Prevalence of enteric pathogens in HIV patients with chronic diarrhoea and their relationship with CD4 count
DOI:
https://doi.org/10.18203/2349-3933.ijam20184763Keywords:
CD4 count, Diarrhoea, HIV, Intestinal pathogensAbstract
Background: HIV presently accounts for the highest number of deaths attributable to any single infective agent. Opportunistic infections (OIs) and associated complications account for a considerable proportion of such mortality. Diarrhoea is among the most common symptom of HIV infection. During the natural course of HIV infection, there is a progressive loss of CD4 T cells. Autors’ aim is to study the prevalence of enteric pathogens in HIV patients with chronic diarrhea and their relationship with CD4 count.
Methods: We analysed 186 HIV positive patients out of which 126 had chronic diarrhea and 60 patients presenting without diarrhea as controls. The faecal samples were subjected to microscopic examination. Zeihl Neelson’s Stain for mycobacterium, Kinyoun’s acid fast stain for microsporodia, stool culture for salmonella and shigella. All patients had barium meal contrast studies, USG of abdomen and pelvis. FNAC of peripheral lymph nodes and finally CD4+ Tcell count using BD FACS.
Results: Total of 68,10,01 patients of HIV diarrhoea with identifiable cause had CD4 <200, 200-250 and >350 respectively. Among HIV diarrhoea without any identifiable cause 22, 17, 08 patients had CD 4 <200, 200-250 and >350 respectively. All diarrhoeal stool samples with Isopora had CD 4 <200, M. tuberculosis 26 patients CD4 <200, 12 had 200-350 and 03 had >350. Microsporodium 03 patients had CD4 >350. Finally, among stool samples with Cyclospora, E. histolytica, Giardia and Strongyloides all patients had CD 4<200.
Conclusions: The present study highlights the importance of testing intestinal pathogens in HIV. Chronic diarrhoea was more common in patients with low CD4 counts.
References
Fact sheet. Latest global and regional statistics on the status of the AIDS epidemic. UNAIDS. 2017. Available at: http://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf.
Global AIDS update. UNAIDS. 2016. Available at: http://www.unaids.org/sites/default/files/media_asset/global-AIDS-update-2016_en.pdf
Ending AIDS: Progress towards the 90-90-90 targets. UNAIDS. 2017. Available at: http://www.unaids.org/en/resources/documents/2017/20170720_Global_AIDS_update_2017
Uppal B, Kashyap B, Bhalla P. Enteric pathogens in HIV/AIDS from a tertiary care hospital. Indian J Community Med. 2009 Jul;34(3):237-42.
Attili SV, Gulati AK, Singh VP, Varma DV, Rai M, Sundar S. Diarrhea, CD4 counts and enteric infections in a hospital–based cohort of HIV-infected patients around Varanasi, India. BMC Infectious Dis. 2006 Dec;6(1):39.
Gupta S, Narang S, Nunavath V, Singh S. Chronic diarrhoea in HIV patients: prevalence of coccidian parasites. Indian J Med Microbiol. 2008 Apr 1;26(2):172-5.
Manatsathit S, Tansupasawasdikul S, Wanachiwanawin D, Setawarin S, Suwanagool P, Prakasvejakit S, et al. Causes of chronic diarrhea in patients with AIDS in Thailand: a prospective clinical and microbiological study. J Gastroenterol. 1996 Aug 1;31(4):533-7.
Prasad KN, Nag VL, Dhole TN, Ayyagari A. Identification of enteric pathogens in HIV-positive patients with diarrhoea in northern India. J Health Population Nutrition. 2000 Jun 1:23-6.
Joshi M, Chowdhary AS, Dalar PJ, Maniar JK. Prevalence of intestinal parasitic pathogens in HIV-seropositive individuals in Northern India. Natl Med J India. 2002;15(2):72-4.
Guidelines for Management and treatment of OI’s and Malignancies in HIV/AIDS. NACO; 2007. Available at: http://naco.gov.in/sites/default/files/Guidelines.
Kulkarni SV, Kairon R, Sane SS, Padmawar PS, Kale VA, Thakar MR, et al. Opportunistic parasitic infections in HIV/AIDS patients presenting with diarrhoea by the level of immunesuppression. Indian J Med Res. 2009 Jul 1;130(1):63-6.
Joshi MA, Chowdhary AS, Dalai PJ, Maniar JK. Parasitic diarrhoea in patients with AIDS. National Med J India. 2002 Mar 1;15(2):72-4.
Mohandas K, Sehgal R, Sud A, Malla N. Prevalence of intestinal parasitic pathogens in HIV-seropositive individuals in Northern India. Japanese J Infectious Dis. 2002 Jun 1;55(3):83-4.
Al-Megrin WA. Patients in Riyadh, Saudi Arabia. Pak J Biol Sci. 2010;13(8):390-4.
Khumalo-Ngwenya B, Luo NP, Chintu C, Sunkutu R, Sakala-Kazembe F, Baboo KS, et al. Gut parasites in HIV-seropositive Zambian adults with diarrhoea. East African Med J. 1994 Jun;71(6):379-83.
Sharma SK, Mohan A, Kadhiravan T. HIV-TB co-infection: epidemiology, diagnosis and management. Indian J Med Res. 2005 Apr 1;121(4):550-67.
Scott B. Diagnostic Microbiology. 12th Ed, Mosby; 2006.
Akinbo FO, Okaka C, Omoregie R. Prevalence of intestinal parasitic infections among HIV patients in Benin City, Nigeria. Libyan J Med. 2010 Jan 1;5(1):5506.
HIV and Tuberculosis. API; Medicine update. 2005;147:726-30.
