for supplying the research team with all required data. Also authors thank Dr. Hamida A. Gohar, Professor of Medical Microbiology Department, School of Medicine, Cairo University, and Dr. Samar Almogy, MD. Medical Microbiology, and DR Marwa Tarek, lecturer of Medical Biochemistry and Molecular Biology Department, College of Medicine, Ain Shams University for their consultations. The authors feel grateful to Dr. Moussa Abdelgawad, Professor of Parasitology and Head of Diagnostic and Research Unite of Parasitology, School of Medicine, Cairo University. The funding was provided by Authors of the papers (Grant Number 9000).

Author’s contribution

EAE and NMA contributed together in data collection using questionnaire, stool and serum samples collection, parasitological examination and performance of Blastocystis hominis culture, PCR and genotyping of the extracted isolates. EAE performed the ELISA for C3 and total and specific IgE. NMA performed the special bacteriological examinations. DHH and AE supplied the research with the clinical data and referred children to the Medical Parasitology Department. SA was incorporated in the molecular study of the parasite.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights

All procedures performed in the study involving human participants were in accordance with the ethical standards of the National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Permission to conduct this study and ethical approval was received from the Deanship of Higher Education and Scientific Researches, Faculty of Medicine, Cairo University. The present study was conducted only on stool and serum samples of the selected cases.

Informed consent

Aims and procedures of the study were explained and parents of all participants assigned informed consent before being enrolled in the study. Patients suffered from cancers were not included. After sample collection, Blastocystis infected patients were offered the antiprotozoal drug “metronidazole” with the standard dose of 40 mg/kg body weight.


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Copyright information

© Indian Society for Parasitology 2019

Authors and Affiliations

  • Enas A. El Saftawy
    • 1
    • 2
    Email author
  • Noha M. Amin
    • 1
  • Dina H. Hamed
    • 3
  • Aly Elkazazz
    • 3
  • Sherihan Adel
    • 4
  1. 1.Medical Parasitology Department, College of MedicineCairo UniversityCairoEgypt
  2. 2.Medical Parasitology Department, College of MedicineArmed Forces College of MedicineCairoEgypt
  3. 3.Department of Pediatrics, Faculty of MedicineCairo UniversityCairoEgypt
  4. 4.Medical Biochemistry and Molecular Biology Department, College of MedicineAin Shams UniversityCairoEgypt

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