Prevalence of Intestinal Parasitic Infections among Pulmonary Tuberculosis Patients in a Tertiary Care Hospital, Bhubaneswar, Odisha, India DC12-DC15
Dr. Ipsa Mohapatra,
Department of Community Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar-751024, Odisha, India.
Introduction: In developing countries like India, Intestinal Parasitic Infections (IPIs) and Tuberculosis (TB) co-infection have been perceived to be high. The geographic distributions of helminths and TB overlap substantially. Parasitic infections affect the outcome of TB by shifting cell mediated immune response to humoral; while mycobacterium infection favours immune escape of helminths.
Aim: To determine the prevalence of IPIs among pulmonary TB patients, to find out the type of intestinal parasitic infection in them and to analyse the association of risk factors with the prevalence of co-infection.
Materials and Methods: A hospital based cross-sectional study was done among the 118 newly diagnosed pulmonary TB (PTB) patients attending the Pulmonary Medicine department of a tertiary care hospital, from 15th July-15th September 2016; after obtaining informed written consent. Demographic and clinical data was collected using structured questionnaire. Stool samples for direct microscopy and formalin-ether concentration technique was done for detection of intestinal parasites. Statistical analysis was performed using Epi Info software. Descriptive statistics, chi-square test were used; p-value of <0.05 was considered as statistically significant.
Results: Of the 118 PTB patients enrolled, 71.18 % were sputum smear positive. The co-infection with intestinal parasites was 27.11%; 87.5% of the infections were due to helminths, of which 65.63% were due to hookworm (Ancylostoma duodenale and Necator americanus), 15.6% were due to Strongyloides stercoralis and 6.25% due to Ascaris lumbricoides. Co-infection was seen more in males (59.32%) and 1-15 years age group. Hookworm infections were higher in sputum smear positive cases than negative ones; this difference was also found to be statistically significant. Co-infection with E. histolytica was also found to have statistically significant difference between smear positive and negative cases.
Conclusion: The study results reiterate the fact of a high prevalence of co-infection in this part of eastern India. There was a higher rate of co-infection among sputum positive TB cases. As co-infection is known to have a negative impact on the treatment outcome of these patients, healthcare providers should screen and treat all TB patients for intestinal parasitic co-infections in order to ensure good prognosis.