Bacterial and Parasitic Agents of Infectious Diarrhoea in the Era of HIV and AIDS - The Case of a Semi Rural Community in South Africa

Abstract

Infection by the human immunodeficiency virus (HIV) is a worldwide public health concern. In the Southern African region, the HIV and AIDS pandemic has grown faster than in any other parts of the world, from infection rate, in pregnant women, of 0.8% in 1990 to 30.2% in 2005 in South Africa and 29.4% in 2009 (DOH, 2000; DOH, 2006; DOH 2010). Due to its destructive effect on the immune system, HIV infection further exposes the individual to multiple opportunistic infections. From the beginning of the HIV pandemics in the 1980s, gastrointestinal diseases have been demonstrated to be a major problem in patients with HIV and AIDS, and diarrhea is reported in up to 60% of patients with AIDS in developed countries and up to 90% in developing countries (Siddiqui et al., 2007; Silva et al., 2010). Recent studies by Bradshaw et al., (2005) have indicated that HIV/AIDS is the leading cause of premature mortality for all provinces in South Africa and mortality due to pretransitional causes, such as diarrhea, is more pronounced in the poorer and more rural provinces. In Limpopo Province as well as other poorer provinces in South Africa, diarrheal diseases are the first cause of mortality after HIV/AIDS (Bradshaw et al., 2005). However, data on specific etiologies is sparse (Obi and Bessong, 2002) and such information will be crucial in the specific management of HIV and AIDS. Although diarrheagenic organisms have been studied in different parts of the African continent, most research activities targeted specific organisms and their role in the production of diarrhea with little consideration to the presence of other organisms, their role in the production of inflammation which might be a considerable part of the pathogenesis of the organisms (Nel et al., 2010). Elsewhere, the combination of environmental factors, new ways of living and structural changes in the genetic material of most microorganisms have led to the appearance of emerging and re-emerging diseases (Lashley, 2006). Combined to the increasing recognition of a widening array of enteric pathogens associated with illnesses of the gastrointestinal tract, these factors highlight the growing need for the understanding