Animal Health Research Institute-New Valley

Role of Cryptosporidial infection as a pathogen of neonatal calf

diarrhea in Assiut Governorate

By
F. A. Osman and A. H. Sadiek*
Dept. of Animal Medicine, Faculty of Vet. Medicine- Assiut University

Abstract
The present study was conducted on 220 neonate diarrheic calves aged 1-
60 days, during the period from November 2007 to April 2008, among of
which 200 calves, were suffering profuse diarrhea. Complete clinical
examination of diarrheic calves was carried out. Fecal and blood samples
were collected for detection of Cryptosporidia by both direct standard
fecal examination and by modified Ziel- Neelsen staining. Variable
degrees of mucoid, blood stained profuse diarrhea, apathy, loss of
suckling affinity, straining, dehydration and recumbency were the main
signs observed. The prevalence of cryptosporidaial infection among
diarrheic calves in this study was 21 %. The highest rate of infection was
in calves aged 10 - 30 days (73.8 %), while the lowest rate of infection
was in calves aged 1 - 10 days (7.14 %). Mixed infection with coccidial
oocyst was noticed in 7 cases (16.8 %) and with Ascaris in 2 cases (4.8
%). The co-existent diarrhea and dehydration were associated with
hemoconcentration which is represented by significant increase in PCV,
blood urea nitrogen (BUN), hyponatremia, hypochloremia, hyperkalemia
and hypoglycemia. Significant increase ( p<0.01) in TWBCs may suggest
an associating bacterial infection. Some infected calves was complicated
with bronchopneumonia, among of which 2 cases has been died. It could
be concluded that Cryptosporidium is recognized as an important primary
or secondary pathogen in neonates diarrheic calves, resulting in severe
economic losses in neonates. Other causes such as bacteria and virus
could not be excluded.

Keyword : Neonate calves, Cryptosporidium, Diarrhea

Introduction
Neonatal calf diarrhea is considered one of the most common and
economically devastating conditions encountered in raising calf industry.
Diarrhea in neonate calves is facilitated by many hygienic, nutritional,
environmental and managemental stress factors in addition to bacteria
such as E. coli, rota and corona viruses (Mackenzie et al., 1994).
Cryptosporidium is considered the most important protozoan causing

1
neonate calf diarrhea and case fatalities either alone or in association with
other bacteria, viruses and coccidia especially in the first 20 days of life
(O'Donoghue, 1995 and Ambroise, 2000).
C. parvum is an intracellular protozoan causing enteritis and
diarrhea in cattle, sheep, goat and man, the first report on bovine
cryptosporidiosis was published in 1971. Now it has been identified as
one of the primary etiological agents of neonatal calf diarrhea (Tzipori,
1985 a & b; Janoff and Reller 1987; and Naciri et al., 1999). The parasite
can be transmitted by the direct fecal oral rout or through ingestion of
contaminated, milk or milk replacer, water or grain (Kirkpatrick 1985).
Herd level prevalence of C. Parvum has been reported to range from 13
to 100% (Wade et al, 2000 and Santin et al, 2004).
The most prominent signs of Cryptosporidiosis in calves are
depression, anorexia, apathy, abdominal pain, fever and mainly diarrhea
accompanied by the shedding of a large number of oocysts, dehydration
and /or poor condition. Calves most often recovers spontaneously within
1-2 weeks even though there is a large variation between individuals in
how they respond to and recover from infection (Tzipori,1985 a and
Mackenzie et al., 1994). Concomitant infection with other enteric
pathogens can aggravate the clinical signs and prolong the duration of
disease. Morbidity and mortality can be very high in calves less than 2
weeks old (Mackenzie et al., 1994). The objectives of the present study
were to investigate the prevalence and significance of C. Parvum in
neonatal diarrheic calves and the extent of its concurrent clinical and
laboratory consequences.

Materials and methods

1- Animals and samples.
A total no. of 220 neonate Friesian calves aged 1-60 days was
selected from different localities in Assiut Governorate during the period
from Nov. 2007 – April, 2008 and used for this study, among of which
200 calves were suffering variable degrees of enteritis, diarrhea and
dehydration. Twenty calves were proved to be clinically and laboratory
healthy and kept as control group (tab. 1). Diarrheic calves were
classified according to their ages into three groups group I: 1- 10 days,
group II: 10 -30 days, and group III: 30 -60 days.
Sampling was collected from all calves during the above mentioned
period to reduce any potential confusing effects of season on the
prevalence of cryptosporidium as follow:
a- Fecal samples were collected directly from calves and immediately
placed in a screw caped bottles. The samples were labeled with the age of
calves, duration and intensity of diarrhea and the associating clinical
signs and sent to the laboratory.

2
b- Two blood samples were collected from jugular vein, in clean sterile
centrifuge tubes. The first blood sample was collected with anticoagulant
(sodium salt of EDTA) for estimation of TRBCs, WBCs and PCV %. The
second blood sample was collected without anticoagulant and stored for
biochemical study.
2- Clinical examination.
Clinical examination of diarrheic calves was carried out according to
Rosenberger, (1979) with special reference to description of diarrhea,
body temperature, suckling affinity, posture and vitality of calves as well
as signs and degree of dehydration.
3- Parasitological examination.
Samples were stored at 4◦c in the laboratory and processed
immediately at the same day of collection. The standard concentration
floatation technique was initially applied on all samples. For each sample,
1g of feces was processed using sugar solution (SG 1.33) as the flotation
medium to recover C. parvum like oocysts and other parasites. Calves
were considered positive, if more than 10 oocysts /HPF with the correct
morphology (i.e. optical properties, internal structure, size, shape) were
found. The modified acid- fast Ziehl –Neelsen stain is most reliably and
traditionally used to detect the presence of Cryptospordial oocysts
(Webster et al., 1998) as follow:
1- Prepare a thin smear by spreading a small amount of feces on slide
with a wooden dowel.
2-Fix with gentle heat until the slide is uncomfortable to the touch and
cool the slide before proceeding.
3- Stain with carbol- fuchsin solution for 3 minutes.
4- Wash in running water until no more stain appears in the wash water .
5- Rinse with decolorizer until no more stain appears in (decolorizer can
easily made by adding 3 ml HCl to 97 ml 95% ethanol).
6- Rinse gently in running tape water.
7- Counter stain with the Methylene blue (0.03%) stain for 30 sec.
8- Wash gently under running water, stand the slides on end and air dry.
9- Oil immersion lenses are corrected for use with cover slide. Permanent
reference slide can be made by dipping the dry stained slide in xyline.
4- Hematological and biochemical analysis.
The total RBCs, total WBCs, Hb concentration and PCV were
estimated according to Coles (1986). Blood glucose, blood urea and
creatinine levels in blood sera were estimated using test kits supplied by
bio–Meraux. Serum sodium and potassium levels were estimated
photometerically by a flam photometer (Corning Model 400 England
ESSEX). Blood serum chloride level was estimated using chloride
analyzer (corning Model 925, England Essex).

3
Results.
Diagnosis of C. Parvum using acid –fast modified Ziel –Neelsen
staining technique revealed that the investigated Cryptospordium oocysts
appeared as acid –fast (red – pink) on a blue back ground . The oocysts
are sporulated, spherical to ovoid in shape with smooth wall, containing 4
sporozoites and residuum measuring 4 -5 um (fig. 1, 2). Results of
microscopic examination of 200 stained fecal smears (Tab. 3) revealed
that 42 (21%) were harbored C . Parvum oocysts, while 158 (79%) gave
negative results. Positive cases of Cryptosporidium oocysts were
associated also with 7 cases of coccidian oocysts (16.66%) and Ascaris
vitulorum eggs (4.17 %) in 2 cases.
Greenish yellow mucoid diarrhea, often bloody stained with,
straining, lack of appetite, rough coat and dehydration were the major
signs observed. Lastly most calves lay down in a profound depression and
harried respiration (tab. 2). Five calves (16.12 %) declared signs of
bronchopneumonia and eventually 2 calves (6.5 %) were found dead 5-8
days after appearance of respiratory symptoms in G II (tab.2). Non
significant changes were observed in RBCs, Hb meanwhile significant
increase in WBCs and PCV, blood urea and serum K associated with
significant decrease in serum Na and Cl were reported.

Discussion
The greenish yellow profuse watery diarrhea, colicy pains, reduced
suckling affinity and the occurring dehydration of diarrheic calves reflect
the destructive lesions occurred in the intestine due to its infection with
Cryptosporidia. Similar observations were reported by El –Khodery,
(1996), Sadiek and Schlerka (1996), El –Sherif et al (2000) and EL –
Dessouky, 2005). In the present study, the prevalence of cryptosporidiosis
was 21 % out of 200 diarrheic calves resembling the previous reports of
EL –Khodery, (1996) and EL-Sherif et al (2000). The obtained results is
considered lower than that reported by Abdel- Salam, et al (1993). Such
variation could be explained by different variables, such as age, feeding,
seasons, individual immunity, housing and managemental factors. The
oocysts recovered are spherical in shape within a clear holes, 4-5 um in
diameter, stained pink and the back ground appeared blue in color.
Eventually animal age plays a great role in calf susceptibility to
Cryptosporidium infection in the present study. It has been observed that
31 calves, aged 10-30 days have the highest rate of infection (73.8%)
followed by calves aged 30-60 days (19.04%) while those aged 1-10 days
have the lowest rate of infection (7.14%) as in tab. 3. The present data
agreed with ỎHanley et al (1999) and EL –Sherif et al (2000) who stated
that Cryptosporidium was an important pathogen when calves were less
than one month old and confirms previous reports from various

4
researchers that Cryptosporidium is a very common enteric protozoan in
calves where about 73% were found in calves less than two months of
age and decreased to about 0- 1% after weaning (Santin et al., 2004).
Signs of bronchopneumonia and deaths among some calves of G II may
reflect association of bacteria and virsus with Cryptosporidial infection.
Similar findings were found by Sadiek and Schlerka, (1996).

Haematological and biochemical parameters (tab. 4).

The non significant changes in the mean values of TRBCs and Hb
values in diseased calves agreed with those previously reported by
Awadalla (1996) and EL- Dessouky (2005). The expected reduction of
TRBCs and Hb values due to anorexia and diarrhea could be masked by
the expected increase in their values due to longstanding diarrhea and
dehydration and the subsequent hemoconcentration (Sadiek and Schlerka,
1996). The significant increase in TWBCs could be declared according to
Malina et al (1994) stating that the infection with cryptospordia or any
protoza like parasites lead to increase in the TWBCs or it may reflect the
associating bacterial infection. Mean values of PCV, showed highly
significant (p<0.01) increase, reflecting excessive loss of body fluid in
diarrheic calves, in addition to inadequate intake of milk and fluids during
diarrhea (Fadl-Alla 1989).
The high significant (p<0.01) decrease in the glucose agreed with
those obtained by EL-Dessouky (2005) that could be related to lack of
glucose absorption from damaged intestine where the cryptospordia
causes damage of villi which impair digestion and absorption
(Anderson,1981). The significant increase (p<0.05) in blood urea with
insignificant increase in serum creatinine may be attributed to the deficit
in renal blood perfusion and reduced urine formation in calves (Walt,
1965 and Sadiek and Schlerka, 1996).The significant decrease in sodium
and chloride levels (p<0.05) could be attributed to the loss of large
amounts of sodium and chloride ions with intestinal secretion and
diarrhea (Fadl-Alla (1989) and EL-Dessouky (2005)..
The highly significant (p<0.01) increase in potassium (K) level
could be attributed to the subsequent acidosis associating long standing
enteritis in which false positive increase in K values in attempt to
compensate the occurring metabolic acidosis which known as K/H
exchange (Radostits et al., 2000). Hyperkalemia is a common problem
associated with the acid-base and electrolyte disturbances that occur in
neonate diarrheic calves (EL. Dessouky, 2005 and Alan et al., 2008).
Lastly it could be concluded that Cryptosporidium is considered a
problem of neonate calves resulting in diarrhea, dehydration and deaths.
Its destructive effect on the intestinal villi resulted in hyponatremia,
hypochloremia and hypoglycemia, hemoconcentration and azotemia.

5
References
Abed Salam,F. A; Ali, H. S and Galal A. A. (1993): Some studies on
Cryptosporidiosis in calves in Sohag Governorate, Assiut. Vet. Med.
J. 29 (57): 151 – 163.
Alan D. W, Moise N. S. and Rebhun W. C. (2008): Hyperkalemic
Atrial Standstill in Neonatal Calf Diarrhea. Journal of Veterinary
Internal Medicine. Volume 6 Issue 5, Pages 294 – 297 (online
published 2008 )
Ambroise-Thomas, P. (2000): Emerging parasite zoonoses: the role of
host-parasite relationship. Int. J. Parasitol. ,; 30: 1361-
Anderson, B. C. (1981): Patterns of shedding of cryptosporidial
oocysts in Idaho calves. JAVMA; 178; 982 -984.
Awadalla, S. A. M. (1996): Studies on enteritis in newly –born buffalo
calves. Ph. D. Thesis. Fac. of Vet. Med. Zagazig University.
Coles, E. H. (1986): Veterinary Clinical Pathology 4th Ed. W. B.
Saunders Company, Philadelphia, London and Toronto.
El –Dessouky S. A. and Nabila. M. El – Masry. (2005): Effect of
Crypt. Parvum infection on the haematological and blood biochemical
changes of buffalo calves with special reference to the prevalence of
infection among buffaloes. Assiut. Vet. Med. J; 51 (105). 108 -123.
El –Khodery, S. A. (1996): Effect of Cryptospordiosis on some blood
parameters in calves. M, V Sc. Thesis. Fac. Vet. Med. Kafr EL
Sheih, Tanta University.
El –Sherif, A. M; Abdel –Gawad, M. A; Lotfy, H. S. and Shokier,
K. A. M. (2000): Impact of gasterintestinal nematodes and Same
enteric protozoal affections on the health of buffalo calves. Assiut.
Vet. Med. J.; 43 (86): 260 -270 .
Fadl –Alla, M. G. E. (1989): Clinical, hematological and biochemical
studies on calves suffering from diarrhea. M. V. Sc. Thesis, Faculty.
Vet. Med. Cairo University
Janoff, E.N and L.B. Reller. (1987): Cryptosporidium species, a Protean
Protozoan. J. Clin. Microbiol. 25: 967-975.
Kirkpatrick , C. E and Farrel, J. P. (1985): Cryptospordiosis
continuing Education. Article. , 1 (3) 154- 161
Mackenzie. W. R. N. J. Hoxic, M. E. Proctor. M. S. Gradus. K.
A. Blair, D. E Peterson. J. J Kamieszak. D. G Addis. K. R.
Fox. J. B. Rose. and J. p. Davis. (1994): A massive outbreak
of Cryptosporidium infection transmitted through the public water
supply. New England. J. Med 331: 161 -167

6
Malina, J. M; Rodriguez –ponce, E; Ferrer, O; Cutierrez, A. C.
and Herndez, S, (1994): Biopathological data of goat kids with
cryptosporidiosis. Vet. Rec. , 135 (67) :67 68,
Naciri, M, L., Mancassola M, P; Poirier P. R., Chermette R. (1999):
Role of Cryptosporidium parvum as apathogen in neonatal diarrhea
complex in suckling and dairy calves in France. Vet. Parasitol. 85:
245 -257.
O, Handley, R. M; Cockwill, C. Mcallister, T. A; Jelinski, M
Morck, D. W. and Olson, M. E. (1999): Duration of naturally
acquired giardiosis and cryptosporidiosis in dairy calves and their
association with diarrhea. J. Am. Vet. Med. Assoc. Feb; 1; 214 (3):
391 -396.
O'Donoghue, P. J. (1995): Cryptosporidium and cryptosporidiosis in
man and animals. Int. J. Parasit.; 25: 139-195.
Radostits O., Gay C., Kenneth W. H., Constable P. D. ( 2007):
Veterinary Medicine: A textbook of the diseases of cattle, horses,
sheep, pigs and goats. 10th Ed. Publisher: Saunders Ltd.; 10 edition.
Rosenberger, G. (1979): Clinical Examination of Cattle, Publisher:
Verlag Paul Parey
Sadiek, A. H. and Schlerka, G. (1996): Studies on Rehydration Therapy
in diarrheic milk fed calves, Tierartztliche Umscahu, 51(9): 544-552
Santín, M. , J. Trout, L. Xiao, L. Zhou, E. Greiner, and R. Fayer.
(2004). Prevalence and agerelated variation of Cryptosporidium
species and genotypes in dairy calves. Vet. Parasit. 122:103-117 .
Tzipori, S. (1985a). Cryptosporidium: Notes on epidemiology and
pathogenesis. Parasitol. Today 1:159-165.
Tzipori, S. (1985b): The relative importance of enteric pathogens
affecting neonates of domestic animals. Adv. Vet. Sci. Comp. Med.
29:103-206.
Wade, SE, HO Mohammed, SL Schaaf. (2000): Prevalence of Giardia
sp., Cryptosporidium parvum, and Cryptosporidium muris (C.
andersoni) in 109 dairy herds in southeastern New York State. Vet
Parasitol 93:1-11
Walt, J. G. (1965): The use of fluid replacement in the treatment of
neonatal diseases in calves. Vet Rec. 77: 1474
Webster, K. A; Green, J. A; Dawson, C; Giles, M. A. (1998):
Diagnostic methods for the detection of Cryptosporidium parvum
oocysts. Journal of protozoology Research, 6 (4): 113 -120

7
 Tables and figures

Tab. 1: Sources and No. of Diarrheic calves selected for the study.
No . of No. of No. of % of
Sources and No. examined positive negative positive
animals case case case
Assiut city Arab- El 16 6 10 37.5%
madabk
Shodb 26 5 21 19.23%
El - zawia 32 6 26 18.75%
Dronka 32 7 25 21.87%
Rifa 36 8 28 22.22%
Total number 142 32 110 22.53%
Abu-Tig Abo –korse 8 2 6 25%
city El-Akadema 7 1 6 14.28%
El-Baliza 10 2 8 20%
Total 25 5 20 20%
Sahel - selem 15 2 13 13.33%
El -Khanyem 18 3 15 16.66%
Total 200 42 158 21%

Tab. 2: The clinical signs observed in diarrheic calves under study.

Age groups G1 (1-10 days) G2 (20-30 days) G3 (30-60 days)
Signs N % N % N %
Diarrhea 3 100 31 100 8 100
Anorexia 3 100 25 80.6 3 37.5
Apathy 2 75 28 90.3 3 37.5
Straining 2 75 15 48.4 4 50
Mild fever 1 33 11 35.5 2 25
Dehydration 3 100 22 71 4 50
Recumbency 2 75 18 58 2 25
Bronchopneum. - - 5 16.12 -
Deathes - - 2 6.5 - -

8
Tab. 3:Incidence of Cryptosporidial infection among calves in relation to
age and sex as well as the co-existence coocidia and ascaris.

Sex Age groups (days)

Variables ♂ ♀ G 1:1-10 G 2: 10-30 G 3: 30-60
N % F % N % N % N %
C.parvum 17 40.4 25 60.6 3 7.14 31 73.8 8 19.04
C. parvum 3 7.1 4 9.5 - - 2 4.8 5 9.6
+ Coccidia
C. parvum - - 2 4.7 - - - - 2 4.8
+ Ascaris

Tab. 4: Mean values of some hematological and biochemical parameters

in healthy (control) and infected neonatal calves.

Items Control healthy calves Diarrheic calves

Parameters N= 20 N= 200
TWBCs (T/L) 8.57 ± 0.17 9.40 ± 0.22*
TRBCs (G/L) 7.95 ± 0.19 8.11 ± 0.18
Hb (g/dl) 10.59 ± 0.23 11.17 ± 0.28
PCV (%) 35.68 ± 0.42 38.83 ± 0.69 **
Glucose (mg/dl) 72.21 ± 1.29 61.43 ± 2.15**
Blood urea (mg/dl) 23.36 ± 0.75 27.49 ± 0.99**
Creatinine (mg/dl) 0.89 ± 0.01 0.95 ± 0.02
Sodium(mmol/l) 133.14 ± 2.09 125.47 ± 1.78*
Potassium (mmol /l) 4.39 ± 0.25 5.77 ± o.23**
Chloride (mmol /l) 96.35 ± 0.38 94.24 ± 0.64*

* Significant at P < 0.05 ** Highly significant at P < 0.01

Fig. 1: Stained fecal smear with ziel-Neelson (to the left) and a non
stained fecal smear (to the right).

9
 ‫‪Fig. 2: Prevalence of Cryptosporidia, Coccidia and Ascaris‬‬
‫‪infection among neonate diarrheic calves in Assiut‬‬
‫‪80‬‬
‫‪70‬‬
‫‪% of infection‬‬

‫‪60‬‬
‫‪50‬‬
‫‪40‬‬
‫‪30‬‬
‫‪20‬‬
‫‪10‬‬
‫‪0‬‬
‫‪Males‬‬ ‫‪Females‬‬ ‫‪GI‬‬ ‫‪GII‬‬ ‫‪G III‬‬
‫‪Groups‬‬
‫‪Crypt.‬‬ ‫‪Crypt. & Coccid.‬‬ ‫‪Crypt & Ascaris‬‬

‫اﻟﻤﻠﺨﺺ اﻟﻌﺮﺑﻰ‬
‫‪Animal Health Research Institute‬‬
‫دور اﻟﻜﺮﻳﺒﺘﻮﺳﺒﻮرﻳﺪﻳﺎ آﺄﺣﺪ ﻣﺴﺒﺒﺎت اﻻﺳﻬﺎل ﻓﻰ اﻟﻌﺠﻮل ﺣﺪﻳﺜﺔ اﻟﻮﻻدة ﺑﻤﺤﺎﻓﻈﺔ أﺳﻴﻮط‬
‫ﺑﻮاﺳﻄﺔ‬
‫ﻓﺘﺤﻲ ﻋﺜﻤﺎن وﻋﻠﻲ ﺻﺪﻳﻖ*‬
‫*‪-‬ﻗﺴﻢ ﻃﺐ اﻟﺤﻴﻮان‪ -‬آﻠﻴﺔ اﻟﻄﺐ اﻟﺒﻴﻄﺮي‪ ،‬ﺟﺎﻣﻌﺔ أﺳﻴﻮط‬
‫ﺃﺠﺭﻴﺕ ﻫﺫﻩ ﺍﻟﺩﺭﺍﺴﺔ ﻋﻠﻰ ﻋﺩﺩ ‪ 220‬ﻤﻥ ﺍﻟﻌﺠﻭل ﺤﺩﻴﺜﺔ ﺍﻟﻭﻻﺩﺓ ﺒﻤﺤﺎﻓﻅـﺔ ﺃﺴـﻴﻭﻁ ﺘﺘـﺭﺍﻭﺡ‬
‫ﺃﻋﻤﺎﺭﻫﺎ ﻤﺎ ﺒﻴﻥ ﻋﻤﺭ ‪ 60-1‬ﻴﻭﻤﺎ ﻓﻰ ﺍﻟﻔﺘﺭﺓ ﻤﻥ ﻨﻭﻓﻤﺒﺭ ‪ 2007‬ﺍﻟﻰ ﺍﺒﺭﻴل ‪ ،2008‬ﻤﻨﻬﻡ ‪200‬‬
‫ﻤﻥ ﺍﻟﻌﺠﻭل ﺍﻟﻤﺼﺎﺒﺔ ﺒﺎﻹﺴﻬﺎل ﺍﻟﺤﺎﺩ ﻭﻤﻀﺎﻋﻔﺎﺘﻪ ﻭ‪ 20‬ﻋﺠﻼ ﺴﻠﻴﻤﺎ ﺃﺨﺫﺕ ﻟﻠﻤﻘﺎﺭﻨـﺔ‪ .‬ﺃﺨـﺫﺕ‬
‫ﻋﻴﻨﺎﺕ ﺍﻟﺒﺭﺍﺯ ﻟﻠﻔﺤﺹ ﺍﻟﻁﻔﻴﻠﻲ ﻟﻠﻜﺭﺒﺘﻭﺴﺒﻭﺭﻴﺩﻴﺎ ﻓﻲ ﺍﻟﺒﺭﺍﺯ ﺒﺎﻟﻁﺭﻕ ﺍﻟﺘﻘﻠﻴﺩﻴﺔ ﻭﻜـﺫﻟﻙ ﺒﻔﺤـﺹ‬
‫ﻤﺴﺤﺔ ﺒﺭﺍﺯ ﻤﺼﺒﻭﻏﺔ ﺒﺎﻟﺯﻴل ﻨﻴﻠﺴﻭﻥ ﻭﺃﺨﺫﺕ ﻋﻴﻨﺎﺕ ﺩﻡ ﻟﻠﻔﺤـﺹ ﺍﻟـﺩﻤﻭﻱ ﻭﺍﻟﺒﻴﻭﻜﻴﻤﻴـﺎﺌﻲ‪.‬‬
‫ﺘﻠﺨﺼﺕ ﺍﻷﻋﺭﺍﺽ ﺍﻹﻜﻠﻴﻨﻴﻜﻴﺔ ﻓﻲ ﻭﺠﻭﺩ ﺩﺭﺠﺎﺕ ﻤﺘﻔﺎﻭﺘﺔ ﻤﻥ ﺍﻹﺴﻬﺎل ﺍﻟﺤﺎﺩ ﻭﺍﻟﻤـﺩﻤﻡ ﺃﺤﻴﺎﻨـﺎ‬
‫ﻭﺍﻟﻤﺼﺤﻭﺏ ﺒﻔﻘﺩ ﺘﺎﻡ ﻟﻠﺭﻏﺒﺔ ﻓﻲ ﺍﻟﺭﻀﺎﻋﺔ ﻭﺍﻟﺤﺯﻕ ﺃﺜﻨﺎﺀ ﺍﻟﺘﺒﺭﺯ ﻭﺍﻹﻨﻬﺎﻙ ﻭﺍﻟﺠﻔﺎﻑ ﻭﻋﺩﻡ ﺍﻟﻘﺩﺭﺓ‬
‫ﻋﻠﻰ ﺍﻟﻭﻗﻭﻑ ﻭﺍﻟﺭﻗـﺎﺩ ﺃﺤﻴﺎﻨـﺎ‪ .‬ﺃﻅﻬـﺭﺕ ﻨﺘـﺎﺌﺞ ﺍﻟﻔﺤـﺹ ﺍﻟﻁﻔﻴﻠـﻲ ﻭﺠـﻭﺩ ﺤﻭﻴـﺼﻼﺕ‬
‫ﺍﻟﻜﺭﺒﺘﻭﺴﺒﻭﺭﻴﺩﻴﺎ ﻓﻲ ‪ %21‬ﻤﻥ ﺇﺠﻤﺎﻟﻲ ﺤﺎﻻﺕ ﺍﻹﺼﺎﺒﺔ ﺒﺎﻹﺴﻬﺎل‪ ,‬ﻭﻜﺎﻨﺕ ﺃﻋﻠﻰ ﻨﺴﺒﺔ ﺇﺼﺎﺒﺔ ﻓﻰ‬
‫ﺍﻟﻌﻤﺭ ﻤﻥ ‪ 30- 10‬ﻴﻭﻤﺎ )‪ (%73.71‬ﻭﺃﻗﻠﻬﺎ ﻓﻲ ﺍﻟﻌﻤﺭ ﻤـﻥ ‪ (% 7.14) 10-0‬ﺃﻴـﺎﻡ ﻜﻤـﺎ‬
‫ﻟﻭﺤﻅﺕ ﺇﺼﺎﺒﺎﺕ ﻤﺨﺘﻠﻁﺔ ﻤﻊ ﺤﻭﻴﺼﻼﺕ ﺍﻟﻜﻭﻜﺴﻴﺩﻴﺎ ﻓﻲ ‪ 7‬ﺤﺎﻻﺕ ﻤﻨﻬﺎ )‪ ( % 16.6‬ﻭﺤﺎﻟﺘـﺎﻥ‬
‫ﻤﻥ ﺍﻻﺼﺎﺒﺔ ﺒﻁﻔﻴل ﺍﻻﺴﻜﺎﺭﺱ )‪ ( % 4.8‬ﻜﻤﺎ ﻟﻭﺤﻅ ﻅﻬﻭﺭ ﺃﻋﺭﺍﺽ ﺍﻟﺘﻬﺎﺏ ﺸـﻌﺒﻲ ﻓـﻲ ‪5‬‬
‫ﺤﺎﻻﺕ ﻭﻨﻔﻭﻕ ﺤﺎﻟﺘﻴﻥ ﻤﻨﻬﻤﺎ‪ .‬ﺃﻭﻀﺢ ﺍﻟﻔﺤﺹ ﺍﻟﺨﻠﻭﻱ ﻟﻠﺩﻡ ﺍﺭﺘﻔﺎﻋﺎ ﻏﻴﺭ ﻤﻌﻨﻭﻴﺎ ﻓﻲ ﻋﺩﺩ ﻜﺭﻴﺎﺕ‬
‫ﺍﻟﺩﻡ ﺍﻟﺤﻤﺭﺍﺀ ﻭﺍﻟﻬﻴﻤﻭﺠﻠﻭﺒﻴﻥ ﻭﻤﻌﻨﻭﻴﺎ ﻓﻲ ﺤﺠﻡ ﺍﻟﺨﻼﻴﺎ ﺍﻟﻤﺼﻤﺕ ﻤﻤﺎ ﻴﻌﻜﺱ ﻭﺠﻭﺩ ﺍﻟﺠﻔﺎﻑ ﺒﻴﻥ‬
‫ﺍﻟﻌﺠﻭل ﺍﻟﻤﺼﺎﺒﺔ ﺘﻡ ﺘﺄﻜﻴﺩﻩ ﺒﺎﺭﺘﻔﺎﻋﺎﺕ ﻤﻌﻨﻭﻴﺔ ﻓﻲ ﺍﻟﺒﻭﻟﻴﻨﺎ ﺃﻴﻀﺎ‪ ،‬ﻜﻤﺎ ﻟﻭﺤﻅ ﺍﻨﺨﻔﺎﻀﺎ ﻤﻌﻨﻭﻴﺎ ﻓﻲ‬
‫ﻜل ﻤﻥ ﺍﻟﺼﻭﺩﻴﻭﻡ ﻭﺍﻟﻜﻠﻭﺭﻴﺩ ﻭﺍﻟﺠﻠﻭﻜﻭﺯ ﻓﻲ ﻤﺼل ﺍﻟﺩﻡ ﻜﺄﺤﺩ ﻤﻀﺎﻋﻔﺎﺕ ﺍﻹﺴـﻬﺎل ﻭﺍﻟﺠﻔـﺎﻑ‬
‫ﻭﺍﻟﺤﻤﻭﻀﺔ ﺍﻟﺩﻤﻭﻴﺔ‪ .‬ﻟﻭﺤﻅ ﺃﻴﻀﺎ ﺍﺭﺘﻔﺎﻋﺎ ﻤﻌﻨﻭﻴﺎ ﻓﻲ ﺍﻟﻌﺩﺩ ﺍﻟﻜﻠﻲ ﻟﻠﻜﺭﻴﺎﺕ ﺍﻟﺒﻴﻀﺎﺀ ﻭﺍﻟـﺫﻱ ﻗـﺩ‬
‫ﻴﻌﻜﺱ ﺍﻹﺼﺎﺒﺎﺕ ﺍﻟﺒﻜﺘﺭﻴﺔ ﺍﻟﻤﺼﺎﺤﺒﺔ ﻤﻥ ﻨﺎﺤﻴﺔ ﻭﻴﻌﻜﺱ ﺤﺎﻟﺔ ﺍﻟﺠﻔﺎﻑ ﻭﺘﺭﻜﻴﺯ ﺍﻟﺩﻡ ﻤـﻥ ﻨﺎﺤﻴـﺔ‬
‫ـﺭﻯ‪ .‬واﻟﺨﻼﺻ ﺔ ان اﻻﺻ ﺎﺑﺔ ﺑﻄﻔﻴ ﻞ اﻟﻜﺮﺑﺘﻮﺳ ﺒﻮرﻳﺪﻳﺎ ﺗﻌﺘﺒ ﺮ أﺣ ﺪ اﻻﺳ ﺒﺎب اﻟﻬﺎﻣ ﺔ ﻟﻼﻟﺘﻬ ﺎب‬ ‫ﺃﺨـ‬
‫اﻟﻤﻌ ﻮي واﻻﺳ ﻬﺎل ﺑﺎﻻﺿ ﺎﻓﺔ ﻟﻸﺳ ﺒﺎب اﻟﺒﻜﺘﺮﻳ ﺔ واﻟﻔﻴﺮوﺳ ﻴﺔ واﻟﺘ ﻲ ﺗ ﺆدي اﻟ ﻰ ﺧ ﺴﺎرة اﻗﺘ ﺼﺎدﻳﺔ‬
‫ﻓﺎدﺣﺔ ﻓﻲ اﻟﻌﺠﻮل اﻟﺼﻐﻴﺮة ‪.‬‬

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