Occurrence of enteric parasitic infections among HIV-infected individuals and its relation to CD4 T-cell counts with a special emphasis on coccidian parasites at a tertiary care centre in South India

Chinnambedu R. Swathirajan, Ramachandran Vignesh, Ambrose Pradeep, Sunil Solomon, Suniti Solomon, Pachamuthu Balakrishnan

Research output: Contribution to journalArticle

Abstract

Context: Diarrhoea is one of the major complications occurring in over 90% of HIV-infected individuals in developing countries. Coccidian group of parasites, being opportunistic pathogens, have been implicated as the most common causative agents of diarrhoea among HIV-infected population. Aims: The aim was to study the magnitude of parasitic diarrhoea with special context to coccidian parasitic infections in HIV-infected individuals and their association with the patient's immunological status measured by CD4 T-cell counts. Settings and Design: This investigation was performed between January 2002 and December 2014 at a tertiary HIV care centre in Chennai, South India. Materials and Methods: Stool samples were collected and microscopically observed for parasites using direct, formal-ether-concentrated wet mounts and modified acid-fast staining for coccidian parasites. CD4 T-cell counts were done by FACScount. Statistical Analysis Used: All statistical analyses were performed using GraphPad Prism software, version 5.0, and P < 0.05 was considered statistically significant. Results: Coccidian parasitic infection accounted for about 23.4% of parasitic infections, and of these, Cystoisospora belli was observed to be the most common cause of diarrhoea (88.8%), followed by Cryptosporidium spp. (9.9%) and Cyclospora spp. (1.3%). Trend analysis of coccidian aetiology during the study period revealed a significant rise in the positivity of C. belli and Cryptosporidium spp. (P = 0.001). Among the HIV patients with CD4+ T-cell counts <200 cells/μL, Cryptosporidium infection was most common (90%), followed by infection with C. belli(61.4%). Conclusions: Coccidian parasites continue to be the most common aetiological agent of diarrhoea among patients with HIV. The increasing trend of positivity of both cystoisosporiasis and cryptosporidiosis over the study period and the high positivity of cryptosporidiosis in patients with lower CD4+ T-cell counts are issues of serious concern. The findings call for the need for the early diagnosis of coccidian parasites and appropriate intervention among HIV-infected patients.

Original languageEnglish (US)
Pages (from-to)37-40
Number of pages4
JournalIndian Journal of Medical Microbiology
Volume35
Issue number1
DOIs
StatePublished - Jan 1 2017

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Parasitic Diseases
CD4 Lymphocyte Count
Tertiary Care Centers
India
Parasites
HIV
T-Lymphocytes
Diarrhea
Cryptosporidium
Cryptosporidiosis
Cyclospora
Infection
Ether
Developing Countries
Early Diagnosis
Software
Staining and Labeling
Acids
Population

Keywords

  • Coccidian parasitic infection
  • HIV
  • parasitic diarrhoea

ASJC Scopus subject areas

  • Microbiology (medical)

Cite this

Occurrence of enteric parasitic infections among HIV-infected individuals and its relation to CD4 T-cell counts with a special emphasis on coccidian parasites at a tertiary care centre in South India. / Swathirajan, Chinnambedu R.; Vignesh, Ramachandran; Pradeep, Ambrose; Solomon, Sunil; Solomon, Suniti; Balakrishnan, Pachamuthu.

In: Indian Journal of Medical Microbiology, Vol. 35, No. 1, 01.01.2017, p. 37-40.

Research output: Contribution to journalArticle

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abstract = "Context: Diarrhoea is one of the major complications occurring in over 90{\%} of HIV-infected individuals in developing countries. Coccidian group of parasites, being opportunistic pathogens, have been implicated as the most common causative agents of diarrhoea among HIV-infected population. Aims: The aim was to study the magnitude of parasitic diarrhoea with special context to coccidian parasitic infections in HIV-infected individuals and their association with the patient's immunological status measured by CD4 T-cell counts. Settings and Design: This investigation was performed between January 2002 and December 2014 at a tertiary HIV care centre in Chennai, South India. Materials and Methods: Stool samples were collected and microscopically observed for parasites using direct, formal-ether-concentrated wet mounts and modified acid-fast staining for coccidian parasites. CD4 T-cell counts were done by FACScount. Statistical Analysis Used: All statistical analyses were performed using GraphPad Prism software, version 5.0, and P < 0.05 was considered statistically significant. Results: Coccidian parasitic infection accounted for about 23.4{\%} of parasitic infections, and of these, Cystoisospora belli was observed to be the most common cause of diarrhoea (88.8{\%}), followed by Cryptosporidium spp. (9.9{\%}) and Cyclospora spp. (1.3{\%}). Trend analysis of coccidian aetiology during the study period revealed a significant rise in the positivity of C. belli and Cryptosporidium spp. (P = 0.001). Among the HIV patients with CD4+ T-cell counts <200 cells/μL, Cryptosporidium infection was most common (90{\%}), followed by infection with C. belli(61.4{\%}). Conclusions: Coccidian parasites continue to be the most common aetiological agent of diarrhoea among patients with HIV. The increasing trend of positivity of both cystoisosporiasis and cryptosporidiosis over the study period and the high positivity of cryptosporidiosis in patients with lower CD4+ T-cell counts are issues of serious concern. The findings call for the need for the early diagnosis of coccidian parasites and appropriate intervention among HIV-infected patients.",
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AU - Swathirajan, Chinnambedu R.

AU - Vignesh, Ramachandran

AU - Pradeep, Ambrose

AU - Solomon, Sunil

AU - Solomon, Suniti

AU - Balakrishnan, Pachamuthu

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N2 - Context: Diarrhoea is one of the major complications occurring in over 90% of HIV-infected individuals in developing countries. Coccidian group of parasites, being opportunistic pathogens, have been implicated as the most common causative agents of diarrhoea among HIV-infected population. Aims: The aim was to study the magnitude of parasitic diarrhoea with special context to coccidian parasitic infections in HIV-infected individuals and their association with the patient's immunological status measured by CD4 T-cell counts. Settings and Design: This investigation was performed between January 2002 and December 2014 at a tertiary HIV care centre in Chennai, South India. Materials and Methods: Stool samples were collected and microscopically observed for parasites using direct, formal-ether-concentrated wet mounts and modified acid-fast staining for coccidian parasites. CD4 T-cell counts were done by FACScount. Statistical Analysis Used: All statistical analyses were performed using GraphPad Prism software, version 5.0, and P < 0.05 was considered statistically significant. Results: Coccidian parasitic infection accounted for about 23.4% of parasitic infections, and of these, Cystoisospora belli was observed to be the most common cause of diarrhoea (88.8%), followed by Cryptosporidium spp. (9.9%) and Cyclospora spp. (1.3%). Trend analysis of coccidian aetiology during the study period revealed a significant rise in the positivity of C. belli and Cryptosporidium spp. (P = 0.001). Among the HIV patients with CD4+ T-cell counts <200 cells/μL, Cryptosporidium infection was most common (90%), followed by infection with C. belli(61.4%). Conclusions: Coccidian parasites continue to be the most common aetiological agent of diarrhoea among patients with HIV. The increasing trend of positivity of both cystoisosporiasis and cryptosporidiosis over the study period and the high positivity of cryptosporidiosis in patients with lower CD4+ T-cell counts are issues of serious concern. The findings call for the need for the early diagnosis of coccidian parasites and appropriate intervention among HIV-infected patients.

AB - Context: Diarrhoea is one of the major complications occurring in over 90% of HIV-infected individuals in developing countries. Coccidian group of parasites, being opportunistic pathogens, have been implicated as the most common causative agents of diarrhoea among HIV-infected population. Aims: The aim was to study the magnitude of parasitic diarrhoea with special context to coccidian parasitic infections in HIV-infected individuals and their association with the patient's immunological status measured by CD4 T-cell counts. Settings and Design: This investigation was performed between January 2002 and December 2014 at a tertiary HIV care centre in Chennai, South India. Materials and Methods: Stool samples were collected and microscopically observed for parasites using direct, formal-ether-concentrated wet mounts and modified acid-fast staining for coccidian parasites. CD4 T-cell counts were done by FACScount. Statistical Analysis Used: All statistical analyses were performed using GraphPad Prism software, version 5.0, and P < 0.05 was considered statistically significant. Results: Coccidian parasitic infection accounted for about 23.4% of parasitic infections, and of these, Cystoisospora belli was observed to be the most common cause of diarrhoea (88.8%), followed by Cryptosporidium spp. (9.9%) and Cyclospora spp. (1.3%). Trend analysis of coccidian aetiology during the study period revealed a significant rise in the positivity of C. belli and Cryptosporidium spp. (P = 0.001). Among the HIV patients with CD4+ T-cell counts <200 cells/μL, Cryptosporidium infection was most common (90%), followed by infection with C. belli(61.4%). Conclusions: Coccidian parasites continue to be the most common aetiological agent of diarrhoea among patients with HIV. The increasing trend of positivity of both cystoisosporiasis and cryptosporidiosis over the study period and the high positivity of cryptosporidiosis in patients with lower CD4+ T-cell counts are issues of serious concern. The findings call for the need for the early diagnosis of coccidian parasites and appropriate intervention among HIV-infected patients.

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