Intestinal Bacteria and Parasites Associated with Diarrhea in Infants and Children in Zakho City, Kurdistan Region, Iraq


  • Jihan A. Abdulqader Department of Biology, Faculty of Science, University of Zakho, Duhok, Kurdistan Region, Iraq
  • Wijdan M. S. Mero Department of Biology, Faculty of Science, University of Zakho, Duhok, Kurdistan Region, Iraq (and Department of Computer Science, Nawroz University, Duhok, Kurdistan Region Iraq)
  • Haval M. Khalid Department of Biology, Faculty of Science, University of Zakho, Duhok, Kurdistan Region, Iraq



Keywords: Microbial diarrhea, Bacteria, Parasites, Infants and Children, Gender, Age.



Intestinal parasites and bacteria especially enteropathogenic Escherichia coli (EPEC) are important causative agents responsible for persistent diarrhea in infants and children worldwide due to their high occurrence in both the hospitals and community settings. However, sporadic outbreaks by these microorganisms occur globally. This study was conducted from August 2021 to January 2022, during which 500 diarrheic stool samples were collected from both genders and various ages (6 month to 12 years) from outpatient in Zakho hospital. In this study the total rate of infection was 64.2% (321/500), considerable number of samples were positive for more than one species of microorganisms, elevating the rate to 89%, with the highest rate (62%) being with bacteria among which E. coli was the dominant species (74.84%), while the rate with parasites was 27%, with E. histolytica being the dominant species (45.93%). Other recorded bacterial species with their rates are: Klebsiella (15.16%) Pseudomonas spp. and Shigella spp. at rates of 6.13% and 3.87%, respectively. While other parasites included: Cryptosporidium spp. (34.07%), Blastocystis spp. (13.33%), G. lamblia (5.93%) and H. nana (0.74%). Single infections were reported in 61.68% (198/321) of the positive cases with the highest rate (49.53%) of bacteria and only 12.15% with parasites. The dominant organisms in single infections were E. coli and the oocysts of Cryptosporidium spp. at rates of 81.13% and 61.54%, respectively. The mixed infections were documented in 38.32% (123/321). Among these, 67.48% (83/123) showed a combination between bacteria and parasites. The most frequent microorganisms encountered in mixed infections were E. coli and E. histolytica at rate of 33.33%. The total rate of infection in females was higher than that in males (59.19 vs 40.81%), with the highest (77.89%) being among the age group 6 months-2 years. In each gender separately, males of the age group 6 months to 2 years showed the highest rate (62.16%,) whereas females of the age group 9-12 years had the highest rate (51.16%). Statistically the relationships between the rate of infection, age and gender were non-significant (P < 0.294). In conclusions it's obvious that 89 % of diarrheal cases were associated with bacteria, and parasites, with E. coli, Klebsiella, E. histolytica, and Cryptosporidium spp. oocysts as leading microorganisms.  About 61.68% were infected with one microorganism and 38.32% with two different species of microorganisms and the prevalence rate of microbes was found to be sex and age independent. Therefore, it is recommended to disseminate the health education and sanitary application programs among the community.  


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). Prevalence of diarrhea and its associated factors in children under five years of age in Baghdad, Iraq. Open J Prev Med.; 4(1):17-21.

Ali, C. I., Mahmood, A. R., Jafar, N. A. and Khorsheed, S. (2012). Prevalence of enteropathogenic diarrhea in Children up to 2 years in Kirkuk Province. Tikrit Med J.; 15(2):124-31.

Al-alousi, T. I. and Mahmood, O. I. (2012). Detection of Cryptosporidium oocysts in calves and children in Mosul, Iraq. The Iraqi Journal of Veterinary Medicine; 36(2): 280-285.

Al-Bayatti, K. K. and Al-Taei, L. H. (2010). Local pattern of acute enteric bacterial infection in school students. AlMustansiriya J Sci.; 21(4):23-30.

Alexander, S. K. and Strete, D. (2001). Microbiology: A Photographic Atlas for The Laboratory. Daryl Fox. USA. 35-80.

Al-Khateeb, A. I. (2008). Diarrhea Causative for Resident Children in General Zahraa Hospital under age group (1 month to 6 years). Journal of Wassit for Science and Medicine, 1 (2): 35- 44.

Al-Shammari, S., Khoja, T., El‐Khwasky, F. and Gad, A. (2001). Intestinal parasitic diseases in Riyadh, Saudi Arabia: prevalence, sociodemographic and environmental associates. Tropical Medicine and International Health; 6(3): 184-189.

Al-Ougelli, S. G. (2007). Epidemiological study of Cyclospora cayetanensis and other intestinal protozoa of man animals and vegetables in Baghdad province /Al-Karkh”, M.Sc. thesis, College of Veterinary Medicine, University of Baghdad.

Al-Sheikly, S. A. A. R. (2002). An epidemiological study and some aspects of pathological infection with Blastocystis hominis in Baghdad", M.Sc. thesis, AL-Mustansirya.

Al-Sorchee, S. M. A., Rabat, A. A. and Juma, I. M. (2013). Microbial causatives of diarrhea in children in Erbil city. Al-Nahrain Journal of Science; 16(3): 19-29.

Badry, A. H., Jameel, A. Y. and Mero, W. M. (2014). Pathogenic Microorganisms Associated with Diarrhea in Infants and Children in Duhok Province, Kurdistan Region/Iraq. Science Journal of University of Zakho; 2(2): 266-275.

Brown J, Cairncross S, Ensink JHJ. Water, sanitation, hygiene and enteric infections in children. Arch Dis Child. 2013;10(1136):1-6.

Bueris, V.; Sircili, M.P;Taddei, C.R.; Santos, M.F.D.; Franzolin, M.R.; Martinez, M.B.; Ferrer,S.R.;Barreto, M.L. and Trabulsi, L.R.(2007). Detection of diarrheagenic Escherichia coli from children with and without diarrhea in Salvador, Bahia, Brazil. Mem Inst Oswaldo Cruz, Rio deJaneiro., 102(7): 839-844.

Center of Disease Control and Prevention (CDC) (2016). Laboratory identification of parasites of public health concern. U.S. Department of Health and Human Services, USA, Gov.

Demers-Mathieu, V., Underwood, M. A., Beverly, R. L., Nielsen, S. D. and Dallas, D. C. (2018). Comparison of human milk immunoglobulin survival during gastric digestion between preterm and term infants. Nutrients; 10(5): 631.

El-Sherbini, G. T. and Gneidy, M. R. (2012). Cockroaches and flies in mechanical transmission of medical important parasites in Khaldyia Village, El-Fayoum, Governorate, Egypt. Journal of the Egyptian Society of Parasitology; 240(1409): 1-10.

El-Sheikh, S.M. and El-Assouli, S.M. (2001). Prevalence of Viral, bacterial and Parasitic Enteropathogens among Young Children with Acute Diarrhoea in Jeddah, Saudi Arabia. J Health Popul Nutr., 19(1):25- 30.

Faust, E. C., Antoni, J. S. D., Odom, V., Miller, M. J., Peres, C., Sawitz, W, (1938). A critical study of clinical laboratory techniques for the diagnosis of protozoan cysts and Helminth eggs in feces. Am J Trop Med.; 18:169-83.

Garcia, L. (2007). Macroscopic and Microscopic Examination of Fecal Specimens. Fifth Edition. Washington, DC: ASM Press. p. 782-830.

GBD 2015 Eastern Mediterranean Region Diarrhea Collaborators (2018). Burden of diarrhea in the Eastern Mediterranean Region, 1990-2015: Findings from the Global Burden of Disease 2015 study. International journal of public health, 63(Suppl 1): 109–121.

GBD 2015 Risk Factors Collaborators (2016) Global, regional and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet.388:1659–1724.

Gualdieri, L., Rinaldi, L., Petrullo, L., Morgoglione, M. E., Maurelli, M. P., Musella, V., Piemonte, M., Caravano, L., Coppola, M. G., and Cringoli, G. (2011). "Intestinal parasites in immigrants in the city of Naples (southernItaly)", Actatropica; 117(3):196-201.

Guerrant, R. L., De Boer, M. D., Moore, S. R., Scharf, R. J. and Lima, A. A. (2013). The impoverished gut--a triple burden of diarrhoea, stunting and chronic disease. Nature reviews. Gastroenterology and hepatology, 10(4): 220–229.

Hadi ZS. A Study of prevalence of intestinal parasitic infection in Shatrah district. Journal of College of Education. 2010;1(5):28-39.

Hasan, H. K. (2020). Co-infection of Echerichia coli Strains Associated with Intestinal Parasites Among Children Under Five Years in Duhok City, Kurdistan Region/Iraq. M.Sc. Thesis. Iraq: Faculty of Science, University of Duhok.

Heidt, P., Lange, D., Riddle, M., (2014). Persisting consequences of intestinal infection. Old Herborn Univ Semin Monogr.; 27:125–137.

Heidary, M., Momtaz, H. and Madani, M. (2014). Characterization of diarrheagenic antimicrobial resistant Escherichia coli isolated from pediatric patients in Tehran, Iran. Iranian Red Crescent Medical Journal; 16(4).

Hellard, M. E., Sinclair, M. I., Hogg, G. G., and Fairley, C. K. (2000). Prevalence of enteric pathogens among community based asymptomatic individuals. Journal of gastroenterology and hepatology; 15(3): 290-293.

Jameel, H. S. and Eassa, S. H. (2021). Intestinal parasite infestation and its risk factors: a cross-sectional survey among children in Duhok city, Kurdistan Region Iraq. Duhok Medical Journal. Volume 15, Issue 1, PP: 81-95.

Kilic, I. H., Ozaslan, M., Karsligil, T., Karagoz, I. D. and Zer, Y. (2007). Investigation of diarrhea agents less than 5 years of age in summer in Gaziantep /Turkey.Pakistan Journal of Biological Sciences,10(17):2915-2919.

Kotloff, K. L., Nataro, J. P., Blackwelder, W. C., Nasrin, D., Farag, T. H., Panchalingam, S., Wu, Y., Sow, S. O., Sur, D., Breiman, R. F., Faruque, A. S. G., Zaidi, A. K. M., Saha, D., Alonso, P. L., Tamboura, B., Sanogo, D., Onwuchekwa, U., Manna, B., Ramamurthy, T., Kanungo, S., Ochieng, J. B., Omore, R., Oundo, J. O., Hossain, A., Das, S. K., Ahmed, S., Qureshi, S., Quadri, F., Adegbola, R. A., Antonio, M., Hossain, M. J., Akinsola, A., Mandomando, I., Nhampossa, T., Acácio, S., Biswas, K., O'Reilly, C. E., Mintz, E. D., Berkeley, L. Y., Muhsen, K., Sommerfelt, H., Robins-Browne, R. M. and Levine, M. M. (2013). Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. The Lancet, 382(9888): 209–222

Leboffe, M. J., and Pierce, B. E. (2011). Photographic Atlas for the Microbiology Laboratory. 4th edition. Douglas N. Morton. USA. 64-144.

Lindsay, B., Saha, D., Sanogo, D., (2015). Association between shigella infection and diarrhea varies based on location and age of children. Am J Trop Med Hyg.; 93:918–924.

Markey, B., Leonard, F., Archambault, M., Cullinane, A. and Maguire, D. (2013). Clinical veterinary microbiology e-book. Elsevier Health Sciences.

McAuliffe, G. N., Anderson, T. P., Stevens, M., Adams, J., Coleman, R., Mahagamasekera, P., (2013). Systematic application of multiplex PCR enhances the detection of bacteria, parasites, and viruses in stool samples. Journal of Infection; 67(2): 122-129.

Mero, W. M.S, Jameel, A. Y. and Amidy, K. S. Kh. (2015). Microorganisms and viruses causing diarrhea in infants and primary school children and their relation with age and sex in Zakho city, Kurdistan Region, Iraq. International Journal of Research in Medical Sciences; 3 (11): 3266-3273.

Navaneethan U, Giannella RAJNcpG, hepatology. 2008. Mechanisms of infectious diarrhea. 5:637- 647

Nguyen, K. H., Operario, D. J., Nyathi, M. E., Hill, C. L., Smith, J. A., Guerrant, R. L. and McQuade, E. T. R. (2021). Seasonality of drinking water sources and the impact of drinking water source on enteric infections among children in Limpopo, South Africa. Int. J. Hyg. Environ. Hlth. 231, 113640.

Owada, K. (2019). Spatial epidemiological approaches to quantify the role of soil-transmitted helminths (STH) in cognitive dysfunction in school-aged population. Ph.D. Thesis, Univ. Queensland, Australia.

Ozcakir, O., Güreser, A. S., Ergüven, S., Akyön, Y., Topaloglu, R. and Hascelik, G. (2007). Characteristics of Blastocystis hominis infection in a Turkish university hospital. Turkish Society for Parasitology; 31(4):277-82.

Rahi, A. A., Magda, A. and Al-Charrakh, A. H. (2013). Prevalence of Cryptosporidium parvum among children in Iraq. American Journal of Life Sciences; 1(6): 256-260.

Rahouma, A., Klena, J. D., Krema, Z., Abobker, A. A., Treesh, K., Franka, E. and Abudher, A. (2011). Enteric pathogens associated with childhood diarrhea in Tripoli-Libya. The American journal of tropical medicine and hygiene; 84(6): 886-891.

Ramakrishnan, B., Gopalakrishnan, R., Senthur Nambi, P., Durairajan, S. K., Madhumitha, R., Tarigopula, A., Chandran, C. and Ramasubramanian, V. (2018). Utility of multiplex polymerase chain reaction (PCR) in diarrhea-An Indian perspective. Indian journal of gastroenterology: official journal of the Indian Society of Gastroenterology, 37(5): 402–409.

Ramakrishnan, R., Houben, B., Rousseau, F. and Schymkowitz, J. (2019). Differential proteostatic regulation of insoluble and abundant proteins. Bioinformatics; 35(20); 4098–4107.

Raof, S. and Abdul-Rahman, H. (2011). Prevalence of Blastocystis hominis and Giardia lamblia Parasites in Patients of Four Regions in East South Baghdad",299The Iraqi Journal Veternary Medecine, 35(2): 74 - 84.

Rashedul, K. (2011). Detection of Different Diarrheagenic Escherichia coli Strains by Multiplex PCR. Doctoral dissertation, Department of Microbiology, Mymensingh Medical College, University of Dhaka.

Saka, H. K., Dabo, N. T., Muhammad, B. and García-soto, S. (2019). Diarrheagenic Escherichia coli Pathotypes from Children Younger Than 5 Years in Kano State, Nigeria. Frontiers in Public Health. 7(348): 1–8.

Siddiqui, F. J., Belayneh, G. and Bhutta, Z. A. (2020). Nutrition and diarrheal disease and enteric pathogens. In: Nutrition and Infectious Diseases; pp. 219-241.

Spano, L. C., da Cunha, K. F., Monfardini, M. V., Fonseca, R. D. C. B. and Scaletsky, I. C. A. (2017). High prevalence of diarrheagenic Escherichia coli carrying toxinencoding genes isolated from children and adults in southeastern Brazil. BMC infectious diseases, 17(1): 773.

Sule, E. I., Aliyu, A. M. and Abdulaziz, B. M. (2011). Isolation of diarrhoeagenic bacteria in children attending some selected hospitals within Kaduna metropolis, Kaduna state Nigeria. Continent Appl Sci.; 6(1):1-6.

Sumathi, W. S., Balasubramanian, S., Pradeebaa, T. and Sumathi, B. (2018). A study on knowledge, attitude and practices of mothers about acute diarrhea and its management with oral rehydration therapy and zinc in children under 5 years. IAIM 7(12), 1-10

Tambekar, D.H.; Shirsat, S.D. and Washing, H (2009). A Cornerstone to Prevent the Transmission of Diarrhoeal Infection. Asian Journal of Medical Sciences, 1(3): 100-103.

Thakur, N., Jain, S., Changotra, H., Shrivastava, R., Kumar, Y., Grover, N. and Vashistt, J. (2018). Molecular characterization of diarrheagenic Escherichia coli pathotypes: Association of virulent genes, serogroups, and antibiotic resistance among moderate-to-severe diarrhea patients. Journal of Clinical Laboratory Analysis, 32(5): 1–11.

WHO, (2007). Combating waterborne disease at the house-hold. International network to promote household water treatment and safe storage.

Zeibig, E. (2014). Clinical Parasitology-E-Book: A Practical Approach. Elsevier Health Sciences.120. Faust EC, Antoni JSD, Odom V, Miller MJ, Peres C, Sawitz W, et al. A critical study of clinical laboratory techniques for the diagnosis of protozoan cysts and Helminth eggs in feces. Am J Trop Med. 1938; 18:169-83.



How to Cite

A. Abdulqader, J., M. S. Mero, W., & M. Khalid, H. (2022). Intestinal Bacteria and Parasites Associated with Diarrhea in Infants and Children in Zakho City, Kurdistan Region, Iraq. Academic Journal of Nawroz University, 11(4), 153–162.