Opportunistic and other intestinal parasites among HIV/AIDS patients attending Gambi higher clinic in Bahir Dar city, North West Ethiopia

The epidemiology of human Taenia solium infections: A systematic review of the distribution in Eastern and Southern Africa

Background

Taenia solium is a tapeworm that causes taeniosis in humans and cysticercosis in humans and pigs. Within Eastern and Southern Africa (ESA), information on the presence of human taeniosis and cysticercosis seems scarce. This systematic review aimed to describe the current information available and gaps in the epidemiology of human T. solium infections in ESA.

Methods/Principle findings

Scientific literature published between 1st January 2000 and 20th June 2022 in international databases [MEDLINE (Ovid), Embase (Ovid), Global Health (Ovid), Scopus (Elsevier), African Index Medicus (via WHO Global Index Medicus), and Open Grey] was systematically reviewed for ESA. The study area included 27 countries that make up the ESA region. Information on either taeniosis, cysticercosis or NCC was available for 16 of 27 countries within the region and a total of 113 reports were retained for the review. Most case reports for cysticercosis and NCC were from South Africa, while Tanzania had the most aggregated cysticercosis reports. Eleven countries reported on NCC with seven countries reporting data on NCC and epilepsy. Unconfirmed human T. solium taeniosis cases were reported in nine countries while two countries (Madagascar and Zambia) reported confirmed T. solium cases. The cysticercosis seroprevalence ranged between 0.7–40.8% on antigen (Ag) ELISA and between 13.1–45.3% on antibody (Ab) ELISA. Based on immunoblot tests the Ab seroprevalence was between 1.7–39.3%, while the proportion of NCC-suggestive lesions on brain CT scans was between 1.0–76% depending on the study population. The human taeniosis prevalence based on microscopy ranged between 0.1–14.7%. Based on Copro Ag-ELISA studies conducted in Kenya, Rwanda, Tanzania, and Zambia, the highest prevalence of 19.7% was reported in Kenya.

Conclusions

Despite the public health and economic impact of T. solium in ESA, there are still large gaps in knowledge about the occurrence of the parasite, and the resulting One Health disease complex, and monitoring of T. solium taeniosis and cysticercosis is mostly not in place.

The epidemiology of Schistosoma mansoni in the Lake Tana Basin (Ethiopia): Review with retrospective data analyses

Schistosoma mansoni is one of the major waterborne diseases grouped underwater based Neglected Tropical Diseases in Africa. In Ethiopia, the Lake Tana Basin has favorable environment (temperature and water) for S. mansoni transmission. The prevalence of S. mansoni varies among regions based on environmental conditions and human water contact. Therefore, this review was conducted to identify hot spots districts and determine the prevailing S. mansoni prevalence in the Lake Tana Basin. Research articles published in English in the last 65 years were searched from Google scholar, PubMed, and Web of science. In addition, four-year S. mansoni data that were reported in health care facilities were extracted from health management information system in 61 districts of the Lake Tana Basin. In total, 43 research articles on S. mansoni that met the inclusion criteria and were published between 1957 and 2022. Over 98% of the articles were cross-sectional studies, while five articles addressed malacological studies. Among 61 districts, 19 (31%) were identified as hotspot districts for S. mansoni infection in the Lake Tana Basin. S. mansoni prevalence and the abundance of its host snail showed spatial and seasonal variations. On average 2000 school children/year attended health care facilities for S. mansoni infection. Swimming habits [adjusted odds ratio (AOR) = 3.2, p = 0.030], irrigation practice (AOR = 3:09, p ≤ 0.001), fishing (AOR = 2:43, p = 0.005) and being male (AOR = 1.74, p = 0.002) were risk factors for contributing to S. mansoni infection. This study showed the spatial and seasonal variations of S. mansoni prevalence and its endemicity in the hottest lowland areas of the Lake Tana Basin. The research articles on S. mansoni had poor geographical coverage. Malacological studies on water bodies, assessments on knowledge and attitude in the community towards S. mansoni transmission are areas of future studies.

Assessment of intestinal parasites and associated factors among HIV/AIDS patients on antiretroviral therapy at Bule Hora General Hospital, West Guji, Ethiopia

Objective:

The study aimed to assess the prevalence of intestinal parasites and associated factors among people living with HIV/AIDS on antiretroviral therapy at Bule Hora General Hospital, West Guji, Oromia, Ethiopia.

Introduction:

Parasitic infection of the intestinal tract is a major source of disease in patients with HIV, particularly in the tropics, where diarrhea is a common complaint with variable severity.

Method:

An institution-based cross-sectional study was conducted from May to August 2021 on 179 systematic randomly selected HIV patients. Data on sociodemographics were collected by interviewing the study subjects using a pretested structured questionnaire. Stool specimens were collected from the study subjects and processed and examined by formol-ether concentration techniques. Data were obtained from each individual using data sheets and then entered into SPSS version 20 for analysis. The chi-square test was calculated, and a p value <0.05 was considered statistically significant.

Results:

Out of 179 study subjects, 52 (29.1%) were infected with intestinal parasites. The most frequently detected parasites were Giardia lamblia (38.5%) and Ascaris lumbricoides (25%) Entamoeba histolytica/dispar (15.4%), followed by Strongyloides stercoralis (11.5%). Factors such as the CD4+ T-cell status and source of drinking water were significantly associated with the prevalence of intestinal parasites among HIV/AIDS patients. The prevalence of intestinal parasites was highly observed among patients who scored CD4+ T cells <200 cells/mm³ 90.4% (47/52) and drink ground water 73.1% (38/52).

Conclusion:

There was moderate prevalence of intestinal parasites among HIV/AIDS patients; therefore, treating unprotected water before drinking and diagnosis of early parasites for HIV/AIDS patients whose CD4+ T-cell count is less than 200 cells/mm³ should be practiced to prevent intestinal parasite infection.

Deep glance on the antiparasitic anticancer activities of wheat germ oil in chronically infected immunosuppressed mice with cryptosporidiosis

Cryptosporidium species are the major cause of water-borne epidemics of diarrhea in both developing and developed countries that vary from self-limited in immunocompetent patients to severe life-threatening in the immunocompromised hosts. There was a proven correlation between cryptosporidiosis and colorectal cancers, although, studies in this field are still limited. Wheat germ oil (WGO) is a natural product with a known antiparasitic effect and potential antiproliferative activities. This study aimed to evaluate the antiparasitic and anticancer activities of WGO in chronically infected immunosuppressed mice compared to Nitazoxanide (NTZ). This experimental case-control study was performed in the period from January till September 2021. Eighty immunosuppressed bred laboratory mice were divided into 4 groups, 20 mice each; GI non-infected; negative control (NC), GII infected non treated; positive control (PC), GII infected, and treated with NTZ, GIV infected, and treated with WGO. Parasitological, histopathological, and immunohistochemical examinations were performed with estimating the rate of maximal survival for the study groups. Parasitological examination revealed a marked reduction in the mean Cryptosporidium spp. oocyst counts in the stool of GIV compared to PC, and GIII (P-value < 0.001). Histopathological and immunohistochemical examinations showed the best results with GIV which revealed restoration of normal villous pattern, with no dysplasia or malignancy could be detected. GIV showed the best survival rate compared to PC and GIII. WGO is an extremely promising agent that has an excellent therapeutic effect against cryptosporidiosis with the ability to control the tumorigenesis process in the chronically infected immunosuppressed hosts.

Protozoan Intestinal Parasitic Infection in Patients with Hematological Malignancies

The aim of this study was to evaluate the frequency of gastrointestinal protozoan infection in patients with hematological malignancies (HMs) undergoing intensive hemato-oncological treatment and to determine the influence of certain biological factors on the incidence of intestinal parasite infection. Stool samples were collected from hematological malignancy patients (n = 50) hospitalized at the Department of Hematology and Transplantology of the Pomeranian Medical University in Szczecin. The control group consisted of 50 healthy participants. We used a direct smear examination and a commercial immunoenzymatic test. Intestinal protozoans were detected in 16% of patients with hematological malignancies and in 6% of individuals in the control group. In stool samples from patients with HM, cysts of Giardia intestinalis (2%), oocysts of Cryptosporidium spp. (10%), vacuolar forms of potentially pathogenic Blastocystis spp. (2%), and cysts of nonpathogenic Entamoeba coli (2%) were found. Cryptosporidium spp. and Giardia intestinalis coproantigens were detected in 5 (10%) and 1 (2%) patients with HM, respectively. In three participants from the control group, vacuolar forms of Blastocystis spp. were found. In the patients with HM, a significantly higher prevalence of intestinal parasite infection was found in individuals working in the garden without protective gloves and those in contact with animals. In patients with hematological malignancies, intestinal parasites should be excluded, even during intensive chemotherapy treatment.

The implementation of the Kinyoun staining technique in a resource-limited setting is feasible and reveals a high prevalence of intestinal cryptosporidiosis in HIV patients

OBJECTIVES

In resource-limited settings, intestinal Cryptosporidia or coccidian infections are common causes of chronic diarrhoea, but usually remain undiagnosed by routine stool investigation. Here, the addition of the Kinyoun staining technique after stool concentration was evaluated as an easy and inexpensive method for diagnosis of intestinal parasitic infection in HIV-infected patients.

METHODS

This cross-sectional study investigated HIV-infected patients with diarrhoea and randomly selected HIV-infected patients without diarrhoea as controls. Stool samples were examined by wet mount microscopy and Kinyoun staining after stool concentration. Clinical, sociodemographic and behavioural data were collected. Statistical analysis was performed using Chi-squared test and multivariate regression analysis.

RESULTS

In total, 163 participants were included (62.0% female, mean age 38.2 [SD ±10.7] years). Diarrhoea was present in 52.1% (85/163). The prevalence of intestinal parasites was 18.4% (30/163). Cryptosporidia infections were more frequent among patients with diarrhoea (12.9% [11/85] vs. 1.3% [1/78], p=0.005) and in patients with CD4⁺ cell count <200 cells/µL (25.9% [7/27] vs. 3.7% [5/136], p=0.001). Risk factors for intestinal parasitic infections were diarrhoea and the habit of regularly eating uncooked food. Kinyoun staining was necessary for detection of cryptosporidiosis.

CONCLUSION

In our cohort, the prevalence of intestinal parasitic infection was high, especially after additional utilization of Kinyoun staining for detection of Cryptosporidia or intestinal coccidia. Considering its clinical relevance particularly in individuals at risk, the implementation of this technique should be considered in resource-limited settings.

Intestinal parasitic infections and associated factors among people living with HIV attending Dessie Referral Hospital, Dessie town, North-east Ethiopia: a cross-sectional study

INTRODUCTION

Intestinal parasites and HIV/AIDS co-infection become a major public health concern in Africa. The management and care of HIV/AIDS patients is being complicated by intestinal parasitic infections. Therefore, this study aimed to determine the prevalence and associated factors of intestinal parasitic infections among people living with HIV at Dessie Referral Hospital, North-east Ethiopia.

METHODS

This cross sectional study was conducted from March to May 2019. Systematic simple random sampling technique was used to recruit study participants. Stool specimen was collected and examined microscopically using wet mount, formol-ether concentration technique and modified Zeihl-Neelsen methods. Socio-demographic characteristics and associated factors were collected using structured questionnaire. The recent CD4 cell count was obtained from patients ART follow-up record. Data were analysed using SPSS version 20 software. Bivariate and multivariate logistic regression was done to investigate the association between independent and dependent variables.

RESULTS

Of the total of 223 study participants 120 (53.8%) were females and 162 (72.6%) were urban resident. The overall prevalence of intestinal parasites was 47 (21.1%). Eleven different intestinal parasites species were detected. The dominant intestinal parasite species was Entameoba histolytica 14 (6.3%) followed by Enterobius vermicularis 5 (2.2%). Multivariate logistic regression analysis showed that individuals who had a habit of hand washing after latrine were less likely to be infected with intestinal parasitic infection (AOR 0.15, 95% CI 0.05-0.412). On the other hand individuals who had CD₄ cell count of < 200 cells/ml³ were 45.53 times more likely infected with intestinal parasites.

CONCLUSION

The prevalence of intestinal parasite was higher than previous report from the same study area almost a decade ago. There was statistical significant association between hand washing habit after latrine, habit of eating raw vegetables and CD₄ cell count less than 200 cells/ml³ and intestinal parasitic infections. Health education program interrupted in Dessie referral hospital should be continued to reduce the prevalence of intestinal parasites. Utilization of water treatment, washing hand after latrine and eating cooked or appropriately washed vegetables should also be promoted. Moreover, periodic laboratory stool specimen examination and prompt treatment are necessary.

National burden of intestinal parasitic infections and its determinants among people living with HIV/AIDS on anti-retroviral therapy in Ethiopia: A systematic review and meta-analysis

Objectives:

The aim of this systematic review and meta-analysis is designed to assess the pooled prevalence and determine risk factors of intestinal parasitic infections among people living with HIV/AIDS on anti-retroviral therapy in Ethiopia.

Methods:

International databases: PubMed, Web of Science, Cochrane Library, Scopus, PsycINFO, African Journals Online, and Google Scholar were systematically searched. Publication bias was determined using the funnel plot and Egger’s regression tests. Heterogeneity between the studies included in this review was checked by I² statistic. The DerSimonian and Laird random-effects model was applied to estimate the pooled effect size. Sub-group, meta-regression, and sensitivity analysis were conducted. Overall, meta-analysis was done using Stata version 14 statistical software.

Results:

Twenty-seven studies with 8946 individuals were included, the estimated pooled prevalence of intestinal parasitic infections among people living with HIV/AIDS on anti-retroviral therapy was 40.24% (95% confidence interval = 33.8–46.6). Based on sub-group analysis, the highest prevalence was observed in the Tigray region 45.7% (95% confidence interval = 7.9–83.5), followed by Oromia region 42.2% (95% confidence interval = 28.8–55.6). Availability of latrine (odds ratio = 26.6, 95% confidence interval = 2.8–15.8), presence of animals at home (odds ratio = 2.7, 95% confidence interval = 1.2–5.8), and source of drinking water (odds ratio = 3.2, 95% confidence interval = 1.3–7.5) were significantly associated with intestinal parasitic infections.

Conclusion:

These findings indicated that the prevalence of intestinal parasites among people living with HIV/AIDS was high in Ethiopia.

Association between Blastocystis sp. infection and immunocompromised patients: a systematic review and meta-analysis

The significance of opportunistic infections in immunocompromised patients and the enigmatic pathogenicity of Blastocystis directed us to conduct the first global systematic review and meta-analysis on Blastocystis prevalence, odds ratios (ORs), and subtypes distribution in various immunocompromised patients (HIV/AIDS, cancer and hemodialysis patients, as well as transplant recipients). The systematic searching procedure was done in Web of Science, PubMed, Scopus, and Google Scholar databases for relevant published literature until November 11, 2020. Random-effects model was utilized to calculate the weighted estimates and 95% confidence intervals (95% CIs). The computed pooled prevalence of Blastocystis inferred from 118 papers (128 datasets) on immunocompromised patients was 10.3% (95% CI: 8.7-12.2%), with 16.1% (95% CI: 11.3-22.2%), 12.5% (95% CI: 8.5-18%), 8.4% (95 % CI: 6.6-10.6%), and 6% (95% CI: 2.6-13.3%) for hemodialysis patients, cancer patients, HIV/AIDS patients, and transplant recipients, respectively. Based on 50 case-control studies (54 datasets), the highest ORs were associated with cancer [2.81 (95% CI: 1.24-6.38, P = 0.013)] and hemodialysis patients [2.78 (95% CI: 1.19-6.48, P = 0.018)]. The most frequent subtype being found in immunocompromised patients was ST3 [41.7% (95% CI: 31.4-52.7%)], followed by ST1 [31.7% (95% CI: 23.2-41.8%)] and ST2 [23.1% (95% CI: 14.8-34.1%)]. Also, the weighted frequency of Blastocystis in various subgroups (publication year, WHO regions, geographical distribution, continents, and country income) was analyzed separately. In total, the results of the present meta-analysis highlighted that one's immunodeficiency status is probably associated with an increased Blastocystis infection, underpinning strict preventive measures to be taken.

Global prevalence and associated risk factors of diarrheagenic Giardia duodenalis in HIV/AIDS patients: A systematic review and meta-analysis

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.

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

Background

Coccidian 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.

Objective

The aim of this study was to determine the prevalence of coccidian parasitic infections among HIV/AIDS cases before and after commencement of antiretroviral treatment.

Methods

An 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.

Results

Among 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.

Conclusion

Prevalence 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.

Molecular characterization of Cryptosporidium spp. from humans in Ethiopia

Data on the distribution and genotype of Cryptosporidium species is limited in Ethiopia. This study examined the presence and genetic diversity of Cryptosporidium species circulating in Ethiopian human population. Stool samples collected from patients who visited rural (n = 94) and urban (n = 93) health centers in Wurgissa and Hawassa district, respectively, were examined for the presence of Cryptosporidium spp. using microscopy, nested PCR and real-time PCR. To detect infection with PCR, analysis of 18S ribosomal RNA was performed. Subtyping was performed by sequencing a fragment of GP60 gene. The overall prevalence of infection was 46% (n = 86) by microscope and PCR. When 48 (out of 86) PCR positive samples were genotyped, two species were identified: C. parvum (n = 40) and C. hominis (n = 8). When 15 of the 40 C. parvum isolates were subtyped, zoonotic subtypes of IIaA14G1R1 (n = 1), IIaA15G2R1 (n = 1), IIaA16G1R1 (n = 2), IIaA16G3R1 (n = 2), IIaA17G1R1 (n = 1), IIaA19G1R1 (n = 1), IIaA20G1R1 (n = 3), IIaA22G1R1 (n = 1), IIaA22G2R1 (n = 1), IIdA23G1 (n = 1) and IIdA24G1 (n = 1) were identified. When 6 of the 8 C. hominis isolates were subtyped, subtypes IaA20 (n = 5), and IdA21(n = 1) were identified. This study suggests that C. parvum and C. hominis are causes of cryptosporidiosis in human in the Wurgissa district and Hawassa in Ethiopia. Zoonotic transmission might be the main route of transmission.

Prevalence, risk factors and impact of cellular immunity on intestinal parasitosis among people living with HIV at Auchi, Edo State, Nigeria

This study was sought to determine the impact of CD4⁺ T-cell count and associated risk factors with intestinal parasitosis in people living with HIV (PLHIV) in Central Hospital, Auchi, Edo State, Nigeria. One hundred and seventy (170) HIV-seropositive subjects were enrolled in the study from 24 August 2015 to 22 January 2016. Sociodemographic data were assessed using structured questionnaires. Blood and stool samples were collected from every participant. CD4⁺ T-cell count and stool parasitology were performed. The prevalence of intestinal parasites was 44.7%. Helminthiasis (67%) was a predominant infection in the study, while 32.9% had protozoasis. Specifically, Ancylostoma duodenale (33.3%) was the most common helminth, and Trichuris trichiura (7.8%), the least. However, Strongyloides stercoralis, Ascaris lumbricoides and Hymenolepis nana were 13.7%, 31.5% and 13.7%, respectively. Cryptosporidium spp. (25.0%) was the only protozoan. Lower CD4⁺ T-cell count, ART naivety (OR = 2.62 p < 0.05), residence in a rural setting (OR = 0.89, p < 0.05), and farming occupation (OR = 1.70, p < 0.05) were associated with the prevalence of intestinal parasitosis among PLHIV. This study revealed a significantly high prevalence of intestinal parasitosis in ART naive PLHIV with reduced CD4⁺ count. Hence, it is recommended to frequently test for intestinal parasitosis and commencement of ART in all PLHIV to improve their health and longevity.

Intestinal Parasites Infection in Children with Cancer in Ahvaz, Southwest Iran

Background

Infection with intestinal parasites is widespread worldwide, especially in developing countries. Intestinal parasites are known as one of the leading causes of diarrhea in both immunocompetent and immunocompromised subjects, but cancer patients are highly susceptible to contamination, and it can be deadly for them. This study aimed to estimate the prevalence of intestinal parasites in immunocompromised patients in Ahvaz. Material and Methods. In this descriptive cross-sectional pilot case-control study, fecal samples were collected from 52 children with malignancies hospitalized in Baqaei2 hospital in Ahvaz. A questionnaire including demographic information, type of cancer, type of gastrointestinal symptoms, and laboratory diagnosis was completed for each patient. The collected specimens were examined by direct smear, Logul staining, and concentration.

Result

The 52 stool samples were collected, 46% were female and 54% male. The age range of children enrolled in the study was from 4 months to 16 years. Of these stool samples, 38.38% were infected with a variety of parasitic intestinal infections (helminths and protozoa). In this study, protozoan parasites, Blastocystis (23%), Chilomastix mesnili (1.92%), Endolimax nana (7.7%), and Entamoeba coli (1.92%), and helminth infection, Strongyloides stercoralis (3.84%), were observed and statistical analysis showed that there was a significant relationship between gastrointestinal symptoms and parasitic infection in children with cancer.

Conclusion

Blastocystis and Endolimax nana are the most prevalent gastrointestinal parasitic protozoans that infect individuals admitted to Baqaei2 Hospital of Ahvaz, Iran. Since parasitic intestinal infections in immunocompromised patients lead to fatal diarrhea, children with parasitic infections must be carefully identified and treated.

Intestinal parasitic infections and associated factors among people living with HIV/AIDS in Ethiopia: A systematic review and meta-analysis

Background

Intestinal parasitic infections are major public health problems throughout the world, particularly in people living with HIV/AIDS. People living with HIV/AIDS are vulnerable groups for a variety of diseases, hence they are easily affected by opportunistic and non-opportunistic intestinal parasites due to the weakening of their immunity. Therefore, this study aimed to estimate the pooled prevalence and factors associated with intestinal parasitic infections among people living with HIV/AIDS in Ethiopia.

Methods

Articles were identified through search engines in the online electronic databases PubMed/MEDLINE, EMBASE, HINARI, CINAHL, Cochrane Library, Google Scholar, and reference lists of previous studies following the PRISMA Protocol. Studies conducted between 2003 and 2020 with English language were included in this study. This review included papers with having high-quality NOS scores. Meta-analysis was computed using STATA version 11 software. Heterogeneity was assessed using the Cochrane Q-test and I² test statistics. Subgroup and sensitivity analysis was employed with evidence of heterogeneity. Publication bias was determined using the funnel plot and Egger’s regression test statistic.

Results

This study included a total of twenty-two cross-sectional studies with 5,833 study participants. The mean age of the study participants was 35 years old. The pooled prevalence of intestinal parasitic infection among people living with HIV/AIDS in Ethiopia was 39.15% (95%CI: 32.34, 45.95). The pooled prevalence of intestinal parasitic infections among people living with HIV/AIDS who had taking ART and who had not to start ART was found to be 28.27% (95%CI 22.47, 34.06) and 41.63% (95%CI: 28.75, 54.52) respectively. Unavailability of latrine (AOR: 4.87, (95% CI: 2.39, 9.92)), CD4+ T cell count <200cells/μl ((AOR: 3.53, (95%CI: 1.98, 6.27)), and having a history of diarrhea (AOR: 4.79 (95%CI: 1.53, 14.99) were factors significantly associated with intestinal parasitic infections.

Conclusion

In this study, the overall pooled prevalence of intestinal parasitic infections among HIV/AIDS patients in Ethiopia was relatively high. CD4+ T-cell count <200cells/μl, unavailability of a latrine, and history of diarrhea were significantly associated with intestinal parasitic infections. Therefore, the policymakers and health care professionals could give special attention to the presence of latrines, early detection and treatment of intestinal parasitic infections, and early initiation of ART drugs.

Prevalence of enteric pathogens, intestinal parasites and resistance profile of bacterial isolates among HIV infected and non-infected diarrheic patients in Dessie Town, Northeast Ethiopia

BACKGROUND

Enteric pathogens like Salmonella and Shigella species as well as intestinal parasites (IPs) are among the main causative agents of diarrhea in people with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), particularly in low income countries like Ethiopia. Antimicrobial resistance against commonly prescribed drugs has become a major global threat. This study, therefore, aimed at determining the magnitude of Salmonella, Shigella and IPs infections, their predicting factors, and antimicrobial susceptibility pattern among HIV infected and non-infected diarrheic patients in Dessie town, Northeast Ethiopia.

METHODS

A cross sectional study was conducted at three health facilities in Northeast Ethiopia between January 2018 and March 2018. Data on socio-demographic and associated risk factors were collected using structured questionnaire from 354 HIV infected and non-infected diarrheic outpatients. Fresh stool specimen was processed according to standard operating procedures. Data were entered and analyzed using SPSS version 22. Descriptive statistics was used to determine frequency, Bivariate and multivariate logistic regression analyses were performed to identify predicting factors associated with the outcome variable. P-value <0.05 were used to declare statistical significance.

RESULTS

Among 354 diarrheic patients, 112 were HIV infected and 242 were HIV non-infected. The overall prevalence of intestinal parasite and bacterial infection among HIV infected versus non-infected, respectively, was 26 (23.2%) and 8 (7.1%) versus 50 (20.7) and 16 (6.6%). Salmonella was the highest in both groups, 6 (5.4%) vs 11 (4.5%). Most prevalent parasite was C. parvum, 9 (8%) among HIV+ while E. histolytica/dispar 39 (16.1%) among HIV-. Having bloody plus mucoid diarrhea, not utilizing latrine and drinking river or spring water were factors significantly associated with bacterial infection. Whereas, being illiterate or having primary level education, diarrhea lasting for 6-10 days, CD4 level between 200-500 cells/μl, not washing hand with soap showed significant association with IPs. The bacterial isolates were 100% susceptible to Ceftriaxone and 95.4% to Ciprofloxacin, while 100% resistant to Ampicillin and Amoxicillin. MDR was observed among 19 (79.2%) isolates.

CONCLUSION

Preventing and controlling infection by enteric pathogens as well as IPs require strengthening intervention measures. The 100% resistance of isolates to commonly prescribed antibiotics calls for expanding antimicrobial susceptibility testing so as to select appropriate antimicrobial agent and prevent emergence of drug resistant bacteria.

Worldwide prevalence of emerging parasite Blastocystis in immunocompromised patients: A systematic review and meta-analysis

BACKGROUND

Blastocystis is one of the most common pathogens of the human intestine, caused by an emerging parasite, which can lead to severe symptoms and even death in immunocompromised patients. We aimed to determine the global prevalence of Blastocystosis infection in people with immunodeficiency. A systematic literature search was conducted on Web of Science, Scopus, Google scholar, Science Direct and MEDLINE databases to select all observational studies reporting the prevalence of Blastocystosis infection in Worldwide, based on different diagnostic methods in immunocompromised patients of any age and published from inception to February 2019. Pooled estimates and 95% confidence intervals (95% CIs) were calculated using random effects models and in addition, the I² statistic was calculated. The geographic distribution of studies was evaluated and the diagnosis of Blastocystis was compared by various techniques. Electronic databases were reviewed for Blastocystosis infection in HIV/AIDS, cancer and other immunocompromised patients, and meta-analyses were conducted to calculate the overall estimated prevalence. Total68 eligible studies were included. The estimated pooled prevalence rate of Blastocystosis infection in immunocompromised patients was overall 10% (95% CI, 7-13%; I² 96.04%) (P < 0.001), of whom 21% [18-25] were in Australia, 12% [4-24] in America, 11% [6-17] in Europe and 10% [5-15], 7% [3-13] in Asia and Africa, respectively. It was calculated that the estimated pooled prevalence rate of Blastocystosis infection in immunocompromised patients was overall 10% and the prevalence estimates ranged from 0.44 to 72.39. Also, overall the prevalence of parasites co-infection in immunocompromised patients was detected as 0.024%. Our finding showed that immunocompromised people show a high prevalence of Blastocystosis infection compared to the control population. Adequate information on the prevalence rate is still missing from many countries. However, current information underscore that Blastocystis should not be neglected.

First detection of Blastocystis sp. in pigs in Slovakia and in Europe

Blastocystis sp. is a single-cell microorganism occurring in the gastrointestinal tract of humans and various animals and is distributed worldwide. Blastocystis exhibits extensive genetic diversity of 28 subtypes (STs) based on the small subunit ribosomal RNA (SSU rRNA) gene. In this study, the genetic diversity and zoonotic potential of Blastocystis were evaluated using pig faecal samples from two farms in Slovakia. Blastocystis spp. were detected in pigs intended for distribution and consumption. ST 5 subtype was identified in all positive samples and age categories with a prevalence of 12%. However, the prevalence on one of the farms was up to 28.6%. This is the first study of Blastocystis in pigs carried out in Slovakia. Although a number of samples obtained was small, the identified subtype of ST5 Blastocystis sp. occurs in humans and animals. It may have zoonotic potential and therefore may be a risk factor due to the close contact between humans and pigs on the breeding farms.

Cryptosporidiosis in HIV-positive patients and related risk factors: A systematic review and meta-analysis

Cryptosporidium is one of the major causes of diarrhea in HIV-positive patients. The aim of this study is to systematically review and meta-analyze the prevalence of Cryptosporidium in these patients. PubMed, Science Direct, Google Scholar, Web of Science, Cochrane and Ovid databases were searched for relevant studies dating from the period of 1 January 2000 to 31 December 2017. Data extraction for the included studies was performed independently by two authors. The overall pooled prevalence was calculated and subgroup analysis was performed on diagnostic methods, geographical distribution and study population. Meta-regression was performed on the year of publication, proportion of patients with diarrhea, and proportion of patients with CD4 < 200 cells/mL. One hundred and sixty-one studies and 51,123 HIV-positive participants were included. The overall pooled prevalence of Cryptosporidium infection in HIV-positive patients was 11.2% (CI95%: 9.4%–13.0%). The pooled prevalence was estimated to be 10.0% (CI95%: 8.4%–11.8%) using staining methods, 13.5% (CI95%: 8.9%–19.8%) using molecular methods, and 26.3% (CI95%: 15.0%–42.0%) using antigen detection methods. The prevalence of Cryptosporidium in HIV patients was significantly associated with the country of study. Also, there were statistical differences between the diarrhea, CD4 < 200 cells/mL, and antiretroviral therapy risk factors with Cryptosporidiosis. Thus, Cryptosporidium is a common infection in HIV-positive patients, and safe water and hand-hygiene should be implemented to prevent cryptosporidiosis occurrence in these patients.

Cryptosporidium infection among people living with HIV/AIDS in Ethiopia: a systematic review and meta-analysis

Studies on the prevalence of Cryptosporidium infection in People Living with HIV/AIDS (PLWHA) are inconsistent and heterogeneous. Therefore, this systematic review with meta-analysis was performed to assess the burden of the infection relative to the proportion of CD4 + T cell count among PLWHA in Ethiopia. Articles published before 15 May 2019, have been retrieved for this systematic review using five databases; PubMed, Scopus, Web of Science, Google Scholar and ProQuest, supplemented by the search for gray literature. The overall pooled prevalence and pooled Odds Ratio (OR) with their 95% Confidence Intervals (CI) were estimated using STATA 14 statistical Software. Of the 255 studies retrieved, 31 were considered for the final analysis. As many as 8,645 Ethiopians infected with HIV were included in the final quantitative synthesis. The overall pooled prevalence estimate of Cryptosporidium infection among PLWHA in Ethiopia was 11% (95%CI: 0.09-0.13). HIV-infected people with low CD4 + T cell count (CD4 < 200 cells/mm3) were 13.07 times more likely to become infected with Cryptosporidium than those with high CD4 + T cell count (CD4 > 500 cells/mm3) (OR: 13.07 (95%CI: 6.38-26.75). Cryptosporidium infection in PLWHA in Ethiopia showed decreasing patterns in 2001-2010, 2011-2014, and in 2015-2019, 14.6% (95%CI: 0.076-0.217), 12.71% (95%CI: 0.086-0.167) and 6.7% (95%CI: 0.044-0.090), respectively (p < 0.001). Though the pattern of Cryptosporidium infection in HIV-infected Ethiopians showed a declining trend; it remains a considerable problem that requires improvement in routine screening for Cryptosporidium in HIV-infected people, particularly with poor or declining CD4 + T cell count.

Aetiology of acute diarrhoea and antimicrobial usage among children aged under five years at health centres in Bahir Dar, Ethiopia

The aetiology of diarrhoea with Cryptosporidium species and pathogenic bacteria has not been identified in the Ethiopian primary healthcare system. Thus, antibiotic consumption for unconfirmed pathogenic diarrhoea is not infrequent. A total of 344 children aged <5 years with diarrhoea were included in the present study to determine protozoal or bacterial aetiology and antibiotic use. Overall, 47.1% of children with diarrhoea had either protozoan or bacterial pathogens. The prevalence of Cryptosporidium species was 12.8% while bacterial pathogens were 13.1%. Based on direct microscopic stool examination, 77.6% (267/344) of children with diarrhoea were treated with antimicrobials. Of these, 16.7%-51.4% of prescribed antimicrobials were appropriate. None of the children with Cryptosporidium diarrhoea were treated with the appropriate antimicrobial. Enteric bacterial pathogens showed a resistance of 51.6% to cotrimoxazole. Empirical treatments are not appropriate for the majority of child cases of diarrhoea.

More Than Half Prevalence of Protozoan Parasitic Infections Among Diarrheic Outpatients in Eastern Tigrai, Ethiopia, 2019; A Cross-Sectional Study

Background

Protozoan infections remain a major public health concern in Ethiopia, which causes malnutrition, protein and iron deficiencies, increment of health costs, hospitalization and long-term deleterious effects. In Tigrai, particularly, in the study area, there are limited literatures on the prevalence of protozoa and associated factors among diarrheic outpatients. Thus, aimed to determine the prevalence and associated factors of protozoan infections among diarrheic outpatients in Eastern Tigrai.

Methods

Health facility-based cross-sectional study was conducted in Eastern Tigrai, Ethiopia from April to October 2019 among diarrheic outpatient in health facilities of Adigrat. Four hundred one eighteen study participants were included consecutively. The stool samples were examined via direct wet mount following formal-ether concentration technique. Both interviewer based and self-administrated questionnaires were used to collect demographic data and factors associated with protozoan infections. Data were analyzed and computed using BM SPSS statistics version 22.0. P-value=0.05 at 95% confidence interval declared statistically significant.

Results

Out of 418 diarrheic outpatients, the overall prevalence of protozoan infection was 59.3% (248/418). A higher percentage of intestinal protozoan infection was recorded for females 130 (31.1%). Using well water as a source of drinking, poor hand washing habits before eating, not home latrine, dirty and untrimmed fingernails were the most important risk factors identified. E. histolytica complex and Giardia duodenalis were the most predominant protozoan infections detected among diarrheic outpatients.

Conclusion

The present study showed that diarrheic outpatients in the study area were heavily infected with protozoan parasitic infection. E. histolytica complex and Giardia duodenalis were the most predominant protozoans detected among diarrheic outpatients. Using well water as a source of drinking, poor handwashing habit before eating, not having home latrine, dirty and untrimmed fingernails were most important risk factors identified. So, cooperative action and health education on preventive measure are needed to reduce protozoan infections in Tigrai, particularly in the study area. The present study showed that diarrheic outpatients in the study area were heavily infected with protozoan parasitic infection.

Nitazoxanide in the Treatment of Intestinal Parasitic Infections in Children: A Systematic Review and Meta-Analysis

OBJECTIVES

To evaluate the efficacy and safety of nitazoxanide in intestinal parasitic infections in children.

METHODS

Four databases, PubMed, EMBASE, Web of Science and Cochrane Library, have been systematically searched from the inception of each database up to March 1st, 2019. The enrolled studies were limited to randomized clinical trials in children, comparing nitazoxanide with placebo or other antiparasitic drugs. The data extraction and quality assessment of pooled studies were conducted by two reviewers independently. For meta-analysis, Stata12.0 was used and a randomized effect model or a fixed effect model was selected according to the outcomes of heterogeneity test.

RESULTS

A total of 1645 subjects in 13 randomized controlled trials (RCTs) were enrolled, including 768 cases in the trial group and 877 cases in the control group. The effect of nitazoxanide vs. placebo and other antiparasitic drugs on the excretion rate of pathogens was uncertain (OR = 2.06, 95%CI [1.01,4.20], P = 0.047; I² = 84.7%; very low quality evidence). Compared with placebo, subgroup analysis suggested that nitazoxanide could significantly improve the excretion rate of pathogens (OR = 7.01, 95%CI [1.82,26.94], P = 0.005; I² = 79.1%; moderate quality evidence), while it made little or no difference compared with antiparasitic drugs (OR = 0.72, 95%CI [0.47,1.09], P = 0.124; I² = 33.1%; low quality evidence). Meanwhile, nitazoxanide might increase the remission rate of diarrhea with OR = 5.12, 95%CI [2.00,13.08], P = 0.001; I² = 72.3%; low quality evidence). However, it might also increase the rate of adverse events (OR = 1.47, 95%CI [1.05,2.07], P = 0.026; I² = 44.7%; low quality evidence).

CONCLUSIONS

The authors are uncertain whether or not nitazoxanide could improve the excretion rate of pathogens. Based on low-certainty evidence, nitazoxanide may improve the remission rate of diarrhea in children with intestinal parasite infections, but it may be associated with an increased risk of adverse reactions. Hence, more RCTs with a low risk of bias are still needed to assess the efficacy and safety of nitazoxanide.

Cryptosporidiosis And Other Intestinal Parasitic Infections And Concomitant Threats Among HIV-Infected Children In Southern Ethiopia Receiving First-Line Antiretroviral Therapy

Background

Children infected with human immunodeficiency virus (HIV) are at high risk of acquiring intestinal parasitic infections. This study aimed to determine the magnitude of Cryptosporidium and other intestinal parasitic infections and concomitant threats among HIV-infected children.

Methods

A hospital-based cross-sectional study was carried out at three antiretroviral therapy clinics in southern Ethiopia from February 2016 to June 2017 in 384 HIV positive children. Socio-demographic and clinical data were collected using structured questionnaires. Direct stool microscopic examination and modified Zeihl–Neelsen staining technique to identify parasites. Chi-square test was conducted to determine the real predictors of the infection. Significant association was considered when p-value <0.05 at 95% CI.

Results

The overall magnitude of intestinal parasitic infections among the study population was 16.9% (95% CI: 13.0–20.8%). The most predominant parasitic infections were Cryptosporidium spp. (9.6%) and the least was Taenia spp. (0.78%). Diarrheal status (χ²=7.653, df=2, p=0.022) was detected to be the only significant associated variable.

Conclusion

Cryptosporidium infection was found to be the most common intestinal parasitosis among HIV-infected children. Routine screening service for Cryptosporidium and other intestinal parasites is important in the clinical management of HIV-infected children.

Risk factors for Blastocystis infection in HIV/AIDS patients with highly active antiretroviral therapy in Southwest China

Background

Blastocystis is a widespread zoonotic protozoan of mammalian species, especially in HIV/AIDS individuals. The aim of this study was to analyze the prevalence and risk factors related with Blastocystis infection among HIV/AIDS patients in Southwest China.

Methods

The cross-sectional study was performed in 311 HIV/AIDS cases in Tengchong City, Yunnan Province from July 2016 to March 2017. For each subject, stool specimen was collected to detect the Blastocystis, and the blood sample was used to detect HIV virus load and CD4⁺ T cell count, in addition, structured questionnaire was used to collect the basic information and risk factors.

Findings

The result showed that the detection rate of Blastocystis was 3.86% (95% CI: 2.22–6.62) among HIV/AIDS patients. Both raising animal (OR = 12.93, 95% CI: 1.54–108.36) and drinking un-boiled water (OR = 8.17, 95% CI: 1.76–37.90) were risk factors for Blastocystis infection in HIV/AIDS individuals. In addition, the interaction of CD4⁺ T cell count and HIV virus load was also contribution to Blastocystis infection (P = 0.007).

Conclusions

A high prevalence of Blastocystis infection was found in HIV/AIDS patients in Tengchong. Poor hygienic habits, the interaction of HIV virus load and CD4⁺ T cell count were identified as main risk factors for infection. These results will help us to develop efficient control strategies to intervene with and prevent the occurrence of Blastocystis among HIV-infected individuals.

Cystoisospora belli infections in humans: the past 100 years

Cystoisospora belli is a coccidian parasite of humans, with a direct fecal-oral transmission cycle. It is globally distributed, but mainly found in tropical and subtropical areas. Many cases of C. belli infections have been reported in patients with HIV, and in patients undergoing immunosuppressive therapy for organ transplants or those treated for tumours worldwide. Unsporulated or partially sporulated oocysts of C. belli are excreted in feces. When sporulated oocysts in contaminated water or food are ingested, asexual and sexual stages of C. belli are confined to the epithelium of intestines, bile ducts and gallbladder. Monozoic tissue cysts are present in extra-intestinal organs (lamina propria of the small and large intestine, lymph nodes, spleen, and liver) of immunosuppressed humans. However, a paratenic host has not been demonstrated. Cystoisospora belli infections can be persistent, lasting for months, and relapses are common; the mechanism of relapse is unknown. Recently, the endogenous stages of C. belli were re-examined and attention was drawn to cases of misidentification of non-protozoal structures in the gallbladder of patients as C. belli. Here, we review all aspects of the biology of C. belli, including morphology, endogenous stages, prevalence, epidemiology, symptoms, diagnosis and control.

Lower prevalence of Blastocystis sp. infections in HIV positive compared to HIV negative adults in Ghana

Background

Sub-Saharan Africa is endemic for intestinal parasites and distinguished for the largest burden of HIV cases. Blastocystis sp. is one of the most common protists infecting humans but its role in human disease is still controversial. Aim of this study was to investigate the prevalence of Blastocystis sp. in HIV positive and negative adults in Ghana and its association with immune status and other risk factors.

Methods

122 HIV positive outpatients and 70 HIV negative blood donors from the Komfo Anokye Teaching Hospital in Kumasi, Ghana, were included in the present study. Demographic, clinical and laboratory data were collected and HIV positive patients distinguished for CD4+ T cell count <200 cells/μl (n = 54) and >200 cells/μl (n = 68). A Blastocystis’s phylogenetic analysis was performed to determine sample subtype (ST).

Results

The prevalence of Blastocystis sp. in adult HIV positive individuals was lower than in HIV negative persons (6.6% vs. 20.0%, p = 0.008) and Blastocystis sp. ST1 was the most prevalent strain. Within HIV positive participants, the prevalence of Blastocystis sp. was lower in those individuals with CD4+ T cell count <200 cells/μl than in patients with higher CD4+ T cell count (1.9% vs. 10.3%, p = 0.076). Multiple regression analysis revealed that Blastocystis sp. was inversely associated with an obese Body Mass Index (BMI) in HIV negative persons (p = 0.040). Presence of Blastocystis sp. was correlated with higher CD4+ T cell count in HIV positive participants (p = 0.049).

Conclusion

It is largely reported that people living with HIV (PLHIV) in Africa are affected from parasite infections and that co-infections may adversely impact on their immune status, accelerating progress to AIDS and worsening gastrointestinal manifestations. Differently, in this study Blastocystis sp. was associated with a better immune status jointly with a healthy body weight while it seems to be reduced with the progression of HIV infection. This data agree with recent suggestions that Blastocystis sp. can represent a component of the healthy gut microbiota.

Prevalence and associated risk factors of Cystoisospora belli and Cyclospora cayetanensis infection among Iranian patients with colorectal cancer

From among intestinal parasites, coccidian intestinal parasites such as Cystoisospora belli (previously known as Isospora belli), and Cyclospora cayetanensis are well-known as opportunist parasites, particularly in patients with cancer. This study assessed the prevalence of C. belli and C. cayetanensis in patients with cancer in Lorestan Province, Southwest of Iran. This cross-sectional descriptive study was conducted on 87 patients with colorectal cancers, referred to the general hospitals of Lorestan from October 2017 to August 2018. A fresh stool specimen was collected from each subject in a sterile labeled container. The collected stool samples were concentrated through sucrose flotation method and then prepared for Ziehl-Neelsen staining for microscopic examination. Demographic and possible risk factors such as age, sex, education, residence, and unwashed vegetable/fruit consumption were collected by an applied questionnaire. Out of the 87 patients with colorectal cancer, eight (9.2%) were found positive for C. belli and C. cayetanensis infections, with five (5.74%) and three (3.44%) patients positive for C. belli and C. cayetanensis infections, respectively. Results also showed that sex and unwashed vegetable/fruit consumption were significantly associated with the prevalence of these parasites (p < 0.01). The findings revealed the considerable prevalence of C. belli and C. cayetanensis in patients with colorectal cancers. It is therefore essential for gastrointestinal specialists to pay special attention to the prevalence of coccidian parasites in patients with colorectal cancer.

Neoplastic patients' knowledge about intestinal parasitoses in southern Brazil

Since oncologic patients have been considered an important risk group for parasitic infections, it is fundamental to find out what they know about intestinal parasites. This study aimed at evaluating knowledge that the adult oncologic patients undergoing chemotherapy in the main centers of treatment for cancer in the city of Pelotas, Brazil, has about intestinal parasites. A semi-structured questionnaire was used for collecting data from two hundred oncologic patients who were undergoing chemotherapy. Results showed that 69.5% know what intestinal parasites are and cited Ascaris lumbricoides and Taenia sp. as being the most known ones. The statistical comparison between the group that knows intestinal parasites and the one that does not know about them - associated with socioeconomic variables -, showed that factors that significantly influenced their knowledge were their place of residence, schooling and household income (p≤0.05). Only 36% stated that they know when they are infected with parasites and misdescribed some signs and symptoms. Regarding prevention, 52% mentioned that they do not know how to avoid parasitism. The population under study showed that there are some gaps in its knowledge of the theme under investigation. Therefore, it is important to implement socioeducational measures in hospitals and clinics that treat cancer patients.

Intestinal parasitosis in relation to CD4 count and anemia among ART initiated patients in St. Mary Aksum general hospital, Tigray, Ethiopia

Background

The geographical distribution of intestinal parasites with conditions of poverty in most countries of sub-Saharan Africa coincides with that of HIV/AIDS. However, there is paucity of studies investigating the relationship between intestinal parasitic infections with CD4 counts and anemia in HIV/AIDS patients starting Antiretroviral Therapy (ART) in this region particularly and in Ethiopia in general. The aim of this study was to determine the prevalence of intestinal parasitic infections in relation to CD4 count and anemia among ART-initiated patients in St. Mary Aksum General Hospital, Tigray, Ethiopia.

Methods

A cross-sectional study was conducted among randomly selected 242 ART-initiated participants during February to April 2017 in St. Mary Aksum General hospital. Data was collected using structured questionnaire and laboratory examination. Logistic regression was applied to assess any association between explanatory factors and outcome variables (P values < 0.05).

Result

The overall prevalence of intestinal parasites was 26.4% and among the six types of parasitic genera identified Entamoeba histolytica/dispar (18.6%) and Giardia lamblia (2.1%) were the leading. According to the multivariate analysis, lack of hand washing before meal, eating uncooked vegetables, history of taking anti-parasite medication, stool consistency, and anemia were strongly associated with intestinal parasitosis.

Conclusion

There was a high prevalence of intestinal parasites among HIV positive individuals. Intervention measures such as deworming, improving hygiene and sanitation practices should be strengthened to reduce the burden of intestinal parasites among people living with HIV.

Electronic supplementary material

The online version of this article (10.1186/s12879-019-3989-0) contains supplementary material, which is available to authorized users.

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 (ײ=13.528, p<0.001), Cyclospora was associated with the type of drinking water (ײ=14.931, p<0.001) and toilet facilities used by the study subjects (ײ=12.463, p<0.01), whiles Microsporidium infection was associated with hand washing behavior (ײ=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/mm^3. 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.

Intestinal Parasitosis and Their Associated Factors among People Living with HIV at University of Gondar Hospital, Northwest-Ethiopia

Background

Most HIV clients die of AIDS related intestinal parasitic infections rather than due to the HIV infection itself. Therefore, this study was aimed at determining the prevalence of intestinal parasite and their associated factors among HIV/AIDS clients at the University of Gondar Hospital, Northwest Ethiopia.

Methods

Institution based cross sectional study was conducted using systematic random sampling technique from March to May 2016. A semi-structured questionnaire was used to collect data. Stool samples were collected and processed using direct wet mount, formol-ether concentration and modified Ziehl-Neelson staining techniques. Besides, blood samples were collected for CD4+ count estimation. Both descriptive and logistic regression analyses were used in data analysis. P-values <0.05 were considered as statistically significant.

Results

A total of 223 participants were enrolled in this study, and the prevalence of intestinal parasitosis was found to be 29.1%. The most predominant intestinal parasite detected was cyst of Entamoeba histolytica (8.5%) followed by Ascaris lumbricoides (6.7%), Strongyloides sterocoralis (3.6%) and Cryptosporidium parvum (3.1%), whereas Schistosoma mansoni (0.9%) and Hymenolepis nana (0.9%) were the least detected. Absence of toilet (AOR= 19.4, CI: 6.46–58.3), improper hand washing before meal (AOR=11.23, 95% CI: 4.16–30.27 and CD4+ count < 200 cells/mm³ (AOR=33.31, 95% CI: 9.159–121.149) had significant association with prevalence of intestinal parasites.

Conclusion

The study indicated that intestinal parasites are still a problem among HIV/AIDS patients in the study area. Thus, routine examination for intestinal parasites and interventions should be carried out for better management of clients.

Prevalence of Cryptosporidium, microsporidia and Isospora infection in HIV-infected people: a global systematic review and meta-analysis

BACKGROUND

Diarrhea caused by opportunistic intestinal protozoa is a common problem in HIV infection. We aimed to establish the prevalence of Cryptosporidium, misrosporidia, and Isospora in HIV-infected people using a systematic review and meta-analysis, which is central to developing public policy and clinical services.

METHODS

We searched PubMed, ScienceDirect, Google Scholar, Embase, Chinese Web of Knowledge, Wanfang, and Chongqing VIP databases for studies reporting Cryptosporidium, microsporidia, or Isospora infection in HIV-infected people. We extracted the numbers of people with HIV and protozoa infection, and estimated the pooled prevalence of parasite infection by a random effects model.

RESULTS

Our research identified 131 studies that reported Cryptosporidium, microsporidia, and Isospora infection in HIV-infected people. We estimated the pooled prevalence to be 14.0% (3283/43,218; 95% CI: 13.0-15.0%) for Cryptosporidium, 11.8% (1090/18,006; 95% CI: 10.1-13.4%) for microsporidia, and 2.5% (788/105,922; 95% CI: 2.1-2.9%) for Isospora. A low prevalence of microsporidia and Isospora infection was found in high-income countries, and a high prevalence of Cryptosporidium and Isospora infection was found in sub-Saharan Africa. We also detected a high prevalence of Cryptosporidium, microsporidia, and Isospora infection in patients with diarrhea. Sensitivity analysis showed that three studies significantly affect the prevalence of Isospora, which was adjusted to 5.0% (469/8570; 95% CI: 4.1-5.9%) by excluding these studies.

CONCLUSIONS

Our findings suggest that HIV-infected people have a high prevalence of Cryptosporidium, microsporidia, and Isospora infection in low-income countries and patients with diarrhea, especially in sub-Saharan Africa, reinforcing the importance of routine surveillance for opportunistic intestinal protozoa in HIV-infected people.

Prevalence of Cryptosporidium species isolated from HIV/AIDS patients in southwest of Iran

This study aimed to determine the prevalence and species of Cryptosporidium among HIV/AIDS patients in southwest of Iran. Two hundred fifty faecal samples from HIV patients were examined for the presence of Cryptosporidium oocysts using a conventional coproscopic approach. Such oocysts were detected in 18 (7.2%) out of 250 faecal samples. Genomic DNAs from 250 samples were then subjected to a nested-PCR-RFLP technique targeting different loci of 18S rRNA gene for species identification. Out of 250 samples, 27 (10.8%) were positive for different Cryptosporidium spp; Restriction patterns resulting from the digestion of the nested amplicon with restriction endonucleases VspI and SspI showed that C. parvum (70.38%) was the most prevalent species, followed by C. hominis (25.92%) and C. meleagridis (3.7%), respectively. The mean CD4+ T-cell count was 215 cells/μL. There was a strong association between cryptosporidiosis and CD4+ T-cell count (P = 0.000) with the highest prevalence recorded among patients with CD4+ T-cell count < 200 cells/μL. This confirms that there is a low opportunity for this parasite to get established as the patients CD4+ T-cell count increases. Also HIV infection increased the risk of having Cryptosporidium. Our epidemiological findings are useful for any preventive intervention to control disease diffusion.

Intestinal parasites in cancer patients in the South of Brazil

Abstract Intestinal parasitic infections in immunocompromised patients can lead to serious complications when not diagnosed and treated early. This study aimed to investigate the frequency of intestinal parasites in cancer patients undergoing chemotherapy in the South of Brazil. Three fecal samples collected from each patient (73 individuals) were processed by Ritchie and Faust techniques and submitted to specific staining methods for intestinal protozoa. A 61.6% parasite and/or commensal positivity was found. Helminths identified were Ascaris lumbricoides (33.3%), Taenia spp. (6.6%), Strongyloides stercoralis (4.4%) and Trichuris trichiura (2.2%). Among protozoans, Giardia lamblia (26.6%), Cryptosporidium spp. (13.3%) and Cystoisospora belli (4.4%) were identified. The presence of Entamoeba coli, Endolimax nana and Entamoeba hartmanni was also recorded. The results obtained warn of the importance of fecal parasitological diagnosis and the use of specific staining methods for the detection of intestinal parasites in cancer patients. These exams should be regularly requested at the patient’s first clinic visit, given the high prevalence found in this study and the possible severity of such conditions for these individuals.

Prevalence of intestinal parasites among inmates in Midwest Brazil

Background

Intestinal parasitic infections constitute a public health issue in developing countries, with prevalence rates as high as 90%, a figure set to escalate as the socioeconomic status of affected populations deteriorates. Investigating the occurrence of these infections among inmates is critical, since this group is more vulnerable to the spread of a number of infectious illnesses.

Methods

This cross-sectional, analytical, quantitative study was conducted in July 2015 at prison facilities located in Midwest Brazil to estimate the prevalence of parasitic infection among inmates. For detection of parasites, 510 stool samples were examined by ether centrifugation and spontaneous sedimentation.

Results

Eight parasitic species were detected, with an overall prevalence of 20.2% (103/510). Giardia lamblia and Entamoeba histolytica/dispar were the most frequent pathogenic parasites. Endolimax nana was the predominant non-pathogenic species. Nearly half of the subjects (53/103; 51.4%) were positive for mixed infection. Logistic regression revealed that inmates held in closed conditions were more likely to contract parasitic infections than those held in a semi-open regime (OR = 1.97; 95% CI = 1.19–3.25; p = 0.0085). A higher prevalence of parasitic infections was observed among individuals who had received no prophylactic antiparasitic treatment in previous years (OR = 10.2; 95% CI = 5.86–17.66; p < 0.001). The other factors investigated had no direct association with the presence of intestinal parasites.

Conclusion

Infections caused by directly transmissible parasites were detected. Without adequate treatment and prophylactic guidance, inmates tend to remain indefinitely infected with intestinal parasites, whether while serving time in prison or after release.

Associations of Giardia lamblia assemblages with HIV infections and symptomatology: HIV virus and assemblage B were they born to each other?

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.

Intestinal parasitic infections and its association with undernutrition and CD4 T cell levels among HIV/AIDS patients on HAART in Butajira, Ethiopia

BACKGROUND

Intestinal parasitic infections and HIV/AIDS have been the major public health problems and remain a vital cause of morbidity and mortality in developing countries. Both problems are linked in a vicious cycle. The magnitude of intestinal parasites was prevalent among people living with HIV/AIDS even in the HAART era. However, the pertinent risk factors associated with intestinal parasites among HIV/AIDS patients were not well investigated in Ethiopia particularly at Butajira town. Therefore, the aim of this study was to determine the prevalence of intestinal parasites and associated risk factors among HIV/AIDS patients on HAART in Butajira, Ethiopia.

METHOD

A cross-sectional study was conducted, and a total of 323 study subjects was involved in the study. A systematic random sampling technique was used to select each participant during data collection. Stool specimen was collected and processed using direct wet mount, formol-ether concentration technique, and modified Ziehl-Neelson staining techniques to identify both common and opportunistic intestinal parasites. Structured questionnaire was used to collect socio-demographic, environmental, clinical, and nutritional data. Both bivariate and multivariate logistic regression analyses were used to assess the association of various explanatory factors on intestinal parasites. P value ≤0.05 at 95% CI was considered statistically significant.

RESULTS

The overall prevalence of intestinal parasites was 35.9% (95% CI 31.0-40.9%). Protozoa's (Entanmoeba histolytica/dispar trophozoite, E. histolytica/dispar cyst, Giardia lamblia trophozoite, and G. lamblia cyst), helminths (Tanea species, Ascaris lumbricoides, Strongyloid stercoralis, Hookworm species and H. nana), and opportunistic intestinal parasites (Cryptosporidium parvum, Isospora belli) were observed in 57 (17.1%), 46 (14.4%), and 28 (8.7%) study participants respectively. Multivariate logistic regression analysis revealed that the presence of animals (AOR 6. 14; 95% CI 3.13, 12.0); using river water (AOR 4.87; 95% CI 1.14, 20.7); undernutrition (AOR 2.59; 95% CI 1.36-4.95); and level of immunosuppression (AOR 4.02; 95% CI 1.78-9.05 and AOR 2.84; 95% CI 1.37-5.89) were significantly associated with intestinal parasites.

CONCLUSIONS

The prevalence of intestinal parasites found to be higher among HIV/AIDS patients receiving HAART at Butajira Hospital, southern Ethiopia. Presence of animals, using river water, lower CD4 T cell count, and undernutrition were significant factors affecting intestinal parasites. Therefore, consistent detection of intestinal parasites and deworming of patients should be performed as well as improving health education on personal hygiene, avoiding contact with pit or domestic animals, and using safe or treated water. Furthermore, improving nutritional support and household food access are recommended.

Prevalence, risk factors for infection and subtype distribution of the intestinal parasite Blastocystis sp. from a large-scale multi-center study in France

Background

Blastocystis sp. is the most common intestinal parasite of humans. Despite its potential public health impact, epidemiological data regarding the prevalence and molecular subtype distribution of Blastocystis sp. in Europe are rarely reported. Therefore, the first multi-center epidemiological survey performed in Europe was conducted in France to diagnose and subtype Blastocystis sp. and to identify risk factors for infection.

Methods

Stool samples from 788 patients were collected either in summer or winter in 11 hospitals throughout France together with patient data. All stool samples were tested for the presence of Blastocystis sp. by quantitative PCR targeting the SSU rDNA gene. Positive samples were sequenced to determine the distribution of the subtypes in our cohort. Statistical analyses were performed to identify potential risk factors for infection.

Results

Using quantitative PCR, the overall prevalence of Blastocystis sp. was shown to reach 18.1 %. The prevalence was significantly higher in summer (23.2 %) than in winter (13.7 %). Travellers or subjects infected with other enteric parasites were significantly more infected by Blastocystis sp. than non-travellers or subjects free of other enteric parasites, respectively. Different age-related epidemiological patterns were also highlighted from our data. The prevalence of Blastocystis sp. was not significantly higher in patients with digestive symptoms or diagnosed with chronic bowel diseases. Among symptomatic patients, Blastocystis sp. infection was significantly associated with abdominal pain. Gender, socioeconomic status, and immune status were not identified as potential risk factors associated with infection. Among a total of 141 subtyped isolates, subtype 3 was predominant (43.3 %), followed by subtype 1 and subtype 4 (20 %), subtype 2 (12.8 %), subtype 6 and subtype 7 (2.1 %). No association between ST and clinical symptoms was statistically evidenced.

Conclusions

A high prevalence of Blastocystis sp. infection was found in our French patient population. Seasonal impact on the prevalence of Blastocystis sp. was highlighted and recent travels and age were identified as main risk factors for infection. Most cases were caused by subtypes 1 to 4, with a predominance of subtype 3. Large variations in both prevalence and ST distribution between hospitals were also observed, suggesting distinct reservoirs and transmission sources of the parasite.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-016-1776-8) contains supplementary material, which is available to authorized users.

Cryptosporidium and other intestinal parasitic infections among HIV patients in southern Ethiopia: significance of improved HIV-related care

Background

Intestinal parasitic infections are known to cause gastroenteritis, leading to higher morbidity and mortality, particularly in people living with HIV/AIDS. This study aimed to determine the prevalence of Cryptosporidium and other intestinal parasitic infections among HIV patients receiving care at a hospital in Ethiopia where previous available baseline data helps assess if improved HIV-related care has reduced infection rates.

Methods

A cross-sectional study was conducted at Hawassa University Hospital in southern Ethiopia from May, 2013 to March, 2014. A consecutive sample of 491 HIV- infected patients with diarrhea or a CD4 T cell count < 200 cells/μl were prospectively studied. A single stool sample was collected from each study participant and processed using direct, formol-ether concentration, and modified Ziehl-Neelsen techniques for the diagnosis of Cryptosporidium and other intestinal parasites. The study was approved by the Institutional Review Board of the College of Medicine and Health Sciences, Hawassa University. Physicians managed participants found to be infected with any pathogenic intestinal parasite.

Results

The overall prevalence of intestinal parasitic infections among the study population was 35.8 %. The most prevalent parasites were Cryptosporidium (13.2 %), followed by Entamoeba histolytica/dispar (10.2 %), and Giardia lamblia (7.9 %). The rate of single and multiple infections were 25.5 and 10.3 %, respectively. Patients with a CD4 T cell count < 200 cells/μl had a similar rate of any intestinal parasitic infection or cryptosporidiosis compared to those with counts ≥ 200 cells/μl, but with some type of diarrhea.

Conclusion

The study shows high prevalence of intestinal parasitic infections in the study population. However, the results in the current report are significantly lower compared to previous findings in the same hospital. The observed lower infection rate is encouraging and supports the need to strengthen and sustain the existing intervention measures in order to further reduce intestinal parasitic infections in people living with HIV/AIDS.

Enteric parasitic infection among HIV-infected patients visiting Tribhuvan University Teaching Hospital, Nepal

Background

Enteric parasitic infection among human immunodeficiency virus (HIV) patients has been a significant health problem in developing countries like Nepal. This study was undertaken to access the burden of enteric parasites among HIV patients and its association with their immune status.

Methods

A cross-sectional study, involving 112 HIV sero-positive patients was conducted in Tribhuvan University Teaching Hospital, Public Health Research Laboratory, Kathmandu, Nepal from July 2011 to June 2012. The fecal samples were processed by direct-smear technique, in both normal saline solution and 1 % iodine solution as well as modified acid fast staining (Kinyoun’s method) after formalin ether concentration and Sheather’s sucrose flotation for the identification of enteric parasites.

Results

Infection with one or more parasite was seen in 33.9 % (n = 38) of the cases enrolled in the study, with the parasite prevalence rate of 41.1 % (n = 46). Literacy (OR = 1.9, 95 % CI 0.9–4.3) and CD4 T-cell count <200 (OR = 2.5, 95 % CI 1.1–5.7) were found to be associated with enteric parasite infection. Similarly, CD4 T-cell count <200 was found to be associated with opportunistic parasitic infection (OR = 3.2, 95 % CI 1.2–7.8). Among opportunistic parasites, Giardia duodenalis was the most common (28.3 %, n = 13) one. Multi-parasitism was observed in six patients (15.8 %).

Conclusion

Enteric parasitic infections are common in HIV-infected people. The poor immune status as indicated by low CD4 T-cell count may account for higher risk of both opportunistic and non-opportunistic enteric parasitic infection.

Intestinal parasitic infections in relation to CD4(+) T cell counts and diarrhea in HIV/AIDS patients with or without antiretroviral therapy in Cameroon

Background

Intestinal parasitic infections (IPI) are a major public health concern in HIV/AIDS patients particularly in resource-limited settings of Sub-Saharan Africa. Studies investigating the relationship between intestinal parasitic infections and CD4⁺ T cell counts and diarrhea in HIV/AIDS patients with or without antiretroviral therapy in the region are not readily available hence the need to perform this study.

Methods

In a comparative cross-sectional study involving 52 pre-ART and 248 on-ART HIV patients. Stool samples were collected and analysed for intestinal parasites by wet and iodine mounts, Kato-Katz, formol ether, modified field staining, and modified Ziehl-Neelsen staining techniques. Blood samples were collected and analysed for CD4⁺ T cell counts by flow cytometry. A pre-tested semi-structured questionnaire was used to collect data on socio-demographic and clinical presentation. Data were analysed using STATA version 12.1. Statistical tests performed included the Pearson Chi-square, logistic regression and student’s t-test. P < 0.05 was considered to be statistically significant.

Results

The prevalence of intestinal parasitic infections in pre-ART and on-ART was 84.6 % and 82.3 % respectively with no significant difference observed with respect to age (p = 0.06), and gender (p = 0.736). All the opportunistic parasites including Cryptosporidium parvum, Cyclospora cayetanensis, Isospora belli and Microsporidium spp. were isolated from both groups, with only Microsporidium spp. significantly associated with CD4⁺ T cell counts below 200 cells/μl in pre-ART (p = 0.006) while Cryptosporidium parvum, Microsporidium spp. and Isospora belli were associated with counts below 200 cells/μl in on-ART. Cryptosporidium parvum was significantly associated with diarrhea in pre-ART (p = 0.025) meanwhile it was significantly associated with diarrhea in on-ART (p = 0.057). The risk of diarrhea was highest in patients with CD4⁺ T cell counts below 200 cells/μl (COR = 10.21, p = 0.000) for both pre- and on-ART treatment.

Conclusion

A very high prevalence of intestinal parasitic infections was observed, which did not differ with respect to ART status. All known opportunistic parasites were isolated in both pre-ART and on-ART patients. Low CD4⁺ T cell count may appear to be a factor for intestinal parasitic infections and development of diarrhea. Regular screening and treatment of intestinal parasitic infections is very vital in improving the overall quality of care of HIV/AIDS patients.

Prevalence and Risk Factors for Blastocystis Infection Among Children and Caregivers in a Child Care Center, Bangkok, Thailand

In September 2009, a cross-sectional study was conducted to evaluate parasitic infections in a child care center in Khlong Toei, Bangkok, Thailand. Of 503 children and staff members, 258 (51.3%) stool samples and questionnaires were obtained. The most common parasitic infection was Blastocystis sp. (13.6%). Blastocystis sp. subtype 3 was predominantly found (80.0%), followed by subtypes 2 (12.0%) and 1 (8.0%). The prevalence of Blastocystis infection varied among different age groups. The prevalence of Blastocystis infection in non-HIV-infected children aged < 10 and 10-19 years were 14.5% and 10.3%, respectively, which were not significantly different. All 31 HIV-infected children were not infected with Blastocystis sp. The most likely reason could be the result of properly using prevention measures for this specific group.

Prevalence of intestinal protozoan infections among individuals living with HIV/AIDS at Felegehiwot Referral Hospital, Bahir Dar, Ethiopia

BACKGROUND

HIV infection continues to pose a serious challenge to global health by predisposing patients to opportunistic infections. A cross-sectional study was conducted from December 2012 to February 2013 to assess the enteric protozoan infection status among individuals living with HIV/AIDS in Felegehiwot Referral Hospital, Bahir Dar, northwest Ethiopia.

METHODS

Stool specimens from 399 HIV-positive individuals were examined for the presence of trophozoites, cysts, and oocysts using direct wet mount, formol-ether sedimentation and modified Ziehl-Neelsen techniques. In addition, CD4+ T-cell counts were measured to evaluate the immune status of the study subjects.

RESULTS

An overall prevalence of 30.6% enteric protozoan infections was recorded. Pre-ART (antiretroviral treatment) individuals were more infected than patients on ART, although this was not statistically significant (p>0.05). The highest prevalence of enteric protozoan infection was due to Entamoeba histolytica/E. dispar (19.3%), followed by Cryptosporidium spp (5.8%), Giardia lamblia (4.3%), and Isospora belli (1.3%). A CD4+ T-cell count of <200 cells/μl and status of being diarrhoeic were significantly associated with the overall prevalence of enteric protozoan infection.

CONCLUSIONS

A relatively high prevalence of enteric protozoan infection was observed among individuals living with HIV/AIDS. Routine stool and CD4+ T-cell examinations should be conducted to monitor the status of HIV/AIDS patients.

Status of intestinal parasitic infections among residents of Jimma Town, Ethiopia

Background

Intestinal parasites cause considerable morbidity and mortality in the world, especially in developing countries like Ethiopia. Both urban and rural inhabitants are vulnerable to infection with intestinal parasites in developing countries. The aim of this study was to determine the status of intestinal parasitic infections (IPIs) among residents of Jimma Town, seven years after high prevalence was reported.

Results

Four hundred and thirty four residents of Jimma Town were included in this study. By the cross-sectional survey, the overall prevalence of intestinal parasites was 209 (48.2%). Nine species of intestinal parasites were isolated, Ascaris lumbricoides and Trichuris trichiura being the most predominant. Residence in Hermata Mentina kebele, Adjusted Odds Ratio (AOR), 3.0, 95% CI, 1.71-5.39), age less than 10 years (AOR, 3.7, 95% CI, 1.33-10.36), illiteracy (AOR, 3.2, 95% CI, 1.64-6.19), estimated monthly family income of less than 500 Ethiopian Birr (AOR, 2.9, 95% CI, 1.32-4.90) and irregular washing hands before meal (AOR, 5.3, 95% CI, 1.36-21.07) were predictors of IPI in this study. The retrospective study revealed a significant decrease (P = 0.037) in the proportion of patients infected with intestinal parasites out of those who requested stool examination over the six-year period.

Conclusion

This study confirms that IPIs are still common among residents of Jimma Town. Nearly half of the study participants were infected with at least one intestinal parasite. Public health interventions targeting prevention of IPIs should be strengthened in Jimma Town.

Intestinal parasitic infections among prison inmates and tobacco farm workers in Shewa Robit, north-central Ethiopia

BACKGROUND

Intestinal parasitic infections (IPIs) particularly soil-transmitted helminthiasis (STH) and schistosomiasis are among neglected tropical diseases (NTDs) globally. Apart from being associated with anemia, malabsorption and retarded cognitive development these diseases are complicating the clinical picture of more serious infections like HIV, TB and malaria. Renewed and up-to-date information on the epidemiology of IPIs in more vulnerable groups such as irrigated-farm workers and prisoners would significantly contribute towards improving the health condition of such at-risk groups.

METHODS

A cross-sectional survey was conducted to determine the prevalence of IPIs among prison inmates and tobacco farm workers in Shewa-Robit, north-central Ethiopia in November 2008. A total of 236 fecal samples were examined microscopically to detect helminths and/or protozoa using direct-smear and formol-ether concentration methods.

RESULTS

Overall, 8 intestinal parasite species have been recovered singly or in combinations from 146 (61.8 %) samples. The prevalence in prison population (88/121 = 72.7%) was significantly higher than that in tobacco farm (58/115 = 50.4%). There were no significant differences in the prevalence of IPI by most socio-demographics. Except for hookworm there was no significant difference in parasite prevalence between different age-groups though the frequency of individual parasites slightly varied between the age-groups. Multivariate logistic regression analysis showed that inmates were more likely to acquire IPIs than tobacco-farm workers (Odds Ratio (OR) = 2.62, 95% confidence interval (CI) = 1.52-4.5). In addition, participants who did not report past treatment for IPIs were more likely to acquire IPIs than participants who self-reported treatment for IPIs in the past twelve months (OR = 3.25, 95% CI = 1.75-6.06). All other socio-demographics were not significantly associated with IPIs in univariate analysis. Entamoeba histolytica/dispar/moshkovskii was the most frequently encountered species in both study sites accounting for 48.8 and 51.7 percent of the positives in prison and tobacco farm population respectively. Other intestinal parasites detected, with slight variation in prevalence in the two study areas, were hookworm, Ascaris lumbricoides, Trichuris trichiura, Schistosoma mansoni, Strongyloides stercolaris, Hymenolepis nana and Taenia sp. 35.5 and 33.0 percent of the total positive cases were mixed infections in Shewa Robit prison and tobacco farm, respectively.

CONCLUSION

The results show that IPIs are common health problems in the studied populations.

Update on the pathogenic potential and treatment options for Blastocystis sp

Although Blastocystis is one of the most common enteric parasites, there is still much controversy surrounding the pathogenicity and potential treatment options for this parasite. In this review we look at the evidence supporting Blastocystis as an intestinal pathogen as shown by numerous case studies and several in vivo studies and the evidence against. We describe the chronic nature of some infections and show the role of Blastocystis in immunocompromised patients and the relationship between irritable bowel syndrome and Blastocystis infection. There have been several studies that have suggested that pathogenicity may be subtype related. Metronidazole is the most widely accepted treatment for Blastocystis but several cases of treatment failure and resistance have been described. Other treatment options which have been suggested include paromomycin and trimethroprim- sulfamethoxazole.

Cryptosporidium spp., Giardia duodenalis, Enterocytozoon bieneusi and other intestinal parasites in young children in Lobata province, Democratic Republic of São Tomé and Principe

Rare systemic studies concerning prevalence of intestinal parasites in children have been conducted in the second smallest country in Africa, the Democratic Republic of São Tomé and Príncipe. Fecal specimens from 348 children (214 in-hospital attending the Aires de Menezes Hospital and 134 from Agostinho Neto village) in São Tome Island were studied by parasitological and molecular methods. Of the 134 children from Agostinho Neto, 52.2% presented intestinal parasites. 32.1% and 20.2% of these children had monoparasitism and polyparasitism, respectively. Ascaris lumbricoides (27.6%), G. duodenalis (7.5%), T. trichiura (4.5%) and Entamoeba coli (10.5%) were the more frequent species identified in the children of this village. Giardia duodenalis (7.5%) and E. bieneusi (5.2%) were identified by PCR. Nested-PCR targeting G. duodenalis TPI identified Assemblage A (60%) and Assemblage B (40%). The E. bieneusi ITS-based sequence identified genotypes K (57.1%), KIN1 (28.6%) and KIN3 (14.3%). Among the 214 in-hospital children, 29.4% presented intestinal parasites. In 22.4% and 7.0% of the parasitized children, respectively, one or more species were concurrently detected. By microscopy, A. lumbricoides (10.3%) and Trichiuris trichiura (6.5%) were the most prevalent species among these children, and Cryptosporidium was detected by PCR in 8.9% of children. GP60 locus analysis identified 6.5% of C. hominis (subtypes IaA27R3 [35.7%], IaA23R3 [14.3%], IeA11G3T3 [28.6%] and IeA11G3T3R1 [21.4%]) and 2.3% of C. parvum (subtypes IIaA16G2R1 [20.0%], IIaA15G2R1 [20.0%], IIdA26G1 [40.0%] and IIdA21G1a [20.0%]). G. duodenalis and E. bieneusi were identified in 0.5% and 8.9% of the in-hospital children, respectively. G. duodenalis Assemblage B was characterized. The E. bieneusi genotypes K (52.6%), D (26.4%), A (10.5%) and KIN1 (10.5%) were identified. Although further studies are required to clarify the epidemiology of these infectious diseases in this endemic region the significance of the present results highlights that it is crucial to strength surveillance on intestinal pathogens.