Uma, S (2009) Prevalence of Enteropathogenic Infections in HIV Patients. Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION : HIV / AIDS is becoming a major threat to the human population across the Globe. According to UNAIDS report, globally there were an estimated 33 million people living with HIV in 2007. There were about 2.7 million new HIV infections and about 2 million AIDS related deaths in 2007. The rate of new HIV infections has fallen in several countries, but has increased in developing countries. Patient infected with HIV suffer from various opportunistic infections, the most commonly encountered in our setting being Tuberculosis, Candidiasis, Pneumocystis jiroveci Pneumonia and diarrhoea due to various pathogens. Intestinal opportunistic infections present commonly as diarrhoea. Studies indicate that diarrhoea occurs in 30-60% of AIDS patients in developed countries and more than 90% in developing countries. Chronic diarrhoea is responsible for considerable morbidity and mortality in such patients. Several species of protozoa and other bacterial infections have been associated with acute and chronic diarrhoea in HIV disease. Only a few studies regarding the prevalence of intestinal opportunistic infections in HIV infected patients are available from South India at present. I took up this study in our institution, to evaluate the prevalence of such infections in HIV patients in our setup and to ascertain the importance of stool examination for the detection of enteropathogens that aids in treatment, thereby decreasing the morbidity and mortality due to opportunistic gastrointestinal infections. AIM OF THE STUDY : 1. To study the prevalence of enteropathogenic infections in HIV positive patients. 2. To study the correlation between CD4 and the prevalence of intestinal parasites. 3. To study the association between the gastrointestinal symptoms and the enteropathogenic infections in our setting. MATERIALS AND METHODS : Setting : The study was conducted in both in-patients and out-patients of Govt. Rajaji Hospital, Madurai. Collaborating Departments : i) Institute of microbiology, Madurai Medical College. ii) Anti retroviral therapy centre / Out patients Design of Study : Prospective analytical study. Study period : June 2007 to August 2008, a period of 15 months. Sample size : 100 consecutive HIV positive patients were included irrespective of the symptomatology, CD4 count and ART status. Ethical Clearance : Obtained. Consent : An informed consent was obtained from each patient. Selection Criteria : Inclusion criteria : i) All men and women who were positive for HIV by two rapid tests and ELISA who presented with or without diarrhoea were included in the study. ii) All patients were above 15 years of age. Exclusion Criteria : 1. Patients under 15 years of age. 2. Endocrine disorders. 3. Malignancy. 4. Collagen vascular disorders. 5. Other organ disorders. 6. Patients on steroid therapy. 7. Pregnancy. 8. Protein losing enteropathy. 9. Crohn’s disease. 10. Irritable bowel syndrome. 11. Unconscious / Bedridden. 12. Non co-operative and non-willing. 13. Patients who were on antidiarrhoeal or on antimotility drugs. 14. Patients using liquid paraffin / laxatives. 15. Renal disorders. 16. Cholestasis. Materials : Data Collection : Socio demographic and clinical data were collected. - CD4 count was done in all the patients - General investigations were done, and physician’s opinion to rule out the other potential causes of gastrointestinal disturbances was obtained for each patient. Patients were explained about the proposed study and asked to collect stool samples. Stool samples were collected in two containers. One containing glycerol phosphate buffer and other containing formol saline. For suspected cases of cholera, stool samples were sent in Venkatraman Ramakrishnan Medium. Stool samples were subjected to the following methods for evaluation of parasites: 1. Wet saline method, 2. Wet Iodine method, 3. Floatation technique, 4. Sedimentation technique, 5. Modified acid fast technique, 6. Stool culture. Collection of stool : For stool sample collection essential criteria followed were 1. Fresh stool samples, 2. Receptacle was kept clean and without antiseptics, 3. Patients were instructed not to mix urine with stool Samples were taken to the microbiology department, within 30 minutes. RESULTS : Out of 100 patients, 54 were males and 46 were females. Out of 54 males 66% were symptomatic and out of 46 females 54% were symptomatic. The symptoms included diarrhoea, vomiting, abdominal pain, flatulence, dyspepsia etc. SUMMARY : Entero pathogenic infections cause significant morbidity & Mortality in HIV patients especially in advanced states of immuno suppression. Socio economic conditions, educational status, unhygienic practices contribute for intestinal parasitosis. There are wide geographic variations in the prevalence of entero pathogenic infections due to variations in the standards of living, hygiene practices, availability of safe drinking water and literacy rate. Since large number of our patients belonged to low poverty line, an attempt was made to study the prevalence of enteric pathogens in our population. A total of 100 consecutive HIV positive patients (54 males ; 46 females) were selected. After thorough clinical examination and investigations to rule out other systemic illnesses, their stools were examined for the gastrointestinal pathogens. Enteric pathogens were isolated in 65% of our patients. Cryptosporidium was the most common pathogen isolated which was found in 50.76% of our patients. The other pathogens isolated were Isospora belli (4.62%), Microsporidia (1.54%) Entamoeba histolytica (4.62%), Ankylostoma duodenale (1.54%), Escherichia coli (1.54%), Mixed infections in 35.38%. The prevalence of infections was high in patients with CD4 count < 200 / mm3. Most of the patients with a lower CD4 count were symptomatic. The isolation of Isospora belli was very less. It may be explained by the cotrimoxazole prophylaxis that is offered to our patients. There are wide geographic variations among the prevalence of enteric pathogens even in areas which are in close proximity to us, in city like Chennai. Therefore large multicentric studies need to be conducted in wide geographic areas to assess the prevalence of such parasites, so that appropriate therapeutic strategies can be planned for the treatment of such patients. Since personal hygiene and good standards of living are essential to prevent acquiring these parasites, proper health education regarding hand washing habits, drinking boiled water needs to be emphasized to all the patients. The availability of resources for treatment especially HAART is mandatory as boosting up the immunity leads to spontaneous clearance of most of the enteric pathogens especially the coccidian parasites. CONCLUSION : The prevalence of enteropathogenic infections in 100 conseutive HIV positive individuals were studied and the following conclusions were arrived at. 1. Enteric pathogens were isolated in 65% of our study population, and the coccidian parasites were the most common gastro intestinal pathogens isolated. 2. Cryptosporidium is the most common enteropathogen isolated. 3. Isospora was isolated only in three of our patients. 4. Escherichia coli was the most common bacterial isolate. 5. Cotrimoxazole prophylaxis appears to offer a significant protection against isospora infection. 6. The prevalence of enteropathogens varies significantly between different centres, despite geographic proximity. 7. 80% of patients who harboured enteropathogens were symptomatic. 8. Mixed infections were commonly seen in profoundly immuno suppressed patients. This signifies that advanced immuno suppression paves way for mixed infections. 9. Patients with advanced illness were more symptomatic than those in the early stages. 10. Enteric pathogens were isolated predominantly when the CD4 count was < 200 cells / mm3.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Prevalence ; Enteropathogenic Infections ; HIV Patients. |
| Subjects: | MEDICAL > Dermatology Venereology and Leprosy |
| Depositing User: | Subramani R |
| Date Deposited: | 02 Mar 2018 03:19 |
| Last Modified: | 03 Mar 2018 02:15 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5969 |
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