Abstract
Introduction: Immunity forms the backbone of our very existence and opportunistic infections have plagued the immunosuppressed since long. A significant morbidity and mortality is attributable to intestinal parasitosis in the immunocompromised population. Objectives: This study aims to study the prevalence of intestinal protozoa in various immunosuppressed groups and to correlate degree of immunosuppression with protozoal infections. Material and Methods: The study was conducted on 400 patients divided into 4 groups: Group I (HIV patients), Group II (patients on chemotherapy/chemotherapy and radiotherapy for various malignancies), and Group III (diabetes patients) and Group IV included children presenting with diarrhea. Group I, II and III included patients with and without gastrointestinal symptoms. Stool samples were investigated microscopically for cysts/trophozoites after concentration with formol-ether method. Iodine wet mount and Modified acid fast staining methods were used. Result: Intestinal protozoa were detected in 40.75% (163/400); more commonly in patients with higher degree of immunosuppression (CD4 count 7: 95.3% in diabetics and moderate to severe malnutrition: 61.8%. Most common protozoa associated was Cryptosporidium in 66 patients (40.5%) followed by, Entamoeba histolytica in 48 (29.4%), Giardia lamblia in 35 (21.5%), Isosporabelliin 9 (5.5%), Blastocystis hominis in 4 (2.5%), Cyclospora cayetenensis in 1 (0.61%). Conclusion: High prevalence of intestinal protozoa was seen in all groups of immunosuppressed patients and a significant association seen between degree of immune suppression and protozoal infection. Focus needs to be on routine screening of all immunosuppressed patients and their immune reconstitution.
Highlights
Immunity forms the backbone of our very existence and opportunistic infections have plagued the immunosuppressed since long
High prevalence of intestinal protozoa was seen in all groups of immunosuppressed patients and a significant association seen between degree of immune suppression and protozoal infection
Focus needs to be on routine screening of all immunosuppressed patients and their immune reconstitution
Summary
Immunity forms the backbone of our very existence and opportunistic infections have plagued the immunosuppressed since long. Among different pathogens causing gastrointestinal infection, parasites are likely to have significant role as primary cause of co-morbidity of diarrhea in the immunocompromised. Previous studies on immunocompromised populations (HIV, malignancy, and others), which mainly comprised adults, reported variable prevalence (2-50%) of intestinal parasitic infections with different etiologic patterns [1,2]. This is the first study done in India to the best of our knowledge that includes various immunocompromised patients of different age groups and correlates the level of immunosuppression with the opportunistic protozoal infections
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