Cell-mediated Immune Function Research Articles

Transcriptome Profiles Characteristics of the Peripheral Immune in Patients with Severe Fever with Thrombocytopenia Syndrome.

Severe fever with thrombocytopenia syndrome (SFTS) is an acute viral infection disease with a high mortality, but there are no specific effective drugs or vaccines available for use. To develop effective treatment methods, more basic researches are urgently needed to elucidate the response mechanisms of patients. Here, we conducted the transcriptomic analysis of peripheral immunity in 14 SFTS patients, ranging from moderate infection to severe and fatal disease. The results showed orderly cytokine signaling pathway modulation in moderate patients, cellular immunosuppression in severe patients, and significant dysregulation of the inflammatory response and coagulation dysfunction characteristic of deceased patients. In addition, WGCNA further showed a significant positive correlation between fatal outcomes and B cell and immunoglobulin mediated immune function modules, as well as a significant negative correlation with coagulation function modules. Overall, our research findings systematically observed potential immune mechanisms underlying clinical symptom heterogeneity and noteworthily revealed multiple signaling pathways leading to coagulation dysfunction in fatal outcomes, not just related to decreased platelet count, which can further elucidate the interaction between viruses and hosts and contribute to clinical treatment.

Integrative approach in managing oral lichen planus

Oral lichen planus (OLP) is a well-known chronic inflammatory disorder which is linked with alteration in functioning of cell-mediated immune function. It is characterised by repeated exacerbations, prolonged evolution, pain, resistant to treatment, thus affecting the quality of life of patients. The present review focuses on treatment strategies of OLP and how these methods improve the quality of life of patient. The main aim of OLP therapy is reducing the symptoms and eliminating the occurrence of mucosal related lesions, along with reduction of oral cancer risk. The common treatment modalities are laser, ultraviolet irradiation, immunomodulatory agents, corticosteroids, retinoids etc.

The changing landscape of infections in the lung transplant recipient.

Infections in lung transplant recipients remain a major challenge and can affect lung allograft function and cause significant morbidity and mortality. New strategies for the prevention and treatment of infection in lung transplantation have emerged and are reviewed. For important vaccine preventable infections (VPIs), guidance has been updated for at risk solid organ transplant (SOT) recipients. However, data on the efficacy of newer vaccines in lung transplant, including the respiratory syncytial virus (RSV) vaccine, are limited. Studies demonstrate improved vaccination rate with Infectious Diseases consultation during pretransplant evaluation. Two new antiviral agents for the treatment and prevention of cytomegalovirus (CMV) in SOT, letermovir and maribavir, are being incorporated into clinical care. CMV-specific cell-mediated immune function assays are more widely available. Antibiotics for the management of multidrug resistant pathogens and Burkholderia cepacia complex have been described in case series and case reports in lung transplant. Although new vaccines and novel therapies for preventing and treating infections are available, larger studies evaluating efficacy in lung transplant recipients are needed.

Good's syndrome: brief overview of an enigmatic immune deficiency.

Good's syndrome, an infrequent adult-onset immunodeficiency is characterized by the triad of thymoma, hypogammaglobulinemia, and increased susceptibility to recurrent infections. The clinical presentation is highly variable, with a spectrum ranging from recurrent bacterial and opportunistic infections to concomitant autoimmune diseases and, sometimes malignant pathologies. Due to heterogeneous clinical phenotypes and the lack of adequate diagnostic criteria, its recognition is often challenging, even delaying it by years. It is one of the most unusual, less studied form of the immune deficiency syndromes with a still unknown pathophysiology. It was initially considered a thymoma-associated variant of primary antibody deficiencies with a reduced or absent number of mature B cells, but it later emerged that significant defects of T cell-mediated immune functions are the underlying cause of opportunistic infections. On the basis of current evidence, Good's syndrome is evaluated as a distinct acquired form of combined immunodeficiency states and classified as a phenocopy of primary immunodeficiency diseases. Epigenetic and acquired genetic factors can play an ultimate role in its evolution.

Perceived income inadequacy is associated with Epstein-Barr Virus latency and mental health outcomes in informal caregivers who are also employed in the healthcare industry

Finances are a prevalent source of stress. In a sample of 799 nursing home workers measured multiple times over 18 months, we found that higher perceived income inadequacy, the perception that one's expenses exceeds one's incomes, was associated with poorer self-reported mental health indicators and Epstein-Barr Virus antibody titers (a marker of cell-mediated immune function). Perceived income inadequacy predicted outcomes over and above the role of other socioeconomic status variables (objective household income and education). Mental health variables were not related to Epstein-Barr Virus antibody titers. Additionally, we found an interaction between perceived income inadequacy and informal caregiver status on our mental health outcomes; informal caregivers with higher perceived income inadequacy had poorer mental health than non-caregivers with the same perceived income inadequacy. Our findings may add nuance to the reserve capacity model, which states that those at lower socioeconomic levels are at higher risk of adverse health outcomes partly because they have fewer resources to address demands and strain. Perceived income inadequacy may significantly predict mental and physical well-being beyond other socioeconomic status variables, especially among lower-income employees. Caregiving stress and perceived income inadequacy may have synergistic effects on mental health.

A Case Study on the Ayurvedic Management of Childhood Atopic Dermatitis

Atopic Dermatitis (AD) is a chronic inflammatory skin condition with impaired cell-mediated immune function and compromised skin barrier. It is characterized by erythema, oedema, vesicles, oozing in the acute stage, and thickening and hyperpigmentation (lichenification) in the chronic stage. The incidence of skin diseases is increasing day by day. Other medical systems provide temporary relief but not a complete cure. Ayurveda can contribute remarkably in the management of skin problems. Atopic dermatitis comes under Twak vikaras which can be correlated with Charmadala described in Kashyapa samhitha. This is the case report of a nine-year-old girl with dry, itchy and scaly skin associated with blackish excoriated lesions and oozing. She visited the outpatient department of Government Ayurveda Hospital. Ayurveda medications were administered along with dietary advice for a period of three weeks, followed by inpatient treatment with internal medications along with Snehapana (intake of ghee) followed by Vamana (emesis) and external procedures like Dhara (pouring of medicated liquids) with Kushtahara (alleviates itching) and Kandughna (anti-pruritic) Dravyas along with dietary advice for a period of one month. Encouraging results were observed in the form of a reduction in itching, dryness, and excoriation. The efficacy of the treatment was assessed using SCORAD (scoring atopic dermatitis scale), where the pre-value is 54.7 and the post-value is 17. On POEM (patient-oriented eczema measure) scale evaluation the condition changed from severe eczema to clear or almost clear. Dietary restrictions and internal medication must be continued to prevent the recurrence of the condition.

Hormonal and immunological responses of Holstein dairy cows from late lactation to the dry period and from the dry period to early lactation

Parturition and dry-off are challenging events for dairy cows partially due to changes in endocrine responses. The aim of this experiment was to evaluate blood concentrations of cortisol and prolactin and their effects on proliferation of peripheral blood mononuclear cells (PBMC) with or without stimulation by common immune cell mitogens (lipopolysaccharide [LPS], and concanavalin A [ConA]) of multiparous dairy cows from late lactation to the dry period and from the dry period to early lactation. Two groups of cows were enrolled: cows from late lactation to the dry period enrolled at 8 d before dry-off (LTD, n = 6, days in milk at dry-off = 332 ± 41 d) and cows from the dry period to early lactation enrolled at 7 d before expected calving date (DTL, n = 7). Blood was collected on d -8, 3, 7, and 15 relatives to dry-off for LTD cows, and on d -7, 3, 7, and 21 relatives to calving for DTL cows to analyze circulating stress hormones and to isolate PBMC. The PBMC were stimulated in vitro with prolactin (PRL), hydrocortisone (HDC), LPS, ConA, PRL + LPS, PRL + ConA, HDC+LPS, and HDC + ConA to assess proliferative responses. Plasma cortisol and PRL concentrations of LTD and DTL cows were not affected by time. Regardless of time, addition of HDC reduced PBMC proliferation stimulated by LPS, but PRL had no effect. No time effect was observed for proliferation of PBMC collected from LTD cows, but PBMC collected at 21 d after calving had higher proliferative responses to LPS and ConA than those from late dry period or early lactation. In conclusion, results from this experiment confirmed the lower PBMC proliferation during the transition period from the final week of gestation to early lactation and suggested that cows transitioning from late lactation to dry period maintained unchanged cell-mediated immune function.

Impact of depression on the quality of sleep and immune functions in patients with coronary artery disease

BackgroundThe risk of major depressive disorder (MDD) and insomnia is higher in patients with coronary heart disease (CHD) than in the general population. In addition, immune inflammation may be a...

Neutrophil-to-lymphocyte ratio as a potential biomarker in predicting influenza susceptibility.

BackgroundHuman population exposed to influenza viruses exhibited wide variation in susceptibility. The ratio of neutrophils to lymphocytes (NLR) has been examined to be a marker of systemic inflammation. We sought to investigate the relationship between influenza susceptibility and the NLR taken before influenza virus infection.MethodsWe investigated blood samples from five independent influenza challenge cohorts prior to influenza inoculation at the cellular level by using digital cytometry. We used multi-cohort gene expression analysis to compare the NLR between the symptomatic infected (SI) and asymptomatic uninfected (AU) subjects. We then used a network analysis approach to identify host factors associated with NLR and influenza susceptibility.ResultsThe baseline NLR was significantly higher in the SI group in both discovery and validation cohorts. The NLR achieved an AUC of 0.724 on the H3N2 data, and 0.736 on the H1N1 data in predicting influenza susceptibility. We identified four key modules that were not only significantly correlated with the baseline NLR, but also differentially expressed between the SI and AU groups. Genes within these four modules were enriched in pathways involved in B cell-mediated immune responses, cellular metabolism, cell cycle, and signal transduction, respectively.ConclusionsThis study identified the NLR as a potential biomarker for predicting disease susceptibility to symptomatic influenza. An elevated NLR was detected in susceptible hosts, who may have defects in B cell-mediated immunity or impaired function in cellular metabolism, cell cycle or signal transduction. Our work can serve as a comparative model to provide insights into the COVID-19 susceptibility.

Hepatitis B–Related Hepatic Flare During Immune Reconstitution Syndrome After Antiretroviral Treatment Initiation in an HBV Surface Antigen–Positive Patient With HIV: Viroimmunological and Histological Characterization

HIV and hepatitis B virus (HBV) coinfection is relatively common. Initiation of antiretroviral therapy (ART) in people with HIV (PWH) causes a progressive restoration of cell-mediated immune functions. In the presence of overt or occult coinfections, immune restoration might lead to immune reconstitution inflammatory syndrome (IRIS). Here, we describe the clinical, immunological, virological, and histological characterization of a case of HBV-related IRIS hepatitis in a PWH after ART initiation. A liver biopsy was performed during HBV-related IRIS hepatic flare, and liver samples were analyzed through immunohistochemistry and molecular techniques, with the assessment of intrahepatic HBV-DNA, covalently closed circular DNA, and HBV pregenomic RNA through a droplet digital polymerase chain reaction system. Immune activation and senescence were also longitudinally assessed. In this clinical case, the hepatic flare occurred 6 weeks after ART initiation with a therapeutic regimen including tenofovir alafenamide (TAF) and emtricitabine (FTC). The episode was self-limiting, characterized by hyperactivation of peripheral blood CD4+ and CD8+ T-lymphocytes, and resolved without ART discontinuation, leading to the achievement of HBsAg seroconversion (HBsAg-/HBsAb+) and HBV-DNA plasma undetectability. Notably, hyperactivation of the immune system plays a pivotal role in promoting the control of HBV replication, thus triggering the achievement of HBsAg seroconversion during treatment with TAF/FTC.

Peroxisomes Regulate Cellular Free Fatty Acids to Modulate Mast Cell TLR2, TLR4, and IgE-Mediated Activation.

Mast cells are specialized, tissue resident, immune effector cells able to respond to a wide range of stimuli. MCs are involved in the regulation of a variety of physiological functions, including vasodilation, angiogenesis and pathogen elimination. In addition, MCs recruit and regulate the functions of many immune cells such as dendritic cells, macrophages, T cells, B cells and eosinophils through their selective production of multiple cytokines and chemokines. MCs generate and release multi-potent molecules, such as histamine, proteases, prostanoids, leukotrienes, heparin, and many cytokines, chemokines, and growth factors through both degranulation dependent and independent pathways. Recent studies suggested that metabolic shifts dictate the activation and granule content secretion by MCs, however the metabolic signaling promoting these events is at its infancy. Lipid metabolism is recognized as a pivotal immunometabolic regulator during immune cell activation. Peroxisomes are organelles found across all eukaryotes, with a pivotal role in lipid metabolism and the detoxification of reactive oxygen species. Peroxisomes are one of the emerging axes in immunometabolism. Here we identified the peroxisome as an essential player in MCs activation. We determined that lack of functional peroxisomes in murine MCs causes a significant reduction of interleukin-6, Tumor necrosis factor and InterleukinL-13 following immunoglobulin IgE-mediated and Toll like receptor 2 and 4 activation compared to the Wild type (WT) BMMCs. We linked these defects in cytokine release to defects in free fatty acids homeostasis. In conclusion, our study identified the importance of peroxisomal fatty acids homeostasis in regulating mast cell-mediated immune functions.

RAMP3 unexplored relevance for innate-T cell immunity

Abstract RAMP3 is a chaperon protein that aids in the transport, activity modulation and pharmacological switch of G-protein coupled receptors (GPCR). Chemokine receptors involved in immune cell recruitment and activation are GPCRs, but the role of RAMP3 in the function of the immune system has not been explored. Our lab found that Ramp3 gene is highly expressed in innate-like T cells in the lungs of mice, particularly for Mucosal-associated invariant T (MAIT) cells. Ramp3 KO mice have an increased absolute number of MAIT cells, while other innate T cells are not affected. These differences are even higher after vaccinations with a live attenuated Salmonella strain containing MAIT-cell antigens. Both at steady-state and after vaccination, Ramp3 KO mice MAIT cells have increased levels of CXCR6, a chemokine receptor that has been associated to lung homing and T cell maintenance in the periphery. Ramp3 KO mice also have a decreased proportion of IL17A-producing MAIT cells in the lung; IL-17-producing innate cells have been shown to be protective, for example following Streptococcus pneumoniae infection. Consistent with the MAIT17 decrease, there was increased bacterial burden after lung infections. While Ramp3 has been reported in several gene signatures related to T cell regulation, its role for T cell immunity has not been explored. This is the first evidence of the relevance of Ramp3 for immune cell function and host protection, influencing innate-like T cell mediated immune function and protection against lung bacterial infections. Supported by grants from NIH 5R01AI137230-04

Immune Infiltration and Clinical Outcome of Super-Enhancer-Associated lncRNAs in Stomach Adenocarcinoma.

Super-enhancers (SEs) comprise large clusters of enhancers that highly enhance gene expression. Long non-coding RNAs (lncRNAs) tend to be dysregulated in cases of stomach adenocarcinoma (STAD) and are vital for balancing tumor immunity. However, whether SE-associated lncRNAs play a role in the immune infiltration of STAD remains unknown. In the present study, we identified SE-associated lncRNAs in the H3K27ac ChIP-seq datasets from 11 tumor tissues and two cell lines. We found that the significantly dysregulated SE-associated lncRNAs were strongly correlated with immune cell infiltration through the application of six algorithms (ImmuncellAI, CIBERSORT, EPIC, quantiSeq, TIMER, and xCELL), as well as immunomodulators and chemokines. We found that the expression of SE-associated lncRNA TM4SF1-AS1 was negatively correlated with the proportion of CD8+ T cells present in STAD. TM4SF1-AS1 suppresses T cell-mediated immune killing function and predicts immune response to anti-PD1 therapy. ChIP-seq, Hi-C and luciferase assay results verified that TM4SF1-AS1 was regulated by its super-enhancer. RNA-seq data showed that TM4SF1-AS1 is involved in immune and cancer-related processes or pathways. In conclusion, SE-associated lncRNAs are involved in the tumor immune microenvironment and act as indicators of clinical outcomes in STAD. This study highlights the importance of SE-associated lncRNAs in the immune regulation of STAD.

COVID-19 vaccine development based on recombinant viral and bacterial vector systems: combinatorial effect of adaptive and trained immunity.

Severe acute respiratory syndrome coronavirus 2 virus (SARS-CoV-2) infection, which causes coronavirus disease 2019 (COVID-19), has led to many cases and deaths worldwide. Therefore, a number of vaccine candidates have been developed to control the COVID-19 pandemic. Of these, to date, 21 vaccines have received emergency approval for human use in at least one country. However, the recent global emergence of SARS-CoV-2 variants has compromised the efficacy of the currently available vaccines. To protect against these variants, the use of vaccines that modulate T cell-mediated immune responses or innate immune cell memory function, termed trained immunity, is needed. The major advantage of a vaccine that uses bacteria or viral systems for the delivery of COVID-19 antigens is the ability to induce both T cell-mediated and humoral immune responses. In addition, such vaccine systems can also exert off-target effects via the vector itself, mediated partly through trained immunity; compared to other vaccine platforms, suggesting that this approach can provide better protection against even vaccine escape variants. This review presents the current status of the development of COVID-19 vaccines based on recombinant viral and bacterial delivery systems. We also discuss the current status of the use of licensed live vaccines for other infections, including BCG, oral polio and MMR vaccines, to prevent COVID-19 infections.

Early life exposure to air pollution and cell-mediated immune responses in preschoolers

BackgroundExposure to air pollution has been linked with altered immune function in adults, but little is known about its effects on early life. This study aimed to investigate the effects of exposure to air pollution during prenatal and postnatal windows on cell-mediated immune function in preschoolers. MethodsPre-school aged children (2.9 ± 0.5 y old, n = 391) were recruited from a mother-child cohort study in Wuhan, China. We used a spatial-temporal land use regression (LUR) model to estimate exposures of particulate matter with aerodynamic diameters ≤2.5 μm (PM2.5) and ≤10 μm (PM10), and nitrogen dioxide (NO2) during the specific trimesters of pregnancy and the first two postnatal years. We measured peripheral blood T lymphocyte subsets and plasma cytokines as indicators of cellular immune function. We used multiple informant models to examine the associations of prenatal and postnatal exposures to air pollution with cell-mediated immune function. ResultsPrenatal exposures to PM2.5, PM10, and NO2 during early pregnancy were negatively associated with %CD3+ and %CD3+CD8+ cells, and during late pregnancy were positively associated with %CD3+ cells. Postnatal exposures to these air pollutants during 1-y or 2-y childhood were positively associated with IL-4, IL-5, IL-6, and TNF-α. We also observed that the associations of prenatal or postnatal air pollution exposures with cellular immune responses varied by child's sex. ConclusionsOur results suggest that exposure to air pollution during different critical windows of early life may differentially alter cellular immune responses, and these effects appear to be sex-specific.

Urinary neopterin of wild chimpanzees indicates that cell-mediated immune activity varies by age, sex, and female reproductive status

The study of free-living animal populations is necessary to understand life history trade-offs associated with immune investment. To investigate the role of life history strategies in shaping proinflammatory cell-mediated immune function, we analyzed age, sex, and reproductive status as predictors of urinary neopterin in 70 sexually mature chimpanzees (Pan troglodytes) at Ngogo, Kibale National Park, Uganda. In the absence of clinical signs of acute infectious disease, neopterin levels significantly increased with age in both male and female chimpanzees, as observed in humans and several other vertebrate species. Furthermore, males exhibited higher neopterin levels than females across adulthood. Finally, females with full sexual swellings, pregnant females, and post-reproductive females, the oldest individuals in our sample, exhibited higher neopterin levels than lactating females and cycling females without full swellings. Variation in females’ neopterin levels by reproductive status is consistent with post-ovulatory and pregnancy-related immune patterns documented in humans. Together, our results provide evidence of ample variation in chimpanzee immune activity corresponding to biodemographic and physiological variation. Future studies comparing immune activity across ecological conditions and social systems are essential for understanding the life histories of primates and other mammals.

Density-dependence of nestling immune function and physiological condition in semi-precocial colonial bird: a cross-fostering experiment

BackgroundNesting in large aggregations provides several important advantages for colonially breeding birds. However, it also imposes certain costs, associated with facilitated pathogen transmission and social stress. The cost-benefit ratio is not similar for all the birds in a colony and it might be mediated by nest density. To investigate the influence of nest density on cell-mediated immune function and on physiological condition of nestlings, we arranged a cross-fostering experiment in three breeding colonies of black-headed gulls Chroicocephalus ridibundus. First, we exchanged eggs between plots of high and low nest density. Afterwards, we performed phytohaemagglutinin (PHA) skin test and we measured blood haemoglobin concentration in nearly 350 nestlings from experimental (exchanged) and control (non-exchanged) groups.ResultsWe found that PHA response was lowest in high nest density control group, indicating that depressed immune function of offspring, likely caused by social stress, can be considered as a cost of colonial breeding. Contrastingly, body condition of nestlings was the poorest in low density control group.ConclusionNestlings hatched and raised in high nest density plots did not have higher blood haemoglobin concentration in comparison to other study groups. Furthermore, they were affected with depressed cell mediated immune function, which is possibly driven by combined maternal (corticosteroid hormones deposited in yolk) and environmental (elevated social stress) effects. These results indicate that breeders from high nest densities do not benefit by rising offspring in better quality, in terms of immune function and body condition, although, in the light of previous studies, high nest densities are occupied by birds of higher individual quality, than low density areas. Our study provides a novel insight into the mechanisms of density-dependence that govern fitness of colonially nesting birds.

Effect of Exercise Intensity on Cell-Mediated Immunity.

Moderate-intensity exercise is considered to enhance immune function and to be useful for preventing acute upper respiratory infections and similar conditions. Many people practice low-intensity short-duration exercise with the expectation of a beneficial effect on immunocompetency. However, it is difficult to affirm the existence of definite evidence of such a benefit. In this article, we discuss the effects of low-intensity short-duration exercise on cell-mediated immunity, and contrast them to the effects of high-intensity and long-duration exercise. Whereas high-intensity exercise induces inflammation and reduces cell-mediated immune system function, low-intensity exercise does not appear to have a large effect on either inflammation or cell-mediated immune function. Low-intensity exercises such as walking and yoga, which are helpful to relieve stress, cannot be considered as harmful to the immune system. Although yoga was shown to impose fewer restrictions on breathing and physical strain, the evidence that yoga enhances cell-mediated immunity remains insufficient. Therefore, further studies are needed to examine the exercise mode that may be most effective for improvement of immune functions.

Immunohistochemical Detection of Aflatoxin in Lesions of Aflatoxin-producing Aspergillus flavus Infection.

To evaluate the presence of aflatoxin in infectious lesions as well as how the toxin is taken up by leukocytes. Pathological specimens from a patient who died from aspergillosis caused by aflatoxin-producing A. flavus were used. Anti-aflatoxin B1 antibody was reacted with paraffin-embedded lesion specimens from the heart, kidney, and thyroid gland of the patient and observed microscopically. Positive reactions were detected in fungal elements and leukocytes (neutrophils and macrophages) in inflammatory lesions. Within the patient's body, A. flavus likely produced aflatoxin, which then was taken up by neutrophils and macrophages.These results suggest that leukocyte function and the immune mechanism are locally suppressed by aflatoxin.

A study of intestinal parasitic infections in HIV infected individuals in Puducherry

Introduction: Human immuno deficiency virus infection has become a pandemic. Infection with HIV results in a chronic illness characterized by a progressive decline in cell-mediated immune function. Diarrhoea occurs in almost 90% of patients with HIV in developing countries at sometime during the clinical course, and is the presenting symptom of approximately one third of patients with HIV infection. Aims: To find out the common enteric parasitic pathogens in the HIV infected individuals. To correlate the immune status to the parasitic infection. To find out the symptomatic correlation to the pathogens. Settings and Design: The cross sectional study was carried out in Puducherry for a period of 15 months. Materials and Methods: Two consecutive stool samples were collected from from HIV seropositive patients. The samples were concentrated and subjected to stool concentration, iodine and saline mounts & Kinyoun’s staining. Statistical analysis used: Epi info 6 computer software package [CDC, Atlanta, Georgia, USA, 1995]. Results: Of the 22 diarrhoeic stools of HIV cases, 7(31.8%) yielded parasites on Kinyoun’s staining; all 7(100%) were opportunistic protozoan pathogens. The prevalence of intestinal parasites among the HIV infected patients is as follows: Cryptosporidium sp. and Microsporidium sp., each were found in 6.3% of HIV seropositive cases. Strongyloides was seen in 2.5% of 80 seropositive cases. The mean CD4 counts in cases with parasites are listed as follows: Cryptosporidium sp.-133.2 cells, Microsporidium sp.-896 cells, Strongyloides stercoralis-228.5, Entamoeba histolytica/dispar-522 cells, Giardia sp. - 884 cells. Cryptosporidium sp. and Strongyloides stercoralis are found more in HIV seropositive cases with CD4 counts less than 200 cells; (p=0.002, OR=36, 95% CI=4-56) for Cryptosporidium sp. and ( OR=14.6, 95% CI=1.5-39.6) for Strongyloides stercoralis. There is a significant correlation between CD4 counts Conclusions: The present study sho