Intestinal Parasitosis and CD4 Levels among Cancer Patients in Calabar, Nigeria

Abstract

Cancer is a public health menace with high rate of mortality, especially in developing countries. The condition as well as its 
therapy may negatively affect the immune system of its patients thereby predisposing them to opportunistic infections, including 
parasitic diseases with management problems. To investigate the intestinal parasite status and CD4 levels of cancer patients 
visiting a Tertiary Hospital, in Calabar, Nigeria, hence proffer solution to the cancer management problems. A cross sectional 
[study design was employed with 317 stool and blood samples, each collected from 186 confirmed cancer and 131 non-cancer 
patients (apparently healthy individuals). Direct microscopy and formol ether concentration techniques were employed for the 
examination and identification of stool parasites. BD-fascount technique for CD4 count. Data were analyzed with statistical 
package for social sciences (SPSS) version 25.0 using Chi-square and t-test, respectively at P < 0.05 and 95% confidence interval. 
The overall prevalence of intestinal parasites in this study was 87(27.44%) with significantly higher prevalence seen in cancer 
65(34.9%) than in non-cancer subjects 22(16.8%), (X2=12.72, P<0.001). Subjects with choriocarcinoma recorded the highest 
occurrence of intestinal parasites. Mean CD4 level was significantly lower in cancer patients (589.30±333.83) than in non-cancer 
subjects (703.37±290.86) (t=3.157, P=0.002). Parasite infected cancer subjects had significantly lower mean CD4 counts than 
their non-infected counterpart (543.86±299.41 versus 617.79±349.11 cells/ul), respectively (t = 1.445, P = 0.001). Parasite 
species detected in the study in order of their frequencies were hookworm 27(40.3%), Ascaris lumbricoides (34.3%), Trichuris 
trchiura (9.0%), Taenia spp (6.0%), Entamoeba histolytica/dispar (6.0%) and Strongyloides (4.5%). This study has confirmed 
that cancer lowers its host’s CD4 level either alone or in combination with intestinal parasites which may play etiologic or 
enhancement role in cancer development, with complications and management problems. Management of cancer cases should 
include parasitological diagnosis and treatment.