Etiology and evaluation of diarrhea in AIDS: A global perspective at the millennium

Pathways linking climate change and HIV/AIDS: An updated conceptual framework and implications for the Philippines

As we commemorate the 40th anniversary of the discovery of Human Immunodeficiency Virus (HIV) while fighting the ongoing COVID-19 pandemic, another global crisis - climate change - is threatening the progress achieved so far in the global fight against HIV/AIDS. The climate emergency is anticipated to generate dire health consequences worldwide in the coming decades. While the pathways that link climate change and different disease areas are better understood, the connection between climate change and HIV/AIDS is still yet to be recognized both in research and practice. In this review, we update one of the frameworks on the HIV-climate nexus described in earlier literature. Four major pathways have been identified: extreme weather events; sea level rise; changes in precipitation and temperature; and increased air pollution. These pathways impact the spectrum of HIV/AIDS-related outcomes through changes in social systems, healthcare disruption, and other climate-sensitive diseases, influenced by the social determinants of health. We also reflect on the significance of this updated framework for the Philippines, a country that is both highly vulnerable to the climate crisis and facing a rising HIV/AIDS epidemic. The framework can aid countries like the Philippines in filling gaps in research, policy, and program design to mount climate-adaptive HIV/AIDS responses. The HIV/AIDS and climate justice movements must also join forces in calling for accelerated worldwide decline in greenhouse gas emissions from all sectors to stabilize the global climate - this will benefit not just people affected by HIV/AIDS but everyone.

Rare Case of Small Bowel Obstruction Secondary to Cryptosporidium in a Young Patient With Uncontrolled AIDS

Small bowel obstruction is a common cause of abdominal pain and accounts for approximately 20% of surgical admissions related to abdominal pain. In the United States alone, there are over 300,000 admissions annually for small bowel obstruction and account for every 15 out of 100 admissions for abdominal pain. If treated appropriately with medical management, over 80% of cases resolve without life-threatening, long-term complications or the need for surgical intervention. The three most common causes including adhesions, tumors, and hernias account for the majority of cases. Less frequently reported causes include infections. We present the case of a 26-year-old male with a history of AIDS who was found to have a small bowel obstruction in the setting of active Cryptosporidium infection. Cryptosporidium is an opportunistic infection that more commonly affects immunocompromised hosts, especially those noncompliant with antiretroviral therapy. Our patient had an uncomplicated hospital course and made a full recovery due to early diagnosis and immediate intervention. We hope to make the medical community more aware of this rare and potentially life-threatening association given the rarity of such a presentation. Early diagnosis and intervention are critical to preventing morbidity and mortality.

Multiorganism HIV-associated diarrhea and telescoping bowel

Diarrhea in individuals with human immunodeficiency virus (HIV) remains a diagnostic challenge. We treated a 53-year-old woman from Africa who presented with acute diarrhea, which yielded a diagnosis of HIV and severe immune deficiency. The patient's diarrhea resulted in hypovolemic shock and acute abdominal pain. Evaluation revealed an intestinal intussusception. Pathology findings were consistent with Cryptosporidium, Entamoeba, Giardia, and cytomegalovirus infections. The actual prevalence of multiple microorganisms causing HIV-associated diarrhea is unknown. A nonmalignant-related adult intussusception in this context is exceedingly rare and of noteworthy significance.

Morbidity benefit conferred by childhood immunisation in relation to maternal HIV status: a meta-analysis of demographic and health surveys

The study determined the prevalence of acute respiratory infections and diarrhoea among sub-Saharan African children. It also examined if there was any significant morbidity benefit conferred by three doses of diphtheria-tetanus-pertussis containing vaccines (DTP3) with respect to maternal HIV status. Data were obtained from the Demographic and Health Survey (DHS) program, United Nations Development Programs, World Bank and Joint United Nations Programme on HIV/AIDS. Pooled odds ratio (OR) and 95% confidence intervals (CI) were calculated for the countries. Test of heterogeneity, sensitivity analyses and meta-regression were also conducted. The prevalence of acute respiratory infections and diarrhoea were similar between the children that were vaccinated and those who were not vaccinated with DTP3. The pooled result shows that children who did not receive DTP3 were more likely to have symptoms of acute respiratory infections than children who had DTP3 (OR 1.09, 95% CI 1.02 to 1.17); with low heterogeneity across the countries. The combined result for diarrhoea shows that children who did not receive DTP3 were less likely to have episodes of diarrhoea than children who received DTP3 (OR 0.83, 95% CI 0.74 to 0.92); with substantial heterogeneity across the countries. There was no difference between the estimates of DTP3 vaccinated and unvaccinated children of HIV seropositive mothers with respect to symptoms of acute respiratory infections or episodes of diarrhoea. Tackling various causes and risk factors for respiratory tract infections and diarrhoeal diseases should be a priority for various stakeholders in sub-Saharan Africa.

Isolation and evaluation of Candida species and their association with CD4+ T cells counts in HIV patients with diarrhoea

BACKGROUND

Gastrointestinal infection is one of the most common infections among HIV patients. Candida spp have been implicated in the aetiology of chronic diarrhoea in HIV patients, but little is known about this in Nigeria.

OBJECTIVES

We determined the prevalence of faecal candidiasis in HIV patients in relation to diarrhoea, CD4 counts, and other socio-demographic factors and the spectrum of Candida isolates involved.

METHODS

One hundred and fifty four HIV patients were investigated. Candida species were identified by standard techniques. Socio-demographic and clinical information was obtained from the patients using a structured questionnaire. The CD4 count was estimated using a single platform flow cytometer.

RESULTS

Candida overgrowth was detected in 61 (39.5%) HIV patients, and diarrhoea was associated with candidiasis in the subjects (P=0.001). Candidiasis was commonly detected among subjects in the 29-39 years' age group. A CD4 count below 200 cells/mm² (62.3%) was a risk factor for acquiring candidiasis among HIV patients (P=0.001). Candida albicans (65.6%) was the most frequently recovered species followed by Candida krusei (16.4%) and Candida tropicalis (14.8%).

CONCLUSION

Candidiasis is an important opportunistic infection in HIV-patients in Ile-Ife. There is need for regular checks for opportunistic infections, including candidiasis in HIV patients to monitor disease progression and prevent subsequent complications.

Global burden of childhood pneumonia and diarrhoea

Diarrhoea and pneumonia are the leading infectious causes of childhood morbidity and mortality. We comprehensively reviewed the epidemiology of childhood diarrhoea and pneumonia in 2010-11 to inform the planning of integrated control programmes for both illnesses. We estimated that, in 2010, there were 1·731 billion episodes of diarrhoea (36 million of which progressed to severe episodes) and 120 million episodes of pneumonia (14 million of which progressed to severe episodes) in children younger than 5 years. We estimated that, in 2011, 700,000 episodes of diarrhoea and 1·3 million of pneumonia led to death. A high proportion of deaths occurs in the first 2 years of life in both diseases--72% for diarrhoea and 81% for pneumonia. The epidemiology of childhood diarrhoea and that of pneumonia overlap, which might be partly because of shared risk factors, such as undernutrition, suboptimum breastfeeding, and zinc deficiency. Rotavirus is the most common cause of vaccine-preventable severe diarrhoea (associated with 28% of cases), and Streptococcus pneumoniae (18·3%) of vaccine-preventable severe pneumonia. Morbidity and mortality from childhood pneumonia and diarrhoea are falling, but action is needed globally and at country level to accelerate the reduction.

Enteric Pathogens in HIV/AIDS from a Tertiary Care Hospital

BACKGROUND

Patterns of enteric infections in HIV in developing countries may differ in several important ways from developed countries, the knowledge of which can often guide therapy when resource limitations hamper the exact diagnosis of the etiological agent in HIV-associated diarrhea.

OBJECTIVES

The primary objective of this study was to define and compare the microbial etiologies of diarrhea in HIV-1 infected and non infected patients and in HIV infected non diarrheal patients.

MATERIALS AND METHODS

This study was conducted between April 2007 and July 2007 at the Department of Microbiology, Maulana Azad Medical College, New Delhi. Stool samples from 50 HIV seropositive cases with diarrhea (study group), 50 HIV seropositive cases without diarrhea (control group I), and 50 HIV seronegative cases with diarrhea (control group II) were examined. After the diagnosis of HIV infection was made, routine parasitological and bacteriological detection was done. An ELISA was used for the detection of Clostridium difficile toxin and Cryptosporidium antigen in stool samples.

RESULTS

The overall prevalence of enteric parasitosis in the study group was 20% and the bacteria identified were Escherischia coli in 24% of the case, Clostridium difficile in 10% of the cases, Salmonella species and Vibrio cholerae in 4% of the cases, and Shigella species in 2% of the cases. Candida species was identified in 36% of the cases.

CONCLUSIONS

Identification of the etiological agent of diarrhea in a patient with AIDS is very important as it can help in the institution of appropriate therapy and the reduction of morbidity and mortality in these patients.

Cyclospore cayetanensis in Anhui, China

AIM: To investigate the infection of Cyclospore cayetanensis in Anhui Province.

METHODS: Identification of Cyclospore cayetanensis was made microscopically by finding the oocysts of Cyclospore cayetanensis in fecal smears taken from the infants, pupils and adults with obstinate diarrhea, and immunocompromised individuals by using a auramine-phenol stain and modified acid-fast stain. Cellular immune function was detected with biotin-streptavidin (BSA), and the specific antibody against Cyclospore cayetanensis was detected with method of ELISA.

RESULTS: (1) The positive rates of Cyclospore cayetanensis infection in infants, pupils, infants and adults with obstinate diarrhea and with immunocompromised individuals were significantly different (P < 0.01), with the rates of 0%, 0.50% (1/200), 5.62% (10/178), and 9.38% (3/32) respectively. (2) The infection rates of males and females were 2.61% (10/383) and 1.44% (4/227) respectively, with no significant difference (P < 0.05). (3) The positive rates of population with oocysts in urban and rural areas were 0.92% (3/325) and 3.86% (11/285) respectively. (4) The positive rates of CD₃⁺, CD₄⁺, CD₈⁺ and the ratio of CD₄⁺/CD₈⁺ of individuals with and without oocysts were significantly different (P < 0.05, P < 0.01), and their values were (64.28% ± 6.55%), (43.55% ± 5.80%), (28.23% ± 4.32%), 1.52 ± 0.32 and (58.97% ± 5.23%), (39.26% ± 4.93%), (30.54% ± 5.17%), 1.26 ± 0.21, respectively. (5) Specific IgG, IgM and IgG+IgM in serum of the patients with oocyst were significantly different (P < 0.01) with the positive rates of 63.41% (9/14), 17.07% (1/14) and 19.51% (4/14) respectively.

CONCLUSION: Cyclospore cayetanensis infection is present in Anhui, China and it was confirmed to be a new pathogen associated with children diarrhea, adults obstinate diarrhea and diarrhea in immunocompromised individuals. Among all the infected individuals, adult obstinate diarrhea patients and immunocompromised individuals are common. Feces examination of oocysts and serological examination of the specific antibody will be of much help in the diagnosis of Cyclospore cayetanensis infection.

Epidemiological survey of Blastocystis hominis in Huainan City, Anhui Province, China

AIM: To provide scientific evidence for prevention and controlling of blastocystosis, the infection of Blastocystis homonis and to study its clinical significance in Huainan City, Anhui Province, China.

METHODS: Blastocystis homonis in fresh stools taken from 100 infants, 100 pupils, 100 middle school students and 403 patients with diarrhea was smeared and detected with method of iodine staining and hematoxylin staining. After preliminary direct microscopy, the shape and size of Blastocystis homonis were observed with high power lens. The cellular immune function of the patients with blastocystosis was detected with biotin-streptavidin (BSA).

RESULTS: The positive rates of Blastocystis homonis in fresh stools taken from the infants, pupils, middle school students and the patients with diarrhea, were 1.0% (1/100), 1.0% (1/100), 0% (0/100) and 5.96% (24/403) respectively. Furthermore, the positive rates of Blastocystis homonis in the stool samples taken from the patients with mild diarrhea, intermediate diarrhea, severe diarrhea and obstinate diarrhea were 6.03% (14/232), 2.25% (2/89), 0% (0/17) and 12.31% (8/65) respectively. The positive rates of Blastocystis homonis in fresh stools of male and female patients with diarrhea were 7.52% (17/226) and 3.95% (7/177) respectively, and those of patients in urban and rural areas were 4.56% (11/241) and 8.02% (13/162) respectively. There was no significant difference between them (P > 0.05). The positive rates of CD₃⁺, CD₄⁺, CD₈⁺ in serum of Blastocystis homonis-positive and-negative individuals were 0.64 ± 0.06, 0.44 ± 0.06, 0.28 ± 0.04 and 0.60 ± 0.05, 0.40 ± 0.05 and 0.30 ± 0.05 respectively, and the ratio of CD₄⁺/CD₈⁺ of the two groups were 1.53 ± 0.34 and 1.27 ± 0.22. There was significant difference between the two groups (P < 0.05, P < 0.01).

CONCLUSION: The prevalence of Blastocystis hominis as an enteric pathogen in human seems not to be associated with gender and living environment, and that Blastocystis hominis is more common in stool samples of the patients with diarrhea, especially with chronic diarrhea or obstinate diarrhea. When patients with diarrhea infected by Blastocystis hominis, their cellular immune function decreases, which make it more difficult to be cured.