Informatics in Medicine Unlocked 15 (2019) 100165

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Informatics in Medicine Unlocked

journal homepage: www.elsevier.com/locate/imu

Automating the clinical stools exam using image processing integrated in an T

expert system
Oscar Takam Nkamganga,b, Daniel Tchiotsopb,∗, Hilaire Bertrand Fotsina, Pierre Kisito Tallac,
Valérie Louis Dorrd, Didier Wolfd
a
Unité de Recherche de Matière Condensée, D’Electronique et de Traitements Du Signal (URMACETS), Department of Physics, Faculty of Science, University of Dschang,
Cameroon, P.O.Box 67, Dschang
b
Unité de Recherche D’Automatique et D’Informatique Appliquée (UR-AIA), IUT-FV, Bandjoun, University of Dschang, Cameroon, P.O.Box 134, Bandjoun, Cameroon
c
Departement of Physics, Faculty of Sciences, University of Dschang, Cameroon
d
Centre de Recherche en Automatique de Nancy (CRAN), UMR CNRS, 7039, Université de Lorraine, Nancy, France

A R T I C LE I N FO A B S T R A C T

Keywords: Background and objective: The diagnosis of intestinal parasitosis disease relies on physiological symptoms and
Parasitic diseases diagnosis stool examination. Often, few specialists are available, and manual stool exam is slow, prone to error, and can
Distance regularized level set evolution cause eye fatigue. Our aim was to design and implement a medical expert system that would be automated and
Neuro-fuzzy classifier helpful for diagnosis of human intestinal parasitosis.
Expert system
Methods: The system was developed based on a decision algorithm. A knowledge base was constructed through
information gleaned from books and physicians with information pertaining to the disease. The user interacts
with the system by answering questions. The symptoms information collected led to a microscopic examination
of stools, which was run on the system to detect parasites. The paradigm for automated microscopic examination
of stools consisted of a combined distance regularized level set evolution, automatically initialized by a circular
Hough transform, and a trained neuro-fuzzy classifier. The neuro-fuzzy classifier was trained for analysis of
twenty human intestinal parasites.
Results: We combined the reasoning scheme of diagnosis and the automated clinical exam of stools in the same
system. The parasites found in microscopic imagery confirmed the suspicious disease. The final recommendation
of diagnosis was then completed, with appropriate proposed therapy. The system was evaluated with sixty cases
of infection, and compared to the diagnosis of two expert doctors; we obtained fifty eight correct diagnoses,
corresponding to a 96.6% accuracy.
Conclusions: The proposed system is automated, since the parameters of segmentation, feature extraction and
classification are set to be computationally guided by the type of suspicious parasite. The system is potentially an
important contribution for medical healthcare assistance.

1. Introduction However, its rules are affected by the coefficients of probability. To

Human intestinal parasitic diseases are part of a neglected group of
tropical diseases causing illness and death. The lack of hospitals and
clinicians is a great barrier for these populations to have an appropriate
level of medical care. Furthermore, diagnosis that relies on microscopic
images analysis is done manually in medical laboratories. Hence, the
production of results is slow, prone to errors, and can cause eyestrain.
Several studies have been carried out in order to assist doctors in
medical diagnostic tasks. MYCIN [1] is an expert system for the diag-
nosis of bacterial infectious diseases of blood. It was the first to provide
a satisfactory separation of inference engine from the knowledge base.
each rule, a particular weight is assigned. The produced engine works
as a simple forward chain, calculating the probabilities of each de-
duction. The system is unable to explain the logic of its operation and to
detect contradictions. Windyga et al. [2] presented an expert system
named SETA, developed for the management of patients in coronary or
cardiac care units. The system was constructed on the multi-knowledge
base architecture using a PC-compatible expert system development
shell named M.1, as a development tool of rules production. M.1 pro-
vided to SETA some facilities in explanation capability. Each knowledge
base follows a particular arrhythmia and relevant complications. The
system suggests therapeutic actions for the treatment of serious

∗
Corresponding author.
E-mail address: daniel.tchiotsop@univ-dschang.org (D. Tchiotsop).

https://doi.org/10.1016/j.imu.2019.100165
Received 28 November 2018; Received in revised form 26 February 2019; Accepted 26 February 2019
Available online 02 March 2019
2352-9148/ © 2019 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/BY-NC-ND/4.0/).
O.T. Nkamgang, et al.
arrhythmias while taking into consideration aspects that are important
to the human expert. However, the system was not designed for real-
time operation. Santosh et al. [3] proposed a diagnosis expert system
for medical consult following fast questioning, and offers in addition
the explanation aspects. The system is based on a symbolic inference
engine handling whole rules; thus, it requires a transcription of the
characteristics and symptoms of the disease to that standard symbolic
system. It returns the problems of the reliability of the data which are
set in the system. Soundararajan et al. [4] presented a knowledge based
system for tuberculosis. The system was developed using fuzzy logic for
class assignment process and a rule–based fuzzy diagnostics decision
support system to assign class labels for tuberculosis. The authors de-
veloped 16 rules for conditions and 323 sets of rules for the determi-
nation of the class of tuberculosis. The system evaluated the level of risk
of tuberculosis patient with received symptoms. However, the system
could not run clinical exams.
Fatumo et al. [5] designed and implemented a medical diagnostic
expert system for various kinds of malaria and typhoid complications,
named XpertMalTyph. The system is based on JESS (Java Expert System
Shell) programming. Java programming language was used as the im-
plementation tool and its Java server page makes the expert system a
web-based application. The database engine used was MySQL in-
tegrated with JESS. The various modules used have been integrated
from a single web interface. Soltan et al. [6] proposed a medical expert
system for heart disease. The proposed system was constructed in Visual
Prolog 7.3. The symptoms of the patients are obtained by answering
questions through a user interface. The system then deduced a diagnosis
and proposed a treatment. The system was focused on several heart
diseases, namely angina pectoris and infarction. Mohktar et al. [7] have
developed a rule base expert system to classify the total cholesterol
level in the body. Authors used bioelectrical impedance analysis. The
study was investigated on 199 voluntary subjects. The expert system
was able to correctly classify 6 of 10 subjects, which is a 0.6 probability
accuracy, for classifying total cholesterol level. However, no clinical
exam could be carried out by the system. The expert system presented
in Ref. [8] assists doctors, nurses, and students in orthopedic diseases
diagnosis. The system provides a repository of information vis-à-vis
multiple diseases. The system was constructed using a tool of expert
systems called a ‘shell’ that allows generating the decision tree, and
incorporated expert knowledge with ES_Buider 3.0. The latter generates
a user interface and has an exporting function for web pages creation.
The authors obtained as results from the expert system information
similar to skilled doctors in the domain. Nevertheless, the system was
unable to run a test, and only analyzes information from answered
questions.
Recently, Nkuma-Udah et al. [9] presented a medical diagnosis
expert system to exactly diagnose malaria and delineate its related
diseases in developing countries, using Nigeria as a case study. The
expert system was designed using CLIPS. Doctors and patients tested the
system, and gave a feedback of possible relevant additions to the system
application. The system only collected information as symptoms to
produce a diagnosis: no clinical examination can be run with this tool.
A multidisciplinary diagnosis system was presented by Nfongourain
et al. [10]. The system used a probability model for the prediction of the
best individual physicians who are assigned to the case of a patient for
diagnosis. They obtained an accuracy of 80% with a multinomial lo-
gistic regression model. Again, the system only addresses information
sharing, and could not analyze or use them for diagnosis. Tchagna et al.
[11] presented two architectures for a complete processing of biome-
dical image data using big data analytics. The authors provide in each
step an optimal method that has a big data architecture solution using
Hadoop and Spark frameworks. The system, based on the tools of big
data technology, analyzes imaging information for biomedical diag-
nostics. Their system was limited to the stage of classification and the
analysis of images, which is a restricted to a part of medical diagnosis
processes. Saha et al. [12] presented an automated medical diagnosis
2
Informatics in Medicine Unlocked 15 (2019) 100165
system for intestinal parasitosis. The authors combined a snake tech-
nique with the Hough transform, to extract parasite features in micro-
scopic imagery. The probabilistic neural network used for recognition
of the parasites achieved a 100% recognition rate. However, their
system was limited to the stage of classification, but may be extended to
diagnostic and treatment proposals. Reviews of another thirteen med-
ical expert systems for diagnosis of various diseases have been carried
out in Ref. [13]. The authors presented for each expert system the di-
agnosed disease, the technique used, input, as well as remarks.
Knowledge Based Systems and Rule Based Expert Systems were recur-
rently used. Those systems receive symptoms or results of clinical
exams as input to infer diagnosis. The results this far obtained as de-
scribed in the literature suggest that expert systems could be useful to
improve healthcare domains. None of the systems, however, have yet
been devoted to human intestinal parasitic diseases.
In this paper, we present an expert system assistant for the diagnosis
of human intestinal parasite disease. To the best of our knowledge, no
expert system has been devoted to the diagnosis of human intestinal
parasitosis. The system integrates artificial reasoning with an automatic
stools exam. This stools exam is automatic, since parameters of parasite
detection and recognition are set automatically according to suspicious
parasites. The system follows a decision algorithm to propose diagnosis
and appropriate therapy.
The remainder of this paper is organized as follows: Section II
presents the materials and methodology used. In Section III, we present
some results and discussion. We close with a conclusion.
2. Materials and methods
2.1. Materials
The proposed expert system is implemented on a HP Elite book
6930p with Intel(R) core (TM) 2 Duo CPU, 2.53 GHz, 2 Go RAM, with
MATLAB 2014a, on Windows 7. The knowledge base includes rules and
facts obtained from relevant books [14,15] and medical doctors. The
automated exam of stools includes a pre-process, a segmentation pro-
cess, and a classification process. We have trained a neuro-fuzzy clas-
sifier with twenty classes of recurrent parasites. We have constructed a
database of microscopic images gleaned from web-sites [16–18]. We
firstly obtained a database of 1240 original images. In order to increase
the size of our database of images, we have added ‘gaussian’, ‘poisson’,
‘salt & pepper’ and ‘speckle’ noise to each image. We have also rotated
each image with angles of 300, 600, 900, 1200 and 1500. A total of 560
new images have then been added to the original database. We have
obtained a comfortable database of 1800 microscopic images corre-
sponding to 90 specimens for each of the twenty classes.
2.2. The expert system
The proposed expert system architecture as presented in Fig. 1, in-
volves the knowledge base, the decision algorithm, the explanation
mechanism and the user interface. It presents the flow of information
exchange between the system and its surroundings: firstly with a
knowledge engineer, who collects rules and facts from doctors and
books to feed the knowledge base of the system, secondly with the user
from whom it receives symptoms and proposes a diagnosis.
2.2.1. User interface
The user interface enables communication between the user and the
system. It takes input to the system (symptoms or signs), and presents
output to the user, such as diagnosis results, explanation, treatment
details, and recommendations. Symptoms and signs of diseases col-
lected leads to recognition of suspicious parasites. Our new system of
automated examination of stools is based on the detection and re-
cognition of intestinal parasites in microscopic images. The method
includes both segmentation and recognition.
O.T. Nkamgang, et al. Informatics in Medicine Unlocked 15 (2019) 100165

Fig. 1. The proposed expert systems archi-

tecture presenting the flowing exchange of in-
formation in the system, and between the system
and its surrounding.

Fig. 2. Extraction process: (a) original image with Entamoeba histolytica trophozoïte, (b) edge map (c) the parasite located, (d) the parasite detected, (e) the
extracted parasite and (f) visualization of histogram oriented gradient features grid locations.

Fig. 3. Extracted microscopic images of parasites. Cyst of: (a) Entamoeba histolytica, (b) Entamoeba coli, (c) Balantidium coli, (d) Chilomastix mesnili, (e) Giardia
lamblia. egg of: (f) Ancylostoma duodenale, (g) Diphyllobothrium latum, (h) Trichuris trichura, (i) Hymenolepis nana, (j) Schistosoma mansoni, (k) Schistosoma
haematobium, (l) Heterophyes heterophyes, (n) Ascaris lumbricoides, (m) Clonorchis sinensis, (o) Fasciola hepatica, (p) Blastocystis hominis, (q) Paragonimus
westermani, (r) Taenia solium. trophozoïte of: (s) Entamoeba histolytica trophozoïte, (t) Iodamoeba butschlii.

Table 1 (x − x a)2 + (y − ya )2 = R2 (1)

Diseases in charge of the designed expert system.

•. Disease 1: Ascariasis •. Disease 11: clonorchiasis

•. Disease 2: Lambliasis or gardiasis
•. Disease 3: Banlantidosis
•. Disease 4: Taeniasis
•. Disease 5: blastocystosis
•. Disease 6: deep-rooted Amoebiasis
•. Disease 7: paragonimiasis or
pulmonary distomatosis
•. Disease 8: intestinal distomatosis
•. Disease 9: Ancylostomiasis
•. Disease 10: Hymenolepiasis
•. Disease 12: trichocéphalosis
•. Disease 13: fasciolosis or hepatic
distomatosis
•. Disease 14: isosporosis or
Coccidiosis
•. Disease 15: colic Amoebiasis
•. Disease 16: diphyllobothriosis
•. Disease 17: infantile Téniasis
•. Disease 18: bilharziosis or
Schistosomiase
where ( x a , ya ) are center pixel coordinates and R is the radius of the
circle.
The output accumulator space has a peak where these contributed
circles overlap at the center of the original circle. The center pixel ( x a ,
ya ) and the radius (R ) parameters for the accumulator with the highest
vote are used to draw the corresponding circle on the original image.
The drawn circle is used as an initial function of DRLSE. The partial
differential equation of the level set evolution is given by equation (2).
∂ϕ/ ∂t = μdiv (dp ( ∇ϕ ) ∇ϕ) − ∂ξext / ∂ϕ (2)

With ϕ being the level set function, μ the distance regularization

Table 2 coefficient of level set function control, and ξext (ϕ) the energy function.
Some examples of symptoms of the knowledge base. DRLSE aims to minimize the energy function ξext (ϕ) . To satisfy this
constraint, the level set function evolves until it accurately fits the
•. Symptom 1: diarrhea •. Symptom 6: anorexia
•. Symptom 2: headache •. Symptom 7: bulimia parasite boundary. The final level set function is a signed distance
•. Symptom 3: fever •. Symptom 8: vomiting function whose value is positive inside and negative outside. The ex-
•. Symptom 4: stomach bloating •. Symptom 9: nausea traction process consists of looking at the corresponding pixel in the
•. Symptom 5: dry cough original image with final negative level set function values, and to set
them to a white color. This method is fast and requires less memory as
compared to the method used by SAHA et al. [19]. As a result, we
2.2.1.1. Segmentation. The edge map of the original image is firstly
generate an image of the parasite alone with white background, which
detected by a canny edge detector. The detection and extraction of the
is proper for features extraction. Fig. 2 illustrates DRLSE, automatically
parasites are done by Distance Regularized Level Set Evolution
initialized using the circular Hough transform, which constitutes the
(DRLSE), initialized by the Circular Hough Transform (CHT). Many
segmentation process of our automated stools exam. We firstly con-
intestinal parasites are ovoid, and their shape in the image can be
verted the microscopic images to edge maps using the Canny algorithm
approximated as circles. According to the circle equation (1), each edge
(Fig. 2 (b)). Next, we located the parasite through the circular Hough
pixel (x , y ) contributes to a circle of radius R in the accumulator space.
transform, and drew circles around them (Fig. 2 (c)). Those circles stand

3
O.T. Nkamgang, et al. Informatics in Medicine Unlocked 15 (2019) 100165

Fig. 4. The decision algorithm flow chart of the proposed expert system, illustrating tests involve in the reasoning scheme.

4
O.T. Nkamgang, et al.
Fig. 5. The automated laboratory test flow chart of the detection of human
intestinal parasites, its extraction from microscopic of stools, and its recogni-
tion.
as initial contours of DRLSE. The contours evolve until they fit the
boundaries of the parasites (Fig. 2 (d)) despite fecal debris around it,
here considered as noise. The final extraction is performed using a
complementary method based on the signed distance character of the
level set function. As a result, we have an image where only the ex-
tracted parasite appears with white background (Fig. 2 (e)). It is then
easy to extract feature characteristics of the parasites for recognition.
2.2.1.2. Classification. We retrieved features from the extracted
parasite using a histogram oriented gradient [20]. The visualization
of Histogram Oriented Gradient (HOG) features grid locations is
presented in Fig. 2 (f). At each pixel, the image gradient vector is
calculated. Given an image I , we obtain the x and y derivatives using a
convolution operation: Ix = I ⋅Dx and Iy = I ⋅Dy . The magnitude (G ) and
the orientation (ϑ ) of the gradient are given by equation (3):
G = Ix2 + I y2 , ϑ = arctan(Iy / Ix ),
We obtained feature vectors whose dimension are on the order of
thousand. This is too large to be directly used by a classifier. The di-
mension of the feature vector is reduced by Linear Discriminant
Analysis (LDA) [21]. LDA finds a subspace which gathers the samples
from the same class and enlarges the margin of samples from different
classes. Mathematically, this objective is achieved by maximizing the
Fisher criterion J (the ratio of the between class scatter (s w ) to the
within class scatter (sb )) (equation (4)).
J = wT sb w / wT s w w
with w the projective vector that maximizes the Fisher separation cri-
terion.
Those features are introduced in a trained neuro-fuzzy classifier for
the recognition of the parasite. It consists of determining the optimum
parameters θ = {SM×N , ΓM×N , WM×O} of the fuzzy if-then rules from the
cost function E (θ) . S and Γ are the matrices containing the width (σ )
and the center (c ) values of the membership functions respectively; W is
the weight matrix of connections from fuzzification layer to defuzzifi-
cation layer. M , N and O are respectively, the number of rules, features,
and classes.
The neuro-fuzzy classifier (NFC) [22] was trained for twenty
Informatics in Medicine Unlocked 15 (2019) 100165
intestinal parasites (Protozoa and Helminths) in various stages (cyst,
egg and trophozoïte). We have used a constructed database of 1800
microscopic images, corresponding to 90 specimens of each type of
parasite. The rotation of the parasite and noise in the image were ad-
dressed. The extracted microscopic image of each parasite is presented
in Fig. 3. From Fig. 3(a)–3(e), we have cyst of parasite; Figure 3(f)–3(r)
present the eggs, while Fig. 3(s) and (t), the trophozoïte of parasite.
From the extracted parasite, we extracted features using a histogram
oriented gradient. Afterwards, the most significant and non-redundant
features are selected using LDA. Those features are used by the NFC for
the classification of parasite. More details on the classification metho-
dology is found in Ref. [22].
2.2.2. The knowledge base
The knowledge base is the heart of the expert system. It is the col-
lection of facts and rules which describe all of the knowledge about the
problem domain. It takes a collection of relevant knowledge that is
stored in a computer and organizes the information in such a way that it
can be used by the decision algorithm. These rules are in the form of IF-
THEN that make use of various tests in or out of a diagnosis. These tests
are scheduled based on suspicion of disease. These rules were im-
plemented according to information collected from local doctors and
relevant book information. Our knowledge base integrates 82 facts: 18
diseases and 64 symptoms. They are declared in the forms given in
Table 1:
The symptoms and signs of these diseases have also been declared as
presented in Table 2.
We have constructed a rule base consisting of 186 rules. Each rule is
stated in the form of:
If patient has symptom1 and symptom 2 and symptom3 and
symptom4 and parasite found in stool is parasite x then Disease is
Disease x.
For example, we have:
•. If patient has chronic diarrhea and fever and stomach bloating or
duodenitis and nausea, and parasite found in stools is Giardia in-
testinalis or lamblia, then disease is Lambliasis or gardiasis.
•. If patient has fever around 38 °C and dry cough and dyspnoea and
vomiting and nausea and parasite found in stools is Ascaris lum-
bricoides, then disease is Ascariasis.
•. If patient has diarrhea with blood or mucus and moderated or os-
cillating fever and stomach pain, and parasite found in stools is
Entamoeba histolytica, then disease is colic Amoebiasis.
(3) •. If patient has abdominal pain and nausea and bulimia or anorexia
and ocular or neurological trouble, and parasite found in stools is
Taenia solium or saginata, then disease is Taeniasis.
•. If disease is Lambliasis or giardiasis, then proposed therapy is
FLAGYL® (métronidazole) 10 mg/kg/day in 2 doses during one
week.
•. If disease is colic Amoebiasis, then proposed therapy is INTETRIX®
(tibroquinol ettiliquinol) 2 g per day during 6 days, or FLAGYL®
(métronidazole) 2 g per day during 7 days.
•. If disease is Ascariasis, then proposed therapy is FLUVERMAL®
(flubendazole) 200 mg per day during 3 days, or ZENTEL® (alben-
(4)
dazole) 200 mg in 1 dose for less than 2 years child, 400 mg in 1
dose for above 2 years. COMBANTRIN® or HELMINTOX® (pamoate
de pyrantel) 12,5 mg/kg in one dose.
2.2.3. The decision algorithm
The decision of our proposed system is guided by a forward-
chaining algorithm. The goal of the decision algorithm is to deduce
facts. Consequences are deduced from the initial facts present at the
beginning in the knowledge base. For that purpose, it will traverse the
knowledge base; it will examine the facts one by one and, looking at
them as fact-conditions, it will seek in the left part of each rule if there
is correspondence between one of the condition-premises of the rule
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O.T. Nkamgang, et al.
Fig. 6. User interface: (a), (b), (c), (d) and (e) dialog for information collection, (f) suspicious parasites.
and the fact considered. The decision algorithm thus explores all of the
rules contained in the knowledge base, seeking for each one of them to
start its consequence. We have implemented the decision algorithm of
the proposed expert system in MATLAB. It follows the flow chart pre-
sented in Fig. 4, which consists of successive tests, depending upon
received answers.
It is completed with the flow chart of the automated stools exam of
Fig. 5 involving the segmentation of the microscopic images of stools of
the patient, and the recognition of the detected parasite. Given a da-
tabase of true facts, all rules that match facts in the database are suc-
cessively applied. The conclusion is added to the database. This is re-
peated until suspicious parasites are deduced, or a new fact is input, or
others expertise is required. The interrupts paths indicate that other
symptoms can be taken into account. Suspicious parasites are found in
microscopic images of stools during automated laboratory tests. Their
recognition is combined with symptoms to produce a diagnostic.
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Informatics in Medicine Unlocked 15 (2019) 100165
3. Experimental results and discussion
Assuming the expert system acts in a manner as a physician for a
patient, the user will answer a few questions about the patient condi-
tions. The system begins with general questions, and is guided by an-
swers regarding suspicious parasites. Fig. 6((a), (b), (c), (d) and (e))
present a sample of questions asked to the user. The user answers
questions by filling the provided space, or clicking on a suitable button.
Questions successively present are oriented by the decision algorithm
according to answers and conducted to the suspicious parasite
(Fig. 6(f)).
In Fig. 7(a), we present the dialog interface of the system proposing
to run a stools exam. If the user clicks on the ‘‘why’’ button, an ex-
planation of the deduction is given (Fig. 7(b)). The suspicious parasite
responsible for health trouble are confirmed or not by the examination
of stools. Fig. 7(c) presents the interface of automatic exam of stools.
After loading microscopic images of stools of the patient using the
button ‘‘load image’‘, the user will successively click on ‘‘CHT-DRLSE’‘,
O.T. Nkamgang, et al. Informatics in Medicine Unlocked 15 (2019) 100165

Fig. 7. User interface. (a) Dialog proposing to run stools exam (b) recalling information for explanation (c) The automatic exam of stools interface (d) diagnostic
result and a proposed therapy.

7
O.T. Nkamgang, et al.
‘‘HOG-LDA’’ and ‘‘NFC’‘. The system will process the segmentation and
the recognition of the detected parasite. The proposed scheme of seg-
mentation was applied on our database of microscopic images with
various kinds of parasites. Results show how robust and accurate the
method is [19]. The parameters of research are set automatically ac-
cording to suspicious parasites. The user can also set those parameters
for a particular research, and the system will learn from new conclu-
sions. Those parameters are accessible at the right side of the interface
presented in Fig. 7(c). They are: the estimated radius of research for
Hough transforms, the weighted area term Ag (ϕ) , the coefficient of the
distance regularization term Rp (ϕ) , time step tstep, the coefficient of the
weighted length term Lg (ϕ) and the maximum number of iterations for
DRLSE. This opens the field to enlarge the research of new parasites.
The database images were divided in two sets for the training and
testing phases. The results show a perfect classification of twenty in-
testinal parasites (Protozoa and Helminths) in various stages (cyst, egg
and trophozoïte). The twenty classes of parasites were classified with a
recognition rate of 100% while testing the trained neuro-fuzzy system
[22]. The recognized parasite is combined with other symptoms for the
diagnosis of disease, and a therapy is proposed (Fig. 7(d)). The system
was trained to recognize twenty parasites independently of their stage
of evolution. Thus, the corresponding diseases are also well diagnosed.
It is worth to mention that the diagnosis and therapy are only a re-
commendation for the user and physician non expert in the domain.
We have simulated the execution of our system on sixty cases of
infection. Questions asked by the proposed system with corresponding
answers of patients were presented to two doctors. Images were picked
in a database of 210 microscopic images. The system obtained fifty
eight correct diagnoses concordant to the same decision of the two
doctors. This corresponds to a correct diagnosis rate of 96.6 0 0 . The
corresponding therapies for each diagnosis were also approved. In the
two other cases, the two doctors and the proposed diagnosis system
were not in accordance. In one case the two doctors provided different
diagnoses, while in the other, the expert system proposed a diagnosis
different from the agreed diagnosis of the two doctors. The system still
has problems because of contradictions. For example, when the suspi-
cious parasite is not found in the loaded microscopic image of stools, or
another parasite different from the suspicious one is found, this causes
contradiction. The knowledge base of the system could however be
increased with facts and rules for remedy. The trained neuro-fuzzy
classifier can also be updated with new types of parasite for more re-
cognition.
4. Conclusion
In this paper, a medical expert system assistant is presented with a
purpose of diagnosis of human intestinal parasitosis. The system in-
tegrates artificial reasoning and automatic stools exam. The reasoning
part of the system is constructed around a decision algorithm which
used the constructed knowledge base and user answers to prognosticate
on the diagnosis. The parameters of segmentation, features extraction,
and classification are set automatically, guided by the type of suspicious
parasite sought in the microscopic image. The user is only called to load
a microscopic image of stools of the patient. This increases the ease of
use of the proposed system. The final recommendation of diagnosis is
completed with proposed appropriate therapies. We have evaluated our
system on sixty cases of infection with the diagnosis of two doctors, and
have obtained fifty eight correct diagnosis corresponding to a 96.6 0 0
rate. The system is also able to explain its reasoning. This confirms the
efficiency of the system, which could then be used by a non-expert in
the task of diagnosis, and as a pedagogic tool for novices. The proposed
expert system is a potentially important contribution in medical diag-
nostic assistance. This system can be improved by increasing the size of
the database with new types of parasites, and the size of the knowledge
base with new facts and rules. The algorithm could be optimized for
real-time application. The system will therefore be of support in fast
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Informatics in Medicine Unlocked 15 (2019) 100165
and reliable care of patients suffering from intestinal parasitosis.
Conflicts of interest
None declared.
Ethical approval
This article does not contain any studies with human participants or
animals performed by any of the authors.
Acknowledgements
The authors wish to thank the laboratory assistant TAFFOC Guy
Aimé and collaborators of regional hospital of Bafoussam (western
Cameroon) for their invaluable support and knowledge sharing. The
authors are also grateful to JIPDI M.N (PhD) and PEACHAP Bruno A. for
improving the overall English level within our manuscript.
Appendix A. Supplementary data
Supplementary data to this article can be found online at https://
doi.org/10.1016/j.imu.2019.100165.
Formatting of funding sources
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
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