Intestinal parasitic infections in relation to CD4(+) T cell counts and diarrhea in HIV/AIDS patients with or without antiretroviral therapy in Cameroon

Epidemiological, Clinical, and Immunological Features of Ghanaian People-Living-with-HIV (Human Immunodeficiency Virus) and Molecular Proof of Cystoisospora belli in Their Stool Samples

Cystoisospora belli is a coccidian parasite commonly associated with enteric infections in immunocompromised individuals. The study was conducted to assess epidemiological, clinical, and immunological features of Ghanaian people living with HIV (human immunodeficiency virus) with and without antiretroviral therapy and molecular proof of C. belli-specific nucleic acid sequences in their stool samples. While C. belli was detected in 4.2% (n = 25) of the assessed HIV-positive patients, this was the case for only 1 (1.2%) Ghanaian control individuum without known HIV infection. Associations of cystoisosporiasis in Ghanaian HIV patients with reduced CD4+ T-lymphocyte counts and increased HIV viral loads, immune-activation as indicated by reduced CD4+/CD8+ T-lymphocyte ratios as well as higher expression of HLA-DR+ CD38+ on CD4+ T-lymphocytes, a symptom complex comprising diarrhea, weight loss and a reduced BMI, a trend towards not being on antiretroviral medication, and lacking access to food safety procedures like storing food in refrigerators were shown. The odds ratios (95% confidence intervals) of the associations were 4.47 (1.52-12.09) for the abundance of C. belli DNA and clinical diarrhea, 3.51 (1.42-9.12) for the abundance of C. belli DNA and CD4+ T-lymphocyte counts <200 cells/µL, and 3.66 (1.52-9.01) for the abundance of C. belli DNA and not having a refrigerator in the household. In conclusion, the assessment contributed to existing insight into the epidemiology of cystoisosporiasis in immunosuppressed individuals in resource-limited tropical high-endemicity areas. Chronic diarrhea among people living with HIV should prompt a diagnostic assessment for confirmation or exclusion of C. belli infections in such settings.

Intervention to Prevent Recurrent Intestinal Parasitic Infections in People Living with HIV in Selected Parts of Eastern Cape, South Africa

Interactions between parasites and hosts are not fully understood, though the dynamic pattern of infection and reinfection in humans varies with different demographic variables and behavioral changes. A community-based non-equivalent control group post-test-only design, an aspect of quasi-experimental design (QED), was carried out between March 2019 and February 2020. For the extraction of data from respondents, structural questionnaires were filled. Their CD4 count and viral load from the database of the National Health Laboratory Services, Mthatha were recorded. The method applied for the identification of intestinal parasites was a direct examination of the stool and the use of concentration methods. The post-test analysis showed that the intervention sites that received THEdS (Treatment, Health education, and Sanitation) bundle had a cure proportion of 60% and a re-infection proportion of 40%. The post-test results on control sites (treatment-only group) showed that the cure proportion was 51.4% and the re-infection proportion was 48.6%. The viral load significantly reduced from 377 to 44 copies/mL with a significant increment in CD4 count from 244 to 573 (cells µL) and (p-value) = 0.002. The combination of THEdS is an effective measure to reduce infection and reinfection of intestinal parasites. The THEdS bundle is a sustainable control and prevention method for the control of helminthes and protozoan associated with unsanitary environment and poor personal hygiene among immune-compromised individuals like HIV/AIDS patients.

Cryptosporidium Species Infections Detected from Fecal Samples of Animal and Human Hosts in South Africa: Systematic Review and Meta-Analysis

This study presents a systematic review and meta-analysis approach of Cryptosporidium species prevalence studies in animal and human hosts published between 1980 and 2020 in South Africa. Extensive searches were conducted on three electronic databases including PubMed, ScienceDirect and Google Scholar. The findings indicated an overall pooled prevalence estimate (PPE) of Cryptosporidium spp. infections in animals and humans at 21.5% and 18.1%, respectively. The PCR-RFLP appeared to be the most sensitive diagnostic method with a PPE of 77.8% for the detection of Cryptosporidium spp. infections followed by ELISA (66.7%); LAMP (45.4%); PCR (25.3%); qPCR (20.7%); microscopy (10.1%); IFAT (8.4%); and RDT (7.9%). In animal hosts, C. parvum had the highest PPE of 3.7%, followed by C. andersoni (1.5%), C. ubiquitum (1.4%) and C. bovis (1.0%), while in humans, C. parvum also had the highest PPE of 18.3% followed by C. meleagridis at 0.4%. The data generated in this study indicated that Cryptosporidium spp. infections were highly prevalent in both animals and humans in South Africa, especially in the KwaZulu-Natal and North West provinces. However, we further observed that there was a lack of prevalence studies for both animals and humans in some of the provinces. This study highlights the necessity for a "One Health" strategic approach promoting public hygiene, animal husbandry and regular screening for Cryptosporidium spp. infections in both animals and humans.

Magnitude of intestinal parasitic infections and its determinants among HIV/AIDS patients attending at antiretroviral treatment centers in East and West Gojam Zones, Northwest, Ethiopia: institution based cross-sectional study

BACKGROUND

Intestinal parasitic infections (IP) are a major source of morbidity in people living with Human immunodeficiency virus (HIV), particularly in resource-limited settings, mostly as a result of high viral load. Hence, this study aimed to investigate the magnitude of intestinal parasitic infections and its determinants among patients with HIV/AIDS attending public health facilities in East and West Gojam Zones in Ethiopia.

METHODS

Institution-based cross-sectional study was conducted on 327 people living with HIV visiting public health facilities from December 2022 to May 2023. A simple random sampling technique was used to recruit participants. Face-to-face interviews were used to collect socio-demographics and determinants. The fresh stool was collected from each patient, transported, and tested in accordance with laboratory standard operating procedures of wet mount, formol-ether concentration technique, and modified acid-fast staining. Data were entered and analyzed in the statistical package for Social Science (SPSS) version 20. A 95% CI with p-value < 0.05 was considered statistically significant.

RESULTS

The overall prevalence of IP in patients with HIV/AIDS was 19.3% (63/327). Hookworm was the most identified parasite 33.3% (21/63) followed by E.histolytica 17% (11/63) and G.lamblia 14.3% (9/63). Parasitic infections were significantly higher among viral load > 1000cps/ml (p = 0.035), WHO stage 4 (p = 0.002), CD4 < 200 cell/mm3 (p = 0.001), and bare foot walking (p = 0.001).

CONCLUSION

IP infections are moderately high among patients with HIV/AIDS in the study area. The proportion of parasites was greatly affected by high viral load, WHO stage 4, CD4 < 200 cell/mm3, and being barefoot; this gives valuable insight to health professionals, health planners and community health workers. As a result, viral load monitoring, and WHO stage controlling were periodically assessed in patients with HIV/AIDS. Health education, awareness creation, routine stool examination, and environmental hygiene were regularly advocated to increase the life of patients with HIV/AIDS.

Combination of inhibitors for two glycolytic enzymes portrays high synergistic efficacy against Cryptosporidium parvum

Cryptosporidium is an intracellular protozoan parasite that causes serious enteric disease in humans and in a wide range of animals worldwide. Despite its high prevalence, no effective therapeutic drugs are available against life-threatening cryptosporidiosis in at-risk populations including malnourished children, immunocompromised patients, and neonatal calves. Thus, new efficacious drugs are urgently needed to treat all susceptible populations with cryptosporidiosis. Unlike other apicomplexans, Cryptosporidium parvum lacks the tricarboxylic acid cycle and the oxidative phosphorylation steps, making it solely dependent on glycolysis for metabolic energy production. We have previously reported that individual inhibitors of two unique glycolytic enzymes, the plant-like pyruvate kinase (CpPyK) and the bacterial-type lactate dehydrogenase (CpLDH), are effective against C. parvum, both in vitro and in vivo. Herein, we have derived combinations of CpPyK and CpLDH inhibitors with strong synergistic effects against the growth and survival of C. parvum, both in vitro and in an infection mouse model. In infected immunocompromised mice, compound combinations of NSC303244 + NSC158011 and NSC252172 + NSC158011 depicted enhanced efficacy against C. parvum reproduction and ameliorated intestinal lesions of cryptosporidiosis at doses fourfold lower than the total effective doses of individual compounds. Importantly, unlike individual compounds, NSC303244 + NSC158011 combination was effective in clearing the infection completely without relapse in immunocompromised mice. Collectively, our study has unveiled compound combinations that simultaneously block two essential catalytic steps for metabolic energy production in C. parvum to achieve improved efficacy against the parasite. These combinations are, therefore, lead compounds for the development of a new generation of efficacious anti-cryptosporidial drugs.

Impact factors of Blastocystis hominis infection in persons living with human immunodeficiency virus: a large-scale, multi-center observational study from China

BACKGROUND

Blastocystis hominis (Bh) is zoonotic parasitic pathogen with a high prevalent globally, causing opportunistic infections and diarrhea disease. Human immunodeficiency virus (HIV) infection disrupts the immune system by depleting CD4+ T lymphocyte (CD4+ T) cell counts, thereby increasing Bh infection risk among persons living with HIV (PLWH). However, the precise association between Bh infection risk and HIV-related biological markers and treatment processes remains poorly understood. Hence, the purpose of the study was to explore the association between Bh infection risk and CD4+ T cell counts, HIV viral load (VL), and duration of interruption in antiviral therapy among PLWH.

METHODS

A large-scale multi-center cross-sectional study was conducted in China from June 2020 to December 2022. The genetic presence of Bh in fecal samples was detected by real-time fluorescence quantitative polymerase chain reaction, the CD4+ T cell counts in venous blood was measured using flowcytometry, and the HIV VL in serum was quantified using fluorescence-based instruments. Restricted cubic spline (RCS) was applied to assess the non-linear association between Bh infection risk and CD4+ T cell counts, HIV VL, and duration of interruption in highly active antiretroviral therapy (HARRT).

RESULTS

A total of 1245 PLWH were enrolled in the study, the average age of PLWH was 43 years [interquartile range (IQR): 33, 52], with 452 (36.3%) being female, 50.4% (n = 628) had no immunosuppression (CD4+ T cell counts > 500 cells/μl), and 78.1% (n = 972) achieved full virological suppression (HIV VL < 50 copies/ml). Approximately 10.5% (n = 131) of PLWH had interruption. The prevalence of Bh was found to be 4.9% [95% confidence interval (CI): 3.8-6.4%] among PLWH. Significant nonlinear associations were observed between the Bh infection risk and CD4+ T cell counts (Pfor nonlinearity < 0.001, L-shaped), HIV VL (Pfor nonlinearity < 0.001, inverted U-shaped), and duration of interruption in HARRT (Pfor nonlinearity < 0.001, inverted U-shaped).

CONCLUSIONS

The study revealed that VL was a better predictor of Bh infection than CD4+ T cell counts. It is crucial to consider the simultaneous surveillance of HIV VL and CD4+ T cell counts in PLWH in the regions with high level of socioeconomic development. The integrated approach can offer more comprehensive and accurate understanding in the aspects of Bh infection and other opportunistic infections, the efficacy of therapeutic drugs, and the assessment of preventive and control strategies.

Regional Differences in Intestinal Parasitic Infections among Army Recruits in a Southern Mozambique Training Center: A Cross-Sectional Study

Due to the high prevalence and diversity of clinical manifestations, intestinal parasitic infections (IPIs) represent a public health problem. The objective of the work was to determine the prevalence of IPIs among army recruits at a practice and training center in southern Mozambique. Sociodemographic information was obtained through semi-structured interviews. Single urine and stool samples were collected from 362 recruits. Parasite diagnosis was made by filtration, formaldehyde-ether and Kato-Katz techniques. Positive individuals underwent abdominal ultrasound. Then, descriptive statistics and cross-tabulations were performed, and p-values < 0.05 were considered significant. The prevalence of infection with at least one parasite was 25.1% (95% CI: 20.5-29.6; n = 91). The most common parasites were Entamoeba coli (10.7%; 95% CI: 7.4-13.7; n = 37) and Trichuris trichiura (6.1%; 95% CI: 4.6-9.9; n = 25). Parasitic infection was associated with the origin of the participant (p-value < 0.001), and the province of Sofala had the highest prevalence among the provinces studied (70.6%; 95% CI: 47.0-87.8; 12/17). Since oral fecal transmission occurs for several parasites, routine screening and deworming prior to enrollment at the army training center is recommended to reduce transmission of intestinal parasites among recruits.

Past, current, and potential treatments for cryptosporidiosis in humans and farm animals: A comprehensive review

The intracellular protozoan parasite of the genus Cryptosporidium is among the leading causes of waterborne diarrheal disease outbreaks throughout the world. The parasite is transmitted by ingestion of infective oocysts that are highly stable in the environment and resistant to almost all conventional disinfection methods and water treatments. Control of the parasite infection is exceedingly difficult due to the excretion of large numbers of oocysts in the feces of infected individuals that contaminate the environment and serve as a source of infection for susceptible hosts including humans and animals. Drug development against the parasite is challenging owing to its limited genetic tractability, absence of conventional drug targets, unique intracellular location within the host, and the paucity of robust cell culture platforms for continuous parasite propagation. Despite the high prevalence of the parasite, the only US Food and Drug Administration (FDA)-approved treatment of Cryptosporidium infections is nitazoxanide, which has shown moderate efficacy in immunocompetent patients. More importantly, no effective therapeutic drugs are available for treating severe, potentially life-threatening cryptosporidiosis in immunodeficient patients, young children, and neonatal livestock. Thus, safe, inexpensive, and efficacious drugs are urgently required to reduce the ever-increasing global cryptosporidiosis burden especially in low-resource countries. Several compounds have been tested for both in vitro and in vivo efficacy against the disease. However, to date, only a few experimental compounds have been subjected to clinical trials in natural hosts, and among those none have proven efficacious. This review provides an overview of the past and present anti-Cryptosporidium pharmacotherapy in humans and agricultural animals. Herein, we also highlight the progress made in the field over the last few years and discuss the different strategies employed for discovery and development of effective prospective treatments for cryptosporidiosis.

Assessment of intestinal parasites and associated factors among HIV/AIDS patients on antiretroviral therapy at Bule Hora General Hospital, West Guji, Ethiopia

Objective:

The study aimed to assess the prevalence of intestinal parasites and associated factors among people living with HIV/AIDS on antiretroviral therapy at Bule Hora General Hospital, West Guji, Oromia, Ethiopia.

Introduction:

Parasitic infection of the intestinal tract is a major source of disease in patients with HIV, particularly in the tropics, where diarrhea is a common complaint with variable severity.

Method:

An institution-based cross-sectional study was conducted from May to August 2021 on 179 systematic randomly selected HIV patients. Data on sociodemographics were collected by interviewing the study subjects using a pretested structured questionnaire. Stool specimens were collected from the study subjects and processed and examined by formol-ether concentration techniques. Data were obtained from each individual using data sheets and then entered into SPSS version 20 for analysis. The chi-square test was calculated, and a p value <0.05 was considered statistically significant.

Results:

Out of 179 study subjects, 52 (29.1%) were infected with intestinal parasites. The most frequently detected parasites were Giardia lamblia (38.5%) and Ascaris lumbricoides (25%) Entamoeba histolytica/dispar (15.4%), followed by Strongyloides stercoralis (11.5%). Factors such as the CD4+ T-cell status and source of drinking water were significantly associated with the prevalence of intestinal parasites among HIV/AIDS patients. The prevalence of intestinal parasites was highly observed among patients who scored CD4+ T cells <200 cells/mm³ 90.4% (47/52) and drink ground water 73.1% (38/52).

Conclusion:

There was moderate prevalence of intestinal parasites among HIV/AIDS patients; therefore, treating unprotected water before drinking and diagnosis of early parasites for HIV/AIDS patients whose CD4+ T-cell count is less than 200 cells/mm³ should be practiced to prevent intestinal parasite infection.

Intestinal Parasitic Infection and Associated Risk Factors among HIV-Infected Patients Seeking Healthcare in a Rural Hospital in Ghana

Background

Parasitic infections among human immunodeficiency virus (HIV)-infected patients are common in various regions and populations across the world and have since remained a persistent public health challenge. Sub-Saharan Africa harbors the greatest burden of the infections due to sociodemographic and behavioral factors. However, the prevalence of gastrointestinal parasitic infections among HIV-infected persons has been poorly investigated in Ghana.

Aim

This study sought to determine the prevalence of gastrointestinal parasitic infections and associated factors in HIV-infected individuals attending the antiretroviral therapy (ART) clinic in St. Mary Theresa Hospital, Dodi Papase.

Methods

A cross-sectional study was conducted from June 2021 to September 2021 among three hundred and thirty-five HIV-infected individuals in the study area. Sociodemographic and behavioral factors were collected with the aid of a close-ended structured questionnaire. Furthermore, stool samples were collected from each participant and examined for the presence of intestinal parasites by microscopy using direct wet mount, formol-ether concentration, and modified Ziehl–Neelsen (Zn) techniques. Data obtained were analyzed using Statistical Package for Social Sciences (SPSS) version 22.0 and Graphpad Prism version 8.

Results

The prevalence of gastrointestinal parasitic infections was 5.97%. Species-specific prevalence was found to be 2.99% for Giardia lamblia, 1.19% for Ascaris lumbricoides, and 0.90% each for Entamoeba histolytica/dispar and Trichuris trichiura. There was a significant association between participants' educational level and intestinal parasitic infection. In addition, gastrointestinal parasitic infections were not found to be associated with age. Unemployed participants, those with a lower frequency of deworming, and those who do not use water closet toilet facilities were at a higher risk of getting infected.

Conclusion

The lower infection rate recorded in this study suggests that public health interventions put in place are yielding significant results. Even though the prevalence is low, routine screening of all HIV-infected patients for parasitic infection is recommended to ensure timely, effective treatment and comprehensive care.

Assessment of intestinal and blood protozoan infections among pregnant women visiting ante-natal care at Tafo Hospital, Ghana

Introduction

Intestinal and blood protozoans cause morbidity and mortality in both pregnant women and developing foetuses worldwide. It constitutes a major health problem in many tropical areas in Africa. This study assessed the prevalence of intestinal and blood protozoans’ parasitic load and their risk factors among pregnant women visiting antenatal care at Tafo Hospital, Ghana from November 2016 to January 2017.

Method

A pilot cross-sectional study was conducted among consented pregnant women who visited antenatal care at Tafo Government Hospital, Kumasi Ghana. Structured questionnaires were administered to obtain socio-demographic data, knowledge on protozoan infections, and their risk factors among study participants. A stool sample was obtained from each participant for the microscopic examination of the intestinal protozoa. Venous blood was taken from participants for the detection of Plasmodium and Toxoplasma gondii infections. Wet mount and the faecal protozoan concentrated method were done for the identification of intestinal parasites. Blood films and serological examination for malaria rapid diagnostic tests (RDT) were done for identification of Plasmodium parasites while an Enzyme-linked immunosorbent assay (ELISA) was used for detecting the antibodies of T. gondii among participants. Data were analyzed using statistical packages for the social sciences (SPSS).

Results

The mean age of the study participants was 27.83, and ranges from 18 to 40 years. The majority of the participants (82.2%) had never experienced stillbirth nor spontaneous abortion. Intestinal parasites were found in 36.7% of participants. Giardia lamblia (28.1%), Cryptosporidium parvum (5.3%), and Entamoeba histolytica/dispar (3.3%) were among the intestinal protozoans detected. T. gondii antibodies were detected by high levels of immunoglobulins, resulting in IgG (48.0%) and IgM (11.3%) being found among participants, with 7.3% testing positive for both IgM and IgG. The prevalence of malaria infection among the study participants was 2.7%. The consumption of raw or cooked vegetables had significant influence on their intestinal and blood protozoan infections status (p = 0.004) (OR = 0.32, CI = 0.12–0.86). There was a significant association between Hb levels and malaria (p = 0.014) and that of intestinal protozoans (p = 0.035).

Conclusion

The prevalence of intestinal protozoans and blood protozoans such as T. gondii were high and therefore effective measures should be put in place to reduce the infectivity. Environmental hygiene should be improved and education by relevant agencies should be intensified on the possible transmission of intestinal and blood parasite infections given the possible role of these infections in adverse pregnancy outcomes.

Global Burden of Cyclospora cayetanensis Infection and Associated Risk Factors in People Living with HIV and/or AIDS

Cyclospora cayetanensis infections remain one of the most common protozoan opportunistic causes of gastrointestinal diseases and diarrhea among people living with HIV and/or AIDS (PLWHA). This study was conducted to provide a summary of the evidence on the global burden of C. cayetanensis infection and associated risk factors among PLWHA. Scopus, PubMed, Science Direct, and EMBASE were searched up to February 2022. All original peer-reviewed original research articles were considered, including descriptive and cross-sectional studies describing C. cayetanensis in PLWHA. Incoherence and heterogeneity between studies were quantified by I index and Cochran’s Q test. Publication and population bias were assessed with funnel plots and Egger’s asymmetry regression test. All statistical analyses were performed using StatsDirect. The pooled prevalence of C. cayetanensis infection among PLWHA was 3.89% (95% CI, 2.62–5.40). The highest prevalence found in South America was 7.87% and the lowest in Asia 2.77%. In addition, the prevalence of C. cayetanensis was higher in PLWHA compared to healthy individuals. There was a relationship between a higher C. cayetanensis prevalence in PLWHA with a CD4 cell count below 200 cells/mL and people with diarrhea. The results show that PLWHA are more vulnerable to C. cayetanensis infection and emphasizes the need to implement the screening and prophylaxis tailored to the local context. Owing to the serious and significant clinical manifestations of the parasite, an early identification of seropositivity is recommended to initiate prophylaxis between PLWHA with a CD4 count ≤200 cells/mL and PLWHA who do not receive antiviral therapy.

The implementation of the Kinyoun staining technique in a resource-limited setting is feasible and reveals a high prevalence of intestinal cryptosporidiosis in HIV patients

OBJECTIVES

In resource-limited settings, intestinal Cryptosporidia or coccidian infections are common causes of chronic diarrhoea, but usually remain undiagnosed by routine stool investigation. Here, the addition of the Kinyoun staining technique after stool concentration was evaluated as an easy and inexpensive method for diagnosis of intestinal parasitic infection in HIV-infected patients.

METHODS

This cross-sectional study investigated HIV-infected patients with diarrhoea and randomly selected HIV-infected patients without diarrhoea as controls. Stool samples were examined by wet mount microscopy and Kinyoun staining after stool concentration. Clinical, sociodemographic and behavioural data were collected. Statistical analysis was performed using Chi-squared test and multivariate regression analysis.

RESULTS

In total, 163 participants were included (62.0% female, mean age 38.2 [SD ±10.7] years). Diarrhoea was present in 52.1% (85/163). The prevalence of intestinal parasites was 18.4% (30/163). Cryptosporidia infections were more frequent among patients with diarrhoea (12.9% [11/85] vs. 1.3% [1/78], p=0.005) and in patients with CD4⁺ cell count <200 cells/µL (25.9% [7/27] vs. 3.7% [5/136], p=0.001). Risk factors for intestinal parasitic infections were diarrhoea and the habit of regularly eating uncooked food. Kinyoun staining was necessary for detection of cryptosporidiosis.

CONCLUSION

In our cohort, the prevalence of intestinal parasitic infection was high, especially after additional utilization of Kinyoun staining for detection of Cryptosporidia or intestinal coccidia. Considering its clinical relevance particularly in individuals at risk, the implementation of this technique should be considered in resource-limited settings.

Incidence and Predictors of Opportunistic Infections Among Adult HIV Infected Patients on Anti-Retroviral Therapy at Dessie Comprehensive Specialized Hospital, Ethiopia: A Retrospective Follow-Up Study

Background

Opportunistic infections are the major causes for morbidity and mortality due to HIV infections. Despite advances in HIV diagnosis and management, the incidence of opportunistic infections remains high. This study aimed to assess the incidence and predictors of opportunistic infections among persons living with HIV/AIDS in Ethiopia.

Methods

A retrospective follow-up study was conducted on 354 samples of adults living with HIV on antiretroviral therapy at Dessie Comprehensive Specialized Hospital. Simple random sampling technique was used to select study participants. The data collection format was taken from national antiretroviral intake and follow-up forms. Epi-data Version 4.6.1 and STATA Version 16 software were used for data entry and data analysis respectively. The Cox-proportional hazards regression model was fitted. Kaplan-Meier survival curve was used to estimate opportunistic infections-free survival time. Both bi-variable and multivariable Cox-proportional hazard regression analysis were done to identify predictors of opportunistic infections.

Results

Of the total 354 peoples living with HIV, 114 (32.2%) developed OI, with an incidence rate of 13.5 per 100 person-year (95% CI: 10.8-15.6). Advanced World Health Organization clinical disease stage (IV) (AHR: 2.1 (95% CI: 1.16, 3.8)), being bedridden (AHR: 1.66 (95% CI: 1.04, 2.65)), poor adherence (AHR: 1.7 (95% CI: 1.1-2.63), and low CD4 count (AHR: 1.92 95% CI: 1.14-3.22) were significant predictors of OIs.

Conclusion

Opportunistic infection among HIV/AIDS continues to be a significant public health concern in Ethiopian health care setting. Our results indicate that the incidence of OI is high. Besides, Stage IV HIV status, being bedridden, low CD4 count and poor adherence independently predicts an increased incidence/decreased survival time of OIs among PLWHIV. Early care-seeking and initiation of HAART and continuous follow-up of patients to take their drug timely are essential to curb the incidence of opportunistic infections and improve overall health. Further research on this area is highly recommended.

Intestinal microsporidiosis among HIV/AIDS patients receiving antiretroviral therapy in Sana'a city, Yemen: first report on prevalence and predictors

Background

Intestinal microsporidiosis is an opportunistic infection associated with persistent diarrhea among HIV/AIDS patients. In Yemen, however, its epidemiology is unknown. Therefore, this study determined its prevalence and predictors among HIV/AIDS patients receiving antiretroviral therapy (ART) in Sana’a city, the capital of Yemen.

Methods

This cross-sectional study included 402 patients receiving ART at Al-Jomhori Educational Hospital in Sana’a from November 2019 to December 2020. Data about demographics, clinical characteristics and risk factors were collected using a pre-designed questionnaire. Stool samples were collected and examined for microsporidian spores using the Gram-chromotrope Kinyoun staining. Blood samples were also collected and used for CD4 cell counting by flow cytometry. Univariate analysis was used to test the association of patients’ characteristics and risk factors with intestinal microsporidiosis. Multivariable logistic regression was then used to identify the independent predictors of infection. Statistical significance was considered at P-values < 0.05.

Results

Intestinal microsporidiosis was prevalent among 14.2% (57/402) of HIV/AIDS patients and was significantly associated with diarrhea (OR 3.4, 95% CI 1.7–6.6; P = 0.001). The significant independent predictors of infection were < 200 CD4 cells/µl (AOR 3.2, 95% CI 1.5–6.9; P = 0.003), not washing hands after contacting soil (AOR 2.5, 95% CI 1.1–5.4; P = 0.026) and before eating (AOR 3.1, 95% CI 1.5–6.4; P = 0.003), eating unwashed raw produce (AOR 2.5, 95% CI 1.2–5.3; P = 0.017) and absence of indoor latrines (AOR 6.2, 95% CI 1.5–25.9; P = 0.012).

Conclusions

The prevalence of intestinal microsporidiosis among HIV/AIDS patients in Sana'a is high and comparable to that reported from several other countries, being prevalent among approximately 14.0% of patients and significantly associated with diarrhea. It could be predicted among patients who have < 200 CD4 cells/µl, have poor hand hygiene after contacting soil and before eating, usually eat unwashed raw produce, or do not possess indoor latrines. Large-scale studies on its epidemiology and predictors among HIV/AIDS patients across the country are warranted.

Association between Blastocystis sp. infection and immunocompromised patients: a systematic review and meta-analysis

The significance of opportunistic infections in immunocompromised patients and the enigmatic pathogenicity of Blastocystis directed us to conduct the first global systematic review and meta-analysis on Blastocystis prevalence, odds ratios (ORs), and subtypes distribution in various immunocompromised patients (HIV/AIDS, cancer and hemodialysis patients, as well as transplant recipients). The systematic searching procedure was done in Web of Science, PubMed, Scopus, and Google Scholar databases for relevant published literature until November 11, 2020. Random-effects model was utilized to calculate the weighted estimates and 95% confidence intervals (95% CIs). The computed pooled prevalence of Blastocystis inferred from 118 papers (128 datasets) on immunocompromised patients was 10.3% (95% CI: 8.7-12.2%), with 16.1% (95% CI: 11.3-22.2%), 12.5% (95% CI: 8.5-18%), 8.4% (95 % CI: 6.6-10.6%), and 6% (95% CI: 2.6-13.3%) for hemodialysis patients, cancer patients, HIV/AIDS patients, and transplant recipients, respectively. Based on 50 case-control studies (54 datasets), the highest ORs were associated with cancer [2.81 (95% CI: 1.24-6.38, P = 0.013)] and hemodialysis patients [2.78 (95% CI: 1.19-6.48, P = 0.018)]. The most frequent subtype being found in immunocompromised patients was ST3 [41.7% (95% CI: 31.4-52.7%)], followed by ST1 [31.7% (95% CI: 23.2-41.8%)] and ST2 [23.1% (95% CI: 14.8-34.1%)]. Also, the weighted frequency of Blastocystis in various subgroups (publication year, WHO regions, geographical distribution, continents, and country income) was analyzed separately. In total, the results of the present meta-analysis highlighted that one's immunodeficiency status is probably associated with an increased Blastocystis infection, underpinning strict preventive measures to be taken.

Global prevalence and associated risk factors of diarrheagenic Giardia duodenalis in HIV/AIDS patients: A systematic review and meta-analysis

Giardia duodenalis is one of the leading causes of diarrhea, mostly in underdeveloped nations of Africa and Asia. The present review provides insights into the prevalence, odds ratios (ORs) and associated risk factors of giardiasis in HIV/AIDS patients. Four major English databases (Web of Science, PubMed, Scopus, and Google Scholar) were excavated for relevant literature without time limitation until 20 November 2020. Next, meta-analysis was performed using a random-effects model and 95% confidence intervals (CIs). As well, heterogeneity among studies was evaluated using Cochran's Q and the I²-statistic. Totally, 19,218 HIV/AIDS patients in 130 studies were examined, showing a 5% (95% CI: 4.2%-6%) pooled prevalence. Also, the weighted random-effects OR of G. duodenalis infection among HIV/AIDS patients in comparison with their controls in 48 case-control studies was estimated as 1.71% (95% CI: 1.1%-2.66%, p = 0.016). Based on sensitivity analysis, there was no remarkable variation in the pooled OR upon omitting individual studies. Diarrhea was a potent risk factor, since HIV/AIDS patients with diarrhea were 3.8-times (95% CI: 1.6-8.9, p = 0.002) more prone to G. duodenalis infection than those without diarrhea. Moreover, the prevalence of the parasitic infection was 1.2-times higher in patients without antiretroviral therapy (ART) than those with ART (p = 0.312). Meta-regression was employed to evaluate the possible association between G. duodenalis frequency in HIV/AIDS patients and some variables such as sample size, publication year, and HDI. Additionally, the pooled prevalence of G. duodenalis infection was estimated based on several subgroups, including publication years, WHO regions, countries, continents, country incomes, and CD4⁺ T-cell levels. Altogether, the epidemiology of giardiasis in HIV/AIDS patients and its association with various risk factors is still open to question and requires more detailed and comprehensive investigations.

Prevalence and genetic characteristics of Blastocystis hominis and Cystoisospora belli in HIV/AIDS patients in Guangxi Zhuang Autonomous Region, China

Blastocystis hominis and Cystoisospora belli are considered to be common opportunistic intestinal protozoa in HIV/AIDS patients. In order to investigate the prevalence and genetic characteristics of B. hominis and C. belli in HIV/AIDS patients, a total of 285 faecal samples were individually collected from HIV/AIDS patients in Guangxi, China. B. hominis and C. belli were investigated by amplifying the barcode region of the SSU rRNA gene and the internal transcribed spacer 1 (ITS-1) region of the rRNA gene, respectively. Chi-square test or Fisher’s exact test were conducted to assess the risk factors related to B. hominis and C. belli infection. The prevalence of B. hominis and C. belli was 6.0% (17/285) and 1.1% (3/285) respectively. Four genotypes of B. hominis were detected, with ST3 (n = 8) and ST1 (n = 6) being predominant, followed by ST6 (n = 2) and ST7 (n = 1). Females had a statistically higher prevalence of B. hominis (11.6%) than males (4.2%). The statistical analysis also showed that the prevalence of B. hominis was significantly associated with age group and educational level. Our study provides convincing evidence for the genetic diversity of B. hominis, which indicates its potential zoonotic transmission and is the first report on the molecular characteristics of C. belli in HIV/AIDS patients in China.

Microsporidiosis in Humans

Microsporidia are obligate intracellular pathogens identified ∼150 years ago as the cause of pébrine, an economically important infection in silkworms. There are about 220 genera and 1,700 species of microsporidia, which are classified based on their ultrastructural features, developmental cycle, host-parasite relationship, and molecular analysis. Phylogenetic analysis suggests that microsporidia are related to the fungi, being grouped with the Cryptomycota as a basal branch or sister group to the fungi. Microsporidia can be transmitted by food and water and are likely zoonotic, as they parasitize a wide range of invertebrate and vertebrate hosts. Infection in humans occurs in both immunocompetent and immunodeficient hosts, e.g., in patients with organ transplantation, patients with advanced human immunodeficiency virus (HIV) infection, and patients receiving immune modulatory therapy such as anti-tumor necrosis factor alpha antibody. Clusters of infections due to latent infection in transplanted organs have also been demonstrated. Gastrointestinal infection is the most common manifestation; however, microsporidia can infect virtually any organ system, and infection has resulted in keratitis, myositis, cholecystitis, sinusitis, and encephalitis. Both albendazole and fumagillin have efficacy for the treatment of various species of microsporidia; however, albendazole has limited efficacy for the treatment of Enterocytozoon bieneusi. In addition, immune restoration can lead to resolution of infection. While the prevalence rate of microsporidiosis in patients with AIDS has fallen in the United States, due to the widespread use of combination antiretroviral therapy (cART), infection continues to occur throughout the world and is still seen in the United States in the setting of cART if a low CD4 count persists.

Prevalence, risk factors and impact of cellular immunity on intestinal parasitosis among people living with HIV at Auchi, Edo State, Nigeria

This study was sought to determine the impact of CD4⁺ T-cell count and associated risk factors with intestinal parasitosis in people living with HIV (PLHIV) in Central Hospital, Auchi, Edo State, Nigeria. One hundred and seventy (170) HIV-seropositive subjects were enrolled in the study from 24 August 2015 to 22 January 2016. Sociodemographic data were assessed using structured questionnaires. Blood and stool samples were collected from every participant. CD4⁺ T-cell count and stool parasitology were performed. The prevalence of intestinal parasites was 44.7%. Helminthiasis (67%) was a predominant infection in the study, while 32.9% had protozoasis. Specifically, Ancylostoma duodenale (33.3%) was the most common helminth, and Trichuris trichiura (7.8%), the least. However, Strongyloides stercoralis, Ascaris lumbricoides and Hymenolepis nana were 13.7%, 31.5% and 13.7%, respectively. Cryptosporidium spp. (25.0%) was the only protozoan. Lower CD4⁺ T-cell count, ART naivety (OR = 2.62 p < 0.05), residence in a rural setting (OR = 0.89, p < 0.05), and farming occupation (OR = 1.70, p < 0.05) were associated with the prevalence of intestinal parasitosis among PLHIV. This study revealed a significantly high prevalence of intestinal parasitosis in ART naive PLHIV with reduced CD4⁺ count. Hence, it is recommended to frequently test for intestinal parasitosis and commencement of ART in all PLHIV to improve their health and longevity.

Prevalence and Genetic Characterization of Cryptosporidium and Microsporidia Infecting Hematological Malignancy Patients

PURPOSE

To evaluate the prevalence of Cryptosporidium and Microsporidia, associated risk factors and species identification in patients with haematological malignancies (HM).

METHODS

A total of 148 consecutive patients with HM and 101 healthy subjects were evaluated for Cryptosporidium and Microsporidia using modified Kinyoun and modified Trichrome staining. Clinical, demographic and laboratory parameters were studied. The species of Cryptosporidium and Microsporidia were studied using PCR-RFLP.

RESULTS

Of 148 HM patients initially screened, 47 were excluded from the final analysis due to inadequate clinical records. Patients with HM [n = 101, 63 (62.4%) male] more often had Cryptosporidium than healthy subjects [n = 101, 65 (74.4%) male] [3/101 (3%) vs. 0/101 (0%), p = 0.02]. Two of 101 (2%) HM patients and none of the healthy subjects had Microsporidia (p = 0.155). Diarrhea was more prevalent in HM patients with Cryptosporidium than those without [3, 100% vs. 39/96, 40.62%; p = 0.04). Both patients infected with Microsporidia presented with persistent diarrhea and fever. Cryptosporidium hominis was identified in all the three HM patients. Enterocytozoon bieneusi was identified in one HM patient infected with Microsporidia, which was classified as genotype Ind2.

CONCLUSION

Cryptosporidium and Microsporidia may infect HM patients leading to overwhelming diarrhea. The commonest species of Cryptosporidium and Microsporidia found to infect HM patients are C. hominis and E. bieneusi.

Prevalence and Predisposing Factors of Intestinal Parasitic Infections Among HIV Positive Patients Visiting Nekemte Specialized Hospital, Western Ethiopia

Background

Intestinal parasites are endemic in many regions of the world where Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS) patients are prevalent. This study aimed to assess the extent of intestinal parasitic infection (IPI) and predisposing factors among HIV positive patients visiting Nekemte Specialized Hospital, Western Ethiopia.

Methods

A hospital-based cross-sectional study was conducted among HIV positive patients and HIV negative controls who visited Nekemte Specialized Hospital from April to August 2020. A structured questionnaire was used to collect socio-demographic and risk-factor data. Stool samples and blood were collected and tested. Data were analyzed using SPSS version 20. P<0.05 was considered statistically significant.

Results

The occurrence of IPIs was considerably higher (73.3%) among HIV positive subjects compared to HIV negative controls (22.7%). Rate of infection with IPI was higher in individuals with CD4+ T cell count < 200 cells/μL. The species-specific distribution of parasites among HIV positive was higher for Giardia lamblia 35% followed by Entamoeba histolytica, 16% and hookworm 17.5%. Among the risk factors; age, educational status and occupation were significantly related with IPI (P<0.05). Habit of washing hands (OR=1.146, 95% CI: 0.189–1.936) and contact with animals (OR=2.926, 95% CI: 1.955–4.380) were expressively associated with IPI. Furthermore, eating raw meat, lack of safe water sources and usage were meaningfully connected with IPIs with OR=1.203, 95% CI: 0.590–2.454 and OR=0.172, 95% CI: 0.112–0.263, respectively.

Conclusion

HIV positive individuals were highly affected by IPI than HIV negative controls. The spreading of intestinal parasites was critically affected by reduced CD4+ T cell counts. Consistent screening and treatment of IPIs and awareness creation is very vital in improving the overall quality life of HIV/AIDS patients.

Predictors of intestinal parasite infection among HIV patients on antiretroviral therapy in Jos, Plateau State, Nigeria, 2016: a cross-sectional survey

Introduction

intestinal parasitic infection has been reported as a cause of morbidity and mortality among HIV patients on antiretroviral therapy (ART) due to interruption in treatment of the defaulting HIV patients. This study aimed to determine the prevalence and possible causes of intestinal parasites among HIV patients on ART.

Methods

a survey involving 375 adult HIV/AIDS patients selected using a systematic random sampling technique was conducted in a Jos University Teaching hospital, Plateau State, Nigeria. Socio-demographic and clinical data was collected using semi-structured interviewer administered questionnaire and electronic dataset review. Fresh stool samples were collected from all participants for laboratory identification of intestinal parasites using formol-ether sedimentation and modified Ziehl-Neelsen techniques. Descriptive statistics, odds ratio and logistic regression model were computed at P ≤ 0.05.

Results

the mean age of the study participants was 41.6±9.3years. Majority 294 (78.4%) were females, 141 (37.6%) lived in the rural area, 50 (13.3%) respondents did not have toilets in their homes. Most 275 (73.3%) had ART adherence level of 95% and above. Prevalence of intestinal parasites was 28.5%. Females (aOR = 2.14, 95% CI=1.12 – 3.89) and participants with no toilet facilities (aOR = 2.0, 95% CI=1.03 – 3.94) were significantly more likely to have intestinal parasites.

Conclusion

the prevalence of intestinal parasites was high among HIV patients. Gender and unavailability of toilet in homes were found to be predictors of having parasites. We recommend that HIV patients should be periodically screened for IPs during the follow-up clinic visits.

Epidemiology of Cryptosporidium Infections among People Living with HIV/AIDS in Nigeria: Results of Systematic Review and Meta-analysis

PURPOSE

Cryptosporidium is implicated in diarrhea epidemics in many parts of the world and is said to be the most common protozoan cause of diarrhea among people living with HIV/AIDS (PLWHA) globally. To provide data on the burden of Cryptosporidium infections among Nigerians living with HIV/AIDS, we reported the prevalence, geographic distribution and Cryptosporidium species diversity among this population in Nigeria.

METHODS

We used the PRISMA guidelines to perform a systematic review and meta-analysis of articles published between January 1, 1995 and April 21, 2020. Pooled estimate (PE), heterogeneity, quality of each study and publication bias were determined using the random-effects model, Cochran's Q test, the 9 point Joanna Briggs Institute Critical Appraisal Instrument and the Egger's regression asymmetry test, respectively.

RESULTS

Forty-six articles reported 2612 positive cases of Cryptosporidium infections from 12,756 PLWHA examined in 20 Nigerian States and the Federal Capital Territory. Overall pooled estimate was 14.5% (95% CI 10.4-19.9) with a range of 0.3% (95% CI 0.0-1.8) to 43.7% (95% CI 35.6-52.3) across sub-groups, with the PEs in relation to CD4⁺ T cell count, species and age showing significant variations at p < 0.05. Cryptosporidium hominis was the most prevalent (3.5%, 95% CI 2.3-5.2) of the six Cryptosporidium species reported in Nigeria.

CONCLUSION

Cryptosporidium infections are moderately prevalent among PLWHA in Nigeria with the highest regional prevalence in the north-east. In addition to personal hygienic practices, the inclusion of Cryptosporidium screening as part of HIV/AIDS clinics in Nigeria will reduce the burden of the parasite among PLWHA in Nigeria.

Malaria and intestinal parasite co-infection and its association with anaemia among people living with HIV in Buea, Southwest Cameroon: A community-based retrospective cohort study

Background

Both malaria and intestinal parasites are endemic in Cameroon, and their co-infection can be of great impact on anaemia among people living with HIV (PLWH). This community-based retrospective cohort study determined the prevalence and association of infections with anaemia in PLWH and HIV-negative individuals in Buea, Cameroon from March to August 2019.

Methods

The study population comprised of 190 PLWH and 216 consenting HIV-negative individuals from the Buea community. Participants were examined clinically, the collected blood sample was used for malaria parasite (MP) detection, HIV diagnosis and haemoglobin (Hb) measurement while stool samples were examined for the detection of intestinal parasites (IPs). Proportions were compared using Pearson’s Chi-square test and association of anaemia with independent variables was evaluated using logistic regression analysis.

Results

Out of the 406 participants, MP, IPs and MP/IP co-infection prevalences were 15.5%, 13.0% and 3.0% respectively. PLWH had a higher prevalence of MP (16.3%, P = 0.17), IPs (23.7%, P ˂ 0.001) and MP/IPs co-infection (3.7%, P = 0.04) when compared with HIV-negative participants. Similarly, PLWH had significantly lower mean haemoglobin value (11.10 ± 1.54 g/dL) than their HIV-negative counterparts (12.45 ± 2.06 g/dL). Also, PLWH co-infected with MP and IPs were observed to have a significantly lower mean haemoglobin value (10.6 ± 1.21 g/dL). PLWH had a significantly (P ˂ 0.001) higher prevalence of mild (56.8%), moderate (18.4%) and severe (1.6%) anaemia when compared with HIV-negative counterparts. The significant risk factors associated with anaemia included being febrile (P = 0.03), MP-infected only (P = 0.001), HIV-infected only (P < 0.001), having dual (P < 0.001) or triple-infections (P = 0.03).

Conclusion

Malaria and intestinal parasites remain public health concerns among PLWH and anaemia as a serious haematological abnormality gets exacerbated even with the viral load suppression. Hence, routine medical check-ups among PLWH are recommended.

Intestinal parasitic infections and associated factors among people living with HIV/AIDS in Ethiopia: A systematic review and meta-analysis

Background

Intestinal parasitic infections are major public health problems throughout the world, particularly in people living with HIV/AIDS. People living with HIV/AIDS are vulnerable groups for a variety of diseases, hence they are easily affected by opportunistic and non-opportunistic intestinal parasites due to the weakening of their immunity. Therefore, this study aimed to estimate the pooled prevalence and factors associated with intestinal parasitic infections among people living with HIV/AIDS in Ethiopia.

Methods

Articles were identified through search engines in the online electronic databases PubMed/MEDLINE, EMBASE, HINARI, CINAHL, Cochrane Library, Google Scholar, and reference lists of previous studies following the PRISMA Protocol. Studies conducted between 2003 and 2020 with English language were included in this study. This review included papers with having high-quality NOS scores. Meta-analysis was computed using STATA version 11 software. Heterogeneity was assessed using the Cochrane Q-test and I² test statistics. Subgroup and sensitivity analysis was employed with evidence of heterogeneity. Publication bias was determined using the funnel plot and Egger’s regression test statistic.

Results

This study included a total of twenty-two cross-sectional studies with 5,833 study participants. The mean age of the study participants was 35 years old. The pooled prevalence of intestinal parasitic infection among people living with HIV/AIDS in Ethiopia was 39.15% (95%CI: 32.34, 45.95). The pooled prevalence of intestinal parasitic infections among people living with HIV/AIDS who had taking ART and who had not to start ART was found to be 28.27% (95%CI 22.47, 34.06) and 41.63% (95%CI: 28.75, 54.52) respectively. Unavailability of latrine (AOR: 4.87, (95% CI: 2.39, 9.92)), CD4+ T cell count <200cells/μl ((AOR: 3.53, (95%CI: 1.98, 6.27)), and having a history of diarrhea (AOR: 4.79 (95%CI: 1.53, 14.99) were factors significantly associated with intestinal parasitic infections.

Conclusion

In this study, the overall pooled prevalence of intestinal parasitic infections among HIV/AIDS patients in Ethiopia was relatively high. CD4+ T-cell count <200cells/μl, unavailability of a latrine, and history of diarrhea were significantly associated with intestinal parasitic infections. Therefore, the policymakers and health care professionals could give special attention to the presence of latrines, early detection and treatment of intestinal parasitic infections, and early initiation of ART drugs.

Strongyloidiasis in Africa: Systematic Review and Meta-Analysis on Prevalence, Diagnostic Methods, and Study Settings

BACKGROUND

Strongyloidiasis is an intestinal parasitic infection mainly caused by Strongyloides stercoralis. Although it is a predominant parasite in tropics and subtropics where sanitation and hygiene are poorly practiced, the true prevalence of strongyloidiasis is not known due to low-sensitivity diagnostic methods.

OBJECTIVE

This systematic review and meta-analysis is aimed at determining the pooled prevalence of strongyloidiasis in African countries, stratified by diagnostic methods, study settings, and patients.

METHODS

Cross-sectional studies on strongyloidiasis published in African countries from the year 2008 up to 2018 in PubMed and Google Scholar databases and which reported at least one Strongyloides spp. infection were included. Identification and screening of eligible articles were also done. Articles whose focus was on strongyloidiasis in animals, soil, and foreigners infected by Strongyloides spp. in Africa were excluded. The random effects model was used to calculate the pooled prevalence of strongyloidiasis across African countries as well as by diagnostic methods and study settings. The heterogeneity between studies was also computed.

RESULT

A total of 82 studies were included. The overall pooled prevalence of strongyloidiasis was 2.7%. By individual techniques, the pooled prevalence of strongyloidiasis was 0.4%, 1.0%, 3.4%, 9.3%, 9.6%, and 19.4% by the respective direct saline microscopy, Kato-Katz, formol ether concentration, polymerase chain reaction, Baermann concentration, and culture diagnostic techniques. The prevalence rates of strongyloidiasis among rural community, school, and health institution studies were 6.8%, 6.4%, and 0.9%, respectively. The variation on the effect size comparing African countries, diagnostic methods, study settings, and patients was significant (P ≤ 0.001).

CONCLUSIONS

This review shows that strongyloidiasis is overlooked and its prevalence is estimated to be low in Africa due to the use of diagnostic methods with low sensitivity. Therefore, there is a need for using a combination of appropriate diagnostic methods to approach the actual strongyloidiasis rates in Africa.

Prevalence of enteric bacteria and enteroparasites in human immunodeficiency virus-infected individuals with diarrhoea attending antiretroviral treatment clinic, Arba Minch General Hospital, southern Ethiopia

In Ethiopia, only limited data are available regarding the prevalence of enteric bacterial pathogens and enteroparasites in human immunodeficiency virus (HIV) -infected individuals with diarrhoea. Hence, this study aims to assess the prevalence of enteric bacteria and enteroparasites, and also the antibiotic susceptibility patterns of bacteria in them. An institution-based cross-sectional study was performed in HIV patients with diarrhoea, who visited the Anti-Retroviral Therapy Clinic of the Arba Minch General Hospital between 1 March and 31 August 2019. Data pertaining to sociodemographic characteristics and other factors were collected using a structured questionnaire. Stool culture is of utmost importance in the case of HIV-infected individuals with diarrhoea. Stool samples were collected and examined for bacterial and parasitic pathogens following standard procedures. The antibiotic susceptibility test was performed as per the Kirby-Bauer disc diffusion technique. Data were analysed using SPSS software. A total of 180 individuals were included in the stool collection process. The prevalence rates of enteric bacteria and enteroparasites were 8.3% and 36.1%, respectively. Parasitic infections were more frequent than bacterial infections in these HIV-infected individuals; commonly identified enteroparasites were Giardia lamblia (8.9%) and Cryptosporidium parvum (8.3%). Campylobacter sp. was the most predominant enteric bacterial isolate (4.4%), followed by Salmonella (2.1%) and Shigella (1.1%) species. CD4 counts <200 cells/μL was significantly associated with both bacterial infections (adjusted OR 9.55, 95% CI 1.54-59.3, p 0.015) and parasitic infections (adjusted OR 3.53, 95% CI 1.3-17.9, p 0.03). Multidrug resistance was also detected in 100%, 75% and 60% of Shigella, Campylobacter and Salmonella sp., respectively. We found that enteroparasitic infections were more frequent than bacterial infections. Statistical analysis revealed that CD4 T-cell counts <200 cells/μL, quality of drinking water sources, hand washing habits after toilet and the presence of domestic animals were significantly associated with the prevalence of enteric pathogens.

The Influence of HIV Status on the Burden and Clinical Manifestations of Gastrointestinal Pathogens in Yangon, Myanmar

The impact of HIV infection on the burden of gastrointestinal pathogens in Myanmar is poorly defined. Stools of 103 HIV-infected and 105 HIV-uninfected adult outpatients at a tertiary referral hospital in Yangon were examined microscopically. Stool antigen tests for Helicobacter pylori infection were positive in 63/103 (61%) HIV-infected and 61/105 (58%) HIV-uninfected patients (P = 0.65). Soil-transmitted helminth infections were much less common, occurring in 9/103 (9%) HIV-infected and 13/103 (13%) HIV-uninfected patients (P = 0.50). One HIV-uninfected patient had Giardia duodenalis, but there were no cases of Strongyloides stercoralis, Entamoeba histolytica, Capillaria philippinensis, Isospora, Cyclospora, or Schistosoma infection in the entire cohort. Despite the high prevalence of H. pylori, only 1/208 (0.5%) had ever received eradication, compared with 159/208 (76%) who had ever been dewormed. Helicobacter pylori appears to be an underappreciated pathogen in Myanmar. Its strong association with gastric cancer and peptic ulcer disease necessitates a more aggressive approach to its management.

Cryptosporidiosis in HIV-positive patients and related risk factors: A systematic review and meta-analysis

Cryptosporidium is one of the major causes of diarrhea in HIV-positive patients. The aim of this study is to systematically review and meta-analyze the prevalence of Cryptosporidium in these patients. PubMed, Science Direct, Google Scholar, Web of Science, Cochrane and Ovid databases were searched for relevant studies dating from the period of 1 January 2000 to 31 December 2017. Data extraction for the included studies was performed independently by two authors. The overall pooled prevalence was calculated and subgroup analysis was performed on diagnostic methods, geographical distribution and study population. Meta-regression was performed on the year of publication, proportion of patients with diarrhea, and proportion of patients with CD4 < 200 cells/mL. One hundred and sixty-one studies and 51,123 HIV-positive participants were included. The overall pooled prevalence of Cryptosporidium infection in HIV-positive patients was 11.2% (CI95%: 9.4%–13.0%). The pooled prevalence was estimated to be 10.0% (CI95%: 8.4%–11.8%) using staining methods, 13.5% (CI95%: 8.9%–19.8%) using molecular methods, and 26.3% (CI95%: 15.0%–42.0%) using antigen detection methods. The prevalence of Cryptosporidium in HIV patients was significantly associated with the country of study. Also, there were statistical differences between the diarrhea, CD4 < 200 cells/mL, and antiretroviral therapy risk factors with Cryptosporidiosis. Thus, Cryptosporidium is a common infection in HIV-positive patients, and safe water and hand-hygiene should be implemented to prevent cryptosporidiosis occurrence in these patients.

Opportunistic parasitic infections in patients with human immunodeficiency virus/acquired immunodeficiency syndrome: A review

The number of human immunodeficiency virus (HIV) cases increases annually, and Indonesia has become the country with the fastest HIV/acquired immunodeficiency syndrome (AIDS) epidemic spread among the five Southeast Asian countries. Indonesia entered the critical phase of HIV/AIDS infections after 5 out of the 33 provinces, namely, Papua, Jakarta, Bali, West Java, and East Java, reported HIV/AIDS epidemic since 2004. In AIDS pathophysiology and immune-suppression are severe, thus, opportunistic intestinal parasitic infections that cause diarrhea in HIV infection may be fatal. Several studies have suggested that Cryptosporidium parvum, Isospora belli, and Blastocystis hominis are the most common intestinal protozoan parasites categorized as AIDS associated illness. Diarrhea caused by parasites is considerably suspected in the cases of chronic and persistent diarrhea in adults, in an era of increasing HIV/AIDS cases nowadays. The present review highlights the current advances in etiologic agents of HIV/AIDS opportunistic infections among countries, epidemiology and prevalence, lifecycle, risk factors, examination methods, and treatment.

Cryptosporidium infection among people living with HIV/AIDS in Ethiopia: a systematic review and meta-analysis

Studies on the prevalence of Cryptosporidium infection in People Living with HIV/AIDS (PLWHA) are inconsistent and heterogeneous. Therefore, this systematic review with meta-analysis was performed to assess the burden of the infection relative to the proportion of CD4 + T cell count among PLWHA in Ethiopia. Articles published before 15 May 2019, have been retrieved for this systematic review using five databases; PubMed, Scopus, Web of Science, Google Scholar and ProQuest, supplemented by the search for gray literature. The overall pooled prevalence and pooled Odds Ratio (OR) with their 95% Confidence Intervals (CI) were estimated using STATA 14 statistical Software. Of the 255 studies retrieved, 31 were considered for the final analysis. As many as 8,645 Ethiopians infected with HIV were included in the final quantitative synthesis. The overall pooled prevalence estimate of Cryptosporidium infection among PLWHA in Ethiopia was 11% (95%CI: 0.09-0.13). HIV-infected people with low CD4 + T cell count (CD4 < 200 cells/mm3) were 13.07 times more likely to become infected with Cryptosporidium than those with high CD4 + T cell count (CD4 > 500 cells/mm3) (OR: 13.07 (95%CI: 6.38-26.75). Cryptosporidium infection in PLWHA in Ethiopia showed decreasing patterns in 2001-2010, 2011-2014, and in 2015-2019, 14.6% (95%CI: 0.076-0.217), 12.71% (95%CI: 0.086-0.167) and 6.7% (95%CI: 0.044-0.090), respectively (p < 0.001). Though the pattern of Cryptosporidium infection in HIV-infected Ethiopians showed a declining trend; it remains a considerable problem that requires improvement in routine screening for Cryptosporidium in HIV-infected people, particularly with poor or declining CD4 + T cell count.

Risk factors for Blastocystis infection in HIV/AIDS patients with highly active antiretroviral therapy in Southwest China

Background

Blastocystis is a widespread zoonotic protozoan of mammalian species, especially in HIV/AIDS individuals. The aim of this study was to analyze the prevalence and risk factors related with Blastocystis infection among HIV/AIDS patients in Southwest China.

Methods

The cross-sectional study was performed in 311 HIV/AIDS cases in Tengchong City, Yunnan Province from July 2016 to March 2017. For each subject, stool specimen was collected to detect the Blastocystis, and the blood sample was used to detect HIV virus load and CD4⁺ T cell count, in addition, structured questionnaire was used to collect the basic information and risk factors.

Findings

The result showed that the detection rate of Blastocystis was 3.86% (95% CI: 2.22–6.62) among HIV/AIDS patients. Both raising animal (OR = 12.93, 95% CI: 1.54–108.36) and drinking un-boiled water (OR = 8.17, 95% CI: 1.76–37.90) were risk factors for Blastocystis infection in HIV/AIDS individuals. In addition, the interaction of CD4⁺ T cell count and HIV virus load was also contribution to Blastocystis infection (P = 0.007).

Conclusions

A high prevalence of Blastocystis infection was found in HIV/AIDS patients in Tengchong. Poor hygienic habits, the interaction of HIV virus load and CD4⁺ T cell count were identified as main risk factors for infection. These results will help us to develop efficient control strategies to intervene with and prevent the occurrence of Blastocystis among HIV-infected individuals.

Cystoisospora belli infections in humans: the past 100 years

Cystoisospora belli is a coccidian parasite of humans, with a direct fecal-oral transmission cycle. It is globally distributed, but mainly found in tropical and subtropical areas. Many cases of C. belli infections have been reported in patients with HIV, and in patients undergoing immunosuppressive therapy for organ transplants or those treated for tumours worldwide. Unsporulated or partially sporulated oocysts of C. belli are excreted in feces. When sporulated oocysts in contaminated water or food are ingested, asexual and sexual stages of C. belli are confined to the epithelium of intestines, bile ducts and gallbladder. Monozoic tissue cysts are present in extra-intestinal organs (lamina propria of the small and large intestine, lymph nodes, spleen, and liver) of immunosuppressed humans. However, a paratenic host has not been demonstrated. Cystoisospora belli infections can be persistent, lasting for months, and relapses are common; the mechanism of relapse is unknown. Recently, the endogenous stages of C. belli were re-examined and attention was drawn to cases of misidentification of non-protozoal structures in the gallbladder of patients as C. belli. Here, we review all aspects of the biology of C. belli, including morphology, endogenous stages, prevalence, epidemiology, symptoms, diagnosis and control.

Cyclospora cayetanensis and Cyclosporiasis: An Update

Cyclospora cayetanensis is a coccidian parasite of humans, with a direct fecal-oral transmission cycle. It is globally distributed and an important cause of foodborne outbreaks of enteric disease in many developed countries, mostly associated with the consumption of contaminated fresh produce. Because oocysts are excreted unsporulated and need to sporulate in the environment, direct person-to-person transmission is unlikely. Infection by C. cayetanensis is remarkably seasonal worldwide, although it varies by geographical regions. Most susceptible populations are children, foreigners, and immunocompromised patients in endemic countries, while in industrialized countries, C. cayetanensis affects people of any age. The risk of infection in developed countries is associated with travel to endemic areas and the domestic consumption of contaminated food, mainly fresh produce imported from endemic regions. Water and soil contaminated with fecal matter may act as a vehicle of transmission for C. cayetanensis infection. The disease is self-limiting in most immunocompetent patients, but it may present as a severe, protracted or chronic diarrhea in some cases, and may colonize extra-intestinal organs in immunocompromised patients. Trimetoprim-sulfamethoxazole is the antibiotic of choice for the treatment of cyclosporiasis, but relapses may occur. Further research is needed to understand many unknown epidemiological aspects of this parasitic disease. Here, we summarize the biology, epidemiology, outbreaks, clinical symptoms, diagnosis, treatment, control and prevention of C. cayetanensis; additionally, we outline future research needs for this parasite.

Lower prevalence of Blastocystis sp. infections in HIV positive compared to HIV negative adults in Ghana

Background

Sub-Saharan Africa is endemic for intestinal parasites and distinguished for the largest burden of HIV cases. Blastocystis sp. is one of the most common protists infecting humans but its role in human disease is still controversial. Aim of this study was to investigate the prevalence of Blastocystis sp. in HIV positive and negative adults in Ghana and its association with immune status and other risk factors.

Methods

122 HIV positive outpatients and 70 HIV negative blood donors from the Komfo Anokye Teaching Hospital in Kumasi, Ghana, were included in the present study. Demographic, clinical and laboratory data were collected and HIV positive patients distinguished for CD4+ T cell count <200 cells/μl (n = 54) and >200 cells/μl (n = 68). A Blastocystis’s phylogenetic analysis was performed to determine sample subtype (ST).

Results

The prevalence of Blastocystis sp. in adult HIV positive individuals was lower than in HIV negative persons (6.6% vs. 20.0%, p = 0.008) and Blastocystis sp. ST1 was the most prevalent strain. Within HIV positive participants, the prevalence of Blastocystis sp. was lower in those individuals with CD4+ T cell count <200 cells/μl than in patients with higher CD4+ T cell count (1.9% vs. 10.3%, p = 0.076). Multiple regression analysis revealed that Blastocystis sp. was inversely associated with an obese Body Mass Index (BMI) in HIV negative persons (p = 0.040). Presence of Blastocystis sp. was correlated with higher CD4+ T cell count in HIV positive participants (p = 0.049).

Conclusion

It is largely reported that people living with HIV (PLHIV) in Africa are affected from parasite infections and that co-infections may adversely impact on their immune status, accelerating progress to AIDS and worsening gastrointestinal manifestations. Differently, in this study Blastocystis sp. was associated with a better immune status jointly with a healthy body weight while it seems to be reduced with the progression of HIV infection. This data agree with recent suggestions that Blastocystis sp. can represent a component of the healthy gut microbiota.

Prevalence and risk factors associated with cryptosporidiosis among children within the ages 0-5 years attending the Limbe regional hospital, southwest region, Cameroon

Background

Cryptosporidiosis is a pathological condition caused by infection with coccidian protozoan parasites Cryptosporidium. Cryptosporidium is one of the most common causes of childhood diarrhea in developing countries. So far, no data has been published on its prevalence among children with diarrhea in Cameroon. This study was therefore, designed to assess the prevalence and risk factors associated with Cryptosporidiosis among children within the ages 0–5 years suffering from diarrhea and being attended to at the Limbe Regional Hospital.

Methods

The study was a hospital based analytical cross-sectional study involving children within the ages 0–5 years (n = 112) hospitalized or consulted in the pediatric departments of the hospital between April 2018 and May 2018. Stool specimens were processed using the modified acid-fast staining method, and microscopically examined for Cryptosporidium infection.

Results

A total of 112 participants were recruited out of which 67 presented with diarrhea. A high prevalence 9/67 (13.40%) of Cryptosporidium was noticed in children with diarrhea than children without diarrhea 1/45 (2.2%). There was a significant relationship (p = 0.041) between prevalence of Cryptosporidium and the presence of diarrhea in children within the ages 0–5 years in the Limbe Regional Hospital. It was realized that children from parents with primary level of education, children whose parents did not respect exclusive breastfeeding and those whose parents were giving them pipe borne water for drinking recorded a higher prevalence.

Conclusions

This study revealed an overall prevalence of 8.9% for Cryptosporidium among children of ages 0–5 years that attended the Limbe Regional Hospital. The prevalence among children that presented with diarrhea was 13.4%. The study clearly demonstrated that Cryptosporidium is an important protozoal etiologic agent for children with diarrhea in Limbe.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7484-8) contains supplementary material, which is available to authorized users.

Opportunistic parasitoses among Egyptian hemodialysis patients in relation to CD4+ T-cell counts: a comparative study

Background

Some reports are available on the prevalence of opportunistic parasitoses among hemodialysis (HD) patients, yet there is a paucity of data on the association of CD4+ T-cell counts with such infections. Therefore, this study aimed to determine the prevalence of intestinal parasites and Toxoplasma gondii in relation to CD4+ counts among HD patients in Alexandria, Egypt.

Methods

A comparative cross-sectional study was conducted on 120 HD patients and 100 apparently healthy individuals between December 2014 and January 2016. Data and samples (stool and blood) were collected from the participants after obtaining their informed consent. Stool samples were examined for parasites after concentration and staining, EDTA-blood samples were used for CD4+ counting by flow cytometry, and sera were analyzed for anti-Toxoplasma IgM and IgG antibodies.

Results

A significantly higher prevalence rate of intestinal parasitoses was found among HD patients compared to apparently healthy individuals (52.5% vs. 12.0%, respectively), with absence of helminths. Cryptosporidium species (32.5%), B. hominis(24.2%) and microsporidia (11.7%) were the most frequent parasites among HD patients, while B. hominis (13.0%), Cryptosporidium species (11.0%) and G. lamblia (4.0%) were the most frequent parasites among their counterparts. Statistically significant differences in parasite infection rates between patients and their counterparts were found for Cryptosporidium species, B. hominis and microsporidia. However, parasite species were not significantly associated with diarrhea. On the other hand, the overall T. gondii seroprevalence rate among HD patients was significantly higher than that among their counterparts (33.3% vs. 8%, respectively). HD patients with CD4+ counts < 200 cells/μl were twice more exposed to intestinal parasitoses compared to those with counts ≥200 cells/μl, but the difference was not statistically significant. However, low CD4+ counts were significantly associated with higher rates of Cryptosporidium species, microsporidia and T. gondii.

Conclusions

Intestinal parasitoses and T. gondii infection rates are significantly higher among Egyptian HD patients compared to apparently healthy individuals, with Cryptosporidium species, B. hominis, microsporidia and T. gondii being the most frequent parasites. CD4+ counts < 200 cells/μl are significantly associated with Cryptosporidium species, microsporidia and T. gondii among HD patients. Therefore, regular screening of HD patients for opportunistic parasites is recommended.

Intestinal parasitosis in relation to CD4 count and anemia among ART initiated patients in St. Mary Aksum general hospital, Tigray, Ethiopia

Background

The geographical distribution of intestinal parasites with conditions of poverty in most countries of sub-Saharan Africa coincides with that of HIV/AIDS. However, there is paucity of studies investigating the relationship between intestinal parasitic infections with CD4 counts and anemia in HIV/AIDS patients starting Antiretroviral Therapy (ART) in this region particularly and in Ethiopia in general. The aim of this study was to determine the prevalence of intestinal parasitic infections in relation to CD4 count and anemia among ART-initiated patients in St. Mary Aksum General Hospital, Tigray, Ethiopia.

Methods

A cross-sectional study was conducted among randomly selected 242 ART-initiated participants during February to April 2017 in St. Mary Aksum General hospital. Data was collected using structured questionnaire and laboratory examination. Logistic regression was applied to assess any association between explanatory factors and outcome variables (P values < 0.05).

Result

The overall prevalence of intestinal parasites was 26.4% and among the six types of parasitic genera identified Entamoeba histolytica/dispar (18.6%) and Giardia lamblia (2.1%) were the leading. According to the multivariate analysis, lack of hand washing before meal, eating uncooked vegetables, history of taking anti-parasite medication, stool consistency, and anemia were strongly associated with intestinal parasitosis.

Conclusion

There was a high prevalence of intestinal parasites among HIV positive individuals. Intervention measures such as deworming, improving hygiene and sanitation practices should be strengthened to reduce the burden of intestinal parasites among people living with HIV.

Electronic supplementary material

The online version of this article (10.1186/s12879-019-3989-0) contains supplementary material, which is available to authorized users.

Enteric Opportunistic Infection and the Impact of Antiretroviral Therapy among HIV/AIDS Patients from Tehran, Iran

BACKGROUND

Opportunistic parasites have been identified as human pathogens, especially in immunodeficient patients. Microsporidian and coccidian infections cause chronic diarrhea as common clinical manifestation in HIV positive patients. In this study, the frequency of opportunistic infections, including microsporidian and coccidian infections, was evaluated in HIV/AIDS patients from Tehran and phylogenic analysis was performed for E. bieneusi isolates from these patients.

METHODS

One hundred and two stool samples were collected from confirmed HIV/AIDS patients, referred to Consult Center of Behavior Diseases, West Health Center, Iran University of Medical Sciences in Tehran, Iran. The samples were transferred to Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences from Jan 2016 to Dec 2016. After conventional formalin-ether concentration, aniline blue staining method and acid-fast staining technique were used for detection of microsporidian spores and Cyclospora oocysts. DNA was extracted and nested PCR was performed.

RESULTS

Two (1.96%) cases were found to be positive for intestinal microsporidia infection using aniline blue staining method and were confirmed as E. bieneusi by nested PCR. One patient was found with Cyclospora cayetanensis infection by acid-fast staining method and PCR. Giardia lamblia and Blastocystis hominis were detected as non-opportunistic parasites in 1/102 (0.98%) and 2/102 (1.96%) of the HIV positive patients, respectively.

CONCLUSION

With respect to the use of antiretroviral therapy (ART) in HIV positive patients, we found a low frequency of infection.

Enteroparasitism and Risk Factors Associated with Clinical Manifestations in Children and Adults of Jalisco State in Western Mexico

Objectives

To determine the prevalence and risk factors associated with intestinal parasites in the population of San Juan Cosala, Jalisco, Mexico.

Methods

A total of 277 samples from 104 participants were analysed using direct smear, flotation, formaldehyde/ethyl acetate, and modified Kinyoun's acid-fast stain methods. The Graham method was applied only for samples from children under 12 years of age for the diagnosis of Enterobius vermicularis.

Results

The prevalence of parasite infections in the study population was 77.9% including: Entamoeba histolytica/E. dispar/E. moshkovskii/E. bangladeshi (37.5%), Giardia intestinalis (11.5%); commensals: Endolimax nana (44.2%), Entamoeba coli (27.9%), Chilomastix mesnili (6.7%) and Iodamoeba bütschlii, (2.9%); emerging intestinal protozoans: Blastocystis spp. (49%), Cryptosporidium spp. (7.7%) and Cyclospora cayetanensis (2.9%); and helminths: Enterobius vermicularis (18.3%) and Ascaris lumbricoides (5.8%). The results also showed that 58.64% of the studied population presented polyparasitism. A significant association was found between protozoan infections and housewives, and houses that were not built with concrete ceilings, brick walls and cement floors (p < 0.05).

Conclusion

Polyparasitism was observed in over half the study population. The most prevalent parasite was Blastocystis spp, whilst the prevalence of helminths was less than that of protozoans. The risk factors for infection to intestinal parasites were being a housewife and not having solid brick, cement and concrete materials for house construction.

Socio-Behavioral Risk Factors Associated with Cryptosporidiosis in HIV/AIDS Patients Visiting the HIV Referral Clinic at Cape Coast Teaching Hospital, Ghana

Objective:

To identify the socio-behavioral risk factors associated with cryptosporidiosis among HIV/AIDS patients with chronic diarrhea symptoms visiting the HIV referral clinic at Cape Coast Teaching Hospital, Ghana.

Methods:

A cross-sectional study was conducted among 50 HIV/AIDS patients with recurrent diarrhea. Questionnaires were administered to collect social and behavioral risk factors associated with Cryptosporidium and other opportunistic protozoan parasitic infections in HIV patients. Stool samples were collected for the diagnosis of enteric protozoan pathogens using modified Ziehl-Neelsen and acid-fast staining methods. CD4⁺ cells counts of study subjects were obtained from patients clinical records. The data obtained were analyzed using Pearson chi-square and multivariate-adjusted statistics tool on SPSS 16 for Windows.

Results:

Twenty-seven (54%) of the subjects were infected with enteric protozoan pathogens. The prevalences of Cryptosporidium, Cyclospora and Microsporidium infections were 46%, 32% and 16%, respectively. Cryptosporidium infection was significantly associated with drinking water (ײ=13.528, p<0.001), Cyclospora was associated with the type of drinking water (ײ=14.931, p<0.001) and toilet facilities used by the study subjects (ײ=12.463, p<0.01), whiles Microsporidium infection was associated with hand washing behavior (ײ=12.463, p<0.01). Enteric protozoans were frequently encountered among subjects with CD4+ T-cell count <200 cells/mm³. However, coinfection of Cyclospora spp & Cryptosporidium spp was not observed in CD4⁺ cell count <200 and >500 cells/mm^3. Multivariate analysis showed that the risk factor for Cryptosporidium infection among HIV/AIDS patients was the source of drinking water (pipe borne water 76.2% prevalence: sachet water 25%; OR=0.10, 95%CI: 0.03-0.39, p<0.001).

Conclusion:

We report the risk factor for exposure of Cryptosporidium infection among HIV/AIDS patients for the first time in Ghana. The contamination of drinking water by protozoan parasites should be a public health concern. These results provide the stepping block to understand the transmission dynamics of Cryptosporidium and other opportunistic pathogens in HIV/AIDS infected patients in Ghana.

Prevalence of enteric parasitic infections among people living with HIV in Abeokuta, Nigeria

INTRODUCTION

Enteric parasitic infections have been increasingly recognized as etiology of life-threatening chronic diarrhea in PLWHA in sub-Saharan Africa. This study investigated the prevalence and burden of intestinal parasitic infection among PLWHA in Abeokuta, southwest Nigeria.

METHODS

Freshly passed stool samples were collected from PLWHA. Detection of Cryptosporidium spp and Microsporidium spp was carried out with Kinyoun's stain and Weber's Chromotrope-based stain respectively. Investigation of other intestinal parasites was done using the direct saline preparation and formol-ether concentration methods. CD4+ T cell count was measured using Partec flow cytometry technique.

RESULTS

A total of 231 (males: females 96:135; mean age 31.81±11.40 years) PLWHA were recruited into the study, among whom 84 (36.4%) were infected with at least one intestinal parasites. Fifty two (22.5%) individuals were positive for Cryptosporidium spp and a significant association between Cryptosporidium sppand diarrhea was observed (p=0.006). Seven (3.0%) were positive for Microsporidium spp. Helminths recovered included Ascaris lumbricoides (20.8%), hookworm (6.5%), Strongyloides stercoralis (4.3%), Trichuris trichiura (5.6%) and Taenia spp. (5.6%). Cryptosporidium spp, Microsporidium spp and S. stercoralis were significantly associated with CD4+ count ≥ 200 cells/mm3 (p<0.05). Cryptosporidium sppand A. lumbricoides were significantly observed among patients that are anti-retroviral therapy (ART) naive.

CONCLUSION

High prevalence of opportunistic parasitic infection was significantly correlated with diarrhea, low CD4+ count and ART naïve individuals in the study. These findings re-emphasize the need for early diagnosis of opportunistic parasites and appropriate intervention among PLWHA.

Opportunistic and non-opportunistic intestinal parasites in HIV/ AIDS patients in relation to their clinical and epidemiological status in a specialized medical service in Goiás, Brazil

Patients infected with the Human Immunodeficiency Virus (HIV) often have opportunistic infections, among which strongyloidiasis and coccidiosis are the most common parasitic infections that aggravate their health status. This study examined the prevalence of intestinal parasites, particularly of Strongyloides stercoralis and intestinal coccidia in patients with the Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS) who were treated at the Specialized Assistance Service (SAE) of Jataí, State of Goiás, Brazil, and analyzed its correlation with clinical, laboratory, and socio-epidemiological parameters. A total of 270 stool samples were analyzed by the Lutz technique, Rugai's method, Agar Plate Culture, Ritchie's method and specific staining, Ziehl-Neelsen modified technique, Kinyoun's method and the rapid safranin method. The prevalence of intestinal parasites was 28.88% including 3.8% of S. stercoralis, Cryptosporidium sp. and Cystoisospora belli. There was a significant positive correlation between intestinal parasites and the clinical status and the use of antiretroviral therapy (ART), smoking, CD4+ lymphocyte counts and sexual orientation. In conclusion, the widespread use of antiretroviral therapy and health assistance contributed to the low prevalence of S. stercoralis and coccidiosis in patients with HIV/ AIDS who were followed up at the SAE.

Prevalence of Cryptosporidium, microsporidia and Isospora infection in HIV-infected people: a global systematic review and meta-analysis

BACKGROUND

Diarrhea caused by opportunistic intestinal protozoa is a common problem in HIV infection. We aimed to establish the prevalence of Cryptosporidium, misrosporidia, and Isospora in HIV-infected people using a systematic review and meta-analysis, which is central to developing public policy and clinical services.

METHODS

We searched PubMed, ScienceDirect, Google Scholar, Embase, Chinese Web of Knowledge, Wanfang, and Chongqing VIP databases for studies reporting Cryptosporidium, microsporidia, or Isospora infection in HIV-infected people. We extracted the numbers of people with HIV and protozoa infection, and estimated the pooled prevalence of parasite infection by a random effects model.

RESULTS

Our research identified 131 studies that reported Cryptosporidium, microsporidia, and Isospora infection in HIV-infected people. We estimated the pooled prevalence to be 14.0% (3283/43,218; 95% CI: 13.0-15.0%) for Cryptosporidium, 11.8% (1090/18,006; 95% CI: 10.1-13.4%) for microsporidia, and 2.5% (788/105,922; 95% CI: 2.1-2.9%) for Isospora. A low prevalence of microsporidia and Isospora infection was found in high-income countries, and a high prevalence of Cryptosporidium and Isospora infection was found in sub-Saharan Africa. We also detected a high prevalence of Cryptosporidium, microsporidia, and Isospora infection in patients with diarrhea. Sensitivity analysis showed that three studies significantly affect the prevalence of Isospora, which was adjusted to 5.0% (469/8570; 95% CI: 4.1-5.9%) by excluding these studies.

CONCLUSIONS

Our findings suggest that HIV-infected people have a high prevalence of Cryptosporidium, microsporidia, and Isospora infection in low-income countries and patients with diarrhea, especially in sub-Saharan Africa, reinforcing the importance of routine surveillance for opportunistic intestinal protozoa in HIV-infected people.

Lessons Learned from Protective Immune Responses to Optimize Vaccines against Cryptosporidiosis

In developing countries, cryptosporidiosis causes moderate-to-severe diarrhea and kills thousands of infants and toddlers annually. Drinking and recreational water contaminated with Cryptosporidium spp. oocysts has led to waterborne outbreaks in developed countries. A competent immune system is necessary to clear this parasitic infection. A better understanding of the immune responses required to prevent or limit infection by this protozoan parasite is the cornerstone of development of an effective vaccine. In this light, lessons learned from previously developed vaccines against Cryptosporidium spp. are at the foundation for development of better next-generation vaccines. In this review, we summarize the immune responses elicited by naturally and experimentally-induced Cryptosporidium spp. infection and by several experimental vaccines in various animal models. Our aim is to increase awareness about the immune responses that underlie protection against cryptosporidiosis and to encourage promotion of these immune responses as a key strategy for vaccine development. Innate and mucosal immunity will be addressed as well as adaptive immunity, with an emphasis on the balance between T_H1/T_H2 immune responses. Development of more effective vaccines against cryptosporidiosis is needed to prevent Cryptosporidium spp.-related deaths in infants and toddlers in developing countries.

Prevalence of Cryptosporidium species and subtypes in paediatric oncology and non-oncology patients with diarrhoea in Jordan

Cryptosporidiosis is a protozoan parasitic disease which affects human and animals worldwide. In adult immunocompetent individuals, cryptosporidiosis usually results in acute and self-limited diarrhoea; however, it can cause life threatening diarrhoea in children and immunocompromised individuals. In the present study, we compared the prevalence of Cryptosporidium species and gp60 subtypes amongst paediatric oncology patients with diarrhoea (n=160) from King Hussein Medical Centre for Cancer in Jordan, and non-oncology paediatric patients with diarrhoea (n=137) from Al-Mafraq paediatric hospital. Microscopy results using modified acid fast staining identified a significantly (p≤0.05) higher prevalence of Cryptosporidium in paediatric oncology patients with diarrhoea (14.4% - 23/160), compared to non-oncology paediatric patients with diarrhoea only (5.1% - 7/137). With the exception of one sample, all microscopy-positive samples (n=29) and an additional 3/30 microscopy-negative controls were typed to species and subtype level at the 18S and gp60 loci, respectively. All Cryptosporidium positives were typed as C. parvum. Of the 22 typed Cryptosporidium positives from the paediatric oncology patients, 21 were subtyped as IIaA17G2R1 and one as IIaA16G2R1 C. parvum subtypes. The 7 typed positives from the paediatric patients from Al-Mafraq hospital were subtyped as IIaA17G2R1 (n=5) and IIaA16G2R1 (n=2). The 3 additional positives from the 30 microscopy negative control samples were subtyped as IIaA17G2R1. The high prevalence of the IIaA17G2R1 subtype, particularly amongst oncology patients, suggests that an outbreak of cryptosporidiosis may have been occurring in oncology patients during the collection period (April to December, 2016). New therapies for cryptosporidiosis in immunocompromised patients are urgently required.

Comparison of parasitological techniques for the diagnosis of intestinal parasitic infections in patients with presumptive malabsorption

Intestinal parasitic infections still remain a public health problem, overall in tropical and subtropical regions. Frequently, patients with malabsorption syndrome can be infected with intestinal parasites, independent that they could be the etiological agents. To compare three coproparasitological techniques Paratest^®, Ritchie and direct wet mount for the diagnosis of intestinal parasitic infections in patients with suspected malabsorption syndrome. A descriptive cross sectional survey was carried out in 82 patients with presumptive symptoms of intestinal malabsorption. Three consecutive stool samples were collected from every patient and they were analyzed by three coproparasitological techniques. The degree of agreement was almost perfect when all parasitological techniques were compared for all protozoan infections. Nevertheless, the agreement between Paratest^® and Ritchie's methods was slightly lower because this last method was superior for intestinal infections with commensals. The technique of Ritchie showed 100% of sensitivity for protozoa infections in general. However, the direct wet mount and the Paratest^®, showed lower sensitivity. When all techniques were compared only for infections with no pathogenic protozoa, the Paratest^® had the lowest sensitivity, and less predictive value for negatives. Ritchie's method showed a higher superiority than Paratest^® for the diagnosis of intestinal protozoa infections in this group of patients. We would recommend the evaluation of new techniques in local conditions before to decide the introduction in the public health network of laboratories.