Among the most prevalent parasites are thought to be intestinal ones. diseases among humans due to their spread throughout the world, especially in developing countries [1], and infections brought on by parasitic pathogens are thought to be a worldwide health issue that affect about 25% of the world's population [2].

Treatments effective against parasites remain limited and are often accompanied by severe negative side effects. In addition, vaccines are also limited for parasitic infections transmitted through food and water [2]

According to the World Health Organization, 23.2 million cases of the disease have been detected. Food-borne parasites and 45,927 deaths until 2010 (excluding primary intestinal infections). In addition, an additional 67.2 million cases of diseases resulting from intestinal protozoa transmitted through food were recorded [3].

They are responsible for numerous illnesses in both humans and animals, some of which can result in bloody diarrhea, like amoebic dysentery caused by the parasite E. histolytica. Giardiasis, ascariasis, amebiasis, are common intestinal parasitic infections. 

Children are more susceptible to parasitic diseases such as malnutrition. Intestinal parasites are also closely linked to the development of anemia, as they cause deterioration in the absorption process and a deficiency in nutrients, leading to gastrointestinal blood loss.

It is clear that the difference in these clinical symptoms is because the host immune reaction and the parasite immunological response differ [4], as well as prior encounters with this infection [5]. Immune system defense is vital to destroy G.lamblia during the infected period and offer a reliable defense against it [6]. Humoral and cellular Acquired immunity is influenced by immunological responses, however the exact processes are unclear [7]. Interleukins (ILs) have a direct impact on the immune response, hence it is crucial to investigate how ILs differ in individuals with parasite infections [8]. Therefore, this study was conducted to identify the types that cause diarrhea, evaluate nutritional status, and estimate the level of interleukins and interferon and patients with diarrhea and compared them to the control group at Al-Hussein Teaching Hospital

During the period from October 2022 to March 2023, 900 stool samples of children arriving to Al-Hussein (PBUH) Hospital in Diwaniyah Governorate who were suffering from diarrhea were examined, and the patient samples were divided into three (3) categories (G0, G1, and G2). People who did not have the parasite were considered Infected and apparently healthy were designated as G0 (control). People infected with one parasite were classified as G1. People infected with more than one parasite were classified as G2.

Blood samples (5 ml) from patients with confirmed parasites and healthy individuals were also pooled as control. Blood samples were centrifuged at 3000 rpm for 5 minutes to separate and collect the serum, and each serum sample was divided into three parts, each of which was stored until used to determine IL-2 IL-10 and IFN-γ levels by ELISA test. According to instructions The manufacturing company.

Statistical analysis

The SPSS statistical software (version 20) was used to conduct the statistical analysis. To find the overall  difference in group means, the data underwent analysis of variance testing ( ANOVA).

The data is displayed as the mean plus standard error. Group mean differences were assessed using the less significant difference (LSD). Chi-square analysis was performed to compare the proportions. It was deemed statistically significant when p≤0.05.

Out of 900 samples collected from infected children, it was found that the number of infected people was 320, while the percentage of uninfected people was 580, as shown in Table 1. 

Table 1: Showing The Intestinal Parasite Frequency in Children with Infection

The infection rate in rural children was higher than in urban children, as the percentages were 2 times more infected than those infected. Giardia lamblia is the most prevalent of the parasites under study in infected children, as shown in Table 2.

Table 2 Shows the Percentages of Intestinal Parasite Infection by Environmental Regression of Infected Patients

And on the effect of some blood indicators of the infected children, he found that the percentage of hemoglobin and the MBI in the affected children decreases comparative with the control group, and the parasitic infection did not affect the weight and height in the affected children, as in Table 3.

Table 3: Shows Age, Bmi and Hemoglobin in Affected Children Compared with Control Group 

p-value was significant, <0.05. BMI; Body Mass Index Hb; hemoglobin.

Table 4 shows an increase in (IL-2 IL-10 and IFN-γ levels levels in children with a comparison with the control group.

Table 4: Show Interleukines and Interferon Concentration in Patients and Control Group (IL-2, IL-10 , IFN-γ) 

a,b – Significant variations exist between the groups.

From the above results in general, the percentage of the youngsters in the study have a high rate of Giardia lamblia and E. histolytica infection. As these parasites have a direct life cycle and are transmitted directly through contamination of water and food with bags of these parasites, but the lowest percentage of infection recorded in this study,

Which is H.nana and may be due to the fact that this worm needs a intermediate host in its life cycle as beetles or may be its life cycle directly, so it is transmitted through contamination of hands with feces [9].

In general, children in rural areas are more prone to infection than kids in cities because to low living, cultural, and health standards as well as the frequent breeding of domestic animals, which raises the percentage of hygienic practices and also provide an opportunity for insects to gather, includes flies, which are the most effective mechanical carriers of worm eggs and protozoan cysts [10].

The current study's findings agree with Fernandez et al. [11] who found that the incidence rate in rural areas is higher than in the city, where it reached 91% in northern India.

It also corresponds to a study conducted by Hany I., et al. which found that the rate of infection with parasites was more in rural areas than in the urban .

The results of the present study are consistent with and [12] who found that the incidence of H. Nana It was 3.9%.

Regarding mixed infection , the results of the present study agree with [13] and [14].

Body weight and hemoglobin ratio had a difference between affected children and non-infected children, where iron deficiency causes growth impairment, sometimes causing death. The results of the current study agreed with [15] who showed that the ratio of hemoglobin and body mass varies in affected children in contrast to the control cohort. The current study's findings differed with the studies [16], Ethiopia [17], Yemen [18] and in Alexandria, Egypt who found that there was no relationship between parasitic infestation and nutritional status.

The results of this study were consistent with many studies, including what was mentioned by the researcher Al-Kahfaji et al., [19]. As well as Mahmuod et al. Find et al. found that pro-inflammatory T-helper 1 (Th1) cytokines, namely IL-2, might be crucial in getting rid of protozoa from human hosts.The generation of B-cell mediated immunoglobulin IgG and immunoglobulins, as well as the activation of mast cells, eosinophils, and bases, are all facilitated by anti-inflammatory cytokines T-helper 2 (Th2) such as IL-4. This results in elevated levels of regulatory cytokines and the conversion of growth factor (TGF) and IL-10. leading to the elimination of parasitic infections.

Innate immune cells, regulatory T cells (Tregs), and B cells secrete IL-10, an anti-inflammatory cytokine that has been demonstrated to block IFN-γ and potentially kill macrophages both inside and outside the body. [20].

The results of the current study contradicted its findings. Mitra [8] which , found a decrease in the giardiasis patients' IL-4 levels. Additionally, it was in odds with., Ahmed and Staven, Joe, [21] who found that the concentration of IL-10 showed no differences in giardiasis patients when compared to the control group.

IFN-γ is inhibited by IL-10, an anti-inflammatory cytokine secreted by B cells, regulatory T cells (Tregs), and innate immune cells. This inhibition has the ability to destroy macrophages both inside and outside the body [20].

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