Cryptosporidium and Strongyloides stercoralis infections among people with and without HIV infection and efficiency of diagnostic methods for Strongyloides in Yirgalem Hospital, southern Ethiopia

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Abstract

Background

Cryptosporidiosis and strongyloidiasis have been reported to be associated with HIV/AIDS. The present study was designed to determine the prevalence of Cryptosporidium and Strongyloides stercoralis infections among people with and without HIV infection and also assess the efficient methods for detection of Strongyloides.

Findings

A cross-sectional study was conducted in Yirgalem Hospital, southern Ethiopia from March, 2007 to October, 2007. Demographic data and stool samples were collected from 384 individuals (192 from each HIV serogroup). Samples were processed using the modified Ziehl-Neelsen technique for detection of Cryptosporidium species. Stool samples were also processed using the direct saline mount, the formol-ether and the water-emergence techniques for diagnosis of S. stercoralis. The prevalence of Cryptosporidium and S. stercoralis among HIV infected individuals was 25% and 12.0%, respectively. HIV positive individuals had significantly higher rate of infection with Cryptosporidium (OR = 15.7; 95% CI 5.5 to 44.5) and S. stercoralis (OR = 6.4; 95% CI 2.2 to 18.9). Among the three diagnostic methods, the larvae of S. stercoralis were more efficiently detected by the water-emergence technique.

Conclusions

In this study, the prevalence of Cryptosporidium and S. stercoralis infections was significantly higher among people with HIV/AIDS. Educating HIV infected individuals to prevent acquisition of Cryptosporidium infection and screening for S. stercoralis using the water-emergence technique is likely to be helpful.

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Most cited references 16

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Epidemiology and clinical features of Cryptosporidium infection in immunocompromised patients.

Gordon Nichols, Craig P. Hunter (2001)

Cryptosporidium spp. are a major cause of diarrheal disease in both immunocompetent and immunodeficient individuals. They also cause waterborne disease in both the United States and United Kingdom. Studies on the mechanisms of immunity to cryptosporidiosis indicate the importance of the T-cell response. The spectrum and severity of disease in immunocompromised individuals with cryptosporidiosis reflect this importance since the most severe disease is seen in individuals with defects in the T-cell response. The most commonly studied group is that of patients with AIDS. These patients suffer from more severe and prolonged gastrointestinal disease that can be fatal; in addition, body systems other than the gastrointestinal tract may be affected. The widespread use of antiretroviral therapy does appear to be having a beneficial effect on recovery from cryptosporidiosis and on the frequency of infection in human immunodeficiency virus-positive patients. Other diseases that are associated with increased risk of severe cryptosporidiosis, such as primary immunodeficiencies, most notably severe combined immunodeficiency syndrome, are also predominantly associated with T-cell defects. Of the remaining groups, children with acute leukemia seem to be most at risk from cryptosporidiosis. There is less evidence of severe complications in patients with other malignant diseases or in those receiving immunosuppressive chemotherapy.

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Intestinal parasitic infections in relation to HIV/AIDS status, diarrhea and CD4 T-cell count

Shimelis Assefa, Berhanu Erko, Girmay Medhin … (2009)

Background HIV infection has been modifying both the epidemiology and outcome of parasitic infections. Hence, this study was undertaken to determine the prevalence of intestinal parasitic infection among people with and without HIV infection and its association with diarrhea and CD4 T-cell count. Methods A cross-sectional study was conducted at Hawassa Teaching and Referral Hospital focusing on HIV positive individuals, who gave blood for CD4 T-cell count at their first enrolment and clients tested HIV negative from November, 2008 to March, 2009. Data on socio-demographic factors and diarrhea status were obtained by interviewing 378 consecutive participants (214 HIV positive and 164 HIV negative). Stool samples were collected from all study subjects and examined for parasites using direct, formol-ether and modified acid fast stain techniques. Results The prevalence of any intestinal parasitic infection was significantly higher among HIV positive participants. Specifically, rate of infection with Cryptosporidium, I. belli, and S. stercoralis were higher, particularly in those with CD4 count less than 200 cells/μL. Diarrhea was more frequent also at the same lower CD4 T-cell counts. Conclusion Immunodeficiency increased the risk of having opportunistic parasites and diarrhea. Therefore; raising patient immune status and screening at least for those treatable parasites is important.

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Cryptosporidiosis and microsporidiosis in ugandan children with persistent diarrhea with and without concurrent infection with the human immunodeficiency virus.

Addy Kekitiinwa, Sabrina Bakeera-Kitaka, Grace Ndeezi … (2005)

Cryptosporidium spp. and Enterocytozoon bieneusi are enteric pathogens that have emerged as significant causes of persistent diarrhea (PD) in immunologically compromised individuals particularly in association with HIV/AIDS. We conducted a cross-sectional study on the clinical epidemiology of E. bieneusi and Cryptosporidium in children with PD, with and without HIV/AIDS, attending Uganda's Mulago National Referral Hospital. Two hundred forty-three children aged 14 days), were analyzed for HIV status and CD4 lymphocyte counts, and stools were screened for the presence of E. bieneusi and Cryptosporidium by microscopy and positive samples genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. Eighty (32.9%) of the children were excreting E. bieneusi, and 76 (31.3%) were excreting Cryptosporidium. Ninety-one of the 243 children had HIV, of who 70 (76.9%) had E. bieneusi, versus 10 (6.6%) of the 152 without (odds ratio = 47.33; 95% CI = 19.88 to 115.97), while 67 (73.6%) had Cryptosporidium, versus 9 (5.9%) without (odds ratio = 44.36; 95% CI = 18.39 to 110.40). Children with counts < 25% CD4 cells were more likely to have either E. bieneusi (odds ratio = 7.42; 95% CI = 3.77 to 14.69) or Cryptosporidium (odds ratio = 6.45; 95% CI = 3.28 to 12.76) than those with higher CD4 percentages. However, only HIV status was independently associated with either Cryptosporidium or E. bieneusi. Among the 243 children with PD, 67 (27.8%) were infected with both enteric pathogens, with HIV being the only independent predictor of coinfection. Finally, some 81% of HIV-infected children with PD excreted one or both organisms, compared with only 10% of children with PD testing negative for HIV. Seventy-four percent of isolates were C. hominis, the anthroponotic species, 17% were C. parvum, the zoonotic species, and 8% were a mixture of the two or others.

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Author and article information

Journal

Journal ID (nlm-ta): BMC Res Notes

Title: BMC Research Notes

Publisher: BioMed Central

ISSN (Electronic): 1756-0500

Publication date Collection: 2010

Publication date (Electronic): 1 April 2010

Volume: 3

Page: 90

Affiliations

[1 ]Hawassa Regional Laboratory, Hawassa, Ethiopia

[2 ]Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia

[3 ]Department of Medical Laboratory Science, Hawassa University, Hawassa, Ethiopia

Article

Publisher ID: 1756-0500-3-90

DOI: 10.1186/1756-0500-3-90

PMC ID: 2873353

PubMed ID: 20359359

SO-VID: 5c4b3f70-d811-4b00-8efb-217e46c609f0

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cryptosporidium and Strongyloides stercoralis infections among people with and without HIV infection and efficiency of diagnostic methods for Strongyloides in Yirgalem Hospital, southern Ethiopia

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Most cited references 16

Epidemiology and clinical features of Cryptosporidium infection in immunocompromised patients.

Intestinal parasitic infections in relation to HIV/AIDS status, diarrhea and CD4 T-cell count

Cryptosporidiosis and microsporidiosis in ugandan children with persistent diarrhea with and without concurrent infection with the human immunodeficiency virus.

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