Download Prevalence of Cryptosporidiosis in HIV/AIDS patients attending

Prevalence of Cryptosporidiosis in HIV/AIDS patients presenting with Diarrhea and
their CD4 levels at Kabale Regional Referral Hospital.
Athours: Mpamize Gordon, Dr Alima Hillary Byaruhanga and Dr Kyebambe Peterson
1Joint Clinical Research centre Mubende branch, 2Joint Clinical Research Centre
Kabale Branch and 3 Kabale Regional Referral Hospital
Abstract
Background
Cryptosporidiosis is a relatively uncommon, but nonetheless worrisome, opportunistic
infection with HIV/AIDS disease. It is the chief AIDS-defining infection in more than
2% of reported cases of the immunocomprised patients. Cryptosporidiosis is an
intracellular protozoan infection that has changed from a rare largely asymptomatic
disease, to an important cause of diarrhea in humans world wide.
In HIV/AIDS patients, cryptosporidium is the most frequent microbial cause of diarrhea,
usually causing chronic bulky and intermittent diarrhea with liquid non bloody stools,
accompanied by pain and abdominal colic, and a noticeable loss of weight.
Cryptosporidiosis in HIV/AIDS is self limiting and usually recovers with in few weeks.
In contrast, the infection may have a severe, chronic and even a fetal clinical course in
HIV/AIDS patients.
Numerous studies outside Kabale Regional Referral Hospital revealed high prevalence in
HIV/AIDS patients but little or no such data is available in the hospital, hence the need
for the current study and it is important preventable cause of morbidity and mortality
among HIV/AIDS patients.
Purpose
The main objective was to determine prevalence of cryptosporidiosis in HIV/AIDS
patients presenting with diarrhea and their CD4 levels at Kabale Regional Referral
Hospital.
Specific objectives
 To establish the proportion of HIV/AIDS patients presenting with diarrhea at Kabale
Regional Referral Hospital.
 To determine the prevalence of Cryptosporidiosis in relation to age, sex and feeding
habbits.
 To
determine
the
relationship
between
CD4
counts
and
prevalence
of
cryptosporidiosis.
Method
A cross sectional study was carried out among ninety six (96) HIV/AIDS patients who
presented with diarrhea using a non-probability convenient sampling procedure from
March 2010 to May 2010. Blood and stool samples were collected under corrective
measures. Stool samples were examined for ova, parasites and Cryptosporidium oocysts
using Modified Formal-ether concentration Technique followed by modified ZielNeelsen and blood was analaysed for CD4 level using Flow cytometer analyzer (BDFacs
Calibur).Data was entered and analyzed using Microsoft software, Statistical Package for
Social Scientists and WHO Epidemiological-information.
Results
Of the ninety six HIV/AIDS diarrheic patients recruited, a total of 5(5.2%) cases had
cryptosporidium infection and 91(94.8%) cases with no cryptosporidium infection were
reported during the study period. Other gastrointestinal parasites detected included
Giardia lamblia in 2(2%) patients,cyclospora in 1(1%) patient and hook worms in
3(3.1%) patients and infection with multiple parasites was found in 1(1%) and 84(87.5%)
patients had no parasite infection and had median CD4+ cell count of >225 cells/µl. The
age range was between 5years and 74years. The majority of subjects 42 (43.8%) were
between 25-44years. Females 62(64.6%) formed the largest part of the study population.
Of the 5 patients who had cryptosporidium infection, 3(60%) were females and 2(40%)
were males. Of the cryptosporidium positive patients, the median CD4 cell count was
105cells/µl. Besides diarrhoerea, the main clinical manifestations were fever, vomiting
and weight loss in 1(20%), 1(20%) and 3(60%) patients respectively. Of the 5 subjects
who had cryptosporidium infection, 3(60%) patients were from the village, 1(20%)
patient from slum and 1(20%) from an urban area.
Discussion and Conclusion
The overall prevalence of cryptosporidiosis was 5.2%. The prevalence was lower than
that of some previous reports due to the introduction of highly active antiretroviral
therapy and better awareness of risk for infectious diarrhea.
Cryptosporidiosis was exclusively found in age group between 25-34 and 35-44 years
because they are most sexually active age groups.
From the study, all patients who were infected with the parasite were suffering from
chronic watery diarrhea of more than one month’s duration. In fact cryptosporidiosis
among adults appears to occur principally at CD4 level less than 200cells/µl. This study
also confirmed that there was a strong association between cryptosporidiosis and CD+
cell level. Such information may provide possible recommended strategies for preventing
cryptosporidiosis in HIV/AIDS patients.
Stool specimens are not routinely examined for cryptosporidial oocysts at Kabale
Regional Referral Hospital, the study results revealed that it is necessary to examine
every diarrheal HIV/AIDS patients for further proliferation and to decrease mortality in
HIV/AIDS. It is concluded that cryptosporidiosis is one of the most important cause of
diarrhea at Kabale Regional Referral Hospital in HIV/AIDS patients, and considering the
severe and untreatable nature of cryptosporidiosis in such patients, it is rather essential
that control measures be taken to achieve improved management among HIV/AIDS
population.
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