الفهرس 
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Abstract
Giardia lamblia and H. pylori are two flagellate microorganisms that grow in duodenum and stomach .
The present study aimed to detect the co infection of Giardia lamblia and H. pylori in patients of CKD treated with hemodialysis and to asses its role in the progress of the disease in 100 patient with CKD with hemodialysis and 100 control group of apparently healthy individuals . stool samples using microscopical examination of wet faecal smear prior and after concentration of stool samples for Giardia lamblia trophozoites and/or cysts and morphology was confirmed by iron hematoxilin permanent stain.
Also, two immunoassays; Giardia lamblia antigen in stool using commprial kit using Elisa in frozen stool sample and detection of H.pylori in stool by Fecal antigen test .
Based on the obtained results of the present study clearly demonstrated that the prevalence of Giardia Lamblia and H.pylori was high in the studied healthy controls as compared with CKD patients . Giardiasis was detected in 13 patients with CKD with a mean age of 45.24 ±14.52 and in 22 patients in control group with a mean age of 45.24 ±14.52 . Among them, male were more prevalent (66%), from rural areas (66.5%) and using tap water (83.5%). H. pylori infection was detected in 22 patients with CKD and in 27 control patients. Co-infection was detected in 10 patients with CKD and in 19 patients control group. Only Dyspepsia symptoms showed a statistical association with co-infection.
Stool samples of 100 of CKD patients group and 100 of apparently healthy individuals (control group) were examined by using microscopical examination of wet faecal smear prior and after concentration of stool samples for Giardia lamblia trophozoites and/or cysts and morphology was confirmed by iron hematoxilin permanent stain.
Also, two immunoassays; Giardia lamblia antigen in stool using commprial kit using Elisa in frozen stool sample and detection of H.pylori in stool by Fecal antigen test . The results obtained were assessed statistically and analyzed for significance. Male patients as compared with females showed higher prevalence of positive co-morbidity but with non-statistically significant difference (p-value= 0.179). Rural CKD patients had a higher rate of co-infection as compared to urban patients but with non-statistically significant difference (p-value= 0.739).
The distribution of patients with co-infection and patients without it was nearly similar as regard the quality of drinking water with non-statistically significant difference (p-value> 0.999). Dyspepsia was associated with statistically higher frequency of co-infection (90%) as compared with absence of dyspepsia (10%); (p-value= 0.016). 31% of Giardia lamblia cases were detected by using direct microscopy.
11 % of Giardia lamblia cases were detected by concentration technique in CKD patients. 19 % of Giardia lamblia cases were detected by concentration technique in control . 35 % of Giardia lamblia cases were detected by ELISA . 49 % of H.pylori cases were detected by immunoassay . Sensitivity of Direct Wet Mount in diagnosing Giardia Lamblia infection was 77.14%; while specificity was 97.57%. Sensitivity of concentrated fecal material examination in diagnosing Giardia Lamblia infection was 77.14%; while specificity was 98.19%.
Sensitivity of Staining by Iron Haematoxylin Stain in diagnosing Giardia Lamblia infection was 65.71%; while specificity was 99.39%. Sensitivity and specificity of ELISA detection of Giardia Lamblia in stool were recorded as 96.4% and 100%
Among CKD patients group the most frequent symptom was dyspepsia (92.3%) followed by diarrhea and abdominal pain (84.6%), fatigue (69.2%) , loss of appetite and flatulence (61.5%) , nausea (38.5%) and vomiting (15.4%).
Giardia lamblia ELISA assay for Giardia lamblia detection in stool surpassed microscopy and Staining technique. It offers the advantage of the rapid screening and detection of the parasite .
Duration of hemodialysis affects prevalence of the Giardia lamblia and H.pylori
Because of the low sensitivity of direct microscopy, It should be complemented with faecal Giardia lamblia ELISA assay that offers a relatively promising practical acceptable alternative for accurate laboratory diagnosis of acute infection in clinically suspected patients. Also, to avoid unnecessary and possibly harmful therapies and to determine the true prevalence and epidemiology of Giardia lamblia. Despite microscopy is available method . However, the great limitation of microscopy is the need of well-trained microscopists.