The Prevalence of Coccidian Parasites in and Around Tirunelveli in HIV Positive Individuals and Its Correlation with the CD4 Count 1182-1186
Sucilathangam G., M.D. (Micro),
Assistant Professor, Department of Microbiology,
Tirunelveli Medical College,
Tirunelveli District, 627 011, Tamil Nadu, India.
Phone: 94420 63819
E mail: firstname.lastname@example.org
Background and Objectives: Opportunistic infections are the hallmark of the Human Immuno Deficiency Virus (HIV) infection. In recent years, intestinal infections such as Cryptosporidium, Cyclospora and Isospora are becoming more prevalent in the Acquired Immunodeficiency Syndrome (AIDS) patients. The purpose of this study was to determine the prevalence of coccidian parasitic infections in HIV seropositive patients with or without diarrhoea and to study the association of diarrhoea and the coccidian parasites with the CD4 counts in our setting.
Materials and Methods: Out of 103 stool samples, 33 stool samples were collected from HIV seropositive patients with diarrhoea and 70 stool samples were collected from HIV seropositive patients without diarrhoea. The samples were examined for intestinal coccidian parasites by microscopy and the modified Kinyounâ€™s acid fast staining methods. The CD4 counts were estimated by using a PartecCyflow counter (Germany). Statistical analysis was done by using the Chi-square test to evaluate the association between the HIV patients with or without diarrhoea and the coccidian parasitic infections.
Results: Coccidian parasites were identified in 58.2% (60/103) of all the stool samples which were examined. Coccidian parasites were detected in 57.1% patients with non-diarrhoeal complaints and in 60.6% patients with chronic diarrhoea (P>0.05). Among the coccidian parasites, Cryptosporidium parvum was the most predominant parasite which was found in the study (42.7%; 44/103), followed by Microsporidia (7.8%; 8/103)) and Cyclospora (3.9%; 4/103) which were detected alone. Dual infections which comprised of those with C. cayetanensis and C. parvum (1.9%; 2/103) and C. parvum and Microsporidia (1.9%; 2/103) occurred in the HIV-positive patients. After being classified by the CD4 T-cell categories, the opportunistic intestinal parasite infections showed the highest prevalence in patients with a low immune level (CD4 < 200/μl). Coccidian parasites were seen at a mean CD4 T cell count of 154.2 cells/μl in our study. The mean CD4 count in patients who harboured the coccidian infections in the non-diarrhoeal cases (144.7 cells/μl) was lower as compared to those in the diarrhoeal cases (173.2 cells/ μl ). C. parvum (32) was the most prevalent coccidian parasite, followed by Microsporidia (3) and Cyclospora (2) in patients with CD4 counts which were less than 200 cells /μl.
Conclusions: In conclusion, our results make an important contribution to the detection and identification of coccidian parasites in the non-diarrhoeic stool samples of HIV positive patients. The maximum parasitic isolation was in the patients whose CD4 cell counts were < 200 cells/μl. Our recommendation is that the health practitioners should receive a more intensive education on the emerging diarrhoeal pathogens and the importance of targeting these common coccidial infections while treating HIV-positive patients for opportunistic infections. The routine examination of the stool samples for coccidian parasites must be done even in the non-diarrhoeal HIV-infected individuals.