1
|
Akanksha K, Kumari A, Dutta O, Prasanth A, Deeba F, Salam N. Prevalence of soil-transmitted helminth infections in HIV patients: a systematic review and meta-analysis. Sci Rep 2023; 13:11055. [PMID: 37422549 PMCID: PMC10329649 DOI: 10.1038/s41598-023-38030-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 07/01/2023] [Indexed: 07/10/2023] Open
Abstract
Soil-transmitted Helminth (STH) infections have been found associated with people living with human immunodeficiency virus (HIV) but little is known about the overall burden of STH coinfection in HIV patients. We aimed to assess the burden of STH infections among HIV patients. Relevant databases were systematically searched for studies reporting the prevalence of soil-transmitted helminthic pathogens in HIV patients. Pooled estimates of each helminthic infection were calculated. The odds ratio was also determined as a measure of the association between STH infection and the HIV status of the patients. Sixty-one studies were finally included in the meta-analysis, consisting of 16,203 human subjects from all over the world. The prevalence of Ascaris lumbricoides infection in HIV patients was found to be 8% (95% CI 0.06, 0.09), the prevalence of Trichuris trichiura infection in HIV patients was found to be 5% (95% CI 0.04, 0.06), the prevalence of hookworm infection in HIV patients was found to be 5% (95% CI 0.04, 0.06), and prevalence of Strongyloides stercoralis infection in HIV patients was found to be 5% (95% CI 0.04, 0.05). Countries from Sub-Saharan Africa, Latin America & Caribbean and Asia were identified with the highest burden of STH-HIV coinfection. Our analysis indicated that people living with HIV have a higher chance of developing Strongyloides stercoralis infections and decreased odds of developing hookworm infections. Our findings suggest a moderate level of prevalence of STH infections among people living with HIV. The endemicity of STH infections and HIV status both are partially responsible for the burden of STH-HIV coinfections.
Collapse
Affiliation(s)
- Kumari Akanksha
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, 151401, India
| | - Ashu Kumari
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, 151401, India
| | - Omprokash Dutta
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, 151401, India
| | - Ajay Prasanth
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, 151401, India
| | - Farah Deeba
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, 110025, India
| | - Nasir Salam
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, 151401, India.
- Department of Biosciences, Jamia Millia Islamia, New Delhi, 110025, India.
| |
Collapse
|
2
|
Otieno BIA, Matey EJ, Bi X, Tokoro M, Mizuno T, Panikulam A, Owens M, Songok EM, Ichimura H. Intestinal parasitic infections and risk factors for infection in Kenyan children with and without HIV infection. Parasitol Int 2023; 94:102717. [PMID: 36464230 DOI: 10.1016/j.parint.2022.102717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/11/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022]
Abstract
It has been reported that HIV infection is not a risk factor for Entamoeba species infection but is for Giardia intestinalis assemblage B in children living in Western Kenya. This study aimed to investigate the prevalence of and the risk factors for Entamoeba spp. and G. intestinalis infection in children living in Nairobi, Kenya. This cross-sectional study included 87 children with HIV [HIV(+)] and 85 without HIV [HIV(-)]. Stool and blood samples were collected for the detection of the parasites by PCR and immunological analyses using flow cytometry. Sociobehavioral and hygienic data were collected using questionnaires and analyzed statistically. The prevalence of Entamoeba spp. infection was significantly lower in the HIV(+) than in the HIV(-) children (63.2% vs. 78.8%, P = 0.024), whereas the prevalence of G. intestinalis infection was not (27.6% vs. 32.9%, P = 0.445). "Not boiling drinking water" (adjusted odds ratio [aOR]: 3.8, P = 0.044) and "helping in nursery care" (aOR: 2.8, P = 0.009) were related to G. intestinalis assemblage B infection, and "CD4/CD8 ratio ≥1" was related to Entamoeba spp. infection (aOR: 3.3, P = 0.005). In stratified regression analyses, HIV infection was negatively associated with G. intestinalis assemblage B infection in females (aOR: 0.3, P = 0.022), but positively associated in males (aOR 3.8, P = 0.04). These results suggest that G. intestinalis assemblage B infection is related to hygienic conditions, while Entamoeba spp. infection is an indicator of better immunological status, and that the role of HIV infection in Giardia infection may differ between Kenyan boys and girls.
Collapse
Affiliation(s)
- Bridget Ivy Agutu Otieno
- Department of Global Infectious Diseases, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | | | - Xiuqiong Bi
- Department of Global Infectious Diseases, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.
| | - Masaharu Tokoro
- Department of Global Infectious Diseases, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Tetsushi Mizuno
- Department of Global Infectious Diseases, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | | | - Mary Owens
- Nyumbani Children's Home, Nairobi, Kenya
| | | | - Hiroshi Ichimura
- Department of Global Infectious Diseases, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| |
Collapse
|
3
|
Tijani MK, Köster PC, Guadano-Procesi I, George IS, Abodunrin E, Adeola A, Dashti A, Bailo B, González-Barrio D, Carmena D. High Diversity of Giardia duodenalis Assemblages and Sub-Assemblages in Asymptomatic School Children in Ibadan, Nigeria. Trop Med Infect Dis 2023; 8:tropicalmed8030152. [PMID: 36977153 PMCID: PMC10051407 DOI: 10.3390/tropicalmed8030152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/25/2023] [Accepted: 02/26/2023] [Indexed: 03/05/2023] Open
Abstract
Giardia duodenalis is a significant contributor to the burden of diarrheal disease in sub-Saharan Africa. This study assesses the occurrence and molecular diversity of G. duodenalis and other intestinal parasites in apparently healthy children (n = 311) in Ibadan, Nigeria. Microscopy was used as a screening method and PCR and Sanger sequencing as confirmatory and genotyping methods, respectively. Haplotype analyses were performed to examine associations between genetic variants and epidemiological variables. At microscopy examination, G. duodenalis was the most prevalent parasite found (29.3%, 91/311; 95% CI: 24.3–34.7), followed by Entamoeba spp. (18.7%, 58/311; 14.5–23.4), Ascaris lumbricoides (1.3%, 4/311; 0.4–3.3), and Taenia sp. (0.3%, 1/311; 0.01–1.8). qPCR confirmed the presence of G. duodenalis in 76.9% (70/91) of the microscopy-positive samples. Of them, 65.9% (60/91) were successfully genotyped. Assemblage B (68.3%, 41/60) was more prevalent than assemblage A (28.3%, 17/60). Mixed A + B infections were identified in two samples (3.3%, 2/60). These facts, together with the absence of animal-adapted assemblages, suggest that human transmission of giardiasis was primarily anthroponotic. Efforts to control G. duodenalis (and other fecal-orally transmitted pathogens) should focus on providing safe drinking water and improving sanitation and personal hygiene practices.
Collapse
Affiliation(s)
- Muyideen K. Tijani
- Cellular Parasitology Programme, Cell Biology and Genetics Unit, Department of Zoology, University of Ibadan, Ibadan 200284, Nigeria
- Division of Clinical Chemistry and Pharmacology, Department of Laboratory Medicine, Lund University, Skåne University Hospital, 221 85 Lund, Sweden
| | - Pamela C. Köster
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, 28220 Madrid, Spain
| | - Isabel Guadano-Procesi
- Department of Clinical Sciences and Translational Medicine, Faculty of Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
- PhD Program in Evolutionary Biology and Ecology, Department of Biology, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Imo S. George
- Cellular Parasitology Programme, Cell Biology and Genetics Unit, Department of Zoology, University of Ibadan, Ibadan 200284, Nigeria
| | - Elizabeth Abodunrin
- Cellular Parasitology Programme, Cell Biology and Genetics Unit, Department of Zoology, University of Ibadan, Ibadan 200284, Nigeria
| | - Adedamola Adeola
- Cellular Parasitology Programme, Cell Biology and Genetics Unit, Department of Zoology, University of Ibadan, Ibadan 200284, Nigeria
| | - Alejandro Dashti
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, 28220 Madrid, Spain
| | - Begoña Bailo
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, 28220 Madrid, Spain
| | - David González-Barrio
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, 28220 Madrid, Spain
- Correspondence: (D.G.-B.); (D.C.)
| | - David Carmena
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, 28220 Madrid, Spain
- Center for Biomedical Research Network (CIBER) in Infectious Diseases, Health Institute Carlos III, 28029 Madrid, Spain
- Correspondence: (D.G.-B.); (D.C.)
| |
Collapse
|
4
|
Mahdavi F, Shams M, Sadrebazzaz A, Shamsi L, Omidian M, Asghari A, Hassanipour S, Salemi AM. Global prevalence and associated risk factors of diarrheagenic Giardia duodenalis in HIV/AIDS patients: A systematic review and meta-analysis. Microb Pathog 2021; 160:105202. [PMID: 34562555 DOI: 10.1016/j.micpath.2021.105202] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022]
Abstract
Giardia duodenalis is one of the leading causes of diarrhea, mostly in underdeveloped nations of Africa and Asia. The present review provides insights into the prevalence, odds ratios (ORs) and associated risk factors of giardiasis in HIV/AIDS patients. Four major English databases (Web of Science, PubMed, Scopus, and Google Scholar) were excavated for relevant literature without time limitation until 20 November 2020. Next, meta-analysis was performed using a random-effects model and 95% confidence intervals (CIs). As well, heterogeneity among studies was evaluated using Cochran's Q and the I2-statistic. Totally, 19,218 HIV/AIDS patients in 130 studies were examined, showing a 5% (95% CI: 4.2%-6%) pooled prevalence. Also, the weighted random-effects OR of G. duodenalis infection among HIV/AIDS patients in comparison with their controls in 48 case-control studies was estimated as 1.71% (95% CI: 1.1%-2.66%, p = 0.016). Based on sensitivity analysis, there was no remarkable variation in the pooled OR upon omitting individual studies. Diarrhea was a potent risk factor, since HIV/AIDS patients with diarrhea were 3.8-times (95% CI: 1.6-8.9, p = 0.002) more prone to G. duodenalis infection than those without diarrhea. Moreover, the prevalence of the parasitic infection was 1.2-times higher in patients without antiretroviral therapy (ART) than those with ART (p = 0.312). Meta-regression was employed to evaluate the possible association between G. duodenalis frequency in HIV/AIDS patients and some variables such as sample size, publication year, and HDI. Additionally, the pooled prevalence of G. duodenalis infection was estimated based on several subgroups, including publication years, WHO regions, countries, continents, country incomes, and CD4+ T-cell levels. Altogether, the epidemiology of giardiasis in HIV/AIDS patients and its association with various risk factors is still open to question and requires more detailed and comprehensive investigations.
Collapse
Affiliation(s)
- Farzad Mahdavi
- Department of Medical Parasitology and Mycology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Morteza Shams
- Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran.
| | - Alireza Sadrebazzaz
- Razi Vaccine & Serum Research Institute, Agricultural Research, Education and Extension Organization, Mashhad, Iran.
| | - Laya Shamsi
- Department of Pathobiology, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran.
| | - Mostafa Omidian
- Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ali Asghari
- Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
| | - Amir Masoud Salemi
- Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
5
|
Casado L, Rodriguez-Guardado A, Boga J, Fernández-Suarez J, Martínez-Camblor P, Rodríguez-Perez M, García-Pérez A, Vazquez F, Gascon J. Use of serology in a systematic screening programme for strongyloidiasis in an immigrant population. Int J Infect Dis 2019; 88:60-64. [DOI: 10.1016/j.ijid.2019.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/28/2019] [Accepted: 09/02/2019] [Indexed: 11/28/2022] Open
|
6
|
Debnath A, Reed SL, Morris SR. Predictors of Failure from Primary Therapy for Giardiasis in San Diego: A Single Institution Retrospective Review. Pathogens 2019; 8:pathogens8040165. [PMID: 31569735 PMCID: PMC6963537 DOI: 10.3390/pathogens8040165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 09/24/2019] [Accepted: 09/26/2019] [Indexed: 01/06/2023] Open
Abstract
This study aimed to determine the presence of giardiasis among HIV patients in San Diego, the rate of failure of metronidazole treatment, and factors associated with treatment failure. We used a 7 year retrospective single-center case series of HIV-infected individuals with giardiasis at University of California San Diego Medical Center. Data were analyzed for the changes in the hematological, biochemical, and immunologic results at pre- and at-diagnosis levels. We also compared the changes at the diagnosis level among patients who were treated successfully and those who experienced treatment failure as defined by retreatment with a second course of antibiotics. In 29 Giardia lamblia-infected HIV patients, following diagnosis of G. lamblia, there was a non-significant decrement in cluster of differentiation 4 (CD4), but a statistically significant increase in the number of white blood cell (WBC). Other indices did not differ between pre- and at-diagnosis levels. Twenty patients (69%) were treated with a single course of metronidazole or tinidazole and seven patients (24.1%) were treated with more than one course of metronidazole. These seven patients had statistically significant higher hemoglobin at the time of diagnosis, but further studies are required to confirm if this is a consistent finding and if this can predict failure from primary therapy.
Collapse
Affiliation(s)
- Anjan Debnath
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA 92093, USA.
| | - Sharon L Reed
- Department of Pathology, University of California San Diego, La Jolla, CA 92093, USA.
- Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA.
| | - Sheldon R Morris
- Departments of Medicine and Family Medicine and Public Health, University of California San Diego School of Medicine, San Diego, CA 92103, USA.
| |
Collapse
|
7
|
Donohue RE, Cross ZK, Michael E. The extent, nature, and pathogenic consequences of helminth polyparasitism in humans: A meta-analysis. PLoS Negl Trop Dis 2019; 13:e0007455. [PMID: 31211774 PMCID: PMC6599140 DOI: 10.1371/journal.pntd.0007455] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/28/2019] [Accepted: 05/09/2019] [Indexed: 02/07/2023] Open
Abstract
Background Individual helminth infections are ubiquitous in the tropics; geographical overlaps in endemicity and epidemiological reports suggest areas endemic for multiple helminthiases are also burdened with high prevalences of intestinal protozoan infections, malaria, tuberculosis (TB), and human immunodeficiency virus (HIV). Despite this, pathogens tend to be studied in isolation, and there remains a need for a better understanding of the community ecology and health consequences of helminth polyparasitism to inform the design of effective parasite control programs. Methodology We performed meta-analyses to (i) evaluate the commonality of polyparasitism for helminth-helminth, helminth-intestinal protozoa, helminth-malaria, helminth-TB, and helminth-HIV co-infections, (ii) assess the potential for interspecies interactions among helminth-helminth and helminth-intestinal protozoan infections, and (iii) determine the presence and magnitude of association between specific parasite pairs. Additionally, we conducted a review of reported health consequences of multiply-infected individuals compared to singly- or not multiply-infected individuals. Principal findings We found that helminth-helminth and helminth-intestinal protozoan multiple infections were significantly more common than single infections, while individuals with malaria, TB, and HIV were more likely to be singly-infected with these infections than co-infected with at least one helminth. Most observed species density distributions significantly differed from the expected distributions, suggesting the potential presence of interspecies interactions. All significant associations between parasite pairs were positive in direction, irrespective of the combination of pathogens. Polyparasitized individuals largely exhibited lower hemoglobin levels and higher anemia prevalence, while the differences in growth-related variables were mostly statistically insignificant. Conclusions Our findings confirm that helminth polyparasitism and co-infection with major diseases is common in the tropics. A multitude of factors acting at various hierarchical levels, such as interspecies interactions at the within-host infra-parasite community level and environmental variables at the higher host community level, could explain the observed positive associations between pathogens; there remains a need to develop new frameworks which can consider these multilevel factors to better understand the processes structuring parasite communities to accomplish their control. Helminth infections are a highly prevalent global health problem. These parasitic worm infections occur in areas also burdened with intestinal protozoan infections, malaria, tuberculosis, and human immunodeficiency virus. While these pathogens tend to be studied in isolation, there remains a need to better understand the nature, extent, and health consequences of helminth polyparasitism and co-infection with major diseases. Here, we reviewed the literature and performed meta-analyses to evaluate the commonality of helminth polyparasitism and co-infection, the potential for interspecies interactions between parasites, the association between parasite pairs, and the health consequences among multiply-infected individuals. We confirmed that polyparasitism and co-infection with major diseases are common in the global South and found that multiply-infected individuals experienced worse health consequences when compared to singly or not-multiply infected individuals. Our analysis suggested the potential presence of interspecies interactions and we identified the existence of positive associations between parasite pairs. These findings support the call for integrating deworming into malaria, TB, and HIV treatment protocols and suggest there remains a need to improve our understanding of the factors influencing co-transmission to achieve sustainable parasite control.
Collapse
Affiliation(s)
- Rose E. Donohue
- Department of Biological Sciences, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Zoë K. Cross
- University of Utah, Salt Lake City, Utah, United States of America
| | - Edwin Michael
- Department of Biological Sciences, University of Notre Dame, Notre Dame, Indiana, United States of America
- * E-mail:
| |
Collapse
|
8
|
Faria CP, Zanini GM, Dias GS, Sousa MDC. Associations of Giardia lamblia assemblages with HIV infections and symptomatology: HIV virus and assemblage B were they born to each other? Acta Trop 2017; 172:80-85. [PMID: 28456597 DOI: 10.1016/j.actatropica.2017.04.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 04/20/2017] [Accepted: 04/22/2017] [Indexed: 12/13/2022]
Abstract
Giardia lamblia is an intestinal parasite that has an extensive genetic variation among isolates. This species is divided into eight different assemblages (A-H), but only assemblages A and B have been associated with human infections. Studies on the associations of G. lamblia assemblages and symptoms have been done but were inconclusive. The aim of this study was to correlate G. lamblia assemblages with symptoms in patients with and without HIV/AIDS and its association with the CD4T cell count. The cross-sectional survey was conducted among patients attending the Evandro Chagas National Institute of Infectious Diseases (INI/FIOCRUZ) in Rio de Janeiro from January 2011 to February 2015. Thirty-eight of 65 microscopically positive stool samples for G. lamblia were from HIV positive patients and 27 were from HIV negative patients. Of the HIV infected patients, 19 (55.9%) were genotyped as assemblage B of which 9 (47.4%) had a CD4Tcell count below 200cells/mm3. In addition, we found a greater number of samples belonging to assemblage B in symptomatic cases (11 of 19; 57.9%). Our data suggest that assemblage B is very likely to be found in HIV infected patients and probably the lower CD4T count gives advantages for assemblage B replication. Furthermore, assemblage B seems to be associated with symptomatology, particularly abdominal pain, asthenia, diarrhea, fever, headache and myalgia. This study provides information on G. lamblia assemblages and symptoms in patients with and without HIV/AIDS virus and their association with CD4Tcell counts.
Collapse
Affiliation(s)
- Clarissa Perez Faria
- CNC - Center for Neurosciences and Cell Biology, University of Coimbra, 3030-548 Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, 3030-548 Coimbra, Portugal; Laboratory of Parasitology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, 21040-900, Brazil
| | - Graziela Maria Zanini
- Laboratory of Parasitology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, 21040-900, Brazil
| | - Gisele Silva Dias
- Laboratory of Parasitology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, 21040-900, Brazil
| | - Maria do Céu Sousa
- CNC - Center for Neurosciences and Cell Biology, University of Coimbra, 3030-548 Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, 3030-548 Coimbra, Portugal.
| |
Collapse
|
9
|
Nooshadokht M, Kalantari-Khandani B, Sharifi I, Kamyabi H, Liyanage NPM, Lagenaur LA, Kagnoff MF, Singer SM, Babaei Z, Solaymani-Mohammadi S. Stool antigen immunodetection for diagnosis of Giardia duodenalis infection in human subjects with HIV and cancer. J Microbiol Methods 2017; 141:35-41. [PMID: 28716658 DOI: 10.1016/j.mimet.2017.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 01/18/2023]
Abstract
Human infection with the protozoan parasite Giardia duodenalis is one the most common parasitic diseases worldwide. Higher incidence rates of giardiasis have been reported from human subjects with multiple debilitating chronic conditions, including hypogammaglobulinemia and common variable immunodeficiency (CVID). In the current study, stool specimens were collected from 199 individuals diagnosed with HIV or cancer and immunocompetent subjects. The sensitivity of microscopy-based detection on fresh stool preparations, trichrome staining and stool antigen immunodetection for the diagnosis of G. duodenalis were 36%, 45.5% and 100%, respectively when compared with a highly sensitive stool-based PCR method as the gold standard. Further multilocus molecular analyses using glutamate dehydrogenase (gdh) and triose phosphate isomerase (tpi) loci demonstrated that the AI genotype of G. duodenalis was the most prevalent, followed by the AII genotype and mixed (AI+B) infections. We concluded that stool antigen immunodetection-based immunoassays and stool-based PCR amplification had comparable sensitivity and specificity for the diagnosis of G. duodenalis infections in these populations. Stool antigen detection-based diagnostic modalities are rapid and accurate and may offer alternatives to conventional microscopy and PCR-based diagnostic methods for the diagnosis of G. duodenalis in human subjects living with HIV or cancer.
Collapse
Affiliation(s)
- Maryam Nooshadokht
- Department of Medical Parasitology and Mycology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Iraj Sharifi
- Leishmaniasis Research Center, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Hossein Kamyabi
- Department of Medical Parasitology and Mycology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Namal P M Liyanage
- Department of Microbial Infection and Immunity, College of Medicine, Ohio State University, Columbus, OH, USA
| | | | - Martin F Kagnoff
- Laboratory of Mucosal Immunology, School of Medicine, University of California, San Diego, California, USA
| | - Steven M Singer
- Department of Biology and Center for Infectious Disease, Georgetown University, Washington D.C., USA
| | - Zahra Babaei
- Leishmaniasis Research Center, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
| | | |
Collapse
|
10
|
Morawski BM, Yunus M, Kerukadho E, Turyasingura G, Barbra L, Ojok AM, DiNardo AR, Sowinski S, Boulware DR, Mejia R. Hookworm infection is associated with decreased CD4+ T cell counts in HIV-infected adult Ugandans. PLoS Negl Trop Dis 2017; 11:e0005634. [PMID: 28542260 PMCID: PMC5462474 DOI: 10.1371/journal.pntd.0005634] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 06/07/2017] [Accepted: 05/10/2017] [Indexed: 01/02/2023] Open
Abstract
Most studies evaluating epidemiologic relationships between helminths and HIV have been conducted in the pre-ART era, and evidence of the impact of helminth infections on HIV disease progression remains conflicting. Less is known about helminth infection and clinical outcomes in HIV-infected adults receiving antiretroviral therapy (ART). We sampled HIV-infected adults for eight gastrointestinal parasites and correlated parasitic infection with demographic predictors, and clinical and immunologic outcomes. Contrasting with previous studies, we measured parasitic infection with a quantitative, highly sensitive and specific polymerase chain reaction (PCR) method. This cohort study enrolled HIV-infected Ugandans from August-September 2013 in Mbale, Uganda and collected stool and blood samples at enrollment. Real-time PCR quantified stool: Ascaris lumbricoides, Ancylostoma duodenale, Necator americanus, Strongyloides stercoralis, Trichuris trichiura, Cryptosporidium spp., Entamoeba histolytica, and Giardia intestinalis infection. Generalized linear models assessed relationships between parasitic infection and clinical or demographic data. 35% of participants (71/202) tested positive for ≥1 helminth, mainly N. americanus (55/199, 28%), and 4.5% (9/202) were infected with ≥2 stool parasites. Participants with hookworm infection had lower average CD4+ cell counts (-94 cells/mcL, 95%CI: -141, -48 cells/mcL; p<0.001) after adjustment for sex, CD4+ nadir at clinic entry, and time on ART. The high prevalence of parasitic infection and correlation with decreased CD4+ concentrations highlight the need to re-examine the effects of invasive helminth co-infection in rural, HIV-infected populations in the era of widely available ART. Elucidating the relationship between hookworm infection and immune recovery could provide opportunities for health optimization, e.g. integrated deworming, in these vulnerable populations.
Collapse
Affiliation(s)
- Bozena M. Morawski
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America
| | - Miya Yunus
- The AIDS Support Organization, Kampala, Uganda
| | | | | | | | | | - Andrew R. DiNardo
- Division of Global and Immigrant Health, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States of America
| | - Stefanie Sowinski
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
- The Gladstone Institute of Virology and Immunology, University of California, San Francisco, San Francisco, CA, United States of America
| | - David R. Boulware
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America
| | - Rojelio Mejia
- Section of Tropical Medicine, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States of America
| |
Collapse
|
11
|
Positive correlation of HIV infection with Giardia intestinalis assemblage B but not with assemblage A in asymptomatic Kenyan children. AIDS 2016; 30:2385-7. [PMID: 27478987 DOI: 10.1097/qad.0000000000001216] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A cross-sectional molecular epidemiological study of Giardia intestinalis infection was conducted among asymptomatic Kenyan children with (n = 123) and without (n = 111) HIV infection. G. intestinalis assemblage B infection was positively correlated with HIV infection [HIV (+), 18.7% vs. HIV (-), 11.7%; P = 0.013], whereas assemblage A infection was not [HIV (+), 4.1% vs. HIV (-), 6.3%; P = 0.510]. Thus, HIV infection is a risk factor for G. intestinalis assemblage B infection but not for assemblage A infection.
Collapse
|
12
|
Cotton JA, Amat CB, Buret AG. Disruptions of Host Immunity and Inflammation by Giardia Duodenalis: Potential Consequences for Co-Infections in the Gastro-Intestinal Tract. Pathogens 2015; 4:764-92. [PMID: 26569316 PMCID: PMC4693164 DOI: 10.3390/pathogens4040764] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 12/11/2022] Open
Abstract
Giardia duodenalis (syn. G. intestinalis, or G. lamblia) is a leading cause of waterborne diarrheal disease that infects hundreds of millions of people annually. Research on Giardia has greatly expanded within the last few years, and our understanding of the pathophysiology and immunology on this parasite is ever increasing. At peak infection, Giardia trophozoites induce pathophysiological responses that culminate in the development of diarrheal disease. However, human data has suggested that the intestinal mucosa of Giardia-infected individuals is devoid of signs of overt intestinal inflammation, an observation that is reproduced in animal models. Thus, our understanding of host inflammatory responses to the parasite remain incompletely understood and human studies and experimental data have produced conflicting results. It is now also apparent that certain Giardia infections contain mechanisms capable of modulating their host's immune responses. As the oral route of Giardia infection is shared with many other gastrointestinal (GI) pathogens, co-infections may often occur, especially in places with poor sanitation and/or improper treatment of drinking water. Moreover, Giardia infections may modulate host immune responses and have been found to protect against the development of diarrheal disease in developing countries. The following review summarizes our current understanding of the immunomodulatory mechanisms of Giardia infections and their consequences for the host, and highlights areas for future research. Potential implications of these immunomodulatory effects during GI co-infection are also discussed.
Collapse
Affiliation(s)
- James A Cotton
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada.
| | - Christina B Amat
- Department of Biological Sciences, University of Calgary, Calgary, AB T2N 1N4, Canada.
- Inflammation Research Network, University of Calgary, Calgary, AB T2N 1N4, Canada.
- Host-Parasite Interactions, University of Calgary, Calgary, AB T2N 1N4, Canada.
| | - Andre G Buret
- Department of Biological Sciences, University of Calgary, Calgary, AB T2N 1N4, Canada.
- Inflammation Research Network, University of Calgary, Calgary, AB T2N 1N4, Canada.
- Host-Parasite Interactions, University of Calgary, Calgary, AB T2N 1N4, Canada.
| |
Collapse
|
13
|
Escobedo AA, Almirall P, Alfonso M, Cimerman S, Chacín-Bonilla L. Sexual transmission of giardiasis: a neglected route of spread? Acta Trop 2014; 132:106-11. [PMID: 24434784 DOI: 10.1016/j.actatropica.2013.12.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 12/28/2013] [Accepted: 12/30/2013] [Indexed: 12/20/2022]
Abstract
Sexually transmitted infections (STIs) are often discussed in the context of syphilis, gonorrhea, herpes, chlamydiasis and AIDS. However, since the past 30 years of the last century, epidemiology and natural history studies have led to improved understanding of giardiasis as a STI, as a result of oral-anal sexual contact. Studies suggest that Giardia is an increasingly recognized infection that may be underdiagnosed under the STI context. Health care providers should maintain a high index of suspicion for Giardia, obtain suitable diagnostic tests to identify and screen those at high risk for this infection, institute appropriate therapy, counsel patients regarding treatment compliance, follow-up, encourage partner notification and teach strategies for preventing the transmission of this disease, including the discussion of the risk of enteric infections after oral-anal sexual contact. We summarize some data concerning the research and clinical literature on Giardia infection as a STI and identify the specific recommendations for control of giardiasis as STI that available evidence indicates can reduce its transmission.
Collapse
|
14
|
Schuetz AN, Pritt BS, Schreiner AM. Iodamoeba butschlii in an anal pap test confirmed by iodine stain. Diagn Cytopathol 2013; 42:775-7. [PMID: 24167099 DOI: 10.1002/dc.23042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 06/26/2013] [Accepted: 08/28/2013] [Indexed: 11/11/2022]
Abstract
We report the finding of Iodamoeba butschlii amebic cysts on a liquid-based anal Pap smear from an HIV-positive male. Iodine staining of the smear confirmed the diagnosis. It is important to distinguish I. butschlii from pathogenic ameobae and other organisms seen on anal Pap smears.
Collapse
Affiliation(s)
- Audrey N Schuetz
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York
| | | | | |
Collapse
|
15
|
Affiliation(s)
- Joe Brown
- Environmental Health Group, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Sandy Cairncross
- Environmental Health Group, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Jeroen H J Ensink
- Environmental Health Group, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
16
|
Roka M, Goñi P, Rubio E, Clavel A. Intestinal parasites in HIV-seropositive patients in the Continental Region of Equatorial Guinea: its relation with socio-demographic, health and immune systems factors. Trans R Soc Trop Med Hyg 2013; 107:502-10. [PMID: 23783759 DOI: 10.1093/trstmh/trt049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Prevalence of intestinal parasitic infections in HIV-positive people and its association with clinical and socioeconomic factors has been investigated on the mainland of Equatorial Guinea, in order to define the precise measures for improvement of their quality of life. METHODS In August 2010, 273 HIV-positive and 60 HIV-negative were recruited. A sample of faeces, T-CD4+ cell counts, and clinical, socioeconomic and demographic data were collected from each patient. Stool samples were analysed by microscopy and immunochromatography. Data were analysed by Pearson's χ2 test and the risk of each factor was measured by odds ratio bivariate analysis. RESULTS Two hundred and ten (76.9%) HIV-positive participants were infected by intestinal parasites and 16 parasite species were identified; 246 (48.9%) were pathogenic helminths, 159 (22.9%) pathogenic protozoa and 142 (28.2%) opportunistic protozoa. Trichuris trichiura, Entamoeba histolytica/dispar/moshkovskii, Ascaris lumbricoides and Giardia duodenalis were the most prevalent parasites; 52 (86.7%) of HIV-negative participants were parasitized. HIV was related to co-infection by Entamoeba spp., E. nana and Blastocystis hominis. CONCLUSIONS The high rates of parasitic infections found highlights the urgent need of environmental sanitation, health education and water distribution actions, as well as early diagnosis and treatment of intestinal parasites.
Collapse
Affiliation(s)
- Margarita Roka
- Area of Parasitology, Department of Microbiology, Preventive Medicine and Public Health, Faculty of Medicine, University of Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain
| | | | | | | |
Collapse
|
17
|
Salvador F, Molina I, Sulleiro E, Burgos J, Curran A, Van den Eynde E, Villar del Saz S, Navarro J, Crespo M, Ocaña I, Ribera E, Falcó V, Pahissa A. Tropical diseases screening in immigrant patients with human immunodeficiency virus infection in Spain. Am J Trop Med Hyg 2013; 88:1196-202. [PMID: 23509119 PMCID: PMC3752822 DOI: 10.4269/ajtmh.12-0714] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 02/18/2013] [Indexed: 11/07/2022] Open
Abstract
Latent parasitic infections can reactivate because of immunosuppression. We conducted a prospective observational study of all human immunodeficiency virus (HIV)-infected immigrants who visited the Infectious Diseases Department of the Hospital Universitari Vall d'Hebron, Barcelona, Spain, during June 2010-May 2011. Screening of the most prevalent tropical diseases (intestinal parasitosis, Chagas disease, leishmaniasis, malaria, schistosomiasis, and strongyloidiasis) was performed according to geographic origin. A total of 190 patients were included: 141 (74.2%) from Latin America, 41 (21.6%) from sub-Saharan Africa, and 8 (4.2%) from northern Africa. Overall, 36.8% (70 of 190) of the patients had at least one positive result for any parasitic disease: 5 patients with positive Trypanosoma cruzi serology, 11 patients with positive Schistosoma mansoni serology, 35 patients with positive Strongyloides stercoralis serology, 7 patients with positive Leishmania infantum serology, intestinal parasitosis were detected in 37 patients, malaria was diagnosed in one symptomatic patient. We propose a screening and management strategy of latent parasitic infections in immigrant patients infected with HIV.
Collapse
Affiliation(s)
- Fernando Salvador
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Sanyaolu AO, Fagbenro-Beyioku AF, Oyibo WA, Badaru OS, Onyeabor OS, Nnaemeka CI. Malaria and HIV co-infection and their effect on haemoglobin levels from three health-care institutions in Lagos, southwest Nigeria. Afr Health Sci 2013; 13:295-300. [PMID: 24235927 DOI: 10.4314/ahs.v13i2.14] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Malaria and human immunodeficiency virus (HIV) are two major infections with enormous public health consequence. Together, they are endemic in many developing countries with anaemia being the most frequent haematological consequence of the infections. OBJECTIVES To determine the prevalence of malaria and HIV co-infection as well as anaemia among selected patients from three health-care institutions in Lagos, Nigeria. METHODS A cross-sectional study of 1080 patients was carried out to determine the prevalence of malaria and HIV co-infection as well as anaemia. Blood sera from each of the patients were screened for malaria parasites, HIV-1 and HIV-2 using Giemsa stain, Cambridge Biotech Recombigen HIV-1/HIV-2 rapid device, respectively while haemoglobin estimation was performed using cyanmethemoglobin method. RESULTS Our data showed that the total number of malaria infected patients were significantly higher in HIV sero-positive patients 47.7% (31/65) when compared with their HIV sero-negative counterparts 25.8% (262/1015) P = 0.047. The result also revealed that 25.8% (8/31) of the patients co-infected with malaria and HIV had anaemia as compared to 11.1% (29/262) infected with malaria alone. Multivariable logistic regression analysis showed that patients with dual infection of malaria and HIV were twice likely to be anaemic than those infected with malaria alone [adjusted OR 2.4, 95% CI, 1.3 to 2.7, P = 0.014]. CONCLUSIONS Our data indicated a higher prevalence of malaria in HIV infected patients and also revealed that patients co-infected with malaria and HIV were more likely to be anaemic.
Collapse
Affiliation(s)
- A O Sanyaolu
- Department of Medical Microbiology and Parasitology, College of Medicine of the University of Lagos, Idi-araba, PMB 12003 Lagos, Nigeria ; Central Public Health Laboratory of the Federal Ministry of Health, Yaba, Lagos, Nigeria ; Department of Medical Microbioloy and Immunology, St. James School of Medicine, Albert Lake Dr. The Quarter, P. O. Box 318, The Valley, Anguilla, BWI
| | | | | | | | | | | |
Collapse
|