Opportunistic Parasitic Infections Research Articles

Intestinal Protozoans among HIV Patients in a Rural Setting, Southern Nigeria

Opportunistic parasitic protozoan infections in HIV infected patients remain a worldwide public health concern. A cross sectional study on HIV patients was carried out in some parts of Imo State with a view of assessing the prevalence of intestinal protozoan parasites. Stool samples were collected and analysed applying standard techniques. Overall, four species of protozoan parasites were isolated namely, C.parvum, E.histolytica, G.lamblia and Ent. coli. Total prevalence is highest (52.2%) amongst the age group of ≤27 years, followed by 45-48years(27.8%) while the least prevalence(11.8%) is recorded for the age group of 49 years and above. More female (26.3%) were infected than male (25.4%). Significant association between age and protozoan prevalencewas noted(p-value=0.007; X2=32.998a, df=16). Further analysis selecting Cramer’s V which is the measure of association based on chi-square shows a weak dependence between age and parasite prevalence (Cramer’s V-value = 0.286). Pearson correlation shows a positive, weak (R=0.170; sig.=0.089c) relationship between age and protozoan parasite prevalence. Test of association between gender and intestinal protozoan parasites shows a non-significant association(p=0.280;X2=5.069a), weak dependence(Cramer’s V-value = 0.280) and a negative, weak relationship between gender and parasite prevalence(R=-0.042; sig=0.674c). Subjects with CD4count <200µ/ml recorded the highest(40.0%) prevalence of intestinal protozoan parasite while 200-349µ/ml recorded the least prevalence(4.0%).Significant association exists between CD4 count and parasite prevalence(x2=53.9a, df=12,p=0.001);then Cramer’s v test shows a medium-strong dependence. High prevalence (37.0%) of intestinal protozoan parasites is recorded for subjects not on HAART while low prevalence (12.8%) is recorded for those on HAART; with Significant association (x2=16.157a, df=4, p=0.003) and medium-strong dependence (Cramer’s v =0.40).The result of this study shows that intestinal parasites are of public health concern among immunocompromised individuals and calls for urgent attention of relevant stakeholders

Case Report: Neglected case of duodenal strongyloidiasis in an immunocompromised patient

Strongyloides stercoralis, one of the common opportunistic parasitic infections, affects a large population in many parts of tropical and subtropical regions and is often a neglected tropical disease. The parasite completes its life cycle inside the human host with a unique feature of autoinfection, persisting in the host indefinitely in dormant form and having the notorious ability to cause fetal complications in an immunocompromised individual. Many factors like corticosteroid therapy, immunosuppressive therapy for autoimmune diseases, human T lymphotropic virus, malignancy, malnutrition etc. can transform asymptomatic strongyloidiasis to fatal outcomes, from hyperinfection syndrome to parasite dissemination leading to increased risk of high mortality rates. It has been neglected in screening unless and until some clinical suspicion appeared during the course of treatment. Early diagnosis and treatment can mitigate the rapid disease activation and evolution in an immunocompromised patient. A mandatory but reliable parasite screening method should always be carried out before administering immunosuppressants, even though simple stool tests and serology are only used when suspicion arises. Our case involved a 50-year-old female on cyclophosphane for systemic lupus erythematous (SLE) who experienced repeated bouts of vomiting and loose stools. Even several days after admission, there was no satisfactory outcome with medical management; a duodenal biopsy was carried out, which revealed numerous larvae of Strongyloides stercoralis.

Prevalence of Intestinal Parasitic Infections and Genotypic Distribution with Risk Factors of Enterocytozoon bieneusi in HIV Patients of Maesai Hospital, Thailand

Co-infections of HIV and intestinal parasites including Enterocytozoon bieneusi (E. bieneusi) are a common cause of gastrointestinal syndrome in HIV-infected people. Our study was designed to detect infection rates of intestinal parasites and the genotypic distribution of E. bieneusi, as well as probable risk factors for infection in HIV patients at Maesai hospital, Chiang Rai, Thailand. Two hundred and twenty-four stool samples from enrolled HIV-infected participants were collected and examined for parasitic infections, using microscopy and polymerase chain reaction techniques. CD4 status as well as the demographic data of HIV-infected participants was also collected and analyzed. Intestinal parasites including E. bieneusi were detected in 4.02 % of all participants. The highest intestinal parasitic infection rate was E. bieneusi (2.23 %) followed by Strongyloides stercoralis (1.34 %), Opisthorchis viverrini (0.89 %) and Giardia intestinalis (0.45 %). Intestinal parasitic infection rate of participants with CD4 count ≤ 200 cells/mm3 was significantly higher than that of participants with CD4 counts > 200 cells/mm3 (12.50 % vs 2.63 %, p = 0.027). Correspondingly, the infection rate of E. bieneusi was significantly higher in participants with CD4 count ≤ 200 cells/mm3 than in participants with CD4 count > 200 cells/mm3 (9.38 % vs 1.05 %, p = 0.022). Two genotypes of E. bieneusi, including D (n = 3) and SH8 (n = 2), were identified from 5 participants. Both of the identified genotypes were likely a zoonotic transmission. Human infection by E. bieneusi genotype SH8 was a discovery for the first time in Thailand. However, no intestinal coccidian infections were diagnosed. The low numbers of intestinal parasitic infections of this study were probably due to wide availability of antiretroviral therapy, improved health sanitation, as well as ease of access to antiparasitic medication in HIV-infected people.
 HIGHLIGHTS
 
 We discovered that HIV patients at Maesai Hospital had a low prevalence of both opportunistic and non-opportunistic intestinal parasitic infections, which was probably due to health improvement and treatment availability
 We discovered Enterocytozoon bieneusi genotypes D and SH8 in HIV patients. Human infected with genotype SH8 was the first to be reported in Thailand
 Low levels of CD4 cells and contact with animals were considered to be risk factors for infection with bieneusi genotypes D and SH8
 
 GRAPHICAL ABSTRACT

Diarrhea in Solid Organ Transplant Recipients in the South Asian Region - Expert Group Opinion for Diagnosis and Management

Diarrhea after solid organ transplantation is a common problem. Posttransplant diarrhea can lead to dehydration, weight loss, graft dysfunction, frequent hospitalization and increased mortality. Posttransplant diarrhea is seen in 20%–25% of patients within 2 years of transplantation and it can be both due to infections and the drugs. The most common cause of drug causing diarrhea is mycophenolate mofetil, and tacrolimus. The common infective causes of diarrhea in posttransplant recipients include viral infections (norovirus, sapovirus, cytomegalovirus [CMV]), bacterial infections (Salmonella, Clostridium difficile, Aeromonas, Campylobactor, Enterotoxigenic, and Enterohemorrhagic Escherichia coli) and parasitic infections (Cryptosporidium, Giardia lamblia, Microsporidia Cyclospora, Strongyloidiasis etc.). Because of overall poor hygienic conditions, infective diarrhea is common in South Asian region. Since most cases of acute diarrhea are infective, and many with viral etiologies, conservative management using oral rehydration solution, antidiarrheal drugs, and where appropriate, a short course of antibiotics helps in the resolution of most cases. A detailed evaluation should be performed in patients with chronic diarrhea, recurrent diarrhea, and those with graft dysfunction. The evaluation of diarrhea should include stool microscopy for ova and cysts, special stains for opportunistic parasitic infection, and molecular diagnostic tools like multiplex Polymerase chain reaction. Colonoscopic and upper gastrointestinal endoscopic examination with biopsies are required to investigate for CMV infection, malabsorption syndrome, inflammatory bowel diseases and posttransplant lymphoproliferative disorder. Although the causes of diarrhea are numerous, an algorithmic approach should be followed both for the diagnosis and the treatment of diarrhea in an organ transplant recipient.

Prevalence of Cryptosporidium spp. in children and the elderly in southwestern Iran.

The current study investigated the prevalence of Cryptosporidium spp. among children under 6 and adults over 60 years of age with diarrhea in the southwest of Iran. Cryptosporidiosis is an opportunistic parasitic infection caused by the species Cryptosporidium that causes gastrointestinal complications and diarrhea. This cross-sectional study was conducted in Khuzestan province between January 2020 to December 2020. Out of 350 patients referring to medical centers with clinical signs of diarrhea, 57.4% were under six years of age and 42.6% were more than 60 years old. Fecal samples were examined using Modified Ziehl-Neelsen (MZN) staining and nested-PCR techniques. The overall prevalence of Cryptosporidium spp. infection in the study population was 0.9% as determined by microscopic and molecular methods (3/47). The study results confirm the prevalence of parasitic infections as reported in previous studies in other regions of Iran. Preventive health measures are necessary.

Intestinal Parasitosis and its Association with CD4+ T Cell Count and Viral Load among People Living with HIV in Parasite Endemic Settings of Northwest Ethiopia.

PurposeTo study intestinal parasitosis and its association with viral load and CD4+ T cell count in HIV-infected individuals at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.MethodsA cross-sectional study was conducted from March to June 2019. Three hundred and sixteen study participants were selected using systematic random sampling technique. Sociodemographic and clinical data were collected using structured questionnaire. Stool samples were collected and examined using direct saline, formol ether concentration technique and modified acid fast staining. CD4+ T cell counts and viral load were determined by fluorescence-activated cell sorting (BD FACS) and COBAS Ampliprep/COBAS TaqMan HI2CAP assay, respectively. Data were entered into Epi Data 3.1 and transferred to SPSS version 20 software for analysis. Bivariable and multivariable analyses were performed using a binary logistic regression model. P values of less than 0.05 were considered statistically significant.ResultsThe overall prevalence of intestinal parasitosis was 24.7% (78/316). The most commonly detected parasite was Cryptosporidium species with 5.4% (17/316), followed by Ascaris lumbricoides with 5.1% (16/316). There was a significant association with low CD4+ T cell count (AOR: 3.207; 95% CI: 1.237, 8.317), high viral load (AOR: 2.933; 95% CI: 1.326, 6.489), individuals aged 31–40 years (AOR: 0.305; 95% CI: 0.124, 0.751) and individuals aged 41–50 years (AOR: 0.261; 95% CI: 0.101, 0.671).ConclusionIn this study, prevalence of intestinal parasitic infections was high and was associated with low CD4+ T cell count and high viral load. Therefore, screening of HIV patients, especially those with low CD4+ T-cell count and high viral load, particularly for opportunistic intestinal parasitic infections would be of utmost importance in the efforts to prevent and control opportunistic infections in HIV patients.

Investigation of the relationship between lymphocyte subsets and intestinal parasites

We analyzed the peripheral blood lymphocyte subsets of cancer patients infected with intestinal parasites, with an aim to find out the relationship between the levels of different types of lymphocytes with the prognosis of patients. 201 cancer patients aged 18 and over were included. Stool samples of the patients were examined using native-lugol, trichrome, modified trichrome (Weber's Trichrome stain), and modified Ziehl-Neelsen staining methods. Microsporidia and Cryptosporidium parvum were investigated at the genus and species levels using PCR. Lymphocyte subsets were determined by flow cytometry in blood samples. One or more parasite species were detected in 115 (56.7%) patients. The most common parasite species were Microsporidia, Blastocystis and Entamoeba coli, respectively. The frequency of parasites was high in patients with low lymphocyte percentage, CD3+ T cell and CD3+ CD4+ T (Th) cell levels in blood samples studied by flow cytometry. Microsporidia infection was significantly higher in patients with low lymphocyte percentage and Th cell levels. Similarly, C. parvum infection was found to be significantly higher in patients with low T lymphocyte percentage and Th cell level. Finally, Blastocystis infection was significantly higher in patients with low lymphocyte percentage and CD4/CD8 ratio higher than 1. The decrease in lymphocyte percentage, CD3+ T cell and Th cell count, and low CD4/CD8 ratio in cancer patients increase the frequency of intestinal parasitic infections. Based on these results, lymphocyte subsets may help identify cancer patients at high risk of opportunistic parasites. We suggest that opportunistic parasitic infections affecting the clinical course of the disease should be considered by clinicians during the follow-up and treatment of patients.

Considering opportunistic parasitic infections in COVID-19 policies and recommendations.

The COVID-19 pandemic has led to a significant increase in the immunosuppressed population worldwide due to the disease pathology and extensive use of corticosteroids. This has subsequently increased the risk of opportunistic parasitic infections such as Toxoplasma gondii, Strongyloides stercoralis and other parasites in these patients. The reactivation of such parasites may remain unnoticed due to overlapping symptoms, the difficulty of diagnosis and lack of guidelines for opportunistic parasitic infections in COVID-19 management. Therefore, recommendations for systematic screening of high-risk patients in endemic regions and active research and surveillance to estimate the impact of these infections are required in COVID-19 policy guidelines.

Toxoplasmosis and Its Potential Role to Change the Levels of C - reactive protein and Vitamin D3 in Atherosclerosis Patients

Atherosclerosis is a condition of the hardening of a blood vessel via the development of plaques around the artery wall which causes the artery to narrow, leading to severe complications. Toxoplasmosis is an opportunistic parasitic infection that causes pathological complications in immunocompromised patients, which lead to increase the burden on the immune system in these patients. This study aims to assess the incidence rate of toxoplasmosis in atherosclerosis patients and its potential to change C - reactive protein (C-RP) and vitamin D3 levels. Serum samples (150) were tested for the positivity of anti-Toxoplasma IgG and IgM antibodies by means of Enzyme-linked immunosorbent assay (ELISA). In addition, C-RP was assessed in all serum samples by means of Latex Fixation Test, while VtD3 was estimated by MiniVidas device. The results revealed that the seroprevalence of toxoplasmosis in atherosclerotic patients was comparatively higher as compared to that in the control group, with significant differences in C-RP and VtD3 levels. These results suggest that the decreased levels of VD3 lead to increase the incidence of T. gondii infection in atherosclerosis patients.

Prevalence of Opportunistic Intestinal Parasitic Infections Among HIV/AIDS Patients Before and After Commencement of Antiretroviral Treatment at Felege Hiwot Referral Hospital: A Follow-up Study.

BackgroundCoccidian parasites are opportunistic intestinal parasites that cause diarrhea in immunocompromised individuals. Although the impacts of coccidian infection are significant among HIV/AIDS infected cases, proper diagnosis and management of coccidian infection is limited in sub-Saharan Africa including Ethiopia.ObjectiveThe aim of this study was to determine the prevalence of coccidian parasitic infections among HIV/AIDS cases before and after commencement of antiretroviral treatment.MethodsAn institution-based longitudinal study was conducted among 304 randomly selected HIV/AIDS cases from February to July 2018 before and after commencement of antiretroviral therapy. A structured questionnaire was used to collect sociodemographic and associated factors data. Stool and blood samples were collected before and three months after treatment. Coccidian detection and CD4+ count were conducted via modified acid fast stain technique and fluorescence-activated cell scanning, respectively. Data were entered and analyzed using SPSS version 20. Descriptive statistics were used to compute coccidian prevalence. Logistic regression was used to compute possible association between associated factors and coccidian parasitic infection. Variables with P<0.05 were considered to be statistically significant.ResultsAmong 304 HIV/AIDS cases, prevalence of coccidian parasitic infection before and after antiretroviral treatment was 23.4% and 8.9%, respectively. Prevalence of Cryptosporidium spp. (19.7%) and Isospora belli (4.3%) before antiretroviral treatment were higher than Cryptosporidium spp. (7.9%) and Isospora belli (1.0%) after treatment. Drinking unprotected water (AOR: 7.41; 95%CI: 1.64–33.45), poor knowledge of HIV/AIDS and coccidian parasite (AOR: 4.19; 95%CI: 1.69–10.40), and CD4+ count below 200 cells/mm3 (AOR: 62.49; 95%CI: 25.32–154.21) were significantly associated with coccidian infection.ConclusionPrevalence of coccidian parasites among HIV/AIDS cases decreases after antiretroviral treatment. Drinking unsafe water, limited knowledge of HIV/AIDS and coccidian parasite and low CD4+ cell count are factors associated with coccidian infection. Therefore, proper detection and treatment of coccidian parasites among HIV/AIDS cases should be prioritized.

Serological and Molecular Survey of Toxoplasma gondii Infection in Hemodialysis Patients with Chronic Renal Disease in Zahedan, Iran

Background: Toxoplasma gondii is one of the most prevalent zoonotic opportunistic parasitic infections in the world. The aim of this study was to examine chronic and acute toxoplasmosis molecularly and serologically in Hemodialysis patients. Methods: A total of 238 serum samples of hemodialysis patients with chronic renal disease (119 samples) as case group and healthy individuals (119 samples) as control group were enrolled in Zahedan City, southeastern Iran. The molecular and serological detection of toxoplasmosis were conducted on all samples using nested-PCR and ELISA. Results: The prevalence rates of anti-T. gondii IgM and IgG and T. gondii DNA in the case group were respectively 0%, 44.5% and 29.4% and the corresponding values in the control group were 0.8%,23.5% and 2.52 % respectively (p≥0.05). Conclusion: In conclusion, preliminary Toxoplasma gondii infection screening is required using serological techniques, particularly in hemodialysis patients who are frequently exposed to hemodialysis so as to stop infection dissemination.

Prevalence of Parasitic Infections and Related Morbidity in Pediatric Patients on Regular Hemodialysis in Ain ‎Shams University Pediatric Hospital, Cairo, Egypt ‎

Background and study aim: Opportunistic parasitic infections have been documented to cause serious complications among ‎immunocompromised patients, including those undergoing hemodialysis (HD). Therefore, this study ‎aimed to determine the prevalence of common parasitic infections and associated morbidity among the ‎HD pediatric patients at Ain Shams University Pediatric Hemodialysis Unit‎‎. Patients and Methods: ‎A comparative cross-sectional study was conducted on 50 HD patients and 20 apparently healthy ‎individuals from January 2018 to March 2019. Stool samples were examined for parasites using direct ‎smear, formol ether concentration, and staining with modified Ziehl- Neelsen stain. The serological ‎analysis for anti-Toxoplasma IgM and IgG and complete blood count was performed. The results were ‎correlated with the history, physical, and demographic data of the study groups‎.‎ Results: The overall prevalence rate of intestinal parasitoses among patients with HD was a little bit higher than ‎the control group (70% versus 60%, respectively) but this was statistically insignificant. Blastocystis ‎hominis (30%), Entamoeba histolytica (28%), and Giardia lamblia (20%) were the most frequent ‎among children with HD, with a statistically significant difference in Blastocystis hominis infection ‎rates between patients and their counterparts. Moreover, the overall Toxoplasma gondii ‎seroprevalence rate among patients with HD was (22%) and the anti-Toxoplasma IgM was (2%)‎‎‎. Conclusion: The overall rate of opportunistic parasitic infections and related clinical symptoms in children with ‎HD was slightly more frequent than in the control group. So, stool examination for intestinal parasites ‎and Toxoplasma gondii screening should be incorporated into routine clinical care for children with ‎HD‎‎‎.

The Prevalence of Blastocystis Infection in Pediatric Patients with Malignancy: A Single-Center Study in Ahvaz, Iran

Background: Blastocystis spp. is known as one of the few intestinal parasites, prevalent in more than 5% and 30 - 60% of the population in industrialized and developing countries, respectively. In this respect, immunocompromised individuals, such as patients undergoing chemotherapy or those with malignancies, are at risk of the clinical symptoms of Blastocystis infection; however, the given condition is often self-limiting in healthy individuals. Objectives: The current study aimed at evaluating the prevalence of Blastocystis infection in children with malignancies receiving chemo drugs. Methods: The current descriptive, cross-sectional study was conducted on 52 stool specimens collected from patients with cancer admitted to the Oncology Ward of Shahid Baqaei 2 Hospital, Ahvaz, Iran, for six months. A standardized questionnaire was filled out for all cases. Each specimen was also prepared using direct smear, the Lugol iodine staining, and the formalin-ether condensation method. Results: Blastocystis spp. was detected in 21.1% of the cases among them, 11.5% demonstrated gastrointestinal symptoms; therefore, a significant relationship was observed between Blastocystis infection and gastrointestinal symptoms. Conclusion: Patients undergoing chemotherapy should be screened for opportunistic parasitic infections such as Blastocystis to avoid potentially life-threatening outcomes. Besides, further studies are required to identify the subtypes of Blastocystis.

Prevalence of &amp;lt;i&amp;gt;Cryptosporidium&amp;lt;/i&amp;gt; Species and Other Intestinal Parasites Among HIV Infected Patients at LAUTECH Teaching Hospital, Osogbo, Nigeria

<i>Background</i>: Cryptosporidiosis though an opportunistic infection in HIV infected patients, increases the mortality and morbidity to the diseases by its effect suppression of the immune system, our quest is to highlights the clinical correlation of diarrhea in immunocompromised individuals and the economic losses associated with managing infected individuals. <i>Methods</i>: Stool samples were collected from 96 subjects. Their personal information regarding their names, sex, age was also obtained. The stool samples were processed for non-opportunistic parasite using the direct and formol-ether concentration method. For Cryptosporidium, Modified Ziehl-Neelsen Technique was used. A total of ninety-six confirmed HIV individuals were enrolled for this study. <i>Results</i>: The mean age of the patients was 24.7 years with the youngest been 3 years old and the eldest 58 years old. 77 (74%) were females while 22 (23%) were males. Table 1 shows the general characteristics of the HIV subjects recruited into the study. The distribution of intestinal parasites detected in patient’s stool is shown in Table 2. Of the 96 stool samples examined, intestinal parasites were seen in 87 samples, while 9 samples showed absence of parasites. The diagnosed parasitic infections were: <i>Cryptosporidium</i> spp (54.2%), <i>A. lumbricoides</i> (9.4%), Hookworm (5.2%), <i>E. histolytica</i> (3.1%), <i>S. stercoralis</i> (1%) and Teania spp (1%). Double parasitic infections with Cryptosporidium were observed in 13 (13.5%) HIV/AIDS patients stool samples. Regarding age and sex distribution of the participants, there were 74 (77%) females and 22 (23%) males. Males (68.2%) were more infected than females (55.4%) but the difference was not statistically significant. Table 3 shows relationship between intestinal parasitic infection and diarrhea in the HIV/AIDS patients. 45 (86.5%) of patients with Cryptosporidium infection presented with diarrhea. <i>Conclusion</i>: The association between diarrhea and Cryptosporidium infection was statistically significant. It may be concluded that in HIV infected patients, both opportunistic intestinal parasitic infections are prevalent.

Opportunistic Intestinal Protozoan Infection Among HIV/AIDS Patients and the Associated Risk Factors in Jalingo Local Government, Taraba State

Opportunistic intestinal protozoan parasites are the major contributors affecting HIV/AIDS patients. This study determined the association between intestinal protozoan infection and some predisposing factors among HIV/AIDS patients. Samples were collected from both male and female HIV/AIDS patients and stool samples were also collected from non-HIV/AIDS patients to serve as control. The procedure of wet mount technique and faecal concentration methods processed the faecal materials collected. The CD⁴⁺ count of patients were determined using the Partee Cyflow Counter, which determines the percentage of CD⁴⁺ cells of individuals. A total of eight hundred and fifty (850) faecal samples were collected from sero-positive and sero-negative HIV/AIDS persons in Jalingo metropolis. Out of the 850 subjects, 650 (76.47%) were sero-positive while 200 (23.53%) were sero-negative (Control). The sero-positive subjects showed higher prevalence of 118 (18.15%) of opportunistic parasitic infection according to the follow-up of hospital locations: Government House, 12 (25.71%); Ummah Clinic, 8 (21.82%); Taraba State Specialist Hospital, 50 (18.18%) and Federal Medical Centre, 38 (15.20%). The prevalence was higher among female positives, 68 (l9.60%) than the male, 50 (16.50%) with no significant difference (p>0.05). The infection based on age groups revealed that the age group 10-15 years had the highest prevalence of 27 (48.21%) while the age group 41-45 years had the least prevalence of 2 (2.63%). There was no significant relationship between age, gender and occurrence of opportunistic intestinal protozoan infection among HIV sero-positive and HIV sero-negative subjects (p>0.05). Analysis on risk factors associated with intestinal protozoan infection revealed that patients whose source of water was from stream are likely to get infected with intestinal protozoans (OR=2.95) than those who used tap water (OR=0.78). Based on method of waste disposal, those who practiced open defaecation are at higher risk of infection with intestinal protozoa (OR=1.02) than those who used water closet system (OR=0.30). Similarly, those who did not wash hands after toilets are prone to infection (OR=2.46) than those who frequently was their hands after toilets (OR=0.14). The public health division in Jalingo metropolis should continue to emphasize the importance of environmental and personal hygiene and collaborate with other Government agencies to provide quality drinking water, good waste management systems, good/faecal disposal systems amongst others to help alleviate the burden of intestinal parasite infections.

Prevalence of intestinal parasites in pregnant women

Parasitic infections affect tens of millions of pregnant women worldwide, and directly or indirectly lead to a spectrum of adverse maternal and fetal/placental effects. To determine the prevalence of intestinal parasites in pregnant women and its association with various factors. Stool specimens were collected from pregnant women in a clean, wide mouth, leak-proof screw capped container. Formol ether Concentration technique was performed to increase the yield of the eggs and larvae. Modified Acid Fast staining was done for opportunistic parasitic infections. Out of the 300 pregnant women screened for presence of intestinal parasites, the prevalence of intestinal parasites was 42.67%. Protozoa (88.65%) were predominant than the helminths (11.34%). The prevalence of intestinal parasites was more in the second and the third trimester as compared to the first trimester. Primigravida women had greater positivity of intestinal parasites than the multigravida. Out of 220 anemic females, 115 (52.27%) had presence of intestinal parasites showing an association between anemia and intestinal parasites. Intestinal parasitosis showed a significant correlation with eosinophilia. Two independently collected stool specimens for routine stool examination should be sufficient to ensure adequate diagnostic sensitivity. Routine screening of stool samples for intestinal parasites, especially in anemic, malnourished and women with eosinophilia should be considered as a part of the routine antenatal care. Considering the fact that sanitation and hygiene is suboptimal in most parts of the country, there should be a strong emphasis on the recommendations in the national guidelines regarding deworming in pregnancy.

Opportunistic parasitic infections in patients with human immunodeficiency virus/acquired immunodeficiency syndrome: A review.

The number of human immunodeficiency virus (HIV) cases increases annually, and Indonesia has become the country with the fastest HIV/acquired immunodeficiency syndrome (AIDS) epidemic spread among the five Southeast Asian countries. Indonesia entered the critical phase of HIV/AIDS infections after 5 out of the 33 provinces, namely, Papua, Jakarta, Bali, West Java, and East Java, reported HIV/AIDS epidemic since 2004. In AIDS pathophysiology and immune-suppression are severe, thus, opportunistic intestinal parasitic infections that cause diarrhea in HIV infection may be fatal. Several studies have suggested that Cryptosporidium parvum, Isospora belli, and Blastocystis hominis are the most common intestinal protozoan parasites categorized as AIDS associated illness. Diarrhea caused by parasites is considerably suspected in the cases of chronic and persistent diarrhea in adults, in an era of increasing HIV/AIDS cases nowadays. The present review highlights the current advances in etiologic agents of HIV/AIDS opportunistic infections among countries, epidemiology and prevalence, lifecycle, risk factors, examination methods, and treatment.

Prevalence of Opportunistic Intestinal Protozoan Infection Among HIV/AIDS Patients in Jalingo Metropolis

Opportunistic protozoans parasitic infection occur frequently in individuals with weakened immune system including people with HIV/AIDS. The study sought to determine the prevalence of opportunistic intestinal protozoan infection in HIV/AIDS patients in Jalingo metropolis. The procedure of wet mount technique and faecal concentration techniques processed the faeces collected. The CD⁴⁺ count of patients were determined using the Partee Cyflow Counter, which determines the percentage of CD⁴⁺ cells of individuals. A total of eight hundred and fifty (850) faecal samples were collected from sero-positive and sero-negative HIV/AIDS persons in Jalingo metropolis. Out of the 850 subjects 650 (76.47%) were sero-positive while 200 (23.53%) were sero-negative (Control). The sero-positive subjects showed higher prevalence of 118 (18.15%) of opportunistic parasitic protozoan infection according to the following hospital locations: Government House, 12 (25.71%); Ummah Clinic, 8 (21.82%); Taraba State Specialist Hospital, 50 (18.18%) and Federal Medical Centre, 38 (15.20%). The prevalence was higher among female positives, 68 (l9.60%) than the male, 50 (16.50%) with no significant difference (p>0.05). The infection based on age groups revealed that the age group 10-15 years had the highest prevalence of 27 (48.21%) while the age group 41-45 years had the least prevalence of 2 (2.63%). Subjects involved in farming had higher prevalence 30 (46.15%) while the least was found among those of trading/business, 33 (13.86%) with no significant difference in infection (p>0.05). <i>C. parvum</i> had the highest prevalence, 46 (24.46%) among the sero-positive individuals while <i>E. coli</i> the highest among sero-negative, 9 (60.00%). It is recommended that clinicians caring for HIV/AIDS patients should request for routine stool examination for the specific diagnosis of opportunistic intestinal parasites infections.

Socio-Behavioral Risk Factors Associated with Cryptosporidiosis in HIV/AIDS Patients Visiting the HIV Referral Clinic at Cape Coast Teaching Hospital, Ghana.

Objective:To identify the socio-behavioral risk factors associated with cryptosporidiosis among HIV/AIDS patients with chronic diarrhea symptoms visiting the HIV referral clinic at Cape Coast Teaching Hospital, Ghana.Methods:A cross-sectional study was conducted among 50 HIV/AIDS patients with recurrent diarrhea. Questionnaires were administered to collect social and behavioral risk factors associated with Cryptosporidium and other opportunistic protozoan parasitic infections in HIV patients. Stool samples were collected for the diagnosis of enteric protozoan pathogens using modified Ziehl-Neelsen and acid-fast staining methods. CD4+ cells counts of study subjects were obtained from patients clinical records. The data obtained were analyzed using Pearson chi-square and multivariate-adjusted statistics tool on SPSS 16 for Windows.Results:Twenty-seven (54%) of the subjects were infected with enteric protozoan pathogens. The prevalences of Cryptosporidium, Cyclospora and Microsporidium infections were 46%, 32% and 16%, respectively. Cryptosporidium infection was significantly associated with drinking water (×2=13.528, p<0.001), Cyclospora was associated with the type of drinking water (×2=14.931, p<0.001) and toilet facilities used by the study subjects (×2=12.463, p<0.01), whiles Microsporidium infection was associated with hand washing behavior (×2=12.463, p<0.01). Enteric protozoans were frequently encountered among subjects with CD4+ T-cell count <200 cells/mm3. However, coinfection of Cyclospora spp & Cryptosporidium spp was not observed in CD4+ cell count <200 and >500 cells/mm3. Multivariate analysis showed that the risk factor for Cryptosporidium infection among HIV/AIDS patients was the source of drinking water (pipe borne water 76.2% prevalence: sachet water 25%; OR=0.10, 95%CI: 0.03-0.39, p<0.001).Conclusion:We report the risk factor for exposure of Cryptosporidium infection among HIV/AIDS patients for the first time in Ghana. The contamination of drinking water by protozoan parasites should be a public health concern. These results provide the stepping block to understand the transmission dynamics of Cryptosporidium and other opportunistic pathogens in HIV/AIDS infected patients in Ghana.

Study of opportunistic and other intestinal parasitic infections in relation to CD4 count among human immuno deficiency virus positive patients

Background: Human Immunodeficiency Virus (HIV) infection is a significant health problem facing in Asia and Africa. Gastrointestinal infections are very common in patients with HIV infection or AIDS where diarrhea is a common clinical presentation caused by intestinal parasites. The main objective of this study was to establish the prevalence of intestinal parasitic infections among HIV positive people in Nepal. Methods & Materials: A total of 202 stool samples from HIV positive patients were examined by Formalin- ether sedimentation and Sheather-sucrose floatation followed by modified acid fast (Ziehl-Neelsen) staining techniques during the period of June to November 2015 at National public health laboratory (NPHL), Kathmandu. Results: Among 40 total infected patients, 33 (82.5%) were found to be infected with single parasite. Giardia lamblia was the most predominant one i.e. 9 (27.27%), followed by Entamoeba histolytica 6 (18.18%), Trichuris trichiura 5 (15.15%), hookworm 4 (12.12%), Ascaris lumbricoides 4 (12.12%), Cryptosporidium 3 (9.09%) and Cyclospora 2 (6.06%) respectively. Co-infection of hookworm and E. histolytica 2 (28.57%) and T. trichiura and A. lumbricoides 2 (28.57%) were the most predominant followed by G. lamblia and Cryptosporidium 1 (14.29%) and T. tichiura and E. histolytica 1 (14.29%). Co-infection with Cryptosporidium, hookworm and G. lamblia 1 (14.29%) was also observed. The prevalence of diarrhoea in infected cases was significantly higher (p < 0.05) than the non-infected cases. Significant difference existed in HIV patients with or without the use of Anti-Retroviral Therapy (ART) and in cases with or without the use of anti-parasitic drugs with p < 0.05 in both the cases. There was no significant difference between the occupation and the parasitic infection (p > 0.05) and between the CD4 count and the parasitic infection (p > 0.05). Conclusion: Opportunistic intestinal infection was observed only in AIDS patients (CD4 count < 200 cells/μl). The result indicates that parasitic infection in HIV patients are mainly due to illiteracy, poor hygiene and lack of access to the portable drinking water. Government and related health sector should take the preventive action for the control of HIV/AIDS and proper screening of intestinal parasitosis in HIV patients.