The effect of intestinal protozoan infections on hematological parameters and micronutrients in colorectal cancer (CRC) patients

The effect of intestinal protozoan infections on hematological parameters and micronutrients in colorectal cancer (CRC) patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The effect of intestinal protozoan infections on hematological parameters and micronutrients in colorectal cancer (CRC) patients Ikhlas Marhoon This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6735971/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Jul, 2025 Read the published version in Journal of Parasitic Diseases → Version 1 posted 5 You are reading this latest preprint version Abstract Background This research examined the effects of intestinal protozoan infections on physiological aspects both hematological parameters and micronutrients among colorectal cancer patients (CRC) who experienced diarrhea. Colorectal cancer exists as the third worldwide cancer form and stands as a significant contributor to cancer deaths, CRC patients are often the most susceptible to parasitic infections, especially intestinal parasites for variety reasons considerable with health poor responsiveness in immune system compared to healthy people. Materials and Methods Sixty-two CRC patients with diarrhea underwent blood tests for hematological parameter evaluation (RBCs, Hb, PCV, WBCs, neutrophils, eosinophils) and micronutrient measurement of iron and zinc. Samples were collected from a randomized group of male and female at different ages that attending to Endocrinology Center and Oncology Department at Al-Diwaniyah Teaching Hospital in Al-Diwaniyah Province – Iraq. A 3ml of blood samples were taken and divided into two parts: 2ml of each sample placed in coagulant tubes and the remaining (1ml) placed in anticoagulant tubes. Samples were prepared to test for measured some hematological parameters which were RBCs, Hb, PCV, WBCs, neutrophils and eosinophils, and two micronutrient-related elements (iron and zinc) . Results Our results showed Entamoeba histolytica infection as the most common parasite affecting 61.29% of patients, alongside Giardia lamblia infection found in 38.70% of subjects. This dual parasite infection resulted in significant reductions of RBCs, Hb, and PCV but produced minimal neutrophil elevation and displayed variable effects on both WBCs and eosinophil levels. Participants experienced a reduction in their iron content when infected with both parasites, while G. lamblia caused major zinc loss, and E. histolytica showed moderate declines in zinc levels. Conclusions The identified protozoan infections of CRC patients generate substantial health consequences, which indicate a crucial requirement for proper parasitic management within this at-risk patient group. Colorectal cancer CRC Entamoeba histolytica Giardia lamblia Introduction Colorectal cancer exists as the third worldwide cancer form and stands as a significant contributor to cancer deaths (Hou et al., 2013 ). Immune suppression in CRC patients occurs from the disease itself and chemotherapy impacts that lead to greater susceptibility toward intestinal parasitic infections (IPI) (Mohite et al., 2024 ; Karthika et al., 2021). The public health domain remains threatened by protozoan infections, especially E. histolytica and G. lamblia infections, which affect severely ill individuals (Evering & Weiss, 2006 ). CRC patients face severe health risks from intestinal parasites because these parasites cause malabsorption problems and chronic diarrhea together with micronutrient deficiencies and worsened systemic inflammation (Jeske et al., 2018 ; Hussein, 2010 ). Studies show protozoan infections have known effects on the gastrointestinal system that modify host immune functions and metabolic processes (Landman & Quevrain, 2016 ). Due to damage of the gut barrier by parasitic infections, patients with CRC experience enhanced intestinal permeability with changed microbiota dynamics, thus putting their health condition at risk. Scientists show through mounting evidence that gut microbiota and parasitic infections could affect CRC development since particular parasitic species trigger inflammatory reactions that either accelerate or decelerate tumorigenic processes (Rasti et al., 2017 ; Puri et al., 2024 ). Intestinal parasite occurrences differ between populations because developing areas experience elevated rates due to lacking sanitary conditions, restricted medical care, and insufficient personal hygiene (Hegazi et al., 2013). The risk is elevated for CRC patients who contract intestinal protozoan infections since these parasites link to both blood cell defects and body nutrient depletion (Wiser et al., 2010). The presence of anemia alongside leukopenia alongside deficiencies in essential elements like zinc and iron regularly occurs among infected patients, which worsens the difficulties in cancer management (Esteghamati et al., 2019 ; Kilic et al., 2003 ). Relevant research has demonstrated E. histolytica and G. lamblia cause important reductions in the count of red blood cells (RBC), hemoglobin (Hb), and packed cell volume (PCV) as well as changes in immune cell numbers involving neutrophils and eosinophils according to Kadir & Mohammed (2011). The pathophysiological damage from these infections emerges through their invasion of intestinal mucosa tissue and their disruption of nutrient absorption, together with their chronic inflammatory response that extends major risks to CRC patients receiving intensive treatments. The frequent diarrhea symptom in CRC patients matches parasitic infection diarrhea symptoms, which activates both nutrient leakage and dehydration complications that harm treatment outcomes (Mehraj et al., 2008 ; Olivares et al., 2003 ). Medical research requires a thorough investigation of intestinal protozoan infections because they strongly affect CRC patient outcomes through modifications of hematological parameters and micronutrient levels. The present study investigates how E. histolytica and G. lamblia affect blood components and vital micronutrient levels of CRC patients for better parasitic infection treatment in cancer care. Analysis of these interactions offers potentially invaluable information for enhancing CRC patient health outcomes and treatment results through research that focuses on abandoned aspects of these fields. Materials and Methods Participants The existing study involved 90 patients diagnosed with CRC who referred to Al-Diwaniyah Teaching Hospital between January and June 2024. The diagnosis of colorectal cancer was confirmed by a qualified gastroenterologist through various diagnostic examinations (e.g., colonoscopy and blood tests). As exclusion criteria, participants must have a confirmed diagnosis of colorectal cancer, present with diarrhea, have a positive stool examination for either parasite, be 18 years or older, and have no history of antiparasitic treatment in the past three months. Individuals will be excluded if they have other gastrointestinal infections, are undergoing chemotherapy or radiation therapy within the last month, have been diagnosed with autoimmune disorders or systemic infections, or have severe comorbidities that affect hematological parameters, such as chronic kidney disease or liver cirrhosis. Sample collection and examination A fresh stool specimen was obtained from each participant and placed in a sterile, labeled container. Subsequently, these stool samples were transported to the Parasitology Laboratory at Biology Department, College of Education, University of Al-Qadisiyah - Iraq, for further analyses. Direct smear method (wet mount) and the formol-ether concentration technique were used to identify intestinal protozoa. Individuals who received a positive diagnosis were subsequently referred to a specialist in infectious diseases for the provision of appropriate guidance, medical treatment, and follow-up care. Blood collection Each patient provided 3 mL of blood, which was divided into two parts: in the first part, 2 mL of blood was placed in yellow hooded coagulant tubes (Gel tubes), allowed to clot for 5 minutes, and centrifuged at 1500 rpm for 5 minutes to separate serum. The serum was stored in a freezer until further analysis. In the second part, the remaining 1 mL of blood was placed in EDTA anticoagulant tubes for complete blood count (CBC) analysis (Obaid, 2014 ). Hematological analysis Laboratory analysis of blood and serum samples was conducted at the pathological laboratory in Diwaniyah province. CBC analysis was performed using an automated hematology analyzer (CBC Diamond). The hematological parameters measured in this study included total RBCs, Hb, PCV, WBCs, neutrophils, and eosinophils. Additionally, iron and zinc levels were measured in blood serum samples (Daniel, 2011 ). Statistical Analysis Statistical analysis was performed using SPSS software (version 26). Before conducting hypothesis testing, data were assessed for normality using the Shapiro-Wilk test. Depending on the normality results, parametric tests (Student's t-test ) were applied for normally distributed variables, while non-parametric tests (Mann-Whitney U test) were used for non-normally distributed data. Categorical variables were analyzed using the chi-square test. A significance level of p < 0.05 was considered statistically significant. Results and Discussion The examinations of 90 fecal samples, which were taken from diarrheic colorectal cancer, totally 62 patients (68.89%) were positive for parasitic protozoa infection and revealed that diarrhea cases in these samples were mainly due to two parasitic protozoa: E. histolytica (61.29%) and G. lambia (38.70%), as shown in Table 1 . Table 1 Infections with Intestinal Parasites in Diarrheic CRC Patients Types of intestinal parasites in CRC patients Number of infections % Protozoan parasites E. histolytica 38 61.29 G. lamblia 24 38.70 Total No. 90 62 68.89 The results demonstrated in Table 1 indicate that the infections of E. histolytica are more than cases of diarrhea caused by G. lamblia , with the infection percentage reaching 61.29% compared to 38.70%. This finding aligns with several previous studies that suggested G. lamblia and E. histolytica are the most common causes of intestinal diarrhea. In the same vein, several other studies have confirmed that these two parasitic protozoa are the most prevalent of all intestinal parasite infections (Hamad and Ramzy, 2011 ; Obaid, 2014 ; Nuchjangreed, 2018 ). Hence, several factors, including the transmission of infective stages of these parasites(for instance, a parasitic organism can be transmitted through contaminated food and water), inadequate hygiene, non-sterilization of drinking water, failure to wash fruit and vegetables before eating, may cause the above-mentioned infections, especially in immunocompromised patients ( Hegazi et al ., 2013; Amin et al. ,2017; Jeske et al. ,2018 ). The results shown in Table 2 demonstrate the impact of infections from two intestinal parasites, G. lamblia and E. histolytica , on specific hematological parameters in diarrhea CRC patients and those with intestinal colic symptoms. Consequently, the results indicated a significant reduction in RBCs, a decline in Hb, and a decrease in PCV when an individual is infected with both protozoa. The prevalence rates of E. histolytica were 3.7%, 9.84%, and 31.02%, respectively, while those for G. lamblia were 4.3%, 9.33%, and 26.27%, respectively, yielding total rates of 4.0%, 9.59%, and 28.65%, respectively. Meanwhile, in both species, the results showed a noticeable decrease in WBCs as well as a minor increase in neutrophils. The rates of infections with E. histolytica were 6.65 and 4.28, respectively, while the rates of infections with G. lamblia were 6.76 and 4.32, respectively, with a total of 6.70 and 4.30, respectively, compared to natural standard levels. In the same vein, the results showed an increase in eosinophils in infections with E. histolytica (0.31) and a normal level (0.26) in infections with G. lamblia and at a total of 0.29 for both compared to natural levels. These findings are consistent with some previous studies that investigated the physiological effects of parasitic infection on hematological parameters. Moreover, these studies underlined a significant decrease in PCV and Hb in patients with intestinal parasites, offset by a decrease in the number of WBCs (neutrophils and eosinophils) and a remarkable decrease in lymphocytes (Al-Mosa and Al-Taie, 2007 ; Le et al., 2007 ; Nuchjangreed, 2018 ; Esteghamati, 2019 ). Anemia is a common symptom of intestinal parasitic infection. According to the World Health Organization (WHO), anemia is defined as a decrease in the value of Hb from 10 g/100 ml (WHO, 2003 ). Intestinal parasite infections significantly affect the absorption of many necessary elements in the formation of RBCs, such as iron, which is a necessary element for the development of Hb, vitamin B12, and folic acid. However, the body loses these elements as a result of damage to the small intestine lining, especially the duodenum and ileum (the preferred places for the presence of G. lamblia and E. histolytica ). These parasites decay the intestinal lining and extend a certain distance from the intestine, causing the affected part to lose its physiological function (Mohammadi-Ghalehbin et al., 2017 ; Rasti et al., 2017 ). In general, the nature of the immune response in infected individuals is a noticeable increase in the total number of WBCs and neutrophils, as well as a slight increase at the normal limit of eosinophils during intestinal parasite infection. Therefore, the levels of WBCs increase when pathogens, including parasites, infect the body because the body increases the production of WBCs to control the pathogen (Heukelbach, 2006 ; Sharifzadeh, 2011 ) but in colorectal patients, WBCs were decreased because of this type of cancer grew and disseminated slowly, and this leads to weakening immune system's response (Spell et al., 2004 ). Calculating WBCs in the blood is useful in illustrating several important health indicators: increasing WBCs may indicate a pathogenic infection or that the body resists a particular disease while decreasing WBCs from normal may indicate that the immune system does not function as it should. Thus, these indications show that a simple infection can cause an acute health problem (Ryan et al., 2004 ). Neutrophils are the most abundant WBCs in humans, accounting for 60–70% of the widespread WBCs in the blood. Also, neutrophils defend the body against bacterial or parasitic infections by swallowing pathogens in a process called phagocytosis (Heukelbach, 2006 ). In normal cases, the bloodstream contains neutrophils, but pathogens specifically cause acute inflammation, which prompts neutrophils to leave the circulatory system and migrate toward the site of infection or inflammation through a process known as chemical attraction. Following that, neutrophils act within an hour of bodily damage. Accordingly, the high number of neutrophils is one of the specific and distinctive signs of the presence of acute infections (Yahya et al., 2007 ). Regarding Eosinophils, it represents form (1–4%) of WBCs, and this percentage rises when the body encounters allergens. In addition to their role in parasite resistance, eosinophils play a significant role in the body's reactions to allergies (Matthys, 2011). Many parasites cause a hyper-eosinophil condition, especially those that invade anatomical functions. When the number of eosinophils is very high, this indicates a histological inflammation. Moreover, a high number of eosinophils can lead to anatomical damage, resulting in symptoms that vary depending on the affected part or organ. The symptoms appear as pain and acute intestinal colic (Triteeraprapabl and Nuchprayoon, 1998 ; Juma'a, 2006 ; Obaid, 2014 ). When parasites spend outside the host cell long time, it stimulates higher levels of immune response, including neutrophils and eosinophils. Intestinal protozoa infiltrate the epithelial cells of the intestine, particularly the ileum and jejunum, which are the preferred sites of intrusion for G. lamblia and E. histolytica . These two parasitic species multiply within the host cell, exploding once they fill with trophozoites of intestinal parasites, which then spread inside the intestinal cavity to infect another cell. In acute intestinal infections, nutritious phases abound in the intestinal cavity, stimulating the immune system to produce defensive cells against such parasitic pathogens as neutrophils and eosinophils. The more defensive cells more likely to destroy pathogens (Yahya et al., 2007 ; Al-Mosa and Al-Taie, 2007 ; Al-Naemi, 2011 ; Daniel, 2011 ). Table 3 illustrates the impact of E. histolytica and G. lamblia on the levels of specific micronutrients essential for the body. This study reveals a considerable decrease in iron levels associated with both types of identified intestinal parasites. In E. histolytica , the iron concentration was 62.14 g/ml, and in G. lamblia , it was 76.15 g/ml, resulting in an average of 69.15 g/ml for both species. Also, results indicated a marginal decrease in zinc levels for E. histolytica (80.40µg/dL), whereas a substantial decrease was found in G. lamblia (60.31µg/dL), culminating in a total concentration of 70.36µg/dL for both parasites relative to the normal levels of these elements. Figure 2 presents the micronutrient levels in diarrheic CRC patients. Table 2 Effects of intestinal protozoan infections on the average of some hematological parameters and complete blood count (CBC) in diarrheic colorectal cancer patients. Parameters Mean ± SE Infection with E. histolytica Infection with G. lamblia Average of both infections Normal parameters Total RBCs (×10 3 /ml) 3.7 ± 0.40 4.3 ± 0.30 4.0 ± 0.35 4.8 ± 0.2 Hb) gm/dl) 9.84 ± 1.17 9.33 ± 1.53 9.59 ± 1.35 15.12 ± 2.1 PCV % 31.02 ± 2.21 26.27 ± 2.54 28.65 ± 2.38 45.68 ± 3.69 WBCs (×10 3 / ml) 6.65 ± 1.22 6.76 ± 1.13 6.70 ± 1.17 7.68 ± 1.71 Neutrophils (×10 3 / ml) 4.28 ± 1.20 4.32 ± 1.3 4.30 ± 1.25 4.21 ± 1.3 Eosinophils (×10 3 / ml) 0.31 ± 0.20 0.26 ± 0.3 0.29 ± 0.25 0.27 ± 0.2 RBC: red cell count; Hb: hemoglobin, PCV: packed cell volume; WBC: white blood cell Table 3 Effects of intestinal protozoan infections with E. histolytica and G. lamblia on the mean of the serum level of micronutrients (Iron and Zinc) in diarrheic colorectal cancer patients . Micronutrients SE ± Mean Infection with E. histolytica Infection with G. lamblia Average of both infections Normal parameters Iron 62.14 ± 2.40 76.15 ± 1.95 69.15 ± 2.18 90 g/ml (40–140 g/ml) Zinc 80.40 ± 2.21 60.31 ± 2.50 70.36 ± 2.35 95 mg/dl (70–120 mg/dl) The results align with previous studies that elaborated on the decrease of certain micronutrients due to parasitic infections, including G. lamblia and E. histolytica . Similarly, numerous studies have demonstrated a noticeable decrease in the levels of iron, zinc, and cobalt in the blood of infected individuals, alongside a decline in albumin and total protein levels (Kadir and Mohammed, 2011; Yahya et al., 2007 ). Intestinal parasites, by their specialized activities, damage the active absorption layer, thereby resulting in the body's loss of numerous vital nutrients (Obaid, 2014 ). Malabsorption, a significant symptom of diarrhea caused by intestinal parasites such as G. lamblia and E. histolytica , results in iron shortage. This elucidates the decrease in iron levels in the present study. Likewise, malabsorption results in a deficiency of essential elements required for the synthesis of RBCs in the bone marrow, including folic acid and vitamin B12. Additionally, the loss of critical components often results from parasite damage (Taheri et al., 2011 ; Lopez-Romero et al., 2015 ). The infection with these two protozoa, especially in CRC patients, results in abrupt malabsorption, intestinal villi destruction, and impaired absorption of proteins, carbohydrates, fats, calcium, zinc, and vitamins in the ileum and jejunum (Shah, 2002 ; Mohammadi-Ghalehbin et al., 2017 ). Zinc is a crucial and scarce mineral that the body requires in minimal amounts to sustain essential physiological functions. Zinc offers adequate amounts that exceed those present in metabolic pathways or by supplements, significantly enhancing the immune system. Zinc is essential for the proteins that control cell formation in the human immune system (Shankar et al., 2000 ). Zinc aids in diarrhea management, while zinc deficiency may increase the risk of several infections. The primary factors contributing to zinc deficiency and hindering adequate absorption include intestinal diseases and chronic diarrhea caused by intestinal parasite damage, especially in CRC patients (Mehraj et al., 2008 ; Salehi et al., 2018 ). Parasitic infections, such as those caused by Entamoeba histolytica and Giardia lamblia, induce hematological changes and micronutrient deficiencies through several interconnected mechanisms. Direct intestinal damage from parasite invasion disrupts nutrient absorption, particularly of iron and zinc, leading to malabsorption and anemia (Rizk et al., 2021 ). Parasites also compete directly with the host for essential nutrients, further depleting micronutrient stores crucial for erythropoiesis (AbouLaila et al., 2020 ). The resulting chronic inflammation and immune response, characterized by increased pro-inflammatory cytokines, contributes to iron sequestration and exacerbates anemia (Rizk et al., 2021 ). Finally, disruption of the gut microbiota and immune modulation by these parasites further impair micronutrient metabolism and absorption (AbouLaila et al., 2020 ) Conclusion Our findings indicate a high prevalence of Entamoeba histolytica and Giardia lamblia co-infection in colorectal cancer (CRC) patients presenting with diarrhea. These parasitic infections significantly impacted key physiological parameters, notably hematological indices (total RBCs, Hb, PCV, WBCs, neutrophils, and eosinophils) and micronutrient status (Iron and Zinc). Specifically, infection was associated with marked reductions in red blood cell counts, hemoglobin levels, and packed cell volume, alongside alterations in white blood cell populations. Furthermore, we observed that both E. histolytica and G. lamblia contributed to significant deficiencies in iron and zinc, elements critical for numerous physiological processes. These results underscore the importance of considering and actively managing parasitic infections in CRC patients. Integrating appropriate diagnostic and therapeutic strategies for parasitic co-infections into the standard of care may improve patient outcomes and quality of life. Declarations Acknowledgments The study was done in the pathological laboratories of Al-Diwaniyah Teaching Hospital and the microbiological laboratory of the Biology Department, Education College, Al-Qadisiyah University. Author contributions IAM designed the experiments, performed them, wrote the manuscript, and approved the final version for publication. Funding/Supports None declared by Authors. Data Availability The dataset presented in the study is available on request from the corresponding author during submission or after its publication. Ethical statement Patient recruitment was carried out in compliance with the principles established in the 1964 Helsinki Declaration. Written informed consent was obtained from all participants, including legal guardians for those individuals who were unable to read. Additionally, the study received ethical approval from the ethical committee of the Education College, Al-Qadisiyah University, Iraq. Consent for publication Not applicable. Consent to Participate declaration Not applicable. Conflict of interest The authors declare no conflict of interest in this study. References AbouLaila M, El-Sayed SAE-S, Omar MA, Al-Aboody MS, Aziz A, Abdel-Daim AR, Igarashi MM (2020) I. Myrrh Oil in Vitro Inhibitory Growth on Bovine and Equine Piroplasm Parasites and Babesia microti of Mice. Pathogens, 9(3), 173. 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World Health Organization, Geneva, Switzerland Wiser MF (2010) Protozoa and Human Disease. Garland Science. https://doi.org/10.1201/9780429258282 Yahya GS, Esraa AM, Majida NI (2007) Effect of Giardia lamblia on some biochemical changes of the human. Tikrit J Pure Sci Tikrit Univ 12(1):29–32 Cite Share Download PDF Status: Published Journal Publication published 17 Jul, 2025 Read the published version in Journal of Parasitic Diseases → Version 1 posted Reviewers agreed at journal 04 Jun, 2025 Reviewers invited by journal 04 Jun, 2025 Editor invited by journal 24 May, 2025 Editor assigned by journal 24 May, 2025 First submitted to journal 23 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6735971","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":466106962,"identity":"b75689fd-562f-453b-be0d-69b2ef8e305e","order_by":0,"name":"Ikhlas Marhoon","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYBACNh4exgMghoEEkPgAFksAI3xaGOBaGGcQo4UBWQszD0wLPsDHc/bAgR9/GOTNpZsff7YpO8zAz55jwPCgDI/DePsSDva2MRjunHPMTDrn3GEGyZ43BgwJ5/Bo4ecxOMDbwMC44UaCGXNu22EGgxtAWxLb8Gs5+OcPg/2GG+mfP1sCtdgT1MLbY3CYh40hcQNQpTQjyBYJQlp4zhgclm2TSN4550yZZM+5dB6JM88KDuDzi3xPjuHDN39sbLdLt2/+8KPMWo6/PXnjwx94QgwKJGCWMoCj5gCQQSxgw2CMglEwCkbBKGAAAPlXUFDnTM6rAAAAAElFTkSuQmCC","orcid":"","institution":"University of Al-Qadisiyah","correspondingAuthor":true,"prefix":"","firstName":"Ikhlas","middleName":"","lastName":"Marhoon","suffix":""}],"badges":[],"createdAt":"2025-05-24 00:08:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6735971/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6735971/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s12639-025-01836-w","type":"published","date":"2025-07-17T16:05:34+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88506110,"identity":"9b39e230-2d7b-4e1c-8467-d235a2da2513","added_by":"auto","created_at":"2025-08-07 07:31:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":649630,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6735971/v1/6331b085-45d5-4b4d-8ff5-2cbc0c068d88.pdf"}],"financialInterests":"","formattedTitle":"The effect of intestinal protozoan infections on hematological parameters and micronutrients in colorectal cancer (CRC) patients","fulltext":[{"header":"Introduction","content":"\u003cp\u003eColorectal cancer exists as the third worldwide cancer form and stands as a significant contributor to cancer deaths (Hou et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Immune suppression in CRC patients occurs from the disease itself and chemotherapy impacts that lead to greater susceptibility toward intestinal parasitic infections (IPI) (Mohite et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Karthika et al., 2021). The public health domain remains threatened by protozoan infections, especially \u003cem\u003eE. histolytica\u003c/em\u003e and \u003cem\u003eG. lamblia\u003c/em\u003e infections, which affect severely ill individuals (Evering \u0026amp; Weiss, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). CRC patients face severe health risks from intestinal parasites because these parasites cause malabsorption problems and chronic diarrhea together with micronutrient deficiencies and worsened systemic inflammation (Jeske et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Hussein, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStudies show protozoan infections have known effects on the gastrointestinal system that modify host immune functions and metabolic processes (Landman \u0026amp; Quevrain, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Due to damage of the gut barrier by parasitic infections, patients with CRC experience enhanced intestinal permeability with changed microbiota dynamics, thus putting their health condition at risk. Scientists show through mounting evidence that gut microbiota and parasitic infections could affect CRC development since particular parasitic species trigger inflammatory reactions that either accelerate or decelerate tumorigenic processes (Rasti et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Puri et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIntestinal parasite occurrences differ between populations because developing areas experience elevated rates due to lacking sanitary conditions, restricted medical care, and insufficient personal hygiene (Hegazi et al., 2013). The risk is elevated for CRC patients who contract intestinal protozoan infections since these parasites link to both blood cell defects and body nutrient depletion (Wiser et al., 2010). The presence of anemia alongside leukopenia alongside deficiencies in essential elements like zinc and iron regularly occurs among infected patients, which worsens the difficulties in cancer management (Esteghamati et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Kilic et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2003\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRelevant research has demonstrated \u003cem\u003eE. histolytica\u003c/em\u003e and \u003cem\u003eG. lamblia\u003c/em\u003e cause important reductions in the count of red blood cells (RBC), hemoglobin (Hb), and packed cell volume (PCV) as well as changes in immune cell numbers involving neutrophils and eosinophils according to Kadir \u0026amp; Mohammed (2011). The pathophysiological damage from these infections emerges through their invasion of intestinal mucosa tissue and their disruption of nutrient absorption, together with their chronic inflammatory response that extends major risks to CRC patients receiving intensive treatments. The frequent diarrhea symptom in CRC patients matches parasitic infection diarrhea symptoms, which activates both nutrient leakage and dehydration complications that harm treatment outcomes (Mehraj et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Olivares et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2003\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMedical research requires a thorough investigation of intestinal protozoan infections because they strongly affect CRC patient outcomes through modifications of hematological parameters and micronutrient levels. The present study investigates how \u003cem\u003eE. histolytica\u003c/em\u003e and \u003cem\u003eG. lamblia\u003c/em\u003e affect blood components and vital micronutrient levels of CRC patients for better parasitic infection treatment in cancer care. Analysis of these interactions offers potentially invaluable information for enhancing CRC patient health outcomes and treatment results through research that focuses on abandoned aspects of these fields.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThe existing study involved 90 patients diagnosed with CRC who referred to Al-Diwaniyah Teaching Hospital between January and June 2024. The diagnosis of colorectal cancer was confirmed by a qualified gastroenterologist through various diagnostic examinations (e.g., colonoscopy and blood tests). As exclusion criteria, participants must have a confirmed diagnosis of colorectal cancer, present with diarrhea, have a positive stool examination for either parasite, be 18 years or older, and have no history of antiparasitic treatment in the past three months. Individuals will be excluded if they have other gastrointestinal infections, are undergoing chemotherapy or radiation therapy within the last month, have been diagnosed with autoimmune disorders or systemic infections, or have severe comorbidities that affect hematological parameters, such as chronic kidney disease or liver cirrhosis.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample collection and examination\u003c/h3\u003e\n\u003cp\u003eA fresh stool specimen was obtained from each participant and placed in a sterile, labeled container. Subsequently, these stool samples were transported to the Parasitology Laboratory at Biology Department, College of Education, University of Al-Qadisiyah - Iraq, for further analyses. Direct smear method (wet mount) and the formol-ether concentration technique were used to identify intestinal protozoa. Individuals who received a positive diagnosis were subsequently referred to a specialist in infectious diseases for the provision of appropriate guidance, medical treatment, and follow-up care.\u003c/p\u003e\n\u003ch3\u003eBlood collection\u003c/h3\u003e\n\u003cp\u003eEach patient provided 3 mL of blood, which was divided into two parts: in the first part, 2 mL of blood was placed in yellow hooded coagulant tubes (Gel tubes), allowed to clot for 5 minutes, and centrifuged at 1500 rpm for 5 minutes to separate serum. The serum was stored in a freezer until further analysis. In the second part, the remaining 1 mL of blood was placed in EDTA anticoagulant tubes for complete blood count (CBC) analysis (Obaid, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eHematological analysis\u003c/h3\u003e\n\u003cp\u003eLaboratory analysis of blood and serum samples was conducted at the pathological laboratory in Diwaniyah province. CBC analysis was performed using an automated hematology analyzer (CBC Diamond). The hematological parameters measured in this study included total RBCs, Hb, PCV, WBCs, neutrophils, and eosinophils. Additionally, iron and zinc levels were measured in blood serum samples (Daniel, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using SPSS software (version 26). Before conducting hypothesis testing, data were assessed for normality using the Shapiro-Wilk test. Depending on the normality results, parametric tests (Student's \u003cem\u003et-test\u003c/em\u003e) were applied for normally distributed variables, while non-parametric tests (Mann-Whitney U test) were used for non-normally distributed data. Categorical variables were analyzed using the chi-square test. A significance level of \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results and Discussion","content":"\u003cp\u003eThe examinations of 90 fecal samples, which were taken from diarrheic colorectal cancer, totally 62 patients (68.89%) were positive for parasitic protozoa infection and revealed that diarrhea cases in these samples were mainly due to two parasitic protozoa: \u003cem\u003eE. histolytica\u003c/em\u003e (61.29%) and \u003cem\u003eG. lambia\u003c/em\u003e (38.70%), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInfections with Intestinal Parasites in Diarrheic CRC Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTypes of intestinal parasites in CRC patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of infections\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eProtozoan parasites\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eE. histolytica\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eG. lamblia\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal No.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results demonstrated in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e indicate that the infections of \u003cem\u003eE. histolytica\u003c/em\u003e are more than cases of diarrhea caused by \u003cem\u003eG. lamblia\u003c/em\u003e, with the infection percentage reaching 61.29% compared to 38.70%. This finding aligns with several previous studies that suggested \u003cem\u003eG. lamblia\u003c/em\u003e and \u003cem\u003eE. histolytica\u003c/em\u003e are the most common causes of intestinal diarrhea. In the same vein, several other studies have confirmed that these two parasitic protozoa are the most prevalent of all intestinal parasite infections (Hamad and Ramzy, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Obaid, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Nuchjangreed, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHence, several factors, including the transmission of infective stages of these parasites(for instance, a parasitic organism can be transmitted through contaminated food and water), inadequate hygiene, non-sterilization of drinking water, failure to wash fruit and vegetables before eating, may cause the above-mentioned infections, especially in immunocompromised patients ( Hegazi \u003cem\u003eet al\u003c/em\u003e., 2013; Amin \u003cem\u003eet al.\u003c/em\u003e,2017; Jeske \u003cem\u003eet al.\u003c/em\u003e,2018 ).\u003c/p\u003e \u003cp\u003eThe results shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e demonstrate the impact of infections from two intestinal parasites, \u003cem\u003eG. lamblia\u003c/em\u003e and \u003cem\u003eE. histolytica\u003c/em\u003e, on specific hematological parameters in diarrhea CRC patients and those with intestinal colic symptoms. Consequently, the results indicated a significant reduction in RBCs, a decline in Hb, and a decrease in PCV when an individual is infected with both protozoa. The prevalence rates of \u003cem\u003eE. histolytica\u003c/em\u003e were 3.7%, 9.84%, and 31.02%, respectively, while those for \u003cem\u003eG. lamblia\u003c/em\u003e were 4.3%, 9.33%, and 26.27%, respectively, yielding total rates of 4.0%, 9.59%, and 28.65%, respectively.\u003c/p\u003e \u003cp\u003eMeanwhile, in both species, the results showed a noticeable decrease in WBCs as well as a minor increase in neutrophils. The rates of infections with \u003cem\u003eE. histolytica\u003c/em\u003e were 6.65 and 4.28, respectively, while the rates of infections with \u003cem\u003eG. lamblia\u003c/em\u003e were 6.76 and 4.32, respectively, with a total of 6.70 and 4.30, respectively, compared to natural standard levels.\u003c/p\u003e \u003cp\u003eIn the same vein, the results showed an increase in eosinophils in infections with \u003cem\u003eE. histolytica\u003c/em\u003e (0.31) and a normal level (0.26) in infections with \u003cem\u003eG. lamblia\u003c/em\u003e and at a total of 0.29 for both compared to natural levels. These findings are consistent with some previous studies that investigated the physiological effects of parasitic infection on hematological parameters. Moreover, these studies underlined a significant decrease in PCV and Hb in patients with intestinal parasites, offset by a decrease in the number of WBCs (neutrophils and eosinophils) and a remarkable decrease in lymphocytes (Al-Mosa and Al-Taie, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Le et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Nuchjangreed, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Esteghamati, 2019 ).\u003c/p\u003e \u003cp\u003eAnemia is a common symptom of intestinal parasitic infection. According to the World Health Organization (WHO), anemia is defined as a decrease in the value of Hb from 10 g/100 ml (WHO, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). Intestinal parasite infections significantly affect the absorption of many necessary elements in the formation of RBCs, such as iron, which is a necessary element for the development of Hb, vitamin B12, and folic acid. However, the body loses these elements as a result of damage to the small intestine lining, especially the duodenum and ileum (the preferred places for the presence of \u003cem\u003eG. lamblia\u003c/em\u003e and \u003cem\u003eE. histolytica\u003c/em\u003e). These parasites decay the intestinal lining and extend a certain distance from the intestine, causing the affected part to lose its physiological function (Mohammadi-Ghalehbin et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Rasti et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn general, the nature of the immune response in infected individuals is a noticeable increase in the total number of WBCs and neutrophils, as well as a slight increase at the normal limit of eosinophils during intestinal parasite infection. Therefore, the levels of WBCs increase when pathogens, including parasites, infect the body because the body increases the production of WBCs to control the pathogen (Heukelbach, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Sharifzadeh, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) but in colorectal patients, WBCs were decreased because of this type of cancer grew and disseminated slowly, and this leads to weakening immune system's response (Spell et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2004\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCalculating WBCs in the blood is useful in illustrating several important health indicators: increasing WBCs may indicate a pathogenic infection or that the body resists a particular disease while decreasing WBCs from normal may indicate that the immune system does not function as it should. Thus, these indications show that a simple infection can cause an acute health problem (Ryan et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). Neutrophils are the most abundant WBCs in humans, accounting for 60\u0026ndash;70% of the widespread WBCs in the blood. Also, neutrophils defend the body against bacterial or parasitic infections by swallowing pathogens in a process called phagocytosis (Heukelbach, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2006\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn normal cases, the bloodstream contains neutrophils, but pathogens specifically cause acute inflammation, which prompts neutrophils to leave the circulatory system and migrate toward the site of infection or inflammation through a process known as chemical attraction. Following that, neutrophils act within an hour of bodily damage. Accordingly, the high number of neutrophils is one of the specific and distinctive signs of the presence of acute infections (Yahya et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2007\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRegarding Eosinophils, it represents form (1\u0026ndash;4%) of WBCs, and this percentage rises when the body encounters allergens. In addition to their role in parasite resistance, eosinophils play a significant role in the body's reactions to allergies (Matthys, 2011).\u003c/p\u003e \u003cp\u003eMany parasites cause a hyper-eosinophil condition, especially those that invade anatomical functions. When the number of eosinophils is very high, this indicates a histological inflammation. Moreover, a high number of eosinophils can lead to anatomical damage, resulting in symptoms that vary depending on the affected part or organ. The symptoms appear as pain and acute intestinal colic (Triteeraprapabl and Nuchprayoon, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e1998\u003c/span\u003e; Juma'a, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Obaid, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhen parasites spend outside the host cell long time, it stimulates higher levels of immune response, including neutrophils and eosinophils. Intestinal protozoa infiltrate the epithelial cells of the intestine, particularly the ileum and jejunum, which are the preferred sites of intrusion for \u003cem\u003eG. lamblia\u003c/em\u003e and \u003cem\u003eE. histolytica\u003c/em\u003e. These two parasitic species multiply within the host cell, exploding once they fill with trophozoites of intestinal parasites, which then spread inside the intestinal cavity to infect another cell. In acute intestinal infections, nutritious phases abound in the intestinal cavity, stimulating the immune system to produce defensive cells against such parasitic pathogens as neutrophils and eosinophils. The more defensive cells more likely to destroy pathogens (Yahya et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Al-Mosa and Al-Taie, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Al-Naemi, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Daniel, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e illustrates the impact of \u003cem\u003eE. histolytica\u003c/em\u003e and \u003cem\u003eG. lamblia\u003c/em\u003e on the levels of specific micronutrients essential for the body. This study reveals a considerable decrease in iron levels associated with both types of identified intestinal parasites. In \u003cem\u003eE. histolytica\u003c/em\u003e, the iron concentration was 62.14 g/ml, and in \u003cem\u003eG. lamblia\u003c/em\u003e, it was 76.15 g/ml, resulting in an average of 69.15 g/ml for both species. Also, results indicated a marginal decrease in zinc levels for \u003cem\u003eE. histolytica\u003c/em\u003e (80.40\u0026micro;g/dL), whereas a substantial decrease was found in \u003cem\u003eG. lamblia\u003c/em\u003e (60.31\u0026micro;g/dL), culminating in a total concentration of 70.36\u0026micro;g/dL for both parasites relative to the normal levels of these elements. Figure\u0026nbsp;2 presents the micronutrient levels in diarrheic CRC patients.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEffects of intestinal protozoan infections on the average of some hematological parameters and complete blood count (CBC) in diarrheic colorectal cancer patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SE\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfection with \u003cem\u003eE. histolytica\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInfection with \u003cem\u003eG. lamblia\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAverage of both infections\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNormal parameters\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal RBCs (\u0026times;10\u003csup\u003e3\u003c/sup\u003e/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHb) gm/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e9.84\u0026thinsp;\u0026plusmn;\u0026thinsp;1.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e9.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e15.12\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCV %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e31.02\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e26.27\u0026thinsp;\u0026plusmn;\u0026thinsp;2.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e28.65\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e45.68\u0026thinsp;\u0026plusmn;\u0026thinsp;3.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBCs (\u0026times;10\u003csup\u003e3\u003c/sup\u003e/ ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e6.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e7.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutrophils (\u0026times;10\u003csup\u003e3\u003c/sup\u003e/ ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.28\u0026thinsp;\u0026plusmn;\u0026thinsp;1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.30\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEosinophils (\u0026times;10\u003csup\u003e3\u003c/sup\u003e/ ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRBC: red cell count; Hb: hemoglobin, PCV: packed cell volume; WBC: white blood cell\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEffects of intestinal protozoan infections with \u003cem\u003eE. histolytica and G. lamblia\u003c/em\u003e on the mean of the serum level of micronutrients (Iron and Zinc) in diarrheic colorectal cancer patients .\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMicronutrients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eSE\u0026thinsp;\u0026plusmn;\u0026thinsp;Mean\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfection with \u003cem\u003eE. histolytica\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInfection with \u003cem\u003eG. lamblia\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAverage of both infections\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNormal parameters\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIron\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62.14\u0026thinsp;\u0026plusmn;\u0026thinsp;2.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.15\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e90 g/ml\u003c/p\u003e \u003cp\u003e(40\u0026ndash;140 g/ml)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZinc\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.31\u0026thinsp;\u0026plusmn;\u0026thinsp;2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70.36\u0026thinsp;\u0026plusmn;\u0026thinsp;2.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95 mg/dl\u003c/p\u003e \u003cp\u003e(70\u0026ndash;120 mg/dl)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results align with previous studies that elaborated on the decrease of certain micronutrients due to parasitic infections, including \u003cem\u003eG. lamblia\u003c/em\u003e and \u003cem\u003eE. histolytica\u003c/em\u003e. Similarly, numerous studies have demonstrated a noticeable decrease in the levels of iron, zinc, and cobalt in the blood of infected individuals, alongside a decline in albumin and total protein levels (Kadir and Mohammed, 2011; Yahya et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2007\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIntestinal parasites, by their specialized activities, damage the active absorption layer, thereby resulting in the body's loss of numerous vital nutrients (Obaid, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Malabsorption, a significant symptom of diarrhea caused by intestinal parasites such as \u003cem\u003eG. lamblia\u003c/em\u003e and \u003cem\u003eE. histolytica\u003c/em\u003e, results in iron shortage. This elucidates the decrease in iron levels in the present study. Likewise, malabsorption results in a deficiency of essential elements required for the synthesis of RBCs in the bone marrow, including folic acid and vitamin B12. Additionally, the loss of critical components often results from parasite damage (Taheri et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Lopez-Romero et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe infection with these two protozoa, especially in CRC patients, results in abrupt malabsorption, intestinal villi destruction, and impaired absorption of proteins, carbohydrates, fats, calcium, zinc, and vitamins in the ileum and jejunum (Shah, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; Mohammadi-Ghalehbin et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eZinc is a crucial and scarce mineral that the body requires in minimal amounts to sustain essential physiological functions. Zinc offers adequate amounts that exceed those present in metabolic pathways or by supplements, significantly enhancing the immune system. Zinc is essential for the proteins that control cell formation in the human immune system (Shankar et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). Zinc aids in diarrhea management, while zinc deficiency may increase the risk of several infections. The primary factors contributing to zinc deficiency and hindering adequate absorption include intestinal diseases and chronic diarrhea caused by intestinal parasite damage, especially in CRC patients (Mehraj et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Salehi et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eParasitic infections, such as those caused by Entamoeba histolytica and Giardia lamblia, induce hematological changes and micronutrient deficiencies through several interconnected mechanisms. Direct intestinal damage from parasite invasion disrupts nutrient absorption, particularly of iron and zinc, leading to malabsorption and anemia (Rizk et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Parasites also compete directly with the host for essential nutrients, further depleting micronutrient stores crucial for erythropoiesis (AbouLaila et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The resulting chronic inflammation and immune response, characterized by increased pro-inflammatory cytokines, contributes to iron sequestration and exacerbates anemia (Rizk et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Finally, disruption of the gut microbiota and immune modulation by these parasites further impair micronutrient metabolism and absorption (AbouLaila et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur findings indicate a high prevalence of Entamoeba histolytica and Giardia lamblia co-infection in colorectal cancer (CRC) patients presenting with diarrhea. These parasitic infections significantly impacted key physiological parameters, notably hematological indices (total RBCs, Hb, PCV, WBCs, neutrophils, and eosinophils) and micronutrient status (Iron and Zinc). Specifically, infection was associated with marked reductions in red blood cell counts, hemoglobin levels, and packed cell volume, alongside alterations in white blood cell populations. Furthermore, we observed that both \u003cem\u003eE. histolytica\u003c/em\u003e and \u003cem\u003eG. lamblia\u003c/em\u003e contributed to significant deficiencies in iron and zinc, elements critical for numerous physiological processes. These results underscore the importance of considering and actively managing parasitic infections in CRC patients. Integrating appropriate diagnostic and therapeutic strategies for parasitic co-infections into the standard of care may improve patient outcomes and quality of life.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was done in the pathological laboratories of Al-Diwaniyah Teaching Hospital and the\u0026nbsp;microbiological laboratory of the Biology Department, Education College, Al-Qadisiyah University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIAM designed the experiments, performed them, wrote the manuscript, and approved the final version for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding/Supports\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone declared by Authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset presented in the study is available on request from the corresponding author during submission or after its publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient recruitment was carried out in compliance with the principles established in the 1964 Helsinki Declaration. Written informed consent was obtained from all participants, including legal guardians for those individuals who were unable to read. Additionally, the study received ethical approval from the ethical committee of the Education College, Al-Qadisiyah University, Iraq.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbouLaila M, El-Sayed SAE-S, Omar MA, Al-Aboody MS, Aziz A, Abdel-Daim AR, Igarashi MM (2020) I. 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Garland Science. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1201/9780429258282\u003c/span\u003e\u003cspan address=\"10.1201/9780429258282\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYahya GS, Esraa AM, Majida NI (2007) Effect of Giardia lamblia on some biochemical changes of the human. Tikrit J Pure Sci Tikrit Univ 12(1):29\u0026ndash;32\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-parasitic-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jopd","sideBox":"Learn more about [Journal of Parasitic Diseases](https://www.springer.com/journal/12639)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/jopd/default.aspx","title":"Journal of Parasitic Diseases","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Colorectal cancer, CRC, Entamoeba histolytica, Giardia lamblia","lastPublishedDoi":"10.21203/rs.3.rs-6735971/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6735971/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThis research examined the effects of intestinal protozoan infections on physiological aspects both hematological parameters and micronutrients among colorectal cancer patients (CRC) who experienced diarrhea. Colorectal cancer exists as the third worldwide cancer form and stands as a significant contributor to cancer deaths, CRC patients are often the most susceptible to parasitic infections, especially intestinal parasites for variety reasons considerable with health poor responsiveness in immune system compared to healthy people.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003eSixty-two CRC patients with diarrhea underwent blood tests for hematological parameter evaluation (RBCs, Hb, PCV, WBCs, neutrophils, eosinophils) and micronutrient measurement of iron and zinc. Samples were collected from a randomized group of male and female at different ages that attending to Endocrinology Center and Oncology Department at Al-Diwaniyah Teaching Hospital in Al-Diwaniyah Province \u0026ndash; Iraq. A 3ml of blood samples were taken and divided into two parts: 2ml of each sample placed in coagulant tubes and the remaining (1ml) placed in anticoagulant tubes. Samples were prepared to test for measured some hematological parameters which were RBCs, Hb, PCV, WBCs, neutrophils and eosinophils, and two micronutrient-related elements (iron and zinc) .\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOur results showed \u003cem\u003eEntamoeba histolytica\u003c/em\u003e infection as the most common parasite affecting 61.29% of patients, alongside \u003cem\u003eGiardia lamblia\u003c/em\u003e infection found in 38.70% of subjects. This dual parasite infection resulted in significant reductions of RBCs, Hb, and PCV but produced minimal neutrophil elevation and displayed variable effects on both WBCs and eosinophil levels. Participants experienced a reduction in their iron content when infected with both parasites, while \u003cem\u003eG. lamblia\u003c/em\u003e caused major zinc loss, and \u003cem\u003eE. histolytica\u003c/em\u003e showed moderate declines in zinc levels.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe identified protozoan infections of CRC patients generate substantial health consequences, which indicate a crucial requirement for proper parasitic management within this at-risk patient group.\u003c/p\u003e","manuscriptTitle":"The effect of intestinal protozoan infections on hematological parameters and micronutrients in colorectal cancer (CRC) patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-09 07:45:13","doi":"10.21203/rs.3.rs-6735971/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2025-06-04T06:42:52+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-04T06:34:45+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"Journal of Parasitic Diseases","date":"2025-05-24T06:03:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-24T05:35:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Parasitic Diseases","date":"2025-05-23T20:08:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-parasitic-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jopd","sideBox":"Learn more about [Journal of Parasitic Diseases](https://www.springer.com/journal/12639)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/jopd/default.aspx","title":"Journal of Parasitic Diseases","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"4fa07ec3-5df6-46d6-b8ea-09b5851ec931","owner":[],"postedDate":"June 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-07T07:14:07+00:00","versionOfRecord":{"articleIdentity":"rs-6735971","link":"https://doi.org/10.1007/s12639-025-01836-w","journal":{"identity":"journal-of-parasitic-diseases","isVorOnly":false,"title":"Journal of Parasitic Diseases"},"publishedOn":"2025-07-17 16:05:34","publishedOnDateReadable":"July 17th, 2025"},"versionCreatedAt":"2025-06-09 07:45:13","video":"","vorDoi":"10.1007/s12639-025-01836-w","vorDoiUrl":"https://doi.org/10.1007/s12639-025-01836-w","workflowStages":[]},"version":"v1","identity":"rs-6735971","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6735971","identity":"rs-6735971","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}