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LETTER TO THE EDITOR
Year : 2011  |  Volume : 55  |  Issue : 4  |  Page : 337-338  

Evaluation of parasites causing gastro-intestinal tract infestations in HIV/AIDS patients


1 Department of Microbiology, Dr. Ulhas Patil Medical College Jalgaon, Maharashtra, India
2 Department of Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences University, Sawangi, Wardha, Maharashtra, India
3 Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences University, Sawangi, Wardha, Maharashtra, India

Date of Web Publication30-Jan-2012

Correspondence Address:
Santosh A Kotgire
Department of Microbiology, Dr. Ulhas Patil Medical College, Jalgaon, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.92422

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How to cite this article:
Kotgire SA, Tankhiwale N, Tankhiwale S, De A, Das D. Evaluation of parasites causing gastro-intestinal tract infestations in HIV/AIDS patients. Indian J Public Health 2011;55:337-8

How to cite this URL:
Kotgire SA, Tankhiwale N, Tankhiwale S, De A, Das D. Evaluation of parasites causing gastro-intestinal tract infestations in HIV/AIDS patients. Indian J Public Health [serial online] 2011 [cited 2019 Dec 12];55:337-8. Available from: http://www.ijph.in/text.asp?2011/55/4/337/92422

Sir,

Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a major problem in India with more than 6 million recorded cases till 2005 end. [1],[2]

AIDS represents the most severe sequel of immunosuppression leading to the development of severe opportunistic infection and otherwise rare tumors. Among opportunistic infections, diarrhea is the significant cause of morbidity observed in majority of studies. [3]

Reports indicate that diarrhea occurs in 30-60% of patients with AIDS in developed countries and in about 90% of such patients are in developing countries. Chronic diarrhea, defined as diarrhea that persists beyond four weeks, is a common symptom in HIV infected patients in the developing counties like India and often leads to weight loss and wasting syndrome. The world health organization (WHO) defines diarrhea wasting syndrome along with a positive HIV serology test to be an AIDS defining illness. [2],[3],[4]

The most opportunistic parasite reported includes coccidian parasites (Cryptosporidium parvum, Isospora belli, Cyclospora cayetanensis and Microspora spp) and that of non opportunistic parasites such as Entamoeba histolytica, Giardia lamblia, Hookworm, Ascaris lumbricoides. Besides these, the nematode Strongyloides stercoralis can cause diarrhea and overwhelming infestations (hyperinfection syndrome) in patients with such immunosuppressive disorders. [1],[2],[5]

Only a few studies regarding the prevalence of intestinal parasite and their association with diarrhea of HIV infected patients are available from central India at present. So the present is undertaken to find out the prevalence of intestinal parasites causing GIT (gastro-intestinal tract) infestations in HIV/AIDS patients at a tertiary care institute located in central India.

A prospective study was conducted from August 2008 to July 2009 on HIV infected and HIV non infected patients at Department of Microbiology, J.N.Medical college, Sawangi, Wardha. A total of 100 HIV infected patients were examined for the presence of intestinal parasites. Stool sample from 100 HIV negative patients having complaints of diarrhea were enrolled for study as control group. HIV positive patients were defined as those who had tested positive for HIV antibody by two sequential ELISA/rapid tests as per the recommendation by WHO. [3] All the patients were advised to give at least two consecutive stool specimens and stool was collected in sterile plastic containers and was immediately sent to Department of Microbiology for further parasitic evaluation. Parasitic infection was diagnosed by examination of stool specimen as fresh wet mount, former ether concentration technique and modified acid fast stain. Fresh and concentrated stool specimen were examined as saline wet mount to detect motile trophozoites and iodine wet mount to detect ova, larvae and cysts. Air-dried smears from fresh samples were fixed and stained by a modified acid fast to detect the coccidian parasite (cryptosporidium, isospora and cyclospora).

Our 100 HIV patients were in the range of 10-60 years, maximum cases were found in the age group of 31-40 years accounting for 52 cases, followed by 27 cases aged 21-30 years, 16 cases aged 41-50 years and 1 case each in 10-20 years and >50 years respectively.

Of the total 100 HIV positive patients studied, 31 patients showed parasite in stool examination while only 15 cases of 100 HIV negative showed parasites in stool sample showed an overall occurrence of 31 and 15% respectively [Table 1]. A total of 41 parasites were found in HIV positive patients among 31 cases, 8 cases showed one or more parasite in stool sample with Cryptosporidium parvum and Entameoba histolytica for 5 cases and 3 cases for Cryptosporidium parvum and Giardia. Lamblia respectively. Among 41 parasites, there was preponderance of Cryptosporidium parvum 15(36.58%), followed by Entamoeba histolytica 10(24.39%), Giardia Lamblia 8 (19.51%), Isospora belli 3(7.31%), Strongyloides stercoralis 3(7.31%) and 1(2.43%) each of Hook worm and Hymenolepis nana respectively [Table 2].
Table 1: Prevalence of enteric pathogen

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Table 2: Distribution of parasites

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While among 15 positive stool samples for parasites of HIV negative patients, Entamoeba histolytica was the common parasite (8) followed by 4 for Giardia lamblia, 2 for Hookworm and 1 for Ascarsis. No coccidian parasites were detected from patients with HIV negative status [Table 2].

In India, 4.2 million HIV positive adults are in the age group of 15-49 years; our study also had maximum cases in the age groups of 31-40 years and 20-30 years respectively. [6] The predominant parasite in the present study was Cryptosporidium parvum (15%) followed by Entamoeba histolytica (10%) and Giardia lamblia (8%).The occurrence of coccidian parasite in the present study is 18% in HIV positive and no single coccidian parasite was found in HIV negative patients

In conclusion, diarrhea in patients with HIV/AIDS is the leading cause of morbidity and mortality in developing countries like India. Studies from various parts of world show contrasting prevalence rate with marked variation from place to place and geographical variation and hence identification of etiological agents of diarrhea in patients with AIDS is very important, as it can help in instituting appropriate therapy and thereby reducing morbidity and mortality in such patients.

 
   References Top

1.HIV/AIDS epidemiological surveillance and estimation report for year 2005, NACO; Apr 2006.  Back to cited text no. 1
    
2.Gupta S, Narang S, Nunavath V, Singh S. Chronic diarrhea in HIV patients: Prevalence of coccidian parasite. Indian J Med Microbiol 2008;26:172-5.  Back to cited text no. 2
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3.WHO case definition of HIV for surveillance and revised clinical staging and immunological classification of HIV related diseases in adult aged 15 years or older. SEARO Publication on HIV/AIDS; 2006.  Back to cited text no. 3
    
4.Joshi M, Choudhary AS, Dalar PJ, Maniar JK. Prevalence of Intestinal parasitic pathogen in HIV-seropositive individuals in northern India. Natl Med J India 2002;15:72-4.  Back to cited text no. 4
    
5.Uppal B, Kashyap B, Bhalla P. Enteric poathogens in HIV/AIDS from a tertiary care hospital. Indian J Community Med 2008;34:237-40.  Back to cited text no. 5
    
6.Mukhopadhya A, Ramakrishna BS, Kang G, Pulimood AB, Mathan MM, Zachariah A, et al. Enteric pathogens in southern Indian - infected patients with and without diarrhea. Indian J Med Res 1999;109:85-9.  Back to cited text no. 6
    



 
 
    Tables

  [Table 1], [Table 2]


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