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High prevalence of diarrhoegenic intestinal parasite infections among non-ART HIV patients in Fitche Hospital, Ethiopia.

ABSTRACT: BACKGROUND: HIV infection has been modifying both the epidemiology and outcome of parasite infections. Hence, this study was undertaken to determine the prevalence of Cryptosporidium and other intestinal parasite infections among HIV positives with and without Antiretroviral Treatment(ART) and its association with CD4+ T-cell count. METHODS: A cross-sectional study was conducted at Fitche hospital focusing on HIV positives who came to hospital for follow-ups. A total of 378 HIV positive persons with and without ART participated in the study. Data on socio-demographic factors and diarrhoea status were obtained by interviewing all 214 with ART and 164 without ART. Stool samples were collected from all patients and examined for intestinal parasites using direct, formol-ether and modified acid-fast staining techniques. RESULTS: The prevalence of intestinal parasite infections in this study was significantly higher among HIV positive persons not on ART. Specifically, the rate of infection with Cryptosporidium species, Blastocystis spp., Giardia lamblia, and Entamoeba histolytica/E. dispar were higher, particularly in those with CD4+ T-cell counts less than 200 cells/µL. Fifty seven percent of the study participants were on ART. Out of these 164/378 (43%) of the non-ART study participants were infected with at least one intestinal parasite species. Significant association was observed between lower CD4+ T-cell count (<200 cells/µL) and the prevalence of Cryptosporidium spp. and Blastocystis spp. The two parasites were significantly more prevalent in HIV positive non-ART patients. CONCLUSION: HIV infection increased the risk of having Cryptosporidium and other intestinal parasites and diarrhoea. Therefore, raising HIV positive's immune status and screening for intestinal parasites is important. This study showed that patients who are taking ART had a lower prevalence of diarrhoea causing parasites and Cryptosporidium suggesting that ART through improvement of immune status of the patients may have contributed to controlling diarrhoea-causing parasites in HIV positive patients.

SUBMITTER: Adamu H

PROVIDER: S-EPMC3753330 | biostudies-other | 2013

REPOSITORIES: biostudies-other

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Project description:BackgroundThe Ethiopian epidemic is currently on the wane. However, the situation for infected children is in some ways lagging behind due to low treatment coverage and deficient prevention of mother-to-child transmission. Too few studies have examined HIV infected children presenting to care in low-income countries in general. Considering the presence of local variations in the nature of the epidemic a study in Ethiopia could be of special value for the continuing fight against HIV. The aim of this study is to describe the main characteristics of children with HIV presenting to care at a district hospital in a resource-limited area in southern Ethiopia. The aim was also to analyse factors affecting pre-ART loss to follow-up, time to ART-initiation and disease stage upon presentation.MethodsThis was a prospective cohort study. The data analysed were collected in 2009 for the period January 2003 through December 2008 at Arba Minch Hospital and additional data on the ART-need in the region were obtained from official reports.ResultsThe pre-ART loss to follow-up rate was 29.7%. Older children (10-14 years) presented in a later stage of their disease than younger children (76.9% vs. 45.0% in 0-4 year olds, chi-square test, ?2?=?8.8, P?=?0.01). Older girls presented later than boys (100.0% vs. 57.1%, Fisher's exact test, P?=?0.02). Children aged 0-4 years were more likely to be lost to follow-up (40.0 vs. 21.8%, chi-square test, ?2?=?5.4, P?=?0.02) and had a longer time to initiate ART (Cox regression analysis, HR: 0.50, 95% CI: 0.25-0.97, P?=?0.04, controlling for sex, place of residence, enrollment phase and WHO clinical stage upon presentation). Neither sex was overrepresented in the sample. Tuberculosis prevalence upon presentation and previous history of tubercolosis were 14.5% and 8% respectively.ConclusionsThe loss to follow-up is alarmingly high and children present too late. Further research is needed to explore specific causes and possible solutions.

Project description:The magnitude of intestinal parasitic infection in acquired immunodeficiency syndrome patients requires careful consideration in the developing world where poor nutrition is associated with poor hygiene and several tropical diseases. However, there have been very few studies addressing this issue in Cameroon. This study was conducted to determine the prevalence of intestinal parasitosis in HIV/AIDS patients in Dschang -Cameroon. Stool and blood specimens from HIV/AIDS patients and control group were screened respectively for intestinal parasites and for HIV antibodies. Intestinal parasites were identified using direct microscopy, formalin-ether concentration and Ziehl Neelsen methods. Out of 396 participants recruited among patients consulting at hospital, 42 (10.6%) were HIV positive, thirty of them treatment naïve. The overall prevalence of intestinal parasites was 14.64%. Out of 42 HIV/AIDS patients, 59.5% (25/42) were infected with intestinal parasites, while only 9.32% (33/354) of the HIV negative patients were infected with intestinal parasites. The parasites detected in our study population included Crystosporidium parvum (2.53%), Entamoeba histolytica (7.52%), Entamoeba coli (4.04%), Giardia lamblia (0.25%), Trichuris trichura (0.25%), Strongyloides stercoralis (0.25%) and Taenia spp. (0.25%). In the HIV infected group, Crystosporidium parvum (19.04%), Entamoeba histolytica (19.04%), Entamoeba coli (21.42%), Giardia lamblia (2.38%), Strongyloides stercoralis (0.25%) and Taenia spp. (0.25%) were found. Crystosporidium parvum was found to be significantly higher in HIV/AIDS patients than in controls (P<0.05). Multivariate analysis showed that the HIV status and the quality of water were the major risk factors for intestinal parasitosis. Routine examinations of stool samples for parasites would significantly benefit the HIV patients by contributing in reducing morbidity and improving the efficiency of antiretroviral treatment. Even after the introduction of free anti-retroviral drugs, opportunistic intestinal infections are still a threat. HIV patients should be screened routinely for intestinal parasites and treated for their overall well being.

Project description:BackgroundInfections with helminths and other intestinal parasites are an important but neglected problem in children in developing countries. Accurate surveys of intestinal parasites in children inform empirical treatment regimens and can assess the impact of school based drug treatment programmes. There is limited information on this topic in Cambodia.MethodsIn a prospective study of intestinal parasites in symptomatic children attending Angkor Hospital for Children, Siem Reap, Cambodia, April-June 2012, samples were examined by microscopy of a direct and concentrated fecal sample. Two culture methods for hookworm and Strongyloides stercoralis were employed when sufficient sample was received. Demographic, clinical and epidemiological data were collected.Principal findingsWe studied 970 samples from 865 children. The median (inter-quartile range) age of the children was 5.4 (1.9-9.2) years, 54% were male. The proportion of children with abdominal pain was 66.8%, diarrhea 34.9%, anemia 12.7% and malnutrition 7.4%. 458 parasitic infections were detected in 340 (39.3%) children. The most common parasites using all methods of detection were hookworm (14.3%), Strongyloides stercoralis (11.6%) and Giardia lamblia (11.2%). Giardia lamblia was most common in children aged 1-5 years, hookworm and Strongyloides stercoralis were more common with increasing age. Hookworm, Strongloides stercoralis and Giardia lamblia were more common in children living outside of Siem Reap town. In a multivariate logistic regression increasing age was associated with all three infections, defecating in the forest for hookworm infection, the presence of cattle for S. stercoralis and not using soap for handwashing for G. lamblia.Conclusions/significanceThis study confirms the importance of intestinal parasitic infections in symptomatic Cambodian children and the need for adequate facilities for laboratory diagnosis together with education to improve personal hygiene and sanitation.

Project description:BACKGROUND: Parasite infections often result in a switch of the human body's predominant immune reaction from T-helper 1 (Th1)-type to Th2-type. Hence, parasite infections are widely expected to accelerate the progression of human immunodeficiency virus (HIV) infections to acquired immunodeficiency syndrome (AIDS). In the People's Republic of China, both parasitic diseases and AIDS are epidemic in certain rural areas, and co-infections are relatively common. However, no population-based studies have yet investigated the frequency of HIV and parasite co-infections, and its effects on immune responses. We studied (1) the immune status of an HIV-infected population, and (2) the effect of co-infection of HIV and intestinal parasites on selected parameters of the human immune system. METHODS: A total of 309 HIV-infected individuals were recruited and compared to an age-matched and sex-matched control group of 315 local HIV-negative individuals. Questionnaires were administered to all participants to obtain information on sociodemographic characteristics, sanitation habits, family income, and recent clinical manifestations. Two consecutive stool samples and 10 ml samples of venous blood were also collected from each individual for the diagnosis of parasite infections and quantitative measurements of selected cytokines and CD4+ T-lymphocytes, respectively. RESULTS: During the study period, 79 HIV-infected individuals were not under highly active antiretroviral therapy (HAART) and were thus included in our analysis; the prevalence of intestinal helminth infections was 6.3% and that of protozoa was 22.8%. The most common protozoan infections were Blastocystis hominis (B. hominis) (13.9%) and Cryptosporidium spp. (10.1%). The prevalence of Cryptosporidium spp. in HIV-infected individuals was significantly higher than that in HIV negative individuals (P?<?0.05). Compared to the non-co-infected population, no significant difference was found for any of the measured immunological indicators (P?>?0.05). However, the following trends were observed: IFN-? levels were lower, but the IL-4 level was higher, in the population co-infected with HIV and helminths. In the population co-infected with HIV and B. hominis, the IL-2 level was higher. The population co-infected with HIV and Cryptosporidium spp. had markedly lower CD4+ T-lymphocyte counts. CONCLUSION: According to the immunologic profile, co-infection with helminths is disadvantageous to HIV-infected individuals. It was associated with a shift in the Th1/Th2 balance in the same direction as that caused by the virus itself, which might indicate an acceleration of the progress from an HIV infection to AIDS. Co-infection with Cryptosporidium spp. was not associated with a significant change in immune factors but co-infection with Cryptosporidium spp. was associated with a reduced level of CD4?+?T-lymphocytes, confirming the opportunistic nature of such infections. Co-infection with B. hominis, on the other hand, was associated with an antagonistic shift in the immunological profile compared to an HIV infection.

Project description:BackgroundIntestinal Parasitic Infections are the most prevalent diseases in the world, predominantly in developing countries. It is estimated that more than two billion people are affected globally, mostly in tropical and sub-tropical parts of the world. Ethiopia is one of the countries in Africa with a high prevalence of intestinal parasites. However, there is a limited study conducted in the study area. Hence, this study was to assess the prevalence and associated factors of intestinal parasitosis among patients attending at Sanja Primary Hospital, Northwest Ethiopia.MethodsAn institutional-based cross-sectional study was conducted at Sanja Primary Hospital from January 1 to August 20, 2019. Stool samples were collected from 1240 study participants and analyzed by direct wet mount and formal ether concentration techniques. Furthermore, sociodemographic and explanatory variables were collected using a face-to-face interview. Data were entered into Epi data version 4.4.2.1 and transferred to SPSS version 23 for analysis. Bivariate and multivariate binary logistic regression models were fitted to identify associated factors of intestinal parasitic infections. Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) was considered to ascertain the significance of the association.ResultsThe overall prevalence of intestinal parasitic infection was 52.9% (95% CI: 50.2%-55.5%). Entamoeba histolytica/dispar (21.5%) was the leading cause of intestinal parasitosis followed by Hookworm species (13.3%). Furthermore, the rate of double and triple parasitic infections was observed in 6.1% and 0.5% of study participants respectively. Being Illiterate (AOR: 2.87, 95% CI: 1.06-7.47, p = 0.038), swimming habits of more than 4 times a month (AOR = 2.91, 95% CI 1.62-5.24, p< 0.001) and not washing hands before a meal (AOR: 3.92, 95% CI: 1.74-8.83, p = 0.001) were the key factors significantly associated with intestinal parasitic infection.ConclusionsThe present study showed that the prevalence of intestinal parasitosis is high in the study area. Therefore, there is a need for an integrated control program, including improving personal, environmental sanitation and health education should be given to have a lasting impact on transmission.

Project description:BACKGROUND:Intestinal parasitic infection is one of the parasitic infections affecting people living in prison. Helminths and intestinal protozoan infections are the most common parasitic infection that may cause serious life-threatening diseases in inmates living in developing countries. This study was aimed to investigate the prevalence and associated factors of intestinal parasitic infections (IPIs) among inmates living in Arba Minch prison, southern Ethiopia. METHODS:Institutional based cross sectional study was conducted on Arba Minch inmates, southern Ethiopian. Pre-tested semi-structured questionnaire was used to gather the data of socio-demographic characteristics, hygiene status of the prisoners, sanitation condition of the prison, and associated factors for IPIs by face to face interview. Direct wet-mount examination and formol-ether sedimentation techniques were used to examine intestinal parasitic infection from stool specimens. Binary logistic regression analysis was used to see the association between different variables and the IPI. Odds ratio with 95% CI was computed to determine the presence association and strength of the associated factors. RESULT:A total of 320 prisoners were participated in this study. Of these, 154(48.1%) of them were infected with one or more intestinal parasites. Eight different intestinal parasites species were identified and Giardia lamblia was the predominant parasite. Among infected inmates, nearly one out of four of them had multiple parasitic infections dominated by Giardia lamblia and E. histolytica/dispar co-infection. Sleeping in group [AOR = 1.9; 95% CI: (1.0-3.8)], married prisoners [AOR = 1.8; 95% CI: (1.1-2.9)], and hand washing habits after handling soil [AOR = 2.4; 95% CI: (1.0-5.6)] were independently associated with IPI. CONCLUSION:High prevalence of intestinal parasitic infection was detected in Arba Minch inmates, southern Ethiopian. Absence of hand washing, marital status, and way of sleeping were the factors associated with the IPI. Implementation of mass drug administration, education on water, sanitation and hygiene (WASH) and periodic screening of intestinal parasitic infection is very important to reduce the high prevalence IPIs in prison.

Project description:Globally about one third of the total population is estimated to be infected with intestinal parasites, of which, the majority are people living in tropical and sub-tropical parts of the world. Cases of intestinal parasitosis are also highly abundant in Ethiopia and hence the aim of present study was to assess prevalence and predictors of intestinal parasitic infections among food handlers working in Arba Minch University students' cafeteria, South Ethiopia.A cross sectional study was conducted among food handlers working in Arba Minch University from April to June, 2015. A pretested structured questionnaire was used for collecting data about socio-demographic characteristics and possible risk factors. Stool specimens were collected and examined microscopically for the presence of eggs, cysts and trophozoites of intestinal parasites. Data entry and analysis were done using SPSS version 20 software.A total of 376 food handlers were enrolled in the study of which thirty one of them were not willing to participate for a stool examination. The majority of study participants were females 273 (72.6 %). About 123 (36 %) of food handlers were found to be positive for different intestinal parasites with the most abundant parasite of Entamoeba histolytica/dispar 48 (14 %) followed by Ascaris lumbricoides 32 (9.27 %). Finger nail status (AOR: 2.2, 95 % CI: 1.29-3.72), hand washing practice after toilet (AOR: 1.71, 95 % CI: 1.06-2.77), hand washing practice before food handling (AOR: 1.69, 95 % CI: 1.04-2.75), preparing food when suffering from diseases (AOR: 3.08, 95 % CI: 1.17-8.13), and using common knife for cutting raw flesh food and other food (AOR: 1.72, 95 % CI: 1.01-2.92) were independent predictors of intestinal parasitic infection among the food handlers.This study revealed a high prevalence of intestinal parasites among food handlers. Since most of the intestinal parasites are transmitted by the feco-oral route, food handlers could be an important source of infection to the students and general population. Therefore, constant epidemiological surveillance through biannual routine parasitological tests and treatment of the infected cases along with the improvement of personal hygiene and environmental sanitation are recommended to control the parasitic infection in food handlers.

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High prevalence of diarrhoegenic intestinal parasite infections among non-ART HIV patients in Fitche Hospital, Ethiopia.

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