Pattern of Parasitic Infestations in Patients with Persistent Lower Gastrointestinal Symptoms in Ismailia Governorate

Background and study aim: Intestinal parasitic infections remain common worldwide and contribute substantially to morbidity, particularly in low-resource settings. We aimed to define the pattern of parasitic infestations among adults presenting with persistent lower gastrointestinal (GI) symptoms at two primary health care centers, one rural and one urban, in Ismailia Governorate, Egypt.Patients and Methods: We conducted a cross-sectional study of 300 adults (≥18 years) with lower-GI symptoms persisting >2 weeks who attended Hai El-Salam (urban) and El-Abtal (rural) primary health care centers. Fresh stool specimens were examined by direct microscopy. Baseline demographics, clinical features, and laboratory parameters (complete blood count including eosinophilia) were recorded. Abdominal examination and pelvi-abdominal ultrasonography were performed.Results: Nine parasitic species were identified. The most frequent was Entamoeba histolytica in 18/300 (6%). Other detections included E. coli (commensal) 16 (5.3%), Hymenolepis nana 15 (5.0%), Giardia duodenalis 15 (5.0%), Cyclospora cayetanensis 15 (5.0%), Enterobius vermicularis 15 (5.0%), Cryptosporidium parvum 12 (4.0%), and Microsporidia 11 (3.7%); mixed infections also occurred. Infected patients more often reported abdominal bloating (51.7% vs 39.9%) and excessive flatus (51.0% vs 39.2%); both differences were significant (P=0.04 for each). White blood cell count and eosinophilia were higher among infected participants (P<0.001), and platelet count was lower (P=0.02). No significant rural–urban difference in overall infection prevalence was observed (P=0.70).Conclusion: Among adults with persistent lower-GI symptoms in primary care, intestinal parasites were common, with E. histolytica most prevalent. Bloating and flatus were associated with infection, whereas residence (rural vs urban) was not. Strengthening parasite prevention and timely diagnosis in primary care may reduce symptom burden.