Alteration of Serum Lipid Profiles among Amoebasis and Giardiasis Confirmed Patients at North West Ethiopia

Alteration of Serum Lipid Profiles among Amoebasis and Giardiasis Confirmed Patients at North West Ethiopia | 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 Alteration of Serum Lipid Profiles among Amoebasis and Giardiasis Confirmed Patients at North West Ethiopia Muluken Semaw, Fenthun Megabiew, Muluken Walle, Dagmawi Woldesenbet, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4292224/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Amoebiasis and giardiasis, common intestinal infections caused by Entamoeba histolytica and Giardia lamblia parasite. These agents are dependent of host-derived lipids for their membrane biogenesis and potentially alter host serum lipid profiles, might results in cardiovascular complications. Yet, limited studies have investigated the association between the infections and lipid profiles in Ethiopia. Methods: A cross-sectional study was conducted from July 10 to August 252023. A total of 180 study participants were recruited using a convenient sampling technique. Socio-demographic and clinical data were collected using structured questionnaires via face-to face interviews and reviewing medical records, respectively. Approximately 5 grams of stool samples were collected and examined under a light microscope. Three milliliters of blood were collected from the case and control groups. The blood samples were then centrifuged to separate the serum from the whole blood. Subsequently, the lipid profiles were analyzed using a Coulter chemistry analyzer. The data were entered into epidata version (4.6), and exported into SPSS (25) for analysis. The lipid profile parameters of case were assessed and compared with healthy control groups using one way ANOVA. A P -value < 0.05 was considered as statistically significant. Result: The study showed that E. histolytica/dispar -infected patients had significantly lower mean serum total cholesterol (120.21 ± 40.11), HDL (33.73 ± 13.36), and LDL (74.63 ± 32.93) levels compared to healthy groups. Additionally, the median interquartile range of triglyceride value decreased in E. histolytica/dispar infected patients (P ≤ 0.05). Likewise, patients infected with G. lamblia had lower mean serum total cholesterol (123.46 ± 48.18), HDL (34.30 ± 14.30), and LDL (73.57 ± 42.65) levels compared to healthy groups. Also, the median interquartile range of triglyceride value was lower in Giardia- infected patients ( P ≤0.05). Conclusion: This study confirmed that E. histolytica/dispar and G. lamblia has significantly altered blood lipid levels in infected patients. Requires routine lipid panel analysis for these cohorts. Lipid profiles Alteration Gardiaisis Amoebasis Sanja Northwest Ethiopia Introduction According to Global Burden of Diseases(GBD) report, intestinal protozoan parasite (IPPS), remains the third leading causes of human death worldwide (1, 2). This infections pose significant public health problems mainly under-resourced countries with poor water and food sanitations practice (3). Amebiasis and Giardiasis are the two most common food-borne protozoan infections of upper and lower gastro-intestinal tract(GIT) (4, 5). These are caused by the Entamoeba histolytica / dispar (E. histolytica/ dispar) ,and Giardia lamblia (G. lamblia) protozoan parasites respectively (6, 7). Both pathogen are characterized by bi-morephic life forms, cyst ( infective/ non-feeding), and trophozoite, (pathogenic/ feeding) stages (8, 9). A diseases formation of these parasite is related with effect of trophozoite attachment to upper portion of small intestine, and their protolytic enzymes (cysteine proteases and glycosidases) (10, 11). This increases rate of enterocyte apoptosis, loss of barrier function, leading to lymphocyte-mediated microvillus shortening and reduction of absorptive surface area, ultimately are responsible for mal-digestion and malabsorption of nutrients (12-14). In acute clinical stages, are almost clinically overlapping that characterized by fever, watery diarrhea and other intestinal disorders (6, 15). Although, majority of gardiasis and amoebiasis are self resolving, yet in some case both result in chronic infection. Thus, the infected populations is might end-up with deficiency of vital caloric source (carbohydrate, protein), normal hemoglobin level, and lipid soluble vitamins (K, A, D, E) (15, 16). Moreover, several experimental finding indicates that both parasites are unable to synthesize their own lipids and cholesterol de novo, due to lack mitochondria, Golgi complexes, and other organelles typical of higher eukaryotes (17). Thus, trophozoite of both parasite species has been suggested to change lipid host transporters lets luminal fat buildup by impairing fat absorptions to circulatory systems (18-21). Besides, the trophozoite stage scavenges host lipids/ fate molecules via endocytic and non-endocytic pathways for the neutrition, survival mechanism, energy production, and membrane biosynthesis (12, 19). This direct to lipid metabolic abnormalities (hypolipidemia) which is characterized by change in blood total cholesterols (TC), triglycerides (TG), low levels of high-density lipoprotein cholesterol (HDL) and high levels of low-density lipoprotein cholesterol (LDL) levels (22). As result, individuals infected with both parasites might end-up with development of majorly cardiovascular diseases, atherosclerosis, stroke (23), and rarely infertility, rickets, osteoporosis, diabetes, Alzheimer’s, and inflammatory bowel disease (24, 25). Even if the chronic infection of both parasite are suggested to cause cardio and non -cardiovascular complications, the scholars research attention is still limited in this area. Moreover, existing studies regarding effect of giardiasis, and amoebiasis in the lipid panels (TC,TG, HDL, LDL) of infected patients reveals controversial results (16, 26). Yet, despite the high magnitude of giardiasisand amoebasisin Ethiopia (27, 28), there is no published evidence that investigated relationship between serum lipid profile and G. lamblia or E. histolytica infection and our study amide to fill this information gapes. The study finding in alteration of lipid profile would be helpful for the management E. histolytica or G. lamblia infectionassociated metabolic syndromes. It might create a better insights/awareness for policymakers and health organizations to plan prevention and intervention measures as well as to prepare improved health care service guidelines. Therefore, the current study amid to assess the alteration of serum lipid profile among amoebasisandgiardiasis stool microscopy confirmed patients using result of healthy controls as comparison standards at northwest Ethiopia. Methods and Materials Study design, period and setting An institutional based cross-sectional study was conducted at Sanja Primary Hospital (SPH) from July 10 to August 25; 2023.This hospital locates 65km away from central Gondar zone town and 792 km from capital city of Ethiopia, Addis Ababa. The area has altitude, annual rainfall and temperature of 1900 m to 2200 m above sea level, 800 to 1800 mm and 25°C to 42°C respectively. Moreover, the study setting has one Public River and stream serving as source of water for bathing, cloth washing and recreational activities(29). Besides, local dwellers have a bad basic hygiene practice including open defecation along waterways and improper waste disposal which can be key sources of common intestinal parasites. A magnitude of both Amoebiasis and Giardiasis were reported to reach 21.6% and 9.2% respectively (27) in the study area. Hospital provides diagnostic and treatment service for the inpatient and outpatient town and surrounding inhabitants. Trophozoit and cyst stage detection in stool wet mount by microscopy is the routine methods for diagnosis of Amoebasis and Giardiasis patients in the study setting. Yet, the hospital didn’t have advanced laboratory test service, requires patients transfer and sample shipment to referral hospitals in the regions. Source of population and Eligibility criteria All E. histolytica/dispar or G. lamblia microscopy confirmed patients who attended at SPH during data collection period and full fill the inclusion criteria were source population for this study. All participants above six months age confirmed with both protozoan infections and who have not been taking anti-protozoan drugs (Metronidazole /Tinidazole) within the last 14 days were included in the study. Besides, apparently healthy volunteer individuals of patient’s caregivers, and hospital staffs without recent history of both infections, taking any of anti-protozoan drugs, and double slide stool wet mount negative were included as control group. Whereas all study participants with a known history of hypertension, renal failure, liver disease, cancer, diabetes mellitus, pregnancy, patients co-infected with malaria, human immune virus (HIV) ,viral hepatitis(B,C) were excluded from this study. Exclusion was made physical examination and clinical observation by expert clinician, patient medical chart review and diagnostic laboratory test results in the setting. Moreover, obese patients were excluded from the study using their body mass index calculated values. Sample size determination and sampling technique Because of cost feasibility issue for lipid profile analysis, we have forced to use rules of thumb for sample size determinations that have been recommended by van Voorhies and Morgan. According to this rules , 30 participants per group are required to recognize real differences, which could achieve an estimated 80% power (30). However, to maximize the power of the study, the number of study participants was increased to two-fold for each groups. Thus, a total of 180 study participants (60 patients infected with G. lamblia: 60 patients infected with E. histolytica/dispar and 60 healthy control participants were recruited using convenient sampling techniques. Operational definition Serum lipid profiles : includes HDL, LDL, TG and TC. WHO categorical of obesity based on the BMI of weight-for-height: underweight (<18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obesity (≥30 kg/m2) (31). Data collection and laboratory methods Socio-demographic and lifestyle related data were collected using a structured questionnaire by two expert nurses and Laboratory a technologist under supervision of principal investigators. Clinical data associated with history of chronic disease (kidney, liver, hypertension, diabetes mellitus and cancers, and other acute symptoms of diarrhea, abdominal pain, vomiting, Amoebic dysentery or blood/mucus in stools, loss of appetite data were obtained from physician/ experienced nurse communication and face-to-face patient’s interviews. Co-infection status of study participants with HIV, hepatitis B and C virus, malaria, other intestinal parasite, and pregnancy status was confirmed by laboratory test by experienced professionals. Biometric Measurement A portable stadiometer and digital electronic scale were used to measure height and weight of study participants respectively. Both devices were able to measure precision levels nearest to 0.1 cm and 0.1 kg separately. All study participants were weighed without extra layers of clothing, shoes, and any items in their pockets. Then BMI was computed by weight in (kg) dividing by height in meter squared (m 2 ) to screen the body fat ratio as WHO guidelines) (31). Laboratory stool sample collection and examinations Following comprehensive instruction for study participants on how to collect stool sample and the goal of the study, about 5gm of stool specimen was collected from both case and comparison groups using labeled clean, dry, and leak proof plastic cup containers. Standard double slide saline wet mount smears were performed from fresh samples up on arrival of laboratory sections in study site for convenient detection and identification of motile/labile E. histolytica/dispar and G. lamblia trophozoit stages. Initial microscopic examination was done by researchers and were confirmed by site Laboratory experts using 10x and 40x power within 30 minutes to one hour. In microscope trophozoit stage both species were identified using species dependent characteristic motility. Blood sample collection, serum separations and shipment procedures Among eligible participants who provide their consents, and following standard operating procedure, a 3 mL of fasting (12-14 hours) antecubital veinus whole blood was collected into a serum separator plane tubes. Collected blood was allowed to clot for 10–20 minutes at room temperature and immediately separated by spun for 5 minutes at 2200–2500 RPM. Separated serum was kept at –20˚C until analysis. Due to lack of automated chemistry analyzer machine for lipid profile analysis in the study area, we had transported serum sample under safe triple-packing cold chains system to Tibebe Ghion Specialized and referral hospital clinical chemistry laboratory units, located at Bahir-Dar, capital city of Amhara regions. Similar step were done for age and sex matched health controls. Lipid profile analysis Prior to actual patient’s sample analysis we had run internal quality control (IQC) using two level (normal and pathologic reagents. The control result was in the acceptable ranges. Lipid profiles test (Total cholesterol, HDL cholesterol, LDL cholesterol and TG) were determined using standard cholesterol LDL precipitating reagent kit at specific wave length with photoelectric colorimetric principles using Beckman Coulter DXC 700 AU machine. Serum lipid profiles analysis of healthy control was done in similar protocols and analyzer machines. Up on the incubation time analyzer displayed specific test result and were carefully printed. All of these tests were completed according to the manufacturer's guidelines. Sample Quality Controls We strictly followed SOPS in all steps of pre-analytical, analytical, and post-analytical phases for the study. Briefly, we had performed normal and pathological QC reagents prior to proceeding actual patient and healthy control sample analysis as for the manufacturer’s instruction. Beside, QC results were interpreted according to West- Gard rules(32). Data quality control An English version of data collection tool developed and translated to the local languages, and then re-translated back to English for gathering data related to independent variables. Half day, training was given for data collectors to assure reliability and validity of data to be collected by principal investigators .Collected data were daily, reviewed, checked and monitored to ensure the accuracy, relevance, completeness and consistency as well as presence of clerical errors. Data management and Statistical analysis All data were code, entered to Epi-Data (version 4.6) software and exported to Statistical Package for Social Science (SPSS, version 25) for final analysis. The kolomogrove smirove test were used to check normality continuous data and found to normally distributed (TC, LDL and HDL) (P>0.05). Descriptive statistics, of percentile, mean and standard deviation for dependent and independent variables were used. The mean difference in Lipid profiles (TC, LDL and HDL) between groups of E. histolytica infected patient, G. lamblia infected patient and healthy control groups were computed by using one way ANOVA test with the 95% confidence intervals (CIs). Moreover, Kruskal-Wallis test was used to determine mean differences between non-normally distributed continuous variables between groups. A P< 0.05 with 95% CI was set as statistically significant for each dependent variable and the results were presented in the form of text and tables. Ethical Consideration We obtained Ethical Clearance from School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar (Protocol number: SBMLS/517). Official permission letter was obtained from the Sanja hospital administrations. Informed consent/assent was obtained from each study participants and confidentiality was kept. Amoeba and Garadia confirmed patients were received treatment service care by hospital and a healthy volunteer with unusual finding was linked to responsible bodies in the setting for appropriate care. The reliability of study methodological issues were carefully validated by institutional ethical review committee, and laboratory procedure including lipid profiles test was performed in accordance with manufacture and international guidelines to assure production of all inclusive and conclusive test result. Results Socio-demographic characteristics of study participants In this study, a total of 180 study participants (60 E. histolytica infected patients, 60 G. lamblia infected patients, and 60 healthy controls) were involved. Majority of the participants in each group were males. Among E. histolytica infected patients, 34 were males while 26 were females. The sex distributions were 104 (57.8%) males and 76 (42.2%) females in the three groups. The mean ages (SD) were 17.22±10.84 in E. histolytica infected patient, 14.07±11.02 in G. lamblia infected patient and 19.40 ±7.28 in healthy control group (Table1). Table 1: Socio-demographic and behavioral characteristics of study participants at Sanja Primary Hospital from July, to August 2023 (N = 180). Variable Category E. histolytica group n(%) G.lamblia group n(%) HC group n(%) Sex Male 34 (56.7%) 36 (60.0%) 34(56.7%) Female 26 (43.3%) 24 (40.0%) 26(43.3%) Age 35 4 (6.7%) 3 (5.0%) 0 (0.0%) BMI (Kg/m 2 Mean ±SD) 20.097± 2.05 19.54 ± 2.00 20.09 ± 2.07 Clinical characteristics of E. histolytica and G. lamblia infected patient participants Clinical data from E. histolytica and G. lamblia infected patients, such as signs and symptoms of E. histolytica and G. lamblia infection, were collected from the patient‘s medical chart. From the total of 120 E. histolytica and G. lamblia -infected study participants, 42 (35.0%) had diarrhea, 72 (60.0%) had fever, 36 (3.00%) had vomiting, 47 (39.2%) had abdominal pain, and 34 (28.3%) had weight loss. Moreover, 43 (35.8%) and 29 (24.2%) had loss of appetite and amoebic dysentery or blood/mucus in stools, respectively (Table 2 ). Table 2: Clinical characteristics of E. histolytica and G. lamblia infected patients at sanja primary hospital from July to August 2023 (N = 120) Clinical characteristics Category E. histolytica infected p atients (N=60) n (%) G. lamblia infected patients (N=60) n (%) Sign and symptoms of E. histolytica and G. lamblia infected patients Diarrhea Yes 2 (3.3) 40 (66.7) No 58 (96.7) 20 (33.3) Fever Yes 34 (56.7) 38 (63.3) No 26 (43.3) 22 ( 36.7) Vomiting Yes 17 (28.3) 19 (31.7) No 43 (71.7) 41 (68.8) Abdominal pain Yes 31 (51.7) 16 (26.7) No 29 (48.3) 44 (73.3) weight loss Yes 16 (26.7) 18 (30.0) No 44 (73.3) 42 (70.0) Notes: N, number; %, percentage Lipid profiles among E. histolytica infected, G. lamblia infected and healthy control of the study participant Since the data were normally distributed across the groups, we used a one-way ANOVA test followed by a Post-hoc H Bonferroni pairwise comparison test to compare the mean differences of lipid profiles across study groups. In one-way ANOVA analysis, the mean ± SD of TC, LDL, and HDL levels were 120.21 ± 40.11, 74.63 ± 32.93, and 33.73 ± 13.36 among E. histolytica- infected patients, and 123.46 ± 48.18, 73.57 ± 42.65, and 34.30 ± 14.30 among G. lamblia- infected patients, respectively. The results revealed that the mean concentrations of TC, LDL and HDL in the blood were significantly decreased in E. histolytica and G. lamblia infected patients compared to the control group(Table 3a).However, the means difference of all lipid profile parameters between patients infected with E. histolytica and G. lamblia infections have no statistically significant (P ≥ 0.05)(Table 3a) Table 3a: Comparison of Lipid profiles among E. histolytica, G. lamblia infected patients and healthy controls at the Sanja Primary Hospital, July to August 2023 (N = 180) Parameters E. histolytica infected G. lamblia infected Mean ± SD (mg/dl) Mean ± SD (mg/dl) TC Patients 120.21 ± 40. 11 123.46 ± 48.18 Health control 148.03 ± 59.36 148.03 ± 59.36 p-value 0.008 0.023 LDL Patients 74.63 ± 32.93 73.57 ± 42.65 Health control 91.32 ± 33.46 91.32 ± 33.46 p-value 0.041 0.026 HDL Patients 33.73 ± 13.36 34.30 ± 14.30 Health control 43.70 ± 10.77 43.70 ± 10.77 p-value 0.001 0.001 Note: TC: Total Cholesterol, LDL: Low Density Lipoprotein, HDL: High Density Lipoprotein, mg/dl: milligram per deciliter, SD: Standard Deviation. The data related to TG was not normally distributed across the groups. As a result, non-parametric tests (Kruskal Wallis test followed by dunn-Bonferroni pairwise comparison test) were used to compare the median differences between study groups. TG level was lower in E. histolytica and G. lamblia infected patients when compared control group. In Kruskal-Wallis analysis, the median (IQR) of TG level was 89.05 (72), 98.00 (74) and 121 (97) among E. histolytica infected patient, Giardia infected patient, and healthy control, respectively. TG level were significantly higher in control group p = 0.05. There was no statistically significant difference of median (IQR) between patients infected with E. histolytica and G. lamblia infections (P ≥ 0.05). (Table 3b) Table 3b: Comparison of TG level among E. histolytica, G. lamblia infected patients and healthy controls at the Sanja Primary Hospital, July to August 2023 (N = 180) Parameters E. histolytica infected G. lamblia infected Median (IQR) (mg/dl) Median (IQR) (mg/dl) TG Patients 95.26 (51.29) 102.90 (52.14) Health control 126.82(61.19) 126.82 (61.19) p-value 0.005 0.014 Abbreviation: TG: Triaglycerol, IQR: interquartile range, mg/dl: milligram per deciliter, *=significant at p-value ˂0.05 Discussion Infections with E. histolytica and G. lamblia are two major public health issues in Ethiopia. Epidemiological study in Ethiopia have reported a high prevalence of both infections(28), but there were limited published reports on the relationship between lipid profile levels among E. histolytica and G. lamblia infected patient, particularly in Northwestern Ethiopia. The current study aimed to compare the lipid profile levels (TC, HDL, LDL, and TAG) among E. histolytica, G. lamblia- infected patients, and healthy controls. Lipid and lipoprotein abnormalities are commonly reported in physiologic and non-physiologic conditions (33, 34).The changes that occur during inflammation and infection are part of the innate immune response and therefore are likely play an important role in protecting the host (33, 35, 36). In the current study, serum total cholesterol level was found significantly decrease in E. histolytica infected patient group compared to healthy control group (120.21 ± 40. 11 mg/dl vs 148.03 ± 59.36 mg/dl) (p = 0.008). The finding is in agreement with a study done in Iraq(37, 38) and India (18) that showed a significant decrease in serum TC in E. histolytica patient . These changes might be due to E histolytica unable to synthesize its own cholesterol de novo; it must scavenge from the host intestine in order to carry out the biosynthesis of internal and plasma membranes as well as other function(19, 39).Additionally, cholesterols play a role in the pathogenesis of E. histolytica , in accordance with studies that demonstrate E. histolytica becomes more virulent in the presence of cholesterol (40).However, our finding contradicts previous studies conducted in Iraq(25). These variations may be due to genetic and lifestyle factors that raise cholesterol levels in the blood (41). The findings of the present study showed that the mean difference for cholesterol-rich lipoprotein levels, such as LDL and HDL, was significantly decreased in patients with E. histolytica compared to healthy controls (74.63 ± 32.93 vs. 91.32 ± 33.46 mg/dl) and [33.73 ± 13.36 vs. 91.32 ± 33.46 mg/dl], respectively. Similarly, the median (IQR) of TAG decreased significantly in patients with E. histolytica compared to healthy controls. Our finding is consistent with previous studies conducted in Iraq (18, 38), and India (18). These changes might be due to the fact that E. histolytica reduces cholesterol absorption in the intestine (18).This reduction in intestinal cholesterol absorption is increasing sterol loss and significantly reducing LDL levels; it also induces a compensatory increase in cholesterol synthesis by the liver (42). In the current study, the mean difference of serum TC, level was found significantly decreased in G. lamblia infected patients compared to healthy control group[123.46± 48.18 mg/dl Vs 148.03± 59.36 mg/dl] by a mean difference of 24.56 mg/dl [95% CI; 5.01, 44.11].This result is in agreement with previous studies conducted in Iraq (38, 43-45)and Iran (26). This may be due to cholesterol is required for Giardia membrane biogenesis, as Giardia is unable to synthesize cholesterol/lipid de novo, which it obtains from the milieu of the upper small intestine (19). In addition, cholesterol starvation initiates encystations. This indicates that cholesterol has a role in pathogenesis as it helps the parasite to remain in trophozoite stage(34).On the other hand, an increase in the TC level was observed in studies conducted in Iraq (46) and Sudan (47). The reason for the disagreement could probably be the increase in total cholesterol, depending on factors such as duration of infection, geographic locations (e.g., urban vs. rural or endemic vs. non-endemic), and BMI (48). The current study demonstrated that serum LDL, in Giardia infected patient significantly decreased compared with control group [73.57 ± 42.65 mg/dl Vs 91.32 ± 33.468 mg/dl] by a mean difference of 17.75 mg/dl[95% CI; 3.889, 31.611]. Similar results were reported in the previous studies done in Iraq (38, 45) and Iran (26). This may be due to an immunologic mechanism since Giardia infection triggers the release of cytokines such as interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α), which alter lipid metabolism (49). Elevated levels of IL-6 and TNF-α in parasitic infection may induce stimulation of the LDL receptor (LDLR), resulting in enhanced LDL receptor activity (50). This may result in lower plasma LDL levels since Giardia needs cholesterol from the host and internalizes it by LDLR -mediated endocytosis (51). The finding of this study is on the contrary with a study done in Iraq (46) and Sudan (47), which reported a higher mean level of LDL in the Giardia- infected group. These variations in cholesterol levels may be influenced more by nutrition, genetics and lifestyle (41).The findings of the present study showed that the median (IQR) of serum TG levels decreased in Giardia- infected patients compared to the healthy control group [102.90 ± 52.14 mg/dl Vs 126.82 ± 61.19 mg/dl], respectively. The findings of this study are in line with the studies conducted in Iraq (45) and Iran (26)that reported a decrease in serum TG levels in giardia-infected patients. In the current study, the mean serum HDL level was found significantly decrease in patients infected with G. lamblia compared to the control group [34.30 ± 14.32 mg/dl Vs 43.70 ± 10.72 mg/dl] by a mean difference of 9.4 mg/dl [95% CI; 4.81, 13.98]. This finding is consistent with a previous study conducted in Iraq (38), Khartoum-Sudan (47), that found a significant decrease in serum HDL level in G. lamblia infected patients. This may be due to a defect in the bile gland caused by blockage of the bile ducts by G. lamblia and thus leads to fat loss, which is a complication of Giardia infection, which leads to foul-smelling stools accompanied by undigested fats. Another possible mechanism for reducing serum HDL levels is Giardia -induced cytokinesis, such as TNF-α, which induces the expression of LDL receptors, which is secondary to a decrease in cellular cholesterol content caused by TNF-α stimulated lipid secretion (52). On the other hand, a significant difference was not observed in studies conducted in Iraq (45) and Iran (26). Conclusions and recommendations In the present study, E. histolytica/dispar and G. lamblia infected patient has low levels of total cholesterol, LDL and TG, therefore these parasites use host cholesterol in order to carry out the biosynthesis of internal and plasma membranes as well as other function. The HDL levels are below the normal range in E. histolytica and G. lamblia -infected patients, which can indicate an increase in the risk of heart disease, including premature coronary artery disease, heart attack, and stroke.We would like to recommend future researchers conduct large-scale studies that include advanced laboratory methods with an adequate sampling of patients to assess the accurate implications of all test parameters of Giardia and Amoeba infections. We recommend future studies include molecular and immunological methods with a longitudinal cohort of patients. Limitations in this study, the sample size was relatively small, especially compared with large-scale population studies abroad. Declarations Acknowledgement We are thankful for Sanja Health center staff, study participants for their invaluable contribution for the study. Our warmest gratitude also goes to Department of Medical parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health science, University of Gondar for all the unreserved service delivery for us. Author contributions MS: Conceptualization and design of the study, TE: Study protocol development, Supervision of data collection, MT: formal analysis and Data interpretation, writing original draft Manuscript, YM: Methodology, Review, FM and AAA: editing of manuscript, MW and DW: data collections and data curation, AA, AM, NC: Idea conceptions, AYM, DMB and BBT: Manuscript Writing. All authors read and approved the final manuscript. Data Availability and Materials Original data that used for analysis are available and applicable up on the request corresponding authors by Journal Computing Interest The author(s) declare no competing interests. Funding Author has not received any specific funds References Herricks JR, Hotez PJ, Wanga V, Coffeng LE, Haagsma JA, Basáñez M-G, et al. The global burden of disease study 2013: What does it mean for the NTDs? PLoS neglected tropical diseases. 2017;11(8):e0005424. Shirley D-AT, Farr L, Watanabe K, Moonah S, editors. A review of the global burden, new diagnostics, and current therapeutics for amebiasis. Open forum infectious diseases; 2018: Oxford University Press US. Abdulraheem Al-rawi ON, Subhi Naef Al-Omar N. Molecular Diagnosis and Phylogenetic Investigation of Entamoeba histolytica and Giardia intestinalis among Diarrheal Patients in Iraq. Iranian Journal of Medical Microbiology. 2023;17(3):361-8. Cook GC, Zumla A. Manson's tropical diseases: Elsevier Health Sciences; 2008. Sengupta P, Chakraborty A. Chapter 31 - Infection of the gastrointestinal tract: Giardiasis and amoebiasis. In: Bagchi D, Das A, Downs BW, editors. Viral, Parasitic, Bacterial, and Fungal Infections: Academic Press; 2023. p. 365-73. Kantor M, Abrantes A, Estevez A, Schiller A, Torrent J, Gascon J, et al. Entamoeba histolytica: updates in clinical manifestation, pathogenesis, and vaccine development. Canadian Journal of Gastroenterology and Hepatology. 2018;2018. Dixon BR. Giardia duodenalis in humans and animals–transmission and disease. Research in veterinary science. 2021;135:283-9. Al-Jawabreh A, Ereqat S, Dumaidi K, Al-Jawabreh H, Abdeen Z, Nasereddin A. Prevalence of selected intestinal protozoan infections in marginalized rural communities in Palestine. BMC Public Health. 2019;19:1-11. Mama M, Alemu G. Prevalence and factors associated with intestinal parasitic infections among food handlers of Southern Ethiopia: cross sectional study. BMC public health. 2015;16:1-7. Espinosa-Cantellano M, Martinez-Palomo A. Pathogenesis of intestinal amebiasis: from molecules to disease. Clinical microbiology reviews. 2000;13(2):318-31. Cuellar P, Hernández-Nava E, García-Rivera G, Chávez-Munguía B, Schnoor M, Betanzos A, et al. Entamoeba histolytica EhCP112 dislocates and degrades claudin-1 and claudin-2 at tight junctions of the intestinal epithelium. Frontiers in cellular and infection microbiology. 2017;7:372. Buret AG, Amat CB, Manko A, Beatty JK, Halliez MC, Bhargava A, et al. Giardia duodenalis: new research developments in pathophysiology, pathogenesis, and virulence factors. Current tropical medicine reports. 2015;2:110-8. Vivancos V, González-Alvarez I, Bermejo M, Gonzalez-Alvarez M. Giardiasis: Characteristics, Pathogenesis and New Insights About Treatment. Current topics in medicinal chemistry. 2018;18(15):1287-303. Al-Ani LJ, Al-Warid HS. Evaluation of Adipokines Among Children Infected with Some Protozoan Intestinal Parasites. The Egyptian Journal of Hospital Medicine. 2022;88(1):3906-10. Al-Mekhlafi HM, Azlin M, Shaik A, Sa'iah A, Fatmah M, Ismail M, et al. Protein-energy malnutrition and soil-transmitted helminthiases among Orang Asli children in Selangor, Malaysia. Asia Pacific journal of clinical nutrition. 2005;14(2):188. Tayrab E, ManalMustafa, Ibrahim A, Abdrabo A. Lipid profile of schoolchildren with Giardiasis in Bashiar Hospital (Khartoum- Sudan). INTERNATIONAL JOURNAL OF ADVANCES IN PHARMACY, BIOLOGY AND CHEMISTRY. 2014;Vol. 3(3):689-92. Beaver PC, Jung RC, Cupp EW. Clinical parasitology: Lea & Febiger; 1984. Bansal D, Bhatti H, Sehgal R. Altered lipid parameters in patients infected with Entamoeba histolytica, Entamoeba dispar and Giardia lamblia. British journal of biomedical science. 2005;62(2):63-5. Das S, Stevens T, Castillo C, Villasenõr A, Arredondo H, Reddy K. Lipid metabolism in mucous-dwelling amitochondriate protozoa. International journal for parasitology. 2002;32(6):655-75. Yichoy M, Duarte T, De Chatterjee A, Mendez T, Aguilera K, Roy D, et al. Lipid metabolism in Giardia: a post-genomic perspective. Parasitology. 2011;138(3):267-78. Kaul D, Rani R, Sehgal R. Receptor‐Ck regulates giardia encystation process. Molecular and Cellular Biochemistry. 2001;225:167-9. Bezerra C. Dyslipidemia: what it is, how to identify, causes and treatment. Brazilian Journal of Implantology and Health Sciences. 2023;5(1):66-72. Sasaki J, Kita T, Mabuchi H, Matsuzaki M, Matsuzawa Y, Nakaya N, et al. Gender difference in coronary events in relation to risk factors in Japanese hypercholesterolemic patients treated with low-dose simvastatin. Circulation Journal. 2006;70(7):810-4. Schmidt AF, Joshi R, Gordillo-Marañón M, Drenos F, Charoen P, Giambartolomei C, et al. Biomedical consequences of elevated cholesterol-containing lipoproteins and apolipoproteins on cardiovascular and non-cardiovascular outcomes. Communications Medicine. 2023;3(1):9. AL-Mahdawy HS, Risan FA, Abd Mohammed KI. Lipid profile level in patients infected with Entamoeba histolytica. Int J Curr Res Chem Pharm Sci. 2016;3(3):25-9. Saki J, Khademvatan S, Maraghi S, Soltani S. Serum lipid profiles and eosinophilia among Giardia cyst passers. African Journal of Microbiology Research. 2011;5(27):4881-4. Eyayu T, Kiros T, Workineh L, Sema M, Damtie S, Hailemichael W, et al. Prevalence of intestinal parasitic infections and associated factors among patients attending at Sanja Primary Hospital, Northwest Ethiopia: an institutional-based cross-sectional study. PLoS One. 2021;16(2):e0247075. Tegen D, Damtie D, Hailegebriel T. Prevalence and associated risk factors of human intestinal protozoan parasitic infections in Ethiopia: a systematic review and meta-analysis. Journal of parasitology research. 2020;2020. (ESS) ESS. Population Size of Towns by Sex, Region, Zone and Weredas as of July 2021. 2021. VanVoorhis CW, Morgan BL. Understanding power and rules of thumb for determining sample sizes. Tutorials in quantitative methods for psychology. 2007;3(2):43-50. Control CfD, Prevention. Anthropometry Procedures Manual. 2007. National Health and Nutrition Examination Survey (NHANES) available from: https://www cdc gov/nchs/data/nhanes/nhanes_07_08/manual_an pdf. 2007. Carroll TA, Pinnick HA, Carroll WE. Probability and the Westgard rules. Annals of Clinical & Laboratory Science. 2003;33(1):113-4. Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, et al. Endotext [Internet]. 2000. Bansal D, Bhatti HS, Sehgal R. Role of cholesterol in parasitic infections. Lipids in health and disease. 2005;4:1-7. Khovidhunkit W, Kim M-S, Memon RA, Shigenaga JK, Moser AH, Feingold KR, et al. Effects of infection and inflammation on lipid and lipoprotein metabolism: mechanisms and consequences to the host. The Journal of Lipid Research. 2004;45(7):1169-96. Khovidhunkit W, Memon RA, Feingold KR, Grunfeld C. Infection and inflammation-induced proatherogenic changes of lipoproteins. The Journal of infectious diseases. 2000;181(Supplement_3):S462-S72. Al-Hadrawy MK. ESTIMATION OF AST, ALT AND COMPLETE LIPID PROFILE IN HUMAN INFECTED BY ENTAMOEBA HISTOLYTICA IN AL-NAJAF GOVERNORATE, IRAQ. Journal of Techniques. 2015;28(2). Wahid-Aldeen EI, Ahmad NA, Sahlah Kh AS. Assessment of Lipid Profile and Cytokine (IL-13, TGF-β) with sICAM-1in Patients Infected with Intestinal Parasite (Entamoeba histolytica, Giardia lamblia and Blastocystis hominis). 2009. Serrano-Luna J, Gutierrez-Meza M, Mejía-Zepeda R, Galindo-Gomez S, Tsutsumi V, Shibayama M. Effect of phosphatidylcholine–cholesterol liposomes on Entamoeba histolytica virulence. Canadian journal of microbiology. 2010;56(12):987-95. Castellanos-Castro S, Bolaños J, Orozco E. Lipids in Entamoeba histolytica: Host-Dependence and Virulence Factors. Frontiers in cellular and infection microbiology. 2020;10:75. Pollin TI, Quartuccio M. What We Know About Diet, Genes, and Dyslipidemia: Is There Potential for Translation? Current nutrition reports. 2013;2(4):236-42. Turley SD, Dietschy JM. The intestinal absorption of biliary and dietary cholesterol as a drug target for lowering the plasma cholesterol level. Preventive cardiology. 2003;6(1):29-33, 64. Ma'ani N, Jabir DM. Study of lipid profile alteration in the patients infected with Giardia lamblia and compare the results with healthy individuals. Al-Qadisiyah Medical Journal. 2013;9(15):119-29. Alhuchaimi SN, Mahmood T, Abdullateef SF, Khadum E. Association between Serum Cholesterol Level and Giardia lambliaInfection among Children with Acute Diarrhea in Al-Najaf Governorate مدﻟا لﺻﻣ ﻲﻓ لورﺗﺳﻟوﮐﻟا ىوﺗﺳﻣ نﯾﺑ ﺔﻗﻼﻌﻟا ﺔﺑﺎﺻﻹاو. kufa Journal for Nursing sciences. 2017;7(1). Khlaf WMA. The spread of the parasite Giardia lamblia in the city of Samarra and its effect on some biochemical variables. Journal of Pharmaceutical Negative Results. 2022:2133-8. Alasady RA, Al-Nafakh RT, Al-Turaihi T, Tayyeh AJ, Hassan ES. Mucin2 and Lipid Profile Estimation in Giardia Lamblia Infected Patients: A Case-control Study. Journal of Communicable Diseases (E-ISSN: 2581-351X & P-ISSN: 0019-5138). 2022;54(2):55-60. Eltayeb Tayrab MM, Ibrahim A, Abdrabo AA. Lipid profile of schoolchildren with Giardiasis in Bashiar Hospital (Khartoum-Sudan). de Groot R, van den Hurk K, Schoonmade LJ, de Kort W, Brug J, Lakerveld J. Urban-rural differences in the association between blood lipids and characteristics of the built environment: a systematic review and meta-analysis. BMJ global health. 2019;4(1):e001017. Pu X, Li X, Cao L, Yue K, Zhao P, Wang X, et al. Giardia duodenalis Induces Proinflammatory Cytokine Production in Mouse Macrophages via TLR9-Mediated p38 and ERK Signaling Pathways. Frontiers in cell and developmental biology. 2021;9:694675. Gierens H, Nauck M, Roth M, Schinker R, Schürmann C, Scharnagl H, et al. Interleukin-6 stimulates LDL receptor gene expression via activation of sterol-responsive and Sp1 binding elements. Arteriosclerosis, thrombosis, and vascular biology. 2000;20(7):1777-83. Rivero MR, Miras SL, Quiroga R, Rópolo AS, Touz MC. Giardia lamblia low-density lipoprotein receptor-related protein is involved in selective lipoprotein endocytosis and parasite replication. Molecular microbiology. 2011;79(5):1204-19. Liao W, Florén C-H. Upregulation of low density lipoprotein receptor activity by tumor necrosis factor, a process independent of tumor necrosis factor-induced lipid synthesis and secretion. Lipids. 1994;29(10):679-84. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-4292224","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":295527356,"identity":"02ceda37-01c9-456c-9e99-acd8bf3a38aa","order_by":0,"name":"Muluken Semaw","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Muluken","middleName":"","lastName":"Semaw","suffix":""},{"id":295527358,"identity":"18aca0a7-5842-493a-b7c4-bcf62a7b5fa7","order_by":1,"name":"Fenthun Megabiew","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Fenthun","middleName":"","lastName":"Megabiew","suffix":""},{"id":295527360,"identity":"09d92db8-4809-4abb-92aa-2fb8dcf6824a","order_by":2,"name":"Muluken Walle","email":"","orcid":"","institution":"Jigjiga University","correspondingAuthor":false,"prefix":"","firstName":"Muluken","middleName":"","lastName":"Walle","suffix":""},{"id":295527362,"identity":"1d43d666-1576-4b2b-9944-5c0a358d32ec","order_by":3,"name":"Dagmawi Woldesenbet","email":"","orcid":"","institution":"Wachemo University","correspondingAuthor":false,"prefix":"","firstName":"Dagmawi","middleName":"","lastName":"Woldesenbet","suffix":""},{"id":295527364,"identity":"5f46ff27-63b7-43a2-ab6b-b5d5da447031","order_by":4,"name":"Mebratu Tamir","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYFACHgglz94AJA0siNWSwCBh2HMApEWCBC0MNxJAPCK06Lb3Hvvw88fhOsaZz69u+FEgwcDf3p2AV4vZmXPJM3sSDkuwS+eU3ewBOkzizNkN+LXcyDFm4AFqYZydk3aDB6jFQCKXgJb7b4wZ/wC1MNw8k3bzD1FabvAYM4NsYbjBfuw2cbacyUtmlklLl9zYk8N2W8ZAgoewX46fPcz4xsaaX579+LObb/7YyPG39+LXggR4DMAkscpBgP0BKapHwSgYBaNgBAEAHcZG7P7RDz0AAAAASUVORK5CYII=","orcid":"","institution":"University of Gondar","correspondingAuthor":true,"prefix":"","firstName":"Mebratu","middleName":"","lastName":"Tamir","suffix":""},{"id":295527365,"identity":"f1d18b47-1c09-4591-bc04-55ca1ab87f3e","order_by":5,"name":"Amare Mekuanint","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Amare","middleName":"","lastName":"Mekuanint","suffix":""},{"id":295527366,"identity":"277f070d-7481-4dc5-b59f-79a9786cb09f","order_by":6,"name":"Abebe Yenesew Mengesha","email":"","orcid":"","institution":"Debre Markos University","correspondingAuthor":false,"prefix":"","firstName":"Abebe","middleName":"Yenesew","lastName":"Mengesha","suffix":""},{"id":295527367,"identity":"9df11250-7e27-46f4-9a75-3ca2634376a0","order_by":7,"name":"Negesse Cherie","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Negesse","middleName":"","lastName":"Cherie","suffix":""},{"id":295527368,"identity":"2da9b8aa-c112-4f24-975d-7516672deb1b","order_by":8,"name":"Dereje Mengesha Berta","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Dereje","middleName":"Mengesha","lastName":"Berta","suffix":""},{"id":295527369,"identity":"6373a0e6-2388-4d37-a796-9da867ce2175","order_by":9,"name":"Bisrat Birke Teketelew","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Bisrat","middleName":"Birke","lastName":"Teketelew","suffix":""},{"id":295527370,"identity":"5ec061ca-3a87-4616-8429-7a8cf972929a","order_by":10,"name":"Abiy Ayele Angelo","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Abiy","middleName":"Ayele","lastName":"Angelo","suffix":""},{"id":295527371,"identity":"d6c28d55-4424-41d8-9df1-3236a98ed887","order_by":11,"name":"Aberham Abere","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Aberham","middleName":"","lastName":"Abere","suffix":""},{"id":295527372,"identity":"bea6cfe9-92f1-4ea5-a2e2-b469252800a4","order_by":12,"name":"yenesew mihiret","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"yenesew","middleName":"","lastName":"mihiret","suffix":""},{"id":295527373,"identity":"3d48d78c-e967-4889-a706-443d0eaab69c","order_by":13,"name":"Tegegne Eshetu","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Tegegne","middleName":"","lastName":"Eshetu","suffix":""}],"badges":[],"createdAt":"2024-04-19 09:28:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4292224/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4292224/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91402299,"identity":"95303418-ada4-432b-932e-a9d013eddca9","added_by":"auto","created_at":"2025-09-16 07:09:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":955800,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4292224/v1/559f4e61-d921-4b87-8d4c-08311d032c98.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Alteration of Serum Lipid Profiles among Amoebasis and Giardiasis Confirmed Patients at North West Ethiopia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAccording to Global Burden of Diseases(GBD) report, intestinal protozoan parasite (IPPS), remains the third leading causes of human death worldwide\u0026nbsp;(1, 2). This\u0026nbsp;infections pose significant public health problems mainly under-resourced countries with poor water and food \u0026nbsp;sanitations practice\u0026nbsp;(3).\u0026nbsp;Amebiasis and Giardiasis are the two most common food-borne protozoan infections of upper and lower gastro-intestinal tract(GIT)\u0026nbsp;(4, 5). These are caused by the\u0026nbsp;\u003cem\u003eEntamoeba histolytica\u003c/em\u003e/\u003cem\u003edispar (E. histolytica/ dispar)\u003c/em\u003e,and \u003cem\u003eGiardia lamblia\u003c/em\u003e (G. lamblia) protozoan parasites respectively\u0026nbsp;(6, 7). Both pathogen are characterized by bi-morephic life forms, cyst ( infective/ non-feeding), and trophozoite, (pathogenic/ feeding) stages\u0026nbsp;(8, 9). A\u0026nbsp;diseases formation of these parasite is related with effect of trophozoite\u0026nbsp;attachment to upper portion of small intestine, and their protolytic enzymes (cysteine proteases and glycosidases)\u0026nbsp;(10, 11).\u0026nbsp;This increases rate of enterocyte apoptosis, loss of barrier function, leading to lymphocyte-mediated microvillus shortening and reduction of absorptive surface area, ultimately are responsible for mal-digestion and malabsorption of nutrients (12-14).\u0026nbsp;In acute clinical stages, are almost clinically overlapping that characterized by\u0026nbsp;fever, watery diarrhea and other intestinal disorders\u0026nbsp;(6, 15). \u0026nbsp;Although, majority of gardiasis and amoebiasis are self resolving, yet in some case both result in chronic infection. Thus, the infected populations is might end-up with \u0026nbsp;deficiency\u0026nbsp;of\u0026nbsp;vital caloric source (carbohydrate, protein), normal hemoglobin level, and lipid soluble vitamins (K, A, D, E) (15, 16). \u0026nbsp;Moreover, several experimental finding indicates that both parasites are unable to synthesize their own lipids and cholesterol de novo, due to lack mitochondria, Golgi complexes, and other organelles typical of higher eukaryotes (17). Thus, trophozoite of both parasite species has been suggested to change lipid host transporters lets luminal fat buildup by impairing fat absorptions to circulatory systems (18-21).\u0026nbsp;Besides, the trophozoite stage scavenges\u0026nbsp;host lipids/ fate molecules via endocytic and non-endocytic pathways for the neutrition, survival mechanism, energy production, and membrane biosynthesis (12, 19). This direct to lipid metabolic\u0026nbsp;\u003cstrong\u003eabnormalities\u003c/strong\u003e(hypolipidemia) which is characterized by change in blood total cholesterols (TC), triglycerides (TG), low levels of high-density lipoprotein cholesterol (HDL) and high levels of low-density lipoprotein cholesterol (LDL) levels (22). As result, individuals infected with both parasites might end-up with development of majorly cardiovascular diseases, atherosclerosis, stroke (23), and rarely infertility, rickets, osteoporosis,\u0026nbsp;diabetes, Alzheimer\u0026rsquo;s, and inflammatory bowel disease\u0026nbsp;(24, 25). Even if the chronic infection of both parasite are suggested to cause cardio and non -cardiovascular complications, the scholars research attention is still limited in this area.\u0026nbsp;Moreover, existing studies regarding effect of giardiasis, and amoebiasis in the lipid panels (TC,TG, HDL, LDL) of infected patients reveals controversial \u0026nbsp;results (16, 26). Yet, despite the high \u0026nbsp;magnitude of \u0026nbsp;giardiasisand amoebasisin Ethiopia (27, 28), there is no published evidence that investigated relationship between serum lipid profile and\u003cem\u003e\u0026nbsp;G. lamblia\u003c/em\u003e or \u003cem\u003eE. histolytica\u003c/em\u003e infection and our study amide to fill this information gapes. The study finding in alteration of lipid profile would be helpful for the management \u003cem\u003eE. histolytica\u0026nbsp;\u003c/em\u003eor \u003cem\u003eG. lamblia\u0026nbsp;\u003c/em\u003einfectionassociated metabolic syndromes. It might create a better insights/awareness for policymakers and health organizations to plan prevention and intervention measures as well as to prepare\u0026nbsp;improved health care service\u0026nbsp;guidelines. Therefore, the current study amid to assess the alteration of serum lipid profile among amoebasisandgiardiasis stool microscopy confirmed patients using result of healthy controls as comparison standards at northwest Ethiopia. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Methods and Materials","content":"\u003ch2\u003eStudy design, period and setting\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eAn institutional based cross-sectional study was conducted at Sanja Primary Hospital (SPH) from July 10 to August 25; 2023.This hospital locates 65km away from central Gondar zone town and\u0026nbsp;792 km from capital city of Ethiopia, Addis Ababa. The area has altitude, annual rainfall and temperature of 1900\u0026thinsp;m to\u0026nbsp;2200 m above sea level, 800 to 1800\u0026thinsp;mm and 25\u0026deg;C to 42\u0026deg;C respectively. Moreover, the study setting has one Public River and stream serving as source of water for bathing, cloth washing and recreational activities(29). Besides,\u0026nbsp;local\u0026nbsp;dwellers have a bad basic hygiene practice including open defecation along waterways and improper waste disposal which can be key sources of common intestinal parasites.\u0026nbsp;A magnitude of both Amoebiasis and Giardiasis were reported to reach 21.6% and 9.2% respectively (27) in the study area. Hospital provides diagnostic and treatment service for the inpatient and outpatient town and surrounding inhabitants. Trophozoit and cyst stage detection in stool wet mount by microscopy is the routine methods for diagnosis of Amoebasis and Giardiasis patients in the study setting. Yet, the hospital didn\u0026rsquo;t have advanced laboratory test service, requires patients transfer and sample shipment to referral hospitals in the regions.\u003c/p\u003e\n\u003ch2\u003eSource of\u0026nbsp;population and Eligibility criteria\u003c/h2\u003e\n\u003cp\u003eAll \u003cem\u003eE. histolytica/dispar\u003c/em\u003e or \u003cem\u003eG. lamblia\u003c/em\u003e microscopy confirmed patients who attended at SPH during data collection period and full fill the inclusion criteria were source population for this study. All participants above six months age confirmed with both protozoan infections and who have not been taking anti-protozoan drugs (Metronidazole /Tinidazole) within the last 14 days were included in the study. Besides, apparently healthy volunteer individuals of patient\u0026rsquo;s caregivers, and hospital staffs without recent history of both infections, taking any of anti-protozoan drugs, and double slide stool wet mount negative were included as control group. \u0026nbsp;Whereas all study participants with a known history of hypertension, renal failure, liver disease, cancer, diabetes mellitus, pregnancy, patients co-infected with malaria, human immune virus (HIV) ,viral hepatitis(B,C) were excluded from this study. Exclusion was made physical examination and clinical observation by expert clinician, patient medical chart review and diagnostic laboratory test results in the setting. Moreover, obese patients were excluded from the study using their body mass index calculated values.\u003c/p\u003e\n\u003ch2\u003e\u0026nbsp;Sample size determination\u0026nbsp;and sampling technique\u003c/h2\u003e\n\u003cp\u003eBecause of cost feasibility issue for lipid profile analysis, we have forced to use rules of thumb for sample size determinations that have been recommended by van Voorhies and Morgan. According to this rules , 30 participants per group are required to recognize real differences, which could achieve an estimated 80% power\u0026nbsp;(30). However, to maximize the power of the study, the number of study participants was increased to two-fold for each groups. Thus, a total of 180 study participants (60 patients infected with \u003cem\u003eG. lamblia:\u0026nbsp;\u003c/em\u003e60 patients infected with \u003cem\u003eE. histolytica/dispar\u0026nbsp;\u003c/em\u003eand 60 healthy control participants were recruited using convenient sampling techniques.\u003c/p\u003e\n\u003ch2\u003e\u0026nbsp;Operational definition\u003c/h2\u003e\n\u003cp\u003e\u0026nbsp;Serum lipid profiles\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eincludes HDL, LDL, TG and TC.\u003c/p\u003e\n\u003cp\u003eWHO categorical of obesity based on the BMI of weight-for-height: underweight (\u0026lt;18.5 kg/m2), normal weight (18.5\u0026ndash;24.9 kg/m2), overweight (25.0\u0026ndash;29.9 kg/m2), and obesity (\u0026ge;30 kg/m2)\u0026nbsp;(31).\u003c/p\u003e\n\u003cp\u003eData collection and laboratory methods\u003c/p\u003e\n\u003cp\u003eSocio-demographic and lifestyle related data were collected using a structured questionnaire by two expert nurses and Laboratory a technologist under supervision of principal investigators. Clinical data associated with history of chronic disease (kidney, liver, hypertension, diabetes mellitus and cancers, and other acute symptoms of diarrhea, abdominal pain, vomiting, Amoebic dysentery or blood/mucus in stools, loss of appetite data were obtained from physician/ experienced nurse communication and face-to-face patient\u0026rsquo;s interviews. Co-infection status of study participants with HIV, hepatitis B and C virus, malaria, other intestinal parasite, and pregnancy status was confirmed by laboratory test by experienced professionals.\u003c/p\u003e\n\u003ch2\u003eBiometric Measurement\u003c/h2\u003e\n\u003cp\u003eA portable stadiometer and digital electronic scale were used to measure height and weight of study participants respectively. \u0026nbsp;Both devices were able to measure precision levels nearest to 0.1 cm and 0.1 kg separately. All study participants were weighed without extra layers of clothing, shoes, and any items in their pockets. Then BMI was computed by weight in (kg) dividing by height in meter squared (m\u003csup\u003e2\u003c/sup\u003e) to screen the body fat ratio as WHO guidelines)\u0026nbsp;(31).\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u0026nbsp; \u0026nbsp;Laboratory\u0026nbsp;stool sample collection and examinations\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eFollowing comprehensive instruction for study participants on how to collect stool sample and the goal of the study, about 5gm of stool specimen was collected from both case and comparison groups using labeled clean, dry, and leak proof plastic cup containers. Standard double slide saline wet mount smears were performed from fresh samples up on arrival of laboratory sections in study site for convenient detection and identification of motile/labile E. histolytica/dispar and G. lamblia trophozoit stages. Initial microscopic examination was done by researchers and were confirmed by site Laboratory experts using 10x and 40x power within 30 minutes to one hour. In microscope trophozoit stage both species were identified using species dependent characteristic motility. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eBlood sample collection, serum separations and shipment procedures\u003c/h2\u003e\n\u003cp\u003eAmong eligible participants who provide their consents, and following standard operating procedure, a 3 mL of\u0026nbsp;fasting (12-14 hours)\u0026nbsp;antecubital\u0026nbsp;veinus whole blood was collected into a serum separator plane tubes. Collected blood was allowed to clot for 10\u0026ndash;20 minutes at room temperature and immediately separated by spun for 5 minutes at 2200\u0026ndash;2500 RPM. Separated serum was kept at \u0026ndash;20˚C until analysis. Due to lack of automated chemistry analyzer machine for lipid profile analysis in the study area, we had transported serum sample under safe triple-packing cold chains system to Tibebe Ghion Specialized and referral hospital clinical chemistry laboratory units, located at Bahir-Dar, capital city of Amhara regions. Similar step were done for age and sex matched health controls.\u003c/p\u003e\n\u003ch2\u003eLipid profile analysis \u0026nbsp;\u003c/h2\u003e\n\u003cp\u003ePrior to actual patient\u0026rsquo;s sample analysis we had run internal quality control (IQC) using two level (normal and pathologic reagents. The control result was in the acceptable ranges. Lipid profiles test (Total cholesterol, HDL cholesterol, LDL cholesterol and TG) were determined using standard cholesterol LDL precipitating reagent kit at specific wave length with photoelectric colorimetric principles using Beckman Coulter DXC 700 AU machine. Serum lipid profiles analysis of healthy control was done in similar protocols and analyzer machines. Up on the incubation time analyzer displayed specific test result and were carefully printed. All of these tests were completed according to the manufacturer\u0026apos;s guidelines. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u0026nbsp;Sample Quality\u0026nbsp;Controls\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eWe strictly followed SOPS in all steps of pre-analytical, analytical, and post-analytical phases for the study. Briefly, we had performed normal and pathological QC reagents prior to proceeding actual patient and healthy control sample analysis as for the manufacturer\u0026rsquo;s instruction. Beside, QC results were interpreted according to West- Gard rules(32).\u003c/p\u003e\n\u003ch2\u003eData quality control\u003c/h2\u003e\n\u003cp\u003eAn English version of data collection tool developed and translated to the local languages, and then re-translated back to English for gathering data related to independent variables. Half day, training was given for data collectors to assure reliability and validity of data to be collected by principal investigators .Collected data were daily, reviewed, checked and monitored to ensure the accuracy, relevance, completeness and consistency as well as presence of clerical errors.\u003c/p\u003e\n\u003ch2\u003eData management and Statistical analysis\u003c/h2\u003e\n\u003cp\u003eAll data were code, entered to Epi-Data (version 4.6) software and exported to Statistical Package for Social Science (SPSS, version 25) for final analysis. \u0026nbsp;The kolomogrove smirove test were used to check normality continuous data and found to normally distributed (TC, LDL and HDL) (P\u0026gt;0.05). Descriptive statistics, of percentile, mean and standard deviation for dependent and independent variables were used. The mean difference in Lipid profiles (TC, LDL and HDL) between groups of \u003cem\u003eE. histolytica\u003c/em\u003e infected patient, \u003cem\u003eG. lamblia\u0026nbsp;\u003c/em\u003einfected patient and healthy control groups were computed by using one way ANOVA test with the 95% confidence intervals (CIs). Moreover, Kruskal-Wallis test was used to determine mean differences between non-normally distributed continuous variables between groups. A P\u0026lt; 0.05 with 95% CI was set as statistically significant for each dependent variable and the results were presented in the form of text and tables.\u003c/p\u003e\n\u003ch2\u003eEthical\u0026nbsp;Consideration\u003c/h2\u003e\n\u003cp\u003eWe obtained Ethical Clearance from School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar (Protocol number: SBMLS/517). Official permission letter was obtained from the Sanja hospital administrations. Informed consent/assent was obtained from each study participants and confidentiality was kept. Amoeba and Garadia confirmed patients were received treatment service care by hospital and a healthy volunteer with unusual finding was linked to responsible bodies in the setting for appropriate care. The reliability of study methodological issues were carefully validated by institutional ethical review committee, and laboratory procedure including lipid profiles test was performed in accordance with manufacture and international guidelines to assure production of all inclusive and conclusive test result.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eSocio-demographic characteristics of study participants\u003c/h2\u003e\n\u003cp\u003eIn this study, a total of 180 study participants (60 \u003cem\u003eE. histolytica\u003c/em\u003e infected patients, 60 \u003cem\u003eG. lamblia\u003c/em\u003e infected patients, and 60 healthy controls) were involved. Majority of the participants in each group were males. Among \u003cem\u003eE. histolytica\u003c/em\u003e infected patients, 34 were males while 26 were females. The sex distributions were 104 (57.8%) males and 76 (42.2%) females in the three groups. The mean ages (SD) were 17.22\u0026plusmn;10.84 in \u003cem\u003eE. histolytica\u003c/em\u003e infected patient, 14.07\u0026plusmn;11.02 in \u003cem\u003eG. lamblia\u003c/em\u003e infected patient and 19.40 \u0026plusmn;7.28 in healthy control group (Table1).\u003c/p\u003e\n\u003cp\u003eTable 1: Socio-demographic and behavioral characteristics of study participants at Sanja \u0026nbsp; \u0026nbsp;Primary Hospital from July, to August 2023 (N = 180).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.86833855799373%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.53291536050157%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.987460815047022%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eE. histolytica\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003egroup \u003cem\u003en(%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.04075235109718%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eG.lamblia\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003egroup \u003cem\u003en(%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.570532915360502%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; HC group \u003cem\u003en(%)\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.86833855799373%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.53291536050157%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.987460815047022%\" valign=\"top\"\u003e\n \u003cp\u003e34 (56.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.04075235109718%\" valign=\"top\"\u003e\n \u003cp\u003e36 (60.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.570532915360502%\" valign=\"top\"\u003e\n \u003cp\u003e34(56.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.46564885496183%\" valign=\"top\"\u003e\n \u003cp\u003e26 (43.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.053435114503817%\" valign=\"top\"\u003e\n \u003cp\u003e24 (40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.480916030534353%\" valign=\"top\"\u003e\n \u003cp\u003e26(43.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.86833855799373%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.53291536050157%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.987460815047022%\" valign=\"top\"\u003e\n \u003cp\u003e19 (31.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.04075235109718%\" valign=\"top\"\u003e\n \u003cp\u003e30 (50.0%)\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.570532915360502%\" valign=\"top\"\u003e\n \u003cp\u003e9 (15.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e12-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.46564885496183%\" valign=\"top\"\u003e\n \u003cp\u003e22 (36.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.053435114503817%\" valign=\"top\"\u003e\n \u003cp\u003e14 (23.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.480916030534353%\" valign=\"top\"\u003e\n \u003cp\u003e19 (31.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e20-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.46564885496183%\" valign=\"top\"\u003e\n \u003cp\u003e15 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.053435114503817%\" valign=\"top\"\u003e\n \u003cp\u003e13 (21.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.480916030534353%\" valign=\"top\"\u003e\n \u003cp\u003e32 (53.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.46564885496183%\" valign=\"top\"\u003e\n \u003cp\u003e4 (6.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.053435114503817%\" valign=\"top\"\u003e\n \u003cp\u003e3 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.480916030534353%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.86833855799373%\" valign=\"top\"\u003e\n \u003cp\u003eBMI (Kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.53291536050157%\" valign=\"top\"\u003e\n \u003cp\u003eMean\u0026nbsp;\u0026plusmn;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.987460815047022%\" valign=\"top\"\u003e\n \u003cp\u003e20.097\u0026plusmn; 2.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.04075235109718%\" valign=\"top\"\u003e\n \u003cp\u003e19.54\u0026nbsp;\u0026plusmn; 2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.570532915360502%\" valign=\"top\"\u003e\n \u003cp\u003e20.09\u0026nbsp;\u0026plusmn; 2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003eClinical characteristics of\u0026nbsp;\u003cem\u003eE. histolytica\u0026nbsp;\u003c/em\u003eand\u003cem\u003e\u0026nbsp;G. lamblia infected\u0026nbsp;\u003c/em\u003epatient participants\u003c/h2\u003e\n\u003cp\u003eClinical data from \u003cem\u003eE. histolytica\u0026nbsp;\u003c/em\u003eand\u003cem\u003e\u0026nbsp;G. lamblia\u0026nbsp;\u003c/em\u003einfected patients, such as signs and symptoms of \u003cem\u003eE. histolytica\u0026nbsp;\u003c/em\u003eand\u003cem\u003e\u0026nbsp;G. lamblia\u003c/em\u003e infection, were collected from the patient\u0026lsquo;s medical chart. From the total of 120\u003cem\u003e\u0026nbsp;E. histolytica\u0026nbsp;\u003c/em\u003eand\u003cem\u003e\u0026nbsp;G. lamblia\u003c/em\u003e-infected study participants, 42 (35.0%) had diarrhea, 72 (60.0%) had fever, 36 (3.00%) had vomiting, 47 (39.2%) had abdominal pain, and 34 (28.3%) had weight loss. Moreover, 43 (35.8%) and 29 (24.2%) had loss of appetite and amoebic dysentery or blood/mucus in stools, respectively (Table 2 ).\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;2: Clinical characteristics of\u0026nbsp;\u003cem\u003eE. histolytica\u0026nbsp;\u003c/em\u003eand\u003cem\u003e\u0026nbsp;G. lamblia infected\u0026nbsp;\u003c/em\u003epatients at sanja primary hospital from July to August 2023 (N = 120)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.458015267175576%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eClinical characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.908396946564885%\" valign=\"top\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.81679389312977%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eE. histolytica\u0026nbsp;\u003c/em\u003einfected\u003cem\u003e\u0026nbsp;p\u003c/em\u003eatients (N=60) n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.81679389312977%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp;G. lamblia\u0026nbsp;\u003c/em\u003einfected \u0026nbsp; \u0026nbsp;patients (N=60) n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.47328244274809%\" rowspan=\"10\" valign=\"top\"\u003e\n \u003cp\u003eSign and symptoms of\u0026nbsp;\u003cem\u003eE. histolytica\u0026nbsp;\u003c/em\u003eand\u003cem\u003e\u0026nbsp;G. lamblia\u0026nbsp;\u003c/em\u003einfected patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.984732824427482%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDiarrhea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.908396946564885%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.81679389312977%\" valign=\"top\"\u003e\n \u003cp\u003e2 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.81679389312977%\" valign=\"top\"\u003e\n \u003cp\u003e40 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;No\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40%\" valign=\"top\"\u003e\n \u003cp\u003e58 (96.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40%\" valign=\"top\"\u003e\n \u003cp\u003e20 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.96629213483146%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eFever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.606741573033707%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.213483146067414%\" valign=\"top\"\u003e\n \u003cp\u003e34 (56.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.213483146067414%\" valign=\"top\"\u003e\n \u003cp\u003e38 (63.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40%\" valign=\"top\"\u003e\n \u003cp\u003e26 (43.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40%\" valign=\"top\"\u003e\n \u003cp\u003e22 ( 36.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.96629213483146%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eVomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.606741573033707%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.213483146067414%\" valign=\"top\"\u003e\n \u003cp\u003e17 (28.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.213483146067414%\" valign=\"top\"\u003e\n \u003cp\u003e19 (31.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40%\" valign=\"top\"\u003e\n \u003cp\u003e43 (71.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40%\" valign=\"top\"\u003e\n \u003cp\u003e41 (68.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.96629213483146%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAbdominal pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.606741573033707%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.213483146067414%\" valign=\"top\"\u003e\n \u003cp\u003e31 (51.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.213483146067414%\" valign=\"top\"\u003e\n \u003cp\u003e16 (26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40%\" valign=\"top\"\u003e\n \u003cp\u003e29 (48.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40%\" valign=\"top\"\u003e\n \u003cp\u003e44 (73.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.96629213483146%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eweight loss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.606741573033707%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.213483146067414%\" valign=\"top\"\u003e\n \u003cp\u003e16 (26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.213483146067414%\" valign=\"top\"\u003e\n \u003cp\u003e18 (30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40%\" valign=\"top\"\u003e\n \u003cp\u003e44 (73.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40%\" valign=\"top\"\u003e\n \u003cp\u003e42 (70.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNotes: N, number; %, percentage\u003c/p\u003e\n\u003ch2\u003eLipid profiles among \u003cem\u003eE. histolytica\u0026nbsp;\u003c/em\u003einfected, \u003cem\u003eG. lamblia\u003c/em\u003e infected and healthy control of the study participant\u003c/h2\u003e\n\u003cp\u003eSince the data were normally distributed across the groups, we used a one-way ANOVA test followed by a Post-hoc H Bonferroni pairwise comparison test to compare the mean differences of lipid profiles across study groups. In one-way ANOVA analysis, the mean \u0026plusmn; SD of TC, LDL, and HDL levels were 120.21 \u0026plusmn; 40.11, 74.63 \u0026plusmn; 32.93, and 33.73 \u0026plusmn; 13.36 among \u003cem\u003eE. histolytica-\u003c/em\u003einfected patients, and 123.46 \u0026plusmn; 48.18, 73.57 \u0026plusmn; 42.65, and 34.30 \u0026plusmn; 14.30 among \u003cem\u003eG. lamblia-\u003c/em\u003einfected patients, respectively. The results revealed that the mean concentrations of TC, LDL and HDL in the blood were significantly decreased in \u003cem\u003eE. histolytica\u0026nbsp;\u003c/em\u003eand\u003cem\u003e\u0026nbsp;G. lamblia\u0026nbsp;\u003c/em\u003einfected patients compared to the control group(Table 3a).However, the means difference of all lipid profile parameters between patients infected with \u003cem\u003eE. histolytica\u003c/em\u003e and \u003cem\u003eG. lamblia\u0026nbsp;\u003c/em\u003einfections have no statistically significant (P \u0026ge; 0.05)(Table 3a)\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;3a: Comparison of Lipid profiles among\u0026nbsp;\u003cem\u003eE. histolytica, G. lamblia infected\u0026nbsp;\u003c/em\u003epatients and healthy controls at the Sanja Primary Hospital, July to August 2023 (N = 180)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.749588138385505%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eParameters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.642504118616145%\" valign=\"top\"\u003e\n \u003cp\u003eE. histolytica infected\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.60790774299835%\" valign=\"top\"\u003e\n \u003cp\u003eG. lamblia infected\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.202635914332784%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eTC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.546952224052717%\" valign=\"top\"\u003e\n \u003cp\u003ePatients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.642504118616145%\" valign=\"top\"\u003e\n \u003cp\u003e120.21 \u0026plusmn; 40. 11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.60790774299835%\" valign=\"top\"\u003e\n \u003cp\u003e123.46 \u0026plusmn; \u0026nbsp;48.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.64378478664193%\" valign=\"top\"\u003e\n \u003cp\u003eHealth control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.50834879406308%\" valign=\"top\"\u003e\n \u003cp\u003e148.03 \u0026plusmn; 59.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.84786641929499%\" valign=\"top\"\u003e\n \u003cp\u003e148.03 \u0026plusmn; 59.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.64378478664193%\" valign=\"top\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.50834879406308%\" valign=\"top\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.84786641929499%\" valign=\"top\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.202635914332784%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eLDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.546952224052717%\" valign=\"top\"\u003e\n \u003cp\u003ePatients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.642504118616145%\" valign=\"top\"\u003e\n \u003cp\u003e74.63 \u0026plusmn; 32.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.60790774299835%\" valign=\"top\"\u003e\n \u003cp\u003e73.57 \u0026plusmn; 42.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.64378478664193%\" valign=\"top\"\u003e\n \u003cp\u003eHealth control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.50834879406308%\" valign=\"top\"\u003e\n \u003cp\u003e91.32 \u0026plusmn; 33.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.84786641929499%\" valign=\"top\"\u003e\n \u003cp\u003e91.32 \u0026plusmn; 33.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.64378478664193%\" valign=\"top\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.50834879406308%\" valign=\"top\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.84786641929499%\" valign=\"top\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.202635914332784%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eHDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.546952224052717%\" valign=\"top\"\u003e\n \u003cp\u003ePatients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.642504118616145%\" valign=\"top\"\u003e\n \u003cp\u003e33.73 \u0026plusmn; 13.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.60790774299835%\" valign=\"top\"\u003e\n \u003cp\u003e34.30 \u0026plusmn; 14.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.64378478664193%\" valign=\"top\"\u003e\n \u003cp\u003eHealth control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.50834879406308%\" valign=\"top\"\u003e\n \u003cp\u003e43.70 \u0026plusmn; 10.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.84786641929499%\" valign=\"top\"\u003e\n \u003cp\u003e43.70 \u0026plusmn; 10.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.64378478664193%\" valign=\"top\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.50834879406308%\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.84786641929499%\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: TC: Total Cholesterol, LDL: Low Density Lipoprotein, HDL: High Density Lipoprotein, mg/dl: milligram per deciliter, SD: Standard Deviation.\u003c/p\u003e\n\u003cp\u003eThe data related to TG was not normally distributed across the groups. As a result, non-parametric tests (Kruskal Wallis test followed by dunn-Bonferroni pairwise comparison test) were used to compare the median differences between study groups. TG level was lower in \u003cem\u003eE. histolytica\u0026nbsp;\u003c/em\u003eand\u003cem\u003e\u0026nbsp;G. lamblia\u0026nbsp;\u003c/em\u003einfected patients when compared control group. In Kruskal-Wallis analysis, the median (IQR) of \u003cstrong\u003eTG\u0026nbsp;\u003c/strong\u003elevel was 89.05 (72), 98.00 (74) and 121 (97) among \u003cem\u003eE. histolytica\u0026nbsp;\u003c/em\u003einfected patient, \u003cem\u003eGiardia\u0026nbsp;\u003c/em\u003einfected patient, and healthy control, respectively. TG level were significantly higher in control group p = 0.05. There was no statistically significant difference of median (IQR) between patients infected with \u003cem\u003eE. histolytica\u003c/em\u003e and \u003cem\u003eG. lamblia\u0026nbsp;\u003c/em\u003einfections (P \u0026ge; 0.05). (Table 3b)\u003c/p\u003e\n\u003cp\u003eTable 3b: Comparison of TG level among \u003cem\u003eE. histolytica, G. lamblia infected\u0026nbsp;\u003c/em\u003epatients and healthy controls at the Sanja Primary Hospital, July to August 2023 (N = 180)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.749588138385505%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eParameters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.642504118616145%\" valign=\"top\"\u003e\n \u003cp\u003eE. histolytica infected\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.60790774299835%\" valign=\"top\"\u003e\n \u003cp\u003eG. lamblia infected\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eMedian \u0026nbsp;(IQR) (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eMedian (IQR) (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.202635914332784%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eTG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.546952224052717%\" valign=\"top\"\u003e\n \u003cp\u003ePatients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.642504118616145%\" valign=\"top\"\u003e\n \u003cp\u003e95.26 (51.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.60790774299835%\" valign=\"top\"\u003e\n \u003cp\u003e102.90 (52.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.64378478664193%\" valign=\"top\"\u003e\n \u003cp\u003eHealth control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.50834879406308%\" valign=\"top\"\u003e\n \u003cp\u003e126.82(61.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.84786641929499%\" valign=\"top\"\u003e\n \u003cp\u003e126.82 (61.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.64378478664193%\" valign=\"top\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.50834879406308%\" valign=\"top\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.84786641929499%\" valign=\"top\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviation: TG: Triaglycerol, IQR: interquartile range, mg/dl: milligram per deciliter, *=significant at p-value ˂0.05\u003c/p\u003e\n"},{"header":"Discussion","content":"\u003cp\u003eInfections with \u003cem\u003eE. histolytica\u003c/em\u003e and \u003cem\u003eG. lamblia\u003c/em\u003e are two major public health issues in Ethiopia. Epidemiological study in Ethiopia have reported a high prevalence of both infections(28), but there were limited published reports on the relationship between lipid profile levels among \u003cem\u003eE. histolytica\u0026nbsp;\u003c/em\u003eand\u003cem\u003e\u0026nbsp;G. lamblia infected patient,\u0026nbsp;\u003c/em\u003eparticularly in Northwestern Ethiopia. The current study aimed to compare the lipid profile levels (TC, HDL, LDL, and TAG) among \u003cem\u003eE. histolytica, G. lamblia-\u003c/em\u003einfected\u0026nbsp;patients, and healthy controls. \u0026nbsp;Lipid and lipoprotein abnormalities are commonly reported in physiologic and non-physiologic conditions\u0026nbsp;(33, 34).The changes that occur during inflammation and infection are part of the innate immune response and therefore are likely play an important role in protecting the host\u0026nbsp;(33, 35, 36). In the current study, serum total cholesterol level\u0026nbsp;was found significantly decrease in \u003cem\u003eE. histolytica\u003c/em\u003e infected patient group compared to healthy control group (120.21 \u0026plusmn; 40. 11 mg/dl vs 148.03 \u0026plusmn; 59.36 mg/dl)\u0026nbsp;(p =\u0026nbsp;0.008). The finding is in agreement with a study done in Iraq(37, 38) and\u0026nbsp;India\u0026nbsp;(18)\u0026nbsp;that\u0026nbsp;showed a significant decrease in serum TC in \u003cem\u003eE. histolytica patient\u003c/em\u003e\u003cem\u003e.\u0026nbsp;\u003c/em\u003eThese\u0026nbsp;changes might be due to \u003cem\u003eE histolytica\u0026nbsp;\u003c/em\u003eunable to synthesize its own cholesterol de novo; it must scavenge from the host intestine in order to carry out the biosynthesis of internal and plasma membranes as well as other function(19, 39).Additionally, cholesterols play a role in the pathogenesis of \u003cem\u003eE. histolytica\u003c/em\u003e, in accordance with studies that demonstrate \u003cem\u003eE. histolytica\u003c/em\u003e becomes more virulent in the presence of cholesterol (40).However, our finding contradicts previous studies conducted in Iraq(25). \u0026nbsp;These variations may be due to genetic and lifestyle factors that raise cholesterol levels in the blood (41). The findings of the present study showed that the mean difference for cholesterol-rich lipoprotein levels, such as LDL and HDL, was significantly decreased in patients with \u003cem\u003eE. histolytica\u003c/em\u003e compared to healthy controls (74.63 \u0026plusmn; 32.93 vs. 91.32 \u0026plusmn; 33.46 mg/dl) and [33.73 \u0026plusmn; 13.36 vs. 91.32 \u0026plusmn; 33.46 mg/dl], respectively. Similarly, the median (IQR) of TAG decreased significantly in patients with \u003cem\u003eE. histolytica\u003c/em\u003e compared to healthy controls. Our finding is consistent with previous studies conducted in Iraq (18, 38), and India\u0026nbsp;(18). These changes might be due to the fact that \u003cem\u003eE. histolytica\u003c/em\u003e reduces cholesterol absorption in the intestine (18).This reduction in intestinal cholesterol absorption is increasing sterol loss and significantly reducing LDL levels; it also induces a compensatory increase in cholesterol synthesis by the liver (42).\u003c/p\u003e\n\u003cp\u003eIn the current study, the mean difference of serum TC, level\u0026nbsp;was found significantly\u0026nbsp;decreased in \u003cem\u003eG. lamblia\u003c/em\u003e infected patients compared to healthy control group[123.46\u0026plusmn; 48.18 mg/dl Vs 148.03\u0026plusmn; 59.36 mg/dl] by a mean difference of 24.56 mg/dl [95% CI; 5.01, 44.11].This result is in agreement with previous studies conducted in Iraq \u0026nbsp;(38, 43-45)and Iran (26). This may be due to cholesterol is required for \u003cem\u003eGiardia\u003c/em\u003e membrane biogenesis, as \u003cem\u003eGiardia\u003c/em\u003e is unable to synthesize cholesterol/lipid de novo, which it obtains from the milieu of the upper small intestine (19). In addition, cholesterol starvation initiates encystations. This indicates that cholesterol has a role in pathogenesis as it helps the parasite to remain in trophozoite stage(34).On the other hand, an increase in the TC level was observed in studies conducted in Iraq (46) and Sudan (47). The reason for the disagreement could probably be the increase in total cholesterol, depending on factors such as duration of infection, geographic locations (e.g., urban vs. rural or endemic vs. non-endemic), and BMI (48).\u003c/p\u003e\n\u003cp\u003eThe current study demonstrated that serum LDL,\u0026nbsp;in \u003cem\u003eGiardia\u003c/em\u003e infected patient significantly decreased compared with control group [73.57 \u0026plusmn; 42.65 mg/dl Vs 91.32 \u0026plusmn; 33.468 mg/dl] by a mean difference of 17.75 mg/dl[95% CI; 3.889, 31.611]. Similar results were reported in the previous studies done in Iraq \u0026nbsp; (38, 45) and Iran (26). This may be due to an immunologic mechanism since \u003cem\u003eGiardia\u003c/em\u003e infection triggers the release of cytokines such as interleukin 6 (IL-6) and tumor necrosis factor \u0026alpha; (TNF-\u0026alpha;), which alter lipid metabolism (49). Elevated levels of IL-6 and TNF-\u0026alpha; in parasitic infection may induce stimulation of the LDL receptor (LDLR), resulting in enhanced LDL receptor activity (50). This may result in lower plasma LDL levels since \u003cem\u003eGiardia\u003c/em\u003e needs cholesterol from the host and internalizes it by LDLR -mediated endocytosis (51). The finding of this study is on the contrary with a study done in Iraq (46) and Sudan (47), which reported a higher mean level of LDL in the \u003cem\u003eGiardia-\u003c/em\u003einfected group. These variations in cholesterol levels may be influenced more by nutrition, genetics and lifestyle (41).The findings of the present study showed that the median (IQR) of serum TG levels decreased in \u003cem\u003eGiardia-\u003c/em\u003einfected patients compared to the healthy control group [102.90 \u0026plusmn; 52.14 mg/dl Vs 126.82 \u0026plusmn; 61.19 mg/dl], respectively. The findings of this study are in line with the studies conducted in Iraq (45) and Iran (26)that reported a decrease in serum TG levels in giardia-infected patients.\u003c/p\u003e\n\u003cp\u003eIn the current study, the mean serum HDL level was found significantly decrease in patients infected with \u003cem\u003eG. lamblia\u003c/em\u003e compared to the control group [34.30 \u0026plusmn; 14.32 mg/dl Vs 43.70 \u0026plusmn; 10.72 mg/dl] by a mean difference of 9.4 mg/dl [95% CI; 4.81, 13.98]. This finding is consistent with a previous study conducted in Iraq (38), Khartoum-Sudan (47), that found a significant decrease in serum HDL level in \u003cem\u003eG. lamblia\u003c/em\u003e infected patients. This may be due to a defect in the bile gland caused by blockage of the bile ducts by \u003cem\u003eG. lamblia\u003c/em\u003e and thus leads to fat loss, which is a complication of \u003cem\u003eGiardia\u0026nbsp;\u003c/em\u003einfection, which leads to foul-smelling stools accompanied by undigested fats. Another possible mechanism for reducing serum HDL levels is \u003cem\u003eGiardia\u003c/em\u003e-induced cytokinesis, such as TNF-\u0026alpha;, which induces the expression of LDL receptors, which is secondary to a decrease in cellular cholesterol content caused by TNF-\u0026alpha; stimulated lipid secretion (52). On the other hand, a significant difference was not observed in studies conducted in Iraq (45) and Iran (26).\u003c/p\u003e"},{"header":"Conclusions and recommendations","content":"\u003cp\u003eIn the present study, \u003cem\u003eE. histolytica/dispar\u003c/em\u003e and \u003cem\u003eG. lamblia\u0026nbsp;\u003c/em\u003einfected patient has low levels of total cholesterol, LDL and TG, therefore these parasites use host cholesterol in order to carry out the biosynthesis of internal and plasma membranes as well as other function. The HDL levels are below the normal range in \u003cem\u003eE. histolytica\u003c/em\u003e and \u003cem\u003eG. lamblia\u003c/em\u003e-infected patients, which can indicate an increase in the risk of heart disease, including premature coronary artery disease, heart attack, and stroke.We would like to recommend future researchers conduct large-scale studies that include advanced laboratory methods with an adequate sampling of patients to assess the accurate implications of all test parameters of \u003cem\u003eGiardia\u003c/em\u003e and \u003cem\u003eAmoeba\u003c/em\u003e infections. We recommend future studies include molecular and immunological methods with a longitudinal cohort of patients. \u0026nbsp;Limitations in this study, the sample size was relatively small, especially compared with large-scale population studies abroad.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are thankful for Sanja Health center staff, study participants for their invaluable contribution for the study. Our warmest gratitude also goes to Department of Medical parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health science, University of Gondar for all the unreserved service delivery for us.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Author contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMS: Conceptualization and design of the study, TE: \u0026nbsp;Study protocol development, Supervision of data \u0026nbsp; collection, MT: formal analysis and Data interpretation, writing original draft Manuscript, YM: Methodology, Review, FM and AAA: editing of manuscript, MW and DW: data collections and data curation, AA, AM, NC: Idea conceptions, AYM, DMB and BBT: Manuscript Writing. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability and Materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOriginal data that used for analysis are available and applicable up on the request corresponding authors by Journal\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComputing Interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthor has not received any specific funds\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHerricks JR, Hotez PJ, Wanga V, Coffeng LE, Haagsma JA, Bas\u0026aacute;\u0026ntilde;ez M-G, et al. The global burden of disease study 2013: What does it mean for the NTDs? PLoS neglected tropical diseases. 2017;11(8):e0005424.\u003c/li\u003e\n\u003cli\u003eShirley D-AT, Farr L, Watanabe K, Moonah S, editors. A review of the global burden, new diagnostics, and current therapeutics for amebiasis. Open forum infectious diseases; 2018: Oxford University Press US.\u003c/li\u003e\n\u003cli\u003eAbdulraheem Al-rawi ON, Subhi Naef Al-Omar N. Molecular Diagnosis and Phylogenetic Investigation of Entamoeba histolytica and Giardia intestinalis among Diarrheal Patients in Iraq. Iranian Journal of Medical Microbiology. 2023;17(3):361-8.\u003c/li\u003e\n\u003cli\u003eCook GC, Zumla A. Manson's tropical diseases: Elsevier Health Sciences; 2008.\u003c/li\u003e\n\u003cli\u003eSengupta P, Chakraborty A. Chapter 31 - Infection of the gastrointestinal tract: Giardiasis and amoebiasis. In: Bagchi D, Das A, Downs BW, editors. Viral, Parasitic, Bacterial, and Fungal Infections: Academic Press; 2023. p. 365-73.\u003c/li\u003e\n\u003cli\u003eKantor M, Abrantes A, Estevez A, Schiller A, Torrent J, Gascon J, et al. Entamoeba histolytica: updates in clinical manifestation, pathogenesis, and vaccine development. Canadian Journal of Gastroenterology and Hepatology. 2018;2018.\u003c/li\u003e\n\u003cli\u003eDixon BR. Giardia duodenalis in humans and animals\u0026ndash;transmission and disease. Research in veterinary science. 2021;135:283-9.\u003c/li\u003e\n\u003cli\u003eAl-Jawabreh A, Ereqat S, Dumaidi K, Al-Jawabreh H, Abdeen Z, Nasereddin A. Prevalence of selected intestinal protozoan infections in marginalized rural communities in Palestine. BMC Public Health. 2019;19:1-11.\u003c/li\u003e\n\u003cli\u003eMama M, Alemu G. Prevalence and factors associated with intestinal parasitic infections among food handlers of Southern Ethiopia: cross sectional study. BMC public health. 2015;16:1-7.\u003c/li\u003e\n\u003cli\u003eEspinosa-Cantellano M, Martinez-Palomo A. Pathogenesis of intestinal amebiasis: from molecules to disease. Clinical microbiology reviews. 2000;13(2):318-31.\u003c/li\u003e\n\u003cli\u003eCuellar P, Hern\u0026aacute;ndez-Nava E, Garc\u0026iacute;a-Rivera G, Ch\u0026aacute;vez-Mungu\u0026iacute;a B, Schnoor M, Betanzos A, et al. Entamoeba histolytica EhCP112 dislocates and degrades claudin-1 and claudin-2 at tight junctions of the intestinal epithelium. Frontiers in cellular and infection microbiology. 2017;7:372.\u003c/li\u003e\n\u003cli\u003eBuret AG, Amat CB, Manko A, Beatty JK, Halliez MC, Bhargava A, et al. Giardia duodenalis: new research developments in pathophysiology, pathogenesis, and virulence factors. Current tropical medicine reports. 2015;2:110-8.\u003c/li\u003e\n\u003cli\u003eVivancos V, Gonz\u0026aacute;lez-Alvarez I, Bermejo M, Gonzalez-Alvarez M. Giardiasis: Characteristics, Pathogenesis and New Insights About Treatment. Current topics in medicinal chemistry. 2018;18(15):1287-303.\u003c/li\u003e\n\u003cli\u003eAl-Ani LJ, Al-Warid HS. Evaluation of Adipokines Among Children Infected with Some Protozoan Intestinal Parasites. The Egyptian Journal of Hospital Medicine. 2022;88(1):3906-10.\u003c/li\u003e\n\u003cli\u003eAl-Mekhlafi HM, Azlin M, Shaik A, Sa'iah A, Fatmah M, Ismail M, et al. Protein-energy malnutrition and soil-transmitted helminthiases among Orang Asli children in Selangor, Malaysia. Asia Pacific journal of clinical nutrition. 2005;14(2):188.\u003c/li\u003e\n\u003cli\u003eTayrab E, ManalMustafa, Ibrahim A, Abdrabo A. Lipid profile of schoolchildren with Giardiasis in Bashiar Hospital (Khartoum- Sudan). INTERNATIONAL JOURNAL OF ADVANCES IN PHARMACY, BIOLOGY AND CHEMISTRY. 2014;Vol. 3(3):689-92.\u003c/li\u003e\n\u003cli\u003eBeaver PC, Jung RC, Cupp EW. Clinical parasitology: Lea \u0026amp; Febiger; 1984.\u003c/li\u003e\n\u003cli\u003eBansal D, Bhatti H, Sehgal R. Altered lipid parameters in patients infected with Entamoeba histolytica, Entamoeba dispar and Giardia lamblia. British journal of biomedical science. 2005;62(2):63-5.\u003c/li\u003e\n\u003cli\u003eDas S, Stevens T, Castillo C, Villasen\u0026otilde;r A, Arredondo H, Reddy K. Lipid metabolism in mucous-dwelling amitochondriate protozoa. International journal for parasitology. 2002;32(6):655-75.\u003c/li\u003e\n\u003cli\u003eYichoy M, Duarte T, De Chatterjee A, Mendez T, Aguilera K, Roy D, et al. Lipid metabolism in Giardia: a post-genomic perspective. Parasitology. 2011;138(3):267-78.\u003c/li\u003e\n\u003cli\u003eKaul D, Rani R, Sehgal R. Receptor‐Ck regulates giardia encystation process. Molecular and Cellular Biochemistry. 2001;225:167-9.\u003c/li\u003e\n\u003cli\u003eBezerra C. Dyslipidemia: what it is, how to identify, causes and treatment. Brazilian Journal of Implantology and Health Sciences. 2023;5(1):66-72.\u003c/li\u003e\n\u003cli\u003eSasaki J, Kita T, Mabuchi H, Matsuzaki M, Matsuzawa Y, Nakaya N, et al. Gender difference in coronary events in relation to risk factors in Japanese hypercholesterolemic patients treated with low-dose simvastatin. Circulation Journal. 2006;70(7):810-4.\u003c/li\u003e\n\u003cli\u003eSchmidt AF, Joshi R, Gordillo-Mara\u0026ntilde;\u0026oacute;n M, Drenos F, Charoen P, Giambartolomei C, et al. Biomedical consequences of elevated cholesterol-containing lipoproteins and apolipoproteins on cardiovascular and non-cardiovascular outcomes. Communications Medicine. 2023;3(1):9.\u003c/li\u003e\n\u003cli\u003eAL-Mahdawy HS, Risan FA, Abd Mohammed KI. Lipid profile level in patients infected with Entamoeba histolytica. Int J Curr Res Chem Pharm Sci. 2016;3(3):25-9.\u003c/li\u003e\n\u003cli\u003eSaki J, Khademvatan S, Maraghi S, Soltani S. Serum lipid profiles and eosinophilia among Giardia cyst passers. African Journal of Microbiology Research. 2011;5(27):4881-4.\u003c/li\u003e\n\u003cli\u003eEyayu T, Kiros T, Workineh L, Sema M, Damtie S, Hailemichael W, et al. Prevalence of intestinal parasitic infections and associated factors among patients attending at Sanja Primary Hospital, Northwest Ethiopia: an institutional-based cross-sectional study. PLoS One. 2021;16(2):e0247075.\u003c/li\u003e\n\u003cli\u003eTegen D, Damtie D, Hailegebriel T. Prevalence and associated risk factors of human intestinal protozoan parasitic infections in Ethiopia: a systematic review and meta-analysis. Journal of parasitology research. 2020;2020.\u003c/li\u003e\n\u003cli\u003e(ESS) ESS. Population Size of Towns by Sex, Region, Zone and Weredas as of July 2021. 2021.\u003c/li\u003e\n\u003cli\u003eVanVoorhis CW, Morgan BL. Understanding power and rules of thumb for determining sample sizes. Tutorials in quantitative methods for psychology. 2007;3(2):43-50.\u003c/li\u003e\n\u003cli\u003eControl CfD, Prevention. Anthropometry Procedures Manual. 2007. National Health and Nutrition Examination Survey (NHANES) available from: \u003ca href=\"https://www\"\u003ehttps://www\u003c/a\u003e cdc gov/nchs/data/nhanes/nhanes_07_08/manual_an pdf. 2007.\u003c/li\u003e\n\u003cli\u003eCarroll TA, Pinnick HA, Carroll WE. Probability and the Westgard rules. Annals of Clinical \u0026amp; Laboratory Science. 2003;33(1):113-4.\u003c/li\u003e\n\u003cli\u003eFeingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, et al. Endotext [Internet]. 2000.\u003c/li\u003e\n\u003cli\u003eBansal D, Bhatti HS, Sehgal R. Role of cholesterol in parasitic infections. Lipids in health and disease. 2005;4:1-7.\u003c/li\u003e\n\u003cli\u003eKhovidhunkit W, Kim M-S, Memon RA, Shigenaga JK, Moser AH, Feingold KR, et al. Effects of infection and inflammation on lipid and lipoprotein metabolism: mechanisms and consequences to the host. The Journal of Lipid Research. 2004;45(7):1169-96.\u003c/li\u003e\n\u003cli\u003eKhovidhunkit W, Memon RA, Feingold KR, Grunfeld C. Infection and inflammation-induced proatherogenic changes of lipoproteins. The Journal of infectious diseases. 2000;181(Supplement_3):S462-S72.\u003c/li\u003e\n\u003cli\u003eAl-Hadrawy MK. ESTIMATION OF AST, ALT AND COMPLETE LIPID PROFILE IN HUMAN INFECTED BY ENTAMOEBA HISTOLYTICA IN AL-NAJAF GOVERNORATE, IRAQ. Journal of Techniques. 2015;28(2).\u003c/li\u003e\n\u003cli\u003eWahid-Aldeen EI, Ahmad NA, Sahlah Kh AS. Assessment of Lipid Profile and Cytokine (IL-13, TGF-\u0026beta;) with sICAM-1in Patients Infected with Intestinal Parasite (Entamoeba histolytica, Giardia lamblia and Blastocystis hominis). 2009.\u003c/li\u003e\n\u003cli\u003eSerrano-Luna J, Gutierrez-Meza M, Mej\u0026iacute;a-Zepeda R, Galindo-Gomez S, Tsutsumi V, Shibayama M. Effect of phosphatidylcholine\u0026ndash;cholesterol liposomes on Entamoeba histolytica virulence. Canadian journal of microbiology. 2010;56(12):987-95.\u003c/li\u003e\n\u003cli\u003eCastellanos-Castro S, Bola\u0026ntilde;os J, Orozco E. Lipids in Entamoeba histolytica: Host-Dependence and Virulence Factors. Frontiers in cellular and infection microbiology. 2020;10:75.\u003c/li\u003e\n\u003cli\u003ePollin TI, Quartuccio M. What We Know About Diet, Genes, and Dyslipidemia: Is There Potential for Translation? Current nutrition reports. 2013;2(4):236-42.\u003c/li\u003e\n\u003cli\u003eTurley SD, Dietschy JM. The intestinal absorption of biliary and dietary cholesterol as a drug target for lowering the plasma cholesterol level. Preventive cardiology. 2003;6(1):29-33, 64.\u003c/li\u003e\n\u003cli\u003eMa'ani N, Jabir DM. Study of lipid profile alteration in the patients infected with Giardia lamblia and compare the results with healthy individuals. Al-Qadisiyah Medical Journal. 2013;9(15):119-29.\u003c/li\u003e\n\u003cli\u003eAlhuchaimi SN, Mahmood T, Abdullateef SF, Khadum E. Association between Serum Cholesterol Level and Giardia lambliaInfection among Children with Acute Diarrhea in Al-Najaf Governorate مدﻟا لﺻﻣ ﻲﻓ لورﺗﺳﻟوﮐﻟا ىوﺗﺳﻣ نﯾﺑ ﺔﻗﻼﻌﻟا ﺔﺑﺎﺻﻹاو. kufa Journal for Nursing sciences. 2017;7(1).\u003c/li\u003e\n\u003cli\u003eKhlaf WMA. The spread of the parasite Giardia lamblia in the city of Samarra and its effect on some biochemical variables. Journal of Pharmaceutical Negative Results. 2022:2133-8.\u003c/li\u003e\n\u003cli\u003eAlasady RA, Al-Nafakh RT, Al-Turaihi T, Tayyeh AJ, Hassan ES. Mucin2 and Lipid Profile Estimation in Giardia Lamblia Infected Patients: A Case-control Study. Journal of Communicable Diseases (E-ISSN: 2581-351X \u0026amp; P-ISSN: 0019-5138). 2022;54(2):55-60.\u003c/li\u003e\n\u003cli\u003eEltayeb Tayrab MM, Ibrahim A, Abdrabo AA. Lipid profile of schoolchildren with Giardiasis in Bashiar Hospital (Khartoum-Sudan).\u003c/li\u003e\n\u003cli\u003ede Groot R, van den Hurk K, Schoonmade LJ, de Kort W, Brug J, Lakerveld J. Urban-rural differences in the association between blood lipids and characteristics of the built environment: a systematic review and meta-analysis. BMJ global health. 2019;4(1):e001017.\u003c/li\u003e\n\u003cli\u003ePu X, Li X, Cao L, Yue K, Zhao P, Wang X, et al. Giardia duodenalis Induces Proinflammatory Cytokine Production in Mouse Macrophages via TLR9-Mediated p38 and ERK Signaling Pathways. Frontiers in cell and developmental biology. 2021;9:694675.\u003c/li\u003e\n\u003cli\u003eGierens H, Nauck M, Roth M, Schinker R, Sch\u0026uuml;rmann C, Scharnagl H, et al. Interleukin-6 stimulates LDL receptor gene expression via activation of sterol-responsive and Sp1 binding elements. Arteriosclerosis, thrombosis, and vascular biology. 2000;20(7):1777-83.\u003c/li\u003e\n\u003cli\u003eRivero MR, Miras SL, Quiroga R, R\u0026oacute;polo AS, Touz MC. Giardia lamblia low-density lipoprotein receptor-related protein is involved in selective lipoprotein endocytosis and parasite replication. Molecular microbiology. 2011;79(5):1204-19.\u003c/li\u003e\n\u003cli\u003eLiao W, Flor\u0026eacute;n C-H. Upregulation of low density lipoprotein receptor activity by tumor necrosis factor, a process independent of tumor necrosis factor-induced lipid synthesis and secretion. Lipids. 1994;29(10):679-84.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Lipid profiles, Alteration, Gardiaisis, Amoebasis, Sanja, Northwest Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-4292224/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4292224/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Amoebiasis and giardiasis, common intestinal infections caused by \u003cem\u003eEntamoeba histolytica\u003c/em\u003e and \u003cem\u003eGiardia lamblia \u003c/em\u003eparasite. These agents are dependent of host-derived lipids for their membrane biogenesis and potentially alter host serum lipid profiles, might results in cardiovascular complications. Yet, limited studies have investigated the association between the infections and lipid profiles in Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA cross-sectional study was conducted from July 10 to August 252023. A total of 180 study participants were recruited using a convenient sampling technique. Socio-demographic and clinical data were collected using structured questionnaires via face-to face interviews and reviewing medical records, respectively. Approximately 5 grams of stool samples were collected and examined under a light microscope. Three milliliters of blood were collected from the case and control groups. The blood samples were then centrifuged to separate the serum from the whole blood. Subsequently, the lipid profiles were analyzed using a Coulter chemistry analyzer. The data were entered into epidata version (4.6), and exported into SPSS (25) for analysis. The lipid profile parameters of case were assessed and compared with healthy control groups using one way ANOVA. A\u003cem\u003e P\u003c/em\u003e-value \u0026lt; 0.05 was considered as statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult: \u003c/strong\u003eThe study showed that \u003cem\u003eE. histolytica/dispar\u003c/em\u003e-infected patients had significantly lower mean serum total cholesterol (120.21 ± 40.11), HDL (33.73 ± 13.36), and LDL (74.63 ± 32.93) levels compared to healthy groups. Additionally, the median interquartile range of triglyceride value decreased in \u003cem\u003eE. histolytica/dispar\u003c/em\u003e infected patients (P ≤ 0.05). Likewise, patients infected with \u003cem\u003eG. lamblia\u003c/em\u003e had lower mean serum total cholesterol (123.46 ± 48.18), HDL (34.30 ± 14.30), and LDL (73.57 ± 42.65) levels compared to healthy groups. Also, the median interquartile range of triglyceride value was lower in \u003cem\u003eGiardia-\u003c/em\u003einfected patients (\u003cem\u003eP\u003c/em\u003e≤0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis study confirmed that \u003cem\u003eE. histolytica/dispar\u003c/em\u003e and \u003cem\u003eG. lamblia has\u003c/em\u003e significantly altered blood lipid levels in infected patients. Requires routine lipid panel analysis for these cohorts.\u003c/p\u003e","manuscriptTitle":"Alteration of Serum Lipid Profiles among Amoebasis and Giardiasis Confirmed Patients at North West Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-30 03:45:49","doi":"10.21203/rs.3.rs-4292224/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f35c9857-a71b-4c1f-ab7c-9cef3be2408f","owner":[],"postedDate":"April 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-16T07:09:16+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-30 03:45:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4292224","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4292224","identity":"rs-4292224","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}